How Sports Shaped a Surgeon’s Philosophy

follow people every couple months. And, and, you know, after a couple or 3 years doing it at doses that were at least reasonable, and, and, you know, starting with the knee because that's the most common thing that we do, patients started saying, this is great, this is the first time I've really noticed a difference, um, long term. And so, so you file that away and you keep doing it, and then you look up and you're like, you know, it seems like 80, 90% of the people are doing great for at least a year. And then papers start coming out with about the same results. And, and like most things in medicine, if we can get the same results in different clinics and offices around the country and world, right, it starts to probably be real.

You didn't build your clinic to feel like an employee in your own business. I'm Matthew Cologli, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable, patient-centered practices. And doing it their way. If I were to classify, if somebody were to say, how would you explain Dr. Don Buford? I would call you the Superman of orthobiologics education because you're like truth, justice, and the American way.

I, I see where you're going. I appreciate it.

Well, I mean, like, you're— of everybody out there, you're like the guy that Driven by the truth. True, right?

Yeah.

Like, is that the thing that just drives you every single day, is finding what's right and what's true?

Yeah. And just— and always, you know, always trying to be a little bit better. Yeah. You know, always trying to be a little better. And that, that, that, that bled over from, from sports, honestly. Yeah.

I was going to ask you, like, how much of that came from Growing up in what is still a very famous baseball family. I mean, yeah.

I mean, it honestly even started even before that. I mean, the real origin story, if you want to call it that. My mother was a schoolteacher, and I'm the oldest of 3 boys. We're all within 4 years. But your poor mom. I know.

Your dad's gone on the road playing baseball. Your mom's raising 3 boys born within 4 years.

I mean, luckily she had—

Y'all have like summer birthdays or something like that? Y'all born in like August and September?

No, it's like, it's like April, June, and August. But, but each one of us was born in one of the cities where Dad played.

Oh, wow.

So you've got Chicago is my— is Darryl, and Baltimore's Damon, and I was born in LA. So, um, but Mom was a teacher, and one of my favorite pictures, which I'll have to share it with you because you, you would get a kick out of it. Dad's playing at the old Memorial Stadium in Baltimore.

Yep.

And, and one of their photographers took a picture of Mom sitting like, you know, where the wives sit pretty close, like 6 rows back, whatever. Right. No one's looking at the game. Game's going on and she's got a Mother Goose book open. And I think Damon wasn't even born. It was just Darryl and I on each hip and she's reading to us in at the stadium during the game. And that was her approach. She, she was all about, oh my God, engagement and, and teaching. And, and at home that became, no one ever tells you no.

Mm-hmm.

And you never stop trying if you want to do something.

Yeah.

You know? And so that, that led into, well, I want to play sports. I don't know if I'm good enough. I'm gonna keep trying until someone actually kicks me out, which led to me getting as far as I could, right, and into pro sports, which I don't think anybody would have predicted that coming out of a little high school.

I mean, how much— so for those that don't know, your dad is Don Buford Sr., and he played baseball and football at USC, correct?

Yeah.

And this was in the '50s, right?

Yeah, late '50s. And, and, and even on that note, you know, it's not just all mom, dad.

I mean, were there— there hadn't been very many African American football.

He was the first Black on the—

He was the first Black player.

On the baseball team.

On the—

For Rod Dedeaux.

Really?

Yeah, he was the first back then. And he went to Dedeaux and said, hey, I wanna be on the team. And they had no more scholarships. And so Dedeaux said, well, I don't have any scholarships. Dad couldn't afford it. And he said, well, football has scholarships. And so he went to the football coach and said, I wanna walk on. And ultimately became starting tailback at USC.

Which has a long history. I mean—

Long history.

Some guy by the name of O.J. Simpson.

Yeah.

And you got Mike White and—

Yeah, so, you know, so they all— Marcus Allen. Knew each other. And, and, you know, so Dad is old school that way, but, but the same thing, you can't tell him no. If you put a roadblock up, he's just gonna figure out a way.

Well, yeah. And he's still alive and kicking, right?

Like, just turned 88.

Jesus.

Just turned 88. Yep. Yeah.

Like, I, I think about that, you know, I think a lot about people's lives.

Mm-hmm.

Right? Like, I think about, I'm fascinated how people become the, the person that they are.

Yeah.

And I'm fascinated by learning about their circumstances. Mm-hmm. And I think about your dad because I, I'm not as big a baseball fan as I used to be. But obviously, I mean, I was born in 1967. Your dad played until '70, '72 here, '72, '76 in Japan. Yeah, yeah. '76 in Japan, but knew the name. Yeah, right. Yeah. My dad was a big baseball player and he played for the White Sox.

And I grew up—

I'm still a White Sox fan, unfortunately. Still a White Sox fan. Not easy. No, it's not. It has not been easy since 2005, but we won one, so that's good enough. And I think a lot about Being Black in professional sports, in collegiate sports, in the '40s, the '50s, the '60s through the '70s. Like, how do you ever— like, you and your dad ever talk about that? Like, or was it just something that he dealt with?

No, we do. Dad is quiet and he's just a quiet source of strength. And, and he grew up and he's this only child from a single mom.

Mm-hmm.

In LA. And, and when he got into minor league ball, you know, this is now early '60s, segregation was still going on.

I was gonna say he was still sleeping at a separate hotel in the South, right?

He and Frank Robinson and Summer Store, segregation's still going on. They would go to play in a city where they had to stay in a separate place and had to eat in a separate place.

Right.

Or had to eat in the kitchen while the team was eating in the restaurant.

It just blows my mind, Don.

Yeah. And so, so, you know, they, they had, You know, they, in dad's words, quickly learned who their friends were. 'Cause in some places, like on some teams, a manager wouldn't go anyplace if the whole team couldn't be together. And so he had support that way. But, but that's something Damon famously said when he was being interviewed was, you know, my dad's hard days are when he had to figure out where to sleep that night. You know, my hard day, 2 strikeouts and a ground ball is not a hard day for me.

Well, in Baltimore, especially in the '60s and '70s, that was not exactly a very Open, no racially town.

No, I mean, and that's just part of our our country's history and of that sports history too, which mirrored the country.

But how do you think that shaped you? Not not just as a not just as a ball player.

Yeah.

But then obviously as a top line orthopedic surgeon.

After all these years, here I am, what, 59 now? I've never heard my dad say you shouldn't do that or you can't do that.

Really?

Never heard him say that.

Really? Never said, son, don't make a spectacle. Keep your mouth shut.

Never never said maybe you should try something else. He anything I wanted to do, he was. Has always been biggest fan.

Where do you— where did that come from for him? I mean, because your dad was born in 19— what, '30?

'30-something. Yeah.

Okay. And LA wasn't exactly— LA's, you know, LA was as bad as any other place.

Yeah. And he was born here in— he was born—

The LA Police Department was not exactly—

I mean, he was born— I'll tell you, man, he was born in a small town in Texas, town called, um, Linden, Texas. And so he actually was born in a state where, you know, Juneteenth, they didn't even let anyone know for, for 3 years. And so So he and his mom made it to LA.

I'm sorry to laugh at that.

No, but it's, but you know, only, you know, that's, that's the history. Um, it's real no matter how they try and, and, and write over it. But, and so that whole side of my family, and mom's the same way, but, but that whole side of the family, um, which was a very extended family. Dad was an only child, but he was, my grandmother on that side was the oldest of like 18 kids. Like literally. So, holy cow. So you talk about cousins and uncles and second cousins, everyone was just uncle and You know, aunt. And so, so Dad had a lot of people around him. The way I see it, his refuge was sports. He was something he was good at. Something—

yeah.

It was a, even though baseball's a team sport, it was something he could practice on his own. He could— yeah. Do different things.

And, and that's why I loved it. I couldn't play football by myself, but I could—

yeah.

I could pitch 9 games.

Yeah.

I could pitch 9 innings.

Yeah. And back then he could throw against the wall. He could, he could run. He, he was on the track team in high school, you know? So, so he just, You know, that's just the way he's built. You know, he had this inner strength, or I don't know. I, I honestly, I wish I knew. I wish I was that strong. You know, I've, I've gotten where I've gotten, but, but give you another good example. I wasn't getting a chance to play in college. This is when I was at Stanford. And I went to, I went to Dad first and said, hey, I, I wanna play. Do you really think I have a chance to play beyond college? 'Cause if I don't, then there's no point in leaving Stanford.

Right.

if I do have a chance, I wanna play 2 years in college or at least 1 good year to get drafted or get a chance to play as a free agent. And, and he said, yeah. He said, I think you really do have the skills. If you work like you work, nobody outworks you. I think you have a chance. You have to weigh that against your father telling you that. But he had never led me wrong before. So I transferred. And so then we went to mom and said, hey, Donnie's gonna transfer.

Where'd you transfer?

To USC.

So you could crack the roster at USC but not crack the roster at, at Stanford?

I was playing behind, a second baseman named Pete Staniszek, who was an All-American, like legit one of the best in the country, and subsequently actually played for the Orioles in the Orioles organization. So I was a year behind him. So there was really no way.

And this is— there was—

yeah, there was no transfer portal. I mean, a guy named John Verducci was playing short. And I mean, there was just— yeah, this is way before the transfer portal. So I wasn't going to break in. I mean, they had a really, really good team. In fact, the year after I left, I think they won the national championship. And then the year after I left SC, they won. So it was kind of like, so basically wherever you, so that's good.

That's good enough. Yeah.

But I got it. But I had a chance to play. It was interesting story. I played, I was the last team that played under Rod Dedeaux. So Dad had been the first.

And Rod went, won like 8.

Oh, more than that. 10 or something like that. Yeah. I mean like John Wooden numbers.

Yeah.

Yeah.

Yeah. A lot.

A lot. That was back when they had fewer schools, so all the good players were funneled into a few schools.

Right.

So yeah, so I transferred, had a chance to start on that team. And, uh, played a couple years and then had a chance, you know, for 4 years, 3 and a half, 4 years in the Orioles organization.

Now, prior to that, mm-hmm, did you, when did you know you were fascinated by the human body and medicine? Ooh, I remember you telling me one time, like, you got this encyclopedia and you thought it was like the coolest thing in the world.

Yeah. Yeah. No, I, uh, was it the Encyclopedia of the Anatomy or something like that? Or, yeah, I, it, it started, I mean, I was interested, probably the first real exposure was when I cut my knee open and I had to be like middle school age. And in the ER, they had to put some stitches in my knee and they kept trying to lay me down. And, and my mom tells a story where I wouldn't, I was like, I, I need to watch this. I wanna watch. And so they were like, who is this kid watching? 'Cause that's not normal. Having been in the ER now myself, it's not normal to have, you know, usually it was crying and yelling and screaming. He is like, I was very calm, maybe a little bit of lidocaine and just watching him sew it up, you know, which, which probably led to me doing my own Achilles with PRP all these years later.

Yeah, we'll get to that. That's on the list, by the way.

Yeah. Yeah. So, but that's where it started, you know, 13, 14 years old. And then in high school, I had a chance to kind of shadow a sports medicine guy, and that really cemented my decision at that point.

So was the plan that you were going to go— in your mind, were you thinking, I'm going to go play professional baseball and then whatever, make it to the bigs or whatever? Right. I mean, I'm sure you weren't playing professional baseball.

No, no, I wanted to get— no, I wanted to— I wanted it. I wanted the whole thing.

And then you were gonna, you know, play whatever, however many years and then go to be an orthopedic surgeon?

Well, if I had played, I, I don't know. It, it would've depended on the career. You know, if I had made it and played as long as Damon or my father did, Damon played 8 and dad played ultimately 14, I probably would've been hard to go back. Yeah. You know, because my other major was economics, so I was interested in a lot of other business and, you know, ventures, real estate, things like that. But that was the plan, was to do both as long as I possibly could. Yeah.

And then what made you decide when you got to AA?

Well, I finally— I finally—

You were then what, 25, 26?

Yeah. And I, I knocked out about a year and a half of medical school in the minors, but I finally got to a point—

Wait a minute, wait a minute. You're in the minors and you're knocking out medical school?

Yeah. Yeah. So that was in, um—

During the offseason?

Yeah. '87, '88. I've been lucky. I've had a lot of people support me with some crazy ideas. Yeah.

I never knew that about you. I've known you for like 4 years.

Yeah. No, there was a, um, The dean of student affairs at UCLA Medical School was a guy named Dr. Pops, Martin Pops, Marty Pops, if memory serves. And I got accepted to UCLA Med, and that was kind of— we lived not too far from there, so it was perfect. But then I went to him one day and said, hey, look, you know, I'm got a chance to play professional baseball. I want to go to medical school also. Is there any way to make that happen? And he said, sure. And he—

well, because UCLA's on the quarter system.

Yeah. But right. That's, that's correct. And he, he, he knew the family. He knew me from high school and from sports in the neighborhood. So he knew that I was a good kid and—

Right.

And had a, a good track record of kind of showing up and being where I was supposed to be. But I said, but here's the thing, you know, spring training, spring training starts in March and the season doesn't end till September. And so is it possible that I could show up after, after the season ends, which would basically be the end of September? School starts in August.

Wow.

And leave in March. Your school doesn't end till end of May. So I'm talking about showing up, you know, 3 weeks late and leaving 8 weeks early. And so he said, he, he kind of did this, he went, ah, well, let's go talk to the faculty in the different departments. And so this is way pre-internet, right? This is, Yeah. How do you do it? So, so there's nothing, it's, it's, it's atlases and books and, and we went to all the faculty and, and they were all minus a couple curious and just kind of interested to do the experiment and see what would happen. Um, you know, in the first and second years there's a lot of classes where you actually have cadaver labs and anatomy and things like that. And especially pre-internet, there's no way to do that without being there. And so those, those courses and those faculty required me to come back.

Okay.

To take exams. But like only—

And, and to be clear, you're playing for the Baltimore Orioles organization and their AA is what, Virginia?

That's in Maryland back then. Maryland. Hagerstown.

Yeah. So, yeah.

So even, even, you know, so the way we did it the first year, the first summer after graduating college, I played and didn't go back into UCLA Med for the whole, like almost like a year and a half almost. And had a chance to go with a special arrangement with UCLA. Their, their one main requirement especially the classes with cadaver labs, was you had to— I had to come back and take the course, take the test with the class. So I was on the bus studying for practical exams. I would, I would take time off, fly back home, take the test, fly back that night, catch up with the team or whatever.

The other coaches were fine with this. The organization.

Yeah, they understood. Yeah, they understood.

I mean, it makes sense. I mean, what's the percentage of guys that—

Yeah.

I mean, you're in AA, single-A and AA.

Yeah, yeah, exactly. And so So, you know, made it work for a year and a half. And then I took another— I was still rising up. And so took another year off. And, you know, the way medical school works, when you get in the upper years, you know, later years of medical school, basically there is no break. It's year round. You're just doing different rotations. And, and so that's when the decision time really, really hit.

Was, was it a hard decision to give up that dream? The dream that everybody did?

Not, not really. Not really. 'Cause I, I loved it. I had a chance to do a lot of great things. I had a chance to go to the Soviet Union back when it still was the Soviet Union.

Really?

They took a bunch of, they took a bunch of minor league players, all-stars over there to help them with their Olympic team. 'Cause baseball was in the Olympics back then and, or it was just getting started and they didn't have, well, they only had like 2 baseball fields in the whole country back then and they didn't have any little leagues. You know, we have baseball here. It's just second nature.

Yeah, it's everywhere.

They had no select teams, no little leagues, no nothing. And so their approach, which was wildly successful 'cause it's the same thing they did with hockey, was, okay, we have no support structure. Let's just go to the best hockey-playing country in the world and get them to help us. So they went to Canada. Canada told them, these, these are what our best hockey players look like. This is their height and build and their skillset. And, you know, they had, they had the Olympics in Russia, in Soviet Union, but they didn't have any position players. And so they took the javelin throwers and kind of made them pitchers and tried to correlate other track and field sports with other position, you know, soccer players became infielders if they weren't.

Right.

And, and we spent 3 weeks over there and I'll never, that was just a fantastic op— you know, one of the things that baseball allowed me to do that I would've never—

That's so cool.

Had a chance to do. So yeah.

That must have been really fascinating. 'Cause that would've been, so you're a couple years older than I am, so that would've been like, that was like mid to late '80s?

No, that was like '91. And the thing about that— Oh wow. Okay. The thing about that was, you know, we had a KGBS corps 'cause we were basically US, envoy, you know, we, we were representing the United States. And so, so they had a lot of security around us.

Did you hotfoot the, the KGB guy? Did you like, you know, play pranks on him?

No, but it, but, but so this is, it was still the Soviet Union, right? And so one, we went to 3 places. We went to Kyiv, which is now in the news, right? And we went to Moscow and we went to Tallinn in Estonia. And this was about 6 months before the Soviet Union fell apart. And if you think back, the, the Baltic states were the ones that declared independence first.

Wow.

That's crazy. That's what he was doing. Yeah. So it was very, when we were playing there for 7 or 8 days, the ballplayers wouldn't talk to us if, if the agents were around. Um, because there was, they were really scared they were gonna be on a watch list or—

Wow.

You know, get disappeared or whatever. So it was a really interesting time historically to be there also. And it was also after Chernobyl. So we went to Kyiv, which was only about 60 kilometers from Chernobyl, and we got stories about the real scoop about how bad that really was.

Did you watch Chernobyl when it was on HBO? Yeah. Mm-hmm.

That, that is a great fascinating.

Absolutely fascinating.

Terrifying and fascinating at the same time.

Yes, exactly. Yes. I mean, just total and complete negligence and incompetence. Well, unbelievable level.

The story the Western world got was just a fraction from what we heard and saw. I mean, you could see like there's like livestock, like we're on the— we're just coming back from this. Like they didn't have— wow. You know, in the instance of cancer, I think still they still don't really Report how bad it really was.

Oh, it's got to be horrible.

Yeah, yeah, yeah.

I mean, you like see the pictures of Chernobyl and it like looks great.

Yeah.

Except we can't spend more than like 20 minutes there.

That's right, right.

Because because you'll get your radiation poisoning will be through the roof.

Yeah.

So the discipline that you created to beat because to look you joke you joke about you only get as high as double A and you had trouble with the curve. You got to double A. I mean, that's pretty damn good. How much of that is that? Was that where really your discipline in that finding the correct way to do something? You feel like it was built during that time?

I think I think a lot of it was because again, during that whole period, I was managing. You know, it's like managing two big jobs. Yeah, I mean, that's each one of themselves is daunting unto them. Yeah, and and. having to, to give each one 110% when I was focused on that. You know, my, my goal with some great coaches and managers and just great people that, that helped me in, in baseball was just to get a little bit better every day. And I had some skills that were, couldn't teach and can't teach speed. I always had that. Mm-hmm. You know, my, my story was if I got on base, there was a good chance I was gonna score. I just had to get on base somehow, whether it was a hit or a walk or hit by pitch or—

Pre-Moneyball days, you were like, yeah, you were like the pre-Moneyball guy.

Yeah. It's like if I got on base, my percentage of coming and scoring was really high. I mean, that's the only way to hit like .230 and score 120 runs and, you know, steal 77 bases and only get thrown out.

Yeah. What was your on-base percentage?

That's what I want to know. Yeah, well, not much higher than .230 probably, but that one year. But also at the time had the record for, for stealing 77 outta 84 bases.

Really? So starting out, that's when they still put a premium on base stealing.

Yeah.

That was Tim Rock Raines' era.

And yeah, and a lot of those are stealing third. So now you're in scoring, you know, there's just a lot of, a lot of background behind it. And, You know, that's, that's what I did. I just, I just, I feel I maxed out how high I could get with what I had. Yeah. And I think anybody that didn't work as hard as I had would have maxed out at, you know, community college. Yeah.

I mean, obviously I never got— I mean, I never played any tour events or tried to play any tour events. For me, golf, that, that was never it for me. For golf, golf for me was always about the passion of the business and the game and all of that. And I think I knew, even though I was like, whatever, 1 or 2 on my high school team, which is nothing, right? Even though we were a top 20 high school team in the state.

Yeah.

I just never— I knew I just— I would see my friends who could play.

Yeah.

And I'd be like, yeah, I don't, I don't have that.

Yeah.

Like, was there a point when we got to the— when you're getting up to AA and like people were coming through and you're like, wow, that you could see that something different in them, that they had like that it factor?

I mean, honestly, no.

Really?

Even to this day, I still felt like if I had just had that option, I would have given it more.

Do you think if you didn't try to do medical school at the same time, you could have?

I had a chance. Yeah, that's the best I can say.

That's not all you want.

You got to get some breaks along the way.

Yeah.

But I had a chance.

Yeah.

And I had some things that would have held up all the way through big leagues, you know, being able to steal bases and being able to field and do things that would've held up all the way through. It, it just came down to, to offense and a little more discipline problem.

And there was a Ripken in front of you too, right?

There was 2 of 'em.

There was Cal on one side, 3 of 'em if you count the dad. Yeah.

And the dad was the manager.

That's why I said dad was the manager. Was it, was it Billy? Yeah. Billy Ripken was the second baseman.

Billy was the second baseman.

And then Cal, some guy named Cal Ripken.

Yeah, yeah, yeah. So, so that's why, that is why I played one season in left field in the minors.

That's a smart move.

So that's a smart move just to see. But you know, in baseball, the, the way that business works, they own you for, 6 years. Mm-hmm. And so I played 4 to get traded or, or to get picked up by another team. If they weren't gonna trade someone, you gotta stay 6. And so that, that's really where, where it didn't, it didn't work with school at that point. Right. Because they weren't gonna gimme— they actually would've at UCLA, but I would've had to start over.

Oh yeah. I don't wanna do that.

Yeah, yeah, yeah.

Well then you got the answers to all the tests. You could just like reset. Yeah.

Well, right. Well, the problem is the, the, the test changes. Yeah, I know. I'm just kidding. Yeah.

I'm just kidding with you. So let's go to the world of orthopedics and biologics. You know, I always joke you're one of the OGs, the original gangsters of orthobiologics. No offense to like—

Yeah.

The feet, the Jerry Malengo who's passed away.

Sure.

And some of the others. What drew you to the world? Because you had a successful career as an orthopedic surgeon. What was the impetus for you to start looking at PRP and BMAC and Adipose and all that other fun stuff?

That's a good question. I, you know, I was, I was 9 years into practice at that point and was already kind of established as a teacher because even from the first year in practice coming out of fellowship, I was helping in cadaver labs of courses that are national orthopedic surgery courses.

And were you the guy on the baseball team that would help people if they were having a hard time fielding? Would you, were you automatically always a teacher?

Yeah, yeah, pretty much. Yeah, on most teams I was on.

Yeah, I was the same way. Yeah, yeah, I was always the guy who was like, hey, try it like this.

Yeah, yeah, yeah. And people, they'd ask you, they come ask you.

Yeah, yeah, yeah, me too.

Yeah, yeah. What do you see? Or, you know, what can I do? And so I'm 9 years into practice, and, and I had a course in Europe, in England, and 2 things happened at that course, both tied together. In hindsight, it was perfect. One was I was doing live surgery And the only imaging they had was ultrasound. And I had zero experience with ultrasound.

Wow.

And so that was my first exposure to ultrasound that when I came back, I had— I'm like, I gotta check this out because it looks so cool, but I don't know if it's, if it's legit or not, you know. But if half the world is using it, there's gotta be something to it.

Right.

And then the other was, that was the first time I heard about PRP. And so I came back from that meeting with those 2 things that obviously are ultimately intertwined now. Just really curious about that, and just the way I'm built, I was immediately put with a company at the time called Sonocyte up in northern part of northwest part of the United States, and and and they introduced me to another young hotshot named Ben Dubois, who we started our course in 2008. And so about that time, I started doing clinical research. Just again, that natural curious nature. I want to know if it works or not. I don't want to just. Read a paper and start doing it. So I started doing my own little research and telling people what I found along the way.

You know, so 2008. God, I'm trying to think what was that? There had to be almost nothing that existed with it. Had to be like because I know when we started doing PRP in the ED clinic in 2015. Yeah. I never heard of sub count. Like we just yeah. We pulled 60 cc's out.

We got like.

whatever we got, like whatever, 6 or whatever it was.

Yeah. Yeah. Yeah.

And we're like, okay, it's great. Like we had no, we weren't, you know, I, I laugh now, right?

Like, yeah.

I mean, so I can't imagine how primitive it was in 2008.

Right. And, and the fact that, the fact that it worked at all or enough to notice, to, to, to notice that it was better, um, was just fortunate. People were paying it, you know, some really thoughtful early people were paying attention and, um, you know, the, Our course started with just shoulder because that's what Ben and I were really— that was our surgical practice.

And that was you. You were— that's kind of your, your jam as an orthopedic surgeon is the shoulder.

At that point, it was about 80%, 90% shoulder, the rest knee. But Ben was like 100% shoulder.

Right. Right.

Which again was fortunate because ultrasound's ideally positioned as an imaging modality for shoulders. So it was perfect. Every patient we see, you can, you can scan. And, and so that's how we started. The, the PRP started with, You know, that first study was with a company called Harvest. It's still putting together good kits and providing good PRP options.

Did you ever hear? I interviewed Rowan Paul last week. Do you ever hear Rowan's story about how he got introduced to?

No, no.

So Rowan was a swimmer at Brown.

Okay.

Right.

Grew up in Canada.

Swam competitively at Brown, and he was having shoulder issues. And you know, PT wasn't working.

Yeah, yeah, yeah.

And so there was this Chinese doctor. He went to go, like, he winds up seeing this Chinese doctor and the Chinese doctor goes, oh yeah, we're doing whole blood. They drew—

Whole blood. Yeah, yeah.

And injected it into his shoulder. He goes, no numbing, nothing. Just injected it in. And he goes, and it got better. And he went, there's something here, right?

Yeah, yeah.

And, you know, he didn't— he wasn't officially pre-med in college. I forget what he studied. But, you know, he had always kind of known he wanted to go into some form of medicine. But I find that story hilarious, right?

Like, I mean, however you get there, you know, however you get there. Yeah. Yeah. That's a great—

what were the studies like then? What were the— what was the data saying in 2008 about PRP?

Oh, there, there wasn't much. There really wasn't.

Was it all anecdotal?

Yeah. A lot of it was anecdotal. The first study I did that I presented to a group of orthopedic surgeons was, it actually didn't work. The PRP that we did, I was adding it to surgery. And, and now we know if you get the dose right, it helps decrease retears in rotator cuff surgery. Yeah. Yeah. But back then I was adding it to rotator cuff repairs. Dose was probably too low. Wasn't using stem cell or bone marrow concentrate. It was PRP. And what we found was that the healing was the same. There was a trend towards the healing being about a week longer if you added PRP. But again, our outlook was probably too short.

And do you remember how many cc's you think you were pulling?

I think we were. I mean, it was the Harvest system, so I think we were pulling 6.

Okay.

But I mean, because their system is still on the market because it's a good system. I just think that But the doses that I would use now for rotator cuff would be twice that.

Right.

Yeah.

Right. Yeah.

Yeah.

So would you guess how many, how many billion of cells do you think you were getting if it didn't get any outcome back then with that system?

I bet it was, it was around 5.

You think it was around 5?

If we were, if we were good because we were drawing 60. Yeah. Yeah. So if we draw 60, 12. Yeah, it was, it was about 5, 5 or 4.

When did you have the moment that you were doing it and you went, Oh, oh, wait a second. I think I got something here. Or what study? What? Like, where were you when you— when the light bulb really went? When you went from curiosity and went, yeah, oh fuck, this can work.

It was patient-driven. It was patient-driven. And what I mean by that was I would follow people every couple months and, you know, after a couple or 3 years doing it, at doses that were at least reasonable. And, and, you know, starting with the knee because that's the most common thing that we do, patients started saying, this is great. This is the first time I've really noticed a difference long-term. And so, so you file that away and you keep doing it. And, and then you look up and you're like, you know, it seems like 80, 90% of the people are doing great for at least a year. And then papers start coming out with about the same results.

Mm-hmm.

And like most things in medicine, if we can get the same results in different clinics and offices around the country and world, it starts to probably be real.

Do you remember what year that was?

Oh gosh, that had to be, I mean, honestly, maybe '10, 2011, '12. Okay.

Somewhere in there.

Yeah, somewhere in there. But then, you know, at that point it's like, okay, this is great. Now let's go up on the dose. And that was my idea. Not only my idea. Or not only.

Yeah, I get it. I understand. But when you say, yeah, I understand.

But yeah, I mean, I think we have to—

I know the crew, like I could just imagine you were with all, you know, Jeremy Lang and a bunch of the other— yeah, I was working through all of this.

Yeah. Because that was about the time, you know, Regenexx started about 2015. IOF started just about 10, 11 years ago. So it was pre, it was pre most of those organizations right around the same time.

Not the same, but for, you know, in the ED clinic. So we started doing PRP in 2015. This was when Ronald was doing the P-Shot, and we actually marketed it as you were going to get thicker, longer and thicker. Now, you know, we, we started testing it on clients, tested it on me, tested it on like a bunch of staff members. We're like, shit, we're 20% thicker. Like, holy cow. Like, okay, this is interesting.

Yeah.

But then when the light bulb went off for me, here's what light bulb went off for me is, and I knew nothing about Peyronie's. So they call it Peyronie's disease, which it's not a disease. For those that don't know what it is, it's scar tissue in the corpus cavernosus, and it causes an unnatural bend.

Correct.

To the penis. It can bend left, right. You get the Bill Clinton, you got the George Bush, you know. And we had a guy come in from Canada and he had so much scar tissue, he went up almost at a 90-degree angle. And we treated him for 6— we treated him every 6 weeks. We did 3 rounds. We were using the Magellan. Yeah, I think the Magellan system.

It's now Isto.

Yeah, yeah. And we would inject them with Trimix and we would measure. So we had a thing that whatever, whatever it is, it measures the bend, right?

Yeah, yeah.

Um, and we would inject them with Trimix.

Yeah.

And then the next day we would do the PRP.

Okay. Yeah.

And he came back for his 3rd visit and he was at 20% bend from like 87%. Oh wow. And I went—

I mean, your biggest fan at that point.

I went Oh shit, we ran a national campaign. We had people flying in from all over the country because it's something like 20— I forget the numbers. It's like 20 million men have more of a bend of more than 20 degrees.

Yeah, it's one of those hidden things, right? Because no one talks about it.

Right.

You have to. Yeah.

And it just happens. The onset is like that. You'll wake up in the middle of the night. You have to go to the bathroom in the middle of the night.

Yeah.

And you look down and the funny thing is, is the number one search is, why is my dick bent? Why is my bent— why do I have a bent penis? That was the number one search phrase on Google. Yeah. We actually had a built— we had a site that says mybentpenis.com.

You ranked number 1 for it.

We ranked very quickly and then we got shut down. But like, so when I made the transition into the regen world, primarily thanks to you and Dr. Petropali, like, I knew instantaneously this stuff would work because I saw we were doing— we were doing 20 to 40 PRP injections per week across 3 clinics for Peyronie's, venous leakage, and just general erectile dysfunction.

Yeah.

And we were getting unbelievable results. We had no idea what we weren't doing. Cell counts. We just did hormone replacement therapy. We got them hormone replacement therapy. We gave them every other day, say, Alice, Alice, like 5 milligrams.

Yeah.

And like, guys are coming back in going, it's like I'm 20 again.

Yeah.

And I'm so like, when, when we first met and I'd been following you online for like a year, maybe longer, maybe 18 months.

Yeah.

And like, it just instantly clicked to me. I'm like, oh yeah, we're at the beginning of something really big and really new.

Yeah. Yeah, no doubt.

Right.

But it sounds like it was, it was that feedback that, that was the aha moment for you too.

Yeah. There were no, there was no, we didn't have any studies.

I mean, we didn't have metrics.

We didn't have, we didn't have, you know, we, we were not running our own placebo study.

Yeah. Right.

No. Like, but we were just like, it was all anecdotal.

We're like, yeah.

Okay, guys are coming in and they're coming back 6 weeks later and they're following up going, yeah, I can have sex without Cialis. Yeah. Like, you're 64, you're on— yeah, yeah, you're on diabetes and high blood pressure medication. How is that possible?

Yeah. Yeah. No, that's— but that's the same thing, whether, whether it's that or, or you're talking about patients with knee arthritis or patients with shoulder pain. You get enough of those stories within enough time, you know, short enough time that you start to think, yeah, this is something worth pursuing.

And for those of you that don't follow Don on YouTube or LinkedIn, I mean, you have like 28,000 followers on LinkedIn.

On LinkedIn, yeah.

I mean, you are posting something at least, at least once a week.

Oh, yeah.

Where if not—

I thought you were gonna say once a day.

Well, I'm talking about debunking a shitty study.

Yeah. Okay.

Yeah. Alright. So let's talk about the crappy studies.

Fair enough.

Yeah. Because there are a lot. You know, we— I go to orthopedic surgeon events, and we get a lot of them come by the booth, and they go.

Yeah, this doesn't work.

And it's so much fun because I've trained my staff. Like, I have them watch your stuff. Yeah. And I have them train their staff. Well, how many cc's? How much you drawing out? Yeah, like 8. Oh, well, you're never going to get this out. And they're like, you know, Christine, like, yeah, absolutely, Chris. They look at Christine.

No, I bet they'll be like, who is this person? And she's right. And she's right. She's right. Yeah, right. Yeah.

So tell me, what are some of the common mistakes? Like, when people say to you that PRP doesn't work Mm-hmm. What are some of the common misbeliefs?

Well, so I usually start with, it depends on where it's coming from. If I'm in a meeting that's a little bit more, we can go into a little more depth. Yeah.

Well, let's talk, let's talk in the industry.

Yes.

In the industry. Let's talk to your peers.

Yeah. So, so the, the number one thing, the easiest thing now is just what Christine does, which is, um, tell me if they're talking about their own PRP, then tell me what you're doing, you know, and, and, and tell me your protocol.

Mm-hmm.

And how do you track your doses? Most people that have that opinion just don't have the clinical experience.

Right.

And either, either treating patients like they've never even done it before, which is a little bit unfair of an opinion if you've never even done it, or if they are doing it, they're doing it in a way that is, is probably not best practices with what we know now.

Like injecting neish as opposed to Yeah, yeah, exactly.

And, and, and, and we just, we continue to track dose as the most relevant metric right now until we have something better. And as a clinician, the, the best way we can impact the dose is by how much blood we drop. And so you've heard me say, you know, at this point, 60 cc's is kind of like, if you wanna play poker at this table, you gotta put in 60 cc's.

Right, right.

Even if you go to a smaller volume, at least the dose will be higher. And we don't really have any studies showing that clinically the dose can be too high. We have a lot of studies showing the dose can be too low.

So it doesn't matter if it's 5 billion, 8 billion, 10 billion cells.

It depends. You can get by with lower doses, I think, for soft tissue indications.

Okay.

For a lot of soft tissue indications, or— and it's a great point because sometimes it's the total dose that we need to focus on. Like there's 2 competing excellent knee papers. One is a single dose for knee arthritis of 10 billion, and the other is a 3-injection protocol, but each injection's 4. So 12 billion total. Okay. So 10 billion. Essentially the same.

Really?

Essentially the same. In the paper as it's currently written up by Dr. Chu and the 12 billion total dose, he followed people for 5 years.

That was my next thing is how long?

Yeah, he followed people for 5 years and he showed by MRI scan that 5 years later they had lost less cartilage in the knee that was treated. Dr. Bonsall's study, the 10 billion single injection paper, Only followed people for a year, and so there might have been two at the odds. No, I think it was just a year. So so people have actually lengthened the results of his paper by continuing to follow that group of people, which I've done the same thing. And so I think at doses of ten billion or above, we're actually getting eighteen months, twenty-four months routinely. And when you ask people two years later, they're still better than they were before the injection. So ultimately, it comes down to dose. When I have a colleague that says it doesn't work, or someone swings by. A table like yours or anyone else's.

It's our favorite. It's our favorite ones.

I mean, you start there because that's usually where— that's usually all you have to do. It's usually just a dosing issue or, you know, when you're talking about the knee, it's rarely an injection issue because most people, even if they aren't using ultrasound, which I think is preferred way to do it, they can— that isn't as big of an issue leading to failures as the dose. Yeah, I think the dose is by far the biggest single Shortfall.

It's fascinating to me because the the cumulative effect of that—I mean, we again anecdotal. This is what we did in the ED clinic—is we started just doing one PRP for ED, and we noticed okay. Then we got the wild hair idea of like well from a business standpoint, right? Well shit, is there a doc? I walked into Hanson's office one day, Dr. Hanson's office. Yeah. Is there any downside if we give him two? He's like, no. Yeah. And you go, I go, so why aren't we doing that? And he's like, I don't know. And I go, what if we— how far would you like to spread it out? And he's like, I got to research it. And he's like, I think it'd be right if we did it every 6 weeks. I'm like, okay, so should we only be doing 2 injections? And he's like, I guess. Like, you know, I guess he's a very smart guy. No, but no, but there was—

but there was no— there was no predicate.

Yeah, but I wasn't thinking about it from a medical standpoint. I was thinking about it from— yeah. I was thinking about it from a patient outcome because from, but it was all from a business standpoint. Sure. I get it. How can I guarantee that I can get as good of result as I possibly can to make the offer so compelling that they have no choice but to move forward? That's how my brain was working. Right. That's how my brain always works. So I'm like, well, if there's no downside to doing 2, and then we're like, what's, is there a downside to do 3? And he's like, no. Yeah. And we started seeing unbelievable results.

Yeah. Yeah.

And then we're like, well, what happens if we make sure they're on hormone replacement therapy 3 weeks before they do it? Yeah. And this was— we were just doing pellets. Yeah, right. Yeah. We saw an amazing—

yeah.

Which is where I came from in the biologic space of like, why wouldn't you include—

We're not there yet. Not everyone.

Not everybody. Right. And a lot are. But, but, but, but again, I always have to understand my viewpoint. It's mostly anecdotal.

Well, but the clinics that have incorporated that are getting amazing. You know, and, and, and if, if your end goal as a clinician is to impact people's lives and give them a better, better quality of life, why wouldn't you look at all those things that you could do?

Have you looked at those studies of including functional? Let's just call it functional. We'll include all of that.

I mean, there's not a lot that I've seen. Yeah. Separately, I've seen a lot of studies altogether. It can all—

You've seen this gets this result, this gets that result. They're on the same time, but it's not—

Yeah. I can't see a downside. And we can throw nutrition into that. You know, how nutritionally Nutritional status impacts outcomes. And a lot of that, again, being a surgeon, I've, I've seen a lot of the literature and, and how much better people do around the time of like joint replacement if you spend a month or 6 weeks ahead of time getting them nutritionally optimized and, and maintain that through the, the post-surgical period. And, and so my question, you know, was of course, what about, why can't we do that with our Patients that we're injecting just for knee arthritis. I mean, they're essentially in a hyper, you know, they're in a hyper state. They're in pain, chronic pain. So they've got inflammation. Their bodies are working pretty hard. They probably deserve the same, the same look, maybe even the same treatment. And so those are things there's a confluence there.

Who's the guy that you had? Dr. Jazz? Yeah, Reza. Reza. Reza. Yeah, he's in Beverly Hills, right?

Yeah, and he's an amazing, thoughtful. Clinical researcher, yeah, an orthopedic surgeon. Yeah, and that's his argument as well. Is pretty compelling argument. It is. You know the interesting thing: all of these, all of these modalities that are showing these results, the the trend is towards earlier intervention and towards prevention. You know, and that's the trend. It's not towards figuring out a better implant or a better surgical procedure anymore. Not nearly as much as right as it used to be. And now it's about how can we even prevent this from happening? You know, I don't want to see anybody with a, with a grade 3 or grade 4 arthritic knee. I want to intervene when they're grade 2 and freeze it in its tracks right there.

You mean you want to actually be a healer?

Yeah.

Like the thing that you're called to be?

Yeah. Yeah. And if we're going to heal, you got to, you got to intervene early. You got to make lifestyle changes and interventions when appropriate early.

How big a factor is food and, and all of those things like what they're putting into their system and drinking sodas or not drinking sodas?

I mean, it's big. You know, I've seen some of those same documentaries about processed foods and things like that. And And, and the lens has changed over the years as we see some of these little shifts in diet and in nutrition. Now we're down to talking about peptides that are only certain amino acids long and what an impact those can have. So, so, you know, it's, it's daunting cuz it turns out probably everything matters.

It's really fascinating too. Yeah. What's your feeling on what Kennedy's trying to do?

I think it's unfortunate. I, I, I think I think it would be possible to have a real unbiased look at all the subjects that they're looking at right now. And I don't know that the look is unbiased right now. I think there is a predetermined bias. And I think it's like—

Going in with the pre— they say they're going to look at it.

I think they've got the conclusion. They've got the conclusion written for the paper. And now they're backtracking.

That's basically what the others were doing too.

Well, remember, and remember the whole— remember, and the proof of this Is that report they produced that was ChatGPT'd for a lot of it, and the references, a lot of them weren't even real. And so you can't tell me that an actual clinician that cared went through that paper and peer-reviewed it or fact-checked it. There's just no way. It didn't happen. I mean, our little itty-bitty journal, if you had sent that in, we'd check the references. Yeah. You know, and if it doesn't exist, that would be a huge red flag. So, so, but, but the, the worry about, you know, vaccines and autism, obviously lots of people have looked at that. If we as a country want to take another look at it and pay some money for it, great, all for it. But, but not, not already having an outcome determined and not having it be politicized. That's— I think that's the unfortunate part.

I think that's the unfortunate part about all of it is it all gets politicized. That's the thing that pisses me off the most. Yeah. And I understand why. I mean, there's, you know, money involved. Yeah. Right. I mean, yeah, there's a lot of money involved. Yeah. And that's not the basis of always making the best decision in the world. I think the thing that— what I get concerned of the most is I think the medical system unfortunately has been completely hijacked.

Mm-hmm.

You are not— it's very difficult for your— you are a healer because of the work you do. It's very difficult for your peers to continue to be a healer. And they get— they're like, well, I only got 10 years left. I'll just suck it up. Right. That's the thing that worries me most about our healthcare system. Yeah. Not single payer versus multi-payer. I mean, right. The thing that worries me the most is we're not, it's no, it's no longer honorable to be a doctor.

Yeah. There, there's something to that. It, it, it, and there's a bunch of things that have led to that. I think, I think separating the, the, the way they've done insurance and the way they changed insurance back in the day, where the people that needed to get healthcare weren't the ones paying for it. Because I think in just about any business, as an econ major back in the day, if I tell you, you and I can go get burgers and they're free, we're gonna get as many burgers as we want until we're stuffed.

Absolutely.

You know, and so if you say healthcare is free or your employer's paying for it and you pay a small percentage, it, it skews the need. And then ultimately when you give these companies the ability like to be nonprofits, In name only. And you look at what happens to the bureaucracy when a company isn't, you know, they, they get dinged if they have too big of a checking account. So they spend the money on salaries and on growth and on mergers and acquisitions.

And then they overpay.

And then they overpay, and then they start buying up practices because they make 30% more to see the same patient that I get. Mhmm. That I see. So the, the general public doesn't really see how much that influences what happens in medicine now, I think, in this country.

Yeah.

And just the fact that it can be done so much cheaper in other countries with the same outcomes is, I think, just empiric proof of that.

The thing that blows my mind is we spend 2.5 times more than the next country on the list.

Mm-hmm. Mm-hmm.

And we have the 50th worst outcome.

Mm-hmm. Mm-hmm.

So for me, it's like, well, then you should— business mind. If I bought a company like that, right, that we were, you know, generating more revenue than our closest competitor times 2.5.

Yeah.

but our profit was 50th. Boy, I'd be going in questioning everything. If I bought that company, I'd be like, we're gonna get rid of this, we're gonna get rid of that. Like, I would just start making arbitrary cuts. Yeah, right. Because that's what you do in business is like, you don't have time to like sit there and overanalyze like what really works. Like, there's just gonna be collateral damage. Yeah, that's— I know that sounds really cold-hearted, everybody, but like, that's—

no, but that's how business works. But sometimes, I mean, that's what you have to do. And I think part of the reason for the success of of some of the other systems is that they're intervening earlier and they're treating people earlier. Now, it's not all perfect. I, I spent some time in the NHS system. You know, Canada's just to the north. We know about some of the, the, the reports of lines and waits for service and waits for care.

A lot of 'em fly down here and pay cash for a lot of my losses.

A lot of 'em do. So, so it's by no means perfect there either. But, but in general, it, it, they don't, they aren't getting that result because people just are sitting at home sick. Right. You know, they're actually, they actually have some lifestyle choices they're making that, that I think our population isn't. And it, it's interesting that the one thing about this administration, if anybody was gonna come in and just say, make a blanket rule and blow things up, it would seem this would be the administration to do it.

This is, you know, yeah, yeah. If we're gonna question everything, then this is the administration.

Yeah. This is the one to do it. Just say, I, I deem that you can't do this anymore, period. You know, dare you to sue me. But, you know, I've always thought maybe a benevolent dictator was the best form of government, but that's not what we, that's not what we got.

They, most benevolent dictators wind up becoming, um, yeah.

megalomaniacs. Yeah, yeah, yeah. I think we— yeah, yeah. Fair enough.

Fair enough. Yeah, it's a, it's a really— here's the thing. And I ask this question to everybody that I always ask, and that's, you know, like, how do you feel about what's going on in Washington? How do you feel about Secretary Kennedy? How do you feel about all of this? Yeah. The thing that scares— that I say, though, is that I don't think we'll ever have as good of a time for us to make the inroads in our industry, biologics, functional medicine, Than we do now. Yeah, because the way things go, there's going to be a pendulum swing, and in three years, Kennedy will be out, and somebody else will come in on the other side. And we're in a period in our history now of our country where all you have is dramatic swings. You don't have common ground, and you have massive swings left to right. Like I had a friend of mine who has since passed away. He's a mentor of mine who. Worked for the Obama administration as a coach, coached all their top, all the top people, right? Yeah. Like he, his office was in the White House. Oh yeah. And I said, when Obama's term was done and Hillary lost, yeah. So yeah. So Trump was coming in, right? And I said, so what's it like for you to know that all the hard work that you just put in in the last three years is going to be overturned on day one? And he looked at me and he goes. It feels fucking horrible. And that's where we are in our country. Like, there's just massive shifts.

Yeah. And it's— yeah, I mean, don't get me started. I don't see if 2 terms is enough for the president. I don't see why we need senators and congressmen.

I'm right there with you.

That can stay forever. That's a problem to me.

Unless you're— well, but unless you have your entire stock portfolio tied to the Pelosi tracker, which I pretty much do.

That's not a bad move.

I'm making a killing.

I bet you are. And, you know, as a doctor, you tie it to UnitedHealthcare. Maybe not anymore.

I know.

But, but up until recently, you tie it to United and Blue Cross. I mean, that's right.

I rail against 'em in my book and I'm like, well, I might as well buy their stock.

I mean, that's my hedge, right? They're gonna kill my fee schedule 'cause they're making money. I'm gonna, I'll, I'll fine, I'll sign up with you. Yeah. But in all seriousness, no, but that, that's, yeah, it, it's, it's, it's unfortunate. I, I don't know. It's hard to, it's hard to keep the ship in the same direction because these are no longer small course corrections like— No, they're not. Used to be, it used to be everyone ended up kind of middle. You say what you want during the campaign. Yep. Everyone kind of ends up governing together and in the middle. Now it's it's just like we're going north or south.

It's not like we're going. Yeah, there's no and it's we're changing direction like this.

Yeah, and and and just it's it's disappointing to see. I think within I mean imagine how great the FDA would be if you had Ron Paul, you had you know Steve you want to see Samson Chris Centeno. I mean imagine if you're if you're if you're FDA panel.

I know Chris if you ever hear this. I mean I don't think we would allow Chris. in politics because he would piss everybody off because he's such a— he's such an iconoclast. Well, he's deserved.

He has opinions that are well earned and he has every right to say them. And he's not wrong. He's not often, if at all, ever.

No. Yeah. No. But yeah, I could see which job you want.

You want— I don't know. I would just love to be a player on that team because—

HHS?

Well, I would love to have the ability to have a product and have somebody present a product to a committee and say, hey, look, I've been tracking the outcome for this. Here's 2,000 cases. Here's my complication rate. Here's the outcomes from the patients' reported outcomes. Can I have permission to study this further, or can I at least get this on the market so we can continue? That's what I thought the FDA meant when they said they're going to look at real-world data, but that hasn't really happened yet because as soon as that happens I mean, just PRP. Why can't we advertise PRP for knee arthritis? I mean, we've got more evidence for that than just about any other drug. Way more than we do for aspirin. Because it's gonna—

it's gonna cut the profits of the pharmaceutical companies. Yeah. Oh, yeah. Right? Okay. That's why. Right.

And so that— that— right. So it becomes a chase your tail kinda argument. You know, you can't— you can't win if you're not in that game.

You know, you— you get a lot of flack because people are like, Donnie's a naysayer. He's a— you can't do it this way. You can't do it that way. Or you can't use umbilical, or you can't Right? Yeah. Where is that? Is that coming from you don't like those things, or do you? Are you coming from this is what the government says we can and cannot do? No, I'm never.

I try and call it as I see it. Right. Because I don't want to have to go to bed and write down in my journal. Okay, you said this today. Remember that you said this, you know, because this was shady, you know. Yeah. So so if there's a study. Anywhere on the planet that shows that Wharton's jelly is better than PRP for knee OA, I'm going to report on it. Right. And if it's compelling, I'm still restricted, in my opinion, in this country from doing it. But that would be a reason to study it here, to try and go and get approval for a study. But that doesn't exist yet. And so when I say something negative about Wharton's jelly, it's never— it's never about the product. What I'm usually saying is we don't have the evidence for that.

Yeah. It's not that it's inherently bad. No. Right. No, it's— you're, you always start from a place of what is the evidence? What is the unbiased evidence? Right. Because there'll be— there's studies out there, but it's not unbiased.

Right. And even, you know, the studies that are out there, you're right. It has to start from a position of what is the best thing I can do for my patient?

So it's not a position. That's the first— that's the first question that you ask. It's not about whether or not it's legal or not.

What's the best thing I can do? What's the best thing?

What's the best thing I can do for my patient?

Because then we can figure something out. Now, if the best thing, and that's the issue, if the best thing I can do for my patient, like, if it happens to be that I've seen a study that really changes my mind that the best thing I can do for a particular indication is a cultured stem cell procedure, and I have a lot of patients that would benefit, I, I will go and set up a cultured stem cell clinic outside this country. Because in this country, I still can't do that. Right. And I have colleagues that have done that. Nothing wrong with that. You know, but you're not there. No, no, no.

You're not there of saying cultured stem cell is— No. The best way to go.

Well, that's just a lifestyle choice. I don't wanna have to travel and that, that to manage that for me at this stage would be a bit much. Okay. And so I, I deal with the patients where what I do still benefits them tremendously, but I don't have to worry about going, you know, traveling that much. Yeah. I spend most of my travel meeting.

I was gonna say, what do you mean traveling that much? Like, you and I should play like a game at the end of the year. Yeah. Who has more miles?

Yeah, I bet you would win, but I'd be close.

You would be close. You travel a lot.

Yeah, I do. I do. I've been executive platinum for a long time.

Yeah, yeah, yeah. You over the million miles?

Oh, I'm coming up on 3.

You're coming up on 3? Yeah. So you got me beat.

Yeah, yeah, yeah. But that's since, you know, 3 since I'd say when I first got my American Advantage number, they confused me with my dad. And so for the first couple years, I, I was him. And then they were so confused when I asked them to break it apart. As soon as I was traveling more than dad, I'm like, this isn't working for me anymore. I gotta keep buying stuff. I want my own. I want my own.

Yeah. Yeah. So your tat's over there going, yeah. Hey mom, let's go.

Yeah. I want, before he spends 'em, I want 'em back. But, but what were we saying? Yeah. So, so I'm never speaking negatively about a product unless it's harmful. I mean, I'll say I think something's dangerous, but what's dangerous out there? There, there aren't many products that are dangerous. It's in the application of 'em, you know, in this country, the, or in the marketing of Or the marketing of it. Yeah.

The marketing is—

The marketing, the marketing for multiple unproven and inherently dangerous applications, like putting something into someone's IV, hoping to treat something distal in their bodies is, is if there's proof for a particular indication, great. But if there's not, that's not a safe thing to do. I, I think a lot of it's driven by it's a cash pay business. Yeah. So it attracts people that, that are interested in that. And, and, and the barrier to entry for this business to use economic talk is low. Anybody that can inject, if you're drawing it out of a bottle, anybody that can inject can do it.

Mm-hmm.

So, so now you can have chiropractors hiring nurses, you can have PAs setting up their own clinics, you can have, you know, doctors that trained in OB-GYN now taking care of hip pain.

Mm-hmm. Vice versa. Yeah.

You know, taking care of, you know, ED for an orthopedic surgeon. Again, if you spend extra time to learn how to do something, no knock against that, but it seemed like overnight or in a relatively short time, the people that had stem cell or PRP on their, on their banner exploded.

Yes.

You know, exploded just because with these products, because these products didn't require drawing blood, they didn't require getting bone marrow or even adipose.

Yeah. I mean, I remember when I had COVID and I had Delta because that's when Delta was out. I mean, I caught it from my friend who subsequently passed away. We were playing golf and he couldn't finish the round. Like, you know, three days later he's in the hospital on the Demosphere, or as they called it, run death is near. You know, I'm like, oh gosh! And I get—I've never done it. I've never been so sick. I'm upstairs in my king bed, and my sheets head to toe are soaked. I've never—my blood ox got to like ninety-two, which is not horrible, horrible. No, but for a healthy athlete, that's—it was—I was not in as good a shape as I am now. I was probably about. 25% body fat. It's the only time in my life I'm like, fuck, is this how it ends? Yeah. And working with a doctor then on my hormones and everything, and I called her like 2 days into it and she's like, why? She was pissed. She goes, why didn't you call me right away? Yeah. And she had me come in and do exosomes via IV. I felt better in 12 hours and I came back and I did it again. Now, Yeah. You can, like, I mean—

But that's how you start. That's how you start.

Right. And what I say, like, I don't— I'm with you. Like, I want to see the studies. Like, to me, you start anecdotally. Yeah. I have, I have people in the industry that I know very closely that do IV exosomes for general health, not necessarily going to make your knee feel better. Right, right. And they get amazing results. And patients come back and say, holy cow, when can I do it again? Right. But I'm with you. The thing that I get worried about is where's the line in that? Where, where's the line for you in that?

Well, so, and you wonder, you wonder if there's a pathway there. The reason why the exosomes are helping is because they're getting optimized in a way that we would also optimize them if they had nutritional supplementation. That's because these people are also on like peptides and they're on all these things. Yeah. And so it's hard to know what the real— I, I, I like ranking what's giving me the best bang for my buck.

Okay.

What, what's giving, what intervention's giving me the best result for the intervention? And it, it's hard when people are doing a lot of different things. But I, I think exosomes IV for general health. Mm-hmm. Is something that needs to be examined. Yeah. Because, you know, unlike the cells that we put in the IV that get stopped in the lungs, exosomes have the ability to, to travel and, and be systemic. Nutrition along the same way. Anyone, everyone can do that. You know, and then there's some testable things that you can track. You know, the problem I have is just with the FDA.

That's where your real issue is.

Yeah, because developing the science is one thing. But once I think that something may be helpful, like, like with your anecdotal story, that's one of the products that the FDA has been really, really, really clear on. I mean, as recently as last month.

You know, it's like an every 6-week thing, I think.

Yeah. I mean, Platinum Biologics. Yep. And Innate Healthcare. Platinum Biologics in Florida and Innate Healthcare in Scottsdale and Phoenix, Scottsdale both got letters and both had exosome products. And, you know, the FDA is not just a marketing agency. They don't just tell you you can't market. They actually are responsible for saying you can't use this in humans unless we approve it, if we say it's a drug. And so exosomes is just— it's a great example of something that may be tremendously beneficial, but somebody's got to quarterback that through the FDA. Well, either the FDA has to change, which would be great because with RFK and these others, maybe they'll just say, okay, we'll just track complications, but you guys can do it as long as you track. That would be maybe a workable, you know, solution. But and like we said, if any, any administration is going to do that, this would be the one, right? Hopefully.

I'm hopeful because I think that they should open it up more. I think we should be I think we should be a lot more open to saying, yeah, run the study. Like, let's go, let's go find the answer as opposed to— it's almost, it's almost like the answer right off the bat is no. Yeah, that's the default, right? And that stifles innovation. I mean, as a country that for most of the 20th century really led in a lot of things in innovation, I don't feel like we do that now. I don't feel like we're really innovating the way that we used to.

No, I mean, there's off-the-shelf stem cell drugs in other countries, you know, and we don't have that. We're not even close to that yet. Yeah, you know, we're getting closer. But, but, but so we definitely are lagging behind. There's not even a— there's no question we're lagging behind. You know, the people, the clinicians that are using some of these products that are deemed drugs by the FDA but not yet approved, I understand because along with that, maybe this is fortunate, but along with that opinion, the FDA is not the FBI.

And so just like last night, carefully might get a knock on the door for that one.

Well, I don't know. Yeah, here I am. Come get me. I'm my my name is Franklin Franklin Smith. Yeah, yeah, right. And so like these two letters that just went out, it was just basically you have fifteen days to respond. How you're going to become compliant. A lot of companies get those letters, and there's no way to become compliant, so they just stop. Some companies change the labels, but but it's not tied to jail time unless the Justice Department gets involved and there's some other issue. Right. So so I guess the point is the penalty for doing something that may not be FDA compliant is right now minimal.

Yeah, it's a it's a scary letter.

It's a scary letter. And you either at that point stop, or at that point you change what you do. But but that's the issue, and so that's why I understand. I just hope the people that are doing it are keeping good notes and and saving it in a reg saving their outcomes in a registry because if the FDA really does finally allow us to present real world data, that'll be we could hit the ground running if they say okay we're going to consider exosomes in this committee meeting in two weeks. If we had eight people that you and I know show up and say here's my data, here's my last. 2,000, and you end up with a total of 10,000 cases that no significant side effects and 70% response rate. I'm just making stuff up. 70% response rate, and these are the indications. I mean, yeah. I mean, that's how we can push the ball forward a lot faster. Yeah.

I mean, there's, again, talking with Rowan last week because it's fresh in my head. You know, that's why he's bringing his event to Japan. He's like, Japan is Way more open, yes, to doing a lot of the things that we can't even think about doing. Yes. And you know there's way more that's going on outside of our country than here. Yeah. And to me it's it's almost like it's the patient is the the patient is the furthest one down on the totem pole as to the consideration of whether or not we should do something. We're not thinking when we run these tests or like the FDA. They're not. It's almost like they're like, well, we don't wanna think about what's really in the best interest of the patient. This anecdotal information. Mhmm. Because what do they know? They're just, you know.

Mhmm. I, I mean, it probably—

I know that's a—

I know it's a broad statement. Well, probably shouldn't say it out loud, but, but, you know, we, we have a pharmaceutical industry that is intimately entwined with the regulate and regulator regulatory body. I should say. Yeah.

They give them a percentage of the profits.

Yeah. So, so that's, you know, they're They're you know. Yeah. If you had to look at what's different between our country and other countries, there's some quantitative and qualitative differences. There's some very and how they're funded and how they're.

Well, I mean, if you listen to Brigham Bueller, so Brigham Bueller is the guy that's taking on the pharmacy benefit managers.

Okay. So he's been on Rogan four times.

Yeah. Okay. And he's got his own podcast. He's a compounding pharmacy manager owner in Austin, Texas. Yeah. Okay. Great. You should check him out.

Like I will.

Yeah. He is. He basically just exposes everything. He's like, you know, he tracks down the healthcare.

They all own each other, right?

United Healthcare. Here's the 11 different businesses that they own, and they own every fucking distribution point. Yeah. So there's no benefit. Like, they're making money. They make more money owning the pharmacy benefit manager than they do in their insurance health insurance company. Yeah. Because there's so many profits. They just got sued for, like, I don't know, some insane amount of money by the Justice Department because.

But even that amount was a drop in the bucket for them.

Yeah. I mean, I mean, it was surrounding error. Yeah. It was like, you know, $25 million fine is nothing.

Yeah. Right, right. And almost like, almost encourages them to continue the bad behavior, in my opinion. Yeah. If the fine's that low, it's like, oh gosh, we can really step it up.

Yeah. It's only $25 million. Yeah. What's it take?

Let's go again. What's it take to get a $50 million fine? Yeah. Come on.

Let's, let's push the envelope. Yeah. Well, that's why, that's what business people are like. We only got fined that much.

Yeah. Okay. Let's get that. That's still pretty good ROI.

We're getting pretty close. Let's push it again. Yeah. So let's just take a percentage of every sale.

That's like me going from $650 to $675 to $700 for my PRPs. Like, yeah, yeah, keep creeping up. Yeah.

Do you think they're— what do you say to somebody in our industry, in the medical field and providers that say we've got to get PRP covered by the health insurance company?

Oh gosh, I just posted about this like 2 days ago.

Well, I know, that's why I'm asking.

Yeah. Oh, okay, good. Yeah.

This is what we call a softball in the industry.

Okay, good. Yeah. So I actually, but even before that post, that was one of the lecture topics I had at at the orthopedic summit that just happened in Vegas three or four weeks ago. And the conclusion of that talk was if they were to cover it and provide the the payment that represented the value and the expertise and the training and knowledge involved, none of us would have a problem with that. The question is what is that number? And my answer to that is well when Tricare covered PRP for five years. The average payment was about $2,000 for one location PRP injection. And that's pretty fair. I think most clinicians doing PRP would think that's— you have to buy the kit. You have to, you know, you figure in all your costs and everything, and that's a pretty fair number. Fast forward 2 weeks and a buddy of mine in town, Dennis Minotti, sends me— first he asked me a question like, have you heard that Blue Cross is covering PRP? And I'm like, no, I haven't heard that. And I pulled up their position statement. It still says online in their own literature that they don't. But then he sent me a copy of, you know, you can put in like codes, CPT codes, right? And they'll spit back what they'll pay. So he sent me a copy of that where he and his staff had done it and a patient had sent them something. And it's a tracking code, which by definition is supposed to mean there's no money because it's a tracking code. Right. And it's been in existence 15 years for PRP. And it includes—

I remember that code because we put it on our super bill for our patients.

We've been talking about it for 15 years. And, and, and it includes ultrasound. So we're like, this is beginning of the end because they've already bundled 2 services that allows them to decrease reimbursement. Anyway, long story short, the dollar amount that they paid, Blue Cross paid for 0232T, which is the tracking code for PRP, was $32 and change. Or it's $32 or $37 and change.

Did you see my post? Did you see my comment? My comment was, oh, you almost, you almost pay for all the, everything to make your own kit. You almost cover the cost of creating your own kit. Almost.

Almost.

Almost. Guess.

Yeah. I mean, you're doing it for free, but almost. And, and so, so that's obviously a non-starter.

Right.

You know, and, and I, I still can't see how that's a mistake because that payment is even lower. Like if I just do ultrasound and send it to Blue Cross, it's like $100, $110, something like that. So I can't see how they can add a bunch of services together and then pay less than any single service. Yeah.

That doesn't, that just something makes no sense to me off.

But maybe not. Maybe they did on purpose. I don't know.

Yeah, doctors will come to me and go, well, how are we going to get insurance companies to cover this? No, no, no. Why would you want them to? No. Well, you know, we can serve more patients. I said, why don't you just charge more? Take a percentage off the top, create your own foundation, and treat people that can't afford it in your own hometown. 100%. 100%.

Because when was the last time that health insurance ever increased a reimbursement I mean, they may eke out a percent or 2, but the overall trend, at least in my specialty, is, is less down.

It goes down every year.

Like, way down. Yeah. Yeah. If you look over a 5 or 10-year timeframe, it's, it's, it'll make you cry.

Mhmm.

It's a horrible business.

It's an awful— which, okay. So when we— this was a year ago. Remember we're in San Francisco at the big orthopedic event? Mhmm. And somebody came out with an article that they basically figured out I forget the timeline. Within 10 years, an orthopedic surgeon will be getting paid $28 an hour, which, given the rise of fast food workers, taco— a person at Taco Bell is gonna be making more than an orthopedic surgeon.

Yeah. I remember the article. I, I don't remember the exact number, but—

I don't remember the exact number either. How do you— is that— do you think that's close?

Yeah. Well, look, you know, a total joint surgeon, even if we— let's not even talk about the training to get there, but a total joint surgeon—

Yeah. Let's, let's eliminate the 12 years.

Yeah. Pretend he just walks outta high school.

Right.

A total joint surgeon gets $1,200 to $1,300 for a, a joint replacement.

Okay.

Okay. They have to cover, they have to see that, that, that includes 3 months of seeing the patient after.

Okay. How many visits is that?

3. Figure 3. Yeah. And so, 1 every 30. And usually after 3 months, you may go to annual unless there's a problem. There's not really a, a reason to keep seeing 'em. So essentially that, that $1,200 or $1,300 is it. That's what you get. Boom. Okay. Somebody's super fast, say it takes 'em an hour. Okay, to do. So it sounds like thirteen.

I'm not sure I want my total joint. Right. But then talk using the phrase, I'm super fast.

Well, you know, the incentive is not to get slow.

I know, but as the patient, yeah, I'm not looking for Speedy Gonzalez to do my total joint.

No, you don't want that on your on your card. The world's fastest. The world's fastest. Yeah. But but that's it. That's all they get. And you know, and and. And there's no allowance for the biggest thing for me. There's no allowance for outcomes. So if, if you and I are both joint surgeons and you get way better results than me, like your people, your joint replacements last 18 years and we have data that mine lasts 4 with infections and stuff. Mm-hmm. We get the same $1,200.

What make— what pisses me off the most is, yeah, someone coming fresh out of same fellowship. Mm-hmm. Gets paid the same as somebody who's been doing—

you've been doing 35 years. Yeah. 35 years. Whatever it is. Yeah. Whatever it is.

Imagine that as a lawyer. That would never happen in a million years.

Never happen. And so, and that's part of the problem with the way the system's constructed. And, and, but that number, that $1,300 number used to be, you know, $2,200, you know, 10 years ago. So rotator cuff is a very, most everything is a very similar story. If you look over a 10-year timeframe, reimbursements are down 30 to 50% on a real number.

Like, and costs are up 60, 70%.

At least.

At least. I mean, just, if not 100.

Yeah. Just the health insurance costs.

Right. Yeah. I mean, just, yeah, for lower cost.

We're funding, we're funding UnitedHealthcare's acquisition spree.

How worried are you about medicine? How worried are you about your fellow doctors?

Oh gosh, I think it's unsustainable. I think it's unsustainable. One of two things will happen. Either the whole system will have to shift in another direction and give some autonomy and authority, frankly, back to the person providing the care. Okay? Making the actual decisions that really most impact what we can do. Because right now, they've even taken that decision-making opportunity away from us. Like the surgery I did before I came here, I had to speak to another orthopedic surgeon to make sure that my plan was okay. And I don't know how you do that as a surgeon if you've never seen the patient, never done an exam. You have a printout of an MRI scan, but printouts are wrong sometimes. You know? And, and so I don't know how somebody can kind of Monday morning quarterback somebody who's in the room with a patient. But, but that's—

Or what's the skill set and the background of that orthopedic surgeon that you're conferring with?

Yeah. Even if he's a surgeon, it's a really good point because, you know, the rule is it has to be someone in your specialty, but it doesn't— the, the specialty is defined as orthopedic surgery. If I'm a shoulder specialist, I may have a very nuanced and different approach and know, know different things than somebody who, is a trauma surgeon. Okay. So, so yeah, the way they define it is still broad to, to my liking. It's still broad. So loss of autonomy. Yeah. Loss of—

that's— you think that's the biggest issue facing?

No, no. So they're turning it into just shift work. Yeah. In my opinion. Yeah. Back to the fast food example in comparison, because, because they are snapping up practices at an alarming rate. 3, I think, I think the number is 3 out of 4 people coming out of fellowship are going into salaried positions. So the entrepreneurial aspect of it and, and the independence of it is essentially evaporating.

Which I think that entrepreneurial background of a doctor is critical for discovering new ways to heal.

100%.

Right?

That, that whole thought process of being intuitive and inventive and—

Or noticing a trend versus just processing.

Because there's no incentive to track your outcomes if you're going to get the same paycheck every 2 weeks.

Right.

I mean, it takes a really special person, and there are some, but it takes a really special person to still care. And usually the people that I know that are that person, even though they're salaried or employed, they've been around, they're my age, you know, they're not just coming out of fellowship.

Right.

You know, they've been around and they've published and they know that they're making an impact if they look at something beyond just their 8 to 5 schedule.

So 2000, 2011 or '12, I can't remember exactly. Let's just call it 2011. 25% of doctors worked for hospitals slash big groups. Today it's over 75%.

Yeah. And that's the issue. And I get it if you're coming out. I'm— I guess I really don't get it because I was never built that way. But if you're—

I don't— I don't— I understand why it's happening. Right. But I don't get why people are putting up with it.

Yeah. Yeah. The, you know, you get— you get a postcard in the mail that says, $650,000 annual salary, 2 weeks vacation. It just becomes a W-2 job. And so some people now are going to medical school just knowing that they'll be comfortable, knowing that they won't have any autonomy. And if they—

Yeah, but that stifles all innovation.

100%. I couldn't agree more. The people that are in practice like me that then sell their practice, The, I would love to see the number, but after 2 years, like after the initial contract is up, the people that go back and get outta that situation is really high. At least just anecdotally from friends I know in this town. Yeah. Nobody likes it.

No.

Nobody likes it. Nobody. Because you, you're in a situation now where you have to see someone every 10 minutes, you know, and you have to, you, you get 40 minutes for lunch or 45 minutes and you get your 2 weeks and you may get 2 meetings a year to go to and You get your RVUs, you can take that $650,000 and move it to—

if you work really hard, maybe to $850,000 or $1 million.

Well, and that's why biologics struggles in that environment, because the RVUs that some of my colleagues get at some of those institutions are the same as a steroid shot. They just get RVUs for the injection.

How do they get away with doing RVUs? Because that's fee splitting. I mean, if I, if I had a practice, And I had an, and I advertised I was gonna give you a commission. Mm-hmm. It wouldn't take long for me to get a letter. Yeah. Right. Correct. Correct. Aren't RVUs just commissions?

I think so. I, I'm sure there's a, there's a reason how they get around it, but, well, no, I mean, I'm just, I'm curious. But that, but that, but that whole corporate practice of medicine is, that doesn't exist anymore.

Nobody gets, nobody gets, I love the fact that they're nonprofits. That's the one. 'Cause when we were look, this is so, again, yeah. Everything's a business problem to me. Right. Right. Like, right. It's Harvard Business School. I mean, this is what we studied in college. Like, Yeah. And so I remember sitting at lunch with my friend Byron, who owns 25 practices at the time. We would meet for lunch every— we did sushi every 6 weeks, and he was mentoring me about growing the practices. And I got to 3, and I'm like, okay. And he's like, so what's the biggest challenge you're facing? I said, this fucking corporate practice of medicine bullshit. I gotta rely on the doctor owning the damn place, right? Like, and I don't want one doctor to own all my clinics in North and South Carolina. What happens if they get— what happens if they have a heart attack or Get a cocaine addiction, anything, right? Whatever, right? Or decide that they're the real power, right? Like, right, you know, right? Yeah. Um, and my investment is gone, right? It could be gone. Yeah. And he goes— and I said— he goes, so what do you think the answer is? Because he dealt with it. And I go, do you realize that there's a gap in the, uh, corporate practice of medicine? Because I studied all 50 states. And he goes, what's the gap? I said, set it up as a nonprofit. And he looked at me— he's a really smart business guy— he looked at me and he goes, I never thought of it. He goes, that's brilliant. You need to explore that. He goes, and I started exploring it, and I'm like, I think I can do it, Byron. They do it in hospitals. Yeah. If we set it up as a nonprofit, I don't need the doctor to own it. No. And lo and behold, what are the venture capitalists doing? They're setting up as a nonprofit. Yeah.

And that's, and that's, you know, the, the apparently you can have like $9 or $10 billion before it becomes a problem.

Yeah. You can have as much money as you want. It's completely, it's like an Indian casino.

You pay a lot lower tax rate. Yeah. Like, you know. Yeah. And then you're on the side. And so then you're on the side of the people that have the power because those are the lobbyists and those are the, you know, because they all want a piece of it, you know? Yeah.

What's the fix? What do you think? What are some of the fixes you would put short, medium, long term in to return medicine back to its healer roots?

That's hard. I think long term, you've got to return insurance to what it was meant to be. Insurance was meant to be for catastrophic things. Yeah. And, and I think we have to go back now. A lot of things— the problem is a lot of things have to happen at once for it to work because you can't just change the cost of one thing and now say, okay, now you pay for your normal medical stuff. People wouldn't be able to afford it because they've been relying on this model for a long time. And so, but I think you have to turn insurance back into you buy a catastrophic, catastrophic or basically a hospital policy where if you have to be hospitalized or have to have major surgery, you're covered.

That's basically what I carry. Right.

And but, but your day-to-day stuff, your average expenses now become you cover it. And that's where our government can have a role. If somebody is below whatever income level that we deem appropriate, they get help. I was a fan of the idea of vouchers for something like that. Yeah. I think that's the way to give people the ability to have choice. The more we can have choice, And, and, and competition, I think the better. I think in this city right now, we've got 3 major, just 3 major choices for hospitals.

You know, what was it 10 years ago?

Well, I mean, it's a sore spot 'cause we had 100% physician-owned hospital 10 years ago and, and we were not nonprofit. We were blatantly for profit, but we paid taxes. We employed 250 people. We had better reviews.

Mm-hmm.

Than any other for-profit, nonprofit hospital. And because the incentives were lined up, you know, we weren't gonna do well unless we took really good care of people.

Yep.

And the doctors weren't going to come to the hospital to operate unless we had a really good hospital.

Yeah.

You know, and got great results and fast turnover and all the metrics were so much better. And, and they shut us down. They shut us down. You know, so, but, but, but it's a great question. I, you know, I think you just, I think you have to find a way to inject choice, meaning getting rid of these lists of HMO doctors that you can go see right now. You know, it's funny that what's changed over the years in terms of how people find me when I ask them that question, it used to be referrals and word of mouth and, you know, friend of a friend. It's slowly changed over the years. My practice has changed a little bit too. But, but even with a mostly cash pay practice right now, The number one thing people will say is, well, I went to my insurance company's website and I got the 10 orthopedic surgeons near me. And then I looked at those 10 on the internet and your reviews were great. So I came to see you. And then I still—

you still take— you still do surgery?

I do. I do. I still do surgery and I still take— the least profitable thing you do.

By far. Yeah. By far. The highest risk.

By far. The least profitable thing that you do. Yeah. I get little returns from that. Why do you still do it? Because I love it. Yeah. Yeah. So it becomes just a lifestyle thing. Yeah. Yeah. I mean, I just— you still love surgery? Yeah, I love to do it. I imagine it's got—

I mean, I can't imagine how cool it's got to be.

Well, I love being able to help someone. I mean, that's the orthopedic side of why I went into orthopedics. I love having a defined issue that I can help with. And then 6 months later, they're— they don't need me anymore. Yeah. Yeah. I never went into internal medicine.

Was that great if kids could be like that? They always seem to just stick around, don't they?

They do. Yeah. Guilty as charged, by the way. I'm, I'm still sticking around home.

You're still sticking around with your—

I'm still— yeah, yeah, yeah.

But you're really lucky, by the way, that both your parents are still alive. Yeah. Lucky. You're, you're a very, you're a very lucky man.

I am. And I'm, I'm grateful for it every day. They just had their 64th wedding anniversary.

Jesus. Yeah. I don't think you and I combined in our marriages have been with— no, 64 years.

No, I would, if I got married today, I've got 27 total. So yeah, no, I'd have to find someone today and be 123 to be married 64 years. So I need biologics and a big— I need, I need your exosomes. I need, I need whatever.

I can hook you up, Donnie.

Yeah, I need it. I need it. I need it all. Yeah. But yeah, but, but your question is a great one and it needs a lot of smart people thinking about it because there's got to be a way to return choice to people, to return insurance to what it was originally designed for. But think of all the lobbies and think of all the industries you're talking about to make that happen.

Yeah. You know, it's like, it's like, it's like, it's like making it so that politicians can't serve term limits. But of course, it's never going to go through. They own them. The lobbyists own them. They're not going to— they're going to fight that tooth and nail.

You'd almost have to start that way, right? Because who's going to want to go into politics to make that change if they're expecting to have a career in politics?

Well, yeah, it's a major league career.

If someone knows they're only going to be there 4 years, then yeah, I can, I can do what I think is really right for People and for the country because I'm gone in four years.

Wasn't that the appeal with Trump this last time around? Yeah, right. I mean, it's a nice pitch initially. Yeah, yeah, initially.

Yeah, it turns out, turns out that may not be true.

May not be true.

Yeah, but it's a great pitch. It is a great pitch.

Yeah, I love the fact that they're now mandating that you have nutrition courses. Yeah, I think it's kind of thrown like a deck chair off the Queen Mary. I also think that they should get business classes. Hundred percent. I mean, if they had a whole yeah, not just Here's how to balance your checkbook. Yeah, but like that's actually one of my goals is to get find one medical school that I can go in and teach a semester of business. That is, I want to start with one and then I want to do two semesters. I want to be able to teach two years of business, and I got enough network people that I can put in there.

Well, do it in Texas so I can go, man. I would go to that class in a minute.

That's actually a dream of mine. Yeah, that. It's there. I really haven't done much with it. You know, I got the new book coming out, which I think is gonna kind of, with this podcast, I think it's gonna kind of drive some things. Mm-hmm. But yeah, I wanna start. I just need one.

Is that something you think you could set up as a, as a virtual system?

Yes, absolutely. Yeah. Totally.

And just, you just have a package because that, that, that's what happens now in a lot of, even at the residency fellowship level and down into medical school is, is funding for them and time, finding time there. I, I can think of several things off the top of my head that could easily should be replaced by business classes. That you know you're not going to use unless you're going into that particular narrow niche specialty. Everyone needs business. Everyone needs that knowledge.

Well, that's when I'm you know a year ago I decided in January I decided not to live in Charlotte anymore. I moved out west. I'm in Phoenix and probably going to wind up. I spent a lot of time in California, but I'm not going to move there. Yeah, because the taxes are insane. Yeah, but you know I was working with Dr. Will Haas. We were going to create an orthobiologics clinic. And we would have fellowships where they could come in and be 18 months and they learn biologics. And then they have another one because he's a functional doc and they would learn functional so they could do another 18 months. But in that, they would— within that 18 months, they would learn business. Yeah. Yeah. That's the other thing I want to do is I want to create a fellowship that's about business.

So that's important. You need to— we need to talk about Iowa having a curriculum item like that.

Okay.

Because we're really good at teaching orthobiologic technique and best practices and evidence-based protocols and all the things. But it's not doing everyone the best service that we could, as IOF is Interventional Orthobiologics Foundation.

Yep. Great. By the way, if you're looking for one of the best places to get training, IOF is it.

But, but we're sending— we're training all these people so they're, they're, they're, they're better than when they came, you know, to the course. But I, I would almost guarantee you that if we had a business offering, I mean, maybe we'll talk about it for ILF Max in June. If we had a business offering specific for that, geared towards orthobiologics or geared towards medicine in general, including functional and everything else. Yeah. It's a gap all the way through, all the way through my whole practice life. It's been a gap. If I hadn't sought it out and sought you out and, and I, I would just be, you know, looking at YouTube videos hoping, hoping, hoping for the best. Yeah.

In the, in the book, and I finished the manuscript about 3 weeks ago, so it's off to the publisher. So in chapter 3, I start every chapter with a story. Okay. And the title of chapter 3 is The Modern Medical Plantation. And I start with the story of Ned Scott, who's an actual sharecropper. And so it was 1904 and he's sitting down and it's the end of the year. And the sharecropper, the landowner says, well, Ned, looks like you didn't have a good year again. You owe me $42. And that's not good. Yeah. You're wrong. And he pulls out a ledger, and he kept his own ledger of everything that he bought at the company store because you paid 2 to 3x at the company store for the seed and the shovels and the clothes and all of that, right? And he showed the plant— the owner, the landowner, yeah, plantation owner— that his numbers were wrong, that he actually was owed money. And he said the only— when they interviewed— it's an actual person— when they interviewed him Whatever, 30, 40 years later, and he said, yeah, I taught myself how to read and write, and I taught myself math because I knew the only way that I could get out of being a sharecropper and own my own land was through education. Yeah. And the point of that story is that I think is what if we can educate the doctors about business, they'll realize how bad they're getting fucked and they're getting fucked. Okay. And they'll be like, wait a second. Yeah. Because, you know, So the only thing that happened in the Civil War in the South, what happened was they stayed on the plantation. Yeah. They became sharecroppers. Yeah. It was another form of slavery. Yeah. And it went all the way up until the 1950s. Yeah. Right. Financial slavery. Right. And it's one thing to have an Emancipation Proclamation. It's another thing to win the war. It's another thing to completely change your mind and your belief system about what you can possibly do. Yeah. And to think, if I can do anything in the rest of my life, it would be to change that. No, I think if I can change that, Donnie. Yeah, that's powerful. My life would be pretty well lived.

Well, that's powerful. You think about, and I've had this conversation with a couple people, you think about if they're offering a brand new orthopedic surgeon coming out of fellowship a half a million dollar salary, it is because they're making $3 to $4 million.

At least.

At least off of that person's salary.

They're making 8.

Yeah. And so, yeah, great. You have a nice W-2. You still need education on what to do with that. If that's your end goal was just to have that. But, but step back and look at the bigger picture. And especially with, you know, the orthobiologics and then the promise of a concierge-type cash pay business, the opportunity exceeds that. You can help way more people if you don't have restraints on in terms of how you should practice.

Yeah. Well, hopefully, hopefully this is the time. I mean, the education you do— tell everybody about what you do with OrthoSono. You've been doing a long time with—

yeah, we have. So, so OrthoSono started off as an MSK musculoskeletal ultrasound training course. And back then in 2008, all we knew was shoulder ultrasound. So our first— I mean, we did 4 courses a year.

I'm sorry, but we could only imagine how bad the machines were in 2008.

They, they, they weren't awesome. They were good enough to have a course, but they weren't— I mean, compared to now, you'd be like, oh, what?

I can actually understand what I'm looking at.

Yeah. Like, now, now they're like, they're like portable MRI machines. Yeah.

It's amazing, isn't it?

But, but the course grew because the need was there. We were right about the, the interest level that would develop. And, and so the course grew. We added foot and ankle, you know, we just added all the different areas within orthopedics that, that makes sense. And, and now we do it twice a year. We've been doing it twice a year for a really long time. Here we are, 2025. So we're 16, 17 years later.

Mm-hmm.

And we've had probably 38 or 39 courses because the first couple of years we did it 4 times a year. And we still, you know, we, we keep it small because it's a training course.

It's a great course.

Small is 70 is our, our average attendance. Um, but those 70 people, again, they're, they're better Monday than they were Wednesday night when they came to the course.

When we have a new staff member come on, mm-hmm, I always send 'em to that one. Mm-hmm. And/or IOF, but I always send 'em to yours 'cause there's more of it.

Yeah. Yeah.

And I make them stay there and watch the training.

Yeah.

And they come out 'cause I hire people that predominantly are not, yeah, in the medical field.

Right.

And they come out and they go, I had no idea.

Yeah, it's— I just— it's fascinating. I think it's pretty cool. I just— I love it. Yeah, that's why I keep doing it. I just think it's cool. Even if I had nothing to do with, you know, teaching, it's just cool. But we, you know, we've expanded and this is new. We've now gone to a full day on the Thursday of the course, which is the first day. That whole day now will be regenerative medicine because the topics we need to cover are just so much broader than they used to be. So we've gone to a full day, we do live demos, and then— I think you do like a live BMAC, right? Well, yeah, and going to a full day on Thursday will give us all afternoon. So we're now, instead of 2, we're gonna have like 6 live demos.

So I brought my sons one year, Colin and Jack, and I'm like, you have to stay, you gotta watch. And they were transfixed. I said, at first they were standing in the back, I'm like, get your ass up here, come on. Nobody's gonna care.

Same price.

They're gonna think you're in medical school. Just go right ahead. And they were like, Dad, that was amazing. Yeah. Like, yeah. They're like, this is what you do. I'm like, no, I don't do things to my people.

Right? Well, and the amazing part is, is you get the report back from the patient. You know what I mean? That, that what I did for 20 minutes, that person been struggling for 4 years, 5 years, and 4 years later, what I did for 20 minutes is still impacting their life in a positive way. Yeah. That's, that's the promise of what we do and trying to, trying to lengthen those numbers, you know, and make it last longer. And make it easier to do.

So if somebody wants to find out about that, that site is— is it orthosono.com?

Correct. www.ortho— so O-R-T-H-O-S-O-N-O dot com.

And it's all the training that you need. And I will tell you folks, like, I've been— I don't know how many years I've been going, 3 years or whatever.

Yeah. At least.

At least. Probably 4 years now.

Yeah. Yeah.

You walk out on Monday and you can do it. You walk out of there, you can do it.

You can do all the basic things. And that's really Now, our course is positioned as beginner-intermediate. We have a fair number of people that are already pretty skilled, and they, they get a chance to, you know, fine-tune whatever they want to fine-tune. But we have now partnered with Interventional Orthobiologics Foundation to be their introductory-level course. And so if somebody is worried that they've never done it before, that's not required at all. If somebody is worried about their specialty, we take, in this course, we take Doctors, we take PAs, we take physical therapists. Oh yeah, it's great. Any musculoskeletal specialty that's interested in ultrasound, we just want to get them some good info.

Because it has to be done correctly. Yes. And that leads to the conversation of you have to do ultrasound-guided in the injection.

Yeah. I mean, there's basically every study that's come out has shown that we're better if we use guidance than, than if we don't. Nobody drives blindfolded, folded. Nobody. You know, I'm sure there's some guy that's figured out how to do that. Yeah, I'm sure it's a parlor trick. Yeah, I mean, it's a visual imaging modality. So if you can see exactly where the needle is, it's kind of like, why wouldn't you?

I was showing Nastasha. She was at not an OrthoSona, but we were at another event. Maybe it was— I can't remember. I think it was AAOM because we were in Vancouver and Two Boots Down, Amy Truong, is getting her back done. And I grabbed Natasha by hand. I go, come here. And I go, watch this. And I grabbed one of my doctor friends. Maybe Farrell was there or somebody else. Or anyway, or maybe, you know, I can't remember. And I'm like, would you please explain what's going on? And he's like, okay, so you see it? You see that's the gap right there. And I watch them fill it in. And he's like, she's like, what? And I go, that's what we teach them. We teach them how to make money with that. That's why we do what we do because they may be able to do that great. But if they don't know how to run a business, no one will ever find out. It doesn't matter. Yeah, it doesn't matter.

Yeah, that's exactly right. You have to, you have to know your audience. You have to know your patients. You have to price. You have to know your value. You know? Yeah, yeah, yeah. All things you've helped me with.

Thanks, man. Yeah, yeah. You know, you changed, you changed my business dramatically. Really? I've never told this story. I was thinking about it on the way over here. So I had, I had owned the clinics. I sold them. I got divorced. Okay, and I had started a mark an agency at first, and I had a week where I lost six clients in a week. The business basically disappeared, and so I wound up doing some coaching, right? Because I had a long background of doing coaching and consulting from my get rich in real estate days, and I'm doing this, and I'm having the damnedest time getting any traction. I'm trying everything. I'm running Facebook ads, LinkedIn ads, LinkedIn messaging, cold email campaigns. Yeah, because I didn't have the money to go to an event. It was just me. Yeah. Okay. I'm like, well, I can't stand in a booth. And I looked at the money you do in a booth and, you know, you go through divorce, it costs a lot of money and then you wind up with, you know, and I had, I had my son at TCU. I think my daughter was finishing in Furman. I'm like, yeah, you know, there wasn't a whole lot of extra capital sitting there. Right. And I literally remember this that week. I'm literally, I'm asking God, Literally. And I go, God, I know I can. My skill set's really good and I can go into another market and make a lot more money if you really want me to stay working with these doctors. And I didn't understand at that time. So this was— was this pandemic, pre-pandemic? Might have been '05. It was right after pandemic.

Not '05, 2020. It was 2020. Yeah.

I think it was like '21. And I said, you got to give me a sign. I was through one of those prayers like, give me a sign, God. Yeah, right. Yeah. Yeah. You literally messaged me the next day.

Is that right?

Yep. And you hired me that same call. Mm-hmm. 3 weeks later, Ariana joined. Mm-hmm. Then Josh Schachter. Mm-hmm. Like it completely changed the trajectory. Yeah.

Like I'm literally like, I, I brought a tribe, man.

Dude, you brought more than a tribe. And then you invited me to speak at the event. Yes. And I think I wound up with like 80% of your instructors have been clients. Yeah. Something like that. Yeah.

I've, I've been surprised by that.

I mean, yeah, you, you would let, like you literally I'm not kidding, you were answered prayers. Like, God, I really like working with these doctors. I know they need my help, but dear fucking God, they're stubborn as hell. Yeah, yeah, yeah. I need like— I need an angel inviting and visiting me, give me like a marketing plan. I need something. And you literally messaged me the next day and I'm like, that's cool, this is a joke. Because I had— I had sent you some messages on LinkedIn.

Yeah, and I— and I had been tracking and, and, and just got to a point where I'm like, you know, everything he says, it— I understand it, it resonates with me, and It's like I know I need help, and I've never been afraid to have a coach. Obviously, obviously, especially if they're if they're making me better, you know. And it just I you know prayers answered. It was just time. Yeah, yeah, yeah.

It's really cool. And I you have given me such an appreciation. It has been fun to watch you and get to know you, and really just the passion that you have for your. For your fellow doctors, thank you. Not just the orthopedic surgeons and not just the ones in Regen. Like you can just tell you have a heart for the truth. Yeah. That's why I called you, you know, Regen Superman.

Yeah. Yeah.

And I appreciate truth, justice, and the Don Buford American way. Yeah. But yeah, Donnie, thank you for taking the time. No, I know it's been a busy week for you. Been moving into a new office. Yeah.

So we finally, after all these years, now I had a little satellite office for about six months, but it wasn't. I wasn't there. Yeah. And so after all these years, I finally have a clinic that's designed for regenerative medicine with big rooms.

Wait a minute. No more 8 by 8 rooms? No. Like the most profitable medical practice known to man.

So my numbers are going to go down in terms of per square foot because we have a little more space.

Folks, if you would have seen Donzo's place, it was 4 offices in a hallway, part of this big orthopedic practice that he was in. Yeah. And the rooms were, what, 8 by 8? Yeah, remember, I'm in the room with you, me, Christine, and a patient at the ultrasound machine, and the ultrasound machine, and like, there was no other room.

No, no, it was, it was affecting my health because I was only getting about 40 steps a day going around my clinic. I was surprised you got 40. Yeah, so now, so now it's going to be up, but it's, it's, it's, it's right size. It's about 2,000 square feet, 4 rooms. Awesome. Separate biology lab, and, uh, right down the street from here And it's just me. So I had a chance to make sure that it meets all the criteria to have a really good, you know, it's all about the experience also. I care about that too.

Yeah.

And I want people to come in and know that we care about their day, you know, and if they're going to spend a couple hours with us, I want it to be 2 good hours where they can tell their friends, yeah, it's a great clinic. I don't want them saying he's a great doctor, but God, his office is just nasty.

Yeah.

Yeah. It doesn't make sense to me.

It doesn't make sense.

Yeah.

Yeah. Well, look, man, the work you do for the industry is—I mean, obviously everybody knows it—but the passion that you have for the passion of the truth of what is real, and it—it has—I think it's done as much to help the industry grow as anything else.

I appreciate it.

So thanks for taking the time. Appreciate it.

Appreciate your friendship.

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