1 00:00:00,080 --> 00:00:02,080 This is Carly Beam with the Becker Spine 2 00:00:02,080 --> 00:00:03,459 and Orthopedics podcast. 3 00:00:03,839 --> 00:00:06,160 And today, I'm thrilled to be joined by 4 00:00:06,160 --> 00:00:08,500 doctor Frank Varonis, chief of neurosurgery 5 00:00:08,880 --> 00:00:10,179 at the Marcus Neuroscience 6 00:00:10,559 --> 00:00:11,059 Institute. 7 00:00:11,359 --> 00:00:13,599 Doctor Varonis, thank you so much for being 8 00:00:13,599 --> 00:00:14,339 here today. 9 00:00:14,794 --> 00:00:15,615 Thank you, Carly. 10 00:00:16,635 --> 00:00:17,774 Pleasure to be here. 11 00:00:18,234 --> 00:00:21,195 And so, doctor Varonis, before we dive into 12 00:00:21,195 --> 00:00:24,154 questions, can you introduce yourself and share more 13 00:00:24,154 --> 00:00:25,375 about your background? 14 00:00:25,994 --> 00:00:26,494 Sure. 15 00:00:26,969 --> 00:00:27,609 So I'm, 16 00:00:28,170 --> 00:00:29,070 Frank Villones. 17 00:00:29,689 --> 00:00:30,510 I'm a neurosurgeon. 18 00:00:31,129 --> 00:00:33,950 I have been, practicing for many years. 19 00:00:34,649 --> 00:00:35,869 I did my 20 00:00:36,329 --> 00:00:38,909 medical school in Athens, Greece. 21 00:00:40,545 --> 00:00:43,745 My master of public health at Harvard, my 22 00:00:43,745 --> 00:00:45,045 PhD at Duke, 23 00:00:45,425 --> 00:00:49,204 and my residency in neurosurgery at Tufts Medical 24 00:00:49,344 --> 00:00:49,844 Center. 25 00:00:50,784 --> 00:00:50,865 I 26 00:00:51,719 --> 00:00:52,219 Prior 27 00:00:52,759 --> 00:00:54,460 to coming here to, 28 00:00:55,399 --> 00:00:56,759 Boca Raton, I was, 29 00:00:57,559 --> 00:00:59,420 for sixteen years at, 30 00:01:00,759 --> 00:01:01,799 USF and, 31 00:01:02,679 --> 00:01:04,140 Moffitt Cancer Center, 32 00:01:05,194 --> 00:01:07,335 where I also served as, 33 00:01:08,075 --> 00:01:09,055 chief of neurosurgery. 34 00:01:10,075 --> 00:01:11,215 That's in a nutshell, 35 00:01:13,194 --> 00:01:14,975 my synopsis of my 36 00:01:15,755 --> 00:01:16,895 life so far. 37 00:01:17,540 --> 00:01:19,719 It's a great impressive background 38 00:01:20,180 --> 00:01:21,939 you have. It looks like just from all 39 00:01:21,939 --> 00:01:23,719 over the world as well. 40 00:01:24,340 --> 00:01:26,680 And, you know, I'm wondering, doctor Varonis, 41 00:01:27,380 --> 00:01:29,540 what are the top three trends that you're 42 00:01:29,540 --> 00:01:31,079 following in health care today? 43 00:01:31,974 --> 00:01:32,454 Yeah. 44 00:01:32,775 --> 00:01:35,674 Certainly, I mean, I'm I'm interested 45 00:01:36,055 --> 00:01:36,555 in, 46 00:01:38,215 --> 00:01:40,155 health care as as a general, 47 00:01:40,694 --> 00:01:41,194 rule. 48 00:01:42,055 --> 00:01:43,034 But in particular, 49 00:01:44,215 --> 00:01:45,354 things that can 50 00:01:46,570 --> 00:01:48,969 help with the efficiency of delivery of the 51 00:01:48,969 --> 00:01:50,350 health care such as, 52 00:01:51,329 --> 00:01:51,829 AI. 53 00:01:52,490 --> 00:01:53,710 That's one thing. 54 00:01:54,810 --> 00:01:55,310 Also, 55 00:01:56,010 --> 00:01:56,510 technology, 56 00:01:57,290 --> 00:01:57,790 innovations, 57 00:01:59,530 --> 00:02:00,909 and also research. 58 00:02:01,635 --> 00:02:02,135 There 59 00:02:02,515 --> 00:02:03,875 are some of the things that, 60 00:02:04,515 --> 00:02:07,015 I would be interested in and, 61 00:02:07,954 --> 00:02:09,814 the the strengths and the weaknesses 62 00:02:10,115 --> 00:02:12,354 of, the system. As you know, there's no 63 00:02:12,354 --> 00:02:14,135 health care system that's perfect, 64 00:02:14,915 --> 00:02:15,415 so 65 00:02:16,080 --> 00:02:18,180 it's important to try 66 00:02:19,599 --> 00:02:21,060 even in small ways, 67 00:02:22,480 --> 00:02:24,819 to to improve on the current one. 68 00:02:25,439 --> 00:02:28,080 Absolutely. You touched on some really big things 69 00:02:28,080 --> 00:02:30,704 going on here. You mentioned health care delivery, 70 00:02:30,844 --> 00:02:33,884 AI, and research. I want to, hone in 71 00:02:33,884 --> 00:02:35,344 a bit. I'd love to hear how 72 00:02:35,805 --> 00:02:38,204 you're using AI in your practice. I know 73 00:02:38,204 --> 00:02:40,364 a lot of spine surgeons I've talked to, 74 00:02:40,364 --> 00:02:42,924 they've shared just the various ways it's helped 75 00:02:42,924 --> 00:02:45,424 them both in the clinical office setting, 76 00:02:46,020 --> 00:02:48,180 with surgery itself. I'd love to hear your 77 00:02:48,180 --> 00:02:48,680 perspective. 78 00:02:49,099 --> 00:02:49,599 I 79 00:02:50,020 --> 00:02:50,500 mean, 80 00:02:51,699 --> 00:02:53,560 AI from, my perspective 81 00:02:53,939 --> 00:02:56,680 right now is on the research tool. 82 00:02:57,219 --> 00:02:58,120 We've developed, 83 00:02:59,219 --> 00:03:00,599 an AI software, 84 00:03:01,694 --> 00:03:03,474 that applies to spine, 85 00:03:04,814 --> 00:03:05,694 so that, 86 00:03:06,414 --> 00:03:07,235 for example, 87 00:03:08,495 --> 00:03:08,995 if, 88 00:03:10,655 --> 00:03:11,155 somebody 89 00:03:11,854 --> 00:03:15,155 we can enter somebody's CAT scan or MRI, 90 00:03:16,209 --> 00:03:19,430 in the system, and then the AI can, 91 00:03:20,289 --> 00:03:21,430 deliver for us, 92 00:03:24,289 --> 00:03:27,330 a computer model of somebody's spine, and then 93 00:03:27,330 --> 00:03:28,069 we can 94 00:03:28,534 --> 00:03:30,155 potentially ask questions, 95 00:03:30,614 --> 00:03:31,594 from a biomechanical 96 00:03:32,134 --> 00:03:32,634 standpoint. 97 00:03:33,414 --> 00:03:35,275 Like, if we do this intervention, 98 00:03:35,974 --> 00:03:38,055 what will happen to the spine and so 99 00:03:38,055 --> 00:03:40,455 on and so forth. So from a research 100 00:03:40,455 --> 00:03:43,354 standpoint, that's, more or less what I have. 101 00:03:44,400 --> 00:03:46,259 We have I have been involved, 102 00:03:46,560 --> 00:03:48,739 as far as AI is concerned, but 103 00:03:49,039 --> 00:03:51,759 I can see that AI has a lot 104 00:03:51,759 --> 00:03:52,819 of other applications 105 00:03:54,239 --> 00:03:56,659 potentially in medicine. We see AI 106 00:03:57,685 --> 00:03:58,185 reading, 107 00:03:58,645 --> 00:04:00,025 CAT scans sometimes, 108 00:04:00,805 --> 00:04:02,425 or or getting warnings 109 00:04:03,365 --> 00:04:03,865 about, 110 00:04:04,324 --> 00:04:05,705 somebody's CAT scans. 111 00:04:06,805 --> 00:04:09,064 And I think there's also a lot of 112 00:04:09,205 --> 00:04:11,305 potential applications of AI, 113 00:04:11,959 --> 00:04:12,620 not just, 114 00:04:13,400 --> 00:04:16,199 in data analytics, but also in, 115 00:04:18,279 --> 00:04:21,079 responses to patients' questions and so on and 116 00:04:21,079 --> 00:04:21,740 so forth. 117 00:04:22,519 --> 00:04:24,824 Definitely. That's really interesting what you're saying about 118 00:04:25,465 --> 00:04:25,965 research. 119 00:04:26,504 --> 00:04:27,564 What do you predict? 120 00:04:27,865 --> 00:04:29,245 Like, how much will AI 121 00:04:29,785 --> 00:04:32,504 grow in the research well realm are you 122 00:04:32,504 --> 00:04:33,004 expecting? 123 00:04:34,585 --> 00:04:36,345 You know, I think I think it will 124 00:04:36,345 --> 00:04:37,379 grow to some 125 00:04:37,860 --> 00:04:40,819 degree. Now what how exactly it's going to 126 00:04:40,819 --> 00:04:41,639 work and, 127 00:04:42,180 --> 00:04:42,839 you know, 128 00:04:43,379 --> 00:04:46,120 and how AI is gonna be coordinated 129 00:04:46,580 --> 00:04:47,480 and so on, 130 00:04:48,020 --> 00:04:51,000 it's difficult really to predict. But for example, 131 00:04:51,694 --> 00:04:52,914 to give you some, 132 00:04:54,254 --> 00:04:55,954 idea, we we get, 133 00:04:56,495 --> 00:04:57,074 you know, 134 00:04:57,535 --> 00:04:58,274 health professionals 135 00:04:59,134 --> 00:05:01,634 get thousands of phone calls a day. 136 00:05:01,935 --> 00:05:03,154 You have to have, 137 00:05:04,209 --> 00:05:05,990 people answering the phone. 138 00:05:06,610 --> 00:05:09,329 A lot of the questions, like, 80% of 139 00:05:09,329 --> 00:05:10,790 the questions are routine, 140 00:05:11,250 --> 00:05:12,069 and, potentially, 141 00:05:12,689 --> 00:05:15,569 AI can answer those questions. So you can 142 00:05:15,569 --> 00:05:16,069 have, 143 00:05:17,014 --> 00:05:18,314 something automated, 144 00:05:18,615 --> 00:05:19,115 whatever, 145 00:05:19,495 --> 00:05:22,074 and answer those questions and only 146 00:05:22,534 --> 00:05:23,034 reserve, 147 00:05:24,375 --> 00:05:26,694 you know, a a face to face, so 148 00:05:26,694 --> 00:05:27,675 to speak, or 149 00:05:28,214 --> 00:05:29,354 a person to person 150 00:05:29,654 --> 00:05:30,154 response 151 00:05:30,819 --> 00:05:32,740 for the 20% 152 00:05:32,740 --> 00:05:35,319 of the questions that they really need somebody 153 00:05:36,100 --> 00:05:37,959 who knows more about things. 154 00:05:38,339 --> 00:05:40,819 So just just a a very 155 00:05:41,540 --> 00:05:43,785 you know, just an idea, so to speak. 156 00:05:44,745 --> 00:05:46,845 I see also AI being, 157 00:05:47,865 --> 00:05:49,324 I think already is 158 00:05:50,264 --> 00:05:50,764 applied 159 00:05:51,225 --> 00:05:52,524 in terms of, 160 00:05:53,464 --> 00:05:54,985 you know, billing or, 161 00:05:56,439 --> 00:05:56,939 scheduling 162 00:05:57,319 --> 00:05:57,819 or, 163 00:05:59,159 --> 00:05:59,879 main times, 164 00:06:00,279 --> 00:06:01,740 for insurance companies, 165 00:06:02,199 --> 00:06:03,019 as far as, 166 00:06:04,680 --> 00:06:07,800 deem as to whether service is appropriate or 167 00:06:07,800 --> 00:06:08,539 not appropriate. 168 00:06:10,375 --> 00:06:11,435 AI has the potential 169 00:06:11,814 --> 00:06:13,334 to analyze very quickly, 170 00:06:14,935 --> 00:06:17,754 a lot of data and respond to things, 171 00:06:18,615 --> 00:06:20,794 much faster than a human can. 172 00:06:21,814 --> 00:06:23,520 So so there's a lot of, 173 00:06:24,879 --> 00:06:28,500 little ways that AI can make a difference, 174 00:06:29,920 --> 00:06:33,300 primarily in the efficiency of health care delivery. 175 00:06:34,319 --> 00:06:34,819 Definitely. 176 00:06:35,360 --> 00:06:37,540 And when you think about, the Marcus Neuroscience 177 00:06:38,154 --> 00:06:39,935 Institute and in your department, 178 00:06:40,394 --> 00:06:42,875 how are you thinking about growth in the 179 00:06:42,875 --> 00:06:44,574 next twelve to twenty four months? 180 00:06:45,915 --> 00:06:46,415 Growth 181 00:06:46,875 --> 00:06:47,375 typically, 182 00:06:48,875 --> 00:06:49,375 happens, 183 00:06:50,154 --> 00:06:52,314 in in the sense of, hiring, 184 00:06:53,310 --> 00:06:54,689 more people to cover, 185 00:06:55,470 --> 00:06:56,449 certain gaps, 186 00:06:57,470 --> 00:06:58,529 that we have, 187 00:06:58,909 --> 00:07:00,849 maybe neurology or surgery, 188 00:07:02,029 --> 00:07:02,849 pain management, 189 00:07:03,389 --> 00:07:03,889 rehabilitation, 190 00:07:04,430 --> 00:07:05,490 things like that. 191 00:07:05,949 --> 00:07:07,409 So growth is through 192 00:07:07,785 --> 00:07:09,004 people, but also 193 00:07:09,465 --> 00:07:09,965 through, 194 00:07:10,504 --> 00:07:11,404 new technologies, 195 00:07:13,705 --> 00:07:14,205 robotics, 196 00:07:16,264 --> 00:07:16,764 augmented 197 00:07:17,225 --> 00:07:17,725 reality, 198 00:07:18,025 --> 00:07:19,165 things like that, 199 00:07:20,040 --> 00:07:20,779 as well 200 00:07:21,399 --> 00:07:22,139 as, research. 201 00:07:23,560 --> 00:07:24,060 We 202 00:07:24,600 --> 00:07:25,339 have been 203 00:07:26,199 --> 00:07:27,660 fortunate to receive, 204 00:07:28,600 --> 00:07:32,199 especially today's day where research dollars are very 205 00:07:32,199 --> 00:07:33,339 difficult to find, 206 00:07:33,704 --> 00:07:34,204 we 207 00:07:34,584 --> 00:07:36,125 have been able to receive, 208 00:07:37,464 --> 00:07:39,004 research funds from, 209 00:07:39,305 --> 00:07:41,964 the Marcus Foundation, which is a philanthropic, 210 00:07:43,784 --> 00:07:44,284 foundation. 211 00:07:44,664 --> 00:07:46,524 And through that, we pursue 212 00:07:47,330 --> 00:07:48,250 research in, 213 00:07:48,689 --> 00:07:51,189 domains such as brain tumor research, 214 00:07:52,930 --> 00:07:53,750 drug delivery, 215 00:07:54,770 --> 00:07:57,029 spine research, so on and so forth. 216 00:07:57,330 --> 00:08:00,050 So these are the areas where we we 217 00:08:00,050 --> 00:08:01,029 see a lot of 218 00:08:01,634 --> 00:08:02,134 potential, 219 00:08:03,555 --> 00:08:04,935 expansion and growth. 220 00:08:05,714 --> 00:08:06,194 And, 221 00:08:06,995 --> 00:08:08,854 we we like to stay 222 00:08:09,474 --> 00:08:12,435 stay current and on the cutting edge of, 223 00:08:12,914 --> 00:08:13,414 things. 224 00:08:14,470 --> 00:08:16,889 Yeah. And are there are there any other 225 00:08:17,029 --> 00:08:18,089 spine and, 226 00:08:18,550 --> 00:08:19,050 neurosurgery 227 00:08:19,509 --> 00:08:21,910 technologies besides, you know, the AI that we've 228 00:08:21,910 --> 00:08:24,169 discussed? Are there any other technologies 229 00:08:24,470 --> 00:08:26,250 that really excite you lately? 230 00:08:27,764 --> 00:08:31,225 What I've been, very excited about, inspiring especially, 231 00:08:32,965 --> 00:08:34,985 without trying to to get into, 232 00:08:35,845 --> 00:08:38,565 too many details and being esoteric is the 233 00:08:38,565 --> 00:08:39,545 motion preservation 234 00:08:40,879 --> 00:08:42,899 technology that has been, 235 00:08:44,000 --> 00:08:47,600 has become part of, my practice in spine 236 00:08:47,600 --> 00:08:48,820 on a daily basis. 237 00:08:49,519 --> 00:08:49,919 And, 238 00:08:50,879 --> 00:08:53,940 as you know, in, spine, we have essentially 239 00:08:55,164 --> 00:08:56,945 two types of procedures. 240 00:08:57,485 --> 00:08:59,745 So just to be very simple here, simplistic, 241 00:09:01,004 --> 00:09:04,544 we can decompress something or free up something, 242 00:09:04,605 --> 00:09:05,745 or we can, 243 00:09:06,764 --> 00:09:07,264 do, 244 00:09:07,965 --> 00:09:08,465 reconstruct 245 00:09:10,089 --> 00:09:10,909 the spine. 246 00:09:11,529 --> 00:09:12,029 Reconstructing 247 00:09:12,409 --> 00:09:15,129 the spine typically has been the domain of 248 00:09:15,129 --> 00:09:15,629 fusions, 249 00:09:16,649 --> 00:09:19,389 where you glue together pieces of the spine. 250 00:09:20,569 --> 00:09:23,154 This works in the short term, but in 251 00:09:23,154 --> 00:09:25,875 the long term, a lot of times, people 252 00:09:25,875 --> 00:09:26,855 develop problems 253 00:09:27,955 --> 00:09:31,235 above or below their fusions because of the 254 00:09:31,235 --> 00:09:31,735 stresses 255 00:09:32,514 --> 00:09:33,735 that developed, 256 00:09:34,434 --> 00:09:34,934 develop, 257 00:09:36,660 --> 00:09:40,200 adjacent to a fused segment of the spine. 258 00:09:41,059 --> 00:09:42,279 So motion preservation 259 00:09:42,980 --> 00:09:43,799 in the sense, 260 00:09:44,179 --> 00:09:44,500 of, 261 00:09:45,940 --> 00:09:46,840 disc replacement, 262 00:09:47,779 --> 00:09:49,559 as well as facet replacement 263 00:09:50,419 --> 00:09:51,160 has been 264 00:09:52,955 --> 00:09:53,934 a thing that 265 00:09:54,634 --> 00:09:58,254 really can restore the motion segment and prevent 266 00:09:59,034 --> 00:10:01,455 this domino effect that we see 267 00:10:01,914 --> 00:10:03,214 with fusions 268 00:10:04,075 --> 00:10:07,134 and stop that particular cascade of 269 00:10:07,559 --> 00:10:10,200 more segments that need to be fused that 270 00:10:10,200 --> 00:10:11,419 lead to 271 00:10:11,879 --> 00:10:14,700 lack of mobility and certainly disability 272 00:10:15,080 --> 00:10:15,820 in the end. 273 00:10:16,600 --> 00:10:18,360 Yeah. And definitely with, you know, with spinal 274 00:10:18,360 --> 00:10:19,740 fusion, I know that's still 275 00:10:20,120 --> 00:10:24,095 largely considered the gold standard in spine, and 276 00:10:24,095 --> 00:10:25,235 then we also have 277 00:10:25,615 --> 00:10:28,434 the push towards motion preservation and its benefits. 278 00:10:28,894 --> 00:10:30,434 How are you in your practice, 279 00:10:32,014 --> 00:10:33,634 how are you kind of balancing 280 00:10:34,254 --> 00:10:36,815 the the benefits and needs of both in 281 00:10:36,815 --> 00:10:37,470 your patients? 282 00:10:38,829 --> 00:10:40,669 I mean, the the issue is more or 283 00:10:40,669 --> 00:10:41,809 less the indications, 284 00:10:43,470 --> 00:10:44,209 as well 285 00:10:44,549 --> 00:10:45,049 as, 286 00:10:45,470 --> 00:10:47,329 what can you do 287 00:10:47,709 --> 00:10:48,209 because 288 00:10:48,750 --> 00:10:49,549 many times, 289 00:10:49,870 --> 00:10:52,610 our biggest problem actually with motion preservation 290 00:10:53,524 --> 00:10:55,384 is getting insurance approval. 291 00:10:56,644 --> 00:10:59,684 A lot of insurance companies, they consider it 292 00:10:59,684 --> 00:11:00,184 experimental 293 00:11:00,644 --> 00:11:04,024 despite the fact that there is, like, decades 294 00:11:04,164 --> 00:11:05,785 of research and, 295 00:11:06,980 --> 00:11:09,879 pretty much everything that we use is FDA 296 00:11:09,940 --> 00:11:10,919 approved. So, 297 00:11:11,539 --> 00:11:14,100 when something is FDA approved, I don't know 298 00:11:14,100 --> 00:11:16,519 how people can claim that's experimental. 299 00:11:17,700 --> 00:11:21,559 But but, insurance denials is a big obstacle, 300 00:11:22,764 --> 00:11:23,504 to utilizing, 301 00:11:25,325 --> 00:11:26,304 these technologies. 302 00:11:27,725 --> 00:11:28,284 I think, 303 00:11:28,764 --> 00:11:31,825 especially for young people, you would like to 304 00:11:32,205 --> 00:11:34,304 do as much motion preservation 305 00:11:34,845 --> 00:11:35,345 operations 306 00:11:36,205 --> 00:11:39,259 instead of fusions. You don't want to have 307 00:11:39,799 --> 00:11:44,059 30 year olds, with fusions because then, inevitably, 308 00:11:44,440 --> 00:11:47,100 they're gonna have more issues down the road. 309 00:11:47,559 --> 00:11:49,179 If somebody's very old 310 00:11:49,639 --> 00:11:50,700 and their spine 311 00:11:51,945 --> 00:11:54,684 is very rigid and, you know, 312 00:11:55,065 --> 00:11:55,565 semi, 313 00:11:56,504 --> 00:11:59,785 fused, so to speak, then, you know, motion 314 00:11:59,785 --> 00:12:01,884 preservation may not be the best, 315 00:12:03,225 --> 00:12:04,205 option there. 316 00:12:04,889 --> 00:12:05,389 But, 317 00:12:06,330 --> 00:12:06,990 I think, 318 00:12:08,250 --> 00:12:08,750 still, 319 00:12:09,290 --> 00:12:10,809 to some degree, we 320 00:12:11,769 --> 00:12:13,930 you know, it it's it's an art and 321 00:12:13,930 --> 00:12:14,430 not 322 00:12:14,809 --> 00:12:15,470 a science, 323 00:12:16,170 --> 00:12:17,950 I mean, to some degree, because 324 00:12:18,605 --> 00:12:22,205 we're still learning about how we effectively can 325 00:12:22,205 --> 00:12:24,625 utilize these type of technologies. 326 00:12:25,884 --> 00:12:27,884 And thank you for breaking that down. My 327 00:12:27,884 --> 00:12:30,305 last question for you, doctor Varonis, 328 00:12:30,620 --> 00:12:32,539 what do you think will be a key 329 00:12:32,539 --> 00:12:35,039 disruptor to spine surgery and neurosurgery 330 00:12:35,419 --> 00:12:36,799 in 2026? 331 00:12:37,740 --> 00:12:38,399 I think, 332 00:12:39,659 --> 00:12:42,779 increasingly, the biggest disrupt and the biggest problem 333 00:12:42,779 --> 00:12:43,440 we have 334 00:12:43,995 --> 00:12:48,095 is is coming from the insurance industry 335 00:12:48,715 --> 00:12:52,014 and the cost of health care products. 336 00:12:53,115 --> 00:12:56,575 So that's that's the biggest issue and whether, 337 00:12:57,559 --> 00:12:59,740 first of all, patients can't afford 338 00:13:00,440 --> 00:13:00,940 insurance 339 00:13:02,120 --> 00:13:04,220 because insurance is very expensive. 340 00:13:05,320 --> 00:13:08,379 Second, whether insurance will cover certain 341 00:13:09,345 --> 00:13:10,384 items because, 342 00:13:11,985 --> 00:13:13,524 as you know, 343 00:13:14,384 --> 00:13:15,504 we don't have, 344 00:13:15,985 --> 00:13:16,725 too many 345 00:13:18,144 --> 00:13:20,325 restrictions as to how much 346 00:13:20,784 --> 00:13:22,725 a new drug or a new device 347 00:13:23,120 --> 00:13:25,779 can cost in The US. You know, FDA, 348 00:13:26,879 --> 00:13:27,379 delivers 349 00:13:28,159 --> 00:13:31,759 or is concerned with safety, but there's no 350 00:13:31,759 --> 00:13:34,580 price control. So anybody can essentially 351 00:13:35,544 --> 00:13:38,264 price it any way they want. So so 352 00:13:38,264 --> 00:13:40,125 pricing of of new 353 00:13:40,585 --> 00:13:42,365 technologies or new products, 354 00:13:42,985 --> 00:13:44,684 lack of insurance coverage, 355 00:13:45,865 --> 00:13:46,365 denials 356 00:13:46,985 --> 00:13:47,725 by insurance, 357 00:13:48,779 --> 00:13:49,600 and affordability 358 00:13:49,980 --> 00:13:51,039 of health care, 359 00:13:51,980 --> 00:13:53,360 is is the potential 360 00:13:53,740 --> 00:13:54,240 disruptors, 361 00:13:55,899 --> 00:13:58,559 that I see that can curtail, 362 00:13:59,580 --> 00:14:00,080 innovation 363 00:14:00,539 --> 00:14:02,080 and, force us, 364 00:14:02,620 --> 00:14:03,764 against the wall. 365 00:14:04,325 --> 00:14:07,845 I mean, physicians are in in the practice 366 00:14:07,845 --> 00:14:08,504 of medicine 367 00:14:09,125 --> 00:14:12,184 because they like what they do, but we 368 00:14:12,325 --> 00:14:16,325 constantly have to shape what we do and 369 00:14:16,325 --> 00:14:17,945 fight for what we believe 370 00:14:18,299 --> 00:14:20,240 with a lot of other, 371 00:14:21,740 --> 00:14:23,519 stakeholders in the health care 372 00:14:23,980 --> 00:14:24,480 industry, 373 00:14:25,339 --> 00:14:27,659 in order to get the maximum benefit for 374 00:14:27,659 --> 00:14:28,399 the patient. 375 00:14:28,779 --> 00:14:31,339 And that's not an easy thing. You know? 376 00:14:31,339 --> 00:14:32,159 And something 377 00:14:32,964 --> 00:14:35,544 has changed over the years. It was not 378 00:14:35,924 --> 00:14:37,464 like that when I first, 379 00:14:38,404 --> 00:14:41,205 practiced medicine. We didn't have to worry about 380 00:14:41,205 --> 00:14:41,945 those things. 381 00:14:43,125 --> 00:14:45,705 But now this is peer reviews, 382 00:14:46,990 --> 00:14:48,769 peer to peer, so to speak, 383 00:14:50,269 --> 00:14:50,769 denials, 384 00:14:51,550 --> 00:14:53,889 things like that are gonna be obstacles 385 00:14:54,509 --> 00:14:55,970 in the health care delivery 386 00:14:56,750 --> 00:14:58,450 because of cost primarily, 387 00:14:59,309 --> 00:15:00,930 and they're gonna limit, 388 00:15:02,445 --> 00:15:03,745 you know, the access, 389 00:15:05,085 --> 00:15:07,325 of the best technologies to a lot of 390 00:15:07,325 --> 00:15:07,825 patients. 391 00:15:08,605 --> 00:15:10,445 Yeah. Doctor Ramos, I wanna just check on 392 00:15:10,445 --> 00:15:12,684 one quick follow-up. With all these headwinds you're 393 00:15:12,684 --> 00:15:13,184 describing, 394 00:15:14,125 --> 00:15:16,220 how what how are you strategizing 395 00:15:16,600 --> 00:15:18,860 to get ahead of these next year? 396 00:15:19,799 --> 00:15:20,299 Well, 397 00:15:21,320 --> 00:15:21,820 we 398 00:15:22,360 --> 00:15:23,579 really cannot 399 00:15:24,120 --> 00:15:26,699 strategize on those things because 400 00:15:27,079 --> 00:15:30,120 they're beyond our controls, to be honest with 401 00:15:30,120 --> 00:15:32,254 you. I mean, whether 402 00:15:32,634 --> 00:15:34,654 Aetna approves something or, 403 00:15:35,595 --> 00:15:36,095 United 404 00:15:36,475 --> 00:15:39,115 approves something or doesn't approve something is is 405 00:15:39,115 --> 00:15:42,075 impossible for us to to really play any 406 00:15:42,075 --> 00:15:43,054 kind of role. 407 00:15:43,529 --> 00:15:46,889 But, what we do, you know, that we 408 00:15:46,889 --> 00:15:47,949 can do is 409 00:15:48,329 --> 00:15:50,110 educate patients about, 410 00:15:51,209 --> 00:15:54,490 the type of technologies we have now and, 411 00:15:55,049 --> 00:15:57,709 provide patients with options, you know, because 412 00:15:58,245 --> 00:16:00,904 also what I've noticed in health care, 413 00:16:01,684 --> 00:16:04,325 inspiring particularly, is a lot of patients are 414 00:16:04,325 --> 00:16:04,825 uninformed. 415 00:16:05,845 --> 00:16:08,565 They they only have the only they're only 416 00:16:08,565 --> 00:16:09,865 given one option. 417 00:16:10,245 --> 00:16:12,585 And sometimes that's not the best option, 418 00:16:13,379 --> 00:16:14,120 for them. 419 00:16:15,059 --> 00:16:15,879 Alright. Well, 420 00:16:16,259 --> 00:16:18,360 thank you so much for joining the podcast 421 00:16:18,420 --> 00:16:21,240 today, doctor Varonis. It's been a pleasure speaking, 422 00:16:21,379 --> 00:16:23,059 and I look forward to connecting down the 423 00:16:23,059 --> 00:16:26,279 line. Thank you, Carly. I appreciate, the opportunity.