1 00:00:00,080 --> 00:00:02,159 This is Carly Beam with the Becker Spine 2 00:00:02,159 --> 00:00:03,459 and Orthopedics podcast, 3 00:00:03,839 --> 00:00:05,759 and I'm thrilled to be joined today by 4 00:00:05,759 --> 00:00:06,980 doctor Eric Anderer, 5 00:00:07,359 --> 00:00:11,279 a neurosurgeon with NYU Langone Health. Doctor Anderer, 6 00:00:11,279 --> 00:00:13,299 thank you so much for being here today. 7 00:00:13,764 --> 00:00:15,764 I appreciate you having me on. So before 8 00:00:15,764 --> 00:00:17,844 we dive into our questions, could you just 9 00:00:17,844 --> 00:00:19,605 introduce yourself and tell us a bit about 10 00:00:19,605 --> 00:00:20,265 your background? 11 00:00:20,964 --> 00:00:21,445 Sure. 12 00:00:22,404 --> 00:00:24,644 As mentioned, my name is, Eric Anderer. I'm 13 00:00:24,644 --> 00:00:27,304 the chief of neurosurgery at NYU Langone Hospital, 14 00:00:27,364 --> 00:00:27,864 Brooklyn. 15 00:00:28,539 --> 00:00:30,699 I'm also the, the co director of a 16 00:00:30,699 --> 00:00:31,839 perioperative services, 17 00:00:32,299 --> 00:00:34,140 sort of a title that used to be 18 00:00:34,140 --> 00:00:36,460 known as surgeon in chief. So help run 19 00:00:36,460 --> 00:00:37,520 the ORs in Brooklyn. 20 00:00:38,539 --> 00:00:40,219 I was born in Japan, grew up in 21 00:00:40,219 --> 00:00:41,820 New York, have been in Brooklyn for the 22 00:00:41,820 --> 00:00:43,545 past twenty some odd years. 23 00:00:43,924 --> 00:00:46,085 So, it really, was sort of an honor 24 00:00:46,085 --> 00:00:47,524 when, you know, I was asked to sort 25 00:00:47,524 --> 00:00:49,445 of head up the the neurosurgery effort in 26 00:00:49,445 --> 00:00:49,945 Brooklyn, 27 00:00:50,405 --> 00:00:52,565 at the former Lutheran Medical Center. So I've 28 00:00:52,565 --> 00:00:55,890 been there since the NYU merger in 2016, 29 00:00:55,890 --> 00:00:57,969 and it's been, you know, almost ten great 30 00:00:57,969 --> 00:01:00,850 years there. That's great. And can you talk 31 00:01:00,850 --> 00:01:02,929 about just what are the top three trends 32 00:01:02,929 --> 00:01:05,109 that you're following in health care today? 33 00:01:06,130 --> 00:01:07,935 Sure. I mean, there's so much to talk 34 00:01:08,015 --> 00:01:10,334 about. I mean, obviously, the landscape is constantly 35 00:01:10,334 --> 00:01:11,935 changing, but I would say that the things 36 00:01:11,935 --> 00:01:12,594 that are, 37 00:01:13,295 --> 00:01:15,534 sort of top of mind for me, number 38 00:01:15,534 --> 00:01:17,875 one would be sort of access to information. 39 00:01:18,094 --> 00:01:20,015 I mean, it's something that, you know, with 40 00:01:20,015 --> 00:01:23,340 the Internet, with, you know, influencer culture, with, 41 00:01:23,420 --> 00:01:24,479 you know, sort of inundation 42 00:01:25,019 --> 00:01:28,060 of information out there, from various sources. 43 00:01:28,700 --> 00:01:30,060 You know, I think in a lot of 44 00:01:30,060 --> 00:01:32,780 ways, it's it's had a positive influence on 45 00:01:32,780 --> 00:01:33,500 the way that, 46 00:01:34,140 --> 00:01:36,379 I think people, experience health care. And what 47 00:01:36,379 --> 00:01:37,519 I mean by that is 48 00:01:37,825 --> 00:01:38,724 this sort of democratization 49 00:01:39,105 --> 00:01:40,004 of of information, 50 00:01:40,545 --> 00:01:42,224 I think has been helpful for people to 51 00:01:42,224 --> 00:01:42,724 be 52 00:01:43,025 --> 00:01:45,665 informed, let's say, about their conditions and such. 53 00:01:45,665 --> 00:01:47,444 So I don't think it's ever gonna replace 54 00:01:47,584 --> 00:01:49,444 going to a doctor, and I think that, 55 00:01:49,825 --> 00:01:52,064 really the best thing to do, when you 56 00:01:52,064 --> 00:01:54,209 have questions about your health, about, 57 00:01:54,609 --> 00:01:56,049 you know, something going on with you, one 58 00:01:56,049 --> 00:01:57,969 of your loved ones is to maybe take 59 00:01:57,969 --> 00:01:59,969 some of that information that you digest from 60 00:01:59,969 --> 00:02:00,709 other sources, 61 00:02:01,409 --> 00:02:03,250 and really sort of, help, 62 00:02:03,969 --> 00:02:06,594 you know, sort of, formulate questions, I think, 63 00:02:06,594 --> 00:02:08,034 that, that you can kinda go in with 64 00:02:08,034 --> 00:02:10,114 and be that much more informed when you 65 00:02:10,114 --> 00:02:11,314 go to your visit and get that much 66 00:02:11,314 --> 00:02:12,935 more out of your visit with your physicians. 67 00:02:13,474 --> 00:02:15,074 But I generally see it as a positive. 68 00:02:15,074 --> 00:02:17,394 I mean, clearly, there's, you know, some negatives 69 00:02:17,394 --> 00:02:19,930 and, you know, just obviously the the access 70 00:02:19,930 --> 00:02:22,409 to sort of voluminous amounts of information that 71 00:02:22,409 --> 00:02:25,290 is sometimes hard to to verify, can be 72 00:02:25,290 --> 00:02:27,950 somewhat problematic. But I think on balance, 73 00:02:28,490 --> 00:02:30,430 it's been a good thing, generally. 74 00:02:30,935 --> 00:02:32,135 So that would be one, 75 00:02:32,855 --> 00:02:34,935 you know, as a surgeon, it's hard not 76 00:02:34,935 --> 00:02:37,335 to talk about tech. Right? And so, that's 77 00:02:37,335 --> 00:02:39,175 another thing I think that I'm super excited 78 00:02:39,175 --> 00:02:39,675 about, 79 00:02:40,775 --> 00:02:42,635 robotics specifically in spine, 80 00:02:43,014 --> 00:02:45,740 but even sort of AI, applications, to 81 00:02:46,200 --> 00:02:48,639 sort of help us understand who are the 82 00:02:48,639 --> 00:02:50,760 right patients for surgery, how, you know, to 83 00:02:50,760 --> 00:02:52,680 predict, you know, how patients are gonna do 84 00:02:52,680 --> 00:02:53,180 afterwards, 85 00:02:53,800 --> 00:02:55,719 where to send them to recover the best, 86 00:02:55,960 --> 00:02:58,040 you know, that's rehab facility at home, that 87 00:02:58,040 --> 00:02:59,985 kind of thing. You know, so I think 88 00:02:59,985 --> 00:03:01,824 it's really revolutionized the way that we, 89 00:03:02,385 --> 00:03:04,865 we look at, at surgery and who should 90 00:03:04,865 --> 00:03:06,865 be having surgery and how how best to 91 00:03:06,865 --> 00:03:07,685 apply that. 92 00:03:08,465 --> 00:03:09,985 And then, you know, the other thing I 93 00:03:09,985 --> 00:03:11,525 think that's sort of out there, 94 00:03:12,510 --> 00:03:13,949 and this is, you know, at the government 95 00:03:13,949 --> 00:03:15,949 level, but all the way down to, you 96 00:03:15,949 --> 00:03:18,189 know, to sort of this the information sources 97 00:03:18,189 --> 00:03:20,530 that I was talking to talking about earlier. 98 00:03:21,030 --> 00:03:22,669 I think there's a lot of sort of 99 00:03:22,669 --> 00:03:25,090 focus on, the root cause of disease. 100 00:03:26,305 --> 00:03:27,985 And, you know, again, I mean, sort of 101 00:03:27,985 --> 00:03:29,365 a lot of chatter out there, 102 00:03:30,224 --> 00:03:32,385 you know, about that. But I would say 103 00:03:32,385 --> 00:03:34,405 that a focus on that specifically, 104 00:03:34,784 --> 00:03:36,784 sort of divorced from, you know, all the 105 00:03:36,784 --> 00:03:37,284 other 106 00:03:37,745 --> 00:03:40,705 kind of, you know, either political, social, cultural 107 00:03:40,705 --> 00:03:42,790 things that can be sometimes associated with that 108 00:03:42,790 --> 00:03:45,430 discourse. I think, that's also on balance, 109 00:03:45,750 --> 00:03:48,069 a a positive thing for patients and and 110 00:03:48,069 --> 00:03:50,469 physicians because I think that, you know, the 111 00:03:50,469 --> 00:03:51,349 reality is, 112 00:03:51,830 --> 00:03:53,830 who doesn't wanna get at? What is it 113 00:03:53,830 --> 00:03:56,294 that's making us sick? And how do we 114 00:03:56,294 --> 00:03:58,134 stay healthy? And, you know, even as a 115 00:03:58,134 --> 00:03:58,634 surgeon, 116 00:03:59,254 --> 00:04:01,094 how do we keep people from having spine 117 00:04:01,094 --> 00:04:01,594 surgery? 118 00:04:02,215 --> 00:04:03,735 You know, there's always gonna be a need 119 00:04:03,735 --> 00:04:06,134 for people to have have surgery, to have, 120 00:04:06,375 --> 00:04:09,180 you know, some sort of structural problem fixed. 121 00:04:09,400 --> 00:04:12,040 But the hope is that, we're really gonna 122 00:04:12,040 --> 00:04:12,540 be, 123 00:04:12,919 --> 00:04:13,819 applying that, 124 00:04:14,199 --> 00:04:15,180 you know, in sort 125 00:04:15,560 --> 00:04:17,180 of very focused cases, 126 00:04:17,639 --> 00:04:19,639 and for the vast majority of people that 127 00:04:19,639 --> 00:04:22,704 experience the very, very common symptom of back 128 00:04:22,704 --> 00:04:24,544 pain. Right? I mean, who hasn't had back 129 00:04:24,544 --> 00:04:25,365 pain out there? 130 00:04:25,745 --> 00:04:28,384 Right. Hope is that it's only the small 131 00:04:28,384 --> 00:04:30,225 minority of people that have that are gonna 132 00:04:30,225 --> 00:04:32,305 that are gonna really need surgery. So, again, 133 00:04:32,305 --> 00:04:33,745 sort of looking at the root cause of 134 00:04:33,745 --> 00:04:35,629 this, how to get people out of, you 135 00:04:35,629 --> 00:04:37,790 know, sort of a sedentary lifestyle, how to 136 00:04:37,790 --> 00:04:39,470 get people eating better, how to get people 137 00:04:39,470 --> 00:04:40,290 moving again, 138 00:04:41,069 --> 00:04:43,389 I think those are all, again, on balance 139 00:04:43,389 --> 00:04:45,230 sort of net positives. So those are the 140 00:04:45,230 --> 00:04:46,990 three things I'm looking at. Yeah. And I 141 00:04:46,990 --> 00:04:48,750 wanna follow-up you on your what you're just 142 00:04:48,750 --> 00:04:52,035 talking about, these root causes of disease and, 143 00:04:52,814 --> 00:04:53,314 spine 144 00:04:53,694 --> 00:04:54,595 pain, etcetera. 145 00:04:55,214 --> 00:04:57,615 Can you talk about just any initiatives or 146 00:04:57,615 --> 00:04:59,794 findings that you've been involved in, 147 00:05:00,175 --> 00:05:01,074 with NYU 148 00:05:01,694 --> 00:05:03,875 to address those head on in the community? 149 00:05:04,680 --> 00:05:06,220 Sure. I mean, you know, 150 00:05:06,920 --> 00:05:09,959 obviously, anything involving spine surgery and the way 151 00:05:09,959 --> 00:05:11,019 we do spine surgery, 152 00:05:11,399 --> 00:05:13,399 you know, is gonna be, I'd say, a 153 00:05:13,399 --> 00:05:15,080 a good thing with respect to the field 154 00:05:15,080 --> 00:05:16,680 and how we're gonna treat patients that have 155 00:05:16,680 --> 00:05:18,464 this disease. And there's so much of that 156 00:05:18,464 --> 00:05:19,824 going on. You know, there's a lot of 157 00:05:19,824 --> 00:05:21,665 stuff going on with, you know, the ways 158 00:05:21,665 --> 00:05:23,824 to do surgeries, the ways to leverage robotics 159 00:05:23,824 --> 00:05:26,064 to do, surgeries in ways that are, 160 00:05:26,705 --> 00:05:28,865 you know, less invasive. And, you know, let's 161 00:05:28,865 --> 00:05:29,764 say, for example, 162 00:05:30,110 --> 00:05:32,269 doing a two part surgery in one sitting 163 00:05:32,269 --> 00:05:32,670 using, 164 00:05:33,069 --> 00:05:34,129 robotic technology, 165 00:05:34,670 --> 00:05:36,110 in ways that we weren't weren't able to 166 00:05:36,110 --> 00:05:36,670 do before. 167 00:05:37,230 --> 00:05:38,509 You know, that's that a lot of that 168 00:05:38,509 --> 00:05:40,750 research is being done here, by, you know, 169 00:05:40,750 --> 00:05:41,649 by our colleagues. 170 00:05:42,875 --> 00:05:45,595 And so that's that's certainly, I think, something 171 00:05:45,595 --> 00:05:46,715 that is, you know, 172 00:05:47,675 --> 00:05:49,754 you know, a positive in terms of how 173 00:05:49,754 --> 00:05:51,115 to how to treat and how to, you 174 00:05:51,115 --> 00:05:53,595 know, kind of move forward with, with treatment 175 00:05:53,595 --> 00:05:54,095 algorithms. 176 00:05:54,660 --> 00:05:56,899 But on the other hand, again, kinda getting 177 00:05:56,899 --> 00:05:58,360 back to the idea of 178 00:05:58,980 --> 00:06:00,680 who is it that needs surgery. 179 00:06:01,540 --> 00:06:03,699 You know, I think that the goal really 180 00:06:03,699 --> 00:06:04,839 is in general 181 00:06:05,139 --> 00:06:07,399 for people with back pain to avoid surgery. 182 00:06:07,785 --> 00:06:09,064 And how do we do that? Well, you 183 00:06:09,064 --> 00:06:10,824 know, there are ways of looking at, 184 00:06:11,545 --> 00:06:13,705 you know, other types of treatments, other types 185 00:06:13,705 --> 00:06:14,525 of modalities 186 00:06:14,904 --> 00:06:15,785 to help with this. 187 00:06:16,425 --> 00:06:17,865 And, again, if it's, like, you know, looking 188 00:06:17,865 --> 00:06:21,225 at returning to activities, returning back into, you 189 00:06:21,225 --> 00:06:22,685 know, sort of functional movement, 190 00:06:23,310 --> 00:06:24,990 there are, you know, modalities, I think, that 191 00:06:24,990 --> 00:06:26,349 we can look at that are that have 192 00:06:26,349 --> 00:06:28,750 been beneficial. So yoga would be one, for 193 00:06:28,750 --> 00:06:29,149 example. 194 00:06:29,709 --> 00:06:31,229 You know, anyone that knows me and that's 195 00:06:31,229 --> 00:06:32,750 talked to me knows that I'm sort of 196 00:06:32,750 --> 00:06:34,909 a fan of yoga, sent my patients into 197 00:06:34,909 --> 00:06:35,149 it. 198 00:06:35,789 --> 00:06:37,464 And, again, not necessarily you know, I don't 199 00:06:37,464 --> 00:06:38,985 want them jumping into, like, hot yoga or 200 00:06:38,985 --> 00:06:40,824 doing handstands or anything like that. But, you 201 00:06:40,824 --> 00:06:41,785 know, I think, 202 00:06:42,345 --> 00:06:45,144 do going into, like, a, a beginner type 203 00:06:45,144 --> 00:06:47,305 of program that's modified for people with back 204 00:06:47,305 --> 00:06:49,404 pain, I think, can be very, very beneficial. 205 00:06:50,120 --> 00:06:50,680 I actually, 206 00:06:51,080 --> 00:06:53,800 you know, wrote a paper with this yoga 207 00:06:53,800 --> 00:06:55,480 teacher named Eddie Stern who, 208 00:06:56,120 --> 00:06:58,520 actually is the one that brought Ashtanga yoga 209 00:06:58,520 --> 00:07:00,379 as a practice to America from India. 210 00:07:01,560 --> 00:07:04,360 And, he is, very interested, I think, in 211 00:07:04,360 --> 00:07:05,420 in this dialogue 212 00:07:06,004 --> 00:07:07,384 between sort of more conventional, 213 00:07:08,324 --> 00:07:11,524 intervention based, medicine and how to use these 214 00:07:11,524 --> 00:07:13,925 other modalities that have been really in place 215 00:07:13,925 --> 00:07:15,225 for, you know, centuries, 216 00:07:16,004 --> 00:07:18,404 to help, kind of be adjuncts, to help, 217 00:07:18,404 --> 00:07:20,105 you know, to I'd say together 218 00:07:20,759 --> 00:07:23,079 formulate this kind of unified way of treating, 219 00:07:23,479 --> 00:07:25,099 treating back pain and spine disease. 220 00:07:25,560 --> 00:07:28,120 That's fascinating. And then I also want to 221 00:07:28,120 --> 00:07:30,680 circle back to what you're saying about this 222 00:07:30,680 --> 00:07:31,180 information 223 00:07:32,039 --> 00:07:35,235 culture we have now. It's I've actually wrote, 224 00:07:35,555 --> 00:07:36,295 an article 225 00:07:37,235 --> 00:07:37,735 recently, 226 00:07:38,274 --> 00:07:38,855 I guess, 227 00:07:39,235 --> 00:07:40,355 this week as of, 228 00:07:40,915 --> 00:07:43,795 you know, November 21 or in this this 229 00:07:43,795 --> 00:07:46,595 week. And, you know, hearing from sponsors and 230 00:07:46,595 --> 00:07:48,214 how they have conversations, 231 00:07:48,514 --> 00:07:49,175 how they 232 00:07:49,660 --> 00:07:52,939 address patients who come in with their own 233 00:07:52,939 --> 00:07:53,439 research, 234 00:07:53,819 --> 00:07:54,379 their own, 235 00:07:55,259 --> 00:07:57,040 ideas, perhaps maybe misconceptions, 236 00:07:57,500 --> 00:07:59,040 you know, after consulting 237 00:07:59,580 --> 00:08:00,080 influencers, 238 00:08:00,540 --> 00:08:02,240 doctor Google, quote, unquote. 239 00:08:02,779 --> 00:08:05,120 I'd love to hear your advice on 240 00:08:05,524 --> 00:08:07,625 how spine surgeons should, you 241 00:08:08,004 --> 00:08:10,584 know, base or address approach these conversations 242 00:08:12,004 --> 00:08:12,985 with, you know, 243 00:08:13,844 --> 00:08:15,224 with this information culture. 244 00:08:15,524 --> 00:08:16,805 Yeah. No. And I I think that's a 245 00:08:16,805 --> 00:08:18,164 good question. And I think that, you know, 246 00:08:18,164 --> 00:08:18,664 truthfully, 247 00:08:19,639 --> 00:08:21,980 a lot of surgeons, I'd say initially, 248 00:08:22,519 --> 00:08:24,040 and a lot of, you know, doctors in 249 00:08:24,040 --> 00:08:24,860 general initially, 250 00:08:26,279 --> 00:08:29,019 can be a little bit, apprehensive or dismissive. 251 00:08:29,079 --> 00:08:31,079 Like I'd I'd say, when those things kind 252 00:08:31,079 --> 00:08:33,425 of things come up. But I I I 253 00:08:33,425 --> 00:08:34,884 honestly look at it as an opportunity, 254 00:08:35,904 --> 00:08:37,845 because anybody that comes in that's informed, 255 00:08:38,384 --> 00:08:39,904 that know that, you know, knows how to 256 00:08:39,904 --> 00:08:41,205 speak the language, knows, 257 00:08:41,825 --> 00:08:42,725 you know, the terms, 258 00:08:43,345 --> 00:08:43,845 knows, 259 00:08:44,304 --> 00:08:46,289 you know, a little bit about the way 260 00:08:46,289 --> 00:08:47,830 this disease process works, 261 00:08:48,690 --> 00:08:50,529 you know, from and getting this from from 262 00:08:50,529 --> 00:08:51,809 various sources, I think, 263 00:08:52,450 --> 00:08:53,350 is not necessarily 264 00:08:53,730 --> 00:08:55,250 a bad thing. And I think that what 265 00:08:55,250 --> 00:08:56,929 you can do is it kinda sets the 266 00:08:56,929 --> 00:08:58,389 groundwork for conversation. 267 00:08:59,490 --> 00:09:00,929 And in some ways, it means I think 268 00:09:00,929 --> 00:09:02,634 you're just that much farther ahead when you 269 00:09:02,634 --> 00:09:04,955 really have the conversation. So I would say, 270 00:09:05,754 --> 00:09:07,774 don't necessarily look at it as an annoyance 271 00:09:07,835 --> 00:09:09,434 or as a hindrance to a discussion like, 272 00:09:09,434 --> 00:09:10,955 oh, yeah. Well, that was doctor Google. It's 273 00:09:10,955 --> 00:09:12,634 not that you know, there is information out 274 00:09:12,634 --> 00:09:13,995 there, and I think what you're really looking 275 00:09:13,995 --> 00:09:16,080 to do is provide the context for it. 276 00:09:16,320 --> 00:09:18,000 And so, I usually look at it as 277 00:09:18,000 --> 00:09:19,519 as an opportunity. It's like, oh, well, tell 278 00:09:19,519 --> 00:09:20,960 me about what you read. Tell me about 279 00:09:20,960 --> 00:09:23,279 what you you know, the the different approaches 280 00:09:23,279 --> 00:09:25,360 that you have, read about to treat your 281 00:09:25,360 --> 00:09:26,100 your disease, 282 00:09:26,720 --> 00:09:28,799 or your issue. And, and I'm happy to 283 00:09:28,799 --> 00:09:30,345 kind of give you my take on it 284 00:09:30,504 --> 00:09:31,784 and why it is that I think, you 285 00:09:31,784 --> 00:09:33,064 know, x, y, or z is the way 286 00:09:33,064 --> 00:09:35,384 to go. So, honestly, I I sort of 287 00:09:35,384 --> 00:09:36,524 see it as an opportunity, 288 00:09:37,544 --> 00:09:39,544 rather than a hindrance to sort of a 289 00:09:39,544 --> 00:09:41,245 a burgeoning doctor patient relationship. 290 00:09:42,184 --> 00:09:43,704 Absolutely. And it sounds like it's a very 291 00:09:44,179 --> 00:09:47,379 it opens the door for more collaboration between 292 00:09:47,379 --> 00:09:50,199 what the patient comes in knowing and then 293 00:09:50,500 --> 00:09:52,259 what you know in terms of the best 294 00:09:52,259 --> 00:09:53,240 course for treatment. 295 00:09:54,259 --> 00:09:54,759 Absolutely. 296 00:09:55,459 --> 00:09:57,375 And then I wanted to ask you, how 297 00:09:57,375 --> 00:10:00,575 are you thinking about growth over the next 298 00:10:00,575 --> 00:10:02,514 twelve to twenty four months? 299 00:10:03,535 --> 00:10:04,915 Yeah. I mean, for me, 300 00:10:05,535 --> 00:10:07,934 personally, I mean, you know, again, given my 301 00:10:07,934 --> 00:10:10,514 background kinda working in a hospital in Brooklyn 302 00:10:10,575 --> 00:10:12,800 that was, you know, truthfully a safety net 303 00:10:12,800 --> 00:10:13,300 hospital, 304 00:10:13,759 --> 00:10:15,920 had been doing great work, but, you know, 305 00:10:15,920 --> 00:10:17,139 I'd say under resourced, 306 00:10:18,320 --> 00:10:20,080 you know, in a community that is very 307 00:10:20,080 --> 00:10:22,259 highly sort of, Medicaid population, 308 00:10:23,375 --> 00:10:25,375 and that really probably didn't have the access 309 00:10:25,375 --> 00:10:27,054 to the level of care they're getting now 310 00:10:27,054 --> 00:10:27,954 in their borough. 311 00:10:28,414 --> 00:10:31,294 I see growth as providing care for people 312 00:10:31,294 --> 00:10:32,674 where they are, where they live. 313 00:10:33,294 --> 00:10:35,134 There's a lot of opportunities out there for 314 00:10:35,134 --> 00:10:36,995 that. And again, just to use our example, 315 00:10:37,769 --> 00:10:39,129 it used to be that if you wanted 316 00:10:39,129 --> 00:10:41,529 complex spine surgery with robotics and all the 317 00:10:41,529 --> 00:10:43,209 bells and whistles, you had to cross the 318 00:10:43,209 --> 00:10:43,709 river. 319 00:10:44,089 --> 00:10:45,370 You had to go into Manhattan to do 320 00:10:45,370 --> 00:10:48,089 that. And, you know, since, we've had this 321 00:10:48,089 --> 00:10:50,384 relationship and basically have, have built, 322 00:10:51,345 --> 00:10:52,085 you know, this, 323 00:10:52,865 --> 00:10:55,445 NYU Langone Hospital Brooklyn, which is essentially, 324 00:10:56,144 --> 00:10:58,544 you know, the same care. And we get 325 00:10:58,544 --> 00:11:00,565 you whatever you're doing we're doing in Manhattan, 326 00:11:01,424 --> 00:11:03,105 theoretically, we're gonna be trying to be doing 327 00:11:03,105 --> 00:11:04,565 the exact same thing in Brooklyn. 328 00:11:05,580 --> 00:11:07,100 And the goal really is to provide the 329 00:11:07,100 --> 00:11:08,240 same level of care, 330 00:11:09,419 --> 00:11:11,419 in in the context that, you know, where 331 00:11:11,419 --> 00:11:13,360 you live, you know, with your families, 332 00:11:13,899 --> 00:11:16,059 with your community without you having to actually 333 00:11:16,059 --> 00:11:17,120 travel for it. 334 00:11:17,475 --> 00:11:19,154 So Very well said. Yeah. I think that's 335 00:11:19,154 --> 00:11:21,075 that's the biggest opportunity for growth. It's based 336 00:11:21,154 --> 00:11:23,315 because there's so many places out there where 337 00:11:23,315 --> 00:11:24,674 that's the case, where they just don't have 338 00:11:24,674 --> 00:11:26,195 that, you know, access to the same level 339 00:11:26,195 --> 00:11:28,034 of care. You have to be sent into 340 00:11:28,034 --> 00:11:29,014 something like tertiary, 341 00:11:29,490 --> 00:11:32,049 you know, academic medical center. And I think 342 00:11:32,049 --> 00:11:34,049 that, the owner should be on these medical 343 00:11:34,049 --> 00:11:34,549 centers, 344 00:11:35,649 --> 00:11:37,169 to go out there and to and to 345 00:11:37,169 --> 00:11:39,169 build the resources and the communities that people 346 00:11:39,169 --> 00:11:39,830 live in. 347 00:11:40,209 --> 00:11:42,289 Yeah. And how are you addressing how will 348 00:11:42,289 --> 00:11:42,950 you tackle 349 00:11:43,404 --> 00:11:46,845 any sort of major headwinds to these goals, 350 00:11:46,845 --> 00:11:49,585 whether for the growth and community care? 351 00:11:50,684 --> 00:11:52,684 Yeah. I mean, you know, I'd say that 352 00:11:52,684 --> 00:11:53,825 that most of the headwinds, 353 00:11:54,764 --> 00:11:55,904 are sort of 354 00:11:56,279 --> 00:11:59,320 infrastructural. Right? I mean, the it's you're certainly 355 00:11:59,320 --> 00:12:01,000 not gonna get a lot of, you know, 356 00:12:02,120 --> 00:12:04,759 headwinds from people. You know, everywhere we've gone 357 00:12:04,759 --> 00:12:06,440 in the community, we've get given talks in 358 00:12:06,440 --> 00:12:08,519 the community, people are are, you know, generally 359 00:12:08,519 --> 00:12:10,335 very, very happy about what's going on. 360 00:12:10,894 --> 00:12:13,134 And oftentimes, they're surprised to hear kind of 361 00:12:13,134 --> 00:12:15,615 the level of care that's, that's happening really 362 00:12:15,615 --> 00:12:16,434 in their backyard. 363 00:12:16,975 --> 00:12:18,815 The headwinds tend to be infrastructural. Right? So 364 00:12:18,815 --> 00:12:20,175 it's all, like, kind of the the more 365 00:12:20,175 --> 00:12:21,934 boring stuff, but the stuff that's vital, it's 366 00:12:21,934 --> 00:12:25,399 like money, resources, allocation, you know, the, you 367 00:12:25,399 --> 00:12:26,300 know, the changing 368 00:12:27,399 --> 00:12:30,540 environment at the federal level, government reg regulatory, 369 00:12:30,920 --> 00:12:33,480 changes. So these things all have an impact 370 00:12:33,480 --> 00:12:35,480 on how you do things because, you know, 371 00:12:35,480 --> 00:12:36,920 at the end of the day, these things 372 00:12:36,920 --> 00:12:39,639 also can't, they have to be self sustaining 373 00:12:39,639 --> 00:12:40,304 in some ways. 374 00:12:41,264 --> 00:12:43,585 And, you know, there's, you know, the saying, 375 00:12:43,585 --> 00:12:45,284 you know, sort of no margin, no mission. 376 00:12:46,144 --> 00:12:48,384 So, you know, fiscal responsibility obviously has to 377 00:12:48,384 --> 00:12:49,745 play a part in this because, you know, 378 00:12:49,745 --> 00:12:50,945 if you don't, you know, you can't take 379 00:12:50,945 --> 00:12:52,144 care of people if you can't keep the 380 00:12:52,144 --> 00:12:54,464 lights on. And there are just many other 381 00:12:54,464 --> 00:12:56,220 factors that go into that, 382 00:12:56,779 --> 00:12:59,279 that may seem sort of boring or whatever, 383 00:13:00,059 --> 00:13:01,679 but that you have to take into account. 384 00:13:01,740 --> 00:13:04,059 So, honestly, I would say it's mostly sort 385 00:13:04,059 --> 00:13:06,860 of the, you know, the regulatory financial environment, 386 00:13:07,179 --> 00:13:09,019 that is probably the what's giving the most 387 00:13:09,019 --> 00:13:10,779 headwinds to to this type of growth that 388 00:13:10,779 --> 00:13:11,759 we're speaking of. 389 00:13:12,204 --> 00:13:14,365 Got it. And my last question for you, 390 00:13:14,524 --> 00:13:15,504 doctor Ander, 391 00:13:15,884 --> 00:13:17,565 is what do you think will be a 392 00:13:17,565 --> 00:13:20,704 key disruptor to spine surgery and neurosurgery 393 00:13:21,164 --> 00:13:22,544 in 2026? 394 00:13:25,089 --> 00:13:26,870 You know, I mean, I think that disruptor 395 00:13:27,009 --> 00:13:27,669 is interesting. 396 00:13:28,289 --> 00:13:30,450 So, I mean, that's clearly, the the obvious 397 00:13:30,450 --> 00:13:32,529 answer to that in, at any, surgical field 398 00:13:32,529 --> 00:13:34,529 is gonna be tech. Right? So, you know, 399 00:13:34,529 --> 00:13:35,750 advanced robotics, 400 00:13:37,024 --> 00:13:38,644 and and this kind of thing, I think. 401 00:13:38,865 --> 00:13:40,544 But I, you know, I would say if 402 00:13:40,544 --> 00:13:42,625 we're talking disruption and just sort of thinking 403 00:13:42,625 --> 00:13:44,304 outside the box here, just there there's just 404 00:13:44,304 --> 00:13:45,605 so much stuff going on, 405 00:13:46,945 --> 00:13:49,985 with AI, predict predictive analytics, like, all this, 406 00:13:50,629 --> 00:13:51,990 you know, where where I think that we're 407 00:13:51,990 --> 00:13:53,830 actually gonna probably end up, 408 00:13:54,629 --> 00:13:55,529 you know, basing, 409 00:13:56,149 --> 00:13:58,789 some treatment on algorithms that were sort of 410 00:13:58,789 --> 00:13:59,190 written, 411 00:13:59,909 --> 00:14:02,149 via some kind of AI model. And a 412 00:14:02,149 --> 00:14:03,350 lot of that's actually being done in the 413 00:14:03,350 --> 00:14:06,184 neurosurgery world. And and, at NYU, it certainly 414 00:14:06,184 --> 00:14:06,684 is, 415 00:14:07,465 --> 00:14:09,144 you know, where we can sort of use 416 00:14:09,144 --> 00:14:10,365 de identified data 417 00:14:10,665 --> 00:14:12,904 to, like, you know if somebody comes in 418 00:14:12,904 --> 00:14:13,884 with this complaint, 419 00:14:14,985 --> 00:14:16,825 at this time of day with this, you 420 00:14:16,825 --> 00:14:19,809 know, we can almost predict kind of where 421 00:14:19,809 --> 00:14:22,129 they're gonna go, what, like, what kind of 422 00:14:22,129 --> 00:14:24,049 problem they're gonna have, where they're gonna get 423 00:14:24,049 --> 00:14:24,549 discharged, 424 00:14:24,929 --> 00:14:27,090 to all these things, which I think is 425 00:14:27,090 --> 00:14:29,570 gonna be sort of interesting, because clearly, it's 426 00:14:29,649 --> 00:14:31,429 you know, you we're gonna have to have 427 00:14:31,715 --> 00:14:33,475 some sort of human oversight into how this 428 00:14:33,475 --> 00:14:34,054 is done. 429 00:14:34,754 --> 00:14:36,615 But, you know, to sort of harness, 430 00:14:37,075 --> 00:14:39,394 the the power of of AI and tech 431 00:14:39,394 --> 00:14:41,394 in general, I think for these types of 432 00:14:41,394 --> 00:14:43,154 things is really gonna change the way that 433 00:14:43,154 --> 00:14:45,575 we, that we diagnose and treat disease. 434 00:14:46,839 --> 00:14:47,240 Well, 435 00:14:47,639 --> 00:14:49,559 doc doctor Andrew, thank you so much for 436 00:14:49,559 --> 00:14:51,799 joining us today. It's been a pleasure speaking 437 00:14:51,799 --> 00:14:53,480 with you, and I look forward to connecting 438 00:14:53,480 --> 00:14:55,320 again down the line. Thank you so much 439 00:14:55,320 --> 00:14:56,220 for having me.