1
00:00:02,000 --> 00:00:04,580
This is where health care leadership comes together.

2
00:00:04,719 --> 00:00:07,839
Becker's sixteenth annual meeting brings more than 3,500

3
00:00:07,839 --> 00:00:10,880
hospital and health system executives and nearly 800

4
00:00:10,880 --> 00:00:14,355
speakers to Chicago, April.

5
00:00:14,655 --> 00:00:17,375
This series event includes keynote conversations with Dallas

6
00:00:17,375 --> 00:00:20,335
Cowboys legend Troy Aikman and former president George

7
00:00:20,335 --> 00:00:23,054
w Bush. For the agenda and event details,

8
00:00:23,054 --> 00:00:25,375
visit beckershospitalreview.com

9
00:00:25,375 --> 00:00:26,975
and click on the events tab in the

10
00:00:26,975 --> 00:00:29,620
upper right. We're looking forward to hosting you

11
00:00:29,679 --> 00:00:30,500
in Chicago.

12
00:00:31,920 --> 00:00:34,079
This is Carly Beam with the Becker Spine

13
00:00:34,079 --> 00:00:36,320
and Orthopedics podcast, and I'm thrilled to be

14
00:00:36,320 --> 00:00:38,799
joined today by doctor Rory Murphy, a spine

15
00:00:38,799 --> 00:00:41,460
surgeon with Barrow Neurological Institute.

16
00:00:41,804 --> 00:00:43,984
Doctor Murphy, thank you for being here today.

17
00:00:44,364 --> 00:00:46,045
Thank you very much for the invite today,

18
00:00:46,045 --> 00:00:48,384
and thank you for setting this podcast up.

19
00:00:48,604 --> 00:00:51,004
Absolutely. So before we dive into our questions,

20
00:00:51,164 --> 00:00:53,484
could you just introduce yourself and share a

21
00:00:53,484 --> 00:00:54,704
bit more about your background?

22
00:00:55,469 --> 00:00:55,950
Yes.

23
00:00:56,429 --> 00:00:58,130
My name is Rory Murphy. I'm a neurosurgeon,

24
00:00:58,350 --> 00:01:00,190
and I'm a neurosurgeon with the Barrow Brain

25
00:01:00,190 --> 00:01:02,030
and Spine Group, and I practice here in

26
00:01:02,030 --> 00:01:02,850
Phoenix, Arizona.

27
00:01:03,390 --> 00:01:05,650
Been here for over eight years.

28
00:01:06,189 --> 00:01:07,484
And, did my

29
00:01:07,885 --> 00:01:09,965
Irish, did my medical school in Ireland, came

30
00:01:09,965 --> 00:01:11,885
over here, did my training and my residency

31
00:01:11,885 --> 00:01:14,204
in WashU in Saint Louis, fellowship in San

32
00:01:14,204 --> 00:01:16,284
Francisco, and then moved here. And,

33
00:01:17,724 --> 00:01:18,224
here,

34
00:01:18,685 --> 00:01:19,344
I do

35
00:01:19,965 --> 00:01:23,409
have a a busy neurosurgical practice, and I

36
00:01:23,409 --> 00:01:25,250
really one of my main areas I'm really

37
00:01:25,250 --> 00:01:28,230
interested in is helping people move, especially after,

38
00:01:29,329 --> 00:01:32,450
cervical injuries, so cervical spinal cord injuries or

39
00:01:32,450 --> 00:01:34,870
helping people with cervical degenerative cervical myelopathy.

40
00:01:35,250 --> 00:01:36,069
And so,

41
00:01:36,905 --> 00:01:37,405
really

42
00:01:38,025 --> 00:01:39,725
working on different ways to help

43
00:01:40,344 --> 00:01:40,844
diagnose,

44
00:01:41,704 --> 00:01:42,204
treat,

45
00:01:42,825 --> 00:01:45,165
better surgical options for those conditions

46
00:01:45,465 --> 00:01:46,204
and also

47
00:01:46,505 --> 00:01:48,365
better research opportunities and

48
00:01:48,980 --> 00:01:51,700
working with companies and setting up companies to

49
00:01:51,700 --> 00:01:52,680
try and commercialize

50
00:01:52,980 --> 00:01:55,380
and get solutions out into the the real

51
00:01:55,380 --> 00:01:56,680
world to help people.

52
00:01:57,219 --> 00:02:00,500
Absolutely. That's all very fascinating. And, doctor Murphy,

53
00:02:00,500 --> 00:02:02,180
I wanted to touch on something that you

54
00:02:02,180 --> 00:02:03,944
had mentioned in the conversation that,

55
00:02:04,424 --> 00:02:07,064
we had earlier, last year. I know there's

56
00:02:07,064 --> 00:02:10,525
been some interesting conversations about cervical disc replacement

57
00:02:10,745 --> 00:02:14,104
infusions around, especially at, like, three levels. And

58
00:02:14,104 --> 00:02:16,185
I want to hear your perspective on this

59
00:02:16,185 --> 00:02:17,944
debate and what you've been hearing from the

60
00:02:17,944 --> 00:02:18,764
spine community.

61
00:02:19,689 --> 00:02:22,250
Yeah. And and it's it's very topical. I

62
00:02:22,250 --> 00:02:24,590
had, two or three people in clinic today.

63
00:02:24,810 --> 00:02:25,550
We discussed,

64
00:02:26,090 --> 00:02:26,750
they had

65
00:02:27,129 --> 00:02:27,629
three

66
00:02:28,569 --> 00:02:29,069
symptomatic

67
00:02:29,530 --> 00:02:30,669
areas with radiculopathy

68
00:02:30,969 --> 00:02:31,629
or myelopathy,

69
00:02:32,754 --> 00:02:34,455
attributable to three levels.

70
00:02:34,915 --> 00:02:37,155
And we had a long discussion with people.

71
00:02:37,155 --> 00:02:38,754
And some of the people today would have

72
00:02:38,754 --> 00:02:41,635
been, one patient who's a neurologist and, one

73
00:02:41,635 --> 00:02:43,794
patient who's an athlete. So we're going through

74
00:02:43,794 --> 00:02:46,760
the ins and outs and nuances, and there's

75
00:02:46,760 --> 00:02:49,580
no exact right answer. I always

76
00:02:50,199 --> 00:02:51,340
discuss with people,

77
00:02:51,879 --> 00:02:52,780
try and match

78
00:02:53,560 --> 00:02:55,400
you'll find out what they hope to achieve

79
00:02:55,400 --> 00:02:56,139
and improve,

80
00:02:56,840 --> 00:02:59,080
then try and give them the options and

81
00:02:59,080 --> 00:03:01,340
potentially match their goals the best.

82
00:03:01,965 --> 00:03:02,465
Ultimately,

83
00:03:03,085 --> 00:03:05,344
disc replacement arthroplasty versus fusion,

84
00:03:05,724 --> 00:03:06,865
currently, the data

85
00:03:08,045 --> 00:03:10,224
says that they are about the same.

86
00:03:10,605 --> 00:03:13,564
Mhmm. We have perspective information and in data

87
00:03:13,564 --> 00:03:14,784
from Norway and Sweden

88
00:03:15,085 --> 00:03:16,385
saying that there's no

89
00:03:17,010 --> 00:03:19,010
difference between them and the disrobeisement is not

90
00:03:19,010 --> 00:03:21,010
better nor worse than the fusion. And similarly,

91
00:03:21,010 --> 00:03:22,689
a fusion is not better nor worse than

92
00:03:22,689 --> 00:03:23,349
the disreplacement.

93
00:03:24,129 --> 00:03:26,610
Other data from The US and especially industry

94
00:03:26,610 --> 00:03:27,510
sponsored studies,

95
00:03:28,129 --> 00:03:28,905
suggests that

96
00:03:29,384 --> 00:03:32,925
disc replacements may have some benefits over fusions.

97
00:03:33,784 --> 00:03:36,025
You know, ultimately, it's down to what a

98
00:03:36,025 --> 00:03:38,764
patient's goals are and probably what a person's

99
00:03:39,224 --> 00:03:41,465
what challenges a person's willing to deal with

100
00:03:41,465 --> 00:03:42,284
in the future.

101
00:03:43,329 --> 00:03:44,449
Yeah. Because I can imagine,

102
00:03:44,769 --> 00:03:45,729
your patient who's,

103
00:03:46,370 --> 00:03:49,569
neurologist versus an athlete, they might have very

104
00:03:49,569 --> 00:03:52,209
different goals on what they want in their

105
00:03:52,209 --> 00:03:52,709
healing.

106
00:03:53,489 --> 00:03:57,090
Yeah. Age, stage in life, their other medical

107
00:03:57,090 --> 00:03:57,590
challenges.

108
00:03:58,544 --> 00:04:00,305
These are very important things to take into

109
00:04:00,305 --> 00:04:00,805
account.

110
00:04:01,504 --> 00:04:02,004
So

111
00:04:02,385 --> 00:04:04,385
this is a very topical conversation. We're gonna

112
00:04:04,385 --> 00:04:06,405
be debating this of the spine somewhat,

113
00:04:06,784 --> 00:04:08,465
in a month's time here in Phoenix in

114
00:04:08,465 --> 00:04:09,284
Desert Ridge.

115
00:04:09,585 --> 00:04:13,125
So myself and doctor Alvesh Patel from Northwestern

116
00:04:13,659 --> 00:04:15,520
will be, as part of the CSRS

117
00:04:16,060 --> 00:04:17,199
and WNS

118
00:04:17,660 --> 00:04:18,480
special courses.

119
00:04:19,180 --> 00:04:20,160
We'll be debating

120
00:04:20,540 --> 00:04:23,360
the pros and cons of three level arthroplasty

121
00:04:23,660 --> 00:04:24,480
versus fusion.

122
00:04:24,860 --> 00:04:27,759
And, I've been nominated to be the proponent

123
00:04:27,819 --> 00:04:29,495
of three level arthroplasty.

124
00:04:29,875 --> 00:04:31,175
So I'm gonna go through,

125
00:04:31,634 --> 00:04:33,475
the data, the most up to date data,

126
00:04:33,475 --> 00:04:35,495
gather information from the registries,

127
00:04:36,115 --> 00:04:38,055
and data from, industry

128
00:04:38,435 --> 00:04:40,854
sources on two versus three levels.

129
00:04:41,419 --> 00:04:42,939
And doctor Patel would do the same for

130
00:04:42,939 --> 00:04:45,100
three level fusions. So we'll go through the

131
00:04:45,100 --> 00:04:45,600
different,

132
00:04:46,220 --> 00:04:48,459
pros and cons of both. So it's I

133
00:04:48,459 --> 00:04:50,939
think everyone agrees that there is a rule

134
00:04:50,939 --> 00:04:53,279
for three level art capacity in some people.

135
00:04:53,524 --> 00:04:56,085
Mhmm. There's, three level fusions better than other

136
00:04:56,085 --> 00:04:56,585
people.

137
00:04:56,964 --> 00:04:58,904
And we just have to try and

138
00:04:59,524 --> 00:05:01,305
match the best solution to the person.

139
00:05:01,764 --> 00:05:03,444
Absolutely. And that sounds like a really,

140
00:05:03,764 --> 00:05:06,404
exciting opportunity you have ahead. And doctor Murphy,

141
00:05:06,404 --> 00:05:08,105
I was wondering if you could dive into

142
00:05:08,439 --> 00:05:10,699
some of the research that you'll be,

143
00:05:11,720 --> 00:05:14,920
doing this year at Beryl, whether it is,

144
00:05:14,920 --> 00:05:17,419
you know, into fusion or arthroplasty

145
00:05:18,040 --> 00:05:20,439
or is any other interesting areas of spine

146
00:05:20,439 --> 00:05:21,100
and neurosurgery?

147
00:05:22,355 --> 00:05:23,735
Yeah. So another,

148
00:05:24,595 --> 00:05:26,115
you know, I spent a long time with

149
00:05:26,115 --> 00:05:28,774
the insurance company this morning. I have a,

150
00:05:29,074 --> 00:05:31,095
you know, 50 year old athletic,

151
00:05:31,714 --> 00:05:32,214
dancer,

152
00:05:32,514 --> 00:05:32,834
and,

153
00:05:33,475 --> 00:05:35,415
she has a two level arthroplasty

154
00:05:35,795 --> 00:05:37,574
at four or five and five and six.

155
00:05:37,919 --> 00:05:41,439
And, she is developing symptoms, severe symptoms in

156
00:05:41,439 --> 00:05:41,939
radiculopathy,

157
00:05:42,800 --> 00:05:43,699
c seven radiculopathy,

158
00:05:44,479 --> 00:05:46,979
changes c six, c seven. Mhmm. So,

159
00:05:47,919 --> 00:05:50,019
her preference after extensive discussion

160
00:05:50,625 --> 00:05:52,705
is to have another arthroplasty because she did

161
00:05:52,705 --> 00:05:54,245
so well after the other two,

162
00:05:54,705 --> 00:05:56,725
but her insurance will not approve,

163
00:05:57,665 --> 00:05:58,404
or cover

164
00:05:59,105 --> 00:05:59,845
a third

165
00:06:00,464 --> 00:06:02,004
disc replacement or third arthroplasty.

166
00:06:03,105 --> 00:06:04,889
So I think there's a lot of information

167
00:06:04,889 --> 00:06:06,350
we need to get out there. We need

168
00:06:06,730 --> 00:06:07,470
to they

169
00:06:08,009 --> 00:06:10,350
their reasonable or their, logical,

170
00:06:11,209 --> 00:06:13,209
reason to deny it is they have to

171
00:06:13,449 --> 00:06:15,149
has already approved it for two levels.

172
00:06:15,529 --> 00:06:16,889
So I think there's a couple of things

173
00:06:16,889 --> 00:06:18,649
we need to do. We need to probably

174
00:06:18,649 --> 00:06:20,944
show that in in certain people, three level

175
00:06:20,944 --> 00:06:21,925
arthroplasty is

176
00:06:22,305 --> 00:06:23,205
safe and effective

177
00:06:23,824 --> 00:06:24,805
and have the FDA

178
00:06:25,264 --> 00:06:26,165
acknowledge that.

179
00:06:26,545 --> 00:06:28,785
And the the other thing we need to

180
00:06:28,785 --> 00:06:31,745
look into more is hybrid. So when you

181
00:06:31,745 --> 00:06:33,365
have somebody who has

182
00:06:34,220 --> 00:06:36,139
primarily disc degeneration that you can do an

183
00:06:36,139 --> 00:06:38,779
arthroplasty on very well, but maybe another level

184
00:06:38,779 --> 00:06:40,399
where they would do better with the fusion,

185
00:06:40,699 --> 00:06:43,279
what's the long term data from a hybrid,

186
00:06:44,539 --> 00:06:45,039
approach?

187
00:06:45,500 --> 00:06:48,139
And I know High Ridge and, are looking

188
00:06:48,139 --> 00:06:50,435
at, doing a study where they're doing

189
00:06:50,814 --> 00:06:54,035
assessing long term outcomes after a hybrid approach,

190
00:06:54,095 --> 00:06:55,394
I. E, doing a disc replacement

191
00:06:55,935 --> 00:06:56,435
and

192
00:06:56,894 --> 00:06:59,615
a the continuous level infusion. So that's one

193
00:06:59,615 --> 00:07:01,694
study we're looking forward to being part of

194
00:07:01,694 --> 00:07:02,435
this year.

195
00:07:02,920 --> 00:07:03,660
That's awesome.

196
00:07:04,040 --> 00:07:05,319
And then I was wondering, you know, what

197
00:07:05,319 --> 00:07:07,879
are some of the top trends that you're

198
00:07:07,879 --> 00:07:09,500
following in health care today?

199
00:07:11,000 --> 00:07:11,480
Well,

200
00:07:12,120 --> 00:07:14,759
couple of things. I am a trustee for

201
00:07:14,759 --> 00:07:17,080
an excellent charity called myelopathy.org,

202
00:07:17,080 --> 00:07:18,854
which is set up by people with ser

203
00:07:19,014 --> 00:07:21,814
degenerative cervical myelopathy to help advocate for them,

204
00:07:21,814 --> 00:07:22,794
help with diagnosis,

205
00:07:23,334 --> 00:07:25,455
and help educate people with degenerative cervical myel

206
00:07:25,654 --> 00:07:27,514
myelopathy. So I that,

207
00:07:28,375 --> 00:07:31,334
group has primarily came out of The United

208
00:07:31,334 --> 00:07:31,834
Kingdom.

209
00:07:32,454 --> 00:07:32,954
And

210
00:07:33,810 --> 00:07:34,629
now, interestingly,

211
00:07:35,089 --> 00:07:37,490
the website is growing in popularity in The

212
00:07:37,490 --> 00:07:40,610
US. So more and more people in, The

213
00:07:40,610 --> 00:07:41,910
US and North America

214
00:07:42,370 --> 00:07:44,610
are logging on to the website because they

215
00:07:44,610 --> 00:07:47,925
they recognize the value. So I think the

216
00:07:48,024 --> 00:07:49,164
patient education

217
00:07:49,865 --> 00:07:51,245
and giving people options,

218
00:07:51,865 --> 00:07:53,464
is really improving. And,

219
00:07:53,944 --> 00:07:55,724
if you have people with myelopathy

220
00:07:56,024 --> 00:07:58,345
in your clinic, I definitely recommend that you

221
00:07:58,345 --> 00:08:00,185
direct them to the myelopathy.org

222
00:08:00,185 --> 00:08:02,360
website where you can get very

223
00:08:03,219 --> 00:08:03,719
balanced,

224
00:08:04,259 --> 00:08:04,759
informative

225
00:08:05,060 --> 00:08:07,079
information for your patients. And

226
00:08:07,459 --> 00:08:09,860
it's a great resource for anyone who tries

227
00:08:09,860 --> 00:08:12,339
to help people with degenerative cervical myelopathy or

228
00:08:12,339 --> 00:08:14,979
who has their family member with degenerative cervical

229
00:08:14,979 --> 00:08:15,479
myelopathy.

230
00:08:15,854 --> 00:08:18,334
Mhmm. So the myelopathy.org,

231
00:08:18,654 --> 00:08:20,495
charity is really growing in The US this

232
00:08:20,495 --> 00:08:21,935
year. I think there's gonna be a lot

233
00:08:21,935 --> 00:08:23,854
of work helping with people with spinal cord

234
00:08:23,854 --> 00:08:25,074
injuries, using

235
00:08:25,454 --> 00:08:26,354
different techniques.

236
00:08:27,615 --> 00:08:29,535
I'm looking forward to hopefully more data. We're

237
00:08:29,535 --> 00:08:30,435
part of the

238
00:08:31,439 --> 00:08:34,259
doctor Alan Levi from University of Miami is,

239
00:08:35,200 --> 00:08:38,399
hypothermia trial where people with acute cervical spinal

240
00:08:38,399 --> 00:08:39,059
cord injuries

241
00:08:39,440 --> 00:08:42,720
will be randomized to cooling or standard of

242
00:08:42,720 --> 00:08:43,459
care treatment.

243
00:08:45,294 --> 00:08:46,975
And, that has been running now for a

244
00:08:46,975 --> 00:08:48,735
number of years. We're one of the sites

245
00:08:48,735 --> 00:08:51,134
along with, three or four four or five

246
00:08:51,134 --> 00:08:53,774
other sites. So, hopefully, the data from that

247
00:08:53,774 --> 00:08:55,695
will come out in the next twelve to

248
00:08:55,695 --> 00:08:57,695
eighteen months. So we're really looking forward to

249
00:08:57,695 --> 00:08:58,355
that data,

250
00:08:59,230 --> 00:09:00,910
because we really need better ways to help

251
00:09:00,910 --> 00:09:02,450
people with severe

252
00:09:02,830 --> 00:09:05,629
cervical spinal cord injuries. And then for people

253
00:09:05,629 --> 00:09:07,950
who you know, once we've decompressed the spinal

254
00:09:07,950 --> 00:09:08,930
cord straight away,

255
00:09:09,470 --> 00:09:11,970
maybe done cooling, maybe used different medications.

256
00:09:13,214 --> 00:09:15,294
If they don't improve after twelve to eighteen

257
00:09:15,294 --> 00:09:17,294
months, what options do we have? And there's

258
00:09:17,294 --> 00:09:19,154
a huge growth in,

259
00:09:19,855 --> 00:09:20,355
neuroprosthetics.

260
00:09:20,815 --> 00:09:24,174
So brain computer interfaces, basically trying to bridge

261
00:09:24,174 --> 00:09:26,595
the gap between the brain and the extremities.

262
00:09:27,100 --> 00:09:29,179
And you can see a number of excellent

263
00:09:29,179 --> 00:09:31,840
companies really pushing to move this forward,

264
00:09:32,220 --> 00:09:32,720
including,

265
00:09:33,500 --> 00:09:34,000
Neuralink,

266
00:09:34,860 --> 00:09:35,360
Paradromix,

267
00:09:36,460 --> 00:09:37,440
Phantom Neuro.

268
00:09:37,980 --> 00:09:38,720
It's really

269
00:09:39,264 --> 00:09:41,204
an exciting time for neuroprosthetics

270
00:09:41,904 --> 00:09:44,324
and helping people respond with injuries or strokes

271
00:09:44,384 --> 00:09:45,845
or other neurological injuries.

272
00:09:46,464 --> 00:09:48,304
Yeah. And I'm curious, you know, with that

273
00:09:48,304 --> 00:09:51,904
technology, particularly the brain computer in interfaces, your

274
00:09:51,904 --> 00:09:53,044
neurolink chips,

275
00:09:53,730 --> 00:09:56,850
What's your outlook for this technology, let's say,

276
00:09:56,850 --> 00:09:58,610
as soon as even in the next five

277
00:09:58,610 --> 00:09:59,110
years?

278
00:10:00,129 --> 00:10:01,250
Well, I think every time

279
00:10:01,889 --> 00:10:03,190
you know, we always see

280
00:10:03,570 --> 00:10:04,629
kind of a cycle.

281
00:10:05,330 --> 00:10:05,830
So

282
00:10:06,324 --> 00:10:09,464
there usually, it takes five to ten years

283
00:10:09,524 --> 00:10:12,324
for the new technology comes along. The first

284
00:10:12,324 --> 00:10:15,125
few years, we're learning about it. We're gaining

285
00:10:15,125 --> 00:10:17,524
familiarity with it. And it takes, you know,

286
00:10:17,524 --> 00:10:19,784
five to ten years before we really,

287
00:10:20,740 --> 00:10:22,419
get comfortable with it and we really see

288
00:10:22,419 --> 00:10:22,980
the benefits.

289
00:10:23,459 --> 00:10:26,919
Examples being the stereotype and navigation for spine,

290
00:10:27,220 --> 00:10:28,120
robotic use,

291
00:10:28,659 --> 00:10:29,159
arthroplasty.

292
00:10:29,779 --> 00:10:31,079
All these things, we

293
00:10:31,620 --> 00:10:34,819
we gain knowledge over time. So, endoscopy as

294
00:10:34,819 --> 00:10:35,459
well. You know, we

295
00:10:36,375 --> 00:10:37,595
so I think the neuroprosthetics

296
00:10:37,975 --> 00:10:40,375
will be quite different in five to ten

297
00:10:40,375 --> 00:10:41,195
years, and,

298
00:10:42,215 --> 00:10:43,894
we'll be using them in ways that we

299
00:10:43,894 --> 00:10:45,035
didn't quite expect.

300
00:10:46,215 --> 00:10:48,375
So I'm looking forward to that. Great. And

301
00:10:48,375 --> 00:10:49,915
then couple other questions.

302
00:10:50,480 --> 00:10:52,019
What do you think will be the biggest

303
00:10:52,079 --> 00:10:55,139
headwind that you'll be facing in 2026?

304
00:10:56,159 --> 00:10:58,399
It's really hard for people to navigate the

305
00:10:58,399 --> 00:11:01,919
health care system. You're unwell. You have a

306
00:11:01,919 --> 00:11:04,399
a severe brain or spine problem. You're in

307
00:11:04,399 --> 00:11:04,899
pain.

308
00:11:05,524 --> 00:11:08,504
Navigating the system is very trippy.

309
00:11:10,245 --> 00:11:11,845
It's hard to get to your primary care

310
00:11:11,845 --> 00:11:12,345
doctor.

311
00:11:12,725 --> 00:11:14,825
It's hard to get the preventative care.

312
00:11:15,365 --> 00:11:15,865
And

313
00:11:16,565 --> 00:11:17,465
when you do

314
00:11:18,089 --> 00:11:19,389
get seen and assessed,

315
00:11:19,769 --> 00:11:22,809
it's hard to get the imaging. And then

316
00:11:22,809 --> 00:11:24,569
subsequently, if you do need a procedure to

317
00:11:24,569 --> 00:11:27,230
help you, the insurance company to approve it.

318
00:11:27,529 --> 00:11:28,029
So

319
00:11:28,409 --> 00:11:30,990
that's my main concern for my patients.

320
00:11:32,384 --> 00:11:34,485
How do they get to the

321
00:11:35,264 --> 00:11:37,845
get assessed, diagnosed, and treated correctly

322
00:11:38,384 --> 00:11:38,884
in

323
00:11:39,665 --> 00:11:41,605
a pragmatic, holistic way?

324
00:11:42,625 --> 00:11:44,004
So, you know,

325
00:11:44,465 --> 00:11:45,445
that's my concern.

326
00:11:46,919 --> 00:11:47,419
A

327
00:11:48,200 --> 00:11:50,039
reduction in care because of,

328
00:11:50,440 --> 00:11:50,940
insurance

329
00:11:51,559 --> 00:11:53,019
and rationing of care.

330
00:11:53,799 --> 00:11:55,799
Got it. And then just the last question

331
00:11:55,799 --> 00:11:57,240
I had for you is, how are you

332
00:11:57,240 --> 00:11:59,879
thinking about growth over the next twelve to

333
00:11:59,879 --> 00:12:00,940
twenty four months?

334
00:12:01,804 --> 00:12:03,804
Well, there's different areas to grow. You know,

335
00:12:03,804 --> 00:12:06,684
I'm always trying to, make sure that my

336
00:12:06,684 --> 00:12:09,085
patients are better educated because the better educated

337
00:12:09,085 --> 00:12:10,445
they are, the better they do. The more

338
00:12:10,445 --> 00:12:12,524
they understand their condition, the more they understand

339
00:12:12,524 --> 00:12:14,384
the options, the better they do.

340
00:12:14,829 --> 00:12:16,429
Practice wise, we're always trying to refine our

341
00:12:16,429 --> 00:12:17,730
practice and make it better.

342
00:12:19,389 --> 00:12:21,970
Growth research wise, hoping to add more new

343
00:12:22,269 --> 00:12:24,350
help options to help people with cervical menopause

344
00:12:24,350 --> 00:12:25,570
and spinal cord injuries.

345
00:12:26,110 --> 00:12:26,610
And,

346
00:12:28,194 --> 00:12:28,855
you know,

347
00:12:29,714 --> 00:12:32,115
on the entrepreneurial side, we're looking forward to

348
00:12:32,115 --> 00:12:35,154
hopefully first in human trials for smart implants

349
00:12:35,154 --> 00:12:37,634
and connected implants in the next, you know,

350
00:12:37,634 --> 00:12:39,714
twelve to eighteen months. So I think that'll

351
00:12:39,714 --> 00:12:41,174
be a big growth area.

352
00:12:42,059 --> 00:12:44,940
Great. Well, doctor Murphy, thank you so much

353
00:12:44,940 --> 00:12:47,660
for joining us today. Look forward to connecting

354
00:12:47,660 --> 00:12:48,480
down the line.

355
00:12:48,779 --> 00:12:50,559
Excellent. Thank you very much.