← Liftoff with Keith: Conversations with Super Founders and Growth Experts sharing useful insights
Liftoff with Keith: Conversations with Super Founders and Growth Experts sharing useful insights
Reinventing Back Surgery: Dr. Steve Falowski on SynerFuse’s Breakthrough in Chronic Pain Treatment
00:33:55
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And there are a large amount of patients that suffer from back pain. In fact, actually, there are more people. This is always staggering when I say it. There are more people that suffer from pain than heart disease, cancer and diabetes combined. The most common reason to call out of work is actually not cold. It's back pain.
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B
Hey.
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C
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B
Thanks.
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C
And show your support for this podcast by sharing some sponsor appreciation. Check these guys out@bww.compass-strategic advisors.
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B
All right, we have another liftoff, and today we're going to take a little bit of a slightly different turn. I have with me Dr. Stephen Falowski, MD, out of Pennsylvania, I think. Correct?
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A
That's correct.
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B
And you're the director of Functional Neurosurgery at Argus Marathi Neurological Neurosurgical Associates of Lancaster. Did I get that right?
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A
That is correct, yes.
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B
Well, and what I'm so excited about in chatting with you today, Doctor, is this whole area of Medtech right now. It seems like we are at a flashpoint in a way. I know everybody wants to talk about AI and we'll probably touch on it ourselves here, but Medtech is on fire right now. I've been invited to more events that have to do with living longer, living better, new solutions, new approaches than ever before. We all want to live healthier. We all want to live forever. And that's. That's been a constant for a while. But I think it just seems like something's happened in the last five or so years that's created this sort of resurgence. Now, you know something about that because you've been around for a while, but in looking at what you're working on with this, with this program called Centrifuge, you're looking to address something that affects 90 million people and, and a million lives. So share with me what. Well, first of all, welcome to Liftoff. And I'm excited you could join, especially on an operating day. I hope I'm not causing any, any delays in surgery right now, because I don't. But welcome to Liftoff. And tell me about Centrifuge.
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A
Well. Well, thank you, Keith. I'm excited to be here. And luckily my OR cases are done now. For the day. So you have my full attention.
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B
Oh, good.
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A
Yeah. So I'll give you a little background on synergies and you're spot on with medtech going in the direction it is right now. It is exploding and there's a lot of startup companies, new products, everything to improve quality of life for patients, longevity for patients, and medical device is right at the forefront of all this. What Synerfuse is doing, it is a company that is looking at chronic pain and there are a large amount of patients that suffer from from back pain. In fact, actually there are more people. This is always staggering when I say it. There are more people that suffer from pain than heart disease, cancer and diabetes combined. The most common reason to call out of work is actually not the cold, it's back pain. So these are very true numbers. And so now the treatments that we have for back pain can vary everything from conservative things like medication and physical therapy, chiropract measures through injections. But then on the other end of the spectrum is what we it's spinal fusion surgery or open spinal surgery. Now, historically, that's what we've used for a long time and it works. And there are proper patients that will benefit from it. But one of the things that we have learned over time is about 30% of those patients will actually come out of the surgery and chronic pain, meaning either the surgery didn't fix their pain, or fusing their back and changing the structure of their spine causes pain. But about 30% of them will have chronic pain, which is a staggering number when you really think about that. What we've used to treat those patients then. So after they have the spinal fusion surgery, they go back to doing conservative things again, pain medications like opioids or therapy. And then they suffer for more years and more years. And eventually what we have used now, which has become a very good therapy for treating it, is what we call neuromodulation or spinal cord stimulation, where we actually implant electrodes on the spine, directly on the nerves to re register their pain patterns and tell the nerves to stop thinking you're constantly in pain. And these have great success rates. And there's been massive growth in that space. What the company is now, to put this all together, what the company Synerfuse is doing is they're now saying, you know what, we shouldn't have to have those 30% of patients wait several more years in chronic pain after a fusion. Let's put these electrodes in, specifically what we call DRG electrodes, which is an electrode on single Nerve roots, put them in at the same time as the surgery that you're having for the fusion to try to prevent that from ever occurring. And that's where we are with the. What's the interfuse?
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B
It sounds like you came at this through a neurological avenue and. And sort of found that there's a physiological aspect to it, that they have to be married. The process has to be combined.
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A
Yes. Yeah. You know, the thought process of actually doing, you know, the electrode implants at the time of the surgery was never thought of before. In fact, actually, if you're rewind, even 10 years ago, neuromodulation or these spinal cord stimulators were considered a last resort therapy. They weren't. Everything else failed. You're going to get this implant, which essentially this implant is a pacemaker for the spine. So there should have been no reason why something that's so minimally invasive, so safe to put in and has such good success rates should have fallen into the category of a last resort therapy. Over the last 10 years. That's really changed. And one of the reasons it's changed is because the results have gotten even so much better. The technology has gotten better. Everything now runs off Bluetooth and wireless technology. Everything's underneath the skin. You don't see a single thing. You control stuff from your cell phone. Now imagine that you can control the electrode on your spine from your cell phone. I mean, that's where we are right now with this.
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B
Man, that is crazy. So. And what you said, pacemaker, the spine. That's such a great analogy because that's so minimally invasive. Right. And you know, I don't know if you could operate it from your cell phone, but it's. That's pretty wild. How is it doing against the 30 number? I'm sorry, how are you doing against that 30 number?
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A
We're actually doing great. When you actually. When you look at. So before we get into the centrifuge and doing it at the same time, in the study that they have done, just neuromodulation in general has so has about an 80 to 85% success rate in treating those patients that live in chronic pain. The most common One is those 30% of patients who come out of fusions in chronic pain who have no other avenues or answers to help them. We carry. We see over 80% success rates in treating those patients, which is in our space for chronic pain is unheard of. That's why so many people suffer in chronic pain, is we don't normally have great treatments. For it. Now with synterfuze though, they did a proof of concept study. So they took 20 patients, implanted the electrodes at the same time as the spinal fusion surgery, and then followed them for one year and basically now showed fantastic results with over 80% of the people improving where over time, even the 12 months, all their opioid use came down, their functionality or their disability got significantly improved, and we diminished their pain scores to very low numbers of like say 1 out of 10, which is unheard of because if you try normal spinal fusion patients after surgery for one year, you would not see numbers like this. So what we're actually seeing already, just from a proof of concept study is we're eliminating a large percentage of those people who would have went on to have chronic pain.
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B
Now let me ask too, because I'm curious. I think so many people have back pain, as you pointed out at the beginning here. A lot of it is because, you know, in my case played sports as a kid all the way through college and then transferred into a desk jockey of sorts. Right. So now I've got the, I've got both sides of the coin covered in worst possible scenario for my back. And so I'm living in some kind of back discomfort. Am I the typical kind of candidate or are you referring more to people that had some sort of injury that's back related?
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A
No, not necessarily an injury that's back related. I would say the most common patients that we treat are those with just arthritis or what we simply call degeneration of the spine. You know, your spine has many aspects to it. So you have joints that sit in the back, you have nerves that run in the center. In the front of the spine is what people think of as discs. When you herniated this are like sponges. Over time, the, the sponge starts losing water and then before you know, it starts collapsing and then the bones start touching each other and then, you know, so it's a cascade of events that happens with arthritis. Yeah, it can happen earlier with some people, it can happen later with others. They say if you live long enough, you're eventually going to degenerate your spine.
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B
So let's, let's slip into our entrepreneurial hat for a second here. That may cross over into a technology discussion. But we're what caused the, the got the, the, the gotcha moment for you. Like wait a second, we got to change the direction here of, of what we're doing. You know, I'm going into surgery all the time, but I'm not getting the results I want to see what was that innovation or that thought process that led to the somewhat of a breakthrough, specifically with this.
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A
The I, I think that aha moment was we. I specialize in neuromodulation. The majority of the surgeries that I do now involve putting these electrodes on the spine. I see how great they work, especially when the patients are chosen correctly and then when you do a good job of implanting them. But what's always been disheartening to me is those patients aren't getting to me for these stimulators until they've suffered in pain for seven to 12 years. We're not talking about your basic, you know, you got an ache every once in a while, you took a 10 mile hike and you, you got to sit down for a little bit. We're talking about these people live in pain all the time, you know, and they may vary, you know, how severe it is, but they're living with this pain all the time. And that really bothered me. So the aha moment that I think came in the space is why are we waiting so long to get to these patients when we have a therapy that works so well and knowing that this technology has been growing. This technology has been around since the 1980s, but the explosion in it over the last 10 to 15 years has been fantastic. And it's all because the technology got even better. We got better at implanting and we got better at choosing patients. So I think this was going to be the next step in how to use these, these therapies.
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B
It sounds really interesting. So at this stage, what kind of usage are we seeing across hospitals that specialize in back pain?
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A
So yeah, absolutely, we've seen massive growth in the use of these spinal cord stimulators or pacemakers of the spine. Historically, if you go back even 10 years ago, there was probably only maybe 10,000 a year going in. We're now in the 50 to 70,000 going in every year, which is a huge, it's a very large number when you look at it. So we've seen the growth in that. But if we want to put on our entrepreneurial hat, just like you said, is there are basically about four major companies that compete in this space and they're the very large companies. When you think of companies like Abbott or companies like Medtronic, these are the big medical device companies and they have these stimulators. The problem is that that creates an environment where it's very hard for another company to develop something similar and try to launch it. So it's very hard for a company to develop a spinal cord stimulator and come to market when they're competing with these big dogs. So with the entrepreneurial hat on is I think what's now separating this is this is going to be a completely separate implant from those companies that are implanted at the time of the initial spine surgery.
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B
I see.
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C
And is it a.
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B
It's a different product too, right?
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A
Correct. Yeah. So it's going to change the landscape. Right now for the proof of concept study, they actually use the Abbott stimulating device. But in the, in the behind the scenes they've been developing their own. That when they now launch the truth. So there was a proof of concept study, but now when we launch the real study in the US we're gonna. They're gonna be using their own product. Who's.
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B
Who's the new product coming from?
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A
It's going to be labeled under Centrifuge. In other words, they worked on the, developed it, you know, ran it through the FDA patents, the whole thing. So it's how another company is going to get to compete with the big dogs.
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B
I was gonna say now we're putting that hat on. Still on. Now we're talking about David with Goliaths. Right. And how. What does that look like? That just seems so ominous as I know a little bit about the space to be dangerous. But competing with those big players that have such strong positions from an R D perspective, from a marketing sales perspective, already have huge coverage, not to mention their government connections and stuff like that. What does it look like to. To compete against those forces?
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A
You're absolutely right. It's a David and Goliath. And that's why we've had many small companies that have tried to compete in this space. And some of them, they get through, they have little breakthroughs, but they're not capturing all the market share. It's very hard to compete with these companies that have unlimited resources for marketing, for a salesforce to go out and sell to physicians and to patients. When you're a smaller company and trying to build your way up, your resources are a little scarce. But I think what's going to help Centrifuge as they launch is their FDA approval will be specifically for this, which those other big companies don't carry that type of FDA approval. So it's going to give at least a good shot at them in the beginning. Because eventually what's going to happen is those companies are going to find a way to piggyback with the FDA of how they can get an approval to do the same thing. But there's going to be at least a several year period where centerfees is going to have the opportunity to grow before that can happen.
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B
It feels like there might be an acquisition possibility as well. But I think the most exciting opportunity.
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A
Though is that entrepreneurial hat you have on there. Because that's exactly how some of us think as well.
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B
Well, yeah, it's a build versus buy as we talk about in the tech world. Right. So we can try to outdo you and work on an FDA thing at the same time, or we can buy you. But I feel like if you can get across a message that's unique and you already have the support that gives the hospitals and the doctors confidence, I would think your conversations with those neurosurgeons are that specialize in back would be pretty positive.
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A
Yes, absolutely. I think this has the opportunity to completely change the landscape of how we look at back surgery, even on neurosurgeons and even orthopedic spine surgeons, which are very similar in our space, how we look at patients. The little background on that is, you know, we've had spinal fusion surgeries for well over 50 years. It's become like the hallmark case for a spine surgeon.
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B
Obviously right around the time of spinal tap, we had the spinal surgeries.
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A
Yeah. But what I will say is the spinal fusion surgery has come under scrutiny is probably the best way to put it. And insurance coverage has decreased for it over the last 10 years. The question, you know, the. There was a New York Times article and I think it was 2016, that question, why are we still doing useless spine surgery? Because the, you know, when we start talking about, well, we have 50 to 70% success rates, but a 30 chance we could make you worse or not help you, you know, it's. Those are not necessarily fantastic numbers. And then insurance companies started saying, well, we're not going to pay the top dollar that we've been paying for this all these years. So I think even the spine surgery community is starting to feel the pressure from that. So I think the neurosurgeons and the orthopedic spine surgeons are geared up to look for something that's going to improve their outcomes and that healthcare dollars want to be used for. And I think this is going to change that. I think this is going to bring spine surgery back into a nicer light.
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B
Is there something about your role as a neurosurgeon, a doctor that works on these things all the time, that has. Has changed your thinking a little bit? Like as opposed to, you know, diagnosing and treating these patients and being focused on successful surgery. Now you're trying to think of, of innovative ways to increase that performance, increase those results in a different way.
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A
That's exactly the best way to look at it. I will tell you. We talked about these aha moments and I'm unique as a neurosurgeon in that I was actually dual trained in not just complex spine, which means screws and rods in the whole spine, but also what we call functional neurosurgery, which is all minimally invasive techniques. It's all about putting electrodes anywhere in the brain or the spinal cord to treat disorders. And believe it or not, all these ideas of putting electrodes in are very minimally invasive approach. When we put in a spinal cord stimulator, that's usually like a 45 minute procedure. The patients go home the same day and we usually tell them to take it easy for one to two weeks. Now you want to put that into comparison to a spinal fusion, which can take four hours in the operating room, several days in the hospital, three months of recovery with rehab. You know, that's very vastly different when you look at these procedures. And one of those aha moments for me was I was dual trained. So I came out thinking, I'm going to be doing fusions, I'm going to be doing electrodes, it'll be half and half. And I quickly realized in my practice that these patients that we were putting stimulators in were having the same, if not better success rates than the fusions. And we were doing it in like a very minimally invasive way where they're going home the same day. So I'm actually really happy because I've been at this a long time. I probably don't look as old as I am, but I've had this a long time. And it's such an enlightening experience to see us get to the point where we are now, where we're starting to talk about combining these two and improving our outcomes.
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B
We talk about the spine surgery. That's about as scary as heart and brain surgery. Maybe not quite as, but it's pretty close. The spine is everything. And I hear about these people with, you know, the spine injuries and the spinal cord and the. What was it? Somebody had a back surgery or he had a leaky spine.
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A
We call CSF leak or spinal fluid leak. Yeah. And it was risk.
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B
Yeah, that's some serious stuff because that threatens your ability to even walk.
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A
Yeah. And I will say too, like One of the challenges we've always faced with trying to put these electrodes in after They've suffered for seven to 12 years of chronic pain is, you know, they went through this big spine surgery with the thought process they were going to be cured.
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B
Yeah.
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A
So after they go through this big surgery, this big recovery, they may or may not have a complication like you said, then trying to even introduce to them, well, we have this minimally invasive 40 minute procedure that's very safe and none of those risks that we were talking about. But then they're still thinking, nope, you're touching my spine. So it actually makes it very hard sometimes to convince these patients to think about another procedure. Even though small or minimally invasive, it is once they've gone through that experience. So you're absolutely right.
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B
What's it take to see this become pervasive, this, this process, this treatment and to make it so easy now to help people eliminate that, that spinal pain, that back pain?
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A
Yeah, I, I think it's going to take time. I think the, you know, in our space we talk about pain management. You know, so the mix in between all those orthopedic spine surgeons and neurosurgeon is what we call the interventional pain physician. They're the ones you think about who do injections in the spine. They do what they call nerve blocks in the spine or another one's what they call ablations or burning of the nerves in the spine. All these things to try to help your nerves not be in so much pain.
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B
Right.
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A
A lot of their goal is to try to prevent you from having surgery and see if they can hold you off and treat your pain so that you can function. So they're like, kind of like a little gatekeepers in our community. I think if we can get this to the point where we also have loosely say the buy in of the fame physicians, where the pain physician's entire job was essentially to try to keep patients away from spine surgeons and, you know, do their minimally invasive approaches to try to hold you off. If we can get to the point now where we actually have such great success rates, low adverse events with these surgeries, where we're combining spine surgery with, with the stimulators, I think we're going to the gatekeepers, those interventional pain physicians will actually start sending more patients earlier on.
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B
I can't, I can't wait to keep an eye on this now. This is exciting to me. So Center Fuse is a privately held company. It's not owned by, it's it's you. And how many other people are involved in the company?
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A
I'm, I'm like a medical advisor for the company. Right. I've helped them with the proof of concept study. Yes. But yes, they are a privately held company.
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B
How many people there do you know?
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A
I would say there's about 15 people total. Look at their advisors and physicians and workers.
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B
Yeah. And where are they in terms of their, you know, launch into the market there?
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A
That procession, the hope is within the next month or so, maybe two months, we're going to launch the large US Study, which is basically going to include like as many as 20 or 25 sites or hospitals in the country. So that's going to begin as early as next year.
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B
That's exciting. This is go time.
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A
This is gonna, this is exactly the time. This is now. You know, within the next year they're gonna have instead of 20 patients implanted. We're probably looking at 100 or more.
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B
So 100 patients are going to get these electrodes. Yeah. And then, then we're going to test and say, hey, how much is your pain better? Because it's not a zero sum thing. Like all of a sudden I'm 100%.
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A
Right, right, exactly.
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B
There's some major improvement, though. It's a, it's a significant, you know, a reaction to the surgery that makes me feel like I've, I've done something intelligent here and my insurance company will be happy to write you a check.
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A
That's the hope. But yeah, this is definitely a go time because once the study launches, it'll probably be done within a year at the most, and then that is analyzed, submitted to the fda. So you're talking about year, year and a half. This is going to become mainstream.
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B
So listen, I know money and price and all that is, is crazy to figure out, but what's it cost then? What's it. Something like this cost versus, you know, the oppo, the alternative?
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A
Well, I mean, if you actually look at the, the cost to healthcare dollars when these 30% of patients come out in chronic pain, and then, you know, those are the patients that are put on opioids, have endless physical therapy, endless injections and nerve blocks, and you know, the amount of healthcare dollars they consume can be, can be tremendous. I mean, opioids and nerve medications alone can cost as much as $10,000 a month to an insurance company. That's not including the therapy, that's not including the injections with the pain. You know, so with these stimulators, there is what's considered A large upfront cost, but that cost is usually in the range of 10 to $20,000 to pay for these implants. However, if you can decrease the amount that they use moving forward, it would be a tremendous savings to healthcare dollars.
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B
It feels like it. Although I would feel awkward telling people I'm going to get implants. But anyway, that's a whole nother topic, Doc.
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A
What?
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B
So I don't think anybody minds getting rid of opioids for a while. I mean, the Sacklers have made their money and we can move on from opioids. I know you have to, you have to prescribe where you have to prescribe, but that's, that's became an epidemic. But what about things like chiropractic services? Are you, do you support that for certain uses? I know it's, that's a little bit different because they don't work necessarily, you know, on spinal surgery type of, of issues. But it's related, right?
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A
Yeah, no, absolutely. And, and I do support a lot of the. What we consider. This is what we consider conservative measures, things like physical therapy, chiropractors, acupuncture, aqua therapy. And I am definitely a big fan of those. As long as at some point some physician has analyzed your spine to determine that that's the direction you should go. Because the one thing we always, I always have to have my neurosurgeon cap on is there are people who are always going to have to have spinal fusions because they have nerve compromise. If we don't intervene in the next year, you may crush that nerve and not be able to walk again. You know, so, you know, we see things like that on imaging and patients that may not be happening at this moment. So that's what we would call nerve compromise. There's also patients, if their arthritis gets bad enough, they have an unstable spine where their bones are physically moving and in danger of hitting the nerves. So, you know, we have to look at things like that and know that there's always going to be a reason for spinal surgery. So.
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B
So here's another weird question out of the left field, but I mean, you went into neurosurgery and neurology is such a fascinating area, almost like incomprehensible to me, but. And most lay people. What made you go into the back injury or the back spinal kinds of issues? I know there's so much being done in Alzheimer's and Parkinson's, which is also falls under neurology. Right. And then a lot of other brain kind of disorders or injuries.
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A
Yeah, it's funny that you. So as a functional neurosurgeon, if you remember, I trained. I did a fellowship, an extra year of training after my regular training in what we call functional neurosurgery, which is putting electrodes anywhere in the body, the brain, the spinal cord. So I actually spent the first 10, 12 years of my career also doing Parkinson's dementia tremor, where we put electrodes in the brain.
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B
Yeah.
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A
But the, the most common way we use electrodes was actually on the spine. And one of the things I realized is that that part of my practice just kept continuing to grow and grow. So it's much more common to actually get electrodes in the spine than it is to get them in the brain. But it's funny that you asked that, because that's exactly what I did for the first 12 years of my career is I had a mix of general neurosurgery, which included spinal fusions. That also included taking out brain tumors. But then also I was trying to specialize in these electrodes. So I was treating Parkinson's. They call them deep brain stimulator electrodes or the electrodes on the spine. It's just over time in my, as my practice evolved, it sort of got more and more just the, the spine portion.
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B
Do you still follow the, the, the technology that's being developed for things like Parkinson's and. Amazing, right?
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A
Yeah, the technology is. It's just, you know, everything grows rapidly and it's exponential because, you know, you think of how long it took to get to a certain point, you know, 10 years or 20 years of research. But now when we have AI and just better computer technology and all, like, things just explode so much faster now. And that space is, is growing very rapidly treating those, those patients.
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B
Yeah. How are you using AI today?
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A
Well, actually, that's funny you say that because with the spinal cord stimulators, what we're doing through these computer algorithms, or AI is figuring out what the best ways to stimulate the spinal cord are. Because if you think about its electricity, there are thousands of ways that we can adjust that and how the patient perceives it or doesn't perceive it. Our goal is actually to have it where the patient doesn't feel anything. They don't even feel that we're stimulating their nerves. So with AI now, what we're really like, these algorithms can read what the patient does their best on and start adjusting accordingly. We're actually getting to the point where we're going to probably pretty soon have what we call self automated programming right now, either Physicians or representatives from the company program these devices. And the patient only has the ability to say, turn up or down the volume. So they can turn up the stimulation a little bit. Turn it down, but they can't change any of the other. They can't change the channel.
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B
They tell you move, move L5 to L7 or anything like that?
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A
Well, no, exactly. Because these electrodes cover a vast portion of your spinal cord. So you can move to the top and leave the bottom. But as of now, the physicians do the programming or the representatives from the company. We're getting to the point where patients are going to have the ability to self program themselves. There's already a company out there that's actually starting to work on that.
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B
So like an intuitive surgical for spinal surgery.
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A
Exactly. Yeah.
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B
That's fascinating. So is your job in jeopardy now, doctor?
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A
No, I don't think so. You're always going to need someone to get it in.
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B
Well, we talk about intuitive surgical, we talk about AI reading it, and then the patient managing is another world that's fast approaching. But yeah, glad you still have a job for the foreseeable future. I think this is really exciting. I think what's, what's happening right now and you underscored it with what you're doing at centerfews. It's just really exciting for people. Makes me wish I, I were a little bit younger. I have a longer future. But I think what, what you're offering now is a lot more pain free as you move into your older years and getting rid of a lot of that. I hope you have tremendous success bringing this out to more and more people.
- [31:35]
A
Oh, that would be the idea. Thank you for that. You know, you said the older. I don't want to digress too much, but you said the older patients. Older patients aren't candidates for spinal fusions and the big open surgeries, but they are still candidates for these minimally invasive procedures. So there's no reason why even in your 80s that you should be living in chronic pain if we have therapies to help you.
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B
No, I think that's a great point. Especially given that people now have an expectation to live 10 years beyond or whatever.
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A
Yeah, absolutely.
- [32:04]
B
So fantastic. Any, any parting words you want to share, doctor, with the audience here?
- [32:10]
A
No, I think this, I think this has been great. I love trying to get the word out. And one of the things I hope it comes out is I'm very passionate about neuromodulation, the idea of stimulating nerves. It's why I went into Neurosurgery because when I chose neurosurgery residency coming out of med school, it was because I was fascinated by all the cutting edge stuff about electrodes going here and there. And you gotta remember this is back in 2004 when I, when I made this career choice. We are not where we are. With the advent of AI and everything now, this was just a thought process of, well, maybe we could put an electrode in the brain or maybe we, you know, we can get these better ones on the spine. So I am very passionate about it. And like, I, I want people to know that these therapies work well and that they, they should definitely, if they think they're a candidate for it, they should find physicians who will offer it. But my ultimate goal is just to get knowledge out there on these therapies.
- [33:04]
B
So it sounds like a fantastic area for you and a great opportunity for people that are, are feeling the need. And there'll be more places available and more patients going through this process. So good luck with the tests that are coming up and, you know, getting more and more people feeling, you know, pain free.
- [33:25]
A
Thank you. That's the goal.
- [33:26]
B
That's the goal. Good stuff. Well, I'll let you get back to it. Thanks for your time.
- [33:32]
A
No problem. Could you maybe email me when you have the final product or.
- [33:36]
B
Yes, I absolutely will. And I will also mention, you know, the, the hospitals or anything else you'd like me to, to include in that.
- [33:46]
A
Okay, wonderful.
- [33:49]
B
All right, thanks, doctor. Good talk.
- [33:51]
A
Thank you.