WEBVTT - Massachusetts Making Push to Offset Trump’s Research Cuts

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<v Speaker 1>Bloomberg Audio Studios, Podcasts, Radio News.

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<v Speaker 3>We're here at Boston Children, so we're going to come

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<v Speaker 3>back to some conversations in just a moment, but we

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<v Speaker 3>also want to touch on a story that's so relatable

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<v Speaker 3>to many of the institutions here in Boston and really

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<v Speaker 3>I feel like around the country anything that's focused on healthcare,

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<v Speaker 3>medicine and biotech.

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<v Speaker 4>Team business leaders, investors and academics of cheered Massachusetts Governor

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<v Speaker 4>Mara Healey's efforts to counter the Trump Administration's research funding

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<v Speaker 4>cuts with state money, so much so that a meeting

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<v Speaker 4>earlier in the fall on the initiative required overflow seating

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<v Speaker 4>with more on the goal and where it sits right

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<v Speaker 4>now and whether this could actually be applied to other

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<v Speaker 4>states too. We are in Boston right now and we

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<v Speaker 4>have joined We're joined by Greg Ryan, he's Bloomberg News

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<v Speaker 4>Boston Money and Power reporter. He joins us on site

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<v Speaker 4>here at Boston Children's So you wrote about this last month.

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<v Speaker 4>The hope here that state funding could offset some of

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<v Speaker 4>the federal funding. Where does it stand right now?

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<v Speaker 5>It's still in limbo. So the governor proposed this over

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<v Speaker 5>the summer. She proposed four hundred million dollars to backfill

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<v Speaker 5>some of the Trump cuts. But lawmakers on Beacon Hill

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<v Speaker 5>here in Boston have been skeptical. They say, there's the

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<v Speaker 5>state has a lot of need right now. Yes, this

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<v Speaker 5>is usually important, the scientific research funding, but you know

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<v Speaker 5>it cuts with snap. There was a hearing on the

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<v Speaker 5>bill that took place in the middle of the shutdown.

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<v Speaker 5>They said there's a lot of need and they're not

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<v Speaker 5>sure how much money they should be devoting to this

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<v Speaker 5>right now.

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<v Speaker 3>Well that's interesting, all right, So take a step back.

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<v Speaker 3>Tell us what Governor Hewley, what her proposal is.

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<v Speaker 5>Sure, So she's she wants to take four d million

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<v Speaker 5>dollars in state funding, apply half of it to public

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<v Speaker 5>universities and public institutions to help them with their scientific

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<v Speaker 5>research funding, you know, help them with the cuts that

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<v Speaker 5>they've experienced because of what's happened in DC. And then

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<v Speaker 5>the other half of the money goes to private institutions,

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<v Speaker 5>so places like Harvard, Boston University, MIT, as well as

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<v Speaker 5>hospitals like Boston Children's.

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<v Speaker 4>So where in terms of of like offsetting the cuts,

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<v Speaker 4>would that cover one of what has been cut?

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<v Speaker 5>It would not know, it wouldn't wouldn't really even come close.

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<v Speaker 5>You know, hundreds of millions this year of loan just

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<v Speaker 5>in nah funding cuts. But the part of the the

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<v Speaker 5>purpose here and something the governor says a lot is

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<v Speaker 5>this sends a signal, this says sends she puts in.

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<v Speaker 5>Massachusetts backs these efforts. It sends a signals to scientists

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<v Speaker 5>just you know, stay here and do their research here.

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<v Speaker 4>Well, that's what I wanted to talk about. And then

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<v Speaker 4>you know, we think a lot about funding and the

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<v Speaker 4>context of Okay, well, if it's going to research, that

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<v Speaker 4>research will then ultimately potentially provide some sort of cure

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<v Speaker 4>or treatment or something. You know, it's an investment in

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<v Speaker 4>the future. But it's bigger than that. I think it

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<v Speaker 4>has to do with a local economy. It has to

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<v Speaker 4>do with a you know, if we're sitting in Boston

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<v Speaker 4>right now, I mean this is an area of the

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<v Speaker 4>country that's known for having biotech research, so some of

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<v Speaker 4>it goes into the private sector. Then ultimately that money

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<v Speaker 4>is used to pay people for the research. That money

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<v Speaker 4>is then spent in the local economy. So they are

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<v Speaker 4>knock on effects. They are repercussions of this pullback absolutely.

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<v Speaker 5>I mean eds and meds is it's known around here.

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<v Speaker 5>Hospitals and universities are a huge part of the economy

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<v Speaker 5>when other parts of the country are in recession. It

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<v Speaker 5>doesn't make our economy recession proof, but it really makes

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<v Speaker 5>it resilient, and it has over the years. But those

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<v Speaker 5>sectors are experiencing threats, really unprecedented threats right now based

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<v Speaker 5>on the funding environment. So that money, yes, it goes

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<v Speaker 5>to life save potentially life saving research, but it also

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<v Speaker 5>you know, it keeps jobs in the state, and it

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<v Speaker 5>has other economic activity as you mentioned.

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<v Speaker 3>Well, the other thing that everybody's so fearful of is, right,

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<v Speaker 3>a brain drain essentially, right, So people are like, okay,

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<v Speaker 3>well the funding isn't here. That's such a big part

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<v Speaker 3>of the medical community. I mean, you know doctors, I've

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<v Speaker 3>got doctors in the family. Like it's just that's a

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<v Speaker 3>big part of what they do, and if the funding

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<v Speaker 3>isn't here and the R and D isn't here, they

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<v Speaker 3>may go elsewhere. I mean, this has been a concern

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<v Speaker 3>about even you know, scientists and you know medical officials

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<v Speaker 3>and so and so forth, even leaving the United States,

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<v Speaker 3>right in terms of the money not being here.

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<v Speaker 5>Yeah, I've talked to hospital executives in Massachusetts and they

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<v Speaker 5>say countries like China, institutions and Europe, they're actively recruiting

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<v Speaker 5>researchers because they know they face a lot of uncertainty

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<v Speaker 5>here and they think they have a persuasive case to

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<v Speaker 5>bring them over.

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<v Speaker 3>Greg, I want to go back to what Governor Healy

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<v Speaker 3>has wanted to do because what's interesting is, and you know,

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<v Speaker 3>this is certainly part of the Bloomberg world for decades,

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<v Speaker 3>this idea of public private partnerships. It was not only

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<v Speaker 3>just public money, right, it was also involving private money

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<v Speaker 3>to help in her mission.

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<v Speaker 4>That's right.

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<v Speaker 5>So the legislation was set up a fund that would

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<v Speaker 5>bring in private philanthropic dollars to supplement the public dollars

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<v Speaker 5>and the idea of being there's a lot of energy

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<v Speaker 5>around supporting these institutions during this time, and so having

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<v Speaker 5>a central funnel to bring in all that money and

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<v Speaker 5>put it where it needs to go.

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<v Speaker 3>So what's the next step? What are we waiting? We

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<v Speaker 3>talked about this meeting where it was like no seats,

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<v Speaker 3>everybody was there. So where does it go or what's next?

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<v Speaker 4>So it's up to the legislature.

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<v Speaker 5>They had their initial hearing on the bill a few

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<v Speaker 5>weeks ago, so the next few months will be key.

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<v Speaker 5>I'm sure they'll be There'll be more hearings and I

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<v Speaker 5>think ultimately sometime next year, while makers will decide whether

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<v Speaker 5>this will pass and how much money they wanted to

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<v Speaker 5>vote to this effort.

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<v Speaker 4>Hey, well we have you. There's something else we want

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<v Speaker 4>to talk about, and it actually is related to what's

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<v Speaker 4>going on when it comes to funding. It's the Millionaire's

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<v Speaker 4>tax and.

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<v Speaker 3>Knew you were going to go there. It's a story

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<v Speaker 3>we were obsessed with when it came across the bloem.

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<v Speaker 4>Well it was actually we spoke yesterday with Vanessa Williamson,

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<v Speaker 4>who's a senior fellow and Government Studies at the Brookings Institutions.

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<v Speaker 4>She got this new book out that's about taxes, and

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<v Speaker 4>she mentioned the story and we knew it because we

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<v Speaker 4>had talked about your story on air a few weeks ago.

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<v Speaker 4>There's a tax of the ultra wealthy that Zorroon Mamdani,

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<v Speaker 4>the Democratic mayor elect of New York likes. It's kind

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<v Speaker 4>of being tested here, and the test here revealed that

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<v Speaker 4>it didn't make people flee the state.

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<v Speaker 5>What are the details so far, I should say, yes,

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<v Speaker 5>So this millionaire's tax, it's a four percent star tax

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<v Speaker 5>on income over a million dollars. It went into effect

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<v Speaker 5>in twenty twenty three, and in the past two years

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<v Speaker 5>it's brought in five point seven million dollars, which is

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<v Speaker 5>three billion dollars more than whailemakers had budgeted for. So

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<v Speaker 5>that's paid for everything from free meals at schools for

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<v Speaker 5>kids to it's the budget gap at the NBTA, the

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<v Speaker 5>local transit authority. It's coming quite handy during this time.

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<v Speaker 5>But you know, I've spoken to executives and business leaders

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<v Speaker 5>who warn, yes, it's bringing me in a lot of

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<v Speaker 5>revenue now, but they still believe. You know, the longer

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<v Speaker 5>this tax is in place, the more people are going

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<v Speaker 5>to move away.

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<v Speaker 4>And you know, again it was just important, Maye. It

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<v Speaker 4>doesn't attract people to the state or people are.

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<v Speaker 5>That movie that too, that too, but just having just

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<v Speaker 5>gone into effect a few years ago. You know, people myself,

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<v Speaker 5>kids in high school, they're going to wait till their

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<v Speaker 5>kids are out of school to move. So the data

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<v Speaker 5>isn't in yet to see how it's affecting migration in

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<v Speaker 5>and out of Massachusetts. But in terms of revenue, it's

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<v Speaker 5>been a success story so far.

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<v Speaker 3>I got to say, I feel like people go where

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<v Speaker 3>the jobs are ultimately and kind of deal with everything else.

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<v Speaker 3>And if it's a good economy, is strong economy, there's

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<v Speaker 3>great jobs, they're going to go there. Just got about

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<v Speaker 3>a minute or so, or just forty five seconds before

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<v Speaker 3>we go great. How would you describe you know, we

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<v Speaker 3>are constantly trying to figure out the economic outlook. How

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<v Speaker 3>is it feeling in Boston? What's the mood, what's the sentiment?

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<v Speaker 5>You know, things are a little people are little pessimistic

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<v Speaker 5>right now, to be honest with you, such as as

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<v Speaker 5>Taxpayers Foundation just came out with a report that the

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<v Speaker 5>state was dead last in job growth for private job

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<v Speaker 5>grop over the past year. At the same time, you know,

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<v Speaker 5>we have Harvard, we have MIT, we have institutions like

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<v Speaker 5>this that the fundamentals are great but you know, the

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<v Speaker 5>economy is struggling.

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<v Speaker 4>A bit at the moment.

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<v Speaker 3>All right, interesting to know, med and ed, meds and eds,

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<v Speaker 3>meds and eds. I'm going to remember that. So glad

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<v Speaker 3>we could catch up with you. Thanks for joining us

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<v Speaker 3>here too at Boston Children's Bloomberg News, Boston Money and

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<v Speaker 3>Power port of Greg Ryan.

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<v Speaker 4>Stay with us. More from Bloomberg Business Week Daily coming

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<v Speaker 4>up after this.

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<v Speaker 2>You're listening to the Bloomberg Business Weekdaily podcast. Catch us

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<v Speaker 3>And I've got to say, one of the most rewarding

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<v Speaker 3>aspects of what we do here at Bloomberg Business Week

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<v Speaker 3>Daily is when we get to actually come out of

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<v Speaker 3>the office and go to different places, step out of

0:09:02.200 --> 0:09:06.000
<v Speaker 3>the studio, dive into another world. We are so entrenched

0:09:06.040 --> 0:09:10.880
<v Speaker 3>when it comes to Wall Street, Main Street, Washington Money

0:09:10.880 --> 0:09:13.360
<v Speaker 3>and markets, how it exchanges with everything, but it's also

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<v Speaker 3>a great reminder that there's just so much going on

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<v Speaker 3>around the world that certainly affects people across the country,

0:09:18.840 --> 0:09:21.439
<v Speaker 3>across the world. And also there's always an investment or

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<v Speaker 3>a money played into it. Let's kick off our coverage.

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<v Speaker 3>We are at Boston Children's. It is the world's largest

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<v Speaker 3>pediatric research enterprise. It is the leading recipient of pediatric

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<v Speaker 3>research funding from the National Institutes of Health. It is

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<v Speaker 3>a primary pediatric teaching hospital for Harvard Medical School. Treats

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<v Speaker 3>more children with rare diseases and complex conditions than any

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<v Speaker 3>other hospital. Delighted to kick off our coverage here on

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<v Speaker 3>this Friday with doctor Joan La Rovair. She a senior

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<v Speaker 3>vice president Interim Chief Medical Officer at Boston children She's

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<v Speaker 3>also co founder and president of the NGO, the Virtue Foundation,

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<v Speaker 3>which when we talked to her last time, we reminded

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<v Speaker 3>you all that it's delivering healthcare and over twenty five countries,

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<v Speaker 3>so global. Doctor Lea Rivera, it's so nice to have

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<v Speaker 3>you here. Last time you came to our home. Now

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<v Speaker 3>we came to your home. Thank you, Thank you so

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<v Speaker 3>much for having us.

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<v Speaker 6>We're so happy to have you here with us.

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<v Speaker 3>It's really delighted, and you know, we are delighted to

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<v Speaker 3>be here. Like we walk in and you feel something.

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<v Speaker 3>And anybody who's had a kid in a hospital or

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<v Speaker 3>visited a young one. It's tough, and I'm sitting in

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<v Speaker 3>this space. Tell us where we are, because anyone kids

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<v Speaker 3>have to deal with things. It's tough, and it sounds

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<v Speaker 3>like this is a place that just makes it maybe

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<v Speaker 3>a little easier.

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<v Speaker 6>That's exactly what this place is designed for. We're in

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<v Speaker 6>the hail roof garden on the tenth floor of the

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<v Speaker 6>home building. The cardiac I See You that I work

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<v Speaker 6>in is two and three floors below us, because we

0:10:41.640 --> 0:10:45.560
<v Speaker 6>covered two floors our cardiac I See You. And we

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<v Speaker 6>need spaces like this for families to be able to

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<v Speaker 6>step away and really, you know, think and decompress, and

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<v Speaker 6>for staff. You know, these are very challenging, complex patients

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<v Speaker 6>that we're taken care of in this building. Our neonatal

0:11:01.480 --> 0:11:04.680
<v Speaker 6>intensive care unit is here, or Cardiac I See You

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<v Speaker 6>is here. We have operating rooms in this building. You know,

0:11:09.120 --> 0:11:12.559
<v Speaker 6>there's a lot of the cap labs are here. So

0:11:12.960 --> 0:11:16.200
<v Speaker 6>it's wonderful that we can have these magical spaces where

0:11:16.200 --> 0:11:18.920
<v Speaker 6>you can just feel that you're in a pedi after

0:11:19.040 --> 0:11:21.640
<v Speaker 6>hospital and there's a place to relax and think.

0:11:21.840 --> 0:11:25.080
<v Speaker 3>Can I just say it's like you're sitting on a tree,

0:11:25.280 --> 0:11:27.600
<v Speaker 3>like a tree bench there's like, I don't know, is

0:11:27.640 --> 0:11:29.600
<v Speaker 3>this a rainbow. It feels like above us. It's pretty

0:11:29.640 --> 0:11:30.960
<v Speaker 3>it's pretty cool, you know.

0:11:31.679 --> 0:11:34.640
<v Speaker 4>Carol mentioned the energy that we feel when we walk

0:11:34.679 --> 0:11:38.560
<v Speaker 4>into a space such as Boston Children's and we're reminded

0:11:38.559 --> 0:11:42.120
<v Speaker 4>that it's not just a teaching hospital, a research hospital.

0:11:42.120 --> 0:11:45.520
<v Speaker 4>It's also a place that treats kids from really all

0:11:45.559 --> 0:11:49.760
<v Speaker 4>over the world. And I'm wondering how you prioritize where

0:11:49.960 --> 0:11:53.440
<v Speaker 4>resources go, whether it goes to treating patients right now

0:11:53.640 --> 0:11:58.720
<v Speaker 4>versus thinking about research, thinking about development, thinking about ways

0:11:58.760 --> 0:12:01.960
<v Speaker 4>to actually help patients in the future, versus working with

0:12:02.080 --> 0:12:05.319
<v Speaker 4>them right now. How do you allocate those resources?

0:12:06.360 --> 0:12:08.760
<v Speaker 6>Well, that has always been part of the DNA of

0:12:08.920 --> 0:12:14.120
<v Speaker 6>Boston Children's Hospital. It's been our mission. We deliver the highest,

0:12:14.240 --> 0:12:20.160
<v Speaker 6>best quality clinical care. Really, that is the foundation of

0:12:20.200 --> 0:12:23.520
<v Speaker 6>it all. And you see that, you know, the motto

0:12:23.520 --> 0:12:26.320
<v Speaker 6>of where the world comes for answers. There's a lot

0:12:26.320 --> 0:12:31.120
<v Speaker 6>of complex patients from the Boston area of Massachusetts, New England. Obviously,

0:12:31.120 --> 0:12:35.840
<v Speaker 6>we provide primary services for all levels of care for

0:12:35.960 --> 0:12:39.760
<v Speaker 6>children in this community. However, there are many from across

0:12:39.760 --> 0:12:43.080
<v Speaker 6>the United States and across the world who really seek

0:12:43.320 --> 0:12:46.960
<v Speaker 6>that type of care and come to us usually the

0:12:47.000 --> 0:12:50.120
<v Speaker 6>most complex cases, and I think that's really where we thrive.

0:12:50.880 --> 0:12:54.320
<v Speaker 6>And the other piece of our DNA is the science

0:12:54.720 --> 0:12:57.079
<v Speaker 6>we as you talked in the beginning.

0:12:57.480 --> 0:12:59.800
<v Speaker 3>That makes a difference, right when there's science involved. I

0:13:00.040 --> 0:13:03.680
<v Speaker 3>feel like it's practitionally, yes, you're dealing with patients, but

0:13:03.720 --> 0:13:05.440
<v Speaker 3>it's people who are like, I want to understand how

0:13:05.480 --> 0:13:06.000
<v Speaker 3>this works.

0:13:06.559 --> 0:13:10.360
<v Speaker 6>That's everybody here. Yeah, that's the doctors, that's the nurses,

0:13:10.440 --> 0:13:14.560
<v Speaker 6>that's the social workers, that's the physical therapists, that's the

0:13:14.600 --> 0:13:19.640
<v Speaker 6>respiratory therapist, it's the pharmacist. I just could keep going.

0:13:20.040 --> 0:13:23.079
<v Speaker 6>So I think that's what's what draws people to work

0:13:23.120 --> 0:13:26.960
<v Speaker 6>here and to stay here, because that purpose that we're

0:13:27.000 --> 0:13:29.600
<v Speaker 6>gonna actually change things and we're going to be able

0:13:29.640 --> 0:13:31.719
<v Speaker 6>to find newer ways of doing things. We're going to

0:13:31.760 --> 0:13:36.480
<v Speaker 6>help more children survive but also thrive, and that takes

0:13:36.520 --> 0:13:39.600
<v Speaker 6>a real concerted effort, and you need the science here

0:13:39.640 --> 0:13:39.920
<v Speaker 6>with the.

0:13:39.880 --> 0:13:41.800
<v Speaker 3>Clinical One of the things I think when you joined

0:13:41.800 --> 0:13:44.400
<v Speaker 3>Tim and I back in New York and listen, everybody's

0:13:44.440 --> 0:13:46.800
<v Speaker 3>talking about AI and I know that, but I think

0:13:47.559 --> 0:13:50.080
<v Speaker 3>we all are thinking about what it could do for

0:13:50.280 --> 0:13:53.920
<v Speaker 3>medicine and R and D and innovation. And I guess

0:13:53.920 --> 0:13:56.640
<v Speaker 3>what we're trying to understand too, is what's the reality

0:13:56.800 --> 0:14:00.960
<v Speaker 3>of what AI is used within the medical community or

0:14:01.120 --> 0:14:04.080
<v Speaker 3>R and D specifically, like where is it today? And you,

0:14:04.160 --> 0:14:08.040
<v Speaker 3>as someone who understands this space so well, and I'm

0:14:08.040 --> 0:14:09.920
<v Speaker 3>curious the conversations you guys have, where do you think

0:14:09.920 --> 0:14:12.800
<v Speaker 3>it could go? Well?

0:14:13.000 --> 0:14:15.760
<v Speaker 6>AI has been a very important part of Boston Children's

0:14:15.760 --> 0:14:19.480
<v Speaker 6>Hospital for a long time. This isn't something new. We

0:14:19.680 --> 0:14:24.640
<v Speaker 6>have incredible research groups and an incredible innovation team here

0:14:24.920 --> 0:14:28.840
<v Speaker 6>who've been really standing up AI initiatives for a very

0:14:28.880 --> 0:14:31.240
<v Speaker 6>long time. We talked about some of the work I

0:14:31.320 --> 0:14:33.880
<v Speaker 6>personally have done in terms of you know, Virtue Foundation

0:14:34.000 --> 0:14:36.480
<v Speaker 6>and the Global Health AI mapping and being able to

0:14:36.520 --> 0:14:37.880
<v Speaker 6>match resource and need.

0:14:38.280 --> 0:14:41.760
<v Speaker 3>You work with Yeah, firms that are like specifically in AI.

0:14:42.080 --> 0:14:44.160
<v Speaker 6>Yes, with theater brigs and data robac I you were

0:14:44.160 --> 0:14:47.720
<v Speaker 6>building those real platforms that people can use. But I

0:14:47.800 --> 0:14:51.480
<v Speaker 6>think about for example, when Chat GPT first came out,

0:14:51.560 --> 0:14:54.880
<v Speaker 6>we had Boston GPT immediately we were looking to get

0:14:55.160 --> 0:14:57.560
<v Speaker 6>that behind our firewalls. How can we integrate that, How

0:14:57.560 --> 0:15:01.640
<v Speaker 6>can we use that for real purpose and improve both

0:15:01.680 --> 0:15:03.320
<v Speaker 6>the care that we get to patients, But how can

0:15:03.360 --> 0:15:07.240
<v Speaker 6>we use AI to also discover new things. I think

0:15:07.320 --> 0:15:10.200
<v Speaker 6>the levels of data that we have, and I think

0:15:10.240 --> 0:15:13.400
<v Speaker 6>you talked upon in the beginning in terms of rare diseases,

0:15:13.520 --> 0:15:18.960
<v Speaker 6>genetic diseases, we are the epicenter of that, and we've

0:15:19.000 --> 0:15:23.640
<v Speaker 6>already been extremely successful in bringing new therapies to market

0:15:23.680 --> 0:15:27.760
<v Speaker 6>for children. But when I look at the infrastructure that

0:15:27.800 --> 0:15:30.320
<v Speaker 6>we're building, and I think you've had doctor Wendy Chung

0:15:30.400 --> 0:15:32.720
<v Speaker 6>come and speak and she's heading up a lot.

0:15:32.600 --> 0:15:33.160
<v Speaker 1>Of that work.

0:15:33.720 --> 0:15:36.200
<v Speaker 6>I think her best days are ahead of us, and

0:15:36.440 --> 0:15:38.960
<v Speaker 6>AI is unlocking that type of potential.

0:15:39.600 --> 0:15:42.200
<v Speaker 4>I like hearing that the optimism about our best days

0:15:42.200 --> 0:15:43.960
<v Speaker 4>being ahead of us. And I think about, just even

0:15:44.040 --> 0:15:46.680
<v Speaker 4>during your career, how much treatments have changed and in

0:15:46.720 --> 0:15:50.720
<v Speaker 4>a pretty short time. I'm curious about the connection between

0:15:50.800 --> 0:15:54.480
<v Speaker 4>kids and adults and treating children. And of course, if

0:15:55.160 --> 0:15:57.560
<v Speaker 4>kids are healthy, then they turn into healthy adults. But

0:15:57.920 --> 0:16:00.320
<v Speaker 4>this is a children's hospital that does a lot of search,

0:16:00.320 --> 0:16:03.680
<v Speaker 4>it does a lot of teaching. Also, are there learnings

0:16:03.680 --> 0:16:07.320
<v Speaker 4>that can be taken from what works with kids and

0:16:07.360 --> 0:16:10.640
<v Speaker 4>even applied to a larger population as not just those

0:16:10.720 --> 0:16:13.240
<v Speaker 4>kids grow up, but as adults also need treatment.

0:16:14.280 --> 0:16:16.800
<v Speaker 6>I think there's two points that strike me there. One

0:16:16.840 --> 0:16:20.520
<v Speaker 6>is that the decisions they were making early in life

0:16:20.760 --> 0:16:24.240
<v Speaker 6>have long term impact. It's something I've thought about my

0:16:24.480 --> 0:16:28.040
<v Speaker 6>entire career in the cardiac space and cardiac intensive care.

0:16:28.760 --> 0:16:31.840
<v Speaker 6>The decisions to have surgery on day two or day four,

0:16:32.320 --> 0:16:35.280
<v Speaker 6>the decisions to use this drug or that drug, all

0:16:35.320 --> 0:16:38.960
<v Speaker 6>of those things are shaping your long term self. But

0:16:39.080 --> 0:16:40.800
<v Speaker 6>it was very hard to be able to look at

0:16:40.840 --> 0:16:43.360
<v Speaker 6>and analyze that type of data until you've opened up

0:16:43.440 --> 0:16:47.280
<v Speaker 6>big data AI. So I think again along the lines

0:16:47.280 --> 0:16:49.960
<v Speaker 6>of our best days are ahead of us, that we're

0:16:50.000 --> 0:16:52.720
<v Speaker 6>going to be able to see so much more through that.

0:16:53.440 --> 0:16:56.880
<v Speaker 6>And then you said the innovations. Now many patients that

0:16:56.920 --> 0:17:01.240
<v Speaker 6>I took care of are adults. We have this huge

0:17:01.400 --> 0:17:06.880
<v Speaker 6>growing adult population that we provide care for. Science is

0:17:07.000 --> 0:17:10.760
<v Speaker 6>that's discovered here. It's in a pediatric hospital, but it's

0:17:10.800 --> 0:17:14.880
<v Speaker 6>bringing forth therapies they're actually treating adults. So I think

0:17:14.920 --> 0:17:18.879
<v Speaker 6>it's it's incredible to see how this innovation engine drives

0:17:18.960 --> 0:17:19.400
<v Speaker 6>so much.

0:17:20.600 --> 0:17:22.440
<v Speaker 3>If you could change one thing, just got about thirty seconds.

0:17:22.440 --> 0:17:24.320
<v Speaker 3>If you could change one thing in terms of the

0:17:24.400 --> 0:17:26.480
<v Speaker 3>work that you guys are doing and the r and

0:17:26.560 --> 0:17:30.000
<v Speaker 3>d that would maybe make it easier. What would it be.

0:17:31.720 --> 0:17:32.600
<v Speaker 6>Make it easier?

0:17:33.600 --> 0:17:37.639
<v Speaker 3>Okay, back word, if you could change one thing though,

0:17:37.800 --> 0:17:40.399
<v Speaker 3>that would help you guys and what you're working on.

0:17:40.440 --> 0:17:42.040
<v Speaker 3>It sounds like you don't need it. Sounds like you've

0:17:42.040 --> 0:17:43.440
<v Speaker 3>got a great team, and we have.

0:17:43.480 --> 0:17:48.200
<v Speaker 6>A great team, but we're always needing, you know, support

0:17:48.240 --> 0:17:54.520
<v Speaker 6>and engagement and we're just trying to drive the next

0:17:54.600 --> 0:17:58.840
<v Speaker 6>level and partnerships to move in that direction. We are

0:17:58.920 --> 0:18:01.919
<v Speaker 6>the leading children's ass but also we're doing well, but

0:18:01.960 --> 0:18:04.679
<v Speaker 6>we're always trying to push the envelope of what we

0:18:04.760 --> 0:18:05.119
<v Speaker 6>can do.

0:18:05.680 --> 0:18:08.000
<v Speaker 3>Yeah, it's fascinating. You could feel it. I felt, you know,

0:18:08.040 --> 0:18:08.639
<v Speaker 3>like walking in.

0:18:08.800 --> 0:18:10.040
<v Speaker 6>You can write the purpose.

0:18:10.119 --> 0:18:13.200
<v Speaker 3>It was busy, it was lots of families, lots of kids,

0:18:13.240 --> 0:18:15.480
<v Speaker 3>and yeah, everybody on a mission.

0:18:15.520 --> 0:18:17.520
<v Speaker 6>It's a privilege to be part of that mission.

0:18:17.760 --> 0:18:19.679
<v Speaker 3>Well, thank you so much, thank you, thank you for

0:18:19.680 --> 0:18:21.520
<v Speaker 3>inviting us, and good to get some more time with you.

0:18:21.800 --> 0:18:25.240
<v Speaker 3>Doctor Joan la Rovere. She is an interim Chief Medical

0:18:25.240 --> 0:18:28.679
<v Speaker 3>Officer at Boston Children's Hospital, Director of Innovation and Outcomes.

0:18:29.720 --> 0:18:31.000
<v Speaker 3>So delighted to talk with you.

0:18:32.400 --> 0:18:36.280
<v Speaker 2>This is the Bloomberg Business Week Daily Podcast. Listen live

0:18:36.359 --> 0:18:39.239
<v Speaker 2>each weekday starting at two pm Eastern on Apple car

0:18:39.359 --> 0:18:42.320
<v Speaker 2>Play and Android Auto with the Bloomberg Business app. You

0:18:42.359 --> 0:18:45.520
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0:18:45.600 --> 0:18:49.200
<v Speaker 2>New York station Just Say Alexa played Bloomberg eleven thirty.

0:18:50.600 --> 0:18:51.000
<v Speaker 4>We want to.

0:18:51.000 --> 0:18:53.320
<v Speaker 3>Continue from Boston Children's and with us now is doctor

0:18:53.400 --> 0:18:58.840
<v Speaker 3>Lissa Baird. She's director of Neurosurgical Oncology and co director

0:18:58.880 --> 0:19:01.920
<v Speaker 3>of the Brain Tumor Center at Boston Children's Hospital, joining

0:19:02.000 --> 0:19:04.879
<v Speaker 3>us here. I keep saying welcome, thank you, but I

0:19:04.920 --> 0:19:08.359
<v Speaker 3>realized thank you for bringing us here. Great to have

0:19:08.400 --> 0:19:10.560
<v Speaker 3>you here. Tell us about your world, like what is

0:19:10.600 --> 0:19:13.280
<v Speaker 3>it that you're dealing with on a regular basis, on

0:19:13.320 --> 0:19:14.600
<v Speaker 3>a daily basis.

0:19:14.560 --> 0:19:17.720
<v Speaker 1>Well, thanks for having me. I take care of kids

0:19:17.720 --> 0:19:22.720
<v Speaker 1>that have branch tumers and it's all ages. All ages, yeah,

0:19:22.920 --> 0:19:28.560
<v Speaker 1>from infants to really young adults, but all through childhood

0:19:28.960 --> 0:19:33.440
<v Speaker 1>and work with a phenomenal team here requires a huge

0:19:33.440 --> 0:19:35.440
<v Speaker 1>team to take care of these kids. They're very complex

0:19:35.520 --> 0:19:41.600
<v Speaker 1>diseases and we work on all aspects of them, so

0:19:41.720 --> 0:19:44.480
<v Speaker 1>active treatment. We do a lot of scientific research, we

0:19:44.560 --> 0:19:47.640
<v Speaker 1>run clinical trials. We really support these kids not only

0:19:47.720 --> 0:19:52.960
<v Speaker 1>through their therapeutic journal journey, but through survivorship and surveillance afterwards.

0:19:53.280 --> 0:19:55.040
<v Speaker 1>So it's a long journey for them and we really

0:19:55.040 --> 0:19:56.960
<v Speaker 1>try to support them at every stage.

0:19:57.000 --> 0:20:00.679
<v Speaker 4>How are clinical trials involving children different than clinical trials

0:20:00.720 --> 0:20:02.520
<v Speaker 4>involving other age populations.

0:20:04.200 --> 0:20:08.080
<v Speaker 1>Well, cancer in children is very very different. The diseases

0:20:08.119 --> 0:20:12.240
<v Speaker 1>are different, the implications are different, especially with brain tumors.

0:20:12.520 --> 0:20:14.639
<v Speaker 3>Why is that? Is it development because of where the

0:20:14.680 --> 0:20:15.400
<v Speaker 3>brain is or what?

0:20:15.640 --> 0:20:19.080
<v Speaker 1>Partially? I mean we're dealing with patients that have developing brains.

0:20:19.200 --> 0:20:21.879
<v Speaker 1>I mean there are very different implications for that. But

0:20:21.920 --> 0:20:25.560
<v Speaker 1>also the diagnoses vary quite a bit. You know, the

0:20:25.960 --> 0:20:28.640
<v Speaker 1>common diseases we see in childhood brain cancer are very

0:20:28.760 --> 0:20:32.639
<v Speaker 1>very different than that in adult cancer, and they require

0:20:32.640 --> 0:20:36.400
<v Speaker 1>different treatments and the support and you know, network needs

0:20:36.440 --> 0:20:38.440
<v Speaker 1>to be different. We have to support these kids through

0:20:38.480 --> 0:20:45.040
<v Speaker 1>developmental stages, through hormonal development, through cognitive development, emotional development.

0:20:45.840 --> 0:20:48.879
<v Speaker 1>You know, the family needs are different, and you know,

0:20:48.920 --> 0:20:54.000
<v Speaker 1>the diseases require very specific therapies. One thing historically that

0:20:54.040 --> 0:20:57.440
<v Speaker 1>has happened is because pediatric cancer has not been as

0:20:57.480 --> 0:21:02.040
<v Speaker 1>well supported. Historically, we have had to extrapolate data and

0:21:02.080 --> 0:21:05.360
<v Speaker 1>treatments from the adult world and it just doesn't.

0:21:05.080 --> 0:21:08.879
<v Speaker 3>Work, you know, I have a good friend and the

0:21:08.920 --> 0:21:12.560
<v Speaker 3>same thing. Her son went through it and unfortunately it

0:21:12.600 --> 0:21:15.440
<v Speaker 3>didn't work out well. But when she started doing research,

0:21:15.440 --> 0:21:18.120
<v Speaker 3>she realized it's just no money, no funding. And they

0:21:18.160 --> 0:21:22.520
<v Speaker 3>actually started a foundation to kind of but selling kids,

0:21:22.520 --> 0:21:25.760
<v Speaker 3>selling cookies and like, just to try and drum up

0:21:25.800 --> 0:21:29.240
<v Speaker 3>money and interest and attention. And we talk about it

0:21:29.240 --> 0:21:31.040
<v Speaker 3>with women that R and D like you just don't

0:21:31.040 --> 0:21:33.320
<v Speaker 3>see it as much and it's getting solely better, but

0:21:33.400 --> 0:21:37.720
<v Speaker 3>with kids, why is it that it's lagged in terms

0:21:37.760 --> 0:21:42.480
<v Speaker 3>of time and money and effort, not here obviously, but elsewhere.

0:21:43.160 --> 0:21:47.639
<v Speaker 1>Yeah, I mean, we definitely rely on philanthropy hugely to

0:21:47.680 --> 0:21:50.000
<v Speaker 1>make advancements in the field. But I think you know,

0:21:50.600 --> 0:21:56.440
<v Speaker 1>historically the numbers are lower. The financial support from government

0:21:56.480 --> 0:22:00.760
<v Speaker 1>has been different. It follows volume, as does industry. You know,

0:22:01.200 --> 0:22:06.440
<v Speaker 1>there's a complex, you know, complex reasons for that. But yeah,

0:22:06.680 --> 0:22:09.680
<v Speaker 1>there needs to be a shift and focus and more

0:22:09.680 --> 0:22:12.480
<v Speaker 1>attention on specific pediatric treatments.

0:22:12.920 --> 0:22:16.240
<v Speaker 4>We are talking a lot about treatments and it makes

0:22:16.240 --> 0:22:19.639
<v Speaker 4>me wonder about if we understand what causes this stuff

0:22:19.680 --> 0:22:22.720
<v Speaker 4>in the first place. And certainly treatments in recent years

0:22:22.520 --> 0:22:26.040
<v Speaker 4>have gotten so much better. In gene therapy, has gotten better,

0:22:27.680 --> 0:22:31.600
<v Speaker 4>but I'm wondering if we have an understanding in the

0:22:31.640 --> 0:22:34.720
<v Speaker 4>medical community about why some kids get sick and why

0:22:34.760 --> 0:22:35.240
<v Speaker 4>some don't.

0:22:35.640 --> 0:22:39.120
<v Speaker 1>Yeah, there have been huge advancements in pediatric brain tumors.

0:22:39.280 --> 0:22:41.560
<v Speaker 1>It's really one of the most exciting fields right now

0:22:41.560 --> 0:22:45.000
<v Speaker 1>because of how many things have really moved forward in

0:22:45.040 --> 0:22:47.480
<v Speaker 1>the field. And so we know so much more about

0:22:47.520 --> 0:22:51.160
<v Speaker 1>the biology of these tumors and the genetic underpinnings to them,

0:22:51.320 --> 0:22:54.840
<v Speaker 1>and can really drill down with each individual tumor to

0:22:54.920 --> 0:22:57.600
<v Speaker 1>find out what the molecular change has been in the

0:22:57.640 --> 0:23:00.399
<v Speaker 1>cells that is driving tumor growth. And that's really helped

0:23:00.480 --> 0:23:03.440
<v Speaker 1>us understand them and opened up a whole new field

0:23:03.680 --> 0:23:08.359
<v Speaker 1>of individual treatments. And so, you know, every tumor is different.

0:23:08.400 --> 0:23:10.719
<v Speaker 1>In some tumors, we've discovered that there may be a

0:23:10.840 --> 0:23:13.520
<v Speaker 1>cell of origin that the child is born with a

0:23:13.560 --> 0:23:16.000
<v Speaker 1>lot of tumors. We don't understand why some kids are

0:23:16.000 --> 0:23:20.160
<v Speaker 1>getting them and some don't. Some may have familial implications

0:23:20.200 --> 0:23:23.159
<v Speaker 1>and some may have environmental We don't understand everything, but

0:23:23.600 --> 0:23:25.639
<v Speaker 1>we're learning more and more every day, and we know

0:23:25.760 --> 0:23:28.400
<v Speaker 1>so much more about the individual genetics of the tumor.

0:23:28.520 --> 0:23:31.000
<v Speaker 4>Could we get to a point within our lifetimes where

0:23:31.200 --> 0:23:34.400
<v Speaker 4>there is some sort of screening for kids when they're

0:23:34.440 --> 0:23:37.639
<v Speaker 4>born or in their early days that helps identify what

0:23:37.720 --> 0:23:41.199
<v Speaker 4>they could be susceptible too, and then we could allow

0:23:41.320 --> 0:23:44.720
<v Speaker 4>for different different treatments ahead of that to prevent it

0:23:44.760 --> 0:23:45.600
<v Speaker 4>actually from happening.

0:23:45.840 --> 0:23:48.040
<v Speaker 1>Definitely, I think so. And it may not be for

0:23:48.119 --> 0:23:50.960
<v Speaker 1>every tumor, but I think we're already getting close to

0:23:51.000 --> 0:23:54.320
<v Speaker 1>that for certain diagnoses where we know specific things that

0:23:54.520 --> 0:23:57.960
<v Speaker 1>you know, we can potentially screen for, and we're finding

0:23:58.200 --> 0:24:03.280
<v Speaker 1>certain you know, germline mutation that are you know, familial hereditary.

0:24:04.720 --> 0:24:06.760
<v Speaker 1>So yeah, I think we may get to that point

0:24:06.800 --> 0:24:09.320
<v Speaker 1>where we're screening is better for all tumors, but we're

0:24:09.440 --> 0:24:11.320
<v Speaker 1>very close for certain types of tumors.

0:24:11.560 --> 0:24:14.800
<v Speaker 3>Is there differences in boys and girls when it comes

0:24:14.840 --> 0:24:17.720
<v Speaker 3>to either tumors or what impacts.

0:24:17.320 --> 0:24:20.280
<v Speaker 1>For some Yeah, for some diagnoses and some have you know,

0:24:20.359 --> 0:24:23.120
<v Speaker 1>greater percentages with boys and some with girls. It really

0:24:23.160 --> 0:24:25.800
<v Speaker 1>just depends on the diagnosis and many many it's equivalent.

0:24:26.080 --> 0:24:28.520
<v Speaker 3>I am also curious about, like you guys seem to

0:24:28.560 --> 0:24:30.400
<v Speaker 3>certainly take a family approach, and you have to when

0:24:30.400 --> 0:24:34.320
<v Speaker 3>it's kids, Like what's involved when you've got specific therapies

0:24:34.359 --> 0:24:37.840
<v Speaker 3>and it's not it's leading to the surgery or whatever

0:24:37.880 --> 0:24:38.439
<v Speaker 3>the treatment is.

0:24:38.440 --> 0:24:40.320
<v Speaker 1>In now, the treatment of these kids takes a village.

0:24:40.320 --> 0:24:45.840
<v Speaker 1>We have a huge multidisciplinary team. I mean we have neurosurgeons, neurooncologists, neurologists,

0:24:46.720 --> 0:24:51.199
<v Speaker 1>the neuropathologists, geneticists, neurediologists, and we also have you know,

0:24:51.240 --> 0:24:57.560
<v Speaker 1>the rehabilitation experts with physical occupational therapy, the neuropsychologists and endochronologists.

0:24:57.560 --> 0:25:01.639
<v Speaker 1>I mean, there are so many different expertise, you know,

0:25:01.720 --> 0:25:03.800
<v Speaker 1>fields that are required to take care of these kids

0:25:03.840 --> 0:25:06.720
<v Speaker 1>because brain tumors really affect every single aspect of their

0:25:06.760 --> 0:25:09.399
<v Speaker 1>life and have the potential to affect every aspect of

0:25:09.480 --> 0:25:14.359
<v Speaker 1>their physical and neurodevelopment. And so you know, we are

0:25:14.400 --> 0:25:16.840
<v Speaker 1>really fortunate here to have so much expertise that we're

0:25:16.880 --> 0:25:21.080
<v Speaker 1>able to really individualize the team needed for each specific child.

0:25:21.880 --> 0:25:25.600
<v Speaker 3>Thank you so much. This is heavy stuff. Thank you

0:25:25.640 --> 0:25:28.720
<v Speaker 3>so much. Really appreciate it. Doctor Lisabaert, director of Neurosurgical

0:25:28.960 --> 0:25:30.800
<v Speaker 3>on College and co director of the Brain Tumor Center

0:25:30.800 --> 0:25:32.680
<v Speaker 3>at Boston Children's Hospital. This is Bloomberg.

0:25:34.280 --> 0:25:37.040
<v Speaker 4>Stay with us. More from Bloomberg Business Week Daily coming

0:25:37.160 --> 0:25:38.040
<v Speaker 4>up after this.

0:25:41.760 --> 0:25:45.760
<v Speaker 2>You're listening to the Bloomberg Business Weekdaily Podcast. Catch us

0:25:45.840 --> 0:25:49.240
<v Speaker 2>live weekday afternoons from two to five pm Eastern. Listen

0:25:49.320 --> 0:25:52.879
<v Speaker 2>on Apple CarPlay and Android Auto with the Bloomberg Business app,

0:25:53.040 --> 0:25:54.800
<v Speaker 2>or watch us live on YouTube.

0:25:56.359 --> 0:25:58.800
<v Speaker 4>Well, let's get back to our depth look and conversations

0:25:58.840 --> 0:26:01.480
<v Speaker 4>about the work that's being done at Boston Children's Hospital.

0:26:01.520 --> 0:26:04.280
<v Speaker 4>That's where Carol and I are this afternoon. We kick

0:26:04.280 --> 0:26:07.000
<v Speaker 4>off this hour with doctor Ellen Grant. She's Director of

0:26:07.040 --> 0:26:11.400
<v Speaker 4>Fetal Neonatal Neuroimaging and Developmental Science here at Boston Children's Hospital.

0:26:11.720 --> 0:26:15.240
<v Speaker 4>Here she leads a seventy person neuroimaging and computational science

0:26:15.280 --> 0:26:18.000
<v Speaker 4>center that's working to develop tools to better detect and

0:26:18.080 --> 0:26:21.520
<v Speaker 4>understand brain physiology and development, all with the goal to

0:26:21.560 --> 0:26:25.879
<v Speaker 4>improve cognitive, behavioral, and neurological outcomes, not just in fetuses,

0:26:26.160 --> 0:26:29.080
<v Speaker 4>but in infants and toddlers and then of course ultimately

0:26:29.400 --> 0:26:31.680
<v Speaker 4>as they get older. Doctor Grant joins us on site

0:26:31.720 --> 0:26:34.679
<v Speaker 4>here at Boston Children's Hospital. Doctor Grant, welcome, How are

0:26:34.760 --> 0:26:35.360
<v Speaker 4>you very good?

0:26:35.359 --> 0:26:36.720
<v Speaker 3>Thank you thanks so much for having me.

0:26:36.840 --> 0:26:39.639
<v Speaker 4>Thanks for joining us. Brain imaging and children. If we

0:26:39.640 --> 0:26:42.200
<v Speaker 4>have a better understanding of the brain and fetal development

0:26:42.320 --> 0:26:44.840
<v Speaker 4>and for babies and toddlers. What will that allow us

0:26:45.080 --> 0:26:47.520
<v Speaker 4>to understand, what does it prevent, what does it treat?

0:26:48.080 --> 0:26:50.560
<v Speaker 7>Well, everything begins in uterul pretty much, so your life

0:26:50.640 --> 0:26:53.600
<v Speaker 7>is an arc from infancy or one you're conceived through

0:26:53.640 --> 0:26:57.080
<v Speaker 7>to adulthoods. So the more we can understand the early development,

0:26:57.080 --> 0:26:59.159
<v Speaker 7>the more we can start to understand how we make

0:26:59.160 --> 0:27:01.679
<v Speaker 7>sure children are on their trajectory. So the goal is

0:27:01.720 --> 0:27:05.000
<v Speaker 7>to characterize brain development very early on, so we tell

0:27:05.320 --> 0:27:07.600
<v Speaker 7>the very earliest point when to start to deviate from

0:27:07.600 --> 0:27:10.000
<v Speaker 7>a normal trajectory, so we can get things back on

0:27:10.080 --> 0:27:13.720
<v Speaker 7>track early as possible. And ideally we want in future

0:27:13.800 --> 0:27:16.040
<v Speaker 7>to be able to prevent diseases from happening, not just

0:27:16.119 --> 0:27:18.159
<v Speaker 7>try to you know, deal with them and try to

0:27:18.160 --> 0:27:20.359
<v Speaker 7>correct them later on when the damage is partly done.

0:27:20.440 --> 0:27:22.719
<v Speaker 3>So how early can we do it today and detect

0:27:22.720 --> 0:27:25.520
<v Speaker 3>that there's something wrong? How early, realistically do you think

0:27:25.560 --> 0:27:26.240
<v Speaker 3>we can get it to?

0:27:26.560 --> 0:27:31.359
<v Speaker 7>Yeah, we start looking at fetuses at about eleven fifteen

0:27:31.359 --> 0:27:33.600
<v Speaker 7>weeks something around there at the earliest, right closer to

0:27:33.640 --> 0:27:37.040
<v Speaker 7>around eighteen weeks. We start to characterize brain development, you know,

0:27:37.080 --> 0:27:39.800
<v Speaker 7>eighteen nineteen weeks or so, So it begins quite early

0:27:40.080 --> 0:27:42.720
<v Speaker 7>when we start to see and look at early brain development.

0:27:42.920 --> 0:27:44.880
<v Speaker 4>Well, you and your team did a study a few

0:27:44.920 --> 0:27:47.680
<v Speaker 4>years ago that gave your results to argue for earlier

0:27:47.840 --> 0:27:51.720
<v Speaker 4>MRI during pregnancy. Yeah, is that study enough to actually

0:27:51.800 --> 0:27:52.880
<v Speaker 4>change the standard of care?

0:27:53.480 --> 0:27:54.760
<v Speaker 3>Well, we do use.

0:27:54.640 --> 0:27:57.600
<v Speaker 7>It early here at Boston Children, So when there's an indication,

0:27:57.720 --> 0:27:59.520
<v Speaker 7>we do it as early as we can to better

0:27:59.600 --> 0:28:02.320
<v Speaker 7>characterize the entire fetus. Because it's not just the brain,

0:28:02.359 --> 0:28:04.159
<v Speaker 7>it's the body it's attached to too, So we want to

0:28:04.240 --> 0:28:07.560
<v Speaker 7>understand not just the brain development, how that brain is

0:28:07.560 --> 0:28:09.840
<v Speaker 7>developing the context of the other organ systems.

0:28:10.119 --> 0:28:12.040
<v Speaker 3>So we can do because it doesn't necessarily run hand

0:28:12.080 --> 0:28:14.480
<v Speaker 3>in hand, like, it can be very different, right or

0:28:14.840 --> 0:28:16.840
<v Speaker 3>like in terms of what's going on with brain development

0:28:16.960 --> 0:28:19.120
<v Speaker 3>versus the rest of the system, they can disconnect.

0:28:19.640 --> 0:28:22.800
<v Speaker 7>No, they're intimately connected in life.

0:28:22.840 --> 0:28:25.000
<v Speaker 3>So if there's one, yeah, so that's why we want

0:28:25.040 --> 0:28:25.520
<v Speaker 3>to understand it.

0:28:25.560 --> 0:28:27.159
<v Speaker 7>So the same For example, we deal with a lot

0:28:27.160 --> 0:28:29.920
<v Speaker 7>of congenital heart disease here that has effects from brain development.

0:28:29.920 --> 0:28:33.040
<v Speaker 7>We deal with congenital dive fromatic hernius that has effects

0:28:33.080 --> 0:28:36.320
<v Speaker 7>on brain development. So everything is happening in the fetus,

0:28:36.320 --> 0:28:38.200
<v Speaker 7>whether there's a brain or not. Is it has the

0:28:38.200 --> 0:28:40.200
<v Speaker 7>potential to have subtle effects on brain development.

0:28:42.040 --> 0:28:45.120
<v Speaker 3>Why do kids, I mean kids do need specialized tools

0:28:45.320 --> 0:28:47.280
<v Speaker 3>for brain imaging to ask us about that one.

0:28:47.360 --> 0:28:50.160
<v Speaker 7>Yeah, that's the whole reason that it came to Boston

0:28:50.240 --> 0:28:53.760
<v Speaker 7>Children's is industries not interested in fetuses and pints and

0:28:53.800 --> 0:28:56.640
<v Speaker 7>young children, so it's really hard to get devices that

0:28:56.680 --> 0:28:59.080
<v Speaker 7>are built specifically for these age range.

0:28:59.240 --> 0:29:01.680
<v Speaker 3>So that's why I brought a team of technical people.

0:29:01.720 --> 0:29:06.720
<v Speaker 7>So they're engineers, physicists, computer scientists, data scientists that help

0:29:06.840 --> 0:29:10.160
<v Speaker 7>to either develop the devices or come up with better

0:29:10.200 --> 0:29:13.800
<v Speaker 7>ways to analyze the data that we get with an

0:29:13.840 --> 0:29:17.640
<v Speaker 7>ion trying to understand pediactors ectric disorders. So for example,

0:29:17.720 --> 0:29:20.920
<v Speaker 7>we want to monitor and we're developing optical devices for

0:29:21.000 --> 0:29:24.080
<v Speaker 7>the nick you to monitor s freeble bloodflow. But the

0:29:24.120 --> 0:29:26.400
<v Speaker 7>heart of a heart rate of a neonate is one

0:29:26.480 --> 0:29:28.360
<v Speaker 7>hundred and fifty, so we have to sample at a

0:29:28.400 --> 0:29:30.320
<v Speaker 7>much higher rate than you would in an adult to

0:29:30.320 --> 0:29:33.080
<v Speaker 7>get the same information. So we have to build specifically

0:29:33.120 --> 0:29:35.960
<v Speaker 7>devices to the physiology. And then I can think of

0:29:36.000 --> 0:29:38.760
<v Speaker 7>ahead of a premature baby. It's very very small, so

0:29:38.800 --> 0:29:40.680
<v Speaker 7>I can't take a probe that we use in adults

0:29:40.720 --> 0:29:42.360
<v Speaker 7>and just put it on a pre term, so we

0:29:42.440 --> 0:29:46.160
<v Speaker 7>have to develop the devices to fit the size of

0:29:46.200 --> 0:29:46.760
<v Speaker 7>the infants.

0:29:47.080 --> 0:29:48.840
<v Speaker 3>I want to just go And I feel like we

0:29:48.920 --> 0:29:51.960
<v Speaker 3>touched on this earlier. I mean we are Bloomberg Business Week.

0:29:52.520 --> 0:29:56.080
<v Speaker 3>We are Bloomberg and very entrenched in financial markets. And

0:29:56.120 --> 0:29:58.200
<v Speaker 3>I feel like the more I've been doing this, money

0:29:58.280 --> 0:30:00.640
<v Speaker 3>just follows everything. Money is why people do things or

0:30:00.680 --> 0:30:03.440
<v Speaker 3>don't do things. Is that really it is just the

0:30:03.480 --> 0:30:05.280
<v Speaker 3>market I hate to even make it that way. The

0:30:05.320 --> 0:30:08.920
<v Speaker 3>market size and so you don't have medical equipment companies

0:30:09.120 --> 0:30:11.480
<v Speaker 3>building the things because they just don't think the market

0:30:11.560 --> 0:30:13.720
<v Speaker 3>size is big enough. That is a big problem. Yeah,

0:30:13.760 --> 0:30:14.040
<v Speaker 3>and I.

0:30:13.960 --> 0:30:15.880
<v Speaker 7>Think it's that's where we're trying to get into more

0:30:15.880 --> 0:30:17.760
<v Speaker 7>of a business perspective. Like if we start to do

0:30:17.840 --> 0:30:20.960
<v Speaker 7>a small startup that starts to answer those questions and

0:30:21.000 --> 0:30:23.560
<v Speaker 7>a bigger company might buy it. But if we stay

0:30:23.600 --> 0:30:26.760
<v Speaker 7>in the research realm, then it's sometimes really hard to

0:30:26.760 --> 0:30:29.720
<v Speaker 7>go that last mile and get something into clinical practice.

0:30:29.920 --> 0:30:31.560
<v Speaker 3>So how do you do that? How do you cross that?

0:30:31.640 --> 0:30:32.320
<v Speaker 3>So what do you do?

0:30:32.720 --> 0:30:35.360
<v Speaker 7>Yeah, this is what we're strategy strategizing on right now,

0:30:35.480 --> 0:30:37.040
<v Speaker 7>is trying to figure out how we do those small

0:30:37.040 --> 0:30:42.360
<v Speaker 7>startups get industry interested if and a lot of things

0:30:42.400 --> 0:30:44.680
<v Speaker 7>we're doing right now. Actually, one of the projects we're

0:30:44.680 --> 0:30:47.719
<v Speaker 7>working on is you know, AI strategies, right, and if

0:30:47.760 --> 0:30:51.480
<v Speaker 7>we can get enough data on infants or fetuses and

0:30:51.480 --> 0:30:53.680
<v Speaker 7>so on, we can start to build models that predict

0:30:54.000 --> 0:30:55.720
<v Speaker 7>not just group outcomes, but we want to get to

0:30:55.800 --> 0:30:58.600
<v Speaker 7>individual outcomes because that's what parents care about, right, So

0:30:58.640 --> 0:31:00.640
<v Speaker 7>if we can figure out get those models together.

0:31:00.800 --> 0:31:02.680
<v Speaker 3>So that's what we're working on now, is trying.

0:31:02.560 --> 0:31:05.760
<v Speaker 7>To create these AI models that are specialized for pediatrics

0:31:06.000 --> 0:31:08.360
<v Speaker 7>and hoping to do startups around that particular concept.

0:31:08.360 --> 0:31:10.640
<v Speaker 3>I have to ask one more quesident. Are venture capitalists interested?

0:31:11.240 --> 0:31:13.520
<v Speaker 7>I don't know because we haven't really talked about me

0:31:13.600 --> 0:31:15.840
<v Speaker 7>that I've heard about, but I think they always want

0:31:15.880 --> 0:31:17.000
<v Speaker 7>something that's almost ready.

0:31:17.040 --> 0:31:19.400
<v Speaker 3>So we're hoping to go further along. Yeah, a little

0:31:19.400 --> 0:31:21.240
<v Speaker 3>bit further along. Okay. Interesting?

0:31:21.320 --> 0:31:24.240
<v Speaker 4>Can what we learn and what you understand through imaging

0:31:24.280 --> 0:31:27.920
<v Speaker 4>about the brains development be applied to how adult brains

0:31:27.920 --> 0:31:28.400
<v Speaker 4>are treated.

0:31:30.160 --> 0:31:33.760
<v Speaker 7>Everything in adult life has its genesis in infants, right.

0:31:33.680 --> 0:31:35.760
<v Speaker 4>So we learn we're all there once.

0:31:35.960 --> 0:31:39.120
<v Speaker 7>Yeah, yeah, exactly, and some of the ways that adult

0:31:39.120 --> 0:31:43.000
<v Speaker 7>brain response is more prominent in a pediatric brain, so

0:31:43.040 --> 0:31:45.680
<v Speaker 7>in some disorders to go to pediatric models to see

0:31:46.160 --> 0:31:49.680
<v Speaker 7>a physiologist. More prominent in neonates or infants, but also

0:31:49.680 --> 0:31:50.640
<v Speaker 7>occurs in adults.

0:31:50.880 --> 0:31:53.560
<v Speaker 4>You know, there was a in doing the research. In

0:31:53.600 --> 0:31:56.000
<v Speaker 4>the prep for our interview with you, there is a

0:31:56.080 --> 0:32:03.120
<v Speaker 4>picture of a physician or a therapist doing some what's

0:32:03.240 --> 0:32:07.960
<v Speaker 4>I think is called therapeutic hypothermia too a brand new

0:32:08.000 --> 0:32:11.840
<v Speaker 4>baby's head. Yes, and my understanding is that oxygen deprivation

0:32:11.920 --> 0:32:15.120
<v Speaker 4>around birth is one of the leading reasons that you

0:32:15.200 --> 0:32:18.240
<v Speaker 4>actually see babies come into the Nike You.

0:32:18.520 --> 0:32:20.760
<v Speaker 3>Yes, that is one of the main reasons. Yes.

0:32:21.160 --> 0:32:24.200
<v Speaker 4>And the therapy for this is as simple as.

0:32:24.680 --> 0:32:26.640
<v Speaker 3>Yeah, you cool them down or down there.

0:32:26.680 --> 0:32:29.680
<v Speaker 7>The normal yeah, at least abnormal thermic is when they

0:32:29.680 --> 0:32:31.920
<v Speaker 7>have injuries. A response to that sort of the whole

0:32:31.920 --> 0:32:34.520
<v Speaker 7>physiological response to an injury is to have a fever,

0:32:35.000 --> 0:32:37.080
<v Speaker 7>and that is detrimental. So we want to keep them

0:32:37.080 --> 0:32:40.040
<v Speaker 7>cool so that they don't set off these cascades of

0:32:40.080 --> 0:32:42.960
<v Speaker 7>brain injury. And that's partly why we build this one device,

0:32:42.960 --> 0:32:45.880
<v Speaker 7>because we want to be able to monitor through the

0:32:45.960 --> 0:32:49.320
<v Speaker 7>nick you stay and optimize management. But it's interesting, we

0:32:49.360 --> 0:32:51.120
<v Speaker 7>don't even know what the great blood pressure for a

0:32:51.160 --> 0:32:53.520
<v Speaker 7>newborn is So this is why we wanted to have

0:32:53.640 --> 0:32:55.960
<v Speaker 7>a probe that could measures rebel blood flow to the

0:32:56.000 --> 0:32:58.880
<v Speaker 7>brain because there is no way to monitor whether there's

0:32:59.000 --> 0:33:01.840
<v Speaker 7>enough brain or sit and getting to the brain with

0:33:01.880 --> 0:33:03.040
<v Speaker 7>the tools that we have right now.

0:33:02.920 --> 0:33:04.640
<v Speaker 3>I feel like we don't even talk about blood pressure

0:33:04.680 --> 0:33:07.360
<v Speaker 3>when it comes to like infants, right, Yeah, we just don't.

0:33:07.920 --> 0:33:10.520
<v Speaker 3>But you need to know. You did your residency and

0:33:10.560 --> 0:33:14.120
<v Speaker 3>fellowship in the nineteen nineties. Curious how imaging has changed

0:33:14.160 --> 0:33:16.160
<v Speaker 3>since then, and then where do you think how will

0:33:16.200 --> 0:33:18.320
<v Speaker 3>it improve in the next I don't know, ten years.

0:33:18.480 --> 0:33:19.800
<v Speaker 3>You know what's a smart benchmark?

0:33:19.880 --> 0:33:20.080
<v Speaker 7>Yeah?

0:33:20.160 --> 0:33:20.440
<v Speaker 5>Yeah, I know.

0:33:20.520 --> 0:33:22.800
<v Speaker 7>When I was in training, NTMAR was just starting and

0:33:22.840 --> 0:33:25.600
<v Speaker 7>it was very slow. So where we come now is

0:33:25.760 --> 0:33:28.840
<v Speaker 7>the acceleration acquisition is just incredible. What used to take

0:33:28.920 --> 0:33:30.840
<v Speaker 7>us an hour to do we can do in ten

0:33:30.880 --> 0:33:33.520
<v Speaker 7>minutes now, So there was creed.

0:33:33.640 --> 0:33:35.240
<v Speaker 3>The speed of acquisition is huge.

0:33:36.120 --> 0:33:40.240
<v Speaker 7>Were also developing a lot of analysis that we can

0:33:40.280 --> 0:33:42.320
<v Speaker 7>do after the images are acquired to give us more

0:33:42.400 --> 0:33:45.600
<v Speaker 7>quantitative metrics, because the whole thing in medicine to get

0:33:45.640 --> 0:33:49.240
<v Speaker 7>past the qualitative read of a radiologist, which is helpful,

0:33:49.280 --> 0:33:51.040
<v Speaker 7>but we want to put more numbers on it, so

0:33:51.080 --> 0:33:53.360
<v Speaker 7>we can have a more dynamic range on how we

0:33:53.560 --> 0:33:56.760
<v Speaker 7>describe each child and this therefore we can get into

0:33:57.080 --> 0:34:00.880
<v Speaker 7>better precision medicine and open prediction. So we're getting more

0:34:00.920 --> 0:34:04.920
<v Speaker 7>to that quantitative aspect of imaging now, and not just

0:34:04.960 --> 0:34:07.120
<v Speaker 7>brain but all body parts of course, and you know,

0:34:07.280 --> 0:34:08.360
<v Speaker 7>down to feudel age.

0:34:08.440 --> 0:34:12.880
<v Speaker 3>Is it for kids to every case is very personal

0:34:13.080 --> 0:34:16.000
<v Speaker 3>and individual? Or are there trends and things that you

0:34:16.040 --> 0:34:18.280
<v Speaker 3>can help and so that one case can help another.

0:34:18.680 --> 0:34:20.480
<v Speaker 3>Is there a body of knowledge that gets built off

0:34:20.520 --> 0:34:20.680
<v Speaker 3>of this?

0:34:20.880 --> 0:34:23.319
<v Speaker 7>Yes, there's body that of knowledge gets built off of this.

0:34:23.480 --> 0:34:25.160
<v Speaker 7>But this is where we come back to AI. I

0:34:25.200 --> 0:34:27.960
<v Speaker 7>only can remember so much, you know, even though I've

0:34:27.960 --> 0:34:29.080
<v Speaker 7>been in practice for a long time.

0:34:29.160 --> 0:34:30.360
<v Speaker 3>Things follow up crap.

0:34:31.880 --> 0:34:34.239
<v Speaker 7>So this is where I'm really excited about AI because

0:34:34.280 --> 0:34:37.759
<v Speaker 7>I can, you know, minor databases to find where's an

0:34:37.800 --> 0:34:41.319
<v Speaker 7>individual child just like that one I'm treated. Now, what

0:34:41.400 --> 0:34:43.600
<v Speaker 7>did they respond to, what worked for them? And how

0:34:43.640 --> 0:34:46.279
<v Speaker 7>are these two similar? So I can mind the databases

0:34:46.280 --> 0:34:49.319
<v Speaker 7>to start to come up with individual outcome prediction, which

0:34:49.360 --> 0:34:50.399
<v Speaker 7>is what we're doing right now.

0:34:50.440 --> 0:34:51.279
<v Speaker 3>With databases.

0:34:51.320 --> 0:34:54.120
<v Speaker 7>We've got some from some of the major trials for hypothermia,

0:34:54.360 --> 0:34:57.479
<v Speaker 7>and so we can use this large database to start

0:34:57.600 --> 0:35:00.400
<v Speaker 7>try to take individual outcomes. You can say, well, I

0:35:00.440 --> 0:35:03.080
<v Speaker 7>have a newborn with this pH that had these, you know,

0:35:03.120 --> 0:35:04.839
<v Speaker 7>and I'm a mother of this age, and put in

0:35:04.840 --> 0:35:07.080
<v Speaker 7>features and they could give you from that database and

0:35:07.160 --> 0:35:10.400
<v Speaker 7>outcome prediction. So working on that and also working on

0:35:10.840 --> 0:35:15.040
<v Speaker 7>making data more available to parents, because I think a

0:35:15.040 --> 0:35:18.319
<v Speaker 7>lot of parents are very frustrated with trying to read

0:35:18.360 --> 0:35:21.200
<v Speaker 7>the literature, even if you're using chat, GPT or overly hards,

0:35:21.239 --> 0:35:23.880
<v Speaker 7>it's really hard. And then you get group statistics and

0:35:23.920 --> 0:35:26.240
<v Speaker 7>then where does my kid fit in between the twenty

0:35:26.239 --> 0:35:28.360
<v Speaker 7>five to seventy five percent you know, good outcome or

0:35:28.400 --> 0:35:31.200
<v Speaker 7>something like that. To get chatbots that can work with

0:35:31.280 --> 0:35:35.040
<v Speaker 7>some of our databases, so people anybody can talk to,

0:35:36.200 --> 0:35:38.040
<v Speaker 7>you know, a physician, so to speak, to give the

0:35:38.080 --> 0:35:39.000
<v Speaker 7>answers that they want.

0:35:39.640 --> 0:35:45.040
<v Speaker 4>That's that's pretty remarkable because you know, I just think

0:35:45.120 --> 0:35:50.360
<v Speaker 4>about the tone of these chatbots and if there's a

0:35:50.400 --> 0:35:53.680
<v Speaker 4>way that they can be you know, we talked about,

0:35:54.080 --> 0:35:57.279
<v Speaker 4>we talked earlier this week about what a challenge it

0:35:57.280 --> 0:36:00.919
<v Speaker 4>can be for people to actually interact with them in

0:36:00.360 --> 0:36:03.680
<v Speaker 4>an quote unquote normal way. But is there a way

0:36:03.719 --> 0:36:07.040
<v Speaker 4>for them to actually be empathetic and work with patients,

0:36:07.080 --> 0:36:08.560
<v Speaker 4>work with parents and with families.

0:36:08.560 --> 0:36:10.120
<v Speaker 3>If you give us we've got about forty second.

0:36:10.160 --> 0:36:11.640
<v Speaker 7>Yeah, yeah, no, we're working on that, but I can't

0:36:11.680 --> 0:36:12.879
<v Speaker 7>tell you all the secrets because we're.

0:36:12.760 --> 0:36:16.480
<v Speaker 3>Going to hang. No, you go all over the bath.

0:36:17.400 --> 0:36:19.560
<v Speaker 3>Can I ask you, when you guys do use AI

0:36:19.920 --> 0:36:24.120
<v Speaker 3>in cha? Do you have hallucinations? Like do the AI hallucinations?

0:36:24.120 --> 0:36:24.319
<v Speaker 5>Do you?

0:36:24.560 --> 0:36:27.400
<v Speaker 3>Or how do you? Especially when you're dealing with medical permission.

0:36:27.440 --> 0:36:29.960
<v Speaker 7>There's a lot of safeguards who put around that, so

0:36:30.000 --> 0:36:33.120
<v Speaker 7>it's it's we have again. This is sort of more

0:36:33.200 --> 0:36:35.239
<v Speaker 7>the secret sauce that I can't talk about yet, But

0:36:36.040 --> 0:36:40.200
<v Speaker 7>there are ways to constrain chatbots to give you reasonable

0:36:40.239 --> 0:36:43.239
<v Speaker 7>answers that are statistically sound. All right, so when you

0:36:43.239 --> 0:36:45.320
<v Speaker 7>can when you come back, yes, it will okay, good stuff.

0:36:45.640 --> 0:36:49.440
<v Speaker 3>So appreciate. Doctor Ellen Grant, director of Fetal Neonatal, Neuroimaging

0:36:49.480 --> 0:36:52.319
<v Speaker 3>and Developmental Sciences here at Boston Children's Hospital, Thank you again.

0:36:52.960 --> 0:36:56.719
<v Speaker 2>You are listening to the Bloomberg Business Weekdaily Podcast. Catch

0:36:56.800 --> 0:36:59.920
<v Speaker 2>us live weekday afternoons from two to five pm Eastern

0:37:00.160 --> 0:37:03.200
<v Speaker 2>Listen on Apple CarPlay and Android Auto with the Bloomberg

0:37:03.280 --> 0:37:06.400
<v Speaker 2>Business App or watch us live on YouTube.

0:37:07.400 --> 0:37:09.799
<v Speaker 4>We are live from Boston Children's Hospital, where we're speaking

0:37:09.840 --> 0:37:11.960
<v Speaker 4>with some of the nations leading doctors on matters related

0:37:11.960 --> 0:37:15.759
<v Speaker 4>to health, health policy, innovation, medical care, and everything that

0:37:15.840 --> 0:37:18.200
<v Speaker 4>has to do with health. Carol, A fixture at my

0:37:18.280 --> 0:37:22.120
<v Speaker 4>high school in college was torn acls volleyball, lacrosse, soccer,

0:37:22.160 --> 0:37:25.600
<v Speaker 4>field hockey. A torn ACL, surgery to reconstruct it, then

0:37:25.640 --> 0:37:29.240
<v Speaker 4>weeks on crutches, months of recovery, and oftentimes it was girls,

0:37:29.239 --> 0:37:31.600
<v Speaker 4>not boys who tore their ACL, which.

0:37:31.400 --> 0:37:33.080
<v Speaker 3>I find interesting. I guess I would have thought it

0:37:33.080 --> 0:37:33.960
<v Speaker 3>was the other way around.

0:37:34.160 --> 0:37:36.520
<v Speaker 4>Girls and women's women tear their acls at a higher

0:37:36.560 --> 0:37:39.760
<v Speaker 4>rate than men and boys. This is doctor Martha Murray's world.

0:37:39.880 --> 0:37:42.600
<v Speaker 4>She's orthopedic surgeon in chief for Boston Children's Hospital. She

0:37:42.680 --> 0:37:45.200
<v Speaker 4>joins us here into Boston where we are at Boston

0:37:45.239 --> 0:37:47.200
<v Speaker 4>Children's Hospital. Doctor Murray, welcome, how are you.

0:37:47.440 --> 0:37:49.160
<v Speaker 6>I'm good? Thank you so much for having sta.

0:37:49.440 --> 0:37:53.080
<v Speaker 4>So you've got this background in material science and engineering,

0:37:53.080 --> 0:37:55.080
<v Speaker 4>it's not typical for a surgeon. We're going to talk

0:37:55.120 --> 0:37:57.680
<v Speaker 4>about your innovation and ACL surgery in just a minute.

0:37:57.680 --> 0:38:02.439
<v Speaker 4>But on the boys versus girls, men versus women. Why

0:38:02.480 --> 0:38:04.359
<v Speaker 4>do ACL tears affect women more than men.

0:38:05.160 --> 0:38:07.239
<v Speaker 8>Well, it's a really interesting question and it's been one

0:38:07.239 --> 0:38:09.440
<v Speaker 8>of much debate for the last few decades, and there

0:38:09.440 --> 0:38:11.680
<v Speaker 8>have been things like, well, it must be a hormone cycle,

0:38:11.880 --> 0:38:14.360
<v Speaker 8>or it's the shape of women's hips and their valgus

0:38:14.360 --> 0:38:17.640
<v Speaker 8>angles to their knees. But a really interesting study came

0:38:17.680 --> 0:38:20.200
<v Speaker 8>out very recently from the Harvard School of Public Health

0:38:20.200 --> 0:38:23.320
<v Speaker 8>as well as Harvard University with doctor Danielson and doctor Richardson,

0:38:23.719 --> 0:38:25.840
<v Speaker 8>where they actually showed that the studies that say that

0:38:25.880 --> 0:38:28.920
<v Speaker 8>women tear their acl more frequently than men were often

0:38:28.960 --> 0:38:32.320
<v Speaker 8>based when the women's teams were smaller than the men's teams,

0:38:32.680 --> 0:38:35.080
<v Speaker 8>and the way they calculated exposures was the number of

0:38:35.120 --> 0:38:38.920
<v Speaker 8>practices or games you played in, not necessarily your playing time.

0:38:39.480 --> 0:38:41.800
<v Speaker 8>So if you're a man who's on a hockey team

0:38:42.200 --> 0:38:44.720
<v Speaker 8>versus a woman who's on a hockey team, the women's

0:38:44.719 --> 0:38:47.160
<v Speaker 8>teams were smaller, so those women were playing more, so

0:38:47.200 --> 0:38:48.720
<v Speaker 8>they were planting hockey.

0:38:48.719 --> 0:38:49.760
<v Speaker 1>It's a bad example.

0:38:49.800 --> 0:38:52.160
<v Speaker 8>Soccer would be better, but if the team is smaller,

0:38:52.440 --> 0:38:54.200
<v Speaker 8>the women are going to be planting and pivoting and

0:38:54.239 --> 0:38:56.880
<v Speaker 8>playing much more time per game or practice.

0:38:56.880 --> 0:38:59.879
<v Speaker 3>So more stress, more stress, more use, more tears.

0:39:00.000 --> 0:39:02.640
<v Speaker 4>So maybe it's not maybe women in all things equal,

0:39:02.840 --> 0:39:05.840
<v Speaker 4>maybe women and men don't have a different rate of torn.

0:39:05.640 --> 0:39:08.880
<v Speaker 8>Acl correct when when they corrected for unit of exposure.

0:39:08.920 --> 0:39:11.640
<v Speaker 8>So kind of game time playing rather than just a game,

0:39:12.000 --> 0:39:13.760
<v Speaker 8>the injury rates look very similar.

0:39:14.120 --> 0:39:18.160
<v Speaker 4>Wow, that's totally different than what's I mean, do you

0:39:18.239 --> 0:39:20.799
<v Speaker 4>is that? Do you is this the standard? Now? I

0:39:20.800 --> 0:39:21.560
<v Speaker 4>mean do you think this is?

0:39:22.280 --> 0:39:24.920
<v Speaker 8>It's relatively new work that's coming out, but it resonates

0:39:24.960 --> 0:39:26.520
<v Speaker 8>with most of us who take care of women and

0:39:26.600 --> 0:39:28.680
<v Speaker 8>men on their on their athletic teams.

0:39:28.840 --> 0:39:31.280
<v Speaker 3>Yeah, I want to ask about your background material science

0:39:31.280 --> 0:39:33.799
<v Speaker 3>and engineering. I know Tim said it not typical for

0:39:33.800 --> 0:39:37.719
<v Speaker 3>a surgeon, but I think it's it's a really smart combination. Well,

0:39:37.760 --> 0:39:41.160
<v Speaker 3>I have a doctor, a foot doctor, same thing engineering,

0:39:41.239 --> 0:39:43.759
<v Speaker 3>and like he doesn't just dealing with my foot, he

0:39:43.840 --> 0:39:45.680
<v Speaker 3>thinks about, Okay, what are you doing? What else is

0:39:45.719 --> 0:39:47.760
<v Speaker 3>going on in your body? Tell me about that mix

0:39:47.840 --> 0:39:51.080
<v Speaker 3>and why it's kind of unique and smart and ties

0:39:51.160 --> 0:39:51.760
<v Speaker 3>things together.

0:39:52.000 --> 0:39:54.320
<v Speaker 8>Well, for me, it was a it was actually a necessity.

0:39:54.400 --> 0:39:54.600
<v Speaker 6>Right.

0:39:54.640 --> 0:39:57.960
<v Speaker 8>So I was an engineering graduate student and a friend

0:39:58.000 --> 0:39:59.719
<v Speaker 8>of mine came into a party one night and on

0:40:00.320 --> 0:40:02.400
<v Speaker 8>as Tim was saying and who had torn his ACL?

0:40:02.480 --> 0:40:03.920
<v Speaker 8>And I said, oh, are they going to go sew

0:40:03.960 --> 0:40:05.960
<v Speaker 8>it back together? And he was a med student. He

0:40:06.000 --> 0:40:08.280
<v Speaker 8>was like, you, stupid engineer, we can't sew it back together.

0:40:08.400 --> 0:40:10.160
<v Speaker 8>You have to take it out and replace it with

0:40:10.200 --> 0:40:11.640
<v Speaker 8>the graft of tenant that they're going to take from

0:40:11.640 --> 0:40:13.280
<v Speaker 8>the back of my leg. And then it's all this rehab.

0:40:13.800 --> 0:40:17.040
<v Speaker 8>And I thought that seems kind of excessive, right, Like

0:40:17.080 --> 0:40:18.880
<v Speaker 8>that's a lot to have to go through. And so

0:40:18.960 --> 0:40:20.640
<v Speaker 8>I spent the next six months or so in the

0:40:20.640 --> 0:40:23.040
<v Speaker 8>medical school library just reading everything I could about why

0:40:23.120 --> 0:40:25.839
<v Speaker 8>didn't the ACL heal? And I realized nobody really had

0:40:25.840 --> 0:40:27.600
<v Speaker 8>figured out why it didn't. You know, they tried it

0:40:27.600 --> 0:40:29.920
<v Speaker 8>sewing back together didn't work. So then went to grafts,

0:40:29.960 --> 0:40:32.560
<v Speaker 8>and we've been doing graphs for fifty years and nobody

0:40:32.600 --> 0:40:35.160
<v Speaker 8>really asked why doesn't it heal? And so for me

0:40:35.320 --> 0:40:37.560
<v Speaker 8>then there was no biomedical engineering at that time, and

0:40:37.640 --> 0:40:40.160
<v Speaker 8>so my choices were to continue on with my project,

0:40:40.160 --> 0:40:43.719
<v Speaker 8>which was developing airplane wings that were invisible to you know,

0:40:43.880 --> 0:40:46.880
<v Speaker 8>to radar, and I thought, well, that's a really cool project,

0:40:46.880 --> 0:40:48.640
<v Speaker 8>but I really want to figure out this ACL thing.

0:40:49.000 --> 0:40:50.359
<v Speaker 8>And my advisor was like, well, I guess you could

0:40:50.360 --> 0:40:51.120
<v Speaker 8>go to medical school.

0:40:52.480 --> 0:40:55.080
<v Speaker 4>This is a net like serious and then so okay, Well,

0:40:55.120 --> 0:40:57.400
<v Speaker 4>the advisor obviously had an impact in her friend obviously

0:40:57.480 --> 0:41:00.359
<v Speaker 4>had an impact. But fast forward, you know, thirty years

0:41:00.360 --> 0:41:02.880
<v Speaker 4>plus and you have actually invented a new way to

0:41:02.920 --> 0:41:06.960
<v Speaker 4>treat ACL tears, the bear method. You did figure out

0:41:07.000 --> 0:41:09.880
<v Speaker 4>that there's a reason why acls don't heal like an

0:41:09.960 --> 0:41:11.719
<v Speaker 4>MCL would actually heal.

0:41:12.320 --> 0:41:14.360
<v Speaker 3>Why is that, Well, it's really interesting.

0:41:14.400 --> 0:41:16.759
<v Speaker 8>So both the medial collateral ligament and the anti a

0:41:16.800 --> 0:41:18.839
<v Speaker 8>cruciate ligament are ligaments. When you look at them under

0:41:18.840 --> 0:41:22.080
<v Speaker 8>the microscope, they look very similar. But interestingly, when the

0:41:22.239 --> 0:41:24.239
<v Speaker 8>MCL tears, you can go on to brace in it

0:41:24.320 --> 0:41:26.400
<v Speaker 8>about six weeks, that ligament will heal fine in your

0:41:26.440 --> 0:41:29.920
<v Speaker 8>back playing soccer. In contrast, the ACL, when it tears,

0:41:30.120 --> 0:41:31.719
<v Speaker 8>even if we try to sew it back together, it

0:41:31.719 --> 0:41:34.759
<v Speaker 8>doesn't heal. And so we wondered why, and so we

0:41:34.800 --> 0:41:36.360
<v Speaker 8>did a series of studies where we looked and we

0:41:36.400 --> 0:41:39.239
<v Speaker 8>compared the two tissues in their response to injury. And

0:41:39.320 --> 0:41:41.600
<v Speaker 8>what we found was that actually the response to injury

0:41:41.640 --> 0:41:43.600
<v Speaker 8>is very similar in the two ligaments. So the tissue

0:41:43.600 --> 0:41:45.319
<v Speaker 8>and the cells and the tissue were doing exactly what

0:41:45.360 --> 0:41:47.440
<v Speaker 8>they were supposed to do in both tissues, but the

0:41:47.480 --> 0:41:50.000
<v Speaker 8>difference was in the MCL. When it tears, the ends

0:41:50.040 --> 0:41:52.799
<v Speaker 8>bleed and that blood clots in forms what we call

0:41:52.800 --> 0:41:55.320
<v Speaker 8>a hematoma between the two torn ends of the ligament.

0:41:55.880 --> 0:41:58.000
<v Speaker 8>And then in contrast, in the ACL, because it lives

0:41:58.040 --> 0:42:00.960
<v Speaker 8>in this fluid environment of the joint, the ends bleed,

0:42:01.200 --> 0:42:03.719
<v Speaker 8>but instead of making a clot or hematoma between the

0:42:03.760 --> 0:42:06.200
<v Speaker 8>torn ends of the ligament, the blood disperses through the

0:42:06.200 --> 0:42:08.399
<v Speaker 8>fluid of the joint, and so the two ends never

0:42:08.440 --> 0:42:11.640
<v Speaker 8>have that scaffolding, that biologic scaffolding to hold them back together.

0:42:12.480 --> 0:42:14.400
<v Speaker 8>So once we discovered that, then it was a fairly

0:42:14.480 --> 0:42:16.759
<v Speaker 8>logical step to say, is there some way we could

0:42:16.760 --> 0:42:19.600
<v Speaker 8>immobilize the blood in between those two torn ligament ends

0:42:19.640 --> 0:42:21.880
<v Speaker 8>and get that biologic signal where it needs to be

0:42:22.280 --> 0:42:24.880
<v Speaker 8>to encourage healing of the ACL. And that's really what

0:42:24.960 --> 0:42:28.840
<v Speaker 8>bridge enhanced ACL repair or BEAR is. So the magic

0:42:28.920 --> 0:42:30.920
<v Speaker 8>is kind of the sponge that we've developed that can

0:42:31.000 --> 0:42:33.880
<v Speaker 8>absorb the patient's blood. You can place that blood laden

0:42:33.920 --> 0:42:36.279
<v Speaker 8>sponge in between the torn ends of the ACL, so

0:42:36.400 --> 0:42:38.680
<v Speaker 8>the ACL back together. But now you have the biology

0:42:39.000 --> 0:42:41.759
<v Speaker 8>plus the sutures and the repair and the ligament will heal.

0:42:42.520 --> 0:42:45.759
<v Speaker 4>So is what is done in terms of numbers or

0:42:45.800 --> 0:42:49.880
<v Speaker 4>percentage with the method that you pioneered, what you invented,

0:42:49.960 --> 0:42:54.440
<v Speaker 4>versus actual reconstruction and using other ligaments.

0:42:54.680 --> 0:42:56.719
<v Speaker 8>That's a great question. So this is still fairly new.

0:42:56.800 --> 0:43:00.880
<v Speaker 8>So we got FDA approval for this product in twenty twenty,

0:43:01.200 --> 0:43:02.960
<v Speaker 8>and so it's only been in practice for a few

0:43:03.000 --> 0:43:06.080
<v Speaker 8>years now. There's studies coming out of Children's here, which

0:43:06.080 --> 0:43:08.160
<v Speaker 8>is where we did the first studies, of course, but

0:43:08.239 --> 0:43:10.400
<v Speaker 8>now other centers are coming along and doing follow on

0:43:10.440 --> 0:43:12.200
<v Speaker 8>studies and those results are starting to come out, and

0:43:12.400 --> 0:43:14.280
<v Speaker 8>it's very exciting to watch it grow.

0:43:14.800 --> 0:43:17.400
<v Speaker 3>I'm also curious you mentioned but like FDA approval, like

0:43:17.640 --> 0:43:20.799
<v Speaker 3>the approval process, is it a smart one? Is it

0:43:20.840 --> 0:43:22.759
<v Speaker 3>the right one in terms of making sure that what's

0:43:22.800 --> 0:43:26.040
<v Speaker 3>being done and studied, the R and D, that it's

0:43:26.040 --> 0:43:27.920
<v Speaker 3>safe for when it's finally done on patients, or is

0:43:28.520 --> 0:43:32.920
<v Speaker 3>it preventing things from maybe putting put into you sooner?

0:43:33.360 --> 0:43:35.680
<v Speaker 3>Like I'm just curious where you guys weigh in. You're

0:43:35.680 --> 0:43:38.440
<v Speaker 3>in it, You're in it every day. Yeah, I think

0:43:38.480 --> 0:43:40.560
<v Speaker 3>it's a delicate balance. But I would say in our

0:43:40.600 --> 0:43:43.680
<v Speaker 3>personal experience, the FDAY was an amazing partner. Okay, So

0:43:43.760 --> 0:43:46.080
<v Speaker 3>we were able to get into an early adoption program

0:43:46.120 --> 0:43:48.239
<v Speaker 3>where they actually met with us and helped us and

0:43:48.239 --> 0:43:50.399
<v Speaker 3>put together a panel of experts that would help us

0:43:50.680 --> 0:43:53.200
<v Speaker 3>figure out how to make this the safest possible product

0:43:53.239 --> 0:43:55.440
<v Speaker 3>and the most effective product before we went to patients,

0:43:55.920 --> 0:43:58.319
<v Speaker 3>and we found their advice incredibly valuable. There was a

0:43:58.320 --> 0:44:01.080
<v Speaker 3>lot of conversation and back and forth and just having

0:44:01.160 --> 0:44:03.760
<v Speaker 3>them it felt like it was a team effort because

0:44:03.760 --> 0:44:05.719
<v Speaker 3>we were in alignment. I mean, as a physician, I

0:44:05.760 --> 0:44:07.320
<v Speaker 3>was going to be shaking the hands of these patients

0:44:07.320 --> 0:44:09.600
<v Speaker 3>that my partners were and we wanted to make sure

0:44:09.640 --> 0:44:11.440
<v Speaker 3>things were as safe as possible, so they helped.

0:44:11.280 --> 0:44:11.560
<v Speaker 6>Us with that.

0:44:11.719 --> 0:44:16.080
<v Speaker 4>Do we have data yet on long term impact or

0:44:16.200 --> 0:44:19.480
<v Speaker 4>long term outcomes yet when it comes to the bear procedure.

0:44:19.600 --> 0:44:21.640
<v Speaker 8>Yeah, Our longest data that we have is at about

0:44:21.680 --> 0:44:23.759
<v Speaker 8>six years, and it's only in the small number of

0:44:23.840 --> 0:44:26.239
<v Speaker 8>patients in those first studies that we did. But the

0:44:26.280 --> 0:44:28.640
<v Speaker 8>reason that we want to study at longer term is because,

0:44:28.800 --> 0:44:31.600
<v Speaker 8>as you may know, many of these patients will develop

0:44:31.680 --> 0:44:34.960
<v Speaker 8>arthritis early in life and as a pediatric orthopedic surgeon.

0:44:35.239 --> 0:44:37.000
<v Speaker 8>I want to make sure we have a procedure that's

0:44:37.000 --> 0:44:39.600
<v Speaker 8>going to last my patients for sixty or seventy years,

0:44:39.640 --> 0:44:41.920
<v Speaker 8>not have the knee breakdown in ten or twenty years.

0:44:42.600 --> 0:44:45.719
<v Speaker 8>And so we're very interested in this arthritis question with

0:44:45.840 --> 0:44:48.400
<v Speaker 8>Bear and in our preclinical studies we were able to

0:44:48.440 --> 0:44:53.200
<v Speaker 8>see that arthritis was actually much less in the subjects

0:44:53.239 --> 0:44:55.920
<v Speaker 8>that we treated with an acl repair with the sponge

0:44:56.080 --> 0:44:58.520
<v Speaker 8>versus a reconstruction. So we're interested in seeing if that

0:44:58.560 --> 0:45:00.880
<v Speaker 8>same thing plays out in patients. Early day to suggest

0:45:00.920 --> 0:45:03.719
<v Speaker 8>that it will it is true, but again that's very

0:45:03.760 --> 0:45:06.080
<v Speaker 8>early data on small numbers of patients, so we're excited

0:45:06.080 --> 0:45:07.120
<v Speaker 8>to see how that pans out.

0:45:07.160 --> 0:45:10.400
<v Speaker 3>We're talking with doctor Martha Murray. She's orthopedic surgeon and

0:45:10.440 --> 0:45:13.359
<v Speaker 3>she for Boston Children's Hospital. That's where we are Tim

0:45:13.400 --> 0:45:18.040
<v Speaker 3>and me on this Friday. Preventive care, Like, so much

0:45:18.080 --> 0:45:20.960
<v Speaker 3>of what we talk about often when we're doing interviews

0:45:21.040 --> 0:45:23.279
<v Speaker 3>is preventive care. And I feel like the whole health

0:45:23.320 --> 0:45:25.319
<v Speaker 3>community has been thinking about this for a long time.

0:45:25.360 --> 0:45:27.960
<v Speaker 3>So what's the preventive care So that as much as

0:45:27.960 --> 0:45:30.480
<v Speaker 3>we don't want you unemployed, like, how do we think

0:45:30.520 --> 0:45:33.279
<v Speaker 3>about taking better care if we're living longer, Like, how

0:45:33.280 --> 0:45:35.880
<v Speaker 3>do we think about this? So there's a couple questions

0:45:35.920 --> 0:45:37.560
<v Speaker 3>on that. So one is how do we help.

0:45:37.440 --> 0:45:39.880
<v Speaker 8>Our teenagers reduce their risk of injury? And I think

0:45:40.040 --> 0:45:42.200
<v Speaker 8>the main thing for that for our athletes when they're.

0:45:42.000 --> 0:45:44.040
<v Speaker 3>In it because we push kids when they're younger. I

0:45:44.080 --> 0:45:46.240
<v Speaker 3>think a lot of parents really push kids.

0:45:46.600 --> 0:45:48.080
<v Speaker 8>So some things we can do to help them is

0:45:48.120 --> 0:45:51.040
<v Speaker 8>help them work on strengthening in addition to just playtime.

0:45:51.520 --> 0:45:53.759
<v Speaker 8>And another thing is cross training, So not playing the

0:45:53.760 --> 0:45:55.920
<v Speaker 8>same sport all year round or playing the same sport

0:45:55.920 --> 0:45:57.840
<v Speaker 8>every day, giving their body a chance to rest and

0:45:57.880 --> 0:45:59.480
<v Speaker 8>heal between exposures to sport.

0:46:00.000 --> 0:46:02.040
<v Speaker 4>Does it's as simple as that, I think? So, Wow,

0:46:02.200 --> 0:46:05.840
<v Speaker 4>does acl TAAR happen more in kids than adults? Or

0:46:05.960 --> 0:46:07.799
<v Speaker 4>and if yes, is it because kids are the ones

0:46:07.800 --> 0:46:09.680
<v Speaker 4>who are playing sports and you know we're just sitting

0:46:09.680 --> 0:46:10.280
<v Speaker 4>at computers.

0:46:10.640 --> 0:46:12.480
<v Speaker 8>I think that's probably part of it. Again, it gets

0:46:12.480 --> 0:46:15.000
<v Speaker 8>to this exposure question. How many times do you plant

0:46:15.040 --> 0:46:17.160
<v Speaker 8>and change direction? And so the peak of a c.

0:46:17.360 --> 0:46:20.239
<v Speaker 8>Andrews is really the high school athlete because there's so

0:46:20.280 --> 0:46:23.200
<v Speaker 8>many everybody's playing a sport and so we see a

0:46:23.239 --> 0:46:23.759
<v Speaker 8>lot of them there.

0:46:23.800 --> 0:46:25.440
<v Speaker 3>I want to ask you at social media and all

0:46:25.480 --> 0:46:27.840
<v Speaker 3>of us sitting on phones, are sitting in front of screens,

0:46:27.920 --> 0:46:29.800
<v Speaker 3>like I just I keep thinking that we're going to

0:46:29.840 --> 0:46:31.319
<v Speaker 3>one day. I don't know whether it's fifty years from

0:46:31.320 --> 0:46:33.359
<v Speaker 3>now we're going to have a neck that basically goes

0:46:33.400 --> 0:46:35.480
<v Speaker 3>over there or maybe not because we're gonna have glasses on.

0:46:35.560 --> 0:46:38.319
<v Speaker 3>And that's like, how do you think about this digital world?

0:46:38.320 --> 0:46:38.920
<v Speaker 3>You're laughing?

0:46:38.960 --> 0:46:41.759
<v Speaker 4>But can you surgically remove my phone from my hand?

0:46:41.800 --> 0:46:42.799
<v Speaker 4>That's what That's what I want.

0:46:42.840 --> 0:46:45.879
<v Speaker 3>But I do think about what it's doing to us. Well,

0:46:46.440 --> 0:46:48.600
<v Speaker 3>look at it, not just on the fixed for you.

0:46:48.640 --> 0:46:50.600
<v Speaker 8>I don't know if I can fix the social media.

0:46:50.560 --> 0:46:53.480
<v Speaker 3>But physically, like I'm just thinking like how you know

0:46:53.600 --> 0:46:56.040
<v Speaker 3>kids are in their phones constantly and stuff in like

0:46:56.080 --> 0:46:58.520
<v Speaker 3>the shape, Like do we need to be thinking about

0:46:58.560 --> 0:47:01.760
<v Speaker 3>what this is doing onto our spine and different things?

0:47:02.160 --> 0:47:02.560
<v Speaker 3>I think so.

0:47:02.640 --> 0:47:04.680
<v Speaker 8>But I also think things come in cycles, right, And

0:47:04.719 --> 0:47:06.200
<v Speaker 8>we see now if you walk down the street, you

0:47:06.239 --> 0:47:08.040
<v Speaker 8>see everybody's on their phone. I think we're going to

0:47:08.200 --> 0:47:09.719
<v Speaker 8>five years from now, we're going to look at back

0:47:09.719 --> 0:47:11.880
<v Speaker 8>at that and say why are we doing that? You know,

0:47:12.040 --> 0:47:15.120
<v Speaker 8>maybe we'll start looking up at the sky more, I hope. So, yeah,

0:47:15.160 --> 0:47:15.960
<v Speaker 8>that's what I hope too.

0:47:17.239 --> 0:47:19.520
<v Speaker 4>Yeah, I mean, gosh, that's like your open air.

0:47:19.960 --> 0:47:21.880
<v Speaker 3>I know. I just I look around on the subway

0:47:21.920 --> 0:47:24.200
<v Speaker 3>and just everybody and I'm just thinking the curvature and

0:47:24.280 --> 0:47:26.279
<v Speaker 3>I don't know, whatever, what's the next thing you're working

0:47:26.280 --> 0:47:27.479
<v Speaker 3>on or that you're excited about.

0:47:27.880 --> 0:47:29.680
<v Speaker 8>I'm really excited about a product that we're working on

0:47:29.719 --> 0:47:33.719
<v Speaker 8>for rotator cuff injuries. And it's a product that's injectable,

0:47:33.920 --> 0:47:36.720
<v Speaker 8>so that potentially it's great. Yeah, you can have ultrasound

0:47:36.719 --> 0:47:38.480
<v Speaker 8>on your shoulder, see where the tear is, and then

0:47:38.480 --> 0:47:40.919
<v Speaker 8>inject the product into the tear, maybe in an office visit.

0:47:41.080 --> 0:47:43.200
<v Speaker 8>So that's what we're working on, but very early days

0:47:43.200 --> 0:47:43.320
<v Speaker 8>on that.

0:47:43.480 --> 0:47:45.520
<v Speaker 4>Again, a challenge with pediatric patients as well.

0:47:45.680 --> 0:47:47.640
<v Speaker 8>No, this is more adults. But we were just we

0:47:47.640 --> 0:47:49.680
<v Speaker 8>thought we could make this work for a ligament, maybe

0:47:49.719 --> 0:47:51.640
<v Speaker 8>we could try it for the rotator cuff ten And and

0:47:51.920 --> 0:47:53.840
<v Speaker 8>the nice thing about the rotator cuff is it is

0:47:53.880 --> 0:47:56.840
<v Speaker 8>accessible by ultrasound and injection and it's a pretty easy

0:47:56.880 --> 0:47:59.040
<v Speaker 8>model for us to study. If we can make that

0:47:59.080 --> 0:48:01.600
<v Speaker 8>injectable work then and there's lots of other places we

0:48:01.640 --> 0:48:03.600
<v Speaker 8>could apply a meniscus other things.

0:48:03.600 --> 0:48:05.600
<v Speaker 4>Did you ever figure out the Invisible Airplane wings?

0:48:05.920 --> 0:48:06.080
<v Speaker 6>No?

0:48:07.320 --> 0:48:10.239
<v Speaker 8>Not too late, well, social media in Visible Airplane Wings

0:48:10.280 --> 0:48:11.840
<v Speaker 8>ACL wrote that you guys are killing me.

0:48:12.360 --> 0:48:15.360
<v Speaker 4>Oh we are glad you ended up going into pediatric

0:48:15.480 --> 0:48:16.400
<v Speaker 4>orthopedic surgery?

0:48:16.640 --> 0:48:20.359
<v Speaker 3>Is there another career like to add on after this?

0:48:21.160 --> 0:48:23.520
<v Speaker 3>You could do it, You could do it. Welcome, This

0:48:23.640 --> 0:48:25.239
<v Speaker 3>was so much fun. It was fun. Thank you guys

0:48:25.320 --> 0:48:28.160
<v Speaker 3>very much, Doctor Martha Murray. She's orthopedic surgeon chief for

0:48:28.200 --> 0:48:29.440
<v Speaker 3>Boston Children's Hospital.

0:48:30.040 --> 0:48:35.400
<v Speaker 2>This is the Bloomberg Business Week Daily podcast, available on Apple, Spotify,

0:48:35.520 --> 0:48:39.240
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0:48:39.280 --> 0:48:43.280
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0:48:43.320 --> 0:48:47.240
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0:48:47.480 --> 0:48:50.280
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0:48:50.440 --> 0:48:52.600
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