Podcasts about functionally

In this forward-looking episode, Lynn Hamilton sits down with Bret Couturier, Executive Director, FSP 360 at Syneos Health, to explore how sponsors can shift from incremental improvements to intentional design when it comes to site experience. With a career spanning frontline monitoring to strategic FSP leadership, Bret offers practical insights into what's working, and what's holding teams back. Key themes include:Why the CRA role isn't disappearing, but rather evolving with AI and data-driven toolsThe importance of designing from the site's perspective, not just for internal efficiencyHow functional service provider (FSP) models can go beyond staffing to drive systemic improvementSimple but powerful steps sponsors can take now to reduce burden and build stronger site relationshipsWhat it means to move from reactive fixes to strategic collaboration, and why the time is now If you're rethinking site engagement, functional models or the next phase of FSP delivery, this conversation offers both strategic clarity and real-world takeaways.The views expressed in this podcast belong solely to the speakers and do not represent those of their organization. If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision-making and investment. You can find it all at https://www.syneoshealth.com/insights-hub. Like what you're hearing? Be sure to rate and review us! We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com.

In this episode of the Functionally Speaking series, host Lynn Hamilton speaks with Carol Aliyar, Executive Vice President and Global Head of Safety and Pharmacovigilance (PV) at Syneos Health, about the transformation of PV from a highly regulated, task-oriented function into a more strategic and technology-enabled discipline. With over 30 years in the industry and a career that spans commercial, clinical and safety roles, Carol brings a rare full-spectrum perspective. Listeners will gain insight into:How PV is shifting from transactional taskwork to strategic lifecycle integrationWhat AI and automation really mean for safety operations and talent needsThe enduring importance of human judgment, especially in the age of AI agentsWhy functional service provider (FSP) models are now resonating in PVHow consistency, flexibility and subject matter depth strengthen long-term partnerships Whether you're expanding your PV model, exploring AI adoption or rethinking how functional teams deliver value, this conversation offers real-world perspective and practical foresight.The views expressed in this podcast belong solely to the speakers and do not represent those of their organization. If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision-making and investment. You can find it all at https://www.syneoshealth.com/insights-hub. Like what you're hearing? Be sure to rate and review us! We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com.

In this thought-provoking episode of the Secret Life Podcast, host Brianne Davis-Gantt explores the complex world of the Type C personality, specifically those who are functionally frozen. Brianne breaks down the traits of this personality type, which combines people-pleasing, emotional suppression, and perfectionism, leading individuals to feel disconnected and numb despite outwardly managing daily responsibilities.Throughout the episode, Brianne delves into the signs of being functionally frozen, such as emotional numbness, lack of motivation, and the overwhelming sense of being on autopilot. She emphasizes that this state often arises from chronic stress, trauma, and burnout, leaving individuals feeling stuck and unable to engage fully with their emotions or the world around them.Listeners will gain insights into the importance of recognizing these patterns and the necessity of seeking support to navigate through them. Brianne shares practical strategies for thawing out of this state, including grounding techniques, reconnecting with the body, and embracing joy and creativity. This episode serves as a powerful reminder that healing is a journey, and it's essential to approach it with self-compassion and support.

What does it take to run a truly effective Functional Service Provider (FSP) model in today's biopharma landscape? From harmonizing global teams to embedding innovation into daily delivery, FSP engagement is more than a resourcing solution — it's about strategic collaboration and approaches that accelerate delivery. The Syneos Health Podcast: Functionally Speaking series explores the nuances that make these models work.  In this episode of Functionally Speaking, host Lynn Hamilton welcomes Matt Lawton, Executive Director of FSP Delivery at Syneos Health, to explore the unique challenges and opportunities facing small-to-mid-size (SMID) biopharma sponsors. Often operating with leaner resources and evolving pipelines, these companies require partners who can flex with their journey—not just deliver headcount.With over 15 years of experience guiding functional partnerships, Matt offers grounded insights on how to build trust-based FSP models tailored to each sponsor's origin, stage and future goals.  Listeners will gain a practical understanding of:What truly defines the SMID segment—and why it's a space of rapid innovationHow functional support needs vary widely across early- to mid-stage sponsorsThe critical role of adaptability in both delivery teams and partnership modelsWhy strong cultural fit and team integration matter more in SMID engagementsWhen to start considering FSP—and how a conversation, not a contract, is often the best first stepIf you're working in or with an emerging biopharma organization, this episode offers a valuable look into how functional partnerships can evolve to meet you where you are—and grow with you.The views expressed in this podcast belong solely to the speakers and do not represent those of their organization. If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision-making and investment. You can find it all at https://www.syneoshealth.com/insights-hub. Like what you're hearing? Be sure to rate and review us! We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com.

What does it take to run a truly effective Functional Service Provider (FSP) model in today's biopharma landscape? From harmonizing global teams to embedding innovation into daily delivery, FSP engagement is more than a resourcing solution — it's about strategic collaboration and approaches that accelerate delivery. The Syneos Health Podcast: Functionally Speaking series explores the nuances that make these models work. In this episode of the Functionally Speaking series, host Lynn Hamilton sits down with Wayne Wise, Vice President of Clinical Operations at Syneos Health, to explore the real-world shifts happening in large pharma partnerships. With nearly two decades at the company and deep cross-functional experience, Wayne shares how agility, strategic governance and trust-based team leadership are reshaping FSP delivery models. From evolving CRA roles and co-created governance to the increasing use of AI, Wayne offers a firsthand look at how functional teams are adapting in real time to operational and strategic shifts across the industry.  You will walk away with insights on:Moving beyond transactional models to strategic, insight-driven partnershipsBuilding agile teams that thrive amid complexityTransforming governance to focus on action, not just KPIsHow the CRA role is evolving with tech-enabled site engagementWhat sponsors can do to unlock value through co-creationThe views expressed in this podcast belong solely to the speakers and do not represent those of their organization. If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision-making and investment. You can find it all at https://www.syneoshealth.com/insights-hub. Like what you're hearing? Be sure to rate and review us! We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com.

Check out Cam's latest novel / audio drama here! Diablo's latest season is like a box of crayons that has one gloriously beautiful crayon inside of it — but the rest is empty. Functionally, this is a season without a story, and as much as we are adoring the new Paladin class, this episode is ultimately about how alarmed we are by the narrative precedent established by this Season of Divine Intervention. Topics include: difficulty curve, constant bugs, fun factor, the new seasonal powers, underlying systems reworks, the seasonal campaign, a class update about the delightful Paladin, and some existential wrap up questions. LINKS: Patreon, YouTube, Spotify, Instagram Feedback & Theories: secondbreakfastpod@gmail.com

After a watery escape from Vastrada, the party convalesce at an Inn and plan their next movesIf you want to learn to play D&D, Gadget is running beginner's sessions on Startplaying.Games. Take a seat at his table and check out what he's got to offer: Professional Game Master - Gadget | StartPlayingCONTACT USModern Escapism are creating Brilliant Podcasts | PatreonEmailInstagramBlueskyDiscordTwitchTikTokCheck out our other podcasts:Modern Escapismhttps://shows.acast.com/smashthatglasshttps://shows.acast.com/deepdiveloungeYou can also follow us individually at:BiggieGadgetStigCandyOodlesThis episode was written, produced and edited by GadgetSupport this show http://supporter.acast.com/scorchedsheep. Hosted on Acast. See acast.com/privacy for more information.

Guest Dr. Sundar Jagannath and host Dr. Davide Soldato discuss JCO article "Long-Term (≥5-Year) Remission and Survival After Treatment With Ciltacabtagene Autoleucel in CARTITUDE-1 Patients With Relapsed/Refractory Multiple Myeloma," and the efficacy of CAR-T cell therapy in patients with heavily pretreated RRMM (relapsed/refractory multiple myeloma). TRANSCRIPT Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO author, Professor Sundar Jagannath, Professor of Medicine at the Icahn School of Medicine at Mount Sinai and the Tisch Cancer Institute. He also serves as Network Director for the Center of Excellence for Multiple Myeloma, and he is an internationally recognized expert in the field of multiple myeloma. Today, we will be discussing the article titled, "Long-Term Remission and Survival After Treatment With Ciltacabtagene Autoleucel in CARTITUDE-1 Patients With Relapsed/Refractory Multiple Myeloma." Thank you for speaking with us, Professor Jagannath. Dr. Sundar Jagannath: Thank you for having me, Dr. Davide Soldato. It is a pleasure to be here. JCO is a highly recognized journal among the oncologists, so I am very happy and privileged to be here today. Dr. Davide Soldato: Thank you so much for being with us. So, I wanted to start a little bit with the rationale of the study and the population that was included in the study. So, the trial that we are discussing, CARTITUDE-1, was already published before, and we observed very good results with a single infusion of cilta-cel. So we had previously reported a median progression-free survival of 30 months, and median overall survival was not reached. So, I just wanted to ask you if you could guide us a little bit into the population that was included in the study and also explain a little bit to our listeners what is the drug that we are discussing, cilta-cel. Dr. Sundar Jagannath: It is a CAR T-cell. This is a patient's own lymphocytes, which goes through apheresis and is sent to the company, where they modify it and introduce the B cell receptor. In this case, you know, there is a heavy chain gene receptor for the BCMA, and in cilta-cel, there are actually two receptor sites on each molecule, or there are two binding domains on each receptor molecule. So, it is considered to be quite efficacious. As you reported, the earlier results that the patients who participated, 97% of the patient responded. Now, you asked about the patients who participated in the clinical trial. This clinical trial was conducted between July of 2018 and October of 2019. At that time, this was a phase 1b/phase 2 trial, and the whole idea was to take patients who had relapsed all the available treatment regimen so that these patients were considered to have, in the unmet medical need situation. So, what does that entail? That means the patient should have been exposed to a proteasome inhibitor, to an immunomodulatory molecule, and to an anti-CD38 monoclonal antibody and should have received at least three or more prior lines of therapy and should be actually progressing on their last line of therapy. So with that requirement, if you look at it, the median number of prior therapy on the patients who participated was actually six. So patients were heavily pretreated. They had exhausted all available treatment options. So, they can participate in this clinical trial. And if not, there have been real-world evidence, such as LocoMMotion, which had reported what is the outcome for such a patient if they were treated outside of this clinical trial, if they were treated with the then available regimen. Their median progression free survival would have been only 3 months, and most patients would have lost their life within a year. So, this was truly an unmet medical need with patients in a very difficult clinical situation. Let's put it that way. So, those were the patients who participated in this particular trial. Dr. Davide Soldato: Thank you very much. And as we mentioned before, the results that were obtained in this clinical trial were really very interesting. And now, in this issue of the Journal of Clinical Oncology, you are reporting data with a longer follow up. So we are actually at more than 5 years of follow up for the patients included in this trial. So, I just wanted a little bit of insight into why you decided to report these long-term outcomes and what type of information do you think you could provide with this study to the medical community? Dr. Sundar Jagannath: This is very important because this was a clinical trial that was done in patients who were, as I said, in unmet medical need. Most of the patients had prior stem cell transplantation, had gone through a proteasome inhibitor. Many of them have had both Velcade and carfilzomib treatment. Most of them had been exposed to lenalidomide and pomalidomide. And as required, all of the patients had to have had prior exposure to anti-CD38 monoclonal antibody or daratumumab. So, the patients were heavily pretreated. Typically, TIL CAR T-cells came into the field at this particular moment, until then, we were developing small molecules, and they usually would have a PFS of 3 months and median life expectancy of a year, the overall response rate of 30%, and that is how, if you look back, that is how carfilzomib was approved, that is how pomalidomide was approved. So, the drugs which were approved, including daratumumab, you know, the response rate was in the same ballpark. So you would see that most agents, single agents, would have had a response rate in the neighborhood of 30%, the progression-free survival would have been between 3 to 5 months or 6 months at the most, and the life expectancy was short. And here comes a drug, and when I was following the patients at Mount Sinai, I found that there were a subset of patients, they got one-time treatment and they were in complete remission, no trace of cancer with annual evaluation with PET CT and bone marrow evaluation for MRD. So, I said this is remarkable, and this needs to be reported. And I went to the Janssen and company, and they agreed to review the entire experience. This is remarkable that 32 of the 97 patients, or one third of the patients, were alive and progression-free. This is unheard of for any clinical trial until now, that the patient will be progression-free, one third of the patients on a clinical trial will be progression-free, in the late stage of their disease. So that is the most important impact. And that is why this 5-year follow-up results were presented. Dr. Davide Soldato: Thank you very much. That was very clear. And as you said, we are speaking about a population that was heavily pretreated, that had exhausted all type of treatment options outside of a clinical trial. And as you said, one third of the patients was alive and progression-free after 5 years from being included and infused inside of the study. So, considering this population that, as we said, had received all treatment options, I was wondering if you observed any kind of differences in terms of disease characteristics when looking at these patients that had exceptional response, so, alive and progression-free at 5 years, and the patients that sadly had developed a progression after the infusion in the study. Dr. Sundar Jagannath: This is very important because we wanted to see who are the patients who are having this exceptional outcome. And we looked at all the 97 patients. If we look at all the patients, we saw that there were initially, out of the 97, 17 patients died earlier in the disease course due to treatment related complications, etc. But there were about 46 patients who had progression of disease and 32 patients, or one third, were alive without progression of disease. Then we looked at the 46 patients who had progression of disease. Of them, we found that 30 had disease progression and its complication, and there were actually 13 patients who were still alive even after progression of disease. So we decided to compare these 46 patients who had progression of disease versus 32 patients who had no progression of disease to see what is the difference. To our surprise, the age was similar, male, female distribution was similar. High-risk cytogenetics, which we would have thought, you know, that is why we say high-risk disease, the term, high-risk cytogenetics was equally distributed. That was really a surprise. Number of lines of prior therapy, number of exposure to drugs, all of that was the same. So that was also interesting. But a theme did emerge. Patients, in general, tend to have lower burden of disease who had the exceptional outcome. But there is one which we considered as bad, the extramedullary disease. Multiple myeloma being a blood cancer, it is usually in the bone marrow. When it starts growing outside of the bone marrow, the extramedullary disease, usually it portends poor prognosis. But we were surprised that actually there were an equal number of extramedullary disease patients even in the long-term survivor as those who had progressed of disease. So the most important takeaway was patients who had lower burden of disease, they had less number of myeloma cells in their bone marrow, percentage wise, and the soluble BCMA level was lower. Soluble BCMA is an indirect measure of the amount of plasma cells in the patient's body. It is like a tumor burden. So they were low. So, this was an important finding because it has future ramification, as you can understand. If this treatment is made available earlier in the disease course of the patients, where we are able to control the disease better, then more patients are likely to have such wonderful outcomes as one third of the patient experience in the late stage of the disease. Dr. Davide Soldato: So, you already mentioned soluble BCMA as a marker of potentially better prognosis as being correlated to a lower volume of disease. I was wondering if you could give us some more information about the biomarkers that you evaluated in the study. For example, you evaluated a little bit the CAR T expansion kinetics and also some others that I think could be interesting and could point to some population that experienced such important benefit. Dr. Sundar Jagannath: That is a very important point because CAR T-cell, it is a live cell and its efficacy depends upon how well the CAR T-cell is going to function. And then, you know, the patient undergoes apheresis. This is a patient's own lymphocyte. So first and foremost is who would generate good CAR T-cell. Those who have plenty of lymphocytes at the time they are coming for apheresis. This is likely to happen earlier in the course of the disease than in patients who have gone through numerous lines of therapy and exhausted. So, in this particular trial, of course this was in late stage of the disease, and so we were able to show patients who had lower number of T cell in circulation, and the way to measure is if they had more neutrophils and less lymphocytes. So that is what is called as a higher T cell over neutrophil, they did better. If they have more neutrophil than T cells, then they did not do well. So, procurement. The second one is also whether the T cells are more naive, you know, not exhausted T cells. So more naive T cells, if you are able to procure from the patient, they did very well. Now, after the CAR T-cell manufacture, then the expansion, when you put it back into the patient, if the T cells expand very well, so that the effector, that is the CAR T-cells to the tumor ratio is good, so there are more effector cells, the CAR T was able to expand and the amount of tumor was less, then the efficacy was very, very good. As I said, the patients in this group, those who had a lower burden of disease, they did better, and that is because of the CAR T-cell expansion, so the effector to the target ratio was favorable. So that is another important. And then there are also the type of CAR T-cells, having CD4 T cells with central memory phenotype at the peak expansion also makes a difference. So all of that matters. But this is important because the efficacy of the CAR T-cell, it is persistent, long persistent and keeping the cancer down. Its ability to get rid of the cancer completely at the first go around because usually we are not able to detect the CAR T-cells beyond 6 months in the majority of patients and very rarely after a year or two. So it is very uncommon to find the CAR T-cells in circulation or even in the regular bone marrow evaluation. So, efficacy, the expansion, having naive T cells, having good effector to target ratio and more central memory kind of T cell, because if it is all effector T cell, they will get quickly utilized and get exhausted, whereas the central memory cells can expand more and give more effective CAR T-cells. Dr. Davide Soldato: Thank you very much. I was wondering if you could guide us a little bit into what is your opinion regarding the positioning of CAR T-cells given all of these logistics that is necessary compared, for example, with bispecific antibodies against BCMA, which have the same target, but they do not have all of these logistics before being administered to the patient. Dr. Sundar Jagannath: That is a very important question, how to sequence these treatments now that we have two BCMA-directed CAR T-cells available. We have three BCMA-directed bispecific and one GPRC5D-directed bispecific antibodies are available. And so the question comes in for at least the currently approved CAR T-cell therapy, there is an obligatory time. You have to go through apheresis and you have to ship to the company, and there is a manufacturing time, roughly about 2 months before they can receive it. During that time, you want to make sure the patient's disease is under control. So that is a given. There are several ways to look at it when we evaluate the patient and talk to the patient. One good thing is now the two CAR T-cells which are approved, one is cilta-cel we talked about, and the other one is ide-cel. Ide-cel is approved in earlier line of therapy, two or more prior lines of therapy, and cilta-cel is approved in patients who have failed one line of therapy and who are lenalidomide refractory. So, the treatment of CAR T-cell is available earlier. And as I said, when you administer CAR T-cell earlier, you are able to keep the disease burden down, and it is a one and done deal. There is a better quality of life for the patient, and you are able to produce long, durable remission and potentially a cure. Now coming to the bispecific, they are currently available in later lines of therapy. So if you look at it from a patient's perspective, you can use the CAR T-cell earlier and then go through the bispecific therapy. But if the patient comes with relapsed refractory myeloma and has not used the CAR T-cell therapy and has not used the bispecific therapy, then the physicians have to decide which one they want to use. If somebody's disease is rapidly progressing and they need immediate tumor reduction and they have already exhausted all available therapy, then going through BCMA bispecific therapy is quite appropriate. And secondly, CAR T-cell therapy is generally given to somewhat physically more fit patients, whereas bispecific therapy, because you are giving antibody at step-wise dosing in this patient, and you have the ability to stop at any particular dose and then come back and redose, whereas CAR T is, you just give it to them one time, you have a lot more control. So intermediate frail or even frail patients can go through bispecific therapy, whereas it would not be in the best interest of the patient to go through a CAR T-cell therapy when they are frail. So that is another important point. But from the information available, when the patient goes on a BCMA bispecific therapy and they start progressing on treatment, usually it is their T cells are exhausted or the BCMA is no longer expressed on the tumor cells. So coming with CAR T-cell later on is usually not effective, whereas giving CAR T-cell earlier, if the patient relapses later, they have good T-cell function and most of the time the BCMA is still expressed. So you are able to give the BCMA to the maximum benefit by using the CAR T first and BCMA later. So if somebody asked me how to sequence this, just off the bat, you will say CAR T first, BCMA bispecific second. But as I said, there are unique situations. Then there is another potential that is happening. You can change the target. You can use a BCMA against GPRC5D to reduce the tumor, and then go ahead and consolidate it with a CAR T-cell therapy. That is also possible. You are changing the target from GPRC5D to BCMA, the tumor is already down, so the patient is likely to benefit. So these are all newer treatment options which have become available to the physician. So they will have to look at individual patients and decide what is the best course of action for that patient. Dr. Davide Soldato: So, I just wanted to close a little bit with your opinion about how these results translate into clinical practice. So considering this outstanding 5-year data that we have seen, one third of the patients who are alive and progression-free after a single infusion of cilta-cel, do you think that we could start to think about functional cure even in patients who have a diagnosis of relapsed refractory multiple myeloma? Dr. Sundar Jagannath: My feeling is this is important because in this particular study which is published, 12 patients who were followed at Mount Sinai out of the 32 patients who are alive and progression-free, 12 were followed at Mount Sinai. And they were evaluated every year with bone marrow MRD testing by clonoSEQ in 11 of the 12 patients, and one was by multiparametric flow cytometry. So most of them were 10 to the minus 6, not even one in a million cancer cells, and all of them had functional imaging, which is called PET CT every year. So these were patients who had no evidence of disease that we could detect with the technology available today, serologically, in the bone marrow, or anywhere else in the body with a PET CT. They were found to be disease free after a single infusion of cilta-cel. So, that would be almost to the definition of a cure because if you look at cure as a definition for any cancer, cure is defined as a state of complete remission with no trace of cancer that persists over a period of 5 years or longer without maintenance. And that will be applicable for breast cancer, lymphoma, leukemia. So it is a general statement. And if we use that in myeloma too, then I could say that these 12 patients from my center, we proved that they are cured of their myeloma. They are not functionally cured. You've got to remember, there is only cure. That was the definition across all diseases. So there is nothing like a functional cure. They are cured of myeloma. So is myeloma curable? This is the first time we are looking at that. We do know, every physician treating myeloma that there are patients out there, 10 year and beyond, without evidence of disease. This has been published by University of Arkansas, Bart Barlogie's group, who has been saying that myeloma is a curable disease for a long time. And many others have shown long-term follow up. But this one in a late stage disease, we were able to show that they were one treatment with no maintenance. All other studies have been in newly diagnosed myeloma patients. Nobody has shown in late relapse patients on a clinical trial a third of the patient will be progression-free. And 12 of them who were studied were actually disease free. So they were cured of the disease. So if we accept that, then the next question is, first step towards cure is achieving complete remission. They should have no monoclonal protein by any technology you want to use, no measurable residual disease using next gen sequencing or clonoSEQ, and functional imaging whole body PET CT or whole body MRI. So that is important, definition of the complete remission. And then it has to be sustained. That is something the IMWG and IMS, International Myeloma Society, they will have to come together for a consensus. How many years should they be followed and should be in this kind of status with no trace of cancer? Is it, 3 years are enough? 4 years enough? 5 years is enough? For me, I said in this paper, 5 years is a good definition for achieving a potential cure. Then you use the term 'functionally cured'. I have a problem with functionally cured and operationally cured or whatever. Functionally cured was originally put out by Paiva from Spain. There were 8% of newly diagnosed myeloma patients who have, after they go get treated, they will have an MGUS like phenomenon, a small amount of paraprotein detectable, and they are only 8%. And he said that these patients could be off treatment and the disease does not progress. But the problem is when you are giving treatment like maintenance therapy continuously until progression, you do not know exactly who is in the MGUS situation. So you have to have done sophisticated flow cytometry like Paiva did, and it is not quite clinically applicable. So functionally cured applies only for 8% of the people, so it should go out of the vocabulary. Then you can say 'operationally cured'. These are the patients traditionally Bart Barlogie and others showed that they have a large number of patients who have been followed for 10 years with no recurrence of disease, not on treatment. But in those days, they did not have MRD PET CT and all of them done systematically. So that is why they had to come up with a situation where they said they were operationally cured. So yes, myeloma patients have been cured since auto transplant was introduced. I completely agree. It is not new to the CAR T-cell therapy. But the beauty of the CAR T-cell therapy was it was in relapsed refractory myeloma, unmet medical need, number one. Number two, they were studied systematically. It was a clinical trial adjudicated by FDA and EMA for drug approval, cilta-cel was approved. So these patients were carefully followed, and it was a multi-center study. And in that group of patients, we were able to show patients- So, I think this would indicate cure is a reality in myeloma, and as these kind of treatments, immunologic treatment, either it is a CAR T-cell therapy or BCMA bispecific or whatever, there is a chance more patients are likely to be cured, and these treatments have to move forward and so that we are looking towards a cure. That is the beauty of it, and I just thank you for asking and also throwing in this so-called functionally cured, which people like to use casually, and I say it is time to talk more cure and not stuck with functionally cured because that does not allow the field to progress. Dr. Davide Soldato: Thank you very much. That was very interesting. Dr. Sundar Jagannath: And provocative. Dr. Davide Soldato: A little bit, but I think that we needed to close the podcast with this kind of reflection coming from someone who is an expert in the field, as you are. So, I really wanted to thank you for joining us today and for sharing more on your article, which is titled, "Long-Term Remission and Survival After Treatment With Ciltacabtagene Autoleucel in CARTITUDE-1 Patients With Relapsed/Refractory Multiple Myeloma." If you enjoy our show, please leave us a rating and a review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts. Dr. Sundar Jagannath: Thank you. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

We're bringing back our episode exploring the American chestnut's history, ecological importance, challenges faced due to habitat change and disease, on-going conservation efforts, and how you can get involved in its ecological restoration.    Our lab is primarily funded by donations. If you would like to help support our work, please donate here: http://UFgive.to/UFGameLab   Resources:   Diamond, S. J., et al. (2000). Hard mast production before and after the chestnut blight. Southern Journal of Applied Forestry, 24(4), 196-201.   The American Chestnut Foundation   The American Chestnut Foundation: Growing Chestnuts   Tree Snapp App   Varner, J. M., et al. (2021). Litter flammability of 50 southeastern north American tree species: evidence for mesophication gradients across multiple ecosystems. Frontiers in Forests and Global Change, 4, 727042.   Do you have a topic you'd like us to cover? Leave us a review or send us an email at wildturkeyscience@gmail.com!   Sara Fitzsimmons sara.fitzsimmons@tacf.org, Website   We've launched a comprehensive online wild turkey course featuring experts across multiple institutions that specialize in habitat management and population management for wild turkeys. Earn up to 20.5 CFE hours! Enroll Now!    Dr. Marcus Lashley @DrDisturbance, Publications Dr. Will Gulsby @dr_will_gulsby, Publications Turkeys for Tomorrow @turkeysfortomorrow  UF Game Lab @ufgamelab, YouTube   Donate to our wild turkey research: UF Turkey Donation Fund , Auburn Turkey Donation Fund    Want to help wild turkey conservation? Please take our quick survey to take part in our research!   Do you have a topic you'd like us to cover? Leave us a review or send us an email at wildturkeyscience@gmail.com!   Watch these podcasts on YouTube   Please help us by taking our (quick) listener survey - Thank you!    Check out the DrDisturbance YouTube channel! DrDisturbance YouTube   Want to help support the podcast? Our friends at Grounded Brand have an option to donate directly to Wild Turkey Science at checkout. Thank you in advance for your support!   Leave a podcast rating for a chance to win free gear!   This podcast is made possible by Turkeys for Tomorrow, a grassroots organization dedicated to the wild turkey. To learn more about TFT, go to turkeysfortomorrow.org.    Music by Artlist.io Produced & edited by Charlotte Nowak  

We're bringing back our episode exploring the American chestnut's history, ecological importance, challenges faced due to habitat change and disease, on-going conservation efforts, and how you can get involved in its ecological restoration.    Our lab is primarily funded by donations. If you would like to help support our work, please donate here: http://UFgive.to/UFGameLab   Resources:   Diamond, S. J., et al. (2000). Hard mast production before and after the chestnut blight. Southern Journal of Applied Forestry, 24(4), 196-201.   The American Chestnut Foundation   The American Chestnut Foundation: Growing Chestnuts   Tree Snapp App   Varner, J. M., et al. (2021). Litter flammability of 50 southeastern north American tree species: evidence for mesophication gradients across multiple ecosystems. Frontiers in Forests and Global Change, 4, 727042.   Do you have a topic you'd like us to cover? Leave us a review or send us an email at wildturkeyscience@gmail.com!   Sara Fitzsimmons sara.fitzsimmons@tacf.org, Website   We've launched a comprehensive online wild turkey course featuring experts across multiple institutions that specialize in habitat management and population management for wild turkeys. Earn up to 20.5 CFE hours! Enroll Now!    Dr. Marcus Lashley @DrDisturbance, Publications Dr. Will Gulsby @dr_will_gulsby, Publications Turkeys for Tomorrow @turkeysfortomorrow  UF Game Lab @ufgamelab, YouTube   Donate to our wild turkey research: UF Turkey Donation Fund , Auburn Turkey Donation Fund    Want to help wild turkey conservation? Please take our quick survey to take part in our research!   Do you have a topic you'd like us to cover? Leave us a review or send us an email at wildturkeyscience@gmail.com!   Watch these podcasts on YouTube   Please help us by taking our (quick) listener survey - Thank you!    Check out the DrDisturbance YouTube channel! DrDisturbance YouTube   Want to help support the podcast? Our friends at Grounded Brand have an option to donate directly to Wild Turkey Science at checkout. Thank you in advance for your support!   Leave a podcast rating for a chance to win free gear!   This podcast is made possible by Turkeys for Tomorrow, a grassroots organization dedicated to the wild turkey. To learn more about TFT, go to turkeysfortomorrow.org.    Music by Artlist.io Produced & edited by Charlotte Nowak  

Join Eric, @DrJoeEsposito, @SteffanPappas, @TimAndrewsHere, @Autopritts, @JaredYamamoto, Greg, and George LIVE on 95.5 WSB from 3pm-7pm as they chat about Trump's meritocracy, Dr. Phil's bankruptcy, free-range children, and so much more! *New episodes of our sister shows: The Popcast with Tim Andrews and The Nightcap with Jared Yamamoto are available as well!

David and Gary sit down with Rachel McLauchlin, founder of Embark Benefits, to unpack what it really takes to rebuild something from the ground up—twice. Rachel shares how her own experience navigating the benefits world sparked a mission to create something better: a system that actually works for people, not against them.This episode digs into the grit behind entrepreneurship, the lessons learned from doing it all over again, and how personal conviction can fuel a business that lasts. Rachel's story is a reminder that the best companies don't just fill a gap—they fix something broken.LINKS:Rachel's EmailEmbark Benefits WebsiteEmbark Benefits Phone Number: (704)- 449-7718___________________________________ Submit Your Questions to: hello@thebigpixel.net OR comment on our YouTube videos! - Big Pixel, LLC - YouTube Our Hosts David Baxter - CEO of Big Pixel Gary Voigt - Creative Director at Big Pixel The Podcast David Baxter has been designing, building, and advising startups and businesses for over ten years. His passion, knowledge, and brutal honesty have helped dozens of companies get their start. In Biz/Dev, David and award-winning Creative Director Gary Voigt talk about current events and how they affect the world of startups, entrepreneurship, software development, and culture. Contact Us hello@thebigpixel.net 919-275-0646 www.thebigpixel.net FB | IG | LI | TW | TT : @bigpixelNC Big Pixel 1772 Heritage Center Dr Suite 201 Wake Forest, NC 27587 Music by: BLXRR

✨Join me for a live in person event in Los Angeles on November 21-23 Early bird pricing is till available

Dr. Eric Morrell sits down with Dr. Maude Liegeois to discuss her paper, "Airway Macrophages Encompass Transcriptionally and Functionally Distinct Subsets Altered by Smoking."

What do you do for what God has done for you? The answer is : MAKE a RESPONSE.  How do you respond? A response is undeniably required.Functionally, today's passage is about money. It is about STUFF.But the stuff is just the "currency" of the response. So are our hands, feet, mouths, and wallets. Realize and respond with me for 7 minutes.https://youtu.be/qdqehK-54kg

Industrial Talk is talking to Tacoma Zach, Co-Founder and CEO at MentorAPM about "Functionally unite end-to-end asset lifecycle management". Scott Mackenzie interviews Tacoma Zach Mentor about Mentor APM, a comprehensive asset management solution. Tacoma shares his background in chemical engineering and asset management, highlighting his experience with Veolia and ExxonMobil. Mentor APM offers a 29-day implementation process, leveraging pre-loaded asset libraries and failure modes. The platform integrates with existing ERP systems and uses AI for rapid, accurate asset assessments. Tacoma emphasizes the importance of proactive asset management, prioritization, and the human component in change management. Mentor APM aims to enhance reliability, reduce costs, and improve operational stability. Action Items [ ] Reach out to Tacoma Zach at mentor APM to learn more about the solution. [ ] Connect with Tacoma Zach on LinkedIn. Outline Introduction and Welcome to Industrial Talk Scott MacKenzie welcomes listeners to the Industrial Talk podcast, emphasizing the importance of celebrating industrial heroes. Scott introduces Tacoma Scott encourages listeners to dive into the industry, emphasizing the need for education, collaboration, and innovation. Scott announces the launch of the Industrial News Network (INN) to keep up with the fast-moving industry and connect people with the right information. Tacoma Zack Mentor's Background and Journey Tacoma Zach Mentor shares his background, starting as a graduate chemical engineer from the University of Toronto. Tacoma discusses his career in contract operations, eventually leading to Veolia, and his transition into asset management. He explains the founding of his engineering company in 2005 and his involvement with Herbalytics, a spin-out from Veolia focused on risk and criticality analysis. Tacoma describes the development of Mentor APM in 2017, aiming to unify various asset management functionalities into one comprehensive solution. Mentor APM's Unique Value Proposition Scott and Tacoma discuss the crowded market of asset management platforms and what sets Mentor APM apart. Tacoma explains the origins of the name "Mentor," derived from the best practices and experiences from Veolia and other companies. He highlights the importance of automation and pre-loading data to reduce rework and manual processes. Tacoma emphasizes the need for a unified solution that integrates various aspects of asset management, from failure modes to prioritization. Implementation and Adoption of Mentor APM Scott inquires about the implementation process and timeline for Mentor APM. Tacoma explains that Mentor APM can be implemented in as little as 29 days, thanks to pre-loaded asset libraries and failure modes. He discusses the importance of prioritization and the ability to quickly assess and manage critical assets. Tacoma highlights the flexibility of Mentor APM to adapt to different customer needs and the importance of change management in the adoption process. Integration with Existing Systems and AI Advancements Scott asks about the integration of Mentor APM with existing ERP systems. Tacoma explains that Mentor APM has published APIs to seamlessly integrate with various systems, including ERP solutions. He introduces Mentor Lens, a tool that allows for...

“What is the sound of one hand clapping?”— Zen KoanLet's start with a confession.Developing the Unified Behavioral Model (UBM) revealed, in many ways, a side quest I didn't expect: Helping large language models (LLMs) navigate the mental spaghetti we humans lovingly call “logic”—which, if followed faithfully, often leads straight to paradox.You know—the deep, crunchy stuff:Body vs. environmentEmotion vs. feelingSkill vs. habitLogic vs. illogicThese aren't just philosophical speed bumps.They're full-blown conceptual cul-de-sacs.Every time the system—human or machine—hits one, it either freezes or splinters into a dozen confident-but-confused directions.What Is Abstract Thought, Anyway?Get it? To “draw away”It's not about sounding smart or solving puzzles.Frankly, it's your one real edge over AI—for now.It's about seeing things and thinking differently, especially when the pieces don't fit.It's Picasso and Pollock pulling apart realism.It's Einstein “riding a beam of light”.It's Lao Tzu explaining how “The soft and the weak overcome the hard and the strong.”Abstract thinking is cognitive flexibility —it's a different lens to process, beyond logic.It's the ability to zoom out and remove the frame.To hold logic and contradiction in the same hand, without blowing a fuse.So, we deliberately choose to go back to FUNDAMENTALS.Not to simplify, but to clarify.Not to dumb down, but to dissolve—to draw away from false binaries.Because here's the thing about dichotomies: Most aren't real.They're often tradition wrapped in Latin, handed down like sacred scrolls, passed around in conference halls and research papers.They survive not because they're accurate, but because they're familiar.“If you can't explain it simply, you don't understand it well enough.” ~EinsteinAnd that's how the Unified Behavioral Model emerged: Not from divine inspiration, but moderate exasperation.Not from clarity, but from watching both brilliant humans and state-of-the-art LLMs get trapped in mental corners built by… You guessed it: LOGIC.Behaviorally speaking:Is the environment separate from the body?Not really. Both are environmental stimulants.If a headache doesn't change your mood and behavior, just like an idiot screaming at a baseball game, let me know.Are emotions and feelings different?Functionally perhaps? Not elementally. Both relay information.They're conduits—waves influencing your Behavior Echo-System.What about habits and skills?Turns out, they're more alike than different. Both are behaviors shaped through repetition, refined over time until they become automatic. Intentional or not, they're built the same way.How do we reconcile logic and illogic?Reconcile? Even the most “logical” among us do spectacularly irrational things—because we're driven by meaning, by narrative, by the stories we tell ourselves.Logic and illogic aren't separate. They're co-pilots.So if you want to teach a machine how behavior works, we first have to ‘draw away' the various dichotomies logic has constructed.And once those dissolve?The behavior model doesn't need to be built.It simply... emerges.Google: “Why doesn't a unified behavior model exist?”The answer begins with complexity.Complexity created by distinctions (above) that are both very important AND fundamentally (behaviorally speaking), not so important.Like jiggling the old TV antenna for the hundredth time, and suddenly the picture locks in—clear as day, as though it was never scrambled at all.Turns out, it —A UNIFIED BEHAVIOR MODEL—does exist. ☝️It just had to be excavated from under layers of distinctions, logic, and dichotomies.Logic is linear.Behavior, like the human experience, is abstract.This is elemental behavioral literacy. This is the Unified Behavioral Model (UBM)We didn't invent it—we excavated it.It was buried.Habits 2 Goals Premium by Martin Grunburg is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.“What is your face before your parents were born?” — Zen KoanBecause while machines crunch data, humans connect dots.While models can simulate logic, you can sit with uncertainty.When you can envision a bigger picture, the frames dissolve.“Reflection” (Man Sitting) M. Grunburg 1987Elemental behavioral science shouldn't be reserved for labs and lectures. We teach adolescents the ABCs and 123s —elemental math and grammar. We can, and should, teach elemental behavior. Maybe abstract thinking will come along for the ride.“Experience and knowledge don't arrive with labels, silos, or departments—we create those. Sometimes those distinctions are incredibly useful (like language itself). And sometimes—also like language—they make problem-solving harder than it needs to be.”

From Hormone Chaos to Hormone Harmony… Reiki & Functional Hormone Expert Melissa Perna unpacks her experience with PCOS, living with half a thyroid and the transition into Perimenopause. We explore how nutrition and nervous system support are the key to balanced, happy hormones.. listen now on the Empowered Hormones Podcast GUEST LINKS Website: www.melissaperna.com.au Social links: https://www.instagram.com/melissapernahormonehealth/, https://www.facebook.com/melissapernahormonehealth LINKS TO SHERADYN: Assess your gut health in 3min HERE Follow me on Instagram Join my Private Gut Health Facebook group Book a Free Gut Health Planning Session HERE See omnystudio.com/listener for privacy information.

In this episode of the FIT40 podcast, we dive deep into the most important numbers to focus on to get fit and stay fit for life when it comes to lifestyle management. We cover key health metrics like blood work, cardio, and strength standards that can have a profound impact on your overall wellbeing. Discover practical tips to optimize your cholesterol, blood pressure, A1C, and waist circumference - all essential markers for longevity. Plus, learn science-backed exercise guidelines to improve your cardiac health and build functional strength. This comprehensive guide provides the roadmap to take control of your fitness and wellness at 40 and beyond.FIT40 LINKS:Toned In 20 Workouts: https://fit40-online-coaching.kit.com/1f640492ffBook Your Free Nutrition Assessment: https://calendly.com/coachfitzz/assessmentFIT40 Coaching Info & Application: https://fit40coaching.my.canva.site/applicationFIT40 Family Facebook Group: https://www.facebook.com/groups/fit40familyAFFILIATE LINKS:Try Tonal for 30 Days Risk Free: https://tonal.sjv.io/FIT40Get 10% Off The Genius Protein Shot: https://www.geniusshot.com/?ref=BRYAN_FIT40&transaction_id=10214dd14c839e450a4423af7b1f8eCONNECT WITH ME ONLINEFacebook: https://www.facebook.com/bryan.fitzsimmonsInstagram: ⁠⁠⁠⁠https://www.instagram.com/coach_fitzz/⁠⁠⁠⁠Tiktok: ⁠⁠⁠⁠⁠https://www.tiktok.com/@coach_fitzz?is_from_webapp=1&sender_device=pcYoutube: https://www.youtube.com/@bryan_fit40CITATIONSMile Run Standards – Citations & SourcesBlair SN, et al. (1996).Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA.▸ Demonstrates strong correlation between cardiorespiratory fitness and mortality.American College of Sports Medicine (ACSM)Guidelines for Exercise Testing and Prescription, 10th ed.▸ Provides normative values for VO₂ max and field tests like the 1-mile run.Cooper KH (1968).A means of assessing maximal oxygen intake. Correlation between field and treadmill testing. JAMA.▸ Foundational study introducing the Cooper test and correlating running distance/time to aerobic capacity.10-Mile Bike Standards – Citations & SourcesCooper InstituteThe Cooper Test Manual (Bike variant).▸ Adaptation of the original Cooper test for stationary and road bikes.Kodama S, et al. (2009).Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events. JAMA.Ainsworth BE, et al. (2011).Compendium of Physical Activities: Classification of energy costs of human physical activities.▸ Supports METs estimation for cycling time trials.British Cycling Time Trial Norms▸ Competitive amateur cycling data used for benchmarking 10-mile efforts.Push-Up Standards – Citations & SourcesYang J, et al. (2019).Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men. JAMA Network Open.▸ Men completing ≥40 push-ups had dramatically lower cardiovascular event risk.ACSM & NSCA Normative DataACSM's Fitness Assessment ManualNSCA's Essentials of Strength Training and Conditioning▸ Provide age- and sex-specific push-up standards.Kraschnewski JL, et al. (2013).Is strength training associated with mortality benefits? Prev Med.Chin-Ups / Inverted Rows – Citations & SourcesRantanen T, et al. (1999).Midlife muscle strength and human longevity up to age 100 years. J Gerontol A Biol Sci Med Sci.▸ Strength and functional movement as predictors of longevity.ACSM Guidelines & NSCA Standards▸ Norms for bodyweight strength tasks including pull-ups and rows.Army Physical Fitness Test (APFT) & USMC Standards▸ Used to create practical strength thresholds for chin-ups by age/sex.Fagan JM, et al. (2020).Maximal upper-body strength and pull-up performance in physically active adults.▸ Correlates pull-up performance with upper body strength and endurance.Reverse Lunge Standards – Citations & SourcesSchoenfeld BJ, et al. (2016).Resistance training volume enhances muscle hypertrophy. J Strength Cond Res.Cook G. (2010).Movement: Functional Movement Systems.▸ Assesses quality and asymmetry in single-leg patterns like lunges.Kraemer WJ & Ratamess NA. (2004).Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc.ACSM's Position Stand on Resistance Training for Healthy Adults▸ Confirms efficacy and safety of loaded single-leg exercises for aging resilience.Functionally-relevant studies on fall risk and lower-body strengthHughes VA, et al. (2001). Age-related changes in strength and performance. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit bryanfitzsimmon.substack.com

1Corinthians 11:8–12 (ESV) — 8 For man was not made from woman, but woman from man. 9 Neither was man created for woman, but woman for man. 10 That is why a wife ought to have a symbol of authority on her head, because of the angels. 11 Nevertheless, in the Lord woman is not independent of man nor man of woman; 12 for as woman was made from man, so man is now born of woman. And all things are from God.  REVIEW:  THE APPLICATION OF 3 TRUTHS OF HEADSHIP 1 Corinthians 11:3 (ESV) — 3 But I want you to understand that the head of every man is Christ, the head of a wife is her husband, and the head of Christ is God.  (v8-9) MARRIAGE & DISTINCTION IN GENDER ROLES  ARE  ROOTED IN THE DESIGN OF GOD'S CREATION, NOT THE DISASTER OF SIN'S CORRUPTION a.   1 Corinthians 11:8-10,  Genesis 1 & 2,  Matthew 19:4, 1 Timothy 2:13  (v10) THE DESIGN OF GOD IS PURPOSED IN THE DISPLAY OF HIS GLORY IN ALL CREATION a.       1 Corinthians 11:10, 1 Peter 1:10-12, Ephesians 1:7-10  Week 4: (v11-12) MEN AND WOMEN EXIST IN RELATIONSHIP INTERDEPENDENT ON ONE ANOTHER,  AND ALWAYS DEPENDENT ON GOD.   INTERDEPENDENCE  BY DESIGN (11a) LIKE ALL THINGS COMPLETELY DEPENDENT ON GOD (11b)  MALE & FEMALE DECLARED EQUAL IN VALUE DIFFERENT INROLE…1.        Equal in Value (Genesis 1:27-28, 1 Peter 3:7) 2.        Different in role a.        Physically (1 Peter 3:7, Jeremiah 50:37, 51:30, Nahum3:13) b.        Functionally  (1 Cor 11:3, 14:34,  1 Timothy 2:11-13, 3:1-11)            THREE MODERN POSITIONSTO COMMUNICATE GENDER RELATIONSHIPS (Egalitarian, Complementarianism, Biblical Patriarchy)Principles in such debates: 1.       Be responsive to scripture more than you are reactive to society.2.       Find unity in the word of God, more than you debate the words of men.         HELPFUL DEFINITIONS OFBIBLICAL MASCULINITY AND FEMININITY “AT THE HEART OF MATURE MASCULINITY IS A SENSE OF BENEVOLENT RESPONSIBILITY TO LEAD, PROVIDEFOR AND PROTECT WOMEN IN WAYS APPROPRIATE TO A MAN'S DIFFERING RELATIONSHIPS.” “AT THE HEART OF MATURE FEMININITY IS A FREEING DISPOSITION TO AFFIRM, RECEIVE AND NURTURESTRENGTH AND LEADERSHIP FROM WORTHY MEN IN WAYS APPROPRIATE TO A WOMAN'SDIFFERING RELATIONSHIPS.”Grudem, Wayne. RecoveringBiblical Manhood and Womanhood: A Response to Evangelical Feminism (p. 51). 

We are calling for the world's best AI Engineer talks for AI Architects, /r/localLlama, Model Context Protocol (MCP), GraphRAG, AI in Action, Evals, Agent Reliability, Reasoning and RL, Retrieval/Search/RecSys , Security, Infrastructure, Generative Media, AI Design & Novel AI UX, AI Product Management, Autonomy, Robotics, and Embodied Agents, Computer-Using Agents (CUA), SWE Agents, Vibe Coding, Voice, Sales/Support Agents at AIEWF 2025! Fill out the 2025 State of AI Eng survey for $250 in Amazon cards and see you from Jun 3-5 in SF!Coreweave's now-successful IPO has led to a lot of questions about the GPU Neocloud market, which Dylan Patel has written extensively about on SemiAnalysis. Understanding markets requires an interesting mix of technical and financial expertise, so this will be a different kind of episode than our usual LS domain.When we first published $2 H100s: How the GPU Rental Bubble Burst, we got 2 kinds of reactions on Hacker News:* “Ah, now the AI bubble is imploding!”* “Duh, this is how it works in every GPU cycle, are you new here?”We don't think either reaction is quite right. Specifically, it is not normal for the prices of one of the world's most important resources right now to swing from $1 to $8 per hour based on drastically inelastic demand AND supply curves - from 3 year lock-in contracts to stupendously competitive over-ordering dynamics for NVIDIA allocations — especially with increasing baseline compute needed for even the simplest academic ML research and for new AI startups getting off the ground.We're fortunate today to have Evan Conrad, CEO of SFCompute, one of the most exciting GPU marketplace startups, talk us through his theory of the economics of GPU markets, and why he thinks CoreWeave and Modal are well positioned, but Digital Ocean and Together are not.However, more broadly, the entire point of SFC is creating liquidity between GPU owners and consumers and making it broadly tradable, even programmable:As we explore, these are the primitives that you can then use to create your own, high quality, custom GPU availability for your time and money budget, similar to how Amazon Spot Instances automated the selective buying of unused compute.The ultimate end state of where all this is going is GPU that trade like other perishable, staple commodities of the world - oil, soybeans, milk. Because the contracts and markets are so well established, the price swings also are not nearly as drastic, and people can also start hedging and managing the risk of one of the biggest costs of their business, just like we have risk-managed commodities risks of all other sorts for centuries. As a former derivatives trader, you can bet that swyx doubleclicked on that…Show Notes* SF Compute* Evan Conrad* Ethan Anderson* John Phamous* The Curve talk* CoreWeave* Andromeda ClusterFull Video PodLike and subscribe!Timestamps* [00:00:05] Introductions* [00:00:12] Introduction of guest Evan Conrad from SF Compute* [00:00:12] CoreWeave Business Model Discussion* [00:05:37] CoreWeave as a Real Estate Business* [00:08:59] Interest Rate Risk and GPU Market Strategy Framework* [00:16:33] Why Together and DigitalOcean will lose money on their clusters* [00:20:37] SF Compute's AI Lab Origins* [00:25:49] Utilization Rates and Benefits of SF Compute Market Model* [00:30:00] H100 GPU Glut, Supply Chain Issues, and Future Demand Forecast* [00:34:00] P2P GPU networks* [00:36:50] Customer stories* [00:38:23] VC-Provided GPU Clusters and Credit Risk Arbitrage* [00:41:58] Market Pricing Dynamics and Preemptible GPU Pricing Model* [00:48:00] Future Plans for Financialization?* [00:52:59] Cluster auditing and quality control* [00:58:00] Futures Contracts for GPUs* [01:01:20] Branding and Aesthetic Choices Behind SF Compute* [01:06:30] Lessons from Previous Startups* [01:09:07] Hiring at SF ComputeTranscriptAlessio [00:00:05]: Hey everyone, welcome to the Latent Space podcast. This is Alessio, partner and CTO at Decibel, and I'm joined by my co-host Swyx, founder of Smol AI.Swyx [00:00:12]: Hey, and today we're so excited to be finally in the studio with Evan Conrad from SF Compute. Welcome. I've been fortunate enough to be your friend before you were famous, and also we've hung out at various social things. So it's really cool to see that SF Compute is coming into its own thing, and it's a significant presence, at least in the San Francisco community, which of course, it's in the name, so you couldn't help but be. Evan: Indeed, indeed. I think we have a long way to go, but yeah, thanks. Swyx: Of course, yeah. One way I was thinking about kicking on this conversation is we will likely release this right after CoreWeave IPO. And I was watching, I was looking, doing some research on you. You did a talk at The Curve. I think I may have been viewer number 70. It was a great talk. More people should go see it, Evan Conrad at The Curve. But we have like three orders of magnitude more people. And I just wanted to, to highlight, like, what is your analysis of what CoreWeave did that went so right for them? Evan: Sell locked-in long-term contracts and don't really do much short-term at all. I think like a lot of people had this assumption that GPUs would work a lot like CPUs and the like standard business model of any sort of CPU cloud is you buy commodity hardware, then you lay on services that are mostly software, and that gives you high margins and pretty much all your value comes from those services. Not really the underlying. Compute in any capacity and because it's commodity hardware and it's not actually that expensive, most of that can be sort of on-demand compute. And while you do want locked-in contracts for folks, it's mostly just a sort of de-risk situation. It helps you plan revenue because you don't know if people are going to scale up or down. But fundamentally, people are like buying hourly and that's how your business is structured and you make 50 percent margins or higher. This like doesn't really work in GPUs. And the reason why it doesn't work is because you end up with like super price sensitive customers. And that isn't because necessarily it's just way more expensive, though that's totally the case. So in a CPU cloud, you might have like, you know, let's say if you had a million dollars of hardware in GPUs, you have a billion dollars of hardware. And so your customers are buying at much higher volumes than you otherwise expect. And it's also smaller customers who are buying at higher amounts of volume. So relative to what they're spending in general. But in GPUs in particular, your customer cares about the scaling law. So if you take like Gusto, for example, or Rippling or an HR service like this, when they're buying from an AWS or a GCP, they're buying CPUs and they're running web servers, those web servers, they kind of buy up to the capacity that they need, they buy enough, like CPUs, and then they don't buy any more, like, they don't buy any more at all. Yeah, you have a chart that goes like this and then flat. Correct. And it's like a complete flat. It's not even like an incremental tiny amount. It's not like you could just like turn on some more nodes. Yeah. And then suddenly, you know, they would make an incremental amount of money more, like Gusto isn't going to make like, you know, 5% more money, they're gonna make zero, like literally zero money from every incremental GPU or CPU after a certain point. This is not the case for anyone who is training models. And it's not the case for anyone who's doing test time inference or like inference that has scales at test time. Because like you, your scaling laws mean that you may have some diminishing returns, but there's always returns. Adding GPUs always means your model does actually get. And that actually does translate into revenue for you. And then for test time inference, you actually can just like run the inference longer and get a better performance. Or maybe you can run more customers faster and then charge for that. It actually does translate into revenue. Every incremental GPU translates to revenue. And what that means from the customer's perspective is you've got like a flat budget and you're trying to max the amount of GPUs you have for that budget. And it's very distinctly different than like where Augusto or Rippling might think, where they think, oh, we need this amount of CPUs. How do we, you know, reduce that? How do we reduce our amount of money that we're spending on this to get the same amount of CPUs? What that translates to is customers who are spending in really high volume, but also customers who are super price sensitive, who don't give a s**t. Can I swear on this? Can I swear? Yeah. Who don't give a s**t at all about your software. Because a 10% difference in a billion dollars of hardware is like $100 million of value for you. So if you have a 10% margin increase because you have great software, on your billion, the customers are that price sensitive. They will immediately switch off if they can. Because why wouldn't you? You would just take that $100 million. You'd spend $50 million on hiring a software engineering team to replicate anything that you possibly did. So that means that the best way to make money in GPUs was to do basically exactly what CoreWeave did, which is go out and sign only long-term contracts, pretty much ignore the bottom end of the market completely, and then maximize your long-term contracts. With customers who don't have credit risk, who won't sue you, or are unlikely to sue you for frivolous reasons. And then because they don't have credit risk and they won't sue you for frivolous reasons, you can go back to your lender and you can say, look, this is a really low risk situation for us to do. You should give me prime, prime interest rate. You should give me the lowest cost of capital you possibly can. And when you do that, you just make tons of money. The problem that I think lots of people are going to talk about with CoreWeave is it doesn't really look like a cloud platform. It doesn't really look like a cloud provider financially. It also doesn't really look like a software company financially.Swyx [00:05:37]: It's a bank.Evan [00:05:38]: It's a bank. It's a real estate company. And it's very hard to not be that. The problem of that that people have tricked themselves into is thinking that CoreWeave is a bad business. I don't think CoreWeave is explicitly a bad business. There's a bunch of people, there's kind of like two versions of the CoreWeave take at the moment. There's, oh my God, CoreWeave, amazing. CoreWeave is this great new cloud provider competitive with the hyperscalers. And to some extent, this is true from a structural perspective. Like, they are indeed a real sort of thing against the cloud providers in this particular category. And the other take is, oh my gosh, CoreWeave is this horrible business and so on and blah, blah, blah. And I think it's just like a set of perception or perspective. If you think CoreWeave's business is supposed to look like the traditional cloud providers, you're going to be really upset to learn that GPUs don't look like that at all. And in fact, for the hyperscalers, it doesn't look like this either. My intuition is that the hyperscalers are probably going to lose a lot of money, and they know they're going to lose a lot of money on reselling NVIDIA GPUs, at least. Hyperscalers, but I want to, Microsoft, AWS, Google. Correct, yeah. The Microsoft, AWS, and Google. Does Google resell? I mean, Google has TPUs. Google has TPUs, but I think you can also get H100s and so on. But there are like two ways they can make money. One is by selling to small customers who aren't actually buying in any serious volume. They're testing around, they're playing around. And if they get big, they're immediately going to do one of two things. They're going to ask you for a discount. Because they're not going to pay your crazy sort of margin that you have locked into your business. Because for CPUs, you need that. They're going to pay your massive per hour price. And so they want you to sign a long-term contract. And so that's your other way that you can make money, is you can basically do exactly what CoreWeave does, which is have them pay as much as possible upfront and lock in the contract for a long time. Or you can have small customers. But the problem is that for a hyperscaler, the GPUs to... To sell on the low margins relative to what your other business, your CPUs are, is a worse business than what you are currently doing. Because you could have spent the same money on those GPUs. And you could have trained model and you could have made a model on top of it and then turn that into a product and had high margins from your product. Or you could have taken that same money and you could have competed with NVIDIA. And you could have cut into their margin instead. But just simply reselling NVIDIA GPUs doesn't work like your CPU business. Where you're able to capture high margins from big customers and so on. And then they never leave you because your customers aren't actually price sensitive. And so they won't switch off if your prices are a little higher. You actually had a really nice chart, again, on that talk of this two by two. Sure. Of like where you want to be. And you also had some hot takes on who's making money and who isn't. Swyx: So CoreUv locked up long-term contracts. Get that. Yes. Maybe share your mental framework. Just verbally describe it because we're trying to help the audio listeners as well. Sure. People can look up the chart if they want to. Evan: Sure. Okay. So this is a graph of interest rates. And on the y-axis, it's a probability you're able to sell your GPUs from zero to one. And on the x-axis, it's how much they'll depreciate in cost from zero to one. And then you had ISO cost curves or ISO interest rate curves. Yeah. So they kind of shape in a sort of concave fashion. Yeah. The lowest interest rates enable the most aggressive. form of this cost curve. And the higher interest rates go, the more you have to push out to the top right. Yeah. And then you had some analysis of where every player sits in this, including CoreUv, but also Together and Modal and all these other guys. I thought that was super insightful. So I just wanted to elaborate. Basically, it's like a graph of risk and the genres of places where you can be and what the risk is associated with that. The optimal thing for you to do, if you can, is to lock in long-term contracts that are paid all up front or in with a situation in which you trust the other party to pay you over time. So if you're, you know, selling to Microsoft or something or OpenAI. Which are together 77% of the revenue of CoreUv. Yeah. So if you're doing that, that's a great business to be in because your interest rate that you can pitch for is really low because no one thinks Microsoft is going to default. And like maybe OpenAI will default, but the backing by Microsoft kind of doesn't. And I think there's enough, like, generally, it looks like OpenAI is winning that you can make it's just a much better case than if you're selling to the pre-seed startup that just raised $30 million or something pre-revenue. It's like way easier to make the case that the OpenAI is not going to default than the pre-seed startup. And so the optimal place to be is selling to the maximally low risk customer for as long as possible. And then you never have to worry about depreciation and you make lots of money. The less. Good. Good place to be is you could sell long-term contracts to people who might default on you. And then if you're not bringing it to the present, so you're not like saying, hey, you have to pay us all up front, then you're in this like more risky territory. So is it top left of the chart? If I have the chart right, maybe. Large contracts paid over time. Yeah. Large contracts paid over time is like top left. So it's more risky, but you could still probably get away with it. And then the other opportunity is that you could sell short-term contracts for really high prices. And so lots of people tried that too, because this is actually closer to the original business model that people thought would work in cloud providers for CPUs. It works for CPUs, but it doesn't really work for GPUs. And I don't think people were trying this because they were thinking about the risk associated with it. I think a lot of people are just come from a software background, have not really thought about like cogs or margins or inventory risk or things that you have to worry about in the physical world. And I think they were just like copy pasting the same business model onto CPUs. And also, I remember fundraising like a few years ago. And I know based on. Like what we knew other people were saying who were in a very similar business to us versus what we were saying. And we know that our pitch was way worse at the time, because in the beginning of SF Compute, we looked very similar to pretty much every other GPU cloud, not on purpose, but sort of accidentally. And I know that the correct pitch to give to an investor was we will look like a traditional CPU cloud with high margins and we'll sell to everyone. And that is a bad business model because your customers are price sensitive. And so what happens is if you. Sell at high prices, which is the price that you would need to sell it in order to de-risk your loss on the depreciation curve, and specifically what I mean by that is like, let's say you're selling it like $5 an hour and you're paying $1.50 an hour for the GPU under the hood. It's a little bit different than that, but you know, nice numbers, $5 an hour, $1.50 an hour. Great. Excellent. Well, you're charging a really high price per GPU hour because over time the price will go down and you'll get competed out. And what you need is to make sure that you never go under, or if you do go under your underlying cost. You've made so much money in the first part of it that the later end of it, like doesn't matter because from the whole structure of the deal, you've made money. The problem is that just, you think that you're going to be able to retain your customers with software. And actually what happens is your customers are super price sensitive and push you down and push you down and push you down and push you down, um, that they don't care about your software at all. And then the other problem that you have is you have, um, really big players like the hyperscalers who are looking to win the market and they have way more money than you, and they can push down on margin. Much better than you can. And so if they have to, and they don't, they don't necessarily all the time, um, I think they actually keep pride of higher margin, but if they needed to, they could totally just like wreck your margin at any point, um, and push you down, which meant that that quadrant over there where you're charging a high price, um, and just to make up for the risk completely got destroyed, like did not work at all for many places because of the price sensitivity, because people could just shove you down instead that pushed everybody up to the top right-hand corner of that, which is selling short-term. Contracts for low prices paid over time, which is the worst place to be in, um, the worst financial place to be in because it has the highest interest rate, um, which means that your, um, your costs go up at the same time, your, uh, your incoming cash goes down and squeezes your margins and squeezes your margins. The nice thing for like a core weave is that most of their business is over on the, on the other sides of those quadrants that the ones that survive. The only remaining question I have with core weave, and I promise I get to ask if I can compute, and I promise this is relevant to SOF Compute in general, because the framework is important, right? Sure. To understand the company. So why didn't NVIDIA or Microsoft, both of which have more money than core weave, do core weave, right? Why didn't they do core weave? Why have this middleman when either NVIDIA or Microsoft have more money than God, and they could have done an internal core weave, which is effectively like a self-funding vehicle, like a financial instrument. Why does there have to be a third party? Your question is like... Why didn't Microsoft, or why didn't NVIDIA just do core weave? Why didn't they just set up their own cloud provider? I think, and I don't know, and so correct me if I'm wrong, and lots of people will have different opinions here, or I mean, not opinions, they'll have actual facts that differ from my facts. Those aren't opinions. Those are actually indeed differences of reality, is that NVIDIA doesn't want to compete with their customers. They make a large amount of money by selling to existing clouds. If they launched their own core weave, then it would be a lot more money. It'd make it much harder for them to sell to the hyperscalers, and so they have a complex relationship with there. So not great for them. Second is that, at least for a while, I think they were dealing with antitrust concerns or fears that if they're going through, if they own too much layers of the stack, I could imagine that could be a problem for them. I don't know if that's actually true, but that's where my mind would go, I guess. Mostly, I think it's the first one. It's that they would be competing directly with their primary customers. Then Microsoft could have done it, right? That's the other question. Yeah, so Microsoft didn't do it. And my guess is that... NVIDIA doesn't want Microsoft to do it, and so they would limit the capacity because from NVIDIA's perspective, both they don't want to necessarily launch their own cloud provider because it's competing with their customers, but also they don't want only one customer or only a few customers. It's really bad for NVIDIA if you have customer concentration, and Microsoft and Google and Amazon, like Oracle, to buy up your entire supply, and then you have four or five customers or so who pretty much get to set prices. Monopsony. Yeah, monopsony. And so the optimal thing for you is a diverse set of customers who all are willing to pay at whatever price, because if you don't, somebody else will. And so it's really optimal for NVIDIA to have lots of other customers who are all competing against each other. Great. Just wanted to establish that. It's unintuitive for people who have never thought about it, and you think about it all day long. Yeah. Swyx: The last thing I'll call out from the talk, which is kind of cool, and then I promise we'll get to SF Compute, is why will DigitalOcean and Together lose money on their clusters? Why will DigitalOcean and Together lose money on their clusters?Evan [00:16:33]: I'm going to start by clarifying that all of these businesses are excellent and fantastic. That Together and DigitalOcean and Lambda, I think, are wonderful businesses who build excellent products. But my general intuition is that if you try to couple the software and the hardware together, you're going to lose money. That if you go out and you buy a long-term contract from someone and then you layer on services, or you buy the hardware yourself and you spin it up and you get a bunch of debt, you're going to run into the same problem that everybody else did, the same problem we did, same problem the hyperscalers did. And that's exactly what the hyperscalers are doing, which is you cannot add software and make high margins like a cloud provider can. You can pitch that into investors and it will totally make sense, and it's like the correct play in CPUs, but there isn't software you could make to make this occur. If you're spending a billion dollars on hardware, you need to make a billion dollars of software. There isn't a billion dollars of software that you can realistically make, and if you do, you're going to look like SAP. And that's not a knock on SAP. SAP makes a f**k ton of money, right? Right. Right. Right. Right. There aren't that many pieces of software that you could make, that you can realistically sell, like a billion dollars of software, and you're probably not going to do it to price-sensitive customers who are spending their entire budget already on compute. They don't have any more money to give you. It's a very hard proposition to do. And so many parties have been trying to do this, like, buy their own compute, because that's what a traditional cloud does. It doesn't really work for them. You know that meme where there's, like, the Grim Reaper? And he's, like, knocking on the door, and then he keeps knocking on the next door? We have just seen door after door after door of the Grim Reeker comes by, and the economic realities of the compute market come knocking. And so the thing we encourage folks to do is if you are thinking about buying a big GPU cluster and you are going to layer on software on top, don't. There are so many dead bodies in the wake there. We would recommend not doing that. And we, as SF Compute, our entire business is structured to help you not do that. It's helped disintegrate these. The GPU clouds are fantastic real estate businesses. If you treat them like real estate businesses, you will make a lot of money. The cloud services you can make on that, all the software you want to make on that, you can do that fantastically. If you don't own the underlying hardware, if you mix these businesses together, you get shot in the head. But if you combine, if you split them, and that's what the market does, it helps you split them, it allows you to buy, like, layer on services, but just buy from the market, you can make lots of money. So companies like Modal, who don't own the underlying compute, like they don't own it, lots of money, fantastic product. And then companies like Corbeave, who are functionally like really, really good real estate businesses, lots of money, fantastic product. But if you combine them, you die. That's the economic reality of compute. I think it also splits into trading versus inference, which are different kinds of workloads. Yeah. And then, yeah, one comment about the price sensitivity thing before we leave this. This topic, I want to credit Martin Casado for coining or naming this thing, which is like, you know, you said, you said this thing about like, you don't have room for a 10% margin on GPUs for software. Yep. And Martin actually played it out further. It's his first one I ever saw doing this at large enough runs. So let's say GPT-4 and O1 both had a total trading cost of like a $500 billion is the rough estimate. When you get the $5 billion runs, when you get the $50 billion runs, it is actually makes sense to build your own. You're going to have to get into chips, like for OpenEI to get into chip design, which is so funny. I would make an ASIC for this run. Yeah, maybe. I think a caveat of that that is not super well thought about is that only works if you're really confident. It only works if you really know which chip you're going to do. If you don't, then it's a little harder. So it makes in my head, it makes more sense for inference where you've already established it. But for training there's so much like experimentation. Any generality, yeah. Yeah. The generality is much more useful. Yeah. In some sense, you know, Google's like six generations into the CPUs. Yeah. Yeah. Okay, cool. Maybe we should go into SF Compute now. Sure. Yeah.Alessio [00:20:37]: Yeah. So you kind of talked about the different providers. Why did you decide to go with this approach and maybe talk a bit about how the market dynamics have evolved since you started a company?Evan [00:20:47]: So originally we were not doing this at all. We were definitely like forced into this to some extent. And SF Compute started because we wanted to go train models for music and audio in general. We were going to do a sort of generic audio model at some points, and then we were going to do a music model at some points. It was an early company. We didn't really spec down on a particular thing. But yeah, we were going to do a music model and audio model. First thing that you do when you start any AI lab is you go out and you buy a big cluster. The thing we had seen everybody else do was they went out and they raised a really big round and then they would get stuck. Because if you raise the amount of money that you need to train a model initially, like, you know, the $50 million pre-seed, pre-revenue, your valuation is so high or you get diluted so much that you can't raise the next round. And that's a very big ask to make. And also, I don't know, I felt like we just felt like we couldn't do it. We probably could have in retrospect, but I think one, we didn't really feel like we could do it. Two, it felt like if we did, we would have been stuck later on. We didn't want to raise the big round. And so instead, we thought, surely by now, we would be able to just go out. To any provider and buy like a traditional CPU cloud would sell offer you and just buy like on demand or buy like a month or so on. And this worked for like small incremental things. And I think this is where we were basing it off. We just like assumed we could go to like Lambda or something and like buy thousands of at the time A100s. And this just like was not at all the case. So we started doing all the sales calls with people and we said, OK, well, can we just get like month to month? Can we get like one month of compute or so on? Everyone told us at the time, no. You need to have a year long contract or longer or you're out of luck. Sorry. And at the time, we were just like pissed off. Like, why won't nobody sell us a month at a time? Nowadays, we totally understand why, because it's the same economic reason. Because if you if they had sold us the month to month or so on and we canceled or so on, they would have massive risk on that. And so the optimal thing to do was to only to just completely abandon the section of the market. We didn't like that. So our plan was we were going to buy a year long contract anyway. We would use a month. And then we would. At least the other 11 months. And we were locked in for a year, but we only had to pay on every individual month. And so we did this. But then immediately we said, oh, s**t, now we have a cloud provider, not a like training models company, not an AI lab, because every 30 days we owed about five hundred thousand dollars or so and we had about five hundred thousand dollars in the bank. So that meant that every single month, if we did not sell out our cluster, we would just go bankrupt. So that's what we did for the first year of the company. And when you're in that position. You try to think how in the world you get out of that position, what that transition to is, OK, well, we tend to be pretty good at like selling this cluster every month because we haven't died yet. And so what we should do is we should go basically be like this broker for other people and we will be more like a GPU real estate or like a GPU realtor. And so we started doing that for a while where we would go to other people who had who was trying to sell like a year long contract with somebody and we'd go to another person who like maybe this person wanted six months and somebody else on six months or something and we'd like combine all these people. Together to make the deal happen and we'd organize these like one off bespoke deals that looked like basically it ended up with us taking a bunch of customers, us signing with a vendor, taking some cut and then us operating the cluster for people typically with bare metal. And so we were doing this, but this was definitely like a oh, s**t, oh, s**t, oh, s**t. How do we get out of our current situation and less of a like a strategic plan of any sort? But while we were doing this, since like the beginning of the company, we had been thinking about how to buy GPU clusters, how to sell them effectively, because we'd seen every part of it. And what we ended up with was like a book of everybody who's trying to buy and everyone is trying to sell because we were these like GPU brokers. And so that turned into what is today SF Compute, which is a compute market, which we think we are the functionally the most liquid GPU market of any capacity. Honestly, I think we're the only thing that actually is like a real market that there's like bids and asks and there's like a like a trading engine that combines everything. And so. I think we're the only place where you can do things that a market should be able to do. Like you can go on SF Compute today and you get thousands of H100s for an hour if you want. And that's because there is a price for thousands of GPUs for an hour. That is like not a thing you can reasonably do on kind of any other cloud provider because nobody should realistically sell you thousands of GPUs for an hour. They should sell it to you for a year or so on. But one of the nice things about a market is that you can buy the year on SF Compute. But then if you need to sell. Back, you can sell back as well. And that opens up all these little pockets of liquidity where somebody who's just trying to buy for a little bit of time, some burst capacity. So people don't normally buy for an hour. That's not like actually a realistic thing, but it's like the range somebody who wants, who is like us, who needed to buy for a month can actually buy for a month. They can like place the order and there is actually a price for that. And it typically comes from somebody else who's selling back. Somebody who bought a longer term contract and is like they bought for some period of time, their code doesn't work, and now they need to like sell off a little bit.Alessio [00:25:49]: What are the utilization rates at which a market? What are the utilization rates at which a market? Like this works, what do you see the usual GPU utilization rate and like at what point does the market get saturated?Evan [00:26:00]: Assuming there are not like hardware problems or software problems, the utilization rate is like near 100 percent because the price dips until the utilization is 100 percent. So the price actually has to dip quite a lot in order for the utilization not to be. That's not always the case because you just have logistical problems like you get a cluster and parts of the InfiniBand fabric are broken. And there's like some issue with some switch somewhere and so you have to take some portion of the cluster offline or, you know, stuff like this, like there's just underlying physical realities of the clusters, but nominally we have better utilization than basically anybody because, but that's on utilization of the cluster, like that doesn't necessarily translate into, I mean, I actually do think we have much better overall money made for our underlying vendors than kind of anybody else. We work with the other GPU clouds and the basic pitch to the other GPU clouds is one. So we can sell your broker so we can we can find you the long term contracts that are at the prices that you want, but meanwhile, your cluster is idle and for that we can increase your utilization and get you more money because we can sell that idle cluster for you and then the moment we find the longer, the bigger customer and they come on, you can kick off those people and then go to the other ones. You get kind of the mix of like sell your cluster at whatever price you can get on the market and then sell your cluster at the big price that you want to do for long term contract, which is your ideal business model. And then the benefit of the whole thing being on the market. Is you can pitch your customer that they can cancel their long term contract, which is not a thing that you can reasonably do if you are just the GPU cloud, if you're just the GPU cloud, you can never cancel your contract, because that introduces so much risk that you would otherwise, like not get your cheap cost of capital or whatever. But if you're selling it through the market, or you're selling it with us, then you can say, hey, look, you can cancel for a fee. And that fee is the difference between the price of the market and then the price that they paid at, which means that they canceled and you have the ability to offer that flexibility. But you don't. You don't have to take the risk of it. The money's already there and like you got paid, but it's just being sold to somebody else. One of our top pieces from last year was talking about the H100 glut from all the long term contracts that were not being fully utilized and being put under the market. You have on here dollar a dollar per hour contracts as well as it goes up to two. Actually, I think you were involved. You were obliquely quoted in that article. I think you remember. I remember because this was hidden. Well, we hid your name, but then you were like, yeah, it's us. Yeah. Could you talk about the supply and demand of H100s? Was that just a normal cycle? Was that like a super cycle because of all the VC funding that went in in 2003? What was that like? GPU prices have come down. Yeah, GPU prices have come down. And there's some part that has normal depreciation cycle. Some part of that is just there were a lot of startups that bought GPUs and never used them. And now they're lending it out and therefore you exist. There's a lot of like various theories as to why. This happened. I dislike all of them because they're all kind of like they're often said with really high confidence. And I think just the market's much more complicated than that. Of course. And so everything I'm going to say is like very hedged. But there was a series of like places where a bunch of the orders were placed and people were pitching to their customers and their investors and just the broader market that they would arrive on time. And that is not how the world works. And because there was such a really quick build out of things, you would end up with bottlenecks in the supply chain somewhere that has nothing to do with necessarily the chip. It's like the InfiniBand cables or the NICs or like whatever. Or you need a bunch of like generators or you don't have data center space or like there's always some bottleneck somewhere else. And so a lot of the clusters didn't come online within the period of time. But then all the bottlenecks got sorted out and then they all came online all at the same time. So I think you saw a short. There was a shortage because supply chain hard. And then you saw a increase or like a glut because supply chain eventually figure itself out. And specifically people overordered in order to get the allocation that they wanted. Then they got the allocations and then they went under. Yeah, whatever. Right. There was just a lot of shenanigans. A caveat of this is every time you see somebody like overordered, there is this assumption that the problem was like the demand went down. I don't think that's the case at all. And so I want to clarify that. It definitely seems like a shortage. Like there's more demand for GPUs than there ever was. It's just that there was also more supply. So at the moment, I think there is still functionally a glut. But the difference that I think is happening is mostly the test time inference stuff that you just need way more chips for that than you did before. And so whenever you make a statement about the current market, people sort of take your words and then they assume that you're making a statement about the future market. And so if you say there's a glut now, people will continue to think there's a glut. But I think what is happening at the moment. My general prediction is that like by the winter, we will be back towards shortage. But then also, this very much depends on the rollout of future chips. And that comes with its own. I think I'm trying to give you like a good here's Evan's forecast. Okay. But I don't know if my forecast is right. You don't have to. Nobody is going to hold you to it. But like I think people want to know what's true and what's not. And there's a lot of vague speculations from people who are not that close to the market actually. And you are. I think I'm a closer. Close to the market, but also a vague speculator. Like I think there are a lot of really highly confident speculators and I am indeed a vague speculator. I think I have more information than a lot of other people. And this makes me more vague of a spectator because I feel less certain or less confident than I think a lot of other people do. The thing I do feel reasonably confident about saying is that the test time inference is probably going to quite significantly expand the amount of compute that was used for inference. So a caveat. This is like pretty much all the inference demand is in a few companies. A good example is like lots of bio and pharma was using H100s training sort of the bio models of sorts. And they would come along and they would buy, you know, thousands of H100s for training and then just like not a lot of stuff for inference. Not in any, not relative to like an opening iron anthropic or something because they like don't have a consumer product. Their inference event, if they can do it right. There's really like only one inference event that matters. And obviously I think they're going to run into it. And Batch and they're not going to literally just run one inference event. But like the one that produces the drug is the important one. Right. And I'm dumb and I don't know anything about biology, so I could be completely wrong here. But my understanding is that's kind of the gist. I can check that for you. You can check that for me. Check that for me. But my understanding is like the one that produces the sequence that is the drug that, you know, cures cancer or whatever. That's the important deal. But like a lot of models look like this where they're sort of more enterprising use cases or they're so prior to something that looks like test time inference. You got lots and lots of demand for training and then pretty much entirely fell off for inference. And I think like we looked at like Open Router, for example, the entirety of Open Router that was not anthropic or like Gemini or OpenAI or something. It was like 10 H100 nodes or something like that. It's just like not that much. It's like not that many GPUs actually to service that entire demand. But that's like a really sizable portion of the sort of open source market. But the actual amount of compute needed for it was not that much. But if you imagine like what an OpenAI needs for like GPT-4, it's like tremendously big. But that's because it's a consumer product that has almost all the inference demand. Yeah, that's a message we've had. Roughly open source AI compared to closed AI is like 5%. Yeah, it's like super small. Super small. It's super small. Super small. But test time inference changes that quite significantly. So I will... I will expect that to increase our overall demand. But my question on whether or not that actually affects your compute price is entirely based on how quickly do we roll out the next chips. The way that you burst is different for test time.Alessio [00:34:01]: Any thoughts on the third part of the market, which is the more peer-to-peer distributed, some are like crypto-enabled, like Hyperbolic, Prime Intellect, and all of that. Where do those fit? Like, do you see a lot of people will want to participate in a peer-to-peer market? Or just because of the capital requirements at the end of the day, it doesn't really matter?Evan [00:34:20]: I'm like wildly skeptical of these, to be frankly. The dream is like steady at home, right? I got this $15.90. Nobody has $15.90. $14.90 sitting at home. I can rent it out. Yeah. Like, I just don't really think this is going to ever be more efficient than a fully interconnected cluster with InfiniBand or, you know, whatever the sort of next spec might be. Like, I could be completely wrong. But speaking of... I mean, like, SpeedoLite is really hard to beat. And regardless of whatever you're using, you just like can't get around that physical limitation. And so you could like imagine a decentralized market that still has a lot of places where there's like co-location. But then you would get something that looks like SF Compute. And so that's what we do. That's why we take our general take is like on SF Compute, you're not buying from like random people. You're buying from the other GPU clouds, functionally. You're buying from data centers that are the same genre of people that you would work with already. And you can specify, oh, I want all these nodes to be co-located. And I don't think you're really going to get around that. And I think I buy crypto for the purposes of like transferring money. Like the financial system is like quite painful and so on. I can understand the uses of it to sort of incentivize an initial market or try to get around the cold start problem. We've been able to get around the cold start problem just fine. So it didn't actually need that at all. What I do think is totally possible is you could launch a token and then you could like subsidize the crypto. You could compute prices for a bit, but like maybe that will help you. I think that's what Nuus is doing. Yeah, I think there's lots of people who are trying to do things like this, but at some point that runs out. So I would, I think generally agree. I think the only thread in that model is very fine grained mixture of experts that can be like algorithms can shift to adapt to hardware realities. And the hardware reality is like, okay, it's annoying to do large co-located clusters. Then we'll just redesign attention or whatever in our architecture to distribute it more. There was a little bit buzz of block attention last year that Strong Compute made a big push on. But I think like, you know, in a world where we have 200 experts in MOE model, it starts to be a little bit better. Like, I don't disagree with this. I can imagine the world in which you have like, in which you've redesigned it to be more parallelizable, like across space.Evan [00:36:43]: But assuming without that, your hardware limitation is your speed of light limitation. And that's a very hard one to get around.Alessio [00:36:50]: Any customers or like stories that you want to shout out of like maybe things that wouldn't have been economically viable like others? I know there's some sensitivity on that.Evan [00:37:00]: My favorites are grad students, are folks who are trying to do things that would normally otherwise require the scale of a big lab. And the grad students are like the worst pilots. They're like the worst possible customer for the traditional GPU clouds because they will immediately turn if you sell them a thing because they're going to graduate and they're not going to go anywhere. They're not going to like, that project isn't continuing to spend lots of money. Like sometimes it does, but not if you're like working with the university or you're working with the lab of some sort. But a lot of times it's just like the ability for us to offer like big burst capacity, I think is lovely and wonderful. And it's like one of my favorite things to do because all those folks look like we did. And I have a special place in my heart for that. I have a special place in my heart for young hackers and young grad students and researchers who are trying to do the same genre of thing that we are doing. For the same reason, I have a special place in my heart for like the startups, the people who are just actively trying to compete on the same scale, but can't afford it time-wise, but can afford it spike-wise. Yeah, I liked your example of like, I have a grant of 100K and it's expiring. I got to spend it on that. That's really beautiful. Yeah. Interesting. Has there been interesting work coming out of that? Anything you want to mention? Yeah. So from like a startup perspective, like Standard Intelligence and Find, P-H-I-N-D. We've had them on the pod.Swyx [00:38:23]: Yeah. Yeah.Evan [00:38:23]: That was great. And then from grad students' perspective, we worked a lot with like the Schmidt Futures grantees of various sorts. My fear is if I talk about their research, I will be completely wrong to a sort of almost insulting degree because I am very dumb. But yeah. I think one thing that's maybe also relevant startups and GPUs-wise. Yeah. Is there was a brief moment where it kind of made sense that VCs provided GPU clusters. And obviously you worked at AI Grants, which set up Andromeda, which is supposedly a $100 million cluster. Yeah. I can explain why that's the case or why anybody would think that would be smart. Because I remember before any of that happened, we were asking for it to happen. Yeah. And the general reason is credit risk. Again, it's a bank. Yeah. I have lower risk than you due to credit transformation. I take your risk onto my balance sheet. Correct. Exactly. If you wanted to go for a while, if you wanted to go set up a GPU cluster, you had to be the one that actually bought the hardware and racked it and stacked it, like co-located it somewhere with someone. Functionally, it was like on your balance sheet, which means you had to get a loan. And you cannot get a loan for like $50 million as a startup. Like not really. You can get like venture debt and stuff, but like it's like very, very difficult to get a loan of any serious price for that. But it's like not that difficult to get a loan for $50 million. If you already have a fund or you already have like a million dollars under your assets somewhere or like you personally can like do a personal guarantee for it or something like this. If you have a lot of money, it is way easier for you to get a loan than if you don't have a lot of money. And so the hack of a VC or some capital partner offering equity for compute is always some arbitrage on the credit risk. That's amazing. Yeah. That's a hack. You should do that. I don't think people should do it right now. I think the market has like, I think it made sense at the time and it was helpful and useful for the people who did it at the time. But I think it was a one-time arbitrage because now there are lots of other sources that can do it. And also I think like it made sense when no one else was doing it and you were the only person who was doing it. But now it's like it's an arbitrage that gets competed down. Sure. So it's like super effective. I wouldn't totally recommend it. Like it's great that Andromeda did it. But the marginal increase of somebody else doing it is like not super helpful. I don't think that many people have followed in their footsteps. I think maybe Andreessen did it. Yeah. That's it. I think just because pretty much all the value like flows through Andromeda. What? That cannot be true. How many companies are in the air, Grant? Like 50? My understanding of Andromeda is it works with all the NFTG companies or like several of the NFTG companies. But I might be wrong about that. Again, you know, something something. Nat, don't kill me. I could be completely wrong. But the but you know, I think Andromeda was like an excellent idea to do at the right time in which it occurred. Perfect. His timing is impeccable. Timing. Yeah. Nat and Daniel are like, I mean, there's lots of people who are like... Sears? Yeah. Sears. Like S-E-E-R. Oh, Sears. Like Sears of the Valley. Yeah. They for years and years before any of the like ChatGPT moment or anything, they had fully understood what was going to happen. Like way, way before. Like. AI Grant is like, like five years old, six years old or something like that. Seven years old. When I, when it like first launched or something. Depends where you start. The nonprofit version. Yeah. The nonprofit version was like, like happening for a while, I think. It's going on for quite a bit of time. And then like Nat and Daniel are like the early investors in a lot of the sort of early AI labs of various sorts. They've been doing this for a bit.Alessio [00:41:58]: I was looking at your pricing yesterday. We're kind of talking about it before. And there's this weird thing where one week is more expensive of both one day and one month. Yeah. What are like some of the market pricing dynamics? What are things that like this to somebody that is not in the business? This looks really weird. But I'm curious, like if you have an explanation for it, if that looks normal to you. Yeah.Evan [00:42:18]: So the simple answer is preemptible pricing is cheaper than non-preemptible pricing. And the same economic principle is the reason why that's the case right now. That's not entirely true on SF Compute. SF Compute doesn't really have the concept of preemptible. Instead, what it has is very short reservations. So, you know, you go to a traditional cloud provider and you can say, hey, I want to reserve contract for a year. We will let you do a reserve contract for one hour, which is the part of SFC. But what you can do is you can just buy every single hour continuously. And you're reserving just for that hour. And then the next hour you reserve just for that next hour. And this is obviously like a built in. This is like an automation that you can do. But what you're seeing when you see the cheap price is you're seeing somebody who's buying the next hour, but maybe not necessarily buying an hour after that. So if the price goes up. Up too much. They might not get that next hour. And the underlying part of this of where that's coming from the market is you can imagine like day old milk or like milk that's about to be old. It might drop its price until it's expired because nobody wants to buy the milk that's in the past. Or maybe you can't legally sell it. Compute is the same way. No, you can't sell a block of compute that is not that is in the past. And so what you should do in the market and what people do do is they take. They take a block. A block of compute. And then they drop it and drop it and drop it and drop into a floor price right before it's about to expire. And they keep dropping it until it clears. And so anything that is idle drops until some point. So if you go and use on the website and you set that that chart to like a week from now, what you'll see is much more normal looking sort of curves. But if you say, oh, I want to start right now, that immediate instant, here's the compute that I want right now is the is functionally the preemptible price. It's where most people are getting the best compute or like the best compute prices from. The caveat of that is you can do really fun stuff on SFC if you want. So because it's not actually preemptible, it's it's reserved, but only reserved for an hour, which means that the optimal way to use as of compute is to just buy on the market price, but set a limit price that is much higher. So you can set a limit price for like four dollars and say, oh, if the market ever happens to spike up to four dollars, then don't buy. I don't want to buy that at that price for that price. I don't want to buy that at that price for that price for an hour. But otherwise, just buy at the cheapest price. And if you're comfortable with that of the volatility of it, you're actually going to get like really good prices, like close to a dollar an hour or so on, sometimes down to like 80 cents or whatever. You said four, though. Yeah. So that's the thing. You want to lower the limit. So four is your max price. Four is like where you basically want to like pull the plug and say don't do it because the actual average price is not or like the, you know, the preemptible price doesn't actually look like that. So what you're doing when you're saying four is always, always, always give me this compute. Like continue to buy every hour. Don't preempt me. Don't kick me off. And I want this compute and just buy at the preemptible price, but never kick me off. The only times in which you get kicked off is if there is a big price spike. And, you know, let's say one day out of the year, there's like a four dollar an hour price because of some weird fluke or something. If there are other periods of time, you're actually getting a much lower price than you. It makes sense. Your your average cost that you're actually paying is way better. And your trade off here is you don't literally know what price you're going to get. So it's volatile. But your actual average historically has been like everyone who's done this has gotten wildly better prices. And this is like one of the clever things you can do with the market. If you're willing to make those trade offs, you can get a lot of really good prices. You can also do other things like you can only buy at night, for example. So the price goes down at night. And so you can say, oh, I want to only buy, you know, if the price is lower than 90 cents. And so if you have some long running job, you can make it only run on 90 cents and then you recover back and so on. Yeah. So what you can kind of create as like a spot inst is what other the CPU world has. Yes. But you've created a system where you can kind of manufacture the exact profile that you want. Exactly. That is not just whatever the hyperscalers offer you, which is usually just one thing. Correct. SF Compute is like the power tool. The underlying primitives of like hourly compute is there. Correct. Yeah, it's pretty interesting. I've often asked OpenAI. So like, you know, all these guys. Cloud as well. They do batch APIs. So it's half off of whatever your thing is. Yeah. And the only contract is we'll return in 24 hours. Sure. Right. And I was like, 24 hours is good. But sometimes I want one hour. I want four hours. I want something. And so based off of SF Compute's system, you can actually kind of create that kind of guarantee. Totally. That would be like, you know, not 24, but within eight hours, within four hours, like the work half of a workday. Yes. I can return your results to you. And then I can return it to you. And if your latency requirements are like that low, actually it's fine. Yes. Correct. Yeah. You can carve out that. You can financially engineer that on SFC. Yeah. Yeah. I mean, I think to me that unlocks a lot of agent use cases that I want, which is like, yeah, I worked in a background, but I don't want you to take a day. Yeah. Correct. Take a couple hours or something. Yeah. This touches a lot of my like background because I used to be a derivatives trader. Yeah. And this is a forward market. Yeah. A futures forward market, whatever you call it. Not a future. Very explicitly not a future. Not yet a futures. Yes. But I don't know if you have any other points to talk about. So you recognize that you are a, you know, a marketplace and you've hired, I met Alex Epstein at your launch event and you're like, you're, you're building out the financialization of GPUs. Yeah. So part of that's legal. Mm-hmm. Totally. Part of that is like listing on an exchange. Yep. Maybe you're the exchange. I don't know how that works, but just like, talk to me about that. Like from the legal, the standardization, the like, where is this all headed? You know, is this like a full listed on the Chicago Mercantile Exchange or whatever? What we're trying to do is create an underlying spot market that gives you an index price that you can use. And then with that index price, you can create a cash settled future. And with a cash settled future, you can go back to the data centers and you can say, lock in your price now and de-risk your entire position, which lets you get cheaper cost of capital and so on. And that we think will improve the entire industry because the marginal cost of compute is the risk. It's risk as shown by that graph and basically every part of this conversation. It's risk that causes the price to be all sorts of funky. And we think a future is the correct solution to this. So that's the eventual goal. Right now you have to make the underlying spot market in order to make this occur. And then to make the spot market work, you actually have to solve a lot of technology problems. You really cannot make a spot market work if you don't run the clusters, if you don't have control over them, if you don't know how to audit them, because these are super computers, not soybeans. They have to work. In a way that like, it's just a lot simpler to deliver a soybean than it is to deliver it. I don't know. Talk to the soybean guys. Sure. You know? Yeah. But you have to have a delivery mechanism. Your delivery mechanism, like somebody somewhere has to actually get the compute at some point and it actually has to work. And it is really complicated. And so that is the other part of our business that we go and we build a bare metal infrastructure stack that goes. And then also we do auditing of all the clusters. You sort of de-risk the technical perspective and that allows you to eventually de-risk the financial perspective. And that is kind of the pitch of SF Compute. Yeah. I'll double click on the auditing on the clusters. This is something I've had conversations with Vitae on. He started Rika and I think he had a blog post which kind of shone the light a little bit on how unreliable some clusters are versus others. Correct. Yeah. And sometimes you kind of have to season them and age them a little bit to find the bad cards. You have to burn them in. Yeah. So what do you do to audit them? There's like a burn-in process, a suite of tests, and then active checking and passive checking. Burn-in process is where you typically run LINPACK. LINPACK is this thing that like a bunch of linear algebra equations that you're stress testing the GPUs. This is a proprietary thing that you wrote? No, no, no. LINPACK is like the most common form of burn-in. If you just type in burn-in, typically when people say burn-in, they literally just mean LINPACK. It's like an NVIDIA reference version of this. Again, NVIDIA could run this before they ship, but now the customers have to do it. It's annoying. You're not just checking for the GPU itself. You're checking like the whole component, all the hardware. And it's a lot of work. It's an integration test. It's an integration test. Yeah. So what you're doing when you're running LINPACK or burn-in in general is you're stress testing the GPUs for some period of time, 48 hours, for example, maybe seven days or so on. And you're just trying to kill all the dead GPUs or any components in the system that are broken. And we've had experiences where we ran LINPACK on a cluster and it rounds out, sort of comes offline when you run LINPACK. This is a pretty good sign that maybe there is a problem with this cluster. Yeah. So LINPACK is like the most common sort of standard test. But then beyond that, what you do is we have like a series of performance tests that replicate a much more realistic environment as well that we run just assuming if LINPACK works at all, then you run the next set of tests. And then while the GPUs are in operation, you're also going through and you're doing active tests and passive tests. Passive tests are things that are running in the background while somebody else is running, while like some other workload is running. And active tests are during like idle periods. You're running some sort of check that would otherwise sort of interrupt something. And then the active tests will take something offline, basically. Or a passive check might mark it to get taken offline later and so on. And then the thing that we are working on that we have working partially but not entirely is automated refunds, which is basically like, is the case that the hardware breaks so much. And there's only so much that we can do and it is the effect of pretty much the entire industry. So a pretty common thing that I think happens to kind of everybody in the space is a customer comes online, they experience your cluster, and your cluster has the same problem that like any cluster has, or it's I mean, a different problem every time, but they experience one of the problems of HPC. And then their experience is bad. And you have to like negotiate a refund or some other thing like this. It's always case by case. And like, yeah, a lot of people just eat the cost. Correct. So one of the nice things about a market that we can do as we get bigger and have been doing as we can bigger is we can immediately give you something else. And then also we can automatically refund you. And you're still gonna experience it like the hardware problems aren't going away until the underlying vendors fix things. But honestly, I don't think that's likely because you're always pushing the limits of HPC. This is the case of trying to build a supercomputer. that's one of the nice things that we can do is we can switch you out for somebody else somewhere, and then automatically refund you or prorate or whatever the correct move is. One of the things that you say in this conversation with me was like, you know, you know, a provider is good when they guarantee automatic refunds. Which doesn't happen. But yeah, that's, that's in our contact with all the underlying cloud providers. You built it in already. Yeah. So we have a quite strict SLA that we pass on to you. The reason why

In this week's edition of Overdrive Radio, Hotels4Truckers.com proprietor Dan Fuller, former driver and independent owner-operator, details completion of a project years in the making. The website and now mobile app as well got its start simply as a cataloging of hotels around the nation where parking a tractor and 53-foot trailer was not only possible but welcomed, provided for by the hotel facilities. Within the last year, users of Hotels4Truckers.com, though, noticed some significant changes, boosting the seamless-experience factor with booking possible now, with discounts, right from the site itself. Functionally, Fuller said, "We're like Hotels.com for the trucking industry now. Tell us where you're looking, you do your dates, and all the hotels come back" with a search, showing the discounted rate available to Hotels4Truckers users and with a built-in parking filter you can use to show only sites where parking's available. The new website soft-launched back last Fall -- legacy users, Fuller added, will need to re-register if they haven't already -- and ever since he's been tweaking the design and adding hotel chains and truck parking-friendly facilities. In total, close to 13,000 rooms are represented within the platform (many with parking) among dozens of hotel brands. In Canada, too, with a very recent update for users up North. That just so happens to be where Dan Fuller lives today -- he came off the road in 2017 after much of his life spent headquartered near Detroit. A second marriage to a Canadian health-industry specialist took up to rural far Northern Ontario, where he's been hard at work building out the new version of his longtime service. I'm willing to bet he's looking forward to warmer climes as he preps for an official launch of the new Hotels4Truckers.com upcoming at the Mid-America Trucking Show in Louisville, Kentucky, next month. (You'll find him in the North Lobby near the main registration -- attendees can sign up for the service there for free and with a special gift as part of the bargain. I think it will be worth the visit, I'll say, for now.) In the podcast, Dan Fuller lays out his personal story trucking, likewise the 15 years or so he's spent at work building a network of discounted hotels and with, as noted, verifiable intelligence about whether tractor-trailer parking is available at any site. Find Hotels4Truckers via https://hotels4truckers.com and via iOS and Android app stores. More Overdrive Radio: https://overdriveonline.com/overdrive-radio

Winegrowing regions in Washington State have many unique challenges from salty soils, to low organic matter, to nematodes. Devin Rippner, Research Viticulture Soil Scientist with USDA-ARS and his colleagues at Washington State University are developing a research vineyard to study soil health building practices. They are testing a variety of management strategies including adjusting irrigation volume to correct for salt build-up, mowing for weed management, compost applications and synthetic fertilizers, and different cover crops. The team is tracking the cost of each practice and will ultimately evaluate wine quality in the coming years. Taking a deeper dive into the future of soil sampling, Devin explains X-ray CT imagery. He has used this technology to evaluate the structure and organic matter from soil columns and aggregates. X-ray CT imagery has also been used to evaluate the impact grape seeds have on tannin flavor profiles. Resources:         80: (Rebroadcast) The Goldilocks Principle & Powdery Mildew Management 90: Nematode Management for Washington Grapes A workflow for segmenting soil and plant X-ray CT images with deep learning in Google's Colaboratory Devin Rippner, USDA ARS Functional Soil Health Healthy Soils Playlist Red Wine Fermentation Alters Grape Seed Morphology and Internal Porosity Soil Health in Washington Vineyards Vineyard soil texture and pH effects on Meloidogyne hapla and Mesocriconema xenoplax Washington Soil Health Initiative Vineyard Team Programs: Juan Nevarez Memorial Scholarship - Donate SIP Certified – Show your care for the people and planet   Sustainable Ag Expo – The premiere winegrowing event of the year Vineyard Team – Become a Member Get More Subscribe wherever you listen so you never miss an episode on the latest science and research with the Sustainable Winegrowing Podcast. Since 1994, Vineyard Team has been your resource for workshops and field demonstrations, research, and events dedicated to the stewardship of our natural resources. Learn more at www.vineyardteam.org.   Transcript [00:00:00] Beth Vukmanic: Wine growing regions in Washington State have many unique challenges from salty soils to low organic matter to nematodes. [00:00:13] Welcome to Sustainable Wine Growing with the Vineyard Team, where we bring you the latest in science and research for the wine industry. I'm Beth Vukmanic, Executive Director. [00:00:23] In today's podcast, Craig McMillan, Critical Resource Manager at Niner Wine Estates, with longtime SIP certified vineyard and the first ever SIP certified winery, speaks with Devin Rippner, Research Viticulture Soil Scientist with USDA ARS. [00:00:41] Devin and his colleagues at Washington State University are developing a research vineyard to study soil health building practices. [00:00:49] They are testing a variety of management strategies, including adjusting irrigation volume to correct for salt buildup, mowing for weed management, Compost applications and synthetic fertilizers and different cover crops. The team is tracking the cost of each practice and will ultimately evaluate wine quality in the coming years. [00:01:08] Taking a deeper dive into the future of soil sampling. Devin explains X ray CT imagery. He has used this technology to evaluate the structure in organic matter from soil columns and soil aggregates. X ray CT imagery has also been used to evaluate the impact that grape seeds have on tannin flavor profiles. [00:01:28] Now let's listen in. [00:01:29] Craig Macmillan: Our guest today is Devin Rippner. He is a research soil scientist with the USDA agricultural research service. He's based out of Prosser, Washington, and he's also an adjunct in the department of crop and soil sciences with Washington state university. [00:01:46] Devin, thanks for being here. [00:01:48] Devin Rippner: Absolutely. Pleasure to be here, Craig. [00:01:50] Craig Macmillan: You are on the leadership team of the Washington State Soil Health Initiative. I think it's a pretty cool little program. Tell us what it is and what it's all about. [00:01:59] Devin Rippner: Yeah, absolutely. So the Washington State Legislature allocated funding to study soil health and soil health building practices in a variety of agricultural systems and so to access that money a number of groups put in competitive proposals at the Prosser Irrigated Agriculture Research and Extension Center, we put in a proposal to study soil health in wine grape systems. [00:02:24] Originally, we actually had it in juice grapes as well, but we were not able to get enough funding for both. Juice grapes are actually a big product out of Washington. [00:02:32] Craig Macmillan: I did not know that. That's interesting. What varieties? [00:02:34] Devin Rippner: Mostly Concord? [00:02:36] I'm less familiar with it. It's something I would, I would like to work in cause they have different constraints than wine grapes. [00:02:41] Ours is focused on wine grapes, but there are systems looking at tree fruit, at potatoes, at small crane cropping systems. There are a variety of systems that are being evaluated. [00:02:54] Craig Macmillan: I looked at a flyer that kind of outlined some of the ideas and issues around , the Wine Grape part. Can you tell us a little bit about that? [00:03:01] Devin Rippner: we have fairly unique soils. We have pretty alkaline soils here in Washington. We're on the arid side of the Cascades. So think Reno rather than like Seattle. we tend to accumulate salts. We also have very coarse textured soils. So a lot of sands to sandy loams or loamy sands. Very little clay. [00:03:23] We have typically under 10 percent clay in a lot of the grape growing regions of washington. we also have low organic matter, because it doesn't rain much here. There has never been a chance for a lot of plants to grow. And so we just have never really built up organic matter. So we typically have about, let's say, maybe 1 percent to 2 percent organic matter in our soils. [00:03:44] That's about half a percent carbon to 1 percent carbon, which is typically it's pretty low for a lot of soils. [00:03:50] Craig Macmillan: It is. [00:03:51] Devin Rippner: those are some of, some of the like unique challenges around soil health. There's also problems with pests. Haven't had too much of an issue with Phylloxera. That's changing. [00:04:01] There are a variety of nematode pests that cause problems in grapes here. When you plant a vineyard into an old vineyard, you're basically putting baby vines into a place that might have a bunch of pests that aren't a big deal for really mature vines. [00:04:14] But as soon as you put a baby in that environment, it does not thrive. [00:04:18] Finding ways to deal with nematode pests, things like that over time , is really important. So those are kind of the things that we are, we are looking at, at our site. [00:04:27] Craig Macmillan: What kind of practices are you investigating to address these things? I hadn't really thought of that about it till now, but nematode is a good one. that's a tough pest. [00:04:37] Devin Rippner: funny thing is this is a long term site, right? So, so our practices for those will really come later. I had a nematologist that worked for me. And she evaluated our soils for for the pathogenic nematodes for wine grapes, and we don't really have them but the thing is they build over time, right? [00:04:52] Just because there might be a few in that soil But when they start colonizing the grape roots over time, they can become problematic We functionally have a rootstock trial at the end of all of our experimental rows and, and rootstocks have been found to be very effective at preventing nematode problems or decreasing the severity of nematode problems. [00:05:13] We will be able to kind of look at that with our rootstock trial. [00:05:17] Craig Macmillan: Do you have any of the GRN stocks in that? [00:05:19] Devin Rippner: We don't, so we have own rooted vines and then we have Telekey 5c 1103p 110r. Let's see then I think St. George [00:05:30] I'm trying to remember what, what the last one is. It's escaping me right now. I apologize. [00:05:34] Craig Macmillan: Well, no, it's all right. Some of the more common root stocks, basically the ones that are very popular. [00:05:39] Devin Rippner: Yeah. Yeah. Yeah. [00:05:41] The reality is that a lot of the like vitis rupestris, vitis riparia, , they are less prone to nematode parasitism. Than Vinifera. , that's the reality of it. [00:05:50] Craig Macmillan: Yeah. Less susceptible. I think it's probably the best way to put it. Nothing's bulletproof when it comes to this, this problem. [00:05:57] Devin Rippner: And Michelle Moyer in Washington has been doing a lot of work with this, with Inga Zasada, who's a USDA scientist. And their, their results are really cool. They're finding that when you try to fumigate, it helps for a little while, but the rebound is bad, and it's just easier to just use rootstocks. [00:06:15] Craig Macmillan: Yeah. Talk to me a little bit more about, you said salinity can be an issue [00:06:19] Devin Rippner: Yeah, [00:06:20] Craig Macmillan: So here's the, the back and forth on that. You would think that a, a coser, your textured soil salinity would be less of an issue, but you don't get the rain to take advantage of that. Is that , the issue here? [00:06:30] Devin Rippner: 100%. That's exactly it. We build up layers called caliche layers, which are evidence of a lack of water moving downward. [00:06:38] So it's, it's really evidence of water moving down and then back up due to evaporation. We get big buildups of carbonates in our soils and carbonates are a type of salt. [00:06:48] So as you apply other chemicals, Salts, a salty irrigation water , we tend to build up salts in our soils. A lot of our irrigation water comes from the Yakima River or other rivers in the area, columbia River. But there are places where people are on deeper wells and they are seeing salt accumulation in their vineyards. [00:07:06] And it's, it's really challenging to deal with. [00:07:09] Craig Macmillan: Do you have any strategies that you're looking at? Anything you're trying out? [00:07:13] Devin Rippner: at our site over time, we're going to look at higher irrigation volumes versus lower irrigation volumes and seeing if that will change the accumulation of salt at our site. , that's kind of the main experiment around that with our soil health vineyard. [00:07:27] Craig Macmillan: Obviously you're doing this with some pretty salty irrigation water and you're comparing that to less salty water. At one site, you're only gonna have one type of water, right? [00:07:36] Devin Rippner: Right. That's not something that we'll be able to do, but one of the interesting things is we are applying compost and. Our compost can be pretty salty. [00:07:45] So we'll, we'll be getting compost. That'll be kind of four decisiemen per meter. I I'm sorry to use those units and so that, so that is salty. [00:07:54] Craig Macmillan: Yeah, it's salty. [00:07:55] Devin Rippner: Young grapevines, if they grew only in that, they would really struggle. It's over the, the two deciSiemen per meter kind of threshold for grapevines. That's something where we're, you know, we are using clean irrigation water, but some of our amendments coming in can be saltier. [00:08:10] When we have kind of a, a low and high irrigation treatment, we can evaluate the salt accumulation in the root zone. From that particular amendment, right? [00:08:19] Craig Macmillan: What about other types of fertilizer? Are there organic fertilizers or something like that that might be less of a salt contributor than let's say a traditional nitrate based fertilizer? [00:08:28] Devin Rippner: As it turns out, at least for us, we don't apply. a massive amount of nitrogen to our grapevines, so we're often applying between 20 and say 60 pounds of N per year which is not a lot compared to say corn or, tree fruit or, or hops or things like that. [00:08:45] And so we, we don't, Exactly. Expect to see a buildup of, of those salts over time. Honestly, some of the organic amendments end up being saltier than our fertilizer. [00:08:55] That's something when we do a high and low for irrigation, we will be able to look at the accumulation of, of nitrates and things like that. [00:09:02] Cause in our arid environment, you do get accumulations of nitrate, which is kind of funny. [00:09:06] Craig Macmillan: Yeah, that's interesting. You also mentioned the soil pH, alkalinity. What, what's going on there? How bad is it in different spots? What can you do about it? I, I'm fascinated by this because like when you look at viticulture, you have like a lot of knobs on the mixing board, right? You got a lot of sliders and, Soil , you can't slide it very well. It's like very hard to make changes to soil over time. [00:09:33] Devin Rippner: it is. [00:09:33] Craig Macmillan: very slow and very difficult. So I'm very interested in , this issue here. [00:09:39] Devin Rippner: It's funny at our site, the soil pH isn't too bad. It's about 8. Across the board, from the, from the top that so, so we've been measuring from the top of the soil down to about 90 centimeters. About three feet. We do see a pH tick up in our sub soil, but still it's, it's around the eights. [00:09:56] We actually have a lot of carbonates in our soil. There's only more organic carbon in the top six inches of our soil. And from that point on, most of our carbon is in the form of carbonates. [00:10:06] Which is kind of unique. And so once you get down to like 60 to 90 centimeters, so two to three feet in the soil, functionally, 90 percent of the soil carbon is carbon from carbonate. [00:10:16] So dealing with that in the region there's wide variation, so people that are planting into old wheat ground where they've used a lot of ammonium based fertilizers or urea, the pH can be in the fives. And then I, I mean, I've measured soil pH is up to about 9. 8 around here. So, so quite high. [00:10:35] Those soils are hard to deal with. So these are carbonate buffered systems. So to try to lower the pH, you basically have to get rid of all the carbonates. And that is not really feasible. We do see in some of the vineyards that we work in. And again, a lot of this data is preliminary. [00:10:51] I'm trying to get stuff out right now. Getting the vineyard set up has been a massive undertaking. And I've been lucky to work with a great team to, to get it done, but it has taken a lot of my time. [00:11:01] Um, but we, we do see seasonal fluctuations with irrigation. So soils might start off with a pH around eight drop over the course of the growing season into the sixes and then as they dry down for winter time. So we cut irrigation. The pH will start to rise back up as the carbonates move from the subsoil to the surface. [00:11:21] Craig Macmillan: Interesting. Interesting. Let's talk about your vineyard. If I understand correctly, you have a research vineyard there in Prosser that you are building from scratch or have built from scratch. Is that true? [00:11:30] Devin Rippner: Yes. . It is a new vineyard to study soil health building practices. We just finished our second season. And we were very lucky. Vina Matos which is a company out of Portugal. They mechanically planted it for us. [00:11:45] Scientist, so it's, it was, yeah, it was a bit of an undertaking. Even now I've gotten a lot better on a tractor than I was. And, you know, I like to run, like, I'd like to do x ray stuff. And then I'm out there on a tractor, like, yeah, doing stuff. It's a unique challenge. [00:11:59] So we do have a vineyard manager Dr. Liz Gillespie is the vineyard manager. , she honestly does most of the tracker work. I only sub in when she's down with an illness or something like that. [00:12:09] It's been a team effort for the last couple of years. [00:12:12] Craig Macmillan: What are you doing in there? You've talked about a couple of topics, but, and how big is this, this vineyard? [00:12:17] Devin Rippner: It's not that big. It's about 4. 1 acres. , [00:12:20] Craig Macmillan: that's, you know, for research, that's good. [00:12:22] Devin Rippner: yeah, yeah, it is good. We functionally have a business as usual. So we call it our Washington 2021 standard. So it's kind of what growers just do. So that's spraying undervined for weed control and then just let resident vegetation pop up where it may and mow it down. [00:12:39] Most people don't spray or till , their tractor rows. They just. Kind of let it go. We don't get that much rain. You end up selecting for annual grasses it's actually a pretty good weed composition for a tractor row. So then we start building from there. [00:12:52] One of our treatments is what if you just mowed everywhere, right? The goal is to select for annual grasses everywhere over time. [00:12:59] And then we have another treatment where we're mowing everywhere. But we're applying compost for fertilization. Our other treatments get synthetic fertilizers for fertilization, and then we have our compost treatment where we're mowing. [00:13:12] Then we have an undervined cover crop, so that's like our cover crop treatment. [00:13:16] We're curious about undervine legume cover crops. So we have a short subterranean clover that , we've seated in to hopefully eventually start adding nitrogen to the system and, and hopefully we'll be able to back off on more of the synthetic fertilizers over time in that system, but we'll let the vines guide us, right? [00:13:35] Craig Macmillan: What species of clover is that? [00:13:37] Devin Rippner: I'm not sure the exact, so it would be like Dalkey. [00:13:39] it's a clover that basically has low flowers and shoots seed downward. And so , that allows it to replant itself really effectively. [00:13:47] The flowers tend to be below the foliage. So we won't have to worry about mowing them down too badly. , they stay low. And so that's why we selected that. just to try to keep the flowers low and keep foliage away from our vines. [00:14:01] Craig Macmillan: Anything else? [00:14:03] Devin Rippner: Yeah, so then we have our aspirational treatment, which is kind of a mix of the subterranean clover cover crop. And then we have compost fertilization and then kind of breaking the full factorial. We're actually changing what's in , , the tractor row. We're planting an intermediate wheatgrass. [00:14:20] We started with crusted wheatgrass. It's so funny with these experiments. , we seeded in crusted wheatgrass a couple of times and just did not take it's not very effective for competing against other weeds, and it's not very good with traffic. And so now , we're seeding in intermediate wheatgrass. [00:14:35] , it is more traffic tolerant and is more weed tolerant. So we're hoping that we'll be able to outcompete all the other annual grasses and just have kind of a perennial grass cover crop. [00:14:46] Craig Macmillan: Is it on these courses? So is this camp is compaction less of a problem? I would think. [00:14:53] Devin Rippner: We do have some compaction. That we've seen out there. Certainly mechanical planting can cause some extra compaction. It, it takes a lot of force to, you know, rip a giant hole in the ground to drop the vines into. And so we do see some compaction from that. [00:15:06] We have taken bulk density cores from all over the vineyard. And we're hoping to see changes over time in that compaction. So we've done bulk density course from under vine and then in the tractor row. And so we're hoping that over time, these various practices will alter the bulk density, hopefully lower the bulk density in the tractor row. [00:15:27] Craig Macmillan: And then I'm assuming that you're also keeping track of costs for these things. [00:15:32] Devin Rippner: yes, we have been keeping track of costs. We are keeping track of the hourly labor , for mowing. Honestly, we've, we've purchased some undervine mowers and , we have really struggled to find a good solution for our young vines. [00:15:45] We're going to, Purchase another one soon. The biggest thing is that if you have a swing arm on it, it's got to be gentle enough that it, it'll push out of the way , with a bamboo stake in the ground. [00:15:55] And a lot of the existing swing arm mowers for orchards and vineyards it takes a lot of force to move that swing arm. [00:16:03] It's been a real challenge for us. So, so we ended up having people go out with weed eaters, which is super expensive and is actually something that some vineyards do either biodynamic vineyards in the area that they'll send people out with weed eaters to go control the weeds under vine. [00:16:17] I don't want this to be just like a hyper specialized science experiment. If we're sending people out with weed eaters, it sounds a little bit ridiculous, but there are folks in the industry that do it. So it's not. It's not that ridiculous. [00:16:28] Craig Macmillan: It's not that ridiculous. It's legitimate. [00:16:31] Whatever tool that you can make work, depending on the size of your vineyard and depending on what your conditions are. But yeah, you're in row mode. That's going to be an issue until these vines are mature to no doubt about that. I hope you still have a vineyard after knocking down these bamboo stakes. [00:16:44] You don't have like real results yet. You've only just gotten started. [00:16:47] Devin Rippner: We've only just gotten started you know, some of the results that we got were prior to our planting, there were no differences among our treatment blocks for our treatments across the site. So that's nice kind of starting at a, a pretty even baseline. [00:17:03] We're going to track the changes over time. Honestly. I hate to speculate, we don't have the data for it yet, but we've been applying, our synthetic fertilizers based on our like compost mineralization rate. And one of the things that's pretty obvious when you walk out there is that weed competition is brutal for young vines. [00:17:23] So where we're spraying with herbicide under the vines, there's less weed competition. Those vines are just bigger., [00:17:28] we're going to up the amount of fertilizer that we apply next year to try to, like, get around that. And it's one of the challenges at our site is that for long term research, we have to manage our vineyard in a way that kind of limits how many comparisons that we can make. Functionally, two out of our three rows are buffers. It just eats up an enormous amount of space and I'm, I'm hesitant to start putting other treatments into those areas. Like, oh, what if we vary the fertilizer rate to see what the effect is with relation to mowing, right? [00:18:01] So can we get over the weed pressure by, Applying more fertilizer. One of my main takeaways is that a lot of the recommendations that you might get for like, for conventional management won't necessarily work if you're trying to change your system [00:18:16] That's where, you know, growers are going to have to play around and understand that if they're mowing under vine, there is going to be more weed pressure and those weeds take up nitrogen. [00:18:27] You may have to fertilize more. I mean, that, that's just a consequence of, of weed competition. [00:18:32] Craig Macmillan: yeah, yeah, yeah. That's interesting. And in irrigation water too, [00:18:37] Devin Rippner: Oh yeah. Yeah, for sure. Absolutely. They use a lot of water. There's no doubt about it. [00:18:42] Craig Macmillan: Which actually brings me back to the clover. I planted crimson clover in my yard once and I irrigated it and it was really pretty and I actually put two and a half foot, three foot high risers off of my lawn sprinklers to get a sprinkler high enough that I could keep growing it. And I was able to grow it up to about three feet tall and it was gorgeous. It was absolutely amazing. But it does make me wonder if, what's a subterranean clover? It's a low growing clover, but how much effect does irrigation have on it in terms of making it taller or taller? [00:19:13] Devin Rippner: That's a good question. I haven't looked into it that much. I consulted with some colleagues here. Who've done work with a variety of cover crops, and they were the ones that recommended the subterranean clover. It has a short stature and part of it is because of how it flowers and seeds, it can't get that tall because it's, it pushes its seeds into the ground. [00:19:32] And so there's no real benefit for it getting taller because then it will be farther away from where it needs to put its seeds. [00:19:39] That's a real concern. I mean, I've learned so much by , having a vineyard gophers, voles, rats, mice, they can be problematic. Right. And if you have a tall cover crop, that's getting into your vines, like that's an easy pathway up. [00:19:52] Keeping the, those undervine weeds and cover crops short is really important. [00:19:58] Craig Macmillan: Yeah. It's also really important for the success of your predators. [00:20:01] Your barn nows and whatnot. They can't really do much when things are tall. So keep going, keep good luck. You're in it. You're in it now, Devon, [00:20:09] Devin Rippner: Oh, yeah. No, that's what it feels like. I feel like I jumped into the deep end of a pool, but didn't realize it was so deep. And so, yeah, I'm learning. [00:20:17] Craig Macmillan: Because prior to a few years back, cause you were, you were at Davis and you were at the Oakville station. Is that right? For a little while. [00:20:24] Devin Rippner: I pulled some samples from Oakville, but no, I was mostly on main campus. I'm a soil chemist by training. Grapevines are relatively new for me. I worked for Andrew McElrone, who , does some great work a lot of my previous work did not involve grapes, and it was mainly, like, tomatoes or other annual crops, and often, like, pretty lab based stuff. [00:20:47] And so this has been a real deep dive for me to do something different. [00:20:53] Craig Macmillan: which is an excellent transition to some of your work which you did at other crops, but you also did some other interesting things related to vines and to soil. And that is x ray CT imagery. You were the first person to introduce me to this concept. I I had no idea I guess I should say X ray micro CT imagery. What, what are the exact terminology? What is it? What can it do? What can we learn? [00:21:20] Devin Rippner: Thanks for bringing this up. Let me just try to keep it simple and I'll build out from there. Just like a doctor's office where you can get an X ray you can actually X ray soils. And plants and look inside of them. X ray computed tomography is where instead of just taking one x ray, maybe you take 1000 x rays as the sample is slowly moving. And what you end up with is the ability to make a three D reconstruction of that sample. Where you're able to look inside of it. [00:21:50] Materials that absorb x rays look different than materials that don't absorb x rays. And so you're able to start Teasing apart structures that are inside of plants and soils [00:22:01] There's different levels to that. Humans have X ray computed tomography done on them, right? You can go in and have that procedure done to look inside of you. It's very much like an MRI there are some tools that it. look at very big volumes. And then there are some tools that look at very small volumes. [00:22:19] That's where there's the x ray microcomputed tomography is looking at very small volumes. And a lot of times those instruments they're low often located. With synchrotrons. So a synchrotron is a particle accelerator that moves electrons at about the speed of light. And then as they're going at the speed of light, , it bends them, it shifts the path of the electrons. [00:22:43] And in doing so , Theory of relativity says that when you have a big shift , in the direction of these electrons they must lose energy. And so they lose energy as the brightest light that we know of in the known universe. And so some of that light are x rays and those x rays are very tunable, and there's a lot of them. [00:23:03] And so we can basically focus on a really tiny area. And still have a lot of x rays. That lets us look at really small things and still have like good contrast and be able to image them relatively quickly. This field is advancing quickly. I know it sounds pretty crazy to talk about x raying soils and plants and things like that. [00:23:23] But the reality is these x rays can also be used to identify elements. And so you can do elemental speciation. So you can be like, Oh, all of the phosphorus there is as phosphate rather than some other form or it's calcium phosphate, not magnesium phosphate. That's called x ray adsorption, near edge structures. [00:23:42] That's how people do that. A long time ago, these instruments used to be unique. You do like a tomography and then you do like these Zains do elemental information, but those things are converging. Now it's possible to do like x ray CT and also do elemental analysis and speciation on the same sample. [00:24:01] in 100 years, that may be how we do our soil testing is you literally have one of these instruments on the back of a tractor. You pull a soil core. You do a quick scan and you say, here's our structure. We can also see the organic matter inside of the soil column. And then by inference from the outer edge of the soil column, we can get What elements are there and what form they're in and then make predictions on their availability. [00:24:27] Were very far from that, but that's like the vision that I have in my head is that at some point, , these will be sensors that people can just use in the field. Will they use an enormous amount of energy? Absolutely. Technology has, shifted in my lifetime and a lot of things that have seemed absurd in the past are now commonplace. [00:24:47] Craig Macmillan: What kinds of things, and it can be other crops as well, but in particular, there was one you did with, I think, grape seeds. Those are the things that can do what, what have you actually. Zapped [00:24:59] Devin Rippner: Yeah. [00:24:59] Craig Macmillan: a better word. [00:25:01] Devin Rippner: You know. [00:25:01] Craig Macmillan: mind here. Okay. So [00:25:03] Devin Rippner: Yeah. So I work with a lot of folks at different national labs. So the Pacific Northwest National Lab is a lab I work at a lot. And we've done a lot of imaging of soil cores and they're big soil cores. So three inches by 12 inch soil cores and to look at soil structure and we're working on segmenting out organic matter from them. [00:25:22] That's something that was not previously possible, but with modern neural networks and deep learning, we can actually train. Neural networks to identify specific compounds in the soil and identify them. We've done it with soil columns. I've done some work with soil aggregates. [00:25:38] So we can look at very small things as well. I've looked at grape seeds, so we had a little study where working with some folks at Davis they pulled out grape seeds, before, during and after fermentation, functionally, and we looked at how the structures of the seeds were changing. [00:25:58] The idea here is that grapeseeds provide a lot of tannins and they're not necessarily like the best tannins for wine, but they do provide a lot of tannins. [00:26:07] People have always wondered like, why do grapeseeds kind of supply a constant amount of tannins during the fermentation process? And as it turns out, it's because the structure of the seeds is changing during fermentation, [00:26:18] They start cracking. And so the internal structures become more accessible during fermentation. [00:26:23] And so that's what we were seeing using x ray tomography is these internal changes that were happening inside of the grape seeds that could potentially promote tannin extraction. [00:26:32] Craig Macmillan: That is fascinating. That explains a lot. I'm just thinking through, Tannin management. The date currently is in the beginning of November 2024. So we're just wrapping up a harvest here in the Paso Robles, central coast area. And so I've been thinking a lot about tannin management last couple of months on behalf of my friends who make wine, not myself. That's not entirely true. Is there a practical application to that in terms of like timing or conditions or things that would contribute to the, the cracking breakdown of these seeds that you identified? [00:27:05] Devin Rippner: We weren't able to go like that in depth and it's some, it's an area that I would like to build on. But the idea is that. The fermentation is a pretty harsh environment. You have a massive change in pH. Microbes are working hard. You have the production of ethanol, which allows the extraction of different compounds. [00:27:24] The seeds are seemingly being modified during fermentation. There needs to be more work done in this area in terms of seed tanning management. We now have kind of a, the more physical. Explanation for why those cannons are coming out of the seeds. [00:27:39] If you are able to pull your seeds earlier from fermentation, I mean, that's like a ridiculous thing to say, but you know, [00:27:45] Craig Macmillan: no, I mean, winemakers are very clever there's a lot of techniques that have become more prominent, I think, in the last 10, 15 years in terms of things like pressing off early, so getting your extraction fast and then finishing out the fermentation off of skins, off of seeds, you know, that's one way that you can do it really using seed maturity as a major variable in your pick decision is another one that I've seen people really draw to. [00:28:09] I remember people crunching on seeds and going, yeah, that's mature. Now I'm seeing people reject a pick date based on that. [00:28:17] Like we were going to wait for these seeds to mature fully before we pull because of, because of these issues with a seed tannin. So just knowing that I think is fascinating. [00:28:28] And if we can put some time and pH things on that, that would be really cool. Are you going to be using this technology with the with the research plot for anything? [00:28:36] Devin Rippner: Oh, yeah. Yeah. I mean, we [00:28:39] already have started that. We've already started down that route. Shortly after planting we collected soil cores from, , the vine row. And then from where the, the planter tires were functionally running just to look at changes in bulk density. So like kind of how compressed the soil is and then trying to get at changes in porosity. [00:28:58] We looked at these cores relative to , a field next door. That has had very relatively little disturbance in the past, like 4 to 10 years. It's kind of variable but has had less disturbance than say, like, right after planting a vineyard mechanically. Some of the things we see are you know, when you mechanically plant a vineyard, the bulk density , in the vine row is much lower than where the tractor tires are running that intrinsically makes sense. [00:29:26] And they're kind of both different than a place that's been no till or low disturbance for four to 10 years. Some of the things that are most interesting, and, and again, this is preliminary, it's got to go through peer review. . But when we look at the CT scans, you can actually see where worms have been moving, [00:29:45] In these, like, low till and no till plots or this field that has just not really been disturbed. [00:29:51] , so worms are actually making sizable holes in the ground, and those holes contribute to the porosity in these, like, low disturbance soils compared to these very disturbed soils. And that was a really interesting thing to visually see. You can see the worm castings in the scan. [00:30:10] I don't know if you've ever seen worm castings before, but they kind of, they're these little, like, kind of football shaped Things that are all clumped together our soils don't really aggregate. [00:30:20] We don't have enough organic matter and we don't have enough clay. And so that's like driving force behind aggregation in our soil seemingly is worm castings. For me, that was just mind blowing. [00:30:31] I was not expecting to see that. I think I was expecting to see a lot of roots or like root channels and they're there, but the worms are like following these roots and root channels around. [00:30:41] I'm a very visual person. And so when I do CT stuff, it's like, Oh, wow. Like I can see it with my eyes. If I can't see it with my eyes, it's hard for me to believe. But when I see it with my eyes, , it's believable. [00:30:52] Craig Macmillan: We've done a number of interviews recently around so the microbiome and just soil biology kind of in general, , is that gonna be part of your analysis as some of these projects go forward? [00:31:03] Devin Rippner: Yeah, absolutely. So we've done something called phospholipid fatty acid analysis. [00:31:09] So that gives us an idea of kind of, The microbial consortium that's there right when we sample phospholipids don't really stick around in soils. They're quickly degraded. We would like to do some sequencing challenges. We don't have a microbiologist on the team. And, and so we would, we would have to pay for the sequencing. [00:31:28] And even then sequencing is really interesting because, you could be like, oh, we did say 16 S-R-R-N-A sequencing. And that's like, that's a particular like region or a particular type of sequencing that is, that only picks up on say bacteria. [00:31:47] Whereas if you want to see fungi, maybe you need to do something called ITS sequencing. And so unless you do like all of the sequencing, you can get an idea of what's happening to the bacterial communities or the fungal communities. But unless you do all of them, it's really hard to get a more holistic picture. [00:32:05] And then, a lot of the sequencing that we do or is done we're missing things. If the regions analyzed aren't big enough, like we can be blind to specific things that we know are there. And so things like my understanding is that fungal mycorrhizae can actually be hard to detect by sequencing. [00:32:21] And so even if you visually see them in the roots by staining, you may not pick them up by sequencing. It is a challenge. Now, I, you know, I think that certainly studying the microbiome and understanding its relationship , with vine performance and soil health is, is crucial and is really, you know, one of the things that it's kind of the Holy grail [00:32:41] Craig Macmillan: Yeah. [00:32:43] Devin Rippner: We're trying to get there. [00:32:44] Craig Macmillan: We're trying to get there. That is definitely the message, but it also, there's definitely the potential. I think that there's a lot of people working on this. I think we're going to get there. It's, genomics is so big. I've talked to people that are like, at some point we, we, we will probably be able to get down to species, so we will know the bad actors from the good actors, we'll get a sense of what the real ecology is. [00:33:05] That's a decade plus away still, but we're going there. Right? We're we're gonna figure it out. We're gonna figure it out at some point. We're gonna get there. [00:33:14] Devin Rippner: Yeah, I agree. And there's, there are some techniques. There's some really cool techniques. So Jennifer Petridge at Lawrence Livermore lab does a lot Carbon 13 labeling of root exudates. So she basically gives plants, she treats them with carbon 13, enriched CO2. And then she looks at how much of the carbon 13 is then incorporated into the DNA of microbes to try to get at how well associated they are with plants. [00:33:41] I think that work is just incredible. And there's some folks at Davis that are, are working that in that area as well. That's kind of the stuff that gets me really excited to seeing when people are trying to really tie it into what's feeding on root carbon, , who's getting these exudates, things like that. [00:33:59] , that to me is one of the, One of the ways that we'll be able to, like, get at these questions is to, to start differentiating, the bulk soil microbiome from like the, the real rhizosphere associated microbiome. [00:34:11] Craig Macmillan: so you got a lot going on. You got , you got a bunch of different things happening. What's the path ahead look like for you? [00:34:17] Devin Rippner: Sure. So, and with with the soil health vineyard. I mean, I'm very excited to keep that going. We'll do another large sampling event in 2027 or 2028. We'll start making wine from our grapes. Not next year, but the year after that. So we'll be excited to see how our different management strategies influence our wine. [00:34:40] The wines that come out of the vineyard, or the wines made, made from the grapes that come out of the vineyard. So those are some of the things , I'm most excited about with regard to the vineyard. [00:34:50] Otherwise, I have a lot of data that I need to process and get out. That's something that's next. [00:34:56] I, I'm collaborating with some folks from the University of Illinois in Berkeley lab to look at changes to the Moro plots in Illinois over time. So that's the oldest agricultural experiment in the United States. The plots there have been in experimental treatments for 149 years. [00:35:15] And the reason I'm involved is because vineyards can be very long lived things, right? I mean, there are vines in California 100 years old. [00:35:23] This is one of the few experiments to me that's like comparable to what we see in vineyards. And so I'm really curious about, you know, how do, how do management practices influence soil structure, microbiome, the metagenome, the metabolome, things like that, on these century long timelines. [00:35:43] That to me is like some of the really interesting questions. If you have a vineyard for, for a century, or if you want a vineyard for a century, what do you need to do? How do you make that work? Knowing that it's going to take 20 years to have your vineyard be profitable. [00:35:57] I mean, you're already on a different timescale than annual crops, right? yeah. And so it's just like, how, how do we make our, our vineyards as sustainable and long lived as possible? Because , that, that initial investment is huge. It is so much money. [00:36:13] Craig Macmillan: I think that's really great. I think coming up with findings on other crops, but with practices that could be transferable is really great. You know, we don't need to be in our little grape silo. All the time. And in fact some of the soil microbiome stuff have been with interviews with people that had no connection to vineyards whatsoever. And it was great. The things that they were learning, they were absolutely transferable to this crop as well. That hasn't gotten that kind of attention. Grapevines are tough little suckers, really from an evolutionary standpoint, they're pretty rugged and so we can kind of get away with a lot just because of that. [00:36:48] And now I think the margin for error is less and less, especially when we get into tougher and tougher sites like you're talking about and different conditions, especially if you've farmed it for a while and things have changed. Being able to look at other, other systems and see what's there. [00:37:03] What is one thing that you would tell growers around this topic of research? [00:37:09] Devin Rippner: vineyard is very informed by grower practices. We have a grower board that like helps us make decisions. A message that I will say is like science is science and science is often pretty, you know, Like straight laced and rigid because it must be. know, We're going to find things and those results hopefully will be interesting. [00:37:27] But it's not the be all and end all . of science and research. Growers continuing to try innovative things push the boundaries of what they think is possible is really how we get progress. And I am hopeful , once this vineyard is more established to start going back out and working with growers. [00:37:48] When I first started in Prosser, I sampled from probably 40 different vineyards around the state just to get an idea of what the soil properties were like. And we've done some, some experiments with that. Some of our results are that permanganate oxidize oxidizable carbon. So this POC C classically it's been called active carbon. [00:38:08] There's some new research that suggests that it's, that's maybe a misnomer and it's really, often plant derived carbon. [00:38:15] It seems like there are some effects from that, that suppress disease. And I think that , that's an area where growers can really kind of play around and see if there's , waste from their vineyard and applying it to their vines trying to look at what that does to their, POC C values and also try, just getting in trying to look at some of the past issues that those vines may have and see if there's any decreases. [00:38:41] A lot of observational science is really important. I like hearing from growers that, yeah, I did this thing and it looks like it made a difference. There's a lot of value in that and, and I don't discount like grower knowledge in any way, shape, or form. Like it is deep knowledge growers know things that I don't, and I find that out all the time. [00:39:02] I value those observations. They they give me guidance on how I want to do my work. And we do try to incorporate that stuff into the soil health vineyard. Over time we are going to have to figure out like, You know, can we sustain funding for a vineyard for, say, 50 years if all we're doing is like a cover crop, some compost, and then a mix? [00:39:23] That seems like it's maybe not the most sustainable thing. Science requires that type of stuff, but it's just not that sustainable. So finding ways to make use of our, border rows and stuff like that is going to be important. And a lot of the research that we do is going to be informed by grower observations. [00:39:39] Craig Macmillan: Yep. Yep. Exactly. Where can people find out more about you and your work? [00:39:44] Devin Rippner: Sure. So you can look me up online. Devin Rippner a lot of stuff will pop up. There's a USDA website that has a listing of my publications and things like that. I also have a personal website. So those are some places to, to check out my work. [00:40:00] I try to make sure that my stuff is open access and usable. So, like the deep learning code, the image segmentation code that I co developed for X ray ct work is now being applied to like other types of imaging on. So people are using it at hops and a variety of other things on. [00:40:18] So that code is online. Like you can find it it's associated with my papers. You can play around with it and try it with your own stuff. Mhm. And, and, and that's a big thing for me is like open data. I, I love sharing a lot of the, the data that I have and the code that I have so that people can, repeat what I did. [00:40:35] Look me up online and yeah, you'll be, you can find that, find those resources. [00:40:40] Craig Macmillan: we will have links to a lot of that on the show page. So please visit the show page and check this stuff out. I was really happy to hear you use the word repeatability. [00:40:49] Devin Rippner: Yeah, [00:40:50] Craig Macmillan: Yeah. And I also was really, it's hard. it's very, very hard and it's often overlooked. You know, the, , the scientific methods we know today was all built around the idea of repeatability. That's how you demonstrate whether something's real, real, or if it's only real under certain conditions, blah, blah, blah, blah. So that's really great. I'm glad you're doing that. [00:41:08] Well, I want to thank you for being on the podcast. This is a Devin Rippner. He is a research soil scientist with USDA agricultural research service and an adjunct position with the crop and soil science department at Washington state university. Really fun conversation, Devin, lots to think about. I will be following this closely. Or annually, probably [00:41:31] Devin Rippner: Cool. [00:41:31] Yeah. [00:41:32] Craig Macmillan: these things are slow. I'm not going to be checking every week. But I just think it's really cool project and is real inspiration. And I would love to see the same kind of thing replicated in other places. [00:41:41] Devin Rippner: Great. Thanks Craig. That was really fun. [00:41:43] Beth Vukmanic: Thank you for listening. [00:41:49] If you enjoyed this podcast, Vineyard Team has a couple of in field tailgate meetings coming up this year that you won't want to miss. [00:41:56] The first is on February 20th in Paso Robles, and it is a dry farming grower around table. Now you don't need to be a dry farmer to enjoy this event. There'll be a number of different growers here talking about their experiences, trials, challenges, and successes. [00:42:13] The second event is on March 12th, and it is Grazing as a Sustainable Practice for Vineyards, taking place in Los Olivos, and we hope to have some adorable sheep on site. [00:42:24] Make sure you check out the show notes for links to Dev lots of research articles, plus, sustainable wine growing podcast episodes, 80. The Goldilocks principle and powdery mildew management, 90 nematode management for Washington grapes, plus a whole healthy soils playlist. [00:42:42] Now for the fine print, the views, thoughts, and opinions expressed are the speaker's own and do not represent the views, thoughts, and opinions of the USDA ARS. As such, the views, thoughts, and opinions. Presented by the speaker do not constitute an official endorsement or approval by the United States Department of Agriculture or the Agricultural Research Service of any product or service to the exclusion of others that may be suitable. The material and information presented here is for general information purposes only. [00:43:14] If you liked this show, do us a big favor by sharing it with a friend, subscribing, and leaving us a review. You can find all of the podcasts at vineyardteam.org/podcast. And you can reach us at podcast@vineyardteam. org. [00:43:28] Until next time, this is Sustainable Wine Growing with the Vineyard Team.   Nearly perfect transcription by Descript

Ruben Pereyra is an award-winning fitness professional recognized for his exceptional skills and dedication. His accolades in the industry reflect his relentless pursuit of excellence and the positive impact he has had on countless lives. As a business owner and creator of “FUNctionally Evolved,” Ruben’s journey is a shining example of how passion and perseverance can transform not only personal fitness goals but also the wellness of entire communities. In this episode, Ruben shares an array of information about creating a personalized approach to fitness, major lessons he has learned as a business owner and simple ways to make fitness a lifestyle. Learn more about Ruben and his transformative movement dedicated to empowering special population seniors and individuals seeking low-impact workouts at: www.functionallyevolved.com See omnystudio.com/listener for privacy information.

Ruben Pereyra is an award-winning fitness professional recognized for his exceptional skills and dedication. His accolades in the industry reflect his relentless pursuit of excellence and the positive impact he has had on countless lives. As a business owner and creator of “FUNctionally Evolved,” Ruben's journey is a shining example of how passion and perseverance can transform not only personal fitness goals but also the wellness of entire communities. In this episode, Ruben shares an array of information about creating a personalized approach to fitness, major lessons he has learned as a business owner and simple ways to make fitness a lifestyle. Learn more about Ruben and his transformative movement dedicated to empowering special population seniors and individuals seeking low-impact workouts at: www.functionallyevolved.com See omnystudio.com/listener for privacy information.

There have been two episodes lately that have sent me down a rabbit hole that I wanted to bring to your attention. Now, disclaimer: I know you people; you're busy. You listen on average to, like, 26 minutes of any given episode. So, yeah … look at me being self-aware. I say all this to say welcome to this inbetweenisode, otherwise known as The Rabbit Hole. But it's like a 20-something-minute rabbit hole, not a day-and-a-half retreat; so just be kind if you email me and tell me I forgot something or failed to dredge into a nuance or a background point. It might be that I just could not manage to pack it in. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. This rabbit hole really, really matters for anybody creating benefit design. It really matters for anybody trying to optimize the health that can be derived from said benefit design. It also probably matters for a whole lot of operational decisions involving patients or members, nothing for nothing. But it really matters for anybody trying not to, by accident, as an unintended consequence, hammer plan members or patients with some really blunt-force cost containment measures that do a lot of harm in the process of containing costs or, flip side, accidentally cost a whole lot but don't actually improve member health. Nina Lathia, RPh, MSc, PhD, kind of summed up this whole point or gave an adjacent thought really eloquently in episode 426. She said there's better or worse ways to do things and doing the worst kinds of cost containment may not actually contain costs. You squeeze a balloon, and that works great for some, like pharmacy vendors who don't really have any skin in the game. (See me using the “skin in the game” term for other people besides plan members? That's some really good foreshadowing right there, by the way.) So, squeezing the balloon works for some when they don't have skin in the game, in the place where the air goes when you squeeze the balloon—like a pharmacy vendor who makes it super unaffordable for patients to get meds so the patient doesn't take their meds and winds up in the ICU, or the patient's formerly controlled with meds condition that is now newly uncontrolled and requires all kinds of medical interventions to get said condition back under control. Like, these are the reasons and the why behind why some cost containment efforts don't actually contain costs at the plan level. But not at the vendor level. You see what I mean? Most pharmacy vendors don't get penalized if medical costs wind up going up. And I'm picking on pharmacy vendors a little bit here, but it's true for a lot of siloed entities. But, you know, balloon squeezing can also work, actually, at the plan level if where the air goes, it's to a place where the member or the patient has to pay themselves. Like, if there's a huge, I don't know, max out of pocket or deductible, does it really matter to a very mercenary plan that's running on a very short time horizon? Do they really care, that plan, if the patient's formerly controlled condition gets uncontrolled? Maybe not, I guess, as long as it doesn't cost more than the max out of pocket that the patient is on the hook for, for any given plan year. So, yeah … again, there are better or worse ways to do things; and a lot of questions kind of add up to, What kind of plan do we want to be? What are our values, and does the plan align with them? But that's not the rabbit hole I wanted to go down today—the aligning with our values rabbit hole—so let us move on. The Relentless Health Value episode that kicked off the rabbit hole for me on multiple levels was the show with Bill Sarraille (EP459) about co-pay maximizers and accumulators. And don't get me wrong, that is a complicated topic with lots of pros, lots of cons; and I am not weighing in on the inherent lawfulness or value of any of this. I am also not weighing in on the fact that there are forthright and well-run maximizers and really not good ones, which cause patients financial, for sure, and possibly clinical harm. But not talking about that right now at all. Go back and listen to the show with Bill Sarraille if you are interested. Where my “down the rabbit hole” spiral started was when I started noticing the very, very common main plan pushback that was given right out of the gate so often when talking about the problems that any given plan sponsor has with these pharma co-pay programs—that if these pharmacopeia card dollars count toward the plan deductibles, then the patient's deductible gets met and the plan member will then often overuse healthcare and cost the plan excessive dollars from that point forward. So again, if you ask any given plan sponsor what I was gonna say their main issue but a main issue that they have with these pharma co-pay programs, that's gonna be it—that if these pharma dollars count toward the plan deductible, then the patient's deductible is met and from that point henceforth, the patient goes nuts and overuses healthcare services and it costs the plan a lot of money. The second episode causing this rabbit hole to open up is the one coming up actually with Scott Conard, MD. So, check back in a couple of weeks for that one. But in the show with Dr. Conard, we get into the impact of high-deductible health plans or just big out of pockets, however they transpire in the benefit design. Both of these scenarios, by the way, the maximizer meets the deductible scenario and the very, very high-deductible plan scenario are to blame, in other words, for this rabbit hole of an inbetweenisode. So, let's do this thing. Let's talk about the moral hazard of insurance to start us off. In the context of health insurance, if you haven't heard that term moral hazard before, it's an economics term; and it is used to capture the idea that insurance coverage, by lowering the cost of care to the individual, because their plan is paying for part of said care, by lowering the cost of care to the individual, it increases healthcare use. So, you could see why this may be related to having a deductible fully paid or not. Pre-deductible, the plan is not paying for a part of said care or paying a much smaller part. And after the deductible is paid for, then the plan is paying for a much larger percentage of care. So, moral hazard kicks in bigger after the deductible is fully paid, when the plan is paying for a bigger percentage or a bigger part of the care. So, before I proceed, let me just offer again a disclaimer to the many economists who listen to this show that this is a short inbetweenisode; so I am 100% glossing over some of the points that, for sure, have a lot of nuance. For anyone who wants a thick pack of pages for background reading, I have included some links below. Because you see, a few weeks ago, my Sunday did not go as planned. And instead of running errands, I wound up reading eight papers on moral hazard. So, my lack of groceries is your gain. You're welcome. I am happy to send you these links if you really want to dig in hard on this. Okay … so, moral hazard is the concept that individuals have incentives to offer their behavior when their risk or cost is borne by others. That's the why with deductibles, actually. We gotta give patients skin in the game because once a member has their deductible paid, it's like member gone wild and they will get all manner of excessive care. Again, I hear that a lot from plan sponsors—a lot, in all kinds of contexts but almost always, again, whenever the conversation has anything to do with manufacturer co-pay card programs and a lot when it has to do with just, you know, high-deductible plans and what happens when the patient meets their deductible. Once a patient or family has a fully paid deductible, their medical trend is like a spike, I hear over and over again. And again, this is the reason why many insist—and again, no judgment here, maybe they're right, I'm just rehashing the conversation—but this is why many insist the moral hazard of letting people have their deductible paid for them by Pharma or whatever is the reason why some believe it is imperative to have maximizers or accumulators where pharma dollars can absolutely not apply to patient deductibles. Because then we have sick patients who now have their deductibles reached, who have very few financial disincentives to go seek whatever care they want. Right. Moral hazard has entered the building. I've beaten this point to death, so let's move on. One time, I asked a plan sponsor, What exactly is it that these plan members are going wild spending plan money on once their deductible gets paid off? And he said, well, you know, they go get their suspicious-looking moles checked. Did you hear that silence just now? Yeah, that was my reaction. I don't know. I would consider getting suspicious moles checked kind of high-value care. There are posters all over the place saying if you have a suspicious-looking mole, it might be melanoma. Cancer. So, you should get ahead of that before you have a metastasized cancer. I'm no doctor, but yeah, this feels like high-value care. So, let's just, in arguendo, say it is high-value care and follow this thread for a sec. Once members reach their deductible, let's say they run around and get high-value care, care they actually need but haven't gotten before because they couldn't afford it earlier or were putting it off until they saved up enough, right? Like, this is the other side of the moral hazard coin. If patients delay or abandon care—and, by the way, there was a survey (it's in the Wayne Jenkins, MD, show from a while ago [EP358])—but 46% of patients with commercial insurance these days have delayed or abandoned care due to cost. But if they delay or abandon care that is high value and medically actually necessary and they put it off or abandon that high-value care because they cannot afford said care, then yeah, we have, again, the opposite of the moral hazard problem. We have members paying a whole lot for insurance that they cannot afford to use, they're functionally uninsured, and it's not gonna end healthfully if they need high-value care and they're not getting it. It's not. Functionally uninsured patients who have chronic conditions that really should be managed will, as per evidence, wind up with health problems if those chronic conditions are not managed. I read another study about this just recently. This is why members with chronic diseases on high-deductible health plans tend to have worse health, by the way. Now, I need to say, same rules do not always apply for healthy patients who, at least at this point, don't need regular healthcare. But do keep in mind, as it comes up in the Dr. Scott Conard show, 30% of patients who think they're healthy, they feel fine—actually they are not fine and will become sick and costly in the coming years. So, yeah … tune back in for that discussion if you are interested, but you get the gist of this whole thing, right? So, that's scenario 1 as to what patients may choose to buy once they're in the moral hazard zone and have met their deductible. They go get high-value care. So, let's move on from the high-value care case study where patients reach their deductible and get high-value care or they haven't met their deductible and fail to get care they actually need. I want to circle over to the other moral hazard potential situation: patients who meet their deductible. And in this scenario, they again embark on a health system jamboree; but they don't get a whole lot of high-value care in this scenario. They run around getting all manner of all kinds of stuff that is well outside of any evidence-based pathway. Like, weird example, I went to a doctor recently asking a question about something that everyone ultimately agreed was nothing. At which point, the doctor asked if I wanted an MRI. I was like, “What?” We and everyone else just agreed this was a big nothing burger. Why would I want an MRI? Is there something else that we didn't discuss to indicate that I need imaging? Like, why are we going there? And the doc said, “Oh, well, everyone in New York City has an anxiety problem. So, I thought you might just want to get an MRI.” Yeah, low-value stuff like that is now not financially prohibitive. So, someone who had met their deductible, in a similar situation to my example, might have shrugged and said, “Sure, I do have some anxiety. Let's go get that MRI.” Or if they hadn't met their deductible, then the whole skin-in-the-game, market-driven approach may work, I guess, to prevent them from getting low-value care that was clearly excessive and pretty wasteful. So, summing up these two scenarios, the implications of the moral hazard issue are, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care from high-value care. And because patients are not good at discerning high-value from low-value care, moral hazard is not mitigated with any sort of binary kind of vote for moral hazard or against moral hazard types of brute-force, broad-stroke tactics. Like, say I'm a moral hazard full-on believer. I assume all or most of the care a patient will go for is low value, right? Because if I try to prevent moral hazard from happening, then by default, what I'm effectively saying is, whatever they choose to buy on the basis of moral hazard is low value. So, I make basically everything I can pretty unaffordable so as not to invoke any moral hazard. But right, the problem with that is that some of the care is actually high value. And it's also expensive for the patient, so they don't get it. And patients are harmed, and balloons might get squeezed. Or the opposite, against moral hazard, right? Like, I'm against the concept of moral hazard. I don't believe in it, so I don't set up absolutely anything to combat it. Maybe because I assume all care that a patient might want to get is actually high value and totally worth it. That's gonna be a problem for the opposite reason. Plans can waste a lot of money this way. Random example, in 2014, the Commonwealth of Virginia reported spending $586 million on unnecessary costs from low-value care. I mean, they say something like a third of all care is waste and unnecessary, so … yeah. Plan sponsors can waste a lot of money on low-value care, and a bunch of that may happen when patients have less skin in the game because they reach their deductible, as one example, and the care is not financially prohibitive and moral hazard is realized. So, yeah … as I said, a couple of weeks ago, I did not spend my Sunday as planned. I spent my Sunday reading papers about moral hazard in insurance and how financial incentives impact patient decision making. And I'm gonna repeat the grand takeaway because this is a podcast and you might be multitasking. So, once again, here's the sum of it all: If it's expensive, people tend not to do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are simply quite bad at distinguishing high-value care from low-value care. Once their deductibles are met, most patients will—due to moral hazard—they will, in fact, go on a spending spree; and part of what they will get done will be really, really important and necessary stuff, like getting their unusual moles looked at or their heart pain checked out or going for that follow-up visit or lab work that their doctor told them they need to come in for. And the other part of what they will do will be things that are outside the best-practice, evidence-based pathway guidelines by the length of the Appalachian Trail—you know, doing what appears to be a tour of specialty medicine physicians for unclear reasons but which lead to a cascade of testing and who knows what else. Why do they do this, these members? Do they do this on purpose? No. There is study after study that shows, again, members/patients do not, most of the time, have the chops to figure out if some medical service is high-value or low-value care. And no kidding. Most members and patients have no clinical training. They're not doctors. They're not nurses. They're not physician assistants. They're humans whose uncle died of cancer, and now they have a pain in their foot and they're convinced it's a tumor. Right? Like, do we blame them when they finally go see a doctor because they crushed their budget that particular year paying thousands and thousands of dollars out of pocket for whatever earlier in the year, and now they've made it to their deductible—do we blame them for taking the very rational step of getting the most out of those thousands of dollars of sunk costs? At that point, it's a “let me get my money's worth” situation because they can't afford to do this again next year. I mean, we hire employees because they're smart and rational, and this is really actually a pretty smart and rational thing to do. It's not somebody trying to commit fraud. Okay, sure … some people are. There's always bad apples. But the vast majority are just trying to live their life and not spend all of their vacation money next year on medical services like they did this year. I'm saying all this because it's actionable, by the way. And I'm getting to that, but indulge me for like 60 more seconds because I want to acknowledge you, listeners of this show, are probably nodding along to this whole thing this whole time and thinking all of this is pretty obvious. Well, yeah … maybe. Except here's the reason I decided to do an inbetweenisode about this rabbit hole instead of doing my normal thing, which is just ranting about it over dinner for three days straight—and God bless my husband for sitting through it—is the bottom line. But the reason we are here together today is the number of emails and posts and et cetera that cross my desk where it doesn't seem like these dots have been connected on all of this or at least connected in magic marker. Like fat, indelible magic marker, which is what I think is necessary for these dots to be connected with the ones between moral hazard and patients not being able to discern high- and low-value care. There are so many ways and places these dots will show up. Like, here's another moral hazard issue with those maximizers or accumulators, which apparently are on my mind right now—the not good ones I'm talking about now, where patients find themselves on the hook for hundreds or thousands of dollars midyear if they want to pick up the meds that they've been prescribed. If you need more details on how that might happen to understand what I'm saying fully, listen to the show again a couple of weeks ago with Bill Sarraille (EP459). But even if you're a little confused, it doesn't matter because the question is this: Do we justify having programs that make drugs really expensive for patients? Do we put in place one of these pretty darn punitive types of accumulators or maximizers, right? Like, there's different kinds, and I'm talking about the punitive ones of accumulators or maximizers. Do we justify putting one of those into place and figure that if a patient really wants the med, they'll pay a whole lot of money for it? Because if they're willing to pay a whole lot of money for it, then, right? It must be high-value care, so they'll figure out how to pay for it. Keep in mind, as I said earlier, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care or meds from high-value care or meds. So, look, Pharma can be up to all kinds of crap, and list prices are really expensive. No arguments here. That isn't the point. The point is, What is the actual problem that we're trying to solve for, for our plan and our patients and our members? And if that problem is making sure that the right patients get the right high-value meds or care, then not letting members get co-pay assistance such that all drugs—the good ones and the too-expensive ones and the ones that we don't really want our members to take for whatever reason—if we make all of them way too expensive with a maximizer or accumulator designed to make all the drugs really expensive … dots connected. We wind up with the all-in to prevent moral hazard issue we just talked about, where patients could easily be harmed and the plan can easily get into a balloon squeezing situation. All I'm saying is that there's a big-picture view of moral hazard here that we need to be looking at and over-indexing into binary, moral hazard black and white, where we attribute malice to members, some of whom, some of the time, may actually be trying to get high-value care, or the flip side, the plan's paying too much for low-value care and causing financial difficulties and not understanding the root cause. Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem. So, look, moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we're not doing black and white, what does the gray in the middle look like? Alright, we don't want to be a solution looking around for a problem. So, let's think about the problems that we want to solve for. I would start with, What's the goal? The goal of plan sponsors providing insurance most of the time is attract and retain talent. Also, I was at the HBCH (Houston Business Coalition on Health) Conference at the beginning of December 2024. And there was a poll question. There was a bunch of employers in the audience, and the poll question asked the audience, “What's your biggest plan goal this year?” Main answer by a mile: Cut costs. Okay … so, we want to attract and retain, and we want to control costs. Obviously, you can go about achieving these three things a bunch of different ways, and they will all be tradeoffs. As Luke Prettol reminded me of the other day, there are no solutions, only tradeoffs. And so, with that, right now, I want to introduce the second concept that I have been ruminating over in my rabbit hole lately, that I've kind of been hinting at for this whole time. But here's a word we've been waiting for to solve all of our problems in a good kind of way, not the bad black-and-white ways that are so often either financially a problem or deploying brute force and harming patients in the name of solving something else: Pareto optimality. Pareto optimality is the state where resources are allocated as efficiently as possible so that improving one criterion will not worsen other criteria. It's essential to consider this, that Pareto optimality is the ideal we should at least be striving for when attempting to overcome any challenge but, in particular, the moral hazard issue, when we know that patients do not know what care is high value and what care is low value. Because if we don't try to at least Pareto optimize (if that's a word), if we try to fix the moral hazard problem and wind up with a new problem or new problems that might be worse than the old problem, that's not optimal. We have improved one criterion and worsened another. So, fixing the members going wild after they meet their deductible by slamming the lid on the fingers of members trying to get high-value care as well as low-value care, well … not sure about this, but I'd assume if not the attract but at least the retain criterion might be compromised by member dissatisfaction. But also, as I've said nine times, we might not actually cut costs. We might be doing a squeeze of the balloon. Especially that could be true when, as we all probably know or suspect, what's driving costs at the plan level is rising hospital prices. There's a show coming up on rising hospital prices as a primary driver of rising plan costs, and it's pretty hard to argue with. So, it's financially pretty advantageous to keep patients from needing to go to the hospital. So, yeah … I'd strongly suggest not squeezing balloons when hospitalizations are where the air goes. I'm not gonna belabor this. My only suggestion is, do the Pareto optimality math. A lot of you already are, I'm sure, and do a great job. But just for any given policy plan change, or decision, keep in mind moral hazard and then really go through the whole cascade of likely impact on other factors based on likely member/patient behavior. It's so easy to get sucked into kind of these philosophical, “those are my enemies” kinds of conversations that are actually philosophically sort of interesting, but they aren't the goal. I mean, there's always unintended consequences; but not all unintended consequences should come as some kind of, like, wild-ass surprise. They were pretty predictable, actually. Let me also mention that when considering Pareto optimal solutions, advanced primary care starts to get really compelling. It's because having a PCP team with data and a relationship to the patient helps patients stay on the high-value care bus. And that can minimize the bad that comes from lowering the barrier to care and inviting in a little bit of moral hazard. Just saying. Okay, so this has been going on a little bit longer than I had originally intended, but I do want to remind you of the so-called theory of second best. It's probably really appropriate here, and one of the reasons why I'm mentioning this and not finishing the show right now is that, in a very synchronistic moment, I was writing up my outline for this inbetweenisode and—how random is this?—Steve Schutzer, MD, wrote an email that included something about the theory of second best. Great minds and all of that. Anyway, the theory of second best is really aligned with Pareto optimality. It's just that sometimes you gotta be really practical. You gotta be a little scrappy. If you cannot achieve the best option, either because you just can't or because the best option for one thing results in too many negative consequences elsewhere, then don't do the best option. Forget it. Do the second best (ie, the theory of second best). There is nothing wrong with that. Don't be a hero. Okay, so in summary, moral hazard is actually a thing and so is the opposite; and it's even more of an impactful thing because most people cannot distinguish high-value from low-value care. And if they meet their deductible that they have paid a lot of money to reach, of course, they are going to want to try to get through their checklist of medical appointments that they have been putting off. This is not a surprise. And it's not all bad, as long as the care that they are trying to go get is high value; and that matters if we're trying to cut costs. Because to cut costs for real and not in a squeezing of the balloon way, we need to direct or limit somehow what gets done to high-value care. And we got to do that without accidentally causing other problems, meaning think through Pareto optimality and possibly consider the theory of second best. I hope this has been helpful at some level. It's helped me. I feel better having vented. Also mentioned in this episode are Nina Lathia, RPh, MSc, PhD; Bill Sarraille; Scott Conard, MD; Wayne Jenkins, MD; Houston Business Coalition on Health (HBCH); Luke Prettol; and Steve Schutzer, MD. Additional studies mentioned: Moral Hazard in Health Insurance: What We Know and How We Know It Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use of Low-Value Health Care Services Healthcare and the Moral Hazard Problem Distinguishing Moral Hazard From Access for High-Cost Healthcare Under Insurance   For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   04:05 Where did Stacey's rabbit hole spiral start? 05:40 What is the moral hazard of insurance? 09:31 EP358 with Wayne Jenkins, MD. 12:49 Why isn't moral hazard mitigated in insurance? 18:16 EP459 with Bill Sarraille. 20:51 “How do we conceptualize a solve?” 22:24 Why should we be striving for Pareto optimality? 25:20 What is the theory of second best?   For more information, go to aventriahealth.com.   Our host, Stacey Richter, discusses considerations for #plansponsors and others. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415)  

Welcome to the first episode of 2025 for The Brain Podcast - the official podcast of the journals Brain and Brain Communications.  This episode features a discussion with senior author Dr Frank Porreca of the Brain article entitled: Nociceptors are functionally male or female: from mouse to monkey to man? Dr Porreca discusses important findings into the  sexual dimorphic nature of nociception and how it could and indeed should affect clinical trial participant design, precision medicine and need for more sex specific studies to unravel the regulation of pain nociception in male and female individuals. Check out the full article on the Brain website as part of the December 2024 issue: https://doi.org/10.1093/brain/awae179 This episode was co-hosted by Chaitra Sathyaprakash and Andreas Thermistocleous,  edited and produced by Chaitra and Xin You Tai, co-produced by Antonia Johnston, original music by Ammar Al-Chalabi.

Mike Johnson is betraying us with more spending even before Trump takes office. I explain why we need a fight over the speakership, but that will not happen unless we get Trump to change his legislative focus. Likewise, we are having similar problems in the red states. We're joined today by state Rep. Jordan Pace, chairman of the South Carolina Freedom Caucus, to discuss everything that is wrong with the state party. Under the leadership of Speaker Murrell Smith, Democrats have been given key subcommittee chairs. Pace explains with painstaking detail the subterfuge GOP leaders use to advance the Democrat agenda without transparency. They have a corrupt process of picking judges, which often results in placing liberals on the bench. Moreover, they continue promoting biomedical tyranny, pushing socially liberal policies, and handing over state lands to the green grift. In South Carolina and elsewhere, unless we support the Freedom Caucus members, the GOP will continue promoting Democrat policies without the Democrats owning the consequences.   Learn more about your ad choices. Visit megaphone.fm/adchoices

University of Canterbury lecturer Mike Grimshaw says students are turning up to university unable to adequately read, write, or think independently.

A university lecturer has fired shots at the education system, claiming the number of tertiary students who are “functionally illiterate” is at crisis level. Associate Professor of Sociology at Canterbury University Mike Grimshaw believes New Zealand is under-educating and over-qualifying. He tells Heather du Plessis-Allanit's a wider societal issue of how we value education, fund it and what we want from the system. New Zealand pumps out around 45,000 tertiary graduates a year. Grimshaw says there is no increase in the societal, cultural and economic outcomes that degrees are said to provide. LISTEN ABOVESee omnystudio.com/listener for privacy information.

By Walt HickeyWelcome to the Numlock Sunday edition.This week, I spoke to Stephen Follows, author of The Horror Movie Report.Stephen and I go back a ways, he's a pop culture data journalist I really respect and you've seen him in the newsletter lately based on his great work on stuff like Hallmark movies. He's out with a really fun new book diving into horror movies, one of the more exciting genres in the film industry these days. We spoke about the rise of horror as a genre, its unique relationship with audiences, and how certain trends have evolved over time.Follows can be found at his website, and the book can be found at HorrorMovieReport.com.This interview has been condensed and edited. Stephen, thank you so much for coming on.Thanks for inviting me. It's always a joy to have a chat with a fellow nerd who likes to go as deep as we do on this stuff.You have this really interesting new book out called The Horror Movie Report: The Ultimate Data Analysis of Horror Films. This thing's amazing. We're going to get into it. But before we dive in, I'd love to start off by hearing about how you'd describe the work you do. Can you tell folks a little about your history as a writer, blogger and analyst?Definitely. I kind of came to this in a strange way. I always knew I wanted to do film and thinking, but I didn't know what that meant. I was a teenager, and everyone told me to go and study thinking, study science and do film on the side. So I did the opposite, because I'm a contrarian. I went to film school and went down a path of writer/producer, and I set up a production company. It still runs, but is now doing more advertising for the charity sector in the UK.I'm still involved with that, but it meant that as my stuff moved away from film, I missed being connected to the film industry. I started to use my thinking principles and maybe 15 years ago I started studying film through the lens of data. I have no training in data. I stopped studying math at about 15, but I have an aptitude for it, and I enjoy it. Not many people do in film. I thought, oh, this is fun. This is a place for me. I started blogging about that, and some in the film industry like it. Not many people run away to do the accounts for the circus. It's nice to have a place.Then that evolved. I've done stuff within gender and other forms of inequality, and things within business to help filmmakers' profitability — but also crazy things, like looking at which Bond film mentions its own title most frequently in the dialogue. Which I don't think you're going to guess.GoldenEye is my only guess.It's a good guess, and you're on the right path, but it's the wrong answer. The answer is Moonraker. You were right to think object instead of character.But that led me on, and I now work for Guinness World Records as a side gig, finding out movie records. That's the sum total of 20 years of numbers and film fun.I love your work. I've always enjoyed your work quite a bit, and I've done a lot of work myself in the pop culture data space and there's not a lot of folks in here. Particularly back in the day, there weren't many folks at all, so it was always really cool to see your stuff. It definitely always got me thinking and is really one-of-a-kind.That's nice to say. And I agree; I would often think of an idea, or someone would ask me about an idea, and I'd be like, I wonder if anyone's done that. Then I'd Google it and it would either be you, me and I'd forgotten, or no one's done it. That's great. What a privilege to have a space to actually make some progress in.It's good. Again, I admire your stuff so much, and this is why when you hit me up and mentioned you were working on this project, I was so excited. Horror movies have been one of the biggest success stories of the past couple of years, particularly in the postpandemic box office. They tend to overperform; they tend to get good ROI. We've seen a surge in horror film production and we've seen the market share increase.Can you talk a little bit about why this is historically anomalous? We've always had horror movies, since the beginning of the invention of the medium, but why are we now seeing a bit of an uptick?You're absolutely right. It's way more than an uptick. If we were looking at how many horror films were made last year worldwide, it was over 1,500, whereas around 2000, it was 500-something, and in the 1980s it was below 200. It's really transformed. As you said, not only have the raw numbers gone up, but also has the market share. Now about 12 percent of movies are horror films. That's a large percentage.It's a number of factors. Certainly all genres have grown in raw numbers, because it's easier and cheaper to make a film than ever before. Every device I own has some sort of HD camera on it — you can do it on a doorbell. It's possible to do that. You also have the ubiquity of information. I went to film school in 2001 and there was education from tutors, there were a few hardback books, but that was how you learned how to do stuff. Now there's so much content online telling you amazing stuff from awesome people for free. That has an effect.But that's across all films. With horror itself, the market share growth is, as you said, the more interesting part of it. There are a few factors. One, we're more accepting that a film is a horror film. A film that we might think of as horror now, if it had been made in the '80s, it might've been pitched as a psychological thriller. There's more acceptance; there's no shame in it. People are like, yeah, it's a horror film, whereas in the past they might not have done.There's also that generation that grew up with VHS horror films, The Evil Dead generation — and maybe even the generation after that, when it comes to executives — where people have grown up loving horror, but also knowing that it does well. Therefore, if there's no business shame and there's no art shame and there's no personal shame, why not say, yeah, I'm making a horror.There's still a bit of way to go. The awards are pretty poor for horror, and the trade press doesn't cover it properly. It's still not as fully accepted as other genres, but production-wise and audience-wise, it's really evolved and grown and, in the last 20 years, really matured.It's so funny that you mentioned the award stuff. I remember when Jamie Lee Curtis won her Oscar for Everything Everywhere All at Once, I thought it was actually really special that she took a moment and shouted out the horror fans. That's a constituency in movies that does not get a lot of shout-outs from award stages, but nevertheless really did keep her in business for a few years.And it was keeping her in business because it was delivering to audiences. There's no hiding from that. It's the most audience-connected genre, in my opinion.All my stuff is from raw data and from doing my own research, but sometimes I'll do a bit of Googling around to get a context before or after I do the work. With the awards, I found a few blog articles about how horror does at the Oscars, and all the numbers were wrong. They were all different, and they were different from mine. I was like, what is going on?It turns out there is a very, very small number of horror films that do well at the Oscars. Most of them are quite questionable horrors, as in, is it a horror or not? Silence of the Lambs. Jaws. Those are two films that IMDB says are not horror films. You can argue either way, and it doesn't matter what my opinion is, but there are a few like that. Or Black Swan, which is very much a horror film, but because it's female led and about a female perspective, people often go, “Ah, it's a psychological thriller,” in a very misogynistic way.A small number of films that have outperformed have really changed that data. You end up almost immediately talking about existential questions of what horror is. I love that. That's what the data immediately suggests we should chat about.I want to talk a little more about that audience for horror. You had a stat in here that was really interesting to me about how horror is the only genre where the audiences that actually go to the cinema to watch it are direct reflections of the actual national audience. I know you write about the UK in there, but also in general, one really interesting thing about the cinema is that you do have quote-unquote “four quadrants” for movies. For the most part, you're going to see a gender skew or an age skew in terms of who attends a film. But I'd love to hear you speak to how horror is really one of the most universal genres.It really is. It's interesting, because as you've mentioned, there are a few different ways we can cut up the data. The one way that horror is not like the population is age. It has the largest percentage of 18- to 24-year-olds. If you split them into the different buckets, as they often do, horror has the lowest percentage of people under 18 and the lowest percentage of people over 45, which is fascinating. It's really condensed within your 20s. However, it's a good gender split, and also crucially, in the UK, they do just the most British thing ever and do stats around social status.Interesting.It's a rabbit hole. If ever you're looking for a rabbit hole, Google social status. Everyone's classed into different groups, usually based on the job they do or that their parents did, or whether they went to university — things that are sort of falling apart. But it does mean they put people in different brackets. They do that for all the different audiences because it's part of the cinema business' advertising: They want to know whether to sell Rolex watches or lager. And when you compare it to the UK population, every other genre is posher. To a large degree, things like biographies are unbelievably posher than the average population.Horror is the one that just reflects the public. Also, almost every genre has a very strong correlation between what critics think of the movie and whether it makes money or not. In almost all genres, it makes sense; if you can make the film better, according to critics, you'll make more money. Horror has little to no correlation — functionally irrelevant correlation. Critics are irrelevant. Horror always gets poor scores from audiences, even, but I think that's because it delivers something different. It still is a film and it still is in the film genre space, but it's the weird cousin that's there delivering because it doesn't have the snootiness. It doesn't have the credibility. It only has the fact that it delivers, so when it does deliver, it does stunningly well. And the audience has a different criteria for what they'll put up with, whether they'll tolerate junkie effects or a bad idea or bad acting. I love that. It has its own identity.I love it, too. I'm glad that you mentioned that, because when I was doing my book, I was really interested in horror. I'm not good at horror movies; I am very easily scared and I don't have fun during them. I'll see them if I'm dragged to by my husband, but nevertheless, I am a gigantic weenie. There's no personal affection for this genre, but I was obsessed with it because, to your point, the first thing that people start messing around with when a new medium is invented is spooky stuff, right?When the novel was invented, you were very quickly after that getting stuff like Dracula, or Frankenstein. Once the medium has ossified, you start getting people experimenting with scares. Some of the earliest films that we have, whether it's Nosferatu or things like that, are people trying to spook one another. It's almost like the stuff that came before the dinosaurs.You're absolutely right. What's fascinating about it is that as soon as there's a new medium, people use it to scare other people, but then they take a long time to acknowledge that. The idea of a horror film as a nomenclature, as a name for it, didn't emerge until the early '30s, when you started to have universal monsters. We had horror films before that, but they didn't call them that. They might be called Gothic. So, there is a very quick move to scare ourselves, but then there's a very slow realization of acceptance, of publicly going, yeah, I don't mind being scared. Which is fascinating, isn't it?It is. It's so cool, and it's cool seeing it replicate itself. Online, you used to have jump-scare videos as some of the first stuff. Some of the earliest viral videos were that. Even with podcasts, a lot of true crime podcasts are horror podcasts.One hundred percent.There's another thing you write about in here that I genuinely just love, which is that there's no link between a filmmaker's experience and the actual profitability of the horror film. This is one of the things that makes this genre so cool, and I'd love to hear your perspective on it and some of the data from it. It's a really approve-yourself kind of genre. A lot of the time, you can show up with a little bit of money and some corn syrup and red food coloring, and they've been really special.Totally. It is the most accessible genre, partly because it has the lowest cost but also because it doesn't need gatekeepers. It doesn't need stars. It doesn't need visual effects. So it's immediately open to more people, but then on the other end, the audience is also willing to go with something great. They're not going to go, “Well, who made it?” They'll just go, “Ah, that was great.” You're right.I looked at the correlation between the number of films that someone had made before and the profitability of their films. I looked at it for writers, producers, directors, and exec producers. What we found, when we were looking through this, is that with writers, producers and directors, there's little to no correlation. Really. That's staggering when you think about it, because most horror films do nothing — that's what films do — and if you have a lot of microbudget films, that's 1,500 a year and not all of them making money. But the ones that do make money can do staggeringly well. You would imagine that experience is a factor, but it's not.Except for the exec producer. There was a correlation, though it's not the strongest. It's not make-or-break. I don't know which way around that is, whether it's exec producers being very good at spotting the right projects, so they become an identifier, or whether they transform the project and therefore become the transformation.Functionally, it doesn't matter. It's a bit of both: a bit of column A, a bit of column B. The horror producers I've spoken to often say it's a mix of those things, that they're not going to come aboard a bad project. But at the same time, it is about having the right relationships to know how to get distribution or how to retitle it or basically how not to eff up one contract that could ruin everything. Sometimes it is just a steady hand.If you're making a horror film and you've never done it before, I don't see that as any kind of problem, but maybe have at least one voice who's experienced that you can go to — infrequently, so they don't have to do a huge amount. The exec producer is not on set picking up trash.It's almost reminiscent of the Roger Corman film school stuff.Totally. The things that the really experienced person will do are basically, here's the big picture, here are some connections, but the bits the audience is actually going to love if they're given the chance to watch the film — the story, the acting, the moments, the editing, the sound — that's all going to be done by the creatives. And that doesn't matter about your experience.I remember an interview with Wes Craven a long time ago where they said to him, why are there so many bad horror films? And he said, because they're made by people who don't love horror. I've got to say, that's probably true. You can't make it cynically, but if you make it with your passion and heart, you have a good chance. Make a Western or a sports movie with your heart and you're not getting the money back. But if you make a horror film with your heart, there's a chance. I'm not saying there's a big one, but there's a route to success and establishment and franchise and all that.Sam Raimi very notoriously tread that path. Even folks like James Cameron. It's interesting to look at filmmakers who really did make their bones by being very passionate about a horror film and getting it done and learning something very cool.The Terminator might be a horror film. I don't know. It certainly doesn't have the money to be what Terminator 2 is, which is solid action.Absolutely.It's not really sci-fi; there's a bit of sci-fi in it, but it's just a man. It's too cheap to have any of the expensive things you'd expect. It's a torment film, or maybe even a slasher, almost. There is an infamous killer.There's another element on this that I wanted to bring up, which is that you have this really cool stat about horror films and shot length. You were able to compare them to other mediums, and horror films just have so much more room to breathe. Can you speak to that?Before I study something, I tend to have a preconception of what it's going to be, which you can't help because you're around. But what I love is that I'm sometimes completely thrown off-kilter. Then I'm forced to go back and be like, what happened there? Why was I wrong? Is my data wrong? Because, as you know, sometimes when you find that anomalous result, you have to double check or even triple check it.This was one of those things. What I found when I was looking at this was that, unsurprisingly, action and sci-fi films had the shortest shot lengths of about four seconds on average, or something like that. That's short, and that's the whole movie. That was across all films. Drama had the second highest, and it was something like 12, 13, 14 seconds — I can't remember, I don't have it in front of me. But horror was 16 seconds on average per shot.That's a long time. And that's an average. First of all, I thought it was an error and I went through it, but no, this is true. Then I thought about it, and of course it makes perfect sense, because horror is about what you can't see. It's about the lack of control. Action is about sound and fury and it's a firework show. You don't really need to know what's going on; you're just excited to be involved. Whereas horror is like, no, you're going to sit there and you can't see what's behind that thing. Or the reverse, which is that you can see it's approaching whoever's on screen, and they're getting closer. No, you can't look away. No, you can't warn them. It's about the control of the image.It might be one of the quintessential genres for film. You watch some films and go, eh, I should have read the book. But with horror, it's not on the page. You have to have the required elements, but it's made on the screen and it's made in the moment of the interaction between the screen and the audience. That's what shot length does. It's control. It's awesome.It is. You also think about Hitchcock movies, where there's an absolute control of the camera. That got boiled out of a lot of dramatic filmmaking and a lot of action-thriller filmmaking, but it's still there in horror because it still does something to us. That's an amazing stat. I like it a lot.It speaks to the medium. It's not a play that's been filmed, which is what drama can be sometimes. It's used entirely differently than in drama, where the camera's just rolling so you capture it. In horror, and in a good horror especially, it's being used by a craftsperson to paint a picture, to force you to feel. That's the bit that horror fans like: the strapping into the rollercoaster. Make me think I'm going to die, you know? That's it.I want to talk a little about content. You're able to do some really awesome content analysis on this stuff, and there are a couple different angles that you've tackled in the book. Some are about the kinds of monsters we see on screen. There was a cool stat in here about aquatic-based monsters and the rise of water as a medium of fear, which I'd love for you to speak to, but what are some of the monster stats that popped out at you? What are some of the things hunting us now that have evolved over time?Well, let's be clear. They're not actually hunting us; this is movies. It's so funny, because sometimes I have reflected and thought, oh my god, the world is — oh, no, these are the stories we're telling ourselves about ourselves.I did see a parallel between serial killers on screen and serial killers in the real world. That was one of the things I found. I was looking at serial killers in the graph over time, and there's a big peak in the '80s, and then I showed it to one of my colleagues at Guinness World Records. They nerd-sniped me and went, “I wonder if that correlates with the real world.” And I was like, well now I have to go and have a look, don't I? Thanks. I thought I was done with this topic.Going back to your monsters, it's interesting. Monster horror movies are two subgenres: There are horror movies, and then there are ones that have to do with monsters. Within that, I classified the monsters where they were flying, aquatic or land-based mammals. There are other bits around the edges, but this has to do with monsters rather than little creatures. I found that the land-based category is the biggest, but has been declining quite quickly over the last two or three decades. Shooting up almost out of nowhere — well, out of the ocean — are aquatic monsters. It's such a clear trend. It's definitely happening. Because I'm looking at decades, and the whole report looks over 27,000 films — not all monster films, but still, monsters is a big genre. So, this isn't an anomaly of the data of just two films.I've got two theories, but they are only theories. This is what I love about this data stuff: I'll do the data stuff, I'll present it to you objectively, and then we'll all sit around over a drink or some food and disagree about the why. My current two thoughts are, one, that environmentalism has changed what we think of as villains and what's unknown. It's changing our understanding of monsters and nature, and the ocean is more unknown. But two, a more practical answer came from a producer friend of mine. I was talking to her about this and she said it was quite expensive to make an aquatic monster without visual effects.What were the monsters you could have in, say, the 20th century? For most of the 20th century, it was a bloke in a suit, or it was ants on a small model. That's it, right? It looks cool, but it is a certain kind of thing, and water doesn't scale. You can't have a miniature because it just looks different. Water is incredibly complex from a visual effects point of view, as well as the way the beings move. If you put a guy in a suit and put him underwater, he's going to drown, because that suit's heavy. But you're freed up in the 21st century to use more visual effects. More are freely available, so now we can live out our aquatic dreams — and nightmares. And, because we haven't for most of history, there's loads more space. There are plenty of more dangerous fish in the sea.Those are my two working theories, but I have no idea. I would happily talk with people about it for hours, because it doesn't matter. That's what I like about this. This isn't instructive. It's not like we must figure this out because it's going to change what people invest in or anything. No, let's just have some fun and talk about movies.There's that scene in Ed Wood where they're like, all right, Bill, just get in there and flail.Exactly.The tech has got to be a part of it. I also thought it was really fun to dive into some of the stuff you had about clowns, because we are in the week where Terrifier is a box office champion. Unforeseeable, unless you potentially foresaw it.Well, it's at least the third in the series, so there's a certain amount of success that's gone on before. But I don't think anyone expected Terrifier 3 to do the kind of business it's done and Joker 2 not to. Those two coming out a few weeks apart have had such different journeys that it's quite dramatic.Terrifier 3 has done exactly what good horror films do. They've got a very clear idea that's been tested before and gone big on it. They know what they're delivering to their audience, which is shock. They've also got a great advertising campaign. From what I understand, from what I've read around, they did test screenings in some cinemas where they didn't tell the audience what they were going to watch. They were like, “It's a holiday film!” and then showed this grotesque film. Lots of people walked out. Some people threw up, apparently. Then, with the remaining people that stayed, they did the piece to camera afterward. Like, “What did you think of the movie?” But loads of people walked out. The viral marketing is spot-on.Clowns weren't a big feature of horror films until about the 2010s, when we started to see them creep up to 1 percent of films, which is quite a lot. I'm not that bothered either way by clowns. I certainly don't think they're fun, but I'm not terrified of them. In reading around, I found a study — I don't have it in front of me, so I can't quote it exactly — that they did on the fear of clowns. It was across many, many people across multiple countries, and they found that over half of people reported some fear of clowns. So I think clowns are inherently scary, and most people, like me, are ambivalent. Someone will get a clown for a kid's birthday party, and I'll go, oh, okay. Whereas some people are actually like, why?That's also what horror is supposed to do, right? Horror is supposed to take something that you feel is safe and make it unsafe, but then in playing out the unsafe, you'll have exorcised the demon that worried you. Therefore you now feel safe, perhaps, because your body thinks you've played with that demon. You've played with that thought.I don't know. It'll die down, it'll get tired and something else will come along. I can't even think what the next thing is. Probably an IT engineer, or something that doesn't feel scary. Though, mind you, you'd have to call that “IT,” and they've already done that with clowns.The SEO on that is quite bad.We'll work on that together off-pod so we can keep the copyright.Terrifier is great, though. It's not my kind of film, but they've done such a good job. Everything they've done, they've delivered to their audience, and they've also created a franchise and a character, so they will be making a lot of money. They've earned it, as far as I'm concerned. Not mine, though; not my money.I thought some of the stuff you wrote in here about survival as an increasing theme in these films was really interesting, which also goes well with what you had about body horror films and infection as a prominent way we deal with that. When the pandemic hit, a lot of films that saw quite a bit of pop were the ones that pertained to this idea of survival during infection and things like that. You had some really interesting, decade-long data.Before we wrap it up, what are some emerging trends? What are some of the charts that have been going up? As we think about the evolution of this really durable genre, where do you see this stuff going?You're absolutely right. The pinnacle of infection movies wasn't actually postpandemic, though we'll see what it will be for the rest of the current decade. 28 Days Later might be patient zero for that kind of movie. But you're right. What we saw during the lockdown was that we wanted to find meaning and structure to the narrative that was playing out in our lives. It wasn't coming from the media, and it wasn't coming from the scientists, because we didn't know. So there were films like Contagion that did such a great job.It's kind of spooky when someone predicts the future. We forget all the ones where they failed to predict the future, or they did a terrible job. Out of however many it was at that point, 20,000 horror films, one of them nailed the future. Mathematicians are rolling their eyes, but at the same time, we're in this emotional experience saying, oh my god. Gwyneth Paltrow went through that, so I can.But it was interesting, actually. There was a film that was shot before the pandemic called The Pink Cloud, a Brazilian film. It was shot in 2019, but it was then edited and ready just as the pandemic was happening. It was relatively low budget, and it's about a big pink cloud that comes over cities and forces everyone to live in lockdown. It's a film about being in lockdown and it was just coincidence. It's great art, but it was just coincidence. It played at Sundance the year it was not physical — either 2020 or 2021, I can't remember. But it was amazing. The timing was sort of weird, and I think that adds an extra spookiness to it.Speaking to your point, obviously there are loads of films that talk about lockdown and infection, but not nearly as much as you'd think. We're done with it. “I get enough of that at home,” if you see what I mean. What is interesting in the trends is that, you're right, survival has gone up, but one of the biggest things that's gone down — which I think is really interesting. This is over almost 100 years of content — is how people are thinking about the brain or the mind.We're seeing fewer films where the brain is being attacked or madness is the cause of the psycho, and we're seeing far more understanding, like maybe they had a bad childhood. I think it's a strong story of mental health moving on from being the thing that you're scared of. You could read Foucault, you could look at 12 monkeys — there are lots of films that have played with this idea of madness and what sanity is. But largely we've moved away from, “He's mad, run away,” to, “He's mad. Let's listen to what he's got to say and try to understand him as a real human being.” That's really interesting. I don't know where that goes, but that's been a very clear trend over almost 100 years of horror films.That is fascinating. Again, so much of horror is interior-looking. A lot of the things that we're scared of and that are played up are more reflections of our own state of mind and our own fears. If we're not worried about madness being contagious in a Lovecraftian way, that is super interesting.Exactly. Throughout all of literature and all of art, madness has been fascinating. Up until a certain point, maybe 500 years ago, it was seen as a root to the divine or harmless. Then at some point, when you start having authority figures in certain ways, you need to shut down the anti-voices. It started to become something terrifying that you lock away, like it might be infectious and a problem.Then, more recently, we start to think about how actually we're all a bit effed up. There are reasons behind this. We can do something about this. It's not mad to go and see a therapist, or a psychotherapist, or whatever it might be. That then speaks to, well, you can't have the motivation of a slasher be that he's mad. It doesn't work; it's just not credible.You need to have a different origin, and you go one of two ways: You either give a lot more context, like he went through this horrific thing as a kid, or you say it's unknown. It's just unknown. It's a man in a mask. What's terrifying is the lack of knowledge, or it's too much information. Each film takes a different route on that.All right. This book is really good. It's called The Horror Movie Report, and it looks at all those different ways these movies take and the history of this stuff, which I think is one of the most fascinating things. Horror in general is just such a cool genre.Stephen, I would love to hear you pitch where folks can find you and where things are going. Tell folks a little about the book and where they can get ahold of it.Thank you. That's high praise indeed, because you're someone whose work I respect a huge amount. That's really cool. You're someone who actually can find the holes in it.If you go to HorrorMovieReport.com, you can get there. It's all digital at the moment; I'd love to do a coffee-table book of it, but that will take a bit of time. I've put it out in two editions. One is for film fans, and it's much cheaper, like 20 bucks. That'll give you the 400 pages and all the charts and graphs. If you love horror films, that's enough. If you're a filmmaker or a data geek, you'll want the film professional version, which is only a little bit more. That gives you all the data as spreadsheets, as well as some bonus reports.I've got different constituencies. Some people just want a pretty graph and then argue about aquatic monsters; others are like, give me the data. So here you go! And by all means, reach out to me if you've read something you want more detail on. I love this stuff, and if you love it, too, we're going to get on. Grab a report, and if you want to reach out, I'm not hard to get hold of.Terrific. Again, your stuff is always so good. People will know it from the newsletter if they've read it long enough. It's great stuff. Thanks again for coming on, I really appreciate it.My pleasure. I'm always here. And if anyone listening has a question about the film industry, if you think there's some data out there somewhere but can't bother to do it, someone else will do it — contact me. The best stuff I do comes from readers, the 4 o'clock in the morning ideas, the shower thoughts. Reach out, I promise I'll give it a go.Amazing. Stephen, have a spooktacular day.Nice.Edited by Susie Stark.If you have anything you'd like to see in this Sunday special, shoot me an email. Comment below! Thanks for reading, and thanks so much for supporting Numlock.Thank you so much for becoming a paid subscriber! Send links to me on Twitter at @WaltHickey or email me with numbers, tips or feedback at walt@numlock.news.  This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.numlock.com/subscribe

Learn from Mika Yamamoto, Chief Customer and Marketing Officer at Freshworks, about blending the physical and digital world to create impactful campaigns. Episode Summary: This episode features an interview with Mika Yamamoto, Chief Customer and Marketing Officer at Freshworks, a company that provides powerful, easy to use Customer service, IT, and CRM software.In this episode, Mika discusses surgically blending the physical and digital world, to create a campaign experience that sticks with prospects. She also talks about encouraging innovation from her team, tying marketing victory to sales' success and focusing on customer over function. Key Takeaways:Blending the physical and digital world when creating campaigns can create more lasting impact and better returns.Allowing your team to divide and conquer different markets and functions allows people to specialize and be the best at what they do, an impossibility if they are doing too many things.Incorporating humanity and a recognition of the human on the other side, not only differentiates your marketing in a B2B space, it makes the whole job more enjoyableQuote: ”In terms of signals, what helps is that we have one operations function that works across all functions. There's traditionally been, marketing comes up and celebrates and says, “Woohoo, we did all this work, we're green!” And then sales is saying, “Well, what the heck you can't claim victory because we haven't met our numbers. So how can you declare victory if we haven't met our numbers?” And so again, the construct that we have is we have one operations group in our organization, Freshworks. So, we have one dashboard that essentially ties together and we're still working on making those ties, but that ties together, marketing doesn't declare victory if sales can't. So, it's driving shared metrics in one dashboard versus this view of the world that is a marketing view, then a sales view then a product view. We want to drive one view, which is more customer focused versus functionally focused.”Episode Timestamps: *(08:24) The Trust Tree: Divide and conquer different markets *(24:12) The Playbook: Focus on demand capture *(39:20) The Dust Up: Assumptions about sellers and marketers*(42:49) Quick Hits: Mika's Quick Hits Sponsor:Pipeline Visionaries is brought to you by Qualified.com, the #1 Conversational Marketing platform for companies that use Salesforce and the secret weapon for pipeline pros. The world's leading enterprise brands trust Qualified to instantly meet with buyers, right on their website, and maximize sales pipeline. Visit Qualified.com to learn more.Links:Connect with Ian on LinkedInConnect with Mika on LinkedInLearn more about FreshworksLearn more about Caspian Studios

Explore the LIFE model of dog training, a force free approach, with David & Josh.

Arkansas Razorbacks' Mike Neighbors is well-known for his "Functionally Fast" offensive. He goes next level, explaining how to teach this face-paced style, how to limit turnovers, and what to practice to make your team faster.A Quick Timeout film breakdown with Coach NeighborsFunctionally Fast CoachTube Course (Free)Actions to Make Any Defense Look Wrong CoachTube CourseThis episode is sponsored by the Dr. Dish Basketball Shooting Machine. Mention "Quick Timeout" and receive $300 off on the Dr. Dish Rebel, All-Star, and CT models.Are you tired of generic workout routines that don't deliver results? If so, then Alpha Progression is your answer. Alpha Progression creates a personalized plan just for you. Download Alpha Progression today and get 20% off your first payment with the code "AQT20".A Quick Timeout is brought to you by Ballogy. A mobile app created by coaches for coaches, the Ballogy mobile app makes it easy for you to effectively evaluate, manage, and track overall skill development for your team. Go to Ballogy.com for more information.

REMIX: Album 5 Track 23 – Functional & Emotional Unison w/Renita BryantWe love an episode with firsts..but how about an episode with multiple first-time answers. Renita Bryant is bringing us jew-els with her compelling answers in our 5-Questions segment that made us stop, listen, and reflect. From a successful author, publisher, and analyst, Renita has forged a path of entrepreneurship while staying authentic and true to herself (and the self she's been since her middle school days). An episode that will hit you to your core and inspire you to think better and be the best YOU there is. Here are a few key takeaways from the episode:Mentee/Mentor relationships can provide value to both partiesHire Slow - Fire Fast - It's a true saying.Authenticity is truly your power (and your personal brand)Functionally & Emotionally When Two-Become-One  NOTES:Show Partner: SpecificityLearn More About Specificity Stay Up-To-Date on All Things Brands, Beats, & Bytes on SocialInstagram | Twitter

When people think of golf apparel they rarely consider anything to be revolutionary. In fact, most people likely look at apparel as another extension of fashion. But what if they could be both? Functionally appropriate and also stylish? That's exactly what the company TRUE Links Wear is doing with their wide toe box shoes with zero drop, and golf apparel which is both unbelievably comfortable and unique. Join host Jeff Hartman as he talks about this, and more, with TRUE representative Jeremy Santana as they discuss how TRUE is changing the golf apparel game, and the story of the company. All on the latest episode of the Fairways & Dreams podcast. This podcast is a part of the Golfer Gang Network of podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices

As a Functionally and conventionally trained registered nurse, I get questions all the time about the microbiome- both from clients, lay people and family members.   This episode is a breakdown of the microbiome, what it is, why it's important to address it for all of our health concerns and so much more!    In this episode, I answer:  What is the microbiome, and why is it important for overall health? Can you explain how the microbiome influences our mental and behavioral health? What specific aspects of mental health or behavioral issues can be impacted by microbiome imbalances? How does the gut-brain axis work, and what role does the microbiome play in this connection? What are some common signs or symptoms that might indicate a microbiome imbalances    

When stress occurs, sometimes there's no where to run and the survival mechanism signals "freeze," and plays possum. In this follow up episode about being functionally-frozen, I'll explain what you can do to melt this deep freeze. You'll be amazed at the difference a few simple techniques can make when we move from sensory overload and isolation to a sense of safety. Be sure to check out my podcast companion workbook, Why Is My Body Betraying Me? at drskyler.net/store. It's like having a one-on-one session with me. Also, I'm offering two FREE downloads at drskyler.net upon signing up for my weekly newsletter, including "5 Things Every Child Wishes Their Parents Knew" and "Healing Phases: Moving From Victim to Warrior."

Ever catch yourself staring into space, mentally numb or checked-out? Or feel like you're watching yourself in a movie, disconnected from reality and find yourself sitting in your car before going inside to avoid the imminent overload of demands once you walk in the door. Some men will hide-out in the bathroom. This is called being functionally-frozen which is a prolonged sensory shut-down. This functional freeze may be harmless, but it could also be a sign of a more serious issue called a dorsal vagal shut-down which can impact gastrointestinal health. In this first of a two-part series, I'll explain what's behind this sympathetic system response that can lead to mental and physical immobilization. Be sure to check out my podcast companion workbook, Why Is My Body Betraying Me? at drskyler.net/store. It's like having a one-on-one session with me. Also, I'm offering two FREE downloads at drskyler.net upon signing up for my weekly newsletter, including "5 Things Every Child Wishes Their Parents Knew" and "Healing Phases: Moving From Victim to Warrior."

Yep, we have coined the Functionally Integrated Tummy Tuck FITT™! What the heck? After years of listening to clients talk about their struggle to work the “lower abs,” the amount of people we've treated with chronic low back pain, and the post partum or menopausal women who struggle to control their bladder, we decided this strategy MUST be shared with the world. It's not another core workout. It's not going to overwhelm you and add more on your to-do list. It's going to EMPOWER and encourage you to make all your core work more effective and efficient. In addition, it's so simple, we'll share with you how to integrate it into daily life to protect your body to work at it's BEST™. Thanks for joining us today! We would love to connect with you! Find Tracy On Instagram and join our Facebook community Hardwired For Health. You can email us to apply for our custom coaching 3D Fusion Transformation as journeystrong3@gmail.com. Want access to our FREE FITT Technique? Click the link and give you freedom to make core part of your daily mundane tasks as well as change all things you do core (and BEST part is it doesn't even have to require you to take extra time to do it today). It will even improve the belly pooch, low back pain and Diastasis Recti! If you're struggling to figure out how to make eating well a simple, integrated part of your day(especially through life's TWISTS), invest in our monthly HAAC™ membership for your daily BEST™ delivered to your phone every morning and Health Assurance, Accountability Coaching to guarantee you keep moving forward in loving yourself no matter how— messy life is. In there, we build community so you don't feel alone and answer your unique questions for your current season challenges. What are we Loving? Jess & Tracy Are both enjoying some toxin-free scents in their home for spring cleaning from Doterra.

Jimi Olaghere is one of the first patients to have been functionally cured of sickle cell disease with a CRISPR gene-edited cell therapy.

Today I spoke with Dr Sharon Surita, PhD, a Certified Functional Diagnostic Nutrition Practitioner and triumphant chronic illness warrior. Her passion for holistic well-being is shaped by her personal four-year journey to overcome challenges with dysautonomia and complications from a hernia mesh implant. Armed with a doctoral degree in Environmental Engineering from Florida International University, Sharon's expertise in air, water quality, and environmental health risks, linked to chemical and mold exposures, enables her to craft personalized strategies using a holistic approach.  She develops bio-individual protocols that have been used successfully to eliminate hidden stressors in the body and remove environmental toxicants, thereby improving the lives of her clients. Owner at Functionally Enlightened Phone 305-766-1312 Web  functionallyenlightened.com Email sharon@functionallyenlightened.com Are you ready to gain a deeper understanding of menopause, breast health, and nutrition? Let's embark on a journey to embrace our new life with renewed energy, vitality, and clarity. I'm Dana, and I am here to guide your transformation from feeling frustrated to being fueled by faith, helping you become the Wise Divine Woman that God has destined you to be! Welcome to the Wise Divine Women Sisterhood! My mission is to provide you with valuable education about your health, strengthen your faith, and help you forge new connections for your Spirit, Mind, Body, and Nutrition. Together, we will delve into captivating interviews and explore a wide range of topics that will empower and inspire you. Visit ⁠⁠⁠⁠⁠⁠⁠⁠https://wisedivinewomen.newzenler.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Thank you for joining me here today! If you liked my podcast today, leave a review and share it with your friends, that would mean the world to me! Did you know I coach menopausal women? You can visit my website to learn more. It is simple and I do offer coaching appointments ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://danairvine.com/work-with-me/ola/services/soul-session-a-time-of-discovery⁠⁠⁠⁠⁠⁠⁠⁠⁠ In your FREE Soul Session 30-minute consultation with me, we will discuss your challenges and goals concerning your health. This will create a unique signature program to meet your needs.  Dana Irvine  Certified Menopause Coaching Specialist Breast Health Educator  Holistic Health Coach Certified Clinical Thermographer Thermography Advisor. ⁠⁠⁠⁠www.danairvine.com⁠⁠⁠ #MenopauseMatters #BreastHealthAwareness #ChristianWomenPodcast #PodcastLife #BrainHealthTips #LibidoBoost #WomenEmpowerment #HealthyLiving #FaithandWellness #MindBodyBalance --- Send in a voice message: https://podcasters.spotify.com/pod/show/wisedivinewomen/message

The interplanetary filesystem, or IPFS, is a peer-to-peer network that uses a distributed and decentralized model. Functionally, IPFS allows users to store and share files without having to rely on a single source of truth for those files. Matt Ober is the Co-Founder & CTO of Pinata. He joins the show to talk about IPFS The post Pinata and the Interplanetary File System with Matt Ober appeared first on Software Engineering Daily.

  We've had more guest mixes than usual the last 6 months and that is a great thing because it means we all get to hear some amazing music and amazing mixes like this one.  This new mix comes from Matthew Ramolo, who records as Khôra. There is a new Khôra album that just dropped in April called "Gestures of Perception" and is described this way - "The album weaves ritualized instrumentals with alien textures and resonant melodies, inviting listeners to transcend into uncommon consciousness." You can find the new album here - https://khora.bandcamp.com/album/gestures-of-perception-3 I was unfamiliar with the music of Khôra, but one listen to the new album and I was all in for a guest set. This mix is so very propulsive, it draws you in and drives you forward with layer upon layer of rhythmic intensity.  Here's what Matthew says about this mix: "This assemblage of material was selected primarily on the basis of substantiating the sonic and conceptual universes that my most recent Khôra release is in lineage with. The vast majority of the pieces presented are percussive or propulsive, but also circular in nature and in one respect I was seeking a fundamental rhythmic presence or energy among my troves of collected music that could be traced across various artists and presented as a single typology or modality that tenders itself in various guises through a cast of contemporary and historical voices. Functionally, the mix pursues a particular genealogy of percussive music across various genres, cultures, histories, technologies, and interpretations which initiates a kind of meditative dancing. Within the outline of this non-linear genealogy, ancient ritualistic and tribal tendencies flower within the unconscious regimes of the body even as the mind and body are provoked to find new appreciations and applications for these emboldening forms of musical intelligence which persist through time but are mutated, conditioned, and understood by the nuances of the listener and their temporal circumstances." Thanks to Matthew for putting together this unique journey. His album is out on the Marionette label and you can find more of their fine releases here - https://marionettelabel.bandcamp.com/   Cheers!   T R A C K L I S T : 00:00 Khôra - Flux and Hieroglyph (Gestures Of Perception 2024) 06:45 Cyclopean - Fingers (Cyclopean 2013) 12:21 The Dwarfs of East Agouza - Resinance (Bes 2019) 15:12 The Comet Is Coming - Journey Through The Asteroid Belt (Channel The Spirits 2016) 20:30 Muslimgauze - Caste the First Stone - (Salaam Alekum, Bastard 2020) 24:44 Love-Songs & Ulf Schütte - Dumpfes hämmerndes Dröhnen (Spannende Musik 2021) 29:29 Various - Radio Delhi #1 (Radio India: The Eternal Dream Of Sound 2004) 32:04 Uwalmassa - Belit (Malar 2022) 36:00 Kilchhofer - Karon ( The Book Room 2018) 39:28 De Leon - A2 (De Leon 2018) 44:44 Khôra - In Petrified Light (Gestures Of Perception 2024) 49:50 Joyfultalk - Kill Scene (Plurality Trip 2018) 53:42 Jon Iverson Meets Prins Emanuel, Golden Ivy & Inre Kretsen Grupp - Drum Steel (Jon Iverson Meets Prins Emanuel, Golden Ivy & Inre Kretsen Grupp 2023) 58:21 D.K. - Going Into Trance (The Goddess Is Dancing 2019) 1:04:15 Antonio Zepeda - Danzando en El Templo Mayor (Templo Mayor 1982) 1:07:30 23 Skidoo - Coup De Grace (Urban Gamelan 1984) 1:09:07 Holden - Blackpool Late 80s (The Inheritors 2013) 1:17:24 Autechre - known (1) (Oversteps 2010) 1:22:00 Stephan Micus - Passing Cloud (The Garden Of Mirrors 1997) 1:27:07 Tomaga - Idioma (Intimate Immensity 2021) 1:31:10 Shabaka - Ital Is Vital (Afrikan Culture 2022) 1:35:35 Roberto Musci - Claudia, Wilhelm R, and Me (The Loa Of Music 1984) 1:38:38 Khôra - Golden Femur (Gestures Of Perception 2024)

With LB on a Hero's Journey through the bowels of Hell, John and Niki once again conscript Producer Jordan into the triumvirate of intellect that is If You're Driving, Close Your Eyes. Topics of discussion for this meeting include (but are not limited to) the contents of John's most recent stress dream, carbon monoxide poisoning, ape films, photos of odd occurrences that Jordan has experienced recently, a "real brief" explanation of the complete history of Transformers, and even without trying, somehow even more.Welcome to If You're Driving, Close Your Eyes, a podcast about navigating the cruelty, chaos, and wonder of our terrifying world. Niki, John, LB— and our producer Jordo— try to find meaning and clarity one or twelve subjects at a time: from the menu at Cheesecake Factory to a human man dressed up as Snoopy tucking you into bed.Who are we?: We are Niki Grayson (https://twitter.com/godsewa) (the Buster Keaton of basketball), John Warren (https://twitter.com/FloppyAdult) (business boy and wassail pervert, short), LB Hunktears (https://twitter.com/hunktears) (handsome genius, 5'8", America's Gamer), and producer Jordan Mallory (https://twitter.com/Jordan_Mallory/) (frog with computer). Music by Jordan Mallory and Art by Max Schwartz (https://maxds.itch.io/).Follow the show: https://www.twitter.com/ifyouredriving Support us: https://www.patreon.com/ifyouredriving Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

Most Christians worship a binity: Father and Son, and that's when their binity isn't merely Jesus and the Bible! The Holy Spirit routinely gets boxed up, put away, and ignored. Functionally, He is the Cinderella of the Trinity: only brought out on special occasions, like a baptismal service: "In the name of the Father, Son, and Holy Spirit." But the Scriptures, Old and New, have much to teach us about the third person of the Trinity. I expore how the New Testament builds upon but then expands what the Old Testament revealed about the Spirit. I also work through 5 different ways the Church (and culture) box up the Holy Spirit, keep him on the back shelf. Let's prayerfully welcome the dynamic, creative, and beautiful work of God's Holy Spirit into our lives!

“Right Now is When You Can Make 5x-10x Your Money Just Catching the Cycle” says Fury Gold CEO Tim Clark. “The problem here is the market. The problem is the lack of liquidity in the junior space. But that will change. And I think my message to investors now is: I'm not asking you to go out and buy a huge chunk of $FURY. But I think you'd be prudent to buy some. Because once this market moves, because of a lack of liquidity, you'll have a hard time getting in at a reasonable price and you'll be sitting there doubting yourself as it is up 50% wondering if it is going to go up 100%. And if it goes up 100% you are going to be killing yourself that you did not get in.” Currently $FURY has a C$78m market cap with a $61m treasury in $DV.v shares ($53m) and cash ($8m). So unlike most gold explorers now, the company does not have financing risk. Functionally, $FURY is currently a call option on Dolly Varden Silver ($DV.v). SVP Exploration Bryan Atkinson reviews the just-released positive infill drill results from the Hinge Target at the high-grade Eau Claire gold project located in the Eeyou Istchee Territory in the James Bay region of Quebec. The Hinge Target infill program has increased confidence in the geological model and potential for expansion of the Eau Claire resource to the west. Drilling continues to intercept multiple zones of gold mineralization including 5.5 metres (m) of 4.52g/t gold and 3.0m of 3.34g/t gold from 23EC-069; 1.0m of 20.20g/t gold and 3.5m of 3.51g/t gold from 23EC-070; 1.0m of 19.55g/t gold from 23EC-066; and 3.5m of 3.82g/t gold from 23EC-067. 0:00 Introduction 1:11 Positive infill drill results 2:15 Accomplished 19,000m drilling in 2023 4:25 Drill program 2024 6:21 Committee Bay project 8:14 Juniors and Producers need to work together 11:12 Robust treasury with apprx $59mm in $DV shares and cash 13:28 Tim's personal investment in $FURY is at significantly higher cost-basis 15:55 Now is the opportunity to position to make 5x-10x in junior gold stocks https://furygoldmines.com/ Ticker: FURY Presentation: https://furygoldmines.com/investors/presentations/ Press Release discussed: https://furygoldmines.com/site/assets/files/6555/2023-11-28-nr-fury-skop89026.pdf Sign up for our free newsletter and receive interview transcripts, stock profiles and investment ideas: http://eepurl.com/cHxJ39 Fury Gold Mines is a Mining Stock Education sponsor/advertiser. The forward-looking statement found in Fury Gold's most-recent presentation found at www.FuryGoldMines.com applies to everything discussed in this interview. The content found on MiningStockEducation.com is for informational purposes only and is not to be considered personal legal or investment advice.

“We are pieces of an important puzzle and there are a lot of pieces. Working together, we can effect a lot of change.”Joining Meagan on the podcast today is Dr. Elliot Berlin, a renowned prenatal chiropractor based out of Los Angeles who is making a huge impact on the birth community. Dr. Berlin is extremely knowledgeable and experienced in holistic birth preparation and advocacy. He is a birth doula, hosts the Informed Pregnancy Podcast, and his most recent project is the Informed Pregnancy Plus streaming service where birth documentaries and other educational videos can be found on one online platform. Dr. Berlin and Meagan discuss TONS of topics that come from your questions! Topics include: What happens during an adjustmentWhen to start prenatal chiropractic careBodyworkAdjustments during laborCPDBreech PresentationPubic SymphysisSupport at homeBreastfeedingAdditional LinksDr. Berlin's WebsiteInformed Pregnancy PlusPediatric Chiropractic Search WebsiteNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello everybody. You guys, we have a very special episode for you today. We have Dr. Elliot Berlin with us today and he's actually live with me so that's pretty cool that I actually get to see his face live via Zoom. Dr. Berlin: It feels like we are in the same room. I'll be honest. Meagan: Right? As live as you can get through a computer. I feel like this is our new norm these days. This is how live works. Dr. Berlin: Yeah. And you know, we got used to it. Meagan: Yeah, we did. We got used to it pretty dang fast actually. We're so excited to have you on today and we have so many amazing questions that our listeners and followers have asked. But I first want to just talk a little bit about you and who you are so if anyone doesn't know who Dr. Elliot Berlin is, you need to know and you need to go follow his page right now. Push pause unless you are driving. You can do that later and go follow @doctorberlin on Instagram because he's amazing and has so many incredible things and has done—I mean, for years—so many incredible things in the birthing community. Dr. Berlin is an award-winning pregnancy-focused chiropractor. If you don't know yet, on this podcast, we love chiropractic care. He's a certified birth doula and host of the Informed Pregnancy Podcast. So again, if you haven't followed his page or his podcast, press pause. Go follow along and go—what's the word? Subscribe to his podcast— Informed Pregnancy Podcast. He combines his passion for entertainment with his desire to educate and spread awareness about important issues in the birth industry. We know that in the birth industry, we have a lot of issues that need to be talked about. His latest project is the brand new streaming channel on Informed Pregnancy Plus dedicated to all things fertility, pregnancy, labor, and parenting. Informed Pregnancy Plus So, Dr. Berlin, I would love to actually start right there before we get into these questions. Will you tell us more about this new project that you've got going on? Dr. Berlin: Thank you for having me and for the incredible work that you do. I was just telling you recently that I feel like we are pieces of an important puzzle and there are a lot of pieces. Working together, we can effect a lot of change. The Informed Pregnancy Plus is a streaming platform. Everything grew organically from me really being a very medical-minded person wanting to go to medical school. Sometimes little arrows pop up. I see my son play video games and he's not sure where to go, then a big arrow pops up and says, “Go this way.” I get those arrows sometimes and it led me on a more holistic path. I fell in love with chiropractic and massage. I smooshed them together to make chirossage. I ended up with my wife and I having a fertility struggle. We ended up overcoming that with natural means when medical options ran out— and she is a psychologist. We started this mind/body program together, wellness care, with an eye on helping people boost fertility. Over time, that turned into babies and pregnancy. Again, coming from a much more medical background—I used to work in ambulances and emergency rooms—everything was brand new to me on the more natural front. Meagan: Mhmm, yeah. Dr. Berlin: I had never heard of doula. So I would get questions a lot that I didn't know answers to. It still happens regularly. I would go on to research. I'd talk to experts, read, and try to prepare an answer that was not, “This is what you should do or not do,” but “These are the facts as we know them. What do you want to do?” As I'd get the same questions over and over again, I started to write that as a blog. It became a magazine for a minute when people still printed stuff and then before I knew anything about podcasts, I was doing a podcast. Then I made a couple of documentaries, one of them about VBAC, Trial of Labor. It's a beautiful film and when we finished it, I realized that the only thing I know less about making a documentary is what to do with it once you have one. How do people get to see it? Right when it came out, there was this big flash of excitement about it. There were screenings and all sorts of people were buying it in lots of different ways and showing it in lots of different ways, but then that excitement fizzled out. It was out there in the blogosphere and the webosphere but people weren't finding it. I was getting these crushing emails saying, “Hey. I saw your movie, Trial of Labor, and I really loved it. I just wished I would have seen it before I had my baby.” I was like, “No, I made it so you could see it before you had your baby.” Meagan: Right. Dr. Berlin: So after talking to some of the other filmmakers in the space, I realized that I'm not the only one having this problem. There's not an easy place where people can go and get iconic films like The Business of Being Born, Orgasmic Birth, The Mama Sherpas, Breastmilk, so on and so forth. So I just decided, “Why not make it easy for anybody to access from anywhere without having to pay $25 for each film?” and just boom. You can have it on your phone or your TV. That's how Informed Pregnancy Plus was born. Every day, we are working on acquiring licensing for more great content. It's expanded from film to also web series, also mind and body like yoga and meditations and workshops. My wife has a workshop on there on relationships how to still like your partner after you have a baby together. We have one on birth plans. We have one on sleep. It's just growing all the time. Anybody can try it absolutely free at informedpregnancy.tv. It also has apps for Apple, Android, and Roku. After that, it's very affordable. It's $7 a month. Meagan: That's what I was going to say. It's $6.99 a month or $59 a year. That's pretty dang affordable. Dr. Berlin: That was our goal. If you have an internet connection, a device, and $60 for the year, you have access to all of this great content. That's what we were hoping to achieve. I don't know how I'm going to survive. It's like each element of this is a full-time job. Meagan: A full-time plus. Dr. Berlin: Full-time plus like Informed Pregnancy Plus but thankfully we have a small crew here but very dedicated to the project and very hardworking, very savvy. It's growing both in terms of content and in terms of viewership. The films are finally having an avenue where they can make a greater impact. Meagan: Absolutely. I love that so much. I wish I had something like this back when I was in my childbearing years or having babies, I should say because even the time. In my opinion, how much time I spent researching VBAC and all of the things during pregnancy, even those courses like yoga classes and all of these things, I spent way more time than I would have money. It would have been so much more worth it to just buy a subscription like this and have it all in one great platform. Dr. Berlin: I mean, that's the goal. Especially for people who live in areas where there aren't prenatal yoga classes. We don't have a ton yet, but we are always adding more. We have Baby by Simone on there for people who can't go to a prenatal workout class. She's got great workouts. The whole idea is that no matter where you are, these tools should be accessible to everybody. Thankfully, they are trickling their way through the internet and people are finding them. I'm getting fewer messages about, “I wish I had seen your film before I had my baby,” so that's very rewarding in the way that finances can't reward. Review of the Week Meagan: Okay, so we do have a Review of the Week so we are going to get into that before we jump into all of the amazing information that Dr. Berlin has. This is from 471046246me and it says, “My Labor and Delivery Nurse Told Me About The VBAC Link.” Oh my gosh, that makes me so excited. If you're a labor and delivery nurse, thank you, thank you, thank you for the love and we would love for you to continue sharing with your patients. It says, “I had an emergency C-section six months ago with my first baby. I planned and prepared my entire pregnancy for a non-medicated, vaginal birth with midwives in a hospital. I had an amazing team. Labor was going great. Hard, but I felt strong. But my son had other plans that involved wrapping himself in his umbilical cord so the sunroof exit he went. Ha ha,” she says. “In my recovery room, my nurse told me that she had an HBAC and told me to listen to The VBAC Link. I am so thankful that she recommended y'all to me because I already am stoked for my VBAC and I'm not even pregnant yet. Thank you for the work you do. I can't wait for y'all to come back from your break.” This was back in 2022. It says, “These stories fill my day with so much joy when I take my son for my daily walks.” Oh, thank you so much for your review. You guys, we do love these reviews. We appreciate them so much. We always welcome them in wherever you leave them. You can Google “The VBAC Link” and leave us a review. You can do it on Apple Podcasts. You can message us. You know it. Wherever, we love your reviews so bring them over and maybe they will be read on the next podcast. Q&A Meagan: If you guys are wondering, we will make sure to have all of his links for his platforms in the show notes so make sure to check out the show notes. Dr. Berlin: Thank you.What Happens During an Adjustment?Meagan: Without further ado, I mean there are so many questions. I don't know if we'll get to all of them today, but I was shocked, but then I thought, “Oh well, from someone that had never gone to an adjustment before during pregnancy, I didn't know either.” One of the questions is, “What happens during an adjustment? What does that look like?” Dr. Berlin: These, I'm sure, are going to be amazing questions because they come from real people who are very curious. This is a great question. The answer is it's different from chiropractor to chiropractor. Generally, the one thing we all have in common is that we're all looking for restriction in the bones—so where two bones come together, they form a joint. There should be good movement between those two bones, a certain amount of good movement. If they become restricted or totally locked up, they can create problems for you. It may be a problem like you feel like a loss of range of motion or swelling around that restricted joint that starts to become an issue that presses on nearby things like nerves or other tissue. Or it may be a problem that you don't feel. It might just be restriction where you should have fluid movement. If you're talking about your low back, hips, and pelvis, those kind of restrictions, that's the baby's studio apartment. So where the baby should be able to move freely, your body may not be able to accommodate that. So what we all have in common, really, is that we look for those restrictions and we try to release them. We try to restore motion between those restricted bones around the joint. There are a lot of different ways to find them diagnostically, a lot of different ways to restore movement therapeutically so if you go to a bunch of different chiropractors, you might have very different experiences. Then sometimes, chiropractors also add on top of that other modalities that they do whether it's a physiological therapeutic thing like electric stim or heat or ultrasound or other types of body work like massage. We tend to combine those two together in our practice. What the adjustment is a restoration of movement where it was previously restricted where two bones come together. Any two bones in the body can pretty much be adjusted but many chiropractors primarily focus on the spine and pelvis and maybe the major extremities. Meagan: Yeah. Like you said, it's the baby's apartment. I remember my chiropractor telling me how my pelvis shifted. My right side would shift forward, so it would kind of be off. She was like, “You need to have it aligned for the baby to come out of the apartment.” Dr. Berlin: Yeah. Meagan: I actually wasn't having a ton of pain. I couldn't have told you that my pelvis was wonky like that, but she was like, “It's so easy. You can do it getting in and out of a car or walking up stairs or putting a laundry basket on your hip.” There is so much that happens during pregnancy. Dr. Berlin: That's before the baby gets there sitting on your hip. Meagan: Right. Your body can get out of alignment through pregnancy. Dr. Berlin: That's one of the interesting things though. If you come in even if you do have pain but there's nothing restricted, then on the pure chiropractic front, there's really nothing for us to do. Sometimes it's the opposite. You can have hypermobility where things are moving too much. There are ways we can treat that as well, but the adjustment wouldn't be one of them in that direct area. But on the other hand, you could have restrictions that you don't feel. We would still want to address them if that's what you want to do.Bodywork Meagan: Yeah. You touched a little bit on bodywork. That was kind of a question that was answered a little bit farther down on our list, but what all does bodywork look like with that? You talked about massage and things like that. Is there more to it or is it just more like prenatal massage and then a chiropractor? Dr. Berlin: Bodywork is a vague term, even more vague than chiropractic. There are a lot of different kinds. In our office, what we do is massage therapy. It's more of a clinical massage therapy so it's focused. It's usually 25 minutes long. It's targeted in a specific area. When it comes to musculoskeletal health in general, I see myself as WD-40. I look for things that are stiff, tight, and restricted, and try to get more motion in there. The other side of that coin is duct tape where things are too weak or unstable, somebody's got to help bring that back together again. That's more like a personal trainer or a physical therapist. When we are working together, we can get really good balance and function and strength around the muscles and bones of the body. You can really feel wonderful even through all of the different stages of pregnancy, sometimes even with multiples all the way until the end. When things are out of whack, sometimes not even a month into pregnancy, you start to feel weird things happening to your body. Bodywork can be a lot of different things. For us, it's that more clinical medium to deep tissue, finding muscles, tendons, and fascia that are too stiff, tight, and rigid and trying to use massage strokes to elongate them, lengthen them, and restore normal tone. Other things that we infuse are trigger-point therapy. Sometimes you have a tendon coming to a bone or the center of a muscle where there's an accumulation of all of the tension in one area so we use trigger-points to release that. Back when I was doing birth work, we would also do a lot of reflexology, cranial massage, craniosacral therapy, jaw releases, and anything that's going to release the mind and the body through the process. Not so much in the office, we do craniosacral therapy a lot. We have two pediatric chiropractors that work from newborn through adolescence and they do a lot of craniosacral. Meagan: Yeah, my daughter had torticollis from my C-section actually. Dr. Berlin: Oh, interesting. Meagan: It was literally after birth when she was little. Then it just kept getting worse and all of a sudden, her ear was touching her shoulder but her shoulder wasn't going up. Her ear was going down. Dr. Berlin: Right. Taco neck, they call it. Meagan: Yeah. It was pretty dang bad. We went to PT and that was great, but ended up finding a craniosacral one. Anyway, it was amazing. They did this adjustment and suddenly she was back up. She wasn't fussy and having acid reflux and all of these amazing things. It is really cool. Dr. Berlin: It is so gentle yet powerful at the same time. Meagan: Right! PT was actually hard on us. It was a lot of forcing her to get in these positions and things then just a few chiropractor adjustments of craniosacral work was a game changer for us. Dr. Berlin: That's amazing. Meagan: And a lot more sleep for this mama, right? Dr. Berlin: Yeah. It's not just great for the baby. It's great for the parents. When to Start Chiropractic Care During Pregnancy Meagan: Yeah. Well, awesome. So when should someone start chiropractic care during pregnancy? Is it something like, “Hey, I'm thinking about conceiving. I should start now.” Should we always be seeing? What does it look like? Dr. Berlin: A lot of that depends on your goals. If you want to optimize your body for pregnancy, it would be great to know ahead of time when you're definitely not pregnant because there's a lot of stuff that we can work on that we can't get to once you're pregnant like all of the core muscles, psoas, hip flexors, and the ones that go behind the baby. Loosening that stuff up if it's tight before you get pregnant is ideal. That happens in my case more frequently either if people are on a fertility journey or they had a pregnancy that was either difficult or birth that was difficult and now they're thinking about getting pregnant again. They'll come in for some pre-pregnancy bodywork. Once you're pregnant, it really depends on the goals. If you're coming for maintenance, in my view, there's not really a time that is too early. We do make modifications in the first trimester then we make modifications again at different times as you get bigger and your body changes, but there are always ways that we can, almost always, get you comfortable, situated on a massage table and/or a chiropractic table and find those restrictions and release them.I would say our typical patient comes in the second trimester so maybe somewhere around 20 weeks unless they are coming for something specific like sciatic pain or positioning issues or just getting ready for birth and they come later. They tend to come maybe twice a month during that middle part of the pregnancy then at the end in the last month or two, they'll come once a week to get ready for birth. We don't prescribe a hard and fast number of visits or frequency of visits. It really depends on your goals, how you're feeling, and what your life looks like—what kind of resources you have or want to put into it. Meagan: Yeah. That's what I did at the end of my pregnancy. I did every other week so twice a month then in the very last few weeks, like my 39th to almost 41st, I ended up going a couple of times because I started getting some discomfort and feeling some sciatica pain and things like that. My baby proved his point. He was hanging out in my back. Dr. Berlin: Ouch. Meagan: Yeah. In labor, he did that for 42 hours. Dr. Berlin: Oh my goodness. Ouch. Ouch. I'm sorry. Meagan: It was fine. I was adjusted twice during my labor. Dr. Berlin: Wow. Meagan: I full-on believe—I mean, I believe that my team and everything and that space I had created was an impact, but I swear that my chiropractor really did impact my VBAC. Dr. Berlin: Some people swear by us and some people swear at us. Meagan: I know. Dr. Berlin: I'm really grateful that you were able to have the VBAC. Structure and function are important when you're trying to get a baby through.Can We Get Adjusted During Labor? Meagan: Yeah. I mean, I saw switches in my labors with both adjustments. It's so awesome. That was one of the questions. Can we get adjusted during labor? As a doula, I've been to a few births where we're seeing this lag in this labor and the same thing. We're working through all of the positions, but something is not quite working. We say, “Hey, let's go get an adjustment.” We'll go to the chiropractor with them and things big-time shift and we've got a baby. But yeah, are there signs that someone could use an adjustment? Maybe we've got people in a rural area where they can't have access to a chiropractor or maybe they're already in the hospital and sometimes chiropractors can't come in. Dr. Berlin: Yeah, nowadays they don't let too many people in. Always, ideally, that's why we switch to once a week as you're getting closer to the end so that ideally, you go into as a labor freely moving ball with enough WD-40 to carry you through. But yeah, there's no problem generally doing adjustments during labor. Some people just schedule it and say, “Hey, will you come check on me when I'm in labor?” Other times, we get called when there are some signs that labor slows if there is no progression like things don't progress in a “reasonable time frame”, if the baby's not in a great position, and if there's back labor like what you were talking about. Those are all signs that it's worth checking. Are there restrictions here in the pelvic bones? Your pelvis is not a solid bone. It is a bunch of bones connected by soft tissue. It has the ability to expand and contract and accommodate or even facilitate the baby's movements but if everything is just in a vice grip, then it may not be able to do that the same way. It can be more resistant to the movements. So we don't do anything to the baby. We're musculoskeletal specialists. We do things to your muscles and bones and make them more functional. That could make you a lot more comfortable. It could provide an environment in which the baby is better able to line up with the runway and things like that. Yeah. So you know, it's never a guarantee. Sometimes I'll get to a birth and there's really nothing to adjust. In my case, I also do body work so at the very least, I can do some body work. There are a lot of reflexology points that are just calming. There are those famous hip squeezes or counterpressure on the sacrum and lots of different massage stuff we can do to open up muscles. A lot of what I do in the office I've learned from birth. When someone is in labor and they're having these weird muscle spasms during contractions, you realize, “Oh, that is so tight.” I never would have guessed ahead of time that it was going to be so then as part of labor prep, I'll explain to somebody, “Do you want to release these muscles because they can play a role?” Sometimes you can't see what looks like the direct effect. It's all anecdotal. No one studies on this but all of a sudden, things start to loosen up where those spasms are occurring during labor and they loosen up, then all of a sudden, you start to see a healthy progression. The other thing you see a lot with bodywork is somebody, especially in unmedicated birth—I don't think there is anything like unmedicated birth. Either you get medications or you make your own. The ones that you make look pretty cool. But if there's someone who's not medicated medically, there's this major transition that you can see when a surge comes through and she doesn't feel totally safe or relaxed and she'll start to tighten up and sort of not consciously but fight the surge and fight herself, really. That can look pretty violent sometimes. With bodywork, you can sort of help the nervous system relax to a point where it doesn't feel like it's in danger. It doesn't feel like it has to fight even when intensity comes. That's the most rewarding thing to me from being at a birth. When I see that shift is when it's like, “Wait a second. This is more tolerable, much more tolerable if I don't fight it.” They get the confidence to relax into it and they realize, “Okay. I've got this.” So it's not always, in my case at least, the adjustments and bodywork. Things that people can do on their own, there are all of the doula tricks if the baby is not wanting to come down with the peanut ball but sometimes you can actually roll different parts of the low back, glutes, and piriformis if they're acting up. There is some stretching you can do. Some of the Spinning Babies exercises come in really handy. There is other stuff that you can do even if you can't get a chiropractor over there. Meagan: One of the clients that I went to, her chiropractor went during labor. He showed me this-- I don't even know what it was—tight ligament or something right down next to the bone. Dr. Berlin: Yeah, above it? Meagan: Kind of on the side. It was honestly by the butt crack. That's where it was, this tight thing. He was like, “Do you feel that?” I would feel it and it was so tense. Dr. Berlin: A spasm, mhmm. Meagan: He said, “During a contraction, press on that.” I would press and eventually, it just released and all of a sudden, we had transition coming. It was really interesting. I don't even know what that is. He said, “Press right here.” I could feel it. It was tight. It was really interesting. Dr. Berlin: Yeah. You'll find little things like that in labor. With permission, a little trial and error, you can sometimes really find a gem that is helpful for birth or that you can do ahead of time or that you can train a partner or doula to do. It can make a huge difference.CPD Meagan: Yeah. Absolutely. So we were just talking about our pelvis and how it moves and shifts and all of these things. CPD, cephalopelvic disproportion is a common, as you probably know, diagnosis in C-sections and people wanting to have a VBAC. It's given a lot. In my opinion, too often. I was given it myself. I was told I would never get a baby out of my pelvis. Dr. Berlin: Oh wow. Meagan: So that's a big question. How can someone tell the shape of their pelvis? Does it matter? How can we make our pelvis “bigger” during birth and what can we do to help these babies navigate through this pelvis without getting this diagnosis of, “Your pelvis is too small”? Dr. Berlin: Well, I think the first and most important thing always with a VBAC is to line yourself up with a provider who is really VBAC supportive, not just tolerant. If you feel really trusting that your provider is like that, then they are only going to tell you things. They know your goal and they are supportive of your goal. They are only going to tell you things that are well thought out or that aren't just fear-based. There are a few things coming together here. Number one, there is the pelvic paradox. You see someone with really tiny hips give birth to a 9 or 10-pound baby with no hiccups really smoothly. Then you see somebody who has big hips. Maybe they've been told their whole life, “Wow. You're going to have great hips for birthing,” and a 6-pound baby gets stuck and doesn't come out. How do you explain the pelvic paradox? One of the explanations is that there is a big difference between structure and function. Structure is your pelvis, the bones themselves, the soft tissues themselves, and how big they are. It is measurable to a degree and your baby and how big they are is measurable to a degree. But if you're just looking at structure without function, you're going to see what looks like cephalopelvic disproportion a lot partially because we don't have great measurements on these things. We have approximate measurements and partially because you're not taking into account function. The baby's head is not a solid bone. It's a bunch of bones meant to smoosh through a smaller passageway than it is at its full size and the pelvis is not a solid bone. It's a bunch of bones meant to expand and transmit something bigger than itself through while you're in labor. If those functions are working, then for sure, a larger baby can get through a smaller space even though on paper structurally, you have what looks like a baby that is too big to come through a pelvis that's too small. Sometimes they are too big and that's the issue. That's why it's really important, I think, to be with a provider who really gets you and supports you and is on board with you because if that provider is saying, “Wait a second. You have a head that is like this or the entryway to your pelvis is a concern,” then you're really going to not be second-guessing them in the moment which is really important, I think, for safety. That's the number-one thing is if you want to have a VBAC or even a vaginal birth the first time, is to have a provider that is really supportive. Number two—this is again really anecdotal. I see a lot of pregnant people every single day. What I did was a little poll on social media like, “How many people told you that your baby was going to be 9 pounds and it was substantially smaller?” A huge number of people came up. I don't think it's nefarious at all. I think that doctors in general and obstetricians in particular are trained to look or what might become a problem at some point which is sort of good. We want them to predict those things. But then it could get carried a little too far away because it's like, how likely is that to become a problem and what are the interventions that we take to prevent that and what are the side effects of those interventions? That's a much more complex equation where there's not always a clear answer. It is sometimes presented as a clear answer rather than, “These are the pros and cons, the risks and benefits as we know them. What would you like to do?” I think that's something all practitioners can learn over time. I'm certainly still a student every day 25 years later learning how I can do things better and more comfortably and more effectively. I think towards the beginning of practice for me too is that you know what you know and you want to be so helpful, but sometimes, the person on the receiving end of that doesn't want that and that's okay. That's your choice. It's 100% your choice. Even if it's not the choice that I would make, at the end of the day, I'm supposed to support whatever choice you want to make. That's a lesson that at least for me, took time as both a chiropractor and a massage therapist and as a doula especially. Meagan: Yeah. That's what I was going to say. It's taken a lot of time for me as a doula. Dr. Berlin: Yeah. Meagan: It can be really hard. Dr. Berlin: Yeah. It's really hard. And very well-intentioned practitioners who want the best for you, who would do the same exact thing for their wife or their daughter are trying to help you, but at the end of the day, it's an informed consent situation. What happens with the measurement is that there's no scale for the baby before it's born. It's a computer doing calculations. The calculations have a margin of error. Let's say that margin of error is a pound or a pound and a half. If I tell you that your baby is going to be 7.5 pounds at birth, based on those calculations, that means it could be anywhere between 6 and 9 pounds if the margin of error is a pound and a half. A) I could have probably told you that without the ultrasound. B) The problem with that is if it's ticking upwards if the baby is measuring 8 pounds in there, now all of a sudden I'm thinking, “What if it's 9.5? That could be too big. It might get stuck. We might have problems. We don't want an injured baby.” Nobody wants an injured baby, so maybe we should just induce you or do a C-section or whatever to prevent that. How many of those babies are actually going to come out at 9.5 pounds? That's the end of the margin of error on that side. On the other side, you have the same issue. If a baby is measuring 6.5 pounds, you start to think, “What if it's 5?” because of the margin of error. Maybe the baby's not getting enough nutrition. These are all logical things to think about and important things to talk about, but we can't forget that there is this margin of error and that there is a person who really should be the one at least involved if not making the decision. So that, I think is what happens and anecdotally what I see in the office happens with cephalopelvic disproportion. Either we're doing measurements and we're guestimating that the baby is a certain size but they may not really be that size and we're not really looking at function. There's a great episode of our podcast called “Labor Day Surprises” where there are two women who have both had surprises at the very end of their pregnancies and they are sisters-in-law. One of them had a breech baby and had quite a very interesting story there and the other one had a surprise 11-pound baby. Meagan: Whoa. Dr. Berlin: Now she is 5'8” or so. She is tall but very petite with tiny, small hips. She gave birth to the baby vaginally, unmedicated and are you sitting down? She didn't even tear. Meagan: Oh my gosh. See? That's amazing. Dr. Berlin: It was the most incredible thing to watch and it's one of the few where you saw a very ecstatic birth almost orgasmic birth at the hospital. She really talks about how she got into that mind frame. Her doctor knew the baby was going to be on the larger side and said, “What do you want to do with this?” She said, “I want to try.” He goes, “Well, if you don't try, we won't know.” Meagan: Oh, that just gave me the chills. If you don't try, we won't know. Dr. Berlin: We won't know. Meagan: Like you were saying, it's informed consent. It should be up to that mama to decide if she feels that it's a good thing to try, but we also have to respect that if we have a provider who is not comfortable with it, we have to respect them too. Maybe that's finding a new provider or working with their partner or something but yeah. It's interesting. Dr. Berlin: I mean, I know that I'm not a good match for everybody out there who is looking for a pregnancy chiropractor. I'm not a good doula for people who are looking for a doula. What's really important is that you find providers that you feel are on the same page and that they are a good match. This happens with dating all of the time. It's like, “You're not for me but I have a friend and they would love you.” I don't think– I'm never insulted if I meet somebody and they're like, “I don't want this type of care.” Great. Let me find someone you would love to see. It's the same with obstetricians. There are some obstetricians who are very paternalistic. They make all of the decisions for you and there are people who love that who don't want to make the decisions and who don't want that responsibility. You guys are a great match together, but you're not going to be a great match for my Prius-driving, vegan, hippie mom, who wants to have her baby hanging from a chandelier over a tub. You know? She's not going to be a match for them. Meagan: Not so good of a match. Dr. Berlin: It's not an insult. Neither one of you wants to be with someone who's not a great match. I always encourage people that if you're not with a provider that you feel comfortable with, if they're not on the same page or your interests are conflicting, then try to find a provider who is on the same page. It makes a huge difference and you don't get to do this very often. Meagan: I know and it's worth finding that provider. Just like it's worth dating and dating and dating until you find the one, it's worth going out and continuing to find that provider because like you said, my best friend went to a provider that may not be the best for me. I'm happy that she found him, but I might need to find someone else and that's okay to take that time and find that provider. Dr. Berlin: Totally and if you're going a more natural route, even psychologically if you end up having a Cesarean, which I don't think is the worst thing on the planet. I think it's a great thing. I've been known to say that I think one thing worse than a Cesarean being forced on someone who doesn't want one and doesn't need one is not having one available to somebody who does need one. A Cesarean is a great medical marvel of our time. The doctors who learn how to do them perfect them and do them with very little risk and a lot of skill. They're heroes to me. But you know, if you want a more natural birth and you end up with a Cesarean and you're not with somebody who you felt like you are on the same page with, you're very likely to leave that birth feeling like, “Did I really need that?” It leads to a lot of not-good mental thoughts at a time that you are already going through a tough– for most people, a big transition. Meagan: Yeah. Dr. Berlin: I can't say it enough. Having a provider that is good for you and that is a match for you is so important on all fronts. Breech BirthMeagan: Beautiful. I love that. I couldn't agree more. Finding that provider is so important. We were just talking about these two cute sister-in-laws. They had a surprise breech and that is a question. If the baby is breech, what things could someone do on their own to help their baby turn? How soon should they start to worry? How could chiropractic care truly help that baby turn? We know that there's not a lot. Breech is kind of dwindling away. It's unfortunate and it's really unfortunate that we're not having as much support in the breech world, but we're not.  A lot of people get put in a corner that if they have a breech baby, they feel like they have to have a Cesarean whether they want one or not, but they want options. How can we work with these breech babies? Dr. Berlin: It's truly interesting. I think if there were more options for safe, vaginal breech delivery– not everybody's a good candidate for that– but if there was more of an option, primary Cesareans would be down. Meagan: I wonder too. Dr. Berlin: Substantially and as a result, secondary Cesareans would be down because all of those people who had C-sections are told, “Once a Cesarean, always a Cesarean.” They don't even get a chance. I think it would bring down the Cesarean rate greatly as a whole. The question is, what is a safe breech birth? There is a lot of debate around that but one thing is for sure. There are some people who are much better off seemingly having a Cesarean birth but they're breech and other people who are much better off with the option to try and deliver vaginally but they're breech. Meagan: You have an episode on your podcast talking about that specific topic with Dr. Brock and some other providers talking about what that looks like. Dr. Berlin: Yeah, we have a 3-part series called Breech 101. It's two midwives and two obstetricians just talking everything breech from all angles. With Dr. Brock, we have another episode called “Vaginal Breech After Cesarean Breech” with a mutual patient, Dr. Donna Lou who had a breech with her first and ended up in a Cesarean because her doctor didn't. She went into labor and didn't have the chance to meet Dr. Brock. At the hospital, her doctor just doesn't have the confidence or the comfort to deliver breech babies. He was very apologetic but she had a C-section. One of the few people I have seen over 20 years who was breech again with no known reason, with her second, Dr. Brock also equally baffled said that she is a great candidate for VBAC and a great candidate for breech birth. The two, the risks that come along with those, don't compound each other. It's just two different sets of risks. What would you like to do? She opted for the vaginal breech birth after a Cesarean breech birth. I have them both on and they talk about the decision-making that went into it and what the process was actually like. When it comes to breech, I have a premise which is that– let's talk about a singleton baby in a first pregnancy. That's where we have the most data. I have a premise that at the end of pregnancy, babies generally want to be head-down. The reason I have that premise is because according to Williams Obstetrics, these numbers are a little bit old, but still seemingly relevant. At 28 weeks into a singleton first pregnancy, about 50% of babies are not head-down yet. Meagan: 50%. Dr. Berlin: 50% at 28 weeks. Now, at 32 weeks, about 10% are not head-down yet. You go from 50 out of 100 babies that are not head-down to only 10 out of 100 babies in a 4-week period of time. Meagan: That's a lot of babies that turn in a very short period of time. Dr. Berlin: It's a big migration and it's seemingly because they run out of space. When they have space to move around, they can move all over the womb. It doesn't really matter. Nobody really cares. They are exploring so no big deal. As they start to run out of space, they have to pick a position that is most accommodating in the space that they have and generally in a typically-shaped uterus for a typically-shaped baby, that is head down. That is where they try to go. At birth, at 37 weeks and beyond in that first pregnancy, the breech rate is 3-4%. So it goes all the way down to 3-4 out of 100 from 50. That's where the premise comes from at the end of pregnancy, babies generally want to be head-down. If they don't go there, there must be a reason for it. There's usually a reason. It could be something structural. It could be something functional. Sometimes when we have no idea why, like in the case of Dr. Donna Lew. Why would babies structurally? Well, there's a lot to consider. Maybe the cord is wrapped around them funny. Maybe the placenta is in the way especially when it's on the front wall, it seems to pose more of a getting-in-the-way factor. None of these, by the way, are absolute factors. I have a lot of people that come in with a placenta in the front and the baby does turn. But it seems like of the ones that don't turn, more of them have the anterior placenta. Amniotic fluid seems to play a role. So if the amniotic fluid index normal is somewhere between 8 and 24, with all of those being normal is a big range. 8, 9, and 10 are healthy but not so much fluid volume for baby to move around. 18, 19, and 20 are also healthy but so much fluid volume that even after 32, 33, and 34 weeks, your baby may have a lot more room to move around than other babies and not have a trigger to pick a position and get head-down. If you add other things to that like it's your third pregnancy so there's more room in the uterus anyway and if you're tall and if the baby's measuring small, you can take all of those things into account. Not all breeches are exactly the same. The shape of the uterus is a big deal too. Sometimes if the shape is different, it seems not conducive for the baby to get head-down or for the baby to be able to. Functionally, it's your body. Your lower back, hips, and pelvis are supposed to be pretty loose, relaxed, and open at the end of pregnancy. Your body is doing that hormonally in several different ways but if everything is stiff, tight, and rigid for various different reasons– injuries or excessive workouts or other things like that without enough stretching, then especially if you're strong, you can have a pelvis that is strong, tight, and rigid. As the baby's running out of space, maybe down there is not where they are being invited to go. Maybe the end of the rib cage is a lot more inviting or if they're trying to move as we said before, the body may not be able to accommodate the movements the same way. When I work on breech, I'm not doing anything for the baby itself. I'm not doing anything to the baby. I'm not trying to turn a baby or move a baby. I'm working on the musculoskeletal structures of the baby's surroundings which is the mom and if they're stiff, tight, and rigid, we're creating more functional space using massage to loosen up the soft tissues and chiropractic adjustments to open up those restricted joints and maybe gravity. We have tables that invert so maybe a little bit of gravity if something is really stuck trying to give the baby an opportunity to move naturally with gravity. We also in our office have acupuncture so we also do moxibustion which seems to stimulate more natural movement so it's synergistic. I can create more functional space and they can create more movement in that space. It gives those babies a chance to turn more naturally. When do we start? Usually around 32 weeks but I always tell people, “Look. At this point in that first pregnancy, 10 out of 100 babies roughly statistically are breech, and in birth, it's only going to be about 3.” If I was a betting person, I would still bet that your baby's going to turn. The stuff that I'm doing is really insurance. It's going to be helpful for birth anyway but I tell them not to panic at that point. And then of course, you have to look at all of those factors that we mentioned to see who is more or less likely to turn and you can tell based on the fluid, the uterine shape, the placenta location, and so on. Meagan: My VBAC baby kept going breech. At 32 weeks, he was going breech. She would motion him and he would flip then the next visit, I was like, “His hiccups are up here again.” He would be breech. He did that until 36 weeks. I think it was 34.5 or 35 and she was like, “We have to trust this baby. We have to trust that this baby needs to be head-up for whatever reason” and I was kind of grouchy because I was like, “I don't want to have another C-section just because I had another breech baby.” I really wanted this VBAC, but yeah. At 36 weeks, I went in and he was head-down and he stayed head-down. Dr. Berlin: Do you remember if your fluid was toward the more generous side, middle side, or lower side?Meagan: It wasn't super high, but it was on the higher of the normal. He did have a shorter cord when he came out, so I don't know if maybe something was bugging him there, but yeah. He flipped head-down. It was great, but it was hard. It was hard not to get panicky. Dr. Berlin: Sure, yeah. That's the thing. A lot more people have to think about breech than actually have breech at the end. Meagan: Yeah. Yeah. Dr. Berlin: So if there are 4 million births in the United States every year and 10% of them are breech at 32 weeks, that's 400,000 people every year thinking about breech but only about 3-4% are breech at the end like 160,000. Meagan: Yeah, I even had a client. I'm going to jump off of the breech topic, but I had a client who was breech and was scheduled for a version the next morning but went into spontaneous labor that night. We went in at 1:00 AM and baby was head-down. She was 9 centimeters when we got there. Her body just needed contractions to finish rotating the baby. I have no idea but sometimes it can happen. Okay, so let's see. Post C-section. This is in regards to cupping fasical release and stuff like that that you guys do in your office as well. Is that something that you would suggest? This is another type of bodywork essentially. Dr. Berlin: New mama TLC. I think whether you have a Cesarean or a vaginal birth, it's a lot on the mind and body, and nervous system, so I try to do a longer session soon after usually by two weeks regardless of the mode of delivery unless there is some kind of injury then you are good. We can do most things. The goals are to– sometimes there are smaller injuries from birth like injury to a tailbone or pubic bone or something like that. We can address those right away. I've had people pop a rib out pushing so hard so we obviously can pop that back in after a vaginal birth right after birth. Meagan: Wow. Dr. Berlin: The goal is if there are any injuries, we deal with them right away. After that, it's sort of like the sports massage when you've run a marathon. Just wear and tear on the body and trying to move that excess fluid around and have it be reabsorbed so we do some lymphatic work and finding those overworked muscles and to relax those muscles and at the same time, if we can work it in, a little sensual nervous system relaxation work to help reboot the system. Meagan: Yeah. Dr. Berlin: And to come back online with calm and quiet. So either a little meditation and/or some cranial work. While our normal visits are 25 minutes at that point, we do an hour-long session to try and get all of that in during the first one or two postpartum visits. There's also a great opportunity at that point, especially for people with more chronic things that they deal with pain-wise. You still have the pregnancy relaxation hormone for a bit. You don't have the baby inside there pushing on you 24/7. You're kind of more moldable clay. I've had several instances of somebody who had a lifelong chronic thing from an injury and during that period, we have a better shot at making a lifelong correction there. Meagan: I've never even thought of that. I've got this long-term back issue. I've got this relaxin and great stuff in my body. Let's work with that. Dr. Berlin: Yes. Let's use that advantage. I had a patient who was really eager to do that and then she got COVID and she couldn't come back. It created a whole bunch of problems for her and she's like, “Damn. I'm going to have to have another baby.” Meagan: I was going to say. That's what I would say. Now I have to have another baby. That is really awesome. Like you said, it doesn't matter. C-section or vaginal, our bodies go through quite an event and take a lot of shifts and changes so chiropractic care can be beneficial after as well. We've talked about it with babies as well. They go through a lot and that can be impactful. My little boy didn't poop forever. It was 9 or 10 days. We got him adjusted and he had the biggest poop in the world. Dr. Berlin: We see that all the time. Meagan: He passed out and slept all night. I woke up all engorged and I was like, “Oh my gosh.”Dr. Berlin: I know. It's the number-one feedback. “My baby slept so well after the adjustment.” Meagan: I know. We need it. Babies need it. It's so impactful. Back in the day, way, way, a long time ago, I didn't love the idea. Chiropractic care scared me. It can be scary because you can hear some people talk about it. Like you say, someone is yelling at you. It can be scary sometimes how people talk about it but it doesn't have to be scary and if you find that really good, skilled chiropractor, they're going to take care of you. They're going to help you through this process. Pubic SymphysisThey're going to help you with pubic symphysis which is another question. I know we're running out of time but if you have anything you'd like to share on pubic symphysis, that is a really big one. The more babies we have, sometimes it starts earlier. Dr. Berlin: Yeah. And then it's weird also. Sometimes it doesn't happen at all. It'll plague somebody in the first pregnancy and then not be there. Just a comment on the scared about chiropractic bit, certainly chiropractic isn't for everyone, but it comes back to finding a good match. As I said at the beginning, there are a lot of different ways to find and release those restrictions. Some of them are very, very gentle. It doesn't have to be that cracking noise that a lot of people are off-put by or violent-looking maneuvers. If you want the benefits of chiropractic but that's what's holding you back, find someone who does a low-impact technique or network or activator. Meagan: Drop table. Dr. Berlin: Drop table. Meagan: Yes, I was going to say the activator. Dr. Berlin: Sacro-occipital technique. There are so many that are gentle. The neuro-emotional technique. Okay, so in terms of the pubic bone, there is a right and a left side to the pubic bone. They are separated by pubic cartilage. I've learned over time that there are different types of pubic pain and they present differently. It's still definitely a work in progress. I'm learning new things all of the time. The most common one that presents during pregnancy is pain on sort of the lower pubic bone, the underside of the pubic bone where the fine meets the bone. It's usually only on one side or substantially worse on one side and it's like when you separate your knees. When you bring that pubic bone apart, that right and left side apart, so if you get out of bed one leg at a time or if you get out of the car one leg at a time or when you engage it to roll over in bed if you haven't been moving for a while. A very common one is to lean over to put on pants and lift one leg then ouch, it's very painful. What seems to be happening there in most cases is that you have an imbalance in the right and left side of your pubic bone. Let's say that you have the muscle coming up your thigh attaching to the underside of that pubic bone and pulling harder on one side than the other side. When you're totally stable, your body can accommodate that. But as the relaxation hormones kick in and they kick in pretty early, the pubic cartilage that is holding it together maybe can't compensate for that imbalance so the right and left sides end up not lined up with each other anymore but they torque so every time you engage it and pull them apart, it's very painful. If you could get them to line up again, then it would be either not painful at all or less painful. The combination that I use in that case that tends to work pretty well but not always is either massaging out the upper adductor like a deep massage to lengthen that adductor so it's not pulling so hard and then a trigger point right where that adductor inserts to the underside of the pubic bone. It's sort of an act of release trigger point as I'm pressing into it. They engage the muscle and then release the muscle. Engage and release a couple of times and then there's a little test that I do for it also which is if you're laying on your back or in a semi-reclined position and your knees are bent, feet on the massage table, or a yoga mat, or anything like that, I'll try to gently pull the knees apart against resistance from the mom. If that is weak, first of all, it doesn't really have a lot of strength. It elicits that sharpness in the place where the pain has been bothering them. That's a pretty good sign that this is the mechanism and that doing that combination of massage and trigger point and then adjusting the pubic bone with a drop table will give significant relief. Meagan: Wow. Okay, so that could be a test to say, “Okay. This could be impactful if you do this technique.” Dr. Berlin: Right. Then if it's not, I wouldn't do it necessarily because it's not the most comfortable thing. It's always up to them. I could still offer it and see if they want to do it even if it's a long shot or not do it even if it's a sure bet. But other types of pubic pain that I have identified are definitely the pubic symphysis cartilage itself sometimes gets inflamed. It's not one side or the other. It's right in the middle and it's higher up on the pubic bone. Oh, that's you. Meagan: That was me. It was ow. Dr. Berlin: I find acupuncture and I'll tell you something else in a second. Acupuncture, icing, and a support belt that lifts the belly up off of the pubic bone are some of the things that are more relieving there. The third type is the round ligament. They attach to the soft tissue right near the pubic bone on sort of the top ledge of it towards the outside, the upper corners of it. If you have a round ligament that is tight and pulling all of the time, then that becomes very sensitive. In those cases, we try to massage out or gently stretch the round ligament until it relaxes. That usually takes the pressure off there. One thing I would also say if you're feeling it there in the pubic symphysis cartilage and especially if you're also feeling it in the back by the sacrum or tailbone is to look for hyperactive pelvic floor muscles, a hypertonic pelvic floor. The pelvic floor runs from the back of the pelvic floor to the front of the tailbone. When it gets really tight, it will pull on both of those areas. Especially athletic women but not only– sometimes you have a hypertonic pelvic floor from all of the activities to strengthen and tighten. You might also be doing that to your pelvic floor. Up until not that long ago, all we knew about pelvic floor was that it can get weak so everybody is instructed to do these kegels and strengthen them but if it's already hypertonic and you strengthen it, you might be making it worse. So thankfully, we have these pelvic healthy physical therapists as a specialty now. People are just training on that and how to strengthen the weaker ones and loosen the tight ones, making pregnancy and birth more comfortable, more functional, and postpartum wellness. Postpartum sometimes can be treated. Meagan: Yeah. So as you are saying this, I have a weird question. I had all of that during labor and then since, I am really active. I am a road cyclist and I like to lift and all of these things. I get adductor pain now where it's not as tight and burning right in that pubic symphysis but right in that adductor. Do you think something could still be connected through that pelvic floor?Dr. Berlin: It's always worth checking if you haven't had it checked. The adductor by itself could just be the adductor. Sometimes just from the workouts that you're doing– lifting especially could make it really tight and it just needs to be rolled out or dug out and you might benefit from those trigger points too on the ends or the inserts on the top and the bottom. Pelvic floor could be a factor. There sometimes are other factors too. Even a little drop incontinence when you get the urge, it's like, “I've got to go right now.” Meagan: Yeah. Dr. Berlin: Or pain during intercourse or things like that or if you jump on a trampoline or you sneeze and you pee, those are signs that something is up with the pelvic floor. It's not functioning quite right and worth investigating with a specialist. Meagan: Yeah. I think a lot of people don't even remember that even C-sections can impact that pelvic floor and our whole body and create that tension and restrict us from having good mobility. Dr. Berlin: That is an amazing point because it is absolutely true. The end of pregnancy puts a lot of strain on the pelvic floor no matter how you deliver. Body Support at HomeMeagan: Yeah, so again, definitely check out the chiropractors in your area. So for those who maybe can't have chiropractors or can't have access, are there any tips or maybe places on the Informed Pregnancy Plus channel where people can learn not to adjust themselves but do stretches and do those things that can help create that mobility and help them have these vaginal births that they're wanting? Dr. Berlin: Yeah, there are tons. Spinning Babies has a whole bunch of great exercises that you can do. It's a good idea. We have a course that we do called Labor Kneads. We only do it live right now, but it's where we're teaching partners and doulas and other support people to do bodywork before, during, and after birth. That's a great idea for us to shoot that and put it up on the streaming service. I can't promise it for one, but I will certainly try to do that. The other thing is that there is a great listing of chiropractors with separate post-graduate training. You should know that anybody who is a licensed chiropractor can work on pregnant people. It doesn't have to be a specialty. Meagan: Or Webster-trained. Dr. Berlin: Yeah, it doesn't have to be Webster-trained or it doesn't have to be somebody who is a prenatal chiropractor. There are some chiropractors who don't feel comfortable working on pregnancies. Some don't have all that much experience, but there are a lot who are not prenatal. They are just family chiropractors and as a result, they see a lot of pregnancies. You don't have to have a specialty to do it. So unless there's no chiropractic in your neighborhood, then there might be people who can work on you even if it's not a specialty clinic like in our case, we call it pregnancy-focused chiropractic. The other thing is that there's a great website by the International Chiropractic Pediatric Association that does a lot of postgraduate training in pediatric and prenatal chiropractic care. They have a listing by zipcode and their website is icpa4kids.com. You can search by zip code in the United States and Canada and maybe some other international options. Meagan: We'll make sure to also put that in the show notes for everyone listening. Last but not least, the big question is does anybody not qualify to receive chiropractic care? Dr. Berlin: Yeah, I mean, I would almost say that there are some conditions during pregnancy that come up that are delicate. During those very delicate conditions, I love to work together with the obstetric provider. At that point, it's usually going to be an OB/GYN or a maternal-fetal medical specialist and just access their comfort level with the things that we do. Almost always, it's going to be modifications. It's not that we can't adjust them at all or do any bodywork with them, it's going to be modifications. Sometimes we'll just wait a couple of weeks and then do the treatments but for the most part, you can do something for everyone who has things that are stiff, tight, and rigid and are either uncomfortable or want to improve their function. Meagan: Awesome. Well, thank you so much for taking this time out of your day with all of your projects. You've got so many hands in buckets. You wear so many hats these days so it's really been such an honor to have you on the show and answer all of these amazing questions. I full-on believe in chiropractic care. Like I said, a long time ago, I was like, “Ah!” and then I started getting into chiropractic and I'm like, “No, this is really impactful on so many levels.” Dr. Berlin: It is. Meagan: I mean, I'm not even pregnant or planning on conceiving but I still go to the chiropractor because it really does impact my life in a better way. Dr. Berlin: We have moms come in here and they make an appointment. They say, “I want to make a postnatal appointment with Dr. Berlin.” The reception team will say, “Oh, how old is your baby?” They'll say, “13 years old.” I'm like, “Yeah.” You don't have to only be pregnant or postnatal to come here. Meagan: A postnatal visit. How old? 13. Okay. That's just called a chiropractic visit. That's all that you have to say. Dr. Berlin: It is, but once you have the baby, you have all of the bending, lifting, holding, feeding, emotional stress, and things like that. The maintenance during that active phase of life is important. BreastfeedingMeagan: Yeah. Oh my gosh. I just said I'm going to end. I feel like I could talk to you all day. Dr. Berlin: Same. Meagan: But something I feel that impacted me and I know a lot of our doula clients is breastfeeding. When we're breastfeeding, we're hunched and curled. Our neck is down and we're in wonky positions then we're out and we're stretching then we're like, “Oh, this is painful” or all of a sudden, my milk supply is not that great, and weirdly enough, chiropractic adjustments can help your body and you nurse better and help your production because your baby is going to nurse easier. You're going to nurse easier. Everyone's going to be better. Dr. Berlin: When you're in a lot of pain, the stress hormones put you more in emergency mode, and making milk is not an emergency function. There's that and there's literally just the– here's one tip I would say that seems to help a lot of people. If you have a nursing station, especially in those early couple of months, you can put a full-length mirror in front of you so you can see what's happening without looking straight down. That seems to be helpful for a lot of people. Meagan: Absolutely. Yeah. To just be able to see and not be curled over. I mean, you are looking at your baby, but you can look down at your baby versus– Dr. Berlin: Across. Meagan: Yeah. Dr. Berlin: Yeah. One thing that gets a lot of people is that you're trying to get some sleep and the baby is in a comfortable position and it's not comfortable for you but you don't want to move because you don't want to wake them up. That's gold for the chiropractors. Meagan: It is. It is. Oh, well thank you so much again. It's such an honor. We're going to make sure to have all of the links to your channel, to your page, and to your website. This chiropractic search forum and everything. Everything will be in the show notes so everybody will be able to find you. Dr. Berlin: Thank you. Meagan: Like I said, if you're listening and you haven't been able to yet, hopefully now you're not driving if you were driving. Stop and go follow Dr. Berlin. Dr. Berlin: Than

A few months ago, kidney specialist Dr. Stanley Goldfarb was fired from UpToDate, a digital research tool for physicians. Last year, the president of the University of Pennsylvania Perelman School of Medicine, where Dr. Goldfarb served as an associate dean, wrote a public letter accusing him of racism while students and colleagues circulated a petition calling for his title as professor emeritus to be stripped.  Dr. Goldfarb's purported crimes had nothing to do with medicine and everything to do with his public opposition to DEI (“Diversity, Equity, and Inclusion”) in medicine. For example, last year, he wrote,   The campaign for diversity is long running and has some value, yet the ideological extremism of the past two years has led medical schools to adopt dangerous strategies. To fight supposed “systemic racism,” at least 40 institutions have dropped the requirement that all applicants take the MCAT, the gold-standard test that measures students' grasp of this life-saving profession.   More recently, he added this observation,  It quickly became apparent that my beloved medical profession, to which I had devoted more than 50 years, was spiraling downward even faster than I had realized. The COVID-19 pandemic accelerated the decline, as did the death of George Floyd in 2020. Suddenly, medical schools were loudly proclaiming that health care is “systemically racist,” that “medical reparations” are urgently needed, and that medical education and practice must fundamentally change. Whereas DEI and social justice were frequently discussed in 2018, by the end of 2020 they were the central facets of medical education, where they remain to this day.  Other examples of Dr. Goldfarb's concerns include the supposed  systemic racism of being seen by a physician of a different race and pledges made by medical students to fight the gender binary and “honor all indigenous ways of healing that have been historically marginalized by western medicine.”   Near the end of the 20th century, it was common to dismiss and deny the possibility of objective truth claims in the liberal arts and social sciences, such as literature, art, and politics. But the “hard” sciences remained untouched until recently. It is now common for the same kind of deconstructions to be applied in math, medicine, or the other biological sciences. As it turns out, the first chapter of Romans accurately describes the very real potential of fallen humanity to deny what is observably true in the world God made.  Contemporary ideas of DEI prove a maxim of G.K. Chesterton, that “(t)he modern world is full of the old Christian virtues gone mad.” The impulse for justice and equality, birthed within the Western world from Christian ideas about morality and the human condition, draws more from the philosophy of Michel Foucault than the Bible. Built instead on a standpoint epistemology rather than eternal categories of right and wrong and human dignity, an individual who belongs to what is understood as a traditionally marginalized group is granted moral status and authority over and above those from groups not assumed to be marginalized. Functionally, objective reality is denied.  As Shane Morris and I recently described, students taught that successfully solving algebra problems will depend more on the color of their skin than knowing algebra, or that their calculus professors are oppressors if they are white, will not only not unlock the mysteries of the universe, they will believe lies about who they are. Even worse, lowering standards for certain students only dehumanizes them, suggesting they cannot reach the standards in the first place.   In the 1990s, renowned economist Thomas Sowell wrote the following about lowering SAT scores:   The Educational Testing Service is adopting minority students as mascots by turning the SAT exams into race-normed instruments to circumvent the growing number of prohibitions against group preferences. The primary purpose of mascots is to symbolize something that makes others feel good. The well-being of the mascot himself is seldom a major consideration.   Sowell understood–even firsthand–racial injustice and the uphill climb that minority students can face to reach success. Yet for Sowell, ditching objective measurements was not the answer:   People of every race and background are fully capable of becoming world-class physicians. Medical schools should seek out the best candidates who are most likely to provide the best care for patients, regardless of what they look like or where they come from. Anything less jeopardizes the very purpose of these institutions.   Critical Theory in all of its forms only critiques, never constructs. Applied, it will only tear down, never build up. Advocates of this ideology should consider that their proposed solutions may be fueling the problems they claim to address.  This Breakpoint was co-authored by Kasey Leander. For more resources to live like a Christian in this cultural moment, go to breakpoint.org.