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Thomas Manuel of the Indie RPG Newsletter and the Yes Indie'd podcast joins me to talk about Secondary Missions, a mechanic from Band of Blades by Off Guard Games.In Band of Blades, a grim military fantasy forged in the dark game, you and your party go off and do missions. Meanwhile, there's a whole other squad out there doing a whole other mission! What's up with them? This mechanic tells us. It's such a change in the mouthfeel of Band of Blades compare to other forged in the dark games.We get into how it supports the genre and themes of the game, all the tough choices it puts in front of players, and how mechanics like this one that couldn't exist in any other game are often our favorites.It's a classic Dice Exploder deep dive this week. Enjoy.Further reading:* Blades in the Dark* Malazan Book of the Fallen* Band of Brothers* Darkest Dungeon* The Watch* Dream Askew // Dream ApartSocials:Thomas on itch and Twitter.Sam on Bluesky, Twitter, dice.camp, and itch.Our logo was designed by sporgory, and our theme song is Sunset Bridge by Purely Grey.Join the Dice Exploder Discord to talk about the show!Transcript:Sam: Hello and welcome to another episode of Dice Exploder. Each week we take a tabletop RPG mechanic and have its back as we head behind enemy lines. My name is Sam Dunnewold, and my co host is Thomas Manuel. Oh, so exciting. Thomas is an Indian playwright, journalist, and game designer. He runs the Indie RPG Newsletter, for my money one of the best sources of IndyRPG news on the internet and an easy subscribe. Plus he's the current host of the excellent Yes Indeed podcast. He's also the designer of This Ship is No Mother, a card based take on the kind of Mothership genre that's very much worth your time. Thomas is great, And he brought on a mechanic from Band of Blades, a grim military fantasy forged in the dark game from Off Guard Games and Evil Hat. Specifically, Thomas brought secondary missions.In Band of Blades, while you and your party are off doing one mission, there's a whole other squad over there doing a whole other mission's worth of stuff. What's up with them? This mechanic tells us.Secondary missions, have a deceptively big impact on the mouthfeel of Band of Blades. We get into how it supports the genre and themes of the game, all the tough choices it puts in front of players, and how mechanics like this one, that couldn't exist in any other game, are often at least my favorites. It's a classic Dice Exploder this week, a deep dive at its very best. Here is Thomas Manuel with Secondary Missions.Thomas, thanks for being here.Thomas: Thank you for inviting me. I'm so excited to talk about Band of Blades.Sam: Hell yeah. What is Band Blades?Thomas: Band of Blades is a sort of dark fantasy military take on the forge in the dark framework. Sam: Yeah. A band of Blades kind of play on Band of Brothers is where the name is coming from. Right?Thomas: Yeah, I, I assume it is a play on that, but it is also different enough from that show that I don't think people should use it as a touchstone. The premise of the game is that you play The Legion, which is an army that has just lost the decisive battle for the fate of humanity.There is an undead horde that is an existential threat to humanity. And we fought that battle and we lost it. And now the legion is in retreat. And it ends up being a kind of a point crawl where you're retreating from the location of the battle to a fort where you hope you can hold up there and figure things out and, you know, other pockets of the legion might end up there as well and that could be the last stand.Sam: Yeah. So we, before we get into specifics of what mechanic you brought from this I just wanna say, first of all, this game has like six different mechanics in it that I would be excited to do episodes on. Like truly there's so much innovative design in this game.And also I. I, I think it's okay. Like, I think it's a great game that was like an okay experience for me. It was like a little dark, like parts of it didn't quite, quite fit with me. Like, my experience with Band of Blades was that I'd started running a campaign in January of 2020 and it was going okay. We were like, kind of getting a feel for it when you know uh, March happened of 2020 and we were all like, this might be a little crunchier and darker than like, we wanna play right now.And I, I never really felt like it was something I was super drawn back to because I prefer a little bit more at that like minimalism level and there's, there's just so much game in this game but I, I really love so much of, of the innovation that went into this game.Thomas: I, I also think that this game is extremely innovative, like has, really interesting design. I think Off Guard Games, uh, Stras and John kind of have done so many interesting things that I am constantly coming back to it and learning stuff about design and like getting inspired by it. I ran, I think this is probably 2021. I, I ran the whole campaign uh, sort of reskinned for Malazan: Book of the Fallen and kinda set in that world if that, which, you know, I'm a big fan of that series. It's also sort of military fantasy and we ran the whole campaign and I, I really enjoyed it. I think it is, yeah, it does have some crunch. It does have some darkness, but I think it kind of balances it out really well for me. And yeah. I'm, glad we picked this one because this is in the spirit of taking something small that is not particularly discussed in the text and then kind of exploding it like, this is a great choice. Sam: Yeah, totally. So let's get into it. So what mechanic specifically did you bring?Thomas: So, yeah, we are gonna talk about secondary missions which I think in the text might be, you know, a page at most. And the idea is that like Blades or other games, one of the phases of play is a mission phase where you are going to take your player character and go out and do a mission that is going to help the legion.And then you come back and there's a second mission. There's a second mission that is other members of the Legion people you aren't controlling, what they did while you were out. And that is resolved with one dice roll. It's basically just the engagement roll. It's the same procedure as the engagement roll for the primary mission. You're gonna roll that engagement role and then just based on the result of that, of that one role, you're going to narrate how the secondary mission went. And yeah, it often goes really badly.Sam: Yeah, I mean, you have to do really well for like many people to not die. And band of Blades like has troupe play, so you're constantly rotating between characters. So you're often like sending out some of your faves onto this secondary mission. And whether or not they fucking die is gonna be determined by a single die roll.It's, it's hardcore.Thomas: It is. It is. And you know, I think it brings in that... like a war game needs to have a certain level of gravitas. And I think that's what the secondary mission is, is bringing.Sam: Yeah, totally. So, yeah, why did you bring this? Like what is it specifically about this that really made you wanna bring it on the show to talk?Thomas: Okay. So I have not seen a mechanic like this in another game. That isn't to say that it doesn't exist, but my experience of the secondary mission was that we would go on this primary mission ,and because this is a forged in the dark game, like our characters are awesome. We are going to go up against impossible odds and we are going to somehow, pull success out of the jaws of victory. And we are going to come home battered and bruised, but triumphant.And then we come back. And then we'd roll the secondary mission and we'd be like, fuck. War is hell. War is hell, and we can't save everybody. And it was often really powerful moments that led to things like, people like talking about like mourning and like how, you know, a character just died. Like how do we, how do we respond to that? Like what are the traditions around that stuff? Like in the Legion, it led to some really great moments. Yeah.Sam: Yeah. Another thing that it does with that sort of, you go off and like kick ass, then you come back to camp, is it gives you that feeling of you can't be everywhere at once. Like the Legion is bigger than just your playgroup. Like what? Any four of you, they're out on a mission or whatever. That there's all of these other people, like both doing their best and succeeding at times away from you and coming back victorious, but also often failing without you, and you just have to... it, it makes you feel small in this way that I think is really appropriate to that war setting.Thomas: Yeah. Yeah. I think through play is again, one of those other things that we could have been talking about today. And this is, yeah, it, it slots into troupe play like really well. And what it does and what true play really does is it makes this the story of the Legion.Sam: Yeah,Thomas: Like every individual character is, their own saga, living and dying. They have all the humanity that we associate, you know, that we want to inject into them and all of that stuff. But the story is the story of this Legion, which is, something greater than any individual.Sam: Yeah. You know, I was just in the Dice Exploder discord, hashtag Dice Exploder discord, this afternoon. We were having this like long conversation about the crew sheet in Blades and whether or not it's effective at what it's doing. Because a lot of people I think feel like the idea of the cruise sheet is really great and also people get attached to their own characters and don't want to... like you're focused on your character. You're not focused on the crew in the way that like Blades, I think, wants you to focus more on the crew at least according to my reading of the text.And I think Band of Blades really succeeds through troupe play explicitly and through mechanics like secondary missions at really doing the thing you're saying at, at foregrounding the story of the legion of the crew more than any individual in it.And that's really impressive.Thomas: Yeah, absolutely. I think that sort of gentle confusion about Blades as priorities is a part of the text. I think John Harper leaves the door open for troupe play but is also like, you know, people like to play their characters. So I'm gonna, I'm not gonna take a strong stance on that.But Band of Blades is like, there's a role called the Marshall, and they decide who goes on the mission, and they decide who's playing who.And I'm like, amazing.Sam: Well, it's, another thread from this conversation from this afternoon was like, a lot of people feeling like a lot of the mechanics on the Blades crew sheet are a bit unnecessary or just like not their favorite or a little bit more like paperwork like, as opposed to the mechanics on the playbooks. And band of Blades actually, like this is another mechanic from this game we could have spent a whole episode on like it's dividing up like the GM role in some ways and like all of this paperwork stuff among different roles at camp that all the players get to play like the Marshall, like you're saying. But somehow like bringing in even more crunch to that the, that crew role basically it, instead of feeling like, oh my God, I'm like drowning in the crunch, it, it really does pull you up into that Marshall level, that bird's eye view of the legion as a whole, as opposed to being down with your individual guy or, or whoever.Thomas: Yeah. Yeah. I think, you know, in terms of GM load, Band of Blades is doing something amazing with that restructuring that we're talking about. And in that sense, the secondary mission roll is also a part of that because what, what the secondary mission does, it takes the pressure off you as the GM to drive home a kind of misery in the primary mission.Like if you as the GM are like, I'm playing a war story. I need to bring these elements of tragedy into it, like the primary mission, players should and can succeed. And because the secondary mission and the design of the game is going to help you hit those notes and that is such a huge relief that the game allows you to simultaneously be a generous and a fan of the players while still still able to experience those themes, you know.Sam: yeah, yeah. Yeah. Another thing I like about it is how the choice of what mission is going to be the primary mission, what mission is going to be the secondary mission. And sometimes you have like a third mission that you just can't do because you don't have the people and you automatically fail it.And that choice of which of these are we gonna prioritize is a really interesting choice every time. I think a lot of that theme that we've been talking about of this being a game of is clearly a game about war and making almost like resource choices almost that like the kind of cold math you have to do in war with human life, I think it, is really highlighted every time you have to choose what mission is gonna be primary and what's gonna be secondary.Thomas: Yeah, I think there are a series of games, especially video games that have this trend of what you're actually doing is you're playing the world's worst HR manager. You know what I mean? Like, like Darkest Dungeon is a good example, right? Like, you are just sending these folks into a bad situation and then you're like, putting them in a, in a bar a church and saying, deal with your stress and come out and then you go back in.And there is a certain kind of inhumanity in that, that that cold calculating thing that you're doing. And I think Band of Blades for me specifically does a better job of that than those games. Like there is in some sense because it's a role playing game. Like you are never really treating anybody as a pawn, like you're feeling their feelings. And it is always like this hard choice to be like, Um, the most common result of the secondary mission roll is the four to five, right? Like that is, you know, it's very common to get one to three, but maybe six. And the critical result is the only result in which nothing bad happens. So, on the four to five, you are given this difficult choice of saying either fail the mission and all the troops return unharmed, or you succeed the mission, two squad members die and all the specialists take some harm. Which are wounds.And what is interesting is while so much of the game is very clear about who makes what call - Commander, you decide whether the Legion moves. Marshall, you decide who goes on the mission - the question of how the table decides this call is not explicit. The only way for us to decide, you know, it isn't the Marsh's decision, it's we all sit and we go like, oh my God, if we succeed, who is dying? And everyone has to kind of like have that thing of like, I don't, I, I don't know. And sometimes it's fine. Like it's a really important mission. You're like, we have to succeed. But sometimes you are like, nah, let's, let's fail this. Like we can eat the failure, but you know, we can't lose people.Sam: I will not have my wonderful bug man die. Like I'm too in love. Like... and no, that's, that's a great observation about Not having a specific person make this choice, unlike a lot of the rest of the game. It almost feels like you all have to get your hands bloody in this choice. Like, it's not letting anyone off the hook. You all have to put your stab into the murder victim's back, like,Thomas: Oh, that is so good. Yeah.Sam: It's, yeah, no one gets to sit this one out.Thomas: Yeah. And yeah, often you fail and then you just feel that failure. And that's, in some sense, that's easier. It's, it's simpler. It's simpler than the four to five, likeSam: If everyone is just sad, at least they're alive. But like sometimes, sometimes also the mission is like save a small town from being eaten by zombies and you're like I mean, they're probably gonna die when the zombies get here anyway. We'll save our two guys. Let's, let's move on. Let's move on. And it's, it's like, it's hard. It's hard choices.Thomas: Yeah, it is. It is. I think that is... a lot of this game is supposed to be hard choices, but I think there are various kinds of hard choices. There's the tactical choices, which is, you know, a lot of the crunch of the game is like, let's make cool tactical decisions about, you know, setting us up for success when we reach our, our destination, which is Skydagger Keep.But a lot of the, the decisions are also just emotional you know, just in terms of like what narrative we want and we've talked about like not letting people die. There's also this moment of your like, I think it's this character dies and I think that is appropriate. I think there's a moment in the Band of Blades actual play on the Actual Play channel where I think they fail a secondary roll or they get a four, five or whatever and they, two, two characters just had a fight in the, in the previous session, in, in the downtime phase or whatever, and they're like one of them died and the other person is going to have to live with the fact that the last thing that they interacted with this person was a fight. Sam: Yeah. Thomas: You know, and I'm like, awesome.Sam: We touched on this, but I really wanna highlight explicitly how this mechanic forces you into the position of doing the math with human life, but it does it without dehumanizing people. That the exact moment you just described is always the thing that you're thinking about as you make this decision that largely comes down to numbers.I, I also wanna say like, I think fundamentally the most interesting part of roleplaying games, oh, story games for me is characters making hard decisions. And not just this mechanic, but this game is absolutely riddled with hard decisions. You also were just saying that, but I, I just think it's so cool to see a mechanic that is so explicitly and reliably, that's the other thing, reliably putting a hard decision in front of people.Thomas: Yeah. You can play Band of Blades and you will have the experience that this game wants if you're willing to engage with the game on its terms and like treat these characters like as people and all this stuff, which most people playing this game will do.But that hard decision stuff, like, yeah, I think it's perfectly fine to flag that that can become grinding down. Like I know some people, Paul Beakley, I think on the Indie Game Reading Club has an article about Band of Blades. He describes how at the end of the campaign, everyone was kind of tired. And that was not my experience, but I, I get it. Like, I guess, you know, that is something that can happen both thematically and mechanically Sam: Yeah, of course. Yeah. Yeah. That's like in a lot of ways that exhaustion I think is part of what the game is about.Thomas: But I, I mean, I think it's still supposed to be fun.Sam: Yeah. Yeah. It is. It is. And we did a whole episode in season one on The Watch. Right? Which is also, I think a lot about not like, can you win the war. But what is the cost of war? How do you live with the cost of war? And, and this is another game that is even more explicit about that, I think, than The Watch is, which is already pretty explicit about it.Like, you, you're not winning. You lost, like, what, cost are you gonna pay?Thomas: Yeah, I think if you are making a war game, you have to be really conscious about, you know, what you're saying about war. And yeah, both of these games, I think The Watch is, kind of using war as, as metaphor and Band of Blades is again, sort of like, very consciously stripping the glory out of this.Like, this is not that game. Which Band of brothers to some extent does have, right? It's, it's a show that it know, you know, war is awful, but like these characters are, are noble and brave and righteous and all of that to some extent. And this game is like, if we focus on the fact that it's a retreat, we can tell an interesting and sometimes under explored facet of war stories.Sam: Yeah, I should state for the record, I've never actually seen Band of Brothers, so I, I, I cannot actually speak to it, but but the, the other thing I wanted to just touch on in all that is just how brutal this game can be and like, very clearly and, and intentionally. And this particular mechanic as we've kind of discussed, I think is especially about brutality. Like when you fail, just three people die. And like several more are like critically wounded. Like you could just wipe out and every person who dies like Thomas: half a squad. Sam: And like the morale is hard to keep up in this game. And you fail one secondary mission and you're just, the whole legion is in so much trouble.It's a hard game. There's a, but you know what? You know what rule we really should have done a whole episode on is the single sentence in Band of Blades "this is a game you can lose." Like it's, yeah, it's a lot.Thomas: Again, like why is that sentence there? Why is this game that you can lose when role playing games usually aren't? And I think, again, that all flows from the decision to make a game about war. And you touched upon this adjacent mechanic, which is morale, which we should clarify that. Like, anytime a member of the legion dies, the legion loses morale and, you lose enough morale, you lose the game.Sam: Yeah. Yeah.Thomas: And other things also, but like yeah. Worse situation. Yeah. The game's over. And yeah, one failure can demoralize the squad in a huge way. And also like if you lose three squad members, a, a squad is like five people. They've lost more than half your squad. All your specialists are, you know, who went on the mission are beaten up. Yeah, it is. It is awful. And so what usually happens is that people will look at the primary mission and say, okay, we are going on this, so we failed the resource here. The fact that we are awesome and we can do stuff, let's load out the secondary mission with the best, best, you know, assets we can give it like Quartermaster, can we send them with like extra supplies? Like, you know what, what do we have to like, increase the odds there? And, and I think that is also like a kind of fun and meaningful choice. Yeah.Sam: There's something really nice in that, about how this mechanic is sort of indirectly encouraging you to be empathetic to that secondary squad. It's like, don't you love them? Don't you like feel for what they're about to go through? Like you should care about them, you should give them the extra ammo.Yeah, Is there anything about this mechanic that you have trouble with or that bumps you?Thomas: It can, if your primary mission has gone badly, it can be a second punch in the face. Like, I think, I think that is that is a thing. But otherwise nothing specifically that I can, that I can think of that is like an issue I have with it or I will change the design or something. Sam: Yeah. Thomas: Yeah. Sam: Another thing, look, one of the first things you said on this episode was that you've never seen another mechanic like this one. And I think that's a testament to how specific to the setting and genre and story that Band of Blades is telling this mechanic is.And I always love it. I love it when I see mechanics like that because I literally just before this recording, moments before this recording, wrapped up a forged in the dark Pirates campaign with one of my home groups where we just weren't using an established setting. We just like have played a lot of Blades and we were like, eh, I'll make up some special abilities and go. And it worked totally fine and for a lot of ideas I can just do that.But it, it takes. Like the new systems, the new games that are really interesting to me are the games that have mechanics like this one that are so bespoke, so tailor made to what this game is doing. And I really love that. I really really respect mechanics like that.Thomas: Yeah, and it is again a testament to band Blades, good design, and why I want to talk about, 'cause I think it's completely like under-discussed. I think we should all be talking about it all the time, is the fact that all of this is so like, enmeshed together. Right? In some sense the secondary roll is necessitated because forged in the dark is such an empowering framework for players.Right. Like, how do I tell a war story with this? And you, and you started that question and then something like this is almost, almost required. I would, I wouldn't have thought of it, but it does, it does like something like this is needed once you decide to go with this framework. And I think, yeah, it is, It does feel like something bespoke and tailor made that has then through play testing kind of integrated into everything smoothly and perfectly.Sam: Yeah. So after you've made the secondary mission roll and you've kind of determined the results of it, there's then this moment that the book encourages of you to sit at the table and sort of flesh out the story of what happened on that secondary mission. Like, you know what the goal of the mission was and you know how many people got fucked up and or died on the mission.But there's a lot between point A and point B there. So it kind of sets you up to devise this short story together of what happened on this secondary mission.And I think it does a good job of giving you enough handholds of what was the beginning and what was the end of that story, to kind of flesh it out such that it doesn't really need a framework of doing that in between. And that in itself is like pretty impressive to me.Sometimes you'll be given a mechanic as you're playing a game, like the game will present you with a mechanic where it, it has a little bit of that, like now draw the rest of the owl feeling to it. Where, where it's asking you to, fill in the blanks on something that it has not set you up well enough to fill in the blanks on. And this moment of fleshing out what happened on the secondary mission in some ways feels like drawing the rest of the owl, but in a way where like I feel empowered to draw the rest of the owl. And that's, that's cool.Thomas: And you know, one reason is that as a GM, before the Commander makes the decision of which is the primary and secondary mission, you fleshed out both equally, right? Like you have as much information on one than the other. So you're starting off in a good place, you're not taking it lightly.And then, yeah, when we get to the result, like there is this question like immediately that comes to mind of like, how did this happen? Like, you know we chose that as a secondary mission 'cause maybe we thought it was safer. And you know, we have to now, now sort of at the table discuss and figure it out because also we might be in the next primary mission playing the people who went on this mission, right?Like, we want to, we want to reflect the fact that, you know, I just broke my shoulder like last time and I'm coming like half patched up into this one. Stuff like that, like, yeah.Sam: Maybe we encountered like a new type of zombie for the first time. And so Thomas: Mm. Sam: that specialist is the only one who's seen that type of zombie before and that's gonna come up next time. They can be the person who's like Uhoh on the next mission and, and do that foreshadowing, but all that, all that.And they can also be like the person telling the horrible war story, like around the campfire, like the ghost story almost of what happened. That can be in itself, a cool downtime scene.Thomas: Yeah, I think that is actually a thing that comes up regularly often where you want to contextualize what happened on a mission to the other characters, not necessarily the players. So you wanna see it through one character's eye, like what they experienced and stuff like that. 'cause if you're going to limp home limp back to camp, you know, half your squad gone, people know it went horribly wrong. And you know, there is like, there is just this sense of like, you know, at some point we need to know why. And often it's at like the Commander Marshall level where, you know, you might role play like having a character debrief the senior officers going like, this is, this is what happened. And the senior officers had to sit around going, Yeah, it's our fault, you know, like, we made that call and we have to settle with it. Yeah.Sam: Yeah. Or like maybe you decide that one person who came back alive really was at fault and you hold a disciplinary meeting for them. Right? Like Thomas: Oh, wow. Yeah. Sam: Um, a specialist who comes back injured and carrying tons of guilt, like, yikes, I, let's do it.There's another line at the end of the procedure here that is, if any squad members died, ask someone what they remember most about one of them, which is really just like sticking a finger in the wound. Right. It, it, it's making sure if it wasn't clear enough already, like you are supposed to feel these deaths.Thomas: Yeah. Yeah. It is again, just and, and if people are sort of hearing this and going, oh, this is a bit, this is a bit much like I cannot overstate how much the primary missions can be just a joy, like a complete, like you can, you can be in this dark fantasy world of zombies. And you know, the humanity has lost the war.But like when you start a primary mission, like when I was playing it very often my players would absolutely flub the engagement roll. And they would start in like a desperate position and I'd really kind of revel in like, how screwed they were. And then they would just go, okay, flashback, this was the plan all along, this is the diversion. I'd be like, shut the.Sam: Flashback this, resist that. Yeah. I've got some explosives in my back pocket. It's all fine. There's, you, you say there's a broken themselves, one of the head zombies coming in to kill us? Like that's fine. We'll just collapse a church on their head. It'll be fine.Um, Thomas: We prepared for this all along.Sam: Yeah. Yeah. It's cool to have both of those dualities in the game, like to have the wild successes. 'cause that also feels like a part of war is like sometimes you do get those miraculous victories too.Thomas: Yeah, I will say that, and this is something that I'm still unpacking, but it can't be overstated how much culturally we have this fantasy, especially for young men of like the greatest destiny being that you gave your life on the battlefield, right? Like that you took a bullet for your comrade.Like that is such a powerful you know, cultural feeling, I think. So And it is hard to sort of have that feeling in games that don't, at the end of it, make you go, okay, yeah, I think we might have glorified war there.Sam: Yeah.Thomas: and it is this game this game lets you do that.So I am, I am going to unrelentingly recommend this to folks even though it can be dark. Like I think you have control of that dial to a huge extent. And you can You can make sure that this is a fun and pleasurable experience.Sam: All right. What mechanic from Band of Blades should I do an episode about next?Thomas: I mean, I think the immediate one that comes to mind is the idea of roles. That the one thing that players have continuity on is that they're either the Commander or the Marshal or the Quartermaster or optionally the spy or, and the Lorekeeper, I think.And yeah, they just, they just divide the GM role in a nice way. Primarily because like, those are now player responsibilities, right? It's the Marshal's responsibility to name every member in the squad as in when they need a name. It's not the GM's job, you know. And that you know, you might think that a small thing, but it's, it's a big thing.So I, I think that's an obvious other thing to kind of discuss all the ways in which Band of Blades gently and, sophisticatedly kind of divides that, GM experience.Sam: Yeah. It both distributes all the paperwork and bookkeeping that the GM or someone would have to be doing among several people so that no one person is fully responsible, and by doing so, it puts more hard choices into the hands of each player.Thomas: Yeah, and it also facilitates their mutual cooperation, right? Like when, when you have a sense of like, whose final call this is, like that doesn't mean you're not gonna discuss it. You're gonna discuss it and then someone has final call and you're going to respect that. And that does a lot for having straightforward and fluid like conversations.Sam: Yeah. Well maybe I'll have you back in a year or two uh, to do that one. Um, But uh, this was excellent. This was great. Thanks for for being here and talking about secondary missions with me.Thomas: Thanks so much. I am thinking about Band of Blades like all the time, you've just given me an opportunity to like talk about it, but if you had it, it'd just be me in my head thinking about it.Sam: Thanks again to Thomas for being here. You can find him on socials at chaibypost, C H A I B Y P O S T, but in my opinion, you're better off just subscribing to the Indie RPG Newsletter and the Yes Indie'd podcast. Links for all that in the show notes. As always, you can find me on socials at sdunnewold, bluesky, and itch preferred, and there's a Dice Exploder Discord! Come on by, talk about the show, and if you've backed the Kickstarter, claim your fancy pants roll. Our logo was designed by sporgory, and our theme song is Sunset Bridge by Purely Gray.Thanks, as always, to you for listening. See ya next time. This is a public episode. 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About ThomasThomas Hazel is Founder, CTO, and Chief Scientist of ChaosSearch. He is a serial entrepreneur at the forefront of communication, virtualization, and database technology and the inventor of ChaosSearch's patented IP. Thomas has also patented several other technologies in the areas of distributed algorithms, virtualization and database science. He holds a Bachelor of Science in Computer Science from University of New Hampshire, Hall of Fame Alumni Inductee, and founded both student & professional chapters of the Association for Computing Machinery (ACM).Links Referenced: ChaosSearch: https://www.chaossearch.io/ Twitter: https://twitter.com/ChaosSearch Facebook: https://www.facebook.com/CHAOSSEARCH/ TranscriptAnnouncer: Hello, and welcome to Screaming in the Cloud with your host, Chief Cloud Economist at The Duckbill Group, Corey Quinn. This weekly show features conversations with people doing interesting work in the world of cloud, thoughtful commentary on the state of the technical world, and ridiculous titles for which Corey refuses to apologize. This is Screaming in the Cloud.Corey: This episode is sponsored in part by our friends at AWS AppConfig. Engineers love to solve, and occasionally create, problems. But not when it's an on-call fire-drill at 4 in the morning. Software problems should drive innovation and collaboration, NOT stress, and sleeplessness, and threats of violence. That's why so many developers are realizing the value of AWS AppConfig Feature Flags. Feature Flags let developers push code to production, but hide that that feature from customers so that the developers can release their feature when it's ready. This practice allows for safe, fast, and convenient software development. You can seamlessly incorporate AppConfig Feature Flags into your AWS or cloud environment and ship your Features with excitement, not trepidation and fear. To get started, go to snark.cloud/appconfig. That's snark.cloud/appconfig.Corey: Welcome to Screaming in the Cloud. I'm Corey Quinn. This promoted episode is brought to us by our returning sponsor and friend, ChaosSearch. And once again, the fine folks at ChaosSearch has seen fit to basically subject their CTO and Founder, Thomas Hazel, to my slings and arrows. Thomas, thank you for joining me. It feels like it's been a hot minute since we last caught up.Thomas: Yeah, Corey. Great to be on the program again, then. I think it's been almost a year. So, I look forward to these. They're fun, they're interesting, and you know, always a good time.Corey: It's always fun to just take a look at companies' web pages in the Wayback Machine, archive.org, where you can see snapshots of them at various points in time. Usually, it feels like this is either used for long-gone things and people want to remember the internet of yesteryear, or alternately to deliver sick burns with retorting a “This you,” when someone winds up making an unpopular statement. One of the approaches I like to use it for, which is significantly less nefarious—usually—is looking back in time at companies' websites, just to see how the positioning of the product evolves over time.And ChaosSearch has had an interesting evolution in that direction. But before we get into that, assuming that there might actually be people listening who do not know the intimate details of exactly what it is you folks do, what is ChaosSearch, and what might you folks do?Thomas: Yeah, well said, and I look forward to [laugh] doing the Wayback Time because some of our ideas, way back when, seemed crazy, but now they make a lot of sense. So, what ChaosSearch is all about is transforming customers' cloud object stores like Amazon S3 into an analytical database that supports search and SQL-type use cases. Now, where's that apply? In log analytics, observability, security, security data lakes, operational data, particularly at scale, where you just stream your data into your data lake, connect our service, our SaaS service, to that lake and automagically we index it and provide well-known APIs like Elasticsearch and integrate with Kibana or Grafana, and SQL APIs, something like, say, a Superset or Tableau or Looker into your data. So, you stream it in and you get analytics out. And the key thing is the time-cost complexity that we all know that operational data, particularly at scale, like terabytes and a day and up causes challenges, and we all know how much it costs.Corey: They certainly do. One of the things that I found interesting is that, as I've mentioned before, when I do consulting work at The Duckbill Group, we have absolutely no partners in the entire space. That includes AWS, incidentally. But it was easy in the beginning because I was well aware of what you folks were up to, and it was great when there was a use case that matched of you're spending an awful lot of money on Elasticsearch; consider perhaps migrating some of that—if it makes sense—to ChaosSearch. Ironically, when you started sponsoring some of my nonsense, that conversation got slightly trickier where I had to disclose, yeah our media arm is does have sponsorships going on with them, but that has no bearing on what I'm saying.And if they take their sponsorships away—please don't—then we would still be recommending them because it's the right answer, and it's what we would use if we were in your position. We receive no kickbacks or partner deal or any sort of reseller arrangement because it just clouds the whole conflict of interest perception. But you folks have been fantastic for a long time in a bunch of different ways.Thomas: Well, you know, I would say that what you thought made a lot of sense made a lot of sense to us as well. So, the ChaosSearch idea just makes sense. Now, you had to crack some code, solve some problems, invent some technology, and create some new architecture, but the idea that Elasticsearch is a useful solution with all the tooling, the visualization, the wonderful community around that, was a good place to start, but here's the problem: setting it up, scaling it out, keep it up, when things are happening, things go bump in the night. All those are real challenges, and one of them was just the storaging of the data. Well, what if you could make S3 the back-end store? One hundred percent; no SSDs or HDDs. Makes a lot of sense.And then support the APIs that your tooling uses. So, it just made a lot of sense on what we were trying to do, just no one thought of it. Now, if you think about the Northstar you were talking about, you know, five, six years ago, when I said, transforming cloud storage into an analytical database for search and SQL, people thought that was crazy and mad. Well, now everyone's using Cloud Storage, everyone's using S3 as a data lake. That's not in question anymore.But it was a question five, six, you know, years ago. So, when we met up, you're like, “Well, that makes sense.” It always made sense, but people either didn't think was possible, or were worried, you know, I'll just try to set up an Elastic cluster and deal with it. Because that's what happens when you particularly deal with large-scale implementations. So, you know, to us, we would love the Elastic API, the tooling around it, but what we all know is the cost, the time the complexity, to manage it, to scale it out, just almost want to pull your hair out. And so, that's where we come in is, don't change what you do, just change how you do it.Corey: Every once in a while, I'll talk to a client who's running an Amazon Elasticsearch cluster, and they have nothing but good things to say about it. Which, awesome. On the one hand, part of me wishes that I had some of their secrets, but often what's happened is that they have this down to a science, they have a data lifecycle that's clearly defined and implemented, the cluster is relatively static, so resizes aren't really a thing, and it just works for their use cases. And in those scenarios, like, “Do you care about the bill?” “Not overly. We don't have to think about it.”Great. Then why change? If there's no pain, you're not going to sell someone something, especially when we're talking, this tends to be relatively smaller-scale as well. It's okay, great, they're spending $5,000 a month on it. It doesn't necessarily justify the engineering effort to move off.Now, when you start looking at this, and, “Huh, that's a quarter million bucks a month we're spending on this nonsense, and it goes down all the time,” yeah, that's when it starts to be one of those logical areas to start picking apart and diving into. What's also muddied the waters since the last time we really went in-depth on any of this was it used to be we would be talking about it exactly like we are right now, about how it's Elasticsearch-compatible. Technically, these days, we probably shouldn't be saying it is OpenSearch compatible because of the trademark issues between Elastic and AWS and the Schism of the OpenSearch fork of the Elasticsearch project. And now it feels like when you start putting random words in front of the word search, ChaosSearch fits right in. It feels like your star is rising.Thomas: Yeah, no, well said. I appreciate that. You know, it's funny when Elastic changed our license, we all didn't know what was going to happen. We knew something was going to happen, but we didn't know what was going to happen. And Amazon, I say ironically, or, more importantly, decided they'll take up the open mantle of keeping an open, free solution.Now, obviously, they recommend running that in their cloud. Fair enough. But I would say we don't hear as much Elastic replacement, as much as OpenSearch replacement with our solution because of all the benefits that we talked about. Because the trigger points for when folks have an issue with the OpenSearch or Elastic stack is got too expensive, or it was changing so much and it was falling over, or the complexity of the schema changing, or all the above. The pipelines were complex, particularly at scale.That's both for Elasticsearch, as well as OpenSearch. And so, to us, we want either to win, but we want to be the replacement because, you know, at scale is where we shine. But we have seen a real trend where we see less Elasticsearch and more OpenSearch because the community is worried about the rules that were changed, right? You see it day in, day out, where you have a community that was built around open and fair and free, and because of business models not working or the big bad so-and-so is taking advantage of it better, there's a license change. And that's a trust change.And to us, we're following the OpenSearch path because it's still open. The 600-pound gorilla or 900-pound gorilla of Amazon. But they really held the mantle, saying, “We're going to stay open, we assume for as long as we know, and we'll follow that path. But again, at that scale, the time, the costs, we're here to help solve those problems.” Again, whether it's on Amazon or, you know, Google et cetera.Corey: I want to go back to what I mentioned at the start of this with the Wayback Machine and looking at how things wound up unfolding in the fullness of time. The first time that it snapshotted your site was way back in the year 2018, which—Thomas: Nice. [laugh].Corey: Some of us may remember, and at that point, like, I wasn't doing any work with you, and later in time I would make fun of you folks for this, but back then your brand name was in all caps, so I would periodically say things like this episode is sponsored by our friends at [loudly] CHAOSSEARCH.Thomas: [laugh].Corey: And once you stopped capitalizing it and that had faded from the common awareness, it just started to look like I had the inability to control the volume of my own voice. Which, fair, but generally not mid-sentence. So, I remember those early days, but the positioning of it was, “The future of log management and analytics,” back in 2018. Skipping forward a year later, you changed this because apparently in 2019, the future was already here. And you were talking about, “Log search analytics, purpose-built for Amazon S3. Store everything, ask anything all on your Amazon S3.”Which is awesome. You were still—unfortunately—going by the all caps thing, but by 2020, that wound up changing somewhat significantly. You were at that point, talking for it as, “The data platform for scalable log analytics.” Okay, it's clearly heading in a log direction, and that made a whole bunch of sense. And now today, you are, “The data lake platform for analytics at scale.” So, good for you, first off. You found a voice?Thomas: [laugh]. Well, you know, it's funny, as a product mining person—I'll take my marketing hat off—we've been building the same solution with the same value points and benefits as we mentioned earlier, but the market resonates with different terminology. When we said something like, “Transforming your Cloud Object Storage like S3 into an analytical database,” people were just were like, blown away. Is that even possible? Right? And so, that got some eyes.Corey: Oh, anything is a database if you hold that wrong. Absolutely.Thomas: [laugh]. Yeah, yeah. And then you're saying log analytics really resonated for a few years. Data platform, you know, is more broader because we do more broader things. And now we see over the last few years, observability, right? How do you fit in the observability viewpoint, the stack where log analytics is one aspect to it?Some of our customers use Grafana on us for that lens, and then for the analysis, alerting, dashboarding. You can say that Kibana in the hunting aspect, the log aspects. So, you know, to us, we're going to put a message out there that resonates with what we're hearing from our customers. For instance, we hear things like, “I need a security data lake. I need that. I need to stream all my data. I need to have all the data because what happens today that now, I need to know a week, two weeks, 90 days.”We constantly hear, “I need at least 90 days forensics on that data.” And it happens time and time again. We hear in the observability stack where, “Hey, I love Datadog, but I can't afford it more than a week or two.” Well, that's where we come in. And we either replace Datadog for the use cases that we support, or we're auxiliary to it.Sometimes we have an existing Grafana implementation, and then they store data in us for the long tail. That could be the scenario. So, to us, the message is around what resonates with our customers, but in the end, it's operational data, whether you want to call it observability, log analytics, security analytics, like the data lake, to us, it's just access to your data, all your data, all the time, and supporting the APIs and the tooling that you're using. And so, to me, it's the same product, but the market changes with messaging and requirements. And this is why we always felt that having a search and SQL platform is so key because what you'll see in Elastic or OpenSearch is, “Well, I only support the Elastic API. I can't do correlations. I can't do this. I can't do that. I'm going to move it over to say, maybe Athena but not so much. Maybe a Snowflake or something else.”Corey: “Well, Thomas, it's very simple. Once you learn our own purpose-built, domain-specific language, specifically for our product, well, why are you still sitting here, go learn that thing.” People aren't going to do that.Thomas: And that's what we hear. It was funny, I won't say what the company was, a big banking company that we're talking to, and we hear time and time again, “I only want to do it via the Elastic tooling,” or, “I only want to do it via the BI tooling.” I hear it time and time again. Both of these people are in the same company.Corey: And that's legitimate as well because there's a bunch of pre-existing processes pointing at things and we're not going to change 200 different applications in their data model just because you want to replace a back-end system. I also want to correct myself. I was one tab behind. This year's branding is slightly different: “Search and analyze unlimited log data in your cloud object storage.” Which is, I really like the evolution on this.Thomas: Yeah, yeah. And I love it. And what was interesting is the moving, the setting up, the doubling of your costs, let's say you have—I mean, we deal with some big customers that have petabytes of data; doubling your petabytes, that means, if your Elastic environment is costing you tens of millions and then you put into Snowflake, that's also going to be tens of millions. And with a solution like ours, you have really cost-effective storage, right? Your cloud storage, it's secure, it's reliable, it's Elastic, and you attach Chaos to get the well-known APIs that your well-known tooling can analyze.So, to us, our evolution has been really being the end viewpoint where we started early, where the search and SQL isn't here today—and you know, in the future, we'll be coming out with more ML type tooling—but we have two sides: we have the operational, security, observability. And a lot of the business side wants access to that data as well. Maybe it's app data that they need to do analysis on their shopping cart website, for instance.Corey: The thing that I find curious is, the entire space has been iterating forward on trying to define observability, generally, as whatever people are already trying to sell in many cases. And that has seemed to be a bit of a stumbling block for a lot of folks. I figured this out somewhat recently because I've built the—free for everyone to use—the lasttweetinaws.com, Twitter threading client.That's deployed to 20 different AWS regions because it's go—the idea is that should be snappy for people, no matter where they happen to be on the planet, and I use it for conferences when I travel, so great, let's get ahead of it. But that also means I've got 20 different sources of logs. And given that it's an omnibus Lambda function, it's very hard to correlate that to users, or user sessions, or even figure out where it's going. The problem I've had is, “Oh, well, this seems like something I could instrument to spray logs somewhere pretty easily, but I don't want to instrument it for 15 different observability vendors. Why don't I just use otel—or Open Telemetry—and then tell that to throw whatever I care about to various vendors and do a bit of a bake-off?” The problem, of course, is that open telemetry and Lambda seem to be in just the absolute wrong directions. A lot.Thomas: So, we see the same trend of otel coming out, and you know, this is another API that I'm sure we're going to go all-in on because it's getting more and more talked about. I won't say it's the standard that I think is trending to all your points about I need to normalize a process. But as you mentioned, we also need to correlate across the data. And this is where, you know, there are times where search and hunting and alerting is awesome and wonderful and solves all your needs, and sometimes correlation. Imagine trying to denormalize all those logs, set up a pipeline, put it into some database, or just do a SELECT *, you know, join this to that to that, and get your answers.And so, I think both OpenTelemetry and SQL and search all need to be played into one solution, or at least one capability because if you're not doing that, you're creating some hodgepodge pipeline to move it around and ultimately get your questions answered. And if it takes weeks—maybe even months, depending on the scale—you may sometimes not choose to do it.Corey: One other aspect that has always annoyed me about more or less every analytics company out there—and you folks are no exception to this—is the idea of charging per gigabyte ingested because that inherently sets up a weird dichotomy of, well, this is costing a lot, so I should strive to log less. And that is sort of the exact opposite, not just of the direction you folks want customers to go in, but also where customers themselves should be going in. Where you diverge from an awful lot of those other companies because of the nature of how you work, is that you don't charge them again for retention. And the idea that, yeah, the fact that anything stored in ChaosSearch lives in your own S3 buckets, you can set your own lifecycle policies and do whatever you want to do with that is a phenomenal benefit, just because I've always had a dim view of short-lived retention periods around logs, especially around things like audit logs. And these days, I would consider getting rid of audit logging data and application logging data—especially if there's a correlation story—any sooner than three years feels like borderline malpractice.Thomas: [laugh]. We—how many times—I mean, we've heard it time and time again is, “I don't have access to that data because it was too costly.” No one says they don't want the data. They just can't afford the data. And one of the key premises that if you don't have all the data, you're at risk, particularly in security—I mean, even audits. I mean, so many times our customers ask us, you know, “Hey, what was this going on? What was that go on?” And because we can so cost-effectively monitor our own service, we can provide that information for them. And we hear this time and time again.And retention is not a very sexy aspect, but it's so crucial. Anytime you look in problems with X solution or Y solution, it's the cost of the data. And this is something that we wanted to address, officially. And why do we make it so cost-effective and free after you ingest it was because we were using cloud storage. And it was just a great place to land the data cost-effective, securely.Now, with that said, there are two types of companies I've seen. Everybody needs at least 90 days. I see time and time again. Sure, maybe daily, in a weeks, they do a lot of their operation, but 90 days is where it lands. But there's also a bunch of companies that need it for years, for compliance, for audit reasons.And imagine trying to rehydrate, trying to rebuild—we have one customer—again I won't say who—has two petabytes of data that they rehydrate when they need it. And they say it's a nightmare. And it's growing. What if you just had it always alive, always accessible? Now, as we move from search to SQL, there are use cases where in the log world, they just want to pay upfront, fixed fee, this many dollars per terabyte, but as we get into the more ad hoc side of it, more and more folks are asking for, “Can I pay per query?”And so, you'll see coming out soon, about scenarios where we have a different pricing model. For logs, typically, you want to pay very consistent, you know, predetermined cost structure, but in the case of more security data lakes, where you want to go in the past and not really pay for something until you use it, that's going to be an option as well coming out soon. So, I would say you need both in the pricing models, but you need the data to have either side, right?Corey: This episode is sponsored in part by our friends at ChaosSearch. You could run Elasticsearch or Elastic Cloud—or OpenSearch as they're calling it now—or a self-hosted ELK stack. But why? ChaosSearch gives you the same API you've come to know and tolerate, along with unlimited data retention and no data movement. Just throw your data into S3 and proceed from there as you would expect. This is great for IT operations folks, for app performance monitoring, cybersecurity. If you're using Elasticsearch, consider not running Elasticsearch. They're also available now in the AWS marketplace if you'd prefer not to go direct and have half of whatever you pay them count towards your EDB commitment. Discover what companies like Equifax, Armor Security, and Blackboard already have. To learn more, visit chaossearch.io and tell them I sent you just so you can see them facepalm, yet again.Corey: You'd like to hope. I mean, you could always theoretically wind up just pulling what Ubiquiti apparently did—where this came out in an indictment that was unsealed against an insider—but apparently one of their employees wound up attempting to extort them—which again, that's not their fault, to be clear—but what came out was that this person then wound up setting the CloudTrail audit log retention to one day, so there were no logs available. And then as a customer, I got an email from them saying there was no evidence that any customer data had been accessed. I mean, yeah, if you want, like, the world's most horrifyingly devilish best practice, go ahead and set your log retention to nothing, and then you too can confidently state that you have no evidence of anything untoward happening.Contrast this with what AWS did when there was a vulnerability reported in AWS Glue. Their analysis of it stated explicitly, “We have looked at our audit logs going back to the launch of the service and have conclusively proven that the only time this has ever happened was in the security researcher who reported the vulnerability to us, in their own account.” Yeah, one of those statements breeds an awful lot of confidence. The other one makes me think that you're basically being run by clowns.Thomas: You know what? CloudTrail is such a crucial—particularly Amazon, right—crucial service because of that, we see time and time again. And the challenge of CloudTrail is that storing a long period of time is costly and the messiness the JSON complexity, every company struggles with it. And this is how uniquely—how we represent information, we can model it in all its permutations—but the key thing is we can store it forever, or you can store forever. And time and time again, CloudTrail is a key aspect to correlate—to your question—correlate this happened to that. Or do an audit on two years ago, this happened.And I got to tell you, to all our listeners out there, please store your CloudTrail data—ideally in ChaosSearch—because you're going to need it. Everyone always needs that. And I know it's hard. CloudTrail data is messy, nested JSON data that can explode; I get it. You know, there's tricks to do it manually, although quite painful. But CloudTrail, every one of our customers is indexing with us in CloudTrail because of stories like that, as well as the correlation across what maybe their application log data is saying.Corey: I really have never regretted having extra logs lying around, especially with, to be very direct, the almost ridiculously inexpensive storage classes that S3 offers, especially since you can wind up having some of the offline retrieval stuff as part of a lifecycle policy now with intelligent tiering. I'm a big believer in just—again—the Glacier Deep Archive I've at the cost of $1,000 a month per petabyte, with admittedly up to 12 hours of calling that as a latency. But that's still, for audit logs and stuff like that, why would I ever want to delete things ever again?Thomas: You're exactly right. And we have a bunch of customers that do exactly that. And we automate the entire process with you. Obviously, it's your S3 account, but we can manage across those tiers. And it's just to a point where, why wouldn't you? It's so cost-effective.And the moments where you don't have that information, you're at risk, whether it's internal audits, or you're providing a service for somebody, it's critical data. With CloudTrail, it's critical data. And if you're not storing it and if you're not making it accessible through some tool like an Elastic API or Chaos, it's not worth it. I think, to your point about your story, it's epically not worth it.Corey: It's really not. It's one of those areas where that is not a place to overly cost optimize. This is—I mean we talked earlier about my business and perceptions of conflict of interest. There's a reason that I only ever charge fixed-fee and not percentage of savings or whatnot because, at some point, I'll be placed in a position of having to say nonsense, like, “Do you really need all of these backups?” That doesn't make sense at that point.I do point out things like you have hourly disk snapshots of your entire web fleet, which has no irreplaceable data on them dating back five years. Maybe cleaning some of that up might be the right answer. The happy answer is somewhere in between those two, and it's a business decision around exactly where that line lies. But I'm a believer in never regretting having kept logs almost into perpetuity. Until and unless I start getting more or less pillaged by some particularly rapacious vendor that's oh, yeah, we're going to charge you not just for ingest, but also for retention. And for how long you want to keep it, we're going to treat it like we're carving it into platinum tablets. No. Stop that.Thomas: [laugh]. Well, you know, it's funny, when we first came out, we were hearing stories that vendors were telling customers why they didn't need their data, to your point, like, “Oh, you don't need that,” or, “Don't worry about that.” And time and time again, they said, “Well, turns out we didn't need that.” You know, “Oh, don't index all your data because you just know what you know.” And the problem is that life doesn't work out that way business doesn't work out that way.And now what I see in the market is everyone's got tiering scenarios, but the accessibility of that data takes some time to get access to. And these are all workarounds and bandaids to what fundamentally is if you design an architecture and a solution is such a way, maybe it's just always hot; maybe it's just always available. Now, we talked about tiering off to something very, very cheap, then it's like virtually free. But you know, our solution was, whether it's ultra warm, or this tiering that takes hours to rehydrate—hours—no one wants to live in that world, right? They just want to say, “Hey, on this date on this year, what was happening? And let me go look, and I want to do it now.”And it has to be part of the exact same system that I was using already. I didn't have to call up IT to say, “Hey, can you rehydrate this?” Or, “Can I go back to the archive and look at it?” Although I guess we're talking about archiving with your website, viewing from days of old, I think that's kind of funny. I should do that more often myself.Corey: I really wish that more companies would put themselves in the customers' shoes. And for what it's worth, periodically, I've spoken to a number of very happy ChaosSearch customers. I haven't spoken to any angry ones yet, which tells me you're either terrific at crisis comms, or the product itself functions as intended. So, either way, excellent job. Now, which team of yours is doing that excellent job, of course, is going to depend on which one of those outcomes it is. But I'm pretty good at ferreting out stories on those things.Thomas: Well, you know, it's funny, being a company that's driven by customer ask, it's so easy build what the customer wants. And so, we really take every input of what the customer needs and wants—now, there are cases where we relace Splunk. They're the Cadillac, they have all the bells and whistles, and there's times where we'll say, “Listen, that's not what we're going to do. We're going to solve these problems in this vector.” But they always keep on asking, right? You know, “I want this, I want that.”But most of the feedback we get is exactly what we should be building. People need their answers and how they get it. It's really helped us grow as a company, grow as a product. And I will say ever since we went live now many, many years ago, all our roadmap—other than our Northstar of transforming cloud storage into a search SQL big data analytics database has been customer-driven, market customer-driven, like what our customer is asking for, whether it's observability and integrating with Grafana and Kibana or, you know, security data lakes. It's just a huge theme that we're going to make sure that we provide a solution that meets those needs.So, I love when customers ask for stuff because the product just gets better. I mean, yeah, sometimes you have to have a thick skin, like, “Why don't you have this?” Or, “Why don't you have that?” Or we have customers—and not to complain about customers; I love our customers—but they sometimes do crazy things that we have to help them on crazy-ify. [laugh]. I'll leave it at that. But customers do silly things and you have to help them out. I hope they remember that, so when they ask for a feature that maybe takes a month to make available, they're patient with us.Corey: We sure can hope. I really want to thank you for taking so much time to once again suffer all of my criticisms, slings and arrows, blithe market observations, et cetera, et cetera. If people want to learn more, where's the best place to find you?Thomas: Well, of course, chaossearch.io. There's tons of material about what we do, use cases, case studies; we just published a big case study with Equifax recently. We're in Gartner and a whole bunch of Hype Cycles that you can pull down to see how we fit in the market.Reach out to us. You can set up a trial, kick the tires, again, on your cloud storage like S3. And ChaosSearch on Twitter, we have a Facebook, we have all this classic social medias. But our website is really where all the good content and whether you want to learn about the architecture and how we've done it, and use cases; people who want to say, “Hey, I have a problem. How do you solve it? How do I learn more?”Corey: And we will, of course, put links to that in the show notes. For my own purposes, you could also just search for the term ChaosSearch in your email inbox and find one of their sponsored ads in my newsletter and click that link, but that's a little self-serving as we do it. I'm kidding. I'm kidding. There's no need to do that. That is not how we ever evaluate these things. But it is funny to tell that story. Thomas, thank you so much for your time. As always, it's appreciated.Thomas: Corey Quinn, I truly enjoyed this time. And I look forward to upcoming re:Invent. I'm assuming it's going to be live like last year, and this is where we have a lot of fun with the community.Corey: Oh, I have no doubt that we're about to go through that particular path very soon. Thank you. It's been an absolute pleasure.Thomas: Thank you.Corey: Thomas Hazel, CTO and Founder of ChaosSearch. I'm Cloud Economist Corey Quinn and this is Screaming in the Cloud. If you've enjoyed this podcast, please leave a five-star review on your podcast platform of choice, whereas if you've hated this podcast, please leave a five-star review on your podcast platform of choice, along with an angry, insulting comment that I will then set to have a retention period of one day, and then go on to claim that I have received no negative feedback.Corey: If your AWS bill keeps rising and your blood pressure is doing the same, then you need The Duckbill Group. We help companies fix their AWS bill by making it smaller and less horrifying. The Duckbill Group works for you, not AWS. We tailor recommendations to your business and we get to the point. Visit duckbillgroup.com to get started.Announcer: This has been a HumblePod production. Stay humble.

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In this episode, moderated by Dr. Alissa Thomas (University of Vermont), patient caregiver Ms. Sandra Klima, hospice and palliative medicine physicians Dr. Gregg VandeKieft (Providence Institute for Human Caring) and Dr. Frank Ferris (Ohio Health), and medical oncologist Dr. Charles Blanke (Oregon Health and Science University) exchange perspectives on medical aid in dying, including legal, ethical and practical aspects. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org.   TRANSCRIPT Dr. Thomas: Hello, and welcome to the ASCO Education podcast series. My name is Dr. Thomas, and I'm a Neuro-oncologist at the University of Vermont Medical Center, and  Associate Professor in the College of Medicine in the Department of Neurological Sciences in Burlington, Vermont. As today's host, I will be moderating a discussion on medical aid in dying with four guest speakers, Dr. Gregg VandeKieft, who is a Palliative Care Physician, Clinical Ethicist and Executive Medical Director at Providence Institute for Human Caring in Olympia, Washington. Dr. Charles Blanke, a Medical Oncologist and Professor of Medicine at Oregon and Health Sciences University in Portland, Oregon. Sandra Klima, who is the partner and caregiver of a patient who passed away using medical aid in dying in Vermont. And Dr. Frank Ferris, who is a hospice and palliative medicine physician, as well as executive director of Palliative Medicine Research and Education at Ohio Health in Columbus, Ohio.     For consistency during this talk, we'll be using the term medical aid in dying or MAID to refer to death with dignity and physician-assisted dying. So, to begin the discussion, I'd love to hear from Sandra about your perspective as a caregiver. Can you share with us what it was like caring for your partner and what your reaction was when you learned about his wishes?  Sandra Klima: Yes. Thank you. I'm glad to participate. My partner had died of glioblastoma in April of 2018. When we found out, it was pretty shocking. The very first thing he brought up was Act 39. And initially I was very surprised and uncomfortable with it because I didn't want to think about death, I wanted to think about living. And he was very quick, Rob was very quick. We made an appointment at the funeral parlor. He wanted to get everything taken care of quickly. So I was shocked that he wanted to use Act 39. I did not feel that it was, as I said, appropriate to talk about, but he explained he had a friend who had glioblastoma and she did not take that action.  And she kept a diary and he said it was very difficult to read. And he did not want to go through that process that she went through. He didn't want to lose who he was. He wanted to die as himself instead of a short time later as a lesser person. And wanted the choice, and Act 39 gave that to him. And I respected and supported his decision once we talked about it. Cancer is a progressive disease and there comes a time when you will not be in control. Facing that and knowing it only goes downhill is scary. So having the option that looked out before the end phase is a blessing, and it is death with dignity, and that's how it feels to me.  Dr. Thomas: Thank you so much for sharing that experience. This has been a hot topic and I'd love to hear from our panel, what are some of the common misconceptions around medical aid in dying, and how is this different from concepts like euthanasia or assisted suicide?  Dr. VandeKieft: Well, for starters in the United States, all the states that allow aid in dying require the person to self administer the agent. So it's not euthanasia where somebody else administers the lethal agent. Our neighbors to the north in Canada actually do allow voluntary euthanasia and about 90% of their aid in dying individuals do it by voluntary euthanasia as opposed to self-administration. Another misconception is that it is heavily targeting the most vulnerable and disenfranchised, when in fact data from Oregon and Washington really indicate that it's mostly the well-educated, economically privileged who tend to utilize the aid and dying acts. And so there's actually been some questions in recent years about equity in rural areas and for other people who have difficulty accessing aid in dying,  Dr. Blanke: I'd love to reinforce that point. So, the Oregon data suggests that 74% of participants have at least some college, and almost 99% actually have medical insurance, although getting the insurance company to actually pay for the drugs is a different issue. I'd like to also suggest that opponents of death with dignity say that it violates the Hippocratic Oath, which I do not believe it does. Death with dignity deaths make up a tiny minority of overall deaths in any of the states where it is legal, and a good chunk of patients, somewhere between 30% and 60%, get the prescription and never even take it. So, I like to say that the act fights out of its weight class. A lot of people get the power and control of having that medication, but never actually need it.  Dr. Thomas: I understand there are a number of safeguards within the law to try to protect patients and help access and protect physicians. Would you be able to touch on the safeguards?  Dr. Blanke: I'll start there if okay, and most of the other states have modeled their law after Oregon's. So first the patient has to make multiple requests over time. They have to demonstrate a continued interest in death with dignity, and the law has built in cooling off periods. The patients have to clearly understand what will happen if they actually take these drugs, and what happens in 99.5% of cases is they will die as a result. The patients have to put in a witnessed written request for medications, and one of the witnesses cannot be related by blood or marriage, cannot be the patient's doctor, and most importantly can't be in a patient's will. They cannot have a financial interest in the death. So I think those are very reasonable patient safeguards.  Dr. VandeKieft: One exception I would call out is the state of Montana, which did not actually pass the legislation or a voter initiative to legalize aid in dying. But it was a state Supreme Court decision that said it was unconstitutional to prohibit it. So they actually don't have a regulatory framework in place, but they do offer protections to physicians. If they participate, they cannot be prosecuted. But all the other states in the US that have laws have a regulatory framework, much like Dr. Blanke just described.  Dr. Thomas: That's really helpful for the legal ramifications. What are the main ethical considerations around medical aid in dying?  Dr. VandeKieft: If you think of the classic ethical framework, autonomy tends to drive a lot of the conversation, that is the patient's right to self-determination. If they choose to pursue aid in dying, even if we morally disagree with the appropriateness of it, is it our position to prohibit them from following through with it? But then many others will also look at the concepts of beneficence, that is the obligation to do good for our patients, and non-maleficence, that is the obligation to not do harm for our patients. And people on both sides of the arguments will invoke those terms. People who oppose it would say the good is to prolong life. People who support it would say the good is to give people the right to choose the best quality of life and self-determination. People who oppose would say that the death, if it's self administered is actually a harm. The supporters would say the harm is making a person suffer, when in fact they have the potential to cut that suffering short on their own terms.  And so those ethics discussions tend to get into it fairly significantly, particularly around the public policy and social aspects. And then finally, at least within the health system I work, we've really shifted our focus away from a lot of the high-level legal and ethical debates and into what do you do for the patients who request it, and how do we make sure that there's non abandonment, accompaniment through the end of life, and that we seek out the reasons that they asked about aid in dying in the first place, and figure out how we can best serve the concerns that raised the question?  Dr. Blanke: I would love to actually strengthen that last point that Dr. V just brought up. A lot of patients use up three months of their expected six months survival barely finding me. Because what happens is they went to their primary provider, asked for death with dignity. Their physician says, "I don't do it. I don't know anybody who does. Good luck with it." This is a legal option in the state of Oregon, as well as about 11 other states. And the question as to whether or not providers have the obligation to at least refer, is a strong ethical point. A lot of the state's statutes say they can't hinder referral. They have to supply records if the patient asks for it, but I'm not aware that any of them have mandatory referral. And I think the physician is ethically obliged to offer that possibility, even if they don't want to write a prescription, which of course is totally okay.  Dr. Ferris: And if I might comment, I think the other obligation here is to, for the patient, particularly with cancer, but with anybody with any diagnosis who might be choosing this pathway is to ensure that they've had very early referral for palliative care services. That all their symptoms, any issues that are causing suffering are actually being addressed. And that as you have suggested, that they are clearly accompanied by somebody without bias, who understands how to unwrap and provide counseling in all the different realms psychological, social, spiritual counseling, to make sure that they and their families or their partners are in a really good place. Everybody's comfortable with the choice. The family lives on after a situation like this, and they need to have been comfortable with that. That the choice was the appropriate one for the person, and that what we're doing is we're respecting that person's choices and they're comfortable with it.  Dr. Blanke: I totally support that. The flip side of the coin is none of the states really say what to do if you are unable to offer death with dignity. They don't certainly mandate palliative care. I see a number of patients who really don't have terminal illnesses, or they have terminal illnesses that they are not expected to die within the mandatory six months. And I think we should ask ourselves, why are they seeking death with dignity? We have to ask ourselves, "Should we be referring these patients for psychiatric care?"  Dr. Ferris: Well, and if I could come back and emphasize that, I think oncology broadly has frequently had late referral patterns to palliative care services. I've got story after story, I'm a radiation oncologist by background, having done palliative care for the last 35 years. Even in the last couple of weeks, students learning with me have said, "We tried to get referrals and the oncologist wouldn't refer. Is there anything wrong with having a partnership?" So, the oncologist continues to do their wonderful work, at the same time we're managing the patient's experience and that people understand all their options, of which this is one of them, and they have a legal right to that in 11 states, so that we do the best possible care for people.  Dr. VandeKieft: I want to amplify your point. Dr. Ferris, if people choose aid in dying as the culmination of excellent palliative or end-of-life care, that's a very different scenario than if they're choosing it in lieu of palliative care because they don't have access. And so anybody who has access to aid in dying certainly should have access to the highest quality palliative care and hospice care and behavioral health, as Dr. Blanke pointed out, to make sure that they aren't despairing for something that could be treated more readily.  Dr. Ferris: And if I could add one more point, I think there's also a palliative care evangelist who says, "Well, if you just do this a little longer, everything's going to be wonderful." Except that we haven't made a difference. We as a community need to recognize when that's the case as well. So none of us are perfect, but it's the making sure we're a really comprehensive team and able to walk with people and honor and respect their choices.  Dr. Thomas: Thank you. We've spoken a lot about some of the logistics and legal and ethical aspects. I'd love to hear about what the experience is actually like. What are the barriers that patients face when they're trying to seek out medical aid in dying? We have a caregiver here who directly experienced this. How was it trying to access this and are their barriers either individually or systemically?  Sandra Klima: When Rob made his choice, we obviously had to go to the physicians and do the two interviews and get the approvals and wait the days in between and sign all the forms. But eventually we got to go pick up this medicine. But there was one pharmacy that had the medicine. We went, made a drive there. It was far from where we were. So we went over there. We had to plan it to be when there was a physician there who would give us the medicine. So that kind of struck me as strange. So you had to schedule everything and then you get there, and I don't know if it was my paranoia or what, but you feel like everyone's looking at you from behind the counter like, "Oh, you are the people coming to get that medicine?" And it was really just a little uncomfortable.  And you feel like you were almost doing something illegal. So that is the pressure I felt during that process about that. The only other piece is once you start this process in motion, we had the hospice people and the palliative care people contact us. We had several meetings with them. We talked about it with our cancer counselor, so I was very comfortable. And most importantly, Rob was comfortable to get the medicine that he would have to take and have it with him. It gave him peace of mind. It gave him freedom to enjoy his life.  Dr. Blanke: I'll add a few practical matters. The states that have death with dignity mandate that the patient takes it through their GI tract. That usually involves swallowing. We have a number of patients who are unable to swallow, or they have GI obstruction. They're allowed to take the medication through their rectum, although that eliminates a lot of the dignity from death with dignity. But we are not allowed to use intravenous formulations. Even if the patient self-administers. We also have patients and patients with Lou Gehrig's disease or amyotrophic lateral sclerosis make up about 11% of death with dignity users. Many of those patients do not have the use of their limbs. I had one young lady who was nearly completely paralyzed. She could move her head and she could move the pinky of one hand. And I spent somewhere north of four hours simply figuring out how she could fulfill the law by self administering a drug.  Finally we put in an NG and she was able to press a syringe plunger while I held a syringe, legal in Oregon, with that single pinky. I think the law is incredibly discriminatory against people with disabilities in the interest allegedly of protecting them. Next issue is we talked about the written request, which I do think offers safeguards, but sometimes it's hard. If patients want confidentiality, which the law allegedly is interested in, they may not want their neighbor to know that they're going to do this and they may not have somebody who is able to sign the form. Finally, we have talked a little bit about finding a participating provider. That continues to be an absolutely huge barrier, particularly because it's not just one provider, it's a prescribing physician and a consulting physician. They have to find two doctors, and if they're in say a Catholic health system or they're at the VA, sometimes it's nearly impossible for them.  Dr. VandeKieft: Loop back to Miss Klima's comment about the peace of mind that her partner experienced, and note that sometimes even just the conversation provides that. I've had numerous patients who brought the topic up, and they weren't actually asking for requests. They were just seeking information or in one instance, trying to let her family know how badly she was suffering and bringing this up was a way of demonstrating that to them. But I had a patient with ALS who brought the question up. The fact that I accepted it, spoke back to her in a respectful and supportive manner, provided her some relief.  But then when the doctors from End of Life Washington, the advocacy group who can help provide support to people in the home, came out and visited her, she responded that it alleviated her anxiety and her depression, didn't resolve them, but eased them. And that also she learned that she didn't have to act as early as she thought she would have on her own. And so I kind of jokingly said, "So meeting with doctors may have actually prolonged your life." And she laughed and said, "You know, doctor, it did, because I would've done it earlier if I hadn't met with them."  Dr. Ferris: If I can speak to what you just said back in the era of HIV and AIDS, when we had very little, I cared for more than 1,000 people out in the community. And I would say more than 60% of them asked me that question of when they got to a spot of intractable suffering, when I hastened their death. And of course that was illegal in those days. But what I was clearly able to do, is talk about palliative sedation for them, to be clear I would look after them, clear I would look after their families. And just as you have suggested, I think one of the huge issues is, "I have an option. I have an alternative here. Somebody is going to look after me. And if I've decided, if I'm going to go to medical aid in dying, if I'm going to go the palliative route, I don't have to experience the horrible part that I don't want to experience."  We need to talk about both of these openly with people, and be clear that they and their families will be accompanied in whatever the process and as you've suggested, without judgment, maintaining confidentiality. These are super important issues for people. I think about my own personal future, these things loom. I think it is people with lots of thoughts about what might happen, maybe a bit too much knowledge, who worry about the intractable nature of suffering, whatever it is, whether it's psychological, physical, spiritual. It's being able to accompany people appropriately and respect their choices.  Dr. Thomas: Right.  Dr. Blanke: So I'd like to add one more practical detail. We talked a little bit about finding providers and how difficult that is. And if you think about the challenge of finding two providers in Portland, you have to multiply that by about 100 to find any providers in Klamath Falls or Eastern Oregon. The good news is telemedicine has made our lives and the lives of our patients quite a bit easier.  Dr. Thomas: As I listen to the conversation, I'd be curious about your thoughts about health equity issues around this. You've alluded to the fact that somebody who has physical or neurologic disability may have challenges depending on where you live. It may be challenging to access. Are there other populations of patients where you worry about health equity and access to medical aid in dying?  Dr. Blanke: Well, I can comment that most of the patients find me or my colleagues who provide this through web searches. So, they have to have access to computers, which is not necessarily all that easy for all the rural residents of Oregon. Even though I told you that 99% of patients have insurance, we also mentioned that getting the insurance company to pay for the drug is very, very difficult. Hospice almost never wants to pay for it for the usual hospice- related reasons, and the drugs are about $700 in Oregon. That is a hindrance to a lot of my patients.  Dr. VandeKieft: I think being mindful of historic disenfranchised communities, people of color, Native Americans, that the healthcare system has not always treated fairly historically, and they have reasons to be suspect at times. Now this is something that usually they will seek us out as opposed to the healthcare system promoting it, but just being sensitive to the fact that we're doing something that could be perceived as problematic by communities who have historically been mistreated by the health system as well as other systems.  Dr. Thomas: I'd like to just have a better understanding of residency and the law. I think that there is written into most of these laws, you have to be a resident of the state where medical aid in dying is available. But what does that mean to be a resident, and how do states define that?  Dr. Blanke: So for us in Oregon, it's not like the classic situation where you have to demonstrate that you have a driver's license or you have to produce a gas bill in your name. The statute basically allows the prescriber to define residency in their own mind.  Dr. Thomas: What advice would you give to oncologists and other physicians who might have patients approach with questions about this? How do you talk with patients about this matter?  Dr. VandeKieft: The very first thing I respond to is... This is a very important question. I appreciate that you brought it up and that you have the [inaudible 00:20:35] and trust in me to raise the topic. But before I get into the details, I'd like to learn more about what led you to ask me about it. Would that be okay? And even that last phrase, would that be okay as intentional and that by asking permission, I'm making sure that they have agency, and demonstrating respect to them. But that approach has made a huge difference in that I have learned on many occasions, people have no intent of actually proceeding with it. As I mentioned earlier, they may simply be asking for information.  One gentleman, his response was, "Well, my buddies told me about it, and I didn't even know that was a law. And when I started to explain it, he said, oh, that sounds too much like suicide. I would never do that. And then the other woman, I referenced, she went through it and then looked at me and said, “Doctor, I would never do it.”, and looked at her daughter and son-in-law, “I just want my family to know how badly I'm suffering.” And so starting with that open-ended question is really crucial because if we make assumptions and if we start projecting our own biases onto them, we may completely miss what they're looking for and the opportunity to provide them the best services that we could.  Dr. Blanke: If I merely mention that this is an option, the patient is going to think that I'm recommending it, and I certainly don't see it that way. It's just one of many options. If we offer chemotherapy, we are not mandating that particular drug or even suggesting they get chemotherapy at all. Certainly, with the exception of palliative care, I recommend they seek that out, that I really want them to seek it out. But I think it's incumbent on the providers if they see a patient with a terminal illness to list this among the many options that are possible for the patient living in Oregon or those other 10 states. I know that's controversial.  Dr. Ferris: Well, I really want to highlight what you just said, Gregg, about the process of inquiry. To me, everybody practicing oncology, everybody practicing medicine needs to be able to model exactly the way you opened when asking any significant question, including prognosis, "When am I going to die? What about this therapy?" Because what we know, many of the times, patients aren't asking what the words specifically say, they're calling out their suffering and how can we help them? Or they've got a plan, they've got something they want to do. So that was beautiful modeling, Gregg.  Dr. VandeKieft: Dr. Blanke, he used that example of people not hearing. And one of the cases that I still struggle with a little bit, I work in a Catholic health system, so I'm not a participating physician. And we're really counseled that we shouldn't be the one to bring it up. And I had an elderly woman. I was doing a hospice home visit and she asked me how long I thought she had. And unfortunately, Dr. Ferris, I didn't think to ask her what led her to ask me the question on that occasion. And I probably should have, because I told her my prognosis and she looked at me with a profound look of disappointment and said, "I don't think I can suffer that much longer." And a couple of days later, she died very unexpectedly. She took an intentional overdose and the fact that I didn't inform her of the option of aid in dying still haunts me that I may have failed her.  Dr. Thomas: Thank you so much for sharing that. Ms. Klima, we've heard a lot from the experts. Is there advice you'd give patient to patient or caregiver to caregiver about what to ask your physicians?  Sandra Klima: You need to ask as many questions as you want and have the doctor answer you truthfully. I think when a patient is asking a doctor a question, they're asking the doctor, "What are my options?" I'm going to assume you're going to give me all the options. I'm not going to assume you're not going to tell me the options you don't like, because I want to know what are my options. I'm the one who's suffering. I'm the one who will have to make a choice. And I can tell you the choice Rob made, to use Act 39 in Vermont, was a blessing for us. It was a peaceful death that I cannot overemphasize. It was the right decision to make. It was for his decision, but it was the right decision to make.  And I think if a physician would not have told us of that option, I would be in the same situation that you felt, Gregg, where the lady took it upon herself. Because you thought through it, you had a plan, it was planned. It was a nice wind up to an ending. And I think that physicians owe it to their patients to tell them all of the options available and let the patient make a choice. I also think physicians owe it to the patient to be clear what the end phase of their life will be. Because it's not roses. If they don't do this, they have to live through that end phase, which sometimes it's horrific. And I think they need to have a clear understanding of what's to come and a clean list of all the options. And I think that should just be required, and personal choice of a physician is not on the table.  Dr. Ferris: So it's important that we explain all the options, I completely agree, that are available within the context of the law. And certainly in the Americas, in Europe, and I've been in many other countries where palliative sedation is one of those therapeutic options. Where the patients can have amnesia, the family can be well looked after. We need to describe all the available options that are within the law, in the jurisdiction in which we live. I completely agree.  Dr. Blanke: And I'll add that that actually also applies to some of the patients who want death with dignity, are suffering horribly but don't actually qualify because they have a chronic illness expected to live too long. I just saw a patient last week and we actually talked about VCED, the voluntary cessation of eating and drinking, which is something that many, many people fear, including providers, but if done properly is fantastic. She used VCED. She passed away. She died two days later and her family could not have been more thankful.  Sandra Klima: I'll chime in on that because the comparison between my father dying and Rob dying, it really just has an impression on my mind. My father did not have a diagnosis of X amount of months to live, but my father had chronic problems and he was suffering. And the death that I watched him go through and was with him for, was nothing like Rob's death. It wasn't peaceful. It haunts me today. It haunts me. My father should have been a candidate, but he wasn't. What was the point of living four more months in this miserable state?  Dr. Thomas: You know, it dawns on me that this is a very different kind of death. It is not suicide legally or medically. It's a different process than natural death from a terminal illness. And it's not even possible in every state or every country. And I imagine it is very different for the people who are left behind, for family members and caregivers to process this kind of death and bereavement after their loved one passes. Can you comment, Sandra, on how medical aid in dying affects the caregivers and affects the family and how you can prepare for bereavement and support in bereavement?  Sandra Klima: I felt that this death was anticipated, and my bereavement, the part that bothered me about Rob's end of life, was that I was unprepared for how quickly the decision was made. The decision was made quickly because he started getting paralyzed again on the side of his body. And he decided, "Today's the day." And it was three or four hours later, and it took me by surprise at how quickly the decision was going to be made. That's the only part I regret was I didn't have a strong enough plan about what was going to happen when that decision was made. That probably needs to be emphasized because you can plan all you want when it's not going to happen. But at the moment it happens, it's like a fire drill. You got to go through and get all those things lined up. And I can tell you, I felt worse for my father's death than I did for Rob's death. So even though it's a different kind of death, it was a peaceful death with dignity.  Dr. Blanke: In terms of the bereavement, I have seen all sorts of responses from patients' families initially, from those who could not be more supportive. Sometimes they even seem to want it more than the patient does, to those who actively oppose it. But in my experience, which now numbers about 205, the families are almost always on board at the end when they see how much the patient has been suffering and how much peace the actual control over the patient's life and death gives them. I always offer after the patient is gone to the family to contact me whether it's a week later or a month later, or a year later, if they have questions about the process, if they need any help in referrals. It's never happened a single time.  Dr. VandeKieft: I think back to the landmark article that Tim Quill published in the early 1990s about his patient, Diane, and how he highlighted that she ended up committing suicide. And there's kind of a shame, it's done in the shadows, and that when you have aid in dying as an option that can be brought out into a planned open manner in the way that Ms Klima is describing with her partner. And then also with the bereavement and the partners, I think we need to listen once again. I just had a case yesterday that somebody was telling me of a gentleman who got the prescription for aid in dying, but ended up not taking it and died of "natural causes."  His wife told the bereavement counselor afterwards, “That was such a relief because I was struggling terribly with the spiritual aspects of this. And I would've really had a hard time had he gone through with it.” She had not shared that with her husband or anyone else because she wanted to be so supportive of him. And it was only by the bereavement counselor, listening and opening up that she could really understand, "What are the true struggles that this family is going through and how can I meet their needs?"  Dr. Ferris: If I can comment, it doesn't matter whether people have chosen medical aid in dying. When people die, there's a loss for anybody who's a survivor. People can be comfortable with the process that occurred or not. They can perceive suffering or not. The loss leads to changes. And what we know is the transitions through the loss period that we call bereavement for different people are profound in different ways. And what we need to make sure is that people are connected with services. It's why with every patient I care for, whatever therapy provided, I do participate in ventilator withdrawal. I participate in palliative sedation. I've done this all my career. I make sure they're in the hospice system, in the United States, which provides people with 13 months bereavement support or more, because if a death occurs in a hospital without hospice care, then the patient gets a decedent phone call from the chaplain, if they're lucky, or they're lucky enough to have a physician like Dr. Blanke who says call me.  Most people don't make themselves available and you're out at sea. And we know that the suffering of a bereavement can lead to incapacitance, people depressed, not functional, people even get illnesses in the process. So there's a huge cost to society for not addressing this issue carefully. It's about the preparation, and what I try to do is get the bereavement conversation going before the person dies, so that we're talking about it and integrating it.  Sandra Klima: Right, I agree.  Dr. Thomas: Thank you all so much for this conversation. Thank you, Sandra Klima and Dr. VandeKieft and Dr. Blanke and Dr. Ferris. I think this was such an important conversation. Talking about death can be very difficult and I just appreciate the openness and sensitivity and your willingness to share these experiences. Thank you to all of our listeners. We appreciate you tuning into this episode of ASCO Education podcast.    Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.  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. 

Debbi Mack interviews crime fiction writer Thomas O'Callaghan. Check us out on Patreon: https://www.patreon.com/crimecafe Please join my fundraising team, DMV Dystonia, to raise funds for research on this rare movement disorder. Remember to pick that team when signing up! :) Debbi (00:54): But first, let me put in a good word for Blubrry podcasting. I'm a Blubrry affiliate, but that's not the only reason I'm telling you this. I've been using Blubrry Podcasting as my hosting service for my podcast for years and it's one of the best decisions I ever made. They give great customer service, you're in complete control of your own podcast, you can run it from your own website, and it just takes a lot of the work out of podcasting for me. I find for that reason that it's a company that I can get behind 100% and say, "You should try this." Try Blubrry. It doesn't require a long-term contract, and it's just a great company, period. It also has free technical support by email, video, and phone, so you can get a human being there. Isn't that nice? If you want to podcast, try out Blubrry. No long-term contract, excellent distribution, and great technical support, too, by email, video, and on the phone. I've included an affiliate link on this blog. Here's a downloadable copy of the interview. Debbi: Hi, again, everyone. Today, I have as my guest, the author of a series of thrillers featuring a New York City detective, Lt. John Driscoll. His work has been translated for publication in at least six countries outside the US. He's also a native New Yorker, so that's a plus because so am I. I'm pleased to have with me today, Thomas O'Callaghan. Hi, Thomas. Thomas: Hello, Debbi. Debbi: I'm so glad you're here today. Thomas: Yeah, nice to be here. Very nice to be here. Debbi: Awesome. I love your bookshelf there in the background. It's so neat and beautiful. Thomas: Thank you very much. Debbi: I wish my shelves were so beautiful. Thomas: Thank you. Debbi: What prompted you to write this series? Thomas: Interesting question. I never thought of writing. In college, I studied history and planned on perhaps going to law school. After that, I began working for an insurance company, Allstate Insurance Company, and I had a pretty good career with them, sales agent. Everything was going well and I figured I'd retire as a sales agent, only I didn't think I'd retire at the age of 49. They changed the way they paid us, and if I wanted to stay on, it meant I was no longer an employee, but I was a franchise agent and I had to pay for secretarial help and other support staff and whatnot. The option was to sell my book of business and leave or retire or stay on as a franchise, so I sold my book of business, and that carried me for about three years. Thomas: But at age 49, I needed something to do. I spoke to a friend of mine who had a similar circumstance. She asked me what did I like to do. If you're going to have a second career, it might be something you might like doing. I said, "Well, I like to take photographs." This was before the advent of the old iPhone. I had an old 35-millimeter camera and I went out and I snapped some pictures. I lived near Prospect Park in Brooklyn at the time and I snapped some pictures and I enjoyed it. Thomas: The enthusiasm waned after about a month and I said to her, I said, "Well, it's not a career choice." She said, "Well, what else do you like to do?" I said, "Well, to be honest with you, I always thought I'd be an actor." I wanted to be a thespian when I was in high school and in college and I performed in theater groups and I did some off-Broadway shows. I said, "That's what I'd like to do," so she recommended I go down and have some training because it had been a while and I went to HB Studios down in Manhattan and that was fun, two months working with a group of other actors and some professional trainers. Thomas: I enjoyed it very much, but again,

The best way to learn something is by doing, which is a lesson that Thomas Lotrecchiano's father taught him early on. Thomas and his father started Omigo together in 2018 as an alternate route to Thomas going to school for an MBA, and in the years since, that lesson keeps cropping up. Omigo is a DTC bidet company, and like many industry disruptors, its biggest challenge is educating the consumer base and converting skeptics into loyal customers. On this episode of Up Next in Commerce, Thomas explains how they have done exactly that by blending humor and educational content, building an infrastructure that allows them to ride the changing tides of demand, and by betting big on TV moving forward. Plus, Thomas shares some of the lessons he has learned from his father, who is an ecommerce gamechanger in his own right, having grown a small online business from a modest five employees to 250 in the early days of the industry.. Enjoy this episode! Main Takeaways:How Long Will It Take?: Getting consumers to adopt a new product, especially an intimate one, requires a great deal of education, patience, and listening. Just because your product works flawlessly and it has certain innate benefits doesn't mean that it will immediately be a hit. You have to invest in educating the consumer base and then listening to and incorporating their feedback into your products and messaging.Don't Overlook the Obvious: It's easy to fall in love with your product and spend time and money selling its unique features, but what actually makes people convert is if you can show them how to use it, how to install it, and lastly the value that can be derived from it. Those are the conversion areas that you should be laser-focused on, and highlighting any of the superfluous features can come later.Basic Building Blocks: There are three fundamental elements that DTC businesses need to start with before getting their company off the ground. They are: customer service, fulfillment, and a functioning, lead-generating website that has the ability to scale. Without these building blocks, your company is not ready to scale.For an in-depth look at this episode, check out the full transcript below. Quotes have been edited for clarity and length.---Up Next in Commerce is brought to you by Salesforce Commerce Cloud. Respond quickly to changing customer needs with flexible Ecommerce connected to marketing, sales, and service. Deliver intelligent commerce experiences your customers can trust, across every channel. Together, we're ready for what's next in commerce. Learn more at salesforce.com/commerce---Transcript:Stephanie:Hey, everyone, and welcome back to Up Next in Commerce. This is your host, Stephanie Postles, co-founder and CEO at Mission.org. Today on the show, we have Thomas Lotrecchiano, the co-founder of Omigo. How's it going, Thomas?Thomas:It is great. You nailed the last name. Perfect.Stephanie:Yes. I'm so happy. I was looking at that like, "Oh, can I do this one?" So many tricky names on this show, but I'm like a 50/50 shot at getting them right, so it's all right. So I'd love to hear a bit about Omigo. I saw it's a bidet company, which was very exciting to me, surprisingly, because I've been to Japan before, and I remember entering the airport and going into one of the stalls, and it closed and music started playing. They had this beautiful toilet. I couldn't hear anything. I was in my own little spaceship. And the toilet was obviously a great bidet, and so I'm very excited about the world of bidets, but I want to hear a bit about how you guys even got into this.Thomas:I love hearing about people's first bidet stories, and they're always so different. A lot of people talk about Japan. Some people talk about [inaudible] or having to use their hand, or bum guns in Southeast Asia, or the traditional ones in Italy, and not having any clue how to use them. Bidets, bidets. So it started when my dad rented a new apartment in Raleigh, North Carolina, and they had an electric bidet seat there, and it was just like the ones that we're selling now. Very similar. So it was his first bidet experience, besides the ancient extra fixtures you see in European bathrooms that you might want to wash your feet in.Thomas:And he didn't use it for a month. Wouldn't touch it. My mom loved it immediately. And so, after some time, he warmed up and he sat down, used it. Basically, I like to imagine an epiphany where he sat down and some angelic music played and lights lit up around him and his life was changed forever. He wouldn't stop talking about it. I had been exposed to bidets in Southeast Asia. A little bit different than what we're selling now. But that's how both of us kind of got our start with a bidet, but the company came from when my dad just would not stop talking about these Japanese toilet seats every family gathering, whenever I was with him, I lived in the same city as him, and it just wouldn't wouldn't end.Stephanie:Yeah. Yep. Once you get that experience, I feel like it's hard to go back. I know when I worked at the main campus at Google, they were everywhere, in every bathroom. And to me, that's such a foreign concept, but there's so many different people there, that was just part of the norm. And I would always have friends come and visit me and family come on campus, and after just me being like, "Go try it. Don't be scared. You're going to love it," it's like it was a conversation for the entire week afterwards. So it was very life-changing. I mean, what's interesting, too, about your guys' company is that you co-founded it with your dad. Which I think is a very fun story and I want to hear a bit about that, because I see he has a big background in ecommerce, as well, and had a company that went from 5 to 250 employees, which you were working at as a teenager. So I'd love to hear a bit of the background there and what it's like working with your dad.Thomas:Yeah, absolutely. Super accomplished guy. Really happy to be working with him now. So just kind of how he and I got started, I'll fast forward to. There was a time where I was choosing a career path after I had done two years of service in AmeriCorps, which is a nonprofit, national organization: NCCC. And we had known we'd always wanted to work together. We're very similar people and we get along. We have a lot of the same thought processes. And so, it came a time where this bidet epiphany had happened, and he said, "Hey, I know that you're thinking about going to school for an MBA. Instead of getting an MBA, we're going to start this business together. You're going to learn more. You're going to actually get paid instead of paying. And it's going to start a new career for you." And I was game-Stephanie:Smart dad.Thomas:Right? Very smart dad. I trusted him, I believed what he was saying, and I knew from all of those years' experience, like you mentioned, that I was going to learn a ton. And so, the business that you referred to that he took from five to... I forget how many hundreds of employees, was called Canvas On Demand. And so, it is a digital or physical image-to-canvas art company, and when he started it, you only really found that in Walgreens. And so, he took it to the ecommerce space, which was... In 2005, selling stuff online was weird. It wasn't huge yet. You were still going to the store, picking things up. But I want to reel back just a little bit more. He started Art.com. He purchased the Art.com domain-Stephanie:Domain?Thomas:And started selling... Yeah, selling posters in 2001 with a different company. And that kind of set him on this online trajectory. Then, he launched into this Canvas On Demand company, which yes, I worked at as a teenager every summer, every holiday, I was probably the eighth employee, technically. From the beginning, I've been working with my dad, and I've definitely watched him run his companies and I've admired what he's done from afar and up close for years now, so it's great to work with him.Stephanie:Yeah. Very cool. So what does the separation of roles look like for what your dad does and when he's like, "And this is for you to run on your own"?Thomas:Yeah, so I would say that my dad is the big picture guy. He is really good at thinking outside the box, pushing the brand, and making sure that everything is in the right place, and then my job is running the day-to-day. So running the store, managing all of our agencies and merchants, and working on [inaudible]. And I'm really in the day-to-day of Omigo.Stephanie:Cool. And how challenging has it been to bring this product to the US, sell people on the benefits? How do you even approach that marketing? Because I feel like unless you've really tried it, it's pretty hard to convince someone who's never even thought about it to be sold on a product like that. So how do you think about introducing people to this kind of new product? At least in the US still feels kind of new.Thomas:Yeah, it's shocking. I still have to convince my friends to try it. I run a bidet brand and it's still work to get people that know and trust me to sit down and wash their butts. Washing your butt is such a foreign concept here and it is maddening, because, like you said, once you try it, it's almost impossible to go back. You have to get some sort of bidet in your home. And we knew it was going to be a challenge, but we know that that fact I just stated, once you try it, you'll never go back, and it's such a better way, cleaner way to go to the bathroom, that it's just a matter of time before it catches on in the United States.Stephanie:But it's been a long time. That's my thing. These have been around for [inaudible]. How much more time do we need? What kind of [inaudible] are you going to get yourself out there? What kind of marketing are you going to use? Are you going to pull a Poo-Pourri and really go hard with the unicorn type of stuff? Or how are you guys thinking about educating and selling this idea?Thomas:Yeah. Well, you need multiple people in the space to start disrupting and pushing this kind of taboo idea in people's faces, and what we've done is we took an educational approach. No one knows what Japanese bidet toilet seats are, and so we have this awesome product that does all these great things, makes you feel amazing, super easy to install, and that's the tactic that we went with was letting people know that it's not intimidating. So we use plain language to describe the installation. We let you know exactly how it functions. And then, along the way, we're using a little bit of humor and that expressive "how it makes you feel" experience, and try to get that across in our visual and audio cues.Stephanie:Yeah. And what kind of formats have you seen do best? Where you're like, "Oh, this one video that centered around humor did better than a pure educational one." What are you seeing connect with people, especially in the marketing campaigns that you're running?Thomas:Yeah. So humor has been a big one for us. We have one called "Bidet, Mate," and it's an Australian man and he talks about if you stepped in a lot of dingo dung, you wouldn't wipe it off, you'd wash it. So use a little bit of humor there, but he's also explaining exactly how this great product works, so it breaks down that wall of, "This is gross. I'm not talking about poop. But poop is funny, so let's make jokes about it." And then it says, "Okay, we're here. We're talking about it. Now, look at this awesome thing. Toilet paper is disgusting. You're reaching down and you're wiping yourself, so why don't you wash instead?" And so, [crosstalk] a good one. And an accent.Stephanie:Any accents you can get into marketing I feel like will probably have a good ROI. I don't know. Don't measure me on that, but it seems like it would. All right, so you're using humor. I sometimes feel like humor can go both ways though. You've got one side that can work really well, like I was saying, like Poo-Pourri and then the Harmon Brothers do a bunch of ad campaigns all around humor and a lot of them have done really well. But then, it also seems like it can be like a short blip of people are excited about the Squatty Potty, and then it's like, "Is anyone still using that thing? What happened to it?" So how are you approaching that balance between funny but then also, "This is something that you're going to keep for a long time"?Thomas:Yeah. So humor's a great attention-grabber. So I make you laugh. It's a little bit funny. You're interested in the product, and then we also have educational, but kind of... So I'll say I am in a video with my dad on YouTube and it is called, "Our Founder Spot and Why We Founded Omigo," and it tells you basically this story, and then, it lets us explain the product without being funny. And we think it's approachable and educational and real, coming from real people, not actors, and that seems to do extremely well combined with that humor. So I agree. It could definitely be flash in the pan and we've done funny stuff that hasn't worked, but on that front end, getting people's attention, humor does seem to work really well for bidets, specifically.Stephanie:Yeah, and I think that authenticity is definitely key, especially around a product that people don't really understand. And yeah, I'm even thinking, how do you guys lean into maybe user-generated content? Which to me, if you see someone using it that is like you, you're like instantly, "I'll probably give it a try, because you're like me and if you like it, I probably would, too." But for something like this, are your customers even willing to talk about it and get the word out there and help spread the message?Thomas:Yeah, so we have seen a steady increase in our post-purchase survey for friends and family, word of mouth. And that's exactly where it comes from: people that you trust talking about such an intimate topic. So UGC isn't always something that I'm going to be showing on my website, because it's true, I'm not going to be able to get the everyday consumer to send me a video while they're on their bidet, talking about how awesome it is. But when we do use that approach, it's been in the influencer space. A lot of people look at influencers as people they trust, guides in their lives, people they aspire to live like. Whether you agree or disagree with how people portray themselves on Instagram or social media, it's still a place for aspirational content and to look at people and see what they're doing. And we've seen some very good traction there, utilizing that influencer content elsewhere on our marketing channels.Stephanie:Mm-hmm (affirmative). What platforms are you working with alongside these influencers?Thomas:Yeah, so they post on Instagram and then we use whitelisting on Facebook and Instagram.Stephanie:Got it. Okay. And then, what are the results for that when it comes to conversions, and what does that funnel look like versus maybe just a typical ad out in the world or on YouTube, maybe running it against your video with your dad, like a very authentic company story. How do those two perform side-by-side?Thomas:Yeah. So we typically don't run those side-by-side or A/B test them. We kind of keep them separate. The best thing about whitelisting... Are you familiar with the concept?Stephanie:Yeah. Go into the detail, because I'm not...Thomas:Yeah, sure. So whitelisting content is working with an influencer where you get them to create some awesome content around your brand. You guide them and let them do their own thing, but then you technically have access to their account, and from there-Stephanie:Oh, got it. Yeah.Thomas:Yeah, you can use their audience and create a lookalike from it on Facebook and Instagram, and then re-target them with that content from the actual influencer. So that's where a lot of the power comes from is building those audiences on Facebook and showing them these people that look and think and talk like them, and then getting them to look at this product and say, "Oh, I've never heard of it. These people are using it. Hmm." It's kind of like that "this is everywhere" approach. You're going to get hit with a funny ad, you'll see my dad and I, and then you'll see an influencer with it. So breaking down those walls and making it normal is a big thing in the customer acquisition.Stephanie:Yep. Yeah. Completely agree. So how do you even garner... I'm thinking about like, you have this product, and do customers give you feedback and do you let that influence the product? Or are you more kind of like tunnel vision? "We know it's good. We've been to Japan. We know what it needs to be like." How do you think about that product development cycle?Thomas:Yeah. The product is what the product is right now. We know that we have a great bidet seat, and we know that we have great bidet attachments, and we have faith in these products to perform extremely well. They're super high quality. A lot of people love them. When you're working with a product that 98% of Americans don't have in their homes, you're going to get a lot of feedback about that product in particular. We are always listening, though. It's not to say we turn a deaf ear to what people are coming back and mentioning about the product, because there are things you can change down the road. So it takes a long time to develop. Years and years. So being able to hear what people are saying, seeing patterns in their responses, will definitely be guiding our product development. But for me, listening to our customers at the beginning was more about why they decided to try the product, what they like about it, and what they were skeptical about, and then taking that feedback and putting it back into our messaging. So that was super important to me.Stephanie:Yeah. That's a really good way to view feedback, from all angles. What are some of the most surprising pieces of feedback, either before the sale or after, that you've received where you're like, "Oh, that's very interesting"? Where you actually maybe implemented it into your copy, your language, the way you educate people? What was something surprising, or more than one thing, that actually helped influence how you talked about it or sold it?Thomas:Yeah, so one thing that we hear a lot, and I love to hear it, is: "Why didn't I do this sooner?" And it's that sentiment where it's like, "Ugh, I've been living my entire life wiping with dry paper, and these bidets have been around. What was I doing before?" And so, we take that sentiment into our marketing now. And then, on the pre-purchase side, it really came down to listening the frustration points of what we weren't showing and telling people on our website.Thomas:So there are little complications with your seat size and shape and your plumbing fixtures, and it's a complicated world down there by the toilet. And I was looking at it from a world of head down in bidets and toilets, and I knew too much about toilets than I ever needed to, and to be able to hear a customer pick your head up and say, "Oh, well, I obviously need to show this information. Why wasn't I doing that before? It doesn't matter. Put it on there now." That always has been a winning tactic for us.Stephanie:Yeah. I mean, it also seems like a good way, even around customer acquisition, building a piece of content of just, "How do I even hook this thing up?" I mean, even if they've bought it from a different brand or they're even considering it, I mean, that'd be my first question is, "Can I even do this myself? Do I need someone to come and install it for me? And what kind of things should I think about before buying something brand-new?" So it seems like a good content angle, too, to attract customers that maybe you wouldn't have otherwise.Thomas:Yeah. We put installation in a lot of our videos, and it's simple language, it's DIY, self-install, no special tools, no plumber required. Right? And that's kind of all you need to know. "Oh. I can handle it," is basically the message.Stephanie:Yep. Yeah. That's great. So earlier, you mentioned working with agencies was a piece of your world, and that's a topic that... We've had many founders on here where some are excited about it, some are like, "It didn't go well." How do you view working with agencies? What things did you choose to maybe hire out? What did you keep in-house? And how do you keep a good working relationship there?Thomas:Yeah, so the agency battle is: it seems incessant, until you find an amazing partner. And we've really settled into a couple of great partnerships, and those are the ones that we work harder at because we like the people internally and the work that they do. We get along with them. We have similar values when it comes to business, and so we put in extra time and effort say, "Hey, we don't really like this right now. We would like to change it this way," or, "We would like to see more of this." And the ones that take your feedback and change are the ones that you're going to stay with, and those are the people that we continue to work with.Thomas:So it's not easy finding a good agency, and we've had agency turnover multiple times with Omigo so far, but settling into a great relationship is extremely fruitful; and it's still going to be work, but that's the approach that we've taken. And to answer what we have kept in-house versus kind of farmed out, we keep customer service and product development in-house. Super important to keep that close to home, understand that feedback loop of what are people saying, how can we answer their questions more efficiently, and making sure that when it comes to a plumbing product, they have a great experience talking to someone and getting their questions answered. So keeping that close to home is super important.Stephanie:Yeah, it definitely seems like a high-touch customer service experience that, once you get past that point, it can be an instant sale as long as you have a good lead in and know everything and their questions are all answered from the start much easier, and you have to kind of keep that in-house. I can see why. So getting back to you working with your dad, and he's done a bunch of cool things before, what are some of the lessons and insights he brought into the company that you're like, "Wow, that really helped get it off the ground," or, "These insights here or his experience here really helped kind of get it going"? What kind of things did he bring to this company today that helped you guys lead it to where it is?Thomas:Yeah, so after he sold and exited Canvas On Demand, he started to consult with other ecommerce brands. So he is the friendliest person I know probably, and loves being around people, talking with them, listening to them, helping them, so it was a natural fit for him to take this... How many years was it? Seven or eight years at Canvas On Demand, where ecommerce was changing. It was in such a growth stage. Everything was different year after year, and so he had to adapt constantly. And I think that really shaped his way of thinking about ecommerce and allowed him to go past this legacy concept of ecommerce, that you might get stuck if you started in 2001, and really grow with that channel.Thomas:So he took that into his consulting career, and so, for the six years in between his sale and Omigo, he was consulting with ecommerce brands of all sizes: $5 million a year to $120-150 million a year and everywhere in between. So what we took from his experience into Omigo was what he calls his "ecommerce playbook," and it was the fundamentals of where you need to start with a direct-to-consumer business. And the basics of that were: great customer service, like I mentioned, solid fulfillment,Thomas:And the fundamentals of a website, so that being: something simple and functional, having a great hero and landing page, having solid email capture, having all of your email flows built and all of your knowledge base in place and everything ready to scale, because something could happen overnight like it did with Omigo, and you have to be ready to go from 10 orders a day to 150. So he brought this ecommerce playbook and this really rich knowledge base and a lot of connections to the start of Omigo.Stephanie:Nice. And so, how many orders are you guys at today? You just talked about going from like 10 a day to a hundred. What does it look like today, and what did that process look like scaling to where you are now?Thomas:Yeah, it fluctuates. So it's been a funny year-and-a-half for Omigo, because at the beginning of the pandemic, the toilet paper shortage hit.Stephanie:Oh, yeah. I forgot about that.Thomas:Right? Forgot about that.Stephanie:Yeah.Thomas:What a crazy time.Stephanie:I like to forget about dumb things like that. We didn't actually have a toilet paper shortage, we just had a logistics problem. But okay. Carry on.Thomas:We had a hoarding problem and a logistics problem. Either way, it was great for the bidet industry. It was an odd time to prosper, when you had a lot of people going through hardships and a lot of unknown in the future, but we couldn't look at that in the moment because people needed a solution to the toilet paper shortage. And bidets are the best answer, so, "Hello. We're Omigo. We've been here. Welcome." And during that time, it was Black Friday every day for a week. And then, that lasted about a month and a half. We sold out. Sales tapered back down in the summer, picked back up during holiday paper shortage, and then kind of continued into the new year. And we're seeing kind of a mini decline right now, and a steadying out of how many purchases we get. So still trying to figure it out. We haven't cracked the code 100% and we're working at it constantly, but definitely going with the flow as far as when orders are coming in and when they're not.Stephanie:So what are some lessons or things that you're adjusting going forward now that you've kind of seen these fluctuations of demand and Black Friday every day for a week, and then tapering down again? What kind of things are you maybe adjusting going forward to kind of future-proof the back end as well to make sure that you can keep up with it when it's there and then still have your suppliers and manufacturers when it's not Black Friday levels? How are you guys thinking about that now?Thomas:Yeah. Well, after we sold out, we realized this could happen again, especially during the pandemic. It was super unsure times. So we really shored up our supply chain. We ordered a lot of product, and we have a lot of product, and we are continually ordering it. Because we know it's a matter of time until bidets are ubiquitous. I mean, I am confident in that. It may take five more years. It may take 20 more years, but there's going to be one day where bidets are everywhere. And our products, they're shelf stable. It's not like they're going to be going bad, so having that on hand, being ready for a boom, is one way that we're future-proofing ourselves.Thomas:And another way is just keeping everything tight on our website. We are constantly A/B testing and trying out new copy or new design to optimize how customers are coming in, learning about our product, and finally purchasing. So keeping everything tight on the website keeps us future-proof. And being direct to consumer, we have a great relationship with our distribution centers, so always knowing that we're going to have a distribution relationship where, "Hey, yeah, we're at X amount of orders today, but that could double in the next three weeks and we need to make sure that you're ready." So having the infrastructure there, as well.Stephanie:So where are you most excited to take Omigo over the next maybe three to five years? What are you guys working towards? What are you most excited about right now?Thomas:Yeah, I'm really excited about television.Stephanie:Yeah?Thomas:I think that it's funny, because you think TV five years ago, you're like, "Oh, TV is dying. It's all going to be streaming." And yeah, it is a lot of streaming, but it's still a traditional marketing platform. There are still ads on every streaming platform and cable is still a booming industry. It is a gigantic industry. A lot of people have cable, Dish, and the like, and I think that for a young direct-to-consumer brand, getting in front of that many eyeballs is really exciting for us. So it's not a new channel; it's just new to us.Thomas:We are going to be launching soon. Yeah, we're going to be launching soon and are excited about the results. We have some people that we know that are doing well on TV and we think that we're going to do well, also.Stephanie:Cool. And is it specifically focusing on cable? Which I do feel like a lot of people are kind of sleeping on that, but I also wonder if maybe it's a generational thing, where it depends on who your target audience is that you're trying to get in front of; where maybe people closer to our age, they might not have cable. They're probably Netflix, Hulu, everywhere else, YouTube. But then, when I about maybe my parents, for sure they still have cable, and they're probably not going to get rid of it for a long time. So which areas... Or are you exploring all of that?Thomas:Yeah, we'll definitely explore all of it. Streaming is great. We have those low-price bidet attachments at Omigo that start at $89. So great entry-level, great price for anyone that wants a bidet. And then, our top-of-the-line bidet is at $649, and we do see the demographic there swing older. And that's a demographic that is humongous in this country. A lot of them are still watching cable, like you said, so they don't know about these luxury bidet toilet seats. And if they see it on TV, I think that kind of awareness is just going to do good things for every bidet company out there.Stephanie:Cool. Yeah, we'll have to circle back once you guys are live and [crosstalk] see you out there in the world on one of the channels.Thomas:You will.Stephanie:That'd be fun to hear the results and how it's going.Thomas:Yeah, so excited.Stephanie:All right. Well, let's shift over to the lightning round. Lightning round is brought to you by Salesforce Commerce Cloud. This is where I ask a question and you have a minute or less to answer. Are you ready, Thomas?Thomas:Yes.Stephanie:Cool. What ecommerce tool or piece of technology are you most excited about right now that you guys are maybe experimenting with?Thomas:So we've been on SMS for awhile, but SMS has just been a great platform for us. Being able to get into people's pockets and the open rate and click-through rate has been awesome. So SMS is a killer. It's not going anywhere and we're super excited about it.Stephanie:Awesome. What's up next on your reading list or your podcast queue?Thomas:Let's see. Guiltily been learning more about crypto lately on my podcast queue, so trying to educate myself on not just kind of what's booming and busting, but the inner workings and how to actually invest longterm into that world. So definitely a little bit of crypto podcasts in there.Stephanie:Nice. Yeah. There's some good ones out there. Personal favorites.Thomas:I'll have to ask. Yeah.Stephanie:I'll just send some episodes your way that are good ones. When you want to get creative, what do you do to get into that headspace?Thomas:I turn off everything around me, because I'm a very distractible person, and I really put myself into the place of who this creative project is for. Put on a little different hat for email, put on a different hat for Facebook, and if I'm stuck, I leave. Wherever I am. I go outside and move my body. I'm a very active person, so being able to get some blood flow gets my creative juices going, too.Stephanie:Yep. Yeah, same. Cool. All right. And the last one, what one thing will have the biggest impact on ecommerce in the next year?Thomas:The next year: the continued at-home life. People are not going to go back to the office full-time. A lot of people are going to keep spending time at home. People are buying houses. So this at-home goods and everything that you can use around the house is going to be huge, because people are still shopping online. People are still getting everything shipped to their door. We're not going to go back to retail yet. I think that's going to be in the next year. A big one.Stephanie:Cool. All right, Thomas, thanks so much for coming on the show and talking about bidets and the fun world. Where can people find out more about you and Omigo?Thomas:Yep, so if you want to find out about me, you can find me on LinkedIn: Thomas Lotrecchiano. And if you want to find out about Omigo, you can go to Myomigo.com. That's M-Y-O-M-I-G-O dot com. We have all of your butt washing needs. Stop wiping, people. Wash your butt.Stephanie:Do it the right way. Come on. All right. Thanks so much, Thomas.Thomas:Thank you, Stephanie. It's been a lot of fun.

Thomas – Thank you to Relevant Radio David – The Mystery of Marriage and helping each other get to Heaven Mary – Is overjoyed to hear news about Patrick’s father Don – Has a question regarding translations of 1st Corinthians 6:9-10 Rose, 8-years-old – why did Jesus a curse a fig tree? Kim – Does […] All show notes at The Patrick Madrid Show: February 08, 2021 – Hour 3 - This podcast produced by Relevant Radio

This conversation covers: An average workday for Thomas as senior systems engineer at Systematic. How Systematic uses cross-functional collaboration to solve problems and produce high quality software. How security and data privacy relate to cloud-native technologies, and the challenges they present.  Systematic's journey to cloud native, and why the company decided it was a good idea.  Why it's important to consider the hidden costs and complexities of cloud-native before migrating. What makes an application appropriate for the cloud, and some tips to help with making that decision. The biggest surprises that Thomas has encountered when  moving applications to cloud-native technology.  Thomas's new book, Cloud Native Spring in Action, which is about designing and developing cloud-native applications using Spring Boot, Kubernetes, and other cloud-native technologies. Thomas also talks about who would benefit from his book. Thomas's background and experience using cloud-native technology. The biggest misconceptions about cloud-native, according to Thomas. Links Systematic Cloud Native Spring in Action book Thomas Vitale personal website Follow Thomas on Twitter Connect with Thomas on LinkedIn TranscriptEmily: Hi everyone. I'm Emily Omier, your host, and my day job is helping companies position themselves in the cloud-native ecosystem so that their product's value is obvious to end-users. I started this podcast because organizations embark on the cloud naive journey for business reasons, but in general, the industry doesn't talk about them. Instead, we talk a lot about technical reasons. I'm hoping that with this podcast, we focus more on the business goals and business motivations that lead organizations to adopt cloud-native and Kubernetes. I hope you'll join me.Emily: Welcome to The Business of Cloud Native. I'm your host, Emily Omier, and today I'm chatting with Thomas Vitale. Thomas, thanks so much for joining us.Thomas: Hi, Emily. And thanks for having me on this podcast.Emily: Of course. I just like to start by asking everyone to introduce themselves. So, Thomas, can you tell us a little bit about what you do and where you work, and how you actually spend your day?Thomas: Yes, I work as a senior systems engineer at Systematic. That is a Danish company, where I design and develop software solutions in the healthcare sector. And I really like working with cloud-native technologies and, in particular, with Java frameworks, and with Kubernetes, and Docker. I'm particularly passionate about application security and data privacy. These are the two main things that I've been doing, also, in Systematic.Emily: And can you tell me a little bit about what a normal workday looks like for you?Thomas: That's a very interesting question. So, in my daily work, I work on features for our set of applications that are used in the healthcare sector. And I participate in requirements elicitation and goal clarification for all new features and new set of functionality that we'd like to introduce in our application. And I'm also involved in the deployment part, so I work on the full value stream, we could say. So, from the early design and development, and then deploying the result in production.Emily: And to what extent, at Systematic, do you have a division between application developers and platform engineers, or however else you want to call them—DevOps teams?Thomas: In my project, currently, we are going through what we can call as maybe a DevOps transformation, or cloud transformation because we started combining different responsibilities in the same team, so in a DevOps culture, where we have a full collaboration between people with different expertise, so not only developers but also operators, testers. And this is a very powerful collaboration because it means putting together different people in a team that can bring an idea to production in a very high-quality way because you have all the skills to actually address all the problems in advance, or to foresee, maybe, some difficulties, or how to better make a decision when there's different options because you have not only the point of view of a developer—so how is better the code—but also the effects that each option has in production because that is where the software will live. And that is the part that provides value to the customers. And I think it's a very important part. When I first started being responsible, also, for the next part, after developing features, I feel like I really started growing in my professional career because suddenly, you approach problems in a totally different way. You have full awareness of how each piece of a system will behave in production. And I just think it's, it's awesome. It's really powerful. And quality-wise, it's a win-win situation.Emily: And I wanted to ask also about security and data privacy that you mentioned being one of your interests. How do those two concepts relate to cloud-native technologies? And what are some of the challenges in being secure and managing data privacy specifically for cloud-native?Thomas: I think in general, security has always been a critical concern that sometimes is not considered at the very beginning of the development process, and that's a mistake. So, the same thing should happen in a cloud-native project. Security should be a concern from day one. And the specific case of the Cloud: if we are moving from a more traditional system and more traditional infrastructure, we have a set of new challenges that have to be solved because especially if we are going with a public cloud, starting from an on-premise solution, we start having challenges about how to manage data. So, from the data privacy point of view, we have—depending also on the country—different laws about how to manage data, and that is one of the critical concerns, I think, especially for organizations working in the healthcare domain, or finance—like banks. The data ownership and management can really differ depending on the domain. And in the Cloud, there's a risk if you're not managing your own infrastructure in specific cases. So, I think this is one of the aspects to consider when approaching a cloud-native migration: how your data should be managed, and if there is any law or particular regulation on how they should be managed.Emily: Excellent. And can you actually tell me a little bit about Systematic's journey to cloud-native and why the company decided that this was a good idea? What were some of the business goals in adopting things like Docker and Kubernetes?Thomas: Going to the Cloud, I think is a successful decision when an organization has those problems that the cloud-native technologies attempt to solve. And some goals that are commonly addressed by cloud-native technologies are, for example, scalability. We gain a lot of possibilities to scale our applications, not only in terms of computational resources, and leveraging the elasticity of the Cloud, so that we can have computational units enabled only when needed. So, if there is, for example, an high workload on the application, and then scale down if it's not needed anymore, and that also results in cost optimization, but also scaling geographically. So, with the Cloud, it's more approachable to start a business that has a target in different countries and different continents because the Cloud lets you use different technologies and features to reach the users in the best way possible, ensuring performance and high availability. Something else related to that is resilience. Using something like Kubernetes and proper design practices in the applications, we can achieve resiliency in our infrastructure at a level that is not possible with traditional technologies. And then we have speed. Usually, a cloud-native transformation is accompanied by starting using practices like continuous delivery and DevOps, that really focus on automating and putting together different skills so that we can go faster in a more agile way and reduce the time to market. That's also a very important point for organizations.Overall, I think there's a part of cost optimization, but at the same time, we should be careful because there are some hidden costs that sometimes are not considered fully. And that is about educating people to use new cloud-native technologies. We have some paradigm shift because some practices that were well-consolidated and used with traditional applications are now not used anymore, and it takes time to switch to a different point of view and acquire the skills required to operate cloud-native infrastructures and to design cloud-native applications. So, to make a decision about whether cloud-native migration is a good idea, I recommend to consider these hidden costs as well, not only the advantages but the hidden costs and the overall complexity, if you think about something like Kubernetes. For some applications, the Cloud is just not the right solution.Emily: What would you say is a type of application that is not appropriate for the Cloud?Thomas: As an application is not actively developed with new features, but it's in a pure maintenance phase and that is fully reaching the goals for its users. If it doesn't need to scale more than what it does today, if it doesn't need to be more resilient because maybe high availability is not that important or critical, then maybe going to the Cloud is not the right solution because you would add up complexity and make things actually harder to maintain. That is one scenario that I could think of.Emily: So, basically, if it's not broken, don't try to fix it.Thomas: Yes. So, cloud-native is the answer to a specific set of problems. So, if you don't have those problems, so maybe cloud-native is not for you because it's solving different problems.Emily: So, would you say, the problems are if you need to really iterate quickly, develop new features, ship them out to customers?Thomas: Yeah, if you don't need this agility because you're not actively developing features, or if it's small things that don't require so much speed or scalability power, then might not be a good idea. Or even if you don't have the resources, to acquire the skills required to design cloud-native applications and to manage cloud-native infrastructure.Emily: What have been the biggest surprises as you've been using cloud-native technology and moving applications to cloud-native technology?Thomas: So, I always think about how logging works. I think it's a fun anecdote that when you move to a cloud-native application, usually logging is managed through files in a traditional application where we set up rules to store those files. But usually in a cloud-native setting, like in a Kubernetes environment, we have the platform taking care of aggregating logs from different applications and systems. And these applications are providing these logs as events in the standard output. So, there's no files. So, one of the first questions for developers when moving to the Cloud is like, “Okay, now where's the log files?” Because when something goes wrong, the first thing is, “Let me check the log file.” But there's no log file anymore, and this is just a fun aspect. But in general, I think there's a whole new way of thinking about applications, especially if we're talking about containerized applications. So, considering Java applications, for example, they're traditionally packaged in a way that needs to be deployed on an application server like Tomcat. Now, we don't have that anymore, but we have a self-contained Java application packaged as JAR in a container. So, it's self-contained, it contains all the dependencies that are needed, and it can run on any environment where we have a container engine working, like Docker. So, developers take on more responsibilities than before because it's not only about the application itself, but it's also about the environment where the application needs to be deployed; that is actually part of the container now. So, we can see a flow of responsibilities that is different than before.Emily: And do you think that that surprises a lot of organizations, that having developers need to take on more responsibilities is something that's not anticipated?Thomas: Sometimes, maybe it's not anticipated. And usually, it's because when considering this migration, we don't consider those aspects of acquiring new skills, or bringing in, maybe, some consultants to help during the migration to help with all those practicalities, that from a high-level point of view, are not very visible.Emily: Excellent. Tell me a little bit—I know you just wrote a book, so I was wondering if you could talk a little bit about your book and what inspired you to write it.Thomas: The book is about designing and developing cloud-native applications using mainly Spring Boot, and Kubernetes, plus all the great cloud-native technologies that are available. The goal is to teach techniques that can be immediately applied to real projects, so to enterprise-grade applications, as much as possible. The cloud-native landscape is so complex, it's so huge that it's impossible to cover everything, but I made a selection of all the aspects that I consider important and my goal is to try as much as possible to do things like I would do in a real application. So, what I would do daily in my job, so considering all those aspects that sometimes are not considered when teaching new technologies or new features, like for example, security. By the end of the book, the reader will have deployed a cloud-native system composed of different applications and services on a real Kubernetes cluster in a public cloud service. And besides this, I also aim at navigating these cloud-native landscape because when we look at this famous landscape picture on the website from the Cloud Native Computing Foundation, it can be really overwhelming, both for new developers, but also for experienced developers that are experiencing different techniques—maybe, you come from a more traditional practice and want to switch to cloud-native, it can be really overwhelming. So, I hope that with this book, I can also help the reader navigating this landscape. The idea for the book, I got it back in January, February have been conducted by the Manning publisher, and about spring, we started considering different ideas. And I was really researching into the cloud-native landscape, in particular, how to use Spring and all related technologies to build strong native applications, so I decided to propose a book about that, that have these two main characteristics of teaching, as much as possible, real-world examples and techniques, and also help the reader navigating the landscape. So, it will not contain everything about cloud-native because that would require several books, but I think it's a good primer for the field.Emily: Excellent. And just, actually, a couple, sort of, basic questions I forgot to ask at the beginning, like how long have you been working with cloud-native technology? When did Systematic start using it and moving applications to cloud-native?Thomas: In Systematic, we have different projects and products. So, depending on that, some teams have started even several years ago, and in my project right now, it's quite recent. But I've been working with Spring for, I think, five years; also with Docker. And it's my favorite set of technologies because I think provides a lot of features to solve many different problems. I also, in my spare time when I have time, I like to contribute to the Spring projects on GitHub. It's a great community, I think.Emily: Fabulous, and who do you think would benefit most from reading your book?Thomas: I think it would benefit experienced developers, back end developers with experience in developing web applications in a more traditional way that would like to move to cloud-native, either because their organizations are doing the migration, or because maybe they would like to understand more how it works, or they would like to find a job in that field. But also for junior developers that have some experience with application development, so some basic experience with Spring and Spring Boot, but would like to take the next step towards the cloud-native world also understanding what is that about, and what, actually, cloud-native means.Emily: What do you think is the biggest misconception about cloud-native?Thomas: I think there's two misconceptions that usually, I find that is… thinking that cloud-native is about containers and that cloud-native is about microservices. So, for the first case, containers are used a lot for cloud-native applications, of course. They're used directly when working at the Kubernetes level, for example, but are used also when leveraging platforms like Heroku, or CloudFoundry. In that case, it's not the developer building the container, but it's the platform itself, but still, they are used. But cloud-native can also be applied to other different technologies, like functions, for example, in the serverless world. So, functions are not containers. So, in that way, I think it's a bit misleading to define cloud-native as containers. I think that containers is one of the technologies and implementations used for developing large native applications. But it's not the definition of cloud-native.And microservices, also. I think it's wrong to imply that cloud-native means microservices because cloud-native applications are distributed systems. Of course, they can be microservices; it's a very used architectural style in the Cloud world, but I don't think that it's a definition. Also, the CNCF previously had a definition for cloud-native technologies that was actually based on containers and microservices, and then they changed that. So, now they are listed as examples exactly because that is not the definition.Emily: Fabulous. What about open-source, what do you think open-source and cloud-native's relationship is?Thomas: One example above all, like Kubernetes, that is open-source. It, I think, is the most popular project on GitHub with the highest number of contributions, if I'm not wrong. And I think that just explains everything about cloud-native because given that this is such a core project, and it's also the project that started all for the Cloud Native Computing Foundation, and it's a, now, very wide landscape of technologies. Open-source, I think it's a very important part of it because it allows contributions from people around the world with different set of skills. And we're not talking just about coding, but also other aspects, like, for example, technical documentation. I know that lately there have been several contributions, for example, to the technical documentation for Kubernetes to improve the documentations and help people approaching these technology and understand the more complex topics. And from a security point of view as well, from a testing point of view, I think that open-source technologies open many possibilities.Emily: Great. Well, I just have a couple last questions for you. The first one I like to ask all of my guests, what is a engineering tool that you can't do your job without?Thomas: That's a very difficult question because I use so many tools. But I will say if I had to choose one, I would probably say my terminal window.Emily: Excellent. And then, how can listeners connect with you or follow you? And in fact, where should they go to buy your book?Thomas: So, they can find me on my website, thomasvitale.com, where I also write blog post about Spring and security. I'm also active on Twitter. My handle is @vitalethomas and on LinkedIn. But on my website, they can find all my contacts there. I repeat, thomasvitale.com. And the book is available on manning.com. That is the name of the publisher, so they can find it there. The title of the book is Cloud Native Spring in Action: With Spring Boot and Kubernetes.Emily: Excellent. Well, thank you so much, Thomas, for coming on the show and chatting.Thomas: Thank you.Emily: Thanks for listening. I hope you've learned just a little bit more about The Business of Cloud Native. If you'd like to connect with me or learn more about my positioning services, look me up on LinkedIn: I'm Emily Omier—that's O-M-I-E-R—or visit my website which is emilyomier.com. Thank you, and until next time.Announcer: This has been a HumblePod production. Stay humble.

African Americans and other people of color throughout the United States are suffering disproportionately from Covid-19. In this interview, Udaya Thomas, MSN, MPH, APRN, CYT, talks about how integrative practitioners can better serve the health needs of underserved populations during this pandemic. Thomas is an integrative primary care nurse practitioner and the board president of Integrative Medicine for the Underserved, a nonprofit organization of multidisciplinary practitioners committed to affordable, accessible integrative healthcare for all. About the Expert A. Udaya Thomas, MSN, MPH, APRN, CYT, is a board-certified nurse practitioner in primary care and practices integrative medicine in a Safety-Net hospital system for the underserved in Southeast Florida at Memorial Primary Care. She is also pursuing her PhD in nursing at Walden University’s interdisciplinary health track, focusing on the integration of behavioral health in primary care. Udaya is also the board president of the non-profit organization Integrative Medicine for the Underserved (IM4US). Disclosure: Thomas is partially funded by Grant #5T06SM060559-07 of Substance Abuse Mental Health Service Association (SAMHSA) American Nursing Association (ANA) Minority Fellowship Program (MFP). SAMHSA is a government resource for practitioners and the ANA MFP is currently accepting applications for more minority fellows. Transcript Karolyn Gazella: Today, our topic is serving the healthcare needs of underserved populations. We'll also discuss the fact that African Americans and other people of color are suffering disproportionately from Covid-19. Hello, I'm Karolyn Gazella, your host and the publisher of the Natural Medicine Journal. My guest is integrative primary care nurse practitioner Udaya Thomas. Udaya presently works in a safety net hospital system for the underserved in Southeast Florida at Memorial Primary Care and she is also pursuing her PhD in nursing. Udaya, thank you so much for joining me. Udaya Thomas: Thanks for having me Karolyn. It's great to be with you and thanks also to my colleague Priscilla Abercrombie, Past President of IM4US for connecting us. Gazella: Yes, that's great. Yeah. Now before we jump into our topic, tell us a little bit about your present clinical work at Memorial Primary Care. Thomas: Well, I work as a primary care nurse practitioner in a patient-centered medical home, and actually for the past 5 weeks instead of person care, we've had to go virtual with Covid-19 pandemic, but our administration led us into a quick change and we're doing 100 percent telehealth encounters. Patients can also message me directly to give them access to me whenever they need it. Gazella: That's great. Now, where does your interest in healthcare disparity spring from? Thomas: I would say from growing up as a first-generation Indian immigrant in a low-resource rural community, I've always actually been interested in integrative approaches. So I chose nursing and public health as my path to work for the underserved in this country. Gazella: That's great. So you're the president of Integrative Medicine for the Underserved, also known as IM4US. Tell us a little bit about that organization. Thomas: IM4US is a nonprofit organization of multidisciplinary practitioners who are committed to affordable, accessible, integrative health for the underserved. IM4US is the only integrative health organization focused solely on the underserved, which makes us fairly unique. We support practitioners that serve underserved populations to outreach, education, research, and advocacy. We also have equity, diversity, and inclusion principles for all the work that we do. And while we typically have an in-person annual conference, due to the coronavirus precautions, we've moved our 10th annual conference to a virtual conference. Our underserved communities have been specifically affected by the crisis, not only because they're more likely to be susceptible to getting ill, but being out of work for this long really puts them at risk by not having an income, leading to less resources and poor health outcomes. Gazella: Yeah, and I want to talk about that in a little bit more detail because right now, given the data that we've received presently more African Americans and other people of color throughout the United States are dying of Covid-19 compared to Whites. Now this crisis is really shining a bright light on existing healthcare disparity. So from your perspective, what is the present Covid-19 crisis telling us about this huge healthcare gap that exists in this country? Thomas: There's so many factors. As Dr. Zwickey mentioned and at the end of your last podcast with her, the coronavirus pandemic has really turned on a loudspeaker to how many disparities there really are. Studies have shown that social determinants of health are responsible for on average 50% of people's health outcomes. For example, The Hill published last week that African Americans are 6 times more likely to die than their white counterparts in Chicago. Yesterday morning, Governor Cuomo commented on CNN, the new rise in Latino cases and deaths in New York. Suffice it to say that comparative to their percentage in the population, minorities are greatly affected and dying at a much higher rate. Current estimates as you might know, are up to 70% areas with concentrated low-income minorities. So is it their racial background or ethnicity that puts them at risk? Well, in the case of coronavirus and most illnesses, actually no. Rather, it's poor social determinants of health, the lack of employment, safe and stable housing, literacy level, and access to healthy food options that determine health outcomes. These determinants are responsible for most health inequities, as well as lack of access to equitable care. For example, Karolyn, a New York hospital was recently highlighted in the lower-income part of town that is struggling with fewer resources compared to wealthier areas. It's a systemic issue. Because of all the challenges and sometimes trust issues, minorities may delay seeking care too. At IM4US we help practitioners attempt to level the playing field by offering low-cost solutions and increase access to integrative modalities and care and to increase trust. We also provide members opportunities to get involved with educational and policy initiatives to support the underserved. Gazella: Yeah, I love that about your organization and it's going to be especially interesting for our listeners and readers because they already practice integrative medicine. So the fact that they can take their medicine and now serve the underserved, I think it's really a cool thing. And you know, you mentioned that 70% of deaths that studies showed that even though 70% of the deaths were in African Americans, African Americans only represented 32% of the population. So that is a really big healthcare disparity issue that we have. Now, as you mentioned, it is a systemic issue and it's clear that it needs to be addressed systemically. But what can integrative practitioners do to help ensure that they're not contributing to the problem or perpetuating healthcare disparity issues in their clinical practice? Thomas: Mm-hmm (affirmative) Great question, Karolyn. While there are many things that practitioners and specifically integrative practitioners can do, but just to mention a few really important things that could make a great impact. One, they can do implicit bias training. This is a free training and it's online and it allows practitioners to find out their own biases as we all have them, whether we work for the underserved or not. Secondly, practices if they don't already have one, can try to secure a legal aid attorney to offer low-income patients legal advice and representation when facing issues like discrimination or eviction for example, and third, they can join our movement. IM4US promotes groups as a way to build trust and increase access to integrative care. In light of the current crisis, we're recommending telehealth groups whether in the time of Covid-19 or not, we can also offer medical group visits via telehealth. It's a great way to connect patients, HIPAA-compliant consent of course together with care team members to increase social connection, reduce loneliness, anxiety and fear that the public is currently living with. Gazella: Yeah, that's true. What about people who may not have internet access? Does the telehealth visits still work? Thomas: Great question. Actually we are putting together some continuing education for our upcoming conference and on that specific topic because we want to address access to everybody. I know actually that even when I do telehealth visits just with family members together, hearing multiple voices together and knowing that they're connected to their practitioner and their care team, whether through telephone or through video really makes their spirits lift and a sense of relief that they had contact with you. And you're right, many don't have high internet speed or access to join by video, but making group chats available is also helpful and just knowing someone is on the other line can save a life. Gazella: Yeah. Like when you mentioned in the very beginning that your patients actually have access to you and they can message you. That's huge. And I would think that that would be a big part of their healing and a part of their care. Now, where can people find more information about IAM4US? Thomas: Well, we have a website and I'll give you the address. It's www.im4us.org. Gazella: Perfect. We'll also put a link to that website on our Natural Medicine Journal site so people can just click over and find access. It's a great organization, lots of resources, and really doing some good work to help underserved populations. So Udaya, thank you so much for joining me today. Thomas: You're welcome, Karolyn. We've been around for about 12 years, so we're still considered somewhat young, but like I said, we're having our 10th anniversary this year and we're really excited to have more of the community join us. Gazella: Yeah, absolutely. Well, happy anniversary- Thomas: Thank you. Gazella: … and this is a conversation that we're going to keep going. I think it's such an important one. You know we provided some good information, but let's just keep talking about it. I think this is very, very important. I also want to remind listeners that you can find all of our past podcasts at naturalmedicinejournal.com. Today I mentioned the ones that I've done with Dr. Zwickey on Covid-19. But we have lots of information at naturalmedicinejournal.com and our podcasts are also available on Pandora, Spotify, iHeartRadio, iTunes, and many other podcast outlets. So thanks for listening everyone and stay safe.

My guest today is Thomas Dose. Thomas is the head of Music Services at DR, the Danish Broadcasting Corporation. In this role, he works with a massive archive of physical and digital music files. In this episode, we talk about how DR organizes it all and what we can learn to help us manage our own music collections better. Listen to the full conversation https://theinformeddotlife.files.wordpress.com/2019/09/the-informed-life-episode-18-thomas-dose.mp3   Show notes Thomas Dose on Twitter DR Spotify IDAGIO Jorge's blog post about Idagio Apple Music Tidal Qobuz MusicBrainz.org RuneAudio The Dark Side of the Moon by Pink Floyd Acousting fingerprint Shazam AcoustID Read the full transcript Jorge: Thomas, welcome to the show. Thomas: Thank you Jorge. Jorge: It's great having you here. For folks who are tuning in and who don't know about you, how do you describe what you do? Thomas: Yeah, well, I'm Head of Music Services in DR. That is the national radio and TV Broadcasting Corporation. The short story of DR is that it is the equivalent of the BBC in UK. So we are a public service organization founded in 1925 and we basically provide news and culture, music, entertainment and such through TV and radio and online services and as well as having seven orchestras and a concert house. So I work within this facility in what used to be the physical music archive and is now basically… We're still managing the physical archive, but we're also obviously we're more data-driven now. So we are developing and operating a number of internal digital services and I work mostly as a product owner for these services and I spend basically all my time thinking about how to organize music and how to facilitate the music production of DR. Jorge: That's fantastic. I'm curious about your background in order to do that. Do you have training in music or… Thomas: No. Actually and I don't have an academic background. I was through the 90s and for as long as I can remember in the early part of my life, I wanted to be a musician or rather a producer. I grew up with open music genres, hip-hop and soul and R&B and a number of electronic music genres. And that was basically where my heart and head was for the first 25 years of my life. But eventually, it became clear that I was more focused on how music worked, I mean technically, than actually… And my talent didn't really reach for a career in the arts. So during the 90s I transitioned into being a sound technician, at first as a trainee on Film School in Copenhagen and then working as a sound technician on a production company. And then parallel with that, I was working in an independent record shop and then from the mid-90s I was exposed to the web and became obsessed with all disciplines of that, including programming and the design. I was part of a quite lively design community in the late 90s in Copenhagen around music. We did a lot of interesting projects with driven radio stations and playlist services and so on and that basically led to the job. I'm holding now In the in the DR. Jorge: You mentioned something that I took note of and I'm intrigued by, which is that you have digital archives and you also have physical archives. Thomas: Yes. Jorge: What kind of things do you store in the physical archives? Thomas: Yeah, we don't store as much anymore though. The department I'm working in has been systematically collecting music since 1949, and the physical archives that they consist of roughly about 900,000 physical units, that is records, which are shellacs, vinyl, CDs, and so on. But obviously for the last decade or so, we haven't really added much to the physical archive. Only on those instances where a release is purely on physical, we will acquire that such. What else it's all digital now. But we're still very happy with the physical archive. It's not collecting dust because the editorial units in DR are basically ordering digitization of older materials every day, and we handle those. And we digitize those from from vinyl and from shellac. And you would be surprised of the volume of music that is still not available on the mainstream streaming services. You think that it's interesting that every piece of music recorded ever is on Spotify. It's not nearly the case. So we're still recording from from our physical archives. Jorge: One of the differences between a physical archive on a digital archive is that by the very nature of the thing you're storing, the physical disks or objects or whatever it is can only be on one shelf in one order at any given time. I'm curious, 900,000 sounds like a lot. Do you have a particular organization scheme for those? Thomas: The only sensible way to organize collecting like that is to basically have it placed in the order they were acquired, and then have an identification to, and then catalog the all the items in order to find them. We do organize them by format. So we have twelve-inch vinyls on one part and then we have seven-inch vinyls and so on. But that is that's the way. So basically when you go through the physical archive, it's sorted in the order they came in which also makes it interesting because you can dive into periods of music that way. 70s, 60s… But that that's how it was done. We acquired or developed our first electronic system in 1978. And from there on it's mostly a true digital system we've been finding and organizing our music. Jorge: That makes sense. And that actually is the primary reason that you and I are talking. I came across this company a few… I guess a couple of months ago, called IDAGIO. And I wrote a little blog post about it because it it intrigued me that it's a service that is using the organization of information — a very particular type of information in this case, classical music — as a competitive differentiator against competitors such as Spotify or Apple Music. And I was very intrigued by this and a common friend of ours suggested that we talked about it. So I'm guessing that you have thoughts on the organization of digital music and in particular this challenge that companies like IDAGIO are looking to solve.  Thomas: Absolutely. Well, no doubt. And it's long overdue. And I'd say that there are streaming reading alternatives to Spotify doing it the right way in terms of describing music not only as a track or a recording, but also the relationship between a recording and the original composition or work and which is basically the crucial component to IDAGIO's business model. We've been doing that as well and DR for a few decades. We were somehow through coincidence lucky enough to not be organized within the program archives in DR and that is quite atypical in all other public broadcasting organizations I know of. In DR, the music archive is a department of the programming archives and the programming archives traditionally lean towards structuring their items the same way as the libraries would do. And through not having been in the program archives, organizations with basically been developing music data models from the 90s that supported this structure of having the composition and the recording separated, which is yeah, the main point is either of IDAGIO. You see a number of other streaming services going the same route as well. But Spotify, the large mainstream streams are still lacking in that department. Jorge: What I'm hearing you say is that in classical music, perhaps more so than in other types of music, the distinction between the artist who composed the piece that you're interested in, can be as or not more important than the artist who performed the piece. Thomas: Yeah. Jorge: And in things like pop music, usually those two things are merged somehow. And if you're thinking of listening to a song by someone like Taylor Swift, you just search for Taylor Swift. Whereas if you're wanting to listen to music by Gustav Holst, there might be many many recordings by different orchestras and different conductors. And how does one deal with that distinction? Thomas: Well in our case, our data model basically supports two types of composition. And one is, you could say, the normal type of composition where you have a title for the composition and then you would have composers and lyricists related to that. And the other type of composition would support sub-compositions, which is basically in one of the obvious example is you have a symphony which would have four movements and then and so those are the sub-compositions. And we are then able to relate each of these sub-compositions or movements to all the different recordings of this movement and this work. So you would have obviously the the classical editorial units in DR would need to search for the composer and then from there on see what recordings there were of this composition, including the orchestras, the conductors, choirs or soloists' performance. And all this is not that different to the structure of of a composition but it's just a crucial step to having these two entities that composition and recording available to you. And also IDAGIO is basically exploring this model but really a lot of other genres could do. Well, it's I mean, especially yes, you would want to explore jazz standards through the different performance recording one composition and also in pop music you would have remixes, you have live versions of the same composition. So really it benefits all genres of music but classical it's just the obvious end to start having these solutions. Jorge: Yeah, what I'm hearing you describe there is that it's desirable to have some way of connecting a piece of music with perhaps variations on that piece or alternate takes or something like that. Thomas: Yeah, that's it. See I think you're gonna… I think Spotify, as we agree on, is lacking, but now you actually can view the credits or at least the composers and the producers of most of the tracks at Spotify. They've just not made them searchable or they haven't implemented this information in a very convenient way yet. So I think you're going to see some of those developments in some of the mainstream services as well. Jorge: I have a lot of thoughts hearing you describe this. I'll just pick one because there's so many avenues we could go down here. One is that there is certainly a distinction between someone who does this, someone like yourself who does this for a large centralized music archive, such as DRs, right? Like there's this… That would strike me as a kind of one-off instance of a music catalog where you're maintaining this catalog and you have to provide it with all these connections and all these organizations schemas so that the people who need the music can easily find it. And the other is what you're describing with regards to services like Spotify, which is we as consumers of music or listeners of music who just want to listen to something. Thomas: Yeah. Jorge: And we we don't have necessarily very good ways of doing this. So I just wanted to draw that distinction between you know, the work that you're doing as a kind of one-off for this very large… Thomas: Yeah. I think the use cases are connected. It's just that these types of solutions that were talking about has been basically only for professional use and we're starting to see with examples like IDAGIO the solutions being fully being put into mainstream solutions as well. I mean we used to have when music was distributed physically, you would have credits obviously on cover sleeves and for a lot of people those were crucial information. And so I think the case of not having those information available as search parameters in streaming services, it's probably just a case of a decade or two transitioning in from physical to streaming. And I think we're going to see a lot of… I think I'm really excited about the next few years because we are seeing the signs now that both from the major label end of the business but also in the open source community, you see solutions providing a much more detailed mixed tastes on music, and I think IDAGIO is only the beginning. You have in streaming services now, obviously Spotify is still is the biggest one, surpassing 200 million users, but it's not… You're starting to see what you could call boutique solutions popping up catering for special needs. Most of this development, I think, has been driven by basically, the audio quality, the technical quality of the streaming. You've seen streaming services like Tidal and Qobuz basically carving out niches within the Hi-Fi communities and their price model is very much based on the technical quality of the streaming of the audio. But you're starting to see that these same services are also competing on the quality of search and metadata basically, which is one thing. The other thing is having these metadata available at first. And this is obviously been the biggest obstacle towards delivering these services. You had a music industry that has been for almost always not really been that tech savvy to to drive those kind of solutions. So it's no coincidence that it's tech companies coming in and and disrupting this this business. You also had a case where the music industry didn't really care because they were making enough money, basically through selling the music. And what I've seen in the last 10 years or so with the crisis in and the devaluation, commercial devaluation anyway, of music, is that even the major labels are now starting to push for better metadata because that is one of the sources of revenue now for them. It's metadata basically that provides them with the royalties from video or any other public use. So you're starting to see the development from both the major industry and as well as the open source communities. Jorge: When you say open source, are you referring to a piece of software that you install on your computer? Thomas: No, I'm more thinking about some of the larger open source music databases. One important one is the musicbrainz.org Initiative, which is basically a catalog of music. And one is special with I think with the MusicBrainz is that data model is very sound and it's quite advanced and it supports both the solutions we've been discussing as well as a lot of others. And MusicBrainz is is driving a lot of development in some of these areas mostly through products ingesting these data and then providing music streaming services on top. I was discussing the Hi-Fi communities one, very important product in that end is Rune which is basically a home streaming solution that supports both your local collection, sound files collection, and as well as your subscription to Tidal or streaming services like Qobuz. So you could basically combine your private collection with these streaming services and Rune lets them provide say a quite convenient interface based on basically MusicBrainz music metadata. So you would have all these search facilities that you're like you're talking about IDAGIO has as well. Jorge: It sounds like it's a service that solves a problem that I face . I'm old enough where I went through the transition from having music in physical media to having a digital collection and that meant digitizing a bunch of CDs, for the most part for me. Thomas: Sure. Jorge: And one of the challenges that I faced there is that… You were touching on this earlier with the notion of the sub compositions. So I have a lot of like electronic music and rock and stuff like that, more kind of pop music. And those are fairly straightforward because those are musical works that were produced for the most part during the era of recorded music, right? So for the most part of the composition fits into an album, this concept of an album. And I'm thinking of something likePink Floyd's Dark Side of the Moon which I think for a long time was the biggest selling album and that's a composition that is as long as an album because of the media that it was recorded for, right? Thomas: Yes. Jorge: And it made the transition to CDs because CDs were designed to accommodate most of these things. And when digitizing that, all that software kind of accommodated that very nicely. Thomas: Sure. Jorge: But then I also have a bunch of classical music CDs, and those include musical forms that are not easily fit into an album length thing, right? You have things like like piano sonatas which are much shorter than what fits into a disk. And therefore you have multiple of those in one plastic plastic disc. And the challenge for me when digitizing all the stuff was, do I like… Let's say that I'm digitizing a disk that has a bunch of Beethoven piano sonatas. Do I save each sonata as its own work or do I save them as a set? Because I acquired it as a set, right? It's been well over a decade since I did this, and I still haven't resolved this. How does one solve this? Thomas: I think what the problem is with these cases. There are no one perfect solution because each release will have its own way of organizing. You see so many variations of releases of the same work, and you have to support those. So I would for I think as a private music user I would definitely look into some of these solutions like Rune or others that have made the attempt to solve this for you. Because it's always going to be a compromise with these types of metadata. I mean, that's even with some of these factual information that everyone should be agreeing off. But but you see so many instances In classical releases that you would have several movements on the same track on the CD, you would have… So if you're organizing based on your media, your CDs, you're going to be in pain for a lot of time. I think the best way to go about it is basically to decide on one of the sensible solutions out there and then live with some of the problems. I personally, with my own with my own consumption I gave up on organizing my own music collection a few years ago once I saw that there were actually some very sensible solutions beginning to emerge. So I would I would I would pass that on to you as a key advice. Jorge: Yeah, thank you for that. I actually did the same I so my trajectory went like this. I digitized my music then I signed up for this –I think it was called Apple music match — service, which basically gave me cloud based versions of the things that I already had. Thomas: Yeah. Jorge: And one of the things that happened when I made that transition is that. For some reason Apple restructured some of the things that I had already digitized, especially around things like classical music that have these challenges we were talking about. And it it basically broke a lot of my careful organization. And I got so frustrated that I said, you know, I'm not going to bother with this. Thomas: Yeah, because I remember that. I didn't I was lucky enough to avoid that myself. But I remember that being the source of quite some scandal that a lot of music lovers basically ruined their collection and all their work of organizing the music for years through that solution. What I didn't mention was one of the key benefits of using some of the Contemporary Solutions is that you basically only provide your sound files and through audio fingerprinting these services will then recognize and identify all your music and will envision your music files with all the correct metadata as well as album covers and cover sleeves if they're available and so on. So it's really that easy now to combine your carefully collected sound files through the years and then your student preferences. So I think it's looking up. Jorge: We're nearing the end of our time together, but I can't pass up the opportunity to ask you about audio fingerprinting. I mean, you said that and it just intrigues me. What is audio fingerprinting? Thomas: Audio fingerprinting is the most popular popular technical way to identify an audio file. It's been popularized by Shazam. I don't know if you ever use that service, but Shazam is a mobile app and it's very popular, especially with younger demographic. It basically makes it possible if you have the app installed to open your microphone and then listen to a piece of music in a room or a restaurant or a club and then Shazam will recognize the music and tell you what it is. The problem with Shazam is you're only receiving the information about the artist and the title. But other services, like the MusicBrainz initiative I was just talking about, on top of MusicBrainz there is an audio fingerprinting service called AcoustID, which is the solution that most of these new products are using, including Rune. So basically Rune through AcoustID will scan all your audio files analyze them and then match them in their database and then through that have access to the complete music database of MusicBrainz. So it does and it does not it's not like all your fingerprinting is affecting the sound files itself. We've been doing audio fingerprinting ourselves in DR and it's basically been a huge game changer in the way we're administering our music because it's… Yeah, basically before we needed to have a very complex flow of metadata to complete production in order Jorge: That's fascinating and I'm sure that we could keep talking about this or so many things to to discuss in this field, but that feels to me like a good place to wrap up our conversation for today. Thank you for that. Just one final thing, if folks want to follow up with you, see what you're up to, what is the best way for them to do that? Thomas: Actually, I'm not that active on social media. I kind of was disillusioned by social media a couple of years ago. Mostly for the same reasons that I mean, the rest of the world was in terms of privacy and so on, so I'm not… I'm kind of hiding myself in this 900,000 large record collection for a few years. But sometimes I am on Twitter. So you're certainly welcome to follow me there. My handle is @thdose. Jorge: Fantastic. Well, I'll link that in the show notes. Thomas. It's been a real pleasure talking with you. Thank you so much. Thomas: Thank you Jorge.

I'm excited to bring you our first Cabral #HouseCall of the weekend where I share answers top our community's wellness, weight loss and anti-aging questions! Here are today's Q&A topics: Jodi: Hi Dr. Cabral, Love your podcasts. I started listening about a month ago and I'm learning lots. What are your thoughts on the new fascia blaster that is being advertised to break up cellulite? I'm wondering if I should purchase one. What are other ideas to eliminate cellulite? Thanks, Jodi Anonymous: Hi Dr Cabral, my mom and I both have little red dots, primarily on our arms. Some are the size of a pin head and some like the tip of a ball point pen. They look like red freckles. My mom has had them all my life and I've had them for at least 20 years. Any idea what causes these and how to get rid of them? Thank you so much for any light you can shed on this topic. Anonymous: Hi Dr. Cabral -I love your podcasts and appreciate the amount of helpful information you give on a daily basis! Two questions: 1. You mentioned in another podcast that not every person can take a probiotic depending on other internal issues. What if you don't know whether your child has one of those? Is it better not to give them at all or is it safe to give them daily? My child takes a gummy by Renew Life called Ultimate Flora with 3 billion daily and I'm concerned I'm doing more harm than good. Thoughts? Also if okay to take - do you know if this is a good quality option? 2. I loved your interview with Sara Gottfried - have been reading her book Younger, which is excellent and following her work. I believe I read on a recent post of Sara's that she is recovering from breast cancer. Part of me feels discouraged that a functional medicine doctor with access to all of the preventative tests, information and resources -- and who has been following the best possible protocol for over 10 years -- can still end up with breast cancer. I would like your thoughts on this. I think very highly of her and her work and wish her a full recovery and this is by no means a criticism of her work or of her. It just left me questioning if there just isn't a way to prevent disease even if you do everything possible to get it "right", Michelle: Hi Dr. Cabral - I have a few questions that are inter-related. I just purchased The Daily Support and wonder the following: 1. Would I as a 105 pound woman use two scoops and my husband at 200 pounds use the same amount every morning or should we adjust based on weight? 2. Am I getting all of my daily vitamins with it only if use the two scoops? 3. If I'm deficient in Bs and Ds is it okay to take an additional supplement? If so, when would I take them? 4. You suggest using it for morning and as afternoon shake - is it possible to take in too many vitamins during a day? I know certain vitamins build up and others like C don't so don't want to take too many or too little. 5. Is it safe to take a daily liver detox which your supplement contains or isn't this something you do once a quarter? Thanks! Lisa: Hi Dr. Cabral, I'm so overjoyed to have found you and your podcast! I'm hooked! Your teachings, insights, and dedication are a blessing in my life. Thanks so much for all you do. I have a question regarding CBD and eye health. I was diagnosed with Vitreal Macular Traction in my left eye in October of 2013 (piece of the macula stuck to the vitreous). I'm in good shape, with no major health issues outside of mild IBS which I manage with diet and probiotics so I was shocked to have this happen. I can see out of the eye, just can't read out of it which is so depressing. Although there's a surgery and gel injection for VMT it isn't always successful and can lead to a permanent black spot on the eye. To support eye healing, I shifted my diet to mostly vegetarian with occasional chicken and salmon at least once a week. Many people with VMT heal spontaneously, so I'm (still) hoping that will be me. My question is this: I have read a few articles stating that people taking CBD for other health issues, had their Macular Degeneration healed as a by product. Could you speak to the potential for healing of eye dis-ease with a CBD protocol? Many thanks! Ava: Hello.. a vain question more than a health one.. I have noticed deeper and more visible creases on my chest area (Decolletage Lines) and I really don't want them to get worse, even more so I'd like to get rid of them without injection/ lazer. Do you have any tips? I am mid thirties and these lines are making me v self conscious. Thank you v much for your insight. Ciara: Hi Dr. Cabral, I have some questions about episode 481 concerning food combining. I've been studying nutrition and holistic health for several years now and I really loved your breakdown about proper food combining. A lot of this information is consistent with what I've studied and I've incorporated what makes the most sense to me. I typically eat fruit on its own or in a green smoothie. What is your opinion on combining sweet and sub-acid fruits with leafy greens in a smoothie, as the food has already been predigested? I've read that leafy greens and fruit combine well together, but I just recently heard that this is a bad combination and only apples will mix well in a green smoothie. Also, your Daily Fruit & Vegetable Blend supplement contains similar combinations. How does this product demonstrate proper food combining?  Britney: Hi Dr. Cabral, I listened to your podcast on the thyroid, which prompted me to ask about the parathyroid. I went to the Dr. for lab work and my parathyroid hormone level was high and my calcium level was high by 1 point. They ran the numbers again 2 weeks later and the parathyroid number had lowered and was slightly outside of the reference range. My calcium had gone down by a tenth of a point. The only things that I changed between the first test and the second were eating a bit more iodine because I thought that I had a thryroid issue, and I began taking one of your daily supplements. I was advised to see an Endocrinologist and I haven't had my appointment yet. I've tried not to ready too many resources because some of what I have read has made me nervous. My Vitamin D is lower than the reference range and my LDL is slightly high. All other numbers were fine for my annual physical. Do Vitamin D and LDL play a role in a high parathyroid number? Do I need more calcium or am I lacking it? Which foods are helpful to lower the parathyroid number? Will foods/supplements keep my levels normal or will these levels need to be maintained constantly? Are any of the foods that are helpful to the thyroid also helpful to the parathyroid?  Thomas Brunhart: Hello, I found the Cabral Concept podcast a few weeks ago and love it. I have listened to many not all of the episodes. I am trying to have this email read on housecalls. Not sure if this proper way to do that or if there is a different website for that. I am a 42 year old male with Interstitial cystitis. I was diagnosed 5 years ago. It started pretty much over night. I am otherwise very healthy. I am 6' 2 '' and 175 pounds. I swim 3-4 times a week and go to they gym for weight training. I have tried many different treatments for my IC. I have tried stem cell treatment, was on a high dose of antibiotics for 1-2 months, I had my bladder stretched, tried Elmiron. The only thing so far that seems to have helped a bit was the first bladder stretching and going on a complete anti-inflammatory diet. I eat little to no gluten and processed sugars. I started taking CBD oil about 8 weeks ago can not say it changed much. However that said living with IC is still a nightmare. I am told there is not cure and would love your opinion or thoughts on the topic. Thank you Thomas Thank you for listening and I'll be back with another HouseCall tomorrow so stay tuned! - - - Show Notes & Resources: http://StephenCabral.com/498 - - - Get Your Question Answered: http://StephenCabral.com/askcabral    

IZ: What's up y'all? This is IZ. I'm with Connected and, man, another blessed opportunity to be standing here with an amazing drummer. Talk to me a little bit more about your process. Thomas: Right. IZ: And playing and playing on records or playing in a live gig? Thomas: Well, just like you said, and pointed out, you know, pocket is really number one. It's the most important thing and it's really the essence of what a drummer should do. So one thing that I really pay a lot of attention to feel, pocket. IZ: Right. Thomas: Making it feel great for the other musicians and really laying down a really solid beat. Whenever I'm working, producing, writing, for me as a drummer, the beat, the rhythm, the groove, the feel. IZ: It's everything. Thomas: That's everything and everything hinges on that. I'm sure, you know, when the beat feels right, everybody is... IZ: Yeah. You know, there's one thing... Thomas: ...nodding along... IZ: Exactly. You feel something. And as a drummer and listening to you do your thing it's like, you know, you hear it right away, right? It's like... Thomas: Exactly. IZ: ...I've heard a thousand drummers. Thomas: Right. IZ: You know, I've heard so many but when somebody's hitting that groove and that pocket, it's like, you stop and you're like... Thomas: Exactly. IZ: ..."Man, that shit is dawg [SP]." Thomas: Yes, time stops. IZ: You know what I mean? Yeah, time stops. And just the experience you've had, man, what are some of the things, as a drummer, you would do in a live setting versus playing on a record or in the studio and the micing process? Thomas: Right. IZ: Tell me all those different things. Thomas: Sure. Well I mean, obviously, in a live situation, there's a lot of factors you can't really control. IZ: Right. Thomas: As well as you know in a studio, and in your, sort of, very familiar environments. So you have to deal with a lot more bleed on stage which affects gates on the kits. I mean if you have 20 mics hot on a large drum set, you have to really make sure you work with phasing problems, you know, overheads, that's a big problem, usually. Also, if you have internal and external micing on the kits, to make sure that the phasing is right and that it's out of phase. Bleed, you use gates a lot more in a live situation... IZ: Right. Gates, yeah. Thomas: ...than in the studio. But other than that, from a playing point of view, you know, I approach it the same way. I make sure that, you know, it feels great, that everybody can hear what I do really well. That I speak... I sort of say very clearly on the kit and that you play the room. That's the really important thing that you play the stage and the size of the room, and adjust your volume and the power to the side of the room, I think. And make sure that you always listen to what everybody else, I think. IZ: Right. You know, that's really crucial information. And even for this, the new generation of drummers coming up, how important is it knowing how to tune your instrument? Knowing just the Sonics of what the kit should sound like for a certain record, or a certain sound, or a certain thing you're going for? How important is the tuning aspect? Thomas: Super important. It's really important and I mean there's really no rule to that. Because obviously, it's also important to be creative, and completely disregard history, and write a new chapter and try new things. But, I think, in order to learn your craft, you have to listen to a huge amount of music and analyze, you know, the tuning sound, the micing, the effects, etc., on records and recordings. Analyze that and try to recreate it to really learn how to use your equipment. And learn and understand what works in certain styles of music and what really supports those specific style, or feel, or groove, sound wise. If you listen to, you know, some Janet Jackson records with those like super gated snare drums... IZ: Gaited snare,, it's real big... Thomas: ...that is just so aggressive and has a certain feel to it. Or if you listen to a Phil Collins [inaudible 00:03:44], you know, and some of the '80s recordings. You know, you have to know how to create that sound and recreate it. And once you know and have a great vocabulary in terms of creating sounds, and making things sound and feel a certain way, then I think it's still like playing an instrument. Then it's time to develop your own style. IZ: I agree. Thomas: And try and create something new and get creative. IZ: What you do is a huge inspiration to... Thomas: Thank you very much. IZ: ... a lot of the cast that wanna do and be who you are. And, you know, it's a great roadmap, man, you know? https://www.rrfedu.com/ http://www.recordingconnection.com/ http://www.filmconnection.com/ https://www.radioconnection.com/ RRFC 1201 West 5th Street, Suite M130 Los Angeles, CA 90017

IZ: What's up y'all? This is IZ. I'm with Connected and, man, another blessed opportunity to be standing here with an amazing drummer. Talk to me a little bit more about your process. Thomas: Right. IZ: And playing and playing on records or playing in a live gig? Thomas: Well, just like you said, and pointed out, you know, pocket is really number one. It's the most important thing and it's really the essence of what a drummer should do. So one thing that I really pay a lot of attention to feel, pocket. IZ: Right. Thomas: Making it feel great for the other musicians and really laying down a really solid beat. Whenever I'm working, producing, writing, for me as a drummer, the beat, the rhythm, the groove, the feel. IZ: It's everything. Thomas: That's everything and everything hinges on that. I'm sure, you know, when the beat feels right, everybody is... IZ: Yeah. You know, there's one thing... Thomas: ...nodding along... IZ: Exactly. You feel something. And as a drummer and listening to you do your thing it's like, you know, you hear it right away, right? It's like... Thomas: Exactly. IZ: ...I've heard a thousand drummers. Thomas: Right. IZ: You know, I've heard so many but when somebody's hitting that groove and that pocket, it's like, you stop and you're like... Thomas: Exactly. IZ: ..."Man, that shit is dawg [SP]." Thomas: Yes, time stops. IZ: You know what I mean? Yeah, time stops. And just the experience you've had, man, what are some of the things, as a drummer, you would do in a live setting versus playing on a record or in the studio and the micing process? Thomas: Right. IZ: Tell me all those different things. Thomas: Sure. Well I mean, obviously, in a live situation, there's a lot of factors you can't really control. IZ: Right. Thomas: As well as you know in a studio, and in your, sort of, very familiar environments. So you have to deal with a lot more bleed on stage which affects gates on the kits. I mean if you have 20 mics hot on a large drum set, you have to really make sure you work with phasing problems, you know, overheads, that's a big problem, usually. Also, if you have internal and external micing on the kits, to make sure that the phasing is right and that it's out of phase. Bleed, you use gates a lot more in a live situation... IZ: Right. Gates, yeah. Thomas: ...than in the studio. But other than that, from a playing point of view, you know, I approach it the same way. I make sure that, you know, it feels great, that everybody can hear what I do really well. That I speak... I sort of say very clearly on the kit and that you play the room. That's the really important thing that you play the stage and the size of the room, and adjust your volume and the power to the side of the room, I think. And make sure that you always listen to what everybody else, I think. IZ: Right. You know, that's really crucial information. And even for this, the new generation of drummers coming up, how important is it knowing how to tune your instrument? Knowing just the Sonics of what the kit should sound like for a certain record, or a certain sound, or a certain thing you're going for? How important is the tuning aspect? Thomas: Super important. It's really important and I mean there's really no rule to that. Because obviously, it's also important to be creative, and completely disregard history, and write a new chapter and try new things. But, I think, in order to learn your craft, you have to listen to a huge amount of music and analyze, you know, the tuning sound, the micing, the effects, etc., on records and recordings. Analyze that and try to recreate it to really learn how to use your equipment. And learn and understand what works in certain styles of music and what really supports those specific style, or feel, or groove, sound wise. If you listen to, you know, some Janet Jackson records with those like super gated snare drums... IZ: Gaited snare,, it's real big... Thomas: ...that is just so aggressive and has a certain feel to it. Or if you listen to a Phil Collins [inaudible 00:03:44], you know, and some of the '80s recordings. You know, you have to know how to create that sound and recreate it. And once you know and have a great vocabulary in terms of creating sounds, and making things sound and feel a certain way, then I think it's still like playing an instrument. Then it's time to develop your own style. IZ: I agree. Thomas: And try and create something new and get creative. IZ: What you do is a huge inspiration to... Thomas: Thank you very much. IZ: ... a lot of the cast that wanna do and be who you are. And, you know, it's a great roadmap, man, you know? https://www.rrfedu.com/ http://www.recordingconnection.com/ http://www.filmconnection.com/ https://www.radioconnection.com/ RRFC 1201 West 5th Street, Suite M130 Los Angeles, CA 90017

Dr. Veronica Anderson, Host, Functional Medicine Specialist and Medical Intuitive interviews Dr. Tom O'Bryan, an internationally recognized speaker and workshop leader specializing in the impact of celiac disease and non-celiac gluten sensitivity, and the development of autoimmune conditions. He has been in practice for over 32 years and is on the teaching faculty of the institute for functional medicine. While traveling the world, he teaches physicians about developing the big picture as to what's causing the symptoms that patients are coming in with. In this episode, Tom translates complex medical information into simple to understand ideas. We will discuss breakthrough plans to stop autoimmune triggers, restore your health and ways to prevent Alzheimer's and reverse Diabetes. Listen to the end to hear Tom’s vaccine administration strategy for infants.   Dr. Veronica Anderson's Links https://www.linkedin.com/in/drveronicaanderson/ https://www.facebook.com/drveronicaanderson/ https://twitter.com/DrVeronicaEyeMD?lang=en https://www.pinterest.com/drveronicaeyemd/?eq=dr.%20veronica&etslf=14837 https://www.instagram.com/drveronica/?hl=en   Recommended Books: http://amzn.to/2p9LK8L   Discussed: Betrayal Series:- http://www.bit.ly/TheBetrayal7PartSeries   Show Notes: 01:58 - What is Autoimmune disease? 08:40 - Thyroid problems in women 16:45 - Food promoting intestinal permeability ( leaky gut ) 19:00 - How your diet affects your thyroid 23:20 - How an autoimmune thyroid disease is triggered 29:40 - Preventing Alzheimer's and Diabetes 31:50 - Wheat sensitivity and inflammation in the brain 33:00 - Reversing Diabetes with a raw food diet 36:00 - Interviewing world experts of autoimmunity 38:20 - Vaccine administration strategy for infants   If you enjoyed this episode, do us a favor and share it! Also if you haven’t already, please take a minute to leave us a 5-star review on iTunes and claim your bonus here!     Want to regain your health? Go to http://drveronica.com/   Transcript Female VO: Welcome to Wellness Revolution Podcast, the radio show all about wellness, in your mind, body, spirit, personal growth, sex, and relationships. Stay tuned for weekly interviews featuring guests that have achieved physical, mental, and spiritual health in their lives. If you'd like to have access to our entire back catalog visit drveronica.com for instant access. And here's your host, Dr. Veronica. Dr. Veronica: Thanks again for joining for another episode of Dr. Veronica's Wellness Revolution. We're going to talk today. I want to jump right into this. I want to have enough time to be able to talk to this gentleman who is a guru. The gentleman I have with me today is Dr. Thomas O'Bryan. He is originally a doctor of chiropractic medicine, but you know what I've found? I feel really silly sometimes because I feel like I went to school before medical school with the chiropractors and I was getting really good grades and they weren't doing as well. And I felt like all these people they're not so smart at going into chiropractor. Then I realized on the back half of my career that I was the dumb one and they're the smart one and I better learn from them. So those of us who were the conventional smart doctors have now kind of thrown away a lot of what we learned. We know about the body and all that, and jumped in the pool with our colleagues because we're all colleagues out to help people get well who were the chiropractors of natural path and nutritionists. And we all collectively are out there getting the word out on how you can heal your own body. Dr. Thomas O'Bryan has a new book out there, The Autoimmune Fix. I see so many people every day who say, "I've been told I have autoimmune disease and they haven't quite given it a name but I have autoimmune disease."  The Autoimmune Fix talks about this but also talks about what's been going on in the health care system. What's been going on or not going on when you'd go to your doctor and here's the latest and greenest. And we also have a surprise coming up on some information that you can get where you can go and hear the world experts in autoimmune disease. Dr. Thomas O'Bryan, welcome to Dr. Veronica's Wellness Revolution. Dr. Thomas: Thank you so much. It's a pleasure to be with you. Thank you. Dr. Veronica: First define for us what it's meant by autoimmune disease? Because as I told you and I said in the intro I get a lot of people who said, "I've been told I have autoimmune." The big diagnosis these days is, "I have Hashimoto's." Every other person has Hashimoto's. "Oh, you have an autoimmune disease too. Autoimmune disease, give us the definition. Dr. Thomas: Sure. Your immune system is the armed forces in your body. It's the army, the Air Force, the Marines, the Coast Guard, the Navy. It's there to protect you. And it's all we have to protect us. And you have exactly the same immune system that your ancestors had thousands of years ago. We haven't genetically changed.  What was it that our immune system was designed to fight? Parasites, bugs, viruses, molds, and fungus. That's it. There was no Polysorbate 80, or red dye number 3, or Bisphenol A, or mercury in the fish. There weren’t any of the toxins that we're supposed to every day. So our immune system is the same as our ancestors, so it's built to protect us from parasites, bugs, viruses, molds, and fungus. There is no way for it to adapt. When you get exposed to Bisphenol A for example, which is the chemical that softens plastic like water bottles, or pop bottles, or soft contact lenses, or credit card receipts have Bisphenol A. There is just millions and millions of pounds of this stuff being dumped every year here.  But when you're exposed to Bisphenol A this chemical gets into your body and it binds on to your cells. It grabs to on to proteins inside your body like an estrogen cell or a testicular cell. Now the immune system that's there to protect you from bugs, parasites, viruses, molds, and fungus has to attach this molecule that got in there that's not supposed to be there. "This is an invader. What is this thing?"  Your immune system attacks this Bisphenol molecule or lead molecule if you have lead poisoning, where mercury molecule, and you create this inflammation as the immune system is trying to destroy this invader. And the inflammation has collateral damage which damages your own cell that the Bisphenol A grabbed on to. And now your immune system has just damaged your cell. When the immune system attacks yourself it's called an autoimmune mechanism. It's the immune system attacking cells.  In the example I just gave you we make antibodies every day to ourself. There's a normal reference range for thyroid antibodies and brain antibodies. There's a normal range, why? Because your immune system is the garbage collector. It's got to get rid of the old and damaged cells, the ones that are breaking down or just worn out to make room for new cells to be built.  You have a whole new body every 7 years. We regenerate every cell in our body. But to make room for cells to regenerate you've got to get rid of the old and damaged ones. There's a normal level of thyroid antibodies. It's normal. But when you have a chemical binding on to the thyroid for this example, the chemical might be chlorine or it could be Bisphenol A binding to a thyroid cell, and your immune system says, "What is this stuff? That's not good for me. I better attack it.  Your immune system attacks that cell and causes the inflammation that damages the thyroid that the Bisphenol A's grabbed on to. Now the antibodies that your body makes to get rid of old thyroid cells, it has to make some more antibodies to get rid of the damaged thyroid Bisphenol A cell, because the thyroid cell's been damaged you got to get rid of it. So you make some extra antibodies to your thyroid. That's not a problem. But you're exposed to Bisphenol A every day. One hundred percent of the infants born today have Bisphenol A in their urine, 100% of them, because mom has it. Mom's toxic with this stuff, right? It binds on to your cells. And so every day you're exposed to this stuff, and then your body makes more antibodies to your thyroid to get rid of the damaged thyroid cell that the Bisphenol A was grabbing on to. And you make more thyroid cells.  And if you did a blood test you'd see you had a high thyroid antibody levels and you make more thyroid antibodies. Until one day this thyroid antibody production becomes self-perpetuating. It's got a life of its own. Now you develop the autoimmune disease, so you're on the autoimmune spectrum with elevated antibodies, but now it moves into an autoimmune disease because you've killed off enough thyroid cells because of the elevated antibodies, the thyroid can't function very well anymore. That's the autoimmune disease.  Mrs. Patient, you pull at a chain, the chain always breaks at the weakest link. It's at one end, the middle, the other end, your heart, your brain, your liver, your kidneys, wherever your genetic weak link is that's where the chain's going to break when you pull too hard. Inflammation is the pull on the chain.  That's why we here about anti-inflammatory lifestyles. It's that you want to live as much of an anti-inflammatory lifestyle with all that that means. And your show talks about that a lot, about anti-inflammatory lifestyles, so that you don't have that link of the chain break and get an autoimmune disease. What's pulling on the chain? What's pulling on the chain is the gasoline or the kerosene that you're getting in your body, if it's air pollution or if it's food you're eating that aren't good for you. The question is it a kidney or a brain cell, is it gasoline or kerosene? When you want to start fixing these problems you have to ask the questions, "Where is my immune system attacking right now and why is my immune system attacking there?" That's the way you uncover what the mechanism is that's causing the diseases that we have. Dr. Veronica: Talk a little bit about thyroid because I think all of us that are in the functional medicine wellness arena, the thyroid people come in because they just seem for whatever reason they're the most miserable... There's other miserable people, but the thyroid people seem to be miserable and go seek their help. Why thyroid and why mostly women, although there's a lot of men now prop up with it. Dr. Thomas: Yeah, but the ratio of women to men with Hashimoto's is 9:1. It's much more prevalent in women. There's a number of reasons for that. The first reason is receptor sites are catcher's mitts. The pitcher throws the ball to the catcher. You have receptor sites on the outside of your cells facing the bloodstream. So as the blood's going by it goes past these receptor sites. Hormones get inside the cell to do whatever they're supposed to do by going through the receptor site. Estrogen in your bloodstream only goes into an estrogen receptor site. It won't go into a thyroid receptor site. And it goes into the estrogen receptor site, it opens the door and the estrogen goes inside the cell and the body will do what it's going to do. Insulin won't go into an estrogen receptor site, it won't go into a thyroid receptor site. It only goes into an insulin receptor site. All the hormones have specific receptor sites. There are chemicals that we're exposed to now every day, never before in the history of humanity but now every day. And there are three chemicals known to compete on thyroid receptor sites.  Now, back up for a minute. There's only two substances for which there are receptor sites on every cell of your body. No, it's not testosterone, no not estrogen, no not insulin, the only substances for which there are receptor sites on every cell of your body are vitamin D... That's why vitamin D is so important for us because every cell needs it, and thyroid hormone. Because your thyroid hormone is the thermostat on the wall in your house.  At night you turn the thermostat down so the furnace goes down. It's colder in the house, so that you sleep and you save fuel. In the morning it automatically turns back on before you get up, and so it warms up the house but you save fuel during the night. Thyroid hormone controls the thermostat. That's called your metabolism and how hot your cells burn, how many calories you burn, that's your thyroid hormone. Every cell needs control as to how hot it should burn, that's what thyroid hormone does. Thyroid hormones in the bloodstream, and it goes past the thyroid receptor site and it goes right into it. It opens the door and the thyroid hormone goes into the cell. As you know many people will feel like they've got thyroid symptoms. They come in and the doctor does a blood test and sees that their thyroid hormone levels are normal but they've got thyroid symptoms so they write a prescription for thyroid hormone. And we're shot gunning thyroid hormone into someone that has normal levels because it's going to help feel a little better. How is it possible that their thyroid hormone levels are normal but a blood test that many doctors do is called TSH and it's a measure in the brain telling the thyroid how much hormone to make. TSH stands for thyroid stimulating hormone. How come the TSH can be a little high but the thyroid hormone levels are normal? And you see that all the time in practice. We all see that. How does that happen? It's because the thyroid hormone is not getting into the cell, it's in the bloodstream. Your bloodstream's just a highway. There's lots of traffic on the highway so you do a blood test and you're looking for are there Chevrolet's on the highway. Is there a thyroid hormone on the highway. There's enough hormone but it's not getting into the cell, so the brain says, "I need more thyroid hormone in these cells." The TSH goes up to say, "Make more hormone, make hormone." But you've got plenty of hormones. And doctor shot gunned with synthetic hormone and people will feel a little bit better. It doesn't fix them but they feel a little better.  How come the thyroid hormone is not getting into the cell? Because there are three chemicals that compete and will go into thyroid hormone receptor sites. But when they go into thyroid hormone receptor sites they don't open the door. They just sit there. The pitcher throws a fastball to the catcher but the catcher's got three baseballs in the mitt. And so the fastball just bounces out. The thyroid hormone just keeps going down the bloodstream, it can't get in.  What are the chemicals that compete in thyroid receptor sites? The most common one... Mrs. Patient, you're in an elevator in a hotel. The elevator doors open. Can you tell right away the swimming pools on that floor? Oh yeah. They smell it. But everybody else in the elevator can't smell it. But they smell it. Why do they smell it? Because they have a chlorine sensitivity. Their detox capabilities are not breaking down the chlorine, so the chlorine is sitting in the receptor sites of the thyroid hormone.  So the thyroid hormone is going by, it can't get into the cell. The thyroid hormone keeps going by, and yet the brain says, "I need more hormone. I need more hormone," and it's chlorine. It's a very common competitor for thyroid receptor sites. Those women, especially the women, cold hands and feet, sometimes they wear socks to bed, or your husband says you got really cold feet. You can't get up in the morning. You wish you had 20 more minutes in bed. Can't lose that last 5 pounds even if you don't eat for a couple of days. Bowels are sluggish, emotions are kind of sluggish, brain's sluggish, you kind of feel a little depressed, all signs of a sluggish thyroid.  Your thyroid hormone levels are normal but your doctor gives you thyroid hormone anyway because we know it's going to help a little bit. And they haven't had the chance to read about this competitive inhibition of chlorine into the thyroid receptor sites. That's a very common mechanism for thyroid dysfunction. How does that relate in terms of autoimmunity? Dr. Veronica: Let me just interrupt. Because you said there are three things, and you mentioned the chlorine, but tell people the other two that go along with chlorine just because people are going to start connecting the dots and say, "That could be me." Dr. Thomas: You won't like this. Fluoride is very, very common. It's a very common thyroid inhibitor substance. It's in your toothpaste, it's in your mouthwash, it's in your drinking water and it competes on thyroid receptor sites. And the result is your thyroid hormone doesn't work as well as supposed to. You gain weight, you feel sluggish, sometimes you can pack on an extra 20-30 pounds over five years that it just creeps up little by little by little. Fluoride is the second one. The third one is bromide.  So it's chlorine, fluoride, and bromide. Bromide is in baked goods. A lot of bromide is used in baked goods. Those are the three chemicals that will compete on thyroid receptor sites. And they don't breakdown, they just stay there. Dr. Veronica: Okay. That's chemicals. I know you're an expert on another food that everybody loves and when you tell them they have to give it up they want to murder you practically because they're addicted. Talk about that food. You don't have to talk to me about... Dr. Thomas: Unfortunately it's the most common food in America today. It's 132.5 pounds per person per year that we're eating. That's wheat. You have toast for breakfast, a sandwich for lunch, a pasta for dinner, croutons on your salad, a cookie or a muffin, and it goes on a day, after a week, after a month, after year, after year.  Harvard's published another study last year. Hollon and his team published a study and they showed that every single human when they eat wheat gets intestinal permeability. The slang term is leaky gut. And that's the gateway into the development of autoimmune diseases that we'll talk about a little bit later, but that's the gateway. And every single person, every time they eat wheat, not just once in a while, every time. And their language was all humans develop intestinal permeability. Anyone that's watching this interview, if you're a human, I think most of you are, that means every time you eat wheat you get tears in your lining in your gut. It's called pathogenic intestinal permeability. Even for those that don't feel bad. Those that feel bad when they eat wheat they're the blessed ones. Because you can't argue with them, they know when they eat it they get sick. But the ones where the weak link in the chain is their brain they don't want to associate the pasta they had last night with the brain fog they've got today. They just don't want to associate it, or with seizures.  In the Journal of Gastroenterology children with drug resistant seizures, that means that they've been to at least two specialists and they've tried at least three drugs before they can get the classification of drug resistant seizures, 50% of those children go into complete remission on a wheat-free diet. Why don't our neurologists know this? Because it's in the gastroenterology journal, and neurologists don't read gastroenterology journals, they read neurology journals. So they just don't know this. Wheat can affect any tissue of your body. I'm going to give you an example of how it affects the thyroid. When you eat wheat, Mrs. Patient. Proteins are like a pearl necklace, hydrochloric acid made in your stomach undoes the clasp of the pearl necklace. Now you have a string of pearls. Our digestive enzymes are supposed to act like scissors to break the pearl necklace into smaller clumps of pearls, then smaller clumps, and smaller clumps, and smaller clumps. Until they get broken down into each pearl of the pearl necklace. That's called an amino acid. And the amino acids go right through the walls of the intestines, and then your body uses those as building blocks to make a new muscle, or a new bone, or a new nerve hormones called neurotransmitters that your body uses the amino acids.  Your intestines are 20-25 feet long. It starts at the mouth and goes to the other end. It's one long tube. It kind of winds around in your abdomen. It twists around quite a bit, but it's one long tube. If you could take a doughnut and stretch a doughnut straight down and look down the doughnut it's one tube. When you swallow food it's not in your body yet, it's still in the tube. It's got to go through the walls to get into the bloodstream and go everywhere else in your body. But there's a cheesecloth that lines the intestines so that only the single pearls of the pearl necklace can fit through the cheesecloth to get into the bloodstream, only the amino acids. The problem with wheat is that no human can breakdown the pearl necklace in each pearl of the pearl necklace. The best we can do is break it into clumps of pearls. There's a 33-pearl clump, a 17-pearl clump, an 11-pearl clump. And these clumps of pearls are gasoline and the fire in the intestines. They cause inflammation. And it's the inflammation that tears the cheesecloth. When you tear the cheesecloth now larger clunks of the pearl necklace of any food can go through the permeability into the bloodstream before there's been enough time for the digestive enzymes to break that food going down the track until it's small enough to get through. Does that make sense? Dr. Veronica: Yeah. Dr. Thomas: You got these clumps of pearls going through into the bloodstream. They're called macro molecules, big molecules. And your immune system says, "What's this? This is not good for me. I better fight this. If you had prime rib for dinner and you chew it three or four times instead of the 15-20 that you should... You chew a couple of times and swallow it down, we shovel more than we chew and you shovel it down you got this clump of stringy meat that's kind of hard to break down. And the enzymes are trying to cut off each pearl of the pearl necklace but it takes a while. That's why you got 20 feet of intestines for the scissors to work on that.  So it's going down in the first part of the intestines now, but there are tears in the cheesecloth. So these macro molecules of prime rib get into the bloodstream. Your immune systems says, "Whoa, I better fight this." Now you make antibodies to beef, and you're allergic to beef, or to bananas, or to chicken, or to potatoes, or to cantaloupe.  And the doctor that does the 90-food panel to see what foods a person is sensitive to, and it comes back with 20-25 foods and the patient goes, "Oh my god, that's everything I eat." Of course it is, because your body is trying to protect you. You don't shut down the immune system, you stop the tears of the cheesecloth. So you have to find out why is the cheesecloth tearing. And when you find out why the cheesecloth is tearing then 6 months to a year later you check again the 90 foods, now you're sensitive to two or three and not 20. That's the mechanism in the development of intestinal permeability, the leaky gut. Let's tie that now to the thyroid. How does this trigger an autoimmune thyroid disease? When this macro molecule of beef gets into the bloodstream and your immune system says, "Whoa, what's this?" The brain says, "You General, you now are General Beef. Take care of this."  General Beef builds an assembly line. The assembly line starts producing soldiers. They're called antibodies. The soldiers are trained to go after beef, that's all they do. They're in the bloodstream looking for beef. And when they see beef clumps they fire their chemical bullets to destroy the beef clumps. Remember your bloodstream's just a highway. There's no lanes of traffic. Everything's bouncing around in there. It's going in the same direction but it's bouncing around.  Think of the antibodies like Arnold Schwarzenegger and he's got his head out of the big Humvee. He's got those dark glasses on. He's got a big submachine gun. "Over there." And he's firing these chemical bullets at beef because he's been trained to go after beef.  The beef macro molecule may be 15 amino acids long because it hadn't had enough time to be broken down into each pearl of the pearl necklace. So there's 15 amino acids there and Arnold has been trained to go after what anything that looks like that 15 amino acids. I'm going to sat AA, B, C, D, but it really is 15 letters long in this example. Let's say Arnold is going after wheat because wheat got in, it tears the cheesecloth, it gets in as a macro molecule. Your immune system makes antibodies to wheat. I said beef to start with but I'm going to talk about wheat now. Let's say Arnold's looking for AA, B, C, D. Bouncing around in the bloodstream looking for AA, B, C, D. He's got these dark glasses on. The surface of your thyroid facing the bloodstream is made up of proteins and fats. That's what the surface is made of facing the bloodstream. Proteins are made up of amino acids. There are hundreds of amino acids long, the surface of the proteins of the thyroid, hundreds of amino acids long. But part of the thyroid includes AA, B, C, D.  Arnold that's looking for wheat, AA, B, C, D, he's like, "Oh look, over there." And he fires his chemical bullets at the thyroid to damage the thyroid cell because it's got AA, B, C, D. That's called molecular mimicry. And it's a big problem for people today, they just don't know it. It's a big problem as to why autoimmune disease is so prevalent.  Arnold starts firing his chemical bullet at the thyroid damaging the thyroid cell. Remember you have a normal amount of thyroid cells but now you have to make a few extra because there's more damaged thyroid cells than normal. That's after having toast for breakfast. But now you have a sandwich for lunch. More Arnold, more damage to the thyroid, AA, B, C, D, if that's the weak link in your chain.  If it's your brain Arnold goes after your brain with molecular mimicry. If it's your kidneys Arnold goes after your kidneys with molecular mimicry. It just depends on what the weak link is in your chain. With wheat it doesn't matter because AA, B, C, D is very common to the structure of the human body. It's a component of... If you think of proteins like it's big, long brick wall, many colors of bricks in there, but there's this pattern. Any time you see that pattern, "Oh look it's there. Oh look it's over too. Oh, it's there too. And that's AA, B, C, D in our bodies. It's very common in our bodies.  So whoever the weak link is in your chain that's where Arnold's going to go. And then you have to make more antibodies to your thyroid until this antibody production to your thyroid becomes self-perpetuating. Now you're on the autoimmune spectrum, killing off your thyroid in this example or your thyroid, killing off cells, until eventually you've killed off so many cells now you're starting to get cold hands and feet, or it's hard to wake up in the morning. Now your thyroid's not working so well for you. You go to a doctor and they take your thyroid hormone. The hormone levels are normal but you're not functioning very well. And they don't check to look for the autoimmunity that's causing all the inflammation in your thyroid and killing off the cells in your thyroid. That's the autoimmune spectrum. Dr. Veronica: Okay. First of all I love your analogies. They're just so beautiful. Thank you. I'm into this story and I'm just like... When you've heard the story before and explained in the medical health and all the lingo with all the stuff behind it it's like, "I've heard about that." But with the Arnold Schwarzenegger behind it with glasses it's like... Dr. Thomas: Yeah, it helps. Dr. Veronica: Thank you so much for that. I would've jumped over because that's a beautiful explanation. Now you're talking about the autoimmune fix and we talked a little bit before we came on about type 1 diabetes which people think, you just got it. There's nothing you can do about it. And also Alzheimer's, you just get old and you just get it. There's nothing you can do. You got the tangles in your brain. You're going to get it.  Talk a bit about can we fix this. Because most people think, "I'm a victim. I just got it. There's nothing I could do about it. I got the pill. I keep going to the doctor and gets adjusted. I feel miserable. This is just my luck in life. My family had it. My mom was like this. Too bad. Oh well." But that's not true. Dr. Thomas: No. That's not true at all. I was just  looking for something. I can't find them quickly so I'll just skip that. No one gets Alzheimer's in their 60's or 70's. It's a decades long process, slowly killing off brain cells. Until you've killed off enough brain cells that the system doesn't work very well anymore just like your thyroid. Dr. Dale Bredesen is at UCLA. He runs the Buck Institute at UCLA. That's the Alzheimer's Research Center. He published a paper in November of 2014 showing complete reversal of Alzheimer's in 9 out of 10 people within 5 years at UCLA. They reversed it within 5 years. How did he do it? There's a 34-point checklist. "They have this. They have this. Do they have this? Do they have this?" Top of the list, wheat sensitivity. Next, dairy sensitivity. Because AA, B, C, D is so very common with the brain when you have a sensitivity to wheat. When I give my lectures to doctors, there's 200 doctors in the room how many know we're suspecting of a sensitivity to wheat? Let me see a show of hands? And I say, "Hold your hands high for a minute please," and they do. I say, "Look around the room," and it's about 80% of the room. Then I'll say, "How many of you know or suspect if you have an inadvertent exposure to wheat it seems to affect your brain? Let me see your hands again? Come on, hold them up." And about 50%-60% of those people raise their hand again. And I said look around the room. This is a talk to doctors, health care practitioners. This is not a celiac group. This is your practice doctors. This is how often it's in your practice. "How many of you are finding it this often?" And maybe there'll be one person that raises her hand. In other words in clinical practice six to seven out of ten people will test positive if you do the right test, looking for a sensitivity to wheat. And of that number the most common system affected for molecular mimicry AA, B, C, D is the brain. Most common for most people it affects the brain. You've got Arnold firing at your brain causing inflammation in the brain, that's pulling on the chain. And eventually one day you say, "I'm getting old. I don't remember the way I used to. Haha..." "Really? How old are you?" "I'm 38." No, that's not supposed to happen. No, that's not normal, you're getting older. No, it's a brain that's on fire. You've got inflammation in your brain. Why? I don't know why. Let's find out.  But you're on the autoimmune spectrum, and that's what this book is about. The Autoimmune Fix just came out two weeks ago. What it's about is to understand this big picture concept. Everybody wants a cure. May I be gentle and say this to your listeners. Wake up. There's no such thing as a cure. There's no magic pill that fixes your diabetes. Wake up. A cure means you don't have the symptoms anymore. You have no markers of the symptoms like blood test or urine test, and you can do whatever you want. Remission means you don't have the symptoms anymore. There is no markers of the symptoms, urine or blood test. And as long as you live the lifestyle that got you feeling better you're going to stay healthy. There's no cure. You want to read about a cure for diabetes? Go to YouTube and type in Type 2 diabetes and raw food diets. And you'll see the videos of African-American post-menopausal women which is a very high-risk group for diabetes, you'll see a video of them. They go on a raw food diet for 30 days and you see the doctors talk about their blood tests, and this is unbelievable, their diabetes is completely gone. Their cholesterol's come down 85 points. I'm taking them off their cholesterol medication. You see the doctors saying this. The most potent thing you can do for your health is what's at the end of your fork. That's it. It's like, wake up people, wake up. And the reason I'm so direct about this is because for the first time in the history of human species, for the very first time the New England Journal of Medicine tells us today that children born today are going to get sick at an earlier age than their parents. They're going to get diagnosed with diseases at an earlier age than their parents, and they're going to die at an earlier age than when their parent's died.  For the first time in the history of the human species. This has never happened before. We're going down. Now, the statistics are very clear, our health care system is one of the worst. The U.S. is ranked second from the bottom in quality of health care at the World Health Organization, yet we spend more for health than anywhere else on the planet. It's in pharma's big interest to keep us dumbed down and not understanding any of this.  That's why I spent a year with Betrayal, The Autoimmune Disease Solution They're Not Telling You. When you guys wake up to this common sense stuff that's in here and that's in Betrayal you're just going to start asking different questions. And when you ask different questions your doctors are being demanded upon to get more answers. Because the things that I write about in this book just make common sense.  Stop throwing gasoline on the fire. Everybody knows that diseases are inflammatory. Alright, stop throwing gasoline on the fire. "How do I do that?" Well, you have to learn. And so it's going to take a while to learn. There's no cure that you take this pill and you're fine. There's no cure. There is remission. And you can have a wonderfully vibrant, dynamic life you can. But we have to learn how to ask the right kind of questions. Dr. Veronica: You mentioned Betrayal, I think so many people feel betrayed by the health care system, betrayed by their doctors, betrayed by the government, society, just betrayed by everything. We talk about Betrayal and we're going to talk about how people can get access to Betrayal and learn. Dr. Thomas: I've traveled the world, literally. For the last few I put 165,000 air miles now in this last year. Lisbon, Barcelona, Leipzig, Germany, three times in London, Dublin, Sao Paolo, all over the world, interviewing world experts, the godfathers and godmothers of autoimmunity. And they know all of this and it's shocking when you hear them talk about it. They've know about this for years these kinds of concepts, but no one's carrying the message out and putting it together. We put it all together. It's a seven-part series online, everything's free. It's about an hour a day for seven days. And you can register for it here with your website, so people can click on it and register and they can watch Betrayal. They're going to hear from the experts.  You're going to hear from Dr. Marta Vives Pi in Barcelona, Spain who is reversing type 1 diabetes with diet and nutrition, regenerating beta cells of the pancreas. So your body starts making insulin again. What we've been told it's impossible. No, it's not. Read her papers. Here's the evidence. It works. It's simple. It's not a drug, and it works.  You're going to read Prof. Yehuda Shoenfeld, the godfather of predictive autoimmunity. His book is there on the shelf, Vaccines and Autoimmunity. It just came out. Dr. Shoenfeld, to get a sense of who this guy is, 28 of the PhD students who got their PhD's under him, many more than that, but 28 of them share departments of immunology in med schools and hospitals around the world. This is the godfather. I interviewed him three times. And you hear him say, "Dr. O'Bryan, I am very much in favor of vaccinations. They have saved millions of lives. However, if the person carries the gene HLA-DRB1, and 30% of the population does, they are very sensitive to having an acute reaction to the adjuvants in vaccine. Thus, it is of wisdom to perhaps be cautious in administering the vaccines. Perhaps a smaller time scale of administration, not seven in one day, not three in one day to these infants that have a weakened, not developed immune system yet. So you give one and you wait two weeks. You give another one.  Sean tells all four vaccinations but he's saying for these patients that are HLA-DRB1 you got to wake up. You can't throw this toxic poison in them because their bodies can't handle it that well. Other bodies may be able to handle it okay. So it's not saying don't vaccinate, he's just saying vaccinate with caution if they have that weak link in their chain. That's the kind of stuff you're going to hear from these experts. It's just such useful information and it saves lives. It's going to save thousands and thousands of lives. I want everyone to watch this. It's all free. Because if you watch it you're going to ask different questions of your doctor. Dr. Veronica: I just got to share because we're just meeting for the first time a little bit before the podcast of how I personally felt betrayed by my medical education. I also felt betrayed in my health care. I realized that I was sensitive to certain things because my sons, one got depressed and one got bipolar, and we figured out that they were sensitive to wheat and soy. One had thyroid symptoms major. Dr. Thomas: AA, B, C, D. Dr. Veronica: The doctor came to me who was my [Unintelligible 00:38:56] Dr. Veronica who's a chiropractic at... "Come here mom. Let me test you." And then what do you know, I'm sensitive. I'm not eating tons of these food so I would get six sometimes and say, "What's going on. I don't even know what happened?" And all of a sudden it answered questions for me. And the other thing that I will say is as an African-American I used to feel, "That's a white people disease." And I realized it's not a white people disease. And probably everybody in my family is suffering from these things and oh my god we better wake up. My mother and my father has diabetes. I'm an eye surgeon by training. My grandmother went blind from diabetes. This is this betrayal that you're talking about needs to get out there into the whole world. So when people go to my Facebook page, to my website, even if it's after the date don't think that you still can have access to it because the world needs to see this. Dr. Thomas O'Bryan I thank you for your work, your book The Autoimmune Fix. For those of you who like to read go get the book. You need it on your shelves so you can pick it up and read it over and over again, because it takes a while to digest this. Dr. Thomas: May I say something about the book? Dr. Veronica: Yes.  Dr. Thomas: Here's the thing on the book. Right now it's on Amazon for 16 bucks. Amazon is selling it at a loss because it's getting more traffic. More people are coming. And then when you're on Amazon you're likely to buy something else, so that's their philosophy. But it's 16 bucks. If I make The New York Times Best Seller list that means I get invitations. I'm now a candidate for Ellen, Oz, Bill Maher, all these shows where I can carry this message out even further. For 16 bucks I promise if you're not happy I'll give you a refund. You just send me a note and I'll give you a refund. I'm very proud of it. It's 30 years of work. But help me carry this message out. Help me if you would by getting the book. There's no profit in this. You make a couple of bucks a book. This is not for that. This is really to carry the message out to wake the world up because our kids are dying younger than their parents, and that's what this is about. So help me and watch Betrayal. Tell your friends about Betrayal. Help us carry the message out there so we can reach a million people with this. Dr. Veronica: Yay, and I'm going to help you reach those million people with the followers of Dr. Veronica and all my posting on social media. Dr. O'Bryan, again, with much gratitude for your work and your time, those 165,000 miles to get Betrayal put together so we all could figure out what we need to do to heal ourselves. Thank you so much. Dr. Thomas: Thank you. Female VO: Thank you for listening to The Wellness Revolution Podcast. If you want to hear more on how to bring wellness into your life visit drveronica.com. See you all next week. Take care. _______________________________ Dr. Veronica Anderson is an MD, Functional Medicine practitioner, Homeopath. and Medical Intuitive. As a national speaker and designer of the Functional Fix and Rejuvenation Journey programs, she helps people who feel like their doctors have failed them. She advocates science-based natural, holistic, and complementary treatments to address the root cause of disease. Dr. Veronica is a highly-sought guest on national television and syndicated radio and hosts her own radio show, Wellness for the REAL World, on FOX Sports 920 AM “the Jersey” on Mondays at 7:00 pm ET.   To get started transforming your health, schedule a consult HERE.  

Today, I have something very, very different. As you know, I usually don’t do interviews, but when I find something that’s this true gem that I feel that people can really truly benefit from, I think this is something really special that people need to hear. Particularly in this case, because most people looking to either augment, increase, or change their career want to know how they can enter. Amy Schmittauer discusses how to develop your authority in the world of social media. A person I have today, Amy Schmittauer, is the curator and developer of Savvy Sexy Social, which is video blogging, also Social Authority. Social Authority gets beyond the blogging, beyond the video, into the rest of the social media world, and how that fits in. Amy, welcome. Amy: Hello, Thomas. How are you? Thomas: I’m doing great. Thanks a lot. Amy: Of course. Thomas: Thank you for sharing your info with us today. Amy: I am so thrilled to be an exception for your show; it just means so much to me. Thomas: I’m glad you’re able to contribute, because I’m sure they can benefit. Give us a little bit of a background. Let’s say somebody all of a sudden hits 48 years of age, they’re taking a look, and they’re saying: “Gee, I don’t know whether I’m going to be around in this job or this career. What might I do to start getting out into another business or career?” How might they use social media? Amy: First and foremost, it’s like the step before social, digital, and the internet. When you’re already going through this mindset shift and you’re not quite sure how to approach it, there’s a lot of barriers in your mind already. The first thing I would recommend is just really think about what you know very, very well, and what your time so far has offered you to become really, really, really smart on. What I find is a lot of people that even want help from me, they could have a very, very clear path or a goal set, but then a lot of other times, there are people that just come and say: “Oh, I hear this social media thing is hot. Can I start a business there? How am I going to monetize my blog?” These sort of questions are frustrating for me, because I would rather hear: What do you have to offer the world that you do better than anyone else? Because that is going to be very important. The product has to be awesome. Then let’s talk about how we’re going to show off your amazing personality so that people will even care about that awesome product. I think first and foremost, you have to understand what value you bring to the world. You need to think about that first, because before you go and get distracted by all of this ADD society of social media, like YouTube, Instagram, Facebook, and Twitter – you really need to be very clear about that value proposition, and: Who’s even going to care about it? Who is that perfect follower, end user, customer, potential advocate for you? These are the really important questions before you can start tweeting. Thomas: That’s interesting. One of the things I find there, and for a lot of people, I’m always hearing: “Passion. Follow your passion. Go in this…” That, well as you may remember, I have an episode, “Passion Sucks …. the Life Out of You.” You have to pick something that really is, as you just said, marketable, something that people really want. It can be there. In many cases, it can be a hobby or something you do. Amy: Sure. Thomas: At the same time, what you’re saying, you have to really have value. While you have it as a hobby, you then also have to make sure that you master it or become an expert at it. Amy: Absolutely, because I think a hobby that is just to please you is one thing, and I know that that could be totally satisfactory, but I think when you go to a place like social media, which is essentially these built-in cocktail parties where you’re going and you’re meeting people who are already talking, already having conversations,

Drew Bledsoe, the top draft pick in the NFL, knew football doesn't last forever. How he transitioned to an entirely new occupation. Career change is a key to life today and must be planned ahead. Today, we have a very special guest and an exemplary position in life to give you a perspective that’s very different and something that we’ve talked about in other episodes, but here we have a real life example. Today we have Drew Bledsoe. If there’s anybody on the planet who doesn’t know or remember, he was drafted number one in the NFL, and then became a starting quarterback, etc. Extremely successful. We know that. I want to talk a little bit both about how he got there, what he went through, what he did, and then the new business he’s in, which is wine; how he did that, how he made the transition, because that’s what so many people have to do so many times in life. Almost nobody ends up in the same place, or the same job, or the same career that they started with. Welcome, Drew. Drew Bledsoe: Thanks for having me on. I’m really excited to visit with you, Thomas, and I welcome the opportunity. Thomas: Thank you. Thank you for coming on. You’re such a good example . Could you tell us a little bit about what it takes to attain the level in sports that you did? Drew:  There are a lot of things at work, there. First, you’ve got to program your mind. If somebody saw me in the seventh or eighth grade, I was not the guy that anybody was going to pick out as the guy who was going to go on to be a professional athlete. I was tall and skinny, and not very fast. I had really big feet; I just didn’t move very well. That didn’t change how I viewed myself in my mind. I really felt like I could be a great football player, and really programmed my mind so that I could never accept anything less than my very best effort, whether it came to training, practice, school – you name it. Because I had those high expectations and that view of myself as somebody that was going to be excellent, I wouldn’t accept less than my very best in anything that I did. That was really where it started. Thomas: It’s interesting, because so often so many people think that somebody has just got this natural ability, natural talent, and that’s why they are where they are. I know in college, etc., when I went to graduate school at Berkeley, my impression was: “Oh, gosh. I’m going to meet these professors, and they’re just these superhuman people.” Then, low and behold, I get in there and I find out they’re there early, they’re there late, they’re working on weekends. These are Nobel Prize winners. It wasn’t just a gift. It was also a dedication, effort, and fortitude. I am hearing you saying something of the same thing. Is that true? Drew: You’re 100% right. One of the advantages that I had, as I was growing up, my father and his good friend ran a football camp and I got a chance to be around very successful professional football players when I was growing up. I got a chance to see these guys and meet these guys, and I discovered that they’re not superheroes. They are regular guys that have athletic ability that obviously is outside the norm, but that’s not really what allowed them to be successful. What allowed them to be successful was the work they put in, and the continued work that they put in. Fred Biletnikoff, who was one of the great wide receivers ever to play professional football, and still, the best receiver in college football every year receives the Biletnikoff Award. I got to meet and be around Fred Biletnikoff when I was growing up, and the guy, I think he was probably 5’10-5’11, probably 180 pounds, and by the time I met him, slightly balding. He was not the guy that you looked at and said: “Man, that guy is an NFL wide receiver.” When I was around him, every time he was on the practice field just coaching kids up, he was always practicing running routes, and he was always practicing proper catching technique,