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Dr. Michael Buckland: The Link Between Repetitive Head Trauma and Mental Health · Broken Brains with Bruce Parkman

• 0:13
  Speaker 1: Hey folks, bruce Parkman here with Broken Brains, sponsored by the Mack Parkman Foundation, where we focus on the issue of repetitive head trauma and from our repetitive head impacts and repetitive blast exposure for our veterans and what this type of trauma is doing to the brains of so many people in our population kids, adults, veterans and how we need to make better choices and be better educated on the impacts of sports and military training on these brains, the resulting epidemic of mental illness and what can be done about it.
• 0:44
  Speaker 1: So every week we reach out to researchers, scientists, professional athletes, kids, parents to bring you the latest information we can so you can educate yourself, because this is a relatively unknown phenomenon in our medical psychological communities and you need to be informed in order to best protect those that you love.
• 1:03
  Speaker 1: Today we've got another amazing guest, dr Michael Butlin, who we know is the Anne McKee of Down Under man.
• 1:11
  Speaker 1: This man is amazing.
• 1:14
  Speaker 1: I'm so excited about this, but he is a senior neuropathologist and head of the Department of Neuropathology at the Royal Prince Alfred Hospital and the head of molecular neuropathology program at the Braid and Mind Center at the University of Sydney, and he's also the co-director of the Multiple Sclerosis Research Australia Brain Bank.
• 1:31
  Speaker 1: He's one of the most pronounced neuropathologists in the world.
• 1:35
  Speaker 1: If you've ever seen his TED Talk that he's done on repetitive head impact and its relationship to rugby, which is basically original, please look up that video.
• 1:46
  Speaker 1: You have to see that because once I saw it, I reached out to Dr Buckland in a heartbeat because nobody's talking about this issue and espoused it so well Dr Buckland, how you been sir.
• 1:58
  Speaker 2: Very well, thank you, bruce.
• 2:00
  Speaker 2: Yeah, nice to see you again.
• 2:02
  Speaker 1: Good to see you again, sir.
• 2:03
  Speaker 1: So what's going on down under?
• 2:05
  Speaker 1: Uh, you know, I got my, my acdc hat on.
• 2:08
  Speaker 1: I do play bagpipes in acdc band, so very excited, uh, you know, to get, uh, to get catch back up with you and and see what's going on in the world of rhi and rbe down under sir yeah, thank you.
• 2:21
  Speaker 2: Yes, well, I mean, for for us Christmas time is our summer holidays, so, uh, generally the whole of Australia shuts down for most of January.
• 2:30
  Speaker 2: Yes, sir, right at the beach.
• 2:33
  Speaker 2: So, uh, when I'm looking forward to having some some time off in the sun very shortly.
• 2:39
  Speaker 1: Yeah, that's right.
• 2:41
  Speaker 1: It's kind of reversed down there with the summer months and coming up.
• 2:45
  Speaker 1: I remember when I used to have my company down in Canberra, I always try to reach my employees, you know, after the Christmas holidays, because in America we're idiots about work.
• 2:56
  Speaker 1: So we're back at work January 3rd and it took me two years to realize that that was just a waste of time, that nobody's going to answer the phone in.
• 3:08
  Speaker 2: January down in Australia.
• 3:09
  Speaker 2: Pretty much, yeah, it's pretty much.
• 3:10
  Speaker 2: Get on it, man.
• 3:10
  Speaker 2: Sorry, I'll just get rid of that Look.
• 3:14
  Speaker 1: I apologize for that.
• 3:15
  Speaker 1: Ah, don't worry about it, sir.
• 3:16
  Speaker 1: So what's been going on?
• 3:18
  Speaker 1: Have you been doing more additional research on the area?
• 3:23
  Speaker 1: I mean, we're seeing a lot of issues coming out.
• 3:27
  Speaker 1: There's a lot of progress being made with the issue of kids in contact sports and repetitive impacts, particularly in the AFL down under.
• 3:36
  Speaker 1: So what are we doing?
• 3:38
  Speaker 1: I think things might be moving the needle a little bit down there.
• 3:42
  Speaker 2: Yes, look, I think it's been a remarkable few years.
• 3:46
  Speaker 2: We've really seen.
• 3:47
  Speaker 2: Really, when we started off with the Australian Sports Brain Bank, we were told that, yeah, australian sports were different.
• 3:55
  Speaker 2: This disease didn't exist down here, it's an American footballer's disease and you know, within six years we've seen that there's now been a federal government Senate inquiry into concussions and repeated head trauma in sports.
• 4:11
  Speaker 2: That came out with some really strong findings, which was great, and probably the most important one was that the federal government Senate acknowledged the causal relationship between exposure to repetitive head impacts and the development of CTE.
• 4:29
  Speaker 2: Really.
• 4:30
  Speaker 2: So we've actually got a governmental acknowledgement now and in that inquest we did see both the AFL, australian Wolves Football and the National Rugby League or the NRL, both acknowledging that link when pressed by the Senators.
• 4:48
  Speaker 2: So it's been quite remarkable to get that sort of on record that now the major contact sports in Australia have acknowledged a link between exposure to repeated head impacts and CTE.
• 5:03
  Speaker 2: I mean that's.
• 5:05
  Speaker 1: I'm sorry, go ahead.
• 5:07
  Speaker 2: No well, I mean, the AFL have now, in fact, through the Australian Institute of Sport, another governmental agency has now indicated changed their concussion guidelines so that there's a minimum three-week stand down for a concussion now, and I think when we started it was six days.
• 5:25
  Speaker 2: So we've certainly seen them moving a lot, which is absolutely fantastic.
• 5:31
  Speaker 1: Yeah, as you say down in Australia, bloody hell.
• 5:33
  Speaker 1: I mean that's amazing.
• 5:35
  Speaker 1: I mean to have.
• 5:36
  Speaker 1: So what has that done?
• 5:38
  Speaker 1: Now that they've done that, that you've recognized because we still have a long way to go up here that link has been recognized.
• 5:46
  Speaker 1: What does it has?
• 5:47
  Speaker 1: What has that done for the sport themselves?
• 5:50
  Speaker 1: Because just changing the concussion protocols doesn't do anything about changing our exposure, which is, we know, is the cause of CTE and everything else that we're talking about.
• 6:00
  Speaker 1: It all comes down to our HI.
• 6:01
  Speaker 1: So have they made any changes?
• 6:04
  Speaker 1: I mean what I'm following on Twitter and stuff I haven't everybody's upset about these red cards and you know 20 minute stand downs and stuff like that, but that is an amazing movement.
• 6:15
  Speaker 1: Were you part of the inquiry that got that going, sir?
• 6:20
  Speaker 2: Oh, yes, I certainly gave evidence at the inquiry, but I think, like most things you know, they don't really care about a doctor's opinion.
• 6:29
  Speaker 2: It was hearing from the families of those that had died from CTE.
• 6:33
  Speaker 2: I think that really, really put a rocket under the senators and made them realize this was a problem that affected everyday people.
• 6:43
  Speaker 2: So, yes, yes, and look, there's definitely more work to be done.
• 6:48
  Speaker 2: As you said, cte is a problem of exposure to repeated head impacts.
• 6:56
  Speaker 2: The codes, often in their public communication, still conflate the issue of concussion with the issue of CTE.
• 7:05
  Speaker 2: So they'll often say this is we've got the best concussion protocols in the world, and I don't know if that's a deliberate conflation or don't quite get it.
• 7:18
  Speaker 2: I'm not sure.
• 7:20
  Speaker 2: But there's been other things as well, actually.
• 7:26
  Speaker 2: So, following on from that Senate inquiry the Royal College of Pathologists of Australasia, which is obviously the medical college that I'm part of they released a position statement on CTE, also confirming the causal relationship and calling for specific CTE prevention protocols.
• 7:47
  Speaker 2: In addition to concussion guidelines, there should be specific protocols and policies around CTE prevention.
• 7:56
  Speaker 2: So that is something we're still pushing now and, as you know, the Concussion Legacy Foundation did release the first ever CTE prevention protocol a year or two ago and we certainly contributed to that.
• 8:15
  Speaker 2: That was led by Dr Chris Nowinski from BU and CLF, bu and CLF, and so we're certainly trying to encourage sports to look at that and to take up that protocol.
• 8:32
  Speaker 1: And what are the primary points of that protocol that you can share with us?
• 8:37
  Speaker 1: Is there anything about delaying exposure, or is it, you know, just being more educated on the issue of RHI, and is RHI even a part of those protocols?
• 8:51
  Speaker 2: Yes, very much focused on RHI and not concussions.
• 8:55
  Speaker 2: It does include, you know, reference to age of first exposure.
• 9:02
  Speaker 2: Exposure seems to be important with severity of symptoms later in life.
• 9:06
  Speaker 2: So it does include delaying exposure to RHI through contact sports until children are in high school, which is usually about 13 or so.
• 9:20
  Speaker 1: Yeah, 13, 14.
• 9:22
  Speaker 2: Yeah, yeah wow, and also just the cumulative exposure.
• 9:26
  Speaker 2: So very similar to what you've probably got.
• 9:31
  Speaker 2: In the US, there's recommendations around limiting full contact training during the week, particularly in a professional game, and that's actually recently.
• 9:42
  Speaker 2: The National Rugby League Players Association have come out and requested that and said why aren't we doing this?
• 9:51
  Speaker 2: They're doing this in the US, why aren't we doing this here?
• 9:54
  Speaker 2: Which again, I think is a really positive move.
• 9:57
  Speaker 2: We're now starting to see the players say hang on a second, we want to look after our brains, which I think is terrific.
• 10:06
  Speaker 1: It absolutely is.
• 10:07
  Speaker 1: I mean, here in America, you know, we know that the NFL has no contact drills for the most part during the season and some of our Ivy League colleges have done that because of their focus on, you know, finally saying hey, academics is why we're here, right, Not playing contact sports.
• 10:22
  Speaker 1: But when it gets to the high schools, we have nothing.
• 10:25
  Speaker 1: 90 something percent, if not all high schools have contact practice during the week and when we explain to them that the NFL doesn't do it, they just don't care.
• 10:36
  Speaker 1: They say, well, kids need to learn how to tackle Tackle's partly in the game.
• 10:40
  Speaker 1: I said, well then they shouldn't be playing the game.
• 10:42
  Speaker 1: I said, well then they shouldn't be playing the game if it's going to be damaging the only organ that's going to get them through life.
• 10:48
  Speaker 1: So where can this take us?
• 10:49
  Speaker 1: Like down in Australia?
• 10:50
  Speaker 1: That's an amazing development and for the national, the leagues, they're understanding now that you know their players are their money or that is the sport.
• 10:59
  Speaker 1: We have to take care of them.
• 11:01
  Speaker 1: But are we seeing any impact further downstream, with the high schools down under?
• 11:06
  Speaker 1: Because it sounds like we've got a lot to learn from the Australians when it comes to contact sports with this kind of progress at these legislative levels and professional levels.
• 11:18
  Speaker 2: Yeah, well, look, I don't want to paint too rosy a picture.
• 11:20
  Speaker 2: I still think we've got a long way to go down here as well as you do, but we've had a couple of high schools private high schools withdraw from contact sports competitions because of this issue, but that's only been a handful.
• 11:41
  Speaker 2: It's definitely still a problem in high schools and, as you say, they're the institutions you trust your children's brain development with, essentially, so to have them not really jump on this does concern me and hopefully we'll see that change.
• 12:06
  Speaker 2: Um, uh, it is.
• 12:10
  Speaker 2: Yes, I mean it's probably like in in the us as well.
• 12:15
  Speaker 2: Some.
• 12:15
  Speaker 2: There are scholarships to prestigious high schools and scholarships to universities based on your sporting prowess.
• 12:24
  Speaker 2: So it is a pathway for people that may be socioeconomically disadvantaged.
• 12:33
  Speaker 2: There's a clear pathway for them to get into the best school and the best university by playing footy.
• 12:40
  Speaker 2: So I can understand the attraction from individuals, but certainly we need to do more and I'm not sure what it's like in the US, but it's quite commonly.
• 12:59
  Speaker 2: The rate of suicide, deaths by suicide in young people is quite commonly talked about in the press and by the government.
• 13:10
  Speaker 2: We're investing millions and millions of dollars into the issue, but I'm yet to see any of those conversations reference RHI or concussions Reference RHI all concussions.
• 13:27
  Speaker 2: It's just not part of the equation, which seems to me a huge oversight, since we're essentially paying to inflict these injuries on our children and then we're paying to clean up afterwards when they have mental health issues or, tragically, take their own life.
• 13:44
  Speaker 2: Health issues or or, or you know, tragically take their own life.
• 13:47
  Speaker 1: Uh, so yes, go yeah, no, I mean, we got the same.
• 13:50
  Speaker 1: You know I argue with people all the time oh, that's our, that's my way out of the hood, is what how?
• 13:54
  Speaker 1: It's always put up here and my in my conversations with them I always tell them.
• 13:59
  Speaker 1: I always tell people look, your, your child has a better chance of becoming an accountant, a doctor or a lawyer than they do playing professional sports.
• 14:12
  Speaker 1: Okay, yeah, they might not get a free ride to school, but there are other ways to get free rides to school and if endangering your child's brain health is going to be one of them number one, you better start them really late because in my professional opinion, dr Butlin, as a semi-pro rugby player, you cannot stop natural talent.
• 14:25
  Speaker 1: If you're going to play in the AFL or NFL or the NRL, you're destined in early life, when you just got the gift.
• 14:34
  Speaker 1: And we tell people all the time.
• 14:36
  Speaker 1: Some of our NFL players didn't start playing football until they were 16.
• 14:39
  Speaker 1: Like they were a junior last two years of school and because they were that good, they just ran over everybody and just walked right into college and went on to play the NFL.
• 14:47
  Speaker 1: And the other side that we have here is that our sports leagues, especially in the NFL, we know is just horrific when these players leave the system and the rates of financial destitution and mental health are through the roof.
• 15:04
  Speaker 1: I personally know of a coach of an NFL team.
• 15:07
  Speaker 1: He's an NFL player.
• 15:09
  Speaker 1: He's got four NFL players on his staff, all of them including himself all with severe mental health issues, all from the years of dedication.
• 15:19
  Speaker 1: See your point.
• 15:19
  Speaker 1: You know we're paying these kids to go to school, but on the other end, you know here we are.
• 15:24
  Speaker 1: You know we're paying these kids to go to school, but on the other end, you know here we are.
• 15:26
  Speaker 1: So it sounds like you down under have the same problems with suicide issues that we have in America.
• 15:31
  Speaker 1: It's a huge problem up here.
• 15:34
  Speaker 1: I mean the level of young people that just don't want to be here anymore or that end up in jail are not there, and I think it all has to do with prioritizing brain health.
• 15:45
  Speaker 1: Give me your opinion on this.
• 15:47
  Speaker 1: Like when I go to the doctor, they check my heart, they listen to my lungs, they smack me in the knee, but nobody has ever asked me.
• 15:55
  Speaker 1: You know how's your brain doing.
• 15:57
  Speaker 1: You know what's going on up there.
• 15:59
  Speaker 1: Have you taken any knocks?
• 16:00
  Speaker 1: You know?
• 16:00
  Speaker 1: I do think that if we could prioritize brain health, we could get a better sense of brain awareness and brain.
• 16:07
  Speaker 1: You know, I do think that if we could prioritize brain health, we could get a better sense of brain awareness and brain.
• 16:10
  Speaker 2: You know, just you know, you know, understanding how important this organ is to us, where we might take a second look at letting Junior play footy at, you know, at 10 years old yes, yes, I um, I often wonder what, uh, like, uh, when our grandkids are adults, if they look back and think, oh my god, what the hell were those people in you know 2024 doing to their kids.
• 16:35
  Speaker 2: You know, and I probably will take that generational change to to really start to appreciate how important our brain health is and we face the same problem.
• 16:48
  Speaker 2: It is because I do a lot of not only with the Sports Brain Bank, I also do a lot of work for the New South Wales State, coroner, which is New South Wales is the state that I'm in in Sydney and it's the largest pot bite population state in Australia and we get a lot of brains through there as well.
• 17:10
  Speaker 2: But what we never get is ever is a history of contact sports.
• 17:15
  Speaker 2: So it might be a history of drug and alcohol use or it might be a history of overseas travel or vaccination history, all that sort of social history which is routinely collected in a medical examination, but never contact sports history.
• 17:32
  Speaker 2: And in fact that was one of the recommendations from the Royal College of Pathologists that a history of contact sports and other TBI exposure be part of every medical history taking.
• 17:45
  Speaker 1: So I agree completely, yes, sir, and I think it should be part of everybody that's going into incarceration as well.
• 17:54
  Speaker 1: I think that if we address brain health as a societal issue, like we prioritize this, like we're prioritizing suicide or drug abuse or a teenage pregnancy, prioritizing suicide or drug abuse or a teenage pregnancy, we could change the, the, the, the.
• 18:11
  Speaker 1: There's so many social ills here that have now now, are now to be understood, or could have been, you know, you know, caused by repetitive head impact.
• 18:17
  Speaker 1: The only reason I'm talking to you, doctor, is that when my son took his life, um, and I waited, you know three months, the coroner finally gave us the autopsy.
• 18:28
  Speaker 1: He's like, mr Parkman, I'm sorry your son took his life.
• 18:30
  Speaker 1: I'm like, wow.
• 18:31
  Speaker 1: I said why.
• 18:32
  Speaker 1: I want you to explain why my son, who was loved, never abused, you know, believed in our Lord, went to a private school, had a, you know, a used car, you know skied, went on vacations, was loved more than anything that I could do.
• 18:45
  Speaker 1: I loved that boy Everything.
• 18:47
  Speaker 1: His family loved him, everybody loved him.
• 18:48
  Speaker 1: He's just, you know, a thousand people showed up to his service.
• 18:51
  Speaker 1: I said why is he not here?
• 18:53
  Speaker 1: You know what he told me.
• 18:54
  Speaker 1: He said did your son play contact sports.
• 18:57
  Speaker 1: That one sentence changed my life and I said what do you?
• 19:10
  Speaker 1: I said, of course he's an American kid.
• 19:11
  Speaker 1: He played contact sports.
• 19:11
  Speaker 1: He played rugby, played hockey, played soccer, he played football, he played wrestling, he played anything he wanted to play.
• 19:14
  Speaker 1: What's that got to do with the fact that he's dead?
• 19:15
  Speaker 1: That is what got me talking to you and Dr McKee, because he said I.
• 19:19
  Speaker 1: He said have you heard about CTE?
• 19:21
  Speaker 1: I'm like the football disease.
• 19:23
  Speaker 1: He goes yeah, he says I tried to do a scan but I don't have the equipment, and that alone sent me on this journey.
• 19:30
  Speaker 1: But to your point, dr Buckle, the majority of our coroners are like our psychologists, like our nurses and, like our doctors, are completely untrained on the issue or the correlation between RHI and contact sports, damaged brains and mental illness, and so when suicides happen, this is not even on the radar.
• 19:50
  Speaker 1: Now, I'm not asking to put a number out there at all, but I do think there might be a statistically significant amount of these suicides that have a.
• 20:00
  Speaker 1: You know, given the number of people that play contact sports, I don't think you're, I think you're going to find a significant amount of these brains that at least have had some exposure.
• 20:09
  Speaker 1: Now the amount of exposure that could have, you know, like, according to the TES protocols, whatever you know caused them to be damaged.
• 20:16
  Speaker 1: But I mean, I think that I think that you're onto something.
• 20:19
  Speaker 1: What would be the path that we're trying to figure this out in America?
• 20:23
  Speaker 1: What would be the path that we're trying to figure this out in America?
• 20:25
  Speaker 1: What would be the path?
• 20:25
  Speaker 1: Think of all the families that could have some closure.
• 20:26
  Speaker 1: Like, I had closure.
• 20:27
  Speaker 1: I could understand.
• 20:28
  Speaker 1: You know, I didn't want to understand why my son might not be here.
• 20:36
  Speaker 1: Okay, brain damage Now I know what.
• 20:37
  Speaker 1: He wasn't crazy, he wasn't caught up in drugs or porn or Satan or whatever.
• 20:40
  Speaker 1: My son had a brain injury.
• 20:42
  Speaker 1: Okay, that gives us some closure.
• 20:44
  Speaker 1: These families deserve that kind of closure.
• 20:47
  Speaker 1: What do you think it would take to make that kind of awareness?
• 20:54
  Speaker 1: You know, like part of corner training, or you know certified medical education credits or anything like that.
• 20:57
  Speaker 1: How do we get there?
• 21:00
  Speaker 2: Yeah, look, I'm with you all the way.
• 21:03
  Speaker 2: I wonder how big the problem is.
• 21:06
  Speaker 2: I don't know.
• 21:08
  Speaker 2: I don't have any statistics, but it does worry me, like it worries you.
• 21:12
  Speaker 2: How many of these young suicides are due to exposure to this RHI and mild traumatic brain injury?
• 21:19
  Speaker 2: We have no idea.
• 21:21
  Speaker 2: We have no idea.
• 21:26
  Speaker 2: I've been working because I have the relationship with the New South Wales state coroner.
• 21:31
  Speaker 2: I have been working with the coroners across the country to try and educate them at their annual meeting.
• 21:41
  Speaker 2: I've presented several times on the issue and I actually feel like things are starting to change a little bit, in that when we first started the Brain Bank down here very much, I was often on the phone calling families asking them if they would consider donating their loved ones' brains.
• 22:06
  Speaker 2: But the last few years it's changed, whereas now we're getting calls and it's either from families or, in a not insignificant number of times, it's from a coroner or a coronial liaison officer from the coroner's office.
• 22:22
  Speaker 2: Um, this case uh, um, you know, may be of interest to you or it may, uh, the family have had asked.
• 22:32
  Speaker 2: So we're happy to help with, um, you know, retrieving this brain donation.
• 22:37
  Speaker 2: So that has changed a little bit.
• 22:40
  Speaker 2: Um, it's we really.
• 22:44
  Speaker 2: I don't know what it's like in the us, but in australia, um again, all that coroner's legislation is state by state.
• 22:52
  Speaker 2: We don't have some overarching national you only.
• 22:56
  Speaker 1: You only have seven states down there.
• 22:57
  Speaker 1: We got 50 and they all don't get along.
• 23:03
  Speaker 1: So, yeah, I got it.
• 23:04
  Speaker 1: I like that.
• 23:04
  Speaker 1: No, but good point, sir, good point.
• 23:06
  Speaker 1: Yeah, we got 50 and they all don't get along.
• 23:07
  Speaker 1: So, yeah, I got it.
• 23:07
  Speaker 1: No, but good point, sir, good point.
• 23:09
  Speaker 2: Yeah, but almost all of the state-based legislation has this clause in the coroner's powers saying that the coroner must determine the cause and manner of death in the least invasive way possible.
• 23:27
  Speaker 2: So many coroners feel that that restricts their ability to go investigating, say, the possibility of brain disease in young suicide people, because they decide that the cause and manner of death is already evident.
• 23:46
  Speaker 2: You know this person unfortunately hung himself.
• 23:49
  Speaker 2: He had a history of mental health problems.
• 23:51
  Speaker 2: It was a suicide note.
• 23:52
  Speaker 2: There's no suspicious circumstances.
• 23:55
  Speaker 2: I don't need to look at this person's brain, which is, I mean, I think it's a good there's obviously that was put in for good intentions, but I think it has unintended negative consequences.
• 24:09
  Speaker 2: Now it's like the coroners can't necessarily follow their gut instinct and go and look at that person's brain because the legislation says you need to do it in the least invasive way possible.
• 24:21
  Speaker 2: So that's something again, hopefully that may change in the least invasive way possible.
• 24:23
  Speaker 2: So that's something that works again.
• 24:25
  Speaker 2: Hopefully that may change in the future.
• 24:28
  Speaker 2: But it's an issue.
• 24:32
  Speaker 2: I'm sorry now I've forgotten your question completely.
• 24:35
  Speaker 1: No, no, that was it.
• 24:36
  Speaker 1: It's like you know, how do we get these coroners to understand that there could be an issue?
• 24:41
  Speaker 1: And if they're collecting the data that would indicate the possibility of an RHI-related, you know mental illness or suicide is high, then they have the duty to investigate for the family.
• 24:54
  Speaker 1: But you know, we also have to educate the families on this, because you know, most families, if their loved ones you know their kids or their spouse, takes their life, they have absolutely no clue that their history of RHI, you know, no matter how, it's induced through military service, domestic abuse or whatever, or contact sports, especially contact sports, because we're groomed to think that these sports are innocuous, right, they're safe.
• 25:20
  Speaker 1: You know, let's just go play.
• 25:22
  Speaker 1: Right, let's go, come on, come on, six year old has a helmet, let's go out there.
• 25:25
  Speaker 1: You know, we're groomed, so then we don't question, we don't even think that they could be related where I think, if we raise the possibility of doubt in the public's mind that hey, there is a link here.
• 25:38
  Speaker 1: And I and you know when, when I, when my son passed, I was going to do anything to get to the bottom of this, I didn't care, I didn't care if I went to jail man.
• 25:46
  Speaker 1: I found out that he was getting drugs to deal with his schizophrenia from the football team.
• 25:52
  Speaker 1: They broke into our house.
• 25:54
  Speaker 1: I mean we had massive criminal case going on.
• 26:00
  Speaker 1: But you know, when a parent's in that position man, they're going to do anything they can to get to the bottom.
• 26:04
  Speaker 1: But I think that's going to be a great and that's something that we could definitely work together on.
• 26:09
  Speaker 1: Let's talk a little bit about the old in vivo diagnosis.
• 26:13
  Speaker 1: There's this holy grail that everybody's looking for the biomarkers and the blood plasma things and all that.
• 26:20
  Speaker 1: And we have this set of protocols in the US called traumatic encephalopathy syndrome protocols.
• 26:26
  Speaker 1: Right, these were approved by NINDS not yet validated, but approved as a screening tool.
• 26:32
  Speaker 1: Right, to either provide a diagnosis that could be then substantiated with, you know, brain scans, and then you know some other.
• 26:41
  Speaker 1: You know tests whatever.
• 26:42
  Speaker 1: We got blood tests, right.
• 26:44
  Speaker 1: But where are we at with that?
• 26:47
  Speaker 1: Because we don't have the means yet.
• 26:50
  Speaker 1: I mean, we have the ability to understand in the research community and in poorly educated people like myself that this is an issue, but at the same time we have a diagnosis tool that could be easily implemented.
• 27:03
  Speaker 1: Any parent could ask those four questions.
• 27:05
  Speaker 1: Right.
• 27:05
  Speaker 1: Where do you think we could take that in the community Australia, uk, america, contact Sportsville, right.
• 27:13
  Speaker 1: What could we do with that?
• 27:15
  Speaker 1: Because I do believe that that could be one of the answers in terms of, you know, evaluating and diagnosing mental illness while the child is still alive.
• 27:25
  Speaker 1: So we can get ahead of this by assessing the history of RHI.
• 27:32
  Speaker 2: Oh gee, that's a good question.
• 27:33
  Speaker 2: So we know with the original TES criteria that they definitely cast a very wide net and even though lots of people satisfied those criteria when they went to validate the first bunch of them, it was only one in five ended up having a pathological diagnosis of CTE.
• 27:59
  Speaker 2: And, as you said, we're still waiting for how the revised criteria are going to perform.
• 28:07
  Speaker 2: I think it's hard when you speak to a pathologist, I think in that, while definitely I mean CTE, the clinical diagnostics are not reliable yet at all.
• 28:26
  Speaker 2: So aware that in fact, most of the degenerative brain diseases, the clinicians are not particularly good at diagnosing it during life, and it may well be that they diagnose the one pathology, but when you look at the brain, there's two other pathologies going on as well.
• 28:51
  Speaker 2: So it's not something that's necessarily restricted to CTE or TES, but it's certainly probably because it's only 15 or 20 years since we've started looking at CTE and TES, so there hasn't been that large body or depth of research over many decades, which is probably why we're a little bit behind compared to other degenerative brain diseases, and that's yeah.
• 29:23
  Speaker 1: I mean all good points, but my point is, doctor, when we have a kid that has mental illness, we can err on the side of caution because the treatment, even if you misdiagnose TES, the worst thing you're going to do is not play contact sports and beat your head up.
• 29:36
  Speaker 1: Right, we're going to say don't play contact sports and then over time it becomes all right, you go back and I'm sorry, I wrecked your foodie career at the age of eight Go play.
• 29:44
  Speaker 1: You know whatever I mean.
• 29:45
  Speaker 1: So that's that was our point is that, look, you know, we might not be able to diagnose it, but at least we're evaluating a potential cause and we're eliminating one of the key factors that could be contributing to the problem.
• 30:00
  Speaker 1: And on the side of caution, we're talking about kids with mental illness, if you know, we at least err on the side of caution and the remedy is not pills or chemotherapy or medication.
• 30:10
  Speaker 1: It's don't play contact sports.
• 30:11
  Speaker 1: I'm sorry you're going to play your medication.
• 30:12
  Speaker 1: It's don't play contact sports.
• 30:14
  Speaker 1: I'm sorry.
• 30:14
  Speaker 1: You're going to play baseball.
• 30:16
  Speaker 1: You're going to you, just don't play rugby.
• 30:18
  Speaker 1: You play touch rugby or soccer.
• 30:21
  Speaker 1: You know, even soccer, without hitting the ball, can be a safe sport.
• 30:24
  Speaker 1: I mean, that's where we're kind of I'm going with that and is like you know, it's the same thing with repetitive blast exposure in our veterans, our suicide rates.
• 30:33
  Speaker 1: Here we've lost 20 times the amount of kids that died in combat to mental illness and suicide.
• 30:40
  Speaker 1: We have no idea where brain damage is involved in that number of suicides and we haven't screened for that because we just don't do it yet.
• 30:51
  Speaker 1: It's just becoming a.
• 30:53
  Speaker 1: You know, paul Scanlon down under, I don't know if you know Paul, paul and I go way back, good man, he's got he's on a one man crusade down there right now on this whole RBE thing.
• 31:03
  Speaker 1: And, and I just think, when it comes to mental illness, you know, you know we're we're talking about modalities that are not covered by insurance, treatment that could help out.
• 31:12
  Speaker 1: So, yeah, yeah I, I think that you know, you know when, if we don't have an in vivo diagnosis, doing something, whether than just, you know, not, educating our you know, our scientific, uh or our medical community would be better than nothing.
• 31:27
  Speaker 2: Look, I take, I take your point.
• 31:29
  Speaker 2: I think you're absolutely right.
• 31:30
  Speaker 2: Uh, in a way, if you can take TES or whatever away from CTE, because it actually doesn't really matter what the underlying pathology is, it doesn't, sir, if they're symptomatic and you think it's due to taking too many knocks to the head.
• 31:50
  Speaker 2: So I agree, that's a very pragmatic approach.
• 31:53
  Speaker 2: Is that you should be thinking, hang on, yeah, they do satisfy these criteria.
• 31:57
  Speaker 2: Let's pull them out of footy for a year or two and see how they go.
• 32:01
  Speaker 2: People doubles their risk of suicide.
• 32:03
  Speaker 2: There's 40% increase in novel neuropsychiatric disorders in young people after a single concussion.
• 32:20
  Speaker 2: So there's fairly good evidence out there that it's not just a CTE thing, it's a brain trauma thing.
• 32:28
  Speaker 2: So, yeah, I agree with you entirely.
• 32:32
  Speaker 1: In conversations.
• 32:33
  Speaker 1: I was talking to Bob Stern and he, at the end of his career, he said Bruce, I don't think TES is related to CTE.
• 32:41
  Speaker 1: Tes in and of itself is an issue.
• 32:44
  Speaker 1: It's a diagnosis, it is a condition.
• 32:46
  Speaker 1: Now, over time, those same factors that led to a TES diagnosis would absolutely lead to a CTE diagnosis post mortem.
• 32:54
  Speaker 1: But you know it was.
• 32:56
  Speaker 1: He was becoming, you know, aligned with you on that point.
• 32:59
  Speaker 1: That TES, or, you know, whatever we're going to call it, is not CTE.
• 33:04
  Speaker 1: It is a separate diagnostic condition as a result of RHI that then can be treated If we can find it in life.
• 33:10
  Speaker 1: I mean, I mean, dr Buckland, what we're coming across now to treat the brain in America, since my son is left between brain supplementation programs and all these technical modalities like TMS and photobiomodulation and hyperbaric oxygen therapy, vagus nerve stimulation, then the whole psychedelics side of this is all providing enormous relief and improvement in all key cognitive, behavioral, psychological areas for veterans and for professional athletes that are trying these, you know, but here in the US none of them are covered by insurance.
• 33:48
  Speaker 1: I mean, that's our big, that's one of our challenges right now.
• 33:51
  Speaker 1: We don't have billing codes.
• 33:51
  Speaker 1: Where do you think the frontier is in this space around the world.
• 33:56
  Speaker 1: You know where we can.
• 33:57
  Speaker 1: You know, once we have a brain that's been damaged by RHR, what are you seeing as some of the novel approaches to treating that brain, besides the approach of drugs and therapy, which is not helping our veteran population at all?
• 34:12
  Speaker 1: That's all we have.
• 34:13
  Speaker 1: For 20 years later, we're still doing drugs and therapy and guess what?
• 34:15
  Speaker 1: We still got a suicide level.
• 34:18
  Speaker 1: That's unacceptable.
• 34:19
  Speaker 1: It's not even close to dropping.
• 34:21
  Speaker 1: So we got to do something different.
• 34:23
  Speaker 1: We have to think outside the box.
• 34:24
  Speaker 1: What are you seeing in terms of the research on the treatment side with brain health that might be coming about that can help those that are affected?
• 34:35
  Speaker 2: that might be coming about that can help those that are affected.
• 34:37
  Speaker 2: Look, I guess as a pathologist, I'm not an expert in that area.
• 34:41
  Speaker 2: Okay, fair enough.
• 34:43
  Speaker 2: I would say that we don't yet understand all.
• 34:52
  Speaker 2: The CGE is easy to see, but there's other pathologies in the brain which we are not good at seeing even under the microscope, and we need to understand how to quantify changes in white matter integrity and blood vessels.
• 35:06
  Speaker 2: And I think there's a lot more.
• 35:08
  Speaker 2: That's probably right there in front of our eyes, but because we don't have the knowledge base to see it, we're not seeing it, we're not counting it.
• 35:18
  Speaker 2: I agree, though, that there does seem to be an explosion in all these treatments.
• 35:24
  Speaker 2: I don't know how many of them have put through clinical trials and shown positive results.
• 35:32
  Speaker 2: Theoretically, I love the idea of hyperbaric oxygen.
• 35:38
  Speaker 2: I don't know if it works or not, but intuitively I'm drawn to that.
• 35:41
  Speaker 2: I'm drawn to that TMS as a therapy.
• 35:45
  Speaker 2: I think that's definitely got enough buzz about it that it needs to be tested in proper clinical trials, and I'm sure, with psychedelics and other drugs, there's probably going to be some good treatments in there as well.
• 36:06
  Speaker 2: What I also wonder about is that it might be.
• 36:11
  Speaker 2: You know, there's CTE.
• 36:13
  Speaker 2: There might be another form of mild TBI that's mostly white matter injury.
• 36:18
  Speaker 2: There might be another form which is a mixture of white matter and blood vessel injury, and maybe, in fact, in 20 years' time, we'll be talking about the eight different subtypes and maybe each one will have a different treatment.
• 36:34
  Speaker 1: And each one will have been caused by repetitive head impact in contact sports, which is what the audience needs to understand.
• 36:40
  Speaker 1: It's.
• 36:41
  Speaker 1: You know this doesn't happen.
• 36:42
  Speaker 1: This doesn't have to happen, you know so.
• 36:46
  Speaker 2: But it might be that just because something doesn't now doesn't work in a clinical trial, it's because we're lumping people with actually all eight different variants into one bucket and testing them and it might be that one of those eight you know variants of tes responds really well to psychedelic therapy.
• 37:05
  Speaker 2: But you won't see that signal because it's diluted out with all the other um one.
• 37:11
  Speaker 2: So often when people ask me look if something's working for you, that's, that's the most important thing.
• 37:18
  Speaker 1: Uh yeah that's a key point.
• 37:21
  Speaker 1: That's a key point.
• 37:21
  Speaker 1: That um did you uh.
• 37:23
  Speaker 1: So how big is your brain bank right now?
• 37:26
  Speaker 1: How many uh brain?
• 37:27
  Speaker 1: I know you're one of the newest, newer brain banks for sports, right.
• 37:31
  Speaker 2: Yes, I think we launched in 2018.
• 37:33
  Speaker 2: Okay, I didn't have any grey hair in 2018.
• 37:39
  Speaker 1: They're wearing you out, man.
• 37:44
  Speaker 2: Great journey.
• 37:45
  Speaker 2: We're up to 130 brains donated now, which you know Australia has a population of 25 million, so it's probably the size of one of your states.
• 37:58
  Speaker 2: So yeah, in that population base I think we've done very well, absolutely.
• 38:05
  Speaker 2: We're just crunching the number on our first, all the numbers, on our first 99 brains, and I think we, for the first time, being able to independently replicate some of the findings from the BU team in terms of, but in an Australian context.
• 38:24
  Speaker 2: So with Australian contact sports, there does seem to be a relationship between a statistically significant relationship between number of years played and CTE risk.
• 38:36
  Speaker 2: So validating those sort of observations in a local context, I think it's really important and does give more power to the arguments that hang on.
• 38:48
  Speaker 2: This is something that we need to be concerned about.
• 38:51
  Speaker 1: Yeah, I don't know if you know that study that we funded we helped fund with Anne McKee that study that was released last August where we we got Dr McKee's team to look at the under 30 brains and they evaluated them means of death, and that study I'm sure you might have seen it, but 40% of those 162 brains all under 30, had CTE.
• 39:24
  Speaker 1: 100% of those brains had structural integrity damage to them, 100% of those brains were associated with severe cognitive, psychological and behavioral disorders and 80% of them died by suicide or overdose.
• 39:36
  Speaker 1: So I mean I would love to see if that type of study could be replicated down under when you, even at whatever level of brains that you have, because I think that will only lend credence, because the only common denominator across those brains was a history of contact sports, rhi, and I think that can, you know, help.
• 39:58
  Speaker 1: I mean we're learning from you now.
• 40:00
  Speaker 1: I mean, on the veteran side, I heard that we're way ahead of the Australians on, you know, veterans legislation stuff.
• 40:05
  Speaker 1: But with some of these moments that you've mentioned, we desperately need to get there in America and I mean it's just amazing to hear some of the progress and I don't think the lawsuits have hurt either.
• 40:18
  Speaker 1: There's some I mean massive litigation going on in the UK and Europe right now, and I think there might be some going on in Australia, if I'm not mistaken.
• 40:31
  Speaker 2: It's looming.
• 40:31
  Speaker 2: Yes, I think that there is a big class action which has been filed but is yet to start or commence.
• 40:38
  Speaker 2: However, that works in the legal setting.
• 40:41
  Speaker 2: But, yeah, look, we're seeing that very disturbing association, I think, of our brains with CTE.
• 40:49
  Speaker 2: It's about 48% died from suicide and compared to, you know, 20% or less than people that didn't have CTE.
• 40:59
  Speaker 2: And, uh, if you look at just the young people, that percentage goes, goes even higher, over 50%, which is definitely concerning.
• 41:09
  Speaker 2: Uh, it's, it's, um.
• 41:10
  Speaker 2: We have a yeah, I am aware of that paper and I got to say that um, and usually, if I think I've had a bright idea, I then find out Anne McKee thought of it two years earlier, which is she's really ahead of the game.
• 41:26
  Speaker 1: We pushed her pretty hard on that one and that started with my son's brain when I asked her, because I ended up writing the book and I wanted to know what was in there, and so we put together you know we were part of the funding but yeah, she did an amazing job and to see where that could go, if that, if that, if that, you know, study helps you in any way.
• 41:49
  Speaker 1: You know we can.
• 41:51
  Speaker 1: There's more to be done, right, but the the, the bottom line is you know RHI, you know it has to.
• 41:58
  Speaker 1: Rhi and brain health have to become, you know a more I don't know what you say just a more accepted part of how we talk about contact sports, because you know it's producing a lot of carnage, as we both well know.
• 42:13
  Speaker 1: You're on the other side of it.
• 42:16
  Speaker 1: So what?
• 42:18
  Speaker 1: Yeah, go ahead, what?
• 42:19
  Speaker 1: So what?
• 42:19
  Speaker 2: what?
• 42:20
  Speaker 2: Yeah, good, yeah, I would love you know, ideally, and I'd probably be shot down in flames for this, but you know, we are a country of 25 million, why aren't we looking at every single brain of people that commit suicide?
• 42:37
  Speaker 2: If it's such a national emergency, why aren't we looking at the brains of the people that commit suicide?
• 42:43
  Speaker 2: I mean, I would love to be able to say we will take anyone's brain that commits suicide for the next three years and we might get a lot of brains.
• 42:53
  Speaker 2: But that's okay.
• 42:56
  Speaker 2: I think it needs to be done.
• 42:58
  Speaker 2: It needs to be looked at in such a way.
• 43:01
  Speaker 2: I mean, you're never going to get it completely unbiased, but even if it's like we don't care if you've played sports or if you don't know if that person played sports, let's just look at them.
• 43:11
  Speaker 1: Let's just look at them?
• 43:13
  Speaker 2: Yeah, because we're not looking.
• 43:15
  Speaker 2: It's the most complex organ we have and all these people have mental health issues.
• 43:22
  Speaker 2: No one cares about looking at their brains.
• 43:25
  Speaker 2: It just to me seems outrageous, and I think our understanding of brain disease it's probably today is like our understanding of cancer in like 1985.
• 43:38
  Speaker 2: Yeah, we're that far behind and we've seen all the explosions in cancer treatments, many of which are based on understanding what's going on in the tissue, and that's going to be even more so, even more relevant, when it comes to brain health and problems with thinking and mood and behavior.
• 43:58
  Speaker 2: So there's a lot to be done, yeah, but I'm with you 100% there.
• 44:03
  Speaker 2: Yeah.
• 44:05
  Speaker 1: No, I mean, but with cancer we don't have, you know, an entire subset of our population, professional sports, all this money pushing back against treatments that can improve, because we'll have to understand and recognize that we've had an impact on brains and now we just have to make it right.
• 44:22
  Speaker 1: I mean, nobody needs to point fingers, nobody needs to write big checks.
• 44:25
  Speaker 1: All we got to do as a society is say, look, now we have this knowledge, now we understand this.
• 44:30
  Speaker 1: I mean, honestly, dr Buckland, in that study, with 40% of those kids having CTE.
• 44:35
  Speaker 1: One of the reasons that we're now finding CTE, in my perspective, in people in their 20s and 30s is because back in the 70s and 80s and 60s, kids didn't put helmets on at six years old, right?
• 44:49
  Speaker 1: And so you know, we have much longer exposure rates as children.
• 44:53
  Speaker 1: That, I think, is driving these you know, skyrocketing rates, you know.
• 44:57
  Speaker 1: You know skyrocketing 40% of these brains having CTE in their 20s and under 30, all of them under 30, 40% of them.
• 45:06
  Speaker 1: And so that comes to how we play contact sports and how do we make better decisions.
• 45:11
  Speaker 1: And that's why, man, I keep going back to your, your TED talk, man, that was.
• 45:16
  Speaker 1: You put that out so eloquently and and it was just, it was and it was just so heartwarming to hear somebody say this with your background that we have to address RHI If we're going to continue as a society and say we love our kids and we love our sports, without addressing this, we're going to continue to have, you know, massive amounts of tragedy, massive amounts of heartbreak and so on and so forth.
• 45:46
  Speaker 1: So so, what are you working on now?
• 45:49
  Speaker 1: How do people find you?
• 45:50
  Speaker 1: I mean, I definitely you know we're going to hang the, the, the, the link to your Ted talk on the on the podcast and we we go.
• 45:57
  Speaker 1: But what are you working on now, dr Buckland, and how can people follow your work?
• 46:02
  Speaker 1: Are you on, you know, social media or you know?
• 46:06
  Speaker 1: How do people follow what you work?
• 46:08
  Speaker 1: Because your opinion, your perspective here in America is so important to the population that we're trying to address medical researchers and parents.
• 46:19
  Speaker 2: Oh, thank you.
• 46:19
  Speaker 2: Look at the moment.
• 46:22
  Speaker 2: I've actually taken a break from social media.
• 46:25
  Speaker 1: I don't blame you.
• 46:27
  Speaker 2: I'm feeling better for it as well.
• 46:29
  Speaker 2: So we're yet to have a significant social media presence, but our website's very simple.
• 46:39
  Speaker 2: It's just wwwbrainbankorgau.
• 46:43
  Speaker 2: Uh, so it's just brainbankorgau.
• 46:46
  Speaker 2: Um, uh, if once we do start to get more of a fraud facing role I mean, I've been trying to tell Chris Nominski he's got to come down here and start, you know, cracking heads in Australian media to uh media to get the exposure.
• 47:04
  Speaker 1: Oh, he'll do it.
• 47:05
  Speaker 1: He'll do it.
• 47:06
  Speaker 1: He's good at it too, man.
• 47:08
  Speaker 1: That man's gone.
• 47:09
  Speaker 2: He's on a mission which is terrific, and we need someone like that down here as well, to be that sort of outward-facing person.
• 47:18
  Speaker 2: But it's just brainbankorgau.
• 47:20
  Speaker 2: All our papers are published there, and once we are on social media, we'll all our handles will be will be published on the website as as well.
• 47:30
  Speaker 2: We are.
• 47:31
  Speaker 2: We have, um uh uh, launched a veterans brain bank, uh, so I have been talking to Paul Scanlon quite a bit.
• 47:40
  Speaker 1: Good for you.
• 47:40
  Speaker 1: Good for you man.
• 47:41
  Speaker 1: He's such a great guy.
• 47:43
  Speaker 2: Love that guy and again a man on a mission, which is absolutely fantastic.
• 47:48
  Speaker 2: We've got three brains in there and we're starting to see some interesting things again, which I think will be important not only to validate what's coming out of the US in an independent set of people, but also to give it that local context.
• 48:14
  Speaker 1: These are Australian branch, yeah, yeah.
• 48:18
  Speaker 2: So that's something that I've been working on quite a bit lately, and we're really now trying to push the basic research Again.
• 48:29
  Speaker 2: As a pathologist, I think we're going to find treatments by understanding the biology in the tissue, and so we've started some quite sophisticated molecular analyses of CTE lesions, trying to look for biomarkers as well as therapeutic targets, which I'm very excited about, because that is, you know, my core business is getting brains making diagnoses.
• 48:56
  Speaker 2: But if that can empower really high-end discovery science by colleagues in Australia that you know, we're going to get answers quicker, and so that's what else we've been focusing on.
• 49:09
  Speaker 2: Yeah, so a lot going on and still a lot to be done.
• 49:17
  Speaker 1: Well, I thank you so much for your time.
• 49:18
  Speaker 1: Well, I definitely want to reach out and get a piece of that, a copy of that legislation.
• 49:21
  Speaker 1: We're writing similar legislation here, but to look at precedents is always going to help and we'd rather just adopt and, you know, see what it's not legislation.
• 49:32
  Speaker 2: It is recommendations from a Senate inquiry.
• 49:35
  Speaker 2: So the Senate recommended all this to the government.
• 49:38
  Speaker 2: The government has said they'll take it on notice and think about it a bit more.
• 49:43
  Speaker 1: Okay, so there we go pause.
• 49:44
  Speaker 1: But the ARL and NRL have accepted the causal link, so that's big.
• 49:49
  Speaker 1: We'll try to get whatever information you can push to us up there.
• 49:52
  Speaker 1: But look, I just want to thank you for your time, sir.
• 49:56
  Speaker 1: I mean, this is another amazing conversation.
• 49:59
  Speaker 1: I cannot thank you enough for what you're doing in the field of brain research, what you're doing for our parents, you know, and for the community at large down under to help us address this issue.
• 50:10
  Speaker 1: It's a problem, as you so eloquently put it in your TEDx talk.
• 50:15
  Speaker 1: I can't talk enough about it, so keep driving on.
• 50:18
  Speaker 1: If there's anything we can do for you, please let us know.
• 50:21
  Speaker 1: I want you to have a Merry Christmas, a very happily extended Australian holiday season, and I am working diligently to get down there and we'll go out there and have one of Australia's best Victoria bitters beer when I end up in Sydney.
• 50:35
  Speaker 1: I look forward to it.
• 50:36
  Speaker 1: Bruce, Thank you for having Dr Buckley.
• 50:40
  Speaker 1: Thank you so much.
• 50:40
  Speaker 1: Uh, Folks, remember, you know you get a chance.
• 50:43
  Speaker 1: You get, you know.
• 50:44
  Speaker 1: Go to our website.
• 50:45
  Speaker 1: Free book, Okay, free book endorsed by Chris Nowitzki, Dr McKee, Dr Julie Stamm, Only book for parents on RHI.
• 50:53
  Speaker 1: Out there it's free.
• 50:54
  Speaker 1: Go get smart 88 pages.
• 50:56
  Speaker 1: You know a couple hundred research papers in the back.
• 50:58
  Speaker 1: I wrote it for you.
• 51:00
  Speaker 1: Go get it.
• 51:01
  Speaker 1: We'll send it down under Dr Buckland.
• 51:03
  Speaker 1: Maybe you can endorse it and recommend it for parents and we'll send you a signed copy.
• 51:08
  Speaker 1: But another great episode of Broken Brains.
• 51:10
  Speaker 1: Really catch you.
• 51:11
  Speaker 1: I'll catch you next week, Thank you.