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The Impact of Repetitive Head Impacts on Brain Health: A Conversation with Dr. Daniel Daneshvar · Broken Brains with Bruce Parkman

• 0:15
  Speaker 1: Nah, dude, man, yeah, we got it going on.
• 0:17
  Speaker 1: Man, yeah, it's all good.
• 0:19
  Speaker 1: So, hey, folks, welcome to another episode of Broken Brains with your host here, bruce Parkman, sponsored by the Mack Parkman professional athletes, and how we, through advocacy and awareness, can change how we look at contact sports and military service and make them safe.
• 0:51
  Speaker 1: And on this show we bring on some of the most amazing guests and we were so blessed to have just an extremely long list of highly respected researchers, news folks and parents and everything, and today is absolutely no different.
• 1:06
  Speaker 1: We're stepping up today talking to Havid with the old Boston thing going on, dr Dan Danishvar, and I want to really outline the fact that this particular guest is somebody that you all need to be listening to, especially if you're a parent here.
• 1:27
  Speaker 1: He's an American neuroscientist and brain injury physician and psychiatrist.
• 1:31
  Speaker 1: Didn't know you were a psychiatrist, dan?
• 1:32
  Speaker 1: He's known for his academic world and traumatic brain injury and long-term consequences of repetitive impacts head impacts which makes him vital to the attention on this show and including chronic traumatic encephalopathy.
• 1:50
  Speaker 1: He's worked closely with Dr Anne McKee over the years and he's also founded the Team Up Against Concussions, which is the first scientifically validating concussion education program for children, and we really want to dial into that with you here.
• 2:02
  Speaker 1: Dan on the show today, and he's also the director of the Institute for Brain Research and Innovation at TeachAids, which created Crash Course, a virtual reality or video-based concussion education program and rehabilitation at Spalding Rehabilitation Hospital at Harvard Medical School in Boston, massachusetts.
• 2:19
  Speaker 1: He's been published in the Journal of American Medical Association, the Annals of Neurology and Neurology, and has received coverage from a number of news organizations and has received several community awards for his public service over the years.
• 2:40
  Speaker 1: Dan Cant, you know, dr Dan, as we love to call you I can't thank you enough for coming on the show and what's going on up there in Havid with everything that you got going on Well it's.
• 2:54
  Speaker 2: it's a real privilege to be here.
• 2:55
  Speaker 2: I mean everything that the Mac Parkman Foundation has been doing to advance brain health and advance our understanding of of what can happen and associated with repeated brain injuries has been remarkable to see.
• 3:07
  Speaker 2: And in terms of what's going on in Boston we're just winding down the summer and getting excited about the fall.
• 3:14
  Speaker 1: Yeah, everybody's doing all the got all the sports things going on.
• 3:17
  Speaker 1: How's the Red Sox doing this year?
• 3:19
  Speaker 2: I mean, you can't even talk about Boston without well, yeah, we're still uh riding off the high of our uh of uh the celtics last year, so we'll just focus on the positive news.
• 3:34
  Speaker 1: Uh, you know exactly you know, originally from boston, back in the day, you know, and I go up there.
• 3:40
  Speaker 1: Actually, I'll be up there for a conference in october and, uh, there's nothing like a clam roll and a piece of Papa Gino's pizza.
• 3:48
  Speaker 1: But after that, with the traffic up there, I'm about ready to go, man.
• 3:51
  Speaker 1: I just, you know.
• 3:54
  Speaker 2: Yeah well, hopefully you're coming not in the middle of winter.
• 3:57
  Speaker 2: You're going to be able to take a little bit of a break from the heat of this.
• 4:02
  Speaker 1: Yeah, no, I mean, it is nice up there, weather-wise, that's for sure.
• 4:05
  Speaker 1: So what's going on?
• 4:07
  Speaker 1: Uh, right now with uh, you know, I see we we met, not in march, we had that conference that we held.
• 4:12
  Speaker 1: It was amazing presentation that you presented there and um, you know, I mean let's just let's talk about, you know, the issue of you know cte, you know the, the.
• 4:21
  Speaker 1: You know CTE, you know the, the.
• 4:22
  Speaker 1: You know uh and and RHI.
• 4:24
  Speaker 1: You know, most importantly for our parents out there, you know, for our audience.
• 4:29
  Speaker 1: So what's going on?
• 4:30
  Speaker 1: I've noticed that you know more and more I'm seeing.
• 4:33
  Speaker 1: You know uh, you know more recognition of RHI as a real, as the critical element in.
• 4:40
  Speaker 1: You know dementia with.
• 4:41
  Speaker 1: You know contact, sports players and mental illness and kids and adults.
• 4:46
  Speaker 1: You know where are we at with that in terms of the science, dr Dan.
• 4:52
  Speaker 2: So when we started doing this work, we thought that concussion was the main thing that we had to worry about, that it was the number of concussions you got over your life that puts you at the most risk of having problems later in life.
• 5:04
  Speaker 2: But now we're realizing that that's not the case, that it's this RHI the repetitive head impacts that you're referring to.
• 5:11
  Speaker 2: So we've done a number of studies along these lines, but one of the biggest ones we did was one where we looked at 660 some odd individuals who passed away and donated their brains for research and we looked at what factors best predicted whether or not they ended up getting neurodegenerative disease later and, if they got neurodegenerative disease, how severe it would be.
• 5:33
  Speaker 2: And what we ended up finding out was that it wasn't concussions.
• 5:36
  Speaker 2: Concussions actually didn't really make much of a difference.
• 5:39
  Speaker 2: What mattered the most was the total force to the head that they got over their life.
• 5:46
  Speaker 2: That's what predicted whether or not they got CTE neurodegenerative disease and if they got it, how bad it was.
• 5:53
  Speaker 2: And so now we're realizing we're putting all of this focus in concussion, and that's important because concussion is a serious problem.
• 5:59
  Speaker 2: But if we eliminated every concussion in sports?
• 6:00
  Speaker 2: But if we eliminated every concussion in sports.
• 6:04
  Speaker 2: That wouldn't necessarily stop the cumulative head impacts that put you at risk for problems later in life, and that's what we're.
• 6:12
  Speaker 1: you know, we're trying to get the word out and you just, you know stated you know what to most parents and even most doctors and medical practitioners out there it's all about the concussion, right?
• 6:27
  Speaker 1: We focus on the concussion.
• 6:28
  Speaker 1: Nih only talks about concussions.
• 6:28
  Speaker 1: The CDC really only talks about concussions.
• 6:30
  Speaker 1: They've had a little bit of mention of RHI, but you and I know that it's not concussion.
• 6:36
  Speaker 1: So why is the focus still there?
• 6:38
  Speaker 1: Why are we still focused on even, you know, on the?
• 6:41
  Speaker 1: You know we've had six kids die in football this year already, all right, and all we keep hearing about is these guardian caps, all right, which do nothing for RHI.
• 6:50
  Speaker 1: I mean, they might drop and I'll just ask you about that and get your opinion on that, but the issue is all about concussions.
• 6:57
  Speaker 1: Why have we not moved on to the?
• 7:02
  Speaker 2: real issue at hand.
• 7:03
  Speaker 2: Yeah, I think in many ways concussion presents a more tangible opportunity for an intervention, right?
• 7:11
  Speaker 2: So the difference between concussion and RHI and you know this already is that a concussion is a hit to the head that results in symptoms, and so you get a hit to the head and let's call it an ADGG, to use the way that we measure force of impacts.
• 7:25
  Speaker 2: If it's ADG impact and I get a hit to the head the exact same spot as you got that hit to the head, adg, same location, but I felt nauseous afterward or I was dizzy afterward and you weren't.
• 7:37
  Speaker 2: Then I got a concussion and you didn't.
• 7:39
  Speaker 2: But when we're talking about things that we can control, no-transcript.
• 8:06
  Speaker 2: And, for example, for an average football player, a offensive lineman, for every concussion they get, they get on average 343 hits to the head that are of equal or greater force than the head impact that resulted in concussion.
• 8:21
  Speaker 2: Those are all RHI.
• 8:22
  Speaker 2: That head impact that resulted in concussion, those are all RHI no-transcript.
• 8:39
  Speaker 1: My boy didn't have a when he had his last concussion.
• 8:42
  Speaker 1: He had two that we knew about.
• 8:44
  Speaker 1: The third one they said might be dehydration, and I said that's it, man.
• 8:48
  Speaker 1: One more, we're done with all this stuff, Cause I didn't know that the aggregate made any difference.
• 8:54
  Speaker 1: He never had another concussion yet.
• 8:57
  Speaker 1: He was a football player and a wrestler and a snowboarder, so he was taking hundreds and hundreds of hits every year and, to your point, and that's what ended up hurting him, it wasn't the concussions.
• 9:10
  Speaker 1: I mean, the last concussion was three years before he passed.
• 9:14
  Speaker 1: So, you know, obviously we've got to get beyond this point, and it goes beyond just about, you know, because we can see it right, we can intervene.
• 9:24
  Speaker 1: It's all about getting, uh, you know, to the next step.
• 9:27
  Speaker 1: But all the focus is on concussions, all the gadgetry, like those neck collars and these guardian caps that are now big.
• 9:34
  Speaker 1: No, you know, the NFL is wearing them.
• 9:36
  Speaker 1: Well, what are your, what are your opinions on these guardian caps?
• 9:39
  Speaker 1: I mean, a lot of people are asking us uh, you know about them and the concussions and repeated head impacts, which is the focus of what we are all looking at, but what's your opinion on those things?
• 9:54
  Speaker 2: Yeah, so I've seen the behind-the-scenes data about the guardian caps.
• 9:58
  Speaker 2: They present some pretty promising numbers about the numbers of reduced concussions and the amount to which it reduces the force of head impacts.
• 10:16
  Speaker 2: But I personally am not entirely convinced yet ways to improve and reduce the head impacts and the forces associated with those head impacts in many, many different ways.
• 10:30
  Speaker 2: But when we're talking about a head impact, a Guardian cap or really any kind of a new technological device, it might attenuate the force associated with the impact by like 5% or 10% at most, right, but that means we're going from an 80G impact to a 72G impact.
• 10:52
  Speaker 2: You know how we make an 80G impact a zero G impact.
• 10:57
  Speaker 2: It's by eliminating the force altogether, right, like that's the answer.
• 11:01
  Speaker 2: And so I feel like there's all this focus on decreasing it a little bit, when we can be doing a lot more common sense things to just eliminate the head impacts that aren't occurring.
• 11:15
  Speaker 1: Yeah, I mean you know, and, and, and.
• 11:16
  Speaker 1: Honestly, even at 70 G's, I don't care if you decrease it 50% the brain cannot stop from moving with the skull.
• 11:25
  Speaker 1: I mean, you're a brain doctor, right.
• 11:28
  Speaker 1: So to our audience, which is military and parents and all that, explain why this concept is so important, that all these, you know, I don't care how new the technology is for the helmets or these guardian caps or these collars you put, Now they're talking mouth guards, all that I mean.
• 11:48
  Speaker 1: Why, from a physiological perspective, why are these just not as a, why can't we get to zero?
• 11:55
  Speaker 2: Yeah.
• 11:55
  Speaker 2: So that's a really great question.
• 11:58
  Speaker 2: Part of the problem is that we're asking a lot from our helmets, right?
• 12:02
  Speaker 2: So if we have a bike helmet, for example, and you're cycling along and you fall and you hit your head, that bike helmet absorbs the impact and absorbs it in such a way that it deforms and breaks and breaks.
• 12:19
  Speaker 2: And so that's why, if you ever have a bike helmet and you get in an accident, you're supposed to toss that helmet and get a new one.
• 12:22
  Speaker 2: Oh wow, because it maximally absorbs that impact.
• 12:24
  Speaker 2: Now, our football helmets can't do that, right?
• 12:28
  Speaker 2: If every time a kid got hit in the head, we tossed the helmet and got a new one, then we wouldn't be able to continue playing the sport.
• 12:35
  Speaker 2: We'd be going through helmets like that.
• 12:38
  Speaker 1: Now, that could help.
• 12:39
  Speaker 1: That would get rid of football, at least at the high school level, before right, I mean, then below right.
• 12:45
  Speaker 1: Yeah, right, gosh Right.
• 12:48
  Speaker 2: But that is what we need for a helmet to maximally absorb the forces associated.
• 12:54
  Speaker 2: We need it to be able to actually absorb the force and deform.
• 12:57
  Speaker 2: But we need that helmet not only to last multiple hits a game, but multiple games a year.
• 13:19
  Speaker 2: I mean, the helmets do an incredible job at what they're originally designed to do, which is to prevent or decrease the risk of catastrophic injuries like the ones that we've seen all too many times this season.
• 13:32
  Speaker 2: That used to be.
• 13:33
  Speaker 2: The rates of these used to be way higher and now, because of helmets, they're happening less frequently, but they're not decreasing the forces at the low end to the extent we need them.
• 13:43
  Speaker 1: That makes absolute sense.
• 13:44
  Speaker 1: And then you know, what we want the parents to understand too is that at any force that brain still moves.
• 13:52
  Speaker 1: I mean it's in, you know, it's in fluid.
• 13:55
  Speaker 1: It's in fluid.
• 13:55
  Speaker 1: And there's actually discussions right now about the way that the helmet is locked in behind the chin actually accelerates some of the mechanisms of G-force.
• 14:08
  Speaker 1: That further damages the brain, and I mean it is.
• 14:11
  Speaker 1: Yeah, helmet technologies is just a trip, but I think it's also.
• 14:15
  Speaker 1: It's that cushion that we rely on.
• 14:17
  Speaker 1: We got a helmet.
• 14:18
  Speaker 1: We did the same thing.
• 14:19
  Speaker 1: We raised fifteen thousand dollars.
• 14:21
  Speaker 1: We got NFL helmets for my son and his football team and it didn't protect my boy, you know from RHI.
• 14:29
  Speaker 1: It probably did protect his skull and that's what they're you know, they're, they're good for, but you know, not too much there, but on the research side.
• 14:39
  Speaker 1: So what's going on with RHI?
• 14:40
  Speaker 1: I think one of the great point you just mentioned is that you can't see it.
• 14:51
  Speaker 1: So how do we elevate RHI through research to get it to a point where this is a risk that everybody understands doctors and nurses, psychiatrists, coroners, parents, athletes, I mean.
• 15:01
  Speaker 1: Right now we're talking 95% plus outside of the research community, and some of the doctors that are out there I mean 60% of them, according to a New England Journal of Medicine survey, would recommend contact sports, sports, I mean, to the children.
• 15:22
  Speaker 1: What's going on in the RHI world from a research perspective that can help elevate this subject?
• 15:27
  Speaker 2: Yeah.
• 15:28
  Speaker 2: So what we need is a better way of measuring and capturing RHI and the RHI that matters for these long-term problems.
• 15:37
  Speaker 2: So you know, for example, any little leaguer that goes out there and is playing and pitching, we have a coach at the sidelines with a counter keeping track of every single pitch that little leaguer is throwing, because of the risk of them having UCL injury and needing Tommy John surgery in 20 years if they become a pro, right so?
• 15:59
  Speaker 2: But we're still, we're so concerned about their ligament and their elbow that we're having them, we're monitoring every single pitch they're throwing, but that same little leaguer get beamed in the head and we're not monitoring that in any way whatsoever.
• 16:13
  Speaker 2: And you tell me in 20 years what they're more likely to need their elbow to be, if they're a professional baseball player or their brain, no matter what they're doing.
• 16:25
  Speaker 2: And so what we need is the equivalent of that pitch counter on the sideline measuring every athlete's cumulative, repetitive head impact exposure, so that we can then make sure we're putting in measures in place to minimize those and, if people are at the higher ends of things, to maybe make decisions in terms of their, their, their future decisions, in terms of what they're doing with with playing football, playing other sports, other contact so with you?
• 16:54
  Speaker 1: know we on that point?
• 16:55
  Speaker 1: You know, for years I mean I actually studied this that most of the device manufacturers.
• 17:01
  Speaker 1: So if you're a parent and you're like, hey, I heard about this RHI thing, I saw Dr D on Bruce's show, I want to measure this.
• 17:10
  Speaker 1: There's nothing out there right now, and there have been I think my last count five or six companies that came out with subconcussive impact devices like the jolt one that you wear on your hat when you're playing soccer.
• 17:25
  Speaker 1: There's been things you can attach to your helmet.
• 17:27
  Speaker 1: I can't remember off the top of my head.
• 17:28
  Speaker 1: All those companies are out of business.
• 17:31
  Speaker 1: Okay, so here you are.
• 17:33
  Speaker 1: You're a parent, you know there's a risk to your kid.
• 17:36
  Speaker 1: Your kid is like I want to play football, whatever, and you can't.
• 17:40
  Speaker 1: Or soccer Heading.
• 17:41
  Speaker 1: The soccer ball, as we know, produces an enormous amount of damage as well, okay, especially to developing brains.
• 17:48
  Speaker 1: So what do we do?
• 17:50
  Speaker 1: I mean, now these mouthguards are coming out, world rugby, I mean, do you think those would be something that we can get measurements?
• 17:59
  Speaker 1: Then how do we determine the appropriate level at which we should stop or pull back?
• 18:07
  Speaker 1: What are your thoughts on the technologies that are coming out?
• 18:13
  Speaker 2: It's funny that you mentioned Jolt, actually, because that was a company that was founded by a couple of my buddies from from mit for college.
• 18:21
  Speaker 2: Uh and uh and yeah, and unfortunately, yeah, it didn't work out.
• 18:25
  Speaker 2: Um, I think that you're at, you hit the nail on the head.
• 18:28
  Speaker 2: There's, uh, there's been, some people who've, uh, been interested in providing this, these information, uh, these, these technologies to, uh, to parents, but, uh, you know, there hasn't been a market, unfortunately, there haven't been parents who are interested in knowing about the exposures that their kids are getting and, as a result, all of them have kind of gone out of business.
• 18:53
  Speaker 2: These mouthguards are really promising, in fact.
• 18:55
  Speaker 2: Actually, I saw some of the behind-the-scenes data, looking at the mouthguard data from NFL players, and it appears that these mouthguards actually might have better information, more accurate prediction of the forces that are being transmitted to the head than the helmet sensors.
• 19:17
  Speaker 2: So there's, you know, some opportunity there.
• 19:21
  Speaker 2: Now, I think parents are more interested and aware about these problems, and so I think that the market might meet the demand for these devices and we might actually see, you know, hopefully some of these companies survive.
• 19:35
  Speaker 2: It'll be interesting to see because you know.
• 19:36
  Speaker 1: Hopefully some of these companies survive.
• 19:38
  Speaker 1: It will be interesting to see because, again, no exposure to RHI is acceptable when a child's brain is developing.
• 19:45
  Speaker 1: As a brain guy, because you are a brain doctor, can you explain to parents why this is so important?
• 19:53
  Speaker 1: The fragility of the brain, the vulnerability of the brain, the criticality of the brain to their kids' futures why should they focus on not exposing that brain to RHI while their child is growing up?
• 20:10
  Speaker 2: So your brain, when it's developing, as it's growing, it creates a ton of different connections to all the brain cells, the other brain cells.
• 20:17
  Speaker 2: It creates a ton of different connections to all the brain cells, the other brain cells.
• 20:20
  Speaker 2: And then as you get older, your early teens, and then all the way up through about 22, the brain is continuing to develop and continuing to figure out which of those connections it needs and which of those connections are overkill or unnecessary or actually bad connections.
• 20:36
  Speaker 2: And that's why we become more mature, we make better decisions.
• 20:41
  Speaker 2: As we get older, it's all part of our brain developing and so some parts of the brain actually in men, the prefrontal cortex, which is part of the area responsible for decision-making, that actually doesn't fully develop until like 23 or 24.
• 20:56
  Speaker 2: For men, develop until like 23 or 24 for uh, for, for, uh.
• 20:59
  Speaker 1: Men a little women always get on that one man.
• 21:01
  Speaker 1: Yeah, you guys are never mature.
• 21:04
  Speaker 1: Actually my wife would probably say that.
• 21:05
  Speaker 1: Yeah, I think my wife would argue my prefrontal cortex is still my wife say you don't even have one.
• 21:14
  Speaker 2: Yeah, but so what we know then is that, uh, the brain is is figuring itself out.
• 21:24
  Speaker 2: It's figuring out what connections it needs and what connections it doesn't.
• 21:28
  Speaker 2: And the problem is, if you're getting hit in the head, then you're disrupting that ability of the brain to prune, to figure out what it needs to have connected and.
• 21:39
  Speaker 2: And what ends up happening then is you likely have a less resilient brain, a brain that's less able to tolerate issues that come down the line.
• 21:46
  Speaker 2: And all of us I mean if you looked at people in their 50s and you looked at their brains and you're able to stain for pathology of Alzheimer's disease, you'd probably find in 50-year-olds, about 40% of them have some Alzheimer's pathology.
• 22:01
  Speaker 2: Right, that's just part of living, and if they live long enough they'll actually end up getting the disease.
• 22:05
  Speaker 2: But the issue is, if you have that same amount of pathology but your brain isn't as resilient you got hit in the head a bunch when you were younger now your brain can't compensate for that pathology and so if it can't compensate, that same amount of pathology that you might not be able to tell is causing a problem in someone in their 50s, it might start causing a problem in their 50s and so you might not before have seen problems until 70s or 80s.
• 22:34
  Speaker 2: Now you're seeing it show up decades earlier and that's really where we start to see the problem of getting hit in the head really a lot.
• 22:41
  Speaker 1: And do you think that has anything to do with the fact that, like you know, I'm a 70s child?
• 22:47
  Speaker 1: I joined the Army in 1980.
• 22:49
  Speaker 1: We didn't have Pop Warner, we didn't have youth football Heck, we lived across the street from the dump.
• 22:56
  Speaker 1: We didn't have anything right from the.
• 22:59
  Speaker 1: You know, we lived across the street from the dump, we didn't have anything Right, you know.
• 23:03
  Speaker 1: So you know, but now I, you know, I'm out there, you know my, my son, you know, could I mean I, we just flipped a a, a, a police activity league team from tackle the flag football.
• 23:09
  Speaker 1: They started six.
• 23:11
  Speaker 1: Okay, you got kids at six.
• 23:14
  Speaker 1: Now, my, you know, unfortunately my son didn't start till middle school.
• 23:17
  Speaker 1: But, heck, if he would have come up to me in six and his friends were playing ball and they had it in the mountains of New Mexico where he was growing up, I probably would have said yes, in my, in my ignorance, right?
• 23:30
  Speaker 1: So the you know, do you think that the dementia that you're seeing, that, the mental health that we're seeing coming, you know, trending?
• 23:46
  Speaker 2: downward now is that?
• 23:46
  Speaker 2: Could that be a result of earlier exposure?
• 23:47
  Speaker 2: Yeah, that's one of the things that we're seeing.
• 23:50
  Speaker 2: That's been remarkable is that playing football at age six it doesn't have that much of a different risk than playing football at age 26 for that year.
• 23:58
  Speaker 2: Basically, every year you're getting exposed, you're increasing your risk of football and so if you're having someone who's most people, they stop playing football.
• 24:09
  Speaker 2: When they stop playing football, right, vast majority of people, about two thirds of people, stop playing at the actually I'd say more than that but 96% of people end up they stop playing football at the end of high school.
• 24:22
  Speaker 2: Another 3.5% stop playing at the end of college and then you have about a fraction of a percent playing in the pro level and they play for as many years as they can.
• 24:31
  Speaker 2: So the tail end, that amount of exposure, that's set.
• 24:35
  Speaker 2: But what's changed and, to your point, is the front end.
• 24:39
  Speaker 2: People are starting to play earlier and earlier and, as a result, the total number of years that they're playing and the total RHI exposure, the total amount of hits to the head they've gotten, has increased.
• 24:49
  Speaker 2: So I treat NFL players in my clinic.
• 24:54
  Speaker 2: I've never talked to a single NFL player who said you know what made it for me?
• 25:00
  Speaker 2: The reason that I'm a pro today is that I started playing football at age eight.
• 25:04
  Speaker 2: Not one of them.
• 25:06
  Speaker 1: No kidding.
• 25:09
  Speaker 2: Yeah, until you hit puberty, you don't know what kind of body, you don't know whether you're going to be a receiver or a lineman or a quarterback, and so you don't need those hits to the head at a young age to know how to play ball to the highest level of the game.
• 25:26
  Speaker 2: So, so why is little Timmy doing?
• 25:27
  Speaker 1: it.
• 25:27
  Speaker 1: It doesn't make any sense to me now that I know what I know.
• 25:30
  Speaker 1: I mean, we were having, um, uh, we were having dinner with, uh, uh, jordan Reed, who's uh, you know, he was the highest paid NFL player and out there and you know he's like I didn't start playing until high school my mom wasn't letting me touch anything and he's still, even though he started late in high school and he's very open about this and he went through, you know, college and I think it was University of Miami, went on to NFL, the highest paid tight end, before he retired.
• 25:58
  Speaker 1: He has issues now and he started late, so he's all about just waiting.
• 26:04
  Speaker 1: I mean, nobody's here and you know nobody here is saying we can't have football or rugby or head the ball in soccer.
• 26:11
  Speaker 1: You know, what we're saying is that we need to change the paradigm.
• 26:15
  Speaker 1: I mean right now.
• 26:17
  Speaker 1: You know, dan, I think it's becoming so painfully obvious with the science, the research, that you know, people are starting to understand that we have a massive problem here and that leads to how do we tell that we have a problem, like you just mentioned people in their fifties, right, or forties, and now we have, you know, you know, ballplayers of all types?
• 26:42
  Speaker 1: Right, you can soccer player, it doesn't matter, it's sports.
• 26:45
  Speaker 1: Right, wrestlers right, you know taking their lives.
• 26:49
  Speaker 1: What do we have out there now that can help us, besides the fact that, hey, you played a lot of contact sports?
• 26:56
  Speaker 1: What are the indicators that their brain's hurting, that they need help?
• 27:01
  Speaker 1: How do we help their loved ones understand that there's something going on that could have a physiological basis to it?
• 27:13
  Speaker 2: You're absolutely right where that's one of the issues.
• 27:21
  Speaker 2: The major issue that we have with these brain diseases is that it's not like a broken arm, where you can see that that arm is broken and you can understand why they don't want to do something with that arm.
• 27:30
  Speaker 2: With your brain, the issues that people experience, they're invisible, and when you're looking at the person, you don't understand why they're acting the way they're acting or why they're having memory problems the way they have, or why they're depressed in a funk that they can't otherwise get out of, and you tend to blame the person for the symptoms that they're experiencing rather than recognizing that this might be related to some sort of a disease process.
• 28:05
  Speaker 2: And so that's where we need to really get better at diagnosing this disease in life, so that we can say these issues that this person's experiencing, they're likely related to a brain disease.
• 28:11
  Speaker 2: There's so many NFL players that I've seen who we've been able to tell hey, you know, this is what we know about CTE.
• 28:21
  Speaker 2: Well, we can't diagnose it in life.
• 28:23
  Speaker 2: Yet you certainly have a lot of the indicators that would put CTE more likely on the differential and being able to say that to them, being able to say that there's a possible brain disease that's responsible for why they're having these mood changes, these changes in their thinking, these changes in their memory, their changes in their emotional ability or flying off the handle more frequently.
• 28:52
  Speaker 2: That gives them and their family something tangible to point to.
• 28:58
  Speaker 1: So, just as a percentage right, the amount of NFL players that you see as a percentage, how many of them in your mind have some form of cognitive, behavioral or psychological disorder?
• 29:11
  Speaker 1: Maybe not even related to football, but, knowing that they had a lot of RHI in your experience, Is it a low, high lot, little?
• 29:25
  Speaker 2: Yeah, so for us, people don't tend to come to see me unless they have some concerns, some complaints, and so you end up with, of the NFL players it's a lot of them, More than half of them end up having some problems.
• 29:43
  Speaker 2: All NFL players, that's the NFL NFL players who are coming in because they're concerned, Um, and so yeah, uh, yeah, I I can't say anything about what the whole group looks like, because outside of my clinic I work with plenty of NFL players that are from NFL players that are operating at really, really high levels.
• 30:02
  Speaker 1: Um, but, uh, but you know what I see in clinic and when you see them on the outside at high levels, right, they're showing.
• 30:07
  Speaker 1: You know you don't know what's going on at night or when they're back home, but you bring up, you know, a couple of really, really good points is that you know brain health is so important.
• 30:20
  Speaker 1: Yet we're at a stage right now where you know that brain health is never assessed.
• 30:27
  Speaker 1: When you go see a doctor, right, they're going to look at your ticker, they're going to put your stethoscope on your lungs, they're going to, you know, they're going to order some labs.
• 30:35
  Speaker 1: But this piece, this organ up here, controls everything that's going on in our body.
• 30:42
  Speaker 1: Right, and why is that?
• 30:46
  Speaker 1: I mean, and it's also an indicator that we've got problems, I mean we got issues.
• 30:53
  Speaker 1: How do we get brain health prioritized in our medical system?
• 30:58
  Speaker 1: Because if we can solve for getting brains right and we'll talk about treatment options here in a second you know the mental health epidemic that we're going through right now.
• 31:10
  Speaker 1: What can we address with that right?
• 31:12
  Speaker 1: Then, all the other cognitive and behavioral disorders.
• 31:15
  Speaker 1: You know anxiety, stress, you know panic attacks, all that emanating from you know brains and different, you know shapes of being injured Just think of the violence and incarceration rates.
• 31:28
  Speaker 1: I mean, all these are affected by brains that don't work right, whether they've been beaten up in football or soccer or domestic abuse, or you had a car crash and years later you're just, you know, a little nuts right?
• 31:43
  Speaker 1: How do we get?
• 31:45
  Speaker 1: I mean, everybody thinks that brain health is the purview of highly respected neurologists and pathologists like yourself, and there's this really unique clique of people that can only talk to the brain.
• 31:56
  Speaker 1: How do we get brain health pushed down to the general practitioner?
• 32:02
  Speaker 1: So it is.
• 32:02
  Speaker 1: You know they're not the specialist, but at least they can.
• 32:06
  Speaker 1: Like you take your car to a shop and you can check the oil and you know if the oil's low, you got a problem.
• 32:10
  Speaker 1: You know we can take some.
• 32:12
  Speaker 1: You know we can take labs.
• 32:13
  Speaker 1: We can do.
• 32:13
  Speaker 1: You know there's all kinds of.
• 32:14
  Speaker 1: You know, you know tests, but you know how do we, how do we fix that part of it?
• 32:19
  Speaker 1: Cause we got an enormous education and awareness problem here in America on the subject.
• 32:26
  Speaker 2: You're right.
• 32:27
  Speaker 2: We need to do a better job of having our frontline healthcare providers be the folks who triage individuals and basically screen everybody for how their brain's doing, because I'm very biased as a brain doctor, but from my perspective, the brain's the most important organ that we got.
• 32:48
  Speaker 2: You can deal with problems in other spaces.
• 32:52
  Speaker 2: The reason that I studied the brain, the reason I'm scared about the brain, is your brain for me is what defines who you are, and without that, then who are you?
• 33:02
  Speaker 2: You're a different person.
• 33:04
  Speaker 2: You can go without organs.
• 33:06
  Speaker 2: You can't go without other organs.
• 33:08
  Speaker 2: You can't go without your brain, and so we need to do a better job of identifying the earliest changes that people are having, because, really, when you go to your doctor, by the time you start to say, hey, my memory is completely shot.
• 33:24
  Speaker 2: That means that the problem is wrong.
• 33:26
  Speaker 2: Way too far down the road.
• 33:29
  Speaker 2: We need the blood test beforehand.
• 33:34
  Speaker 2: We need to be able to find the earliest indicators of problems with thinking, memory, mood, behavior that correlate with simple blood draw, the way you get your blood sugar test.
• 33:46
  Speaker 1: Exactly.
• 33:47
  Speaker 2: And so that's one of the things that we're working on in the research.
• 33:49
  Speaker 1: So I mean the um, yeah, because when you go to see a doctor right now, I mean number one none of this is is assessed at all.
• 33:58
  Speaker 1: And, you know, without the education and awareness you know, we, we were, we're, we're we're just not getting the attention, um, that we need.
• 34:09
  Speaker 1: Because, you know, one of the things that we have to get out there is that what you just described psychological, cognitive and behavioral disorders are indicators that the brain is not working right.
• 34:20
  Speaker 1: It's not.
• 34:23
  Speaker 1: We tend to think that, you know, psychological disorders or cognitive behavioral disorders are the result of emotional trauma.
• 34:31
  Speaker 1: Okay, you know, we, we, even with brain injuries, there's not a significant correlation in the medical field right now that, oh, your mental illness could be related to your brain injury.
• 34:42
  Speaker 1: We are not making that connection.
• 34:44
  Speaker 1: You know, and, and and I think that when that knowledge becomes apparent, or that awareness, the possibility that your brain could be, you know, and and and I think that when that knowledge becomes apparent, or that awareness, the possibility that your brain could be, you know, your mental illness, let's look at something, not not just send you to a psychiatrist, but let's look at the physiological.
• 35:02
  Speaker 1: You know, you know history that you have, you know, have you been a victim of domestic abuse?
• 35:08
  Speaker 1: Were you beaten as a child, as I was, as a kid, you know?
• 35:13
  Speaker 1: Did you?
• 35:14
  Speaker 1: Were you a parachutist in the military?
• 35:16
  Speaker 1: Were you around a lot of explosive blasts?
• 35:18
  Speaker 1: Did you play football?
• 35:19
  Speaker 1: Had you had a lot of soccer balls?
• 35:20
  Speaker 1: All these things should be going into any general evaluation of an individual to determine, you know, if their brain's right and if it isn't, then, to your point, you know, can we come up with those blood tests?
• 35:36
  Speaker 1: So you say you're working on something like that right now.
• 35:39
  Speaker 1: How far down the road are we?
• 35:41
  Speaker 1: Because if we could have a simple blood test that could indicate that the brain health is suffering, I mean, oh, doc, that could change the world for so many.
• 35:55
  Speaker 2: Americans yeah, I think, as always, hit the nail right on the head.
• 36:00
  Speaker 2: I work, actually, with a number of different organizations, including one that works with police officers who are experiencing mental health crises, and one of the things that we've worked on is bringing to them an understanding that many of these individuals, before they were officers, they played football or they had other head impact exposures car accidents Many of them in the line of duty, also get head impact exposures, both in training and in duty, and we're bringing to these individuals the idea that we need to better capture and characterize their head impact exposures and that those exposures might have some relationship to how they're thinking and feeling right now, and so that's one of the innovations that we've been bringing to them over the last couple of years.
• 36:50
  Speaker 2: In terms of the research for the biomarkers, though, so I don't think it's going to be as easy as it is with diabetes or one of these other tests, where you have one lab test that if this one's high, if it's above this level, then there's a problem.
• 37:03
  Speaker 2: What I think it'll, what we're working on and what we've come to, is understanding that there's probably going to be a set of six or so different study that's led by a great colleague, the TRAC-TBI study led by Michael McRae.
• 37:38
  Speaker 2: Led by an international consortium of individuals across the US, they're looking at the blood-based biomarkers after brain injury and identifying that exact fingerprint.
• 37:51
  Speaker 1: Wow, I mean, and to your you know that would be exciting and I want you know, folks to know out there that there is hope, there's a lot.
• 38:01
  Speaker 1: If you've played a lot of sports, if you've, you know, been in the military and had a lot of explosions, you know a lot of explosion, explosive exposure.
• 38:10
  Speaker 1: Or if you're, you know, or you're you're a parent of a child that, oh man God, my son's been playing.
• 38:15
  Speaker 1: I hear this a lot.
• 38:16
  Speaker 1: You know my son's been playing for six, seven years.
• 38:18
  Speaker 1: What do I do?
• 38:19
  Speaker 1: You know now, even since my, my son's passed, we're aware of, you know all the, you know a lot of these new treatment options that are out there, from hyperbaric oxygen therapy to vagus nerve stimulation, all these non-pharmaceutical type of approaches.
• 38:34
  Speaker 1: Now we have a huge problem that a lot of them are covered by insurance right now because we have a damaged brain.
• 38:53
  Speaker 1: Therapy and pharma right now, at least on the psychological, SSRI side of things, are not really treating the true cause of the issue, which is brain damage.
• 38:56
  Speaker 1: In your opinion, what's out there now that you're seeing or hearing about that can help these athletes that can help these adults that have played a lot, car crash victims, these victims that are suffering in silence right now because there's no help for them right now.
• 39:13
  Speaker 1: You know what's out there on the horizon that can help them.
• 39:19
  Speaker 2: Yeah, the most boring answer that I can give, which is also the most effective one, and it's unfortunate because it's a war nobody's interested in.
• 39:30
  Speaker 2: When we're talking about neurodegenerative disease, the best study and the most effective intervention that if I could put it in a pill, it'd be a billion-dollar drug is exercise.
• 39:41
  Speaker 2: When you're talking about Parkinson's disease, if you enroll people with Parkinson's disease in an exercise intervention, multiple national and international studies have shown you can decrease the rate of their decline and actually improve their decline in some cases.
• 39:59
  Speaker 1: Just through exercise.
• 40:02
  Speaker 2: Just through exercise.
• 40:04
  Speaker 2: So the data is not nearly as incredibly.
• 40:08
  Speaker 2: I mean, in Parkinson's it's out of this world, absolutely incredible With Alzheimer's it's very, very, very good data that also supports that.
• 40:17
  Speaker 2: We don't have the data for CTE, but I'd be shocked if it's also not just as good.
• 40:22
  Speaker 2: Basically, your brain health is your body health and your body health is your brain health.
• 40:28
  Speaker 2: Brain health is your body health and your body health is your brain health.
• 40:31
  Speaker 2: So that's the first thing for every NFL player that comes to my clinic, for every elite special operator that comes to my clinic, first thing I look at is their exercise.
• 40:38
  Speaker 2: The second thing I look at is their sleep.
• 40:42
  Speaker 2: So in many ways, sleep, poor sleep or disrupted sleep, disordered sleep, is like pouring gasoline on whatever fires already exist.
• 40:53
  Speaker 2: So if you have problems with pain, if you have problems with thinking, if you have problems with your behavior and you get bad sleep on top of that, those small fires become raging forest fires, and so if we can get the sleep under better control, then those other things end up getting under better control.
• 41:09
  Speaker 2: Then those other things end up getting under better control too, on top of that disordered sleep, breathing.
• 41:13
  Speaker 2: So disruption in your deep sleep, like obstructive sleep apnea that interferes with this process.
• 41:22
  Speaker 2: It's called the glymphatic system in the brain.
• 41:24
  Speaker 2: It's basically the process by which your brain clears toxic neurometabolites.
• 41:29
  Speaker 2: Mostly happens at night during deep sleep.
• 41:32
  Speaker 2: If you just interrupt that, multiple different studies in animals and in people have shown you increase the rate of toxic protein buildup.
• 41:44
  Speaker 2: That leads to Alzheimer's disease, leads to other neurodegenerative diseases.
• 41:48
  Speaker 2: So if you can get better sleep, you're going to have better outcomes, better thinking for multiple reasons.
• 41:56
  Speaker 2: So those are two really boring interventions, but they're interventions that have incredible evidence.
• 42:02
  Speaker 1: Okay, and what's your opinion on HBOT therapy, the psychedelics route?
• 42:08
  Speaker 1: Psychedelics is getting a lot of attention right now from, uh, you know, a brain health perspective.
• 42:13
  Speaker 1: Uh and uh you know, and we're seeing a lot of studies on that.
• 42:18
  Speaker 1: Is that anything that you're working on up there at harvard at all?
• 42:23
  Speaker 2: yeah, so uh, some of the uh the psychedelic work is actually done on mclean, so one of the affiliate Harvard campuses here that's actually where it originally started and they're showing particular benefit for individuals who have treatment refractory depression.
• 42:42
  Speaker 2: So basically, we tried a bunch of the normal treatments and nothing's working for these folks.
• 42:48
  Speaker 2: Those are the individuals that it seems to have the most benefit for, and I think that increasing the study and easing the access for those individuals to get treatment they need is important.
• 43:00
  Speaker 1: And that's big with you know, especially our veteran population that have, you know, been really been well, we find have been over-medicated, because a pill creates a symptom.
• 43:12
  Speaker 1: They give a pill for the symptom and it's just how medicine's done nowadays, not blowing anybody up.
• 43:18
  Speaker 1: But I think it could be much better done.
• 43:21
  Speaker 1: And we do run into so many of these guys and girls that are just I've tried everything, man, I've got a bag of drugs, I've been talking to therapists for five years, dude, I'm done.
• 43:33
  Speaker 1: And that's where we're seeing plant medicines change lives.
• 43:36
  Speaker 1: I mean it's really amazing what's going on.
• 43:39
  Speaker 1: But, to your point, these are people that are at the end, right, they've tried everything, it's not working, they can't get ahead, and you know.
• 43:48
  Speaker 1: But you know, my point was that there are, there is hope, you know, for those people that understand.
• 43:53
  Speaker 1: That's why they're coming to you, dr Dan.
• 43:55
  Speaker 1: I mean you're, you're giving them hope, you're showing them that, yeah, you're probably going to end up with a diagnosed CT, just like I know I am, but you know you can still be a productive.
• 44:05
  Speaker 1: You know father, husband and and all that, and, and I think that's what we need to hear, that is, in this time as this issue of RHI.
• 44:16
  Speaker 1: Uh, start, it starts to dominate the conversation, like I'm.
• 44:21
  Speaker 1: I'm seeing more stuff on Twitter right now videos, conversations, litigation, everything from you know people outside the normal, you, normal, you know.
• 44:35
  Speaker 1: Uh, athlete and researcher community.
• 44:36
  Speaker 1: People that know that this is an issue, right.
• 44:37
  Speaker 1: Uh, people you know.
• 44:37
  Speaker 1: The awareness is building even on the political side right now.
• 44:40
  Speaker 1: So you know, but it's going to take, um, you know, but you know it's going to take folks like you to help us get there.
• 44:47
  Speaker 1: So, before we cut here, so what's Dr Dan working on?
• 44:52
  Speaker 1: Don't have to give away no secrets.
• 44:56
  Speaker 1: We don't want you to give away your next billion-dollar drug, but what are you working on?
• 45:00
  Speaker 1: How can people follow you?
• 45:02
  Speaker 1: How can they track you and your clinic and the work that you're doing?
• 45:06
  Speaker 1: Just go ahead and pitch yourself here to our audience, because you're the kind of subject matter experts that we all look up to when it comes down to brain health.
• 45:18
  Speaker 2: Well, that means a lot coming from you, especially considering all the incredible work and advocacy that you've done to really advance brain science.
• 45:25
  Speaker 2: I really appreciate that.
• 45:26
  Speaker 2: It means a lot In terms of what we're working on these days.
• 45:30
  Speaker 2: I think you've summarized it perfectly in terms of it's this message of hope, this idea that I tell every single one of my research participants, I tell every single one of my patients who's struggling now that right now we're working on it, but we don't have any intervention that can treat the disease process in someone's brain.
• 45:52
  Speaker 2: But what I can do is separate the extent to which that disease process, whether it may or may not be there, is affecting your day-to-day life.
• 46:01
  Speaker 2: And if you're able to go and do the things you want to do and enjoy your life in the way you want to enjoy it, at a certain point it doesn't really matter the amount of pathology that may or may not be in your brain if you're living the life you want to live.
• 46:17
  Speaker 2: And so that's what I try to do.
• 46:19
  Speaker 2: I try to basically separate the amount to which that pathology is expressing itself.
• 46:25
  Speaker 2: And basically the idea is, in terms of research, in terms of other outreach, how can we better improve someone's overall functioning, someone's overall thinking, someone's overall mood and behavior, and we're coming up with some pretty exciting things to do that.
• 46:45
  Speaker 2: I was on a call earlier today where we're looking at some potential therapeutic interventions, a drug, basically, that might work, and trying to get into a phase three clinical trial that might help work with medications.
• 47:02
  Speaker 2: So there are a lot of different things in the pipeline and so the most important message I can say to anyone who's struggling, to anyone who's concerned, is seek out a expert in this field, seek out somebody who knows that you can get better and work with them to get better.
• 47:20
  Speaker 1: Okay, well, I really appreciate it, dr Dan.
• 47:22
  Speaker 1: I mean we, we do know that by reducing exposure, if we could take to your point earlier, if we, you know, if we got the kids out of contact sports and then reduced exposure through, you know, through the practices I mean practice alone is 80% of the exposure Then these adults can play these games If they start, especially if they start as adults and and and have the quality of life and you know, and then come see you for other problems instead of brain problems.
• 47:50
  Speaker 1: Right, you know, you know joint problems.
• 47:53
  Speaker 1: I would prefer.
• 47:54
  Speaker 1: Yeah no, I mean no, dude.
• 47:59
  Speaker 1: They'll always be a need for Dr Dan's as well.
• 48:01
  Speaker 1: So, sir, thank you so much for coming on and sharing your knowledge and expertise with our audience today.
• 48:06
  Speaker 1: Uh, we look forward to having you on again see at the conference and and may with our audience today.
• 48:10
  Speaker 1: We look forward to having you on again, see you at the conference in May of next year and I think we're going to be working on some stuff together.
• 48:14
  Speaker 1: So you know, thanks a lot for sharing and we really appreciate the foundation it was a pleasure.
• 48:23
  Speaker 2: Thanks for having me.
• 48:24
  Speaker 1: Thanks for everything else you're doing, also Doing our best.
• 48:26
  Speaker 1: We can man Appreciate it, sir, we'll talk to you later.
• 48:29
  Speaker 1: Cool, so you.