Panel Discussion Including All Speakers

Summary

In this insightful panel discussion, experts explore the application of transcranial magnetic stimulation (TMS) for treating PTSD, highlighting the effectiveness of targeting the ventromedial prefrontal cortex and amygdala. They delve into the nuances of treatment efficacy, the role of motor dominance, and the integration of behavioral measurements. The conversation also touches on the importance of accessibility in mental health care, the potential of digital therapeutics, and the challenges of scaling precision medicine globally. The panel emphasizes the need for further research and the development of efficient, personalized treatment approaches.

Takeaways

• 🧠 TMS Treatment for PTSD: The script discusses the use of Transcranial Magnetic Stimulation (TMS) for treating Post-Traumatic Stress Disorder (PTSD), specifically targeting the ventromedial prefrontal cortex and amygdala.
• 💡 Motor Dominance and TMS: The effectiveness of TMS does not seem to be linked to motor dominance, with most symptomatology manifesting in the left frontal lobe, which is dominant in most people.
• 🔍 Behavioral Measurements: The incorporation of behavioral measurements using ecological momentary assessments and other methods to capture behavior is discussed as a potential next step in mental health research.
• 📈 Natural Language Processing: Advances in natural language processing models have made it easier to analyze personal experiences and behaviors through speech and text, which could be applied to mental health assessments.
• 📊 Cognitive Tests: A large database of cognitive tests and behavioral data has been collected over many years, providing a standardized cognitive battery used across studies for assessing various cognitive domains.
• 🚑 Accessibility in Mental Health: There is a significant discussion on the accessibility of mental health treatment, with long waiting times for treatment being a major concern, even in privileged areas.
• 🌐 Digital Therapeutics: The potential of digital therapeutics to increase accessibility and provide scalable solutions in mental health care is highlighted, including the use of wearables and passive sensing.
• 🔗 Integration of Physiological Systems: The importance of integrating physiological measures, such as cortisol and glucose monitoring, into mental health assessments is emphasized for a more comprehensive understanding.
• 🛡️ Privacy Concerns: The discussion touches on the importance of dealing with privacy issues when using wearables and capturing personal data for mental health assessments.
• 📈 Resource Allocation: The challenge of resource allocation in mental health care is addressed, with a focus on ensuring that basic mental health services are available to everyone while also advancing precision medicine approaches.
• 🔬 Research to Clinical Practice: The script highlights the need for translating research findings into clinical practice effectively, including the use of genetic markers to inform treatment decisions and avoid adverse effects.

Q & A

What is the main topic of the discussion in the provided script?

The main topic of the discussion is the application of transcranial magnetic stimulation (TMS) for treating PTSD, the use of behavioral measurements in mental health studies, and the integration of digital therapeutics and precision medicine in mental health treatment.

What is TMS and how is it being used in the context of the script?

TMS stands for transcranial magnetic stimulation, a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. In the script, it is being discussed as a treatment for PTSD, targeting the ventromedial prefrontal cortex and amygdala.

What was Dr. Phillip's response to the question about the effectiveness of TMS treatment for PTSD?

Dr. Phillip indicated that the TMS treatment for PTSD seems to work quite well, even though the treatment shown in the slides was standard for the dorsolateral prefrontal cortex, not the ventromedial prefrontal cortex and amygdala as initially assumed.

What does the term 'dorsolateral prefrontal cortex' refer to in the context of the script?

The dorsolateral prefrontal cortex is a region of the brain that is involved in various cognitive processes. In the script, it is mentioned as the area where the TMS treatment was applied, which is different from the ventromedial prefrontal cortex discussed in the context of PTSD treatment.

What is the significance of the ventromedial prefrontal cortex and its connections in treating PTSD with TMS?

The ventromedial prefrontal cortex and its connections are significant in treating PTSD with TMS because they are involved in the regulation of emotions and behaviors, which are often dysregulated in individuals with PTSD.

What was the question about the impact of stimulating the dominant versus the non-dominant hemisphere on psychiatric symptom change?

The question asked whether there was a difference in the effectiveness of TMS treatment for psychiatric symptoms when stimulating the dominant hemisphere (usually the left side for most people) versus the non-dominant hemisphere.

What is the role of ecological momentary assessments in capturing behavior related to mental health?

Ecological momentary assessments are used to capture real-time data on an individual's behavior and experiences in their natural environment. They can provide insights into mood, reward processing, and other aspects of mental health that may not be apparent through traditional clinical assessments.

What is the significance of natural language processing models in understanding mental health?

Natural language processing models can analyze the content and manner of speech to provide insights into an individual's mental state. This can be particularly useful in understanding mood and behavior patterns without the need for constant self-reporting.

What challenges are associated with the accessibility of mental health treatment, as discussed in the script?

The script discusses the long waiting times for mental health treatment, even in privileged areas, and the need for greater integration of digital therapeutics to improve accessibility. There is also a concern about leaving some individuals behind if the focus is too heavily on scalable solutions.

What is the potential of wearables and passive sensing in mental health treatment?

Wearables and passive sensing have the potential to provide continuous, real-time data on an individual's physiological and behavioral state without the need for frequent self-reporting. This can lead to more personalized and timely interventions in mental health treatment.

What is the importance of integrating physiological measures with mental health assessments?

Integrating physiological measures, such as cortisol levels or glucose metabolism, with mental health assessments can provide a more comprehensive understanding of an individual's mental state and the potential interactions between physical health and mental well-being.

Outlines

00:00

🤔 TMS Treatment for PTSD and Brain Stimulation Inquiry

The panel discussion begins with an informal introduction by Reed Kaplan, who explains the Q&A process. Dr. Phillip discusses the use of transcranial magnetic stimulation (TMS) for treating PTSD, focusing on the ventromedial prefrontal cortex and its connections. He clarifies that while TMS is typically applied to the dorsolateral prefrontal cortex, treating the ventral region has shown positive results for PTSD. The conversation delves into the impact of stimulating the dominant versus non-dominant hemisphere, with Dr. Andy Kol's work suggesting motor dominance does not strongly correlate with psychiatric symptom changes. It is noted that most effective symptomatology appears in the left frontal lobe, which is dominant in most individuals. The discussion also touches on the broader implications of TMS treatment and the need for further exploration of different stimulation spots.

05:02

🔍 Behavioral Measurements and Ecological Assessments

The discussion shifts to the incorporation of behavioral measurements in mental health studies, with a focus on the U engage study's use of Mindstrong's approach. Helen addresses the complexity of capturing behavior through ecological momentary assessments and the challenges of using wearables for data collection. She highlights the potential of natural language processing models to analyze speech patterns and behavior, emphasizing the importance of personal experience in mental health research. The conversation also touches on the annoyance of constant self-reporting and the need for more accurate and less intrusive measurement methods.

10:03

🚑 Accessibility and Precision Mental Health

The conversation explores the issue of accessibility in mental health treatment, particularly in privileged areas like the Bay Area, where long wait times for treatment are common. Dr. Caroline discusses the importance of advocacy, outreach, and digital therapeutics to increase accessibility. She also mentions the use of videos for education and the potential of wearables and passive sensing for assessment. Concerns are raised about the potential for digital therapeutics to widen the gap between those with access to such technologies and those without, highlighting the need for balanced approaches to treatment.

15:05

💡 Integration of Physiological Measures in Mental Health

The panelists discuss the integration of physiological measures into mental health assessments, comparing it to the routine use of such measures in conditions like diabetes. The potential for high-reach measures, like wearables and imaging facilities, to be linked with mental health conditions is explored. The conversation also touches on the cost and access issues related to these technologies, with a focus on how to make them more widely available and efficient. The importance of understanding the necessary and sufficient data for effective treatment is emphasized, along with the challenges of resource allocation.

20:05

🛑 The Importance of Timing and Education in Mental Health Treatment

The discussion delves into the importance of timing in mental health treatment, drawing parallels with the evolution of stroke treatment. The need for public education on recognizing mental health issues is highlighted, as well as the challenges of distinguishing between similar symptoms. The conversation also addresses the historical shifts in treatment approaches, such as the pendulum swing between drug therapy and psychotherapy, and the importance of personalized treatment. The potential of physiological systems, like glucose monitoring, to inform treatment is also discussed.

25:07

🔄 Scaling Precision Medicine in Mental Health

The panelists consider models for scaling precision medicine in mental health, using pharmacogenetics as an example. They discuss the potential for tools developed for mental health to benefit other fields and vice versa. The conversation highlights the importance of identifying the most effective treatments and the challenges of resource allocation to ensure that everyone has access to the basics. The need for awareness and education for both clinicians and patients is emphasized, along with the potential for technology to facilitate this process.

🔬 Application of Healthy Participant Research to Psychiatric Disorders

The final paragraph addresses the application of research findings from healthy participants to those with psychiatric disorders. Dr. CH explains that despite the study involving healthy individuals, some participants exhibited symptoms of psychiatric disorders and had experienced early life stress. This suggests that the findings could be relevant to clinical populations. Dr. CH also mentions plans to include subjects with more clinical symptoms in future research phases, indicating a commitment to expanding the applicability of the research.

Keywords

💡PTSD

PTSD stands for Post-Traumatic Stress Disorder, a mental health condition triggered by experiencing or witnessing a terrifying event. In the video, it is mentioned that TMS (Transcranial Magnetic Stimulation) is being explored as a treatment for PTSD, specifically targeting the ventromedial prefrontal cortex and amygdala, which are regions of the brain associated with emotional regulation and response to fear.

💡TMS

TMS, or Transcranial Magnetic Stimulation, is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. The script discusses its application in treating PTSD and the importance of targeting specific areas of the brain for effective treatment.

💡Ventromedial Prefrontal Cortex

The ventromedial prefrontal cortex is a region of the brain involved in decision-making, emotion, and social behavior. In the context of the video, it is identified as a target area for TMS treatment in PTSD, highlighting its role in emotional processing.

💡Amygdala

The amygdala is an almond-shaped part of the brain that plays a key role in processing emotions, particularly those of fear and aggression. The script refers to the amygdala as another target area for TMS treatment, emphasizing its importance in the treatment of PTSD.

💡Dominant Hemisphere

The dominant hemisphere in humans is typically the left side of the brain, which is associated with language processing and other functions in most people. The script discusses whether stimulating the dominant hemisphere versus the non-dominant hemisphere in TMS treatment affects the outcome of psychiatric symptoms.

💡Ecological Momentary Assessments

Ecological Momentary Assessments (EMA) are a method of collecting real-time data on participants' behaviors and experiences in their natural environments. The video mentions the potential of EMA in capturing behavioral measurements for mental health studies, which can provide a more nuanced understanding of patients' conditions.

💡Natural Language Processing

Natural Language Processing (NLP) is a field of artificial intelligence that focuses on the interaction between computers and human language. In the context of the video, NLP is discussed as a tool for analyzing the content and manner of speech to gain insights into an individual's mental state and behavior.

💡Wearables

Wearables refer to electronic devices that can be worn on the body to track various health metrics. The script discusses the use of wearables for passive sensing and data collection, which can provide insights into an individual's health and behavior without the need for active participation.

💡Precision Medicine

Precision medicine is an approach to patient care that tailors treatment to the individual's unique genetic makeup, environment, and lifestyle. The video discusses the challenges and opportunities of applying precision medicine to mental health, emphasizing the need for personalized treatment plans.

💡Accessibility

Accessibility in healthcare refers to the ease with which individuals can obtain the services and resources they need. The script highlights the issue of accessibility in mental health treatment, noting the long wait times for patients to receive care and the need for more efficient and scalable solutions.

💡Digital Therapeutics

Digital therapeutics are evidence-based therapeutic interventions delivered through high-quality software programs. The video discusses the potential of digital therapeutics to increase accessibility to mental health treatment and improve patient outcomes through scalable interventions.

Highlights

The discussion explores the use of TMS (Transcranial Magnetic Stimulation) for treating PTSD, focusing on the ventromedial prefrontal cortex and amygdala.

TMS is shown to be effective for PTSD treatment, even though the standard approach targets the dorsolateral prefrontal cortex.

The effectiveness of TMS on the dominant versus non-dominant hemisphere for psychiatric symptom change was examined, with motor dominance not correlating well with symptom change.

Behavioral measurements using Mindstrong's approach and ecological momentary assessments are considered for future research.

The challenge of incorporating more behavioral measurements due to their complexity and potential intrusiveness is discussed.

Natural language processing models are highlighted as a promising tool for capturing personal experiences and behaviors.

The importance of timing and synchronization between brain state and behavior in mental health treatment is questioned.

The potential of wearables and passive sensing in mental health monitoring and treatment is emphasized.

Concerns about accessibility and the digital divide in mental health treatment are raised, especially in privileged areas.

The integration of physiological systems with mental health assessments is advocated for a more comprehensive approach.

The role of education in improving the speed of diagnosis and treatment for mental health conditions is highlighted.

The potential of pharmacogenetics in tailoring treatments for individuals based on genetic markers is discussed.

The need for resource allocation to ensure that basic mental health services are available to all is emphasized.

The importance of creating awareness about the importance of timely and correct treatment in mental health is stressed.

The challenge of scaling effective treatments to reach a wider population while maintaining quality is addressed.

The potential of using healthy participants' data for understanding and treating psychiatric disorders is explored.

Plans to extend the study to include subjects with more clinical symptoms are mentioned for future research.

Transcripts

how this is going to work is it fairly

um informal so if you have a question we

have roving mics please just put up your

hand or stand up let us know um who on

the panel you'd like to ask it to and if

there are multiple people please let

us start

yeah the very

backk you uh Reed Kaplan here again uh

this is a question for Dr Phillip uh

correct me if I'm wrong but I think

earlier in your

presentation you intimated that the

treatment that you were trying for PTSD

with TMS was to the ventor medial

prefrontal cortex and the amydala and I

assume its connection bya the unson at

facular regions is that

correct so uh

um there we go so so the the TMS that I

was showing everybody in all of those

slides the transcranial magnetic

simulation actually was standard boring

dors lateral prefrontal cortex so the

biology right always involves the the

the the ventromedial prefrontal cortex

and its various connections um but uh it

is remarkable that uh you know treating

the dpsc seem to work quite well for

postra stress as well okay and follow up

to that regardless of the actual

connectivity did you examine whether it

made a difference if you stimulated the

dominant versus the non-dominant

hemisphere I I so I love the question um

and uh so I can't take credit for for

answering that but I'll I'll I'll direct

to some work that's been done by my

colleague uh Andy kol um who's actually

done a lot of work stimulating uh uh

ipsilateral and sort of bilateral sides

um and um I think that the simple answer

is that the motor dominance doesn't link

well with the um uh psychiatric symptom

change um but I think there's probably a

lot more in there dep depending on how

uh how folks may be wired even so most

effective symptomatology seems to

manifest predominantly in the left

frontal lobe which would be dominant in

most people correct uh so yeah and I

think and and we also have to remember

and and sort of the broader comment here

is that folks have largely stimulated

left doors latal proof hunel cortex

because that's where the field started

and they found a signal in so folks have

have done what they know works and I

think there's there there is uh not

nearly as much looking at um different

spots thank you um thanks

yeah oh oh Walter go

ahead what I

have lean I remember you had

incorporated into the U engage study

some behavioral measurements uh using

mindr Strong's uh approach and others um

I haven't seen that talked about very

much in today's presentations how we can

using ecological momentary assessments

and other ways of capturing behavior and

I'm just wondering is that something

that is uh uh the next layer on top of

this to be done soon or is it uh an

aspect of we don't have very accurate

measurements in that Arena so we're

dialing back just curious about the

thoughts of the panel for incorporating

more behavioral measurements it's a

great question I'm I might ask um Helen

to jump in on this one

yeah I think the um the concept is right

I think the level of complexity needed

is being worked on so I think you know

it goes way back to even CP thinking

about movement in bipolar and how

regularly irregular movement can emerge

and that those properties aren't linear

and how you can pick them up so I think

embedded in movement on a watch with

actigraphy or foraging and even novelty

um there have been some interesting

papers that I'm going to miscite that

have tried to look at reward processing

and foraging as as an indicator that you

can do a readout on Mood by the amount

that you move when you walk around in

your environment in a novel way so I

think that that but it's not a

straightforward metric as people have

shown even in cardiovascular disease the

other hand this thing of asking people

how they're doing all the time is really

annoying and I don't know if anybody has

actually done that and tried to do it

before you have someone else do it you

basically throw the device at a wall

after a couple of days and I think it is

sort of remarkable that people will do

those things but you I think as soon as

you ask someone the question you don't

get the answer you really want so the

notion though of what people's personal

experience is and how you capture it is

actually really important so I think the

emerging natural language processing

models that just even in the last year

have just blown up that going from it

cost you a fortune to transcribe an

interview to you can throw it into

whisper and get a perfect transcription

in any language pretty fast allows you

to build models on the nature of what

people say and how they say it which is

the fundamentals of behavior and I think

that naturalistic data capture in dense

ways is going to evolve but I think it's

the thing that that lean said so

brilliantly and that was really

inspiring to hear about your place by

the way but this idea that if the brain

leads how do

you simplify and how do these things tie

together but what's the right data and

the right density of collection to build

the model that you want that goes with

the brain State because they're not

collected when you do you know cranial

recordings you get slammed all the time

about time syncing and how can a Time

sync for a behavior match the brain

State I don't actually believe you

actually need that because these signals

are actually kind of slow and so I think

that the

wearables in all of its forms by how you

talk in your texts and how we deal with

the Privacy is another issue but the

signal is there and we just haven't

modeled quite

[Music]

right this is a sous question but how

about a psychiatric evaluation is a

requirement for prerequisite for running

for political office perhaps that would

save the world a

lot as employee of the US federal

government I am definitely not going to

touch that

question so maybe I could um ask a

question that is not on my list but I

was very intrigued Dr toy with the uh a

slide that Dr William show that Tau

about 5,200 cognitive tests and I wonder

could you expand on exactly what kinds

of test those were and where they were

sourced from that was kind of

impressive yes so

[Music]

sorry yeah sorry mine is oh no now it

works sorry just took a second sorry yes

so uh this is really uh one huge

Advantage at the center so for for many

many years uh Dr Williams and others

have been collecting a very large amount

of Behavioral data and the huge

Advantage like in the studies we we

showed before and also what Dr Williams

was saying is that uh the same

standardized the cognitive battery has

been used across all studies so not only

we have this data from a very large

amount of people and this involves for

example measures of memory you know

reaction times uh emotion

processing uh Cog executive function

various forms of cognitive uh measures

but also healthy Norms to which we can

then Norm this data and so Express

really at the level of the individual

how affect each cognitive domain is so

that's the the huge advantage of you

know being consistent and consistent in

data acquisition and then that enables

us to pull uh you know this state across

a very large number of people and we

think going forward that's going to be a

big asset uh as we uh focus more and

more also on the cognitive aspects of uh

the disorders we investigate for example

depression uh and that's going to be a

gold mine for that you know well that's

very uh helpful to hear and uh very

exciting there is not a standardized

approach to assessing cognition in

younger adults with a range of

psychiatric disorders we have a very uh

uh strong body of empirical data in

depression for example as people get

older but these uh ways more digital

ways of assessing cognition in real time

I think could be instrumental so it's

very exciting work that you're

[Music]

doing

yeah

Dr hello it's good to see Ruth and

and good to see you lean um I'm

wondering about um you know in the Bay

Area even beyond the Bay Area it takes a

very very very very very long time for

somebody to get into treatment to begin

with metol treatment so I'm wondering

how you kind of balance accessibility

you know we have slides filled with all

these measures and all this stuff we're

going to do and then we're going to find

it and then we're going to do this but

in reality you know I heard of statistic

that it could take up to a year up at

UCSF or somebody with depression to get

into the clinic down here it's not much

better so maybe just a little bit about

like Precision medicine Precision mental

health and accessibility and especially

like in a privileged place like this and

you know there's the rest of the

world I guess I I could start do you

want to jump in

Caroline

yes testing okay um Dr thank you so

much for this uh wonderful question and

um you know I think you know you for me

personally I think um that my you know

my research is just but one domain of

what's important and necessary for

mental health um and at least in OCD it

takes 14 to 17 years for somebody to be

identified so part part of um you know I

I feel like a mission is um advocacy and

and Outreach and help and and Stanford

has a wonderful resource of videos um

that that are for the community for

Education um that are free videos

available on YouTube and they're doing

them in English and different disorders

and also in Spanish translation to

increase um accessibility and access and

I'd love to take your question back to

you which is you're doing really

brilliant um work in digital

Therapeutics um both at the VA and

Beyond and just have done such an

amazing training for students and I

really feel like that that that is the

future in terms of um increasing

accessibility so I hope you don't mind I

would love to hear a little bit more

about you know what what you've heard

and what what you think could be ways to

to open this as well sure well well of

course I would uh uh advocate for more

digital Therapeutics I think the

assessment side of it and what we can do

with wearables and um passive sensing

it's really the the the New Frontier

where we can just get these data without

having to burden people with bothering

them six times a day with a prompt and

yeah throwing with our veterans

especially you know throwing things at

the wall would probably be that mourning

of the first time they get binged but I

do think that um having these scalable

um I I don't know if we want to call

them low intensity maybe High Reach I

think Keith humph calls them High Reach

interventions but um also just kind of

balancing that with we're going to be

putting these out there and are we going

to feel like okay well we've covered the

low and middle- inome countries with

these things and over here we still have

all this great stuff that's going on and

therefore we don't have to worry too

much about that that's my burden is that

we're gonna I mean my concern is that

we're going to leave a lot of folks

behind because we're going to feel like

we're we're doing the right thing um for

them when maybe they're not getting

exactly or the the type of treatment

that they would need you know to that

point Eric and I mean you've really

we're way ahead of the field in trying

to get some of these applications both

for tracking symptoms as well as for

treating um you know in in 2013 I had I

was 2009 to 2013 I served on the dsm5

and we were asked in the first uh sort

of sessions as they routine us up for

our work groups on uh what would you

wish for the DSM 5 to do that hasn't

been done and I raised my hand and said

I think greater integration with

physiological systems Leanne talked

about cortisol we also have glucose

monitoring which H I think is going to

revolutionize our understanding of the

relationship between blood sugar levels

and psychiatric symptoms obviously not

the case in all cases but really there's

an unprecedented opportunity here to

integrate at that time when I said

better assessment of physiological

systems beyond the mental health systems

I was told that was a pipe dream and

pipe down and now I have to say that

this is a vision that also can be

operationalized there's so many systems

for sleep for uh uh glucose metabolism

for um stress that we can measure in

real time with the kinds of applications

you've developed to actually get and see

if there are uh interactions there that

are may be very potent uh type 1

diabetes is one of the highest rates of

suicidality for example and yet who's

tracking that in real time particularly

in Rural and more distal populations

that may not have access to the care you

raise so I think it's a wonderful

opportunity at this point in

time maybe to

mention pausing to mention picking up on

that theme of

integration and I can Circle back to the

elephant onto the cpit about cost as

well which um I'm always asked about

understandably to me the what what Ruth

was just highlighting about

physiological measures being routine for

diabetes or other conditions that's an

opportunity to to harness what has been

done for mental health because obviously

it would be a huge shift to have Mental

Health Integrated as part of Health

fully but if it was we'd be able to make

use of all of the workflows and systems

that are already available for all other

conditions including the Imaging

facilities the

EGS and we' have the evidence base for

linking those to the wearables and

the what did you call it again the not

high touch but the high reach high reach

measures which I again go back to

Framingham that I think did a great job

of that because they've linked the

understanding of the organ of interest

to those High Reach

measures and I've been very heartened by

um conversations and collaborations with

other disciplines so I'm including

Radiology neuro Radiology I'm including

um all the the disciplines that use

EG and then those who are at the front

lines

clinically neur neur radiology's been

fascinating I've spoken at their

meetings and I learned to my surprise

that they're thinking that Psychiatry is

um already has the solutions and that

we're we're waiting on them so from NE

Radiology point of view at least from my

experience they're saying we're ready

like we're used to introducing new

assessments for what is the next and

complex condition we've done that for

all of the

conditions so yes scale is an issue but

that's that's what they do um and then

that idea of how do you link to the high

reach of course there's the cost and

access issue and I've really looked a

lot at that because the costs are very

different as to whether you're talking

about research or clinical use and which

country you're in um research-wise we

think of Imaging as expensive because it

is upfront expensive in terms of the

actual allocated cost in the clinic is

not that much different excluding

facilities fees between Imaging and EG

used in sleep and other areas act the

actual cost of the

assessment it's about then onethird of

the price in many other countries and

it's routine if you need to have a

evaluation for myig green you would be

referred for a a scan so I think if we

had the opportunity to have these tests

available the the cost and the would

come down and the workflows would be

there to make it efficient and of course

not everyone will get them but that's

been addressed in areas like mamography

where it's like if you don't have access

to the scanning facility how can we get

to you and how can we get to you with

maybe a a an an Outreach measure that

gives us a good proxy even if it may be

taking in in a

fotograph so I know that was a free

association but I'm sure Ellen wants to

show yes so um not to be buzzkill but

there is I think the issue of how

resource allocation will happen given

that we have the most you can do but

then to actually scale it to the people

who have the least and to how to get all

the data we need to know what part is

necessary and sufficient and then to

have resource allocation that can move

through the pipeline so that everybody

has access to the basics but that Basics

assumes that there is a basic which

implies that the biology has an

evolution over time that it isn't just

equally potential match people to the

treatment that they need because

everybody has a treatment and you just

kind of move through the system until

you get matched up but in fact how do we

create awareness if it's true that

actually getting the wrong treat

treatment isn't just wasting time but is

actually hurting you and I think that

you know in the evolution of stroke I

mean I remember when I was a resident

somebody would show up Hemi you know

hemic and couldn't speech and the family

would be there and you go how long has

this been and it'd be like three days

and when was it going to occur to you

that not being able to move the entire

side of your body or speak was like

actually bad and it became the education

of what is a stroke and then as the

treatment became there's window to treat

then things mobilize to do things in the

same way how did we teach people that

chest pain needed to be dealt with but

how do you parse the difference between

a heart attack and a bad burrito and

that they might feel the same but um not

but I think that the thing that we

didn't really talk about today was the

idea

about you know again England went

through a period remember we I mean it

was about 20 years ago that no drugs are

you know everybody got drugs as a first

line and then nobody got therapy and

then they did 180 and said everybody

should get therapy we should teach

everybody how to do CBT then nobody got

drug and we're back to the thing as

though it's one is better than the other

rather than you need to be getting what

you need and then it gets into are there

stages of these illnesses where actually

the timing matters because if timing

matters maybe if you identified some

with mood symptoms that the stress was

creating a pro-inflammatory or pro-

insulin sensitivity state that actually

the glucose would tell you that you had

the problem or vice versa and how do we

build these platforms so that we catch

the kind of the

diaspora faster with the least

expenditure because I me I mean what I

did at 1:00 was I had to be on a call

for the National Academy of Science on

DBS and why hasn't

DBS um not for what I do but even in

Parkinson's you talk to people you have

readouts you have these devices built

nobody has time and nobody's learned how

to do it and the education is bad so you

build the device you build the stuff you

have experts that know how to do imaging

or physiology you have no way to

translate it so that regular docs can do

it so I I think the thing is how do we

take what you do which I certainly want

to know more about and actually how do

we triangulate so that things that are

done in many things meet the things that

are done in a few because you'll never

get neur Radiology to be able to do what

we heard today about these analytics

because they just won't be Personnel

when you're reading 500 scans a day to

invest that time unless you can build

the algorithm so how do we bypass it so

that the most people get Basics and then

you you move up the pyramid so that very

few people need what I do or that I kind

of reverse engineer to find the people

earlier on not use resources and and get

them back to functionality yeah so it

definitely sounds like that that

efficiency that could potentially come

out of this would open up resources for

a whole um you know group of other

people that wouldn't have those

resources available so thank you and

sometimes times and to Helen's point

that um is that point of the scaling is

not actually where you might think it

would reside so a very good example we

have an investigator Terry kleene who

resides in our department of

bioinformatics and data sciences and she

got a center several years ago to

actually uh collate and curate all the

data and you can imagine how much it is

on a pharmaco genetics and uh treatment

response and eventually you know out of

all the thousands and hundred thousands

of data points we're now at a point

where there are several fairly standard

medications that have profound negative

adverse effects in certain individuals

and they actually created really a list

of that and so the question became

exactly as you ask how do we get this

out to the community to the clinician

what is the clinician going to do order

genetic test or a boutique test what

they actually did and it started they

went to some of the hospitals and not to

the clinicians but to the pharmacists so

the hospitals and one of them in

Cincinnati has actually taken that

information just a very small set of

genetic markers that have profound

adverse effects with certain medication

interactions that save thousands in

terms of the time in hospital the

mortality rates and of course what's

happening now in this educational piece

is that they're telling others how to do

this because the cost savings for the

hospital is so dramatic and I think what

we have to do to the 's point is look at

some of these other models and see where

we could take a model like that are

there some aspects of what we bring to

the table in our tools that could

benefit pharmaco uh genetics being one

of them uh and help with an increased

Precision medicine approach applying to

mental health but there are examples of

other scaling just not yet in our

domain you like this discussion continue

maybe we could continue it over the

poster session you are very generous and

keeping on time everyone today and i' I

am not on time right now so I don't want

to hold you back from the poster Session

One Last Question of Dr that's exactly

what I was going to suggest so we're

going to wrap up with one question and

then we'll head to the poster session so

this is one for you Dr

CH given your results are from healthy

people how would you like for them to be

used for people with psychiatric

disorders that's a great question um so

I want to answer it in two ways but keep

it short because I know people are

excited about the poster session despite

our findings from a healthy participants

group actually they show certain level

of PDs D symptoms and some of them even

reach the level of moderate pdsd

symptoms and they also suffer from early

life stress um so from that point of

view we believe our finance could be

translated into the clinical population

uh the second point is we're actually in

the plan of trying to collect subjects

with more clinical symptoms in the phase

two um data collection of our sample so

please keep uh stay tuned we will have

more results maybe next year for the

next

Symposium thank you to all of our

speakers I'm I'm absolutely honored that

you all joined us today and presented it

was a brilliant program I'm sure you'll

all

agree