David Putrino, is a physical therapist, a PhD in neuroscience, and he studied computational neuroscience at Harvard Medical School, MIT, and NYU. David is a guy who loves to take on and find solutions to the most challenging and complex problems by bridging the gap between professional athlete care and stroke patients and general medical care.He also works with the guys at the Not Impossible Labs and is seen working with many leaders in sports performance, including frequent collaboration with the high performance division at Red Bull. David's research has been featured in multiple media outlets, including the ABC, Sports Illustrated, The Wall Street Journal, BBC, Time, Wired, and The LA Times. David has spoken on the TEDx stage and most recently was awarded the Global Australian Of the Year.
In this episode David tells a series of stories and innovations that have lead to some incredible technology created to solve complex medical problems. We learn how David and his team at Putrino Lab are able to leverage a “yes” attitude and curiosity to drive innovation and explore the Not Impossible.
In this episode we cover:
Selected links and books from the episode:
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Gary Bertwistle: Our guest this week is David Putrino, a physical therapist. He's got a PhD in neuroscience, and he studied computational neuroscience at Harvard Medical School, MIT, and NYU. David is a guy who loves to take on and find solutions to the most challenging and complex problems in wellness and health. He's often called to collaborate at the high performance division at Red Bull. He also works with the guys at the Not Impossible Labs and is also seen working with many leaders in sports performance. David's research has been featured in multiple media outlets, including the ABC, Sports Illustrated, The Wall Street Journal, BBC, Time, Wired, and The LA Times. So with all that, David, welcome to the Inspiring Lives Podcast.
David Putrino: Well, it's great to be here. Thank you for having me.
Gary Bertwistle: You do interesting work. How do you like to describe to somebody what you do?
David Putrino: I do stand a fairly broad range in what I do. My most boilerplate, simple explanation of what I do is, I run an experimental research lab that tries to use technology to make people better. Now as to what the word better means, that can be recovering from a stroke or a traumatic brain injury or a spinal cord injury or it could be you're an Olympian and you want to win gold at the next Olympic games, but either way, we're using the latest technology, the latest thought leadership and the latest research to achieve that.
Gary Bertwistle: Do you personally and the people who work in the labs around you, is there a stated mission that you have that you will work towards, David?
David Putrino: Absolutely. Our major mission is to establish best clinical or performance practice with the latest leading edge technologies. So, when we initially started out, it was all about, we were getting really frustrated because we were seeing all of this amazing new technology and it had the potential to change lives, but no one was adopting it just because it seemed too difficult. It was like, you've got a physical therapist or a rehab doctor or a sports medicine doctor and they're very set in their ways, and they were like, "Oh well, I've got all the patients that I need or I've got all the clients that I need. Why would I want to uplevel my technology or change the way that I'm doing things?" Even though we knew that there was a higher standard that we could hold people to and its lack of tech adoption was getting really frustrating to me, especially since we were seeing how much money was being invested in it without any adoption going on.
David Putrino: So, to give you some rough numbers in the health technology space, we know that Americans, the American market in venture capital will invest around $90 billion per year in health technology. But most health technology companies in the United States, sorry, the vast majority, 98% of health technology companies in the United States fail before they touch a patient. So to me that was just like an incredible loss of opportunity and capital and good ideas just because people weren't really all that willing to change the way that they treated patients and it was to the patient's detriment. So our mission is always to get the latest and greatest technology into the hands of patients and clients as quickly as possible so that they can be the best version of themselves.
Gary Bertwistle: You just mentioned the word difficult with the work you do in your own soul and those around you. Do you think you, as a leader, as an individual, do you think difficulties that does it almost in some way turn you on?
David Putrino: Oh, 100% yeah. I mean if I wanted easy, I would've just stuck around in Australia running a physio practice and seeing the same old clients day in, day out because that is easy. You know, that's a nice cruisy existence with a good work life balance and you don't really need... Then I could have just been one of the clinicians saying, "Hey guys, I don't really want to change what I'm doing. I just want to keep seeing my patients, charging them a couple of hundred bucks a session and go home and be with my family". Definitely this was a tougher problem to solve and it's all about trying to, really trying to influence the field, try and move the needle in a significant way. Because I saw a lot of lost potential in a lot of our patients and it wasn't going to get any better if we just kept doing things the same way. So it is a hard problem. I like hard problems. I've always chasing hard problems. So definitely I think that that sort of thing gets me going and gets me up in the morning.
Gary Bertwistle: I sit, and I suspect and I think I'm being pretty accurate with this, that you're going to face a lot of roadblocks and what you and your team do is essentially, in fact, in some ways, you almost have to chase failure. You have to embrace failure. How do you frame failure in your own mind for yourself and as a leader so that people don't lose heart with the view there's something better at the end of that road?
David Putrino: Yeah, I think that a resilience to failure is a really important part of what I do. It constantly what we're doing, anytime you try to do something new, you're going to face roadblocks. You're going to face entrenched viewpoints. You're going to face people who have made a real big name for themselves, following the status quo and have gained a lot of profit from following the status quo. And so therefore they resist you because they've kind of lost the mission along the way that... Our mission is always to serve our patients and to make our patients better and my firm belief is that so long as we never lose that mission, so long as we keep asking ourselves and being really self-effacing.
Is everything we're doing right now to serve our patients and not to keep the lab open or to make a buck, but we're just really doing what we set out to do to make people better. We're always going to be facing roadblocks. We're always going to be facing people that we're doing it, telling us that we're doing the wrong thing or, that we're crazy or that we're barking up the wrong tree. But for me, and what I always try to teach everyone that's working in my lab is to not be afraid of failure and not be afraid of failing. I think it was Edison that said something like, I didn't fail, I just worked out 99 solutions that didn't work.
And that's the sort of thing that we keep in mind. It's like every single time an experiment doesn't work out or a technology doesn't go like we planned, we get excited because we've learned something new and we learned the new aspects of the project and we always design our experiments, we always design our clinical trials in such a way that even if the worst happens and if everything absolutely does not work, we still learn something that can push the body of knowledge forward.
And that's something we try to instill in the companies that we work with. Often we hear them say, "Oh, we don't want to publish", or "we don't want to tell the world" if the experiment doesn't work. And what I try to say to them is, well, definitely still publish, it doesn't need to be linked to your product. You can still publish on the fact that this didn't work, just not in relation to your product because at this point your product has evolved because you've learned what didn't work and you're moving onto what did work. And in the meantime you've raised the bar of knowledge around everything that you're doing.
Gary Bertwistle: David, is there a process, system, standard operating procedure that you run as a leader to keep your people inspired because you're in a business which is all about exploration. And exploration is surrounded by what did not work, although saying it won't work. Is there something you have as a mandatory non-negotiable you do with your team to keep them on task and keep them with that inspiration to push through those roadblocks?
David Putrino: Absolutely. And I would say that the main thing that we do is insist on patient/client contact with everybody. Everybody from our interns all the way through to the most senior staff or the most tightly focused administrative staff. You know, we've got people in the lab who work entirely on just the paperwork process and getting ethical approval for what we need to do and things like that. Everyone has to interact with our patients and our clients. Everyone has to sit around at happy hour and meet our patients and our clients and have conversations because although not everything works. We have a lot of failure and whenever we run a clinical trial or a technology trial, some people respond and some people will say that this is life-changing for them and some people will say that, "Oh my God, I can't imagine what I would have done if this just didn't work out".
And that's all the inspiration that most people need because everyone who comes into my lab knows that they're signing up for a nontraditional science experience. It's finding out for something that's a little bit different, maybe a little bit risky and what I believe keeps them hooked and keeps them coming. I am really fortunate, especially with the team that I have now that I need to tell people to go home. I don't need to be looking at my watch worrying that they're not coming in early enough or they're not staying late. I'm the person who's saying, "guys, you've worked hard enough today. Go home, go home and get some rest". And I think that most of that is because everyone has a really solid sense of mission and purpose and mainly it's because they get to always see the people that they're helping.
Gary Bertwistle: I think it's a really good point and that can be used, I think, I'm just trying to, as you talk about that, I'm thinking about any industry where you, if you had the right mission and the mission had meaning, then having everybody in the company have access and have to spend time with a customer or client or a patient, I think that's really quite powerful. When you're assembling your team, David, take out the technical skills required. What are the characteristics of somebody you're looking for? So when someone sits in front of you, you're going to employ them, be part of your team in this exploration team, what are the absolute core characteristics you need for someone who can front up to what's in front of them?
David Putrino: Yeah, really good. Really good question. The first thing that I'm always looking for is someone who has a level of sort of enthusiasm/naiveté, where they're actually going to, that they say yes to things. You know there are yes people and there are no people. There are people that if I ask, "Hey, do you think we can try this out?", there's a whole group of people that will say, "no, that's not practical" or "no, that's too hard" or whatever, and then there's a bunch of people say "yeah, we'll give it a shot. Don't know how it's going to play out or pan out, but we'll give it a shot".
The first and foremost thing that I'm always looking for is I want that yes personality because although that doesn't always work in every business and every department, we're all about innovation and for innovation, you need someone who isn't going to immediately dismiss an idea out of hand. They're constantly going to be thinking creatively, how can we make this work? How can we think about that? So that is always the number one thing that I'm looking for. Then of course I need someone who's passionate in the right way, but ostensibly on paper in terms of bureaucracy and admin. They're joining a science lab, so they need to have certain qualifications. But I need people who understand that they're joining a science lab where they're not going to be following a typical science career trajectory. So when I'm working with postdoctoral research fellows, if I say to them, "where do you want to be in five years?"
And they say, "well, I want to have this many publications and I want to be applying for this grant and that grant", I'm not interested in them because like I said earlier, we're mission driven. We're not focused on what's the next incremental scientific discovery step that we can make. We're interested in five years time, how many patients will I have helped, how many clients will have helped, who will I be working with trying to make them better and what project is going to be my main passion. And so I need to see that level of passion about projects, about ideas, about areas of medicine or human performance science. I don't want to see, well, I'm really interested in this incremental scientific question. And again, not to say that that is a negative, I work with a lot of brilliant basic scientists that I deeply value what they do. It's just not what we do. And so when I'm hiring people, I need to make sure that they're not bringing the traditional scientific mindset to the job because it just won't merge well.
Gary Bertwistle: You know what's really interesting, I was going to ask you, how do you go about convincing somebody that something is possible when they and potentially many others believe it's impossible? But what's, what's really curious about what you just said is that if you employ the right people, you don't have to. So what you're really saying is if I find that person as a yes person, and to your point you said, I'll give it a crack, then you actually don't have to convince them. You just have to, I suspect, put forward the proposition, the potential outcomes and the mission and then leave them to it. So the selection is really important for you, isn't it?
David Putrino: Selection is everything. And in terms of convincing someone to do the impossible, the other thing that I find really, really helpful is presentation of the problem in the appropriate way. So we've done a lot of projects over the years that people said, this is an impossible problem or this is a problem that can't be solved and then we went on and solved it and invariably every single time I can tell you that's the way that we solved the problem, was presenting it as helping one person. So telling people a patient story and saying, we need to find a solution for this person. Forget about the field, forget about what's been done before. Forget about everything else. We're here to find a solution for this one person.
David Putrino: And when you convince a team of innovators and yes people of that age and you get them passionate about the problem, nothing is going to stop them. And they may not make the most elegant solution and they may not make a scalable solution, but they will solve the problem. You know, in terms of how I convince people to do the impossible, that's how I do it. It's like, you know, the patient who has the problem, get to it.
Gary Bertwistle: Let me know how you go.
David Putrino: Well, we've had a pretty good track record up until now.
Gary Bertwistle: And we're going to talk about that in a second. I'm going to take a little off ramp here just for a moment, because I think there's an interesting learning in your very early days as a child that led you to where David is today. But I heard you say that as a kid you were really clumsy and very injury prone, so you spent a lot of time in hospitals and that had an influence on your career choice. Just take us back to that moment because this is ... I find this fascinating for any person who was fortunate enough to be a parent or plan to be a parent. Is that how the trajectory of a child simply by observation can help to being in a place today where you can be quite honestly changing the world. Take us back to that clumsy injury prone kid being in hospital.
David Putrino: Yeah, I mean hospital work is pretty much in my DNA. As you rightly pointed out, I was just constantly in and out of hospitals when I was growing up. It all started when I was about 18 months old. I had a seizure that ended in respiratory arrest, which meant I stopped breathing. I stopped breathing for about six minutes before I was resuscitated, and it resulted in a paralysis on the left side of my body. The doctors in that particular hospital in Perth, Western Australia, 1984 probably wasn't the pinnacle of rehab. Nothing against Perth now.
Back then it was a different place. And my parents who happened to be two Italian immigrants who had never even completed high school let alone had a university education or anything like that. They looked at my doctors in the eyes, said, "You guys don't know what you're talking about, he's going to walk again and he's going to do everything again." Sat me down, and with some pretty straightforward logic to get well, if his left side isn't working, we're just going to put things on his left side and stop him from using his right side to do everything and just work on that until something comes back.
Pretty simplistic logic and a pretty basic idea. But these days in the clinical world, we would call that constraint induced movement therapy. And it's the leading way of treating cerebral palsy in young kids today. And you'd probably pay a lot of a lot of money for it in a fancy US clinic.
Very, very fortunately all my movements returned all of my function returned. I can walk around and move my hands and use everything with no deficits. And one of the things that did happen as I was growing up as a younger kid, I still didn't have a lot of residual sort of clumsiness and loss of ... sometimes I just fall over for no good reason, loss of muscle control, things like that. And it resulted in a lot of stitches. I was also a bit of a dick as a kid, I was always climbing on different things and getting into stuff.
So it was a combination of falling from great heights a lot of the time or running around and doing more than my motor system could handle.
And over time I started to get a sense of how a hospital was run, and it did really lead me to one of my first career choices because I was finishing up high school and we were getting to this point of, what do you do? Do you want to go into medical school and become a doctor or do you want to do something different? And so I was staring down the barrel of, I knew I wanted to work in healthcare, but I didn't know where I wanted to work.
Then I had another hospitalization for a broken leg and I started to really get a sense of who the change agents were in my opinion. So I had this doctor that would walk in and out of my room, make a few cold clinical observations to a room full of residents, and then sort of slip out majestically without asking me questions without getting to know me, without forming a bond with me. And then I had a physio who worked with me, day and night, knew everything about me.
And in my particular case, because it was a bad break, she even happened to get emotional when I started walking again because it'd been so long on crutches that she was just like, "Jesus the kid is going to walk again."
And I saw all of this and internalized, and I was like, that's the sort of clinical medicine I want to be a part of. That's what it's all about me, not this sort of a high level directing of services and not forming relationships with patients. So that was really the decision point that led me down the course of physio.
Gary Bertwistle: That is fascinating. And then as a physio you described a lady you met, you said she was a sassy lady, and she had an issue with her left hand. And then that was kind of the next career trajectory point when you worked with that lady. Just tell us about that.
David Putrino: Yes. I was working a little over and in lots of different areas and PT, and I was very drawn to neuro PT because of my background a little bit. And also just because I've always found the brain and neuroscience really fascinating. But one of my biggest issues with neuro PT was that, we always are changing our opinion on why it works and what works and what doesn't and it seems very, very old myth what we're doing. And I really wasn't okay with that, I wanted to do better.
And I think it all came to the head with me when one of my patients at another hospital in Western Australia, she had had a stroke. She was very determined to get better. She used to play the piano and she had complete paralysis of one of her hands and her doctors and her physios ... I was a junior physio at the time, because senior physio had told her that she just couldn't expect recovery.
She was to find out the track of the recovery that if movement in the hand hasn't come back yet, it wasn't going to come back. And they told her that was so much certainty and I was like, "God, how can you be so certain about this? I feel like I'm pretty smart and I know a lot about the neuroscience and I'm not certain of anything."
And then the other thing that really bothered me was that they were so certain that nothing was coming back, but because she had what we call flaccid paralysis. Because she had so much paralysis that she couldn't even move her hand, they weren't exercising it because she couldn't move it. And I was like, well how ... and additionally, not only how could you be so certain about things, but my follow up question is, how on earth would you expect to hand to get better when you're not working on it, you're not even trying to exercise it to make it better and stronger.
And so with those sorts of ideas in mind, I just spent some time with her and I said, "Hey, I know you can't move your hands, but what I want you to do is imagine moving it. And since you still love playing the piano, I just want you to ... I play the piano as well. I want you to sit and imagine playing the piano, get it in your mind, visualize it and start playing the piano." And on top of that, she didn't like the way her hand looked after the stroke, so she wore a glove. I said, "Take the glove off, look at your hands, touch your hand, play ... like I want you to attend to it. I want you to really fall back in love with this hand. I want you to get a relationship back with it."
And over the course of about a week and a half of doing that, she started getting movement back into her fingers. She started to move the hand more and more. And then by the time we were just charging her, she was using her hand functionally to do a lot of stuff that she had been told that categorically she would not be able to do. And she was incredibly grateful. And for me, that was a real decision point of, wow, we don't know what we're doing, and I'd better go off and do a PhD and try and understand how we can help more people.
And of course when you're in crisis you always think you need to do a PhD. Because PhD solves everything but-
Gary Bertwistle: I've always thought that. Yeah, I've always thought that.
And if we fast forward David to today, let's just talk we might get too deep in the science of it, but just go into the work you're doing. Tell me about this technology that you guys have worked on called Feeling the Music and the impact that is having on people who are dealing with Parkinson's.
David Putrino: Yeah, so the music projects that we worked on, we started working on about three years ago now. It was all meant to be for deaf individuals. It was all meant to be for deaf individuals who wanted to experience music, have a live music experience, but of course they can't hear. And what I learned through the course of trying to solve this problem was that most deaf people they'll do things like they'll pass a balloon around, or they will like get right up close to the speakers and just feel the vibration of what's going on. And they can get some sort of an experience that way. But it can get pretty muddy and doesn't have a lot of fidelity all the time and it's just not that great of an experience.
And so what we did was we just started playing around with technology that could maybe help people have a better experience. So our initial prototype was ... it was a disaster, but it was a fun disaster. We were using like the lowest cost vibrating motors that money can buy, which turns out to be getting on Amazon and buying pages now defunct technology of a little pager which happens to vibrate when you page someone. You can buy them on Amazon for about one cent per piece.
And we would buy a pager, dig out the vibrating motor and then plug it into our Frankenstein vest that we made and program it to vibrate when a certain frequency or something like that. And so we started messing around with that and we got to a point of perfect principle that yes, we could tell when a particular song was playing based on the vibration profile and we started getting more and more attention for the work that we were doing, and people started helping us build better and better versions.
And we got to a point where now like some really awesome people have worked without technology. We've had like Lady Gaga try out the vest. We've had [Ferrile] try out the vest, we had a bunch of different people really experience it and not just to experience music but to make music with it. And that was great and I was really happy that that has happened and move forward.
But, and a really interesting thing happened, which was ... A friend of mine reached out to me and, and this was ... it was after we had our first live music demo of the technology. So we're all kind of on a high, we just played like an audience of about 300 people and they're all wearing the vest and a whole bunch of deaf people had the time of their lives with this live music experience.
And a really close friend of mine reached out and she said, "Hey my dad, his Parkinson's is getting worse." And she goes, "I read this article about maybe vibration can help people with Parkinson's disease." She goes, "Do you not happen to know anyone at all who's like building a wearable or something that vibrates some command?" And I just burst out laughing over the phone. I was like, I can't believe you're calling me right now because what the last three months of my life has been about. So I showed up, her dad at the time, he lived in the city and I knew where he lived at, visited him a bunch of times and I just showed up to his house and we put this stuff on his wrist. And we turned on the devices and he had this really prominent tremor.
And as soon as we turned on the devices, it just stopped, feels like you're flicking on a light switch. His tremor just stopped and he started playing the piano again. And he got real emotional. We got real emotional and we've since run a clinical trial on this technology and showed that in a large population of people with Parkinson's disease, we can create a 30% reduction in tremor by applying this technology. And we're now working with a bunch of different organizations to run lots of trials, work with the FDA to get this technology approved for sale to people with Parkinson's disease and really just sort of get it out into the community.
Gary Bertwistle: There is an amazing technology you guys are working on. I think it's called Think Click. Tell us about where that's at.
David Putrino: Oh, so that's an Aussie company actually. I feel very privileged to work on that. So the company is actually called Synchron and the idea behind the technology is as you said, a basically a thought controlled click at the moment. So doctor Tom Oxley is actually the founder and the CEO of Synchron, brilliant neurosurgeon working at working in the US, he's actually at Mount Sinai. I met him about seven years ago. Again, complete random coincidence.
I was working in a lab at NYU and we got a DARPA grant, which is for those of you who don't know DARPA, it's like this branch of the military in the US that focuses on really cool, next level futuristic technology. We had received a grant and he had received a grant and that was when I first met him. And when you get a DARPA grant, it's a little bit of street cred because DARPA only gives money to really bad ass project.
So if you're getting a DARPA grant, you're doing something cool. And what immediately struck me about Tom is out of everyone who got a DARPA grant, Tom was doing the craziest shit. Everyone was like, yeah, we're all doing something pretty crazy. But he was the guy in the group that we were like, this is definitely going to fail because this is ridiculous. And his technology is you take an endovascular stent, which is a widely used piece of neurosurgical equipment that if someone is having a stroke or is having some other blood vessel problems, the stent can be used to open up someone's blood vessel and keep it held open so that blood can still pass through it. Even in the presence of the pathology that wants to close the blood vessel down.
And what Tom had done, which was brilliant, was he had created a stent that has electrodes on it so you can put it into an area of the brain ... you can get it into an area of the brain with very little level of invasive procedure. It's a procedure that every knows how to do a thousand times over. And from there it just seals itself into the blood vessel and records brain activity. So it's this very clever way to get into the brain.
And what Tom has shown in his research is that his technology allows ... you can get meaningful signal from his technology. So we're hoping that it will allow people who are completely locked in with conditions like motor neuron disease, which is known as ALS here in the United States or a high, high level spinal cord injury or brain STEM stroke. It will allow them to start to control a computer with thought alone.
So the idea is that they can use eye tracking technology to point at what they want and then they can use a thought controlled click command. So they think click and the technology will click for them. Tom has implanted his first study participant actually in Australia.
Study participant, actually in Australia and the technology is doing really well. The gentleman that they've implanted is healthy and happy and, and doing real well. And that's been a massive turning point for the technology. And in 2020 we're looking to recruit our first U.S. patient so long as the FDA gives us the blessing and lets us start the work. But we're really excited to move that forward.
Gary Bertwistle: Incredible technology. And I've heard you talk about David, that the risk of brain injury or brain problems increases as we get older. So with our aging population, are we about to see some serious increases in brain injury or brain problems in the near future?
David Putrino: Without sounding like too much of a panic monger, I would say yes. I mean, the way that I think about it is just a straight numbers problem. So I don't know why scientists do this, but 2050 seems to be, you know, the date that everyone's pessimistic about. You talk to a climate scientist and they'll tell you by 2050 we're all going to be underwater and in a heatwave. And when you talk to a health economist, they tell us that in 2050 the number of people who are living over the age of 65 will be tripled. So we're looking at a lot more older adults in all countries. And so if you think about it from just a straight numbers point of view, then what that tells us is that we're also going to see triple the number of strokes.
: We're going to see triple the number of traumatic brain injuries that occur in older adults more commonly than anyone else as a result of falls. And we're going to see triple the number of things like Parkinson's disease, which is age-related and Alzheimer's disease and so on and so forth. And these are conditions that cause a lot of longterm disability, longterm functional loss and therefore enormous costs and enormous emotional burden to people who are caring for older adults. I think we all know somebody who has a loved one or a parent or a grandparent with Alzheimer's or stroke or a brain injury. And one of the things that we always hear about is, you know, no one ever plans for it. No one ever thinks it's going to happen to them. And then all of a sudden you just got to kind of deal with it.
And it's incredibly burdensome to everyone involved. You find yourself becoming all about delivering care to your loved one, which is of course what we want to be able to do for our loved ones. If anything happens to your parents, you want to be able to be there and provide everything that they need because that's what they did for us. But that takes a big toll. And so one of the things we think about a lot is that this is coming and we need to be prepared for it because as the aging population multiplies the way that it is, the younger population is not multiplying at the same rate. So what we need, what we're going to have is a lot of people who need the same standard of care or better with less people to provide that care.
Gary Bertwistle: I want to put a few threads together here. You talked about working sport, you talked about rehabilitation. Can you tell us about a lady you met you got to work with called Rebecca Rush, who has a reputation of being the Queen of Pain. When you met Rebecca Rush and you were working with the guys at Red Bull, you said you took some learnings for Rebecca and how she's approaches sports that you've now applied to rehabilitation. What was your key learning from that, David?
David Putrino: Oh my God. I mean, I learned a lot from her every day because she's one of the most resilient human beings I've ever worked with. But the first thing, you know, when I first started working in high performance sports, the thing that was, the thing that really struck me was that when I deal with a stroke survivor and I look at ... when I look at the standard level of care across the world that we give to people who have had a stroke, they've had a brain injury, they need to relearn movement. And so we sit with them, we get a physio to sit with them or an OT and we say, okay, we want to get your hand working again. So I want you to perform a hundred repetitions of it, of the hand movement. And I want you to just do it over and over again. And yeah, it's not going to be exciting, but this is what you've got to do to get better. So you better do it. And then more often than not in a standard care model, the physio will, or the OT will then say, all right, you're going good, good, good, good movement, good movement. I'm going to go off and work with another patient because I don't want to watch you do a hundred repetitions of this, that's boring.
: But you just keep at it , no pain, no gain, et cetera, et cetera. That's my motivational speech for you today. See you later. Off they go. Now then when I started working with performance athletes and I saw the team that they had around them, they had nutritionists, they had strength and conditioning coaches. They had physios, they had doctors, they had sports psychologists, they had everyone individualizing every single thing to their needs. They had everybody making sure that everything they did, they did with so much enjoyment and so much engagement and so much passion for what they were doing.
My big came from, I was seeing these people working so hard. They worked six days a week. They work six hours a day and every moment they're enjoying what they're doing and they're surrounded by a team of people that are chanting, you can do it, you know, and they were only incrementally improving. They're athletes. It's not like with all of that training, they improved by leaps and bounds every single day. They were getting these small modest improvements over time as they went through this grueling process. I had this real solid self effacing moment where I was like, I actually can't believe that our stroke survivors improve at all with the crappy level of care that we're giving them. Because if you think about exercise therapy as a dose, the dose we're giving them doesn't even remotely approach what appears to be appropriate to drive change.
And it became really clear to me that if we want people to recover from traumatic brain injuries, their spinal cord injuries, we need to be getting them dramatically, radically higher dose of therapy. And we need to come up with clever technological hacks that allow us to do that. Because obviously, although I wish it were different, every stroke survivor is not an athlete that's winning world championships and so they don't have that budget behind them. So we had to fight, we had to be creative, we had to use clever technologies to deliver the same dosage of tech.
Gary Bertwistle: You're now using VR, virtual reality, in treating pain. How's that working? Is it starting to see some success?
David Putrino: Yeah, we've been seeing some really great success in that clinical trial. We initially started with a pilot where we just wanted to see if there was anything worthwhile in working with VR technology. And Then we saw a little bit of signal, you know, like we put the VR headset on a couple of people with spinal cord injury who had chronic neuropathic pain and we started seeing ... They were telling us that their pain was better. So we started recruiting more and more people into the study. And what we're seeing across the board right now at this moment, and you know the jury is still out so we're still studying a lot of things that range from is there an effect all the way through to are there certain psychological properties that people who respond versus people who don't respond, all the way through to what sort of content is best for creating a pain relieving effect. But across the board we're seeing some really great improvements and it seems like as little as 15 to 20 minutes of exposure to virtual reality videos can result in around a 30% reduction in pain.
Gary Bertwistle: Just to wrap this up, I find the stuff you're doing absolutely fascinating and it's been said that to have creative outputs, you need creative inputs. Now I saw a show, a documentary on Netflix called Inside Bill's Brain, which is about Bill Gates and basically his standard operating procedures. And he is an insane reader. He carries this beach bag full of books. It's an incredible documentary to watch and he, one of his non-negotiables is reading and he just reads, reads, reads. As someone who is taking what is seen to be not possible to make it possible or taking on, as you said at the start of the show, chasing the hard things, the difficult things to find possibilities. You can't do things the same way other people do them. So you need creative inputs. Bill Gates reads very widely, as does Mark Zuckerberg, as did Steve Jobs. A lot of the great creators read widely. Elon Musk. Are you that guy? Do you read a lot and if you do, how do you curate your learnings in order to be able to go and then use them?
David Putrino: I don't read as much as I would like to, but I would say I still, I probably aim to get myself through one book a month kind of thing and then I consume a lot of content in terms of like podcasts and things like that just because for my lifestyle it's just more convenient. But I try to, in terms of reading, I try to put myself to sleep reading every night. And yeah, my reading list is very broad and very wide. I mean for the most part in terms of the way I curate it, it's people I trust telling me that I need to read a book that is really, really good. And yeah, my reading list is kind of ridiculous. I read neurophysiology textbooks sometimes that have just come out and people tell me are excellent and put a new spin on on neuro rehab that I should know about. And neurobiology textbooks like Behave by Robert Sapolsky was a massive reading mission for me because it was like 800 pages. But it was also one of the most incredible books I've read for a while.
Stuff that my performance coaches are reading and telling me about like the Culture Code by Dan Coyle. Incredible. All the way through to, you know, a book I just finished that I really enjoyed that really gave me a new sort of a spin on the way I think about a lot of stuff is ... oh my god, the name of the book, but it was Jonathan Van Ness' book. One of the Queer Eye guys, or the new Queer Eye on Netflix. And he wrote a book about his experience and his experience from going from, you know, this sort of closeted young guy living in the middle of nowhere in sort of rural America to being on the Queer Eye show and it's confronting, but it also gives you like an amazing point of view that ordinarily I wouldn't get to see. So yes, I think good ideas come from diversity of opinion. I think that good ideas come from being willing to expose yourself to ideas that will make you uncomfortable and doing it anyway. And reading is a big part of that for me because of course that allows you to insert yourself into many different people's lives and points of view.
Gary Bertwistle: Speaking of books, Cal Newport wrote a book which is being talked about a lot in the biohacking podcast blogging world as a great piece of work where we spend, deep work is an extended period of time on a cognitively challenging piece of work. That sounds like you, and it sounds like the work you do. Do you actually have a time you set aside for deep work where you sit and think about a challenge or something that's difficult for long periods? Do you have a ritual or routine around it? Is it done ad hoc? What's the setup for David?
David Putrino: Again, to kind of borrow from some of the approaches I've learned from Red Bull and the Red bull high-performance program, I'm kind of ... I'm always thinking about, I'm always trying to think about what's next. Like I don't like being comfortable. I don't like slipping into the status quo, so I'm always trying to think what's the next idea? What's the next thing that is interesting and has the potential to sort of reshape the field that I'm in? And once I get there to an idea that I want to sort of next investigate or next make people uncomfortable about, what I start to think about and what I start to do is I start to construct a camp where I can like meet up with people. So what I'll do is I'll reach out to my friend group and my connection group and I'll say who knows a lot about this or who knows a lot about that and so on and so forth.
And then we try to all come together and discuss it for three or four days, like let's ... So rather than having dedicated time in a scheduled way, which is probably actually [inaudible] a good idea, but I just don't do it. What I do cause I'm terribly unhealthy and you know I'm all or nothing is, I clump it all together and I'm like okay, over four days we're going to do a deep dive on this and we're all going to do it together and we're all going to live in one space and we're all going to just focus on it and come out the other end with a program and some deliverables and some ideas that are going to help us come up with the next set of ideas and next set of questions.
Gary Bertwistle: I think the stuff you talk about, David, is not just science and health related but it's business and people related. The work you do, the mission you have and the breakthroughs you're having, it must be so fulfilling to be able to go home each night making, being able to say that you either made a difference or you are making a difference. I think it's absolutely wonderful, the work you're doing. For people to, and the people you're working with around the world, different organizations is very impressive. Where do people find out more about you? The lab, the technologies around stroke, Parkinson's. Where's the hub for David?
David Putrino: I think these days if you Google my name and the abilities research center, you should get redirected to a Mount Sinai website that has the most complete information about who we are and what we're doing right now. We have a couple of websites that we'll be launching soon about our performance research, which sadly are not up and running right now. But you know, we'll get there. And then also on Twitter and Instagram, I'm @PutrinoLab and we, especially on Instagram, we do a real effort to sort of get a lot of good content up there about who we're working with, what we're doing across the range of human performance all the way through to sort of advanced technology and rehab. And we curate that Instagram page quite a bit so people often reach out to us on that and ask us questions and enter into conversations with us.
Gary Bertwistle: Well David, this has been great. Thank you so much for getting Inspiring Lives into your busy schedule for Athletic Greens and on behalf of me and Australians, you're doing us proud, mate. Keep fighting the fight. Keep doing the great work, taking on the difficult things, and we'll be sure to keep in touch with you, mate.