Welcome to Huberman Lab Essentials,

where we revisit past episodes for the

most potent and actionable science-based

tools for mental health, physical

health, and performance.

I'm Andrew Huberman and I'm a professor

of neurobiology and opthalmology at

Stanford School of Medicine. And now for

my discussion with Dr. Casey Halpern.

Casey, I should say Dr. Halpern,

welcome.

>> Thank you. Great to be here.

>> You're a neurosurgeon, which I consider

the astronauts of neuroscience. For

those that aren't familiar with the

differences between neurosurgery,

neurology, psychiatry, you could just

educate us a bit. What does a

neurosurgeon do and how do you think

about and conceptualize the brain?

>> Yeah, the scope of neurosurgery is quite

broad. We take out brain tumors. We clip

aneurysms in the brain. We take care of

patients that have had traumatic brain

injury, um concussion, uh spine

surgeries, 90% of what neurosurgeons do

around the country. uh you know taking

care of herniated discs and lumbar

fusions. So you know the the scope is

the entire central nervous system

including the peripheral nervous system.

We take care of patients with carpal

tunnel syndrome and nerve disorders.

Historically neurosurgeons did

everything in that domain but now we

subsp specialcialize and I'm lucky to be

at pen medicine where we can focus on

one of these areas. So I'm uh chief of

stereotactic functional neurosurgery.

All I do is deep brain stimulation

surgery and a complement to that is

focus ultrasound or transcranial focus

ultrasound which is a non-invasive way

to do an ablation in the brain. Recently

FDA approved and it's FDA approved for

tremor at the moment. Deep brain

stimulation is a procedure where we have

to place a a very thin wire that's

insulated deep into uh a part of the

brain that's involved in Parkinson's

disease for example. Uh but that's

actually not the therapy. The therapy is

delivering electrical stimulation

through the tip of that wire or one of

the tips as there actually are multiple

contacts at the bottom of the wire.

They're very small. It's a bit more like

I have to implant a a tool to to deliver

you a medication. Uh but that medication

is going to be in the form of

electricity and it's going to be

delivered into a very small region of

the brain. I'm very privileged to be

able to interact with the human brain in

this way. It's always in the with the

goal of trying to provide somebody with

a meaningful therapy. But when we

deliver electrical stimulation, these

electrodes, while they might be sitting

in a very small region of the brain,

there are regions within a few

millimeters of where these electrodes

are that if stimulated, could cause a

temporary, very brief side effect, a

moment of laughter, like you said, or a

moment of panic. And of course, we can

just shut that electrode off. But often

these side effects could be therapeutic.

And actually that's how we have

discovered ways to use deep brain

stimulation um not just for movement

disorders like Parkinson's disease but

for example patients with Parkinson's

disease that have a psychiatric uh uh

coorbidity like depression or

obsessivempulsive disorder. A lot of

these patients are highly compulsive uh

and impulsive. Um,

sometimes these problems actually melt

away and we're trying to help their

tremor, but the patients also tell us

that their gambling issue has gotten

better or their mood has improved. And

why is that? Well, you know, there's

probably more than one reason. You know,

you can help somebody's mood by making

their tremor go away, of course, but we

see laughter in the clinic sometimes.

And and why is that? And that's because

we're stimulating parts of the brain

that are not just involved in these

motor circuits, but they're also

involved in what we call a liyic circuit

or or part of the brain involved in

emotion. And if we learn how to modulate

those areas therapeutically, step by

step, we can actually develop these

therapies for other indications like

depression. I would say the most

impressive and consistent effect we have

when we have a patient with tremor who

has been tremoring for the past 20

years. If we can deliver stimulation

through that electrode in the clinic, we

have immediate relief of tremor. And

that is the effect that inspired me to

be a neurosurgeon when I was in college.

I've never really wanted to do anything

else except help develop that type of

therapeutic for another another kind of

symptom. I'd love to learn more from you

about OCD. Could you perhaps just tell

us what is OCD? Um

>> what are some brain areas involved? What

are the current range of treatments and

what's the difference between someone

who is obsessive and somebody who has

true OCD?

>> My perspective on OCD may be a little

bit different than a psychiatrist who

who lives and breathes OCD and sees

patients every single day with OCD. Uh I

probably take care of three to five

patients a year with deep brain

stimulation for obsessivempulsive

disorder. So I don't see these patients

as routinely but my laboratory is geared

as a researcher. Uh I'm very focused on

trying to improve outcomes of deep brain

stimulation for for OCD. So I I do feel

I have expertise and and a perspective

to share. I do feel that as a

neurosurgeon I am obligated to better

understand where the obsessions in the

brain come from and how we can interrupt

them to stop the compulsion that's

associated with the obsession better

than we're actually doing it. I've been

uh leading an endeavor with a number of

collaborators around the country to try

to

better understand these circuits in the

brain uh study them in humans both

invasively and non-invasively. That

would be with an electrodebased surgery

u sort of like we do in epilepsy to

understand where seizures come from. We

want to understand better where

obsessions come from. But we're also

working with imaging experts and

geneticists to understand OCD u at a

broader level as well. I consider OCD to

be a a spectrum disorder in a way. Uh

and I I I apologize to those who who

might feel that I'm using that term

incorrectly. I I'm using it in a way to

describe patients that have obsessions

and even some related compulsions might

not meet criteria for OCD. As a

neurosurgeon, I'm really obsessive about

safety and compulsive about my surgical

procedures. So you know I I think that

some aspect of OCD which we often joke

about but we should you know consider

seriously cuz people do suffer from this

u some aspect of it helps us u there are

you know famous u CEOs that probably

have some level of OCD uh surgeons and

scientists alike so u perhaps if it can

be controlled it's an asset and uh but

if it goes ary and is uncontrollable

then it becomes

obsessivempulsive disorder and uh I tend

to see the patients that are the most

severe. So they have failed medication

and there are multiple medications that

are worth trying for OCD. Some can

actually be very helpful.

>> Which which neurotransmitter systems do

they tend to poke at?

>> Well, SSRIs are sort of the the first uh

line for OCD, but also tricyclic can be

helpful. So this is still the serotonin

system. Um but as we know the serotonin

system interacts with the you know

neurogeneric system and the dopamine

system. So it's hard to um uh be

specific to one of these things. And I

think that's also why it's hard for us

to predict how these medications are

going to to work for these kinds of

patients. But tricyclic and SSRIs can be

very helpful and are definitely first

line. And there's others. exposure

response prevention is probably the most

effective option which is kind of like

cognitive behavioral therapy but these

are different and offered by

psychologists and this is a whole field

and there's a whole clinic at my

institution um uh focused was started by

Ednafoa um uh at Penn who this is what

they do for these patients uh is offer

these types of cognitive therapies

exposure to the stressor and to try to

get patients to habit habituate to

whatever it is that stresses them and

causes these uh compulsions to help

these patients live in every day and

function. The these are all fabulously

helpful uh therapies for a variety of

patients, but there's still about 30% of

patients that still suffer from OCD and

some of them have severe OCD. Sometimes

it's moderate to severe and those are

the patients that I'm really motivated

to try to help. um our therapies for

those patients right now uh I would say

are are worth pursuing but not optimal

um and so it's it's one of those things

that we have to balance as a researcher

because when you see patients like this

you want to do everything you can to

help them and I think it's important to

educate patients on the risk and

benefits of them this is deep brain

stimulation surgery but also capsulotomy

which is more of an ablation approach a

little bit like deep brain stimulation

but rather than delivering stimulation

through an electrode you can actually

heat the tissue and even destroy it.

Some would say this part of the brain is

very safe to destroy. It's kind of like

an appendix. Um, others would say it's

safer to modulate. I have seen uh

patients do very well with these

ablations. And so, you know, you asked

me earlier what what I find so amazing

about the brain, these effects that we

can have. Sometimes the lack of effect

is what's so amazing. You can actually u

traverse parts of the brain without

having any adverse effects on patients

um function at least that you can test.

Um, but you can also destroy small parts

of the brain. We're talking 3 or 4

millimeters in size. These little

ablations can be really helpful for

patients, but have no obvious side

effects that we can tell perhaps after a

short recovery from surgery. Uh, but

nonetheless, despite how safe they might

be, uh, these surgical procedures still

are surgical procedures and patients are

hesitant to proceed, especially when

they know that their chance of a

transformative effect is quite low. we

we can generally um uh achieve a

responder rate of about 50%. Um and

responders still have symptomatic OCD.

So I'm really uh uh sort of inspired to

uh really find a way to deliver these

therapies in a more disease specific or

symptom specific way. were one to come

into your clinic this you know for this

sort of a work of ablations or

stimulation uh where would you first

start to probe in the brain?

>> Yeah, you this is a uh a disorder of

both cortex and the sub subcortex. We

find that areas in the cortex like the

prefrontal and orbital frontal cortex

are are not functioning they the way

they would in a nonCD patient. They're

often hyper functioning and we need to

find a way to try to normalize their

function. And then there are projections

to the subcortex. This is the basil

ganglia codeputaman or the dorsal

straightum. And these are interconnected

with the vententral stratum. This is an

area of the brain that I uh focus a lot

of my energy in. Um this is the

vententral stratum which is not limited

to but includes the nucleus circumbent.

Um this is an area of the brain that uh

we know to be involved in gating

reward-seeking behavior. When it's

perturbed, it seems to gate compulsive

behavior, meaning a rat will pursue a

reward despite punishment, despite foot

shock, for example. And that can be

similar to an OCD patient. They will

check their home for safety until 3:00

a.m. in the morning and not sleep that

night. Doing something because of the

urge, but despite the risk. when our

judgment is consistently

uh sort of puts us at risk, that's where

we have something like OCD,

contamination behavior where they if

they feel contaminated, they will wash

their hands for hours repeatedly or if

they drop their toothbrush on the floor.

This will lead to a compulsive behavior

of cleaning a toothbrush or brushing

your teeth consistently. Very very

common symptoms that we see uh or signs

that that patients report to us or or

that we observe. But you know patients

with eating disorders you know they tend

to if if they have binging disorder

they'll overeat. If they have bulimia

they might purge despite the risk of

these things. And so um addiction is is

similar. We we tend to drug seek if

we're addicted. Um uh we'll we'll pay

off a dealer u in order to get our fix

despite the risk. And and that type of

urge despite the risk is something that

I I've always been really interested in

and and it's a common denominator to all

of these problems. And if you think

about these problems, I mean, these are

some of the most common conditions in

our society today. And I think the

nucleus ccumbent and the cortical areas

that we've been discussing that that

sort of send projections to these areas

are are probably at least one of the

main circuits involved in these kinds of

things.

>> What is nucleus? What roles does it play

in healthy brain behavior and in

pathology? Yeah, the nuclear circumbent

is a part of the brain, part of our

reward circuits. It has a lot of

functions. Uh, it interconnects with

many parts of the brain. So, when I

started getting interested in reward and

what a what I could do as a surgeon to

try to improve how we manage rewards.

And what I mean by that specifically is

if you have an urge for a reward, that

that's a normal phenomenon. That that's

not something we're trying to stop. The

the issue is if you have an urge for a

reward that either puts you or somebody

else at risk, it's probably a reward we

shouldn't have. If you're a drug addict

and you uh use heroin or opiate, that

opiate might make you feel better cuz

life is stressful. But the risk of doing

those things is really high. in fact

potentially lethal. If you have OCD and

you

can't sleep at night because you're so

nervous that you didn't lock the door

and you've checked 30 times, that's an

urge we got to treat. Eating disorder is

the same. This problem can be ailarated

or improved upon by a better

understanding and a tailored treatment

to the nucleus. Specifically, it seems

that repeated exposure to something like

a drug of abuse or any type of reward

that is a really strong reward in a way

it can hijack normal functioning of the

nucleus cumbent. So, the goal is to just

disrupt perhaps what is kind of habitual

um or or at least this kind of recurring

problem that is happening. You know,

people that have binge disorder at least

at a severe level, they tend to

about once a day. So what we decided to

do in the operating room was to actually

try to leverage a tool that we use all

the time when we take care of patients

with Parkinson's. So with Parkinson's,

these a lot of these patients, not all,

have tremor. And so when we place an

electrode into this motor structure to

try to improve their movement disorder,

uh we often can hear tremor cells and

they sound we convert their electrical

signal to an audible signal. So we can

actually hear it and it sounds kind of

like the tremor looks like the frequency

of the signal is the same as the hand

shaking.

>> So

exactly and you're poking around in a

dedicated careful way of course one poke

at a time.

>> One poke at a time with a very fine wire

a set of wires listening to the

electrical activity until you you

encounter some cells that are sending

out electrical activity at a similar

frequency.

>> Exactly. And then you can stimulate them

or quiet them and see if the tremor goes

away.

>> So we we are very confident that when we

stimulate that area of in this case the

subthalamic nucleus we will disrupt that

tremor circuit and that tremor will

dissolve and it does.

>> So what is the um analog to tremor in

terms of appetite and desire to binge?

>> Craving. So craving is a term that you

know there's probably other terms we

could use by the way but that that's the

term we've chosen to use for a number of

reasons. One because people relate with

that term. People that have binge eating

disorder or obesity they if you ask them

if they crave the answer will often be

yes. Um if you ask them if they lose

control or binge they might not know

what you mean or they might not actually

feel out of control even when they are.

Um so uh but the word craving is

relatable and so we set out to see if we

could identify craving cells. Um in a

patient with OCD which is related in

fact we target a very similar part of

the brain uh we tried to identify

cells related to obsessions and we

believe we did do that. It was a single

case study uh where we tried to optimize

where our electrode was placed. So we

had some proof of concept that we would

be able to elicit a sort of

disease-specific symptom in the

operating room assuming the patient

could tolerate being awake. Not

everybody needs to be awake for this

procedure but at least for these first

in human trials where um we're trying

we're trying to establish where in the

brain we need to be. Uh I think this

type of approach is really critical.

>> What is the status of non-invasive brain

stimulation ablation and blocking

activity in the brain? My understanding

is that transcranial magnetic

stimulation is being used to treat

depression and a number of other um

brain syndromes uh non-invasively. So no

no drilling through the skull. My

understanding is that the spatial

precision isn't that great. Um

ultrasound is something I hear a lot

about these days. Um and my

understanding is that ultrasound can

allow researchers and clinicians to

stimulate specific brain areas. What are

your thoughts on these forms of

non-invasive meaning no flipping open of

a piece of the skull type brain

stimulation and blockade of brain

activity? We need to embrace

non-invasive approaches. Some of them

are a little fluffy in that we don't

understand how they work. We don't

necessarily understand how deep brain

stimulation works by the way. So, but

because we don't know exactly how they

work, they're not as precise as we would

like them to be. So, we have work to do

there. And I actually think that work is

doable and actually underway. TMS

transpanomagnetic stimulation. It is FDA

approved for depression. By the way,

it's also FDA approved for OCD and for

nicotine addiction. We believe we can

use TMS to to define a circuit that if

modulated improves OCD, albeit

temporarily. And in those patients, if

it's temporary, they would be

appropriate for an invasive study. So,

um something we're actively working on.

I've always believed that neurosurgeons

need to be part of the discussion with

these non-invasive approaches. we don't

need to do them. Um but um I think we

can help make them more precise and to

probe non-invasively with purpose.

Perhaps one day there will be a TMS

target for anorexia and obesity. Uh if

we are scratching the surface with

invasive approaches to these problems,

we we're even doing less with the brain

stimulation. Um so we have so much work

to do there. eating disorders and TMS

have been so um sort of scarcely studied

or or there have been such little

research done in that space and so it it

is an area that we need to to work on.

So ultrasound right now transcranial

magnetic guide magnetic resonance guided

focus ultrasound. So um uh this this is

an FDA approved method to

deliver an ablation to the brain

non-invasively.

There are uh researchers myself included

that are trying to use transranial

magnetic guided magnetic resonance

guided focus ultrasound or MRI guided

focus ultrasound u to use it in a

modulatory way not just as an ablation

but to drive neuronal activity or

inhibit it perhaps. We're still learning

how to do that. Um there are trials u

that are trying to understand if you can

use ultrasound to open the bloodb brain

barrier so you can deliver a medication

to that specific uh area uh perhaps for

a brain tumor or something like that. So

um it's a very exciting field um and it

is FDA approved for tremor right now and

so I actually do it routinely um for

patients with uh tremor with Parkinson's

or essential tremor and so um I I love

doing it. It's uh often just kind of a

miracle because there's no incision. I

don't have to place an electrode into

the brain to achieve a similar result.

It's fabulously effective for these

patients. It treats patients on one

side, usually their dominant hand or

their worse hand. And it um it really

speaks to the fact that wow, you can

deliver non-invasively an ablation to

the brain in a hypothesized zone that we

think is related to the problem at hand.

And at least with tremor, it works

really well. Could this be effective for

psychiatric disease, obesity, eating

disorders? Uh well um perhaps uh

actually that would be the ideal. The

problem is we don't know where to do the

ablation. Um there is a trial that we

would like to do for OCD where we would

deliver an ablation to the same area of

the brain that we've been delivering

ablations to for years for patients with

OCD and it helps a bit. That's called a

capsulotomy. Um but really the outcome

is probably going to be about the same.

It's a nice method because it's it's

noninvasive, but we need to find a new

target for these for these conditions

and because of the common denominator of

the urge despite the risk sort of that

compulsion. Um yeah, perhaps it could be

the same target. I don't know. Um but I

would argue we need to do these

modulatory experiments either with a

device or with uh invasive recordings uh

to better understand where these

problems are coming from to define where

we should do an ultrasound treatment.

There has been a revolution in America.

It was in Europe before it was in

America where we would do stereo

encphilography which is basically like

doing an EEG of patients with epilepsy

but with invasive electrodes and we

would place tiny little wires less than

a millimeter in diameter all throughout

the brain into parts of the brain that

we believe are involved in seizures and

we would admit the patients to the

hospital and figure out where the

seizures were starting and propagating

and then um you know we could stimulate

these electrodes to see if there was a

symptom that was important and try to

identify by a region that we thought we

could either remove surgically, ablate

with a laser or put a stimulator in it

perhaps. Um, that's common place now for

epilepsy. Um, and it works extremely

well and it's very safe. Of course, it's

still a brain procedure. Um, but the u

the complication rate is surprisingly

low quite honestly for the amount of

electrodes that we place and it's

extremely well tolerated. Most of these

patients leave the hospital and they

don't even feel like they've had

surgery. So uh there's actually a lot of

interest in using that procedure to

study mental health disorders. We are

trying to do it for patients with

obsessivecomp compulsive disorder. We're

awaiting an FDA decision on that. Uh but

actually I credit uh uh our colleagues

at Baylor and at UCSF for for studying

this uh already bringing together the

epilepsy technique and the psychiatry

expertise to study how we could better

target electrodes in depression. And

I'll tell you if they have a consistent

target perhaps there becomes an

ultrasound target. Um but right now the

approach is a bit more reversible

because you can always shut that

electrode off or even remove the

electrode if perhaps it's not in the

optimal location to treat the

depression. Uh but actually after a

large volume of uh cases perhaps they

could pull that data to develop a a new

ultrasound target for depression. I

think that would be fabulous. probably

is their long-term goal. Not to speak

for them, uh, but that would be

something that I I'm sure is on their

radar. You might ask, well, why aren't

you doing this for obesity right now in

uh in our in our study? And the reason

is that um we've developed a target for

obesity uh and binge eating disorder uh

developed out of mice that we believe um

is relevant for the human state because

you can model this problem in a mouse a

bit better than than you can model

depression or OCD. So, we feel like we

can rely on the pre-clinical studies

more. Whereas with these perhaps more I

don't want to say more complicated, but

more human mental health conditions that

are hard to model in a mouse, you really

have to study it in the human. And you

can perhaps start in an epileptic

patient, a patient that has electrodes

and try to provoke a depressed state or

study epileptics that have comorbid

depression, for example. Uh, and that

can really validate this approach as

well. But in the end it's it's getting

into the human brain that we need to do

in the disease specifically u that will

eventually lead to a non-invasive

approach uh either a lesion or

modulatory approach. Modulatory would be

like TMS or lesion approach would be

with ultrasound. If people can be made

to feel or make themselves feel just a

little bit better, a little less anxious

just prior to a craving episode or a

binge episode.

Maybe even if people can become better

at detecting their own internal states

and when they're kind of veering toward

a binge or veering toward using a drug

or maybe even veering towards suicidal

thinking. Seems like that awareness

seems like maybe among the best tools

that people could develop.

>> Yes, I've always thought that if we can

improve awareness, we can improve

outcomes. I think that's probably true

for many of these patients. The problem

I think comes down to the fact that some

of these patients are so resistant to

treatment and the patients that we see

as a surgeon for example are the

patients that they've tried cognitive

behavioral therapy certainly have tried

medications they've tried behavioral

management they're as aware as they

could possibly be and they still lose

control. We've had this studied in the

lab. So we will bring patients to the

laboratory with this implanted device to

to try to provoke this electrographic

electrical signal u that can be detected

by the actual device that will stimulate

them when they're at home. But before we

actually initiate stimulation, we want

to to see can this device detect this

craving cell signal which is going to be

different than what we saw in the

operating room because that's a single

cell. But these devices, these

electrodes are about a millimeter in

diameter instead of like a tenth of a

millimeter, which is what we use in the

operating room. Um, so they're they're

only hearing or or detecting, I should

say, thousands of cells responses. And

we actually have a way to provoke

binges. It's called a mood provocation.

It's very well, very well validated.

It's a little bit like provoking

seizures in the epilepsy monitoring

unit, but here in the sort of uh

psychiatric monitoring unit or the the

food monitoring unit, uh we we actually

have a psychiatrist and eating disorder

specialist come and induce a mood that

is related to each patient's sort of

selfdescribed binge episode. So the

psychiatrist comes in and provokes

>> Yes. a feeling that can evoke the

negative behavior.

>> That's exactly right. So that we can

video and synchronize the video to the

brain signal recordings. Um the patients

all wear an eye tracker so we can see

what they're eating at all times and

what they're looking at specifically.

And that allows us to have the best

temporal resolution possible to

understand what is happening right

before the bite. And even under video

surveillance through a one day one-way

mirror in a laboratory setting when

patients are very well aware that

they're there to be studied if they're

going to binge. They still do and we

believe they do because they just can't

control it as aware as they are of it.

And it's probably because they're the

most severe. So I think if we can

improve awareness, not just the societal

awareness that I was talking about

earlier, but the patient awareness uh

around their problem, I think that could

be a powerful way to help so many of

these patients. And that's sort of the

role of cognitive behavioral therapy. Um

the problem with cognitive behavioral

therapy or I should say the limitation

of it, I actually don't have any problem

with it. I think it's a wonderful

treatment. Um

is that if you stop it, many of these

patients go back to their old behaviors.

I don't want to say old habits, but it

might be a habit, but the old behaviors.

And so, um, that's the problem is it's

not necessarily lasting in the absence

of continued cognitive behavioral

therapy. Some people can benefit from it

long term, but some can't. Uh, but I

think in in in in the less severe

patients, improving awareness key, but

in these really refractory patients,

this is this is kind of like this is the

disease. Despite the awareness, they

can't control themselves. And that's

what we're trying to restore is that

improved ability to control their

behavior.

>> Do you think there's a role for machines

and uh artificial intelligence here? Uh

there are a couple laboratories up at

the University of Washington that are

using

particular signature patterns of within

voice to try and help suicidal uh people

who are suicidally depressed know when

they're headed towards an episode before

they even can consciously know. So this

gets right down to issues of free will

and whether or not machines can be

smarter than we are. But you know, one

could argue that some of the search

algorithms on Google and other search

engines are actually more aware of our

preferences than we are.

>> Um, basically what these are, these are

devices that are listening to people

talk all day. They're also paying

attention to patterns of breathing and

how well people slept, etc. integrating

a a huge number of cues and then

signaling somebody with a, you know, a

yellow light, you know, you're headed

into a depressive episode and the person

might say, "I feel fine or I feel pretty

good. This is kind of baseline state for

me." and they say, "Uh-uh, this is where

you were preceding the last episode that

took you down a deep, dark trench and it

took months to get out of."

>> Um, I wonder whether or not some of

these devices could help with the sorts

of things that we're talking about

today.

>> Yeah, I think so. Um, I've always said

we have to get in the brain before we

get out of it. And if we get in the

brain and understand what these signals

look like, we'll know what those

non-invasive signals are. I think it's

possible that we are uh scientifically

sophisticated enough to

use machine learning and sort of this

kind of bot tech technique to anticipate

when somebody is going to be highly

impulsive. You know, suicide is the most

dangerous impulse. It's something that

is

immensely a focus of the lab is

impulsivity. We've talked mostly about

compulsion. Compulsion being, you know,

going after a reward or or the urge

despite the risk. Um, impulsivity is is

similar but different. It's it's kind of

going after something um a little bit if

you if you model impulsivity in a in a

mouse, it's, you know, related to, you

know, going after a food reward without

the sort of paired tone that you're the

mouse is supposed to wait for. The mouse

doesn't want to wait anymore. They they

just go after the food. Um,

>> I've been that mouse. Yeah, we've all

been we can all relate with this uh to a

certain extent. Again, it's a spectrum.

>> So, um so in any case, I nonsequiter,

but I I I certainly think that there is

a way to use our own body's physiology

to anticipate

when these impulses are coming online.

How best to do that? I think we're just

scratching the surface, but um these are

the kinds of solutions we need. Some of

these problems are of epidemic

proportions. Largest public health

problems in this country, in this world,

obesity, opiate crisis, depression,

suicidality. I mean, that's like a third

of our country, maybe more. We need

scalable solutions. But, you know, I'm

I'm a neurosurgeon. I'm only going to be

able to treat the most severe of

patients with these problems. you know h

you know we've only done about 200,000

deep brain stimulation surgeries ever.

So I mean the problem we're talking

about here is 50 million Americans.

There's no possibility that surgeons can

address that problem. But we could help

inspire an initiative to go after that

kind of problem or help make it more

rigorous because the last thing we need

is a you know some sort of wearable

fancy tool that you know

wastes people's money and time you know

we need real therapies for these things.

Not that these devices that we're

discussing are not uh I think actually

there's lots of promise and we use

machine learning in the lab all the

time. I'm not a an electrical engineer

or the computational neuroscientist

doing this type of work. I I just help

develop the hypothesis around it, but um

and help fund raise around it. But I I

definitely think there's a future for

it. I just I I suspect we're we're

scratching the surface on how best to do

it.

>> I really appreciate you sharing uh those

tools, a number of people uh I'm

guessing out there might want to become

neurosurgeons. I really believe that in

hearing today's conversation that you

will spark an interest in medicine andor

neurosurgery. I hope so. Um well,

certainly you need to be a physician

before you can become a neurosurgeon.

end neurosurgery in some cases and that

would be beautiful and I predict that

will be happen that will happen excuse

me as a consequence of what you've

shared today really want to thank you

for taking time out out of your not just

immensely busy but very important

schedule because again the work that

you're doing is really out there on that

cutting I don't want to say bleeding

edge because in this context it's not

going to sound right but on that extreme

cutting edge of what we understand about

how the human brain works and how it can

be repaired. on behalf of everybody and

myself as well. Thank you so so very

much.

>> I'm honored. Thank you so much for

having me.