Brigham Buhler

00:01Joe Rogan podcast, check it out. The Joe Rogan experience. Train by day, Joe Rogan podcast by night, all day. Good to see you, brother. Good to be here. Listen, first of all, I want to thank you, because over the last year and a half, you have, and your company, Waste Well, has fucking sorted me out multiple times. All these little nagging injuries that would have set me back a long time. And as you know, I've been fucking waving the flag for stem cells for quite a while, since I had Neil Reardon on, and since I've had my own stem cell therapies. So how did you get involved in this, the whole stem cell world? So I kind of have to go back to the beginnings. I was a drug rep right out of college and did that job for three years, and then I jumped into that and to search. You've got some fucking fascinating stories about being a drug rep. It was crazy.

00:58It's so illuminating when you were telling me, like, the, just, if you could get into that a little bit, I'd love to just get into that. Yeah, it'd be easier to get into that and tell you how we got here, because then the reason we're doing what we're doing makes a lot more sense. Okay. So right out of college, I was actually interning at Hewitt Packard, and I thought I was going to go into, like, work for a computer company. And so I was a business major in college. I took the sales class. And for shits and giggles. I, like, went and interviewed with Eli Lilly, but I wasn't supposed to graduate for, like, a year and some change. And they offered me a fucking job. And so I literally had to graduate college in two and a half years to be able to get this job with Eli Lilly. And it was like a dream job. So you had to have a degree? You have to have a degree. So what did you do?

01:48Just fucking take crazy amounts of courses? I took 24 hours in summer school. I got a letter from the dean, or letters from four professors to the dean asking if I could take extra hours every semester. And I worked full-time jobs. So I was interning at Hewitt Packard, then taking all these night classes. But I'm like, this is a chance of a lifetime. I'm going to come right out of school, make more money than I've ever thought I'd make in my life. I have a company car, an expense account. And it was the Wild West. Like, I didn't even know what drug I was launching. They just told me we have a blockbuster drug coming. There's an opportunity, but you've got to be graduated and ready by this date. So I don't remember the exact dates, but I took 24 hours in summer school was the hardest part. One of the professors had me, like, write the case studies for the next semester's students.

02:38And they just kind of gave me unique ways to get my credits, if that makes sense at all, so I could get out quick. And that all transpired because I had a meeting with the dean. And I said, hey, I understand why you have these rules and limitations. You're limiting me by not allowing me to take a shot at this. I have a 399 GPA. Let me take a shot at this. I can get out of this shit quick and go get a job and make money. So they let you. They let me. So what was it like being a drug rep? And what did you think it was going to be like versus what was it actually like? Yeah. I didn't really have a means of comparison because I was right out of school. So I was young and naive. So you're going into it blind. Blind. And I start and they give me a $17,000 a month expense account. Whoa. A company car. And the drug I got to launch was Cialis. Now when you. Ooh. Which is the Viagra. 36 hour Viagra.

03:31So when you say expense account, like does that mean to take people out? It does. Whining and dining. It does. And this is Avamed had started and it already existed, but it wasn't as strict. And so I can't really speak to what they do today. All I can tell you is what they did when I was there, which at this point was 20 years ago. You know, I'm 42. I was 21. So yeah, almost 20 years ago. Yeah. They gave me a $17,000 and it's use it or lose it. So if I didn't use the expense account, I would get in trouble. Like my, my manager would say, what are you doing? Why aren't you doing dinners? What? Like, you've got to go use this budget or we'll lose it. And I was in Waco, Texas. It's not like I was in LA. I'm in Waco, Texas, slinging dick pills right out of school. It was ridiculous. And, uh, but it was fun. It honestly, and that's where the, when I got into it at first, it was so, uh, surreal

04:27because I was like, this is awesome. I'm there. They're going to pay me this much money. And all I got to do is go talk to doctors about this new drug that they all want to talk about. So you walk in and when you have a drug like Cialis, I would walk in. And one of the things they would say is drug companies only hire hot chicks. They're not going to hire a guy. They had transitioned from hiring pharmacists and very clinical individuals to a pivot. And the industry had moved to hiring, uh, good looking young people who will go out and hustle more of like sales type people who have no clinical background. Um, but when you go, the training is rigorous. Like I went off for six weeks to Indiana, uh, and they had, you know, doctors coming in and educating us and had to learn about all these different studies and trials and different things that had gone on. Um, it was a weird, and you carry multiple drugs.

05:17So my primary drug was Cialis, the Viagra competitor. That was fun. Cause you're like a rockstar. Like in, you walk into a clinic and there's a, you know, the toe fungus girl sitting there who has been waiting for three hours. And the doctor's like, bring them. Come on, come on back. The money's in dick pills. Yeah, it was fun. And so why were they hiring, hiring primarily hot women? Um, I think what happened is as healthcare, well, this is part of this story I want to get into too. In the early days, if you look at medicine and what it used to be, a doctor knew their patients, they would go to their houses, they put their, all their stuff in a little leather bag and they knew the kids and they knew the wife and they knew everybody. When we pivoted to this insurance based model, they at first started having pharmacists call

06:07on doctors and educate the doctor on the unique pharmacogenetics of this molecule and what it can do in the body. And it was super scientific. That changed, uh, at some point. And it's probably because physicians got to a point where a primary care in America has seven minutes to spend with a patient on average, seven minutes, seven minutes. That's all you get. And they're overworked, underpaid. We're under, we're on a massive shortage. I don't know if you know this, they're expecting a 40% shortage in the next decade. Uh, we don't have enough providers. We're going to have 150,000 less, uh, primary care providers. And there's already three, four month wait list to get in with primary care at a lot of states. What is causing the shortage? They don't want to do the job anymore. I mean, uh, in a recent interview where, uh, I think it was the American journal of medicine

06:55interviewed clinicians that are primary cares and 35% of them said. They're looking to retire or transition jobs in the next few years. And it's because it's thankless. No, their job is a beat down. It's a beat. I watched it. You literally get paid. So as soon as insurance took over and we moved to an insurance model, these doctors get paid minimal reimbursement. And so they have seven minutes to get you in and out of there to get to the next patient so they can see enough patients to pay their staff, to pay for their overhead, all these things that being a clinician's not what it was in like the eighties. Uh, now it's just a beat down of a job. And so I think that pharma made a pivot because they realized this guy's not going to, it's like you, you're busy as shit. You're not going to sit down like, uh, during your lunch break and have a pharmacist bore you to death with pie charts. You're just not.

07:47But if you can send somebody in who's attractive, charismatic, and this girl can just get one or two plugs in, or this guy, uh, can get one or two plugs in that move the needle a little bit. Um, that was the goal and it becomes a relationship deal. It really does. Like that was one of the things they told me when I started, you will become best friends with the most important practitioners in this region. That's the only way you're, you'll sustain your job. It's the only way you'll be successful. And so I had a call list and I had a list of the doctors, what they wrote in the previous week. I knew every prescription that was coming out of their practice. How many of, how many Viagras they wrote. And then obviously if you're a smart business guy, you, you plan your schedule around where the big fish, you know, I go fish where the big fish are.

08:35And so you go and sometimes it's hard and sometimes it's easy. Like if, if I just tried to always be genuine and honest with people and, uh, and tell them the pros, the cons, and just get to know them. Because if you can build trust, then when we launch another drug or when something else comes out, if you're the guy who always steered them straight, they use you. And they, they come to you for, Hey, what's going on with this? Or, Hey, what's going on with that? But it's so weird that something like medicine, which is something that you would in the best case scenario, you would only want to provide people that actually need it. So there wouldn't be any incentive to sort of, uh, coerce someone or to be charismatic. Like that wouldn't even come into play, but it seems like that was a big part of your job. It's a huge part.

09:25And so what, what would happen is, and even today, this is a constant struggle. Um, a study came out of Harvard and it said within 18 months, the new forecast is 18 to 24 months after med school. Most of what you learned is antiquated. That's how fast things are evolving. So for these clinicians, right? I got to see a patient every seven minutes. It's, I'm literally working my ass off, doing my best to navigate the broken insurance model, where if I submit to get like so many patients say to me, uh, well, my doctor, uh, pulls all my blood work or I did a physical or a checkup. A primary care is physical is still the same physical they were doing in 1925. They knock on a knee, test your reflexes. They look in your ear, look in your eyes, look in your nose, look down your throat and check your pulse and your heart rate. And they run a minimal panel.

10:19Uh, they're not doing a deep dive because one, they don't have the time to do a deep dive. And two, if they did, the insurance is going to hammer their asses. So they, they, they are very scared to push back on big insurance and big insurance controls a lot of what happens nowadays. Why would the insurance freak out on them? Um, man, this is going to get, we'll layer through all of this, but what, what the, the general gist is the big five insurance companies essentially control all of healthcare now, a hundred percent front to back. Every drug that you get prescribed, every drug that's on formulary reimbursements, what a physician gets reimbursed or paid. They will send back to, and a lot of it's an obstructionist mindset. So example I can give you is if we deny the blood work, you know, and make it so much of

11:08a pain in the ass for the doctor to pull comprehensive blood panels, then the doctors will stop pulling comprehensive blood panels. And we, the insurance company save money, right? Because you are beholden to your shareholders every quarter. You've got to produce for wall street every quarter. It's all about quarterly earnings. If I can, the whole system set up that way. Now that's the problem. Like whether it's insurance, big pharma, big medical, the pressure is so high to hit those quarterly earnings and produce for wall street. It is not about patients. It is not about patient outcomes. It is not about helping people. That's what it used to be. And at some point the system lost track of that. I don't know when exactly, but even when, even in the last 20 years, I've seen it change a ton. Um, you know, when I was in it back then, Avamed hadn't really gotten strict.

12:01So you could still wine and dine doctors, uh, a bunch of different. When you say strict, what do you mean? So they released, and a lot of people think this was the government. There is no government. The government's not really regulating a lot of, uh, the whining and dining and stuff that big pharma does. Big pharma went and lobbied and said, Hey, hold on. Don't, don't restrict us. We'll restrict ourselves. Let us draft the guidelines for all the other big pharmaceutical companies. And we, as a organ, as a group of powerhouse pharmaceutical industry will regulate ourselves and what we do with doctors. And, uh, because so much shit was getting exposed. Yeah. Self-regulate. That's hilarious. And that's, that's kind of the, the direction it went. So when I was there as a drug rep, and this was, you know, again, 20 years ago, it was, I had a call pattern. I needed to call on 10 physicians a day.

12:53I needed to prioritize those physicians based off their volumes and what they're producing. And then I would get analytics the next week. Did my lunch work? Did my dinner work? Did my meeting work? Um, and it was, it was rare in primary care where doctors would say anything like, well, I'm not using your product cause you don't pay me or that, that didn't really happen to me ever. Um, I did have doctors say, I've got a great relationship with the Pfizer rep. I'm not going to use your shit. The Pfizer rep's been my rep for 10 years and they're my buddy. I don't care if your product's better. I'm not using it. And so that's a challenge because in one hand I get that and I appreciate that they have loyalty to their sales rep. But in the other hand, if it was my dad or my mom on the other end of that treatment protocol, I would want the best treatment possible to optimize their opportunity at,

13:43you know, getting good results. Um, cause I didn't just sell, uh, you have multiple products. So my primary product was Cialis. My bonus was based off Cialis. Uh, I finished like president's council. They, I mean, I'm, I'm a fucking kid, dude. I finished president's council. They fly like you're in the top 5% or whatever of the sales force. So they flew me to some like crazy extravagant hotel in Phoenix and Britney Spears was hanging out at the pool. And it was like, I'm like, this is insane. This is amazing. It was, it was great. And one of the misnomers though, is people think in their head that reps are bad or have bad intentions. Like an example I can give you is Cialis was fun, right? That's an easy one. Really easy. It was fun. Doctors love talking about it. It was a bunch of jokes and men loved it. Once they took it, it sold itself. It's a safe drug.

14:35Uh, it's used today in an array of different things off label, uh, for performance enhancement beyond sexual performance enhancement. It's a vasodilator. Um, and so that was great. But I also sold a Vista, which was an osteoporosis drug. Uh, and it was, that was an uphill battle because nobody wanted to talk about Vista. So then I was the rep waiting in the lobby forever, uh, trying to get with that doctor to educate them on the, you know, why I, our product is supposedly the best. Um, and I didn't have a heartburn about what I was doing until I got relocated to Houston and they changed my portfolio. So I was doing really well and they said, Hey, we want you in a bigger market. And so they moved me to Houston, Texas and then changed my entire portfolio of drugs. I was carrying to Prozac and Cymbalta and, uh, and basically mental health antidepressant type medications.

15:28And now when you do something like that, do they give you a course on how to handle these things or do they educate you in it? And what's, what's involved in that? You go off. Um, so there's learning modules, you train online, you have to take tests that are timed and then you go off to like school at, uh, the corporate office where you're literally there. I think it was like four to six weeks, like doctors presenting every day, you're taking notes and then you've got to take tests to show that you've downloaded all the data points in your head and that you can talk about a vertebral fracture and what are the occurrences. And it's a lot of statistics, a lot of studies, a lot of data. Um, but one of the things I remember my boss always saying is there's liars, there's damn liars. And then there's statistics like these numbers, they, it's all in how you present them and what they look like.

16:22You know, it's, it's so hard. Like an example I can give is we would promote this drug of Vista and it didn't increase bone mineral density astronomically, uh, in women as compared to some of the other products on the market. And, but the fracture rates were equivalent. So the measure, the way they would measure was how much their bone mineral density improved or ceased to decline. Um, this drug was based off that an inferior product to what else was out there, but based off the results of the study, which as you know, could be an anomaly. The women didn't fracture disproportionately more than they would have with these other drugs that I competed against. Does that make sense? So we would say, doc, it's because it's not about the quantity of bone. It's about the quality of bone. Is that bullshit? I don't know. I mean, that's what they taught us and they would have like thought leaders.

17:13The other thing they did, the only thing that I saw in pharma personally that was shady is they would, they would do these courses on never off label promote. Don't talk about this. Don't talk about that. And you would sign all these documents saying, I'm not going to talk about this. Yeah, definitely. And then a week later, have us come listen to a thought leader in the field, off label promoting all the shit they told us not to talk about. Explain off label promoting. So let me think of an example. An example would be Zyprexa and they got exposed for this on Zyprexa. Zyprexa was indicated essentially for, let me, I'll do a better one. If you look at Oxycontin, how did Oxycontin take over the marketplace? It's because what they did is they got the reps to go out and began to recommend Oxy. So originally Oxy was meant for people who were like terminally ill with cancer and were

18:05in severe pain or somebody who's on the upper echelon of the pain threshold. And the goal of a company and a rep is to grow the market and to hit the number. And so when you go out, it's like, how do you grow the market? Well, we're going to grow the patient demographic. We're going to have to grow. We're getting, we need the doctors to write more of this. So what they did with Oxycontin was they went out and started, it got to a point where they were literally promoting it for people with migraines. And they were pumping these pain pills into all these practices. Was this before or after it had been proven that it was highly addictive? They knew it was highly addictive based off the studies. So I know you and I have talked about dope sick, but the story on this family is absolutely insane. So the family that owns Oxycontin is one of the richest families in the country.

18:55They're up there with the Rockefellers and the Vanderbilts. They made all of their wealth in the 1960s by creating the Valium pandemic. They launched Valium into the marketplace, told people that it was non-addictive, non-abusive, grew the market. They were writing Valiums for headaches, Valiums for knee, shoulder, elbow pain. And it created, they went under governmental investigation. The government ended up investigating the family in the 60s and then jumped forward. They get off. They buy their way out of that. Jump forward. And this is another thing we'll talk about. There's so many data points. It's their patent on hydrocodone was expiring. So big pharma does this a lot. And I'll get into this. Like they say we innovate, but it costs 10 times. We make 10 fold on one drug because we innovate and so many go by the wayside. They don't innovate. They re-engineer and reapply.

19:55And like Zyprexa got combined with Symbiax, two drugs that were already on the market to extend the patent. Right? So the goal is to play this shell game where you, when your patent's close to expiring, you have to reapply and extend the patent via a new indication or some sort of new combination of a couple of different products. And so hydrocodone was expiring. The hydrocodone oxy, like long delivery system was, or the cotton system was expiring. So what they did is they looked at their revenues and they're like, we're fucked. Like we can't, we won't hit our numbers. We can't continue these growth trajectories unless we get a new patent on a new pain med. So they went out and they said, what else is out there that we could put into our patented delivery system? And the answer was oxy. And the problem with that is it's 10 times more addictive than hydrocodone.

20:51So then you go, okay, well, they're going to have to do safety studies and prove it in humans and show that it's non-addictive, non-abusive. Nope. Human study never happened. They were able to piggyback on their hydrocodone cotton delivery system. Take the delivery mechanism. And all it is, is basically they grind up the powder and they create layers. So in theory, if you take the pill, you won't get a hundred milligrams of oxy at once. It'll over eight hours dissolve into your body and you'll get that absorption. That was the premise. And so they said, because of our patented delivery system, this drug is non-abusive, non-addictive. We have a great safety profile. Uh, the other thing that happened is they went to the FDA and this is where there's a lot of fuckery. They, they literally met with the head of the FDA at the time after hours at a hotel. This is all documented now.

21:42And he helped them draft their application. Then rubber stamped it and pushed it through and gave Oxycontin the golden fucking ticket. He put in the label that Oxycontin is less likely to be addictive or abusive compared to other opioids in the market. And then you give a rep that and you set them out in a marketplace and you give them a $20,000 a month expense account and you have them taking guys to dinner, drinking wine and eating steaks. And they show in the label, Hey, we're less addictive. This is a safe drug. We've got to stop pain. You know, let's, let's really, this isn't just anymore for the cancer patient. This is anybody in your practice who has pain. We're on a mission to stop pain. And all of them started getting addicted. I mean, it was rampant. Uh, and the, the system was trashed because once you grind up the pill, you've just circumvented the delivery mechanism.

22:42And now it's super addictive because they're going to get high doses of an opioid. And that's what a lot of people were doing that were abusing it, right? They were grinding it up and snoring it up. And then they, it reminded me a lot with COVID because what happened is patients were, doctors were blowing the company up. Purdue Pharma is the name of the company and the families, the Sacklers. So the Sackler family, this is all documented now. And also, Jamie, anything I bring up, I've put on the ways to well website slash JRE, uh, because we're going to go over a lot of stuff. So any data point or study or any of that I bring up is available on the website. Um, what they did was, uh, the Sackler family ended up taking a agreement with the U.S. government. And part of that deal was they would pay, I think, $3 billion.

23:32And then there was no, uh, they could not prosecute them or come after them criminally. And it was done. So it was a settlement. And where's the $3 billion go? Well, they made, I think, $9 or $12 billion, $9 to $12 billion. I can't remember the number. But the three that they pay. I don't know if it goes to the family or the government. I don't know. I'm not sure where it all, if it went to the families of people. And this hits close to home for me because my brother died of opioids. My brother died at 27, man. And it's, I watched that documentary and it makes me want to fucking vomit. I'm just like, and it's not just the Sacklers. It's, you know, Johnson & Johnson, they're known for their diapers and their, uh, no teary eyes, baby soap. Johnson & Johnson made more than anybody during the opioid pandemic. They were literally growing. They were doing what people do in the marijuana trade.

24:20They were turning, basically juicing up and synthetically altering opioid plants to grow faster and more potent so they could turn them over quicker. And so they supplied all the opium into the United States and made billions of dollars, billions of dollars. And the FDA, uh, at this point in time, the, uh, DEA was getting involved, going to the FDA, going to all these governmental bodies and saying, look, this shit's getting crazy. Like this is getting out of control. The addiction rates are through the roof. What Purdue did at that time was pivot and go out and educate doctors on breakthrough pain. These patients aren't addicted. They're just still in pain. And the way to fix it is to write them more opioids. So they launched a 200 milligram pill and gave people more opioids. Oh my God. There's a tragic, uh, that the one that is dope sick is, is like a docu-series, but it's not a documentary.

25:22It's like a fictional reality. Yeah. Um, there is a documentary documentary and it's tragic. It's this Mormon family. And he talks about, this is the level of bravado that physicians oftentimes have his wife. They grew up Mormon and they had been married. They had multiple kids. And the story is his wife got in a car wreck, injured her neck and was doing okay. She was seeing a primary care doctor and a neighbor said, you need to go to the pain clinic and go meet Dr. So-and-so on story short, he puts her on oxy. He puts her on a bunch of other meds. Uh, she ends up passing out all over the house. The husband's like taking pictures of her to document for the doctor. And she ends up in the ER at one point. After she gets out, they put her in rehab. They get her clean again. And that doctor's practice reaches back out and asked to meet with the family and the wife.

26:14This is like a true story in this docu-series. And when, when the doctor meets with them and I've seen stuff like this happen, the doctor said, I, and I alone will make the medical decisions on my patient, not you. So are we on the same page here? And this, this guy said, I looked him in the eye and I said, yes, sir. Anyways, the guy's wife OD'd and died like literally a month later. And so they're suing the doctor. They're suing his practice. So the doctor got her back on pills. Dr. Got her back on pills. And what was his justification? What's this is where it gets so tough because when you're in it, like when I was in it, like erectile dysfunction and Viagra, like I said, Cialis, that's fun. Right. But some of the drugs you're, you are really passionate about. Like, and so I, I think he, I do believe that there's good and bad in every person. Right.

27:09And sometimes people's egos get in the way and he's probably been to course after course. I mean, the narrative they spin in this is he made hundreds of thousands of dollars in consulting fees from Purdue Pharma and was paid as a consultant and over a time span made, I think like three or $400,000 off Purdue Pharma. And so of course he's going to push Purdue Pharma's product. Right. Is, is the narrative. But what I saw a lot was you begin to drink the Kool-Aid and bleed the belief, if that makes sense. Like this is, we're changing the world. We're going to launch these pain meds and they're going to help. Because you're being financially incentivized for it. So you have a reason to think. You have a reason to be skewed. And then you're opening the door to let yourself be educated in a biased manner. Does that make sense? You're only listening to half the narrative. And that's a problem.

28:03And a lot of times physicians are listening to the big pharma company rather than their patients. God damn. Yeah. So, I mean, I experienced that. Like we had a drug, Stratera. And it wasn't like a dangerous drug. It was a really safe drug meant to treat children with ADHD. And I was passionate about it. Like I believed in it because I fucking failed kindergarten. I literally went to pre first. There were kids in my class with helmets because I was ADHD and dyslexic. And at the time, the only thing on the market was Ritalin. And they said, we want your son on Ritalin or we're recommending that he goes to like special education basically. So I had to go to a pre first. And then I jumped forward. I'm 23 and had graduated college and I'm making great money. And I see this drug that is non-abusive, non-addictive that we could be using to treat ADHD in kids

28:58and have them not go through all the headaches that I went through as like an ADHD kid. I was like, this is amazing. Instead of Adderall and all these stuff. And so you bleed it. Like you get really passionate about it when you buy in. And nothing bad ever happened with that drug. It wasn't as efficacious as the company presented it to be. It didn't seem to work as effectively. Isn't that always the case though? I mean, is there ever a drug other than Cialis? Yeah. Which really does what it advertises. Yeah. But is there, are there, I mean, that's kind of always the case that they exaggerate the benefits. Well, the biggest challenge is not only the exaggeration potentially of the benefits. It's the, if they begin to re-engineer or apply it to a different disease state. Right. I'm trying to think of an example that would be a good one to give you. They can take a drug and the patent's about to expire.

29:50All right. So let's say they have a year left on the patent. At that point, the company will begin to say, how do we extend the patent so we can continue to get insurance coverage and get paid and hit our numbers for Wall Street? We've got to get another indication. So when they resubmit for a new indication based off just efficacy, they do not have to go back and do safety studies. And so they don't do human trials. And so what they're doing is they're piggybacking it, but the dosages may change. The disease states change. The patient populations change. Yeah. It may have been safe, you know, as a osteoporosis drug and 60 year old women, but is it safe now that you're using it in a 20 year old girl? You know, that's the type stuff that happens all the time. And the guy who approved Purdue Pharma, this is the craziest part, the one who helped them draft their agreement and all that.

30:46Guess where he went to work 18 months later? Purdue Pharma. Making 300 grand a year. Which is always the case, whether it's in the financial sector or in medical. Yeah. Right. That's what they do. They always wind up working for some enormous corporation after they set the regulations that would benefit that corporation. They get a cushion job. Yeah. I think it was 12 out of the last 15 heads of the FDA have taken jobs in private industry for a big medical or a big pharma. God. And so I will say being behind the scenes, I've heard you say this about police officers. 90% of people, I think, are trying to do good. They're good people. But there are outliers in every capacity of life. Period. Just because somebody works for the government doesn't mean they're good. And just because somebody's a doctor doesn't mean they're good. And just because somebody's a rep doesn't mean they're bad.

31:42I didn't see very many bad reps. Like there weren't... I didn't see unethical. When I say bad, I mean like I didn't see a lot of unethical reps. They existed. Like I'm not saying they didn't, but not disproportionately any more than I saw in the rest of society. So they're incentivized to make a lot of money. And the best way to make a lot of money is to try to... First of all, the patent system. So if they lose their patent, then the drug becomes generic and then it's worthless to them. Correct. Because then anybody can make it. Correct. So they have to figure... And what is the time period where a drug can become generic? You know, I think it's like seven or eight years. I don't know the exact number, but they have a long time. They have a good amount of time to recoup their revenue and make their profits. And that's one layer of what's happening.

32:30So I don't want anyone to think Big Pharma is not guilt-free because they're not. There's a lot of aggressive tactics that happen. Like me knowing exactly what prescriptions they wrote. One of the other things I saw they did is when I first started, we could type in call notes. And so I'd come out of a doctor's office and I had to type in the computer what the doctor discussed, what they said. What happened with that is people started reporting adverse events. They would type in there, doctor said that the patient had a migraine headache or whatever it is. Well, now that's in the computer. And now that's turned into corporate. And now corporate has to report that back to the FDA depending on the event. And in my time in pharma, they switched from that to drop-down boxes where it didn't give me an option to type that stuff. Now they tell you. When you say drop-down boxes, what do you mean?

33:26So it literally was like they would prescript it. I discussed with the doctor the efficacy and benefits of Cialis. Doctor agrees, Cialis, da-da-da-da-da. And it's just like bullet point, bullet point. And I choose from a drop-down menu like multiple choice. Oh, what did I talk about today? So you don't have the option to put in commentary on what. Correct. And now I will say it's the same thing they did with don't promote off-label, don't promote off-label. Oh, wait, we're going to have a thought leader come talk to you and educate you on what he's doing in his or her practice. And then they're promoting it off-label the whole time. And then they send you out into the field, right, where nobody's looking and nobody's around. And this thought leader told you this stuff. You know what I'm saying? It's a shell game. It's like don't say this stuff, but we're going to teach you this stuff.

34:15And all of them do that. And Eli Lilly was viewed as – that's who I worked for. They were viewed as the most ethical – at the time, that was like their war cry, their battle cry was we are the most ethical company in big pharma. And, again, I'm not saying they were unethical. I'm really not. It's just there's – That's like being the Dexter of serial killers. Right? Exactly. You only kill the people that deserve it. So true. And it's just – they set it up for failure. That's all I'm getting at. The system is set up for failure. Okay. My bonus is based off volume. If I don't get the volume, I don't get the bonus. If I don't get the bonus, I can't afford to remodel my kitchen or whatever it was at the time. You know, I was a kid. And I'm looking at it going, okay, well, do you talk about this off-label stuff because this guy is, you know, complaining about XYZ?

35:10Maybe this is a niche where I can explain to him where somebody else is finding success with this product. Does that make sense? Yeah. You're not saying, hey, how do I get this product that's going to hurt people into the doctors? Nobody thinks that. Right. They think this is a good product. This guy told me ways he's using it that aren't necessarily FDA approved. The company told me, you know, in their online HR test that I'm not supposed to do this. But then they gave me all the data and resources to be able to do this. And nobody's here and it's me and my buddy having wine at a bar. Like, do I talk about these off-label things or do I not? And I think a disproportionate amount of the time people feel the pressure and they do. Because they're financially incentivized. Correct. And so when they do have these adverse events, when they do have overdoses, addiction, all these different things,

36:01and they've switched this drop-down system of reporting, like how do those adverse events get reported and how do they get documented? Now, they would still heavily encourage you. That's the part where I was going with the – it's kind of – it's an unspoken thing. Does that make sense? So they would say, if you hear about an adverse event, you have to report it. And there would be emails about if there's an adverse event, you have to report it. And trainings on if there's an adverse event, you have to report it. But that wasn't what happened in the field. If you reported something, all of the sales forces pissed at you. Because you just fucked their next six months or whatever it is. So there's – I think the most recent data – and this is med device. I don't know if this is pharma, but less than 2% of adverse events are reported. And that's also a huge disproportionate. So a huge disproportionate.

36:56That's right. That's the vaccine, the VAERS report. They said it's somewhere in the neighborhood of 1% of adverse events get reported. I would believe it. And they're not even asking, though. I have a friend who – she's a clinician. She's a surgeon in Houston. She trains Muay Thai. She's lean. She runs marathons. Phenomenal shape. 34 years old. Had to get vaccinated for her job. Got vaccinated. Got boosted. Started having blood clots. Now she's, like, been in and out of the hospital. Almost died. They had to do a blood transfusion. I mean, it's been a nightmare. And I asked her, did they – and I'm not – and she got it after her booster. And I didn't – I'm not saying that's what caused it because we'll never know. But I said, did the hospital ask you or even, like, begin to ask questions like, is anyone even alluding to that potentially this could be caused by that? And she said, no. Nobody's brought it up.

37:49And she works at the hospital. So I'm like, man, that's so crazy to me. It is crazy. And so they're trying to figure out a way to continue promoting these drugs, whether it's the COVID vaccine or whether it's any of these other drugs. And the best way to do that is sort of minimize the exposure to the adverse events. Correct. And then the other issue is you could have to recall, depending on the nature of the adverse events, you could have to recall, did this data show up in studies? Now you're under a governmental investigation. You know, if the data was in the study and you swept it under the rug or hit it, which is what happened with Oxy, they know. They were getting report after report. There were emails flying around in the first year of the drug launching that, hey, I think we have a problem here. Patients are showing addictive tendencies.

38:40And they would just, they would, they literally hired a thought leader, the same guy who killed the woman that I was telling you about. They hired him as a speaker and they taught him to educate clinicians on pseudo addiction. And the message was this patient's not addictive. They're not addicted to the drug. It looks like addiction. It's pseudo addiction. They're addicted to the relief the drug is providing them. Oh my God. So the answer is to up their dose. Oh my God. To avoid the breakthrough pain. Oh my God. Breakthrough pain. It just, it went crazy. Like breakthrough infections when they were trying to show the efficacy of the vaccine. That's why when they started saying it, I was like, hmm. Yeah. But it's, and it turned out the breakthrough infections were not just rare. It was more common than not. Yeah. I mean, pretty much everybody that got vaccinated. I saw it, I saw it yesterday on Apple news.

39:35And it was like, it was an article about the state of California. And it said that California is thankful that so many people are vaccinated because COVID deaths are rising. And I thought to myself in, in the state of California, I thought, well, then that means that it's not even doing the secondary thing they said it would do, which is reduce the risk factor of it being more catastrophic to the individual. I'm like, I'm skeptical of, I'm not, I'm not going to go one way or the other on the vaccine. I'll say this. There's two entities I definitely don't trust in this world, the federal government and big pharma. And they're both in gahoots. Yeah. And it's, and there was a tremendous amount of pressure to ramrod a drug into the marketplace. Tremendous amount of pressure to get these drugs into the marketplace. And for these pharmaceutical companies, they have carte blanche.

40:22There's no risk factor for them. Zero. Yeah. They can't, they're not even responsible. So they, even if there is something that comes back. And my thing is, if you're asking me to trust you, then act in a manner that builds trust. You've never done that as an industry. You've never as an industry been transparent, open, and honest. You've always misled us. It's like over and over and over again. Well, and this one also, it was so crazy because people were buying into it in a way that they had never done before. Where people were enthusiastic about a medication to the point where they were evangelizing it. And they would wear, you know, they would put syringes in their Twitter bio showing everyone that they'd been vaxxed. It was, it was a sign of virtue. Yeah. This definitely was the, it was, I mean, it was propaganda essentially. But it was definitely pushing a narrative. And yeah.

41:17It was pushing a narrative, but it was also people wanted that narrative. They bought into it wholesale. Well, people wanted to feel safe. Yes. Everyone wants to feel safe. Yeah. But. And they thought that was the solution. I mean, we'll see. I guess time will tell what the long term ramifications are. God. Yeah. That's, that's the other thing. If you, if you, some of the products that hit the market, they don't do long term studies on. So they may only be short term studies. And so some issues don't manifest till down the road. Um, trying to think of another example, like Zyprexa. I mean, I, I was another, that was a mental health drug that I carried. And doctors would tell me, Brigham, this lady came in, my patient, she's gained 20 pounds. Like, and she's like the fifth one. And I go back to the company and say, Hey, this is like, this doctor's telling me all these people are gaining weight.

42:08Well, you know, in the early stages of depression, when somebody comes out the other end of these, uh, depressed psychotic states, uh, they're up, they're mobile, they're active. So they're like eating again. And think about a lot of times these people hadn't eaten in weeks. Um, and now they're back up and eating and living life and enjoying life again. And so then I'd go back out and regurgitate that, but it turns out it wasn't the case is known that it is impacting people's, uh, I think like insulin response. I can't remember the details, but they got sued and they got sued for an array of different stuff on that, that drug Zyprexa, which was a blockbuster drug, uh, for Eli Lilly. And so is it a similar situation like with Vioxx, which is where they made like 12 billion, but they got sued for a fraction of that.

42:53And so they walk out of it with an enormous amount of profit, no matter what, even though they've been penalized. That's what happens over and over again. It's happened. I mean, there's dozens upon dozens upon dozens of examples. Uh, that is the market. That's the game. And in the COVID vaccine market, that's not even going to be the case because they're not able to get sued. Yeah. So for them, this is like the Willy Wonka golden ticket. Yeah. What scares me more about that is, and we're going to talk about this throughout the whole market. It's not sustainable. If it's all about profits and hitting quarterly earnings, and now you artificially inflated the earnings of all these big pharma companies for the last two and a half years, they're going to have to get creative to hit their numbers for wall street next year. What are they going to do to do it?

43:38What products are going to get pushed through the market faster to be able to do it? Uh, it, the good news is on pharmaceuticals. They do require large studies and they do typically require safety data in humans, not just in animals. But the, the but to that is unless it's a product that's already been on the market. And so most of these products, a lot of these products, they just change the indication, reapply for the patent. And now all of a sudden they're using a different dosage or a different, uh, using it to treat a different illness. Um, and so it's, it's tough. I'm sure you've seen that this new, uh, COVID booster, the Omicron booster, the new variant booster, they've done no human trials. Oh, I didn't know that. No. See if you can find that. But that makes sense. Yeah. And everybody's like, wait, what? Yeah. None? Yeah. Zero? This is a new medication.

44:34So it's a new version of a COVID vaccine and there's no human trials. It's crazy. And they're allowed to do that. How? Wow. Here it goes. FDA to authorize new COVID boosters without trials in people. Not only that, this is for Omicron, which is very mild. So this is not done to protect lives. This is done to maintain profit margins. Well, one of the challenges, and it's not, again, if we, it's human nature for us to try and find a witch and hunt it. Right? And so everyone says big pharma is bad. I'm not here to tell you big pharma is good or bad. Big pharma is what it is and it's big business and big business is about big money. And so just be cautious. Do your research. Understand that things aren't always what they're presented to be. But it's not just big pharma. That's where people misunderstand. Big medical, your surgeons, your doctors, the big insurance companies.

45:34Everyone has a part to play in this disaster that we're calling a health care system that's not. It's a sick care system. We do not practice preventative medicine. We do not prevent disease states. We wait for somebody to get really sick and then we give them a pill. And we treat the symptoms, not the root cause. And it's because the model is built in a manner that is not conducive to practicing preventative care. In fact, most insurance companies won't cover preventative care. Less than 2% of an insurance company's spend is geared towards preventative care. Most of the time, if you try to get any sort of preventative care, the carrier will deny it. One example I can give you is if you are pre-diabetic, you're on the verge of diabetes. We know if you transition to diabetes, it will cost seven-fold annually in health care expenses to keep you basically up and running.

46:31Why would an insurance company not proactively try to get you from progressing into that disease state? The answer is because just like big pharma, just like everything else, it's based on quarterly earnings. And they know we got to hit these numbers. And they also know the average American switches jobs every two and a half years. And most Americans are insured through their employer. So their thing is, do we spend the money on this person today, this man or woman today, to treat a disease state that's going to be somebody else's problem tomorrow? Probably not. Probably not worth it. And so they punt. They kick the can down the road. And it's the same with everything. Like the insurance companies are a major, major powerhouse. I would say the single most influential and terrifying part of health care. It's not big pharma. Big pharma has its flaws. All the stuff you and I have talked about.

47:25And it's scary. And, you know, again, I think there's outliers. There's good and bad. But big insurance controls more than people realize. Like it controls every aspect of medicine. Why is that more dangerous? So one example I can give you is a lot of people don't know this. But so the big five insurance companies, they there was a group called a PBM. Have you ever heard of a PBM? A lot of people haven't. It's called a pharmacy benefit manager. OK, the PBM was brought out, I think, in the 70s or 60s. And the goal was to sort through all these new medications coming on the market. And they were a consumer advocate. The job of the pharmacy benefit manager was to go negotiate with big pharma and drive down the rates of these new products and new drugs so that patients could afford it. And it worked for a while. But what people didn't realize happened is over time, the PBMs began to negotiate rebates.

48:29And they're covered by safe harbor. So we, the public, have no visibility. The federal government has no visibility. Nobody knows what the pharmacy benefit managers are getting paid. Here's what I mean by that. Insulin. Eli Lilly launched insulin. That's a hot button right now. Everyone talks about insulin and the cost of insulin. When Eli Lilly launched the product, they made $145 per vial in profit. All right. Or in revenue. Um, it, since then, even though the price of insulin has tripled, Eli Lilly now makes less than, I think, $120 for the same vial. So the question becomes, wait, where did those additional dollars go? It's the same on all these drugs. What happens is the pharmacy benefit manager goes to the big pharmaceutical companies and says, do you want patients to be able to get coverage and use this drug and have it covered by their insurance? Then you've got to give us a rebate.

49:29We want $50 a vial. Or I think, I think right now they're getting $30 an insulin vial or something like that is the, what the analytics say. And all this is also on the website. I put all this out there. So the pharmacy benefit manager is indirectly running up the cost of care because what they're doing is negotiating a cut for themselves. So then Eli Lilly and these companies go, oh, okay, well, we're going to raise our price by $25 a vial. So we can pay the rebate to the pharmacy benefit manager. So we can get preferred tier pricing on an insurance plan. And so almost any drug on an insurance plan, that's a tier one, meaning like that's the, the, a drug the insurance pushes you towards typically has a rebate that goes to the pharmacy benefit manager. Jesus. And so here's why that gets even more fucked up. The pharmacy benefit managers control 82% of the prescript three, the three big pharmacy

50:21benefit managers control 82% of the medications filled in America. 82% of the prescriptions filled in America are controlled by three big powerhouse pharmacy benefit managers. But the plot thickens who owns the pharmacy benefit managers, the big five insurance companies, Cigna, Aetna, United, they've gone out and bought the pharmacy benefit managers. So the people who decide what drug goes on formulary, what your copay is, what your employees, what employers expenses are, what gets reimbursed, what doesn't get reimbursed are also getting rebate incentives on the backend. And here's why that's really important. And this is what most people are not understanding. I had, I owned a retail pharmacy that would bill insurance carriers. If you come into my pharmacy, if your grandma comes in and she tries to fill a prescription, I'll give you Metformin. My cost on Metformin is roughly $2.

51:24I would sell her Metformin for $4. As soon as she discloses that she has insurance, I have a gag clause. I am not allowed to tell her my cash pay price. I swipe her insurance card, Blue Cross, whatever it may be. Boom. Copay $10. And she gets her medicine. I charge her $10. Immediately when I swipe that card and I enter all that in the computer, I get a $7 clawback. Where does it go? It goes to the VVM. So, you give it, like, I could have saved her $6, but I can't disclose to her that. And now the money, the profits, I make less money. She pays more money. And the money goes back to the big insurance companies. And so, I watch this fucking asshole talk in front of Congress who's like the head of the PBM, I don't know his exact title. And he's like, if we didn't save money, nobody would be employing us. You're employing yourself, dipshit. What are you talking about? Wow. If we didn't save money.

52:28So, they created these nets. And so, this gets tricky because think about it. If you have an elderly person over the age of 65, the average elderly American's on four or more meds. Okay? So, if grandma is getting price gouged on four or more meds and her out-of-pocket expense on those meds, because sometimes your co-pay is bigger. So, like on a tier one, they go, well, hey, that drug's more expensive. You're going to have to pay us, you know, $30 co-pay for it. That all goes back to that private payer. So, it is a dangerous, dangerous game. And it's gotten out of hand. That's why insulin's through the roof. And this isn't all anecdotal bullshit. The state of West Virginia felt like they were being defrauded by the big insurance companies and the PBMs. They fired them. And they said, we're going to bring everything in-house. They saved $22 million in the first 12 months. Whoa.

53:22You can Google PBM get fired by state. And state after state. Right now, the state of Texas is suing, I'll butcher it, Centene or something like that. They're a very small PBM, but they control the governmental pay. And so, even that gets tricky because as we begin to talk about power, big insurance will literally rip the head off of big pharma and shit down their throat. They have all the fucking power, dude. A hundred percent. All the power is in big insurance. They control what drugs get approved. They control what drugs get covered. They control, like, which tier placement they get. And now the big insurance companies control all your lab testing. Any of the, like, if you want to get a blood work done, like an example is, too, I owned a blood lab. You know, I've had a bunch of different experiences in this space.

54:15And when we would go out and educate clinicians and say, hey, here's the reason why you'd want to pull blood work. All the things that is now ways to well. I explain, you've got to stop practicing sick care. We cannot wait for patients to get sick. What we need to do is get proactive and not reactive. How do we do that? We begin to do that by analyzing the patient at a biological level and identifying potential risk factors based off their markers. And maybe they don't have diabetes today. But if they're on the verge of diabetes, treat. Let's start now. Let's get ahead of it before they progress. And the disease state or the hole gets too big that they have to dig out of. And doctors would say, okay, yeah, this makes sense. We'd start educating them on all the panels to pull. And for about 12 months, we got reimbursed.

55:08And then the insurances started sending letters to doctors saying, we don't think you should have pulled this blood work. If you continue to pull these extensive panels, we will put your contract under review. Wow. So if I'm a clinician and I lose Blue Cross Blue Shield, I'm out of business. We will put your contract under review for taking proactive measures to keep people healthy. For running up the cost of health care is what they will say. Like big insurance's narrative is this guy's running up the cost of health care, pulling unnecessary blood panels on a patient. And, you know, this guy's 33. Why did you pull a full panel? Well, again, that's why we ended up pivoting and doing ways to well and going cash pay and cutting out all these people, which we'll get into. But, I mean, layer upon layer upon layer. Another example, pharmacogenetic test. Have you ever heard of it? No.

56:02Most people fucking haven't. You know why? Insurance doesn't fucking cover it. So it's an amazing test. And we launched it. It's a cheek swab. You drop it in an envelope. Within 48 hours, we know your unique genetic makeup, what your cytochrome P450 variance is, and how you're going to metabolize a majority of the medications on the market, including high-risk medications like Plavix, that if somebody's a slow metabolizer, it could kill them. It had a black box warning. Like, we could go down the list of all the benefits of this pharmacogenetic test. And clinicians loved it. And they're like, oh, my God. It tells me how, what, it'll tell somebody if an opioid won't work. Because certain outliers of the population have a unique genetic marker that makes their body incapable of properly processing an opioid and getting pain relief.

56:52And so we would say, test these patients before you write them these catastrophic medications. Like, let's make— So this is a known variable, and it's not taken into consideration when they prescribe oxys? Correct. Yeah. And it's the test got covered by insurance for probably 12 to 18 months. And then insurance sent letters saying, we're no longer covering this. We're not going to cover these tests. What happens to a person if they have that variant? And then they do get prescribed opiates. Well, they don't get relief. And so then the question becomes, is this patient drug-seeking or is this patient just in pain? Right? And that's part of what we were trying to clear up. And do they just ramp up the dose? Typically, they'll end up up in the dose or they'll try and pivot and find something else. What is a pivot? Like, how do you pivot when someone is not responding to the most potent?

57:42Well, that's what's hard. And, you know, like, yeah, in the pain field, they've got an array of tools in their tool belt. I was never a pain specialist. I wasn't really in that space. But the other part of that, what would happen is they came out and they, after the opioid disaster, they had all these guidelines on. We want you to, if you're going to prescribe an opioid in order to protect from divergence or misuse, we recommend that you do a toxicology screening. Okay? Well, even that, the insurance quit covering. They used to cover that and they stopped covering, in the majority of cases, toxicology screening. So all of the tools that are safety nets are being strategically eliminated. And it's not some bad intention of let's create this terrible environment for people. It literally just comes down to whether we're talking about big insurance, big pharma, or big medical, or big hospitals.

58:37They are trying to hit quarterly earnings. And so when you have something like COVID vaccines that come along and create this enormous source of profit, and then they're not necessary anymore because it becomes endemic. And then the variants decrease in the potency to the point where it's like a common cold, which is how many people experience Omicron. Then they have to find reasons why you need to continually medicate. Yeah. Because they need to keep funneling those profits in. You got it. Because they're in a place of constant growth, right? If you're involved in a corporation, they don't want bad years. They don't want bad quarters. If they've made enormous windfalls, they want to continue that. Yeah. You got it. No. If there is a way to continue to reskin a drug and not have to go through the R&D phase, then they're going to do it 10 out of 10 times. And it's even crazier in med device, man.

59:39Wait until we talk. Med device. Med device is anything in the operating room. An implantable, a pacemaker, a knee, a shoulder, mesh, stitches, sutures, anchors, screws, plates, all of it. I brought this. I brought a plate to show you. I want to show you this. And tell me what you think this amazing marvel would cost. Well, it's a piece of – is this titanium? It's like just a little piece of titanium metal. What does that cost? That is about $800. And then each one of those holes is a screw. And the screws start at $125. Is this the set bone? It's to – If you do a break? If you break in your wrist, it's to set that. And so when we start talking about the price of healthcare, it's like that piece of technology has been around for, what, 30, 40 years? That plate. And we're still charging $700 for a plate that costs, what, 50 cents to make? I mean I can't fathom that costs more than a couple bucks.

60:42I can't fathom. Well, titanium is kind of expensive. But I don't know. I don't know enough about it. But $700 for that and a screw is $125. It looks like something you could pick up at Home Depot. But where it gets crazy with big medical – and I didn't know this when I was in medical. They have a process. So the same way they try to extend patents in pharma so they don't have to do safety studies. In the 1970 – I think it was 1975, the FDA established what they called the 510K approval process. And most – nobody knows this. Essentially what it was was devices, technology were now coming up quickly. And they needed a way to get this technology into the OR safely and efficiently and quickly. And the FDA didn't have the resources. Most of their funding comes from private industry. That's one of the other challenges. I think 62 or 63 percent of the FDA's funding is from private industry.

61:40So it's not a – it is a governmental entity, but it's funded by private industry because the market's grown so fast. And they're understaffed. I think they have 6 or 7 percent of their annual budget goes towards biologics. So very, very little of their resources are towards biologics. And I say that so later when we talk about the biologics, you'll understand why it's taking so long. But – oh, so the 510K process says this. If you can show that there is a like product on the market, then they will allow you to forego human trials and safety trials and launch the product into the marketplace. Okay? And this started in 1975. They call it a daisy chain.

62:31So an example I can give you is by the time I was in the operating room doing surgical sales, we were selling state-of-the-art, high-definition camera systems that would go into the body and allow physicians to have visibility without cutting you open and do surgery laparoscopically or arthroscopically, all of those things. That's just one example. But that technology was based off older technology. It had never been safety studied. And that's across the board. So when the FDA gave this loophole in 1975, they said, we're going to give you, the industry, a loophole. And if you can show it's safe because something else is in the market like it, then you'll be grandfathered in and you can launch the product into the OR. The plan was less than 10% of the products in the operating room would go through this process. That was the expectation.

63:2398% of the shit that is in the operating room came in through the 510K approval process. Why that's important? There was never a safety study. There was never human trials. And this stuff's getting put in people. So an example I can give you is metal on metal hips. There's all sorts of lawsuits. It's about metal on metal. They launched a hip based off 25-year-old patents that were already out there. And all they did was change it to a metal on metal hip. And patients were beginning to experience dementia, Alzheimer-like effects because what was happening, metal on metal, the metal's grinding. And metal shards are breaking off and getting into the bloodstream. And people were getting metal poisoning. And so they, to this day, don't know how many people were poisoned by metal on metal hips. And most of the companies have pivoted away from metal on metal. But that's just one example.

64:20There was a mesh launched by Ethicon, which is also Johnson & Johnson, which is the people who made all the money off the opioids. And they're a powerhouse. They have a lot of lobbying power. J&J launched a mesh. The mesh had been in the marketplace forever, but it hadn't been used for women's health, like as a vaginal mesh for women who had prolapsed vaginas or issues, female issues. So they started putting these mesh up in women's bodies. But they've never done a human trial or safety study on what would happen. And the uterus began to eat the, like, scar and swell around the mesh and cause all these issues. So women were having to have hysterectomies. There's a big lawsuit on that. Ethicon, to this day, denies that it's an issue. But there's lawsuit after lawsuit on it. But I'm trying to think of some other examples. I mean, there's so many, man.

65:12There's just – it's like one after the next after the next. Some of them – like an example would be, like, Esher is this sterilization technique to help a woman who doesn't want to get pregnant but didn't want to go through a hysterectomy. And so it's this little spring-loaded device that they would shoot up in there. The problem with it is they never did any studies to see how to take it out. And so as soon as they have adverse events, now it's like, well, shit, we didn't really do a study to see how do we remove these items. Or these people with hips having these issues. Like another example would be – I won't say the company, but a company launched a hip that squeaks. And so it's known. Like two years down the road, your grandma is going to be walking. It's going – Loud. Yeah. And so that's an issue. I mean, there's just – there's dozen upon dozen upon dozen.

66:02Medical is still, in a way, the Wild West. We had – and it's just – it's crazy to me. And I say all this because I want people to understand everything is risk-reward. Stay healthy as long as you can. Take care of yourself. Get proactive. You do not want to go into surgery unless you absolutely have to. Like you do not want to be on these different treatments and medicines unless you absolutely have to. And 80 percent – it's actually 82 percent of all-cause mortality is preventable. 82 percent of the shit that's killing Americans is preventable. And without having to go down the path of having diabetes and atherosclerosis and cancer and all these different things, we can prevent a lot of this stuff if we just got proactive. But the system's not built to do that. The system is built to crank patients in and out, to get them to use their insurance and pay their co-pays and deductibles,

67:05and move on down the road. You know, you and I have had conversations about this before, but never so in depth. Yeah. And I'm even more depressed now. It is. It is sad. So where I was going, I'm so ADHD. I wanted to tell you, like, a real tragedy is the elderly population. We're rapidly – there are more people – I think it's in the next decade – there's going to be more people over the age of 65 than under the age of 17. So we are rapidly progressing towards an elderly society in a market where we're rapidly digressing with the amount of clinicians available to treat those people. 40% reduction in primary care over the next decade. Where are these people going to go for preventative care? So your grandma goes in and she has four prescriptions, and she gets caught in that whole model I was telling you about. This is where it gets really, really bad.

67:54Most of the time, like, let's say – I'm just going to use simple numbers to try and make it easy. Let's say she has $10,000 in coverage a year for medicines. That's what her insurance plan covers. When they artificially inflate the number, right, to the average wholesale price, including their rebate, what they're doing is wiping out her deductible faster. You get what I'm saying? They never pay that price. So let's say insulin is $200. They didn't pay $200 because they got the rebate. But what they did is your grandma only had $10,000 in coverage. She's got four medications that month. If all of them were $200, that's $800. Grandma is out of treatment by eight, nine months into the year. Now she's got to come out of pocket. And so the insurance says, no, we don't cover it. We covered the first $10,000. You're on the hook now. It's called the donut or the gap.

68:47And so that's the problem with the way they have this structured in these rebates and this shell game that they're playing is I think one in four Americans – the newest study says one in four Americans can't afford their prescription medications. My friend's mom is mentally ill and she has schizophrenia and a few other things. And she's in a care facility. And they just – because of the insurance, they just minimized her dose. They just reduced her dose. And she's having full-on episodes. And they won't do anything. And he tried to talk to her and he tried to talk to the people at this facility and say, hey, you've got to put her back on her medications. She's going off crazy. And they're like, you're not a doctor. We're not going to listen to you. And so now he's helpless watching his mother have these schizophrenic breakdowns. She thinks there's a chip in her brain.

69:42She thinks people are talking to her. The government's plotting against her. Full-on episodes. And they had it under control with the proper medication. But then that proper medication became too expensive. She ran over her money. It's sad. It is really sad. It's really hard. It's the same in the surgical market. On average, it takes three to nine months to get approved for a spine surgery. And so the problem with that is now they're addicted to opioids. Somebody with a catastrophic spine injury and you're arguing with the insurance for three to nine months to get a surgery done. By that point, they're going to be hooked on opioids. They've been on opioids for almost a year. Like, good luck. And not to mention, you've wrecked their endocrine system because opioids are catastrophic for hormones. I mean, it is such a cascade effect of decline. It's terrible.

70:35And then this is why I'm so passionate about regenerative, preventative, using biologics, using peptides, getting ahead of the curve, stopping disease states before they happen. And 30 fucking percent of spine cases end up back in surgery. What happens as soon as I think I told you this, as soon as you and I'll use this water bottle, as soon as I lock in this and fuse this portion of the spine, all the vertebrae below it are still moving. All the vertebrae above it are still moving. So now anatomically, I've created a structural stress issue. And what happens inevitably is within a couple of years, most people end up back under the knife getting another fusion, getting fused in a different vertebrae. Is that mitigated in any way by these articulating titanium discs that they're using now? Because I know quite a few people that have had that done. You know, I haven't those.

71:27I didn't see those when I was in the OR, so I don't know how much that's changed. I do know if you look at spine satisfaction rates, they're pretty low. They're pretty horrendous. Everyone that I know that's gotten fused is fucked, including Ronnie Coleman, who came in here, who has his whole back done. I mean, they started doing him and then they wound up doing his whole back and he can't walk now. I mean, I know he's gotten some stem cells and apparently he's had some improvement in that regard, but they literally just fused everything in his back to the point where his legs are atrophy. That's why I don't understand why they don't. And I do understand because what I tell people is fighters fight, bakers bake, sergeants cut. That's what they know. If I talk to, like, one of my really good friends does all the Texans and rockets and has been a team doc for all these teams.

72:19And we've argued over stem cells because his thing is, like, stem cells don't exist. You can't get stem cells in the United States. You know, they're illegal. I mean, just the whole narrative that he's been taught. And the truth is, do you want me to break down stem cells and try and explain it? So most of the products on the market do not have live cells. There are two types of products. There are cellular and there are acellular. Cellular products have to be stored in a cryo freezer kept at extremely cold conditions or kept on liquid nitrogen. That's the only way to maintain cellular viability. So that's one component. The other component is the founder of these MSCs, the scientist who discovered these mesenchymal stem cells, has since, in an open letter apology to the medical community, redacted the name and said, I should have never called them mesenchymal stem cells.

73:26Is it mesenchymal or mesenchymal? You can say either. It's both. It's both. Depending on where you're from. Nuclear or nuclear? Yeah, it's the same. But a lot of the PhDs that I've done calls with and stuff say mesenchymal. So that's what's been hammered into my head. But I asked that same question because I didn't want to sound like an idiot. And he's like, oh, you can say either. Dr. Kaplan's who discovered this. And he said, I did a disservice. These are mesenchymal signaling cells, not stem cells. And how did that bloop happen? It's because in vitro, in a petri dish, he was able to get the cells to differentiate. But when in vivo, put in the body, these cells do not differentiate. They don't become anything. But that's not bad. That's not good or bad. It's just it is what it is.

74:16The blessing is one of the fears from the FDA and a lot of these regulatory bodies is what if we put these cells in and they become a cancer cell and they start growing cancer in patients? Again, the fact that they don't differentiate means they don't become anything. So you get all of the benefits of the signaling cells triggering the body's own natural healing process. You get not only mesenchymal signaling cells, but you get cytokines, exosomes, scaffolding, vesicles, all of these goodies that feed cells. And the cool thing about these MSCs is they will literally connect to a cell that's dying and transfer their mitochondria. So they will give their mitochondria to dying cells. And that's a that's a lot of the reason why they think there's such good results on like skin.

75:13Like I was telling you with my face when we treated my face with stem cells, you're literally getting rid of the dying cells and rejuicing them, refueling them and then triggering the body's own natural healing process. But MSCs have become like the big focal point. But in reality, there's a plethora of like nutrients and goodies in these tissues. So the reason that people would say they're illegal are one, they're not mesenchymal stem cells. They renamed it to mesenchymal signaling cells. They don't differentiate. Those are important things to know. The second is these tissues are all placental derived, meaning placental or perinatal derived, depending on cellular or acellular. Why is that important? During the Bush administration, they were worried that people would be aborting fetuses and taking fetuses and cloning cells and manipulating cells to try and find the fountain of youth.

76:11And that was the fear from the community. Oh, my God, are they going to start killing babies to make make stem cells? This comes from all of the thought leaders today. For the most part, agree that the best place to get it is the placenta because it's and they do this through a healthy birth, healthy mother, preplanned C-section. They then take these tissues that would have previously been discarded. They cryo freeze them. They take them to a ISO certified lab. They run them through a rigorous screening process. One in 10 umbilical cords makes it through to the end because if there's any contaminants or cross contaminants, those get thrown out. What you cannot do in the United States, what is illegal, is fetal stem cells or using any sort of fetus to harvest stem cells. And it is also illegal to isolate or manipulate the cell and put it in the body.

77:08And so even though Neil Reardon's using placental derived tissues in Panama, what he's doing differently is he's isolating out the MSCs and then, for lack of a better term, culturing them in a Petri dish and creating a larger number of the MSCs and putting that into the body. Now, is there a benefit to that? I don't – my answer to that would be that I don't know of a downside. I really don't. But in medicine, they say therapeutic dose is the minimal dosage required to elicit the desired response with a minimal side effect profile. And so I look at what's available here in the United States and say, I mean, you've experienced it. I can go – we could go through testimonial after testimonial. Hundreds and hundreds of people and athletes and elderly people and people with, you know, back injuries, knee injuries, shoulder injuries, elbow injuries.

78:03We've had phenomenal results just using perinatal tissues. And there are live cells. That's what people need to – because what their doctor will say is, oh, that's bullshit. There's no live cell. You can't do stem cells in America. They don't know. They don't know the literature. And I also – on the website, I included just so it's not bro science, study after study. There are white paper studies. It just got presented at the Orthopedic Journal. They did a study with amnion in the hip. And amnion versus placebo, it was like 70-something percent of people had significant improvement in hip pain four weeks out and up to a year out versus placebo, which was like 90 percent of them were miserable. And so this stuff works. I understand where the FDA is coming from. Their stance is – well, another area of where this is illegal is just so we can debunk all of it.

78:58What happened is a lot of bad players – and this happens with every time something new comes out, there's loopholes, right? And so because the federal government recognized the value in amnion in some of these placental-derived tissues and perinatal tissues, they gave what was called a Q code. A Q code is just a billing technique that allows a temporary loophole on a treatment so that the doctor can get reimbursed for what they're doing. So jump forward, that Q code was indicated for basically wounds, wound management. If you have a severe wound or you're a diabetic wound, you can bill for that product and it'll get covered. But then what happened is it got in the marketplace and people began to manipulate the system and use it in a spine, use it in an elbow, use it in a wrist, use it and tell the patient, well, it'll be covered by insurance.

79:53Well, they were billing it using a Q code that wasn't approved. The Q code was indicated for a wound. You're not treating a wound, so you can't bill that code. That's health care fraud. That happened. And so then all the payers get mad and then the Department of Justice gets involved. And so they start putting pressure on the FDA. A lot of the backlash on these products is nothing to do with safety or efficacy. It has a lot more to do with bad players doing bad stuff. That's it. Like even the adverse events. Like, I mean, these products have been – they're not even products. These tissues, these cells have been around millions of years. This is millions of years of evolution. I don't know if you were there when Tony was telling me the doctor said this is bro science and that he – how much of the literature these doctors read when they spout out this is bro science?

80:46It seems like this is really comprehensive and time-consuming research to try to educate yourself about the efficacy of these things, how they've been applied, how they've been effective, what's worked, what hasn't worked. Is there any incentive for these doctors to even do this work? And, like, where are they getting this narrative that it's bro science? Well, you're going right down the right path because the truth of the matter is, like I said earlier, a surgeon's tool is to cut. That's what he knows. That's what he or she's trained in. That's their proficiency. That's their passion. And that's where they know that they can make an impact. I'm not here to say that's good or bad. But anything that disrupts that is an antagonist to their practice, is an antagonist to their livelihood. So there is no financial incentive to embrace this technology.

81:41And so when we start talking about this, there's an age-old quote, and it's, Science evolves one funeral at a time, and it is the most true fucking thing I've ever heard. Wow. That's harsh. The current thought leaders will always suppress the up-and-coming thought leaders. And it's not until those guys either die off or retire that new trains of thought and procedures make it into the marketplace. Our market is typically 20 years behind the technology. It's 20 years. It took us 15 years for doctors to accept penicillin. They thought he was a quack. And now I think he won a Nobel Prize Prize and is like a legend in medicine. But for 15 years, he was ostracized and told he was a quack and doesn't know what he's talking about, and you're crazy. And now it's embraced.

82:33And so I just think it's an easy way out is to say, I don't have time for that, and I'm busy, and I know that if I do this procedure, it works. You know? I mean, it does, but what does the patient have to go through to get to that end point? If there is a better solution, I mean, 30% of patients are unhappy with their total knee. Can we avoid a total knee? I think the answer is yes. I think as these products evolve, and there's a ton of these products in stage 3 trials with the FDA, it's finally, finally coming. I think in the next few years, you're going to see a lot of it hit the market. Will insurance cover it? I don't know. Insurance doesn't cover what's best for the patient. Insurance covers what's best for their pocketbook. That's why we're still using 20-year-old joints. When we talk about innovation, people say, well, why is that plate so expensive?

83:26Medical device, big pharma, whatever it is, the narrative is, it's expensive because we spend millions and millions of dollars on innovation. Bullshit. We've been using the same fucking knee for 25 years. Literally, we've changed. It's metal. Now it's plastic. Now it's polyplatin. Now it's it. It's like, but it's the same knee. It's been out 20 years. Why aren't they innovating? They're not innovating because you don't get paid to innovate. You can't. So the insurance controls the reimbursements. The insurance is cut reimbursements to the hospital. An orthopedic surgeon wants to do a joint. He's making less money per joint than he's ever made in his life. He's having to do more joints per day to make the same money and make that Porsche payment and all of those things.

84:08And then at the same time for big medical, they're taking a 5% cut typically annually from the hospital systems on the same joint that they were selling a decade ago for double the price. Right. And so every year, 5% cut, 5% cut, 5%. That's not going to go back up. You think you're going to launch some new state of the art joint into the marketplace and all of a sudden be able to charge $5,000 a joint? No, there's no way because the hospital is going to say hit the bricks. And now that's even controlled. When we talk about innovation, what's happened is where I was going earlier with the doctor used to know the family and used to come to the house and used to know you as a human. You're just a number. You're coming into the hospital. He's got to see 42 patients that day. He's hoping that a percentage of you need surgery so he can continue to up their numbers.

84:56And most guys, again, like I said, 90% of these people truly care. Like they do. They're not bad guys. And they come in with the best of intentions, but the system chews them up and spits them out. And so big medical is not innovating anything that's not going to get reimbursed. And we're in an insurance model. So innovation is now stifled because I can't launch a state-of-the-art joint if I'm not going to get paid for it. And you're not going to get paid for it in this sick care system. You're going to make less next year than you made this year. That's just where we're at. And the hospital is going to get paid less next year than they did this year. While the profits of the big five insurance companies are the biggest they've ever been. Halfway through this year, I want to say, and Jamie, you can fact check me if you want. I'm not positive.

85:43But I want to say it's $300 billion in revenue is what UnitedHealthcare had done halfway through the year. I mean, the numbers are just getting staggering. And they have so much power and so much lobbying. They control what products get put on the formulary. They control what reimbursements are on surgeries. They control what your co-pays and deductibles are. They control what the employer's plan costs the employer. And the only way to continue to make the Ponzi scheme work is to either cut benefits or increase cost. And so they're doing a little bit of both. Every year, the cost of our health care goes up and we get a little less coverage. They say I think it's 50 percent of Americans are underinsured or something. It's crazy numbers. Like the statistics are scary. And so all of this train wreck shit is the reason why we started Ways to Well. We were in it. I saw it.

86:40I saw them not allowing patients to get blood work. I saw the pressure they put on these providers. And I realized the only way that a provider can spend the time it takes to truly uncover the root cause of what's going on with somebody is if we go to a cash pay model and cut all these middlemen out. Wow. And so that's how we ended up structuring that. So how did you make this leap? So I want to take you back to you going from selling Cialis to they move you to Houston. You start selling these psych meds and this is what you're promoting. Like when do you become aware that this is a real giant issue? And how do you make this like pivot in your mind? I was still young and dumb. So I didn't see pharma as a bad guy. I just thought, man, I don't like that. I don't want to sell this anti-psychotic. I don't really believe in it. I don't feel comfortable. So I would focus. I had multiple drugs in my bag.

87:35I would only sell what I believed in. But then I get in trouble for not selling the other drugs. So then I'm like, oh shit. I got to start selling these other drugs. But I don't want to sell these other drugs because I don't believe in them. So I started to look at what are my other options. Med device jumped out. It's like, man, you're in the operating room. You're helping pioneer state-of-the-art surgeries. This sounds pretty cool. And it took me about a year to get in. That's a tough, tough gig to get. It's like for sales in a sales world, med device is the creme de la creme. Like it's the be all end all. You can make more than the surgeon doing the surgery. It's insane. I was 100% commissioned. I literally, it's the same thing. This is where I'm saying, it's not, nobody ever gives you a bad message. I carry thousands of products.

88:25Thousands of, like literally a book like this of different plates and implants and screws and thoracic cases and urology cases, OB-GYN cases. So I was crash coursing on all the different anatomies and procedures and trying to figure out where can I sell this camera and where can I do this and where can I do that. And you're just set off into the, I was in the Texas Medical Center, which is the largest medical center in the world. And I just went out, started meeting surgeons. Like it was a interesting job when they hired me. I loved it because my boss said, I don't want you to sell. I need you to change that mindset. You are not a salesperson. Like do not do the pharma thing. You're not here to data dump. You're not here to preach to doctors. I want you to go out and make friends. Go out and make friends and solve problems. And if you do those two things, you're going to do great here.

89:18And so I did that for 13 years. I was the number two rep in the company. I never missed quota in 13 years. I was one of two guys to never miss a number. But the stress was high as shit. You're 100% commission. I took the job and literally was nine months in and hadn't sold a single fucking thing. I put like 12 grand on my credit card, trying to like no expense account, no whining and dining. This is, you go out and you grind. You show up at hospitals and you begin to build relationships and you try and get your stuff into the operating room. It was nuts. And so I was like 12 grand credit card debt thinking, oh my God, I made the worst mistake of my life. Taking this job, 100% commission. I mean, it was scary. And so the first year I ended up making quota like with a few weeks left in the year. And I was 100% commission.

90:10And so I didn't get a paycheck until like the last quarter of the year I got my first paycheck. And they do a draw. So I got a big paycheck because I sold a big hospital contract. But then they took all my money because they had been floating me until I sell. So when I say this, not because I'm bashing the company, it was a fun job and it was cool. But it is very high stress, very, very high pressure because I am 100% commission. If I go spend, like an example I can give you is I did a trial at Texas Children's Hospital and showed them the state-of-the-art equipment. I spent two months in there. I brought lunches. I did dinners. I stood in surgery from dusk till dawn. I got up at 4 a.m. I got home at 9 o'clock at night, crashed, woke up, did it all over again because you have to be there early in the mornings to make sure all the equipment's ready, the sets are ready.

91:02You've got everything you need for this surgical procedure. Every procedure is different. Every procedure requires different tools. And you've got to have all your stuff there. Three months, did the whole thing. And they call me and they're like, hey, we're going with you. We're giving you the deal. You worked your ass off, kid. It was the OR director. She was so nice. She's like, you worked your ass off. We're going to give you this deal. About a week later, they call me and go, we have a doctor who doesn't want to use your stuff. We're going another direction. I'm sorry. So think about like I went from thinking I'm going to get a paycheck for all my hard work to I made zero. I burned not only made zero, I spent all my money. And so I say that narrative because it is a dangerous game to play in my mind with people's lives. Sometimes when there's that level of pressure on a salesperson, right?

91:49And it's do or die. And you need to get this deal or you lose your job. Or if you miss quota, your territory gets cut. So once you miss, like when they put guys up on the stage and they go, this guy made a million dollars last year. And he did. But if he misses his number, his territory gets cut in half. So now he makes $500,000. If he misses it again, his territory gets cut in half again. It's not makes $250,000. You can move backwards real fast. And so the game is like how do you keep growing? And that's how they've structured it because, again, it's not about patient outcomes. It's about profits and financials. And so the other thing they get is they gamify it, which was genius. They hired all athletes. Literally all my counterparts were like former NFL guys, like retired NFL guys, retired college athletes, at least collegiate level. And they make it a game. We're going to rank you.

92:47We're going to show the rankings. We're going to like you're going to compete against each other. We're going to have the winner's breakfast and the loser's breakfast. If you hit quota, you get to go to the winner's breakfast. We're going to give you a big check. If you miss, you're going to the loser's breakfast where you get cold eggs and like they give you a speech about how to not suck so bad. Like I never went to one of those. I don't know. So but it was terrible. Everyone would be embarrassed when they'd have to go to that breakfast. And the reason I want to share that is that level of pressure to me is just not a good idea in health care. And that's all med device. Med device is very high pressure pressure cooker. So you have reps in there trying to push product, trying to hit numbers, trying to hit quotas, trying to get their commissions and their bonuses.

93:31And that's not conducive to like necessarily doing what's best for patients. So how do you make this pivot towards ways to well? Like what is your what's your journey? Like how do you go and eventually branch out? Honestly, it was almost it was really so to two different major events happened. One, the passing of my brother passing from opioids. And how did your brother get hooked on opioids? What was the he had some sort of I think it was his ACL. He had a procedure. He got on pills and then he started taking them and then he started getting on black market. None of us knew that he was addicted. And then what happened is once they tighten up the restrictions on opioids, it became harder and harder to divert and get opioids illegally. So that when they talk about the opioid deaths, what's totally misleading is they're only telling you how many people died of opioids.

94:22What they're not telling you is once they pulled those opioids off the market, everyone turned to heroin. So how many people died over heroin over the last 10 years? That's what happened with my brother. He had never taken heroin. We had all the text messages. He he couldn't get pills anymore. And he he went out and got heroin for the first time and he snorted it. It was powder heroin and it was cut with fentanyl and it stopped his heart. And I remember I was like sitting in my house and I got a phone call from a stepmom screaming and I couldn't understand her. I was like, what, Tammy, what's going on? I thought it was my dad. And she just said, your brother's dead. He's fucking dead. And I was just like in shock, like total shock. And so that. If you want to try it, we can try it. But I would not try it. Right. And I would just be honest with them. So then they would say, what do you think of this?

95:37What do you think of that? And to just being honest, I killed it. It was crazy. It was like this weird anomaly. It's like, hey, just tell the truth and everything's going to be OK. Like you win some, you lose some. I don't have to sell you everything. Let me find what I have that can help you and your patients and your patient population. And let's use that. Let's focus on that. But as the doc, so the doctors began to trust me and jump forward after my brother passed away and a bunch of different things happened in the state of Texas. This is a whole nother condoluted space. So cut me off if anybody gets boring. There's because it's a lot to cover. It is. People don't understand this. Every single thing that touches your physician's practice, there is a potential that they either indirectly or directly have a financial interest in. Forget big pharma. Forget them getting paid as a consultant.

96:29That's pennies on the dollar. Your orthopedic surgeon owns the braces that get put on your knee and marks them up. They own into the labs and the MRI centers. They own into the surgery centers where they cut. They own into all of it. Right? So what happened is insurance pays less and less and less. Doctors start making less and less and less. Doctors look for ways to recoup the income that they lost. Merges with or in launches into what's called an ancillary market. So all of a sudden, overnight on every corner, MRI centers popped up. Because people went out and told doctors, you can own into the MRI center. Instead of sending it off to just a random MRI center, send it off to your MRI center and you own in. And I'll manage it. And I'll run it for you. And so, now granted, again, 90% of people do shit right. 90% of them are doing these MRIs anyway.

97:26But there are the outliers that are terrible humans that are going to run more MRIs because they have a financial interest. My doctors came to me, one of my big providers, and he said, hey, I trust you. I don't trust these other guys. Would you have any interest in jumping ship from surgical and going out and building physician-owned labs and pharmacies? And I told him, I'm interested, but I need to explore it and figure out what it looks like, how this works. You know, I just want to make sure anything we do, we do right. How can they do that? Are they allowed to have ownership? And so, long story short, he's like, if you do it, I can bring you a huge, huge group of providers. Like, we'll all sign with you because we trust you. I went out, and this is crazy.

98:16I went out, I took the money I had saved up from being a device rep, and I spent a huge chunk of my life savings on meeting with former DOJ attorneys, healthcare compliance attorneys, just data downloading, trying to understand how does this work? If we're going to do it, we're going to do it right. What are the risks? What are the pitfalls? How do we make this ethical? How do we make this not dirty and grimy? How do we do it in a way that's fair and just to the patient, but in a way where we can still be profitable and make money? And to me, the answer was, if these are tests that doctors are doing anyway, and we establish clear, concise clinical protocols, then, yeah, there's no issue with them having a passive interest in the entity because they're going to do it anyway. So, it may as well be with an entity that I own.

99:02And so, we went out and started structuring these entities, and there's a way to do it right and there's a way to do it wrong. So, I'm going to tell you because it gets wild, dude, wild. I went out and I hired Dr. Bill Massey, who sat on Donald Trump's opioid abuse, or Obama's opioid abuse committee. And he's a PhD, a thought leader in the field. He established all of the clinical protocols. He's a former, like, he established the protocols for the Mayo Clinic at one point. He's a thought leader. And I said, Bill, what makes sense? Tell me what's good medicine. And I will roll those initiatives out to the doctors. And so, that's how we ran a model. And so, what essentially, long story short, we owned pharmacies, we owned labs, we owned all these things. And physicians are legally allowed to have a passive interest.

99:51Meaning, so the way the law reads is you can never pay a provider or an influencer of referrals on the value or volume of his or her referrals. That's the law. But, you're allowed to sell them an interest in a business entity. So, when your surgeon takes you to a surgery center, they own into that, typically. And the way the law reads is they can own up to 40%. Now, what you're not allowed to do is ever adjust or change things based off that provider's referrals. So, the way we ran our model, everybody writes a check. Everyone buys in. Everyone has equal equity. Everyone gets a distribution on the success or failure of the entity. I don't care if you send me 500 patients or five. It doesn't matter. You're all getting the same distribution. Does that make sense? Yeah. In an effort to not skew that line.

100:45And then, for me, it was so passionate because what we were selling was non-abusive, non-addictive pain creams. And I'm like, oh, my God. This is – we can save lives. We can get people away from taking these abusive drugs. That was the thought. And you say pain creams? Like, what's in the pain creams? It's a ketamine-based pain cream. But you can't isolate out or extrapolate the ketamine. And so, when implied topically, it'll basically numb the neuropathic pathway that's sending the signal from the knee to the brain or from the elbow to the brain. And it was an array of different things like the genetic testing, pharmacogenetic, all these different things. And we did that for a brief stint, and it was the Wild West. The long story short is it was so corrupt. It was so dirty. It was terrible, dude. Dude, I'm sitting here, so I'll tell you how I ran mine so you have a means of comparison. I went out.

101:44I hired Bill Massey. He established all my clinical protocols. My meeting with a physician would go something like this. If this was your mother, if this was your daughter, if this was your sister or brother, would you do this test? And if the answer is yes, then do the test. And if the answer is no, then don't do the fucking test. Period. Like, let's just do what's right. And here are Dr. Bill Massey's recommendations. Here's his clinical protocols that he established for the Mayo Clinic back in the day. And this is what I think. What say you? Do you think this makes sense? And we would take a clinical approach. I was, and then, so there's that aspect. Then I went out and got a fair market value assessment from an independent third party. Like, anything I do, I'm going to do right. I went in with belt and suspenders. I'm like, I'm going to get a fair market value assessment.

102:34I want to make sure that everything that we're doing here is on the up and up. So I got two different fair market value assessments from an independent third party accounting firm to make sure whatever we distributed to doctors was fair. And then I hired a former FBI agent to run my compliance. Compliance. Because I said, this is such a sticky space and it's so confusing. So I brought in a former FBI agent to run compliance. I brought in a former DOJ prosecutor to structure everything and tell me what I can and can't do. And so I spent all this money. Launch all of this. Launch all of this. And get it all ready. And I'm ready to go. And I go to meet with the doctor who had asked me to do all this. And he says, yeah, we're going to go another direction, Brigham. We have these guys that they told us we can make a bunch of money and that they'll come set up our clinic and we can kill it.

103:25And, you know, yours just sounds way more complicated and way more complex. And so I literally, Joe, I swear to God on my life, I went home that night and I laid in bed and I cried. Because I'm like, I just wasted my whole fucking life savings trying to build this thing out. I thought this was going to be my career. I thought I was going to leave and go build this new company and da, da, da. And I laid in bed that night and I woke up the next morning. I'm like, either I can give up and just say it's over and I lost everything. Or I can take all this stuff I've built out and go out and start trying to see if there's somebody who wants to do it right. And I went out and started meeting with doctors and educating them on why these guys are criminals. Like, do not do this. If you do it the way these guys are telling you, if they're telling you they're going to adjust your shares, that's a kickback.

104:13If they're telling you that they're going to pay you more if you send more, that's a kickback. Do you understand this? That's a felony. You'll go to prison and the doctors just didn't understand it. It wasn't that anybody wanted to commit crimes. I just think they were naive. They were like, oh, well, they have an attorney's letter and they have this. It doesn't matter. Did you explain that to the initial doctor who turned you down? Yeah. Yeah. Long story short, he ended up coming back. He ended up coming back to me. So and this is on. I built it the right way. And that was a blessing and a curse because. There's so much shit, Joe. Jesus. The market shifted. So what happened when I started this? I always say you can't judge somebody today for what they did yesterday because the world's changed.

104:58And so the market when I started this, the narrative from health care compliance attorneys and regulators and former DOJ prosecutors was. As long as you don't touch governmental pay, you can have a physician invested model. Just make sure you run it right. And you follow the rules and you do your best to hit the safe harbors. Very laissez faire. Not like you better get it right or you'll go to prison. They should have been telling guys, you better get it right or you'll go to prison. Because what I saw in the marketplace will blow your fucking mind. I was competing against guys. There was there. They got federally indicted. A group of guys had what was called the slambulance where they converted an ambulance to a strip with a stripper pole. And their biggest prescriber of the month would get to go out and party.

105:47And they take them to titty bars and they would have strippers dance on them in the ambulance. And they called it the slambulance. And so there was that. There was like, I mean, just egregious thing after egregious thing. And you saw it. It's like it started here and then it just got way over here for these people. And I'm still here trying to run this thing. And I'm like, this is just not sustainable. I'd have doctors email and say, well, this guy told me he could pay me way more money than you. And I would just send it on to my FBI agent and go, hey, you go talk to this guy. Kick him out of the group. I'm not doing this. Like, I don't care. And it was so stressful. It was so stressful. I hated every I hated life. It was miserable. I didn't think I really feel like we did a really, really good job of running something. Clean, safe and efficiently, but it just was not.

106:40And then then I got behind the curtain and I started to see what was happening. Like, oh, the insurance companies won't reimburse on this stuff. Oh, even though the patient needs it and there's medical necessity, the insurance doesn't want to cover it. Oh, even if there's medical necessity and the patient needs it and the insurance does cover it, they're going to send a nasty letter to a doctor and start threatening them. This is not sustainable. The only way to do this is a cash model. And so I began to take the money I made and I bought a building and I built out a 503A sterile pharmacy and we got into sterile compounding. And I began to tell clinicians, hey, let's offer patients these products for cash, for pennies on the dollar. Let's just take them out of this insurance model. Let's give them these solutions for cheap and cut out the insurance agents and insurance companies.

107:31And that space that I was in, as I built out my pharmacy, that space blew up. And so what happened is people started getting federally indicted left and right, left and right. And so for the kickbacks, for kickbacks. And it depends. Like if it's structured appropriately and implemented appropriately, in theory, you are within the rules and regs of the law. But the law is very gray. I mean, there's a lot of gray. And so I will say even in that space, there are outliers. There's the guys doing the slambulance and all that stuff. But the majority of people wanted to do it right. And what happened is the big insurance companies go to the DOJ and they tell one half of the story. Doctors are getting kickbacks. Doctors are making crazy money off of all these ancillaries. And they're defrauding us, the insurance companies, on these tests or whatever it may be. That's their side of the story.

108:32And there is truth to that in some instances. But most of the clinicians I worked with, they did the test they were going to do anyway. We structure it in a manner. There's no incentive to send more because you're getting the same. If you send 500 or 10, you're getting the same distribute. Does that make sense? It's based off your equity in the entity, not the value or volumes of your referrals. That's how you're supposed to structure it. That is not how other people were structuring it. And they would say, well, I talked to my attorney and they said I could do this, this and that. And so anyways, that space began to implode. But before that, I was already like, this is too stressful. I'm going to move to a cash pay model. And we built out a cash pay pharmacy and began to educate clinicians on non-abusive, non-addictive pain creams.

109:19We can get it to your patients for pennies on the dollar mailed to their doorstep after surgery. So you don't have to write an opioid. And what spurred that was the death of my brother. Like having seen what opioids did, I was like, we can make a difference. We can. We can give people treatments that aren't going to kill them. And we can do it for cheap. But the only way to do it is to cut out the big insurance, cut out big pharma, and basically manufacture these treatments, compound these treatments. And so that's how that part started. And then for the wellness side, you want me to keep going? There's a lot. For the wellness side, I know it's like data. No, but it's fascinating. And it's like, so let me just like break it down from here. You create this compounding pharmacy and you're just compounding pain creams? Is that what you're doing?

110:10Well, the plan was initially the plan was to compound anything that the insurance didn't cover. So let me back. Sorry, I'm all over the board. That's okay. When I owned a pharmacy, I would get every month a book like this that told me all the prescription, like an inch and a half thick book of paperwork that listed all the drugs they were no longer going to cover. Okay, sometimes I've already shipped out hundreds of thousands of dollars in those drugs. I've already shipped the drugs. And now you, the insurance company, are going to tell me you don't cover those drugs. But I already gave your patients the meds. And so I would just eat that. I would have to lose that money because you can't litigate against a big insurance company. They'll crush you. They're billion dollar corporations. So you'll be tied up in litigation for the rest of your life.

111:00And so seeing all that and seeing the corruption, and I want to give the big insurance companies credit too. I don't want to say all bad. There are scumbags. And there are people doing really bad things. And that is who the insurance company is so frustrating because that's where the insurance company can hold up an example and say, look at this. And their narrative is the witch hunt is the doctors and the reps and these corrupt companies. That's the insurance company's narrative. Big Pharma's narrative is we're here trying to make these drugs and the insurance companies are beating us up. Everyone's pointing fingers at each other. But the truth is they all have crucial roles to play. All of them. They're all part of the problem. And they're all part of the solution. And it seems like it's an untenable system. It seems like it's also you can't correct it. There's no fixing it. That's what I was trying.

111:48That's where I was going with all of this. That's what the genesis of ways to well. So I built that pharmacy. And then I'm myself, 33, 25% body fat on the verge of obesity. My dad's diabetic. My brother's diabetic. My sister's diabetic. My mom's diabetic. I'm trying to do CrossFit every morning at 4 a.m. before I go run around and do all my stuff. I went and saw a nutritionist. I was hopeless. I swear to God, I just thought, I am fucked. And this is because of eating habits? No, I was seeing a nutritionist. I was doing everything. And I thought, I guess it's just my genetics. I don't have the genetics. My dad's fat. My mom's fat. They're all diabetic. This is it. And it was such a big hole. And I'm like, I can't. I'm not going to be able to dig out of this. No matter how hard I work, I'm moving backwards. And finally, my nutritionist said, this is how ways to well was founded.

112:43My nutritionist said, dude, you work your ass off. Something's not fucking right. I need you to go see a specialist. I want you to go get a blood panel. Have you ever had a blood panel? And I said what everyone tells me. Yeah, man. My primary care pulls my blood every year. I've had a blood panel. So naive, not thinking that, wait a second. I should know this. They don't let your doctor pull a full blood panel. I've been in the space now. I've seen behind the curtain. I've seen the Wizard of Oz. I know what's going on now. These motherfuckers are denying coverage. And so I don't really know what's going on. So I finally went in and got blood work. I was on a hunting trip in Canada. And I get a call. And it's the urologist. And he's a little Jewish guy from, I think, New York. And he lives in Houston. He's a thought leader. He's an amazing human. But his bedside manner, this is what he tells me. What are you doing?

113:35I'm like, I'm on a hunt. What's up? And he's like, your testosterone is terrible. That's a great impression. Yeah. I'm like, what do you mean? He's like, you have the testosterone of a little girl. And I'm like, what are you doing? He's like, your testosterone is 110. What have you been doing? Your testosterone is 110. I'm like, I don't know. I have no idea. Like, why would it be? He's like, I don't know. He goes, you know, I don't know if you're fat because you have low testosterone or if you have low testosterone because you're fat. But I can tell you, you're definitely fat with low testosterone. And I'm like, God damn it. So literally, I swear, all I did was when I got back into town, I went by his clinic and I met with him live and I said, hey, I don't want to do treatment. I'm scared. I don't. I'm worried that it could cause cancer.

114:22Like, I don't want to like become impotent or have my balls shrink or all these things that you hear. And he looked me dead in the eye and he goes, and I said, and I don't want to be on this the rest of my life because, you know, I don't, I heard once you go on it, your hormones are screwed. He looked me in the eye and he goes, you're fucked. Your hormones are fucked. You're fucked. There's no screwing it up. If you go on treatment, we reduce your risk of diabetes. We reduce your risk of atherosclerosis. We reduce your risk of heart attack and stroke. We reduce your risk of cancer. All of these major killers of man can be reduced by optimizing your hormone levels. We are going to get you to optimal levels. But let me break it down to what he was saying. Like, he didn't know whether or not your hormones were fucked because you're fat. Correct. Did you, you said you were working with a nutritionist.

115:19What were they doing to try to reduce your body fat? We were eating six meals a day, all lean muscle mass based. I did a DEXA, analyzed my lean muscle mass, did a pinch test as well monthly. And we were trending my lean muscle mass versus my body fat. And so literally when I started treatment, I went from 25% body fat, did not change my diet, did not change my workout plan, did not change anything. I went to 7% body fat within six months, just fixing hormones. And there was no way to do that organically? I think that's a misnomer too. And there's people like Peter Atiyah, I know you've had on. I really respect him. He's brilliant. And I agree with a lot of what he says. But a lot of the viewpoints are this. I'm not going to write you a hormone or anything to boost your hormone levels until you change your diet and lifestyle. And to me, that's, I was already practicing that. So this isn't about me.

116:19But I look at that and think, you know, that's pretty short sighted. Because not treating and not giving this person an optimal chance at getting these levels improved is a hindrance. They're going to be more tired. They're going to be more lethargic. They're going to have lower energy level. Whether the chicken or the egg came first, who cares? We're here now. And how do we fix this? Are they going to naturally boost your hormone levels to an optimal place? There are. And that's, that's a, but even then. So my testosterone is 110. Show me a study. My challenge would be to any clinician. Show me a study that's going to boost my testosterone 500 fold or whatever it's going to take to get me up into the normal ranges, you know, five times fold basically to get me. It doesn't. When you diet, exercise, sleep, nutrition is huge. And it's important. It's a cornerstone. And we talk about that at Ways to Well.

117:17But as we age and in this world, we don't know if it's the plastics. We don't know if it's the lifestyle, the fast food, what we ate growing up. They really don't know. I asked him the same question. I said, what could have caused this? And he said, it's rampant. He said, Brigham, 30 million men are diagnosed with low T a year. And he starts breaking all of that down for me and explaining it. So I don't know what caused mine. I really don't. Head trauma can cause it. Concussions can cause it. Did you have any of that? I mean, I played basketball and I hit my head on the. I mean, yeah, I've had like two concussions, but I'm like, could those two concussions have caused this? I don't know. I don't know what caused it. And I don't know if I was getting fat because my hormones were low or my hormones were low because I was fat. Like, I don't know. I really don't to this day.

118:12But what I believe in is like what he explained to me, and this is what I would explain to the layman. One, you are at an increased risk of all of the four horsemen of death for mankind if you do not optimize and correct your hormones. And if you want to try and do that through diet and lifestyle, it's got to be a part of what you do, period. Even if you go on hormone boosters like an HCG or something to boost your natural testosterone level, you still need to obviously implement diet, exercise, nutrition, sleep. All of those are crucial. There is no silver bullet. There's no one size fits all. Everyone's different, and it's going to take all of these things being dialed in to get improvement. And so going through that process, though, it took me three months to get in with that urologist. I got there that day. I waited four hours, Joe, in a packed clinic. They pull my blood.

119:10For the first time in my life at 30-something years old, I got a full blood panel. Never had it. I get a bill in the mail, even though it was insurance, for $480 for my blood work because insurance denied some of the panels and said we're not paying those. We don't think you needed them. So I had to come out of pocket for that. And seeing what all they did with that and then seeing my experience and how life-changing it was, I went from 25 to – and I became obsessed with, like, biohacking. How do we do this better? What are the loopholes? What are the challenges? Like, what are the pitfalls of this current system? And the big thing is it's underdiagnosed. People aren't looking at the full comprehensive picture, right? They're immediately – you come in with diabetes, they're writing you a diabetes med. Well, have you ever run a full panel?

120:01Do you even know all the root causes of what's going on with this patient? Like, let's do a deep dive. Let's really look at this patient. You can't do that in the insurance model. You can't. The insurance won't cover it. So if the insurance isn't going to cover it, then the patient has to pay out of pocket. And now the patient's mad because they thought their insurance would cover it. And the doctors don't want to have that conversation, so they just don't do the test. Wow. And then the insurance wins because you don't get treatment. Wow. And so it's a win-win for the insurance companies because they're spending less and they're still charging you all your, you know, expenses on it. So did you try HCG? I did. I did HCG first and I got great results. And then it was as you began biohacking and wanting to get more optimal. So there's a difference between, and this is another thing I'll clear up.

120:54There's a, I also found that other than urologists, most of these practices did not know what they were doing. So urologists are obviously intimately aware of these hormones and usually know, you know, have a good blueprint for success. Low T centers that are popping up on every corner, they're terrifying. They're just literally giving every guy the exact same thing. It's all about cattle call. Get them in and out of here. Get your money. But they're not monitoring. Again, they're looking at testosterone. Testosterone is one hormone in a symphony of hormones. And in order to play beautiful music, every hormone has to be optimized. And so we can't focus just on testosterone. We have to look at somebody holistically. And we treat women too at Ways to Well. And there's a big gap for women.

121:44And so the challenges I saw and the reason I started Ways to Well was if you talk about primary care, they're seeing a patient every seven minutes. They don't have the time. They can't get the blood work done. And even if they do, they don't know how to treat it. And even if they did want to learn to treat it, they were still in their minds. To this day, a lot of primary carers will tell their patient, I wouldn't get on testosterone or any of those hormones. They cause cancer. That comes from a study done. Testosterone has been on market since 1931 or 32. The study done by Dr. Huggins in 1942, he came out and said, when I treat men with testosterone, this alpha phosphatase level goes up. When I chemically castrate a man, the level drops. So I think the synopsis of the study was if you give a man testosterone, you will exasperate prostate cancer or potentially cause prostate cancer. Why?

122:50I don't understand. Well, and this is how I'll explain it. And then his answer was, but if you're a man with prostate cancer and I suppress your testosterone to castrate levels, which is below 50 nanograms per deciliter, is basically no testosterone in your body. If I suppress it, I can slow the progression of prostate cancer. All right. But is there a correlation between? No. No. This is the 1940s. Okay. That study came out. This was the thought leader in urology, the godfather of urology back in the 1940s. He won a Nobel Peace Prize for some other work he did. He set the narrative. For 50 effing years, nobody ever looked at the study. Nobody ever questioned the study. It became dogma. Medical schools taught practitioners. If you write testosterone to a patient and they have prostate cancer, it is the equivalent to dumping gasoline on a fire.

123:48And if they don't, you increase their risk profile or propensity to potentially develop prostate cancer. And this is important to get out. I know it's not exciting, but it's like in 1997, the new thought leader, Dr. Morgan Tyler, Boston Urology, began treating men in the 80s with testosterone because there was no Viagra. And he had a lot of guys coming in with erectile dysfunction and impotence and low sex drive. And then he thought, you know, I'm going to have to really monitor them for prostate cancer because I'm worried I'm going to see an increase. What he started seeing was no increase. It was 13% of his patient population who were not on testosterone developed prostate cancer. Do you know what percentage developed it who were? 13%. The exact same number. And he said, man, that's weird. I've been doing this for like 10 years. I'm going to do some research.

124:42He went back and looked at the literature from the Dr. Huggins study because it was the only study in 50 years that showed any correlation. What he found was Dr. Huggins study had a patient population of three people. What? Three people. Yes, this is a true story. It's on the website too. I attach the link so you can review the study. This is white paper, peer reviewed, peer reviewed literature. This isn't me making shit up. It's insane. Three people. One guy dropped out of the study on day three. One guy was chemically castrated, meaning he doesn't have testosterone. So yes, of course, when you take someone from chemically castrated to normal. Why was he chemically castrated? I don't know. They didn't explain why. I think because he had a preexisting prostate cancer or something like that. But they're checking your PSA. At the time, it was a different marker. It wasn't PSA.

125:34It was alpha phosphatase or some shit like that. So the third guy and the only guy that the data was based off of was low testosterone but then treated in his alpha phosphatase level. I'm not sure if I'm even saying that right. It's PSA now is what they measure, but it was what they thought PSA was back then. It was erratic, meaning indecipherable. It went up. It went down. It went up. It went down. And so at that point, Dr. Morgan Tyler said, all right, I got to do the research. And he went back 50 years, looked at all the different studies. There was never once other than this Dr. Huggins study, which was one patient population of one, any evidence of an increase in cancer. So for decades, men were deprived of hormone optimization. And so when I was outside waiting for you, the girl asked me, why has testosterone taken off so much?

126:30Do you think it's that doctors are overprescribing or do you think that it's that now they're diagnosing it? And I said, I think it's all the above. I think one of the problems was there was such a stigma around it for so long. And med schools taught these primary care providers that this was going to cause prostate cancer or exasperate it. So they didn't touch it with a 10-foot pole. Dr. Morgan Tyler released all of his findings in the New England Journal of Medicine in 1997. I attached that on the website. Debunks all this. There is zero correlation, zero correlation between optimizing testosterone levels and cancer. In fact, what they find is once you get above low, you actually have some cancer insulation, some protection. It reduces certain types of cancers and their likelihood. And I even heard – I'm bringing this up because I listen – I'm a huge fan of David Sinclair too.

127:29And I listen to one of his podcasts. He talks about the risk-reward of hormones and that testosterone has been proven to cause cancer. And I'm like, where are you getting this literature? Are you talking about the Dr. Huggins study from 1940s that's been debunked for over 20 years? Because the thought leaders now today, the general consensus is you treat within optimal physiological levels. And it's almost all reward. There are – there is – every single treatment on the market has some sort of risk profile. But when we look at testosterone, it's been on the market since the 1930s. Androgel launched in 2021. That was the first big bang for testosterone. In 2021, Pfizer launched Androgel. Millions of prescriptions went out. Millions of men got on testosterone therapy. And they did the analytics. And do you know what they saw? 13% of men develop prostate cancer.

128:26There was no increase in the level of prostate cancer. So is prostate cancer primarily genetic? It's an age-related disease state. So what they're saying now is as you age, all cancers are essentially typically correlated to age. I know there's like some childhood cancers. But a lot of cancers become more statistically prevalent as you age. And so is it some sort of cellular deterioration? I don't know. But the point of that whole narrative was testosterone is safe. It is one of the most studied medications or treatments on the market. It's been around for a long, long time. And when utilized appropriately, it is a very valuable tool in longevity. And so if we began to look at the killers of man, and this is how I started WasteWell. I looked at the primary care practices, and they wouldn't write these things because they were scared of cancer.

129:25Then I look at the urologist, and I'm like, well, it takes three months to get in. You have to have a referral from a primary. Insurance doesn't even cover the treatment. I was having to come out of pocket. 80-something percent of insurances refuse to cover hormone optimization or hormone replacement therapy. And so even if you do try to stay in the insurance model, the chance that they uncover that you have a hormonal imbalance are slim to none, unless you're seeing a urologist or an OB-GYN. And then if they do uncover it, the chances the insurance cover the treatment are slim to none. And so I had to come up with a solution to make it more cost-effective. And that's when we built out our pharmacy, and we started doing an array of different testosterone and all of the regenerative stuff that's not covered, peptides, BPC-157,

130:15all of these various really interesting molecules that are better suited for proactive use than reactive use. And what I mean is, like, let's get ahead of the disease states. Let's stop you from becoming obese. Let's stop you from becoming diabetic. Let's, like, prevent it rather than waiting. Now, I've talked to people that have said that there's no studies that show that peptides are effective. I've attached those, too. There's a ton. Peptides, so, okay. Peptides. Where's that coming from? Do you know where peptides? Because I've talked to intelligent people. Well, my rebuttal of that would be, like, do they realize insulin is a peptide? Are they saying insulin is ineffective? Well, I think they're just primarily talking about the current use of BPC-157 and the like.

130:58There is BPC-157 is not an FDA-approved peptide, meaning it has not gone through clinical trials like what we're talking about with all these other drugs. But what's different is it's not a drug. It is an amino acid. BPC-157, all peptides, all they are is short-chain amino acids. They are literally, like, a key that connects to the lock. And the key is the peptide and the lock is your cells. And so what happens is these peptides will go and bind to protein receptor sites on cells and do whatever their signaling cell is. It's the same thing I talked about with mesenchymal signaling cells. That's the same thing that peptides are. They're mainly signaling peptides. They're these amino acid chains that, when arranged differently, have different results in the body. So they're naturally occurring in our food and our diet and our meat.

131:55And as we begin to age, our bioavailability of these various amino acids deteriorates. And it's the same thing with our cells. And that's where these MSCs and these peptides and all these things are kind of, from what I've seen, have a synergistic effect. And that's what's really hard, too. We've had such good results at Ways to Well treating injuries and ailments. But a lot of times we're using a multitude of treatment modalities combined, right? Most of the guys who are doing peptides or who are doing any placental-derived tissues are also doing peptides. So there are studies. I attached them on the website. There's one in mice where they literally severed mice's spines and then injected them with BPC. And the mice that got the injection within, I think, like four to six weeks recovered use of their legs. But the mice that didn't did not. There's all sorts of interesting data.

132:51But the original peptides that took off happened during the Cold War with Russia. So Russia had guys dying because their nuclear reactors were leaking and on submarines. And they brought in this Nobel Prize-winning scientist and said, what can we do? And he began to analyze, like, how he could use amino acids to help cellular health and soft tissue health and all these different things. And each peptide targets a different type of tissue. And so long story short, it worked. They started using it on all their sailors, on all their people that were enlisted. And then they even used it in Chernobyl. After Chernobyl went off, they used this exact same peptide. And there are studies that show that peptide, the patients who were administered the peptide, had lower cancer rates than the patients who didn't get administered the peptide.

133:43I think when people say there's no science, what they're saying is there's no double-blind studies that have gone through the FDA stage three clinical trials. And the FDA's main concern is, is this safe and does it work? And the other issue with that is the FDA, all of these things start to fall under what's called biologics. And that's why I was talking about the crucial side of where does the money come from? Right. The drug companies, the med device companies. Biologics is less than, I think, 8% of the FDA's allocated funds. They're already short-staffed. So biologics is a much slower-moving space. And that's why, in certain instances, for things like Amnion, they gave a Q code. They said, hey, we know this is going to take a while. Like, we don't have the resources. They end up giving a Q code. So there's a way to get a reimbursement. But all of those loopholes have been shut down now.

134:35And so insurance won't cover any of these things. So if you act a primary care, they're not going to know what this is. At the Gordon Ryan matches, I went up and a guy came up and started talking to me. He thought, what's your security detail? He goes, hey, man, are you Joe's security detail? I'm like, no. No, I just know him. And he said, well, what do you do? When I told him I wasn't security, I go, oh, I have a wellness company. We're trying to bring personalized medicine to the masses. We're trying to be predictive and proactive rather than reactive and use the tools that are available to diagnose disease states before they ever occur. And he's like, wow, that's crazy. So do you do peptides? And I was like, yeah, we actually do. He told me the story. He had his ACL done. He asked his doctor about BPC. He said, I've never heard of it. It's quackery. I don't know about it.

135:25He ended up going to a longevity anti-aging clinic because four months after his surgery, his knee was still killing him. He still didn't have full range of motion. He was struggling with a lot of stuff. He went and got BPC and treated. And he was like, literally in four weeks, everything was good. Like, this stuff's crazy. And we've seen that with Tim. Tim talked. Tim Kennedy talked about it with his knee. We used peptides and we used what people were calling stem cells, placental-derived tissues, perinatal tissues to treat Tim. There's a synergistic effect. Peptides work. These products work. It's obviously going to vary by patient. And I've got to tread real lightly of not making medical claims because, again, until something's been through a double-blind, placebo-controlled trial with the FDA and gone through rigorous safety testing, they're wary about people going out and making claims.

136:23And that makes sense, too. Is there any potential for that happening? For what? Double-blind, placebo-controlled studies. Yeah, there's a lot of stuff going on in stage three trials now. I think your buddy Neil Reardon is in the middle. I think he's in stage three. He already submitted safety data on the same tissues we've been using for years, by the way. Like, it's not – this is – it's by – Tony said that the physician told him it's bro science and the technology's not there yet. And I said, Tony, it's not bro science. There's white paper study after white paper study in animals and in humans now, especially when we're referring to orthopedic injuries like knees, hips, shoulders, elbows. There are tons of studies that have been done that are published in journals regarding amniotic tissue, placental-derived tissue, Wharton's jelly, all of these cellular and acellular products.

137:18And there's a wide array of them. Some of them work. Some of them don't. But the studies are promising. And one of the articles that is on the website, it's the white paper study in hips. The whole synopsis was there is tremendous promise in these treatments. We just need to tread lightly about overpromising or essentially telling people that it's going to cure everything, you know. And that's what happened. People did get out there and they started overpromoting. And that's where the FDA came in and started hammering clinics. Clinics were out there telling people it'll cure your MS. You can inject it in an eye and you'll be able to see again. Like, you can't make claims without studies, you know. There's got to be studies and data. Anything I've discussed with you and that you've seen is anecdotal because we haven't put them through a study.

138:09But I can tell you at the ground level, the feedback's phenomenal. The results are phenomenal. I mean, we've helped so many people who were told they needed spine surgery. I mean, you, again, I've asked all these people. Gabe Tuttle was told he needed spine surgery. Kyle Kinzel told he needed spine surgery. Tony Hinchcliffe told he needed spine surgery. Those are just three. Yeah, he was, Tony was literally making calls to schedule a surgery. His neck was in so much pain that he had to sit a certain way while he was doing Kill Tony or he'd be in agony. Yeah. So he'd have to, like, put his foot under his butt and, like, lean like this because if he sat normally it would just ache. He was in constant pain. And you guys shot him up with, what did you use? With Tony, at the time it was Wharton's Jelly and BPC-157. And I want to get into— And what is Wharton's Jelly?

139:04Wharton's Jelly is essentially the tissue taken from the placenta. It's the jelly that's found in the placenta that the baby sits in. And Wharton's Jelly is rich with cellular nutrients, MSCs, mesenchymal signaling cells. If it's cryogenically preserved and it's a cellular product, it's going to have cytokines, exosomes, scaffolding, and extracellular vesicles. All that means is it's a bunch of goodies that feed cells, heal—help cells, like, essentially, for lack of a better term, optimize and refuel mitochondria. But more than anything, what it's doing is triggering your body to heal itself. That's the goal. Can we trigger your body to heal itself? Why does a pregnant woman have such amazing skin? You always hear about the pregnancy glow. Your skin looks great. Your hair looks great. Your nails are great. When a woman's pregnant, they have the lowest cancer risk they'll ever have in their life.

140:00There's a reason for that. This is millions of years where I was going with that when Tony's doctor told him it's bro science and the technology's not there yet. My rebuttal was, Tony, he's a dipshit. It's not technology. It's biology. The biology's been 2 million years in the making. Like, how long have modern-day Homo sapiens been around? 200,000 years? At least 200,000 years in the making. These are all naturally occurring elements in nature, in our body. That's why there's no adverse events. All the adverse events you're hearing are either improper utilization, right? Injecting something into somebody's eyeball was one of the things that came up. And it was like, okay, well, yeah, of course. That guy's a quack. The other one is improper storage or utilization. And what I mean by that is one of the big bad players in the space early was a company called Livion.

140:52And they went out and they're still in the marketplace. These yahoos went out and told people to store their product in liquid nitrogen. But the casing they put it in wasn't leak proof. So liquid nitrogen was leaking in to these cellular products and getting injected into people's spines. Crippling people. I mean, it's crazy. But almost all the adverse events are related to things like that. It's not. Again, these cells have been around thousands and thousands of years. This is not anything new. They've used amnion and Morton's jelly on wound victims and gunshots and all these things for severe wounds and diabetics for literally 20 years. It's been around. It's just the science is finally catching up and the research is catching up. And all the info I get, the other thing you'll learn is if you want answers on stuff that's cutting edge, you don't go to MDs.

141:46An MD, you go to the guy who invents the hammer, not the guy who wields it. Like the guy who wields it knows how to use the hammer once it's there and the product's ready. But I want to meet the guy who built the hammer, discovered the hammer, and engineered the hammer. That's a PhD. That's the guy sitting at the bench. Those are the guys doing all the studies, like Sinclair, doing the studies in mice, on the cutting edge, in the know, on the very first to do clinical trials. So they're going to be much more informed and knowledgeable than an MD. Because the MD is, again, trying to make it through the day and do their surgeries and do their procedures, and it's a lot. And they don't have the time to do the research. They do continual training, but they get to choose what that training is focused on, and it's typically focused on reiterating skill sets that they're already working on.

142:35Well, I can tell you anecdotally what it's benefited me from. And, you know, I've talked in length about this on the podcast before that I went to Dr. Rodney McGee in Las Vegas, and he injected stem cells in my rotator cuff. I had a full-length rotator cuff tear. Then I went back to him six months later, and we did an MRI, and the tear was gone. And he said, this is the most extraordinary thing I've ever seen. He said, you have to understand, this is like when they really were first starting doing this kind of stuff. And he said, this is surgery. You needed surgery. He goes, your shoulder was fucked. My shoulder is full range of motion, full strength. I have zero problem with this shoulder. When I mean zero, I mean nothing. I mean I do cleans and presses with 70-pound kettlebells. I do windmills with 70-pound kettlebells, which is a shoulder stabilization thing.

143:29Because you're holding this kettlebell overhead, and you're dropping all the way down to the floor, touching the floor. And it's completely solid. It doesn't bother me at all. I kickbox with it. I lift weights with it. I draw a bow back with it. Zero problems. I believe in it. I'm a believer. I believe in it. Our patients believe in it. I believe in peptides. I have seen extraordinary things. Tim said the same thing. It's science. When Tim came in, he was a skeptic. When Tim Kennedy came in, he's like, is this real science or is this bullshit? And then we treated him. And I'm honest with people. I said, Tim, you have a full tear. You've got to go get that addressed. This is going to help with inflammation and the injury. But he also had a partial tear. And when he went in for the surgery four weeks out, his partial tear had fully healed. And the doctor was like, what are you doing?

144:18And he's like, well, I'm doing these peptides. And I did some sort of stem cell treatment is what he called it. But placental derived tissue, Wharton's jelly treatment. And it worked. I mean, it works. Like, I don't know what to say. I can't tell. I'm not saying that it's going to work for everybody and that everyone should rush out and do it. Talk to a clinician. Do your research. Educate yourself. Understand that a lot of times clinicians are not offering you the best product on the market. They're offering you the best product that insurance will cover. And that's a difficult conversation for clinicians to have. In fact, they don't have it. If you've got to pay cash for something, your clinician is not going to have that talk with you nine out of ten times. Again, they got to get you in and out of there.

145:00They're not going to sit there and educate you on why this regenerative treatment may be a solution. And how has your understanding of these things evolved? And how has your implementation of these things evolved as you started Ways to Well? The biggest change, honestly, is less on the placental-derived tissue side and more on the hormone optimization side and the preventative side. And, like, seeing the results on people's blood works and seeing, like, their blood sugar level improve, their diabetes improve. My brother lost 100 pounds since coming on with Ways to Well. I mean, we've treated over 7,000 patient lives in the state of Texas. Our pharmacy's treated over 167,000 people. I mean, we've been doing what Mark Cuban's doing for a decade, for eight years, seven years, whatever it is, almost a decade, seven years.

145:56Offering generic prescriptions for pennies on the dollar mailed to a patient's doorstep. You can go to Ways to Well Rx, look up a prescription, we'll mail it to your doorstep. If you're in that sick care model and you want to hold somebody honest and see what you should be paying for a drug and know what a cash pay price is, oftentimes we're cheaper than the insurance co-payer deductible. So there's that space. The other is in the regenerative space, the biggest is peptides keep evolving and coming out. I do think a lot of the stem cell products, what people are calling cellular products, will begin to get more regularly accepted. I've just seen more and more buzz about it, more and more people talking about it, more and more very influential, wealthy people investing in it. And so I feel like for better or worse, it's here.

146:45The fear becomes, you know, the bad players, the people doing bad things, the people being snake oil salesmen and charging grandmas and promising them the world and, you know, taking money from these people. That gives everybody a bad rap and that creates an environment that increases the potential of more regulation, not less regulation and more strictness. So in when when people are one of the big evolutions was trying to get people over the fact that when they think stem cells are illegal or you can't have them, that's like the biggest. And I haven't seen that change yet. Like the average American is of the impression that they've got to go to Panama or fly to Germany and spend twenty five thousand dollars in order to get a treatment. And I think the way this is headed in another five years, this will be pennies on the dollar.

147:38People will be able to pay cash and get a knee injection for an extremely cost effective price, way more cost effective than a surgery. So what would be the benefit of going to these places like going to Colombia? If money is no object, again, like I don't I think clinically there's not a downside. I can't say there is a downside, but my rebuttal again would be, you know, the efficacious dose is the minimal dosage required to elicit the desired response. We've had such phenomenal results just using these, you know, three sixty one and three fifty one exempt products that we can use here in the United States. The placental derived tissues. So when people say these are illegal or this is that.

148:25Any of these cellular products have to fall under one of two designations, a three sixty one, meaning a minimally manipulated tissue, meaning I cannot alter, edit, clone or expand the tissue in a Petri dish like they can in Panama or Germany. That's really the only difference. They're taking the exact same tissue and they're expanding it. So they're just giving you a larger dose, larger dose of it. And my thing would be I'm not saying that's bad. I don't I think time will tell. But we're getting phenomenal results with what's readily available here in the U.S. Now, is there any concern that new regulations and new restrictions could apply to what you do? On everything. Yeah, I think there definitely is. There's always that risk. I do think the FDA is doing their best to sort through a very complicated thing because you got to think the FDA was never in the biologics world. They were approving drugs.

149:23And so one of the challenges with bringing a stem cell, I keep doing air quotes or placental derived tissue to the mass market via an FDA trial is one of the things the FDA will look at and want is consistency. And that's understandable. But this is human tissue. Right. This is not a pill that I'm manufacturing where I get the dosage right. So one part of one particle of tissue may have exponentially more live cells than another. There's there's just no way. So they most of the tissue banks now do it by weight, by the weight of the tissue. And it's an estimation of the live cells, whereas Neil. And this is another advantage of what they do in Panama is they run it through and they count them and they're all there's this many. Again, if we were getting bad results or things weren't working, I would be like, oh, man, OK, I guess we're going to have to open a clinic in Panama.

150:16We get phenomenal results with the products that are readily available here in the U.S. And so is there any pushback against this? Like, is there are there any? The FDA's main pushbacks are twofold. One, it's it's the private industry, the big insurance companies and the governmental payers because they were upset about these Q codes and people misrepresenting the product and billing them in a manner that is inappropriate. And so that created backlash. The other is snake oil salesman. It's people literally making promises. I mean, you can go to websites where people like will heal your spine, will heal your. They're they're making claims that are unsubstantiated and shouldn't be made. And and I understand that. And so the FDA has means of action to reach out and grab those people like the Federal Trade Commission. They did go after a clinic in California and they lost.

151:12This just happened like a month ago, three weeks ago. They went after a clinic. And this is a different situation. This was not placental derived tissue. What he was doing was taking adipose tissue, fat tissue from a stomach, isolating it and are curating the culturing those cells in a in a dish and then administering them as stem cells. And so I understand where the FDA is getting weird about that, because now you have an MD playing Ph.D. and a practice in some small little lab. You know what I'm saying? It's a little different than an ISO certified giant lab with a bunch of Ph.D.'s running around lab coats and sterile clothes. And they've got all the protocols and procedures to make sure these products are safe. There's a little bit more consistency and predictability, even though it's tissue.

152:00At least we know the tissue is, you know, contaminant free, disease free, healthy, safe to use in a clinical setting. The FDA's concern was if you're pulling this tissue out and then extrapolating out these cells and then pushing these cells back in the body, we don't think you should be doing that. The judge ruled in favor of the providers, the judge in this instance. So the FDA will either have to appeal it or precedent is set that physicians are going to have the autonomy to be able to potentially use those treatments and practices. Well, this is wild stuff, man, and this is about as thorough a breakdown as I've ever heard of all these things from the insurance companies to the clinicians to everything. And I appreciate everything you've done for me and everything you've done for my friends. And I think what you guys do is fucking amazing. No, I appreciate it. It's helped me tremendously.

152:55And it just I'm a big believer. So thank you. Thank you. WaysToWell.com. WaysToWell.com. WaysTo, the number two well. The main focus of our practice is regenerative and preventative care. What we're trying to do is use predictive tools to get ahead of disease states and keep people healthy. Don't wait to get sick. If you're overweight, if you're struggling with your weight, if you're trying to get in shape, we can help. We can help give you the tools you need. We can help give you the resources you need. And we have measurables that will allow us to help tell you if you're headed towards a trajectory of getting to live to be a centenarian. If your goal is to live to be a happy, healthy 100-year-old and able to lift your grandkids and do all these things, there are ways to assess if you're there. Are you headed on the right trajectory? And if you're not, there are interventions that are out there.

153:47But it's going to take cash pay model. Insurance is never going to cover this. And, yeah, that's it. And WaysToWell.com. Thanks, JRE, for all the references and all the studies that you cited. Yep. Brigham, you're the fucking man. All right. Thanks, Joe. Appreciate it. All right. Bye, everybody. Bye. Bye. Bye.