#409 Charles Nduka from Emteq: How Can Health Wearables Reconnect Us With Ourselves?

0:00Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology and I'm your host James Summeru. Everyone this week I am joined by Charles Nduka and he is the founder of EmTech. Now I'm going to let Charles explain exactly what EmTech does but we did a bit of work together a long time ago And Graham, who was the CEO at the time, came onto this podcast to talk about the whole story of EmTech quite a long time ago. Now, I don't expect anyone listening now to remember. There'll be a few OGs that listen to this that will probably remember that, but there won't be many. So I'm going to let Charles explain all that in a second.

0:43But before we get into EmTech and everything that you're up to, Charles, how are you? It's been a while. It has. I think it's about four years since we were last. in touch. It's been, you know, the world has changed. We've had financial crises, well, multiple. Multiple financial crises, yeah. Multiple once-in-a-lifetime events in finance, which has been fantastic as you're trying to build a bit of wealth. Yeah, we've had that, which obviously has impacted on sort of fundraising. We've had the government change. We've had the pandemic finish. We've had a war breakout in Ukraine. We've had a war breakout in the Middle East.

1:22We've had all sorts of things but we're still here pushing forward and no it's a really exciting time just just doing our best aren't we Charles we're just we're all just muddling through trying to do our best so listen man the other thing that's happened is the world has sort of caught up with what you've been talking about for at least the last four years which is super interesting everything that you have been part of for all of that time things like simply vr and where we are with the metaverse and things like that the other things are i guess the value of empathy and human emotion and where that plays in health care at a time where cognition is now commoditized the phrase that i learned on the last podcast that i did with chat gbt and ai and all the other llms basically just removing the need for a lot of cognition and certainly removing the need for memorizing facts and so it's super interesting the things that you've been talking about for a long time watching the world now catch up and actually the the sheer value I think of what you have in understanding emotions the use of VR and before I give away too much on that I guess I'll hand over to you Charles to just explain a little bit about yourself and your story because it's obviously fascinating where you've got to in your career completely independent of EmTech and founding the company so give the listeners a bit of a flavor what have you been up to to get to this point tell me about your other career and also tell me about EmTech.

3:07Where do I start so yeah I'm a plastic reconstructive surgeon by background I've always been interested in the effect of being I guess a bit outside or be seen as an outsider on the person that may have a deep background in just my dad having come to the UK back in the 1960s sort of the civil war that was going on in Nigeria and the impact of that landing here in the UK and just seeing some of the struggles that the family went through at that time I think being aware of being seen as other on a person and its impact on mental health and other things definitely left an impression on me. Sadly, I had two siblings with significant mental health issues.

3:59My sister developed schizophrenia actually from age 12. She sadly is no longer with us. She died in her early 20s. My brother, who was four years old, he had a sort of breakdown, depression, actually She took me there in life too. So I've always been very strongly aware of the role of being outside, if you like, on a person. And I decided to become a plastic surgeon, perhaps as sort of – my dad was an engineer, so always being aware of the potential role of doing something practical to try and, I guess, fix a problem. And that maybe is a bias. and I'm reflecting more and more about that just now and why did I choose this career out of the many others.

4:51But yeah, so I went to university. I did psychological disorders as part of my intercollegiate degree at university. Again, to explore that interest in the brain and how the brain affects the body and how the body affects one's perspective. And then plastic surgery was something I was just really, really drawn to. when I was in training I met a patient who had he'd been seen by the consultant who I was under for quite a few months and he the patient was very very distressed um the consultant said you know I don't know why he keeps coming back because you know he's only got a very minor issue essentially this patient just couldn't raise one eyebrow and um I spent a bit of time with this patient talking to him about his issue, why it concerned him so much.

5:42And it was only really after quite a long chat that he revealed that he'd actually been, he'd been tortured. He was from Iraq. He'd been tortured by Saddam Hussein's henchmen for weeks and months. They'd sort of beaten him in all sorts of places around his body. But the one thing that really affected him was he was hit with a blunt instrument, I think the bustle of a rifle or something, on his head and they basically damage the branch of the facial nerve that supplies the forward muscle and this meant that every single morning you know the first thing you do in the morning last thing you do at night is to go to the bathroom look in the mirror and you know this thing this visual signifier of that time that most terrible time of his life was just there looking him in the face and what was really interesting was that it was a very simple thing to do to address for him was just to actually rebound his his brow the impact on his whole psyche his whole demeanor was was incredible and that really was a bit of a light bulb moment for me in recognizing the role of of the face in particular in one sense of identity and yeah how it makes a person feel so yeah so I there I met subsequent that I met a surgeon called Daniel Labbé he's a he's a a French facial paralysis surgeon who was getting some really great results with a technique he developed and I went out to France, studied with him, went to Brazil, Daniel came to Brazil as well, worked with another surgeon who he'd known called Fausto Vizobo and then really developed a passion for facial palsy, facial paralysis surgery and so when I became a consultant myself at the Queen Victoria Hospital which is in East Winstead, this is a hospital that was made famous by the work of someone called Sir Archibald McIndoe, who was a surgeon who worked on the pilots of the Second World War.

7:38Wow. He had been damaged and burnt and injured. And his story actually was also very, very impactful for me because he really saw the important role of seeing the patient holistically. These are pilots who, at the peak of their powers, in terms of their young, dashing, spitfire pilots, and suddenly they were brought low by having faces and bodies burnt and damaged by their war efforts. And he really put them back together, not just physically, but also psychologically. They were essentially known as the guinea pigs, and he insisted that they didn't have to wear uniforms, as most military patients had to.

8:22he really sort of focused on the role of social interaction both within the hospital but also within the town there's a book written about him called um i think like the man who made no the man who stopped the town from staring just because yeah these patients were having to have some really extraordinary procedures he was grafting bits of tissue from other parts of body so for example you may have your nose attached to your shoulder for weeks at a time to allow the fresh tissue to be brought in and then that be detached and you'd waltz tissue up the body uh to the face to enable uh transplantation of tissue a really innovative surgeon and because these techniques were in many cases new um and these patients were essentially you know guinea pigs they called themselves the guinea pig club and uh actually sadly that the last members had only died quite recently and actually it was actually the 60th anniversary of um sorry 65th anniversary of McIndoe's death just literally this month oh so it was uh and obviously it was VE day as well just recently which is kind of uh um uh yeah I wrote a short blog about it on my subs that because you know he was such an important person he really recognized the importance of taking a holistic approach to both medicine, in his case reconstructive surgery, and the psyche, and how the mind and the body work together.

9:53Anyway, so I started at the Queen Victoria Hospital in 2005, as local, and then took my full-time post and set up the facial palsy service in 2007. And from the beginning, I really was keen to work closely with colleagues and a multidisciplinary team and also with patients and in 2012 with the encouragement of some patients in particular somebody called Karen Johnson who at the time she was born with facial palsy she developed a website herself to help provide information to people because it's such a difficult thing to learn about it's a relatively rare condition and we founded the charity Facial Palsy UK in 2012 which has been amazing working with some fantastic volunteers amazing trustees amazing colleagues on the medical advisory board the website now gets something like just under half a million hits a year visitors a year actually many of them from outside the UK just providing comprehensive information on this condition and just so you know as a doctor, facial paralysis most commonly people recognise it as Bell's palsy but it also can be caused by 50 other causes including infections including accidents including tumors a whole range of things can cause it and because it's a relatively rare condition the management was really really very poor when we started the service we had patients coming in oftentimes five ten even 20 years post paralysis they found out about us through various routes and were coming from all over the country.

11:40So one thing we were trying to do with the charity was trying to ensure that there were sufficient numbers of services like ours across the UK. And gratefully, over the last dozen years or so, the number has increased and patients aren't having to wait so long. In doing that facial palsy surgery, sometimes you're having to do very long operations, six hours, sometimes longer, transplanting nerves and muscles to try to help people to improve their symmetry at least at rest and ideally to help them to smile, the thing that people most often miss. But it perplexed me why sometimes patients who clearly had a big problem to solve, you know, it affected them tremendously psychologically, as we demonstrated in published research, but then sometimes they weren't able to do the exercises that were required to help the brain to relearn how to use this newly transplanted ability.

12:32Right. And it's funny because it's a problem that all doctors have really experienced. You know, you tell patients that, okay, well, this is the treatment or this is what you have to do. But sometimes it's actually really difficult for them to do that and we don't have any way of helping them. In our case, we got patients to do something called mirror by feedback. So they'd look in the mirror and they'd practice expressing with their unaffected side, with their reconstructed side. But the problem is that if you just had an operation, sometimes looking in the mirror repeatedly many times a day is psychologically very uncomfortable.

13:05In many cases, patients don't want to look in the mirror in any case, let alone after you just had an operation. But it does mean that we couldn't really maximize the benefits of our treatments, be it surgical or non-surgical, if the patients weren't able to get feedback on the expressions. And so we did some initial work seeing whether we could extract away the expressions by using technology, initially using an iPad app to use computer vision and show a representation. But the problem is that we know that you need to get more feedback because patients can often do quite a good posed smile. But when they're in the moment, enjoying or laughing spontaneously, then they'll go back to their asymmetric expressions.

13:51And so we use a system called EMG electromyography, which is basically like measuring heart signals from the ECG, but this is for muscles outside of the heart. So electromyography is an old technology, decades old, involves putting electrodes on the skin. And when you do a movement, you can see it as a representation on the screen. And one day a patient asked me, why can't I have one of these at home? Because I can see how valuable it is to see even small movements represented on a screen. I can wear this and get feedback continuously about what I'm doing. I said, well, of course you can't because this costs£10 ,000.

14:32It's an expensive piece of device. But, you know, it set me thinking because when I looked at this device, the actual components of it were just a few hundred pounds. So why was it£10 ,000? Why couldn't he have one? You know, he was asking this question and it sort of set me down this path thinking, well, you know, could we develop something that patients could actually use? Anyway, it was an itch I had to scratch. and so I applied for funding and on a second go got funding from the National Institute for Health Research here in the UK to do a pilot development project working with partners Professor Philip Reardon in Nottingham and Professor Ala Shepura who's a health economist in Coventry and they're working with the facial pauses in the UK and some patient representatives who give us feedback on what we were working on and yeah, we we set up a project essentially an r &d project around this we got to the end of the project and actually so i had to spin out that as a as a company to enable that project to happen because basically it was an innovation uh funding for um for companies rather than for hospitals it was called a product development award and but then realized that actually for what is a relatively rare condition such as facial palsy, the unit cost would end up being actually quite high than many thousands because you don't have, you know, making hardware is expensive and the cost of regulatory approvals is also really, really high.

16:05But because I'd done that work previously on psychological disorders at university, I did know that electromyography, EMG, is used in neuroscience and psychology to study emotions hence the idea of saying well if we could find use cases beyond facial palsy for this technology then that would enable us to reduce the unit cost tremendously and therefore make it available and cost effective for patients to have as their sort of home-based coach on their expressions and um and so forth um yeah so that was that was kind of the beginnings of this and And then around the same sort of time, there was a lot of excitement around VR, and that was obviously really useful because you had this system where you could see on a screen your data, you could practice potentially interactions on that, and then use the sensors to give feedback to the individual.

17:02The difficulty we had there was that we developed this technology called M-Tech Pro, and it was used by researchers, used by us to do some really, really, really exciting research which we can talk about later on perhaps. But it was still quite expensive and quite bulky. And the thing about VR is that it's used episodically. You're a bit like watching TV. You actually go to a destination, if you like, and use it. It's something you would have in a day-to-day life. And so the idea, which had originally been planted about having something that was in glasses, was always in the back of my mind. How could we do that?

17:37how could we try and sense the face in a form factor that people will be willing to wear continuously because by doing that you get much better data much better improvements and and also it could be used for other things that also affect the face such as mental health conditions such as depression bipolar such as social interaction training through things like autism conditions that affect the face like Parkinson's disease, et cetera, et cetera. And then a strange thing happened very, very early one morning. I know this because I actually recorded it on my phone because it was one of those moments that you just knew it was really significant.

18:14Wow. And this idea came to me that we didn't have to use a sensor on the skin as EMG does. If you ever try to swat a fly, you know that's really difficult because they manage to vanish away before you're even close to it. And the reason why they do that is because their vision isn't as ours is where we create an image. They just see a flow of movement called optical flow across their sensors. And so this tiny brain of a fly is able to evade a brain many, many thousands of times bigger than it because it's basically seeing at a very high frame rate. So your hand, you think it's moving quickly, it's moving actually really, really slowly towards it.

18:55and so yeah this idea of using optical flow sensors to track muscle movements I basically imagined a fly sitting on my glasses and what it would see when I smiled and it would see the texture of my skin moving across its visual field and so that was the birth of this idea of facial optomiography that we patented and which basically is the core of our technology that we call OcoSense the name is derived from the name of the sensor on the fly's back called an Ocelli, which is O-C-C-E-L-L-I. So it's been kind of a mad journey. So EMG is amazing. It's a gold standard, and we've used it to validate our technology.

19:37We did a huge study at the Science Museum in London, which someone called Roger Highfield, who's the director there, helped us to set up, enabled us to prove out with a fantastic researcher called Iffy Mavridu, who did a PhD with us, that we could actually measure emotional responses called effective responses in people. She created basically three scenarios, a positive, neutral, and a negative scenario. And people filled out sort of personality and psychographic data and see how people responded emotionally to these different emotionally evocative scenarios. And that was the core of our model around measuring emotional responses based on facial expressions.

20:22and then we basically transplanted that core model into the glasses-based system and which is now being used by researchers. So it's been a really long journey to get to this point and it's just so exciting now that the idea that was kind of planted as seed from those clinical interactions is now being instantiated in a device that will hopefully help a lot of people in the future. That is an amazing story, Charles, honestly. and even going right back to the beginning and thinking about, I guess, how your personal stories, and thank you for sharing that, by the way, I didn't know about that previously, about what happened to your siblings and things, and I think it always fascinates me, you know, what motivates people and where the sort of meaning comes from, and I think you've obviously got so much meaning, and a lot of that I relate to, actually, in the sense of, you know, seen as the other you know my dad was I say was my dad is African um trained as a nurse came over from Mauritius on a boat when he was 18 and you know black male nurse in the 60s that can't have been easy you know very much othered I've walked on the street and seen him othered and heard him othered in his face you know as a child you know these these these experiences sit with you don't they like for a long time and i'm sure you know you've you've got a lot of that stuff personally as well more so than me i think and you know i think in some way someone actually asked me the other day like why am i so obsessed with community why am i so obsessed with like building community in health tech and around all the media stuff and setting up the next gen community for the next generation to have a voice and like why am i why am i trying to like so hard to like do these things that seemingly don't have much commercial value but seems to be scratching some sort of itch and it's like I don't know but I think it a part of life is that we're we find we find meaning and we find purpose from wherever it comes from and it can be seen as adversity but it can also be seen as privilege because actually the anxiety does seem to to disappear somewhat when you're taking action against something that's to do with your purpose and there's a there's a beauty in that i think and that's quite nice and i think part of the goal in life is to figure out what that is for you and to figure out what that is for the people listening of what is it that's actually gonna not make you care as much about the financial rewards or whatever it is and finding whatever it is that's going to drive you and i think that you told that story so beautifully about your personal side but also the the medical side as well i think as a plastic surgeon there's an interesting equation that sort of comes into my mind that hadn't ever come into my mind previously that when you talked about holistic look at patients when you talked about the face and identity i think it's very easy in medicine to reduce things to cause symptoms diagnosis treatment and actually in the in the example that you gave about someone that was tortured uh under the saddam hussein regimen hit on the head with a rifle and every time they look in the mirror that's what they think you know people in health care and health or health tech people in health tech like you can build a solution with a market size and you could like You could talk in these terms, right?

24:01And you can talk about these things. But when you've been a clinician, you've spoken to that patient and you've understood that story, it is almost impossible, even the lowest level of empathy, to not connect with that and to not think like, hey, there's a metric, there's a measurement, there's some sort of energy or there's some quantifiable thing that we're not quantifying here that that story is full of. there's a reason for doing this that seems to transcend financial metrics and how much time and energy it's going to take me and there's some sort of there's some sort of like connectivity or empathy or there's some sort of score there that that exceeds the maximum amount of that isn't in a lot of other places that i think as as as humans we haven't figured out what that is yet but i think there's a lot of answers in whatever that question is like yes um and i can't quite put my hand on that and that's very poorly explained for me so kudos if you've understood that correctly but it's like yeah no i i i think i mean ultimately as a as a doctor as a health professional of any kind to be honest you know it's talking because they talk about this thing this job to be done you know our our job to be done is to help people to feel better that word field is is relevant there because it's ultimately it's all about emotions um and you know i apologize to many of my patients who end up sitting outside and waiting for my clinic overruns yes again is because sometimes um it's actually the conversation is the therapy is the way that you help the patient because you have to really understand what is the root cause you know when a patient comes in with the concern about their face.

25:51It isn't necessarily always just to do with the anastomy you see in front of you. And, you know, we actually did research on this because I was so perplexed why sometimes you'll see patients with a very marked degree of asymmetry, facial asymmetry, and it's like, yeah, doc, this helped me, this helped me from watering and this helped me dribbling and I'm fine. You know, even though they have a very marked asymmetry in other patients, who have a relatively mild asymmetry and it's destroyed their life. They've given up their job. They are not going out. They're socially isolated. They're very depressed.

26:24We studied this and there's a very low correlation between the severity of palsy as measured with our standardized tools and the anxiety and depressive symptoms. So it's really trying to get to that core. And with plastic surgery, it's interesting that a lot of my colleagues are slightly perplexed by, you know, why would you spend all this time and effort to become a consultant plastic surgeon, which is, as you can imagine, because of its potential financial rewards, highly sought after as a career. Why do you do that, climb this ladder and then spend so much time, effort and money to try and address this thing?

27:03But I think it's actually the same job. As a plastic surgeon, your core role is to help patients

27:14see what's in their mind eye. So in the case of somebody who's having even an aesthetic improvement, they have a vision, they have an image of themselves that isn't reflected in the mirror when they see themselves in the morning. Same with somebody with facial palsy. It's the same thing. They even talk about this loss of identity. I don't recognize myself anymore. They'll often say that if they've developed a facial palsy due to an infectional accident etc and that personality schism if you like is tremendously depressing because they can often to get about it when they're in the world and then suddenly they'll catch a reflection in a shot mirror or somebody will take a photograph without them knowing when they're in a social setting and then it'll be posted online and it'll suddenly just come rushing back to them a patient said to me once this expression which really stuck with me that fish discover water last and I sort of looked at them quizzically and I said well you know it's only when that fish is full of water and they suddenly realise this thing that was around them this thing that they had all the time they took advantage and only when you lose your ability to express yourself and express yourself how you intended to do you realise what it is that you've lost and so it's that is at the core of what we do as a doctor.

28:40You're trying to help people to feel better. In some cases it's with a tablet, in some cases with an operation procedure, in some cases it's just with information and helping people to

28:54see themselves differently or perhaps to marry what's in their mind's eye with what is actually in the mirror, what others see. I think if anyone listening is in any doubt at all of why we need to increase the efficiency of healthcare then they should replay what you have just said because i think a lot of a lot of narrative around ai we've got this we've got the ambient scribes you've got this like we can increase throughput we can do more doctors can see more patients like more more more more more like what you've just described is that actually when you're allowed to deliver a standard of care that you want to deliver it takes time because you're a surgeon you should love cutting you should and you do i'm sure absolutely yeah absolutely time disappears you know when you're in flow in surgery it's uh absolutely but you also love solving the problem and you see that as your role you don't have to love it even but you see it as your role to make the patient feel better that takes time it's and as we get more tools call them ai or otherwise i don't care but as we improve healthcare as we improve the efficiency of healthcare we need to ring fence or increase the amount of time doctors have to see patients and select people for their ability to do what you can do so well because you can just tell Charles that you care right like you care about these patients do you find it hard by the way like it might be a stupid question but like you you're you do seem so connected to to your job and these people as patients like is it do you do you have really difficult days with this i mean it's very rare for there not to be tears in one clinic uh it's very very rare um you know last clinic uh patient she's a tv presenter it could you imagine that your whole career is based around being able to deliver um information in a way that's not distracting to the viewer and he developed a facial paralysis in her case as results or through pregnancy pregnancy is one of the risk factors for developing bell's palsy which didn't really recover and yeah i mean totally you know we talk about how difficult it could be to look in the mirror twice a day if you're going to be on camera on screen and dealing with the consequences of a facial paralysis it's tremendously difficult and so yeah it's a very emotional time this is why i'm really lucky working with an amazing team of uh facial therapists and psychological therapists and other colleagues because it's yeah it's it cuts the heart of a person's identity it really does the story that you then went on to go and tell about mtech and founding the company like this is the establishing like the meaning for this and your purpose for this is it's so incredibly clear and what what's a driving force you have to go and solve all of these problems it's incredible and it's the first thing I actually want to ask you about is this like this um this sort of light bulb moment now obviously that's that you thought about mtake you thought about the way that the company could be built the product the device could be built and and that story is very much aligned with how a lot of people on this podcast talk about very rarely do we hear about like light bulb moments actually um but this this sense and this feeling of hey this is what a fly does this is how a fly will analyze movement hey let's now think about the the physiology of of the expression of emotion and what actually happens and looking into it that detail and and that kind of light bulb moment um what do you what do you think contributed to that because i think a lot of people want these light bulb moments a lot of people i've actually read a book on ideas and how to get ideas and a lot of things a lot of the narrative in there is like don't walk the same route every single day vary your environment like a lot of that sort of stuff and another school of thought seems to be do everything you can to create the environment for ideas and then put no pressure on yourself like let the idea be a gift let the idea be a gift for the work that you put in to just creating the right environment so light bulb moments i rarely get to ask someone about light bulb moments because it very rarely happens so i'm interested in yours like what do you think led to that that's yeah that's interesting i i mean i think you can if you talk about being able to ask your subconscious uh about things and interesting that's you know if you go to bed i think i think thomas edison did this apparently he used to sort of i think something about him saying he used to go to bed and ask his subconscious to to solve this problem and it was really interesting in this case because literally i you know i get up very early in the morning i woke up you know whatever 5 30 it was still dark i didn't put lights on and um i was in the bathroom and the moonlight was shining through the trees uh outside and it was it was windy and the tree the branch of the trees were putting a shadow across the um across the window and it was that that evoked this idea of of the movement and which sort of trigger this thing and i mean in my case i i'm obviously i've always been really into biology i've always been into nature and much of what we do is based around biological processes because basically you can't trump millions of years of evolution absolutely people people sort of worry about ai and doing this but you know together the human brain runs on 20 watts of power it's It's a tiny amount of energy.

35:14It's highly, highly efficient. And so you can't really compare this incredible capacity that we have as humans compared with these large-dimensional logics, which are hugely energy-intensive. And then in this case of the fly, yeah, I guess it's just kind of thinking like, why can't I best this thing that's tiny? And yeah, just getting back to first principles and keep asking why. That's the other thing. I read a book years ago. In fact, if there are any entrepreneurs listening, I really strongly recommend reading this book called Lean Startup by someone called Eric Rees. He talks a lot about this philosophy of cutting to the core.

35:58When you have a problem occurring, you just keep asking why. Let's call it the five whys. It comes from the Japanese manufacturing process. he gives a really great anecdote in this about when Toyota I was going to say is it Toyota yeah yeah that's right yeah they had this it's fascinating but he had this anecdote about when they tried to produce a factory Toyota in America because they were overtaking the American auto industry because they were very much more efficient had better quality in visiting one of the car factories there an American car factory said, oh, well, this is where we fix all the cars and all these guys, like four or five guys, checking all the door openings and closures and adjusting the frame, this, like, and the other, and the little mallets to improve things.

36:51And the Toyota representative said, why didn't you just do it correctly the first time?

37:01Because they've got a system there, the Toyota production system, basically, that everyone on the production line is empowered with a thing called the Andon cord. It's like a cord, or there are multiple cords along the production line. And everyone from the cleaner to the engineer, anyone is empowered that if they see something wrong going on, anything to do with the production of this vehicle, they pull this cord and the whole thing will stop at the cost of tens, hundreds of thousands of yen. but people are rewarded for doing that and the point is that if you can get to the root cause of problems you can have a small defect that occurs early on in the production process but that's going to be manifested later on so I have that philosophy of the five whys I keep asking why when a problem occurs gets the root cause and that philosophy when I read that I was thinking a lot about healthcare and how so often in healthcare there's a problem that appears and you want to add a solution rather than asking the five whys.

38:05You know, a patient comes to my clinic and they need to have surgery, but they can't operate on them because they're smoking. And I ask, well, you know, I can't operate on you because it's going to impact on the result because the blood supplies it, et cetera. But then I think, well, why are they smoking? And, you know, I dig into it. Well, you know, I found I'm really struggling with my weight. And in many cases, many female patients who smoke, it's because it's a useful way of managing their weight. well why is the weight usually well I really really struggle because I have a really stressful job and I find that when the stress gets too much I find that I want to kind of have a binge and I have this food and then what is it you're eating well I worked long hours and anything that's available so you go back and you actually realise that so much of the root core problem there is emotional i.e.

38:59the stress and how they manage the stress or don't manage the stress and then the kinds of food that they're eating and and you know it's been embarrassing to realize just how poor our education as doctors is around dietary health and its impact on both our behavior and our moods and this is something that we're really sort of leaning into just now with some work we've been doing with the glasses so yeah that that five wise approach you keep asking why then you realize actually when you look at the top 10 causes of premature death and you ask the five whys you know if you ask most people say what the biggest cause of death they'll say what cardiovascular disease well people don't have heart attack from nothing typically it's related to things like smoking things like poor diet and lack of exercise if you ask the five whys of those things it gets comes back down to those two things the diet and the emotions the reason why people don't exercise is oftentimes because they're either too stressed, haven't got enough time, or they don't feel motivated enough, even though exercise is by far in the way the most effective antidepressant that exists.

40:05A big review published in BMJ showed that. If you ask people, why does somebody have a stroke? Oh, they had raised blood pressure. Why did they have raised blood pressure? The majority of it is because of diet, high salt diet and lack of exercise. Why aren't they exercising? It literally comes back down to it. I didn't realise until two years ago that 30 % of solid cancers are due to obesity. Obesity is a massive issue now. People talk about it a lot, to do with GLP-1s, etc. But obesity as a cause of both cardiovascular disease, as a cause of type 2 diabetes, which themselves are causes of premature death, is huge.

40:46And then obviously things like Alzheimer's, which is growing in its prevalence, which again is hugely to do with metabolism. Again, diet is estimated between 30 % and 40 % of Alzheimer's is related to diet. Obviously a big chunk of the other parts of it are to do with lifestyle. Again, things like exercise. If you have a major break of a bone, hip fracture, for example, and you're over 70, there's something like an 80 % risk of death within the year. I need to check the figure, but it's something like that. That's an automatic. It's a massively high risk. Now, what's the risk of a fall? Well, it's due to instability, lack of muscle strength.

41:28Again, it comes back down to those behaviors. And so it's been really interesting for me just digging into the research and asking that why and realizing that we've done a really good job in understanding, say, sleep. We've got devices now, like Oura Ring and others that help us to understand that. done a really good job on perhaps understanding physical activities, the pedometer, step counting via your Apple Watch or your Fitbit, etc., your Whoop device. But we really haven't done a good job at all on understanding those other two big pillars of health, let's say dietary health and emotional health.

42:05And the glasses certainly have a role to play on emotional health. We worked with somebody called Professor James Stone. He's a psychiatrist and neuroscientist at Sussex University. with the glasses and he did a study that was published in Frontiers in Psychiatry that showed that the glasses can distinguish between depressed and non-depressed people using a standardized protocol where they are exposed to effective, emotionally stimulating material, which is amazing. And he's looking to apply for further funding to develop that program further. That study was done in a lab. And that's where you see that work in the real world and to look at things like bipolar disorder as well.

42:48super fascinating we work with a researcher called Lisa Feldman Barrett and her colleague Karen Quigley who do some amazing work and who's really revolutionised our understanding of emotional responses I mean she doesn't like the word facial expression because it's true it is facial movements rather than expressions but the core of this is that we do respond to our environments each person has a personalised response to their environment so you can't have a one-size-fits-all approach but as long as you take that into account and the context of their response well, in much the same way that you learn from your loved ones your partner, your family members you learn or can infer how they're going to behave based on their expressions and their movements well, so too can technology and you can now develop personalised models to understand mood Yes, and this is what I want to come on to Charles because I think this is where you were ahead of your time i think five years ago with this because as the conversations that i've been having recently about where ai is taking us and i i don't like using the term ai really in this context too much but it's basically where technology is taking us that technology broadly is taking things off our plate it's taking cognition and thinking off our plate and you know i've talked to people about people that say oh we're past we're past peak human like we're not we're not going to have to do the same level of research and thinking and and analysis and all this sort of stuff because you know llms are going to do it and this is going to do it and that's going to do it but it's interesting isn't it because i think a lot of that energy that we were spending it's like calculators yeah like i said this on the last episode it's like calculators coming along like yeah we're not going to do long division on paper anymore we're going to lose the ability to do long division like on paper but we're going to redistribute that energy into something else now and then we went and built computers like the next thing and all the rest of it but i think there is probably you know broadly there's going to be a redistribution of what peak human actually means to go from memorizing facts and doing research that computers can do and i think we are gonna have especially in health care by the way we're gonna have to have more of a view and a vision and an understanding of emotions because it is going to make health care better for all the obvious reasons you've talked about in plastic surgery and plastics broadly and like everything that you've you've mentioned about the ability for people to feel better because of lots of different things the analysis of emotion there is obviously incredibly important in mental health distinguishing how depressed people are on a spectrum and a scale and and all and bipolar and all the conditions that you've mentioned this allowing us to read things from that perspective but i almost think of it as well the other way around of the clinicians because again a lot of the thinking and and talking that i've been doing with people now is is the more that we can understand what level of emotion is required in a certain clinical interaction from a cancer diagnosis at one end to i don't know just a bog standard gp appointment about your little toe fungus i don't know like at the other end they require very different emotions they require a very different eq profile and actually can we start to read people better for their ability to deliver empathy and that rather than just going for you know self-directed guidance in medicine of where we end up best can we actually start reading that better of people and reading that better of situations is a new age clinical skills training going to look more like people with mtech glasses on and then getting a score of well you read the emotions right or wrong and you delivered the emotions right and wrong and here's some feedback and some learning and can we can we teach people how to make people feel better to an optimal level not just going well this person's pretty good at it so we'll stick with impallative care or like can we actually teach this a lot better and show people so people can learn it and i think there's going to be a redistribution I think of of how important it is that we learn these things so it feels to me like you're perfectly primed with the device and so with with that in mind I guess can you just talk about like high level summary what the device is what the device does in various different areas that you're focusing on from research to clinical applications and all these different things just give me like the top line view and yeah I guess what you're looking to do with it in the next few years?