#451: A new biomarker for depression?

0:02We've normalised the guesswork in mental health in ways that wouldn't be acceptable in other therapy areas. Chronic depression manifests and remains untreated in adult life. You double the mortality risk and you double the chance of developing Alzheimer's or Parkinson's. The only thing that separates these conditions is time.

0:24Hey ready, this week I have got Ben Finlay. and I've known Ben for a long time actually from when you were at Publicis but you've been at Medtronic, you are now a partner at Strat, you are an advisor to RomVA.ai, don't get that confused with Ranvier, it's not Ranvier, it's RomVA and we're going to hear about the origins of that but yeah looking forward to having you on man, it's been a while and yeah it should have got you on a long time ago but it's taken us this long to find a time, you're a busy man. Indeed, no it's great to see you James, thank you And yeah, we began chatting, I think, in 2019, pre-COVID.

1:01And I think it's one of these relationships we've had, which has never come face to face. It's so true. The next episode we could do, you know, on the couch. Let's do it. Let's do it. Yeah. Looking forward to getting into this one. So, I mean, give us the whole story because I think there's a lot here. Obviously, there's drug development stuff in your history. There's Medtronic in your history. and yeah obviously then publicist and getting more into my world of of things there um on the communication side the consulting side more that you were part of i guess and moving into what you're in now so why don't you yeah why don't you start the beginning and just give us the whole give us the whole journey absolutely yeah so i think um it's fair to say i wasn't really academic as a kid right so i kind of left school um you know pre-university so i went straight into employment and I was lucky enough to find a role in clinical research right in the lab and I think I owe a huge debt of gratitude to a person called Bob Johnson who who was head of the lab and he spotted me and said you know you really could go a bit further with your sort of you know inquiry into biology and your interest in in science so he actually encouraged me to go to to uni as part of an undergrad sponsorship scheme.

2:20So I do owe a lot to Bob for that phase of my life. And yeah, I think learning the ropes of lab research gave me a good grounding in evidence-based approaches. And then I spread my wings and developed a interest for a field-based role. So I joined Medtronic to look at market access, right, for complex and novel devices at the time. So this was the early 2000s. And, you know, learning how to raise awareness, learning how to enable access and get novel therapies into market was, again, just a huge learning experience for me. And it was during that period around 20 years ago when I met Nick Patel, who was just about to be a certified consultant in neurosurgery and come full circle 20 years later.

3:17And it's Nick, who I'm now supporting with the Ranvier.ai business. Yeah. And in between then and now, I've set up my first digital agency in 2008. And this was the era of just about when the iPad was being released. So, you know, you think about pharma life sciences, you think about commercial lawless excellence, you think about medical scientific education. a lot of what we were doing then was preparing large pharma companies to go to market with the right information, the right evidence points, the right talking points to really look at increasing share of market, right? Or increasing the scientific knowledge of a given therapy.

3:58So, you know, the red thread throughout all of this has been, you know, my passion for evidence and my desire to create meaningful work that helps to improve health outcomes. And then, yeah, I did a very nice stint at Publicis for around eight years. I was the chief innovation officer looking at MarTech and Marcoms, but more broadly looking at service design, service innovation, and how you can connect novel data sources with unmet patient needs. And then actually, you know, kind of, I call myself the Robin Hood of pharma at the time where we were taking funding from big pharma companies, right, and helping to use that funding in ways that helped communities.

4:39So we were building preventative care services for the aging population. We were building supportive care services for complex medicine or building tools that help to identify rare disease patients, right, in a microscopic proportion of the population. So, yeah, I've had a long and varied career. But really, I think all roads do lead to this point where now I advise companies on how to get to market with, you know, responsible investment in technology and data and people and help, you know, get products and services and therapies into the hands of patients that need it the most. Great story, man.

5:19Loads that we can talk about. The first thing that jumps out, actually, from what you've said, it feels like you've been a little bit ahead of your time in some areas. you mentioned there like preventative care services um and you mentioned connecting data to patient needs and all of this stuff which you know you mentioned those two things literally today and you're like oh yeah we're just thinking about doing these things you know years and years and years ago like that that that it feels it feels very i guess ahead of the time and i mean it wasn't to some extent in the of course there were companies doing this in a certain way but But you being in this sector and your technological areas and your areas in healthcare, the world's changed a lot, right?

6:03Like what you can do today in a single prompt is very much what companies that I imagine you are part of were taking weeks, months, years to do. How does it feel to have kind of lived a career through that? And how do you keep pace with everything that's going on? Well, I think keeping pace is, that's a challenge that will never leave us. Now that we have, you know, any number of LLMs at our disposal. You know, it's a really interesting observation, James. Ultimately, we were building novel approaches and concepts of trying to do things differently. Yeah, 10, 15 years ago. And I think, you know, when I think back to 2014, 2015, we began building fairly complex language models within healthcare back in those days.

6:57Really? 2014? Yeah. Yeah, yeah, yeah. So, I mean, this goes back to some great people I worked with back at Publicis and specifically within Sapient. And these guys, those guys were ahead of their time. Right. You know, and ultimately, you know, it wasn't as finesse as it is now, right? We were literally Salotate, Blu-Tag, sticking together different modules, right? It's when IBM Watson for Health was a thing, right? IBM were working on very large, large data sets then. And this was before Nuance was acquired by Microsoft. So we were stitching together, you know, inference engines, ontology mapping from Microsoft, Google AI servers.

7:42and putting together these systems just to see how it could work. Wow. Right? And one of the biggest questions we had in those times was around the device that you interact with, right? Whether or not we should be building or partnering or borrowing a device to then distill and communicate this novel AI experience through. And unfortunately, back in those days, we actually did decide not to invest in hard tech and go down the sort of the platform and the OS routes, right? So through people's phones. A really funny story was when we were doing some remote co-design with physicians, you know, to understand what they might need from an AI assistant.

8:28We shipped, I think, like 30 individual mobile phones with an innovation manual that was guiding people through. and um you know we gave them this phone for a few days and said whenever you have a request just press the button just ask okay this thing and and we'll log it and we'll respond to you but we're just looking at data just looking at data and we we received like 516 data requests over three days from 30 physicians and it was like you know what's the dosing instructions for this therapy or where can I get an x-ray booked in automatically or how might I integrate with pharmacy for a request but one of the funniest requests was um from a really really entertaining doctor in Chicago he just he just is his only request of information on this on this app was is chicken a fish and and it was and obviously it was a dietary related question I think also related to a certain faith group and actually it was one of those examples where you know tech and the availability of a new service isn't always about prescribing information or a dosing instruction or a limitation of what's on the label.

9:43It's actually sometimes about lifestyle or in the moment, how can you help me solve a question I have for a real patient need? And how can I guide someone on, for example, fasting, right? Or other dietary requirements that might be super important to someone, but actually it could affect when that person takes the treatment or if they take it whatsoever. So I think the idea of experimenting with novel technology and different approaches has just been in my blood. It's just been probably part of my restless nature. I've looked at things and thought, that doesn't interest me. Let's do it differently.

10:23And that was one of those projects back in those days. So I think that, you know, it's having the ability to or having the freedom to operate differently is one of the best aspects about, I think, you know, my role and the roles I've had and being able to give, you know, honest thoughts to solving the same challenges, but in different ways. Yeah, this is great context for the world we live in now. And actually you being part of that development of this stuff, I find this stuff fascinating. Before I just ask you a question on that, though, it does remind me of a story, actually. And, you know, we talk about technology taking over our lives and in medicine, this reminder that we are human, and we have these very human type questions that we want to ask of AI or, or perhaps to ignore it completely.

11:11I remember my GP supervisor, I was a medical student and I was sat in their GP practice and they, someone came in with, and I think it was an ear infection, but I can't quite remember. It was, I think it was an ear infection, but anyway, they didn't prescribe the inverted commas usual or best medication. They prescribed a different medication. and I you know as a medical student the one thing that you do know is you've got book knowledge you don't have real life knowledge and so I then pipe up at the end of the consultation and they were super lovely super lovely man Martin his name was um and he said he was waiting for me to ask the question you know what why why have you given this when the gold standard is this or nice guideline says this and i'm you know reciting all of this nonsense uh to try and impress him and he said to me uh because she prays five times a day and actually the medication will be mapped to her prayers and i was like what it was like one of those moments that's that's just so fundamental to your learning as a person of this is how the world works like this is how this is my this is me having a very expansive moment of ah you can't learn everything that you need to learn in a book that is not how the world works it does remind me of that of how this constant reminder of however much technology there is there is so much to be said about experience and being a person and actually that trumping a lot of this stuff but actually you know in the modern world plot twist can you actually write that stuff into ai so that it prompts you to ask those sorts of questions and I think that's even more of the world we're in now.

12:55But the question I have for you of what you talked about there in those development days of stitching that stuff together, I see this a lot of technology, actually, of the way that we seem to move forwards in technology. I can remember trying to build a website maybe 15 years ago, 20 years ago, was all about what you kind of just described. It was piecing together all of these different things. And you had to learn about DNS and CNAME and A records. And you had to learn about all these. things and you had to piece them from different places and you had to do a bit of like coding yourself and there was no drag and drop wix or squarespace like these things didn't exist but but they came in right then wix and squarespace come in and they go right we're now the one platform you don't have to do any of that now you just do it in this one step and it's and it's funny that that seems to be how the world seems to work i code i say coded i did not code anything But I, with Claude, I built the other day a, for this podcast, you can go on the health tech podcast.com and you can now click on AI search.

13:59And the AI is going to search all of our, you ask it a question, it's going to search all the historical transcripts of the podcast. And it's going to tell you which episodes that your question relates to. It's going to give you the quotes and the comments of exactly where you can find that info. And you can just click the links and it'll go straight to that point in the episode. it was a full day of working with claude and github and deep something and like it was five or six different platforms like all this stuff and i was like why can't claude just do it like surely claude will just be able to just do it at some point um but it's funny like that's how i think that now that i can see patterns i've been in this game long enough of like ah what what a good thing if i productized that and just did it all in one platform then that becomes what i just things it's better for people to do my question for you though in those development days is that when you were stitching all that stuff together in the same way that i was just with that ai search thing were you were you doing it commercially like what was your driver to do who were you doing that with in your career and what was the driver behind it because i can remember ibm watson i can remember these different things and it all it never really clicked with the healthcare space i don't think And we saw that in kind of the outcomes of it and what ended up happening to it.

15:14But yeah, what was your place in the history of it, if that makes sense as a question? I mean, the majority of innovations that I've been lucky enough to be involved in or lead have been a result, sorry, have been the result of an intention of a company. Right. Right. So typically a small to medium or medium to large size farmer, they want to do something novel. or they want to do something different. And this is where we're sort of juxtaposed with improving health outcomes, you know, versus the self-interest of a corporation, right? There is a fine balance here. Interesting. Between those two things.

15:53You know, ultimately, what companies try and do in the health and life sciences space, whether you're a drug maker or a service provider or a pharmacy or similar, what most companies are trying to do is to gain or protect market share. So it's competitive by its nature. So we would normally take professional service fees and use that to then go look somewhere different, go and find a novel or differentiated approach in a service or a particular digital experience. So the commercial side of it has historically been sponsored by companies. And, you know, long will that continue. It's great, yeah?

16:30But as you mentioned earlier, we are now, we're almost normalizing the execution layer of digital. Right. We're making accessible so that interns or undergrads or younger can, with very little experience, create what looks like seemingly intelligent experience layers of connecting things together. That was unimaginable 15 years ago, probably even five years ago. It was unimaginable. right but so we're now democratizing what it takes to get to a credible looking experience the real finesse comes in the plumbing and the piping right and understanding how you know why you might have made an experience a certain way it must always be tied back to unmet human needs otherwise it won't get adopted but crucially also has to have the right kind of interface with data layers the right interface with security the right interoperability so you become able to operate across physical borders or across jurisdictions.

17:34So the one observation I've had over these years is, yeah, commercial sponsorship of projects is great, but it's a bit like global conflict. What if everyone just fought for the same thing, like to get to the moon quicker? Everyone pooled resources. That would be fantastic. It's not going to happen, unfortunately. But in healthcare, it could. What if we got partnerships with major pharma? And rather than Novartis doing a deal with Anthropic and Novo doing a deal with OpenAI, maybe there's a shared data platform where we still maintain competitive factors. But perhaps for rare disease, you're pooling data because it's so hard to find patients in those sectors.

18:17So I would like to see a shift in the way that health and life sciences operates to be a little bit less self-centered. That would be great. It's a little bit ambitious. But actually, if you think about it, more and more of our decisions are being made on data, data quality. If you implement data standards and then increase the volume of data by partnership, you know, by law, you typically will have better results. So I think there's a move coming in the future, which will see more and more collaborations, a bit like, you know, Flatiron and Rosh and whatnot. And we'll see, hopefully, that impact the end user or the patient or the family caregiver or the people close to those taking therapy.

18:58So, yeah, it's traditionally been commercially sponsored. But actually, I do wonder if there's an intermediary layer that's going to emerge, which sort of specialise in maybe LLM data, you know, across platform. And that could then be used to sense the inquiry from patients and consumers using LLMs, right? Because more and more people, I think over half of inbound inquiries to large pharma now come from language models, not search engines. Oh, interesting. Over half? Over half. Over half of inbound inquiries from both consumers and healthcare professionals. Wow. They originate in a language model of their choice.

19:37Wow. So now pharma is having to look at language model optimization, look at ways to integrate a more seamless or frictionless flow within language models. So if they inquire about a replacement inhaler within Clawed, they get served the nearest opportunity to resolve that requirement within Clawed. They're not being directed elsewhere. So, yeah, I do see certainly the opportunity for enterprise-grade partnerships that could help pool data and improve the availability of choice and improve the decision systems that sit behind better health choices. a couple of questions on that and i want to move on to actually talking about the companies you're involved with the two you know two things you're involved in a bit more specifically in a second but what needs what needs to happen to enable that you've got big companies that are trying to maximize shareholder value what is it that unites them in this single goal that we all then pull towards is that a vision thing is that more of a practical what is the deal type thing is it segmenting like their territory a bit more so that okay we've got this new collaborative but you play here commercially i play here commercially i mean is that even legal is that a competitions authority thing i don't even know like what what yeah what what actually helps with that that's like saying how do you get well well yeah it's going to be difficult right It is difficult, but I think it's more of an aspiration and a guiding concept than anything else.

21:31You know, you're never going to have Novo and Lily playing nicely in the GLP conference. That is very true. But you might have, you know, for some novel treatments, for some super, super rare disease that require precision therapy, you know, pooling of that data, you know, between competitors might help identify those that need the therapy the most. The thing that comes to mind is, and this is not a solution, and by no means do I deserve a seat on the WHO, but if you think about the FHIR regulations, the FHIR regulations across health systems across Europe and parts of the developed worlds, we have templates, we have standards for interoperability between health record systems.

22:14yeah and you know prior to prior to brexit you know if you went off to to do some you know um winter skiing in in in france you know your medical records are pretty pretty good if you like me fell over and did your shoulder you could fairly quickly get treatments and and you know in that moment doctors can access your health records from overseas you know so we've demonstrated as as a set of individual countries we've already demonstrated how we can bring together health record data and the ability to map and mine that data in responsible ways, in private ways. So I see that as the nearest analogy, if I'm honest.

22:54You know, there's most likely going to be some specialist cases that would benefit first the most. And then, you know, you would spread out towards general medicine. But obviously, you know, the abundance of data now, the availability of data processing and the server farms that are popping up all over the place, that obviously lends itself to companies being able to process more data and get more out of that data. I think ultimately we have to probably shift from companies measuring prescription uplift to companies measuring an uplift in health outcome measures. And that's a really tricky one to try and get right.

23:34To incentivise, yes. To incentivise on health, oddly enough, not profit. but um you know been been in this game long enough to realize that won't change overnight no because that becomes a policy thing doesn't it in a lot of ways because if you can then move the policy you then just move the goalposts of what people are aiming at especially if that policy is linked to financial stuff tax breaks this not the other if they actually achieve things and that's broadly how we can do it so one of the things i learned the most actually about policy when i when i went into policy I was at Health Education England and a little bit with Tony Young at NHS England I did learn that actually policy isn't just this boring place where things happen really slowly which was kind of cool to say at the time when you're in your early 20s and you just want to like move fast and break things in inverted commas but it I ended up learning that do you know what it was it was um overnight they uh they implemented a new policy in healthcare which was that all gp practices had to have um 24-7 triage and in one policy in one policy move an entire market of ai companies was like it's game time here we go right finally the phones are going to start ringing and they certainly did so it's it's it was so it's so interesting to me that like ah i've actually seen this in real time i've genuinely genuinely seen this in real time that as soon as you activate policy in a certain way you can enable an entire market of things to uh to end up happening which is super interesting i can imagine now that you could run scenario models on policy shift good point and and then marry that with scenario models on in a response to a molecule or a therapy or a service intervention you know it doesn't have to be necessarily a therapy or a drug it could be you know something else a bit more human And so with the rise and this advent of huge availability of computational power, I think policy could be a really interesting area for disruption.

25:39That's so true. That probably already is happening. That's so true. Like a Cambridge Analytica for good modelling all of this stuff. For good. Yeah. Yeah, for good, please. Yeah, the results of that we're still seeing with recent voting, etc. but um the other question i had for you before we move on to the stuff you're doing uh with your companies is uh what do you think then of the chat gpt for health claude for health like perplexity for health probably like all of yeah all of these four healths that basically these these massive data companies are now encouraging you not only not only have they got all of your search data i've said this a few times but just say like that i remember seeing a talk from the the head of google health once um who ended up saying like not only of my caveat it might not have been google health i can't remember which one but it was one of them um not only do we know what drugs people are on because of what they search for we know the side effects not not only do we know the side effects we know the rare side effects not only do we know the rare side effects we know the rare side effects and the rare contraindications we have data from search history on absolutely everything so now extrapolate that to what the AIs are capable of so not only people are putting that search data in they're then just being encouraged to just oh just whack in all your blood tests and then we'll give you even better data oh just whack in all of your wearable data like I will give you even better insights oh just whack in all your hospital letters whack in all of this like literally anything that you get from over there like we don't we're not going to interrupt we're not going to be interoperable with all that stuff but but we are encouraging you to like whack it all into here um that data set and now by the way loads of value being given to those at the individual level who doesn't care about any of the stuff that you need to worry about like the cool yeah on the individual level i will get amazing insights from all of that stuff and and even on the again like bringing the consumer stuff like for google health you know they're bringing out their new band no subscription like you you again can just get even more data through that and like by the way whack in all of your medical stuff as well and we'll just give you even more insights it's a strange time that we're able to do that and and i'll come back to it at the individual level creates so much value because there are people and i've seen you know the chat gpt for help the video is is amazing people in remote communities that do not know much about their health that have a chronic condition or an autoimmune condition or something like that they have a flare-up they don't know what to do they don't have very good access to health care very quickly in terms of interventional stuff but they get immediate information they've got all of the recent stuff they can be informed about potential flare-ups about to happen like all of this stuff at the individual level is incredible and amazing but from what you've built over your career and knowing the back end of these systems and how you architect them there are concerns that people have over security and power quite frankly of what people can be capable of the disproportionate kind of power dynamic between well my data's worth something to you but i'm only getting that that kind of recompensed if there is an issue and all that sort of stuff then i then i get information back but am i not entitled to that stuff anyway so it's it's a it's a strange time but how do you feel with all of this stuff happening and it's more of a feel question than anything else because you're you're so connected to it all i imagine you've got a very long technical answer to that but like how how does it feel for you broadly i mean i'm i'm i'm less of a skeptic than i think interesting the majority of people well that's interesting because you're very informed with yeah i'm less of a skeptic because maybe I'm just a little bit, you know, I just believe in the best.

29:31But I feel that, first of all, you know, directors of any company in most developed worlds have fiduciary duties. And if they don't observe them, they'll get put in prison. Right. We've seen that with Bitcoin. And secondly, you know, I do believe that from what I've read of individual testimony and also just seeing how governments across the world are adapting, to this new normal. I do believe that we are putting the right checks and bounces in place. Thirdly, I believe that, you know, when large companies, large pharma engage with these enterprise providers, you know, they are, it takes far too long to get new therapies into market.

30:18Let me start with that, right? And that's because pharma and healthcare are very, very, hold themselves to very high standards of regulation and accountability. so so when you see moves from from novartis and novo and other companies going big with enterprise ai like that will not have come without serious consideration and legal protection right so so we're already operating within a conservative regulated environment so i believe i truly believe that that that we can hope for the best and it is a hope and a feeling like you asked for um but i'll give you a personal account right so 2013 i i was finally diagnosed with an autoimmune condition um called ankylosing spondylitis it's a it's an inflammatory bone disease so just for whatever reason my t cells and my blood markers whenever i get a common cold or a sore throat it just sends my my joints haywire so i suffer really chronic severe pain most mornings.

31:18But particularly when I've got an illness, it's just like, don't talk to me, please. And when that happened back in 2013, I was taking food diaries. I was doing all these things to try and have a better health pattern or better health knowledge. Fast forward 13 years, all I got to do is upload my bloods, upload my wearables, tell my GPT coach project how I'm feeling today right send a photo of the food i've had throughout the day and every single evening it gives me a readout and says you might feel in your right hand a bit more inflammation because you had a bit too much pasta yesterday like i i don't have any issue with with sam altman owning that data yeah like they can have it for free because the benefits i get are personalized advice and prompts for me to ask my physician and my specialist care team at UCL for me to be more informed and me to ask better questions at the point of health.

32:19And that's where I feel we've got an incredibly strong potential in healthcare to bring everyday health choices to the consumers rather than a patient. Because quite often, as we'll discuss in mental health, when you're talking to a patient, it can be too late. What we should be talking to, who we should be talking to is the human looking to make better choices. So I think the idea of, of, of personal coaching, the idea of personal data and, and, and sharing, you know, all your secrets with a, with a machine, you know, so what, like, I'm just not bothered about that. I'm more bothered about being happy each day.

32:58And I'm more bothered about learning about my health choices and then feeding that into whatever I do in my career. So I think the old adage is nothing to hide, nothing to worry about. So I do feel regulation as a starting point is already there and companies that don't adhere will then fail and we will just survive and roll on regardless. So yeah, I think, yeah, I just have a very personal anecdote there. But ultimately, I think something like two thirds of mental health inquiries begin in GPT now. I'll get the citation there. But more and more people are using it. In fact, there's now a PhD content available and you can do courses, certainly over in the States, where you can become a certified coach through GPT, right, for mindfulness and wellbeing.

33:52So this is not going away. This is not a fad or a niche challenge. or, you know, that there will be more and more people, more and more projects being used at a personal level. And I just feel it's going to drive more people towards making better choices because it's truly personalized around their lifestyle. Yeah. No, thanks for sharing that, Ben. I didn't know that you've been diagnosed with that. But I, yeah, I appreciate it from the patient side. It's funny, isn't it? It's very easy, I think, for people in healthcare to talk in generalizations when they don't go through it i mean they say you know when you're healthy you've got a thousand problems when you're unhealthy you've just got one and it's your health and like you know we've all we've all been there with health scares and you know even just a sore throat can do that to be perfectly honest like you just want to get rid of it and feel better and let alone a condition like you've described and that kind of thing and i think it does become about the deal doesn't it like the it's you you said there like it feels like a fair deal and i think that's really important to remember and i'm sort of coaching myself here that that is important to remember and we can get on our high horse about specifics of security and all these different things but at the end of the day there is a patient at the other end asking a question and probably getting an answer and we just need to make sure and we need to be absolutely certain that it's the right answer and that there's an element of determinism and all these different things that is thrown into the llms but the other the other thing is that there is also media accountability as well which we've seen play out with everyone moving from open ai to claude for example for reasons of deals being done with weapons and all the rest of it and you know the media reporting on that and then the public voting with their feet and going no thank you we want to go to the one that has a seemingly better moral compass um not that we truly know what goes on behind the scenes of all of this stuff but at the same time you're right the checks and balances do exist in the world that make these things possible and a bit more palatable i guess and thank goodness it's not just one of these companies at least we can vote with our feet towards the ones that do have a better morality and therefore at least that then is on the table of okay we need to fix our brand and do the right things and have these values and all the rest of it at least it at least it forces that side of things as well yeah fortunately there's not a monopoly and and you know as you mentioned this morning you know you fired up granola i thought you were talking about breakfast but you weren't yeah right there's there's so many more providers out there but but again that comes with risk because you're not sure the level of regulation they're undergoing but But certainly, you know, I feel optimistic perhaps blindly, but that's because I've waited 20 years for healthcare to take some risks, frankly.

36:51Yeah, but you've also built this stuff as well. Like you have actually done the deals with the pharma companies and you've been on the side of the build and you know the technical architecture more than most people will do and you'll know the limitations. And I, yeah, I mean, I take delight in hearing that you're optimistic rather than pessimistic because that could have frankly gone either way um but no i no i definitely appreciate that and as i say thank you again for sharing i appreciate the the the patient insight as well um it does move us nicely onto you know your career has obviously taken you to a place where you can i guess choose to put your time and energy into to what matters to you.

37:36And tell me what you're up to now then as a result. The best way to describe what I do is global healthcare advisory. So I advise companies on how to get to market, you know, by accelerating insights, by orchestrating commercial launch excellence, by having the right medical scientific content in one place, and by helping people understand the benefits of new therapies. And that can also be a service, you know, equally so. And one of the things I've been supporting with over the past three years is a novel company that is focused in neurological wellness. It's a company that's evolving very quickly.

38:22As I mentioned earlier in my career um i met with nick patel who was then an up-and-coming neurological uh sorry an up-and-coming neurosurgeon and um and nick is now one of the world leaders in in movement disorders um helping to um you know help people with um parkinson's alzheimer's as well as um severe treatment resistant chronic depression um so nick is nick is a world leader in uh essentially neurosurgery that helps to relieve the symptoms of untreated neurological disorders. And the company is called Ranvier, ranvier.ai. So we've developed a very simple to use taste test that enables people to objectively measure their mood.

39:10So we were able to give an attributable score to how people feel. And that has its origins rooted right back in the science of levels of serotonin. So we're able to detect, yeah, essentially codify how people feel through a simple swab test. Amazing. So question then. What you're saying is that the objective truth here then, scientifically, what sounds like evidence-based, is that people's perception of sweetness and taste is altered in a correlation fashion with their mood so low mood don't know whether it increases or decreases i assume decreases their perception of sweetness and how they taste is that correct why was i not taught this at medical school ben like what that That is, what?

40:10Yeah. So the company is called Ranvier. It's named after a professor, a French professor, Professor Ranvier. And he discovered the gaps in essentially the insulation of our neurons, okay, that run throughout our body. And those gaps are called in the myelin sheath. Yeah. So we have the nodes of Ranvier. Oh, that's where I've heard it. Yes. Nodes of Ranvier. Yes. Interesting. There you go. So everyone's body has a natural level of neurotransmitters. And those neurotransmitters essentially help the neurological signal jump the gap over the node of Rhombi. Yeah. Right. So throughout our body. And when those neurotransmitters are low or when those neurotransmitters are depressed, we are considered in a clinical state of depression.