Ann Berger, MD, MSN. May 2024

Transcript

• 00:00So we have a small group here,
• 00:01I expect a few more we'll join
• 00:03and we're and we are recording.
• 00:04So I know often these are very
• 00:06popular downloads for people who
• 00:07aren't able to make it at this time.
• 00:09So let's go ahead and get started.
• 00:13So it's a real pleasure to welcome
• 00:16Doctor Berger today to give what
• 00:18will be our last seminar in the
• 00:20Psychedelic Seminar series for the year.
• 00:22We'll start up again in September,
• 00:24and we're very interested in
• 00:26everyone's suggestions as to who
• 00:28we should invite for this series.
• 00:30I think it's been a lot of fun.
• 00:31I've certainly learned a lot,
• 00:34and I know that today will be no exception.
• 00:36I'm grateful to Julian Uruti for making
• 00:38the connection with Doctor Berger.
• 00:40She has a long history of working in
• 00:44the areas of pain and palliative care.
• 00:46She completed fellowship in medical
• 00:48oncology at Yale and was on the
• 00:51faculty here for many years,
• 00:52but then has gone to found the the
• 00:54pain and palliative care unit of
• 00:56the National Institutes of Health
• 00:58where she continues to work.
• 01:00And there she does patient care,
• 01:01education,
• 01:02administrative and research responsibilities.
• 01:04So you probably how your schedule
• 01:06probably looks something like mine.
• 01:10Doctor Burgers, published extensively in
• 01:12the field of pain and palliative care,
• 01:14Wellness, and ways to measure
• 01:17psychosocial spiritual healing.
• 01:18He's currently a consultant in
• 01:20helping organizations transform from
• 01:21the culture to improve resilience,
• 01:23Wellness, compassion, empathy,
• 01:24and human relationships.
• 01:26And she's going to discuss with us today
• 01:28the development of the NIH Heals study,
• 01:31which is a major trans institute
• 01:33endeavour at the National Institutes
• 01:36of Health to focus on on Wellness,
• 01:39pain, addiction and various
• 01:43other aspects of of healing.
• 01:46And I'm looking forward to hearing
• 01:48what you have to share with us.
• 01:50Thank you for being here.
• 01:51OK,
• 01:52Well, thank you for having me.
• 01:54Actually, I have retired from
• 01:56NIH as of the end of January.
• 02:00So congratulations and administrative
• 02:03responsibilities have gone away.
• 02:04I'm still doing a lot of teaching.
• 02:06I'm, I'm jealous, you know,
• 02:08as a volunteer, a special volunteer,
• 02:10and I do a lot of teaching I'm doing.
• 02:12I'm continuing my research.
• 02:14I'm doing scholarly work with the fellows
• 02:17you know. And then and then I'm part
• 02:20of this JQ consulting where we're
• 02:23changing systems in terms of things like,
• 02:25you know, using mindfulness and
• 02:28other integrated modalities.
• 02:30So I'm still very, very busy.
• 02:33As I told Jessica,
• 02:34I will not be playing mahjong or
• 02:37whatever else people do or supposed
• 02:39to do. It won't be me.
• 02:44The other thing is just to clarify
• 02:46the NIH heels that we developed
• 02:49this tool is not out of NIH
• 02:52from the Heel initiative.
• 02:53Yes, I'm actually
• 02:55part of the Heel initiative and I'm still,
• 02:57that's still something they have
• 02:58me roped into to give grants
• 03:02and intramurally for that.
• 03:04But this is actually different.
• 03:06And when we named this,
• 03:08we'd already named it before the NHL
• 03:11when we first published the tool.
• 03:14I actually even sent it up to
• 03:15Doctor Collins just to make sure
• 03:16that wouldn't be a problem and
• 03:18he was fine with it. So well.
• 03:22So I've I've already proved the
• 03:23truth of my own words, which is
• 03:25that I have a lot to learn today.
• 03:27Exactly. But that's OK.
• 03:31So how do I go to next?
• 03:33What did we do here?
• 03:35Previous. Oh, here.
• 03:36Next. OK, no disclosures.
• 03:38As you can well imagine,
• 03:40when you work for NIH,
• 03:42you don't you don't own stock or anything.
• 03:44Or now this is my mentor,
• 03:47Dame Sicily Saunders,
• 03:49who was also a doctor or nurse like myself.
• 03:53She was also actually a social worker
• 03:56and started Hospice a long time ago
• 03:59in UK but actually was the one who
• 04:03started Branford Hospice in Connecticut.
• 04:06So the biopsychosocial spiritual model,
• 04:10just to go over that a little bit,
• 04:14is the bio is clearly the illness,
• 04:17the injury of the genetics,
• 04:19the psychologic, anxiety,
• 04:20fear, guilt, anger,
• 04:22social response of significant other
• 04:25support systems, and spiritual.
• 04:27Now, the spiritual piece is a piece that
• 04:31I've been most interested in my research in,
• 04:35because it is the piece that clearly
• 04:39helps lead people towards healing,
• 04:42and we'll talk about what healing is.
• 04:44But spiritual is a whole
• 04:46lot more than religion.
• 04:47I know people hear the word spiritual
• 04:49and much like palliative care seems
• 04:51to be a term that people think
• 04:53is just the end of life care.
• 04:55And it's not.
• 04:56Well, spiritual is much more than religion.
• 05:00For some people,
• 05:02it is their religion,
• 05:04but for many others it's not.
• 05:06And so it has to do with transcendence,
• 05:09increased sense of connections,
• 05:11relationships, meaning and purpose,
• 05:14values and beliefs.
• 05:17And so we'll talk a little bit
• 05:19more about this in the tool itself.
• 05:21So in today the objectives are to
• 05:24understand the concept of what healing is,
• 05:27describe the NIH heals and its development,
• 05:30define the three factors and describe
• 05:32how it's been used in a study with
• 05:36patients receiving psilocybin.
• 05:37And you know,
• 05:38I'll I'll go over much of the studies,
• 05:41how we got there and even what
• 05:43we're doing now like a sneak peek
• 05:46so NIH heals is a psychosocial
• 05:51spiritual measure of healing that
• 05:53assesses positive transformation in
• 05:55response to challenging life events.
• 05:58It's a 35 item self report form that
• 06:02is scored on a 5 point likelihood
• 06:04scale from strongly disagree to
• 06:06strongly agree and then there are four
• 06:09items that have reversed scoring.
• 06:14Now for a palliative care doctor this is
• 06:19not a hard lead to go to some patients.
• 06:22What we've you know,
• 06:24what I've seen is some patients with
• 06:26life threatening or chronic illness
• 06:28report positive psychological,
• 06:30social and spiritual change during the
• 06:33course of their treatment or their disease
• 06:36even in the face of unfavorable prognosis.
• 06:39So I was interested to know and
• 06:43identify factors that contribute to
• 06:46this positive transformation known as
• 06:49healing in the world of palliative care.
• 06:51You can call it life transforming events,
• 06:54whatever and has far reaching
• 06:58implications for improving well-being,
• 07:00quality of life, mind,
• 07:02body and spiritual Wellness in
• 07:04the face of life's challenges.
• 07:07You know and even at Yale I was a
• 07:11oncology fellow and then stayed
• 07:13on as faculty with a joint faculty
• 07:16and anesthesia and oncology.
• 07:19And I did a lot of not only
• 07:23supportive oncology but a lot of
• 07:25chronic pain people with failed back,
• 07:28people with fibromyalgia.
• 07:29And what you would see was that there
• 07:33would be patients with life threatening
• 07:36illness who would feel healed and
• 07:39those with diseases like fibromyalgia
• 07:41that could get out of the bed.
• 07:43So I was interested what is going on here?
• 07:47And then how can we measure this
• 07:50psychosocial spiritual healing.
• 07:56So what I'm talking about here is that
• 08:01in terms of level of functioning,
• 08:03it's, you know, before the event and
• 08:05then you can either succumb to it,
• 08:08survive with impairment, recover from it,
• 08:11which implies more resilience,
• 08:14or thrive from it better than before.
• 08:18And the next few slides will go over a
• 08:20patient that you know you'll hear her voice.
• 08:23Because the first,
• 08:25the first thing we did was to
• 08:29discover what was this healing
• 08:32experience was interview patients.
• 08:35In order to develop a tool,
• 08:38I felt like you needed to actually start
• 08:40from the qualitative and the information
• 08:43you get from qualitative is tremendous.
• 08:46So we interviewed,
• 08:47viewed patients who had cancer,
• 08:49who had survived cancer,
• 08:50we interviewed patients who had
• 08:52survived cardiac conditions and we
• 08:54also looked at some HIV patients,
• 08:57some patients with HIV disease.
• 09:04So we did initial clinical observations,
• 09:07lit review,
• 09:08we did the qualitative interviews.
• 09:10We then did a review from this.
• 09:13We came up with a bunch of
• 09:16questions and streamlined them.
• 09:17We did an initial pilot study with
• 09:20100 patients to do an initial factor
• 09:22analysis and reduce some of the items.
• 09:25We then did cognitive interviewing and then
• 09:27we did a study to actually validate the tool.
• 09:32So the first two studies were with
• 09:35cancer survivors and with cardiac
• 09:37survivors at a local hospital near
• 09:39us and NIH Clinical Center and Smith
• 09:42Farm Center for Healing,
• 09:43which is in DC.
• 09:45So here's a lady who talks
• 09:47about what healing is.
• 09:49We didn't use the word healing.
• 09:51They were included in the trial.
• 09:53If they said they had positive
• 09:55life transforming events,
• 09:56she uses the word healing.
• 10:16Hearing the audio. I don't know
• 10:17if it's playing on your end.
• 10:21Yeah, you can hear it.
• 10:22No, can't hear the audio. Oh,
• 10:26oh, it is playing
• 10:27here. I think there's a
• 10:29Zoom setting, but you have.
• 10:32I'm not quite sure how to do it.
• 10:35Anyone on the call know how to connect it?
• 10:37So zoom will pick up the audio
• 10:40from Anne's computer.
• 10:44All right. So yeah, that's odd,
• 10:46'cause I am hearing it.
• 10:52But what she talks about
• 10:54here is she's 30 years old,
• 10:58she gets breast cancer and she
• 11:02had to go through a lot of both
• 11:05curing the disease because she
• 11:07was told that she had this life
• 11:10threatening illness as well as
• 11:13healing on a lot of different levels.
• 11:14And so she talks about how she goes
• 11:18back to the trauma of losing her dad,
• 11:20who was in his early 40s and had also
• 11:24died from a cancer of some type,
• 11:27and says here it was more than
• 11:30just saving myself from cancer.
• 11:33It was much saving.
• 11:34It was going through healing
• 11:36on a lot of different levels.
• 11:38And so it was like Technicolor.
• 11:40It was like my life has been
• 11:41in black and white and all of
• 11:43a sudden this diagnosis,
• 11:44it went to Technicolor
• 11:49now. And if you want to try to share,
• 11:51there's a suggestion in the in the chat
• 11:54about how you can share the audio.
• 11:56I think it's an option in
• 11:58your share screen menu.
• 12:02Oh, why don't I think
• 12:03you move on, 'cause if if
• 12:04you're not gonna have a lot more. Yeah,
• 12:07I'm not. No, no,
• 12:08it was the only one. All right.
• 12:11So the initial, the initial study,
• 12:17you know, was the qualitative.
• 12:20And then we followed that up
• 12:22with an initial factor analysis
• 12:25of preliminary factor analysis.
• 12:27And what happens when you do qualitative
• 12:30work is, you know, because frankly,
• 12:32it took them about, you know,
• 12:3520 years at NIH to tell me that,
• 12:39yes, doing qualitative work also
• 12:41was a true science. I had to have,
• 12:43I had to have reviewers from the outside,
• 12:45you know, and some of them were
• 12:47from the National Academy say,
• 12:48well, actually, yes,
• 12:49this is a real science that she's done.
• 12:52So what happens is you come up,
• 12:55you come up with themes when
• 12:57you do qualitative work.
• 12:59I don't know who if people are
• 13:01familiar with qualitative work and
• 13:03you come up with themes and sub
• 13:05themes and then you can put them
• 13:08into little baskets or factors.
• 13:11And so we at that time found
• 13:13that there were four factors of
• 13:15these questions that had come out
• 13:18of the qualitative interviews.
• 13:20We we called it at that time
• 13:21and you could call it anything,
• 13:23but we called it religion,
• 13:24spirituality, intrapersonal relations
• 13:26and interpersonal relations.
• 13:29Now as you see, that's gonna change.
• 13:33Patients during one of our studies
• 13:38spoke about what healing meant to them.
• 13:41They said getting appropriate treatment,
• 13:43accepting the illness, not blaming myself,
• 13:45letting go of the past, less pain,
• 13:49feeling better physically and mentally
• 13:52and regaining strength to make whole
• 13:55and to function at a normal ability,
• 13:58focus on getting well instead
• 14:00of finding a cure. So again,
• 14:02it's not always cure driven healing,
• 14:05it's it's getting well,
• 14:07it's making whole and in palliative care.
• 14:11Those are words that we're very familiar,
• 14:13were very familiar with achieving
• 14:17a sense of well-being,
• 14:19free of pain, distress,
• 14:20to correct my body and rid of my disease,
• 14:23Expecting what you accepting what you
• 14:25got to go through and making progress
• 14:27from one state of health to another.
• 14:29So all of these type of things
• 14:31helped us come up with questions.
• 14:34But again,
• 14:34as you'll see later,
• 14:36the tool is a tool of
• 14:39psychosocial spiritual well-being.
• 14:43One of my favorite pictures.
• 14:47Anyone who knows me knows that I've always
• 14:49liked to bring normality to the patients,
• 14:52so I would bring tea cards out.
• 14:55This was a guy we saw before he
• 14:58had a bone marrow transplant.
• 15:00We always were consulted on and
• 15:03still are consulted on patients
• 15:05from the day they come to the
• 15:07institution to get their transplant.
• 15:10And the only symptom he had was anxiety.
• 15:13And so we asked, well, how are we
• 15:16going to be able to help your anxiety?
• 15:17And the answer was not
• 15:19giving him a medication.
• 15:20It was, let's get me a magic wand and hat.
• 15:26So the day of his transplant,
• 15:28we gave him a magic wand and hat,
• 15:30and we all wore magic wands and hat.
• 15:32And this guy was with us,
• 15:35you know, on and off,
• 15:36in and out of the hospital
• 15:37and outpatient for about two
• 15:39or three years until he died.
• 15:40But Needless to say,
• 15:42you know we were his team that he
• 15:44could totally trust because we had
• 15:47gotten him his magic wand and hat.
• 15:49So sometimes that's all it takes.
• 15:55So the validation, we finally got up to
• 15:59the validation trial and there we recruited
• 16:02200 patients at the NIH Clinical Center
• 16:05with severe and or life threatening
• 16:07illness from June to December of 2017.
• 16:10The NIH heels at that time was 42 items.
• 16:16So we started with like 56 and we
• 16:18just kept whittling it down going
• 16:21through all the different studies.
• 16:24And the way you get,
• 16:27the way you validate,
• 16:29you have to validate the tool based on
• 16:32other tools so you can get convergent
• 16:36and divergent validity and reliability.
• 16:40So we use the Facet Spiritual,
• 16:45which is a very common tool used
• 16:49in the not only health Care World,
• 16:51but really the oncology world
• 16:54developed by David Seller.
• 16:56He's developed all these tools
• 16:58for chronic illness.
• 17:00We use the self and this was
• 17:03for convergent validity.
• 17:05Self Integration scale was a very
• 17:07interesting scale that had questions that
• 17:10actually were for convergent validity
• 17:13and those that were for divergent.
• 17:16We were also interested in mindfulness.
• 17:19So we use the Mindfulness
• 17:21Attention Awareness Scale,
• 17:22but that was not for the actual validation.
• 17:25We also use the Connor Davidson
• 17:29Resilience scale and we used a
• 17:32trauma scale and those are not for
• 17:36the validation that was for you
• 17:38know looking at at other things.
• 17:42Can you since we have a rather
• 17:43mixed audience at this seminar,
• 17:44can you define what you mean by
• 17:46convergent and divergent validity when
• 17:47you're doing scale development like this
• 17:52what you're trying to
• 17:53see is how it it relates.
• 18:00You know, is it similar to scales
• 18:01that are asking similar questions?
• 18:03Is it divergent from scales that or
• 18:06are questions that have nothing to do
• 18:09with the thing that you're looking at?
• 18:11You know, so if you're looking at
• 18:13psychosocial, spiritual healing
• 18:14and has nothing to do with those,
• 18:15then it shouldn't, you know,
• 18:17they shouldn't line up.
• 18:21Thanks, sorry.
• 18:25Oh, and then we did
• 18:26and then we did a another factor
• 18:29analysis which you have to kind of do.
• 18:32So it it demonstrated excellent reliability,
• 18:35internal consistency was
• 18:39a Chromebook Alpha .89.
• 18:42And as we see here from in terms
• 18:45of the convergent divergent
• 18:48validity and the different scales
• 18:51with the convergent validity,
• 18:53we use the questions from that
• 18:55CIS scale that I talked about,
• 18:57the integration scale and it the total
• 19:02score as you see here was statistically
• 19:06significant not only in the total
• 19:09score but in all of the factors.
• 19:12And we'll talk about the factors.
• 19:15The factors turned out to
• 19:17be 3 at the end and not 4.
• 19:20The facet has different factors also,
• 19:24much like our scale does.
• 19:26So the different factors in facet was faith,
• 19:29was peace and meaning.
• 19:31And again,
• 19:32it converged beautifully with our scale
• 19:36and then DIVERGENT again there it didn't,
• 19:41you know it,
• 19:42it was our scale was not similar to it.
• 19:46So these are the three factors that we found.
• 19:51And these are important because these are
• 19:56the factors that when we got involved
• 20:00in looking at it with psychedelics,
• 20:02people who were doing psychedelic
• 20:03research came and said,
• 20:05Oh my God,
• 20:06this is what the patients are telling us.
• 20:08So these are factors of connection,
• 20:12reflection and introspection
• 20:13and trust and acceptance.
• 20:15So connection has to do with connection
• 20:18with religion and higher power,
• 20:21but also has to do with support from family
• 20:25and family becoming a higher priority
• 20:30and essentially support from a community.
• 20:33It does not have to be religion,
• 20:37reflection.
• 20:37Introspection has to do with things
• 20:41like difficult circumstances in life has
• 20:45increased my compassion towards other.
• 20:48I take more time to be in the moment.
• 20:50I find meaning in helping others.
• 20:53I I have an increased sense of gratitude.
• 20:57Being surrounded by nature is meaningful.
• 21:00I wanna make the most of my life creative
• 21:03arts to bring peace to their lives.
• 21:07Awareness,
• 21:08so self-awareness,
• 21:12activities that involve both mind and body.
• 21:15Working through my own grief brings
• 21:17meaning to life, more connection in
• 21:21all relationships and doing something
• 21:24I'm passionate about gives purpose.
• 21:26So again, it's about meaning.
• 21:28It's about purpose,
• 21:29it's about self-awareness.
• 21:33And this was between this and the
• 21:37connection became very important
• 21:39to those studying psychedelic.
• 21:42So we can, you know,
• 21:43talk about how we got there
• 21:45and then trust and acceptance.
• 21:49So there's a sense of which
• 21:50was also a a topic that we had
• 21:53heard in the psychedelic world.
• 21:56But this was developed before
• 21:58the people that started studying
• 22:00psilocybin had come to me.
• 22:02So I I have a sense of peace in my mind.
• 22:04I have a sense of purpose.
• 22:07I am content with life.
• 22:10I feel calm.
• 22:11I accept things that I can't change.
• 22:16Support for medical
• 22:18caregivers were important.
• 22:19And all of these we've written
• 22:22papers about and also talks about
• 22:27multiple losses because a lot
• 22:30of what we've seen with some of
• 22:33the trauma scale that we use,
• 22:35trauma absolutely correlates to less healing
• 22:41and you know many people have trauma.
• 22:45Now another great picture of
• 22:50a of a tea party that we had.
• 22:52We do tea parties and this was
• 22:55actually the patient was a physician
• 22:57and he was in the ICU but we did a
• 22:59tea party for he and his wife and
• 23:02the wife is wearing the hat and
• 23:04this is like a whole oncology team.
• 23:06This happens to be Doctor
• 23:07Rosenberg and there are O,
• 23:08TS and PTS and research people
• 23:11and for 24 years we did tea
• 23:13parties and people loved it.
• 23:18So we then looked at the data from our
• 23:25200 patients on differences between
• 23:27males and females and there was a
• 23:30suggestion that there was a difference.
• 23:33There was no difference in 31 out of
• 23:3635 items and no difference in males and
• 23:41females on two of the three factors.
• 23:44But males and females differ significantly
• 23:46on the factor of reflection, introspection.
• 23:49And the items that were different was
• 23:52compassion towards other gratitude,
• 23:55desire to be more positive and mind
• 23:57body practices important a little bit.
• 23:59We haven't gone back to look at this.
• 24:02Important to just keep that in
• 24:05mind 'cause sometimes when we pick
• 24:09modalities for our patients,
• 24:11you know they may not be
• 24:13the same for each patient.
• 24:14And for males and females.
• 24:18We looked at, as I said,
• 24:20trauma and history and severity.
• 24:24And trauma severity was significantly
• 24:27correlated with the NIH HIELDS
• 24:29trust and acceptance factor.
• 24:31As one would probably guess,
• 24:34we also looked at the NIH Hields as a
• 24:38related to resilience and mindfulness
• 24:40in patients with severe and or
• 24:43life limiting medical diagnosis.
• 24:47And again the Conner Davidson Resilience
• 24:52Scale as I'm sure your group knows
• 24:55has 10 items and that's the scale use.
• 24:58It was positively and significantly
• 25:00cut correlated with our scale,
• 25:03the NH Hills and each of its factors.
• 25:08The same you're gonna see is true of
• 25:11the Mindful Attention Awareness Scale.
• 25:13It was positively and significantly
• 25:16correlated with our NIHL total
• 25:19score and all three factors,
• 25:24and this is just a diagram of that.
• 25:34So the results of the current study
• 25:36indicate a relationship between
• 25:38psychosocial spiritual well-being,
• 25:40resilience and mindfulness,
• 25:42and demonstrated that it possibly
• 25:45was related to resilience and
• 25:50psychosocial spiritual
• 25:51well-being and mindfulness.
• 25:56So we did another trial.
• 25:59We've done a few trials in Africa where we
• 26:03validated our tool there and it's now in
• 26:06about four different African languages.
• 26:08And then we get up to the
• 26:11United Heals psilocybin.
• 26:12So there was cognitive interviewing
• 26:14in Africa and that's what where are
• 26:17you cognitive interviewing of a scale,
• 26:19You go and ask the patients,
• 26:23you read the questions of the scale and
• 26:26ask them how they understand the scale,
• 26:29how they understand that question.
• 26:31So it's different than qualitative
• 26:33interviewing in that that was much more it,
• 26:37it was more open.
• 26:39This is actually looking at the squid.
• 26:42This questions on the scale
• 26:44that you have 17 were women.
• 26:4731 of the questions were comprehensible.
• 26:50Some four of them needed rewording
• 26:54for another populations in Africa
• 26:57and the ones that needed rewording,
• 27:00I want to make the most of my life.
• 27:01I seek more of a connection
• 27:03in my relationships.
• 27:04I take more time to be present in the moment,
• 27:07and working through my own grief
• 27:08has brought meaning to my life.
• 27:10The scale has also been looked at in
• 27:15populations of elderly and specifically
• 27:18elderly African Americans in the South.
• 27:22So we've tried to broaden it out to different
• 27:26populations and again there in Africa,
• 27:30the the,
• 27:31the,
• 27:34the thing that came back when they were
• 27:36asked about what is healing to you.
• 27:38Much like in the United States where I
• 27:41had talked about developing wholeness,
• 27:44developing well-being,
• 27:46they talk about having hope,
• 27:50surrendering to the supernatural
• 27:53being and similar type themes.
• 27:58Now we then got involved in the
• 28:02psychedelic world because they came to us.
• 28:06It was a practice not far from NIH.
• 28:09Everybody had trained at
• 28:11NIHD oncologist Suncoast.
• 28:15I assume most in this group had
• 28:18are aware of Suncoast and they
• 28:20had come to us saying we you know
• 28:23came across your tool and the
• 28:25factors that you're talking about,
• 28:28the connection, the self reflection,
• 28:31introspection,
• 28:31the trust and acceptance are to our
• 28:35themes that our patients are talking about.
• 28:38But we've not been able to capture it before.
• 28:42And so the the first study that was
• 28:45done was with this group of patients
• 28:49at Suncoast that Manish Hagarwal had.
• 28:52I know he has the tool now
• 28:56in many other of his trials,
• 28:59Ali Zarabi at Emory said.
• 29:02His trial I think is completed
• 29:04and he was going to share the
• 29:06data with me at some point.
• 29:07I just need to reach out to
• 29:09him and see what he has found.
• 29:11But it is being used in other trials.
• 29:14But this was our first intervention trial,
• 29:17so it was kind of exciting for us
• 29:19because we had developed the tool,
• 29:20which took about 12 years to develop.
• 29:23It didn't go from you know one day
• 29:26and next thing you have a tool.
• 29:29So this was a study that involved a one
• 29:31time psilocybin administration to 30
• 29:34patients with both cancer and depression.
• 29:37And the NIH heels was administered
• 29:39at baseline day, one day,
• 29:40week one, week 3 and week 8.
• 29:44Improvement was noted in the NIH Heels
• 29:47total score and its three factors over
• 29:50time in response to the psilocybin
• 29:52and at every time point compared to
• 29:55the baseline consistent with outcomes
• 29:58of anxiety and depression measures.
• 30:01So of course we were pretty excited.
• 30:04The age was
• 30:0930 to 78 mean of 56.
• 30:13Females were more representative
• 30:15in this study as you see here.
• 30:19Here's the ethnicity and race.
• 30:21It was a highly Caucasian population.
• 30:26Marital status was also 66%,
• 30:30and 83% of these patients were employed.
• 30:37In terms of number of depressive episodes,
• 30:43there was 40% that have greater than three.
• 30:47So there was a lot of
• 30:50depression in this group.
• 30:52Baseline depression severity
• 30:54was also significant.
• 30:57Prior antidepressant group also 50%
• 31:00significant and cancer prognosis,
• 31:0453% were non curable, 46% were curable.
• 31:08Now I had sat in on some of these when
• 31:12he was doing it because I actually
• 31:15wanted to see how it was done and
• 31:21it was, it was interesting to see both
• 31:26you know, the curable and the non
• 31:29curable individuals were equally being,
• 31:35you know gaining well-being
• 31:38from the psilocybin treatment.
• 31:40So as you see here,
• 31:42the baseline NIH shield score was
• 31:461/19 and week 1 it was 133 and it went
• 31:51all the way up to 134 at week eight.
• 31:53So the the well-being psychosocial,
• 31:56spiritual well-being scores
• 31:59remained up even at week 8.
• 32:03And this is the reflection
• 32:06and introspection factor.
• 32:07This is the same true for the
• 32:10trust and acceptance factor.
• 32:16So let me go back for one SEC.
• 32:24So we were excited and you know published
• 32:28on this show that our NIH site Silas
• 32:32Simon clearly improved psychosocial
• 32:34spiritual well-being in cancer patients.
• 32:36But our tool this was the first tool
• 32:39that our that was an intervention
• 32:41trial that there was a difference.
• 32:44I'm gonna give you a sneak peek of another
• 32:48one that we just sent for publication.
• 32:50So again, you know,
• 32:52we can't be quoting that one, but the
• 32:56NIH heels is a tool that is very robust.
• 33:01We're finding now and the world,
• 33:05the psychedelic world.
• 33:06I know there are people using
• 33:08it now and using it in research.
• 33:10Not all of them have contacted me,
• 33:12so I don't know them all.
• 33:13I know Manisha is, I know Ali Zarabbia is,
• 33:16but this is a robust tool that I
• 33:19think you know can safely be used,
• 33:23you know,
• 33:24and I'd love to hear if you're
• 33:26using it at some point.
• 33:30So we
• 33:35have recently completed a trial,
• 33:36This is not with psychedelics.
• 33:38We've recently completed a trial
• 33:40looking at health care providers who
• 33:43took care of COVID patients and they
• 33:46received they were either a control
• 33:48arm or a nature adventure arm or a
• 33:52nature adventure plus mindfulness.
• 33:56And we see here this, in this study,
• 34:00there were more females.
• 34:03Again, I don't know if more females
• 34:06generally sign up for studies.
• 34:08Age was about 35,
• 34:13a large percentage of Caucasians,
• 34:1858% were nurses, 15% were physicians.
• 34:21And then we have physician assistants,
• 34:24social workers and others.
• 34:28So we randomized as you see here
• 34:33control group and it was a control
• 34:36wait list group nature only and
• 34:39nature plus or minus mindfulness. Our
• 34:47primary endpoint was after the mindfulness.
• 34:55So everybody you know was looked at then and
• 34:59then the secondary was eight weeks later.
• 35:04Now what is interesting here is
• 35:06that we used a lot of scales,
• 35:09but we used the PSS or the perceived
• 35:14stress scale as the primary endpoint.
• 35:19Other scales we used were the mindfulness
• 35:23tension scale, burnout scale,
• 35:25We looked at heads for depression,
• 35:28we looked at sleep, the ISI for sleep.
• 35:33We looked at self efficacy and what
• 35:37we found is that the only thing
• 35:39that changed in this group of of
• 35:42healthcare providers was the NIH heels.
• 35:45None of the other scales,
• 35:48including the BSPSS which was our
• 35:52primary endpoint, did not change at all.
• 35:59Now the NIH Shields, that was the PSS.
• 36:02The NIH Shields did change over
• 36:06time and so the control did,
• 36:11which is the one below did not change.
• 36:15The intervention groups,
• 36:17Both the nature and the nature
• 36:20plus the mindfulness did change
• 36:22in terms of the NIH Shields.
• 36:25So again, and this is the
• 36:27intervention groups combined the
• 36:29nature and the nature mindfulness.
• 36:31So we know we have a very robust tool here.
• 36:35It's not only for patients
• 36:38with life threatening illness,
• 36:40it's for healthcare providers
• 36:41who took care of COVID patients.
• 36:43Now granted, as I've said,
• 36:46these are also a fairly stressed
• 36:49group of individuals,
• 36:51but it was interesting to us 'cause
• 36:53we assumed the PSS would change and it
• 36:56did not and we are going to report,
• 36:59we were reporting on it because
• 37:00it's important that that information
• 37:02get out there.
• 37:07So the last sneak preview,
• 37:10this also is submitted for
• 37:12publication but not out there yet.
• 37:14We developed a nine question questionnaire
• 37:19from the scores and we have looked
• 37:22at it now in after developing it we
• 37:26that that's in publication as I said
• 37:30but we also have looked at it in two
• 37:33of our other studies and the nine
• 37:37question tool correlates very well
• 37:40with the 35 item And we partly did
• 37:43this because those looking at it in
• 37:46the psychedelic field have said you
• 37:49know a shorter scale would be good
• 37:51because you're using so many other scales.
• 37:54And so the questions that they came
• 37:55out to be as I have a sense of purpose
• 37:58working through thoughts about dying
• 38:00brings meaning to life difficult
• 38:02circumstances of increased compassion
• 38:04difficult situation strength and connection.
• 38:08Religious beliefs help me feel calm.
• 38:11It takes more time to be present at the
• 38:13moment I have a sense of peace and I
• 38:16have an increased sense of gratitude.
• 38:18So conclusion,
• 38:19it's a 35 item valid and reliable measure.
• 38:23We developed a short form history of trauma.
• 38:27Resilience and mindfulness are
• 38:29factors in experience of healing.
• 38:31Preliminary data shows that it's
• 38:33sensitive in psilocybin and now we find
• 38:36it sensitive in healthcare providers
• 38:38who took care of COVID patients.
• 38:41There's another one that we're
• 38:43looking at now,
• 38:44but we actually looked at it in a
• 38:47group of teachers who got a eight
• 38:50week mindfulness program and the
• 38:53NIH Shields has also shown change
• 38:56but that that data is very,
• 38:58you know we have we really need a lot
• 39:01more looking at that and we continue
• 39:04work nationally and internationally.
• 39:11Couldn't do this without a big team,
• 39:13both research, clinical and
• 39:15just a lot of great people.
• 39:25Great. Thank you so much.
• 39:27You've done a lot of work and it's
• 39:29a really nice example of how we can
• 39:31do more than just measure symptoms,
• 39:33symptom improvement,
• 39:34which is so often the primary focus,
• 39:36but not necessarily what our
• 39:37patients care most about.
• 39:39So it's interest.
• 39:40And it was interesting in that COVID study.
• 39:42I mean, we looked in COVID Healthcare,
• 39:45we've looked at that over and over
• 39:47again with the symptoms of stress and
• 39:50depression and this and that and sleep.
• 39:52And we were like, this is not possible,
• 39:55How is this not possible?
• 39:56We made our statistician nuts going back
• 39:58and forth and headed in all kinds of ways.
• 40:01But it's really more about
• 40:05well-being and psychosocial,
• 40:07spiritual well-being.
• 40:08And it's actually very powerful.
• 40:12I mean, I think it's a it's something
• 40:14in my research that I'm quite proud of,
• 40:18yeah. I I was wondering you showed
• 40:22the three factor structure in the
• 40:23original tool and you they emerged
• 40:25out if you call it well four,
• 40:26but then three that emerged out
• 40:28of the qualitative work and then
• 40:29that was in the original tool.
• 40:30Two questions about that.
• 40:32First, is that three factor
• 40:33structure captured in the brief
• 40:35version of the tool or have you
• 40:37sacrificed that dimensionality in
• 40:38order to get the more convenient
• 40:40we we had to sacrifice that but are
• 40:43there questions from each factor? Yes.
• 40:46But with 9 questions you're not gonna get,
• 40:48we're not going to get that.
• 40:50But it correlates actually,
• 40:51'cause we, we have looked at it,
• 40:53We're not reporting on that in
• 40:55that in the paper that we just
• 40:58submitted on the COVID study,
• 41:00but we have the data,
• 41:01it correlates the nine item,
• 41:03correlates very well with the 35 items.
• 41:06So I think it's going to hold up.
• 41:08We also are looking at it
• 41:10in the teacher study.
• 41:11We asked them both the 35
• 41:13item and the nine item.
• 41:14So and again that data is still the
• 41:17statistic she's still working on.
• 41:20But you know she gave me a sneak
• 41:22preview and interestingly PSS didn't
• 41:24change there either for the teachers.
• 41:28So interesting have you looked at in
• 41:32either of those in any of the three
• 41:34studies have you looked at sort of
• 41:36conventional quality of life measures
• 41:38to see if this is AI mean I I would
• 41:41predict that this might be a better
• 41:44predictor of well depends on what
• 41:46exactly what's being captured by the
• 41:47tradition what I call the traditional
• 41:49quality of life measures exactly
• 41:50because in every world's different.
• 41:53So like in our study, you know,
• 41:56in our validation study,
• 41:57we compared it to the Facet spiritual,
• 41:59which is considered an
• 42:01oncology quality of life.
• 42:03You know, fool, you know,
• 42:07known in more of my world.
• 42:08But I think David Sella is actually,
• 42:11you know, 'cause he developed all those
• 42:13tools and he developed all the promise tools.
• 42:15He's so he's gone well beyond just oncology.
• 42:21But you know,
• 42:23I I think that this stands up quite
• 42:27well 'cause it it it answers,
• 42:29there are a lot of questions in
• 42:32there that are not in other tools
• 42:34about the meaning and purpose and
• 42:36connection and self reflection
• 42:38and trust and acceptance.
• 42:40And so it captures a lot.
• 42:43I just, I what I was wondering is if these
• 42:45constructs that you're measuring are better
• 42:47predictors of a very general question,
• 42:50like do you feel that life is going well?
• 42:52Do you feel better than you did before?
• 42:54If you ask, if you ask very
• 42:56general questions in a way that
• 42:59captures what patients or subjects,
• 43:01what they actually care about,
• 43:02yes, I feel better than I did.
• 43:05And I'm wondering if what would
• 43:06be the best predictor of that?
• 43:08And it might not be symptom reduction,
• 43:10it might be meaning as you
• 43:13as you're suggesting, right.
• 43:15But I didn't have to, but I suspected is
• 43:18the meaning and and that's
• 43:20the spiritual piece that we
• 43:22don't talk about in medicine.
• 43:24It's it's the meaning and purpose.
• 43:26And I mean that's the piece that
• 43:29is most important to patients
• 43:33and and to not only to
• 43:34patients, to people in life.
• 43:37Sure. You know I did wonder going back to the
• 43:41factor structure of the original instrument.
• 43:43It seemed like you said you emphasized
• 43:45a couple times in a couple of these
• 43:47studies that the you had a significant
• 43:50improvement both in the the overall
• 43:53score and in the factors and they all
• 43:55and they all correlated with one other.
• 43:56I'm wondering if you've seen any circumstance
• 43:59where the different factors dissociate.
• 44:01No, we didn't from one another.
• 44:04OK, so they may be they may be
• 44:07measuring closely related, you know,
• 44:09different aspects of but of a
• 44:11closely related unitary construct.
• 44:13Right. OK.
• 44:17There's a question in the chat.
• 44:18I bet you're welcome to speak
• 44:19up or I can read it out.
• 44:22Yeah, I I can't see the chat.
• 44:23It says any correlations or
• 44:25relationship with or or I will add or
• 44:28relationship to the placebo effect,
• 44:33all right. I mean, I don't know.
• 44:34We haven't looked at it
• 44:35in the placebo effect. But
• 44:39again, I'm not sure it matters.
• 44:43If the placebo effect is what helps you,
• 44:49you know, feel better from a emotional,
• 44:52spiritual point of view and makes
• 44:54you feel more connected and gives you
• 44:57more self-awareness, that's great.
• 44:58Then I think it's going to pick it up.
• 45:04But there may be different like placebo
• 45:06effect, which is itself a we should have
• 45:08Jerry Santacora's been thinking a lot about
• 45:10the placebo effect in this parsed out.
• 45:12We should have him come and talk.
• 45:13He's he's got some really
• 45:15interesting observations on what
• 45:17people mean by the placebo effect.
• 45:18But in any case, it seems like
• 45:20they may be two different things.
• 45:22Well, you're looking for ways to
• 45:23measure change in a domain that we use.
• 45:25That's super important,
• 45:26but we don't usually pay attention to.
• 45:28And the placebo effect is asking about
• 45:31changes that are attributable to quote,
• 45:34non specific, interpersonal,
• 45:36environmental.
• 45:37You know those two things may dissociate,
• 45:40right? You can have placebo
• 45:41responses in pain or symptoms.
• 45:43You could have placebo responses in
• 45:46hope and meaning and you could have,
• 45:49you could have treatment specific
• 45:51responses in pain or symptoms.
• 45:53You could have treatment specific
• 45:54responses in hope or meaning.
• 45:55They may be orthogonal.
• 45:57So, so I can answer that in
• 45:59some way in that I came in,
• 46:02you know, I was brought in, like I said
• 46:05to Manisha's trial because of the tool.
• 46:09And so I wanted to see how the how the
• 46:12psychedelics worked and what was going on.
• 46:14Because honestly,
• 46:16I am probably the only one in the
• 46:19psychedelic world 'cause now, you know,
• 46:21I've gotten hooked up with the whole
• 46:23psychedelic research world out there.
• 46:25I'm probably one of the few who
• 46:29has never tried psychedelics.
• 46:33OK, so I have never tried it.
• 46:35So I came with open eyes with
• 46:38like, you know, OK, well,
• 46:39what does this really do?
• 46:41And you know, how does this work?
• 46:44So I came to the sessions,
• 46:47and the sessions say first,
• 46:48as probably you're aware,
• 46:50the first session is a group of them,
• 46:54and there's accounts,
• 46:55There's a therapist on the side
• 46:58sitting right next to them,
• 47:00and they're actually given,
• 47:03they were given a flower
• 47:04or something to hold.
• 47:05They were given something to hold.
• 47:08And I'm sitting there going,
• 47:10Oh my God,
• 47:11what's not being measured
• 47:12here is intentional healing
• 47:17when we I'm one
• 47:18that you know, has done Reiki for patients.
• 47:21So when we do Reiki or even
• 47:24teach mindfulness, we ask for
• 47:27people to set their intentions.
• 47:30I'm a big believer and have given
• 47:32lectures on healers need to us.
• 47:35The health care providers need to
• 47:38also set healing intentions and what
• 47:41were they doing there? It was absolutely
• 47:45setting intentions and that's not,
• 47:48you know that's not something that
• 47:50is recorded in the in the research.
• 47:54It's the psilocybin 25 milligrams
• 47:58worked but you know and decrease the
• 48:01depression and increase well-being.
• 48:03But it's all of that stuff around
• 48:07that whether you want to call
• 48:10it placebo effect or whatever,
• 48:12where people are actually setting intention,
• 48:14that does make a difference,
• 48:17A huge difference.
• 48:21Jordan, I see your hand.
• 48:26Hey, and thanks so much for
• 48:29your work. I've done some psilocybin research
• 48:32here and looked at psychological measures
• 48:35and correlations with symptom improvements.
• 48:37So I'm happy to see another scale
• 48:40looking at this domain that also
• 48:42goes beyond just mystical experience
• 48:47questionnaire and is is broadening this.
• 48:50I had a couple questions about the scale and
• 48:53the and just the psilocybin study I just
• 48:56noticed with the in the connection domain.
• 48:59I thought it was interesting
• 49:01that like the nature,
• 49:02there was one piece about nature
• 49:04connection which has gotten discussed
• 49:05in the the psychedelic community,
• 49:07but it wasn't in the connection bucket,
• 49:10it was in sort of the other bucket.
• 49:12And also it didn't seem like
• 49:16interpersonal connectedness was
• 49:18in the connection domain either.
• 49:20I was just kind of curious how you
• 49:22parsed out what was connection like.
• 49:24It seemed like the connection
• 49:26was more this religious spiritual
• 49:28idea rather than interpersonal.
• 49:30The connection was
• 49:32the the initial connection questions
• 49:34were in the 35 item or connection
• 49:37with religion, higher power,
• 49:40and connection with family.
• 49:42The connection with friends and
• 49:45nature are actually in the factor of
• 49:49self reflection and introspection.
• 49:51So what happens when you do a
• 49:53factor analysis is they load in.
• 49:56The questions themselves load in
• 49:58different areas and you can't
• 50:01force them to load somewhere else.
• 50:03They loaded together with all the
• 50:06other questions about compassion and
• 50:11you know all of those questions
• 50:13mindful behavior and mind
• 50:15body in that self reflection
• 50:20awareness, type self reflection piece it it.
• 50:24So it wasn't called connection,
• 50:27it was separate from that connection,
• 50:30but it's still in the tool because the
• 50:32loading in the factor analysis is not
• 50:34you can't take the questions and say,
• 50:36well I want it to be in this factor.
• 50:41I didn't go away. Yeah,
• 50:42I mean I have a lot of slides
• 50:43on the factor analysis itself,
• 50:45it's I just have to pick and choose what
• 50:47I'm doing. But yes, you can't. So that that's
• 50:50how it ended up there.
• 50:51Now as you notice it's not in
• 50:53the nine item one, but nature is
• 50:56very important and that's why,
• 50:57I mean they seem to correlate very well.
• 51:00But you know, my bias is still gonna
• 51:02be if you could use the 35 item,
• 51:04use the 35 item and we've now used
• 51:06it in many trials and you know,
• 51:09even very seriously ill people
• 51:10are able to do 35 questions.
• 51:16But yeah,
• 51:18thanks. And I was just wondering about
• 51:21the some of the terminology like
• 51:23there was one item that talked about
• 51:26connection or support from a quote
• 51:29specifically a religious community.
• 51:30And I was wondering why sort of
• 51:33emphasize religious community
• 51:34as opposed to any community.
• 51:37And then another factor talked
• 51:40about religious beliefs specifically
• 51:42as opposed to maybe spiritual
• 51:44beliefs or something more broad.
• 51:47So I was just curious about
• 51:49the specific use of religious.
• 51:50In both cases,
• 51:52we got religious,
• 51:53and that was a question
• 51:55that has come out a lot.
• 51:58But we got the word religious from
• 52:02the initial qualitative work.
• 52:04Those are the, those are the
• 52:07words that our our subjects used.
• 52:11And so, you know, and then I don't know if,
• 52:15I mean it's interesting,
• 52:16'cause we studied it then in an HIV,
• 52:19an African American HIV population.
• 52:21We studied it in elderly
• 52:23African Americans in the South,
• 52:25we studied it in Africa.
• 52:27I don't know if maybe that's why the
• 52:30religious peace keeps coming back.
• 52:33I was actually concerned about
• 52:35that since we have so many who are
• 52:38not affiliated in the country.
• 52:40But it seems to be a word
• 52:43that continues to draw people.
• 52:49Do you, when when patients do
• 52:51fill that out, do you kind of give
• 52:53them guidance that if they don't,
• 52:54if they're part of a different community,
• 52:56they can still score it?
• 52:57Like I just imagine that would create a
• 53:00little difficulty for non religious folks.
• 53:02I I I haven't but
• 53:04certainly you can say
• 53:06religious slash spiritual.
• 53:08I mean I, you know and
• 53:09and we we went round and
• 53:11round about this 'cause I was like even
• 53:14when we did the 9 item I was like I I,
• 53:16you know I feel uncomfortable
• 53:18with this because I had actually
• 53:20shown it to my kid at the time
• 53:23who was who is a neuroscientist.
• 53:25He's an MDPHD neuroscientist.
• 53:27It's a piece on the neurology spectrum.
• 53:30He does Lewy body dementias
• 53:34and that you forgive him and so
• 53:38so and he's at Hopkins
• 53:39but you know he immediately
• 53:42was like, you know this,
• 53:44these religious terms are
• 53:45not gonna hold together,
• 53:47but they are even holding together with
• 53:49this group of COVID healthcare providers.
• 53:51So I can't, we can't change it.
• 53:53Can we say religious slash slash spiritual?
• 53:57Probably yes, because that's
• 53:58all you see in the literature.
• 54:01Well, it but in the original
• 54:03qualitative work you had two religious
• 54:05and spiritual as different domains.
• 54:07Like your 4 domains were religious,
• 54:09spiritual, intrapersonal and interpersonal.
• 54:10Which implies to me that there's going to be.
• 54:14I mean there is something different
• 54:16about having spirituality fused
• 54:18with a structured institutional you
• 54:20know that that that is a different
• 54:22category than a spirituality that's
• 54:24more individual or or less less.
• 54:26But I think this I would assume that
• 54:28you're gonna have other questions
• 54:30that are gonna pick up the non
• 54:32religious spiritual components.
• 54:34So, so the distinct from the factors,
• 54:36the two other factors, the self
• 54:38reflection, introspection and the
• 54:43and the trust and acceptance are
• 54:45picking up the spiritual piece.
• 54:48Those are the two factors
• 54:49picking up that spiritual.
• 54:51So there may be value,
• 54:52even if it only resonates with a a portion,
• 54:54a large portion in this country,
• 54:56but a portion of your of your respondents,
• 54:58you may still be picking up something
• 55:00that's importantly different when you
• 55:02use the word religious than when you use
• 55:04the word spiritual as long as you're
• 55:05getting the spiritual with other items.
• 55:07So and you might lose that if you
• 55:09switch to religious slash spiritual
• 55:11and muddied what may actually
• 55:12be an important distinction.
• 55:16Well, we left it
• 55:17even in the nine questions there are still
• 55:19like two or three with the religious,
• 55:21you know because it was just interesting
• 55:23to me that even in this healthcare
• 55:26providers who are all young people,
• 55:28of course everybody's young to me,
• 55:31but they're all young people and they still
• 55:35scored the religious as positive. So and
• 55:40I just had one last quick question.
• 55:42You said the NIH heals you said
• 55:45was consistent without the outcomes
• 55:48of changes in depression and
• 55:50anxiety in the psilocybin study.
• 55:51But when you say consistent with
• 55:53you mean like the IT correlated,
• 55:55the change correlated with those,
• 55:58yes. And that was
• 56:00that was the Suncoast study.
• 56:02The the primary outcome there
• 56:04was not the heels of course.
• 56:06The primary outcome was depression. And do
• 56:10you know if they collected some of
• 56:13the other commonly used measures of
• 56:16subjective experience in the study like
• 56:19the Mystical Experience Questionnaire or
• 56:22the Emotional Breakthrough Inventory?
• 56:24And I'm just curious how the NIH heels
• 56:27think if that if it the change in heels
• 56:30correlated with depression and anxiety.
• 56:32Did did it also correlate with those other
• 56:35measures that are commonly used in the
• 56:38psychedelic literature or was there some,
• 56:40I don't know if they did,
• 56:42I mean that was Manisha's study.
• 56:44So I I'm assuming you know Manish,
• 56:46you could probably reach out to Manisha.
• 56:49I don't think they studied that.
• 56:51I'm sorry, what was studied what?
• 56:53I don't think they looked
• 56:55at the mystical scale,
• 56:57you know, but you can ask him.
• 56:59It was his study.
• 57:00Manish Agarwal at some
• 57:03It's Sun Sunstone.
• 57:04It's Sunstone. Yeah. Yeah.
• 57:07Manish worked with Hopkins,
• 57:09with the Hopkins group on their
• 57:11original cancer study and then
• 57:13sort of split off to form this
• 57:15freestanding institute, Sunstone.
• 57:18And this was the initial
• 57:19study before this was
• 57:20the. That's. Yeah. This was the Hopkins
• 57:23Stage 4 cancer study. Well, Hopkins
• 57:27and essentially compass.
• 57:30Mm hmm. You know,
• 57:31Compass is the one who
• 57:33funded that initial trial.
• 57:36Yeah. And then he,
• 57:39you know, did Sun Sunstone.
• 57:42I think he's not even
• 57:44doing oncology anymore.
• 57:48I mean other than psychedelics
• 57:49in oncology, but.
• 57:53Oh, good. Thanks so much.
• 57:54We are, yeah, we are at time.
• 57:56This has been great and and broadening.
• 57:59So thank you for spending this time with us.
• 58:01Thank you all for joining.
• 58:03Oh, so we contacted me if you
• 58:05have any questions.
• 58:07Great. Take care everyone.
• 58:09Have a good weekend and we'll be
• 58:11coordinating whether our our schedule
• 58:13for the seminars in the fall. OK.
• 58:17Thank you. Thank you. Thank you.