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Why Brain BioMarkers are Needed to Improve Outcomes

Episode 376

Recommended Book:

Atlas of EEG in Critical Care

Best Way to Contact Nathan:

Linkedin

Mentioned Link:

Company Website

Why Brain BioMarkers are Needed to Improve Outcomes with Nathan Intrator, Founder at Neurosteer | Convert audio-to-text with Sonix

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Saul Marquez:
Welcome back to the podcast. Today I have the privilege of hosting Nathan Intrator. He's the co-founder and CEO at Neurosteer. Nathan has founded this company. He's on leave from Tel Aviv University where he's a professor of Computer Science and Neuroscience. He's an international scholar in neural computation, machine learning and pattern recognition with more than 140 referred scientific publications. He develops machine learning and signal processing methods for BCI most notably for extensive information extraction from EEG electrodes. He's a past CEO of a publicly traded asthma management company and a founder of a sonar and biomedical signal processing company. A serial entrepreneur as well as a scholar, it's a true privilege to have you on the podcast, Nathan thanks for joining us.

Nathan Intrator:
Thank you so much.

Saul Marquez:
So tell me Nathan, did I leave anything out in your intro that you want to share with the listeners today?

Nathan Intrator:
That was quite an extensive one so I wouldn't say that you left anything. I would say that my current concentration is really helping people that's not in the in my CV but that's really the main focus of these days.

Saul Marquez:
That's the driver.

Nathan Intrator:
Yeah.

Saul Marquez:
Love it. And the niche you guys are working in is as fascinating. Listeners we're going to dive into the work that's being done at Neurosteer for brain health, clinical trials and medical interventions, so stick with us here. But before we do dive into that I'd love to ask you Nathan, what got you into health care to begin with?

Nathan Intrator:
So my background is as you said mathematics and signal processing but I was always fascinated by the brain. I actually started that on my peers thesis because of this signal processing background. The first half of my academic career was devoted to try and understand how animals perform signal processing so beautifully and so I was analyzing bats, dolphins trying to figure out what's going on there why did they perform signal processing so much better than we can do. For example their sonar is much better than our ultrasound.

Saul Marquez:
What was one of your main findings that I find sonar and animals so fascinating. What was your main takeaway from that if you could summarize to like the one Aha?

Nathan Intrator:
Well we could actually dive seriously into it. But the funny part is that the theory of radar which was then converted to sonar was pretty much sealed in 1953 when the first journal of Tripoli signal processing was published and thousands of papers that were written after that kind of flows supported that specific theory. That theory actually puts a limitation, a specific limitation on their ability to actually estimates time and frequency together. That's called Heisenberg's Uncertainty Principle and from measurements that we were able to put our hands on, it became clear that the dolphins are getting much better results. So obviously they didn't read all this physics and electronics papers but obviously there was no way that they could break the physics the basic rules. And so that was fascinating to me to understand how do they do it better and what is it that we are missing. And obviously it was you know one of the assumptions of this whole thing. Basically they send a lot of pings and combine them together in a very smart way much smarter than we felt we could do we could do the theory that I was talking about was based on a single ping for a single ping. That's correct.

Saul Marquez:
That is so interesting and. I love that you visited this and it's a great reminder for everybody listening. And it's been a theme here in the last few podcasts that we've had is this idea that if you're going to make a difference and and truly, truly push the envelope you've got a question all assumptions. Even the most core assumptions that could be in place and this example by Nathan is definitely a case in point. So thanks for sharing that Nathan and say you you took this brilliant focus in sonar and built a couple companies but now you're you started Nuerosteer. I'd love if you could just tell us a little bit about that your work there and then they're the key item that you think needs to be on health leaders agenda today.

Nathan Intrator:
So we have no in the 21st century. We have a monitor over and in many cases a very small monitor for a lot of the organs in the body for the main ones if it is cardio respiratory or glucose or anything that's related to cardiorespiratory which could be blood flow blood pressure ofcourse cardiac activity. So we expect to be monitored when we have problems with those organs. But the most important and richest organ in terms of changes in activity is of course the brain. And we do not have any medical monitor for the brain. That is easy to use that is portable very small and can really go with the patient everywhere something like the cardiac watch that people are now using. And that's a huge problem.

Saul Marquez:
That's right.

Nathan Intrator:
Because know many cases even in the healthy brain or kind of not sick rate let's call it. Things change very rapidly and it's very important to know that anxiety kicks in the tension goes down etcetera, fatigue etc.. And of course in the more severe cases after traumatic brain injury there's a series of events that are occurring that may cause more damage to the brain than the initial brain injury which happened during the car accident et cetera. So it's important to monitor continuously and that's really what we are trying to build in the company.

Saul Marquez:
Well I think it's a really great point that you're bringing up Nathan. And I think it's fascinating right. When you take a look at the landscape you're talking about OK physiological monitoring brain monitoring huge mess. And then when we take a look at the landscape of mental health right. Finally we're starting to catch up with taking care of folks physical and mental health. So it's interesting how we totally like skipped over this mechanism that we use to do all our thinking.

Nathan Intrator:
You're absolutely right. I mean the key is what's called objective biomarkers. So if someone comes to the hospital and he says Well I think I had a heart attack then you know there's several tests that can be done if it's this enzyme test or an echocardiogram that provides actually full details of what happened, what's the damage etc. When someone comes with a certain brain the problem and you mentioned psychiatric so someone says he's depressed there's no simple objective biomarker there's actually no objective biomarker that can provide any indication that a person is really depressed and that of course is unexpected in the 21st century.

Saul Marquez:
Yeah that's incredible. So you guys are honed in the device is is a sticker. I mean that's thinness of a sticker, it's placed easily. You get readings, it's cloud based software it works well. Give us an example of how your company has created results or improved outcomes by doing things differently.

Nathan Intrator:
Well I'll tell you what what is the current main focus. The elderly population is growing growing rapidly as the expectancy of life expectancy is going forward. And as we are really dealing with the other problems for example cardiac problems and hopefully skin cancer quite well. And so there's an exponential growth in elderly population and then the Dementia, Parkinson's, Alzheimer's and other neurodegenerative disorders are becoming pretty much the biggest issue as expected that in 2030 there will be about 70 million people with dementia and in 2050 we're talking about hundreds of million which is like a huge state in the road. There's no solution, there's no way to avoid or repair dementia or our concerns. There's some way to reduce some of the symptoms but those diseases which develop along something like 20 years to be inverted very easily if there's a way to detect very early that deterioration is beginning then of course one can change lifestyle, one can actually change the slope of the development of the disease. And we find this fascinating and actually very very helpful in order to do that one has to have a very inexpensive way to screen a large population to population of people above 65 people with high risk. And in some places like in the north of Italy it would actually be people around the age of 45.

Saul Marquez:
Why is that. I mean why why 45 there?

Nathan Intrator:
They suffer from a certain genetic mutation.

Saul Marquez:
Is that right?

Nathan Intrator:
Which actually starts dementia, frontotemporal dementia where young…

Saul Marquez:
I wasn't aware of that. Not to get off on a tangent there but very cool. Very interesting.

Nathan Intrator:
So if we could find.

Saul Marquez:
These populations right. Yeah. It's gonna be inexpensive.

Nathan Intrator:
Yes. Because otherwise you know nobody will go into a functional MRI once a year if let's say functional MRI was the best way to detect changes. So we are fascinated to work on this with the people actually in Italy and try to provide a very inexpensive and simple way to screen. Actually that could be used at home. So the idea of going to the clinic is another.

Saul Marquez:
Interesting.

Nathan Intrator:
Aspect that can be improved.

Saul Marquez:
I think this is fascinating and you're right. The way that we do things in our health system we take care of sick and it's not really as much about. I mean let's just be frank it's not as much about prevention. I think more and more employers are starting to to want to help their employees be healthier. Maybe that's a space that that you know you guys are tackling or are working on but I think these are some really great work that you guys are starting to develop to help the broader populations. Tell us an example of a setback you had Nathan and maybe what you learned from that to make you guys better today.

Nathan Intrator:
We had many setbacks. So if I'll go dive a little bit into the company you know so one setback I would say although the main novelty and the main real aspect of the company is the algorithm that the novelty and the algorithm that analyzes the brain age is signal. But in order to do great work on the analysis we also have to improve the electronics and just improving the electronics is not enough. We also wanted it to be a consumer cost so that it can really be used by the bus. And this turned out to be a very challenging task. So to reduce costs or reduce energy consumption and to obtain the most sensitive EEG that exists turns out to be non-trivial. And we find ourselves spending a lot of time much more than expected in doing just that. So that's something that was unexpected and certainly has to be addressed.

Saul Marquez:
So you guys are still working on that?

Nathan Intrator:
We are working on that. We are improving it all the time but it just takes longer than expected.

Saul Marquez:
Yeah well you know and your and your goal is is pretty audacious right I mean you're you're looking at to sink the cost keep the performance high. So you know the work that you're coming out with is great. So you know it's hitting the mark but not your mark yet.

Nathan Intrator:
Yes that's true. So if I cannot true to many of my dreams or plans for the future but some people look at me still and say well you haven't done enough. You haven't reached what you want, and I say "No no no. I'm still having some plans for lots et cetera." Yeah I guess we are definitely stretching the envelope of the latest innovations in electronics and seeing that processing in the Cloud processing and I believe that's the real way to really stay ahead and do what we have tried to do in the best possible way.

Saul Marquez:
I admire your focus and your drive to continue making it better despite the fact that it probably is already the best option out there. What would you say one of your proudest experience is has been to date whether it be with Neurosteer or the asthma company, the sonar company in your whole work your whole career.

Nathan Intrator:
Well I'll share with you something very very personal that I never felt will happen. So at some point I was recording the brain activity of a person who was five years in a coma and that person when I saw him there was no muscle moving in his face, the eyes were just staring forward not moving totally. No no indication of any response but when I put the sensor on that person and we started this stimulate with music with his wife talking with him and other stimulation it turned out that he was extremely responsive to scientific lectures. We saw amazing brain response. We didn't believe. But because the whole thing is real time we could actually play with few times and really get convinced that this is what happens. And that person that was not treated with the right medications. I'm not going to go into the details changed the course of his. As a result of that his wife and family changed the course of his treatment and brought people from the village that they were living in to spend time with him every day all day. So there was no other person every hour of the day stimulating him reading the newspaper today and talking to him etc.. After eight months this guy opened his eyes was able to answer what is the derivative of x square. And his wife told me "you brought my husband back" and that someone something that no one ever told me. I thought you know I had a lot of publications and I was very proud. You know when the publication was received this is nothing compared to this sentence. So I was happy that science could actually do something like this.

Saul Marquez:
Yeah. That's an incredible story, Nathan. And you can just take us to the room. I felt like I was there and it's incredible right. When everything on the outside is telling and no then you have a technology that could tell you Yes, there's actually something going on there and curse to the family and that and just the friends that that were able their work with the caretakers and caregivers to help them turn around and nice job man. That's amazing.

Nathan Intrator:
Thank you.

Saul Marquez:
So that's just you. You can't, that's a fulfillment that no paper can get you. And now you're doing it on a broader scale so I'm definitely excited to see where this goes. Tell us about an exciting project or focus you guys are working out today.

Nathan Intrator:
So as I mentioned before I think elderly monitoring elderly is certainly one that we are most exciting these days. As you know pharmaceutical companies really are failing in providing novel medications to deal with the neurodegenerative disorders and part of it is the inability to do inexpensive screening go for large population to find the right one so that actually fits the characteristics of a specific drug or to monitor them during the study where compliance is very poor in those patients and the ability to help pharmaceutical companies in developing drugs by providing better screening or monitoring is something we are very excited about.

That is very exciting. How about the neuro modulation side of it?

Nathan Intrator:
Absolutely. So neuro modulation is a huge, huge field and a very untapped field in the sense that people are trying a lot of different modulations a lot of different parameters and in some cases it works wonderfully and in some cases it doesn't do anything. And the ability to get feedback that enables them to know when it works, what works better is kind of the difference between learning to dance in front of a mirror versus learning to dance in the dark and we tried to provide such a mirror but to neuro mdulation as well.

Saul Marquez:
It's definitely an area where I think it's an art not necessarily having those objective biomarkers like you guys are working on developing so it's promising for sure. Yeah it's interesting. So getting close to the end here, Nathan, fascinating work that you're up to and thank you for sharing all of this updates with us. Let's pretend you and I are building a short syllabus for the listeners and improving outcomes based off the work that you do. I've got a couple questions for you that our lightning round so I'll ask and you'll have brief answers and then we'll follow out with a book that you recommend to the listeners. You ready?

Nathan Intrator:
Sure.

Saul Marquez:
All right. What's the best way to improve health care outcomes?

Nathan Intrator:
I think to provide ways to prevent and to early early detect problems for the cure.

Saul Marquez:
What is the biggest mistake or pitfall to avoid?

Nathan Intrator:
Stay to do more of the same and not to think outside of the box specifically not to take advantage of the mass amount of sensors chemical and electrical sensors that are out there now and being developed.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Nathan Intrator:
Actually read about these developments participate in the roads conferences for example there's a blog applysite.com that actually my wife is editing and it does try to list the most advanced innovations in this field.

Saul Marquez:
applysite.com that's a good one and what's an area of focus that drives everything in your organization, Nathan?

Nathan Intrator:
To provide the solutions that don't have to be the best but have to be good enough to improve intervention so listen to the caregivers, find out what it is that they are looking for and try to provide exactly something that can improve their assessment and leads to better intervention.

Saul Marquez:
Love it. These next two are more on a personal level. What is your number one health habit?

Nathan Intrator:
Running. I didn't mention it before when I was giving those staggering numbers about the elderly but the biggest risk reduction of dementia and neurodegenerative disorders is physical activity.

Saul Marquez:
Is that right?

Nathan Intrator:
Yes and I like to run.

Saul Marquez:
That's awesome Nathan. And so you know I haven't asked you this earlier. So why do you think the numbers are increasing so much? I mean you kind of gave us our future timeline of what these neurodegenerative disorders the number of people they're going to in fact I mean why do you think it's increasing so much, is it an age thing is that a lifestyle thing?

Nathan Intrator:
Oh the yellow UFO Aloha is making an issue about the fact that these days more people are dying as a result of obesity versus dying as a result of not eating enough. And that is part of it. So part of it is eating too much, eating poorly and not exercising. If we add to this the increase in life expectancy from the age of 75 and up the probability of neurodegenerative jumps by a factor of two every five years.

Saul Marquez:
Is that right. Yeah the combination of these three things fascinating and what is your number one success habit?

Nathan Intrator:
I don't know for the number one success I'm trying to stay focused, trying to keep a list of what I need to do so whenever I find myself having a little time I don't remember what I need to do. I can actually go through that and that helps me stay focused.

Saul Marquez:
Love it. What book would you recommend to the listener. Aside from your publications and works.

Nathan Intrator:
Well it's a very very difficult question because there's so many books in different areas but I would say that the book that kinda was shocking to me or was totally outside of my envelope is a book by Lawrence Hirsch was a professor of medicine at Yale University and it is called an Atlas of EEG where he describes in really painfully diligent way specific changes in EEG as a result of specific brain problems. And for me not coming from the medical field but coming from the Signal Processing field that was kind of amazing to make a correlation between what I read there which was more describe medical terms and correlating that with signal processing.

Saul Marquez:
Amazing. Atlas of EEG. Folks, you could you could find our entire interview transcript as well as a short version of the syllabus that we just put together for you go to outcomesrocket.health and in a search bar type in Nathan Intrator or just type in Neurosteer you'll find everything there including links to the book you recommended, link test company. This has been a ton of fun. Nathan I'd love if you could just leave us with a closing thought and then the best place for the listeners can follow your work.

Nathan Intrator:
So as you said follow my work is definitely on the neurosteel website or Facebook or LinkedIn and I really need help in improving the outcomes of elderly of people during the middle time of their lives dealing with anxiety, depression etc. Later with the very early days of infancy maybe the first year of babies and I'm very happy if you approach me and suggest what it is that you can do to help us. That would be great.

Saul Marquez:
A great call to action there Nathan and if you're listening to this, feel like you have some answers or some collaborative strength. Reach out to Nathan. Definitely a great opportunity to collaborate. Love the work that you're up to, appreciate that you shared it with us. Nathan and definitely looking forward to staying in touch. Thanks for sharing your time.

Nathan Intrator:
Thank you so much. It was a pleasure.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

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