December 11, 2020 • 46 mins
This week we are delighted to welcome Dr Todd Ponsky to the Podcast. Dr Ponsly is a renowned Paediatric Surgeon, Professor of Surgery and Director of Clinical Growth and Transformation at Cincinnati Children’s Hospital in the US.
As a paediatric surgeon, Todd focuses on always trying to find the least invasive way to solve a child’s medical problem.
He specialises in minimally invasive surgery with a focus on neonatal disorders and hernias. Todd was the first to perform and report single port surgery in children and modernised the methods of the laparoscopic paediatric hernia repair.
Dr Ponsky believes that each child is unique. As such he spends a great deal of time listening to their questions and concerns and addressing them. Allowing him to understand the best approach to improve their health.
When not providing clinical care, Todd works at the forefront of innovation, by making leading-edge knowledge available to surgeons internationally. Unfortunately, there are great disparities in knowledge across the globe, and not all surgeons have access to the same knowledge as Todd and his colleagues.
He founded GlobalcastMD and Stay Current in Surgery, both of which serve to modernise the way in which surgery is taught and learned.
You can contact Todd on Twitter here.
Details for iSPI can be found here.
Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!
Thinking of Oscar website and contact details can be found here.
Follow us on Twitter here or Instagram here.
Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast artwork thanks to The Podcast Design Experts
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David (00:00):
Hello, and welcome. This is the Not Mini Adults podcast,
(00:04):
Pioneers for Children'sHealthcare and Wellbeing. My
name is David Cole. I'm joinedby my wife, Hannah and together
we are the co founders ofchildren's charity Thinking of
Oscar. Incredibly, this isEpisode 12 of the second season
(00:24):
of the podcast meaning this isour 24th episode in total.
Unfortunately the final episodeof season two before we take a
small break for Christmas, butwe will be back in the new year
with a new season. Today we arejoined by Dr. Todd Ponsky. Dr.
(00:46):
Ponsky is a renowned paediatricsurgeon, Professor of Surgery
and Director of Clinical growthand transformation at the
Cincinnati Children's Hospitalin the US. As a paediatric
surgeon, Todd focuses on alwaystrying to find the least
(01:06):
invasive way to solve a child'smedical problem. He specialises
in minimally invasive surgery,with a focus on neonatal
disorders and hernias. Todd wasthe first to perform and report
single port surgery in childrenand modernise the methods of
(01:27):
laparoscopic paediatric herniarepair. Dr. Ponsky believes that
each child is unique. As such,he spent a great deal of time
listening to their questions andconcerns and addressing them,
allowing him to understand thebest approach to improve their
(01:49):
health. When he's not providingclinical care, Todd works at the
forefront of innovation. Bymaking leading edge knowledge
available to surgeonsinternationally. Unfortunately,
there are great disparities inknowledge across the globe. Not
(02:09):
all surgeons have access to thesame knowledge as Todd and his
colleagues. He founded GlobecastMD and stay current in surgery,
both of which serve to modernisethe way in which surgery is
taught and learnt. Today, we'regoing to be talking about those
(02:31):
innovations, as well as the workthat he does from a surgical
perspective. We're very excitedto share our conversation with
Todd, and we hope you will enjoyit as much as we did.
(02:54):
Todd, Hi, thank you so much forjoining us on the Not Mini
Adults podcast. We're so excitedto have you.
Todd Ponsky (03:01):
As am I. Thanks for having me.
David (03:03):
Fantastic. So I think as we tend to do on these things,
you know, fortunately, you and Iknow each other, but it'd be
great for you to give a littlebit of overview as to what
you're doing. But moreimportantly, I think how you got
to be doing what you're doingtoday, please.
Todd Ponsky (03:20):
Yeah, here's a brief synopsis of the journey.
So I wanted to be a writer.
That's how I started off andactually would have loved to
have been in theatre. Then I gotsick and actually funny enough
my father's a physician, myolder brother's a physician, but
I didn't want to have anythingto do with that. I wanted to be
on stage or writing. Then I gotsick and I had a great doctor. I
(03:44):
actually turned everythingaround. I started getting good
grades and working hard andstopped going out and having fun
every night and went intomedical school. I really loved
working with children andwanting to be a paediatrician
until I rotated on surgery. Isaw this incredible concept that
(04:05):
you could fix things right away.
Instead of having to wait formedicine to take time. It's like
they come in and an hour later,they're cured. That was
phenomenal to me. I love thatand I completely switched from
paediatrics and wanted to becomea surgeon. Then in the second
year of surgery, I realised thatyou can actually be a paediatric
(04:27):
surgeon. I didn't even knowabout the specialty. It was a no
brainer for me. The only problemwas there's very few spots in
the United States. So I actuallyhad to kick it into gear and
work to do what it took tobecome that so I took research
time off and eventually became apaediatric surgeon and trained
(04:50):
in Washington DC. Then I'vealways had an inkling for
innovation and whatever's on thecutting edge. So when I took my
first job, I asked them if theywould send me to Denver,
Colorado with a gentleman by thename of Steven Rothenberg, who
is really cutting edge andlearning how to operate on tiny
(05:10):
newborns using needle sizeinstruments. So almost no
visible scars, I really wantedto do that and went and spend
time with him. I learned how todo minimally invasive surgery
using needle size instruments ontiny newborn babies. So that's
my area of interest. That's myspecialty. When I started, I
(05:32):
wanted to teach people aboutthis concept and we started
having courses and I realisedpeople started off initially
coming and no one wanted totravel anymore, their hospitals
weren't paying for it. So wewent online. From that started
Virtual Education, we called NBCwith a broadcasting company who
taught us how to make it like atelevision show. So we went from
(05:54):
just a webinar to TV streamthrough the internet for
doctors. I started a companycalled Globalcast MD and that
became a medical streamingcompany. I then took a job with
Cincinnati Children's to head uptheir innovation in the
(06:16):
Department of Surgery. We focuson how to use media innovation
through educating surgeonsaround the world, and also on
how we can get surgeons andclinicians to actually take part
in innovation, because most ofthe innovation in medicine is
not done by the clinicianthemselves. It's done by
researchers or industry. So thatin a nutshell is my career.
Hannah (06:40):
When you talked about the TV, part of when you were
taking education and deliveringthat as a TV show, then I
thought of as your marriage ofthe theatre, you know, the
theatre and the and the medical,then you got to communicate, you
know, one of your passions in adifferent way.
Todd Ponsky (06:57):
Hannah you just nailed it. So it all came
together, because I've alwayswanted that. Finally, I married
them together, just like yousaid,.
Hannah (07:04):
Perfect
David (07:05):
The bit that you just said that she in terms of that
you I've never thought aboutsurgery as a, you know, you've
kind of you've done it, andyou're on your way as opposed to
waiting for medicine to kick in.
It was something that gave youalmost instantaneous kind of
success, hopefully, in a lot ofways. So that is that's a
different way that I will I willlook things moving forward. When
(07:26):
we were, you know, as we've beengoing through these podcasts,
I've had so many people say tome, you got to get tired, you
got to get tired. So, you know,for that reason, I'm so glad
that you come on. But there's somany different things that we
could we could talk about, but Ithink the innovation element and
the way that you're looking atthat you've touched on, you
(07:47):
know, a question that I hadalready, which was, you know,
around, actually, it's theresearch side of things that
really drives the innovation,because the clinicians don't
necessarily have the time to dothat. We talked about that, you
know, a bit earlier. And then,you know, I'm really keen to
obviously talk about some ofthese initiatives that you're
doing. But let's, let's go tothat point in terms of the
(08:10):
research element, or researchersor, you know, innovation comes
from research, can you just,
Hannah (08:17):
Sorry I didn't mean to interrupt you is trying to tag
on the end. But when you'retalking about that originally, I
thought it when David was, youknow, describing the preamble of
conversation you guys had hadoffline, I thought it was about
is it the right people that aredoing the research, and I didn't
know if you were trying toconnect, because there's
something that clinicians dobring to progress, which is just
(08:38):
practical, hands on experience,day in day out. And so whereas t
e pros and cons of who is ands not involved in the innovati
n proces
Todd Ponsky (08:47):
The answer is you need everybody. So it's all
about collaboration. So to bringthat all together, the
clinicians do not have time todo it. They don't have time
unless they're given dedicatedresearch time, it's very hard to
have, you can try to dabble inresearch, but you'll be doing
just that dabbling. You won't bemaking really impactful things
(09:09):
unless you have time to do it.
Innovation, although some somesurgeons or clinicians are given
time for research, I don't knowvery many clinicians that are
given time for innovation. Andit's really easy to ideate. So
if you talk to a clinician whois in the trenches, and I'm not
talking about, I keep saying soit's any healthcare provider. It
(09:30):
can be anyone who's on the frontline, working with patients.
They're the ones who see theproblems the most. Instead of an
idea or looking for a problem tosolve it starting with the
problem and saying we know thereal problem, we need a
solution. So they in my opinionare the best to be coming up
with the ideas. The problem is,the real work starts after the
(09:52):
idea is there because it takesso much work, you have to really
put the idea together. You haveto a patent search, you have to
prototype, you have to thenraise money and it's a ton of
work. That's why they never goanywhere. So the answer is
creating a conveyor belt. Wewant to embrace the brains of
the frontline workers get theirproblems, and say, Okay, we'll
(10:14):
take it from here. That's whatwe're trying to build the Okay,
we'll take it from here, get theideas off their brains and then
have a team that's a conveyorbelt that moves the ideas
forward. But the key element andthere you go Hannah, that's why
you have a collaborative team,of the researchers, of the
venture people, of the theengineer. You have them all
(10:36):
together, but the clinicianneeds to be involved,
understanding that they don'thave much time. So you get the
ideas, and then you have theconveyor belt, take it to
fruition.
David (10:47):
So how do you bring that together at Cincinnati?
Todd Ponsky (10:50):
Yeah, so the main thing we started doing is. I'm
fascinated by this concept ofsomething called systematic
inventive thinking. A greatbook, if you haven't read it is
called Inside the Box thatreally talks about this new way
of systematically innovating,that you don't have to be
necessarily creative, that youcan systematically come up with
(11:12):
an idea. So we start off withthe problems. So that's going
through whatever qualityassurance method you have in
your organisation. For surgeons,we have something called M&M,
morbidity and mortality. It's aconference we have every week
where we present the problems.
So it's an incredibly scaryenvironment, because you stand
(11:34):
up in front of the room, and yousay, this terrible complication
that happened. Everyonehistorically would then say,
Well, why did you do this? Andwhy didn't you do that? It's
punitive. We want to flip that.
We make it called instead ofm&m, we call it M M, and I,
morbidity, mortality andinnovation, so that it's
actually an upliftingconference, you say this went
(11:55):
wrong, we could have done thisdifferently. But before you sit
down, you have to come up withsomething that doesn't exist
yet, that would have solved theproblem. So we're mixing
innovation. If we get excitedenough about it, we then take a
team we meet and we do somethingthat my fellow Raj Gerardo
called RSI. So RSI is a termused in medicine, when a patient
(12:18):
is sick, and you need to quicklyput a breathing tube in their
mouth. It's rapid sequenceintubation, we call this rapid
sequence innovation. What thatmeans is we go fast, no slow. So
the problems presented at thatmeeting. If people think it's
big enough, we say in the nextweek, we're having a meeting to
ideate. We do some research inthat following week, we do the
(12:39):
two hour session where we gothrough systematic inventive
thinking. We then vet thoseideas, we came up with other
surgeons, the pick the one welike, we do rapid prototyping,
so one week to prototype it withthe engineers. Then one week to
do prior art patent searching.
So in a month, you should gofrom idea to product. That's
what we're doing, a rapidsequence innovation.
David (13:02):
Wow, I mean, the rapid part of it is just incredible,
that you're actually able tomove that quickly. You know,
there's lots of organisationsout there that have much, much
more resources than you probablyhave your disposal that can't do
that.
Todd Ponsky (13:22):
If you start with that in mind, they can even the
biggest organisations, if theysay, No, you only have four
weeks. Then even the biggestorganisations could probably
flip and do that if they say, weonly have it, you have a short
timeline, people can quicklyadapt and go quickly when
they're told to.
David (13:41):
Absolutely, in terms of book recommendations as well,
I'm sure that you've read if youread Blackbox Thinking by
Matthew Saeed.
Todd Ponsky (13:49):
No, but I'm looking for a new book.
David (13:52):
So he's a British author, actually, he does a lot of work
in sports and what have you, butyou've written many books. This
one is specifically around howthe medical world doesn't
necessarily look at its errorsand try and do something about
it. Whereas one of the examplesthat he gives, in terms of where
(14:16):
they do this is aviation. Ifthere's ever a problem in
aviation, any kind of crash,obviously, you've got the black
box, that's where the name ofthe book came from. They always
go back and look at what'shappened. That has helped them
to innovate and move forward andnow obviously, air travel is one
of the safest modes of travelthat you can have. It explores
(14:38):
many different areas butobviously the bit that resonates
given this conversation is thatthat doesn't seem to happen in
medicine as well as it may beshould do. I mean even if you
look at some of the litigationbudgets that national services
have their vast. But what youguys are doing is kind of
changing that around entirelywhich which sounds, you know,
(15:01):
amazing.
Todd Ponsky (15:02):
Yeah, no, I totally agree with you. One quick thing
I want to say about this, thehardest part we were just
discussing before this podcastwith my team, the hardest part
is the first thing you have todo is called breaking fixedness.
It's really hard. You know, it'sthe same idea with Henry Ford
and the horses that he saysthat, you know, people would
(15:22):
would say, make our horsesfaster. The hardest part that
makes the surgeon angry is whenyou tell them remove something
that you assume you have to do.
They almost get viscerally angrywhen you have them break their
fixed mindset. So there's a lotof a lot of work to be done. But
I can't wait to read that book.
David (15:43):
Yeah, it comes back to it's one of the kind of mantras
that I picked up from a fewdifferent places, actually,
which is, to go back to the kindof Henry Ford example, if you
wanted better, he would havemade it a quicker horse. But it
needs to be different. It needsto be different in order to be
taken on. It needs to bedifferent in order to really
(16:03):
make a difference and moveforward. So you know, I think
that's it. It just rings true inso many areas of life and walks
of life, I think. Can you talkabout any of the examples of
success that you've seen throughthat MMI process?
Todd Ponsky (16:17):
Yeah, so what's really exciting is that we don't
just do it with devices, it'salso processes. So one was we
had a child that had a feedingtube that got clogged and it
ended up leading to acomplication. We then said,
okay, it sounds like cloggedcatheters are a big problem. And
(16:39):
so we did this in four weeks,and we came up with two ideas
that I think are going to solveproblems we didn't even think
of. So that's number one. Numbertwo, is we have a phenomenal
colorectal centre where theytreat children from all over the
world with the most complexcolorectal problems. We want to
(16:59):
figure out how to provide carefor people that can't always get
to Cincinnati, Ohio. So well,they have to come. I mean, they
have to come because they haveto get this and they have to get
that and I said, But why? Maybethey don't have to get that. And
they said, Oh, no, no, no, theydefinitely have to get that. And
I said, but let's breakfixedness let's say you're on a
(17:21):
deserted island, and you don'thave that thing. Do you think
you still could treat thepatient? Yeah. And I said, Okay.
then there's this thing aboutthe good enough principle.
That's what I call it. When theperson who invented the digital
camera, showed it to Kodak, theydidn't like it because it wasn't
as good as the camera photo. Butit was good enough. And that's
what they didn't recognise thatmost of the people would have
(17:43):
been just fine with that. Butit's the people that want
exactly the way they've had itbefore. That stopped them from
innovating. Once you get pastthat point, it's going to be an
incredible breakthrough in howwe treat patients, because now
we're going to have almost noradiation because we realise we
really don't need these tests wethought we needed. We can treat
people from any corner of theearth and developing nations can
(18:04):
adopt this, who don't have allthe resources and can find that
they can still treat thesepatients even without these
fancy radiology tests. So weboth do product and process and
it's very exciting.
Hannah (18:16):
What's about on, you know, when you're talking about
this process, this systematicand inventive thinking process,
then speed is very obvious andhow you're getting through that.
But do you also improve yourchances of success? Because
innovation is an area where it'snotoriously difficult to
successfully implement somethinginnovative and implement change?
(18:37):
And I'm just curious about yourperspective on that.
Todd Ponsky (18:41):
Let me tell you where I'm not good, which is
most things. But here's anexample of one thing of many. So
we're great at ideating andgetting the thing made. The
problem that most children'shospitals have and we've been
talking through Ispy, theInternational Society for
paediatric innovation, on how wecan all work together as
(19:02):
children's hospitals is is thatyou have all these things now
how do you get them to themarketplace? And that's a real
challenge. We're brainstormingsome innovative digital
solutions that might help raiseawareness of getting these
products out there, becausemaking paediatric products is
very difficult.
David (19:21):
I think that's always been something that's kind of
bugged me a little bit. It's thecollaboration element of it. So
you've got collaboration withinyour institution, that's
absolutely fine and as it shouldbe, but the the collaboration
between Children's Hospitalwe're going off on a slight
tangent here, but let's go withit. You know, the collaboration
between children's hospitals oreven just collaboration between
(19:42):
hospitals, but especiallychildren's hospitals. Given
that, you know, if you arecreating an innovation,
intervention, which everyoneshould know about. They should
just be, you know, out there foreverybody to use, to utilise.
Iknow that you have a differentsystem in the US to potentially
(20:03):
have we have in the UK. But youknow, how do we do that? How do
we do that more?
Todd Ponsky (20:09):
Okay, let me. I want to make one comment that on
our last thing, and then I wantto answer that my goal is not
probably what it seems. Iactually care less about getting
a product out there. I want toget their brains trained to
think different. I want theclinicians to be, you know, we
were taught safety in theoperating room. But for years,
(20:32):
we did things away that wasn'tas safe. Once they started
teaching us the safety training,it's instinct now. You walk in,
you know, you put the secondglove on instead of one, or you
announced what you're going todo better than we did before. I
want innovation to beinstinctual. I want it to be
that, oh, I have an interestingidea. So number one is making
the product isn't my number onepriority, it's getting the
(20:54):
brains to change. Back to yourquestion about collaboration.
That's why I love Ispy and Ijust recently joined that it's a
mindset. It has to be wherehospitals come together, the
right people have to cometogether, where they leave their
egos at the door. The culture isset within this group where we
are working together. The risingtide raises all ships and this
(21:18):
is what happens. We meet everyweek and we say, all right, I
have this idea. How can you guyshelp me? Well, let's do this
together. I think it's a cultureand a mindset. And once people
start seeing it happening andgetting legs, everyone's going
to want to join the sameprocess.
David (21:32):
Yeah, and we will, we'll make sure that, that we put, you
know, links to Ispy and whathave you in in or the show
notes. And, and it is a furtherconversation. You know, we've
had we've touched on iSpi, butit's one of the things that we
want to cover, you know, inseason three of the podcasts is
to really go through that. But Ithink, you know, I was
introduced to it. 2017. So it's,you know, it's a relatively new
(21:57):
concept. But I think it'sgrowing and getting more and
more collaborative, as you say.
Todd Ponsky (22:02):
Yep.
David (22:19):
Let's move on to you know, you mentioned Globalcast.
And this I think fits into allthe conversations that we've
just had. Anyway, in terms ofsharing of information, talk to
us a little bit about how thatcame about and what you're doing
with it.
Todd Ponsky (22:32):
Alright, so here's my question is, the one question
that's in my head is, how willdoctors learn in 10 years from
now? I don't know the answer.
But that's all I think aboutthat literally keeps me up in
the middle of the night, becauseI feel like the answer is out
there. What I do is I look tosee what my kids are doing,
because it usually predictswhere doctors will be 10 years
(22:53):
later, because we're so slow. Soif I look at the way that right
now, the younger generation isconsuming information. How are
anything that my children knowwhere is most of it coming from?
I think I narrowed it down tofour things. Gaming. They're
getting information from gaming,because now it's social gaming.
(23:13):
Right? That's the socialisationespecially during COVID. They're
actually like talking to people,they're getting information and
because it's fun, they'reenthralled with it. Their mind
goes into it. So gaming isnumber one, social media is
number two, they're gettinginformation from social media.
Now, I don't know if you've seensocial dilemma, but it's scary.
(23:33):
But it can be harnessed in agood way. And so some gaming,
social media, video, videoconsumption, people go to
YouTube, they don't read amanual anymore. So I don't think
people read very much anymore.
You can get it all on video. Thefinal thing, go figure. I don't
(23:54):
know if you guys have heard ofthis, but audio podcasts. That's
a obviously you know, so that'swhere I think it is. Video,
audio, gaming and social media.
What about I think, what's that?
About Austin's parents? Yeah,well, I'm not so good at that.
So maybe they don't learnanything from me. Yeah, no,
good. So I mean, that's actuallyyou know, you joke. But I think
(24:15):
actually, it's your colleaguesright around you, whether it's
your parents or whatever. Soit's word of mouth around you.
So the The point is that thoseare the four things we're
focusing on. So if I'm going tothink about how I'm trying to
make, there's two ways doctorsget information, push and pull,
when they want, when they have apatient and they want to look
something up, they'll go andpull what they want. So we have
(24:38):
to make a platform that makes itincredibly easy to find
something. So findability, youtype something in and you get
something that is exactlyingestible, that works for a
doctor. So that's why audio iscritical because the best
downtime we have is when we'redriving to work or working out.
So it's multitask learning. Soit has to be designed where you
(25:01):
can get, you can find somethingexactly what you need to learn
about the patient that you aredealing with right now, and get
it consumable in a way that iseasy to digest. While you're
going through your day, soaudio, video, or reading it, if
that's what you like. So youhave to have it in all forms of
media. The second thing is, ifyou're just going after stuff
(25:24):
that you are are looking for,you're going to be missing new
content, because you won't evenknow it's there to look for it.
So there has to be pushedcontent too. So there's pulled
content and push content, pushcontent is something they don't
know about that they need toknow about. The problem is, if I
just send out an article,there's too much information
now. So there's 2.5 millionpublications a year, there's no
(25:47):
way to push everything out. It'sinformation overload. So once
it's deemed that this is animportant topic, whether by
crowdsourcing or artificialintelligence, and we say this is
important, then we have to pushit out. So we have to filter it,
and then deliver it. So once wefilter it through crowdsourcing
or AI, then we have to deliverit in a way that someone would
(26:08):
actually pay attention to it.
That's where edutainment comesin. It's got to be fun,
exciting, it's got to capturetheir attention. To repeat that,
again, there's got to be coldcontent that's got to be
accessible in a format thatdoctors need. Then there's push
content, which has to be wellfiltered. It has to be delivered
in a way that's going to capturetheir attention. Otherwise,
(26:30):
they'll ignore it. That's themain thing that Globalcast
focusses on.
David (26:35):
The other bit that that struck me with it is the
democratisation of data. Soyou've just described the
reasons, or the ways that you'redoing it, and you're delivering
it and how people will consumeit. But but that works in a, you
know, that's what we do in inthe UK, or the US or wherever it
might be, but what about in someof these, you know, areas that
(26:56):
are not so fortunate? You know,that's that's one of the primary
reasons for youcreating it,right?
Todd Ponsky (27:01):
Right. So our hashtag is knowledge should be
free. So right now, it's onlythe wealthy countries that get
the most cutting edgeinformation, because the
textbook costs. it can costanywhere up to $1,000. If it's a
very highly specialised textbookin a very, very specific space,
but they're usually several $100for a textbook. Someone in a
(27:24):
developing country is going toget an old book that is out of
date. So you have a completedisparity in knowledge. And it's
crazy to me that in 2020,there's disparities in
knowledge. So our hope is thatby putting content out in
digital form, which isinteresting, even the most
(27:44):
underdeveloped nations stillusually have access to internet.
So if you can push the contentfor free, in engaging ways,
we're going to start seeing alevel playing field, that
everyone's going to start havingthe same access to the same
information, it's going todisrupt the industry, because by
providing free information isgoing to put a lot of things
(28:04):
into a tailspin. The questionis, how do we financially
support that? That's a goodquestion. We're, we're we're
figuring that out. It's going tobe either, you know, donations
or monetization through havingads, or allowing people to pay
to put their content out there.
We'll figure that out. But rightnow, it's working fine.
Hannah (28:26):
How do you break through the noise? How do you reach the
people for whom the informationis so valuable?
Todd Ponsky (28:35):
So the two things that I'm going to answer that
with so there's filtering thecontent, and how do I get it to
them. So take a surgeon who isin some remote country
somewhere. First thing I had todetermine is what's important, I
haven't figured that out yet andworking with much smarter people
than myself, we're working on AIalgorithms, we just presented at
(28:55):
our national meeting. I am noteven an amateur and below an
amateur. So we were able tousing the machine learning
algorithms, we were able topredict what the editorial
boards would have also predictedwas a good article. So if we can
find companies to help us makean algorithm that would probably
(29:18):
give you a good idea that thisis a good article, or important?
That's step one. crowdsourcingalso is very critical to this.
Once we've determined that, howdo we get it to them? So we use
social media to make peopleaware of what's out there and
then direct them to where thecontent is. It always has to be
(29:39):
the free content that we directthem to. So we've created a
mobile app that's free. It's youknow, it's been downloaded way
more than we anticipated. Sothat's how we're doing it now.
David (29:53):
I was gonna ask you about numbers and also just
geographical location. Have yougot an idea as to how
gegraphical the spread of usersis now.
Todd Ponsky (30:03):
Yeah, so numbers and geography. So let me do
geography first. So Globalcastused to only do live events.
Because we started 12 years ago,we were with our webcams. I
mean, this was before there waszoom or anything like that. So
we found the biggest gap wasAfrica. We would put push pins
(30:27):
all over the world where we werebeing viewed except for Africa.
We talked to people there. Andit's the access to fast enough
bandwidth to be able to watch alive event when we went into the
offline app, the mobile appwhere you can watch on demand.
It spreaded out equally allover the world. So that was the
thing that held us up andreaching Africa. It's a complete
(30:49):
geographic spread, spreadequally around the world. What I
get excited every morning, whenI see the new people that have
joined our group, I love seeingthe most remote countries you
can imagine. Numbers. So to giveyou an idea, we have 700
paediatric surgeons in theUnited States. So it's a very
small specialty 700. So we have6500, verified paediatric
(31:17):
surgeons or paediatric surgerynurses. So we think we have a
probably about 80% of theworld's population and that's
only in the tiniest ofspecialties. So once we start
doing this in other specialties,we feel like we'll make a real
impact.
David (31:37):
I've got to ask this, because I do work in AI. Still
not anywhere near where, youknow, the guys that are creating
the algorithms are going to bebut what do you think about when
it comes to bias and giving theright information to the right
people? You know, so one of thethings that we think about is,
(31:58):
if you take imaging, forexample, you could train an
imaging algorithm on apopulation, which has absolutely
no bearing on the populationthat might actually use the
algorithm. So you need to makesure that you're, you know,
either either you're verytransparent, in terms of
demographic and what data thatyou've trained it on. So how do
(32:20):
you make sure that theintervention that you're doing
on a, you know, on a child inCincinnati is the right thing to
be given to someone in SubSaharan Africa, for example?
Todd Ponsky (32:31):
This is exactly the same question that everyone
keeps bringing up. I don't havean answer. I'll give you an
example, though. We put outstuff that was really, really
important. This is how I'msolving it. We put out papers
that were important. I gotemails from people and it's
funny, I don't care how manyemails I get, I always answer
every single one of them,because that's how we're going
to get to the answer. They said,You're only talking about things
(32:54):
that we don't even see in SubSaharan Africa. How much are you
talking about TB? Because that'sa big problem for us. You don't
even mention it. I said, Okay,so we created something called
the idea team, the Internationaldigital education Alliance. I
put a video out there, I said,join us, we need democratisation
(33:16):
of knowledge, not only goingout, but coming in. So we need
to know what's important. Sothat's not an answer to what
you're looking for, which is theAI answer, because I don't know
how to rule out bias inartificial intelligent
algorithms. I can tell you, whatwe're doing now is that we are
getting input from a diversegroup of people instead of, you
(33:40):
know, the same people in thesame city, that should dictate
what everyone else in the worldwants to see. Then the problem
is we're going to have todeliver the content in a very
specific way. So someone inAfrica can look at content
that's relevant to them, andsomeone in Cincinnati can look
at content that's relevant tothem.
David (33:57):
I think that's brilliant that you're doing it that way.
When you mentionedcrowdsourcing in this respect,
as opposed to crowdfunding, thatto me is also a way in which you
can, you build up that knowledgein terms of they can help you
know that the power of the crowdis that they can help you to
determine what needs to go whereand how it goes. I think it's,
(34:22):
you know, again, I'm not anexpert on this, but it's
probably an underutilisedelement of society today.
Todd Ponsky (34:28):
So I believe crowdsourcing is critically
important. The argument that Iwill get from the naysayers,
which is a very valid argument,is that while I believe the
crowd is smarter than the coreof experts, we have the core of
experts that are editorialboards. These are people that
have been deemed to know whateveryone wants to read.I think
(34:49):
the crowd is going to be smarterthan the core of experts. A
great book Machine PlatformCrowd. Anthony Chang told me
about it, great book. It reallytalks about the difference
between you know the value ofthe crowd versus the core. And
but the argument against that isthat the crowd will only pick
(35:09):
sexy, fun topics and won't delveinto the scientific process. I
said, Well, I'm not sure aboutthat. Let's find out. So what
we'll have to do is go back andtest to see did the crowd pick
articles that are fun, funtitles? Or did the crowd really
pick high quality articles? Theanswer is probably going to be a
Wikipedia answer. Wikipedia iscrowd sourced with an editorial
(35:32):
board. It's hybrid together.
David (35:35):
Yeah, no, I think I think that's fascinating. I just want
to I'm just conscious of time,and I want to talk about a
little bit of your, I guess, dayjob to a certain degree in terms
of the surgical side of things,you know, where you're actually,
you know, with patients, and Iguess the bit the bit about the
job that. You know, brought youto it in the first place. But I
know that you've done quite alot of innovation in that
(35:58):
respect in terms of, So youtalked about minimal invasive
surgery and perfecting that andyou know, your goal is to make
sure that you're giving, you'redoing that as least invasively
as possible with minimalscarring and all this kind of
stuff. But talk to us a littlebit about some of the
technologies that you've broughtinto to assist you because
they're fascinating.
Todd Ponsky (36:18):
Yeah. So my goal, personally, that I have an
interest in is two things. One,really pushing minimally
invasive surgery. So we've wentfrom not being able to treat and
then eventually saying, Oh,well, we can figure out an
operation that fixes it, butit's with a big scar. So it was
no therapy to invasive therapy.
Like we figured out how to doit, but it really hurts and it's
(36:41):
impactful to the kid. Then thethird one is minimally invasive
surgery, which is tiny scars forthe same operation. Ultimately
now we're working on no scars.
So that is putting an endoscopeinto the mouth and being able to
get inside and do it scarlesssurgery. That's called notes,
natural orifice transluminalendoscopic surgery. And and that
(37:05):
is something that is happeningin the adults, but not so much
yet in the kid. But it's juststarting. So it's minimal
invasion is my interest. I amvery interested in particular,
hernias is an interest of minebecause of how we can do it,
since it's a very commonoperation. But my bigger
interest is something calledtelementoring. So now that
(37:30):
surgery is usually on video, sowe're operating and we're
watching on the screen. Now, onesurgeon in one place could see
what another surgeon is doingand actually mentor them live by
drawing on the screen andsaying, This is what you do. So
we've been really pushingtelementoring, which has, as you
can imagine, carries a lot ofcontroversy. But we have really
(37:51):
demonstrated it's better for thepatients. So laparoscopic
surgery, the minimally invasivesurgery really lends itself well
to telementoring, which is theother big question we're trying
to do, which also goes alongwith democratising knowledge
because now surgeons in remotelocations can get guidance from
surgeons in in other locations.
Hannah (38:10):
You said that doing the micro surgery will minimal to
not seeing at all surgeries,starting in adults less so in
paediatrics and that what arethe factors that you need to
consider aside from the actualsize of the implements that
you're using.
Todd Ponsky (38:29):
That's what it is, it's the size. So the
instruments that go in throughthe mouth. So the scope goes in
and it has all these instrumentsthat come out and can do the
operation like a robot from thescope. But the problem is the
scope itself is too big to fitdown the oesophagus of a child.
So if we could figure out how todownsize those, and that's this
(38:52):
just keeps happening. It'salways how it is it's first made
in the adult world. Then we tryto downsize it. So right now, we
just don't have the appropriatesize for children.
Hannah (39:07):
Have you looked at it from the other way around that
because we obviously Not MiniAdults podcast, we're talking
about exactly that premise thatit's not just a matter of
scaling something downnecessarily. So I'm thinking
with a systematic and innovativethinking in mind of what what
what have you come up with andyou go with a blank sheet of
paper instead.
Todd Ponsky (39:27):
Okay, so this kind of circles back to the original
discussion. Let's say I get agroup of us together, and we
apply systematic inventivethinking and figure out a way to
downsize and create a miniversion of an endoscopic
(39:47):
surgical solution. That and I'mbeing a little bit of a
defeatist here, but that's goingto cost quite a bit of money to
make and there are very fewcompanies that would be willing
to invest in creating somethingthat big and expensive for the
paediatric market? No one wantsto make products for paediatrics
(40:08):
because the markets too small.
So we would have to come up withnot only a compelling
instrument, but a compellingmarket that would allow the
companies to make it for us. Sothe usual, the really big
advanced technologies areusually ones that are the
hardest to get through. Whereasthe smaller devices are easier
(40:31):
if something like that would begame changing. But people have
had a lot of failures so far intrying to bring adult technology
into paediatrics because no onewants to make it.
Hannah (40:43):
Yeah, it's a it's a familiar story,
David (40:44):
Unfortunately. So and I was really hoping when you were
first describing that, that itwas a case of we've got this for
paediatrics, because then youcould expand it out to adults
much easier. Right? Then also,because of their physiology,
that there's, you know, is lessof them to go round, if that
makes sense. Right?
Todd Ponsky (41:05):
Yeah.
David (41:05):
If you had something of scale, then, you know, it would
work. But what I'm about to kindof come to what we what we tend
to ask everybody in terms of afinal question, but I think what
you've discussed in terms ofjust the changes of education, I
found out not that long agothat, that actually education
for surgery in particular. Sothere's a doctor in the UK
(41:28):
called Shafi Hamad, I don't knowif you've ever, you know,
amazing what he's trying to dowith VR, and AR and all these
different things. He obviouslyhas pioneered to a certain
degree actually webcasting andon all different media and
platform, all of the, you know,surgical interventions that
(41:49):
they've done. But I remember himshowing a picture in a lecture
that I saw not that long ago,just, you know, a bank of seats
of clinicians or surgeons thatare training just watching this
happening. But it hasn't reallychanged so much in the last kind
of 150 to 100 years. So theseadvances that you're talking
(42:13):
about and that you're pioneeringare you know, really what is
going to change that and and Iguess thinking it with or in my
head, thinking it with theGlobalcast and thinking about
how you actually help surgeonsin Sub Saharan Africa or India
or, you know, these lessdeveloped countries, you know,
you've got a real opportunity todo that. Because let's face it,
(42:37):
the technology will be there inorder to get the broadband
signal, whatever it might be inorder to do it. It's just a case
of making sure that we'regetting that information to
them.
Todd Ponsky (42:46):
Yeah.
David (42:48):
So look, Todd, thank you, you know, so much as I knew this
was going to be a fascinatingconversation. We've gone, you
know, lots of different anglesand trajectories and it's been
fantastic. But what we there'sone question that we tend to ask
everybody on here, which is thatif you had a magic wand, and you
could do anything, you know, tochange, paediatrics or to solve
(43:11):
something in paediatrics, whatwhat would it be?
Todd Ponsky (43:15):
It's this holy grail, I'm going to go back to
the beginning, it's the holygrail how to democratise
information, all these otherthings that we're working on
these cool instruments, thesecool processing innovations,
that's great. But the biggestimpact, I believe, that we can
have on worldwide care ofchildren is, is flattening the
(43:36):
playing field of knowledge.
That's the biggest disparitythat I've noticed that people in
remote locations can get bywithout the latest technology,
but they cannot get by withoutthe latest information or the
latest knowledge. So if we couldfigure out how to filter through
the content, how to get it intopeople's brains, and what is
(43:59):
going to be the future of howpeople are going to consume
information. And I want to seethat we talk again in a few
years, and we look back and sayit happened. Look, it's a whole
different world. Now. Knowledgeis shared equally around the
world, through this technologythat we haven't even thought of
yet. I don't know what it'sgonna be. If I could look back
(44:19):
at of all the things I'm workingon the minimally invasive
surgery, the rapid prototypingall that that's secondary to the
fact that I really want to beable to say that knowledge is
equal around the world.
David (44:37):
I think we said a lot but we could not agree more. I
could not agree more. You know,the reason I'm still you know,
working and doing the job that Ido as a day job is because I
want to try and make thathappen. So and I know that
you're trying to do that withiSPI and everything else. So
Todd, thank you so much forjoining us. It's been such a
(44:59):
pleasure, and a great right wayto end our second season. So we
really appreciate that. And, youknow, we wish you and your
family very happy Christmas andNew Year. And I think we're all
looking forward to 2021.
Todd Ponsky (45:10):
You too, and I just want to congratulate the both of
you because this is so importantthe work that you're doing. And
this is an exact example of thesteps we need to take to
accomplish exactly what I'mlooking to accomplish. So
congratulations to you.
David (45:24):
Thank you. Thank you so much. Thank you to Dr. Todd
pomsky for joining us on the NotMini Adults podcast this week.
Also a really big thank you toeveryone that is listening week
in week out, and the very kindfeedback that we've been
receiving. This is the finalepisode of season two. We can't
(45:44):
quite believe that we've gotthrough 24 episodes since we
started in the summer. It's beena real honour to speak to the
people that we've spoken to. Ifthis is the first episode that
you're listening to, please dogo and check out the back
catalogue where you'll find ushaving conversations with some
truly inspirational people, asever. If there is someone that
you think that we should betalking to, then please do get
(46:05):
in touch. All the details fromtoday's show and for thinking of
Oscar can be found in the shownotes. Finally, thank you to
everyone that's been on thepodcast with us. Please join us
again in the new year for seasonthree. And until that point, we
wish you a very Merry Christmasand a Happy New Year.
Hello, and welcome. This is the Not Mini Adults podcast,
(00:04):
Pioneers for Children'sHealthcare and Wellbeing. My
name is David Cole. I'm joinedby my wife, Hannah and together
we are the co founders ofchildren's charity Thinking of
Oscar. Incredibly, this isEpisode 12 of the second season
(00:24):
of the podcast meaning this isour 24th episode in total.
Unfortunately the final episodeof season two before we take a
small break for Christmas, butwe will be back in the new year
with a new season. Today we arejoined by Dr. Todd Ponsky. Dr.
(00:46):
Ponsky is a renowned paediatricsurgeon, Professor of Surgery
and Director of Clinical growthand transformation at the
Cincinnati Children's Hospitalin the US. As a paediatric
surgeon, Todd focuses on alwaystrying to find the least
(01:06):
invasive way to solve a child'smedical problem. He specialises
in minimally invasive surgery,with a focus on neonatal
disorders and hernias. Todd wasthe first to perform and report
single port surgery in childrenand modernise the methods of
(01:27):
laparoscopic paediatric herniarepair. Dr. Ponsky believes that
each child is unique. As such,he spent a great deal of time
listening to their questions andconcerns and addressing them,
allowing him to understand thebest approach to improve their
(01:49):
health. When he's not providingclinical care, Todd works at the
forefront of innovation. Bymaking leading edge knowledge
available to surgeonsinternationally. Unfortunately,
there are great disparities inknowledge across the globe. Not
(02:09):
all surgeons have access to thesame knowledge as Todd and his
colleagues. He founded GlobecastMD and stay current in surgery,
both of which serve to modernisethe way in which surgery is
taught and learnt. Today, we'regoing to be talking about those
(02:31):
innovations, as well as the workthat he does from a surgical
perspective. We're very excitedto share our conversation with
Todd, and we hope you will enjoyit as much as we did.
(02:54):
Todd, Hi, thank you so much forjoining us on the Not Mini
Adults podcast. We're so excitedto have you.
Todd Ponsky (03:01):
As am I. Thanks for having me.
David (03:03):
Fantastic. So I think as we tend to do on these things,
you know, fortunately, you and Iknow each other, but it'd be
great for you to give a littlebit of overview as to what
you're doing. But moreimportantly, I think how you got
to be doing what you're doingtoday, please.
Todd Ponsky (03:20):
Yeah, here's a brief synopsis of the journey.
So I wanted to be a writer.
That's how I started off andactually would have loved to
have been in theatre. Then I gotsick and actually funny enough
my father's a physician, myolder brother's a physician, but
I didn't want to have anythingto do with that. I wanted to be
on stage or writing. Then I gotsick and I had a great doctor. I
(03:44):
actually turned everythingaround. I started getting good
grades and working hard andstopped going out and having fun
every night and went intomedical school. I really loved
working with children andwanting to be a paediatrician
until I rotated on surgery. Isaw this incredible concept that
(04:05):
you could fix things right away.
Instead of having to wait formedicine to take time. It's like
they come in and an hour later,they're cured. That was
phenomenal to me. I love thatand I completely switched from
paediatrics and wanted to becomea surgeon. Then in the second
year of surgery, I realised thatyou can actually be a paediatric
(04:27):
surgeon. I didn't even knowabout the specialty. It was a no
brainer for me. The only problemwas there's very few spots in
the United States. So I actuallyhad to kick it into gear and
work to do what it took tobecome that so I took research
time off and eventually became apaediatric surgeon and trained
(04:50):
in Washington DC. Then I'vealways had an inkling for
innovation and whatever's on thecutting edge. So when I took my
first job, I asked them if theywould send me to Denver,
Colorado with a gentleman by thename of Steven Rothenberg, who
is really cutting edge andlearning how to operate on tiny
(05:10):
newborns using needle sizeinstruments. So almost no
visible scars, I really wantedto do that and went and spend
time with him. I learned how todo minimally invasive surgery
using needle size instruments ontiny newborn babies. So that's
my area of interest. That's myspecialty. When I started, I
(05:32):
wanted to teach people aboutthis concept and we started
having courses and I realisedpeople started off initially
coming and no one wanted totravel anymore, their hospitals
weren't paying for it. So wewent online. From that started
Virtual Education, we called NBCwith a broadcasting company who
taught us how to make it like atelevision show. So we went from
(05:54):
just a webinar to TV streamthrough the internet for
doctors. I started a companycalled Globalcast MD and that
became a medical streamingcompany. I then took a job with
Cincinnati Children's to head uptheir innovation in the
(06:16):
Department of Surgery. We focuson how to use media innovation
through educating surgeonsaround the world, and also on
how we can get surgeons andclinicians to actually take part
in innovation, because most ofthe innovation in medicine is
not done by the clinicianthemselves. It's done by
researchers or industry. So thatin a nutshell is my career.
Hannah (06:40):
When you talked about the TV, part of when you were
taking education and deliveringthat as a TV show, then I
thought of as your marriage ofthe theatre, you know, the
theatre and the and the medical,then you got to communicate, you
know, one of your passions in adifferent way.
Todd Ponsky (06:57):
Hannah you just nailed it. So it all came
together, because I've alwayswanted that. Finally, I married
them together, just like yousaid,.
Hannah (07:04):
Perfect
David (07:05):
The bit that you just said that she in terms of that
you I've never thought aboutsurgery as a, you know, you've
kind of you've done it, andyou're on your way as opposed to
waiting for medicine to kick in.
It was something that gave youalmost instantaneous kind of
success, hopefully, in a lot ofways. So that is that's a
different way that I will I willlook things moving forward. When
(07:26):
we were, you know, as we've beengoing through these podcasts,
I've had so many people say tome, you got to get tired, you
got to get tired. So, you know,for that reason, I'm so glad
that you come on. But there's somany different things that we
could we could talk about, but Ithink the innovation element and
the way that you're looking atthat you've touched on, you
(07:47):
know, a question that I hadalready, which was, you know,
around, actually, it's theresearch side of things that
really drives the innovation,because the clinicians don't
necessarily have the time to dothat. We talked about that, you
know, a bit earlier. And then,you know, I'm really keen to
obviously talk about some ofthese initiatives that you're
doing. But let's, let's go tothat point in terms of the
(08:10):
research element, or researchersor, you know, innovation comes
from research, can you just,
Hannah (08:17):
Sorry I didn't mean to interrupt you is trying to tag
on the end. But when you'retalking about that originally, I
thought it when David was, youknow, describing the preamble of
conversation you guys had hadoffline, I thought it was about
is it the right people that aredoing the research, and I didn't
know if you were trying toconnect, because there's
something that clinicians dobring to progress, which is just
(08:38):
practical, hands on experience,day in day out. And so whereas t
e pros and cons of who is ands not involved in the innovati
n proces
Todd Ponsky (08:47):
The answer is you need everybody. So it's all
about collaboration. So to bringthat all together, the
clinicians do not have time todo it. They don't have time
unless they're given dedicatedresearch time, it's very hard to
have, you can try to dabble inresearch, but you'll be doing
just that dabbling. You won't bemaking really impactful things
(09:09):
unless you have time to do it.
Innovation, although some somesurgeons or clinicians are given
time for research, I don't knowvery many clinicians that are
given time for innovation. Andit's really easy to ideate. So
if you talk to a clinician whois in the trenches, and I'm not
talking about, I keep saying soit's any healthcare provider. It
(09:30):
can be anyone who's on the frontline, working with patients.
They're the ones who see theproblems the most. Instead of an
idea or looking for a problem tosolve it starting with the
problem and saying we know thereal problem, we need a
solution. So they in my opinionare the best to be coming up
with the ideas. The problem is,the real work starts after the
(09:52):
idea is there because it takesso much work, you have to really
put the idea together. You haveto a patent search, you have to
prototype, you have to thenraise money and it's a ton of
work. That's why they never goanywhere. So the answer is
creating a conveyor belt. Wewant to embrace the brains of
the frontline workers get theirproblems, and say, Okay, we'll
(10:14):
take it from here. That's whatwe're trying to build the Okay,
we'll take it from here, get theideas off their brains and then
have a team that's a conveyorbelt that moves the ideas
forward. But the key element andthere you go Hannah, that's why
you have a collaborative team,of the researchers, of the
venture people, of the theengineer. You have them all
(10:36):
together, but the clinicianneeds to be involved,
understanding that they don'thave much time. So you get the
ideas, and then you have theconveyor belt, take it to
fruition.
David (10:47):
So how do you bring that together at Cincinnati?
Todd Ponsky (10:50):
Yeah, so the main thing we started doing is. I'm
fascinated by this concept ofsomething called systematic
inventive thinking. A greatbook, if you haven't read it is
called Inside the Box thatreally talks about this new way
of systematically innovating,that you don't have to be
necessarily creative, that youcan systematically come up with
(11:12):
an idea. So we start off withthe problems. So that's going
through whatever qualityassurance method you have in
your organisation. For surgeons,we have something called M&M,
morbidity and mortality. It's aconference we have every week
where we present the problems.
So it's an incredibly scaryenvironment, because you stand
(11:34):
up in front of the room, and yousay, this terrible complication
that happened. Everyonehistorically would then say,
Well, why did you do this? Andwhy didn't you do that? It's
punitive. We want to flip that.
We make it called instead ofm&m, we call it M M, and I,
morbidity, mortality andinnovation, so that it's
actually an upliftingconference, you say this went
(11:55):
wrong, we could have done thisdifferently. But before you sit
down, you have to come up withsomething that doesn't exist
yet, that would have solved theproblem. So we're mixing
innovation. If we get excitedenough about it, we then take a
team we meet and we do somethingthat my fellow Raj Gerardo
called RSI. So RSI is a termused in medicine, when a patient
(12:18):
is sick, and you need to quicklyput a breathing tube in their
mouth. It's rapid sequenceintubation, we call this rapid
sequence innovation. What thatmeans is we go fast, no slow. So
the problems presented at thatmeeting. If people think it's
big enough, we say in the nextweek, we're having a meeting to
ideate. We do some research inthat following week, we do the
(12:39):
two hour session where we gothrough systematic inventive
thinking. We then vet thoseideas, we came up with other
surgeons, the pick the one welike, we do rapid prototyping,
so one week to prototype it withthe engineers. Then one week to
do prior art patent searching.
So in a month, you should gofrom idea to product. That's
what we're doing, a rapidsequence innovation.
David (13:02):
Wow, I mean, the rapid part of it is just incredible,
that you're actually able tomove that quickly. You know,
there's lots of organisationsout there that have much, much
more resources than you probablyhave your disposal that can't do
that.
Todd Ponsky (13:22):
If you start with that in mind, they can even the
biggest organisations, if theysay, No, you only have four
weeks. Then even the biggestorganisations could probably
flip and do that if they say, weonly have it, you have a short
timeline, people can quicklyadapt and go quickly when
they're told to.
David (13:41):
Absolutely, in terms of book recommendations as well,
I'm sure that you've read if youread Blackbox Thinking by
Matthew Saeed.
Todd Ponsky (13:49):
No, but I'm looking for a new book.
David (13:52):
So he's a British author, actually, he does a lot of work
in sports and what have you, butyou've written many books. This
one is specifically around howthe medical world doesn't
necessarily look at its errorsand try and do something about
it. Whereas one of the examplesthat he gives, in terms of where
(14:16):
they do this is aviation. Ifthere's ever a problem in
aviation, any kind of crash,obviously, you've got the black
box, that's where the name ofthe book came from. They always
go back and look at what'shappened. That has helped them
to innovate and move forward andnow obviously, air travel is one
of the safest modes of travelthat you can have. It explores
(14:38):
many different areas butobviously the bit that resonates
given this conversation is thatthat doesn't seem to happen in
medicine as well as it may beshould do. I mean even if you
look at some of the litigationbudgets that national services
have their vast. But what youguys are doing is kind of
changing that around entirelywhich which sounds, you know,
(15:01):
amazing.
Todd Ponsky (15:02):
Yeah, no, I totally agree with you. One quick thing
I want to say about this, thehardest part we were just
discussing before this podcastwith my team, the hardest part
is the first thing you have todo is called breaking fixedness.
It's really hard. You know, it'sthe same idea with Henry Ford
and the horses that he saysthat, you know, people would
(15:22):
would say, make our horsesfaster. The hardest part that
makes the surgeon angry is whenyou tell them remove something
that you assume you have to do.
They almost get viscerally angrywhen you have them break their
fixed mindset. So there's a lotof a lot of work to be done. But
I can't wait to read that book.
David (15:43):
Yeah, it comes back to it's one of the kind of mantras
that I picked up from a fewdifferent places, actually,
which is, to go back to the kindof Henry Ford example, if you
wanted better, he would havemade it a quicker horse. But it
needs to be different. It needsto be different in order to be
taken on. It needs to bedifferent in order to really
(16:03):
make a difference and moveforward. So you know, I think
that's it. It just rings true inso many areas of life and walks
of life, I think. Can you talkabout any of the examples of
success that you've seen throughthat MMI process?
Todd Ponsky (16:17):
Yeah, so what's really exciting is that we don't
just do it with devices, it'salso processes. So one was we
had a child that had a feedingtube that got clogged and it
ended up leading to acomplication. We then said,
okay, it sounds like cloggedcatheters are a big problem. And
(16:39):
so we did this in four weeks,and we came up with two ideas
that I think are going to solveproblems we didn't even think
of. So that's number one. Numbertwo, is we have a phenomenal
colorectal centre where theytreat children from all over the
world with the most complexcolorectal problems. We want to
(16:59):
figure out how to provide carefor people that can't always get
to Cincinnati, Ohio. So well,they have to come. I mean, they
have to come because they haveto get this and they have to get
that and I said, But why? Maybethey don't have to get that. And
they said, Oh, no, no, no, theydefinitely have to get that. And
I said, but let's breakfixedness let's say you're on a
(17:21):
deserted island, and you don'thave that thing. Do you think
you still could treat thepatient? Yeah. And I said, Okay.
then there's this thing aboutthe good enough principle.
That's what I call it. When theperson who invented the digital
camera, showed it to Kodak, theydidn't like it because it wasn't
as good as the camera photo. Butit was good enough. And that's
what they didn't recognise thatmost of the people would have
(17:43):
been just fine with that. Butit's the people that want
exactly the way they've had itbefore. That stopped them from
innovating. Once you get pastthat point, it's going to be an
incredible breakthrough in howwe treat patients, because now
we're going to have almost noradiation because we realise we
really don't need these tests wethought we needed. We can treat
people from any corner of theearth and developing nations can
(18:04):
adopt this, who don't have allthe resources and can find that
they can still treat thesepatients even without these
fancy radiology tests. So weboth do product and process and
it's very exciting.
Hannah (18:16):
What's about on, you know, when you're talking about
this process, this systematicand inventive thinking process,
then speed is very obvious andhow you're getting through that.
But do you also improve yourchances of success? Because
innovation is an area where it'snotoriously difficult to
successfully implement somethinginnovative and implement change?
(18:37):
And I'm just curious about yourperspective on that.
Todd Ponsky (18:41):
Let me tell you where I'm not good, which is
most things. But here's anexample of one thing of many. So
we're great at ideating andgetting the thing made. The
problem that most children'shospitals have and we've been
talking through Ispy, theInternational Society for
paediatric innovation, on how wecan all work together as
(19:02):
children's hospitals is is thatyou have all these things now
how do you get them to themarketplace? And that's a real
challenge. We're brainstormingsome innovative digital
solutions that might help raiseawareness of getting these
products out there, becausemaking paediatric products is
very difficult.
David (19:21):
I think that's always been something that's kind of
bugged me a little bit. It's thecollaboration element of it. So
you've got collaboration withinyour institution, that's
absolutely fine and as it shouldbe, but the the collaboration
between Children's Hospitalwe're going off on a slight
tangent here, but let's go withit. You know, the collaboration
between children's hospitals oreven just collaboration between
(19:42):
hospitals, but especiallychildren's hospitals. Given
that, you know, if you arecreating an innovation,
intervention, which everyoneshould know about. They should
just be, you know, out there foreverybody to use, to utilise.
Iknow that you have a differentsystem in the US to potentially
(20:03):
have we have in the UK. But youknow, how do we do that? How do
we do that more?
Todd Ponsky (20:09):
Okay, let me. I want to make one comment that on
our last thing, and then I wantto answer that my goal is not
probably what it seems. Iactually care less about getting
a product out there. I want toget their brains trained to
think different. I want theclinicians to be, you know, we
were taught safety in theoperating room. But for years,
(20:32):
we did things away that wasn'tas safe. Once they started
teaching us the safety training,it's instinct now. You walk in,
you know, you put the secondglove on instead of one, or you
announced what you're going todo better than we did before. I
want innovation to beinstinctual. I want it to be
that, oh, I have an interestingidea. So number one is making
the product isn't my number onepriority, it's getting the
(20:54):
brains to change. Back to yourquestion about collaboration.
That's why I love Ispy and Ijust recently joined that it's a
mindset. It has to be wherehospitals come together, the
right people have to cometogether, where they leave their
egos at the door. The culture isset within this group where we
are working together. The risingtide raises all ships and this
(21:18):
is what happens. We meet everyweek and we say, all right, I
have this idea. How can you guyshelp me? Well, let's do this
together. I think it's a cultureand a mindset. And once people
start seeing it happening andgetting legs, everyone's going
to want to join the sameprocess.
David (21:32):
Yeah, and we will, we'll make sure that, that we put, you
know, links to Ispy and whathave you in in or the show
notes. And, and it is a furtherconversation. You know, we've
had we've touched on iSpi, butit's one of the things that we
want to cover, you know, inseason three of the podcasts is
to really go through that. But Ithink, you know, I was
introduced to it. 2017. So it's,you know, it's a relatively new
(21:57):
concept. But I think it'sgrowing and getting more and
more collaborative, as you say.
Todd Ponsky (22:02):
Yep.
David (22:19):
Let's move on to you know, you mentioned Globalcast.
And this I think fits into allthe conversations that we've
just had. Anyway, in terms ofsharing of information, talk to
us a little bit about how thatcame about and what you're doing
with it.
Todd Ponsky (22:32):
Alright, so here's my question is, the one question
that's in my head is, how willdoctors learn in 10 years from
now? I don't know the answer.
But that's all I think aboutthat literally keeps me up in
the middle of the night, becauseI feel like the answer is out
there. What I do is I look tosee what my kids are doing,
because it usually predictswhere doctors will be 10 years
(22:53):
later, because we're so slow. Soif I look at the way that right
now, the younger generation isconsuming information. How are
anything that my children knowwhere is most of it coming from?
I think I narrowed it down tofour things. Gaming. They're
getting information from gaming,because now it's social gaming.
(23:13):
Right? That's the socialisationespecially during COVID. They're
actually like talking to people,they're getting information and
because it's fun, they'reenthralled with it. Their mind
goes into it. So gaming isnumber one, social media is
number two, they're gettinginformation from social media.
Now, I don't know if you've seensocial dilemma, but it's scary.
(23:33):
But it can be harnessed in agood way. And so some gaming,
social media, video, videoconsumption, people go to
YouTube, they don't read amanual anymore. So I don't think
people read very much anymore.
You can get it all on video. Thefinal thing, go figure. I don't
(23:54):
know if you guys have heard ofthis, but audio podcasts. That's
a obviously you know, so that'swhere I think it is. Video,
audio, gaming and social media.
What about I think, what's that?
About Austin's parents? Yeah,well, I'm not so good at that.
So maybe they don't learnanything from me. Yeah, no,
good. So I mean, that's actuallyyou know, you joke. But I think
(24:15):
actually, it's your colleaguesright around you, whether it's
your parents or whatever. Soit's word of mouth around you.
So the The point is that thoseare the four things we're
focusing on. So if I'm going tothink about how I'm trying to
make, there's two ways doctorsget information, push and pull,
when they want, when they have apatient and they want to look
something up, they'll go andpull what they want. So we have
(24:38):
to make a platform that makes itincredibly easy to find
something. So findability, youtype something in and you get
something that is exactlyingestible, that works for a
doctor. So that's why audio iscritical because the best
downtime we have is when we'redriving to work or working out.
So it's multitask learning. Soit has to be designed where you
(25:01):
can get, you can find somethingexactly what you need to learn
about the patient that you aredealing with right now, and get
it consumable in a way that iseasy to digest. While you're
going through your day, soaudio, video, or reading it, if
that's what you like. So youhave to have it in all forms of
media. The second thing is, ifyou're just going after stuff
(25:24):
that you are are looking for,you're going to be missing new
content, because you won't evenknow it's there to look for it.
So there has to be pushedcontent too. So there's pulled
content and push content, pushcontent is something they don't
know about that they need toknow about. The problem is, if I
just send out an article,there's too much information
now. So there's 2.5 millionpublications a year, there's no
(25:47):
way to push everything out. It'sinformation overload. So once
it's deemed that this is animportant topic, whether by
crowdsourcing or artificialintelligence, and we say this is
important, then we have to pushit out. So we have to filter it,
and then deliver it. So once wefilter it through crowdsourcing
or AI, then we have to deliverit in a way that someone would
(26:08):
actually pay attention to it.
That's where edutainment comesin. It's got to be fun,
exciting, it's got to capturetheir attention. To repeat that,
again, there's got to be coldcontent that's got to be
accessible in a format thatdoctors need. Then there's push
content, which has to be wellfiltered. It has to be delivered
in a way that's going to capturetheir attention. Otherwise,
(26:30):
they'll ignore it. That's themain thing that Globalcast
focusses on.
David (26:35):
The other bit that that struck me with it is the
democratisation of data. Soyou've just described the
reasons, or the ways that you'redoing it, and you're delivering
it and how people will consumeit. But but that works in a, you
know, that's what we do in inthe UK, or the US or wherever it
might be, but what about in someof these, you know, areas that
(26:56):
are not so fortunate? You know,that's that's one of the primary
reasons for youcreating it,right?
Todd Ponsky (27:01):
Right. So our hashtag is knowledge should be
free. So right now, it's onlythe wealthy countries that get
the most cutting edgeinformation, because the
textbook costs. it can costanywhere up to $1,000. If it's a
very highly specialised textbookin a very, very specific space,
but they're usually several $100for a textbook. Someone in a
(27:24):
developing country is going toget an old book that is out of
date. So you have a completedisparity in knowledge. And it's
crazy to me that in 2020,there's disparities in
knowledge. So our hope is thatby putting content out in
digital form, which isinteresting, even the most
(27:44):
underdeveloped nations stillusually have access to internet.
So if you can push the contentfor free, in engaging ways,
we're going to start seeing alevel playing field, that
everyone's going to start havingthe same access to the same
information, it's going todisrupt the industry, because by
providing free information isgoing to put a lot of things
(28:04):
into a tailspin. The questionis, how do we financially
support that? That's a goodquestion. We're, we're we're
figuring that out. It's going tobe either, you know, donations
or monetization through havingads, or allowing people to pay
to put their content out there.
We'll figure that out. But rightnow, it's working fine.
Hannah (28:26):
How do you break through the noise? How do you reach the
people for whom the informationis so valuable?
Todd Ponsky (28:35):
So the two things that I'm going to answer that
with so there's filtering thecontent, and how do I get it to
them. So take a surgeon who isin some remote country
somewhere. First thing I had todetermine is what's important, I
haven't figured that out yet andworking with much smarter people
than myself, we're working on AIalgorithms, we just presented at
(28:55):
our national meeting. I am noteven an amateur and below an
amateur. So we were able tousing the machine learning
algorithms, we were able topredict what the editorial
boards would have also predictedwas a good article. So if we can
find companies to help us makean algorithm that would probably
(29:18):
give you a good idea that thisis a good article, or important?
That's step one. crowdsourcingalso is very critical to this.
Once we've determined that, howdo we get it to them? So we use
social media to make peopleaware of what's out there and
then direct them to where thecontent is. It always has to be
(29:39):
the free content that we directthem to. So we've created a
mobile app that's free. It's youknow, it's been downloaded way
more than we anticipated. Sothat's how we're doing it now.
David (29:53):
I was gonna ask you about numbers and also just
geographical location. Have yougot an idea as to how
gegraphical the spread of usersis now.
Todd Ponsky (30:03):
Yeah, so numbers and geography. So let me do
geography first. So Globalcastused to only do live events.
Because we started 12 years ago,we were with our webcams. I
mean, this was before there waszoom or anything like that. So
we found the biggest gap wasAfrica. We would put push pins
(30:27):
all over the world where we werebeing viewed except for Africa.
We talked to people there. Andit's the access to fast enough
bandwidth to be able to watch alive event when we went into the
offline app, the mobile appwhere you can watch on demand.
It spreaded out equally allover the world. So that was the
thing that held us up andreaching Africa. It's a complete
(30:49):
geographic spread, spreadequally around the world. What I
get excited every morning, whenI see the new people that have
joined our group, I love seeingthe most remote countries you
can imagine. Numbers. So to giveyou an idea, we have 700
paediatric surgeons in theUnited States. So it's a very
small specialty 700. So we have6500, verified paediatric
(31:17):
surgeons or paediatric surgerynurses. So we think we have a
probably about 80% of theworld's population and that's
only in the tiniest ofspecialties. So once we start
doing this in other specialties,we feel like we'll make a real
impact.
David (31:37):
I've got to ask this, because I do work in AI. Still
not anywhere near where, youknow, the guys that are creating
the algorithms are going to bebut what do you think about when
it comes to bias and giving theright information to the right
people? You know, so one of thethings that we think about is,
(31:58):
if you take imaging, forexample, you could train an
imaging algorithm on apopulation, which has absolutely
no bearing on the populationthat might actually use the
algorithm. So you need to makesure that you're, you know,
either either you're verytransparent, in terms of
demographic and what data thatyou've trained it on. So how do
(32:20):
you make sure that theintervention that you're doing
on a, you know, on a child inCincinnati is the right thing to
be given to someone in SubSaharan Africa, for example?
Todd Ponsky (32:31):
This is exactly the same question that everyone
keeps bringing up. I don't havean answer. I'll give you an
example, though. We put outstuff that was really, really
important. This is how I'msolving it. We put out papers
that were important. I gotemails from people and it's
funny, I don't care how manyemails I get, I always answer
every single one of them,because that's how we're going
to get to the answer. They said,You're only talking about things
(32:54):
that we don't even see in SubSaharan Africa. How much are you
talking about TB? Because that'sa big problem for us. You don't
even mention it. I said, Okay,so we created something called
the idea team, the Internationaldigital education Alliance. I
put a video out there, I said,join us, we need democratisation
(33:16):
of knowledge, not only goingout, but coming in. So we need
to know what's important. Sothat's not an answer to what
you're looking for, which is theAI answer, because I don't know
how to rule out bias inartificial intelligent
algorithms. I can tell you, whatwe're doing now is that we are
getting input from a diversegroup of people instead of, you
(33:40):
know, the same people in thesame city, that should dictate
what everyone else in the worldwants to see. Then the problem
is we're going to have todeliver the content in a very
specific way. So someone inAfrica can look at content
that's relevant to them, andsomeone in Cincinnati can look
at content that's relevant tothem.
David (33:57):
I think that's brilliant that you're doing it that way.
When you mentionedcrowdsourcing in this respect,
as opposed to crowdfunding, thatto me is also a way in which you
can, you build up that knowledgein terms of they can help you
know that the power of the crowdis that they can help you to
determine what needs to go whereand how it goes. I think it's,
(34:22):
you know, again, I'm not anexpert on this, but it's
probably an underutilisedelement of society today.
Todd Ponsky (34:28):
So I believe crowdsourcing is critically
important. The argument that Iwill get from the naysayers,
which is a very valid argument,is that while I believe the
crowd is smarter than the coreof experts, we have the core of
experts that are editorialboards. These are people that
have been deemed to know whateveryone wants to read.I think
(34:49):
the crowd is going to be smarterthan the core of experts. A
great book Machine PlatformCrowd. Anthony Chang told me
about it, great book. It reallytalks about the difference
between you know the value ofthe crowd versus the core. And
but the argument against that isthat the crowd will only pick
(35:09):
sexy, fun topics and won't delveinto the scientific process. I
said, Well, I'm not sure aboutthat. Let's find out. So what
we'll have to do is go back andtest to see did the crowd pick
articles that are fun, funtitles? Or did the crowd really
pick high quality articles? Theanswer is probably going to be a
Wikipedia answer. Wikipedia iscrowd sourced with an editorial
(35:32):
board. It's hybrid together.
David (35:35):
Yeah, no, I think I think that's fascinating. I just want
to I'm just conscious of time,and I want to talk about a
little bit of your, I guess, dayjob to a certain degree in terms
of the surgical side of things,you know, where you're actually,
you know, with patients, and Iguess the bit the bit about the
job that. You know, brought youto it in the first place. But I
know that you've done quite alot of innovation in that
(35:58):
respect in terms of, So youtalked about minimal invasive
surgery and perfecting that andyou know, your goal is to make
sure that you're giving, you'redoing that as least invasively
as possible with minimalscarring and all this kind of
stuff. But talk to us a littlebit about some of the
technologies that you've broughtinto to assist you because
they're fascinating.
Todd Ponsky (36:18):
Yeah. So my goal, personally, that I have an
interest in is two things. One,really pushing minimally
invasive surgery. So we've wentfrom not being able to treat and
then eventually saying, Oh,well, we can figure out an
operation that fixes it, butit's with a big scar. So it was
no therapy to invasive therapy.
Like we figured out how to doit, but it really hurts and it's
(36:41):
impactful to the kid. Then thethird one is minimally invasive
surgery, which is tiny scars forthe same operation. Ultimately
now we're working on no scars.
So that is putting an endoscopeinto the mouth and being able to
get inside and do it scarlesssurgery. That's called notes,
natural orifice transluminalendoscopic surgery. And and that
(37:05):
is something that is happeningin the adults, but not so much
yet in the kid. But it's juststarting. So it's minimal
invasion is my interest. I amvery interested in particular,
hernias is an interest of minebecause of how we can do it,
since it's a very commonoperation. But my bigger
interest is something calledtelementoring. So now that
(37:30):
surgery is usually on video, sowe're operating and we're
watching on the screen. Now, onesurgeon in one place could see
what another surgeon is doingand actually mentor them live by
drawing on the screen andsaying, This is what you do. So
we've been really pushingtelementoring, which has, as you
can imagine, carries a lot ofcontroversy. But we have really
(37:51):
demonstrated it's better for thepatients. So laparoscopic
surgery, the minimally invasivesurgery really lends itself well
to telementoring, which is theother big question we're trying
to do, which also goes alongwith democratising knowledge
because now surgeons in remotelocations can get guidance from
surgeons in in other locations.
Hannah (38:10):
You said that doing the micro surgery will minimal to
not seeing at all surgeries,starting in adults less so in
paediatrics and that what arethe factors that you need to
consider aside from the actualsize of the implements that
you're using.
Todd Ponsky (38:29):
That's what it is, it's the size. So the
instruments that go in throughthe mouth. So the scope goes in
and it has all these instrumentsthat come out and can do the
operation like a robot from thescope. But the problem is the
scope itself is too big to fitdown the oesophagus of a child.
So if we could figure out how todownsize those, and that's this
(38:52):
just keeps happening. It'salways how it is it's first made
in the adult world. Then we tryto downsize it. So right now, we
just don't have the appropriatesize for children.
Hannah (39:07):
Have you looked at it from the other way around that
because we obviously Not MiniAdults podcast, we're talking
about exactly that premise thatit's not just a matter of
scaling something downnecessarily. So I'm thinking
with a systematic and innovativethinking in mind of what what
what have you come up with andyou go with a blank sheet of
paper instead.
Todd Ponsky (39:27):
Okay, so this kind of circles back to the original
discussion. Let's say I get agroup of us together, and we
apply systematic inventivethinking and figure out a way to
downsize and create a miniversion of an endoscopic
(39:47):
surgical solution. That and I'mbeing a little bit of a
defeatist here, but that's goingto cost quite a bit of money to
make and there are very fewcompanies that would be willing
to invest in creating somethingthat big and expensive for the
paediatric market? No one wantsto make products for paediatrics
(40:08):
because the markets too small.
So we would have to come up withnot only a compelling
instrument, but a compellingmarket that would allow the
companies to make it for us. Sothe usual, the really big
advanced technologies areusually ones that are the
hardest to get through. Whereasthe smaller devices are easier
(40:31):
if something like that would begame changing. But people have
had a lot of failures so far intrying to bring adult technology
into paediatrics because no onewants to make it.
Hannah (40:43):
Yeah, it's a it's a familiar story,
David (40:44):
Unfortunately. So and I was really hoping when you were
first describing that, that itwas a case of we've got this for
paediatrics, because then youcould expand it out to adults
much easier. Right? Then also,because of their physiology,
that there's, you know, is lessof them to go round, if that
makes sense. Right?
Todd Ponsky (41:05):
Yeah.
David (41:05):
If you had something of scale, then, you know, it would
work. But what I'm about to kindof come to what we what we tend
to ask everybody in terms of afinal question, but I think what
you've discussed in terms ofjust the changes of education, I
found out not that long agothat, that actually education
for surgery in particular. Sothere's a doctor in the UK
(41:28):
called Shafi Hamad, I don't knowif you've ever, you know,
amazing what he's trying to dowith VR, and AR and all these
different things. He obviouslyhas pioneered to a certain
degree actually webcasting andon all different media and
platform, all of the, you know,surgical interventions that
(41:49):
they've done. But I remember himshowing a picture in a lecture
that I saw not that long ago,just, you know, a bank of seats
of clinicians or surgeons thatare training just watching this
happening. But it hasn't reallychanged so much in the last kind
of 150 to 100 years. So theseadvances that you're talking
(42:13):
about and that you're pioneeringare you know, really what is
going to change that and and Iguess thinking it with or in my
head, thinking it with theGlobalcast and thinking about
how you actually help surgeonsin Sub Saharan Africa or India
or, you know, these lessdeveloped countries, you know,
you've got a real opportunity todo that. Because let's face it,
(42:37):
the technology will be there inorder to get the broadband
signal, whatever it might be inorder to do it. It's just a case
of making sure that we'regetting that information to
them.
Todd Ponsky (42:46):
Yeah.
David (42:48):
So look, Todd, thank you, you know, so much as I knew this
was going to be a fascinatingconversation. We've gone, you
know, lots of different anglesand trajectories and it's been
fantastic. But what we there'sone question that we tend to ask
everybody on here, which is thatif you had a magic wand, and you
could do anything, you know, tochange, paediatrics or to solve
(43:11):
something in paediatrics, whatwhat would it be?
Todd Ponsky (43:15):
It's this holy grail, I'm going to go back to
the beginning, it's the holygrail how to democratise
information, all these otherthings that we're working on
these cool instruments, thesecool processing innovations,
that's great. But the biggestimpact, I believe, that we can
have on worldwide care ofchildren is, is flattening the
(43:36):
playing field of knowledge.
That's the biggest disparitythat I've noticed that people in
remote locations can get bywithout the latest technology,
but they cannot get by withoutthe latest information or the
latest knowledge. So if we couldfigure out how to filter through
the content, how to get it intopeople's brains, and what is
(43:59):
going to be the future of howpeople are going to consume
information. And I want to seethat we talk again in a few
years, and we look back and sayit happened. Look, it's a whole
different world. Now. Knowledgeis shared equally around the
world, through this technologythat we haven't even thought of
yet. I don't know what it'sgonna be. If I could look back
(44:19):
at of all the things I'm workingon the minimally invasive
surgery, the rapid prototypingall that that's secondary to the
fact that I really want to beable to say that knowledge is
equal around the world.
David (44:37):
I think we said a lot but we could not agree more. I
could not agree more. You know,the reason I'm still you know,
working and doing the job that Ido as a day job is because I
want to try and make thathappen. So and I know that
you're trying to do that withiSPI and everything else. So
Todd, thank you so much forjoining us. It's been such a
(44:59):
pleasure, and a great right wayto end our second season. So we
really appreciate that. And, youknow, we wish you and your
family very happy Christmas andNew Year. And I think we're all
looking forward to 2021.
Todd Ponsky (45:10):
You too, and I just want to congratulate the both of
you because this is so importantthe work that you're doing. And
this is an exact example of thesteps we need to take to
accomplish exactly what I'mlooking to accomplish. So
congratulations to you.
David (45:24):
Thank you. Thank you so much. Thank you to Dr. Todd
pomsky for joining us on the NotMini Adults podcast this week.
Also a really big thank you toeveryone that is listening week
in week out, and the very kindfeedback that we've been
receiving. This is the finalepisode of season two. We can't
(45:44):
quite believe that we've gotthrough 24 episodes since we
started in the summer. It's beena real honour to speak to the
people that we've spoken to. Ifthis is the first episode that
you're listening to, please dogo and check out the back
catalogue where you'll find ushaving conversations with some
truly inspirational people, asever. If there is someone that
you think that we should betalking to, then please do get
(46:05):
in touch. All the details fromtoday's show and for thinking of
Oscar can be found in the shownotes. Finally, thank you to
everyone that's been on thepodcast with us. Please join us
again in the new year for seasonthree. And until that point, we
wish you a very Merry Christmasand a Happy New Year.
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