A Diagnostic Odyssey: The UDN and n-Lorem's Roles
Dr. Sessions Cole shares his career being a neonatal pulmonologist and his involvement in the undiagnosed diseases network, the UDN. Dr. Cole estimates that it can take up to 12 years to get a diagnosis for a patient with a rare genetic condition and that there could be as many as 30 million of these patients in the U.S. who are undiagnosed. The UDN is working to elevate the awareness of the diagnostic odyssey these patients undertake and diagnose up to one third of patients who are referred to the UDN. Dr. Sesh is part of n-Lorem’s access to treat committee (ATTC), the committee that evaluates and recommends patients to n-Lorem. Dr. Cole discusses the robust processes involved in the evaluation of each application to n-Lorem and the hope and value that n-Lorem is providing to nano-rare patients today.
Transcript
Hello, I'm Stan Crooke, I'm founder, chairman and CEO of in
Speaker:n-lorem. Welcome to the n-lorem podcast series in which we focus
Speaker:exclusively on the needs of patients, who are what we've
Speaker:referred to today as Nano-rare Patients, patients who have a
Speaker:unique mutation often the only patient in the world with that
Speaker:particular mutation. Today, we are very privileged to have as
Speaker:our special guest, Dr. Sessions Cole. Dr. Cole is the Park J.
Speaker:White MD Professor of Pediatrics and Professor of Cell Biology
Speaker:and Physiology. He is the Vice Chair of the Department of
Speaker:Pediatrics and the vice chairman for children's health of the
Speaker:division and the Division Chief of newborn Medicine at the
Speaker:University of Washington, in medical school in St. Louis. Dr.
Speaker:Cole, thank you so much for joining us today. And welcome.
Speaker:Thank you very much, Dan. It's a pleasure to be here.
Speaker:So Sess, you've got this enormous title, but I think
Speaker:maybe to start with, maybe you can tell our listeners what you
Speaker:do every day.
Speaker:So Stan, I'm a baby doctor, a doctor specifically for sick
Speaker:babies, otherwise professionally known as a neonatologist. So I
Speaker:see patients who are the smallest and the sickest in
Speaker:medicine. And many of them have a whole variety of problems, but
Speaker:a lot of them have lung problems,
Speaker:A Sess you, I know you trained at Harvard, but how did you come
Speaker:to be interested in being a neonate, natal pulmonologist or
Speaker:lung doctor?
Speaker:Well, in in the neonatal intensive care unit, where my
Speaker:patients are hospitalized, they have very different problems,
Speaker:some are very premature, some have infections, some encounter
Speaker:accidents of nature during the birth process, some have birth
Speaker:defects, but almost all of them have lung problems. And so as a
Speaker:neonatologist, I became very interested in lung problems, and
Speaker:made the observation that some of the children in the neonatal
Speaker:intensive care unit have lung problems that are based on their
Speaker:inheritance or their DNA or their genetics. And so I became
Speaker:very interested in trying to understand inherited or
Speaker:genetically based lung problems in both babies and in older
Speaker:children,
Speaker:I suppose in the, in the lung, just like every other organ,
Speaker:that there are frequent mutations, and but there are
Speaker:probably just a group of a limited number of mutations that
Speaker:really cause significant lung problems, aren't would you say?
Speaker:Or is that just not right?
Speaker:Well, in in, in babies, because the lung is so important in the
Speaker:transition from womb to world. In human babies, the lung is the
Speaker:last organ to mature before delivery. Mutations, that cause
Speaker:lung problems are in several genes, but are very rare.
Speaker:Because these mutations or changes in genetic code, reduce
Speaker:the ability of the baby to survive beyond the newborn
Speaker:period. Many of them do survive now, thanks to the technology
Speaker:associated with neonatal intensive care. But there are
Speaker:several genes that we've identified that have rare or
Speaker:novel genetic code changes that lead to these kinds of
Speaker:genetically inherited problems in newborn babies and an older
Speaker:and older children as well.
Speaker:So you know, we're interested in the the sort of Nano-rare
Speaker:patient to patient who has a mutation that's unique to that
Speaker:patient or unique to a very small number of those patients
Speaker:in the entire world. I'm sure you encounter those patients
Speaker:that it's at some reasonable frequency, don't you?
Speaker:Yes, we have a lot of patients in the new Intensive Care Unit
Speaker:to have lung problems and other problems like birth defects or
Speaker:metabolic problems, who have novel, novel genetic code
Speaker:changes. And these novel genetic code changes frequently, one,
Speaker:code change in 3 billion code, code numbers can cause babies to
Speaker:have progressive breathing problems and in some situations
Speaker:rare without a lung transplant, they cannot survive beyond the
Speaker:neonatal period, 28, the first 28 days of life.
Speaker:So what fraction of the patients you see on a regular basis
Speaker:actually ended up requiring a lung transplant?
Speaker:We see approximately six babies a year, out of a total admission
Speaker:pool of about 1400 babies, so a very small fraction. Nationally,
Speaker:these babies, of course, are very rare, and we hear about
Speaker:many of them, because we not only can help provide the
Speaker:genetic diagnosis for these babies and families, but we can
Speaker:also provide them access to lung transplantation, if their
Speaker:families choose to pursue that particular option.
Speaker:Is a lung transplant a cure?
Speaker:So a lung transplant for babies with genetic problems that cause
Speaker:them to have breathing difficulties is is not a cure.
Speaker:It's a trade of an acute, lethal problem for a chronic lethal
Speaker:problem. We've been very fortunate and have learned a
Speaker:great deal about lung transplantation for babies. But
Speaker:it is still, I think, a palliative intervention rather
Speaker:than a curative intervention for these babies. And we are very
Speaker:interested in trying to develop therapies that would give these
Speaker:babies better long term outcomes than lung transplant.
Speaker:But it must be very difficult because to create a medicine for
Speaker:one baby in as the number that you gave, it would would seem
Speaker:very, very hard. And and of course, that's the area that
Speaker:we're interested in at in n-lorem. Are there any any
Speaker:medicines that are useful today that you can that you can use in
Speaker:these babies?
Speaker:We have tried a variety of medicines that in older children
Speaker:and adults may work, but quite frankly, these medicines are
Speaker:nonspecific, and predominantly ineffective. And so we really
Speaker:are left with a situation which is a difficult problem for us as
Speaker:providers, as well as for the families of these babies were
Speaker:left in a situation where we have really not very good
Speaker:choices. Choice one is to see if the baby can survive until lungs
Speaker:are available and as you can imagine, availability of infant
Speaker:lungs is very scarce. Or, option two, is what we call is what we
Speaker:call palliative care. And in that situation, families choose
Speaker:not to subject their babies to the prolonged, painful
Speaker:interventions of being in a neonatal intensive care unit and
Speaker:those babies pass away.
Speaker:That sounds terrible. So you're dealing with these, these brand
Speaker:new babies who are terribly sick, and you're having to
Speaker:support them with a breathing machine and all of that, and,
Speaker:and to a large extent, you have very limited opportunities to
Speaker:offer these particular babies a real long term solution.
Speaker:That's correct. And it's, it's very difficult. The one thing we
Speaker:can offer to families after the resolution of their baby their a
Speaker:transplant or passing away is that we can provide knowing that
Speaker:genetic code changes for a specific baby, we can provide
Speaker:some advice about the likely recurrence of the problem for
Speaker:that particular family. And therefore we can help them begin
Speaker:to consider once the loss has become a little more manageable,
Speaker:what their options are to have an unaffected baby in the
Speaker:future.
Speaker:It sounds like a really tough way to spend your days how do
Speaker:you manage the just the emotions of all the all the sadness
Speaker:around these babies?
Speaker:It is it is hard. There's no question about that. But I would
Speaker:say that the resilience and strength of the families of the
Speaker:babies are very inspiring to all of us who care for these babies.
Speaker:And it's really the strength of the families that I use, because
Speaker:I can't imagine what they're going through. And yet they are
Speaker:able to come to the hospital every day, see little changes in
Speaker:their babies that you know, help them have hope. And so I think
Speaker:it's very important to understand that these families
Speaker:and these families have extraordinary strength and
Speaker:resilience, and that strength and resilience really help all
Speaker:Those who care for the babies support the babies and support
Speaker:the families.
Speaker:Now, you know, it's very much my experience both in, in in, you
Speaker:know, making medicines for large populations of patients and tiny
Speaker:populations and now at n-lorem, is that it's just astonishing to
Speaker:me the strength and commitment of parents and to to their
Speaker:children and what the lengths that they can go to, to try to
Speaker:help and, and it's wonderful to see so many people come together
Speaker:and try to help these patients. And hopefully, we'll be able to
Speaker:do a lot more as the as the future unfolds here within
Speaker:n-lorem and other other approaches that are taking
Speaker:place. I know that you've been extensively involved in the
Speaker:Undiagnosed Disease Network. And I think that's an important
Speaker:thing for our listeners to understand. And, you know, with
Speaker:the groundwork that it's laid to help us begin to think about
Speaker:treating some of these patients, you want to just tell us how you
Speaker:got involved with the with the Undiagnosed Disease Network,
Speaker:which we'll call the UDN, to reduce the length of words. And,
Speaker:and and you know, what it does, and what's important about what
Speaker:they've accomplished in this in this program?
Speaker:Yes, the UDN was conceived by Dr. William Gahl at the National
Speaker:Institutes of Health. And he recognized that patients, both
Speaker:That is a really great achievement. And, and it's taken
Speaker:babies and children as well as adults, would benefit greatly
Speaker:from a diagnostic standpoint, with the new technology of being
Speaker:able to decipher every bit of gene code in every person who is
Speaker:undiagnosed. And so he took that approach, and was very
Speaker:probably about a decade as I, as I recall. And I think it's
Speaker:successful for several years running a program that was just
Speaker:at the National Institutes of Health. And then Dr. Francis
Speaker:Collins, then the director of the National Institutes of
Speaker:Health, decided to support the expansion of Dr. Gah's program
Speaker:across the United States. And currently, there are 12 clinical
Speaker:important that our listeners know that it's only the
Speaker:sites, who evaluate patients who have frequently been who have
Speaker:been almost always an extensive and prolonged diagnostic
Speaker:odysseys up to eight, nine, ten, twelve years, and these patients
Speaker:fortunate few who make their way to the UDN. The vast majority of
Speaker:have seen multiple sub specialists at multiple centers
Speaker:have gone through a whole variety of diagnostic
Speaker:procedures, imaging procedures, blood tests, and still, while
Speaker:they have objective findings of problems in their hearts, or in
Speaker:their brains or in their lungs, or in their kidneys, still do
Speaker:patients with the Nano-rare type of diseases and that are
Speaker:not have a unifying diagnosis. And the UDN has really elevated
Speaker:the awareness of these patients, both for the public, as well as
Speaker:for insurance companies. In addition, the UDN has helped
Speaker:elevate the awareness of the importance of these patients.
Speaker:essentially all genetically caused, unfortunately progress
Speaker:Across the United States. It's estimated that there are 30
Speaker:million patients with undiagnosed diseases in the
Speaker:United States. And fortunately, the UDN has leveraged
Speaker:subspecialty expertise, integrating the expertise with
Speaker:very advanced state of the art gene deciphering gene code
Speaker:their disease and succumb to the disease long before they even
Speaker:deciphering strategies, and has been able to make diagnoses and
Speaker:about a quarter to a third of these patients. And so a
Speaker:diagnosis for these patients is a critical step in trying to
Speaker:figure out what to do for the patients. It the diagnosis also
Speaker:have a chance to get diagnosed. It's it's just an awful
Speaker:gives patients access to other rare disease patients with
Speaker:similar diagnoses because they have the same gene problem. And
Speaker:being able to use social media to sort of come together has
Speaker:also been a very important part of what the UDN has done. And
Speaker:situation and the n-lorem and n-lorem effort has laid the
Speaker:the UDN I think, now is, has provided in n-lorem, and other
Speaker:foundations with a group of patients whose specific gene
Speaker:code diagnosis is known. And hopefully, that will that
Speaker:knowledge will help n-lorem identify potential strategies
Speaker:foundation for for the work that now is being taken on by many
Speaker:for treatment.
Speaker:Personalized Medicine Centers, in addition to the UDN sites.
Speaker:Isn't that true?
Speaker:Yes, there are, there are there are 12 UDN sites, but just to
Speaker:give a sense of the mismatch between the the achievements of
Speaker:the UDN and the need of patients, the UDN has evaluated
Speaker:a little over 5000 patients in eight years, has made diagnoses
Speaker:in about 1500 of these patients. But there are still 30 million
Speaker:patients out there who need evaluation. And so the UDNs
Speaker:strategies and approaches have been recognized and to some
Speaker:extent adopted by multiple other Precision Medicine Centers,
Speaker:almost always at academic medical centers where there are
Speaker:multiple sub specialists, there are resources for advanced
Speaker:imaging and other kinds of sophisticated diagnostic
Speaker:technology. The National Organization for Rare Disorders,
Speaker:has recently recognized a number of centers around the country as
Speaker:being Centers of Excellence for rare and undiagnosed disease
Speaker:patients and those kinds of centers are the ones that will
Speaker:hopefully help to begin scaling, increasing the number of centers
Speaker:available for rare and undiagnosed disease patients so
Speaker:that more of them can have access to this kind of these
Speaker:kinds of evaluations and gene code deciphering technology.
Speaker:So in simple terms, the patient gets referred to a UDN site,
Speaker:then the the the patient's genetic characteristics are
Speaker:determined, the mutation is defined, the manifestations of
Speaker:the disease, which we can call the phenotype is, is defined.
Speaker:And then, of course, the gene is functionalized. So so that we
Speaker:know if we, if we alter the gene function, what we what might
Speaker:happen, and all of that is done, sort of patient by patient. Is
Speaker:that fair to say?
Speaker:Yes, that's right. Almost, many of the patients have novel gene
Speaker:code problems, and trying to understand how to rescue the
Speaker:problems that are caused by the gene code change requires a
Speaker:whole nother set of scientists and investigators who can use
Speaker:model organisms, organisms like flies, fruit flies, worms, and a
Speaker:small fish called zebrafish. And they use these model organisms
Speaker:because these model organisms can test the functional
Speaker:disruption that the gene code problem has for individual
Speaker:patients. And then once that testing is done, we then have
Speaker:clues about the best therapeutic strategies that might be pursued
Speaker:to rescue the problems that are caused by the gene code
Speaker:mutation.
Speaker:Wow, thats an incredible achievement. But it is true that
Speaker:even with all those resources, about a quarter to a third of
Speaker:the patients get diagnosed the others don't it how do you
Speaker:account for that?
Speaker:I think that the fact that about two thirds to three quarters of
Speaker:the patients evaluated don't receive a genomic diagnosis is a
Speaker:reflection of how much we still have to learn about how genes
Speaker:work. We have very, very sophisticated techniques to try
Speaker:to comb through gene code results to identify those
Speaker:differences in gene code that might be responsible for
Speaker:individual patients conditions. But we clearly have much more to
Speaker:learn about how to analyze gene code. In addition, there may be
Speaker:other situations where an environmental, an unrecognized,
Speaker:environmental problem interacts with a person who is susceptible
Speaker:because of the gene code changes. And we don't recognize
Speaker:the environmental problem that is actually part of the cause of
Speaker:the undiagnosed disease. So, we still have a lot to learn, but I
Speaker:am optimistic that with the progress that's being made now,
Speaker:we will continue to increase the number of undiagnosed patients
Speaker:who received diagnoses in a reasonable period of time, as
Speaker:you say, before they succumb from their diseases.
Speaker:That's great, and so, one of the key things that the that the UDN
Speaker:has achieved is, its generated a whole lot of data from which
Speaker:we're learning every day about why some patients are
Speaker:diagnoseable, and others aren't. So why don't you tell us how you
Speaker:got involved with the UDN?
Speaker:Well, I got involved with the UDN because, at Washington
Speaker:University in St. Louis, where I practice, there are many, many
Speaker:resources, people, diagnostic capabilities that are available,
Speaker:but they had not really been united under a single program.
Speaker:And I was fortunate to sort of lead the efforts at Washington
Speaker:University, three or four years ago, to try to pull together
Speaker:those resources in an application to the National
Speaker:Institutes of Health, to be able to become a site in the
Speaker:Undiagnosed Diseases Network, and we were successful with that
Speaker:application. It's also part of my sort of own DNA, that,
Speaker:especially for babies, but also for all patients, older
Speaker:children, and adults, I feel very strongly that we all need
Speaker:as providers, never to accept the fact that we can't find a
Speaker:diagnosis, we need to pursue the diagnostic possibilities in
Speaker:these patients because a diagnosis is so important for
Speaker:patients who are struggling with not easily classifiable problems
Speaker:that are both life impacting, and sometimes life limiting.
Speaker:You bet. You know, once you have the mutation sorted out, it
Speaker:doesn't really matter what you call the disease, the mutation
Speaker:then becomes the actionable event, that's your problem, and
Speaker:this is this, this then gives us a target to fix it. So it is,
Speaker:you know, it's just the vital first step in ever treating a
Speaker:patient properly is to get to a diagnosis, and I think it's fair
Speaker:to say too, that, when patients feel they have at least a name
Speaker:to call their problem, that's also an important emotional step
Speaker:for patients. I'm sure you see that in your practice as well.
Speaker:Absolutely. And I would say that patients who are struggling with
Speaker:an undiagnosed disease, want to trust someone to help them find
Speaker:the answer for their problem. And one of the other
Speaker:characteristics of the Undiagnosed Diseases Network
Speaker:evaluation, is that there is a trust developed between those of
Speaker:us who are trying to figure out a diagnosis in the families or
Speaker:patients who are affected by not having a diagnosis. And that
Speaker:trust is so important, because, as you might guess, especially
Speaker:for patients and families who have been on prolonged
Speaker:diagnostic odysseys, there develops sometimes some
Speaker:skepticism about what is really going to happen to me and what
Speaker:can doctors and scientists really offer me, so we try to
Speaker:provide tangible, accessible hope for these patients who have
Speaker:been undiagnosed.
Speaker:You know, of course, that one of the first collaborations that we
Speaker:did it in n-lorem was with the UDN but I've been surprised and
Speaker:very encouraged that less than half of our applications have
Speaker:come from UDN sites. And I'm encouraged by that, because that
Speaker:says, many, many other Personalized Medicine Centers
Speaker:are, are joining in the in the pursuit of solutions for these
Speaker:patients, and that's great. But, my feeling about a mutation
Speaker:diagnosis is that as a general rule, the the answer that has to
Speaker:be given to the patient is, there is no treatment today for
Speaker:for you. And I'm sure that's very disappointing for patients
Speaker:to hear, even when they have a name for their problem.
Speaker:It's very disappointing for patients. And quite frankly,
Speaker:it's very disappointing for those of us who are taking care
Speaker:of the patients. Because a diagnosis is critical, but
Speaker:almost every patient and family asked me, as soon as we find a
Speaker:diagnosis, now, what do we do?
Speaker:And of course, that's where n-lorem comes in. And we offer,
Speaker:you know, genetic medicines that so we take that mutation, once
Speaker:we know the mutation, we can fix it in many cases. And of course,
Speaker:the medicines began there, since their genetic medicines, we we
Speaker:designed a medicine to to address that particular
Speaker:mutation. And your involvement at n-lorem has been a really
Speaker:critical part of our success at in n-lorem, to-date. You know, I
Speaker:should know, but I don't really know exactly how you came to be
Speaker:so involved with us.
Speaker:Well, I I was very fortunate to be asked by Dr. Joe Loscalzo who
Speaker:was involved with n-lorem, to serve on the access to treatment
Speaker:committee. And, and n-lorem is really pioneering the kinds of
Speaker:processes that are so necessary to link a therapy with a genetic
Speaker:diagnosis. The access to treatment committee includes sub
Speaker:specialists from many different many different areas, who come
Speaker:together and pool their expertise and experience to try
Speaker:to figure out what might be the best therapeutic approach for a
Speaker:gene mutation that is novel that has never been seen before. And
Speaker:these kinds of discussions are so important and quite frankly,
Speaker:are novel across the country, they are they are, they must
Speaker:include a rigorous understanding of the gene mutation, and what
Speaker:the gene mutation does, they must include a rigorous
Speaker:understanding of what is happening to the patient, and
Speaker:what symptoms and signs can best be used to evaluate a potential
Speaker:response or the effectiveness of, of a possible therapy. And
Speaker:they must include also understanding of what it will
Speaker:take from a regulatory and ethical perspective, to be able
Speaker:to provide a test therapy for a novel genetic disease.
Speaker:Well, you know, at n-lorem, are focused focus is, is on n of 1
Speaker:type patient, and, and to identify ASO, treatments
Speaker:experimental ASO treatments, our technology, that can be used,
Speaker:provided to these patients for free for life and we're, we're
Speaker:grateful to be able to do this. We are, of course of a nonprofit
Speaker:foundation, as you know, well. And one of the things that I
Speaker:felt was so important in putting in n-lorem together was to
Speaker:ensure that each step in the process was of the highest
Speaker:quality possible, because what we can't do is treat these
Speaker:patients in ways that are cavalier. We must know what
Speaker:we're treating, why we're treating and how we're going to
Speaker:measure what we the benefit that we hope to see for each of these
Speaker:patients. And the access to treatment committee is
Speaker:comprised, as you said, have all of these types of expertise plus
Speaker:tech plus expertise in our technology. And so it's an
Speaker:incredibly valuable support for these patients and for me,
Speaker:because the recommendations from the ATTC come to me and I make
Speaker:the final decision what patients we treat, and and we've been
Speaker:very busy. In contrast to what I expected, which was a few
Speaker:applications, we're now approaching 130 applications and
Speaker:we're proceeding towards treating, you know, as many as
Speaker:50 of these patients, which is a remarkable number. If you if I
Speaker:forced you to say the two or three things that you've learned
Speaker:that are most important to you out of your experience and ATTC,
Speaker:what would you say?
Speaker:I would say that the first thing is that, as you've referenced,
Speaker:the quality of the scientific approach must be impeccable. And
Speaker:what impeccable means is that we need to be sure that what we're
Speaker:going to propose to do for a patient therapeutically is safe
Speaker:and effective. And all of us want every treatment for these
Speaker:undiagnosed patients to work the first time, without, without any
Speaker:ambiguity. However, we can't let our bias about wanting the
Speaker:treatment to work, to cloud our judgment, when it comes to
Speaker:ensuring that we have objective metrics with which to measure
Speaker:the effectiveness and safety of the of the therapy that we're
Speaker:proposing. So I think that's that kind of tension between
Speaker:wanting to be able successfully to treat a patient and knowing
Speaker:that we have objective findings that will tell us when the
Speaker:therapy is not working, is so important.
Speaker:And so you're comfortable with the systems we put in place it
Speaker:in n-lorem?
Speaker:Absolutely. I've been I've learned so much about the
Speaker:multiple dimensions of the process of evaluation of the
Speaker:patient, evaluation of the mutation, and evaluation of the
Speaker:possible therapeutic approaches. It's been so important for me,
Speaker:as an individual, because when I speak with families and
Speaker:patients, I need to be able to help them understand what the
Speaker:what the process is, what the challenges are, and what the
Speaker:potential, both downsides and successes are going to be if we
Speaker:can develop a potential therapeutic approach.
Speaker:Well, Sess, thank you very much for the opportunity to have you
Speaker:participate in this podcast series. And much more
Speaker:importantly, for your commitment to patients that we care about
Speaker:you care about and all the help that you've provided in n-lorem
Speaker:over the brief two year history that we have, we couldn't have
Speaker:done it without you and your colleagues on the ATTC. And so
Speaker:I'll open it up to you for any final comments and then we'll
Speaker:we'll we'll close this podcast. It's been a great privilege to
Speaker:get to know you and and, and I'm sure our audience feels
Speaker:privileged to get to know you a bit on this in this interview.
Speaker:Any final words for us?
Speaker:Well, Stan, thanks for your kind words, I would say that n
Speaker:n-lorem is doing pioneering work in an area of enormous need. And
Speaker:I am privileged to be a small part of that work.
Speaker:Thank you so much. And thanks, everyone for listening to this
Speaker:podcast. We hope it's been informative for you and it's
Speaker:certainly informative and inspirational for me.
Speaker:n-Lorem is a nonprofit committed to discovering and providing
Speaker:personalized experimental treatments for free for life to
Speaker:patients with genetic diseases that affect one to 30 patients
Speaker:worldwide, referred to by n-lorem as Nano-rare. Many of
Speaker:these patients progress and die without ever achieving a
Speaker:diagnosis. This is where n-lorem comes in. They do the impossible
Speaker:by providing hope, and for those that they can help free lifetime
Speaker:treatment. For more information about n-lorem or today's
Speaker:episode, visit n n-lorem.org. Any questions can be sent into
Speaker:podcast@nlorem.org. Search and n-lorem on Twitter, Instagram,
Speaker:YouTube, LinkedIn and Facebook to connect with us. Please rate
Speaker:and review the podcast on Apple, Spotify, or wherever you listen.
Speaker:This truly helps us climb the charts and allows others to find
Speaker:the show. This podcast is hosted by Dr. Stan Crooke, our
Speaker:videographer is John Magnusson of Mighty One productions. Our
Speaker:producers are John Magnuson and Kira Dineen of DNA today. Thank
