Bloomberg Audio Studios, Podcasts, Radio News.
This is Bloomberg Business Week Daily reporting from the magazine that helps global leaders stay ahead with insight on the people, companies, and trends shaping today's complex economy. Plus global business, finance and tech news as it happens. The Bloomberg Business Week Daily Podcast with Carol Masser and Tim Steneveek on Bloomberg Radio.
We're here at Boston Children, so we're going to come back to some conversations in just a moment, but we also want to touch on a story that's so relatable to many of the institutions here in Boston and really I feel like around the country anything that's focused on healthcare, medicine and biotech.
Team business leaders, investors and academics of cheered Massachusetts Governor Mara Healey's efforts to counter the Trump Administration's research funding cuts with state money, so much so that a meeting earlier in the fall on the initiative required overflow seating with more on the goal and where it sits right now and whether this could actually be applied to other states too. We are in Boston right now and we have joined We're joined by Greg Ryan, he's Bloomberg News
Boston Money and Power reporter. He joins us on site here at Boston Children's So you wrote about this last month. The hope here that state funding could offset some of the federal funding. Where does it stand right now?
It's still in limbo. So the governor proposed this over the summer. She proposed four hundred million dollars to backfill some of the Trump cuts. But lawmakers on Beacon Hill here in Boston have been skeptical. They say, there's the state has a lot of need right now. Yes, this is usually important, the scientific research funding, but you know it cuts with snap. There was a hearing on the bill that took place in the middle of the shutdown.
They said there's a lot of need and they're not sure how much money they should be devoting to this right now.
Well that's interesting, all right, So take a step back. Tell us what Governor Hewley, what her proposal is.
Sure, So she's she wants to take four d million dollars in state funding, apply half of it to public universities and public institutions to help them with their scientific research funding, you know, help them with the cuts that they've experienced because of what's happened in DC. And then the other half of the money goes to private institutions, so places like Harvard, Boston University, MIT, as well as hospitals like Boston Children's.
So where in terms of of like offsetting the cuts, would that cover one of what has been cut?
It would not know, it wouldn't wouldn't really even come close. You know, hundreds of millions this year of loan just in nah funding cuts. But the part of the the purpose here and something the governor says a lot is this sends a signal, this says sends she puts in. Massachusetts backs these efforts. It sends a signals to scientists just you know, stay here and do their research here.
Well, that's what I wanted to talk about. And then you know, we think a lot about funding and the context of Okay, well, if it's going to research, that research will then ultimately potentially provide some sort of cure or treatment or something. You know, it's an investment in the future. But it's bigger than that. I think it
has to do with a local economy. It has to do with a you know, if we're sitting in Boston right now, I mean this is an area of the country that's known for having biotech research, so some of it goes into the private sector. Then ultimately that money is used to pay people for the research. That money is then spent in the local economy. So they are knock on effects. They are repercussions of this pullback absolutely.
I mean eds and meds is it's known around here. Hospitals and universities are a huge part of the economy when other parts of the country are in recession. It doesn't make our economy recession proof, but it really makes it resilient, and it has over the years. But those sectors are experiencing threats, really unprecedented threats right now based
on the funding environment. So that money, yes, it goes to life save potentially life saving research, but it also you know, it keeps jobs in the state, and it has other economic activity as you mentioned.
Well, the other thing that everybody's so fearful of is, right, a brain drain essentially, right, So people are like, okay, well the funding isn't here. That's such a big part of the medical community. I mean, you know doctors, I've got doctors in the family. Like it's just that's a big part of what they do, and if the funding isn't here and the R and D isn't here, they
may go elsewhere. I mean, this has been a concern about even you know, scientists and you know medical officials and so and so forth, even leaving the United States, right in terms of the money not being here.
Yeah, I've talked to hospital executives in Massachusetts and they say countries like China, institutions and Europe, they're actively recruiting researchers because they know they face a lot of uncertainty here and they think they have a persuasive case to bring them over.
Greg, I want to go back to what Governor Healy has wanted to do because what's interesting is, and you know, this is certainly part of the Bloomberg world for decades, this idea of public private partnerships. It was not only just public money, right, it was also involving private money to help in her mission.
That's right.
So the legislation was set up a fund that would bring in private philanthropic dollars to supplement the public dollars and the idea of being there's a lot of energy around supporting these institutions during this time, and so having a central funnel to bring in all that money and put it where it needs to go.
So what's the next step? What are we waiting? We talked about this meeting where it was like no seats, everybody was there. So where does it go or what's next?
So it's up to the legislature.
They had their initial hearing on the bill a few weeks ago, so the next few months will be key. I'm sure they'll be There'll be more hearings and I think ultimately sometime next year, while makers will decide whether this will pass and how much money they wanted to vote to this effort.
Hey, well we have you. There's something else we want to talk about, and it actually is related to what's going on when it comes to funding. It's the Millionaire's tax and.
Knew you were going to go there. It's a story we were obsessed with when it came across the bloem.
Well it was actually we spoke yesterday with Vanessa Williamson, who's a senior fellow and Government Studies at the Brookings Institutions. She got this new book out that's about taxes, and she mentioned the story and we knew it because we had talked about your story on air a few weeks ago. There's a tax of the ultra wealthy that Zorroon Mamdani, the Democratic mayor elect of New York likes. It's kind of being tested here, and the test here revealed that it didn't make people flee the state.
What are the details so far, I should say, yes, So this millionaire's tax, it's a four percent star tax on income over a million dollars. It went into effect in twenty twenty three, and in the past two years it's brought in five point seven million dollars, which is three billion dollars more than whailemakers had budgeted for. So that's paid for everything from free meals at schools for kids to it's the budget gap at the NBTA, the
local transit authority. It's coming quite handy during this time. But you know, I've spoken to executives and business leaders who warn, yes, it's bringing me in a lot of revenue now, but they still believe. You know, the longer this tax is in place, the more people are going to move away.
And you know, again it was just important, Maye. It doesn't attract people to the state or people are.
That movie that too, that too, but just having just gone into effect a few years ago. You know, people myself, kids in high school, they're going to wait till their kids are out of school to move. So the data isn't in yet to see how it's affecting migration in and out of Massachusetts. But in terms of revenue, it's been a success story so far.
I got to say, I feel like people go where the jobs are ultimately and kind of deal with everything else. And if it's a good economy, is strong economy, there's great jobs, they're going to go there. Just got about a minute or so, or just forty five seconds before we go great. How would you describe you know, we are constantly trying to figure out the economic outlook. How is it feeling in Boston? What's the mood, what's the sentiment?
You know, things are a little people are little pessimistic right now, to be honest with you, such as as Taxpayers Foundation just came out with a report that the state was dead last in job growth for private job grop over the past year. At the same time, you know, we have Harvard, we have MIT, we have institutions like this that the fundamentals are great but you know, the economy is struggling.
A bit at the moment.
All right, interesting to know, med and ed, meds and eds, meds and eds. I'm going to remember that. So glad we could catch up with you. Thanks for joining us here too at Boston Children's Bloomberg News, Boston Money and Power port of Greg Ryan.
Stay with us. More from Bloomberg Business Week Daily coming up after this.
You're listening to the Bloomberg Business Weekdaily podcast. Catch us live weekday afternoons from two to five pm Eastern Listen on Apple CarPlay and Android Auto with the Bloomberg Business app, or watch us live on YouTube.
And I've got to say, one of the most rewarding aspects of what we do here at Bloomberg Business Week Daily is when we get to actually come out of the office and go to different places, step out of the studio, dive into another world. We are so entrenched when it comes to Wall Street, Main Street, Washington Money and markets, how it exchanges with everything, but it's also a great reminder that there's just so much going on around the world that certainly affects people across the country,
across the world. And also there's always an investment or a money played into it. Let's kick off our coverage. We are at Boston Children's. It is the world's largest pediatric research enterprise. It is the leading recipient of pediatric research funding from the National Institutes of Health. It is a primary pediatric teaching hospital for Harvard Medical School. Treats more children with rare diseases and complex conditions than any other hospital. Delighted to kick off our coverage here on
this Friday with doctor Joan La Rovair. She a senior vice president Interim Chief Medical Officer at Boston children She's also co founder and president of the NGO, the Virtue Foundation, which when we talked to her last time, we reminded you all that it's delivering healthcare and over twenty five countries, so global. Doctor Lea Rivera, it's so nice to have you here. Last time you came to our home. Now we came to your home. Thank you, Thank you so much for having us.
We're so happy to have you here with us.
It's really delighted, and you know, we are delighted to be here. Like we walk in and you feel something. And anybody who's had a kid in a hospital or visited a young one. It's tough, and I'm sitting in this space. Tell us where we are, because anyone kids have to deal with things. It's tough, and it sounds like this is a place that just makes it maybe a little easier.
That's exactly what this place is designed for. We're in the hail roof garden on the tenth floor of the home building. The cardiac I See You that I work in is two and three floors below us, because we covered two floors our cardiac I See You. And we need spaces like this for families to be able to step away and really, you know, think and decompress, and for staff. You know, these are very challenging, complex patients
that we're taken care of in this building. Our neonatal intensive care unit is here, or Cardiac I See You is here. We have operating rooms in this building. You know, there's a lot of the cap labs are here. So it's wonderful that we can have these magical spaces where you can just feel that you're in a pedi after hospital and there's a place to relax and think.
Can I just say it's like you're sitting on a tree, like a tree bench there's like, I don't know, is this a rainbow. It feels like above us. It's pretty it's pretty cool, you know.
Carol mentioned the energy that we feel when we walk into a space such as Boston Children's and we're reminded that it's not just a teaching hospital, a research hospital. It's also a place that treats kids from really all over the world. And I'm wondering how you prioritize where resources go, whether it goes to treating patients right now versus thinking about research, thinking about development, thinking about ways to actually help patients in the future, versus working with
them right now. How do you allocate those resources?
Well, that has always been part of the DNA of Boston Children's Hospital. It's been our mission. We deliver the highest, best quality clinical care. Really, that is the foundation of it all. And you see that, you know, the motto of where the world comes for answers. There's a lot of complex patients from the Boston area of Massachusetts, New England. Obviously, we provide primary services for all levels of care for
children in this community. However, there are many from across the United States and across the world who really seek that type of care and come to us usually the most complex cases, and I think that's really where we thrive. And the other piece of our DNA is the science we as you talked in the beginning.
That makes a difference, right when there's science involved. I feel like it's practitionally, yes, you're dealing with patients, but it's people who are like, I want to understand how this works.
That's everybody here. Yeah, that's the doctors, that's the nurses, that's the social workers, that's the physical therapists, that's the respiratory therapist, it's the pharmacist. I just could keep going. So I think that's what's what draws people to work here and to stay here, because that purpose that we're gonna actually change things and we're going to be able
to find newer ways of doing things. We're going to help more children survive but also thrive, and that takes a real concerted effort, and you need the science here with the.
Clinical One of the things I think when you joined Tim and I back in New York and listen, everybody's talking about AI and I know that, but I think we all are thinking about what it could do for medicine and R and D and innovation. And I guess what we're trying to understand too, is what's the reality of what AI is used within the medical community or
R and D specifically, like where is it today? And you, as someone who understands this space so well, and I'm curious the conversations you guys have, where do you think it could go? Well?
AI has been a very important part of Boston Children's Hospital for a long time. This isn't something new. We have incredible research groups and an incredible innovation team here who've been really standing up AI initiatives for a very long time. We talked about some of the work I personally have done in terms of you know, Virtue Foundation and the Global Health AI mapping and being able to match resource and need.
You work with Yeah, firms that are like specifically in AI.
Yes, with theater brigs and data robac I you were building those real platforms that people can use. But I think about for example, when Chat GPT first came out, we had Boston GPT immediately we were looking to get that behind our firewalls. How can we integrate that, How can we use that for real purpose and improve both the care that we get to patients, But how can
we use AI to also discover new things. I think the levels of data that we have, and I think you talked upon in the beginning in terms of rare diseases, genetic diseases, we are the epicenter of that, and we've already been extremely successful in bringing new therapies to market for children. But when I look at the infrastructure that we're building, and I think you've had doctor Wendy Chung come and speak and she's heading up a lot.
Of that work.
I think her best days are ahead of us, and AI is unlocking that type of potential.
I like hearing that the optimism about our best days being ahead of us. And I think about, just even during your career, how much treatments have changed and in a pretty short time. I'm curious about the connection between kids and adults and treating children. And of course, if kids are healthy, then they turn into healthy adults. But this is a children's hospital that does a lot of search,
it does a lot of teaching. Also, are there learnings that can be taken from what works with kids and even applied to a larger population as not just those kids grow up, but as adults also need treatment.
I think there's two points that strike me there. One is that the decisions they were making early in life have long term impact. It's something I've thought about my entire career in the cardiac space and cardiac intensive care. The decisions to have surgery on day two or day four, the decisions to use this drug or that drug, all of those things are shaping your long term self. But it was very hard to be able to look at and analyze that type of data until you've opened up
big data AI. So I think again along the lines of our best days are ahead of us, that we're going to be able to see so much more through that. And then you said the innovations. Now many patients that I took care of are adults. We have this huge growing adult population that we provide care for. Science is that's discovered here. It's in a pediatric hospital, but it's
bringing forth therapies they're actually treating adults. So I think it's it's incredible to see how this innovation engine drives so much.
If you could change one thing, just got about thirty seconds. If you could change one thing in terms of the work that you guys are doing and the r and d that would maybe make it easier. What would it be.
Make it easier?
Okay, back word, if you could change one thing though, that would help you guys and what you're working on. It sounds like you don't need it. Sounds like you've got a great team, and we have.
A great team, but we're always needing, you know, support and engagement and we're just trying to drive the next level and partnerships to move in that direction. We are the leading children's ass but also we're doing well, but we're always trying to push the envelope of what we can do.
Yeah, it's fascinating. You could feel it. I felt, you know, like walking in.
You can write the purpose.
It was busy, it was lots of families, lots of kids, and yeah, everybody on a mission.
It's a privilege to be part of that mission.
Well, thank you so much, thank you, thank you for inviting us, and good to get some more time with you. Doctor Joan la Rovere. She is an interim Chief Medical Officer at Boston Children's Hospital, Director of Innovation and Outcomes. So delighted to talk with you.
This is the Bloomberg Business Week Daily Podcast. Listen live each weekday starting at two pm Eastern on Apple car Play and Android Auto with the Bloomberg Business app. You can also listen live on Amazon Alexa from our flagship New York station Just Say Alexa played Bloomberg eleven thirty.
We want to.
Continue from Boston Children's and with us now is doctor Lissa Baird. She's director of Neurosurgical Oncology and co director of the Brain Tumor Center at Boston Children's Hospital, joining us here. I keep saying welcome, thank you, but I realized thank you for bringing us here. Great to have you here. Tell us about your world, like what is it that you're dealing with on a regular basis, on a daily basis.
Well, thanks for having me. I take care of kids that have branch tumers and it's all ages. All ages, yeah, from infants to really young adults, but all through childhood and work with a phenomenal team here requires a huge team to take care of these kids. They're very complex diseases and we work on all aspects of them, so active treatment. We do a lot of scientific research, we
run clinical trials. We really support these kids not only through their therapeutic journal journey, but through survivorship and surveillance afterwards. So it's a long journey for them and we really try to support them at every stage.
How are clinical trials involving children different than clinical trials involving other age populations.
Well, cancer in children is very very different. The diseases are different, the implications are different, especially with brain tumors.
Why is that? Is it development because of where the brain is or what?
Partially? I mean we're dealing with patients that have developing brains. I mean there are very different implications for that. But also the diagnoses vary quite a bit. You know, the common diseases we see in childhood brain cancer are very very different than that in adult cancer, and they require different treatments and the support and you know, network needs
to be different. We have to support these kids through developmental stages, through hormonal development, through cognitive development, emotional development. You know, the family needs are different, and you know, the diseases require very specific therapies. One thing historically that has happened is because pediatric cancer has not been as well supported. Historically, we have had to extrapolate data and treatments from the adult world and it just doesn't.
Work, you know, I have a good friend and the same thing. Her son went through it and unfortunately it didn't work out well. But when she started doing research, she realized it's just no money, no funding. And they actually started a foundation to kind of but selling kids, selling cookies and like, just to try and drum up
money and interest and attention. And we talk about it with women that R and D like you just don't see it as much and it's getting solely better, but with kids, why is it that it's lagged in terms of time and money and effort, not here obviously, but elsewhere.
Yeah, I mean, we definitely rely on philanthropy hugely to make advancements in the field. But I think you know, historically the numbers are lower. The financial support from government has been different. It follows volume, as does industry. You know, there's a complex, you know, complex reasons for that. But yeah, there needs to be a shift and focus and more attention on specific pediatric treatments.
We are talking a lot about treatments and it makes me wonder about if we understand what causes this stuff in the first place. And certainly treatments in recent years have gotten so much better. In gene therapy, has gotten better, but I'm wondering if we have an understanding in the medical community about why some kids get sick and why some don't.
Yeah, there have been huge advancements in pediatric brain tumors. It's really one of the most exciting fields right now because of how many things have really moved forward in the field. And so we know so much more about the biology of these tumors and the genetic underpinnings to them, and can really drill down with each individual tumor to find out what the molecular change has been in the
cells that is driving tumor growth. And that's really helped us understand them and opened up a whole new field of individual treatments. And so, you know, every tumor is different. In some tumors, we've discovered that there may be a cell of origin that the child is born with a lot of tumors. We don't understand why some kids are
getting them and some don't. Some may have familial implications and some may have environmental We don't understand everything, but we're learning more and more every day, and we know so much more about the individual genetics of the tumor.
Could we get to a point within our lifetimes where there is some sort of screening for kids when they're born or in their early days that helps identify what they could be susceptible too, and then we could allow for different different treatments ahead of that to prevent it actually from happening.
Definitely, I think so. And it may not be for every tumor, but I think we're already getting close to that for certain diagnoses where we know specific things that you know, we can potentially screen for, and we're finding certain you know, germline mutation that are you know, familial hereditary. So yeah, I think we may get to that point where we're screening is better for all tumors, but we're very close for certain types of tumors.
Is there differences in boys and girls when it comes to either tumors or what impacts.
For some Yeah, for some diagnoses and some have you know, greater percentages with boys and some with girls. It really just depends on the diagnosis and many many it's equivalent.
I am also curious about, like you guys seem to certainly take a family approach, and you have to when it's kids, Like what's involved when you've got specific therapies and it's not it's leading to the surgery or whatever the treatment is.
In now, the treatment of these kids takes a village. We have a huge multidisciplinary team. I mean we have neurosurgeons, neurooncologists, neurologists, the neuropathologists, geneticists, neurediologists, and we also have you know, the rehabilitation experts with physical occupational therapy, the neuropsychologists and endochronologists.
I mean, there are so many different expertise, you know, fields that are required to take care of these kids because brain tumors really affect every single aspect of their life and have the potential to affect every aspect of their physical and neurodevelopment. And so you know, we are really fortunate here to have so much expertise that we're able to really individualize the team needed for each specific child.
Thank you so much. This is heavy stuff. Thank you so much. Really appreciate it. Doctor Lisabaert, director of Neurosurgical on College and co director of the Brain Tumor Center at Boston Children's Hospital. This is Bloomberg.
Stay with us. More from Bloomberg Business Week Daily coming up after this.
You're listening to the Bloomberg Business Weekdaily Podcast. Catch us live weekday afternoons from two to five pm Eastern. Listen on Apple CarPlay and Android Auto with the Bloomberg Business app, or watch us live on YouTube.
Well, let's get back to our depth look and conversations about the work that's being done at Boston Children's Hospital. That's where Carol and I are this afternoon. We kick off this hour with doctor Ellen Grant. She's Director of Fetal Neonatal Neuroimaging and Developmental Science here at Boston Children's Hospital.
Here she leads a seventy person neuroimaging and computational science center that's working to develop tools to better detect and understand brain physiology and development, all with the goal to improve cognitive, behavioral, and neurological outcomes, not just in fetuses, but in infants and toddlers and then of course ultimately as they get older. Doctor Grant joins us on site here at Boston Children's Hospital. Doctor Grant, welcome, How are you very good?
Thank you thanks so much for having me.
Thanks for joining us. Brain imaging and children. If we have a better understanding of the brain and fetal development and for babies and toddlers. What will that allow us to understand, what does it prevent, what does it treat?
Well, everything begins in uterul pretty much, so your life is an arc from infancy or one you're conceived through to adulthoods. So the more we can understand the early development, the more we can start to understand how we make sure children are on their trajectory. So the goal is to characterize brain development very early on, so we tell the very earliest point when to start to deviate from a normal trajectory, so we can get things back on
track early as possible. And ideally we want in future to be able to prevent diseases from happening, not just try to you know, deal with them and try to correct them later on when the damage is partly done.
So how early can we do it today and detect that there's something wrong? How early, realistically do you think we can get it to?
Yeah, we start looking at fetuses at about eleven fifteen weeks something around there at the earliest, right closer to around eighteen weeks. We start to characterize brain development, you know, eighteen nineteen weeks or so, So it begins quite early when we start to see and look at early brain development.
Well, you and your team did a study a few years ago that gave your results to argue for earlier MRI during pregnancy. Yeah, is that study enough to actually change the standard of care?
Well, we do use.
It early here at Boston Children, So when there's an indication, we do it as early as we can to better characterize the entire fetus. Because it's not just the brain, it's the body it's attached to too, So we want to understand not just the brain development, how that brain is developing the context of the other organ systems.
So we can do because it doesn't necessarily run hand in hand, like, it can be very different, right or like in terms of what's going on with brain development versus the rest of the system, they can disconnect.
No, they're intimately connected in life.
So if there's one, yeah, so that's why we want to understand it.
So the same For example, we deal with a lot of congenital heart disease here that has effects from brain development. We deal with congenital dive fromatic hernius that has effects on brain development. So everything is happening in the fetus, whether there's a brain or not. Is it has the potential to have subtle effects on brain development.
Why do kids, I mean kids do need specialized tools for brain imaging to ask us about that one.
Yeah, that's the whole reason that it came to Boston Children's is industries not interested in fetuses and pints and young children, so it's really hard to get devices that are built specifically for these age range.
So that's why I brought a team of technical people.
So they're engineers, physicists, computer scientists, data scientists that help to either develop the devices or come up with better ways to analyze the data that we get with an ion trying to understand pediactors ectric disorders. So for example, we want to monitor and we're developing optical devices for the nick you to monitor s freeble bloodflow. But the heart of a heart rate of a neonate is one hundred and fifty, so we have to sample at a much higher rate than you would in an adult to
get the same information. So we have to build specifically devices to the physiology. And then I can think of ahead of a premature baby. It's very very small, so I can't take a probe that we use in adults and just put it on a pre term, so we have to develop the devices to fit the size of the infants.
I want to just go And I feel like we touched on this earlier. I mean we are Bloomberg Business Week. We are Bloomberg and very entrenched in financial markets. And I feel like the more I've been doing this, money just follows everything. Money is why people do things or don't do things. Is that really it is just the market I hate to even make it that way. The market size and so you don't have medical equipment companies building the things because they just don't think the market
size is big enough. That is a big problem. Yeah, and I.
Think it's that's where we're trying to get into more of a business perspective. Like if we start to do a small startup that starts to answer those questions and a bigger company might buy it. But if we stay in the research realm, then it's sometimes really hard to go that last mile and get something into clinical practice.
So how do you do that? How do you cross that? So what do you do?
Yeah, this is what we're strategy strategizing on right now, is trying to figure out how we do those small startups get industry interested if and a lot of things
we're doing right now. Actually, one of the projects we're working on is you know, AI strategies, right, and if we can get enough data on infants or fetuses and so on, we can start to build models that predict not just group outcomes, but we want to get to individual outcomes because that's what parents care about, right, So if we can figure out get those models together.
So that's what we're working on now, is trying.
To create these AI models that are specialized for pediatrics and hoping to do startups around that particular concept.
I have to ask one more quesident. Are venture capitalists interested?
I don't know because we haven't really talked about me that I've heard about, but I think they always want something that's almost ready.
So we're hoping to go further along. Yeah, a little bit further along. Okay. Interesting?
Can what we learn and what you understand through imaging about the brains development be applied to how adult brains are treated.
Everything in adult life has its genesis in infants, right.
So we learn we're all there once.
Yeah, yeah, exactly, and some of the ways that adult brain response is more prominent in a pediatric brain, so in some disorders to go to pediatric models to see a physiologist. More prominent in neonates or infants, but also occurs in adults.
You know, there was a in doing the research. In the prep for our interview with you, there is a picture of a physician or a therapist doing some what's I think is called therapeutic hypothermia too a brand new baby's head. Yes, and my understanding is that oxygen deprivation around birth is one of the leading reasons that you actually see babies come into the Nike You.
Yes, that is one of the main reasons. Yes.
And the therapy for this is as simple as.
Yeah, you cool them down or down there.
The normal yeah, at least abnormal thermic is when they have injuries. A response to that sort of the whole physiological response to an injury is to have a fever, and that is detrimental. So we want to keep them cool so that they don't set off these cascades of brain injury. And that's partly why we build this one device, because we want to be able to monitor through the
nick you stay and optimize management. But it's interesting, we don't even know what the great blood pressure for a newborn is So this is why we wanted to have a probe that could measures rebel blood flow to the brain because there is no way to monitor whether there's enough brain or sit and getting to the brain with the tools that we have right now.
I feel like we don't even talk about blood pressure when it comes to like infants, right, Yeah, we just don't. But you need to know. You did your residency and fellowship in the nineteen nineties. Curious how imaging has changed since then, and then where do you think how will it improve in the next I don't know, ten years. You know what's a smart benchmark?
Yeah?
Yeah, I know.
When I was in training, NTMAR was just starting and it was very slow. So where we come now is the acceleration acquisition is just incredible. What used to take us an hour to do we can do in ten minutes now, So there was creed.
The speed of acquisition is huge.
Were also developing a lot of analysis that we can do after the images are acquired to give us more quantitative metrics, because the whole thing in medicine to get past the qualitative read of a radiologist, which is helpful, but we want to put more numbers on it, so we can have a more dynamic range on how we describe each child and this therefore we can get into
better precision medicine and open prediction. So we're getting more to that quantitative aspect of imaging now, and not just brain but all body parts of course, and you know, down to feudel age.
Is it for kids to every case is very personal and individual? Or are there trends and things that you can help and so that one case can help another. Is there a body of knowledge that gets built off of this?
Yes, there's body that of knowledge gets built off of this. But this is where we come back to AI. I only can remember so much, you know, even though I've been in practice for a long time.
Things follow up crap.
So this is where I'm really excited about AI because I can, you know, minor databases to find where's an individual child just like that one I'm treated. Now, what did they respond to, what worked for them? And how are these two similar? So I can mind the databases to start to come up with individual outcome prediction, which is what we're doing right now.
With databases.
We've got some from some of the major trials for hypothermia, and so we can use this large database to start try to take individual outcomes. You can say, well, I have a newborn with this pH that had these, you know, and I'm a mother of this age, and put in features and they could give you from that database and
outcome prediction. So working on that and also working on making data more available to parents, because I think a lot of parents are very frustrated with trying to read the literature, even if you're using chat, GPT or overly hards, it's really hard. And then you get group statistics and then where does my kid fit in between the twenty five to seventy five percent you know, good outcome or
something like that. To get chatbots that can work with some of our databases, so people anybody can talk to, you know, a physician, so to speak, to give the answers that they want.
That's that's pretty remarkable because you know, I just think about the tone of these chatbots and if there's a way that they can be you know, we talked about, we talked earlier this week about what a challenge it can be for people to actually interact with them in an quote unquote normal way. But is there a way for them to actually be empathetic and work with patients, work with parents and with families.
If you give us we've got about forty second.
Yeah, yeah, no, we're working on that, but I can't tell you all the secrets because we're.
Going to hang. No, you go all over the bath. Can I ask you, when you guys do use AI in cha? Do you have hallucinations? Like do the AI hallucinations?
Do you?
Or how do you? Especially when you're dealing with medical permission.
There's a lot of safeguards who put around that, so it's it's we have again. This is sort of more the secret sauce that I can't talk about yet, But there are ways to constrain chatbots to give you reasonable answers that are statistically sound. All right, so when you can when you come back, yes, it will okay, good stuff.
So appreciate. Doctor Ellen Grant, director of Fetal Neonatal, Neuroimaging and Developmental Sciences here at Boston Children's Hospital, Thank you again.
You are listening to the Bloomberg Business Weekdaily Podcast. Catch us live weekday afternoons from two to five pm Eastern Listen on Apple CarPlay and Android Auto with the Bloomberg Business App or watch us live on YouTube.
We are live from Boston Children's Hospital, where we're speaking with some of the nations leading doctors on matters related to health, health policy, innovation, medical care, and everything that has to do with health. Carol, A fixture at my high school in college was torn acls volleyball, lacrosse, soccer, field hockey. A torn ACL, surgery to reconstruct it, then weeks on crutches, months of recovery, and oftentimes it was girls, not boys who tore their ACL, which.
I find interesting. I guess I would have thought it was the other way around.
Girls and women's women tear their acls at a higher rate than men and boys. This is doctor Martha Murray's world. She's orthopedic surgeon in chief for Boston Children's Hospital. She joins us here into Boston where we are at Boston Children's Hospital. Doctor Murray, welcome, how are you.
I'm good? Thank you so much for having sta.
So you've got this background in material science and engineering, it's not typical for a surgeon. We're going to talk about your innovation and ACL surgery in just a minute. But on the boys versus girls, men versus women. Why do ACL tears affect women more than men.
Well, it's a really interesting question and it's been one of much debate for the last few decades, and there have been things like, well, it must be a hormone cycle, or it's the shape of women's hips and their valgus
angles to their knees. But a really interesting study came out very recently from the Harvard School of Public Health as well as Harvard University with doctor Danielson and doctor Richardson, where they actually showed that the studies that say that women tear their acl more frequently than men were often based when the women's teams were smaller than the men's teams, and the way they calculated exposures was the number of practices or games you played in, not necessarily your playing time.
So if you're a man who's on a hockey team versus a woman who's on a hockey team, the women's teams were smaller, so those women were playing more, so they were planting hockey.
It's a bad example.
Soccer would be better, but if the team is smaller, the women are going to be planting and pivoting and playing much more time per game or practice.
So more stress, more stress, more use, more tears.
So maybe it's not maybe women in all things equal, maybe women and men don't have a different rate of torn.
Acl correct when when they corrected for unit of exposure. So kind of game time playing rather than just a game, the injury rates look very similar.
Wow, that's totally different than what's I mean, do you is that? Do you is this the standard? Now? I mean do you think this is?
It's relatively new work that's coming out, but it resonates with most of us who take care of women and men on their on their athletic teams.
Yeah, I want to ask about your background material science and engineering. I know Tim said it not typical for a surgeon, but I think it's it's a really smart combination. Well, I have a doctor, a foot doctor, same thing engineering, and like he doesn't just dealing with my foot, he thinks about, Okay, what are you doing? What else is going on in your body? Tell me about that mix and why it's kind of unique and smart and ties things together.
Well, for me, it was a it was actually a necessity.
Right.
So I was an engineering graduate student and a friend of mine came into a party one night and on as Tim was saying and who had torn his ACL? And I said, oh, are they going to go sew it back together? And he was a med student. He was like, you, stupid engineer, we can't sew it back together. You have to take it out and replace it with the graft of tenant that they're going to take from the back of my leg. And then it's all this rehab. And I thought that seems kind of excessive, right, Like
that's a lot to have to go through. And so I spent the next six months or so in the medical school library just reading everything I could about why didn't the ACL heal? And I realized nobody really had figured out why it didn't. You know, they tried it sewing back together didn't work. So then went to grafts, and we've been doing graphs for fifty years and nobody
really asked why doesn't it heal? And so for me then there was no biomedical engineering at that time, and so my choices were to continue on with my project, which was developing airplane wings that were invisible to you know, to radar, and I thought, well, that's a really cool project, but I really want to figure out this ACL thing. And my advisor was like, well, I guess you could go to medical school.
This is a net like serious and then so okay, Well, the advisor obviously had an impact in her friend obviously had an impact. But fast forward, you know, thirty years plus and you have actually invented a new way to treat ACL tears, the bear method. You did figure out that there's a reason why acls don't heal like an MCL would actually heal.
Why is that, Well, it's really interesting.
So both the medial collateral ligament and the anti a cruciate ligament are ligaments. When you look at them under the microscope, they look very similar. But interestingly, when the MCL tears, you can go on to brace in it about six weeks, that ligament will heal fine in your back playing soccer. In contrast, the ACL, when it tears, even if we try to sew it back together, it doesn't heal. And so we wondered why, and so we did a series of studies where we looked and we
compared the two tissues in their response to injury. And what we found was that actually the response to injury is very similar in the two ligaments. So the tissue and the cells and the tissue were doing exactly what they were supposed to do in both tissues, but the difference was in the MCL. When it tears, the ends bleed and that blood clots in forms what we call a hematoma between the two torn ends of the ligament.
And then in contrast, in the ACL, because it lives in this fluid environment of the joint, the ends bleed, but instead of making a clot or hematoma between the torn ends of the ligament, the blood disperses through the fluid of the joint, and so the two ends never have that scaffolding, that biologic scaffolding to hold them back together.
So once we discovered that, then it was a fairly logical step to say, is there some way we could immobilize the blood in between those two torn ligament ends and get that biologic signal where it needs to be to encourage healing of the ACL. And that's really what bridge enhanced ACL repair or BEAR is. So the magic is kind of the sponge that we've developed that can absorb the patient's blood. You can place that blood laden sponge in between the torn ends of the ACL, so
the ACL back together. But now you have the biology plus the sutures and the repair and the ligament will heal.
So is what is done in terms of numbers or percentage with the method that you pioneered, what you invented, versus actual reconstruction and using other ligaments.
That's a great question. So this is still fairly new. So we got FDA approval for this product in twenty twenty, and so it's only been in practice for a few years now. There's studies coming out of Children's here, which is where we did the first studies, of course, but now other centers are coming along and doing follow on studies and those results are starting to come out, and it's very exciting to watch it grow.
I'm also curious you mentioned but like FDA approval, like the approval process, is it a smart one? Is it the right one in terms of making sure that what's being done and studied, the R and D, that it's safe for when it's finally done on patients, or is it preventing things from maybe putting put into you sooner? Like I'm just curious where you guys weigh in. You're in it, You're in it every day. Yeah, I think it's a delicate balance. But I would say in our
personal experience, the FDAY was an amazing partner. Okay, So we were able to get into an early adoption program where they actually met with us and helped us and put together a panel of experts that would help us figure out how to make this the safest possible product and the most effective product before we went to patients, and we found their advice incredibly valuable. There was a lot of conversation and back and forth and just having them it felt like it was a team effort because
we were in alignment. I mean, as a physician, I was going to be shaking the hands of these patients that my partners were and we wanted to make sure things were as safe as possible, so they helped.
Us with that.
Do we have data yet on long term impact or long term outcomes yet when it comes to the bear procedure.
Yeah, Our longest data that we have is at about six years, and it's only in the small number of patients in those first studies that we did. But the reason that we want to study at longer term is because, as you may know, many of these patients will develop arthritis early in life and as a pediatric orthopedic surgeon. I want to make sure we have a procedure that's going to last my patients for sixty or seventy years, not have the knee breakdown in ten or twenty years.
And so we're very interested in this arthritis question with Bear and in our preclinical studies we were able to see that arthritis was actually much less in the subjects that we treated with an acl repair with the sponge versus a reconstruction. So we're interested in seeing if that same thing plays out in patients. Early day to suggest that it will it is true, but again that's very early data on small numbers of patients, so we're excited to see how that pans out.
We're talking with doctor Martha Murray. She's orthopedic surgeon and she for Boston Children's Hospital. That's where we are Tim and me on this Friday. Preventive care, Like, so much of what we talk about often when we're doing interviews is preventive care. And I feel like the whole health community has been thinking about this for a long time.
So what's the preventive care So that as much as we don't want you unemployed, like, how do we think about taking better care if we're living longer, Like, how do we think about this? So there's a couple questions on that. So one is how do we help.
Our teenagers reduce their risk of injury? And I think the main thing for that for our athletes when they're.
In it because we push kids when they're younger. I think a lot of parents really push kids.
So some things we can do to help them is help them work on strengthening in addition to just playtime. And another thing is cross training, So not playing the same sport all year round or playing the same sport every day, giving their body a chance to rest and heal between exposures to sport.
Does it's as simple as that, I think? So, Wow, does acl TAAR happen more in kids than adults? Or and if yes, is it because kids are the ones who are playing sports and you know we're just sitting at computers.
I think that's probably part of it. Again, it gets to this exposure question. How many times do you plant and change direction? And so the peak of a c. Andrews is really the high school athlete because there's so many everybody's playing a sport and so we see a lot of them there.
I want to ask you at social media and all of us sitting on phones, are sitting in front of screens, like I just I keep thinking that we're going to one day. I don't know whether it's fifty years from now we're going to have a neck that basically goes over there or maybe not because we're gonna have glasses on. And that's like, how do you think about this digital world? You're laughing?
But can you surgically remove my phone from my hand? That's what That's what I want.
But I do think about what it's doing to us. Well, look at it, not just on the fixed for you.
I don't know if I can fix the social media.
But physically, like I'm just thinking like how you know kids are in their phones constantly and stuff in like the shape, Like do we need to be thinking about what this is doing onto our spine and different things? I think so.
But I also think things come in cycles, right, And we see now if you walk down the street, you see everybody's on their phone. I think we're going to five years from now, we're going to look at back at that and say why are we doing that? You know, maybe we'll start looking up at the sky more, I hope. So, yeah, that's what I hope too.
Yeah, I mean, gosh, that's like your open air.
I know. I just I look around on the subway and just everybody and I'm just thinking the curvature and I don't know, whatever, what's the next thing you're working on or that you're excited about.
I'm really excited about a product that we're working on for rotator cuff injuries. And it's a product that's injectable, so that potentially it's great. Yeah, you can have ultrasound on your shoulder, see where the tear is, and then inject the product into the tear, maybe in an office visit. So that's what we're working on, but very early days on that.
Again, a challenge with pediatric patients as well.
No, this is more adults. But we were just we thought we could make this work for a ligament, maybe we could try it for the rotator cuff ten And and the nice thing about the rotator cuff is it is accessible by ultrasound and injection and it's a pretty easy model for us to study. If we can make that injectable work then and there's lots of other places we could apply a meniscus other things.
Did you ever figure out the Invisible Airplane wings?
No?
Not too late, well, social media in Visible Airplane Wings ACL wrote that you guys are killing me.
Oh we are glad you ended up going into pediatric orthopedic surgery?
Is there another career like to add on after this? You could do it, You could do it. Welcome, This was so much fun. It was fun. Thank you guys very much, Doctor Martha Murray. She's orthopedic surgeon chief for Boston Children's Hospital.
This is the Bloomberg Business Week Daily podcast, available on Apple, Spotify, and anywhere else you get your podcasts. Listen live weekday afternoons from two to five pm Eastern on Bloomberg dot com, the iHeartRadio app, tune In, and the Bloomberg Business App. You can also watch us live every weekday on YouTube and always on the Bloomberg terminal