Dr Priddy === Daniel: [00:00:00] Well, I'm interested in the cuff links there. I assume that has to do with Oh yes. The conversation we were just Vince: having. Well, that's part of, that's part of practice protocol. If you refer to, um, do you wanna be Matt or Matthew? Matt, please. Okay. , Matt: Matt, or, Vince: uh, their ceo. Joe. It's. Cufflings Matt: Cuff. Sure. Yeah. Well, yeah, so I mean, this is the, the last time I drove, uh, my car, one of my cars with the stick shift to the, to any restaurant notice. Okay, gotcha. It was, uh, you, nobody can, no valet knows how to drive a stick shift anymore and Ooh. Anything like that. Interesting. I always have to ask them and they almost always look at you and they go, no, no, sir Deer the headline. Just tell me where you want me to put the car. Yeah. Right. Yeah. So interesting. Vince: That makes me wanna teach one of my kids how to learn. Oh yeah. How to drive a stick shift. But then I gotta find a stick shift Matt: to, well, their Volkswagen golf is still available in the stick shift. Great little car. Not expensive. Right. And you know, I mean, the best way to make sure that your kid never has to [00:01:00] lend their car to another kid is to get 'em a stick shift. That's a good's a good one. Good point. Yeah. Yeah. And nobody, and like, who's gonna steal it? They can't drive it. . Yeah. Can't be. That's a nurse. It's millennial anti-theft device. . They should remarket it no longer as a manual. That's right, that's right. Antitheft, millennial Antitheft device. You know, if you're under the age of 35, you, you probably, there's a 5% chance you can drive this car. Yeah. Vince: And only one of us at this table is in that age group. I can drive a Daniel: stick shift, so yeah. Oh, you can, I can. Oh, there you go. Yeah. Good for you. How, how'd your head of the curve? So, uh, learned on my, one of my dad's cars. . Um, but that was not an enjoyable experience, learning experience driving a car that he cherished and learning how to drive a stick shift. So I, I got good enough to where I could get home if it to, if something were to happen. Um, but then it annoyed me enough that I didn't know how to do it. So I bought an older BMW and, uh, kind of worked on it and learned how to drive stick, then owned to Mini Cooper for a little [00:02:00] bit. And then, ah, mini Coopers. Um, now, can now It's like riding a bike. Yeah. I don't own one. I don't Matt: Yeah, but it comes back to you though. It is. Yeah. I got a job at Dan Young Chevrolet when I was 16 years old on the service drive and, uh, I didn't know how to drive a stick, so I had like a week to learn because I didn't wanna like burn out, you know, in a Corvette. Yeah. In front of the owner. So I was like, I gotta, I gotta get home and I gotta let my mom had like a little Honda of Prelude and I learned on that real quick. Right. So that's a good car. I was highly motivated to learn , right? Yeah. Well, Vince: so I didn't want to, you didn't ruin any clutches, right? Matt: No. Not that you're aware of. No. Well, there it was flat. Right. You know, the clutch ruining is always on the hill, you know? True. Well, he was working Daniel: at a service center. You were just creating more business. That's right. That's, Matt: that's a good point, right, . Anyway. Is this thing on?[00:03:00] Vince: Hey guys, welcome back to another episode of the Summits podcast. Thank you for joining us from wherever you guys get your podcast, or if you're watching us on the Heroes Foundation YouTube channel. Thank you for doing so. Um, don't forget, hit that little subscription button and a little notification belt so you can be alerted with new episodes like this one. If you haven't already done so, it's free of charge. So we highly recommend, uh, today, uh, good friend of ours, Dr. Matt Purdy from Priority Physicians is joining. Matt, welcome to the podcast. Thanks for having me, guys. Appreciate it. You're welcome. Yeah. Um, why don't you give our listeners a little Matt: intro? Okay. Well, um, I am a family medicine doc. Uh, I live here in Carmel. Um, and, uh, I've been in practice for 20 years now. This is my 20th year. Yes. Um, and so, um, I. This will be my actually 20th year, uh, of marriage as well. And I've got a five year old daughter [00:04:00] at home. Uh, and, um, yeah, we, we, um, we've got a, a, I would consider a fairly successful practice. There's 10, 10 docs in our practice and, um, uh, We practice a little bit more in intense preventative medicine maybe than, than a lot of places do. So, and it's just because the way our practice is set up, we've got, uh, we've got more time to spend with our patients. Right. Yeah. Vince: I can testify to that. Yeah. It's, it's been very Matt: intense. Yeah. Yes, that's exactly right. Um, Vince: what I, one question I wanted to ask you about that is, as that whole industry has evolved and you've seen it evolve over the last, I mean, how long has priority been? Around? 20 years has been, it's been 20 years. Okay. Okay. So you've seen a lot of probably ebbs and flows in that industry over that 20 years. Let me ask you this. What made you decide to go into it and start it? Uh, start this concept Matt: 20 years ago. Well, I mean, I, [00:05:00] self-preservation really, you know, I mean, I, um, it, I, I'd love to say there I have some sort of grand plan, but in residency even then, you know, um, in our clinics we would have a half day, uh, and they'd, they'd have us seeing 12 people, you know, and, and three and a half hours and very, Complicated patients, you know, um, with multiple medical issues. Half of 'em didn't even speak English, so there's a translator in the room. Okay. And, and I thought, I, you know, wow, I, I don't want to do this for the next 35 years. Right. You know, I mean, I, I, I think I'll, I'll burn out. And part of it is, you know, just knowing, uh, that you're not, you're not able to provide the type of care that you could, not because you. Smart, but because you, you're on a time restraint all the time. Mm-hmm. . And so, um, I, I just sort of started looking around and there were a couple practices on each coast, um, that had started doing this a few years before. The first one was in 96 and we opened in 2002, [00:06:00] um, late 2022. Um, but um, but yeah, yeah, I sort. let it be known that this was something I was looking into. And then my partner, Craig Veach, was also gonna be doing that. And, uh, so the two of us got together and, and, and started a practice with no patience, which is a great business model. , highly recommended . Little risky. But, you know, I, I mean, I was right outta residency and so I was used to making 30 grand a year, and I'm like, oh, you know, it doesn't work out. I'm sure somebody will hire me. You know, so I mean, people will say, oh gosh, you know, you must. How ballsy was that? And I'm like, not really. You know, my wife was still in residency and we were, you know, used to living on nothing. Right. So it was, you know, nothing ventured, nothing gained sort of thing. Right. Yeah. Vince: Um, well, things have obviously taken off. I mean, you guys have, have done well over the last several years. Um, when, when you look at where's, where's the practice headed? Um, and, and. My crystal ball is not any better than anybody [00:07:00] else's, but do you see. More location now. You guys are up to two locations now. Yeah. Yeah. Do you see more locations Matt: or, you know, I, I, I don't know. I mean, we're, we just expanded our Carmel location. Um, we are getting ready to build a building out in Fishers and make that one bigger. I think the biggest question is sort of like, what's the, what's the market cap on, uh, on, on a service? This. And you know, if you would've asked me that 20 years ago, I would've thought maybe, you know, there might be a couple hundred, you know, 400 people enough for Craig and I to take care of. Right. And that would be about it. Mm-hmm. . And, you know, I I, I'd like to think a lot of it is us sort of raising the bar on, on providing primary care. I think at the same time the bar is being lowered around us, you know? Um, and, and some of that is older doctors retiring have ha having had enough of, after Covid. Some of that is just, I just heard recent Vince: story, like literally earlier this week of that [00:08:00] exact scenario. Yeah. Matt: You know, like, you know, they've just had it. Um, and um, you know, meanwhile the population is getting older. More and more people are moving to the Indianapolis, you know, metro area. Um, this is not enough primary care doctors and so, you know, if for patients who value, um, you know, the ability to get in at, you know, a reasonable amount of time mm-hmm. and actually talk to their doctor, like the, the, there are other options, but, but. , you know, we sort of hold ourselves out as, you know, the, essentially the pinnacle of what it could be. Yeah. If you, if you did everything to focus on what the patient would want. Sure. Yeah. Um, so I mean, I, I, yeah, we'll probably have some more offices around here. We've had some offers to help other people in other cities and I don't know if we're gonna do that or not, but, right. Um, Yeah. I mean, I, I, I, I don't, I don't see, well, you know, Joe, I don't see Joe and I like saying, well, you know, we're in our late forties, we're done, we're shutting it down, you know, we're not gonna get any bigger and we're just gonna ride off into the sunset for the next 20 years.[00:09:00] Probably not. Right? You're builders. Yeah. It's fun, you know, I mean, what would we do, uh, if we weren't growing the practice? So, right. Yeah. Yeah. Vince: Yeah. Maybe go out and play with cars and do stupid stuff Matt: and . Yeah. Yeah. I mean, I, I, I, we have, we have a good time too, but it, it is, it is sort of, um, you know, I, I think a lot of physicians, um, , you know, doctors are the smartest people in the room always. Right? So ev all doctors think that they're good. We can edit, edit that part out, right? Yeah. Excellent. Daniel: It's Matt: why, it's why like the number one, uh, cause of small airplane crashes or physician pilots, you know, because they're, they're, if you're a neurosurgeon, you must be an awesome pilot too, right? Um, you have to be, but you're just hot. You know? Also, you have to get back for surgery on Monday, so it doesn't matter if it's raining, you're flying. Um, so, you know, I, I, I, I wouldn't hold ourselves out as, as being, uh, the smartest business people, but we have a lot of experience in, in over 20 years that we've sort of, you know, learned the hard way, what does and doesn't work, uh, with this business model. Um, so that's [00:10:00] been, it's been fun, it's been interesting, and we, you know, It's been interesting talking to folks around the country and learning what they're doing and sort of taking snippets of, you know, hey, this guy's doing this really great. Um, bringing it back and integrating into, into our practice. Yeah. Well I, Vince: as a patient, and hopefully I'm not breaking any laws by admitting Matt: No, you can say, I Vince: can't say. Yeah. Um, the things that I value are, are some of the annualized stuff that you do, cuz I mean, let's. , it's up to the person typically to initiate, okay, I need to get my annual physical, or I want to do this, or I wanna do that. The fact that that's just part of your guys' normal annual protocol, I don't wanna say forces it, but in a way it does. It serves as a hell of a reminder. And, you know, as many of our listeners know or followers of the Hero Foundation, like, know my story. And so I think because of that, fortunately we were able to catch some things early and, and which is a good thing of course, in, in, in the cancer world or any other healthcare related issue. Yeah. Um, and can and hopefully address [00:11:00] it ahead of the game and, and. It's gonna have a more successful outcome. So that's one of the things that drove me to you guys. It's one of the things I, it keeps me there and I appreciate just the fact that, um, it's not, not so much the service level, which is obviously very high, but just that, those annualized things that, um, otherwise I don't know if I'd be getting done. Well, Matt: I mean, you know, get, getting one's prostate checked is usually not, you know, high up on, on, on somebody's list of fun things to do on a Thursday. Right. . Um, or getting your colonoscopy, you know, and I, I mean, I, we've got great, um, uh, nurses who work for us and, you know, I mean, literally will, will just bug the crap out of people until they acquiesce and they, they, they, you know, gimme a date. I need a date. You know? Now you're a year past due and there's something, I mean, we've had folks. two years later, they're like, fine, just stop call. I'll get it if you'll stop calling me. You know, resistance. Right? And, and, and, um, and, and so, you know, some of those things, like you said earlier, I mean, I don't care what it [00:12:00] is. If you, you, you catch heart disease, diabetes, early cancer, early, it's always better than catching it late. You know, because there's so much we can do, um, uh, ahead of the game to, to. change in many cases, even with cancer, you know, a stage one cancer is generally treatable with surgery. Yeah. Stage four never is, you know, and so, um, how, how early you catch a cancer or how early you identify somebody who's, you know, gonna be a diabetic in four years if they don't lose weight, um, or going to have a heart attack and, you know, whether it's six months or in five years, um, you know, right there heart. diabetes and, uh, or sorry, heart disease, cancer, and, you know, vascular disease, stroke, top three killers of America. Right? And you know, a lot of people, if you don't have pro prevention as part of your, your, your yearly routine, you [00:13:00] find out about, you know, the heart disease when you drop dead of a heart attack, which. dumb way to find out that you have heart disease. Yeah. Yeah, for sure. Vince: Mm-hmm. , if you were gonna give someone, so I mean, we're you and I are about, about the same age, if not the same age, you're obviously quite a bit younger. Um, you were gonna give some a piece of advice to someone in our age group that whether they're priority, uh, patient or not, what is like the singular biggest piece of advice that you would give to Matt: someone our age? Hmm. Okay. Have a doctor . Yeah. And, and even if you only see them for 10 minutes a year, go in and get your labs tested. Mm-hmm. . Um, because, uh, and so, so get your labs tested by somebody once a year. Um, from a cardiovascular standpoint, uh, if, if you haven't had a heart scan and you don't get one regularly, I would, I would say that, that everyone should get one of those. [00:14:00] Yeah. Um, that's the, the, the single easiest and cheapest. They're like 50 bucks. Way of determining, you know, stratifying your risk for cardiovascular disease. If you're 48 years old and you've got a zero heart. That's what I would expect to see. And that's great. Doesn't mean you don't, couldn't have cardiovascular disease, but if you've got a big honk in calcium score, then then you, your goalposts for your, for your. Labs just got moved big time. You know, and, and you probably need a cardiologist, um, uh, or a primary care doc, you know, who is really into prevention. Yeah. Mm-hmm. , um, I know we did a heart scan. Vince: How often do those aren't done annually? How often are those Matt: typically done? Yeah, I mean, so there, and that's something that's, that's changed for us in the last five years. Um, You know, we used to do heart scans about every three years on everybody starting at 40 for higher risk people, 45 to 50 for lower risk patients. Um, and now the [00:15:00] technology has, has shifted from, from coronary calcium scoring over into, uh, coronary CT angiography. Okay. And the difference there, a heart scan gives you, a score, which is essent, quite literally cubic millimeters of calcified old hard plaque in your heart arteries, which is important to know, but that score just puts you on a, on a. basically a graph and says, Hey Vince, you're at the 50th percentile for guys your age. What it doesn't do is tell us, Hey, you know, you have a X percent blockage. If you do, where is it? Right. Um, and probably most importantly, um, if you have a blockage, is it all old hard plaque and it's just a little narrowed? Or do you, are you, is the process ongoing? Yeah, because I've seen guys our age that have a calcium score of 15, which is really. Uh, and then you get a coronary CT angiogram on 'em. And the reason it's low is cuz most of their plaque [00:16:00] is soft, you know? Okay. Mm-hmm. . And, you know, quite literally, I mean, if you looked at an this stuff on an autopsy, it's, it looks like the fat you'd trim off a chicken, right? Um, uh, it's the same consistency. It's, it's, it's gooey. and that is the stuff when you hear about some guy or gal who's out jogging or shoveling their driveway and they just drop dead. It's not the old hard stuff that that that does that. It's the soft stuff. breaking up, almost like blowing up like a zit into the inside of your artery, and you go from being 20% blocked to a hundred percent blocked mm-hmm. in 30 seconds in your toast. Yeah. And so it's super important to know that. Yeah. And so we use the, the heart scan as sort of an entree, uh, and if it's zero, Um, then yeah, maybe every three, four years. We'll, we'll, we'll repeat the heart scan. It's easy, it's quick. Very low dose radiation if it's anything but zero. Now those patients buy themselves a coronary CT angiogram, at least one. Okay. Um, and if they, if we find out that it's hey from [00:17:00] party and hard when they're 25 and they smoked and they ate like crap. Um, but now they've changed all that and they've just got a little bit of old calcified plaque and that's it. Again, you know, I might not re-scan 'em for 5, 6, 7 years mm-hmm. because I don't care. That's never gonna be a problem. Yeah. Okay. Um, but I've had patients where it looks terrible and we full court press 'em on their cholesterol and their blood sugar and their blood pressure and I bring 'em back in 18 months and repeat their coronary CT angiogram. Okay. Because they've got like a 60% narrowing and it's soft plaque and like if that thing gets goes to 70, they need a stack. Right. . Daniel: Okay. You, you mentioned technology. I know you're an Apple guy. What are your thoughts on like the Apple Watch playing into some of that? It's a great question. And how do you, at Priority physicians, do you, do you pull any of that data in or use it at all? Matt: Well, we do. You know, you do have to be careful with sort of data overload. Yeah. Um, uh, you know, I, I. I have a lot of friends who practice in California, and whenever I'm out there at conferences, you know, everybody wants to sell you like something that aggregates all this [00:18:00] data, you know? And I'm like, look, let me tell you, the last thing I want to do is get up in the morning and look at a computer screen that shows how every single one of my patients slept last night. You know, I don't want to know. Like if you can, if you can have it, send me like the one guy who hasn't slept in three days and I can call him. Great. You know? The Apple watch is really interesting. I mean, we have absolutely caught, not so much from a blockage standpoint, but from a cardiac rhythm standpoint. Okay. It is getting really good at, at telling people, Hey, I. Apple Watch says, I think I'm in atrial fibrillation. And many times it's right. Oh, really? Um, so you, you know, the, um, uh, that's been a, I mean, I think it's fantastic. Yeah. Um, you know, the, uh, um, to have, to have a wearable say, Hey, you know what, you, you should, um, you should go see your doctor because this is abnormal. Or just so you know, in the middle of the night last night. Resting heart rate went up to 140, which is not normal. Um, you know, and this turns out, this patience is going into atrial fibrillation. So, um, you know, in [00:19:00] AFib, especially in patients, some people feel terrible in it, but some people don't know, and those people who don't know are the people that when they go into abnormal rhythm, their hearts, the top part of their heart stops beating. it just quivers. Instead, they form a blood clot in there, it goes back into rhythm and it shoots that blood clot out. And if it, you know, if you're unlucky, it goes to your lungs and you get a pulmonary embolus, or it goes to your brain and you have a stroke. Um, and, uh, oftentimes in the past, uh, you know, we would find out that somebody has atrial fibrillation when they have a stroke. Yeah. Um, if, if they are somebody that doesn't feel bad when they're in AFib. . So, yeah. So yeah, I mean, I think wearables are great for that. Um, and, uh, that, that population, you know, and, you know, obviously there's not a lot of 20 year olds with atrial fibrillation, but man, I've, I've 40, 50, 60 year olds definitely had their Apple watches diagnose that. Yeah. Daniel: That's pretty interesting. Yeah, it's cool. Yeah, [00:20:00] yeah. Matt: Neat stuff. What you're saying is I need to Daniel: get an apple water. Yeah, it's pretty much wonderful. I just keep trying to change his bubbles from green to blue for me , and, uh, so I just needed another point in, in that corner. So thank you. Thank Matt: you. You got it. You got it. Happy to. Well, Matt, you know, um, Vince: our podcast and the Heroes is all about about cancer. What's, uh, what's your cancer story? Matt: So it's not a great one. Um, my, um, uh, When I was a, um, when I was 25, uh, my brother, uh, who was two years younger than me, um, uh, I was in my fourth year of medical school and he was in his second year of medical school. Uh, we lived together, uh, in Broad Ripple and, um, he started having abdominal pain, which is weird, you know, he was a very healthy guy. Um, and, um, Uh, eventually it got bad enough. He went into the emergency room and they did a [00:21:00] CT scan on him, and basically his liver just lit up with a bunch of, uh, what they didn't know what it was. Um, but it didn't look good. Um, and it, um, after they did a surgery, um, essentially an exploratory surgery, uh, it, uh, it was a a t-cell lymphoma. Um, so, uh, he fought that for. About a year, um, uh, got, uh, an autologous bone marrow transplant, um, and, uh, did okay for a little while and then, um, just got worse. Uh, and, and, and died about a year after his initial diagnosis. Um, uh, when, uh, during my, my intern year, uh, uh, of training. So, um, you know, . That is something that was formative for me. You know, I mean, it literally happened, uh, my first year of being an [00:22:00] quote real doctor, if you will. Yeah. Yeah. Um, and, um, you know, uh, It's never great when, when, when somebody gets cancer, obviously. But, but when, when you have a, you know, somebody in their early twenties get cancer and and die that quickly, it, it seems especially tragic, you know? Um, yeah. Somebody, you know, just, just getting ready to be a physician himself. Um, and he would've been a great doc. Um, and, uh, he was a. And, you know, it still makes me sad. It still pisses me off. Mm-hmm. . Um, and, uh, I think that, you know, one of, one of my passions for, for finding things early, finding cancers early, uh, is that we just know we can do so much more for somebody. When we, we find it before their abdomen is chock full of mets. Okay. Now, in a blood cancer, it's different. You know, I'm, I'm happy to say that the, the, the cure rates for the type of cancer that he had are [00:23:00] drastically different today Yeah. Than they were 20 years ago. Thanks to, you know, LLS and other, um, uh, cancer research, uh, organizations that have, massively changed the survival rates for blood cancers. Mm-hmm. , you know, through gene therapy and other, other, um, much, much more effective ways of, uh, of treating, uh, patients, you know, short of the old way, which was, you know, newcomb with chemotherapy and then give them a bone marrow transplant. Mm-hmm. , that was kind of, that was. You know, their, their options one, two, and three 20 years ago and that that's what they did. Yeah. Um, and if the bone marrow transplant doesn't work, uh, or in the, his case where he had an autologous transplant, you know, I mean, like it just didn't kill the cancer. You know, the cancer just came right back. Yeah. Yeah. So, Yeah, Vince: we're sorry to hear that. Yeah. Um, I knew, I knew of the story and, and knew certainly it was, it was close to you, um, but had not actually heard the story, so thank you for sharing that. Sure. Mm-hmm. , um, we talked about [00:24:00] prevention. Um, and we know that there's a lot of things that can go into minimizing your risk. Obviously we'll never take it to zero because your brother's a great example. I'd like to think I was somewhat similar example where Yeah, it just happened, right? Just bad luck. Um, yeah, bad luck is a great, great way of putting it, but there's a lot of, um, outside of the obvious, which are, you know, Take care of yourself by, um, being physically fit, working out, watching what you eat, things like that. Um, there are new testing out today, and I know you wanted to, we wanna talk about the, the blood testing that you were talking about earlier. Yeah. So Matt: I mean, this is, this is sort of the, in my mind, the, the biggest change in cancer screening that has come along will certainly in, in my career, and maybe not, this is not a hyperbole, maybe. Yeah. Um, from a cancer screening standpoint, so, you know, when we look at cancer screening, that is recommended right now, you know, through the US Preventative Services Task force. It's all [00:25:00] single cancer screening. Um, and, uh, you know, we screen for the most common cancers that people get. Mm-hmm. , uh, in men, the most common are. Colon, skin and prostate. Okay? And in women, you take out prostate and you replace that with breast cancer. And those are the, the top four for women. Okay? And we have pretty decent screening, uh, tests for, for, for those things. Um, but the problem is that even if you were up to date on all of those screenings, as a, as a man or a woman, you're still only going to catch about 30% of the cancers that affect men. With those screening tests. Yeah. And the other 50 cancers that are out there, common cancers that people get, when I say common, they're not individually common. They might only be 1% or 2% of the cancers, but when you aggregate 'em, it's like 70%. Of the cancers that people get from the, we don't have a single screening test for 'em. Okay. You know, and you're thinking about your pancreatic [00:26:00] cancers or your ovarian cancers or stomach cancer tons. Cancer, you know, brain cancer, like the cancers that you hear about somebody getting, and then six months later they're gone. Yeah. Um, and the reason for that is when you don't have a screening test for something, then you tend to catch those cancers when it's in stage three in the lymph nodes or stage. Everywhere. Uh, and then unless you're lucky, uh, and you, you lucky, unlucky lucky and get a cancer like testicular cancer, that we have a good, you know, regimen for even when it's in stage four, then there's not a whole lot you can do. Mm-hmm. . I mean, you could be, Steve Jobs one of the richest guys in the world, and if you have stage four pancreatic cancer, it doesn't matter. All right. Um, There's a new, um, a new category of tests. Um, some people will call them liquid biopsy tests. Essentially it's a blood test. Um, and we've known for a long time that cancer, um, When it grows, you know, some of those cancer cells die, and when those [00:27:00] cancer cells die, they release the, the, the insides, the guts of their cells into the bloodstream. Okay. Okay. Um, cancer, even more so than a lot of cells, cuz it's growing really fast. A lot of times it'll outstrip its blood supply. And some of those, you know, you'll have some necrotic cancer, uh, cells in there as well. And so, um, there's a, a, a company, um, called Lumin. , uh, and they are the, um, biggest, uh, manufacturer of gene sequencing devices. Um, and just to give you a little, background when I was in college, um, they were sequencing the human genome. Yeah. Okay. And, uh, they were like 15 years into it and they're, they're like, we think it's gonna take another five years. You know, so it's gonna be 20 years, I think. Something like, something crazy. They spent billions of dollars, um, sequencing one human genome. Um, and, uh, and now we can do it in a day. You know, and it, and it costs about a grand, right? So, so so, you know, part of this is a [00:28:00] confluence of, of technology, you know, sort of catching up with, you know, we knew that cancer, you know, shedded shed DNA n a into the body. But if it takes 20 years and a billion dollars to find it, then that was never gonna be a good test. Yes. It's not viable. Um, so, so this company, um, it's, it's an interesting backstory. They, they were developing a test to look for fetal anomalies in maternal blood. Basically a replacement for the amniocentesis. Right. Because it's dangerous to stick a, a needle Sure. In there. Yeah. And so, um, they, they did and they, they were developing this successful test to look for for. Birth defects in, in the, in the fetus that the DNA was shed into the mom's blood and they accidentally found cancer. Okay? Not in the fetus, but in 20 of the women that were in the study, they accidentally found cancer, and so they. they thought, oh gosh, you know what, if we actually tried to find cancer, right? Instead of accidentally [00:29:00] finding what, what would that look like? And so there, you know, there are things that happen to cells that we know about in cancer and people have heard about, you know, a, a mutation, whether that's a point mutation. Some cancers are caused by like part of one chromosome going in. attaching itself to a different chromosome. Okay. Um, so that's called a translocation, uh, that, that can, that can cause cancer. And then there are other things that we know of, uh, that are sort of common to all cancers. Um, and, and, and those things are mutations in the genes that regulate cell growth. Okay. So when. Vince was the size of a grain of rice. You know, , we all were Right. I've heard that right there. You know, there were, there are, there are genes that are turned on that, that make you grow, that make your liver go from, you know, the, the size of a, a speck of sand to the size of a football. And then when your liver's done growing, it's supposed to stop. Right? So those jeans turn off, those, those onco genes is what we call them. They're called onco genes cuz [00:30:00] onco, they were first found in cancer, but they're not cancer genes per se. They're just genes that are. That are that. Regulate the growth of, of cells in the body. And we know that in cancer, a lot of those genes that are supposed to be turned off get turned back on again. Okay. Okay. And so that's something called epigenetics where it's not so much there's a mutation. It's There is, but it, it's not in the actual gene itself. It's. , the part of the DNA that turns the gene on or off. Okay. So there's something called a methylation pattern that you can look at on, on a piece of DNA that just tells you, hey, which genes are turned on? And which genes are turned off. Mm-hmm. and C cancer tends to have a common methylation pattern, especially bad cancers that grow really aggressively. All those genes are turned back on. Okay. And it's a bad thing, right? Because they just grow like, like weeds, right? And so this company has been able. , take a blood test, [00:31:00] look for these. It's called free floating or cell-free dna. Dna that's not in cells anymore. It's just in your blood. These little snippets, they sequence them and then they have an AI algorithm look at it and go, Hey, does this look like normal, a normal methylation pattern, or is this a cancer methylation pad? Yeah. Okay. And then the most badass thing about it is, If it does find a cancer methylation pattern, then they go back and they sequence the other genes and they, what other genes are turned on? Oh, this came from a pancreas, or this came from your liver. Oh, wow. Or this came from your brain. And 90% of the time they can, they can pinpoint the tissue of origin for the cancer as well. Wow. So literally a blood test that tells you you can find stage one cancer and give you a tissue of origin. . That's pretty, how, how Vince: long have they been doing this particular blood test to the general Matt: public? It's been out for about 16 months. Okay. So, oh wow. So it's, it's brand new? Brand new, brand new. Yes. Yeah. We're our, our freaking, we, we just have, I've just had my first batch of [00:32:00] patients that have had their second test. Okay. Um, and, uh, you know, I mean, I, it's exciting for a lot of reasons. Yeah. But you know, . And not that it's all about me, but you know, my brother's example, um, or, um, I, I can't tell you how many patients I have had in the, in 20 years where like I had a very memorable patient of mine who wintered in Cortez, Colorado. He left in the fall. He looked great. He came back, you know, he is like, man, I wanna come in and see you. It was like March or April. And he said, I just, I'm tired. And, and man, I could, I could see from the doorway how jaundiced he was. Mm-hmm. . And he had, uh, he had a metastatic cholangiocarcinoma, basically a carcinoma of a bile duct in his liver. Guy had never been in the hospital a day in his life. He was 85 years old and, Dead within six months. Um, and you know, I mean, like you think about it and you're like, God, if we would've been able to catch that when it [00:33:00] was early, before it spread all over his liver and ultimately all throughout his entire body, he might still be alive. There was nothing wrong with the guy. He is on less medicine than I take on a daily. I mean, basically took a baby aspirin and that's it. And he was 85. Yeah. Right, right. You know, and so, Vince: um, I'm thinking all the pancreatic patients who, I mean you mentioned earlier. typically don't start to have any effects until it's already spread somewhere else. Exactly. And by Matt: that point it, there's just too late you can do about it. Yeah. Yeah. You know, pancreatic and ovarian are the two that, that, you know, it's just, Uh, you know, you can, you can start to get symptoms depending on like, where it is, if you have a tumor in your brain, you know, but man, ovarian cancer, it's always, they always come in with a bloated abdomen and mets everywhere. Mm-hmm. , I mean, that's how we diagnose ovarian cancer. Um, and, uh, you know, because it affects women, younger women, uh, can affect older women too, but you know, it can affect women in their forties and 50. You know, it is, [00:34:00] it is something that is absolutely worth finding early. Right. Um, you know, you find a stage one ovarian cancer, you take out the over it, you're done. That's all you gotta do. Yeah. There's no radiation, there's no chemo. That's it. Yeah. Um, stage four, there's nothing you can do for it. Yeah. So, I mean, it really. . It's sort of, it's not sort of, in my mind, it's a game changer. I mean, there's only a couple reasons to not do it. It's expensive. Okay. It's like 950 bucks. Okay. Yeah. So like, but that's, don't get me wrong, that's Vince: not cheap, but it's not like outrageous. Well, and of course, like most things, I'm sure at over time it's gonna start coming down. Matt: So that, I mean, the company is doing a, um, a prospective study in England right now with 140,000. S um, 70,000 are getting the test every year, and 70,000 are okay and their goal. is to prove to the NHS that it's gonna save them money. Right. Okay. As soon as that, and it's a three year study, as soon as that comes out now [00:35:00] is, you know, is the FDA or Medicare gonna listen? I don't know, but, but as soon as governments are like, oh my gosh, you know, if we do this on everybody over the age of 50, Yeah. You know, it's gonna save us, you know, 3 billion a year. That'll be the game changer, right? Yeah. Because, you know, yes, the price needs to come down, but what really needs to happen is Medicare needs to start paying for it. And when Medicare starts paying for it, then regular insurance companies will start paying for it, and it will become part of everybody's labs over a certain age. You know, I mean, I, I want to be clear, this is not a, a good test for somebody who's, who's 18. Um, but, um, someday it might be, I mean, where is that threshold on age and, and, and why? I mean, well, I mean, honestly, the, uh, here's my analogy. You know, if you went to. them all and you took, you know, had a 10,000 guys give you a urine sample, And you and you, and you dipped them all to see if they're pregnant. Okay? The chances are one of those pregnancy tests is gonna come back positive, okay? Not because [00:36:00] that guy's pregnant, but because there's a baseline error in the text, okay? And so if you are testing the wrong. for something, then the chance that the test is going to be wrong goes up. Yeah. Okay. Sure. Mm-hmm. . And so we know that the incidence of cancer goes up as people get older. In fact, it is the number one risk factor for cancer is getting older. Yeah. Okay. Mm-hmm. , when you hit 50. , your risk of developing cancer is about one in 200. Okay. That year when you're 50 years old and it only goes up as you get older. Mm-hmm. . Okay. Um, less than 50, is it? It's lower than that. Now. That is, that is on average. Mm-hmm. . So to be clear, if you have somebody whose mom had breast cancer when she's 55 and you're. BRCA positive? No. You know, maybe you should start getting this when you're 25. Okay. Yeah. Yeah. We have patients, um, who have something called F A P, which is an inherited, um, mutation that massively increases their risk of colon cancer. And we've [00:37:00] been, we've been doing it on them in one of the, those kids is in their twenties. Okay. Uh, and they also, by the way, are getting colonoscopies like every 18. Okay, so it's, I want to be clear, this is not a replacement for any of the screening tests that we have, right? Uh, and it's not a perfect test. Um, you know, the, it has a positive predictive value of 44%, though. Okay. Um, which means that you basic, it's close to a coin flip. If it says you have cancer, there's about a 50 50 chance that the test is, right? Yeah. Um, and for a screening test, that's pretty good. Um mm-hmm. like mammograms, the positive predictive value is four. So like a hundred abnormal mammograms. Only four of 'em are breast cancer, and the other 96 is something else, you know? Okay. Yeah. Benign calcification or nothing. Or a cyst or something like that. Right. But we still do 'em. because you don't wanna miss breast cancer. Right. You know, and so it's not that mammograms are a bad test, it's that it's not a perfect test and we've all sort of accepted the Yeah, yeah. You know, it's not perfect test and sometimes you gotta get a breast biopsy and [00:38:00] sometimes you gotta come back and get an ultrasound. It's a pain in the neck, but you don't wanna miss breast cancer. Right. So, um, the negative predictive value of the, of the blood test is awesome. It's like 99 and a half percent. Okay. So if it says you don't have cancer, pretty much take to the bank that you don't, uh, and, um, you know, , theoretically, you do that every year and you know, you, you, um, uh, you know, you sort of, uh, it becomes part of the screening protocol. Yeah. The other thing that's super cool about the tech, like what's coming down the pipeline mm-hmm. is that right now when they do that liquid biopsy and they compare your methylation pattern against sort of a, a population, the AI looks at, you know, the last 250,000 of these. Yeah. And you know, knows these people have cancer and knows these people didn't. Yep. In the future, they're gonna be able to take that data and when you have sequential data, your cancer screen, over the last five years, they're gonna be able to compare your [00:39:00] methylation pattern to your old methylation pattern. Oh, that's interesting. So basically, Hey, here's Vince's baseline. Hey, something has changed. Right. You know, and if, if it changes a little, you know, they don't necessarily flag it, but if there's a massive change compared with what they've seen in the past, this is. Available yet. But this is what I've heard from talking with the, the, the, the research scientists that are doing the product. They're going to be able to basically, like we do with anything like a PSA or a cholesterol, say, Hey, look, you man, you know, here's your last four cholesterols. This is terrible compared to where it was last year, we got change something. Uh, or you know, hey, your PSA has always been one and now it's four. We gotta, we gotta look into this. Yeah. Because this is, this, this is a, there's a marked change. Mm-hmm. . So that's also, you know, in the works and. Talk about precision medicine and, and you know, specifically for the patient themselves. Right. That's gonna be a really, yeah. Cool. Advancement in this sort of cancer screening tech. At, Daniel: at the beginning of this, you said they, they found it kind of by accident, right? Yeah, yeah. So obviously they're [00:40:00] collecting a lot of data, it'ss, kind of a blood sample from that standpoint. Are they using any of that? accidentally find something else? Or are they just kind of continuing to hone in on, and I mean, I assume they're keeping a lot of that data. They be able Matt: to mine it later. Fortes of data, like, I mean, I have no idea, you know, probably taking up an entire server farm somewhere of data. Yeah. Um, they, they do have the ability to go back and look. One of the things that's interesting is every single case that they have, where a positive shows. , the company follows it very closely. They work with that. I mean, it doesn't happen very often, thankfully, but Yeah. You know, they're on it. Mm-hmm. . Um, and they want to know, you know, hey, you know, do have you, have you found it? Mm-hmm. . Right. Um, if they, if you haven't found it, you know, it's not like if we can't find it, we're just like, all right, well, everything's great, , you know, I mean, like, I'm, we're we're bringing that patient back in three months. I'm gonna scan 'em again. Yeah. Um, I'm gonna repeat the test in six months, you know? Yeah. And by the way, [00:41:00] It's free, so that's nice. Um, they don't make you pay for it. If, if it looks like a false negative, they will repeat it for free. Hmm. Um, but you know, if you repeat it and the cancer signal gets stronger, man, you're definitely keep looking. You know, if it goes away, the first test might have been wrong. The other possibility, you know, we all have immune systems. Right. And the thought is that we probably all have a cell somewhere. Mm-hmm. that goes rogue on, on the daily, you know, and your immune system just, you know, kills it. , we're picking up cancer on a molecular level. There's always a possibility that you did have cancer and now you don't because your body got rid of it. Which would be a good thing. Mm-hmm. . Yeah. Um, but, you know, there is some concern. Are we creating like a whole new cadre of patients that are cancer survivors? Cuz they had a. Test that came back positive once and now it's negative. I don't know, you know, um, are you gonna be able to get life insurance if you have a cancer test come back positive and then it's negative. But you know, now they're like, well, we don't believe the negative one. We think you're gonna get pancreatic [00:42:00] cancer and we're not gonna insure you. I don't know. Yeah. You know, I mean, there's a bunch of unknowns. I mean, honestly, I, I think it'll be not more than a year or two before anybody, you know, trying to get a policy over a certain amount. They're just gonna make 'em do one, you know? Sure. Yeah. You know, because if you're buying a 50 million life insurance policy, what's 950 bucks to Lincoln Financial, you know, You know, nothing. Yeah. You know, so I mean, I, that, that I think will probably happen sooner rather than later if I was to, if I was to bet. Yeah. Uh, for, not for everybody, but for somebody that's looking to get, you know, a, a big policy. Yeah. So, um, but apart from insurance abusing the tech, um, which, you know, why wouldn't they? Um, you know, I, as a physician, I'm just super excited that, that we, you know, have a, an ability now to plug. , what was it? Just a giant gaping hole in our ability to find 70% of the cancers that kill people. Yeah, yeah. You know, and, and you know, if it, the other thing is like, if you were only finding it in stage [00:43:00] four and this guy was gonna die anyway in, in a, in three months, then maybe it's not such a great task, but, but it, you can find it in stage one and stage two, which this can, because it's finding it on a molecular level, you know? That is the difference between. Curing and not curing a cancer. Yeah. Yeah. So I have a, this was not my patient, but one of my friends who has a practice in Denver. Um, 51 year old lady. You know, like I said, the test just came out. This happened last year. 51 year old lady did the gallery cancer screen, came back positive for ovarian and they scanned her and she had a tiny little tumor on her ovary. Stage one ovarian. . Wow. Like, yeah. That test saved that woman's life. Yeah. You know, she would've died. Yeah. When, I don't know. But she would've died sooner than she should have. Because, because, you know, she had, she was 51 with an ovarian cancer. Right. Yeah. So, um, you know, it doesn't take too many stories like that before you're like, Hmm, you know, this is. Maybe, maybe [00:44:00] we should figure out a way to get this for everybody, right? Yeah, Vince: yeah. Uh, random question. This may be a dumb one, but Yeah. If someone has a, has been diagnosed with a low grade cancer Matt: already mm-hmm. , um, would Vince: you still run that test on them? Or, I guess maybe it depends on which, kind of, like, for, for prostate you can already do the psa, so maybe it doesn't make sense to Matt: do this one. Yeah, it's a really good question. Um, so, you know, there's a, um, . First off, if somebody has had cancer and has been successfully treated for the cancer, then you can run the test on them, okay? Okay. Um, the lab would say you should wait three years from the resolution of that cancer. Okay. You probably don't need to wait that long, but you sh if you had, like, let's say you had lung cancer and you had a lobectomy, you should at least wait until you're healed up from that. You don't want to be picking up bits of dead cancer cell, you know, that are floating around in the blood. Yeah. . If you have [00:45:00] somebody with a, you know, prostate cancer is a great example, sort of a smoldering low-grade cancer mm-hmm. that you're following, it's probably not a great test to get because it's almost certainly there's a decent chance it's gonna pick up that cancer. Okay. Okay. And it's just gonna tell us something that we already know. The flip side of that is, , just because you have a prostate cancer doesn't mean you can't get another kind of cancer. Yeah. That's, you know, and so, um, but there's, so the, we don't really have a good answer for that. Um, right now, what the, the lab says is don't order it on somebody that you know already has cancer. Okay. Okay. Okay. Um, because you know, either what's gonna, it's either gonna come back and say, this person has cancer, or it's not gonna say that and you're gonna go, well, the lab's a piece of crap. You know, , um, you know, prostate cancer's another very interesting, um, example. In many people, it's so slow growing, which is not a bad thing, but it's so slow growing that it doesn't [00:46:00] shed a lot of DNA into the blood. And this test is actually particularly poor at picking up very slow growing. Low-grade prostate cancers. Okay. So it's not a great test for that. Um, now will it pick up, you know, an aggressive prostate cancers that's eaten through the prostate ca capsule and going into your Absolutely. But it's not the greatest test for that. Uh, it's not particularly great at finding, uh, Cancers in the bladder or in the kidneys because most of those cancers shed their, their DNA into the urine and you just pee it out rather than going into the blood. Yeah. So they're working on a, a, a urine addition to it, but it's not great. I had a, i, it missed a patient of mine earlier this year, uh, with a superficial bladder cancer. Okay. Um, we found it in a different way. Um, but the, you know, literally, um, uh, actually a patient was getting a, an MRI of their prostate cuz his PSA went up and his p prostate looked fine on the mri, but they're like, yeah, there's something hanging out in his bladder there. And he ended up having a superficial bladder cancer. Okay. Um, and, uh, his. , his gallery [00:47:00] test was negative for both prostate cancer and it was negative for a bladder cancer. Mm-hmm. . It was superficial. He's fine. Yeah. Um, you know, so if it would've been a massively aggressive invasive cancer, probably would've picked it up, but it missed this one. Right. Interesting. It's no good at picking up melanoma. Um, again, because melanoma grows superficially, and then by the time it gets in your blood, by definition at stage four in your. You know, don't stop looking at your skin, you know, just cause you're getting the test. Right? Yeah. Vince: So, wow. That's, uh, very cool to hear about. Yeah. Um, I was unaware of that. That's, that's good to know. You gotta love technology and what it's doing to, to help us all Matt: out. Mm-hmm. . Well, you know, and I, I think that one of the, the things that I love about my, my job in particular is that, you know, we can identify some of these things that are, you know, I mean, there's real science behind it, but it's gonna take a while before. this becomes standard of care. You know, it might be 15 years, I don't know. Sure, yeah. But if you, if you wait for, you know, standard of care to catch [00:48:00] up with optimal care, people are gonna die. Mm-hmm. , and you, you have to be okay with that. Um, and again, I want to be clear, it's not like we're out there doing every new, you know, shiny, chasing every new shiny quarter, but when something comes along, like this was one of those things where like the 10 of us sat around and were. We gotta do this. Yeah. You know, this is, this is cool. Uh, and it's expensive. Um, but, you know, I have off, I've, I've really found that I don't, I tell all my patients about it and they can decide whether or not it's worth it. Right. Um, you know, I don't want to be the one who, because we have people, you know, that, that absolutely have that grand that don't want to do it. And we have people that, you know, they don't have the money, but they're gonna cut something else out in order to do that. Sure. Mm-hmm. . Yeah. . Vince: Well, cool. Yeah. Well, thank you for sharing that. Yeah, that's good to know. Um, I guess before we exit, I just wanna say thank you for your personal support and priority physician support, the Heroes Foundation. Mm-hmm. , uh, we, we love partnering with you guys. We think it makes sense and we're, [00:49:00] we're, we're glad to have Matt: you on board. We're happy to do it. Vince: Thank you. Um, got anything else? No, I think that's it. Any questions for us? Okay. Well that was easy. Yeah, that was easy. . Thanks for having me. All right, well thanks for coming to being here. And thank all you guys for checking out this episode of the Summits podcast. Uh, again, from wherever you get your podcast or on the Heroes Foundation YouTube channel. Thank you for doing so. Hit that subscription button if you haven't done so, it's absolutely free. It won't even cost you 950 bucks, I promise. Just hit it up and hit that little notification bell so you can be literally like alerted when new episodes drop like this one. And don't forget, guys beat cancer.