Radio Cade

Deep Brain Stimulation to Treat Parkinson's Disease

April 28, 2021 Dr. Michael Okun Season 3 Episode 35
Radio Cade
Deep Brain Stimulation to Treat Parkinson's Disease
Show Notes Transcript

The fight for a cure to Parkinson's Disease has been a decades-long battle, with several treatments evolving alongside the evolution of medicine as a practice. In this episode, host Richard Miles sits down with Dr. Michael Okun, the Chair of Neurology, and Professor and Executive Director of the Norman Fixel Institute for Neurological Diseases at the University of Florida College of Medicine.  He is an expert on deep brain stimulation, and author of over 400 peer reviewed articles as well as the book Parkinson’s Treatment: 10 Secrets to a Happier Life.  

Here, Dr. Okun dispels myths surrounding Parkinson's, talks about his research and clinical work, and discusses his involvement with several non-profits raising awareness on other conditions and diseases.  "Every day that I practice medicine, I know less," says Dr. Okun.  "It's a profession where you have to have a lot of humility. You have to have an open mind and things change over time." 

Richard Miles (00:01):

Inventors and their inventions. Welcome to Radio Cade, a podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade, who invented Gatorade in 1965. My name is Richard Miles. We'll introduce you to inventors and the things that motivate them, we'll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace. Parkinson's Disease. What do we know about it? Why does it seem to be more common and how do we treat it? Welcome to Radio Cade. I'm your host Richard Miles today. I'm pleased to welcome Dr. Michael Okun the Chair of Neurology and Professor and Executive Director of the Norman Fixel Institute for Neurological Diseases at the University of Florida College of Medicine. Dr. Okun's also an expert on deep brain stimulation and author of over 400 peer-reviewed articles, as well as the book "Parkinson's Treatment: 10 Secrets to a Happier Life." Welcome to Radio Cade, Dr. Okun.

Dr. Michael Okun (01:11):

My pleasure to be here, Richard.

Richard Miles (01:12):

So before we start, I have to mention you're also a poet and that caught my eye mostly because I find myself in middle age becoming very interested in poetry, but only as a reader, not an actual poet. So I have to start, is this something you've always done or is it because being a brain doctor wasn't challenging enough for you? What got you into poetry?

Dr. Michael Okun (01:28):

My original bent was in humanities, and I have a degree in history. And so, I love to write, and I love to try to express myself in different ways. I love poetry, because there's a new precision towards, and I think that through poetry, you can express concepts using emotions and other modalities to reach your readers. And so, over the years I've done a number of poems, and I have an old book called "Lessons From the Bedside" and have done some writings in said time as well.

Richard Miles (02:01):

I love that analogy too, to the work that you do. Cause one of the things I have noticed in my very limited foray into studying poetry is precisely what you said, that the precision of the use of certain words versus not other words. And that reveals a lot of the thinking and so on. And I imagine studying medicine, there is some similarities there.

Dr. Michael Okun (02:18):

That's right, and really keeping an open mind. And I am also a neurologist by training. And so I practice medicine and I say often that every day that I practice medicine, I know less. It's a profession where you have to have a lot of humility. You have to have an open mind and things change over time. And we're really like cabinet advisors to people. We're here to help with the best information that we can, but we really shouldn't be so prescriptive, and so sure of ourselves. And I think anybody, whether you're an inventor, you're a scientist, you're a clinician or all of the above, will look back and say what I did five years ago, versus what I'm doing now, is different. And it might seem subtle because you lived it, but if you think in those terms, that's, I think what I would term as wisdom and you realize that practice of medicine and the understanding of diseases evolves and that there's not one solution for everyone.

Richard Miles (03:15):

That's a great way of looking at it. And that really helps, I think, for what we're about to talk about now, and that is you have developed, or you're known as really one of the world's experts on a technique to treat Parkinson's. But before we get into the details of what that is and how it works, I'd like to talk more broadly about Parkinson's itself, which is a disease that most people probably have heard of or know somebody with Parkinson's, but they may not know exactly how it works and what are some of the underlying causes. And I noticed that a few years ago, you wrote a paper called "The Emerging Evidence of the Parkinson Pandemic," which caught my eye, obviously because we're in the midst of another pandemic. And so pandemics in general, I think are of higher interest to everyone. But in that paper, you said that neurological disorders are now the leading source of disability globally, and the fastest growing neurological disorder in the world is Parkinson's disease. And you said that from 1990 to 2015, so about a quarter century time period, the number of people with Parkinson's disease doubled to over 6 million. And finally your quote, "for most of human history, Parkinson has been a rare disorder, but various factors have now created" what you call Parkinson's pandemic. There's a lot there, but why don't we start by briefly describing for listeners who are maybe not exactly sure how Parkinson's differs from other types of neurological diseases. Define it for us. And then why don't we spend some time talking about those various factors that have caused it apparently to go from a rare condition to pandemic-level proportions.

Dr. Michael Okun (04:40):

So first Parkinson's Disease, it's a neurological syndrome, and it comes with symptoms that people can readily detect. Oftentimes when you're in a crowd, you see somebody might be shaking, they might be shuffling their feet, their handwriting might be small when they're at the bank, and they may be struggling with some of these, what we call motor features and also what we call non-motor features. So it's a brain disease that affect depression, anxiety, and quality of life. And it turns out that Parkinson's Disease is not just a disease of dopamine. And so a lot of people believe that you lose dopamine in the brain and you get Parkinson's, it's actually degeneration of multiple circuits. I've spent my career studying the circuits and Parkinson and in other diseases. And when we think of Parkinson, I remember when I was at the White House in 2015, I was quoted as saying, "Parkinson is," and I'm not the first person that said this and won't be the last, "the most complex medical disorder period," because there's over 20 motor features and non-motor features. So tremor, stiffness, slowness, (and not everybody gets tremors and not everybody gets stiff necessarily, it could be different varieties) in depression, anxiety, sexual dysfunction, other issues too. And then you throw in dopamine replacement therapies, you throw in deep brain stimulation ,what you mentioned, and it's something that we've been researching now for a few decades here at University of Florida with one of my partners, Kelly Foote, and Mendez and many other people in the laboratory. And so Parkinson's Disease is a neurological disorder. It is rapidly expanding. And about eight years ago in the book, 10 Secrets to a Happier Life, in the prologue, I said: "Parkinson has all the same characteristics of a pandemic." And that was very controversial at the time. That's eight years ago. And our most recent book that just came out from Hatchette publishing, "Ending Parkinson's Disease," it was originally titled the Parkinson's pandemic. The publisher changed the title, and they wished they could have that back because it came out in March, 2020. So, "pan" means "all" in Greek, "demos" means "people." And when you apply the concepts of a pandemic, they can apply to other diseases. Although, I was just on a call with the World Health Organization last week, and I think it's fair to keep the term pandemic reserved for infectious diseases. Although people should know that the rapid expansion, the geography, the people not being immune to it, it all applies to other diseases like Parkinson's.

Richard Miles (07:06):

So tell us, what are some of the factors that researchers have uncovered, or maybe that you hypothesized are at work here that are causing it to grow, I'm guessing, dramatically on a per capita basis? Are there geographic differences, for instance, in range between different countries or different demographic groups? What is going on here, and what do you think is behind it?

Dr. Michael Okun (07:25):

So we just had a conference with our colleagues in Geneva, Switzerland at the World Health Organization that have taken this on. And there's a working group of us from all different countries, from rich countries, from poor countries, from countries somewhere in the middle...Parkinson occurs in all of the above. Now, one of the myths of Parkinson is that it's all due to aging. And so as you get older, you get a higher prevalence of Parkinson and that's true. Now, many people might be surprised when I tell you in our waiting room, I see people in their teens, and twenties and thirties with Parkinson's, and it becomes more of a common as you get older, but it doesn't mean it can't occur in young people, as well as people--I don't say old people--I say more seasoned people. And it turns out that age, it's a myth. Age is not the only thing that's driving this increase. There is going to be a doubling of Parkinson between 1990 and 2015. That's already happened. It's going to double again from 2015 to 2040 and could collapse healthcare systems, cause lots of suffering if we don't get out in front of it. And so there are other factors that are driving this. And one of the ones that we talked about in the latest book is about pesticides and chemicals and environmental factors, and how those factors and the industrialization of society and how that's changed the game.

Richard Miles (08:47):

That's fascinating. So let's move on to, what are some of the treatments that are available? You mentioned deep brain stimulation that you and Dr. Foote and others have been working on for a couple of decades. What led you to that I guess, and tell us how it works and what sort of improvements that you see?

Dr. Michael Okun (09:02):

Back in the 1930s and 40s, there weren't treatments for Parkinson's and for other diseases of movement. Some of the early attempts were actually making holes in people's minds and disrupting these abnormal conversations. So if we think of the brain as a group of islands and the islands are all talking to each other, if you disrupt the conversation, people discovered that this is a potential way to treat specific symptoms, depending on which circuit you disrupt that conversation. And as time evolved, we were able to modulate conversations by using medicines. And the first major medicine was introduced by George Cotzias in the 1960s, and that was dopamine replacement therapy. And that actually modulates, it changes the way the brain's oscillations are moving, and everybody, whether you're awake or you're asleep, your brain is always oscillating. And when you have a disease, particularly in neurological disease, that oscillates in different ways. So surgeries came back; when we have better technology to get to very specific sub millimeter zones of the brain, we started burning out pieces of the brain and that's what I did during my training. And then as we moved along, we began to understand how the different areas were talking to each other, and we develop what's called neuromodulation, so sticking straws in, introducing electricity into those circuits, I'm trying to change the way that they would talk to each other. And so my mentor and one of Kelly Foote's mentors who I work with is a man named Mahlon DeLong at Emory University. He's retired now, but a tremendous human being, and he was the one that really spent years and years at the National Institute of Health, and then at Hopkins, and at Emory decoding what the circuits are. And in 2015, he received the Lasker Award, which is one of the highest awards in medicine, just under the Nobel, for this work.

Richard Miles (10:50):

Doctor, now that this is becoming more common and will become more common, walk us through what happens when, let's say someone's parent they're 60, 65, 70 years old, they're brought in to a doctor like you or a clinic somewhere, and they're diagnosed with Parkinson's. What are some of the first steps of treatment? And coming back to deep brain stimulation, is this a one and done type of treatment, or is this a continuous regimen of treatments over time? And then what does the outcome look like for, say, someone in their mid-fifties or early sixties?

Dr. Michael Okun (11:20):

So when we think about Parkinson's Disease, the first thing we think about is when somebody comes in, we need to understand when you say those words, "you have Parkinson's Disease," it's not the end of the world. Okay? There are a lot of different forms of Parkinson's Disease. And I have folks in my practice I've taken care of for 20, 30, 40 years. Okay? So it's important for us to dispel that myth. And as we dispel the myth and begin to deliver treatment, we recently wrote in the Lancer last week, a seminar on Parkinson's Disease, 20 page-seminars, get your coffee if you want to read it. But we talk about, in that seminar, there's a picture of when we started here at University of Florida, we had this concept of model for caring for the Parkinson person. And we said, the person's the sun, and we should all orbit around the person and the family, because this is such a complex condition. And there are so many, you know, specialists; you need an archeologist, a neurosurgeon, neuropsychologist, PT, OT, and speech, or maybe you need a nutritionist, access to clinical trials... We have over a hundred clinical trials, it becomes confusing. And so, we need to integrate the care, and if we integrate the care into what we call a multidisciplinary team, we've learned that it isn't just--I call myself the drug dealer as a neurologist. It isn't just the drug dealer or the device dealer, where we take people to the operating room and put a device in that provides the best possible care. It's this model of interdisciplinary care, and it continuously changes over time, and you have to actually listen to the people, so it's a different specialty, and to actually listen to the clues that they give you on how they're living in order to change timing and change doses. There's over a dozen different medications, there's all sorts of infusions, there's deep brain stimulation. And I like to teach, and we have fellows here who, after they're done with their neurology residency, spend two years with us to train in this, and we've trained about 70 of these were all over the world. And what I like to tell people is Parkinson is like a lifetime disease. Think of all these different therapies, and you need to understand how the disease evolves and when is the right window to apply each one. So deep brain stimulation isn't for everyone at all times, but there are points in the treatment where it can provide extremely beneficial effects on things like just suppressing tremor or movements we call dyskinesia. And so knowing the disease and knowing the person, and then creating the right multidisciplinary plan is important. And the last point is, we wrote something for the Journal of the American Medical Association last year with Melissa Armstrong here at UF. And we, as experts said, a first-line therapy now is exercise. We now recognize that exercise is so beneficial for this disease, that it's now considered a first-line therapy, right along with the medications. And so that should tell you something about the humility of treating this disease for so many years and us understanding what's good for folks and what's not.

Richard Miles (14:18):

If we compare this to a disease like cancer, is Parkinson's something that could actually be put into remission, or is this a steadily degenerative disease? All the treatments are just slowing down or resting that trajectory, but essentially it's going down, or can you stabilize somebody for a decade, for instance, with no decline? How does that compare to something like cancer?

Dr. Michael Okun (14:37):

Parkinson's is a progressive neurodegenerative disorder. Now there are multiple what we call phenotypes. So we have what some people call benign Parkinson, because it progresses so slowly. And then there are other forms that progress faster. We're just beginning--it's like Genesis of the Bible--we're just the in first couple of days in understanding actually the differences between some of these entities, but it is progressive. Now people might say, well, tell me, how did Pope John Paul get anointed as a Saint, right? Didn't he cure a nun of Parkinson disease, and that's how he achieved sainthood. Well, we'd like to leave that story alone because it turns out that many people who are presumed to have Parkinson's disease do not. And so if you get better then you may not have Parkinson's, and then there's a group of people who have tremors and other symptoms that look like Parkinson's. About 10%, about one in 10, very early on, when you first see them, then never progress. And a lot of times people don't go back and realize, wait, this person's not progressing at all -- hey actually don't have Parkinson, they have something else that's more benign. And we realized that, and we gave this crazy name to that called scans without evidence of dopaminergic denervation. I would never call a person a sweat, that's what it stands for. But, if you're not progressing, you may not have Parkinson's. And sometimes early on the diagnosis can be made in the wrong direction as well. And so it's very important, but when you do have Parkinson right now, it's progressive. Now we are searching for things that will slow the disease down and, or provide precision medicine or other treatments for it, but we haven't gotten there yet.

Richard Miles (16:15):

So let me come back to something you just said about perhaps a faulty diagnosis. It sounds like the ideal treatment or regimen of treatment is this interdisciplinary approach, which you've got multiple people looking at it and working on it from different angles for a patient, but I'm guessing that that level of complexity of care is not available to everyone. Do you have to be next to, say a major research hospital, like University of Florida, or some major metropolitan area to get that kind of care? And if you're not, and you're in a rural area or in a very poor country, for instance, what is the outlook for somebody in their mid-sixties?

Dr. Michael Okun (16:44):

So in general, if you can get access to one of these multidisciplinary teams, it's better. We know from Medicare data done by Allison Willis, who is at the University of Pennsylvania, that if you have access to even a neurologist, and most people don't actually see a neurologist, if you have access to a neurologist, your morbidity and mortality, your nursing home placement, all of those things that are super important, those numbers get better. Just having access. If you have access to multidisciplinary care, the data is beginning to point that this is also better. There are centers of excellence that have been set up through foundations, ike I work as a medical advisor and former medical director for the Parkinson Foundation. We have 47 centers all over the globe, but these aren't widely available to people. What we do at the University of Florida is we see people from all over the world, we always have, and we try to construct plans for them, so these plans can be carried out by people within local zip codes, whether your local zip code is in Australia or Asia, or you have flown in to be seen, you know, from there where we set the plans, and then we ask the therapists to follow them out. Beause a lot of therapists and other members of a multidisciplinary team, they may be giving you the wrong therapy. And sometimes the wrong therapy, Richard, is worse than no therapy in a disease like this. And so setting the right plans, communicating and creating public health value is important. And one of the three things, we just had a campaign it's still ongoing called the Give a Dime for Parkinson's Disease campaign, and our first goal was to get to 10,000 red cards to the White House. We've now reached 25,000. One of the three points, while we asked for three things-- because if you ask for too many people get distracted--we're asking the White House and congressional members to consider as one of the three things is to maintain telehealth access for people in the United States. That didn't happen before COVID-19, and many people don't realize that that's not permanent. That has to be made permanent, and then we have to develop these types of interdisciplinary models, so that people who don't have access or don't live right next door can still get access and the right advice, and then put the right team together, so they can have the best outcomes. The best outcomes mean less falls, less fractures, billions of dollars in healthcare savings, happier people. And so I think it's in everybody's best interest, particularly as the disease has exploded.

Richard Miles (19:06):

And Dr. Okun, In addition to your research and your clinical work, I know you are involved in at least several nonprofits that I know of, probably more. Tell us a little bit about what you're doing in those areas, like Tyler's Hope and so on, and what has been the response as you're trying to raise awareness on some of these conditions or diseases that are not as well known.

Dr. Michael Okun (19:23):

Yeah. So I think when you look at other diseases and what they've done to change the trajectory, the story of polio, the story of HIV, and in HIV, it took what we call four pillars to do that. So you have to develop a system with any of these nonprofits for any of these really important diseases that are going to affect society. P is for prevent, A is for advocate, C is for care, and T is for developing new treatments through research. We call it the PACT. So when we went and we researched, we said, what do you need to do? So we need to get all of our non-for-profits together and we need to organize and sum our voices, and reach that inflection point where we can become loud enough. We can advocate with enough force to actually push change. And that's what happened in HIV. For example, they went from a few hundred million in funding to 3 billion, a year in funding. And now HIV, when I was an intern, my first year out of medical school, 25 years ago, this was a bad word to be on. If you have HIV, it was kind of the death word, and it was really not great. And now, it's a chronic livable condition, the trajectory has changed for literally tens of thousands, if not more people, worldwide. And there's a reason why that happened: prevent, advocate, care, and treat them. And advocacy was huge. And so I'm a big believer in non-for-profits and even more than opening the checkbook and writing the check, getting involved. And I'm a believer that when you sum voices together, if you can get to a certain level--and nobody knows exactly what that is, maybe we can ask them out loud while our tipping point lives through these things. But there is a moment where things tip. And so one of the things in Perkinson, for example, we're trying to tip, one of the three things we're asking for us increase the funding from 200 million to 2 billion a year, by 10 times, because we know that if you increase it by two times, you're going to get twice as much research, twice as many young researchers. And so this is going to have a multiplicative effect. When it comes for Tyler's Hope for just only a cure, here, this is a disease where we know the deletion. We know where it lives. We know quite a bit about it. We have a lot of technology, we just need to, sum our voices, push more money into this, and that's what Tyler's Hope is doing, push the advocacy, and we can create a precision medicine treatment. And I think we're on our way and that disease as well, there's still a way to go, but the same for Tourette. So I've been in the tourette world with a non-for-profit called the Tourette Association of America. So I think the story is the same, but I think part of the formula to reach impact is you have to bring together globally voices. And when we were speaking with World Health Organization, there were representatives from all countries talking about Parkinson and creating that grassroots movement. And we have a grassroots movement called the PD Avengers on Twitter. Now there's 3000, like really loud, obnoxious people on one of them that are really making a lot of noise. And that's what we need. We don't need to be polite anymore. We need to be aggressive and charismatic and a bit obnoxious for these diseases.

Richard Miles (22:26):

I like how you put that and, as a comment, as an aside, I spent a good portion of my career overseas. And one thing that non-Americans are amazed by is the level for nonprofit activity that we have in the United States, directed towards all sorts of things, but in particular medicine or health, and the vibrancy of that sector really is something almost distinctly American. They obviously exist in other countries, but not nearly at the level and scope of what you see all over the place in small towns, big towns, and so on.

Dr. Michael Okun (22:53):

It's a very special thing. And you're absolutely right. I've done outreach to other countries. And I, I won't say which country I was in, we actually brought some devices in and probably could have been arrested for doing that. And we were helping the doctors with some devices and some implants. And we were out seeing people all over, who just needed help. And it struck me in that experience, and I've seen it in other countries as well, that we helped a woman, and then they invited us to dinner, and we realized that, Oh my God, this woman that we helped is the mother of somebody huge in the country that has these huge business interests all over the country. And we said, why don't you give a whole bunch of money to Parkinson's disease? And they said, "give money to Parkinson disease? We don't give money. This is an American thing." You know, too, we're having this discussion. "You all give away your money. We don't do that. We don't do charity." And I thought, wow, it is really something special. And, and then I think they felt a little bit embarrassed. And then they said, well, we do give charity. But the charity we give is we support our sports teams. And so we explained to them, well, that's not exactly charity. And so I do think that it is a uniquely American thing. It's one of the things that differentiates us, makes us stronger and gives us the potential to mobilize and galvanize against diseases and other issues that face society.

Richard Miles (24:12):

And it's also a perfect way to mediate between the individual who alone can't do much, and the government, which often has a lot of resources, but is not terribly efficient in how it distributes them, so it creates this whole layer between small groups and very large governments. Dr. Okun, one final question or a couple of questions actually. At the Cade Museum, we like to not just tell a story of inventions, but the inventors, and not just the story of technology, but the researchers behind the technology. So tell us a little bit about pre-professional Michael Okun: what were you like as a kid? Did you know, early on you wanted to be a doctor or a researcher? What were some of your early influences?

Dr. Michael Okun (24:48):

Yeah, so I had it pretty good as a kid. I grew up with a good house. I had two parents. My father was a dentist, my mother was teacher. And so I kind of got left brain, right brain. They had very different ways of looking at the world. I was always memorizing things like the backs of baseball cards, statistics, things like that. And my life I've always had a joy. I've always been a person that's had pure joy to be part of things. And so for me, a lot of my joy was in reading history and humanities and things like that. And so I saw myself more as a teacher and a teacher of history and even going into medicine for me, I saw myself as a black bag family practice doc. But what happened to me was life as a journey. And it's like a lot of Chinese philosophers say, Lu Zhen is a famous Chinese philosopher who talks about roads, and there are no roads, and when there are no roads, a road is formed because people walk on that road. And so you walk your journey and you take your opportunities. And sometimes you don't know exactly what you're interested in or not interested in. And so even when I ended up saying, I want to go to medical school now and try to help people in underserved communities, I couldn't tell you the difference between a neurologist and neurosurgeon you know, at that point in my life, and you just keep walking the road, and it turns out I've always been fascinated by people with tremors and movements and saying why. And I said, I would never do research. I'm a teacher. I would never do research. And then I realized that the government will give you a whole bunch of money to study things that you're super passionate about that can help people. And so I was super passionate about figuring out where in the brain ticks came from. And so I've spent 20 years working on that problem, and we've developed devices, systems and things to try to address that problem, same with Parkinson and tremors and certain movements and funny walks. And so I've always been fascinated by that. I think the secret is, you find your passion, you spend as many minutes as you can doing your passion. And if you can get somebody to actually pay you to do it, then that's the bonus, but the bonus doesn't always happen. And I think in my life, all of those things have aligned and I have great joy every day that I come to work ,every day that we go to the operating room, Kelly and I, I have great joy. We're always thinking, we're always innovating. And we consider our labs a continuous beta test. We're always writing papers. We're always thinking about stuff. Now, one thing we're not for people that are listening to this podcast, we're not like business entrepreneurs. So we patented a whole bunch of different things: how you do a cap on this, how you do reporting on that, how a device would do this, how one side might turn this side on. And, we get involved with all of these things--vaccines--but our job is we just keep innovating, and then we hand that over to someone else and innovations square and let other people run with it, because our passion and our impact is trying to help as many people as we can. And so there are various different aspects to the creativity process, to the invention and the innovation process. And we have kind of a human laboratory, you know, in the operating room and in the clinics and in seeing people and they tell us what the problems are and we try to innovate for them. And the next steps happen as we try to create that, we try to write it down. Remember I like to write poetry and other things. We try to write it down and tell people what we did, and then the next steps will happen. So there is this beautiful process of innovation that happens, and there are a lot of people that quietly do that in the background like Kelly Foote and groups here that are just quietly doing their jobs, writing down what they're doing, and then letting other people take it to the next level and commercialize these things and make sure that they get out there to help people. And there's a great quote, I think it was Jonas Salk who they said, are you going to patent polio vaccine? And he said, well, that would be like patenting the sun. And so we're all into patents and innovations and everything. But at the end of the day, we have a certain amount of minutes on the planet, and if we can come up with innovations that are going to help and impact people's lives, I think that's what most of the people, at least on the medical disease side of innovation, are interested in. And so you asked me what my message would be for kids or young people would just be follow your road, spend as many minutes doing the passion that you can, impact as many lives as you can. Don't worry about the money. Don't worry about that. Just worry about how much joy you have in your heart. That's all you need to do.

Richard Miles (29:14):

That's a great answer. And whether intentionally or not, you summarized also a good chunk of the origin story of the Cade Museum and Dr. Robert Cade, who invented as you know, Gatorade, because he didn't have any idea how to take that product to market. He liked to write poetry. He had just a real joy in life for helping others and to his final day, he and his co-inventors, the number one thing they were proudest about, about Gatorade, was the fact that it became the cheapest and most widely available treatment for infant diarrhea in the third world. Wasn't intended to do that, but that's what they are really the proudest to have, not that it became a culture or a sports icon. And so it's nice to hear you say that, but just in different words.

Dr. Michael Okun (29:50):

I think it's a great story, and one I hope kids are listening to, but so many people will give you advice about your career and everything, and I think they make it more complicated than it needs to be.

Richard Miles (30:01):

You precluded my last question, was what would your career advice be? And you just gave it to me anyway, but it's great advice and really appreciate having you on the show. You're doing tremendous work, keep doing it. It's inspiration on all sorts of different levels and wish you the best of luck.

Dr. Michael Okun (30:13):

It's my pleasure, and we love the Cade Museum. We talked about being involved in non-for-profits, my wife and I are involved in, and we think it's just a great thing for not only this community, but for the world. So thanks for all you do.

Richard Miles (30:25):

Thank you. Radio Cade is produced by the Cade museum for creativity and invention located in Gainesville, Florida. Richard Miles is the podcast host and Ellie, Tom coordinates, inventor interviews, podcasts are recorded at Heartwood, soundstage and edited and mixed by Bob McPeak. The radio Cade theme song was produced and performed by Tracy Collins and features violinist Jacob Lawson.