Orthobiologics: Evidence-Based Medicine And Real-World Results | Conversations in Regen Episode 23

Evidence-based medicine and real-world results — what actually matters in your clinical decisions?
See What the Data Isn’t Telling You → Visit my Website : https://pxllnk.co/AD/BOBsite

This content is designed for doctors and healthcare professionals exploring orthobiologics, but patients and curious learners are absolutely welcome to follow along and learn.

In this episode of Convos in Regen, hosted by Dr. Ariana DeMers with guest Dr. Dwight Lin, the conversation tackles one of the biggest tensions in modern orthobiologics: balancing evidence-based medicine with real-world clinical outcomes.

Doctors are often caught between published data and what they’re actually seeing in practice—especially when it comes to platelet rich plasma therapy and other regenerative treatments. This discussion dives into how to interpret PRP results, when to trust emerging data, and how to think critically about orthopedic innovation without losing clinical integrity.
You’ll gain insight into how experienced providers navigate uncertainty, build confidence in their protocols, and ultimately deliver better outcomes using orthobiologics in the real world.

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

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Transcript

SPEAKER_02 0:00

You can read the papers all day long, but it makes a huge difference to have a group of colleagues who are experienced with it. If you feel like you can just power through the work, the insurance model has got us all like hypnotized. If you are trying to straddle the two, it's really hard. You can't be half pregnant. You are gonna have to come to a point where you feel like this is the right thing to do. I'm gonna do it.

SPEAKER_00 0:34

We are exploring the frontiers of PRP, BMC, MFAT. And this is an exclusive webinar series where we talk with pioneers as well as up-and-coming physicians for regenerative medicine. And we may tackle some more controversial topics and uncover cutting-edge insights that are shaping the future of interventional orthobiologics. So today I am going to talk to you guys a little bit. For those of you who don't know me, I'm Dr. Ariana Demers. I'm a board certified fellowship trained orthopedic sports medicine surgeon and regenerative medicine aficionado. I do a lot of training and educating both in orthobiologics and ultrasound. I have successfully moved my rural Northern California practice away from insurance-based care. And I focus almost exclusively on injection-based therapies in a cash-based model. And the most important thing that I want you to know today is I am passionate about helping physicians incorporate orthobiologics in their practice seamlessly. So I am so honored for Dr. Dwight Lin to be joining us today. He is the founder of Regenerative Medicine and Rehabilitation in Honolulu, Hawaii. He is a Harvard-trained PMR. He is Hawaii's only licensed Regenx physician. And he has been a member of the Interventional Orthopedics and Regenerative Medicine and member of Interventional Orthobiologics Foundation for quite some time. And he's had over 20 years of non-surgical orthopedics and regenerative care under his belt. So warm welcome to you, Dwight. You know, from the great state of Hawaii, we're all jealous until it floods, and then we're not as jealous. So I hope you've been safe recently. So welcome. So everybody, thanks for joining. Thanks for taking time out of our day to hear from renowned experts in regenerative medicine, maybe explore some controversial topics in both orthobiologics and regenerative medicine. And hopefully, you will gain actionable insights that you can implement in your practice immediately. So we will have a live QA session at the end to get your burning questions answered. So I believe that orthobiologic treatment will be first line treatments for musculoskeletal care in the next five years. The train is already leaving the station. If you are not actively offering these treatments to your patients, get on the train. It is leaving the station. So the question is, is how do you do it successfully? Successful integration of orthobiologics is sometimes really difficult. We know orthobiologics is the best treatment for our patients, but how do you be successful? Maybe you've tried some things, maybe you're thinking, I'm not so sure about the science, maybe the techniques are a little confusing or elusive, and maybe just the cash-based business is daunting. We didn't learn how to be business people in medical school. And then there's whole business of sales and marketing. So maybe you've just thought, I don't know, I'm just not good at this business thing. I don't want to be a salesy doctor. That's weird. But it's not your fault. You didn't learn that in medical school. None of us did. And you know, some of us are struggling on how to be successful. Some of us are stuck one foot in the insurance world, one foot in the regenerative medicine world, and we're thinking, gosh, how do we capitalize on this four billion dollar orthobiologics market? So some of you're saying, why is this so hard? Some people make it so easy, but here I am struggling. And what I'm thinking is we all deserve more. So if you are struggling, please put in the chat what you're struggling with so we can make sure to address that tonight and make good use of your time. So, how do we win, right? How do we win not only in life but in business? And while we are gonna be talking about our orthobiologic knowledge, we need a system. And we're not gonna go over all of this today, but we are gonna get a little further down the journey to be wildly successful in your orthobiologic practice. So we do need a system, and we're gonna get started with some knowledge, and for sure we have questions. So we're gonna get started and get down to business with our questions for Dr. Dwight Lynn. So I see a lot of regenerative clinics blending PRP peptides, IV therapy, hormones, and calling it optimization or longevity. So, what at what point do you think that it stops being medicine and starts becoming this wellness marketing piece? What are your thoughts on this?

SPEAKER_02 6:19

So, uh yeah, first of all, thanks so much for having me on your on your event here, Ariana. I think this is a really important set of topics for physicians in orthopedics to be looking at. And it's it's challenging for all the reasons you just mentioned. Most of us in practice are learning new things all the time. And I think that's that's where orthobiologics is, you know, we we aren't letting our practices and our patients' outcomes be determined by basically ration, resource rationing from the insurance model, right? And so I think the other end of the spectrum is is kind of getting into this wellness model. I think the the most successful orthobiologics clinics that I've seen are really strong on anatomy and precision and making a careful diagnosis. And I think where I still struggle to integrate a lot of the peptides and and hormones, the whole optimization thing, which I do think is important, right? You need to have a good healing environment for the platelets to do their thing or for cells to do their work. I I feel like if it's a situation where a treatment can be kind of swapped out depending on regardless of what the diagnosis is, and I think it's kind of gone too much towards marketing. I think a clinic that is really focused on understanding the biomechanics and the anatomic cause, as long as those other modalities are trying to optimize that, I think that still seems reasonable, like a fair thing to be doing. But what do you think?

SPEAKER_00 7:57

Yeah, well, you know, I agree. And I always tell my patients, my first job is to get the right diagnosis, right? Because if you go off the rails there, all bets are off, right? So I am really obsessive about getting the right diagnosis. I do all sorts of things. We test, we look, because if you start off on the wrong foot, it's really hard to get back on track. When you add hormones, I personally do a lot of optimization. I do nutrition, I do hormones, I do consideration of peptides, especially the ones that are within the FDA purview, uh, IV therapies for the right patients who are nutritionally challenged. And so that is optimization. There's a lot of testing that goes on, and we know that you know the the base or this body that is not nutritionally optimized, that is not sleep optimized, that is not stress optimized, that is not hormone optimized, is not do gonna do as good of a job at healing. And so I I you know I kind of cringe both ways, right? Because you see some a bunch of this wellness marketing, you're like, you're sort of right, but man, uh, you gotta do a really good job at making sure the diagnosis is is right first. So I I 100% agree. So if you stripped down your practice to only what has strong level one or level two evidence, what percentage of your current offerings would survive?

SPEAKER_02 9:42

Yeah, I still think uh a reasonable, yeah, probably over 60 to 70 percent. Well, probably more 60 percent. I think what's actually more important than what the level one evidence is may or may not be showing is you know, a a patient in a double-blinded placebo-controlled trial is not the same as a complex chronic pain patient coming into the office who needs help for chronic low back pain, which in and of itself as a diagnosis is you know, is is a huge box of things to unpack, right? So I think as as important as it is as physicians that we really focus on evidence and data, I do think where orthobiologics has to always push is clinical experience. Because that's really, I think, where we've we've kind of lost our way as physicians. I feel like the insurance industry has, you know, because we're for so long, most of us have been, you know, following ICD 10 codes and and letting that process dictate how we're allowed to look at a patient or how much time we can spend with the patient. And so I think that if we are gonna practice orthobiologics responsibly, I don't think we can wait for all the data to always come through. And so that's why a lot of times, yeah, there's you know, we have to lean heavily on the data and the evidence-based data, but if there's data on, you know, introsseous injections for the knee, do we have to wait to go on every other part of the body? No, I think you have to use your clinical judgment. And same thing with using platelets or platelet lysate to to get results. So I don't think I I would be going out of business if you took all of my level one data treatments, or you if I only did level one, level two treatments, but the reality is that is where the difference is gonna be made in a clinic that can really that can really perform. Because if we're waiting and waiting just for that perfect scenario, it's that's not gonna happen.

SPEAKER_00 11:42

Yeah. Well, so interestingly enough, you know, the FDA has changed their stance on randomized controlled trials. And they recently came out with a statement that said that they are putting significant weight on real-world data, meaning registry data, outcomes, patient-reported outcomes data. So I think you're exactly right. We can't just base our treatments on randomized controlled trials. Well, I will say though, is when we have that aggregate data, that is much more translatable to the real world, to those patients, those chronic back pain patients that are coming in. And if we have a very large database of patient-reported outcomes for a given treatment showing efficacy, showing effect, I think that's as strong or stronger than those randomized control trials that are artificially kind of, you know, stripped down and have really no real patients in them, right? So that's been for me one of those really encouraging signals in the field is that the value of real world data has significantly accelerated what can be done. And it's pushing FDA approvals for a lot of things, is if you can present your real world data as a surrogate to randomized controlled trials for getting approval. So that's you're exactly right. Absolutely. So, Dwight, we still have more questions, of course.

SPEAKER_02 13:24

Oh, okay.

SPEAKER_00 13:25

We have massive amounts of questions. I'm always asking questions. So, do you think regenerative medicine, the regenerative medicine space is currently over-promising outcomes to patients? And if so, where do you think the line is being crossed?

SPEAKER_02 13:43

I think it that the market is if you'd like. So I I think, yeah, the the reality is there, I mean, we we live in the internet age of marketing, so I I think there's gonna be a lot of hype out there. And so when you know, Mel Gibson and Joe Rogan are talking about miraculous cures for you know everything from Parkinson's to autism to spinal card injury with an IV injection, I think there's a lot of expectations that that get blown out of proportion, right? And so even when I go into a room to discuss something with patients, I think they're hearing certain terminology and they have these very, very high expectations. So I I think what's really, really important is to set realistic expectations. And even though it might not be the not the easiest conversation to have with patients, you know, I we we turn patients away quite often if I you know, if I really don't think it's gonna help, or if I feel like you know this is not appropriate, like we're gonna say it. So does that answer a question there?

SPEAKER_00 14:43

Do I do I think it's absolutely I mean, you know, so when we're talking to patients, you you you know, you're like, gosh, I really want this to work. And sometimes I feel like, what is PRP not good for, right? Shoot, it's good for a lot of things. And so am I overpromising that it's going to be beneficial for tissue healing, whether we use it in the shoulder or the foot or the knee or the hip? Well, sometimes it sounds too good to be true, but in reality, it's just harnessing the own the the human body's ability for the reparative process. And so while it does maybe sound too good to be true, I don't think we're overpromising in that realm, right? So yeah, yeah, that absolutely answers your question. And I do think that that's an ethical responsibility that lays on the physician to not just, you know, give it to everybody and say, well, let's let's just try it, you know, go and go in like hotcakes. Everybody gets one, whether you need it or not. So I think that there is that ethical responsibility to turn patients away who are not good candidates. And I think it does more for the field and elevates that field if we're treating, if we are appropriately treating patients who are going to have the proper results. I think that's really important as a as a physician to guard against outcome dilution for when we're using these for improper applications.

SPEAKER_02 16:18

I mean, I what I've seen more and more often, I think is that there's if there's clinics or practitioners are kind of new to it, and it almost becomes like a, hey, it's it's good for what ails you type of approach. Um, and I think as you become more experienced with the technology, you start to realize, like I said, older patient, different type of pathology versus a 24-year-old, you know, soccer player who just got injured, you know, four weeks ago. And so again, that that clinical judgment I think makes a big difference.

SPEAKER_00 16:46

Yeah, yeah. I mean, and that's I think that's one of the things that I really struggled with is when I first started out, was that I didn't have any experience and I was, you know, struggling with that. Um, so how do like how do you get really smart really fast with this, you know, with the clinical judgment piece? Does it just come with time? Or, you know, what do you think were the the top things that you really benefited from to be able to kind of accelerate that clinical judgment piece?

SPEAKER_02 17:29

Well, you know, it's interesting. I don't know if you if you got to spend some time working with Victor, Victor Ibrahim before he passed away. But Victor and I had spent a lot of time talking about things, and he at one point he did say to me, because I was very skeptical, this is you know, this is 12 years ago, and I I said, you know, you just can see it in my face. And he said, you know, Dwight, like if you look at the data, at least look at it carefully with an open mind. If you're gonna go into it and you know just totally reject the data as it is, like I think you you need to look at it with an open mind and and really embrace it for what it is. Otherwise, you know, that that comes through in how you're going to use the technology. So I think for anybody here too, you know, you do need to do your homework and and understand what the technology is about and and why do we use a higher concentrated peer-to-peer. Why do we, you know, why do we why some doctors prefer to do intraosseous injections rather than intra-articular? I mean, you need to understand why, so you can educate your patients. And patients are smart, they know, they can tell if you're just trying to offer them something quick, you know, really, you know, really embraces something that's gonna help help them.

SPEAKER_00 18:38

Yeah, you're so right. You know, if you're offering it because you want to make a quick buck versus if you're offering it because you really believe and you know the science and the data, and you're like, oh my gosh, this is really gonna help you. And here's why. I think, yeah, we're not, you know, we're all grown-ups here. We all uh are very clear when we're being sold to versus when we're being, you know, when when our physician is coming alongside and saying, hey, you know, we don't have a ton of data, but the data we do have is amazing. And you know, day by day, week by week, we are amassing a very large amount of data. And so still the age-old outage is like, oh, there's not enough data, which at this point in 2026 is clearly not true. You know, I had a patient come in today and I was talking to him about PRP, and there he had all of the trials listed out and the outcomes, you know. ChatGPT does a great job, Claude does a great job as and telling him like what the data is, right? And he's like, I don't know what ESCA is. I was like, Well, that's a European society. He's like, Oh, and but what it said, and what I was really impressed about is there was an N of 76,000 treatments from an ESCA paper. I mean, that is a massive data set, and so this is not dabbling. This is not, you know, oh, this fringe thing. He's like, man, it looks like all of Europe has been doing this for a while now, huh? I was like, yeah, well, that might be true. So, you know, in five years, if we we, you know, what's one treatment that you're offering right now that in five years you look back on and say, ah, maybe that wasn't the right choice. Is there anything that sticks out? Because, you know, even now, like, you know, 10 years ago, I was giving cortisone to everybody, right? Oh yeah. Surgeon, like, get a get it well as high.

SPEAKER_02 20:42

Like cortisone and penal and transilone, right? With the flavor of the day.

SPEAKER_00 20:46

Right, right. And so then I like now with all the data coming out, I'm like, oh my goodness, like I'm cringing, and I'm thinking, how many hip arthritis patients did I speed up their arthritic change? How did I accelerate and increase their risk of a lot of bad things? Like, I know it's I I didn't know at the time, but you know, when we look back and five years from now, when it's you know 2031 and we're thinking, oh my gosh, can you believe we did that? What do you what do you think is the the one thing that you're like, hmm?

SPEAKER_02 21:24

You know, I think it's probably not being more precise with the procedures that I do. I think, I think, you know, we all go through this learning curve, right? Like we we are kind of new to it and we kind of you know, we're not as aggressive as we should be. And then I think you go through this phase when you're super aggressive with stuff, and then you kind of then you become more refined with the technique. When I first started using a a lab to prep PRP, I think I did a, I think we dialed it up to like a 30x concentrate, and then we injected a patient who had bad CMC joint arthro. And she came back, like her hands were like super inflamed. She was not happy at all. And so I think what is it that I will look back on and say, I probably should have been doing that. I think there are definitely things that we're doing that will become more refined, but you're you're not, I don't know, it's it's not always that obvious. I think if anything, there are things I'm probably doing now that I'm not being as precise with. You know, we talk about treating a functional unit in the spine. We look at a spine and and the pain clinic has been treating, or the the spine surgeon wants to do a microdisc at L5 on the left, uh microdyskectomy on the left. And we are seeing listhesis at two or three levels above, we're seeing facets three, you know, three levels above, and lax ligaments, we're looking at treating everything. Do we need to treat everything? Biomechanically, you could make the argument for it, but could we be more selective? Yeah, probably. I mean, I think there's ways we'll be more our our clinical judgment will get better with time. So I I think I I really believe in what we're doing right now in terms of data. Like I feel like this is using platelets and and cells is a much better way to treat any of the pathology than using any type of a cortisone shot or ablation procedure. But I do think in the next five years we'll be much more selective on how and how where we place those things.

SPEAKER_00 23:23

So I had the luxury of traveling to Colombia and I went and saw a stem cell clinic down there, and I had that was I it was like a full day of scientific uh, you know, presentation from all the data scientists and all of the clinical scientists, and I had this distinct feeling of being a little bit like man, I I'm what I'm doing is pretty crude because you know they have these full purity culture expanded cells, and they have their you know exosomes and fully characterized, and and they do use PRP for very select population of young healthy people, right? For more metabolically challenged or the you know these other things, they're not recommending autologists for the reasons that we kind of hint at, but in this country we don't have the ability to pick and choose, right? So I I did have this like this feeling of like, oh, I think we're behind with what we do, and I had just like the you know, previous week I'd done a Belmairo Harvest and an out of post-harvest, and I'm thinking, ah, these are great. And then I go and I look and I'm like, wow, this is the next step forward.

SPEAKER_02 24:53

So do you think so? I guess my question is when you're were you able to pull back the curtain and see all those safeguards and all those features to make sure everything was being done meticulously.

SPEAKER_00 25:04

Yeah, so you know, it was very cool because they had their lab is on site. There they have a massive ISO 7 GMP facility on site at the site of treatment. So their clinic and their and their GMP facility are on this on the same premise.

SPEAKER_02 25:20

So where do they get their cells from?

SPEAKER_00 25:22

Yeah, so that is uh umbilical cord, Wharton's jelly as the source, and and they have a it was really impressive. I was like, oh, they have a chain of command from from harvest at the birth, and they they follow this these this whole thing, it never leaves their chain of command through the time when they apply it to the patient. I was like, okay, well, mine doesn't either because I do it on site, it's in my lab, but you know, at a post-harvest or you know, bone marrow concentrate is like it's great, and they do some of that as well, but man, it was pretty slick, right? And if you look at uh some of the data for culture expanded cells, it's like for certain applications, I think it is going to be that next step.

SPEAKER_02 26:21

I know I'm sure there's there's amazing technology that we yeah, we are not able to do, but I still feel like if you had a choice between your own culture expanded versus Stranger X, I don't know. You gotta be supremely confident in that chain of command.

SPEAKER_00 26:38

Yeah, yeah, no, absolutely, absolutely.

SPEAKER_02 26:41

And as much as we we complain about the government and the regulations, things are so wacky in DC right now. I mean, who knows what'll happen.

SPEAKER_00 26:50

Yeah, it it is, you know, there's a lot of complaints about FDA and has been for years that they've been so slow, and they've been slow. And so, you know, you never want to be first to the the finish line and you never want to be last. So I think you know, this is something that I'm very interested in, and I think you know, in five years it'll be very different from how we do this today. But I don't know which way, right? Yeah, I'm definitely keeping keeping my popcorn and watching the show. So I have a couple more questions for you. Yeah, you know, so in your practice, you're not just doing injections, right? You are having optimization, you're combining these precision treatments. So, what have you had seen clinically when you're treating the whole patient instead of just a standard interarticular injection or standard, you know, one-sided, one-level TFE, like we used to do with, you know, a steroid, right? What do you what's different?

SPEAKER_02 27:57

Well, the patients are so much happier. I think, you know, when you when you talk about someone who's got you know meniscus tear and medial knee osteoarthritis, and they got a painful knee and they've got L4-5 weakness because of a chronic spinal scenosis, they're gonna feel so much better when the mechanics of how they're even distributing force through the knee joint is improved because they've got you know improved neuromuscular function controlling the joint. So I think to your point, we we've become so myopic, I think, when when it comes to pain management. And I think, you know, as we were speaking early before we started about mindset, I think the whole pain management industry is so myopic. It really has become this field where it's just drilled down on the one pathology and burn it away. And I mean, that's why we got in the opioid crisis, you know. I mean, it was just such a blind-sided approach to everything. And so I think for doctors here who are looking for like, what are we, what are we striving for in orthobiologics? We're we're trying not just to, we want to help people in pain, of course, but we're really trying to get at the source of the problem beyond just like where does it hurt the most? And so patients are so much happier because they're used to going to see, hey, no, we can't talk about your your back because we're focused on your knee today and we've only got 10 minutes. And so I think to be able to make that shift, but it it takes a it takes a mindset shift on behalf of you know the doctors who are trying to change how they practice. And it's been hammered in so hard because of because of all the the codes and and all those sorts of things. And so it's a you know, but when you're talking about how do you help someone improve their strength, the range of motion, like getting back to the slopes or you know, getting back in the court, like there's no comparison, they do so much better.

SPEAKER_00 29:57

Yeah, you said something that was really interesting. You know, so you said it's a mindset shift, and you've got to maybe get to the root cause. And and you know, this is a bit cliche, like, oh, I I practice root cause medicine, but we really do. And I think I would call I would go so far as to call it whole person health, right? Where we're focusing on what drives health instead of what is driving disease. And so, you know, thinking about that, but I think even one step further is and and what I uh you kind of alluded to is it's a different style of medicine, it takes more time, it takes more precision, it takes more care. And in the standard, you know, insurance-driven care, you you as a uh physician don't have enough time, autonomy to say, yeah, no, this person needs an hour because you're not compensated for the quality of care that you give. You're it's just another widget, it's just another next, next, next, next, next, right? And so it's not the the way the system is constructed has nothing to do with getting good outcomes. It had it is a numbers game only, and it's a volume-driven solution instead of an outcomes-driven, value-driven solution. So that I think that mindset shift is is so important. But I also think you know, it you were said something about your patients, like, oh my god, they're so much happier. And what about the doctor, right? Yep, you're so much happier when you need to take really, really good care of patients, they get awesome outcomes. And you're like, oh my gosh, I'm I'm doctoring. Like, this is great. Yeah, this is what I went to school to do, like real doctoring, right? Taking care of the whole patient and not being restricted to, you know, oh, I only do right knee, right? Like that's I always joke, like, oh, you've got to go to the different surgeon for the left knee, you know. Yeah, we've gotten so myopic, so siloed, you know, that's the running joke. But what a what a really good consideration that it is mindset and it is important. So in your experience, what do you think is the biggest factor that determines whether this you know, a regenerative treatment succeeds or fails? And and we're gonna say maybe the things that maybe the intangibles. When you get when you come in and talk to a patient, what are those intangibles that you're like, oh man, these people are gonna do great?

SPEAKER_02 32:50

Oh, I I think a lot of that has to do with how we educate the patients before they even come in. I think if they have the expectation that their doctor is gonna spend time with them to understand what's happening there, if they've heard, like, oh, I I heard you know, you do an ultrasound when I when I come in, you're gonna take someone told me you're gonna actually take a look and you can tell me right now, is there flu in my knee? As opposed to, hey, we'll see you back, you know, in two weeks and and we got to get authorization for this or that. You know, I think having imaging studies, getting all that stuff slotted up in advance so patients feel like they're being efficient with their visit makes it makes a huge difference. And the patients that, you know, the patients that everybody everybody wants that efficiency, but I think the patients that are being more proactive about it, they come in expecting that they they have better outcomes. Part of that, I think, is is educating our colleagues about you know what we do and how how differently we go about it, and how it's not just the scan, but that scan is a piece of puzzle. I need all of it. I need all of it to do a careful examination and to go over the medical history. I I can't do this if we're gonna spend five different visits doing jumping through this hoop or that hoop. I we gotta have all that information and time to sit down and examine the patient, talk to them all at once.

SPEAKER_00 34:10

Yeah, to the to that end, do you require all the labs, all the MRI, all the data before you ever see the patient?

SPEAKER_02 34:19

No, we don't require it because our patients are struggling with the system too. And they're still, you know, they come, they come to us like looking for solutions. But if you're saying like, what are the biggest factors that seem to determine if the treatment tends to, but I think it's when patients come in with the expectation, like, look, I'm ready. I'm I'm going through the trouble of getting all my stuff together. Here it is. Please, like, this is everything you need, like help me. And I think when they're when folks come in like that, that sets a really good stage for a successful outcome. And and sometimes the successful outcome might only be, you know, 30 or 30 to 50% improvement. But if that buys them time to to avoid fusion or to avoid getting that joint replacement, technology is always getting better. The implants are getting better, the material science getting better. I mean, surgical techniques are constantly being refined. So anything we do to help patients, you know, hold on to what Mother Nature gave them, that's that's kind of what we we try to help people with.

SPEAKER_00 35:22

Nice, nice. So, you know, I think you have built a practice in a very high expectation cash-based market. What are the non-clinical elements that you've draw dialed in to drive patient trust that then drives outcomes? How do you accelerate that trust factor for your patients?

SPEAKER_02 35:49

That that's actually something I I didn't have a chance to think about a whole lot, right? The non-clinical. I think I I know that part of what we do here is we we try to create it, try to create a situation where it's easy for patients to to feel comfortable and confident when they're coming in. Like I don't, I don't do the other things. People still think I'm a pain specialist. You are, right? Yeah. But but we don't, you know, I don't, we just don't have those other options here at all. And so when patients come in and they're looking at the materials or they're hearing about things, or I'm explaining things and the staff, I mean, everybody needs to be on the same page. I think when when clinics are doing ablations and epidural steroids and and everything else, microdyskectomies, and oh, by the way, yeah, we do regenerative medicine too. Here's a brochure, you know, maybe it'll maybe it'll help you. You can try it if you want. Like that's a very different experience for a patient than when they come in and where, you know, everybody from the person who answers the phone to my medical assistant to even someone who's calling to make sure that they are ready for their procedure has an understanding of what what the patient is coming in for. And that's a very different experience than if they go into the pain clinic at the hospital where it, you know, it's just they're just a number and they're they're gonna go in and wait for 45 minutes in the you know, in the hallway in a hospital gown, right?

SPEAKER_00 37:20

Yeah, yeah. So it's a curated experience. Um and I think we have the same or similar experience where you know, I have very intentionally constructed the lobby of our office to feel like when you, you know, when you step into a spa and you're like, huh, okay, and it allows that expectation, it allows the annoyance from the outside world. Maybe you had trouble parking, you're finding and you're rushing. And when you step through our doors, you know, you are met with that sensory experience of you know, a water feature, of soft music, of a calming scent, a welcoming face that knows your name. And you know, you're like, oh, you know, when you sort of like the same thing when you get off the airplane and someone's holding your your name, you're like, Oh, yes, that's me. I'm here. This is so great. This is all just for me, right? And so that experience, I think, changes how people experience care instead of having to fight to get heard, instead of having to to you know, fight to just be seen, they can then relax and avail themselves to this this give and take relationship with their physician, where you know, this allowing us to be the guide towards health, towards wellness, towards recovery, I think for for us has really been helpful for our patients.

SPEAKER_02 39:02

Sure. You know, to that to that point, Arian, I think the other thing is it's so important also to think about the language that we use when we're speaking with patients. I think, and that's something that I have to talk with my staff about sometimes too. Even subtleties and language and inflection can really encourage a patient to feel more confident in what's going on. There's, you know, it's it's interesting when you are coming into a situation where you're thinking about taking care of the patient, not just the pathology, but as a whole, you're thinking about what they're hearing when they're getting a procedure done, what the staff is saying, like if someone drops something, if you know something something makes a loud sound in the middle of procedure, you know, how you react to that. And so all those things I think make a big difference in terms of how the patient feels when they're coming into the office. And they I think they should have a, even if it's not something they really perceive consciously, I think it's something that makes a big difference in terms of how they feel about when they come see you, yeah.

SPEAKER_00 40:09

Yeah, I think I think that part of our patient journey is something that we haven't been taught in medical school, but I think it's worth, and for everybody here on the call tonight, I think it's worth really considering. Number one, from the patient's eyes and perspective, how is your office perceived from when they pick up the phone? Are they exuding care and confidence and and kindness and helpfulness? You know, as you walk in, is it clean? Is it you know bright and airy and like feels like a great place to get better, right? So I think doing a quarterly audit of your office, of the way that the pre-patient perceives the office is really important. And you know, we can always get better, we can always improve. Um but I think a quarterly audit is really important to kind of slow down and and take it from the patient's perspective and walk through and be like, uh, that felt like not so good, or this room is like pretty rough, right? And that it just doesn't instill confidence that they're gonna get well taken care of. So I think uh that's something that we have instilled in our clinic is this quarterly audit to make sure that the patient journey is what we want it to be so that we can have the patients feeling a certain way, right? Taking care of loved because that's that's that's part of our ethos, that's part of what we do for our our patients and for a clinic, and not only for our patients, but for our coworkers and everybody. Like this this part of the lucky thing about having a private practice is we can construct it to serve our patients, serve our employees, serve our uh fellow physicians, uh practitioners in a in a way that makes everybody really excited and do a great job.

SPEAKER_02 42:09

Yeah, 100%.

SPEAKER_00 42:12

Yeah, awesome. Well, so I I just want to share, you know, we so this was something that we have been talking a little bit about is this insurance-driven care, right? And and so how the heck, like I I I something is breaking, right, in medicine. What's happening right now is we know medicine is getting harder to practice, and it's getting really hard to be a very good doctor. We have less time, less control, more pressure. And let's be honest, like most physicians feel that, but are at a at a at a loss of this clear path forward. Like, how do we make it better? If you ask any physician, like, how do we make the the medical system better? They're like, oh man, I have no idea. Not only are we supposed to be like fixing the system, but how do we even look out for ourselves and our patients? That's that's a daily task that is uh really rough. So this isn't a skill problem. You're not undertrained, right? It's the wrong system. The system that we currently have is limiting us. It's limiting how we can deliver care and how we're compensated for it, right? No matter what we do, whether we do a good job or a bad job, we're gonna get paid the you know, the $45 that the insurance company wants to pay us. Like that's not in the patient's best interest, and it's not in the physician's best interest. So, this future of medicine is not an evolution, it's not gonna be an iteration of what it is now. We are on the precipice of An a completely different system, right? Traditional insurance-based medicine is volume-driven care, controlled pricing, limited interaction, fragmented care where you go here and here, and nobody's talking to anybody. That loss of autonomy for doctors, where we can't even make good decisions for our patients. And when we transition to a different system altogether, we then are able to, with orthobiologic cash-based care, have this value-driven, outcome-focused care where the physician is controlling the pricing. We have the time, the luxury of time to evaluate and treat our patients. We do root cause and regenerative care. We're actually helping patients heal tissue. And we are able to be the decision maker and align with our patients and get paid for doing it, right? This is a completely different practice and system of not just adding that service of regenerative medicine. So a lot of patients and and they're they're frustrated, but I think doctors are more frustrated because a lot of physicians are feeling stuck, right? They know something's gotta change. They take a course, maybe learn regenerative medicine, maybe they take a you know injection course, but really no one is showing them how each piece of the puzzle is put together. And so, you know, you don't have the integration, you don't have the structural framework, there's really minimal support out there to be like, okay, how do we do this? And then as physicians, we've been told that if we don't know every single thing about every single thing, we shouldn't even consider starting because of the risk. And so there's a lot of fear of getting it wrong. Uh so the problem is if we don't solve this problem, then physicians are going to be uh dependent on insurance, continue this uh cycle of burnout and dissatisfaction with their job. And the reality is doing nothing, right? Staying stuck is still a decision. And it means staying in the system, but it's getting harder to win in. And all along, the physicians who figure this piece out are gonna be able to move ahead and thrive. So there is a way, there's a structured way, and what's not been missing is information. Man, we just talked about all of the data coming out, but what's been missing has been integration, and that's why we have built a program called TrueMD, and it is a structured framework that brings together clinical, technical, and marketing business, and then also shows you how to actually implement in that in your practice. So I am introducing it. This is a three-day program. This is not a conference, this is a small group working session to build your roadmap. And this is uh not a passive event. You're not sitting and listening and scrolling, doom scrolling through Facebook, you are sitting and building every hour, every day with guidance in real time. And so at the end of the weekend, you have your roadmap, you have your plan, and you have support ongoing after the event. So, what I'm going to ask of you all is that at some point, every physician has to decide am I going to adapt where the medicine is going? Because we know that this is going to be first-line treatment, or are you going to stay inside the system, right? That's getting harder to sustain. So if you know there's something that needs to change, but you don't want to figure it out alone, this is why we built this. And it's not for everybody, but if that resonates with you, take a few minutes and scan that QR code and see if this is the right fit. And I'm confident you will be very intrigued. You'll be the right fit. And then we can see you in Phoenix. It is capped at 40 physicians, so definitely once we hit that 40, we will cap it. It'll be closed, and you will have to wait until the next practice launchpad live event. So I just wanted to invite you all to that. I wanted to thank you all for being here. We have now the ability to open it up to QA. So I will take a look at our chat if there's anything that is in the chat, any questions that are you're wondering about both, you know, PRP, functional spinal unit, optimization, how it is that you've been so darn successful. You know, if no one else has questions, I definitely am gonna, you know, put you on the the hot seat and ask you, you know, what those qu what those decisions along the way have been. So I'll open that up if anyone has any questions about how Dr. Dwight Lynn has been so successful in Honolulu, Hawaii, really changing the way that care is delivered for his fellow Hawaiians. Please raise your hand, speak up, put your your comment in the chat. Otherwise, I get to have the chat full time and we'll go from there. So, Dwight, when you first started out and started adding this regenerative medicine, PRP, to your practice, what was the single best decision that you made that that pushed you and said, okay, I'm gonna do this?

SPEAKER_02 50:20

The single best decision.

SPEAKER_00 50:22

Like, how did you what what how did you like you were like a pain doc. You were like doing your thing with cortisone, hanging out, and next thing you know, you're offering these newfangled treatments. Like, how what was that decision that that kind of flipped the switch where you were like, you know what, I gotta do something different?

SPEAKER_02 50:40

Well, you know, when I started doing this, there there actually wasn't a whole lot of data. I think there was there was a study out of Stanford on lateral epicondylitis, right? There's like one study. And so like Dr.

SPEAKER_00 50:54

Alamisha, right?

SPEAKER_02 50:55

Yeah, that's right. Uh Alamisha study. And when we were starting to do knees and then spine, like there, there was not a robust database at all, right? So when the study started to come out, that I think that was around the time when Victor and I had that conversation. He said to me, He's like, Dwight, you you have to look at the data and believe in this stuff because otherwise you're not gonna implement it. So I think for a lot of doctors who might be tuning in and listening, I think if you if they have been practicing an insurance model, it is really a big mindset shift. And and I'm not I'm not gonna make it to your conference, Ariana, but I would tell for any of your you know people who are here on the chat, it's actually really important you do get to work with someone in person. You know, it it makes a huge difference. You know, we all go through, we're all surrounded by our our assistants and our medical assistants or colleagues during the day, but to be with a group of people who are really focused on ortho biologics, that makes a huge difference. And so, you know, we we talk about I can bring this up again, the mindset is so important. You can read the papers all day long, you can read the studies, you can look at your textbooks, but it it makes a huge difference to have a group of colleagues who are who are experienced with it kind of leading you through it. And if you don't believe that the mindset matters, if you feel if you feel like you can just power through the work, you know, the insurance model has got us all like hypnotized. And so if you are trying to straddle the two, it's really hard. It's a you know, it's you can't be half pregnant. I think you you have to, you are gonna have to come to a point where you feel like, all right, that this is right, this is the right thing to do, I'm gonna do it. And so for me, it was always feeling nervous, uh, that you know, yeah, there's not a whole lot of data for it. And that finally, you know, I think somewhere in mid-teens, 20 teens, like there was a lot more data coming out, and and then that was a big shift for me. But I think what accelerated for doctors who are still lukewarm is to go to a conference where, like something that Dr. Namares is doing, where there's a group of experienced physicians who are, you know, they've been through it, and and that is so critical to be in the right state of mind to do this work. Because you can't be, you know, oh yeah, we do PRP too, and there's a little bit of this you can toss in there if you want. It makes a huge difference to really be focused.

SPEAKER_00 53:20

Yeah, awesome. Well, there's a question from Amit Lak, and he would love to know what a regenerative lab looks like. What bits of equipment are needed, who do you employ? And he says, thank us in advance from down under. So I'll let you answer your piece and then I'll give a little preview of what I have in my lab.

SPEAKER_02 53:40

So, and since you've been you've basically been in my lab before, Ariana, so you kind of know, but I think you know, of course, I know everything.

SPEAKER_00 53:48

Come on.

SPEAKER_02 53:49

There's there's a time period where you know we just had these generic kits in early 2010 or so, there were these generic kits floating around. Dr. PRP, take you know, a few, a couple tubes of of blood, and then there was a period where if you really want to be able to get higher concentrate and isolate things, you need to have a sterile lab, you know, a positive pressure environment where your tech can process lab and blood with open open containers, and you've got protocols in place to make sure nothing's gonna cross-contaminate or or get patients mixed up, right? But but now there are other ways to get higher concentrations and to isolate what you need. And and you know, all right. I'm sure you could spend like a whole afternoon talking about the different technology that's there. Yeah, but uh Dr. Luck, I think there are things you need to do to be able to process uh if you're in Australia. I don't know exactly what the limitations there are.

SPEAKER_00 54:45

If you can't can you you can't grow and use blood just the same down there.

SPEAKER_02 54:52

But I think yeah, if you're just talking about processing for PRP or a bone marrow, I think those are pretty there's systems that you can get a hold of. You don't have to have like a sterile lab. You need you you need people who are skilled at performing things with sterile technique, but you don't have to necessarily build out a whole sterile lab to get started.

SPEAKER_00 55:10

I think the best best practices, if you're gonna be using conicles and open, open, you know, what we would call home brew, then I think having uh a hood or laminar flow is still best practices. It's not required to get the high concentration PRP. We've shown across the board that is some of the high performing kit-based systems can get you really good results. I actually used to open process and I got my hemocytometer to prove that I could back engineer a kit to do exactly what I wanted to do from open processing to a kit-based system. So there's a lot of really good high-end kits out there, and but you have to know how your kit performs. That's the reason I have a hemocytometer, so I can know exactly what I have. And I would urge everybody to know what that looks like. I do have a part-time lab technician, she's also my LVN or you know, nurse. So, and across the board, I've trained all sorts of people to do my lab processing. You don't have to have somebody that's dedicated, but the the more you do it, I think the the more precise you can be about a repeatability across across the board of getting the same outcomes, getting the same injectate, you know, concentrations and you know, constituents as you would like to dial them in. Dr. Pandit had a question for you, Dwight. I might have missed it. What is your optimization protocol? And then do you charge them separately for it or do you bundle it?

SPEAKER_02 56:49

No, we we put that together in the treatment program. And I don't I don't do any functional medicine testing. There are certain things I I think I'm very probably overly conservative with in terms of you know which peptides we can use. I don't I don't use any injectable peptides or anything like that. There's some oral things we'll use. And you know, you just the way I would treat it is if you're just gonna do, I know with a lot of pain clinics, they'd pretty much just say when you're ready to get the injection done, but I think it's important to look at you know, metabolically, just at least checking your CMP and your CBCs to make sure there's nothing totally out of whack. And then you're you know, kind of doing like an endocrine screen to see if there's any other symptoms that are popping up. If you can partner with a good experienced functional medicine person, that's that's fantastic. But the other side of the coin is to is to go deep and learn that stuff too. And again, I don't I'm really just focused on the orthobiologics. I have not integrated a lot of the functional medicine component or the hormone replacement therapy, but I I do think there's value in it, absolutely.

SPEAKER_00 57:50

Yeah, so you know, for everyone in on that's listening, I do I have a uh four-week optimization program that I bundle into all of my orthobiologics. It is like a gym membership. You do not get to opt out. So we do draw basic labs, we call it Foundational Health, and we draw CBC, CMP, sedate, CRP, hemoglobin A1C, thyroid, and to really have a metabolic screen, make sure there's nothing too crazy. We also do a very like cursory hormone panel just to make sure that there's nothing like really overt. So, and then we do nutritional supplementation, anti-inflammatory diet, exercise program, macro optimization for you know that diet, and then and then we feel confident and comfortable to go forward with the regenerative therapies, and and then we keep them on supplementation, anti-inflammatory diet, all of those things afterwards as well. And it's included my foundational health program, it is included in every single biologic program that I do. So you don't I raise the price.

SPEAKER_02 59:01

So, but you don't you don't have an option to do that a la carte either, right? It's like this is part of my program, this is what it is, and so we don't really we don't really have the bandwidth to to dissect that and say, hey, you can just come here to get that that stuff optimized.

SPEAKER_00 59:17

Like, yeah, not for the foundational past. Yeah, I have a I have a full or you know, a full program that does more. It's we call it our reset program, but and that does a little bit more from a functional health standpoint, but um that is that is new and that's our you know our more of our longevity and functional health. It's it's like functional health, right? But we do hormones and we do thyroid and we do, you know, the things that matter from a musculoskeletal standpoint for me, right? I am a musculoskeletal clinic, but if you are estrogen deficient, we're still gonna have an issue with your tendons, right? So I do need to optimize you. If your testosterone is zero, we're gonna have a really hard time rebuilding your muscles. So those are those are things that are I'm never gonna be a functional health clinic, but I am gonna have really optimized patients for my orthobiologic treatments.

SPEAKER_02 1:00:11

No, that's the way to fly. Absolutely.

SPEAKER_00 1:00:13

Awesome. Well, Dwight, thank you so much for taking time out of your busy schedule. I really appreciate it. Is there anything else that you want to leave anybody with? Some thoughts, your last thoughts? Would you share maybe a little bit more about your thoughts and you know, your specifically the mindset? Like how how do you kind of get into this mindset to be really confident and comfortable offering these amazing treatments?

SPEAKER_02 1:00:42

So I don't know if I can I can get everyone to the mindset in 30 seconds, but I will say, you know, if you're skeptical about how important mindset is, how much how important it is the things that you say to yourself, the things that, you know, getting an EOB from an insurance company that's like $37, like what does that do to your psyche? You know, if I say to you right now, don't think of a pink elephant, what are you thinking of?

unknown 1:01:08

Right.

SPEAKER_00 1:01:08

For sure, the pink elephant, right?

SPEAKER_02 1:01:11

So it's not, it's not a lot of times, you know, like I said, you can study all you want, take the courses, but to be around a group of doctors who are talking about what it's like to implement it, who are troubleshooting things, who have been in the trenches before, and you're going through them with them, I think it that makes a huge difference in kind of getting your mind in the right place. But uh, yeah, if you're here listening in, then you're obviously taking the right step. So keep on.

SPEAKER_00 1:01:39

Awesome, awesome. Well, I've just put up a code. If you're not sure where your next step should be, you can just scan that code and there's a little quiz, and it can kind of tell you what the heck is the next step. So thanks so much everybody for listening. We did go over, but always love the insight from you. Dwight, I appreciate it. Dr. Dwight Lynn, everybody from Honolulu, Hawaii, uh, thanks so much for joining us. We'll see you next time on Conversations in Regenerative Medicine.

SPEAKER_02 1:02:06

Aloha, we'll see you.