Yeah, yeah. Doctor Cohen, you know, let's start with the basics. Could you. Yes. You know, tell me a little bit about yourself and sort of your path into medicine. Yeah. You know, that's a very good question, Chad. No, I want to thank you for doing this great podcast. You're a very creative and talented guy, and I'm so much looking forward to the series. We really want to just bring people into the world of medicine and the world of neurosurgery, what it takes to sort of go to the next level in terms of improving your health. And at the same time, some of the lessons I've learned as a neurosurgeon, my career interacting with many patients who have so much inspired me and so many others who have given me great lessons, and also some of the mistakes I've made that I liked myself and all of us together can learn from. So starting from basics, how did I end up in neurosurgery? You know, I came to this country as a refugee about 40 years ago, and I always wanted to do something special to give back to this great country what it gave me more. I knew when I really needed it, when I came to this country as a very poor immigrant, working very hard, trying to really prove myself and to this country and everyone that I'm worth it, you know what I mean? So when I came here about four years ago, 40 years ago, I wanted to do something in medicine to help people. But there are many professions. You can help people. It's not just medicine. And so the other thing I was very interested in something artistic with my hands. And I also went to medical school, and I was very interested in learning more. And art of medicine, I found a cardiac surgery and brain surgery were two that really your hands were especially important in healing people and eventually being in neurosurgery and going to the operating room and learning the incredible, talents needed to be able to use your hands to give life, to relieve suffering. Those were really incredible, moments. I saw the surgeon in the operating room and showing their art. And so I fell. Love and neurosurgery. Not because he was medicine, but because he was artwork. Because, I had a really this passion for technical excellence and bring everything to a new level to impact people's lives in an unprecedented fashion. And I think it's been a privilege. It's truly not a right, but a privilege to be able to be in this position. And it's been a God's blessing, really. I think God's faith, my hard work, God, family, country, and really what this country has given me have been all important elements that I'm forever blessed and appreciated for. Absolutely. So what was what was the moment when you were a medical student where you kind of have that. Well, yeah, this is like this is it like I am ready to do this. That is my life's calling. What is that moment? You know, I remember I was interested in either heart surgery or brain surgery and I went to both operations when I was rotating in these services in as medical student. And I just felt the brain is truly the, seat of the soul, the crown jewel of creation, and so much we don't know about it. And there's so much potential to improve and be able to work under the microscope, such delicate, you know, operations was really something that inspired me to go into it. And I had mentors who really supported me in or surgery to do that. Wonderful. So, so lucky, you know. So speaking of that, yes, mentorship and then institutions that you've, you know, been so privileged to be a part of and had such. Yes. You know, you've come back to, to the University of Southern California to, yes, to give back. So, you know, what what was that kind of spark, what sort of brought that, you know, conversation, you know, to fruition? Yeah. You know, I, I started in UC San Diego in college. I went to USC for medical school. I'm a Trojan. And then I went to Mayo Clinic, did my residency in neurosurgery, and did a couple of fellowships at Yale University, University of Arkansas, and then practiced in Indiana University for about 18 years. I'm indebted to Indiana University and the Hoosiers and the people of Indiana. It was truly an honor to care for them, the trust they had in me. I was able to perform over 7500 complex brain operations, which is unprecedented and really one of the largest in the world ever for a practice still practicing neurosurgeon. And after those, because most of my family are in Southern California, that makes sense, as I saw my family getting, you know, extended family getting older, coming home, having the kids go to, you know, their religious school and be able to keep the tradition again, God, family, country theme was important. So it was an honor to come back to USC at Keck School of Medicine and be able to finish the career there. Absolutely. You know, and, you know, kind of talking about tracking through your history, and you already had these like, pivotal moments that were, yes, for you. When did you feel like, you know, you had sort of you made early career kind of completed that transformation and like, like, today's the day I became a neurosurgeon. Yeah, that's a very good question. When do you really feel like you're home? When do you see. You know, I'm I'm really it. I go where I want to be after, you know, God knows 15 years of training, which is really incredibly taxing. Everyone comes to that moment at a different time in their lives. When do you have that confidence in the operating room that you can do this alone and you don't anyone to be around? I think I took a very proactive, effort during residency to learn every time I could and build a sense of safe comfort. And I think there's two types of confidence. You're confident you can hurt people, but you're confident knowing that you can get yourself out of trouble in the operating room any time you can. And I think that was during my chief residency last year at Mayo Clinic. There were just maybe the second half was when I really felt like I got home, and I'm home. I feel confident, comfortable doing cases that may have been made of not seen or done before, but because I'm sticking with the principles of surgery and I know how to get myself out of trouble, I can keep the patients safe. No. Absolutely, absolutely. You know, and so to have those moments where you're in those high. Yes. And you're, yes, you know, ground truth and first principles of your training, you know, what's your, you know, in terms of your day to day, you know, before you're going in the operating room, like, what gets you, you know, sort of in the zone. Yeah. Ready for. You know, that's a very good thing. Because what? It gets you in flow. I sometimes say, you know, athletes get in flow and the concept of flow that me Holly has defined and I, you know, advice people read his book. It's incredible. Is athletes getting to this total absorption in the task. And they don't know the sense of time anymore. You could be playing basketball like Michael Jordan, or you could be swimming like Michael Phelps for hours, but you have no sense of time. So what does it take to get in flow? And I think it is easy to know it when you see it, but it's very difficult to define it that total absorption in the task chat, I think it comes with a passion. You have to be the best at what you do without a question. To push yourself as farther as anyone has, there is no limit into your effort. You're going to put in your work, which I have always believed in, and there's also a sense of challenge, skill, balance. You have to do things that challenge you at all times to for you to stay in zone. And so I always do surgeries that are more and more challenging. I tackle cases that I push the boundaries to benefit the patient at any cost. And by making the case more challenging for the benefit of the patient and by really the passion to do whatever it takes to do better than anybody has ever thought about. I think those are elements that put me in flow to be where I am today. Absolutely. You know, it's something I've heard you say before is it's not just about being. Yes, you can do. It's about, you know, pushing yourself to that edge and being the best that anybody can do. Exactly. And, you know, it's amazing to see the kind of growth that people can, you know, have within themselves. When you know, you, you no longer accept that arbitrarily personal, you know, kind of, yes, you know, blocking down and instead you constantly push the ceiling up and the growth that you experiences as a person and as a clinician is, is really something. Right? I like what you said. It's doing the best anyone can but not do the best you can. When patients come to me and say, you know, Doctor Quinn, can you do the best you can right before surgery? I said, don't ask me. Don't expect me to do the best I can. They all get surprised and, you know, get almost for a second scared. I tell them, you should only demand that I do the best anyone can, because that's what you deserve. That's what every patient deserves. And you should never put your limits into what's your competitor and how amazing they are. And to get there, you always have to put that the really the threshold of success way beyond that and every moment thrive for it. Thriving for excellence. I think it's it's so incredibly important. I think, somebody said to one of the basketball coaches, I forget his name. He said, if we, thrive for perfection, we achieve excellence. And I think that is so important. Absolutely. Yeah. And, you know, and it's it's. Yeah. And you know, when, you know, it's the times I've, you know, I approach being operating with. Thank you. And seeing, you know, how you do that with a team and you can feel, you know, the energy changes where you're like, okay, we're right. We're giving 100% before you walked in, we're all doing 120%. And it's just to see that flow state. All that. Is. Is really, it's one of those rare moments of, of human achievement, collaboration that is I mean, thank and it's like, you know, you're the maestro with the orchestra and to, you know, here everybody be so in tune and see everything just, you know, perfect flow is is really something. And that's something I kind of ask you about is, you know, we talk about collaboration in medicine. Yes. So, Miles, you know, can you talk a little bit about the role that, you know, working with other professionals sort of plays? Yes. We have very complicated relationship. We see that. Yes. You know, sometimes other surgeons do. Yes. You know, so how would you say that? You kind of approach the philosophy. You, you know, what's your philosophy of cooperation? You know, it's a team sport. It's always been. Maybe previously, surgery wasn't considered as much, but currently it is for success. For one person to be really in a team approach, it's comes to respecting everybody's opinion no matter what. They are making everybody feel like they have a value for the team and inspiring them. It's really comes leadership. It's about inspiring others to achieve their excellence and how it's a tough art. It's easier said than done. How can I inspire everyone in the room with many different personalities to achieve their full potential? And when you ask them to do something, they don't feel like they're being ordered, but in fact, or working for a common goal. And I think it's all comes down to define a very clear goal, which is the best outcome for the patient, and then defining individual roles, defining individual goals and metrics. And, you know, respectfully treating everyone to achieve those metrics in an objective manner. And I've always said people never forget, what people may forget what you tell them, but they never forget how you make them feel. And so you really want to keep that in mind. The emotional intelligence, the fact that everybody has their own stressors, everybody has their own things at home. And when they come to work, they want to feel good about what they do and don't feel like they're just, you know, a small wheel in the factory. Yeah. You know, and you know, and, you know, especially, you know, touching on like those, those emotional things that, yes, despite doing their best to leave them at the door that they bring with them, you know, you know, how do you, you know, because we can we talk about it as a team sport. We have all these, you know, moving parts. Certainly. Yes. But sometimes, you know, even when the team has you know, practice as best they can, everybody's doing the absolute best that anyone can. You know, sometimes the outcome isn't necessarily okay. And you know, I think a lot of time, you know, folks who don't work in medicine don't really understand. Yes. All it takes on us, you know. Yes. People see us as and as, you know, they think we're just these, you know, smart, you know, technically savvy. Yes. That don't go through these things ourselves. But we all have these faces, challenges. You know, it's part of the human condition, especially with, you know, as, as, you know, sort of heavy of a area that we work in, you know, how how do you handle those emotions, right, with tough cases. Yeah. So, you know, we take risks. If we don't take risks on people's lives, we're not going to save a portion of those patients lives. If you always do everything extremely in a very conservative manner and don't push the boundaries, they're going to be a group of patients who are going to miss an opportunity to have a chance at better life. How do you balance that risk of people pushing the boundaries, improving lives versus placing some of them at risk? And that's something that defines, in my opinion, the success of many neurosurgeons and many people in business. And it's a very fine line. It's really depends on how much risk you want to take. What are your resources? What are your other, abilities to control risk if anything goes wrong? In my life, I've been blessed to push the limits, and a majority of time I've been very lucky. I have to say that part of it comes faith. You know, I always say upper room is a temple, is a church is a mosque. We really are accountable in front of God. And can you do everything and go home and look into your children's eyes and say, I did everything for the patient during the day? If I had looked into the children eyes of that patient, if you do that and say yes, you have done your duty, anything. Otherwise you need to do a lot of soul searching. you know, you know what you're saying about the the the temple. Yes. Where we work, it's, you know, the accountability is so. Yes. So key, you know, especially and, you know, I mean, we, you know, we're just in an ever evolving field. Correct. You know, in order to make sure that we're doing the very best that anyone can, for these patients, you know what? What would you say are, you know, some of your strategies for staying, you know, the absolute top of the game, you know. How do you stay on top of the game? That's that's the challenge. But, you know, many of my colleagues, neurosurgeons who started doing brain surgery and within five years of training, the burned out and left, they went to spine surgery or they ended up doing other things. It is a very stiff and tough marathon that mental fitness to be able to deal with your failures. Nobody can say I have no failures in brain surgery or anything special in brain surgery. The stakes are so high it takes such a huge toll. So, so many people dropped out. So how did some stayed in and became the gladiators? I always some I sometimes call myself and some of my colleagues, maybe not as humbly as I should be. Gladiators. Because we really are the knights, the gladiators that carry the message for the next generation. But pushing the boundaries, teaching the next generation what to do. And I think that comes with really your commitment and your passion that you learn from your failures and you move on, but you never forget every face of every patient. That despite all my candid efforts, I could not deliver to his or her family. Unfortunately, I remember, I remember, and I learned a huge lesson to do better next time. However, I didn't let it make me quit and not be able to have a chance at the next patient to improve their lives or save their lives. And I really, since toughness that you need to have, safe confidence. You have to be confident safe to know your limits but push the limits safely. That's a tough line. It's a tough line. Absolutely. You know, and a lot of times if we're if we're talking about, yes, gladiators and crusaders and. Yes. They have, you know, sort of a, holy mission, regardless of what you believe in, you know, when you have that, within you, you know, there's always a, you know, a central text in, in any context and, you know, you have produced in, you know, this arena, what many consider the, you know, not to be, in religious but the Bible. To. Ten know, surgical atlas. You know what? At what point in your career did you go? I can I can create this amazing resource. Yes. That other, you know, neurosurgeons, you know. Yes. Behind me, people ahead of me, you know, everybody can use, what was the kind of the process like for you going. This is what I'm going to do. Yeah. Neurosurgical Atlas is a nonprofit organization. We have a very large website for neurosurgical education. It's been extremely popular. We've been blessed for that along the way. All over the world, many surgical videos of nurse surgical techniques. Why did I do that? Why did I spend, you know, more than a decade of my life doing that is because I saw there was no line of clear communication between surgeons to talk about techniques when, never has videos of surgeries, lots of textbooks. It's very difficult to learn surgery from textbooks. Most residents learn from one institution and then go to practice. They never have a chance to learn from others. And so we wanted to create a collection that all these surgical videos are curated. So you can really see technique in real time, and every patient becomes a document to learn from for the next patient, and to create that collection of an immense surgical videos and really, I call it very secretive, pearls of technique that really have not been passed along in the history of neurosurgery and be able to preserve that is crucial. And that's how Neurosurgical Atlas was created. You know, and and speaking of that, yes, talking about, you know, you know, for yes folks listening that don't, you know, know kind of some of the, the jargon we may use in terms of we'll try to do our best to explain them, you know, so as a young attending, meaning a new, physician who's in charge of, you know, a panel of patients, who's completed their training, you know, for you, Doctor Cohen, for, you know, a young attending neurosurgeon. What if you have one piece of advice and you wish somebody would have given you, right, starting out as a new attending, what would it have been? I would find my first job at a place where you have great opportunity to practice safely, with great volume of cases and great mentorship. I wouldn't put money or location as the first thing. I would put the environment out for you to learn. Because learning I learned today, we always going to be learning, especially when you finish your residency. That's the peak of your time to learn more on your own and from others. When you have that freedom and you're no longer a learner, we're always a learner, but not an official learning or residency program. So I think choosing a place to work where you have a great opportunity to help grateful patients and to build your confidence and then have mentorship from your colleagues, I think also critical, and it's most critical for you to become a great surgeon. There are many great, talented people that never become a great surgeon or an athlete or businessman because they were never placed in the right environment. Absolutely. And, you know, I mean, environment is so crucial, especially, yes, it's something that we I mean, you know, it's a cultural trope, you know, neurosurgery, you know, oh, don't turn it into brain surgery. People see this field as something being, you know, synonymous with just being, incredibly difficult. Yes. But as a field, it's still, you know, sort of, you know, creeping around amongst the youngest of the medical specialties overall. And, you know, I know you're, you know, a very strong historian on, on the specialty itself. You know, who you know when it kind of give our listeners an idea of like, when did emerge as a distinct specialty. And we were kind of the pioneers for, you know, shaping that. Right. I think, you know, neurosurgery is in its infancy right now. Still is. There's so much to learn. We do sometimes use cruel, I mean, crude instruments to, you know, open the skull and do surgery. We're always evolving, but there's no that we don't know much about the human brain. Still, there's so much that we need to learn. And so I think this is the time when we're using very basic principles to cure people and touch their souls. And it's even more challenging to be able to do the right thing. But I think with time, we're going to see an immense evolution of skills, techniques and understanding of human brain and how it works that will revolution of the care of many patients. you know, we've we talk about. Yeah, like we did just a moment ago about, you know, the the temple that the is and so much of, you know, how much of what we do affects not just the physical in our day to day, but, you know, there's sort of a, there's a, a metaphysical component to where we, where we talk about the human experience and how neurosurgery, you know, kind of aims to, preserve that. You know, how would you say, you know, neurosurgery, you know, working the field has shaped the way you view, you know, a person's sense of identity and human consciousness. Yeah. You know, the patients have been an inspiration to me. And really seeing them go through such difficult times and learning how humanity deals with difficulty. Imagine, you know, a young, newly married, man or newly dead, or a new dad who just found out they have a brain tumor and they have less than a year to live. Yeah. And just exactly, Chad, just imagining what they're going through. And this is a journey that we go through with the patient. And many times I place myself in their own position. Yeah. And, my niece passed away from a very difficult brain tumor at age 12. And that was a transformative experience to really put yourself in the position of these really inspiring patients. Yeah. That's an element of it. That's separate from the surgery and what you learn from the human mind in terms of operating on the brain and how the brain works. What are the structures, that fit together and the segments of the brain that work together to make us who we are? And it's extremely intriguing. But going back to something that's even much more realistic to think about is that human experience of going through extremely difficult times. What does it take to go through that? How do you cope with difficult times and crisis? How do you survive and how do you remain grateful? How do you use your support systems? And when you have only less than a year to live, the reaction these patients have in terms of, the time spent with their family is really an inspiring and a very good lesson for all of us. Absolutely. Absolutely. You know, and, you know. Yeah. That again, it's it's it's something that comes up so often, you know, as, a central theme in our field. Yes. The, you know, the the tenacity of the human spirit. And, you know it, you, you know, obviously, you know, sort of. Rachel, your niece is. Yes. Impacting all of us who have had the privilege of working. Thank you. Absolutely. Before we go to the same question, I have to also mention most brain tumors are benign. So when we talk about these tough times, these are segment is subsegment of the population. So when a patient is diagnosed with a tumor most often they have a benign brain tumor. And if they have a very skilled neurosurgeon whose specialties brain tumors really have dedicated a career to their career, to that, you'll see that with good expertise, these tumors often can be cured or nearly cured. And these patients can have a very productive life ahead of themselves. In, to that end, Doctor Cohen. Yes. Obviously the neurosurgical Atlas is, yes, resource for clinicians and, you know, folks that work in the field. But, you know, do you have a good resource for patients and their families that, you know, you would recommend in terms of, you know, learning what the different kinds of neurosurgeons there are? You know? Yes. You know, different tumor types and disease processes. What what resource would you recommend for that? Yeah. You know, actually we create a website, that's, you know, if they Google my name comes up and it provides really detailed information about every brain tumor. And we really collected a lot of real world data. You know, often the patients go to Doctor Google and they want to find data that way. These information can be extremely confusing and can be distracting at times, can really lead to the patient to feel very desperate. In fact, more desperate because when you don't have good information and you just get a very scattered set of data, you become more nervous, you become more unsure. And to really bring the patient a power of good information and information is power. We created the website and you're welcome to go to Aaron Cohen Hyphen Dotcom, where every, you know, tumor type in the brain has been very clearly defined. All the diagnoses, symptoms, treatments, surgery from a very research verified perspective described. So the patients can really learn in a very concise manner rather than dealing with a lot of technical information that could be a lot more confusing and put more fear in their heart. And the moment you have fear in your heart, you make poor decisions, and that can lead to more challenges later. Absolutely no. That's perfect. So for, for the folks listening to this, you know, it's on Spotify, on Apple Podcasts, that's Aaron ROA, CEO, ETN, hyphen Godot Aaron Cohen, middle.com. For more information on benign brain tumors, aneurysms, spine tumors, all kinds of information. Anything that touches the brain, your spine. That's a great resource. And, we recommend you check it out if you have questions. Thank you. And it really is very broad. Remember when we talk about brain tumors or vascular malformations or to venous malformations, cavernous malformations, meningioma, glioma, pituitary adenomas, core tumors, Conder sarcomas really a very wide range of lesions that the patients face. But the critical aspect in all of this is going to a surgeon who has a lot of experience. I know often the patients choose a hospital. Oh, this is a top three hospital to country. So that means I'm going to good care. I'm going to get a good care. I nobody can guarantee that because the hospital doesn't operate on you. Right. It's the surgeon. So you have to choose your surgeon, not your hospital. And that's a big error people make. They assume if I'm going to a hospital, if I'm going to this good hotel, for example, I'm going to get a good service. It doesn't always work that way. So you have to choose your surgeon rather than your hospital. There are some incredible surgeons in, you know, mid-level hospitals that are much, much better than those standards in that are in the top hospitals. So you got to do research on your surgeon. You got to really ask around and make good decisions based on who is taking. Care of you. Absolutely. Yeah. So in, you know, in, in this is something I've heard you say before. Yes. But again, for our listeners, you know, if you had to, you know, make a obviously very well educated guess, but a guess for, you know, some of that's been, you know, working in the field as long as you have normally, about how many cases have they done? Yeah. You know, unfortunately many neurosurgeons mostly do spine surgery. So when you go to your neurosurgeon and your likely to someone that's primarily their work is focused on spine, which is great. I mean, we need great spine surgeons. And most of the work on neurosurgery is spine. However, if you have a complex brain tumor, if you have a brain tumor that you really want to get somebody with that specialty, you got to do your research. You got to find out what is their fellowship of the surgeon, how many years of experience they have within their area. Are they focused in treating those tumors in your area or they're just general neurosurgeon? And it's not just or they treat a wide variety of simple cases. And so I think it's really critical to get to know and see how many two brain tumors your surgeon does a year. He or she, I think at least should do about 100 cases a year just to remain competent. And if the two is very complex, you really need to go to a place where there are very few people in every state that do those kind of tumors and have extensive experience just because you're going to a very well-known hospital does not mean by any chance, you're getting the best surgeon currently in 2025, almost the top 50% of any hospital in this nation has every technology you want, and there is no advantage of one hospital over the other. It used to be that the top hospitals had special technologies that nobody else has. Unfortunately, the patients still think that way. But that's unfair. That's not correct. The top 50% hospitals in this country have exactly the same technology for your surgery. It all comes down to who's doing the operation in the operating from. Yeah. Yeah. It's, it's not the it's the tools. It's the it's the hands operate, you know? Exactly. Say a full with a tool. Still a full. Right. Right. Yeah. That's, that's 100% true. And, you know, so. Yeah. So a competent, you know, specialist neurosurgeon who can do complex cases at the same length of time that you've been doing this around 2000 or so. Right? I read correctly, it was about you've done. 7575. That's it. That's a very. Yeah. It's probably not going to happen again. That was a very unusual situation where I, you know, I was in Indiana early in my career and practiced in a very centralized system where all the patients came to the same place, and it was a very, very unique. And, it was a huge blessing to be able to take care of those great patients. But yes, 7500 number probably is going to be difficult to reach because now the health system in the United States, you know, spread out. So it's very difficult for an individual surgeon to be able to build that much of experience. Yeah. Oh, that's thank you. Those numbers are still. Thank you. Thank you chair. That's, you know, and that's again why you've become. Thank you. Thank you. Anybody that's listening to scientifically minded, you know, we know that more and better data. Yes. That's a much better perspective. And is able to allow people to make much better informed choices. Right. And so, you know, your data set is very robust and very unique. You know, the cases are one thing, Chad, as you mentioned, the more cases you do, the better. But there is also another element that are you going to really commit yourself and dedicate yourself to be the best at what you do? Like we talked about earlier. It's exactly. That anyone. Right to be the best and anyone can. You really have to put everything to the side. You have to put, you know, sometimes time with a family to the side, you have to put, you know, financial returns to the side. You have to put sometimes your own life to the side. And you really have to focus on doing this as an arts. And that requires an extremely unusual commitment to be able to go there, to really sit, to be critical of yourself and, ask others to be critical of you, especially at the beginning. And that's hard to do as a neurosurgeon, because when you become a neurosurgeon, you you believe that you're always right because you're doing such an extremely important task and you're saving lives and you're touching lives, and every error can have a huge and ultimate price. So for you to feel vulnerable at the same time, but to have the confidence of being able to do whatever it takes beyond humanly possible is a very fine line, and very few people can walk it. I mean, many of my dear friends, quit doing brain surgery very early on in their career and and dedicated themselves to spine because it's really a work of a gladiator. You you really have to be there and fight for the art and fight for really proving yourself every day to everyone that this is the right path forward. And to fight for that same time, to feel vulnerable and to balance the two together and face your disappointments. It's it's an extremely tough task. I would say it's requires a very special personality and temperament. I always say one of the important ingredients for a great athlete or a neurosurgeon is, is that temperament. Can you deal with failure but push forward as strong as you you as if you never had a failure? How can you learn just enough without being you know, disillusioned and disappointed, which can happen very often. So I think those are some of the critical aspects of, you know, life in general rather than neurosurgery or anyone who wants to become the best at what they do. Yeah. Yeah. You know, and that's I mean, and thank you for sharing that perspective because again, we so often we think of, yes, neurosurgeon. And as these hundred and 20 hour week superhumans who like we talked about earlier, you know, everybody, you know, especially in the last few years, there was sort of yes, out there where, you know, we're all heroes. And, we're expected to kind of put ourselves on the altar a little. Yes. And doing the best for our patients is part of that. And we and we certainly, you know, wouldn't be doing this work if we didn't want to do that. Correct. But it is, I think, for everyone, you know, very important to keep in mind that, you know, it takes a special person to work in this environment. But like, we are still human and we share that human experience with our patients. And, I think that's just something that we just don't hear enough about. Generally, but, you know, kind of circling, back to, you know, your robust, you know, training data sets, you know, we're starting to see questions about the future more generally. Yes. Artificial intelligence is is transforming medicine and, and transforming every part of society and work in an unprecedented rate. You know, your own house. GPT is. Yes. I mean, essential tool for, you know, clinical neuroscience trainees, neurosurgery residents, attending surgeons with experience. You know, I've been using it to, glean really useful insights. You know, where do you kind of see it going? You know, in the next decade when we're taught, you know. Yes, it's. The new Year, we're talking about 20, 25. Where do you see medicine as it relates to AI in 2030? Yeah, that's a good question. Before we go to that question, I want to finish off the last one chat. And in general not just as a neurosurgeon or athlete. How do you be able to deal with your failures? Remember, there are some neurosurgeons or athletes that are very conservative. They don't take risks, but they don't achieve their full potential and they don't help as many patients because for those really very high risk cases, the top 20% that are very risky, the surgeon has to take some risk to help a portion of those patients. If you don't, then all those 20% are sort of left behind. And to take that extra risk to help those and the failures, you have to deal with those. And always, you know, looking back saying, well, maybe if I had done this differently, that patient would have not suffered, I would have not been paralyzed or would have had a much better quality of life with their family. And how do you look in the eyes of the children and the wife of their family? When you operate on the husband, how could I have done different? How could I do differently next time and still maintain your bold, confident behavior to be able to make that extra effort for those patients who don't have a perfect chance? Or how do you balance removing more tumor versus placing the brain at risk, which is very adherent to the tumor? Those are the big questions that really differentiate those, you know, knights or gladiators from the rest of the neurosurgeons. And how when you fall in your life, get up and move forward. You know, when you fall, it's that moment of, loss and extremely short of doubt in yourself. And then you have to get up and move as hard as you can very quickly. That's really, I think, the essence of success in any human being. I don't think you can look at any extremely successful people. Successful people either in business like Steve Jobs, Elon Musk, or in, even in neurosurgery, and see that they didn't have failures. They definitely had failures. And how they dealt with a failure differentiated them to be where they are today. If it was a smooth sailing, anybody would look like a great captain. It is that captain who really can bring the ship home in extremely turbulent waters that defines excellence. And I think that's critical as a lesson in life going back to the question about AI, I think AI is going to make a huge difference in medicine. Yeah. I mean, our experience with, at least GPT for neurosurgery specifically has demonstrated that the amount of information that can be processed through the AI models is significantly more than the human brain. And although at this time the AI appears to be as an assistant more than a major decision maker, I think very soon, within five years, we will see AI models who would be certified in psychiatry and can practice independently as a psychiatrist, especially mental health, I wouldn't be surprised seeing doctors who are virtual AI models and really will be able to provide a great care. Obviously not for procedures, but for consultation. I think we're going to see era of the superintelligence that means intelligence AI that is above humans. Right? You're referring to like AGI that we hear. Exactly right. About so much in the discourse around quote, in terms of, you know, safety and those kind of ethical concerns. It seems like we're on a trajectory that regardless, we are going to have AGI as a matter of what is going to be doing it, how safe it will be, and things like that. Right. And I think that I think sometimes patients feel like, well, I'm not going to have a doctor, I'm just going to have this model without any supervision. You'll be very surprised how some of these models actually do better than doctors. And in fact, there's numerous studies to demonstrate that they even have more a sympathy toward the patients. I think there's going to be a while before surgeons are replaced by, by, by AI models. I do believe there's still going to be a very strong rule about physicians who don't do surgery as an adjunct to AI models, but the AI models will remove the bias that often the physicians have because of how they trained, who was their mentors, how they, what was their experience with their previous last patients? Maybe something happened that had nothing to do with the disease. But we always remember our failures so much that it negatively affects our decision. Next time too much. But to have a model that really remains unbiased uses only verified information and data in research. Obviously, I'm not talking about ChatGPT. I'm talking about, you know, retrieval, augmented generated or generation Rag models that are very contextual for specific areas, subspecialties of medicine. Do you private data that is vetted through very, clear research? I think those kind of very specific models that just don't use any information on internet like ChatGPT does, would be extremely instrumental in revolutionizing how we treat with, treat patients and how we deal with decision support. Absolutely. Yeah. I mean, it's yeah, I mean, you know, yeah, the the new the new rag architectures that we see with, that can be ported on two models, that are well known and have that specific, you know, training data set is, is really mind blowing. And, you know, especially with that with GPT, I mean, it's it's really incredible. Okay, cool. Yeah. Yeah. Great work with. That. Yeah. I always tell people if you're doing some work and you're not somehow incorporating AI, you're probably not going to be reaching your full potential. AI is going to affect everything we do in the future. Yeah. It's like, like, you know, again, here, the in software world, you know, it's like somebody being a ten x engineer. Yes. To scale the productivity and everything that you have, you know, tools like this or those ten x tools, even 100 X in terms of. Right. It's really, mind boggling if you've, you know, never worked. But yeah. It's like an internet. It's like, imagine the era of internet when the internet and dotcom around came out and everybody was just, you know, either you were on the internet or you didn't exist. And it's the same thing. AI is a very similar technology, the next revolution in our lifetime. Absolutely. And, you know, in talking about AI and of course, yes, you know, not only is it a revolution in in software, we're. Yes. Just again, it seems like every two months there's a new bit of news about, you know, a new BCI, a brain computer interface. You know, Neuralink has implanted in you first set of human. Yes. I mean, you know, you know, a young, young man named Nolan Rabon was, had his device implanted. And, you know, he always. I mean, no one, if you're listening, you know, I noticed that you said you're interested in coming on your podcast. We'd love to have an opportunity conversation with you. But, you know, he had his surgery. And, again, this is all public information. You know, in, in Phoenix, Arizona. And now see the videos of him, you know, playing video games with his mind. It's it's like something out of science fiction movie from I agree and years ago and now it's it's all rapidly accelerating to incredible potential. But, you know, when what do you think or is kind of, you know, the timeline for we go from special use cases for folks when you know that, yes. You know, spinal cord injuries. Yes. Those things into it becoming a consumer technology. How far away? You know, I've had some friends who have discussed this topic with Elon Musk in detail, and I think it's going to be much sooner than everybody thinks. Yeah. I think the use of the, chips right now for spinal cord injury patients is just the tip of the iceberg. Imagine if just diverting a little bit to another topic, if everybody drives a car that's controlled by AI, do we know car accidents? And so imagine a world where we have control of our actions, but we have an ability to correct them with a chip in our brain that connects all of us together and be able to avoid, you know, certain sort of communications or certain things that people do that could potentially place other people at risk. And we have a warning ahead of time to be able to control that. I mean, just remember, just imagine the individual who caused so much injury and devastation in Louisiana during a New Year's Eve. Imagine if you had a chip and you could really understand what he's thinking an hour before and be able to control that accident. I mean, that's or events that would be major, that would that would be very worthwhile. But there's and will, with all of us have a chip on our brain at some point. As scary as it sounds, I think it's very likely. Well. It's very likely. Yeah. I mean, it's. Yeah. And that and that is, you know, a big aspect of it to people that are, are, are the naysayers, you know. Yes. The argument that they make is that, you know, there's it creates that, you know, sort of Orwellian dystopian future. Yes, I have all come to be afraid of. But, again, it's a question we, I kind of have to ask ourselves inside is, okay if I can have my brain supercharged by a, you know, a GPU inside my skull, you know, and, you know, we all have to think about what is the balance between liberty and peace, safety and prosperity for us all. Very important. The sooner that you know people in that space take control of that conversation and find, you know, the most appropriate safeguards, see the appropriate safeguards. Then we will have a much better conversation rather than, you know, sort of the, yes, faceless, unelected who, make the decision for us. So I know you're thinking about these things and, you know, I have so many close colleagues and friends that, are contributing so heavily to this field because, we need we need folks like you. Thank you. But remember, there's significant ethical issues around this that have to be resolved first. You know, I don't think anybody would expect that they're going to put on a chip of every American and then control their thoughts. I don't think that's the goal whatsoever. And I think people create their fear to say, oh, we're going to put a chip and control you and take your liberty away. I mean that that's all against the Constitution. Nobody would ever do anything like that. I would look at it as more of a chip that can assist you and help you, and a way for us to recognize there is issue of risk to others, because eventually our Constitution and the role of all of us is to protect each other and make it a better world for each other. So if we have a tool to do that within a framework that protects our freedom. Yeah, I think that's extremely, reasonable, very favorable. But again, I don't think this idea that many people talk about the moment, you know, we're having dinner with friends, ask me how we all are going to have a chip. And I say, most likely yes. Two of I extremely freaked out. I don't think the goal is to control you. The goal is, how can we make you even a better person and a more productive person at your liberty and freedom to do what you want? And I think that's what we are talking about. I mean, the goal of really, AI is to be able to make good decisions using the technology. We have either a self-driving car or robots that helps us in every day to become more productive. I mean, eventually in a few years, the robots are going to be cheaper than 20 K a piece. And imagine having a robot where you can communicate with extremely easily through your chip without even mouthing words, and they can be able to do that job for you much better than you can. How extremely attractive that world would be. That's what I would look at. Rather than saying, okay, somebody is going to pass these, you know, thoughts through an antenna into my chip and control my actions. I don't think there's any goal to or any, in my opinion, any way to do that or any legal way to do that, and most importantly, any good way to do that. Yeah. Yeah. No, that's I think that's you know, again, that's what the, you know, fears boil down to, right, with people that are, people are so afraid of the unknown. And we for the first time since the internet revolution and honestly before that, you know, the telecommunications revolution, industrial revolution, these, you know, the gap between these periods of time gets shorter and shorter. Yes. The point that, you know, like we're, you know, know I'm talking about off camera before, you know, OpenAI, they release the full version of their, you know, stay the art model at the beginning of a month ago and two weeks later released, you know, a a restrained version that is apparently so good. And, yes, has so much potential for rest that, they're only letting a few people see it, whether or not that's a marketing techniques, it's kind of driving. Yes. Versus the reality of, oh boy, we may have cracked AGI already, you know, now a month into, you know, the new year, by the time you're listening to surprised to hear this, it's, it's just, you know, there's a lot of potential on the table. For what? What the world will be looking like in in the next five, ten years. It's it's fast is. It's. So it is a weekly almost, sort of moving target. Yeah. Yeah. And it is, it's. Yeah. I mean, the updates that we see to you know, models that are, you know, for the consumer that are getting more accurate, with so many topics, it's just, it's mind boggling. But before we managed to cross into, you know, cybernetics, everybody's kind of, you know, version of RoboCop kind of territory. Yes. In the meantime, we are still humans with organic tissue. Yes. And you know what would be, in your opinion, from folks at home base about trying to optimize themselves, you know, sort of, you know, doing a little bit of, you know, biohacking to improve their cognitive function, you know, especially across the lifespan. Yes. You know, and reaching into this age, and as we get older, what do you think is the best thing people can be doing to maintain that cognitive fitness? Yeah, that's a really $100 million question. How can I remain young and cognitively fit and be sharp? You know, I think it all comes down to the basics of sleeping well, eating well, exercising well, and having sort of a great environment that can optimize your happiness. I think stress is one of the biggest challenges that compromises our fitness. A cognitive fitness, I think not being able to, eat well, you know, irregular eating and not be able to have a good diet, not be able to sleep on time and wake up on time now, be able to exercise to keep your physical fitness, which so much correlates with your cognitive fitness. I think those are extremely basic concepts that we all know about. I think everybody knows about what I'm talking about, and there's nothing new here, but there's a difference between hearing and listening. And I think that's the part that I'm really trying to bring home. Cognitive fitness. Part of it is obviously how we were born. There's nothing we can do about that, but be able to remain cognitively fit and get to the next level should really be able to sleep well. A good diet, control the sugar, the fat, the processed food, you know, the microplastics that so many people. And I think it's going to be a much bigger topic coming up soon. And to really keep a very as much possible, there's no life without stress, a relatively stress free life, and focus on what's your goals in life and right satisfaction on what you have. Because when you're satisfied, you sleep well and you eat well, you exercise well. All those four elements together, I think, is such an important sort of level of higher octane for your engine to be performing better. Absolutely. You know, and and to that end, you know, it's it's sort of what, what is old and new again, you know, and that's, that's the funny thing is we see, you know, folks that, you know, are trying to optimize their health. It's everybody's kind of looking for that little that little edge. And you know, the but it simply goes at the basics, like you're just saying eat, sleep well, you know, have maintain your basic biological functions and, you know, kind of help reduce that stress level. But, you know, obviously we can say that. And yes, and it's the same advice. It's been around for a very long time, but often people will try to cope with, you know, other yes, you know, any number of forms, advice, drugs, alcohol, you know, many other forms of addiction. But, you know, there is always some concern about like, what are those things doing to our brain? How can you like, touch on that a little bit especially. Yes. You know, especially this time of year. You know, we just had the holidays, you know. Yes. Right. You know, what is you know, so that people have a better perspective. What is, what are some of the biggest risks that come from. Right. You drink excessive drinking. Yeah. We're going to go through that in one of our sessions in detail because I think that's an important topic. I think a lot of people ask me when I go to parties or get get togethers, how can I avoid the risk of Alzheimer's disease? How can I live long? How longer, how can I, you know, have a more cognitive fitness longer period of time as I get older? How can I, you know, be a better, you know, a more capable person overall? We all thrive for that. But, you know, just in very simple terms, you know, we I don't drink coffee. I think coffee, for example, which obviously is very different than alcohol, gives you a real sudden boost boost. And then you feel energetic, but then suddenly you crash a little bit. And those mood swings at times can be really sort of in, interfering with your activities. Do you know what I mean? Coffee in the morning is very reasonable, but getting into this habit of one coffee, then after the other, or Coke after the other, and these sugar sort of binges that we see currently in the younger population especially, is really something that affects the brain and prevents the balance of mood. I think the mood balance is something we don't talk about much. Would you rather have a lot of energy and then calm down a little bit and have to push yourself up a little bit and then come down? Would you rather control your mood in a very relatively stable manner? Nobody has a perfectly stable mood, but I think the critical question comes down to a heavy two, supporting as of a stable mood as you can, because that's when your brain can avoid those modulations that you can sort of you have to, at times counteract to bring yourself back to balance. Life is a work of opposing forces, and the more you can keep those opposing forces balanced and work that that balance of moderation, I think the more successful you'll be in life. I mean, you can be either a hard core Democrat or extremely hard core Republican. I think those are like extremes again, but being a more moderate always seems to be a more long lasting solution. Any, successful strategy in life. And if you think that life everything is an opposing force, are you religious? You marry a less religious person and how you balance each other to stay within that moderation is always key and I always say, if you're religious, try to marry someone who is a little bit religious, then you so you guys can keep the moderation rather than both of you flying on one. One extreme of the expect. But going back to the issue of alcohol, I think all those drugs, no matter what they are, you know, marijuana or alcohol or even no more hardcore drugs, the effect they have in causing imbalance in the brain that really carries on long time after they have been cleared from the from the brain are extreme, problematic, have long term consequences in altering the connections, or we call synapses between the neurons in the brain and can can really affect you in ways you would never know. Yeah. Okay. So, you know, to to that end, we know of course we can. You know, definitely our listeners should, tune in for more later because we'll touch them on and know, try and do some deep dives on these topics. But you know, something that, you know, has historically had an invitation for being, you know, harmful, in terms of. Yes, you know, what we historically thought of as a drug, you know, things like, you know, psychedelics, you know, psilocybin mushrooms, things that are start you know, we're seeing data that they are now to genic. They contribute positively to neuroplasticity. You know what role do you see those kind of things having. How do you feel about that? You know, I think that I would rather save that for a session dedicated to it. But I think there are very good in-depth trials to support their use and I respect that. But again, it goes back to really reviewing the data, being objective, making sure people who conduct these, sort of projects or experiments to prove the efficacy of these drugs don't have financial interest in these drugs. If you have a company who's making the drug or which is making the drug, and then they're doing the trial to prove to you that it works, I mean, they're not going to report a trial that's negative or inconclusive. So I think these are all reasonable, but they have to be conducted extremely carefully with transparency to make sure that people are making, very well informed decisions. Oh, absolutely. Absolutely. Yeah. Because that's, you know, one of the things, again, you know, the controversy when started out with, with cannabis, we saw, you know, it started out as being, advocated for as for medical use. And then, you know, the last few years we've seen a huge surge in just legalization straight out. And especially, you know, here in California, you know, I was one of the first states to do so. And now we see, you know, in the emergency departments, in the hospitals, you know, you see people who are developing conditions from overconsumption. So, again, that ties back into the original point of everything in moderation. And, you know, with, therapeutic goals in mind can be beneficial. But, you know, everybody has to kind of be careful on the lookout for those. Yeah, that's always the most difficult approach. And, how do you legalize something but at the same time keep people accountable. Right. And if there was a clear and easy solution to that, this world would be a much better place. Absolutely, absolutely. Wow. thank you so much for all your, perspective on on all of this Dockercon. It's been a very informative and and enticing episode. Thank you. Yeah. Especially talking about the future in consciousness and. Yes. AI and all these things that, are, are such rich, big topics right now. Yeah. So looking forward to sit down, be more to do this. You know, as the weeks go on. So, you know, thank you so much. You're welcome. We're going to we're going to have some incredible discussions. Chad, about details of a lot of topics that we've just briefly touched upon, really some things that are very important to our listeners and viewers, such as how can you have brain health? I couldn't have how can you live a better life? What is how can you be a better person in the future? From a perspective of a neurosurgeon and a neurotic entrepreneur who really is, trying to immerse himself in this and try to bring some perspective rather objectively about the future of life, future of the brain, the future of tech. Thank you, thank you. Thank you for watching the very first episode of the Atlas and Access podcast. I've been here with our host, Dr. Aaron Cohen-Gadol, and I'm the co-host. My name's Chad Smith. Thank you and take care. Thank you. God bless you.