Chris Casey (00:32):
Welcome to Health Science Radio and we have a special episode this week where we'll be talking with an expert in neurology, neurosurgery and physiology and biophysics, Dr. Cristin Welle who will share her expertise on a topic that's been in the news a great deal lately – brain-computer interface.
Thomas Flaig (01:11):
It's a very important topic.
Chris Casey (01:11):
Have you been following this, Tom?
Thomas Flaig (01:13):
I've been following it both in the popular press and in some of the scientific press. I think it's a very interesting area and it's quite scientific actually.
Chris Casey (01:22):
It is indeed. Another aspect that we have to talk about, just before we jump in, is that I'm very excited to share with you that we have new theme, or intro and outro, music for our Health Science Radio podcast.
Thomas Flaig (01:37):
Outro music.
Chris Casey (01:39):
Yeah.
Thomas Flaig (01:39):
That's a whole new thing. I knew we had intro, and now we've got outro music.
Chris Casey (01:42):
Well, we've had outro music and it's been on the tail end of the podcast.
Thomas Flaig (01:48):
Now, is this you and your ukulele or this is different?
Chris Casey (01:51):
No, this would be different. But we've upgraded significantly in the music department. We're featuring a band now that's given us permission to use a song of theirs. The band's called Low. They're an indie rock band out of your home state, Minnesota, the Gopher state.
Thomas Flaig (02:10):
Fantastic. I like it already.
Chris Casey (02:12):
I think you'll like it. It features prominently a nice bit of keyboard at the beginning, a nice bit of drums which have kind of a heartbeat rhythm, which coincides with our great graphic done by Jenny Merchant here in the office. Then a nice kind of guitar groove.
Thomas Flaig (02:31):
Very much looking forward to it.
Chris Casey (02:32):
Oh, terrific.
Thomas Flaig (02:33):
Intro and outro the whole thing.
Chris Casey (02:35):
Intro and outro. With that bit of news out of the way, we will jump right in here. As I said, our guest today is Dr. Cristin Welle. Dr. Welle is a systems neurophysiologist with expertise in the interaction between medical devices and the nervous system. She completed her PhD in 2010 from the University of Pennsylvania and then started the neural interfaces program at the FDA Center for Devices and Radiological Health Office of Science and Engineering Labs. She helped craft the FDA guidance on brain-computer implants. In 2016, she joined the faculty of neurosurgery and physiology and biophysics here at the University of Colorado School of Medicine. Welcome Dr. Welle.
Cristin Welle (03:34):
Thank you so much. It's a pleasure to be here.
Thomas Flaig (03:38):
It's great to have you here. This is a really neat and interesting topic.
Chris Casey (03:42):
Definitely. Cristin, with your appointments here at the School of Medicine, you span a lot of territory between neurosurgery and physiology and biophysics. So to me that seems like two complex worlds, a foot in both. Could you explain what drew you to pursue both of those fields?
Cristin Welle (04:06):
Yeah, absolutely. I feel like I'm in a really privileged position to be able to have one foot in the clinical realm with my position in neurosurgery, and then one foot in the basic neuroscience and physiology realm in physiology. That really kind of spans my research program very well, because what I'm interested in is understanding how neurotechnology and devices that interact with the nervous system, how they can be used to drive plasticity in the nervous system. I want to not only understand the effects – like what kind of a difference can we make in the lives of patients, how can we help people to recover from neurologic injury – but I also want to understand why. Why does this happen? How can this kind of technology really make these changes in the human nervous system?
I run a lab that primarily is preclinical, so we're using advanced neuroscience techniques to explore the why – of why neurotechnology works. We also are transitioning into running clinical trials to see if some of our new findings that we've found in our preclinical work can really translate into the clinic and make a difference in the lives of patients.
Thomas Flaig (05:24):
If we had interviewed you when you first came to CU many years ago and asked you to think forward to 2024, would the person at that point be surprised where we are today in terms of Neuralink and these new developments?
Cristin Welle (05:38):
Oh yeah. There's been a lot happening in this space. A huge amount of changes both in the academic side, amazing advances in our neuroscience and technology development. There's been huge changes in the commercial side. There's a plethora of companies. Back when I started, there was really just one company that was making technologies for brain-computer interfaces in humans, and now there's probably close to a dozen for implanted technologies.
Even at the FDA, the number of device reviewers that are looking at neurotechnology, I would say has at least quadrupled since the time that I began at the FDA. The reason for that is because this field is growing so rapidly and there's just been a burst of activity over the last decade or so. So yeah, it's exciting. It's an exciting time to be in this space and I think we're really just at the beginning, at the advent of this. It's going to continue to grow.
Chris Casey (06:34):
What do you attribute to that growth, Cristin? Is it things like Elon Musk's endeavor with Neuralink and all the attention that that's receiving or was this just going to be a natural progression anyway?
Cristin Welle (06:50):
I think the reason that Elon wanted to be in this space is because of how exciting it was. I don't think he caused the growth; it was already growing and changing quite a bit and very rapidly. Why is that? It is because the mind, the brain, is the final frontier of human health. We understand a lot about the body and physiology. We know a lot about the heart and how many of the organs function, but the brain is in many ways still a mystery. So really understanding how it works, what makes us human, what causes us to have different types of neurologic conditions and how we can solve those is in some ways in its infancy, but it’s being explored more and more every day.
Thomas Flaig (07:34):
I wonder if I could just ask kind of a table-setting question. Just for the people listening to this: What are the basics that we're talking about here? What are these implantable (devices)? What types are there... How many are there? How are they being placed in the brain? Just that high level for the field.
Cristin Welle (07:49):
Yeah, absolutely. I've talked about the field of neurotechnology. That's a broader field and it encompasses brain-computer interfaces, but it also encompasses things like deep-brain stimulators that can help patients with Parkinson's or vagus nerve stimulators that can be used to treat epilepsy. But if we look just at brain-computer interfaces, the goal of that technology simply is to read people's minds. It's to put electrodes in or near the brain to listen to the chatter that's happening all of the time between the neurons, which are the cells that are in the brain talking to each other constantly using electrical signaling. You can put an electrode in or near the brain, listen to those signals, those conversations, and use complicated mathematical formulas, computer algorithms, to decode what those neurons are saying. Then you can use that to help drive different types of external devices.
So for instance, patients with brain-computer interface technology right now often are tetraplegic, so they have paralysis of all of their extremities. These devices are implanted into their brain and then the signals that these devices are listening to can be used to do things like have the patients control a cursor on a computer screen or control a robotic arm. It's an amazing, almost a little bit sci-fi, kind of space. Here we are, we're letting people control devices with their mind, essentially. But it's an amazing advance for these patients who really have lost that ability to physically interact with their external world.
Thomas Flaig (09:43):
I'm an oncologist by training, a cancer doctor. But thinking back to my neurology training many, many years ago, there's these two functions. There's the input to the brain and the output. It's happened when someone has a tetraplegia, they're not able to use their limbs, that outgoing signal has nowhere to go, or it's been interrupted. I think what you're saying these devices are doing is taking that signal and using an adjunct then, so to speak, to allow them to be received, those signals.
Cristin Welle (10:09):
Yeah, that's a great way to describe it. Exactly. It's like using the signals that the brain can still generate, but they no longer can be used to control the body. This is allowing the patients to use those signals to control something else instead.
Chris Casey (10:25):
Yeah. You mentioned being used in tetraplegic patients, so that's kind of a good way to transition into this first in human trial, if you like. With Neuralink, their P-1, I believe they're calling the patient, he had the brain implant put in fairly recently. I'm just curious, Cristin, from your vantage point and having been at the FDA, do you have any concerns about how that first-in-human trial rolled out or just any due diligence aspects to this? Because that is a big leap forward.
Cristin Welle (11:11):
It is a big leap forward. I think that the Neuralink patient, Noland, has been implanted for a little over a hundred days (at the time of podcast recording in late May) and there's been some really cool interviews with him. He seems to be really enjoying the process from what we can tell from social media, and has a lot of new capabilities to control computer cursors, play video games, which is really exciting. I think it is a breakthrough.
But taking a step back, brain-computer interface systems have been implanted in patients for over two decades. So fundamentally, this isn't new breakthrough in that sense. The first patient report was published in the early 2000s, and since then patients have been able to do things like control computer cursors and play video games, etc., in the two decades since then. There's been a lot of work building up to this moment that Neuralink is sort of relying on and building upon. They're not the only company doing this. There are a number of other companies in this space who are making really interesting and novel technology. Neuralink has, I guess, the street cred of being backed by Elon Musk, so that's always exciting and generates a lot of buzz. Obviously, what they're doing is exciting and really interesting, but should be taken in the context of the fact that fundamentally this has been going on for a couple of decades.
Thomas Flaig (12:50):
In that light, it's an important point to make about the history of the field. What is unique in your view of what Neuralink is adding to the field scientifically?
Cristin Welle (13:00):
What Neuralink essentially did is, they took a lot of really cutting-edge ideas from the academic community, and they poured a bunch of money into their company. So they were able to integrate some new technological innovations that haven't been used before in humans. These include the electrodes that are being put into the brain of the patients are really flexible and really tiny. Previously the electrodes that were being put in were pretty small, but they were rigid. You think of maybe the brain as just sitting there inside your skull, not moving around a lot, but actually every time your heart beats, your brain moves quite a bit. There's a lot of movement in the brain. There was actually some concerns that have been developing over time, that perhaps having a rigid device in the brain that's always moving leads to a mismatch in that stiff material of the electrode and the soft moving material of the brain.
Neuralink sourced some ideas from academia about how to develop ultra-thin flexible electrodes, and they're the first to get FDA approval to put a soft technology into human patients. That's pretty cool. It's an advance. The other things that they've done is they built a new surgical robot that lets them put in these flexible electrodes. Surgical robots are an exciting space for a number of different types of surgeries, including brain surgery, but they developed one that's really specialized for putting these electrodes in. Then finally their system is fully implanted. With some other systems, the subjects, the users have to go into the clinic, back to the hospital or the outpatient clinic and get physically connected to these external devices that let the system work. The Neuralink system is fully self-contained, it's fully implanted. Noland can use this at home, and that's a really cool new breakthrough as well.
Chris Casey (15:06):
In a recent tweet, I saw that Elon Musk mentioned that he thinks long-term it'd be possible to just shunt the signals from the brain motor cortex past the damaged part of the spine and thereby allowing even greater capabilities perhaps with the implants. Could you comment on that?
Cristin Welle (15:29):
Yeah, I'd be happy to speak to that. This is a great idea, but Elon Musk didn't come up with it. In fact, it's been done a couple of times by some other research groups. We actually just had on campus Abidemi Bolu Ajiboye from Case Western Reserve University who is one of the leaders in this space. A few years ago, he published a paper where they used a brain-computer interface and extracted signals and then fed that information back into stimulating electrodes in a patient's muscles and nerves in the arm. So the patient who was fully tetraplegic was able to reanimate their arms and reach and grab a cup and bring it up to their mouth and take a sip. It is a cool idea. It would be great if Neuralink is moving in this direction, because I think that the more ideas and investment resources that go into making these kinds of solutions for patients, the faster we'll get to something that could be commercially available.
Thomas Flaig (16:28):
One technical question, and I just don't know the answer to this. So this is a fully implantable device, it's self-contained, it doesn't require a power source per se, or it does?
Cristin Welle (16:41):
It does. It is rechargeable and can transmit through the scalp. It is fully self-contained, but does very much require that recharging, and also the data transmission can be transmitted through the skull so that researchers can see what's really going on and happening.
Thomas Flaig (17:01):
Fascinating. Yeah, there's a lot of technology in this work, isn't there?
Cristin Welle (17:04):
Yeah, there really is. There are huge breakthroughs in technology. It's interesting how some of this medical technology really ties into different types of fields like computer science and AI, and even your iPhone. All of these miniaturized, extremely high-performance electronics that are being made for the commercial market for different applications so people can play really fast and really complex video games and your iPhone and other applications. Those technological advances then make things like these really advanced brain-computer interfaces possible. Those kind of hardware are being used for these types of applications too.
Chris Casey (17:43):
It seems almost like the sky could be the limit here, even possibly I've read that perhaps somebody who has vision issues or maybe blind perhaps could even... This kind of technology could maybe restore sight. Is it going that direction?
Cristin Welle (18:06):
Certainly could. Again, there has been some of that work done. There was a company called Second Sight. In fact, on our campus we hosted some of the clinical trials that allowed this product to be commercialized onto the market. This was an ultra-thin, high-density electrode array that was situated on the retina and was able to restore some amount of vision to patients. That product's not on the market anymore, but there is a lot of interest. There are other companies that are moving in that direction to restore a vision either in the eye or in the brain, in the visual centers of the brain. I absolutely think that it is a possibility.
But I do want to just kind of take a step back and say that although this technology is extremely exciting, there is a reason that it's been in development for two decades and it's still not going into patients. There are a few reasons. One is that this technology, it's hard to make and it doesn't last that long. The brain is actually a harsh environment. It's very hot. Think about putting your iPhone in a bucket of salt water that's at body temperature, 98 degrees, that's sloshing around all the time. It's not going to last very long. It's actually a pretty difficult environment for these ultra-fine micro-electrodes to live in. There are problems with the longevity of these devices.
In fact, in a recent blog post, Neuralink admitted that some of their electrodes have not stayed in the brain. They've actually popped up out of the brain, which points to potentially a limitation of this very soft, very flexible modality that they're exploring and something that they might need to go back a little bit to the drawing board to see if they can find a way to make sure that their electrodes can actually stay in the brain for a longer period of time. While this is very exciting, I think we've got a ways to go before this is something that can really be commercialized to patients.
Chris Casey (20:13):
I think I might've read a comment that you made in the media that, this is along the lines of what you're talking about, even brain fluids pose the risk of maybe eating away at the insulation of these devices, causing them to not operate correctly.
Cristin Welle (20:35):
Yeah, exactly. The insulation, which of course is really important because electronics don't like fluid, so you need something to keep those electronics from getting wet. The insulation is essentially a plastic, different types of plastics are explored as insulation polymers. All polymers eventually will start to allow water to pass through them; it's just the nature of the polymer material. That is just a fundamental limitation to the lifetime. Now people are exploring different types of insulating materials, but again, this is kind of still early days for some of those new materials.
Thomas Flaig (21:12):
When these devices – Neuralink or others – are implanted, what's the expected lifespan or the useful period of those kind of devices?
Cristin Welle (21:19):
I would say that the sample size is pretty limited. Another company that's been in this space for 20 years or more is BlackRock. They published a retrospective recently – or some researchers worked with them to publish a retrospective – and they looked at 14 patients that had been implanted. The average lifespan (of the device) was about, I believe it was like two to three years. That's a reasonable amount of time, but on the other hand it does require brain surgery to put them in, so you probably don't want to have to replace these things every two to three years. Certainly everyone's working to make these devices more robust, to improve the lifespan, and we have yet to see what a flexible electrode modality such as the one that Neuralink used, what their longevity might be as opposed to these rigid devices. It may be shorter just because they are so tiny, but I don't know, and I'm not sure that anyone really knows yet.
Thomas Flaig (22:20):
It's a big unknown at this point.
Cristin Welle (22:21):
Yeah, it's an unknown.
Chris Casey (22:24):
Just to shift gears a little, Cristin, and talk about what your lab studies here on campus. Could you just give us an encapsulated look at some of the main projects that your lab, it's called the BIOelectrics Lab, I believe, that you're working on here in the Department of Neurosurgery at the CU School of Medicine. What are a couple of your projects you’d like to highlight?
Cristin Welle (22:49):
Yeah, absolutely. When I was at the FDA, we worked primarily on brain-computer interface technology. So in my time here, I've done a little bit of work looking at long-term safety and performance of these micro-electrodes that go in the brain. But more recently, my lab has switched its focus from the devices that can record from brain signals to devices that can apply electrical current to the brain to help to change brain activity. That's kind of a space that's called neuromodulation. We're really interested in how stimulating the vagus nerve, which is a nerve that travels throughout your body, how it connects your brain to almost all of your internal organs.
It can be electrically stimulated and it has some really interesting effects. It can help reduce seizures in patients with epilepsy. It can improve depressive scores in patients with depression. And it also seems to drive plasticity in the brain so that it can help patients recover motor function that they've lost as a result of stroke. Or in our case, we're looking specifically at multiple sclerosis. We're very interested in exploring how vagus nerve stimulation might be able to both restore myelination in the brain and also recover lost motor function, which is actually something that is problematic for up to 75% of patients with MS are deficits in fine motor function. We've been working with the Hughes Lab here on campus who has expertise in MS. We found some really exciting things that perhaps vagus nerve stimulation may help the brain to regenerate new oligodendrocytes, which are the cells that create myelin in the brain.
Thomas Flaig (24:52):
That's very interesting. So with your research, you've kind of done a full circle. That we started out talking about in Neuralink where it's essentially taking that brain output, trying to find a way of expressing that.
Cristin Welle (25:01):
Right?
Thomas Flaig (25:01):
If I understand you correctly, you're adding more input to the brain to try to model and modulate things in that way. So you're getting both the input and the output covered here.
Cristin Welle (25:09):
I think the future vision for myself and many of us in the field is to combine those two things. What would be really exciting is if you could listen to the brain, find out when something's going wrong, and then provide a little burst of the right stimulation to help fix it in real time. Right now, our stimulation that we apply is based on an outcome, but we're not listening to the brain, we're actually just looking at behavior. But it would be really cool if we could bypass the behavioral outcome and just listen to what the brain is telling us and use that to drive the stimulation instead.
Thomas Flaig (25:59):
It's so interesting to talk about the vagus nerve; I think it’s called the wandering nerve. In the past you would do vagotomies – you'd sever the vagus nerves for different ailments. Very crudely, you'd cut the nerve for peptic ulcer disease or gastritis and so forth. Now you're using that nerve and its distribution in these much more sophisticated ways.
Cristin Welle (26:21):
That's right. I think it's an understudied and underappreciated sense. We think of our bodily senses as touch and sight and smell, and those of course are senses, but actually the vagus nerve is a major sensory nerve. 80% of vagal fibers are sensory, and they're just giving the brain a lot of information about what's going on in the body. There's been some cool studies showing that when you activate fibers in the gut that might be activated by a sweet or fat, something rewarding, it actually drives activity in the reward centers of the brain. Which makes sense: Your body is constantly speaking to your brain and telling it about yourself, about your state. I think that actually there's a lot of power in the vagus nerve that has only been explored in the smallest way up until this point.
Thomas Flaig (27:18):
There's been an appreciation for a long time the importance of the nerve and I think with the sophistication of technology, people like you thinking about this, there's much more nuance now on how to harness that.
Cristin Welle (27:27):
That's right. And much more precision.
Thomas Flaig (27:28):
Much more precision.
Chris Casey (27:32):
I can't help but think about how, in the more macro sense here, you have companies that are moving ahead and innovating on the brain-computer interface front, and then you have a regulatory body back here that's trying to get its arms around what's happening. This kind of goes back to a little bit what we were talking about before, but it seems like there would be a real tension there. You've been in both worlds of FDA and now you're delving in on the more innovation side of the technologies: How do regulatory agencies keep up or are they being left behind here?
Cristin Welle (28:19):
I think when I was at the FDA, I was running a research group there and also participating in the regulatory review process. One of the ways that the FDA does sort of keep up, so to speak, is by having researchers in-house that have an understanding of these different types of technology and are conducting experiments, not on any one company's product, but more broadly to understand a category of technology. So absolutely, the FDA has kind of a tough job. They have to balance safety. They want to make sure that patients are safe and informed about the types of trials that they're going to participate in, but they also want to promote innovation. They have started a bunch of programs in the last five to 10 years that are really designed to help spur innovation. One of these is called the Breakthrough Devices Program, which allows companies to say that they're doing something really novel and it gives them a little bit more face time with the FDA. They can talk more frequently and have more informal interactions.
There's been other programs too that have really helped move the field along. When I was at the FDA, one of my goals was to bring the scientific community and the regulators together. I hosted a couple of public workshops on brain-computer interface technology, and one of those workshops resulted in the framework for this guidance document that was then later published after I left the FDA, but it was something that started when I was there. I think that the FDA has continued that work in large part. I would say that most of the people I talk to now, although they may feel frustrated with the speed of the regulatory process, they also feel that the FDA appreciates pushing innovation forward.
But it's still a tough job. One of the spaces that's really difficult and almost intractable for some neurotechnology is the insurance coverage. Even after you get approved by the FDA, you can sell your device here in the U.S. Getting reimbursement can be extremely daunting, and the Center for Medicaid Services, CMS, is very conservative when they make designations about insurance coverage. That's actually been a breaking point for a number of neurotechnology companies recently.
Thomas Flaig (30:36):
It's really helpful to hear about your experience working in the FDA, working as a research in the FDA and then working out in the research community. Just as a professional disclosure, as I've gone through my career and been to FDA workshops and done some visits to the FDA, you really have a respect for what they're doing there in the balance that they're taking on. I agree. I think over the last number of years, you've seen them try to promote innovation in that balanced, very rational way, but your perspective, particularly in this field, is really great.
Cristin Welle (31:07):
Yeah, thanks. People ask me all the time, "Oh, do you think that Neuralink got through the FDA because of who they are or because of who's backing them?" And I always say, "Really, no. I think the FDA holds everyone to the same standard." As has been reported in the field, Neuralink was not able to get their approval for their clinical trial on the first try. They had to go back and redo their testing and really demonstrate that what they were doing was safe. They've had some other bumps in the road, some issues with their animal experiments early on, and then of course, this recent disclosure about these electrodes coming out. But I think that the FDA's perspective is probably taking the balance of what are the safety risks that can be posed by these sort of issues, versus what are the benefits that could come to patients eventually and then making an informed decision.
Chris Casey (32:04):
Well, you've really covered this exceptionally well, Cristin, and thanks for offering a window into this world because it's fascinating. I could talk about this for hours. You've touched on a few of these things already, but what would you say is the biggest challenge that's still out there facing this BCI technology?
Cristin Welle (32:29):
Well, there's a couple of challenges. There's technical challenges and we've covered some of those. Making these devices last for a long period of time in the brain is really hard. But the other challenge is that we just don't understand the brain enough. I've said likely that we can just decode these neural signals and figure out what the patient is thinking, but that is actually not particularly precise at this point in time because a lot of neurons have very complex signals, and we still don't really understand those. We also don't necessarily know the right parts of the brain to target. So there's a host of animal studies that are going on trying to piece that apart and that've gotten us really far along, but there's still a lot of unknowns.
Especially when you start talking about other conditions like neuropsychiatric conditions or other disorders that are not so clearly linked to a movement output. I think understanding the brain is something that we need to continue to explore. It's exciting that on this campus we have some really great neural engineering groups, including Dan Kramer and John Thompson who are doing work in human patients to understand how the brain is functioning. Dan Kramer is launching a brain-computer interface program here on campus which is really exciting. I think that kind of work needs to be done to really bring this technology to the place where it can reliably help the patients that it's aiming to help.
Thomas Flaig (34:00):
That sounds like a great future episode.
Cristin Welle (34:01):
Yeah.
Chris Casey (34:02):
Oh, for sure.
Thomas Flaig (34:04):
I would say this topic though, I've gotten kind of the neighbor question about this, "What's this Neuralink thing?" I see patients... Just unrelated to what I'm seeing them for (asking) “What do you think about this?” There's just a lot of interest in this and part of it's the media. This is a tough question. What's the right expectation for the general public five or 10 years down the road in this field? What's a reasonable expectation of what could be achieved or might be achieved?
Cristin Welle (34:30):
My prediction is that within five years, we'll see a commercialized brain-computer interface technology product. Now, whether it's a commercial success is harder to say, if they're going to get the right insurance coverage. People are also a little wary of putting things in their brain. Understandably so. So sometimes there are those who are technology curious, but then there are other patients who would prefer to try other routes. I don't know what the future looks like or whether the first company to launch is going to be the one that really makes it all the way. But I think we'll see a product coming out that can help patients sometime soon. I think with all of the different companies that are working towards commercialization, we're going to see rapid improvements in the quality of those products as the years go by.
What I'd really love to see is more investment in the space and more understanding of how the brain works, and also bringing patients into the process even more than they have been already. I sit on the Scientific Advisory Board at the Christopher and Dana Reeve Foundation and as the part of the foundation we are pleased to be a part of a new collaborative community that's been launched, called the Implanted Brain Computer Interfaces Collaborative Community. It's an FDA commercial and scientific group where everyone's coming together. Neuralink is a part of it. Many other patient advocacy groups are part of it – BlackRock's in there, but a bunch of researchers. The goal is to bring the patient advocate, the patient perspectives, the commercial entities and the researchers all together and help to talk through some of these problems with the FDA in the room and in the conversation, so that we can help to work through some of the tricky technical issues and move this field forward a lot more quickly.
Chris Casey (36:28):
Well, props to you for navigating all these complex networks out there – both in the brain and the human soft side and bringing all the different disciplines together.
Cristin Welle (36:40):
Different levels of networks.
Chris Casey (36:41):
Yeah, that's something to be applauded, to have that initiative. I think it's fascinating. Appreciate you sharing your expertise with us, Dr. Welle. Please keep up the good work and we would love to hear more about this in a future episode.
Thomas Flaig (36:59):
Yeah, really enjoyed the conversation and your expertise in this area. I agree, I'd love to hear more about your work that you're doing here and future episodes, just make some additional advances there. Just fantastic.
Cristin Welle (37:12):
Yeah, that'd be great. Thank you again so much for having me on, and I'd be happy to talk anytime. This was fun.
Thomas Flaig (37:14):
Terrific. Thank you.
