Bowel Moments
Real talk about the realities of IBD...On the rocks! Hosts Robin and Alicia interview people living with Crohn's disease, ulcerative colitis, or indeterminate colitis (collectively knows as Inflammatory Bowel Diseases or IBD) and the medical providers who care for our community. Join us to meet people affected by IBD- we laugh, we cry, we learn new things, we hear inspiring stories, and we share a drink.
Bowel Moments
Meet Dr. Marla Dubinsky!
Join us for a fascinating conversation with Dr. Marla Dubinsky, a trailblazer in pediatric gastroenterology and a fierce advocate for people living with inflammatory bowel disease. She shares her journey from pediatric residency to becoming a leading voice in IBD care, shaping the future of treatment and advocacy. Through her work at Mount Sinai and as co-founder of Trellus Health, she’s revolutionizing patient care by integrating resilience and digital health solutions.
We dive into the intersection of medicine and entrepreneurship as Dr. Dubinsky reflects on the mentors who shaped her path and how she’s working to make innovative healthcare solutions both impactful and commercially viable. She also highlights the importance of a holistic approach, bridging physical and mental health to empower patients in their care journey.
Plus, we explore her work in women's health, particularly in IBD management during preconception and pregnancy. Through initiatives like We Care in IBD, she’s helping to create tailored programs that support women at every stage of life. Don’t miss this deep dive into precision medicine, prevention clinics, and the future of IBD .
Links:
- Info on Trellus Health
- Innovative programs at Mount Sinai IBD Center
- A video about Dr. Dubinsky for her Jacobi Medallion award
- The book Dr. Dubinsky mentions- "Likeable Badass: How Women Get the Success They Deserve" by Dr. Alison Fragale
Let's get social!!
Follow us on Instagram!
Follow us on Facebook!
Follow us on Twitter!
Hi, I'm Alicia and I'm Robin and you're listening to Bowel Moments, the podcast sharing real talk about the realities of IBD Serve on the rocks. This week we talked to Dr Marla Dubinsky.
Speaker 1:Dr Dubinsky is the Division Chief of Pediatric, gi and Nutrition, the co-director of the Susan and Leonard Feinstein IBD Center and co-director of the Marie and Barry Lipman IBD Preconception and Pregnancy Clinic at Mount Sinai. She's also the CEO and co-founder of Trellis Health. We talked to her about Trellis Health, which is a digital health solution that helps people living with IBD build resilience, adhere to treatments and actively engage in their health. We talked to her about her preconception and pregnancy clinic and how she developed that as a way to better serve women and people living with IBD. We talked to her about what it was like to seek out mentors and colleagues to help her foster and advance her passion and expertise, and we talked to her about what it's like for her to now be that mentor that people seek out to help them develop their passion and expertise in IBD, and what it's like to build future leaders in IBD care. She's definitely a likable badass Cheers.
Speaker 2:Hi everybody, Welcome to Vow Moments. This is Robin.
Speaker 1:Hey guys, this is Alicia and we are so excited to be joined by Dr Marla Dubinsky. Dr Dubinsky, welcome to the show.
Speaker 3:Thank you for having me. I've been dying to be on the show.
Speaker 1:Gosh, I hope that's the truth, because we are so, so, very, very excited to have you on the show. Our very first unprofessional question for you is what are you drinking?
Speaker 3:I've been really into because it's really cold here in New York these days I've been drinking. It's not really exciting as a cocktail, but it's ginger tea. That has been like my obsession over the past couple of months. My husband chops up the ginger, so imagine how special that is Fresh ginger tea. My husband's Dominican, so when he was growing up that was sort of it heals all elements. Ginger tea is the answer to everything, so he's convinced me of such. So that's been my. You know my progression is healing myself emotionally and physically with some ginger tea.
Speaker 1:Actually, I am also drinking tea with you, although mine is like an immune support tea, so I think it does have ginger in it.
Speaker 3:but similar similar story Robin.
Speaker 1:what about you?
Speaker 2:I am also drinking tea. Oh my God, ladies, tonight I wanted to try something different, so I have a green tea with blueberries.
Speaker 1:Cheers number one. Okay, dr Dubinsky. Next question for you is what is your IBD story? What's your connection to the IBD community? What brought you to us?
Speaker 3:Yeah, so my story sort of starts. One just to also level set, is that I don't have anyone in my family that has inflammatory bowel disease. That often is a driver for where passion leads you in terms of trying to solve a problem that you are personally connected to. What happened for me is that when I was doing my pediatric residency this was in early 90s actually, and I just want to remind everybody that in the early nineties we really didn't have any effective, you know, approved biologic based therapies. We were using steroids, we were using nutrition for kids, because a lot of children, you know, had growth failure and it was sort of like, you know, children were having to take nutrition through an NG tube. There were steroids, there was 6MP, which was, which was a drug that many were using before the introduction of biologics, and really there wasn't a lot. And I just had this like the families that I connected with the most while they were in patients because as a PEDS resident, you're sort of really meeting patients and families in the ward right Because you're a resident and you're totally integrated into the service and I just had this like really immense connectivity to these incredible kids who were living their best life and then derailed like literally, just like that day, you know, something happened. They had increasing abdominal pain, they had, you know, a bowel obstruction, or something happened that sort of derailed them completely from being the healthy preteen or adolescent that was going through puberty, which is already difficult, and then having this sort of to add this other thing that I have you know, it's already tough being a teen and I was just so amazed by the resiliency of these kids and the families and the connection you have, because back then we didn't have Remicator, we didn't have therapies, that you would sit in a chair and then you'd magically go off and eat McDonald's, you know, after you got your infusion. That was not the case, and so we would spend days in the hospital getting to know these families, and every time I saw an IBD patient I always said to myself I feel like there's so much more to be done Now.
Speaker 3:I also was passionate about liver transplant. By the way, I actually went into PHGI Fellowship. Fun fact to be a liver transplant physician. I trained in Canada, I did my pediatric residency in Calgary through the University of Alberta, and I was really inspired by the gastroenterologist that was, you know, the GI team. I was like God, how can I be that smart? Like I was just so inspired that this individual seemed like he was so smart you know the GI system, you can't see anything, you know it's hidden and he was so smart about physiology, nutrition, liver, pancreas, like it just amazed me and I was like I one day want to really be as smart as Brent Scott. That was my mentor, that was my North star in Calgary and because I really thought, also chronic condition, clearly liver transplant and wow, imagine taking a six month old or a one year old and doing a transplant and transforming their life.
Speaker 3:I sort of felt that way, similarly about IBD patients that if you can get them back on track, you've transformed a life right, you've given them back the hope and sort of the motivation that they can resume their life. And I felt similarly about these chronic liver condition patients who would get transplant. So I was always in this vein that when I think about and I mentor others, they say like how did you get from there to there and what made you choose to go to Montreal and then Los Angeles? I actually always followed. I always say the guy or the girl, what does that mean? There was a physician at University of Montreal on the French side. I am an Anglophone, I'm from Montreal, but the University of Montreal is the French side. The McGill is the English sort of the Anglophone side, although it's multilingual, but in terms of primary language French. At the University of Montreal and one of the physicians who had recently joined trained with a physician in France called Alagiel. Now there's a syndrome named after Alagiel which is Alagiel syndrome and I thought, oh my God, I need to go where the guy who trained with the guy who has a disease named after him, that's a liver disease.
Speaker 3:So I always sort of have this like vision in my head and the theme doesn't stop when I talk about the next move in getting me from here to there was. You know, I wanted to go cause I said, if that person trained with like one of like the leaders in the field, that person is going to help, mentor me and train me to hopefully be similarly a leader in that field. So that has been my philosophy very strategic, not manipulative, but strategic in attaching myself to folks who can actually help me go from A to B and thereafter, or at least get me to where I think I'd like to be and may see something in me that I didn't know I had. Right, those are like the qualifications that I always sort of strive to do. And so in the end, six months in, I fell completely like head over heels in love with the research that was being done in Crohn's disease and ulcerative colitis. I sort of felt like I was like cheating on Alagil.
Speaker 3:You know, I went to where Alagil's mentee was and I was no longer interested in Alagil or liver. But I really bonded with my mentor at the time, who was the division chief at the time and he was an IBD expert and you know he sort of said like what do you want to do if you don't want to do liver? I said I really like what you do, I love IBD, I love, you know, the work that you're doing. He was more of a basic scientist and I'm really a clinician and he said well, do you want to do research? I said, yes, I'd like to do research. So he gifted me with a project that ended up really springboarding my interest in precision medicine, pharmacokinetics, drug levels, drug monitoring. It sort of created this path, but I was doing it pre-REMI, so there was no story about infliximab and drug levels and it was in another drug which we were using before.
Speaker 3:And in order to come back to Montreal, quebec has limited spots. You have to leave the province because it's a little bit different than in the US and you have to go and learn something and bring something that they don't already have in the spots that are being filled by physicians that were in Canada, but specifically Quebec. So he sent me, you know, he gave me options and he said well, I'm working with this guy. Again, the guy concept comes up and it's the guy. And I was like who is the guy? And he said, well, his name is Steph Togan and he happens to be the first author on the first ever Remicade paper in Crohn's disease in the New England Journal of Medicine. I thought that's another guy.
Speaker 3:So I like went all right, montreal, los Angeles, I met with Steph and it was like love at first sight. I was like I want everything. I want everything you're doing, feeling, saying, and I just like, again, you get inspired and you get excited about the passion and I followed passion that's, I guess, a nice way of saying I've actually followed my passion and others have, you know, given me and shared with me their passion and sort of led me and then I really jumpstarted my career at Cedars-Sinai with Steph and he, you know I I had gotten a chronic colitis grant and I was really getting my research legs. And the cool thing was is that because at the time Canadians, I didn't have my, I didn't have a medical license, I was a fellow, I was a research sort of fellow and I was on something called a trade NAFTA visa, which is back then, and the rules were that you don't see patients, you don't examine them, you don't have an. You know, it's just you're doing research and you're really focused on doing research.
Speaker 3:So I audited my MPH at UCLA, had a backpack, was in school with like students at UCLA, like I completely just like, was open to everything I wanted to absorb, eat, sleep, drink, research and really figure out what my path is going to be. And when Steph said, well, what do you want to do next? And I said whatever, I want to be you, but in pediatrics. So I'm giving you sort of the background of like how it really is. It's about those that inspire you and see something in you and want you.
Speaker 3:Like if Ernie had not sent me to Steph, my life would be very different. I'd be in Montreal I'd still be at the University of Montreal, probably, you know, and having a very different life. I would have had a very different path, which I'm sure I would have been enjoying, loving, happy, but that's just who I am. It's like wherever, as long as I'm doing good stuff and I'm helping to change people's lives, it doesn't matter where I'm actually stationed. You know, it's just that I have patients, and so I stayed at Cedars for 16 years and thought that I would start and end my career looking at the Hollywood sign on West.
Speaker 1:Third, street in LA.
Speaker 3:And an opportunity had arisen and my personal life was such that my husband has a daughter and she was young and we had met and decided that I'm going to move to New York because that's where him and his daughter were from. And so for the first time, I actually had to make a decision where I put my personal life. This is a true difference in as you mature. This for young folk out there to understand is that it was always about career, career, career, and it wasn't that I was selfishly about myself. It was actually about how much can I give to others and really answer important questions and give as much to my patients, my families, and create novel ways of approaching, you know, this disease. And then I put my personal life for the first time in a lens, like before my professional, and around the time that I was thinking what am I going to do? Am I going to go into private practice? Am I going to be ready to leave everything I had just sort of invested my entire existence in? But it was okay. I felt like I had done good, you know, and I was ready to say if I needed to take a break or have a different path at that point. It was worth it because my stepdaughter needed her father and her stepmom at that point, and so it just so happened at the same time there was an opening at the Mount Sinai Abundance Center, the birthplace of Crohn's disease.
Speaker 3:Who and fun fact when I first started as a research fellow at Cedars-Sinai and I thought to myself, how am I ever going to get? Because as a young, impressionable fellow, you're like don't you want to work at Mount Sinai? Like everything was happening at Mount Sinai, it's the birthplace of Crohn's disease. It was like this really, you know giants in the field that were still practicing and were people that I would see on stage when I was a fellow. I was like I need to work there. But you know, it took me 16 years.
Speaker 3:I married a guy from New York. That was probably a good, a good strategic. I told you I'm strategic. That was one example of.
Speaker 3:But the idea was that it just happened that there was opening and Bruce Sands, who's a very close colleague and friends of mine, who runs the adult GI side, me and John Fred really formed the IBD directorship, me more on the clinical ops side, him leading some of the research stuff, and it was a marriage made in heaven and I was able to transition there and run the IBD operation, run the GI division, and I've just invested more of my life, imagine, imagine, thought there was not much more you can do, but I'm completely inspired and continue to try and be as innovative as possible, to try and change as many lives as possible.
Speaker 3:And that is the story of how I sort of got interested and then doubled down and have continued to double down and has led to a lot of the things that I'm sure we'll get into as to like why, how and all of that. But I think it kind of gives you an idea of like where my mindset is and how I sort of tracked my path so that I can be in a position to help as many people as possible.
Speaker 2:First of all, that was delightful to hear how passionate you are about IBD. As a patient, I want to say thank you. Thank you so much for sharing so much.
Speaker 1:Sorry to the liver folks, sorry guys.
Speaker 2:Yeah, sorry liver people, but we got her Too bad. It was no offense. No person like nothing personal here. Yeah, how do you feel now about being? The guy for so many other people.
Speaker 3:When I get asked that question I think about it. So last year, you know, there was an award at Mount Sinai called the Jacobi Medallion, which is not to tell you like that. I want it's less relevant, because who cares really?
Speaker 1:But at the end of the day.
Speaker 3:The reason for it was thinking about the path and the role of being a mentor and helping people to continue to inspire and aspire and to feel the responsibility that I have for the folks who have helped me understand that the responsibility now is for me to ensure there is a legacy. I realized very clearly that it's not about me and that was interesting. I just want to say that when I was at Cedars, it was all about me because I didn't have fellows. I ran the IBD boutique. It was like Cedars is a really cool place because IBD is sort of its own institution, almost within the GI division. We didn't have a division, I didn't have fellows. I had rotating fellows and folks from UCLA would come over, but it was like a really cool sort of almost private practice field but in a hospital type setting. So the idea being is that I was thinking about when I was switching to Mount Sinai. One of the things I needed to remember is that this is no longer going to be about me. This is going to be about taking everything that I've done, thought about, learned, acquired, you know, greatness, great ideas and seeing what a true leader is. That is what I need to do here at Mount Sinai and was I ready for that? Was I ready to no longer be just about me? It's like a really interesting phenomenon and it wasn't that, as I noted earlier, it wasn't like it's all about Marla, but I say, like my career and trying to like bulldoze through and make these discoveries and realize that what it is really about this maturity as you mature in your career is it must be about the next generation, because people with IBD will continue to suffer from IBD. It doesn't stop with me, it doesn't stop with infliximab, it doesn't stop with you know, it just doesn't stop. And I really want to be able to make sure that there is a long legacy of folks who will continue to deliver innovation, transformative approaches to care for folks suffering from IBD. And in order for me to do that, it means I need to switch and I need to make sure that there are multiple future generations.
Speaker 3:So I sort of at this medallion ceremony, when I gave my acceptance speech or my thank you speech, I really recognized the immense responsibility that what it means to be the guy, the gal, the person is that you need to be intent, you need to own it and you need to be a role model and sometimes I catch myself. If I'm responding in a certain way or emailing and one of my mentees is on it, I have to actually say, like Marla, they see you, they will mirror their behavior through you. So it's not just about being the guy, but it comes with, so in a good way. I love the aspect that it's important for me to be intentional in the way I speak, the amount of planning I put into every meeting, because it's important for me that I am perceived in the way that I want others. It's not and it's not about do I? Yes, I care about what other people think because I have taken on the responsibility to be a role model to others. So I want to be seen in a certain way. I want to be an inspiration to others, and so part of it is how I present myself and that includes the way that I think very carefully about my wardrobe, think very carefully about the way that I speak, the way that I lecture, the way that I educate, the way I interact, and that comes with intent, which is why I say that understanding the responsibility that I've taken on has been really insightful for myself to practice that and to ensure that I'm truly.
Speaker 3:You know, perception meets reality. Cause that is actually one of a differentiator for me is when I'll have someone say, you know, you're exactly the way I imagined you to be, and I'm thinking, oh God, what does that mean? Before we get into, you know what that means. But it's that you know, I had this vision. Or just people will ask my fellows oh, what's it like to work with her? They're like it's exactly what she's like when she's up on the podium. There's nothing different. That is Marla. So you know, it's. That's important to me and that's why I make that perception reality.
Speaker 3:Comment is that that is being the guy or being the person. I really take that role. Probably, aside from being a wife, a stepmom, being from there for my family, it is one of the most important things I take very seriously is responsibility, and I think my team, they know that because they know that I will always make sure that they're first. That's what a mentor-mentee relationship needs to be and that doesn't always happen, which is why I sort of take on that role and have taken it on seriously and take a lot of pride in knowing that there's many future, the guys and the being put into leadership positions and talk to me about you seeing that evolution being part of that evolution and kind of how far has it come.
Speaker 1:But where do you think it needs to go? What's still not there yet?
Speaker 3:Yeah, it's funny I was thinking about as I was saying to Guy I was like it truly was. It was like you were like part of the guys and I was always part of the boys, like it was just a thing. You know, there was like three or four of us. It's me, maria Abreu.
Speaker 1:Uma.
Speaker 3:Mahadavan. I'm talking older school women that were originally in this doing advanced fellowships. There wasn't that many of us. Like you know, maria and I trained together at Cedars as well. We overlapped and then she came to Mount Sinai and then I came. We are sisters from another mother, so it was like the original.
Speaker 3:You know those in the U S, there wasn't many and there was no vision in my mind. This is important. What I'm, what I'm going to say is that I never saw gender, which means I didn't experience what a lot of women see Now. Is it entirely possible that I just had my head down and bulldoze right through and didn't even pick my head up to even pay attention? I would venture to say that's probably the case and that is what we have. A lot of us have in common sort of grew up in a very sort of, you know, male dominated field. Ibd, gi is much better. It's many more than it was. It's still more to come, but IBD, there are some incredible, powerful, incredible women in this space and it's, like you know, truly.
Speaker 3:I'm into this, and you'll get me derailed when I tell you that I'm reading this book that I was recommended called A Likeable Badass and so what it is, so that I could just even make it clear as to where I've seen and instead of me saying badasses in terms of like these women are. But what has become interesting is we are seeing leaders that are both warm, compassionate and assertive, not cold and aggressive, sort of the extreme of a likable badass we're talking. You know, we have this spectrum of warm and cold and assertive and aggressive, and women have a little bit of a more difficult time. The expectation is that we're both warm and assertive. That is the goal that we all want to be. Now, a lot of women who may not, who may be one of those and full, you know, on the spectrum of more cold or shy or whatever the concept viewed as not compassionate or not likable. Those are the likable badass pieces. That a likable badass is the idea that you're warm, you're compassionate, but you also get shit done. That's sort of the concept and learning about that and teaching some of even my NPs, and so you know, talking about what that means and when I look at the field now and again, maria myself, uma, probably fit into pretty well the reason why you're probably part of the crew and there was no, like I said. I'm sure many people have tried, but we just went like what? I don't even see you, so I'm just doing my thing, like whatever you're. That's your problem. That is not my problem.
Speaker 3:I don't see myself through my gender, I see myself through my work and I put my head down and I tell all my young faculty if you pick your head up to look around right and left to see if that's happening, you know you missed your opportunities. I'm very clear that if you're worried about your gender, everyone else is going to be thinking about your gender. So you just get work done and let the work speak for yourself. You know, and I feel that a lot of incredible women, especially younger generation and mid-career, are just like incredible role models and it's so exciting to see and I love, you know, being on panels with them and I love being in a room and you know we all need inspiration, no matter what right. We all need still mentors, still role models, to say this is possible. So I think for me that's sort of been my driving force and and, like I said, I am sure there are plenty of times that gender came into play, but my mentors didn't matter. They saw something in me and I was showing them value. And if you show value, it doesn't matter what your gender is, just show value to anyone you can. Who's then going to keep asking you? Because you always get shit done, and that's sort of the concept is, but being warm and kind, both practicing powerful speech as well as powerless speech. You don't have to always have powerful speech, you know, just learning that is really important, and so that's sort of my thing now is to say how can I help others gain those skills that really may create barriers for them? They don't have to be me. I told them, one of me is like so much enough that you know that's not what I'm asking for. I just want to share with you some features or characteristics that can allow you to go from here to here.
Speaker 3:One of the things I did late in life was I actually got an executive coach. I got someone who can help me think about executive function. I wanted to understand how does my brain work. Now you think, 56 years later, marla, you would know how your brain working. You probably could have predicted what your brain was going to say. However, I needed to understand what are my limitations, how to manage up, how to bring people in for things that I'm just it's.
Speaker 3:I'm not my strength. Let's say I don't lead with empathy. That's a true fact. That I don't lead with empathy it doesn't mean I'm not compassionate or warm, it just means that accountability and the way that I lead a team is there's accountability and kindness, right, but accountability comes first. That's more of an executive sort of CEO kind of mentality.
Speaker 3:And I remember thinking, oh my God, I have low. My empathy quadrant is lowest of all. And everyone could have guessed that if I show my brain all the time and I show the four quadrants, it wasn't like it was zero, it just wasn't like the strength. And so I remember saying to my executive coach oh my God, I can never lead a team. I'm not empathetic. She's like no, that's not what your executive function is going to be. You are going to organize everything, you're going to take people from A to Z. You're going to be a strategist, you're going to be, you know, you're analytic. That's the strength you have. And you'll bring in people who could help on the quadrant of selective empathy, as my friends say, so that you bring empathy out when it needs to be.
Speaker 3:And so learning all of that has really been over the last like five years.
Speaker 3:I've really embraced as I've matured in myself.
Speaker 3:I've took me a long time to understand why I say the things or why my brain sees things in a certain way, and it has helped me, I think, be a better leader and really bring the right people around me and admitting what I don't know at this stage and saying, well, that's not how I'm best skilled, it's not like I'm going to learn a new thing at 57 years of age, you know.
Speaker 3:So I need to know what I'm really good at so that I can surround myself with folks who can complement where maybe I have some limitations. So that's also been an evolution. So I think that also the vulnerability around understanding what your strengths and limitations are as a leader has also worked for me, meaning in a good way. I've wanted to put in that work so you could see by the therapy session we're having that I've really disclosed sort of what, the evolution of being the guy and how I've created, you know, for myself goals to be intentional and to be as much of a role model as I can and aspire, you know, to inspire others to continue to create their path and their unique way of leading in the field.
Speaker 1:Speaking of sort of learning new things. One of your interests is digital health, and that is definitely like an up and coming area that continues to evolve. How did that interest start? Where did it start? And then how did you parlay that into your venture, trellis Health?
Speaker 3:It's funny, it goes back to your role model. So Steph Targan is like the scientific entrepreneur of all time. He started Prometheus Labs and started Prometheus Bioscience. That was acquired by Merck for $10.8 billion and I have watched Steph like literally I've studied him, you know, not creepily, but studied him in his how he takes what helps people and wants to scale, wants to ensure that not just the folks that are in the four walls at that time at Cedars had access to what he believed to be something that can help 10 million people worldwide or whatever the concept at that point not just the thousands that were showing up at Cedars and I saw how his passion translated into discovery and innovation.
Speaker 3:I kept watching him do it and it started with the patient wanting to solve her problem, figuring out how to solve the problem, building the right team to solve the problem, and then saying I'm going to scale this. I think there's a marketability, I think there's a commercializable strategy here, and so I sort of have been taught by the master, in my opinion, and I remember, you know, back then, being an entrepreneur and commercializing your know-how. It's like docs who sort of went into pharma. It was like the dark side, like how do you justify making money, you know, really, that's how I thought that what we do best is, you know, we, we help people, our ideas are worth something, and if it means that you're going to make a little bit more money for all the incredible work and know how that you put into changing people's lives, it's not the dark side, you know, and this was like a lot. So I remember staff, you know, and all the conflict of interest disclosures, and it was like I just remember, you know, and he really taught me that if you feel that you can do something that is going to help millions of people, you put your head down and you keep doing that and you break through sort of the noise because, knowing how many lives you can change, you will not have a problem going to sleep at night, and that was really sort of important, you know, and I sleep well, just so you know. So you know, the idea being is that when I saw what stepped in and I came to Sinai and you know the field had evolved so much to a point where it was no longer acceptable to treat patients' symptoms and worry about their colonoscopy results and that our drugs were great but we still had a therapeutic ceiling. And I really believe that unless we treated the whole of a person, not just the physical symptoms, not just the colonoscopy ulcerations, and getting a Mayo score like that doesn't matter, because my patients want to live their best life and they wanted to be seen by the whole of them and that means mind and body.
Speaker 3:And it used to be that. Oh, we said. Well, the reason why you're depressed or anxious is because when your symptoms, you know you're having situational anxiety or your mood will get better when we get your symptoms better. And that was a real ignorance on a lot of our side and we really didn't sort of take into account the real role of inflammation in brain health, in mental health, in emotional health, and we kept thinking that if we just got your symptoms better, oh, you won't have anxiety, you won't have depression, you won't have, you know, any medical PTS whatsoever, like, oh, an osteopath, we just got to get you, you know, sorted on. You know completely. You know we all knew it was difficult. But, iomy, back, we just got to get you, you know, sorted on, you know, completely. You know we all knew it was difficult, but I don't think we understood that we can help. And I think that was a real switch over the last sort of decade plus like a little bit more than a decade.
Speaker 3:And I remember going to an advisory board and I met Lori Kiefer. So Lori Kiefer is sort of like literally like the queen of, you know, gi psychology, health psychology in general, but also, you know, in the realm of GI. And I saw her talking a language I had never heard before, which was the concept of resiliency and self-efficacy, meaning confidence and ability to bounce back from adversity, and that we're all born resilient. Stuff happens. We get a challenge in our life and it is binary. There are two roads to go down. We either go down the stress response and languish, or the resilience response and flourish. It is that binary Again, you can tell.
Speaker 3:I get obsessed and need to have whatever that is and figure out a way on how to spread the word, because it's like evangelical for me If I could help spread this message about this new, different way of thinking about people with chronic conditions and not waiting for people to develop anxiety and depression, but actually proactively giving them the toolkit and mitigating and building the resilience and the tools and the insight to be able to be more confident that you can self-manage with your medication, you know, or whatever else is happening, that I need to empower people to be in control of their health and control was not defined by you know why you have rectal bleeding or how many stools you have, which is our typical Epic checkbox or whatever, and we'd go right. Here's your count protecting level. Your white count was fine. Your next visit will be in six months and I'll scope you, you know, and rule out colon cancer.
Speaker 3:I mean, that is like that is not treating the whole person and so, fun fact, I sort of figured out a way where I called her after the meeting. She was in Chicago and I said you know, I really love your self-efficacy scale because she had developed one for adolescents. So I sort of said would you mind? This is my way in to try and get her to come to New York? I said I'd love to collaborate. Would you mind if we did a study with your self-efficacy? And before the phone call ended I said oh, and by the way, do you have any reason why you'd want to come to the Northeast? Like my whole family's in New Jersey, I've been looking for an opportunity to come.
Speaker 3:She had an amazing opportunity. She was doing a stop, a Jill work with the amazing team at Northwestern, but her real passion was about taking her skill and really changing the lives of people with IBD. And this was an opportunity where we could do it together. So I said give me three weeks. And this was an opportunity where we could do it together. So I said give me three weeks. And in those three weeks I needed to get approval to open a new position, get philanthropy to fund a resilience-based program talk to our Dean about and he's a resilience expert. So it was really cool because he was I was really obsessed around. Has anyone ever really applied the concept of resilience outside of trauma or in the mental health space or prisoners of war or any kind of physical or sexual trauma? And it was never really done.
Speaker 3:Understanding that Lori's work was really trying to bring this positive psychology field into chronic condition management, I was like totally, you know, obsessed and so it was great. So I called her back and I said all things are go, we'd love to be able to have you come and build an entire resilience program wrapping around the patients, the providers, their medication and really elevating this patient-centered whole person model. And when I saw the results of seeing a great doctor I mean I'm saying anyone in the IBD center plus a good medicine, because we have good meds, plus being wrapped around and empowered by these resiliency concepts and mindset, and seeing that people were not going to the ED, we were lowering the rates of surgery, people were staying on their medication, we were annihilating hospitalizations, we were significantly reducing ED visits. We were actually, I said, lowering surgeries, decreasing mental health comorbidities. I said this is not something that only people who have the resilience to drive over the George Washington Bridge or get through the tunnels to come to the Upper East Side. This needs to be available to as many humans on this planet as we can. And I said to her hold tight, give me three weeks. This is like my typical I need three weeks to sort this out, to map it out.
Speaker 3:And I went to our tech transfer office and I said you know, I know that you're used to. You know transferring molecules or potential mechanism of action or maybe treatments or biomarkers. I feel that healthcare is going in a way that if we had a way to digitize and package what we're doing at Sinai and be able to scale it digitally, we will change millions of people's lives and we're going to save a lot of money to the healthcare system. That was like the rosy way of thinking about that. Value-based care was more of talk at that time. Now it's getting into more policy and a lot more health plans are really, you know, concentrating on value, meaning better outcomes, less costs, so that we can continue to get good outcomes for our patients, et cetera. So I told that to my tech transfer office and the officer and they said so.
Speaker 3:I told that to my tech transfer office and the officer and they said well, here's a seed incubator fund. Can you digitize Lori's assessment that she had built us a developer to work with? And they were really supportive. And then they put us through some entrepreneur kind of courses and we had somewhat of a roadshow where there were different investors who came and one of the investor groups really liked the idea. They had done some investment in other two other Sinai projects and we're very thought, wow, this is cool, this is a different way of technology that Sinai is developing and we'd love to be involved. So we got a seed investor who gave us some seed investment to start building the platform, building a skeleton team Lori and I were co-founders at the time and continued for a while to be that and we're able to get a CEO in place as well as a few sort of minimum employees that were working on the digital health side of it and grew the business and we actually raised money publicly. So Trellis Health is the scaling of the resilience program at Sinai, I should note. So Trellis was born in July of 2020, right in the middle of the pandemic and we went public on the London Stock Exchange because they have this really cool mechanism that small startups or early stage could raise money and do it publicly instead of privately.
Speaker 3:So there's sort of you know pluses and minus to everything, but at that time there was a lot of desire to invest in digital health care, especially if it was mental health or behavioral health, especially after what had transpired. And the word resilience was very sexy. I mean, even Obama was using the word resilience. I mean, everybody loved the word resilience, didn't quite understand that it's not Angela Duckworth. You know resilient employees. This is really about being resilient in the face of an obstacle, such as a physical, you know, chronic health condition. But same constructs, you know, being positive, optimism, self-regulation, empathy, self-compassion. You know disease acceptance. Those are sort of constructs that are not dissimilar except for the disease acceptance part.
Speaker 3:And so we built the platform between you know 2020 and then launched our first real commercial program with UnitedHealthcare in March of 2023 in the Northeast. So we were providing Lori's method and the program, which is both a digital as well as real-time coaching. So we've got trained folk who are empowering people, and United was covering the cost of the program, which, for anybody would know, that's really a momentous occasion to have a health plan who says we understand that this will help our members but also, of course, consider the benefit to the cost, and so that's sort of you know where Trellis started, which was in the health plan business. But we definitely have recognized and expanded our approach, that we've also realized that you know we need to expand to patient support in general. That includes, you know, supporting patients on various therapies and being part of. You know the goal is to wrap around and be part of patient support programs, knowing that a copay assistance card is supported but it's not supporting the whole of me and really starting to expand and really develop ways of also helping patients in clinical trials, because you know clinical trials are very stressful. You've failed a lot of meds, potentially the optimism that this med is going to work and I'm going to get a placebo. So being able to help people get themselves ready for clinical trials by building the resiliency to get into a trial is also like my passion and my dream is to, you know, get new drugs to the market but get people to get into these trials so that we can actually bring even more innovation. So you could see that my passion for what I do in my day job and what I continue to be extremely passionate about has been able to take that and be able to sort of bring that to Trellis to expand access for as many people as we can and also integrate, empowering people and really building happiness and health for as many people as we can, has really been what Lori and I wanted Trellis to be, and that's what it is today.
Speaker 3:I will tell you that two plus years ago I was asked to take over as CEO of Trellis.
Speaker 3:So I talk about why I did my brain. I needed to make sure that before I took on being executive of an operation in something, I've never been a CEO of a publicly traded company Maybe I was born a CEO, but not of this public traded company, right, I think I had that mindset, but I wasn't sure that I knew what to do in my medical you know world and I knew how to build a program, et cetera. But those skills remain and that's why my brain was so important, because it showed me that these are my strengths. This is not my strength how to build a team. And so I've been doing both, both my work at Mount Sinai and my consulting and my speaking and my developing programs, and then also leading the team at Trellis Health. So that is sort of the really it all comes down to. What are you most passionate about and what can I do to help as many people as I can was really what gave birth to you know, the foundation of Trellis.
Speaker 2:I really hope that in 2025, you are able to accomplish your goals in the expansion process. I mean, all the patients who listen to the show know and you know from treating us that it's like, uh, you're good for a little while and then something happens again, and so it's like a. It's a never ending cycle of reminding yourself that you have to be resilient and not wallowing or you know saying, okay, I'm going to wallow in this for a little bit because it really sucks, but now I need that little push to get back to the other side of thinking positive and being resilient and really sharing that. So I'm excited about where Trellis can go. Yeah.
Speaker 3:I'm excited, so we'll know. I think that you know we're heading in the right direction and it comes from the right place. You know, and listen, I also have to be realistic that not all startups succeed. You know, just in general, like I'm also, you know, realistic. But I feel like when you have the right people, you have the right intent, you have the right passion, that you're doing good and good science and good business and good people and, hopefully, good outcomes. And that's sort of the attitude you know. You have to be resilient. Oh my, I can't tell you.
Speaker 3:Every day there's a different emotion and you know that bounce back and you could absolutely keep feeling like those bobo balls and you know, and you keep coming back. I am not going away. You know that concept of that. I'm punching that thing and you're like keep it coming. I'm going forward, I'm going to bounce back even further. And I think that's the concepts of really trying not only in our daily lives and what I talk to my patients about really focus on them and empowering them and understanding the fact that so many more decisions need to be made when you have a chronic condition compared to when you don't, especially one that involves bathrooms, unknown what's going to happen. I may eat something. You have to plan so much more. There's enough decisions without IBD and then adding IBD and we just don't get that Meaning typically, providers, we're very good at sticking in our lane, but we need to be able to, you know, expand and understand what else our patients needs, and that's sort of the premise between trying to wrap around patients and providers as much as we can.
Speaker 2:I want to talk about women's health. You're a pediatric GI and and adult.
Speaker 3:So I realized that if there were two populations that needed extra attention, it's women and children. And so, funny enough, the extension this goes back to my Cedars days is that after Maria left, like I was it, I was the female gastroenterologist who did IBD. So because I always I'm always involved in adult trials, I wasn't seen as like, oh, you're a pediatrician only, but you do both adult speeds. This is historical. But because I was the only woman, it was sort of intonated you must know something about pregnancy. It's like, well, I've never been pregnant, but yeah, I got two X chromosomes, maybe I do. So it just became by default that Marla's going to see these patients and she's going to tell them about the safety of the meds. Because back then there was only a few of us who were actually involved in sort of even safety of these biologics in pregnancy and sort of doing the work. Uma Mahadavam really was leading you know the story and we were doing a lot of work at Cedars as well. So it sort of made sense and so I would see them, I'd say your meds are safe. And back then we, and so I would see them, I'd say your meds are safe, and back then we only really had Adalimumab or Humira and Remicade at that time. There was nothing much else. Because we know of revolutionary revolution until 2016 and beyond, really, or 2014, with fet stop their meds and they should continue. And it just started snowballing after that.
Speaker 3:And then I was going through my own fertility struggles and really realized that women want to talk to women. Women want to talk about sexual function, they want to talk about pelvic floor and they're not talking to my colleagues, about my male colleagues, not because they wouldn't be receptive, but it's not being brought up. So my female patients weren't bringing it up and you know, talking about sexual health, sexual quality of life, it just wasn't happening. And so when I was developing these really you know key relationships with a lot of these women that I was seeing for my colleagues at the time to sort of help them get pregnant, they would hand them to me during pregnancy was almost like, oh my God, I'm not touching them during pregnancy. I'm like no problem, you're with me for 10 months and then I'll hand you back. I will give the gift back to you. Know, you gave me a gift for me to be able to help you get pregnant and stay pregnant, and then you'll see me next time. You know we'll come back. So I committed to sort of managing them during this time that a lot of folks were uncomfortable and it's true there wasn't as much data as we have now. Piano registry hadn't been, you know, finalized, so no one knew really was it safe? And so I was bold to talk about it and be able to say we'll get you through this and we'll work through it and our preliminary data looks like it's safe. You know, being authority in it help people feel more comfortable around it.
Speaker 3:And then I started a clinic at Cedars where I really felt after my fertility journey that I wanted a maternal fetal medicine specialist with me in the clinic. This was like a novel sort of thing. So I went to the head of OB at Cedars at the time and she thought it was great and we started doing clinics whereby I would see a patient and then they would move from my room to her room at the time, and it was great because they still got us on the same day. But then I realized, ooh, I think I could even do something more amazing whereby we're all in one room together patient there, everybody surrounding one message, no confusion, no inaccurate information center of truth, this is where it happens and triage them to whoever they need. And so when I was coming to Mount Sinai, before I even started, I wanted to be sure that I can have adult privileges, so I can see adults, but also that the maternal fetal medicine team would be interested in coming to the IBD center and running a clinic with me so that we were together seeing the patient and preconception counseling her pregnancy. And, honestly, it's been 10 years and I just had it today, and it is like the favorite day of my life Every Wednesday that I'm in eye prep clinic having conversations about the most emotional time in our female patients' lives be able to say, you know, oh, don't worry, we're going to get you pregnant.
Speaker 3:This is what we're going to do, having a plan, having a timeline, telling them what we need to get you well and why control of inflammation is important. Running away from the meds and the OB saying to you to stop your med and all kinds of that. I said, if you did not hear it from this mouth, it is not true. That's like I've become, you know, sort of trying to be evangelical about you. Call me whatever someone says to you if you haven't heard this and then you get conflicting information anywhere else, call me, write me in the portal, I'll clarify.
Speaker 3:But it is really the ability to take women who have literally walk in the room, I could tell, holding their breath, you know, holding their pelvic floor and just waiting for me to tell them that it's going to be okay. And then by the time they leave the office they're, like you know, ready to go to sleep. They're so relaxed and so happy and I breathed for the first time. And you know, leading up to the appointment today, one of the patients, the husband, said oh, we were told nothing happens until you see Debinsky. And that's like a funny thing, cause it's like, yeah, I stand in the way of getting pregnant.
Speaker 3:And your other opinion, like usually, I say you know, I am part of it, I helped you get pregnant. But it's not quite the same. Although I have asked for me to be named, some of the babies we named Marla, even a middle name. That's not happened. But anyway, that ability to sort of just take all of the misinformation, the stress, anxiety, getting newly married, your husband, you know, wanting to have a family, you're not sure, because someone may have once told you, it doesn't matter what, and then to be able to turn that like 180 and just have them walk out knowing that it's all going to be okay and I'm regardless of what's going to happen. I'm going to be okay and I'm regardless of what's going to happen. I'm going to make sure that they get what they want and that their motherhood journey is going to begin and go wherever they want it to. I leave it to their choice.
Speaker 3:But it's kind of been, you know, really just the most fulfilling aspect and because I actually could not get pregnant. So my experience with fertility treatments et cetera, has helped me develop relationships with young women who are, you know, who don't know about that. They, they just think they can get pregnant and someone told them, you know, or they don't know, about the impact of the hormones on their pregnancy, so they never wanted to do it because they were told that I can't, I don't know how patients do it, because they were told that this is I can't. I don't know how patients do it, because the amount of information, some accurate, most not that people's experiences aren't always the same and it's like, I feel, the fact that we have this program that is able to really be the center of truth for them and you know it's changed so many lives and the babies that we have, you know, born out of it and it's just been really. I mean, I love managing young children and their families of people of all ages, but the ability to take this population and give them the gift of motherhood, of which they didn't know they could even have, like you can't even describe what my Wednesday feels like. So it's just the best feeling and that's like really for me.
Speaker 3:Why having and training? So Zoe Gottlieb, which is a young faculty who trained with me in this clinic environment and has just got a big grant from Helmsley to do the first ever prospective fertility registry, do you know that when patients ask, does IBD decrease fertility, that we have never studied that prospectively and all we say is well, in old retrospective studies that have measured success of fertility based on live birth registries. To me a lot can happen between conception and a live birth, and so the fact that we don't even know truly that. People who had J-pouch surgery there's literature that says that it may decrease your fertility and it probably does, because when you just dissect the rectum and create that final, you know the J-pouch, that sure, but it doesn't mean that your uterus can't carry as many babies as you want. It just means that the plumbing may not allow that you get pregnant, naturally. You know, some folks were saying you can't even get pregnant if you've had a J-pouch and some of the data is all over the place. So Zoe and I and Eugenia Schmidt, who's at the University of Minnesota, who also trained at Sinai and went and scaled this iPreg clinic concept and that's sort of the pay it forward for me as a legacy, I was saying, is that they were able to get a grant from Helmsley. It will be the first prospective fertility registry to finally answer a question that impacts 1.5 million women in the US and probably 4 or 5 million globally for IBD Does IBD, yes or no, impact my ability to get pregnant?
Speaker 3:Do my meds impact? Does surgery impact? Does my social determinant help All of it and create sort of a risk profile so that we can quickly get someone to a reproductive endocrinologist and not wait until you're 44. And age limits you from getting pregnant, because everyone's always told you no, you have to wait till your disease is completely better, but there's nothing that they're doing to control the inflammation. No one gave them an additional treatment to actually control the inflammation. That's why it's like the amount of lives we can change in a one hour visit where all we do is talk, we listen to the story, we listen to their goals, we ensure that we're making the right decision and get them to the right team at the right time in terms of fertility if they need it, et cetera, and managing the mental health aspect of that postpartum depression. And it's a whole other thing that truthfully so blessed that we have that at Sinai and people can get access to us.
Speaker 3:But as part of that and you can see my theme of scalability that it doesn't stop here is I created an organization. Myself and Susie came from Mayo Clinic like way back in the day when we were almost fellows, I think, which I'm not how long ago that was, but as long. I already told you in the 90s I was a Peds resident that we started an organization called we Care in IBD. The intent of that originally, way back was when it was me Susie. I left Susie out. Sorry me, susie. Uma, youie, uma. You know, maria, core IBDologists was. We wanted to create an environment where other women could be empowered to go into IBD.
Speaker 3:But then I realized, when I really took a step back and said where's the need Is that we're getting more and more female leaders. There's more emphasis on leadership at AGA, acg, wecare. I need to think outside of getting women to manage more women with IBD. I need more women to have a virtual preconception clinic online so I can totally transition the website, which is wecarenibdcom, to be entirely a preconception clinic. So I've taken all of the research, all of the knowledge, all of the data and I put it onto the website so it gives you everything you would get if you came live in person. You get all of the most important up-to-date information and we have a directory of all the women that are involved in managing Women With IV across the country, based on state. So really, really cool stuff.
Speaker 3:So you could see the end of the day, there's nothing that stays just in my head. Two is it doesn't just stay with me, it doesn't just stay with my patient. My goal is to make sure that everybody, no matter where you live, who your insurance plan is, who your doctor is, that you get what I believe to be what you deserve in terms of gold standard care, and that's sort of been the theme of whatever I've done. I have scaled, you know, whether it's through clinics, out on the website, through Trellis, through my legacy building future leaders. My vision has been, as I noted before, is, if I can touch as many people's lives as I can through the work that I am passionate about, then I go back to I say, when I put my head down on that pillow, I feel good that I've done good today, you know, and that's really what drives me in my in my passion for this field.
Speaker 2:It is so obvious that you are a woman that gets shit done, likeable badass. Now I have a challenge for you. What about the next stage in women's lives? What about perimenopause and menopause? From my own personal experience I know hormone fluctuations affect my IBD and perimenopause and menopause is like trending right now because of Gen X. So what is the next stage? How do we get people researching that? How do we get people finding out about hormones and a lot of the symptoms of perimenopause mimic symptoms of you know that you could be experienced if you have active inflammation. So, marla, solve that one. Get other people involved in that.
Speaker 3:I have to develop a whole program around that. Okay, listen, someone gives me a challenge. As you noted, I get shit done. It will, something will happen. But yes, the goal would be to say is that you're're 100% right.
Speaker 3:There is a growing interest in I use the term aging population meaning things that are happening. You know used to be 65, then start to be, you know those that are 16 and above. But one of the interest is definitively around bone health, postmenopausal and role of hormones, especially. You know I deal with women, who you know for osteoporosis. I'll just take that as an example. You know I deal with women who you know for osteoporosis. I'll just take that as an example. You know, osteoporosis could be a side effect of just malnutrition, could be a side effect of steroids, longstanding steroids. Then you add age and you know what men is safe, what men should they be on. How does that impact blood clot risk if I'm on hormone replacement therapy? And what if I want to use RENVOC, which is a drug that may have, you know, all kinds of stuff? You're right, there is not enough. I'll be a hundred percent agree with you that it itself is a special population and I think that part of the next generation, which hopefully this will stimulate someone to say this is an area that I could really build a career around and that's why I'm always about I tell them. I am like can you imagine being on an interview for a fellowship with me and I say to you that I'm not going to talk to you about you know, the fellowship schedule, because you'll learn that from everybody else, or how many calls you're going to have, or, with the scope, how many scopes you get? I said, what I would like you to think about is I want you to think that the next three years in training for fellowship is you need to think about your interview today and choosing a place that in three years from now, when you're interviewing for your first job, what's that golden ticket? Do you want a career or do you want to just pass your boards and find a general GI job? If you want a career, sinai is this is what we do.
Speaker 3:You know, for me, it's about creating opportunities and creating careers and when there's a need and a gap, that's where it all starts. It's sort of, you know, starts grassroots, right, like it's organic. It's like wow, robin just asked Marla about what's happening here and nothing's happening here and then tomorrow I'm going to go tell my young faculty that they need to do this, you know. So these are. This is how it starts Like. It's that organic that we hear from patients what the needs are, what the gaps are, and try and fill them and do the work to make sure that we're addressing the entire sort of life cycle of someone with a disease. It's not just about the 18 year old going to college. It's not just about the 32 year old who wants to get pregnant. There's also the postmenopausal female patient who's struggling with, still has IBD. That hasn't changed. But now I have new challenges that we're not addressing. So I agree with you. So I think definitely that is a gap. Similarly, sexual health is a gap.
Speaker 3:Focusing on, I'm obsessed with pelvic floor these days, meaning I'm explaining to a lot of my patients that you know having a chronic disease where urgency and just sort of you know the anxiety around urgency, having an accident, you know all of that that impacts your pelvic floor and if you're walking around anxious about having an accident, I mean that is going to impact your pelvic floor and then we get you pregnant and you've got all this weight in your pelvic floor. You know I do a lot of discussions around pelvic floor and pelvic floor therapy and so that's why, you know, I'm very open about everything and even if I have never seen something, it won't be like I'll be. It definitely can't be IBD or can't be your medicine. I'll be like, hey, I've always seen things once that changed from how I was before. Now it's like everything's possible. I have no idea. I would just say I've never seen it, so it's always possible. And then you know, there are new things that we see. But I think, robin, you bring up a really important idea. So if anyone is out there who's interested in knowing what's happening in this space, I think you know creating some buzz around the importance of this area for women with IBD.
Speaker 3:Beyond all the amazingness, everything changes after you've had your babies, et cetera. What are we doing about that? So, yeah, so you know, I think that there's so much more we can do. Oh my God, if only there was more time in a day. You know, I think that we all also just the responsibilities we have clinically. You know it's gotten a lot harder for docs because they have to produce and we're, you know, have to be in clinic, do more scopes.
Speaker 3:It's amazing that research is getting done, and I think that's all because there are certain parts of in the country, certain programs in the country, like Sinai, which is all about a future generation of researchers. And you know, we're even starting a prevention program at Mount Sinai where we're going to create a clinic where we will see first degree relatives and we will start giving environmental and dietary interventions that have been looked at as being risk factors, like there's so much going on. And so, yeah, we're going to change, continue to change the world and lives of people with IBD, and that's just what we do and we'll continue to do it with passion and grit. Right, that's it. And you guys are the warriors, by the way. We're just trying to, you know, help as much as we can. That's why we wake up every day and do what we do continue to change and impact as many lives as possible.
Speaker 2:And we appreciate it. After all of that information that you just gave us, what is the one thing that you want the IBD community to know?
Speaker 3:Although progress has made and incredible treatments and we've come to this understanding about treating the whole you, the amount of work that is being done in this space is exponential. I mean we are not sitting back drinking Mai Tais or ginger tea going. We've done the work, you know. We figured out this drug, that drug Absolutely not. We are continuing to sort of it's like peel back the onion and the more we peel the onion, the more we find things where we can even do better.
Speaker 3:And I think the future of more precision medicine, more like the oncology world, the idea that I'm even mentioning that we're actually going to build a prevention clinic so that folks who are worried about the next generation imagine if we can get to a day where we can say there are things we can do to lower the risk of in those at risk, you know, of getting IBD.
Speaker 3:So I mean we're thinking really boldly like we're not stopping here, we're looking for new treatments, we want to give you the treatment that is most going to match your biology and we're going to get there early and we're going to start being really innovative around prevention strategies. So there's some really cool stuff happening. And to note that we're not sitting back. If anything, we're doubling down. So I think that the excitement around the discovery and the fact that we're doubling down on what is possible, I think I hope inspires and gives hope to everybody, because what do we have if we don't have hope and optimism right? So I hope that my journey will inspire and give hope to others in terms of on the professional side, and I hope patients understand that there are folks just like me that are waking up every day to try and make patients' lives better.
Speaker 1:Dr Dubinsky, it has been an absolute joy and pleasure to have you on the show, Thank you. Thank you so much for coming and spending some time with us this evening and sharing so much of your experience and wisdom with our folks. I think it's going to be really great and thank you everybody else for listening and cheers everybody.
Speaker 2:Cheers everybody.
Speaker 3:Hi, this is Marla, and if you enjoyed this episode, please rate, review and subscribe to bowel movements.
