Dr. Fertig: Well, I want to emphasize that I didn’t write it for the money. Yeah, it was quite a journey, and I did it perhaps for the scientific credentials; but really for the loftier goal to improve society, to improve, prolong human life and health spans and it’s important to recognize the frontiers of medicine are not in outer space. They’re right here in our backyard, and well, the catalyst of the book was really the unexpected passing of a dear friend and colleague, Walter, back in 2012. 

He was only 57 years old. Apparent paragon of fitness. He ran eight miles a day. As a human being, he was kind and humble, fun-loving… although not a singular event. This catalyzed for me a must-do, which is to understand why someone so young, and for no apparent reason, like somebody in the world today would suddenly pass away or be blindsided by some catastrophic diagnosis. This led to a 10-year journey to better understand the root cause of disease and to find a model that can predict and prevent this type of tragedy from happening in many future Walters.  

Deepak: How old was your friend? 

Dr. Fertig: He was 57. 

Deepak: And what was the diagnosis? What was the cause of death? 

Dr. Fertig: You know, we don’t know. He had an autopsy, it was negative. He was a diabetic. He just took Metformin. He was very well-controlled, but he was an exercise fiend. He died by the treadmill, so what I suspect, even if you’re insulin-resistant, you have a three-and-a-half-fold increased risk of sudden death from autonomic neuropathy, and I think that the exercise induced hypoglycemia, triggered a fatal arrhythmia. That’s what I suspect. 

Deepak: That makes sense. So, Brian, who does this book target? Who’s this book for? 

Dr. Fertig: Well, it targets medical practitioners, students, biomedical researchers for the purpose of understanding each other’s language, and to buttress a scientific creativity that promotes the skill sets for problem-solving in medicine. Now, it also targets interested lay people with a high school background in the sciences. Many drafts of this book were made for the goal of improving the demands for clarity; to make the information in this book accessible to the general public. 

Deepak: In one sentence Brian, what’s the book about? 

Dr. Fertig: Well, the book is in two volumes. It covers a wide swath of territory, but in essence it’s about the chronic diseases of aging, and through the lens of metabolism and biophysical processes, and what causes things to go awry in the context of aging and human behavior. 

Deepak: Let’s go a little deeper and a little more granular into, you know, why these two volumes… you obviously have two volumes, you have a lot to say. The physics of biological engines and the metabolic landscape of health and disease – can you comment on both these ideas? Take a little time to let me know. 

Dr. Fertig: Thank you. Volume I looks at modern disciplines of physics as perspectives for understanding human physiology and to help medicine evolve, which is at levels currently unimaginable; and we take advantage of this potential through the introduction of our physiological fitness landscape model (PFL), which is really the ultimate wellness model for the future of medicine. Now the intersection of physics, medicine and philosophy, historically, is very important. 

For example, “physician” and “physicist” both come from the same root word, physics, which in turn comes from the Greek knowledge of nature. Now nature, logic, law, and God are all part of the same logo, which was rooted in Judaic religion, was built into Greek culture, and ultimately, Christianity. The idea is that God creates the laws of nature, which is responsible for the infinite wisdom and the organizational perfection of living systems. Now, until the late 1700s, physics was really known as natural philosophy, which dealt with all matters of science from the stars, planets, and the practice of medicine. In fact, Aristotle and Hippocrates were the father and grandfather, respectively, of modern medicine. 

Now, since the passing of many decades and centuries, medicine and physics have diverged, and with a gulf between them. However, since physics tends to generalize laws of nature, while biology and medicine seek details and specifics, underscoring a very different nature of hypothesis and scientific methodology between the two disciplines, the remarriage of the two fields promises an enlightened future for the practice of medicine as an art that sits on top of a more bolstered science. 

Now, Volume II has some key messages that connect the intersection with medicine and physics, for example, the light-dark cycle is really the umbilical cord and the organizing framework for metabolism and physiology. 

Deepak: Which cycle?  

Dr. Fertig: The light-dark cycle. 

Deepak: Light-dark cycle, yes. The circadian cycle every day. 

Dr. Fertig: It’s a temporal organizing framework of physiology and it’s orchestrated by these molecular clocks, which are astonishing evolutionary microcosms of the earth’s rotation around its own axis. Now, desynchronized physiology within and between tissues, accompanied by chronically activated hormonal and autonomic nervous system branches of the stress response, along with microbiota-disturbed composition and diversity, together lie at the core of metabolic decline with important links not only to obesity and diabetes, but all the chronic diseases of aging including heart, vascular, Alzheimer’s disease, and cancers. 

Deepak: So, you talk about God, and of course, you know in scientific circles, God is kind of unfashionable these days. I’ve been able to talk about intelligence and cosmic consciousness or pure consciousness, which is the fundamental ground of all existence that differentiates into noise, modes of knowing, and those things that are known; and in our case, what we know is a human mode of knowing through which we look at the world. What we call the objective world, actually, is the perceptual activity in our own consciousness, which is modified by this field of all possibilities, infinite possibilities, infinite correlation, unpredictable but creative and self-evolving, self-regulating, self-organizing. I’m comfortable with that word pure consciousness or universal consciousness, and that we are differentiated aspects of that. Would you go along with that idea that the underlying ground of all existence is a field of pure potentiality past, present, and future but it is also creative, and it actually is responsible for what we call our metabolism, our perception, our cognition of biology; that in fact our biological activity, our perception of ourselves and the world, our cognition, our modes of knowing are all modified aspects of this eternal timeless field of all possibilities. Are you comfortable with that phraseology? 

Dr. Fertig: I am. Yeah, I do believe that there are some things – the very fabric of consciousness, such as empathy, compassion, love, and intuitions – these are not really made in the neurons. They don’t live there, so I do believe that there’s a universal consciousness that isn’t innate to the human body. Consciousness is a phenomenon, and a discussion in and of itself but does it come from the universe or does it come innately from the human body? There are many examples of children who have never been to other countries and can, with incredible accuracy, recognize, know landmarks and geography of another country they’ve never been to and they’re just five or six years old. 

You know, there’s lots of examples of these kinds of things and how do they know this? This is fascinating stuff. I just have to say that if time as an absolute quantity does not exist, consistent with special relativity and the Dirac equations, then the past, the present, the future, are all happening simultaneously. Imagine the astonishing implications of this on our physiology, or our reality, our experiences, everyday experiences, and spiritually. It’s hard to argue that this is not the case. No, I just want to say that this is only one of many… like we all think of somebody and all of a sudden, we get an email or text message and it’s not even a loved one. It’s somebody you haven’t talked about in a long time. All of a sudden, how did that line up the way it did? 

I had a patient in the hospital and I didn’t agree with the management. I called the internist and said, “You know, this congestive heart patient, she needs a cardiologist.” She doesn’t need an Infectious Disease-Pulmonary specialist, and then the discussion evolved, and I said to myself as I was talking to her, “wow!” I said this conversation… I dreamed this entire conversation; that is, I brought the future – to the present in a dream. Now how does that happen? I mean, there’s so many examples. There’s a lot of this in the book. 

Deepak: Once you understand that consciousness, or the Divine but Infinite is omnipresent but omnipotent and omniscient. And I think of this in three ways. Omnipotence is infinite energy, omnipotence is infinite energy, omnipresence is non-local correlation, and omniscience is infinite knowledge or infinite information and that seems to pervade all biological systems. How does a human body think thoughts, play, feel pain or kill germs, remove a toxin and make antibodies all at the same time while making a baby at the same time and tracking the movement of stars and planets as its own biological rhythm, so I totally get what you’re saying. Say a little bit about the ancient Greek philosophers and their notions of reductionism and emergence to empirical observation, and how this ultimately ties in with your PFL model, as you call it, the physiological fitness landscape model. 

Dr. Fertig: Sure. Well, you know, the ancient Greek philosophers not only practice medicine but their philosophical insights of reductionism and emergence really ushered in the development of modern-day molecular science and medicine. Reductionism was the legacy of the 20th century and the crowned jewel of analytical science and scientific discovery. It taught us the linear systems of biology, such as gene coding of proteins and molecular pathways of cell biology. However, the interactions, the outcome of the interactions between these pathways could not be predicted by reductionism leading Aristotle to introduce the notion of emergence as the opposite of reductionism 

that is capable of creating a new system whole that is more useful and greater than the sum of its parts. So where does this leave us? How does this connect to the current and future of medicine? 

Well, physicians specialize in the application of art and science to the execution of patient care, so the application of science to the diagnosis of disease and prediction of treatment responses employs principles of reductionism, while the application of art to the unpredictable elements of human health and disease employs empirical observation, which calibrates risk benefit profiles followed carefully over time requiring intuitive non-algorithmic decision-making including such things as patient fears, expectations, biases, and belief systems. However, to truly evolve medicine to levels capable of reliably prolonging human life and health span will require a more bolstered science capable of regulating emergent processes. Now, this will require a precision, personalized, and dynamic scale of AI. Today, there are personalized scales of AI for the management of cancer, for example; but they’re not precision mathematical-powered. They’re not dynamic. They’re not predictive, and they’re subject to a lot of flawed data in the literature. This led us on to introduce the physiological fitness landscape. 

Deepak: Very, very interesting. But you also say that this physiological fitness landscape as a model can apply the theories. Einstein’s theory of special relativity to biological systems, I think most people would never have thought of that. This is very fascinating to me; that there’s a connection between special theory of relativity, which has to do with the fixed speed of time depending on… doesn’t matter where the observer is or what the observer is doing but there’s, you know, there’s a limitation to light and also that both length of objects and time changes with the speed. But are you talking about something entirely different? 

Dr. Fertig: Yes, I am talking about exactly this at least metaphorically… let me explain because I think the special relativity application to the physiological fitness landscape helps us understand the landscape. You know there’s some more basic functions of how the landscape works and what it does. But this is a very important perspective and I agree, is incredibly fascinating, but simply stated Special Relativity concerns the relative rates of the passage of time from the perspectives of, for example, an object approaching the speed of light for which time is moving slower. We call this time dilation relative to a stationary observer on the ground for whom time is moving faster. Now a biological application of this, at least metaphorically, are the divergent rates of biological and chronological aging. 

Now in this case, however, it’s the slower basic chronological aging, which equates to the stationary observer on the ground as a reference point relative to the faster pace of biological aging. Now the biological application special relativity can be plotted on this PFL landscape, and I want you to try to imagine a metaphorical mountainous terrain of connecting peaks and valleys that describe the metabolic decline that occurs over the lifetime of an individual, whereby biological age equates to fitness, maximum fitness occurs by the age of 30, when biological and chronological age are the same, and the fitness altitude is at its highest point. 

Now a hallmark of this feature is that it’s dynamic. It changes with time and biological aging. If the maximum human lifespan approaches 120 years, which would always be the biological age at the time of death whether that equates to a chronological age of say 60, 80, 100 or even 120 years. Now as biological age progresses, the fitness altitude declines until it reaches ground level, which is tantamount to death.  

Now stay with me here, because the biological application of special relativity is truly about two things. One, the quantum manifestation of energy production as a hybrid of classical metabolism. Two, the resilience of metabolic machinery to the work imposed on it by physical, mental, and circadian stresses. Now when metabolic resilience is exceeded, the divergence of biological and chronological age accelerates due to inflammation and reactive oxygen species generation, which are two metabolic pathways of energy production. This equates to the heat and randomness of a physical system, which drives entropy, the arrow of time. 

Accordingly, reactive oxygen species oxidatively modify and degrade the molecular chemistry and the fidelity of the exquisite and beautiful organizational complexity of the human body, while inflammatory heat collapses the quantum mode of energy production, which can no longer slow the passage of time, the aging process. Now conversely, the quantum mode of energy production, quantum metabolism, and in a sense, is the spatially unconstrained flow of energy propagating through the body approaching the speed of light. Accordingly, metabolic rate as an integer of time is slowed, and slower metabolic rate equates to biological aging in slowed motion. 

 There’s an important caveat here that in physical Special Relativity the relativistic and quantum effects are two separate phenomena; they’re independent, whereas in the biological application Special Relativity, the relativistic effects are a consequence of the quantum mode of energy production. 

Deepak: I get what you’re saying. Now let me share with you what some of the Eastern wisdom traditions say because I think you mentioned biological stress but you also mentioned mental stress, and in Eastern wisdom traditions and even going back to thousands of years, Yoga Vasistha, he says time is the consumer and we are its food. We are Time’s food, so if you slow down the experience of time then you prolong biological age because biological aging is the metabolism of time according to this framework; and so, with this framework, we have been using meditation as a technique to reduce the experience of time because, you know, other than the special theory of relativity, our personal experience of time is determined by our internal dialogue. If I’m running out of time, my heart rate speeds up, my adrenaline goes up, my platelets get sticky, and all of that, cortisol goes up if I’m running out of time. If I have all the time in the world… today we thought we were running out of time because we were late for this, but my attitude is time never runs out. 

Time is always the eternal timeless present, so if you’re grounded in the present moment or if your internal dialogue says I have all the time in the world, or if you transcend time, as sometimes in meditation this is called samadhi, where the subject-object split disappears when you transcend time then even time stops for that moment. You know of transcendence. Now, based on this, we did a study about 12, 10 years ago, actually, and one of the investigators with us was Elizabeth Blackburn who, at that moment, knew nothing about meditation or this kind of thinking about time. But she had won the Nobel Prize for discovering telomerase and we convinced her to join our study, which was a one-week retreat of meditation with controlled subjects who were on vacation. But at the end of one week, the telomerase level went up by something like 40 percent, which was shocking; and then all the genes that were responsible for self-regulation and homeostasis and inflammation or reduced inflammation, all those genes went up. 

In other words, the gene activity for self-regulation and homeostasis went up. All the genes that were associated with say, Alzheimer’s, with cancer, with heart disease, with inflammation, with depression, etc., went down. We published this study in Nature Translational Psychiatry. Other people have replicated similar findings in meditation retreats and practice of vegan stimulation, and yoga, and various breathing techniques and certainly, it’s very obvious to us that our personal experience of time; mental experience of time, influences a metabolic activity. Do you have any comments on this? What I just shared with you? 

Dr. Fertig: Oh sure, I first want to say that this brain-derived neurotrophic factor (BDNF), which inactivates the cortisol receptor and gives you more resilience to stress by preventing or slowing the transition to a burnout phase. Whereas high levels of BDNF is very bad by promoting burnout, moderate amounts of BDNF inhibits the transition to burnout – exercise does this and now there’s early data that meditation and yoga do this as well, underscoring one of the mechanisms of the benefits of these lifestyle behaviors. 

The intersection of physics and medicine applies to therapeutic strategies for prolonging human life and health span. Ultimately, the goal is to reduce inflammatory and oxidative stress, which encourages, in my view, this quantum mode of energy production, an incredibly efficient, synchronized energy production, so you don’t require as much energy. Metabolic rate in a quantum sense is actually slower, and you don’t create a lot of reactive oxygen species in the process. This occurs as a hybrid of classical metabolism. 

In my view, there’s three ways to do this. One, you reduce excess dietary consumption, excess physical and mental activity because these processes are correlated to the oxygen consuming energy production that creates reactive oxygen species, oxidative stress. Two, to reduce circadian stress, which desynchronizes physiology within and between tissues and bi-directionally cause and effect uncouples glucose metabolism from the mitochondrial pathways of energy production. Mitochondria are the powerhouses… the power plants of cells… and use oxygen to make energy. Mitochondria is where most energy is made. Mitochondrial dysfunction, uncoupled from the initial phase of glucose metabolism (via the glycolysis pathway), is the sine qua non of metabolic decline. This uncoupling is also the basis of the cardiac stress test. In the future of medicine, stress testing will be used in disease states of all specialties. Third, I hypothesize, that the quantum electromagnetic regime of consciousness synchronizes, intuitively synchronizes, with the quantum metabolism mode of energy production, systemically as a model for mind-body phenomenon. 

Now this can be accomplished in two ways. One, meditation – mindful meditation – and mind-controlled physical activities such as yoga. Two, vitalizing activities that engage skill sets and personal resilience. There are two forms of this. One is behaviors of physiological purpose where nothing elevates us more than becoming part of a new system whole that’s greater to the sum of its parts by promoting the joys, opportunities, the health and general welfare of others, which are inseparably entangled to those of our own. Now the second is through goal-oriented behaviors. This requires energy but slows the pace of biological aging relative to the energy put into it in the sense that – and this equates for all vitalizing behaviors – it doesn’t exceed metabolic resilience. Additionally, it couples the quantum physiological manifestations of consciousness and energy production. 

Can I just say one more thing because in Okinawa, Japan you know, there’s the highest number of centenarians in the world. Now as I understand, these people don’t do a lot. They don’t work hard, and they don’t eat much either, so it’s been questioned: Do they truly live this long, or does it just seem longer? However, in all seriousness, the attitudes between the East and West are very different; in the West – Europe and North America we are very individualistic. We’re motivated by goal-oriented accomplishments and pride; whereas in the East – Asia – it’s more about a sense of collective belonging, family, community, and strong social bonding. So, this notion of collectivism and individualism or an integration of the two, are critical to considering how we live our lives.  

Deepak: It’s fascinating to me how you kind of discuss the causes of inflammatory and oxidative stress relationship with metabolic resilience, and that your model of quantum metabolism is, in a way, a hybrid to classical metabolism. And you hypothesize synchrony of quantum physiological manifestations of consciousness and energy production, and you also discuss in your model, and you just did differences in attitudes of Eastern and Western cultures. But you do have in your books a formalized lifestyle model, a qualitative model of what you call PFL, the fitness landscape model. Share a little bit about this formalized lifestyle model. 

Dr. Fertig: Sure, sure. Now, I think this is key because the quantitative model of the physiological fitness landscape will require a scientifically integrated cultural shift and therefore, a longer time horizon. However, there’s also a qualitative version that offers some immediate insights for your audience.  

Society has long recognized that lifestyle behaviors can promote or delay the onset of chronic disease. However, to date, there’s never been a formalized model that puts that into practice. Lifestyle behaviors are stress behaviors in the sense that they’re not dormant, they’re not dormancy; all stress behaviors can be either vitalizing or toxic, and a caveat is that no toxic stress behavior exists in isolation. So, for example, when you’re stressed-out, half of us undereat, half of us overeat, but we all eat the wrong kinds of foods, and usually at the wrong times of the day. The stress behaviors can be described as a quartet of trios, where they are either physical, mental, or circadian in nature, defined by the quantity, quality, or timing of diet, sleep or activity. Activity, in turn, can be described as physical, cognitive, or social in nature. 

When the quantity, quality, or timing of any of these stress behaviors is poor, that generates inflammatory cytokines, which loop back on the brain, reduce the threshold of the perception of stress, activate the branches of the stress response, desynchronize physiology, and disturb the microbiota in this self-amplifying matrix of pathogenicity.  

Now let me just describe an application of the PFL model quickly using a single physiological parameter of body weight for simplicity and overeating as a control parameter, which is a relatable way to understand many of the key features of this terrain.  

The valley between mountains is a stability zone. It can be a body weight set point, and there exists, just before reaching the top of the mountain, a threshold of criticality whereby up until that point, simply removing the stress behavior is enough to restore metabolic stability such as the prior body weight set point. However, if you continue to overeat, you push through that threshold and you reach the top of the mountain, that’s an instability zone where you cannot get your footing, and even after the overeating stops, you continue to gain weight until you fall off the cliff on the other side of the mountain, into a new valley at a lower fitness altitude, higher body weight set point, and the new onset of metabolic disease states such as high blood pressure, elevated lipids, or new onset diabetes.  

Deepak: As you know, our profession, the medical profession, is particularly vulnerable to burnout and toxic stress because of disruption of circadian rhythms, because of time deadlines, because of not being able to meet the needs that people have, at the same time take care of yourself; and caretakers are particularly subject to toxic stress and burnout. You think your model should really help our profession more than anybody else’s… 

Dr. Fertig: Well… 

Deepak: … because we are at more risk than even other people? 

Dr. Fertig: Yes, for sure. I think that you know this notion of promoting the joys and the opportunities to health and general welfare of others is fundamental to our own health. But with toxic stress, what happens is a few things. First, you get the cortisol responsiveness, which works on the cognitive and emotional centers of the brain; one thing it drives is the fear response, and anger is rooted in fear. However, chronic fear doesn’t really exist; it’s imaginary. However, the consequences of anxiety and depression are not imaginary. For example, depression is associated with a greater odds ratio for causing heart disease than any of the classic Framingham risk factors – high blood pressure, cholesterol, cigarette smoking, or diabetes – and it portends a 30 percent increase incidence of an acute cardiovascular event such as a heart attack, and a 36 percent incidence of a fatal arrhythmia, sudden death. I want to say that Mark Twain had a very apt quote. It’s one of my favorite quotes of his, “I’ve suffered a great number of tragedies in my life, most of which never happened.” Now, that’s a take-home message that everyone should remember. 

When toxic stress is unremitting, it progresses to the burnout stage, which is mediated by very high levels of brain derived neurotrophic factor (BDNF) which inactivates the cortisol receptor, characterized by loss of the fear response. Conversely, exercise is known to promote moderate levels brain derived neurotrophic factor (BDNF), and now there is early data that yoga, and meditation also promote moderate levels of BDNF that increases resilience and prevents the transition to burnout. 

 But think about what burnout is, if you no longer have the fear response, this is worse than not having it; think about not having fear of the consequences of giving up, for example, leading to things like alcohol and drug addiction, divorce, and even suicide. This hardens your core values, what really makes us unique as human beings, what makes us successful in life, what makes us good physicians, and things like empathy, compassion, intuition, humility, and conscientiousness; when you lose these things, not only is it bad for you, but think about the poor patients, and in fact, anyone, independent of whatever specialty or industry you’re in. I think physicians are uniquely very sensitive to burnout because of the incredibly high demands, sleep deprivation and long hours. But this does really apply to people in all fields and industries because it’s a very stressful world we live in on many scales. The key is to take restful breaks and vacations, and to find a balance of vitalizing stressors. Perhaps most important is your job itself has to be vitalizing and aligned to skillsets and resilience. 

Deepak: I’ve been speaking to Dr. Brian J Fertig, who’s the author of these wonderful two volumes: Metabolism and Medicine, and The Physics of Biological Engines; and of course, part two is Metabolic Landscape of Health and Disease. As I mentioned at the beginning, Dr. Fertig, I, and Jack Tuszynski are now writing a book called Quantum Medicine and it’s about the future of well-being. 

So, before I finish, I just want to mention that these two books are extraordinary in that they not only give us the science but the prescription for healthy aging, for prolonged life, for what we call increasing health span but they go very deeply into, you know, the mechanics: the cortisol-mediated versus cortisol-inactivated mechanics of the stress response, and their manifestations as well. So, Brian, before we end, a little bit about your background, but it’s very interesting that you’re in this wonderful place, you’re a professor, you teach. You did share your personal reasons for why you wrote this book, but share with our audience a little bit about your background that qualifies you to write this amazing book. 

Dr. Fertig: Well, thank you for that question. Actually, I’m a medical practitioner and I specialize in endocrinology, diabetes, and metabolism practice. 

Deepak: Like myself, I’m also an endocrinologist by training. 

Dr. Fertig: I wanted to say that too. I’ve been in practice for almost three decades. Now, you, Deepak, launched your medical career in the same hospital that I started my medical practice, Muhlenberg Hospital in Plainfield, New Jersey. Now, I grew up, I was born and raised in Plainfield, but there’s more serendipity between us. Like you just said, we’re both endocrinologists, we’re both interested in the intersection of medicine and physics, and we both collaborate with the same genius in physics, Jack Tuszynski. I want to say that if he weren’t such a humble guy, you would never know if you didn’t look at his legendary 80-page CV, that he was hired by the governments of Italy, France, and now Germany, to organize their science. He’s the Canadian Ambassador of Science, and he’s a Nobel Prize nominee in Physics.  And you, Deepak, were named as one of the greatest icons and heroes of the century by Time Magazine. I am truly standing on the shoulders of giants, and I am grateful for the honor and the privilege. 

Deepak: You’re very, very kind, Brian. Final words: What do you hope the book will achieve? 

Dr. Fertig: Oh, this is important. As a healthcare practitioner, I have been, and remain, focused on finding and treating the root cause of disease. Through the PFL model we can change the future of medicine and medical practice by predicting and preventing the onset of disease before it’s too late. So, I invite the global scientific and medical communities to join this transformative journey and the next evolution of a scientifically integrated cultural shift in the practice of medicine and healthcare delivery. 

Deepak: It’s been a great privilege for me to speak to Brian J Fertig, and as I mentioned, we are going to be coming out with Quantum Medicine the Future of Well-being. But in the meanwhile, if you are an academic or a medical student or a resident or a physician or somebody who’s interested in health span, lifespan, longevity, and how we can optimize self-regulation in our bodies through a deep understanding of both Eastern and Western philosophical systems but also sciences, then this is the book for you to read right now; and I encourage you in not only reading the book but sharing it with your friends and actually starting some discussion groups around the topics of this book. 

Brian, it’s been a privilege to speak with you and we shall continue this conversation in future sessions.  

Dr. Fertig: Thank you very much.  

Deepak: Thank you.