Heal, Grow, Love, Transcend: Ketamine & the Future of Mental Healthcare

Podcast Highlights

• Understanding the differences between Spravato and generic ketamine, and the role each might play in the future of psychedelic-assisted therapy.
• ‘The Skill of Psychedelics’ - looking at medicines like ketamine in the bigger picture of healing, growth, and transformation.
• Dr. Zand’s Four phases of healing: Heal, Grow, Love, Transcend
• What differentiates Better U from other telemedicine psychedelic-assisted therapy services
• Dr. Zand on effective dosing, intention-setting, and utilization of psychotherapy.
• Exploring the correlation between dissociative experience and positive transformation
• How ego actualization and ego dissolution fit into the greater path of healing and transformation.
• Transcending pathology and the disease-care model of mental healthcare to embrace the biopsychosocial-spiritual model.
• The ‘Powered by Better U’ Model of collaboration to bring beneficial ketamine treatments beyond the clinic.
• Closing

Show Links

1. Better U
2. Better Universe Foundation
3. Dr. Zand on LinkedIn
4. Recent clinical trial on the safety and efficacy of at-home ketamine treatments
5. Third Wave’s Guide to Ketamine
6. MAPS

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Podcast Transcript

0:00:00.5 Paul Austin: Hey, listeners, welcome back to the Psychedelic Podcast by Third Wave. Today, I am speaking with Dr. Sam Zand, the Chief Medical Officer at Better U.

0:00:10.9 Sam Zand: I think the ultimate goal is to land in self-exploration, right? We are nothing. Let us not define ourselves by anything. We're just neutrons, protons, and electrons floating around. And for some reason we call this life. And so if we can release the definitions, then we really empower ourselves to be whatever we wanna be. So enhancing self-exploration and identifying areas of our life that are not in harmony, that are not in balance. That's the key. I think that's where we want to land as a medical standard of care.

0:00:43.0 PA: Welcome to the Psychedelic Podcast by Third Wave. Audio mycelium, connecting you to the luminaries and thought leaders of the psychedelic Renaissance. We bring you illuminating conversations with scientists, therapists, entrepreneurs, coaches, doctors, and shamanic practitioners, exploring how we can best use psychedelic medicine to accelerate personal healing, peak performance, and collective transformation. Hey listeners, I'm so excited to have Dr. Sam Zand on the podcast today. Sam is a DO, has a lot of experience in psychiatry and performance, and now in ketamine treatment. He's the chief medical officer of Better U, which is actually a company that we are building and launching a partnership with as part of a new coaching program that we're coming out with called Personalized Psychedelic Coaching. And so today's episode, this is both an introduction to that partnership, but more so it just gives you a sense of what Better U's approach is, what the role of healing is, what the role of growth and transcending is, and why ketamine is an ideal legal option for that pathway. So Sam and I cover his story. We go into why telemedicine ketamine is effective. We talk about lozenges versus IV and IM. We talk about Better U's model.

0:02:13.2 PA: All of that is included in this conversation. I hope you enjoy it. I think you'll find it to be really enriching. But before we dive into today's episode, a word from our sponsors.

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0:05:52.8 PA: Alright, that's it for now. Let's dive into the episode. I hope you enjoy my conversation with Dr. Sam Zand. Hey folks, welcome back to the Psychedelic podcast. Today we have Dr. Sam Zand, the co-founder and chief medical officer of Better U. Sam, good to have you in the show. Welcome to the podcast.

0:06:10.8 SZ: Hey, great to be here. Thank you for having me.

0:06:13.7 PA: So we hosted a virtual summit maybe six months ago or so now that you fortunately we had a last-minute cancellation. You were able to step in. You delivered a phenomenal talk about this sort of new paradigm in psychiatry, talking a little bit about what Better U is up to as it comes to virtual ketamine-assisted psychotherapy. And there are a number of other sort of contextual elements that you weaved in from your background, having been involved in peak performance, having been trained, you're a clinically licensed psychiatrist, and also a DO, which provides another sort of unique angle, I think, on the psychiatry part, which we can get into a little bit. And so, just to set the groundwork for our audience before we sort of dive deep into new paradigms and ketamine-assisted psychotherapy and Better U's methodology, where does your psychedelic story start? So at what point did you become aware of psychedelics? At what point did you find some utility or benefit from psychedelics? What was sort of the initial inspiration for you behind Better U?

0:07:15.8 SZ: Yeah, I think it was a journey. The universe kind of aligned to make this happen. It started in undergrad at Johns Hopkins doing just initial research. I think we were very ahead of things at that time, but it didn't really land for me clinically until I was actually practicing. Went to med school in Las Vegas, did my residency in Las Vegas. We always say if you can heal Vegas, you can heal the world. So I was losing my home and I love this place. And once I started practicing, I can remember four or five years ago, vividly, a patient came to me and said, "I wanted to see a new psychiatrist. I left my last one." I said, "Why?" He said, "He kept trying to give me ketamine." [chuckle] Five years ago, I didn't have the education about ketamine. I thought, how negligent? What is going on here? ketamine just sounded like that illicit drug to me. It wasn't until Spravato became FDA approved. And unfortunately, that's the path for doctors, right? We learn from Big Pharma often, which isn't the best path forward. But in this case, it was very enlightening because all of a sudden we started treating with Spravato in our clinics and patients were just night and day responding relative to the traditional antidepressants and psychotherapy methods.

0:08:24.1 SZ: So knowing that, having some mentors in the space, getting the firsthand experience, understanding psychedelics at its core, now it was wide open for us, right? Let's have some fun and really help people. I think in my career path, I've been struggling when I was a young psychiatrist, kind of resisting the methodologies of the standard of care. And this has now allowed me so much more peace to align and just go with the current, not have to resist because I feel like now we're all on the same team. We're practicing psychedelic medicine. We now at UNLV are training psychiatric residents on psychedelic therapy. I think we might have been one of the first programs to get ahead of that. And so, it's really exciting that this is now becoming part of the curriculum where it wasn't for me. I didn't learn this in med school or residency. It was all kind of self-taught. That was my journey and origin of really understanding ketamine as a legal pseudo-psychedelic. And then, years came around where the conversation became, how do we scale this and make this more not only accessible but affordable? That was the big obstacle. If you can remember, 10, 20 years ago, these ketamine injections were $1,500, $2,000 a pop.

0:09:35.2 PA: Oh wow.

0:09:35.6 SZ: Now the prices have gone down a little bit. Injections and fusions maybe are $500, $750. We've effectively brought it down to almost a hundred bucks a treatment. And so, that's something we're really proud of and still trying to advance access to those that maybe can't afford it. You know, can't get hooked up through their insurance with Spravato, can't afford the injections. How do we make it easier and more accessible? So that's been the calling and what brought me to this place.

0:10:02.0 PA: Specifically Better U, right? So the idea behind Better U is let's use not Spravato but generic ketamine. Let's do it in a way that we can deliver at scale, making sure it's accessible, having some prep and integration support around that experience and doing it all by the book. And so, there's a lot to unpack there. It's been at least a few years since we've really had someone on the podcast to talk in depth about this model of ketamine-assisted psychotherapy. I know that there has been some research that's recently been published, maybe in the last three to four months, about the efficacy of at-home ketamine treatment on depression and a few other things. And the efficacy is quite high, especially as it relates to other, let's say, SSRIs or pharmaceuticals. So I'd love just as a starting point, and this is very tactical, but I think our audience, it will help them understand some of the nuances of ketamine-assisted psychotherapy. What is the difference between Spravato and generic ketamine? And why might someone use Spravato and why might someone use generic ketamine? Just help us understand a little bit more about the differences between those two.

0:11:11.9 SZ: Yeah. I think it's a great question. To understand the landscape here, Spravato was FDA approved, which means your insurance will pay for it, but you have to be diagnosed with treatment-resistant depression. And then that requires you to try and fail to antidepressants. A lot of our patients and clients, they don't wanna try and fail to antidepressants. So that's the path forward. And the insurance co-pays on that could be as low as $0-$50, could be as much as $1,000-$2,000. The Spravato is an S-ketamine formulation. What they did was they took the generic ketamine, which has been around for 50 years, can't make money on that, by bringing it out and trying to manufacture it, really, unless you have a new patent. That's where the big profits come in. If you follow the money, all of a sudden we created this enantiomer of ketamine just to make it a little bit different and patentable. And then Johnson & Johnson bought that patent and marketed it as Spravato. It is a nasal spray. It has to be done in the office. It's once or twice a week, and you're not allowed to take the medication with you.

0:12:16.9 SZ: So there's advantages and disadvantages. Again, the insurance factor is great. If you wanna use your health insurance, you can. But the disadvantage of going to the clinic often, I've heard horror stories. They've put Spravato patients in their waiting room. Imagine doing a kind of psychedelic experience in a waiting room. And at our clinics, we have a really nice immersive experience. We start with breath work, meditation. We do smoke cleansing. We do aromatherapy. Really bringing the body, mind, and spirit to a peaceful place to get prepared for that kind of treatment. That's not the standard of care. So what we thought was, how do we take this modality and really make it more safe, more effective, and more convenient? And that's where Better U came in using the generic ketamine formulation. You meet with your psychiatric provider, virtually like this, and then if you're a candidate, we do a medical review, psychiatric review, really prepare you for treatment, then you get a box shipped to your home with the medication, eye mask, blood pressure monitor, all the things you need. And then we have our integration guides check in with you before treatment to really enhance that preparation and then have post-session reflection.

0:13:26.9 SZ: I think all of those components are so key. And when you think about the other popular option is the infusion clinic, many of them are run by anesthesiologists. They're run by primary care docs. Don't have the psychological background that I think is really important to help facilitate this work. And again, you're kind of left in this cold setting and not really much integration. So those are all the different methods of administration and really teach their own. I've had people tell me, "My home is not the right environment to do a treatment. My home is too chaotic. Can I please come to your office?" And I'll say, "Of course, that option is available to you." But the majority have said that getting to the office through traffic, having to get a ride home, all of that hinders the experience. So we find that the at-home model is actually more effective for most.

0:14:16.5 PA: So when it comes to Spravato versus generic ketamine in lozenge form, I've also had a ketamine prescription in the past that I just picked up from a pharmacy that was nasal. I had to pay for it. I think it was like 50 bucks or something, negligible in terms of the overall amount. There's ketamine infusions. You can go in and do intravenous. You can do intramuscular. There's all these different ways to actually work with ketamine. And I'm just curious, and maybe you don't have the precise numbers, but just for our audience to get a sense, 'cause I'm going to extrapolate this to some of the future psychedelic stuff. What's the percentage of people that you think are using Spravato as a ketamine treatment compared to all of the other sort of generic ketamine infusions, IVs, IMs, lozenges, that sort of stuff?

0:15:09.2 SZ: Yes. It's a good question. Spravato has been out three to four years, and the challenge really is more so on the operator side. It's creating the clinics, making it the right set in setting, having the right personnel, making it work from a business model has been challenging with Spravato. To be honest, it's a loss leader for us. We don't really make money. We just change lives, and that's more important. But there are ways now to kind of incorporate group sessions and bringing the pharmacy in-house. So because of all of those bottlenecks on the administration and management side, there's not a lot of Spravato centers out there. Even if your doctor wants to give you Spravato, they can't. They have to be REMS-certified through the FDA program. And so right now there's a huge hurdle for providers to be able to give this medicine to their patients. For that reason, I think the majority of the population is using generic ketamine. I see that shifting. I see that you got to follow the money, and unfortunately, like, Big Pharma is going to push their agenda, right? And all of a sudden we're seeing, and I think it's a good thing, we're aligned now because Spravato is a fantastic drug, and we're seeing more and more centers pop up every day.

0:16:22.7 SZ: So if we have this conversation in another two or three years, I'm assuming you're gonna see tons and tons of Spravato centers, but right now it's hard to find.

0:16:32.1 PA: And what comes up for me, just to sort of extrapolate this beyond ketamine, 'cause both of us know the power and potency of ketamine. What we love about it is the fact that it's legal currently. It's shorter lasting. With the ketamine lozenge, it's anywhere from one hour to two hours in terms of the experience. So it's something that people can do. They don't have to set aside an entire weekend to have a 12 hour LSD experience or a six hour psilocybin experience. And ketamine is very different than classic psychedelics in terms of what it does to the brain and glutamate and neurotransmitters and all those other things which we can get into detail on. But just in terms of making this point, I think a consideration for listeners at home, and I'd also love to hear your thoughts on this, Sam, because part of what we will talk about in this podcast is new paradigms around psychiatry. A lot of folks know that MAPS is bringing MDMA through clinical trials. They're doing so as a nonprofit in some ways. I think that that line is becoming increasingly blurry as they've taken in investment through an SPV.

0:17:31.9 PA: Compass Pathways is bringing psilocybin and they're patenting psilocybin in something called Comp360, which sounds like somewhat of a parallel to Spravato, in terms of they're just making slight adjustments and patenting psilocybin. So I think where I was sort of going with that point is my sense is generic ketamine, because it's so cheap and inexpensive, will continue to increase in popularity. And Spravato will as well, just because generally speaking, there's gonna be more education around efficacy of ketamine. And yet because of all these loops... I'm sorry. All these red tape and bureaucracy and all that, it just feels like adoption of Spravato probably won't necessarily be greater than adoption of generic ketamine. And the reason that I'm making that point is because there's this sort of big fear in the psychedelic space of these biotech companies that are coming in, they're patenting psilocybin. Oh my gosh, they're gonna take over the entire industry. And sort of where I go to is I don't think so. It could be that 10-15% of people do want to use Comp360 or another psilocybin patent, patented psilocybin. But the fact that it's becoming easier to grow your own mushrooms, the fact that Oregon is legalized psilocybin, Colorado is on the verge of legalizing psilocybin in plant medicines, it seems like there's a lot of accessibility, where the future of psychedelics is gonna be much more around the service rather than the drug.

0:18:53.0 PA: And so that's an opening because I think that's in some ways what you even in our virtual summit and what you've talked about is in terms of these new paradigms in psychiatry, that may be part of the shift where there's less of an emphasis on this drug will fix you and more of an emphasis on care surrounding the actual experience.

0:19:12.7 SZ: Yeah, I love all of that and I fully agree that this is more powerful than just one medicine. It's changing the way we practice mental health from my perspective as a psychiatrist. And before we dive into that, the last thing to wrap on with this Spravato versus generic ketamine conversation, it really is also a cost thing. A lot of people can't afford these treatments and we're doing our best to bring the cost down. I think we're one of the cost leaders in the industry. We're trying to make this as cheap and affordable for people as possible. But still, we have people on payment plans because they can't do the lump sum and to be able to offer that is a fantastic thing as well. But if I have health insurance and I can't afford a fancy treatment, I'm still gonna try to find someone who takes my health insurance.

0:19:57.6 SZ: And that's what's going to stagnate, I think, some of the progress. So until we can get the payers in line... A lot of them are covering generic ketamine now, unique payers, a lot of EAP programs, employee-assistant programs. So, I'm in this for the greater good. And however we get there, let's meet the patients, meet the people where they are. And if they need health insurance options, great. If they have the luxury for otherwise, then they're going to be more robust, probably programs centered around self-pay options. And that's where it gets fun. And we're trying to create our programming. I always say to my team, I run a big telepsychiatry practice. We put our patients first, put our team second, and we put the business last. And we want to practice medicine the same for the affluent population and the underserved. And so, when you come into our offices and do Spravado, you're gonna get an immersive experience.

0:21:01.3 SZ: And I think in the future, hopefully that's the way we're just gonna practice in general. It's not just sit here and talk for five minutes and here's a pill. It's empowering you to understand how to take control of your own life, of your mental state. And doing that through immersive programming, doing that through traditional and non-traditional methods, aligning Western medicine with Eastern medicine, doing shadow work and young men strategies on top of some of the Western medicine luxuries that we have. So that's what I'm really excited about, creating a psychedelic agnostic center where you just come in and in the future, hopefully the provider will be able to tell you this is your best option, not just we have one option and that's ketamine. Of these five psychedelics, what you're going through and things that you've experienced in your life and the obstacles that are hard to surmount, maybe MDMA is a better option. Maybe in a legal setting, if we can get there psilocybin and some other things, will be able to curate that a little bit better for everybody.

0:22:00.2 PA: Yeah, it's what we refer to as like the skill of psychedelics, at least on the practitioner or coaching back-end, if you're working within a client container. Not only what's the potentially right medicine, so we not only talk about MDMA and psilocybin ketamine, but we talk about Ayahuasca, 5-MeO-DMT, Iboga, San Pedro, Huachuma. Although these are sort of broadly classified as psychedelics or as plant medicines, each one is different in its own way and is better. Even when it comes to the plant medicine, Ayahuasca, better for shadow work, Huachuma better for vision quests, mountains, sort of visionary, so 5-MeO-DMT great for transcendence and the God molecule and connecting to the divine and kind of what that might entail. So there's all these different ways to skin the cat, if you will.

0:22:55.6 SZ: Yeah, and we have a framework in mind for this. Right now, we use it for our ketamine therapy. It's four phases versus just self-healing. We find that ketamine is great to get out of your own way, to give yourself permission to find peace and happiness. A lot of my patients, they're not ready to be happy. They don't even understand what that means. They don't even know that that's possible for them. And so, that perspective shift, that gentle introduction at a low dose that ketamine gives is so powerful for healing. Then we get into self-growth, and a lot of that is traditional cognitive behavioral methods, self-help, self-improvement methods. But we see that growth and creativity are amplified by a lot of these psychedelics as well. The next phase is self-love and really understanding that our relationship with others, our relationship with the world begins with our relationship with ourselves. Self-love is a concept that scares a lot of my patients. They just get a feeling like, "I don't like that term. I don't really like myself."

0:23:54.7 SZ: And that introduction down the road, hopefully MDMA, is that quick understanding of self-love. I am this one vessel, it's a miracle that I'm even here, that my heart is beating 10,000 times a day. I don't ask it to. I better love myself. If I had the choice, why wouldn't I? And then finally, the fourth phase is self-transcendence. Once you've gone through the hurdles to overcome any traumas and stressors and heal, once you're focused on a growth mindset, once you've enhanced your self-love, it's time to let it all go and realize that if we assign our beliefs to something bigger than ourselves, that's really the most healing and purposeful and fulfilling place to be. So we bring it back to a spiritual exploration of life, of community, of contribution and giving, and really just understanding those age-long humanistic questions. Why are we here? What's the point of all this and what happens after we pass? These are also topics that can be quite scary for some people. And I think these medicines really help us to hone in on these really pivotal pillars of our mental health.

0:24:58.1 PA: Yeah, there's sort of like a stepwise approach here, right? Because with something like healing, as you said, ketamine, for a lot of folks now, is a great opening. It's a great introduction to that, especially for the psychedelic naive to have that space. If ketamine is used within, let's say, a safe and comfortable container where people can just let go, like what you have at your in-person clinic, there's a very, very low chance that there will be a "bad trip" or a challenging experience or sort of a freakout. And a lot of those, when they do happen with ketamine, it's often because someone is just put into a chair in a dark room, they're infused with ketamine, and they're left to their own devices, which is quite irresponsible. And then the self-growth, psilocybin, self-love, MDMA, self-transcendence, this is where I think these higher-point medicines, Huachuma, Ayahuasca, sometimes 5-MeO-DMT can be super potent and powerful. Because really, as you said, it's an onboarding into a new paradigm. It's a new paradigm of how we approach life, what we find to be meaningful. And I love, on that note of a new paradigm, we talked a little bit about psychiatry and the new paradigm, what psychedelics are doing for that.

0:26:10.2 PA: But I'd love you to drill down a little bit more into Better U. So over the last, I wanna say three or four years now, there have been probably three 'cause it was right before COVID hit is when these companies started to come out. A lot of companies coming out offering telemedicine ketamine. So one of the first ones was Mindbloom, New Life Health, Better U, Wonder Sciences. There are a ton of different companies that are... There's probably a bunch more that I just don't know about at this point in time that have sort of started to come onto the MAP and made anything. And I think it's phenomenal because there isn't... Yes, there's competition, and yes, I'm sure there is a sense of a little bit of competitive camaraderie. And yet we know the pie is growing so big and that there is such a need for this, that we're really all looking to be as collaborative as possible. So I'd love for you just to talk about as a co-founder of Better U and the chief medical officer, what is it that distinguishes Better U from a lot of these other companies that either have or are starting to pop up in the telemedicine ketamine space?

0:27:15.4 PA: Why is it that you really believe in what it is that you're doing? Why should someone trust you to take care of them compared to some of these other folks in the space?

0:27:23.8 SZ: Yeah, thank you for the question. I have nothing bad to say about anybody else in the space. Anyone who's after healing people and trying to improve mental health, they're doing good work. I think what differentiates us, makes us unique, is that this was established over years of practice in the clinic. This is medically guided. We have a very fantastic medical advisory board, prominent neurosurgeon, pain doctor, multiple psychiatrists, psychologists. And so the intention was very thoughtful to craft a medical plan for people over three, four years that then translated to the online form. I think some of the other companies started in the tech space, started kind of understanding how to run tech businesses and then added a medical modality to their service. And it's just a different angle. It's a different approach. I think our patients really, what they share with us is that they feel like they're getting more support, more medical guidance. And I think a big differentiator is you can call us, text us anytime. And some of the other companies in the space don't have a phone number at all. I get that. It's a big burden to have people calling you all the time.

0:28:38.3 SZ: But we made it a point of emphasis to create a large care coordination team that is highly trained and has all day interaction with the medical providers so that all these messages can be relayed. No one feels like they're going through this alone. So patients who join our program really feel like they're in this together. And it's a customized approach as well. I think a lot of others in this space, they're trying to figure out dosing. A lot of them said, we're just gonna dose low and this is gonna be sub perceptual or it's gonna be just mildly dissociative. Others said, "No, this is a psychedelic treatment. We're going to blast you into another galaxy day one." And I think what is unique about our approach is we have a very intentional dose acclimation process where we want people to build experience to overcome any fears and anxieties. And being in this space, someone who has comorbid high anxiety or PTSD, a lot of them aren't ready for this work. And if you go into it fearful, you know better than anybody, you're going to come out of it a little bit worse. And so that preparation and support goes such a long way.

0:29:50.1 SZ: The programming that coincides with the team that's there for you is, I think, also very unique in that this is a curated kind of proprietary treatment protocol. And within that Heal, Grow, Love, Transcend framework, they have very specific modalities that help people kind of foster their own self-therapeutic growth. And that's what we're after in that paradigm shift. I think in mental health, we all need is to stop going to the doctors for everything and start going to ourselves and start looking within the doctors should provide the guidance to empower the patient to not need us anymore. And that's really the goal. And I think our program, one, two, three months is what we preach. Give that a try and take some time off. We don't want you to do this for the rest of your life. Maybe you check in once a month or every six months or even once a year. But it's designed to really allow you to be there for yourself, know when you need this work done, and know the tools to provide for yourself. And in collaboration with coaches from Third Wave and therapists all over the nation and psychiatrists, this is what we're learning together, how do we create a more thoughtful programming that allows the patient to not be reliant or dependent, but become independent in their growth?

0:31:12.6 PA: Yeah. Sovereignty is a word that comes up when thinking about that approach, minimizing codependency, minimizing some level of even patronage in a way, 'cause there is a lot of that with often doctor-patient relationships. There becomes a level of "The doctor told me to do this, so I'm going to do this." And a big, huge part of what we can continue to come back to in terms of the paradigm shift of psychiatry is, "Oh, no, actually, I can make an informed decision, not necessarily only from my doctor," although definitely talk with a doctor, listen to their opinion. Many of them are well-informed, but also from my own intuition and sense of what is true. And maybe even by wearing an aura ring and doing other blood tests, there's a capacity to really go, "Okay, this is what's really happening for me because I am a unique snowflake." And I think that's also a huge shift. It's like, how do we personalize these? Which comes back to your perspective on anyone who's coming into Better U can really personalize their experience for what it is that they wanted to be, where it is that they are. And I'd love for you to talk a little bit more about that because we were landing on this before we pressed record and we were talking about how disassociation versus more psycholytic dosing would probably be the technical term for it. And I'd love if you could just talk a little bit about that spectrum.

0:32:39.1 SZ: Absolutely.

0:32:40.7 PA: When is psycholytic appropriate? When is total complete ego dissolution appropriate? Are there things in between that? What's the context there that you approach that situation?

0:32:55.6 SZ: Yeah. And this is actually what I'll be talking on, on microdose regarding dosing of ketamine safety efficacy. Do we need to get full dissociative? Do we not? We have a lot of different evidence and a lot of different research. So if we start there and look at the research and papers, Spravato actually released a four year retrospective kind of analysis of their clinical trials. And that's unique. Most drug companies, they do one month, maybe they do six months. They never really go further than a year. So to see how this data was captured three, four years out, is very valuable. And what we learned from that data is there was no correlation. It's gonna be surprising, no correlation with dissociation and efficacy. Now, that's just data. When it comes to real life situations, I think there is correlation. I think if you can enhance the dissociative experience and that psychedelic journey with the proper intention setting and therapy augmentation, then what we've seen in our practice is we get an even greater response. And the key thing about this Spravato data is there's no therapy being done with the treatment. It's literally just you take the nasal spray, sniff it and you sit there for an hour and that's it.

0:34:15.1 SZ: So with that, they noticed no difference between those who commented that they dissociated and those who didn't. They found the neuroplastic benefit was consistent across the board, which is, I think, really insightful to know that the sub perceptual or those psycholytic doses, those low to moderate doses, plenty of data that says they're helpful. We call this Medication-Enhanced Meditation, MEM. And I think it's a really powerful tool for those who don't know how to meditate, don't know how to declutter their mind to do a low dose, mildly perceptual dose. All of a sudden they are in this meditative state that maybe they're not used to, and then they can recapture that in the future. And now they can practice meditation for our new users. Teaching meditation is so hard. I'm sure you know that. And to learn it for the first time, it's like a foreign language. But all of a sudden, when you're in a low dose ketamine session, it all makes sense. And so Medication-Enhanced Meditation is something we advocate for all of our patients to try before getting into the really psychedelic assisted therapy. And we see benefit up and down the scale.

0:35:25.1 SZ: And really at the low doses, we recommend more of a proactive experience where they can maybe do some visualizations, some meditations. They can be a little bit reflective, but more present to the experience. And then when they get into the higher doses, we encourage them to have much more intention before and after and then just let go and have more of a passive journey at a high dose. And so, this is the shot of the coaching that we give to our patients when they ask about low dose and high dose. And often our patients oscillate. They'll do one high dose one week and then a low dose the next week. And they'll realize the benefits from unique approaches in doing it that way.

0:36:06.8 PA: So there are a couple of notes that I took. One is the Medication-Enhanced Meditation, MEM. I like that. Another word that I've used, I believe on the podcast as well, is a keta-tation, when we do a ketamine meditation. And those can be really profound. Usually the amount that I've done in the keta-tation is about 100 milligrams lozenge where I'll swish it around, swish it around and then swallow. On that note... There's a couple of other things, too, that I want to get into. But briefly on that note, in terms of the Better U protocol, spit or swallow? What approach are you using?

0:36:42.7 SZ: Sure. So we educate on both techniques. And again, we're very customizable, so we don't try to put anybody into a box and say this is the one way you have to do it. And so generally we say hold the medication in your mouth for oral absorption for 15-20 minutes. And then after that 20 minutes or so, you have the option to use a spit cup, which will decrease the duration of your treatment. It'll leave you, have you go into the treatment and come out of it a little cleanly and quickly. Others who might have comorbid pain, chronic aches and pains, they hold tension in their body, have related that the ingestion method is such a relief physically because it gives them a longer duration of treatment. Again, some say that when they ingest, they feel a little brain fog, they feel a little cloudy. And this is the key. We are all different. We can't just prescribe one protocol for everybody. So we try to empower everyone to understand the education and know their options and trial different approaches and see what's the right fit for them as they continue to talk with their provider.

0:37:44.8 PA: And do you communicate the amount to take if that's the case? So, for example, when I did one of these telemedicine ketamines and I did 300 milligrams and I swallowed and I had a full sort of dissociative mystical experience, I also had an Apollo Neuro and I was laying down in an acupressure mat and I had a soundtrack going and I was just... Like, prior to that, I had done 200, I had done 150, I had done 100. So I had a sense, I knew I was pushing my limits. However, I was also aware that had I done 300 milligrams and just spit it out, the intensity of that experience would have been much less. So how do you look at that in terms of spitting versus swallowing, the amount that you take? What's some education there?

0:38:30.6 SZ: So for someone who's naive, we always have them start with a low dose. We recommend 50-100. We recommend doing the spit cut method at first, just so if it doesn't sit well with them, it's not in their system for a longer duration of time. And then we generally max people to around 400. There are many other factors that go into that. Some people need a little bit of a higher dose because of other factors. And what we've seen, and if you think about the science behind it, you said that if you didn't ingest, you may not have had the intensity. And that's not always 100% correlated because the oral absorption that goes through the mouth, you get about ballpark 30% of the bioequivalence versus like an IV. When you ingest, you get maybe 15-20% and you've held it in your mouth for maybe 15, 20 minutes. Then you ingest. It's not going to kick in for maybe another 30 minutes, depending on if you just ate, how it's in your stomach, how slow you metabolize things. Now, you might have that second wave kick in 30, 45 minutes later.

0:39:35.4 SZ: So for many people, not actually increasing the potency with ingestion, but you're increasing the duration. Some people who maybe they were fasting, maybe they have real quick metabolism, they can do the oral absorption plus ingestion and notice that the potency is higher. But that's not across the board the case.

0:39:55.7 PA: That's super helpful. So I appreciate you explaining some of that context. One more thing that I wanna double back on before we move into a couple other topics while we have you here is this sort of context around the relationship between disassociation and efficacy. With Spravado, they noticed that there was no relationship because it's not within a typical psychedelic-assisted psychotherapy model. It's really just focused on sort of a biological reductionist model. Whereas with your experiences that you're having clients go through, I would say this is true for myself as well. And other folks that I've talked to that depth of disassociation is increasingly effective as long as there's proper preparation and integration associated with it.

0:40:45.3 SZ: Yeah. If it's used appropriately and that's what we've seen. We're doing our own internal study right now. And we're looking to publish that by microdose as well to be able to talk about it. And we do see broadly that the dissociative effect leads to so much more healing and transformation. You can look at any of the scales and measures, PHQ-9s, GAD-7s, these are depression scales, anxiety scales. We've created our own happy quotient scale because we feel like all the scales out there are just kind of morbid and sad. Why don't we ask the questions about how empowered do you feel? How inspired are you? How motivated are you?

0:41:18.7 PA: It's very pathological in terms of the orientation. It's pathology. It's like that whole frame.

0:41:24.0 SZ: Right.

0:41:24.8 PA: That's what it is.

0:41:26.6 SZ: Which I've listed out into that topic. But I've actually had patients in my clinic say, "You'd give us this depression scale before we do our Spravato ketamine treatment. It's not putting me in a great mind state." And we're required to for Spravato to give them these scales. And so we've reworked that a little bit to say, "We don't want you setting your intentions, setting it to be... To tell us about how depressed you are." And so we use those scales after treatment and we use the happy quotient before treatment.

0:41:57.1 PA: That's interesting. That's super interesting. Because the priming is so important, right? Before they go into an experience, it just becomes amplified then. So if they're in that mindset of critiquing themselves before they go into medicine.

0:42:07.6 PA: I think this is the wisdom of being in medicine for so long and having so many clinics and practitioners collaborating on this. Because, that's such a subtle detail that had I not done the work with my patients, and it took two or three patients only for me to tell me that before we switched our procedures, right? Like, you got to listen to that feedback and we're constantly learning. We're constantly evolving. I think that's the key here. We shouldn't look at ourselves as competitors in this space. Anybody who's doing a modality like this, we need to learn from each other. Now, there is no textbook approach on this. And so collaboration is key, in my opinion.

0:42:47.4 PA: One last point, and then I want to talk a little bit about pathologies and kind of why they don't work and what the limitations and downsides are of them. But before we get into that, on that note of a relationship between disassociation and efficacy, when Johns Hopkins, your alma mater, published their initial research on the efficacy of psilocybin for having this mystical experience and thus being efficacious for end-of-life anxiety, for alcoholism, for depression, for some of these other elements, what they found is the more intense of a mystical experience that someone had, which in this conversation, there's a correlation between mystical experience and disassociation. They're not totally and completely the same, but just for the fact of ease of parallels, the stronger the mystical experience that someone had, the longer the benefits of that experience lasted. So in other words, there's a direct relationship between the profundity, the insights, the ego dissolution and the intensity of that, and how long the actual benefit lasts from the experience and the sort of quantifiable impact of the psychedelic itself.

0:43:58.8 SZ: Yeah, and I think it coincides with, like you said, the process of ego actualization. If you really wanna have that ego death, if you really want to have that perspective shift... I wish I could prescribe vacations to my patients. Just get out of the house, see something different, see something beautiful. And if you correlate that psychologically to just a shift in perspective, that's what we're offering our patients in just 30 minutes to one hour of a treatment. It is this kind of vacation, a perspective shift from their normal set patterns of thinking. And so to really achieve that ego actualization, I think starts with a MEM. Approach, medication enhanced meditation to increase ego awareness. We gotta be present, we got to understand who and why we are the way we are. And then once we understand those defining beliefs that we hold so rigidly that some aspects define our ego, the next step is ego dissolution, which is now kicking it up into that higher dose to experience what life is like without those rigid set of beliefs.

0:45:06.4 SZ: And then finally, the ego never goes away. And I think it's a misnomer to say that the ego is a bad thing. It just is. It's part of the human experience. There's ego reemergence. I think that's where we really coach in our protocols on how to understand the way we tend to be, how life was without those rigid constructs. And now, let's give ourselves the ability to reformat, reprogram and manipulate what's important to us. I give the example, a very simple example of the overachiever who's highly ambitious, highly successful, works super hard. And their ego is attached maybe to success, to the fruits of their labor. But they might go through the experience and say, you know what, why am I so attached to success? That's not a belief that empowers me now that I've got this third person perspective of myself. So instead, what if I'm more convicted to how many people I serve rather than how successful I am as a result of that? And that could be very aligning with someone's ego. And so that's an example of ego actualization that I think requires both medication enhanced meditation at a low dose and psychedelic-assisted introspection and reformatting at a high dose.

0:46:19.5 PA: Okay. So just to make sure I'm clear on that first step is ego dissolution.

0:46:24.1 SZ: Ego awareness. We gotta be aware of how we are.

0:46:26.0 PA: First step is ego awareness. Thank you. I was missing that. Okay. So it is a four step process.

0:46:31.7 SZ: Yeah. The steps towards ego actualization, I'd say are in three phases. There's the ego...

0:46:36.3 PA: Awareness, dissolution...

0:46:37.6 SZ: Awareness.

0:46:38.1 PA: Reemergence.

0:46:39.6 SZ: Right. That's how we would achieve...

0:46:41.4 PA: Actualization.

0:46:41.8 SZ: Actualization. Yeah.

0:46:45.3 PA: And I'm glad that you also brought up the point of the ego is. There is sort of this unfortunate oversimplification of the ego being bad, if you will. And in some ways it's understandable why that's emerged because a lot of the rigidity of our egoic structures is responsible for depression and addiction and other things like that. And so it really is about, let's say, resetting the ego. It's about allowing those tendencies to sort of soften, so we're more receptive and open and listening rather than saying, let's just get rid of this. 'Cause if we just get rid of it, then some people do that, shamanic priestesses or those in shamanic lineages. Part of that initiation is to totally let go of the ego. But if you don't know how to manage that and sort of navigate that, that's what we call psychosis or schizophrenia or some of these grandiosity. There's a lot that can come from just always being ego dissolved and most of it's not good necessarily.

0:47:44.9 SZ: Right. From a Freudian perspective, the ego is defined as the manager of the id and the superego. And the superego is our moral compass. We know what's right. We know what we should be doing. And our id is our carnal desire. We're pushed to want to have this aggressive or sexual or whatever, fill in the blank tendency. And when our ego is not in harmony, meaning our moral values are not in line with our carnal desires, then we're in conflict. Then we're depressed. Then we're anxious. Then we're manic, psychotic, fill in the blank. And so, understanding that and not shaming any part of us, but accepting all those parts so that we can align harmoniously. That's the paradigm shift we're after. And I think that's where we're heading in the standard of care and medicine. I'm very optimistic and I'm a huge advocate of changing the way that we have been practicing, especially mental health.

0:48:35.2 PA: So let's talk about that. That's a good segue into pathology. Right. So we know mental health up to this point in time has been defined by labels. It's been defined by I'm depressed or I have an addiction or I'm anxious or whatever else. And this isn't to discount the usefulness of pathologies. It's also not to discount those who struggle with depression or those who do struggle with an addiction or those who struggle with anxiety. These are real and it's why psychedelics are being sort of heralded as this new revolution in mental health treatment. And yeah, what I think we both agree on and what many of our listeners will agree on is the entire frame of mental health just sucks, more or less. So I'd love just to hear your thoughts of pathology on how that could shift on kind of the role that Better U wants to play in shifting us away from that pathology driven mindset into one that's much more sort of expansive and open, ghat can reach everyone and not just those who are clinically depressed, addicted, anxious, whatever it is.

0:49:39.5 SZ: Yeah. And this is just such an important topic because if we understand the current state of things, as a psychiatrist, I cannot treat you if you're not sick. If you come in and say everything's fine, I can't diagnose you with a "mental illness." I can't bill your insurance. Your insurance will say, "He was fine. Why would we pay you anything" And so we're stuck having to diagnose everybody that we treat, which then, put yourself in the shoes of a practitioner, now we're just looking to categorize people and really label them and understand within a 15-30 minute visit, "Okay can we call them depressed? Can we call them anxious? Can we call them bipolar?" And then put yourself in the shoes of a patient. Now we're trying our best to understand ourselves and better ourselves. And we just got labeled. We got identified as someone who deals with a disorder, someone who has an illness. And this sick state, this disease model state of medicine, let's table the physical side of things.

0:50:40.8 SZ: But on the mental side of things where this is so subjective, I can't image your brain or take a blood test and then diagnose you bipolar. I have to go by your best account of understanding yourself through the questions I ask you and then run it by an ICD-10 checklist from a DSM manual. This isn't good medicine. This is not good nomenclature. We're not helpful in these diagnostics. The next step is, "All right, now I've diagnosed you and I follow a treatment algorithm. If you're depressed, you take an antidepressant. If you're bipolar, you take a mood stabilizer." And what you see is that these medications actually cross so many diagnostics. You look at a medication like Aripiprazole, it's an antipsychotic. It was used initially for schizophrenia. That patent ran out. They got a patent for bipolar. That patent ran out. They got a patent for depression. And now you're a patient Googling this medication that you're giving. You're saying, "I was just given Aripiprazole. Does my doctor thinks I'm schizophrenic? Like, what the heck just happened?"

0:51:44.9 SZ: And so there's so much confusion there rather than understanding. And that deeper understanding is really what people come to mental health providers for. So leaving that diagnostic modality, where do we go? Where do we land? And there is already a blueprint for that. I think the ultimate goal is to land in self-exploration. We are nothing. Let us not define ourselves by anything. We're just neutrons, protons and electrons floating around, and for some reason we call this life. And so if we can release the definitions, then we really empower ourselves to be whatever we wanna be. So enhancing self-exploration and identifying areas of our life that are not in harmony, that are not in balance. That's the key. I think that's where we want to land as a medical standard of care. And to get there, the blueprint we have is what we call the biopsychosocial-spiritual model, which sad to say a lot of practitioners don't even know. Psychiatrists don't follow the biopsychosocial-spiritual model. And what that says is our life is composed of four categories. All the physical factors, biological things like sleep, activity, nutrition, medical issues, drug use.

0:52:52.8 SZ: And then there's the psychological factors, traumas, acute stress, our beliefs about ourself and the world, our self-esteem, our self-image, our thought patterns. Then there's the environmental factors. Look at COVID over two years. Now our whole world, our whole human species took a hit for two years because our environmental health went down. Being cooped up in our house and not having healthy social outlets, not having a change of scenery. That's the anti-neuroplastic effect. We became neuro rigid. And so environmental health is a big one. And then there's our spiritual health. And that's kind of this fourth component that many stop at. They just go biopsychosocial and they don't add the spiritual element. And I think that's the power that psychedelics are giving because as practitioners, you see healing in a way that can't be described medically many times when there is a spiritual element. I remember early in my med school, I volunteered at a Free Pain Clinic, not pain, just a Free Medical Clinic. And it was a pay it forward program. You got to come in and do three acts of kindness for the community, write a letter about it, and that's your payment in exchange for free care. We've adopted that model now. We do this nationally.

0:54:04.0 SZ: But what I learned from that experience that never left me. I was a third year med student. This lady came in with chronic knee pain, debilitating. And she said, "I never had enough money. I don't have any health insurance. I haven't been to see a doctor. This has been bothering me for five, six years." Not much we can do as a free medical clinic, give her some stretches, give her some anti-inflammatories. We can't really do any imaging or surgery, there's just not a lot. But one thing that we offered everybody at this free clinic was prayer and non-denominational and they can refuse. This lady said, "Yes, I would love to receive prayer." So we all huddled around her and offered a prayer. And this woman started crying, bawling. I looked and I said, "What's wrong?" And she said, "I haven't felt my pain for the first time in five years." And I'm thinking, "I never learned this in medical school." [chuckle] Like, what is going on here? Why are we not using this component of love, of optimism, of connectivity and spirituality to heal people? And so, my calling now is not to just add love and spirituality to medicine, but use love and spirituality as medicine. And that's, I think, where we're shifting and in this paradigm of what we used to do for 50 years in psychiatry and now what's evolving.

0:55:24.5 PA: And we've seen that in research, too, that even, there's been some papers that have come out comparing a control group that's using no psychedelics, but they have a lot of great therapy and then an experimental group that's using psychedelics with a lot of great therapy, even those who don't necessarily use psychedelics, but have a lot of great therapy and support are improving significantly compared to the default. Those who use psychedelics on top of that are improving even more so because of what psychedelics do with opening us up to this mystical experience, to unconditional love, which for so many of us we've never experienced. Right. So you have the sort of internal experience of love when you're working with a psychedelic. And if that can be mirrored by incredible support on the external, then you have, I think, a win-win solution that really allows for true healing. Because what I continue to come back to in all of these conversations over the last several years is like the true medicine is community and connectivity and being with other people.

0:56:26.5 PA: Psychedelics are phenomenal amplifiers and they help us to recognize that as true in many cases and situations. But they aren't the thing itself. What they allow for is just us to sort of let down our guard and be seen in that way. And that vulnerability even is what I'm hearing that allowance for vulnerability is what is so key for true healing.

0:56:47.3 SZ: Absolutely. Isolation and love and perceived loneliness. Those are the biggest killers. You look at COVID. What did they say? People that died were those who had comorbid medical issues. There was a statistic that the biggest impact you could make to not suffer adverse consequences of COVID is to decrease your anxiety and stress levels. And we're out here talking about vaccines and all these different treatments. It's just everyone relax, be there for yourself, meditate, support your body and your immune system. And that's the beauty of medicine, is all we're trying to do is go back to the origin. Homeostasis is a beautiful thing. And how do we just get all of the toxins out of our own way so that our body can restore itself? And then if we get past diagnostics now, to be clear, we still use diagnostics, we have to. We have a whole legal team telling me if you can't diagnose somebody, you can't treat them. But imagine the power if that wasn't the case and the ability to say, "Let's work on couples therapy. Let's work on family dynamics. Let's work on corporate burnout. Let's work on all the things that we see in research, detox, end of life care."

0:58:06.7 SZ: These are not standard of care for ketamine right now. You've got to be diagnosed with treatment resistant depression, anxiety, PTSD. That's the standard of care. So it opens up, I think, a possibility to really enrich our lives in a way that we don't have to start from being sick. We can start from being empowered.

0:58:26.7 PA: So last thing, 'cause this will be a nice sort of way to wrap all this up, especially in light of the recent conversation around pathology and diagnoses and empowerment and all that sort of thing. So one of the aspects that we talked about, I believe when we first met about a year ago at Wonderland, was this concept of being powered by Better U. Right. And so there is sort of this inherent then orientation towards collaboration within what you're doing. I'd love if you could just tell our audience a little bit more about kind of that frame in terms of what you have in mind for powered by Better U, what you have in mind for collaboration. And then we could talk a little bit about the collaboration between Better U and Third Wave in terms of what we're anticipating to roll out in the coming coming weeks and months.

0:59:12.7 SZ: Absolutely. Being a service provider, our model is directed to consumer mostly. What we've learned is we've created a modality, a safe, effective and intentional place to practice medically guided ketamine therapy. And then, there are other service providers, healers of many different modalities who could utilize that ketamine therapy in their practices, but maybe don't have the medical staff team guidance. So we've created kind of an enterprise program, a service rendering where other agencies can use our medical team to be the facilitator of getting their patients ketamine, doing it in a safe, therapeutic way, and then they can add their own modalities. So one other example is a veteran residential treatment program that we're aligning with. They're using that powered by Better U model. And then we have a detox and recovery program to be able to really just use ketamine post detox in a way that helps, you know, reset and instill that recovery. And now they can use our medical providers and they've been able to broadcast that through all of their different centers. So we're really excited, not just to the direct to consumer but to be kind of that B2B, where if you're doing good work in your space and you think that psychedelics or ketamine can really help your clientele, then we'll be that medical team to facilitate for you.

1:00:41.4 PA: And kind of just for broader context for those who are listening at home, Third Wave, we we've had our training program that we've rolled out where we're starting to train and certify coaches in the skill of psychedelics. And one thing that is then being asked for is as we're training these coaches, how do we roll out a way for the broader world to work within our framework and our methodology? And as many of you know, who are listening to this, we really don't focus as much on the sort of medical clinical diagnoses model. The orientation that we surround experiences with is much more around growth and leadership and performance and flow and creativity and innovation. And yet there's... These are not either or, these are both and this is a spectrum of gray. It's not black and white. And so we're rolling out a one-on-one coaching program. We're calling it personalized psychedelic coaching and it'll be powered by Better U. And the reason we're working with Better U is because of everything we've talked about in today's episode.

1:01:46.3 PA: With Better U, we can actually those who want to enroll in our program, which will be a different price point than a lot of others, and we'll use our own coaches that we've trained in our methodology. But as everyone knows here, like ketamine is still the only really legal option that we have to work with a type of medicine that is efficacious. Yes, we have our grow kit and you can grow your own mushrooms. Yes, within, let's say, the next nine months, psilocybin will be legal in Oregon and you could potentially go there and work with psilocybin. But it really won't be probably until 2024, if not 2025, that psychedelics really become not just ketamine, but MDMA and psilocybin become more widely accessible and available. And yet the time is now, right? Like people need healing, people are looking for support. And so we're choosing to roll out this program. It will be available in January as a beta. If you are interested in enrolling with us, you can send us a note or an email and we can put you on the wait list. And that will be powered by Better U to make sure that it's as easy as possible for those who qualify to get access to ketamine as part of that protocol.

1:02:52.4 SZ: Absolutely. And the work that you're all doing in this space to provide that intensive coaching, to really teach these tools, now, that's so powerful to have that intensive one-on-one. And where we're the medical guides, we're providing the safe comfort to really understand this treatment for those who really want that medical guidance. We're gonna meet you where you are. Now they have this extra layer of coaching and support from Third Wave. And I think it's such a beautiful alignment. You guys have been leaders in this field and I admire and respect the work you're doing to be able to be that professional medical provider, really is just a win-win for society.

1:03:33.4 PA: Love it. Dr. Sam Zand, any last final words on sort of projects you have coming up at Better U, or... We'll have lots of links in the show notes in terms of if people want to check out what it is that you're up to. Just what do you have on the horizon and where can people go to learn more information about better?

1:03:51.0 SZ: Yeah, yeah, definitely. You can check us out directly betterucare.com and our alignment with Third Wave powered by Better U. Sounds like hopefully rolling out soon. That's an option if we want more intensive coaching. We have a foundation that we kind of co-created with a lot of different advocates in the space called the Better Universe Foundation. A Better Universe Begins with a Better U is really what we're all about, saying that we can focus on ourselves and understand that we all have a mental health journey. Then we're gonna improve not only ourselves, but our communities. And in addition to the awareness that a lot of our advocates and professional sports and entertainment and such are sharing their own stories, vulnerably, we're also plugging the gaps. So if you don't have access to care, if you don't have the resources, you can go to betteruniverse.foundation. It's a lot of seven minutes self-reflection intake and we'll connect you with a student volunteer who will be your accountability buddy and help you get the resources, the connections that you need, not let you fall through the cracks.

1:04:54.2 SZ: Finally, I'm really excited about a new project called Metamorphosis. It's our psychedelic retreat in Puerto Rico, launching in 2023, where you can actually stay for the week and the month and live with your provider team and a beautiful tropical oasis with ketamine immersive experiences, equine therapy, breathwork meditation, all the beautiful healing that comes from nature combined with both Western medicine and Eastern medicine approaches. So Metamorphosis Resort is on the horizon and just continuing to collaborate with you guys and everyone else in this space to do this together and not to be adversarial, but to be collaborative is the goal.

1:05:36.3 PA: That's beautiful. Well, betterucare.com, Better Universe, Metamorphosis is the upcoming retreat in Puerto Rico. Dr. Sam, it's been a pleasure to have you on the show today. I really appreciate. You have some great frames, the self-healing, self-growth, self-love, self-transcendence. We talked about ego awareness, ego dissolution, ego reemergence, ego actualization. There's a bunch of... The medication enhanced meditation, a lot that we talked about today. So I just appreciate you coming on, dropping some wisdom bombs. It's really been a pleasure to have you on the podcast.

1:06:08.5 SZ: It's always a pleasure, Paul. You're such an inspiration. Keep doing the great work you're doing and we look forward to our next discussion.

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