The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”

Episode 24: 'SURGICAL INNOVATION' with Dr Todd Ponsky

December 11, 2020 Season 2 Episode 12
The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
Episode 24: 'SURGICAL INNOVATION' with Dr Todd Ponsky
Chapters
The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
Episode 24: 'SURGICAL INNOVATION' with Dr Todd Ponsky
Dec 11, 2020 Season 2 Episode 12

This week we are delighted to welcome Dr Todd Ponsky to the Podcast.  Dr Ponsly is a renowned Paediatric Surgeon, Professor of Surgery and Director of Clinical Growth and Transformation at Cincinnati Children’s Hospital in the US.

As a paediatric surgeon, Todd focuses on always trying to find the least invasive way to solve a child’s medical problem. 

He specialises in minimally invasive surgery with a focus on neonatal disorders and hernias.  Todd was the first to perform and report single port surgery in children and modernised the methods of the laparoscopic paediatric hernia repair.

Dr Ponsky believes that each child is unique. As such he spends a great deal of time listening to their questions and concerns and addressing them. Allowing him to understand the best approach to improve their health.

When not providing clinical care, Todd works at the forefront of innovation, by making leading-edge knowledge available to surgeons internationally. Unfortunately, there are great disparities in knowledge across the globe, and not all surgeons have access to the same knowledge as Todd and his colleagues.

He founded GlobalcastMD and Stay Current in Surgery, both of which serve to modernise the way in which surgery is taught and learned.

You can contact Todd on Twitter here.

Details for iSPI can be found here.

Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!

Thinking of Oscar website and contact details can be found here.

Follow us on Twitter here or Instagram here.

Theme Music - ‘Mountain’

copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths

Podcast artwork thanks to The Podcast Design Experts

Show Notes Transcript

This week we are delighted to welcome Dr Todd Ponsky to the Podcast.  Dr Ponsly is a renowned Paediatric Surgeon, Professor of Surgery and Director of Clinical Growth and Transformation at Cincinnati Children’s Hospital in the US.

As a paediatric surgeon, Todd focuses on always trying to find the least invasive way to solve a child’s medical problem. 

He specialises in minimally invasive surgery with a focus on neonatal disorders and hernias.  Todd was the first to perform and report single port surgery in children and modernised the methods of the laparoscopic paediatric hernia repair.

Dr Ponsky believes that each child is unique. As such he spends a great deal of time listening to their questions and concerns and addressing them. Allowing him to understand the best approach to improve their health.

When not providing clinical care, Todd works at the forefront of innovation, by making leading-edge knowledge available to surgeons internationally. Unfortunately, there are great disparities in knowledge across the globe, and not all surgeons have access to the same knowledge as Todd and his colleagues.

He founded GlobalcastMD and Stay Current in Surgery, both of which serve to modernise the way in which surgery is taught and learned.

You can contact Todd on Twitter here.

Details for iSPI can be found here.

Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!

Thinking of Oscar website and contact details can be found here.

Follow us on Twitter here or Instagram here.

Theme Music - ‘Mountain’

copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths

Podcast artwork thanks to The Podcast Design Experts

David:

Hello, and welcome. This is the Not Mini Adults podcast, Pioneers for Children's Healthcare and Wellbeing. My name is David Cole. I'm joined by my wife, Hannah and together we are the co founders of children's charity Thinking of Oscar. Incredibly, this is Episode 12 of the second season of the podcast meaning this is our 24th episode in total. Unfortunately the final episode of season two before we take a small break for Christmas, but we will be back in the new year with a new season. Today we are joined by Dr. Todd Ponsky. Dr. Ponsky is a renowned paediatric surgeon, Professor of Surgery and Director of Clinical growth and transformation at the Cincinnati Children's Hospital in the US. As a paediatric surgeon, Todd focuses on always trying to find the least invasive way to solve a child's medical problem. He specialises in minimally invasive surgery, with a focus on neonatal disorders and hernias. Todd was the first to perform and report single port surgery in children and modernise the methods of laparoscopic paediatric hernia repair. Dr. Ponsky believes that each child is unique. As such, he spent a great deal of time listening to their questions and concerns and addressing them, allowing him to understand the best approach to improve their health. When he's not providing clinical care, Todd works at the forefront of innovation. By making leading edge knowledge available to surgeons internationally. Unfortunately, there are great disparities in knowledge across the globe. Not all surgeons have access to the same knowledge as Todd and his colleagues. He founded Globecast MD and stay current in surgery, both of which serve to modernise the way in which surgery is taught and learnt. Today, we're going to be talking about those innovations, as well as the work that he does from a surgical perspective. We're very excited to share our conversation with Todd, and we hope you will enjoy it as much as we did. Todd, Hi, thank you so much for joining us on the Not Mini Adults podcast. We're so excited to have you.

Todd Ponsky:

As am I. Thanks for having me.

David:

Fantastic. So I think as we tend to do on these things, you know, fortunately, you and I know each other, but it'd be great for you to give a little bit of overview as to what you're doing. But more importantly, I think how you got to be doing what you're doing today, please.

Todd Ponsky:

Yeah, here's a brief synopsis of the journey. So I wanted to be a writer. That's how I started off and actually would have loved to have been in theatre. Then I got sick and actually funny enough my father's a physician, my older brother's a physician, but I didn't want to have anything to do with that. I wanted to be on stage or writing. Then I got sick and I had a great doctor. I actually turned everything around. I started getting good grades and working hard and stopped going out and having fun every night and went into medical school. I really loved working with children and wanting to be a paediatrician until I rotated on surgery. I saw this incredible concept that you could fix things right away. Instead of having to wait for medicine to take time. It's like they come in and an hour later, they're cured. That was phenomenal to me. I love that and I completely switched from paediatrics and wanted to become a surgeon. Then in the second year of surgery, I realised that you can actually be a paediatric surgeon. I didn't even know about the specialty. It was a no brainer for me. The only problem was there's very few spots in the United States. So I actually had to kick it into gear and work to do what it took to become that so I took research time off and eventually became a paediatric surgeon and trained in Washington DC. Then I've always had an inkling for innovation and whatever's on the cutting edge. So when I took my first job, I asked them if they would send me to Denver, Colorado with a gentleman by the name of Steven Rothenberg, who is really cutting edge and learning how to operate on tiny newborns using needle size instruments. So almost no visible scars, I really wanted to do that and went and spend time with him. I learned how to do minimally invasive surgery using needle size instruments on tiny newborn babies. So that's my area of interest. That's my specialty. When I started, I wanted to teach people about this concept and we started having courses and I realised people started off initially coming and no one wanted to travel anymore, their hospitals weren't paying for it. So we went online. From that started Virtual Education, we called NBC with a broadcasting company who taught us how to make it like a television show. So we went from just a webinar to TV stream through the internet for doctors. I started a company called Globalcast MD and that became a medical streaming company. I then took a job with Cincinnati Children's to head up their innovation in the Department of Surgery. We focus on how to use media innovation through educating surgeons around the world, and also on how we can get surgeons and clinicians to actually take part in innovation, because most of the innovation in medicine is not done by the clinician themselves. It's done by researchers or industry. So that in a nutshell is my career.

Hannah:

When you talked about the TV, part of when you were taking education and delivering that as a TV show, then I thought of as your marriage of the theatre, you know, the theatre and the and the medical, then you got to communicate, you know, one of your passions in a different way.

Todd Ponsky:

Hannah you just nailed it. So it all came together, because I've always wanted that. Finally, I married them together, just like you said,.

Hannah:

Perfect

David:

The bit that you just said that she in terms of that you I've never thought about surgery as a, you know, you've kind of you've done it, and you're on your way as opposed to waiting for medicine to kick in. It was something that gave you almost instantaneous kind of success, hopefully, in a lot of ways. So that is that's a different way that I will I will look things moving forward. When we were, you know, as we've been going through these podcasts, I've had so many people say to me, you got to get tired, you got to get tired. So, you know, for that reason, I'm so glad that you come on. But there's so many different things that we could we could talk about, but I think the innovation element and the way that you're looking at that you've touched on, you know, a question that I had already, which was, you know, around, actually, it's the research side of things that really drives the innovation, because the clinicians don't necessarily have the time to do that. We talked about that, you know, a bit earlier. And then, you know, I'm really keen to obviously talk about some of these initiatives that you're doing. But let's, let's go to that point in terms of the research element, or researchers or, you know, innovation comes from research, can you just,

Hannah:

Sorry I didn't mean to interrupt you is trying to tag on the end. But when you're talking about that originally, I thought it when David was, you know, describing the preamble of conversation you guys had had offline, I thought it was about is it the right people that are doing the research, and I didn't know if you were trying to connect, because there's something that clinicians do bring to progress, which is just practical, hands on experience, day in day out. And so whereas t e pros and cons of who is and s not involved in the innovati n proces

Todd Ponsky:

The answer is you need everybody. So it's all about collaboration. So to bring that all together, the clinicians do not have time to do it. They don't have time unless they're given dedicated research time, it's very hard to have, you can try to dabble in research, but you'll be doing just that dabbling. You won't be making really impactful things unless you have time to do it. Innovation, although some some surgeons or clinicians are given time for research, I don't know very many clinicians that are given time for innovation. And it's really easy to ideate. So if you talk to a clinician who is in the trenches, and I'm not talking about, I keep saying so it's any healthcare provider. It can be anyone who's on the front line, working with patients. They're the ones who see the problems the most. Instead of an idea or looking for a problem to solve it starting with the problem and saying we know the real problem, we need a solution. So they in my opinion are the best to be coming up with the ideas. The problem is, the real work starts after the idea is there because it takes so much work, you have to really put the idea together. You have to a patent search, you have to prototype, you have to then raise money and it's a ton of work. That's why they never go anywhere. So the answer is creating a conveyor belt. We want to embrace the brains of the frontline workers get their problems, and say, Okay, we'll take it from here. That's what we're trying to build the Okay, we'll take it from here, get the ideas off their brains and then have a team that's a conveyor belt that moves the ideas forward. But the key element and there you go Hannah, that's why you have a collaborative team, of the researchers, of the venture people, of the the engineer. You have them all together, but the clinician needs to be involved, understanding that they don't have much time. So you get the ideas, and then you have the conveyor belt, take it to fruition.

David:

So how do you bring that together at Cincinnati?

Todd Ponsky:

Yeah, so the main thing we started doing is. I'm fascinated by this concept of something called systematic inventive thinking. A great book, if you haven't read it is called Inside the Box that really talks about this new way of systematically innovating, that you don't have to be necessarily creative, that you can systematically come up with an idea. So we start off with the problems. So that's going through whatever quality assurance method you have in your organisation. For surgeons, we have something called M&M, morbidity and mortality. It's a conference we have every week where we present the problems. So it's an incredibly scary environment, because you stand up in front of the room, and you say, this terrible complication that happened. Everyone historically would then say, Well, why did you do this? And why didn't you do that? It's punitive. We want to flip that. We make it called instead of m&m, we call it M M, and I, morbidity, mortality and innovation, so that it's actually an uplifting conference, you say this went wrong, we could have done this differently. But before you sit down, you have to come up with something that doesn't exist yet, that would have solved the problem. So we're mixing innovation. If we get excited enough about it, we then take a team we meet and we do something that my fellow Raj Gerardo called RSI. So RSI is a term used in medicine, when a patient is sick, and you need to quickly put a breathing tube in their mouth. It's rapid sequence intubation, we call this rapid sequence innovation. What that means is we go fast, no slow. So the problems presented at that meeting. If people think it's big enough, we say in the next week, we're having a meeting to ideate. We do some research in that following week, we do the two hour session where we go through systematic inventive thinking. We then vet those ideas, we came up with other surgeons, the pick the one we like, we do rapid prototyping, so one week to prototype it with the engineers. Then one week to do prior art patent searching. So in a month, you should go from idea to product. That's what we're doing, a rapid sequence innovation.

David:

Wow, I mean, the rapid part of it is just incredible, that you're actually able to move that quickly. You know, there's lots of organisations out there that have much, much more resources than you probably have your disposal that can't do that.

Todd Ponsky:

If you start with that in mind, they can even the biggest organisations, if they say, No, you only have four weeks. Then even the biggest organisations could probably flip and do that if they say, we only have it, you have a short timeline, people can quickly adapt and go quickly when they're told to.

David:

Absolutely, in terms of book recommendations as well, I'm sure that you've read if you read Blackbox Thinking by Matthew Saeed.

Todd Ponsky:

No, but I'm looking for a new book.

David:

So he's a British author, actually, he does a lot of work in sports and what have you, but you've written many books. This one is specifically around how the medical world doesn't necessarily look at its errors and try and do something about it. Whereas one of the examples that he gives, in terms of where they do this is aviation. If there's ever a problem in aviation, any kind of crash, obviously, you've got the black box, that's where the name of the book came from. They always go back and look at what's happened. That has helped them to innovate and move forward and now obviously, air travel is one of the safest modes of travel that you can have. It explores many different areas but obviously the bit that resonates given this conversation is that that doesn't seem to happen in medicine as well as it may be should do. I mean even if you look at some of the litigation budgets that national services have their vast. But what you guys are doing is kind of changing that around entirely which which sounds, you know, amazing.

Todd Ponsky:

Yeah, no, I totally agree with you. One quick thing I want to say about this, the hardest part we were just discussing before this podcast with my team, the hardest part is the first thing you have to do is called breaking fixedness. It's really hard. You know, it's the same idea with Henry Ford and the horses that he says that, you know, people would would say, make our horses faster. The hardest part that makes the surgeon angry is when you tell them remove something that you assume you have to do. They almost get viscerally angry when you have them break their fixed mindset. So there's a lot of a lot of work to be done. But I can't wait to read that book.

David:

Yeah, it comes back to it's one of the kind of mantras that I picked up from a few different places, actually, which is, to go back to the kind of Henry Ford example, if you wanted better, he would have made it a quicker horse. But it needs to be different. It needs to be different in order to be taken on. It needs to be different in order to really make a difference and move forward. So you know, I think that's it. It just rings true in so many areas of life and walks of life, I think. Can you talk about any of the examples of success that you've seen through that MMI process?

Todd Ponsky:

Yeah, so what's really exciting is that we don't just do it with devices, it's also processes. So one was we had a child that had a feeding tube that got clogged and it ended up leading to a complication. We then said, okay, it sounds like clogged catheters are a big problem. And so we did this in four weeks, and we came up with two ideas that I think are going to solve problems we didn't even think of. So that's number one. Number two, is we have a phenomenal colorectal centre where they treat children from all over the world with the most complex colorectal problems. We want to figure out how to provide care for people that can't always get to Cincinnati, Ohio. So well, they have to come. I mean, they have to come because they have to get this and they have to get that and I said, But why? Maybe they don't have to get that. And they said, Oh, no, no, no, they definitely have to get that. And I said, but let's break fixedness let's say you're on a deserted island, and you don't have that thing. Do you think you still could treat the patient? Yeah. And I said, Okay. then there's this thing about the good enough principle. That's what I call it. When the person who invented the digital camera, showed it to Kodak, they didn't like it because it wasn't as good as the camera photo. But it was good enough. And that's what they didn't recognise that most of the people would have been just fine with that. But it's the people that want exactly the way they've had it before. That stopped them from innovating. Once you get past that point, it's going to be an incredible breakthrough in how we treat patients, because now we're going to have almost no radiation because we realise we really don't need these tests we thought we needed. We can treat people from any corner of the earth and developing nations can adopt this, who don't have all the resources and can find that they can still treat these patients even without these fancy radiology tests. So we both do product and process and it's very exciting.

Hannah:

What's about on, you know, when you're talking about this process, this systematic and inventive thinking process, then speed is very obvious and how you're getting through that. But do you also improve your chances of success? Because innovation is an area where it's notoriously difficult to successfully implement something innovative and implement change? And I'm just curious about your perspective on that.

Todd Ponsky:

Let me tell you where I'm not good, which is most things. But here's an example of one thing of many. So we're great at ideating and getting the thing made. The problem that most children's hospitals have and we've been talking through Ispy, the International Society for paediatric innovation, on how we can all work together as children's hospitals is is that you have all these things now how do you get them to the marketplace? And that's a real challenge. We're brainstorming some innovative digital solutions that might help raise awareness of getting these products out there, because making paediatric products is very difficult.

David:

I think that's always been something that's kind of bugged me a little bit. It's the collaboration element of it. So you've got collaboration within your institution, that's absolutely fine and as it should be, but the the collaboration between Children's Hospital we're going off on a slight tangent here, but let's go with it. You know, the collaboration between children's hospitals or even just collaboration between hospitals, but especially children's hospitals. Given that, you know, if you are creating an innovation, intervention, which everyone should know about. They should just be, you know, out there for everybody to use, to utilise. Iknow that you have a different system in the US to potentially have we have in the UK. But you know, how do we do that? How do we do that more?

Todd Ponsky:

Okay, let me. I want to make one comment that on our last thing, and then I want to answer that my goal is not probably what it seems. I actually care less about getting a product out there. I want to get their brains trained to think different. I want the clinicians to be, you know, we were taught safety in the operating room. But for years, we did things away that wasn't as safe. Once they started teaching us the safety training, it's instinct now. You walk in, you know, you put the second glove on instead of one, or you announced what you're going to do better than we did before. I want innovation to be instinctual. I want it to be that, oh, I have an interesting idea. So number one is making the product isn't my number one priority, it's getting the brains to change. Back to your question about collaboration. That's why I love Ispy and I just recently joined that it's a mindset. It has to be where hospitals come together, the right people have to come together, where they leave their egos at the door. The culture is set within this group where we are working together. The rising tide raises all ships and this is what happens. We meet every week and we say, all right, I have this idea. How can you guys help me? Well, let's do this together. I think it's a culture and a mindset. And once people start seeing it happening and getting legs, everyone's going to want to join the same process.

David:

Yeah, and we will, we'll make sure that, that we put, you know, links to Ispy and what have you in in or the show notes. And, and it is a further conversation. You know, we've had we've touched on iSpi, but it's one of the things that we want to cover, you know, in season three of the podcasts is to really go through that. But I think, you know, I was introduced to it. 2017. So it's, you know, it's a relatively new concept. But I think it's growing and getting more and more collaborative, as you say.

Todd Ponsky:

Yep.

David:

Let's move on to you know, you mentioned Globalcast. And this I think fits into all the conversations that we've just had. Anyway, in terms of sharing of information, talk to us a little bit about how that came about and what you're doing with it.

Todd Ponsky:

Alright, so here's my question is, the one question that's in my head is, how will doctors learn in 10 years from now? I don't know the answer. But that's all I think about that literally keeps me up in the middle of the night, because I feel like the answer is out there. What I do is I look to see what my kids are doing, because it usually predicts where doctors will be 10 years later, because we're so slow. So if I look at the way that right now, the younger generation is consuming information. How are anything that my children know where is most of it coming from? I think I narrowed it down to four things. Gaming. They're getting information from gaming, because now it's social gaming. Right? That's the socialisation especially during COVID. They're actually like talking to people, they're getting information and because it's fun, they're enthralled with it. Their mind goes into it. So gaming is number one, social media is number two, they're getting information from social media. Now, I don't know if you've seen social dilemma, but it's scary. But it can be harnessed in a good way. And so some gaming, social media, video, video consumption, people go to YouTube, they don't read a manual anymore. So I don't think people read very much anymore. You can get it all on video. The final thing, go figure. I don't know if you guys have heard of this, but audio podcasts. That's a obviously you know, so that's where I think it is. Video, audio, gaming and social media. What about I think, what's that? About Austin's parents? Yeah, well, I'm not so good at that. So maybe they don't learn anything from me. Yeah, no, good. So I mean, that's actually you know, you joke. But I think actually, it's your colleagues right around you, whether it's your parents or whatever. So it's word of mouth around you. So the The point is that those are the four things we're focusing on. So if I'm going to think about how I'm trying to make, there's two ways doctors get information, push and pull, when they want, when they have a patient and they want to look something up, they'll go and pull what they want. So we have to make a platform that makes it incredibly easy to find something. So findability, you type something in and you get something that is exactly ingestible, that works for a doctor. So that's why audio is critical because the best downtime we have is when we're driving to work or working out. So it's multitask learning. So it has to be designed where you can get, you can find something exactly what you need to learn about the patient that you are dealing with right now, and get it consumable in a way that is easy to digest. While you're going through your day, so audio, video, or reading it, if that's what you like. So you have to have it in all forms of media. The second thing is, if you're just going after stuff that you are are looking for, you're going to be missing new content, because you won't even know it's there to look for it. So there has to be pushed content too. So there's pulled content and push content, push content is something they don't know about that they need to know about. The problem is, if I just send out an article, there's too much information now. So there's 2.5 million publications a year, there's no way to push everything out. It's information overload. So once it's deemed that this is an important topic, whether by crowdsourcing or artificial intelligence, and we say this is important, then we have to push it out. So we have to filter it, and then deliver it. So once we filter it through crowdsourcing or AI, then we have to deliver it in a way that someone would actually pay attention to it. That's where edutainment comes in. It's got to be fun, exciting, it's got to capture their attention. To repeat that, again, there's got to be cold content that's got to be accessible in a format that doctors need. Then there's push content, which has to be well filtered. It has to be delivered in a way that's going to capture their attention. Otherwise, they'll ignore it. That's the main thing that Globalcast focusses on.

David:

The other bit that that struck me with it is the democratisation of data. So you've just described the reasons, or the ways that you're doing it, and you're delivering it and how people will consume it. But but that works in a, you know, that's what we do in in the UK, or the US or wherever it might be, but what about in some of these, you know, areas that are not so fortunate? You know, that's that's one of the primary reasons for youcreating it, right?

Todd Ponsky:

Right. So our hashtag is knowledge should be free. So right now, it's only the wealthy countries that get the most cutting edge information, because the textbook costs. it can cost anywhere up to $1,000. If it's a very highly specialised textbook in a very, very specific space, but they're usually several $100 for a textbook. Someone in a developing country is going to get an old book that is out of date. So you have a complete disparity in knowledge. And it's crazy to me that in 2020, there's disparities in knowledge. So our hope is that by putting content out in digital form, which is interesting, even the most underdeveloped nations still usually have access to internet. So if you can push the content for free, in engaging ways, we're going to start seeing a level playing field, that everyone's going to start having the same access to the same information, it's going to disrupt the industry, because by providing free information is going to put a lot of things into a tailspin. The question is, how do we financially support that? That's a good question. We're, we're we're figuring that out. It's going to be either, you know, donations or monetization through having ads, or allowing people to pay to put their content out there. We'll figure that out. But right now, it's working fine.

Hannah:

How do you break through the noise? How do you reach the people for whom the information is so valuable?

Todd Ponsky:

So the two things that I'm going to answer that with so there's filtering the content, and how do I get it to them. So take a surgeon who is in some remote country somewhere. First thing I had to determine is what's important, I haven't figured that out yet and working with much smarter people than myself, we're working on AI algorithms, we just presented at our national meeting. I am not even an amateur and below an amateur. So we were able to using the machine learning algorithms, we were able to predict what the editorial boards would have also predicted was a good article. So if we can find companies to help us make an algorithm that would probably give you a good idea that this is a good article, or important? That's step one. crowdsourcing also is very critical to this. Once we've determined that, how do we get it to them? So we use social media to make people aware of what's out there and then direct them to where the content is. It always has to be the free content that we direct them to. So we've created a mobile app that's free. It's you know, it's been downloaded way more than we anticipated. So that's how we're doing it now.

David:

I was gonna ask you about numbers and also just geographical location. Have you got an idea as to how gegraphical the spread of users is now.

Todd Ponsky:

Yeah, so numbers and geography. So let me do geography first. So Globalcast used to only do live events. Because we started 12 years ago, we were with our webcams. I mean, this was before there was zoom or anything like that. So we found the biggest gap was Africa. We would put push pins all over the world where we were being viewed except for Africa. We talked to people there. And it's the access to fast enough bandwidth to be able to watch a live event when we went into the offline app, the mobile app where you can watch on demand. It spreaded out equally all over the world. So that was the thing that held us up and reaching Africa. It's a complete geographic spread, spread equally around the world. What I get excited every morning, when I see the new people that have joined our group, I love seeing the most remote countries you can imagine. Numbers. So to give you an idea, we have 700 paediatric surgeons in the United States. So it's a very small specialty 700. So we have 6500, verified paediatric surgeons or paediatric surgery nurses. So we think we have a probably about 80% of the world's population and that's only in the tiniest of specialties. So once we start doing this in other specialties, we feel like we'll make a real impact.

David:

I've got to ask this, because I do work in AI. Still not anywhere near where, you know, the guys that are creating the algorithms are going to be but what do you think about when it comes to bias and giving the right information to the right people? You know, so one of the things that we think about is, if you take imaging, for example, you could train an imaging algorithm on a population, which has absolutely no bearing on the population that might actually use the algorithm. So you need to make sure that you're, you know, either either you're very transparent, in terms of demographic and what data that you've trained it on. So how do you make sure that the intervention that you're doing on a, you know, on a child in Cincinnati is the right thing to be given to someone in Sub Saharan Africa, for example?

Todd Ponsky:

This is exactly the same question that everyone keeps bringing up. I don't have an answer. I'll give you an example, though. We put out stuff that was really, really important. This is how I'm solving it. We put out papers that were important. I got emails from people and it's funny, I don't care how many emails I get, I always answer every single one of them, because that's how we're going to get to the answer. They said, You're only talking about things that we don't even see in Sub Saharan Africa. How much are you talking about TB? Because that's a big problem for us. You don't even mention it. I said, Okay, so we created something called the idea team, the International digital education Alliance. I put a video out there, I said, join us, we need democratisation of knowledge, not only going out, but coming in. So we need to know what's important. So that's not an answer to what you're looking for, which is the AI answer, because I don't know how to rule out bias in artificial intelligent algorithms. I can tell you, what we're doing now is that we are getting input from a diverse group of people instead of, you know, the same people in the same city, that should dictate what everyone else in the world wants to see. Then the problem is we're going to have to deliver the content in a very specific way. So someone in Africa can look at content that's relevant to them, and someone in Cincinnati can look at content that's relevant to them.

David:

I think that's brilliant that you're doing it that way. When you mentioned crowdsourcing in this respect, as opposed to crowdfunding, that to me is also a way in which you can, you build up that knowledge in terms of they can help you know that the power of the crowd is that they can help you to determine what needs to go where and how it goes. I think it's, you know, again, I'm not an expert on this, but it's probably an underutilised element of society today.

Todd Ponsky:

So I believe crowdsourcing is critically important. The argument that I will get from the naysayers, which is a very valid argument, is that while I believe the crowd is smarter than the core of experts, we have the core of experts that are editorial boards. These are people that have been deemed to know what everyone wants to read.I think the crowd is going to be smarter than the core of experts. A great book Machine Platform Crowd. Anthony Chang told me about it, great book. It really talks about the difference between you know the value of the crowd versus the core. And but the argument against that is that the crowd will only pick sexy, fun topics and won't delve into the scientific process. I said, Well, I'm not sure about that. Let's find out. So what we'll have to do is go back and test to see did the crowd pick articles that are fun, fun titles? Or did the crowd really pick high quality articles? The answer is probably going to be a Wikipedia answer. Wikipedia is crowd sourced with an editorial board. It's hybrid together.

David:

Yeah, no, I think I think that's fascinating. I just want to I'm just conscious of time, and I want to talk about a little bit of your, I guess, day job to a certain degree in terms of the surgical side of things, you know, where you're actually, you know, with patients, and I guess the bit the bit about the job that. You know, brought you to it in the first place. But I know that you've done quite a lot of innovation in that respect in terms of, So you talked about minimal invasive surgery and perfecting that and you know, your goal is to make sure that you're giving, you're doing that as least invasively as possible with minimal scarring and all this kind of stuff. But talk to us a little bit about some of the technologies that you've brought into to assist you because they're fascinating.

Todd Ponsky:

Yeah. So my goal, personally, that I have an interest in is two things. One, really pushing minimally invasive surgery. So we've went from not being able to treat and then eventually saying, Oh, well, we can figure out an operation that fixes it, but it's with a big scar. So it was no therapy to invasive therapy. Like we figured out how to do it, but it really hurts and it's impactful to the kid. Then the third one is minimally invasive surgery, which is tiny scars for the same operation. Ultimately now we're working on no scars. So that is putting an endoscope into the mouth and being able to get inside and do it scarless surgery. That's called notes, natural orifice transluminal endoscopic surgery. And and that is something that is happening in the adults, but not so much yet in the kid. But it's just starting. So it's minimal invasion is my interest. I am very interested in particular, hernias is an interest of mine because of how we can do it, since it's a very common operation. But my bigger interest is something called telementoring. So now that surgery is usually on video, so we're operating and we're watching on the screen. Now, one surgeon in one place could see what another surgeon is doing and actually mentor them live by drawing on the screen and saying, This is what you do. So we've been really pushing telementoring, which has, as you can imagine, carries a lot of controversy. But we have really demonstrated it's better for the patients. So laparoscopic surgery, the minimally invasive surgery really lends itself well to telementoring, which is the other big question we're trying to do, which also goes along with democratising knowledge because now surgeons in remote locations can get guidance from surgeons in in other locations.

Hannah:

You said that doing the micro surgery will minimal to not seeing at all surgeries, starting in adults less so in paediatrics and that what are the factors that you need to consider aside from the actual size of the implements that you're using.

Todd Ponsky:

That's what it is, it's the size. So the instruments that go in through the mouth. So the scope goes in and it has all these instruments that come out and can do the operation like a robot from the scope. But the problem is the scope itself is too big to fit down the oesophagus of a child. So if we could figure out how to downsize those, and that's this just keeps happening. It's always how it is it's first made in the adult world. Then we try to downsize it. So right now, we just don't have the appropriate size for children.

Hannah:

Have you looked at it from the other way around that because we obviously Not Mini Adults podcast, we're talking about exactly that premise that it's not just a matter of scaling something down necessarily. So I'm thinking with a systematic and innovative thinking in mind of what what what have you come up with and you go with a blank sheet of paper instead.

Todd Ponsky:

Okay, so this kind of circles back to the original discussion. Let's say I get a group of us together, and we apply systematic inventive thinking and figure out a way to downsize and create a mini version of an endoscopic surgical solution. That and I'm being a little bit of a defeatist here, but that's going to cost quite a bit of money to make and there are very few companies that would be willing to invest in creating something that big and expensive for the paediatric market? No one wants to make products for paediatrics because the markets too small. So we would have to come up with not only a compelling instrument, but a compelling market that would allow the companies to make it for us. So the usual, the really big advanced technologies are usually ones that are the hardest to get through. Whereas the smaller devices are easier if something like that would be game changing. But people have had a lot of failures so far in trying to bring adult technology into paediatrics because no one wants to make it.

Hannah:

Yeah, it's a it's a familiar story,

David:

Unfortunately. So and I was really hoping when you were first describing that, that it was a case of we've got this for paediatrics, because then you could expand it out to adults much easier. Right? Then also, because of their physiology, that there's, you know, is less of them to go round, if that makes sense. Right?

Todd Ponsky:

Yeah.

David:

If you had something of scale, then, you know, it would work. But what I'm about to kind of come to what we what we tend to ask everybody in terms of a final question, but I think what you've discussed in terms of just the changes of education, I found out not that long ago that, that actually education for surgery in particular. So there's a doctor in the UK called Shafi Hamad, I don't know if you've ever, you know, amazing what he's trying to do with VR, and AR and all these different things. He obviously has pioneered to a certain degree actually webcasting and on all different media and platform, all of the, you know, surgical interventions that they've done. But I remember him showing a picture in a lecture that I saw not that long ago, just, you know, a bank of seats of clinicians or surgeons that are training just watching this happening. But it hasn't really changed so much in the last kind of 150 to 100 years. So these advances that you're talking about and that you're pioneering are you know, really what is going to change that and and I guess thinking it with or in my head, thinking it with the Globalcast and thinking about how you actually help surgeons in Sub Saharan Africa or India or, you know, these less developed countries, you know, you've got a real opportunity to do that. Because let's face it, the technology will be there in order to get the broadband signal, whatever it might be in order to do it. It's just a case of making sure that we're getting that information to them.

Todd Ponsky:

Yeah.

David:

So look, Todd, thank you, you know, so much as I knew this was going to be a fascinating conversation. We've gone, you know, lots of different angles and trajectories and it's been fantastic. But what we there's one question that we tend to ask everybody on here, which is that if you had a magic wand, and you could do anything, you know, to change, paediatrics or to solve something in paediatrics, what what would it be?

Todd Ponsky:

It's this holy grail, I'm going to go back to the beginning, it's the holy grail how to democratise information, all these other things that we're working on these cool instruments, these cool processing innovations, that's great. But the biggest impact, I believe, that we can have on worldwide care of children is, is flattening the playing field of knowledge. That's the biggest disparity that I've noticed that people in remote locations can get by without the latest technology, but they cannot get by without the latest information or the latest knowledge. So if we could figure out how to filter through the content, how to get it into people's brains, and what is going to be the future of how people are going to consume information. And I want to see that we talk again in a few years, and we look back and say it happened. Look, it's a whole different world. Now. Knowledge is shared equally around the world, through this technology that we haven't even thought of yet. I don't know what it's gonna be. If I could look back at of all the things I'm working on the minimally invasive surgery, the rapid prototyping all that that's secondary to the fact that I really want to be able to say that knowledge is equal around the world.

David:

I think we said a lot but we could not agree more. I could not agree more. You know, the reason I'm still you know, working and doing the job that I do as a day job is because I want to try and make that happen. So and I know that you're trying to do that with iSPI and everything else. So Todd, thank you so much for joining us. It's been such a pleasure, and a great right way to end our second season. So we really appreciate that. And, you know, we wish you and your family very happy Christmas and New Year. And I think we're all looking forward to 2021.

Todd Ponsky:

You too, and I just want to congratulate the both of you because this is so important the work that you're doing. And this is an exact example of the steps we need to take to accomplish exactly what I'm looking to accomplish. So congratulations to you.

David:

Thank you. Thank you so much. Thank you to Dr. Todd pomsky for joining us on the Not Mini Adults podcast this week. Also a really big thank you to everyone that is listening week in week out, and the very kind feedback that we've been receiving. This is the final episode of season two. We can't quite believe that we've got through 24 episodes since we started in the summer. It's been a real honour to speak to the people that we've spoken to. If this is the first episode that you're listening to, please do go and check out the back catalogue where you'll find us having conversations with some truly inspirational people, as ever. If there is someone that you think that we should be talking to, then please do get in touch. All the details from today's show and for thinking of Oscar can be found in the show notes. Finally, thank you to everyone that's been on the podcast with us. Please join us again in the new year for season three. And until that point, we wish you a very Merry Christmas and a Happy New Year.