How We Plan to Be the Best Functional Medicine Clinic

Exciting updates, SIBO research, and thoughts on the field of Functional Medicine.

On today’s episode of the podcast, I’m taking you behind the scenes to talk about some of the exciting new things we’re doing at the clinic. We know that more tests, more supplements, more money, and more time spent in appointments don’t lead to better results. At ACFM, we’re actively doing and publishing research in order to document what does work, including upcoming research on triple probiotic therapy for SIBO. 

Listen for details on this and other exciting updates, reflections on the field of functional medicine, and some thoughts on what I’ve learned throughout my own health optimization journey.

In This Episode

Intro … 00:00:45
Clinic Update and Vision … 00:01:27
Personal Updates … 00:12:57
Thoughts on Peptides … 00:23:05
Thoughts on Mold … 00:30:52
Episode Wrap-Up … 00:38:26

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Hey everyone, this is Dr. Ruscio. Welcome back to Dr. Ruscio radio. Today I’m flying solo, and we’re going to go over some important updates at the clinic and some of the cool stuff that we’re doing over there. There are a few personal updates including what I’ve learned in my own healthcare and optimization journey. Also a few reflections on things that are wrong and things that are right with the field of Functional Medicine as indexed to my own personal experimentation and reflections on things happening at the clinic. A lot here to unpack, and a potpourri of different topics. Okay, let’s jump right in.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone, this is Dr. Ruscio. Welcome back to Dr. Ruscio radio. Today I’m flying solo, and we’re going to go over some important updates at the clinic and some of the cool stuff that we’re doing over there. There are a few personal updates including what I’ve learned in my own healthcare and optimization journey. Also a few reflections on things that are wrong and things that are right with the field of Functional Medicine as indexed to my own personal experimentation and reflections on things happening at the clinic. A lot here to unpack, and a potpourri of different topics. Okay, let’s jump right in.

Clinic Update and Vision

DrMR:

Regarding the Clinic, I’m really pleased to say that by the time this podcast airs, we will be enrolling patients into a study where we will be assessing the impact of probiotic triple therapy. That’s using a Lactobacillus bifidobacterium blend combined with a Saccharomyces boulardii, and also combined with a soil-based probiotic, triple therapy. It will be assessed in the treatment of SIBO, including hydrogen sulfide SIBO. We will be doing pre/post breath testing, and we will also be administering a pre/post IBS symptom score and a quality of life measure. So I’m very excited about that.

DrMR:

Simultaneously we are working on finally publishing that biofilm data. It’s essentially in the process of being submitted. Also a retrospective chart review on if gastrin tracks as a marker for indicating low HCL and therefore increased risk for being SIBO positive. Definitely some interesting stuff there. I’m really happy to say that even though I’ve been talking about the research for a while, there was a fairly steep learning curve. We wanted to do a placebo-controlled trial, if you remember me mentioning this, and we just could not get the placebos off the ground.

DrMR:

As the Clinic has grown, the research initiatives have taken a back seat to making sure that clinical care stays on the absolute cutting edge and is the best it can be. Research is a luxury of having enough time and resources to then look into and perform the research, and I’m happy to say that we have the luxury of having that time and resource availability in order to do what I feel is crucially important work. I mean, it doesn’t take precedent over clinical care, but once that’s where it should be, then we can move on to research, and I’m happy to say that we now are in full force.

DrMR:

I mentioned some of this on the podcast before, but we’re making some additional systems updates as well. One of the things that I’ve learned as the Clinic has grown is we’re reaching and helping more people outside of the epicenter of our audience, the people who I think are the most familiar with my work. We’re starting to reach people who maybe have heard one or two podcasts, read an article, they know of the work, they appreciate what we’re trying to do, our ideals and what we stand for, but they may not have the full understanding of all that goes on behind the scenes. Some of our updates now are geared toward helping patients better understand that more time with a clinician doesn’t equal better results.

DrMR:

It’s interesting to observe, and I guess rightfully so, how people really resonate with the message that more testing and more supplements doesn’t necessarily equal better results. “Yeah, I don’t want to spend money that I don’t need to. I don’t want to take a bunch of pills.” But that same framework of aiming towards efficiency also applies toward if I spend an hour and a half with you, there is, in my opinion, a very high probability that there is wasted time. So what we can do is be more focused in our visits, and that will allow us to spend less time with you, but more time behind the scenes, organizing, dashboarding, making notes, double checking, mapping out plans, checking contingencies, double checking things from the history, and making sure they’re tracking with what we’re predicting to happen in the future. That’s really where I think most of the magic comes in, but patients aren’t aware of that. So we’re changing, updating, and refining some of our communication with patients so that they better understand that.

DrMR:

Also, I’ve been working a lot over the past few months, and most of that work has been in preparation for the hiring of two new doctors. I’m not sure if this will be the first time you’re hearing this. If so, Dr. Omar and Dr. Hannah are two new clinicians on the staff, and I’m exceedingly excited about having both of them on our team. What I’ve been working towards is making sure that the training for the clinical model and everything that we do at the clinic is exquisitely clear and helpful.

DrMR:

The evolution has been from my pre-transition private practice, which occurred August of 2020, that was kind of Clinic 1.0. Then Joe and Rob came on board, and that became the Austin Center for Functional Medicine. Well, now we’re going into the Austin Center for Functional Medicine Version 2.0, where I’ve allocated time every week to really make sure that everything that I’ve learned, everything in my head, all of the reflection, rumination, time in the research, collaboration with Joe and Rob, all of this has been really codified and organized into the model. I have to say that things now I think are better than they were before. I really want to articulate for people that you don’t have to work with me to get excellent care. What’s been so nice is I’ve freed up some time every week to work even more on the Clinic in thinking about how can we do the best for patients? How can we be the most effective? How can we be the most organized?

DrMR:

That’s what’s been a lot of the additional work lately. I shouldn’t say I freed up more time because I’m just working more. But to that end point, I have offset some responsibilities so that I freed up some time which allows me to work more to solve more problems behind the scenes. Then I benefit from those problems, but so does every clinician. So really now that there’s more of a team at the Clinic, I think there’s a better offering that we can put forth together than when it was just me in private practice alone. And this may sound a little bit perhaps self-aggrandizing, laudable, or grandiose, but our goal is to become the best clinic in Functional Medicine and for that not to be refutable. How we’re planning on getting there is through publishing the research that documents that our results are the best in the field.

DrMR:

Again, I know that may sound a little bit strong, and I’m not trying to say that through the perspective of trying to tear others down to make us look better. That’s not the goal at all, but there are clearly a number of problems in the field that are kind of looked at as normal. And that’s the spirit of where my comment comes from. These things that are normal need to be rectified. To say it plainly, not only do people spend more money than they need to, but this array of tests that are used lead people to think they have more wrong with them than they actually do. This is a serious problem. The gene testing, the adrenal testing, the hormone testing, the excessive GI testing, and I even think some of the mold testing, which I’m really starting to question.

DrMR:

So if someone comes in with a few symptoms, they leave thinking that they’re far worse than when they went in. This is why I oftentimes use the analogy of a musculoskeletal injury or of an athlete, and this is how I think we should be framing things for most people. You are a normal, healthy, strong individual. You’ve suffered an injury. We can fix that injury, get you some time to heal and some rehab, and you’ll be back in the field at full function.

DrMR:

What doesn’t help people is when they have one or two complaints, such as “I’m fatigued and I have a little bit of brain fog,” and they have not pathologized that. Then they go see a Functional Medicine provider. The Functional Medicine provider says, “Oh, you have antibodies to your cerebellum tissue, to your neo-cortical tissue. You have high levels of inflammation and Zonulin and leaky gut and adrenal fatigue. Oh, and MTHFR, so you can never have folic acid.” Then people leave and they think that they are absolutely, almost irrevocably, screwed up. This is such a damaging nocebo that needs to stop.

DrMR:

And so when I say our goal is to be the best clinic in Functional Medicine, it’s because we see the clinic who steps up and correct those things as the clinic that will be hopefully looked at as the best. I want to also be careful to frame this as something that we want to do collaboratively, leading from within, in a lock-armed fashion, but fortunate enough to have the resources, to publish the research, to ask the questions, and then to answer the questions with research and show people, “Hey, there’s a better way. And maybe some of what you’re doing is influenced by nutraceutical companies or lab testing companies. And you’re doing the best work that you’ve been taught how to do, but part of the problem is who’s teaching you has biased information. And so this is a natural byproduct of drift when incentives are misaligned in the field.” So send your hate mail to the office. No, I’m just kidding.

DrMR:

The other thing I want to quickly mention one more time is the other thing I have on my plate to start working on more directly. It’s something I’ve been working on indirectly and collecting notes on for years, probably most of my life actually, and that is the optimization plan. I’m exceedingly excited about how we go into this 2.0 model where, using the prior analogy, we’re past the point where the athlete is injured, and now we’re trying to get the athlete actually running as fast as we can. So how do we go from, “Oh, I have fatigue, insomnia, brain fog, bloating, constipation. Those are now gone, but I want to have even more energy at the end of the day. I want to be preventative.” That’s coming soon.

Personal Updates

DrMR:

Some personal updates. As I’m pretty sure I’ve mentioned the podcast one or two times, I had a crash recently, and sometimes it takes a bit of reflection to figure out where a crash really came from. Perspective is also crucial. And the way I look at this when this happens to me, is almost like a football player trying to advance the ball down the field, and he’s going to get knocked. He’s going to get knocked over, but he’s going to get up and keep running. And so you’re going to get hit, and you’re going to get thrown off stride, but you’re always pursuing the finish line. Rather than the other perspective when you have a crash, which is, “Oh my God, I’m chronically ill, and this will never end,” and going to this place of despair. That is a really damaging framing.

DrMR:

So the way we look at this is, I’m healthy, I’m strong, I’m moving forward, but falling off the horse, getting knocked down, that’s going to happen. It’s so important to have the resolve to know that it’s going to happen, so you can remind yourself of that when you hit that down place, that darker feeling, and not tip over the edge into despair.

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DrMR:

I think it’s also important to keep in mind that things that we do to make us better or healthier can make us worse. This is why it’s so crucially important to listen to your body and not to follow the crowd. As an example here that ties this all in, the crash likely came from a combination of two things. Overtraining, yes, but I think that was actually the minority factor. The majority factor was actually the peptide Tesamorelin. I finally figured out after going off of it, leveling out, and then going back on it, that I saw the same things reappear, which were predominantly, once all the dust settled, fatigue and anxiety.

DrMR:

The anxiety was strong. I am not an anxious guy, in fact, I’m probably on the opposite end of the spectrum. I tend not to be flustered or upset by things. If anything, I’ll get amped up and a little bit angry, but anxious is different. Anxious is more of a panic feeling. Anger is more of wanting to run through this wall or punch someone in the face. That’s really how it feels to me anyway. But I would describe anxiety as this very energetic fearfulness. So you’re fearful and you have a lot of energy, and so that fear is really fueled. So something that can ostensibly make you better, Tesamorelin, growth hormone, anti-aging youth; it did have some positive impacts for me from a body composition and workout perspective, but ultimately that was the cause of a net suffering. So listen to your body. Don’t follow the crowd, because I would submit to you that most of the crowd has it, or at least many things in the game of life, wrong.

DrMR:

So those things are important to keep in mind. Also, to frame my previous crash positively, this is part of being the best that you can, finding that line, finding that edge. That’s going to involve setback or injury. Again, using the athlete example, the athlete who pushes it to the absolute max may have a sprain or a pull or some sort of setback. And if you can frame that in the perspective of, “Yes, this stinks, but I found the edge. At least I can say I left it all on the field, and I pushed to the point where one couldn’t push anymore,” then I think there’s a sense of accomplishment that should be associated with that. So again, the framing is important; a positive frame as compared to a negative frame.

DrMR:

Some updates on sleep. I’m finally eating earlier, and the only way I was able to make this work was changing my workouts to midday. That was the only way to make it work, because I usually end up working until about six, better case scenario. By the time I go to the gym and come home and sauna and then eat, I oftentimes wasn’t eating until eight or sometimes even nine. So now I go to the gym midday and I do the sauna at about six or 6:30 and then eat right afterwards. My sleep is noticeably better, mainly through my Oura Sleep Score and my Readiness Score.

DrMR:

Now, didn’t I say before that mouth taping helped my sleep? I think it did, but there were two variables that changed. You may remember me saying I started this during the snow apocalypse in Austin. I wasn’t working out during that time, so I was also eating earlier. After about two weeks, I also ended up having an allergic reaction to the mouth tape, and that ironically was causing insomnia. It was not because I was having fear of suffocating because my mouth was taped, but more so because I’m chemically sensitive to plastics. If you remember back when I tried putting the silicone wax in my mouth for the Crozats, that caused joint pain, loose bowels, and fatigue. Well, I’m just sensitive to plastics. And so I’m going to try a different tape. I was using the SomniFix; I’m going to try the 3M instead, but I’ve since stopped mouth taping.

DrMR:

Within the theme of getting knocked off the optimum stride on occasion, I also went and saw Dr. Ted Belfor in New York, and was fitted for a Homeoblock. I have to rerun the experiment, but I’m pretty confident that the plastics in the Homeoblock were also causing an insomnia reaction for me. Now again, I have to retry that, it could have been a coincidence, but I’m pretty sure that is the case. So that was really frustrating. If we’re going to be talking about frustration in one’s journey to improve their health, I went all the way to New York from Austin and spent a decent chunk of change only to find that this option, which I was hoping was going to the option, because I couldn’t do the Crozats because they cause this slur or lisp, and that may not work either. But just like the football player who is getting knocked down as he’s pursuing the finish line gets back up and just keeps moving, well, that’s what I will do. I will keep moving forward.

DrMR:

I have a sleep study tonight, so I’ll be curious to see what this actual attended PSG sleep study finds, because I did two home sleep tests, which we are now doing at the clinic by the way, and these two home sleep tests both essentially found either mild sleep apnea or Upper Airway Resistance Syndrome. What does that mean? That means that while sleeping, my heart rate had a max of 88 beats per minute, and on the other test, 123 beats per minute, while the pulse oximeter found that my oxygen levels went down. So something is presumably interfering with respiration. That’s causing my oxygen to go down, and my heart rate to go up.

DrMR:

So of course this is not good. You don’t want this to happen. But the good news is that as I continue forward on this road and I remedy what I’m assuming is Upper Airway Resistance Syndrome, ultimately the muscles in the palate and the throat and the tongue don’t have proper tonality or room. So the oral appliance helps with the room, and certain myofunctional exercises help with the tonality, and the airway won’t collapse. My oxygen levels won’t go down. My heart rate won’t go up. I won’t be having these bouts of stress while I sleep. I’ll have better sleep quality. I’ll be invincible; I will rule the world. That’s the story that I’m telling myself.

DrMR:

That’s how these things should play out sans a few interruptions in the plan, like the Homeoblock potentially causing a reaction because of the plastics. But I’m learning from all this, and all of these things are being incorporated into the optimization plan at the Clinic. So you benefit from my trials and tribulations.

Thoughts on Peptides

DrMR:

A couple of other thoughts. I’m not sure if this podcast will release before or after the podcast with Kevin Wallace on peptides, but that was an interesting podcast. The world of peptides is an interesting world. Like many things, I kind of have mixed emotions. On the one hand, I’m allured by the potential gain that peptides offer. But I’m also concerned that there is the zealotry and placebo running rampant in some of these circles. And by the way, this also happens in my primary area of GI. So I’m not saying that GI is immune to that. This is something that permeates every area, but because peptides are often injected in a small pinch of belly fat subcutaneously, I think they’re much more prone to placebo. And so I’m assuming that the realm of peptides is much more deeply ensconced in placebo than other areas of healthcare and medicine.

DrMR:

I really appreciate Kevin sharing his perspective, and I think it’s important to toggle between the boots on the ground clinician’s perspective, and then the skeptical evidence-based perspective. Toggle back and forth, back and forth, back and forth, so that you can have the optimum balance of being curious, inquisitive and open-minded on the one hand, but willing to call out the BS and look for evidence on the other.

DrMR:

He mentioned the DSIP, the Delta sleep-inducing peptide as an example. I went on the internet and did a little bit of research. You go into either Google or PubMed and you get different results. When I go onto Google, there’s some “Dr. So-And-So, I want to tell you all about Delta sleep-inducing peptide and the 22 ways it can help you,” or something like that. What’s so interesting about this is that it taught me a valuable lesson or reminded me of a valuable point. This gentlemen had a 14-ish minute video on all the mechanisms for why Delta sleep-inducing peptide can help you.

DrMR:

I go into PubMed, and there’s only been a couple of clinical trials. The results of those trials are pretty tepid, meaning no effect, or maybe people reported improved sleep quality from a subjective perspective, but none of the objective measures improved. Now full disclosure, this was a quick query I performed in PubMed, so I could have missed something. But I’m also pretty good at doing these queries efficiently, so I’m not assuming I made any egregious oversights.

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DrMR:

So here’s what’s so frustrating about the field. Coming back to my earlier point about wanting to be one of the best in the field, someone could go watch 15 to 20 minutes of all the reasons why Delta sleep-inducing peptide can help you, but when this has been studied in at least the two clinical trials I pulled up, essentially no effect was found. Now the problem is that people want to be told why things can help them. And there’s a story there, “This peptide sits on this membrane or this part of the brain that stimulates melatonin. And this puts you into a deep sleep state and Delta waves and Beta waves.” You can run wild with this story that you want to hear.

DrMR:

It’s much less sexy to the untrained ear or eye to say, “Well, in a clinical trial of 22 individuals with insomnia, DSIP led to no improvement in subjective or objective markers of sleep.” That’s not as sexy. People want to fall in love with the story, and that’s why the storytelling sells so well. This is something that I’m continually trying to share with our audience, so that you’re armed with the knowledge not to fall in love with the specious argument, the argument that sounds so good, that 15-minute YouTube video, but is totally dismantled if there’s one good piece of quality evidence showing that peptide doesn’t actually do anything. The mechanistic conjecture is meaningless if we can’t demonstrate a viable clinical outcome. So, just a note about my quick query into Delta sleep-inducing peptide.

DrMR:

Now, Dr. Wallace had said that it works really well, and so I returned to two things. One, it’s possible that it does help, and this has not yet been demonstrated in the trials, probably less likely since there’s been two trials, but possible, and I’ll remain open to that. What’s more likely is placebo. This is one of the challenges with these realms of medicine, especially if the doctors are amenable to placebo. Then, oh my goodness, this is just placebo on placebo. And I suppose that’s not a bad thing if these things are inexpensive and safe, but unfortunately what I think ends up happening is that we’re “nocebo-ing” people with a bunch of tests, and then we’re “placebo-ing” people with a bunch of treatments that may not be effective. It’s like the worst combination that you could construct.

DrMR:

Now all that being said, I will probably try Delta sleep-inducing peptide, because I trust myself to be objective enough in the analysis of my sleep, and I also have objective measures like Oura ring. Also, I might repeat a home sleep test and see if there’s demonstrable improvement in that. So a few notes there on how you can be so much more efficient and protected from making mistakes if you simply look at the type of evidence someone is using in their argument when they’re trying to sway your healthcare related, decision making. I mean, it really applies to any sort of decision making, but specifically for healthcare especially, we can use the evidence-based model to really keep us more on target.

Thoughts on Mold

DrMR:

A final few notes, Joe and I from the clinic are having this back and forth. Dr. Joe Mather, just in case you’re not familiar with who Joe is. He’s not just some guy who hangs out in the Clinic. He had mold in his former office. He suffered with it personally. I have not had the pleasure, thankfully, but I’ve run three tests on myself, actually four now. I’ve run a RealTime Labs and also three Great Plains urinary mycotoxin analyses. What’s interesting is to look at Joe’s labs and experience and parallel that with my labs and my experience. With the exception of a couple of months in Austin here last summer, I’ve always lived somewhere where I always had windows open and tons of fresh air. The probability that I have had mold in my environment is about zero.

DrMR:

Now, perhaps the building I did my internship in 10 years ago had mold, but I am not convinced of the whole mold colonization, “You’re going to have mold in perpetuity,” argument. I think that argument just does not make any sense to me, save maybe a rare exception. So my tests have always been elevated, at least three mycotoxins normally and fairly high levels. What’s interesting is that my test from day one and my test from day almost 365, almost a year later, look almost identical. I mean, there’s some shifting, but they look very similar. All that while in the interim, from day one to year one, I have taken fairly high doses of binders, Glutathione, exercised regularly, and sauna most days, sometimes twice per day. So I sweat a lot. So if that is insufficient to produce a clear test, I don’t know what would be. And if I felt normal the entire time, then it really makes me question the value of the test. My suspicion is that probiotic supplementation and/or consumption of fermented foods will cause a false positive.

DrMR:

Now, from what I’ve heard in some of the bandying Dr. Joe and I have gone through, there has been one study that found that wasn’t the case. I haven’t reviewed that study, but I question the results. Also, regarding Joe, who had notable anxiety and fatigue, his test and my test don’t look discernibly different. Admittedly, I do need to do another side-by-side comparison, but from my memory of looking at his test from months ago, you have a few positives. I have a few positives. There was no demonstrable difference. It wasn’t like Joe had every toxin pinned at the max. So if someone has known exposure and is exhibiting symptoms, really important, and their test and my test, who has no known exposure and exhibits no symptoms, I have a real hard time thinking that these tests have any merit.

DrMR:

Now it’s not to say that mold exposure and mold toxicity is not a thing. I think it very much so is a thing. I’m just questioning if these labs are actually helpful. One of our plans in the near future, maybe the second half of this year, is to do testing on 10 people with known exposure, at least as best able to be documented, and 10 healthy controls, and then go through some biostat analysis and publish the results. I will conform to whatever the data show. But as of right now, I’m not confident that good data has really been produced to substantiate these tests. What’s also been frustrating in speaking with some other colleagues is the first thing you get is, “Well, maybe Joe’s a poor excreter and you’re a good excreter, so you’re being exposed and you’re excreting all these toxins, and Joe’s being exposed a lot, but he’s not excreting that much so your tests look similar.”

DrMR:

My thinking is B.S. If we have to go through all this hand-waving and eye-squinting and tea leaf reading to justify the test, it tells me that the test is probably wrong. And that’s really important. It’s important that we’re able to say, “You know what? I don’t think this test is helpful,” because that’s how the field moves forward in a positive direction. We shouldn’t be rationalizing results. Results should track with the individual. There should be minimal need for rationalization. There’s going to be some nuanced exceptions, but as a general rule, the more you have to rationalize, the more likely the test is flawed, for whatever reason.

DrMR:

So a little bit there about the ongoing debate Joe and I are having on these tests. And this is part of what I’m so excited about what we’re building at the Austin Center for Functional Medicine. Different clinicians with different perspectives operating underneath this idea meritocracy where the best ideas win. And when we don’t have a clear answer, we now have the capability to be able to set up a research study to produce an answer. So for obvious reasons, I’m quite excited about this. So more to follow there on the mold piece.

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Episode Wrap-Up

DrMR:

Okay, I think that’s it. Just some things I wanted to catch everyone up on. Yeah, it’s been quite a road over the past few months, and there has been so, so, so much to do, and I’m just deeply appreciative for everyone on our team at the Clinic, everyone on the team at the Ruscio Institute. We have an amazing group of people working hard behind the scenes to make sure that we’re giving you well-thought-out information, fact-checked, evidence-based information, but also progressive and looking for whatever answers there are. And however we can help people even when there may not be a great evidentiary base for answers, for reference.

DrMR:

So anyways, I really appreciate the fact that you guys are listening to the podcast. Personally, this is something that I really think I want better for everyone, because it’s the kind of healthcare that I would want. When we see people at the Clinic who have suffered needlessly, it really motivates me to keep doing what we’re doing. So thank you for seeing the value in that. Thank you for your patronage and for your readership and listenership. And if you haven’t yet, please give the podcast a review. That really does help us get some of the biggest guests. As an example, I really want to have Cal Newport, who wrote this book Deep Work, on the podcast, but we have to be big enough to get some of the biggest names in authorship and research. So you really do benefit from promoting and reviewing the podcast, because the bigger we get, the more we can reach those biggest names in journalism, research, and academia. So please do, if you have not yet. Thank you guys again, so, so much. I appreciate everything, and we will talk to you next time. Goodbye.

Outro:

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