Dr Andrew Greenland: 0:00

So, welcome back to Voices in Health and Wellness. This is the show where we dive deep into the minds of trailblazers, reshaping how care is delivered and experienced. I'm your host, Dr. Andrew Greenland, and today I'm especially excited. I'm joined by Dr. Joe Purita, Chief Medical Officer of Pureform. We had a great exchange about our shared passions for functional medicine, detoxification, and innovative modalities in patient care a few weeks ago. I'm very delighted that he's joining us today. Dr. Purita is a globally recognized pioneer in orthobiologic and regenerative medicine at Pureform in Boca Roton in Florida. He's leading clinical innovation using advanced tools like EBO2, plasmapuresis, hyperbaric oxygen, and cryotherapy, all aimed at supporting patients with chronic and complex health conditions. So with that, Joe, I'd like to welcome you to the show and thank you so much for joining us today. Well, thank you so much. It's an honor to be here, and I uh look forward to our little talk. Wonderful. What if we could start at the top and perhaps just give us a little bit of your kind of background and your journey in terms of how you've ended up doing what you currently do? Because I think it's always interesting for listeners to get that context.

Dr Joe Purita: 1:01

Okay. Well, well, by training, I'm an orthopedic surgeon. I was at the University of Miami in Jackson Memorial training. But even then, I got the bug. I was bitten by the bug of kind of the out-of-the-ordinary things. I remember uh I was working with one of the professors, and we were doing um uh a study where we were using collagenase, which is an enzyme that can dissolve tissue in disks, and we were actually getting very good results. And then uh when I was in private practice, I started doing that, and it became a very good thing, and many people started using it, and then it was opened up to more practitioners, and that's where they ran into problems because they had some allergic problems, and you had people that didn't know what they were doing, so unfortunately it fell out of flavor. And then um I started also doing laser dissectomies, so I was always involved in the cutting edge. I was doing laser dissectomies 40 years ago, uh, so you know, really got into that. But but then the real thing that started my journey is I was doing joint replacements, hips and knees, and things like that, and I found out there was this thing called PRP. I said, Well, tell me about that. And they said, Well, it can help enhance healing. I said, Okay, let me see, I'll try it. So I kind of said, okay, can make it for me. And I kind of sprayed it in the wound, and then I sprayed some plate, the poor plasma on top of the wound. And all of a sudden I said, Wow, these people are getting better quicker. Something's going on here. And then I really started reading about it. I said, wait a minute, all we're doing is we're mimicking what nature already does. You know, we're basically putting growth factors in there like nature does, and we're just speeding it up. So then I became more inquisitive and I said, I've got to find out more about this. Next thing you know, I'm doing PRP. Then I said, Well, this is good, but I bet you there's another step. Ah, stem cells. That's what PRP is doing. It's stimulating stem cells, et cetera. So then I started using bone marrow aspirate. I started using fat and things like that. And it's just come on and on. And then part two was, you know, I had an aha moment once. I was looking at a chart, it had the pathways of stem cell aging. And it was talking about mTOR, it was talking about AMPK. And I said, you know, if you know these pathways and you start studying this stuff, you should be able to make someone healthier. And that's what I said. Wait a minute, that's all anti-aging medicine. You know, I have a little something I tell my patients. I say, you know, think of your body, your organs and your cells as the computer hardware. And the pathways in your body are the computer software. Now, when you have a problem with your computer, the first thing you do is say, oh heck, it's not working right. Let me reboot it. And lo and behold, it works again. And that's what we're attempting to do with these pathways. We're attempting to reboot them, to make them start functioning again. You know, we're born with pathways that are working pretty good. Unfortunately, we pick up viruses, both literal and figurative, that can, you know, put a little problem with these pathways. And that's what we try and do in regenerative medicine, to stimulate these pathways and make them much more effective. And a more effective pathway is going to make a happier and a healthier patient.

Dr Andrew Greenland: 3:57

Amazing. So that leads us on nicely to talk a little bit about your practice. So tell us a bit about Pure Forum. Give us a bit of a snapshot and what your vision is or was for the clinic when you established that.

Dr Joe Purita: 4:08

The first thing that usually comes out of my mouth is I say, we're not a med spa, we're a med wellness facility. And people realize that when they come here. You know, we have about 12,000 square feet here, and it's a multimodal um uh facility. We do all sorts of things. We have uh cryotherapy, we have uh cold plunge pool, we have the infrared saunas, red light beds. Uh, we're a big fan of that. Um whole body cryotherapy we do. And now we also uh we have two chambers for hyperbaric oxygen. Uh we have one that you sort of crawl into, like the regular chamber you see. And then we have one where you just open a door and you walk into it. It's a two-seater, and it's like sitting in business class in a uh on an airplane. And and I'm really a big fan of that. And and one little pearl I'll give everybody you know, most people know hyperbaric oxygen works because it supplies more oxygen to the tissue because of the laws of physics. And that's true, but the real key, I think, with hyperbaric oxygen is from the work of Dr. Tom at the University of Pennsylvania. What his thought was is, you know, the real mechanism of hyperic oxygen, it increases nitric oxide in the body, which then stimulates the bone marrow to release more stem cells into the circulation. And he said 20 treatments will increase circulating stem cells by eight times. More stem cells means a healthier patient, you're going to basically heal things quicker. And that's the real reason why hyperbaric oxygen, I think, works. Now, one thing we do is we'll give patients when they go and get a hyperbaric treatment a uh a supplement that can stimulate nitric oxide production in the body. Uh, I happen to like a supplement made in the United States here called Neo40. It's by a company called Human. It's just something you you suck on and it's it tastes good and it increases nitric oxide production. So nitric oxide is a very important singling molecule. It's a gaseo singling molecule. There's two other ones, hydrogen sulfide. And the other gaseous singling molecule is one that kind of throws people for a loop. And you really, if you don't have adequate amounts of it, you may not be functioning as good as you could, and that's carbon monoxide. Believe it or not, we can't really have good health without carbon monoxide, but it's the hermetic effect. A certain dose is very beneficial, but too much is toxic, too little is toxic. So there you are. So that's one of the things we do. Another thing we do, and not only do we do it here, but we teach it all over the United States, the Caribbean, Europe, is an entity called EBO2, which stands for extracorporal blood oxygenation and ozonation. Now, what is this in a nutshell? Well, we have one IV that leaves the patient. The blood is pulled by a peristaltic pump, so it's, you know, kind of we get a bigger volume. It goes into a dialysis filter that's flipped upside down. Now, from the top of the filter, ozone gas enters. The bottom of the filter, the blood percolates up, and the two of them mix in the filter. But no ozone ever enters the body because as soon as the ozone comes in contact with the plasma, it gets converted to a number of different compounds. Oxygen, obviously, gets converted to hydrogen uh peroxide, which is a very potent stimulator of the immune system, and a number of other uh chemical reactions occur. Then the blood leaves the dialysis chamber, it then goes into a little reservoir, then it enters another apparatus that we use, and I'm actually the medical director of that company, it's called the hemolumen machine. Now, hemolumen is photobiomodulation. I'm a big fan of that. I've lectured many different places in the world on that entity, and I'll get into it in a little bit. So, what happens with this machine? It subjects the blood to six different color lights: red, infrared, blue, green, ultraviolet A, and ultraviolet C. And then the blood finally goes back into the patient. Now, what do we accomplish with the um the EBO2 apparatus? Well, a number of different things. First of all, it it can help make um NAD in the body because it does some chemical reactions. But the main thing we're looking for in this is it does a few things. It can get rid of the virus flows. Now, as we age, we have more viruses in our body. The more viruses we have, the more inflammation we have. The more inflammation, the more aging, inflammation, hence. So the ozone and the ultraviolet A and C lights can really do a job on viruses because it can basically affect their lipid envelope. Ozone, especially, can crack the lipid envelope open. As soon as that envelope is open, the DNA and RNA are exposed, and think next thing you know, that virus is going to basically perish. We also have very good results using this for mold and things like that. And another thing that's very important, it's very good for autoimmune conditions, uh, post-COVID type things, because it stimulates a pathway in the body. I'm getting back to that, you know, the pathway, so to speak, the software, called the NRF-2 pathway, which is the major pathway in the body that reduces inflammation. When this pathway is stimulated, and NRF2 is basically what we call a transcription factor, meaning it kind of hangs out in the cytoplasm, and given the right sort of circumstances and the right sinkle, it travels to the nucleus, it then transfers into the nucleus, and then it gives genes instructions of what to do, and the genes start making compounds like glutathione and other antioxidant compounds. So it's a very potent stimulator of the antioxidant system. And that's why we have good success with it. And other things that it can be used for, like I say, post-COVID, COVID vaccine. But a lot of times we'll just do it for general well-being because getting rid of the viral load and things like that is important. Now, we've done some analysis of what we're removing from the patient. We sent it to a company here in the United States. We we would get a bucket of stuff, so to speak, waste products, and it was showing us it was mycotoxins, it was forever chemicals, uh, petroleum products, things like that. So things that you really want to get rid of. So it's a very good modality, and and probably of anything I do in the office, it probably gives you the biggest bang for your buck, so to speak, because it stimulates so many different pathways. It can help stimulate the AMP pathway, which can help with glucose and things like that. So it's a very good thing. Now, I consider this an oil filtration, so to speak. Uh now the other entity that we do in our office is plasmapheresis. Now that is an oil change. What we're doing in plasmaphoresis is we're basically taking, oh, approximately two liters of plasma and we're throwing it away and we're replacing it with albumin. Now, some people will get concerned to say, well, albumin, that's a blood product. I'm concerned about that. I don't want to get, you know, virus or something like that. Well, the way albumin is made, it's it's processed so much that it's essentially pasteurized and sterilized. So there's no organisms that you're going to pick up from the albumin. And albumin is a very potent anti-inflammatory agent on its own, so it does a lot of good things. Now, what we're doing also after we're doing the plasmaphrasis, especially, is we're now recommending some IV exosome therapy. Now, in the state of Florida, our legislature has passed some laws that allow us to do this. Other states in the United States are not able to do that at this point. So, you know, it's federal law versus state law, so it's kind of a little controversial, but I think we'll be okay. Now, other things that we do here. Well, let's see. Well, another thing I'm very much a fan of is intermittent hypoxia therapy. So we have a machine, and you'll just kind of breathe at it with a mask, and it'll start giving you levels of oxygen that goes down to 9%, which is kind of equivalent to what you would get at about 22,000 feet, and then it can go up to 40%. Now, we'll do a similar thing when we have a patient get hyperbaric oxygen. We'll do what they call an air break. So what happens here is when you start tricking the body, when the body starts perceiving different concentrations of oxygen, various pathways get involved. The hypoxia-inducible factors, things like that. And one of the things that I can tell you about intermittent hypoxia therapy, and that's not to be confused with chronic hypoxia, which is not a good thing, but intermittent hypoxia therapy is a great thing. It's one of the most potent stimulators of mitochondria that we know of. It can really stimulate mitochond mitogenesis and also mitophagy. And these are things to basically make you have better mitochondria. As far as I'm concerned, most diseases, if you look at all your neurodegenerative diseases, most of them are basically diseases of your mitochondria. And that's what we're attempting to fix with the intermittent hypoxia. Red light therapy does very similar things. Red light therapy, for instance, stimulates cytochrome C oxidase, which is part of the electron transport chain. Bottom line is acts as a coenzyme to help have the mitochondria produce more ATP, the body's energy currency. Um, you know, we do a variety of um IVs here. We do methylene blue. Now, what we do that's unique is we have a method of uh photoactivating compounds before they even get into the body, before they're even put into an IV bag. I have a machine that I basically invented. It's more for cell therapies, but it's called a purelite, but we also use it now for IVs. We've also found that when we do IV NAD and we give TMG trimethylglycine and have the patient sip on coffee, they can cut the time it takes them down by at least one half. But now we've realized what we're using now. I'm not sure if it's available in England, but we're having niagen, which is a new form of NAD, and patients can do 250 milligrams 20 minutes or less. So that's not not a big deal. And then the last thing, but probably one of my favorites, is various cell therapies. So I utilize uh cell therapies, both allogenic, meaning from other sources such as the umbilical cord, et cetera, and autologous, meaning from the patient. So I basically will take bone marrow aspirate, I'll take fat, um, I'll take PRP, we'll photoactivate everything, and then we'll inject it into various joints and things like that. Uh we also do something called a V cell, very small brionic-like stem cell that we get from the blood. We have to incubate it overnight at four degrees centigrade in low oxygen and give it back to the patient uh intravenously the next day. It's a uh it's sort of a pluripotent type cell, it's kind of an emergency cell that people have. Now, the newest cell that I'm utilizing, and I literally gave a talk about this at a very large medical meeting last week in Fort Lauderdale, is something called a MUSE cell, M U S C, multi-linearage stress-enduring cell. I'm very, very intrigued by these cells to say the least. Now, why am I intrigued by them? You know, the name of my lecture was pluripotency without the tumor genetic. So, in other words, these cells are not, you know, multipotent like most MSCs, but they're pluripotent, meaning they can form almost any cell, uh, which is a very in interesting thing to say the least. And secondly, unlike most cells, when you're giving most stem cells and things like that intravenously, most of them get trapped in the lungs. Now, if unless you do a crazy dose, that's not going to really be a problem for the patient, because what happens is these things undergo apoptosis and then they get converted into other things. They release growth factors, they get converted to something called a T reg cell. But maybe of all those cells you give, 99% get trapped in the lung. Maybe if you're lucky, less than 1% may travel to the areas that you want to treat. Now, the mu cells, on the contrary, they will escape the lung because of certain um homing characteristics they have, and maybe 15 to 20 percent of those will get incorporated into the tissue. Now, another thing I tell patients is a MSC cell, mesenchymal stem cell, can accomplish repair. A mu cell can accomplish regeneration. So big difference. And I think we're gonna see a lot of these cells as time goes on. We have them ourselves, and I think we can culture them in the lab, much as we do with MSCs. But right now we can also get them from the umbilical cord. So that's pretty much it in a nutshell. Um, you know, I've tried to give you a real, it's a lot of things I mentioned there, but we can go into any other things you want to talk about in more depth. That's fine.

Dr Andrew Greenland: 16:13

Thank you. That's an amazing setup you've got. I'm really impressed with the multiple modalities that you have. And I suppose the thing's on the front of my mind is I'm trying to think of a very complex patient with a multi-system disorder, and how they how you would stack these things together. Let's take an example of somebody with um mycotoxin illness, you know, florid SERNAS, systemically unwell, all systems affected. How would you stack these things together? Um, presumably all the time. What was the kind of uh you broke up a bit? What was the uh entity that they had, what disease? I was just gonna suggest something particularly complex like um mycotoxin illness, you know, chronic inflammatory response syndrome. How would you kind of tailor a package with because I imagine they probably need quite a few of these things, and I'm trying to imagine what the visit would look like for them.

Dr Joe Purita: 16:55

Again, my first thing usually that I lean on is the EBO2, extracorpal blood oxidation and ozonation. Why? Because it's gonna basically help clean things out, it's gonna stimulate anti-inflammation, it's gonna help produce some ATP, it's gonna basically produce NED, it's gonna get rid of some of the senescent cells. So it does so many different things. Then probably what I would do. Now, the other thing we do when we do an uh EBO2 is pretty much all the time we'll give intravenous phosphatidylcholine afterwards. Because, you know, I'm giving a talk um at the American Academy of Anti-Aging Medicine uh in April on the cell membrane. And the cell membrane is probably the most important thing for longevity when all said and done, because it's the eyes and ears of the cell, it reacts with everything. And phosphatidylcholine is about 60 to 70 percent of the cell membrane. So we want to really flush out any more toxins that we can and go from there. Now, what else would I do in this patient? Well, one thing I didn't mention that we do a lot of here is hydrogen gas therapy. So patient just kind of sits in a chair and is breathing in hydrogen gas. Now, hydrogen gas is so unique in that it can go ahead and get into all the nooks and crannies in the body. It can cross the blood vein barrier, etc. It's a very potent antioxidant, anti-inflammatory. So many times what I'll do is while a patient's getting an IV, in this case, maybe I would give some um some methylene blue, as long as they're not on an antidepressant, because you can't uh give them methylene blue if they're on antidepressant because of the possible serotonin syndrome. And I'd have them, you know, maybe breathe in some hydrogen gas at the same time. Might want to also consider some IV curmin, which we use, maybe some EGCG, which is the main ingredient of green tea. We have an IV of that also. And and just see how the patient does, and maybe some hyperbaric treatments. So there's many number of things that we can do, and then we could even look into some cell therapies also, maybe some exosomes and things like that. So a lot of different things.

Dr Andrew Greenland: 18:49

Amazing. You're clearly on the cutting edge of all of this. What what are these shifts that you're seeing in this in the wider space right now? What are you excited about?

Dr Joe Purita: 18:57

I'm excited about these MU cells. You know, I I I'm I'm looking at Muse cells the way I looked at cell therapy like 20 years ago. I said, wow, these things are really something. And and and I think they're gonna really look, I could be wrong, but I think they're really gonna make a difference. So I'm excited about that. I'm excited about gene therapy too. I think we're gonna see a lot of things about gene therapy as time goes on. And I think it's gonna be not for the ultra-rich, but it's gonna be for the everyday person as time goes on. I think the prices are gonna come down for that significantly. Um, you know, I I mean the genie's out of the bottle at this point. People are not, you know, foolish anymore. They realize regenerative medicine is here to stay and it's an important thing. You know, I have people that used to make fun of me, physicians that made fun of me years ago when I was doing cell therapies. Now these guys call up, hey, can we come over and spend some time with you and learn this stuff? So, you know, what it makes you feel good, you know, when when you were getting all kinds of tomatoes thrown at you, and now people kind of are giving you the respect, which is good.

Dr Andrew Greenland: 19:56

And you mentioned in our earlier chat that you'll see more cases of forefochemicals and microplastics. And I just wondered how you were approaching these emerging challenges that we're seeing so much on the other side.

Dr Joe Purita: 20:05

Well, you know, what what I'm my next project, I can give you a little insight into that. What I want to do is when we do the dialysis, uh, the EBO2, we use a dialysis filter. And I'm certain that that filter is trapping a lot of the microplastics and things. So what we're gonna do is we're gonna send a couple of filters to get an analyze, and I'm pretty sure it's gonna show that. It looked like we had some plastics that we certainly had some plastics actually that were being in the waste product that we were getting that we sent. And again, the report I have is like 25 pages, and you can go to my website, you can see some of that results. So I think the for forever chemicals are important because they're all over our body. I think the real thing we have to do is figure out how to mobilize these products. That's the real key. And I think that's gonna be a a real difference maker when we can figure out how to mobilize them out of tissue, into the circulation, and then get rid of them that way. I think that's what we have to do, and I'm not sure we're able to do that yet.

Dr Andrew Greenland: 21:03

Got it. Um so where where is the field headed next? I know you've talked about your excitement about muse cells, but what's what are we on the cutting edge of uh or you know, a few years down the line?

Dr Joe Purita: 21:16

You know, uh always uh, you know, how do we how do we get rid of senescent cells in a more efficient way? Um, how we slow down aging, how we increase health span. I mean, you know, the modalities are there, we're gonna have some new modalities that if we were talking five years from now, we're gonna things that we're not even mentioning right now. So this is what that this is what's an exciting field. And what I like to say about this field, you know, if you're a cardiologist or orthopedic surgeon like I am or something, you're probably not gonna make any difference in the world. But if you're a regenerative medicine doctor, you have the potential to change lots of lives, which is a big difference. You can make some kind of discovery or something, you can say, Wow, I mean, we're like medicine. Was you know in the early 1900s, there's all sorts of things that you know are coming along the pike, and and that's what's so exciting about this field.

Dr Andrew Greenland: 22:08

So obviously, you're running a very impressive setup, very complex. You've got a lot of um capital. Please come and visit if you're ever in this neck of the woods. I'd love to check myself in. Sounds amazing. Um, what's working particularly well for you from the kind of the more of a clinical business side of the operation?

Dr Joe Purita: 22:24

Well, you know, I must admit I have some partners that are not physicians, and that was probably a great thing because they're very good. They were actually patients of mine, they're very good businessmen. And they came to me and said, Why don't we form a center together? And I said, Great. And and they can give me some of the business acumen that I don't have as a physician. And the things that I said, well, I'm not sure that's gonna work. Well, it turned out to work fine, you know, what they what they do. And and they're not impatient, you know. They they're looking at the long, which I kind of do too. I look at the long haul, so to speak, not just a short thing. And and it's been a very fortunate thing for me. I'm very happy with them, they're good guys, and uh they're making it so we can take this to the next level.

Dr Andrew Greenland: 23:05

And on the other side of the coin, what are some of the challenges of the work that you do or the the running the business side of things, or anything that's been particularly frustrating that you're still kind of working working on?

Dr Joe Purita: 23:15

You know, some of the regulations. I mean, for years I was always very reluctant to using some of these products because of the FDA, and and I'm still very reluctant to certain things. I just said, well, look, you know, the FDA is not really keen on that, so I'm not too happy with doing that. So you you gotta kind of pick and choose your battles. I think that's the thing. And you know, and the other thing I've noticed is uh one of the things that upsets me is people that don't know the science, but they they want to do these things, they need to understand the science, otherwise, don't do it. Go get in some other field. That that's what upsets me more than anything else. I get frustrated when I see some of these people on Instagram, like you know, they're showing things, and I'm saying that makes no sense. It's not scientifically what's really happening. You know, that's when you have some of the hucksters, as I call them.

Dr Andrew Greenland: 23:59

You're obviously very hands-on, you're both clinical, you obviously run the operation, you're involved in the systems and the teams. What's the biggest time drain for you? I'm sorry, what's the biggest what? The biggest time drain in terms of you know, if you look at your hours that you spend in the clinic, what are the things that you least enjoy doing that take up the most amount of time?

Dr Joe Purita: 24:19

Well, I can tell you one of the things I told my partners that guys, one thing I'm not interested in doing is hormone therapy. Because to me, it's boring. Okay, what happens is, and look, there's nothing wrong, people need it. But you give somebody testosterone, okay, come back a couple weeks, we'll measure your level. But it's not necessarily a lot of thinking involved. It's not innovating. Okay, what can we do to make this better? What can I do to make EBO2 better? What can I do to what can I put rapamycin with to make that better? How can we get the GLP1 so you don't lose so much muscle mass? But stuff like that, I'm just that that's kind of like regular medicine, and um, that's not my cup of tea.

Dr Andrew Greenland: 24:55

Um if your um operation suddenly doubled in size over the next 12 months, what would need to fundamentally change about how you operate? If you had a sort of massive surgeon, I think we could I think we could accommodate it if we have to.

Dr Joe Purita: 25:10

Again, I have a great staff here. These guys are very smart, very shrewd, and they they look to the future, so that doesn't worry me. You know, that's what's nice. It it lets me concentrate on medicine. You know, I yes, I have some input, obviously, in here and there, but you know, I mean, I'm the medical director, and that and that's what I can do. I can direct the medicine.

Dr Andrew Greenland: 25:33

Do you have any plans for growth? Are you happy with what you have, or do you want to grow, expand more?

Dr Joe Purita: 25:39

I mean, I think anybody would like to grow and expand. I mean, we've we've toyed with the IBR maybe of a franchise here and there, but you know, we'll we'll see. We're you know, we're always looking to add new things. I'm you know, I'm always looking around. Like I say, I'm looking to add maybe some what we call SVF stromovascular fraction. You know, the machines have been very expensive, but now I think uh they may have come realistic in in maybe six, seven thousand dollars instead of a hundred thousand dollars. So I'm looking at because I've done that, I also practice once in a while in the Cayman Islands, and I've been doing it down there, but it's been very time consuming, but this is much, much less time consuming.

Dr Andrew Greenland: 26:16

So, in a field like regenerative medicine, where innovation often moves faster than regulation, how do you navigate that kind of tension between ethical caution and market demand?

Dr Joe Purita: 26:24

Well, I try to not make it I I don't make any crazy claims. I'm not telling people, look, you know, you've got Alzheimer's, I'm gonna cure you, your your child has autism. We we don't cure anybody, okay? And anyway I do cell therapy, I don't cure you, I can make you better. I I tell patients, for instance, what stem cells do in this case is they can change the chemistry of the joint so it's no longer inflamed on a very long-term basis. And I think that's fine. As long as you're honest with people, I think you're gonna be fine. If you try and make some of these crazy claims, oh, we're gonna cure you arthritis, we're gonna give you a brand new name. No, that's not gonna happen, sorry.

Dr Andrew Greenland: 26:58

Now you've been at the forefront of regenerative medicine for a while, many decades, I guess. What's something that you see that you think the industry still misunderstands? Because there's a lot of miss, there's a lot of noise, there's a lot of misunderstandings, there's a lot of incorrect information floating around on the internet. Well, what do you think is the biggest problem?

Dr Joe Purita: 27:16

I think cell therapies. I mean, I I'm not sure why cell therapies haven't just taken off more. I mean, there's a lot of regulatory issues, and I think some of that is related to probably big pharma. You know, right now big pharma is saying, wait, how do we kind of, you know, get more money for these kind of procedures if we're using the patient's own cells or something like that? So I think that has a lot to do with it also. Um, you know, I remember when I was in orthopedics, you know, they were making tremendous amounts of money for these hip replacements, knee replacements for the prosthesis itself. I mean, it was crazy. You know, as an as an orthopedic surgeon, I wasn't getting tons of money, but boy, these people were paying, you know, tens of thousands of dollars. I mean, sometimes I would get twelve hundred dollars as a surgeon for a hip replacement or something, which was crazy. So I think that's where it is still. I think, you know, but hopefully I think regenerative medicine is just gonna, you know, gonna be able to keep it in check and really, you know, is this can be something that doctors can still take the reins of and really make it work better. I think it's gonna be kind of a symbiotic relationship, but I think we're in the driver's seat.

Dr Andrew Greenland: 28:24

Amazing. Um if you had a magic wand and you could fix one thing in the business tomorrow, what would that be, if anything?

Dr Joe Purita: 28:33

Yeah, magic wand. That's what I always ask patient. If having magic wand, what would you want me to get better? Um you know, I would I'd really like to know who were the best candidates for things. You know, I mean you have this clinical suspicion and it usually it works pretty good, but you just don't know for sure. So if I could make so give me the acumen to figure out what's gonna work best on everybody, and then that's the art of medicine.

Dr Andrew Greenland: 29:01

Lovely, I like that one. Um and I guess finally, if you were going to launch from scratch tomorrow with everything that you know, and obviously hindsight's a wonderful thing, would you do anything differently, or would you follow the same path that you followed when you started? And listen, I'm happy with my life the way it is, so I would do the same path. Wonderful. Well, with that, Joe, I'd love to thank you for joining me on the show today. It's been my pleasure and an honor to be with you. Thank you. You learned a huge amount in a very short space of time and very impressed with your operation, the multimodal approach, and just hearing about all the different modalities that you have and how they help the clients that you serve has been really fascinating, giving your insights into the industry and where things are going. It's been a delight. Thank you so much for joining me.

Dr Joe Purita: 29:41

Thank you again. My uh pleasure and my honor. Have a good day and so long, everyone.