117. Progress Note #11: Flawed Research & Continuous Blood Pressure Monitoring

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Welcome back to another progress note, progress note 11 to be specific. In today's discussion, Darsha and I talk about an article recently published in Nature regarding how flawed research can be and the harms of flawed research. This is definitely a topic we've talked about before, but this time we're looking at it from a different lens, and we also provide some resources that we haven't touched on in the past that can make you better equipped to digest information because we know it's coming faster than we can even absorb. After that, we talk about an interesting topic of continuous blood pressure monitoring. We're guilty of not spending enough time talking about blood pressure, but considering that nearly half of the adult population in the United States qualifies as hypertensive, this is an area that we're going to start spending more time on. So a cool article that Darsha came across that we talk about continues blood pressure monitors and some of the other issues that we have seen with prior technology, but our plan is to get an expert and talk a little bit more about blood pressure and how to manage and all the things that go into that. So stay tuned for that and until then, please enjoy this discussion and progress note 11. Ultimash another day, another progress note, how are we doing? Doing good, doing good man, excited to be here, yeah, cool. So we got a couple topics we're going to talk about again for the listeners, we keep these progress notes more to current events, different articles that are popping up in the news, and so that way we try to analyze those for you if they have come across your screen or if you've heard them in podcasts, we'd love to kind of just break down the most recent trends or the most recent articles that kind of come out. So Ultimash, why don't we go through the first one, which was pretty interesting to me. I mean, not a new concept for us, but I think it was a paper in nature that talked about how research is or how flawed research can be. So definitely want to provide some insight as far as that goes. Yeah, and I guess it was in the magazine article, right? It wasn't like an actual journal paper. Was it? Oh, okay. It was under the actual nature, like journal, but maybe not maybe it was the magazine. Okay. It was magazine. Gotcha. Yeah, yeah. No, I think what it was an online article that people were preventing commentary on different studies for at least that's what came across my social media feed, but it initially saw it. Maybe I guess I'll date this for the beginning of August and things was published in some of our mid July, late July. And when it came across my social media feed, I was like, oh, just another article, people are just sharing and resharing about flawed research, nothing new. And we've touched on this in some capacity before when we've talked about just sifting through social media and whatnot, but just to get the listener up to date on what the article talks about. So the title is medicine is played by untrustworthy clinical trials. How many studies are faked or flawed? And it just goes through the journey of several different scientists in various fields and provides examples of how flawed statistics can be, how flawed research can be, and particularly randomized control trials. So it started talking about this anesthesiologist who is the editor of Journal of anesthesia, John Carlyle. And really just, you know, some time over three or span up to like 2018, or I forget exactly what the timeframe was. He would be getting up every single day and 90 minutes before his wife would get up and just look through articles. I don't really know who does that, but anyway, that's what this guy's mourning from 430 to 6am included. And he's scrutinized over 500 studies, primarily randomized control trials. He was able to get access to these things that called IPD, right, individualized, participant data in all of those trials for, no, not all of, excuse me, for 150 out of those 500 trials. And what he learned was that nearly half of these had some type of flawed data, half of the ones that he was able to get the actual raw data for, right? Things like impossible statistics, you know, impossible calculations or duplicated numbers. And so he started, I don't know, he coined it or, but he designated them as zombie trials, right? Because on the surface, they look real, but when you dig deeper and if you actually have the raw data available to you, and sometimes there are these databases that provide that, you really cannot extract anything meaning from them. The issue is that the reason he would be able to figure out this information was because he had the access to the raw data. Now most of us don't have, don't dig deep enough to be able to get that, right? Obviously, it's a lot of works, three years, 90 minutes a day for this guy's time or whatever it was. And so when he ignored that IPD, the individual parchment data, he was only able to assess that one percent of them could be pinpointed as zombie trials. Basically that the data was flawed, it didn't really mean anything. And so I think that just kind of goes to show is that, hey, like a good amount of stuff that we end up seeing that's actually published in journals is somehow either fabricated, it's good old human error, but what they were seeing whether or not statistically significant or clinically significant isn't actually what it seems to be. And so his suggestions was that when journals are looking at papers that they should just assume that the research is flawed rather than accepting it as accurate. And so basically it's guilty until proven innocent. I thought that was really interesting and quite poor business model and making more work for journals. And then it just kind of goes on and talking about examples of how Japan's guidelines for osteoporosis talks about this guy named Sato who had fabricated data for, I don't know, somewhere in the neighborhood of 113 papers and 27 of them were retracted. But out of the 27 papers of this guy's articles that were retracted, they were already cited 88 systematic reviews and clinical guidelines and that's what they were used for and how harmful that could have been for patients because the guidelines and the treatments and the providers on the front lines are using these guidelines systematic reviews to provide treatment for these patients. So it's just a very, very interesting article that I recommend anybody who isn't in the scientific field to check out. Do we know what type of papers he was looking at, like out of those 150, like were they the quote unquote world class papers, men analyses where they just run the mill, anyone can kind of produce this paper and it got published. Primarily RCTs. Primarily RCTs. Yeah. Which is, and that's the scary part of it, right? I think when people look at that, the classic evidence beer pyramid, we realized that on the top of it is systematic reviews and men analyses. But most people will say, most people in the field will say, well, actually randomized control trials are the gold standard, right? And then you take a bunch of randomized control trials, like the cream of the crop will take randomized control trials and do a systematic review on that. And then a meta analysis on that if you have this efficient amount of data. But this is that classic thing that people have heard about garbage and garbage. If you have bad randomized control trials, taking in, you're going to produce a bad output, right? What's really, really scary about that is that, again, most physicians aren't like you just, I think we just, in greener a mind, it's a systematic review assume might be good. Right. To be honest, like when I'm learning about a new topic, one of the first things that something that I'm not familiar with at all is I'll start with a review paper, systematic review. I want to know what's the state of the evidence in order for me to know what the state of the evidence is much easier to go to a systematic reviewer meta analysis. And it's especially concerning, and so that was a part, actually, I dug a little deeper into it because I was like, okay, what does this really mean? And so I want to share with you, I came across another paper, a 2011 paper in the British Medical Journal, the Journal of Medical Ethics. And in this study, the first author's grandstein, we'll put it in the show notes for people. During that 10 year frame, they looked at 788 retracted English language papers. And they've found that, you know, out of the retracted papers, the ones that were retracted were cited over 5,000 times. And over 28,000 subjects were enrolled in treatment-related studies. And nearly 10,000 of them were treated in 180 studies that were retracted later on. So that's the interesting part. What's the scary part is secondary studies that cited these primary studies, which are later retracted, had over 400,000 subjects enrolled, and 70,000 of them were treated. So you know, what's crazy about flawed research or bad research, we'll just call it bad science, is it gets published. And I'll mention some research later on, if people do call it out, if it does get retracted a later point, we're like, okay, no harm, no foul, well actually, sometimes it's actually most of the time it's too late, right, for the example that I gave you, is because people end up citing that, and then they're basing off further treatments off of prior research. That's just research 101. You need to look at what's been done, and you build off of that stuff. So if your foundation is so poor and you're building off of flawed research, you might be set up for disaster. And so that's a challenging. And what's another interesting thing about it is, when papers get retracted, like particularly RCTs, if they've already been included in systematic reviews and meta-analyses, they're not, the systematic reviews and meta-analyses that have cited the paper, they're not getting retracted. That's still out there, you know? And so it's a little bit messy and scary, but yeah, yeah, it's fascinating. So I guess two follow-up questions for this, right? I guess the first thing the audience might be wondering about is like, if why aren't these journals that they're submitting to, why aren't they requesting the raw data to begin with? Why are they not comparing the published paper to whatever the researchers have started with? And why are we waiting, like, how do these papers even get retracted? Why is that not happening in the, like, further, or I should say, in more of the beginning of the course? Yeah, so I think at the outset, why is it, again, I'm not an editor of the journal, and so I couldn't tell you there, but I have been offered to review papers in different journals. And I could tell you that a lot of these positions, I would say most of these positions for, you know, so anybody just to bring you back here, when you submit a publication to a different journal, right, you have usually an editor is going to review it, but you have multiple reviewers who actually take the deeper diving to the paper and the editor kind of just looks at it over, and sometimes the editor doesn't even look at it, right? They'll just kind of, if the reviewers accept it, the editor will accept it depending on the journal, how stringent the criteria is. But most of these reviewers are not being compensated for it, right? So it's just more work. I mean, people are already doing free work, and I can ask them to go even deeper and look at the data and correspond data and run statistics and re-run people's statistics and do the calculations over it, right? And so the idea is, like, there has to be academic integrity, and you're hoping those people are doing the work well, and you're only looking at the manuscript and seeing does it make sense, does it not make sense? What's cool is something that another article that I came across in 2022 was published by, like, Northwestern. They did an analysis of, like, retraction of academic papers, and what they found was the retraction, as I mentioned, doesn't dampen the negative effects of the initial papers, because by the time those papers are retracted, as I mentioned, the damage is already done, right? The harm is already done. And then I already mentioned how they're included in the clinical, you know, the systematic reviewers and stuff, and so, you know, you can't even put an asterisk on those paper. But in this analysis, what they found was that the papers that were later retracted, they tended to have, like, significantly higher numbers on social media platforms, such as Twitter, right? And online news outlets, blogs, Wikipedia, then papers that were actually never retracted. So bad science gets promoted a lot more than good science, right? And this makes sense, right? Because things that are more inflammatory are going to be shared more, and people go in their comments, and they're like, I'm following this thread, right? And that kind of stuff. And so that's really cool. But they also realize in this analysis from Northwestern that Twitter is also beneficial in the sense that it does create discourse, right? And people tend to share their opinion a lot more than just stating the facts. And you have people from all over the world who have domain expertise, and can quickly come in and chime in on the topic, and just come in, chime in, and jump out. And so you have a lot of discussion like that. And in that regard, Twitter has been very, very good in helping just flag stuff that doesn't make sense. So, you know, the Twitter mob sometimes can be very beneficial in the sense of, like, wait, this doesn't quite make sense. And then everybody starts resharing it, and you call BS out, and then people can get those stuff that were retracted. Interesting. Right. And media has kind of helped to at least look and investigate and make that deeper dive. So, you know, I guess the next obvious question is, how do we, as society, interpret people who use these papers as data, right? And a lot of us obviously have confirmation bias. And so you're looking for the papers that support your belief, right? And obviously on social media, there's people like Lane Norton, Dr. Idz, who will take other people's anecdotes and claims, and then talk about the research that they found that go against that, right? And now the natural, you know, conversation in our heads is, well, who's right? I mean, you can't really, if we're saying a lot of this research is flawed, how do we believe people? Who do we believe and how political does it actually get, right, even within the social media realm? So, like, how are you going to take this information after you do in this deep dive and kind of, like, what's your viewpoint now moving forward? Yeah. And so the artists that we talk about, the authors do point out, I think it's important when these things get shared. It's another reason when this thing, the nature article, start again, shared is we don't want this to be fear modeling. It's not, I don't think then most of the people who are trying to produce research, it's the majority are not malicious, right? They don't have malintent, but you do have to be honest. So the BMJ article that I talked to you about, that looked at papers from 2000, 2010, right? That's probably before Twitter, I remember it, or Twitter was 2008 or not, I remember it just before Instagram. And so if you accelerate the next decade, now information gets shared and reshared even more rapidly, particularly with TikTok, right? So I'm willing to bet that that has risen exponentially. And so I think people have to just be critical when they're looking at this stuff and really any type of study out there. As you mentioned, we all have a bias, and when we see papers that are aligned with our bias, we're immediately likely to promote that. Me, for instance, I love exercise, I know you do as well. So no matter what the issue is, when the paper comes out, like, hey, this exercise is good for your mental health, exercise is good, I'm like, see, exercise another. So when I mock for exercise, and sometimes honestly, I don't even read the paper or let alone the abstract, and just look at that. And so I'm guilty of it, too, because the work is to actually dig deeper, and it's just that you would never be able to kind of get through of how rapidly the information is coming at you. So I think for me, take away is like, have a critical standpoint when you're looking at any type of information is coming at you, right, to scrutinize it. And the other thing is, okay, we also have to recognize that, you know, any information piece that we're getting, we're reading, it might be flawed, but sometimes it's just innocent human error. You remember the podcast by Breardy that comes to mind is when they're talking about the I'm calling BS, I think I forget who he had, the guy who like makes this his full-time job calling out. And they talk about how rigorous they have to be in order to publish something out there that contradicts prior research, because, you know, these are professors, people, let's just say, who have been publishing papers, it's their livelihood, there's academic reputation, it's millions of dollars on the line, it's maybe their careers, and there's a way to go about disputing that as well, you know, on Twitter, you can just call somebody out and you just bash them left on the right on Instagram, that's maybe the new thing to do, and I think there's a reason for that as well, but appropriately doing it in the scientific community is like, okay, if you find an error in a article, there's a corresponding author for a reason, you know, maybe you reach out to the corresponding author, hey, I came of course study, here's what I thought, this didn't make sense to me, can you elaborate a little bit further, or just outright point it out. And more often than not, they'll just respond to, hey, thank you for catching that error, we'll fix it, right? And if they do end up fixing it, fantastic, if they don't end up fixing it, then maybe you take it up, then you maybe take it up to the journal editor, you know, there's a waste about it before you publish and just start bashing them, although I guess maybe just tagging them and bashing them is a lot easier to do nowadays, yeah, you definitely will get you more views. Yeah, it's interesting. I think one of the things I've always heard about is, you know, people within the academic setting talk about how just corrupt the publication processes, right? I mean, you're putting in all this work to get it on your resume, the funding, the reputation, and it's almost like a monopoly, right? Like these journals don't pay you. You actually have to pay them to, you know, get these submitted into like prestigious journals. And so I know there's been a call, obviously, to action and kind of get the process change and all, but I don't really see it happening anytime soon. But I think obviously that's one way of trying to avoid these situations from happening to avoid flawed research and to help promote a healthy culture at least, you know, within the academic setting so that there is more rigorous testing and more debate and more discussion. And, you know, we can then finally let go of the whole anecdote data, you know, all these just different words we throw out as if they are against each other rather than using them to help each other out. So, yeah, you asked about resources or you pointed out, Dr. Itz, I had actually convened for God. I guess he has like his own school now, but people can look at it. He's really good at Instagram. I'm a fan of his reps. We've talked about before by Elaine. He does a really good job. It stands for research, explain practical summaries. They're more in-depth analysis. They, I think they usually have about five papers in the health and fitness studies related to that supplementation, et cetera, and they'll go deep into that stuff. We've mentioned multiple times examine.com, right, where they'll take study summaries like usually again topics related to health and whatnot. Ed Penn Reviews is a good one. They're exclusively looking at books. And what I like that they do is they grade books based on three main criteria, scientific accuracy, reference accuracy, and what they call healthfulness, which is, you know, will the book actually, will the advice in the book improve your health? And so these are all health related books, diet books primarily. And then the one that I came across reading this article was something called Retraction Watch.com. This is the parent organization that runs this website is a Center for Scientific Integrity. And their mission is to essentially promote transparency, integrity and science and scientific publishing. And so it's a database of all the papers that have been retracted, maybe not all of them, but a lot of the papers that have been retracted and expressions of concern related publishing events they call. And they also have long form, larger impact writing, including magazine articles, reports, and books that. So I think that's actually really, really cool too that you can kind of monitor things that have been retracted. Yeah. Cool. Cool. Cool. Cool. Awesome. Well, anything else you want to add to that topic? No, just actually this, have you ever heard of Brendelini's principle or Brendelini's law? No. Have not. Yeah. I mean, I think, so this is the reason why a lot of people, respectable people on social media have started taking the stance of just starting bashing people who are producing band information. And I forget where this guy, this is, this is somewhat a recent law, Brendelini's law that maybe 10 years old, somebody in 2013, some IT tech guy coined this, they call it the bullshit asymmetry principle. It was an internet adage that was coined 2013 and emphasized the effort of debunking misinformation in comparison to the relative ease of spreading misinformation, right? The law essentially states that the amount of energy needed to refute BS is an order of magnitude bigger than that needed to produce it. And so, you know, the people, I think, get a lot really, really frustrated. You remember, there are some people that come to mind who would just, we talked about these Dr. famous who would call like functional medicine people quacks and this and that. And although I'm not a fan of that type of stuff, that type of behavior, I can understand it. Right? And I can empathize with those people how frustrating it must be to try to put out good information for 20, 30, 40, 50 years. And that's not getting likes, that's not getting shares, that's not going views. And I don't know what Twitter is now interactions or whatever Twitter has X, I suppose, is this called Twitter or is it called that? I don't know. I have the bird logo, but then now the X logo, so I'm confused. Oh, it's all that's a fully X logo, so I guess it's X. Yeah, well, that if you start fashing it, if you start making it more inflammatory, it's going to get more shares and repeat. And that's how you can combat misinformation. I don't know. It's really, really interesting. But yeah, I like this Brennan-Lini's law a lot, but it's so incredibly true. That is very interesting. It's cool law, okay? I've never heard that. But yeah, it definitely makes sense. And the grand scheme of things is the why people have the behaviors they do on social media at least. Cool. All right. Well, let's transition then to our second topic. So this one's going to be about blood pressure and continuous blood pressure monitoring. So obviously with technology, whoop, polar monitors for heart rate, respiration, I mean, the amount of wearable technology has really increased the amount of metrics that we can measure continuously, right? Continuous glucose monitors, for example, whoop can measure respirations at heart rate. But one thing that has been lacking out of all of those vital signs has been blood pressure. And Peter T. actually talks about this in one of his recent AMAs, I think, probably like three or four months ago, about the need for having continuous blood pressure monitoring. I think the reason why, right? There's a couple things is in the article that we were reading about 47% of US adults have a diagnosis of hypertension, right? So it's pretty high. And, you know, though the sequela of having high blood pressure over time is multi, you know, a factorial, I can also affect the kidneys, it can lead to stroke, it can affect the heart, obviously. And so thereby, a lot of these organs and then eventually affecting the brain as well, right? When I mentioned stroke. So having continuous blood pressure monitoring will just help with more data points, right? Because the only times we're really measuring blood pressure is maybe when we go to the doctor's office, if you're healthy, if you're hospitalized, you might only do it with your vital signs, which might be every shift, so every 12 hours, or every eight hours, or you might even have a blood pressure monitor at home. But how frequently are you checking? Maybe in the morning when you get up or during your routine, maybe after eating lunch or at night, right? So we're not getting enough data points that actually help us accurately measure blood pressure. And so what we do is we rely on the number that we see on the screen. And we take that at face value and say, okay, your blood pressure is 150 over, let's say, 80. And that means you have high blood pressure, well, not necessarily, right? It's the same concept as all our other vital signs. If you're working out and you just got done a workout and you check your heart rate, it might be in the 120's. But that doesn't necessarily mean that you have sustained tachycardia, right? Every single day, your respirations are going to be high. That doesn't mean you need more oxygen because your oxygen saturation is going to be okay. So this principle, which really makes me upset in the hospital, right, is when I'm on call and I'll get a phone call from the nurse saying, hey, blood pressure for this patient is 160 over 90. What do you want to do? Should we give the high drop, you know, and most people, we have parameters in the hospital, right? So don't call me unless it's above X, 160, 170, 180. And then there's usually this training rule that we have that when it's over a certain number, you give hydrozene, which is a medication that will quickly lower the blood pressure, but can have a compensatory increase in heart rate, right? So it's a very transient medication that just quickly lowers the number. And this goes down to the principle, right, of like even what we look at MRIs and back pain is that we're taught, don't treat a number and don't treat an image, right? You treat the patient and you treat the patient symptoms and how they're feeling. But so often in medicine, when it comes to blood pressure, we're just treating that number. And then we obviously have this concept of white coat hypertension. So when people go into the doctor's office, they may naturally just have an increase in blood pressure just due to either being stressed or having some anxiety, just situational, right? And it's certainly mean that they have high blood pressure, but it's just in that instance. The other second thing here is that people don't take blood pressure accurately, right? So the proper way of taking blood pressure is actually sitting down, feet on the floor, making sure your respirations are okay. You should not be having, you should not be measuring after smoking or any caffeine. And you should be pretty much in a, in a peaceful environment. And you should be at least sitting down there for five minutes and then taking the blood pressure, right? For like the truest, most accurate rating. And then you can imagine you're in a hospital with lines beeping, nurses are coming in and out. You're not even sitting. Most of them are laying in the bed, right? So naturally, when you're laying down, your blood pressure is going to be higher. So all of these things pretty much confound when they're laying down, higher is fine, right? Yeah, when they're sleeping by, high, right? Yeah, yeah, because the blood flows up. When they're sitting down, you get the orthostatic hypertension, because the, oh my god, this is, this is how you know I've been out of patient medicine too long, right? So yeah, so, so think about, right? When I'm getting these pages from the nurses at night, these patients are laying down and they're saying, hey, this blood pressure is 170 or whatever. What do you want to do? Most people get the hydroxy, right? Because, because you're just treating the number. And that's what sets me because my go to is we're not going to do anything, right? Unless it becomes urgent hypertension or emergent hypertension where the blood pressure reading is super high, over 180 in the 200s, there's some sort of symptoms like a headache where you know there's some end organ damage. And sure, that's going to require some immediate intervention. Otherwise, I keep, I tell my nurses that, hey, this is just one data point, right? Let's check in 30 minutes even and see if it goes down, especially if they're asymptomatic. Or let's check at the next shift and the next shift after that. If I'm seeing this up and down kind of data points for blood pressure, I'm not too concerned. But if I see after two, three days that it consistently is elevated, that tells me that I need to give a blood pressure medication, right? Whether it's a calcium channel blocker or whatever it might be, but it means that they probably have sustained hypertension at that point that I need to treat this, right? So now we kind of come full circle as to why continuous blood pressure monitoring is useful. Because now you're just getting so many data points that you can actually understand, is it sustained? Or are we just getting throughout the day these inflection points, right? And when are these inflection points happening? So you can liken it to a glucose monitor where after certain meals your glucose is going to spike, okay? You now know what to do because of that. So this gets us back to the research article about this or in University of California, San Diego, there's a company that has created a blood continuous blood pressure monitor device called BP Clip. And so you actually just attach it to your cell phone, and I'm not going to get to into the weeds of the physics, but using the light sensor, you can basically tell how much blood flow there is, right? So if there's more blood flow, light actually gets picked up more. If there is less blood flow, it doesn't get picked up. The other cool thing though is they measure your pressure of your finger. So how hard are you actually pushing onto this clip? So they have a spring that can tell you how much pressure you're pushing, right? Obviously, if you're pushing harder, you're getting less blood flow to the area, if you're pushing lighter, you're getting more. So using these metrics, they're essentially able to calculate your blood pressure in that moment. Now, short, it's not continuous, second to second to second. But obviously, user-friendly, you're able to keep your finger on there, how many every times you want in a day to get more data points. Now they say, okay, there are already devices out there. The problem is the other devices require external calibration. So you don't even know when they're in sync, right? This is like blood pressure coughs, things like that that require this calibration because they use indirect measurements to calculate the blood pressure. Whereas this BP clip is actually using direct measurements of your blood flow of pressure and just using physics to actually calculate your blood pressure in that moment. So I just think it's the next wave of a, it's the next vital sign, at least, to come out with something that we can measure more continuously. And I think just given that, you know, close to 50% of American adults have hypertension, at least allows us to, one, treat it better, but two, also give us better education as far as not even transient medications, but actually proper medications for people so that we can treat or we don't have to treat unnecessarily. Couple of follow-ups, the points that you made, I wholeheartedly agree with, with patients being in the hospital and healthcare providers who interact with them, start freaking out that the, that, you know, you have these, essentially, how labial it is and whether we're not going to intervene because we're treating the number. For the outpatient, that's not an issue, right, like, you're seeing a doctor, maybe you're seeing a doctor three months from now and it's really hard to assess. So this data that you're talking about, two things I really love about it, well, one, they mentioned how cost is going to be minimal compared to the blood pressure cups. Like the good quality cups that you're going to get are going to be 50, 80 bucks, maybe 100 bucks off of Amazon in the pharmacies and whatnot. And then they're not easy for somebody to figure out, right, line up with a break-up artery, do that. Most people, the cuff isn't the right size or doing it over their sleeve and, and this is not even accounting to everything that you talked about how you have to be sitting there for five to 10 minutes, feet, all the things they mentioned already. So those two things, so my question for you is, are there other devices similar to this technology out there where people are looking it off, because it sounds very similar to high-ward checking pulse ox, right, you're evaluating that a pressure off finger. Is there stuff out there that you're familiar with? There are blood pressure apps, at least, that you can check, like by just putting your finger on the sensor. The problem is it's not using as much physics as this company is, right, like this company has it down to the front, using the light coming through a pinhole, basically being able to measure the pressure. So they're able to actually measure blood flow more accurately, but I don't know if there are any other companies similar to BP Clip that are out there, but I do know there are other companies out there that use similar kind of concept, but just indirect measurements. Yeah, blood pressure probably just as important when it comes to cardiovascular health, brain health, really every single organ that you can think about, and something they work kind of guilty of not talking enough about in this podcast. So we need to pencil in and get somebody and spend some time talking about that. Again, as you mentioned, nearly 50% of the people, at least in the United States, that are going to be prehypertensive, unrecognized, just as much as, you know, we were talking about metabolic health, and this is part of that component. So just loosely, peripherally, we've touched on that, but it is going to be just as responsible for things of, and not necessarily athletic sclerosis, but certainly, you know, CVAs and cardiovascular disease and things of that nature. So we got to, we got to have a little bit deeper into that too. Yeah, definitely silent killer, right? And even complicated with athletic sclerosis, right? So it's a double whammy, you know, if you're most people who are probably athletic, have some form of blood pressure, I'm assuming, or hypertension. So yeah, definitely into the CVA and whatnot. Feature is bright, man. Yeah. I'm looking at, I quickly pulled up type of continuous blood pressure stuff on Amazon, and yeah, it's all cup based. It's all cup based. I'm not seeing, I mean, there are apps that are connected via Bluetooth to, but again, cup based and bad, not good reviews. Oh, I guess maybe there are some watches that are probably telling you that information, right? But that's looking off of radio artery. So that's not going to be as, as precise or it will be more precise checking the elasticity. If they can measure the pressure, so that's the thing the article talks about is like, you can always get light shining through to see how much blood is getting picked up. The harder part is to figure out how much pressure you're putting on the skin, which can then also evaluate how much blood flow is actually coming through the device. Awesome, man. Oh, I to circle back to the very first comment we've made about that nature article. It actually is published first on the single other Richard van Nordin published in July of 2023. So this is actually based off the nature article, which does not have an abstract available. And I am not paying for that. So, but either way, they're both going to link them in the show notes for people to take a look at. Yeah. See, but that's the issue. We got to pay for it. This is like exactly the point, right? Like the vicious cycle of trying to get good information or whatnot. I agreed on that note. I don't know if you have, have you heard of Sy Hub? Sy Hub. No, this is a website that tries to democratize research, you know, clearly their believers, whoever the originator is, you got to check this out. They have research articles available for free for people. I'm not actually sure if it's legal or not, to be honest with you. It's the most controversial project in modern science. Yeah, the people are so, so anybody who does check it out, you know, use at your own discretion. And this is not medical or legal or any type of advice for people to check out. But it is interesting that somebody pointed it out. It's like, wow, this is, this is interesting that they have stuff that they're just making open access because they believe everything should be open access. So they have been hit by lawsuits, yeah, on their website. They talk about it. Yeah. They openly talk about how they have a legal fight. Yeah. All right, at least they're open about that. Yeah, I just learned about it. Not too long ago for somebody. They were like, oh, yeah, it's, it's so maybe, maybe in that reason, we shouldn't be using it. Interesting. Very cool. Yeah, a lot of medicine chemistry and biology in here. Okay. Awesome. All right. Well, I think that does it. I mean, the last thing I was going to say is as far as blood pressure goes, I know Joel Khan, who's also been in the Joe Rogan podcast, he's a cardiologist. He talks about continuous blood pressure monitor. So we can definitely try to get him on to deep-type blood pressure and whatnot. That would be awesome. Yeah. Cool. All right. Well, I think it was a good episode for the audience. If you guys have any questions about anything, let us know. We'll put all those resources into the show notes. And we'll see you with some more episodes and then progress notes in the future. All right, man. All right. All right. Thank you for tuning into another episode of Medicine Redefined. As always, we are highly appreciative of your support. And if there are any other topics that you want us to cover, or if you have any feedback for us, or just want to say hi, we are at medredefinedatgeema.com. We also medredefined on all the social platforms. So please feel free to reach out to us. And lastly, we want to thank our team, Ethan Zhu, and Rita Yeperi, for the help and production of this podcast. And before you sign off, do remember the important disclaimer that everything in this podcast is for educational purposes only. It does not constitute the practice of medicine nor should it be construed as medical advice. 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