SPEAKER_1: Welcome to StarTalk, your place in the universe where science and pop culture collide.
SPEAKER_1: StarTalk begins right now.
SPEAKER_1: This is StarTalk Sports Edition, Neil deGrasse Tyson here, your personal astrophysicist.
SPEAKER_1: And let me once again welcome my co-host, Chuck Nice.
SPEAKER_1: Chuck.
SPEAKER_3: Hey Neil, what's happening?
SPEAKER_1: All right, a professional stand-up comedian and in your current resume, we have to now call you an actor.
SPEAKER_1: You've been acting in stuff lately.
SPEAKER_3: Yes, yes.
SPEAKER_3: I'm acting like a stand-up comedian.
SPEAKER_3: It's working out well.
SPEAKER_1: We'll see how that goes.
SPEAKER_1: And of course, Gary O'Reilly.
SPEAKER_4: Hi Neil.
SPEAKER_1: Coming to us today, actually from the UK, visiting mom.
SPEAKER_1: That is so sweet.
SPEAKER_2: Yep, here we are.
SPEAKER_2: Mom's kitchen.
SPEAKER_1: And she's stuffed you in the kitchen.
SPEAKER_1: That's the best.
SPEAKER_2: Yeah, I've been banished.
SPEAKER_2: Do those dishes, boy.
SPEAKER_3: I was gonna say, take a hint and clean something while you're there.
SPEAKER_1: Clean, so make yourself useful.
SPEAKER_1: So today we're gonna talk about stopping the clock of age with regard to sports performance.
SPEAKER_1: And this whole field, I mean, just think about that.
SPEAKER_1: I mean, I know everybody thinks about, can I live forever?
SPEAKER_1: But the ones who can really monetize that are athletes.
SPEAKER_1: And I got a list here.
SPEAKER_1: I just, you know, Tom Brady is now 44.
SPEAKER_3: Doesn't count, doesn't count.
SPEAKER_1: Okay, he's a machine, okay.
SPEAKER_3: Yeah, he sold his soul.
SPEAKER_3: He sold his soul to the devil.
SPEAKER_3: He sold his soul to the devil, okay.
SPEAKER_3: You got extra information there.
SPEAKER_3: Bargains with Satan do not count as, you know, medical marvels.
SPEAKER_1: Okay, yeah, okay, we'll ignore the Satan deals on this.
SPEAKER_1: Carmelo Anthony is 37 and LeBron James is 36.
SPEAKER_1: You know, these are old timers in their professions, right?
SPEAKER_1: And soccer star Cristiano Ronaldo also 36.
SPEAKER_1: How are you running up and down the field like that if you're 36?
SPEAKER_1: I remember when I was 26 versus 36, 36 is really different than when you're in your 20s.
SPEAKER_1: So we want to know, are they outliers?
SPEAKER_1: Are they, you know, or are they something that we could possibly emulate either with hard work or hard medicine or some kind of training that we don't yet know about?
SPEAKER_1: So we've got an expert for this, okay?
SPEAKER_1: We got Kevin Stone, Kevin Stone, welcome to StarTalk.
SPEAKER_3: Our returning champion.
SPEAKER_1: A return, yes, yes, a friend of, if you've been on the least once before, we now call you a friend of StarTalk.
SPEAKER_1: So you're a world-renowned, should I say this right, biologic joint replacement surgeon.
SPEAKER_1: Is that a fair thing to call you?
SPEAKER_4: That's a fair slice of it.
SPEAKER_1: Oh, slice, okay.
SPEAKER_1: Don't use the word slice.
SPEAKER_3: Wow, that was...
SPEAKER_1: But more interestingly for me and more important for this show is you are chairman of the Stone Foundation.
SPEAKER_1: And if you're a scientist, surgeon, physician, you're all of these things, coming together, bringing your broad expertise on this subject, coming together to help patients sort of bounce back and extend their, you know, delay their expiration date for whatever it is they're doing in their sport.
SPEAKER_1: And more recently, just at the end of last year, in 2021, your author of a new book, Play Forever, which is destined for the bestseller list because that's what we all want to do.
SPEAKER_1: So let's get this party started.
SPEAKER_1: And how much does medicine know?
SPEAKER_1: I would lead off.
SPEAKER_1: I know Chuck and Gary, you got a lot of questions.
SPEAKER_1: How much does medicine know today to, for any of us to believe that it could have any influence on our longevity?
SPEAKER_1: Because it's one thing to live for a long time.
SPEAKER_1: It's another thing to be in your prime for a long time.
SPEAKER_1: And those are not the same thing.
SPEAKER_4: It's a great point.
SPEAKER_4: And the answer is we know a lot about what doesn't work.
SPEAKER_4: And so the first part of that is that, first of all, 36 today is, or a good way to say it is, 36 is the new 26.
SPEAKER_4: If you started out on the right foot, if you're now an older athlete and you weren't taking great care of yourself all the way along, then you've got a whole other set of things to think about about how do you extend your playing time.
SPEAKER_4: So we know a lot about how to do that now, but we really know a lot about what doesn't work too.
SPEAKER_1: Yeah, well, okay.
SPEAKER_1: So there's some obvious things we think don't work, like drugs and alcohol, yet.
SPEAKER_1: Yet.
SPEAKER_1: Mick Jagger is turning 80 soon.
SPEAKER_1: And I don't know that he and his teammates on stage were any poster children for a model diet or a model lifestyle.
SPEAKER_1: So if he can do this at 80, what do we need you for?
SPEAKER_4: So what you need me for is to point out what worked for Mick and what doesn't work for others.
SPEAKER_4: And one of the things that you notice that works for him is he has this tremendous amount of exuberance.
SPEAKER_4: And an optimistic approach and exuberance is a big part of health.
SPEAKER_3: Interesting.
SPEAKER_3: I mean, are you saying, but I mean, there are a lot of people who feel like what you just said is a lot of this is literally in your head.
SPEAKER_3: Could that be the case?
SPEAKER_1: Is that what you're saying, Kevin?
SPEAKER_4: So if you took Mick Jagger's lifestyle and put it into somebody who was depressed or somebody who wasn't enthusiastic, somebody who was just going along in life, I don't think you'd have a Mick Jagger.
SPEAKER_4: If you took Mick Jagger's lifestyle and put it into somebody who's exuberant, let me give you an example.
SPEAKER_4: A patient who goes into surgery, when I'm taking a patient into surgery, if they have a smile on their face, they have a better outcome.
SPEAKER_4: They influence the surgeon, they influence the anesthesiologist, they influence the nurses in recovery, they influence their rehab team, they do better.
SPEAKER_3: What if I pay you more money?
SPEAKER_4: Because we get happy patients out of it and we smile and we enjoy it.
SPEAKER_1: So I think positive outlook, no one's going to argue that that doesn't help and isn't good for things, but that feels kind of new agey.
SPEAKER_1: Not that that's a bad thing, but when I turn to medical experts, I want to hear what's going on with my DNA.
SPEAKER_1: I want to hear what chemicals are happening.
SPEAKER_1: I want to hear what cells are dying at what rate.
SPEAKER_1: And I don't think they care how I think or feel, do they?
SPEAKER_4: Actually, they really do.
SPEAKER_4: So, you know, there's a whole field of genetics, but there's also a whole field of epigenetics.
SPEAKER_4: And that's how your environment in part influences your genetic expression.
SPEAKER_4: And so, yes, if you're a little new agey and you're happy and you're optimistic and you're going into things with a great attitude, you do have better genetics and you do have better health.
SPEAKER_4: And one other thing about that is that the other side to the mindset, as you were saying, it's all in your head, the other side of the mindset is so many of the injuries I see in athletes of all ages are mental errors.
SPEAKER_4: Their mind wasn't in the game.
SPEAKER_4: They were thinking about their girlfriend.
SPEAKER_4: They were on their cell phone.
SPEAKER_4: They were skiing fast and thinking about something else.
SPEAKER_4: They actually, in that moment, were not in the game.
SPEAKER_4: And that's where we see the errors occur.
SPEAKER_2: All right, doctor, here.
SPEAKER_2: If I, as a professional athlete, if I got an injury or I needed to face surgery as a result of something, I'm really not a happy person.
SPEAKER_2: It's difficult for me to crack a smile knowing I've lost my place in the team.
SPEAKER_2: I'm going to be out X weeks, X months.
SPEAKER_2: But you are saying to...
SPEAKER_1: You are angry.
SPEAKER_2: On a good day, I'm pissed off.
SPEAKER_1: Right?
SPEAKER_2: This is how it is.
SPEAKER_2: But you are saying we have to look at this as an opportunity.
SPEAKER_2: Yeah, look at this as an opportunity for me to come back even better rather than the tragedy I've got going off in my head as of this injury.
SPEAKER_4: Exactly right.
SPEAKER_4: And so if I can bond with you, talking with you before we go into surgery, if you need surgery, if I can convince you to use that injury as an excuse, as an opportunity to become, as we say, fitter, faster and stronger than you've been in years, then you're going to turn that injury into something that helps you.
SPEAKER_4: And so listen, any pro athlete coming into our clinic is coming in with his rehab team, his nutrition team, his massage therapist, his psych counselor, his coach.
SPEAKER_4: Why not treat yourself to the same set of skills and same set of resources or at least the same set of techniques because they're so available?
SPEAKER_4: And why not take, even if your main sport is going for a walk in the mall, let's use that as a goal to be able to go for a walk without having pain.
SPEAKER_4: But if your sport is to come back to playing football, either European football or American football, why don't we use that injury?
SPEAKER_4: And the best athletes do this all the time.
SPEAKER_4: They'll use that injury to come back better than they were before.
SPEAKER_2: So do we all have to be elite athletes?
SPEAKER_2: We all have to have the elite athlete mentality?
SPEAKER_4: You have to.
SPEAKER_2: Not everybody's got it.
SPEAKER_4: That way.
SPEAKER_4: Treat yourself like a pro athlete would.
SPEAKER_2: Not everybody can, doctor.
SPEAKER_4: What we're trying to teach in this book and what we're trying to teach to our patients and what we're trying to spread the word about is that the resources online, the resources from your doctors, your therapists, your trainers, they're there.
SPEAKER_4: You just have to access them.
SPEAKER_4: You just have to switch that switch in your own mind and say, I can do this.
SPEAKER_4: I can turn this negative into a positive.
SPEAKER_4: So it really does, as Neil brought up before, it really does affect your biology.
SPEAKER_4: It affects how you heal.
SPEAKER_4: It affects how fast you heal.
SPEAKER_4: It affects how all your teammates and your therapists and everybody else view you.
SPEAKER_4: And so if you can turn that injury into that opportunity, you'll do so well.
SPEAKER_4: So part of our mission here in the book Play Forever is how do you drop dead at 100 play in the sport you love?
SPEAKER_4: The way you do that is looking at every little bump in the road as an opportunity to do better, to become fitter, faster and stronger.
SPEAKER_3: Okay, so let me ask this then, if you're looking at it from a psychological standpoint, is it possible to overcome some of the bad habits that a lot of people have?
SPEAKER_3: Let's say for instance, look at what sugar does to the body.
SPEAKER_3: Sugar causes inflammation and the inflammation has a reaction that is damaging.
SPEAKER_3: So I can't like positive think my way out of that, right?
SPEAKER_4: But you can positive think your way to a healthier nutrition, a healthier diet.
SPEAKER_4: You can take the Tom Brady approach, you can take the approach that so many athletes were acting as role models for all of us and say, listen, if I feed myself, if I fuel my body, the way I'd wanna fuel my engine of a car, of a race car, then my body will perform that way.
SPEAKER_4: And if I fuel my body poorly, the body will perform poorly.
SPEAKER_1: Yeah, but Kevin, I think what I came to learn is, and I came to this revelation, maybe it was obvious to everyone else, but I had to figure it out on my own.
SPEAKER_1: Look at Michael Phelps, and people always got the body for a swimmer.
SPEAKER_1: Well, he's in the water six hours a day, right?
SPEAKER_1: So, all right, that's a factor in this, or however many hours the man trains.
SPEAKER_1: Then I realized that what will distinguish elite athletes from the rest of us is the boundless urge to work on their body and their performance.
SPEAKER_1: We had Lindsay Vaughn as a guest.
SPEAKER_1: Oh my gosh, you hear her.
SPEAKER_1: She fell one time going down a thing and twisted something.
SPEAKER_1: She was helicoptered away, and all she could think of was getting back on the slopes.
SPEAKER_1: Not, oh gee, my gosh, am I hurt?
SPEAKER_1: Well, I was skidding, shit, that was not in her thoughts.
SPEAKER_1: And the next day she was back skiing.
SPEAKER_1: And so it was, this is not a common way to think about our bodies and ourselves.
SPEAKER_1: And so what you're saying is true and is common, but it seems to be only in this very selected set of people whose minds have this, can reach these levels of access to their own performance that the rest of us can't.
SPEAKER_4: But you can.
SPEAKER_4: You don't need to perform at an Olympic level to be healthy and fit and play forever.
SPEAKER_4: You just need to play every day.
SPEAKER_4: You just need to say every day, I'm gonna play my sport, workout, do something exercise wise for my mind and my body.
SPEAKER_4: And if you do that every day, Neil, you become addicted to the good pheromones and hormones and testosterone and adrenaline that you feel when you get to that point of exercise when you know you've exhausted yourself or tired yourself.
SPEAKER_4: Your level doesn't have to be Olympic.
SPEAKER_4: Your level has to be just a little better than Neil is today.
SPEAKER_1: It's just my, whatever is beyond what I am, whatever that is.
SPEAKER_4: Neil, that's why you never watch TV or read a book when you're working out.
SPEAKER_4: Because if you do, you're losing half the point of working out, half the benefit.
SPEAKER_4: You need to hear your heart rate, feel where you're breathing, know where your muscles are tired and go just a little bit beyond that every day.
SPEAKER_2: Agreed, totally do.
SPEAKER_2: All right, so doctor, here's my thought process.
SPEAKER_2: Are we going to see players in the future, maybe Chuck's favorite, Tom Brady, maybe LeBlanc, maybe someone coming through who have 30 plus year careers go into their 50s?
SPEAKER_2: Is, I mean, we always know the desire is there.
SPEAKER_2: It got us there in the first place.
SPEAKER_2: What changes is our physicality.
SPEAKER_2: Indeed.
SPEAKER_2: But you're saying we can be overcome?
SPEAKER_4: I have many 70 year olds now who are running marathons, running centuries, they run their age and they are performing at levels you'd never dreamed of before.
SPEAKER_4: And in part is the mind, in part is the physicality, their ability to have developed themselves over the years.
SPEAKER_4: Many of my top athletic women did not become runners and athletes until they were in their 40s.
SPEAKER_4: So they shifted to that maturity that permitted them to listen to themselves and push their bodies a little bit fast.
SPEAKER_1: All right, Kevin, we got to take a break, but when we come back, we're going to find out what the hell you're doing to these people in your lab.
SPEAKER_1: When we come back, we're going to find out what might be actually happening in Kevin Stone's lab, who will be the of StarTalk?
SPEAKER_1: Sports Edition returns.
SPEAKER_1: So we're back, StarTalk Sports Edition.
SPEAKER_1: And I'm here with our guest, Dr.
SPEAKER_1: Kevin Stone, who's head of the Stone Foundation.
SPEAKER_1: Did I say that right?
SPEAKER_4: Stone Clinic and the Stone Research Foundation.
SPEAKER_1: Yeah, the Stone Clinic and the Stone Reference.
SPEAKER_1: What a coincidence it has the-
SPEAKER_3: Exactly.
SPEAKER_3: Two eponymous organizations.
SPEAKER_3: I wonder who's behind that.
SPEAKER_4: And there's no D.
SPEAKER_1: No D, no Stone, right, Stone.
SPEAKER_1: And of course, we've got Chuck and Gary here.
SPEAKER_1: In our first segment, we just talked about what effect the mind would have on your body and your performance.
SPEAKER_1: But I want to sort of shift, re-steer that now, and talk about what you actually do with people physically.
SPEAKER_1: I mean, you're a surgeon, and you specialize in joints.
SPEAKER_1: These are usually the things that first go out, that first fail in any kind of attempt to do things a long time.
SPEAKER_1: And so, the first thing that comes to mind is arthritis.
SPEAKER_1: Like, what do you have to say about that?
SPEAKER_1: Because that sort of arises typically later in people's lives.
SPEAKER_1: But also, what about drugs that you might give people that would rebuild their muscles or their bones or whatever else?
SPEAKER_1: What physically do you do?
SPEAKER_4: So, what we're doing now that's so different from what people heard about before, is that every time someone injures the key tissues, just focused on the knees, so their meniscus cartilage or their ACL, we repair or replace those tissues.
SPEAKER_4: We replace the meniscus if it's injured and a surgeon takes it out.
SPEAKER_4: So, we've learned that if you take the key tissues out of the joint, you develop arthritis.
SPEAKER_4: So, so many of us on this call, so many of the listeners have injured their knee in high school or college, the surgeon went in, they took out the meniscus, they said, come back and talk to us when you develop arthritis years from now or you need your knee replacement.
SPEAKER_4: So, what we've changed is now it's come back immediately and put the meniscus back in the joint, regrow the articular cartilage that we thought we couldn't regrow and we've learned now how to regrow it.
SPEAKER_4: And we do that both for young athletes and we do that for people who already have arthritis.
SPEAKER_4: And so arthritis used to be go home and rest your knee and wait for your joint replacement.
SPEAKER_4: Now arthritis is come in, let's replace or regrow the tissues, let's lubricate the joints, let's add growth factors and recruit your body's own stem cells.
SPEAKER_4: Let's do all these things that do regeneration of tissue rather than taking it out and waiting for your joint replacement.
SPEAKER_1: Okay, sure.
SPEAKER_1: But does that bring you back better than you were when you hobbled into your clinic?
SPEAKER_1: Who cares?
SPEAKER_3: That's so cool.
SPEAKER_3: I would do it just to do it.
SPEAKER_4: It certainly brings you back better if you've been limping around for years or cutting back on all your sports because it hurt.
SPEAKER_4: You stopped running because your joints got stiff and were painful.
SPEAKER_4: So what we're trying to do is restore the biology of people's joints.
SPEAKER_4: So we can then work with them physically to train and exercise and play the sports they want.
SPEAKER_3: But what do you do if that degradation and deterioration is due to another problem outside of just wear and tear or use?
SPEAKER_3: Like what?
SPEAKER_3: For instance, if I have some type of autoimmune disorder that causes a deterioration of my joints or causes inflammation in my joints, which then turns into deterioration.
SPEAKER_4: So it's a great question.
SPEAKER_4: So there's basically two major groups of arthritis.
SPEAKER_4: There's the inflammatory arthritis and that's the rheumatoid infections, autoimmune diseases, Lyme disease.
SPEAKER_4: That's one group of patients that are not the patients that we're treating with joint replacement tissues and injection.
SPEAKER_4: The group that we're treating are the post-traumatic arthritis and the osteoarthritis.
SPEAKER_4: That group is usually athletes or people have injured their knee or had or picked their parents poorly and they got the genetics of osteoarthritis.
SPEAKER_2: So doctor, there was another technique that's, I don't know if it's still around.
SPEAKER_2: It used to be called micro fracturing.
SPEAKER_4: Right.
SPEAKER_2: And I know a number of basketball players have had it, but I'm not, I mean, it's not something I've experienced.
SPEAKER_2: It's just something I'm aware of.
SPEAKER_2: But what are we doing?
SPEAKER_2: This is obvious as the title says, they're micro fractures.
SPEAKER_2: So how are we doing this?
SPEAKER_2: Does this work?
SPEAKER_4: So micro fracturing taught us all a lot that if you bloody a dead arthritic area in a joint, you can get the marrow cells that have all these progenitor and growth cells in them to stimulate a repair process.
SPEAKER_4: But unfortunately in micro fracture, the repair process led to scar tissue.
SPEAKER_4: But we learned from that that you can stimulate a healing response.
SPEAKER_4: So now we add something called a paste graft or a mixture of articular cartilage and can sell us bone to that micro fracture or a super micro fracture where we stimulate a much bigger response in the joint.
SPEAKER_4: And then we add growth factors to it to stimulate full healing back to a healthier kind of cartilage repair.
SPEAKER_1: What does the word articular mean as you used it?
SPEAKER_4: Thanks, so in the joint, you've got two types of cartilage.
SPEAKER_4: So when you crack open the chicken wing, that white shiny circle, that's articular cartilage.
SPEAKER_4: And when you get arthritis, it's wearing of that articular cartilage down to the bone.
SPEAKER_1: Okay.
SPEAKER_4: That articular cartilage is that white shiny surface that we're trying to regrow.
SPEAKER_2: So this process when you apply the regenerative paste, if I can call it that, is that an anabolic therapy?
SPEAKER_2: Because isn't testosterone good for healing fractures, but we don't maybe have enough of it in our own bodies to achieve the process fully?
SPEAKER_4: So when we think about anabolics, we're thinking past testosterone now.
SPEAKER_4: So we're trying to stimulate the body's own natural stimulation or anabolic healing process as opposed to catabolic.
SPEAKER_4: So if you have arthritis, you have degradative enzymes in the joint that are breaking down your tissues.
SPEAKER_4: And we want to shift that to an anabolic or positive set of growth factors and cells that are building up your tissues.
SPEAKER_4: And so not testosterone, although we are studying testosterone in order to prevent muscle atrophy after injury.
SPEAKER_4: But generally when we're talking about regenerative therapies, rebuilding people's joints biologically, we're talking about adding tissues and adding recruitment factors that recruit your body's own stem cells and stem cell derived repair cells to the site of injury.
SPEAKER_4: And that's the most exciting part of this, because each of you sitting here, even as mature as Neil have billions of stem cells in their body.
SPEAKER_4: Young people have more, but everybody has them.
SPEAKER_1: No, wait, wait, wait, Kevin, I have to correct you.
SPEAKER_1: I have billions and billions, billions and billions.
SPEAKER_4: Neil is what he was studying all these years in astrophysics.
SPEAKER_4: Had he just looked inside, he would have found the same number of billions of interesting constellations of cells that is where we're studying today and trying to recruit those supernovas to your own injury.
SPEAKER_4: That's what this whole field is about now.
SPEAKER_3: So do these stem cells, do our stem cells age like other cells?
SPEAKER_3: Do they become less effective as you get older?
SPEAKER_4: In fact, they do not.
SPEAKER_4: The beauty to a stem cell is that it regenerates itself and so when we go recruit your body's stem cells, what happens is we're sending these factors out, they cause the stem cell that lives in the walls of vessels to release, divide into two.
SPEAKER_4: One is a daughter cell exactly like the mother and the other is a progeny or a progenitor cell that rushes to the site of injury and starts doing its work.
SPEAKER_2: So, here, Doctor, here's a thought and I've experienced this through teammates back as a player and then through my own self.
SPEAKER_2: Athletes don't recover at the same speed and sometimes as you get older, your recovery time for an injury you would have had in your early 20s is maybe twice as long.
SPEAKER_2: Why?
SPEAKER_2: If we're regenerating our stem cells, why aren't we recovering at the same pace each time?
SPEAKER_4: So, it's a great question.
SPEAKER_4: A couple of things around that.
SPEAKER_4: Number one, as you get older, you do have fewer cells, even though you still have billions of them.
SPEAKER_4: Number two, your biology of your tissues is not the same as you age.
SPEAKER_4: The makeup of the tissue is different.
SPEAKER_4: And then number three, if you ask yourself the question, which all our athletes ask, Doc, why does it take a year to come back from my ACL injury or my Achilles rupture, these tissues that need to regrow?
SPEAKER_4: And hey, Doc, isn't there something you can just add to accelerate that healing process?
SPEAKER_4: And so all of the research that we're doing at Stone Research Foundation in San Francisco is around which factors should you give which injury?
SPEAKER_4: So clearly an arthritic knee should get different factors than an ACL injured knee or an Achilles rupture.
SPEAKER_4: And we're getting very targeted now about identifying which cells will respond to which factors.
SPEAKER_2: So if I'm an elite athlete, Neil, if I'm an elite athlete into my 50s and then I go bonkers and refuse to leave, and I'm in my 60s, what body parts would you imagine, actually am I a cyborg by then?
SPEAKER_2: Have you replaced most of my body parts?
SPEAKER_1: Yeah, wait, wait, wait, let's unpack that.
SPEAKER_1: So Kevin, when do you have to actually start replacing body parts versus encouraging the body to heal itself?
SPEAKER_1: At some point you say, look, you need a new knee or you need a new hip or you need a new shoulder.
SPEAKER_1: All right, at some point you're doing that, I presume, right?
SPEAKER_4: So there's two parts to that.
SPEAKER_4: Number one, you can run forever as long as you don't get hurt.
SPEAKER_4: So it's injury or bad genes picking your parents poorly that can develop arthritis.
SPEAKER_4: But if you have a healthy joint, you can run on it forever.
SPEAKER_4: The joint is designed to last.
SPEAKER_4: That's number one.
SPEAKER_4: Number two, 80% of the people who have been told they need to have a knee replacement don't.
SPEAKER_4: There is an alternative for them.
SPEAKER_4: And an alternative could be either a biologic replacement, putting tissue back in, or a partial knee replacement where you just resurface one part of the knee.
SPEAKER_4: Or nowadays, if we have to do a full replacement, we use a robot and we avoid cement because of the precision of the robot so that we can get these people back to playing the sports they love, even if they've had a joint replacement.
SPEAKER_1: You're saying the robot is the surgeon.
SPEAKER_4: Robot makes the surgeon, me, much more precise than I could ever be.
SPEAKER_3: So let me ask you this then.
SPEAKER_3: If a healthy joint can last forever, what happens during an injury that makes it so that that joint now is so compromised that it can't last forever?
SPEAKER_4: So remember, we talked about that white shiny surface in the chicken wing.
SPEAKER_4: That white shiny surface is five times as slick as ice on ice if it's not injured.
SPEAKER_4: Once you injure it, you create a rough spot in it, and you've changed the entire properties of that articular cartilage, and it starts off the wearing away process.
SPEAKER_4: If you don't get injured and you've got some good genes, you can go for her.
SPEAKER_1: So, getting back to Gary's point, if Gary wants to keep playing soccer in his 50s and 60s and into his 70s, at what point have you touched every one of his joints?
SPEAKER_1: You're saying if he doesn't get injured, his joints are still working just fine.
SPEAKER_1: That's what you're...
SPEAKER_1: So, Gary, you're not Cyborg.
SPEAKER_1: You're just Gary.
SPEAKER_2: Yeah, with some seriously injured joints.
SPEAKER_3: No, I got a feeling with Gary right now, Dr.
SPEAKER_3: Stone would have to stand above him while he raises them up to lightning and go, it's alive.
SPEAKER_2: It's just about right.
SPEAKER_1: Kevin, have you seen this YouTube video of centigenarians racing a 100-meter dash?
SPEAKER_1: Have you ever seen this?
SPEAKER_4: I haven't seen that video.
SPEAKER_1: It's very interesting.
SPEAKER_1: You know, they're not going real fast, but they're putting it all out.
SPEAKER_4: Something we should answer, though, is there's no limit to the age at which you can either have a tissue repaired or a tissue replaced.
SPEAKER_4: And I think you were asking that earlier.
SPEAKER_4: If you're 70 and you come into my clinic and say, hey, doc, I'm still running.
SPEAKER_4: I want to keep running.
SPEAKER_4: I'm not ready for a joint replacement.
SPEAKER_4: I really would like you to take a shock absorber back in my knee and give me a few more years.
SPEAKER_4: There's no reason why we can't do that as long as there's still joint space.
SPEAKER_4: If they come in too late and it's bone on bone, then we have to shift to capping it with a metal cap.
SPEAKER_3: It's like brakes.
SPEAKER_3: It's like when you get your brakes fixed, you know, if you go in, if you go in, they're like, oh, man, I'm sorry.
SPEAKER_3: That's metal on metal.
SPEAKER_3: That we could do for you, buddy.
SPEAKER_3: We got to, we got to replace the pads and the rotors, the pads and I'm sorry.
SPEAKER_4: It's a perfect analogy.
SPEAKER_1: Plus every time you mention lubricant to the joints, all I can think of is the Tin Man and in the Wizard of Oz.
SPEAKER_1: So do you, do you have a list of athletes that is in your, sort of your honor roll for those who you've helped?
SPEAKER_4: We do.
SPEAKER_3: That was awesome.
SPEAKER_3: He was like, and my doctor patient confidentiality says that I can't tell you who they are.
SPEAKER_3: Let me ask you this, doctor.
SPEAKER_3: So we're talking a lot about knees here and, you know, knees and hips, which are, you know, common problem areas.
SPEAKER_3: But what about these areas where we're looking at like tendons?
SPEAKER_3: So where you got, you know, something soft going to the bone itself.
SPEAKER_3: What are you able to do for stuff like that?
SPEAKER_3: Because that's another area of injury that happens to a lot of people, athletes and otherwise.
SPEAKER_4: It brings up a great point.
SPEAKER_4: So in the past, when you came in with a tennis elbow or a sore Achilles tendon, the doc would jam some cortisone into those tissues and send you on your way.
SPEAKER_4: And unfortunately, often when you went on your way, you ruptured that tissue because the cortisone shuts down the healing response and inhibits cell metabolism.
SPEAKER_4: So today when you come in, we inject growth factors, usually taken from your own blood called PRP and soon some other types of factors as well.
SPEAKER_4: Because just as we talked about earlier, we want to recruit your body's healing response, augment it, accelerate it at that spot of degeneration or sometimes inflammation.
SPEAKER_1: So that's the exact opposite of putting in steroids.
SPEAKER_4: Exactly.
SPEAKER_1: It's the exact opposite.
SPEAKER_4: Exactly.
SPEAKER_4: Steroids have almost gone away from our practice.
SPEAKER_1: All right, we got to take a quick break.
SPEAKER_1: But when we come back, we're going to ask Dr.
SPEAKER_1: Stone about the future of all of this.
SPEAKER_1: What can we expect in five, 10, 20, 50 years?
SPEAKER_1: And will we all be living forever one day?
SPEAKER_1: And what does that even mean on StarTalk?
SPEAKER_1: StarTalk Sports Edition.
SPEAKER_1: We'll be right.
SPEAKER_1: Back.
SPEAKER_1: Back to StarTalk Sports Edition, Dr.
SPEAKER_1: Kevin Stone, an expert in making you live longer better, I guess, if I characterize that.
SPEAKER_1: And we got, of course, Chuck and Gary.
SPEAKER_1: Kevin, where can we find you on the internet?
SPEAKER_4: So at stoneclinic.com and stoneresearch.org.
SPEAKER_1: Excellent, and we can find your book, right?
SPEAKER_1: Your book was just released, Play Forever.
SPEAKER_1: So all very good.
SPEAKER_1: In this segment, we want to just talk about the future implications of your work, not only for those who you're treating now, but the future Kevin Stone or descendants of your points of views and philosophies on this landscape.
SPEAKER_1: But let me lead off with a question before I hand back to Chuck and Gary.
SPEAKER_1: In your book, Play Forever, you list five reasons to avoid space travel.
SPEAKER_1: And other than the rocket might blow up, I'll give you one of those.
SPEAKER_1: Is that one of them?
SPEAKER_1: I don't know.
SPEAKER_1: That would be a reason to avoid space travel.
SPEAKER_1: But what else might you, what else have you put in that list?
SPEAKER_4: Yeah, so our concerns about space travel are many, of course, but excess radiation, loss of gravity, mental status are all the first three that pop up in people's conversations.
SPEAKER_4: And so we are really encouraging people to focus on what they can do while here on Earth and how to make Earth better, because I think space travel will be predominantly for robots.
SPEAKER_3: And now is there any...
SPEAKER_1: Okay, wait, that's the end of this interview.
SPEAKER_1: Wait.
SPEAKER_2: No.
SPEAKER_4: No.
SPEAKER_1: No.
SPEAKER_1: No, I have one rebuttal.
SPEAKER_1: Just one.
SPEAKER_1: The other is I'm cool with.
SPEAKER_1: The day we design rotating space stations, there's no concern for loss of bone mass or anything else that has so preoccupied the medical community about what happens when you're in zero G for so long.
SPEAKER_1: You rotate the space station, you're in one G for as long as you want.
SPEAKER_1: And so that whole problem goes away.
SPEAKER_1: Radiation, we're still working on that.
SPEAKER_1: We've got top people thinking that through.
SPEAKER_1: And yeah, we've got problems on Earth.
SPEAKER_1: No bow to doubt it.
SPEAKER_1: But who are we to say or to think that the solutions to those problems would not be found exploring the rest of the universe?
SPEAKER_1: That's all, I'll put that out there.
SPEAKER_1: But anyhow, let's go into the future of this.
SPEAKER_1: And Gary, you're always thinking about AI.
SPEAKER_1: So what's your AI question here?
SPEAKER_2: Okay, so can AI, will AI be able to unlock the biologic story?
SPEAKER_2: And then sort of allow us and enlighten us to be able to see the areas of which we can address aging.
SPEAKER_2: We can address certain elements that have been beyond our grasp so far.
SPEAKER_4: Absolutely, yes.
SPEAKER_4: So in the pocket of your doctor is a high powered computer, otherwise known as an iPhone.
SPEAKER_4: And on that iPhone, you can load the most potent artificial intelligence programs that help everyone make a better diagnosis and a better decision for the patient.
SPEAKER_4: In the same way that if you take a photograph of your iPhone today, it makes you look like Ansel Adams, you know, a brilliant, perfect photograph.
SPEAKER_4: The AI on that camera has made all other cameras obsolete.
SPEAKER_4: And so the AI in the pocket of the doctor will make the doctor's decision-making so much better.
SPEAKER_2: Where are we going to go?
SPEAKER_2: Where, in your field, right?
SPEAKER_2: Where would you like AI to address its gaze and find you solutions?
SPEAKER_4: Specifically in the treatment, prevention and cure of arthritis.
SPEAKER_4: So as we like to say, cancer may kill you, but arthritis ruins your life.
SPEAKER_4: And so I think we can help so many people, so many athletes, so many of all of our friends and parents and children, if we can just address and focus on solving arthritis, which all of our research shows is totally solvable.
SPEAKER_3: Can I ask you this about arthritis?
SPEAKER_3: I had a piano teacher who had arthritis and continued to play although his hands were mangled.
SPEAKER_3: And by that, I mean, they looked like they had drawn up into themselves and he couldn't bend the joints any longer, but he adapted his hands to play a different way.
SPEAKER_3: What is it that's going on with arthritis that causes that effect of the joints drawing into themselves and taking this calcified kind of state?
SPEAKER_4: So the destruction of the articular cartilage, the bearing surface is the beginning, but following that, the lining of the joint becomes contracted and the muscles and tendons around it become shortened.
SPEAKER_4: And so that you can no longer extend that joint.
SPEAKER_4: So a big part of arthritis prevention is making sure that you maintain your flexibility.
SPEAKER_4: So all of us who are active in fitness training focus now more on mobility first and strength second, because without mobility, you don't have the ability to perform, to use that strength in the most optimal way.
SPEAKER_4: But back to Neil's point, I'm a huge fan of space exploration because I think that we learn so much from environments that challenge us in ways that our local environments don't.
SPEAKER_4: In the same way that we learn so much about biology from the arthritic joint, we learn so much about healing from the injured athlete, especially the injured athlete and almost all of my injured pro athletes cheat.
SPEAKER_4: Meaning I tell them to do something and they do much more without telling me.
SPEAKER_4: And then I learn from them, I learn from them what works because they push the limits past what I thought could work.
SPEAKER_4: It's the same thing that happens in space.
SPEAKER_4: We learn from the people and the instruments that go to space.
SPEAKER_4: What are the limits of our design, of our knowledge, of our experience on earth?
SPEAKER_4: So space is a huge teacher for us to be able to excel.
SPEAKER_4: I just, my bias is that I think space will be predominantly dominated by robots rather than people because we are so fragile.
SPEAKER_1: So you more than once have mentioned choosing your parents well, right?
SPEAKER_1: And so the future version of that is gene editing, isn't it?
SPEAKER_1: Where I can't choose my parents, but I can alter my genetic.
SPEAKER_3: I can edit them out.
SPEAKER_1: Damn, Chuck, why you got to be so negative?
SPEAKER_3: Sorry, mom, gotta Photoshop you out of this.
SPEAKER_1: You left all this bad stuff in my DNA.
SPEAKER_1: Exactly, so that's the equivalent to this, isn't it?
SPEAKER_4: In a nicer way, the way we say it is that some of the genes that your parents passed on to you, you can do things to stop the expression of those genes so that they don't destroy your life or your joints or your imagination.
SPEAKER_4: So in so many ways now, we've learned to affect your mind, we've learned how to affect your body, we've learned how to affect how you express things.
SPEAKER_4: And so we know that when you take a simple supplement like glucosamine, which we all have been exposed to, it not only makes you feel less stiff and it acts as a precursor to the building of the lubricant and the joint hyaluronic acid, but it affects how the genes express that lubricant.
SPEAKER_4: And so our nutrition affects our genetic expression and it affects our epigenetics, how our genes are expressed as well.
SPEAKER_4: So even though Neil was going down the line of, hey, will we be doing draconian editing of our children?
SPEAKER_4: Yes, we do, but we do it in ways that are natural, that are healthy, that are inspiring.
SPEAKER_4: You don't need to go in and edit out their genes to edit out their expression.
SPEAKER_2: So, doctor, where are we going to go with nanotechnology?
SPEAKER_2: What do you expect that to be with humans in the future?
SPEAKER_4: So, we have an experiment going on right now using nanoparticles of copper that we add to cells in tissue culture to see if we can make the cells produce more extracellular matrix, meaning behave stronger and start the healing response.
SPEAKER_4: So, the ability to use extremely small particles to develop, to deliver stimulants is a wide open field that we think will make a lot of progress in.
SPEAKER_3: Wow.
SPEAKER_2: All right.
SPEAKER_2: So, take that forward.
SPEAKER_2: You've talked about robots in space, but what are our surgical robots going to look like in the future?
SPEAKER_2: Are they going to be able to do things that we can't quite dream of right now, or are we pretty much got an idea of what they can do?
SPEAKER_4: Oh, I think we're only in the very beginning.
SPEAKER_4: I've learned, and when I picked up a surgical robot about eight years ago to make my partial and total joints replacements better, I learned very quickly that it was far more precise than I could ever be.
SPEAKER_4: And so my precision has increased dramatically.
SPEAKER_4: And I think going forward, my interaction with robotic technology will make my decision-making and my surgical precision better.
SPEAKER_4: So I think right now it's helping technically, but going forward it'll help with the AI-enabled robots to help diagnostically and in decision-making.
SPEAKER_1: Yeah, but Kevin, it's one thing for the robot to make you better.
SPEAKER_1: But I think in the real future, we'll have robots that can do things that you wouldn't even have attempted.
SPEAKER_1: Isn't that correct?
SPEAKER_1: I mean, just, I don't know what would be an example.
SPEAKER_3: An example would be like going, instead of putting in a stent, going in and actually cleaning out an artery, like a tool that small that could go in, identify a blockage, remove it and move on.
SPEAKER_1: Yeah, exactly.
SPEAKER_1: And so it'll be kind of tools that would perform operations that were undoable in a previous time, rather than just simply making you better at what you were already going to do.
SPEAKER_4: Are you implying that there's something that I can't do?
SPEAKER_4: Yes.
SPEAKER_2: No diss in the dark.
SPEAKER_2: So, all right, while we're here looking forwards, we're at a certain point with stem cell knowledge.
SPEAKER_2: Are we going to take that a lot further, or are we kind of pushing as far as we think we can go right now?
SPEAKER_4: Oh, we're only in the very beginning, because as I mentioned to you, you have billions of stem cells, and how we induce them, and how we get the right cells to the right spot, how we induce the cell that goes to that spot to do what we want it to do, how we get healing to occur faster, so that ACL injured athlete doesn't have to wait a year.
SPEAKER_4: These are all spaces that we're experimenting with now.
SPEAKER_4: We have an interesting model called the lab on a chip, where we can take the cells of the patient, put it on a slide, the way you used to put it on a microscopic slide in your high school biology.
SPEAKER_4: And on that slide, we have tons of little micro vessels there or portals there so that we can add different cell behaviors, different growth factors to those cells and see what happens.
SPEAKER_4: So we're taking the lab on a chip model, the stem cell model, the growth factor model, and testing it individually for each patient.
SPEAKER_4: And so this field of called microfluidics and lab on a chip is the space that we're using to push forward the entire healing process information that we wish we knew more about.
SPEAKER_1: But Kevin, this feels very different from the conversations people are having about living forever, right?
SPEAKER_1: You're talking about just the absence of pain and joints as we get older so you can still do stuff.
SPEAKER_1: But that doesn't stop you from dying, does it?
SPEAKER_1: Unless you've got some other plan in your lab.
SPEAKER_4: No.
SPEAKER_4: And the answer is that, number one, your relatives, your government, nobody wants you to live forever.
SPEAKER_4: They can't afford you, Neil.
SPEAKER_4: Yeah.
SPEAKER_4: What they want, it's only you that wants it.
SPEAKER_4: What they want and what we're trying to do is help you drop dead at 100 playing the sport you love.
SPEAKER_4: So we want to help you live an active, healthy, fulfilled, enthusiastic lifestyle all the way to the very end.
SPEAKER_4: And if we can do that, we feel like we've contributed much more to you than just prolonging a life.
SPEAKER_1: Not only that, the entire healthcare system that is supporting 80-year-olds and up, that would be completely transformed in the face of what you're talking about.
SPEAKER_3: Oh, it dramatically reduced the cost.
SPEAKER_2: You said to me a couple of years ago, Doc, what we know now is not good enough.
SPEAKER_2: We're here, we're in the beginning of 19, yes, Gary, 2022.
SPEAKER_2: What we know now, is it good enough?
SPEAKER_2: Have we made the serious progress you would have expected?
SPEAKER_4: Let me answer that and say, what we know now is how little we know.
SPEAKER_2: Oh, thanks.
SPEAKER_3: Answer that one.
SPEAKER_3: There you go.
SPEAKER_1: Next question.
SPEAKER_3: Next.
SPEAKER_3: Honey, where were you last night?
SPEAKER_3: What I know is that I don't know.
SPEAKER_2: All right, so here, Chuck, something Chuck touched on earlier in this show was about ligaments and, you know, we've harvested animal parts to replace human tissues.
SPEAKER_2: In the future, are we going to kind of 3D print our own or is the body going to reject that sort of material?
SPEAKER_4: It's a great question.
SPEAKER_4: What we're going to do and what we've started doing is 3D printing the regeneration templates for your body to grow into.
SPEAKER_4: Since we now are getting better and better at stimulating your body to regrow, often it doesn't have the template or the rose trellis to grow out over.
SPEAKER_4: But if we give it that template, the body can regrow tissues that we used to think we couldn't, and that includes meniscus and articular cartilage and ligament.
SPEAKER_4: So a big part of the 3D printing part is not to replicate exactly what evolution has spent millions of years developing.
SPEAKER_4: It's to replicate a trellis, a stimulant for the body to grow through.
SPEAKER_4: So the salamander can regrow its tail without that trellis.
SPEAKER_4: A child can regrow the tip of its finger without it, but you seem to lose that as you grow older, even though you have the genetics inside you that know how to do it.
SPEAKER_4: And so what we're learning now is if we give it that template, if we then stimulate those cells, we can get the body to regrow a number of tissues we didn't think were possible.
SPEAKER_3: So now with that type of, will we ever, speaking of the salamander, will we ever have the ability to regenerate that which was never generated?
SPEAKER_3: For instance, some people have congenital problems where they're born without an arm or whatever.
SPEAKER_3: Would we be able to then program cells to go in and then grow where that arm was not?
SPEAKER_4: It's not out of the question.
SPEAKER_4: It's outside of the field of what I'm doing now, but it's not out of the question.
SPEAKER_4: And where that applies right away, it's clearly in the spinal cord where people have injuries or defects there.
SPEAKER_4: And there's been tremendous progress in stimulating neurons to grow and cells to grow that previously we thought you just couldn't do, including brain tissue, liver tissue, heart tissue, all the tissues in the past that we used to think once you're injured, you're done.
SPEAKER_4: That's really not the case.
SPEAKER_4: And it's likely going forward that we'll be regrowing these tissues that we didn't think we could.
SPEAKER_1: Guys, we've got to land this plane.
SPEAKER_1: Listen, Dr.
SPEAKER_1: Stone, it's been great to have you back on StarTalk.
SPEAKER_1: This is really interesting frontier stuff.
SPEAKER_3: Always.
SPEAKER_1: And we'd love talking about that on this show.
SPEAKER_1: And if you can keep us plugged in, delighted about your new book.
SPEAKER_1: And tell us who published that and where we can find it.
SPEAKER_4: So you find it on Amazon.
SPEAKER_4: Play forever.
SPEAKER_4: And I hope that it inspires you and your listeners to stay active and play the sports they love and not let anything get in the way.
SPEAKER_1: And drop dead the day after 100.
SPEAKER_4: Playing the sport you love.
SPEAKER_1: All right.
SPEAKER_1: We will make sure that.
SPEAKER_1: So guys, that's it.
SPEAKER_1: That's all the time we have.
SPEAKER_1: Chuck, Gary, always good to have you there as my co-host.
SPEAKER_1: And Kevin, we will find you again because this topic is not going to go away.
SPEAKER_1: And as more and more athletes ascend into their twilight years, but it's actually the dawn years in your reckoning of time.
SPEAKER_1: So this has been StarTalk Sports Edition.
SPEAKER_1: Neil deGrasse Tyson here, your personal astrophysicist.