Exclusive interview: Jeffrey Gladden, MD, longevity coach to top Rejuvenation Olympians

He has 4 athletes in the top 20

Dr. Jeffrey Gladden, thinking about how to make 100 the new 30

Dr. Jeffrey Gladden, MD, is a board-certified cardiologist with a medical diploma from Temple University. Today, he runs a longevity clinic, Gladden Longevity, out of Irving, TX.

Gladden is the "coach" to 3 of the top 20 Rejuvenation Olympians, as per the latest results on the Rejuvenation Olympics absolute leaderboard. What's more, Gladden is a top Rejuvenation Olympian himself.

According to biological tests, Gladden, who is 69, has the body of a 30-40 year old man. As a result, he currently sits at position 20 on the Rejuvenation Olympics absolute leaderboard.

I sat down with Dr. Gladden to find out what exactly he is doing to get such rejuvenation results for his clients and for himself. The answer, it turns out, is quite a lot. Here are the details.

John Bejakovic:

I guess the first thing that I'd like to know is, who comes to you? So who are these people? What's their motivation? And what's their current health status?

Dr. Jeffrey Gladden:

Yeah, it's a great question. You know, people come to us for really two different reasons. And the way I think about it is it depends on the questions that they're asking. So people can come in asking the question, "Hey, I want to live young for a lifetime. How do I get back to age 30? How good can I be? How do I live well beyond 120?"

These are questions, if they're asking those questions, they come to us because we have the ability to actually assess where they are, and actually help them live young for a lifetime. So this has been very exciting work.

Other people come to us asking a specific question, like "I just got diagnosed with cancer," or "I just had a concussion or just had a stroke, or my blood pressure is out of control, or I hurt my knee or my shoulder, can you help me?" So some people come in with a much more focused sort of question, based on a pain point that they're having.

So people either come in because of a pain point, or because of an aspiration, or it could be a combination of the two. So those are typically the people that come in.

John Bejakovic:

What's the ratio of one to the other? What percentage are in the optimizing group, and what percentage are dealing with a pain point?

Dr. Jeffrey Gladden:

Most people come to us to optimize. But I will tell you that everybody that comes to us to optimize also has something else to fix, right? Everybody's dealing with something. And so you know, what we try to do is make ourselves accessible to the people that just have something to fix.

It's like, "I've gone to three doctors, I can't get my shoulder right." I met with a guy this past weekend. He had a shoulder replacement surgery, he's been doing his doctors, he's now having numbness and tingling weakness in the arm. It's like, "Can you help me?"

Yes, we can likely help you here. But first, we have to actually see the studies related to your arm and the nerve conduction study to see what's actually going on. And then from there, I'm quite sure we can help you. Which is really one of our main tenants is we can't really help anybody until we understand where they are, right?

So we don't we don't just start throwing things at people, we actually really do a deep dive to unravel where they are in terms of what cards are they holding. What are their genetics? What are their predispositions? And then where are they in the game that they're playing?

If the game is "I want to live young for a lifetime," well, then how old are you? And how many different mosaic of ages are we going to measure for you? So we give you a scorecard and give you a sense of where you're at?

If you're coming in because you have a bad knee, okay, well, let's get the past history of everything that went into that knee. Maybe there's a family history of joint issues, maybe there's some genetics that actually played into joint disease, and autoimmunity and things like this. And so once you start actually unraveling that, then you get much better solutions for these people. And so that's our approach. It's very thoughtful before we take action.

John Bejakovic:

Do you have a standardized, let's say, onboarding process? Or is it case by case, where it entirely depends on who comes in and what their situation is?

Dr. Jeffrey Gladden:

We have a standard process. The content is what changes. The categories remained the same. The content inside the categories can change.

So if I have a if I have a 30-year-old woman comes in because she's having difficulty getting pregnant, and she wants us to help her with that, that's a different set of questions than a 65-year-old person that wants to, you know, not only sell this company but start three more and have another 30 years of great impact on the planet. Those are two different questions.

So the process remains the same in terms of understanding who the individual is, what are the pain points, what are the aspirations and then doing the dive into that area. What are the genetics, what are the what are the metrics around the health of this organ system or the system as a whole.

And then from there, once you really understand the cards somebody's holding, and where they are in their particular game that they're playing, I'm gamifying this a bit, then we can actually start to come up with really intelligent, very thoughtful answers, where we can elegantly provide the best solutions and use this as few stones to hit as many birds if you will.

The problem I see with lots of clinics is that people come in with a problem and they have a solution and they throw the solution at the problem. In our world, we have all those solutions. But we just don't know which one is right for you until we actually understand what your the nature of your problem because every problem requires something a little bit different.

John Bejakovic:

In order to make sure that we don't go too broad with this interview, let's pick a specific patient who comes in to see you. Maybe we can walk through what that patient would actually be like.

Dr. Jeffrey Gladden:

So the ideal client for Gladden Longevity would be somebody who, at some point in time, started to face their own mortality. They've gone through enough of the aging process.

We work with people in their 30s and 40s, 50s, 60s, 70s, even 80s, right. But typically, someone will get to a point in their life where they don't feel like they want to or can't do what they want to, they may not look like they want to.

And at that point, they have a decision to make. Either, “I'm gonna accept this as the ‘aging process’ and acquiesce to that and go down that road,” or “No, I don't want to go down that road. I want to live young for a lifetime. I actually want my youth.”

So our ideal avatar is somebody who wants to live young, wants to be young. And typically, that translates into somebody that also wants to have a big impact on the world. And access opportunity, big opportunities as they come along.

So our ideal avatar is typically someone that's an entrepreneur or business owner, or an executive who really loves what they're doing. And the biggest fear they have is that they only have another five years to do it, or another 10 years to do it before they feel their health is going to start to crumble, and they're going to lose that ability to make that contribution that they want to make.

And people are also tied into this aspiration because of commitments to family. It's not just about the global world, right? They want to be there for the grandkids, they want to snowboard with their great grandkids, they want to do these things.

And so, when people come to us with those aspirations, we really believe that this is we're the first generation to not have to go down the same glide path of aging that everybody else went down.

We feel like we can take those people and do the deep dive. What are the cards you're holding? What are your aspirations? Where are you in the game? What are your metrics of aging? Where do you measure over 60 different metrics of ageing?

People talk about a single biological age. We're talking about measuring many, many, many biological ages that you have so that we get a really clear understanding of how well is your brain working right how well is your muscular system working. And we break it down into four different circles of areas.

The first is life energy. We want to understand where are you with related to what we call the life energy circle, which has to do with mindset. Are you married to your questions or are you married to your current answers? Are you a binary thinker? Or are you a quantum thinker?

Binary people are thinking about trying to get to an answer. Quantum thinking people are actually looking at a whole sphere of possibilities and trying to get to the best solution.

So we find that people that are quantum thinkers, people that are married to their questions and not their current answers, they have this growth mindset because of that, and this ability to adapt and grow. Those are perfect people for us.

Because to work with us, you're stepping outside the confines of traditional sickcare, you're moving into a new paradigm, right?

I've worked with a guy for a number of years here who owns an oil company, and he's doing great. We've helped him through a knee replacement, we helped him get rid of an infection. And he had another knee replacement when he first came to us. He's made tons of progress.

But he says, "When people ask me what I'm doing now, because I look so good, I don't even bother to tell them. I don't even bother to tell them anymore."

Because you have to be willing to step outside what most people would even consider normal to get these kinds of results. And so our avatar is somebody who in that life energy circle, who has a drive to be different than the people around them.

And then in that life energy circle are also things related to mental health. So anxiety, depression, PTSD.

Everybody has had trauma in their lives. And we all end up living in reaction to that trauma in one form or another. And that anxiety, depression, fear, etcetera, has a big toll on our bodies. It has a big toll on our biology, not just our psychology, but our biology.

And so being able to help people unravel those knots to understand what were the traumas. Why did they occur? How did you perceive them?

Being able to heal those traumas, and then being able to transcend those traumas, to the point where you become grateful for everything that happened, there is nothing bad that ever happened to you, because it all brought you to this moment, getting people to walk through those steps are really transforming their lives and their perspective on their own life.

And what's happened becomes very, very important because it has such a major impact on biology. It makes our life better, but it also de-stresses the system tremendously.

So then making sure people have great relationships, understanding what great relationships are. I wrote about all this extensively in the book 100 Is the new 30: How playing a symphony of longevity will enable us to live young for a lifetime.

So looking at relationships. And then looking at things like spiritual health, right? Every study that's ever been done shows that people that feel connected to something greater, do better. They live longer, they're happier, they recover better in the ICU. Study after study after study.

So where are people in terms of their own spirituality? We're not interested in religion, per se, but spirituality is very powerful.

And then, you know, this idea of wisdom, ow much wisdom are people developing? And the reason wisdom is important is because when we make great decisions for other people, as well as ourselves, as well as the community, as well as the nation, as well as the planet, when we make those wise decisions, we feel so good about what we're doing. We feel so connected. And that also pays big dividends back to us.

And then one of the other things that's super important is feeling safe. A lot of people don't feel safe. And I think that all anxiety, all depression, fear, anger, most of those things, if you if you really start to dissect it back, peel the onion, back at the center of it is not feeling safe. And so then the question goes, Okay, well, then how do I feel safe?

Well, the first thing, you have to realize that there's nothing external to you that can ever make you feel safe. There's no amount of money, there's no position, there's no set of relationships, all of that can be taken away. History has shown us that everything can be taken away. So how do you ultimately feel safe?

There's another thing here about self love also, right? A lot of people are hard on themselves, they beat themselves up, they don't have unconditional love for themselves. So unconditional love for yourself is an inside job and making yourself feel safe is an inside job. And we help people walk through this and and develop these areas to where they actually change their perspective on life who they are, how they go through life.

It's transformative for them. It's really cool. And and having a sense of purpose and feeling worthy of all this. A lot of people will go around feeling, "Well, I'm not worthy. Why should I invest dollars into myself? Maybe I should give that to the church or give it to this school or whatever."

And yet, people are worthy. And what we love is that our people, as they feel so much better and act so much younger, their ideas flow, they start new companies, new businesses, their contributions to the world go up and up and up. It's a really spectacular return on investment for them.

So that is life energy. Then we go through a whole longevity circle, where we break down all the metrics related to the drivers of aging, the hallmarks of aging that people have heard about.

We're up to 16 hallmarks now. I won't rattle them all off here, but I wrote about it extensively in the book. And we have ways to measure most of those at this point in time. Not all of them. But all but about three or four.

And then there's then there's health, the health circle, so all the different organ systems, brain, heart,liver, kidneys, hormones, thyroid, muscle, bone, eyes, ears, gut, all of it. Everything is looked at in there so we can understand what's going on.

And then when it comes to performance, that's the last circle. Our goal is to be fast, agile, strong, quick, balanced, with great cardiovascular endurance and great recovery and flexibility. So if you're going to be if you're going to have that level of performance, then you have to train for that, right?

When you're 18, you can go for a run and lift some weights, and you're pretty good to go. But that's not how it is anymore. Every decade, you have to keep changing the way you work out.

You know, if people are married to the way they work out, like, "This is what has always worked for me in the past," okay, that's great. But you know what, as you go through life, making some modifications here will get you even better results. And train your nervous system better.

Most people confuse working out with training their muscles. What they're really doing is training their nervous system. The muscles come along for the ride. But you're really training your nervous system to be fast as well, strong, quick, balance.

When you start lifting a weight, for example, the first thing you're strengthening is actually the nervous system, the nervous impulses, not the muscle itself. So you're really training the nervous system.

And then being able to access flow states and things like this, where you can go into a state of flow, which is like meditation, basically an action, and you can live your life from that space. We have we have people that just just skyrocket through things that were holding them back, when you put all these pieces together.

So we're really married to this question of, how good can you be? How much contribution can you make? How many opportunities can you access?

And so our ideal client is someone with whom that message resonates. That would be our ideal client.

John Bejakovic:

So when you were talking about the the first circle, about life energy, it got me wondering, how do you actually work with people? So they come in for a consult. They do some tests. But this sounds like it's a very ongoing feedback system. Just walk me through how you would actually work with somebody who comes and says, "Make me as good as I can be." What does that look like?

Dr. Jeffrey Gladden:

So there are different surveys that we use for people, We can do different surveys to tease out things around the anxiety or depression or fear or trauma or things like that. So we can sort of tease those things out via some of the surveys that we give.

In addition, some of it's just very conversational. Just talking with someone, right? If I was asking you, it'd be like, well, let me let me understand better how you're thinking about this or feeling about there. So explain to me what what's happened. So it becomes conversational, where we really get to know the individual, right.

And then we can work with therapists of different varieties, whether it's PT for your shoulder, or whether it's a psychotherapist for your psycho-spiritual wellbeing.

And then we have technologies we can use to augment brain function and decrease anxiety and decrease depression and things like that. So there's different technologies that we use for that as well as different supplements.

And, and then ideas about self love and feeling safe. Those are ongoing conversations. Those those are the kinds of conversations at first you have to be asking the question, "How do I feel safe? How do I give myself unconditional love?"

Once you start asking the right questions, then we have continued conversations about how to do that. I had a couple of nice conversations with people last Friday around these very topics. Some things have come up in their life that are challenges.

And so when the challenges come up, it's like, "Well, I'm now back reading your book again, section one about life energy, because I'm finding it very inspiring."

And I said, "That's great. Let's talk about that. Tell me a little bit about what you're thinking and feeling here." And then from there, I was able to coach them around. "Okay, well, I'm seeing where you are. Now, this was the next things I would start to think about. And I would start to implement it in this particular way."

And that rang very true for the individual, for both of them, actually. And so we we try to allow people to take action and steps that they can. You can't take too big of a leap in these areas, but it's conversational. And so over time, that's how we work to optimize it.

John Bejakovic:

Got it. Okay, when I prepared the questions that I wanted to ask you during this call, I had a number of standard categories of longevity interventions, things like diet and exercise.

Now that we're talking, I'm not sure to what extent it makes sense to ask you about those because it sounds like what you do is very customized to individual people based on what their needs are, what their test results show.

That said, does it make sense? Can you go through these categories? Can you give me recommendations that you've seen work?

Dr. Jeffrey Gladden:

So let me just tee this up for the audience here. You know, if you have these four circles, right?

There's a circle around all the other circles. That's the life energy circle. Inside that circle is a Venn diagram of the other three circles, where they overlap with each other.

And there is no doubt that exercise and hormetic stressors, like saunas and cold plunges, and things like meditation, and things like eating the proper foods that are good for your system, and the variety of foods that are good for your system, maintaining nutrient good nutrient status, exercise, eating on a regular basis, but exercising in a way that's good for you on that particular day, that never goes away. That's always going to be central and core to this whole longevity equation.

But it's not enough. It's not enough. And so everybody that had exercised, ate better, slept better, decreased anxiety, learned to meditate, they all got older, too, right? They all got older, and they all passed away.

So we know that you can accelerate the aging process if you don't pay attention to that. And we know you can decelerate it if you do pay attention to it. But it doesn't solve the equation.

And part of the problem is that people have this perception that aging is linear. They think, "It's another year, I'm a year older, I'm not that much different." If they think they're in a linear process. But they're actually in an exponential process. Aging is an exponential problem. It accelerates so much more between ages 63 and 78.

Stanford data shows that the aging protein released into the blood is just massively increased over this time span. And so aging is anything but linear. And when you have a strategy of lifestyle, optimizing lifestyle, that is actually a great strategy, but it's a linear strategy to an exponential problem. And it will never crack the code.

So what you need is an exponential strategy for an exponential problem. So that includes all the lifestyle pieces, but then you also have to have all the longevity pieces, right?

Where you're going at the actual drivers of aging, you have to tease that apart, where is somebody relative to those hallmarks of aging, and help them move those back in time. Because those are independent. And sure diet and exercise has some impact, but there's more to be done there.

And then in addition to that, there's performance. Many people sort of take for granted their performance. It's like "Yeah, I work out."

"Okay, well tell me what you do."

"Well, I'm doing this and I'm doing that and I have a trainer, we do this."

And then it's like, "Okay, well that sounds great. Let's do some fitness assess assessments and see what see what things look like."

So we measure them for VO2 max and anaerobic threshold. How in shape they are, how good is their cardiovascular system? Because when you have a high VO2 max, which is your basically your body's ability to pump blood, how much blood can you pump every minute, you live longer, you're stronger, you're healthier, you get less cancer, less heart disease, less dementia. So having a high VO2 max is something to train for. And yet most trainers are not training for this right.

Then how do you deal with muscle loss as you age right? This becomes a more intricate problem. But there are solutions when you start to put hormone therapy with the right supplements with the right kind of training and the right days in the right sequence with the right peptides, you can actually build muscle at any age, you can build bone density in any age.

But you have to deconstruct the problem before you construct the solution is what we found. So, we really want to have people that are optimizing performance or optimizing the hallmarks of aging, then optimizing the health pieces, which includes the lifestyle pieces, but then that life energy circle, having that equanimity, having that sense of calmness, and peace, because stress just sabotages the biology.

We all know this. So you have to have all of that, when you put all that together with one other piece, which is basically constructing and architecting the environments that you reside in to support the mission. That's the fifth circle, let's call it.

We all live in four environments. We live at home, we live in the office, we live on business travel, and we live on vacation. And architecting each one of those environments to support the mission so that it's as effortless as possible, to do your workouts, to get the good sleep you need, to access the food that you need. Making those environments work for you, instead of trying to work against you becomes really important.

You know, we have people that that come in and say, "I was doing great. I was doing fantastic. I'm making all kinds of progress. And I went to Italy for three weeks, and the wheels came off."

So you see, if you're not intentional about this, where you're really architecting all these environments... my idea of going on a vacation is to come back stronger than when I left. Not weaker than I left. So that's kind of how I think about it.

John Bejakovic:

A lot of the stuff that gets talked about in terms of longevity is either very exciting, scientific research that's not really ready to be applied to humans yet, or there's a lot of lifestyle advice that's been around for a long time that's maybe gotten incrementally updated, but it's not drastically different from what we knew, let's say, 5 years ago, 10 years ago, maybe even 20 years ago.

In between that, I heard you mention different interventions that people might not know about, that are cutting-edge longevity treatments, that go beyond diet and exercise, and that are pointing towards things that are coming in the future. Can you tell me some of the stuff that you do with your patients that fall into that category?

Dr. Jeffrey Gladden:

Yeah. So let's just focus on the longevity piece for a second. We're gonna bypass health and performance and just focus on those hallmarks of aging. So, you know, we have to measure telomere lengths, and there are ways to really lengthen telomeres also, that we're working with.

We have ways to measure the age of someone's immune system. You may have heard that immuno-senescence is a big problem, that when the immune system ages, it can no longer recognize foreign invaders or cancer cells. And so doing things to actually reboot the immune system, make it younger, less senile, so to speak, and then increase its activity, in appropriate ways.

We have strategies for all that — different supplements, different peptides, different protocols. But again, we measure directly to see where somebody is, before we do anything.

And then, we can look at changing DNA methylation ages. A lot of this is done through lifestyle changes for the most part. And you can significantly impact your rate of aging by lifestyle changes. Glycan age is another age that we measure, which has to do with endogenous blood sugars that are attached to antibodies. These are sugars that your body makes. It's not sugars that you're eating. Sugars modify proteins for different functions, so that protein can function in different ways.

And there are patterns of these sugar attachments to antibodies that basically are associated with aging or with youthfulness. And it's possible for people to be decades younger and all these areas right.

And then we have panels that will look at inflammatory markers that typically go up with with aging and things like klotho. We can measure klotho. Klotho is a protein that when it's elevated, it decreases cardiovascular aging, maintains brain health, maintains kidney health, etc.

So things like this we can measure. We can look at DNA damage, we can look at other markers associated with with senescence cells and the accumulation of senescence cell burden.

And then we've actually developed another test, a transcriptomic and proteomic tests, looking at how DNA is transcribed and what proteins are made from it, that can look at things like cancer risk potential, what's the body's ability to handle inflammation and oxidative stress currently? What's happening with telomere shortening actively? Not what are their lengths, but are their ongoing processes that are shortening them?

You know, things like this. What's the senescent cell burden? How are the mitochondria doing? We have access to all of these through different lenses. So we can look at many, many of these hallmarks. So when you do that, then you can construct therapies. Of course, lifestyle will be involved. But there are things that go well beyond that.

For example, we can do plasmapheresis, where we remove old plasma from people, which in and of itself, has been shown to rejuvenate the body. Also because we're in Texas, we can couple that with the young plasma. So we can take out old plasma, put in young plasma, right now, that has the rejuvenating impact on its own as well.Those youthful factors in the young blood, like GDF11, will have an impact on the body in a positive way.

And then we also can use regenerative products like different kinds of stem cells and exosomes and PRP and things like this, that when you start to sequence these things, you get the best results.

For example, if you're just going to use stem cells, let's say, well, a stem cell going into an older individual doesn't actually do nearly as much as it can. If you first clean out the old stuff, put in good new stuff, then add the stem cell products and the exosomes, and then add in signaling peptides, that will actually help orchestrate everything to move forward.

When you do that, and combine it with lifestyle, now you're really getting changes, right? So this is really exciting. And then we can use something called brain frequency to actually rejuvenate people's brains, whether it's it's been from anxiety, depression, stroke, head trauma, PTSD, even addiction can be addressed this way.

So this is a transcranial magnetic stimulation device that measures the electrical strength of the electrical impulses of the neuron. So where they're weak, we can stimulate it with the magnet to actually strengthen that those neurons. So it takes 20 to 40 sessions. But over that period of time, the brain is tracked by an EEG every 10 sessions, we can see the brain getting stronger.

So these are cutting edge things. We can deconstruct dementia. We've been helping people enhance their cognitive abilities, their hormone function or sexual function. We have people that come into us on five blood pressure medicines, and six months later, they're on one medication and some supplements.

And the reason is because we've unraveled a knot first, what's actually going on with them? What are the cards that they hold? And where are they in the game?

And next thing you know, we have clues as to basically how to go about this in a more elegant fashion. And we get them back under control. It's very exciting work. We'd love doing this kind of stuff.

John Bejakovic:

Absolutely. Actually, I guess that we've covered a lot of what I wanted to cover. It really sounds extremely comprehensive. And it sounds like this is not something that people can be doing at home, and it's a good reason to come talk to you.

But that said, if somebody is at home, if they are looking to optimize their longevity, if they're not ready to come and work with you, do you have any advice to them beyond what they're reading about supplements and diet and exercise?

Dr. Jeffrey Gladden:

Yeah. I think grabbing a copy of the book 100 Is The New 30 would be really a great start. You'll find there's so much actionable information that I've put into that book. We're really trying to democratize the information. Of course, you don't have the benefit of actually working with somebody to deconstruct it for you. But you are getting lots of useful information. So that's number one.

Number two is we do have a supplement shop also where we sell supplements that we know are good and generally good for basically everybody or most people. It's broken down into different categories of things, whether it's gut health or brain health or cardiovascular health or immune support or GI tracts support gut support. So people can go in there and read about the supplements that we have, and make choices there.

And then the last way to actually access us, apart from reaching out to us, would be to go to the podcast, the Gladden Longevity podcast. I think we're coming up on 240 shows or something like that. So there's really a wealth of information in there on many topics that people would enjoy. So those are ways to access it from more of a generic standpoint, if you will.

But if people are really interested, like, you know, I've got a lot to live for, I really want to accomplish a lot in my life, and I'd like to invest in myself, then they can reach out to us on the website, and we can reach back out.

I will tell you that to work with us, to do all that initial testing is probably going to be the better part of $40 to $50k to get it all done, if someone's just, let's say, 65, to 80. Because they've got a lot going on, it has to be understood. But I will also say that everybody pays for it pre-tax. There are ways to run this through an HSA or a business or different ways you can talk with your accountant about it.

So let's say you're in a 40% tax bracket, if you're in California, maybe it's 50%, I don't know. But all of a sudden, if you take that and you've cut it in half, the return on investment is is so dramatic for the dollars that you actually put in. So we feel like it's an amazing value, quite honestly.

John Bejakovic:

And do people only work with you by flying into Texas and working with you directly? Or how does it keep going if if somebody's not from there?

Dr. Jeffrey Gladden: 

Great question. So medically, legally, we have to see somebody in the state of Texas to establish a physician-patient relationship. So they do need to come to Texas for us to be able to do that. And they usually come and spend two or three days with us to get all the testing done up front, and we go through results with them at that point.

And then from there, we can do a lot of it via Zoom. We do love it if they can come back in six to eight weeks when we get all the tests back, so we could spend another day with them kind of going through everything, showing them stuff, having them practice something so that when they go back home, they don't have to start implementing everything.

And we make it bite size, right? Like we're not going to try to fix everything at once. Let's start here, or move our way through it as we go through a year.

So when people do that initial assessment, that's kind of the launch module. That's really where we get all the basic testing, what cards you're holding, where are you in the game, and then make the initial recommendations.

Then people have an option. They can say, "Great, I'll take it from here, I really appreciate it." Or, "I'm gonna go work with my local doctor." Or, "No, I love the way you guys think. And I love the technologies you can give to me that I can't get elsewhere. I want to work with you."

At which point we'll sit down and build out a plan based on understanding now what they really need and build out a plan for the rest of the year basically, and do some things that way.