Biological & holistic dental adviceMercury free dentistry by Dr. VinogradInternational Lecturer on Biocompatible Dentistrybiocompatible dentist on youtubebiocompatible dentist on linkedin

Holistic Health & Nutrigenomic Profiling P4

Just support for the fact that metals especially aluminum inhibits the ability to regenerate BH4 and that’s why we worry so much when we see those A1298C mutations where we may have intrinsic problems with generating BH4 in addition to the presence of aluminum.

The reason aluminum is putting vaccines is that it helps to stimulate your immune system. But it can over stimulate the immune system. Aluminum also can play havoc on your lipid profiles and your phospholipids that are so important for membrane fluidity.  And in a little while  we’re gonna also talk about the role of the PEMT enzyme – that’s a new snip that  we’ll be looking at and how that seems to affect the membranes.  Also looking again at the role of aluminum and myelin, and we need to be able to read re-myelinate these nerves.

So taking a break from all the information again, just looking at some excretion of aluminum and again these are unprovoked metal tests, and all we’re doing is supporting the body to get around mutations in the methylation cycle as well as supporting the body to be able to deal with bacteria in the system as well as Viroqua.[00:43:18.25]

And so we’re looking at the excretion of a tremendous amount of metals by addressing and balancing the methylation cycle, as well as applying some of the techniques that we’re going to talk about in a few minutes to deal with the bacteria. And I spoke this morning and I’ve talked about before, plotting your excretion, looking for the bell-shaped curve, looking for what’s going on and when you’re at a sufficient endpoint. And I’ll just run through these tests very quickly, but again getting the metals out because leaving them in the system that’s where I think we’re getting the low muscle tone, seizure activity as well as the problems with language and cognition.

Now when we look at adults, and we’ve been working with a lot more adults recently on the chat group – it can take longer for an older individual and sometimes the amount of excretion isn’t as stellar as some of those black ones across the page that we saw just now.  But we can look at something more subtle and so here we’re dealing with an adult. We’re not seeing any aluminum over time okay. So from year to year we’re not seeing aluminum excretion at all,  Ok, nothing

At this point we added in a compounded mitochondrial support supplement.  And once we start to support the mitochondria we are starting to see aluminum excretion for the first time in years. And we are maintaining that aluminum excretion.  And even though it’s not as impressive as those black lines across the page, the fact that we had no excretion, and now we’re seeing consistent excretion supports the fact that you want to be looking at dealing with the bacteria in your system and supporting the mitochondria in the body.

Again dealing with the mitochondria – in this case will looking at a major increase in tungsten excretion – and if you look at the difference in creatinine and you account for those differences, this is probably more than a four-fold increase in tungsten excretion simply by supporting the mitochondrion in the body. Okay, so where are we at this point? Bacterial loads can be related to iron levels, we want to be paying attention to the SHMT plus.  Other nutrigenomic markers that  play a role in this gut environment in the swamp, ACAT, BHMT, A1298C.

Bacteria have the capacity to hold onto metals.  And when we’re addressing chronic bacterial issues we want to be looking at excretion of any number of metals on a UTN, a UEE, a fecal metal as well as a hair test OK.

And now I want to get into more  of the specifics of the interaction between  aluminum and the mitochondria and oxidative stress.

So the mitochondria are the energy producers in your body, they are what help to generate the energy for the ATP that your body needs to drive reactions, okay.  And they’re doing it by moving electrons back and forth through the cytochromes that we looked at before, but in the process they generate oxygen radicals.  And this energy cycle, this Krebs cycle that we’re used to looking out on a map test, is related to ACAT mutations because they can’t feed in,  and we need to be able to come from this cycle and feed in to this part of the pathway to generate the energy we need ATP to drive reactions in your body.

Thallium disrupts the Krebs cycle and affects ATP production and that’s why anyone who is running tester through our office when I see thallium I’m telling you to add ATP. When we’re seeing unbalanced amounts of sodium, potassium and phosphorus on a UEE,  I’m suggesting we need to look at more ATP because thallium may be a problem.

And so ATP and thallium have a…aah.. an antagonistic relationship. So when you’re seeing thallium you want to be thinking about ATP and the mitochondria and energy in the body okay.

Aluminum directly affects the cycle were looking at. Aluminum directly interferes with it,  so that we have a problem at this point in the cycle as a result we end up with additional oxidized species and the TCA cycle isn’t working correctly. Which means we can’t generate the ATP that we need, so that when you are looking at one of those tests that show you what’s going on in the cycle, if you’re finding lower numbers here and higher numbers here, one of the first things you want to think about is aluminum toxicity.

Okay so again, we have that cycle where you still looking at. We need to feed in to this pathway in the mitochondria so that we can bounce electrons back and forth across this membrane, generate in energy potential and in doing so, have ATP that we need to drive reactions. And in doing so we generate oxygen, which can create oxidative stress and damage if we don’t have sufficient antioxidants in the body. And the same thing that goes on in our mitochondria is what goes on in bacteria and this is a nice graphic to help to show you that. We’re moving back and forth through this membrane.  We generate that membrane potential, and that’s what drives the energy for that ATP that we need to drive reactions. And so when you go back and you read that Times article that came out this week and they talk  about the voltage gated calcium channel and seeing a higher prevalence of that snip in that mutation in autistic boys, what they’re talking about is something very similar to this for calcium, that that voltage gated means using that kind of energy and that kind of potential, in order to control calcium in and out of the body.

And so the way we measure this energy and evaluate it in mitochondria, is the same as what I did twenty years ago measuring this energy  and bacteria.  And so we’re looking at very similar problem whether we are looking at microchondria or  looking at bacterial at this energy gradient and actually how it impacts on uptake of glutamate into the body, okay. And so looking at the membrane potential’s and how they play a role in transport and antibiotic resistance and bacteria and energy generation.  And so just another graphic to show you that in the mitochondria we’re generating oxidative damage in the process of having this energy potential that helps for transport, into the body and you want to be using antioxidants, whether it’s melatonin or whether it’s  CoQ10, [00:52:31.22] or whether it’s NADH, to try to help to pull the oxidative damage down.

And so mitochondria are major source of reactive oxygen species and are particularly prone to oxidative damage okay.

Going back to BH4 again, we want to be thinking about the fact that the relationship between the ability to have adequate BH4 levels in the body, the A1298C mutation,  if we have aluminum and it affects our BH4 levels, and when we want to layer in hyperbaric oxygen. I’m not averse to adding it in to help with anaerobes, but we want to be thinking about when is the best time to be adding oxygen to the system. My personal preference is look at  a CSA.  Let’s get it  a clean CSA, let’s get rid of the bacteria that may be holding onto some of this aluminum, let’s pull the oxidative stress down, let’s get rid of the aluminum so that we can repair the damage, and then let’s look at adding in a little more oxygen to deal with the anaerobic bacteria.

And just a slide to reiterate and remind you in case you haven’t seen it before I have forgotten that the amount of BH4 that you have in the body controls what type of species in terms of reactive oxygen molecules that you’re going to have. And so when you had two molecules of BH4 we handle these radicals very efficiently.  But if we only have one or we have none that’s when we’re generating some of these very dangerous radicals that then cause neural damage.

And again whether were talking about an aging system  or a  damaged system that the mitochondria in the process of generating the energy they need, cause these free oxygen radicals that can play a role in  aging, and in the case we are looking at, making it more difficult to be able to get rid of heavy metals from the body. And this was a very nice visual and science recently mitochondrial gone badly.  And the counter side of mitochondria that we need them to be able to generate energy but in doing so we’re generating these oxygen radicals and so we need to this energy, we can’t survive without ATP and we need to be able to move these electrons back and forth to get that membrane potential.  But in doing so we’re creating oxygen radicals which layer onto the problem of the aluminum that’s already causing that oxidative stress and nickel.

And if we look at the ability of nerves to be able to grow the way they need to. We are looking at what happens in the absence of antioxidants versus the presence of antioxidants.   So mitochondria and the oxidative stress can be a key to getting some of the repair we need,  and the importance of the use of antioxidants and controlling this oxidative stress and getting rid of the bacteria they’re holding onto the aluminum and other problems that they’re causing with respect to oxidative stress.

And so again going back to the schematic we want the TCA cycle functioning properly and aluminum can inhibit that directly. We need to be able to generate this energy. And when do so, we create oxygen free radicals that we need to be in a position to deal with.  Methionine directly helps to deal with oxidative stress. And I can’t tell you how many UAAs I’ve looked at where methionine is all the way to the left.  We’re way too low on methionine. Methionine is right in the middle of the methylation cycle that we look at all the time. If we’ve got mutations in that cycle, especially in a  case let’s say where  we have a CBS up regulation, and all the intermediates of our  cycle are draining out through taurine. Methionine is essentially in the toilet. So if we’ve got aluminum, and we’ve got oxidative stress and we’ve got no methionine we’re in a position where we can’t even deal with some of that stress. That’s why again I’m not spending a lot of time in the genetics today but what I’m assuming is you’re gonna look at those mutations, you’re gonna bypass those, you’re gonna support that cycle so we can get those methionine levels where we need them, and if simply bypassing mutations alone doesn’t get us there, then we want to be supporting with low doses of methionine or using some of that methionine  RNA.  Get those levels up there because methionine is so central when it comes to oxidative stress.  And in a few moments I’m going to give you one of those things when you… one of those light bulb moments… when you look at it and say, “Where does the sky end?” and just believe me that methionine is so critical basically for life itself, that we really need to keep that cycle  in balance as well as the role that it’s playing for oxidative stress.

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The Lower Denture Nightmare

denture painHello, this is Dr. Daniel Vinograd, biological dentist in San Diego, California. Today, I’d like to speak about something that’s dear to my heart. I’ve been practicing dentistry for over 30 years and there are a lot of pains in my work that give me great satisfaction. I’m very blessed that I can say that I really, truly love what I do.

But one of the things that brings the most satisfaction to me is to help people who have dentures – lower dentures in particular.

I believe that a lot of people don’t really understand how challenging a lower denture is. When people sometimes get tired of having a lot of cavities, gum disease, sometimes they just want to “get rid of the problem”, get the teeth out and get some dentures on.

Of course, today, that’s becoming less and less of a problem, but we still have a large number of people out there with dentures that are struggling with them.

Now, why lower dentures? There was actually a dentist that used to say, “I usually charge only for my upper dentures and I give my lower dentures for free because inevitably, patients come back with great problems with their lower dentures.”

And so why is it that lower dentures are so much more challenging than upper dentures? Well, a properly executed impression and a properly done upper denture can achieve in most cases a good seal especially if the flanges on the back and the post stem on the denture is well-secured.

Once we get that suction in that upper denture, if you really think about it, the upper denture really is going to be suctioned up to a non-movable arch. The arch is really part of our skull and our skull is not really moving at all. Actually, when we chew, when you think about it, it’s really the jaws, the mandible that is actually doing all the movement and all the work.

So having said that, we can easily understand that the part that’s constantly moving is the lower jaw. In addition to that, we have the tongue, which actually tends to move the floor of our mandible up and displaces the denture.

So between the jaw moving and the tongue moving and having less surface for that denture to create suction on, plus the great re-absorption of the bone, we really have a very, very challenging situation.

The latest statistics that I’ve read is that 90% of the people that have lower dentures are very dissatisfied. That is not the case for upper dentures at all. For most of other dental work, not even close.

So I would say this is probably the most challenging piece of dentistry that a patient can actually use that will cause patient dissatisfaction.

What is the answer? Today, we can actually place implants. Implants can actually change the quality of a person’s life.

Two challenges with the implants, two problems that we have with the implants, one is the cost because in order to place fixed restoration with the lowers, we need at least four large implants (if not more) and a soft structure and then the bridge.

So we’re talking usually tens of thousands of dollars to get this done if not more depending on the circumstances and where it’s done.

The other challenge is that often enough, there’s not a lot of bone in the mandible area. And so that creates a challenge to place the implants. So that leaves us with sometimes very little to work with.
In the recent past, smaller implants, smaller diameter implants have actually been used for actually securing a lower denture. By actually using the denture and creating a situation where we can actually snap the denture into a fixed position, we can actually not necessarily get rid of the denture, but make it so that the denture is no longer challenging.

overdentureI have to say that this is one of the most satisfying things that I have done for patients where patients come and they are so exasperated, so frustrated with their lower dentures, unable to have really a decent quality of life. Once we secure that lower denture, the look on people’s faces, their ability to function again, their ability to chew is just heart-warming.

So once again, if you have a lower denture, you are challenged by the denture and the quality of your life is not great, think about going to your dentist and asking about the possibility of having an over-denture made for you.

Obviously, you can always explore the quality of your bone and the quantity of your bone to see if actually fixed prosthesis can be placed. But if the finances or the bone are problematic, you no longer have to just sit and suffer.

I hope that was helpful. All the best to you from San Diego, California, Dr. Daniel Vinograd.

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Holistic Health & Nutrigenomic Profiling P3

Do they have the PowerPoint in like a book…?  they are on a CD okay.

I will probably upload these also by the way so that you don’t have to don’t go crazy trying to write everything down.

Okay so what we showing here is,  you’re not seeing much excretion here on urine toxic metal. As I spoke about this morning, when I am supplementing B12 and I’ve talked about this in the past but I’ll reiterate if briefly now. We are looking to see a black line of cobalt across the page when we have sufficient B12 in the system in my estimation.  Once we hit that black line across the page I’m looking to keep the B12 at the same high levels.  And I reiterate this because we had a question recently where a parent had a couple of B12 someplace  and said “Okay am I done, can I stop with B12 now?”.  No. Once we have this black line we want to keep that level of B12 in place, support with the antioxidants. I’m awaiting to see the black line go back to baseline while we still stay at the high levels of B12 support.  And so generally,  if I am seeing a black line across the page, at that point I’m expecting to see excretion.  But this UTM isn’t showing me much. And this UTM from the same individual isn’t showing much. So at this point we shift over to hair test  and fecal test during that same time period. Clearly we are getting excretion, we just weren’t seeing it via the  urine excretion tests. And similarly with the hair elements were seeing a lot of excretion, and so what I’m saying is look at a number of factors if you’re getting a UTM and you not seeing much and you are discouraged. Look at your UAA, see if you have markers that are indicating detox is going on.  Look at the cobalt levels see if you have sufficient B12 in place. If you do,  and you’re not seeing anything, it might be time to look at a different form of excretion, particularly as we’re talking about today.  If you’re dealing with gut microbes, if you’re working on the bacteria; if your secretory IGA levels are dropping,  I’m generally suggesting go do a fetal metal at that point because that might be where we’re seeing the excretion.  Alright, we are going to take a moment and then shift to Part Two.


Alright so we’re going to shift now specifically to aluminum.  Why I worry so much about aluminum, the relationship of aluminum to bacteria in the body.  But again just to take a moment and reiterate:  We want to pay attention to iron – even a little bit of iron is not a good thing as far as I’m concerned.

We want to pay attention to the genetics.  What snips are we dealing with? What do we need to bypass those snips?  What do we need to do about the general environment?  And we’re not just talking about aluminum as you just saw on those UTMs.  Any range of etals can be excreted. Now many of you have probably seen this particular slide before that steff,  but I don’t forget simply limited to steff will in fact retain and take up aluminum in the body. And based on some of the other references we just saw, I think you can be confident that a number of other bacteria can take up aluminum as well as other metals.

We know that long-term aluminum feeding can affect acetylcholine levels and there was worked on years ago looking at imbalances in acetylcholine levels in autism. Aahm… it inhibits the activity of acetyl cholinesterase, which means some of those acetylcholine levels can climb too high and some of the consequences acetyl cholinesterase inhibitions were seen most markedly in Gulf War Syndrome, but also in a number of other conditions.

Some of the kids who problems with tetanus toxin and reacted poorly to DPT’s. I’ll touch on that again briefly, because we’ve talked about it before and there’s a lot of new information I want to cover.  But looking at the effect aluminum may have to exacerbate some of these other issues.  And in terms of acetyl cholinesterase inhibitions some of the kinds of things you might see, including bladder issues, muscle weakness, and that in fact I think ties back very much so aluminum toxicity in the body.

Aahm, if we look at the effect of aluminum on oxidative stress. And I touched on this this morning in the doctors workshop but we’re gonna look at this probably in more detail than most if you want to in a few minutes.

The role the mitochondria in the body – The mitochondria are the energy center in your body. They are what help to drive reactions and transport and generate the energy you need.  But in doing so it creates oxygen radicals and oxidative stress, and your body needs to be in a position to offset the oxygen radicals that are generated from the mitochondria and balance that where certain compounds in the body that you really need such as glutathione, won’t stay in the reduced form.  If glutathione becomes oxidized it’s not going to give you what you need.  And so we’re looking at this balance between oxidative stress and oxygen generated for mitochondrial energy and needing to keep the system and balancing a reduced form.  And what can tip the scale is added pressure on the system from something like aluminum that can increase the oxidative stress on the body.

And so what we’re looking at here is, that the amount of oxidative damage that you’re seeing in the presence of aluminum, is a lot higher than if there’s no aluminum present. And if we look at the level of reduced glutathione, it’s lower than if there’s no aluminum present. And if we look at other species of glutathione, in the presence of aluminum versus the absence of aluminum you can see the difference.  And catalase, which is another enzyme in your body,  in the presence of aluminum versus the absence of the aluminum. So aluminum is having a direct effect on oxidative stress in the system, essentially making it worse and perhaps tipping the scales so that we can’t keep the body in the balance we need. And so we say that aluminum is causing oxidative damage basically. And it can promote biological oxidation, whether it’s in a test tube or in a body okay.  And so this is why we’re focusing so strongly on aluminum as well as those other metals and looking at that relationship between the bacteria in the body and the ability to hold onto that aluminum., which then tips the scales for the oxidative stress, so that instead of staying in balance,  we’re falling out of balance.

And the use of antioxidants – I am giving just this one example about how melatonin can play difference. And so if we look at in the presence of something like melatonin – this is your oxidized form of glutathione, and when you add melatonin, look at how that oxidizes form goes down okay. So let’s just look at this again.

Oxidized glutathione which is not the form that we want it  in. And once we add an antioxidant – in this case it’s melatonin – you can pull the level of that oxidized form down.  So we want to be very conscious of the antioxidants we’re adding and keeping that system in balance.


In the mitochondrial membrane, [00:36:35.24] the way that mitochondria generate energy is through this series of reactions that occurs in the membrane with the cytochromes. And when it’s generating this energy the ATP we need to drive reactions in the body, it also generates oxygen, okay. So it’s a series of reactions, that give us the energy we need we have to have this happen. But at the same time, it is generating oxygen that can create damage in the system. And then that is exacerbated in the presence of something like aluminum. And whether we look at melatonin or another antioxidant, its role is to help us to deal with these oxygen species and to be able to reduce things like glutivian back to the form we need.

NADH is another key intermediate that helps us to deal with oxidative damage.  And so just looking at it another way, if we’re looking at the energy  in that membrane, and I’m going to go back over that in a minute, particularly because it’s very tightly tied to the newest snip that’s been found for this voltage gated calcium snip in autism.  You’re looking at the energy potential to drive reactions, and if it’s a young individual, we have a high level of energy. As you age that goes down and that has a lot to do with oxidative stress. When we use an antioxidant such as melatonin we can get that energy potential, that energy generation in the membrane back to where things were in a younger individual.

Now it’s not just aluminum that can create additional oxidative stress.  Nickel can also cause that problem and often times I’ve mentioned in the past that we see excretion of nickel before we see excretion of mercury.  We’re not only interested in nickel as an indicator that mercury might flow next. But also the fact that we’ve got that much nickel in the system, how much more oxidative stress are we creating on top of that from aluminum.  As well as what’s naturally generated by mitochondrial function. [00:38:59.21]


Aahm…biofilms have been a hot topic in autism for a while, and if we look at the ability to form a biofilm, okay, if nutrients are depleted we’re going to have more biofilms but in the presence of oxidative stress the ability to form a biofilm is going to be a lot greater than in a mutation where you’ve removed the ability to form a biofilm, okay.

So to summarize so far, because I know it’s a lot of information in a short amount of time: Aluminum can contribute to oxidative stress,  mitochondria themselves generate  oxidative reactants.  There’s a Catch-22, we’ll get to that in a minute, of the effect  aluminum  on the TCA cycle, the energy cycle. Because aluminum inhibits points in the cycle as well as the fact that it increases oxidative stress. And so basically aluminum is helping to cripple the activity of the mitochondria in my opinion. And that’s part of the reason I think we see some of the seizure activity and low muscle tone when we have aluminum toxicity. Nickel can increase the effect of oxidative stress, we look at the positive role of melatonin and other antioxidants and again where our focus today is on the gut bugs, the role oxidative stress can have  on increasing the likelihood of having biofilms in the body, okay. So now,  going back to the effect… other effects of aluminum on the system in addition to oxidative stress.


We’ve talked about before the gluto aluminum interferes with much glutamate dehydrogenase. Why do we care about that?  If  we can’t move from glutamate to alpha ketoglutarate, we can’t feed into the Krebs cycle but now we’re stuck at glutamate. We’ve  talked about the consequences of excitotoxins and glutamate at length before.

Aluminum also inhibits the activity of  an enzyme that helps to regenerate BH4, and if you recall we need BH4 to make serotonin, we need BH4 to make Dopamine. So our neuro transmitters depend on BH4. Also adequate BH4 is necessary to be able to deal with oxygen radicals in a healthy way.  And so again another one of these Catch-22s. Aluminum creates havoc  such that we have more oxidative problems, and in addition it inhibits the enzyme that makes the compound that might help us to be able to deal with these oxidized species.

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Holistic Health & Nutrigenomic Profiling P2

­­­­­Okay so we’ve  talked about before that viruses and bacteria are two types of microbes you can have in your system.  And both of them can create a situation where you’re retaining metals in the body. Now focusing first on the bacterial issue in part three of this talk today we’ll talk about virus. Where is the bacteria coming from? It could be a maternal streptococci that is transmitted to the infants at birth. It could be related to SHMT, A129AC, AC18 mutations, decreased gut pH, antibiotic use, lack of normal flora, problems with gut pH and stomach acid related to lack of B12 and some of the mutations that require higher doses of B12 or SUOS’ lack of bile related to some of the other mutations;  methylation cycle mutations.  So if we don’t have a methylation cycle properly supplemented and we don’t have adequate immune responses, regulating what’s self, what’s non-self; what’s an invader and how do we react to it.

So starting first as I said with a role of iron. And we’re gonna go through this pretty quickly because the bottom line is iron increases bacterial virulence.  As I spoke about in the doctors workshop this morning when I’m looking at a UEE I don’t want to see any iron on the UEE. If I see iron I am suspecting an SMHMT plus situation that I’m going to find that snip.  Sometimes however we’re not SMHMT plus, but we are seeing iron on the UEE and just know that that iron can increase bacterial virulence. And so what you got your number of references supporting the fact that iron does in fact increase bacterial virulence. And some specifics that a lot of the types of bacteria that we’re used to seeing and having problems with whether it’s strap, whether it’s eccoli,  whether it’s staf…aahm…Pseudomonas,  that iron increases bacterial virulence.

Clostridia which is such a problem for so many other children.  Even parasites; and you’ll notice when you start to run some of the DNA stool tests that a lot of those same kids who’re coming up positive for anaerobes are also coming up positive for parasites.  So we’re looking at this interaction between iron, microbes and the SHMT status.

Now Ferritin is a compound in the body that helps your body to move iron around and hold on to it properly. Work has shown that there is a connection between ferritin and the ability of your body to take in and use foliates and also to help to regulate certain aspects of the methylation cycle in particular the SHMT mutation. And so what we find is that when we have high levels of iron it increases the activity of this enzyme. And the net result is to pull the cycle that methylation cycle we looked at earlier away from the production of methionine. And we’ll talk about methionine a lot today and the central role that it has in helping to reduce oxidative stress. Pulling you away from methionine, away from some of the other intermediates like SAMe and the other building blocks that we need and towards this portion of the pathway which is going to increase thymidine synthesis, but decrease your level of SAMe, decrease your level of  5 methyl THF. If you’ll remember if you have a C6 717 mutation we’re already having trouble generating that, or if we have some of the MTR – MTR are mutations – we’re having trouble moving from five methyl THF to mathianine.  And so when we have iron present. Especially in addition to an SHMT plus status we’re shunting our cycle towards this portion of the pathway and away from some of the areas where we need  for healthy function of the system.

And so what you want to be looking for is even subtle levels of iron on a UEE. And so it doesn’t have to be a lot, but if we are seeing SHNT plus any iron on one of these tests is something that I’m looking out for. Also something that I mentioned this morning in the doctors workshop,  if you’re looking at seeing even just a very low-level of iron, but your creatinine level is high remember that the creatinine level is the number you’re dividing all of your values by on one of these tests. So if your creatinine is sitting up around 150 you’re dividing by a big number, therefore even a little bit of iron is more meaningful because if you creatinine were down at 25 like we will see on some of other tests later, you’ll be  dividing by a much smaller number and that value would be higher.

Again we’re look at the SHNT plus and we’re seeing iron. And again…and what I will try to do today as I hit you with a lot of scientific information is,  interspersed with  data,  to break it up a little bit but also to give you something you’re familiar with and that you used to looking at so that you can be looking at your own test at home and seeing if you see some of these patterns again. Okay so just emphasizing to you the importance of iron and  virulence looking for iron on  your urine essential aliment test especially if you have an SHNT plus status. But even if you don’t,  you want to be looking for iron because if  we’ve  got iron; I am concerned about gut bugs.   If we are seeing iron on a UEE , I want to see a CSA to see what’s going on in the gut.

Okay, so SHMT plus may relate to iron levels.  Iron can relate virulence and the bacterial load.  So now we’re going to look at the role of this increased bacterial load on metal accumulation in the body, how it plays a role. And again if we’re seeing iron or SHMT plus I’m worried about what’s going on in the gut, run a CSA or a similar test. Sometimes I’ll get a file and the CSA test in there is two or three years old. I think that’s way too long to wait for new test.  I mean frankly I think people should to be running CSA tests and,  if needed,  DNA stool test at the very least once a year, more likely at least twice year or more often than that. The role of these bacteria in the body is so critical and knowing what you’ve got and knowing whether or not you’ve pulled that load down, you don’t want to just assume that everything is static for three years or even a year frankly. [00:21:36.23] Interviewer:


So uptake of metals by bacteria.  A lot this work was done years ago looking at the ability to use bacteria to break down oil spill.  Some of the original work was done it got to be 20 years ago by (Inaudible)… GE, looking at the ability of bacteria to break down oil spills. And so much of that data supporting and proving that bacteria do in fact accumulate metals comes from some of the environmental work. And if we look at the number of different bacteria and the different types of metals that they can accumulate and the different mechanisms that they have to retain metals in the body, you can start to see why I keep going back to this “look at the gut, let’s get the gut clean”, because if we’ve got a swamp and we got bacteria in that swamp we are going to be having metals.  And if you look at just the different ways that the bacteria have to hold onto all these metals in the body, sometimes people will say to me “Well, where the metal coming from?”   Well they are coming from inside.  That every one of these UTMs,  fecal metals,  hair metals that you’re seeing, these are metals that are trapped in the body helping to create havoc and the goal is get them out and part of the way to get them out is to be able to address these microbes in the system.


We can even look at…I mean…you’re looking at pictures of Pseudomonas that’s actually accumulated heavy metals. These are electro micrographs to show you bacteria retaining metals within them. Okay.  And it’s not just… you know whether it’s lead… whether it’s aluminum and we’ll talk a lot more about aluminum later, but many of these metals that you’re seeing excreted on the urine toxic metal tests in fact you can actually see these organisms holding onto metals. Okay.  And it’s scary to think that when you look at a CSA  and can you see pseudomonas of four plus, and we’ll look at how we address some of that in the next talk, that this may be part of what’s going on in the body.  That…that it’s just not “Oh there’s some bacteria but”… but it’s a much more complex and dangerous situation.  I mean you know just look at the amount metal in some of these microbes.  Okay.


So if we look at the relationship between lead accumulation and bacterial concentration… I mean it is definitely suggesting that bacteria interact with metals in the body.  And in the next part of the talk we are going to look at the structure of bacteria,  the difference between a gram-positive and a gram-negative bacteria; how they can hold onto metals differently and what different approaches we need to take to address the different types of bacteria.


And again just reiterating the point that heavy-metal accumulation by bacteria, the organisms and the kinds of metals that are proven to hang onto and in some cases up to 50% of the driveway to these bacteria can be heavy metals.

If we talk about gram-positive bacteria, many of you may not know the difference between a gram-positive and a gram-negative right now, but in another hour so you will.  And they have a very thick outer surface to them and that can easily (inaudible) [00:26:36.52] and hold on to metals.  Gram-negatives have two layers and though the metals there can get trapped in between those layers almost like a sandwich.  And so the techniques that we are using to address gram-positive versus gram-negative are not identical.  And I’ll give you some flowcharts later in the PowerPoint presentation so that you have some tools to be able to know again  how do we address specifically what we’re seeing.  So we’re worried about the genetics which we’re glossing over today, but we’ve talked about before there is PowerPoints about them before; the new book we will go over it and the workbook goes over it.  There’s the gut environment that I’ve talked about at length, but the swamp we want to clean up and then our focus today is specifically the gut microbes.

What do we have?

How do we identify it?

What do we do about it?

And why do we care?  And part of the reason we care is because of the ability to have metals in the system even to levels approaching 50% of the dry weight of the bacteria.

What we see clinically agrees with the concept that addressing bacterial issues can relate to the release of metals in the body okay. So we’re going to run through some tests that look familiar to you so that I don’t overload you with information but also to give you a reference point to be able to go back and look at your own tests. And look for some of what we’re talking about.  And so whether it’s lead, or mercury or cadmium, or thallium a tungsten – we talked a lot about thallium this morning in the doctors workshop with respect to ATP, and we’ll talk about that more  in terms of mitochondrial function pretty soon.

Again more cadmium, thallium so just a range of metals and I won’t belabor the point, just a visual that as you address the microbes in the body you can see excretion of metals from the system and most of the examples I just gave you were UTMs. For some individuals if you’re not seeing that excretion on UTM, and particularly if you’re seeing indications on UAA that perhaps detox is going on.  Then go to fecal metal, go to a hair test if the secret Tori IGA levels are very low on your CSA then at that point you might want to look at a fecal metal also.

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Holistic Health & Nutrigenomic Profiling

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My name is Jenny Kaylas and I’m a parent just like many of you.  I have two children.   My nine-year-old son was diagnosed with autism in 2004; and while his younger sister never received a formal diagnosis, we knew very well that she had many characteristics of autism as well.  I had those really sick kids, and over 30 medical specialists were unable to help us – unfortunately a story that many of you know all too well.

Our family started the biomed journey back in 2005, and like many of you in this room , the improvements we saw – no matter how big or how small – fueled our fire to continue to learn and help our children. Through this journey we have had many heroes and guardian angels some of whom are in this very room.  But here today, I want to acknowledge one special person who has been helping us reach the finish line in the autism marathon.  A person who has given us all the hugs and the hope we have needed to make recovery a reality. She uses an approach called Nutri genomics.  She brings a unique technique array of insight, scientific knowledge and clinical experience to her approach to autism and to other forms of neurological information. She holds a doctorate in Microbiology, Immunology and Infectious Disease; and she is widely recognized for her pioneering work with RNA. She has extensive research and clinical experience in both allopathic and integrative medicine. And since 2004, she has helped nearly 9000 families affected by autism.  It is with great honor and privilege that I introduce today, Dr. Amy Yasko.


Thank you very much.

First I want to thank Ed and Terry for the opportunity to be able to come here and speak today to all of you.  And we have a lot of information to cover today and so I’ll get started on and we’ll take some break in between when I will have to reload the PowerPoints for you.  What I’m going to focus on first in part one of this talk is the factors that play a role in chronic gut inflammation. What’s going on with the gut bugs, the role of mitochondria, the role of oxidative stress, how estrogen plays a role and how we’re going to integrate a number of the other pieces such as BH4 levels, tryptophan levels, dopamine into this picture of gut bugs.

In the second part of the talk what I’ll do is share some exciting new information about approaches to specifically addressing some of these gut bugs. And then in the third part of the talk we will look at some of the results we have been found using similar programs for chronic fatigue as well as addressing viral infection.


So, just to start out a little slowly before we really gain some momentum here with the number the newer concepts -  What I like to do is look at the situation that we’re   dealing with it with respect to autism as well as other neurological inflammation as a multi-factorial condition.  So there’s a number of factors that need to come together at the same time in order to create the condition that we’re looking at.  And so we’ll look at the role of environment, toxins, infectious agents,  as well as underlying genetic susceptibility that all are the pieces of the puzzle that need to come together in the right or the wrong way to have some of these conditions.

And as many of you who seen some of the DVDs in the past know,  I use what I call my Princess Diana example. If the car wasn’t speeding, if the paparazzi wasn’t chasing them, if she was wearing her seatbelt, if they weren’t in a narrow tunnel, if perhaps alcohol wasn’t involved.  If you could remove anyone of these factors, you might not have a tragedy.  And I think we’re dealing with a very similar situation when we look at autism as well as other adult neurological disease. And so, for any given individual what we want to do is break down the environmental component, the genetic component, infectious disease component and see if we can’t start to remove some of these factors or  lower the burden to have a condition be less significant, less severe and we can work our way towards recovery.

And so, again, we’re looking at nutrigenomics as a way to evaluate the genetic contribution.  And I’ve talked about that a lot in the past. I’m not going to go heavily into nutrigenomics today other than when I refer to certain specific mutations and how we look at supplementing or have may play a role.  We do have a workbook that is free, it’s in the back of the room or you can go to the booth and get one if you like and I know we have that information on DVDs if people would prefer to have it in the format.  The moms on our discussion group have helped to put this together and it will help to step you through the program, help to get you started in a more step-by-step fashion. The new book which is called “Pathways to Recovery” should be available within the next few months, and this is the workbook that goes along with it.  And so there are certain or more basic concepts that I’ve gone over in the past that I’m going to fly right by today.  And I would refer you to the workbook when it comes to some of the basics.

And so again, genetic susceptibility, we want a way not just to evaluate where the weaknesses are,  but also a means to be able to address it and that’s what the idea behind some of the specific supplement lists,  to bypass mutations in the methylation cycle and some of the newer compounded supplements to streamline the process to be able to bypass mutations.

And again I’m not going to go into detail today about the specific mutations other than when I refer to some of them… in the other parts of the top.  But most of you’re probably familiar with these pathways recognizing that the neutrogenomic tests we run look at imbalances in this pathway and then help to guide you in terms of supplement choices to bypass these mutations.  Aahm, usually we’re used to thinking of the single mutation creating a disease condition, yet in the case of autism it appears that multiple factors may go wrong simultaneously, and so it’s not a one-gene, one-condition situation.  And so that it may be that a number of biomarkers in the pathway are necessary in order to have the condition of autism.

Later aahm… in the talk, I’ll refer to… I don’t know if any of you’ve seen the recent article in the Times magazine this week looking at aahm,  specific mutations in the calcium voltage gated transporter in the cells and the relationship between the frequency of that snif and increased autism in males. And so we’re going to see that I…  Well it may not be a sufficient condition it may be a predisposing factor along with other mutations in the methylation cycle.

And so again just to reiterate that when we are looking at autism and when we are looking at the genetic component aah… multiple alleles or changes are what were looking at the same time and looking to address these simultaneously. So I don’t personally believe that there’s going to be a single autism gene per se.  I think we’re looking at a number of genes and pathways where when we have imbalances that occur at the same time it’s a predisposing condition for autism.  But what I’m focusing on today is assuming that you’re going to look at a genetic component, that you’re going to look at supplementing to bypass those weaknesses and we are going to focus more on the microbes in the metals and what we need to do to address those and how they tie back to some of the mutations that we look at.

And so just to briefly reiterate some of the…what’s this…?  Alright well, let’s skip the point.  AAhm… some of the snips that we look at that appeared to be very significant when we are looking at gut  issues are ACET SHM T some of the BHM T snap CBS and a 12986.  And it’s not simply individual imbalances that are an issue but sometimes the combination of imbalances.  And so I would suggest that if you do have your neutrogenomics in light of the conversation that we are going have today about the gut environment, make sure that you’re supplementing to bypass weaknesses and these genetic areas.

But when we look at the gut, and that’s what we’re really going to focus on today, there’s really three main factors that we’re looking at.

One is what I want to call the gut environment,  and as I referred to earlier in the doctors workshop this morning – Do we have a clean environment work or do we basically have a swamp? And what I’m looking at when I’m concerned about that swamp is the pH.

Thank you,  oh that’s excellent. Thank you very much.  Thank you.

Aahm, so when we are  looking at that gut environment, what we want to be thinking about is what is the gut PH  look like? What are the short chain fatty acids looking like?  Aahm, what other…how about the secret  OIGA some of the factors that were looking at on the CSA. What is the general gut environment? What are the genetics looking at some of these specific snips and are we supplementing to bypass mutations in those snips. And then finally, what are the specific microbes that we are looking at that are a problem?

So what I mean, and what we’re going to look at in the second part of the talk today is not just we are seeing markers on a map that suggests that we have some imbalances, but let’s take a look at that DNA stool test;  let’s take a look at CSA.  And I want to know specifically what gut bugs do we have?  Are we dealing with strap or Ecoli or Pseudomonas or Klebsiella and how are we specifically going to deal with those gut bugs in addition to getting rid of the swamp and bypassing the genetic issues.

And so in the past I’ve talked about the relationship between virus and the body, chronic viral infection and the ability of the body to hold on to toxic metals as a function of that chronic viral infection.  But what we’re going to see today is it’s not just a virus that can have this effect on the body,  but it’s also bacteria. That the bacteria can help the body to hold on to metals in a way that can create havoc in the system.  And so we will focus heavily on aluminum, because aluminum has so many effects on the system. But we are also going to talk about thallium and lead and cadmium as well as mercury, which we all know is an issue.

And so what we will start with, and I will make frequent stops in this presentation to summarize along the way. Because as opposed to the talks last year where was my first year to have the privilege of speaking at Autism 1 and where  I felt that I needed to lay the groundwork for the program for those of you who weren’t familiar with the program. Today we’re going to take off from that point and really not go over much of the groundwork at all. But I will stop frequently and kind of review where we are, what we’ve covered before we go on to the next bit of information.

And so today were going to look at,  initially, how iron can increase virulence when it comes to bacterial issues; why we are concerned about the SHMT plus mutation; how that affects metals; the effect on the mitochondria. How this plays role in seizure activity, oxidative stress how this feeds got into issues with BH4 levels and aluminum and the A1298 C snaps.  How this can then play a role on dopamine levels as well as serotonin levels?

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Health Leadership P13

My speaking tour was at plain tree hospitals or designated hospitals and it’s a constant challenge because you’re always going to get you really need a certain doctor and he has all the qualifications and she has all the qualifications, but there are good reason why some animals eat their young, and you’re always going to have some mean person that comes in and tries to tear it apart and comes at you and builds power, and I mean, it’s just the nature of that type of organization. Good question, though. Anybody else? Any questions? Think of something. Seriously, like the last four years were so painful to me I can’t even tell you, because your friends may come and your friends may go. Because I mean, it’s such a small area they’re all still here.

I mean, I go to the mall at Christmas and it’s like I get these darts in my neck. And I was nice, and then that was one of the interesting things about it. I think it’s harder to work for a nice boss sometimes. It really is, because I was nice, and so I tried to do this with dignity, but I got rid of forty-four people, and the forty-four people over that twelve year period that I got rid of were pretty much just all the same person, they just had different faces and different bodies. But the personality type was so similar that I finally went to HR and I said, “Look, why can’t we prescreen, why can’t we do a psychological profile exam so we don’t hire that person over and over and over?”

Because there are a lot of people like that person that go into healthcare. And it used to be when you think about when docs went into healthcare, it was purely because they were caregivers, but then healthcare became the medical industrial complex, and it’s big money. I mean, I had guys working for me that made a million dollars a year in Windber for twenty years. It’s big money for some of these people, and when you make a change that in any way impacts their home income, that gets real person. It gets real personal, so there were, I mean, I’m not going to go into all the details, but it was hard. It was very hard. And I was a change agent, and typically a change agent should leave after four or five years, but… Yeah, I probably would. I’d do it smarter, you know?

Would I do it again now though, no. I’m sixty-four years old, I don’t plan to go start another hospital and do it again. What else? What do you think? What was stupid to you here? What’s something that just outrages you, and you’re nuts? Come on, I can take it. What do you think was just completely nuts? You didn’t tell any difference. It was just like any other hospital. Oh, okay. No, don’t say that. Yeah. But see, part of that’s the Hawthorne effect. I mean, if you’re nice to them, they’re nice to you, they’re nice to your patients.

And I think that, not that people aren’t nice and I’m not comparing it, but I think that generally in hospitals, the climate is the military climate. It’s I’m the boss, kiss my feet, you know? And it really works in the military. I have to tell you, I recruited five people out of Walter Reed, and all five of them, it was just a nightmare for me because their culture was so different. One of the ones I recruited used to actually run Walter Reed, and so having a general work view, he was late the first day of work, and I said, “You’re late.” He says, “Yeah.” He says, “I sat in the back seat for twenty minutes before I realized I don’t have a driver anymore.” He was kidding, but it’s true. Anything else? Anybody else? Well, thanks. Yeah.

You know, that was an interesting thing. So there was this young MD by the name of Peebles, and he went to Harvard. Army. Full scholarship. And he went to MD Anderson to get his fellowship training, and we met him and were talking to him that day, and he said, “Yeah, I’ve been working on a breast cancer vaccine.” And I said, “Well what’s the idea?” And he said, “The vaccine identifies which protein is spreading the cancer, and you get this vaccine, and then your body builds up the antibodies so that the gene can still tell it to spread the cancer, but then the protein goes thanks, I pass. I’m not going to do it.” So you build up the antibodies to keep the protein from actually functioning in a way that it normally would, but the gene thinks it did. The gene tells it what to do, it goes yes sir, and then it doesn’t do it.

That’s the basic down to earth concept on it. Now, I don’t know if you’ve heard the latest update, but this was a single peptide vaccine, so it was based on a single protein, and so he said, “I’d like to try this vaccine.” So we set up an immunology center on the campus of [inaudible] hospital only because that’s where the building was available, put about six million dollars into this place, and we began vaccine trials at Walter Reed and in Windber. And it was one of those things where you think “That’s a nice thing for the locals, and hopefully it’ll work.” But understand that the way the trial thing goes is you try it on a couple thousand people, and you try it on ten thousand people, but then the big one is two hundred thousand people, so by the time you get to the two hundred thousand people one, you’d better have a pharmaceutical company that’s going to spend the billion bucks to do that.

So we start the vaccine trials, and all of the sudden, some strange things start to happen. I’m getting calls from the Holiday Inn, and we’re talking, and they’re saying, “Yeah, there’s this woman that flies in here every week from LA for her vaccine,” and I’m going, “What?” And there’s this other woman that’s coming in from Virginia, oh, and Dan Rather’s producer’s wife is coming in, and, you know, they go through this list of people that are flying in to [inaudible] from literally Canada, and we had one woman who came in from the United Arab Emirates. They were coming from [inaudible] to get these vaccines, and the common link from all of them is that most of them worked in breast cancer research labs, and they were tracking what was going on.

And so it was like for the longest time, we were having really, really good results. Now they have come up with multiple peptide vaccines, and this really feeds into the story, because our single peptide guy didn’t want to change because he had everything invested in a single peptide vaccine, and so I think that he will kind of fall out of favor as these multiple peptide vaccines come into play, because there’s three hundred thousand proteins, and who knows what the nuances are of the different proteins? But here was Windber, Pennsylvania giving breast cancer vaccines that were only available at Windber and Walter Reed Army Medical Center. People were flying in from all over the world, and you go, “What? Betty Grable had her thyroid removed here?” So what’s possible, you know? And I think it’s all possible.

Thanks everybody. Thank you very much.

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Health Leadership P12

You saw my title was international director, so I’m working for this little five million dollar company made up of twenty accountants where life is black and life is white, and here I am, Mr. Lala Land, and they say, “Well, we don’t know what title to give you. What do you want for a title?” I said, “International director.” They said, “But we already work in a couple states.” I said, “International director.” So I’m flying back from Chicago, and I’m sitting beside this twenty-three, twenty-four year old interior designer who wants to get into hospitals, and we’re talking back and forth, and I give her a copy of one of my books, and – you haven’t gotten yours, but I have – so we’re flying back, and we trade cards as we’re landing in Pittsburg, and she goes, “Hey! You got to make up your own title!” I thought that was pretty insightful. I said, “Yeah, I wanted to call it intergalactic, but they wouldn’t let me.”

The second phone call I got was from the Netherlands. Now, if I had just called myself a director, and I wasn’t the international director, might I have gotten that phone call? Because the third phone call I got was from Argentina, and I just spoke in Denver, and the two groups invited me to come to their hospitals from Japan and from Denmark. Because I didn’t say that I’m not the international director, I said that I’m the international director, and now, guess what? I’m the international director. You tracking me here? What are the limitations that you place on you? Where are you going with this stuff? What do you want to do? Because somebody gets there. Somebody makes it.

You know, let’s be honest. I wanted to be a professional trumpet player. But to be a professional trumpet player, I had to be in the upper .02 percent of trumpet players. And I played for the Ice [inaudible] and the ice [inaudible] and Disney and all those things, but I never made it. I couldn’t have been  a Hollywood recording trumpet player or a New York Broadway pit player. I couldn’t have done it. I didn’t get it. And it wasn’t because I didn’t practice, and it wasn’t because I didn’t care about it. I mean, I just read the book The Outliers. Have you ever read that one by Malcolm [inaudible]? You’ve got to read that book.

It talks about guys like Bill Gates and it tell you about people that we all assume are just brilliant people that made it, and you find out that there were a whole lot of forces involved. I mean, you know, Bill Gates’s mother was on the board of IBM, and his father was one of the most successful attorneys in the whole United States, and he went to the only private school in the world where he had access to a mainframe computer twenty-four hours a day in 1965. Okay?

I mean, there were some things that fed it, and the other thing that fed it is that Bill Gates spent ten thousand hours on that computer before he dropped out of Harvard to start Microsoft. And what he found, what Malcolm [inaudible] found, is that all those people spent ten thousand hours that made it, practicing their trade, practicing their craft, getting really good at it. I spent the ten thousand hours, but there’s a point at which there is a separation. Now, having said that, [inaudible] wasn’t better than me. Did you ever hear of him? Probably not. There were trumpet players who weren’t better than me who made it. So somewhere along the line, something in my head said, “You’re clumsy, or you can’t do that, or –“ You tracking me here?

Because there are people who aren’t as good as me. I mean, look at the singers. There are multimillionaires that are basically talentless, you know? But they make it, so what is that that gets you over that and through it and into it if you want to do that? I mean, you know, and I’m not saying you need to be a professional trumpet player or a professional football player or a professional, but yeah, I feel sorry for the guys. I know a guy that tried out for the Steelers twice, which is a big deal to even get invited to try out twice, and got rejected twice, and has now spent the last fifteen years living that life of “I didn’t make it. I was rejected. I didn’t get there.”

You know, the guy’s like standing in the corner every day, just staring at the wall. So you can’t let that happen, either. I mean, you have to set goals that are within some realm of personal reality, but having said that, I could never have predicted two hundred fifty million dollars in grants. I could never have predicted an international research institute that now has the breast cancer genome mapping tissues for the world out of Windber. Who could predict that? How could you predict that? How could anybody have even dreamed that? But I tell you what, when someone came to my door and said, “I have an idea, can I talk to you?” Guess what I said? Always, guess what I said? “Come on it. Let’s talk.”

Even though twenty out of twenty-five of them or twenty-seven of them were stupid. But every once in a while you get that gem, you get that idea, and you work with somebody, something happened. Just like the colonel said. Well, as long as we’re doing genomics, we might as well do proteomics, too. Might as well. I don’t know what it means, and because of that we became the genomic and proteomic center with the tissue repository that was important enough that the president of [inaudible] sent an entire jet full of scientists from [inaudible] to come look at.

So we start to say okay, something good is happening here. Something good came out of this. Did any of you know that the Today show broadcast live from the Windber medical center? Did any of you know that? But they did. The Today show was in Windber broadcasting live. I forget what year it was, 2004, 2005. And you know why? Because we had a breast center designed by people who had breast cancer. And you know what they did? They said, “You know, it’s really a drag when you go in to get your mammogram because it hurts, you aren’t allowed to use deodorant, there’s never a mirror to comb your hair after you take your clothes off. You’re standing naked from the waist up in a room. It’s cold, it’s uncomfortable, it’s humiliating.”

And so we designed everything away from that, and we designed a [inaudible] where only one breast was exposed at a time and you could Velcro it back up, and dignity was part of what we sold there. And the Today show had a producer whose mother had breast cancer who just went through the other end of it and said, “Wow, I’ve got to show this place.” So the Today show came up. And we were front page of [inaudible] college international, and we were twice written up into Wallstreet Journal, and Forbes, and Fortune, and four times in USA Today. If someone would have told me that all that would happen and really nothing, that you would be able to sit in this room and not even know it, I would have said, “You’re crazy.”

But guess what? There’s  [inaudible] stations now. There’s twenty-four hour everything. It’s just a screen that’s going on out there now compared to what it was. If we’d have been on the Today show fifteen, twenty years ago, that’s all that would have mattered. The world would have come to an end as we know it. But we still tripled in size. And all of this, all of this was from not being afraid to try that jump, and I think that as you go forward in your life, in your career, in your work, you need to remember just parts of today. And I’ll tell you a really cute story. So I got invited to make a speech by a chairman of the board of a large health system.

And sometimes when I speak, my peers don’t care for it. Actually, blue cross had me speak to all the CEOs once, and it was like deer in the headlights out there, because I’m talking massage and doggies and harps and they’re going, “Oh, yeah. This guy’s nuts.” Alright, so I’m making the speech to this health system. Now, I knew about halfway through that, the CEO wasn’t enamored with this story, because he actually left. He got up and walked out, but I kept going on, and at the end of the speech the chairman gets up, comes up to the front of the room, shakes my hand, standing ovation, puts his arm around me, grabs the microphone, and says, “If only ten percent of what this man said is true, it’s incredible.”

I guess that was a compliment. That means I’m a ninety percent liar. So anyway, I’m done doing this. Consider yourself the most lucky class in the world, because I’m never coming back. You all need to ask me anything you can think of, ask me any questions you want. If you don’t have any questions, then it’s up to your bosses what you do. Yeah, that was a lot of the push back I talked about. I mean, basically, in all candor, the nursing was probably thirty percent behind nursing at the other facilities financially, and so whenever I’d say “We’re going to implement this,” they’d say, “We don’t have time to do that. We don’t have time to do that. You’re not paying us enough to do that.”

But it really wasn’t a process, it was a brain process, and so what I decided was okay, if I can surround them, their patients, with other people that will provide comfort and care and love and nurturing to them, that would take the pressure off of them. And the other thing that happened is that we had a settlement from blue cross about two or three years into my tenure there that amounted to like a million dollars, and so we ended up being able to increase the salaries all around, and that began to soften things up.

But I remember the day I walked into the hospital, I’ll never forget this day. And the heaviness was gone. It just felt good. I mean, it always smelled good, but it felt good. And I walked into the HR department, and I said, “It feels different here. How many people have we hired?” Well, we had hired as many people as we had working there when I got there, so once we got to the critical mass where there were twice as many people working there and they were all new and they wanted to be there, that’s when it really started to take off. I mean, it took me at least twelve years to get to probably eighty percent of what I tried to implement with plain tree. Right after I left they became a plain tree designated hospital, which means they’re one of ten in the world out of five hundred, but maintaining that and keeping that level of commitment is a very big challenge.

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Health Leadership P11

This is what the government’s asking patients. I can’t get her to lie. I can’t, whenever she leaves the hospital, slip her a hundred dollar bill and say, “Lie.” You know, I can’t do that. I can’t say “Make this stuff up.” Now, why are they doing that? Do you have any idea why they would do this? Do you have any idea where healthcare’s going in the United States right now? It’s going to quality, too. It’s going to quality, and if you aren’t producing a quality product, your reimbursement’s going to go down, down, down, down, down, down, down. So we were in the top ten percent the first year that HCAPS came out in the whole United States. In the entire United States. This is what happened right after Rod left. We were here. We were there when you left, right? Wasn’t that the year that was – yeah. We were projected at a million dollar loss, and that’s where we – it actually was 2.3 million, they adjusted it after I left. And this was some really interesting accounting that I’m not going to get into again, it was system related, but the reality was it was profit in an area where Mercy and [inaudible] should both still be, but they’re gone and Windber is still there.

Think about that. When I got there, there was six million dollars, about six million in the bank, six million dollars that was flexible. Not really flexible. And I convinced the board to allow me to build a new building, and that new building ended up costing ten million dollars, but once we started the building and people saw the vision behind the building, we got a federal grant and we got a state grant and we got a local grant and we got a community grant, and we got – and so we ended up with – and we got a million dollars in donations through a hospice, so the ten million dollar building became a reality by borrowing basically against the last six million dollars that we had. And when you think about going through that at a time when there was some serious activities going on at the federal government at this level, because basically, if you think about what happened when Clinton was the president and Mrs. Clinton tried to get healthcare reform passed, once the hospitals did not back that, we became public enemy number two, right behind the Mafia.

And hospitals function, they have something called a charge master – this this? I don’t know how thick they are, Rod, they’re pretty darn thick, right? So everything’s in there, like what it costs for a Q-tip, what it costs for an aspirin, what it costs – and if you inadvertently, if someone in the food chain marks one of those wrong so it says a Q-tip is forty-one dollars instead of twelve cents or whatever, and you inadvertently charged for that Q-tip every single time somebody used a Q-tip, that was a federal offense. That was a federal offense, and my peers, some of them went to prison. It was a crazy, tough time. This is something that never could have figured would happen. And this went on, by the way. It’s like down here now.

So it just kept going down. What does that mean? Well, typically, you’re paid on diagnostic related groups, which means that if you have your gallbladder out, you’re going to get X number of dollars, and you’re going to get X number of dollars based on your geography, so if you’re in downtown New York City, Manhattan, or if you’re in Windber, the same operation’s going to cost differently and you’re going to be reimbursed differently, but it’s going to be the same for everybody that’s supposedly in your geographic type arena.

And let’s say hypothetically that you should be in the hospital on a regular gallbladder surgery for three or four days. You’re going to get paid the same amount of money whether they’re in for three or four days or three or four hours. Generally, unless it’s outpatient [inaudible]. This is way too much detail for you, but the bottom line on this thing is that the sooner the people left, and weren’t readmitted and weren’t still sick and didn’t have to come back, what did that mean for you?

You use less resources. You made more money. So this ended up being a very important aspect of what’s going on. The average length of stay dropped. This is something that nobody ever in the whole world could have predicted. Hospitals infect you, nationally, at the rate of nine percent. I had a friend who went in for a surgery two weeks ago, [inaudible] knee surgery, came home, died. I had two friends went into a very prominent, major heart hospital, had two incredibly difficult surgeries, came home, both died. Now, the ones that died from those surgeries didn’t die from the surgery. What did they die from? The infection. They died from the infections.

And hospitals breed infections. They morph. They grow. It’s kind of like they just happen. One of the reasons not too many people are fighting tearing down [inaudible] is because they have all kinds of real exotic infections now from all the different world wars and all the fighting from all the places. So the average hospital infection rate is nine percent. That means you have almost a ten percent chance of going into the hospital perfectly healthy, getting a simple little surgery, and getting a staph infection that might or might not kill you. That’s unacceptable from my perspective.

I mean, I had three heart [inaudible], and there’s only a one percent chance they would screw up on a heart [inaudible]. They screwed up three times on me. So even one percent when it’s you, you know, major surgeries, anything that happens to me. Our infection rate dropped to below one percent. And again, if I extended this, it stayed below one percent. National average nine percent, ours was one percent. Now, some people would say, “Well, you must have washed your hands more often.” I don’t thinks so. Some people would say, “Well, you were a little, crappy hospital and nobody sick really came there.” Nah. Sick people came there just like they came to all the hospitals around here from the same nursing homes with the same infections.

So we had high morbidity, high mortality, high infections, but our infection rate never went about one percent, and the joint commissioner [inaudible] say, “It’s impossible. It’s impossible.” And we’d say, “Nope, that’s what’s going on.” And department of health would come and say, “You can’t have a one percent. It’s got to be nine percent or eight percent, or some hospitals that you know of are at twenty-four percent, twenty-seven percent.” They didn’t publish these numbers, but they’re going to. You’re going to be able to call and say, “What’s your infection rate before I have my surgery? Can you tell me what your infection rate is in that area?” Ours dropped to below one percent, and it stayed below one percent.

Why do you think it did that? I’ll tell you why I think it did it. I had Penn State and Georgia Tech come study us. They couldn’t figure it out. Let me ask you something. Have any of you ever been admitted to a hospital for anything other than like nothing? Any of you ever go into a hospital? So, hospitals are scary places. And if you think about the typical environment of the hospital, you have overhead paging going on, you have codes going on, you know, if someone died in the room next to you. You have people coming in and out, looking at you, shaking their head, writing things, putting it away. It’s not a comfortable place to be. You can’t sleep well. You don’t like what it smells like usually. So take that environment and flip it upside down.

We had the plug in things that put out good aromas, and we had you laying in bed and a massage therapist says, “Would you like to have your feet massaged, would you like to have your neck massaged?” And the harp player or the guitar player comes in and says, “What’s your favorite song?” They start to play for you. Your loved one, you want her to stay here? Yeah, absolutely, she can stay here, that’s fine. Here’s a bed for her. She can sleep here. Now all of a sudden instead of being in an environment where you’re waiting for the saber tooth tiger to jump on your face and eat you, you’re with someone that you care about, hopefully, and cares about you. Hopefully. If you want them. If you don’t want them, they don’t have to stay there.

And we stopped the overhead paging, and we stopped the middle of the night wake you up for no reason. Think about that. I think that the infection rate dropped to one percent because your white blood cells actually get a chance to work. You get to fight off infection because you’re not living there going, “I’m going to die. There’s a tiger on my throat.” Right? Is it possible? Philosophically it’s possible. This is the one I wanted to do the billboard on. Mortality comparison by hospital. This is assuming the same co-morbid conditions. These are all of our peer hospitals, and that would be Windber. And the billboard would have read, “Come to Windber. You’ll die less often.”

I don’t know if any of these things are anywhere there now, but I’m talking this was a picture in time, and it’s not a pro-Windber advertisement. Like I said, I’m detoxed, do whatever you want to do, but I’m pointing out to you that there are some amazing things that came out of this that I couldn’t have predicted, which is why we made 2.3 million dollars. I mean, if your length of stay goes down and your restraint rate goes down and your readmission rate goes down because they aren’t coming back sick, and you don’t have to bring people back in to treat them for the infections that you gave them for which the government will no longer pay you starting about a year or so ago, I guess. So you start to look at all these things, and it’s like wow, if you’re nice to people and you’re nice to employees and you do things a little differently but they’re not so far out, I mean, I didn’t bring in like witch doctors from the street corners to shake crystals over people.

I mean, we were very careful. We had credentialing process, and we did all the things that you have to do to be acceptable, but if you do that and you wow people and you treat them with dignity, you don’t have to leave your dignity at the door. We gave them pajama bottoms for gosh sakes. Your butt didn’t have to stick out. Dignity. Used to give them bath robes, but they stole them all. So what are the limitations? The limitations are what you self-impose. It was really funny.

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Health Leadership P10

And the third time we will help you find work, and so ten percent of the people that wouldn’t take their shoe off were helped to find work at the neighboring hospitals, and I called them for Windber the gift that just keeps on giving because they’re being mean and nasty at the other hospitals, and people were like, “I don’t want to go back there. She told me I’m a jerk. She yelled at me and she wouldn’t let me –“ So they were gone. Ten percent gone. Then the doctor thing started, right? Well, I mean, I would have been unemployed if I had fired some of those original doctors in the early days, and so consequently it was how do we deal with this? Well, there are contracted doctors, anesthesiology, laboratory, emergency, X-ray, and these doctors typically are part of a larger group that cover multiple hospitals, and typically when you have that, there are at least a third of them who don’t ever want to be at your facility but are forced to because they’re part of the larger group.

And, I remember getting a phone call, like two AM because a husband was outraged because the anesthesiologist had been screaming at his wife because he didn’t want to come in to give her anesthesia to have her baby. Like she could have had any control over when the baby was going to come out. He didn’t want to get up at two o’clock in the morning. And so I met with him, I met with his boss, and I fired the group. They were good. And I went out and got another group, and the same thing happened with a couple of other groups, and after that, the medical executive committee took over, and when a surgeon would throw scalpels at an employee or scream and yell or take a fit or do whatever they did, not just surgeons, any of the docs, the medical executive committee would call them in, and they would say, “This is not the type of hospital that we have here. So you have two choices. One choice is that you can resign right now and go practice somewhere else, or the other choice is that you straighten up. We’ll get you anger management, we’ll do whatever we need to do, but if you do it again, we will take your practicing privileges away from you and we will report you to the national physician data bank.”

How cool was that? They got rid of the bullies, and the people that came there came because they wanted to be in an environment that was not a typical hard, harsh environment. I had an employee that had worked for me – well, not for me, but for the hospital – for twenty some years, and this employee decided to take me on over an issue here, and it was – plain tree is a movement, there are five hundred plain tree hospitals. We were the third one in the United States, and it’s basically a movement that says let’s humanize healthcare. That’s what the movement is, it’s an attitude. It’s give people access to their medical records, allow their loved ones not only to stay but also to become part of a care giving team. It’s twenty four hour visiting, it’s massage, aromatherapy, music, all those things that I wanted to do.

And so this person decided to take me on, and was wired to the board, and I let her go, and at the next board meeting, I had attorneys on my board, it was like I was on trial for murder, and they started just screaming. “You do not have the right to let this person go. This person’s been loyal for twenty-two years. Blah blah blah.” And it was interesting, because there I was with kids in college. I still owed seventy thousand dollars for my education. I had, you know, my wife was in school for her education, and it was like, and I stood up, and I said, “Then you don’t want me as your CEO. That you want to make all the employee decisions, that you decide who works here, who doesn’t, who’s hired, who’s fired, who will take your philosophy forward, who won’t,” and I started for the door.

Then the board chairman came and pulled me back, and we talked our way through it, and that was the last time that ever happened. So understand that this isn’t all painless getting there. Understand that it isn’t without risk, but also understand that if you have a passion and you have belief and you have a desire that you can change it, and you can make things work, and you can make things happen. So I ended up going through actually two, three – it took me three sets of vice presidents. Second group was all young guys full of testosterone fighting with each other over who controlled whom and not sharing and silos of power and whatever, and the third group was primarily women with kid, older men, people who were nurturers, and it was a nurturing environment that I was seeking. Now, if you’re running an ammunition plan, you probably don’t necessarily want a nurturing environment, but you know, it’s interesting, because I had a young woman that was a relative of the family who lived in our home during an internship, and she had gone to Geneva College, and she told me about a factory outside of Meadeville, and this was a steel fabricating shop.

Have any of you ever been into a steel fabricating shop? Yes, right? What are they typically like? They’re noisy. They’re dirty. Smoky. Very loud. So, tough environment. Tough environment. She described this steel fabricating shop. She said, “Floors were painted and spotless. There were cut flowers around in vases. The people were interacting at all times with their bosses. The boss knew every one of their names. He knew their birthdays,” and it’s like the waiting list to get into this place, and there was not a shortage of jobs at the time, the waiting list was two years long of people wanting to work there. Well, what was going on, again, was the Hawthorne effect.

The owner was taking responsibility to allow those employees to know that he cared about them, that he was involved with them, that their success was his success, his success was totally based on their success, and when they left at night, there was no company. They are the company. The employees are the company; it’s not the building. It’s not the CEO. It’s you all that are the company. So what happened? Patients loved it, family loved it, public loved it, media loved it. Most importantly, I loved it, and the greatest compliment I ever got was there was a review by the department of health, three nurses. The one nurse, she was in charge, and she turned to the second nurse at the end of the exit interview. Now, this is where they had gone through the hospital with a fine tooth comb.

They do it every year, making sure that you’re doing everything right so that you can get your license and get your medicare and whatever. She says to the second nurse, “Is there anything you’d like to say to Mr. Jacobs?” And she said, “Yeah.” She said, “This is the thirty second hospital that we have reviewed this year.” Thirty-two. And she said, “I’m from Philadelphia, and I called my husband last night, and I told him that no matter where I am, no matter what happens to me, I want you to bring me to this hospital.” It was the greatest compliment I could have ever gotten, and it’s like, you look at that and say, “Wow. This is a person that does this for a living, and they wanted to come to this hospital.”

And truthfully, I don’t ever want to go to a hospital that wouldn’t be like that. I’ve been to them. You know, you have your heart [inaudible] and they bring you bacon and eggs for breakfast and slap it down in front of you, say, “Well, I just had heart [inaudible], I have heart disease.” Well, so what? Here’s your bacon and eggs. So there were some things that didn’t work because when you take the power away from a bully and that’s their way of life, they become desperate victims. They don’t know anything else, and that happened to me with several people. And this was an old Nigerian saying. Your friends may come, your friends may go, but your enemies accumulate.

These are just some things that happened internally, I won’t go into all the details out of respect for those present, but here’s the thing I think that really, really, really made it fly. We began to celebrate. We had an offstage room where the employees could go to unwind where people didn’t see them feeling frustrated over dealing with some cranky old patient or whatever. We had parties. I was telling this story at a [inaudible] fortune one hundred HR speech, and I said, you know, we had buses to the Pirates games, and somebody put their hand up and said, “Was the for the bad employees? You made them go to the Pirates games?” So the future became a design function. The future became a design function.

Now, what does that mean? It means that we took ideas. What were some of the ideas? What were some of the things? Humanizing healthcare? Can you think of anything? Betty Grable got her thyroid removed. I mean, we took that, right? Can you think of anything we did? Baking bread in the halls. Yeah. Bringing dogs into the hospitals. Yeah. When you think about that, it’s like bringing a dog into the hospital? We did everything that was against conventional wisdom. Fountains. Dogs.  Twenty-four hour visiting. That’s all bad stuff, right? Bad. Terrible.

But we did all that, and what do you see the results? Because the results were not what any of us expected. Our emergency room visits tripled, which also allowed us to do this. We went from three hundred plus employees to seven hundred plus employees, we started doing pay per performance. There were people every year making eight and a half percent raises in the time when the rest of the world was making two percent, three percent because of the work that they were putting forth and the things that they were doing.

The average three year growth and net patient revenue in the state was 4.8. Ours was 21.58 percent. I was at a hospital in Alaska and theirs was about the same, but it’s because of oil. We didn’t have oil. We didn’t even have coal anymore at that time. Our donations over that five year period were over five million dollars in a town where the average income was twenty-two thousand. And there was nearly a hundred million dollars at that point in grants and contracts that eventually became two hundred and fifty million. We split it fifty fifty with Walter Reed to give us credibility of having a strong partner, and so 125 million dollar poured through for breast cancer research. Average Pennsylvania operating margin was .98 percent.

That was the average hospital in Pennsylvania. Ours became 3.36 percent. My last year at Windber, we brought in 2.3 million net in a fifty-seven bed hospital in western Pennsylvania where blue cross control the reimbursement and where our health system decided to pay us twenty percent less than blue cross was paying them, and they kept it kind of a secret for a long time. So that was millions of dollars a year less than other people were receiving. Our HCAP scores were – now, the HCAP scores are an interesting invention. It’s invented by the Federal government, and the concept is you’ve been in the hospital, we’re going to ask you stuff like how was it? Was your doctor good? Did you like your doctor? How about your nurse? Was she good? Was it noisy?

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Health Leadership P9

Well, you know, we can poo poo that because we’re from Western science, but they’ve been doing it for like five thousand years in China. I saw a video tape where a guy had open heart surgery without anesthesia. No anesthesia, open heart surgery where you cut your chest open with a saw and spread it and operate on your heart by cutting a vein out of your leg and sewing it to your heart. That’s what they did without anesthesia, just using acupuncture needles. And he’s going, “Hey, how’s it going?” He’s talking to them the whole time. So what we know in our dimension is “Put me to sleep, Doc. Wake me up when you’re done.” Okay? That’s our flea box.

There’s a different flea box out there. So these people were doing spiritual touch, and I don’t know if it was nuts, and I didn’t care, because you know what? I had patients come to me and they’d say, “It changed everything. I just feel so much better now, and I feel good,” and I’m thinking, “I don’t care if it clicked a switch in your brain that made you feel better and it was a placebo.” You know, I don’t care. I don’t care as long as you feel better and you’re out of here, that’s all I care about. Well, I went away for a conference, and while I was gone, the medical staff got together, and they banned spiritual touch. It was banned in the hospital.

We’re the only hospital in the United States where spiritual touch was banned. They don’t touch. It was banned. Now, what was really going on? Do you have any idea what was really going on? It had nothing to do with spiritual touch. It had to do with drawing a line in the sand. It had to do with power. It had to do with control. You know, these were the bulls who stood on top of the hill every day and picked out their cows. They were the bullies. They were the people who were running the place, and all of a sudden, there’s a new sheriff in town. And the new sheriff said, “Well, we’re going to try this, we’re going to do this, we’re going to do this, we’re going to do this,” and it was change, and it was different from what they experienced, and it was not where they wanted to be in their own mind, because their mind saw [inaudible] county border, Windber border, [inaudible], Somerset county border, [inaudible] Pennsylvania border.

All those limitations were in their mind because they were trained that way. Then we got a call from – was it Ray Streets was the old senior one? Was it Ray, also? Ray Streets, and they were going to picket the hospital. He was going to get all the Baptists in the area and they were going to picket the hospital. I said, “Ray, why?” He said, “Because you’re stealing people’s souls away with Eastern religions.” I said, “How?” He said, “You’re doing yoga.” I said, “Well, we’re not talking about Eastern religion. It’s meditation. It’s just meditation. I don’t care if they bring rosary beads, I don’t care if they say Baptist prayers, I don’t care what they say. I don’t care if they go [inaudible]. I don’t care. I’m not stealing their souls.” So that was a big negotiation back and forth, and we changed it to stress management instead of Eastern yoga. You tracking me here?

This is kind of funny now, isn’t it? It wasn’t so damn funny fourteen years ago. Could you imagine? Me having the entire Baptist community walking around the hospital with signs. You’re stealing souls. You know? Not good. And the last thing was we introduced that heart disease program. I used to have one doctor that would walk into the heart disease program meetings eating pork rinds and told everybody to go get their bacon. Go on the Atkins diet. Don’t go on the [inaudible] diet. Go on the high fat diet. You’ll do better. So change. Resistance to change. Blocking change. Twenty-four hour visiting we already talked about. So for each one of these there was a significant push back. Each one of them. I had three doctors who were very, very, very, very ultra-conservative religious who felt that we shouldn’t have any other symbolism in our chapel that represented anything except Christianity.

Well, there were Jewish people that came to our hospital, and in the research institute, now I had Muslims that came to our hospital, and I had [inaudible], and I had Hindus. It was really funny, because when I built the research institute, one of the things that I thought would be really symbolic was that every one of the PhD’s offices looked out into the church below with the crosses.  I had no Christians. Didn’t move them very much. So here I had all these people who were not Christian. You know, we’re talking, like, there’s a billion Muslims. You know?

I had all these people that weren’t Christian, and so I wanted them to have a place where they could go and be with their God, as well. Whomever. I remember one Chinese scientist saying to me that her god was a female god that she prayed to, and that she had a vision from her god that she would come to a little town somewhere in the United States and work for a former teacher. And that’s how she ended up at Windber Medical Center. Well, how could I question that? I mean, I don’t really know how that happened, or care. She came to work for us. So it’s like these doctors said no. No, you can’t have religious diversity. And the first thing that happened when I left Windber is they went in, they removed everything that was there that wasn’t on the crucifix.

So you start to look at that and say where’s the flea box here, you know? Yeah, we can be compassionate about our beliefs, and I’m not questioning your Christianity, I’m not questioning any of those things, but you have to recognize the fact that there are people who aren’t you. There are people who don’t have your same beliefs. I remember I was teaching at Garfield Junior High School. They had just closed down Joe Johns, which was a highly African American attendance school, and they moved them into Garfield Junior High School at the time, and Garfield Junior High School was an Eastern European stronghold. You know, the children of the ethnic steel workers and coal miners that moved in, and when those two groups got together, it was just explosive.

We had fights every day. And I remember being on hall patrol one day before school actually started and seeing hundreds of kids running, and I’m thinking, “This is not good.” It was like a quarter after seven in the morning. I go outside, and literally outside in front of me are about six hundred students, and it’s African American kids and Eastern European kids, and they had run through the years around Garfield, and they had clothes poles, and they had stones, and they were ready to kill each other. And all of the sudden, this car pulled up, and this African American gentlemen jumped out, and he was stocky. He was about, probably five six, but really ripped.

He looked like Arnold Schwarzenegger. And he ran into the middle of this crowd, and within five seconds he had disarmed it by his voice and his mannerisms, and it dispersed, and my life was saved. And they went back into the school, and I went up to this guy, and I said, “How did you do that?” He said, “I’m a prison guard at a juvenile facility in California and I was here visiting my relatives.” And so the principal hired him to teach about diversity for a two or three lecture series, and he taught it – let’s just say it would have been X rated, but it was amazing because, you know, he said to these teachers – a lot of them were bigots and prejudiced people – he said to them, he said, “Let me ask you a question. How many of you have ever gone more than thirty-five miles an hour in a thirty-five miles an hour?”

He said, “You’re breaking the law. That is against the law.” And then he gave an example of something that was typical in the African American community, because, again, the typical African American family did not have a father. It was like seventy percent were without a father living in the home, so the oldest daughter typically became the mom, because the mom had to go work three part time jobs to provide enough for the family, and he gave an example of something that they might to do that in our mind’s eye was completely against the law.

But our driving more than thirty-five in a thirty-five mile zone was, eh, a little gray. And he gave us these descriptions of our impression of this is where we think we should be, these are our borders, these are our lines, this is, you know, there’s a woman, in the book Change or Die, there’s a woman, a little four foot eleven woman, psychologist, from San Francisco that realized that the state was going bankrupt because of all their jails, and interestingly enough, the prison guard unionist fighting closing and changing the laws. It’s a three strike law and whatever, so there’s all these lifers in prison in California forever, and the state is bankrupt, and this woman figured out that one of the reasons of the rate of recidivism is so high after someone has been arrested, that the crime level was so high, is because they’ve never, ever, ever been taught how to act in a middle class world.

They wait for a few more [inaudible] they probably won’t have to worry about it because there won’t be any middle class, but having said that, regardless of your politics, having said that, she then set up a center where the judge said to the person, “Look, you can go to Alcatraz,” or whatever, they don’t go to Alcatraz anymore, “you can go to jail, or you can go to this woman and live in these apartments and work in the stores and the shops and the restaurants that she has put together down there all run by former prisoners, and if you screw up, you’re going to go back to prison. You’re going to go back for life. Or you can work with her.” And what they found was they could retrain these people into what our expectations were so that they could survive in a culture that was not the culture they grew up in. Interesting, right? Yes? Change or die.

So ten percent of the staff was never, ever, ever going to change. They were mean, they were hateful, they were ugly to patients, they were ugly to each other, they were ugly to their families, they were unhappy human beings. And we built into the appraisal methodology and human resources. The first time you are turned in for that, we will talk to you and counsel you and explain to you, and the second time we will give you a couple days to think about not doing it again, and we’ll give you those couple days without pay.

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