TCE(Trichloroethylene) and PCE(Tetrachloroethylene): an Invisible Cause of Parkinson's

Webinar & Transcript

Dr. Jaime Hatcher-Martin: [00:00:00] So it is my absolute pleasure to introduce today, um, Dr. Ray Dorsey, um, who I've known, I was trying to remember Ray the first time I met you. I think it was, I don't know, maybe 15 or 16 at one of the Huntington study group meetings. So, um, Dr. Dorsey is the David M. Levy Professor of Neurology at the University of Rochester, and he has been working to identify and eliminate the root causes of Parkinson's disease.

His research on brain diseases and digital health has been published in leading academic journals and featured in multiple news outlets. And in 2020, Ray, with several other colleagues, wrote the book, Ending Parkinson's Disease. And this provides a prescription for ending the world's fastest growing brain disease.

He's showing it to us there. Uh, he previously directed the Movement Disorders Division in Neurology Telemedicine at Johns Hopkins and worked as a consultant for McKinsey and Company. And in 2015, the White House recognized him as a champion for change in Parkinson's disease. So Ray, thank you so much for joining us today.

Dr. Ray Dorsey: Glad to be with you, Jamie. And it'd be great to be with you guys. And a huge fan [00:01:00] of Synapticure and all the great work that Brian and Sandra are doing to change the course of ALS. 

Dr. Jaime Hatcher-Martin: We appreciate that. So I just wanted to start off with just for those of us, those of you who are new to Synapticure just to give you a quick little summary about who we are before we get into the meat of the presentation.

So Synapticure is a virtual clinic for patients living with neurodegenerative diseases like Parkinson's disease. And our goal is to really simplify the care journey for everyone, um, by offering comprehensive virtual care with subspecialty neurologists that are trained in movement disorders. We are covered by most major insurances and we're working on obtaining additional coverage for other major insurance plans as well.

We offer integrated care coordination and caregiver support and accelerated referrals to clinical trials. Um, some that might be near you and then for those of you that are willing to travel, um, we have access to other clinical trials as well that we can certainly make referrals for. And in addition to the clinical care we have in our telemedicine clinic, we offer additional [00:02:00] services like insurance navigation, physical and occupational therapy, speech and language therapy.

Um, and we're working on rolling out behavioral health for not only patients, but their care partners as well. And this is just a quote from one of our patients, um, that was diagnosed with Parkinson's in 2013. Um, and they said, I found everyone at Synapticure to be incredibly competent, kind, and compassionate.

For the first time in many years, I could say to my husband, they not only listen to me, but they also hear what I said. So this is really the, the ethos of our whole company and the core of everything that we were really, um, We want to focus on, you know, we're a company founded by a patient for patients.

And this is really at the heart of all that we do. So we're really happy today to have Dr. Dorsey here. Um, as we start these webinars, we really wanted to bring in experts in the field, um, to talk about, you know, their interests and things that might be interesting to our patients. So Ray, I know we want to talk about your book and we want to talk about, uh, trichloroethylene, which I'm sure you're going to tell us more about.[00:03:00] 

Um, but. You know, I know one of the big things that you want to focus on is sort of the future of care in Parkinson's disease, um, sort of more broadly. Um, and I know you've been a great advisor for us at Synapticure. So can you talk a little bit about kind of what you see going forward for the future of Parkinson's disease care?

Dr. Ray Dorsey: Yeah. So, um, I, first of all, thank you for having me. Um, I think if you think about it, it's kind of odd that we ask sick patients to come see us generally healthy clinicians on our terms. If anything, it should be how the clinician is seeing sick patients on their terms. And we did do that in the 1930s, 40% of physician patient encounters were in the home, it was a house call.

And I think Synapticure and others are trying to bring care to patients instead of patients to care. Um, and when you do that, I think there was something really, really, really powerful about that, uh, as indicated by the quote from one of your patients. Um, there's something, you know, it's a little foreign at first, but I think people soon realize, hey, this doctor, this clinician is [00:04:00] seeing me on my terms.

And it's interesting what I am experiencing and seeing me in my natural environment and, you know, I'm 6 foot 5 and, you know, I can be intimidating in the right setting, but, you know, when we see patients over telemedicine, we see him, uh, sitting down, I generally leave my white coat in the office. Um, and then in reality, people are in control.

They really don't like the doctor. They can just press a button and gone is the doctor. It's really hard to do that in clinic. So I think for a whole host of reasons, this is a really powerful way. Not to mention that ALS and Parkinson's are very disabling, not to mention that most people with Parkinson's disease tend to live in, older adults tend to live in rural and suburban areas where, while most specialists are located in urban areas.

People want to be seen more frequently. This allows for brief encounters. The list of advantages is long, um, is long. 

Dr. Jaime Hatcher-Martin: Yeah, I think one of the things I've really enjoyed about, you know, I'm very touchy feely. So I always wonder when I really transitioned into telemedicine, if that [00:05:00] would still get across.

And I feel like I'm still able to make those relationships with, with patients, but I get to meet more family members too, right? I get to meet. You know, the daughter that lives in Washington and the son that lives in Florida and I get to meet dogs and, you know, other, other family members that I often wouldn't have gotten to meet otherwise.

And as you mentioned, you know, seeing, seeing where people are, um, you know, the, the challenges they have at home for things like balance and, um, you know, I've, I often tell a story about a patient of mine that kept falling and I couldn't figure out why until I saw him at home and I saw all these things that he was trying to navigate around and his cat was kind of weaving in and out of his legs.

And, um, you know, I never would have been able to, I never did pick that up for all the time that we had been seeing him in clinic. But once we, we know we did telemedicine, I was able to pick that up. So. Maybe we can start off with just a little bit of background, uh, if you could talk to us a little bit about just the incidence of Parkinson's disease and how that's changing over time and, and why this is so important now.[00:06:00] 

Dr. Ray Dorsey: Yeah, so if you look at brain diseases as a whole, Parkinson's, ALS being among them are the leading cause of disability in the world. So more than cancer, more than heart disease, more than infectious diseases, more than COVID, the leading source of disability in the world is brain diseases. And if you look among those brain diseases, the fastest growing of those brain diseases is Parkinson's disease.

Over the last 25 years, the number of people with Parkinson's disease has more than doubled. If we don't change our course, if we don't address the root causes of Parkinson's disease, the number of people with Parkinson's disease will double again in the coming 25 years. Um, and I think a lot of it is preventable.

So, um, it gets me a little bit frustrated and upset, but, uh, we, uh, persevere and will eventually help create a world where Parkinson's and ALS are increasingly rare, not increasingly common. 

Dr. Jaime Hatcher-Martin: So, you know, I know that there was a recent publication, um, talking about the history and, and the relationship of this chemical trichloroethylene or TCE to Parkinson's disease.

Can you [00:07:00] walk us through that a little bit, you know, a little bit about the history of it and how did it. How do we know what's related to Parkinson's? 

Dr. Ray Dorsey: Yeah, so this is trichloroethylene. I keep it with me everywhere I go. It's a really, really simple molecule. It's got six atoms. So most people know that water's H2O, two hydrogens and one oxygen, three atoms.

This is a whopping six atoms, two carbons and black, one hydrogen and green, and then three chlorines. Uh, hence it's named trichloroethylene. And this was developed in 1864, and it's been used to do everything from decaffeinate coffee, to degrease metal, uh, to dry clean clothes. It's known to cause cancer.

That's well established. It's been linked to liver cancer, kidney cancer, non Hodgkin's lymphoma, multiple myeloma, and prostate cancer, among others, including likely breast cancer and brain cancer. Research done by Sam Goldman and Caroline Tanner, both at UC San Francisco, currently showed a decade ago that [00:08:00] it's associated with a 500% increased risk of Parkinson's disease.

And then this chemical has contaminated numerous sites around the country, the most famous of which are infamous of which is the Marine base Camp Lejeune in North Carolina. And I think last week, or maybe 2 weeks ago, a study by done by Dr. Goldman and Dr. Tanner and colleagues showed that Marines who served at Camp Lejeune had a 70% increased risk of developing Parkinson's disease compared to Marines who serve on the West Coast at Camp Pendleton.

Um, Animal studies have linked both in mice and rats by a wide range of investigators have linked TCE to Parkinson's disease, and there's also research linking TCE to ALS. Yeah, I was 

Dr. Jaime Hatcher-Martin: when I was, you know, obviously I've heard a lot about TCE, but I was when I was reviewing some more of the literature, I was actually shocked to find out.

I knew about, you know, the decaffeination and the dry cleaning rates used as a drive as a degreaser, which is why we think [00:09:00] it may be. In some cases, maybe significantly related for veterans because of all the machinery and the tanks and everything else that it's used for. But it was actually until the seventies was used as an inhaled anesthetic as well.

So it's, there's not just these sort of, you know, secondary exposures to a lot of these things, but actually even some direct exposures for people. 

Dr. Ray Dorsey: Yeah. So, um, it was using an anesthetic. Um, it was, uh, see if I, it was using obstetrics, especially as an analgesic agent, it was considered the anesthetic of choice.

Um, 1 quote from a physician, male physician saying that, uh, it will find it find a useful place in, uh, in every male obstetricians office. Uh, and then it was, um, banned by the FDA because of its toxicity in 1977. It was also found in, like, typewriter correction fluid, carpet cleaners, gun cleaners. A study in Italy found that three quarters of the population had TCE in their blood and urine.

Dr. Jaime Hatcher-Martin: Yeah, it's [00:10:00] unreal. I also found there was a quote by a physician, I think it was like 1936, somewhere in the mid 30s, who even at that time had already started to comment on the concerns about, you know, the risks of it, um, the health related risks, especially for those that are working, were working directly with it.

Dr. Ray Dorsey: Yeah, so we've known, uh, since 1932, at least in the Journal of American Medical Association about its toxicity, uh, both for people who come into skin contact and from inhalation, and we just haven't been paying attention or maybe things have been concealed from us. That should be considered. Yeah. 

Dr. Jaime Hatcher-Martin: So, you know, so we've talked about some of the, um, you know, situations where TCE has been used, um, some of these, you know, degreasers and things like that.

Does that mean for people who have not worked in those particular fields or those particular, um, you know, types of jobs that they're not at risk of exposure?

Dr. Ray Dorsey: I wish. Um, so first of all, about 10 million people, Americans work with the chemical in the 1970s, printers, [00:11:00] painters, mechanics. Engineers work in Silicon Valley with electronics, Silicon with Silicon wafers.

If, um, shoemakers, taxidermists, embalmers, the list is long. But it also contaminates up to half of Superfund sites in the United States. These are the most toxic sites around the country. Contaminates up to 30% of the groundwater. In the United States, it's estimated that one third of American cities in the 1980s had TCE in their drinking water.

Um, and then many people know that radon can evaporate from soil and, uh, enter people's homes and cause lung cancer. Turns out TCE can evaporate from contaminated soil or groundwater, which can move away from, uh, contaminated dry cleaning sites, for example, or military sites. And enter people's homes, workplaces and schools undetected.

So there are people, kids in Newport Beach, California, right where I went to high school today who are breathing in [00:12:00] TCE and other related chemicals in their playroom. It's in people's master bedrooms, it's in their living rooms in Newport Beach, California, and then if it's in Newport Beach, California, you should be wondering where else is it.

Dr. Jaime Hatcher-Martin: Absolutely, absolutely. So, what are the thoughts on how TCE might be related to Parkinson's disease? Why might it, why might it cause it or at least increase the risk of it? 

Dr. Ray Dorsey: Yeah, so, uh, this is where I get kind of excited because I think this also applies to ALS and I think it can tell us ways to prevent both these terrible diseases.

So, um, as you know, the brain is a gas guzzling or glucose, uh, guzzling organ is only consumes 3% of our body mass, but 20% of our energy of our glucose is consumed by the brain and not surprising in the cells in the brain that are consuming most of that energy or our neurons or nerve cells. And it turns out that, uh, the cells that produce dopamine, the brain, um, have huge [00:13:00] energy demands.

They have about a million different connections to other nerve cells. They're not mildly, they're not insulated, so they have huge energy demands. And because of those connections, if you stretched them out, they're, uh, four meters in length, which is, you know, twice my height. So imagine a four meters in length.

So they're basically big fat, big blobs filled with jelly beans and those jelly beans are the energy producing parts of cells called mitochondria and, uh, TCE. And pesticides, certain pesticides like paraquat and air pollution, all of which are likely environmental factors fueling the rise of Parkinson's disease, all damage to the energy producing parts of cells, that big bag of a big nerve cell that's filled with these jelly beans.

This is a toxicant aimed at those jelly beans. And so you should ask, well, what other nerve cells have lots of those jelly beans or those mitochondria? And it's motor neurons, the same neurons that motor nerve cells that are implicated in an ALS, because some of [00:14:00] those motor neurons, they go from your brain, you know, all the way down to your spinal cord.

Some go from your brain to the lower part of your spinal cord, and then from your lower part of your spinal cord, all the way to your toe. Um, and so those things can be a meter in length unstretched. And so I think we're finding that there's a common mechanism by which people might be developing ALS and Parkinson's, and that's from mitochondrial toxicants that target nerve cells, selectively target nerve cells, or that nerve cells are selectively vulnerable or exquisitely vulnerable because of their huge energy demands.

Dr. Jaime Hatcher-Martin: So what about, you know, there's obviously there's, there's a lot of genetic causes of Parkinson's disease that we've identified over time. Are these completely different cases than what we're seeing with things like TCE? 

Dr. Ray Dorsey: Um, so, uh, about 15% of people have a family history of Parkinson's disease and about 15% of people, uh, have identifiable genetic risk factor.

Um, so said another way [00:15:00] 85% don't so we must be wondering what's going on with those other 85%. But it turns out for those people who have genetic risk factors. We know that almost all the purely genetic causes which are really, really rare just like an ALS that purely genetic causes of ALS are really, really rare, but the purely genetic causes of Parkinson's disease.

Uh, have impaired mitochondrial function. So those energy producing parts of cells we know are impaired by genetic mutations. So it stands to reason if genetic mutations are causing damage to those energy producing parts of cells, then enter then environmental factors that damage those same parts of cells would be implicated.

And those genetic factors might explain why some people who are exposed to these toxicants develop the disease and why some don't. We know that for those genetic causes of Parkinson's disease, like LRRK2, that there are known interactions with environmental factors, so that's likely can explain why.

It's worth recalling that the majority of people who are exposed to smoking don't develop lung cancer, only 10% of [00:16:00] smokers develop lung cancer, so there have to be other genetic and environmental factors. that explain why some people develop lung cancer from smoking and why some don't. Right. 

Dr. Jaime Hatcher-Martin: And I think the thing that, you know, we all learn in sort of Genetics 101 when it comes to these sort of gene environment interactions is, right, your genetics loads the gun and then maybe something in the environment, some sort of exposure that you get sort of pulls the trigger as far as actually developing 


Dr. Ray Dorsey: disease.

And I would say the environment does more than just pulling the trigger. I think it might, in some cases, you know, 85% of them don't have a genetic risk factor. So it may be loading the gun and pulling the trigger. Um, for some people, I think, you know, if you get a really, really high dose, it may just overwhelm.

And then some of these things could be, you know, depend on how long you were exposed, when you were exposed. I think kids are perhaps more likely to be damaged by these, by early exposures. Um, and then it could be the way some people metabolize these drugs or break them. I mean, these, uh, toxins might also explain why certain people develop disease and some don't.

Dr. Jaime Hatcher-Martin: Right. So a lot of [00:17:00] times we hear that, you know, mitochondria related to oxidative stress. And I think one of the biggest things that I certainly questions I get asked in clinic, and I'm sure you do as well as, you know, well, can I just go, can I get this, you know, infusion for this antioxidant, or can I take this supplement?

It doesn't just, what's the, does it work like that or. 

Dr. Ray Dorsey: So people tried. So that'd be, that'd be wonderful. So people, uh, as you recall, uh, looked at medications or even over the counter supplements to see if they can help with the function of these energy producing parts of cells. People looked at coenzyme Q10.

People have looked at vitamin E in Parkinson's disease. Unfortunately, large studies for both those showed them not to be a benefit in people with early disease. The key thing is to minimize exposure. I get really concerned about people who have ALS and Parkinson's who have ongoing exposure. So, some people may not even know that they live on top of a contaminated water with TCE and are still breathing it in, even though they already have these [00:18:00] diseases. I worry about people who are drinking well water that might have either or pesticides in it, and so getting exposure to that. So I tell everyone with Parkinson's and may be true for ALS, I know less about ALS, but you know, I buy organic produce 'cause I can afford to do so.

But I think it's just a good idea, especially if these diseases, I wash my fruits and vegetables, I probably put a water filter on my water. I like a carbon filter that you can get easily from the grocery store. If I lived near a, a, well, if I ever gained my water from a well, I'd have it tested specifically for these chemicals and uh, pesticides.

I would avoid pesticides like the plague if I had ALS or Parkinson's disease. So not just consuming it, not just eating it. But, you know, if you live in a farm area, you could be exposed to it just inhaling it. Or, you know, what people put on their lawn, or their neighbors put on their lawn, or whether people put on golf courses.

All those things could be factors and, um, perhaps worsening, um, both diseases and air pollution is [00:19:00] also been shown to be associated with an increased risk of hospitalization for people with Parkinson's disease. 

Dr. Jaime Hatcher-Martin: Absolutely. And not to be overly morose about it, but you know, right, there's organic pesticides like Rotenone that have actually been used to, to actually create a model of Parkinson's disease in the lab.

So, uh, you know, I think there's a lot of research to be done there. 

Dr. Ray Dorsey: And the person who helped create that Dr. Kim Greenmeier just recently had shared his story and signed our top journal in the field that he developed Parkinson's disease. So we've actually. During the experiments, even on ourselves, demonstrating that these factors are likely causes of the disease.

And the corollary of some things that cause diseases, that's a preventable disease. A lot of ALS, and I think most, a large proportion, and most of Parkinson's disease is preventable. Say that again, ALS may be preventable. I strongly suspect it is. And most of Parkinson's disease is likely preventable. We increasingly know what the causes of these diseases are.

It's [00:20:00] on us. To eliminate those causes so that we can create a world where future generations don't have to deal with these disabling and deadly diseases. 

Dr. Jaime Hatcher-Martin: So, and is this, is this what you mean when you say, you know, one of your quotes, you say that Parkinson's is largely a man made disease? 

Dr. Ray Dorsey: Yeah. And so, uh, when Dr. Parkinson described the condition, he did so in 1870 in London, he said, one, this is a disease that's not been classified in the medical literature. He's 61 years old. He's been practicing surgery. For probably 30 years is I think his father was a surgeon. He knew the medical literature and he goes to great length to describe people who've had tremor in the past.

That's been described, but this shuffling gate, the stoop posture, this tendency to go forward really fast. Those were all new, and if you look at what's going on in London in 1817, it's the height of the industrial revolution. London's the capital. The air quality in London is terrible. The London fog. Was twice as bad as it was in 1952 during the Great Smog, which if any of you watch the TV series [00:21:00] The Crown know caused 12, 000 deaths and mass hospitalizations.

Air pollution in 1800 London was twice as bad, as bad as it is in Delhi, India right now, which is among the most polluted cities in the entire world. So I think air pollution, which was, you know, prominent in London in 1817 when Dr. Parkins described the condition. And later, TCE and later, um, synthetic pesticides, ones that we created ourselves, man made pesticides, um, are likely fueling the rise of the disease.

Dr. Jaime Hatcher-Martin: Yeah, and I think it's always important to, you know, when we talk about pesticides, right, the whole goal for the vast majority of them is to attack the nervous system of whatever pest you know, that we're trying to get rid of, but there's a lot of similarities, at least at the, at the very basic levels between our nervous system and that of the very pests we're trying to injure.

Dr. Ray Dorsey: Yeah, these pesticides can kill insects on contact. You should be wondering what it might be doing to chronic long term [00:22:00] exposure to humans . 

Dr. Jaime Hatcher-Martin: Absolutely. So I have, you know, some other questions that I, I certainly would love to address, but we've got a lot of questions coming in. So if it's okay, we'll, we'll take a few of these.

So, um, 1 person asks, has there been any research to understand why some people get cancer? Some people get Parkinson's disease versus any of these other conditions based on this theoretically, the same TCE exposure. 

Dr. Ray Dorsey: Yeah, so it's a great question. And, um. There's been just so little attention to these environmental causes.

If you look at every research dollar that goes to Parkinson's, and my guess is the same thing's true for ALS, but for Parkinson's, only 2 cents of every Parkinson's research dollar is aimed at preventing the disease. Only 2 cents of every Parkinson's research dollar is aimed at preventing the disease, and that's likely true for cancer.

And so forth. So that would be a great question to answer. Why do some people who are close to TC develop Parkinson's? Why do some get cancer? Why do some maybe get ALS? Um, we don't even have great answers as far as I know for a lung, for [00:23:00] smoking, why some people 10% get. Lung cancer, some get heart disease, some get strokes, some, some get, um, emphysema.

Um, so I don't have a great answer as to why it is. I suggested some of these genetic causes. I suggested that the timing of exposure. I suggested dose and duration exposure, maybe the route of exposure. I really can get concerned about people inhaling. These toxicants, because the nose, maybe the front door of the brain and bypasses that bypasses our blood brain barrier bypasses detoxification liver.

I don't have a good answer as to why some people get cancers, for example, and why some get Parkinson's. In some cases, I think people get both. So, um,

Dr. Jaime Hatcher-Martin: That's a few cases where people definitely have both. So, okay. So another question was Michael J. Fox mentioned in his early interviews that there were four people from the show, Leo and me, they were all diagnosed with Parkinson's. [00:24:00] Um, so one, if you could maybe comment. We talked about sort of the global or at least at least in the U.

S. sort of how that, you know, Parkinson's disease is growing. But maybe if you could talk a little bit about how common Parkinson's disease is that baseline. And then this person also asks, has anyone investigated whether there was exposure or pesticide exposure where they were filming? 

Dr. Ray Dorsey: Wow. So that person should contact me, uh, Because that person seems to know a lot. Um, so, uh, and so Michael J. Fox in his interview with Jane Pauley said that, uh, he thinks he got Parkinson's disease from exposure to quote some kind of chemical. Um, as the person indicates that's well known and been published in the literature about Michael J. Fox was part of a cluster of individuals. Um, who developed Parkinson's disease, including four people from this TV show. The TV show was formed in under as far as I know. Was formed in an underground studio and the Canadian broadcasting company in [00:25:00] Vancouver and almost every city in the country is littered with TCE contaminated sites, including likely Vancouver, including Rochester, New York.

So, um, if I had to have my druthers, I would be concerned about TCE or closer to a chemical called perchloroethylene as a potential, um, explanation for, uh, people who are clusters of, uh, Parkinson's disease, uh, whether it's Michael J. Fox or my friend Dan Cannell, uh, we investigate a cluster of attorneys who developed Parkinson's disease because they live near our contaminated site.

And we found high rates of Parkinson's disease and high rates of, uh, cancer in that cohort. I wouldn't be surprised if that applies to hundreds, if not thousands, uh, of other cohorts. I'm on the crazy side. I wouldn't be surprised if TCE is the most common cause of Parkinson's in suburban and urban areas in the United States.

Because most people in the United States live in suburban and urban areas, I wouldn't be surprised if TCE is the most. Common cause of Parkinson's in the [00:26:00] United States. 

Dr. Jaime Hatcher-Martin: So, I guess it would be interesting to see is as it's been banned, at least in some areas, right? It's not banned everywhere, but as it's been banned in some areas over time, theoretically, with the incidence of PD go down, 

Dr. Ray Dorsey: There's only 1 great study that shows a decrease in incidence of Parkinson's and that's in the Netherlands.

And if you look at air pollution drops substantially between prior to the decline incidence levels of pesticides and people's fat drop precipitously before the decline. And levels of TCE in the air in 1981 were the lowest in all, all of Europe. So these three risk factors, all mitochondrial toxins, all substantial decreases associated with a decrease in the incidence.

About Parkinson's disease. I think, again, evidence that Parkinson's is preventable. 

Dr. Jaime Hatcher-Martin: Right. So on that, I guess sort of on that same thought, you know, given how common Parkinson's disease is, if I have a family member with Parkinson's disease as well, should I be worried [00:27:00] about a, like say, you know, let's say my mom's dad had Parkinson's disease.

He didn't, but let's just say he did. Um, am I, should I be worried about a genetic cause? Should I be worried about an exposure? Um, or do you think it's possible that, Just common things being common. 

Dr. Ray Dorsey: So about one to 2% of people over 65, uh, have Parkinson's disease. If you have a first degree relative, your in risk is two to four times greater, still, 90 plus percent chance that you won't develop Parkinson's disease.

So one, you can breathe, take a deep breath, uh, and hopefully, uh, Parkinson's and ALS or generally relatively uncommon diseases, you know, compared to like high blood pressure, high cholesterol thing, diabetes. Um, That said, so there are genetic causes, so that that would be a thing, especially if it runs in multiple members, uh, these, some of these, two of these genetic mutations, LRRK2 and GBA, the two most common, tend to be more common in Ashkenazi Jewish populations, tend to be more common in Arabs from North Africa. So those would be considerations. But it's also worth noting that, in addition [00:28:00] to sharing genetics, families tend to share environment.

So there are other, it could be environmental factors that might be a concern, so, You know, if your neighbors all developed or your parents, neighbors, all developed cancers or Parkinson's disease, that would get me more concerned about environmental. 

Dr. Jaime Hatcher-Martin: Absolutely. And you know, one of the things we often do with new patients when we see them at Synapticure, we talk about not just where you've lived, like Seattle or New York City, but specifically zip codes, because we know that certain times there may be areas, let's say you're at the bottom of a hill and you're, you know, there's a lot of runoff from a particular area that that specific area may have a higher incidence of disease.

But then when you look at the whole, the city as a whole, we're very careful. You may not see a big difference, so there can definitely be sort of pockets, you know, of exposure. 

Dr. Ray Dorsey: And it's good that SinatraCure and others are asking why you have Parkinson's disease, because one, uh, if you know why you have Parkinson's disease, a couple things.

One, it might tell you what other diseases you're at risk for, and you could screen like for cancer, right? It's also great if you know why you have a disease. That's the gateway to getting [00:29:00] a cure. Um, so just a little tangent. So when Jamie and I were in medical training, um, it was widely thought before, before we were medical training that, uh, stomach ulcers were due to remember what people thought stress.

And so they're people doing relaxation therapies and stop working everything, but that didn't do anything. In fact, also just continue to get better worse. And many people died from ulcers. Now, almost no one dies from ulcers because we know what the cause of ulcers are. And that cause is it's a bacteria.

So it's a bacteria. And so what do we do once you figure out the bacteria, you give people an antibiotic and they'll be okay. Miraculously, we get rid of ulcers. And that's happened for, uh, ulcers. It's happened for hepatitis C. It's happened for a wide range of diseases. If we find out what the cause of these diseases are, not only can we stop ongoing exposure, minimize the rates of progression, but we can come up with entirely new treatments and potentially cures for disease. I can't think of a disease [00:30:00] that we can cure medically where we don't know its cause. All of us are interested in cures for Parkinson's, ALS, Alzheimer's disease, but if we don't know what's causing it, it's really, really, really hard to cure disease. But if we find the cause, it can sometimes become really, really easy.

I don't think it's gonna be as simple as an antibiotic, but it could be as simple as not getting exposed to these chemicals and prevent people from ever getting these diseases first of all.

Dr. Jaime Hatcher-Martin: And I think for me, you know, in the, in the couple of decades since I've started training, you know, just how cancer care has changed so much.

And, you know, in a lot of cases we don't, we don't know exactly what causes it, but we've learned a lot about the different biomarkers and the genetic contribution. So in some of those cases we may, sometimes we can cure it, but at least we can sort of keep it at bay or sort of maintain a level instead of it continuing to progress.

So, okay. So there's another, um, these are sort of questions that are all related, um, to how do we [00:31:00] know if we're being exposed? How do you get tested? How do you get rid of it? If you know, if we, if we find out what our levels are, how do we get rid of it? 

Dr. Ray Dorsey: Um, so, uh, if you're, so water's easiest. Um, so if you're getting city water, municipal water, that's really based by the Safe Drinking Water Act, and that should in theory be, uh, have safe levels of TCE.

That said, I get municipal water. I still put a water filter on my things. I don't know when I still get concerned because some people were getting water from city sources or from freshwater sources. And we're still getting exposed and there are other chemicals that I just don't want to get exposed to too.

So I put a carbon filter on my water. I'm drinking water and it's been filtered by a very inexpensive carbon filter, you know, like Pure, Britta and all those things. Um, if you get wells, you need to test those wells for TCE and perchloroethylene. Perchloroethylene has one additional chlorine atom. Another chemistry is vinyl chloride, which is really maybe linked to ALS, has just one chlorine atom.

[00:32:00] That's the chemical that's at East Palestine, Ohio from the train accident. So, uh, I would test my well for those chemicals specifically. Um, you can get, just like people can test for radon in your basement, you can test for TCE, um, in your home. I've put some black pages in the back here of our book, um, and you go to the EPA website, uh, around vapor, it's called vapor intrusion, maybe Jaime can type that in, vapor intrusion, um, and find out how to do it.

Now, getting it, Oh, and if you live near a dry cleaner, I would definitely be testing. And if you live near a contaminated site, I would definitely be testing. And if you were an apartment building above a dry cleaner, I would be getting it out. I think it's really, really hard because the relevant exposure might have been decades ago.

Um, so. If you've been exposed in the past, I don't know of a way to get it out. We, there was a study recently trying to get, uh, we know that people with Parkinson's and [00:33:00] Alzheimer's have high levels of metals in their brain, including iron. And there was a study looking at a drug that could get iron out of the brain.

So see if that would be helpful. And they gave the drug and got iron out of the brain, people with Parkinson's, but it made their Parkinson's worse and it caused more side effects. So the people got worse. They did much worse. Um, so I think it's really hard to get it out. Um, so what else can you do?

Exercise can protect those remaining nerve cells. So vigorous exercise. This is definitely true for Parkinson's, and I think for ALS as well. I always tell people at least an hour a day of exercise, running, swimming, yoga, tai chi, ballroom dancing, rock steady boxing, I think are all beautiful things that you can do to release growth factors to protect the remaining nerve cells.

And by all means, avoid getting exposure to additional of these chemicals. If you live in like Southern California, where my parents do, my kids got them an air filter for Christmas for their home to decrease exposure. If you drive through traffic, roll up your windows, put on your air [00:34:00] conditioning, circulate the air, reduce your exposure to these toxicants.

Dr. Jaime Hatcher-Martin: And I think this gets to one of the other questions is, you know. Is it thought that TCE is like a causative agent, or is it maybe like a combination of multiple things? 

Dr. Ray Dorsey: I think it's likely a cause. Now, you know, everyone gets all bent out of shape, but like, can you prove it? Um, you know, there's a great line from Senator, I mean, from, uh, retired master sergeant, uh, Jerry Enzmiger, who was a drill instructor at Camp Lejeune.

His daughter died from leukemia, likely from TCE. And he goes, the benefit of the doubt should go to the people, not the chemical. So absent evidence that TCE is safe, uh, I think there's more than enough evidence to suggest it's not. It can cause, it causes cancer, that's established, the World Health Organization says that, the EPA says that.

And I think just the evidence from Camp Lejeune, I think the evidence from the twin study, I think the evidence from animal models, all really suggest that this likely, uh, is a cause of Parkinson's. And maybe it needs some [00:35:00] other, other interactions, it may not be sufficient by itself. I think there's more than enough evidence for us to think, hey, we can avoid people from ever getting this disease, right?

Dr. Jaime Hatcher-Martin: And no one's ever gonna do the experiment to see if that exposure leads to Parkinson's. But like you said, we know, we know it's related to a lot of the cancer. So, you know, from that alone. There's definitely, you know, reason enough to try to ban some of these chemicals and then hopefully see what, what comes down the line.

Um, okay. So, so there's a couple of other questions about, you know, other types of exposure. So somebody asks about, you know, insect repellents and other types of, so not necessarily a pesticide, but other types of repellents. Do you have any thoughts on those? 

Dr. Ray Dorsey: Yeah, I would, um, I'd avoid. We have a lot of dandelions in our front yard. I'd avoid. If I had Parkinson's, there's no way, if I had ALS, there is no way I would be hanging out near pesticides. Okay. And not [00:36:00] all pesticides are linked to it, but there's just so many I wouldn't hang out near pesticides. We don't know. 

Dr. Jaime Hatcher-Martin: Okay, so somebody else asks, um, do you believe athletes like Kirk Gibson and Muhammad Ali who got Parkinson's are due to concussions or repetitive sub concussives and traumatic brain injury?

Do you believe it's multifactorial? So this is a little bit sort of, uh, 

Dr. Ray Dorsey: Michael Okun, co author on the study, just wrote a paper in JAMA Neurology. He was one of the physicians who helped care for Muhammad Ali, arguing that he thought most of his Parkinson's was due to head trauma. Now, obviously, he had a significantly more head trauma than most of us.

Uh, Kirk Gibson, I'm a little bit less, uh, sure about. I haven't just done a deep dive. I know he was a great athlete. Um, I also, and so we know that head trauma increases your risk of Parkinson's. Head trauma is way worse, uh, for ALS. And way worse for Alzheimer's disease than it is for Parkinson's. I think I get really concerned. So there's study [00:37:00] 3 studies that have shown that soccer players are an increased risk for developing ALS. So, why would soccer players be an increased risk? You know, why generally healthy people are not enjoying a higher risk with the. I think head trauma, and I think people are getting exposed to pesticides.

So I think they're inhaling the pesticides that are sprayed on fields. And if you're a soccer player, baseball player, you're hanging out on fields that are, um, sprayed with pesticides, golfers. Um, but obviously not getting the head trauma, but I get concerned about the interaction. And so we know in animal models that there's a synergistic amplification of the risk for animals who have been exposed to pesticides and head trauma. And so I really would worry about that, um, for athletes. It'd be 

Dr. Jaime Hatcher-Martin: It would be interesting to see too. And I actually, I don't know the answer to this is, you know, Has TCE or similar compounds been used in artificial turf too, right? It seems like as much as it's used everywhere else, is there something in the production of artificial turf too?

Dr. Ray Dorsey: Again, I'm not an expert. I'm a neurologist, not a toxicologist or environmental scientist. Studies in artificial turf have looked at, like, [00:38:00] cancer much more than Parkinson's or ALS to my knowledge, but Um, data lines, I think, are much less likely to be dangerous than a great. 

Dr. Jaime Hatcher-Martin: So, um, actually, another neuroscientist asks, how can we measure functional reserve to see who is at risk of developing PD from exposures or genetics?

So maybe you can talk a little bit about. At what point do people develop Parkinson's disease? What, you know, how much reserve do we have? And 

Dr. Ray Dorsey: So one, there was a, uh, there was a biological marker that the Michael J. Fox Foundation, uh, found, uh, in the spinal fluid that can identify people who are likely to have Parkinson's and when it's normal, identify people who are not unlikely to have Parkinson's and perhaps more powerfully identified people who are likely to develop Parkinson's before they did.

So that's one marker in the spinal fluid and research study as suggested. I think all these diseases, Parkinson's, cancer, and maybe ALS, I suspect ALS, [00:39:00] take years, if not decades, to unfold and develop. And so our body is compensating for these diseases until something happens, you know, the tumor gets so big that it starts to cause symptoms and bleed, get another mutation.

You get sick and you're in the hospital and your reserve capacity is diminished and you start to tremor and the doctors, you're hanging around doctors and they identify you with the disease or other things. And I just don't know, but I suspect that we're able to handle this for large periods of time.

Until the disease progresses or progresses such that we, um, it no longer can. And I think the gift of longevity has allowed people to live longer, disease to progress more, and maybe our capacity to manage or keep the disease at bay diminishes over time, and the disease then becomes manifest. 

Dr. Jaime Hatcher-Martin: Yep, absolutely.

Um, so is there another question? Um, is there any [00:40:00] research of exposure to pesticides TCE and the impact by sex or gender and sort of looking at the interaction of hormones? We know that there's sex differences in the incidence of PD. So. 

Dr. Ray Dorsey: Yeah, and so in animal models, it turns out male rats and mice, which are far from my area to teaser seem to be at higher risk of, uh, for developing Parkinson's than women.

Female rats, and there's some thoughts that estrogens protective. I, I think for Parkinson's in humans, I think the sex differences is more sociological than biological. So if you look at the United States, I told you pesticides are linked 75% of farmers are men. I told you about pest pesticides 97% of pesticide applicators in the US are men.

I told you about getting exposure to this like in degreasing and those things those occupations spew heavily toward men. There are exceptions. So, um, I believe in South Korea, and I think Taiwan, it might be Japan, at least two of those countries, rates of Parkinson's are equal among women and [00:41:00] men. And in one of those countries, the rates of Parkinson's is higher among women than men.

And I looked back, and it turns out in those countries, most of the farmers were women, used to be women. So I think the differences in Parkinson's disease are largely driven by sociology, what people are doing in their environments, as opposed to biology. 

Dr. Jaime Hatcher-Martin: Very, very important point. Um, so, and there's a couple of questions that have sort of come in with this.

I'll sort of lump them all together. Um, are there other Um, compounds you mentioned, so TCE, PCE, are there other types of compounds or specific, you know, either, either classes or specific compounds that, um, have been investigated in relation to Parkinson's disease that, that may increase the risk? 

Dr. Ray Dorsey: I think, I think you want to look for these compounds that impair the function of mitochondria.

I think ones that are inhaled, it could be ingested too, and so some of this is likely due to facts, people drinking contaminated water, for [00:42:00] example. Things that are inhaled and damaged mitochondria. I don't think we have a huge, uh, we don't have an exhaustive list. I just think TCE, air pollution, and certain pesticides, given their widespread use, given the evidence that we have to date, given the animal studies, I think those are the three most common.

And the perchloroethylene, the other one that has another chlorine atom, I think are. And I think these are also for ALS, um, and I think they're for cancer. Um, I wouldn't be surprised at all if there are other ones, other chemicals and by knowing, so I think these, these are the only ones, but I think these explain a lot of them.

Dr. Jaime Hatcher-Martin: Yeah. And I think it's, you know, right. I mean, this is, this is my background for research when I was in graduate school and a lot of the pesticides that we studied. Are, you know, even though many of them have been banned, they were designed to be – to stick around for a long time. They were right. That's that was that's what made them effective is.

You could apply them once and they would work for long periods of time. And unfortunately, like you said, you know that a lot of these exposures are we're now, you know, [00:43:00] years and years later, starting to see a lot, you know, potentially a lot of the effects of them. 

Dr. Ray Dorsey: I'm just reading some of these, uh, questions.

Can I answer a couple of these? Yeah, please do. Oh my gosh. So, uh, electricians and aviation, uh, I would be worried about TCE exposure and, um, sounds like, uh, one of the listeners was exposed to that. Um, permethrin is a class of, uh, pesticides. They're actually naturally occurring. They're produced by chrysanthemums, which I think the first patient Dr.

Parkinson described with the condition was a gardener. And chrysanthemums were widely grown in England. So I think that's maybe that's pure speculation, but for methods have been associated with, uh, uh, Parkinson's. I didn't know about the ALS association, but, um, yes, um, yes, there have been clusters of Parkinson's in agriculture areas.

So people who work with, uh, Paraquat, this pesticide that's also strongly linked to Parkinson's [00:44:00] have 150% increased risk of developing Parkinson's disease. There have been studies in Canada and Australia, and I'm sorry, in France that show a near perfect correlation between pesticide use in agriculture areas and rates of Parkinson's, near perfect correlation.

Like, even height and basketball players doesn't have a perfect correlation. The strength of the level correlation is just, um. A very, really high, um, and it turns out the pesticide manufacturer for Paraquat knew about the study. And they were concerned that they might expose be exposed to liability, like this asbestos manufacturers.

And they said that Parkinson's can go on for decades, and they're right, um, is there a map of contaminated sites? There should be a map of contaminated sites. Some, the EPA, I think, has a map of Superfund sites. Our book has a map of some Superfund sites and sites in Silicon Valley. And California, I think, has a map of sites.

Um, but they're, they're [00:45:00] there, but they're not exactly the most user friendly, but they're there, um, to be had.

Dr. Jaime Hatcher-Martin: So I'll mention while you're looking for those two, you know, there's, there are a lot of efforts for whether it's pesticides or TCE or a lot of these compounds looking at how can we, how can we break these compounds down, but one of the biggest things is we want to make sure that the breakdown products of it are not.

Just as toxic, if not more toxic, or they can be spread more easily than than the parent compounds. So, um, I think it is important to note that people are, you know, even if some of the legislation might be behind the times, there are a lot of people that are looking at how we can actually try to, um, you know, break a lot of these things down 

Dr. Ray Dorsey: And a couple more that I'll let you ask some questions.

So, uh, it's one time exposure enough. I think it's unlikely. Um, but every time I say that about TCE I get have And someone comes and tells me of some concern. So I used to think dry cleaning was safe. And then [00:46:00] someone points out that some people like blue collar jobs, they would have their, their uniform dry cleaned every day.

And they'd be wearing the thing. And we know that dry clean clothes off gas. They release the gas into it. And they are 30 years of that. And yeah, that might be the exposure to do it and people ask about the lag and so you don't smoke a cigarette and develop lung cancer the next day. It takes 25 years or more.

For lung cancer, and it turns out research by Dr Goldman and Dr Tanner. 10 to 40 years between exposure and development of disease, the camp lejeune study. So, man, remember, these are Marines, you know, who, by definition are healthy, right? So these are the best and brightest of the US. So these individuals were exposed at age 20.

they were exposed for 2 years on average. And they were developing Parkinson's in their fifties, if not sooner. 

Dr. Jaime Hatcher-Martin: And I think an important point on that too is, you know, we talked about the role of traumatic brain injury and things like that. When you look at [00:47:00] Marines from Camp Lejeune versus Camp Pendleton, theoretically, I don't think they looked at this, but theoretically the risk of head injury and those things should be about the same.

So you sort of take that part of it, you know, those sorts of things out of the mix and what you're left with is potentially different exposures. 

Dr. Ray Dorsey: Yeah, and there's good reasons to think that that 70% is an underestimate. There are, were early in the course of, uh, these people are still young, they had other features.

Some people who weren't diagnosed with Parkinson's already had a tremor, suggesting that they're going to be. Turns out that people at Camp Pendleton was also contaminated with TCE, so there was likely artificially inflated rates of Parkinson's in the control group. So all this is understating it. Um, so if I'm scaring you, I should be, I mean, this should be scary, but I think that's hopeful.

We can get rid of these things. We can get rid of these chemicals. In New York and Minnesota have passed bans to ban TCE, so you're not allowed to use TCE anymore in New York State where I live, but there are still contaminated sites. The EPA said that both these chemicals, TCE and [00:48:00] this perchloroethylene pose an unreasonable risk to human health, pose an unreasonable risk to human health.

It's time for the EPA to ban it. Senator Cory Booker in New Jersey has proposed legislation that would ban Paraquat. If we do all of these things, we can create a world, may not help the people right now, but I think it could still help people right now. But it will definitely help the millions of generations of humans to come in the future from ever getting these disabling and deadly disease.

Dr. Jaime Hatcher-Martin: Right. And to get to your point before, you know, if, if you have a diagnosis already, if you can reduce continued exposure, you know, then perhaps it'll slow progression or at least not, you know, it won't be as accelerated as it was. Um, so there's a couple of other questions. Um, so somebody was saying they love the quote, "The benefit of the doubt goes to the people, not to the chemical."

I 100% agree with that one. Um, we talked about, you know, sort of the detoxing, um, if we can break these, these things down. Um, so, uh, one gentleman with, with Parkinson's is saying is. It really sounds like [00:49:00] PD should no longer be categorized as a movement disorder, but rather as a nervous system disease, which I think we, most of us consider it that way, even though the, we sort of identify it by the actual movement part of it.

But do you think as we look at some of these exposures that it would change the way we classify some of these disorders? 

Dr. Ray Dorsey: Yeah, I think sometimes we're blinded by what we see. And so, um, Dr. Parkinson was describing what he saw. And actually of the six people he described, only three did he actually examine.

So the other three who just describing what he saw. And so the most visible manifestations are the movements. And so that's why it's class and movement disorder. But we know the earliest symptoms of Parkinson's are loss of smell and constipation, which gives us a great clue as to where Parkinson's might be beginning.

And this guy, Heiko Brock, in 2003, put forth this hypothesis that Parkinson's disease isn't even primarily a brain disease, that it begins outside of the brain, that it begins external to the brain, either in the gut moving up to the brain through the vagus nerve, or through the nose and then back [00:50:00] to the parts of the brain.

So, um, you know, you could say it's a nose disease, um, I think that would probably be more accurate than just saying it's a brain disease, but we know it has manifestations, and I'm not convinced that, you know, it doesn't have manifestations in other parts if these things are damaging the mitochondria, it's suggested why the nerve cells might be most vulnerable, but doesn't doesn't preclude other cells and becoming more also being vulnerable to. And you can just see the pathology marches out over time. 

Dr. Jaime Hatcher-Martin: Absolutely. So there's several questions about sort of other types of exposures and chemicals. So there's been a couple questions about the role of alcohol, especially I think more on a sort of an alcohol abuse level. And if it's if there's any relationship between part with that and Parkinson's.

Dr. Ray Dorsey: Not, not, not a huge amount, um, but alcohol has its own nerve neuro is its own toxicity. And if I had a brain disease, I [00:51:00] would be avoiding anything that would be making my challenging my nerve cells. So I would avoid, I would minimize exposure to alcohol. 

Dr. Jaime Hatcher-Martin: And then somebody else asks about, um, how does encephalitis or von Economo?

Right. So those of you who watched, um, uh, I just blanked on the name of the movie, awakenings, Awakenings, um, which is right, is interesting considering how Robin Williams ended up passing away to related disorder to Parkinson's. Um, so how, how is that thought to have caused Parkinsonism and how does some of these other disorder, you know, other exposures or may cause Parkinsonism, and what does Parkinsonism mean?

Dr. Ray Dorsey: Yeah, so Robin Williams, as an aside, grew up, uh, right next to a golf course. Um, so. Um, and there are some viruses that have caused, uh, likely cause, uh, Parkinson's disease due to their ability to get into the brain. COVID is, does not appear to get into the, into the brain. And so this sleeping sickness, which happened in the [00:52:00] 1920s, right after the influenza pandemic, no one, as far as I can tell, can really tell us what, uh, caused it, but let's assume it's a virus or a reaction to the virus, which is called inflammation of the brain, and people develop Parkinsonian symptoms.

Later, and they got frozen in time, and then people, um, Oliver Sacks and others gave them levodopa, and that led to this awakening where they could move again. I don't have a great sense of for, uh, how sleepiness actually caused Parkinsonism, no question that it did. Um, but I don't know why, I don't know if it, the virus or the inflammation was selective to the areas of the brain that we know are affected with Parkinson's, I, I would suspect, I don't think I've ever seen autopsy studies, I presume that they have been.

Um, but, um, I don't know, I'm not sure, and I actually have one. There's one on Brian Grant. So people talked about Michael J Fox. So it turned out Brian Grant. Why did he get part of these the former NBA basketball player and we discussed in the paper we just wrote. He was his father was a marine his father stationed at campus Lejeune, he was [00:53:00] a three year old boy.

At Camp Lejeune, drinking, likely drinking, bathing, uh, taking baths with the contaminated, uh, chemical. His brother almost died from a respiratory illness. His father died of Esophageal cancer, both linked to, uh, TCE. So, uh, I think Brian Grant's story is another example of why I think Parkinson's may be preventable and how we can, uh, create a world without this disease in the future, just like it's just like it was a really rare disease when Dr. Parkinson might be described when Dr. Parkinson described. 

Dr. Jaime Hatcher-Martin: Absolutely. So, uh, I think in the interest of time, there's a lot of other questions. So I'm going to try to get to those off, um, offline.

We'll, we'll try to answer all of these questions. Um, so what's, what's the takeaway? What, um, you know, what can we as individuals do regarding. You know, TCE in general, what are the, what are the future directions that you see that that we can help with, or that needs to be done in this field? 

Dr. Ray Dorsey: So we've like [00:54:00] inherited gifts from previous generations.

We live in a world that's free of typhus. We live in a world free of smallpox. We live in a world where polio is not curable, but essentially we live in a world largely free of polio because we prevented it. We live in a world where HIV is both preventable and treatable. We live in a world where drinking, driving and socially unacceptable and thousands, if not millions, likely millions of us have benefited from all these changes all occurring in the lifetime of many people.

Uh, participating on this call. So these are all gifts we've received from previous generations. And with a gift, you have an obligation to receive. And then you have an obligation to reciprocate and so I think we should be thinking about creating a world where ALS, Parkinson's disease and many other brain diseases are extraordinarily rare instead of extraordinarily common.

And we can do that by cleaning up our environment and identifying the likely causes and certainly the known risk factors from the disease, we can create a world largely free of Trichloroethylene. It's been around for 100 years. I think a century of causing cancer is enough. We can create a world where [00:55:00] dry cleaning chemicals, we're not exposed to dry cleaning chemicals just so our clothes don't shrink, and they're feeling the rise of Parkinson's, we can get rid of pesticides that are from the 1960s. If engineers can develop safer cars and airplanes, chemists can certainly develop safer pesticides. And I can't think of a better gift that physicians can give than to a world where the diseases that they're caring for just don't happen or are really rare.

I can't think of a much better gift for people who are most directly affected by the disease than to ensure that other people are not going to suffer the disability that these diseases have put upon them. Um, what a great gift to give to future generations is to say that we're the last generation that's going to bear the burdens of ALS.

We're the last generation that's going to bear the burdens. of Parkinson's Disease, and although we're bearing the burden now and today, and we suffer with it, we're going to make sure that future people don't do it. 

Dr. Jaime Hatcher-Martin: Yeah, absolutely. If I could do that for my my sons or, you know, it's it's the greatest gift we could do.

Well, Ray, I really, really appreciate it. It [00:56:00] was we could talk. There's lots more questions. We'll definitely work on getting those answered. I think we could talk for another hour on a lot of these things, but we really appreciate you taking the time today to join us. I'm going to share. There's 1 more question I wanted to get to. I'm going to share my screen. Um, So if you would like to learn more about Synapticure, um, you can book a free consultation today. There was a question about how we can work with your existing clinic if you're, um, if you already have a neurologist. And so I, I always like to tell people, you know, a lot of times you may have, um, issues that come up between visits. Um, so we're happy to work with you, um, in between your visits with your neurologist. We want to communicate with them to fill in, um, any areas where you still like you feel, feel like you still need some support. Um, and this model is not new, right? We've, we've talked about cancer a lot today, actually.

Um, we see this in oncology as well, where people often have a local, um, neurologist, and then they also work with an oncologist. And so in some cases you may be able to work with the local neurologist. Did I say, I think I might've said neurologist the first time too, a local neurologist, and then maybe a movement disorder [00:57:00] specialist.

So feel free to reach out to us. Um, we're happy to talk to you more about, um, what specifically we can offer and answer any questions that you might have. So thank you everyone for joining us today. Ray, thank you again. 

Dr. Ray Dorsey: And, uh, it's always great. And just to say, if people have additional questions, I didn't get to answer that.

You don't, you can't answer that. If you want to tell me more about their stories, I'd love to hear it. info@endingpd.Org. If you haven't got a copy of our book, please get one. It's all proceeds, all the author's proceeds are going to efforts to prevent and the disease. If you can't afford it and you want a copy, just email us your mailing address and we'll send you one for free Yes. 

Dr. Jaime Hatcher-Martin: Perfect. Okay. We'll make sure we put it out too. When we, uh, when we post the recording of this for anybody who didn't get to see it, we'll make sure that we put that in the comments as well. 

Dr. Ray Dorsey: And hi to John and Jack out there. 

Dr. Jaime Hatcher-Martin: Thanks so much. Have a great day, everyone.

Bye bye.