Treatments for Dementia: An Interview with Dr. David Haase

What follows is a transcript for the podcast: How to Regain Cognitive Function: A Systems Medicine Approach to Dementia

Sub-section topics within the interview include the following:

1. Working Towards Solutions for Dementia
2. Creating Treatment Plans for Dementia Patients 
3. Young Plasma for Alzheimer’s Disease
4. Remarkable Findings in the AMBAR Study
5. Lifestyle to Support Cognitive Health
6. Benefits of Connections Between Younger and Older People
7. How Systems Medicine Will Transform Healthcare
8. Risk vs. Benefit of Plasma Transfusions 
9. Concerns About Frequency of Plasma Donations

Working Towards Solutions for Dementia

Dr. Heather Sandison: Welcome to Collective Insights, I'm your host today Dr. Heather Sandison and I have Dr. David Haase here with me today. Thank you so much for joining us.

Dr. David Haase: Hello Heather, it's great to be with you.

Dr. Heather Sandison: So it sounds like you and I got into this dementia world for similar reasons. I was drawn to dementia and autism. Excuse me, Alzheimer's and autism because I thought, "Okay, if I can help with the hardest things where nobody else can help, then what can I not do." Right? Then I can help anybody who walks in the door and that's there goal, right? To be a good doctor as you were talking about. If you can help everyone who walked in the door, you'd be doing-

Dr. David Haase: You're a glutton for punishment actually.

Dr. Heather Sandison: Yeah, right. You'd at least be making an impact. And so then as I worked more with Alzheimer's, I think you and I came to the same conclusion. It's like, wow, you have these people at the height of their wisdom and experience and God knows that the world needs some wisdom and experience these days to come up with solutions to the problems that we have on the planet.

Right, so if we could help to support these humans, these humans who are advancing in their age to be more engaged in their communities and their families and their work and their passions, then maybe we would get back a little of what we were losing with this increase in the rates of Alzheimer's as people age. So it sounds like you had a very similar process, can you tell me what happened that got you interested in dementia?

Dr. David Haase: Well, I think that like I said, I did not want to work in dementia. I mean, I really didn't want to. I love neuro performance, man, I'm all about making databases of peak performance and neuro hacking and I've been working in a very small group of people to take that to the next level. And there's a lot of fun because when you have high performers that are performing even higher they're like, "Yeah, high fives in the office, this is good fun."

But when you really ask what's meaningful and just like you said there, I would think the highest end ... the thing I want the most of in the world is more wisdom. It is the most important resource that we need as we move forward as a society and as a world and wisdom is held in elders.

And an elder is an old person with wisdom, so we need to have these individuals' brains last as long as their bodies and we have to figure out this system's problem that is causing the unbraining. And that's really what dementia is, it's unbraining and there's not a single cause, it's a multifactorial process that occurs over the course of time.

And my big challenge is that people don't get here soon enough, right? Because there's a lot that we can do for brain cells that are limping along, but nobody's raising the dead. So, when a brain's cells have died, we have a decrease in our capacity, we have a decrease in our reserve functioning, our organ reserve of our brain. So the sooner that we can intervene, the better and I just became passionate.

All these same tools that we're using in autism or in peak performance, it's the same work and it's the same body. We should be applying these tools to our elders and that's been a over decade long project. It's my pet peeve when individuals start having cognitive decline, they have not checked out because and this is our bias.

This is an awful problem that happens is that our world, since we don't have anything yet that we believe helps, the immediate setpoint we go to is that, "Okay, it's time to give up. And the faster I give up, the better off everything is going to be." And that's horse hockey. I mean, that is absolutely wrong.

But we get this mindset and so anything that is not giving up, we actually can develop some hostility towards. It's like, wait a second, this is how I believe the world is and you're telling me it could be different. Anyway, all kinds of emotions come up in the people with dementia as well as you have noticed right?

Dr. Heather Sandison: Yeah, well, and not only for the person suffering with dementia, but for their family members. Everyone who's invested, not financially even, but just emotionally to have hope that they could potentially do better and then to be let down. Nobody is interested in getting into that cycle and so there's just a huge amount of investment it takes emotionally to be on this wild ride with someone you love.

Creating Treatment Plans for Dementia Patients 

Dr. David Haase: Right. So I'm going to go back a little bit, you asked me how we bring people in, but we go through a bunch of testing but then it creates a report and a plan of action. Because the plan of action needs to be multifactorial as well. It's to address sleep and activity and diet and nutritional supplementation and mind body.

And it may also include things like photo stimulation, electrical stimulation, plasma exchange, peptide therapy. We're going to come to some IRBs going around exosome therapies, so the number of things-

Dr. Heather Sandison: I feel like a kid in a candy store right now, you just said all of my favorite things. I basically want to go through each one of them and pick your brain for hours on each of them.

Dr. David Haase: Well, because the point of this and the point is how can I express the good doctor in the way that I am. And I have an ability to be very curious. I wrote a book called Curiosity Heals the Human because I really believe that that's the fundamental thing. If we start asking different questions, that's what gives us a potential for different answers. And I love days when I am proven wrong. I love days when somebody changes my mind with better data.

I love days when I am proven wrong. I love days when somebody changes my mind with better data.

I am thankful for that, I have tried to really nurture that in my professional development because it's dangerous being an expert. When you're an expert, you start tying your ego into what you have said. And so you say, "Oh, this is the way, this is the program." And I think there's a lot of caution in that. We like to follow experts, we like to follow people that we give our authority over to.

Dr. Heather Sandison: You know what I have been impressed by with you is just your caution and how and over promising. You are very careful to say that although there's hope for dementia it doesn't mean that we're batting a hundred, right? We're not getting this right every single time and we don't want to suggest that that's the case, but are there some people where yes it reverses? That's true, right, there's truth and then there's a degree of humility to it as well which I really appreciate in your presentation.

Dr. David Haase: Well, I don't think you can be a physician and have your eyes open and not be humble. I've never understood that because the human condition is so complex and even if we're the most head top nologist in the world in our field, we still know nothing compared to reality. And so anyway.

Dr. Heather Sandison: But it comes with a sense of reverence, right?

Dr. David Haase: We can do so much, that shouldn't stop us from doing what we can, but it shouldn't also, just because it hasn't been done before is not a valid reason for not doing it now, right?

Dr. Heather Sandison: Right.

Dr. David Haase: And especially we are failing in dementia and if we continue to fail, everybody is harmed. Everybody, the society, nobody wins.

Dr. Heather Sandison: If nothing changes, it literally will bankrupt the country.

Dr. David Haase: Yes.

Young Plasma for Alzheimer’s Disease

Dr. Heather Sandison: So, I want to go back to the fun list, but young blood transfusions or plasmapheresis is something that you have more experience and wisdom than probably anyone on the planet around. So you got into this early on, tell me the story of how you got into it and then where are we right now, what do we know about the potential of this therapy?

Dr. David Haase: Sure, and let me be really clear, I really never say young blood. I mean, that's a great marketing term by I think some unscrupulous folks. I think that that is a hype cycle that some people like being known and they want to-

Dr. Heather Sandison: Well, words are important so let's name it.

Dr. David Haase: So I think young plasma is really what we're talking about here. So let's go back. It's a funny story how I got into this. So I have the privilege and honor of taking care of some very high resource individuals that seek me out to either pursue peak performance or very challenging medical needs because I really like problems that I have no limit to how deep I can dig into them. And so that is so joyful for me to work with people who both have the financial resources and also the mental predilection to want to dive deep.

And the things we learn and then I teach about those, I teach other doctors, we teach other ... nothing of this should be secrets. As soon I learn something, I try to blather it out as fast I can because and then prove me wrong or prove me right or add into the story. That's what moves our health science forward in this field of systems medicine. Because we have to go deep with few people and really understand that before we're going to be able to go broad with many people.

So anyway, so I have one of these individuals, a C-level employee of a major tech firm out there in Silicon Valley and everybody has used a product he's developed in probably most days. And anyway he is just a remarkable individual and I'm having my intake evaluation with him and I said, "So, what do you want to accomplish as we work together?" And he said, "Well, I want to live forever."

Dr. Heather Sandison: No big deal doc, no pressure.

Dr. David Haase: [inaudible 00:10:47] farm boy, okay. I grew up on a dairy farm, I'm very rooted in the natural processes of life and death and I have an agricultural view of health, we should grow it et cetera. So hearing this, I was like, okay, I have a choice here. I can immediately blow off what he just said as being hyperbole or I could actually take him serious and because who he is, I'm going to be taking him seriously and see what I can learn from it.

So for a period if time, I just decided to suspend my reality, suspend any belief that I had that this wasn't possible and I dug deeply, and this is about four years ago, dug deeply into everything dealing with anti-aging, regeneration, longevity et cetera. And there's so much horse hockey out there in this field and a lot of great promise and a lot of great ideas. The SENS Institute that is run by Aubrey de Grey I think has really been an amazing ... Aubrey is a fascinating fellow, have you had him on yet? If not, you should.

Dr. Heather Sandison: Yeah, I know, he's on the list, he's very close to the top of the list. (Click here for our episode with Aubrey de Grey)

Dr. David Haase: Because he's conceptualized, he's thought about anti-aging, of longevity medicine, what are the principles that we're going to have to overcome. And one of the things that shocked me is that I had never thought of aging. Aging is really the excess of damage over repair. So every day that you have more damage than repair, you have aged. And so how do I repair, how do we start regeneration, well you need to go to stem cells.

So stem cells and satellite cells and there's a whole host of various potency cells that do the job of repairing. So how do we turn those on in the tissue where they are because you can give some concentrated stem cells in a knee or a joint and you can help regeneration in an area. We're working towards growing new organs, we're doing stuff that if we're really going to help somebody towards forever, healthfully, we need to remarkably increase repair and cause the stem cells body-wide to act younger and be more functional.

And so then it comes to the next part of the story. So in my research I came across parabiosis and parabiosis has some fascinating studies done in Berkeley, Harvard, MIT, Stanford and they took mice that are clones of each other and they took a young mouse and an old mouse and then they sewed them together side by side. I know it's sad, but-

Dr. Heather Sandison: Why did they do this? What made them do this to begin with?

Dr. David Haase: Well, this actually has a very long history because they were trying to understand could young blood change ... could young effect old. And a remarkable thing when they were attached is that in about a week, the old mouse started to turn young. So new skin starts to have increased health, hair growth patterns change, liver function, renal function, muscle strength, bones started getting more osteoblastic activity and new neurogenesis.

And not just neurogenesis, but we've now found out more synaptogenesis which is the making of new synapsis elsewhere in the brain which really excites me more than even the new neurogenesis. So how do we induce this effect? So that old mouse started turning young and the young mouse was actually poisoned by the old. Their stem cells body-wide were stunted and after about a month they recovered, separate the mice, young mouse lives to its normal expected lifespan.

And in some studies and there's not many of them because this is not the point of the study is that old mouse lived to closer to the lifespan of the young mouse. And the data on this is very sparse, I don't want to make any ... again, in this field people want to extrapolate out wildly. I am just interested in healthier stem cells. That's the most important and if we do that, we actually will have effect on longevity I believe, but that all has to be proven.

So anyway, that's how I got into it and I went, "Oh my gosh, youth, this is the important message. That healthy plasma induces old stem cells to act younger."

Dr. Heather Sandison: And maybe it's not the plasma itself, but the signals within the plasma?

Dr. David Haase: Sure, but, okay, here's the fun part about this, well what is it? So, the study was done to extract plasma from old rodents and then they pulled plasma out of young rodents and injected into old rodents and viola the same thing happened. So they were able to show that it was in the plasma. Now, what's in the plasma and this is where the systems medicine versus reductionism really comes into play.

And what has occurred in the science part of this is it's split off a couple of ways. Lots of interest, big pharmaceutical companies have gotten involved and said, "Okay, well how do we investigate this more fully. What are the small molecules that could be developed out of this that would, here's an individual drug. Here's an individual peptide or protein, here is a cocktail of a modified plasma." And it's good, we need to be investigating all these different angles and we need to put them up against scientific rigor and figure them out.

But, so there's many different ways to try to hack and figure out what this is, but the bottom line-

Dr. Heather Sandison: It sounds analogous to herbs, right? Are you getting just that active component or do you get the whole herb and you get the very different experience when you distill down and reduce it to the active component versus using the whole herb. And so same thing with the plasma.

Dr. David Haase: Yeah, because the plasma is a system. It is a system and that system is now interacting with an ... the young plasma is a system that interacts with the old system. And so ideally you'd say, well, what would happen? How could we put young plasma into an old person and see what effects that would have. Now, there's a lot of barriers to getting that done, so I'm a trained apheresis specialist, so that's actually one of the things we do in apheresis is you do that process removing old plasma and then replacing it with something else.

Remarkable Findings in the AMBAR Study

Dr. David Haase: And that something else that we have the most data on right now is not young plasma, but it's albumin. And so the AMBAR study, so let's talk about the AMBAR study. The AMBAR study was sponsored by the drug company Grifols and they enrolled over 400 patients, I think it was 490 some, and they put individuals into a placebo in three different arms and they decided okay, let's study this. Let's remove the old plasma and let's replace it with albumin which is just the main protein that's in the blood of other humans.

And let's put a little albumin in immunoglobulin and let's see what happens and then we'll do plasma exchanges. So in a person my size I'd have about four, four and a half liters of plasma running through my body. So a full plasma exchange would be removing that four to four and a half liters and then replacing it with albumin. And so you've essentially done an oil change for the brain is the approach that they're going through here, right?

And they did six individual plasma exchanges once a week for six weeks and then they did once a tiny plasma exchange and a lot of people in the field went why'd they do that, but they did a tiny plasma exchange once a month then for 12 months. So over a 14 month period, they got about 18 of these some type of an exchange of some type. Placebo controlled, double blind, this was multi-national done in the United States, done in Spain. Over 14 academic centers involved, great scientists, great clinicians, good controls, good ethical protocols, they did a good job with this.

But what they haven't done is published. So, they have presented at three major organizations, dribbling out a little bit of information at each one of these national meetings, but we don't have the published article yet. But because this has been under so much scrutiny in the apheresis community, we feel like it has been done well and you'd ask, well haven't they published this? Okay, let me tell you the results, that's when you're going to really why they didn't publish. So the results are pretty remarkable.

So if the individuals had moderate dementia, what they found as a group is that the individuals who went through this plasma exchange had a 60% decrease in the rate of progression over 14 months. 60% decrease, this is the largest apheresis study ever done when measured by total apheresis procedures completed. This is not a small study, it's a small study because apheresis is hard to do, it's expensive, it's time consuming, there's not many of us trained to do it.

And so anyway, but 60% decrease in the rate of progression and this is without any lifestyle change, this is without any testing, this is without even ... they didn't probably do a great job of absolutely being certain that these were clear Alzheimer's patients because when they did their CSF amyloid, there's about 25% of individuals who had no detectable CSF A-beta 42 and no detectable phosphorylated tau. But anyway, so that was remarkable, but in my-

Dr. Heather Sandison: But they were doing some kind of testing because they could tell that there was a 60% reduction.

Dr. David Haase: There's so much more here, okay?

Dr. Heather Sandison: Okay.

Dr. David Haase: They did before and after FDG PET scans which measured the metabolism of the brain. So the more glucose metabolism you have on this FDG PET scan, the more neurons are active at that time consuming glucose. And so what you typically see is this lowering and lowering and lowering of metabolism over the course of the time in the brain. And what was found is that the individuals who went apheresis had a substantially lessened decline in their whole brain metabolism over these 14 months.

So they've had metabolic improvement, number one. Number two, in the moderate dementia they saw a cognitive improvement, functional improvements and behavioral improvements. And then they did CNF A-beta 42 and phosphorylated tau and they were able to show that those markers of decline stabilized in the individuals undergoing this apheresis.

And in mild Alzheimer's and the problem is here, again, it's a small study so we don't have a large group. So the powering, we're still waiting for the study. We're trying-

Dr. Heather Sandison: Get it out there.

Dr. David Haase: I want to dig into all the little detail of it, but in mild dementia there was an actual improvement noted. And that was published, that was presented at one of the meetings in California in December-

Dr. Heather Sandison: And you said this is with no other intervention, this is a single intervention. So they really [inaudible 00:23:01].

Dr. David Haase: Remember, it's not a single intervention it was 18 separate exchanges.

Dr. Heather Sandison: But type of intervention, so no lifestyle change, no increase in exercise, no change in diet, nothing else. So can you imagine the potential if you coupled that?

Lifestyle to Support Cognitive Health

Dr. David Haase: So, exactly, so I said this. It's important for everybody to recognize that the health is in the plasma. The plasma is informing the stem cells body wide in what's going on. Well, what do lifestyle interventions impact? So your plasma is the interface in between the outside world and the inside world. Pretty much everything that comes in from your gut is getting to all of your organs through your plasma. Everything you put on your skin is getting to your organs through your plasma. Everything you breathe in, some of it goes directly to the brain, but most of it goes through the plasma.

So this is a fascinating surrogate and actually a confirmation to so much of what we do, that the plasma is healthy. Lifestyle interventions have tremendous impact and I think it's as we contract stem cell activity with lifestyle interventions and doing maybe tissue-based transcriptomics and there's a host of ways that we can look at this to gather group data and then understand what are the particular findings that go on, I think it's quite remarkable. But we have folks coming from all over the place doing apheresis with us, so.

Dr. Heather Sandison: So I mentioned, oh yeah go ahead. So I mentioned to you that I recently bought a facility because if your loved one has dementia and you can no longer care for them yourself and you want to get help from a home, there is not a single residential care facility for the elderly in the United States that doesn't serve cake and ice cream after every meal. Except for breakfast, but breakfast is pancakes and waffles with whipped cream.

Dr. David Haase: The recipe for rotting the brain right there.

Dr. Heather Sandison: Exactly, it really is and then not only that, but in terms of movement, the caregivers and managers they don't people to get out of bed because they're a fall risk and they don't want the falls on the record. So, they're limited in movement, they're being served basically poison for the brain and so there wasn't as people were asking me, where do I send my loved one, I had nowhere to turn. There was no resource, so I've had the genius idea of well why don't I do it. It can't be that hard, right?

So I would love to hear from your perspective, if you were in a residential facility, if you were in a residential care facility, what would be the cornerstones, what would your day look like not from a medical perspective, but from a residential perspective? How would you plan out your day for the best brain health because lifestyle, we can all agree, lifestyle is a huge factor in what's going to happen.

If this is how we're going to send signals to the plasma without having to do apheresis, what do we do?

Dr. David Haase: Absolutely, that's a great question. Yeah, in functional medicine we've been thinking and talking about this for a long time. [inaudible 00:26:14] Wilner, Dr. Dr. David Haase Perlmutter, Dr. Dr. David Haase Jones, these are the pioneers in this field. Dr. Jones is who taught Dr. Bredesen. We've been around that, this is systems-based medicine is in reproach and I'm thankful to Dr. Bredesen for writing his book and creating an awareness around that.

And I will also add that the clinical practice is often not as simple as a protocol. You're trying to bring things like this to the masses which is the most complex of the complex is very challenging. And so working with a clinician who really understands the nuances and can apply it to that individual's life is super important. And so anyway, I just wanted to say that number one because it's challenging work.

So I applaud you and I love the idea of a facility because that gives such ... you want to have an environmental intervention. If you can change the environment so that the changes are easier, especially in a time when their decreased cognitive function. It's just cruel in many ways to be asking people who are at the height of their cognitive decline to be making these massive lifestyle changes.

Dr. Heather Sandison: Oh my gosh, yeah, to change your diet, change how you shop, remember to take all these supplements and these ones are away from food and this one is with food and yeah, to ask someone to that it's next to impossible. They have to have a caregiver that is very dedicated.

Dr. David Haase: Absolutely and really the health, it's caregiver dependent. And the joy that that caregiver then does get, however, from seeing these things change and working with their loved on can be remarkable. That's been really surprising for me as well, just how much change happens in the caregiver's life also towards their own prevention of dementia which is the next layer we need to get to, right?

For every dementia patient that's out there, there are very likely offspring that have a very strong message to get started now, please.

Dr. Heather Sandison: Get the ripple of this.

Benefits of Connections Between Younger and Older People

Dr. David Haase: This is going to be better off, so I think the one thing to my forefront of my mind is actually community. Because community is a profound influencer. We become the five people we hang around the most and if we're hanging around positive active individuals, if we're hanging around young people. And I think this is one of the really, I always get a kick out of George Burns, you see pictures of George Burns and living to a hundred, he was always surrounded by young people.

Betty White always has young people around her, right? And so I think that it's important, you nurture youth. To have youthful contact and to have meaning, I think one of the other things that are important is that that there's meaningful things to do. How can you contribute? I think, shoot, a daycare facility combined with this could be an amazing synergistic opportunity.

Dr. Heather Sandison: That's the Scandinavian model, right? And thank you, this is very validating because that's one of the questions on our application is how do you see yourself contributing to the community. I think that you have to come with an attitude that I'm not just going to show up and receive, but I'm going to be actively engaged.

Dr. David Haase: Right, and so the diet stuff, lots of other people talk about diet et cetera, but I think what's so important from a lifestyle standpoint is making it easy and making it joyful. So that this is not some kind of a, you know, this is something you get to do and oh my gosh, this is more fun than I could have imagined and this is the best time of my life. That's what I would be shooting for. It's a party all the time and then fun music, bright colors and also I think the fun music would be the music from the era of wherever those people are.

I mean I think that we're profoundly affected by the music of our youth. From our late teens to mid twenties is always our music, but I grew up when I did, so. I'm not big with horrible '70s music.

The Study Dr. Haase Would Do With Unlimited Resources

Dr. Heather Sandison: I love it. So, if you could do any study that you could think of, unlimited bandwidth of intellectual capacity or finances, what study would you design and what question would it be that you wanted to answer?

Dr. David Haase: Oh my gosh, I have chills. So I would want to study the full transcriptomic, proteomic and metabolomic effects of a therapeutic plasma exchange using the plasma from highly qualified, healthy donors in individuals with frailty. And I say frailty rather than Alzheimer's because a frailty is the dementia of the body. Dementia and frailty go hand in hand and they are diseases of aging. I'm actually working on building a new age chip so this is going to be a complex laboratory assessment, we'll be looking at several thousand markers to quantify age. I can't talk about it just yet.

Dr. Heather Sandison: Can I ask you a couple yes or no questions?

Dr. David Haase: No you can't.

Dr. Heather Sandison: Oh, dang it.

Dr. David Haase: But it's going to combine at a much lower price point several different components including DNA methylation, including [crosstalk 00:32:41]

Dr. Heather Sandison: Those were my questions. [crosstalk 00:32:42]

Dr. David Haase: Because everybody has their measurement. If you're a protein scientist, oh here are these nine proteins and Tony Wyss Coray published a great article showing that there's nine proteins that vary of the lifespan and you can track these nine and get an age print with proteins. Steve Horvath has done wonderful things with DNA methylation, there's so many ways that we can do this, but it needs to be done in a way that's cost effect enough to do it frequently and it needs to involve thymic evaluation.

So anyway, my study would really be how do we quantify what changes occur when we change the milieu and we change the system as a whole. Because that's going to give us or we're going to see which genes are activated. So the transcriptomic patterning is going to help us understand when are we aging earlier. Because when do we need to know what is uniquely ... what is your personal kryptonite is one of my favorite questions.

How can we figure out what your personal kryptonite is because a toxin is not a toxin is not a toxin and I think sometimes we give way too much credit to toxins and in others we give way too little, but it depends upon that person. And so once we can now track what is actually representing the reversal of aging, which I think we will see when we are able to these studies. But we need highly validated sources of plasma, we need super great funding, we need to have centers, multi-center trial. That's the data that we ultimately want to have.

But in the meantime, let me say this, in the meantime I think it's unethical for us to do nothing. I think it is unethical for us when we have basic science, animal science, early human clinical data, I think we're bordering on being unethical by having inaction. And in our current medical community is rightfully cautious, rightfully cautious, I mean doctors and medicine are responsible for the death of many people and hubris with thinking we have the answer and giving well-intentioned ideas have harmed people over the course of time.

And this is why my profession and I'm very proud of them for that, we're a conservative profession, there's a good thing to being conservative. But there's also, there's the dark side. So, we have to check our egos at the door, we need to make sure that we are doing everything possible to ensure safety whenever any intervention is done. And we need to make sure that informed consent is robust and if we do those things, we should be innovative.

And then we should report on our findings and help our science and the humanity forward, but it takes money. It takes money and I've got several studies that need funding, so I'm always open for funding sources. And I try to run cheap studies because I want the data right? We need that. You got me going mighty good, my brain explodes at that point in time because I have so many questions.

Dr. Heather Sandison: I love it.

How Systems Medicine Will Transform Healthcare

Dr. David Haase: [inaudible 00:36:23] do science better. The NRH, just recently it was reported that only about a third of the trials that go on clinicaltrials.org have results. So many drug companies, many individuals that put up for and say oh we're doing a research are not reporting results out. And negative findings are super important. If something didn't prove out, we need to know. And that is our failures are more important data pieces many times than our successes because then you don't have somebody else going over that.

But it's unacceptable to just say, "Oh, we don't have science so we can't do that." No, we have science. Oh my God we have so much science, but this is why the best science always happens in the actual practice of medicine. This is where systems medicine has to be evaluated. It is in actual practice.

Dr. Heather Sandison: And it's where you can't ignore systems medicine. You cannot avoid it in the real world.

Dr. David Haase: You can't just avoid systems. You can ignore systems medicine, but you cannot-

Dr. Heather Sandison: Well, you can try, but that's what got us where we are.

Dr. David Haase: We come for you, yes we will.

Risk vs. Benefit of Plasma Transfusions 

Dr. Heather Sandison: So Dr. David Haase I know that you are a very busy man, I have one more little question about the plasma transfusions. So one of the obvious risks that comes up what I think of is okay all of my patients in their 60s and 70s who had needed a blood transfusion in the '70s and now have Hep C. So are there things, these are blood products, are there potentially things in the plasma that we don't know to look for yet that may become a risk especially if we're expecting these people to live for a long time. Is it possible that there is a risk decades down the road that we're just not aware of?

Dr. David Haase: Absolutely there's a risk. Absolutely and I think to whitewash that is inappropriate for everybody concerned. The people I'm interested in types of treatments for are those individuals who have a short health span left. Without intervention the likelihood of them having a life that they would want to live is pretty low.

Dr. Heather Sandison: So this takes us full circle back to your conversation around risk versus benefit and cost.

Dr. David Haase: Exactly and this got all hyped up, what was the show Silicon Valley and you got your blood boy, hook up your blood boy get some young blood. I mean, that's the hype cycle and you want to sensationalize things so that they become something that people want to click on. So damn much is made for clickbait, but medicine actually-

Dr. Heather Sandison: You didn't consult on that episode?

Dr. David Haase: No, no I do not. I absolutely did not, no. And for the record Peter Thiel has even come on board and said no, he doesn't participate in this, so a lot of urban legends have been made by some unscrupulous actors in the field. And it's probably why this is the first time anybody has ever heard me talk about this. I think that we need to get things sorted out in the practice of medicine and in science et cetera.

So anyway, I backed up, so I'm going to go back to risk. And there's even more risks, so there are risks for something called trolley. So if you're getting plasma from another person's body put in you, this trolley is transfusion related acute lung injury. And that is then triggered by HLA and HNA antibodies. Well, guess what, we can screen for those now. We didn't know about this several years ago and those antibodies can be screened for to make the plasma supply safer and that should be being done for everybody, but it's not a standard of our current blood banks.

We can do a whole nother session on blood banks and on process of acquisition of plasma, but there is one company called New Plasma in Texas and they are an American association accredited blood bank and again they do a testing way above and beyond the testing of most other blood banks. Things that when you're thinking about how can you get the healthiest plasma and I'm not even thinking for ... golly, let's just not go so far to think that this is plasma exchanges for making youth or for treating disease yet, just how do we have the safest plasma is what we should be talking about.

Dr. Heather Sandison: For anybody who needs it.

Dr. David Haase: Everybody, right? And there are some additional tests that can be done to search for likely reactive molecules as HLA and HNA antibodies is one of them. Other things we can do is pool that plasma, so you harvest from one individual, have one individual donate and then have them wait a month before the next donation and then don't release that first unit until they come back and are tested again as being clean.

Then what you've done is you have dealt with that period of latency that does occur in several infections. I think that's an important process to do. I think that there are ... and in decreasing the number of donors one would get plasma from because you can get sensitized. I think there are a ton of very important considerations to go here, but doing this I think can improve the plasma supply for everybody, looking at our standards, but that will increase the cost of getting donations.

Dr. Heather Sandison: Right.

Concerns About Frequency of Plasma Donations

Dr. David Haase: And right now most plasma donations, people that donate plasma will do it twice a week sometimes and I'm concerned for them getting depleted. The United States is the number one exporter of plasma in the world. It actually accounts for over 1% of our GDP, how's that?

Dr. Heather Sandison: Gosh, I had no idea.

Dr. David Haase: So people make a big oh my gosh. People that don't understand that this already big business. It's also maybe because it's big business it has some friction, I wouldn't be surprised by that. But again, I believe that the people in the healthcare field be they pharmaceuticals, be they insurance companies, be they hospitals, doctors, nurses, everybody in concern, I think they're really good people. They're the best people on the Earth and they're making statements and doing things for the right reasons to move the health of patients and people forward. And by listening, again, checking your ego at the door, but not being timid either.

Dr. Heather Sandison: Okay Dr. David Haase, one more, the most important question. When can I come hang out with you for a week and just absorb what's in your brain?

Dr. David Haase: We'll talk off camera, how about that?

Dr. Heather Sandison: All right, okay, I hope that's a yes.

Dr. David Haase: Yeah, that would be fun.

Dr. Heather Sandison: Oh, you heard it everyone.