Dr. Andrew Holman | CEO of Inmedix | Innovative Diagnostics in Rheumatology & The Power of Stress Management

Dr. Andrew Holman is a rheumatologist and the CEO of Seattle-based Inmedix, which recently received FDA clearance for the first cloud-based heart rate variability (HRV) diagnostic platform. Dr. Holman shares how a “detective” mindset led him from early interests in orthopedics and cardiology into rheumatology, fibromyalgia research, and ultimately entrepreneurship. He explains how chronic stress, the autonomic nervous system, and conditions like sleep apnea and restless leg syndrome can influence cardiovascular risk and autoimmune disease outcomes, and why measuring stress biology with medical-grade precision matters. Dr. Holman also offers hard-earned advice for physician-innovators, reflects on pivotal study results, and shares what he hopes to be remembered for: never dismissing patients in distress. 

Guest links: https://www.inmedix.com | https://www.linkedin.com/company/inmedix-inc

Charity supported: Save the Children

Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com. 

PRODUCTION CREDITS
Host & Editor: Lindsey Dinneen
Producer: Velentium Medical

 

EPISODE TRANSCRIPT
Episode 088 - Andrew Holman

[00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world.

[00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them.

[00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives.

[00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives.

[00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives.

[00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference.

Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm delighted to be welcoming as my guest Dr. Andrew Holman. Dr. Holman is a rheumatologist and the CEO of Inmedix, a Seattle-based medical diagnostics company that recently received FDA clearance for the first cloud-based heart rate variability diagnostic platform. He has 25 years of clinical experience with 16 peer-reviewed papers and clinical trials demonstrating that measuring stress biology with medical grade precision can improve success rates in autoimmune diseases.

All right. Andrew, welcome to the show. I'm so glad you're here today.

[00:01:30] Andrew Holman: Yes, happy to be here. Thank you for inviting me.

[00:01:33] Lindsey Dinneen: Course, of course. Well, I would love, if you wouldn't mind starting out telling us a little bit about who you are, what your background is, and what led you to medtech.

[00:01:44] Andrew Holman: Sure. Well, I'm a, a guy from Seattle, Washington. Grew up here, but trained everywhere else, became a rheumatologist. We study autoimmune diseases, lupus, rheumatoid arthritis. I also was very interested in fibromyalgia and pain. We're the immunologists of medicine. So, I started my practice, golly, a while ago. 1992, I finished my prac- my training, and I was the main rheumatologist at a large suburban hospital at the southern end of Seattle. So hometown, circle back to the hometown. I went into rheumatology because you have many choices when you do internal medicine. You can go be a specialist in many things. But I like the puzzles. The immunology has grown and it's a, it's a particularly sort of detective-oriented specialty. So, I didn't set out to be an entrepreneur. That came 25 years later. I was an in-the-trenches doc trying to help the person in front of me with these devastating diseases that are crippling diseases, usually of young women mostly.

[00:02:45] Lindsey Dinneen: Yeah. Okay, and I'm sure there's, there's much more we're gonna dive into, but one thing that really stood out really fast was you, you kind of called yourself a detective, which I really love that term. And so I'm curious, is that something that you always thought you wanted to specialize in, in medicine, or was this, you know, detectiving to come later? Was this something that, you know, you ended up learning more about while in med school and thought, "Oh, this sounds really cool. I could put really two interesting passions together"?

[00:03:19] Andrew Holman: Yeah, it was-- you know, things just sort of come into play sometime. For those who are not in medicine, they may not realize it takes about ten years to go to college, med school, re- internship, residency, fellowship, you know, and then you, then you finally get to go be a doctor, and you have to go learn how to be a doctor s- a little more. The patients teach you a lot more than people realize. So I was gonna be an orthopedist. I liked orthopedics. I liked architecture, bones, joints. I thought it was a lot of fun. I just had very little aptitude for what they do. I, I don't-- I, I'm not very g- a good carpenter. I just, you know, I didn't-- just wasn't gonna be a great orthopedist.

So then I thought, "I really love cardiology." Rhythm disturbances, all kinds of things. In the 1980s, when I was in medical school , all the new stents and procedures and non- less invasive things than bypass surgery were all coming up. Joint valve replacement. You know, it's really exciting. But I never... and I never took a, a f- a course in rheumatology until I was actually an intern in internal medicine program in Denver, all set to be a cardiologist.

And there were 12 of us in the, in the program per year, and s- five of us became rheumatologists because of this one doctor who took us out, a guy named Daryl McCarter. Prob- maybe people who know him, he's retired recently. He would bring us in the office, and we'd see every other patient with him because in between the patients, he would give us an X-ray, say, "I want you to look at this. There's a clue here. See if you can find it." Or, "I want you to look at this pathology slide," or something. "There's a secret, you know, to figure this one out."

And I go, "Wow, this is really fun stuff." And once you figured it out, we weren't as good at treating it yet, but we were getting better. We were getting better. So it was the cutting edge and very fertile ground for discovery. So, rheumatologists are called the consult of last resort for a reason. There aren't very many of us. You've usually seen everybody else first, and by the time they-- you see us, we're pretty good at figuring out the rare diseases that are not in other people's board exam. But we're also pretty good at figuring out the common disease that presents in a very strange way, you know?

And, and that's what our strength is. So we may... Everybody who sees us who gets diagnosed may not have a rheumatology answer, but we try to get them an answer. And now we're really in the golden age of rheumatology in the last 20 years of really making a difference for so many people. The downside, we don't make a difference for enough people, you know? We, we... That's the problem. So we've got these very motivated doctors out there, eager, and we just need, you know, more. And that's why I became an entrepreneur, because I learned more neurology than I was supposed to know and more sleep physiology than I was supposed to know. You just follow the breadcrumbs, you know?

[00:06:17] Lindsey Dinneen: Yeah. Okay, so I know you didn't start out wanting to, or maybe even being interested in being an entrepreneur, but that is the path that you chose, and I would love to hear about that, the company, and what you're all doing. And then also would love to hear about your journey into deciding that this is the next right step for me.

[00:06:38] Andrew Holman: Yeah. Well, thanks for asking it. It is a little unusual. So I was actually studying and trying to help patients with fibromyalgia about 30 years ago. And fibromyalgia patients terribly dismissed till they're all making this up. There's not 10 million people that can make anything up and be consistent. I mean, they all say the same thing. So I thought that was nonsense, and I was really thrown into the crowd of, you know, "You're, you're crazy too." And I go, "Well, I'm board certified in crazy." So I w- I was interested in it, and I was irritated that these people were dismissed.

And I was around other doctors in Seattle who were similarly that way, which was very, very unusual. It's unusual to find people in the '90s who had an avid interest in that disorder. And so I started doing what rheumatologists are good at, incrementally advancing ideas and therapeutics very carefully, very cautiously. We do a lot of things off-label. When I was-- finished my fellowship in 1992, half the diseases on our board exam had no FDA-approved treatment. We had to do something, right? You couldn't just say, "Well, come back when there's a couple of articles in the New England Journal of Medicine." You, you can't do that, right? People are depending on you.

So rheumatologists are particularly good at that, and that's not something most doctors want to do. Most doctors find that very uncomfortable. They're very, very careful people. And, and rheumatologists are careful too, but we take this mission seriously that we need to do something for you. So basically, I was looking at off-label ideas and work on fibromyalgia, and I'll share this with your audience. I was actually pulled up-- pulled in by some senior doctors who said, "We wanna talk with you." And I'd been there about three years as a new doctor. Oh, you know, seem to be doing a good job. Maybe they wanna pat me on the back or something. No, not that. It was actually an intervention, which I had never... I mean, I had no familiarity with what an intervention was. And they said, "Look, we like you. You're a great doc, but you're gonna ruin your reputation if you believe all these people, mostly women And you really need to not take it so seriously or write prescriptions for this c-- this and that."

I said, "Well, thank you very much." That's polite. That's not what I was thinking. And I, I... But it prompted me to pull all the charts and say, "You know, I think I'm making some progress here with some ideas here, and let me see if I'm getting fooled and just seeing the people who get better to come back. Let me really honestly look at my performance." And so I pulled about 200 charts. It was my first abstract at the national meeting. And you know what? We were making progress. That had morphed into more progress, following the breadcrumbs, looking at neurology, looking at the autonomic nervous system. So that was about a five-year process. Y-you know, I didn't lose my reputation, obviously. I lecture around the world now. But it led to being very careful about getting clinical evidence if I had a hypothesis.

And so we were using the office, and we actually finally did a double-blind prospective study where I bought all the drug myself, had it reformulated, little capsules that, you know, and, and worked with the FDA to get permission to do the study. And that study in fibromyalgia to this day has the highest response rate of any fibromyalgia study for pain that's ever been done. Now, we don't use that treatment anymore. It's 20 years later, we have other things to do. But it did prompt Pharmacia, got bought by Pfizer, I believe, and Boehringer Ingelheim, which co-marketed the drug I was using and reporting on, to pay me $10 million for the patents that I had filed, utility patents.

I didn't own the drug. I didn't use it for Parkinson's disease, but I thought there was use in fibromyalgia. So before I told the world, I filed utility patents, and they wanted to exploit that discovery. So did two other pharmaceutical companies, and they had to pay for the privilege of doing it. So at 46, I retired. So I didn't intend to do that, but I do come from a family of lawyers and judges, and so the idea of having a utility patent on a n- a new innovative idea was not a foreign concept to me.

[00:10:40] Lindsey Dinneen: Yeah.

[00:10:41] Andrew Holman: That is something I teach all young doctors.

[00:10:46] Lindsey Dinneen: That is awesome, and I, I was thinking, okay, this is a great segue because first of all, that's an incredible story. Secondly, I, I would be very curious to know exactly that, what is your advice for some of these incredible physicians, great ideas, that are potentially going to end up becoming an entrepreneur just because that's the path that, that is sort of presented to them? What is some of your advice for that? 'Cause that can't just be... you, you had the privilege at least of, of, of knowing and having some background in that, the legal aspects of IP protection and whatnot, but what are some of the things that you tell people?

[00:11:22] Andrew Holman: Well, a couple things I would say and I have these conversations often 'cause I really like the younger people coming along. I say, first of all, don't define yourself as an ent- as being an entrepreneur. Make sure you have other things in your life that are more important to you. Now, the investors are not gonna like to hear that. They, they want you to live and die on your, on your company, right? But I'm saying, you know, you don't have to tell the VCs, but have other things that matter more in your life. You still gotta work really hard because you may, you may find that it's really a slog, and it's very long, and it's very hard.

But, you know, make sure that, that, that what you-- though is important, your family, you know, your integrity the scientific problem at hand, the patients, you know, they're number one. Make sure we don't lose sight of all that, and do a few things. Go for a walk. Do something for yourself. Something. I do this twenty-four seven for the last 10 years, you know, every day 'cause I love doing it. It does wear you out, though. Even if you make-- even if you're successful with milestones, it does wear you out. But that's what I tell them. I say, "You know, make sure that you take care of yourself a little bit, too." It's kinda like a analogy. What do you do for a pregnant woman who has a, who has a, a lupus? Lupus is terribly dangerous for the fetus and for the mom. Though the worst thing you do to-- for the baby is not take care of the mom. Take care of mom,

[00:12:44] Lindsey Dinneen: Mm-hmm.

[00:12:45] Andrew Holman: then get the baby delivered. So, you know, everybody's talking about the baby, but take care of mom. That's the most important thing you do for that baby. So that's kinda what I would say.

[00:12:54] Lindsey Dinneen: Yeah. Yeah, that's great. I appreciate that. Yeah, that, that makes a lot of sense too. We've been talking, actually it's been a, a bit of a theme too lately in some of the conversations that I've been having with folks, especially leaders, to talk about that identity component and, and be aware that your job isn't the only thing that defines you or needs to. There's a lot more to your life. There's a lot more to who you are. And so also, you know, our identities change over time and how you refer to yourself and th- those are, those are good things. That's growth, that's movement. So, being comfortable with who you are outside of your career. Yeah.

[00:13:33] Andrew Holman: The other thing too is, you know, people used to joke 20 years ago that participation mem- medals were like a farce and what. That's the l- that's the last thing I would say to anybody. Give yourself a pat on the back for going out there trying to attack the castle, you know. Give yourself some credit there because a lot of people just wouldn't do it. My middle daughter was a hundred-meter hurdler at Boise State. She's a Division I athlete. There's a lot of sprinters out there that don't wanna get anywhere near that hurdle 'cause it really hurts when you hit it, right? And so half of that was not-- was being brave. So be brave, be brave, you know. My other daughter was a Division I athlete at Rice. She was a h- she was a volleyball player. Yeah. So, yeah. So I, I, I, I watch other people, see how they persevere and, you know, okay, gotta pick yourself up. Gotta go. Gotta get up this morning. Gotta go.

[00:14:23] Lindsey Dinneen: That's right. That-- Yeah.

[00:14:25] Andrew Holman: Then remember, people are depending on you, not just your investors. I take that so seriously. But the s- the people who have decided that they're gonna hook their wagon to you.

[00:14:34] Lindsey Dinneen: Yeah.

[00:14:35] Andrew Holman: You know, that's a lot of responsibility.

[00:14:37] Lindsey Dinneen: It is. Yeah.

[00:14:38] Andrew Holman: Give yourself a little credit that you're stepping up.

[00:14:41] Lindsey Dinneen: Yes. Great advice. Yeah. Okay, so all right. So let's talk about your company now. So now you're an entrepreneur, in addition to obviously the rest of who, what makes you, you. But and I know that you're also a clinical professor, and I would love to hear about both of those things if you don't mind sharing.

[00:14:59] Andrew Holman: Yeah, sure. So, technically I'm an associate clinical professor at the University of Washington. A, a lot of private docs do, and they participate in helping teach the y-young residents and fellows and so forth. So it's a joy to me. I, I think my job is a job of teaching. I'm constantly talk... I'm not-- I don't see patients anymore, although I do maintain my license in malpractice 'cause I get, I get contacted for the fibromyalgia work I did. So it's, my email's on the papers, right? So I, I don't wanna let that go. People need help.

But basically, we're constantly teaching patients, you know. Now, we're listening, hopefully do better and better at that, but then I have to make a case. You know, I'd, the-- I'd like you to try this or that. Why do I wanna do that and so forth. We're constantly, you know... We don't-- It, it sounds too trite to call it selling something. We're not doing that. We're in there with you. We're collaborating. But I have to be, I have to have a reason and be persuasive and all that, so that, that academic teaching part's kind of fun. Now, sometimes I go into the lion's den. I will tell you, it's a little nerve-wracking to give rheumatology grand rounds at Harvard. Yeah, yeah, okay. You know, and the University of Washington, they're a little friendlier. It's my hometown.

But Guy's Hospital in London and the Hospital for Special Surgeries, I... My first rheumatology grand rounds came at the HSS in 2009. I get there, I completely bomb. All these famous people are in the front row. I'm... They're, they're just not buying any of this thing we call immunoautonomics and how stress affects the immune system. I'm quoting the NIH. I'm doing everything I... I know how to do it, right? Pathology slides, I'm there. Then I find out the way they pick the speakers is the fellows get to find something interesting, and they pick the speakers, not the not the high mucky-mucks.

So the only reason I was there is because the fellows, the young folks, thought, "This is an interesting topic. We'd like to hear more." And it turns out they were 15 years ahead of the rest of the world, because this is the most fascinating topic of how the immune system affects the autonomic nervous system affects the immune system, so it inflames it.

[00:17:03] Lindsey Dinneen: Yeah. Oh my gosh. Actually, that is one thing I wanted to talk about, 'cause I, I noticed on your LinkedIn profile there was, you know, a reference to how much stress affects cardiovascular health maybe particularly chronic stress. And I would just love to hear more about that and, and maybe some ways... I know there's like, y- of course you always get your standard, "Here are some things that you could do to lower your stress." But, but from your perspective as a physician who's studied this, I'd love to hear more from you about, okay, how does this affect health, especially cardiovascular health, and then really what are some practical things that we can do?

[00:17:39] Andrew Holman: Yeah, let me see what I can do. Now I wish I could fast-forward because we will have some magnificent things in the next five to 10 years based on what's being discovered now. But the bottom line is, stress and pain are awful things, but they have a purpose in the near term. So pain is good because it'll keep you from putting your hand back in the fire, right? Just don't do that again.

But chronic pain is terrible and not productive. Stress is the same thing. You wanna get away from the lion. You, you, you need to perform. If your child needs you, whatever, you, you need to perform on it instant. But chronic stress is not productive. The problem with the stress response is it's controlled in the brain by the autonomic nervous system, which is called the ANS, and it's divided into two components, the sympathetic fight or flight, which we all know what that feels like. You know, ooh, scary.

And the other is the parasympathetic, which is getting more talk now, which is the opposite, which is related to rest, restorative, sleep, recovery, growth hormone, all these things. And both of these systems are on simultaneously all the time, but they jockey for predominance depending on what the demands are around you, right?

So turns out the sympathetic part has a significant negative impact on cardiovascular health, as you might expect, right? If you're driving your car at five thousand RPMs-- now, nobody has a stick shift anymore-- but if you're driving at five thousand RPMs, you're gonna wear down your engine, even if you go at the same speed as someone who has a two thousand RPMs, right? It, it's, it's what's going on inside the hood there is really important. So stress responses chronically do have measurable, tangible, well-published effects on cardiovascular mortality in long prospective studies.

So if we had a magic something, we would do something to lower that epinephrine adrenaline response. Unless, of course, you're in the military, where someone's-- you need every heightened, m-- you know, response that you can get to survive. But for the rest of us, it's better that that system does not ramp up and activate. And we all have a different propensity to how powerful it is and how much it turns on, and also how poorly it turns off.

So the stress response, we think of it like epinephrine, adrenaline. That's the easiest way to do it. So what you'd wanna do is to make sure this magnificent part of your brain that is your-- does all your housekeeping functions, this autonomic nervous system, the command and control center that you just wanna work, you don't wanna think about it, is not on a turbocharged, right? And there are people I take care of that they were just born that way. A lot of them, by the way.

So things like all the wellness opportunities you can think of are, are targeted just to simply calm the autonomic nervous system. Tai chi, meditation, diet, exercise, all these things have been around for thousands of years because of that. That's what they do. And the practitioners will share that with you. I mean, the there are monks that can lower their heart rate, you know, to like, you know, what would seem lethal to the rest of us, right? That's the parasympathetic drive that lowers heart rate, lowers blood pressure. So those wellness opportunities are real. It will be important that you can manage whether the-- what you're doing is working or not.

[00:21:04] Lindsey Dinneen: Mm-hmm.

[00:21:04] Andrew Holman: Right? And that's where my company comes in. But the other is things like obstructive sleep apnea. You might think heavy guys... See, someone's gonna send me for a sleep study for sure, but they're not gonna send you. Big mistake, because it turns out that fifty-three percent of Japanese women with rheumatoid arthritis have unexpected obstructive sleep apnea. Oops. And, and we were just taught that we wouldn't even check those people. Well, turns out sleep apnea untreated is a major cardiovascular risk factor equal to cigarette smoking, according to the Sleep Heart Health Study in 2004. That's a big deal. And also, we learned in rheumatoid arthritis, getting back to my work,

world, that patients with rheumatoid arthritis don't die from joint disease, they die from premature heart disease. They can also get cancers. So why is that? Well, there's been a lot of effort to try to figure that out in the last twenty-five years, and their risk factors for cardiovascular disease are not explained by the Framingham risk factor of hypertension, cholesterol, smoking, and all the things we, we look, see. But nobody looked at sleep apnea.

[00:22:15] Lindsey Dinneen: Mm-hmm.

[00:22:17] Andrew Holman: The other reason it's so relevant, though, is sleep apnea is a potent sympathetic arousal. It, it-- You struggle to breathe, right? You kind of obstruct. And what part of your brain tells you to breathe? Your autonomic nervous system. Breathe, right? And it stimulates this adrenaline response over and over and over, and it pounds your heart over the years, and it can lead to sudden death and arrhythmias. So there's a, there's a link there. Never miss sleep apnea.

The other one is we found in our office and published about restless leg syndrome. You know, people tap their toes in the airport or they kick the covers around at night. It's pretty benign for most people, but it looks like it very well might be a sympathetic arousal, and there may be relevance there. The therapies for that may have relevance to what we're talking about. Again, very off-label. We're not talking about FDA-approved here. But it-- You ask what can you do? The other one that's coming is vagus nerve stimulation. That is FDA-approved now for rheumatoid arthritis, and they're going to other opportunities to, again, to, to increase the parasympathetic and to lower the sympathetic, right? So that background activity doesn't harm you.

The autonomic nervous system may be the primary reason that two patients respond differently to the same treatment. What you bring to the table. It's no different than if I have two people coming to me for a back problem. One is five foot three and one is seven foot three. The way their spine is designed makes it a whole lot harder to treat the seven-foot back, right? I'm not surprising anybody here. So there are things that the patients can bring to the table that matter.

Here's the irony. Ninety-seven percent of patients with rheumatoid arthritis in a survey in England said that stress affected their disease activity. It's no surprise to them. And sixty-five percent said they thought it predated getting the disease, that it actually contributed to getting it in the first place. And now there's evidence to suggest that may be true.

[00:24:17] Lindsey Dinneen: Oh, boy.

[00:24:19] Andrew Holman: So we can't miss sleep apnea just out there. We can't miss restless leg. We can't miss Ehlers-Danlos type three hypermobility type where people can... you can't see me here, but my fingers can bend backwards. But it's, it basically it's very, very common, and those people tend to have increased sympathetic activity naturally.

[00:24:39] Lindsey Dinneen: Fascinating.

[00:24:39] Andrew Holman: So yeah, so we're, we're waking up a little bit to some very important features here of individuals that may help us do better with the diseases they also come in.

[00:24:50] Lindsey Dinneen: Yeah. Wow.

[00:24:52] Andrew Holman: Sorry, long answer. Sorry, but there's a lot.

[00:24:54] Lindsey Dinneen: No, that's great. I appreciate it, and yeah, well, then there you go. Managing stress is critical to, to your health. It's not just a nice to have, like yeah, yeah, kind of thing. Okay. Whew.

[00:25:07] Andrew Holman: Good learning.

[00:25:08] Lindsey Dinneen: Okay, awesome. Yeah, so, I'm curious... Okay, so, so again, I like, I like looking at guests' LinkedIn profiles and, and learning more about, you know, what makes you tick outside of your career as well, and I noticed some very fun things that you have listed. So we've got creative writing, horsemanship, golf, and vintage passenger rail cars. I feel like this warrants...

[00:25:33] Andrew Holman: Yeah, it's called... Yeah, the American Association of Private Railcar Owners. Yeah. I get ribbed a lot for that, but they're a great bunch. There are about --I don't know if I know all the numbers now, but about 75 to 80 vintage cars from the '20s, '30s, '40s, '50s, who tag on the back of Amtrak, and Amtrak drags them around, and you can actually go rent them, stay in them, whatever. And they have a a annual meeting where they just get on a private train, and they go on tracks that you wouldn't go on naturally, like private rails in the, you know, middle of nowhere. So that's what they like to do. And it's just a lot of fun, especially the dome cars.

[00:26:12] Lindsey Dinneen: Okay. That's so cool.

[00:26:14] Andrew Holman: I've been a handful of times. I've got a lot of friends there. I don't own a car, but boy, I'd sure like to have one.

[00:26:19] Lindsey Dinneen: Yeah. Okay. That is so cool. And then how about horsemanship? How did you... Have you been riding horses your whole life, or how did that come about?

[00:26:29] Andrew Holman: So I went to a high school called Thatcher School in Ojai, California, where there are 50 in a class, and there was a requirement, this is over 100 years old, this school, that you had to have a horse. And they would say s- that something about the "outside of a horse is good for the inside of a boy," right? I was the last all-male class in 1977. Now young women get to go there too. It's of note that I have 15 people from Thatcher investing as family and friends in, Inmedix. So, th-they that, that's pretty special.

But it's a boarding school. I was there for four years. My dad had gone there, so I'd heard of it. But I got a tremendous education. Th-there aren't a lot of prep schools on the West Coast, but there are some. And, and that's where I learned how to ride a horse like riding a bicycle. My sister is a thoroughbred horse trainer for 40 years. She's retired. She had three or four or five horses, a har-- not the fancy kind of stuff at the Derby. But they, you know, get up at 4:00 a.m. and ride, you know, that kind of... Tough life, but she loved horses. So yeah, I, I'm as, I'm more comfortable on a horse than I am around anything, probably.

[00:27:34] Lindsey Dinneen: That's so cool. Okay. Well, this has been really fun to, to get to hear your incredible life story so far, and I'm excited to see where the company continues to advance medical technology. So, you know, I really appreciate everything you're doing. But I do want to ask, is there a moment that stands out to you along your career path so far where you just thought, "Wow, I am in the right industry at the right time"?

[00:28:02] Andrew Holman: Yeah, I'd, I'd say there probably was. When we unblinded the prospective double-blind study that we did looking at this five-minute next generation heart rate variability, this HRV we got through the FDA last year. When we unblinded the study, and although that's not part of the FDA clearance, it was a very important moment for me because it showed that it predicted a year in advance who would respond to treatment of rheumatoid arthritis with ninety percent sensitivity, ninety-five percent specificity.

So I wanna emphasize that is not what it's cleared for. It's cleared as an HRV tool that doctors can use at their discretion. But that study is what you asked me to answer. And when you unlock a study and you see the results, two things happen. One is we were happy that I was on the right track. That was nice. You know, positive study. Your hypothesis is valid. But it completely changed the view of immunology,

[00:28:58] Lindsey Dinneen: Hmm.

[00:28:59] Andrew Holman: Because we would have a test now that could measure the autonomic nervous system with exquisite precision. Nobody cared except me. About 10 years ago, we were waiting for better biologics, the things on TV, right? They asked, "Ask your doctor if it's good for you." Nobody realizes that they work about twenty-five percent of the time in terms of disease control. That's a big gap, but it looks like it's the brain that monitors inflammation. The inflammation the immune system is not firewalled against everything. The brain c-controls it, and it's not the endocrine so much with cortisol, it's the autonomic that works in milliseconds that, that epinephrine response. So that's a... You know, you're pretty nervous when you un-- when you-- someone tells you, "Okay, here is the results."

[00:29:48] Lindsey Dinneen: Yeah. Wow.

[00:29:50] Andrew Holman: And, and, and that was it. And then it turned out in 2015, the other moment was when I was going through the airport at Seattle and I saw the cover of of Scientific American, Bioelectric Medicine, Setpoint Medical's vagus nerve stimulation, hacking the the vagus nerve to fix the autonomic nervous system to reduce the burden of rheumatoid arthritis. I go, "Okay, now it's time." We had the patent on it. Okay. Ten years forward, we're where we are now. We're launching in June, and we have a software juggernaut here and a literally a vital sign. So, th-the doctors decide what to do with this, but we've put it in their hands, and it's paid for by insurance. So yeah.

[00:30:34] Lindsey Dinneen: Amazing. Well, that's, that's so cool. Congratulations on that. That's fantastic. Okay, so to pivot the conversation a little bit just for fun,

[00:30:43] Andrew Holman: Hmm?

[00:30:43] Lindsey Dinneen: imagine that you were to be offered a million dollars to teach a master class on anything you want. What would you choose to teach?

[00:30:53] Andrew Holman: Well, I, I learned that you've all had professors that didn't probably know as much as they should about a subject, but they thought it was just fun. I would probably stick with what I know. So I would do a master class on fibromyalgia because you can actually treat it. And there's published data, but it's very-- it's not widely known. We will be using Inmedix and autonomic testing to do research to validate and get that problem finally solved and put to bed. And then the other is this thing called immunoautonomics. It, the term-- I made up the term 15 years ago. It's in the medical literature. So that's what I would teach. Teach what I know.

[00:31:27] Lindsey Dinneen: I love that. Okay, excellent. And how do you wish to be remembered after you leave this world?

[00:31:34] Andrew Holman: Well, I, you know, it all come... I define myself by what the patients, how they do and what they say. It's not about five stars and all that, you know, you know, there's plenty of those. But it's, it's... I made a, a commitment if somebody says anything about me, I made a commitment when I was a rheumatologist with all these mostly young women upset, that I would never leave the room with them crying. Didn't matter how far behind I was, didn't matter. We went through a lot of Kleenex. There's a l- it's devastating to get these diseases when you're a young woman. And they can put that on my tombstone, not to dismiss people. We had a saying in the office, "It's gotta be something." You know? It's, it's always something.

Drives me crazy when doctors will say, "Oh, that's nothing." Well, well, first of all, we know it's not nothing. It, it is always something, and there's something that defines your success, and there has to be things that define your failure. So let's figure out what the something is, but let's not argue that there's nothing there. So let's not dismiss people who are frightened and worried, and maybe they don't tell the story as clearly as we'd hope. But you know what? It's not, it's not their fault. They're in distress. It's amazing what people are like after you help them with their chronic pain.

[00:32:45] Lindsey Dinneen: Yeah. Yeah. That is really cool and makes so much sense. Yeah. Thank you. Okay, and then final question: what is one thing that makes you smile every time you see or think about it?

[00:32:59] Andrew Holman: It's making me smile right now. When I talk to the young fellows that are in their training and they're finishing up, so they've done three years or four years of medicine, three years of internal medicine after that, and then they do three or two, three, four years of rheumatology, and then they're gonna go out, I tell them how jealous I am of what they're gonna see. The, the last, the last 40 years we had these young men mostly coming in with terrible weight loss and immune systems, falling apart, and these strange tumors, and they're dying of, of infections like yeast and candida that, you know, everybody did fine with, and it was HIV, right?

It had to be figured out. Now HIV is a chronic disease. It's like diabetes. We had so many people die in the '80s. Hepatitis C was... You'd have liver enzymes up, and it wasn't hepatitis A 'cause we could test for that, and it wasn't hepatitis B 'cause we could test for that. So we just called it non-A, non-B. Literally, that's what we called it. And then that got to be called hepatitis C, right? 'Cause it was too embarrassing to call it n- what it wasn't. And now hepatitis C is curable with antiviral agents in, like, three weeks. I mean... And then the biologics showed up. They're not perfect, but they were a big step. And then this immunoautonomics and, and understanding how pain and sleep and the autonomic nervous system work. I'm just really jealous of what those young clinicians are gonna get to see.

[00:34:27] Lindsey Dinneen: Yeah. Yeah, that's really... Yeah, I can see why. But it sounds like you are, you know, keeping, keeping your what, what would they say? Like, toe in the water or something so that you're able to, to watch some of this as well and be a part of that next

[00:34:40] Andrew Holman: I feel like I'm a ne- I feel like I'm neck deep and I'm just hoping I don't go down any lower.

[00:34:47] Lindsey Dinneen: Fair enough.

[00:34:48] Andrew Holman: 'Cause I have to find a way to pay for it.

[00:34:50] Lindsey Dinneen: Oh, yeah, yeah, yeah. The details, you know. Yeah, yeah.

[00:34:53] Andrew Holman: You got those details, yeah.

[00:34:54] Lindsey Dinneen: Yeah. Oh my gosh. Well, this has been an incredible conversation. I really appreciate your time today and sharing your insights and, and stories and, yeah, I'm so excited to see the future of medicine, and I appreciate perspectives of, like yours, where you just, you share a lot of hope and optimism, and you're actively working to change lives for a better world. So, thank you.

[00:35:16] Andrew Holman: Yeah, I, I irritate a lot of people with that optimism, but I'm sorry, it's just there. I can't fix it.

[00:35:22] Lindsey Dinneen: Brilliant. Well, I love it. It makes my heart happy, so thank you so much again, and I hope you have the best rest of your day.

[00:35:31] Andrew Holman: Thank you so much. Thanks for having me.

[00:35:32] Lindsey Dinneen: Of course.

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