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Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses.

We discuss:

• The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30];
• Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45];
• How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30];
• How awake brain surgery is performed [22:00];
• How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15];
• How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15];
• Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30];
• Edward’s clinical trial using ECoG to restore speech to a stroke patient [1:01:00];
• How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45];
• Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15];
• The 2030 outlook for brain–computer interfaces [1:34:00];
• The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00];
• Edward’s vision for how neurosurgery and treatments for glioblastoma, Parkinson’s disease, and Alzheimer’s disease may evolve by 2040 [1:42:15];
• The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45];
• How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain’s functions [1:46:15]; and
• More.

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

• Peter’s experience with debilitating back pain [3:00];
• Anatomy of the back: spine, discs, facet joints, and common pain points [14:15];
• Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
• Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
• How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
• The pathology of bulging discs [43:00];
• The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
• The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
• The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
• Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
• Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
• Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30];
• When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30];
• Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15];
• Tarlov cysts: treatment and surgical considerations [2:00:00];
• The evolution of patient assessments and the limitations of MRI [2:02:00];
• Pain relief related to stiffness and muscle bulk through training [2:06:45];
• Advice for the young person on how to keep a healthy spine [2:14:00];
• Resources for individuals dealing with lower back pain [2:25:15]; and
• More.

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Josh Spitalnick is a clinical and research psychologist with expertise in treating a variety of anxiety conditions with cognitive-behavioral therapy (CBT) and other evidence-based approaches. In this episode, Josh unpacks the four layers of anxiety—psychological, emotional, cognitive, and behavioral—highlighting why avoidance is the key feature that transforms ordinary worry into disorder. He explains why he continues to treat OCD and PTSD as anxiety conditions despite their DSM-5 reclassification, and he draws important distinctions between worries versus worrying and thoughts versus thinking. The discussion explores health anxiety, illness anxiety, and the impact of modern contributors such as wearables, social media, and the COVID era, while weaving in real-world case studies and Josh’s structured assessment approach. Josh also breaks down evidence-based treatments, from exposure therapy and cognitive-behavioral therapy (CBT) to acceptance and commitment therapy (ACT), along with the role of medication, lifestyle factors, and how shifting from avoidance to committed action can build long-term resilience.

We discuss:

• Josh’s professional background and his holistic approach to treating anxiety [3:00];
• Definition of anxiety and changes in the DSM-5 [5:00];
• The psychological and cognitive aspects of anxiety [10:45];
• Breaking down anxiety symptoms: triggers, fears, and hidden mental rituals [17:00];
• Thoughts versus thinking and worries versus worrying: what constitutes dysfunction [20:15];
• Health anxiety and the limits of medical reassurance: understanding illness anxiety and somatic symptom disorder [24:30];
• Triggering events for health anxiety, symptom fixation, heritability, and the role of nature versus nurture [36:30];
• Historical and modern shifts in health anxiety, from HIV/AIDS in the 1980s to today’s heightened fears of cancer [45:30];
• Modern factors and recent events that have amplified societal anxiety levels [47:15];
• Josh’s approach to patients with excessive health-related rituals and/or OCD using CBT and exposure therapy [54:30];
• Hypothetical example of treating a person with a fear of flying: assessment, panic disorder, and the role of medication and exposure therapy [1:03:15];
• The four types of exposure therapy and the shift from habituation to inhibitory learning [1:14:00];
• Treating people with OCD that manifests in disturbing and intrusive thoughts, and why therapy focuses on values over reassurance [1:21:00];
• Acceptance and commitment therapy (ACT): reorienting patients toward values-driven living rather than symptom elimination [1:31:45];
• Mindfulness as a tool to cultivate presence, awareness, and healthy engagement with life [1:36:30];
• Hallmarks of successful therapy and red-flags that therapy is not going well [1:38:15];
• The relationship between anxiety and substance use, and the therapeutic challenges it creates [1:44:45];
• Anxiety’s overlap with ADHD, OCD, autism, and physical health conditions [1:49:45];
• Debunking the harmful myth that health anxiety is a “made up” condition [1:51:30];
• Prevalence, severity, and evolving treatments for health anxiety and OCD [1:54:45];
• Treating health anxiety is about providing patients with skills to improve quality of life—a discussion on how to address symptoms often attributed to long COVID [2:01:30];
• Balancing the benefits of abundant health information with the risks of fueling health anxiety [2:06:30];
• Advice for finding a telehealth provider with expertise in health anxiety [2:11:00]; and
• More.

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