Wearable Music For Your Body - Dr. David Rabin, Co-Founder and Chief Medical Officer at Apollo Neuroscience

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm happy to welcome Dr. Dave Rabin, a neuroscientist, psychiatrist, health tech entrepreneur and inventor who has been studying the impact of chronic stress in humans for over fifteen years. He's the co-founder and chief medical officer at Apollo Neuroscience, whose wearable device uses gentle vibrations to help the body adjust to stress.

Dr. Rabin specializes in treatment-resistant mental illnesses -- including depression, anxiety, post-traumatic stress disorder, and many others -- using minimal and non-invasive strategies such as ketamine-assisted therapy. 

In addition to his clinical psychiatry practice, he is currently conducting research on the epigenetic regulation of trauma responses to help understand the mechanism of psychedelic-assisted psychotherapy and the neurobiology of belief. 

I had the honor of meeting Dave and his team at Apollo Neuroscience at the Psychedelic Science 2023 Conference in Denver. So, it's a pleasure to have you on the podcast, Dave. 

Dr. Dave Rabin: Great to be with you, Shiv. Thanks for having me. 

Shiv: So, as I mentioned in your intro, you have a really interesting mix of interests and experiences. I wanted to start by just asking you in your own words to tell our audience, most of whom are current or future healthcare professionals, how you got to where you are today and maybe just walk us through some of the highlights. 

Dr. Rabin: Sure. So I'm, as you mentioned, I'm a psychiatrist and neuroscientist. I still practice clinical psychiatry and have been for a number of years. And I think one thing that -- like many of us who were trained in the traditional Western model who have any kind of research background -- is when we start to treat groups of patients that are not responding to the treatments we were taught to use, or at least not responding the way we were taught they were going to respond, we start to ask questions about what else can we do to help them and that really is where all of my research came from. 

Originally, when I started working on chronic stress, I was mostly focused on dementia and aging disorders of blindness, and just trying to figure out, you know, why do so many people suffer from these disorders and not get better and how maybe understanding the way that our neurons talk to each other and the way they age could help. I was able to do some really interesting work there and then over time, I realized how much more interested I was in treating the whole person rather than just a specific group of cells or specific organ system. 

So, when I saw the growing burden of mental health, not just in our general population, but especially in our clinicians -- you know, we have a higher suicide rate in clinicians and doctors than we've ever had, which is absolutely tragic, especially because of the amount of training we have to go through to master the skills that we use to deliver care -- that really stood out to me that we just weren't meeting the needs of our communities on the mental health side. And so I started to look at everything else that was available other than the current strategies we were taught to use, like prescription medicine and therapy. Are there things of Eastern or tribal practices we can take that are advantageous, ancient Western medical approaches that are useful, things from the Hippocratic days and Maimonides days, and then even combined with newer things like technology and psychedelic assisted therapy? So, that kind of led me full circle to really focus on how to provide improved access to care by helping people manage chronic stress more effectively and try to figure out what's going on underneath the surface for all of us. 

Shiv: Yeah. We obviously have a lot of shared interests here. When you were zooming back to when you were in med school, did you go into med school knowing you'd be a psychiatrist? Or did you want to be like a trauma surgeon, then you had a great psych neuro rotation or something

like that?

Dr. Rabin: Yeah, I had no idea I wanted to be a psychiatrist going in. I actually thought I was probably going to be a surgeon, vascular neurosurgeon, neurosurgery, or ophthalmology, eye surgery, or neurology, something more in the hard brain, eye region of the body. I did have a really fantastic psychiatry rotation with the people with amazing mentors. It was really in 2012, though, when a fellow med student colleague who knew she was going to be a psychiatrist forever sent me a bunch of papers. She knew I was very interested in consciousness and meaning making and the way we deal with chronic stress, not just in our bodies, but up here, and sort of where the interface between the mind and the body exists - which is not really talked about a lot in Western medical practice. She sent me about ten or twelve of the leading publications on psychedelic assisted therapy. 

I started to dive into that and realized that this is shifting the entire paradigm of mental health, where we're able to give people intensive psychotherapy and just a few doses of medicine without prolonged daily doses of medicine, and people were actually getting better. That really sparked my interest and taking it one step further. The way these medicines seem to be working was that they're activating safety cascades in the emotional brain that helped to rebalance the autonomic nervous system or our stress “fight or flight” system in our parasympathetic rest and digest recovery system. When I started to see these patterns, it really became interesting, and the fact that these world-renowned researchers were doing and publishing research in incredible journals, I saw there was a very high degree of quality around it.

That really shifted me into realizing that psychiatry was going to be at the forefront of medicine in the next ten, fifteen years. Right there in that twenty-four-hour period for reading those papers, I knew what my decision was.

Shiv: Wow, that's amazing. Great, great friend of yours to share that with you. So, that's interesting. You chose your interest in psychedelics before even going into psychiatry. So that was about a decade ago, based on kind of the timeline. What have been some of the most interesting things you've seen over the past decade, including in your own clinical practice? 

I'd love to get into some of your big takeaways from the conference, which seemed like a coming of age with over 12,000 people, I believe, in attendance.

Dr. Rabin: Yeah, for sure. I think the thing that's most exciting, if I was going to put it all together, is that we're seeing that it's very clear that we're struggling on Western medicine side with treating chronic illnesses in general -- be that anything from metabolic disorder to autoimmune disorders to mental health disorders and chronic pain. These disorders that exist for many, many years don't necessarily have a clear physical injury or something that happened to the body that we can identify and are notoriously challenging to treat in the Western medical paradigm. We treat them very similarly to the way we treat acute issues like an infection, or when people come in with a broken limb, and they need surgery. We treat these other disorders in very similar ways, and they don't respond well in the gross majority of cases, I think. 

Just looking at PTSD, on the whole we see that roughly 70% of people who are treated with two or more gold standard treatments for PTSD -- which include SSRIs and all the FDA approved stuff and the psychotherapy -- that over 70% don't respond long term in terms of achieving remission. So, that means that over 70% of people are still symptomatic long term, even after trying two or more of what we call the “gold standard” treatments in Western medicine. So, there was clearly a lot of room for improvement.

That started to help me understand that perhaps there were other disciplines of medicine that have existed either simultaneously with Western medicine or prior to Western medicine that actually have a lot of knowledge to share with us about how to prevent development of illness better and treat chronic illnesses better. So, I turned to Eastern practices, Chinese medicine, yogic and Ayurvedic medicine and just studied some of that stuff and found people who are experts who could explain it to me in words I can understand. Then, as I started to dive deeper into that -- and also the more modern versions of that which would be like biofeedback, neurofeedback, and things of that nature -- I started to realize how much they all had in common, and that all these techniques were, regardless of how you approach them, all improving autonomic tone. They were all reducing activity in the fight or flight sympathetic system that was thought to be overactive and they were increasing activity in our vagal system in our parasympathetic rest and recovery system. 

What's interesting is those two systems share resources, and there's only so much blood to go around, right? So, if our body is interpreting threat, then it's going to divert all the blood flow to our skeletal muscles, our heart, our lungs, our motor cortex of our brain, our fear center, and where does that blood come from? It comes from our reproductive system, our digestive system, our immune system, our sleep and recovery system, our empathy systems, and all the parts of us that are important when we're not under threat. That in particular stood out to me, and the importance of safety in the patient experience and the healing experience, because psychedelic medicines really expose a lot of vulnerability in the individual. I've been trained in ketamine assisted therapy and MDMA assisted therapy from the best in the world, and these techniques all build on the core value of the clinical physician-patient relationship that is founded in the patient feeling safe with us. If the patient doesn't feel safe with us, then the medicine experiences -- no matter how powerful the psychedelic -- are not going to necessarily get people to their goal and it can actually cause harm. 

So, seeing these patterns was really interesting because it helps us understand that there's a convergence happening, right? It's not just “let's do the Western approach and if that doesn't work, you're out of luck.” It's “let's see where the Western approach, the Eastern medicine approach and the tribal medicine approaches kind of all meet in the middle. And then if we can understand where they meet in the middle and where their conversations are shared, then perhaps we can start to replicate some of the benefits of that with technology. 

So, Apollo -- actually the device I'm wearing on my chest -- delivers soothing vibrations to the body to activate the vagal nerve system and was developed out of this understanding through these different ancient practices, but also from the way that psychedelic medicines amplify the safety cascades in the brain to give people access to more vulnerable states of their themselves. That was really fascinating and of what I've learned over the years in particular, that's been the most core thing that just keeps coming back over and over again. 

When it comes to what's interesting about the conference in particular, it's the biggest psychedelic conference in the world ever. Most of the vendors are ketamine clinicians, and most of them don't understand this core principle, right? They're administering a very powerful psychedelic medicine, ketamine, to people regularly -- sometimes doing ten, twelve IV infusions a day -- and very few of them, maybe 90% of them, do not understand that the foundation of the healing experience for the patient is that they have to have this safe, trusting relationship with the clinician. That that needs to start before they get their medicine and needs to continue after. So, I think that over time, we're going to see these fields kind of really coming together but we're still not quite there yet. 

Shiv: That's very interesting. You know, we had Jim Fadiman -- who's the father of microdosing -- on the podcast, and he talked to us about the importance of set and setting, which is a common thing people talk about in the psychedelic space. What you're describing here is obviously about going in with the right mindset or sympathetic nervous tone and setting where there's a trust relationship. Certainly folks like Bill Richards and Mary Cosimano, who we've also had on the podcast, have talked a lot about the importance of choosing the right psychedelic therapist who you build rapport with over many sessions before you actually get dosed with any particular psychedelic.

So, let's talk about Apollo a bit. I tried it on briefly at the conference. I was really impressed. There was a lot of buzz around it...a lot of people coming into the tent to try it on. Can you talk to us about the founding story of Apollo and the science of how it works and what results you're seeing with the device?

Dr. Rabin: Yeah, absolutely. I think this comes full circle with what we were just talking about, about, you know, reaffirming the safe setting for a client. Because when you think about, when you're coming to see your doctor, when you're coming to see your psychiatrist, you're being asked to talk about stuff that you think is wrong with you, right? And these could be anything from stuff on the surface to your deepest, darkest secrets, and that's uncomfortable to talk about and sometimes really painful. If we feel like we might be judged or we might be criticized or that the person on the other side just isn't listening, then we're not going to feel safe enough to be able to talk about that stuff. But talking about that stuff, bringing that vulnerability to the surface is really where all of the healing comes from and so we have to prioritize that as part of the healing experience. Jim Fadiman, who you mentioned, is a good friend and colleague and is a huge fan of Apollo. He describes it as wearable microdose. It's a sub-threshold gentle vibration that delivers safety signals to your skin in the form of sound of music, but low frequency music that you can't really hear, but you can feel through your skin. Just like if you were standing next to a subwoofer or a bass player, like plucking the bass, you feel that more through your body than you actually hear it through your ears. 

When I did my MDMA training in 2016, thanks to the good graces of Rick Doblin, what I found was that MDMA -- from the past studies of it in animal models and what we were seeing in the clinical world -- is helping people above all else feel safe enough to be vulnerable. Even with extremely painful traumatic experiences, like things that they have told themselves they never want to remember, and yet they can go back and remember them and heal from those experiences and remake meaning around them. That was so powerful to watch that when I went back to the lab after that training, I thought, “Well, if this is how it's working, and this is consistent with what we're seeing in the clinical world in terms of what happens to people when they struggle with PTSD and other mental health disorders, then perhaps if we pull on that a little bit, maybe we can activate that safety pathway in other ways.”

So, we tested out everything from electricity to soothing music and soothing touch vibration that activates the touch receptor system, just like holding a purring cat or getting a hug from your friend or having a loved one rub your back nicely or hold your hand. All of those things instantly send safety signals to our emotional brain that's hundreds of millions of years old. That part of our brain is hard wired since the oldest mammals who have nursed their young to deliver nonverbal safety signals to the brain to calm a crying baby who can't understand what you're saying. 

We thought about that a lot and then we mapped out all the nervous system pathways that go from the skin to the brain and the ears to the brain, et cetera, and we realized, “Hey, these soothing natural things like getting a hug are actually seem to be activating the same parts of the brain that MDMA does, but at a lower level.” So, would it be possible to deliver that kind of signal to the body on the go, not so they feel like they're high on MDMA all the time, but so that they feel like 60% of that safety effect that they get from MDMA on the go. They can still function, they can still drive, they can still perform surgery, give talks, work, take care of their children, whatever -- they're not psychologically altered -- but they're safe enough to be present and safe enough to feel their own feelings. When we started to explore that, we actually found that it was extremely effective and we tested it originally in two double-blind randomized placebo-controlled crossover studies in the Department of Psychiatry at the University of Pittsburgh. 

The first was published last July, and we found that Apollo increases heart rate variability reliably and statistically significantly without you having to do anything, just by wearing it. Heart rate variability is the single best metric we have right now that you can measure through the skin that demonstrates a balance between the vagal nervous system, the recovery system, and the stress response system. So, as we started to see these clues -- and we know that heart rate variability is almost always low in people with PTSD -- we thought, okay, let's start to explore this more. It became very clear that this was really helpful for people with PTSD and other mental health issues. It was helpful for us when just being stressed out and working too much and not getting enough sleep.

So, we started to produce it and release it to the world in 2020 after doing thousands of real-world case studies and several lab studies. And that became Apollo, which is now commercially available to everyone as a wellness device. At the same time, it's also going through FDA trials for ADHD and PTSD. It's really exciting because it's a new form of technology that we can take on the go that has no side effects because it's just wearable music for your body, and it just helps to give you a little bit of that boost to your parasympathetic recovery nervous system that we should have been taught how to do as kids, but I wasn't, and most people, it turns out, weren't either. So, it's really helpful. 

Shiv: Yeah, that's incredible. I know there's a lot of wearables. We recently had the head of Google's Fitbit program on the podcast. And wearables have taken consumer health by storm ever since, I think, ten, fifteen years since we donned basic pedometers, largely because of this ability not just to track, but in your case, you're actually intervening -- not just measuring something, but intervening -- to activate different pathways to hopefully generate reduced stress. I wear an Apple Watch and I get reminders to breathe, take mindfulness moments and breathe, which clearly is another way to reduce stress and anxiety. Some people just meditate. I'd be curious, is there a dose-dependent effect? Is somebody wearing this ten hours a day, three hours a day? And then also, I remember there were different programs within the app for different personality types or different states of being you wanted to tap into. How does that work? It seems hard enough with one small device to activate one pathway, let alone multiple different types of pathways. 

Dr. Rabin: The best way to think about it is with music. You've had experiences where you're listening to music that's energizing, and it makes you want to work out or makes you want to socialize or dance. And then you've had other situations where you're listening

to music that's calming, and it helps you meditate or other situations where there's music that helps you focus or fall asleep, and you wouldn't mix those musics. You wouldn't listen to workout music when you're trying to fall asleep because it wouldn't work. But it's still music. 

This is the same thing. Apollo is based on all the same principles that music is based on, and it is music that's just composed for a different organ. We know very intimately how these different intensities and frequencies and rhythms of music can either give us energy or reduce our energy or help us access different states of being. What we figured out in the lab at the university that was really exciting is that you don't need your ears to get that same effect. It's really about rhythm. The rhythms that we discovered are rhythms that are uniquely activating to the touch receptors, just like a purring cat and when you feel that vibration, the body, it turns out, knows what to do. So, you don't really need to do much. Ideally, the vibration rhythm that you feel is aligned with your goal. 

In Apollo, there's seven or eight vibes, depending on which version of the app you have. They range from the highest energy, which is called Energy to Social to Focus to Recover and then the deeply calming vibes are Calm, Unwind, andSleep. Those are all effectively different songs that are composed based on the rhythms that our heart and lungs like to get into when we enter into a meditative state, and the energy that we like to have for each of those given states. So Social is much more energizing for most people than Unwind. Unwind is something that you would want to use before bed, but you wouldn't want to use Social before bed because it's too fast, too much, too energizing. But it's great for when you're out and you want to socialize with other people and you're feeling tired or sluggish, or you don't want to drink, things like that. It really helps get you in the flow of that environment. 

Similar to music, it really delivers that kind of effect to the body and that discovery was really interesting because it really demonstrated that you can do all of this straight through the skin to the brain. You really don't need the ears to get any of these effects, and they're all effects that can be induced with breath as well.

Shiv: That's fascinating. Wow, cool. I'm excited to try it out more and try these different modes. So, where are you guys right now with Apollo, and are there things that you're most looking forward to when you kind of try projecting the future...the next twelve to twenty-four months?

Dr. Rabin: Yeah, so we've released several iterations of the app so far. It can be worn anywhere in your body, by the way. We say our average use is about four hours a day of it actually vibrating on your body. Most people wear it for about that much because we've seen also that people wear it for that long. You don't have to have it vibrating all the time, but if you're having it on your body, vibrating for about three to four hours a day and giving you that positive safety signal, then we see people are getting -- and we're going to be publishing the study soon -- but we're seeing people getting up to thirty more minutes of sleep at night that's concentrated in deep and REM sleep...like, 19% more deep sleep just from wearing this thing on your body and having it help regulate your stress response when you're awake and asleep. And it regulates your whole circadian cycle for you, your whole sleep and wake rhythms, just by scheduling it. 

We've created it to basically not need much input from the human because we want you to be present. The whole goal of the technology is to help you be present and centered and not in your head and not in your phone. So, the device is focused around “set it and forget it” features. You can schedule it to turn on at certain times of the day, or we can customize the schedule for you, which is sort of where the future of the product is going...more customization, more personalization for you specifically. We're hitting like 90% effectiveness rate for people, as soon as you add in personalization. You start to be able to hit everyone because you're giving them exactly what they need when they need it. 

So that is really what's exciting. When you think about how well we've fulfilled the promise of personalized medicine, we haven't done a very good job and there's a lot of gaps. Most people are still being treated the same based on their presenting symptoms and demographics. There aren't a lot of personalized tools that really help to give people the basics of what they need, customized for them without actually paying a doctor to really sit down with you and review all of your details and all of your issues and give you that feedback. That's expensive and time consuming and so we thought, well, perhaps there are tools we can give you that you can take home out of the office that help you do it more yourself using things like AI. If AI can be so powerful that it can generate essays for us and write term papers and all these other things -- and it can potentially even take over the world and destroy all humans - then why can't it help us heal? 

The newest, most exciting feature set that's coming that anybody with an Apollo can sign up to be on the wait list to get first access to is called Apollo Labs. It is the first AI system that I'm aware of that actually uses AI to detect and train Apollo to know when you're sleeping well and when your sleep is disturbed, and then it turns on Apollo when it detects that you're about to wake up in the middle of the night and keeps you asleep. There's never been a solution to help people avoid unwanted middle of the night wake ups until now. So, this is really exciting because then you start to get real time personalization, real time customization that's actually hitting people when they need it, and more of that is coming in the next year.

Shiv: Wow, that is fascinating. Very exciting, and speaking my second love language, which is AI so that's super cool to hear how you guys are combining that. I want to be respectful of your time so I only have two other questions for you. The first is, as I mentioned, a lot of our audience are currently in medical or nursing or some other health professional program right now. What advice would you give to them about their careers?

Dr. Rabin: That's a good question. You know, I think it's a really tough time to be in healthcare. It's possibly one of the hardest times that it's ever been. I've lost two colleagues this year alone to suicide who are very, very well-trained physicians. It was extremely devastating, and all of these people that are our colleagues who have suffered and contemplated suicide, which is so tragic, most of them are suffering from burnout and untreated mental illness. The field of medicine is not one to be taken lightly. It's not one to go in for the money because the money is not nearly as good as what it used to be. It's really for the love of caring for other people and for improving the health and well-being of our communities and that opportunity is still there. There's still an incredible, incredible opportunity to really help individual patients and our communities heal by looking more objectively at the problems we're facing as a society in public health and trying to think of new ways that are outside of the box to address them that maybe we haven't thought of yet. 

I do a lot of training of clinicians as well and we run a lot of burnout research for Apollo because we're trying to help combat this crisis in healthcare that we're seeing. I think the main thing to take away is that there's hope not just for our patients in this paradigm shift we're seeing in mental health, but there's hope for all of us as clinicians to understand that burnout is avoidable and that we need to take better care of ourselves. Taking better care of ourselves also means taking better care of our patients. Apollo is obviously not the only tool that does this, but it is the only tool of its kind that really gives people these kinds of benefits that we're talking about in this way and helps to really combat chronic stress and burnout in the way that it does. 

But the other tools that are there that don't cost any money have always been there -- the intentional breathing, soothing touch, soothing music, movement, stretching -- all of these things are free. They're available to all of us most of the time and we're just not doing them because we spend so much time caring for others that we forget to care for ourselves. And so, you know, we have to balance peak performance with peak recovery, or we will burn out, and burnout is avoidable. Start these healthy techniques early. If you have never learned how to use or master these techniques, then Apollo can help train you how to do it. It trained me how to do it because I never learned how to do this growing up. 

The main thing is there's hope and while we're at a somewhat low point right now, the field is heading in a tremendous direction, and we have a lot of exciting stuff coming down the pike in mental health and treatment of chronic illness in particular. I have a feeling things are going to get a lot easier, but it's with the help of all of these young people now with fresh minds coming into the field to help us think of better, newer ways to do things. 

Shiv: Yeah, absolutely. I share your optimism and would echo that for our audience and also very much agree that, you know, there's actual research that shows that clinicians who practice what they preach -- whether that's healthy diet or exercise or stress reduction techniques -- are more credible when they preach that to their patients or if they have the time to do that as well. 

So, between the work you're doing and a lot of the artificial intelligence work, I think there's a lot of reasons to be hopeful for the practice of medicine getting better. 

Last question is an open mic. Anything else that we haven't discussed that you'd like to get across to our audience today? 

Dr. Rabin: We covered a lot of it. I think the main thing is that there are a lot of disciplines of medicine out there that are not just Western. We didn't really talk much about Eastern practices here, or tribal practices. But I've spent a lot of time studying alternative medicine and other cultures and the way they deliver medicine, and one of the things that we struggle with the most in our society is a sense of fractured trust in ourselves and a sense of really having a foundation of being able to trust ourselves, not just as clinicians -- we train to do that all the time -- but as human beings. Our patients who are struggling with trauma -- which is most of them, regardless of whether that's the reason why they're in to see us -- they struggle with the same things. And, you know, ancient techniques of medicine have a lot to teach us, and they shouldn't be neglected. They can really help to augment our ability to fulfill the needs of our patients in so many ways. 

One of my favorites that I'll leave you with is what we call the four pillars of self-trust, which I practice every day. I recommend everybody practice them as often as you can remember them, and it just requires remembering them to practice them. They are from Shipibo tribal culture, which is one of the oldest medicine cultures of South America. They are self-gratitude, self-forgiveness, self-compassion and self-love. The more that we think about these things, the more we practice them, they become very powerful emotional skills, just like building muscles in the gym. You're building your emotional muscles that help us be more resilient, more thoughtful, more able to adapt to stress and less likely to burn out because we're refilling our batteries at the same time as we're struggling, and that's the way we want to be, right? You want to create like a sustainable loop where we face stress, but then we recharge really quick afterwards. These tools have been incredibly helpful to me and all of my patients. I encourage everyone to explore and look outside to some of the other medical traditions, because there's so much we can learn. 

Shiv: 100% totally agree with that. And we've been fortunate to have some people on this podcast from those cultures and experiences who are talking about that. So, anyways, Dave, thanks so much for taking the time to be with us today and more importantly, for the work that you've been doing to push forward the field through both Apollo and your clinical work. It was a real pleasure speaking with you. 

Dr. Rabin: My pleasure. Thanks, Shiv. 

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together. Take care.