Marom Bikson
All right, Elliot. I want to jump right into it. And the first question I have for you is: how did your involvement with neuromodulation for pain begin?
Elliot Krames
That is a piece of stories for me.
I trained as an anesthesiologist at the University of California, San Francisco. And I did a fellowship in obstetrical anesthesia because I originally was going to become an obstetrician. That was my interest in medical school. And matter of fact, I did an OBGYN internship. And that was 1972 at Mount Zion Hospital in San Francisco.
You know, it was basically pure obstetrics - and I was enjoying it. And during my internship, I heard a talk given at Mount Zion Hospital as an invited speaker was Saul Schneider. Saul was the basic, well, he was the founder of obstetrical anesthesia…textbook and he's from UCSF. And he gave a talk on epidural anesthesia, analgesia…for labor and delivery to our group at Mount Zion Hospital. And that blew me away because as an obstetrician in training, pain or me was - pain in the labor - for me was the hardest thing to deal with.
I did not like to see women screaming in pain.
So, after this talk on epidural analgesia, which blew me away. I went up to Saul and said, Dr. Schneider, I said. You know, this problem in pain in childbirth is a big bugaboo for me and I want to do what you do. How do I do that? He says, well, you…internship and then anesthesia training and after anesthesia training you do a fellowship in obstetrics anesthesia - and I did. Short story, I got in and I think Saul had something to do with that. In ‘72 I became an anesthesia trainee, which at that time was a two year program.
And then I did a fellowship with Sall, a year of research and a year of training in obstetrical anesthesia.
And then I became head of the Obstetric Anesthesia Department in Mount Zion, Osborne.
And I hired two other people - and the three of us were doing obstetrics anesthesia. At that time, I had no interest in general pain. I was all about obstetrics.
Well… In, I think it was 75, I read a paper by Joe Wang, who was an anesthesiologist, I think, at the Cleveland Clinic - again, I'm not sure, but the paper was on the use of interspinal morphine for the relief of pain in cancer patients. Now I need to retrogress because in ‘74, Saul, who had done a fellowship - I'm sorry, not a fellowship, but he took off a year from his work at UCSF and went to Israel. And he studied with some people in Israel on the use of morphine for epidural analgesia, different pain. At a cocktail, which really changed my life. Saul and I were talking about interspinal analgesia for labor pain - interspinal morphine. And I decided to do some research about it and I did. I was doing research on the use of interspinal morphine versus a plane epidural analgesia for labor. And just so happens, I was the only person in west of the Mississippi who was using it for spinal cord. Even Saul wasn't using it. And then an oncologist by the name of Jay Gershel - he's now dead - but Jay read the paper by Joe Wang and asked me if I would take care of the patient who was screaming in pain, cancer pain. And he gave me the paper, I read it, Joe Wang’s paper. And I was taking care of woman in labor with an epidural. And I said, I'd be happy to do it. I will do it. And I walked across the street to the oncology department. When I opened the elevator, there was this woman screaming, screaming, screaming. And when I got to her, people were holding her down. She was just screaming in pain. And I did the dirty and I gave her a spinal with four people holding her down, the morphine. went back to my epidural and an hour later came back and here was this lady sitting in bed smoking a cigarette.
It changed my life.
It almost wants to make me cry - but it basically changed my life. At that point on, I decided I wanted to be a pain doctor and help really make people in pain. I continued as chief of obstetrical anesthesia at Mount Zion and then started a cancer pain clinic. And I would go into people's homes, four or five times a day when I wasn't doing obstetrical anesthesia to do spinal morphine or epidural local anesthetics for people in severe - with my nurses. And I started a comprehensive cancer pain.
And then I knew that I needed to find a way to.
Marom Bikson
This is late 70s? Early 80s?
Elliot Krames
This was the 70s. I needed to find a way to deliver interspinal morphine continuously. I couldn't keep on going in every other day and doing an injection. I read a paper - trying to think
Rosaline Krames
Dennis Coombs.
Elliot Krames
Rosie, Dennis Coombs from Mary Hitchcock Clinic in Rhode Island - on the use of interspinal morphine continuous.
And I called Dennis. I said, Dennis, I want to do this. How do I do this? And he gave me a telephone number to contact the name of the company at that time, Rosie?
Rosellen Krames
Infuseaid.
Elliot Krames
Infuseaid. - who they were the first implantable pump for morphine…Dennis and Burton M. Onofrio…the University of Minnesota neurosurgeon, they wrote this paper, do that.
And anyway, Infuseaid told me that I could do this in a study, which I did. I did not have surgical privileges, so I got a surgeon who helped me - and we implanted about 20 pumps, 17 of which were cancer patients and three were patients who non-malignant pain.
And I published that study in the Journal of Cancer. And I won an award as the best paper in the Journal of Cancer for that year. And I think that was 1980…
Rosellen Krames
1984
Elliot Krames
1984. Anyways… Medtronic heard about read that paper and they sent out Rosellen - my wife, now - who asked me some questions about that paper. And we became friends and then we married in 1989. Anyways, she came out in 85 and became my nurse. And around 1986, I got privileges, the first anesthesiologist in the world got privileges to do surgery - not anesthesia for surgery, but surgery. And I planted my own pumps.
Medtronic sent this guy to speak to me. Says, since you have privileges, would you be willing to put in a spinal cord stimulator - which I knew nothing about. I knew nothing about electrical stimulation, but basically, it's the same procedure as putting in a pump. You put instead of putting in an inter-spinal catheter, you put it in an epidural electrode.
Marom Bikson
So what year was this? And at this point, these are percutaneous. These are not paddles anymore.
Elliot Krames
These are this percutaneous. Anyway, got to tell you, Medtronic told me I was the first anesthesiologist in the world to put in this spinal cord stimulator, which I did. And I don't remember the exact year. I think 85, 86. I'm not quite sure - but I was running a pain program now, not only for cancer pain, but for non-malignant pain.
And the simulator I put in was an Itrel 2.
Rosellen Krames
….
Elliot Krames
Rosie tells me Itrel 1. An Itrel 1 - you had to when you put in the electrode, you had to program with the patient. I'm sorry. With the patient in the operating room, you had to program it in the actual stimulator. You had to screw in some the electrodes, the ones that you wanted. And you couldn't change it unless you open the patient again. There was no external program. And that I did that. The year was ’85 – 5, I’m not sure
Marom Bikson
Was there at this point a trial period or basically it was one shot and you…
Elliot Krames
With the patient awake. And you got the stimulation in the right place and that was it.
Marom Bikson
but - paresthesia based obviously – and this this is paresthesia based?
Elliot Krames
Excuse me?
Elliot Krames
Paresthesia based. And the only people that I knew that were doing this at the time…was Jay Law in Colorado a neurosurgeon. Rick North at Johns Hopkins and Giancarlo Barolat, at University of Pennsylvania. - at that time.
You need to contact Rick North. Yeah. If you want answers. They probably they were neurosurgeons who were leading the pack and I was the first anesthesiologist and boy they didn't like it that an anesthesiologist was doing this. But we became friends. You know I had just as much experience as they did. We became friends… yeah, that's a big history.
Marom Bikson
And, if there were no perc leads, but if it was just paddles, it would not have been something you could have taken on or not taken on. There's the fact that the perc
Elliot Krames
[Paddles] Required a laminectomy. And I wouldn't have done that. I wouldn't have gotten privileges to do that. The only reason I got privileges is I knew how to use an epidural needle and I can put in a percutaneous lead.
Rosellen Krames
We got privileges because of pocket surgery. The cardiologists are doing it.
Elliot Krames
Yeah, and the only reason I got a privilege is to do a pump was that prior to me, cardiologists were getting approval to do their own surgery - pocket surgery - for pacemaker. And they were not surgeons, so the arguments that surgeons who tried to block was that I have no training in surgery. Well, I did have training in surgery, a whole year of surgery in obstetrics. And I was doing C-section. So, I told them, look, it's pocket surgery and cardiologists are doing pocket surgery and putting their own leads in. So, I got approval.
Marom Bikson
So when you started, I guess this is mid 80s, did you, first of all, did you need convincing? I mean, why, why did you, it sound, did it sound crazy to you? Were you, was there evidence that it would, you know, that you were looking at? Was it just that Medtronic was pushing for it? And also, was who trained you? Was it basically the reps from Medtronic who had the skills?
Elliot Krames
That's the way it was. Medtronic, their reps, basically told me where to put the lead and they spoke to the patients. The rest was more skills that I already had. I know how to make a pocket and I knew how to put in a lead. Well, I can tunnel that. There was no problem. Tunnel of the lead to the pocket. There was no problem.
Marom Bikson
But the notion of using electrical stimulation was that…
Elliot Krames
Foreign. It was foreign to me. I knew nothing about frequency, pulse width. I knew nothing about any of that/. And I had to learn it, which I did. I read a lot, you know as much as they could and It was all on the job training
Marom Bikson
All right, so now keep going. So now you're with your, guess you're expanding your practice. You're doing more neuromodulation. What happened next as this starts to, as the field and your own practice starts to grow?
Elliot Krames
My interest is using spinal cord stimulation basically was for patients who had low back pain with major radicular pain. Of course, that was the only way people were using stimulation at the time. So, I was using that.
And you know, I still published a lot on intraspinal analgesia. I published...,guidelines for the use of interspinal analgesia. I've published a series of cancer patients and non-cancer patients. On the use of adjuvants to morphine local anesthetics and other things. So, I never didn't publish anything on a series of spinal cord stimulation until the early 90s.
Rosellen she…after when she came out and I published that one paper, she said to me, Elliot, with all your experience and all these patients that are doing stimulators and spinal analgesia, why have you only published one paper?
By the time that I that I retired in 2014. I had published 182 papers . Well, my name was on
Busy guy. But another big change for me came in the early 90s. When I was in my kitchen cooking, I liked it. And I got a call. And my wife picked it up, not Rosellen, but my wife at the time was... Anyway, doesn't matter. She said, a Giancarlo Barolat is on the phone for you. You want to take the call? I said, oh yes, I want to take the call.
I had never met Giancarlo when I had...
Rosellen Krames
….
Elliot Krames
That was you?
Rosellen Krames
Yeah, that was ‘92.
Elliot Krames
I was ‘92…see, my memory…Let's continue.
Elliot Krames
Giancarlo had read my papers on interspinal allergies and Giancarlo had just been made president of the International Neuromodulation Society. And the board, who asked him to be the new president, all quit. They said, you create your own board.
All of them quit, except there was Giancarlo. And the board were basically the only members of the International Neuromodulation Society. Their purpose was to hold meetings, nothing more than to hold meetings. So they all quit on mass. Giancarlo had read my papers, and he called me and invited me to be on the board of the IANA. 92, 97, like that. 92, 93. Yeah.
And so, I did and he invited other members and...my first meeting of the INS board was in Nottwil, Switzerland. And I remember clearly I never met any of these people. Some of these people you probably know, Holsheimer, Ben Linderoth
Rosellen Krames
I have a picture…
Elliot Krames
You have a picture? Yeah, anyway, it was amazing. And at that meeting basically was the birth of the INS. Because at that meeting, I asked some questions. I said, besides putting on meetings, where do you guys publish? How could you have a society where you don't have an avenue for publishing? And after much debate,
And with the objection of Jan Holsheimer we voted to create a journal. And they made me, told me that you create and you're the first editor. Well, I had no experience.
Anyway, I did. I don't know if you know Tia Sofatzis. She's the executive director of the INS. I hired her to be my secretary. We created the journal together and rest is history. Pretty much history.
Marom Bikson
In that point, early 90s, what is the state of SES for pain? Are there thousands of practitioners? Are the anesthesiologists really involved? What's the state of the pain field…
Elliot Krames
There was a handful of practitioners, a handful of experts, but Medtronic was trying, since I was the first anesthesiologist, they were trying to recruit anesthesiologists all over the world to do this - certainly in the United States first. And you know, Peter Staats, Peter Staats. He found out that I was doing this and he came to train with me. And he still couldn't get privileges at Johns Hopkins because of the objections of the neurosurgeons, including Rick North. So yeah, then slowly and slowly over time, I think in the 90s, anesthesiologists became - because percutaneous implantation was much more popular than laminectomy for a plate implant. And today, 99 % of all stimulators are done by anesthesiology.
Marom Bikson
So then early 90s is basically one company, I mean it's Medtronic, that right? Do you remember if there was a sense that the technology was moving forward at that time as well? Do you remember any significant...
Elliot Krames
Yeah, you know, there was another company, the precursor to ANS, Advanced Neuromodulation Systems. Do remember what that company was called Rosie?
Rosellen Krames
Neuromed.
Elliot Krames
Neuromed, that's right. Neuromed was a just a startup company.
Rosellen Krames
Yeah, up the East Coast.
Elliot Krames
On the east coast that That was not implanting one electrode, but two electrodes. And they wanted me to implant and I was speaking to people and I don't remember who it was that were using two electrodes at the time. think Rick North and Jim Collarwood, but
Marom Bikson
These are two leads with like four contacts.
Elliot Krames
Two leads with four contacts. Actually, two leads with eight comments.
Marom Bikson
Okay.
Elliot Krames
Neuromed had eight contacts. And there were some papers by Jay Law, were some papers by Rick North about the use of eight contacts.
And, but you know, I, at that time, I was happy with Medtronic. They...basically gave me a platform to teach. And I was going all over the United States teaching other anesthesiologists and neurosurgeons on the use of implantable technology, including spinal cord stimulation. And the people in our group was Rick North, Giancarlo Barolat, Marshall Better.
Rosellen Krames
John Oakley.
Elliot Krames
John Oakley, John Oakley was a neurosurgeon, one who became my best friend and unfortunately, he died in a plane accident.
And so we went around the country to give talks.
You know, I went to Medtronic and I said, look, you know, I'm feeling loyal to you guys, but I need you to make a...a eight electrode lead. And they said, we're not going to do it.
I said, well, you're not going to do it. Okay. So, I'll go. And I went to Neuromed and started to implant their lead. Well, Medtronic didn't like, they were really upset with me. And at my meeting in the year 2000, call World Congress of Pain. It was the largest pain meeting ever -- had 2,300 people. And it was because I was on the board of the INS, I was on board of World Institute of Pain, and I was on the board of NANS, I made this a multi-sponsored move.
After the meeting, had the first pain and neuromodulation meeting as a satellite in Napa Valley. And we had about 100, we had about 20 people I invited that Medtronic refused to sponsor, but Neuromed did sponsor it. Pain neurosurgeons and anesthesiologists had a meeting sponsored by Neuromed.
Marom Bikson
Sorry - This was in Napa. This is in late 90s?
Rosellen Krames
No, 2000.
Elliot Krames
Yeah. Year 2000.
Rosellen Krames
You know, was earlier.
Elliot Krames
I was earlier…Anyway, I did have a satellite meeting and a hundred people came to Napa Valley. Not, but before that I led a meeting in…and you can ask Rick North and, and other people, um, what year that was, but Neuromed sponsored that meeting and it was the first meeting on spinal cord stimulation for pain.
Where people got together - I led that meeting - people got together to discuss their research and..
Rosellen Krames
It was at Meadowood in
Elliot Krames
It was at Meadowood in the 90s. At that time, I was the chief of the journal and I would not just be a Medtronic guy or a Neuromed guy. Neuromed by the way became ANS, Advanced Neuromodulation System, which then became Abbott.
Rosellen Krames
….
Elliot Krames
Yeah, no, they were not, no, by that time it was Neutronic, ANS, Advanced Bionics, which was bought out by Boston Scientific. And ANS, was bought out by Abbott. And then.
Marom Bikson
Through St. Jude, bought through St. Jude to Abbott.
Elliot Krames
Another piece of history you need to know. I'm sitting in my office at Pacific Pain Treatment Center. And one of my secretaries said, there's a guy, Rose, did you remember his name?
Rosellen Krames
Is it from Al Mans’ Company?
Elliot Krames
No, The founder of.
Rosellen Krames
….
Elliot Krames
At that time it was Nevro. It was a different name. It wasn't Nevro. The founder of the company, and I can't remember his name, he was a Greek guy. And he came and he said, look, I've been doing research.
Rosellen Krames
He was a businessman, wasn't he?
Elliot Krames
Yeah, he was a businessman…
Rosellen Krames
….
Elliot Krames
And he said, I have a bunch of papers on high frequency stimulation in the brain. And I want to do high frequency stimulation in the spinal cord and( look up the history of Nevro). And I'll pay you to review the paper, the stack of papers was about a foot long. And I'll pay you to review this. If you tell me I should continue.
Rosellen Krames
Konstantinos
Elliot Krames
Yes, Konstantinos Alataris, Konstantinos Alataris. And he started a company called Nevro, I think…because it's a Greek word for neuron. So, I said, look, if you're going to do a company, I want shares in your company, and I want to be paid for my time. He said, OK, we'll do that and sign the contract.
And... I took me about six months to review these papers. And I basically gave Konstantinos Alataris: Yes, I think it's safe to do in the spinal cord, but before you do that, you need to study this in rats, and then you need to study this in non-human primates, and here are the people that you should get to do these studies, because I'm not going to do these studies. basically, I never heard anything more. Until five years or six years later and I held a bunch of shares in this company.
And yes, they honored their shares and they wanted me to become chief medical officer of this. I forget his name; he was the first CEO. I forget his name, but he went Medtronic to Nevro and he sat down with me and Rosie had a very nice dinner and asked me to be the chief medical officer and I said, no, but I will be a consultant, which I was. And I was a consultant for Abbott and I was a consultant for Medtronic…
Elliot Krames
That's basically my story.
Marom Bikson
There's a lot that was skipped. I want to rewind a little bit. Along the way, you mentioned that you were on the NANS board, but NANS had to be created. Right?
Elliot Krames
I started NANS. I started NANS with a group of, I think it was nine people. It was down in Florida. It was supported by Medtronic and that was the only hand. And we started, we said it wasn't NANS. was American Neuromodulation Society, not North American. Right.
Then that was before I was on the board of the INS And Giancarlo Barolat, Rick North and I, and Marshall Better, and I think Peter was there. And Giancarlo Barolat, John Oakley, and some other people, we started this. But because
There was a company called ANS, American Neuromodulation Systems. We had to change our name to North American Neuromodulation Society. And at that time, we invited the Canadians and the Mexicans to join us.
I think it was after the second board meeting of NANS...I and Giancarlo were on the board of the INS. Giancarlo was the president. We came to INS and to NANS and we said, look, we're the International Neuromodulation Society. We should have chapters in countries. And since we have North American Neuromodulation Society, we invite you to, we think that we should be the first chapter of the INS. Wow. Did that create a lot of discussion? In matter of fact, one of the guys who was the first president, and I forget his name, Giancarlo would know his name. He called us foreign spies. Literally, we were foreign spies. And boy, that didn't go well. There was a lot of discussion. And anyway, we went out. It was voted by NANSs board to become the first chapter of the International Neuromodulation Sociey
Marom Bikson
Now.
Elliot Krames
And to accept the journal, which I was editor-in-chief and founder, to be the journal of the North American New Roman.
Marom Bikson
You also going back, you mentioned some technology, think you said, so Neuromed had four contacts, Neuromed eight contacts and on top of that, two leads. Then Alfred Mann's company is also coming along the line. So do you remember when these innovations were coming down? the fully implant, so moving away from sort exterior power to fully internal powered… more contacts you know why…why did you care about more contacts you know obviously the current control introduction do you remember which of those innovations sort of made a difference to you which did
Elliot Krames
You know, it's all a blur, but I can tell you when it made a difference to me.
First system I put in was the Itrel-1. I told you; you couldn't externally program it. And it was a radio frequency oil charging system. And the second was the Itrel-2, which was the first fully implantable, externally programmable system. Then ANS came in with their fully implantable - which was I want to say dual-4s at first but then became dual 8’s [electrodes].
Al Mann's company, Advanced Bionics, was the first externally fully chargeable battery…and me and one of my fellows wrote a paper comparing at that time all systems... which were all externally programmable. And I believe at this time, Medtronic had an eight, I'm not sure. All these systems sort of muddled, but they were all, the only differences was bells and whistles - to basically a same system. All basically the same.
You know, a balanced charged delivery. think Abbott, not advanced neural modulation systems, they were using charge driven, I mean, not charge driven. Excuse me.
Marom Bikson
Current control stimulation.
Elliot Krames
Thank you. You know, I've been out of this since 14, so Current control stimulation. Medtronic was the voltage controlled system. we did an Advanced Bionics was the current controlled system. And we did a study and published in Neuromodulation that there was no difference in outcomes in any of these. They're all the same outcomes….there were no differences in waveforms, all charge balance waveform at the time. And boy, the people at Advanced Bionics and Medtronic, they came down on me and I said, look, we just did the study. We just showed that there was no difference, but they were only like 14 patients that we studied and we rotated.
Now, what was your question? I lost…
Marom Bikson
No, you were answering it. I was wondering about new technologies coming down the pipe and how significant they were to your, from a research perspective, but also how significant they were to your practice. And you're suggesting there wasn't that much in your experience, practical differentiation between these early technologies.
Elliot Krames
Until Nevro It offered high frequency stimulation, which none of the other companies were able to do. You know, at this time, this is already in the late 2010, 11, 12. Up until that point, there was no difference in any of the companies other than bells and whistles.
Do you understand when I talk about bells and whistles? Yeah.
Marom Bikson
Basically, from like, you're almost describing situations where almost from like the 80s to the early 2000s, in your mind, the innovations were bells and whistles. They weren't categorical.
Elliot Krames
Correct. Correct…Correct.
Marom Bikson
Was there, there was a, for a patient getting a device in 2005, there was a difference in expectations than a patient getting a device in 1985, right? Those bells and whistles were significant, right? You wouldn't be installing a 30 year old device at that point, right? These bells and whistles, more channels, more flexibility maybe in programming. These weren't these weren’t’ meaningful as far as outcomes or you think you could have installed an Intrel-1 and gotten the same benefit in 2005.
Elliot Krames
Definitely not. So now we had eight leads. Now we had research of Jan Holsheimer out of Twente Netherlands. We had the research of Holsheimer and Barolat on a crosstalk between two eights and two fours [electrodes]. So, there were a lot of changes in programming that did make a difference.
Before changes in waveforms and then high frequency and waveforms, they do make a difference. Then Saluda came in and that surely made a difference, although I never implanted a Saluda. I just knew the papers and studies and did some consulting with them.
Sure, there was a major difference… in cross talk in programming. Advanced Bionics had a algorithm for programming that did make a difference in outcomes. So, for sure, you know, and then I introduced the concept of doing spinal cord stimulation and peripheral nerve stimulation in the same patient with the same system - and then being able to talk between those systems. And that made a difference. And for the first time with Advanced Bionics with two 8’s [electrodes], changes in programming, complexity of programming, the use of peripheral nerve stimulators and spinal cord stimulators, we were able now to stimulate the low back, stimulate the neck, and the appendices, the hand and the leg at the same time. It made a difference in stimulation and outcomes for patients.
Marom Bikson
When is the sort of rise of peripheral nerve stimulation in the context of this historical arc where you're seeing, where that's part of the portfolio of the anesthesiologist or when it first starts to emerge as a tool?
Elliot Krames
The first peripheral nerve stimulators required surgical implantation of either a paddle lead and then - first of they were all paddle leads…
And... Rosie, help me. Clinic, anesthesiologist. Came to visit.
Rosellen Krames
……
Elliot Krames
Anyway, a friend of mine, I haven't seen him in years, so.
Rosellen Krames
Michael.
Elliot Krames
Michael Stanton-Hicks. He published papers out of the Cleveland Clinic on the use of peripheral nerve stimulation. I think those were the first papers.
Rosellen Krames
No, He used a cuff electrode. He used a cuff..
Elliot Krames
Rosie says he used the cuff. Yeah, he taught me, he actually came out and taught me using a paddle electrode - not cuff electron. Gabor Racz, you know that name? Gabor? Okay. Gabor is an anesthesiologist out of Texas who was basically one of the fathers of interventional analgesia.
Marom Bikson
I was first started with the copper.
Elliot Krames
He published a paper on peripheral nerve stimulators and I read the paper by Michael Stanton Hex and invited Michael to teach me since I already had surgical privileges for implanting stimulator.
You're falling asleep?
Marom Bikson
Me?
Elliot Krames
Yeah.
Marom Bikson
Definity not.
Elliot Krames
He came out and we implanted three stimulators in a week and I got privilege to do peripheral nerve stimulation. So, we were using peripheral nerve stimulators for patients with CRPS, complex regional pain syndrome.
Marom Bikson
But you think, I mean, since you mentioned the work out of Cleveland, they were using cuffs. Maybe those cuffs were coming out of, you know, Case with their engineering program there. But were the early PNS systems essentially borrowing SCS technology? So they took the perc leads from SCS?
Elliot Krames
The early peripheral nerve stimulators borrowed the technology from this from SCS and use paddle leads on the nerve.
No percutaneous leads until maybe the late 90s, the early 2000s. Teodor Goroszeniuk, he was publishing on peripheral nerve stimulators, calling it something, their targeted stimulation.
That's where you need to….And he wasn't implanting them. He was putting a lead through a needle. Goroszeniuk a Polish guy.
Marom Bikson
Tell me about neuromodulation of science, because I know… I'm going to be seeing you in a couple of weeks in Napa, obviously for Napa pain with neuromodulation of science is actually going to be the first time, right? They're giving out an award in your name, but tell me about the origins of Neuromodulation the Science, what were your goals for it and how it came about.
Elliot Krames
sure 2013…actually 2012, was clear to me that the 2012 was clear to me as a person who I was still editor in chief of the journal…the only people who were really publishing on stimulation science was Bengt Linderoth, Bob Forman…Linderoth and the other guy from Sweden.
Rosellen Krames
….
Elliot Krames
Bjorn Meyerson. Bjorn Meyerson. These are the only guys doing it. And there was some science on interspinal analgesia, which I was involved in.
So, I went to the board. At that time, I was president of the INS. And I made a proposal that the INS should sponsor a yearly or every other year meeting on science of neuromodulation - not clinical science - but bench science. And bench science should include neuroscience, neural engineering, bioengineering - and that this would be a meeting…You know, at that time, the NIH was running a meeting called Neural Interfaces Conference, of which I went every year for preceding 2012. I went because I wanted to learn. And it was bioengineering, it was neuroscience, it was mathematics, it was chemicals, the whole bit. And I just was excited about that meeting. I invited, I had met Dominique Durand at one of those meetings and he was the editor of Neural Engineering and I was the editor of
Marom Bikson
Here's my PhD advisor as well, actually… he taught me.
Elliot Krames
He was your advisor?
And we became friends. He would come out. He had children in San Francisco and he would come out and we would get together. And so, we made a pact. That any studies that they couldn't do or I couldn't publish, they couldn't publish. We would offer them as an alternative journal to publish. And which we did. And it was out of that that I really knew that the INS / NANS was missing the boat. You know, they were at our meetings, would be like a discussion, poor presentations on science. Everything else was clinical.
And I knew that the science was out there because of NIC. The science was out there and they didn't know it. So, I said to two boards, the INS first and North American Neuromodulation second, of having a meeting that just focused on
You know, it was really, for me, it was really important that the INS take the lead. After all, was the INS was the mother organization of neuromodulation and should take the lead in inviting engineers, neuroscientists, postdocs, students to come to a meeting that focused on all aspects of neuromodulation. And I ran a meeting in - because that was my idea, I ran a meeting in Mexico - the International Neuromodulation Society, where I had a whole day of… which I called a neurotechnology day. I didn't call it neuroscience, a neurotechnology day. And I invited Peckham, I invited Dominique Duran, and that, and at that meeting I had all these companies to show their science, their technology, you know.
It was unheard of. Prior to that meeting, the only people who sponsored meetings were the clinical companies, Medtronic, Abbott, you know, they were that. And now we have people for a day to show their wares in bioengineering and new technology.
Rosellen Krames
And you couldn't, we couldn't get people out of the room. Nobody wanted to do it…too excited.
Elliot Krames
Did you hear that? We couldn't get people out of the room. People were excited. And there must have been 300 people at that particular day. And we had a neurotechnology corner for people, for companies to be able to talk to their companies - to their customers. And it was wonderful.
And out of that, I said, look, INS, need to do this every other year. NANS… We can't make money, we'll lose money. And they didn't want to lose money. And I didn't give up. I didn't give….
Rosellen Krames
You're recorded.
Elliot Krames
I didn't get it recorded. But I didn't give a [beep]. You can take that. can edit that. Whether we made money or lost money, it was important that we did science.
So, INS turned me down, NANSs turned me down, so I went to Eric, Eric Grigsby. And said, Eric, I told him what we needed to do. And he said, I'm all in. He said, I'm all in, let's do it. At that time, he had Neurovations, so they were into it, into technology.
And for two years, I worked my ass off - every day - sending out emails and I created the scientific programming and trying to get…Eric didn't have anybody in his company could help me. So, I did it myself. 2012, ramped up in 2013.
Rosellen Krames
We 60 people there.
Elliot Krames
Yeah. And we created the first, which I called Neurostimulation Mechanisms of Action. That was the first meeting. 2014 Orlando, Florida. First day, 60 people at eight o'clock at night. Nobody wanted to leave.
Rosellen Krames
There were least a couple hundred people, but there were 60 speakers.
Elliot Krames
Yeah, Rosie said there were a couple hundred people, 60 speakers. Nobody wanted to leave. that meeting, I created the sort of a template for each session. The session would be what's old, what's new, and then we would have a panel discussion of where we had to go from here.
And the scientists in the audience, they were people from professors from multiple universities who were in on discussion from the audience with the panel discussion on where we have to go from here. What were the gaps in the science?
Rosellen Krames
The meeting with three hours over.
Elliot Krames
We went three hours over and finally I went …I was invited, I went to dinner, it was eight o'clock, we were supposed to finish at five, but at eight o'clock we were still going. And I had a dinner, I was invited by Kevin Tracy's group to a dinner. Kevin wasn't there, he didn't wanna come, but Chris sure was at that dinner, it was the first time I met Chris…Jojo Platt
And went to dinner with Rosie and, you know, they could not believe that day. That was a major change in the way we looked at our neuromodulation and the discussions. Of course, for the first time, the clinicians didn't lead the discussions. The scientists and bioengineers led the discussion.
Well, I went back to my room and I had a stroke. That was the night I had a stroke. And if it wasn't for that stroke, I would still be heavily involved in neuromodulation. But it was clear to me, I was totally paralyzed right side, could not speak, lost my speech. And three weeks later, thank God everything came back, but it was clear to me that I could not work as hard as I was working.
And I retired from clinical medicine. And in the interim, Hunter Peckham, Ali Rezai, and myself, I knew, written a textbook called Neuromodulation. And after my stroke, I retired from clinical practice and I basically did the second edition. I got no help from Hunter nor help from Ali because they were still working and I could do it. And I worked for a year with the second edition of neuromodulation.
And then I got to say this to you, one of the most fortunate things in my career and for Neuromodulation Science was meeting you. at a consultancy in New Jersey. Yeah. You were doing a Neuromodec at the time - and you saw a need. And you came to me and said, let's work together. Well, you were the first true scientist to come to me and say, let's work together. And it was clear to me that you had a network that I didn't have. I had a large network because all the people from NIC, they knew me and I knew them and I knew that work. And you brought noninvasive neuromodulation and bioengineering expertise. So, it was clear to me that when I couldn't continue, you should continue with it. So, I'm really pleased about that.
Marom Bikson
Why…I mean, the NANS meeting, the INS meeting, they are amazing meetings. bring together a lot of clinicians. You know, there's a lot of ideas that are shared there. Why do the neurotechnology basic science meetings need their own space? You know, instead of, you know, it seems hard to grow that critical mass inside these clinician dominated meetings. - you're saying is they need their own little bubble where there are different people leading the show.
Elliot Krames
Are we talking about the neuroscience as bioengineers?
Marom Bikson
Right, exactly. Or even clinicians who are just up to their neck in the basic science.
Elliot Krames
Yeah. Well, you know, I am hopeful that you and Eric will continue to lead their Neuromodulation to Science. I think it's a real need for
You know, I, I, first of all, I was the first anesthesiologist in this world to get involved in any of this. Before that, neurosurgeons thought they owned it all. And it was clear that when there was a move away from laminectomies for stimulation to percutaneous leads, that the anesthesiologists were going to lead the world.
So, I have a lot of history of getting anesthesiologists and neurosurgeons to work together. Give talks together, be part of our meetings and that was the basis of the INS. So, the INS was clearly an avenue to bring in disparate groups. We made an attempt to bring in cardiologists in our meetings. And in fact, we were somewhat successful that some cardiologists…urologists..., it was my idea and I was giving talks all over the world that neuromodulation is the future of medicine. Big step. But I believe it. And so, I gave this talk all over the world about it.
So, our meetings grew, INS grew to include other clinicians, urologists, cardiologists, and others. And then, course, we had ENT docs giving talks on a neurostimulation for hearing.
And then because of my increasing network in science, bioengineering, I wanted to bring us all together. And that was the concept of the textbook, Neuromodulation, to bring us all together - which you're part of. Bring us all together in one field. Clinical field and basic science field called neuromodulation. Well, you know, that is coming up against already established organizations. IEEE… And I see, you know, they had their own meeting.
And so, it was my idea rather than to consider these people as competitors, to consider all these organizations as colleagues. We're all in this together. See why we can work together to expand this field.
And I got to tell you, I haven't been around since ‘14 because of my stroke and then I had two heart operations. So, it's…I look at where we've been and where we're are and where we're going. And I do believe we've created a larger, greater, larger community of neuromodulations than ever existed. For example, the INS meetings is no longer a pain meeting. It is true, although it's basically a clinical meeting with, I think, too little science. It's now included multiple organizations, multiple people in bioengineering. And I created the first business corner for INS where businesses can talk to their science and talk to the companies then. And that's become a hit in INS.
I think there's always resistance anytime that you want to do something new when trying to change old patterns. There's always resistance, but that doesn't mean in the long run you're not going to win out.
Marom Bikson
I like that. I like that… I think that's a beautiful place to end on. I know we covered a lot. There's probably a lot more to cover.
But thank you, Elliot. That was perfect.
