BIO

Gerald A. Maguire, MD, is Professor and Chair in Psychiatry and Neuroscience at the University of California, Riverside School of Medicine. Dr. Maguire earned his medical degree from St. Louis University School of Medicine in 1991. He carried out his residency in Psychiatry at UC Irvine from 1991 to 1995, where he was Chief Resident his final year and later served on faculty for 20 years. Dr. Maguire served as residency training director and Sr. Associate Dean of Medical Education at UC Irvine during his tenure. 

Dr. Maguire is a Distinguished Fellow of the American Psychiatric Association (DFAPA). Dr. Maguire is listed in the “Best Doctors in America” and in the past as “Orange County Physician of Excellence” as recognized by his peers.

He also serves as the Chair for the National Stuttering Association and in the past, as Vice Chair of the International Stuttering Association.

He has received numerous teaching awards at both UC Riverside and UC Irvine. His research in areas such as stuttering, schizophrenia, bipolar disorder, and Alzheimer’s dementia has appeared in various publications, including The Lancet Neurology, NeuroReport, Comprehensive Psychiatry, Annals of Clinical Psychiatry, American Journal of Psychiatry and the Journal of Clinical Psychopharmacology. He served as an investigator on the National Institute of Mental Health CATIE trial for schizophrenia. Dr. Maguire has presented his research at various conferences and symposia, including the American Psychiatric Association, US Psychiatric Congress, the American Speech and Hearing Association, Collegium Internationale Neuropsychopharmacologicum, and The American College of Neuropsychopharmacology.

Listen to this episode on Apple Podcasts, Spotify, Google Podcasts or your favorite podcast platform. You can also watch the interview on YouTube.

HIGHLIGHTS

0:00 - 20:55 Intro

20:00 - 36:30 Become a Licensed Physician

36:30 - 45:40 Community Relations Committee

45:40 - 49:27 Brain Scans

49:27 - 55:52 Looking at the brain during choral reading

55:52 - 1:16:20 Neurophysiology of stuttering

1:16:20 - 1:21:18 Focus on your own well-being

MORE QUOTES

“I have said acceptance, neurodiversity, and research and treatment are one. For example with depression, acceptance is the first thing. You accept it, you work on self-help, you work on your therapy. The world now I can’t discriminate against something who’s depressed. That’s the advocacy. That’s the neurodiversity. But at the same time, we champion for better research and better treatments.” - Dr. Gerald Maguire

“My colleague and I have found that there is a minority of people who stutter because it is an infection cause. You can have an infection as a kid and you can get an autoimmune cross-reaction that attacks the developing part of the brain. That’s one cause and here are people like me who stutter because it’s genetic. It’s a unified theory we will come out with the full information soon.” - Dr. Gerald Maguire

TRANSCRIPTION:

Uri Schneider: good morning. My name's Uri Schneider. You'll notice that my guest is not here yet. He's finishing his previous meeting, but I figured I would do little introduction even before he gets here because his bio is kind of long, but, uh, it's a big treat. My name is Uri Schneider from Schneider speech hosting a conversation.

But my good friend, dr. Gerald McGuire, um, we're going to have the privilege to talk to the person who is the most eminent leading researcher, practitioner, and connector in the space of looking at, uh, psych, you know, pharmacology and solutions for treating stuttering. In ways that are different than the ways that have been traditionally done.

And here he just popped on Jerry. I started at life just, I figured I would start your intro. It's fine. I figured it's a long

Dr. Gerald Maguire: intro. Oh, you got it already. How are you? My friend?

Uri Schneider: I am, well, I hope you're here.

Dr. Gerald Maguire: Yeah. Hey, good. And

Uri Schneider: I am in the, my, uh,

Dr. Gerald Maguire: AirPods pro here, noise canceling. What do you think of that high tech?

Right?

Uri Schneider: I'm the antithesis of the AirPods. I go with the job, bruh. The job

Dr. Gerald Maguire: you do that is wonderful.

Uri Schneider: The next ones are coming out. I was nervous, Jerry, that if I did that, I would like on the airplane or something. I'd put my shirt on and they'd get flicked out and go through like the

Dr. Gerald Maguire: sewers. You're absolutely right.

You know what? This happened to me. I shouldn't have talked to you before I invested in my, uh, wireless ear buds, man,

Uri Schneider: unsolicited plug. I have no interest full disclosure, but John bruh, on October, mid October, they're coming out with the 85 T, which is the third generation I have the 65 T if you want to save yourself some money, get the old version.

They are unbelievable. I've had them for two years through flights. Getting dressed in my bedroom. They fall, they almost got run over by a bus. They're very strong, awesome friend of mine posted with the care pod, the air pod, not to take everyone's time, not like Jerry's busy, but he was munching on nuts at his desk.

And he had his AirPods. He took them out and, and then he had only one air pod because he actually popped it in his mouth and crunched on it. So don't put your AirPods down when you're crunching on nuts.

Dr. Gerald Maguire: Hey, thanks. Very great. Great meeting you. Thank

Uri Schneider: you. Awesome to have you here. We've got a couple more than a couple of people on onboard

Dr. Gerald Maguire: here, guys.

Thank you.

Uri Schneider: This is great. So Jerry is the chair of psychiatry and neuroscience at the university of California, Riverside school of medicine. He is also a distinguished fellow of the American psychiatric association and he is the chair of the national stuttering association. He also the past vice chair of the international stuttering association, he's been listed among the best doctors in America.

I won't go on, but I did say that you are the address. We're very forward thinking ways of looking at new thoughts and thinking and research on stuttering. Of course, uh, looking at the, uh, pharmacological opportunities or ways we can enhance treatment of Slattery. Lots of questions about that. Um, I will facilitate that anybody's.

Can I interrupt, but the other thing is, Jerry, I just want to acknowledge you look less of Jerry than you did last time I saw you. You're you're looking good.

Dr. Gerald Maguire: Let me tell you why that's all the theory here, right. And beyond, right. I'm just going to go with it. Right. Are currently a lot of our agents that we've studied and used in stuttering can lead to weight gain.

I was going to be honest with you, right? A lot of them, the ones we've studied in the past, that's published olanzapine or Risperidone, all those right. I think habits solved this. I'm telling you, right. So let's just say in may, right? Uh, made a little switch, but under my doctor, right? I don't prescribe it.

Uri Schneider: There's a little pretext here. You're not only a researcher. You're also a person who stutters.

Dr. Gerald Maguire: Right.

Uri Schneider: So just do the pretext. Can you just give us

Dr. Gerald Maguire: God, I got to go get it right. First. Just stutters. Right? My older brother stutters my. You know, my maternal uncle, I've got maternal cousins. It's all on my Italian side go.

Right? So little kid, man, and a speech therapy at a judge, right. Taken out of school. Right. That, and then my mom and dad being the Progressive's, they are said, you know what? You need to see a good stuttering therapist. Right? So we went to a specialist, a doctor, bill Shrum, who was at the university at Chico state for years.

Right. And so I, I got speech therapy through my childhood into college. Right. So. For me, it was always a different therapist because I'd have a different graduate student every year, you know, growing up there, it was wonderful. But I learned, um, as a person, right. I grew up with therapy. I hear I'm this person, right?

Even in first grade, taken out of class, missing playing basketball, going to activities, I'm in speech therapy. Right. And my whole, that was it. Part of my initial thought was, I'm gonna resist this, man. I want to go play basketball. I want to be on the baseball team. I'm going to hide it. You know, I'm just going to go around.

So even in kindergarten it was like, The teacher said, Hey, um, tomorrow, everybody talk about your family. Tell us how many brothers and sisters you have. Like, God, I can't see the word brother, man, what am I going to do? Right.

Uri Schneider: There's old guard

Dr. Gerald Maguire: getting card. Right? So I in kindergarten I'm five. Right? And I'm going, okay.

I gotta say brother tomorrow. And what am I going to do? So dad had like this big book under our telephone, our rotary dial telephone. Right? And I look it up. It was called the Saurus right at the source, right? I'm five. What kindergarten? Or picks up a Saurus right. So I pick it up. I go, man, I got to get another word for brother.

I got to get another word for brother. I look up and says, brother, A male sibling, like, yes, I'm good. Cause I'd be words are tough. I get in front of the class and they say, okay, Gerald, Gerald. I told Tom cruise movie, I became Jerry, but Gerald, Hey Gerald. Tell us about your family. How many brothers and sisters you have?

I said, I have four siblings, three males and one female. Great. Alright. I didn't say a B word. I'm like, yes, I got ready and I sat back down. So that's it. Therapy, all along person who stutters. Right. When I get into college and med school, I said, well, even before yeah, high school, I said, you know what, there's something with me.

This therapy's helping, but there's something not quite right. They're entirely. I think there's something in my brain manic. I don't know because I, I looked to another kid in class, like I'm not smarter. This is guy. And he can just, what is it? I have therapy. What's doing these tests. So that's why I became a doctor.

I became the doctor to say, I want to really figure this out. So through med school and I started doing research, my first publications, I was still in school. I joined the national stuttering association. Really three years after it started in the NSP, I was a student. I was a chapter. I started going to my chapter.

You know, I was I'm sure that I was trying to kind of growing up and the people said, Oh, you will become a doctor or doctors. I'm going to find out something was stuttering. Oh, that's great kid. Go ahead. But I grew up. And then I started doing research and I said, you know, I think medicines could do something here and that's where I've grown.

So I'm working with my doctors taking medicines. I'm my first Guinea pig with everything. Right. I don't prescribe

Uri Schneider: only the leading researcher. You're also, um, one of the subjects.

Dr. Gerald Maguire: Well, in my research, I can't be. Yes, right. You're rolling.

Uri Schneider: You're experiencing both on the inside, but also in the laboratory, but it's part of your life.

Dr. Gerald Maguire: And you've been working in my life and it's, it's, it's my mission. I really think there's a no, why am I here? Why is it a little boy? What can I do? You know? Um, and that's why, so I

Uri Schneider: think good. What would have happened if you didn't have a thesaurus and you about that?

Dr. Gerald Maguire: I would have been avoiding more. It would have hit my mind into more Bora.

I wasn't even in therapy yet. Cause it was kindergarten. Right. I didn't think, I don't think I started therapy. So maybe second grade, third grade you were already like seven or eight.

Uri Schneider: You Chris? No, Chris Constantino. I love what he says. He says, look, you know, well, he doesn't say the first part. The first part is stuttering can be very hard and he knows that very, very well.

Aside from the very positive spirit and everything he's doing now, he knows all too well, the very, very, very good and challenging parts of stuttering and whatever, what it can be like. And Chris Constantino likes to also look at what are some stuttering games. What are some of the things that growing up with stuttering?

What are some things that it's taught you that it's given you that have become muscles that are stronger for you because of the fact that you grow up with a stutter. Now, I think that's profound. One of the games that a lot of people say is they say they're like a walking for Saurus. So learning that you think you can't say a certain word, you start having much more thinking about various ways to say the same thing, which can be frustrating and exhausting, but ultimately it can be a great, you know, lexicon builder, but so go back to that.

Dr. Gerald Maguire: Yeah. I just want to take it right. Okay. So, yeah, so I I've worked on a new compound. I think, uh, we actually had a phase three of a new compound, and I can say this eco PI, Pam, right? I'm not on that study because it's FDA regulated and we worked on it. We thought of it just like COVID vaccines, right? Like Oxford mind, university might develop something, but then a pharmaceutical company has to pay for it and bring it through the process.

So that's where we are. You see Riverside thinks of this, my university. With me. And now there's a company with these trials. That's just the FDA process. So there's a study going on now with eco pipe. Pam we've published as well too, that there's not the weight gain. There could be other side effects, like feeling depressed and other things.

So we have to do the phase three trial. I can't say it's secure yet. It's double blind placebo control. Just like COVID vaccines. That is going to start like this next week. You can go under, under a website, clinical trials.gov. Eco PIP am that, but you know, we've got that. Um, so I'm on a similar compound. I can't divulge it yet because of all this nondisclosure it's already an FDA approved compound was not approved for stuttering.

My doctor, um, that I work with, I went to him and said, mate, I think this might work for stuttering and it won't have the weight gain. So what you've seen is the stress stick, weight loss, um, since may. Um, four 42 pounds. I'm back actually to my weight. I was in college actually right after high school. I'm pretty sure with my wife, I might wear my Letterman's jacket that I had in 10th grade.

We're going to see no, you're right though. She gave a tell. It's great. Can I just share a game that I've had?

Uri Schneider: It's

Dr. Gerald Maguire: not only for me as a person associated, like committed. I got to understand what's wrong. Do I really want to help? But it also taught me, Hey, therapy's good. Right? It's important. Right?

Self-help in my journey before I was on medicine, I was in the NSP and the NSA. Right. That's helped me as much as anything. My therapy myself help my acceptance. That's all the journey and then the medicines are all part of that. So that's the model that I really am working with. Uh, I was just on a call a little late with a great speech language pathologist,

Uri Schneider: and I hung out like you and me over and wine.

Dr. Gerald Maguire: Although I didn't believe

Uri Schneider: we were in Croatia, but a year ago, it's hard to believe we could do

Dr. Gerald Maguire: that. Right. And we're just talking about a mutual thing. You're sorry. Random overtime time with her. It's all about acceptance and self help, all understanding education empowerment. And for many of us too, maybe a medicine to kind of boost things along.

That's just kind of theory. It's not mutually exclusive. And that's what we're doing and we're riding up with her. We're here. I really think this is the future of stuttering treatment. You and I have been talking for years about this, your dad, all of us. It's like, this is where we go because in depression, when I treat people with depression, it's not like here's Prozac.

See you later. We're working with therapy. We're looking in acceptance. Self-help it's not one or the other. So that's a game for a lot of

Uri Schneider: people. They hear your name. They hear about the research we're doing and they think, okay, how soon before it's approved so that I have the pill, I could

Dr. Gerald Maguire: just take

Uri Schneider: the blue pill or the red pill, which pill do I take?

Stutter stuff. So it's not that simple. You want to just unpack?

Dr. Gerald Maguire: Yeah. We already have medicines on the market that can help stuttering. Not everybody. We're learning, right? There's different. All you say this word, we never used to say this causes of stuttering. There are different. I really believe the data I have.

I'm working with our great colleague in Sweden, peril, ALM great researcher pair, just published a great article. Look at it in frontiers the neuroscience. If you haven't seen this journal, it's a special issue. Journal being edited by our colleague, pure polo Busan. Who's an Italian. Stuttering researcher, Martin summer in Germany.

I've got one article in there. Hopefully two more pairs got one in there. It's the latest science on stuttering. It's a special issue. Just look it up. It's two unchains in there. Scott yards is in there. We're all doing this stuff for understanding of the brain and everything has to bring it together. But night, right?

Pairs work worked at postulate. He just published. That what we thought long ago, that there's a minority of people who stuttered because it's an infectious cause or a little kids. This is crazy, but it's true. We've seen an OCD and Tourette's that you have an infection as a little kid. I'll usually a little boy could be a little girl and you get an auto immune cross reaction that attacks the developing part of our brain, like pans as sort of pediatric auto-immune neurologic syndrome attacks your brain and.

That's why we started. So it's a sudden onset there's some of us, right. Then there's people like me. Who's a genetic form of stuttering and we know it's going to be different kinds of genes. Brain is gene says this by friends in China. Our work says this. They're all

Uri Schneider: going to Billy. Joe's going to be on soon.

We'll talk about genes with strategy,

Dr. Gerald Maguire: right, right. And what we're going to do, right. I'm working with I'll work with Skelly, Joe and others and payer and Sheree or shake the high great guy, NIH researcher, young guy also stutters. Right. Um, so unified theory, we're going to show why all these genes and all this is why it's there.

We're going to come out with all that. So, but with that, I'm committed here. So I, I try this. I wouldn't give these medicines on the market, some of them, but they're not marketed for stuttering. There's no pharmaceutical company. That's going to market it and get a label except run right now. That's in phase three.

We've convinced, we'll say you've got it right. I've got another one. I'm worried we're working on from a great,

Uri Schneider: was that a stutter there? Jerry? I just

Dr. Gerald Maguire: don't. You've got it yet

Uri Schneider: for people that see how quick. That the Jerry McGuire brain goes and how much he's producing both verbally and in literature and research, uh, he still occasionally does stuff.

Right.

Dr. Gerald Maguire: But if I stop these medicines, right Mike it's right. It's backwards.

Uri Schneider: If you didn't take the meds that you're taking, what would, what would Jerry speech look like? Cause I think interesting. It's a very interesting and provocative question, but adults who seem to get over, it seems to be cured and then you talk to them and you find out they still have moments.

They have blocks, but it's so what is it for you? Like if you didn't take

Dr. Gerald Maguire: the meds or if I don't the medicines for three days, three days, for me, four days, I'm back to moderate on the SSI. I've got eye blinks, facial hair, uh, hesitations blocks. I might back. So for me, it's not, I've recovered. I'm treated right.

I'm treated, that's it. Like we treat diabetes. If someone stops your medicines or blood sugar goes up, I'm treated. I have hypertension. I've had high blood pressures is 22. My mom, I got to tell you, but if I stop my lisinopril. In two days, my blood pressure is back. So I'm treated, I'm treated big difference.

So if you want to, next time, I'm on, I'll stop my medicines for four or five days.

Uri Schneider: I was going to ask you that. W have you ever done that? Have you ever taken a week and said, you know,

Dr. Gerald Maguire: I don't really mean me too, but let's say I go on a trip somewhere. Like I forgot the packet. Damn. It's gotta be a tough trip.

I it's, I don't intentionally, uh, maybe I have to take a week off. I'll do that for you, but not during the baseball playoffs. I want to cheer for my San Diego Padres and everybody had nevermind. Um, but I want to tell you another game, another game, not just about at the source, right? But as a clinician, as a father, as a husband, right?

Battering the develops compassion, humility far greater than the source. Right. I've worked with thousands of people, right? My I'll say this, my staff, my medical assistants, right. I have patients with depression, bipolar majority are people who splatter my staff who schedule, right. Patients love the people, right.

We people who stutter are so understanding as a group, right? We are not. Complainer's right. It's been hard for us as kids, the bullying and so forth. So when someone treats us nice yet, we're so happy back. Right. So I just tell you people, I hire nurses and stuff. They've never worked with people, so they just come up and be like, Hey man, these people and they're great patients are, so they show up on time.

They're so appreciative. There were other people, right. It can be rude, right? Demanding. Alright. I can't think of one person who stutters right. Who I, my staff is ever saying, you know what? This guy's a real pain in the ass McGuire. Do we really need to see it's the opposite? My staff says these are great people.

And also right. I've trained doctors and students right there. I gotta tell you, there are bad doctors. There are doctors who, you know, who yell at people, throw stuff in the operating room. Nurses, Hayden. Right. Do I think they might be good doctors and skills and techniques, but people won't like them. They don't connect every doctor I trained who stutters people love.

And I got to tell you why kind of as a virtue, right? It's not how we speak that patients want to know. Patients say he listens to, right? So we, people who stutter are damn good listener. You know, and so I have never, and I had, before I became, I'm a psychotherapist, I wasn't treated, I woke, I mean, I was treated but therapy, but I wasn't as fluent, I would say from the side now, Sorry, this story, right?

My first ever psychotherapy patient, right at talk therapy, I had people in medical school or we say you can't be a psychiatrist. You don't talk. You've got to be a pathologist.

Uri Schneider: Tell us about that. Your med school. That's where you got put in, because you're talking about your students who stutter, who are in med school, and you said they've become great doctors and obviously have an affinity for them, but you're feeling like they're good doctors.

You didn't have that experience, did you?

Dr. Gerald Maguire: No. I got to tell you, and even at most medical schools, They don't get that still. I get people call me still in the

Uri Schneider: story. Let's go personal,

Dr. Gerald Maguire: go. Okay. We'll go personal. Right. I'm in college, right. I interview for a minute. It's an oral interview. You go to these schools, right.

And I know within 10 minutes of being the guy and I'm stuttering very good. Not only was I, you know, I'm nervous, right? I'm a 21 year old kid. Go into this high powered place meeting with some big professor. So I didn't even own a suit. I had to go get a suit, right? I'm a kid from paradise. Like first time I bought it, I'm wearing it.

I can

Uri Schneider: show up in a shirt like this, a print.

Dr. Gerald Maguire: So I'm wearing a suit for the first time. First time wearing a tie, go into the sky. You're very nervous. I'm stuttering way a lot. I'm like, I know one of the first five minutes I'm not getting in here. This is not going to take me. Finally won a couple of schools, believed in me.

Right. And I was able to go and they saw that. Right? I lost tell you then. Right? I'm glad I got the MD. They agreed with me now, even to become a licensed physician in the United States, you got to take a 30 minute timed exam, or you got to, you got to interview someone with no notes. Ask them all these questions and then present it to somebody for 30 minutes in a timely manner.

They don't want to comedy. Boy was I nervous, man. I got drive past. Right. Then I go, yeah. To residency interviews. Right. And I go to people. I'm stuttering. I wasn't one and there was no meds that we understood. I went to some high powered places. I went to UCLA and Duke and Northwestern, and I said, I really want to study stuttering.

And I stutter. I like to look at this and look at brain imaging and genes and maybe medicines. No, one's really doing this. And these guys at these high powered places, you know what no one's doing that. You can't do it right. Then I go to a little place called UC Irvine. Right? Cause beautiful weather and stuff.

And the guy was interviewing me. He was a PhD MD and he was wearing a Aloha shirt like this and flip flops, like I am now. Right. And I go there and I said, you know what? I stutter. I really want to do some research. I think I'd be back. Could help people is that, you know, it's a brilliant idea. No one's doing that.

You should do it. You should come here. So I went there, he believed in me, but there was another doc there that you interviewed that day. And I could tell it wasn't going well, man. He was like, I had people telling me med school, you can't, you have to be at radiologists. You can't talk to people I'm interviewing with this guy.

I can just tell. It's not like he, you know, when you're a person who stutters it is this guy that knew me out, whatever. So anyway, it goes on for the, you know, he's like my faculty for the next four years. I reluctantly, I guess I'm in this program. Cause the other guy believed in me instead of treat me poorly also.

So anyway, like four years later, right, my classmates. Like me, the other faculties I became what's called the chief resident. Right. I was in charge of all that. And you know, I'm a purchasing status, right? Yeah. So one day, right. The coordinator had all these paper files out of all the evaluations. Cause he was transferring them to microfiche.

Right? Like today we'd scan them. Right. So they're there, I'm just walking by the desk. And there it is my evaluation for my interview, from that guy, like who I can't help, but not look at that. I'm not supposed to look at my own file, but I look at it. All these assaults like about knowledge base compassion, one to five scale, five being good.

He circled all once that I'm not compassionate. I have poured knowledge and all he writes and comments stuttered. That's it. That's it. So, in other words, I gotta be, I have no compassion. I have no knowledge just because I started, you know,

Uri Schneider: wait a second. You're telling them the story 2020. It is 2020. You tell it in hindsight.

At that time. Can you share like what that did to you as the student who felt you just bombed at your head, these high hopes you're in this position, you looked at something you shouldn't have looked at and it validated your greatest fears of what your intuition.

Dr. Gerald Maguire: So my greatest fears. Well, that also tells me that even physicians, even psychiatrists have a stigma against people it's under, you know, it's like, wait a minute.

This is supposed to be the healing profession understanding. But you know, what's later I became that guy's boss and let me see. He's not around anymore, but what

Uri Schneider: was it like for you with the young man? That's what I want to get.

Dr. Gerald Maguire: I got to tell you, man, I felt injustice, right? And I said, I'm not gonna sit back.

I'm gonna change this. Right. So literally what happened in three years, I became that guy's boss couldn't get rid of them, but the minute he screwed up, honestly, had a sexual harassment thing against them. I'm not defending him. He's got to go. Now. I'm like, yeah, this guy's a jerk. Anyway, see you later. I won't say his name, but that's it.

That's all the words karma.

Uri Schneider: You just want to highlight. And this is outside the scope, but this is the real deal. Is that. Nobody who stutters and no professional should be boxed into one camp. People think Jerry McGuire, they think this is the guy with the meds. No, this is the guy with the yellow Hunter drinking mint lemon.

Dr. Gerald Maguire: Well, that's all I got. Okay. Infusion water. I grow lemons in my backyard in mint. So man, this is how you avoid diet sodas. I'm telling you, this is how you lose 42 pounds, then whatever you're

Uri Schneider: drinking, I'll have some looks. I am two years. Yeah. Awesome. But it's amazing because, because it speaks to another person would be in that same situation, Jerry, and they would feel buried and they would feel like nailing the cough and that's it.

And they would go back into retreating into their turtle shell, which is a legitimate response. And you had this, maybe the Italian piece. No, I'm going to show them we're going to, we're going to fight for justice. And I think it's so powerful because so many people have come on this conversation. And one of the themes I'm picking up is somebody opened a door.

For me, someone believed in me, someone along the way gave me the beliefs, gave me the hope, created an opportunity right out was a champion for me when other people weren't. And that's a big game changer and then those people end up paying it forward. And that seems to be that's it.

Dr. Gerald Maguire: I do that there for me.

It was my interview with st. Louis university medical school that went well. Dr. Mootz was there. He's still there. Uh, this was 30 years ago. Dr. George Grossberg was there. He said go to psychiatry. Be great psychiatrist. Even today he's in practice, right? I've always called him. Dr. Grossberg, right. He's a guy.

Right. But you know what? Two years ago, they invited me back to my med school to give a special grand rounds to all the doctors on Saturday. I was like this alum, right. They believed in me 30 years ago when I was, and you know what I'm like, damn you guys believe to me anything you need. Let's say what schools I give to as an alum that's at school.

You know why? Because they believed in a kid. That's right. Who was 21 years old stuttering. And they said this kid could be a good doctor

Uri Schneider: when everybody else features parents and position of influence.

Dr. Gerald Maguire: Well, my dad and mom always agreed my uncle, right. They all started, so my family was open. Like he stutters, but it doesn't mean anything right.

To me, we'll just get him some therapy, help them. Never. I could do that. It was never a question. So I had great support from him. Wonderful. Right. And then at the university I found the university professors who believed in me, you know, And they really said, yeah, you can be a good doctor. You should be a psychiatrist.

It's great. I will tell you this in one other session, right? My first talk therapy patient. It's not just about a teacher. You see them,

Uri Schneider: you talk therapy. I

Dr. Gerald Maguire: do, man. I'm a psychotherapist.

Uri Schneider: Well, you talk, it sounds like you could talk to her. Yeah.

Dr. Gerald Maguire: Keep Colgate. Okay. So a psychiatrist, right? We do talk therapy and meds.

I do all this stuff. I do psychoanalytic cognitive behavioral. Right? So as, as a second year resident, I just have a psychotherapy patient, right? Your first one. So I finished med school. Now I'm training for four years in medicines and psychotherapy. This idea that psychiatrist to get meds is. Not a good psychiatrist, we do everything right.

So if you're with,

Uri Schneider: by the way, on this point, just the side, the parentheses, your comment on for anyone interested, or, or, or their psychiatrist is interested in dabbling in exploring some of the meds we've discussed or that you're researching and we'll have more evidence. Uh, can you just give some do's and don'ts just as a real quick,

Dr. Gerald Maguire: we got people from all over the world could be watching this right.

As we know, right. There are some countries. I

Uri Schneider: know they are like, got it.

Dr. Gerald Maguire: Okay.

Uri Schneider: From Europe was on a minute. We got people all over

Dr. Gerald Maguire: that. All of it. Right. I know there are some countries right. Where someone can go into a pharmacy and pick up something without a doctor's order or guidance.

Uri Schneider: That's different than the dispensary.

That's different than the dispensary in Colorado. We're talking about like vitamins medications. Yeah. Right. Onward.

Dr. Gerald Maguire: Right. Certain countries not take any of these without. Guidance of a good physician who knows the potential side effects and dosages, right. People all over the world. They email me, like I took this medicine, I bought it at a pharmacy in whatever country and they picked the wrong friends.

My friend

had

Uri Schneider: a prescription. Right.

Dr. Gerald Maguire: Don't don't ever do that because it could, if you've got another medical condition, it's not good. Right where you take a super high dose that causes a side effect or a dose that wouldn't even work. And you say it's gotta be under a physician's guidance, right. And monitoring for side effects.

And that physician must know, unfortunately, 99% of doctors around the world had no idea of Saturday. So if you go in there and you say, I want a pill for stuttering, they give him some money. I think that will work. Not every most pills don't work. And then the people say I've tried medicines, they don't work, but their medicine would be like, Hey, I tried to, you know, I try to, you know, uh, insulin for my high blood pressure.

It didn't work. It doesn't work for that. So a good doctor. And if that doctor doesn't know, what's doing reach out to me and that's it important. Good. You got it. Also talk therapy. My first ever talk therapy patient, right? And it was a patient who was seeing like some high end and Newport beach psychiatrist.

Right. She was probably paying back then, you know, 400 bucks an hour right. For it. And then she gets a divorce. Right. And she doesn't have the money. So she's got to go see the trainee at the university for like 20 bucks an hour. Right. So I'm seeing their shit, my first patient I'm like, and I'm stuttering, man.

I'm so nervous. Right. I'm integrated to ask questions. Right. I'm thinking in my mind, She was seeing this high end psychiatrist cash pay. And I think, you know, she's lost her money. I just think in her mind, like, this is what I get for 20 bucks, like guy who's right out of med school who stutters. I'm like, Oh my God, I'm done

Uri Schneider: her therapist.

Cold talk conversation, talk.

Dr. Gerald Maguire: It's going into my head. I'm like going, Oh man, I don't think I can do this. I can't be a talk therapist. Why go into this field? And at the end of the hour, She says, no, she had depression and anxiety issues with her ex husband. And she said, you know what? Dr. Maguire, I I'm really gonna, I'm going to like working with you because I can see you struggled with something her whole life.

So you'll really understand me. I'll see you next week. Well, I'm like I should have given her 20 bucks. She made me feel so good. I mean, box

Uri Schneider: don't

Dr. Gerald Maguire: be cheap. No, no, but that's what it was as a resident. So it taught me something. It taught me something that we, people who start have so much to offer. It's not, if I was fluent or not, I got the information.

It took me a little longer, but what that showed my patient is I'm not perfect. I'm a human being. And to her, I understand her. I am not this doctor mandated. She was even complaining how the other doctor never connected, even though he was 400 bucks an hour. And I was 20 bucks because I'm a person who's felt that I was in therapy.

Right. It might take me longer to ask my question or comment, which was my patient. I have never, ever had a patient say, I'm not going to see you because your stutter or even tell my nurse or anything. No one's fired. And Mike, I've never had a malpractice lawsuit, even child against me.

Uri Schneider: First one is you're a person who stutters and you have the interest in pursuing either talk, talk therapy as a profession or medicine.

You should know that Jerry is living that in his journey. Aside from that one doctor was a real show Kendrick, and there will be those haters and people out there that are gonna give you a hard time. He has not had a patient say, I don't want to be treated by this person. He hasn't had someone come back, not come back because of his stutter.

So all the thoughts that you hold yourself back and others as a counter story of evidence of kind of testing reality, that the world is ready. And in fact may even have an affinity. To the authenticity and the connection. And some of those gains that you're talking about, listening, the empathy, the connection, and what the woman said is so powerful.

Cause I think for those of us that don't stutter and myself included, or my father, when we're working with people, it's a strange thing that happens. People ask you, start it right? No, no. Well, how do you get it? How do you get through listening? And these conversations are also, if you're a person that's gone through something else, she didn't need help with stuttering, but she appreciated that you were someone that went through something.

You

Dr. Gerald Maguire: got it. And I'll also tell you that too. Right? I treat depression, right. I connect with my patients. Fortunately I've never had depression. I've never been suicidal. I'm so thankful. Many of my patients have, but I get it in the us. I haven't lit stuttering. I really get, but I can feel their pain. Well, my patients say I connect with them.

It's just reflective statements. Right? So my patient says, you know, struggling with suicide and depression, like it's princess right now, I'm treating a patient who suicidal, but it's coming through. She had, was severely abused as a child sexually, physically awful. Right. And so fortunately I had a good childhood.

I didn't, you know, had great, you know, but with me, I, I'm not the words I says, I can only imagine how hard that was for you as a little girl to endure that. I can only imagine it's just so, but then I say reflective statements. You've been a great mom. You stopped this, you married a good man who doesn't do this.

You're healthy. You're free. Congratulations. What you've overcome is I can't even imagine what you've overcome, but I'm so proud of you. We're going to work. We have to, your resilience is amazing. So even fortunately, I never had anything like that to me. Right. As severe as what. Sexual trauma or abuse, fortunately.

Right. Um, but she sees me every week and we've done this for 15 years. My talk therapy. It's the connection. She I'm the only person she's pulled this too. Wow. Right. And now it's coming out to her husband, maybe a friend, you know, I'm not I'm male. Right. I'm 10 years younger than she is. Right. But just forming that Alliance, that openness, the key as well is nonjudgmental.

Right? A good therapist. Doesn't judge. We just allow this to happen. And if she says these things about or mixed feelings toward these people in her childhood, I understand. I don't judge. I just, so I can imagine that your feelings are natural. No, it's reflective statements. So there you've got, I really want to think.

Yeah. Yeah.

Uri Schneider: For the NSA, the national stuttering association read things they're doing right now. Isn't an initiative on these things with stigma, right? That's an improvement. So we work project. I encourage everybody check it out. I had a wonderful chat with Pamela Mertz and with Carl coffee and Catherine

Dr. Gerald Maguire: and I, I gotta tell you another thing we're going to do here.

I've started on my chair, uh, community relations committee. Hm, what I want to do, right. I'm going to put this bold our next year. My goal as chair, we're going to mobilize is through education with leaders is to make stuttering up parity, diagnosis, and treatment. What I mean by that? Isn't sure these companies in America restrict access.

For people who are stuff, it is a stigma. It is a discrimination. Mental health went through something similar where for years, the insurance companies and Medicare and Medicaid would say, you know what? We're not covering psychotherapy for depression. We're not covering psychiatrist visits. Right. It's not a medical condition.

Right. You have to pay out of pocket. So that's why people with depression never got care. Even now with stuttering, curricular and wrong jury, most insurance companies don't pay. They don't pay

Uri Schneider: tricky and you have to Katie Gore and the NSA have done a lot and I've borrowed from it. But you do have the good, so you can fight with the insurance company to get what you're entitled to, but it's still a fight and appeal

Dr. Gerald Maguire: got to tell you stuff like, so what, actually, it was a fight for us in medicine psychiatry for years, all those got to take is a ruling.

I won't tell you how this could happen, right? To really list stuttering as a parody, P a R I T Y diagnosis. That means it's the same as depression or whatever. However you label it. I'm not, you know,

Uri Schneider: to throw it into a, a bucket of things that are different than it, but to give it the entitlement of benefits and rewards.

Exactly.

Dr. Gerald Maguire: I got to tell you that this is the deal behind why I've always said. It has to be listed as a disorder. Right? There's a lot of talk about why we shouldn't do that. I got to tell you if you'd say it's nothing, they'll never be treatment, they'll never be research. Right.

Uri Schneider: And I just want to highlight that you and I have talked about this.

I remember in Fort Lauderdale, sitting down at a table, you know, this binary compensation about no, you know, a neurodiversity, we need to accept that. We need to go with a social model and reject the medical model of disability and disorder. There's something to that. People who stutter should be accepted for who they are, right.

And as, as fully capable and fully valued people, no different than anyone else as with so many things. And there's a big stigma we need to fight against. But this business that Jerry's talking about is, is the same thing I talk about when I label kids with a diagnosis, which I never do. I don't label kids

Dr. Gerald Maguire: that's for the sake of a report.

Uri Schneider: For the sake of an, I need for the sake of funding for care and access to certain rights and privileges, one needs to use the lingo. And the,

Dr. Gerald Maguire: and I got to tell you, there are even bigger. I have said acceptance, neurodiversity and research and treatment are one that was a first step. They're not mutually exclusive.

Right. So for instance,

Uri Schneider: how does it go together?

Dr. Gerald Maguire: It goes together right? With depression, right? Acceptances of first thing, right? You accept it. You work with self help. You work on your therapy. The world. Now can't discriminate against someone who's depressed. That's the advocacy that's neurodiversity, but at the same time, they, we champion for better research and better treatments.

That's why I thought backward people in my own organization. Hey, they're all one. They're all one acceptance. Diversity. Understanding advocacy support, they're all together, treatment and research and the understanding if we ignore what it is, I'm going to share with frontiers in neuroscience journal right now.

Okay. Tell me this,

Uri Schneider: but I also have two pages of written notes that I have questions about but you tell me about that. Okay. Got it.

Dr. Gerald Maguire: So I'm going to do this, right? So. There's a new issue out in frontiers, in neuroscience. Right? Look at the journal special issue editor by pure polo Busan. Our great colleague in Trieste, Italy, just new data from pair on Scott yards is in their shoe and Chang we've written articles.

I'm in there. Nicole. Nice. It is clear. It is clear. We have different causes of stuttering. I'm going to say this word, different causes, understanding genetic auto-immune. But yeah, so things we got, right. It's clear, right? We can't ignore the evidence. Right. It is clear as well that we can biologically treat stuttering.

It's clear. There's effective treatments. They're not cures, right. There are differences in brain is physiology differences in metals causes of stuttering. I can use over cause now it's bold. We have effective treatments. And what we're proposing is these trees. You mentioned the first stage is acceptance and understanding and therapy and maybe bipolar treatments are they're going to be there folks in one to two years, there'll be medicines marketed for stuttering.

So just

Uri Schneider: people ask me what in the world I have to do with you and university of California, Riverside school of medicine. So that's something Jerry, uh, spoke to me about the, the part that I can play in the clinical side is kind of looking at the, the presentation of these subjects, right?

Dr. Gerald Maguire: Figuring out exactly because what we don't understand,

Uri Schneider: who's different.

Who are these subgroups? So we've got one umbrella and it's important that one big tent called stuttering because it helps people find community helps people find support, helps people find people who get it. Helps them find their people, people that are going through similar experiences, but the treatment for two people is going to be as different as night and day, potentially because they might have different causes.

They might have different temperament. They might have different, uh, morbid, uh, issues that they're dealing with, whether one has depression and the other has add. And the other has neither. So treatment needs to look different and needs to be multi considering different factors. So what I'm looking at in this team here, which is like, Humbling to be in the presence on these zoom calls.

I said that to Scott, I always highlight who's on the zoom call and I say, wow, how did I end up here? But I'm subtypes are very, very important. And clinically that's what we've known. That's what we've seen and what the team is doing. Looking at it from the point of view of genes, looking at the scans, looking at the response to different meds, you start to see it very clear.

Dr. Gerald Maguire: There are

Uri Schneider: types of people who stutter.

Dr. Gerald Maguire: You got it. And there's likely means different causes for instance, hypertension, right? High blood pressure. I've got high blood pressure, 22, right. Many people diet and exercise, that's it. Right. Uh, other people, no matter what you do, medicines are needed. Right. Other people it's decreasing stress, gender, life, anxiety, everything else.

Right. So it's all together.

Uri Schneider: And what we're going to do, the studies that you showed, um, I think it's important to highlight. It's not poking a hole in them, but. When you look at the sample size and you look at the response to the therapy while you get a good result of effect, the variability between the subjects is quite interesting.

Dr. Gerald Maguire: Right? So I gotta take, right. Any medicine I developed right at best will work in 60% of people, right. When you look at it, right. The best genetic variability. So it should be able to, it doesn't work right. Let's see, we're really beginning to end this next phase of the eco pipeline. The studies will really show that if you know, um, what it is, right.

There are different aspects of stuttering, right? Where equal pie pan and where, you know, olanzapine right. Work on fluency. I'll use that term substantial stuttered duration of blocks. Right. But then they start to address the other issues, the social anxiety via avoidance, right. Then we develop a compound.

Those work on dopamine don't means an agent that really ups timing, initiation, speech, right? Give,

Uri Schneider: and you did this, you did this so beautifully for me. Can you just give a quick share on these two loops of speech in that arena and the neuroscience now? And yeah, you can pull up anything. I'll give you something to show that right here.

Dr. Gerald Maguire: Got to hear it

Uri Schneider: to say, if you could, if you could share with people how certain types of even speech therapy seem to address one of those loops with the meds,

Dr. Gerald Maguire: you've got it.

Uri Schneider: You to go for it. Got it. Good.

Dr. Gerald Maguire: Well, give me a, you know, when you we're good on time, because I just, uh,

Uri Schneider: that's fine.

Dr. Gerald Maguire: No, go wait. I just told my next meeting I'm late, which is good.

Alright, so let me go here. Hey, you know what? This is the most important thing, man, around here, right?

Uri Schneider: Thanks for me. It's okay.

Dr. Gerald Maguire: Good. Sorry. I was late. All right. This is a study. I did. I was still a trainee. I was just in med school dementia. I was a resident, right. We looked at, I was the first person to really do.

What's called pet imaging scans and stuttering. This is years ago. People said he's a med guy, right. That's where I've evolved to. But also that imaging work I've done. We're the first university to have a brain donor program. We're actually looking at tissues and brains that no one's ever done that. No other university.

All right. So what we have here. Are brain scans. These are people who stutter, um, in there, right? It's a composite image. We're doing an activity. You were reading aloud alone. So we're stuttering right here. We are stuttering, right? Hi, can you print

Uri Schneider: activity? Not structured activity,

Dr. Gerald Maguire: right? Different structures are different.

Now we got better structures to in Chang, everybody, but higher level means us using more glucose, more fuel. So moving my right arm, that area, that controls right arm, it's going to light up. Right. So we're speaking. Here we go. These are higher dose area of the brain looking here. These are people who, uh, don't stutter.

These are controls, right? So we, people who stutter, right. We're lower. They're more red here. The people who study Oh, or controls have higher activity in the speech areas, right. Broca's area here. Right? Um, and here as well, too, right here. Big difference here. All of these people are right-handed so pop it out.

See how blue this is right here. Look at how yellow this is here. It's more active. This is an area, right? Just on both sides. This is known as a, uh, statistical subtraction image, right? We're taking these composite images of all people who stutter and it pops out right there. An area of the brain called the cotton containment known as Australia.

This is. Not active in people who stutter and Suwon Chang's work and Nicole Neves and Watkins, and everybody has shown this is true, right. We've actually looked at this Lambo cortical loop. So one's done this work where this region of the brain, right through this whole system. Doesn't develop right in our brains who stutter it's vindictive,

Uri Schneider: who people what's the responsibility or role of the Strait.

Dr. Gerald Maguire: Yeah. I will show that. Right. We're going to show the, I'll give you another slide here. Right? So I will say this, we're seeing a

Uri Schneider: difference in function in that area of the striatum what's important to understand is what is the straight I'm doing. Got it.

Dr. Gerald Maguire: Let's try it and really works as our switch, the timer and initiation of movement and speech is the most fine.

Muscle movement. We have

Uri Schneider: most complex the most complex.

Dr. Gerald Maguire: Right. And that's where I

Uri Schneider: even say, right.

Dr. Gerald Maguire: As much as we'd like to have an animal model, a mouse squeak, for instance. Right. I

Uri Schneider: heard you have some mic to stutter in that, in that recent article there. Yeah.

Dr. Gerald Maguire: It's not my, well, I'm getting access to that. I'm going to tell you.

But I also said, right. I think it's a stretch to go from squeaks. To hire human cortical.

Uri Schneider: Absolutely. The other thing that's missing in mice is they don't have language. They don't have novels.

Dr. Gerald Maguire: Bingo. Right. So anyway, we'll look at that. There might be something right Gary on, right. Even when we looked at finches, right with dr.

Roosevelt, right? Songbirds is different. We are human. What makes us different is really reasoning and speech, our brains. We're much more frontal lobe than the chimpanzee will say, right. We verbally communicate it's one of the higher is what makes us human. We'll go there. That's where I like to say stuttering in many respects is the most, highest, most complex human condition, right?

Because we're working at something unique it's speech, right. I would like to say too quickly. My cardiology friends have a lot easier because of the study. Uh, you know, dog's heart and ours. Right. Big, sorry. Right. We're talking about really the most complex human brain, the language. Okay, here we go. So these are people who stutter, right.

Again, right now we're making them fluent with course reading or singing, essentially right where we're activating, why we're fluent 98% of us. Right. We can speak fluently and. Of course reading or reading, I'm

Uri Schneider: just going to reiterate it cause Jerry's moving quick and he's got the pods, which are not jobbers, so it's not as clear.

I just want to make sure it's super clear. What we're looking at here is the contrast between reading aloud as the previous slide. This slide is looking at choral reading. So looking at the brain during choral reading. So here we know that people who stutter most of them when they're doing choral reading or singing or some kind of not.

Not that authentic communication or reading aloud, they tend to have more fluency. So here we've got a contrast to the previous slide. Yeah.

Dr. Gerald Maguire: Got it. Right. So now these are the people who started doing their stuttering. Now their core reading and speaking fluently. Boom. We're more active, more red, right?

You're true. Everything pops up Broca's area. Right. It's all better. Right. But look right there, but it doesn't change. Is Australia. God will move on. Right? So my colleague, my mentor, dr. Glenndon Riley who's since passed away. Great guy. We worked together. I was still a student. He's a professor of speech, language pathology.

I really learned speech language, but I'm not a speech pathologist, but I understood from him. He's a great man. His wife, Gina. And he really proposed. We presented this in like nine Megan and 95 and about two loops of speech. And this is also based upon Nudleman the other's people's work. We have two loops of speech inner loop and an outer loop we'll understand that.

Right? So here is our people who started right. Vernon keys area, pardon? Brain. This is fine. We know what we're going to say. Right. We know what we want to say. Right? Our normal speech, our natural speech really is, goes through the strangle. That's our timer in the shader we people have said, or have trouble with the beginning, usually initiating something and timing it.

Well, we have to take another breath. We got a solid rollover. So we go through the striatum and Broca's area. This is that it's work has looked at this there's this, this, the Lamoille cortical loop, striatum thalamus Broca's area where we think something's not right. And what it is is here. The striatum acts as that timer.

It acts as that initiator, we see it with people with Parkinson's

Uri Schneider: it's like the conductor it's like the connection.

Dr. Gerald Maguire: Right. And it's sometimes if you give a little push, right, it works better. So that's why I meet people who started to develop things where we say, well, uh, you know, and get it going. Right.

So great. Right. It was up here until recently, right. We really couldn't affect this area. Right. So, but our great therapy right. At work sometimes. Is activating this outer loop or other forms of therapy. Say you don't get this strange, started ease into the words, low down and tight. So we're actually timing.

Are straight into work

Uri Schneider: or reducing, reducing the duration.

Dr. Gerald Maguire: Right. You've got it right.

Uri Schneider: Fall apart at a certain level. If we can reduce some of those demands, that seems to be going through that inner loop.

Dr. Gerald Maguire: Right. You got it. You got it. And that's what therapy. Thanks. I'll

Uri Schneider: try nailing. You fluency shaping, which goes on, let's say rhythm, or let's say like some metronome kind of therapy thing.

That would be that. The outer loop perhaps

Dr. Gerald Maguire: got it. Or you explained it precisely. Right.

Uri Schneider: So I learned how to loop. I only understood it after you gave me some private lectures on this. Yeah.

Dr. Gerald Maguire: Right. So that's a outer loop, right? There's other forms of therapy. Right. She got it. Right.

Uri Schneider: And then outer unique about that from a speech therapy, clinical point of view, those are the things that's often feel most unnatural.

They feel most distiller. Communication. And when you want to go authentic, you've got to go through that inner loop by definition, and you run into trouble. Cause perhaps perhaps that striatum, the conductor does not coordinate in a way that makes things fluent. And so we're looking at different ways, both therapy, behavioral therapy, and things like that, as well as perhaps what are the pharmacological pieces where we can input to give it a little boost?

What are those.

Dr. Gerald Maguire: Got it. You got it. This is wonderful. You and I are going to write an article on that matter was brilliant, Rhonda you're on it. Okay. So here are medicines, right through dopamine can increase the function of the strain. Yeah. There's not cures, right? You're just going to facilitate this conductor to work

Uri Schneider: one sec.

I just wanted to make sure I got that. It's a dopamine inhibitor or a it words

Dr. Gerald Maguire: increasing dopamine. Yeah, no, I got to take it here. I'm going to say. I'm going to now evolve to the word modulation. Nice.

Uri Schneider: I like that word. I like that

Dr. Gerald Maguire: regulation. We're going to modulate it and that's where we're going to go because in some people, right, increasing it, maybe the way to go, most people blocking it because there's actually some people you've seen this.

If they're on a stimulant for ADHD,

Uri Schneider: I want you to just highlight that many people ask. Wait a second. My kid's stutters and he also has raging in impulsivity. That's really getting in the way in his life and they want to give him meds. But I heard that if you give a kid who stutters a stimulant, you're going to put them through hell with his stuttering.

Dr. Gerald Maguire: You, you got it, right. Supplier got it. Right. Five years ago, I'd say, yeah, it's bad. It's bad. Don't do it. Now. There are medicine, 80% of the time that could make it worse. Right. But we also have. Individuals, they take a Ritalin methylphenidate Conserta Adderall, right? They get better. Right. And there are data years ago about methylphenidate helping some people who study any more data, you know, are good trend show a and show a D E R not under her.

Uri Schneider: I'll be having a chat with me.

Dr. Gerald Maguire: Good. Good guy. Just talking about that. I

Uri Schneider: want to actually chat. We're going to highlight that

Dr. Gerald Maguire: I would love, I'd love to, I'd love to talk to you about it, right? Because there's some right. Joe and I got to talk to him doctor for a while, but it's a modulation, right? And I'm working with pear and others, right.

There are some people increasing, the dopamine can help others decreasing it. And in some of our newer medicines modulating, and it also depends on the receptor. So two or three years ago, I'd say blocked opening. You know what? Now? As we're understanding evolving, we're going to modulator it, but that's not the whole story.

The social anxiety that is so disabled. Pressure stutter really? That's also a good therapist, right? We work on the social anxiety, the cognitive behavioral therapy, the avoidance, right. We're all there self-help is great at that. Right. We

Uri Schneider: just, for the, again, if you can't follow, I'm just trying to break it down for those of us, that process a little slower there's stuttering, which is a physical neurophysio.

Would you support the idea of describing it as neurophysiological

Dr. Gerald Maguire: bingo? That's my article. What was the article? I wrote the neurophysiology

Uri Schneider: of stuttering. So narrow, and then you grow up with stuttering, you develop all kinds of psychosocial, emotional layers around that, and these impact and interact and can exacerbate or can alleviate the experience because they do interact with each other.

But at its core, it's not caused by trauma. It's not because you're an anxious person, but certainly if you have anxieties diagnosed anxieties or just a tendency towards being a warrior, That tendency is going to impact your experience and reactivity with stuttering. And this ties into this whole thing, but the loop you're talking about now is kind of like, not even one of these loops, it's another layer that interacts with this.

Correct.

Dr. Gerald Maguire: Got it. You've also got great work by others than Nicola, maybe at others about the cingulum and the amygdala being involved in the sleep. And that is where anxiety is kind of generated

Uri Schneider: from a scene. That's a little further out. It has an illness there.

Dr. Gerald Maguire: I don't have it here. I don't have it here in this simplistic model, but it's an interplay there and we'll share all that.

So in other words, if you talk about, I haven't think maybe biologically, right. And, but definitely emotionally and psychologically, we, people who stutter have been more prone to social anxiety, that's work out a Mark on those labs on others. Right? Very good. So you have to get all these data together and it's not us versus them.

It's all of us together understanding and bringing in the world of magic. I just

Uri Schneider: want to highlight with all this, the amazing generosity that Jerry has bringing the people together, taking this time, going around the world, talking about this, but also the team at the zoom call is like mind boggling. You got.

Michigan, uh, for the Chang's Shelley, Joe, craft's got Jerez pair. Um, I mean, pulling people from so many different disciplines is the way we're going. I'm going to get this forward. We've got to take,

Dr. Gerald Maguire: got it.

Uri Schneider: Every team. And that's, what's exciting about that. Some of this stuff. So it's not just Jerry, this, this pharmacology it's really bringing together the people that have the knowledge and the expertise from different disciplines.

We're going together to get the full you've. Got it.

Dr. Gerald Maguire: So I was Sydney emailing, Mark ons all last night. Right. It's bringing all the different understandings into one.

Uri Schneider: He doesn't know it, but he's on deck. Yeah. Great.

Dr. Gerald Maguire: Okay. Great. Talk in. And if you want, you get Ross, Ross Menzies.

Uri Schneider: Can't wait a good guy.

Dr. Gerald Maguire: I'm just telling you guys, we bring the everyone's got their understanding, their expertise, just unite.

Get together. Shelley Jo Sue ones, Scott pear, Don Salo, Liao. LeasePlan in. Every continent. Right? Um, our colleagues in China, Japan, we're all working for the same year. Okay. So here, but daba can play a role. Gabby could play a role through the singular everything else, but here we're going to work at modulating dopamine, and maybe even GABAergic agents.

That's where Pega comb. Actually we go back to Pega clone. It didn't make it. Because of the following. When we submit this as a stupid thing about medication development in the USA, right. You actually have to submit to the FDA what's called your primary endpoint. Right. And then at the FDA, if you hit that, the FDA says you can put on the market.

Right. So the company at this time, we're developing it, right. They decided, right. The FDA wants one primary endpoint. You have to pick one, right? They picked at the time as our best understanding of 2007% syllabus stutter, right. Extent syllabus done right now. You know, the variability in that, right. People have a good day, bad day.

And we also show just by the 40 or fifth time you see someone were stuttering lens. Well let's okay. So what we showed there, right? It got better. People got better on Pega call, right?

Uri Schneider: And package in contrast to the eco bypass bag is loan is working on the gap.

Dr. Gerald Maguire: You got it. It's a GABA agent, right? So we showed some effect on flu sent, sold, started, got some better.

But because of the variability of stuttering for placebo got better too. So when we looked at,

Uri Schneider: went through this, whether they got the medication or they got the placebo, that the way they were measuring impact with percentage level stutters, all showed improvement, because we know that that happens by itself, which is why on these newer studies, we've gotten multiple layers, which we worked on the transcript.

Yeah. So the Gamba, what you're saying was that we didn't get to go there because of the financial crisis, but the PAGA clone promise was very different than the eco pipe hemp. You just dry on that. Got that.

Dr. Gerald Maguire: So we were looking with Pega clone with that percent's a little bit stuck, right? Because of the variability of the metric, we didn't meet it.

Right. So the company in 2008, seven, everybody said, you know, we don't have the stock price. The medicine's going to be off patent 12 years. And that's my dog marketing. Sorry. Yeah. And so they, they said. Well, we're not going to invest the 500 million with the FDA. We can't do it now. It would probably we're looking at it, the financial crisis, the money, right.

They didn't have the stock. Right. So they couldn't invest in this. And we even said, okay, but what we did in that phase that study is we found very strong improvement, very strong way over placebo on social anxiety. Like we did the Leibovitz social anxiety scale, those people on the active medicine way, like P a 0.01 strongly less socially anxious than placebo.

Right. So, but because the

Uri Schneider: gavage driven pack of clone, what was exciting about it was perhaps on helping people reduce the social anxiety impact, which was something that exacerbates the physical manifestation stuff. Was that the thought, the thought right. But

Dr. Gerald Maguire: that's not what we thought. That's not what we thought at first.

We thought when we did this study, we, the FDA said, pick one thing. If you meet it, your medicines approved. Right. We picked percent syllable stutter, right. It was a big discussion was 2007. Right. We were just developing a waste, some variation.

Uri Schneider: I would've, I would've told you I'm the social. Yeah,

Dr. Gerald Maguire: I know. Well, I pushed for it as well.

So at least I included, I included the metric. I was talking to Scott and we included it, but it was secondary. Right. So per the FDA, what we'd have had to do done is do one more study. With that social anxiety as a primary, if you woulda got it,

Uri Schneider: I'm feeling the disappointment you have. No,

Dr. Gerald Maguire: but let me tell you here, but it's also a problem in our worlds drug development pipeline, right?

Yeah. You're seeing it at the COVID vaccine, but I'm just going to put it out there. Right. Oxford university comes up with a vaccine, right? Well, they can't develop it because they don't have the mill hundreds of millions of dollars to go through the regulatory in Europe and. The U S the file, all this stuff.

It's hundreds of millions of dollars to do these studies got to go with them big pharma, right. Even though the university develops it, it's what it is. Right. You're seeing it with COVID. They go with AstraZeneca. Other people are going with Pfizer, you're going with Johnson and Johnson, these big pharma, and then you get people with money involved and they say, you know what?

We're not going to invest in that because we're not going to put the 500 million. Cause we probably only get hundred million back in sales in five years. Right. So what happens on our drug development is it's money driven. It's not science driven. We have to change that. We had a great plot, I tear, but I couldn't get someone to invest the hundreds of millions of dollars to get that approved.

Uri Schneider: But among other things that Jerry's going to shake up is the entire way that drugs are developed and approved, but back to our gap. Right.

Dr. Gerald Maguire: Have you got it? I know. Right. So again, so that's why it ended, right? So the GABA, social anxiety, dopamine. Is here. I'll show you one more slide, activates that switch.

We're going to go there. Right? So we did finish

Uri Schneider: that previous Nigerians to tie back to what you said before, different subtypes. So for those who have very significant social anxiety, the pack of cologne, they have been a drug to consider. Of course there were side effects and all kinds of other considerations that need to be brought in, but there are those who don't have much social anxiety.

It might not be indicated for them. Would that be correct? You

Dr. Gerald Maguire: got it. Yes. Right. I'm just sending a text about my next meeting. I'm not

Uri Schneider: no problem. I'm sorry to

Dr. Gerald Maguire: keep it. So, you know, you got this for

Uri Schneider: people that really want to wrap their head around that you're getting the best explanation possible and it's exciting next gen stuff.

Dr. Gerald Maguire: Got it. We're gonna do that. Right. So you got it so Gabba, right? Okay. We're going to go there. Right. But we also study the people who stutter or dope mean levels or are more active. We showed that. Right. So good. I'm going to go here and I'm going to show you, I'm going to publish these data, right. Um, what we're showing is Risperidone, which is a compound, um, like a lands of pene, kinda like equal pipeline, different receptor.

Right. We studied people in a blinded fashion off the, before they were on the medicine and after, right. And what do we show on treatment? They didn't know they're on treatment or whatever. This is a left side image. Bingo. Straight umpire. That's it right. Should we actually show a mechanism there as to why these medicines might work?

So what it also shows here is therapy helps that cause you're going to get that other speech and they're going to help that ferritin and work better. You're also going to show a sentence is the real key, right? No one will excite. They're not mutually exclusive understanding avoidance getting beyond avoidance acceptance.

And I will say this. Understanding stuttering, having a biologic basis with a neurophysiologic will protect us more from discrimination and stigma and bring us into greater acceptance with society, right? Because what society is saying, just relax. There's something wrong in your, you know, you're just a nervous guy.

You can't do this job, but you have poor verbal communication skills, but by being listed. As a protected disability and being listed as a brain disorder will really fight people from discriminating against us. Because what I want to change too is a young physician. I know young physicians, unfortunately, area who haven't passed that exam.

Because the medical licensing community says, well, you have to speak in 30 minutes. That's a requirement to be a physician. And if you can't do it, you can't do the job. Wait a minute. They accommodate other people. If someone's in a wheelchair, they're not going to make that person stand and do a surgery.

Right. So they understand it because this guy's got a spinal cord injury with us. They say, no, this guy can't do it. Who's a defective human being or whatever. I hate that term, but that's what my medical community says. You have to speak fluently, right?

Uri Schneider: Yeah. I'm

Dr. Gerald Maguire: going to say the image. So what I have to say to bring my neuro diversity friends in I'm with you, right?

The, um, if the, I, I joined NSA and a speech, the acceptance, right? We grow. We, these are all together. We are inclusive. We understand that that's just stuttering community. All of us are together. It's parents, it's grandparents. As my therapist, growing up as a kid who I saw from second grade to today, um, who've helped me.

We're all part of one collective community. We can't be, um, exclusionary. Why, why should we, people who stutter. Exclude and bully people who don't just because we were excluded and bullied as kids, we're going to give it back. We're one people, we are inclusive. I want to go and politically, but. We need to get an eye on this world.

I won't, but I got to tell you that I want to say it, but we gotta unite.

Uri Schneider: There's two quantitative. So would you say, I want to ask you two questions, get your response and I'll get you off. I know you got to run one. Would you say that things like cognitive behavioral therapy therapy act. And different types of mindfulness exercises and other things of that sort do those things have the capacity to change the brain, to retrain the brain, to re recreate and strengthen and weaken different connectivity that starts getting hot.

Dr. Gerald Maguire: Not only is it my opinion, it's proof. I will show you now here, I'm going to tell you the data here, right?

Uri Schneider: I just want to make the statement that you're thought of as the pharmacology guy, as the pill guy, but not only are you saying, look, it's nice to compliment medicine with therapy. What you're saying is good therapy.

Can affect changes in the brain in the way the brain functions. And so, however you start off, you've got a tendency to go there, but you can do quite a bit to retrain and rewire. I'm

Dr. Gerald Maguire: going to show you why, right. I'm going to show you why. Right? My pharmacology research that gets the press, right? My pharmacology treatment, you know, that's the Atlantic

Uri Schneider: that's, that's,

Dr. Gerald Maguire: that's the Smithsonian magazine.

Right? When I come up with that, like, wait, this guy's got a pill for stuttering. I'm way more than that. Right. But because that doesn't meet, you know, the Google alert that's right. That, you know, he's really, he's a pill guy, right? I'm an NSA or I was an NSP or I am an acceptance. I'm self help. I'm therapy.

Uri Schneider: You're still the guy that read the paper. You weren't supposed to look at it and you're still trying to be a champion for those that are still

Dr. Gerald Maguire: in the, got it here. That is right. But I'm doing the genetics work as well. Right. Um, but brain tissue, we're working, I'm working Shelly Jo, and we're working together.

Imaging. We got that. Scott, we're doing this cause they have skillsets. I don't have, but I'm the only one licensed MD I think in the world. Who's really looking at biologic.

Uri Schneider: That's why it's so good to see you so many pounds later and looking

Dr. Gerald Maguire: you got it, but I will say okay. Yup. Okay. Tell me about that.

Okay. But I want to say this here, the

Uri Schneider: change

Dr. Gerald Maguire: in the brain, fruitfulness, mindfulness, cognitive behavioral therapy, change the brain, and I'll tell you where we need to be. Right where we need to be here. I'm going to bring a thing here. In 1991 or so. Right. A biologic treatment came out for obsessive compulsive disorder.

It was called Clomipramine. Right. And then later, a couple of years later, flu oxytocin or Prozac gets approved. Right. People had OCD right. For years. Right. They never got treatment. They wouldn't, they never went out because they thought there was no hope. They were just burdened in their own homes.

Touching objects. Couldn't leave their home. Couldn't go see a therapist or nothing. Suddenly a pill comes out that it could help. Right. So that gets people out. There's a big education campaign. If you have OCD who could be helped. Right. So suddenly right. Millions of people around the world. I bet you, in 1991, people didn't even know what OCD was.

There was no. Acronym for OCD. It was hidden in the literature as obsessive compulsive disorder, right? No one people back in the 50, 60, 70,000 God, this guy is weird. He touches things. The white paper it's Howard Hughes, Howard Hughes. Right. He had severe OCD. Right. You'll look back. Right. He had you look at the movie, the ABN, right.

He's washing his hands. Right. He's touching things. He is so severely OCD, right. He locks himself in a hotel room for the rest of his life. Doesn't even see anybody. He died a reckless because of OCD. Really? I I've never met him, but look at this story, right. He couldn't even talk about it. Cause there there's no treatment, no one even knew what he had.

Later a pill comes out, right? And people say, God, I got that. That's me. I touch things all the time. I can't leave my house. So they go to a doctor and that doctor says, you know what? The spill can only do so much. You got to go to therapy too. So they start going to therapy again, because we really understand like cognitive behavioral therapy.

Can really help this and mindfulness company, right? So then the doctors and the psychologists and the therapists are working together. And then, so we show an effect that the mill, the pills, Prozac, whatever, help a region of the brain called the cingulet one way. Right? And then they show cognitive behavioral therapy does that too.

And then they showed that both of them together work better, but you really help if you're doing cognitive behavioral and mindfulness in OCD. It makes the medicines work better and vice versa. And they show that with imaging scans. So, you know what I'm talking to someone right now, dr. Randazzo and others, right.

We're going to do studies, which look at medicine therapy alone and medicine and therapy, Scott. And I bet you it's going to be that third arm. That's going to work better. And so what's going to happen in three years, but model of stuttering will be, yep. You get your therapy, you get yourself help. And you know, for those of you, if this is tight, tight, then you get medicines too.

But it's not going to be mutual exclusive people with OCD right now. It's accepted you can't fire anybody. If he touches objects, right youth, this person's got to get time off from work or extra time to complete a task. For instance, I treat. A doctor with OCD. He is the best radiologist in the world. And this guy looks at a film.

He looked at every little detail, right? Every little detail. You want him looking at your chest metric? Cause the cc's a little splotch. He's going to pick it up where the other guy puts a film up for three seconds and puts it down. This guy is so detail oriented, but the hospital was saying, he's not reading films fast enough.

He's not generating enough revenue. Like he can't. Right. He's so obsessive too. The stories are great. Radiologists. We have to look at the bill tape, but he's good at it. So I had a file as an accommodation to that hospital. You know what paying the same amount, just cause you're paying people to read films.

He's doing a better job. You gotta accommodate him that instead of reading up just a trivia in three minutes, he takes 10 minutes. Right. But he does a better job. So you gotta pay them the same. It's a work accommodation he's doing well. They had to modify it because it's a diagnosable disability.

Uri Schneider: Right?

No send disorder was helpful to get them that accommodation keeping them the

Dr. Gerald Maguire: job you got it. And they can't fire him. Right. And how we get treatment today is medicine and therapy. One last question.

Uri Schneider: What do you want to see me in the next three to five years? What can I do to help move this off? Good.

Dr. Gerald Maguire: What you're doing now is you get into the world.

What I want to do too is what you and I have in common uniting the world, acceptance of avoidance and interdisciplinary care. We've shared clients. This is what it's all about. It's not get appeal here. It's not get therapy. Here is together. Across disciplines, speech, language, pathology, psychology, psychiatry, educate the world.

Just don't pick up a pill. I don't care. Even if it's one FDA approved, just don't do that. See a therapist too. If you're you're there, your speech language pathologists will be the primary clinician, but I want the understanding of the speech language pathologist to say like many of my colleagues do.

Yeah. I think you could benefit from a medication.

Uri Schneider: This conversation is moving that forward. I think we need to recognize speech therapy for stuttering. Is in need of a big upgrade and you're at the forefront among so many others that I'm having these conversations with and more moving it forward. And certainly in the times we're living in making it more available to more people in the world.

So this conversation couldn't have happened. And another time, thank you for taking the time out where I hope to be is right here with.

Dr. Gerald Maguire: Wonderful.

Uri Schneider: That's good. We're going to take a block. We're going to take a walk again,

Dr. Gerald Maguire: take a walk and you know what? I've lost 40 pounds and said, man, so I got to get new that

Uri Schneider: new clinic.

I'll be able to keep up with you. I don't know if I'll be out. I won't say who, but someone was on this call with me. They have the opposite experience as you. They told me they haven't put on a pair of pants because all their appointments are on zoom. All their lectures are on zoom. They haven't put on a pair of pants.

If they tried to, it probably wouldn't fit because they're wasted.

Dr. Gerald Maguire: I gotta tell ya as a doctor, right? COVID is all over the place. It's brought us challenges say, right, there's going to be some good things, actually come out of it. And that is one uniting the world around this. Right. Getting a renewed. So that's one number two.

I want us all to focus on our own wellbeing as, as a doctor, right? Fortunately, I've had kind of a time to say, okay. Instead of me driving in a car, eating crappy. Even if you think you're getting healthy, fast food at sandwich shop or something, there's still more calories. And if he gets something better yourself, I think it's really, that's a part of it too.

I'm not on the run. Right. I'm able to walk my dog. It's not just the pill. So the change in diet, it's the exercise. It's a time where I'm not sitting in a car, sitting in meetings, drive myself. It's like focus on yourself, focus on your family, right? And then they make sure your time in the Kobe to get that exercise, eat the right stuff.

Right. A lot of your stuff. Yeah. And that's part of it too, right?

Uri Schneider: Yeah. You save time on the commute. You're saving time, but all of us are feeling, it gets eaten up. If we don't deliberately grab that time, carve it out to put in some good habits. And if you're home stuck with your family and everyone's ripping each other's heads off, that's understandable and normal.

I had a wonderful friend. I invited to do this conversation. He turned me down. I was a little bit shocked at first because he's a good friend. And then he told me I'm just a little overwhelmed. I'm mr. Mom tell you,

Dr. Gerald Maguire: there's a couple of things here, right? I'm a psychiatrist too. I'm a psychiatrist too. This is not just the

Uri Schneider: stuttering records.

Dr. Gerald Maguire: I have a son. I'm just telling this what people do, what I've done, but I've done. I run a department, I've got 150 employees, right. I put together and I said, this, you know, this is it. No meetings before nine o'clock. Your Workday was eight to five, no meetings before nine. Nothing after four. Right. And every meeting going forward is not to the full hour.

It's 10 to 15. It's like nine o'clock. Right? The meeting is nine to nine 50, no more hour long meetings. No more half hour meetings or 20 minutes, I would go into zoom. You flipped your meeting. It's nine, nine 30. Just click the end date, 10 minutes earlier that allows you time to go get a cup of coffee, use the restroom, talk to your kids, whatever what's happened in America and all the world is we're back to back.

And when we were in commuting, which was in positive, you had a little bit of downtime. You go to your car and you can think about it with things like that. You're walking to work or not walking to work. So we got to bring back and hopefully it's benefits that is lock time. Talk to your boss, everything we're doing a lot of this work on workplace.

You need a couple hours outside the zoom in email to go for a walk and for the families, you're all over each other dynamics, work on the positives. That may mean someone's in this part of the house, something that's part of the house. Get some time away, go for a walk, go for a walk with the family, get out of the house, right.

Be together in a non stressful environment. And with your coworkers just told, send 80 frigging emails every day.

Uri Schneider: So I just want to know from the ride we had in the car two years ago, have you bought into my idea of a sauna or you still do everything on email? We

Dr. Gerald Maguire: are in fact, the meeting I'm at right now.

Now I'm supposed to be in is a workflow management meeting. So we, okay. We bought into a sauna, which is great. We're using it. Thanks to you, your risk, California. They're now they're switching to Microsoft teams and that's a meeting going on right now. Our assumption of the, what it is, I think it's because of all the security stuff,

Uri Schneider: the key is you can't manage your life with emails, cause it's basically other people's priorities in your face.

But just one tip I have for families that are on top of each other, we started with the headphones. When kids can be on headphones, they're going to concentrate and learn better in the meetings they're in and not hear the noise and distractions around and vice versa. Everyone should have a good pair of headphones at home and some corner of the house.

That's like their space, their little pod, whatever. However, you create that in whatever small space you have. Everyone should have a little space. That's their private right spot. If you exactly.

Dr. Gerald Maguire: So what I'm doing is I'm putting in a covered patio, right? It will, because right now my daughter's at home from college, our mother-in-law lives with us, my wife, it's like, we're all in this place.

Right? So I'm getting a little space where they get their space. It'll be kind of like my remote office, those in the U S right now I talk to my tax. Deeds is a tax deduction because I don't, I'm an IRS guy, talk to your accountant, but. Because I mandated, I got emails for work from home, basically. I mean,

Uri Schneider: it's pretty clear you're in a bedroom.

Um,

Dr. Gerald Maguire: right.

Uri Schneider: I've got the background going. So you have no idea where I am. Cause I'm too in to want to show my mess. But Jerry, I just want to thank you,

Dr. Gerald Maguire: your honor. Thank you. Hey guys, but anytime Mary I'll see you together, man. We'll a great scene. You're you're you're wonderful. I thank you all. Thanks to the stuttering community.

We're all together. Right

Uri Schneider: through the connection because you continue to do good things together and we'll keep our zoom meetings in the future shorter than this.

Dr. Gerald Maguire: All right. Take care guys. Thank you. Take care. Bye bye. Thanks sir. Bye bye.