Ronak Dholakia, PhD

Medical Device Engineer/Scientist/Inventor; Opinions are my own; RTs ≠ endorsements

[Bill Ackman @BillAckman]

At midnight on February 6th, earlier this year, the doorbell to our apartment rang. The doorbell was followed by a pounding on the door. I answered the door and a security person in our building handed me his phone. It was my oldest daughter Eloise. She had found my 26-year-old daughter unconscious on the floor of her apartment and had called 911. The EMT team was already there, but they did not know what was wrong with Lucy or to which hospital they would take her.

I threw on some clothes and jumped in an Uber heading east toward Brooklyn. (Lucy lived alone in Williamsburg.) On the way, I learned that they were taking her to Elmhurst, a City trauma hospital in Queens. I arrived about five minutes after the ambulance to join Eloise, Lucy’s mom, and a friend, and waited to learn what was wrong.

After about 15 minutes, I asked a nurse where she was. I looked over his shoulder to his computer. Next to her name, it said “non-responsive.” I walked into the emergency room and wandered around looking for her until I found her unconscious on a gurney surrounded by several doctors and nurses.

By about 2:30am with the results from a CAT scan, Lucy’s doctors had determined that she had a massive brain hemorrhage and would need an emergency hemicraniectomy to release the pressure on her brain and remove the blood from the hemorrhage. I called our wonderful friend and family doctor Eddie Fisher and explained what was going on. He woke up Josh Bederson, Chairman of Neurosurgery at Mount Sinai, to find out more about Zach Hickman, the neurosurgeon on call that night. Dr. Bederson said Hickman was an excellent surgeon, which was comforting as we had no choice.

The surgery to save Lucy’s life began around 3:15am and finished around 5:30am. It was successful.

The following day, I joined Lucy in an ambulance while she was being transferred to Mount Sinai on Madison Avenue. Later that day, we determined from Lucy’s Oura ring that her hemorrhage had occurred around 9am, which meant that more than 19 hours had passed from the time of the hemorrhage to the completion of the surgery to release the pressure on her brain (I only wish @ouraring had an alert for this kind of a medical event. Imagine it could call a family member if the wearer doesn’t cancel the alert).

I later learned that the standard of care is not to do surgery to save a patient with a large brain bleed if more than five hours have passed since the hemorrhage. Even when the surgery is done, I was told that the likely outcome for the patient is a few months in a nursing home and death from pneumonia.

When I met Lucy’s doctors, I did my best to inspire them: “Let’s see what can be accomplished if we give her the best care possible and we invest unlimited resources to restore her to life.” And I promised that whatever we learned we would make available to everyone.

Dr. Chris Kellner, her neurosurgeon, and Dr. David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System have led Lucy’s care team since that day. Words cannot describe the remarkable and compassionate care that she has received beginning with the EMT team and then from nurses, doctors, therapists, and the army of people who have worked to save her and return her to life. To this day, we have a daily Zoom where we discuss her progress and make adjustments to her care. While her care and oversight have been incredible, the learnings for the Mount Sinai team have also been elucidating and will assist in the care of many others.

Lucy began in a bad place. She was in a coma for several weeks and then awoke not being able to breathe on her own, unable to walk, see or speak.

Over the last six months, she has recovered her cognition – she understands everything including her circumstance – is able to walk a hundred or more steps at a time with assistance, is making progress with sounds, vowels and consonants and the beginnings of speech, but she remains unable to see.

Each day, she makes a little progress, and daily progress compounds. Every day I tell her that she just needs to make a little progress and it won’t be long before she is back.

We remain optimistic that Lucy will return to normal function. It will likely take years, but I believe it is only a matter of time, hard work, and technological progress, along with some, and perhaps a lot, of divine intervention.

Many people have been praying for Lucy and we are incredibly grateful for the prayers and remarkable support she has received. Lucy’s friends have been with her every day since the beginning, and their presence and friendship have saved her life and helped to rebuild and maintain her spirit. And on a very positive note, Lucy’s challenge has brought together our entire modern family who have all been incredibly devoted to her care and recovery.

Lucy's vision and other faculties may require some form of brain computer interface, work that is underway at Neuralink, Precision Neuroscience, Science, Synchron, Nudge, and other companies in the space.

If you are going to have a devastating brain injury, now is the best time in history for that to happen. We are living in a world when you can be confident that the blind will soon see again. We are going to do everything we can to help make that happen, including by assisting existing companies in the space.

With respect to our promise to make Lucy’s care available to others, we have made good progress. In May, a real estate colleague made me aware of a 93% vacant, brand new, 400,000 square foot Class A+ purpose-built biotech facility on West End Avenue between 65th and 66th Streets that missed the market and was available for sale. The Pershing Square Foundation acquired the building 60 days later.

We also put under contract an adjoining 130,000 square foot building at 320 West 66th Street that is currently being used by Saturday Night Live for studio space. The building has 35-foot ceilings with massive column-free spaces that can be converted into superb rehabilitation facilities. We will close on the SNL building in December.

We are also acquiring an adjoining vacant lot with additional air rights. With just the existing zoning rights, we can add a 150,000 square feet for a total of 680,000 square feet, a lab footprint larger than Rockefeller University, and that’s without including the potential for an upzoning that would allow for substantially more buildable area on the site’s 3.4 acres with spectacular views of the Hudson.

Our goal is to build the world’s greatest brain research, rehabilitation, recovery, human optimization, and longevity institute. We have named it The Ackman Oxman Institute or the AOI for lack of a better name, but also to reinforce the point that Neri and I and our family are all-in on the mission.

The AOI will be patient-centric. It will not be an academic research institute that produces lots of papers, a Nobel Prize winner or two, but little if any results for patients. We will be laser-focused on cures, treatments, devices, rehabilitation and exercise equipment, and targeted and basic research with a goal of massively accelerating the time from idea to innovation to production to helping a patient.

While the AOI will be a non-profit, it will have highly commercial instincts. The AOI will have its own venture funding and will work to develop innovations to create companies that we will seed, assist, and spinout to ensure technologies, treatments, techniques, and drugs get to patients as promptly as possible.

On one 3.4 acre campus in what is still the greatest city in the world, we will do neurosurgery, neuroscience, rehabilitation, nutrition, BCI and device development, human trials, hyperbaric oxygen treatments, and life extension programs, and we will mandate and incentivize collaboration among the teams with no silos, politics, bureaucracy, or any other constraint that is inconsistent with the mission.

Mount Sinai will be an important partner and deservedly so, but it won’t be our only hospital or medical school partner as we don’t believe any institution has a monopoly on the best ideas or the best talent. We don’t believe in exclusive relationships because that is not in the best interest of patients.

Five years ago, we considered launching a brain institute inspired by Neri’s mom who sadly died from Alzheimer’s. We couldn’t make the math work as the real estate was too expensive and we believed it would be too difficult to recruit the best talent from universities to our effort.

Since then, the real estate became available at a 70% discount, universities became a much less attractive place to work due to politics outweighing meritocracy, protests that disrupt learning, the curse of antisemitism, and a decline in funding. Fortunately, during the same time, I made sufficient personal economic progress to make the AOI possible.

The advance of AI in the last few years will also enable us to greatly accelerate our mission. AI still has a lot to learn about human intelligence and the brain, and the AOI should be at the forefront of the interplay between the brain and AI.

Today, I am making a public filing disclosing a gift from Neri and me of ~$400 million or 10,000,000 shares of Pershing Square Inc. (PS) to the AOI. It is very early days for Pershing Square so these shares are intended to anchor the long-term work of the AOI as the shares compound over time while generating what we expect will be a growing stream of quarterly dividends to fund the Institute.

We will also be announcing an additional gift of similar and potentially greater size which won’t be in the form of Pershing Square stock to provide the AOI with the short- and intermediate-term runway necessary to enable it to achieve its goal of becoming a self-sustaining institute, which reinvests all of its revenues, royalties, and the economic rewards of company formation to advance the fields of brain health and human longevity.

Neri and I have chosen to anchor the funding of the AOI to maintain vision alignment and limit the need for the organization to focus on fundraising. We expect the AOI to be the best-resourced brain, rehab, recovery, and longevity institute in the world.

We are grateful to have been able to form a board which includes Dean Kamen (our generation’s Thomas Edison), George Yancopoulus (CEO of Regeneron), James Rothman (Nobel Laureate), Bernardo Sabatini (neuroscientist), Chris Kellner (neurosurgeon), Olivia Flatto (CEO Pershing Square Foundation), Neri Oxman, and myself.

We have recently identified a CEO who we expect to announce by October along with other key hires, and are beginning searches for a Chief Scientific Officer, a Chief AI/Technology Officer, a Chief Operating Officer, a Chief Financial Officer, and other key leadership roles.

If you find what we are building compelling and want to be part of the leadership team that creates and builds the AOI from a standing start, please send an email to: [email protected] with a short note as to why you believe you can help. Please include your best three ideas for the AOI along with a summary of your background and your most important accomplishments.

We promise strict confidentiality to those expressing interest in working with us.

We have learned from Lucy that the brain can recover from even catastrophic injury. There is so much more work to be done as the mind is a terrible thing to waste.

For details from my Pershing Square SEC filing see:

https://t.co/gZKafCw6Ia

[Ronak Dholakia, PhD @CardioMaverick]

Prevalence of Silent Atherosclerosis across Adult Life | New England Journal of Medicine https://t.co/bEMK6miLSZ

[Eric Topol @EricTopol]

Do blood thinners prevent stroke and embolism safely (without major bleeding) in people with atrial fibrillation and only 1 risk factor?
There hadn't been a randomized trial. Until today #ESCCongress @NEJM
The answer is yes. ~ 70% relative reduction, small 1% absolute reduction
https://t.co/h5rjj4RpaN

[Michael T. Lawton, MD @mtlawton]

Large, wide-neck aneurysms treated endovascularly can recur. Microneurosurgeons need to be ready with solutions like bypass/flow reversal. Today’s challenge is to master these technically demanding procedures on the infrequent cases done these days, and remain at the ready…#SevenBypasses

[Michael T. Lawton, MD @mtlawton]

Everybody’s talking robotics. But robots are built to do one task w/precision, need simple, consistent anatomy to operate surgically, like w/cholecystectomy. This brain AVM extends from cortex to ventricle, is supplied by convexity arteries + deep perforators, sits next to motor strip. Good luck Optimus….

[Keith Siau @drkeithsiau]

4 patients undergoing routine joint replacement surgery were mistakenly injected spinal potassium instead of the spinal anaesthetic mepivacaine, resulting in paralysis from spinal cord injury. One of the worst examples of a drug error in recent times.

[Adam Feuerstein ✡️ @adamfeuerstein]

This is among the CRAZIEST stories I have ever reported. Link in next post.

One of Rhode Island’s most-wanted fugitives — a former doctor convicted of sexual assault but on the run for 20 years — appears to have been living a secret life as a biotech executive.

Ron Fischer was arrested last week after authorities boarded a sailboat cruising off the NJ coast. The boat was registered under the name Richard Graydon, an alias used by Fischer, U.S. Marshals said.

That is the same name as a doctor and seasoned drug development executive hired last March by Immix Biopharma $IMMX, a Los Angeles-based biotech company, as its new chief medical officer.

"Graydon" also worked for $ATOSS as its interim CMO in 2022.

You have to read this story, including details about what Immix did after I contacted them on Sunday. It's insane.

[NEJM @NEJM]

For patients with acute ischemic stroke, endovascular thrombectomy has improved outcomes in large-vessel occlusions, but its benefit in medium-vessel occlusions remains contentious. Research findings from the ORIENTAL-MeVO trial are summarized in a new Quick Take video. https://t.co/llPDSrhiyI

[NEJM @NEJM]

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: https://t.co/qAMC2o36Mi

Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://t.co/KyOWdblUR3

[SVIN @svinsociety]

An exciting dive into the Late-Breaking Trials unveiled at this year’s SVIN conference, spotlighting breakthrough findings poised to shape the future of stroke and neurovascular care!

🔗 https://t.co/sK8XgwZXLN
#SVIN #SVIN25 #SVINAnnualMeeting #interventionalneurology #SVINFellows

[Ronak Dholakia, PhD @CardioMaverick]

https://t.co/aRc1dq5fCw

[Aditya Raj Kaul @AdityaRajKaul]

#BREAKING: Islamist terrorists killed tourists in Pahalgam of South Kashmir after checking that they were not Muslims. Trousers of tourists pulled down, ID Cards checked. Listen to what the Hindu victim says. Tourist killed because he was not a Muslim. This is what Pakistan does.

[Aditya Raj Kaul @AdityaRajKaul]

Traumatic experience of those tourists who saw Pahalgam terror attack in front of their eyes in Kashmir and managed to escape. Indian Army comes to the rescue. Heart goes out to all the victim families in India. We stand in solidarity with each one of you.

[Ronak Dholakia, PhD @CardioMaverick]

https://t.co/z8ZWUxy3fZ

[Fawaz Al-Mufti, MD, FSVIN @almuftifawaz]

9 days 11 Hours left to register for the best neuroendovascular conference of the year @svinsociety!
#BeatProcrastinationNow
DO IT NOW
DO IT NOW: https://t.co/nTgGoDxPEw
#SVIN24 @MThrombectomy

[Stroke AHA/ASA @StrokeAHA_ASA]

🧵#STROKE Highlights for October are here:

🌟Patients in rural hospitals are less likely to receive timely thrombolysis for ischemic stroke, with longer pre-hospital delays and lower odds of utilizing emergency medical services. @GCFMD @ShumeiManMD

[Ronak Dholakia, PhD @CardioMaverick]

Long-term Mortality After TAVI Lower With DOACs vs VKAs https://t.co/qP5iO1acRe

[frank arko @farkomd]

What would you do next? Coarct repair 35 years ago, what questions would you ask this patient. What further imaging would you like? #AortaEd

[JNIS @JNIS_BMJ]

🧠💡 #CerebralAngiography via radial approach shows similar rates of embolic events compared to fem but with increased patient satisfaction & fewer complications. Tailored, patient-focused care could revolutionize NIR! #Neurology #PatientCare
@JNIS_BMJ https://t.co/7MZR2M8g2O