Loading summary
Transcript40 lines
- [00:04]
A
When did making plans get this complicated? It's time to streamline with WhatsApp, the secure messaging app that brings the whole group together. Use polls to settle dinner plans, send event invites and pin messages so no one forgets mom 60th and never miss a meme or milestone. All protected with end to end encryption. It's time for WhatsApp message privately with everyone. Learn more@WhatsApp.com.
- [00:36]
B
Welcome to Talking Feds. One on one deep dive discussions with national figures about the most fascinating and consequential issues defining our culture and shaping our lives. I'm your host Harry Littman. Well, more what should we call it? Idiosyncratic, maybe wacky health advice from the administration. And it's on the one hand kind of risible, but on the other, no joke given its potential for harm. As always, when health matters and policy come up together, we turn to the best combined medical policy analyst out there. That of course is Dr. Kavita Patel. She served in the Obama White House as Director of Policy for the Office of Intergovernmental affairs and Public Engagement. That's a governmental mouthful, isn't it? And now works as a primary care physician. Yay. Really hands on. And a leading health policy research. And she's also a professor of medicine at Stanford, a regular contributor to NBC and MSNBC News. It's really good to talk with you. Let me just start with something. Probably not the wackiest maybe up there, but I'm sure has really caught the attention of nearly every American home that would be Tylenol. So President Trump last week announced that women shouldn't take it while pregnant, that they need to try to tough it out instead, and that the FDA will be notifying doctors to adjust the their guidance accordingly. This is all because he says the key ingredient to cinemafen can cause autism. Where in the world did this announcement come from? What kernel of possible truth does it have or not have? How bad is it? Man, oh man, you know, are we, Are we bleach Covid Part 2 what the Heck?
- [02:40]
A
Yeah, that's what I started asking myself. Like where am I and is this reality? Can't discern what's truth from fiction these days and seems like there's no line in between. So I'll give, as the kids say, the tldr on kind of where this came from. And by the way, this has been a rough kind of go for Tylenol for a lot of reasons, including the fact that Tylenol, the brand manufacturer, has specific company that makes it can view their stock Plummeted, as you can imagine. And then there's acetaminophen, the generic that's also known as Tylenol. And, and people are like, what is acetaminophen? So nobody really knows what that is. It started with a set of studies. It was not one study. There's been this kind of posting by the White House and then others that have reinforced on social media that there's quote unquote, a Harvard study that is incorrect. What Harvard did was to actually do kind of what we call a systematic review or a study of studies. And they basically like an epidemiological thing. They basically, it's something we do often, by the way, like, so just as a standard, what we will do in science is that if there's something that we're like trying to understand better, for example, is there a relationship between mom taking acetaminophen or Tylenol and autism after birth? Is there any relationship whatsoever? What we will do is we will scour as many studies between a certain year and another year. We'll say, hey, during this period of time, are there any studies that have been done that look at maternal use of Tylenol and any incidence of autism in a family? And that's exactly what Harvard School of Public Health set out to do. And they reduced it to 19 studies that they could look at over, I believe, at least a 10 year period. But it might have been a 20 year period. But it's. They looked at 19 studies. Not all of those studies are done the same. So these are independent studies that were published in the literature, had different methodologies and had different findings. But these studies put together compile what we call a systematic review. Think of it as if you were to take over the last year and you were just to try to take the average temperature in Washington D.C. and you just look at 365 days of temperature and you come up with an average. So that's essentially what a systematic review does. It looks at all these studies, it throws out the ones that don't deal with your original research question. And then it kind of takes and it does. It combines the results so that it feels like it's all one study. And that's where I think the confusion has come from. Anyway, this one kind of systematic review, a study of studies, as I'll refer to it, found that there was a correlation, meaning there was a statistical chance that was there, that if you had a mom who took acetaminophen during her pregnancy, that there was a chance that you also had autism in the family. And now what does that mean? That just means that there's a correlation. It means that for me as a public health scientist, that there's probably something to look into further. And I'll get into that in a second, which is where my. There's another study that was not included in the study of studies that becomes even more important. So it does tell us a little signal, but it did not show any causality. You're going to hear that word a lot like causation, right?
- [06:00]
B
Causation risk, correlation.
- [06:01]
A
I think one causation correlation. Causation can only be found when you actually do a study, Harry, in order to actually look for that specific effect. So think right now, literally, as we're recording this pod from here forward, I am going to look at every mom who takes acetaminophen and I am going to follow them and also look for any confounders and any other variables and try to follow them over their lifetime to see if any of their children have autism.
- [06:32]
B
So now this may be, Kavita, a sort of imponderable for you, but I don't mean this in a mean, disparaging way, but it seems clear to me Trump doesn't read. So somebody came and with all the. There are studies out there, this a pretty weak finding of mere correlation. Somehow someone came to him and kind of, kind of caught his fancy. So he's now trying to dictate to the, to the whole. And by the way, I just want to point out, I remember the time when autism was ascribed to unloving mothers and how painful and cruel that was to them. Now we have mothers out there thinking, did I take us in and give my child autism? But how did we come from this very weak study of studies that doesn't include the one you're about to tell us about to a. This announcement from the White House. Do we have any sense of how, how the hell things work there? I know you know how they used to work.
- [07:28]
A
So what I do know is that Secretary Kennedy has been looking for a while, both in his personal prior to taking on his role as Secretary of Health and Human Services, that this role of potentially Tylenol in autism has been something that he has been exploring, much like vaccines and autism. He's very, I don't think it's an overstatement to say he's obsessed with autism as somebody should be. We have so many children with autism.
- [07:52]
B
So I think such a spike in diagnoses. Yeah.
- [07:55]
A
And I think that also became an issue that the president harped on, by the way. So you have in the secretary an agenda, a clear pre existing kind of obsession with this topic area. And then here you have like this, you know, you have Harvard kind of the dean of the school of Public Health kind of handing you this, what seems like a study on a silver bladder that says, you know, by the way, Tylenol. Yeah, there's something there. And then on the other hand, at the same time, you have this vitamin B9, folic acid, also known as leucovorin, that just happens to also be very small trials showing you a positive result for patients with autism. So on one hand here you've got something that might cause autism, and on the other hand, you might have a potential cure, both of which are overstated, but both of which give Bobby something to hand to the President. You know, this president loves a win, right? So he's, I think knowing what I know about this White House and this HHS is that you had an obsessed secretary and you have a president who doesn't care about health, who doesn't care about the details, but likes having that kind of gotcha moment. Like, you know, hey, I think Tylenol, that's bad, bad. And it should, you know, this is.
- [09:04]
B
And he's something I know that nobody else does. And nylon can fix it, as it were.
- [09:09]
A
And here, you know, let me trot out like, you know, he had three doctors behind him at Oz, Makary at the FDA and J. Bhattachary at the nih. Three doctors behind of this. So they're stone.
- [09:19]
B
You really want to call them three doctors.
- [09:23]
A
I should say.
- [09:24]
B
There's three medical degrees.
- [09:26]
A
There were three people with MDs behind their name. And they were standing there much like Nancy Burks and Tony Fauci stood there when he said bleach and sunlight. And you know, when you're, you're kind of standing there like, so it had deja vu for me for a lot of reasons.
- [09:41]
B
Okay, you've shown me the kernel here and why he might run with it. We've talked motivation, something off and try to avoid, let's talk consequences. So he, he, he makes this his own. He gives it to all doctors. What happens in the country, starting just with headaches for pregnant women?
- [09:59]
A
Yeah, I think it's, it's played out practically, like women asking me like, so should I take Tylenol, Should I not take Tylenol? And by the way, there's not much, there's not many options for pregnant women for fever relief because we actually don't recommend taking things like Advil or ibuprofen, because there have been studies that show that early in pregnancy there can potentially, you know, there can be fetal harm if you take it in high doses. So we actually prefer Tylenol. So it has already resulted in that confusion at the level of any pregnant woman who is trying to figure out what to do or what not to do. But I think it can then just to your point, I think this kind of guidance can translate to potentially liability. Right. So if I am a doctor who tells a pregnant woman that sure, this is safe in these doses in this situation, but then fast forward and indeed that woman has a child with any amount of autism spectrum disorder traits, could that be something that I'm held liable for? Possibly especially with the statement being made then the second, and it's the kind.
- [10:58]
B
Of thing as doctors say, that a possible cause of action that stays open forever.
- [11:03]
A
It stays open forever. Right. And then the second is actually the harm that happens from following the advice. Because I think that for a lot of women when they have high fevers, our highest priority is to get the fever down. Because fever in and of itself is like a non specific reaction that your body has to try to kind of protect itself. When you have a fetus and you're trying to actually also protect some other potential living creature inside of you, fever can harm both of you. So we, we will likely see these unfortunate statistics of, you know, untreated fevers or untreated infections. And I think that this is one of those cases where what might have seemed like some judicious advice when, you know, you can, I can imagine the White House memo that had to go in to the President that said, here's our strength of evidence, here's what we would like to do, here's what the FDA is going to do. Then you have a president who makes a comment which I'm 100% certain was not in his talking points memo to say tough it out. You should. Why do you need to take a pile at all? Just tough it out. So I think that's where something that might have even started. You could argue there was even a, like a reasonable chance that you should put this forward, kind of came off the rails once the President made that set of statements that he did last week.
- [12:20]
B
Got it. Okay. But I was particularly struck, and I guess I'd say alarmed, but I wanted to ask you when Kennedy discharged Susan Monterez, the very well respected head of the cdc, because she wouldn't and you know, and the Same kind of reason, not, you know, healthy debate is not tolerated. She wouldn't rubber stamp his agenda now, you know, CDC is a big kind of partner in all this sort of policy, health, relationship with the government. What's. Does he have the ability to, you know, just write them off and then do you have a sense of what is going on at the cdc? And to the extent the government incorporates a profound, you know, it's a little like Fauci behind in the bleach, a professional level of nonpartisan, thoughtful, cutting edge researchers. Are they, are they all out to pasture now?
- [13:17]
A
Yeah, well, it does feel like that. So the CDC is an interesting entity that's been fraught with, I'll call it just, you know, criticism in both administrations, both Republican and Democratic administrations. This has been an entity by, by the way, many of us in D.C. think it's because it's in Atlanta. I mean there's just a really. Not because you need all the scientists in D.C. but it's really hard to advocate for an organization where it just feels like it's out there. And same, same as some of the little fact here. The NIH Institute around Environmental Health Sciences is in North Carolina. One argues that we don't have as much of like the cutting edge climate change science coming forward because they're in North Carolina doing that research. So I think the CDC has been kind of criticized on both sides of the aisle and having come out of COVID and now into like a time when, you know, RFK is basically tearing apart anything that disagrees with his mantra and replacing it. So for example, In June, before Dr. Manarez was even in the CDC chair, he replaced the entire Advisory commission on Immunization Practices. All of them gone, with the exception of one member, Cody Meissner, who is kind of a. Not a vaccine skeptic, but he's certainly somebody who questions a lot and is someone who can probably be put in that sort of skeptic category. But I would say that that was my first signal and the staff at the CDC knew that.
- [14:47]
B
Your first signal of what?
- [14:49]
A
My first signal that the CDC was going to get cut off, that there was no chance that you would have an independent agency. Once I saw RFK move to replace that committee, I knew that he was going to try to get rid of a lot of the career staff. Whether it was forcing them out or buying them out or however that got done, those of us who knew Susan told her that this was gonna be a very risky endeavor. She, I think in her testimony has been pretty Clear that she has always held steadfast, that she would do what the science told her, and that she sat with the secretary and had good conversations, and that he told her, I'm not against vaccines. This is very nice. Then she gets into the job. There's a shooting at the cdc. The first hints of disagreement with her, and what I know came from how that was handled. There was a lot of pressure on Susan to not let the staff work remotely, that they wanted to send a signal that they would not back down from. You know, they were not afraid, but her staff was afraid. Again, this is, like, very easy to tell staff where, you know, dc. I know this sounds terrible, but we're used to kind of these chaotic events. This is not what happens at the CDC in a suburb in Atlanta. It's just not. And so they. So she. She talks very eloquently about how, like, from the jump, she did not necessarily have, like, an independent voice. She was being told what to do. And then push came to shove when she was surprisingly just confronted and said, you know, are you gonna. Are you willing to fire these staff? And she said there was a list and there were all these people. And she's like, no, I can't do that, and I can't sign off on these recommendations. So I know the staff that are there are in two camps. One, I need to stay. One camp is I gotta stay here and I gotta preserve what's good about this place and keep my people together, and I just gotta stay. And then there's a camp. And it was very vocal, the people who walked out and resigned. But then there's many more that you and I have not heard about, but that have left who have said, no, I'm not gonna be able to work in this agency anymore. So what my concern is is that now you see these states, there's now 13, maybe more. There are at least a dozen states, all Democrats as governors, all blue, that have said, fine, we're going to go our own way, and we're basically going to make our own CDC by coming together. My fear is that that's not good for the health of the public, because we need the infrastructure for not just a pandemic. We need this infrastructure for things like salmonella outbreaks. We need this infrastructure for knowing when we see a spike in wastewater flu, when we see problems with hospitalizations because of viruses. Like, we. We need this infrastructure to be in place, and we need to press to get Republicans and Democrats to see that. But I don't see any of there's so much noise. It's all getting lost in that noise and that message.
- [17:48]
B
It's such a good point. And what do you think of the same thing's going on in doj, my little ballywick? We found out today a third, a third of the leadership have just gone. When I was there, I would often try to make the case. People would say, why do you still. Or why is there still federal laws against drugs like marijuana? I tried to explain the FDA perspective that look, if you need one unified, top learned place, because otherwise you'll have states saying, oh, go for lateral, go for that. You know, and it so happens that drugs get housed there. But that basic idea and as you say, and kind of stunning. And who knows if and how we crawl back from this. You've got west coast states saying, we're not going to rely on CDC guidance anymore. We're going to make our own traditional vaccine policy recommendations, which stand to reason, I guess, as being more rational and science based on than those now coming out of Washington. But are we headed toward a sort of balkanized health policy with each state, especially blue, going its own way? And can you explain why, you know, notwithstanding the virtues of federalism and the American republic, as an experiment, being that sort of loosey goosey where public health is concerned is a real cause for concern?
- [19:18]
A
Yeah, let me answer that first. Viruses don't know any state boundaries. I mean, this is the problem. Like viruses and bacteria for the most part don't actually comprehend when you've left the state of Maryland and you've wandered into the state of Pennsylvania, they could care less.
- [19:32]
B
Guys, come here. We got a good one.
- [19:33]
A
All right, so that's first and foremost, my biggest concern is that we don't have the luxury of saying to the measles like, oh no, you stay in the state of Texas. They were totally fine with the CDC the way it was. So I feel like as a doctor, it is just completely idiotic. And then, and then let's go to the like level of insurance care. So I think that this has nothing to do with the CDC directly, but indirectly it does. Like when the CDC makes certain recommendations. Just usually insurance companies kind of follow. When the CDC recommends a flu shot every year, insurance companies, thanks to the Affordable Care act will say, okay, we will pay for that without any CO pays. You will not have to pay out of pocket to get that flu flu shot because why? The evidence recommends that the CDC signed off on it and the US Preventative Services Task Force has endorsed it. Thumbs up when we Have a CDC that feels and appears and is dysfunctional, then. And then the states are off going to do what they want to do. When you're a national insurance company like United, like Humana, like Cigna, like Aetna, like most of us who get our health insurance through an employer, you have to then wrestle with, well, am I following those guys? Am I following the state of California? Which one? So there becomes a very pragmatic and.
- [20:46]
B
Wrestle with insurance company. Right?
- [20:48]
A
Yeah, right. So it's. So I think that's like. But the first and foremost is that diseases and viruses know no boundaries. And so when we have this Balkanization or even this, like, lack of support for something that's more federated, we just have, unfortunately, we, we've exposed ourselves. And then the area that I'm less familiar with but have like a peak of it because of the pandemic is national security. I mean, we had a lot of conversations about Wuhan and whether or not the coronavirus was, you know, manufacturer gain of function, like, what was it? And you've seen the reports, as I have here. You know, it seems like we've come out where it's like a little bit of both. This was a natural kind of evolution of a potential previous virus to the coronavirus. But could there have been a role in, like, research in this maybe? At this point in time, our country is incredibly exposed to some of these, like whether it's a novel virus or just some infrastructure attack, because they can set off anthrax like we had several decades ago. You know, in the white, in the, in on the hill. There's just a lot of things that we're susceptible to now from a security standpoint.
- [21:54]
B
You know, I've done some work on this kind of stuff, tabletop exercises. There's nothing scarier. There's nothing scarier got, you know, somebody gets smallpox, comes to the country. Yeah. Okay. Well, as you mentioned, you're also a primary care physician. So I mean, it's just a slice obviously of the, of patients in the country. But in that role, are your patients, you know, in large numbers, coming to you worried or confused about these things that they're hearing in the news? What sense do you have of how this is affecting just normal, regular patients in Americans?
- [22:33]
A
More confusion. And I'm going to be honest with you, it started before RFK became secretary. I think ever since COVID became, in its own right, politicized. Like politicized. Politicized. Politicized, sorry. In its own right. We've had, I've had Patients who have said, so am I, should I be getting this shot? Should I not be getting this shot? So it started with a little bit of that around Covid specifically. Now we have parents. I see adults, so I don't see children. But in our practice, there's pediatricians that I practice nearby. So what'll happen is like, the kid will be seeing the pediatrician and the parent will see me or kind of vice versa. And usually now, now more than often, the parents will say, you know what, I think we should hold off on these shots. Like, I think we should wait because it sounds like we don't need them or they might be bad. And what's unfortunate, here's what's really, this is the truth. Nope. Very rarely are you going to hear a doctor who practices kind of tell you the truth. The moment I walk into a room, I've got about six to seven minutes with the patient because it's a 15 minute visit. There's like all this junk you have to do. I have five to seven minutes of precious time with that patient. If the majority, that time is spent kind of trying to convince them to get their annual flu shot and their Covid shot. Guess what I'm not doing. I'm not screening you for diabetes or cancer or some of the other things. I'm like, you know what, come back next time. We'll talk about all the other stuff. So whether I like to admit it or not, our system is broken as it is, is now even a little bit more broken because we're spending a lot of time and I, by the way, I am completely okay to have these conversations. I regret that that's the conversation I'm having. I regret that I'm not telling enough 45 year olds they should be getting a colonoscopy because I regret that I'm not telling enough 40 year old women to go get a mammogram. I am not doing like a breast exam because I'm sitting there talking to people about like whether their kids should get a measles shot. Like, so it's a very strange time. And I'm going to. This is the next thing I'm going to say. It's the first time I've said it out loud to like a non medical audience. I thought that the burnout during COVID was very real. Like I felt it, I was depressed. And there's something even more depressing right now because it, during COVID at least you remember, like, you know, people were like clapping and like kind of hailing like Health care novel.
- [24:51]
B
Yeah.
- [24:51]
A
And like, you know, they seemed like that there seemed like for a moment that we all just kind of understood that like this thing sucks and that like there were people who kind of did, you know, EMS workers, doctors, nurses, everybody was like part of like the set, you know, the people to help kind of figure this crap out. Right now. What I feel like I have no agency or power or voice or anything because it doesn't feel like anything I say matters. If the president can go on the air and just undermine decades of my education, like it just so I've. I've seen more burnout or at least this feeling of hopelessness amongst healthcare workers than I have seen before. Talking Feds is supported by the Brennan center for Justice. In this new political era, the Brennan center will do what they do, defend the Constitution and the rule of law. They're prepared to fight against presidential overreach and will continue advocating for reforms to resist weaponized government, stop billionaires from corrupting our elections, and ensure every eligible American has the freedom to vote. Stay informed by visiting BrennanCenter.org there's one.
- [25:59]
B
More aspect of this kind of demolition job on American health that we're talking about. Wacky views, et cetera. The guy is also cutting funds like a maniac. We just read that he cut basically all funds to research cancer. So we've got really draconian cuts. Are you feeling them yet? Do you have a sense of the price to pay? What's going on? I mean, it's just we're certainly, we're already seeing in the foreign policy era, here are our patients being left, you know, in the lurch.
- [26:32]
A
Yeah. So Stanford, for example, has a great deal of funding tied to NIH and to other federal agencies and there's been a definite double digit decrease in funding. And also what I would say is, to your point, it feels very mercurial. Right. Like I'm just cutting off all funding for cancer. I'm cutting off all funding for cancer.
- [26:54]
B
They're actually.
- [26:55]
A
Previous autism research was cut, MRNA vaccine research was cut. So there's been lots of these broad swath areas that are just done away with and unfortunately not all of it's being replaced with something. So if you were somebody who did research in pandemics or vaccine hesitancy, that work is gone. But then there's not anything to kind of replace it with to kind of pivot your career to. So we have a lot of faculty who are up in limbo or trying to figure out how to cross subsidize their work. And then I think an even bigger question is, let me be frank, like the NIH wasn't necessarily the only game in town. If you were a cancer researcher, there are a lot of things that you depend on to get cancer funding, but you never really. The NIH was always kind of this like core essential, and you never thought it would go away. And now with the NIH going away, pretty much, where do these researchers turn to? They're going to other countries. So we know of many prominent faculty who are interviewing for jobs in Europe, interviewing for jobs in Asia and Canada. And so there's a brain drain that I think in not just science, but I think in other sectors as well, that's happening. And a lot of it is, you know, we self imposed, we brought this on ourselves.
- [28:10]
B
And atrocious, you can overlay that with that. The immigration stuff, international students not knowing what to do. But just in general, the very successful, robust partnership of research universities and the government seems like it's being demolished. It's so valuable to have you. I know you got to go, but I just thought I'd serve up to you. Are there other healthcare stories maybe not making the news that are keeping you up at night or perhaps conversely, causes for some sanguinity that aren't getting reported on much?
- [28:44]
A
Yeah, I think that it's getting a little bit of news just because of the standoff with the budget in terms of like the Affordable Care act and subsidies for Affordable Care act plan premiums. What's not making the news is the fact that we're now starting to see the cuts that the one big beautiful bill that was passed earlier this year, that we are now starting to see and feel the effects of the cuts on Medicaid and rural health because we are now seeing hospitals that are having to close as well as insurance companies that are having to offload patients that are, you know, going in 2026 will no longer be insured by a Medicaid plan and have nowhere else to go. So that story is kind of getting hidden in like a lot of the like top above the fold headline news around the budget standoff. But what's not getting like front of page or any news right now is what's happening to these millions of people who are just kind of getting dumped and then who's taking care of them because the rural health clinics or the r. Rural hospitals, you'll hear Trump talk about $50 billion going to help the rural kind of population, but that's in light of approximately $900 billion in cuts. So it's not even math. And so I think that's one. And then the second one is around health AI. You're seeing some shifts that are really under the radar around how we think about regulating or in some cases not regulating health AI. And I think think that that's important because if you and I think about what you, what we use Chat GPT for, most of the country is using it for things that are medical, but they're not supposed to be used in that setting. So it's so, so it's a, so it's an interesting time. So I think those are all regulatory things that are happening like in the background, but don't get as much front of the page attention but should. If you're somebody who uses ChatGPT as a therapist, which approximately 40% of Americans do, then it kind of matters what's happening it kind of matters what's happening with the regulation of those of that software and of that intelligence, and that's happening below the radar. So those are mine.
- [30:50]
B
Wow. Is that another full episode? Especially with what I understand ChatGPT's propensity to kind of tell you what it thinks you want to know. Kavita Patel, always a pleasure to be with you and hope to see you soon and everybody else out there. Talk to you later. Thank you for tuning in to One on One, a weekly conversation series from Talking Feds. If you like what you've heard, please tell a friend to subscribe to us on Apple Podcasts or wherever they get their podcasts. And please take a moment to rate and review the show. You can also subscribe to us on YouTube, where we are posting full episodes and daily updates on Top legal Stories. Check us out on substack harrylitman.substack.com where we're posting two or three bulletins a week breaking down the various threats to constitutional norms and the rule of law. And Talking Fez has joined forces with the Contrarian. I'm a founding contributor to this new media venture, committed to reviving the diversity of opinion that feels increasingly rare in today's news landscape, where legacy media seems to be tacking toward Trump for business reasons rather than editorial ones. Rest assured, we're still the same scrappy independent podcast you've come to know and trust, just now linked up with an ambitious and vital project designed for this pivotal moment in our nation's legal and political disruption. Find out more@contrarian.substack.com thanks for tuning in and don't worry, as long as you need answers The Feds will keep talking. Talking Feds is produced by Luke Cregan and Katie Upshaw. Associate producer, Becca Haveian. Sound Engineering by Matt McCardell, Rosie Dawn Griffin, David Lieberman, Hansa Mahat Drenathon, Emma Maynard and Hallie Necker are our contributing writers. Production assistants by Akshay Turbailu and Sebastian Navarro. Our music, as ever, is by the amazing Philip Glass. Talking Feds is a production of Deledo llc. I'm Harry Littman. Talk to you later. SA.