CMCL Interview: Frantz M. Berthaud, MPH, FACHE

Welcome back to another episode of the Changing Minds, Changing Lives podcast. My name is Julie Sowash. I'm the executive director of disability solutions. Um, and I thank you for tuning in. If you have not seen some of our earlier episodes, I want to encourage you to go check them out.

We've had such amazing guests so far, including our last podcast, which had Wesley Hamilton from Disabled but Not Really, and queer eye fame. Um, that was one of my silly, kind of nerding-out fangirl experiences, and I was so excited to have Wes on the show. But we also had Jamie Shields from the UK, which was an amazing conversation, um, and Andrea Delzell, um, the nurse from the seated position who I learned so much from, um, and as you guys may know, if you know me or have heard me speak lately, I do have a real passion around something other than disability employment, and it's really access to.

To healthcare, uh, for people with disabilities, and creating equitable opportunities. And I've had the pleasure over the last couple of years to work with today's guests, um, on a couple of different projects related to access and equity in clinical trials for people with disabilities. So something that is way different than what you'll usually hear me talk about here.

But just like disability employment, when we thoughtfully approach diversity inclusion in clinical trials, we can see demonstrable outcomes. And so I'm so very excited to welcome my friend and guest this week, Franz Berthoud, market director of oncology at a large health system based out of West Texas, and, um, innovator at the intersection of oncology and equity.

Franz, welcome to the show.

Thank you so much for having me, Julie, I always love chatting with you. Um, and I'm so happy to be here.

Thank you so much. So, Franz and I met, I think it's about two years ago now, um, maybe longer. Um, and he was a guest on my other podcast, crazy and the king, that I do with my good friend Torren Ellis. And he came on the show right after the COVID vaccine rolled out and was such, ah, an interesting conversation because we really dove in so quickly on the intersection of healthcare and equitable access to health outcomes.

And so tell me a little bit. I was teasing you before we jumped on that. Innovator is sort of this new title I saw, and I loved it on your LinkedIn. Innovator at the intersection of oncology and equity. Tell me what that means to you.

For sure. Um, so really, the way I approach it is, um, I see my world and the contributions to what I do in really, these two lenses. One uh, being equity, without a doubt, that being a foundational kind of through line, um, to everything that I do. And you mentioned at the beginning, and when I think about, uh, equity, it's this tide rising thing where if you do it well, you're deliberate, you're thoughtful and you build it into what you're building.

Um, it's going to benefit everyone, right? It's going to benefit and anyone and everyone. A rising tide, uh, raises all boats. And so equity is such a big piece for me. It's one of these, these roads that I constantly go down. And then the other being, um, cancer care.

I've dedicated my professional career, um, to the cancer care space. And so when you think of two roads, um, that are merging, you know, I live on that corner of the street, uh, where both of those meet. And it's for me, that's my home in a place that I welcome anyone and everyone to.

And I'll always be in that space, hopefully effectively impacting, um, uh, communities. As we look at cancer care, the words you're using, access and the ability to care for all different types of people with, um, that diagnosis, but in a really, really thoughtful, deliberate and equitable way.

Yeah, I love that. Because so often when we talk to, I'm going to say employees, leaders, people in their professional lives, they really have a hard time understanding that those two ideas can live together, that we can be both professionally successful and committed to the work that we are doing, uh, the incredibly important work that you are all doing, but also being thoughtful and proactive in the ways that we think about how that work is done.

Absolutely. And that is, um, I go back to my undergrad. I had this professor, uh, father himes, um, and he talks about kind of the three questions, um, that you're being asked in your life. Uh, and certainly I think in our professional lives, we ask them. And I might butcher this if I can't remember the three questions, but I'll certainly remember some of the most important ones.

It's like, what are you good at? Um, I think what energizes you or what makes you happy? And the other is, what does the world need you to be? The questions are not centered around what do you want to do? And I think oftentimes we're driven by like, I want to do this, I need to do this.

Um, you think about this in a very global way, in a very collective and kind of communal way. Well, what does the world need you to be? And that's a huge kind of existential question. And when you can answer that, right. And it coincides with what makes you happy.

Um, it operates in this way to make the huge distinction between occupation and vocation, right? Like, what is your job? What do you get up? You do every day, right? You pour your coffee, you're ready to get to it, um, walk out the door, or if you're remote, right.

You know, um, hop on the computer screen. But then the other is your vocation is like, what's your calling? What are you called to do? And very on, uh, early on in my professional career, I think I made that, um, distinction. I discovered it, right. Or maybe it manifested in some way, but it came to light.

And, um, it has helped guide me, uh, in making every single professional decision on a daily basis, on an annual basis. And so when I'm pushing equity principles in the organization, when I'm trying to make initiatives happen, and I'm trying to bring, um, a higher level of cancer care, um, to the community, you know, those three questions are stacked up, and they are right.

If there was one more, it would be your, uh, north, south, east and west, right. It's my professional and personal compass.

And when you think about what the world needs you to be, it's hard not to have a lot of energy and passion. When you kind of are able to core your being, understand that your impact is creating a ripple effect that's going to last much longer than you and I, and it's going to create the next generation of leaders that, um, don't have to do the work that we're doing now because we did this work now.

And just thinking of us as sort of a foundational piece of a pyramid M as we move towards greater equity is a really, it's, uh, just a really energizing way to think about it. Thank you for sharing that. And, you know, over the last couple of years, again, you, year and I have had the opportunity to work on two different projects related to better inclusion of people with disabilities in clinical trials.

But I want to even take a step back further than that is, you know, really tell our viewers and our listeners, what is the basics of a clinical trial? We'll say a clinical drug trial from your oncology perspective. And why is it important to have. Have, um, a trial population that's reflective of the group of people that will get that diagnosis and hopefully live after you've been able to treat them through the amazing work that you all do at your hospital?

Yeah, absolutely. So clinical trials, when you think, certainly in the cancer and oncology space, um, let's say you have a patient who's been diagnosed with, you know, breast cancer, and, um, they've gone through three, four lines of therapy, right? They have a first line therapy they try that doesn't necessarily work, right.

It's not yielding the outcomes that we expect. They do a second line, third. And then. So it gets to the point where it's like, okay, the traditional ones, the kind of tried and true cancer, uh, drug regimens, they're not working, um, for this person, for whatever reason. So we need to seek other options and clinical trials.

Is that kind of that. That, um, other option where, you know, um. And why it's so important where we fully understand, um, that person's kind of, um, genetic makeup, the mutations of that cancer, really personalized, like, at that cellular level, to say, okay, this particular person has this kind of breast cancer, right, really granular.

And from all of the research that we've been doing in looking at the combination of these two drugs, this new one that we're introducing says, these folks have had a better outcome. This particular type of cancer has a good outcome when you combine these two drugs. And so we then introduce, or at least get that patient onto that clinical trial, because that gives them a better chance after having tried all of these other, um, lines of therapy.

And so I always look at clinical trials as it's so critical and important, um, because what we're saying is there are options and there's hope, right? There's opportunity. And when we go back to the access or the equity piece, if we don't have clinical trials and, um, particular communities, it means that we're relegating that community to not have as many options as others.

And that is a foundational principle of access and equity. It's like, where we are, uh, we need to ensure, at the very least, these communities have the same access. And as far as clinical trials go, and I always point to, you know, the Gleevec story, which was a, um.

Gleevec was this drug, um, manufactured for, uh, cancer care. Um, I believe it might be specifically gleevec, uh, might have been for leukemia. And don't quote me on that. Um, we can backtrack and check later. But so Gleevec was this. People were, you know, um, saying, it's this miracle drug.

It's incredible. It's working so well. And what they started to see was, yeah, it's working really, really well in one particular population. And they're like, okay, once they started introducing it to others and said, well, why is it not working in this other, you know, say, ethnic and racial group.

And what they found was like, well, when they were starting out the clinical trial for Gleevec, they left out that entire group, right? It was such a small proportion of and not represented in the clinical trial. And so what they're touting as this miracle drug is, yes, for one particular group.

And when I think about access and equity, clinical trials, um, and certainly population of folks, um, who have disabilities, who are often left out of clinical trials, um, for a slew of reasons, right. Folks say, like, well, we don't know, can they sign consent or, you know what? It's going to be harder to get them onto clinical trials.

You know, all of these reasons, um, and, you know, I'll call them excuses where. So then you have folks who are not, again, as you stated, they're not. They're part of the larger population, yet they're not represented on the clinical trial. So how can we truly say that a drug, um, or drug regimen, a drug combination, uh, certainly in the cancer space, is going to work for folks if we've not truly, um, included them in the very beginning, right.

The nascent of the work that we've been doing. And m. It's that. It's that piece when of, we leave people out, you know, we're leaving them out of opportunity, we're leaving. Leaving them out of care, um, and essentially, we're excluding them from hope. And that's just something that doesn't sit well with me.

So I love the way that you frame it, and it, again, kind of goes back to your intersection of oncology, inequity, or health care and equity. And, you know, as we went through this journey together over the last few years, what at least I think was the most overt case of, um, exclusion that we saw was when the Centers for Medicaid and Medicare Services said, um, for an Alzheimer drug trial, one that is now being touted, I believe, as one of the most effective treatments that's going to come to market.

CMS said, um, people with down syndrome cannot participate. So our own federal government came out and said, people with down syndrome cannot participate, and really only gave the reasoning around, um, the ability to consent. So, as you mentioned earlier, but what we know is that people with down syndrome are more likely to have Alzheimer's.

And by the time they reach the age of 50, a majority of people who have Alzheimer. I'm sorry, have down syndrome, will also have Alzheimer's. And there was a big outcry and there was a big pushback to that. And CMS had to relent because it was not a decision based on sound science or even appropriate expectations for the ability of people with down syndromes to understand what they are entering when they're entering a clinical trial.

But the other thing that I think that we see probably most often, and I would say kind of two things, one is disability. Inclusion is always reactive. I, uh, have someone who shows up and they need an interpreter. Oh, well, can. Is my consent form, can it be translated to american sign language?

Does that count? Or, you know, something to that effect, or to the other point that you made? It's going to be harder for me, the healthcare worker who is doing this work, and I want to make sure that we say

that's not a criticism of clinical trial workers, because, uh, something I didn't understand, because I'm not from your world, is how hard the researchers are working to make sure that they can get people through in an equitable way.

Right, right. And I think, you know, what you said is so salient because we see it, if it's an Alzheimer's drug, if it's an oncology drug, I think, um, we're not giving folks enough credit, um, as people, as humans, to be able to be part of this. Um, and again, we're leaving them out of opportunities to live longer and fulfilling lives.

And, um, it's certainly a disservice at the very least.

Mhm. Yeah, no, absolutely. And as we're, again, kind of thinking about greater access to health care and the drugs that are needed, um,

we started talking a little bit. And really, I think in the work that needs to be done, we just barely scratched the surface in how artificial intelligence is going to dramatically impact not just people with disabilities, but any underrepresented or marginalized group in healthcare in general, but especially in clinical trials, to have even the opportunity or the awareness to participate.

Can you talk a little bit about what you're seeing in terms of use of AI in clinical trial, clinical trials?

Absolutely. And I think AI technology will certainly help make research more inclusive, um, the ability to reach new populations, again, who previously didn't have access to clinical trials, um, counteracting the biases that have led to gaps in what we see and gaps in access, gaps in diversity, uh, uh, of participants in clinical trials.

Um, so when you have AI and you have this technology, um, that can perform these functions, and the thing that's really interesting, but also, um, we have to be thoughtful about machine learning, is it will perpetuate and start to understand systems based on the data that's, um, put into it.

And so we have to ensure, like why, while AI will help in perform some of these functions and do this work, we have to input that information in. So it actually still requires us to have representation, um, even in the data, so that what's being fed into the system, fed into the technology will regenerate and perpetuate and it starts to understand things.

Um, we have to make sure it's in the outset, right, it's happening there. But I think also what AI is going to be able to do, and certainly in the clinical trial space is almost this precision matching, uh, of, uh, patients with clinical trials, right. It starts to understand, well, uh, hearkening back to what I said, oh, this patient has this particular, um, type of cancer, this mutation, it's using that information, it's using demographic information and saying, like, okay, here are clinical trials that might best fit this patient, and maybe if demographic information is also in there where they live, it might say, and here are some sites that offer these clinical trials.

So it's really pumping up that access piece, um, enabling, uh, folks to find clinical trials that are closer to home, um, that are going to include them and doesn't exclude them, so that we're reaching our recruitment goals, um, for clinical trials and getting folks the care that they so need.

That was a very nice and rosy picture, and I like it because I think, uh, you know, I, I am seeing how you are evolving in this conversation. You and I have just privately had some, like, or at least for me, sort of near panic type thought processes. When I think about this big black box of data and then how the machine learning and the AI is going to work, um, to exclude.

But what I liked about what you said just then is that it is going to be able to bring much more awareness and much more information more quickly to the potential patient than what we have now. And that is very exciting. As we always say, the first barrier is knowing that the trial exists, knowing that the information is out there and where to find it.

Because just like anything, if you haven't had cancer, if you haven't had a very serious illness, you don't think about how to participate in a clinical trial. You may just assume, hey, if I'm eligible for something like this, my doc will tell me, because my doc has to know everything.

And that's not a fair assumption. So this is really a positive way to think about how, um, the AI is going to help with information generation, um, as well as then if we do have that demographic information, which you know, I want to talk a little bit about right now is.

Is not being collected on a regular basis right now.

Right.

And that, that, again, was something, as a non scientist, I'm a process person, I'm a tech person, was really hard for me to understand at the beginning why that just wasn't a normal part of the process. Like, sort of, to me, like, it's a no brainer.

Um.

Um, and then when I started meeting with researchers and clinical trialists, and they started to help me understand where their mindset was in just finding a population that has these specific, um, diagnosis or this specific, um, set of circumstances, how adding that extra piece of complexity is hard for them to kind of rationalize and why that's important.

And I think the tide is starting to shift, um, a little bit in that way, but kind of. What is your experience kind of right now in 2024 of, you know, are we making forward progress, ah, as an industry, um. Or are we starting to stagnate a little bit?

Because Dei is kind of going out of vogue, but what we should really be focusing on is greater humanity and how to be better humans to the patients that you all, as an industry, are interacting with every day.

Absolutely. And that's a great question, because I think to go back to the clinical trial, um, scientists and, you know, the PiS principal investigators saying, like, well, it adds this layer of complexity. You know, I venture to say, like, humans are complex, right? Like, and that's okay. Um, I do think that we are better off now than we were prior to, and I'll tell you why.

And I even think, unfortunately, and if this has to be a silver lining of the. The COVID-19 epidemic, what we saw in health care and what we're seeing in health care, um, and I'm emphasizing the word because public health, for a very long time, ran on foundational principles and fully understood social determinants of health.

Right? Yes. If we're calling things Dei and Deib, and we don't want to have that nomenclature because it's now having some sort of odd and negative, um, connotation, but social determinants of health have always been a thing, right? And so as the pandemic occurred and people started to understand, well, why is there a lower vaccine uptake in particular communities, um, versus others?

Why are certain neighborhoods not getting vaccinated? Like, what's going on? And it forced health care, as an industry to kind of adopt some of the public health, um, understandings. And what we're also seeing on the healthcare side is you're seeing the governing bodies like the CMSs, Medicaid, and, um, CDCs.

Uh, and folks saying, all right, if you're having issues with keeping patients out of your ER, they keep particular patients keep cycling through, and you're trying to understand as a hospital or health system, like, why does this keep happening? And finally, some folks said, like, well, we realize this patient is unhoused.

They're experiencing homelessness. This is why they keep returning, right? There's not a place to go. Um, and if the ER is being utilized more like primary care, because individual doesn't have an occupation, right. They don't have a job, not being paid a living wage, and therefore, they don't have, um, health insurance that is tied to their employment, right.

Kind of all of these things that, uh, for the longest time, like, well, this is how healthcare works. And so now you have governing body saying, we're gonna ding you, or you're going to have to figure out how to help with social determinants of health, because it is now part of how we judge you as a hospital or health system.

It's now how you get paid. And when I, when I tell you that, you start talking about how hospitals get paid and the healthcare system gets paid. Oh, they'll, they'll shift, they'll change. And so you're starting to see social determinants of health and kind of principles of health equity being, um, part of the payment structure for health care.

And so hospitals are like, yeah, yeah, we're going to change this. Like we're going to be effective. And you're starting to see hospitals and health systems that are investing in, um, creating homes for the community. You're seeing hospitals who have rooftop gardens, and they're, the physicians and clinicians in the hospital are prescribing healthy food to patients.

There's a hospital in Boston, Boston medical Center, who has solar panels on their roof, and they're starting to subsidize electricity for patients, right? Because when you're, you're starting to see the shift in the understanding of the distinction between public health and health care. And what Michael, uh, Stein, um, and, um, uh, who's a chair at the bu School of Public Health and kind of, uh, Chris Lewis, who's a professor there as well.

Um, Sandro Galeo. It's like this idea of public health versus the public's health. And how do you care for the broader, um, amount of people in a way, and create really sustainable impact that's going to, again, be tighterizing, uplifting an entire community so that the community is healthier. And so you're seeing less folks, um, cycling through the ER because now they have a place to call home to, ah, rest their heads.

Right. Um, you're seeing job, uh, creation, you know, another hospital who, um, bought, um, and built a grocery store, right? So it's like, yes, we can provide healthy food and we're gonna have folks in the community be the ones to run the store. And it's this type of thinking when we see ourselves as healthcare entities, part of the community and like, what is our role?

Oftentimes you'll have large health systems who, uh, might be the largest employers in their community. And so what do you need to do to ensure that you are remaining in that community? As a fixture in service to the community, not just to provide health care, but to provide public health.

Right. To take care of your community in a way that's much broader than the kind of circumstantial or episodic, like, we're gonna replace your hip. And it's like, no, we're going to clean up this park, we're going to build affordable housing. We're going to work with loan, uh, folks and real estate developers to provide micro loans to community members so that they can actually afford those homes.

We'll build a rooftop garden, and we're going to feed the community, because that is healthcare. And now that we have a better understanding in the healthcare industry and the business, if you will, that social determinants of health keep people healthy and, um, keeps a better balance of who should and should not be in the hospital, um, there's certainly money behind that.

Um, and it's a good business model and I'm a firm believer that we can do good and do well financially.

Yeah. So it's so funny because my husband, Chad and I were talking about this yesterday. So I'm m really, I'm a big junkie in the stock market and all of that kind of stuff. And I'm very interested in how, in particular, these weight loss drugs like Ozenbeck or Wagovi, um, are going to have what I think will be the kind of impact on our healthcare system that you're talking about.

And so, you know, since we live in Portugal part of the year, I know when I go there, the doctor calls you and says, hey, it's time to come in for your annual, it's time to come in for your female checks. It's time to do all of these things, because the focus there is how do I keep the population healthy versus how do I treat the sick?

And so it's a very different way of thinking. And, you know, correct me if I'm wrong, but how I always think of healthcare kind of very broadly, and maybe not appropriately, is, um, the money's made treating sick people. It's not made keeping people healthy. And so when we have kind of fundamental, um, foundational and change in not just what we're being incentivized on from the government, who, who should be driving that kind of payment structure, um, that you're talking about, but also if one of the fundamental aspects of our unhealthiness, um, starts to shift as a country, um, and I think that's just such an interesting way to think about how to monetize by making a positive impact and understanding that when groundbreaking, you're drugs do come and have the potential to potentially upend the way that we've made money, um, within an industry, many industries, even outside of healthcare, um, that we have to start thinking about the population and the communities that we're in differently, for sure.

I think in the cancer space, we have a full comprehension that prevention and screening changes everything. Changes everything. And so I think that as hospitals and health systems, when we adopt that same approach, right, preventative medicine, um, like we're going to take care of our folks. And I think why there's a, uh, I don't want to call it an economic like transaction, but why it is

able to still generate money, if you will, or pay for itself is because when you take care of people really well, they will come back to you. Whether it's in the form of wanting to work at that healthcare, um, institution, organization, um, wanting to. It certainly if it's a, um, nonprofit, um, hospital or health system wanting to donate, right.

Folks leaving, you know, hospitals and their wills, um, and so there's a bit of brand ambassadorship that happens when you do a really good job of taking care of people. Very empathetic, um, and real. And, uh, going back to what you said in a really human way, um, it will come back to you trifold like, I'm a full believer in that.

And, um,

I want to talk a bit about what you said with those particular drugs. And what you're seeing right now in the news with them is, um, what it costs to produce the drug is this minimal and nominal fee, we'll call it, versus the actual ticket price of the drug that reaches $1,000 a month or so.

Now there's administrative pushback to say, like, wait a second, we're creating an access issue right. If we're, if the drug is priced at that amount per month, but it doesn't actually cost you that much to produce it, we need to figure out a much better balance. And I fully understand the business of it.

Right. Like, yes, you know, these folks will be, um. The companies want to make sure it makes sense for them, and that's the c e n t s. Um, but I think we need to ensure that it's balanced in a way that it is accessible to everyone, or at least there's an opportunity for them to get it.

And oftentimes that's what happens in healthcare, is the haves are going to be able to access these revolutionary drugs and the have nots are relegated to whatever else is left. And I think, um, and I like to see that oversight from the powers that be that say, wait a second, like, this is a little bit, um, you know, the scales are tipped in one way and we need to, uh, seek a different way to accomplish this.

Yeah, I think that's just such a good point. And I even just sort of checked my own thought processes, as you were speaking, because I actually was listening to a podcast this morning about how basically ozembic costs $10 to make, and, and it gets to that thousand dollar a month price tag.

And that's if you have a job that has healthcare associated to it. That's if you have access to that kind of, uh, money and those kind of things. So even as I'm thinking about how I see the economy going to change, I'm saying that from a place of privilege, a person who has healthcare, a person who, you know, could not spend $1,000 a month, but could have access to that kind of medicine.

And that's such a good point. As we sort of round back to so much of this is about this simple process of building something where someone has access and the ability to participate. So if it's close, if it's in an accessible building, if it's not going to cost too much out of pocket, if there are systems and processes to help me make sure I follow up with the protocols, like all of those pieces, um, are actually what make dramatic differences and that can be measurable impacts.

Such a good point. And you've been so generous with your time. I have one more question, um, just really about, you know, that I live as a person who lives with mental illness. And one thing that I've been learning about over the past couple of years is just sort of the amazing amount of stigma in healthcare providers, um, who, you know, especially after COVID in the oncology world, have some of the most difficult jobs in the world and understanding and admitting that they need support around their mental health to be able to do the best job and also just be the best parent, husband, you know, community member that they can.

How are you seeing just, you know, from an overarching perspective? Is the conversation around, um, mental health and mental illness in the provider community shifting at all to be more open and or more proactive in how, um, administrators are thinking about keeping, um, and treating and retaining these amazing researchers?

Without a doubt. Um, and again, as you, you kind of alluded to, COVID, uh, 19 and that pandemic illuminated for a lot of people how we were kind of just running our healthcare system, um, and all the clinicians that are part of that engine. Um, and, you know, if you are, if you ever run a car with no, you know, fuel in it, you know, you're going to have issues.

Ah. And I think that, um, it helped us to better understand, and the big buzzword for the last few years has been burnout. Um, and we're only at probably the tip of the iceberg as far as what can we do for our physicians, nurses, clinicians, social workers, anyone and everyone who kind of touches a healthcare system and helps to make it run?

Um, how do we care for the caregivers? Um, that is the kind of big philosophical question. Um, the caregivers, the cup fillers, if we can't fill their cup, how can they go on to fill others? Um, and it's a big question, but, uh, I do believe that, number one, the fact that we've been talking about it in healthcare, uh, for the last several years is unbelievable.

Right? It's incredible, um, that we're there, and yet I know we still have so much more work to do. When we think about residents and the numbers of hours that they work, when we think about how we, you're a process person, how we schedule patients and does it allow for lunch breaks, all of these things, we have to just be super thoughtful.

Um, and I use the t and the d often thoughtful and deliberate, because, like you, we got to do it on purpose. We have to, um, essentially run on purpose and do things on purpose. And I think that's where, um, you know, at that intersection, I think that's where we will, um, care for all of these folks in a much better way, which in turn will enable us, uh, to care for our patients and our communities and our loved ones, um, in a much better way.

Awesome. So just as a little side tease. Franz and I will be probably seeing you all at a medical conference, uh, over the next couple of years, talking about the research that we did around better inclusion for people with disabilities in clinical research. Um, we are passionate about this work.

You've been such an amazing partner, and you have taught me so much. Um, and you're so thoughtful in the way that you address better equity. Thank you for joining us. Um, if you want to connect with Franz, where can he find you?

Um, you can find me on maybe LinkedIn. Uh, it's Franz. F r a n t z m. Berthaud. B e r t h a u d. Um, I would say x, but I'm hardly ever on it these days. I'm hardly ever on it, um, these days. But I love having these conversations, and I welcome the, um, opportunity to think through it and brainstorm with anyone, whatever.

It gets us to a better place.

Amazing. Thank you so much. Thanks for joining us again for another amazing episode of changing minds, changing lives. We'll catch you soon.