Rethinking Health, Longevity, and Quality of Life

Good morning everyone. If it's still morning, yes. Good morning everyone. Please come on in, take a seat. We are going to get started in the next minute or so. So we'll let people trickle in, but we're going to kick off. Thank you so much for joining us for this conversation. I'm Ellie, and we're here to talk about rethinking health, longevity, and quality of life. And I'm going to start by introducing our esteemed panelists, then I'm going to give you a bit of context on how this session works, we're going to get going. So Wendy Barnes, who is on the end here, is the President and CEO of GoodRx, Rashima Kemp's Polanco, Chief Commercial Officer, US for Novartis, and Novartis is our sponsor for this session, so we're super grateful to them for making it happen. and then Paula Schneider in the middle is the CEO at the Institute Advancing Women's Health. Now I want you guys to hear from me as little as possible in this session. So I'm going to ask a couple of questions and then it's open to the floor for you to take it wherever you want to go. Julia has a mic and she's going to be darting around when you have something to say. So what we really want to do I think is paint a picture of where we're at with women's health but also talk about solutions because I think to an extent we're all pretty aware of the gaps that exist. I want to talk about what comes next and what we can all do once we leave this room. So I'm going to start with Paula. So tell us a bit about your new institute. It's focused on closing the gap between what science knows and what women actually experience in care. What are some of the most aggressive gaps that exist right now how long do you have um it's on it's on women's midlife health so it's after your reproductive years from 45 on to the great beyond and on average women will go see five or six doctors to try and figure out all the little parts and pieces of what's going on with your body once you hit like perimenopause and menopause and there's no holistic health And it's fascinating because when you are in medical school, and this is in the U.S., although it is a global institute, it gets worse in a lot of places and better in some. But when you're in medical school, on average, you get about two hours if you are studying to be an OBGYN on women's midlife health. So the education is not there. And that's also why when you go and you say, I have this going on and that going on, you may have to go see a specialist for one thing versus the other thing. instead of looking at your holistic health. So our institute is about, it's called Ask, Know, Act, and it's not just a marketing campaign. It's actually the strategy for the organization is asking women, what do you need? And then making sure that women have the knowledge to ask the questions of their providers. It's knowing, it's teaching clinicians. We have a partnership with a medical certification company for continuing medical education so we're creating and using AI to do that but it's all evidence-based we're creating clinician training and when's the last time you actually saw your doctor or how many times do you see your nurse or your nurse practitioner or anyone else and you are probably in most major cities versus when you get out into the rural world or you may never see your doctor your primary care provider so it's making sure that our trainings are available all the way down the line to anyone who touches the patient. And then on the flip side of that, whatever trainings we're putting out there, we're educating women on what to ask. So if your hair is falling out or, I mean, there's so many, there's a plethora of things that could be and may be happening to you, whether it's frozen shoulder, et cetera, so that you know what questions to ask your doctor. And then my favorite part of it is the Erin Brockovich side, which is finding the things that are so egregious and working to close the gaps on those because it's just common sense and I'm happy to belabor that in a little bit. How are you getting this information to women? So what platforms, how are they interacting with you? Yeah, we just started. I was the CEO of Susan G. Komen for eight years and left in the end of last year and then started this. And we have a lot of different ways. for instance, and if I can take just a minute more, one of our biggest initiative is that if you guys, and this is something for all of you, if you are over 40 and you go get a mammogram, you need to ask for your breast arterial calcification to be checked, okay? Because if you do that, it has nothing to do with breast cancer. They'll check it for breast cancer if you're getting a mammogram. It's a twofer. That could be a precursor to heart disease. And breast arterial calcification, it's called BAC, okay? So the reason I bring this up is because of your question that you asked. I'm working with AARP, and they're sending out a newsletter to their 80 million women to say that you should ask for your breast arterial calcification. If they see it, and it's really easy to see for your radiologists, you have, it's clearly there, it's binary, it's there or it's not. And if you do have it, it has nothing to do with breast cancer. It doesn't even have to do with if you get a CAC score on your heart. It has to do a lot of times with midlife that you will present with this, and it could be a precursor to heart disease. It doesn't mean you have to run to the emergency room, but you should have the knowledge, just like you have the knowledge of dense breasts. So for that, we are starting from the bottoms up to get women really pissed off because when you get women with pitchforks, they really get a lot of things done. And so we're working with different outlets to amplify this for us and different organizations to help us to let women know. And if any of you have large organizations that your women should know that they should ask for this, because it's just another data point, but it's a really important one. Rashima, so your portfolio includes oncology, immunology, neuroscience, cardiovascular, renal, metabolic diseases, I'm sure much more. Where are you seeing the most interesting work right now around advancing awareness and conversations around women's health? Where's the most progress happening? Yes, you know, one of the things I'll just say is when you think about longevity and women's health, one of the things we think about in terms of leadership and careers is that we normally hear sometimes our own ambition gets in our way. Before we even get to answering that question, one of the things I have seen firsthand is that our health status gets in our way. And that really matters, right? Because if you're not able to stay in the workforce because you're facing health conditions and chronic conditions, because there's a lot of focus on, as you know, we've worked together, breast cancer and other conditions, but it is these invisible symptoms that are a constellation of symptoms that require women to go to different types of doctors and each gets treated in isolation. Tell us some of these invisible symptoms, what you're talking about. So in the space of autoimmune conditions, and if you take some of them similar to, I would say, chronic spontaneous urticaria and people will say this is just hives but it actually isn't if you talk to women they will tell you at night they can't sleep because they feel like their skin is on fire it feels like fire ants are crawling on on them these are very young women and we're working on medicines in this space we have one approved already but when you talk to them around how long it take for them to get diagnosed sometimes it's years because there's a symptom here you go to see this doctor there's a symptom there you go to see this doctor and again each one is treated in isolation another one is Sjogren's disease is it's another autoimmune condition that we're working on and when you look across these autoimmune conditions they break towards women in certain cases women represent these diseases up to 80 percent and so if you think about it you're the matriarch of the family you're the caregiver are you at the height of your career and again many of these women are young they're taking care of young families as well it becomes really hard with Sjogren's we found the data tells us it takes on average four years for the patient to be diagnosed to get a full diagnosis so think about that four years again because it is a constellation of symptoms and there's a lack of education to really know what's the underlying mechanism of these conditions, and many times they're immune-mediated. So that's really a space that we're really interested in. Certainly breast cancer, you know, we're a leader in breast cancer and continue research there, but also in heart disease. The other one I will speak about, and I love what you said. I'm going to ask for that, by the way, because I don't think I knew that. I think we should all ask for that. I didn't know it. Yes, and I would say the symptoms of heart disease show up very differently in women. How many of you knew that? So if you think about the typical chest pain that will happen in men, it doesn't necessarily happen that way. And many times women will go to the emergency room or they won't. So they'll go to the emergency room, but they're complaining of nausea, GI symptoms, not necessarily chest pain, and they'll get sent home. And so these are the things we have to do in terms of education around heart disease to recognize how does symptomatology show up differently based on gender and then if you start to think about now cultural ethnic backgrounds then you start to overlay zip code then you've got double triple some of the health care gaps that we see in women getting diagnosed and getting treated and having some of those conditions resolved in a timely manner. There's a lot to talk about that I wonder on the point of the mammograms that you mentioned what's the obstacle to women not knowing that information why is their primary care physician not telling them what to ask for when they get to the breast department well the most interesting thing because we went to the head of a very very large many of you probably carry it for your health insurance and said do you do it and if not why and the question was and this was a friend of mine so that I got I actually got the candid information back in an email that I read myself and said that we don't have a code, okay? So, and it would be great if NAAW, which everyone needs to be in awe of us, that's our acronym, if NAAW could help us get a code. And I'm thinking to myself, they've got 8 billion people working on this and they're looking to me to get them a code, but okay, I'll go get them a code. So it's really, and we're kind of like the tail wagging the dog. We partnered with Washington Research Foundation, which is a research fund in the state of Washington, and what we're doing with them is we're working and we hope to be working with one of the major universities up there as well, you might guess which one, but we can't say yet, and about figuring out what's the protocols, okay? So what's the protocols and what's the best practices? Now interestingly enough, I don't even know that we need that, I think it's more of an advocacy play because the state of Maryland just started as of October 1st. If you get your mammogram in the state of Maryland, you get to find out whether you have back or not. So we're going to work state by state, but the challenge is that if they don't have a code or a protocol, but then I spoke with the head of medical officer at Axia Women's Health and said, so you guys have been doing this for a while now since 2024. What's your protocol? What's the flow? Oh, if we see it, we tell either their OBGYN or their primary care doctor, or if they have a cardiologist, we tell them. Oh, okay, that seems so complicated. So, you know, that's what we're up against when you're in the medical world is trying to put together the dots. And this really does require, like, cardiologists and radiologists to work together, right? and even okay I have three radio three medical advisory board members from Yale and they and since we started having conversations on this in the last six months Yale is now implementing it it's really about just getting the word out there so if we can start to overwhelm the system with women that are asking for what they need then that's that's what Inovio exists to do is to close these gaps because the education is there it's there's so many things that we need to continue researching. But these are just specific little things that will make a big difference because you have, especially in younger women in their 40s and 50s, because they may not have high blood pressure or high cholesterol or anything else that would show them that they have this. And it could be a very important thing for them. If you get into your 80s, you're going to have like 40% of women that have it. Okay, fine. You've lived your long life, but in your 40s and 50s you you want to be able to know that it's just something that we should know just like dense breasts Yeah sure Wendy you've chatted do you want to follow up on something and then i have a question i mean i think that the theme that you're you know referring to amidst trying to solve some some very difficult nuances that are insurance and god love you for chasing all of those i mean they're they're complicated it's difficult at the end of the day payers are on the whole public companies needing to meet shareholder interests and it's it's an underwriting question on the whole i mean that's the practical business answer to why certain things aren't covered or if they are why they're still expensive out of pocket and that is that was my primary motivation for coming to get Rx which is the mission that we can negotiate costs down for the overwhelming majority of drugs on the cash side of the equation and that you should be able to use it with or without your insurance. We're really somewhat indifferent, and you shouldn't be penalized for doing so if you do or don't have insurance. And furthermore, to take it even one step beyond that, and that you should be able to utilize your HSA and FSA dollars when you're purchasing drugs on the cash side of the equation. It really shouldn't matter. Those are your dollars. And so we're we're pressing on that um in dc as well um but look more holistically when it comes to taking advantage of uh better pricing uh for you to get a drug standing at the counter i mean we we just that is what we're living and breathing and trying to do but what we know across the u.s is that our primary consumer who utilizes GoodRx does tend to be that woman who is head of household who is often managing not only the decisions for her family but for her parents that there's you know a caregiver element in the equation so she is not only navigating trying to get the prescription for family but for family members with confusing coverage and so our primary aim has been integrating with payers where you can i mean our holy grail is whether you've got coverage or not on your phone you're staring at what is my best cash price what is my price through my insurance and at a host of pharmacies and whatever geography you're in at the moment then you decide there are plenty of reasons why you may want to pay something more on your insurance or you may want to go to a pharmacy that's slightly more expensive that's your decision choice i i'm agnostic to that as is GoodRx but i believe unequivocally that there should always be a cash price for a drug and a funded price for a drug, not the least of which is not everybody has insurance, even though most of our users have insurance. 85, 90% of GoodRx users have insurance, which tells you something, right, about how coverage actually works. It's kind of pseudo coverage these days. Even those of us who have exceptional coverage, and I would put employees of GoodRx in that boat, I'm still shocked occasionally at what the out-of-pocket it is that's just how it goes and look I spent a long period of time inside one of these payers and I understand the reasons for that but I just can't stress enough that we as consumers and we all are should demand that you have a fair cash price and that you know what it is you shouldn't have to search for it it shouldn't be a mystery it should just be evident to you and then you make the decision I want to open it up to give you all an opportunity to comment on what you're hearing um julia has the mic who who wants to kick off does anyone have a comment or shida yeah we're going to get you a mic shida okay take it away i know you don't do research wendy i don't know Paula, I couldn't get whether you fund research we do not, we're not, we used to though, we used to know, right? When I ran Susan G. Komen we were the largest, I just found out, you all probably know this, but this blew my mind that only about two or three years ago did they start doing research on women's menstrual blood only to discover it's an incredibly bio rich, it's an incredibly rich bio fluid that's giving so much information about women's health and um, even opportunities to take care of women's health, so I would be interested in, I tell that everywhere I go because I'm hoping someone will pick up on it and start doing more research because it's been treated as waste until now and it ends up being an unbelievable fountain of information so I'm just using this as a moment for a soapbox to get the word out that this is something someone should pick up on, there's a small cohort of fringe scientists that have some funding to do research on it, fascinating, anyone want to know, we're just going to take that question here, please tell us your name and where you're from Wendy Short-Barty from New Jersey. I work for Bristol-Myers Squibb. Rashima, you said something that resonates. It's this idea that many of us are a sandwich generation who are taking care of children and parents and trying to manage very demanding careers. And because of who's in the room, our careers are not just taking care of the job, it's taking care of organizations. And so if you had to think about one piece of advice you would each leave us with in terms of what is the thing that we should be thinking about prioritizing so that we can continue to function at the level that we're required to function at? Thank you. Great question. I love that question. Let me just give a little anecdote, a little anecdote on a person, a woman I met not long ago. And she is now, I believe, in her 80s. And she was imparting to me words of wisdom as I was thinking about my own career. And she told me that she left a very big job with a very big Fortune 500 company, I won't go into that, at age 48. And she said the reason she left because she said if she didn't leave, the job would kill her. This is someone who looked, like, looked fantastic. I was thinking, if I'm in my 80s, I look like this is going to be great. But that really stuck with me. Kill her from a stress perspective? Kill her? It was what Wendy is speaking about. It is about taking care, being in the sandwich generation, taking care of aging parents or aunts and uncles. You still have children, and even if you have older children who have graduated, it's hard to find a job now. How many children are coming back home? So you're taking care of helping your adult children for longer. And then you think about women live longer, but they tend to live longer in poorer health. And so then taking care of maybe a partner. And then if you're working also, and just everybody has stress. Stress is, you know, whether you're a man or woman or whatever, I don't think stress of these demanding jobs discriminate. but there are gender roles and look those have been shifting so not to be stereotypical but there are gender roles that are also chosen because that's who people want to be and so there is just uh it can feel like an extra mantle that that person has to carry and so when she told me this story it was about prioritizing her health and that she could have gone all the way she could but it was at what cost and so that's why I say it wasn't a lack of ambition that you start to see sometimes women tap out to say this as far as I'm going or I'm going to go and do something else or maybe I'm going to do that second chapter earlier because we're starting to see that it is more important to prioritize your health and women tend to ask at what cost is that and so my advice is And I'm saying this for myself because I have a list on my desk of all of the medical things that I have to get done. And it is good to have friends. I have some in the room who ask me constantly, did you go see this person? Did you go see that? We have to do that for each other because we won't. But we will make sure that our partners go see. Like I was on my husband and I texted him today. Did you go to PT? He's put it off for three weeks. But I will actually call and make appointments for him. sometimes before I make the appointment for myself I will make sure that my children have all their appointments and kids have a lot of appointments right I will make sure that my mother who lives with me gets to all of her appointments and then there are my appointments that I and I was proud and I said oh I finally got that thing done that I was supposed to do and then I looked at the list the three other things that I have to do and so I think it is forcing ourselves to prioritize our own health and it's kind of like flying put your gas mask on first because we have a lot of other people who we have to put their mask on right um and have someone who forces you who asks all the time did you do this did you do that have you done that because I think that's the only way it needs to be a community for us to support each other to make sure that we live in the best health and then it's about choices you create your own optionality whether you want to stay on track or not, but it doesn't have to be because you're worried about sacrificing your health. Great point. And I would just chime in, just thinking about, I'm certainly close to the last chapter of my career, I think at this point. Yes, like you, all of the demands that we've just defined, I think for me, it's in addition to, and I know this is going to seem somewhat counterintuitive, it's saying yes to the community that are my girlfriends that often were the ones that got scratched off on the bottom of the list between parents kids now largely flown the nest but still on the payroll still you know in graduate school those types of things so while not at home absolutely you know still a pretty strong tether there a spouse who's got his own career and but still I mean we all know what those things add up to be and for years I made the decision that but it was the the female friendships and closer friendships that would often get cut out from a prioritization perspective and I've in the last 10 years made more of an effort to say no this is getting on the calendar and this is equally important and that for me has created a second kind of accountability network around how are you feeling how are you really doing how is this thing that we saw in an interview here like what was really going on you know behind that's where you can have a little bit more real talk and it feels a little different than your significant other obviously feels way different than conversations with your parents who at this point still don't really understand what I do you know for a living despite describing it that for me has been it's been a real gift and while I'm also kicking myself for having not done more of it the point is I'm doing it now and I realize it's additive but wow does it feed the soul it's just been a beautiful gift we have a lot of leaders in the room and i would love your take on what it looks like when a workplace takes women's health and specifically women's midlife health seriously what what are some concrete um policies benefits that workplaces should be thinking about implementing and any of you can take that one i'll take it um one of the there's just been a law passed in chicago and it was with through one of my medical advisors who's a preeminent psychiatrist and coined the phrase brain fog and university of illinois and it was brain fog within menopause right within midlife and all of the ramifications of that and it's it's essentially just making sure and understanding that when this menopause law requires workplaces to make accommodations for women. It's the most comprehensive midlife law that's been passed, and it hopefully will be lobbied in other states. But it requires training for clinicians in order for them to stay up with their continuing medical education. It also requires workplaces to make sure that there's accommodations. First one. What kind of accommodations? If you have to have time off for going to doctors or if there's any kind of leave that happens, et cetera, it's all being worked through. But it's similar to making sure that when you're breastfeeding that you don't have to sit in the bathroom stall like I used to have to do. So it's treating it like a real medical condition. It's a medical condition. And that understanding that because it's a medical condition, and it's just a series of medical conditions that all culminate at the same time. So it's being aware that that exists. It's giving it air time, right, and understanding that that's when you lose women. And when women stop, you know, even at 45 because you're so stressed and then you have other things that are going on in your body and your brain and you think, oh, my God, I can't remember her name and I know I've met her 72 times and, you know, and whether that's delirium or, you know. Or the word you can't call it up quite as fast as you. And then you wonder if you're suffering from early senility or dementia. Oh, God. I don't understand. I do have one more thing to throw in there because we're talking about this. One of our initiatives that we're thinking about doing is trying to get vaginal estrogen over the counter. Because if you can, if you are prone to UTIs, you need to know that there, especially as you get older, that there's a thing called delirium that happens, which people think is early onset Alzheimer's or Alzheimer's or whatever, but it has to do with actually having UTIs and the estrogen the vaginal estrogen can actually help with that so it can help stop the UTIs and it can help you from not having these other symptoms that bubble up so that you know like we are not just like a back organization for breast arterial calcification we're about finding these things that are super simple that will help millions of women if we just can get them to the right place. We've got a question or comment here. Comment. Thank you. I just wanted to contribute. My name is Amanda. I am the Chief People Officer for Bristol-Myers Squibb. And a reflection on your question is, I think, something that all of us can do, and that is to just be willing to have the conversation. And I think that I have the privilege of sitting on a leadership team with, you know, with another five women who age ranges are 40 to 60-ish. And, you know, I think at BMS, what has been so powerful is just creating a space for the conversation. We have been, as the chief people officer, that is something I'm super passionate about. And so we leverage not only our women's, you know, our women's ERGs, our women's affiliate groups very deeply. And so we are menopause accredited and celebrate being menopause accredited in, in many markets. But, but also just to open a place to have a conversation. I mean, I've learned so much about you know, I'm not, I'm not having you know, night sweats or hot flashes but boy am I having a number of other symptoms around joint pain and you know stuff that I didn't even know frozen shoulder frozen shoulder uh and so I think there's something as women of any age uh that is very important for us to just be willing to acknowledge and have a conversation to educate ourselves and then to be open to educating others great point um I Can I make a comment? Yeah, of course. One of the red threads, if you just think about what we've been talking about, again, are these isolated symptoms and how long it takes to figure it out, right? And this is where I think technology in the age that we're in today, one of the greatest things I think that AI can do in healthcare is to help connect the dots and help connect the dots sooner. because many times we try to do these things in isolation or as pilots and you make a dent here you make a dent there but if you think about the problems that have always existed and now you know if you look at those problems what are the problems that have always existed but now we can solve them in a different way better faster different cheaper you know the thing that I'm hopeful for is how can companies leverage AI and it will be multi sector whether it's with government with AI companies the industry or what have you to start to close some of these critical care gaps or these health gaps to say okay where there's a symptom over there and you know the patient went to see you know a dermatologist and then they went to see an allergist and maybe then they went to see a rheumatologist and then they saw their primary care and you can't always count on those records being connected but I remember having to go to an ER because I was having symptoms didn't know you know the different symptoms were connected and honestly I just plugged it into AI because I was sitting in the ER for I was like well let me just see I got plenty of time plenty of time let me just see so I started putting in all this stuff and so it was amazing now I don't know how accurate it was but it did help me have a conversation right to ask certain questions about the collection of symptoms and so it really got me thinking what is now possible uh for patients women men what have you to be able to now connect those dots and get screening treatment diagnosis and care sooner um there's a lot of platforms and companies out there right now um targeting women in midlife we heard about Midi last night with Olivia Walton there's also a lot of celebrity backed platforms and companies and i'd love your take on how you figure out the signal from the noise and and who to trust if you are going to one of these new midlife companies uh for women that has sprung up what should you be looking for i think like any discerning consumer right i mean you've it's it's always a kind of test and see sort of thing i mean i'm certainly not here to represent what other platforms are saying. What I will put forth, however, is that anywhere that you're going to seek care should be backed by clinical evidence, should be backed by real science. You should be getting access to the actual molecules that were produced by the manufacturer. They shouldn't be some gray market and or inexplicably compounded alternative. When you say getting access to, what do you mean there? I'm sorry, what? When you say getting access to the molecules, what do you mean? I mean that whatever the platform is through which potentially you may be getting a prescription is actually the drug that they're claiming it is, and not a copy that wasn't endorsed by a biosimilar or something that actually went through a viable FDA pathway to produce said drug. And I would just say, buyer beware otherwise. I mean, people are going to make those decisions on their own, and that is your prerogative to do so. But you're asking as someone who's been sitting in the drug business a long time, I personally wouldn't do that, candidly. So those are all things I think that, again, as a consumer, you should be asking those types of questions. I also think imperative that if you need a follow-up for whatever platform it is you're partnering with, you have the ability to engage with an actual clinician as opposed to it completely being AI-enabled. I think it's important to be able to engage in that fashion if that's what you feel is necessary. Those are all things that I would look for personally. Those are all things that as GoodRx has designed subscription offerings, companion offerings, which is an offering we have to get access to care in combination with drug adjacent to your insurance. Those are all things we've built into this because it's just an important component, I think, to have a reliable clinically relevant offering in the market i just think it's the responsible thing to do i i was i spoke at the academy of medicine a couple of weeks ago and they had a marketer on stage who was who was talking about the marketing for health care because there's such a crisis of faith with doctors and that you actually get so much more information from your tiktoker of choice than you do your actual doctor because you don't see them that often etc and that women have or well because it was a women's conference it was all specifically about women there's been this shift to believing right what you're hearing in your algorithms and you have to be really careful of that because these these compounds and the things that she's um that when she's been talking about can be really really dangerous for you so you know it it needs to be evidence-based and evidence-based means it's peer-reviewed it's you know there's there's there's um a clear pathway to why you should do it but um it's it's fascinating because there's there's been an attack on science there's been an attack on so where doctors are less trusted than they used to be which is really fascinating and i think we have to get more information that's viable information that's you know evidence-based information out there which is why i'm doing what I'm doing because I think that you need to educate women on the why right and give them the tools that they need in order to ask the appropriate questions and get the get the best health care and not just because and by the way you know if you look on Instagram and you see women that you know there's a lot of women out there or doctors out there that have millions and millions of followers that are OBGYNs and talking about menopause but then selling all of their own supplements right so skeptical of that i think so i mean you know or look into it for sure you know i know that my evidence-based doctors that are so hardcore are adamantly adamantly against that so you know what are good sources for women to go to trustworthy sources obviously the work you're doing yeah but i'm we're just starting yeah so so i mean i know we have a whole repository of of peer-reviewed research that you can get access to so do i mean there's the WebMDs of the world, there are plenty of legitimate sources to get clinical information inclusive of your actual provider. You know, he's writing your prescription. And look, we all acknowledge how often do we actually get to dialogue directly with your caregiver, maybe not as much, but certainly their support staff can give you access to peer-reviewed information. So it's there for the taking, but once again, the burden falls on us to figure it out. But you have to be your own best advocate. That's right. And that's what it comes down to. And be discerning. Yeah. I mean, at the risk of closing out with a bit of another story, my daughter gave me permission to share. I mean, she's 23 now. She was 20 when it started, had just horrible abdominal issues, turned into, again, a GI doc who just squarely was like, let's scope. It's got to be something related to, and just went down the easy path, didn't even contemplate. It could be inflammatory, autoimmune related, all of those things. She went through all of the circuitry route, through rheumatologists, through functional medicine partners. I mean, just wildly trying to find answers. All of the meanwhile, being incredibly ill, being told that she had colon cancer. I mean, things that just really were so far off base and up and until we finally sat down as a family who let's be real this room is pretty resourceful we have access to these types of answers but just started putting the pieces together and insisted that yet another physician take a look from either PCOS or endometriosis things that again were all somewhat inflammatory related but could manifest in some of these other things and up and until insisting on that type of review. She didn't get the answer she was looking for. And now it was a pretty simple solution. And IUD seems to have solved the overwhelming majority of she can eat whatever she wants to at this point. This is after three years. She could have been saved so much down to like bone broth and all while she was an undergrad, you know, trying to experience all of the joys of, you know, being in a fun campus environment. So I share that simply to say she had to be her own best advocate as a very young person but the resources are there it's hard it's hard it's really hard we're out of time but i want to ask you each in one sentence if possible for a breakthrough a piece of progress that you would love to see in the next few years that would drastically change the landscape for for women's health um uh quickly um and again it's not probably specific to women's health it's it's just to health in general and we as consumers and it is GoodRx's ongoing push But again, that cash price is always there next to your funded price, and you can make a decision around it. I mean, that's it. You should always know what the best price is. Paula? I think it's education for the clinicians and the health care providers. That it changes. Okay. Rashima? I would say more research in the space of women's health and understanding the mechanisms of aging. For example, at Novartis, we have biomedical research where we actually have a dedicated team that is looking at these mechanisms, diseases of aging as well as regenerative medicine. And so, again, the more we can understand the biology and the mechanisms, the better we can understand how to design studies, the targets, and understand what medicines can not only treat conditions but also help improve function and ultimately help women live longer and in better health. Rashima, Paula, Wendy, thank you. It's such an important subject. Give them a round of applause.