Latest / Becker’s Healthcare Podcast / The Future of Colorectal Cancer Screening: Reaching the Unscreened

Transcript

The Future of Colorectal Cancer Screening: Reaching the Unscreened · Becker’s Healthcare Podcast

• 0:00
  - Hello, everyone. This is Jacob Emerson with the
• 0:02
  - Becker's Healthcare Podcast. Thank you so much for
• 0:05
  - tuning in today where we're gonna be talking
• 0:07
  - about the future of colorectal cancer screening and
• 0:10
  - how to reach the unscreened.
• 0:12
  - Joining me for today's discussion is doctor AmirAli
• 0:15
  - Talazaz, who is the cofounder and co CEO
• 0:18
  - of Guardant Health. Doctor Talazaz, thank you so
• 0:21
  - much for taking the time to be with
• 0:22
  - me on the podcast today.
• 0:24
  - Thank you, Jacob, for having me. It it's
• 0:26
  - great to be with you. Likewise. And before
• 0:29
  - we dive into everything we wanna talk with
• 0:31
  - you about today, Emera Lee, can you tell
• 0:33
  - us a little bit more about yourself,
• 0:36
  - and a little bit about your role and
• 0:38
  - what you do today at Garden Health?
• 0:40
  - Yeah. Sure. So I'm Ira Talasos.
• 0:43
  - I'm,
• 0:45
  - one of the founders of Garden Health,
• 0:48
  - pioneering
• 0:49
  - liquid biopsy company in the field of clinical
• 0:52
  - genomics.
• 0:54
  - We started a company now about fifteen years
• 0:57
  - ago, you know, with really the mission
• 1:00
  - of having a simple
• 1:02
  - routine blood test
• 1:04
  - that could have
• 1:06
  - basically guarded the body against this disease. That
• 1:10
  - was the mission that we have in the
• 1:11
  - beginning. We didn't know exactly how to do
• 1:14
  - it, but
• 1:15
  - fast forward fifteen years after, there are a
• 1:18
  - lot of great advancements that we've seen in
• 1:20
  - the field.
• 1:22
  - I'm also a father of,
• 1:24
  - three kids with my beautiful wife
• 1:27
  - and,
• 1:28
  - you know, trying to do something good for
• 1:30
  - society and also my family.
• 1:32
  - Absolutely. Well, let's talk a little bit about
• 1:34
  - that. Obviously, as you know, Gartner pioneered the
• 1:37
  - industry
• 1:38
  - a decade ago with blood based cancer screening
• 1:42
  - technology.
• 1:43
  - So talk to our audience a little bit
• 1:45
  - about what you saw early on that convinced
• 1:47
  - you that blood could fundamentally change
• 1:51
  - how we detect and manage cancer?
• 1:55
  - Yeah. So when we actually
• 1:57
  - started working in the field and we, like,
• 2:00
  - pioneered this clinical testing using liquid biopsy
• 2:04
  - more than a decade ago,
• 2:06
  - we're driven by this reality that, you know,
• 2:09
  - cancer is touching
• 2:11
  - all of us directly,
• 2:13
  - indirectly.
• 2:15
  - And more than often, I feel cancer is
• 2:17
  - being caught far too late.
• 2:19
  - You know, we realized, in fact, in order
• 2:21
  - to save lives, similar to other kind of
• 2:24
  - maybe,
• 2:25
  - diseases like advancements, for instance, in the cardiovascular,
• 2:30
  - in order to really add more value,
• 2:33
  - we needed to make screening tests more effective,
• 2:37
  - making them more easier for patients to adhere
• 2:40
  - to and go through,
• 2:42
  - and really
• 2:43
  - integrate
• 2:46
  - pleasant routine screening tests into routine clinical care.
• 2:50
  - Now if you go back to those earlier
• 2:52
  - days,
• 2:54
  - you know, the field of NIPT,
• 2:56
  - the field of looking at
• 2:58
  - fetus,
• 3:00
  - and, you know, through maternal blood
• 3:03
  - was making very good progress.
• 3:06
  - The field of next generation sequencing
• 3:09
  - was making
• 3:10
  - very good progress. And in theory, if we
• 3:13
  - could have married running next generation sequencing
• 3:16
  - technologies
• 3:18
  - in the blood of cancer patients, we could
• 3:20
  - have
• 3:22
  - made significant advancements in the field of oncology.
• 3:25
  - And unlike the data generation and clinical
• 3:29
  - insight generation
• 3:31
  - from these cancer patients where
• 3:34
  - really the diagnosis
• 3:36
  - and information
• 3:37
  - was typically locked in a tumor biopsy sample.
• 3:41
  - But there were a bunch of technological
• 3:43
  - challenges.
• 3:44
  - The accuracy of next generation sequencing
• 3:48
  - was not at a place
• 3:51
  - to really detect tiny amounts of fragments which
• 3:54
  - are coming from the tumors
• 3:56
  - and was circulating
• 3:57
  - in the blood of cancer patients. I remember
• 4:01
  - this field during those days
• 4:03
  - looked kind of mission impossible.
• 4:05
  - You know? We were dealing with a lot
• 4:07
  - of technical challenges. But now
• 4:10
  - we have a blood test for advanced cancer
• 4:13
  - patients, which are
• 4:15
  - routine standard of care. More than thirty percent
• 4:18
  - of all advanced cancer patients
• 4:20
  - are getting tested with our blood test, Guardant360,
• 4:24
  - for their treatment selection. Almost everybody in The
• 4:27
  - US have access to this blood test.
• 4:31
  - And more recently,
• 4:33
  - we are very excited with our shield blood
• 4:36
  - test.
• 4:37
  - First, FDA approved Medicare covered blood test for,
• 4:42
  - cancer screening with the first indication for colorectal
• 4:45
  - cancer screening.
• 4:47
  - The shield blood test was really the,
• 4:51
  - the fruit of ten years of
• 4:54
  - innovation,
• 4:55
  - data gathering,
• 4:57
  - experimental
• 4:58
  - progress that we,
• 5:01
  - made, and we leveraged a lot of actually
• 5:04
  - and recent advancements in the machine learning and
• 5:08
  - artificial intelligence
• 5:11
  - to really
• 5:12
  - build this simple blood test,
• 5:15
  - which the patient physician experience is very simple
• 5:19
  - in terms of having a routine blood test,
• 5:21
  - but with very sophisticated,
• 5:25
  - algorithm at the back end that we can
• 5:27
  - find these traces,
• 5:29
  - tiny traces that are coming from early stages
• 5:32
  - of the cancer.
• 5:34
  - So unlike
• 5:36
  - traditional screening methods, this blood test
• 5:40
  - can
• 5:41
  - detect cancers early
• 5:43
  - with a modality that patients are very used
• 5:46
  - to. You can count on patients actually
• 5:50
  - doing it. In real world, we've seen in
• 5:52
  - over 200,000
• 5:54
  - shield blood tests that we've done. More than
• 5:57
  - ninety percent of the patients, when the doctors
• 5:59
  - ordered this blood test, in fact, go and
• 6:02
  - complete and get their screening test done,
• 6:05
  - which is a contrast to some
• 6:08
  - other modalities that we have that they work
• 6:11
  - greatly,
• 6:12
  - but the overall adherence rate of the patient
• 6:15
  - had remained to be very low. Still, we
• 6:17
  - have
• 6:19
  - over fifty million people in United States that
• 6:22
  - they need to get their colorectal cancer screening
• 6:25
  - done,
• 6:26
  - but they are not doing it for different
• 6:28
  - reason. And now we have a blood test,
• 6:30
  - which is FDA approved,
• 6:32
  - covered by some insurancecom,
• 6:34
  - companies,
• 6:35
  - and even have a better performance than,
• 6:39
  - to detect
• 6:40
  - the disease, the colorectal cancer
• 6:43
  - disease across all stages
• 6:46
  - than
• 6:47
  - published performance
• 6:49
  - of even gold standard fit test, which is
• 6:52
  - the,
• 6:54
  - global leader of
• 6:56
  - doing colorectal cancer screening. So we are very
• 6:59
  - excited of the impact that this Shield blood
• 7:02
  - test can have on the society and bring
• 7:04
  - health healthier days to patients.
• 7:07
  - Absolutely. And and, Namiro, you just
• 7:09
  - hinted at the the persistent,
• 7:12
  - on screening gaps that still exist. I know
• 7:14
  - that despite multiple screening options available out there
• 7:17
  - today,
• 7:18
  - roughly one in three eligible Americans still remain
• 7:21
  - on screen.
• 7:22
  - And, of course, colon cancer rates, we're we're
• 7:24
  - seeing rise among adults 65
• 7:27
  - all all across the country.
• 7:29
  - So why did Guardant
• 7:31
  - believe that a blood based option could address
• 7:34
  - this this gap that continues to persist?
• 7:37
  - Jacob, as you mentioned, you know, there are
• 7:39
  - already some available option. Like, the gold standard
• 7:42
  - of colorectal cancer screening continues to be colonoscopy.
• 7:46
  - We had access to colonoscopy
• 7:48
  - based screening for, you know,
• 7:51
  - probably over a decade now. Some stool based
• 7:53
  - technologies have been around for over a decade,
• 7:56
  - some over two decades.
• 7:58
  - So the fundamental issue is not lack of
• 8:02
  - options.
• 8:04
  - It's a gap in participations
• 8:06
  - by patients.
• 8:08
  - Millions of people are not up to date
• 8:10
  - with their screening. And we know, in fact,
• 8:13
  - seventy five percent of all colorectal cancer death
• 8:17
  - is coming from those people who are not
• 8:19
  - up to date with their screening.
• 8:22
  - So the barrier is not really the patients
• 8:25
  - don't care about their health. You know, some
• 8:27
  - of that exists, but that's not the main
• 8:29
  - issue based on the studies that we've done.
• 8:32
  - Really, the main issue is the current screening
• 8:35
  - modalities
• 8:36
  - come with significant frictions
• 8:39
  - and need significant patient follow through. When we
• 8:43
  - are thinking about,
• 8:45
  - you know, special bowel preps, when we are
• 8:47
  - thinking about people need to get time off
• 8:49
  - work, they need to find solutions for
• 8:52
  - right,
• 8:53
  - you know, to get in or get out
• 8:55
  - of the procedure,
• 8:57
  - or
• 8:58
  - even with stool tests, there's some kind of
• 9:00
  - a weak factor still that exists in handling
• 9:03
  - stool samples and, you know, storing stool samples
• 9:07
  - or shipping those kind of samples.
• 9:09
  - We those,
• 9:11
  - tests and modalities
• 9:12
  - are very effective,
• 9:15
  - but there is a participation
• 9:16
  - gap. And now
• 9:18
  - we have a simple blood test. Like, if
• 9:21
  - you look at CDC reports, like, there
• 9:23
  - are, we are finding that, you know, ninety
• 9:26
  - percent of the patient age 50 and above
• 9:28
  - are in fact doing some kind of blood
• 9:30
  - work for some reasons, for wellness checks, annual
• 9:33
  - checkups, or for monitoring some conditions that they
• 9:37
  - have.
• 9:38
  - And now we have this shield blood test
• 9:41
  - that can just tag along to that routine
• 9:44
  - blood test
• 9:45
  - and effectively gives patient,
• 9:48
  - physicians,
• 9:49
  - and systems
• 9:51
  - a new choice,
• 9:53
  - a new
• 9:54
  - opportunity, especially
• 9:55
  - to reach the patients which
• 9:58
  - they are not participating
• 9:59
  - in this screening journey right now.
• 10:03
  - And sometimes, they are not participating
• 10:05
  - in other kind of clinical pathways.
• 10:08
  - So we can engage them. We can bring
• 10:10
  - them to the screening journey.
• 10:12
  - Hopefully, we can find the cancers at much
• 10:14
  - earlier stages when they are more treatable, Jacob,
• 10:19
  - and also bring them back to the clinical
• 10:21
  - pathway.
• 10:24
  - Understood. So clearly several major challenges still out
• 10:27
  - there in in terms of addressing
• 10:29
  - that that persistent gap merely. But
• 10:33
  - as you've just explained, Shield has been rapidly
• 10:35
  - evolving from
• 10:37
  - emerging technology,
• 10:39
  - to now being recommended by leading guideline bodies.
• 10:42
  - You have commercial payer coverage. So talk to
• 10:45
  - us about what these milestones mean for for
• 10:47
  - patients, for physicians.
• 10:49
  - Why is this an important moment for colorectal
• 10:52
  - cancer screening within the context of of the
• 10:55
  - challenges that you just laid out for us?
• 10:58
  - Yeah. We are very excited with these advancements.
• 11:01
  - And, you know, it's kind of you know,
• 11:02
  - I'm I'm seeing even with my kids when
• 11:04
  - they get to some ages that you see
• 11:06
  - some of the fruit of work and investments
• 11:08
  - that you've done on them more clearly.
• 11:12
  - You know, this is something
• 11:14
  - that was our mission for about fifteen years
• 11:16
  - and specifically during, like, you know, more than
• 11:19
  - ten years of r and d work,
• 11:22
  - finally seeing the fruit of all that advancements.
• 11:25
  - And frankly, not all the work just by
• 11:28
  - Guardant held by the whole community of, you
• 11:30
  - know, other researchers in the field, that now
• 11:33
  - we are seeing the
• 11:34
  - clinical impact and adoption that we are seeing.
• 11:38
  - But definitely, it's very exciting days, you know,
• 11:41
  - when we are thinking about
• 11:43
  - NowShield
• 11:44
  - is f Shield blood test is FDA approved,
• 11:48
  - covered by Medicare,
• 11:49
  - covered by some major payers like UnitedHealth
• 11:52
  - Group,
• 11:53
  - major guideline bodies like, you know, NCCN
• 11:57
  - and American Cancer Society
• 12:00
  - is including shield blood test,
• 12:03
  - as an option for colorectal cancer screening for
• 12:07
  - right patient types.
• 12:09
  - It's very exciting. It came as a result
• 12:12
  - of, I think, rigorous clinical validations that we've
• 12:16
  - done. We've showed that it works. The quality
• 12:19
  - of the test is very good.
• 12:21
  - And then the real world evidence and the
• 12:24
  - impact of this test, we've done randomized studies
• 12:27
  - in some health systems, in some
• 12:30
  - suburb areas even, in the
• 12:33
  - some health systems where the overall colorectal cancer
• 12:37
  - screening rate was forty five to fifty percent.
• 12:41
  - And then they added Shield as a new
• 12:43
  - choice, and then
• 12:45
  - the overall colorectal cancer screening went to high
• 12:48
  - eighties or low nineties in terms of
• 12:51
  - percentage of participation
• 12:53
  - by patients.
• 12:55
  - It's very exciting to
• 12:57
  - see and, you know, I think physicians are
• 12:59
  - very excited about this shield blood test. What
• 13:02
  - we are seeing is when they see the
• 13:04
  - performance of this test, the FDA approval,
• 13:08
  - the sensitivity
• 13:09
  - of detecting this blood test in early stage
• 13:12
  - CRC relative to,
• 13:14
  - you know, published performance by,
• 13:17
  - other modalities,
• 13:19
  - they're finding this is the first blood test.
• 13:22
  - It's the best in the class
• 13:25
  - that can
• 13:26
  - really, meet their need.
• 13:28
  - And when they offer it to their patients,
• 13:32
  - the follow through by patients is typically even
• 13:35
  - in the office, in the clinic before they
• 13:37
  - leave the,
• 13:39
  - the clinic, the health system, the blood draw
• 13:42
  - is done. Over ninety percent
• 13:45
  - of the orders
• 13:47
  - of the offered test
• 13:49
  - get converted to getting the actual screening done.
• 13:53
  - So this is very exciting for
• 13:56
  - physician and patients right now.
• 13:59
  - Jacob, actually, when we look at now,
• 14:02
  - both some of the recent guideline and insurance
• 14:05
  - coverage,
• 14:06
  - about seventy million lives out of total of
• 14:08
  - hundred twenty. So about sixty percent of people
• 14:12
  - are now covered
• 14:14
  - to,
• 14:16
  - get access to shield blood test. Their payer
• 14:18
  - is actually covering this innovative test. We made
• 14:21
  - significant progress. Still,
• 14:23
  - there is a lot of work in front
• 14:24
  - of us to make sure even the rest
• 14:26
  - of patient population get equitable access to this
• 14:30
  - breakthrough technology,
• 14:31
  - but we are very pleased with where we
• 14:33
  - are. And
• 14:34
  - for the patients who are covered by some
• 14:36
  - private insurance, in fact, vast majority of them
• 14:41
  - have $0 out of pocket costs to get
• 14:44
  - access to this chilled blood test. So, really,
• 14:47
  - like, you know, the conversation has changed, you
• 14:50
  - know, from,
• 14:51
  - you know, a blood test for cancer screening
• 14:54
  - is mission impossible. Like, you know, from ten
• 14:56
  - years ago to right now,
• 14:59
  - we have a blood test that it's FDA
• 15:02
  - approved. Majority of people have access to it,
• 15:05
  - and really the conversation is now focused
• 15:07
  - on, you know, what's the responsible
• 15:10
  - way
• 15:11
  - to make to
• 15:12
  - incorporate this blood test and clinical
• 15:15
  - pathway to make sure we can reach
• 15:17
  - more people
• 15:19
  - and
• 15:20
  - increase the overall screening rate.
• 15:23
  - And and you mentioned the work, that you're
• 15:25
  - you're doing with health systems, and we've got
• 15:27
  - a lot of hospital leaders listening in today
• 15:30
  - primarily. So
• 15:31
  - what would you say to those systems who
• 15:34
  - they're they're working hard to reach their patients
• 15:36
  - who remain onscreened
• 15:38
  - despite all the the other options available today?
• 15:41
  - Where do you see the greatest opportunity,
• 15:44
  - for our listeners to incorporate more blood based
• 15:48
  - screening into a comprehensive,
• 15:50
  - screening strategy?
• 15:52
  - Yeah. Absolutely. Like, you know, at the end,
• 15:54
  - 80%
• 15:55
  - of all the care in US are
• 15:58
  - provided through the health systems. And for health
• 16:00
  - system, I think
• 16:02
  - there's this there's an opportunity, Jacob, for them
• 16:04
  - to step back and ask,
• 16:07
  - you know, we had other modality of cancer
• 16:10
  - screening, colonoscopy
• 16:12
  - stool based test, But now that we have
• 16:14
  - this blood test,
• 16:16
  - what's the best pathway? How could we use
• 16:19
  - these multiple modalities
• 16:21
  - in a smart way
• 16:22
  - in a comprehensive
• 16:24
  - screening strategy?
• 16:26
  - And then making sure some of these patients
• 16:29
  - that have not been connected to the system
• 16:32
  - now,
• 16:33
  - we can, in fact, maybe reengage them through
• 16:36
  - this simple blood test.
• 16:38
  - The reality is when we are doing shield
• 16:40
  - blood tests in the onscreen patient population,
• 16:44
  - a fraction of them, they need to get
• 16:46
  - follow-up,
• 16:47
  - diagnostic colonoscopies.
• 16:50
  - And then that would be an a reengagement
• 16:52
  - opportunity
• 16:53
  - for that patient that patient to join back
• 16:55
  - or come back to that health systems for
• 16:58
  - all the clinical pathways that that patient needs.
• 17:00
  - So, I think it's a huge win win
• 17:02
  - opportunity
• 17:04
  - for patients and health systems
• 17:07
  - to start
• 17:08
  - using this innovative blood test
• 17:11
  - as a new modality
• 17:14
  - in a comprehensive menu that they can have.
• 17:17
  - Our experience actually has shown that physicians and
• 17:20
  - patients
• 17:21
  - are gonna have high degree of satisfaction
• 17:25
  - when they are going through this experience.
• 17:28
  - So some of the
• 17:30
  - measures in terms of patient feedback and patient
• 17:34
  - satisfaction and provider satisfaction,
• 17:38
  - is gonna be impacted when the patients really
• 17:41
  - and providers really get access to this innovative
• 17:43
  - blood test.
• 17:45
  - Well, in talking about beyond the the blood
• 17:48
  - test itself,
• 17:49
  - primarily,
• 17:50
  - why is it important
• 17:52
  - for Arden to work with health systems beyond
• 17:54
  - the test itself to help translate innovation into
• 17:58
  - a broader population
• 18:00
  - impact?
• 18:01
  - Yeah. I think there is this partnership with
• 18:04
  - between companies like us, Guardant Health, and health
• 18:07
  - systems are super important and strategic. The the
• 18:11
  - reality, Jacob, is the impact of Shield blood
• 18:14
  - test
• 18:16
  - is way beyond
• 18:17
  - just the blood draw.
• 18:19
  - As I mentioned, it's an opportunity to move
• 18:22
  - that patient through the entire clinical
• 18:25
  - pathway and an opportunity
• 18:27
  - to reengage
• 18:28
  - these on the screen patient population
• 18:32
  - in their clinical care.
• 18:34
  - Effectively, maybe we can look at it as,
• 18:37
  - you know, Shield is just opening
• 18:39
  - the door. It's the front door.
• 18:43
  - We are
• 18:44
  - reaching out to these individuals that previously were
• 18:47
  - unreachable
• 18:49
  - and motivating that
• 18:51
  - motivating those patients
• 18:53
  - that when, you know, Shield is finding some
• 18:55
  - kind of a signals in them that they
• 18:58
  - promptly need to follow through with a diagnostic
• 19:00
  - colonoscopy
• 19:01
  - in order to
• 19:03
  - finish that clinical
• 19:05
  - pathway
• 19:06
  - to identify
• 19:07
  - early stage cancer.
• 19:08
  - And that would generate a lot of opportunity
• 19:11
  - for health systems, and we need collaboration with
• 19:14
  - health system to show
• 19:16
  - that, in fact,
• 19:18
  - Shield
• 19:19
  - can go beyond just detecting something in blood
• 19:23
  - into really reducing
• 19:25
  - the cancer mortality
• 19:27
  - because the patient is sticking through that journey
• 19:30
  - and going all the way through
• 19:32
  - the diagnostic colonoscopy and the intervention,
• 19:35
  - which may be required
• 19:37
  - after
• 19:38
  - terms of surgeries or
• 19:40
  - treatment that the patient needs to go through.
• 19:42
  - So, effectively,
• 19:45
  - I think it's a joint opportunity to make
• 19:47
  - sure we can reengage these on the screening
• 19:49
  - patients,
• 19:50
  - not to just
• 19:52
  - increase the rate of screening,
• 19:54
  - test. That's very important by itself,
• 19:57
  - but reconnecting the patient to all diagnostic and
• 20:00
  - downstream care
• 20:02
  - that can
• 20:03
  - get provided by the health system.
• 20:06
  - So clearly, a lot of exciting developments stalling
• 20:09
  - the horizon in this space, AmirAli.
• 20:12
  - I would ask you before we go today,
• 20:14
  - if you were to look ahead
• 20:16
  - five years,
• 20:17
  - what do you hope will be fundamentally different
• 20:20
  - about colorectal cancer screening? And what would you
• 20:22
  - also encourage
• 20:23
  - the health system leaders listening in right now,
• 20:26
  - how to think differently about all of this
• 20:28
  - today?
• 20:30
  - And when we look at actually
• 20:32
  - the way the pathways work, screening pathways works,
• 20:34
  - you know, they're essential, but they are not
• 20:36
  - reaching everyone. You know, we are losing
• 20:39
  - ends of millions of people like what I
• 20:42
  - would like to see, like, you know, few
• 20:44
  - years down the road, and it's beyond the
• 20:46
  - hope. I'm confident that we could see it
• 20:49
  - if we have strong private public partnerships.
• 20:52
  - We can reach to a point that
• 20:55
  - overall mortality of colorectal cancer could go down
• 20:58
  - further,
• 20:59
  - especially for younger patients now.
• 21:03
  - In colorectal cancer is becoming number one cancer
• 21:06
  - related killer in United States,
• 21:09
  - and we can really change that trajectory by
• 21:12
  - making sure we can prevent cancer mortality
• 21:15
  - by detecting it early through really a comprehensive
• 21:18
  - screening program and adding this innovative blood test
• 21:21
  - as a new option.
• 21:23
  - So I think success
• 21:26
  - is
• 21:27
  - not gonna be defined as just
• 21:30
  - shield blood test is waning, as single modality
• 21:33
  - is waning, but really success would be
• 21:36
  - we can bring more and more patients around
• 21:40
  - the table,
• 21:41
  - engage them,
• 21:42
  - screen them for cancer,
• 21:44
  - detect those cancers early, especially in the rural
• 21:48
  - underserved communities.
• 21:50
  - And I think that fatty shield blood test
• 21:52
  - can do its its own contribution.
• 21:54
  - But we need very strong
• 21:56
  - partnerships.
• 21:57
  - We are in the early innings of
• 22:00
  - some very exciting conversations
• 22:03
  - with few dozen health systems as we speak.
• 22:06
  - So I'm
• 22:08
  - confident about what we can do together, but
• 22:10
  - there is work in in work in front
• 22:13
  - of us.
• 22:15
  - Absolutely. Well, doctor Talzaz,
• 22:17
  - I can't thank you enough for taking the
• 22:19
  - time to join me on the podcast today
• 22:21
  - and for sharing your insights
• 22:23
  - with our listeners. We really appreciate it.
• 22:25
  - Thank you, Jacob. I really enjoyed it, and
• 22:28
  - looking forward to staying in touch.
• 22:30
  - Likewise. And I'd also like to thank our
• 22:32
  - podcast sponsor, Garden Health. You can tune in
• 22:35
  - to more podcasts from Becker's Healthcare by visiting
• 22:38
  - our podcast page at beckershospitalreview.com.