Latest / Clearly Hormonal / Ep 09: The Menopause Penalty

Transcript

Ep 09: The Menopause Penalty · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health And recharge the conversations you are having with your health care providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your health care provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:41
  Dr. Komal Patil-Sisodia: Before we dive into episode nine, I wanted to take a minute and thank everyone for their support.
• 0:48
  Dr. Komal Patil-Sisodia: When I was first starting this podcast, I thought maybe, you know, 10, 20 people would listen, mostly friends and family.
• 0:56
  Dr. Komal Patil-Sisodia: But so many of you have taken the time to download and listen to an episode.
• 1:00
  Dr. Komal Patil-Sisodia: And from so many different cities and countries around the world, we've hit 2, 500 downloads at eight episodes in, and I am just so grateful to everyone who's taken the time.
• 1:12
  Dr. Komal Patil-Sisodia: So thank you very much.
• 1:14
  Dr. Komal Patil-Sisodia: In today's episode, I wanted to a topic that's been weighing heavily on my mind.
• 1:21
  Dr. Komal Patil-Sisodia: We are about to be in a public healthcare crisis.
• 1:26
  Dr. Komal Patil-Sisodia: And I'm not saying this to be dramatic.
• 1:28
  Dr. Komal Patil-Sisodia: And I'm also not talking about another global pandemic like COVID 19.
• 1:32
  Dr. Komal Patil-Sisodia: I'm talking about what is inevitable for us as women, which is not only that we will all go through menopause, but we may not actually have enough physicians left to take care of us later.
• 1:44
  Dr. Komal Patil-Sisodia: Hear me out.
• 1:45
  Dr. Komal Patil-Sisodia: This is what I mean.
• 1:46
  Dr. Komal Patil-Sisodia: Currently women make up 54 percent of students going into medical school.
• 1:53
  Dr. Komal Patil-Sisodia: Several decades ago, that was not the case.
• 1:55
  Dr. Komal Patil-Sisodia: The first woman was not even admitted to medical school until I think 1847, Elizabeth Blackwell.
• 2:02
  Dr. Komal Patil-Sisodia: So it's really wonderful to see that we've made these strides to where women are reaching equal footing in medicine.
• 2:09
  Dr. Komal Patil-Sisodia: As the first female physician in my immediate family, I didn't really have a clear idea of what the effort of becoming a physician and going to medical school would look like.
• 2:21
  Dr. Komal Patil-Sisodia: I am so lucky that I love my job because the road to medicine is a really long one.
• 2:27
  Dr. Komal Patil-Sisodia: Traditionally, once you graduate high school, it will take four years of college, four years of medical school, followed by a minimum of three years of residency before you can become a practicing physician.
• 2:40
  Dr. Komal Patil-Sisodia: And that's if you go straight from high school all the way through.
• 2:45
  Dr. Komal Patil-Sisodia: So, if women start this process at the age of 18, they will be 29 by the time their training is complete.
• 2:54
  Dr. Komal Patil-Sisodia: Currently, the data shows that by year 6 of practice, up to 40 percent of women will either go part time or leave medicine altogether.
• 3:04
  Dr. Komal Patil-Sisodia: That's not a great stat.
• 3:06
  Dr. Komal Patil-Sisodia: And that data only accounts for women who are in academic medicine.
• 3:10
  Dr. Komal Patil-Sisodia: I've been practicing for about, gosh, 15 years now.
• 3:13
  Dr. Komal Patil-Sisodia: And in my observation, that still tracks for women physicians who are not in academic medicine.
• 3:18
  Dr. Komal Patil-Sisodia: And by that, I mean those who are at your local hospital or at your community clinics.
• 3:25
  Dr. Komal Patil-Sisodia: So why does that happen?
• 3:27
  Dr. Komal Patil-Sisodia: Well, perimenopause symptoms can start as early as 35, and if you track back to the math we were just doing, 18 plus 11 years of training puts you at 29 plus 6 years of practice puts you at 35, at the earliest.
• 3:43
  Dr. Komal Patil-Sisodia: That doesn't really account for any other time that Women have taken in between becoming, fully fledged physicians to year six of practice.
• 3:53
  Dr. Komal Patil-Sisodia: If you take time off to be with family, to start a family, any additional gap years that you've taken between high school and college, college and med school, possibly pursuing even a different career path before deciding to pursue medicine, this age gets bumped out.
• 4:08
  Dr. Komal Patil-Sisodia: And while perimenopause can start as early as 35, most women will be affected starting in their 40s.
• 4:15
  Dr. Komal Patil-Sisodia: If 40 percent of women physicians are reducing their hours and stepping out of practice.
• 4:20
  Dr. Komal Patil-Sisodia: Where does that leave us?
• 4:23
  Dr. Komal Patil-Sisodia: With not enough doctors.
• 4:24
  Dr. Komal Patil-Sisodia: And that is a huge problem.
• 4:26
  Dr. Komal Patil-Sisodia: Before anybody gets overly excited about what I'm trying to say here, I need to be very, very clear about my message.
• 4:32
  Dr. Komal Patil-Sisodia: Women are incredible physicians and need to be supported in the workplace.
• 4:37
  Dr. Komal Patil-Sisodia: I will get to how and why later in this podcast, but that is the message.
• 4:41
  Dr. Komal Patil-Sisodia: Women need to be supported in the workplace, period, regardless of whether they're physicians or not.
• 4:47
  Dr. Komal Patil-Sisodia: But since I live in the world of medicine, that's the example that I'm living and giving.
• 4:52
  Dr. Komal Patil-Sisodia: Thanks for listening.
• 4:53
  Dr. Komal Patil-Sisodia: We need women in medicine, just like we need women in all other industries.
• 4:57
  Dr. Komal Patil-Sisodia: And the problem that I'm describing is actually not just confined to medicine.
• 5:02
  Dr. Komal Patil-Sisodia: It's estimated that half of the women in tech leave the industry by the age of 35.
• 5:08
  Dr. Komal Patil-Sisodia: Women in finance will leave between age 29 and 40.
• 5:13
  Dr. Komal Patil-Sisodia: Are you all seeing a pattern here like I am?
• 5:16
  Dr. Komal Patil-Sisodia: What I'm seeing is that the gender gap starts with motherhood and gets worse through the menopause transition.
• 5:25
  Dr. Komal Patil-Sisodia: Our lives as women are changing.
• 5:27
  Dr. Komal Patil-Sisodia: complicated.
• 5:28
  Dr. Komal Patil-Sisodia: They revolve around competing timelines.
• 5:30
  Dr. Komal Patil-Sisodia: We are being pulled in so many different directions, family, relationships, education, career, and we are taught that we can have it all.
• 5:40
  Dr. Komal Patil-Sisodia: All we need to do in order to do that though is keep our heads down and work hard.
• 5:46
  Dr. Komal Patil-Sisodia: And by normalizing that thought process, we can start to get a little numb to our surroundings.
• 5:51
  Dr. Komal Patil-Sisodia: We don't notice this slow creep of symptoms like fatigue, poor sleep, achiness, weight changes, et cetera, because that becomes the norm for us.
• 6:02
  Dr. Komal Patil-Sisodia: Women, whether we are choosing to stay at home with our families or go to the workplace or do a little bit of both, we will all experience that same burnout and creep of symptoms because that's because of how our bodies are changing.
• 6:18
  Dr. Komal Patil-Sisodia: With how busy society is, it all just layers on top of each other.
• 6:24
  Dr. Komal Patil-Sisodia: And as a group, we just wear that fatigue and that sense of being busy, like a badge of honor, almost like a status symbol for everything that we are achieving in our lives, whether it's at home or in the workplace.
• 6:37
  Dr. Komal Patil-Sisodia: If you look up the motherhood penalty, it is defined as the phenomenon by which women's pay decreases once they become mothers.
• 6:46
  Dr. Komal Patil-Sisodia: And there's been a good amount of conversation and activism around the motherhood penalty.
• 6:50
  Dr. Komal Patil-Sisodia: We are nowhere close to closing that gap, but we're making strides.
• 6:56
  Dr. Komal Patil-Sisodia: However, I think it is an incomplete conversation to only focus on that.
• 7:02
  Dr. Komal Patil-Sisodia: Not all women, either by choice or by circumstance, will pay the motherhood penalty.
• 7:07
  Dr. Komal Patil-Sisodia: We do, however, all pay the menopause penalty.
• 7:11
  Dr. Komal Patil-Sisodia: Once that thought came to me, I started to wonder whether anybody had actually defined the menopause penalty.
• 7:18
  Dr. Komal Patil-Sisodia: So I started to look for papers to see if anything was popping up.
• 7:22
  Dr. Komal Patil-Sisodia: I came across a working study that was recently published by the Institute for Fiscal Studies in London that looked at women in Northern Europe.
• 7:32
  Dr. Komal Patil-Sisodia: It states, quote, menopause affects a broad swath of women's lives, ranging from a temporary increase in visits to the doctor due to a persistent decline in full time employment and earnings, and an increased receipt of social transfers.
• 7:49
  Dr. Komal Patil-Sisodia: The earnings losses amount to 20 percent relative to pre menopause levels, end quote.
• 7:55
  Dr. Komal Patil-Sisodia: Just as a side note, social transfers in Europe are basically the equivalent of our, what we call social services in the United States.
• 8:05
  Dr. Komal Patil-Sisodia: But I don't want to lose the point of what the statement or the conclusion of this paper is, which is that earnings losses are 20 percent when women are trying to navigate menopause.
• 8:16
  Dr. Komal Patil-Sisodia: That is just crazy.
• 8:18
  Dr. Komal Patil-Sisodia: I also came across a study that was released by the Mayo Clinic in 2023 that showed that women in the United States lost$1.8 billion per year in productivity and working time.
• 8:32
  Dr. Komal Patil-Sisodia: On top of that, it's estimated that women pay or spend$13 billion to treat their symptoms.
• 8:40
  Dr. Komal Patil-Sisodia: And we haven't even accounted for the gender pay gap, which shows that women earn 84 cents to every dollar earned by men.
• 8:48
  Dr. Komal Patil-Sisodia: If you actually did the math and right sized the numbers to take the gender pay gap into account, the true cost would be 2.
• 8:57
  Dr. Komal Patil-Sisodia: 14 billion lost and 15.
• 8:59
  Dr. Komal Patil-Sisodia: 5 billion spent while trying to navigate menopause transition.
• 9:05
  Dr. Komal Patil-Sisodia: That is a lot of money.
• 9:07
  Dr. Komal Patil-Sisodia: I haven't really been able to get those stats out of my mind.
• 9:11
  Dr. Komal Patil-Sisodia: Even though I'm an endocrinologist, I don't think that I ever realized how impactful menopause could be on the rest of my life in so many areas outside of my health.
• 9:24
  Dr. Komal Patil-Sisodia: And as I've had time to sit and digest this information, I've come to the conclusion that the menopause penalty is so much more complicated.
• 9:35
  Dr. Komal Patil-Sisodia: From my viewpoint as a wife, a mother, a leader in my organization, a physician who specializes in hormonal health.
• 9:46
  Dr. Komal Patil-Sisodia: I came up with my own definition of the menopause penalty because there really wasn't one that looked outside of just finances alone.
• 9:54
  Dr. Komal Patil-Sisodia: So I define the menopause penalty as the decrease in quality of life and or loss of opportunities due to the menopause transition on the following four areas of a woman's life.
• 10:07
  Dr. Komal Patil-Sisodia: Number one, health.
• 10:09
  Dr. Komal Patil-Sisodia: Number two, relationships.
• 10:11
  Dr. Komal Patil-Sisodia: Number three, finances.
• 10:13
  Dr. Komal Patil-Sisodia: And number four, career.
• 10:15
  Dr. Komal Patil-Sisodia: Let's go through these one by one.
• 10:18
  Dr. Komal Patil-Sisodia: Health.
• 10:19
  Dr. Komal Patil-Sisodia: I think it goes without saying that there are so many health implications of menopause.
• 10:24
  Dr. Komal Patil-Sisodia: There are podcasts about all of that.
• 10:25
  Dr. Komal Patil-Sisodia: In fact, I have episodes on my podcast that are about that, so I will not belabor the point and list all of the symptoms one by one.
• 10:35
  Dr. Komal Patil-Sisodia: What I do think is important to know is that 85 percent of women will have symptoms of menopause.
• 10:43
  Dr. Komal Patil-Sisodia: And 47 percent of women will actually have adverse symptoms of menopause that require them to disengage from certain parts of their lives in order to treat their symptoms.
• 10:55
  Dr. Komal Patil-Sisodia: The good news is there's a lot of physicians who are out there advocating in this space, and we're also looking back at old research that's been overlooked in favor of the Women's Health Initiative and doing new research to help women navigate this time.
• 11:07
  Dr. Komal Patil-Sisodia: We have a 20 year delay, unfortunately, because of the Women's Health Initiative, but we're finally starting to push ourselves outside of this box we've been locked in for the last two decades.
• 11:17
  Dr. Komal Patil-Sisodia: So health is definitely one area of major impact.
• 11:21
  Dr. Komal Patil-Sisodia: Let's move on to relationships.
• 11:23
  Dr. Komal Patil-Sisodia: The number of examples I can give for my female patients, my friends, my colleagues, it's astounding.
• 11:32
  Dr. Komal Patil-Sisodia: So many women are experiencing feelings of isolation in their relationships with their partners, their families, their friends, and their colleagues, all as they're trying to navigate the symptoms of menopause.
• 11:46
  Dr. Komal Patil-Sisodia: And because women are having children later now than they were, you know, one, two generations ago, menopause can hit around the same time that puberty starts for their children, which can put a strain on relationships.
• 11:59
  Dr. Komal Patil-Sisodia: I mean, the hormones are up, they're down, they're all over the place, and that can make for a very difficult environment within the home.
• 12:07
  Dr. Komal Patil-Sisodia: There was another survey that was done by AARP that estimated 60 percent of divorces were initiated by women in their 40s, 50s, and 60s, all during this very difficult time that they're going through.
• 12:21
  Dr. Komal Patil-Sisodia: It's no wonder that relationships suffer during this time.
• 12:26
  Dr. Komal Patil-Sisodia: Let's move on to finances.
• 12:28
  Dr. Komal Patil-Sisodia: Based on the working paper I referenced earlier, as well as the Mayo Clinic study, financial losses can be 20 percent compared to premenopausal levels.
• 12:36
  Dr. Komal Patil-Sisodia: And we are spending billions of dollars to take time off of work and to treat symptoms of menopause.
• 12:42
  Dr. Komal Patil-Sisodia: The researchers from the first paper I quoted stated that, quote, policies aimed at supporting women who suffer more serious symptoms around menopausal transition may have wide ranging benefits, end quote.
• 12:56
  Dr. Komal Patil-Sisodia: And I completely agree with this statement.
• 12:59
  Dr. Komal Patil-Sisodia: We have to help women get through one of the most significant health changes in their lives because it is having a terrible financial impact and that puts them behind for retirement and being able to navigate the later years of their lives.
• 13:14
  Dr. Komal Patil-Sisodia: Now let's move on to the last one of the four areas of impact, which is career.
• 13:20
  Dr. Komal Patil-Sisodia: I know we all have examples of amazing women in our industries who are pushing boundaries that are inspiring leaders, but are in systems that don't support them as they enter menopause transition.
• 13:34
  Dr. Komal Patil-Sisodia: Let's be real.
• 13:35
  Dr. Komal Patil-Sisodia: Most systems don't because there has not been any conversation around menopause and how to treat it for the last 20 years.
• 13:43
  Dr. Komal Patil-Sisodia: And that coincides With the increase of women in the workforce, the number of women has increased in the workforce and There is a gender disparity gap that widens when women hit mid career usually when they're in middle management In medicine, the workforce is 77.
• 14:03
  Dr. Komal Patil-Sisodia: 6 percent female, but women only occupy 30 percent of c suite roles and only 15 percent of CEO roles The tech workforce is made up of 27.
• 14:13
  Dr. Komal Patil-Sisodia: 6 percent women.
• 14:16
  Dr. Komal Patil-Sisodia: Only 17 percent of CEO roles are held by women and 8 percent of chief technology officer roles are held by women.
• 14:24
  Dr. Komal Patil-Sisodia: In entry level finance roles, 52 percent are held by women.
• 14:31
  Dr. Komal Patil-Sisodia: But only 18.
• 14:32
  Dr. Komal Patil-Sisodia: 4 percent of global C suite roles in financial services are held by women.
• 14:37
  Dr. Komal Patil-Sisodia: So we're seeing a pattern here.
• 14:39
  Dr. Komal Patil-Sisodia: The workforce is largely women, but the leadership roles are not with the exception of tech.
• 14:44
  Dr. Komal Patil-Sisodia: Obviously the tech numbers are skewed.
• 14:46
  Dr. Komal Patil-Sisodia: The only place where women are predominantly in C suite roles is that of chief human resources officer.
• 14:54
  Dr. Komal Patil-Sisodia: Women hold 55 percent of those roles across all industries, which is amazing.
• 15:00
  Dr. Komal Patil-Sisodia: Let's look at another statistic.
• 15:02
  Dr. Komal Patil-Sisodia: There is a startling difference in the average age and tenure of a female CEO compared to a male CEO.
• 15:09
  Dr. Komal Patil-Sisodia: According to an article that was published in Financial Research Letters, the average age of a female CEO is a full two years younger than her male counterparts.
• 15:20
  Dr. Komal Patil-Sisodia: So 53 years versus 55 years, another article that was published in fortune magazine stated that the average tenure for a female CEO was 4.
• 15:31
  Dr. Komal Patil-Sisodia: 5 years compared to 7.
• 15:33
  Dr. Komal Patil-Sisodia: 2 years for a male CEO.
• 15:36
  Dr. Komal Patil-Sisodia: Again, why do we think that is?
• 15:39
  Dr. Komal Patil-Sisodia: Women are getting into these roles at a younger age, showing that they are more than capable of being there, but they're not able to retain the roles for the same length of time.
• 15:50
  Dr. Komal Patil-Sisodia: In my mind, there is a clear link to the onset of menopause, which is defined as the cessation of menstrual cycles, which occurs between the ages of 50 and 55.
• 16:01
  Dr. Komal Patil-Sisodia: And again, the menopause transition leading up to that time and the onset of menopause are some of the most significant health changes a woman will go through in her lifetime.
• 16:12
  Dr. Komal Patil-Sisodia: I think I may have said this earlier, but 85 percent of women will experience symptoms of menopause.
• 16:17
  Dr. Komal Patil-Sisodia: That is the majority and not the minority.
• 16:20
  Dr. Komal Patil-Sisodia: So how do we better support women in our current system?
• 16:23
  Dr. Komal Patil-Sisodia: The foundations of the modern workplace were built by men during a time when traditional gender roles were the norm.
• 16:30
  Dr. Komal Patil-Sisodia: We know now that that has been shifting for the last several decades, but the structure of the workplace has not necessarily shifted at the same rate.
• 16:41
  Dr. Komal Patil-Sisodia: There is research that shows women are excellent leaders and workers.
• 16:45
  Dr. Komal Patil-Sisodia: In my field of medicine, there have been a series of articles showing that women physicians have.
• 16:52
  Dr. Komal Patil-Sisodia: better patient outcomes, which one would think would be fulfilling and encourage people to stay in their careers.
• 16:58
  Dr. Komal Patil-Sisodia: Yet female physician turnover and exit from practice is higher than that of male physicians.
• 17:03
  Dr. Komal Patil-Sisodia: I think the stat is like 40 percent which I quoted earlier to 27 percent for male physician.
• 17:11
  Dr. Komal Patil-Sisodia: A survey that was done by Korn Ferry that looked at 8, 000 women said that 47 percent of women were adversely impacted by menopause symptoms, causing 19 percent of them to take a week or more off of work during a month.
• 17:27
  Dr. Komal Patil-Sisodia: 13 percent of these women had considered quitting their jobs and 15 percent had actually quit their jobs.
• 17:34
  Dr. Komal Patil-Sisodia: And interestingly, senior leadership roles were the most affected.
• 17:38
  Dr. Komal Patil-Sisodia: 44 percent of women who quit their jobs in the survey had senior leadership roles.
• 17:44
  Dr. Komal Patil-Sisodia: Why?
• 17:46
  Dr. Komal Patil-Sisodia: It's because we have not addressed or supported women through the menopause transition.
• 17:51
  Dr. Komal Patil-Sisodia: The current system does not take this into account when it is creating jobs or education in the workplace or even benefits.
• 17:59
  Dr. Komal Patil-Sisodia: There was a recent paper that also quoted that only 4 percent of employers offer any type of benefits for menopause.
• 18:06
  Dr. Komal Patil-Sisodia: And most of these benefits are centered around mental health and counseling, not actual medical care.
• 18:12
  Dr. Komal Patil-Sisodia: The choices are limited in terms of what is available as medical care and structural support.
• 18:18
  Dr. Komal Patil-Sisodia: That being said, not all is lost.
• 18:20
  Dr. Komal Patil-Sisodia: We have a lot of advocacy happening from physicians who are pushing back against what was put forth from the women's health initiative.
• 18:28
  Dr. Komal Patil-Sisodia: The original authors of the women's health initiative actually came back and published another paper in May of this year that walked back the hysteria that was created around the safety of hormone replacement therapy.
• 18:41
  Dr. Komal Patil-Sisodia: And women are questioning the status quo.
• 18:45
  Dr. Komal Patil-Sisodia: They are demanding more for themselves.
• 18:47
  Dr. Komal Patil-Sisodia: It's no longer a requirement to suffer in silence.
• 18:50
  Dr. Komal Patil-Sisodia: Additionally, we have a set of female colleagues in these chief human resources officer roles that are uniquely positioned to advocate for more resources and job support for menopause transition.
• 19:02
  Dr. Komal Patil-Sisodia: So this is my call to action for all of our amazing female CHRO colleagues.
• 19:07
  Dr. Komal Patil-Sisodia: This is your time to advocate for all of your female employees.
• 19:13
  Dr. Komal Patil-Sisodia: We have covered a lot of information in this episode.
• 19:17
  Dr. Komal Patil-Sisodia: Being better informed about the impact of menopause on our lives gives us the power to advocate for ourselves and to make sure that we have more choices on how to navigate it.
• 19:28
  Dr. Komal Patil-Sisodia: More information leads us to feeling more empowered, and when you're more empowered, you feel hopeful at least.
• 19:36
  Dr. Komal Patil-Sisodia: And despite all of the crazy stats that I shared over the last however many minutes I've been talking, I still have hope that women will one day be in control of the choices they make for their lives and their wellbeing.
• 19:51
  Dr. Komal Patil-Sisodia: I really hope that this episode has done the following for you.
• 19:56
  Dr. Komal Patil-Sisodia: Number one, given you an understanding that the menopause penalty comes for all women and has a profound effect on health, relationships, finances, and career.
• 20:08
  Dr. Komal Patil-Sisodia: And if the penalty is coming for women, it's also coming for their partners and their families.
• 20:13
  Dr. Komal Patil-Sisodia: So please listen up and be there for the woman in your life who is going through these changes.
• 20:18
  Dr. Komal Patil-Sisodia: It will make a world of difference, I promise you.
• 20:23
  Dr. Komal Patil-Sisodia: Number two, I hope this inspires you to think about how you can advocate for women's health in your own life and career.
• 20:29
  Dr. Komal Patil-Sisodia: And number three, I hope that it sparks some creativity and encourages you to think of and implement different ways to build more resources and support in your industry for women who are going through this midlife transition.
• 20:45
  Dr. Komal Patil-Sisodia: This is just the tip of the iceberg.
• 20:47
  Dr. Komal Patil-Sisodia: The more awareness that we can continue to bring to the impact of menopause transition on the lives and wellbeing of women, the better.
• 20:55
  Dr. Komal Patil-Sisodia: We all deserve to have and truly own our choices to build lives that we love.
• 21:01
  Dr. Komal Patil-Sisodia: Thank you for joining me today.
• 21:02
  Dr. Komal Patil-Sisodia: Please feel free to reach out through my website or my socials with any questions or topics you want to hear about.
• 21:09
  Dr. Komal Patil-Sisodia: Until next time.