Latest / CareTalk: Healthcare. Unfiltered. / Rebuilding Trust in Public Healthcare w/ Dr. Tyler Evans

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Rebuilding Trust in Public Healthcare w/ Dr. Tyler Evans · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Dr. Tyler Evans has battled Ebola in Africa, led New York City's COVID-19 medical response, and he warns that vaccine lies and policy failures are fueling preventable disease outbreaks across the United States.
• 0:14
  David: So what will it take to rebuild trust and science and protect our most vulnerable communities?
• 0:27
  David: Welcome to Care Talk, America's home for incisive debate about healthcare, business, and policy.
• 0:32
  David: I'm David Williams, president of Health Business Group.
• 0:35
  John: And I'm John Driscoll, the chairman of Ukon Health.
• 0:38
  David: Well, Dr. Tyler Evans is co-founder of Wellness and Equity Alliance, former Chief Medical Officer of New York City, and author of Pandemics Poverty and Politics.
• 0:47
  David: Dr. Evans, welcome to Care Talk.
• 0:50
  David: Thank you.
• 0:50
  David: Great to be here.
• 0:52
  David: Now you've had a front row seat to some of the world's most pressing public health crises.
• 0:56
  David: I'm talking about Ebola COVID-19.
• 0:59
  David: What drew you into this kind of work and how has your global experience shaped your view of public policy here in the us?
• 1:08
  Dr. Tyler Evans: That's a, that's a great question.
• 1:09
  Dr. Tyler Evans: I, um, I was originally sort of, uh.
• 1:15
  Dr. Tyler Evans: Uh, intrigued or compelled to, to get into global health and to kind of focus on what we now describe as the social determinants of health?
• 1:23
  Dr. Tyler Evans: Um, as the result of, uh, my spending a lot of time in Africa in the nineties and early two thousands, particularly during, um.
• 1:32
  Dr. Tyler Evans: Uh, what was known at that time as the sort of the HIV crisis, particularly in southern, southern Africa.
• 1:38
  Dr. Tyler Evans: And, uh, you know, just saw way too many people, far too many people that were infected with the virus, did not have access to the medications 'cause it was outside of their, uh, hands as they didn't have the purchasing power.
• 1:48
  Dr. Tyler Evans: There was a lot of sort of dissident science taking place, um, that was sort of, you know, getting away from, you know, how to, to both prevent and treat.
• 1:56
  Dr. Tyler Evans: Um, HIV and uh, and then through.
• 2:00
  Dr. Tyler Evans: Decades of, uh, of, of additional sort of experiences working in, uh, both the global South, which are low and middle income countries like Sub-Saharan Africa, Latin America, middle East, as well as sort of the, the foxholes of, uh, of the inequities in the United States, in places like South Bronx, uh, south Los Angeles.
• 2:17
  Dr. Tyler Evans: Um, you know, I, I, I, I really started to sort of, um, understand the sort of the patterns here, um, and the sort of common thread through a lot of these.
• 2:27
  Dr. Tyler Evans: Um, sort of, uh, areas, uh, or, uh, domains was the social and political drivers, um, of healthcare.
• 2:35
  Dr. Tyler Evans: Um, particularly access and sort of the, um, the sort of outcome outcomes of the sort of, uh, inequities in access.
• 2:42
  Dr. Tyler Evans: And, um, you know, as the results, you know, I, I, I sort of form this organization, wellness Equity Alliance in order to sort of bridge that.
• 2:50
  Dr. Tyler Evans: To bridge that gap to, as we're sort of experiencing so many cracks in the pavement, um, which are worsened during infectious disease outbreaks, which ultimately then become epidemics to pandemics, many of which are, are, are preventable or, or are more easily sort of mitigated if we actually focused on ways, um, to, you know, to manage the, manage and prevent and, and protect the most historically marginalized, but we don't, um, unfortunately, and, and, um.
• 3:18
  Dr. Tyler Evans: While we think sometimes we can learn from these, uh, lessons, you know, we seem to be sort of taking several steps back.
• 3:25
  John: So, so, but, so, so Dr. So, so that we know that we fail the, the most vulnerable and it's just more exposed during a pandemic and, uh, epidemic.
• 3:38
  John: What does the Wellness and Equity Alliance wanna do to basically start to build bridges to better health for the most vulnerable?
• 3:46
  John: Because the things that fail in a dramatic way, in a pandemic or an epidemic are there, to your point, in plain sight in places like where, you know, you and I have worked in the South Bronx, or, or, or, or, or the poor parts of Brooklyn, or the poor parts of any urban or rural area, they're there right now.
• 4:04
  John: What can, what does the Wellness and Equity Alliance.
• 4:07
  John: To, to sort of start to address those.
• 4:11
  Dr. Tyler Evans: Sure.
• 4:11
  Dr. Tyler Evans: So Wellness Equity Alliance was formed, um.
• 4:16
  Dr. Tyler Evans: Essentially to, to, to sort of bridge, bridge the gap.
• 4:20
  Dr. Tyler Evans: We were, we were born outta the pandemic.
• 4:22
  Dr. Tyler Evans: Uh, we ended up, uh, working with government agencies across the country.
• 4:26
  Dr. Tyler Evans: Uh, we administered over 2 million COVID vaccines, um, across the country, including over a million in California.
• 4:31
  Dr. Tyler Evans: Uh, what we were most proud of was really kind of working with the most historically marginalized and the ways in which we were successful was working with community health workers.
• 4:42
  Dr. Tyler Evans: Uh, which we describe as sort of trusted messengers.
• 4:44
  Dr. Tyler Evans: Um, we need to really rebuild that trust, uh, with the communities.
• 4:49
  Dr. Tyler Evans: And, you know, the way in which we're, we're, we're sort of traveling with, you know, RFKs, um, posse and, and you know, the, the, the information that misinformation that's being sent out, it's even that much more challenging to.
• 5:06
  Dr. Tyler Evans: To basically get the right sort of messages out to the communities.
• 5:09
  John: Well, how do you combat the, the, the crazy with content that's gonna connect?
• 5:14
  Dr. Tyler Evans: You know, I, my, my, my mantra has always been stick to the science.
• 5:19
  Dr. Tyler Evans: You know, as long as we can continue to stick to the science and work with community health workers, work with the communities to engage, you know, medicine, you know, scientists, physicians, nurses, frontline folks, um, you know, there was a, a recent Pew study.
• 5:35
  Dr. Tyler Evans: Um, that identify physicians and nurses as being the top five most trust, trusted professionals out there.
• 5:42
  Dr. Tyler Evans: Um, and I, I don't think that has changed, you know, that much science scientists, it's a little bit different.
• 5:47
  Dr. Tyler Evans: Um, but you know, if we can continue to have those relationships, physicians and nurses with the communities, with community health workers, community leaders who really have the faith and the trust of those communities, perhaps it's possible.
• 5:59
  Dr. Tyler Evans: Just divert the crazy at the federal level.
• 6:03
  Dr. Tyler Evans: Um, it's harder.
• 6:04
  Dr. Tyler Evans: It's much, it's much, much more challenging when you have people with so much agency that you know, people that were essentially on the, on the fence about certain things and you have, you know.
• 6:14
  Dr. Tyler Evans: Secretaries and leaders of, of some of the largest health agencies telling you, don't do this, don't do that.
• 6:19
  Dr. Tyler Evans: Of course, it's easy to sort of follow that direction, but if people really are able to connect with physicians and nurses and local public health professionals on a local level, it's possible to divert.
• 6:30
  Dr. Tyler Evans: You know, the crazy, that's, and that's what I've seen in a num number of other countries as well.
• 6:34
  John: Then just for the, for folks, I mean the, the community health worker, uh, that there's a connection that you're creating between the doctors and nurses.
• 6:44
  John: For those who don't know, maybe just quickly explain what a what and who a community health worker is because they're creating a, a human bridge.
• 6:54
  John: To that third of the population that, that, that is having real, real challenges, a third of the US, often in the poorest and most vulnerable communities connecting to conventional healthcare.
• 7:06
  John: But just you just quickly describe
• 7:08
  Dr. Tyler Evans: Yeah.
• 7:09
  John: Who those community healthcare workers are.
• 7:11
  Dr. Tyler Evans: Community health workers are, are, are there really that's, this is the future of, of, of engagement in, in both healthcare and, and public health.
• 7:20
  Dr. Tyler Evans: Uh, in the US particularly with, with the most historically marginalized, uh, community health workers.
• 7:25
  Dr. Tyler Evans: This is nothing new community health workers have existed.
• 7:28
  Dr. Tyler Evans: Uh, you know.
• 7:30
  Dr. Tyler Evans: Centuries, uh, and it's in a more kind of formalized fashion, you know, it's existed for decades with really good evidence in, in places all over the world.
• 7:38
  Dr. Tyler Evans: I've personally worked with CHWs in places like, uh, democratic Republic, Congo, and South South Africa, and in the US unfortunately, where we've been sort of behind the curve in terms of incorporating CHWs into our workflow.
• 7:52
  Dr. Tyler Evans: Um, many CHWs were not, there was not a reimbursement model, um, for CHWs.
• 7:57
  Dr. Tyler Evans: So in, you know, in US healthcare, if you cannot reimburse, it doesn't, if you cannot reimburse for it, it doesn't exist.
• 8:02
  Dr. Tyler Evans: Uh, increasingly that has started to change and, uh, particularly in places like California.
• 8:08
  Dr. Tyler Evans: Uh.
• 8:08
  Dr. Tyler Evans: Um, there are models in which CHWs are starting to become incorporated into the workforce in terms of training for, for CHWs.
• 8:16
  Dr. Tyler Evans: There's a number of training programs out there.
• 8:18
  Dr. Tyler Evans: There's a number of certifications, um, out there.
• 8:21
  Dr. Tyler Evans: Unfortunately, there's sort of too many certifications and so it, it's hard to sort of really.
• 8:26
  Dr. Tyler Evans: Standardize,
• 8:27
  John: but you're recruiting from the community.
• 8:29
  John: For the community Yeah.
• 8:31
  John: To create, you know, sort of lightly trained folks who are typically non-clinician, but really connecting the conventional infrastructure to the, to the, to the social and social anthropology.
• 8:44
  John: Yeah.
• 8:44
  John: And so social, uh, topography to, to, whether it's walking the streets of East New York or, or, or going door to door in a rural community that.
• 8:52
  John: That's having a hard time.
• 8:54
  John: Can I, I think it's just awesome.
• 8:55
  John: So David, it sounded like you hit a drum.
• 8:57
  John: Did you want to get in on this conversation?
• 8:59
  John: I hit, I
• 8:59
  David: hit a drum.
• 9:00
  David: Yeah, I mean, so I tell you, you talk, you've talked about sticking to the science.
• 9:03
  David: So let's, let's, let's do that for a minute.
• 9:05
  David: So, one of the things that you've been pushing back on is the RFK Junior's false claims about, you know, aborted fetus, fetus debris in the vaccine.
• 9:14
  David: So maybe you can just start with, you know, what is actually in the MMR vaccine?
• 9:20
  David: I. Why did these narratives get out there?
• 9:22
  David: Why are they so hard to debunk?
• 9:26
  Dr. Tyler Evans: Uh, so there's, there's no, I mean, first, first of all, in terms of the, um, the, you know, the, the, the fetus tissue and all the whatever sort of claim that that exists, it changes every week.
• 9:37
  Dr. Tyler Evans: None of that is, is, is, is based in, in reality or, or, or there's no evidence for that, uh, whatsoever.
• 9:44
  Dr. Tyler Evans: Um, you know, the MMR vaccine is, uh.
• 9:49
  Dr. Tyler Evans: It's very safe.
• 9:50
  Dr. Tyler Evans: It's been, you know, it's been used for, used for decades.
• 9:53
  Dr. Tyler Evans: It's one of the most effective vaccines out there.
• 9:56
  Dr. Tyler Evans: Um, it is.
• 9:57
  Dr. Tyler Evans: There's, there's typically adjuvants that are connected to, um, to, uh, any vaccine.
• 10:03
  Dr. Tyler Evans: It's just to kind of, to, to boost the immunogenicity of it.
• 10:06
  Dr. Tyler Evans: Um, you know, some of them are based, uh, and, uh, and, uh, you know, they're, they're typically very inert.
• 10:13
  Dr. Tyler Evans: Do not have any.
• 10:15
  Dr. Tyler Evans: Any sort of, uh, issues, uh, vaccines do not give you the infection.
• 10:20
  Dr. Tyler Evans: So when people say, you know, I got the flu shot and I got the flu, that it's not a fact that never exists.
• 10:27
  Dr. Tyler Evans: Um, you know, you can get a flu-like illness as the result of the flu shot.
• 10:32
  Dr. Tyler Evans: You can get, uh, you can spike a fever, you can get some muscle pains as a result of the MMR uh, vaccine, but you are not getting, uh, those, uh, those infections.
• 10:40
  Dr. Tyler Evans: Um.
• 10:41
  Dr. Tyler Evans: And so it's again, really, really important to stick to the science and, uh, you know, vaccines have been, both in the United States and and globally have, have essentially been one of the most important, um, instruments that we've had in order to protect, uh, populations and to improve, uh, survival, improve more morbidity, mortality.
• 11:03
  Dr. Tyler Evans: I, I've worked in, you know, some of the poorest countries in the world.
• 11:07
  Dr. Tyler Evans: Focusing on mass immunizations for child, for children, which were challenging just to get in there.
• 11:12
  Dr. Tyler Evans: So the fact that we have them at such, with such ease in the United States, and yet we, we have all these challenges, um, with, with, you know, relatively good reason.
• 11:22
  Dr. Tyler Evans: I mean, people have been, parents have been scared as the result of the Wakefield.
• 11:26
  Dr. Tyler Evans: Um, the Wakefield study, which had an N of four, you know, which was essentially claiming that there was a, a link between the MMR vaccine and.
• 11:35
  Dr. Tyler Evans: Autism that has been debunked, that that paper was, was pulled, that that scientist Wakefield was, has been discredited.
• 11:43
  Dr. Tyler Evans: Yet we continue to cite that.
• 11:46
  Dr. Tyler Evans: And now there's, uh, you know, an investigation inquiry into the actual connection with sort of vaccines and environments and autism, even though that that has all sort of been.
• 11:57
  Dr. Tyler Evans: Uh, deep on.
• 11:58
  Dr. Tyler Evans: So again, we just need to stick to the science, understand the importance of, of the effectiveness of vaccines and, and the safety.
• 12:05
  Dr. Tyler Evans: That's been, again, this, there's, we have millions of data points on these, on these pieces, including COVID-19.
• 12:12
  David: So on the MMR vaccine now is just thinking one of the reasons maybe that people are open to these.
• 12:18
  David: Concerns, safety concerns about vaccines is they don't remember, they hadn't seen what these childhood illnesses were like before.
• 12:25
  David: And I was just, um, you know, NMR has his, you know, measles, but also mumps and rubella.
• 12:30
  David: Right.
• 12:30
  David: So I was just listening to, um, Ron Howard's memoir, and he talks about being on the Andy Griffith Show and he says, Andy Griffith said, you know, he couldn't have kids.
• 12:39
  David: And it's, it's apparently because he attributed it to, he had mumps.
• 12:43
  David: As a kid and it left him, you know, unable to have to have kids.
• 12:46
  David: And so I think, you know, those stories were common, you know, a lot of people with polio, you know, in those, in those days.
• 12:52
  David: How much of the vaccine hesitancy or um, just concern among from parents, I'm not talking about from the secretary, is driven by just not seeing those things that it's meant to be, to protecting, and then you just worry about the vaccine itself.
• 13:06
  David: Is that a major factor?
• 13:08
  Dr. Tyler Evans: I, I couldn't agree more.
• 13:09
  Dr. Tyler Evans: Here's the thing, we.
• 13:12
  Dr. Tyler Evans: As the result of decades of strong public health efforts.
• 13:17
  Dr. Tyler Evans: Right.
• 13:18
  Dr. Tyler Evans: Um, and, and getting to, um, you know, getting to sort of, um, outcomes of, of close to herd immunity for, for c vaccine preventable diseases.
• 13:31
  Dr. Tyler Evans: We almost, we have no real reminders of, of what these diseases actually look like.
• 13:37
  Dr. Tyler Evans: So the fear factor, which you know, is, is not.
• 13:42
  Dr. Tyler Evans: The best way to communicate sort of messaging on public health, but a little bit of fear, um, as a reminder of what could be, what could, what sort of exists out there?
• 13:52
  Dr. Tyler Evans: Um, it can be effective.
• 13:54
  Dr. Tyler Evans: And, uh, and we don't have it, right?
• 13:56
  Dr. Tyler Evans: I mean, we, we, we starting to get it right with the measles outbreaks.
• 14:00
  Dr. Tyler Evans: Although for many folks, it's an abstract concept.
• 14:02
  Dr. Tyler Evans: I mean, they're hearing on the radio, but they don't actually, you know, know what it is.
• 14:05
  Dr. Tyler Evans: I mean, measles could be, is one of the most infectious diseases out there and gets people, particularly kids, very, very sick.
• 14:13
  Dr. Tyler Evans: I mean, it, while it can lead to death, you know, in many sort of instances, it doesn't lead to death, but it gets, it is very, very.
• 14:22
  Dr. Tyler Evans: Uh, sort of, you know, a very.
• 14:27
  Dr. Tyler Evans: Sort of manifests, you know, disease that really causes, uh, a lot of sort of morbid sort of conditions.
• 14:33
  Dr. Tyler Evans: And if there are comorbidities could really be worse.
• 14:36
  Dr. Tyler Evans: There was, I saw mumps outbreaks taking place in Los Angeles.
• 14:40
  Dr. Tyler Evans: Um, there were, uh, there was an outbreak that took place, I think 20 20 17, uh, particularly among men who have sex with men.
• 14:46
  Dr. Tyler Evans: Um, and so, you know, we were seeing, you know, different sort of manifestations of mumps, things that we haven't seen, you know, uh, for decades.
• 14:54
  Dr. Tyler Evans: Um, and we, we saw sort of, you know, swelling of, um, of, of, of different sort of inflammatory, um, glands, particularly the scrotum.
• 15:03
  Dr. Tyler Evans: Uh, you know, that was, uh, that was definitely sort of palpable.
• 15:06
  Dr. Tyler Evans: Uh, we have, uh, we have definitely seen, you know, certain sort of like episodic episodes of Rubella.
• 15:13
  Dr. Tyler Evans: And then beyond that, I mean, we've seen, you know, uh, we haven't seen polio.
• 15:17
  Dr. Tyler Evans: We haven't seen a lot of these other, uh, other pieces, uh, because we are so protected.
• 15:22
  David: So, so let's talk about COVID-19.
• 15:25
  David: For a minute.
• 15:25
  David: So COVID-19 was certainly a reminder of what, what could happen and what I was, uh, you know, call me naive or over optimistic, which John never does, 'cause usually I'm not.
• 15:34
  David: But, um, you know, you had people that had the vaccine and they, COVID was prevented, um, or severity was, was reduced.
• 15:43
  David: And then you had a lot of people that, you know, were, were dying and they were saying, gee, I, you know, I wish I hadn't listened and, you know, people should really listen to me and they should get the vaccine.
• 15:51
  David: And I was fooled by the propaganda, et cetera.
• 15:53
  David: So you'd think.
• 15:55
  David: Based on our earlier logic that, oh, now people have seen it and, you know, you had people like repent from being vaccine, uh, skeptics, but somehow that hasn't translated.
• 16:03
  David: And if anything, just about the opposite.
• 16:05
  David: So how do we understand that?
• 16:08
  Dr. Tyler Evans: Um, I wrote my book, which is called, uh, pandemics Poverty and Politics.
• 16:12
  Dr. Tyler Evans: Uh, the subtitle of that is, um, decoding the Social and Political Drivers of Pandemics, um, from the Third Plague to COVID-19.
• 16:19
  Dr. Tyler Evans: And so, you know, using COVID-19 really as a springboard.
• 16:23
  Dr. Tyler Evans: To discuss many of the, the, um, ideas that had sort of, um, that had again emerged, um, you know, in sort of my mind, uh, over the course of, of, of decades of, of my, um, experience, but had sort of existed for, uh.
• 16:39
  Dr. Tyler Evans: Centuries was that there were social and political drivers that were impacting, uh, that were impacting the emergence of epidemics that led to pandemics, um, over the course again of, of centuries.
• 16:54
  Dr. Tyler Evans: And when we get to COVID-19, this was one of the pandemics that in contemporary society.
• 17:01
  Dr. Tyler Evans: Almost everybody had exposure to, right?
• 17:04
  Dr. Tyler Evans: Everybody had exposure.
• 17:05
  Dr. Tyler Evans: Almost everybody was one degree of separation away from COVID-19.
• 17:09
  Dr. Tyler Evans: And, um.
• 17:11
  Dr. Tyler Evans: Which was very different from your HIV, your tuberculosis, your malaria, um, you know, your, your, your, your, your pediatric diarrheal diseases, um, your, you know, meningitis, uh, your meningitis belt.
• 17:23
  Dr. Tyler Evans: This is for a lot of those diseases.
• 17:27
  Dr. Tyler Evans: The, the, some of the biggest infectious disease, um, outbreaks that are currently sort of the.
• 17:33
  Dr. Tyler Evans: The, the, the most formidable sort of, um, threats to, uh, to our, to our world in the, in, in the global north, in the United States, Europe, uh, many parts of East Asia.
• 17:44
  Dr. Tyler Evans: They did not have access to that, uh, that to that sort of real manifest exposure.
• 17:49
  Dr. Tyler Evans: It wasn't real enough to them.
• 17:51
  Dr. Tyler Evans: For them it was, it was, it was, for many of them, it was an abstract.
• 17:54
  Dr. Tyler Evans: Abstract sort of concerns.
• 17:55
  Dr. Tyler Evans: And while it might be charitable, while they want to provide, um, opportunities to, um, to basically, you know, help protect these other communities in sort of Africa and Latin America, et cetera, um, it wasn't real to them with the exception of COVID-19.
• 18:12
  Dr. Tyler Evans: HIV was close.
• 18:13
  Dr. Tyler Evans: Um, but COVID to 19 really kind of, you know, check those, check those sort of boxes.
• 18:18
  Dr. Tyler Evans: And, um, and so what we saw was particularly, not only was everybody.
• 18:24
  Dr. Tyler Evans: Sort of exposed, but it was the most historically marginalized that were the most at risk.
• 18:29
  Dr. Tyler Evans: And, and so, so again, all these people exposed, but then they feels like, well, maybe I'm not the most at risk.
• 18:38
  Dr. Tyler Evans: 'cause we knew that the, you know, the, the folks that were, I. The most at risk were those were, you know, morbid obesity, diabetes, chronic comorbidities, and a lot of these were socially determined.
• 18:47
  Dr. Tyler Evans: So for people that, that had more privilege, that had more access, they felt, well, maybe, maybe we're most, we're, we're not at risk as, as, as much as we thought.
• 18:54
  Dr. Tyler Evans: Um, but what happened was by not addressing the social and political drivers that impacted the most historically marginalized, we secondarily impact.
• 19:06
  Dr. Tyler Evans: The sort of other communities, your closest, your closest communities, because hospitalizations were hospitals were completely maximized, right?
• 19:15
  Dr. Tyler Evans: The hospital capacity was, was, was over completely overstretched.
• 19:18
  Dr. Tyler Evans: ICU capacity was completely overstretched.
• 19:20
  Dr. Tyler Evans: And so as a result for, for, for folks, suburban folks, urban folks, you know, who, you know, whatever we call the one 10 percenters, et cetera.
• 19:29
  Dr. Tyler Evans: Um, folks that had access, they no longer had access.
• 19:33
  Dr. Tyler Evans: So guess what?
• 19:33
  Dr. Tyler Evans: Now it, now it impacts everybody.
• 19:36
  Dr. Tyler Evans: And, and, and if it doesn't impact them in, in a material way, it impacts their, their bottom line.
• 19:42
  Dr. Tyler Evans: Um, the economics of not investing in, in, in, in, in, you know, good population prevention, um, efforts are impacting, you know, these communities.
• 19:52
  Dr. Tyler Evans: So that's, that's a really important message to get out.
• 19:55
  David: That's it for yet another episode of Care Talk.
• 19:57
  David: Our guest today has been Dr. Tyler Evans from the Wellness and Equity Alliance, and he is author of Pandemics Poverty and Politics.
• 20:05
  David: I'm David Williams, president of Health Business Group,
• 20:08
  John: and I'm John Driscoll, the chairman of U, the Yukon Health System.
• 20:11
  John: If you liked what you heard or you didn't, we'd love you to subscribe on your favorite service, and thank you Dr. Evans for joining us this morning.
• 20:17
  Dr. Tyler Evans: Thank you.
• 20:18
  Dr. Tyler Evans: Pleasure to be with you.