Sarah Taylor: The Science of Breastfeeding

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Today, our guest is Dr. Sarah Taylor, but we always like to check in on current or hot topics in health and healthcare. And so Harlan, why don’t you kick us off?‌‌

Harlan Krumholz: Thanks, Howie. I don’t know. This week, I thought I’d talk about a little bit about this direct-to-consumer healthcare through the lens of Hims & Hers. You’ve heard of Hims & Hers, of course, right?‌‌

Howard Forman: I have. And they were obviously a big topic during the Super Bowl for other reasons so, yeah.‌‌

Harlan Krumholz: Well, they’re a juggernaut. They’re a juggernaut, and they’re really part of this broader shift in healthcare around trust and information access and what’s happening with regard to how people are actually getting their care. So they’re a really dynamic case study in this direct-to-consumer healthcare. They’ve achieved this remarkable growth. Their revenue is just about $1.5 billion last year, a 69% increase year over year. And their subscriber base, they’re people who just are repetitively getting prescriptions and so forth from them, reached 2.2 million, which was a 45% increase over the prior year, indicating this strong consumer demand for convenient, technology-driven health services.‌‌

And what they do is that they provide medical care via apps and telehealth. So they leverage data analytics and a little bit of AI—at least they say so—to offer these personalized solutions and experiences. Of course, they do their own compounding, so they’re producing for you what they’re saying you need. And the appeal is something like, consumers can avoid traditional healthcare pain points such as inconvenient appointment times, short visits, and personal interactions. And they can get this fast, convenient, responsive care that they’re promoting is being tailored to their needs.‌‌

And I think it started off as a company that was providing things that had some stigma around them, like erectile dysfunction or baldness. People were reluctant to even go to their doctors and be able to talk about these things. And here, they could quickly—and with the belief, confidentially—be able to have these quick interactions and thinking that “I really don’t need to talk to someone for an hour about this. I just need to get Viagra. And how do I get that?” And the idea was that this is not just about innovation in the technology, but I think it is also emblematic of this growing skepticism towards traditional healthcare providers.‌‌

And you had talked about this Gallup poll and we have discussed about how trust in medical doctors has declined dramatically. Even over the last from 2021 to 2024, about two-thirds of people said that they trusted their doctors down to about half of people saying that they trusted. That’s the steepest drop among all the surveyed professions. Of course, we’re in this moment where people are not trusting authority figures, but the doctors had the steepest decline.‌‌

And then there’s a Wall Street Journal article that came out just, I think, yesterday or day before that was talking about, “What is this problem? People not trusting their doctors, having these rushed appointments, fragmented care, inadequate communication.” And I think it’s just that people are feeling unheard, undervalued, and having options to get answers elsewhere. The CDC recently reported that 60% of American adults now use the internet to search for medical information. Women a little bit more likely than men. And it’s higher as you might expect among younger people. My youngest daughter, I know she has a problem. She’d rather transact it on her phone than actually go see someone at the doctor’s office. And this is breaking down the traditional information asymmetry, the idea that you needed to go to someone who had the knowledge because you don’t have the knowledge. And now with these ChatGPT and all these other things, I mean, people are going to be able to get access to information at whatever literacy level they have. And I think this is going to really disrupt the entire healthcare system.‌‌

So I just want to ... In summary, there’s this building on the mistrust, the inconvenience, the traditional ways of doing things, feeling unheard, and impersonal care. This is moving towards this hyper-personalization. I saw they’ve got these combo pills where they’re putting together something special for you. By the way, we can talk about compounding because this is not what’s being FDA-approved. They’re creating their own special meds for you.‌‌

Howard Forman: And that’s where a lot of that growth came from. So I would just be a little skeptical about the obesity side of things because a lot of their growth is at risk to giving people semaglutide or even tirzepatide, not through the traditional channel of Eli Lilly or Novo Nordisk, but rather through their secondary market that they have.‌‌

Harlan Krumholz: Yeah, but I think once you’ve got 2.2 million people, people are starting to get used to this as a way. They do have... they’ve got these hair blends. They’ve got also, like I said, erectile dysfunction and baldness things. Some of the stuff they’ve got, which has got strong evidence behind it. Some of the stuff has not as strong evidence behind it, but it’s pretty impressive what they’ve been able ... 45% subscriber growth over a year. Like I said, 69% revenue growth, some of it being fueled by the anti-obesity, a lot of it being fueled by the anti-obesity medications, but they’re poised for a lot of stuff. Mental health, derm, they’re going to continue the sexual health.‌‌

Howard Forman: You and I have talked about before that if you’re going to have to wait six months for an appointment to see your own specialist versus getting on an app and having something resolved in 15 minutes or half an hour, it doesn’t take much to overcome that. I mean, it’s an easy pivot to try.‌‌

Harlan Krumholz: Yeah. I think we’re seeing some of these clinics closing, the primary care clinics, like at Walmarts, Walgreens that were built like this, but this thing seems to be growing. We’re going to see how dependent it was on weight loss, see what happens next year. But if I were the big healthcare systems, I’d be looking over my shoulder, because once they have a relationship with these people, their ability to steer and suggest and create, you know, going to centers of excellence, people may not go anymore to the closest place for what they need. If they feel they’re going to get special care, personalized care somewhere else, it may change the whole face of the way that....‌‌

Howard Forman: I agree.‌‌

Harlan Krumholz: ...discretionary care gets taken care of. But anyway, I just wanted to share that they had the recent investor call. So some of this came from the stuff in their investor call. I’m excited about this interview. Let’s get to it.‌‌

Howard Forman: Dr. Sarah Taylor is the director of neonatal clinical research as well as a professor of pediatrics in neonatal and perinatal medicine at the Yale School of Medicine, a practicing physician. She’s also the chief of neonatal-perinatal medicine at Yale New Haven Hospital. Her research focuses on infant nutrition and growth and centers on human milk medicine, including disparities in lactation, the biology of milk production, and the role of human milk intake in preterm infant growth and development. Dr. Taylor established the Yale Neonatal NOuRISH—which stands for Yale Neonatal Nutrition Outcomes Research In Sustaining mother and infant Health—Center to investigate how fetal and neonatal nutritional and metabolic exposures impact outcomes. She received her bachelor’s degree from Wake Forest University, her medical degree from the University of Miami Miller School of Medicine. And she completed her pediatric residency at the Medical University of South Carolina, as well as her neonatal perinatal fellowship, where she also received a master of science in clinical research.‌‌

And I have to say that you and I first met when a medical student came to me upon arriving at Yale, a student who was going into the MD-PhD program, and she was interested in the intersection of cost and women’s health and neonatal health, and she was interested in breast milk banking or human milk banking. And so we started talking about this topic, and I did not know nearly enough about human milk, breast milk. And so we reached out to you and she was actually enthralled with that. She knew of you as well. I think she might have even talked to you separately. And we did this project on what is the cost of human milk, breast milk? And it got me thinking a lot about it, but I don’t know nearly enough. And in the ensuing time, there’s just been a lot of issues around breast milk or human milk.‌‌

So first of all, can you tell us a little bit about what mothers, new mothers, or future mothers, or anybody should know about the concerns people raise about human milk versus powdered milk? What are the trade-offs? What are the considerations?‌‌

Harlan Krumholz: And what was it like working with Howie? That’s what we really want to know.‌‌

Sarah Taylor: Yeah. Well, I will say it was an excellent opportunity to work with Howie. My knowledge of health economics is incredibly small and I learned a lot, steep learning curve, in writing that paper. So really enjoyed that collaboration. And thank you all for the invitation to be here. This is fantastic.‌‌

So, yeah, when it comes to infant feeding, we have a couple of options. Formula feeding is the most common other option that is not from a human. And that formula can be either a powdered supplement, which is the less expensive type, it’s what is the most available, say, in the grocery stores and such, or it can be a liquid. And I think some of what you’re referring to, Howie, is the controversies that have gone on with the powdered formulas not being sterile, and so potentially can carry pathogens that can impact and have impacted babies. But when it comes to the human milk, which is either feeding at the breast or feeding mom’s milk from a bottle or the donor human milk, which is always, of course, fed from a bottle, the important things to know is that we’ve done a great job in the U.S. of getting families interested in breastfeeding.‌‌

Eighty percent of women choose to initiate breastfeeding, which is great, and it should always be a choice. Our job as healthcare providers is to inform, and then the family chooses what they want to do. And some choose formula feeding, which is also acceptable as long as it’s an informed decision. Eighty percent of women are initiating breastfeeding. They drop off so quickly. And this gets to the paper you and I wrote. Breastfeeding is, I think the title was, it’s not a free lunch. There’s a lot of work that goes into a breastfeeding family. It’s not uncommon.‌‌

And actually, it’s more common for families to not achieve their goals for breastfeeding because we’re down to a rate of about 26% when you look at exclusively breastfeeding through six months, which is what the American Academy of Pediatrics and the World Health Organization both recommend. So we’ve gone from 80% to 26% in six months. So that’s the hard work that is not being adequately supported. So I want all moms to know that, that they’re not alone, that it’s a wonderful, beautiful thing to do. I don’t want to make it sound like it’s just all difficult. When it works, when it finally clicks, it’s easy. It’s all the work to establish breastfeeding, which is where we lose so many people from achieving their feeding goals. And then it’s also trying to sustain breastfeeding when you’re going back to work, when you’re taking care of other kids, when you’re taking care of other family members to so many things that get in the way of that.‌‌

Howard Forman: Yeah, we just... I’ll turn it right over to you, Harlan, but we addressed in the paper peripherally, but it is challenging for a lawyer or a radiologist to continue to pump or breastfeed when they go back to work. It’s practically impossible for a service worker in many firms to be able to do that. So it varies tremendously on what type of work you do, whether you have to work.‌‌

Harlan Krumholz: Well, these are ... It’s so important, this has to do with what kind of choices people make and what kind of opportunities they have. I was fascinated by a lot of the other aspects of this that you have delved into that I think people listening would like to hear about. And I’m going to tick off some, I don’t know, I have to share my time with Howie, so I’ll let Howie ask his question. But I’ve got a bunch here that I want to... the traditional view of breastfeeding emphasizes the mother’s role, but recent research, including what you’ve written about, talks about the infant’s active contribution, which is something I didn’t really appreciate or understand. And that infant suckling stimulates hormonal and cellular responses within the breast, influencing the actual milk composition.‌‌

And also, its volume and nutrient density and milk fat content, for example, is lowest when the breast is full, highest when it’s nearly drained, suggesting infants can indirectly control their nutritional intake through feeding behavior. Can you just talk a little bit about how the infant influences the biological processes that determine breast milk composition during these nursing sessions? Because this was something entirely new to me when I was reading your work.‌‌

Sarah Taylor: Yeah, it’s new to us, too. It really is. This is a new area, and I will say a fair amount of it is based on preliminary data or hypothesis considerations. We still have quite a bit to do to really prove all of these mechanisms. But yes, that feeding pattern of the infant, how they suckle, the pace that they set, how long they suckle, and that pace changes through a breastfeed, and it’s completely unique to the individual infant. Even a mom, probably many women could tell you this, they’ve breastfed more than one child, they had a different lactation experience with each child because each child has their own personality when it comes to feeding and—‌‌

Harlan Krumholz: Even at that very young moment of birth, after birth, yeah.‌‌

Sarah Taylor: Even at that very young... exactly. Yeah. This is from the beginning. And these babies have been developing suckling in utero. It’s not uncommon to see them sucking on a thumb when they are in utero. And that’s another thing, sometimes at the breast, a baby can change to where it’s completely nonnutritive, where they’re actually not suckling to where they get food, but instead suckling just for comfort. They can make that change.‌‌

Harlan Krumholz: Well, let me sneak another one quick in and then I’ll hand it back to Howie, which is, breast milk is a flavor bridge. And this is another interesting concept that human milk transmits dietary flavors from the mother’s diet beginning even in utero through the amniotic fluid. And that what, I think, you were terming this “flavor bridge” concept explains why some infants develop preferences for certain foods early in life. The exposure can shape dietary acceptance and potentially influence eating patterns later in childhood. I mean, this is really interesting that whether a mom’s eating spicy foods or ... can you just maybe help us understand this, how robust is this connection between flavors transmitted through breast milk in children’s later dietary preferences? Is it well established?‌‌

Sarah Taylor: Yeah. So one of the co-collaborators on that paper has done most of that research, and she just really has the details of this and really looking at the flavor patterns is quite innovative, but yet also impressive. So we still are determining all the variations here and what they could possibly mean for future taste. So I’m not going to say that it’s fully established except that we know that there is an association or there is some patterning that’s occurring with this.‌‌

Howard Forman: I want to pivot, it’s not a full pivot because it’s all really related, but you’ve also done a lot of work on bringing parents and grandparents into the neonatal intensive care unit, which historically was never the case. I mean, if anything, parents were kept on the other side of a wall and rarely allowed to interact with their neonates. And some of this research has to do also with breastfeeding. And I was just wondering about what are the take-home messages for our audience about evolving patterns of “couplet care” as you talked about it or more involvement of family members in these very, very delicate neonates?‌‌

Sarah Taylor: So this was a huge culture change during my time as a neonatologist. When I started out, we had visiting hours in the NICU [neonatal intensive care unit] and we would kick parents out, for lack of a better term, when we did not want them there. And, of course, staff were used to that. So then when, all of a sudden, there’s this idea that families should have 24/7 access to their infant, this, staff, “I can’t work like that, we’re not going to be able to do our jobs.” It was just an incredible change to do that. And once we started doing that, though, it just kept rolling. And really where we are now or where we should be is when the family is in the intensive care unit, that area around their baby, that’s their home away from home, that is the family space, and we are the guest and now we’re important guests because we might be doing some really critical things to take care of that baby, but we still need to realize and not refer to the families as visitors to their baby.‌‌

They’re not the visitors. We’re actually the visitors. They are there where they’re supposed to be with their baby, same with grandparents, and, of course, fathers feeling very involved. We focus a lot on moms and neonatology because we need mom’s milk and we need to remember to also focus on the dads, of course, because they’re critical to their baby’s development.‌‌

We’re still learning how to do this well in an intensive care unit, but that new mental model where you’re the visitor to the room—so we’re fortunate at Yale New Haven Hospital, we have single-patient rooms, so when I walk into that room in the past, it would have been my room and the family was visiting. Now it’s their room. I’m asking permission to enter, and I’m treating it as their family space. Whole new mental model, but hopefully, families are feeling that difference. And we need to do this because bonding with their NICU baby, I mean, it’s critical that they develop the same bonds that they would if this infant was at home. So we really need to empower them with that opportunity to do that.‌‌

Howard Forman: And you’re showing some early outcomes that follow-up visits and breastfeeding are more likely if you’re able to have more encounters.‌‌

Sarah Taylor: Absolutely, yes. So if the families are able to be there and be engaged in the care, that’s the other thing. Why can’t the family change the diaper or start the feed, even if it’s like a syringe feed that we’re giving or a tube down to the stomach, they can hold the feed while it’s being given. All of those things definitely impact mother’s milk supply, and we know stress relates to mother’s milk supply. So the less stress, the more good, positive hormones she’s experiencing, endorphins being there with her baby, the better her milk supply is going to be. And then, of course, families are more engaged if they’re there and we’re talking to them about what to expect at home and why their baby’s going to need this follow-up appointment, they’re much more likely to go than if we just hand them a paper at discharge and say, “Show up at all these appointments.”‌‌

Harlan Krumholz: Yeah, I think that’s just brilliant. What a great frame shift. I mean, who is the visitor here, and how important is that to people’s ability to bond and encourage recovery? It’s incredible. I love hearing it. Okay, I’m going to go back to the breast milk.‌‌

Sarah Taylor: Yeah.‌‌

Harlan Krumholz: I’m going to pepper you with two other quick questions. Going to get into my two quick questions here. One is, I was surprised to learn that breast milk actually contains its own microbiome, this complex community of microorganisms that influence gut colonization, immunity, long-term health, and that infants shape the milk microbiome through their own oral microbiome, what’s in their mouth. So it turns out they’re each unique in the way that they’ve got this community growing with them as we all do. And some of it’s transferred during breastfeeding, and that disruptions such as preterm birth or antibiotic use, and so forth can influence this. How significant is the role of the infant’s microbiome in shaping this breast milk consumption? And what implications does it have? Because I don’t think we’ve thought that much about that in the past.‌‌

By the way, we’re often sticking our own fingers in their mouth so they can suck on our thumbs and stuff like that. By the way, my daughter just had a baby, so I’m watching her breastfeed. By the way, she’s not only a medical student, but she’s a registered dietitian, so she’s very interested in nutrition. So this is a shout-out to Sarah. I hope she’s listening to this because it’s a cool way to explore it.‌‌

Sarah Taylor: Absolutely. Oh, that makes me so happy to hear of a medical student who’s also a registered dietitian. That’s perfect. And a new mom.‌‌

Harlan Krumholz: And a new mom, yeah.‌‌

Sarah Taylor: Yeah. That is great. Yeah. So this goes a little bit to what I was talking about with the infant’s reflux, the infant’s oral microbiome. This is an area ... and I was actually recently with other researchers in this field to make sure that, just to discuss, are we all still thinking about this the same way? Because we need to prove it. There’s a lot of this that we need to prove, but first of all, the milk contains the microorganisms from mom’s gut. How does bacteria get from mom’s gut to the breast milk? We’re not 100% sure how that travels. We think it may be through the lymph system rather than through the blood system. So through the lymph node system. There’s a lot of lymph tracts that go through our chest from the GI tract that might then drop off these bacteria at the mammary gland. But that, we’ve got to figure out, it’s a long-held theory that we really need to explore further, and then, yeah, the impact of the baby. And so, one way to look at this is how the microbiome of the milk may be different in different pregnancies. Some of that could be environmental and exposures, but looking at how each infant may impact the microbiome.‌‌

Harlan Krumholz: Okay, I’m going to get in my last one here because I know we’re getting close to time. So another area that’s really interesting to me is these breast pumps. So you and Howie thought a lot about what do they cost and do people get access to them, but you’ve also highlighted that, this research that there are differences in milk expressed through pumping versus direct breastfeeding. So it’s not just, you can just stick these pumps on and you’re going to get the same milk that you would have got with the baby. And that relates to the research you’re doing about how the baby interacting with the breast is influencing the nutrition. And that also the pumps can vary in terms of, okay, their effectiveness, I get, how much milk they can do and how comfortable they are. But I didn’t realize that the different pumps may vary in the kind of milk composition that they produce.‌‌

So I just wonder if you could just talk a little bit about that, because I think when people are shopping for breast pumps, so they’re thinking about breast pumps, they’re just thinking, “This is just taking the place of the infant, it’s just producing the milk.” Again, comfort costs. People think about that, but they don’t think that actually they may vary in the quality of the milk that they’re producing. That was a surprise to me.‌‌

Sarah Taylor: Yeah. Absolutely. And it is. And it’s an area that... again, a lot of what you’re ... Great questions you’re asking, because these are the areas we need to continue to explore. But yes, I would say when you’re shopping for breast pumps, for one is, if you’re going to be separated from your infants, especially in, say, your infants in the neonatal intensive care unit, you need what we call a hospital-grade pump. It is an expensive pump, so most people rent them rather than buying them. They can be multi... they’re made so that more than one person can use them, so you can rent them. But that is a pump that is made to sustain breast milk even when you’re not putting your infant to breast or rarely putting your infant to breast.‌‌

Otherwise, it is nice, the availability of pumps, the specialty of pumps has exploded in, say, the past 20 years. So there’s so many more options for families, but it also then is really confusing. So there’s pumps such as hands-free pumps, there’s pumps that you can wear under your clothes. And I was with someone this weekend in the NICU who was pumping, and I would have never known it. I couldn’t hear a thing and such. Those are wonderful and have changed ... when Howie talks about people who weren’t ever able to breastfeeding, anesthesiologists had a difficult time breastfeeding because they don’t really control their schedule, that the surgery goes six hours, you’re there. They now are able to pump by these hands-free pumps.‌‌

But those should not be where you start. You should start with more of a established standard breast pump at home. And then as you establish your lactation and your milk’s coming in, say you’re getting to more, four weeks lactation, then you can try out these other options. Some of them don’t work for all women. And so one thing to consider is—and unfortunately, it can get expensive if you purchase one and then it just did not work for you—but I think the first thing is to make sure that that pump is the right pump for the woman to sustain the milk supply. Otherwise, the biggest thing is to make sure that the breasts are fully pumped so that you get all of that fat. You’d mentioned, Harlan, that that fat is often at the end of the feed. And I think that’s the biggest mistake that we make is, we’re rushed, so we can only have so much time to pump and we don’t pump to emptying of the breast. And you really have to pump to emptying of the breast, one, so your baby gets the fat, two, because it’s breast emptying that keeps the supply up.‌‌

Harlan Krumholz: Yeah. Oh, this is just terrific. What a great interview. Thank you.‌‌

Howard Forman: You are awesome. I really do say, when I talk to our listeners, I think that this is what makes you all great, is that we have these colleagues who are subject-matter experts, leaders in their field, running clinical services and practicing medicine. You are astonishing and a great friend. So thank you very much for joining us.‌‌

Harlan Krumholz: Thank you so much for joining us.‌‌

Sarah Taylor: Thank you for having me. I loved it. You guys have great questions.‌‌

Harlan Krumholz: Howie, that was terrific. Wow, I’m so glad that you brought her in. And some of you’ve collaborated with, that was just amazing. But now let’s get to another favorite part of the show for me—hearing what you’ve got to say.‌‌

Howard Forman: Yeah. I mean, there’s so many negative topics that I thought about, but I realized that there’s actually some good news out, and I thought maybe we could just highlight a paper that’s in the Journal—‌‌

Harlan Krumholz: I am dying for good news. I’m dying for good news. I’m like, “Someone in a desert, please.”‌‌

Howard Forman: Here you go. So here it is. There’s a paper in the Journal of the American Medical Association, which is a follow-up to our podcast of 18 months ago, Episode 97 to be exact. And in that episode, we talked about the healthy opportunities pilot program in North Carolina, which is something that was first conceived by our alum, Secretary of Health Mandy Cohen, when she was still in that office, but the pilot itself started right after her departure. This pilot project sought to test whether interventions in social determinants of health across several domains could reduce healthcare spending. This is a long-standing important issue to resolve, and it was illuminated over a decade ago by the book written by Lauren Taylor and Betsy Bradley, both our prior guests on this podcast, and their book was The American Health Care Paradox: Why Spending More is Getting Us Less. So this will become clearer in a minute.‌‌

So back to this pilot, this intervention provides greater food security, violence protection, and greater housing security through a host of specific and trackable interventions, and importantly, evaluates the outcomes, and notably, the total program costs to medical costs in this Medicaid population. It was made possible through a federal Medicaid waiver, and it began in March 2022, so three years ago, but tracking began even a year before that. We’ve previously reported some really early results, but now we have a 20-month evaluation period, and more results are going to come. So what have they learned? Number one, costs go up initially because the interventions actually cost money. No surprise there.‌‌

Costs associated with food, housing, social services are meaningful, but the spending then turns down and turns down in a substantial statistically significant way compared to the comparative growth, so much so that by Month 8, costs are lower for the intervention for the pilot project group. Emergency department use was lower. There’s no statistically significant change, at least in this period, for in-patient admissions or out-patient visits. This is by no means a double-blind, randomized controlled trial, but it is still a methodologically sound investigation with many limitations, and the authors acknowledge them, but the early results are very enlightening and favorable. Eighty percent of the interventions are around food. So that’s a key point to make. And much of that is just simply fruits and vegetables, and delivered or available healthy meals. It also includes training around diabetes and nutrition management and education.‌‌

And I’m not going to assert that this proves that certain health-related social needs interventions are actually cost savings because we’re not there yet, but it brings us closer to understanding them. And the answer leans toward yes, we need to do more thoughtful investigations and continue to follow this cohort over the remaining years of the investigation. And we should also be open to the possibility that short-term investments in health and well-being for this population may yield longer-term savings as well as healthier, happier people. So I felt like that was a really positive study that wasn’t getting nearly enough press during a time of really, a lot of health news.‌‌

Harlan Krumholz: So do you have any sense that this will be something others will pick up on?‌‌

Howard Forman: So it’s very well watched. It’s an expensive pilot project. It’s only, like I said, 20 months into the five-year investigation. But I think it gives more fodder to at least maintaining this pilot project, particularly when people are talking about cutting Medicaid. And it really should encourage communities that are impoverished for which they live in what are called nutrition or food deserts to consider these interventions, particularly since they do seem to start to pay back after eight months or so.‌‌

Harlan Krumholz: Yeah. Yeah. Well, that’s terrific. Thank you for covering that. I think what to me strikes me as important is not only did they do the project, but they were committed to doing the science to try to report out what they found. And then there is this piece about, you have to make an investment. It may not be an immediate return.‌‌

Howard Forman: Right.‌‌

Harlan Krumholz: And the question will be whether or not people have the budget to be able to weather that initial period in order to get the longer...‌‌

Howard Forman: That’s exactly right.‌‌

Harlan Krumholz: ...benefit, but that’s just terrific. Good. And next week, Howie, maybe we can talk a little bit about... We’ve got our NIH nominee and our FDA nominees going before Congress this week and—‌‌

Howard Forman: We’ve got a lot to cover. Yeah.‌‌

Harlan Krumholz: So there’ll be a lot of news. There’ll be a lot of news.‌‌

Howard Forman: Yes.‌‌

Harlan Krumholz: Yep. You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.‌‌

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on social media, particularly LinkedIn or Bluesky.‌‌

Harlan Krumholz: And we always love to hear your feedback. Give us your questions, your experiences on these topics. Rate us if you’d like. It helps people find us. We always enjoy that, too.‌‌

Howard Forman: We certainly do. And if you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌‌

Harlan Krumholz: Health & Veritas is produced with the amazing Yale School of Management and the incredible Yale School of Public Health. And thanks to our researchers, the spectacular Inès Gilles, Sophia Stumpf, Tobias Liu, and to our remarkable producer, Miranda Shafer. It’s great to work with all of them and to work with you, Howie, and to work with you.‌‌

Howard Forman: It is the greatest joy, honestly, working with all of you. So thank you all very much.‌‌

Harlan Krumholz: Talk to you soon, Howie.‌‌

Howard Forman: Thanks very much, Harlan. Talk to you soon.‌‌