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Speaker 1: What is a moon shot? Doesn't they have to do

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Speaker 1: with when when we put a man on the moon

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Speaker 1: in the nineteen sixties and making achieving a dream of

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Speaker 1: something that seems impossible sounds like a good explanation. Hi,

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Speaker 1: and welcome back to Bloomberg Benchmark, a podcast about the

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Speaker 1: global economy. It's Thursday, June thirty. Spoiler alert, this is

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Speaker 1: not a show about Brexit. There'll be plenty of time

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Speaker 1: to talk about Brexit. We're going to deal with a

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Speaker 1: more somber, more fundamental theme this week. But first I'm

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Speaker 1: Daniel Moss, executive editor for Global Economics. This week in

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Speaker 1: the studio is Scott Lanman, my colleagues. Scott, tell us

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Speaker 1: a little about yourself. Yeah, I've been an economics reporter

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Speaker 1: and editor at Bloomberg for worth than ten years, with

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Speaker 1: three of those years in Beijing editing our coverage of

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Speaker 1: China's economy. Well, that's a very special economic skill to have.

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Speaker 1: But our show today is special for another reason. We're

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Speaker 1: participating in Bloomberg's Focus on Farma, a monthlong deep dive

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Speaker 1: into the world of farma and biotech that leverages the

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Speaker 1: power of Bloomberg data analytics and editorial content a cross

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Speaker 1: platforms to offer hopefully some pretty sharp insights. Scott, are

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Speaker 1: you ready for some leveraging? I I sure am, and

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Speaker 1: let me tell you the topic of our show today

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Speaker 1: is the economics of cancer. As you know, Dan, I

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Speaker 1: have a very personal interest in this issue. My sister

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Speaker 1: Cheryl died last year at age thirty four, three years

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Speaker 1: after being diagnosed with breast cancer. And in addition to that,

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Speaker 1: my wife carries one of the b r c A

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Speaker 1: genetic mutations, which greatly increases one's risk of breast cancer

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Speaker 1: and ovarian cancer. She has actually undergone several preventive surgeries

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Speaker 1: over the past year to reduce her risk because her aunt,

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Speaker 1: grandmother and great grandmother all died of breast cancer relatively

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Speaker 1: young ages. And if that gene and treatment sound familiar,

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Speaker 1: it's because it's similar to what Angelina Julie did, because

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Speaker 1: she's also a carrier and her mother died of ovarian cancer. Scott,

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Speaker 1: You've got a unique perspective, and you know, I just

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Speaker 1: want to say, on behalf of the economics team, we

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Speaker 1: appreciate the dignity with which you've conducted yourself through this

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Speaker 1: ordeal and whatever support you and Rachel need you're going

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Speaker 1: to continue to get We're going to talk about some

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Speaker 1: stats regarding cancer, some of the main issues. We're going

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Speaker 1: to talk about the Vice president's famous moon shot, how

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Speaker 1: it got that name, and how this fits into well

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Speaker 1: the global economy. Cancer is actually it's the second leading

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Speaker 1: cause of death in the United States, just a shade

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Speaker 1: behind heart disease, and according to some measures, it's the

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Speaker 1: number one cause of death in the entire world. But

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Speaker 1: one study suggests that the total economic impact of premature

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Speaker 1: death and disability from cancer worldwide is nearly one trillion dollars,

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Speaker 1: or put another way, one point five pc of global GDP.

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Speaker 1: It's more than the economic toll from heart disease. And

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Speaker 1: right now, that's some GDP we could shore us and

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Speaker 1: speaking of our focus on farmer Worldwide, spending on cancer

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Speaker 1: drugs reached a hundred and seven billion dollars and may

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Speaker 1: rise all the way to hundred and seventy eight billion

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Speaker 1: dollars by Spending on cancer drugs in the United States

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Speaker 1: is up seventy two in the last five years. Or

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Speaker 1: President Obama earlier this year announced a cancer Moonshot initiative

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Speaker 1: led by Joe Biden, which aims to cut through some

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Speaker 1: of the red tape and rivalries among drug companies with

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Speaker 1: the idea of speeding up the pace of some of

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Speaker 1: these advances. Before we get into that, first of all,

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Speaker 1: why is it called the moon shot and what is

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Speaker 1: a moon shot? Doesn't that have to do with when

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Speaker 1: when we put a man on the moon in the

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Speaker 1: nineteen sixties and making achieving a dream of something that

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Speaker 1: seems impossible sounds like a good explanation. Well. In fact,

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Speaker 1: just this week, the Vice President is hosting National Cancer

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Speaker 1: moon Shot Summit in Washington, and similar events are being

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Speaker 1: held around the country. As you may know, also Biden

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Speaker 1: lost his son to brain cancer last year. To help

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Speaker 1: us sift through all this, were joined on the phone

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Speaker 1: by Dr Lewis Wayna, director of the Georgetown Lombardy Comprehensive

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Speaker 1: Cancer SANTA in Washington. He's also chairman of the Department

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Speaker 1: of Oncology at Georgetown. Interesting fact, the SANTA is actually

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Speaker 1: nineful legendary football coach Vince Lombardi, who was treated for

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Speaker 1: cancer at the same and Dr Wiener is also a

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Speaker 1: member of a Blue Ribbon Panel working group on the

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Speaker 1: Cancer Moonshot Initiative, tasked with focusing on immunology and prevention.

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Speaker 1: In the interest of full disclosure, Georgetown is where my

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Speaker 1: wife underwent her preventive surgery last year. Also, our boss,

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Speaker 1: the owner of this company, Mike Bloomberg, wrote an op

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Speaker 1: ed with Vice President Biden recently about how the Moonshot

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Speaker 1: Initiative and public private partnerships can help cure cancer, and

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Speaker 1: he has donated substantial funds towards cancer research. Dr Weener,

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Speaker 1: thank you so much for joining us today. It's my

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Speaker 1: pleasure to be here. Let's just start first of all,

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Speaker 1: Dr Weener, can you tell us about the state of

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Speaker 1: cancer care and what kinds of advances are going on

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Speaker 1: and why it's an exciting time right now. So I

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Speaker 1: think it's important to understand that while obviously humans have

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Speaker 1: been at war with cancer throughout human history, the formal

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Speaker 1: war on cancer was declared by President Nixon in one

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Speaker 1: and at that time there were roughly a million new

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Speaker 1: cases of cancer in the United States and about half

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Speaker 1: of those patients were succumbing to the disease at some point,

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Speaker 1: so there was a generally cure rate because surgery can

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Speaker 1: be very effective to eliminate cancers at an early stage.

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Speaker 1: Here we are now after forty years of dedicated effort

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Speaker 1: with intense federal support over those years, and dramatic expansion

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Speaker 1: of the pharmaceutical industry to test new concepts and ideas

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Speaker 1: that emanate from research. And roughly one point six million

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Speaker 1: Americans get cancer every year, And that sounds bad at

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Speaker 1: first blush. However, it's important to remember that the population

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Speaker 1: in its states has increased dramatically since so that the

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Speaker 1: rate of developing cancer is certainly no higher than it

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Speaker 1: was back at that time. And about five thousand people

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Speaker 1: will die of cancer this year, So the number of

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Speaker 1: cancers has increased by more than fifty in the death

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Speaker 1: rate has remained relatively constant, suggests what has actually decreased

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Speaker 1: dramatically forgive me, so that roughly two out of three

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Speaker 1: almost patients with cancer are now cured. Now, that sounds

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Speaker 1: like modest progress, but when you think about it in

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Speaker 1: terms of the number of lives that have been saved

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Speaker 1: and on a yearly basis because of advances in cancer

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Speaker 1: research and care, it's several hundred thousand Americans a year

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Speaker 1: who are being cured of a disease that would have

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Speaker 1: likely taken their lives only forty years ago. Now, the

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Speaker 1: other exciting news in that regard is that the death

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Speaker 1: rate from cancer has reduced every single year since, again

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Speaker 1: a reflection of advances in research, education, and care. And

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Speaker 1: we are very pleased to have been a part of

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Speaker 1: these great advances, but we obviously have quite a bit

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Speaker 1: of work left to do, and what's happening in the

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Speaker 1: recent few years has really been extraordinary in terms of

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Speaker 1: a deepening understanding of what causes cancer and a better

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Speaker 1: understanding as well of what some of the molecular targets

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Speaker 1: might be that we want to attack in cancers in

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Speaker 1: order to improve treatments and ultimately cure patients. Now that's

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Speaker 1: the US picture. Doctor has the death rate declare mind Similarly,

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Speaker 1: outside the United States, the death rates around and you know,

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Speaker 1: I don't know those numbers as well as I do

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Speaker 1: for the United States. I think that the world is

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Speaker 1: a very large place, and I think that in the

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Speaker 1: more developed countries such as Western Europe and Japan, it's

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Speaker 1: quite likely that we're seeing similar improvements in outcome because

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Speaker 1: those areas of the world have access to sophisticated care

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Speaker 1: and can benefit because they are wealthy enough societies to

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Speaker 1: benefit from the advances with new therapies that are being

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Speaker 1: developed the rest of the world. It's not such an

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Speaker 1: easy situation. Uh. And I believe that especially as poverty continues.

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Speaker 1: Yet there the poverty is lessened to the point where

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Speaker 1: folks can live longer because they're not dying of infectious diseases,

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Speaker 1: for example, the cancer burden increases and there's inadequate ability

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Speaker 1: to actually treat those people properly. So the cancer burden

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Speaker 1: around the world is still quite enormous and is not

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Speaker 1: satisfactorily addressed by current strategies. Now, that leads into a

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Speaker 1: topic that we often talk about in our economic coverage,

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Speaker 1: which is the widening gap, the inequality gap, wealth gap

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Speaker 1: throughout the world. Uh, it sounds like what you're talking

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Speaker 1: about is almost like a cancer care gap between the

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Speaker 1: wealthier societies and the poor societies. Is that something that's

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Speaker 1: happening or is likely to happen as the cost of

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Speaker 1: these new treatments goes up. So I'm not an expert

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Speaker 1: on that specific area, but it is my um perspective

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Speaker 1: and and and uh and belief based upon what I

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Speaker 1: have read and heard and discussed that the availability of

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Speaker 1: sophisticated therapies and even basic even fairly basic screening strategies

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Speaker 1: is so much better in the developed world that the

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Speaker 1: gap in care between the wealthier societies and less wealthy

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Speaker 1: societies is, if anything, going to grow as we develop

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Speaker 1: more exciting and effective therapies for cancer therapy, for cancer

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Speaker 1: treatment that are really predicated on the assumption that the

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Speaker 1: society has enough resource to pay for it. You spoke

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Speaker 1: a few minutes ago about the declining death rate here

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Speaker 1: in the United States, and I'm wondering whether to get

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Speaker 1: it significantly lower than where it is here, we need

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Speaker 1: to jump a wall. That's a very interesting question. The

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Speaker 1: the death rates are declining, they've been declining when at

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Speaker 1: a relatively even slope over the last twenty years. We

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Speaker 1: all would like to see those rates drop in a

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Speaker 1: more precipitous way, and the way to do that is

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Speaker 1: by addressing several different areas. The first of those areas

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Speaker 1: is to assure unit form access of quality care and

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Speaker 1: access to transformative therapies for all people, irrespective of their

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Speaker 1: economic or social conditions, and that, of course is an

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Speaker 1: ongoing uh the challenge, but I think it's one that

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Speaker 1: we're very mindful of. The second is to continue to

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Speaker 1: invest in um transformative research so that we can in

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Speaker 1: fact continue to make the kinds of discoveries that are

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Speaker 1: going to change the trajectory of cures. And I'm going

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Speaker 1: to give you an example of that. So one of

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Speaker 1: the most exciting new areas of cancer research and cares

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Speaker 1: in the area of immunotherapy, which can be described as

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Speaker 1: treating the body's immune system, so the immune system can

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Speaker 1: go ahead and treat the cancer. And it's been demonstrated

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Speaker 1: the cancers erect a variety of protective wall to prevent

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Speaker 1: the immune system from attacking them. And if we can

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Speaker 1: identify what those particular mechanisms are in any given individual

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Speaker 1: and attack those defenses very specifically, you can break them

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Speaker 1: down and in fact the immune system can then eliminate

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Speaker 1: the person's cancer. And so there have been extraordinary clinical

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Speaker 1: benefits for people with advanced melanomas and many other cancers

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Speaker 1: with so called checkpoint antibodies developed by a number of

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Speaker 1: pharmaceutical companies based in the United States. And these treatments

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Speaker 1: have the capacity to cure people with advanced metastatic cancers

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Speaker 1: that were otherwise going to kill them very very rapidly.

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Speaker 1: So this has really been uh like an electric shock

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Speaker 1: in our field in terms of being able to um

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Speaker 1: excite investigators and patients and doctors and really give us

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Speaker 1: a sense of what the future could look like. This

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Speaker 1: is all the result of very painstaking research, and I

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Speaker 1: might add was research that many people didn't think was

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Speaker 1: going to be productive for many many years, and it

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Speaker 1: was only because enough money had been placed into the

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Speaker 1: research and development pipelines both within academia and employment, that

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Speaker 1: these kinds of transformative advances were possible. So I think

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Speaker 1: that the greatest challenges we have the wall that needs

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Speaker 1: to be jumped, and this is where what we're doing

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Speaker 1: today is perhaps a little bit different from the moonshot

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Speaker 1: initiatives of the nineteen sixties, where it was necessary to

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Speaker 1: put a man on the moon, is that in that

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Speaker 1: ladder circumstance, we had the technology and we knew how

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Speaker 1: to build rockets. We basically knew what had to be

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Speaker 1: done to get somebody on the moon, and it was

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Speaker 1: just a huge amount of work to make it happen.

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Speaker 1: In the area of cancer research and care, we have

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Speaker 1: some of the tools we need to be able to

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Speaker 1: make transformative advances, and in fact that the great progress

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Speaker 1: is being made, but there's still additional knowledge It needs

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Speaker 1: to be created in order to be able to really

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Speaker 1: take a where we want to go, and that's going

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Speaker 1: to require continued investment. Now that sounds really exciting, doctor.

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Speaker 1: How are you going to pay for these advances? You

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Speaker 1: talk about funding for research, but there's also the cost

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Speaker 1: on the other end to the patients. How are patients

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Speaker 1: going to pay for it? How is our medicare system

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Speaker 1: going to keep paying for these kinds of treatments? Are

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Speaker 1: our patients able to pay for these treatments? Now? Are

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Speaker 1: you seeing any streams yet at Georgetown in terms of

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Speaker 1: insurance or medicare not covering these kinds of new treatments

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Speaker 1: that doctors are recommending. So it's a very good question

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Speaker 1: and a very complicated question, obviously, and I'm gonna try

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Speaker 1: and break it down into several different components that if

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Speaker 1: I could. Firstly, let's remember that the as as was

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Speaker 1: mentioned earlier, the cost of cancer to the society in

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Speaker 1: terms of lost wages, lost productivity, destructure, the family, family

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Speaker 1: structures is just unimaginably high around the world, and we

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Speaker 1: have to always think about the costs in that context.

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Speaker 1: Remember that in the United States, in the next two

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Speaker 1: days more than three thousand people will die of cancer.

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Speaker 1: That is an unacceptable rate of death. It is if

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Speaker 1: this was happening from any other cause, I think that

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Speaker 1: the American people would be justly outraged and would demand action,

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Speaker 1: say what do we need to do to fix this

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Speaker 1: and fix it more rapidly. We certainly do that in

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Speaker 1: many other spheres when it involves national security, for example.

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Speaker 1: So I think that when we talk about how expensive

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Speaker 1: cancer care is, let's also remember how expensive cancer is. Secondly,

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Speaker 1: I think it's important to recognize that when you have

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Speaker 1: treatments that really work well, the ultimate cost is going

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Speaker 1: to be less all aroun out. I think one of

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Speaker 1: the real challenges we faced in the field of cancer

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Speaker 1: care and the cost of cancer care, as we've had

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Speaker 1: a number of expensive treatments that were approved that created

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Speaker 1: marginal benefits for patients with cancer, and that makes the

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Speaker 1: ultimate cost of cancer very large and perhaps and perhaps

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Speaker 1: it's not as cost effective as it should be. But

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Speaker 1: as we develop more effective therapies, and as we develop

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Speaker 1: additional disciplines that allow us to only use those treatments

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Speaker 1: that are likely to have major benefits to our patients,

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Speaker 1: I think that we will find that treatments are in

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Speaker 1: fact not only affordable, but desirable because it benefits society. Thirdly,

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Speaker 1: with respect to how insurance companies are dealing with with

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Speaker 1: with these costs at this point in time, I would

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Speaker 1: say that when we are using these agents for their

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Speaker 1: approved indications and patients who have the kind cancer where

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Speaker 1: these treatments have been demonstrated to be effective, I have

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Speaker 1: not run into any major challenges. Certainly, the insurance companies,

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Speaker 1: which are always looking to control their their expenditures, are

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Speaker 1: examining these requests quite carefully and are likely to deny

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Speaker 1: the requests if there if these are based upon physicians

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Speaker 1: intuition or belief and not supported by data, but that's

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Speaker 1: perhaps not that inappropriate. I think that as we move forward, though,

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Speaker 1: we're going to be dealing with some real big challenges, because,

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Speaker 1: for example, the drugs targeting one of these immune checkpoints

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Speaker 1: which can get that either the PD one or PDL

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Speaker 1: one immune checkpoint molecules. We find that these drugs can

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Speaker 1: work and maybe twenty five different cancers, but they don't

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Speaker 1: work in every patient with each of these twenty five cancers.

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Speaker 1: They work in some of the patients with each of

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Speaker 1: these twenty five cancers, So you can imagine there will

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Speaker 1: be some significant challenges when thinking who should be treated

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Speaker 1: with these drugs and how are we going to be

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Speaker 1: able to pay for it when we know that not

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Speaker 1: everybody with a particular disease as we currently understand it,

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Speaker 1: is going to benefit from these expensive therapies. And that's

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Speaker 1: where additional research is absolutely necessary so that we can

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Speaker 1: in fact begin to hone in one of the subpopulations

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Speaker 1: of patients with a particular cancer who might benefit from

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Speaker 1: a particular expensive therapy. So the answer to your question

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Speaker 1: is it's complicated, Dr Wyna. Thank you so much for

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Speaker 1: sharing your perspective with us, And complicated though it may be,

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Speaker 1: it's vitally important and you've addressed some big themes here.

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Speaker 1: Thank you, Thank you well, Scott. That was quite a

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Speaker 1: tour to force. And you know, it's just a reminder

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Speaker 1: that economics is a personal thing. It's not just GDP,

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Speaker 1: it's not just non farm pay rolls, it's not just

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Speaker 1: an f O MC just sasion once every six weeks, right,

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Speaker 1: And there's more dimensions to the economy than just these

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Speaker 1: kinds of things that we think about about stimulus and

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Speaker 1: central banks and jobs that there's there's six billion people

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Speaker 1: and each of them have have a risk of cancer.

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Speaker 1: They can get disease, they can die, and that affects

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Speaker 1: their productive capacity in the world, but also their personal

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Speaker 1: connection to their loved ones and everyone else. It makes

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Speaker 1: me wonder whether the economics profession and those of us

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Speaker 1: who write about it perhaps sometimes get too focused on

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Speaker 1: the stats and not enough attention is paid to the

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Speaker 1: human equation which underlies it all. I think that that's

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Speaker 1: a good point down And you know, we do pay attention.

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Speaker 1: We try to pay attention to the human equation here

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Speaker 1: at Bloomberg, but there's also value in taking a step

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Speaker 1: back and figuring out the big picture. And sometimes one

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Speaker 1: way to understand cancer is to focus on the big

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Speaker 1: picture and to see these kinds of trends and to

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Speaker 1: figure out, all right, should we put this money and

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Speaker 1: how are we going to pay for it? Because that's

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Speaker 1: the way that our society is going to get better

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Speaker 1: over time. Well, I want to thank you for your

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Speaker 1: candor here on the show. I know some of this

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Speaker 1: hasn't been easy for you, and you know continued God

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Speaker 1: speed to you and Rachel and the journey that your

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Speaker 1: family walks on. Thank you for your support down I

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Speaker 1: really appreciate it, and thanks to all of you for

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Speaker 1: listening to us on Bloomberg Benchmark. Will be back next week.

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Speaker 1: Until then, you can find us on the Bloomberg terminal

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Speaker 1: and Bloomberg dot com, as well as iTunes, pocket Cast, Stitcher,

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Speaker 1: and Google Play. Why are there? Take just a minute

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Speaker 1: to rate and review the show so more listeners can

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Speaker 1: find us. Scott's on Twitter at wait for it, Scott Landman.

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Speaker 1: That's all it is. Spell it for us, s C

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Speaker 1: O T T l A N M A N. You

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Speaker 1: can get met at Daniel Moss, d c Acchi and

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Speaker 1: Tory will be back with us next week. See Ye're

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Speaker 1: in