Speaker 1: It's the big take from Bloemberg News and I Heart Radio.
Speaker 1: I'm West Gasova today. Why the f d A is
Speaker 1: going slow on are proving a possible breakthrough treatment for
Speaker 1: a l S. Something that you'll hear frequently in the
Speaker 1: A l S community is a LS is fatal. There
Speaker 1: is no cure, there is no effective treatment, so we
Speaker 1: literally will try anything. We have a very high tolerance
Speaker 1: for risk. Some of us say, we don't care if
Speaker 1: it's known to be a poison. If there is a
Speaker 1: chance that could help us, we are willing to take it.
Speaker 1: So the thought of it, trying of medication through expanded
Speaker 1: access was simply a no brainer for us. That's Cassandra.
Speaker 1: She asked us not to use her full name, and
Speaker 1: she is far too familiar with the devastating effects of
Speaker 1: a LS often called Luke Garrig's disease. Many members of
Speaker 1: Cassandra's family have died from a l S because of
Speaker 1: a rare gene that's passed down through generations. Will hear
Speaker 1: Cassandra's story later in the program for her family and
Speaker 1: thousands of others. A new treatment still in development from
Speaker 1: the company Biogen, shows some early promise of possibly slowing
Speaker 1: the rapid progress of the disease. The U S Food
Speaker 1: and Drug Administration is moving cautiously. It's wary of approving
Speaker 1: the drug before Moore is known about how effective it
Speaker 1: is and possible side effects. But als, activists and people
Speaker 1: afflicted are pressing the FDA for rapid approval of the drug, or,
Speaker 1: like you heard Cassandra say, just now, early expanded access
Speaker 1: to the treatment before approval for those who may have
Speaker 1: no other hope. Bloomberg's chief medical writer, Robert langerth joins
Speaker 1: me now to explain what's happening. Robert Langer, thanks so
Speaker 1: much for joining me today. It's great to be here.
Speaker 1: But can you talk a bit about a l S
Speaker 1: the disease itself, what actually does it do? A LS
Speaker 1: is one of the most devastating diseases. Basically, the nerves,
Speaker 1: the control all the voluntary muscles slowly die, and that
Speaker 1: includes those responsible for breathing, chewing, swallowing. Most people die
Speaker 1: within three to five years is a typical, and if
Speaker 1: you choose to go on a respirator and a feeding tube,
Speaker 1: you can get a new condition that's called locked in,
Speaker 1: where you're essentially fully paralyzed, unable to communicate with the
Speaker 1: rest of the outside world. Your mind and sensors are
Speaker 1: fully intact about how many people in the US, around
Speaker 1: the world are afflicted by a L S. Yeah, so
Speaker 1: in the US figures very about twenty to thirty thousand
Speaker 1: afflicted with LS. Approximately ten percent of them cases are
Speaker 1: running families. And then you know the cases roughly uh,
Speaker 1: the causes are are unknown, so it's you're, not a
Speaker 1: common disease, but it is just totally devastating. So that's
Speaker 1: a lot of people in numbers, and yet not a
Speaker 1: lot of people when it comes to a drug company
Speaker 1: spending a lot of money that it takes to develop
Speaker 1: a drug, and that's been one of the problems associated
Speaker 1: with trying to find treatments or cures for the disease.
Speaker 1: It's been very little known about the cause. It's just
Speaker 1: been a graveyard for drugmakers with numerous failed trials. And
Speaker 1: one of the problems the disease it's not actually straightforward
Speaker 1: to diagnose. There's no like simple blood tests for LS,
Speaker 1: so it's a kind of a diagnosis of exclusion. So
Speaker 1: they basically rule everything else out until they can say,
Speaker 1: you know, the only cause we have we know for
Speaker 1: the reasons you're progressively getting paralyzed is a LS. We've
Speaker 1: ruled out everything else, so that means people like often
Speaker 1: don't get diagnosed until late. That's, you know, another issue
Speaker 1: for for drugmakers, because you want to try to treat
Speaker 1: as early as possible. If you've been online in the
Speaker 1: last few weeks, there's a good chance you've seen someone
Speaker 1: taking the ALS ice bucket challenge, people dumping ice cold
Speaker 1: water on their heads and nominating others to do the same.
Speaker 1: I think we all remember about nine years ago now
Speaker 1: the ice Bucket Challenge where people were pouring cold buckets
Speaker 1: of ice over their heads as a way to raise
Speaker 1: awareness and money for a l S. That's certainly raised awareness,
Speaker 1: we were all talking about it, but in the almost
Speaker 1: decades since that happened, did it do anything to jump
Speaker 1: start both funding and research for cures. Yeah. So one
Speaker 1: of the historical issues with a LS is that because
Speaker 1: people die so quickly, it doesn't have that kind of
Speaker 1: constituency of survivors at some diseases have that can really
Speaker 1: a lobby and push and attention and money for treatment
Speaker 1: and research into new treatments. So the ice bucket Challenge
Speaker 1: kind of did like bring a lot of attention and
Speaker 1: a lot of new funding to it, and that did
Speaker 1: appear to result in, you know, more drugs and trials
Speaker 1: now that than ever before. And in your latest story
Speaker 1: about a l S, you write about a new therapy
Speaker 1: from Biogen which they're trying to get accelerated approval from
Speaker 1: the FDA, and there's been a bit of back and forth.
Speaker 1: Can you tell us about that? So in the story,
Speaker 1: we write about a drug called Toeferson from Biogen, which
Speaker 1: would be the first drug to attack a known genetic
Speaker 1: cause of a LS, one of these handful of rare
Speaker 1: genes that causes rare, familiar forms of a LS. It's
Speaker 1: a complicated controversy, but Biologen conducted a small Phase three
Speaker 1: trial of the drug. I did not succeed on the
Speaker 1: main goal of its trial and slowing the disease, though
Speaker 1: it did show promising signs. But what it does do
Speaker 1: is that it does very clearly lower levels of this
Speaker 1: blood protein called neurofillment, which is a protein that's released
Speaker 1: when nerve cells are dying. It's a sign of nerves
Speaker 1: cell damage. So that sign is clearly decreased. So it's
Speaker 1: applied for accelerated approval for TOPS and basically approval of
Speaker 1: a drug, you know, based on a kind of a
Speaker 1: bio marker alone without proof that it slows the clinical decline.
Speaker 1: You mentioned that it was based on a bio marker.
Speaker 1: What is that. Yeah, so bio markers that's kind of
Speaker 1: basically a fancy word for blood tests or scans or
Speaker 1: some other kind of lab or testing value that might
Speaker 1: kind of show what's kind of going on in the
Speaker 1: underlying process of disease. So, so it shows promise, but
Speaker 1: it hasn't been shown effective yet. It hasn't been proven
Speaker 1: yet to show clinical effectives. Now, this experimental drug that
Speaker 1: Biogenna is working on and seeking approval for it is
Speaker 1: for a subset of a LS that runs in families.
Speaker 1: So this is not for overall a list, but especially
Speaker 1: devastating form of the disease where entire families can be affected. Yeah,
Speaker 1: this is for people with ALS due to a bad
Speaker 1: gene called s O D one or sod one, and
Speaker 1: people with this bad gene that run in their family.
Speaker 1: If you have just one copy of this gene, you're
Speaker 1: almost certain to get a l S in your lifetime.
Speaker 1: It's so devastating when the people they get it they
Speaker 1: can they can die within twelve to eighteen months, often
Speaker 1: an ultra rapid progressing form of LS, and then it
Speaker 1: can run through families for like generations, like back literally
Speaker 1: hundreds of years. In your story, you write about a
Speaker 1: family from Pennsylvania, the Webber family, and they've been afflicted
Speaker 1: with this form of ALS for generations. You spoke with
Speaker 1: Cynthia Weber and her daughter Cassandra. What did they tell
Speaker 1: you about the family's history with a l S. Yeah, So,
Speaker 1: in Cynthia Webber's closet for many years, there was a
Speaker 1: family tree and it was sprawled over two large pages
Speaker 1: of architecture paper literally detailed three fifty ancestors going back
Speaker 1: well into the eighteen hundreds, and I gave dates of deaths,
Speaker 1: the names, dates of births and deaths and causes. And
Speaker 1: the reason it was buried away in the closet wasn't
Speaker 1: that people didn't know it was there, you know, it
Speaker 1: was because nobody really in the family wanted to look
Speaker 1: at it because so many people in the family over
Speaker 1: the years and decades and centuries had died from a LS.
Speaker 1: And in fact, more than thirty people on that family tree,
Speaker 1: on that blueprint, their deaths are marked with the letters
Speaker 1: A L S, and so in Cynthia Webber's and Cassandra's family,
Speaker 1: the way they think about it, you know, some people
Speaker 1: pass on jeans or red hair or green eyes, but
Speaker 1: they pass on a legacy of death from a LS.
Speaker 1: For many years, people in the family were told that
Speaker 1: before you got married, you had to tell your spouse
Speaker 1: about the bad genes, about the A L S risk
Speaker 1: that ran the family, so your potential spouse could have
Speaker 1: a chance to back out and they would know kind
Speaker 1: of what they were getting into. For a few years, though,
Speaker 1: Cynthia Webber's generation, her generation themselves were beginning to think
Speaker 1: that the bad gene, the L S gene, had sort
Speaker 1: of skipped their generation because none of Cynthia Webber's siblings
Speaker 1: had gotten a LS. But then in two thou nineteen,
Speaker 1: Cynthia Weber's brother Dwayne started developing symptoms of LS, and
Speaker 1: he quickly got worse. Bobbing your story, you write how
Speaker 1: the Webber family sought recent therapies and really had a
Speaker 1: difficult time and mixed results. Can you describe their experience
Speaker 1: with trying to get these drugs that potentially could have
Speaker 1: prolonged life so because the s a D one or
Speaker 1: sod one gene runs in the Webber family, that is,
Speaker 1: the a LS causing gene in their family, they are
Speaker 1: ideal candidates for this experimental drug from Biologen called Toferson
Speaker 1: that targets that specific gene that runs in their family.
Speaker 1: So Cynthia Webber's brother, Dwayne lindsay he was the first
Speaker 1: in the recent generation of the family to be diagnosed
Speaker 1: with a L S, and he in fact managed to
Speaker 1: get into bao Jen's main phase three trial of it's drug. Toverson,
Speaker 1: that's the drug that targets a specific gene that runs
Speaker 1: in the Cynthia Weber family. The family does not know
Speaker 1: whether he got placebo or the active drug. They believed
Speaker 1: that when he was on the injections that his LS
Speaker 1: appeared to progress much more slowly, and then the minute
Speaker 1: some of the injections were stopped, he declined rapidly. And
Speaker 1: the reason they suspect this was because he was in
Speaker 1: the trial during the beginning of the pandemic and so
Speaker 1: he missed three treatments because the trial sites shut down
Speaker 1: during the pandemic temporarily, and during that period when the
Speaker 1: trial sites shut down, his condition just declined markedly, and
Speaker 1: the family suspects that he was on the active drug
Speaker 1: during that period. When we come back, what it's like
Speaker 1: when a l S runs in the family. Cynthia Weber's
Speaker 1: daughter Cassandra, who we heard at the beginning of the episode,
Speaker 1: has seen the devastating effects of a l S in
Speaker 1: her own family. Robert Langrith talked about how Cynthia Weber's brother,
Speaker 1: Cassandra's uncle was diagnosed. Robert spoke to Cassandra and she
Speaker 1: described the experience and what has happened since. My mom
Speaker 1: called us and said, girls, I have bad news. Your
Speaker 1: uncle Dwayne has a l S. And that was I
Speaker 1: believe in twenty nineteen. It was pre COVID. At first,
Speaker 1: the results looked promising. Cassandra's uncle Dwayne appeared to be
Speaker 1: responding to the treatment, and then COVID came and unfortunately,
Speaker 1: his experimental trial site decided to stop giving him the
Speaker 1: to Pherson injections, so he missed three injections and started
Speaker 1: to rapidly decline. He was able to resume and he
Speaker 1: got two more, but he had begun progressing quite quickly.
Speaker 1: After my uncle was diagnosed, he asked his siblings to
Speaker 1: please get tested. My mom went to her family doctor
Speaker 1: in January and requested to have testing done. In June,
Speaker 1: she called the family doctor's office and asked where her
Speaker 1: results were. It's easy to get distracted. We were busy.
Speaker 1: She was here with the grandkids all the time. So
Speaker 1: finally they got back in contact with the genetic testing
Speaker 1: company and my mom called me a few days later
Speaker 1: and said, Honey, I have to go into the office.
Speaker 1: And I said, Mom, if you have to go into
Speaker 1: the office, I have to go with you. And she
Speaker 1: never wanted to bother anybody, so she said, no, don't
Speaker 1: take time off from work. But I knew in my
Speaker 1: heart what the results were. Cynthia became the thirty third
Speaker 1: person in her family to test positive for the A
Speaker 1: L S gene, but she wasn't showing signs of the disease.
Speaker 1: A month later, in July, Cynthia's brother, Dwayne died of
Speaker 1: a LS. Not long after that, Cassandra noticed small changes
Speaker 1: in her mom. Her first symptom was that she couldn't
Speaker 1: lift her leg up off the floor to get into bed,
Speaker 1: and she thought it was just a grief reaction that
Speaker 1: she was upset about her brother and things were kind
Speaker 1: of in her head, and so she chose to ignore them,
Speaker 1: and I can't say that I blame her. Within a
Speaker 1: few months, it became apparent that she wasn't walking very well,
Speaker 1: and because I knew her genetic test results, I was
Speaker 1: watching her pretty closely. She was also sixty nine years old,
Speaker 1: getting older, and I knew that her risk was going up.
Speaker 1: Our gene has caught a high penetrance rate, meaning by
Speaker 1: the time you're seventy years old, you have a chance
Speaker 1: of getting a l S. Sometime around September, I started
Speaker 1: to notice that Mom couldn't keep up with us. We'd
Speaker 1: walked to the park down the street with the kids.
Speaker 1: We've done that walk hundreds of times, and she was
Speaker 1: lagging behind a little bit. And then October came with
Speaker 1: the kid's birthday and she was doing pretty good. And
Speaker 1: then she always went trick or treating with us, and
Speaker 1: she couldn't keep up, even to go around the block.
Speaker 1: So finally, in a quiet moment, I confronted her and
Speaker 1: I said, Mom, I'm really worried about your leg. So
Speaker 1: within a few weeks she called me and she said, honey,
Speaker 1: I need to see someone. I was at work and
Speaker 1: I walked out to the parking lot and I screamed
Speaker 1: because I knew it was coming. The first thing I
Speaker 1: did is I called the group I had been working
Speaker 1: with vir Genetic Counseling, and I said, what can we do?
Speaker 1: And this was December. She had not been officially diagnosed
Speaker 1: by anybody, but we knew because Santra tried to get
Speaker 1: Cynthia enrolled in the trial for the same drug Cynthia's
Speaker 1: brother had tried with some success, but the trial was full.
Speaker 1: She pressed for her mother to be placed in Biogen's
Speaker 1: Expanded Access program, another way to get the treatment. After
Speaker 1: some advocacy from her doctor, Cynthia's application was approved. So
Speaker 1: getting expanded Access was based on your score, which includes
Speaker 1: things like can you go up and down the stairs?
Speaker 1: Can you cut your own food? Can you adjust your
Speaker 1: own sheets? So at that point, my mom was still
Speaker 1: doing really well. She was actually still walking with a
Speaker 1: lot of difficulty and not far, but with a walker
Speaker 1: she could transfer and do most of her own care,
Speaker 1: but she was starting to progress. At this point, Cassandra
Speaker 1: made another decision. So after my mom received her genetic
Speaker 1: testing results, I realized that I needed to be tested
Speaker 1: as well, because I had a fifty fifty shot of
Speaker 1: carrying the gene, and I needed to know so that
Speaker 1: I could try and be proactive and find anything I
Speaker 1: could do to try and prevent a LS, even though
Speaker 1: there isn't anything really, and so that I could know
Speaker 1: to plan for my family's future and to figure out
Speaker 1: if my children would need to consider genetic testing at
Speaker 1: some point. Because of COVID, everything was over Zoom, So
Speaker 1: they ship a kit to your home and you do
Speaker 1: your own cheek swab and send that out to the
Speaker 1: lab and then it takes about six weeks for your
Speaker 1: test results to come back. So the results disclosure was
Speaker 1: on a Zoom call with the geneticist followed by a
Speaker 1: meeting with a neurologist. They told me I had a
Speaker 1: time that there wouldn't be any chit chat and as
Speaker 1: she would come right out with my results. My husband
Speaker 1: and I had told ourselves we will be prepared for
Speaker 1: it to be positive, and that if it was negative,
Speaker 1: we would just be happy. But you can't prepare. I
Speaker 1: knew as soon as I saw her face that my
Speaker 1: results were positive, and when she said it out loud,
Speaker 1: I collapsed. We were sitting at the dining room table
Speaker 1: and I felt like someone had punched me right in
Speaker 1: the heart. I couldn't hear, I couldn't see. I just
Speaker 1: collapsed in thinking what about my children? So I knew
Speaker 1: there was a fifty fifty chance of having a JANEK
Speaker 1: result come back positive, and even though we had told
Speaker 1: ourselves to be prepared, we weren't. There really is no
Speaker 1: way to prepare for hearing this news. I knew all
Speaker 1: of the numbers. I knew we had a high penetrance rate,
Speaker 1: that I had a nine chance of getting a last
Speaker 1: by the age of seventy and you my grandfather died
Speaker 1: at sto and his brother at thirty. And the only
Speaker 1: thing I could think about was that I could have
Speaker 1: given this gene to my children. Each of my children
Speaker 1: have a shot of carrying this gene, and we can't
Speaker 1: test them until they turn eighteen, and they need to
Speaker 1: make that choice. But as a parent, as mom, to
Speaker 1: think that you may have passed something like this onto
Speaker 1: your children is heartbreaking. It's devastating. And I also didn't
Speaker 1: want them to watch me die of a LS like
Speaker 1: I watched my uncle, my grandfather. How many generations of
Speaker 1: our family have to watch each other die by May
Speaker 1: of this year, Cynthia's a l S had progressed significantly.
Speaker 1: She believed to overson the drug had extended her life,
Speaker 1: but she had lost most mobility in her limbs and
Speaker 1: decided to stop treatment. She moved into the home of
Speaker 1: Cassandra's older sister. Three months later, in August this year,
Speaker 1: Cynthia passed away. Everyone who knows my mom would tell
Speaker 1: you that she was the kindest person, always a true friend.
Speaker 1: She was a registered nurse worked at Harrisburg State Hospital
Speaker 1: doing inpatient mental health for over twenty five years, loving giving.
Speaker 1: I found a letter one of the doctors wrote about her,
Speaker 1: and it was just beautiful. He called her a true
Speaker 1: nursing professional. He acknowledged her thought process, her compassion, and
Speaker 1: that's what everybody would tell you. As a nurse practitioner,
Speaker 1: I understand the path of physiology of a l S,
Speaker 1: why the things are happening that are happening, But nothing
Speaker 1: can prepare you for living through a l S with
Speaker 1: yourself or a loved one. To see the date by
Speaker 1: day changes. One night she could use her hand, the
Speaker 1: next day she couldn't. To lose the use of your
Speaker 1: thumb means you can't feed yourself. To see someone deteriorate
Speaker 1: every single day. There's no way to prepare for that.
Speaker 1: It absolutely changed the way I view A l S
Speaker 1: because now I've lived through it, I've seen it firsthand.
Speaker 1: I've watched her die from it. Nothing can prepare you
Speaker 1: for that. Since her mother's passing and her own positive
Speaker 1: test for the A l S gene, Cassandra has become
Speaker 1: an activist for more research and greater access to treatments.
Speaker 1: I think as soon as someone in your family or
Speaker 1: someone you love gets an LS diagnosis, and you see
Speaker 1: the fight that we're up against, you see the limited options,
Speaker 1: the lack of hope, it kind of turns everyone into
Speaker 1: a warrior. I haven't met an A l S patient
Speaker 1: or family yet who hasn't gotten into advocacy. It's kind
Speaker 1: of like the all time underdog, and we all just
Speaker 1: want to fight, fight for our loved ones, fight for ourselves.
Speaker 1: I don't think there's a decision to become an advocate.
Speaker 1: I think it automatically happens when we come back. Robert
Speaker 1: Langrith talks about the future of treatments for A l
Speaker 1: S and other uncommon diseases. Bob the Webbers and other
Speaker 1: families who are suffering from a L S have rallied
Speaker 1: the FDA for more rapid approval of these experimental drugs,
Speaker 1: and there's been a lot of tension in back and
Speaker 1: forth over that. Can you describe what's happening in the
Speaker 1: f d A when it comes to deciding whether or
Speaker 1: not to release a drug earlier than it normally would. Yeah,
Speaker 1: So what's happening is that a LS activists they want
Speaker 1: to see lots of new drugs for a LS, just
Speaker 1: like there in recent years have been just lots of
Speaker 1: new drugs for various types of cancer. The debate is
Speaker 1: over like how much should the standards, you know, be
Speaker 1: a lesson. You don't want to put something that doesn't
Speaker 1: work on the market. You could actually inhibit the development
Speaker 1: of actually effective therapies. Why does the FDA draw this
Speaker 1: distinction between cancer treatments which can be approved on an
Speaker 1: accelerated basis, and diseases like a L S, where it can't.
Speaker 1: What's the difference there from the FDA's perspective, not that
Speaker 1: drugs and other diseases can't use the accelerator process. It
Speaker 1: just that the accelerator process is much more controversial and
Speaker 1: some of these other diseases that much less is known about.
Speaker 1: Biogen had a drug for Alzheimer's which they pressed very
Speaker 1: hard for early approval, and it was approved, and that
Speaker 1: caused quite a big controversy, didn't it. Yeah, So the
Speaker 1: Biogen had a drug for Alzheimer's that they did not
Speaker 1: clearly show i was effective in slowing disease, and two
Speaker 1: large trials one showed it slowed the disease slightly and
Speaker 1: the other showed no effect. But it was able to
Speaker 1: get the drug approved using the accelerated process because at
Speaker 1: lower levels of a bad brain protein called brain amyloid.
Speaker 1: And that was just extraordinarily controversial because of the contradictory
Speaker 1: results on whether it actually slowed the disease. And even
Speaker 1: if one of these drugs is approved on an accelerated basis,
Speaker 1: sometimes insurers don't want to pay for it and some
Speaker 1: doctors are hesitant to prescribe them. Yeah, that's something that
Speaker 1: can happen. Yeah, the situation for neurological diseases is so
Speaker 1: new that it's not clear, you know, how it's going
Speaker 1: to play out. Certainly with the case of Biogen's Alzheimer's drug,
Speaker 1: agile Helm, essentially medicare the program for the elderly declined
Speaker 1: to cover an a broad basis, citing the lack of
Speaker 1: proof that it's low clinical decline. What did Biogen say
Speaker 1: about the response to it's Alzheimer's drug. Basically, they've vigorously
Speaker 1: campaigned to get Medicare to cover their Alzheimer's drug, agire Helm,
Speaker 1: but it ultimately refused and they were very disappointed by
Speaker 1: that decision. So what now is the status of Toberson,
Speaker 1: the A L S drug that Biogen is developing. So
Speaker 1: it has been submitted to the US Food and Drug Administration.
Speaker 1: We are waiting a decision by the US Food and
Speaker 1: Drug Administration, and the company has also submit to the
Speaker 1: drug to regulators in Europe. So there should be a
Speaker 1: lot of action on it early in bob in the
Speaker 1: best case scenario, what can we expect from to person?
Speaker 1: The Webber family had mixed results. It was unclear whether
Speaker 1: Cynthia Webber and her brother received a placebo or the
Speaker 1: actual drug. What do we know about its effectiveness and
Speaker 1: what people suffering from this form of als can expect
Speaker 1: from this drug? And so Biogen's drug to Person and
Speaker 1: its main trial after six months did not clearly show
Speaker 1: a difference in slowing functional decline between drug and placebo
Speaker 1: after six months. However, big and reported continued studying the
Speaker 1: drug after the official main part of the trial was over,
Speaker 1: and in June it reported that people who could receive
Speaker 1: the drug early on had less decline than those who
Speaker 1: had originally been on placebo and got switched to drug
Speaker 1: drug later. And the drug also lowers level of a
Speaker 1: blood protein called neurofilment that is released when nerve cells
Speaker 1: are damaged or dying. And it's this lowering of levels
Speaker 1: of neurofilment the drug is ability to do that. Biologen
Speaker 1: is seeking approval accelerated approval upon and do you think
Speaker 1: that that will happen with Toeferson Bolgin has already completed
Speaker 1: the longer term trial that showed that it failed in
Speaker 1: its main goal and then showed, you know, more promising
Speaker 1: results on the extension of the trial. But it's seeking
Speaker 1: approval accelerator approval based on the ability to slow bio markers.
Speaker 1: So it's really hard to predict exactly what's going to happen.
Speaker 1: Robert Langreth, thanks so much for speaking with me today.
Speaker 1: Thank you. You can read Robert Langreth reporting on a
Speaker 1: L S at Bloomberg dot com. Thanks for listening to
Speaker 1: us here at The Big Take, the daily podcast from
Speaker 1: Bloomberg and I Heart Radio. For more shows from my
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Speaker 1: or comments to Big Take at Bloomberg dot net. The
Speaker 1: supervising producer of The Big Take is Vicky Bergelina. Our
Speaker 1: senior producer is Catherine Fink. Our producers are Mal Barrow
Speaker 1: and Michael Falero. Rafael l'm seley is our engineer. Original
Speaker 1: music by Leo Sidrin. We'll be taking a break next week,
Speaker 1: back with fresh episodes starting Tuesday, January three. In the meantime,
Speaker 1: please check out some of the shows you might have missed.
Speaker 1: Thanks again for listening. I hope you have a great
Speaker 1: new year.