Trials with Maya Z

  Hello, and welcome to the next episode of Trials with Maya Z, brought to you by TrialHub, a data intelligence platform that helps clinical research organizations and sponsors plan clinical trials. This podcast is about how we can make clinical trials more successful and patient-friendly. Friendly, I am your host Maya C and in every episode, I will be interviewing a leading expert from various industries in order to discuss some of the major challenges and brainstorm how we can solve them.

Let's get started.

Hello, everyone. And welcome again to another episode with Trials with Maya Z today I have a dear friend of mine and an expert in patient recruitment. Ross Jackson to discuss again, the world of clinical research and most of all, focus on the patient recruitment world. Ross, welcome.

And yes, tell us a little bit more about yourself. Ross.

 

Yeah, well, thank you for having me on, Maya. Yes, I've been working in patient recruitment for many years and yeah, I've written two books about it. The Patient Recruitment Conundrum is the most recent one that came out. And my original book was specifically about Facebook ads for clinical trials, which is where I started off, but I'm sure we'll get into that.

So yeah I've, worked with a range of companies in the clinical trials ecosystem. to improve patient recruitment and help make sure that patients are getting enrolled into trials and shortening the time of the trial taking place so we can get the treatments to people quicker.

Great. of Ross, thanks. Thanks for this quick introduction. I have to say that I read both of the books.

 

Yeah.

 

The last one I read during my flight to San Francisco earlier this year, and I was like, everyone should read this book because the story is literally a story, like very often in industry, we speak in very, these industry terms, and sometimes this.

Prevents us from understanding the complexity because we need to simplify it, but you actually did a great job in simplifying the different roles and stakeholders and their ways of thinking. So great job, Ross. Thanks for sharing this book with everyone, including me.

 

Uh, no thank, thank you very much. I'll tell you why that happened because I was actually just writing, I was, I thought I write about the o overall patient recruitment, you know, all the stakeholders and things that happen. And then the title occurred to me, the patient recruitment conundrum, and then I thought, that sounds like a thriller.

It sounds like something, you know, Robert Ludlam might write. So I thought, okay, let me see if I can rewrite it as a fictional story. And that's what I did. Yeah, so, I did that. Actually, the central character is called Josh Black whose initials are JB after James Bond.

So, and Jason, Jason, Bourne, you know? So I thought, right, let's see.

Interesting. Yeah, interesting. Thank you. Thank you for sharing that. Ross, I was thinking, yeah, we were going to speak about patient recruitment, but I realized that there are so many different people with different backgrounds coming into this industry, contributing to patient recruitment.

But I know I owe you for many years now that you work in that space, but I never knew where. Where are you coming from? What's your background? How come you ended up in clinical research and patient recruitment? Did you work before in any organization or how did it happen? Tell us.

Yeah, it's interesting. I, and the more I see interviews like this interviews you've done other interviews or talk to people, it seems to be that almost nobody starts off in clinical research. They always come into it from another angle and I'm the same. I actually started off in digital marketing. I started off on my own in 1998, which is it's quite a long time ago, 26 years ago, I think was amazing.

But the same year Google started I was promoting websites. And one of my very first clients in 1998 was a local doctor who wanted to recruit patients for a new treatment he'd developed. So I thought, okay, I'll give this a go. I liked it. And I started to get more of a specialism in healthcare from then.

Went through different areas of healthcare. Then after a few years, I got approached by an agency that said, right, we're recruiting for a clinical trial. And like most people, I would be thinking, okay, clinical trials, yeah, okay, I know a little bit about it, but I know I started to learn more, obviously, from what I've been doing in healthcare.

But when I got into it, I realized that it was a good niche for me. It was a good specialism for me to get into. And I just, I loved the idea of being able to help people with my skill set. And also the fact that the industry was so, so bad at doing it. It remains a problem to this day. My digital background was focused on customer experience, getting customers into funnels, that sort of thing.

So I translated that into the trials arena and was successful. Eventually, Facebook came along with its own advertising. I was doing a lot of Google stuff in those days. Facebook came along with its own advertising. Gave it a go. I tried it and it was miles better for patient recruitment.

The book Facebook for Patient Recruitment.
The first book was about Facebook Facebook ads and that just carried on from there. So I, yeah, so I, I developed a niche through the digital and that's where I got people asked me in to help them on their trials, a lot of rescue trials coming in because they hadn't been able to recruit, which is, you know, it's a very common issue.

And then eventually because I'd been working on so many trials, I started to understand more about all the different stakeholders, all the different possibilities, reaching out to doctors, community outreach, whatever it may be, even getting site databases so I've worked on lots of different angles since then.

And starting off from the digital, I now am a sort of advisor consultant. About patient recruitment in general and retention because I think retention is a big part of it. I always think it's like the fifth leg of patient recruitment is retaining the patient.

There's no point in constantly having to fill the funnel with new patients. If you can keep the ones you've got. So, yeah, so that's my background, how I got there and where I got here, which is now where I'm an advisor to the industry, uh, about all things, patient recruitment and retention.

Interesting. And, Ross, while I was listening to you, I was thinking, what is the difference between patient recruitment 1999

  Yeah, a lot more digital. This is certainly true. There's a lot, a lot more folks. There are a lot more trials. That's the other factor. The 400, 000 trials, that sort of thing. So there's a lot more trials. There are lots of biotech companies. So there's a lot more niche trials, a lot more rare disease trials going on. Back in the day people would, the standard format would be obviously site feasibility. You'd reach out to the sites, and get them to say, have you got enough patients? Even then everybody knew the sites didn't have enough patients. So it was, I never understood this, why everybody realized. They were not telling the whole truth, but everyone went ahead with it anyway and planned their trial as though the predictions were going to happen, even though they never did.

When I first came into the industry, I was thinking, why does this happen so frequently? People, must really, if you do what you've always done, you'll get what you've always got, people must realize it. But anyway, I think there's perhaps a whole other conversation there about maybe, maybe some of the stakeholders in the industry.

are not inclined to shorten the timeframe of a clinical trial. And
because it helps their revenues to keep the trial going on and on and on without recruiting quickly. Anyway, that's a different thing. But I've had that conversation many times with people, but yeah, What people would do, they'd look at the sites, they'd do this, they'd set their plans based on what would be happening, what the sites had told them, patients they could recruit.

Then they would probably do some press advertising. So local newspapers or even national newspapers, actually here in the UK, national newspapers would take clinical trial adverts. Radio advertising as well, often targeted locally. When the internet started to get a bit bigger you know, the internet was obviously around in the late nineties, but it started to get bigger in the early to mid 2000s.

And then when everybody was using it, then the online, first of all, I would say that it was the online publications that people started to reach out to. So there's a. Newspaper in the UK called the Daily Mail or the Mail and Mail Online was a very big website so people used to advertise on that a lot, but you could also advertise on local like London newspaper websites through the same format.

And that's it. It gradually morphed into the idea that, okay, let's do this online. And so a lot of it's now gone more online. I also think now there's a lot more opportunity in the U S in particular for utilizing health records and patient health records, lab data, that sort of thing, you can get access to this sometimes in some form.

It's not so easy in the EU or the UK, but yeah, so the differences,
it's almost the evolution of advertising, I would say, is the same sort of,

 That's interesting.

And, I guess that this digital patient recruitment very much depends on the country where you're in because you mentioned in the States, you can do these things in the UK, EU you can do these things, and then in the APAC, let them probably complete the other things. So when you have to think about a global patient recruitment strategy no matter whether it's digital or not, how actually do you decide?

Can you actually do a country localization, let's say, critical is that, and how would you do it?

  it is. And usually what would happen is the trial has been set up in the first place to target particular geographies. So, at the stage when the digital outreach is happening, usually, it's been predetermined where to target. So then you have to look at what the laws are in that country. And also especially, you know, which we might be talking about language, we might be talking about language differences even within different the same country, it makes sense to have different languages being targeting people.

Otherwise, you are limiting the number of potential patients. But yeah, if you talk, if you're talking about a Europe-wide campaign, you might have. seven different languages going on. It's not just about language. There is a cultural understanding that happens. So it is, it's always useful to have people on the ground in the country who know what they're doing to be able to ask them at least, which is one of the things I'm always recommending is to get patients involved and get the research sites from the locations involved, get the patients from the locations involved.

In well, the protocol design ideally,

but certainly when you're reaching out and the outreach through a digital means or any, any other means, get them to guide you as to what's likely to work, what phrases will work, whether people are interested in particular things, whether home visits, lots of people don't like the idea of home visits.

Some people do like it because it's easier. So there's so many variations. And again, you can't. Just look at, well, everybody in Spain thinks this, because there's 30, 40 million people in Spain. They obviously don't think, nobody thinks alike. It's like lumping every, every diabetes patient into the same bucket and saying, oh yeah, there were diabetes patients like this.

Do they, you know, it's so, so there's all sorts of things going on, but can't be too optimistic. micromanaging about it. Cause the name of the game is to get the people into the trial eventually.

  But you mentioned that the best option will be to work with like the local partner, let's say. But then I also know that, if we exclude patient recruitment, even like when we exclude patient recruitment, Even then, clinical operations directors have to deal with so many. So I think something like 10 plus vendors, each clinical trial.

And if you include for every country, or let's say every second country, like a different vendor for patient recruitment, how can you even manage that? Like, have you seen this successfully happening?

  I have seen it successfully happen, but it's not easy. It's I think the sort of vendor oversight, it's another sort of thing that I've done a bit of more recently which is to look at how to manage the actual solutions providers that are. I'll put working in a trial and it's not an easy process at all.

And most organizations I've seen who are doing it some trials, they've got 45 different vendors working on it for different, different things. And you think like, there's no reason for this in my opinion, but you know, it's just historical, it happens, but yeah it, most people have got to the point, the points they are, where they are managing through, muddling through maybe, or having, this is the way we've always done it.

We can get it, we can keep on top of it. So maybe not the most efficient way of doing it, but they can point to the effectiveness, not necessarily in patient recruitment, but in the other areas where. Yeah, even though we may not be doing this most efficiently, the trial is actually going on. So it is a tricky one.

And it's, I agree it, it would be, it's very complex to actually set these things up  multiple vendors and be able to manage them all at the same time.

 I hope you're enjoying this episode. If you find this topic relevant, you'll find it helpful to book a demo with our team on trialhub. com. Since 2019, we've supported more than 3, 000 clinical trials with country, site, and patient feasibility. We'd love to show you how and help you get your trial right from the start.

And now, back to my guest.

  Lately, like for the past year or so, maybe it's like even for longer, but for longer now on the market, but there are these softwares that help you manage multiple vendors in patient recruitment, per se, one of our dear, Partners like Trialbee, for example, have a similar software. And I've always called that decentralized patient recruitment, which allows actually local vendors to support you in your efforts to recruit patients from communities from but there should be a mechanism to help you oversee this.

And I see the softwares exactly in that space. So hopefully that will help us achieve better. Let's say results at the end of the day by choosing the right ones for the right country for the right community and so on and so forth. Um, speaking about patient recruitment strategies Ross, I know maybe that's like too vague and too high level, let's say, but what are the best practices today for building a strong patient recruitment strategy?

The best way to build a strong patient recruitment strategy is to start before you need to recruit the patients.

To get the, to actually build the trial itself, the design of the trial in a patient-friendly manner in a way that actually people want to then participate. take part. Nobody's that keen to take part in a clinical trial.

People will say, yes, I'd like to take part in it. But if people did not have the condition, that would be their ideal scenario in the first place, rather than taking part in the trial. So you've automatically got people with a bit of a burden. So giving them more of a burden on the trial is something we try and we should be lessening.

We should be decreasing that as much as possible. So starting at the protocol design stage, the trial design stage should make it easy for people to do lots of things happen through DCT being the big buzzword over the last four or five years and now being pushed under the carpet a bit, but I think that's mainly because DCT practices have been adopted into most trials.

There are elements of DCT tech, certainly that have been adopted and practice in most trials, in most trials, you could say are hybrid trials now even though it is majority going to a research site.

Like what Craig Lipset says, more or less, DCT is just the new clinical trial today. So maybe that's why I don't speak about DCT, basically clinical trials do implement some of the components that DCT was just favoring, not favoring, but like leading as a new movement, as a new way of doing clinical trials, but that's the new norm.

It is the new norm. So that's why we don't speak that much about DCT because it's not. Like nothing new on the market, but it's actually the new way. I guess the difference between what was during the wild times during the COVID pandemic and today is that back then we were trying to push everything absolutely remotely because the times were such, and it requires that.

But today we don't live in this world anymore. Like thankfully, and now it's about which are these components that make sense to be remote and others that don't make any sense to be remote.

And also it depends, like you said, on the country and the culture and so on.

Well, and I think it's offering a choice. This is what I'd love to see. It's offering people the choice of being able to do things remotely if they want to, or being able to do things at the site if they want to. I think a lot of people will choose to go to the site anyway. I mean, one of the biggest problems in recruitment is access to the trial.

It's, you know, being able to actually get to a location where you can actually take part in the trial. And that's because sites are not always located nearby. So that's one of the big problems. So having these additional opportunities I'd love to see more, primary care physicians being involved in trials because they've got the premises, people that know, nobody's that far from a local pharmacy or a local doc.

Yeah.

So they should be able to do this. I know there are complications.

They already tried, by the way, like in the space, at least they already tried. Why do you think that this didn't work out at least so far? I mean, they're like trying to pull away from this to get away from this business. Maybe there is I'm pretty sure that there are a lot of details around this decision.

It may be not like for the sake of clinical trials' benefits only, but what's your opinion? Why pharmacies are not heavily involved in clinical research today?

I think they misunderstood what it was about because for instance, CVS getting involved in the in the COVID vaccinations, giving someone a vaccination does not require the same amount of paperwork and record-keeping as administering a clinical trial. And I think this is where doctors come in.

I've heard this from doctors where they say that there's a lot of what they call one-and-done doctors. So they do one trial and that's it. They're done. They don't ever do another one because they hadn't realized quite how, how much paperwork, how much record keeping, how much, you know, administration and governance there was involved.

Um, Once you've got to a point where that sort of is just ingrained in what you're doing, it becomes a lot easier. I would suggest it. The downside is the money isn't that great either. For people

to get involved in it. So it's certainly individual doctors, they might look at think it's another income stream.

But if they're not being paid particularly well for it, and there's a lot of extra hassle.

Mm hmm.

You start to think, well, what's the point of this?

If I had two trials, it'd be twice as much hassle. So I think this is why it hasn't happened. I think it should, there's no reason at all in my mind that local pharmacies, local churches, local community centers,

why shouldn't these be places where you can go and take part, et cetera.

I'm not talking about ones where you need scans and things like that.
Certain ones that will only ever have to be done at big hospitals or university sites, but the majority of trials don't usually require that.

No, I agree. And I agree with you, Ross, that probably one of the biggest issues out there is the access to patients. On our platform, we have a platform that supports patients. Actually, we see all the time people asking is there any clinical trial in my region? I have this disease, I can't travel every day or let's say every, two times a week, for example I don't feel well and yeah, there are a lot of complications. In fact, that was the thing that led me to start working at FindMeCure and then TrialHub later because my sister was in such a situation. Actually, we did find the clinical trial for her. We did find a clinical trial for her, but it was like in another country.

That was like 10 years ago. It was even more complicated in Europe in general. It is complicated and in the space. So I completely understand. Have you heard of this satellite sites concept?

In what sense?

So that's something I heard, probably last year or maybe even before that. I don't remember exactly when, but that's my hope. Let's say that

Know what you mean.

These doctors that are not yet investigators kind of become satellite sites in a way, your doctor becomes a satellite site.

And I personally, that's my hope because I understand that for pharmacies, for the local, whatever, like stores or no, like local churches conducting a trial, maybe a little bit like more heavily think they may be great partners for patient recruitment or some, let's say high level observational like trials.

For example, when we speak about the heavy lifting trials, maybe these are not the best places,

even if I'm to be, let's say, a past patient going through cancer, I'm not sure that I will be happy and feel absolutely safe with the pharmacy with the local pharmacy. I want to see a doctor at the end of the day.

See a specialist. Yeah, yeah. yeah.

But what about, let's say, my own doctor can become?

I agree. I think there's software available, there's organizations who will help you to, you know, the doctor just using their facilities or even just having a room and the practice nurse, maybe if it's just a blood draw that's going on, you don't need to do much there, really.

You have to have all the storage capability, but I would say most of these places will have this built in. pretty much there anyway. So it's not that difficult, I think, to have the, as you call them, the satellite sites and with the central principal investigator even being able to do something like this with you know, online, so they can talk to the person.

But they could be hundreds of miles away. I, think, yeah, local doctors, I'd love to see them getting more involved. And in fact, the ultimate way to get people onto trials, the best possible way of getting patients on trials is for their local doctor, that they have a relationship with to recommend it.

Actually misled you. I heard about satellite sites many years ago. I actually heard the term satellite. Last year, but I heard about the concept many, many years ago. So I guess that's been out there for many years. Why isn't that scaling? Why isn't that the new norm, like the centralized components, for example?

What do you think we should do in order to make sure these local doctors are a part of the trials? Is it regulations? Is it awareness? What do we need to change?

I think it's a combination of all those things actually. Most of them are probably unaware that they can do it. Most of them would have seen some horror stories, especially from the Warren and Dunn doctors, and they say, oh, I don't want to get involved with that. Most of them are not that interested. What you probably need is, an entrepreneurial-minded doctor to be interested because it's another income stream potentially.

Now in the UK, it's slightly different because obviously the NHS, a lot of Europe, it's not, you know, you're not going to get necessarily the entrepreneurial-minded doctors to the same degree. But yeah, I think that's what you need. Someone who's thinking a bit more smartly about, Okay, how can we use our premises, our resources to do other things?

I mean, I have come across doctors who are just not convinced that clinical trials are that good an idea anyway. And they say clinical trials work, but they don't want necessarily to risk their patients. And I understand.

Okay.

Because that's a risk.

I would be worried as a patient to go to a doctor who is not let's say open to clinical trials, because at least to me, that will mean that they're not open to other alternatives. But, yeah, that's another story.

But I think it is, that is one of the things it's, an industry that is, it's quite old fashioned, it's slow to move and a lot of the people in the industry are old fashioned and slow to move and a traditional primary care physician in the UK might think, yeah, I've got 15 minutes to see my patient, I can't spend 10 minutes of that explaining a clinical trial.

So there's all sorts of reasons why people don't do it. But if you had a group of. doctors who were more of a mind to try and try some innovation, do things a bit more unusual, not like they normally do. Then that would be it. And I just think that we're not at that tipping point. We're not at the point where that's going to sweep the world yet. T you know, I think it's getting bigger.

Yeah, hopefully. Yeah, hopefully and as I'm listening to you, I'm thinking that actually maybe The problem comes from even how we educate doctors. We've been chatting with a few friends of mine that are in the clinical research education space and they're saying how much, not just doctors, but every single healthcare professional, they're not even offered clinical research as a career option.

So maybe at the very beginning of medical education let's say science education, we should speak more about clinical research and why this may be a career option, what this clinical research is all about, how it works, ike the income, like additional income, maybe to rethink, is it really the case how much you're expecting to be let's say, reimbursed for the time you're spending on doing all these administrative work, what of a burden this is and speaking about burden, I want to go back to the burden of the patient and you mentioned that the best practice for today's patient recruitment strategy is actually starting at the very beginning before you've even started patient recruitment with the design and making sure that you calculate the patient burden according to the like design the, whole schedule, eligibility criteria, the requirements and like everything basically around that, Do you think we, like the industry is already doing that, like assessing the design with patients?

Like how, much do they do that today?

It does happen when we were both at SCOPE recently and you, when you attend some of those sessions it, seems like the whole industry is doing this all the time. Clearly is not, clearly is not doing that all the time. But there, there, you know, so it does happen and it's a small amount, but yes, that each of the big pharma companies will have patient engagement teams.

It is getting better and I think it is shifting. But the vast majority of trials are not doing this in reality. If they did, I think that there may be no need for people like me to exist. If they're actually doing a better job in the first place. So I'll give it a few years before it really tips over.

Yeah, I think that ultimately the industry talks a good game about all sorts of things diversity, bringing patients involved, getting the, all the voices, et cetera, et cetera. Ia that what we see every day on the ground?

Yeah. Yeah. That's interesting. That's really interesting. Diversity is a whole new topic. I'm not going to even start. I am actually planning soon an episode on diversity which is eye-opening. Why feasibility not feasibility, but like diversity may be doomed, but like

Wow.

I said, it's a whole new topic.

Speaking about design and assessing the design with the patients, I just wonder If companies are saying, we are doing that, we want to do that. What stops them from doing it in reality? That's your opinion,

Again, it's a combination of things, but it's, you know, do what they've always done. It's a very slow moving,

Mmm. Slow to change industry. So it's like, yeah, a lot of the pharmaceutical companies just say, right, we've got a new trial. We'll use the same CRO, they use the same sites, et cetera, et cetera.

And we know how it's going to end up because the same result always happens, but they still do it.

So that's, banging your head against the wall there. But it's a cost factor as well.

Cost factor. Mm hmm.

Yeah, it will take some extra resources to get this involved. At the end of the day as well, you've got to be careful because some of the patients who make the most noise are not necessarily representative of patients in general.

Yeah, I know quite a few patient advocates and some of them have different views as to as to how they should be involved. One thing I always think is very useful, even if you're not going to get patients involved at the trial design stage, get them involved on the study team. Get at least a patient there because this is for retention as much as anything so that when patients are suffering and they just, oh, I just don't want to I, my own condition means I don't want to leave the house.

I don't want to go in. And they ring the research site. they can feel awkward about it. And they're more likely to think, oh, they don't understand me. I'm not going to. We're not going to continue with this trial, whereas I've seen this happen many times where if they can talk to a patient, who's got the same condition as they have on the study team and they have like a, you know, this is your first point of contact for any of these questions and they can get a response and that person understands them and says, Oh yeah, that's fine.

We understand perfectly. We'll rearrange the appointment or whatever. And it just, it's that sense of empathy and it's, it really helps with the patient engagement. So getting patients involved out on the study level is definitely something I recommend.

You remind me of the story of I'm not going to mention like the name of the company. Probably most people will recognize which company I'm speaking about. But in the space of diabetes, they basically went back to their employees, like the leadership said, guys, we are working in this space. We must have like diabetes is so prevalent. We must have diabetes patients among us, let's bring your voice while we're developing, treatments for people like you. Let's listen to your stories. Let's listen to your voice. So, actually, they use patients.

Literally their internal staff was going through the experience to actually build better treatments, better clinical transfers, better treatments. It is a success story today. So hopefully it's not always possible, but I also agree that this can be very powerful if you have someone who's constantly there, but also someone who comes with personal experience.

So, yeah, like incredible. Ross, I have so many other questions, but we are running out of time. Let me ask you my usual final question before we wrap up.

What is the one thing that you can think of that will make clinical trials more patient-friendly and successful?

What I'm thinking really, and it's, kind of one of the conclusions in the book I've come to, it's that it, there's no one solution, there's no magic wand particularly, but we're trying to get as close to a magic wand as possible. So the way to try and do that is not to get this solution works, this solution works, this solution works.

It's about bringing things together. We are, we're all trying to get the same end at the end of the day. We're all trying to achieve the same goals. We want to bring treatment. We want to help people live better, longer, et cetera. So the silos that exist, even within companies are crazy. The silos that exist between pharma and CRO and site and patient and everything else is crazy.

The fact that there's a lot of finger-pointing about what going wrong and all. If people actually could work together more and get all the voices together. I mean, this industry has trillions of dollars of money in it and it's not going away. There are only gonna be more requirements for clinical trials over time for treatments, whether medical devices or drugs or whatever.

This is a long-term project, but if you start now, a lot of these companies are going to be here 50, a hundred years from now, um, yeah, start now, 10 years from now, you perhaps see the benefit of all this working together and it will help.

I know you've, you've got a responsibility to your shareholders sometimes, but you've also got a responsibility to the key people which is the, the patients and the people. So I think working together, I'd love to see more collaboration, even, bring the co-creation.

And create the trial from all the voices at the beginning, rather than, right, someone has gone into a lab and said here's, this, what we need, these are the endpoints we need, all 700 of them. And then you, build me a trial like that. Let's, get voices in at that stage.

Yeah. Well, you're not the first one to say that collaboration is something that we lack in industry. Maybe one of the reasons I started this podcast is exactly to bring these different perspectives together and hopefully encourage people to, understand, to, to The other roles and the other people better and drive better collaboration.

So, Ross, thank you so much for providing your perspective today. I really hope that opened the eyes of some people. And gave them ideas. Maybe these people can also connect with you later and you can continue this conversation and brainstorm again. How can we better collaborate? How can we work towards better results?

At the end of the day, it's not even doing its job. For people, it's actually doing it for our own families, we're doing it for us.

But like people like me, we know that we are doing it for ourselves, basically for our family, for our children, for us.

Even if we ignore doing it for altruistic reasons, we're doing it for ourselves and that requires a lot of effort and collaboration. Thank you again for joining me, Ross.

No, thank you, Maya, I've enjoyed it. Thank you.

 Hope you enjoyed listening to Trials with Maya Z. If you're interested to hear more about how clinical trials can serve patients globally, subscribe to the podcast on Spotify, Apple Podcasts, and Google Podcasts. Have a great day.