Cutting Edge Products To Make Sex Safer

Title:

In this episode of Real Talk, KJK Student Defense Attorneys Susan Stone and Kristina Supler are joined by Dr. Lauren Streicher, a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, and the founder and medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for  Sexual Health.  In this episode, they talk about if current contraceptive methods really prevent STIs, current edge products to make "safe sex" a reality, and misconceptions around current contraceptives.

Show Notes:

(02:20)  Getting Real about Failure Rates with Contraception
(04:20)  Why Failures Rates are So High
(06:14)  Why Condoms Don’t Prevent STI’s
(07:28)  HPV Vaccine: Should College Students Get It?
(08:44)  Protection During Oral Sex
(09:36)  Introducing a New, Superior Woman-Controlled Contraception
(13:08)  What Makes the New LUWI Superior
(14:42)  Does the LUWI have Lubrication?
(15:45) FDA Testing of the New LUWI
(17:32)  Misconceptions Around Emergency Contraception
(19:11)  Why the “Morning After” Pill Works for 5 Days
(20:26)  Reproductive Rights and IUDs
(21:53)  Why “The Pill” Can Fail
(25:17)  Why the LUWI Will Be on College Campuses First
(27:40)  Myth or Fact: Do You Gain Weight on “The Pill”
(28:32)  Contraception and the Impact on Dating Apps

Pull Quotes:

Susan Stone: It has been approximately one year since the Dobbs opinion, and I'm still in shock. Are you? 

Kristina Supler: I, it was interesting over the weekend reading news stories and it's like, wow, a year has passed and it it's wild, wild. 

Susan Stone: And it's changing the election.

It's changing culture. We are really reverting back and, so the topic today is more important than ever. We're gonna talk about contraception post Dobbs. And we're gonna hopefully unpack myths and make sure students know what they need to do to be safe out there. You know, last week we had a guest and we were talking about the health issues of transgender.

We actually learned a new word larc. Remember that? 

Kristina Supler: I do. And I'm. Certain that our guest today has more to say. 

Susan Stone: I think she knows a larc is not a bird. It's a long acting reversible contraception. But today we have a repeat guest that we love to see. 

Kristina Supler: Yes, today we are really happy to be joined again by Dr. Lauren Streicher. Welcome, Dr. Streicher. Welcome back. I should say welcome back. 

Dr. Lauren Streicher is a clinical professor of Obstetrics and Gynecology at Northwestern University's Medical School. And she's the founder of Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Medicine. Dr. Streicher's, a medical correspondent for top rated news programs in Chicago and has been a guest on other national shows like the Oprah Winfrey Show, C N N, C B S.

2020 just to name a few. Dr. Streicher's also a bestselling author. She's written several books and she hosts the popular podcast called Dr. Streicher's Inside Information Podcast, Menopause, Midlife, and More. Welcome, Dr. Streicher.

Dr. Lauren Streicher: it's a pleasure to be back. 

Susan Stone: Anything new? What's different, on the horizon coming up? Birth control. Give us the landscape. 

Dr. Lauren Streicher: Yeah. first, let me tell you that there, there are always new things and I'm gonna tell you about some very exciting new things.

But I'm glad you started off with talking about larcs, L A R C, as you said, not l a r k, which is the bird. And this is actually not a new term. For us, new term for you, but we've been talking about long acting reversible contraception for a long time. And the reason is, is that we are in an era right now, which it is more important than ever to have reliable contraception. Because when we talk about contraception, we not only look at user, preference, but we look at failure rates. And we know that something that is not going to be controlled on a case by case basis is what's going to have the best rates of success. 

So when we look at a long acting reversible contraception, that is something that is not, as we say, user dependent. These are contraceptions that we set and forget, and as we go through the list of options for college students to use, that is certainly high on the list when it comes to the most reliable.

But before we get to the specific contraceptions, I just wanna kinda set the stage for why this is such an important conversation. Because please, absolutely, Dobbs, no question, but even before the Dobbs decision, when it became potentially life-threatening, you know, now it's, it's not just inconvenient or scary, it's, Life threatened to become pregnant. But beyond that, we know that women in college are very high risk for not only getting pregnant, but for getting a sexually transmitted infection.

We're talking one in four women will contract a sexually transmitted infection. We know that most college women, about at least 70% are sexually active. And when I'm talking sexually active, I am talking penile vaginal intercourse. Because sexually active of course you mean many things. A lot of different things.

But if we're talking about just the ability to get pregnant, we're looking at about 70% most people. 

Susan Stone: Is that just because you're more fertile in your twenties? 

Dr. Lauren Streicher: It's a combination of increased fertility. And it's a combination of complacency of not using contraception on a consistent basis or using it correctly.

And that's one of the things that is really the theme of today, is I think many college women are very much aware of what's available to them. But just because they're using a contraception does not mean that they use it correctly. And in fact, if you look at statistics for unplanned pregnancies, roughly 50% of pregnancies are unplanned.

And according to the Guttmacher Institute, 50% of those use some form of contraception in the month before. Now think about that. That's really wild. You know, so many people think that if someone gets pregnant it's because they were just complacent or they were lazy, or they, the worst is when people actually think that some people use abortion for contraception, which is simply not true.

50% of unplanned pregnancies are people who did use some form of contraception, but it failed. And some methods are more likely to fail than others. 

And at the top of the list, quite frankly, are male condoms. I'm currently doing a study with the Kinsey Institute that I will tell you about with male condoms.

And so I've been reading a lot about it and looking at these studies. And I was floored at the number of couples that even if they say, yeah, we use a condom, they don't use them properly and they have incomplete use of condom, meaning they're not using a condom from the start to the finish of sex.

And the 

Susan Stone: Question though, in terms of preventing sexually transmitted infections, Am I correct that the condom, 

Kristina Supler: the condom was the best way 

Susan Stone: or the only way? How else can you prevent an infection? 

Dr. Lauren Streicher: Okay, so let's switch gears for a little bit and we're gonna switch from contraception to protection of STIs.

So when we talk about STIs, the most common STI out there is human papillomavirus, right? Where women get human papillomavirus on the vulva. Do condoms protect their vulva? They do not. So when we look at condoms as protecting against STIs, it is one of the best methods that we have out there. But it is not the only method and it is not as protective as it needs to be. 

Because it is going to protect against cervical, sexually transmitted infections. Gonorrhea, chlamydia. Things such as that. But it will not protect against herpes. It will not protect against H P V, and that's even if the condom is used properly. These studies, which completely, you know, just I was like blown away by is the number of men who do not use a condom from start to finish because of condom associated erection problems.

Something we don't think about in young men, but certainly exists. They talk about, 

Susan Stone: We've been hearing about it in a lot of our cases. Yeah. But I just want you to back up a little bit. sure. I know with the H P V, we now have a vaccine. Yes. We don't have a vaccine that I'm aware of for herpes. Correct.

So what's, what's a gal to do? 

Dr. Lauren Streicher: Okay. Well, first of all, let's circle back to the vaccine for a minute. I wish I could say that 100% of college age men and women have been vaccinated against hpv, but they have not. Some of them are also folks that were vaccinated earlier on so that they got the quadrivalent vaccine, meaning that it only protects against four subtypes of H P V as opposed to the newer vaccine, which prevents against nine subtypes.

So even people that were vaccinated, depending on when they were vaccinated, may not have complete protection. But there's an awful lot of people that aren't protected. And quite frankly, a lot of times it's the guys that aren't protected. But to your point, herpes. 

There is no vaccine and herpes is has nothing to do with intercourse. In many cases it's about oral sex. There's this idea that type one herpes is on the mouth and type two herpes is on the genitals. And we know that's not the case. You can have both type one and type two on the mouth or the genitals because of transference during oral sex. So how do you protect yourself?

Let's, I mean, I'm sure all the parents are sitting out there and people are saying, okay, we'll get to it already. Yikes. how could you protect yourself, understand it, give us answers, short of stepping in a hefty bag or locking yourself in your dorm room and becoming abstinent, which is not gonna happen.

So number one. There is a new product called Laurels, r o l a l S. Are you familiar with this one? We are, yes. Yeah. Laurels is a disposable latex panty, which is worn by a woman, and the purpose of laurels is to protect her during oral sex. So if a guy or a woman is giving her oral sex and that person has herpes on their mouth or gonorrhea on their mouth as you can. And, that means that this will protect her. It's latex. And this is a disposable panty. It's a one use panty that is, does not decrease sensation. In fact, some people think it increases sensation. I actually have a whole podcast on it in my, Protecting Yourself Podcast. And it's really an interesting new product.

And the idea being that. It also can be for anal play, not just for vaginal play, but it's not for penetration. It's not for penetration. What's new out there for penetration is there is a product which is about to get f d a cleared. I'm working with this company, it's very exciting, and it's called LUWI, as in L U W I, as in let us wear it. 

And what LUWI is. Is this is a woman controlled, very important, a woman controlled contraception for both pregnancy protection and S T I protection. And this is a polyurethane single use internal liner. So it's an internal sheath that protects the vagina, but it also protects the vulva. And this is inserted by the woman up to eight hours in advance.

And she's not aware of it. The men are not aware of it. And the idea is it, not only is it not going to decrease from her pleasure, but it is going to protect from STIs both in the vagina and the vulva. And what's interesting, and I mentioned, I'm doing a study with the Kinsey Institute right now.

The study that we're doing is specifically to identify couples that the man either doesn't use a condom. Or does it use it from start to finish in complete use? Because he says that it impacts on his sensation, it impacts on his ability to orgasm. He can't maintain his erection. He has discomfort with the condom. There's a whole long list of excuses, right? 

So what we wanna see is with use of a woman controlled contraception with LUWI, are we gonna cross all of those things off the guy's list? What's really interesting is, I don't know if you're familiar, with A C H A, the the American College Health Association.

Are you familiar with this group? No. No. I just came from their conference. This is basically a group of all of the people that run student healthcare. All over the country. So there are 700 different colleges that participate in A C H A. They have a conference every year. The American College Health Association Conference, it took place three weeks ago in Boston.

I was there, and the reason that I was there is because we were introducing LUWI to all of these college, health student, centers. And I gotta tell you, The excitement was over the top. 

Susan Stone: No pun intended, right? 

Dr. Lauren Streicher: Yeah, no, really, because they are what they do the, colleges buy condoms, you're aware of that, that they buy condoms?

Yes. 

Susan Stone: Yes. And they, but are they easy to use and Yes. Can they get stuck in the 

Kristina Supler: vagina? I was wondering, does it get stuck? Does that float around? 

Susan Stone: Can it cause toxic shock? 

Dr. Lauren Streicher: No, not at all. So if this wasn't a podcast, I would show it to you because I happen to have one right here with my purple sparkle vulva that we were using.

hold it up and we'll describe it to our 10 seconds to step away and get my purple vulva. I 

Susan Stone: gotta see it. Get your purple vulva and listeners out there. We will describe the LUWI LUWI to you. I speaking. LUWI. 

Kristina Supler: Oh, 

LUWI. LUWI. Ok. Here we 

Susan Stone: go. That's right. Carrying the 

Dr. Lauren Streicher: right. Here we go. Here is my purple vulva.

All right. So you can see in the purple vulva. Here's the vaginal opening. Here's the clitoris just to orient you. Okay. And we made the vagina clear. So that you can see what happens inside. Okay, so this is LUWI. It looks just like a condom, a male condom, except it 

Susan Stone: looks like a condom. Exactly like a condom.

So listeners out there, it actually looks like a condom. Yeah. 

Dr. Lauren Streicher: What the difference is it's made out of polyurethane. And so what that means is it's much softer. It's much thinner. It doesn't decrease sensation. There's no odor. It doesn't have that funky latex odor. It's completely colorless. There's no color to it, and there's this very kind of soft, flexible ring.

So basically the way that it works is a woman just takes it and she just pushes this inside her vagina. super like a tampon. Not even. Yeah. But it doesn't even have to go up as far, you just, like with her fingers, she just pushes it in and then she takes this ring and she puts it right over her vulva. And then when the penis goes in, it pushes it in for her, gets it in all the way.

So then, but this is, it's cool. It is, as you can see, it's over the vulva. And if you, if someone touches it when it's thin, you can't. It doesn't decrease sensation at all. But the beauty is, is a lot of women position this ring right over this clitoris. You know where I'm going here. So what this means is that it's going to ensure that during intercourse that the woman's not just gonna have less pleasure, she will potentially have more pleasure.

Studies also show that she'll have more pleasure cuz she won't be as worried. if someone isn't worried about getting an STI, or getting pregnant, they have more pleasure. So this act, so this covers the vulva, and what this means is that if the guy has herpes or H P V, her vulva is protected. This can also be used for anal intercourse.

Male to male, female to male. Same kind of protection instead of pushing. 

Susan Stone: What about lubrication? Does it block the lubrication? 

Dr. Lauren Streicher: It comes with a lubrication. Okay. So the lubricant is inside, and I mean around the side of outside of it. This one's on lubricated for demo purposes. Otherwise, my purple Volvo gets all greasy.

And the recommendation is to use a lu with a lubricant just because it's gonna be easier. And in fact, the packaging will come with a lubricant. So when we went to this meeting and there was a tremendous amount of excitement because the healthcare services know more than anybody that there's all these STIs and undesired pregnancies.

And that this is really going to be a huge solution. They were all signing up to, to buy them for, to distribute on campuses. So with the condom fairy, if the college, lots of college campuses have condom ferries and all kinds of things that they go around and they're gonna be distributing these.

And it's not gonna be for this school year because the F D a clearance is just coming through and they're just being manufactured. But we are looking at the 2024, 25 school year. So that's the newest thing that's coming out. That's very exciting. And the thing that's exciting, 

Susan Stone: women have to worry about leakage when you pull out?

Dr. Lauren Streicher: No. So this is part of the FDA clearance, process. It's just like with the latex condom, they test it to make sure that sperm can't get through, that the STIs can't get through. Sure, like a male condom, if somebody pulls it off or doesn't use it, or doesn't use it from the beginning, of course there's always gonna be a chance of there being a problem.

But if it's properly used, you don't have that problem and it's very, very easy to use. You know, there's been, it's been tested. We've looked at focus groups. It's launching, interestingly, it's for any age woman. But it's being launched on college campuses for a variety of reasons. And one of it is because they have one of the greatest unmet needs when it comes to protection.

And again, people are not aware. You are. But the general population is not aware of incomplete condom use. And improper condom use on the part of men. And even though a lot of these women do have, as we talked about, very reliable, long acting, reversible contraception, that's not user dependent. That's not gonna protect them against an STI.

I love IUDs. I think every single woman should have one 99% protection against pregnancy. But that is not gonna protect her against a sexually transmitted infection. 

Susan Stone: Wow. 

Kristina Supler: Dr. Streicher bringing us the latest cutting edge developments and contraception. When there's discussion and debate between birth control oh and abortion, and obviously again it in the wake of Dobbs, it's really important that listeners and, and everyone out there is aware of the distinction between the two. 

Because there's often a lot of conflation. And so can you clearly explain for our listeners whether an I U D or an emerge or emergency contraception plan B, do they cause abortion?

What is the difference between? 

Dr. Lauren Streicher: And I'm glad we're discussing it because there is a great deal of misconception and has been from the get go. And one of the reasons historically is that emergency contraception, the first morning after pill, came out about the same time as we started having medical abortions.

So it was very confusing and they are very different things. And to put it very simply, there's a difference between terminating in a established pregnancy, that's when abortion is, versus preventing pregnancy. So if you look at emergency contraception, that is basically preventing pregnancy from occurring. It is not an abortion. 

And it's something that we have been using for decades, even before they had an FDA approved option available. Because it was something that gynecologists did off label, meaning we would use a combination of standard birth control pills given within a short time after unprotected sex, particularly in emergency rooms when someone would come in as a victim of rape and you don't want them to get pregnant, of course.

So we would give them our version of emergency contraception. And so fast forward now, here we are. that we have much more, reliable and FDA approved emergency contraception. So we have emergency contraception pills, which we don't call them morning after pills anymore, because there's this idea that if you don't take it the morning after that, it's not gonna work.

And we know that's not the case. The sooner you take it, the better. Ideally within 72 hours. But you do have up to five days to, to use emergency contraception. 

Susan Stone: We've had cases where they. Don't work. So we've heard that they don't work if you're ovulating. Is that true? 

Dr. Lauren Streicher: No, it does. It can work because this is the timeframe.

When someone ovulates the egg is released from the ovary, it then travels down the fallopian tube. If a sperm meets up with that egg in the fallopian tube, that's actually where the sperm penetrates the egg. And then it makes that trip down the fallopian tubes and then it lands in the uterus. Where if there's a nice cushy bed that's, comfortable in waiting for this potential pregnancy, it's gonna land and it's gonna in bed.

But that's why you have, even if you have sex, the moment you're ovulating, you've got this five day window before it's gonna travel down and become an established pregnancy. So again, it is not a pregnancy, a viable pregnancy until it lands in the uterus. 

So the same can be said for IUDs. We now know the placement of an intrauterine device.

Within five days of unprotected intercourse is going to dramatically decrease the rate of an unintended pregnancy. And then the beauty of the I U D then is you could just leave it there and you're protected going forward. And that's critically important because in this world of jobs, not only is abortion at risk, but so contraception. 

Mm-hmm. And I think's very clear about that is that when we're looking at reproductive rights in these states that are passing these insane anti-woman laws, it's not just about their ability to get an abortion. It is about the ability to get contraception.

And so my advice to women, who are looking for reliable contraception is quite frankly, almost, basically a hundred percent of women are candidates for an intrauterine device. And the beauty of that is that no one can take away your I U D no matter what laws passed. So if you get placements of an I U D, you're gonna be good for up to eight years, maybe even a little bit longer as far as contraception.

Susan Stone: And so how does the plan B fail? Well, it can, it can fail. 

Dr. Lauren Streicher: If it's taken too late, it can fail. And the other thing also is that, most of these contraceptive methods are not a hundred percent. Even if you look at a lot of the user dependent methods like birth control pills or the patch or the ring, we know that these are not 100% effective. Because there's theoretical effectiveness, which is very different than typical use failure rates.

Typical use failure rates are higher. So for example, if you look at birth control pills and you think, how can birth control pills fail? 7% of the time they do. And one of do you get to 

Kristina Supler: take it? Do you go to bed and you 

Dr. Lauren Streicher: Exactly. And the other thing also is the most common time to miss a pill. You know when that is during your period?

No, it's the beginning of a new pack and Oh. Oh, that's interesting. I didn't know that. Reason why is some insurance companies and some healthcare, student healthcare systems, they're not gonna give you 12 packs. They say you gotta come in every month. Who's busier than a college student? Who has less access to getting to the pharmacy than a college student?

So they go off their, pill for their five days or seven days, depending on the pill. It's time to start the new pill. They've got a final. They've got something to coming up. They say, I'm not gonna make it there. So instead of starting their new pill pack on a Sunday, they might start it on Tuesday.

And that's the greatest likelihood of having a failures at the beginning. I'm a huge, huge advocate of continuous pill taking. Meaning there is no off days. There's no placebo days. There's no period. Get your pill. Take an active pill every single day. Because not only are you not gonna get a period, which is a wonderful thing for all the obvious reasons, get rid of the cramps, the expense of tampons.

The list is very long, of, of advantages to not having a period. But the other advantage that people really don't appreciate is that you're your failure rate's gonna be lower. Because it's with starting that new pack that people ovulate and quite frankly, when you send your student off to college, one of the best things you can do is forget insurance, purchase a couple of extra packs, a pill, send them off with some extra packs.

So if they go away for the weekend and they forget it, or it gets flushed down the toilet or whatever, you wanna make sure that that you're gonna have some extra pill packs and that they can take them continuously without worrying about it. And the same is even like with the ring. You know when you look at the new ring and Vera, are you familiar with those two?

Yes. And the people may not be familiar with Vera, which is a vaginal ring with estrogen and progestin and it that can be used for up to a year. And the recommendation on the part of the manufacturer and the FDA approval is you remove it one week a month to get your period. And I'm like, are you kidding?

Don't remove it for God's sakes. Put it in and leave it there for a year and just don't even think about it. And it's, and that's safe. That's healthy. Absolutely. But they didn't. But for a variety of reasons, the FDA did not, did not okay it for that, and the company didn't try and get it through because, It's really not about medical, it's more about that.

it's just it's perfectly safe to take your pill continuously. It's perfectly safe to leave your ring in. If you wanna take it out, you can take it out for a couple of hours, rinse it with cool water, put it back. But every time you take it out is a chance for it to get lost, for it to get forgotten, and for not to be put back in time.

So maybe if you wanna take it out and get a light period, don't take it out for the whole week. Take it out for two, three days and put it back. it's a lot of this. It doesn't have to always be done by the book. There's ways to, to use these different methods of contraception so that you will decrease the failure rate based on some of the real life situations that come up.

Susan Stone: Kristina, I just thought about the funniest thing preparing for this podcast. Did you watch Seinfeld? 

Kristina Supler: I did. Loved it. 

Susan Stone: Do you remember? Elaine and saying, is someone sponge worthy? Oh, yes. Do you remember? Yes. No, we're 

Dr. Lauren Streicher: enough that we know about sponges, but the college students certainly don't know about sponges.

Susan Stone: So do you think now it's gonna be, are you LUWI worthy?

Dr. Lauren Streicher: the thing is that,it could be. But the idea is to make this stuff easily attainable and affordable. Absolutely. The reason it became sponge worthy was because they were so hard to get expensive who were hoarding them. But the idea, particularly on college campuses, is you want to be as easy as buying a pack of gum is to have access to reliable contraception.

It shouldn't have to be LUWI worthy. It shouldn't have to be condom worthy. It should be. Just in case worthy, I'm gonna, I love that I'm put this in because I don't know what's gonna happen tonight. But in the event that something does happen, I sure don't wanna wake up tomorrow morning and think, oh my God, what did I, you know, what just happened there?

And obviously we wish that there weren't situations where people had too much to drink. Where there was non-consensual sex. But let's talk real life. Let's talk what's going on on campuses. And if a woman goes to a party or is out drinking, even if she has no intention of having sex, if she can place something in her vagina that is gonna protect against both STIs and pregnancy.

Think of the peace of mind. Think of the anguish that young women go through the morning after when sometimes they're not even sure if something happens. 

Susan Stone: But how long can that stay in you? The LUWI? 

Dr. Lauren Streicher: Eight hours. You can put it in eight hours in advance. 

Susan Stone: Okay. So it's not something that a young woman should keep in her backpack or purse and then run to the bathroom.

It should be something put in before 

Dr. Lauren Streicher: Yeah, no. She can put it in 10 seconds, but you can do both. Yeah. But you can have it in up to eight hours, But you can absolutely keep it in your backpack. And and everyone should. And it's, I really think it's gonna change the landscape because not only do you get the increased protection, but let's face it, historically, it all comes down to being women controlled.

Always has been. 

Kristina Supler: You've shared so much information with us today and I think, our listeners have learned a lot, hopefully by listening to this episode. 

I want to clear up one piece of information that I hear often and regularly and it's been going around for an eternity. And that is, oh, I don't wanna go on birth control cuz it's gonna make me gain weight.

Yeah. Myth or fact. 

Dr. Lauren Streicher: Total myth. Total myth. And this isn't my opinion, this is based on literally millions of women over long periods of time. And you know, multiple, multiple studies that the average weight gain at most with a birth control pill is like two pounds, and the majority of them there is none.

And the reason women gain weight when they go off to college is, the reasons you knows everything. 

Kristina Supler: The unlimited meal plans, 

Susan Stone: not alcohol. Alcohol. 

Dr. Lauren Streicher: The alcohol is actually a huge factor because I think that the college students forget about, Not only how many calories there are in alcohol, but you kinda lose your willpower when you're sitting there drinking.

You're also 

Susan Stone: I know that's true at any age. That's my menopause excuse too thought I, it's not the red wine. Okay, this was a great episode. 

Dr. Lauren Streicher: If you do think it's gonna make them gain weight, it will not. But there are so many other options and I really do believe that an i u D is critically important for young women of all ages.

But I wanna, one other little fact that you may not know that's so interesting is there is,the Executive Director of the Kinsey Institute, Justin Garcia, he is the consultant for match.com, and every year they do an analysis of what people are looking for on online dating, as many students will do, and Tinder and what are the factors, all of them, right?

And they found for the first time ever, that being anti-choice was a deal breaker for a record number of women. Isn't that interesting? 

Susan Stone: I'm so happy you didn't let us stop this podcast until you got that out. that's a great fact. That's a beautiful and interesting fact. Yeah. And I wow. 

Dr. Lauren Streicher: A whole episode with Dr. Garcia talking about all the match findings and it is really interesting. But I love that one cuz it, it means women are paying attention. And Absolutely they're changing their behaviors based on it. 

Kristina Supler: Well, thank you so much for your time today and all the wonderful information you've shared.

It's always such a pleasure to have you on. 

Susan Stone: You know we're gonna ask you back cause anytime wealth of information. Thank you so much. 

Dr. Lauren Streicher: Thank you.