Loneliness

Hello, everybody. Welcome to Health Chatter. Today's show is on loneliness and we'll be addressing isolation as well. We have a really superb guest with us. Stay tuned for that for in just a second. Our crew is second to none, really a second to none. They do our background research, they do our production with us, they do our marketing, the whole nine yards, and they're really, really good. First of all, we have Maddy Levine-Wolf, who's helping with our recording today and does research for us. Erin Collins, Deondra Howard, Matthew Campbell, and Sheridan Nygard all do our great work for us, including our production and marketing. So thank you to everybody. Human Partnership is our community organization that really does some great community work, oriented work for us in especially in the Twin City metropolitan area. So thank you to them. Along with us today is Dr. Barry Baines, our medical advisor. Then of course there's Clarence Jones, who is my co-host and partner in this initiative. So thank you to all of you. So today, loneliness and isolation. We have a great guest. Her name is Julianne Holt-Lundstad. was a professor of psychology and neuroscience and director of social connection and health lab at Brigham Young University. We really appreciate her being with us because we're recording this show in the morning and it's earlier for her because she's in mountain time. So again, thank you, Julianne for that. She is also the founding scientific chair and board member for the US Foundation for Social Connection and Global Initiative on Loneliness and Connection. When you really get down to the idea of loneliness, there really is no doubt in my mind after hearing from her and reading her background that she is really the consummate expert on this subject. So welcome, welcome to our show today. It's really nice having you. Thank you, it's a pleasure to be here. All right, so let's get this thing going here. There's a lot of information around loneliness all of a sudden. And my question is, is this something new? It's like all of a sudden, we're talking about loneliness. What the heck? What's going on here? Yeah, no. I mean, it's not new. But certainly, we are hearing a lot more about it in public discourse, for sure. So I've been doing research on this for a little over two decades, and certainly I'm not the first to do research on this. And so the scientific evidence around this has been building for decades. But I think one thing that, well, I should say we're growing concerns in the public. Even before the pandemic, so we saw the UK appoint a minister for loneliness back in, I think it was 2017 or 2018. And we started hearing things like concerns of, you know, quote unquote, loneliness epidemic. But then we experienced a global pandemic in which we all needed to reduce our social contact in order to reduce the spread of the virus. And this really had a global impact on people's levels of not only social contact, but just isolation and feeling lonely. And everyone to some extent really felt it, whether it was themselves very profoundly lonely or people they knew and cared about really, really struggling. And so I think this brought greater public awareness to some of the kind of at least the emotional effects, but we have very good evidence of the physical effects as well. So, you know, I've heard it's a public health issue. Okay, and to a certain extent, you know, as I've read about this, it's kind of like you asked the question, is loneliness more of an individual type of thing, or is it more community-based type of thing? Are we dealing with more of a medical issue, or more of a, I guess, public health community-oriented issue? Well, I wonder if it makes sense to... maybe first define what loneliness means. Um, because in the public discourse, we hear loneliness being used quite broadly. And it is often used as a catch-all term to encompass all the ways in which we can perhaps lack social connection. But of course, it actually means something a little bit more narrow than that. And so I think it's first important to distinguish it from isolation because we also use the terms isolation and loneliness interchangeably. And so isolation is really more objectively being alone, having few relationships, infrequent social contact. Whereas loneliness is really more the subjective feeling, a distressing feeling. that comes from the discrepancy between our desired level of connection and our actual level of connection. And so, of course, they often can co-occur because objectively being alone can increase our risk of feeling alone. But often people are not isolated and, you know, they're surrounded by other people and still feel lonely. feeling lonely in a crowd, feeling lonely at a party, even feeling lonely in a marriage. And conversely, we can be objectively alone, but not feel lonely. And so we might actually enjoy that time of solitude. But one of the important things to note is that both isolation and loneliness are associated with risk. but they're also part of a larger aspects of how we might lack connection. So we might lack connection because we don't have people to rely on for support. We might lack connection because of poor quality relationships. And all of these different ways of lacking connection are all associated with risk. So... And then conversely, having connection is associated with better kinds of outcomes and actually protective. And so when we start to ask, you know, then when you ask the question of is this a public health issue and is this more of an individual issue or a societal issue, it's all of the above. And so we know that, for instance, loneliness can be felt very personally. But we also know that the ways in which we might lack connection and the barriers that people face to connection can not just originate within the individual, but also originate in their communities and society. And so there may be all sorts of barriers to connection that and underlying causes to that may be playing a role. And of course, the pandemic is just a very good illustrative example of how something external can be contributing to that that's really outside of someone's control. And of course, there are many other kinds of factors, whether you live in a safe neighborhood, that could influence the extent to which you feel comfortable. engaging with others. There are many, many factors that can occur. And so really what we think about when we think of, is this a public health issue? First off, we have very strong and robust evidence of the impacts on objective health outcomes. And the other is that we have good evidence of a significant portion of the population that is affected by this. And so from that standpoint, we really do need to take a public health approach to this issue. So you mentioned the UK. Is this a worldwide phenomenon? I mean, alone, is it happening all over the world or is it just here in America? That's a great question. And for a while we really had limited evidence in terms of the types of countries that we had data on. So most of the evidence was coming from North America, Europe, mostly wealthy nations, Western nations, and we're now starting to see data globally. And in fact, I participated as an academic advisor on a recent Gallup and Meta survey. It was a global survey of the global state of connection. And it surveyed 142 countries. And what was interesting is we found that nearly a quarter of the global population reported feeling either fairly or very lonely. So, but what was interesting was among the 29 countries that reported more than a third. 22 of those 29 were in Africa. And so what this suggests is that this is indeed a global issue and not just something that is experienced in these wealthier Western kinds of nations. And certainly not just the US. Yeah, right. So, a couple of follow-ups to that. Is there... a country that isn't as lonely, that for some odd reason, you know, everybody is kind of hunky-dory and happy and there isn't a high level of loneliness. Is there any particular countries that stand out? So I should give one caveat to that global state of connection survey, and that was that it simply used one item. And many other surveys use more comprehensive assessments of loneliness. And so when we look at kind of differentiating these, we see slightly different results when we look at a more comprehensive assessment versus a single item assessment. And so trying to identify that consistently has been a little bit challenging. I will follow up with a note on that. on the global aspect of that is that the World Health Organization has established a commission on social connection to really address some of these issues on a global level. And I am part of their technical advisory group, so I will be advising them on that work. And so over the next three years, the commission will be tackling some of these issues to really kind of narrow in on some of these as currently, though that data looking at, which countries are the loneliest or least lonely, we're not getting consistent findings that suggest a particular area is far better than others. But we're getting hints at that. And so I think it's really promising and hopefully we'll have some more firm answers soon. I was hoping you'd be able to tell me, because then I'd know which country to move to if I had to. Well, I can say that at least the global happiness index that Gallup does, they consistently show that the Nordic countries tend to rate themselves as the happiest countries. I guess that makes some sense. Yeah, Barry. Yeah, well, kind of following through with that, as I was reading over some of the research, the name that popped into my head was Dan Buettner, who wrote The Blue Zones. And, you know, there are some, you know, clear global implications of certain communities, certainly, that have lots of social connection and better health outcomes. Julianne, one of the questions that I had for you, I have a bunch of them, but I'll... I'll control myself here. Would social connection be the main factor that mitigates loneliness or that I don't wanna say cures loneliness, but that impacts loneliness or are there other sort of other things other than just social connections with other people that can help to reduce loneliness? Yeah. So first off, I just want to mention I've actually been to several of the blue zones several times. I direct an international study program. And I'll just note that one distinction between the blue zones and some of this other data is the blue zones are focused on, you know, hot spots where there are higher concentrations of centenarians. So in a way, those are kind of like outliers, right? Whereas the other kind of data that we're looking at is where the overall country is faring better or worse than others. So just wanted to make that slight distinction. But of course, social connection is an incredible predictor of longevity, and so that's really important. To answer your next question about social connection and Um, how, how that relates to loneliness. I think it's also helpful to really put into context that loneliness is something that is actually adaptive. And I know that sounds really strange to hear. Um, but it's part of normal human experience, um, much like hunger and thirst. Although it feels a little uncomfortable. It's a biological signal that motivates us to seek out a biological need, right? And so just like hunger motivates us to seek out food, loneliness motivates us to seek out social connection. And so from that standpoint, it is something that is normal in the short term, but when it becomes chronic is when it, and those needs are left unmet. that can be problematic. That's very helpful. And so when we think about how to really, ultimately we need to meet those social needs. And so one way to reduce that signal is to actually meet those social needs. However, it is possible that we could dampen that signal without meeting those needs. And so that might be potentially problematic. Imagine just dampening your hunger or thirst without actually getting any food or water. And so we have to be really careful about just focusing specifically on the signal and kind of ignoring the needs. But they are importantly connected. There's also instances in where that signal seems to be not, for lack of better terms, maybe not well calibrated in the sense of it would be like still continuing to feel hungry even though there's plenty of food available and you're getting plenty of food, right? And so there are instances where perhaps, through various, cognitive restructuring or other kinds of therapeutic techniques that individuals who find themselves stuck in this feeling of loneliness can learn various techniques and skills to help begin to alleviate when that signal has become dysregulated. So let me, you know, are there certain personality types that tend to be more lonely or experience loneliness? For instance, if you take extroverts versus introverts, okay, is there any indication that there might be, like, I'll just guess, introverts are more lonely than extroverts? Is there been any studies? on that? There is some evidence on that. And interestingly, the public perception is that for some reason that perhaps introverts don't need as much social connection. They prefer less. And so they may be less lonely. And in fact, I remember seeing during the pandemic all sorts of memes that said, introverts have been training for this our whole lives. Let's reach out and support our extroverted friends. You know, this idea that all the extroverts were suffering and the introverts were just kind of like happy as a cloud. Right, right. And the data doesn't seem to actually support that. And in fact, there were some surveys done during the pandemic that showed actually that introverts were suffering more. And When we look at just prevalence rates, there is some evidence to suggest that introverts are at greater risk for becoming both isolated and lonely. And so what this suggests is, A, we shouldn't make assumptions about who is lonely and who isn't, because anyone could that we all have these human needs for social connection, although we may have different preferences for how those needs are met. Yeah, yeah, interesting. Clarence. How is technology connected to loneliness? Oh, okay. Because I was just thinking, I was thinking today, I had this conversation with some other colleagues and we were talking about the fact that, you know, you talk to younger people, they're just all up in their, all up in their phones and all up on the computer. Is they're doing, you know, older guys are doing the, whatever they do. But anyway, technology, loneliness, is there a connection here with that? Well, it's a really complex issue. It's something though that is on the top of, I think, most people's minds. And so certainly if we look at the correlations and we look at trends over time, there seems to be a coexistence, I should say. that as various technologies have been introduced, that it has changed the way that we interact socially, or that these changes have co-occurred at the same time. And so it makes it really difficult to say, did it cause that, right? But that they are co-occurring. And so we also have to really be careful about thinking about what do we mean by technology? Um, and so there is, um, a number of kinds of technologies that have been implemented that have, um, that could potentially have an impact, right? Um, from, um, you know, just the introduction of the television, um, there are, you know, people are able to get their entertainment, um, in. in private spaces versus going out into public spaces. Then most, much of the attention more recently has been on social media. I'll note that I did serve on a recent National Academies consensus report on that issue on adolescent health. And the data is very complex. So we see both harms and potential benefits, and that occurs both between different uses and different groups of people, but also even within the same people. And so I'll just give one example. So for people who have, for instance, rare health conditions, or people who are members of marginalized communities or minoritized communities where they may not be getting adequate support locally. Sometimes these can be online sources, can be sources of support or lifelines to support. But often those, and particularly marginalized groups, Those same, you know, same uses can also be sources of online harassment and bullying. And so you can experience both positive and negative kinds of social experiences on these platforms. But then we also have to think about even other kinds of technology and how particularly, During the pandemic, we got really comfortable using more tools to interact more remotely. Many people are now preferring to work remotely. We can now stream just about whatever we want to get our entertainment at home without ever leaving the house. We can order our groceries, order our food without leaving the house. And so in a way, a lot of these technological advancements are making things more touchless, automated, and can potentially reduce our contact with other humans. And so technology is really complex because it brings all sorts of incredible conveniences and things that we love, but also can potentially have some other kinds of consequences as well. It's interesting that you think about connectedness. For many of us, growing up, a telephone was tethered in your home. In other words, if you wanted to make a call, you had to do it out of something that was wired, in your home or somebody else's home, or even in a phone booth. Okay, so now you think about mobile technology, mobile phones, where you could be walking down the street and chit chatting with somebody, which also kind of begs the question of connectedness, okay, which certainly gets to your point. Go ahead, Clarence. You're on mute. Yeah, I was just thinking that you were talking about that book, 1990s high tech, high touch. And it just, I mean, so sure, and that's the only comment I have to make is that it brought to my mind, Dr. Julia, that particular book. I got to go back and read it again, because I know that it has something to do with this conversation today. But yeah, I still think it's a great book. You know, connectedness, you know, being a grandparent you know, with grandkids that are, you know, living, you know, out of town, families are living out of town. You alluded to, Julie, on the idea of touch. And yes, I'm connected with them. you know, via Zoom or FaceTime or whatever. But I've often said, I've often said that it's certainly, you can't put your arms around them. And that to me is part, at least from a personal standpoint, that to me is part of this whole scenario we're talking about. Go ahead, Barry. Yeah, so I have a question about how loneliness is measured. from the perspective, are there either standardized tools or some tools that can be used? In particular, I'm putting on my family practice clinician hat here. Over the past number of years, you can't go into a, see a doctor and not have one or two questions like a PHQ, PH2 about depression. And I believe, and please correct me if I'm wrong, that there is a link between isolation, loneliness and depression. And we ask a lot about depression, but oftentimes I think of loneliness as being a precondition or somehow related. And so I was just wondering if there are tools for how to measure loneliness and the intensity of loneliness. And just wonder if you can... Yeah. Maybe share a little bit about some of those things. Happy to. So first off, I should just mention that loneliness and isolation can often go hand in hand with depression, but it is independent of depression. And so many studies have shown independent effects over and above any effects of depression. So it is something different. It's not the same thing. So just measuring depression won't be enough. But there are standardized and validated instruments for measuring loneliness. The most widely used is a short version of the UCLA loneliness scale. And I will note that I was part of the Gravity Project that helped bring the isolation, loneliness, and social support into the electronic health record. So it is available there. and I know it's available in Epic, which is one of the most commonly used ones. However, I am told that it's an option and so different systems may build it in differently. So it might take some work to find it, but it is there. And so you can assess it. And in fact, it's been recommended. not only by the National Academies of Science and the Institute of Medicine to assess this in medical settings, but also the Surgeon General's advisory, part of those recommendations that's also included in that. I served on both of those. And for clinicians or healthcare providers who might be listening, I also published a piece in the New England Journal of Medicine that provides a framework because I know clinicians often they may experience patients who are dealing with this but may not feel like they have the adequate tools to deal with it. And so we provide a very simple framework that we call the EAR framework, which is an acronym for Educate, Assess, and Respond. So the Educate is helping patients become aware of how this is relevant to their health and their treatment. The assessment is, you know, assessing this and including this in the electronic health records so that... you can see how people's or your patient's levels might be changing over time. And then respond is also really responding in a way that is responsive to their needs. And so in a way, it's not a coincidence that, you know, ear suggests that you ought to really listen, right? And really listen to what might be going on. so that you can connect them with the most appropriate resources. So whether that is integrating more social support throughout their treatment, either in a clinical setting or whether that is referring them to resources out in their community. Very helpful. Hopefully that will help. Yes, thank you. Yeah. So let me ask this question. Is there like a timeframe for loneliness? In other words, you know, it's like, you might ask me today, you know, on some kind of an inventory, Stan, are you experiencing loneliness? Well, is it loneliness for a week? Is it loneliness for two months? Is it lonely? Is loneliness just based on a year? You've been in that state for a year. How is it that it seems to me it can ebb and flow a little bit for us as human beings? Right, right. And so certainly that can occur. I will note that there is some evidence to suggest quite a bit of stability for many individuals. But one of the things that we do find in research is that when it is consistently high over time, that is what is linked to greater risk. So, and when we see that, so when it's persistent over time, when that, when it tends to go away or has only been occurring for a short period of time, it is still associated with some poor outcomes, but not to the extent of those that have more persistent levels. And so I think that's actually really hopeful in the sense that there's opportunities for us to intervene and to change that risk trajectory in a way that can help people. On a previous show, we had a veterinarian on and talked about the human interaction with pets. So I'm just curious, does having a pet, a dog, a cat, whatever, or any, does that play into the un, being unlonely? In other words, does that help the connectedness aspect? Or when we talk about connectedness, are we only talking human to human? So I will give the caveat that most of my research is focused on humans. Human, okay, I get it. But certainly there has been a lot of interest in how we can connect to non-humans, whether that is a pet, a robot, or even- God. Yeah, spiritual. Right, right. And so there have been studies that have looked into this. There is a fair body of evidence that has examined pets. It's not as strong and robust as the human literature. And unfortunately, a lot of the studies are more correlational. and so it or lack adequate kinds of control groups. But there does seem to be some benefit associated with that. But like I said, the evidence isn't as strong. The interesting note is that in some ways, some of the evidence suggests that for instance, having dogs, is more beneficial. But often the mechanism is that because you need to walk a dog, you're leaving the house, you're more likely to engage with other humans when you're out, but you're also getting more physical activity. So there may be additional kinds of factors that are playing a role other than simply just the companionship of that. You know, it's interesting when I take my own dog, Murphy, for a walk, he really gets into listening to woodpeckers. And so it's like for some odd reason, he has to stop. And it's like, he almost communicates to me as if to say, come on, we need to listen to this together. You know, the pecking of a woodpecker. But it's interesting. I think it would be interesting to see if there's research on that. So you know it's interesting that there is starting to grow some interesting evidence around even just being out in nature. And so then, okay, well, the pet can bring you out in nature as well. Correct. But some of the benefits of just even spending time in nature. Correct. And so you don't have to do it with a pet. You can just connect with nature, you know, as far as that. connectedness. Although it sounds like your dog is helping you notice things that you wouldn't have otherwise. Dogs are good at that. I'll say that. So all right, so this is what our research crew is, like I said before, is second to none. Hopefully, it's consistent and correct with what you're seeing in your research, Juliette. But one thing that does stick out is the differences by age. And so there's some striking things. And I just want to make sure that these are correct, first of all, like the Generation Z. And for our listening audience, that's like the 18 to 22, 23 year olds is the loneliest generation. Is that, does that bear out with what you're finding as well? Yeah, so I mean, like I said earlier, anyone can be lonely. Correct. We see the highest prevalence rates in that adolescent to young adult range. All right, so what's going on there? Well, I mean, is it just what are we dealing with here? So there are many hypotheses. I wish I could just say this is it. Yeah, right. And. But there may be many factors contributing to this. And so one factor is that when you look across generations, adolescence just seems to be a hard time for people. So developmentally, it's a time when you are trying to figure out who you are. Also, that young adulthood period often leaving your home of origin for the first time. And so all of these kinds of developmental changes can be difficult. And on top of that, you also don't have the years of wisdom and experience behind you to deal with them. And so there's that aspect of it. But there is some evidence to suggest that this generation may be somewhat different compared to previous generations when they were adolescents. And so because of that, some are suspecting the role of technology and social media and to what extent that is playing. I will note that is highly debatable. And so, and highly charged when people talk about it. But certainly is something that, you know, all generations are pretty much using. But this generation kind of started with this at a critical time. And so that may be one potential explanation. There's also other kinds of explanations around just the emphasis on economic success and how so many young kids are, so to speak, over-scheduled and may not have as much time for socializing. But then you now, in terms of looking to the future and thinking about younger generations, we also have to think about the impact of the pandemic. And so going forward, we're going to have this generation of kids that... depending on what stage of infancy childhood, adolescence, or young adulthood they dealt with this, is that there was a two to three year period where there was significant reductions in social contact, socializing, at very important developmental stages. And to what extent is this going to have long-term kinds of effects on on their social skills and other kinds of ways that we aren't even thinking of yet. And so we can look at kind of what's the data we have now, but then also thinking about like what's the data going to look like going forward. I should point out that interestingly when we look at the American Time Use Survey, This is data on how Americans spend the minutes of their day. And they look at this. And so there was some data that was released not too long ago that is from 2003 to 2020. And what we see is significant increases in time spent in isolation, significant decreases in time spent with family, both household and non-household family. time spent with friends, time spent with others, and time spent in companionship. And when you look at the age breakdown, one of the most dramatic reductions is you can see in the young category from 2003, so over the past 20 years, young people, there has been a dramatic drop in time spent with friends. And so, and that started well before the pandemic. So going back 20 years. And so it does raise concerns about kind of where we are at in these trends, what led to these trends and where we're going in the future is our... And is there reason to believe that these trends will reverse or are they going to continue to get worse? It's kind of like we're morphing. Perhaps we're morphing into a different kind of way of just going about life, which is .. And we've talked about technology and all these other variables. One thing I have noticed that... So there's Generation Z, there's adults, there's older adults. Seems to me that what's affecting the percentages there are life events that go on. As you get older, you experience different life events that perhaps can have an effect on the loneliness factor. Certainly when you get older, there's a bunch of things you can do as a spouse or a significant other. changes in lifestyle such as retirement, those types of things. It seems to me that there's life events. Yeah, and becoming a new parent. A new parent is another, believe me, that's another one. Moving, yeah, all of those, yeah. Clarence. Loneliness by gender. Who struggles the most, men or women? So there are studies that have shown some gender differences, but when you look overall, so when meta-analyses like take into account all the different studies, the differences are essentially zero. So that doesn't mean that we experience it the same, but rather the prevalence rates are equivalent. And by, there's also by race, we're seeing, you know, supposedly differences. in the black community, the Hispanic community, is that perhaps for at least some of these communities, a function of integrating into particular lifestyles, moving from a country to here, emigrating for instance, what are we seeing? We're seeing race differences in that sense. Yeah, so one of the things I want to make clear is there's nothing about someone's race that makes them more prone to isolation or loneliness. It's rather the conditions that they may face. Oh, yeah. And so we need to... That's a good clarification. Yeah, yeah. And so, you know, you may face more discrimination. You may face more kind of systemic kinds of barriers. that need to be considered. You also mentioned migration. So that is something that is one of the explanations for why perhaps we are even seeing these high prevalence rates in low and middle income countries is that we're seeing due to economic situations that often younger generations are migrating and leaving their area of origin to seek out economic opportunities, which often leave the older generation behind. And then there's of course the, when you are now displaced from your network, that can also have impacts on the younger generation. So these life changes, systemic kinds of barriers, particularly associated with marginalization and minoritizing particular groups can put people at greater risk. You know, it's, you know, to come to a conclusion in our show, you know, it begs the question, okay, so what do we do about this? And, you know, it's, to a certain extent, we've discussed what is, what we're seeing, all right? Then the next thing is how do we truly address it? And for our listening audience, in our research and background that's attached to this show when it comes out to you is, you know, what you can do if you're experiencing some loneliness, there are resources out there. And also, Julianne, if you know of some that you think that we should, you know, make available to the public that perhaps isn't on our list, please let us know. So it's one thing knowing that it exists. It's another thing is how do we respond to it? How do we help people address this going forward? Any comment on that? Yeah, so I served as the lead scientific editor on the US Surgeon General's advisory on this topic. And one thing I should note is that it does more than just kind of raise the alarm bells or provide the evidence on why this is something that is a major health concern, but it also provides a framework and a framework for a national strategy, as well as detailed recommendations across different kinds of, you know, recommendations for the healthcare sector, for the tech sector, for government, but it also provides recommendations for individuals, for parents. So I would highly recommend that, and that is something that is freely available online. I do know that the report is a little bit long, but if you go to the end, that's where you find all of the recommendations. The summary, right? Yeah. Right, right, right. Alright, Barry, last thoughts. This was just very illuminating and was just fantastic to learn so much more about loneliness and isolation. And we know that it's prevalent in the pandemic highlighted a lot of these things, but it's clear that this has been with us for longer than just that pandemic. It might be an exacerbation factor. I don't have any more particular questions other than to say Julian, just thank you so much. This was just great to learn more about this and to hear about some of the resources that are available that potentially has an impact. Lawrence. Thank you again, Dr. Julian. It was very insightful. And personally, I think we need to have additional conversations about this because to take a deeper dive into this, because as we started talking about some things, my mind started to think about some factors, but also how we could utilize this information to inform the community. I mean, that's really why we want to do this information. So I really do appreciate what you've given to us today. Yeah, it's been really, really insightful, for sure. Certainly, as you learn more, and I anticipate that you will be, feel free to get in contact with us. We'll have you on the show again because this is a great venue to be able to provide some very, very useful information out to the listening audience out there if they're experiencing or they know people that are experiencing loneliness and isolation. So thank you. Many, many thanks for being on our show on Health Chatter. Oh, it was very much my pleasure. Thank you so much for having me on the show. Yeah, you're eloquent, really. For our listening audience, great shows coming up. Our next show, believe it or not, is on stress, which I assume somehow or other is linked. with loneliness and isolation. It is. So with our guests for that, we'll make that linkage. We're also gonna be looking at access to healthcare and health insurance, infant mortality, healthcare disparities, great shows coming up on Health Chatter. So for all of you out in our listening audience, keep health chatting away.