What is it, and why are bankruptcies forced to take this approach in the mass tort cases? I mean, you mentioned the scale, uh, but also what effect does that have on the other traditional thresholds that we have in bankruptcy?

Starting off with the, this, w- as you mentioned, the $1 valuation.

It seems like an elegant solution, but it actually creates a lot of problems.

So every claimant is given this $1.

Their claim is recognized as, as having $1 in value.

And then for voting purposes, they all submit their votes.

What I think Congress tried to do to balance the risk of some sort of exploitation is requiring that a creditor class, in order to deem to have approved the plan that's been proposed, at least 75% of claimants in that class have to vote in favor of the plan.

So talk to us a little bit about your proposed solutions.

[laughs]

I'm, I'm joking.

Uh, but, but, but, but, you know, I think that we're at a moment where, uh, you know, as I look over how we're as a healthcare system in this country trying to provide care, people are coming together.

Um, you know, I work hand-in-hand with cardiologists, for example, with endocrinologists, and together we're interested in how, you know, medicines like the SGLT2 inhibitors, medicines like the GLP-1s seem to work for each of our organs, uh, or each of the conditions we treat, you know? Uh, it works for heart failure, works for chronic kidney disease, works for diabetes.

Let's come together and figure out which patients and how to implement these, uh, in a rapid and, uh, you know, uh, uh, make them highly accessible.

So I do think actually the science is compelling us to come together, uh, in new ways, and we should have always come together, uh, but I would, uh, I guess I would say better late than never.

Uh, so I think that there are some emerging opportunities in this kidney cardiometabolic arena, um, a- and collaborations as well in, in other fields.

Um, if someone is considering donating a kidney, whether it's because there's a person in their family, there's somebody within their friend group that, uh, needs a kidney, what are the considerations that a potential donor might want to make?

And I, I don't know how this is gonna finally play out, but I think we do need to kind of look back and say, "Hey, maybe all this pushing aggressively, there's some downsides." And, and how, how are we supposed to-- Do we need to change the-- our approach going forward?

Yeah.

Uh, Joel, thanks so much for bringing this up.

And, um, you know, we're in the middle of an experiment right now, right? The experiment started about a decade ago, uh, which was to have, uh, representation from the pharmaceutical industry, representation from the FDA, representation from investigators to come together and say, "What are we doing for IgA nephropathy? You know, uh, you know, we, we, we've got steroids, uh, and we're watching, uh, these patients kind of march forward with their illness.

What, what can we do to transform this field?" Um, and that experiment continues to unfold.

And as you alluded to, uh, there has just been an avalanche of innovation as a result of moving the goalposts to this surrogate marker of proteinuria.

Uh, that's a very evidence-backed, uh, recommendation.

And so, uh, you know, how, how do we deal with we're moving the science forward, but actually getting these medicines into people's hands is lagging dramatically behind?