We’re revisiting the supply chain with a new focus: the pharmaceutical industry. Joining us is Leon Xu, an Assistant Professor in the Supply Chain Management & Analytics Department at the University of Nebraska. Leon and Gus dive into the significant challenges facing the U.S. healthcare system, such as drug shortages, the opioid crisis, and exorbitant drug prices — all of which can find their root causes in the pharmaceutical supply chain.
Related Articles Provided by our guest:
Drug and Vaccine Approval:
Hospital Staff Shortage:
Disclaimer: This transcript is auto-generated and has not been thoroughly reviewed for completeness or accuracy.
[00:00:00] Gus Herwitz: This is Tech Refactored. I'm your host, Gus Herwitz, The Menard Director of the Nebraska Governance and Technology Center at the University of Nebraska. Today we're joined by Leon Xu. He's an assistant professor in the supply chain management and analytics department at the College of Business here at the University of Nebraska.
And his current research interest resides in two main fields, pharmaceutical supply, chain management, and data driven operations manage. Now astute listeners might keep in mind or might remember that this is the, the second time that we've spoken to someone about supply chain management issues in the last few episodes, and [00:01:00] that's because they're fun and interesting and fascinating and I always learn when I talk to folks who specialize in this area. So I'm really looking forward to, uh, talking, uh, to Leon today. Leon, welcome to the show.
[00:01:12] Leon Xu: I'm glad to be here.
[00:01:15] Gus Herwitz: So let, let's just start, uh, a little biographical. Can you tell us a little bit about who you are and what your research is?
[00:01:22] Leon Xu: Great. So my name is Leon Xu. I graduate from Penn State University with my PhD in supply chain Management and joined, uh, UNL since then, uh, in 2019.
During my PhD study, I start to look into the pharmaceutical supply chain because this is so fascinating. Everything we see in the in, in our life, in our daily life, there is a supply chain behind it, including the drugs we purchase. Okay. And in US there is a lot of complicated issues right now that's going on, like opioid crisis, like hydraulic [00:02:00] prices, and they all find root cause in their supply chain.
And I trying to understand, trying to propose, uh, policy. Suggestions for those, uh, difficult issues by looking into their supply chain.
[00:02:14] Gus Herwitz: So when we're thinking about the, the pharmaceutical supply chain generally, uh, how, how is it different from ordinary supply chain issues? Um, a lot of people probably are thinking in their mind stuff stuck on containers, on boats off of the coast of California right now when we're thinking supply chain, um, is that all that we're dealing with when we're talking about pharmaceutical?
[00:02:38] Leon Xu: Well, that's an interesting question is quote from some professionals in the pharmaceutical industry, what they said that is pharmaceutical is not a box of boats and nuts. Okay? It's quite different from the typical things we see because they require very high standards in [00:03:00] sanitation and production Complexity is also a huge, uh, huge thing.
Uh, also about there is limited sh uh, shelf life on those products, particularly for say, injectables. Yeah. That's why we sell a lot of shortages, some essential drugs that is on shortages that are injectables.
[00:03:25] Gus Herwitz: And reading some of your work, I know that you touch a lot on, uh, the pipeline of pharmaceuticals as well, the FDA regulatory issues and how we actually develop these.
Can you say anything just generally how that fits into the supply chains of issues?
[00:03:42] Leon Xu: Yes, sure. Uh, I think it's, it's very important that we know how drug is developed and approved because they are very vital to save lives. So FDA need to make sure the drug that they prove is safe and effective. And [00:04:00] in fact, this has been proved very important in the history of, uh, few drugs that later prove, say European country later prove to be very deadly.
So FDA is proud of being rigorous and looking into the safety and effectiveness of each drug. But that's actually very difficult to do if you think about this, because we have two wrong clinical trials, phase 1, 2, 3, so that we can accumulate enough data and evidence to show the safety and efficacy of a drug.
And this process takes over a decades, usually on average, about 10 to 12 years to finish this clinical trial process. And it's very risky. So the scientist, they. They try different molecules and then they test on small animals and then test on human. And during this process, [00:05:00] probably only one over 5,000 molecule can make.
To the, to the market. So it's very risky. Takes a long time, and it takes a lot of also capital to develop drugs.
[00:05:14] Gus Herwitz: So I, I love every aspect of this. I, I love anything that's interdisciplinary, and, uh, uh, you're a, an an economist that a business school and, uh, I'm a lawyer, so I love regulation. We're talking about, uh, supply chains and economics and regulation and pharmaceutical development.
So biosciences, it's all there together. Which I guess coming back to, uh, the, the biographical, uh, side of things, how, how did you end up working on the pharmaceutical side of supply
[00:05:48] Leon Xu: chains? Oh, there is an interesting story behind us. So when I was first, um, doing my PhD, my formal advisor, [00:06:00] She was diagnosed with brain cancer, unfortunately.
Sorry to hear. Yeah. At that time, she is- she is- she is a very strong mind person, so she's very positive. She. She's very actively trying to seek treatments. Okay. But at that time, there is one drug that is in clinical trial stage. As I mentioned, it takes decades to develop a drug. So it is very often the drugs that might be promising can still in the development stage and the patients could not get access.
So she was, uh, very curious. Then we. Interested in looking into this process, trying to understand why it takes so long. Is there a better way or better mechanism? That we can show them this process so patients can have, uh, kind can have more readily access to those life saving drugs. And then all [00:07:00] kind of get started, you know, trying to get connected to a, to FDA to different, uh, manufacturer trying to understand this process.
[00:07:08] Gus Herwitz: I- uh, have to ask, how did things turn out for your advisor?
[00:07:12] Leon Xu: Uh, so my advisor eventually, she passed away half, two years fighting with cancer. She also tried to come to different part of the world because some of the world, the, the drug may be more readily accessed compared to U.S., but eventually, brain cancer just is very difficult.
[00:07:32] Gus Herwitz: Um, obviously very sorry to hear, uh, that, and it, it, uh, demonstrates that there, these are real world issues. Yes. Uh, supply chains aren't just these artificial constructs that something about the economy and maybe. Chairman Fed Powell is doing no, they're, they're humans involved in, in a very real way. Um, with that, every part of this, uh, supply chain, what does your research tell us about pharmaceutical supply [00:08:00] chains and supply chains more generally?
[00:08:00] Leon Xu: So, particularly looking at the drug development process, which I just mentioned takes. Decades. Uh, we trying to look at one innovative mechanism come up with by FDA called accelerated approval process. So the idea is just to test the drug on a so-called surrogate measure, and then trying to predict whether this drug is going to be effective or not, instead of observing the full efficacy evidence.
Right? So based on that surrogate measure, The FDA will give early approval and then once the company get an early approval, of course they can start selling the drug. Patients can studying, having access to these drugs, then they can help patients. But meanwhile, FDA don't want to compromise the safety and efficacy evidence of the drug.
So the company are required to continue to do postmarket in your trial [00:09:00] to study whether the drug is really effective. To give an examples. For example, you are developing cancer treatments. So typically if you want to measure how effective cancer treatment is, you have to measure the, say, two year or five year survival rate, right?
By taking this drug, how many person can, can, can survive after, say two years or five. Okay. And if you think about this, this is difficult to measure. It takes that amount of time to observe, and usually it leads a large sample because the benefit you get is not going to be very big. So you need a very large sample to get a statistic meaningful result.
And that takes time. So instead of measuring the survival rate, you can measure how, whether the drug can prevent the growth of the tumor. So they called, uh, the tumor free, uh, rate or tumor [00:10:00] progression free. Uh, rate, right? So that's a very good indicator. You feel your, the tumor stopped growing. That's a very good indicator that this drug is working, right?
So that's called surrogate measure. So for many disease there are surrogate measure like this, which can be more readily observed. So, so they use this surrogate to speed up this approval process mean that sounds good. This sounds very clever. Yeah, idea.
[00:10:27] Gus Herwitz: I'm sitting here thinking, so you've got this, this surrogate and it shows you the drugs working.
Why do we need anything more? Let's just go get it to market. So why, why don't we just do that?
[00:10:37] Leon Xu: That's a good question because it doesn't guarantee the, the clinical benefit or the survival benefit. Okay. It's, we call correlation may not be caus Okay. So you need a sound. Evidence showing the actual clinical benefit.
And there is some example that drugs works on the surrogate, but [00:11:00] do not bring the clinical benefit. Eventually the drug has to be, has to be withdrawn.
[00:11:04] Gus Herwitz: So I, I guess one of the, uh, More common or intuitively understandable circumstances Where we see, this is where we don't necessarily understand the mechanism by which a disease or illness causes harm, but we understand some of its symptoms.
So it's possible what the drug is doing is it's treating a symptom without treating the underlying cause, and we don't understand that. So if we focus on that, that symptom, that's surrogate where we're measuring the wrong.
[00:11:34] Leon Xu: Yes. That's a great way to put it. Yes. So, but as you can imagine, this brain, a moral has a problem once the drug is on the market, right?
If I'm a developer, I lose the incentive. To continue to study the efficacy of the drug. So why should I do that? I can sell my drug, right? I can, If I'm doing this, I can doing this post market study, I need to spend more money and there's [00:12:00] risk, right? So the result may turn out to be bad.
[00:12:04] Gus Herwitz: So, Oh, I, I love that.
So I, I, I, I just have to, uh, uh, uh, give my, my restatement of what you just said, uh, uh, to make sure I'm understanding it with this accelerated approval process. Uh, there's kind of a, a quid pro quo. We, the FDA, are going to allow you, the drug manufacturer to start marketing this drug, but in order to do that, you have to keep doing the studies and demonstrate after some period of time, or I guess, At in some way demonstrate, keep doing the research to show this is safe and effective.
But you used a great term there, a moral hazard. Mm-hmm. , if there's a likelihood that the result of those studies are going to show that this drug doesn't actually work, the drug company doesn't want to do the studies. Yes. And if a significant portion of these studies turn out that way. That's gonna be a really strong moral hazard.
[00:12:57] Leon Xu: Yes, you're right. [00:13:00] So there are some statistics that is striking. I think one third of the, of the, the post market study are either delayed or not completed. There are some extreme example, There's some post market study are delayed for eight to 12 years, never get started. And that's the problem we're trying to solve.
That's the the thing we we're trying to induce the compliance with the post market study. Mm-hmm. and we talk with FDA and the main issue. To the problem is the lack of infallibility or lack of teeth for the fda. So FDA have in approval letters, they have made it clear right in say, next five years, you have to complete the study, otherwise your drug will be withdraw from the market.
Mm-hmm. . Right. That's pretty fair. Right. The, the problem is FDA does not have that teeth to withdraw. [00:14:00] They don't have that enforceability to enforce that penalty. And in many cases, once the drug is on the market, the company would have many different ways to either lobby the patients, like there are many patient groups, will lobby FDA saying, This drug is working great on us.
Why? Why should you withdraw this? . Right? So that's really a problem of impossibility. You don't, you cannot enforce the penalty of withdraw the drug.
[00:14:31] Gus Herwitz: So do, do you know why that is? From the lawyer asking the economist for legal questions now? Uh, do, do you know, uh, why it is that the fda. Uh, can't enforce that.
They, they have the, the power to, uh, uh, pull drugs from the market. Is this a, a question of legal authority or, uh, political, uh, Will or just pragmatics? Uh, that they wouldn't be able to?
[00:14:55] Leon Xu: I think it's more of a trade off between risk and excess. [00:15:00] So FDA do have the authority, but they still have to trade off the risk and access.
Right. So if patients, they are the many patients who are on this medicine and there is no evidence, no study show in this, this drug is bad. Mm-hmm. and with join that drug will be, it will be hard.
[00:15:22] Gus Herwitz: Oh. So that, that's, uh, Uh, great. I mean, we just need to make this, uh, clear. If the company hasn't done the study, it hasn't shown the drug doesn't work.
It also hasn't shown that it does work. So the fda, if they withdraw it, they are risking. Withdrawing approval of a drug that actually does work. And you'll have a lot of incentives there. You'll have patient groups who are saying, Yeah, this, this works for us, or it might not work, but we're desperate. We, we really need this.
You probably have insurance companies who are saying, Yeah, this is an expensive drug. [00:16:00] We love it because we get to charge employers, consumers never see the cost, so we're able to, uh, uh, get money actually by ensuring patients who are taking this drug. So, uh, the, the incentives just are horribly misaligned there.
[00:16:13] Leon Xu: Yes, Yes. So we, we also propose to FDA for such post market study maybe is better to. The say, government like NIH can lead such study and, or even before you give them approval, you should have all the proposal, you have all the clinical site ready for the post market study, then you as a condition to give that approval.
[00:16:37] Gus Herwitz: So the, the idea is, Either there's some competitive leader in the market, the NIH, who's able to do the study. So if the company doesn't do it on their own, they know someone else is going to do it, or they have to have made some credible commitments incurred some sunk costs before that initial approval comes through where [00:17:00] they're, they're going to need to be positioned to start doing those studies.
[00:17:04] Leon Xu: Yes, and also FDA should have more. Enforceability. Well, we, we went to FDA and talked to the fda, and right now they just have one person who would, uh, periodically review f the post market study progress. And there's just not enough attention on on that. So most of the attention of the actually FDA is very short, stuffed.
Most of attention is to get. The drug out, they have, they receive a lot of application, lot of materials. So a lot of those stuff is looking on how to finish those, review and get a drug approved. The less stuff on the post market study. So they also mention they should have more people actively tracking the progress of post market study and sending notification to manufacture if they are not on the on the track.
[00:17:59] Gus Herwitz: [00:18:00] We are talking with Leon Zoo from the University of Nebraska about pharmaceutical supply chain issues. We will be back with some more of this discussion in a moment.
[00:18:14] Lysandra Marquez: Hi, listeners. I'm Lysandra Marquez and I'm one of the producers of Tech Refactored. I hope you're enjoying this episode of our show. One of my favorite things about being one of the producers of Tech Refactored is coming up with episode ideas and meeting all of our amazing guests. We especially love it when we get audience suggestions.
Do you have an idea for tech refactored? Is there some thorny tech issue you'd love to hear us break down? Visit our website or tweet us at UNL underscore NGTC to submit your ideas to the show and don't. The best way to help is continue making content. Like this episode is word of mouth, so ask your friends if they have an idea too. Now, back to this episode of Tech Refactored. [00:19:00]
[00:19:10] Gus Herwitz: and we are back talking with Leon Xu from the University of Nebraska about, Pharmaceutical issues and, uh, supply chain management. And there, there's a obvious question that I need to ask, an obvious topic, uh, that we, uh, should get into, which is, of course, Covid 19 and the pandemic. We have seen all sorts of pharmaceutical supply chain issues here, some of which seem possibly directly to relate to your work.
Uh, The, um, uas, the emergency approvals for vaccines, somewhat similar in concept to the accelerated approval, uh, mechanism. I guess maybe that's a question for you, . Um, and also just, uh, uh, challenges of distributing vaccines, especially within the country and over. Sees, uh, shipping them on boats and all that stuff.
So I'll, I'll [00:20:00] just use that as a prompt to ask if you have reflections on aspects of your research that we see playing out in, uh, the current situation.
[00:20:08] Leon Xu: I'm glad you mentioned about UA emergency using act. I guess it's mostly when you have a state of emergency like this, you would, uh, trigger that UA and we study saw like vaccine and some of the treatments there are in this emergency use.
And of course after this they have to go through the regular approval process if you continue to sell on, on the market. But back to the Covid lighting, I think the biggest impact, just like many other regular products like toilet paper or other things, we have shortages. And one of the reason is the supply chain issues.
Many of the products, if. We, including pharmaceuticals, medical supply, actually made oversee in China or India. I think that's the [00:21:00] biggest two market where we source those medical supply from. So with covid lighting, with so many conject in the parts, so we are not getting some of those medicine. Uh, I have a friend, physician friend.
He once told me, uh, a story. So he is working in a hospital and then the medical stuff hand him a dose of sedation and told him, This is the last one. Be careful to use it. Make sure you use for good purpose. He said, Well, what do you mean by the last one? Let me, So that's the last units in a whole. and of course the hospital staff, administrative administration people, they trying their best to, to manage this and resolve this so that to avoid impact, patient cares.
But that's, that's very real. The short, the drug shortages. So
[00:21:58] Gus Herwitz: a, a question about [00:22:00] that and the, the inter interplay with. Supply chain issues in the healthcare industry and regulation. So much of the healthcare industry is heavily regulated, especially things like, uh, the size of doses and the proper use of things like PCR tests or any sort of testing regime.
Over the last two years, I've seen occasional discussion of things like when you're. When you have a limited number of covid tests, the one thing that you could do is mix samples from 15 patients into a single test to identify whether one of those patients is infected. And that tells you, Okay, this, this cohort we have an issue with.
We need to test more, uh, carefully as a way of effectively managing the supply of, uh, covid tests. But that's all heavily regulated and I. I I'm curious if you have thoughts on [00:23:00] the adaptability of supply chains to changing circumstances when they are heavily regulated.
[00:23:08] Leon Xu: Well, that's a very good question. I think that, not, probably not, uh, the example I'm gonna use is probably not the texting, but the vaccination.
I think, uh, in very beginning, When vaccination vaccine is still in an limited supply and people are discussing, uh, should we give two dose first? Or everybody get their first dose and then we going to give the second dose. I think that's in many cases, should be a scientific question depending on which way is more effective.
And definitely when their supply chain issue comes in a capacity limited, there should be an optimal. Way of doing things. And I believe there are many research that's been done on how to test, right? Should we do a batch test? Should we do [00:24:00] random testing? I think, uh, when we have, when we first. Encounter Covid and UN L is trying to organize the task force to organize the best or to fi figure out the best testing strategy.
And that time is should we have, you know, everyone should do the test or should we do random tests? And of course is subject to how many testing capacity we have. And definitely by doing, uh, this kind of operation research type of work, we can find. A better solution.
[00:24:35] Gus Herwitz: And, and again, it just emphasizes the importance of, uh, these interdisciplinary efforts and understanding because if you, if you're coming from the purely scientific side, you're going to think, Okay, this, this is clinically speaking the best way to deliver these doses, but.
If the supply chain can't manage that, then it's not. So you, [00:25:00] you need to understand what the supply chain is capable of and, uh, uh, the regulations also put limits on how we're going to deal with that. So understanding what the law will allow and what the flex, what flexibility might be in the law is necessary on both the supply chain and the medical side to making informed decisions.
So it's even more complex than merely complex set of issue.
[00:25:22] Leon Xu: Yes. The, the good thing is the covid lining put everybody in aligned. Essentially we are thinking, uh, with the same goal. So it is, is much easier to, to, it's much, it's much easy to align everybody together with, with such an emergency like this. Mm-hmm.
[00:25:42] Gus Herwitz: So I, I do want to come to that, that idea what lessons are we learning and how does that affect future work? But before we get to, uh, that I, I know you're, uh, interested as well in hospital operations management and things that we're seeing, [00:26:00] um, with staffing shortages at hospitals and the like.
What are you seeing and how are you thinking about this?
[00:26:07] Leon Xu: Well, I think we probably need a better. Kind of emergency, uh, plan for this type of situation because right now we are in a really bad situation of staff shortages, especially nurses, and we are putting the nurses working. In a very hard situation, and many of them are very stressed.
They are risking their health, even their health of their family, so many of them has to air force to quit a job. And so that cause shortages. And on the other hand, you have, uh, a surge in a demand. So that makes the situation really bad. And the hospital. They have to hire some, uh, part-time nurses, uh, to [00:27:00] fill the gap.
And if you know that hu the part-time nurses, they are paid much, much better than the regular nurses. So that creates a really weird incentive that many people choose to quit and being a part-time nurse. So the incentive is, is, is very misaligned for. Dealing with this type of situation.
[00:27:25] Gus Herwitz: Yeah, and I, I've been thinking about this as well from the what comes next perspective, because as, as you describe, there's a, a mis misaligned incentive here for current nurses to leave their current jobs and go to the part-time and mobile, moving from state to state market where they can make a whole lot of money.
And hopefully at some point in the near future we're going to. Past the pandemic or a past this type of response to the pandemic, at which point staffing levels will need to return to [00:28:00] normal. And we're going to have a, a bounce back effect where, uh, the um, uh, long term stable employment. Uh, of nurses is going to be dramatically, uh, short staffed and we're going to have this large cohort of nurses who've been, become used to these higher salaries, and that's going to create curious labor dynamics.
We we're actually seeing there, there's a case, I think it's in Wisconsin that was just, uh, decided, or an injunction just came into play. Very weird case. I don't know all the details, but one medical group hired basically all the. From another hospital offering to pay them a lot more money and the hospital went to court saying, You, it's an unfair trade practice for you to steal all of our employees like this.
Um, and actually gone injunction preventing them, uh, the employees from starting work. Weird case. But what I'm thinking about is the company that, uh, swooped in and hired away all the staff paying a [00:29:00] lot of money, they're responding to the current situation. In another two years, they're going to probably just close up shop and all these employees that they stole away will be out of jobs.
And that's not a good situation. How we respond to these dynamics in labor supply is another aspect, uh, that I, I don't think many people are thinking about. Right.
[00:29:22] Leon Xu: It's definitely great if we can bring different people from different fields, like law, like human resources, hospital administration, people to discuss and think about, uh, policy to prevent the these.
[00:29:38] Gus Herwitz: So what, what's uh, next for you and your work? What projects are you working on? Right. .
[00:29:44] Leon Xu: I'm actually, these days I'm actually very interested on drug pricing, so also drug shortages because these are very difficult policy issues that has a deep impact on the [00:30:00] care delivery in us. And specifically if you think about drug price, it is just so expensive, become so unfordable for the US and, and again, it has its causes in the supply chain because there are many middle men in a supply.
That is not from the manufacture wholesaler to pharmacy, but there are like pharmacy benefit manager who make the formulary, who design the benefit and they will take profit from the drug price. And again, the way they get paid is by percent of the cells of the drug and. Also the hospital, they, they also reimbursed by the percent of the average sales price of a drug.
So it seems that everybody would benefit. From a higher drug [00:31:00] price except patients, right? So that's why there being some policies have been discussed to make the drug price more transparent, to eliminate rebate, to prevent the inflation of drug price during a supply chain. I think that's a very fascinating, uh, topics.
[00:31:22] Gus Herwitz: So I, I don't know if you'll know anything about this, but are you familiar with Good Rx? And if so, can you explain it to me?
[00:31:29] Leon Xu: Uh, I use Good Rx and it all started from the story, the, the founder of the company who tried to buy medicine and couldn't find the information, uh, of drug price. So he called the pharmacy near in the nearby region and.
Put up in websites showing this is how much it costs at at each pharmacy. And that's because we don't have price transparency on the, on the things. And in addition to the price you pay, [00:32:00] there is also a lot of manufactured coupon because manufacturer trying to encourage people from using the drug. So, It might be a high price drug.
If without coupon, the patients would not choose it or choosing a similar version or generic version. So they provide coupon to that and by using, I think that's a good way. That we can, we, we can get price discount from this broken system.
[00:32:27] Gus Herwitz: So is, could our x just finding prices that already exist. And, uh, it, it's really just about, uh, facilitating price transparency that otherwise consumers don't have access to.
[00:32:41] Leon Xu: Yes. It's more like a transition period before we get to a good system. Uh, I think that's what the good RX says. It's, it is a solution to this broken system. It's not a final solution.
[00:32:56] Gus Herwitz: I, I almost think of good RX as a non pharmacy [00:33:00] benefit manager. Or some something like, yes, outside of the PBM system, helping you find what the prices are that you can get.
So you, you can make your purchasing decisions independent from PBMs and insurance. Yes. Okay. Well, this is a, a fascinating, uh, set of, uh, topics and, uh, discussion. Um, any, uh, closing thoughts that you want to, to leave us with?
[00:33:26] Leon Xu: Well, I think pharmaceutical supply chain is very relevant. To people because we, while everyone in our life, at some point, you, either you or your family probably would get sick, and at that moment we probably start to think those issues.
But in fact, the many people who are suffering from medical issues and they really need a better healthcare system and. I [00:34:00] think actively participates on this type topic, like join the Tech Refactory podcast is a great way to learn those topics. Mm-hmm. and trying to use our vault to influence some of those policy uh, decisions.
[00:34:16] Gus Herwitz: Yeah, I think for better and obviously in many ways worse, it, there's a silver lining to a lot of what we've seen over the last, uh, 24 months or so in terms of people understanding these issues and understanding supply chains. They, they matter and the way that we structure our economy and where we place manufacturing capacities and delays that we might put in place, that all matters.
And it's becoming a more visible to more people in a way that I think in the long run hopefully will give us a more resilient economy.
[00:34:49] Leon Xu: Yeah. So this is the best time to be a supply chain professor.
[00:34:53] Gus Herwitz: Yes, indeed it is. Well, uh, Leon, this has been a real pleasure. Uh, thank you for joining us. [00:35:00] And to our listeners, uh, I've been your host, Gus Herwitz.
Thank you as well for joining us on this episode of Tech Refactored. If you want to learn more about what we're doing here at the Nebraska Governance and Technology Center, or just want to submit an idea for a future episode, you can go to our website at ngtc.unl.edu. Or you can follow us on Twitter at UNL underscore NGTC.
If you enjoyed the show, please don't forget to leave us a rating and review wherever you listen to your podcasts. That's a supply chain thing. Our show is produced by Elsbeth Magilton and Lysandra Marquez. And Colin McCarthy created and recorded our theme music. Until next time, you have my accelerated approval.[00:36:00]