So my name is Lisa Blaschka, and I am the chair of the board of the Eden Fellows, and I'm here today with Steve Wheeler, who is an Eden senior fellow and has been with Eden since 1996. He's a Learning Innovations Consultant and former associate professor of learning technologies at Plymouth Institute of Education, where he chaired the Learning Futures Group and led the computing and science education teams. He continues to research into technology-supported learning and distance education, with a special emphasis on pedagogy underlying the use of social media and Web 2-0 technologies. He's also a research interest in mobile learning and cybercultures. He's given numerous, numerous keynotes, both within Eden and outside of Eden, in numerous countries, numerous organizations. He has written over 150 scholarly articles, and if you haven't already, please be sure to check out his blog, Learning with Ease. And he's going to be talking to us about some of the challenges that we face right now in really being face to face, but at a distance. How do we build learning communities online when we're faced with this pandemic, with a global crisis? And so I'm going to hand it over to Steve so that he can start with his presentation. Welcome to everyone, and once again, just to reiterate, please put your questions and answers into the Q&A box, or if you're in YouTube in the chat. Here in Zoom, please do not put your questions in the chat, but put it in the Q&A box. So, Steve, handing it over to you. Thank you, Lisa. Hello, everyone. I hope you can hear me okay. Is that all right? And I hope you can see my slides as well, which I'm going to put up onto the screen for you now. I hope you can see those too. If you can't, then stop me and we'll make sure that the technology works. But it's lovely to be with you all, and it's lovely to see you here from here, virtually wherever it is, from all over the world. And indeed, this is what I would call a global learning community. And I think this is something we're going to have to get used to for a while, if not forever, because I think this is the new normal. And I hope you're feeling safe and that you're keeping healthy and that this seminar will have something for everyone. I'm going to try and take a few risks today. And as I go through these slides, you'll see why I say that is because I'm going to try and dabble in some theories and some ideas, which not everybody finds useful or sometimes people might find them challenging. But the idea behind this is that we are face to face at a distance. And I got the idea, that phrase from an old mentor of mine, a man called Ray Winders, who was my mentor back in the 90s when I first entered into the world of distance education. And I was at Plymouth University at the time as a researcher. And he coined this phrase, face to face, but at a distance. And I thought, well, that's a great idea. Steve, we're not seeing your slides. Could you please share your screen? I'll let you know. Let's just see if I can bring them up onto the screen for you. And so we did test this beforehand. So it does work. Wonderful. Thank you, Steve. You can see it now. I hope that's better. So let me just quote now from this guy here. This guy, Peter Drucker, I'm sure some of you have heard of him. The danger is not so much in the turbulence. It's in thinking in past ways, using yesterday's logic as he says. And I want to hark back to what Alan Tate said in the last seminar, which is where he was talking about the idea of the horseless carriage, what became known as the car, which was built originally on the design of the old horse drawn carriages. And our danger, as he said, is to keep using old logic and to keep thinking in old ways about new problems. We have a huge global emergency right now and we need to start thinking in new ways. And this idea of reverse assumption theory, this guy called Matthew Said, he came up with this book called Rebel Ideas. And then he talks about taking the assumption and reversing what we think about that particular idea. So let's take a taxi firm, for instance. Could we take a taxi firm and say, okay, that taxi firm has no cars whatsoever? Well, of course we can because it's now called Uber. We could do the same with, I don't know, with bed and breakfast, hotels. They've got no rooms and that would be a B&B, of course. And he says the same about education. What if we took education and said, okay, education is not about pushing knowledge anymore, it's about something else. And this is the kind of reverse assumption idea that I kind of quite like because it appeals to the rebellious nature in me and I think all of us have that in us somewhere. All of us have this kind of what we call the positive deviant in us, the idea that we want to do something good but we don't want to do it in the way that everyone is telling us we should. So let's take that idea and run with it, if we can. And let's take the idea of blended learning to start with because that seems to be something that's been around for a long time and everyone accepts blended learning as an exotic mix between being present in the same room and being remote. So face-to-face or at a distance. And it's a kind of a binary. You're either in the same place or you're not using technology to mediate that community of learning. But let's take some other types of blended learning now which may be not considered as blended learning but in fact, when you look at it, they actually are because often we switch between synchronous and asynchronous live and recorded types of education online. And we also switch between teacher-led and student-led. And both of those have a validity but they're different in different contexts. They have different outcomes, different challenges, different contexts around them. And another one is the tethered against the mobile, the kind of the switch between the two. And all of these are considered to be blended learning but if you look on the left-hand side, I would call those very much a traditional mode. You can do those very much without any technology mediation whereas the ones on the right, they are much more progressive. You need the technology then to actually make them happen. So then you become completely reliant on that technology or as I said recently when I was talking to a group of teachers who have had to go onto this online pivot and suddenly become involved in teaching completely at a distance. I said to them, that's okay as long as you realize you're relying on your home Wi-Fi, the bandwidth of your hub and a three-year-old laptop, which is often the case. If that goes, then everyone suddenly becomes blind and deaf, don't they? All of our students are just cut out of the process. So we've got to be careful about what we're talking about when we talk about blended learning. What is our assumption about blended learning? I'm going to move on from there and throw you another idea. This is my old friend Michael Moore, who I've known for many, many years, talks about transactional distance. He talks about the idea that there's a balance between dialogue and structure. If we put too much structure into our online learning experiences, then it drives down the potential for personalized learning. It drives down student autonomy and it drives up this idea of having a psychological gap, what he calls the transactional distance. If, on the other hand, you push structure down and push dialogue up, then the reverse happens. You get less transactional distance. You get less problems for students feeling that they're isolated. And this and ideas behind this, I did some research on this back in the early 2000s on dialogue itself as part of the theory and I realized from my data, and Michael agreed with this, that there are in fact two aspects of dialogue at least. One is social presence. The other one's immediacy and I'm going to explore those with you in a second. Another idea is the idea of student autonomy which Michael himself talked about and there's a third idea about motivation that comes into this and Maslow's a classic case of that. There's another one here, the three types of interaction which more curiously talked about and the fourth one around Carl Rogers idea of student-centered or client-centered learning and each of those I'm going to try and explore as well. But I'm also going to have a look at some neo-Marxist theories to see what we can learn from those as well. So I'm going to throw a lot of ideas at you and hopefully you'll think about how we can reduce the psychological gap and how we can promote the sense of community within our learners as they study online and at a distance, albeit face to face. So social presence. I guess this comes from the work of Short Christian Williams from back in 1976. The idea that there are lots of aspects to this but in effect what we're trying to do here is to create a presence whereby we feel we're together even when we're separated by geographical distance. So to overcome the psychological distance is one thing, to overcome the geographical distance is another. Geographical distance is quite easy to overcome. The psychological distance is harder. That's the premise. And here's another idea which you need to think about as well. So all of these components together are thought to provide what we would call social presence within an online community of learning. And when we talk about immediacy, here's some other ideas for you. This is the Trident Model from David Winter where he talks about the three components of immediacy but ultimately this is all about trying to respond to students quickly and in a timely manner. And I discovered for many years of working online with tutoring for both post-grads and undergrads that the quicker you respond the more the student feels that they're connected with you, the more the student feels that they're connected immediately with the context of what they're learning about. So I made it a rule that I would try to respond to my students within 24 hours if not earlier. On most occasions I would respond within the hour because if they were asking me a question then generally speaking they wanted some kind of support. They were in some kind of trouble. I think it was Patricia Carnwell back in 2000 that talked about the three types of support that students need. There's the academic support, there's the social support and then there's the technical support. And I found that the technical support and the emotional support are often supplied by the students themselves. It's the academic support that they really have a problem with and need help with and that's where you and I as tutors come in. So immediacy and social presence are really important components. And when we talk about this third aspect, the interactive aspect, the idea of I suppose where student autonomy could arise from and also a sense of belonging. The learner and the teacher is one type of interaction but the learner and the content I think is equally important and the teacher is not always there, remember? The teacher is often there in a token effect really through the content and also through learners. Those are the three aspects I think that more identify way back in 1992 in the American Journal of Distance Education but there's a fourth type of interaction which was later identified by people like Leslie Muller in fact and also Mark Wooden Johnson who talked about the device interface which I think is really interesting because increasingly we're doing this increasingly interfacing with screens and with the content through those devices and I think that bears a lot more kind of thought about what is that interaction and there is research being done on this it has been since 1994 I still think we're a long way from understanding exactly what we do when we interact with our space with that space, that personal space between us and our device which is quite fascinating to me as a psychologist I'm going to move on quickly because I've been creating content during this crisis I thought what can I do, I'm not a nurse I'm not a doctor, what can I do to help my teaching colleagues and so I decided to create a whole load of resources through the Zill Learn platform which is completely free loads of other people are doing the same thing and what we've done with those is we've created these standalone very quick micro learning courses which people can do in under an hour and come away with new information and new skills and new knowledge about how they can support learners online how they can identify digital literacies how they can see the significance of things like digital identity and so on within these online communities and that's just a quick heads up to you about some of the stuff that's out there that's free and available for people to support them during this time but let's go off to this Father Christmas-like character here who's got a bit of a Napoleon complex I think as well he's got his hand inside his jacket posing for the camera and Marxist theory I used to turn me off but then I got into it and I thought actually there's some interesting ideas in here especially the Neo-Marxist ideas things like the dialectical view how we transform social aspects of life the kind of the dialectical process which I'm going to talk about in a minute the idea of how we overcome inequality the idea of how we can gain production of the means of knowledge production itself gain control over the means of production of knowledge and the idea also that reality is actually constructed by Marxist the historical materialism theory you've got knowledge and reality being constructed by people and I think that's also fascinating and maybe these ideas can inform us a bit more about how we create better communities of practice so let's explore a few come with me and we'll try and look at some of these so the first one George Wilhelm Friedrich Hegel German realist philosopher who influenced Marxist theory talked about this idea of a process whereby we have an idea and it's challenged by an opposing idea I'm sure you're familiar with this idea but let me expand on it for you the thesis and antithesis combined the process of clarifying, discovering expositing going through criticism, arguing and so on the rhetoric behind that will lead to a synthesis of ideas which leads to another thesis which can also be challenged and so on and so forth all the way down through and through a process of dialect we gradually modify our ideas our opinions, our beliefs, our judgments and so on and I think that's a fascinating idea because that could lead to a form of what we call triadic learning the idea of the triangle effect the thesis antithesis, thesis that's synthesis I've used that for a variety of online modules over the past few years in what I call a challenge-based or ill-structured problem-based learning and I'll give you a quick example of that I had a group of master's students who were studying at a distance with me and instead of shoving content at them which you can do anyway very easily in both face-to-face and online situations and everyone tries to do that when they first start out with it instead of just shoving content at them I gave them some ideas to play with and I set them a scenario which had certain elements present and certain elements missing then they had to solve a problem based around that scenario then once they'd solved the problem and come up with a solution they had to share that solution and then defend their solutions against everyone else's solution and it was interesting because I had primary, secondary and tertiary training people all in the same group together and when you put four different sectors of education together in the same online space and you give them a problem to solve where elements are missing ill-structured problems then they came up with solutions and you can see the vast amount of different ideas that come together and then they can argue why they have merits against someone else's solution that was a very powerful mix of what I call the dialectical process this idea that this idea that you can look at other people's problems and solutions and learn from them even though you haven't thought of it yourself so that is one idea which I thought was quite powerful so Hegelian dialectical process this has a place I think in modern contemporary online learning and another neo-Marxist theorist a guy called Louis Althusser which I'm sure some of you may be familiar with he came up with this idea of interpolation which essentially is where because of the culture that we're immersed within or because of the media that we're exposed to we feel that we are becoming subject to the ideology of it especially when it causes personally and this is a picture of Lord Kitchener here from the First World War he's been trained to try and recruit as many people as possible to send them to battle, young men appealing to their sense of identity and it looks like he's looking straight at you pointing straight at you as well this is a classic example of interpolation and I thought how can this be used also in online learning and so here's an interesting quote here so we can use this in many different ways it's one that's very valid for today of course but one of the things we need to do I think is to make students feel that they are being hailed personally that we're calling them by name almost and there are lots of ways of doing this where I introduced Wikis into education back in 2007 in my own context they've been used for a couple of years Ward Cunningham had created them back in about 2002 but the idea of the Wiki was that it was an online collaborative space and that it could be used to help groups to formulate ideas together and share ideas and create shared documents and so on we use Google Docs a lot now for the same purpose but I guess the idea behind this was that people felt lost when they were inside the Wiki and so the first task I gave them to do was to introduce themselves and to say something about themselves that nobody else knew and to create a space for themselves within which other people could come in and comment and the second thing I got them to do was what I called gold digging which is where they often found a piece of content or a source of material which they thought would be useful for the whole community and then bring it in and share it and say why they thought it was important so this was almost like a form of interpolation like hailing students directly saying this is you this is your identity how are you going to present yourself now and then another kind of Marxist theory it comes from in fact Soviet Russia back in the 1920s and 30s Vygotsky was the counterpoint to the western idea of Piaget's cognitive constructivism and Vygotsky was charged by Stalin so the story goes to actually create his own theory of learning which would involve a kind of a Marxist perspective of the kind of community perspective and he came up with the idea of social constructivism with three zones in it and of course the central zone here is the ZPD as we call it the zone of proximal development and it's always been classically thought of that the zone of proximal development it's actually always has to have a knowledgeable other person involved in it and it's true to a certain extent but I'm also putting it out that we can use digital forms of scaffolding to use Bruno's term the idea that now the teacher doesn't have to be present anymore but the artefacts they've created the artefacts the expert creates can be and then people can learn on their own in almost like a self determined way and they can be digitally scaffolded through those technologies and well of course and there's the idea of Paragogy which Cornelian Danoff came up with recently the idea that in fact peer education is equally important in today's digital economy and ecology it's equally important because everyone knows something but no one knows everything even the teacher doesn't know everything and so therefore everyone can teach everyone and the differential the power differential in the ZPD can be equalised where the expert was up there and the novice was down here everyone is the novice together everyone's an expert together and we can all integrate our ideas together and can share our ideas together and so from that we came up with various theories around self organised learning I'm going to rush through some of these because some of these will be familiar to you and the idea of self organised learning environments I know that Sugata Mitra came up with the term originally but it can be used for other things besides students learning with a computer and a hole in the wall I'm sure he would agree with that and one of the first uses of this I saw in social media there's probably earlier ones but one of the first ones I was involved with was PurposeEd which was a hashtag that was created by a number of people including people like Doug Belchor British scholar and the idea of PurposeEd was that you took the hashtag and you used it to write your own thesis your own kind of thesis on what you thought was the purpose of education then you shared it through your blog or through a Wiki or through an online space and everyone debated this through social media it was a superb project, it went on for months and you saw multiple perspectives then myself and somebody, an American colleague called Amy Boval we came up with various ideas, I came up with the idea of Twisted Pair and we came up with Blimage which is blog image where we sent each other images and challenged each other to write about nothing but the image and what it meant to us in terms of education what kind of thoughts did it evoke and Amy and I started off together and then others joined in Twisted Pair was another challenge where you took two completely disconnected people I don't know people like Donald Trump and Mickey Mouse that's a bad example actually but two disconnected people and you put them together and saw what that would mean in terms of the educational implications and of course we had incredibly incredibly creative blog posts and videos and all sorts were made, this is one where I showed a picture that I'd taken as I was walking along the streets in New York, Manhattan once I bought this bread thrown on the side of the road it had all been stale, it was thrown out on the side of the road and I took a picture of it and I sent it to Amy and said write what you can from that and she wrote a beautiful blog about it and then sent that out somebody else followed with the Blimage hashtag and before long we had something like four or five hundred blog posts from all over the world in something like ten days and each one of them was a very powerful representation of that person's educational philosophy their idea behind what they thought learning meant in terms of that image so it was quite a provocative but also evocative and creative process and it was all done in a sense through the Paragogy idea, the Pyrogogy idea of teaching each other through those technologies no teachers involved whatsoever except ourselves of course and another kind of neo-Marxist perspective and when Gilles Deleuze was in fact a neo-Marxist theorist and him and Philip Gutierre came up with the idea of the rhizome in society and of course that was then taken up by other people such as people like Dave Cormier for instance and myself and others talking about the nomadic nature of knowledge and identity of course and how you can roam around almost like in a flannery way you've heard of flanneryism wandering around through a digital terrain and discovering for yourself what is out there that interests you and going off into all sorts of rabbit holes and coming back out again and learning stuff that you never planned to learn and of course rhizomatic learning there's no hierarchy in it there's no centre to it it expands as it will it's like an underground root structure that grows any which way it wants to and in fact it's a representation of both of our neuronal pathways but also of the pathways that are created in hypertext and hypermedia on the web so this is a classic now example of how we can learn in different ways and take chaos and bring meaning to it bring order to it and from that of course came the idea of massive online open courses I was involved in one of the first ones with Stephen Downs and George Siemens back in around about 2005 I think it was we did one of the first ones and I came in remotely from Ireland at the time when I had about 15 of my students in Ireland with me we were visiting a university at the time and Stephen was moderating from Canada and there were other students around the place all over the place and we all learnt together and the idea behind that the C MOOC at least, the constructivist MOOC was that it was an open flexible and student driven or learner driven mechanism but the X MOOCs took over and of course it became very commercialised now it's nothing more than online learning in most cases I think that's my critique of it anyway it's become too commercialised and the owners of the means of production are now the big multi companies but embedded MOOCs is quite interesting because you can take existing MOOCs and embed them into traditional courses there's a new type of blend that has emerged over recent years I think and I like this idea also that it's not content driven not the C MOOC anyway, the C MOOC is not content driven it's driven by the students and their interests and how they share them with each other how they interact so interaction is becoming increasingly important especially with content and the theory behind this is connectivism and I'm quoting Woodrow Wilson here that was when America had a president and I not only use all the brains that I have but all that I can borrow so Karen Stephenson took this and she said look I store my knowledge of my friends and I like the idea of that because for me it's not so much what you know anymore as where you need to go you need to know to find it so we need to know so much but we also need to connect now to a community of practice as Vanga talks about the idea of connecting with people that know things that you don't know and you can have a knowledge exchange as you need them I'm coming up very quickly to an end now but there's three theories that I've mentioned I mentioned heterogogy is one of the leases involved in this itself I've talked with Stuart and Lisa about this and heterogogy the idea of self-determining I think is going to be increasingly important there's a great book that's out on it which Lisa co-edited which is on my bookshelf behind me here you can't see it but it's up there and I've thumbed through it a lot so those three theories I think combined are going to be really important in the future crowdsourcing or learning building a personal learning network these are going to be important, more important than ever in this time and finally the idea of the wisdom of the crowd it's not so much the individuals in the crowd, they get smarter because of the whole network, the amplification and the kind of the the connections that are made that's what makes the crowd get smarter that's just a few ideas for you to kind of get your ideas going and get some discussion going maybe and I hope that's being useful too I hope you've found that illuminating or challenging in some way and I think we'll stop there and maybe do some discussion shall we Lisa is that 30 minutes perfect Steve you were right in time that was great we've got a number of questions in the chat box and also coming in over YouTube I'll start with this first one from Andrew Jacobs he asked a couple of questions the first one is Uber is unprofitable and relies on private funding to remain afloat is profit now a reversed assumption so that's a question you might want to consider the other is what is the relationship between teacher and content is it more distance now with the technology moving at pace thank you Andrew we'll drink for that one perhaps when we get back together again next in London I'm glad you're there Andrew comes from an L&D background so obviously he's talking about return on investment because that's what they all talk about in L&D learning and development yeah I think Uber was an interesting experiment I don't think it's over yet Airbnb is more successful I think that what we're doing really is disruptive elements and I think some disruption works better than others some disruption is deeper than other disruption some disruption works off we've had discussions for a long time about this Andrew and I and some disruption is impossible to achieve it just becomes disruptive destructive but I think from all disruption we can find some kind of positivity and the question about the information sorry the interaction between teacher and content learner and content really is the interaction because teacher and content I see is very similar things because the teacher creates the content in the traditional method I think what we're seeing is a shift and it's been happening since the Read-Write Web or the Web 2 began I think we can probably trace that back to about 2001 when we began to see the ability to write the Web as well as read from it and it became more participative and I think that content is now being generated by learners just as much as it is by experts we witnessed this in one of the largest rhizomatic structures in the world called Wikipedia and Wikipedia as well and various other OER kind of environments as well there's been a lot of content that is being repurposed and revisited combined and synthesized and I think it's an exciting time in fact I was even involved in a project on this a European funded project way back about 10 years ago looking at the benefits of user generated content in higher education and that was a fun project to be involved in because we discovered an awful lot about the usage and the challenges of user generated content so I think the learner and the content is going to be much more important as an interaction in the future okay now we've got a couple of questions related to devices one of them comes from Pankajkana and I apologize if I don't pronounce that correctly where the question is presently students are confused with too many devices there will be connect, google meet one lecture is on one device and another is on another device what's the solution for this confusion and then a related question from Adia Dube while the learner is at center what's the interaction of teacher device and content so maybe you could speak to that relationship and how can we ease into that relationship or alleviate the stressors I think it's an interesting question because often teachers like me and like you and people of I suppose older generations who have been teaching for a long time we worry about how our students are going to cope with the technology and I know that there are kind of ideas around that we have digital natives and so on I don't subscribe to that idea but what I do subscribe to is the idea that younger students choose their devices themselves we don't choose them for them, they choose them themselves and they have a vested interest in becoming familiar with those technologies in fact they become intimately familiar with them and they use them without thinking they become an extension if you like of the human body they become an extension of their memory they become a kind of a way to amplify their skills and their knowledge and I think we worry too much about how students are going to cope with the technology what we should be more concerned about is creating environments within which those technologies can be used to expose the knowledge and to motivate them to gain more knowledge and I suppose to prompt them to connect with that knowledge in different ways so I don't think we ought to worry so much about them being confused what we should be worried about is getting them to interact and to persist in that interaction and engagement this question is also coming through on zoom and it's from who's asking how can we minimize the problem of impersonalization in virtual education yeah one size fits all doesn't it which is a lie always has been it's a lie that the education system perpetuated upon it for years mainly because of the need from governments to push content and to assess to the nth degree so that everyone's tested to know whether they've learnt something or not whether the money the government's putting into you know sound like an old Marxist don't I but the idea behind this I think is that we've got to move away from this thing about you know content content content we've got to I think push the idea that one size does not fit all we've got to win hearts and minds on this and say look you know everyone's different we talk in schools about differentiation we've got 30 children in the class they're all different some of them have special needs some of them are brighter than others how can we differentiate so you have to write something like five or six lesson plans don't you we're at lesson time with five or six variations in it with five or six different types of resources well actually what we should be doing is 30 different types of resources but that's impractical it's difficult to do so how do we get over this problem but there are no easy solutions but what we do have to do is allow children to create their own and students of all types and all ages to create their own pathways to create their own desire lines if you like and to personalize their learning and the only way you're going to do that is by using more and more personal devices so that the curriculum remains but within that there's an incredible amount of variation flexibility agility so that you know everyone can play their own furrow and go in their own direction without being penalized and that is a new mindset that's a reverse assumption that's what I meant when I started off with you know education should not be about pushing knowledge anymore it should be about other things okay our next question is from Sandy Barker who asks should we worry about the students that do not want to be involved in the class or in the community and our passive learners or I think what Michael Bowden called witness learners yeah this is an interesting one because we call them lurkers in some online environment I would say lurk in the background you think why aren't they getting involved and there's two ways to look at it either you can panic and say oh they're not they're not learning anything and they're not being involved they're not engaging, they're not participating or you can look at it from Leven Banger's perspective and say look they are legitimate peripheral participants they're sitting around the edge but they're gradually going to be drawn in now the trick there is to actually draw them in gradually to give them incentive to get them into the core and not remain on the peripheral forever I think it is legitimate I agree with Leven Banger there's a legitimate idea behind peripheral participation but we can actually move closer as people become more engaged and the only way you're going to get people engaged is to give them as a personal incentive back to the last question really and the personal incentive will involve us interpolating them and hailing them and say look you can do this you can be a part of this the way I used to do it with my face-to-face students will say to them look what I'm going to do here is I'm going to speak for a little while I'm going to show you some slides or a video and at the end of it I'm going to come to one of you in the room and you're going to ask me a pertinent question and you won't know who I'm going to come to so in effect it's almost like a compelling version of participation where they're almost forced to be there but to actually to listen hard and to have a question ready it does actively engage people a lot more but there's lots of ways of doing it I'm sure you can think of other possibilities another question from Romina Katia and this question is a major challenge at the moment especially for teachers and I know we've experienced this as well I also translated to students keeping up with the curriculum this limits the possibility of allowing students to learn on their own and to find their own path of learning this period could be a window of opportunity in personalized learning and in finding and in helping students find their own pathway how do we create a balance we need to we need to be operating at the level of government really I think that's the only solution it's a top-down approach to this there's only so much grass root stuff that can go on before you hit a brick wall and then the rhizomatic root doesn't it you can't go any further so we need to be representing ourselves at government level or at least department of education level to say look this cannot go on here's an opportunity now this crisis has created huge destruction huge grief and horror across the world let's try and take an opportunity here to take this disruptive aspect of our lives and turn it into something creative to stop doing things the way we've always done them they say the first sign of madness is doing the same thing over and over and expecting different results go back to Peter Drucker's comment earlier on that I quoted for you the idea that the turbulence is not the problem it's how we respond to it the problem and if we keep responding in the same way stuffing our curriculum with stuff that you know is there just in case rather than having the just for just in time and just for me just enough type of curriculum then we are going to go back to the same problems we've had before and it's time for a change this is another question that I think is related to the question that you just had what do you think or how do you think the post-coronavirus will change our attitude with risk management and education and do you think we're ready for new paradigms and can we overcome old dogmas in education this is Coke by the way it's Coke Zero I'm mitigating the risk that's the problem you see there's always a risk in education just like every other profession is always a risk you cannot minimise the risk somebody could come in and beat me up in the classroom it's never happened but it could happen we hear of shootings in classrooms in various parts of the world mainly America but recently other parts of the world and these are horrific things how are we going to mitigate against something that's invisible an invisible virus well we can't but we can there are certain ways that we can do it I'm in the risk category I've been locked down for what is it now 53 days 53 days inside four times with my wife to get shopping and that's it in that time and I have an underlying health condition and I said to my colleagues at the university I teach at now how are we going to manage this when the students come back in September and they said well the only way we're going to be able to do this is technically because there's several of us have underlying health risks and we cannot do until there's a vaccine or until we manage to solve this problem with a cocktail of drugs medicines that will stop us from dying in huge numbers there's no way that we're going to be able to go back to a face-to-face situation so it's going to have to be face-to-face at a distance for many people in the future I think that's the only way at the moment that we're going to be able to minimise the risk and to keep learning going. Learning doesn't stop even in war time learning doesn't stop but what we've got to do is create new pedagogies that actually produce exactly the same or better outcomes than we've got at the moment and like I said before this is a huge opportunity to make the sea change. Okay the next question is from Dr.P.B. Radhika how do we enhance meaningful interaction in MOOCs and how can we supplement instructor's teaching? So same as how can we create meaningful interaction in a face-to-face traditional teaching environment you make sure it's interesting you have to motivate the students to achieve but you also have to connect with their interest and somebody asked me yesterday what are the three key characteristics of a great teacher and I said well knowledge empathy and passion if you haven't got passion for your subject why are you teaching empathy and knowledge are important but passion is I think the top of the pyramid you know without that passion why are you there and I think we've got to be passionate educators we've got to constantly think creatively and think outside the box think about new ways of engaging students like some of the ways I showed you the evaluations from the students on those courses that I produced were tremendous and you know the outcomes were incredible and people were saying how are you doing this basically all I was doing was providing them with challenges which interested them I was giving them the personalized routes to actually creating their own solutions to problems which they were then able to argue about and defend in an online shared environment and that was all they needed they had to go off then and take pride in what they were doing and grab the knowledge from wherever they wanted to find it to actually marshal their arguments and create the best possible solution so that ill-structured problem-based solving learning was a very powerful method that's one way of doing it there are loads of other ways of engaging students at various levels this question is from Ruizan Mekwabitze I'm really getting in my practice here pronouncing names in different languages and it's related to what you just said but it's more along the lines of what kinds of platforms are the best to use for creating these kinds of communities in an online environment one of the things that you mentioned is the technical and emotional support that students can provide each other for example you use the example of Paragogy we should be as instructors providing academic supports how can we use different platforms for different purposes to realize those communities well there's the key what you just said there how can we use different platforms for different purposes it's about different contexts so for instance in the past I've used wikis to actually get people to work together when they're separated to create online shared spaces to collaborate with I've used other platforms like VLEs or LMSs to actually get people to work together on problems and to submit their work and so on I've used shared blogs I had a research group I had a group of students who were doing a research project they were all having to produce their own research study on common problems how do you understand methodology what does epistemology mean how is it different to ontology all these big questions I created a shared blog on which they would once a week write a progress report and then comment on each other's progress reports and offer support and that had a number of different purposes one was so that they could constantly keep themselves motivated to write and to study and the other purpose was to actually show their progress to me and to each other and the third was to actually provide support for each other fourthly I could monitor what they were doing and say okay I ended being when I need to but normally I would just step back out of the way and let them discuss for themselves what they needed to do and they gained ownership of their learning over that a lot more than if I imposed upon them something else and my current students have a lot of WhatsApp spaces and they always do too they do one for me and one for themselves one with me present and one with me not present so they can have a moan about me if they want to and I think again that gives them ownership so in the end I think you'll find that students will set up their own Facebook pages, WhatsApp groups and so on to actually support themselves I think you don't make the assumption that's going to happen but often it does okay there's a question from YouTube from Francesca Neville should we pay more attention to engagement to lay the path to acquire skills rather than worry about content that's a really tough question because I think content and the actual idea of knowledge itself and skills both can derive from content so you can separate them out or you can combine them so knowledge and skills two different things they have a common baseline there and you try and separate the two and they'll fall over so I think both are important but I think you mentioned engagement as the route through to skills development it probably is because you need to engage with ideas, you need to engage with devices technology, with content with people to actually learn things which you wouldn't learn through just flat content as I call it I think it's a fine balance that you have to achieve there, it's a form of blended which you need to pursue where you have a fine balance of content and activities experiences that together provide the student with what they need to go away and practice professionally I can't say any, it's much more complicated than that, it's much more complex but it's about a balance between activities, content and interaction between those This question is a bit related to that Steve, is there a need for more project based learning in this age of advanced online learning and development and that's from Pat Always more room for project based learning always because for me it's it's so wide reaching, it's so far reaching when it gets involved in a project they have to think in so many different ways, back in the day, back around about when was it, 1985-86 I was training nurses and one of the things I'd advise for them to do which seemed totally unrelated to what they were learning at the time was to go out in a small group of maybe three or four students with a video camera and go and film a three minute video with some aspect of their nursing experience and so they would go out all day and they would record it and come back and then edit it and then they'd present it that afternoon as the last session to the rest of the group 30 students in the group maybe I don't know about 7 groups, 8 groups and each of them came up with a different video and my colleagues were saying to me Steve, what's the purpose of this? Why are they doing a project based on video they're nurses not video technicians and I had to defend that and I did show them that actually there was something like 14 major skills that they would learn by going and doing that there was teamwork there was negotiation of meaning there was technical aspects there was decision making there was problem solving and a whole range of these skills and it turned out that every single one of them was applicable to nursing and they went wow! How did you think of that? I said well you did just stand back away from it a bit and then look at it and think what are we really trying to get these people to learn? Is it content? Yeah but there's more to it than that. Okay I'm going to ask you two more questions because we're coming close to the top of the hour the first question is kind of a mix of different questions that have been coming across through the chat and through the question and answer and that's along the lines of you know how do we within these communities address issues where there's intercultural issues that arise or ethical issues that could arise or language issues how do we create I guess a democracy within these communities when these kinds of issues arise? That's a huge question Sorry In fact there's three different questions aren't they really? I think the answer is that if the students own, they have ownership of the program they're studying if they take pride in and they kind of appreciate the privilege that they're having by being there because it's a privilege to learn with other people isn't it really? Let's face it it's a human right but it's also a privilege to belong Maslow talks about belonging there's so many different ways of looking at belonging and it's a privilege to belong it's a really important thing so if they can take pride in that then they will treat each other with empathy and with equity if they don't then something's wrong I think I've had only one or two occasions where I've had groups of students who have treated each other badly and those have usually been because of underlying relationship problems that existed before they came into the classroom or before they came into the virtual space and I think you have to kind of deal with that very sensitively it could be a cultural thing, it could be an ethnic thing, it could be a language thing there are lots of ways that transactional distance can be amplified and that's the whole point of understanding the idea of that psychological gap is that there are lots of ways that can cause that to happen but there are also things that can cause it to reduce and one of the most important ones is making more sense is dialogue constant dialogue, constantly talking the minute you stop talking you might as well give up yeah the last question is a bit provocative but that's from Alfredo Suero Alfredo Suero and he asked can you explain why the Marxist theories in education did not succeed in the Soviet Union ha ha ha ha we know Alfredo don't we that it was suppressed, I mean Vygotsky was suppressed in the west until probably about 76, 78 and then you started to see things like Mind & Society coming out but I think that I can't speak for the Soviet system because I don't know much about it but I know that certain ideas like social constructivism are rife in western education simply because it's intuitive and we can see why it's important that we have social dimensions to learning I'm not sure why it's failed in the Soviet in the former Soviet countries I don't know, I mean Diana the former Soviet country Soviet satellite state of Romania as it was I don't know whether it works there or not I think the answer to that Alfredo actually we're all social beings and you can never knock the social out of us look at what we're doing now we're all stuck in our own rooms in our own houses but we're still connecting with each other and we're still learning from each other we're still being very very social we're still face to face even though we're at a distance hasn't answered the question I know but we'll have to talk about that when I see you again Alfredo okay well we're coming up to the end Steve thank you so much for taking the time to be with us today and to share your thoughts about the different theories the different approaches for creating communities online and I would just like to maybe put up the slide for the conference that we have coming up in June the Eden conference the annual conference which was planned for Tima Soara in Romania unfortunately we will not be able to hold that face to face however we will be having an online conference and so we encourage everyone to submit submit their papers and their proposals the deadline has been extended until the end of May so if you are working on a paper or have some ideas that you'd like to share for the conference please be sure to submit that you can find more information on the Eden page and I would also like to invite all of you to come and visit us next week for our webinar the next one in this series which is how to manage the onslaught of information and fake news and our speakers will be Francesca Amanduni and Irvin Katz and the moderator will be Antonella Poch and until then I wish you all a very safe and healthy time ahead thank you for coming today we appreciate it


Okay, this one says identify the Lewis acids and bases in the following reaction. So remember Lewis acids are often different than Bronsted-Lowry acids, okay? So Lewis acids will have an empty orbital where lone pair electrons are being donated into. So if we think about these two particles making this particle here, okay, this molecule or this ion, sorry, has no electrons, right? But it's got an empty 1s orbital. This ion here of course has electrons and it's around its oxygen, in fact that negative charge is formally put on that oxygen. If you want to think about putting your electrons around it, putting the charge where it's supposed to be, what's going to happen is these electrons are going to donate into that 1s orbital there. Okay, so when that happens we make this molecule water, okay, and we want to identify which one of these particles is the Lewis acid and Lewis base. Well, remember the Lewis base has the electrons and the Lewis acid doesn't, so this would be the Lewis base and this would be the Lewis acid. Do you have any questions on that one? Pretty straight forward, okay.


And to the reporters on this call, thank you for your work to report on this critical issue of prescription drug pricing. There's obviously a lot to talk about and we're really pleased that you came to join us today. I'm Jen Taylor. I'm the Senior Director of Federal Relations at Families USA. It is my honor to kick us off. As we all know, last week, the Biden administration announced the first 10 drugs that the Secretary of HHS will negotiate for, for fair prices as part of the new Medicare negotiation authority provided under the Inflation Reduction Act. These drugs are gonna be the very first drugs that Medicare has ever had the authority to negotiate for. So this is a monumental step towards lowering drug costs, certainly for the millions of older adults and people with disabilities that rely on Medicare and hopefully really taking us in a new direction for the entire country and achieving affordable prescription drug pricing. These are drugs that we're gonna be talking about today that so many of us and our families and friends rely upon to treat chronic conditions. They cost people who rely on Medicare thousands upon thousands of dollars for just routine treatment. Among these drugs are blood thinners, diabetes medication, treatments for heart failure, cancer drugs, taken all together. These drugs cost the Medicare program $50 billion over the last year, representing 20% of total part D drug spending over that time. So perhaps it's not surprising then that we see that seven drug companies, the US Chamber of Commerce and the National Infusion Center Association have all filed suits against Medicare negotiation in order to protect these profits. But as it's so clear that drug pricing negotiation is gonna have tangible, meaningful benefits both for the Medicare program writ large and most importantly for the millions of people who rely on Medicare for their prescription drugs. We have to also be clear that any company seeking to upends negotiation is seeking to protect their profits at the expense of people who rely on these medications for their health and their livelihoods. So you didn't come here today to hear from me. We've got three incredible advocates for prescription drug pricing reform who can speak from their different perspectives on the critical importance of this new step of Medicare negotiation and what's at stake in getting this right. So first up is a man who perhaps needs no introduction but I'm giving him one anyways. Senator Pater Welch from the great state of Vermont is elected to serve in the US Senate in 2022. And so while he may be a relatively new member of the upper chamber, he's certainly not new to Congress or to work on prescription drug pricing as a longtime member of the House of Representatives and a senior member of the House Committee on Energy and Commerce, he's been at the table for the better part of two decades on federal drug pricing reform work. He was a champion of the IRA when he voted for it in the House of Representatives. And now in the Senate, while he's accomplished much he's still not resting on his laurels. He's introduced the Strengthing Medicare and Reducing Taxpayer or SMART Prices Act which would build on the success of the IRA and give HHS enhanced authority to negotiate for drug prices in Part D. So we are beyond honored and thrilled to spend this time with you today. Sir, I know you have votes so we're gonna kick it over to you. Appreciate you making it all work. And with that, I turn it over to the Senator from Vermont. Thank you very much and I wanna thank Family to USA. I wanna thank my partners in crime, Sarah to Sylvie and David Mitchell and Bailey you're there. I really appreciate, it's a big day. But here's the question, okay? What is more important to any country than to have a healthcare system that takes care affordably of the healthcare needs of its citizens? That's the question. That's much more important than the particulars of what a procedure cost or who does it or whether it's private, whether it's public. It's about a country coming together to do its best to have a healthcare system that delivers affordable and accessible care. And that is to every citizen, whether they're poor or rich, whether they have a job where the employer provides healthcare or it doesn't. That's the ongoing challenge. What has happened, of course, in healthcare is that medications have become more and more important in the treatment, in the pain relief for our citizens. And we have a situation here that's unique to America where the pharmaceutical companies who do good things. So all of us here, either personally or a loved one has had the benefit of pharmaceuticals that have extended life for relief pain. But what is happening where this country is unique in that it's the only country where the government that is to represent the objective of affordable and accessible healthcare stands on the sidelines and seeds to the pharmaceutical companies, total pricing power. And of course it starts out with the patent where by law the inventor of the medication can charge whatever they want. And none of us here oppose that. That's to protect the incentive. But what has happened is that our drug companies have essentially abused the patent system. And then when there was the passage of the Medicare Part D, stopped the government on behalf of people from doing what every other government does. When it buys wholesale, it wants to pay wholesale. We're the only government where we buy wholesale and we have to pay retail. I mean, it's really that simple. So why is it if you ask a person that embryo, just as an example, if you need it in the US, it costs $5,000, right? We're right, Sarah, you and I, we're right on the Canadian border. We cross the line, we pay $1,000 in Canada. And why is that? It's because the US essentially says to the pharma companies charge what you want, we'll pay it at the expense of taxpayers, at the expense of our employers who want their employees to have access to healthcare but are constantly dealing with these premium increases that then mean lower pay increases for people who need to pay the bills. And it doesn't have to be that way. Now, the Medicaid price negotiation essentially brings us the United States of America through the Medicare program into the same situation that the Pentagon's in and that every other country is in. If you're buying huge quantities, whether it's aspirin or emerald, you get to negotiate a bulk price discount. It's as simple as that.  And what's heartbreaking to me about that, we all have our stories of people who are in these horrible situations. And it's always more severe when it's not about you, it's about your child, it's about your partner where they need this and it's right within reach, but they literally can't afford it. And they start cutting the pills in half, they start missing, taking the doses. That is a result of public policy. It's not necessary. But the reason I'm so upbeat about this is that this law more than anything else recognizes that the government that is for the people has an obligation to stand up and defend when there's been really an abuse, in this case of the patent system. We've got to make healthcare accessible, that means it has to be affordable. Now, the big pushback from pharma, it's the standard one, this'll decrease innovation and the logic that they have is that let us charge whatever we want, no matter how much it bankrupts an employer or government, because we won't innovate unless we can rip you off. That's literally what it comes down to. But you know what? It doesn't have to be that way. Why is it that we pay 5,000 and in Canada it's 1,000 for that drug, Emeril? So the business model of pharma is to just stick it to American taxpayers and American consumers and the American medical system. You know what? Even out, let the folks share the cost of the research and development. So this is significant because we do have to bring the cost down in service of making healthcare affordable to every single person. And we're seeing the big pushback and if our pharma executive making $20 million a year and the delivery of the shareholders, I'd probably be a little bit nervous too because now I'm actually gonna have to earn my salary, but earn it by actually coming up with innovation, having to find a business model that doesn't stick it to American taxpayers and consumers and folks who are in desperate need of healthcare. So this is very affirming because I see this is fundamentally about making healthcare affordable. And in no way do I see this as a threat to innovation. So it's been a long and tough battle and the effort goes on. There's a lot of litigation. And basically the litigation premise is that we should be, it's uninstitutional for us to have to negotiate the price. And I think they're gonna lose the litigation. And I think as people start seeing the benefits of this is gonna be embedded. And I hope we can deal with this and addressing other cost issues in healthcare to make it more accessible and affordable. So thank you all very much for your leadership and the fight continues. It does indeed. And we are very, very lucky to be able to have you as a champion and a partner in that fight. So thank you, Senator for joining us today. I know you're gonna try to stick around for some questions if you don't get pulled away to vote. So with that, I'm gonna kick over to Sarah to Sylvie. Thank you again for joining us, literally during your clinic hours up in Vermont. So I will keep this brief. Sarah is a Vermont based nurse practitioner working at Georgia Health Center for the last decade. She practices full-factor rural family practice, pediatrics to geriatrics, taking care of many four generation families. She went back to school to get her doctorate in health systems leadership and quality and loves taking care of patients and working to take care of patients better. I think we all can agree we would love to have a provider just like you. When she is not at the health center, she leads a national collective charged with developing language and data standards to address social determinants of health. So she is well versed both in the day-to-day impacts of what we're talking about today and what it looks like from a policy perspective. So Sarah, with that, I give you the floor. Thank you so much. First off, I wanna say I'm just grateful to be here speaking on this very, very important topic. It's one of those that's mission-driven for me. So if there's ever an opportunity to speak to it, you know, I'll be there. I'm gonna build off of Senator Welch who's speaking of and lean into a topic that I think is very near and dear when it comes to this area is called moral distress. There's this term that we have in healthcare, which is when you know the right thing to do, the ethical thing to do, but you're constrained from doing it. And it's such a crucial concern that we name it and talk about it. And there's very clear applications of that feeling of moral distress when it comes to the conversations that we have to have on a regular basis with patients who have Medicare coverage regarding the difference between what we know we should be doing for them, the medications that they should be on, and the medications that they can afford. The list, this first, which I hope a first of many medications that are on this list for negotiations are the best in class recommended medications for some of the highest risk concerns that I see on a daily basis. My patients with heart failure, my patients with diabetes, my patients with different kinds of inflammatory arthritis disease. And each of these medications has a very clear space on the guidelines for what I am supposed to do for you. But I sit with patients every day and I say, I know we're supposed to give you this medication. I tried, it's too expensive for you. So what do we do next? Even simple insulin is on this list as well. So I just wanna hold that up that what we're really talking about is like an ethical problem that is not necessary, right? In order to address that, it's very simple. Do we just need to be able to negotiate on these and many more medications to come because this is what we should be doing for patients. It's what the evidence says we should be doing. These are the patients that we're trying to keep well and living their lives and out of the hospital, but simply we cannot afford to do it. And that's an ethical problem. And I think that's really the heart of it for me. I can go on and on about different patient stories, but that's what comes down to and it just needs to be addressed and we need to stop and just do better and be more like other countries as we focus on this approach. Thank you so much, Sarah. And they may just have some questions for you when it comes to patient stories in just a moment. So before we get to questions, I do want to introduce last, but certainly not least, David Mitchell who has joined us today in his role both as president and founder of Patients for Affordable Drugs, which we may all know him speaking from, but also as a patient. And I think that's why David is such an extraordinary champion for affordable drugs. As you probably know, Patients for Affordable Drugs is the only national patient advocacy organization exclusively focused on lowering prescription drug pricing. They have a very clear vision, which is just simply that every person in the United States can get the prescription drugs they need at prices they can afford. Again, he's been an extraordinary champion for affordable drug pricing as an expert with more than 40 years of experience working on healthcare and public health, but also as a patient with an incurable, but treatable form of blood cancer and depending himself on drugs costing hundreds of thousands of dollars a year for his survival. So I'm not sure there's anyone who could speak to this issue more passionately and eloquently than David and we really appreciate you being here today. Well, thank you very much for having me and Sarah. It's a pleasure to hear from you. Senator Walsh, good to see you and always good to hear you lay things out so clearly and so powerfully. And thanks to FamiliesUSA for pulling this together. You know, the drug provisions in the Inflation Reduction Act are historic. Over time, they're gonna save money for millions of Americans by allowing Medicare to negotiate directly on prices by curbing annual price increases by holding the line on premiums. And finally, finally putting in place an annual out-of-pocket cap in Medicare Part D. As the Congressional Budget Office points out, the reforms are going to improve both the financial wellbeing and the health of people, more of whom are going to be able to afford to buy and take the drugs they need. As to negotiation specifically, it's really important to know the history. Back in 2003, when the Medicare prescription drug benefit was enacted into law, Big Pharma bought a sweetheart deal. The chairman of a key committee, Billy Towson, inserted into the bill a prohibition on Medicare negotiating directly with drug companies for lower prices. Now, shortly thereafter, Towson left Congress and went to work for the Powerful Industry Trade Association pharma for a salary of $2 million a year. Now, for almost 20 years after that, pharma fought successfully to keep that sweetheart deal. Drug companies could dictate a price and the American government could not negotiate directly for a better deal. Now, that changed last year with the passage of the Inflation Reduction Act. But of course, the drug corporations and their trade associations are not having it. They filed nine lawsuits. Apparently one was withdrawn today. So maybe there are eight, there could still be nine to block the new law and to thwart the will of the American people, more than 80% of whom support Medicare negotiation. Now, the fact is Medicare sets prices for everything else it pays for in healthcare. Doctors, hospitals, tests, but pharma says no, they won't even negotiate. Pharma says it has to have the power to set prices for the brand name drugs we buy. Now, as a patient with, as was pointed out in curable blood cancer, whose drugs carry a list price of almost $1 million a year, the four cancer drugs I have to take, I can tell you it's wrong. Just one of my cancer drugs, an oral drug under Part D called Pomelus, costs about $1,000 per capsule, but it costs less than a dollar a capsule to make. And I have to pay my out-of-pocket currently based on that $1,000 per capsule price. And that list price means I'm paying more than $17,000 per year out-of-pocket for that one drug. Eloquous, a blood thinner I have to take, that maybe one of the first drugs is going to be one of the first drugs negotiated as a list price of almost $7,000 in the U.S. Because it's maker, Bristol Myers Squibb has blocked competition. In Canada, where there's a generic, the price is less than $1,700. Now, the drug companies also claim, as the senator pointed out, that negotiation leading to lower price going to kill innovation and new drug development. But this is a red herring that just doesn't hold up. In fact, the new drug law is going to spur innovation because drug companies won't be able to generate huge profits by extending monopolies and raising prices at will on old drugs that we're going to negotiate over. They're going to need to innovate. What's more, the negotiating process under law requires that Medicare gives central weight to the clinical value of the drug, whether it represents a therapeutic advancement and the extent to which it meets an unmet need. In other words, drug companies are going to get higher prices for high quality innovative drugs. The law maintains the incentives for innovation that already exist in the U.S. by allowing drug makers to be rewarded for investment and risk by setting their launch prices and maintaining that FDA awarded period of exclusivity, exempting all medications from negotiated prices for a nine to 13 year period. So we can't let the drug companies overcome the will of the American people and restore their sweetheart deal. We're supporting the legal fight against Big Pharma. We've always already signed on to one amicus brief opposing a preliminary injunction in Ohio to stop implementation of the law. And we are going to keep working, doing everything we can to make sure the courts understand how patients are going to be harmed if the law is delayed or overturned. Thank you so much. Thank you to all three of you for your comments today. I'm going to open it up to any questions that folks in the call may have for either the Senator, Sarah or David. We do have a question in the chat. Since Kennedy, Warnock and Collins should be insulin bells don't address the high list prices and only Bush Sanders bill insulin act for all of 2023 addresses the high list prices. Do you think provisions from the Bush Sanders bill should be included in the insulin bill that might be included in a Senate drug price and package since it addresses the root of the problem? Or do you think it will be difficult to include the provisions of the Bush Sanders bill? Sarah, I'm going to say you don't have to answer that question. That's probably not going to kick it straight to you. I don't know Senator Welch if you had a position on the bill from your colleagues or David if patients for affordable drugs has a position on that issue. Sorry, the long question. So we can also repeat it if that's helpful. It would be helpful to repeat it. Bailey, you're breaking up a little bit. Apologies, and I can also talk a little slower. Is that better? Yeah. Great. So essentially the Kennedy, Warnock and Collins, Shaheen insulin bills don't directly address high list prices, whereas the Bush Sanders bill insulin for all act of 2023 does address list prices. Do you think that provisions from the Bush Sanders bill that addresses list prices should be included in any insulin bill that could be included in the Senate drug pricing package? But not just capping out of pocket for insulin, but also addressing insulin list price, the crux of the question. We're firm believers that we really should be trying to do both, that you can't really lower out of pocket without lowering price. Otherwise patients just wind up paying in other ways with higher premiums. They get less money in their paycheck if they're getting their healthcare from their employer. So we believe that lowering out of pocket needs to be coupled with lower prices. However, things happen in steps. And we took a huge step last year in winning the drug pricing provisions in the Inflation Reduction Act. And we will begin to negotiate now 10 drugs to begin with then 15 and 15, 20 and 20 in the ensuing years. So we need to always remember that we have to reach for what is the best we can achieve. And if it isn't one bill exactly the way it was written or another bill the exactly exactly the way it's written, that's not nearly as important is making sure we get the best possible result that we can achieve that will help the greatest number of people. Thank you so much, Bailey. Do we have any other questions in the chat? At this time, there are not any questions in the chat. If folks want to feel free to use the Q and A chat or the regular chat to submit questions I can read them aloud. In the interim, I know we did have a question for the Senator, some reflections on the moment we're in. Bailey, do you want to go ahead and ask? Yes, thank you. We did get a question for the Senator which is given this moment, sorry, let me pull it up real quick. All right, given this moment, what does it mean to see the law that you fought to pass in the house go into effect with the announcement of the first 10 drugs? There's two things. One, it's been like a 20 year battle and it's about addressing affordability issues. And we've got those across the economy that really affect working families but there's nothing more poignant than when you can't afford the medication your child needs or your partner needs. So the fact that we've got government standing up for fairness and affordability is really a thrill. Second, not a moment to lose. We've got to keep at it. The fight never stops. The challenges that we face to make healthcare affordable, those are going to continue. So I feel good, but I don't feel, I feel good, but nervous. We've got to keep at it. 100%. As we give just another moment or two for questions in the chat, Sarah, I am coming to you now. You didn't have to answer the wonky legislative question but I am going to come to you for that personal touch that you talked about. I know you've seen a lot of stories in terms of firsthand impacting your patients. Is there anything you'd want to lift up today that you really want people to sort of keep in mind as we move forward in how we're working on this? I guess the thing I want to stress is that in our work and taking care of people, we think about negotiable things like and things that are must haves, right? And so for patients that live on the margin and many and most of my patients in rural Vermont live on the margin, they have a small social security allotment, they have a fixed price rental, they're getting by as best they can. These prices affect everything, right? So if they choose to go forward in the medication that's required and they're paying extensive out-of-pocket, it becomes like the gas they can't buy or the foods they can't afford to eat that drives the diabetes that is uncontrolled or the heart failure admission that we could have prevented, right? There is not like in the lives of many of the people that will be most drastically affected by the reduction in prices out-of-pocket and negotiations, everything's interconnected. It's housing, it's food and the medications are things that if they can't afford them, if they actually make the choice to go forward and they're paying those prices, they're living on the margin with everything else, right? That they're scrimping and saving, they're not doing things that they should be doing in other areas because they're making this the thing that they do and we have to solve all of that for them, right? So solving the price problem is solving like a general wellness problem that shouldn't be there in the first place. Looks like we didn't get any more questions in the chat. Anybody else have last comments they wanted to leave folks on the call with David or Senator Welch, if there's anything else you wanted to leave us with? No, I just want to take a second to thank Senator Welch for his leadership and the fight goes on. And this is not a man who rests on his florals. So we're really glad he's there. Thank you, Senator. Well, you're kind of do that, but it's really, really hard. Sarah, you have patients that come in and you see the anxiety that they have and the shame they have if they can't afford something, there's no way they can afford because they regard it as their obligation to take care of the person they love, no matter what. And it's like you've seen people if they can get a second mortgage, they'll do it. If they can go into the retirement, they'll do it. But do we really want to be a society where we impose that anxiety and uncertainty on people when we really don't have to? So this is a righteous cause for a healthcare system that's affordable and accessible. And we can have it with the innovators and the creative efforts to create new viewers. We can continue to support that and maintain our position of doing that, but it's got to be affordable. I think that was part of the reason. Thank you all so much for joining us. You're extraordinary advocates and really extraordinary humans. And I appreciate both the thoughtfulness and the human compassion and empathy that you approach this work, all three of you. So thank you so much for the time today and to all the reporters who joined. I know this is a story that is going to be ongoing. You're gonna continue to have questions and want to make connections. I know Families USA is available to you at any time. And certainly while these are some very busy folks on the phone, I am sure that they will be available for follow-up questions you may have as you continue to really bring this story to the public and keep reminding folks why it's so important. Thank you all for your time. We'll let you get back to your busy days and keep up the good fight. Take care. Thank you.