In this episode, we explore how family dynamics can influence child health outcomes, specifically the impact that fathers can have on their children's health and development and the importance of including fathers in public health data collection, with guest Dr. Craig Garfield. Dr. Garfield leads the Family and Child Health Innovations Program (FCHIP) which is housed in Manne Research Institute at Lurie Children’s, and is part of the Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center.

Guest: Craig Garfield, MD, MAPP, Professor of Pediatrics (Hospital-Based Medicine) and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Attending Physician, Hospital-Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago

Host: Patrick C. Seed, MD, PhD, FIDSA, Attending Physician, Infectious Disease; President & Chief Research Officer, Stanley Manne Children’s Research Institute; Children’s Research Fund Chair in Basic Science; Professor of Pediatrics (Infectious Disease) and Microbiology-Immunology, Northwestern University Feinberg School of Medicine

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Show Notes

  • The Pregnancy Risk Assessment Monitoring System for Dads (PRAMS for Dads) was designed in collaboration with the CDC to gain public health insight on fathers. 
  • PRAMS for Dads was launched in a pilot in Georgia in 2018, and since then, Michigan, Ohio, North Dakota, and Massachusetts have also joined with growing interest and adoption across other multiple states.
  • The impact of fatherhood on long-term health includes areas of concern around mental and heart health and weight gain in fathers using longitudinal data. Research shows there is an increase in depressive symptoms in fathers during the first five years of fatherhood. Dr. Garfield urges the public to recognize and address paternal postnatal depression and to support family health with mental health screenings.
  • Dr. Garfield collaborates with legislators to address gaps in data collection and support for fathers, such as updating birth certificates to include more accurate contact information.
  • Despite the efforts and initial funding from the CDC, there has been no sustained federal support for PRAMS for Dads, yet, the Congressional Dads Caucus has brought new attention to the importance of father involvement, with legislators working on securing federal funding and support.

Transcript

[00:00:00] Patrick Seed, MD, PhD: This is In Pursuit: research perspectives from Ann & Robert H. Lurie Children's Hospital of Chicago. I am your host, Dr. Patrick Seed, President and Chief Research Officer of Stanley Manne Children's Research. Institute, one of the nation's largest free-standing pediatric research centers. Our guest today is a nationally recognized researcher who studies how family dynamics can influence child health outcomes, specifically the impact that fathers can have on their children's health and development. He's an attending physician for hospital-based medicine at Ann & Robert H. Lurie Children's Hospital of Chicago, and a professor of pediatrics and professor of Medical Social sciences at Northwestern University's Feinberg School of Medicine. As a fellow doctor and a dad, and with Father's Day approaching, I'm really excited to welcome Dr. Craig Garfield to the podcast. Welcome Craig.

[00:00:57] Craig Garfield, MD: Thanks, Pat. I'm excited to be here.

[00:00:59] Patrick Seed, MD, PhD:  So here at Manny Research Institute, you lead the Family and Child Health Innovations Program. Our FCHIP, it's referred to, and I know Father's Day is a busy time of the year for you and your team. With that in mind, I want to just jump right ahead and learn more about your father-focus research that you've been leading. Let's start with something pretty exciting, which is your pregnancy risk assessment monitoring system for dad, or PRAMS Dads. And what I really want to get to is learning about PRAMS for Dads, but particularly how this came to the attention of Georgia Senator Raphael Warnock where I think he wrote a letter to the Georgia Public Health Department saying, Hey, look at this program. We need to institute that. So tell me about that. It's super exciting.

[00:01:42] Craig Garfield, MD: Yeah, it's actually something we've been working on for probably eight to 10 years. And you kind of have to think about the context of the CDC and their responsibility for understanding the public health of the nation. And they created the Pregnancy Risk Assessment Monitoring System over 35 years ago that focused specifically on mothers. It really is the gold standard of information in public health data that we get for mothers in the perinatal period. So from pregnancy through the first year of life. And it's a survey based on a random sample of birth certificates. And 81% of births in the country are included in PRAMS, maternal PRAMS. And it gives us really important information about did mom get prenatal care starting the first trimester? Was she exposed to secondhand smoke? What are her breastfeeding behaviors? What are the safe sleep behaviors? Really, really key public health data and it is one of a kind. And what started happening was that in the free text area of the surveys, mom started to write, why is the only question you ask about my partner is, did he hit, kick, beat or slap me during pregnancy? And they went on to write to say, the only way I made it through this pregnancy was with the help and support of my partner. And that's the only question you ask about is inter-partner violence. So the CDC approached us because of the work that we had been doing on fathers to say, gosh, how can we address this? How would you actually access dads? What would you ask them? How would you reach them? We don't really have any public health line of sight on fathers. And so that's where we started to like really go back to the drawing board and talk with dads in the community primarily in Chicago with some support from the CDC to say, would you answer this survey? Is this something that you wanna be asked about? And overwhelmingly, dad said, no one asked me anything and I really do have opinions and I know that I want to be involved with this baby. And so we worked really hard to figure out how we would do that, and Georgia remarkably was the first state that wanted to do this PRAMS for Dads. We called it PRAMS for Dads because we knew people had familiarity with PRAMS. And so Georgia in 2018 piloted the very first PRAMS for Dads survey. Turns out it's also very close to the CDC headquarters, so it worked out wonderfully to be in that same place. So when we did the pilot, we now have published probably six different articles off of the data that came outta Georgia. I am an Aspen Institute Ascend fellow. And it turns out, so is Senator Warnock from Georgia. So I reached out to Senator Warnock after seeing him at an Aspen Institute meeting. And he was extremely excited about it and extremely proud of the role that Georgia played in fielding the first pilot of PRAMS for Dads. And Georgia has been a terrific partner in this all along. So I think Senator Warnock really wanted to get the word out on the value of this information, on the importance of including fathers as we think about children and families early on from the very beginning. And in his support of this in Georgia. And since that time we actually have now expanded to include Michigan, Ohio, North Dakota, and Massachusetts. We have probably presented to over 35 different states across the country, states and jurisdictions about this project. And many more states are interested in it. There's really been a sea change in what people and states and government organizations want to know about , the role that fathers play. But it really is the first of its kind measure of public health data on fathers, there's nothing else like it across the country. And so we're really proud to have started that. And I think what it gets back to is this kind of slogan that we have. I'll tell you two of them. One in FCHIP is, children thrive when families thrive. And so we really need to understand what it is that helps families thrive to help children thrive. And I think that's one of the missions that we have. The other thing that really drives us is that we don't know what we don't measure and we can't change what we don't know, and so really trying to get some data on fathers and how to help them during that key transition to fatherhood is what the idea is behind PRAMS for Dads.

[00:05:27] Patrick Seed, MD, PhD: That's really incredible. The uptake by the different states and the interest is really phenomenal and I think it speaks to the importance that people are seeing in the work that you're doing. Tell me a little bit about some of the unexpected things you've learned so far. What are some of the things that made you sort of crane your head to the side and go, really, like, I was not expecting that.

[00:05:47] Craig Garfield, MD: So when we started this survey. I knew from talking with families across all different race, ethnicities and ages and marital statuses that dads do want to be involved. They just aren't sure how to be involved. I felt that my job as a pediatrician and our job in pediatrics more generally was to actually not close the door on the dad, but actually open it, welcome them in, and include them in the care of their child because that's what they are expecting. So when we did the PRAMS for Dad survey we actually did a randomized control study. That was the first thing we did because we knew that Dads had said the reason why we aren't involved in research is no one asks us any questions. And then the other side of research, which is the approach that kind of Fragile Families took, was let's ask moms permission to include dads. So we said, all right, let's take dads at their word and we're gonna randomize into two different arms. One arm, we're gonna send them survey directly to dads, addressed to them, it's gonna look different, gonna have a different envelope on it, and we're gonna send that to dads. Then we're gonna pit that against what we call mother as gatekeeper approach. So we put the survey in the same survey that was being sent to moms for Maternal PRAMS, and then we just sat back and said, all right, let's see what the response rate is like, who's gonna respond more in this randomized study is if we sent the survey directly to dad in an envelope for him, or if we send it in, tucked into moms? What really blew me away, and I had no idea what was gonna happen, but it was dead even Pat. And what that allowed us to do on the PRAMS for Dads project was to actually use both approaches. So in some of the states that we're working with now, we can actually take advantage of reaching out to dad early when it's still a very new thing for him. And then if we don't hear from him, then we can tuck a survey in when it gets out to mom and have mom try and get dad to do it as well. So we're still in the middle of experimenting with that, but it's those sort of questions that I think have really driven my career and the work that we're doing with fathers and trying to figure out how to place them in the world of pediatrics and child health.

[00:07:34] Patrick Seed, MD, PhD: It is really interesting. There's unmet questions all over the place, and that's such a fundamental one about how we connect with people, right? If we can't connect to your original point, you can't get the data you need to come up with a solution to the problem that you've identified. I know you have some recent news about long-term consequences of being a father on mortality, heart health and outcomes like that. Tell me a little bit about the relative involvement of a father as a parent, and what sort of the long-term consequences are, both beneficial and potentially the things that are downsides for dads who are involved.

[00:08:12] Craig Garfield, MD: Yeah. Kind of gets back to the question of what we knew about dads and what we didn't know about dads and some things we knew anecdotally, stories from our own little world of our grandparents or our fathers or friends of ours and colleagues and peers that are fathers as well. And then really just trying to say, well, let's document that. While it may be intuitive, we may not necessarily have the data on it show it , and prove it. So for example we had done a study where we looked at-- this is in the ADD Health dataset, the longitudinal study of adolescent health. And we looked at BMI, right? So we had thought for a while like what might be the role of becoming a father on a man's weight.Almost as an aside here, we know we have neglected women's health for decades in medicine and there's an important emphasis now on women's health as it should be. And most of the research historically has been done on men. However, when you look at actually the health and the life expectancy of men, it just continues to get worse and worse. In 1920, the difference in life expectancy between a man and a woman was about a year. And now it's about six years where men are dying six years earlier than women. One of the things that we knew from the literature was that marriage was protective for men. So when men get married, they actually had little bit of a longer life expectancy. So a lot of our work early on was trying to figure out, okay, well we've uncoupled marriage in society now, and people have kids without getting married, so what's the impact of just becoming a dad? That led us to kind of two different really important health issues, one being weight and the other being mental health. So we looked at this data set that had been collected since people were in their teens in high school, in their adolescence, and then followed all the way into young adulthood. And we said, okay, well let's look at BMI, let's look at weight between men who are fathers and men who are not fathers. And we were able to look at that both in their time in fatherhood and when they became a father and kind of matched that to their age controls who were not fathers. We found that on average in this sample of about 3000 men that men who became dads had about a five pound increase in their weight. And when you talk to dads, I think it's understanding that their life changes, right? You're a dad. I'm a dad, and what we used to do maybe before kids changes, like, and you feel this responsibility as a father. And some of what that means is you're putting what you want to be doing on the side. So whereas you might go to the gym or you might go hang out with your friends or something like that, you're actually putting that to the side and at the same time, what's happening in the house is very different. You're not sleeping as much. There's different food around. And I think that may be part of the reason, along with some of the changes in hormones and things that can happen with fatherhood as well. So that was one study. The other study that we did was looking at mental health and again, looking at depression screening symptoms in this same sample of men who are fathers and men who are not fathers. And really finding that in that first five years after the birth of the child, there was about a 68% increase in depressive symptom screening scores in men who are fathers. What that really tells us that when you put that in context is that if you're scoring low on depressive symptoms, a 68% increase is not a big deal. But if you're kind of on the edge or already kind of scoring positive in the depressive symptom score or scale, a 68% increase may kick you into actually being depressed. And so what that really tells us, I think, and a lot of our work backs this up, is that that period of the transition in a fatherhood when you first start having your baby, is a key time where a men are looking. What should I do? I feel like I have these new responsibilities. I'm very excited about it. It's a lever for change and B, is making sure that in the healthcare system, we're aware of this and ready to embrace dads at that moment and guide them towards what they should be doing and can be doing for their health, for the health and support of their partner and for the wellbeing of the mother as well. So that's kind of like some of the older research that we've done. And then we just had a paper come out with JJ Parker from Lurie who's an academic general of pediatrics looking at heart health in particular and finding that men who are fathers, heart health is actually worse. Yet among black fathers, it's actually a little bit better. And so really starting to tease apart and taking an approach that says fatherhood is a social determinant of health that we have neglected to date. And really starting to think about how we can use that lever for change, for the benefit of health, for the benefit of the family, to get more men healthier as they become fathers, and to keep them healthy throughout their life's time.

[00:12:29] Patrick Seed, MD, PhD: I wanted to ask you with the mental health part, Craig, 'cause I'm curious what you think the underlying reason is. What is it about being a father that mechanistically might be driving that, getting to the point where, I know this is always in your line of sight of what do we do about it, right? How do you intervene?

[00:12:46] Craig Garfield, MD: When I first started researching this, I was a Robert Wood Johnson Fellow at the University of Chicago, and my officemate at that time was a doctor named Stacy Lindaw, who is an OB GYN at the University of Chicago. and I said to her, Stacy, why are so many women coming to the attention of the healthcare system for mental health issues during pregnancy? And she said, because that's actually when they're coming in. They finally have access to healthcare. They're coming in and they're seeing someone who now can identify their depression, schizophrenia, anxiety, whatever it is. And that's even aside from the hormonal shifts that are happening in women as well and the changes in the roles and responsibilities and the stress that may be happening to them. There is no corollary for that for men, right? We don't suddenly have, after pediatric care, there's no real easy entry for men into the healthcare system. Typically anecdotally what happens is, the next time that you see a man is when they kind of come into the ER with an MI or chest pain of some sort. And there's this big gap there. And so I think that's one of the issues that we need to be thinking about is how do we bring men in. The Affordable Care Act did a big change and actually there was improvement in men's access to healthcare through the Affordable Care Act. And that's one of the benefits so that men now have a place to go. But even in the PRAMS for Dad study where we looked at data out of Georgia, only about half of the dads in our sample had a primary care doctor and significantly fewer, down around 30% had seen a doctor in the last year. So while access may be there, they may not feel that they have a medical home. And I think that's a big issue in trying to understand the health and wellbeing of fathers. And specifically in terms of the mental health, what the research has shown again and again is that, about 10 to 15% of mothers will have postnatal depression, and about half of that number will have paternal postnatal depression. And that impacts, and the reason why it's important early on is because parents are so important in the bonding and attachment with that child and then making sure that child has a secure and safe environment. And if either parent is depressed, that's gonna impact the child ultimately. And there's good research that shows that fathers can be protective in the situations where there's maternal mental health of that child as well. So it really behooves us in pediatrics to think holistically about the family and not just think about it as a dyad of a mother and a child or a mother and infant or in strictly in maternal child health way in MCH way. We really neglect the other parent in this. And I think there's a lot of work that can be done on that. Starting with recognizing it's a problem and starting to screen. I was a co-author on the very first American Academy of Pediatrics report on fathers and pediatrics. It came out of the committee on psychosocial aspects of child health. And that was with Bill Coleman, who's a developmental pediatrician. And we actually said, screen fathers for postnatal depression. And one of the first comments that came back, and this was around 2004, was there's no such thing as paternal postnatal depression, and we can't just start screening people willy-nilly with basically the comment. And so Bill and I said, huh, okay. We all know that we've seen depressed fathers in the clinic like that was known, but we have no data on that. So we pulled it back and we said. Discuss with dad how the transition to fatherhood is going for him. That's kind of what we laid on. And then it was about two years later that Paul Ramchandani and Paulson published in Lancet and in JAMA the actual incidences for postnatal paternal depression. And so finally we had the data. So with that data, we now have the ability and the power to say we need to do something about this. So around 2012 when we did the second AAP report on fathers and pediatricians. I'd say half of that report is about the mental health of fathers because the research now had kept up with it. Now we're working on the third one, Michael Yagman and I and it should be out ideally in the next year or so, hopefully by Father's Day next year. Also, we're talking about fathers today, but this actually goes for all non-birth parents and second parents, right? Because we don't know that much about same-sex couples. We don't know that much about trans families. But that doesn't mean we should ignore them, and fathers have been ignored for way too long. We don't wanna repeat those mistakes. So we are calling for a screening at the four to six month visit. It fits nicely into general pediatric visits and wellness visits, and that there should be funding for it in the same way there's funding for moms. And our hope is that that will really put it on the billboard of how we take good care of our families. And with that data then we can actually start to make improvements in the care for fathers, but ultimately for families and children too.

[00:17:00] Patrick Seed, MD, PhD: I'm wondering is the social construct of what it is to be a father and a man, at least in American society, does that create barriers to participation by fathers in the work that you do? Are there certain sense of not showing vulnerabilities, both mentally, physically, and things that create barriers to engagement in the work that you do? 

[00:17:20] Craig Garfield, MD: So again, I work in primarily in the Prentice neonatal intensive care unit in the newborn nursery. So when we walk into the room and nowadays with cell phones and like dad's on their phone or something like that. And we only talk to the mom and we talk about breastfeeding and we kind of gear the whole conversation around moms, when you turn to the dad and I do this all the time, and you actually say, now, dad, how's it going for you? Congratulations. How do you feel about this baby? What's going on? They put their phone down and they start to engage with you and they start to ask you questions and they want answers to their questions and their questions are different than mom's questions. So back to your question of like what's happening in society in general I've just seen too many dads from so many different walks of life who stereotypically you think, God, this dad's not gonna be involved or not wanna even touch the baby, who really wanna know what's right for their baby and want to do what's right for their baby. And that's kind of the approach that I take. I think there's a lot of attention on dividing fathers and thinking about, well, what about this type of father and that type of father? And the work that we do is really trying to get at the universality of fatherhood and how that has an impact on the health and wellbeing of children and families and fathers, with an understanding and appreciation there are huge cultural implications to fatherhood. There is historic racism. There's this culture of incarceration, of how do you bring men back in from after they've been incarcerated into the family? And there's a tremendous amount of work to be done in that area. One of my dreams is to do PRAMS for Dads in the prison system because the overwhelming majority of men in the prison system have children on the outside. And through work with Ebony Underwood and We Got Us Now, which is a wonderful organization for children of incarcerated parents, we're working with trying to understand how better to serve fathers who are either in jail or coming out and how to keep them united with their children, with their babies. And that is even more important when in this work with Ebony we discovered that the Ohio justice system has rebuilt many of their prisons. And as part of that, they took away visitation rooms and made zoom rooms. So you can have, they said, this is great you can have much more interactions. You can be on Zoom with your kids. You can be on Zoom with your family. It's easier for us. But that physical connection between a father and their child is now missing, and that is just appalling. Right? So I think trying to understand in the populations that have not been studied and need to be studied, how is it we can do that the same that we have to figure out how do we do PRAMS for dads out here in the United States, how can we bring something like that to understand better the needs of men who are fathers who are in the prison system or in other situations? I'd be remiss if I didn't also talk about the structural racism that has existed for generations in families, and the fact that many families still believe in that it's punitive to have a man in the house. Because that's gonna take away their state services. And working to kind of understand the role of child support and how that can truly be child support and not necessarily punitive towards men who are fathers is part of the work for PRAMS for Dads too, that we're trying to understand and get a better grip on. As an aside, when you start to do research on fathers, you have to figure out how do you actually reach fathers. That was one of the things we had to do for PRAMS for Dads. It's why so much of my work is in the NICU because fathers are there 'cause we have their babies. So we actually do a lot of work there and have a very successful, probably one of the first of its kind NICU dads group there. That's been just overwhelmingly successful and supportive of families, when you start to try and figure out how do you reach dads, for example, and this goes back to the public health issues that we started talking about early, mom's information is on the birth certificate. If the couple is married, the dad is presumed to be, have the same address and contact information. one of the outcomes from doing PRAMS for Dads in Georgia, and one of the things that I think Senator Warnock is excited about that I know Representative Jimmy Gomez is excited about and representatives Kelly and Underwood from Illinois, is that this work starts to point to where the gaps are and the importance of good public health data, starting with the birth certificate. And so Georgia has actually found funding to change the birth certificate to collect much better information to actually include emails and cell phones remarkably in 2024 way that most people communicate on the birth certificate, so that now when we're reaching out to them, we're gonna have better information to contact them.

[00:21:28] Patrick Seed, MD, PhD: I know you do a lot of work interacting with legislators. You just rattled off another handful of them that are partnering with you in different ways. Can you talk about some of the engagement you've been doing thinking about the Dad's Caucus and other work at the national or even some of the state level?

[00:21:43] Craig Garfield, MD: Yeah, absolutely. Lurie Children's Hospital has been incredibly supportive of FCHIP and the government relations team has been fantastic. And that includes Joe Fregos and Rob Bradner who have really taken on PRAMS for Dads as an initiative that goes beyond Chicago and Illinois. And I really am grateful for that because they see the value of this as a national program. And I think that's where we're working towards. In the states that I mentioned, Georgia, Massachusetts, Ohio, Michigan, and North Dakota, each one of those states has had to find funding to do their PRAMS for Dads. That might be state funding from a men's health initiative like North Dakota. In Michigan, we have funding from Steelcase Foundation and the Kresge Foundation to do PRAMS for Dads, both in Kent County and in Detroit metro area. And then there were some Covid relief funds that are being used in other states. But there's been no federal support of this beyond the initial about a hundred thousand dollars that CDC had given us as an innovation fund to get this going. So there's been no federal support of this. And what's happened now with Representative Gomez from California bringing his baby onto the floor to do the vote that happened a year or so ago. And creating the Congressional Dads Caucus is that there's new attention to fathers and it's necessary attention. And one of the women representatives actually said, look women have been doing this for decades, right? Like, this is nothing new to us Jimmy, but if you doing this brings attention to the issue, we're all for it. And I think that's really where many of our elective representatives are, and if you look at the data from 1965 till today, men are involved almost three times as much in the childcare and rearing of their children than ever before. It's really remarkable and Covid actually boosted that as well for many men. But we have such poor family leave programs here that most men are taking less than two weeks of leave after the birth of the baby. It's unpaid leave, generally speaking, which is very difficult for families. And we are the only wealthy country in the world that doesn't have a program in there to support families. What Jill Fraggos and the government relations team has really been helping us do is figure out how does this work from a legislative perspective. They have been helping us work with not only the Congressional Dads Caucus, but the Black Maternal Health Caucus with Representative Underwood's office, with Representative Kelly's office to try and get some federal support for this. So currently we have a letter for pilot funding on Secretary Becerra, the secretary of HHS, on his desk. We're working on appropriations language and we're working on authorization language to try and get funding to get this done. We have a shovel ready solution, right? We are ready to deploy the PRAMS for Dads survey anywhere really and can do it pretty quickly. And we know how to do it. Our questions are validated. They match up with the PRAMS surveys for mothers that CDC is doing. So in that way we can actually really triangulate what's happening in families. And we know what has to happen to get it into the field, and then to use that data to inform policy down the road. So we've now been in the field for almost a year in our other states, and we're gonna get that data weighted so that now it is representative of births in those states. And we'll be starting to do reports and things like that from that data that should influence future legislation. It's a very antiquated view of the family, that it's just a mother taking care of a child in a family. And more men are taking time away from work as more women get more advanced degrees in education and there's equity in pay. It makes sense then that women would be in the workplace more. So from a pediatric perspective, that should mean that more men will be at home taking care of the children, and are they ready for that? And are we ready for that in pediatrics is one question we always think about.

[00:25:22] Patrick Seed, MD, PhD: You fill me with a lot of optimism, Craig, that you and your team are behind driving hearts and minds with the data. And, I think a really clear message as to the advantages of I think from a legislator's view, the investments in families, particularly through parental support that includes dads and moms. Well, I'm gonna now throw you probably the hardest question of the whole podcast here. So I hope you're ready for it, which is, I'd love to finish with a favorite, and it's hard to choose one, but a favorite Father's Day memory that you have.

[00:25:55] Craig Garfield, MD: Oh man. Yeah, it's a tough one. I love the generational aspect of fathering, parenting and pediatrics, that you have multiple generations of people that all shift when a baby is born, right? So when a baby is born, suddenly your father becomes a grandfather and your grandfather becomes a great-grandfather. And so I think probably my first Father's Day when my son was born, and we actually moved back to Chicago and had my father and my grandfather all in the same room. It's just magical. Like you really, you see the generations right there. And I think that's probably for me what many families see when they bring the children into this world, that there's this seismic shift in the family. And that shift actually occurs also in what people wanna do with their life and how they see themselves in this world. And to me that's really exciting because that's energy going forward to the next generations.

[00:26:48] Patrick Seed, MD, PhD: What a great memory. Well, happy Father's Day. I really want to thank you, Craig, for joining me today in the podcast. It's really been a treat. I learned a ton and I know our audience will both have learned a lot and be inspired by what you're doing with your team. So thanks so much.

[00:27:01] Craig Garfield, MD: My pleasure. Thank you for the time.

[00:27:02] Patrick Seed, MD, PhD: For more information on Stanley, Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago. Visit our website research.luriechildrens.org.