Hi, I'm Wendy Zuckeman and you're listening to Science vs. Today on the show, the abortion pill.
It's the most common way to get an abortion in the US these days.
There is a huge spotlight on these pills right now.
Now to the abortion pill battle, the Justice Department is - We've got some breaking news now here in the US.
We saw the Louisiana House passing a bill that can make that state the first in the country to criminalize abortion pills.
And that spotlight is about to get even brighter because soon the Supreme Court will decide if the FDA has made those pills too easy to access.
Supreme Court deciding the future of the abortion pill.
This is now a case about how easy is it gonna be to get that pill.
You see now, in some US states, you can have abortion pills sent in the mail without ever seeing a doctor in person.
and some say that this is bananas and totally dangerous.
How is it safe when one in 25 women will have to visit the ER?
Others say that all that talk is just politics.
But amidst all of this attention on the abortion pill, what's kind of wild here is just how little some people know about the basics of these pills.
A recent review paper found that even many primary care doctors don't know how well they work or their side effects.
And this can leave the folks who were taking the pills stuck in the middle, unsure of what's about to happen to their own bodies.
People like Heather Witten.
She's a documentary photographer who lives with her husband, four kids, and according to her website, too many pets.
Heather, what is too many pets?
Too many pets is two dogs, two cats, three rabbits, two hamsters...
The hamsters! Oh, no, they're still going.
And two foster bunnies.
So, it is entirely too many pets.
Back in 2019, Heather and her husband were in a tricky situation.
I found myself unexpectedly pregnant with our fifth child, here I was, like in my 30s, married with children, and I didn't want this.
Heather was done having kids, and both her and her husband wanted to put their energy into taking care of the children that they already had.
So Heather decided to have an abortion.
Yeah, it was, it was a hard moment.
She went to a clinic and was given a bunch of pills to take at home.
And Heather didn't really know what was about to happen.
Like in TV shows, you see people go to the clinic and have, you know, go behind the double doors and you don't know what happens back there.
And I felt like it was the same with medical abortion.
I had no idea what it was going to feel like or look like.
I just wasn't prepared for the intensity of it all, honestly.
I think I was just so overwhelmed.
I very much came home and we made my husband's insectomy appointment the next day.
Like, I was like, I will never do that again.
Yeah. Yeah. And to Heather, all of this mystery around the abortion pill, it was frustrating.
Why is it shrouded in the secrecy and taboo and shame and fear.
Why can't we bring it out front and center and shine some light on it?
So, let's shine some light on the abortion pill.
Hundreds of thousands of people get abortions in the US every year.
So let's take the secrecy and the politics out of this.
Today we're going to walk you through exactly what happens when you take these abortion pills.
And heads up, we are going to get detailed.
And we'll also talk about how safe they are for your physical and mental health.
Is it really just politics when people say it can be risky to take them?
Think about this episode as a what to expect when you don't want to be expecting.
It's all coming up just after the break.
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Welcome back. Today on the show, The Abortion Pill.
Tell me about the cactus.
Oh, wow. So, it's a crochet cactus that looks more like a penis.
This is Dr Sarah Whitman, Deputy Medical Director at Sexual Health Victoria in Australia.
What came first? The pun about the cactus or the?
No, no, the art came first. The crochet came first and then it was named the cactus.
Okay great, great. So as part of your work, do you prescribe the abortion pill?
I do, yes. Just how many people do you think in your career you've given it to?
I'd say it'd be around about a hundred, yeah.
Sarah doesn't just prescribe these pills.
She also does a lot of education around how they work.
And so I asked her to walk me through the cold hard facts about the abortion pill.
Even though, you know, it's pretty soft and warm where we're going.
And that's because our first question is simply how exactly do these pills work?
And to answer that, we need to head to the uterus.
Okay, so each month, the lining inside the uterus changes a lot.
At the start of your cycle, like just after you get your period, it's pretty thin, but then your body will pump out hormones which head to the uterus.
and that helps the lining what we call ripen.
What do you mean by ripen?
I know, there's no real good term for that.
I am imagining like my uterus as a peach at this point, right?
I know, I know. I mean, you can also say stabilise or thicken.
I'm gonna go with thicken.
So the lining of your uterus is getting thicker and thicker, and it's basically building this really cosy place so that just in case a sperm comes along, Your uterus is going to be prepared to make a baby.
So what it's saying is, hey, Leining, stay there, get ready, something might happen.
If you think of it as icing on the cake, but it's a nutrient -rich, blood -filled, oxygen -rich icing.
The best kind of icing.
The best kind, the best kind.
If nothing happens, no sperm, no fertilisation, then levels of a hormone called progesterone will naturally drop.
And that lining that icing on the cake, it's gonna shed.
It'll fall down your vagina, along with blood, blood vessels and mucus, and that is your period.
But, let's say the cactus gets a little trigger -happy and you get pregnant.
Progesterone will keep getting pumped out and the icing in your uterus is gonna get thicker and thicker.
Now if you'd rather that didn't happen, well, enter the abortion pill.
This is also called a medication abortion.
In the US, it's approved to be used for a pregnancy that's up to 10 weeks along.
And normally, you'd be given two different kinds of pills.
The first you'll take is called Miphyprisone, which is what the Supreme Court is looking at.
Now this drug basically tells that nutrient -rich lining...
Stop, don't grow anymore.
Don't support this pregnancy.
Okay, stop. It does this by blocking progesterone.
And that means the uterus is basically like, huh, no progesterone.
I guess no pregnancy.
Time to say goodbye to that nutrient rich lining.
It's time to let it shed away.
And that's a lot more like what happens if you don't get pregnant.
That's so interesting that it is sort of on some level mimicking the process of just having a regular period.
Progesterone drops, and your body's like, you don't need this.
Yeah, it is, and that's why you bleed.
Some people might start bleeding as soon as they take pill number one, mifepristone.
But for most of us, the bleeding starts after pill number two, which you'll take a day or two later.
That second pill is called misoprostol, and it's filled with a chemical that heads for the muscles that live around your uterus, and it makes them squeeze, so it basically empties what's in the uterus, which might sound kinda weird, but Misa -Prostyl is just a synthetic version of this chemical that we naturally make when we have our periods.
Now this whole process of taking these two different kinds of pills, it works well.
About 97 to 98 % of the time, the abortion will be complete.
And now let's go back to Heather, our mother of two dogs, two cats, two hamsters, five rabbits and four children to get a better idea of what all this can feel like.
So Heather took the first pill while she was still at the clinic and she didn't feel anything from it and then a couple of days later she took the misoprostol by now she was nine weeks along her husband booked a hotel room for her that night away from the hamsters and children so that she could have her abortion in relative pace.
And Heather and I talked about it.
So you, you burnt a candle, right, in the room?
Yes, yeah, don't tell the hotel.
Oh, right. And you put the mesoprostol in your mouth, and then when, was that a weird feeling?
It's four pills, right, it's a lot of pills to be.
Yeah, it's gritty and nasty.
I mean, it's not totally nasty.
I just remember it being chalky, and I couldn't wait to be able to just swallow it and rinse my mouth out.
Within the hour, Heather could feel something.
It just started feeling like that ache of beginning your period.
So I was just, like, aware of my uterus.
And, like, I had some back pain, some pain in my thighs, which is all normal for me when I start my period.
So I was still chatty and happy.
But then the cramps got worse, and Heather went into the bathroom.
she wanted to have a warm bath.
And Heather was in the hotel with a friend of hers, Sarah, who's also an abortion doula, which means she helps people through abortions, so she's a very handy person to have around.
I think I got in the tub pretty quickly, and Sarah had, like, lit candles all around me and was, like, pouring cups of water on my back for me and stuff like that.
It was really beautiful.
The pain got worse and worse, though.
Heather said it was extremely painful for about five hours.
Having gone through childbirth before, she said it was actually pretty similar to being in labor.
Not like full -blown labor, but you don't get the lull of contractions either.
It was just one big contraction the whole time.
It didn't let up. So it wasn't even like the wave of breaks.
And Sarah was sleeping for part of it.
And I wanted to just throw shit at her.
Like, wake up. I'm in pain.
But there was nothing she could do, you know?
Like I just had to ride it out.
Because I also had horrific diarrhea and vomiting.
Oh, man. Yeah. So I would momentarily have to get out of the tub to throw up or use the bathroom.
And I was livid. I just got angry that I was in the position that I was in and I was mad at my husband And, like, I was just a grumpy, pissed off woman in a bathtub.
Roughly 50 % of the people who take abortion pills will describe the pain as moderately or extremely painful.
Taking ibuprofen or maybe codeine might help.
And, yeah, it's also pretty common to get nausea and maybe vomit after taking myzoprostol.
Now, for the some 40 % of women who are getting abortions and who have never given birth before.
Sarah says, expect this to be worse than your period.
So, on the upside, if you don't get painful periods, it might not be that bad.
And in one study of hundreds of women, around one in 10 said they felt no pain.
So now let's talk about the bleeding and what to expect there.
Because when it comes to how much blood is gonna come out of you, Dr. Sarah Whitman says that that worse than your period guideline, it applies here as well.
I think it's really important to say it's more than a period and I think if you don't know that it's going to be heavier than a period, that is a shock.
Because we're used to our periods.
You're bleeding like this because it's not just your period, right?
That lining of the uterus has now gotten thicker plus there's the embryo and placenta.
And the further that you're along, the more that you'll bleed.
The heavy bleeding should let up within 24 hours and after that the bleeding should be more like a regular period.
So that's what's typical and for Heather that's basically how it was but sometimes things can go wrong and people can bleed a lot and it can be scary.
They end up in the hospital and this is what folks who want to restrict access to these pills focus on.
Stuff like hemorrhaging or where these large blood clots can fall out of you.
Here's Sarah. If you're passing grape sized blueberry size, that's probably normal.
But if you go up to a lemon size, that is abnormal.
A lemon sized clot!
Yeah, yeah, and we do use the word lemon. I mean, that would be so scary.
That's so big! Yeah, yeah.
It is it is big and you would really want to be seeking help.
So how often does that happen?
How many of us are having lemon sized blood clots and gushing so much blood that we need to go to the hospital.
That's coming up just after the break.
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Welcome back. Today on the show, the Abortion Pill.
We've just walked you through how it works.
Now we want to know what happens when things go wrong.
Last year, a Texas judge made this really important ruling that he basically said that the abortion pill was dangerous, and he implied that lots of women were hemorrhaging as a result of taking it and heading to emergency rooms. This case is now being heard by the Supreme Court and whatever they say could have implications throughout the U .S. Like I said, important.
And the thing is in that judge's decision, he used scientific studies.
Like he cited this paper from Finland.
And so senior producer Meryl Horne and I Called up the guy who led that study.
I've been working with Miifepristone for actually 40 years.
Oh, wow. I didn't even know it existed for that long.
Yes, me and Miifepristone, all the way back.
This is Oscar E. Heikinhemo, a professor of obstetrics and gynecology at the University of Helsinki in Finland.
And for him, this study started in the year 2000, when Miifepristone was first approved in Finland.
It's around the same time as the U .S. And researchers like Oscar E.
weren't exactly sure how this would go.
Because yes, this pill had been tested in clinical trials, but now you'd have all these women in Finland taking it.
And so, he wanted to know.
Are there adverse events, what kinds of adverse events, are there serious complications, serious complications which you may not see if you do a study, you know, with 100 patients?
So, in this paper we had some 42 ,000 women.
Yeah. 42 ,000 women.
It was basically every woman in Finland who got an abortion in the early to mid -2000s.
And Oscar got that information because, in Finland, all patients getting an abortion have their data entered into a registry.
And so once Oscar got access to that registry, he could look and see.
How many of them came back to the hospital with questions or concerns?
And he saw that quite a lot of women They did come back to the hospital.
And in fact, there was one diagnosis that they were given over and over again.
Many people had the diagnosis of hemorrhage.
Hemorrhage. In fact, almost 16 % of the women in Oskari's study were diagnosed as having a hemorrhage.
That's roughly 1 in 6.
That sounds scary. history, but just as Jafar said in Aladdin, things aren't always what they seem.
Because Oskari said that in his study hemorrhaging just meant someone who was having any kind of bleeding and was concerned about it.
Obviously, I see that the term hemorrhage seems certainly a worrisome term, but that's a diagnostic code.
to anyone who came in with any kind of bleeding that was like, boom, you're hemorrhaging.
Exactly, yep. Cause that's the code.
We only have one code for bleeding and it's hemorrhaging.
Exactly, that's where the term came from.
So it's not like someone's gushing blood.
No, no, no, no, no. Could have just been that they had some blood and they were really worried and so they went to get checked out.
Yes. Oskari told us that a lot of women that were coming to the hospital were actually totally fine.
Their bleeding was normal.
You know, given that they've just taken the abortion pill.
And so, Oscar is like, don't use my study to suggest that tons of women who use the abortion pill are in danger and bleeding out.
Well I think it's a misuse of scientific data if you go cherry picking and then you take one sentence from here, and another sentence from there, and you know, it's not serious work.
You don't think there are being good researchers.
Well, I don't know about them as reasserts, but I think that's pure cherry -picking to advance a political agenda.
Oskari also told us that, you know, if you want to be a good researcher, don't use his paper which was tracking abortions that happened 20 years ago.
Because doctors have learnt a thing or two in that time.
So, to find out how many of us these days will lose dangerous amounts of blood after taking the abortion pills, we're going to need a different nerd. I love, love, love doing research. Ooh, I found one.
My name is Dr. Ushma Upadhyay.
Ushma is a Professor and Public Health Scientist at the University of California, San Francisco.
And this year she published a study of more than 6 ,000 people who took the abortion pill, and she carefully tracked the big things that went wrong.
So we looked at blood transfusions, major surgeries, major infections.
And it's worth saying that in Ushma's study, these people actually got their abortion pills in the mail.
So, before taking the pills, they never actually saw a doctor in person.
Instead, they either had a video chat with a doctor or did what was called the asynchronous model, which means that the entire communication process is overtaxed.
Wow, I don't know what emojis they would say when you tell them.
They mentioned, somebody mentioned the emojis too.
Love hearts, stronger!
Yeah! Exactly. And that kind of model of care where you don't see a doctor in person, remember, this is exactly the kind of thing that the Supreme Court is questioning right now, But Fuschma as thousands and thousands of patients started doing this, she was excited.
Yes, yes. It's incredible how that there were so many patients that the data were coming in.
What did you find? How many of them had serious side effects after taking these pills?
A quarter of one percent of patients experienced a serious adverse event.
A quarter of one percent, so— Zero point two five percent.
Two to three people out of a thousand.
Yeah. So the risk of something like needing a blood transfusion or getting an infection is super small.
Out of a thousand people, it'll happen to maybe three of us.
By the way, when we look at other research, we can see that that risk is pretty much the same whether you're just texting with a doctor or you saw them in person, and maybe they even gave you an ultrasound.
It actually doesn't matter.
Then there was something else that Ushma could see in the data, and it's actually really important.
You see, every now and then people were going to the ER, sometimes thinking that they were bleeding too much. But they were actually totally fine and sent home pretty quickly.
Now the truth is, it can be tricky at times to know what's normal bleeding and what's not.
There are guidelines, and they say that if you are filling two MaxiPads in two hours or you're passing lemon -sized blood clots, like we talked about, that's too much. But speaking to Uxmaa, it's like, wait, what exactly is two maxi pads worth of blood?
I was just at a meeting yesterday, and someone was like, where did this guidance even come from?
And like, who really knows how much a pad actually, how much blood is that?
And like, what does that mean?
And I just think that we haven't researched it enough, it's just something that has been written into lots of guidelines with no citation.
Oh, interesting, it's the same in Australia.
I have two MaxiPads, and I was like, you go into the pad section today, and there's like a million different MaxiPads.
Exactly. I'm like, isn't this super?
I don't know. With wings, without wings.
Like, whoa, which MaxiPad are we referring to?
That's exactly. And this was a meeting of medication abortion experts, and we were all talking about this one.
Still, despite the MaxiPad unit of measurement not being as precise as we might want it to be.
Dr Sarah Whitburne over in Australia tells it to her patients and she says it is helpful.
Like, Sarah told me that she actually had a patient who needed a blood transfusion, and she told them beforehand, if you are filling two MaxiPads in two hours, that's too much. They said to me, we were having that bleeding you talked about, so we went up to the hospital and they gave us a checkup, said, yes, you're bleeding a bit more than we'd like and your red blood cells and you has dropped.
We're going to give you a transfusion.
And that's what helped help the bleeding slow down and help the person feel better.
And were they all right?
Yes, they were. They were all right.
They said at the time, they found the bleeding and the pain was scary for them.
As in, oh, this is more than we expected.
But they knew what they were doing.
And so that's the two things they sort of said is they were saying, Oh, this is more than we expected.
this is heavy, but we knew what to do because you'd said to us, go to the hospital.
It's okay to go to the hospital.
That's what we need to do.
Sarah also told us that a lot of her patients are worried about whether the abortion pill is going to affect their fertility later on in life when they're ready to have a baby.
And the good news is that it doesn't.
OK, so those are some of the physical risks to your body when it comes to taking the abortion pill.
But our final question is about the psychological risks of having an abortion.
Because you'll hear, and it definitely came up in that Texas court case, that abortions can be crappy for your mental health.
In fact, the judge wrote, quote, many women also experience intense psychological trauma and post -traumatic stress, from excessive bleeding and from seeing the remains of their aborted children.
So, is that true? Well, remember, this pill is generally used in early pregnancies.
In the US it's up to 10 weeks.
So the embryo is pretty small, maybe the size of a small strawberry.
And we don't have a lot of research specifically on how people feel, when or if they see it, but the little research we have shows that, yes, for some people this can be difficult.
Like one study from 20 years ago found that out of almost 60 women who saw, or thought they saw, the contents of the pregnancy, just over half said they had strong negative feelings about it, like they were shocked, sad, or scared.
Some people felt shame and guilt.
But one in five women either felt neutral, curious, or even positive.
I talked about what this was like for Heather when she had her abortion.
Like we mentioned, she was nine weeks alone.
And take care while you're listening to this, because for the next few minutes, we're going to get detailed.
So remember, she was with her friend, Sarah during her abortion.
Did you see the embryo come out at the end?
If whatever you feel comfortable talking about?
Yeah. So I was in the bathtub and I remember I sitting cross -legged in the tub, sitting up talking with Sarah, and I remember feeling like a stronger contraction and then I was like, I feel like there might be something between my legs and the eye pulled out the little embryo and I probably wouldn't have even noticed that the embryo was what it was because it just looked like a blood clot.
It just felt different than a blood clot, like it...
this is really gross, but I don't know a better way of explaining it, and I'll preface it by saying that I'm a mother of four, but it feels like a crusty booger, like it's slimy, but still has, like, some substance to it, you know?
Like, so... and it was kind of all...
because I didn't know what it was, so I think I smushed a tiny bit, and so I handed it off to Sarah, and she kind of rearranged it so that I could see the different parts.
And yeah, you could see where...
I mean, I don't know how much you want me to describe it.
Ladies, please, no, no, details, it's helpful.
Okay, okay, yeah. So you could see where a little bit of an eye was forming, you could see a little bit of the umbilical cord. Really?
Right before that, I had passed...
I had felt that I passed what I thought was a large clot, but Sarah put on gloves and kind of went into the toilet to look, and it was the placenta, like the early placenta.
What did it look like, the early placenta?
It looks like a little pink sponge, like feathery sponge -like circle, you know, like it fits in the palm of your hand.
Light, light, pink.
Yeah, it doesn't look like what a placenta for a full term pregnancy looks like, at all.
And how did it feel seeing it?
I don't remember anything but curiosity.
I was very curious to see it, and it felt very cool to be able to see it.
I didn't feel attached to it in any way.
I didn't feel, like, that's my baby or sad in any way that I can remember.
After her abortion, Heather actually trained to be an abortion doula herself.
She also started a photography project documenting other people going through medication abortions.
And so I asked Heather now, having seen other people go through this, how do they respond to seeing the embryo?
I have seen people that have just not wanted to see it whatsoever, or have seen it, and have had strong reactions to it.
Well, one person comes to mind, her embryo fell out of her as she was walking across a yoga mat in her bedroom, and so it was this very dramatic moment where she was just walking and then, boom, her, her waters broke, you know?
Like there was like a trickle of water and blood, and then this embryo fell from her.
And she dropped to her knees and begged for forgiveness, like right then and there she just kept saying, I'm sorry, forgive me, forgive me.
And I don't know who she was talking to, but she really like kind of cried and kind of with tears, you know, holding this embryo in her hands.
And, you know, she, she quickly kind of pulled herself together and stood up and took a shower and got dressed and that was really powerful to see, and such a stark contrast from my experience.
But we're not a monolith, you know?
Like, so many people have different experiences, and each one is valid.
Like we mentioned, there's not a lot of research on how people specifically feel when they see the embryo.
But what we do have is quite a lot of research just more generally on whether abortions affect your mental health, including medication abortions.
And here's what it finds.
So the careful studies that compare rates of depression before people got pregnant to then after their abortion, find that on average, abortions do not affect the chance of you getting depression or feeling suicidal.
In fact, when Ushma looks at the research, she says that on average in the long run, abortion has no impact on mental health.
It's really surprising our obsession with abortion and the trauma it's going to cause, but it's really not a mental health story.
No, not at all. So, in terms of regret, the data show that the vast majority of people, you know, over 95 percent feel confident about their decision, feel no regret about their abortion decision.
For me personally, it's just been positive since the abortion.
I've never looked back on it.
Well, I won't say never.
One time, I looked back on it and I was kind of like, life just turned out a little different than I thought it would after the abortion.
Maybe I should have had that baby.
But then I thought about it and I was like, no, I love my life, like what I'm doing now.
I'm so thankful I'm not spending the next five years attached to a child.
I'm so glad that's not what I'm doing.
And just finally despite all of these fear campaigns around abortion pills, studies have found that many women prefer these pills to the other option that's out there which is surgical abortions.
That's where you often have to go to a hospital or a clinic and you get an anesthetic.
So some women prefer the abortion pills because of the cost, In the US, they tend to be cheaper.
There are also shorter wait times.
It's more private, you get to be in the comfort of your own home, and you get to avoid surgery.
One study found that almost 90 % of women who got a medication abortion would recommend it to a friend.
So, you know, with Yelp reviews like that, am I right?
So, bottom line, while taking the abortion pill is not like a day at Disneyland.
Professoruscari Hakunhemo, who's probably helped more than a thousand patients through medication abortions, says that he just doesn't see the evidence that the abortion pill is causing psychological or any other harm to loads of people.
Medication abortion is used in more than 90 % of all abortions in the Nordic countries.
And obviously, if we had any thought that we would be putting our young women into harm's way by using medication and abortion, we certainly wouldn't be doing it.
That's Science Versus.
Hey, Meryl Hord, senior producer at Science Versus.
Hey, Wendy. Hi. So how many citations are in this week's episode?
I don't know. You told me.
Well? There are many.
Sunny, there is 108 citations.
Whoa, 108 citations.
People want to read more about the science of medication abortions.
Where should they go, Meryl?
They can go to our show notes and then follow the links to the transcripts.
Yes, and today on Instagram, we have photos from Heather Witton's project documenting medication abortions.
So these are photos of people as they're going through their medication abortions.
The photos are really, really powerful so please check it out.
Just head to Science Underscore VS. The project by the way is called the abortion project and Heather has actually moved on.
She's not working on it anymore.
She's still a professional photographer, though.
And also in this episode we did talk about some kind of heavy stuff at times.
So if it's making you feel a certain way and you want to talk to someone, we're going to put a link to some resources just in the show notes.
All right. Thank you so much for listening.
Thanks, Feral. Thanks, Wendy.
This episode was produced by Meryl Hawn and me, Wendy Zukerman.
You can find me on TikTok, by the way.
I'm at Wendy Zukerman.
The episode was also produced with help from Rose Rimler and Michelle Dang were edited by Blythe Terrell, fact -checking by Diane Kelly, mix and sound design by Bobby Lorde, music written by Bobby Lorde, Emma Munger, So Wylie, Boomi Hidaka, and Peter Leonard. Thanks to all of the researchers that we spoke to for this episode, including Dr. Tiffany Green, Dr. Ned Kalong, Professor Jenni Higgins, Dr. Daniel Aaron, Dr. Beverly Winokoff, and Dr. Abigail Eakin.
Also, thanks to Lauren Silverman, the Zuckerman family, and Joseph Levell Wilson.
Science Versus is a Spotify Studios original listened to us for free on Spotify or wherever you get your podcasts.
And if you like the show, please rate us.
Give us a five star review.
If you are listening on Spotify though, follow us and tap the bell icon so then you'll get notifications when new episodes come out.
I'm Wendy Zuckerman.
Back to you next time.
