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This November, Heartland Study lead researcher and HHRA board member (ex-officio) Dr. David Haas joined Healthcare Triage podcast host Dr. Aaron Carroll to discuss the possible impacts of rising pesticide use on public and obstetric health. The Healthcare Triage podcast is sponsored by HHRA research partner the Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care. 

Archived HHRA News Posts
  • HHRA Paper Analyzes Pesticide Dietary Risk in Individual Samples of Foods

    One of the main sources of pesticide exposure is through  the diet. It is critically important to understand pesticide residues in foods and how dietary risks have changed over time. Over the last 20 years HHRA’s Executive Director Charles Benbrook has developed an analytical database that quantifies the relative risk posed by residues in the diet. Known as the Dietary Risk Index (DRI), this  system was created to help researchers compare risk levels across foods and pesticides, track changes in dietary risk over time, and assess the impact of where food is grown on residues and risk levels, as well as how production systems influence residues and risks (conventional versus organic). The DRI combines the results of United States and United Kingdom pesticide residue testing programs with data on food serving sizes and each pesticide’s chronic Reference Dose or Acceptable Daily Intake. Chronic DRI values are a ratio: the amount of residue in a serving of food relative to the maximum amount allowed by regulators. DRI values are a ratio: the amount of residue in a serving of food relative to the maximum amount allowed by regulators. Data generated by the DRI helps guide HHRA’s policy and public health by highlighting which food-pesticide combinations account for the most worrisome risks in the food supply. The DRI system initially reported aggregate values for a given food/pesticide combination. These values are derived from multiple individual samples of a food collected by regulatory agencies.  For these DRI values, each individual number represents many servings of a given food. In 2022, HHRA added additional functionality the the DRI to report dietary risk in individual samples of a given food. The paper “Tracking pesticide residues and risk levels in individual samples—insights and applications,” which was published in the peer-reviewed journal Environmental Sciences Europe in July 2022, describes the methodology and data sources used to calculate these individual sample DRI values, and highlights some of the results and what they can tell us about residue levels in the global food supply. This is the first analytical system worldwide to provide this level of insight into residues in food. As the paper reports, “dietary risk levels are highly skewed. A large number of samples pose moderate, low, or very-low risks, and relatively few samples pose high or very-high risks.” Thus, regulators and researchers can use the DRI to pinpoint where pesticide dietary risks needs to be mitigated. Like all of HHRA’s peer-reviewed publications, this paper is open access and available free of charge. Click here to view the full text. Access DRI data here.

  • Worrisome Trends in Herbicide Exposures Highlighted During HHRA Sponsored Session at APHA

    On November 8th, HHRA-sponsored a 90-minute special session on “Herbicides and Birth Outcomes” at the annual meeting of the American Public Health Association (APHA) in Boston. Our session was among a very few exploring how food and farming systems impact public health. Four speakers, all of whom are HHRA science advisors, will described ongoing efforts to deepen understanding of whether the rising use of glyphosate, glufosinate, 2,4-D, and dicamba herbicides are causing or contributing to more frequent and/or more severe reproductive problems, adverse birth and developmental outcomes, or possibly other health problems.  Check out the presentations from the session here. Dr. Cynthia Curl shared recent insights gained in a birth cohort study she leads at Boise State University. Glyphosate-based herbicides are among the pesticides her project is focused on. Daniele Mandrioli traveled to Boston from Belogna, Italy and the Ramazzini Institute to describe the Global Glyphosate Study (GGS) and share early findings. HHRA is among the funders of the GGS and benefits from scientific collaboration with the Ramazzini Institute at many levels. Marlaina Freisthler presented the findings of her paper in Environmental Health. The analysis draws on urine data generated by the Centers for Disease Control, coupled with 2,4-D herbicide use data from the USDA. The paper concludes that rising use of 2,4-D has brought about more frequent detections of 2,4-D in people’s urine. Phil Landrigan discussed why he and other scientists started The Heartland Study and the challenges that lie ahead in sorting out which herbicides, if any, are contributing to adverse birth and developmental outcomes. He also shared worrisome findings on trends in the levels of some herbicides in the urine of pregnant women in the Heartland. HHRA Biomonitoring Data Accurate estimates of exposure are essential ingredients in birth-cohort and other epidemiological studies. The most practical and affordable way to estimate exposures in a large birth cohort study like our Heartland Study is measuring levels of pesticide analytes in the urine of pregnant women (“analytes” include parent compounds and the metabolites that herbicides break down into). HHRA’s research goals include generating and compiling the data needed to quantify how herbicide exposure levels have changed since the early 1990s, before the commercial release of GMO herbicide-tolerant crop varieties. Such data are badly needed in light of the major changes occurring in herbicide-use patterns across the Midwest, changes brought about by the ongoing spread of dozens of herbicide-resistant weeds. To fill data gaps, HHRA has been testing urine samples from pregnant women in the Midwest using analytical methods capable of detecting 17 pesticide analytes. These include glyphosate and glufosinate, and dicamba and 2,4-D, four of the herbicides that corn, soybean, and cotton farmers have become far more reliant on in recent years. We now have glyphosate and glufosinate results from our analytical lab, the Centre de Toxicologie du Québec (CTQ) in Canada for around 700 hundred samples spanning 2010 through mid-2022. HHRA also has data from CTQ for another 13 pesticide analytes from about 150 samples collected from 2010 through spring 2022. These results include the levels of 2,4-D and dicamba in the urine of pregnant women. Use of dicamba and 2,4-D has been rising dramatically in the last decade. Further increases are likely because both herbicides are marketed in association with genetically engineered, herbicide-tolerant seeds. Rising reliance on dicamba and 2,4-D is worrisome because both are classified as “possible” human carcinogens by the International Agency for Research on Cancer, and multiple studies have reported heightened risk of reproductive problems and adverse birth outcomes among pregnant women exposed to relatively high levels of these herbicides. HHRA’s new biomonitoring data point to four preliminary findings. The average level of dicamba in the urine of pregnant women has increased over 3-fold just since widespread planting of dicamba-tolerant seeds began in 2017. Recent increases in farmer reliance on glufosinate (Liberty-brand herbicide) is now leading to possibly significant exposures to glufosinate and its primary metabolite 3-MPPA (3-MethylPhosphonicoPropionic Acid). Some good news — the levels of 8 out of 10 synthetic pyrethroid and organophosphate insecticide analytes have fallen over the last decade or so, including about a 50% decline in the primary metabolite of the organophosphate insecticide chlorpyrifos. Based on HHRA’s data spanning 17 pesticide analytes, the average person in the Midwest over the last two decades has been exposed on most days to at least 7 pesticide analytes. HHRA is highlighting the new data on dicamba and glufosinate because, to our knowledge, these are the first, significant datasets collected worldwide on levels of these herbicides in human urine. Such data are essential for regulators, farmers, and the pesticide industry to accurately quantify pesticide risks and when determining whether steps are warranted to reduce exposures. Why HHRA is Focusing on Pesticides and Birth Outcomes Food and beverages are the most common source of pesticide exposures for the general public. The highest levels of exposure are experienced by people who handle or apply pesticides, or live or work near where pesticides are frequently applied. If HHRA had the funding needed to test our urine samples for all, or even most widely used pesticides, the data would likely show that most people are exposed to 10 or more pesticides on a near-daily basis. We know that herbicide use and exposures are rising steadily, but very little research has been carried out since the 1990s to track possible impacts on reproductive health and birth outcomes. This is why we started the Heartland Study. As of early November, we have enrolled 340 pregnant women in The Heartland Study (HS). About one-half have given birth, marking the end of Phase 1 in the HS protocol for these women and infants. By the end of 2024 or early 2025, we hope to have enough mother-infant pairs through Phase 1 to begin publishing clinical findings. But now, HHRA is able to share important new data and insights on changes in herbicide exposure levels. It is likely that most herbicide-induced adverse birth and developmental outcomes, and other health problems, will rise or […]

  • An Update from HHRA

    HHRA’s team has been making lots of progress in our important work at the intersection of food, farming, and health. We started the spring/summer of with a bang as we brought HHRA on the road to the Public Health Conference of Iowa in May. At the same time, farmers across the Heartland were preparing  fields for planting and carrying out early weed management practices.  The end of spring into the early summer months (March-July) is the peak herbicide spray window in the Midwest, which in turn means sometimes higher exposures for families in the Heartland living near corn and soybean fields. Capturing data from our flagship project The Heartland Study during this window is essential to better understand how pregnant women in the Heartland may be impacted by herbicide exposures. Heartland Study Progress We have been successfully enrolling 15 or more pregnant participants each month into The Heartland Study for the past several months, with almost 300 Mother-Infant Pairs enrolled so far. Our newest study site at Gundersen Medical Center in La Crosse, Wisconsin should begin enrolling pregnant women in September. Welcome to the team, Gundersen! We recently sent the first batch of Heartland Study urine samples to be evaluated by the Center for Toxicological Research (CTQ) in Quebec, Canada, our analytical partner for herbicide exposure assessments. To our knowledge, no one has run any urine sample tests with a method capable of quantifying low-levels of dicamba. A first batch of Heartland Study urine samples have been sent to our analytical lab, CTQ in Quebec, Canada. At HHRA’s request, the great team at CTQ has developed a new method that detects dicamba, 2,4-D and 11 other pesticide analytes in urine. Our Heartland Study will include the first large-scale study of dicamba in human urine conducted anywhere in the world. Previously there was no practical, vetted method for quantifying dicamba in urine, which is why there are no data on dicamba in urine accessible to regulators or public-health scientists. This is a consequential data gap given that the use of dicamba has risen more rapidly in the last five years than any other herbicide. “The new dicamba method may be one of the most significant enhancements in herbicide analytical chemistry methods in decades,” says HHRA Executive Director Charles Benbrook. Looking Ahead Boston here we come! We are exited to be hosting a session at the American Public Health Association annual conference this November with some of our Alliance partners: • Cynthia Curl: Associate Professor, School of Public Health and Population Science Director, Center for Excellence in Environmental Health & Safety, Boise State University • Daniele Mandrioli, MD, PhD, Director Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bologna, Italy • Marlaina Freisthler, JD, MPH, George Washington University • Philip Landrigan, MD, MSc, FAAP, Director, Global Observatory on Planetary Health, Boston College The special 90-minute session during the APHA annual meeting will discuss recent advances in methods available to epidemiologists to assess linkages between herbicide use and exposures and adverse birth outcomes, reproductive problems and chronic illness. The experts will provide an overview of ongoing, prospective birth-cohort studies and toxicological investigations. The panel will describe how integration of research tools and insights from multiple disciplines can accelerate progress in understanding how herbicide exposures may impair sperm quality, reduce fertility, increase adverse reproductive outcomes, and trigger microbiome dysbiosis, neurodevelopmental deficits, and chronic disease. We hope to stress the importance and the need for new investments in biomonitoring and larger birth-cohort studies, coupled with developmental assessments of newborns and children through adolescence and into adult life. We are looking forward to bringing our work to the broader public health community!

  • Better Late Than Never: Farmers, Ag Scientists and the Public Health Community Come Together in Iowa and Pay Tribute to a Sustainable Ag Pioneer

    By: Audrey Tran Lam and Chuck Benbrook “I have been trying to bring together farmers and the public health community in Iowa for my whole career and tonight it finally happened.” This is what one attendee told the HHRA team at the end of our May 3, 2022 reception in Ames, Iowa. Our reception was a tribute to sustainable ag pioneer, Fred Kirschenmann. It was sponsored by HHRA, Practical Farmers of Iowa, and the Farming for Public Health program (FFPH) at the University of Northern Iowa. HHRA Board member, Audrey Tran Lam, manages the FFPH and helped organize HHRA’s participation in the 2022 annual Public Health Conference of Iowa (PHCI). The epicenter of herbicide-intensive weed management in the Heartland seemed the right place to debut HHRA science, and the beginning of the herbicide spray season a fitting time to do so. The pictures accompanying this blog capture the meeting’s good energy and fellowship. During the conference a steady flow of public-health practitioners stopped by the HHRA booth and engaged our dynamic duo, Grace Koch and Molly Funk, in dialogue about HHRA and the Heartland Study. Many of these public health professionals had either historic roots in farming, or were farmers themselves. The genuine interest in bringing a public health lens to agricultural practices in Iowa was inspiring. Interactions at our booth sparked discussions about farming, public health, climate change, soil health, environmental justice and more. We handed out HHRA and Heartland Study materials to public health professionals from all backgrounds and specialties. A bagful of certified organic mini-chocolate bars disappeared as fast as Grace and Molly could replenish the supply! Many people stopping by our booth shared  personal stories about times they were sprayed with pesticides, or smelled that smell in the air, or wondered whether their water was safe to drink. Others told us about a family member (or members) or friends with cancer. One woman told us about a farm family she knew in which three members had been diagnosed with the same cancer over a two-year period. They lived on a farm with pesticides in the well water. At our booth, questions were raised almost non-stop about whether pesticides might be playing a role in some of the health problems that seem on the rise in Iowa. Exposures through drinking water came up over and over. As important as water is as a route of herbicide exposure, we were struck by the fact that very few people were aware that many Iowans, and most people in farm country, are breathing in air laced with a pinch of volatile herbicides on many days from mid-June through August, and have been doing so since 2017. During the HHRA and FFPH co-led concurrent session, the Iowa public-health community was understandably troubled upon hearing some of what we had to say, but many expressed gratitude that Iowa’s #1 industry had made it onto the agenda of their state’s annual meeting of public-health practitioners. For most of the ~400 people at the May 3-5 meeting, it was the first in-person professional meeting since Covid shut down travel and large gatherings. HHRA was the “Keynote Sponsor” for the meeting. It was a great investment that provided us the opportunity to introduce HHRA and the Heartland Study to conference attendees at the beginning of each day’s plenary session. On day one, Chuck Benbrook covered HHRA and HS basics and invited all attendees to our reception that evening — the tribute for Fred Kirschenmann.  Chuck also pitched our substantive session Wednesday morning entitled “Iowa-Centric Public Health Challenges in the Wake of Rising Herbicide Use.” And – impressing his staff – he did so in just over his allotted three minutes! Audrey Tran Lam opened the plenary on day two with a deeper dive on why she was pleased to introduce her Iowa public-health colleagues to the Heartland Study and HHRA science, and why she hoped this would be the beginning of an information-rich and sustained conversation. A Special Tribute The highlight of the trip, though, was the reception and tribute for Fred Kirschenmann. Fred is well into his 80s and retired last year after nearly 25 years at Iowa State University. For many of those years, Fred was the Director of the once-world renown Leopold Center for Sustainable Agriculture at Iowa State University, where the conference was held. Despite the Leopold Center’s many valuable, practical, and appreciated contributions to farmers and farming in Iowa, the political powers-that-be in Iowa incrementally dismembered the Leopold Center, diverting and/or cutting funding and staff positions, ending programs and driving away faculty that wanted to work with the Center. Now, there is no Leopold Center and Iowa State University — and Iowa — is the lesser for it. Upon Fred’s retirement from ISU there was no celebration honoring his contributions to the institution, to the many students and faculty who worked on Leopold Center projects, and to people across the country and around the world who benefitted for a half-century from Fred’s unselfish sharing of knowledge and insight, connections and wisdom, all deep-rooted and time-tested. It was an honor for HHRA, PFI and the FPHP to host the tribute for Fred. Many of his friends and colleagues at ISU attended and took advantage of the opportunity to tell Fred how deeply his work and fellowship was valued and appreciated. In addition to the familiar faces at our reception, there was an impressive turnout from national and local public and environmental health officials interested in learning more about the mark Fred left on sustainable agricultural practices, as well as the many ways in which farming impacts the health of the communities they serve. Fred’s message at the close of his remarks was classic Fred. There is still much work to do and the only way to tackle it is through new connections, cooperation, and community. Three words that sum up a life’s work well done and also capture, succinctly, why we traveled to Iowa. 

Healthcare Triage Q&A with Dr. David Haas

Dec 22nd, 2021
This November, Heartland Study lead researcher and HHRA board member (ex-officio) Dr. David Haas joined Healthcare Triage podcast host Dr. Aaron Carroll to discuss the possible impacts of rising pesticide use on public and obstetric health. The Healthcare Triage podcast is sponsored by HHRA research partner the Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care. 

Carroll: Welcome back to the Healthcare Triage Podcast! Today we have a returning guest David Haas. He’s the [Robert A. Munsick] professor of obstetrics and gynecology and vice chair for research in the department of obstetrics and gynecology at Indiana University School of Medicine.

I hoped you might first, like we always do, talk about what you do and how you got there? What made you decide you want to be a doctor? Then into OB/GYN and from there to get involved in research and in the areas you’re interested in researching?

Haas: I never really had that sort of lightning bolt moment that said I wanted to be a doctor. It just sort of came to me one day in high school and I thought, sure, that sounds like a cool thing to do. It sort of happened that way and everything went well for me then during medical school as I was going through my rotations. As you know, you know you rotate in all sorts of different specialties and really it wasn’t until the end of my third year, when I got to the OB rotation and didn’t really have any desire to do it, but it had everything I wanted in medicine. It had some primary care. I loved to operate and then there’s just nothing like delivering babies and so it was exactly what I wanted to do.

When I came home halfway through the rotation and told my wife she said “you know you’ve been happier in this rotation when you’ve come home and more excited to talk about your days than you had on any other rotation” and so she sort of figured I was going to lean that way too.

During residency I just wanted to answer the “why questions.” There were so many things we didn’t know, so I really got bit by the research bug in that way. Trying to answer those questions about why we do things, the way we do things, and how can we improve outcomes?

Carroll: So what do you like to focus on in those areas with respect to trying to improve outcomes? What specifically are you interested in?

Haas: I am a general ob gyn so I like all of obstetrics and gynecology, but in the research area I am mostly focused in obstetrics in improving pregnancy outcomes and reducing risks so that at the end of the day everybody’s goal is a happy mom and a happy baby. If we can achieve that and if we can find ways to help us achieve that for this new family, that’s really the goal.

Carroll: One of the things that has been making the news recently and I’ve been reading about is plastics and concerns about some different kinds of chemicals or exposures and how those would relate to pregnancy. I know you do work in this area, specifically something called The Heartland Study, so I was hoping you could tell us a bit about that and a bit  about whether I should be worried about these things.

 Dr. David Haas is an ex-officio member of HHRA’s Board of Directors and one of the Co-Principal Investigators of The Heartland Study.

Haas: The Heartland Study is a new study that we started just about a year ago. We’ve recruited over 100 women here at IU. So far the plan recruitment is to recruit 2000 women and we’re really trying to expand into the whole state because we want rural women who are pregnant to also be in this cohort as well. It’s really about environmental exposures. It’s not necessarily as much plastic, but it is pesticides. Really looking at how farmers are waging this war against weeds and against insects and other pests and what are those chemicals that are helping increase crop yields doing to our health? So what we’re doing is recruiting a cohort of women that’s going to be multiple sites across the Midwest. We are really trying to understand and measure these pesticide levels in pregnant women’s urine and then also look at the pediatric outcomes and follow these kids out for several years to look at what kind of developmental impacts the exposures may have.

Carroll: When we’re talking about pesticides and exposure to them,  is it that these mothers live near farmland where water runoff or other things are leading to their exposure, or is it that it gets on food in general and no matter where you live you’re going to get exposed, or is it something else?

Haas: Short answer is yes to all of those. We know that these are sprayed on crops and they get into the environment that way, but most of the exposure for women, for instance in a downtown urban area, is going to come from food. We also know some of these environmental exposures happen just in dust particles that travel around. So there’s a lot of different ways that people can get exposure and that’s one of the reasons why we’re doing the study and taking really detailed histories of what you eat. We’ve worked with some of our environmental health folks here at IU in the past looking at how we can understand where your water source is. Are you on well water? Are you on city water? And what are the ways that you might be exposed to these things? We know that exposure is really common and we want to understand what those concentrations look like for women and for their babies, and what potential impacts it could have on the pregnancy outcomes.

Carroll: So are you just doing questionnaires or are you actually having to travel and test people’s food and water and what they’re consuming?

Haas: Right now it’s with questionnaires, however as we move along in the project it’s something we may think about. If we’ve got pockets of participants who are in different areas we may go out and measure those things. We would have to get funding for that but that is something that’s in the back of our minds to do.

Carroll:  Are you also looking at air quality and things like that, or is it for the most part just food at the moment?

Haas:  Most of it is food. However,  we’re getting addresses for all of these participants so we’ll be able to go into public ag databases and other air quality databases to look at some of those things based on their location physically.  We’re looking at the various common outcomes that we look at in pregnancy preterm birth growth restricted babies: preeclampsia, gestational diabetes, and then how the babies will grow and develop. That’s the phase two component of the project.

Carroll: Are you expecting to find that there are serious problems? I mean, is this one of those where I’d be horrified to learn that people are consuming chemicals and then there are bad outcomes, or are these things incredibly rare and you’re trying to fix things at the margins from other work that’s been done?

Haas: We know that a lot of these substances are very prevalent in the urine, particularly in women in Indiana since we are such an agricultural state. There have been some association studies that have pointed to potential exposures with increased risks of some pregnancy outcomes that are things like growth restricted babies and shorter gestational length. So what we want to do is, in a bigger study and a little bit more robust of a study, to measure these concentrations to see if it’s just any exposure or if there’s a dose effect exposure that the higher your concentrations of these chemicals in your urine are the worse your outcomes might be.

Carroll: Do you envision that the outcomes from this would be telling people to eat or live differently, or would be to change regulations and how we actually use some of these chemicals?

Haas: It is very possible that some of the information that we are able to gather from this could definitely inform public policy and could inform people’s choices. We want to make sure we have good rock solid data before we start to get into any kind of other public education and advocacy work. But that is part of our funding agency who’s funding this project, the Heartland Health Research Alliance. They definitely have an eye to that next step, as to how do we get science translated into society?

Carroll: Is there a lot of variation between how farmers use these chemicals? Or I mean to the point where you need to know, okay it’s not just that you ate a lot of vegetables, but that you eat a lot of carrots and it’s this kind of carrot and that carrot comes from this farm?

Haas: We aren’t capturing which farms these things come from, although that may be a component we need to look at in the future. However, our dietary questionnaire is pretty detailed about which vegetables and which components and how much of your diet is quote unquote organic and where does that come from.

Carroll: How many moms and babies do you have to enroll in order to get some good data on this?

Haas:  We are planning to enroll 2,000 women and mother-infant pairs, so we are at the very beginning. We will be recruiting other hospitals through the Midwest likely in the next year or so. We’ve just recruited a hospital system in Wisconsin to help us as well. We’re also working with Franciscan Health down on the southside of Indianapolis. It’s going to be a large cohort and nothing like this has really ever been done in the Midwest. We are also looking at some samples that we received from the nuMoM2b, which was a really large [10,000-participant] first-time pregnant women study. We’re analyzing those specimens right now to see what the exposure may have been when nuMoM2b was done back in the 2010 to 2013 range. We do know that the usage of these pesticides is going up as they’re trying to counteract resistant weeds, so there’s a lot of work and a lot of interest.

Carroll:  Are you looking for outcomes just around birth, or are you going to follow babies further out once they are born?

Haas: Once they’re born we’re definitely going to be following the babies. That’s one thing I’ve always struggled with in obstetric research, is that the minute we hand the babies off to the pediatricians we sort of stop. So there’s a lot of push nowadays in obstetric cohorts to follow these kids out longer term. In The Heartland Study we’re absolutely going to plan following these kids for at least three years of life and see how it goes.

Carroll: How do you get women to enroll? Is it that they have to be taken care of by certain physicians or certain places, or is this the kind of thing with pregnant women no matter where they are no matter what they’re doing?

Haas: Now that we’re talking about collecting things at a distance, patients could get more involved in research. For many of our projects we will take anybody who wants to sign up. A lot of our cohort studies like Hoosier mom’s cohort, like The Heartland Study, are listed on the research at IU sites. For the all-in for health, those kinds of recruitment sites anybody is welcome to reach out to us here at the department and we can definitely get you enrolled. Particularly for The Heartland Study we want rural participants. We’d love to have at least 20 to 30 percent of our participants be out in the Heartland, in the farming communities, in rural communities. We know that there’s exposure in downtown Indianapolis, but we also know there’s exposure, and looking for how much of exposure, is a difference in rural areas. We’ve had all of these great processes that we’ve not necessarily perfected, but we’ve really improved upon how we do distance research. We can send things to you so you can send us your bio specimens back. There’s a lot of remote work that we can do for participants in various areas of the state and even if we have to see a participant physically to take their blood pressure or to do something like that, we can figure out ways to get that done. There’s a push through the CTSI and IU health and other health systems to see how we can get research resources in other areas of the state that we could have various hubs around to really make this a more robust research endeavor.

Click here for the full interview on Healthcare Triage Podcast

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