The ProLife Team Podcast 64 | Tara Sander Lee | Looking at Life Scientifically

The ProLife Team Podcast
The ProLife Team Podcast 64 | Tara Sander Lee | Looking at Life Scientifically
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Hear Tara Sander Lee and Jacob Barr talk about how life begins scientifically along with other scientitic info that is helpful for PHCs.

Summary

This is Jacob Barr from the Pro-Life Team Podcast. In a recent episode, I had the enriching opportunity to speak with Tara Sander Lee, a scientist with extensive experience in pediatric disease research. Tara, currently the Senior Fellow and Director of Life Sciences at the Charlotte Lozier Institute, shared her deep knowledge on the scientific aspects of fetal development, emphasizing the undeniable fact that life begins at conception.

Tara highlighted the rapid development of a baby within the womb, noting the presence of a heartbeat just 22 days after fertilization. She stressed that this heartbeat is a clear indication of life and health. Tara also discussed the advancements in prenatal screening and the moral implications associated with it, especially the high rate of false positives in low-risk pregnancies, which often leads to unwarranted decisions for abortion. The discussion also touched upon the revolutionary field of fetal surgery, particularly for conditions like spina bifida, showcasing the distinct humanity and individuality of the unborn child.

This conversation underscored the importance of understanding the scientific truths about the beginning and development of life, emphasizing the need for pregnancy clinic leadership teams to be well-informed in these areas. The podcast aimed to dispel common misconceptions and provide a clear, scientific perspective on the miracle of life, from conception onwards.

#ProLifeTeamPodcast #JacobBarr #TaraSanderLee #FetalDevelopment #LifeAtConception #HeartbeatSignOfLife #PrenatalScreening #FalsePositives #FetalSurgery #SpinaBifida #ScienceAndLife #MiracleOfLife #UnbornChild #EmbryonicDevelopment #EthicalConsiderationsInPregnancy #AdvancementsInPrenatalCare #ProtectingUnbornLife #EducatingForLife #ScienceForLife #CharlotteLozierInstitute

Transcript

The transcript was automatically generated and may contain errors.

Jacob Barr :

Welcome to the pro-life Team Podcast i’m Jacob Barr and I’m here with Tara Sandra Lee. We’re going to be talking about the miracle of life in the very beginning moments of life through a scientific lens. So please enjoy this podcast as it talks about the miracle of life, talks about the how the heartbeat is a critical measurement of life and essential to life developing in the womb. And I hope you enjoy this scientific viewpoint and angle as we’re looking at these fundamental topics within the pro-life world. So Tara, I am really excited to have you on the Pro-life Team Podcast. Would you introduce yourself as if you were talking to a small group of pregnancy clinic leadership teams?

Tara Sander :

Absolutely so my name is Tara Sander Lee i am a scientist with 20 years experience in academic and clinical medicine with an emphasis on the cause of paediatric disease. I my training and experience as a PHD in biochemistry followed by postdoctoral training at Harvard Medical School in Boston in molecular and cell biology. And I actually LED a research lab and a clinical lab for over 15 years where I did basic science research to try to understand pediatric disease and then I actually served as Scientific Director of molecular Diagnostics at a Children’s Hospital in Wisconsin. I am currently the Senior Fellow and Director of Life Sciences at the Charlotte Lozier Institute, which is a science, which is really an action think tank in which we do science and statistics for life.

Jacob Barr :

Awesome so I wanted to start us off by asking you if you could tell us about some scientific developments that would be helpful for pregnancy clinic leadership teams to understand.

Tara Sander :

Yes, absolutely i think it’s so important for everybody to understand that the baby inside the womb is not just a clump of cells. The baby inside the womb is a living human being from the very moment of conception or fertilization when the sperm fuses with the egg. And this is a scientific fact. We know this from years of objective scientific experimentation that have demonstrated very clearly that the baby is a human being from the very moment of conception, and then that baby very quickly grows and develops throughout the stages of pregnancy i mean, we know just within the first two weeks the baby has already implanted into the mother’s womb, and that’s where the baby will stay for the rest of the pregnancy in order to gain the nourishment that he or she needs to continue to develop throughout pregnancy. We know that just 22 days after fertilization that the baby already has a heartbeat and that corresponds to actually the sixth week gestation of pregnancy, which is a different way of dating based on the woman’s last menstrual cycle. And we know that in that six week, it’s just incredible that heartbeat is not only beating, but it’s beating rhythmically at about 110 beats per minute. And then once we move on from the heartbeat, I mean, there’s just so much else going on in that the brain is developing, It’s already started to divide into its three subsections. We know that by the by the tenth week gestation that the baby is in its final week of being an embryo. And by that stage, the baby already has almost, you know, all of its organs have started to develop we know that the baby has its fingers and toes fully developed they’re already wiggling we know that the baby already has a preference for whether he or she will be left or right-handed by that week. And so it’s incredible we can know that the baby has eyelids and you know, nose and lips it’s just it’s incredible. And so we this is all within the very first ten weeks of embryonic development and then following that in the fetal development. Then that baby just continues to grow we see that by 15 weeks the baby already absolutely can feel pain. We know that baby can touch, can taste. We know that there is the baby can already undergo, if needed, fetal surgery in order to repair some birth defects if they’ve occurred, not all, but some birth defects such as spina bifida or 20 twin transfusion syndrome and because the baby feels pain, we know that they use anesthesia to help that baby from so that baby doesn’t suffer during those fetal procedures. So there’s just, there’s so much that we know about fetal development and So what we have done is we have put all those facts together into one website called The Voyage of Life. So you can go to voyageoflife.com in which you will see all these fascinating facts about the baby, the fact that the baby has fingerprints that they learn inside the womb, they practice breathing and so you can go to this website, you can go week to week and see just the baby developing from the very moment of fertilization all the way up until birth you’ll see videos, You’ll actually see footage of the actual heart beating inside the womb. And so there’s just, you know, it’s just it. We know that sometimes those that advocate for abortion will try to convince others that the baby living inside that mother is not a real human being and it’s just absolutely not true. And so we encourage people to go to voyageoflife.com just to see for themselves just the beauty of the unborn child and all these stages of pregnancy.

Jacob Barr :

Wow, what an awesome description of life going from beginning through these early stages of developing. One of the things I like about podcasts is that we can take something that we sometimes will speed right by, and we can slow it down and explore it deeper. So I’d like to try that with the very first moments of life. So what is your understanding of what happens in the very first moments of you know of from before life to when life begins?

Tara Sander :

So before life begins, I mean we know that at that point we have the sperm and the egg that are you know, they are separate cells. Ok, so they are unique, but we know that from the moment that sperm and egg unite that creates a unique single celled human being called a zygote. And so when does life begin it’s when that the two individual components, the sperm from a man and the egg from a woman, join together to form something new. And so I think what’s really important to understand is that separate from each other, they are nightlife, but only together when they come together, do they do they create a brand new unique human life unlike any other life in the world and so that’s how our creator designed it, that even when you look at the DNA that is in the sperm and the egg, it has half the amount of DNA needed to create life. And only when they come together, when the sperm and the egg come together, do they have the full complement of DNA needed to create life. And so that DNA is going to produce not only life, but that DNA is going to create all the genetic variation that we see in an individual you know, their eye color, their hair color, their physical traits, is going to determine whether they are male or that individual is going to be a male or a female because if they have two X chromosomes, they’re going to be a female if they have an X and a Y chromosome, they’re going to be a male. And so it’s just it’s fascinating to know that there is enough genetic variation in this world that no two humans ever have been or will be genetically the same. And so you know we know that at the moment that this life occurs that this then that is the that moment when that human life occurs at fertilization, then that’s when the cells then immediately start to the cell immediately starts to divide 1 cell the zygote will become two cells, then four cells and eight cells. And then that early human being is what’s going to travel through the fallopian tube and then into the woman’s womb where it will then find a place for implantation and then further growth and development will occur. So that’s what’s just so amazing you know, when we what the Holy Spirit revealed to King David, you know, thousands of years ago in Psalm one thirty nine when David wrote that we are fearfully and wonderfully made and knit together in our mother’s womb. I mean even that word, you know, knit together and or woven together like in the mother’s womb. I think it’s important to understand that when the structure for DNA was determined years later, centuries later, they actually found that DNA wraps around itself like 2. There are like 2 ribbons of DNA that wrap around themselves like ribbons and so it’s like with the Holy Spirit revealed to King David thousands of years ago, science just further confirmed years later showing that yes indeed, just in the same way that DNA is wound around itself and it actually is the blueprint for life for creating this human life that helps us. You know that defines who we are being knit together in our weathers room, you know that is indeed what we knew from centuries ago and from scripture and so, indeed, science just continues to reveal these truths to us. That these children inside the womb that are growing, are human beings from the very moment. And they’re Every single child developing inside the womb is fearfully and wonderfully made from the very first day.

Jacob Barr :

Wow, that that’s really beautiful. So some people say that it’s, well, it seems like it’s obvious that life begins at conception. But for some reason, one of the false beliefs that I think gets put forth in is that many scientists will not say that life begins at conception is that true, or do a majority of scientists actually agree that life begins at conception?

Tara Sander :

So when you so that was really interesting that there was actually a survey that was done outside of the university, a study that was done out of the University of Chicago not that long ago and the and the study was actually published. They actually performed a survey in which they surveyed biologists they surveyed over 5000 biologists from over a thousand different institutions all over the world from 86 different countries and the majority of these biologists were PhDs, held APHDA doctorate in philosophy but specifically in the Biological Sciences. And what they found when they when they asked all these individuals when does life begin. Over 96 % of those biologists agree they said life begins at the moment of fertilization, when the sperm prefuses with the egg, that is when human life begins. So if you if you ask biologists when life begins, that is the consensus because it’s based on validated scientific fact, right. This is and when you actually look at who these biologists were, you know they weren’t from a remote section of the world that you know we’re only religious or conservative or pro-life no when you actually looked at who were these biologists, the majority of them were non religious, the majority of them were liberal and the majority of them were pro-choice so when it comes to when life begins, this is not, it is not something that we just make up because it this is a scientific fact that human life begins at the moment of conception. And I think it’s also important to understand that the standard used by all biologists to an embryologist to explain the first eight weeks post fertilization or 10 weeks gestation, they use what’s called the Carnegie stages of development there are 23 very well defined stages of development that are specific milestones during that very early period of human development. And this is the standard used by all embryologists to, you know, to determine to define what human life is in those first few weeks of you know, of being alive and so I think if anybody states that, well, that’s just not true you know, there’s only a fringe group of scientists that believe that life begins at the from day one when the sperm fuses with the egg and that’s just absolutely not true, ’cause if you look at the literature, it’s very clear from textbooks, from surveys that it’s a scientific truth. And it’s the it’s the consensus of biologists that that’s when life begins.

Jacob Barr :

I’m really glad to hear that because, well, very often I feel like we’re always trying to expose false beliefs. And I think it’s a very large false belief that commonly gets put forth that it’s not settled. It seems like life, beginning at conception, is Evergreen it’s obvious, it’s logical, it’s scientific, you know, scientifically proven. And so I feel like this false belief needs to be exposed as the scientific community not agreeing with it in the scientific community overwhelmingly saying that life does begin at conception. What are your thoughts about the heartbeat and how it’s an important factor to consider and look at for determining someone’s life and how they’re living and perhaps, yeah, how? How we can measure someone’s life by their heartbeat and what that represents?

Tara Sander :

Yeah, absolutely and so, you know, you may have seen, you know, the mainstream media and, you know, there’s a, there’s a lot of, there’s a lot of individuals right now that are trying to convince people that the unborn child does not have a heartbeat. Because if they can do that, if they convince others that the baby doesn’t have a heartbeat, then they can basically convince others that it’s OK. They can justify that it’s OK to commit the act of abortion and to end a human life. And it’s important for people to understand that anytime an abortion is performed, that ends the beating heart of a child every single time, because science makes it really clear. And i can tell you this from, you know, years of studying heart development. I started, I started this work when I was at Harvard Medical School in really better trying to understand how do babies hearts develop inside the womb. And we wanted to know that question so that when things went wrong, we could better understand well what was what was supposed to happen and when they have disease, what went wrong. And so that was the purpose and I carried on this research into my own lab after I finished my training at Harvard. And so it’s very clear that the heart is the very first functioning organ in a developing baby inside the womb. And like I mentioned earlier, the heartbeat starts just 22 days after fertilization and that’s the sixth week. Gestation and you know, this is again based on scientific fact, you can look at textbooks, you can look at there’s peer reviewed literature that is accessible that is available and accessible to the public it’s called, it’s a online website called Pub Med. And so there you can see all the peer review literature and so it doesn’t take long to even just do a quick search and see that, you know, like one of the first papers that might pop up is this one that i refer to people a lot it’s like it’s a study from Oxford that says very clearly that the heart is, you know, the first organ to form in a developing human being. And why is that well, the heart has to form very early in embryogenesis that means embryo development, human development very early in human development while the baby is forming, because that baby survival requires the circulation of oxygen carrying blood throughout the rest of the body so that the rest of the organs can continue to develop the way that they should and so again, this is validated in all Embryology textbooks and so the heartbeat can actually be measured and identified in most viable pregnancies and so it’s important to understand is that the heartbeat is really a sign of health and life. And so, you know, when we look at other papers that explain in more detail, well, OK, if the heart starts to beat a day 22 in the sixth week, of gestation, like well, how fast is the heart beating? Well, that heart rate actually is beating pretty fast it’s beating rhythmically it’s actually beating during that week at about 110 beats per minute. And then it will continue to rise past 150 beats per minute just by, you know, a couple weeks later and so they actually find that slow embryonic heartbeats are associated with a worst short term prognosis so meaning that like if a baby has a good healthy heart rate, that’s a really good sign that baby is going to survive all the way through the pregnancy. If that baby’s heart rate starts to actually dip early on in pregnancy, that’s actually a sign that there might be an increased risk of that baby’s demise of natural death inside the womb. And so the overall, you know, a physician an obsession, an obstetrician watches and monitors that heart rate very early on in pregnancy because it is such an important sign of the health of that baby. And so anybody that comes back and says well that’s actually not a real heartbeats that’s actually not a real heart. It’s actually, you know, that’s it’s just, it’s absolutely just not true that the way that the baby is designed to develop is that the baby has a primitive heart, too, very early in pregnancy that is beating, and then that heart just continues to grow throughout pregnancy i mean, it’s no different than like the baby’s brain, right? Even when a child is born, a person’s brain isn’t fully developed until they’re 25 years of age so do we. Do we not call it a brain though, until 25 years of age and that’s just not true, right we call it a brain from the very moment when it starts to develop early on in pregnancy, during the embryogenesis. And it’s the same with the heart we call it a heart because it is a heart and it and it does have a heartbeat. It’s just that it’s it continues to mature as the as the baby is develops throughout pregnancy.

Jacob Barr :

Wow, that is so amazing. Yeah, I did not know that the heart was the first organ to fully develop, but it makes so much sense that it would be needed in order to pump the blood and the oxygen and the resources to the other parts of the body being developed. So what else would you like to talk about that you think a pregnancy clinic leadership team would benefit from?

Tara Sander :

Hearing, you know, I think it was really important for pregnancy care centers to understand, first of all, I thank them for all the work that they do because they are just meeting. They’re meeting families where they need it most and they’re meeting them, you know, right at the moment when they might be facing unplanned pregnancy and whatever needs that they need at the time so I just my heart goes out to them for all that they do to walk with these women and their families throughout the duration of their pregnancy. I think it’s really important for them to understand that. And i speak about this a lot because there is an increasing. There’s a lot of. There’s a there’s a lot of pregnant women that are being encouraged to undergo what’s called prenatal testing or screening. And So what this is very early on in pregnancy even women that are at low risk are really being encouraged to undergo this screening, which is called non invasive prenatal screening or testing in which they just take a small sample of blood from the mother. Because what they can do is they can screen for potential abnormalities in the baby by looking by looking at the circulating DNA for the baby inside. So it’s really quite remarkable there’s new technology that very early on in pregnancy, the baby actually has circulating DNA in the mother’s blood and so you can take a sample of that blood and you can say, OK, does this baby have a risk for Down syndrome, right, because Down syndrome is caused by an extra piece of chromosome 21 And so there they have developed screens that can be in an early way to say, OK, is this baby at risk for an, you know, for some congenital conditions such as Down syndrome or trisomy 13 or trisomy 18. And when these when these screens first started, you know, I think the heart was in the right place, they wanted to screen women that were just at high risk for carrying a baby like with Down syndrome. So for example, women that were of advanced maternal age often meaning over the age of 35 So what their purpose was that they wanted to screen these women very quickly and say does your baby have at risk of Down syndrome and if your baby is, let’s confirm that first by other more diagnostic tests and then let’s walk with you through this pregnancy and help you prepare for a baby with Down syndrome, right. That’s the best case scenario. But what has happened is that they are not, they’re no longer just screening women at high risk, They are screening all women at low risk even. And what they’re doing is that they’re being screened for case, you know, for risk, such as Down syndrome. And often they’re told that their baby has a high risk of Down syndrome. But what they’re what we’re finding is that a lot of these tests have a really high incidence of false positive, meaning that they tell the woman that she is carrying a baby with a high risk of Down syndrome when in fact that baby carries no risk at all. And so there, this is really becoming a major problem because women are feeling pressured A to have these screens and then once they receive a positive result, a lot of times they’re feeling pressured to abort the baby. And we know that babies are being discriminated and being aborted just because of a risk of Down syndrome and they’re being aborted even without further confirmation of other diagnostic tests. I mean we know just from looking at the literature that a baby that is diagnosed at risk with Down syndrome, that baby has over a 50 % chance of being aborted. Some studies show it can be as high as like 90 % chance of being aborted once there’s a risk. And so it’s really important for women to understand that especially if they’re at low risk of even having a baby with Down syndrome that if they receive a positive result from one of these screens that and this is went through the blood test that screen is called a non invasive prenatal screen NIPS or NIPT that there is actually a 50 % chance that result is wrong. That’s a that’s a really big problem you could basically flip a coin and you could you know it could be better. And so and it’s also important to know that a lot of these companies that are advertising these screens and they are not just they’re no longer just screening for Down syndrome trisomy 13 and 18, they keep expanding it’s kind of becoming an arms race they’re like expanding and offering more and more screens and for more rare disorders and the more rare the disorder is like Prater Willy or Angelman syndrome that then the risk of getting a false positive, a wrong result goes even higher the New York Times actually of all places brought this into the forefront shortly after the first of the year, this year in 2022 they published an article that really brought attention to this really big problem and then that you know, these rare tests like Preda really or Angel man, they can be wrong sometimes up to 90 % of the time. I mean it is unbelievable. So I think it’s really important that pregnancy care centers understand this whole area of prenatal screening and testing and that there is a really high chance that especially when you’re screening women that are low risk, you know there’s no, there’s no history they’re under the age of 35 There’s no other ultrasound images that suggest that there’s anything wrong that there really is a very high chance that these women are have a false positive so I think it’s really important that the pregnancy centers be aware of that so that if any family comes in and says hey I received this you know the screening test or this result saying that my baby has a chance of carrying some kind of disorder that they that they just understand that there’s a that they need to educate that. And we have resources on our website and encourage people to go to lozierinstitute.org because we’ve testified on this a lot of states are actually passing non discrimination laws that would prevent women from having an abortion just because the baby has a risk of having a disorder, a disease such or not even a disease not even a disease but you know have carrying Down syndrome. And so we’re trying to say you know this is discriminatory. First babies, you know it should not be discriminated enough against just because they have a different, they look different than us, right we are all fearfully and wonderfully made and that baby has value. They shouldn’t they a they should not be aborted just because they look or have different abilities. And then second, we testify in the States to help people understand just the limitations of these screens and of these tests so people understand the real risk of not only just, you know, of also just aborting a perfectly healthy baby that doesn’t carry any risk at all.

Jacob Barr :

That’s amazing. So what? What findings could be found through a screening that might result in a surgery or some sort of medication while the baby is still in the?

Tara Sander :

Yeah no, that’s a great question so when it comes to, let’s just use Down syndrome as an example, OK. So finding out early on you know for that family and it depends on the family, but you know it could be highly beneficial to know that early on. So that and then if it’s confirmed through other diagnostic tests then shortly after birth then the baby, you know there might be some, there might be some surgeries or interventions that the baby might need shortly after birth so then they can be better prepared for that. Ok and find maybe deliver the baby at a care center that could provide those resources and those interventions very early on. The other example is Trisomy 13 and trisomy 18 again, these disorders sometimes can be life limiting not always but sometimes there are studies that show that shortly after birth if they receive very active interventions from the care team, the medical care team that they might be able to survive longer. I mean, there are some incredible studies that show that babies with trisomy 13 and 18, if there’s a heart problem, OK, that if they, if they actually help these babies after they’re born to receive such, you know, surgical interventions to help correct their heart defect that they can lead, that they can live long lives i mean there’s some studies that show that they can live life and I think it’s their fifties i mean it’s remarkable so not for all babies with trisomy and 13 and 18, but it’s just it’s important to know that if you have this information, you’re around the right medical care team that can provide the care that baby needs. It might significantly help them live longer. Sadly for some babies knowing early on is it may not there might not be a cure but even in those cases you can help there can be healing without a cure there are resources called perinatal Hospice. So this is this is a way that hospitals can provide healing for the family while they say goodbye to their child and it’s just the it’s of course, it’s a very painful process for families to go to, but it’s a beautiful option for these families to have the care and attention that they need to just to hold their child, right, to see their child and to give them the care that they need at that time, for however long that baby is supposed to survive. So Perinatal Aspen is a wonderful option. Just a few if you know that your baby has a condition. But I also want to just go back to what I said earlier too about this amazing technologies and fetal surgery. So even though spina bifida is not ’cause, right now, there’s no known direct genetic ’cause, right so if you do one of these non invasive prenatal screens, there’s not going to be really a test or a screen you can do to say, oh, for sure there’s a genetic component this baby has spina bifida. Often Spina bifida is determined during a 20 week screen ultrasound screen in which they then can they can see that there is or even earlier I should say earlier they can even sometimes pick this up. But if you if you find through ultrasound screening that the baby has spina bifida, because of the significant advancements in spine and fetal surgery, these babies can now undergo repair inside the womb before they’re born and they’re finding that this surgery has far better outcomes than if these babies were to have surgery after birth. So there was actually this groundbreaking study that was done called the mom study, OK and it was various different fetal care centers that came together and they said, OK, what happens if we, if we have babies that we know have spina bifida, What happens if we perform surgery on them before they’re born versus babies after they’re born? The success for the babies before they were born, doing the surgery before they were born, it was so successful the outcomes were so, clearly, so much better that they stopped the clinical trial early because it wouldn’t have been moral or ethical to withhold that care from babies that were in the group to receive it after, right. So that just shows that they stopped the study early they said we’ve got to stop this we’ve got to change our standard of care and offer this to all babies inside the womb once we know that they have spina bifida because it’s just so it’s and like I said you know and they use pain medication right and these babies because they feel pain at that stage so it’s a, it’s a remarkable surgery to help these babies to walk again, to have an incredible quality of life and even save their lives in some cases. And it just reminds us of just the humanity of these unborn children, right these are separate patients when you have a pregnant mother, you have two patients, you have the mother and you have the baby. They’re two patients and so fetal surgery is probably just the most beautiful example and reminder that this is a real human being, this is a separate patient and they they’re actually being, in some cases, they’re actually undergoing this life saving surgery inside the womb. And, you know, I don’t know if you’ve seen the picture, but if you go into the Voyage oflife.com you’ll see we talk about this amazing fetal surgery. And you can see there’s a picture of a baby during the fetal surgery called the Hand of Hope because the baby’s finger is actually wrapped around the fetal surgeon’s hand during the surgery. So it’s just encourage you to really see some of those really powerful images that just remind us all the time of just the humanity of the unborn child and just how far advancements have come i mean, I think we need to remember that, you know, about 50 years ago we could barely even see the unborn child inside the womb. It was grainy black and white dots today we have amazing ultrasound that can see these babies with clarity, 3D and 4D ultrasound and that has ushered in this whole amazing era of being able to diagnose early on and then treat these babies before birth it’s remarkable.

Jacob Barr :

This is so interesting. Yeah, it makes a lot of sense to test for something that could be treated in the womb. But then it also seems like it’s a moral issue when it comes to testing for something that can’t be treated. And maybe the results would lead someone towards abortion for someone just as valuable as someone who may have had a different result. So from my understanding, the birth defect rate is like 2 point something % or less than 3 %. And it sounds like these screenings are producing a much higher percentage with all the false positives and so they just seem to be not reliable. And it seems weird to have a 50 % failure rate or even higher. That just does not seem to be helpful as a test to use or to consider.

Tara Sander :

Yeah it’s and especially among low risk women because you will see a higher chance of success amongst high risk women. But that’s what’s so, which just says it’s, you know, the fact that there’s screening actually women that are low risk to begin with and they’re the ones that face the highest risk of having that false positive.