The briefing is a traditional kick-off event to mark JP Morgan week in the City, a time when hotel rooms go for $1,000 a night and just reserving a table in the lobby for meetings can set you back hundreds of dollars. Fortunately, the ARM briefing is free. And worth every penny.
Lambert ran down the numbers that highlighted how the field is growing and expanding:
987 companies world wide – most of those in the US
1,000 + clinical trials
$9.8 billion in revenue/investments
Saying “for many of these patients these therapies don’t just bring improvements, they bring dramatic improvements” Lambert pointed out that when those 1,000 clinical trials are fully enrolled it will mean 60,000 patients getting stem cell and gene therapies. She says it’s estimated that in the coming years around half a million patients in the US alone will get one of those therapies.
More and more of the clinical trials are at advanced stages:
100 Phase 3
591 Phase 2
381 Phase 1
The biggest sector for clinical trials is cancer, but there are also substantial numbers for central nervous system therapies, muscular skeletal and even rare diseases.
Lambert said there are two key issues facing the field in the coming year. One is improving the industry’s manufacturing capability to ensure we are able to produce the cells needed to treat large numbers of patients. As evidence she cited the fact that Pfizer and Novartis are investing hundreds of millions of dollars in in-house manufacturing facilities.
The second key issue is reimbursement, so that companies can get paid for delivering those treatments to patients. “There is appetite and interest in this from people around the world, but right now most conversations about reimbursement are taking place one at a time. We haven’t yet evolved to the point where we have standard models to help get products to market and help them be commercially successful.”
The forecast for the year ahead? “Sunny with some clouds. 2019 was a year of significant growth and we enter 2020 with hopes of continued expansion, as we look to grow the impact on patients.”
One of the favorite
events of the year for the team here at CIRM is our annual SPARK (Summer Program to Accelerate
Regenerative Medicine Knowledge) conference.
This is where high school students, who spent the summer interning at world
class stem cell research facilities around California, get to show what they
learned. It’s always an engaging, enlightening, and even rather humbling
The students, many
of whom are first generation Californians, start out knowing next to nothing
about stem cells and end up talking as if they were getting ready for a PhD.
Most say they went to their labs nervous about what lay ahead and half
expecting to do menial tasks such as rinsing out beakers. Instead they were
given a lab coat, safety glasses, stem cells and a specific project to work on.
They learned how to handle complicated machinery and do complex scientific
But most importantly
they learned that science is fun, fascinating, frustrating sometimes, but also
fulfilling. And they learned that this could be a future career for them.
We asked all the
students to blog about their experiences and the results were extraordinary.
All talked about their experiences in the lab, but some went beyond and tied their
internship to their own lives, their past and their hopes for the future.
Judging the blogs
was a tough assignment, deciding who is the best of a great bunch wasn’t easy.
But in the end, we picked three students who we thought captured the essence of
the SPARK program. This week we’ll run all those blogs.
We begin with our
third place blog by Dayita Biswas from UC Davis.
Personal Renaissance: A Journey from
Scientific Curiosity to Confirmed Passions
As I poured over the pages of my
battered Campbell textbook, the veritable bible for any biology student, I saw
unbelievable numbers like how the human body is comprised of over 30 trillion
cells! Or how we have over 220 different types of cells— contrary to my mental picture of
a cell as a circle. Science, and biology in particular, has no shortage of these
seemingly impossible Fermi-esque statistics that make one do a
My experience in science had always been studying from numerous textbooks in preparation for a test or competitions, but textbooks only teach so much. The countless hours I spent reading actually demotivated me and I constantly asked myself what was the point of learning about this cycle or that process — the overwhelming “so what?” question. Those intriguing numbers that piqued my interest were quickly buried under a load of other information that made science a static stream of words across a page.
That all changed this summer when I
had the incredible opportunity to work in the Nolta lab under my mentor,
Whitney Cary. This internship made science so much more tangible and fun to be
a part of. It was such an amazing
environment, being in the same space with people who all have the same goals
and passion for science that many high school students are not able to truly
experience. Everyone was so willing to explain what they were doing, and even
went out of their way to help if I needed papers or had dumb questions.
This summer, my project was to create embryoid bodies and characterize induced pluripotent stem cells (iPSCs) from children who had Jordan’s Syndrome, an extremely rare neurodevelopmental disease whose research has applications in Alzheimer’s and autism.
I had many highs and lows during this research
experience. My highs were seeing that my iPSCs were happy and healthy. I
enjoyed learning lab techniques like micro-pipetting, working in a biological
safety hood, feeding, freezing, and passaging cells. My lows were having to
bleach my beloved iPSCs days after they failed to survive, and having
unsuccessful protocols. However, while my project consistently failed, these
failures taught me more than my successes.
I learned that there is a large gap
between being able to read about techniques and being “book smart” and actually
being able to think critically about science and perform research. Science,
true science, is more than words on a page or fun facts to spout at a party.
Science is never a straight or easy answer, but the mystery and difficulty is
part of the reason it is so interesting. Long story short: research is hard and
it takes time and patience, it involves coming in on weekends to feed cells,
and staying up late at night reading papers.
The most lasting impact that this
summer research experience had was that everything we learn in school and the
lab are all moving us towards the goal of helping real people. This internship
renewed my passion for biology and cemented my dream of working in this field.
It showed me that I don’t have to wait to be a part of dynamic science and that
I can be a small part of something that will change, benefit, and save lives.
This internship meant being a part of something bigger than myself, something meaningful. We must always think critically about what consequences our actions will have because what we do as scientists and researchers— and human beings will affect the lives of real people. And that is the most important lesson anyone can hope to learn.
And here’s a bonus, a video put together by the SPARK students at Cedars-Sinai Medical Center.
At first glance, a scientific conference is not the place you would think about going to learn about how to run a political or any other kind of campaign. But then the ISSCR Annual Meeting is not your average conference. And that’s why CIRM is there and has been going to these events for as long as we have been around.
For those who don’t know, ISSCR is the International Society
for Stem Cell Research. It’s the global industry representative for the field
of stem cell research. It’s where all the leading figures in the field get
together every year to chart the progress in research.
But it’s more than just the science that gets discussed. One of the panels kicking off this year’s conference was on ‘Why is it Important to Communicate with Policy Makers, the Media and the Public?” It was a wide-ranging discussion on the importance of learning the best ways for the scientific community to explain what it is they do, why they do it, and why people should care.
Morrison, a former President of ISSCR, talked about his experience
trying to pass a bill in Michigan that would enable scientists to do embryonic
stem cell research. At the time CIRM was spending millions of dollars funding
scientists in California to create new lines of embryonic stem cells; in
Michigan anyone doing the same could be sent to prison for a year. He said the
opposition ran a fear-based campaign, lying about the impact the bill would
have, that it would enable scientists to create half man-half cow creatures
(no, really) or human clones. Learning to counter those without descending to
their level was challenging, but ultimately Morrison was successful in
overcoming opposition and getting the bill passed.
Temple, of the Neural Stem Cell Institute, talked about testifying
to a Congressional committee about the importance of fetal tissue research and
faced a barrage of hostile questions that misrepresented the science and
distorted her views. In contrast Republicans on the committee had invited a group
that opposed all fetal tissue research and fed them a bunch of softball
questions; the answers the group gave not only had no scientific validity, they
were just plain wrong. Fortunately, Temple says she had done a lot of
preparation (including watching two hours Congressional hearings on C-SPAN to understand how these hearings
worked) and had her answers ready. Even so she said one of the big lessons she
stressed is the need to listen to what others are saying and respond in ways
that address their fears and don’t just dismiss them.
Other presenters talked about their struggles with different
issues and different audiences but similar experiences; how do you communicate
clearly and effectively. The answer is actually pretty simple. You talk to
people in a way they understand with language they understand. Not with dense
scientific jargon. Not with reams of data. Just by telling simple stories that
illustrate what you did and who it helped or might help.
The power of ISSCR is that it can bring together a roomful
of brilliant scientists from all over the world who want to learn about these
things, who want to be better communicators. They know that much of the money
for scientific research comes from governments or state agencies, that this is
public money, and that if the public is going to continue to support this
research it needs to know how that money is being spent.
That’s a message CIRM has been promoting for years. We know
that communicating with the public is not an option, it’s a responsibility.
That’s why, at a time when the very notion of science sometimes seems to be
under attack, and the idea of public funding for that science is certainly
under threat, having meetings like this that brings researchers together and
gives them access to new tools is vital. The tools they can “get” at ISSCR are
ones they might never learn in the lab, but they are tools that might just mean
they get the money needed to do the work they want to.
From even before we were created by the passage of Proposition 71 back in 2004, the voices of patients and patient advocates have been at the heart of CIRM’s existence. Today they are every bit as vital to the work we do, and even more essential if we are to be able to continue doing that work.
In 2004, the patient advocate community recognized that the research we fund could help them or a loved one battling a deadly disease or disorder. And over the last 15 years that’s exactly what we have done, trying to live up to our mission of accelerating stem cell treatments to patients with unmet medical needs. And with 54 clinical trials already under our belt we have made a good start.
But it’s just a start. We still have a lot to do. The problem is we are quickly running out of money. We expect to have enough money to fund new projects up to the end of this year. After that many great new ideas and promising projects won’t be able to apply to us for support. Some may get funding from other sources, but many won’t. We don’t want to let that happen.
That’s why we are holding a Patient Advocate event next Tuesday, June 25th from 6-7pm in Petree Hall C., at the Los Angeles Convention Center at 1201 South Figueroa Street, LA 90015.
The event is open to everyone and it’s FREE. We have created an Eventbrite page where you can get all the details and RSVP if you are coming. And if you want to get there a little early that’s fine too, we’ll be there from 5pm onwards so you’ll have a chance to ask us any questions you might have beforehand.
It’s going to be an opportunity to learn about the real progress being made in stem cell research, thanks in no small part to CIRM’s funding. We’ll hear from the researchers who are saving lives and changing lives, and from the family of one baby alive today because of that work.
We will hear about the challenges facing CIRM and the field, but also about a possible new ballot initiative for next year that could help re-fund CIRM, giving us the opportunity to continue our work.
That’s where you, the patients and patient advocates and members of the public come in. Without you we wouldn’t be here. Without you we will disappear. Without us the field of stem cell research loses a vital source of support and funding, and potentially-life saving therapies fall by the wayside.
We all have a huge stake in this. So we hope to see you next Tuesday, at the start of what may be the next chapter in the life of CIRM.
But then came news that another big name celebrity, in this case Star Trek star William Shatner, was going to one of these clinics for an infusion of what he called “restorative cells”.
It’s a reminder that
for every step forward we take in trying to educate the public about the
dangers of clinics offering unproven therapies, we often take another step back
when a celebrity essentially endorses the idea.
So that’s why we are
taking our message directly to the people, as often as we can and wherever we
In June we are going
to be holding a free, public event in Los Angeles to coincide with the opening
of the International Society for Stem Cell Research’s Annual Conference, the
biggest event on the global stem cell calendar. There’s still time to register for that by the way. The event is from 6-7pm on
Tuesday, June 25th in Petree Hall C., at the Los Angeles Convention
Center at 1201 South Figueroa Street, LA 90015.
It’s going to be an
opportunity to learn about the real progress being made in stem cell research,
thanks in no small part to CIRM’s funding. We’re honored to be joined by UCLA’s
Dr. Don Kohn, who has helped cure dozens of children born with a fatal immune
system disorder called severe combined immunodeficiency, also known as “bubble
baby disease”. And we’ll hear from the family of one of those children whose
life he helped save.
And because CIRM is
due to run out of money to fund new projects by the end of this year you’ll
also learn about the very real concerns we have about the future of stem cell
research in California and what can be done to address those concerns. It promises
to be a fascinating evening.
But that’s not all. Our
partners at USC will be holding another public event on stem cell research, on
Wednesday June 26th from 6.30p to 8pm. This one is focused on
treatments for age-related blindness. This features some of the top stem cell
scientists in the field who are making encouraging progress in not just slowing
down vision loss, but in some cases even reversing it.
We know that we face
some serious challenges in trying to educate people about the risks of going to
a clinic offering unproven therapies. But we also know we have a great story to
tell, one that shows how we are already changing lives and saving lives, and
that with the support of the people of California we’ll do even more in the
years to come.
From Day One CIRM’s goal has been to advance stem cell research in California. We don’t do that just by funding the most promising research -though the 51 clinical trials we have funded to date clearly shows we do that rather well – but also by trying to bring the best minds in the field together to overcome problems.
Over the years we
have held conferences, workshops and symposiums on everything from Parkinson’s
palsy and tissue
engineering. Each one attracted the key players and stakeholders in the
field, brainstorming ideas to get past obstacles and to explore new ways of
developing therapies. It’s an attempt to get scientists, who would normally be
rivals or competitors, to collaborate and partner together in finding the best
It’s not easy to do,
and the results are not always obvious right away, but it is essential if we
hope to live up to our mission of accelerating stem cell therapies to patients
with unmet medical needs.
For example. This
past week we helped organize two big events and were participants in another.
The first event we
pulled together, in partnership with Cedars-Sinai Medical Center, was a
workshop called “Brainstorm Neurodegeneration”. It brought together leaders in stem
cell research, genomics, big data, patient advocacy and the Food and Drug
Administration (FDA) to tackle some of the issues that have hampered progress
in finding treatments for things like Parkinson’s, Alzheimer’s, ALS and
ambitiously subtitled the workshop “a cutting-edge meeting to disrupt the field”
and while the two days of discussions didn’t resolve all the problems facing us
it did produce some fascinating ideas and some tantalizing glimpses at ways to
advance the field.
Two days later we partnered with UC San Francisco to host the Fourth Annual CIRM Alpha Stem Cell Clinics Network Symposium. This brought together the scientists who develop therapies, the doctors and nurses who deliver them, and the patients who are in need of them. The theme was “The Past, Present & Future of Regenerative Medicine” and included both a look at the initial discoveries in gene therapy that led us to where we are now as well as a look to the future when cellular therapies, we believe, will become a routine option for patients.
different groups together is important for us. We feel each has a key role to
play in moving these projects and out of the lab and into clinical trials and
that it is only by working together that they can succeed in producing the
treatments and cures patients so desperately need.
As always it was the patients who surprised us. One, Cierra Danielle Jackson, talked about what it was like to be cured of her sickle cell disease. I think it’s fair to say that most in the audience expected Cierra to talk about her delight at no longer having the crippling and life-threatening condition. And she did. But she also talked about how hard it was adjusting to this new reality.
Cierra said sickle
cell disease had been a part of her life for all her life, it shaped her daily
life and her relationships with her family and many others. So, to suddenly
have that no longer be a part of her caused a kind of identity crisis. Who was
she now that she was no longer someone with sickle cell disease?
She talked about how
people with most diseases were normal before they got sick, and will be normal
after they are cured. But for people with sickle cell, being sick is all they
have known. That was their normal. And now they have to adjust to a new normal.
It was a powerful
reminder to everyone that in developing new treatments we have to consider the
whole person, their psychological and emotional sides as well as the physical.
And so on to the third event we were part of, the Stanford Drug Discovery Symposium. This was a high level, invitation-only scientific meeting that included some heavy hitters – such as Nobel Prize winners Paul Berg and Randy Schekman, former FDA Commissioner Robert Califf. Over the course of two days they examined the role that philanthropy plays in advancing research, the increasingly important role of immunotherapy in battling diseases like cancer and how tools such as artificial intelligence and big data are shaping the future.
CIRM’s President and CEO, Dr. Maria Millan, was one of those invited to speak and she talked about how California’s investment in stem cell research is delivering Something Better than Hope – which by a happy coincidence is the title of our 2018 Annual Report. She highlighted some of the 51 clinical trials we have funded, and the lives that have been changed and saved by this research.
The presentations at
these conferences and workshops are important, but so too are the conversations
that happen outside the auditorium, over lunch or at coffee. Many great
collaborations have happened when scientists get a chance to share ideas, or
when researchers talk to patients about their ideas for a successful clinical
It’s amazing what happens when you bring people together who might otherwise never have met. The ideas they come up with can change the world.
For years we have talked about the “promise” and the “potential” of stem cells to cure patients. But more and more we are seeing firsthand how stem cells can change a patient’s life, even saving it in some cases. That’s the theme of the 4th Annual CIRM Alpha Stem Cell Clinics Network Symposium.
It’s not your usual
symposium because this brings together all
the key players in the field – the scientists who do the research, the nurses
and doctors who deliver the therapies, and the patients who get or need those
therapies. And, of course, we’ll be there; because without CIRM’s funding to
support that research and therapies none of this happens.
We are going to look
at some of the exciting progress being made, and what is on the horizon. But
along the way we’ll also tackle many of the questions that people pose to us
every day. Questions such as:
How can you distinguish between a good
clinical trial offering legitimate treatments vs a stem cell clinic offering sham
What about the Right to Try, can’t I just
demand I get access to stem cell therapies?
How do I sign up for a clinical trial, and how
much will it cost me?
What is the experience of patients that have
participated in a stem cell clinical trial?
researchers will also talk about the real possibility of curing diseases like
sickle cell disease on a national scale, which affect around 100,000 Americans,
mostly African Americans and Hispanics. They’ll discuss the use of gene editing
to battle hereditary diseases like Huntington’s. And they’ll highlight how they
can engineer a patient’s own immune system cells to battle deadly cancers.
So, join us for what
promises to be a fascinating day. It’s the cutting edge of science. And it’s
To Mend: (verb used with object) to make (something broken, worn, torn or otherwise damaged) whole, sound or usable by repairing.
It’s remarkable to believe, but today doctors literally have the tools to repair damaged cells. These tools are being used to treat people with diseases that were once incurable. The field of regenerative medicine has made tremendous progress in the last 15 years, but how did these tools come about and what is the experience of patients being treated with them?
These questions, and hopefully yours too, are going to be answered at the fourth annual CIRM Alpha Stem Cell Clinics Symposium on April 18, 2019 at the University of California at San Francisco.
The symposium is free, and the program is designed with patients and the public in mind, so don’t be shy and put your scientific thinking caps on! A complete agenda may be found here
Perhaps one of the most remarkable discoveries in the past decade are new tools that enable doctors to “edit” or correct a patient’s own DNA. DNA correction tools came about because of a remarkable string of scientific breakthroughs. The symposium will dive into this history and discuss how these tools are being used today to treat patients.
One specific example of the promise that DNA editing holds is for those with sickle cell disease (SCD), a condition where patients’ blood forming stem cells contain a genetic error that causes the disease. The symposium will describe how the CIRM Alpha Stem Cell Clinics Network, a series of medical centers across California whose focus is on stem cell clinical trials, are supporting work aimed at mending blood cells to cure debilitating diseases like SCD.
Doctors, nurses and patients involved with these trials will be telling their stories and describing their experiences. One important focus will be how Alpha Clinic teams are partnering with community members to ensure that patients, interested in new treatments, are informed about the availability of clinical trials and receive sufficient information to make the best treatment choices.
The fourth annual CIRM Alpha Stem Cell Clinics Symposium is an opportunity for patients, their families and the public to meet the pioneers who are literally mending a patients own stem cells to cure their disease.
The Golden State Warriors, the current US basketball champions – and your favorite Stem Cell Agency’s neighbors in Oakland – have a slogan, “Strength in Numbers”. That could well apply to the field of Regenerative Medicine because the field is growing in numbers, growing in strength, and growing in influence.
Yesterday, the Alliance for Regenerative Medicine (ARM), the organization that represents the field, held its annual State of the Industry briefing in San Francisco, detailing what happened in 2018. It was pretty impressive.
In fact, just the number of people in the room was impressive. More than 800 RSVP’d for the event, more than for any previous meeting, but even then the room was filled over capacity with many standing around the edges because there were no seats left.
ARM itself is growing, 32 percent last year, and now has more than 300 members. Other impressive numbers include:
906 gene and cell therapy companies worldwide
484 gene and cell therapy companies in the US alone
1,028 clinical trials taking place worldwide
598 of those clinical trials (58 percent of the total) are targeting cancer
59,575 patients are slated to be enrolled in those trials
All those numbers are up dramatically on last year. You can see all the details on the ARM website.
Another sign the industry is growing comes in the amount of money being invested. When people are willing to pony up hard cash you know it’s a sign they believe in you. Last year the field raised $13.8 billion worldwide, that’s up a whopping 73 percent on 2017. That represented a strong year across all fronts from corporate partnerships to Initial Public Offerings (several CIRM-supported companies such as Orchard Therapeutics and Forty Seven Inc. are in that number) and venture capital investments.
Clearly there are still challenges ahead, such as figuring out ways to pay for these therapies when they are approved so that they are available to the people who need them, the patients.
One of the issues that is going to be front and center in 2019 is reimbursement and developing new payment models. But that in itself is a sign of a maturing field. In past years the emphasis was on developing new treatments. Now that those are in the pipeline, we’re working on ways to pay for them.
My fellow CIRM team members and I just got back from two days in Sacramento where we attended one of our favorite annual events: the CIRM SPARK Student Conference. SPARK, which is short for Summer Program to Accelerate Regenerative medicine Knowledge, is a CIRM-funded education program that offers California High School students an invaluable opportunity to gain hands-on training in stem cell research at some of the leading research institutes in California.
This meeting represents the culmination of the students’ internships in the lab this summer and gives each student the chance to present their project results and to hear from stem cell research experts and patient advocates. Every summer, without fail, I’m blown away by how much the students accomplish in such a short period of time and by the poise and clarity with which they describe their work. This year was no exception.
To document the students’ internship experiences, we include a social media curriculum to the program. Each student posts Instagram photos and writes a blog essay describing their time in the lab. Members of the CIRM team reviewed and judged the Instagram posts and blogs. It was a very difficult job selecting only three Instagrams out of over 400 (follow them at #cirmsparklab) that were posted over the past eight weeks. Equally hard was choosing three blogs from the 58 student essays which seem to get better in quality each year.
Over the next week or so, we’re going to feature the three Instagram posts and three blogs that were ultimately awarded. Our two winners featured today are UC Davis SPARK student, Skyler Wong, a rising senior at Sheldon High School was one of the Instagram Award winners (see his photo above) and Stanford SPARK student Angelina Quint, a rising senior at Redondo Union High School, was one of the Blog Award winners. Here’s her blog:
Best Blog Award:
My SPARK 2018 summer stem cell research internship experience By Angelina Quint
Being from Los Angeles, I began the SIMR program as a foreigner to the Bay Area. As my first research experience, I was even more so a foreigner to a laboratory setting and the high-tech equipment that seemingly occupied every edge and surface of Stanford’s Lorry I. Lokey Stem Cell building. Upon first stepping foot into my lab at the beginning of the summer, an endless loop of questions ran through my brain as I ventured deeper into this new, unfamiliar realm of science. Although excited, I felt miniscule in the face of my surroundings—small compared to the complexity of work that laid before me. Nonetheless, I was ready to delve deep into the unknown, to explore this new world of discovery that I had unlocked.
Participating in the CIRM research program, I was given the extraordinary opportunity to pursue my quest for knowledge and understanding. With every individual I met and every research project that I learned about, I became more invigorated to investigate and discover answers to the questions that filled my mind. I was in awe of the energy in the atmosphere around me—one that buzzed with the drive and dedication to discover new avenues of thought and complexity. And as I learned more about stem cell biology, I only grew more and more fascinated by the phenomenon. Through various classes taught by experts in their fields on topics spanning from lab techniques to bone marrow transplants, I learned the seemingly limitless potential of stem cell research. With that, I couldn’t help but correlate this potential to my own research; anything seemed possible.
However, the journey proved to be painstakingly arduous. I soon discovered that a groundbreaking cure or scientific discovery would not come quickly nor easily. I faced roadblocks daily, whether it be in the form of failed gel experiments or the time pressures that came with counting colonies. But to each I learned, and to each I adapted and persevered. I spent countless hours reading papers and searching for online articles. My curiosity only grew deeper with every paper I read—as did my understanding. And after bombarding my incredibly patient mentors with an infinite number of questions and thoughts and ideas, I finally began to understand the scope and purpose of my research. I learned that the reward of research is not the prestige of discovering the next groundbreaking cure, but rather the knowledge that perseverance in the face of obstacles could one day transform peoples’ lives for the better.
As I look back on my journey, I am filled with gratitude for the lessons that I have learned and for the unforgettable memories that I have created. I am eternally grateful to my mentors, Yohei and Esmond, for their guidance and support along the way. Inevitably, the future of science is uncertain. But one thing is always guaranteed: the constant, unhindered exchange of knowledge, ideas, and discovery between colleagues passionate about making a positive difference in the lives of others. Like a stem cell, I now feel limitless in my ability to expand my horizons and contribute to something greater and beyond myself. Armed with the knowledge and experiences that I have gained through my research, I aspire to share with others in my hometown the beauty of scientific discovery, just as my mentors have shared with me. But most of all, I hope that through my continued research, I can persist in fighting for new ways to help people overcome the health-related challenges at the forefront of our society.