All Episodes

July 21, 2025 24 mins

In this episode of One Thing Trump Did, we talk about the growing number of measles cases spreading across the country, and how anti-vaccine rhetoric may be contributing to the rise in cases. Jeremy is joined by Dr. Omer Awan, a senior contributor for Forbes and practicing radiologist physician in Baltimore, Maryland who writes about issues in healthcare and public health. #measles #MMR #vaccines #antivax #RFK #HHS #health

See omnystudio.com/listener for privacy information.

Mark as Played
Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Welcome to One Thing Trump Did, available exclusively on the
Middle Podcast feed. I'm Jeremy Hobson, and as you know
if you're a regular listener, each week on this show,
we pick one thing coming out of the Trump White House,
we focus on it, we break it down in a
non partisan way with someone who knows what they're talking about.
And we know our guest today knows what he's talking
about because he's been on before. That is doctor Omer Awan,

(00:36):
senior contributor for Forbes and a practicing radiologist physician in Baltimore, Maryland.
And we're going to be talking today about the growing
number of measles cases that are being reported in communities
across the country. The outbreaks are surprised to many, considering
that the disease was declared eliminated from the United States
in the year two thousand by the World Health Organization

(00:59):
because of successful vaccination efforts, but cases have been surging
in recent months, particularly in communities that have low rates
of vaccination. Health and Human Services Secretary Robert F. Kennedy Junior,
a noted vaccine skeptic himself, recently provided an update on
the situation during a visit to the USDA headquarters in Washington.

Speaker 2 (01:19):
We've done a very very good job at controlling it.
We have all the places where there's outbreaks. The outbreaks
are actually declining, and we are also taking care of
those populations that don't want to vaccinate. Most of the
case are unvaccinated Americans. There are some populations that do
not want to vaccinate. We're making sure that there are

(01:40):
protocols for treating people who actually get measles, you know,
in the individual states. If there are issues, we are
there for them. But I we don't at this point
consider it a national emergency.

Speaker 1 (01:56):
And despite not characterizing the situation as a national emergency,
others like Democratic Senate Minority Leader Chuck Schumer, have urged
the administration to classify measles as a serious growing threat
in the country. Well, joining me now is doctor Awan.
It is great to have you back on my pleasure.

Speaker 3 (02:13):
Thanks for having me Jeremy.

Speaker 1 (02:15):
Okay, So I got to ask you this very simple
question first, and that's important because people like me who
are vaccinated haven't had to think about measles in a
long time. What is measles, what are the symptoms, and
what are the consequences of getting it?

Speaker 4 (02:28):
Well, measos is an extremely contagious virus. It's a virus,
and it's one of the most contagious viruses that we
have out there, even more contagious than COVID nineteen, the flu, polio,
I mean, you name it. It's probably more contagious than
that virus. It can spread very easily. If you're sitting
in a room where there's measles circulating and you're not vaccinated,

(02:50):
you have a ninety percent chance of getting infected. Common
symptoms are like those of the common cold really for
most people, things like fever, sore throat, cough, watery red eyes.
But in a subset of people it can really lead
to more severe and devastating symptoms, things like pneumonia for example,
which is the infection of the lung, encephalitis which is

(03:13):
swelling of the brain, even deafness and blindness, and of
course for some people death right three people have died
already from the measles outbreaks here that are spreading across America.
So definitely devastating, an important disease for us to look at.

Speaker 1 (03:27):
And how is it treated if you do get it?

Speaker 4 (03:30):
There's not much direct treatment for measles. Treatment is very supportive.

Speaker 3 (03:35):
You know.

Speaker 4 (03:35):
Really the way we try to go about treating it
is by preventing it to begin with with vaccines. So
you know, the vaccine is extremely effective at combating measles.
For example, typically people get two shots of the vaccine.
They get it when they are twelve to fifteen months
of age, and then they get a second shot when
they're four to six years of age. And even getting

(03:56):
one shot of that vaccine offers you ninety three percent
protection against the virus, and if you get two shots,
like most of us do, you're ninety seven percent protected
against getting it. So that essentially means you're more or
less not going to get measles if you have two
shots of the vaccine. Now, if you were to get
it and you're not vaccinated, treatment is mainly supportive, you know,
giving fluids, making sure that you control pain, control the symptoms,

(04:18):
and things like that. There's nothing really direct that if
you were to get it, you know, is able to
kill and tackle the virus you.

Speaker 3 (04:25):
Know, head on.

Speaker 1 (04:26):
Kind of like the early days of COVID nineteen, before
we had things like packslovid that people just you just
kind of tried to make them feel better while they had.

Speaker 3 (04:33):
It, that's right, that's right, jeer me.

Speaker 1 (04:35):
So the vaccine that we get for this is the
MMR vaccine, which is measles, mumps, rubella. This is what
we get as kids. As you say, two shots, but
years apart.

Speaker 3 (04:44):
That's right.

Speaker 4 (04:45):
Yeah, So one is when you're pretty much one years old,
and then you get another one when you're about five years old,
you know, four to six. This is part of the
childhood vaccination schedule that most people get and often a
lot of schools require you to get. So you may
have got in it just as part of having to
go to school. You know, when you go to public school,
they you have to show proof of vaccinations. MMR is

(05:07):
one of those vaccines that you know, you have to
show proof for before you, you know, can enter public schools.

Speaker 1 (05:12):
And more than ninety percent of Americans right now, I
think are vaccinated in some way.

Speaker 4 (05:17):
The rate that I've seen lately, I think is like
ninety two point seven or ninety two point three percent,
which you would think is good, but unfortunately it's not
good enough, Jeremy, because MEAESLS vaccine really requires a herd
immunity rate of ninety five percent. So what that means
is Jeremy herd. Immunity is the immunity that's conferred to
the protection that's conferring upon a general population when a

(05:39):
certain percentage of the population is vaccinated. So for measles,
that ends up being ninety five percent because it's so contagious,
we need to have a rate that high to protect
the entire population. So the fact that this rate now
is ninety two percent, that's below, you know, the ninety
five percent threshold that we need. And in some communities,
like in Texas where MELS is surging, that rate is

(06:01):
well below that is, like eighty two percent or eighty
three percent in some communities in Texas. So this is
also why measles is spreading very rapidly.

Speaker 1 (06:10):
And it started in this latest outbreak, and you talk
about Texas, it started in a Mennonite community, which I'm
thinking not very vaccinated population, just as in twenty nineteen
when there was an outbreak it started in an Orthodox
Jewish community in New York where obviously low rates of
vaccination or no vaccination. What do we know about the

(06:31):
outbreaks that we're seeing right now. Are they all connected
to the Texas cases or are they just popping up
in various parts of the country.

Speaker 4 (06:38):
They're not all connected to the Texas cases. The epicenter
we know is in Texas and New Mexico. That's where
the vast majority I mean, we have over thirteen hundred
cases now in the United States, and seven hundred and
fifty to eight hundred are just in that population, you know,
Texas slash New Mexico. And all the deaths have occurred
in that population, you know, two childhood deaths and one

(06:59):
adult death. But what we also know, and I think
the most important thing to know here, Jeremy, is that
the vast majority of these cases are in unvaccinated individuals.
You know, ninety two percent of these cases throughout America.
I'm not just talking about Texas, but throughout America are
either in unvaccinated cases or in cases that we don't
know their vaccination status. So this is a disease of

(07:21):
unvaccinated individuals. I mean, let's just be clear and simple
about it. This is occurring because vaccination race have declined
and parents are not choosing to vaccinate their children.

Speaker 1 (07:31):
There are those some cases that are happening in people
who are vaccinated. Is that just sort of because the
vaccine is not one hundred percent effective.

Speaker 4 (07:41):
That's part of it, Jeremy. So part of it is
that nothing, no vaccine is perfect. I mean MMR is
close to perfect as we get I mean ninety seven
percent protection. You can't say that for many other vaccines.
You can't say that for the flu vaccine. I mean,
I don't even thin you can say that for the
COVID vaccine. But for MMR, it's honestly one of the
best vaccines that we have in public health. Seven percent protection,
So obviously it's not one hundred percent, so some people

(08:03):
are going to still get infective. The other thing is
is that immunity does wane over time, right, I mean
everyone naturally it WANs. I mean it doesn't wane as
much for measles, honestly because the vaccine is just so
powerful and it's very effective at preventing disease.

Speaker 3 (08:17):
But it does wane.

Speaker 4 (08:18):
And the other aspect of this is that when there's
a high rate of measles viral activity in the community,
as potentially there is in Texas and New Mexico, that
can overwhelm the immune system and that can often make
you somewhat more susceptible to getting the virus. So this
is also why we're seeing some of the cases. And
also we have to talk about people that have weakened

(08:40):
immune systems to begin with. You know, people like infants
whose immune system is not developed properly, elder people with
chronic conditions who are more likely to get it, and
they can often get this. So this is why part
of the reason why we're seeing some of the new
race and part of the reason why sometimes vaccinated individuals,
although rare, can often get the infection.

Speaker 1 (08:59):
Before the vacaccination, it sounds like everyone got measles, kids
got measles, and hundreds of kids would die each year
because of it.

Speaker 3 (09:07):
That's right.

Speaker 4 (09:08):
So before nineteen fifty seven, measles was endemic. I mean,
it was widespread in America. People got it, people died,
and then honestly, even if you know the CDC recommends it,
if you were born before nineteen fifty seven, there's no
need for you to even get the vaccine because you're
likely immune to measles because.

Speaker 3 (09:24):
It was so widespread.

Speaker 4 (09:25):
But then things change when we you know, started to
give the vaccine, and now we must get the vaccine
in order to stay protected.

Speaker 1 (09:32):
So one of the things that I've read about this
is that experts like you see measles cases as a
canary in a coal mine for other preventable diseases, that
if we start seeing this, we're going to start seeing
other things. Is that just because people who are unvaccinated
for this might be unvaccinated for something else, or do

(09:52):
measles cases end up leading to other things that were
that are then going to spread on their own among
the population.

Speaker 4 (09:58):
Partly both hear me, Let me explain what I mean
by that. So the major reason is is, well, first
of all, this is already happening to other diseases. If
you take a look at whooping cough, for example, that's
also very preventable. But we're seeing thousands of new cases
every year in America because people aren't deciding to get
vaccinated right. So the DTaP vaccine prevents against whooping cough.
So this vaccine hesitancy, this increased vaccine hestency where people

(10:22):
are hesitant to vaccinate their children is leading to the
resurgence of preventable infectious diseases, among which is measles, Among
which is whooping cough, but part of it also is measles.
Measles is a really deadly and dangerous virus. So what
it does is it can attack some of your immune cells.
It can attack your T cells, which are part of
your immune defense mechanism that help prevent infectious diseases, and

(10:45):
that can wipe out your immune memory. I mean, this
is one of the only viruses that does this. And
then it can allow you or prevent you from attacking
and warding off other viruses that come. I mean, seriously,
this is what happened. This is what research has shown.
So this is why it's it's particularly important to get
vaccinated with measles. But you know, really, the reason why
we're seeing all the researches of all these other viruses

(11:06):
is because of misinformation and vaccine hesitancy. You know, people
don't really understand the importance of vaccines, the efficxy of vaccines.
There's a lot of not truce about vaccines, and people
are not vaccinating, and people are getting scared to vaccinate.
People think that these vaccines can harm them, when in fact,
these are responsible for saving a lot of lives.

Speaker 1 (11:28):
So the CDC says that vaccination is the most effective
way to prevent measles, but that a vaccine is a
personal choice. Is that not a strong enough statement for you.

Speaker 3 (11:39):
It's not because it's a new statement.

Speaker 4 (11:41):
It's a statement that's been made by our new Secretary
of Health and Human Services, Robert F. Kennedy Junior. Of course,
getting vaccinated is a personal choice. I mean, no one
can force you to get vaccinated. I mean you, and
we know that here in America, right. I mean, if
a parent doesn't want to vaccinate their child, they don't
have to by all means, they don't have to. But
I would hope that the message is a little bit
more clear and stronger and profound, particularly with what's going

(12:04):
on here. I mean, now for the first time we
have more cases of measles for the last thirty three years.
We're at risk of losing our World Health Organization elimination
status because of continuous transmission now for about seven months.
If it happens for more than twelve months, we will
lose this elimination status like in twenty twenty six. If

(12:25):
this continues till December January, it will no longer be
eradicated here. So this is a problem, definitely, no doubt
here in America. And you know, I would wish that
the messaging was a little bit more clear a little
bit more bold in stating that this is the only
way to prevent measles, and you should get vaccinated. I

(12:45):
think that's the message that I would hope to hear,
and I think that's what public health experts and public
health officials would want for communities to ensure that everyone
is safe.

Speaker 1 (12:53):
Well, we're going to talk more about the messaging and
the politics of this in a moment. One thing Trump
did with for senior contributor doctor omer Awan will be
right back. Welcome back to one thing Trump did exclusively

(13:27):
on the Middle podcast feed. I'm Jeremy Hobson. This episode,
we're talking about the growing measles outbreak in the United States,
and I'm joined by Forbes senior contributor doctor omer Awan.
So this is what Robert F. Kennedy Junior said on
Fox News in the spring quote. There are adverse events
from the vaccine. It does cause deaths every year, It
causes all the illnesses that measles itself, cause encephalitis and blindness,

(13:50):
et cetera. And so people ought to be able to
make that choice for themselves. When you hear that, it
does sound like he is not encouraging but discouraging people
from getting vaccinated for measles.

Speaker 4 (14:02):
It's very discouraging, and of course, if I didn't know
any better, I probably wouldn't vaccinate my kids either. But
everything he said is false, and I think you have
to understand that that it's simply not true. The vaccine
is extremely safe, it's extremely effective. I mean, side effects
from the vaccine would be things like, you know, pain
at the injection site, maybe a rash that would go

(14:23):
away in one or two days, redness in the area.
Certainly not blindness, deafness, or any of the more serious
things that he's talking about. It's just the data doesn't
support that. There's nothing in science that supports what he
is saying, and in fact, it's the opposite. It prevents
those things. It prevents you from getting infected, It prevents
you from ultimately getting these devastating consequences like deafness and blindness.

(14:46):
And this is the misinformation I'm talking about. The misinformation
is coming from the top, unfortunately, and it's causing vaccine
hesitancy and people are more and more skeptical to get vaccinated.

Speaker 3 (14:57):
And then what happens is that we.

Speaker 4 (14:59):
Start to get mus searches and we started to see
things that we haven't seen in over decades. So it's
very concerning, and this misinformation epidemic is fueling many of
these cases that we're seeing throughout America.

Speaker 1 (15:12):
Well, in the Wall Street Journal editorial board, which is
quite friendly to President Trump in general, wrote about this
and criticized Kennedy for saying that, but said liberals criticism
of mister Kennedy for spreading misinformation might carry more weight
with the public if they hadn't made the same criticism
against the opponents of COVID lockdowns. What do you think
about that the attack that is coming from the right

(15:33):
on this that, well, you know, people like you and
experts don't have a leg to stand on because they
thought we should be wearing masks and locking down during
COVID nineteen.

Speaker 4 (15:42):
It's unfortunate, you know, when people start to politicize certain things.
We can only speak about the facts and what we
know and the best evidence at the time. No COVID nineteen,
I mean, regardless of what you want to say about
how things were handled, and I don't believe things were
handled one hundred percent effectively during the COVID nineteen pandemic,
but vacs do save lives. I mean, if we look
at the COVID nineteen vaccine, despite it being a very

(16:04):
polarized topic and people talking about, you know, whether people
should have gone vaccinated, should there have been vaccine mandates,
research shows that it saved over you know, thirteen fourteen
million lives. I mean, that's a fact in research, right,
you know. Masking although people may not want to do it,
it does decrease the spread of infectious diseases. So, based

(16:24):
on the information that public health experts had at the time,
these were the best things to do. So to equate
the measles and how we're dealing with measles and the
vaccine with things that happen in COVID, I think is unfair.
I think it doesn't rely on evidence. And you know,
in public health we rely on evidence. We rely on
sound evidence, what the data shows that can help and

(16:45):
protect the public.

Speaker 3 (16:46):
And we know that the.

Speaker 4 (16:48):
Measles, especially measles, we're talking about a vaccine that is
ninety seven percent effective.

Speaker 3 (16:54):
That should be the message.

Speaker 4 (16:56):
The message should be getting vaccinated will essentially protect your
kid for life from getting measles in their lifetime.

Speaker 1 (17:03):
Is it possible to rebuild trust among the people who
lost trust in the health experts because of COVID nineteen.

Speaker 4 (17:12):
It is, but it's going to take time, Jeremy. I
mean this nothing is going to happen overnight. We have
to be a little bit more diligent in our messaging.
I think the data needs to be stressed. You know,
the data doesn't lie, Jeremy. You put numbers there. I mean,
this measle's outbreak is a perfect example. There are thirteen
hundred outbreaks, thirteen hundred cases excuse me, of measles here
in America. Ninety two percent are in unvaccinate individuals. I mean,

(17:34):
what does that tell you? That tells you that people
who aren't getting the vaccine are the ones that are suffering.
They're the ones that have these symptoms. They're the ones
that are at risk for having these complications. They are
the risks for dying. All three individuals that have died,
guess what, they were unvaccinated.

Speaker 3 (17:50):
Right.

Speaker 4 (17:50):
There hasn't been a single person that got vaccinated that
has died from measles currently in this outbreak that we're
seeing in America.

Speaker 3 (17:57):
So the numbers don't lie, Jeremy.

Speaker 4 (17:59):
So I think we have to really be clear about
what the data and then also be willing to have
transparent conversations, you know, instead of attacking one side or
the other. Why can't we all just sit and talk
about this in a very non partisan way. So much
of what we're doing here, I think, you know, I
think that's why I think this is great, you know,
to talk about this in a very non partisan way,

(18:20):
just talk about the facts, have people on both sides.

Speaker 3 (18:23):
You know, I would love to sit there and talk
to Robert F.

Speaker 4 (18:26):
Kennedy in a chat or something and just discuss I mean,
that would be excellent. I think that would be great
for the country, you know, to have other public experts
talked about talk to him and see what his concerns are,
so that people just really understand what's at stake here.

Speaker 1 (18:41):
There's an article in Time magazine about Kennedy and some
of the other things that he has been doing. Just
to remind our listeners, he removed all seventeen members from
a CDC vaccine advisory committee and put several members on
there who have been vaccine skeptics like him the committee.
The committee met a few weeks later. It voted to

(19:03):
stop recommending flu shots that contain an additive that the
anti vaccine movement has attacked for years despite no evidence
that it causes problems, and the committee also said it's
going to review other childhood immunizations. Are you worried about
this new panel? I mean, could this have a real
impact on the health of the country.

Speaker 4 (19:22):
Well, it's going to certainly have a huge impact on
the health of the country because this ACIP committee that
you're talking about sets the childhood vaccination schedule, so they
can do whatever they want essentially, and you know, Secretary
Candy has picked and tapped the people that align more
or less with his views, which are skeptical for a vaccine.
So my fear is that we will start to see

(19:45):
vaccines not recommended or not recommended as robustly as they
have in the past. So, yes, this will be a
major problem and we're going to start to see the
ramifications of this. There should really be I think a
more balanced viewpoints at are repor and not just those
who oppose vaccines. If you talk about you know what
you're talking about is thimersol, which is a mercury based

(20:05):
derivative in flu vaccines, and research has shown that there's
no harm in that in the concentrations that are given
in those flu vaccines. In fact, thimersol prevents you know,
multidose vials from getting contamidated from fungi and other bacteria,
so that's the reason why they put it in there.
But you know, it's only in four percent of flu

(20:27):
vaccine constituents, so it's not like it's the vast majority
of those flu shots don't even contain it. So I
think what this does is this undermines science, This underminds evidence,
This undermines trust, and this creates even more fear and
more hesitancy in vaccines. So I believe it's unfortunate. This
is my opinion. I believe it's unfortunate this is occurring.
And I don't believe this is going to restore trust

(20:50):
in science or in vaccines based on what's already currently happening.

Speaker 1 (20:53):
Okay, just to give some context here, the United States
is not the only country that is dealing with a
surge in cases of measles. It's happening in Mexico and
Canada and other places. Is that for the same reasons,
just vaccine skepticism in other countries.

Speaker 4 (21:08):
For the most part, Yes, it is. So we're talking
about social media, right, Social media travels faster than a virus.
Jare me, right, So you post something on social media.
I post something, everyone in the world can see it.
So this vaccine skepticism, this misinformation that we talked about,
is not just in America. I mean in Europe. We're seeing,
you know, cases of measles in.

Speaker 3 (21:29):
All pretty much all around the world.

Speaker 4 (21:31):
And because people have access and social media, people have
access to x to Instagram, to all of these various
platforms where people are spreading some of this misinformation and
people are trusting some of this from non experts. But
there are even doctors that say this type of stuff.
You know, there are quote unquote experts who are saying that,

(21:52):
you know, vaccines may not be safe for effect there,
or they may be saying that, you know, vaccines can
cause harm. So that causes pause to people that don't
understand this high level Jeremy right, so and understandably. So
you know, if I'm to put myself in those shoes,
if I wasn't a physician, I wasn't a public health expert,
it would probably give me pause too. I'd be like,
oh my god, wow, I have four kids. Should I

(22:12):
be vaccinating my kids? I mean this is what I'm reading.
So many people are saying this. Now there may be
an anecdotal one or two examples of this. Maybe I
shouldn't do it either, you know, so you can see
the rippling effectis can have, and you know, very easy
for people that want to do well.

Speaker 3 (22:26):
For their kids. So it's unfortunate.

Speaker 4 (22:28):
It's unfortunate that this misinformation spreads very rapidly, particularly with
social media.

Speaker 1 (22:34):
Okay, final question to you, just for our listeners. You're like, well,
I'm vaccinated. I feel like I should be fine. Are
they Is there anything that vaccinated people need to do
because of these measles cases?

Speaker 4 (22:47):
For the most part, if you're vaccinated, particularly against measles,
you should be fine. I mean, ninety seven percent protection
is ninety seven percent.

Speaker 1 (22:53):
You know.

Speaker 4 (22:53):
The other things are try to avoid overcrowded areas. If
you're in an area like Texas for example, where measles
is circulating at a high rate, potentially considered wearing a mask.

Speaker 3 (23:05):
But the vaccine is very good.

Speaker 4 (23:08):
It's literally one of our best vaccines in public health.
So I think if you've gotten two shots of the vaccine,
you've done your part. You've done your part in protecting yourself.
Part of the reason we also get vaccinated is to
protect other people. So those that can't protect themselves, elder
people that have weakened immune systems, infants who don't have
or can't get the shot and they don't have developed

(23:29):
immune systems, so that's why it's so critical. But just
being visial and making sure that you're in safe areas
and to get vaccinated, you should be good.

Speaker 3 (23:38):
That is.

Speaker 1 (23:39):
Doctor omer Awan is a senior contributor for Forbes and
a practicing radiologist physician in Baltimore, Maryland. Doctor jan thank
you so much for joining us.

Speaker 3 (23:46):
Yeah, my pleasure.

Speaker 1 (23:46):
Thanks for having me, Jeremy, and thanks for listening to
One Thing Trump did. It was produced by Harrison Patino.
Our next middle episode is coming to your podcast feed
later this week. We're gonna be talking about what can
actually be done to fix the national debt, which is
now thirty six trillion. If you like this podcast, please
rate it wherever you get your podcasts, and write a
review or theme musical was composed by Noah Haidu. I'm
Jeremy Hobson.

Speaker 3 (24:07):
Talk to you soon.
Advertise With Us

Host

Jeremy Hobson

Jeremy Hobson

Popular Podcasts

Dateline NBC

Dateline NBC

Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.

On Purpose with Jay Shetty

On Purpose with Jay Shetty

I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!

Music, radio and podcasts, all free. Listen online or download the iHeart App.

Connect

© 2025 iHeartMedia, Inc.