 Without further due, I will introduce the first debate on technology who is in the driver's seat. In order to do this, we'll have a first introduction by Jacques Biot, born member and adviser to companies in the field of digital transformation and artificial intelligence, also well known as former president of the Eco-Politique in Paris. So this will be followed by a complimentary review of Alexandra Priet, she is the president of Al Cediaghe. This is a subsidiary of Alzen, a classified technology group focused on innovation and she has also launched a company called SkillSend, so these will be the two introductions. So Jacques, over to you. Thank you, Patrick. And so, yeah, the question is, what is the invisible hand in the healthcare market? And we're going to see that actually, there is no invisible hand in my view, and we definitely would need one, and we would need one which would be at the end of a long arm, which would have a strategic view. So basically, my paper will be about managing healthcare, the need for and the difficulty of the strategic approach. So if we just look at the situation, do healthcare systems work well? My answer, although the French are very proud about their own healthcare system, is in general, healthcare systems don't work well. There are many inefficiencies, costs are growing, burgeoning, and at the same time, a number of indicators, and we'll see that one of the difficulties is about finding good indicators of health. Indicators are not necessarily going in the right direction. And so the question is, why is that? My point is that we're going to explore the interests of the various players, and we'll see that the interests of various players are extremely different. And there is nobody in the driver's seat, as Thierry said, to really steer the issue. And one of the issues we'll see is that if you want to steer an organization or to steer a system, you need to have metrics. And we'll see that one of the big issues is that there are no recognized metrics or not enough recognized metrics in healthcare. So basically, when we start from, well, strangely enough, I've been working for 30 years about in the healthcare industry. And what strikes me, if you compare it to other high technology intensive industries like the aerospace industry or the telecom industry, healthcare is extremely fragmented still. It's extremely fragmented, especially when it comes to the provision of healthcare and to the supply of healthcare goods. If you look at basically the major players, the major health provider in the US would really earn only a very little market share of hospitals. They operate less than 200 hospitals among 5,500 facilities, which are active in the US. The top US providers are responsible for only 18% of all in patient days. And that's something which basically is in place in almost all countries. If you look at the industry of healthcare goods, drugs, or medical device, the current leader in Pharma, which is in pure Pharma, which is Pfizer, earns about 5% of the market. If you look at the medical technology industry, the top 10 earn less than 40% of the market. So very fragmented. And so, and the question is why didn't a consolidation happen like what happened in, for instance, the aerospace industry or in telecom? And we're going to see that to some extent, the market didn't play this role. And we know that the market doesn't play this role in healthcare because actually there is no consumer. There are several players. There is the patient whom I will keep for the end to talk about because he's not truly somebody who has a say on what happens to him until now. And there are prescribers and there are providers, not always the same. And then there will be payers or insurers. And this really splitting of the various functions of consumerism are the real cause for the lack of a strategy. Now, as mentioned, the issue is, first of all, how do we measure health? WHO has a very demanding definition of health, which is the fact that health is a state of well-being disregarding any question of illness or disability or whatever. So it's all I mean, health, according to the WHO definition is almost unachievable. Now, once you get one step deeper, you can discover that still for WHO and for the medical community in the world, there are today 55,000 of pathological situations. And actually, there is no ranking between these pathological situations. So 55,000 illnesses, according to the ICD, which is now going to become the ICD 11, 11th version, which will be rolled out in January 2022. And to address those 55,000 different diseases, what do we have? We have basically innovation, which is very bottom up and which is not driven by any, I would say, upper force. And those trials, I mean, there are about 350,000 clinical trials going on at any time, of which 46,000 are published currently, which all stem from initiatives, which are basically initiatives from the industry. And so you are left with a situation where you have governments or payers who have a hand on the budget, who have very little lever on how to orientate those expenses. Basically, if you're a government, what happens? You have a budget that you have to levy from tax payers or from injured people. And you have to allocate it to various silos, some of which are not flexible at all. Basically, health care provision, you know, hospitals are very heavy, I would say ships, with heavy investment and the staff. So you can't change the, basically, at a very fast pace the way in which you fund and operate hospitals. And so the only, I would say, leverage that you have short-term, if you want to curb expenses, is to cut expenses on health care goods. And so that's basically what governments do. And without really trying to set priorities, if you look at the priorities currently, I mean, WHO priorities are not disease-based. They are about health for all or health for women, adolescents and children, or health care at the time of climate change. So they are very broad and very transverse, but they don't provide a clue to industry players as to where do we want to orientate our research. And if you look at governments, it's pretty much the same. So if you're a government, you're left with your larger or smaller bulk of money, but you have little opportunity to allocate it in a different way. And the only way to do this is to cut expenses on health care goods. Now, if you are a hospital, what can you do? I mean, you earn, again, a very expensive facility. You are chasing for market share locally. You chase for recruiting or in competition to recruit good physicians, which are really the people who are going to attract patients to your place. You are potentially chasing for nurses because that's a resource which often is lacking. And you're not going to have much strategic leeway. If you want to develop a specific pathology, this may take time. If you look at the profitability of health care provision, you realize that this is the lowest profitability in all the system. It's basically depending on places in the range of just a few percentage points and very often decreasing. It's decreasing, for instance, in the US. And the only exceptions are people who are focused on some specific diseases and who address specific pathologies and try to build differentiation because they address a specific pathology. But basically, a very unprofitable, unproductive business, McKinsey showed that over the last, I think, 10 years, basically the contribution of health care to the GDP was much less than it should have been if you compare it to the increase in jobs. So health care created some growth, but basically it hired many more people and it lost productivity. So a very unproductive world in health care provision. If you are head of strategy at a pharma or at medical technology company, what do you do? I mean, you don't have any clue from governments as to where they would like you to develop things. We have a clue currently on vaccines because that's kind of, I would say, anecdotical. It's something that doesn't happen all the time. But in the stable state, there is not much orientation from governments. There are a few exceptions. There is the vaccination quest by the Bill and Melinda Gates Foundation. There are cancer plans in many countries, but not many indication. So you're left with trying to find out from the epidemiology how many patients are going to appear in a given pathology to estimate at which price you will be able to sell a potential solution. And then you are going to direct your strategy. And what has changed a lot in the world of the pharma industry is the fact that after outsourcing most of the development to large clinical research organizations, so-called CROs, now the pharma industry relies mostly on startups also to provide even the new molecular entities or the biologicals. So even the science has been outsourced, and which means that the pharma industry, which traditionally enjoys, with the exception of generic companies, traditionally enjoys high profitability, the pharma industry has shifted the risk to venture capitalists. And so they have also shifted part of the profitability towards venture capitalists, and we see a decrease in the profitability of pharma. Now the last question, so that's basically the situation. What are the solutions? Well, the solutions from my perspective, first of all, would be to agree on metrics. Because if you look at health in general, there are not many elements to measure health in a country. Or there are many indicators, but there is, of course, life expectancy. And then you're going to kind of mitigate this with disability. So you reckon in terms of disability-adjusted life years, you may use what is called quality-adjusted life years. But in the end, nobody has a clue as to whether governments should prioritize the treatment of disease A or of disease B, or of a solution which is provided in a disease rather than another one. And so the issue of the metrics, and the metrics issue, I don't have time to go into the issue of metrics in clinical trials, but the issue of the metrics is extremely difficult. If you remember that you have like 350,000 clinical trials going on, this means that you're going to have outcomes which are going to be very detailed on different endpoints, which have been defined, these per disease, and agreed upon by clinicians. But you have no clue of what should I prioritize. And this is one of the big issues of the system. And this is why the whole system is going to a situation where, of course, the economy will not be sustainable. There are 6,000 about rare diseases with high expectations from patients. And patients are organized in groups. And so when a company develops a treatment for a rare disease, patients will go to the governments and they will ask the treatment to be reimbursed. Now, most of those treatments may cost several hundreds of thousands of dollars per patient. And with a rare population of 100 patients, you end up very quickly with a few hundreds of millions of dollars for a rare disease. Times 6,000, you realize that there will be no way to address the expectations of patients. So my point, and I'd like to finish here and to leave room for the discussion. And of course, I think we can provide a lot more data to this discussion. My point is, what should be done? First of all, invest in research, in epidemiology and health economics, because this is something that not many people understand, whether in the population, in the press, in governments, in administrations. So this is a very rare, I would say, club of people who understand amongst themselves. But this is very difficult to translate. And so the idea is first, let's develop the research in epidemiology and in health economics. And then it would make sense to create some kind of a multilateral discussion, like has been suggested by Thierry this morning, truly see how we can prioritize efforts in research and development. And while of course keeping this serendipity-based research, which provides solutions to current who's, but really decide where governments should input resources instead of being always kind of forced to consider solutions that they didn't necessarily have the initiative of launching. So with this, I would like to thank you and I will be happy to answer questions later. Thank you, Jacques, for this overview of the economics of the health care activities.