Digital Healthcare has gained meaningful growth in Bangladesh over the last two years amid the coronavirus pandemic. The vertical was already on the rise, thanks to growing internet and technology penetration, the pandemic has accelerated the pace.
We have seen an influx of new healthtech startups scale their operation in the past two years. Amarlab, a digital healthcare startup that provides at-home diagnostic test services, online doctor consultation, a platform for doctors to run their practices digitally among several other solutions, is among the most prominent players in the vertical. The company started with on-demand at-home diagnostics services and has since expanded to several verticals, as we mentioned above, taking the advantage of the integrated nature of the healthcare service.
Amarlab has been in the most recent cohort of Accelerating Asia, a Singapore-based accelerator and startup fund, and is in the process of raising its pre-seed and seed investments. The company now aims higher and aspires to change the overall healthcare service in Bangladesh.
We recently sat down with Amarlab Co-founder and CEO Tazin Shadid to get an insider view of Amarlab: how the company came into being, what is Amarlab, services, and products it offers, how the company operates, the state of its business today, and ambition going forward, the healthcare sector in Bangladesh, challenges early-stage founders face, and much more.
This is a fascinating read. We hope you enjoy reading it as much as we enjoyed doing it.
Future Startup: Could you please talk briefly about the beginning of Amarlab? What was the origin of the idea? What was the motivation behind it? How did you put together the initial resources to get started?
Tazin Shadid: We have been working in the health care sector for around 15 years. In 2007, my mother was diagnosed with late-stage cancer. I was working at Microsoft back then. My mother, Alhamdulillah, has miraculously survived. But those were difficult days. For the first time, I had a direct experience of going through the healthcare system in Bangladesh. Healthcare is a challenge in many countries in the world. While our healthcare system has its good sides, it is a broken system nonetheless. The experience with my mother’s illness was the first inspiration for me to start working in the healthcare sector.
In 2007, I founded a clinic to provide free medical services such as consultation, tests, etc. Dr. Ishtiaque Zahid, my co-founder at Amarlab, was the first doctor to join our clinic. Within just 10 years, we had served more than 200,000 patients in our clinic.
In 2016, I returned to Bangladesh permanently. By that time, we learned a lot about the healthcare sector in Bangladesh. We realized that lack of innovation and creativity is a challenge in the sector. It is not that we need disruptive ideas to transform the sector, rather we need comprehensive basic solutions to address the basic problems around healthcare delivery and quality services.
We realized that healthcare is not a problem for underserved people alone, it is an equally uphill battle for affluent people. We realized the challenges in the sector can’t be solved through charity work alone. We need robust initiatives to address these challenges.
Just to give you an understanding of the challenges we are facing in healthcare in Bangladesh: we have only six doctors for every ten thousand people. For every 73,000 people, there is only one medical technologist. The challenge is not only about the socio-economic issues, but also about the lack of experts and access.
It takes around five and a half hours on average to do a diagnostic test. A patient has to go to the diagnostic center, wait for hours to do the test, and once done, they have to visit the diagnostic center again later to collect the test report. This entire process is not only time-consuming but also stressful for the patients and their relatives. We thought we could do something innovative in this area to solve this problem. Therefore, I, Dr. Ishtiaque Zahid and Sabbir Amin, a friend of mine and a successful entrepreneur, started to look for an innovative solution for this problem.
There are several reasons why we choose to solve issues related to diagnostic tests first: many times patients do not complete their required diagnostic tests after being prescribed by their doctors because of the hassle involved with doing a test. It is time-consuming, difficult, and for many patients, a challenge due to their age and physical condition. In the case of elderly patients, someone needs to accompany them while going for a test. Overall, the experience of doing diagnostic tests is not pleasant in most instances.
We thought we could design a service to address these challenges where patients can get this service at home. Since we ran a clinic, we had an understanding of how this works. But we decided to understand the realities and requirements of providing at-home diagnostic services. We spent almost a year in R&D to develop our sample toolkit, develop the processes and systems, develop the user experience, etc.
While it appears like a home delivery service, it is not. This is an intimate service. Patients are allowing our people inside their houses. Our staff has to work with the patients and their family members. In hospitals, they have a convenient and straightforward working environment. But here they have to visit patients’ houses, talk with the patients and their family members and deal with any emergencies and situations that might emerge. Hence, we took a year to build our entire service and train our staff.
When we finally launched Amarlab, Tamzid Siddiq Spondon, the Managing Director of NeoFarmers and Zanala Bangladesh, took over the responsibility to run it since I and Zahid were working on other initiatives. He ran Amarlab for a year, managing the entire operation, building the MVP, and finding the initial transaction to the stage where it needed more attention. Later I and Zahid took over the responsibility and now we are working here full time. This is how we started Amarlab. We’ve learned a lot along the way.
Now we have pretty steady growth. Our month-to-month growth is around 140%. Especially when COVID hit last year, we saw a surge in demand as visiting diagnostic centers for the COVID-19 test is risky. We have done some 12,000 orders so far. Usually, when people use our service once, they never go back to the diagnostic centers again. We have also launched several other related services such as telemedicine, prescription drug delivery, etc.
We want to provide people healthcare service at their homes, within their comfort zone. From running a clinic, we have learned that the majority of healthcare services can be delivered at home with the proper equipment and preparation. Our vision is to make healthcare accessible to everyone everywhere in Bangladesh.
Future Startup: You spent a year doing R&D, what were the major challenges you faced in those early days?
Tazin Shadid: In terms of operation, we are completely different from other home-delivery services as we have to go inside the patients’ homes. Timing is an important factor in our service. While collecting samples, our staff may have to wait for 10-15 minutes for the patients to get ready. Sometimes they face some challenges such as getting interrupted by a family member of the patient while collecting samples, etc. Since our staff has to face different types of challenges while collecting samples, we focused on those issues during our R&D.
We serve four major groups of patients: the first one is the elderly patients with chronic diseases. They need to do various diagnostic tests regularly. The second group is the pregnant women. 10% of our users are pregnant women. They have to do regular diagnostic tests for about a year. The third group is the busy professionals for whom convenience and time are important. We do their tests in their offices. The fourth group is the newborn babies.
We have worked on these groups as each group has different needs. We had to figure out how to provide our service to different groups of patients.
Right now, we are working on health data. My mother miraculously survived after being diagnosed with cancer. But dealing with her medical needs remains a challenge. Still, when I take her to the doctors, I have to carry the printed copies of the diagnostic test reports of the past 15 years. I have all these documents organized in different files. We want to solve this challenge. We want to provide people with an option to record, preserve and access their health data so that they can keep track of health and do not need to carry the printed copies of their prescriptions and health records with them anymore.
Future Startup: You have come a long way from those early days, what are some of the things that have worked for Amarlab?
Tazin Shadid: One thing we have always focused on is providing a top-notch customer experience. We, me and Dr. Zahid have not only worked in Spreeha and Amarlab, but also with other clinics and healthcare providers. From our experience, we have seen that in many cases the quality in healthcare is mostly about the compassion and empathy of the healthcare providers, which can affect the overall experience of healthcare.
From day one, we have focused on our customer experience. We have seen that once someone takes our service, they do not go back to diagnostic centers. Prioritizing user experience has paid off for us. We have around 5000 recurring customers.
Our customer acquisition so far is completely based on word of mouth. We have not spent a single penny on marketing till now. We hired our first marketing person just last month.
We have focused on gaining the trust of our users. Lack of trust in healthcare providers is a major challenge in Bangladesh.
We have also focused on ensuring a safe working environment for our people. Our Chief Clinical Operation Officer is an epidemiologist. During the pandemic, our medical technologists had to visit COVID patients for testing — a high-risk job. They couldn't maintain social distance like everyone else. Having an epidemiologist in our team has helped us to manage and run our operation amid the pandemic. We have even trained our partners to deal with the current situation.
We are a passionate value-driven organization. Making money was never our driving motivation. Dr. Zahid and I have always wanted to solve healthcare problems in Bangladesh. We want to bring a change to the entire healthcare sector of Bangladesh through our work. We always welcome people who want to work and improve the healthcare sector of Bangladesh.
Recently, Amarlab has acquired a company called OnCall Medico that provides several healthcare-related solutions for doctors. For example, they have a solution through which doctors can create their website and manage their work including booking appointments, online consultation, providing digital prescriptions, receiving fees online, etc. The reason we have onboarded them is that the two co-founders of OnCall Medico are passionate about solving healthcare-related issues in Bangladesh. Their motivation and passion complement ours.
We have always focused on onboarding the right people. Even in terms of investors, we are looking for people who are not driven by business interest alone and also have experience working in the healthcare sectors in Bangladesh and abroad.
We have built a learning culture, where we approach everything with a learning mindset. Similar to Microsoft where the tech giant has shifted from a know-it all company to a learn it all company. We have tried to create a culture where we are continuously striving to be better than yesterday. We concentrate on learning to grow as an organization, team, and individual. We are always working hard to improve our service.
For example, the sample kit we are using currently is version 4 of the kit. We will soon introduce version 5 which we are developing in collaboration with PUM, a Netherlands-based organization that works with SMEs across the world. We are following the WHO standard in developing the kits. We are constantly taking feedback from the experts to make our sample kits better.
These are some major areas we have focused on which helped us to grow and come this far.
Future Startup: Amarlab has evolved a lot over the past years. You started with on-demand at-home testing service and now offer several other related services. I wanted to understand the trajectory of the company. Could you please briefly talk about the trajectory of the company from early days to where you are today? How many services were you providing in the beginning? How much has Amarlab evolved so far? To add to that, what is Amarlab now?
Tazin Shadid: Our business model has evolved gradually. Our initial idea was that we would provide service from our own lab. But we came to learn that people have their preference when it comes to diagnostic centers. Hence we turned our business model into a platform where we connect customers with our partner labs.
We have built a platform where our users can go, select a test and diagnostic center of their choosing, and we then collect the sample and get the test done from the client’s preferred diagnostic center and deliver the test report to the customer. In Bangladesh, no other platform gives you the freedom to choose a lab for diagnostic tests from multiple options and compare test prices.
Within a few months after our initial launch, we pivoted and turned Amarlab into an online platform. We focused on working with the reputed diagnostic centers in the country. We don’t work with just any diagnostic centers. We are extremely quality conscious. We are regularly onboarding more labs and scaling up our platform.
Besides diagnostic tests, we have been experimenting with multiple other solutions. For example, we have been providing telemedicine service for quite a while. As I mentioned earlier, we have acquired a healthtech company that helps doctors create and manage their digital chambers. This service has proven extremely useful for both doctors and patients amid the coronavirus pandemic. Using the solution, doctors can create their website, manage appointments, prescription — an end-to-end solution to manage virtual chambers for doctors. We have created another solution where doctors can create a chamber via zoom.
We are now working in four areas: online doctor’s consultation, diagnostic tests, prescriptions medicine delivery, and lastly, health data. Our main goal is to make these healthcare services accessible to everyone.
Future Startup: So you are partly an online marketplace for diagnostic centers and hospitals where people can take at-home diagnostic tests from their preferred diagnostic centers.
Tazin Shadid: You can say that. But we are slightly different from an online marketplace. Because in a marketplace the vendors provide the services or the products. But in our case, we are the ones who are providing the services. Labs only do the testing. After a patient chooses a lab, our staff visit their house to collect samples. We ensure the safety of sample collection. We use our own sample collection kit and process. We then deliver the test result to the customers.
However, since we connect different diagnostics centers and hospitals and give people the options to choose from them, we can be called a marketplace as well.
Future Startup: How does your relationship with lab partners work?
Tazin Shadid: We have two types of partners: regular and premium. We have 14 premium lab partners including Popular Diagnostic Centre, Ibn Sina hospital, United Hospital, Thyrocare BD, Praava Health, Dr. Lal Path Labs, etc.
We work based on a revenue-sharing model with our premium partners. Apart from that, we charge our customers a flat fee of $3 which equals 200tk for our service and sometimes we waive this fee. But that’s our other revenue stream.
While most of our lab partners are premium partners, we have some regular partners as well. We don’t earn from these partners but if our customers choose these labs, we can get the tests done from these labs.
Future Startup: How does the revenue-sharing model work? Is there any fixed rate or anything?
Tazin Shadid: The model is a bit complex which depends on the types of labs and the tests. For example, for the CBC test, the government has a fixed rate and we have to go with that. Then there are some tests that are expensive and the revenue generated for those tests is split between us and our partners. The number of customers and tests also matters here. So it varies from lab to lab.
Future Startup: How do your online consultation and other services work?
Tazin Shadid: Previously, we ran them like MVPs. Now we are integrating them with the main Amarlab platform. We used to outsource our technology development. But since we have acquired OnCall Medico, we manage our tech in-house at present. We have a strong tech team now.
We have brought all our services including video consultation, prescription, medicine delivery, diagnostic tests, etc under one platform.
Besides that the solutions OnCall Medico was providing to doctors are running and have seen excellent growth in the past months. We have integrated it with our platform so that our patients can directly connect with these doctors.
We have 70 doctors who are using the virtual chamber service using the technology developed by OnCall Medico. We have 2500 registered doctors on our platform on the telemedicine end.
Future Startup: How do you generate revenue through this service?
Tazin Shadid: It has a different revenue model. Doctors pay us a one-time setup fee to build their website and virtual chamber. We manage the payment system through the payment gateway from where we get a commission.
Future Startup: So through this service doctors can create their website and patients can directly visit their websites to book appointments. But also you have an aggregator model where you have virtual chambers for doctors registered under your platform. Don’t you think it is a bit challenging for individual doctors to get traction using his/her website if s/he is not someone really renowned?
Tazin Shadid: The 70 doctors who are using our service to manage their website are already established doctors and have a large group of loyal patients. There are very few platforms providing this kind of solution for doctors in Bangladesh. The platform makes it easy for doctors to manage their work. Using the service they can manage their online chamber besides managing their offline appointments and so on. Doctors prefer this solution because it is a one-in-all solution.
Yes, it is also true that not every doctor has a large patient base. So for them, we are building a SaaS model which will be like a marketplace where doctors will be listed and people will be able to book an appointment with their preferred doctors. This service will be provided to both individual doctors and small groups of doctors who run small chambers.
Future Startup: How does your medicine delivery service work?
Tazin Shadid: We are running this service as a pilot project. We tried out two models for this. One is the usual medicine delivery model and another one is a subscription model.
40% of our patients suffer from chronic diseases and they have to take their medicines and do tests regularly. Under our subscription model, we deliver their medicines at the beginning of the month according to their prescriptions. We have created some MVPs for this model.
We are now trying to understand whether it is good for us to do the delivery ourselves or should we partner up with third-party logistics. We are still testing out different ideas.
Future Startup: Healthcare is an integrated solution, which means it allows you to build and deliver multiple services at once. You started with on-demand diagnostic tests and have expanded into several other services eventually. While the integrated nature of healthcare allows that to happen, do you see doing multiple things at once as a challenge because these are quite big problems individually?
Tazin Shadid: Of course, it is challenging. For example, we are still trying to figure out whether we should provide our diagnostic services in one location or should we provide them in different locations. We are still testing and learning. In terms of telemedicine, we already have doctors on our platform and through the acquisition, we now have a separate platform for doctors. We are also working to connect them with our main platform.
We are planning to expand to Chittagong where we have already onboarded four labs. We have to decide in Chittagong whether to only provide our diagnostic service or also include other services. As I have mentioned before, quality is imperative for us and we want to provide our patients with an end-to-end solution. To figure out the right strategy to scale up Amarlab, we are testing out different ideas in multiple verticals. We will figure out the best strategy as we move forward.
Future Startup: How do you deal with safety issues when collecting samples from patients’ houses and then carrying them to the lab for the test?
Tazin Shadid: I think Dr. Zahid or our medical officer can answer it better. But in my opinion, this is where we differ from others. When other diagnostic centers do sample collection at patients’ houses they usually do not carry the right equipment to ensure safety measures. But we have a unique sample collection kit for that purpose which we plan to patent. It can be called our IP as we have developed it ourselves through R&D.
We have a built in waste management system in our sample kit to ensure the safe disposal of medical waste. Treating medical waste has a standard process. We have adopted those practices to ensure we are not throwing medical waste mindlessly. We have some quality procedures which we regularly maintain. Moreover, to make sure that the test reports are accurate we sometimes do testings in different labs at our own cost.
Quality remains a key concern for us. Healthcare is a sensitive service. We remove any lab from our partner list if they do not provide quality service, to ensure the best quality for our customer.
Future Startup: There is a demand for diagnostic tests everywhere in Bangladesh. Access particularly remains a challenge in remote areas, villages, and suburbs. Do you have any plans to expand to those areas? If so, how do you plan to do that since you can’t access labs in most of these areas?
Tazin Shadid: We have plans to expand across the country gradually. We have the tech to execute this expansion. Remote testing is not a new thing. We have tests that we can’t do in Bangladesh. Hospitals or diagnostics centers usually collect samples for these tests and send them abroad. For example, we have partnered up with Dr. Lal PathLabs who do high-end tests and they are mainly India-based. All renowned hospitals and diagnostic centers of Bangladesh work with them. Dr. Lal PathLabs is one of our premium partners. We also offer several health checkup packages in collaboration with them.
The point I wanted to make here is that, if we can do tests from abroad and then get the report delivered to Bangladesh, why can’t we implement the same model for the rural areas of Bangladesh?
In terms of telemedicine, Spreeha, who is our partner, has launched telemedicine services in some remote parts of Bangladesh such as Bandarban, Satkhira, etc. We have a collaboration with Spreeha. The patients from these areas can directly get a consultation from the doctors via video conferencing.
We are planning to extend our service in those areas so that we can collect samples, bring them to Dhaka for tests and then deliver the digital report of the tests to the patients in those areas. Having Spreeha as our partner is helpful as they have some healthcare programs of different categories which even include Rohingyas.
Future Startup: Could you give us an overview of Amarlab today i.e, how big is the team, how the operation works,size of your business, etc?
Tazin Shadid: We are a team of 26 people including 16 full-timers and 10 part-timers. We have a big team of medical technologists who collect samples from patients’ places. Though we have our website, in terms of healthcare service people prefer to talk with someone. We have a call center for that and people can order tests via phone.
Our Chief Operating Officer looks after our operations. We have a growth team that looks after partner growth and launching new services on our platform, etc.
We have just hired our chief marketing officer who will soon build her team.
Dr. Zahid and Dr. Sazzad look after the clinical aspects. We have a teammate who looks after our finances and regulatory affairs. Since we operate in a sensitive industry like healthcare, the regulatory affair is critical for us.
We have served 5000 customers so far. Our growth has entirely been organic through word of mouth.
We have started marketing recently. Our customer acquisition cost remains significantly low which is around $5. In the last year, we have generated some $150k in revenue. In terms of numbers, our LTV is around $180. We get a lot of recurring customers.
Future Startup: You mentioned you have built an organization which is big on learning, could you please tell us more about your culture?
Tazin Shadid: We try to work differently. We operate in a decentralized manner. All of our departments operate independently. We have a flexible work environment. As I have mentioned before, our motto is Learn it All and we try to keep that in mind while operating. Individual departments have the freedom to make their own decisions which allows faster decision making and execution of ideas
We like to try out new ideas and we are not afraid to fail. When an idea does not work, we simply move on to the next idea.
Customer experience is a big part of our culture. We try to think from our customer's perspectives and build solutions to solve their problems. We take a customer-centric approach to everything we do.
As an organization, we always prioritize empathy. We believe to develop useful solutions for our customers, empathy is a must.
Future Startup: You are expanding into multiple vertices of healthcare and have grown the business meaningfully, what are some of the major challenges now?
Tazin Shadid: One of the major challenges is learning about raising funds. We bootstrapped all our previous startups. So raising capital is a new idea for us. We had to start learning from the basics. Accelerating Asia has been super helpful in terms of guidance and technical aspects. Still, fundraising is a major challenge for us. It has been a learning curve for me. But we are in the process of closing our pre-seed round soon. In terms of investors, it is a small community in Dhaka. We are new to the ecosystem and we have just started to build a network. We have started to reach out to investors such as Bangladesh Angels, Anchorless Bangladesh, etc and we still have a long way to go.
The second challenge is hiring the right people. As we hire medical technicians, they have to go through some rigorous processes to prove their skills and just a degree is not enough for that. Having the skills alone is not enough either. As I have mentioned before, we prefer to onboard people whose vision and mentality match with ours. While recruiting someone, we have to keep that in mind.
There are some regulatory challenges. In Bangladesh, the development of the healthcare sector is still in the early stage. For example, if we want to partner up with DG Health, we have to be either a lab or a clinic, or a hospital. We can not partner up with them as a tech company. We are a member of BASIS as a tech company. But there is no category for the healthtech companies to work with healthcare-related agencies and authorities of the government.
We have both local and foreign investors and we face some challenges handling the legal issues there. Navigating these challenges takes up a lot of our time. But we are getting better gradually in terms of facing these challenges.
Future Startup: HealthTech has seen excellent growth in the past few years. The pandemic has accelerated that pace. What is your observation about the digital healthcare ecosystem in Bangladesh?
Tazin Shadid: One of the main things COVID has brought to our attention is, healthcare is a basic service and we need to focus on it. The vulnerability of our healthcare sector has been exposed because of the pandemic. I have lived in the US for about 17 years and from my experience, I can say that even in the US the healthcare sector still needs development.
The overall healthcare sector has a huge opportunity for innovation and there are a lot of things that can be done. When we talk about innovation, we usually think about advanced technologies like Artificial Intelligence. But innovation can be done on the basic levels as well. For example, in Bangladesh, the system which has been developed for the registration of the COVID-19 vaccine is more effective than the system they are using in the US. In Bangladesh, all you have to do is to register online for the vaccine, go to the vaccination center, and you are done. It can be called a digital healthcare service and through this, a lot of people have been vaccinated. We can use this system in other healthcare vertices as well. In Bangladesh, there are a lot of opportunities in the healthcare sector. We need more competitors in the digital healthcare vertical. Competition accelerates innovation and quality.
Healthcare is a hard nut to crack. Digital healthcare sector is not ecommerce. It requires credibility and we have to take a different approach to acquire clients. You can not try out healthcare services like other products you buy online. Hence people prefer to visit the same doctor again and again rather than going to different doctors. In terms of healthcare service, it takes years to build credibility and it can all be gone in a minute if you fail to provide quality service once. Hence you can not survive in this sector if you do not have patience and passion.
Future Startup: You are raising investments.
Tazin Shadid: We will raise seed funds throughout this month. We have commitments for a $200k pre-seed fund. And we are looking forward to raising another 100k. We have Accelerating Asia demo day soon.
Future Startup: What are the priorities for Amarlab in the next two years?
Tazin Shadid: We want to expand our service into three more cities outside Dhaka, invest further into growth and improve our tech stack. New investments will help us to offer more services in the future. We have a product roadmap for the next 18 months. We want to integrate all our services into one platform and build a super app to provide end-to-end digital healthcare service.
We also want to focus on the solutions we are providing for the doctors and the diagnostic centers to improve them. We are about to launch a prescription writing app for doctors soon. We have been working on it for a while now. So these are our plans for the next two years.
Future Startup: Building a business from scratch is hard. You have done it before and are doing once again now. What are some of the lessons you have learned?
Tazin Shadid: While working in Microsoft, one of the lessons I have learned was to surround myself with people who are better than me. I always keep my recruiting hat on and whenever I find anyone good, I try to hire them. Recently, Mahenaz Chowdhury has joined the Amarlab team as the CMO. I have known her for around 10 years now. She was a volunteer at Spreeha and was an HR manager at GraphicPeople before Amarlab. She got interested in healthcare and hence we boarded her. Our COO, Bishwa, whom I know through Career Key, joined Amarlab during the pandemic as Career Key decided to wind up for now and then I reached out to him as he has experience in operation management. I look out for people who are smarter than me.
I try to give people a platform where they can flourish. Our people can do things their way and are always encouraged to bring their full selves to the work. It allows me to focus on other areas. I do not have to work full-time in Spreeha for this reason.
Another lesson I have learned while working at Microsoft was to always think about getting hit by a bus scenario. My first manager of Microsoft told me that your organization should not stop operating if you are not there anymore. I carry this lesson with me to this day. In every organization I have worked in, I have tried to make it self-reliant and not dependent on one person. If anyone is not there then other people can take over the responsibilities.
Future Startup: In the process of building Amarlab, two things you have found to be beneficial which early-stage founders should be mindful of.
Tazin Shadid: Sometimes founders can get fixed into one idea and do not want to change based on the customers’ needs. Many times they blame it on the systems or other aspects rather than being open. I think being flexible is necessary. As a founder, you have to be open to learning from your customers, your team, and other people.
Building a team is important. Founders should spend dedicated time in finding, hiring, and training the right people.
A founder should focus on building the culture from day one. If you are not setting your culture right from the early days, it gets very difficult to fix later on. You have to make sure you are hiring people with the right values. Otherwise, there will be issues in the company in the long run.