Charles Rotimi: Panel, the first comment I have for your post
doc is, did you ask him to play the lottery?
Carlos Bustamante: Did I what?
Charles Rotimi: Did you ask him to play the lottery?
Carlos Bustamante: Did I ask him to play the lottery?
You know, that kid is so extraordinarily bright.
He had done his Ph.D. in this area, but what he does now is actually grape reading.
His actual post doc project was to develop a genetic map of grapes, that, you know, with
successful, I think there's a picture in the New York Times for those of you who are interested
in that.
Charles Rotimi: Yes.
I'm not quite sure who came first, but --
Female Speaker: Yes.
Charles Rotimi: Was the first question here?
Female Speaker: She was actually first, but...
Charles Rotimi: Excuse me?
Female Speaker: She was first.
Charles Rotimi:Who?
Linda Heywood: Here.
Female Speaker: She came before me.
Charles Rotimi: Oh.
Okay.
Go ahead.
Linda Heywood: Okay.
Thank you.
This is just -- I'm blown because now I'm thinking what about, then, climate, and all
the sort of discussions that have gone on to the early sort of adaptation to climate
which is associated with, you know, pigmentation, malaria, all of this.
Can you then kind of make that connection or disconnection so I could change some of
the way I have been saying this when I sort of just say, "Oh, if you study genetics, you
will find this, if you study geography" -- thank you.
Carlos Bustamante: Yeah, Aravinda, you want to -- I can take
it, or you can take it.
Aravinda Chakravarti: Go ahead.
Carlos Bustamante: So, I mean, it's interesting, the, you know,
I would say, if there is any dogma out there it's that Vitamin D and folate are linked
to skin pigmentation, but, in fact, it still remains this area that we don't fully have
the entire picture figured out.
And I sit on the Board of PLoS, and we get many different hypotheses, you know, trying
to link the causal relationship.
I think in this particular case, you know, it's one of those that there is an impact
on skin pigmentation as well of this allele, so --
Aravinda Chakravarti: No, but we also know that they -- that the
-- at least in human skin pigmentation, that this has -- there has been selection, and
climate and radiation has been a very, very important part of it.
But I don't want you to look at any one of these as mono-causal.
You know, with the results of forces that have gone on for a long period of time, and
presumably multiple ways of getting there.
Charles Rotimi: Okay, next question.
Female Speaker: Hi, my question is for the entire panel.
There is so much enthusiasm for people to go search for their roots, their genetic roots,
because, I guess in the last panel presentation, it helps them with their identity formation
and with being part of a, I guess, shared identity, whether it's from Africa or with
some -- trying to trace their family lineage.
And there's also evidence that this genetic stuff can be influential with health disparities
research, because I guess some -- as the presentations mentioned, there's increased variation, and
people with a certain genetic expression respond differently to certain treatment compared
to another population.
But my question is, how are you going to get some of these same populations to have the
same enthusiasm for the clinical research needed, and specifically with the clinical
research that a lot of you have done, how did you get so many people of -- so many minorities
to be -- to do the clinical research that you have done?
And how can you continue that fire for all of the other clinical research that's yet
to be done?
Esteban Gonzalez Burchard: That was easy, and I'm very proud of that
because the NIH has been moaning and groaning that we don't get minorities in clinical trials,
and you go to the good old boy networks that have all the clinical trials, and they're
all non-minority positions, and they can't tap into it.
And, you know, I was young punk that came by in 1998, and I, being Hispanic myself,
having grown up in a Hispanic neighborhood, I just knew how to go.
Get all the Hispanics on my side.
And I just got off my butt, and I went to minority-serving clinics, and, you know, low
and behold, we now have 9,000 kids.
That's the largest pediatric study in the United States of asthma.
And the NIH just invested $60 million in this study called Soul [spelled phonetically],
and they got 16,000 Hispanics.
But with my little study of $6 million we got 7,000.
So, we're doing this.
We're doing this in the minority community.
The key thing, I think, was to have good connections.
We had minority recruiters.
We had minority physicians.
I made millions of community presentations.
We got community buy-in.
We had the National Medical Association involved, which is the largest and oldest black physicians
group in the United States.
They backed us.
They're backing us now.
It just makes common sense.
It was easy for me.
Charles Rotimi: Yeah, I'd just like to add a little bit to
that from my own experience in doing studies in the U.S. and outside of the U.S.
I think it's important, the message we convey to people.
So one of the ways I say, you know, I say, if you want your clothes to fit you, you have
to show up at the tailor so you get measured.
If you don't get measured, you know, you are going to rely on other measurements.
You hope that those clothes will fit you.
That is precisely what Carlos and others on the panel have showed that there are certain
genetic variations that are specific to populations, and if those populations don't show up, guess
what?
Those clothes will not fit.
Esteban Gonzalez Burchard: Yeah.
I have to be -- we have to be mindful of Tuskegee and other atrocities.
Female Speaker: Exactly.
Esteban Gonzalez Burchard: And the Native American groups haven't participated,
but the fact is the genetic train has left the station.
And there have been a million benefits that have derived from the Human Genome Project.
Unfortunately, they are going to be applicable to just a few populations.
And it is a civil right, in my view, to participate in clinical trials, and an obligation to participate
in clinical trials, so that all of us benefit from the fruits of the Human Genome Project.
Aravinda Chakravarti: So I'm going to give you a somewhat more general
answer.
So, over the last week, you know, there has been a major report published on the status
of U.S. health.
I don't want to get political, although there is nothing you can say in this town and not
be political, so here goes.
[laughter]
So I think the bottom line, despite whoever comes from any political persuasion, is that
the U.S., among 14 other peer nations, we have the worst health and we spend the most
money.
So, whatever the wisdom is or whatever we are doing, it just doesn't work.
And there are many reasons.
Health disparities are a very big part of it.
It appears that we all ingest too many calories.
There's too much violence, meaning firearm-induced violence in home and outside.
And all of you should report -- read this report.
It is a sobering sort of review, having nothing to do with being a geneticist, or everything
to do with being a geneticist or being a health expert.
I think every American needs to read this report.
So I agree with just what Esteban just says.
I think it's an obligation for us to hold all of our politicians accountable in the
sense of, and for us, too, but it means we need to participate.
On the genetics equation, I think I have a broader view.
I don't know what's going to happen.
I wish I knew.
If I wish -- if I could wish the answer, then I think I could design the studies in a much
more simpler way.
I really think I don't know.
Genetics might be, in many cases, and in some cases, like the example you saw in PCSK9,
is probably the easiest way for us to intervene and find a drug that could affect, in that
particular case, you know, lowering the effects of the worst LDL of the worst cholesterol
in reducing heart attacks.
But in many other cases, might not be the most effective way.
There are other things we could do.
We could vaccinate every child in this country, and that could prevent other kinds of illnesses.
So I am not a genetic exceptionalist.
What I do is very near and dear to me.
But I think we need to fit genetics into the larger healthcare equation, and in that, our
ancestry will play a very strong role, be it on the gene side, be it on the environment/social
side.
And I said that what I'm going to say is going to be political because I think our healthcare
system has to embrace both.
There is no other way.
We can't just hide our, you know, ignorance by saying it is only social factors, or it's
only genetic factors.
Esteban Gonzalez Burchard: We've also got to have academic-community
partnerships, because, as you know, the number one cause of death in young black men is violence.
And there are ways that we can get around it.
We just started an academic-community partnership in San Francisco General and UCSF to implement
wrestling programs in elementary schools, which will allow kids to get out there aggression,
to have positive thinking.
And we just -- that's something that is near and dear to my heart.
It's not genetics, doesn't it get me funding, but it actually is an important contribution
to public health.
Charles Rotimi: I think we will take two, just two more questions.
Male Speaker: Yes.
Last two people.
And if you can keep it short and move forward.
Charles Rotimi: Please.
Female Speaker: Well, it depends on their answer, how long
it takes.
[laughter]
You've discussed genetics and health of Hispanics.
Now, as far as I know, there is no genetic predilection for speaking Spanish.
So what do you mean by Hispanic, and what is it that you really are looking for?
What do you think the word Hispanic is standing in for?
What is it you are actually studying?
Esteban Gonzalez Burchard: So, because the first slide I showed you about
the significant differences in the rates -- prevalence rates of asthma in the United States -- highest
in Puerto Ricans., highest in African-Americans., lowest in Mexicans -- when I was a young medical
trainee in 1997, I was very inspired by that.
And I made it my life's career goal to study that.
So we only recruited individuals that self-identified themselves and their grandparents as being
100 percent Puerto Rican, or 100 percent Mexican, or other Latinos.
Now, that is actually a beautiful population because -- and I didn't show the data, but
they're a tri-hybrid mix of Native American, European, and African.
Now, we could look at it from the purely genetic factor and adjust for those racial differences
and get down.
Chris G. Ngu [spelled phonetically], who's my graduate student here, just identified
a gene, a novel gene for asthma that tended to be -- had significant ancestry differences:
African versus Native American versus European.
I am mindful, and I try to make that clear, that this identity, this social identity of
being Puerto Rican, or Mexican, or African-American, is like a shopping cart of other social experiences.
So, like African Americans, it's not just about African ancestry.
It's the social experiences, perceived discrimination, which might lead to increased stress, which
might lead to increased blood pressure, which increases your risk for kidney disease and
heart disease.
So we try to be very comprehensive.
And that's when I started that large study, the GALA and SAGE study, we measured all those
factors.
Charles here is a big proponent of looking at the whole picture.
And I think I came to that first, and then you joined me, or -- no, I'm just joking.
No, no --
[laughter]
Charles Rotimi: [unintelligible] wrestler.
Esteban Gonzalez Burchard: No, no, no.
From an epidemiologic point of view, we try to look at the whole picture, not just "Are
you Hispanic?"
There's genetic, and social, and environment factors.
Female Speaker: Okay.
Charles Rotimi: Okay.
Last question.
Female Speaker: Yes.
This has to do with what's happening now and moving forward in terms of training, the whole
idea of who's coming through medical schools, who's coming through public health schools
and universities.
How do you see this information changing the way -- because it is slippery, and it's moving,
and it's messy, in some ways, because it's not just the science and it's not just the
genetics, but it's also culture -- how do you see this affecting the training of people
whose job it will be to do this work in the next generation?
Esteban Gonzalez Burchard: We --
Carlos Bustamante: I think it's super -- sorry.
Esteban Gonzalez Burchard: Go ahead.
Carlos Bustamante: No, I think it's fundamental.
And one of the issues that -- you know, so I run one of our T32 training grants at Stanford,
and I'm also involved with some of the NIH decision-making around training grants.
And, you know, it's a very -- in fact, that's a very political issue, right, that NIH is
now rethinking -- different institutes are rethinking where they're going to invest.
There is the sequester, there is a reduction in NIH funding.
Training is unfortunately one of the areas that will also be impacted, and I don't think
there is an easy answer except to say that if we do not train both a diverse workforce
and a workforce that can think about these problems, we are going to be in a tremendous
amount of trouble, right?
You know, our -- the proportion of GDP that gets spent on health care is just going up
and up, and it really is unsustainable.
So --
Esteban Gonzalez Burchard: You know, in 1813, all -- the number of black
physicians in the United States was 4 percent.
2013 is 4 percent.
We're doing a terrible job, a terrible job.
And, unfortunately, you guys are funding it.
And so we need to put political pressure not only on medical schools, not only on the NIH,
but we also have to work -- we have to address the pipeline issue.
It begins in grammar school.
It begins in kindergarten.
And we need those -- the Head Start programs to keep going.
Aravinda Chakravarti: So let me just add just one more thing.
I -- there is absolutely no doubt that we live in a much more complicated world, even
a more complicated academic world, let alone the world outside.
And I think there are three parts.
The science is important, I agree with you.
But I think our students are much more savvy and much more exposed to the societal aspects
of at least the information.
And the third part, which I think is really a part that's missing on much of the non-medical
science and non-medical graduates is we teach human biology only to physicians anymore.
We do not teach it to others.
And I think this mixture of teaching human biology, the much more detailed molecular
science -- by the way, that also includes quantitative thinking, as well as understanding
how the information is relevant to the world outside -- I think it's a new concept.
It is changing, but change comes slowly.
Even in Hopkins, we have a new curriculum that is called "From Genes to Society."
It's taken some time to get there.
Some have said that changing curricula is like moving a graveyard.
It's not easily done.
And -- but I think -- I think we are -- you know, this is a very, very important part.
We are not so separated from our subjects or universal community as we used to be.
Carlos Bustamante: I also want to say two things.
Number one, is that, you know, one of the agencies that is particularly under fire is
unfortunately the National Science Foundation.
I think the National Science Foundation does extraordinary work.
They are really the only agency that is taking on K-to-12 training in STEM areas.
I can say that the only reason I am in science is because I was part of the National Science
Foundation program when I was in high school, right?
If not, I was going to be a lawyer.
And also I cannot fail to mention that I was an intern in this building.
And so, you know, I think the Smithsonian and other institutions have an important role
to play as well.
And I think, you know, all STEM areas are important.
All STEM areas are great.
We should just be pushing, and pushing, and pushing, and saying, look, you cannot cut
in those areas.
It's just -- it really is about U.S. competitiveness.
Every dollar that gets spent in STEM training is returned multi-fold, right?
I mean, it's just absolutely crazy to not continue to invest.
Yolanda Moses: So with that note, we are going to have to
come to an end to this session.
And I want to thank the panel.
[applause]
And we are going to move directly into our next panel on Arts and Culture and Ancestry.
And we will not be taking a break after that panel.
We will move into the last panel and complete our day.
So we will move the tables now and have a very different conversation with our moderator,
Dr. Cole, the director of the African Art Museum.