Ancestry and Health (Panel)

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.

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