Dr. Eric Green, Director of the National Human Genome Research Institute at NIH

( Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli .

Margaret Flinter: A nd I am Margret Flinter .

Mark Masselli: Well Marg a ret , it's hard to turn on any new source and not be
inundated w ith talk about the Ebola epidemic . While it has been thus far
contain ed largely in West Africa the first case in the United States has caught a
ripple effect of reaction.

Margaret Flinter: And officials at the Centers for Disease Control have been
saying all a long we have a much more soph isticated infrastructure in place in the
United States that could deal with any such outbreak , b ut when the first patient in
Dallas succumbed to the disease we realize d our public health protocols have to
be initiated across the country that’s aimed at tar geting , isolating and
aggressively treating any infections.

Mark Masselli: Although CDC Director Tom Frieden did say recently that a rapid
global response has helped to contain the spread of the disease, unchecked it
could have turned into the next AIDS epidemic in his words. While that hasn’t
happened there have been thousands of casualties.

Margaret Flinter: There are so many health care workers that are among those
who ha ve died . That and the lack of available hospital beds as well as essential
equ ipment has really contributed to the spread of the disease in these third world
countries.

Mark Masselli: Travelers coming in from the hardest hit areas are being
screened at airports for fever and other potential symptoms while we seem to
have a solid h andle on the situation here.

Margaret Flinter: But a ll frontline clinicians and providers know that while we
tend to focus on a new and unknown threat like Ebola , we have the ongoing real
threat to public health in this country from things like influenza every year or the
proliferation o f antibiotic resistant bacteria . These pathogens are here at h ome.
The y lead to the deaths of thousands in this country every year. So I guess our
vigilance has to be on many levels all the time.

Mark Masselli: Margar et, you are 100% right, and it is a perfect time to remind
our listeners to be vigilant when it comes to vaccinations. Flu vaccine is an easy
thing to obtain . It's highly effective in staving off a bout with flu which causes
billions of dollars of lost p roductivity and h ealth cost as well as being lethal for
certain population s. So do the right thing for you and your family and your love d
ones and your community ; go out there, and get a flu shot.

Margaret Flinter: Our gues t today is at the helm of an o rganization that’s
dedicated to the eradication of diseases through genomic research. Dr. Eric
Green is Director of the National Human Genome Research Institute, a division
of the National Institutes of Health.

Mark Masselli: Dr. Green has been on board from the very beginning on the
team that ultimately map ped the human genome.

Margaret Flinter: Lori Robertson will look into more false claims spoken about
healthy policy in the public domain. But no matter what the topic , you can hear
all of our shows by g oing to www.chcradio.com .
Mark Masselli : And as always , if you have comments , please e - mail us at
www.chcradio.com
, or find us on Facebook or CHC Radio on Tw itter beca use we
love hear ing from you .
Margaret Flinter: We wi ll get to our interview with Dr . Eric Green in just a
moment .
Mark Masselli: But first , here is our producer Marianne O'Hare with this week’s
Headline News.
(Music) Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines . The
death of the first Ebola patient in the U.S. combined with amped up fears has
sent the government and hospital administrators into action. While the federal
government ordered screenings at a number of the nat ion’s airports that receive
the highest percentage of passengers from Ebola ground zero in West Africa ,
h ospital s and health centers are read y ing for the worst, creating isolation areas,
increasing the purchase of hazmat suits and revising protocols for in fectious
disease management . While Ebola continues to scare the population ,
Enterovirus D68 is here , first charted in a children ’s hospital in Kansas City , k ids
coming in with symptoms so severe they required ventilators and the ICU. They quickly realize d it was beyond the scope of what they had seen before. Now charted across the country with hundreds of cases reported in 45 states, the
virus may be responsible for an estimated five deaths so far.
Wal - Mart is taking some heat for dumping some 30,000 pa rt - time employees off
their insurance roles, those working less than 30 hours per week, claiming the
Affordable Care Act ha s increased their own personal health care cost s . While
it's incurred some outrage from employee organizations and those supporting the
Health Care Law , there may be an upside to the headline ; those 30,000
employees will likely qualify for subsidized health coverage under Obamacare
and might have gotten cheaper coverage that way.

And we are fast approaching the second round of open en rollment under the
Affordable Care Act . In some ways it shou ld be easier for folks to apply. Under
the revised system , about 70% of the people who haven't bought coverage
through the site before are likely to go through an identity verification portal an d
then complete an application that is 16 web pages long down from 76 pages last
year.

I am Marianne O'Hare with these Health Care Headlines .

(Music)

Mark Masselli: We are speaking today with Dr. Eric Green, Director of the
National Human Genome Resear ch Institute at the National Institute of Health.
Dr. Green has been at the institute since 1994, and has been its director since
2009. The institute is the largest organization in the world dedicated solely to
genomic s research. Prior to becoming direc tor Dr. Green led a large research
group involved in studying the human genome , including being a start - to - finish
participant in the Human Genome Project . Prior to joining the institute, Dr. Green
was Professor of Pathology , Genetics , and Internal Medicin e at Washington
University School of Medicine in St. Louis where he earned his PhD in cell
biology as well as his MD. He is also the Founding Editor of the j ournal Genome
Research, and Co - Editor of the Annual Review of Genomics and Human
Genetics. Dr. Gr een, welcome to Conversations on Health Care .

Dr. Eric Green: Thank you , h appy to talk with you.

Mark Masselli: You have played a major role in the Human Genome Project
completed in 2003, clearly one of the great scientific achievements of the age ,
and as complex and groundbreaking a s that task was , you say it was really just a
starting point . And you have been involved in genomics since the beginning , and
tell our listeners how has the Human Genome Project and subsequent genomic
efforts influenced the direction of medical research, and how has the mission of
your institute evolved over the years?

Dr. Eric Green: I would probably describe genomics as transformative in many
ways. The genome project’s goal was to create th is foundati onal information
re source about our blueprint , which then has provided since its completion 11.5
years ago really a context for being able to learn a tremendous amount about
how the human body works by knowing more about our blueprint , but also
knowing how our blueprint can break leading to disease. It's really finding its way
across all areas of biomedical research.

Margaret Flinter: So Dr. Green , at a recent NIH gathering, you shared some
pretty compelling conclusions of an external advisory group about how all
component s of NIH manage and use research data. How is your institute in the
NIH going to approach this issue of the problem , or really the opportunity of Big

Data which really seems to be somewhat confounding people in the health and
science research space?

Dr. Eric Green: Ye s , I mean it's a new world. Genomics has become bit of a
poster child for the biomedical Big Data challenges, and the reason for that has
to do with the technological explosions that have taken place in genomics since
the end of the Genome Project whereby we have these incredibly powerful
methods for now reading out our DNA, not just across one human, but now have
done this across tens of thousands of humans. And that creates massive digital
datasets that are incredibly powerful to analyze, but that means that we have to
get them in the hands of researchers around the world, and that’s just genomics
data.

We are seeing a shift in biomedical research where we are going from being
relatively data poor to being data overwhelmed, and genomics s ort of le d the
way, but I don’t want to leave your listeners with the impressi on that it's just
genomic. We have had similar technological innovations in imaging and then
there are other ‘ omics ’ coming down the road besides just looking at DNA, but
lookin g at our proteins and proteomics and our metabolism , metabolomics and
so forth. An interesting statistic is that if you go back to 1993 for example , if you
took all of the world’s genomic data which is housed here in a public database
called GenBank , in 1 993 it would fit on one CD - Rom ; you go to do that today,
and it would require 400 million four - drawer file cabinets to house all that data .
And that’s just genomic data. The future of biomedical research is going to be
heavily a data science endeavor, an d the question we had to ask ourselves --

Mark Masselli: Well that alliance obviously a s part of the NIH program has just
launch ed the Big Data to Knowledge Initiative, or BD2K as it's called, and you
say the BD2K Initiative is focus ing on improving the b iomedical research
enterprises . It relates to the Big Data in the four key areas. Can you tell us what
these are, and how you see this facilitating more robust data sharing and use
platforms?

Dr. Eric Green: You know, the overarching aspect of this pro gram is , as much as
anything , to begin a cultural shift in science, in biomedical science in particular ,
whereby we value the production of data and the sharing of data in a fashion that
allows and empowers other scientists to use all the data in very crea tive ways.
And there are a lot of barriers to that . Some are cultural, and some of them are
mechanical, and we are trying to fix all of those things. So among the
components of BD2K is developing better ways of sharing data and finding data.
Another co mponent is building better software tools. We need to empower all
scientists to be able to analyze the data being generated , including data outside
of your immediate field . So if I have a genomic research er , I want them to be
able to analyze imaging data and see how it aligns with some other genomic
data, and if it's so specialized and they can't access that software to get the kind
of results they need, that’s a problem. So we need to enhance that capability .

And then we need to s etup a series of sort of centers of excellence as we call
them where we have major groups who se focus is how to get broader use of
these incredibly large datasets, and we have lots and lots of scientists really
around the world analyzing all the world’s biomedical research data in creative
ways that really wasn’t possible before. So we are funding groups to help really
come up with those solutions.

Margaret Flinter: You know Dr. Green , so often on our show and in
Conversations we come back to the issue , at one level you can c all it workforce.
You have addressed the fact that there is something of a scarcity of data
scientist s in the marketplace who are equipped to handle this volume of Big Data
out there, and the challenges and the opportunities that it pose s . I have a feeli ng
that BD2K is also thinking about training, both training people in the field now,
training people who are going to come through the field in the future . Maybe you
can tell us a little more about how do we really create this next generation of data
scie ntist s for this work .

Dr. Eric Green: That’s a great question . When I g i ve talks I sometimes show a
slide from an article that was featuring the new opportunities in data science, and
st
I call the data scientist the sexist job of the 21 Century, a nd I s how this article to
my teenage children t o remind them of that because indeed they are the
generation that are goi ng to see this thing be reality. So we are thinking about
that at NIH for biomedicine, and we are thinking about how do you train the next
ge neration, and that’s part of the BD2K Initiative is to develop new curriculum
and develop new approa ches to make a graduate student, or a medical student ,
or a pharmacy student, and all the health professions very facile with analyzing,
manipulating Big Da ta because that’s the world we are going to live in.

But let’s not forget about the current generation . I think about my medical school
classmates, my graduate school classmates, and we all have another couple
decades ahead of us in our profession, and t he fact is the world of Big Data and
data science has come on fast and furious, and we were not trained for any of
this in graduate school or medical school. So what are the things that we could
put into place to help mid - career individuals climb that com petency ladder if you
will, all these things are important, and all these things we are looking at, and in
fact, are funding program s to address both of these areas.

Mark Masselli: We are speaking today with Dr. Eric Green, Director of the
National Human Genome Research Institute at NIH where he previously served
as scientific director at the institute , and director of the genome technology
branch. We are seeing the world respon d to global epidemics from Hep C to
Ebola and the scientific communities ampe d up their efforts to create effective
treatments. While these epidemics are certainly frightening truth is far more
common deadly pathogens that probably you will encounter including antibiotic
resistant bacteria th at are having devastating effects on hu man health . How

does genomics play a role in this dash to find treatment s or cures for emerging
diseases like Ebola and morphin g pathogens like antibiotic resistant bacteria ?

Dr. Eric Green: This really represents one of the very beneficial outcomes of the
Human Genome Project and subsequent programs . The Human Genome
Project mostly focused on human and another small set of organisms and their
genomes , b ut the immediate program s that follow ed the Genome Project
involve d developing new powerful technolog ies for sequencing DNA, and those
can be use d to sequence a bacteria or virus ’s DNA just as easily, in fact, much
easier than sequencing a human genome because the human genome is much,
much bigger than a microbe genome. And so what we are finding is that the cost
and also the speed at which you can sequence a microbe is really remarkable
now such that in the case of the recent story with Ebola , we are able to
sequence, and one of our investigators, a good colleague of ours , did just the
study, got some of the early isolates from Ebola outbreak and quickly sequence d
the genomes of those isolates and with that gave immediate information about
sort of the origins of it and some of the patterns of transmission that otherwise
might have taken months if not year s to figure out .

So we can get real time read out of what’s going out in an infectious outbreak like
Ebola. Now what’s happening with antibiotic resistant bacteria where we think
we know what the routes of transmission are , now you can do detective work by
sequencing the isolates as they appear in different patients, and as we have
seen story after story , surprises come about where you figure out that what you
thought was happening is not really what’s happening , and that teaches us
immediately how to bet ter contain some of these outbreaks even within a
hospital .

Margaret Flinter: Dr . Green , I would like to take a look at what I think if we look
back over the arc of time since 2003 and the conclusion of the Human Genome
Project, one of the real promises seem to be the concept of personalized
medicine or precision medicine as some people call it where each of our unique
genomes would be the guide for the treatment protocols tailor ed to fit us
specifically . And while the cost of sequencing one’s own genome has come
down significantly it seems as though this reality is still a long way off or at least
it's not spoken about as part of our current practice pattern, what is the state of
the science about personalized medicine?

Dr. Eric Green: Yeah. I actuall y might slightly disagree with you in that I actually
think it is starting to be here and now, and I might just point to the Angelina
Jolie’s story as an example where there is a situation when she was very public
about this, and it illustrated a situation where she has a change in her genome
that makes her, and a well - known gene, that makes her susceptible to breast and
ovarian cancer. I would actually say go look on the new ss tands, and you will
see , it just came out a couple of weeks ago, a big thick spe cial issue of Time
Magazine , all about DNA and genomics and how DNA sha p es our li f e. I see

routinely , at least in the Washington D.C. area now , cancer treatment centers
and health care networks, and they are using the word ‘genomics’ in their
advertisemen ts that are streamed into your living room. Those examples are
some of the low hanging fruit, and I would immediately tell you that we are
maybe 1% of the way towards implementing personalized medicine, genomic
medicine, precision medicine , whichever word you want to use, the best is yet to
come. But in areas like cancer, let’s say it's here and now for some kinds of
cancer.

Another example is pharmacogenomics, big word, pharmacology and genomics .
The reason we all respond to medications differently is because of differences in
our genomes that influence how we metabolize drugs, and for more and more
drugs we are figuring out who are the good responders versus the bad
responders by reading out specific parts of the genome. And I think the other
area tha t’s here and now for precision medicine has to do with these rare cases
of diseases that sort of stump clinicians, these diagnostic odysseys that are often
about children but sometimes adults. Now for a few thousand dollars you can
read out their genome s equence, and in a fair percentage of the case s , you can
figure out what’s wrong with them.

Mark Masselli: Dr. Green, we had your colleague NIH Dr. Francis Collins on the
show a while back . He expressed some g rave concerns about the cuts to
funding for N IH research and the impact it would have on future research. It’s
always had a history of being supported across the board, and that seems to
have changed . And you and Margaret were talking earlier about the sort of
group of young people that we want to come into this field, and they don’t do it for
the money for the most part, but money does help. So give our listeners
assessment of what’s happening in the state of scientific research funding
including genomics and the impact these budget cuts are havin g on the present
and future research protocols at NIH.

Dr. Eric Green: It's not a good situation. I mean as an American, America led in
genomics during the Human Genome Project , some of these spectacular
technological advances I have talked about that h ave come about in the last 11.5
years since the Genome Project , and they have been brought about by generous
support of investigators in the private sector which was also met by a granting
program we had here that’s led to that . And yet if we look around where the
countries are really increasing their commitment to research and genomics
research in particular, it's not the United States, and we risk ceding [ph] our lead
in this area if we are not careful. If you actually look at what’s happened to our
bud get over the last decade, our purchasing power has basically dropped by
25%. So overall, we have 25% less dollars to do our science with than we did a
decade ago, and this is at a time where we should be filling up our fuel tanks,
and not starving it.

It is really not a good situation . The first outcome is we are just not making
advances as quick as we could , b ut the second consequence is that we are
scaring off the next generation because we are not convincing them that this is a
value in the United Sta tes , and that there is going to be opportunities for them to
run their laboratories or to conduct the kinds of clinical studies that are going to
be needed in the future. And so it's hard to give encouraging signals to the next
generation when they look a t these curves, and they see these trends and they
say this is not going to be support ed well in the United States.

Mark Masselli: We have been speaking today with Dr. Eric Green, Director of the
National Human Genome Research Institute at the NIH . You can learn more
about their work by going to www.genome.gov . Dr. Green, thank you so much
for joining us on Conversations on Healthcare today.
Dr. Eric Green: Great. Nice talking to you.
(Music) Mark Masselli: A t Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy. Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a non - partisan, non - profit con sumer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what have you got for us this week?
Lori Robertson: Well, birth control has become an issue in few senate races across the country, and some Republican candidate s are proposing the sale of
oral contraceptive s or the pill over - the - counter without a prescription. The idea
isn’t new. Reproductive health organizations formed a working group to explore the issue a decade ago. They support over - the - counter birth cont rol pills as a
way to increase access for women , b ut Congress can't make this happen.
Instead it's up to a drug manufacturer to submit an application to the Food & Drug Administration, and the FDA to then review and approve it, and when it comes to the pi ll , there are many different brands and formulations that would
ha ve to go through the same process.
In Colorado, Republican Cory Gardner has been pushing the idea and says over -
the - counter sales would make the pill cheaper , but it’s not clear whether tha t
would be the case. The available research is mixed , and it doesn’t specifically
address the pill. Research from 2005 found out - of - pocket cost decrease d for
antihistamines, but a 2002 study found consumers cost went up for certain drugs
that moved from prescription to over - the - counter status. Emergency
contraception or morning - after pill went up a bit in price when it became available
without a prescription. Under the Affordable Care Act, most private insurance
plans are required to cover the full cost of female contraception including the pil l ,
sterilization, IUDs, and more with no cost sharing. What would happen if the pills

were sold over - the - counter? Gardner’s campaign says he wants women to be
able to be reimbursed through their insurance, but th at didn’t stop Planned
Parenthood votes from saying in the TV ad that he wants women to “pay for all of
it.” That’s not what Gardner has proposed. And that’s my fact check for this
week. I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret F linter: FactCheck.org is committed to factual accuracy from the
country’s major political players, and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, e - mail us at www.chcradio.com . We will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Margaret Flinter: Each week, Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. Health care providers are forever on the lookout for that magic elixir that can cure a host of
chronic ills in one step. And in the case of obesity, depression, anxiety and stress, that elixir could be turns out a number of steps as in taking a hike. A
large study conducted by several institutions including the University of Michigan and Edge Hill University in the U.K. looked at the medicinal benefits derived from regular group hikes conducted in na ture. Researchers, evaluators, some 2,000 participants in a program called Walking for Health , in England which sponsored
some 3,000 walks per week across the country.
Dr. Sara Warber: There was investment in th e s e walking group s, t raining
leaders to ta ke people on walk s , finding trails that were good for people to do
even if they had health problems.
Margaret Flinter: Dr. Sara Warber, Professor of Family Medicine at the University of Michigan School of Medicine said this study showed a dramatic improv ement in the mental wellbeing of participants.
Dr. Sara Warber: Depression was reduced, perceived stress was reduced, and people , they experience d more positive feelings or positive emotions.

Margaret Flinter: Other studies have shown a link between mo od and exercise,
but Dr. Warber says this is the first study that reveal ed th e added benefits of
group hikes in nature and significant mitigation of depression. Walk for Health, a simple guided group nature hike program which incentivizes folks suffering from depression and anxiety to step into the fresh air with others, improving their mood, reducing their depression, increasing their overall health at the same time, now that’s a bright idea.
(Music)

Margaret Flinter: This is Conversations on Health Ca re. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brou ght to you by
the Community Health Center.