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

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Mark Masse ll i: This is Conversations o n Healthcare . I am Mark Masselli .

Margaret Flinter: And I am Marg a ret Flin ter .

Mark Masselli: Well Marg a r et , it’s been a good few weeks for a quality in this
country . First the Supreme Court upheld the tax subsidies for the Affordable
Care Act essentially keeping the law alive by ensuring that no matter what state
you live in you are entitled to tax subsidies to offset purchases of health
insurance . Then there was the decisi on legalizing gay marriages for all citizens
no matter what state you live in both victories for equal rights and access to the
same rights for all Americans regardless of geography .

Margaret Flinter: Once again seeing the enormous impact that laws have on our
society Mark , millions of Americans will be able to hold on to Affordable Health
Coverage which was essential to the Affordable Care Act and the marriage
equality decision had very interesting implications for the country . Same sex
couples are ofte n facing very challenging issues and impacting everything from
being able to share health benefits to adopt children even visit the spouse in the
hospital setting even at the end of life .

Mark Masselli: So many years same sex couples have struggled to achieve
access to the same basic rights as all Americans after such a long st ruggle for
acceptance a big win for this country .

Margaret Flinter: Well certainly a momentous turning point for us as a nation .
You know those there is momen tous turning points come in many ways some of
are social legislatives, some of them are scientific and mapping of the human
genome a few years ago was a lso a big turning point . It shifted health and
medical research into entirely new direction where perso nalized medicine can
truly be realized . We can be so much more precise and that something our
guest today knows quite a bi t about .

Mark Masselli: Dr . Eric Green is director of the National Human Genome
Research Institute at the National Institute of Health . The real work has begun to
find translational scien tific discovery on the DNA of disease . He is leading some
exciting work in genomics at NIH .

M argaret Flinter: And Lori Ro berston will be stopping by the managing editor of
FactCheck . org . Lori is always on the hunt for misstatements spoken by health
policy in the public domain .

Mark Masselli: But no matter what the topic , you can h ear all of ou r shows by
going to chcradio . com and as always if you have comments , please e - mail us a t

[email protected] or find us on Facebook or Twitter ; we love hearing
from you .

Margaret Flinter: We will get to our interview with Dr . Eric Green in just a
moment .

Mark Masselli: But first , here is our producer Maria n n e O’ Hare with this week ’ s
Headlines News .

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Maria n n e O’ Hare : I am Maria n n e O’ Hare with the se Healthcare Headlines . The
Supreme Court has been busy with matter s of health, life and death . First
upholding of the tax subsidies and Affordable Care Act ruling came down . Now
all Americans have a right to access those subsidies regardless of their state of
residence . Then they upheld the use of a controversial drug approved for use in
lethal injections of death row inmates . Several executions were bouche due to
the drug not working specifically well sparked a moratorium on its use until the
high court ruled it was ok ay . And the State of Texas has been attempting to
close the state’s re maining abortion clinics in round about ways by exerting a
new ruling requiring facilities to operate more like hospitals . The High Court
ruled the Sta te was over stepping its bounds . Many women in Texas who are
poor and uninsured use these clinics for all their prevented women’s health
needs . And from Kaiser Health N ews the right to marry in any state won’t be the
only gain for gay couples after the Supreme Court ’s ruling . The decision will
probably boost health insurance among gay couples; same sex spouses get
access to employer plans that according to benefits consultants and analyst .
How much is unclear but it’s going to increase coverage in a community that has
often h ad trouble getting access to medical services according the Kaiser Family
foundation . The logic is simple fewer than half of employers that offer health
benefits make the insurance available to same sex partners who aren’t married,
virtually all of them o ffer coverage to spouses . And the FDA has made is official
no more Trans fats in processed food that will take 3 years for food manufactures
to come into full compliance . The FDA is also looking at the proliferation of
vaping or e - cigarettes seeking comm ent on whether they should be further
restricted . A number of studies are mounting now showing they are already
leading to an increase of nicotine addiction among teens . I am Maria n n e O’ Hare
with the se Healthcare Headlines .

Mark Masselli: We are speaking today with Dr . Eric Green Director of the
National Human Genome Research 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 orga nization in the world dedicate solely to
genomics research part to becoming director, Dr . Green lead a large research
group involved in studying the human genome including being a star t to finish
participating in the human genome project . Prior to joining the institute Dr. Green

was the Professor of Pathology Genetics in Internal Medicine at Washington
University School of Medicine in St . Louise and were here on his PhD in cell
biology as well as he is MD . He is also the founding editor t he Journal of
genome research and co - editor of the annual review of Genomics in Human
Genetics . Dr . Green welcome in Conversations on Healthcare .

Dr . Green: Thank you happy being talking to 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
is complex and ground breaking that task was you say it was really just a starting
point and you have been involved in genomics since the beginning and tell o ur
listeners how has the Human Genome Project in subsequent genomics efforts
influenced the direction of medical research and how has the mission of your
institute evolved over the years .

Dr . Green: I would probably describe genomics as transformative in many ways .
The Genomes Project’s goal was to create this foundational information resource
about our blue print and which then has provided since its completion 11 and half
years ago . Really a conte xt for being able to learn a treme ndous amount about
how the human body works by knowing more about our blue print , but also
knowi ng how our blue print can break leading to disease . It’s really finding its
way across all area s of biomedical research .

Margaret Flinter: So Dr . Green the r ecent NIH gathering you share some pretty
compelling conclusions of the external advisory group about how all composed of
NIH manage and used research data . How is your institute in NIH is going to
approach this issue of the problem are really the opportunity of big data which is
seems to be some more cofounding people in the health and science research
space.

Dr . Green: Yes, I mean, it’s a new world genomics has become that of a poster
child for the biomedical big data challenges . The reason for that has to do with
the technological explosion that have taken place in genomics since the end of
the Genome Project, where by we have these incredibly powerful methods for
now reading out our DNA not just across one human but now have done this
across t ens of thousands of human . And that creates massive digit al datasets
that are incredibly powerful to analyze but that means that we kept to them in the
hands of researchers around the world and that’s just genomics data . We are
seeing a swift in biomedic al research where we are going from being relatively
data poor to being data overwhelmed. And genomics sort of lobbed away but I
don’t want to leave your listeners with impression that it’s just genomics . We
have had similar technological innovations in imaging and there is other Omix
coming down the road b esides just looking at DNA but look at our proteins and
proteomics and our metabolism and metabolomics and so forth . And an
interesting statistics is that if you go back to 1993 for example if you took all of

the worlds genomic data is housed here a publi c database called Gen bank .
1993 which sit on one CD - ROM you go to do that today and it would require 400
million fou r door file cabinet to house all that data . And that’s just genomic data .
The future of benchmark research is going to be heavily a data science endeavor
and the question we had asked our self --

Mark Masselli: With that alliance with obviously is part of the NIH’s program this
just launched th e big data to knowledge initiative over BD2K as it’s called . You
say the BD2K initiative is focusing on improving the biomedical research
enterprises 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 . Green: You know the overarching aspect of this program is as much as
any thing to be gin a cultural shifts in science and biomedical science in particular .
Wh ere by we value the production of data and the sharing of data in a fashion
that allows and empowers other scientist s to use all the data in very creative
ways, a nd there is 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 component is building better software tools . We need to empower all
scientists to be able t o analyze the data b eing generated including data outside
of your im mediate fields . So if were genomics researcher I want the m to be able
to analyze data and see it alliance with some of their genomic data . And if it’s so
specialize and they can’t access that software to get the kind of result they need
that the problem . So we need to enhance that capability and then we need to
setup a series of sort of centers of excellences as we call them . We have major
gro ups whose focus is how to get broader use of this incredibly large dataset and
having lots and lots of scientists really around the world analyzing the entire
world’s biomedical research data in creative ways that it really wasn’t possible
before so we are funding groups to help really come up with those solutions .

Margaret Flinter: Dr . Green so often on our show and conversations we can
back to the issue at one level you can call it workforce . You have addressed the
fact that there is something of a scarcity of data scientist in the market places
who are equipped to handle this volume of big data out there and the challenges
and opportunities that oppose. I have a feeling that BD2K is also thin king about
training both training people in the field now training people who are going to
come through the field in the future maybe if you can tell us a little more about
how do we really create this next generation of data scientist for this work .

Dr . Green : Oh it’s a great question when I give talk to something so slide of an
article that was featuring the new opportunities in the data science and I call the
st
data scientist sexiest job of the 21 century . And I saw this article of my teenage
childre n remind me of that because indeed they are the generation that are going
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 generation? And that’s part
of the BD2K initia tive is to develop new curriculum and develop new approached
to make a gradate student or a medical student or a pharmacy student and you
know all the health professions very facile with analyzing manipulating big data
because that’s th e world we are going to live in . But let’s no t forget about the
current generation I think about my medical school classmates my graduate
school class mates and we all have a another couple decades ahead of us in our
profession . And the fact is the world of big data and data science has come on
fast and furious and we were not trained for any of these I gr aduate school or
medical school . So what are the things that we could put into place to help mid
career individuals climb that, that competenc y leader if you will . All these things
are important and all these things we are looking at and in fact our funding
programs to address both of these area s .

Mark Masselli: We are speaking today with Dr . Green director of the director of
the National H uman Genome Research Institute at NIH where he previously
served as scientific director at the Institute and director of the genome technology
branch . We are seei ng the world respond to global epidemics from hep C to
Ebola and the scientific communit ies a dd up their efforts to create effective
treatments in , w hile these epid emics are certainly frightening, truth is far more
common deadly pathogens that probably will you encounter including antibiotic
resistant bacteria they are having devastating effects o n human health . And how
does genomics player role in this dash to find treatments or cures for emerging
diseases like Ebola and morphine pathogens like antibiotic resistant bacteria .

Dr . Green: This really represents one of the very beneficial outcomes of the
Human Genome Project and subsequent program s. You know, the Human
Genome Project mostly focused on human and another small set of organisms
and their genome . But the immediate program s that follow the Genomes Project
involve developing ne w powerful technologies for sequencing DNA and those
can be used to sequence a bacteria or virus ’s as DNA just as easily in f act 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 are really remarkable
now . Such that in the case of the recent story with Ebola, we are able to
seque nce in one of our investigators , a good coll ea gue of our s did just this study
and got some of the early isolates from Ebola outbreak and quickly sequence the
genomes of those isolates and with that given immediate information about sort
of the origins of it and some of the patters of transmission . That otherwis e might
have taken months of not years to figure out . So we get real time read outs of
what’s going ou t in an infectious outbreak like Ebola . Now what’s happening in
with antibiotic resistant bacteria where we seek we know what the routs 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 above where you figure out that what you thought was happening is not

really what’s happening and that t eaches us it im mediately how to better contain
some of these out breaks even within a hospital .

Margaret Flinter: Dr . Green I would like to take a look at what I think if we looked
back over the arch of time since 2003 and the conclusion of the human genome
project . One of the real promises seems to 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 p rotocols tailor ed to fit us specifically . And
while the cost of sequencing one zone gen ome has come down significantly . It
seems as thought this reality i s still a long way off or at least it’s not spoken about
as part of our current practice pattern . W hat is the state of the science about
personalized medicine?

Dr . Green: Yeah I actually might slightly disagree with you , and that I actually
think it is sta rting to be hear now , and I might just point to the Angelina Jolie story
as an example where there is a situation where she came it was very public
about this and 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 stands and you’ll see
that just came out a couple of weeks ago . Big fix special issue of time magazine
all about DNA and genomics and how the DNA shapes our life . I see routinely at
least in the Washington DC a rea now cancer treatment centers and healthcare
network and they are using the world genomics and there are advertisements
that are streamed into your living room . Those examples are some of the low
handing fruit and I would immediately tell you that we are m aybe 1% of the way
tow ards implementing personalized medicine , genomics medicine , or precision
medicine , whichever word you want to use . The best is yet to come but in areas
like Cancer and its here now for some kinds of Cancer . Another example is
Pharma cogenomics big word Pharmacology in genomics . The reason we are all
respond to medications differently is because of differences in our genomes that
influence how we metabolize drug and for more and more drugs we are figuring
out who are the good responde rs verses the bad responders by reading out
specific parts of the genome . And I think the other area that here now for
precision medicine has to do with these rare cases of diseases that sort of stum p
clinicians, these diagnostic odysseys that often involve children but sometime
adults . You know, now for a few thousand dollars you can read out their genome
sequence and in a fair percentage of the case you can fi gure out what’s wrong
with them .

Mark Masselli: Dr . Green we had your colleague at NIH D r . Francis C ollins on
the show well back he express some grave concerns about the cuts to funding
for the NIH research and the impact it would have on future research . As always
had a history of being supported across the board and that seems to have
chan ged in the 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

what’s happening in the state of scientific research funding including genomics
and t he impact these budget cuts are having on the present and the future
research protocols at NIH .

Dr . Green: It’s not a good situation I mean as an American, you know America
lead in the genomic s during the Human Genome Project some of these
spectacular technological advances I have talked about that have come about in
the last eleven and half years since the Genomes Project ended have been
brought about by generous support of investigators in the private sector which is
was also met by a granting program we had here that’s lead to that and yet if we
look around were the countries are really increasing their commitment to
research and genomics research in particular it’s not been out of state . And we
risk seeding our lead in this area if we are not careful . If you actually look what
happened to our budget over the last decade our purchas ing power has basically
dropped by 25% . So overall we have 25% less dollars to do our sc ience with
and we did a decade ago . And this is at a time where we should be filling up our
fuel tank not starving it .

Mark Masselli: Absolutely .

Dr. Green: It is really not, really not a good situation the first outcome is we are
just not making adv ances as quick as we could. But 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 States and that there is going to be opportunities
for them to run their laboratori es 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 at these curves and these see these
trends and they say this is not going to be supp orted well in United --

Mark Masselli: We have been speaking with Dr . Green director of the National
Human Genome Research Institute at the NIH you can learn more about their
work by going to Genome . gov . Dr . Green thank you so much for joining us in
Conversations on Healthcare today .

Dr . Green: Great nice talking to you .

Mark Masselli: At Conversations on Healthcare , we want our audience to be
truly in the know when it comes to the facts about Healthcare reform and policy .
Lori Robertson is an a ward - winning journalist and managing editor of
FactCheck . org, a nonpartisan, nonprofit consumer 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: Ever three months we take a look at what we call Obama’s
Numbers a statistical record of Obama’s time in office . And that now includes an
update on how many have gained insurance under the Affordable Care Act the

administration says that the 60 million people have gained coverage because of
the law that number is based on polling by the Gallup Organization and includes
an estimated 14 . 1 million adults w ho ga ined coverage from October 2013, the
st
start of the 1 open enrollment period for the AC exchange s through the
beginni ng of March of this year . The other 2 . 3 million in the administration ’s total
are young adults , age 19 to 25 who previously gained coverage after the law
began requiring that insurance plan allow children to remain on their parents plan
until aged 26 . The national center for health statistics mean while estimated that
only 11 . 9% of all Americans lacked health insurance at the time they were
interviewed last year that’s down from 14 . 4% in 2013 . But it leaves an estimated
37 . 2 million without insurance the NCHS numbers are preliminary based on
interviews conducted during the first 9 months of 2014 . The Urban Institute
Health Reform Monitoring Survey looks at the uninsured who se age is 18 to 64,
in that age group an estimated 9 . 7 million gained coverage between September
2013 and December 2014 ac cording to the quarterly survey, a nd that’ s my Fact
Check for this week . I am Lori Robertson , managing editor of FactCheck . org .

Margaret Flinter: 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, email us at Chcradio . com, w e will ha ve FactCheck . org's Lori Robertson
check it out for you here on Conversations on Healthcare .

Each week , Conversations highlight s a bright idea about how to make wellness a
part of ou r communities and everyday lives . During the school years some 21
million American children receive free or reduced priced lunches through their
schools often the h ealthiest meal these children eat during the schools day . Ye t
one school is out only 10% of these children participate in the f ree meal
program s during the summer t ime and studies have shown that many of these
kids tend to gain significant amount of weight over the summer as a result . A
group of researchers at the University of South Carolina shot to tackle that issue
with a program they developed called the healthy lunch box challenge . They
deployed the program at a number of large community bases to summer day
camps and lead researcher Dr. Michael Beats say they are relied on the simple
known fact about kids they love competition .

Man: Staffers during the first snacks period what asked kids to holdup the fruits
or vegetables or water that they brought and staffers would then count the
number o f kids that brought those items and assign them points . You get a point
for a fruit or a point for veget able point of bringing in water . And then throughout
the course of the week everybody’s group points are tallied and then at the end
of the week on Friday when they get together to do an assembly they announce
the winner of the health lunchbox challenge f or that week . And so there is this
comparative process .

Margaret Flinter: Dr . Beat says the simple competition and group reward system
created a dramatic shift in the average camp er’s lunch box from Chips, cookies
and sugary drinks to more fruits, vegetables and bottled waters .

Dr . Beat: We saw some pretty dramatic increases in the proportion of kids that
brought fruits and vegetables and water but then in the back end, we also saw
that they also reduce the things that we didn’t want them to bring in without even
sa ying please reduce these things .

Margaret Flinter: The study published in the journal of nutrition education and
behaviors showed a dramatic shift in the kid ’ s home made lunche s with this really
simple and inexpensive incentive program . The see this as a model for summer
day camp s across the country which serve some 14 million children per y ear
often in under served areas .

Dr . Beat: In our next stud ies, which are going to be larger that will incorporate
the health y lunchbox challenge . We will also be tracking BMI to see if these
interventions which -- if those have any perceptible effects on changes .

Margaret Flinter: The healthy lunchbox challenge , a simple competitive
challenge in the reward system designed to get kids to switch out high fat, high
sugar high calorie foods from their diet s in favor of healthier snacks and
be verages now that’s a bring idea .

This is Conversations on Healthcare . I am Marg a ret Flin t er .

Mark Masselli: And I am Mark Masselli . Peace and health .

Co nversations on Healthcare , broadcast from the campus of WESU at Wesleyan
University, streaming live at Wesufm . org and brought to you by the Community
Health Center .