Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Mar garet a momentous event at the UN in New York , the Paris
Climate Agreement was signed by over 170 world leaders . The complex agreement
seeks to significantly reduce the world’s carbon emission by 2025 and beyond and it's
going to take significant cooperat ion to achi e ve the goals laid out in this historic
document .

Margaret Flinter: And how great was it that this accord was signed on Earth Day, Mark .
It's the first times that all nations at the table were able to reach the agreement including
the US very exciting.

Mark Masselli: As we know Margaret , a climate change has a direct impact on global
health and we are already seeing the effects which experts say will only worsen over
time more frequent and devastating storms rising sea levels leading to epic floods ,
crushing droughts as well as record heat waves, all of which impact air quality and safe
drinking water , agriculture and the spread of diseases.

Margaret Flinter: If left unabated , climate change will lead to an estimated quarter of
million deaths worldwide every year by 2030 and beyond. Climate change is real , it's
based in science , it presents an imminent threat to global health and now we have a
framework in place to tackle the worst of the anticipated effects.

Mark Masselli: Part of what makes this possible is now that we have technologies that
will assist us in weaning off our dependence on fossil fuels this agreement is a very
important and bold step forward.

Margaret Flinter: Well there is a tide shifting in healthcare as well, Mark . And all of this
is something that our guest today know s quite a bit about , Eric Dishman is the newly
appointed Director of the Precision Medicine Initiative at the National Institutes of Health
to advance precisi on medicine in the 21st centur y, something we were waiting quite a
for.

Mark Masselli: And Dishman has a personal story that illuminates the need for
personalized medicine.

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

Margaret Flinter : And Lori Robertson will be stop ping by, she is always on the hunt for
misstatements spoken about health policy in the public domain. But no matter what the
topic , you can hear all of our shows by going to chcradio.com.

Mark Masselli: And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter ; we love hearing from you.

Margaret Flinter: We will get to our interview with Eric Dishman 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 healthcare headlines. Health
insurer UnitedHealthcare the nation’s l arg e st made waves last week announcing they
are puling out of most of the markets where they have been participating in the
insurance exchanges, 34 states total down to just a few. Ac cording to analysis by the
Kaiser Family Foundation, the insurers exit f rom the exchanges leaves about 10 states
mostly in the south and mid - west with only one insurance provider to choose form. Just
a day before it was supposed to launch , the Obama Administration announced it was
postponing the hospital star rating system on its Hospital Compare website . T he ratings
were based on mortality, hospital readmission rate s , effectiveness and timel i ness of
care. The American Hospital Association’s contention was the rating system based on
Medicare data wouldn’t necessarily be help ful to say a woman seeking a place to give
birth.

A recent study shed light on the impact of wealth and health revealing the gap between
and haves and haves nots is significant when it comes to life expectancy. The study
showed the gap between them grew in the post recession period with the life
expectancy of wealthy males growing during that time period while the poor saw a
decline in life expectancy overall. Now another study out showing the life expectancy
for white women has retreated just a bit ; alcohol, drug abuse and suicide being pointed
to as some of the reasons .

And Type II Diabetes expecting to affect some 89 m illion Americans by 2030 , th e baby
boom generation aging into a tsunami of chronic illness conventional wisdom has been
once diagnosed always thus afflicted . There is some mounting evidence that condition
can be reversed with diet. A small study done in England recently showed some
interesting results a cohort of patients diagnosed with Type II Diabetes put on a strict

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

liquid diet regimen actually put their condition into remission even six months after the
special diet had ended. Six months later those who gone into remission immediately
after the diet were still diabetes free , t he key according to experts is being able to keep
the weight off. I am Marianne O'Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Eric Dishman, Director of the Precision
Medicine Initiative Cohort Program at the National Institute s of Health having served as
vice president and fellow of Intel Corporations Health and Life Science group. He
founded Intel’s first Health Research and Innova tion lab in 2002. Mr. Dishman served
on the President’s Precision Medicine Initiative advisory board. He holds a bachelor’s
degree in Speech Communication from the University of North Carolina. He earned his
master’s degree in Speech Communication from Southern Illinois University . Eric,
welcome to Conversations on Healthcare .

Eric Dishman: Well thanks for having me. It's great to be here.

Mark Masselli: You know first of all I have got to say, I really enjoyed your TED Talk
and I know you are going to tell us about your own personal story. You found yourself
in a role of patient and subsequently a patient advocate about 20 years ago when a
[ Inaudible 00:05:30 ] diagnosis lead to incredible odyssey with a health system , and
wonder if you could tell our listeners about your own journey and how it lead you to
develop your own views on personal health systems and how would you describe
Precision Medicine from your point of view?

Eric Dishman: Well you know it all started , I was age 19 that passing out while at work,
I was working, training for marathon at the time and I eventually started doing scans and
different things in my body and found out I had a kidney problem . And it didn’t take long
before they came and said, yo u have a rare form of kidney cancer and you have got
about a year to live , this at a guy who felt no pain . And that basically started the 23 year
odyssey of cancer and cancer treatment , more than five dozen rounds of treatment.

It all came to head about five years ago, I was in full kidney failure , I was in my last
business trip , Intel’s executive in charge of Health and Life Sciences . At least what I
thought it was going to be my last business trip because my kidneys had both failed, I
was about to have to start dialysis and the chemotherapies that I were on was at least
keeping things moving slowly , I was going to have to go off of and I thought, okay this is
it .

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

And on that last business trip I visited a genomic start up and they needed a bunch of
Int el’s fastest computers and storage to be able to deal with these huge files that
happen when your genome is sequenced . And they said, well why don’t we sequence
you? And they did. And I didn’t think much about it, and that was that, I mean I sort of
und erstood what sequencing was, they explained it to me , I am not a biologist so I was
like, okay that’s kind of cool .

And then seven months later my team lets me know that they have been working with
the company , they have never done this before, a patient before . And they came back
and they said, well bad news is 92% of every drug we ever put you on was destined
never to have worked . So the good news is we think that your cancer even though it's
in your kidneys , it acts more like the mechanisms that cause pancreatic cancer. We
want to put you on experimental drugs for pancreatic cancer. Three months later I am
cancer free for the first time in 23 years, eligible for a kidney transplant and now at age
48 I am h ealthier than I was when I was 19.

Margaret Flinter: You know I am not sure there is follow up question.

Eric Dishman: Well the question is, how do we make that available to everybody ?

Margaret Flinter: That’s exactly the question I was going to ask you . Even while you
were at Intel your passion for innovation as you oversaw research and development of
wide ranging technologies that have helped advance personalized medicine, you have
talked about how as a teenager you even crafted your own tele - monit oring solution from
products you found at the local radio shack for your grandparent dealing with
Alzheimers. It seems that infrastructure hasn’t been there but the funding incentives
haven’t been in place until now either, so talk about this recent shift in the incentives
part of the equation.

Eric Dishman: Well it's interesting , my first start up was for Paul Allen's think tank more
than 25 years and it was a telehealth start up focused on independent living for seniors .
That had been motivated by certainly caring for my grandmother when I was 16 and
also had been motivated by the two of the times that I came closest to death in my own
cancer journey were driven by hospital borne infections . And we have known for a long
time t hat you could actually do care effectively safely from the home b ut until the
paradigm of payment for healthcare shifted from fee for service we are stuck in this
perverse incentive wor ld in which , hey care at home that can be done more safely and
cheaply, well so I don’t get paid for it . Well and so you have great people giving the
best care possible in a very reactive medicine paradigm that the financial incidents
didn’t match with. And my Intel role showed the moment this healthcare reform sta r ted

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

to p ass you know the innovation engine started up . And there were so many incentives
for hospitals to want to figure out , how do they distribute care beyond the hospital ?
How do we understand your genetics and your medical history and collect all that data
o n you so that we can develop a prevention plan that’s going to keep you from ever
having to go into the hospital.

Mark Masselli: We have been following report since the President State of the Union
address where he announced the Precision Medicine Initiative and the goal is to
research a cohort of about million Americans and supply that vital health information to
central data bank all of course de - identified [PH] and looking to the nation’s community
health center s to help provid e many of these volunteers, could you talk to our listeners
about how you plan to get this first important step underway?

Eric Dishman: Sure. The Cohort Program is this audacious goal , and we are going to
achieve it . A million or more American voluntee rs being willing to donate their data to
science and to accelerate science and medical breakthroughs for Precision Medicine .
Nowhere in the world have we ever collected data on a wide range of people with health
status, with a diversity of disease states or wellness states . And we will understand for
the first time with new data types the unfolding of disease where we will even be able to
make discoveries around rare diseases that you can't understand until you get a million
or more Americans actually vol unteering for it. It will also be things like genomic data
and the new areas like wearable and imaging data as we start to see more and more
Smartphones and wearables around. So the combination of those data types as well as
the diversity of the people i n the cohort will help us make breakthroughs in people that
have never been studied before.

Margaret Flinter: Well Eric I understand that resources have also been allocated to the
Office of the National Coordinator for Health IT to foster interoperability between
system s to facilitate the flow of all this data. How are you going to tackle what has until
now been kind of daunting [ Inaudible 00:11:04 ] for developers to run?

Eric Dishman: One of the key aspects of the program is w e want any American who , to
be able to volunteer themselves is call the direct volunteer program. The fundamental
enabler of that is making it easy for them to tell their clinic i an to say, I want to be able to
share my electronic health data and we will c all it think for science . The work s that
ONC had already done to help build out the nation’s infrastructure and getting people
adopting meaningful use of electronic health records was a first step to now I got to
attend the first staff meeting with the se cretary with the head of FDA, with the head of
ONC and see that it's all department efforts trying to make these PMI efforts successful ,
The National Cancer Institute to ONC , and then the FDA and they are all contributing for

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

the success of how do we accel erate Precision Medicine for all enabling all of these
researchers with the right access and credentials obviously to come and use the data to
accelerate their scientific questions as well as actually citizens scientist to maybe
interested in using the dat a set so that 10,000 flowers may bloom of research studies
that then moved to clinical practice.

Mark Masselli: We are speaking today with Eric Dishman Director of the Precision
Medicine Initiative Cohort Program at the National Institutes of Health . Mr. Dishman
has served as vice president fellow of Intel’s Health and Life Science group. Eric, you
have talked about the ideal personalized health system of the future that will include
each patient having their genomic information as a standard part of their individual
health profile, talk about these emerging disciplines and how important they are to
achieve the intended goals of Precision Medicine.

Eric Dishman: There is four streams of data that needed to be brought to bear ; clinical
and claims d ata , your medical history and database of your past history , imaging data
and other diagnostic data that’s been collected over the years for you . The two new
emerging data typ e s that we beli e ve will be game changing , and genomics was in my
own case are om ic data types and genomic is the first one , t here is also metabolomics
and proteomics . And the n the wearable consumer generated data collecting wearable
data from devices they already have or new diagnostic devices that can go in the home.
It's really the synergy of those four data types into knowledge.

When I was taught how to be a patient advocate from a woman named Verna , she used
the phrase with me knowledge of survival. And when I was first diagnosed she took me
to Duke University library and showed me the statistics for people that have been
studied with the disease that I had. I am 19 years old diagnosed with that disease at
the time, I have been told that I am going to live a year but when you go look at the
studies t hat inform that knowledge that you only have a year to live , t he vast majority of
the people that were ever studied were in their 70s and 80s.

Margaret Flinter: Yeah, interesting.

Eric Dishman: So they had literally had no knowledge about somebody with 19 with this
disease . Today the healthcare system is doing the best it can to individualize care to
you but with almost no knowledge about you . Precision Medicine is about knowledge
based care for you as an individual and knowledge based care for the wh ole population.
One of the problems that we anticipated at the population at the level but then how do
we customize care to you as an individual ? We don’t know what we don’t know . We
are starting to make breakthroughs with some genetic testing for like the BRCA gene for

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

breast cancer an increasing pipeline of data that’s coming almost weekl y. It says, okay
here's a mutation that correlates with this cancer , that ’s part of what PMI has to do.
There is so much dark matter in the genome we don’ t understand and if we add things
like wearable and diagnostic data that’s coming a real time and then once that science
is proven out say, okay we need clinical interventions and moving that science and
clinical practice a long forward that’s job one for w hat PMI cohort needs to do.

Margaret Flinter: Well you spoke a few times and mentioned the home and you have
been talking about the home as a node of care . And we have had certainly an
explosion of health monitoring devices and we have connected home di agnostic
systems, tell us how you think t hat these technologies all support the ideal personal
health system, maybe you could describe your vision of that.

Eric Dishman: In our Intel work, particularly with older people that we studied and one
of the fir st early studies that we did long before there as this phrase the Internet of
Things was trying to outset some simple sensing on medication , dispensers of pill
bottles in the home of frail seniors who are struggling to take their meds a day and to
help their families from a distance know you know are they up around their normal time,
are they getting coffee and did they take their meds, right. Think of that pattern , that
rhythm of somebody in their home, your mom in her home is al most a vital sign in and
of itself she has got a routine , and being able to know that there has been a real change
in a routine .

There is two sets of questions around that, first is how do you alert family caregivers or
neighbors that there ’ s has been a c hange , can you check in and make sure something
is okay . But it's possible that the collection of that data over a long period of time could
significantly help you understand the emergence or the even differentiation of different
kinds of dementia that ar e emerging . But back then we didn’t have the algorithms and
the machine learning to know that so we did some simple things like different
medication reminder strategies for different people . And we would find you know some
one individual likes the voice of opera reminding her to take her pills, somebody else
liked their television show being interrupted and say go take your meds and wouldn’t
play football again.

The point was that was Precision Medicine that had nothing to do with genomics that
was simpl e wearable sensors and some software customizing to your style and
preference and behavior the kind of medication reminder that you wanted, right. So
that’s – I try to use that example to say, genomics is important but so are these other
data types . And we can actually collect movement data about you because your watch

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

is capturing it , what it could tell us about the emergence of heart disease or arthritis and
the fundamental science will be done as a result of the PMI Cohort Program .

Mark Masselli: You know other health focus initiative that the president launched in this
past year is this Moonshot for Cancer which I believe the vice president is going to
heading up and very focusing on multi - disciplinary teams of experts working together
and you kno w the value of that, tell us what the intersection will look like between the
work that you and your team will be doing a the Precision Medicine Initiative and how it
intersects with the President’s Moonshot for Cancer.

Eric Dishman: It's certainly true that the PMI Cohort Program you know people will have
and will get cancer over the course of the lifetime o n the study when we do it right I th i nk
it will be decades long and it will be something like the Framingham Heart Study that
continues to teach Amer ica and the world breakthroughs in medical science. So we will
be contributing and sharing data with both the PMI cancer effort and CI effort as well as
the Cancer Moonshot.

And one of the things I just love the fact that vice president Biden is out doin g is really
pressing for the universities , the companies who have collected data to share it so that
they can have large enough datasets to really make new breakthroughs . So the last
things I am doing a s I walk up the doors our Collaborative Cancer Cloud program and
it's really a technology that allows people to share access to their data for analysis
without moving that data . That issue of data sharing must be overcome as the million
person cohort is going to be a massive dataset that we have never had o n the planet to
us e before. At the same time there is all this existing data that these players have and
finding ways to insist that they share data for the greater advancement of science and
medical breakthroughs I just love the vice president’ s messages on that.

Margaret Flinter: Perfect. We have been speaking today Eric Dishman, Director of the
Precision Medicine Initiative Cohort Program at the National Institutes of Health . You
can learn more about their work and how you might get involv ed by going to
nih.gov/precision - medicine - initiative - cohort - program or simply follow him on Twitter
@ericdishman . Eric , thank you so much for joining us today on Conversations on
Healthcare and best of luck in your important new position.

Eric Dishman: Thank you and hope to talk to you again sometimes.

(Music)

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

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 award - winning journalist and managing editor of FactCheck.org , a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Have Washington DC and Chicago been at the top of the list for years
in terms of murder rates ? That’s what senator Ted Cruz in arguing against gu n control
laws. But Cruz is wrong about that, he went on to distort the facts in claiming that most
jurisdictions with the worst murder rates have the v ery strictest gun control laws.
Studies actually suggest the opposite , s tates with a higher number of firearm s’
restrictions have lower firearm deaths b ut that’s only an association not a causal
relationship . Cruz, who is running for the Republican presidential nomination was
responding to a question about guns being shipped to New York from southern states
with more lenient gun control laws. He pointed to Washington DC and Chicago saying,
b oth of them have for years effectively banned firearms and both of them have for years
been right at the top of murder rates.

Chicago ha s been near the top in total numbers of annual murders but its rate
expresses a percentage of the population is nowhere near the top as a Pew Research
Center’s analysis of 28 - years of FBI data found. In 2014 Chicago’ s murder rate was
35th highest among cities with the 100,000 or more residents . Washington has had the
highest murder rate in the past b ut the last time was in 1999. In 2014, D.C. had the
29th highest in the country.

As for the relationship between gun laws and murder rates there is no evidence that gun
control laws result in more murders and the Cruz campaign did not respond with any
evidence when we asked. Several studies counter Cruz’s claim and find instead that
stronger gun control laws are a s soc i ated with lower rates of gun homicide. For instance
a 2013 study by researchers at Boston Children’s Hospital and the Harvard school of
Public Health measured the strength of states gun control laws and mortality rates from
2007 to 2010. The study found that a higher number of gun laws are associated with a
lower rate of gun deaths overall and for suicides and homicides individually . And that’s
my fact check for this week, I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactChec k.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
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

(Music)

Mark Mass elli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. No parent wants to hear their
young child’s chronic health issues are a result of serious defects requiring complex and
risky surgery . B ut that was exactly the case for 3 - year old Mia Gonzales, plagued for
years with severe life threatening respiratory issues and multiple hospitalizations. Her
doctors discovered the cause was a severe aortic abnormality that would eventually kill
her without intervention. Dr. Redmond Burke, Head of the Pediatric Cardiovascular
Surgery at Nicklaus Children’s Hospital in Miami would once have deemed her condition
inoperable. So h e chose a new tactic, created 3D printed m odel of her actual heart to
offer surgeons a chance to map out an approach to the complex surgery that would not
only minimize the high level of risk but also yield a more hopeful outcome.

Dr. Redmond Burke: This was printed out because she was thought t o be inoperable,
and by having this type of model we were able to conceive of an operation that hadn't
been done before connecting the small veins from her lungs up to her heart.

Mark Masselli: Dr. Burke said he carried the heart around him for weeks, an alyzing the
problem from every conceivable angle, sharing ideas with colleagues until they agreed
upon the best surgical solution. The surgery ended up being a resounding success.

Dr. Redmond Burke: Her operation was extremely successful and she is reco vering
very well. And now her life instead of being measured in terms of days and weeks, it's
going to be measured in terms of years and decades.

Mark Masselli: Dr. Burke said that prior to 3D printing technology like this they would
have deemed her cas e inoperable or at least too risky to chance. This offered a visual
problem solving solution before subjecting his young patient to complications from risky
surgery . Creating stem cell generated 3D printed organs for implementation is still
years away, t his method of deploying 3D technology could help surgeons everywhere,
create workable solutions to complex surgical problems. A 3D printed model of a
patient’s organ , offering surgeons a visual tool to help tackle complex surgical
dilemmas, leading to bet ter surgical outcomes, now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Eric Dishman, Director of the Precision Medicine Initiative at the National Institutes of Health

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