“She Has Her Mother’s Laugh” – New York Times Science Writer Carl Zimmer on Heredity and the Genomics Revolution

Carl Zimmer

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Margaret Flin ter : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, and the great minds who are
shaping the health care of the futu re. This week , Mark and Margaret
speak with Carl Zimmer , multi - award - winning science write r a nd
columnist for The New York Times , whose most recent book was
selected by Publishers Weekly as one of the 10 best for 2018 , She Has
Her Mother's Laugh : The Power s , Perversions , and Potentials of
Heredity , where he examines a scientific revolution underway with
genomics and how to harness this emerging science to not only
understand our origins , but also advance , or else .

Lori Robertson also checks in , the managin g editor of FactCheck.org ,
looks at misstatements spoken about health policy in the public
domain , separating the fake from the facts .

We end with a bright idea that ' s improving health an d well - being in
everyday lives. If you have comments , please email u s at
[email protected] or find us on Facebook, or Twitter , iTunes , or
wherever you listen to podcasts . You can also hear us by asking Alexa
to play the program , Conversations on Health Care.

Now , stay tuned for our interview with New York Times science
write r, Carl Zimmer , here on Conversations on Health Care.

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Mark Masselli: We're speaking today with Carl Zimmer, science columnist and author
of numerous books , including his latest, She Has Her Mother's Laugh :
The Powers, Perversions , and Potentials of Heredity , which has been
selected as one of the top 10 books for 2018 by Publishers Weekly .
Mr . Zimmer has written on science topics for The New York Times
since 2004 , incl uding the popular column , Matter .

Prio r to joining the Times , he was a science writer and senior editor at
Discover and has written for numerous other publications , including
the National Geographic , Wire d, The Atlantic , Time , and STAT . He is
an adjunct professor in the School of Biophysics an d Biochemistry at
Yale. Mr. Zimmer has won numerous awards , including a three - time
winner of the American Association for the Advancement of Science
Journalism Award and the National Academies of Science
Communication Award.

Carl , welcome to Conversations on Health Care.

Carl Zimmer: Thanks for having me.

Mark Masselli: Yeah. You've written extensively about the world of science for a

Carl Zimmer

couple of decades with a focus on evolutionary science, genomics,
and DNA . In your most recent book , She Has Her Mother's L augh , you
examine this explosion of knowledge that's under way and our
fundamental understanding of the impact of DNA on heredity , and
how we're learning so much from the genomics world .

I'm wondering if you could share with our listeners how some of thos e
more recent scientific breakthroughs are revolutionizing our thinking
about heredity and why this shift compelled you to write this book.

Carl Zimmer: Yeah . It's been kind of astonishing to see how much things have
changed really, even in just the past f ew years. When I started out in
the 19 90s as a journalist , the idea of sequencing one human genome
was rare. Now , it's possible to sequence a human genome for maybe
$1,000 . You can do what's called genotyping from a place like
23 andMe for maybe $ 100 . All o f a sudden , we're just s wimming in
data about our genes.

Scientists can really look gene by gene , mutation by mutation that
exactly how we inherit genes from our ancestors . We're even finding
other kinds of heredity. For example , you can inherit your gene s from
more than one person. Many people are actually [inaudible 00:03:41]
where these are made up of a mixture of cells from different
individuals that might be a twin and those cells are traded before
birth. Mothers can actually absorb a fetal cell , whic h actually become s
incorporated into their bodies. They don't just have their children in
their thoughts . They have their children's cells in their brain. Heredity
is just becoming a lot more interesting now.

Margaret Flinter: Well , you say so clearly that the accessibility of the information with
the price of personal genomic testing coming way down, as you said,
through entities like Ancestry .com or 23and Me , and others . You also
talk about your own experience of having your whole genome
sequenced and say that it led to more questions than answers in your
case.

Share with us what you learned from that experience , but also what
sort of recommendations and cautions you would offer to people who
are interested in gaining access to their own genomic profiles.

Carl Zimmer : When you go to a company like 23 andMe or Ancestry , what they do is
something called genotyping , where basically they look at about 1000
of the genetic letters in your DNA of the kinds of genetic variants that
you have . If you want to really ge t the full picture, you do something
what ' s called whole genome sequencing. That's not really a consumer
product yet. I do various tricks and twists that I talk about in my book
with able to actua lly get hold of my whole genome. One day , a
external hard dr ive with 60 gigabits of data shows up on my front
doorstep . I've got it . It's amazing . Of course , if I plug that into my

Carl Zimmer

computer, what I'm looking at is a gigantic spreadsheet , which means
nothing to me.

What I did was then went to different scientists w ho have different
areas of expertise and said, you stud y genomes . What can you see in
my genome? I would say that, I'm not particularly unusual, when it
comes to my genome , but it is fascinating to really dig into a big piece
of DNA that is yours. Yet t her e are a lot of questions that you end up
asking , maybe more questions than answers.

Mark Masselli: You ' ve launched a very interesting series of partnerships with the
online health publication , STAT. You called it Game of Genomes ,
catchy title , in which you , as you said to us, take my Petri dish of data
and explore it to this whole group of scientists. You shared that
process in an award - winning series that help explain more fully your
specific genomic traits . Tell us what perhaps the public needs to
underst and about genetic research and also its implications in their
lives.

Carl Zimmer: It can be an amazing experience , but you have to recognize that the
science is very young. It's not like there's like some complete catalog
of revealed truth that's just wait ing for you. Scientists are just starting
to figure this stuff out. A lot of this research takes a huge amount of
time . Just going through the 3 billion or so base pairs in one person's
DNA is a gigantic labor . For example, I have roughly 1% , 1.5%
Neandert hal DNA . I was actually able to look at a complete catalog of
my Neanderthal genes.

Then the next thing I 'd do is I 'd say, okay, well , what does that gene
do? Well, nobody knows . If you're curious about what are the
Neanderthal genes that are sprinkled th roughout your chromosomes,
these are programs that these scientists are using on their computers
that they wrote themselves , and they're just sort of like hacking
together.

There's not some great big computer where all this data comes out of.
It turns out that there are a lot of mutations that you can find in your
genome where scientists can say, well, if I look at that mutation , I
have a pretty good feeling that that is going to actually have a real
change to one of your proteins . I don't know if that's h armless. It
could be even beneficial . We don't know. There are certain mutations
that are very strongly linked to certain diseases and then there's a
gigantic twilight zone.

Margaret Flinter: Well, Carl, one thing that really is fascinating to me is that t he more
that you've researched this topic , the more you've discovered that
nurture seems to have a powerful impact on gene expression and
heredity. We've had some guests on the show , Mark , talking about
this topic . I remember Dr. Donald Wa rne at the Univer sity of North

Carl Zimmer

Dakota talking so compelling ly about the epigenetic impact of cultural
trauma , Native American people , and how that's affected multiple
generations.

Then we had Stan ford's Dr. Raj Chetty on the show , discussing his
research on how one Zip C o de impacts health outcomes may be more
than the individual's genetic code. You've been analyzing this nature
versus nurture paradox as well. Tell us what insights and conclusions
you have about this.

Carl Zimmer: We've been trying to think about nature and nurture for a long, long
time. Actually Shakespeare uses those words in one of his plays . This
isn't something that's new . What is new is that we can really tease
apart these different contributions. We can say, well, just how much
does it matter where you are born geographically in terms of the
social conditions that you are experiencing ? How much does it
depend on particular genes that you inherit ? Certainly , like geneticists
cannot blind themselves to th e power of these social factors. If people
are in a very hard , challenging environment growing up, why is it that
some people are resilient and some are not?

There may be an answer in the different genes that people carry .
There isn't any sort of clean line that you can divide really between
nature and nu rture because the way your genes work often is
controlled by the environment. Likewise , your genes may actually
cause you to seek out different environments to shape the
environment around you. We can't think about it in sort of an
either/ or thing.

Mark Ma sselli: We're speaking w ith Carl Zimmer, multiple award - winning science
writer and author of numerous books , including his latest , She Has
Her Mother's Laugh : The Powers, Perversions , and Potentials of
Heredity.

Carl , I can't help , but think that if we're having a conversation about
genome that we don't want to talk about CRISPR technology and its
impact on our sort of general landscape . I'm wondering what your
thought is about this type of gene editing process that has a wide
variety of applications , incl uding use in some basic biology research
tools. How do you think that's going to change or revolutionize how
we think about curing diseases and our sort of own mortality?

Carl Zimmer: Well , what I'm most excited by are some trials that are actually
startin g literally right now where scientists want to use this
technology for editing DNA to treat , maybe even cure , inherited
diseases that until now have had no good treatment at all. Sickle cell
anemia is a case in point. It's an inherited disease. It's the re sult of
mutations in genes for hemoglobin . There are treatments that people
can get that can extend their lives , but still today people are living into

Carl Zimmer

their 40s and 50s at most on average . These diseases cause a huge
amount of pain and suffering along the way .

Mark Masselli: It's a single gene mutation , right, sickle cell ?

Carl Zimmer: That's right . If you have a mutation on both copies of this gene, you're
going to get this disease. What scientists are exploring now in a
clinical trial is using this techn ology , CRISPR , to create molecules that
can go into cells and can cut out a little piece of DNA, to alter that tiny
little bit of DNA very precisely. What's going to happen is that these
cells are going to be able to start making healthy hemoglobin again
b ecause their DNA has been altered.

Now it's a completely up in question whether this is going to work or
not, that devil's in the details , and these sorts of things , but these
clinical trials are starting lots of experiments on mice with diseases
like mus cular dystrophy and so on suggested this could work. I think
this is a really potentially revolutionary treatment.

Now , what gets people really riled up is not what I just talked about.
What gets people riled up is the ide a of using this on human embryos
because if you do that , then that person who develops from that
embryo is going to have that engineering and every one of their cells
then will pass that down to future generations. I think that's a
separate discussion that we do need to have. I think that what you ' ve
seen from a lot of atheists [ PH 00:12:56] and scientists have talked
about this is we really should not even be talking about this kind of
procedure , except for things for which there's no other alternative . It
would really only be an incredib ly rare set of circumstances where you
could medically justify this sort of approach on embryos.

That being said , I'm sure there would be some parents who would
love to use it to make their kids taller, to change their appearance, to
give them genes that they 've been told will make their kids more
successful. We really have to withstand that seduction .

Margaret Flinter: Well, Carl , that ' s in many ways a great segue int o the next question ,
and that is, given this phenomenal world - changing set of tools and
s oon to be increasingly at our disposal, what's the best way to think
about getting ready to teach and prepare the next generation of
clinicians in health care , so they're ready to adapt to all of this
evolving scientific discovery that's going to lead to b etter ways to
treat and manage , and diagnose maybe , even prevent the onset of
disease ?

You've written some important textbooks in science education. What
do you think about preparing our clinical workforce for the future ,
which increasingly in our health and health care is going to be moving
more towards genomic space personalized medicine ?

Carl Zimmer

Carl Zimmer: I do think that clinicians just really have to practically start over with
their education because so much has changed so quickly. T he patients
are going t o be coming to doctors with results they're getting from
direct to consumer services as customers , and they're going to say,
look, 23 andMe says I have this. What are you going to do about it ?

Margaret Flinter: Yeah, they already are .

Carl Zimmer: Yeah, exa ctly . You need to learn how to talk about , for example, risk .
What does it mean to have a variant tha t raises your risk of a disease ?
There 's a big difference between a mutation that guarantees you're
going to get Huntington's disease and a mutation that ' s slightly on
average increases the risk of heart disease. Yet it's hard for people to
recognize it . If it's there on the report , they think it's all the same. At
the same time , I think that clinicians are going to have to really get to
understand lots of v ery common diseases are influenced by hundreds
or thousands of different genes . That can sound like a nightmare if
you're trying to look at each and every gene .

There are these approaches , known as polygenic risk scores that are
going to be coming more an d more into practice , where you'll
sequence a patient's whole genome and then come up with a score ,
which then translates to a real different kind of risk depending on
what category you're in. Actually with heart disease , this has already
been demonstrated pretty effectively in just some recent papers from
Harvard Medical School .

What scientists are starting to do is develop a way to look across the
entire genome at lots and lots of different variants and figure out how
do they add up in each person to a r isk for a particular disease.
Scientists that are in medical school have been pioneering this with
heart disease . Their scores are pretty impressive now. If you divide
people up , they have very different risk profiles , and these scores do a
good job of pre dicting how many people in each category are going to
get a heart attack or not. This stuff is coming really fast . It's going to
be a communication challenge . It's also going to be just a learning
challenge.

Mark Masselli: It's interesting . I think your bo ok sort of talks about this hopeful
promise , but also this cautionary tale about science and how it could
be misused and advance certain agendas. On the other side of the
equation , you ' ve got people who are talking about anti - vaxxe rs, the
climate change de niers.

Just sort of a larger question of what is it going to take to bring
science back to its proper place in our political discourse ? I think you
understand the fundamentals of science are important for this in
some way should be a settled matter that w e have some faith and
trust in science . Yet it seems that we have extremes as well. Thoughts

Carl Zimmer

about that ?

Carl Zimmer: Well, certainly within medicine and beyond , pretty much every major
improvement in human welfare had something to do with scientific
resea rch and discovering things through science. I do think that
people do have a great respect still for scientists and for doctors , and
so on , b ut there are these certain areas where people will want to
reject the findings of science because it somehow feels like a
challenge to how they identify themselves or the way they look at the
world. I think we all have to sort of recognize our own biases and to
learn how the scientific process actually works , and how science is an
ongoing process .

In that way , we can make sure that with genetics, for example, that it
doesn't end up being used for justifying racism or other really noxious
kinds of ideologies. It's happened in the past . Unfortunately , some
scientists themselves have been part of the problem. I think we h ave
to be very clear in terms of education and in our own experiences and
conversations to recognize what science really is and the benefits that
it can give us.

Margaret Flinter: We've been speaking today with Carl Zimmer, multiple award - winning
science w riter, longtime columnist for The New York Times , and the
author of She Has Her Mother's Laugh: The Powers, Perversions , and
Potentials of Heredity , which was just selected as one of Publishers
Weekly ' s best 10 books for 2018. You can learn more about his work
by going though his website , carl zimmer .com or follow him on twitter
@ carl zimmer .

Carl, thank you so much for your prolific body of work , for sharing
your rich insights , and making it understandable to the general
population , and for joining us on Co nversations on Health Care today.

Carl Zimmer: Thank you. It's been a pleasure .

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Mark Masselli: At 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 Robert son 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 U . S . politics.

Lori, what have you got for us this week?

Lori Robertson: In several of his midterm campaign rall ies, President Donald Trump
has made false and uns upported claims about the right - to - try law he
th
signed on May 30 . He claims that until he signed the law, " we
couldn't even come close " to letting terminally ill patients use
pr omising , but unapproved medications. In fact, the FDA for years has

Carl Zimmer

approved applications from patient s seeking access to investigational
drugs.

Trump also claims there have been tremendous and incredible results
already under the months ' old federal law , but we could find no
evidence that any drug manufacturers have granted access to any
medications under the new law. The President made these claims in
Texas, Penns ylvania , and Kentucky .

The right - to - try legislation aim s to circumvent the FDA and give
ter minally ill patients access to unapproved drugs more quickly than
through the FDA's Expanded Access Program . FDA Commissioner , Dr.
Scott Gottlieb , testified to Congress in October 2017 that the FDA had
approved 99 % of the mor e than 1 , 000 annual application s it gets for
such access .

Under either the FDA's Expanded Access Pr ogram or the new federal
right - to - try law , patients along with their physician s can request
access to drugs that haven't yet been approved by the FDA directly
from manufacturers if there are no comparable trea tments. Under
right - to - try , which applies only to drugs , there 's no FDA or IRB
oversight. In both processes , the drug manufacturer decides whether
or not it wants to mak e the drug available.

The right - to - try law is nearly five months old , which isn't a lot of time
to see i ncredible results as the President claims . We asked the FDA,
the Goldwater Institute, and an expert on preapproval access to
treatment s whether any drug companies have granted ac cess to
drugs under the new law. They knew of no such instances. We asked
the White House Press Office about the President's claim , but did not
receive a response.

That's my fact check for this week . I'm Lori Robertson, managing
editor of FactCheck.org.

Margaret Flinter : FactCheck.org is comm itted 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'd
like checked, email us at chcradio.com . We 'll have FactCheck.org ' s
Lori Robertson check it out for you here on Conversations on Health
Care .

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Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our c ommunities and everyda y lives. Health care
providers are forever on the lookout for that magic elixir that can cure
a host of chronic ills in one step. In the case of obesity, depression,
anxiety, and stress , that elixir could be a number of steps as in taking
a hike .

Carl Zimmer

A large study conducted by several institutions , including the
University of Michigan and Edge Hill University in the UK, looked at
the medicinal benefits derived from regular group hikes conducted in
nature. Researchers evaluated some 2 , 000 participants in a prog ram ,
called Walking for Health in England , which sponsors some 3 , 000
walks per week across the country .

Dr. Sara Warber: This is a national study in the UK . There was investment in these
walking groups in training leaders to take people on walks, finding
t rails that were good for people to do even if they had health
problems.

Margaret Flinter: Dr. Sara Warber , professor of family medicin e at the University of
Michigan, School of Medicine , said this study showed a dramatic
improvement in the mental well - bein g of participants , especially
those who had recently experienced something stressful , like the loss
of a loved one or a serious illness.

Dr. Sara Warber: Depression was reduced . Perceived stress was reduced . People had ,
the y experience d more positive feeli ngs or positive emotions . There's
been a really lovely research that's shown that when we have positive
emotions, we actually have better health in the long run. Our control
group of people at one time intended to be part of walking groups ,
but they never took up the practice . We could see how they deferred
overtime.

Margaret Flinter: Other studies have shown a link between mood and exercise, but Dr.
Warber says this is the first study that revealed the added benefits of
group hikes in nature and significan t mitigation of depression .

Dr. Sara Warber: Because we 're really interested in whether if you are more stressed,
would you get some better benefit from being in nature . In fact , that
did pan out .

Margaret Flinter: 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 , n ow that's a bright idea.

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Mark Masselli: You 've been listening to Conversations on Health Care. I'm Mark
Masselli .

Margaret Flinter: I ' m Margaret Flinter.

Mark Masselli: Peace and h ealth .

Margaret Flinter : Conversations on Health Care is recorded at WESU at Wesleyan
University , streaming live at chcradio.com , iTunes , or wherever you
listen to podcasts. If you have comments , please email us at

Carl Zimmer
[email protected] or find us on Facebook , or T witter. We love
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