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>>HI, I'M DAN KASTNER.

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I AM THE SCIENTIFIC DIRECTOR

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EMERITUS AND A SENIOR

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INVESTIGATOR IN THE NATIONAL

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HUMAN GENOME RESEARCH INSTITUTE

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AND IT IS MY ENORMOUS PLEASURE

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TO WELCOME YOU TO THIS, THE 14TH

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INSTALLMENT OF THE 23RD SEASON

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OF DEMYSTIFYING MEDICINE AT THE

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NIH.

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THIS IS A COURSE SERIES THAT WE

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PUT ON, WE MEANING MY

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COMODERATOR, DR. WIN ARIAS, WHO

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IS A SENIOR SCIENTIST EMERITUS

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AT THE NIH, AND THE FOUNDER OF

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THIS COURSE, AND MYSELF, WE PUT

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TOGETHER THIS COURSE TO BRIDGE

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THE EXCITING DEVELOPMENTS IN

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BIOLOGY AND ENGINEERING WITH

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MEDICINE.

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AND BRIDGING IS TRULY IN WHAT WE

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ARE INTERESTED IN DOING,

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BRINGING TOGETHER EXPERTS IN A

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PARTICULAR FIELD OF INTEREST TO

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HIGHLIGHT SOME OF THE IMPORTANT

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ACCOMPLISHMENTS IN THAT FIELD

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AND TO EXCITE THE VIEWER WITH

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THE NEW OPPORTUNITIES FOR

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ADVANCEMENT IN THAT FIELD.

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AND JUST LIKE THE TWO MEN ON

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THIS ICONIC PHOTO OF THE

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CONSTRUCTION OF THE BROOKLYN

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BRIDGE IN THE UPPER RIGHT,

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PROUDLY ONE OF THEM FROM MA

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MANHATTAN, THE OTHER FROM

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BROOKLYN, HAVING A CONVERSATION

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ABOUT SOME OF THE MATTERS OF THE

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TIMES IN THE 1870s, BUT NOW WE

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ARE IN THE 21ST CENTURY AND WE

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HAVE A COUPLE OF NEW

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INTERLOCUTORS TO DISCUSS THE

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LATEST DEVELOPMENTS IN A

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PARTICULAR FIELD.

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THE TITLE OF THE

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PRESENTATION IS:  OUT OF AFRICA,

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GENOMIC AND ENVIRONMENTAL

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DETERMINANTS OF GLOBAL HEALTH.

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AND WE HAVE TWO STELLAR SPEAKERS

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THIS AFTERNOON.

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THE FIRST OF THEM IS DR. CHARLES

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ROTIMI.

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THE GOOD DR. ROTIMI IS

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SCIENTIFIC DIRECTOR OF THE

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DIVISION OF INTRAMURAL RESEARCH

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AT THE NATIONAL HUMAN GENOME

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RESEARCH INSTITUTE, AND HE WAS

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THE FOUNDING DIRECTOR OF THE

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CENTER FOR RESEARCH ON GENOMICS

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AND GLOBAL HEALTH AT THE NIH.

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HE'S ALSO AN NIH DISTINGUISHED

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INVESTIGATOR.

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HE CURRENTLY IS THE PRESIDENT OF

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THE AMERICAN SOCIETY OF HUMAN

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GENETICS, AND HE IS THE FOUNDING

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AND PAST PRESIDENT OF THE

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AFRICAN SOCIETY OF HUMAN

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GENETICS.

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HE GOT HIS BACHELOR'S DEGREE AT

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THE UNIVERSITY OF BENIN IN

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NIGERIA.

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HIS MASTER'S DEGREE IN HEALTH

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SCIENCE ADMINISTRATION FROM THE

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UNIVERSITY OF MISSISSIPPI, AND

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HIS DOCTORAL DEGREE IN

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EPIDEMIOLOGY FROM THE UNIVERSITY

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OF ALABAMA AT BIRMINGHAM.

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HE'S THE RECIPIENT OF A NUMBER

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OF AWARDS AND PRIZES, INCLUDING

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THE CURT STERN AWARD OF THE

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AMERICAN SOCIETY OF HUMAN

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GENETICS, AND HE'S A MEMBER OF

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THE NATIONAL ACADEMY OF

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MEDICINE.

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HIS RESEARCH GROUP CURRENTLY

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DEVELOPS ANALYTIC TOOLS FOR

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GENETICS IN ADMIXED POPULATIONS.

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HIS GROUP HAS PLAYED A LEADING

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ROLE IN THE DEVELOPMENT OF

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GENOMIC RESOURCES FOR THE STUDY

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OF AFRICAN ANCESTRY POPULATIONS,

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INCLUDING THE HAPMAP,

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1000 GENOMES AND AFRICAN GENOME

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VARIATION PROJECTS.

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IN ADDITION, HIS GROUP HAS MADE

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MAJOR CONTRIBUTIONS IN THE

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GENETICS AND GENOMICS OF

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DIABETES, HYPERTENSION AND

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CARDIOVASCULAR DISEASE.

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AND HE'S BEEN A LEADER OF THE

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HUMAN H HEREDITY AND HEALTH IN

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AFRICA, H3AFRICA INITIATIVE, TO

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DEVELOP A PAN-CONTINENTAL

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NETWORK OF LABS TO STUDY THE

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GENETIC AND ENVIRONMENTAL BASIS

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OF DISEASE IN AFRICANS.

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IF WE CAN HAVE THE NEXT SLIDE,

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WE WILL TURN TO OUR SECOND

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SPEAKER IN THIS TALK, SERIES OF

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TALKS ABOUT THE GENOMIC AND

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ENVIRONMENTAL DETERMINANTS OF

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GLOBAL HEALTH.

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AND OUR SECOND SPEAKER IS THE

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GOOD DR. CLEMENT ADEBAMOWO, FROM

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THE UNIVERSITY OF MARYLAND.

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HE IS A PROFESSOR OF

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EPIDEMIOLOGY AND PUBLIC HEALTH,

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AND DIRECTOR FOR GLOBAL HEALTH

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CANCER RESEARCH, AND ASSOCIATE

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DIRECTOR FOR DIVERSITY, EQUITY

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AND INCLUSION AT THE MARLENE AND

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STEWART GREENBAUM CANCER CENTER

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AT THE UNIVERSITY OF MARYLAND.

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HE'S THE PRINCIPAL INVESTIGATOR

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ON AN NIH-FUNDED TRAINING

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PROGRAM IN NON-COMMUNICABLE

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DISEASES RESEARCH IN NIGERIA,

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AND DIRECTOR OF THE

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FOGARTY-FUNDED WEST AFRICAN

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BIOETHICS TRAINING PROGRAM.

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HE GOT HIS MEDICAL DEGREE WITH

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HONORS AT THE UNIVERSITY OF JOS

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IN NIGERIA.

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HE HAD TRAINING IN SURGICAL

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ONCOLOGY IN IBADAN, ALSO IN

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NIGERIA, AND HAS A DOCTOR OF

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SCIENCES DEGREE IN NUTRITION AND

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EPIDEMIOLOGY -- NUTRITION

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EPIDEMIOLOGY AND BIOSTATISTICS

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FROM HARVARD.

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HIS RESEARCH GROUP WORKS ON THE

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EPIDEMIOLOGY OF CANCER IN

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AFRICAN POPULATIONS, AND IN

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PARTICULAR, WORKS ON THE

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INTEGRATIVE EPIDEMIOLOGY OF

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PERSISTENT HIGH RISK HPV

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INFECTION, HOST GERMLINE AND

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SOMATIC GENOMICS AND EP

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GENOMICS, AND THE VAGINAL

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MICROENVIRONMENT INCLUDING

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CYTOKINES AND THE MICROBIOME,

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AND THE RISK OF CERVICAL CANCER,

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AND ALSO WORKS ON THE GENOMIC,

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MICROBIOME AND ENVIRONMENTAL

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RISK FOR BREAST CANCER IN

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AFRICA.

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SO WITHOUT FURTHER ADO, I'M

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GOING TO TURN THINGS OVER TO THE

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GOOD DOCTOR ROTIMI, WHO WILL GET

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US STARTED BEFORE WE TURN TO OUR

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SECOND SPEAKER.

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DR. ROTIMI, PLEASE, TAKE IT

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AWAY.

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>>THANK YOU.

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SO AGAIN, THANK YOU FOR THAT

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WONDERFUL INTRODUCTION.

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I JUST WANT TO SAY THAT MY GOAL

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HERE TODAY IS TO PROVIDE INSIGHT

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INTO THE IMPORTANT ROLE OF

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AFRICA, THAT GEOGRAPHICAL AREA

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OF THE WORLD WE CALL AFRICA

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TODAY, IN TERMS OF HUMAN

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GENETICS, ALSO HUMAN HISTORY,

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AND TO BRING US HOME, ALL OF US,

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IF WE TRACE OUR ANCESTRY FAR

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ENOUGH, WE'RE GOING TO END UP

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SOMEWHERE IN AFRICA.

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AND THAT IS MY ROLE TODAY, AND

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BEFORE MY GOOD FRIEND CLEMENT

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TALKS TO YOU SPECIFICALLY ABOUT

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HIS RESEARCH.

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SO I DON'T HAVE ANY DISCLOSURE,

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AS HAS BEEN SAID.

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I HAVE A LEARNING OBJECTIVE.

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AGAIN, UNDERSTANDING HOW THE

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GEOGRAPHICAL REGION OF AFRICA

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HAS SHIFTED REVOLUTIONARY

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HISTORY OF HUMANS AND ALSO THE

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IMPACT ON OUR HEALTH AND

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DISEASE, THROUGH THE LENS OF

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FOSSIL RECORDS AND GENOMICS.

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SO THE FIRST INSIGHT HERE, IF I

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CAN GET A POINTER, SO THE

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HISTORY STARTED A LONG, LONG

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TIME AGO AGAIN IN THAT

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GEOGRAPHICAL AREA CALLED AFRICA.

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OUR INITIAL SPLIT FROM OUR

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CLOSEST RELATIVE ABOUT 6 TO

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7 MILLION YEARS AGO, AND SINCE

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THEN, WE HAVE BEEN EVOLVING AND

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TRAVELING ACROSS AFRICA, AND

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THEN AS YOU WILL SEE LATER, SOME

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OF US VENTURED OUT OF AFRICA.

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SO THIS REMARKABLE SIMILARITY

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BETWEEN US AND OUR CLOSEST

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RELATIVE, THE APES, ARE THAT LED

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CHARLES DARWIN, IN 1871, TO

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PREDICT THAT AFRICA WAS THE

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LIKELY PLACE WHERE THE HUMAN

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LINEAGE BRANCHED OFF FROM OTHER

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ANIMALS, THAT IS, THE PLACE

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WHERE THE COMMON ANCESTORS OF

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CHIMPANZEES, HUMANS AND GORILLAS

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ONCE LIVED.

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NOW I'LL TELL YOU WHAT IS EVEN

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MORE REMARKABLE ABOUT THAT

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PREDICTION IN A MINUTE.

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SO MOST OF THE RECORDS AND

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HISTORY THAT HAVE BEEN WRITTEN

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ABOUT HUMAN MIGRATION INSIDE AND

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OUT OF AFRICA -- THE SOUTHEAST

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AFRICA IS WHERE WE STARTED THE

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HUMAN STORY, WHERE PEOPLE

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MIGRATED TO DIFFERENT PARTS OF

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THE WORLD, BUT AS I WILL SHOW

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YOU IN A MINUTE, THERE HAS BEEN

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SOME REVISION OF THAT HISTORY A

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LITTLE BIT.

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THIS IS WHEN I VISITED, I HAD

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THIS WONDERFUL PICTURE TAKEN.

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AGAIN, LOOKING AT LUCY,

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3.2 MILLION YEARS OLD IN THAT

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AREA DISCOVERED IN 1974, AGAIN

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GIVING US A VERY LONG HISTORY OF

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HUMANS IN THAT PART OF THE

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WORLD.

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SO RECENTLY, THIS IS THE STORY I

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WAS TELLING YOU ABOUT, THERE WAS

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A DISCOVERY IN MOROCCO THAT

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CHANGED THE STORY OF THINKING

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THAT EVERYTHING STARTED FROM

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SOUTHERN AND EASTERN PARTS OF

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AFRICA TO A PAN-AFRICAN

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UNDERSTANDING OF HUMAN EVOLUTION

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ACROSS AFRICA.

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SO THIS RECENT DISCOVERY REALLY

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CHANGED THE PICTURE, AND WHAT I

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WILL SAY IS THAT WE ARE GOING TO

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CONTINUE TO MAKE DISCOVERIES, SO

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IT IS SUFFICIENT TO THINK THAT

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IT IS TRULY A PAN AFRICAN STORY

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TO HUMAN MIGRATION OF HUMAN

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ORIGIN AFTER WE MIGRATED OUT OF

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AFRICA AND POPULATED THE REST OF

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THE WORLD.

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SO IN TERMS OF GENOMIC EVIDENCE,

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THIS PAPER THAT WAS WRITTEN IN

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2017 ACTUALLY SUMMARIZES IT

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QUITE NICELY.

259
00:10:50,560 --> 00:10:54,640
AS YOU WILL SEE, A LONG HISTORY

260
00:10:54,640 --> 00:10:57,000
IN THAT PART OF THE WORLD IN

261
00:10:57,000 --> 00:10:59,640
AFRICA, UNTIL SOME OF US

262
00:10:59,640 --> 00:11:02,480
MIGRATED OUT ABOUT 100,000 YEARS

263
00:11:02,480 --> 00:11:04,320
AGO TO POPULATE THE REST OF THE

264
00:11:04,320 --> 00:11:07,680
WORLD, AND WHAT IS REMARKABLE IS

265
00:11:07,680 --> 00:11:10,120
THAT GENOMICS AND GENETICS

266
00:11:10,120 --> 00:11:13,400
INFORMATION ENCODED IN OUR DNA

267
00:11:13,400 --> 00:11:14,720
IS KNOWN TO CONFIRM THIS, AND

268
00:11:14,720 --> 00:11:18,120
THIS IS WHAT I WAS SAYING IN

269
00:11:18,120 --> 00:11:19,400
TERMS OF CHARLES DARWIN, THAT IT

270
00:11:19,400 --> 00:11:21,720
WAS TRULY REMARKABLE THAT JUST

271
00:11:21,720 --> 00:11:22,800
BY APPEARANCE AND LOOK, HE WAS

272
00:11:22,800 --> 00:11:25,800
ABLE TO MAKE A PREDICTION IN

273
00:11:25,800 --> 00:11:28,920
1871 THAT IS NOW FULLY SUPPORTED

274
00:11:28,920 --> 00:11:33,640
BY GENOMIC DATA IN SEQUENCING

275
00:11:33,640 --> 00:11:35,280
DNA GENOTYPING OF THOUSANDS OF

276
00:11:35,280 --> 00:11:36,480
HUMAN BEINGS AROUND THE WORLD

277
00:11:36,480 --> 00:11:38,480
AND IN AFRICA.

278
00:11:38,480 --> 00:11:41,960
ONE OF THE REALLY INTERESTING

279
00:11:41,960 --> 00:11:45,760
STORIES THAT WE COULDN'T HAVE

280
00:11:45,760 --> 00:11:46,680
UNDERSTOOD UNTIL VERY RECENT AND

281
00:11:46,680 --> 00:11:54,320
WITH THE HELP OF GENOMICS IS

282
00:11:54,320 --> 00:12:00,120
THAT -- THAT WE ACTUALLY SHARE

283
00:12:00,120 --> 00:12:02,120
DNA WITH DINOSAURS AND OTHERS

284
00:12:02,120 --> 00:12:03,520
THAT WE DON'T HAVE THE

285
00:12:03,520 --> 00:12:05,720
INFORMATION ON YET, AND THAT IS

286
00:12:05,720 --> 00:12:07,800
TRULY REMARKABLE BECAUSE THERE

287
00:12:07,800 --> 00:12:08,880
WAS NO WAY WE COULD HAVE

288
00:12:08,880 --> 00:12:11,000
UNDERSTOOD THAT LOOKING AT

289
00:12:11,000 --> 00:12:12,280
FOSSIL RECORDS.

290
00:12:12,280 --> 00:12:15,000
SO GENOMICS HAVE PROVIDED

291
00:12:15,000 --> 00:12:16,040
INSIGHTS, SO I'M NOT SURPRISED

292
00:12:16,040 --> 00:12:18,320
THAT THE NOBEL PRIZE OF MEDICINE

293
00:12:18,320 --> 00:12:20,120
THIS YEAR WAS INDEED GIVEN TO

294
00:12:20,120 --> 00:12:25,600
THIS ASPECT OF GENOMIC SCIENCE,

295
00:12:25,600 --> 00:12:26,120
AND -- DNA.

296
00:12:26,120 --> 00:12:32,400
SO GIVEN THIS LONG HISTORY OF

297
00:12:32,400 --> 00:12:36,040
HUMANS IN AFRICA, ACROSS AFRICA,

298
00:12:36,040 --> 00:12:39,520
IT IS INDEED REMARKABLE THAT WE

299
00:12:39,520 --> 00:12:43,960
SPENT OVER 99% OF OUR HISTORY,

300
00:12:43,960 --> 00:12:46,080
OF OUR EVOLUTIONARY HISTORY, ON

301
00:12:46,080 --> 00:12:49,160
THAT CONTINENT AFTER THE

302
00:12:49,160 --> 00:12:50,600
CHIMPANZEE HUMAN DIVER JAN'S.

303
00:12:50,600 --> 00:12:55,080
DIVERGENCE.SO THAT IS TRULY REMD

304
00:12:55,080 --> 00:12:56,160
I WILL SHOW YOU WHAT IS SO

305
00:12:56,160 --> 00:12:56,840
IMPORTANT.

306
00:12:56,840 --> 00:12:59,760
SO THIS LONG HISTORY HAS INDEED

307
00:12:59,760 --> 00:13:00,640
GENERATED SEVERAL IMPORTANT

308
00:13:00,640 --> 00:13:02,800
CULTURAL AND GENETIC

309
00:13:02,800 --> 00:13:04,360
CHARACTERISTICS IN AFRICAN

310
00:13:04,360 --> 00:13:05,440
PEOPLE AND DIFFERENT PEOPLE

311
00:13:05,440 --> 00:13:07,400
ACROSS THE WORLD.

312
00:13:07,400 --> 00:13:11,280
SO AFRICANS HAVE OVER 200

313
00:13:11,280 --> 00:13:12,360
LANGUAGES.

314
00:13:12,360 --> 00:13:13,360
AND THAT'S ABOUT ONE-THIRD OF

315
00:13:13,360 --> 00:13:14,880
THE LANGUAGES THAT EXIST IN THE

316
00:13:14,880 --> 00:13:15,480
WORLD.

317
00:13:15,480 --> 00:13:16,640
JUST THINK ABOUT THAT FOR A

318
00:13:16,640 --> 00:13:18,280
MINUTE.

319
00:13:18,280 --> 00:13:20,560
AND IN NIGERIA, WHERE I WAS

320
00:13:20,560 --> 00:13:22,880
BORN, IS ONE OF THE MOST

321
00:13:22,880 --> 00:13:23,640
LINGUISTICALLY DIVERSE COUNTRIES

322
00:13:23,640 --> 00:13:26,760
IN THE WORLD, WITH OVER 500

323
00:13:26,760 --> 00:13:27,560
LANGUAGES SPOKEN.

324
00:13:27,560 --> 00:13:31,600
IN FACT, I WAS JOKING WITH

325
00:13:31,600 --> 00:13:34,480
CLEMENT, WHO'S ALSO FROM

326
00:13:34,480 --> 00:13:39,600
NIGERIA, AND GROWING UP,

327
00:13:39,600 --> 00:13:40,680
20 KILOMETERS FROM EACH OTHER,

328
00:13:40,680 --> 00:13:42,440
YOU RUN INTO A DIFFERENT

329
00:13:42,440 --> 00:13:43,080
LANGUAGE GROUP.

330
00:13:43,080 --> 00:13:46,760
SO IT'S ABSOLUTELY REMARKABLE.

331
00:13:46,760 --> 00:13:50,800
SO AFRICAN POPULATIONS DISPLAY,

332
00:13:50,800 --> 00:13:52,480
AGAIN, BASED ON THIS HISTORY AND

333
00:13:52,480 --> 00:13:54,480
CONTINUOUS MIGRATION AND

334
00:13:54,480 --> 00:13:56,800
VARIATION AND SHARING OF DNA,

335
00:13:56,800 --> 00:14:01,840
DISPLAY CONSIDERABLE PHENOTYPIC

336
00:14:01,840 --> 00:14:03,480
VARIATION IN TERMS OF SKIN

337
00:14:03,480 --> 00:14:08,600
COLOR, HAIR TEXTURE, HEAD SHAPE

338
00:14:08,600 --> 00:14:16,040
AND WE ARE TRYING TO TAKE

339
00:14:16,040 --> 00:14:18,360
ADVANTAGE OF THIS.

340
00:14:18,360 --> 00:14:19,640
SO IT IS NOT SURPRISING THAT

341
00:14:19,640 --> 00:14:22,520
PEOPLE WHO LIVE CLOSE TO THE

342
00:14:22,520 --> 00:14:24,800
EQUATOR ARE DARKER IN

343
00:14:24,800 --> 00:14:25,120
COMPLEXIONS.

344
00:14:25,120 --> 00:14:28,760
THIS IS TO PREVENT SUNBURN, SKIN

345
00:14:28,760 --> 00:14:33,560
CANCER AND PHOTOLYSIS OF FOLATE

346
00:14:33,560 --> 00:14:35,440
AND DAMAGE TO SWEAT GLANDS.

347
00:14:35,440 --> 00:14:39,800
SO THIS I IS A VERY IMPORTANT

348
00:14:39,800 --> 00:14:43,320
EVOLUTIONARY DEVELOPMENT, IN

349
00:14:43,320 --> 00:14:47,680
THAT PART OF THE WORLD.

350
00:14:47,680 --> 00:14:49,240
SO IN TERMS OF GENETICS, IT IS

351
00:14:49,240 --> 00:14:51,760
IMPORTANT FOR US TO RECOGNIZE

352
00:14:51,760 --> 00:15:01,040
AND SHARE THIS STORY THAT GIVEN

353
00:15:01,040 --> 00:15:05,600
OUR COMMON HOME, AFRICA, CREATOR

354
00:15:05,600 --> 00:15:09,440
OF HUMANITY, WE SHARE A LOT OF

355
00:15:09,440 --> 00:15:11,400
GENETIC INHERITANCE.

356
00:15:11,400 --> 00:15:12,960
BECAUSE WE WERE THERE BEFORE WE

357
00:15:12,960 --> 00:15:13,800
MOVED TO DIFFERENT PARTS OF THE

358
00:15:13,800 --> 00:15:14,160
WORLD.

359
00:15:14,160 --> 00:15:15,480
THESE ARE SHARED BY ALL PEOPLE

360
00:15:15,480 --> 00:15:16,800
AROUND THE WORLD.

361
00:15:16,800 --> 00:15:17,880
AGAIN, IT'S A VERY IMPORTANT

362
00:15:17,880 --> 00:15:20,560
MESSAGE THAT WE DON'T TELL WELL

363
00:15:20,560 --> 00:15:23,160
ENOUGH, AND THAT IS WHY WHEN YOU

364
00:15:23,160 --> 00:15:25,360
LEARN OF THE GENOME OF A LOT OF

365
00:15:25,360 --> 00:15:26,520
DIFFERENT PEOPLE FROM DIFFERENT

366
00:15:26,520 --> 00:15:28,440
PARTS OF THE WORLD, THEY ARE

367
00:15:28,440 --> 00:15:29,880
REMARKABLY SIMILAR TO THE POINT

368
00:15:29,880 --> 00:15:34,440
THAT THEY ARE ALMOST BORING,

369
00:15:34,440 --> 00:15:36,800
ALTHOUGH THERE ARE STILL SOME

370
00:15:36,800 --> 00:15:39,120
DIFFERENCES WHICH MEDICINE AND

371
00:15:39,120 --> 00:15:40,120
SCIENCE ARE TRYING TO TAKE

372
00:15:40,120 --> 00:15:44,240
ADVANTAGE OF TO UNDERSTAND.

373
00:15:44,240 --> 00:15:45,720
SO WHY IS IT THAT WHEN YOU LOOK

374
00:15:45,720 --> 00:15:50,160
AT AFRICAN POPULATION, AND

375
00:15:50,160 --> 00:15:51,040
THEN -- OR POPULATIONS FROM

376
00:15:51,040 --> 00:15:52,680
OTHER PARTS OF THE WORLD, THE

377
00:15:52,680 --> 00:15:55,040
VARIATION YOU SEE IN THE OTHER

378
00:15:55,040 --> 00:15:58,240
PARTS OF THE WORLD SEEMS TO BE

379
00:15:58,240 --> 00:15:59,680
ALMOST A SUBSET OF WHAT YOU SEE

380
00:15:59,680 --> 00:16:00,840
IN AFRICA, AND THAT IS BECAUSE

381
00:16:00,840 --> 00:16:05,520
OF THIS ORIGINAL MIGRATION AND

382
00:16:05,520 --> 00:16:07,760
BOTTLENECK EFFECT.

383
00:16:07,760 --> 00:16:14,000
THOSE ADVENTUROUS MEMBERS THAT

384
00:16:14,000 --> 00:16:15,000
EMIGRATED OUT OF AFRICA ONLY

385
00:16:15,000 --> 00:16:16,520
TOOK A SUBSET OF THE VARIATION

386
00:16:16,520 --> 00:16:17,840
THAT EXISTED THEN, AND,

387
00:16:17,840 --> 00:16:21,120
THEREFORE, AFRICA IS THE ONLY

388
00:16:21,120 --> 00:16:23,440
PLACE YOU CAN TRULY STUDY THIS.

389
00:16:23,440 --> 00:16:24,840
AND I'LL SAY A LITTLE MORE ABOUT

390
00:16:24,840 --> 00:16:25,240
THIS.

391
00:16:25,240 --> 00:16:27,240
THIS IS WHY I THINK IT'S

392
00:16:27,240 --> 00:16:30,640
TREMENDOUSLY IMPORTANT FOR US TO

393
00:16:30,640 --> 00:16:31,240
SYSTEMATICALLY SAMPLE AFRICA,

394
00:16:31,240 --> 00:16:36,160
THE NO JUST FOR ANOT JUST FOR AT

395
00:16:36,160 --> 00:16:37,480
FOR THE WORLD BECAUSE WHAT WE

396
00:16:37,480 --> 00:16:38,560
WILL LEARN WILL BENEFIT

397
00:16:38,560 --> 00:16:38,880
EVERYBODY.

398
00:16:38,880 --> 00:16:42,600
SO USING THE DATA FROM THE

399
00:16:42,600 --> 00:16:46,240
HAPMAP WHICH CLEMENT AND MYSELF

400
00:16:46,240 --> 00:16:51,080
HAHAVE BROUGHT TO FRUITION IN

401
00:16:51,080 --> 00:16:55,000
NIGERIA AND ALSO KENYA AND THE

402
00:16:55,000 --> 00:16:56,760
1000 GENOME, WE'VE BEEN ABLE TO

403
00:16:56,760 --> 00:16:58,800
SHOW VERY WELL THAT THIS

404
00:16:58,800 --> 00:16:59,600
DIVERSITY THAT WE'VE BEEN

405
00:16:59,600 --> 00:17:01,560
TALKING ABOUT IN TERMS OF

406
00:17:01,560 --> 00:17:03,640
AFRICAN POPULATION AND

407
00:17:03,640 --> 00:17:04,840
EVOLUTIONARY HISTORY IS INDEED

408
00:17:04,840 --> 00:17:07,440
TRUE, WE HAVE EVIDENCE OF IT IN

409
00:17:07,440 --> 00:17:08,480
GENOMES.

410
00:17:08,480 --> 00:17:12,280
AFRICAN POPULATIONS HAVE THE

411
00:17:12,280 --> 00:17:13,920
HIGHEST NUMBER OF VARIABLE SIZE

412
00:17:13,920 --> 00:17:18,160
BY GENOME.

413
00:17:18,160 --> 00:17:19,720
LOSS OF FUNCTION VARIANTS,

414
00:17:19,720 --> 00:17:22,560
AFRICAN POPULATION TENDS TO

415
00:17:22,560 --> 00:17:24,360
DISPLAY THE LARGEST NUMBER OF

416
00:17:24,360 --> 00:17:31,800
VARIATION THAT YOU SEE AGAIN

417
00:17:31,800 --> 00:17:33,560
VERY, VERY CONSISTENT WITH THAT

418
00:17:33,560 --> 00:17:34,000
EVOLUTIONARY STORY.

419
00:17:34,000 --> 00:17:35,840
SO WHAT DO WE SEE WHEN WE LOOK

420
00:17:35,840 --> 00:17:38,360
AT GENOMES OF AFRICAN PEOPLE?

421
00:17:38,360 --> 00:17:40,640
YOU SEE MORE HAPLOTYPES.

422
00:17:40,640 --> 00:17:45,560
MORE LEVELS OF LINKAGES TO --

423
00:17:45,560 --> 00:17:49,520
PHYSICALLY STRUGGLE -- WHETHER

424
00:17:49,520 --> 00:17:51,280
THEY'VE BEEN BROKEN DOWN SO YOU

425
00:17:51,280 --> 00:17:54,960
DO SEE YOU HAVE LOWER LEVEL OF

426
00:17:54,960 --> 00:17:58,480
LINKAGE DISEQUILIBRIUM, BECAUSE

427
00:17:58,480 --> 00:18:01,320
OF VERY LONG HISTORY, THESE HAVE

428
00:18:01,320 --> 00:18:04,320
HAD MORE TIME TO RECOMBINE.

429
00:18:04,320 --> 00:18:07,320
MORE DIVERGENT PATTERNS OF

430
00:18:07,320 --> 00:18:09,440
LINKAGE DISEQUILIBRIUM AND MORE

431
00:18:09,440 --> 00:18:11,840
COMPLEX PATTERNS OF POPULATION

432
00:18:11,840 --> 00:18:12,160
SUBSTRUCTURE.

433
00:18:12,160 --> 00:18:14,440
SO I USE THIS TO TRY TO EXPLAIN

434
00:18:14,440 --> 00:18:15,880
THIS IN A VERY SIMPLE WAY.

435
00:18:15,880 --> 00:18:21,800
WHEN YOU TAKE THE GENOMES OF

436
00:18:21,800 --> 00:18:26,120
THESE YORUBA AND COMPARE THEM TO

437
00:18:26,120 --> 00:18:30,960
THESE MAASAI, SO YOU SEE THE

438
00:18:30,960 --> 00:18:34,120
DIVERSITY, AND THAT IS WHY IT IS

439
00:18:34,120 --> 00:18:34,920
CRITICALLY IMPORTANT THAT WHEN

440
00:18:34,920 --> 00:18:38,040
WE LOOK AT PEOPLE IN TERMS OF

441
00:18:38,040 --> 00:18:41,240
COMPLEXION OR SOCIAL

442
00:18:41,240 --> 00:18:42,640
DEFINITION -- THAT WE MAY INDEED

443
00:18:42,640 --> 00:18:44,840
NOT BE FULLY APPRECIATING THE

444
00:18:44,840 --> 00:18:47,320
DIVERSITY THAT EXISTS WITHIN

445
00:18:47,320 --> 00:18:48,480
THESE POPULATIONS THAT WE ARE

446
00:18:48,480 --> 00:18:49,040
GROUPING TOGETHER.

447
00:18:49,040 --> 00:18:50,000
AND I WILL SHOW YOU MORE

448
00:18:50,000 --> 00:18:53,160
EXAMPLES OF THAT.

449
00:18:53,160 --> 00:18:57,680
SO IN THE CONTEXT OF

450
00:18:57,680 --> 00:18:58,680
PHARMACOGENOMICS, THIS IS REALLY

451
00:18:58,680 --> 00:19:00,920
AN EXAMPLE OF TALKING ABOUT HUGE

452
00:19:00,920 --> 00:19:02,000
DIVERSITY IN AFRICAN POPULATION.

453
00:19:02,000 --> 00:19:04,640
SO WHEN YOU LOOK AT ADVERSE

454
00:19:04,640 --> 00:19:07,520
REACTION TO A DRUG FOR THE

455
00:19:07,520 --> 00:19:13,760
TREATMENT OF HIV, THERE'S AN HLA

456
00:19:13,760 --> 00:19:14,880
THAT HELPS US TO IDENTIFY

457
00:19:14,880 --> 00:19:15,840
INDIVIDUALS WHO WOULD HAVE

458
00:19:15,840 --> 00:19:16,960
SENSITIVITY TO THIS DRUG.

459
00:19:16,960 --> 00:19:18,600
NOW, WHAT IS REMARKABLE ABOUT

460
00:19:18,600 --> 00:19:24,360
THIS IS THAT THE FREQUENCY OF

461
00:19:24,360 --> 00:19:26,360
THIS HLA VARIES ACROSS THE WORLD

462
00:19:26,360 --> 00:19:26,800
TREMENDOUSLY.

463
00:19:26,800 --> 00:19:31,520
NOW WHEN YOU LOOK AT TWO AFRICAN

464
00:19:31,520 --> 00:19:34,600
POPULATIONS, THE MAASAI AND

465
00:19:34,600 --> 00:19:36,360
YORUBA, YOU SEE TREMENDOUS

466
00:19:36,360 --> 00:19:40,680
DIFFERENCE IN THE ALLELE

467
00:19:40,680 --> 00:19:42,560
FREQUENCY.

468
00:19:42,560 --> 00:19:44,000
WHICH YOU WOULD EXPECT IN GIVING

469
00:19:44,000 --> 00:19:49,440
THE HISTORY OF WEST AFRICA AND

470
00:19:49,440 --> 00:19:50,520
POPULATIONS IN AMERICA.

471
00:19:50,520 --> 00:19:52,040
SO THE POINT I'D LIKE TO MAKE

472
00:19:52,040 --> 00:19:53,160
HERE IS THAT WHEN YOU USE A

473
00:19:53,160 --> 00:19:57,000
CONCEPT OF AFRICANS OR BLACK,

474
00:19:57,000 --> 00:20:02,240
YOU'RE RADICALLY -- IT CAN LEAD

475
00:20:02,240 --> 00:20:03,880
US TO DECISIONS IN TERMS OF THE

476
00:20:03,880 --> 00:20:05,000
PRACTICE OF MEDICINE.

477
00:20:05,000 --> 00:20:10,360
SO WE HAVE TO RECOGNIZE THIS

478
00:20:10,360 --> 00:20:11,880
DIVERSITY ACROSS THE POPULATION,

479
00:20:11,880 --> 00:20:16,000
ESPECIALLY AFRICAN POPULATIONS.

480
00:20:16,000 --> 00:20:18,240
SO IN SCIENCE, AS DR. KASTNER

481
00:20:18,240 --> 00:20:19,560
SAYS, IN MY LAB WE ARE BEGINNING

482
00:20:19,560 --> 00:20:20,760
TO TAKE ADVANTAGE OF THIS

483
00:20:20,760 --> 00:20:23,480
DIVERSITY THAT WE SEE IN AFRICAN

484
00:20:23,480 --> 00:20:26,440
POPULATIONS TO UNDERSTAND THE

485
00:20:26,440 --> 00:20:30,840
GENETIC BASIS OF LOGICAL COMPLEX

486
00:20:30,840 --> 00:20:32,800
DISEASE, AND THE EXAMPLE HERE IS

487
00:20:32,800 --> 00:20:38,280
THAT WE'VE BEEN ABLE TO USE TO

488
00:20:38,280 --> 00:20:43,880
LOCALIZE WHAT WE THINK IS THE

489
00:20:43,880 --> 00:20:45,360
CAUSAL VARIANT, GET CLOSER TO

490
00:20:45,360 --> 00:20:48,360
THE CAUSAL VARIANTS, SO I'LL

491
00:20:48,360 --> 00:20:51,920
HIGHLIGHT AND GO MORE

492
00:20:51,920 --> 00:20:53,240
SPECIFICALLY, WITH URIC ACID,

493
00:20:53,240 --> 00:20:57,400
BUT WITH THIS PARTICULAR GENE,

494
00:20:57,400 --> 00:21:01,800
WE ARE ABLE TO FINE MAP WHAT WAS

495
00:21:01,800 --> 00:21:04,080
DISCOVERED IN THE EUROPEAN

496
00:21:04,080 --> 00:21:07,200
POPULATION OF 250KB TO UNDER

497
00:21:07,200 --> 00:21:12,520
50KB USING AFRICAN -- THE

498
00:21:12,520 --> 00:21:14,440
DIVERSITY THAT WE SEE IN AFRICAN

499
00:21:14,440 --> 00:21:15,480
POPULATION.

500
00:21:15,480 --> 00:21:16,320
SO QUITE REMARKABLE.

501
00:21:16,320 --> 00:21:20,120
NOW THIS IS A MORE SPECIFIC AM

502
00:21:20,120 --> 00:21:21,760
AND A TRUE FIRST DEMONSTRATION

503
00:21:21,760 --> 00:21:25,360
OF HOW THE FINE GRAIN --

504
00:21:25,360 --> 00:21:31,840
STRUCTURE IN AFRICAN POPULATION

505
00:21:31,840 --> 00:21:34,040
HAPLOS IN THE GENETICS OF TYPE .

506
00:21:34,040 --> 00:21:39,720
SO WHEN YOU LOOK AT THIS REGION

507
00:21:39,720 --> 00:21:43,280
FOR TCF7L2, YOU SEE WHEN YOU

508
00:21:43,280 --> 00:21:47,560
LOOK AT THE EUROPEAN POPULATION,

509
00:21:47,560 --> 00:21:54,560
CHINESE POPULATION COMPARED TO

510
00:21:54,560 --> 00:21:56,120
KENYA, YOU SEE THE AFRICAN

511
00:21:56,120 --> 00:21:57,320
POPULATION, THIS REGION HAS BEEN

512
00:21:57,320 --> 00:21:58,880
BROKEN DOWN MULTIPLE, MULTIPLE

513
00:21:58,880 --> 00:22:01,400
TIMES TO THE POINT THAT THE

514
00:22:01,400 --> 00:22:03,240
RELATIONSHIP IN AFRICAN

515
00:22:03,240 --> 00:22:05,040
POPULATION IS VERY, VERY, VERY

516
00:22:05,040 --> 00:22:07,520
SMALL AND IN RELATIONSHIP

517
00:22:07,520 --> 00:22:08,960
EUROPEAN POPULATION IS QUITE

518
00:22:08,960 --> 00:22:09,840
HIGH, THEREFORE YOU'RE NOT

519
00:22:09,840 --> 00:22:12,720
REALLY ABLE TO IDENTIFY THE TRUE

520
00:22:12,720 --> 00:22:13,240
CAUSAL VARIANT.

521
00:22:13,240 --> 00:22:16,280
SO USING THE AFRICAN FINE GRAIN

522
00:22:16,280 --> 00:22:17,800
HAPLOTYPE STRUCTURE, WE'RE ABLE

523
00:22:17,800 --> 00:22:20,200
TO BETTER LOCALIZE THE

524
00:22:20,200 --> 00:22:23,280
PARTICULAR VARIANTS IN THIS GENE

525
00:22:23,280 --> 00:22:26,760
TO A SINGLE SNP, SO THAT IS HOW

526
00:22:26,760 --> 00:22:28,240
POWERFUL USING AFRICAN GENOME

527
00:22:28,240 --> 00:22:32,880
AND THE HISTORY AND LONGER

528
00:22:32,880 --> 00:22:33,360
EVOLUTIONARY HISTORY.

529
00:22:33,360 --> 00:22:37,040
THIS IS ANOTHER REMARKABLE

530
00:22:37,040 --> 00:22:38,280
EXAMPLE FROM THE LAB, AND THAT

531
00:22:38,280 --> 00:22:39,360
IS ONE OF THE AREAS WHERE WE

532
00:22:39,360 --> 00:22:41,640
HAVE BEEN VERY SUCCESSFUL IN

533
00:22:41,640 --> 00:22:44,600
GENOMICS IS USING WHAT WE CALL

534
00:22:44,600 --> 00:22:46,360
GENOME WIDE ASSOCIATION STUDY,

535
00:22:46,360 --> 00:22:49,560
WHICH IS BASICALLY AN AGNOSTIC

536
00:22:49,560 --> 00:22:51,160
WAY OF SEARCHING THE GENOME TO

537
00:22:51,160 --> 00:22:54,880
SEE WHERE YOU SEE A SIGNAL FOR A

538
00:22:54,880 --> 00:22:56,640
SPECIFIC TRAIT, IN THIS CASE,

539
00:22:56,640 --> 00:22:58,040
TYPE 2 DIABETES.

540
00:22:58,040 --> 00:23:00,160
IN EUROPEAN POPULATION, WHICH WE

541
00:23:00,160 --> 00:23:01,880
HAVE DONE MOST OF THE WORK, WE

542
00:23:01,880 --> 00:23:04,920
HAVE BEEN ABLE TO IDENTIFY OVER

543
00:23:04,920 --> 00:23:06,600
400 VARIANTS, BUT THE REASON I

544
00:23:06,600 --> 00:23:08,320
WANT TO SHOW TO YOU HERE TODAY,

545
00:23:08,320 --> 00:23:09,800
THIS STUDY CALLED AADM THAT WE

546
00:23:09,800 --> 00:23:11,960
HAVE BEEN DOING IN GHANA,

547
00:23:11,960 --> 00:23:15,320
NIGERIA AND KENYA, WE WERE ABLE

548
00:23:15,320 --> 00:23:17,440
TO STILL MAKE NOVEL DISCOVERIES

549
00:23:17,440 --> 00:23:23,520
FOR TYPE 2 DIABETES IN THIS GE 

550
00:23:23,520 --> 00:23:25,280
GENE, ZRANB3.

551
00:23:25,280 --> 00:23:27,560
THIS WAS REMARKABLE FOR US

552
00:23:27,560 --> 00:23:32,840
BECAUSE THIS GENE -- THE REASON

553
00:23:32,840 --> 00:23:37,760
IS QUITE SIMPLE, IT IS

554
00:23:37,760 --> 00:23:40,280
AFRICAN-SPECIFIC, IN NON-AFRICAN

555
00:23:40,280 --> 00:23:42,600
POPULATIONS, BUT WE DIDN'T KNOW

556
00:23:42,600 --> 00:23:45,080
ANYTHING ABOUT ZRANB3 IN THE

557
00:23:45,080 --> 00:23:48,360
CONTEXT OF TYPE 2 DIABETES SO WE

558
00:23:48,360 --> 00:23:50,560
WENT TO MODEL IN THIS CASE WITH

559
00:23:50,560 --> 00:23:50,880
ZEBRAFISH.

560
00:23:50,880 --> 00:23:54,680
WHEN WE KNOCKED DOWN ZRANB3, WE

561
00:23:54,680 --> 00:23:56,120
OBSERVED A MASSIVE REDUCTION IN

562
00:23:56,120 --> 00:23:56,560
BETA CELLS.

563
00:23:56,560 --> 00:23:58,440
SO THIS IS THE CONTROLS, AND

564
00:23:58,440 --> 00:24:03,040
THESE ARE THE -- WHERE WE KNOCK

565
00:24:03,040 --> 00:24:10,040
DOWN ZRANB3.

566
00:24:10,040 --> 00:24:12,000
THE -- REDUCED TREMENDOUSLY.

567
00:24:12,000 --> 00:24:13,440
THIS IS INDICATION FOR TYPE

568
00:24:13,440 --> 00:24:14,000
2 DIABETES.

569
00:24:14,000 --> 00:24:16,160
THEN WHEN WE WENT TO MAMMALIAN

570
00:24:16,160 --> 00:24:19,800
CELL LINES AND SUPPRESSED, WE

571
00:24:19,800 --> 00:24:21,440
WERE ABLE TO FULLY APPRECIATE

572
00:24:21,440 --> 00:24:23,280
THE CONSEQUENCE OF THIS GENE IN

573
00:24:23,280 --> 00:24:25,840
THE CONTEXT OF TYPE 2 DIABETES

574
00:24:25,840 --> 00:24:28,160
BECAUSE THESE CELLS WERE UNABLE

575
00:24:28,160 --> 00:24:30,320
TO RESPOND IN A HIGH GLUCOSE

576
00:24:30,320 --> 00:24:31,880
ENVIRONMENT IN TERMS OF INSULIN

577
00:24:31,880 --> 00:24:32,400
PRODUCTION.

578
00:24:32,400 --> 00:24:36,160
SO THAT WAS REALLY SORT OF AN

579
00:24:36,160 --> 00:24:38,960
AHA MOMENT IN THIS EXPERIMENT.

580
00:24:38,960 --> 00:24:43,800
THE SAME STORY HERE IN TERMS O

581
00:24:43,800 --> 00:24:47,080
OF -- AGAIN MAKING NOVEL

582
00:24:47,080 --> 00:24:48,840
DISCOVERY IS SIGNAL 4D IN

583
00:24:48,840 --> 00:24:50,360
RELATION TO BODY MASS INDEX.

584
00:24:50,360 --> 00:24:55,600
WHAT WAS REMARKABLE IS THAT

585
00:24:55,600 --> 00:24:58,760
CARRIERS OF THE C ALLELE OF THIS

586
00:24:58,760 --> 00:25:00,280
VARIANT WEIGH ABOUT 6 POUNDS

587
00:25:00,280 --> 00:25:01,680
HEAVIER AND THAT IS TREMENDOUS

588
00:25:01,680 --> 00:25:04,080
IN TERMS OF POPULATION EFFECT.

589
00:25:04,080 --> 00:25:08,080
AND WE WERE ABLE TO SHOW THAT

590
00:25:08,080 --> 00:25:09,960
INDIVIDUALS, WHETHER THEY'RE MEN

591
00:25:09,960 --> 00:25:12,920
OR WOMEN WHO WERE OBESE WERE

592
00:25:12,920 --> 00:25:23,080
EXPRESSING -- 4D SEMA4D AT A LEL

593
00:25:23,080 --> 00:25:25,200
THAT IS MUCH HIGHER, NOT PICKED

594
00:25:25,200 --> 00:25:30,240
UP IN EUROPEAN POPULATION.

595
00:25:30,240 --> 00:25:31,520
NOW THIS IS ONE OF THE MOST

596
00:25:31,520 --> 00:25:32,880
EXCITING WORK I THINK COMING OUT

597
00:25:32,880 --> 00:25:37,760
OF OUR LAB, AND THAT IS HOW WE

598
00:25:37,760 --> 00:25:39,520
USE GENOMIC DATA, SEQUENCE DATA

599
00:25:39,520 --> 00:25:43,760
FROM DIFFERENT PARTS OF THE

600
00:25:43,760 --> 00:25:45,440
WORLD TO ANSWER SOME VERY OLD

601
00:25:45,440 --> 00:25:47,960
QUESTIONS IN TERMS OF SICKLE

602
00:25:47,960 --> 00:25:48,560
CELL.

603
00:25:48,560 --> 00:25:51,880
WE WERE ABLE TO RESOLVE A

604
00:25:51,880 --> 00:25:58,760
40-YEAR-OLD DEBATE ABOUT THE

605
00:25:58,760 --> 00:26:00,640
ORIGIN OF THE SICKLE ALLELE.

606
00:26:00,640 --> 00:26:04,160
THIS HAS BEEN GOING ON, AROSE

607
00:26:04,160 --> 00:26:05,480
MULTIPLE TIMES IN ONE PLACE.

608
00:26:05,480 --> 00:26:08,400
WE SHOW USING OUR DATA THAT IT'S

609
00:26:08,400 --> 00:26:09,400
ACTUALLY ORIGINATED IN ONE

610
00:26:09,400 --> 00:26:13,320
PLACE, AND WE WERE ABLE TO DATE

611
00:26:13,320 --> 00:26:15,640
THAT MUTATION TO ABOUT 7300

612
00:26:15,640 --> 00:26:19,240
YEARS AGO IN AN AREA IN THE

613
00:26:19,240 --> 00:26:20,600
SAHARA, TODAY A DESERT, BUT IT

614
00:26:20,600 --> 00:26:22,760
WAS INDEED VERY GREEN AND WET AT

615
00:26:22,760 --> 00:26:24,040
THAT POINT, SO YOU CAN SEE HOW

616
00:26:24,040 --> 00:26:28,440
IT CAN INDEED SUPPORT MOSQUITO

617
00:26:28,440 --> 00:26:30,640
LIFE IN THAT PART OF THE WORLD.

618
00:26:30,640 --> 00:26:32,440
AND THEN WE WERE ABLE TO

619
00:26:32,440 --> 00:26:35,880
SIMPLIFY THE HAPLOTYPE BASED

620
00:26:35,880 --> 00:26:38,080
CLASSIFICATIONS, AND THEN WE

621
00:26:38,080 --> 00:26:40,600
IDENTIFIED 27 LINKED VARIANTS

622
00:26:40,600 --> 00:26:46,640
THAT WE BELIEVE MAY INFLUENCE

623
00:26:46,640 --> 00:26:47,480
DISEASE SEVERITY.

624
00:26:47,480 --> 00:26:50,680
THIS WAS ABSOLUTELY AN EXCITING

625
00:26:50,680 --> 00:26:52,080
DISCOVERY.

626
00:26:52,080 --> 00:26:53,960
WE RECEIVED INTERNATIONAL

627
00:26:53,960 --> 00:26:55,560
RECOGNITION, PARTICULARLY LIKE

628
00:26:55,560 --> 00:27:00,400
THIS HEADING FROM "THE NEW YORK

629
00:27:00,400 --> 00:27:03,440
TIMES," HOW ONE CHILD'S SICKLE

630
00:27:03,440 --> 00:27:04,840
CELL MUTATION HELPED PROTECT THE

631
00:27:04,840 --> 00:27:05,880
WORLD FROM MALARIA.

632
00:27:05,880 --> 00:27:07,480
THAT IS INDEED THE STORY, AND WE

633
00:27:07,480 --> 00:27:09,080
WERE VERY EXCITED ABOUT THIS

634
00:27:09,080 --> 00:27:11,080
DISCOVERY.

635
00:27:11,080 --> 00:27:12,360
SO GIVEN EVERYTHING THAT I'VE

636
00:27:12,360 --> 00:27:16,040
SAID TO YOU SO FAR, IT IS INDEED

637
00:27:16,040 --> 00:27:18,000
A LITTLE TROUBLING TO KNOW THAT

638
00:27:18,000 --> 00:27:22,400
WE HAVE REALLY DONE GOOD WORK

639
00:27:22,400 --> 00:27:26,840
SAMPLING DIFFERENT AFER CAP AFRN

640
00:27:26,840 --> 00:27:28,080
POPULATIONS SO WHEN YOU COMPARE

641
00:27:28,080 --> 00:27:30,800
A NUMBER OF AFRICAN GWAS

642
00:27:30,800 --> 00:27:32,560
STUDIES, GENOME WIDE ASSOCIATION

643
00:27:32,560 --> 00:27:33,880
STUDIES THAT HAVE BEEN DONE IN

644
00:27:33,880 --> 00:27:36,640
AFRICAN POPULATIONS, YOU'LL SEE

645
00:27:36,640 --> 00:27:40,960
UP TO 1%, AND COMPARED TO CLOSE

646
00:27:40,960 --> 00:27:44,040
TO 96% IN THE EUROPEAN

647
00:27:44,040 --> 00:27:45,040
POPULATION.

648
00:27:45,040 --> 00:27:46,560
THIS IS WHERE SOMETIMES THE

649
00:27:46,560 --> 00:27:48,080
SCIENTIFIC PROCESS IS NOT VERY

650
00:27:48,080 --> 00:27:50,760
RATIONAL IN THE SENSE THAT GIVEN

651
00:27:50,760 --> 00:27:52,800
THE HISTORY, GIVEN THAT AFRICA

652
00:27:52,800 --> 00:27:54,200
IS THE CRATER OF HUMANITY AND

653
00:27:54,200 --> 00:27:55,400
THAT'S WHERE WE HAVE MOST OF THE

654
00:27:55,400 --> 00:27:57,360
VARIATION, YOU WOULD THINK THAT

655
00:27:57,360 --> 00:27:58,840
AS THEY WILL START AND MOVE TO

656
00:27:58,840 --> 00:27:59,800
DIFFERENT PARTS OF THE WORLD,

657
00:27:59,800 --> 00:28:01,640
BUT AGAIN, THAT IS NOT A STORY

658
00:28:01,640 --> 00:28:04,280
OF SCIENCE, AT LEAST SCIENCE --

659
00:28:04,280 --> 00:28:07,720
AND FOR US, WE WERE VERY WORRIED

660
00:28:07,720 --> 00:28:08,680
AND CONCERNED ABOUT THIS BECAUSE

661
00:28:08,680 --> 00:28:11,320
WE WANTED TO MAKE SURE THAT

662
00:28:11,320 --> 00:28:16,440
TOMORROW'S MEDICINE IS INDEED IN

663
00:28:16,440 --> 00:28:18,480
THE FUTURE TO ALL HUMANITY.

664
00:28:18,480 --> 00:28:23,040
WE WERE ABLE TO CONDUCT A LARGE

665
00:28:23,040 --> 00:28:25,840
STUDY THAT WAS TALKED ABOUT IN

666
00:28:25,840 --> 00:28:27,120
MY INTRODUCTION EARLIER.

667
00:28:27,120 --> 00:28:29,000
THIS IS A REMARKABLE STUDY

668
00:28:29,000 --> 00:28:31,280
FUNDED BY THE NIH AND THE

669
00:28:31,280 --> 00:28:36,360
WELLCOME TRUST IN THE U.K., AND

670
00:28:36,360 --> 00:28:38,000
MONEY HAS GONE TO DIFFERENT

671
00:28:38,000 --> 00:28:38,760
AFRICAN INSTITUTIONS AND

672
00:28:38,760 --> 00:28:42,600
INVESTIGATORS TO THE POINT WHERE

673
00:28:42,600 --> 00:28:47,160
THETHEY HAVE ENROLLED OVER 100,0

674
00:28:47,160 --> 00:28:48,480
AFRICANS INTO THIS STUDY AND WE

675
00:28:48,480 --> 00:28:51,560
HAVE TRAINED A LARGE NUMBER OF

676
00:28:51,560 --> 00:28:55,920
AFRICAN SCIENTISTS WHO A.

677
00:28:55,920 --> 00:28:58,320
SO THE STORY I BRING TO YOU HERE

678
00:28:58,320 --> 00:29:01,640
IS IN A RECENT PUBLICATION IN

679
00:29:01,640 --> 00:29:04,920
TWEB 20.

680
00:29:04,920 --> 00:29:05,960
ONE OF THE INTERESTING STORIES

681
00:29:05,960 --> 00:29:07,440
THAT ALMOST ALWAYS HAPPENS IS

682
00:29:07,440 --> 00:29:08,960
WHEN YOU SEQUENCE AFRICAN

683
00:29:08,960 --> 00:29:11,240
POPULATION, YOU ALMOST ALWAYS

684
00:29:11,240 --> 00:29:12,360
DISCOVER NOVEL VARIANTS.

685
00:29:12,360 --> 00:29:15,480
IN THIS CASE, WE DISCOVERED OVER

686
00:29:15,480 --> 00:29:16,200
3 MILLION NOVEL VARIANTS.

687
00:29:16,200 --> 00:29:21,000
AND WE WERE ABLE TO IDENTIFY

688
00:29:21,000 --> 00:29:22,720
62 NEW LOCI ON THAT VERY STRONG

689
00:29:22,720 --> 00:29:29,840
SELECTION, INCLUDING DATA FROM

690
00:29:29,840 --> 00:29:32,560
BACTERIAL, VIRAL, DEFENSE

691
00:29:32,560 --> 00:29:37,960
AGAINST NEMOTODES, HEMO STASIS

692
00:29:37,960 --> 00:29:38,720
AND PIGMENTATION.

693
00:29:38,720 --> 00:29:40,960
BECAUSE SOME OF THESE PATHOGENIC

694
00:29:40,960 --> 00:29:44,400
VARIANTS ARE IN NORTH AMERICA,

695
00:29:44,400 --> 00:29:48,000
EUROPE, CARRIED BY A NUMBER OF

696
00:29:48,000 --> 00:29:50,640
AFRICANS, SO IT STARTED TO BRING

697
00:29:50,640 --> 00:29:54,680
TO QUESTION, SOME OF THESE

698
00:29:54,680 --> 00:29:58,080
PATHOGENIC VARIANTS MAY NOT BE

699
00:29:58,080 --> 00:30:02,680
AS PATHOGENIC, CALLING FOR MORE

700
00:30:02,680 --> 00:30:03,880
STUDIES TO BE DONE.

701
00:30:03,880 --> 00:30:05,920
WE ALSO INFORMED HUMAN

702
00:30:05,920 --> 00:30:07,360
HISTORIMENT WE CONTINUED TO

703
00:30:07,360 --> 00:30:08,480
INFORM HUMAN HISTORY.

704
00:30:08,480 --> 00:30:10,120
ONE OF THE LARGEST MIGRATIONS IN

705
00:30:10,120 --> 00:30:12,880
AFRICA IS THE BANTU MIGRATION.

706
00:30:12,880 --> 00:30:16,440
WHICH STARTED AROUND THE AREAS

707
00:30:16,440 --> 00:30:17,880
OF -- AROUND CAMEROON, AND THERE

708
00:30:17,880 --> 00:30:20,000
HAVE BEEN DIFFERENT MIGRATION

709
00:30:20,000 --> 00:30:22,920
ROUTES THAT HAVE BEEN SUGGESTED,

710
00:30:22,920 --> 00:30:27,760
BUT WE BELIEVE USING OUR DATA,

711
00:30:27,760 --> 00:30:32,120
THAT THE WAREHOUSE SO TO SAY IS

712
00:30:32,120 --> 00:30:36,640
SWSOMEWHERE IN ZAMBIA, NOT IN ET

713
00:30:36,640 --> 00:30:37,960
AFRICA LIKE WE TALKED ABOUT.

714
00:30:37,960 --> 00:30:39,600
SO THIS AGAIN IS A VERY

715
00:30:39,600 --> 00:30:40,880
IMPORTANT DISCOVERY, AND THIS IS

716
00:30:40,880 --> 00:30:43,320
FOR ME ONE OF THE MOST

717
00:30:43,320 --> 00:30:46,800
FASCINATING STORY FROM THIS

718
00:30:46,800 --> 00:30:50,320
WORLD, BECAUSE -- THERE'S A

719
00:30:50,320 --> 00:30:53,400
GROUP IN NIGERIA, ALMOST THE

720
00:30:53,400 --> 00:30:54,800
MIDDLE OF NIGERIA, THAT SHOWED A

721
00:30:54,800 --> 00:30:57,560
VERY HIGH LEVEL OF NILO-IS A

722
00:30:57,560 --> 00:31:05,640
HA-IS-SAHARANANCESTRY.

723
00:31:05,640 --> 00:31:07,680
WE'RE ABLE TO DATE THIS TO ABOUT

724
00:31:07,680 --> 00:31:09,240
1850 YEARS AGO, SO THE QUESTION

725
00:31:09,240 --> 00:31:15,520
IS HOW DOES THIS VARIATION --

726
00:31:15,520 --> 00:31:17,760
MOI DELVE NIGERIA.

727
00:31:17,760 --> 00:31:21,080
SO WE CONTINUE TO -- THE POINT

728
00:31:21,080 --> 00:31:23,400
HERE IS WE NEED TO SAMPLE MORE

729
00:31:23,400 --> 00:31:24,160
AFRICAN POPULATIONS.

730
00:31:24,160 --> 00:31:28,280
SO NOW I'M GOING TO MOVE INTO

731
00:31:28,280 --> 00:31:31,040
THE OTHER ASPECTS OF AFRICAN

732
00:31:31,040 --> 00:31:31,880
ANCESTRY POPULATION THAT I THINK

733
00:31:31,880 --> 00:31:33,640
IS CRITICALLY IMPORTANT.

734
00:31:33,640 --> 00:31:36,880
HERE I SAY THAT AFRICAN

735
00:31:36,880 --> 00:31:39,440
POPULATIONS, YOU KNOW, REALLY

736
00:31:39,440 --> 00:31:42,280
PROVIDE SCIENTISTS A UNIQUE

737
00:31:42,280 --> 00:31:43,720
HUMAN LABORATORY TO STUDY HOW

738
00:31:43,720 --> 00:31:45,360
OLD GENES INTERACT WITH NEW

739
00:31:45,360 --> 00:31:47,120
ENVIRONMENT IN THE EVOLUTION OF

740
00:31:47,120 --> 00:31:53,120
COMPLEX TRAITS.

741
00:31:53,120 --> 00:31:55,040
BECAUSE AFRICAN POPULATION ARE

742
00:31:55,040 --> 00:31:57,880
NOW SPRAYED ALL OVER THE WORLD,

743
00:31:57,880 --> 00:31:59,600
HISTORY IN TERMS OF SLAVE TRADE,

744
00:31:59,600 --> 00:32:01,800
AND NOW IN NORTH AMERICA, IN

745
00:32:01,800 --> 00:32:03,240
BRAZIL AND DIFFERENT PARTS OF

746
00:32:03,240 --> 00:32:05,840
THE WORLD, AND THEY SHARE A

747
00:32:05,840 --> 00:32:07,680
DIFFERENT LEVEL OF EUROPEAN,

748
00:32:07,680 --> 00:32:11,760
NATIVE AMERICAN AND AFRICAN

749
00:32:11,760 --> 00:32:13,200
GENETIC BACKGROUND, AND WE CAN

750
00:32:13,200 --> 00:32:17,760
TAKE ADVANTAGE OF THIS USING

751
00:32:17,760 --> 00:32:18,960
STRATEGY LIKE ADD MIXTURE

752
00:32:18,960 --> 00:32:20,160
MAPPING AND I'LL TALK ABOUT THAT

753
00:32:20,160 --> 00:32:23,760
IN THE NEXT SLIDE.

754
00:32:23,760 --> 00:32:25,320
SO ONE OTHER STORY HERE WHICH IS

755
00:32:25,320 --> 00:32:29,240
REALLY IMPORTANT IS THAT WHEN

756
00:32:29,240 --> 00:32:31,840
YOU LOOK AT PEOPLE WHO

757
00:32:31,840 --> 00:32:33,600
SELF-IDENTIFY AT AFRICAN

758
00:32:33,600 --> 00:32:35,880
AMERICAN, THERE'S HUGE VARIATION

759
00:32:35,880 --> 00:32:37,240
IN TERMS OF THE AFRICAN GENETIC

760
00:32:37,240 --> 00:32:38,000
POOL.

761
00:32:38,000 --> 00:32:42,600
RANGING FROM .6 TO 99.7%.

762
00:32:42,600 --> 00:32:45,120
SO -- AND THE AVERAGE IS ABOUT

763
00:32:45,120 --> 00:32:45,720
80%.

764
00:32:45,720 --> 00:32:47,640
SO THIS IS WHERE AVERAGE BECOMES

765
00:32:47,640 --> 00:32:50,920
NOT VERY USEFUL OR HELPFUL IN

766
00:32:50,920 --> 00:32:51,320
THIS REGARD.

767
00:32:51,320 --> 00:32:55,560
SO YOU SEE THIS PERSON HERE,

768
00:32:55,560 --> 00:32:56,920
AGAIN ALMOST COMPLETELY WHAT WE

769
00:32:56,920 --> 00:32:58,880
CALL EUROPEAN ANCESTRY, AND THIS

770
00:32:58,880 --> 00:33:00,240
ALMOST COMPLETELY AFRICAN

771
00:33:00,240 --> 00:33:01,160
ANCESTRY.

772
00:33:01,160 --> 00:33:05,480
SO AGAIN, -- IN TERMS OF HOW WE

773
00:33:05,480 --> 00:33:05,960
CLASSIFY PEOPLE.

774
00:33:05,960 --> 00:33:08,440
BUT THE ADMIXTURE MAPPING HERE

775
00:33:08,440 --> 00:33:09,840
IS REALLY TAKING ADVANTAGE OF

776
00:33:09,840 --> 00:33:13,880
THE FACT THAT IN THE CONTEXT OF

777
00:33:13,880 --> 00:33:15,360
AFRICAN AMERICAN, SO MOSTLY

778
00:33:15,360 --> 00:33:19,280
AFRICAN AND EUROPEAN POPULATION

779
00:33:19,280 --> 00:33:25,840
TOGETHER AND OVER TIME, THE

780
00:33:25,840 --> 00:33:26,600
RECOMBINATION -- DIFFERENT

781
00:33:26,600 --> 00:33:28,920
FRAGMENTS OF THE GENOME NOW

782
00:33:28,920 --> 00:33:29,720
CONTAIN DIFFERENT INFORMATION

783
00:33:29,720 --> 00:33:30,760
FROM THE TWO ANCESTRAL

784
00:33:30,760 --> 00:33:31,320
POPULATIONS AND WE TAKE

785
00:33:31,320 --> 00:33:32,600
ADVANTAGE OF THAT IN MAPPING

786
00:33:32,600 --> 00:33:35,800
GENES.

787
00:33:35,800 --> 00:33:39,120
AND WE ALSO DEVELOP -- TAKEN

788
00:33:39,120 --> 00:33:42,040
ADVANTAGE OF -- THE STORY I WANT

789
00:33:42,040 --> 00:33:44,440
TO TELL YOU TODAY IS REALLY

790
00:33:44,440 --> 00:33:46,840
ABOUT KIDNEY DISEASE.

791
00:33:46,840 --> 00:33:48,920
AFRICAN AMERICAN -- ABOUT 18% OF

792
00:33:48,920 --> 00:33:51,560
U.S. POPULATION, BUT ABOUT 32%

793
00:33:51,560 --> 00:33:55,480
OF KIDNEY FAILURE, AFRICAN

794
00:33:55,480 --> 00:33:56,720
AMERICANS ARE FOUR TIMES MORE

795
00:33:56,720 --> 00:33:59,960
LIKELY TO DEVELOP KIDNEY FAILURE

796
00:33:59,960 --> 00:34:01,520
THAN THEIR EUROPEAN COUNTERPART.

797
00:34:01,520 --> 00:34:03,760
SO THERE'S THE HYPOTHESIS THAT

798
00:34:03,760 --> 00:34:07,280
IF INDEED THIS DISPARITY IS DUE

799
00:34:07,280 --> 00:34:09,920
TO GENETICS, THEN THE SIGNAL IN

800
00:34:09,920 --> 00:34:11,840
OUR GENOME SHOULD TRACK THE WEST

801
00:34:11,840 --> 00:34:14,360
AFRICAN PART OF THAT ANCESTRY.

802
00:34:14,360 --> 00:34:18,480
AND IT WAS INDEED, YOU KNOW,

803
00:34:18,480 --> 00:34:25,200
SHOWN BY THE GROUP FROM NIH, DRR

804
00:34:25,200 --> 00:34:26,840
COLLEAGUES IN HOPKINS, PICKING

805
00:34:26,840 --> 00:34:29,240
UP A VERY STRONG SIGNAL IN 2022,

806
00:34:29,240 --> 00:34:34,560
WHICH WAS PREVIOUSLY THOUGHT OF

807
00:34:34,560 --> 00:34:35,720
AS MHY9 LOCUS, BUT SUBSEQUENT

808
00:34:35,720 --> 00:34:40,360
SEQUENCING DATA SHOW THAT --

809
00:34:40,360 --> 00:34:45,840
GENE THAT WAS A STRONG LINKA

810
00:34:45,840 --> 00:34:48,400
LINKAGE -- SO WHAT IS IMPORTANT

811
00:34:48,400 --> 00:34:49,920
ABOUT THIS DISCOVERY?

812
00:34:49,920 --> 00:34:53,440
IT IS VERY RARE FOR US TO SEE

813
00:34:53,440 --> 00:34:56,280
RISK -- ALL RATIO THAT IS THIS

814
00:34:56,280 --> 00:34:57,680
HIGH IN COMPLEX TRAITS.

815
00:34:57,680 --> 00:35:03,720
THERE WAS ABOUT 10 FOR FSGS AND

816
00:35:03,720 --> 00:35:06,440
OVER 7 FOR END STAGE KIDNEY

817
00:35:06,440 --> 00:35:08,520
DISEASE.

818
00:35:08,520 --> 00:35:10,800
REMARKABLY, THIS VARIANCE IS

819
00:35:10,800 --> 00:35:13,720
ABOUT 40% -- ABOUT 20% AMONG

820
00:35:13,720 --> 00:35:19,840
AFRICAN AMERICANS, NOW THIS

821
00:35:19,840 --> 00:35:21,520
DIDN'T MAKE ANY EVOLUTIONARY

822
00:35:21,520 --> 00:35:24,720
SENSE BECAUSE IF SOMETHING IS

823
00:35:24,720 --> 00:35:28,280
THIS -- TO SURVIVAL, THEN --

824
00:35:28,280 --> 00:35:30,360
SHOULD BE TRYING TO ELIMINATE

825
00:35:30,360 --> 00:35:30,880
IT.

826
00:35:30,880 --> 00:35:34,000
IT TURNS OUT THAT IT'S

827
00:35:34,000 --> 00:35:36,720
ABSOLUTELY PROTECTIVE, BEGINS

828
00:35:36,720 --> 00:35:39,680
THE SO CALLED AFRICAN SLEEPING

829
00:35:39,680 --> 00:35:40,000
SICKNESS.

830
00:35:40,000 --> 00:35:42,960
SO THAT IS REALLY A WONDERFUL

831
00:35:42,960 --> 00:35:44,520
STORE HE'LL.

832
00:35:44,520 --> 00:35:46,880
WHAT IS TRULY REMARKABLE IN THIS

833
00:35:46,880 --> 00:35:51,480
CASE IS THE FACT THAT 1 IN

834
00:35:51,480 --> 00:35:55,920
5 PEOPLE WITH TWO COPIES OF THE

835
00:35:55,920 --> 00:35:58,280
APOL1 RISK VARIANT WILL DEVELOP

836
00:35:58,280 --> 00:36:03,080
KIDNEY DISEASE.

837
00:36:03,080 --> 00:36:06,280
AND OVER 70% OF NON-DIABETIC

838
00:36:06,280 --> 00:36:07,680
KIDNEY FAILURE IN AFRICAN

839
00:36:07,680 --> 00:36:10,120
AMERICANS IS DUE TO

840
00:36:10,120 --> 00:36:10,920
APOL1 VARIANTS.

841
00:36:10,920 --> 00:36:13,120
4 IN 10 AFRICAN AMERICANS ON

842
00:36:13,120 --> 00:36:15,880
DIALYSIS HAVE TWO COPIES OF THIS

843
00:36:15,880 --> 00:36:16,360
APOL1 VARIANT.

844
00:36:16,360 --> 00:36:20,920
SO YOU SEE HOW IT CAN REALLY

845
00:36:20,920 --> 00:36:23,120
INCREASE THE DISPARITY IN TERMS

846
00:36:23,120 --> 00:36:24,680
OF KIDNEY FAILURE.

847
00:36:24,680 --> 00:36:26,760
AND MORE IMPORTANTLY, IT'S ALSO

848
00:36:26,760 --> 00:36:29,520
ALREADY HAVING CLINICAL UTILITY

849
00:36:29,520 --> 00:36:32,040
IN THE SENSE THAT IF YOU ARE

850
00:36:32,040 --> 00:36:36,960
ABOUT TO DONATE YOUR KIDNEY, IT

851
00:36:36,960 --> 00:36:38,240
IS IMPORTANT TO BE SCREENED FOR

852
00:36:38,240 --> 00:36:40,920
THIS VARIANCE BECAUSE THE

853
00:36:40,920 --> 00:36:42,280
LIKELIHOOD OF THE KIDNEY FAILING

854
00:36:42,280 --> 00:36:43,640
IS QUITE HIGH, AND IF YOU'RE

855
00:36:43,640 --> 00:36:45,320
ALSO A KIDNEY RECIPIENT, IT

856
00:36:45,320 --> 00:36:47,120
WOULD BE GOOD FOR YOU TO KNOW

857
00:36:47,120 --> 00:36:49,040
THE STATUS OF YOUR DONOR,

858
00:36:49,040 --> 00:36:52,400
BECAUSE, AGAIN, THE LIKELIHOOD

859
00:36:52,400 --> 00:36:53,920
OF THE KIDNEY YOU ARE RECEIVING

860
00:36:53,920 --> 00:36:55,720
FAIL SOMETHING ALSO QUITE HIGH.

861
00:36:55,720 --> 00:37:00,280
NOW, THIS IS THE WONDERFUL STORY

862
00:37:00,280 --> 00:37:01,200
ABOUT HUMANITY.

863
00:37:01,200 --> 00:37:02,920
WE LIKE TO TRAVEL, WE LIKE TO

864
00:37:02,920 --> 00:37:05,760
VISIT DIFFERENT PLACES, AND MORE

865
00:37:05,760 --> 00:37:08,080
IMPORTANTLY, WE LIKE TO SHARE

866
00:37:08,080 --> 00:37:08,720
DNA.

867
00:37:08,720 --> 00:37:15,280
AS A RESULT OF THIS SHARING,

868
00:37:15,280 --> 00:37:17,720
THIS PARTICULAR RISK VARIANT FOR

869
00:37:17,720 --> 00:37:18,880
KIDNEY DISEASE HAS SPREAD ALL

870
00:37:18,880 --> 00:37:20,680
OVER THE WORLD TO THE POINT NOW

871
00:37:20,680 --> 00:37:24,720
WHERE YOU CAN -- USE -- TO

872
00:37:24,720 --> 00:37:26,160
IDENTIFY WHO IS AT RISK.

873
00:37:26,160 --> 00:37:29,080
AGAIN GIVING US CAUTIONARY TALES

874
00:37:29,080 --> 00:37:31,400
ABOUT HOW WE CLASSIFY PEOPLE OR

875
00:37:31,400 --> 00:37:33,480
LOOK AT PEOPLE ESPECIALLY IN THE

876
00:37:33,480 --> 00:37:35,920
CONTEXT OF MEDICINE, WHICH IS A

877
00:37:35,920 --> 00:37:38,280
SAMPLE SIZE OF 1, IT IS YOU AND

878
00:37:38,280 --> 00:37:38,960
YOUR DOCTOR.

879
00:37:38,960 --> 00:37:40,840
SO AGAIN, VERY, VERY IMPORTANT

880
00:37:40,840 --> 00:37:41,680
DISCOVERY, AND I THINK THIS

881
00:37:41,680 --> 00:37:43,760
MIGHT BE MY LAST SLIDE HERE, TO

882
00:37:43,760 --> 00:37:46,800
REALLY TELL YOU ABOUT

883
00:37:46,800 --> 00:37:47,680
INTERACTIONS IN TERMS OF

884
00:37:47,680 --> 00:37:52,680
DIFFERENT ME TABULATE --

885
00:37:52,680 --> 00:37:53,080
TRIGLYCERIDES.

886
00:37:53,080 --> 00:37:54,720
WHICH IS THE BAY OWE MARKER FOR

887
00:37:54,720 --> 00:38:00,960
BIOMARKER FOR HEARTDISEASE, STRB

888
00:38:00,960 --> 00:38:02,280
WE'RE ALWAYS WONDERING WHAT'S

889
00:38:02,280 --> 00:38:05,160
GOING ON WITH TRIGLYCERIDES

890
00:38:05,160 --> 00:38:08,080
BECAUSE WHEN WE MEASURE THEM IN

891
00:38:08,080 --> 00:38:09,480
EUROPEANS, EAST AFRICANS AND

892
00:38:09,480 --> 00:38:13,360
WEST AFRICANS, THEY ARE

893
00:38:13,360 --> 00:38:15,200
REMARKABLY SIMILAR DESPITE

894
00:38:15,200 --> 00:38:17,400
DIFFERENT LEVEL OF PHYSICAL

895
00:38:17,400 --> 00:38:23,320
ACTIVITY AND WOULD DEMAX INDEX,

896
00:38:23,320 --> 00:38:27,320
REMARKABLY -- ACTUALLY HAVE

897
00:38:27,320 --> 00:38:30,320
ALMOST WHAT I WOULD CALL

898
00:38:30,320 --> 00:38:31,360
EXCELLENT TRIGLYCERIDE LEVELS.

899
00:38:31,360 --> 00:38:33,160
AND THAT IS NOT WHAT WE OBSERVE

900
00:38:33,160 --> 00:38:34,680
IN EAST AFRICANS AND IT'S ALSO

901
00:38:34,680 --> 00:38:36,200
NOT WHAT WE OBSERVE IN

902
00:38:36,200 --> 00:38:36,720
EUROPEANS.

903
00:38:36,720 --> 00:38:38,200
SO WE WANTED TO STUDY THIS A

904
00:38:38,200 --> 00:38:38,840
LITTLE MORE.

905
00:38:38,840 --> 00:38:41,920
SO WE PUT TOGETHER A VERY LARGE

906
00:38:41,920 --> 00:38:46,760
STUDY COMBINING -- OF 32,000

907
00:38:46,760 --> 00:38:47,600
PEOPLE FROM DIFFERENT PARTS OF

908
00:38:47,600 --> 00:38:48,680
THE WORLD IN DIFFERENT

909
00:38:48,680 --> 00:38:51,240
ENVIRONMENTAL SETTINGS.

910
00:38:51,240 --> 00:38:54,480
AND ONE OF THE THINGS THAT WE

911
00:38:54,480 --> 00:38:57,240
OBSERVE CLEARLY IS THAT FOR SOME

912
00:38:57,240 --> 00:39:01,720
OF THESE -- WE FOUND VERY CLEAR

913
00:39:01,720 --> 00:39:04,360
ANCESTRY PATTERNS TO THE POINT

914
00:39:04,360 --> 00:39:07,840
WHERE WE DIDN'T SEE A LOT OF

915
00:39:07,840 --> 00:39:08,360
ENVIRONMENTAL INFLUENCE.

916
00:39:08,360 --> 00:39:09,800
BUT THAT STORY WAS VERY

917
00:39:09,800 --> 00:39:11,000
DIFFERENT FOR WHEN WE LOOK AT

918
00:39:11,000 --> 00:39:13,080
THE RELATIONSHIP BETWEEN

919
00:39:13,080 --> 00:39:14,320
TRIGLYCERIDES AND TYPE

920
00:39:14,320 --> 00:39:17,280
2 DIABETES, WHERE WE SAW THAT

921
00:39:17,280 --> 00:39:20,360
IN -- WHERE WE SAW THE STRONGEST

922
00:39:20,360 --> 00:39:22,000
EVIDENCE OF EVIDENCE IN RURAL

923
00:39:22,000 --> 00:39:22,880
WEST AFRICAN COMMUNITIES, WHICH

924
00:39:22,880 --> 00:39:25,360
AGAIN SHOWS THAT THERE IS REALLY

925
00:39:25,360 --> 00:39:26,280
STRONG ENVIRONMENTAL CONTEXT, WE

926
00:39:26,280 --> 00:39:31,880
ARE GOING TO STUDY THAT MORE.

927
00:39:31,880 --> 00:39:34,360
SO I WANT TO LEAVE YOU WITH THIS

928
00:39:34,360 --> 00:39:34,600
MESSAGE.

929
00:39:34,600 --> 00:39:40,520
THIS IS FROM MY -- FRIENDS WHO

930
00:39:40,520 --> 00:39:42,360
WROTE THIS REVIEW PAPER AND

931
00:39:42,360 --> 00:39:44,480
ARTICLE, AND REALLY SAID THIS

932
00:39:44,480 --> 00:39:45,520
VERY WELL.

933
00:39:45,520 --> 00:39:47,600
THE GENETICS OF AFRICAN

934
00:39:47,600 --> 00:39:50,040
POPULATIONS REVEALS AN OTHERWISE

935
00:39:50,040 --> 00:39:51,880
MISSING LAYER OF HUMAN VARIATION

936
00:39:51,880 --> 00:39:57,280
THAT AROSE BETWEEN 100,000 YEARS

937
00:39:57,280 --> 00:40:00,320
AND 5 MILLION YEARS AGO.

938
00:40:00,320 --> 00:40:02,400
BOTH THE VAST NUMBER OF THESE

939
00:40:02,400 --> 00:40:03,960
ANCIENT VARIANTS AND THE

940
00:40:03,960 --> 00:40:10,320
SELECTIVE PRESSURES THAT THEY

941
00:40:10,320 --> 00:40:11,880
SURVIVED YIELD INSIGHTS INTO

942
00:40:11,880 --> 00:40:13,480
GENES RESPONSIBLE FOR COMPLEX

943
00:40:13,480 --> 00:40:15,040
TRAITS IN ALL, IN ALL

944
00:40:15,040 --> 00:40:18,840
POPULATIONS.

945
00:40:18,840 --> 00:40:20,800
THIS IS WHY I THINK STUDYING

946
00:40:20,800 --> 00:40:24,040
AFRICAN POPULATIONS AND IN A

947
00:40:24,040 --> 00:40:29,120
VERY SYSTEMATIC WAY IS A GLOBAL

948
00:40:29,120 --> 00:40:33,800
BENEFIT AND IS SCIENTIFIC AND

949
00:40:33,800 --> 00:40:35,880
SOCIAL -- IT'S AN EQUITY ISSUE

950
00:40:35,880 --> 00:40:37,840
THAT WE NEED TO DO AND STUDY

951
00:40:37,840 --> 00:40:39,520
VERY WELL FOR THE BENEFIT OF

952
00:40:39,520 --> 00:40:41,000
AFRICANS AND FOR THE BENEFIT OF

953
00:40:41,000 --> 00:40:42,440
THE GLOBAL POPULATIONS.

954
00:40:42,440 --> 00:40:44,200
SO THANK YOU, QUITE A BIT OF

955
00:40:44,200 --> 00:40:46,760
DATA FROM MY LAB ARE FROM THESE

956
00:40:46,760 --> 00:40:47,160
INDIVIDUALS.

957
00:40:47,160 --> 00:40:49,360
I'M JUST THE CHAIR LEADER, AND

958
00:40:49,360 --> 00:40:51,200
I'M GLAD TO TAKE QUESTIONS AFTER

959
00:40:51,200 --> 00:40:52,200
CLEMENT FINISHES HIS TALK.

960
00:40:52,200 --> 00:40:53,640
SO I'M GOING TO STOP SHARING NOW

961
00:40:53,640 --> 00:40:55,480
AND I THANK YOU FOR LISTENING.

962
00:40:55,480 --> 00:40:57,480
>>I'M CLEMENT ADEBAMOWO.

963
00:40:57,480 --> 00:41:00,640
AS DAN KASTNER HAS PREVIOUSLY

964
00:41:00,640 --> 00:41:02,160
INTRODUCED, I WORK NOW AT THE

965
00:41:02,160 --> 00:41:06,000
UNIVERSITY OF MARYLAND, WHERE I

966
00:41:06,000 --> 00:41:08,000
CONTINUE TO TEACH AND DO

967
00:41:08,000 --> 00:41:13,040
RESEARCH.

968
00:41:13,040 --> 00:41:17,080
I'M EXTREMELY EXCITED TO FOLLOW

969
00:41:17,080 --> 00:41:19,040
UP ON THE BRILLIANT PRESENTATION

970
00:41:19,040 --> 00:41:24,600
THAT DR. ROTIMI JUST GAVE ON THE

971
00:41:24,600 --> 00:41:27,320
VALUE AND THE OUTCOMES OF

972
00:41:27,320 --> 00:41:28,560
CONDUCTING GENOMIC RESEARCH IN

973
00:41:28,560 --> 00:41:33,480
AFRICAN POPULATIONS.

974
00:41:33,480 --> 00:41:35,800
SO I'VE TITLED MY PRESENTATION

975
00:41:35,800 --> 00:41:39,720
"INTO AFRICA," IN CONTRAST WITH

976
00:41:39,720 --> 00:41:42,000
HIS TALK, WHICH IS FOCUSED ON

977
00:41:42,000 --> 00:41:43,240
OUT OF AFRICA.

978
00:41:43,240 --> 00:41:45,960
AND THE REASON WHY I'VE DONE

979
00:41:45,960 --> 00:41:50,120
THIS IS TO SAY THAT WE'RE AT A

980
00:41:50,120 --> 00:41:51,760
BIT OF A CROSS ROAD AND WE NEED

981
00:41:51,760 --> 00:41:59,040
TO BE THINKING ABOUT HOW NEXT WE

982
00:41:59,040 --> 00:42:00,120
SHOULD ENGAGE AFRICAN

983
00:42:00,120 --> 00:42:01,320
POPULATIONS AND AFRICAN

984
00:42:01,320 --> 00:42:03,720
SCIENTIFIC COMMUNITY IN

985
00:42:03,720 --> 00:42:05,240
ADVANCING GENOMIC RESEARCH AND

986
00:42:05,240 --> 00:42:07,880
GENOMIC MEDICINE IN AFRICAN

987
00:42:07,880 --> 00:42:09,520
POPULATIONS.

988
00:42:09,520 --> 00:42:13,360
SO AFRICAN POPULATIONS ARE NOT

989
00:42:13,360 --> 00:42:18,120
ONLY PARTICIPATING IN

990
00:42:18,120 --> 00:42:21,560
EPIDEMIOLOGICAL STUDIES THAT

991
00:42:21,560 --> 00:42:24,840
THEY MAY NOT DERIVE MEDIUM AND

992
00:42:24,840 --> 00:42:28,720
SHORT TERM BENEFITS FROM, BUT

993
00:42:28,720 --> 00:42:35,400
THEY ARE ENGAGED IN STUDIES THAT

994
00:42:35,400 --> 00:42:37,720
DELIVER ON THE PROMISE OF

995
00:42:37,720 --> 00:42:41,640
GENOMICS FOR MEDICINE AND PUBLIC

996
00:42:41,640 --> 00:42:44,160
HEALTH.

997
00:42:44,160 --> 00:42:47,760
SO I HAVE NO CONFLICTS TO

998
00:42:47,760 --> 00:42:48,200
DISCLOSE.

999
00:42:48,200 --> 00:42:52,040
I HOPE THAT BY THE TIME I FINISH

1000
00:42:52,040 --> 00:42:54,360
MY PRESENTATION, YOU WILL HAVE

1001
00:42:54,360 --> 00:42:58,200
HAD THE OPPORTUNITY TO

1002
00:42:58,200 --> 00:42:59,840
APPRECIATE THE OPPORTUNITIES AND

1003
00:42:59,840 --> 00:43:01,840
CHALLENGES FOR GENOMIC MEDICINE

1004
00:43:01,840 --> 00:43:05,200
IN AFRICAN POPULATIONS,

1005
00:43:05,200 --> 00:43:08,480
UNDERSTAND THE CLINICAL PRACTICE

1006
00:43:08,480 --> 00:43:12,080
AND HEALTH RESEARCH ECOSYSTEMS

1007
00:43:12,080 --> 00:43:14,080
IN THESE AFRICAN COUNTRIES, AND

1008
00:43:14,080 --> 00:43:17,440
THE IMPLICATIONS OF THE

1009
00:43:17,440 --> 00:43:21,200
ECOSYSTEMS FOR THE

1010
00:43:21,200 --> 00:43:23,440
IMPLEMENTATION AND UPTAKE OF

1011
00:43:23,440 --> 00:43:25,800
GENOMICS INTO CLINICAL MEDICAL

1012
00:43:25,800 --> 00:43:29,960
PRACTICE AND PUBLIC HEALTH.

1013
00:43:29,960 --> 00:43:33,600
SO I WILL NOT GO ABOUT THE

1014
00:43:33,600 --> 00:43:36,040
TERRAIN DR. ROTIMI HAS GIVEN A

1015
00:43:36,040 --> 00:43:41,920
VERY GOOD SUMMARY OF THE

1016
00:43:41,920 --> 00:43:44,240
CONTRIBUTIONS OF RESEARCH IN

1017
00:43:44,240 --> 00:43:53,880
AFRICA THROUGH GLOBAL GEE DMOA S

1018
00:43:53,880 --> 00:43:55,200
DATA AND PUBLIC GOOD.

1019
00:43:55,200 --> 00:44:01,240
SO WE KNOW MANY OF THIS ALREADY,

1020
00:44:01,240 --> 00:44:05,080
AND MANY OF THESE GOODS OCCURRED

1021
00:44:05,080 --> 00:44:08,440
BECAUSE OF SEVERAL RESEARCH

1022
00:44:08,440 --> 00:44:09,160
PROJECTS.

1023
00:44:09,160 --> 00:44:11,760
SOME OF THESE ARE CONSORTIUM

1024
00:44:11,760 --> 00:44:14,120
PROJECTS LIKE THE INTERNATIONAL

1025
00:44:14,120 --> 00:44:16,440
HAPLOTYPE MAPPING PROJECTS, THE

1026
00:44:16,440 --> 00:44:21,640
THOUSAND GENOMES, HUMAN HEREDITY

1027
00:44:21,640 --> 00:44:24,680
FOR HEALTH IN AFRICA, TCGA,

1028
00:44:24,680 --> 00:44:27,600
PRIMED CONSORTIUM, WHICH IN THE

1029
00:44:27,600 --> 00:44:32,240
DIFFERENT WAYS HAVE ENABLED THE

1030
00:44:32,240 --> 00:44:34,760
AVAILABILITY OF TREMENDOUS

1031
00:44:34,760 --> 00:44:38,080
AMOUNT OF GENOMIC DATA FROM

1032
00:44:38,080 --> 00:44:41,320
AFRICA TO BE AVAILABLE IN PUBLIC

1033
00:44:41,320 --> 00:44:41,680
DATABASES.

1034
00:44:41,680 --> 00:44:45,040
AND THEN THERE ARE NUMEROUS

1035
00:44:45,040 --> 00:44:46,800
INVESTIGATOR-LED GENOMIC

1036
00:44:46,800 --> 00:44:49,120
RESEARCH THAT HAVE ALSO

1037
00:44:49,120 --> 00:44:51,200
CONTRIBUTED TO WHAT WE KNOW AND

1038
00:44:51,200 --> 00:44:56,240
WHAT IS AVAILABLE.

1039
00:44:56,240 --> 00:45:00,720
YET DESPITE THIS PROGRESS AND

1040
00:45:00,720 --> 00:45:02,600
CONTRIBUTIONS FROM AFRICAN

1041
00:45:02,600 --> 00:45:05,520
SCIENTISTS AND POPULATIONS, AND

1042
00:45:05,520 --> 00:45:09,160
AS DR. ROTIMI'S PRESENTATION HAS

1043
00:45:09,160 --> 00:45:13,800
DEMONSTRATED, GIVEN REALLY

1044
00:45:13,800 --> 00:45:16,000
INTRIGUING AND INTERESTING

1045
00:45:16,000 --> 00:45:21,560
FINDINGS THAT LEAD TO NEW

1046
00:45:21,560 --> 00:45:23,400
BIOMARKER DISCOVERIES, NEW

1047
00:45:23,400 --> 00:45:26,040
UNDERSTANDING OF DISEASE

1048
00:45:26,040 --> 00:45:29,920
MECHANISMS IN AFRICAN AND GLOBAL

1049
00:45:29,920 --> 00:45:35,160
POPULATIONS, THERE IS AN

1050
00:45:35,160 --> 00:45:37,360
UNFORTUNATELY LIMITED AMOUNT OF

1051
00:45:37,360 --> 00:45:41,280
GENOMIC RESEARCH TO BE DONE IN

1052
00:45:41,280 --> 00:45:44,760
AFRICAN POPULATIONS.

1053
00:45:44,760 --> 00:45:49,920
WHAT IS EVEN MORE CHALLENGING AS

1054
00:45:49,920 --> 00:45:53,640
WE GO FORWARD IS THAT THE

1055
00:45:53,640 --> 00:45:56,320
PROPORTION OF GENOMIC RESEARCH

1056
00:45:56,320 --> 00:45:59,120
BEING DONE IN AFRICAN

1057
00:45:59,120 --> 00:46:03,960
POPULATIONS MAY ACTUALLY NOW BE

1058
00:46:03,960 --> 00:46:07,200
EITHER STATIC OR BE DECLINING,

1059
00:46:07,200 --> 00:46:09,640
AND PART OF THE REASON FOR THAT

1060
00:46:09,640 --> 00:46:12,040
IS MANY OF THOSE CONSORTIA

1061
00:46:12,040 --> 00:46:13,600
PROJECTS THAT HAVE BEEN

1062
00:46:13,600 --> 00:46:17,760
INCREDIBLY HELPFUL ARE COMING TO

1063
00:46:17,760 --> 00:46:22,480
AN END, AND RESEARCHERS IN OTHER

1064
00:46:22,480 --> 00:46:29,240
PARTS OF THE WORLD CONTINUE TO

1065
00:46:29,240 --> 00:46:32,200
GENERATE AND DUMP HUGE AMOUNTS

1066
00:46:32,200 --> 00:46:36,600
OF GENOMIC DATA FROM DIVERSE

1067
00:46:36,600 --> 00:46:38,120
POPULATIONS.

1068
00:46:38,120 --> 00:46:44,040
SO WE SEE A SITUATION WHERE THE

1069
00:46:44,040 --> 00:46:49,720
POTENTIAL FOR DISCOVERY AND

1070
00:46:49,720 --> 00:46:53,880
DELIVERY OF THE BENEFITS OF

1071
00:46:53,880 --> 00:46:57,200
GENOMIC MEDICINE AND PUBLIC

1072
00:46:57,200 --> 00:47:00,520
HEALTH APPEAR TO CERTAIN DEGREE

1073
00:47:00,520 --> 00:47:05,960
TO BE -- FROM AFRICAN

1074
00:47:05,960 --> 00:47:06,760
POPULATIONS.

1075
00:47:06,760 --> 00:47:08,080
TO COUNTER THIS, THERE HAVE BEEN

1076
00:47:08,080 --> 00:47:10,960
SEVERAL PROPOSALS.

1077
00:47:10,960 --> 00:47:16,880
PERHAPS THE MOST WELL-KNOWN AND

1078
00:47:16,880 --> 00:47:18,160
PARADIGMACTIC EXAMPLE OF THESE

1079
00:47:18,160 --> 00:47:22,360
PROPOSALS IS THE ONE FROM

1080
00:47:22,360 --> 00:47:29,760
AMBROSE -- OF THE SEQUENCING OF

1081
00:47:29,760 --> 00:47:30,760
3 MILLION AFRICAN GENOMES TO

1082
00:47:30,760 --> 00:47:34,080
BUILD A REPRESENTATIVE HUMAN

1083
00:47:34,080 --> 00:47:38,440
REFERENCE GENOME AND ESTABLISH A

1084
00:47:38,440 --> 00:47:39,560
PAN-AFRICAN BIOBANK OF CLINICAL

1085
00:47:39,560 --> 00:47:47,000
INFORMATION AND SAMPLES.

1086
00:47:47,000 --> 00:47:48,400
SO ON THE ONE HAND THEREFORE, WE

1087
00:47:48,400 --> 00:47:55,000
HAVE THE CHALLENGE OF GENERATING

1088
00:47:55,000 --> 00:47:57,720
MORE GENOMIC DATA FROM AFRICAN

1089
00:47:57,720 --> 00:48:00,480
POPULATIONS, MAKING THEM

1090
00:48:00,480 --> 00:48:02,120
PUBLICLY AVAILABLE SUCH THAT

1091
00:48:02,120 --> 00:48:08,280
THEY CAN CONTRIBUTE TO DISCOVERY

1092
00:48:08,280 --> 00:48:09,720
IN AFTER CAN POPULATIONS AND IN

1093
00:48:09,720 --> 00:48:14,320
THE REST OF THE WORLD.

1094
00:48:14,320 --> 00:48:18,400
A DIFFERENT BUT RELATED CONCERN

1095
00:48:18,400 --> 00:48:22,120
IS THE LIMITED APPLICATION TO

1096
00:48:22,120 --> 00:48:26,160
DATE OF GENOMIC MEDICINE IN

1097
00:48:26,160 --> 00:48:32,200
AFRICAN POPULATIONS.

1098
00:48:32,200 --> 00:48:34,680
BECAUSE THESE POPULATIONS HAVE

1099
00:48:34,680 --> 00:48:39,000
CONTRIBUTED AS YOU HE HEARD FROM

1100
00:48:39,000 --> 00:48:40,760
DR. ROTIMI'S PRESENTATION, IT IS

1101
00:48:40,760 --> 00:48:48,600
REASONABLE THAT WE WILL SEE

1102
00:48:48,600 --> 00:48:49,960
COMMUNITIES AND PATIENTS WITH

1103
00:48:49,960 --> 00:48:52,440
EXPECTATIONS OF DOWNSTREAM

1104
00:48:52,440 --> 00:48:56,840
BENEFITS FROM GENOMIC RESEARCH

1105
00:48:56,840 --> 00:48:58,360
THAT HAVE BEEN DONE IN THEIR

1106
00:48:58,360 --> 00:48:59,400
COUNTRIES AND IN THEIR

1107
00:48:59,400 --> 00:49:04,600
ENVIRONMENTS.

1108
00:49:04,600 --> 00:49:09,440
AND RESEARCHERS, WHEN WE ENGAGE

1109
00:49:09,440 --> 00:49:11,960
THESE COMMUNITIES, TYPICALLY

1110
00:49:11,960 --> 00:49:17,920
ASSURE THE COMMUNITIES THAT THEY

1111
00:49:17,920 --> 00:49:22,160
WILL AT SOME POINT BENEFIT FROM

1112
00:49:22,160 --> 00:49:27,320
THE OUTCOMES OF THESE GENOMIC

1113
00:49:27,320 --> 00:49:29,520
RESEARCH PROJECTS.

1114
00:49:29,520 --> 00:49:33,040
BUT WHAT WE SEE IS THAT THERE

1115
00:49:33,040 --> 00:49:38,360
HAS BEEN LESS ATTENTION TO

1116
00:49:38,360 --> 00:49:43,720
DISSEMINATION OF THE BENEFITS OF

1117
00:49:43,720 --> 00:49:44,560
GENOMIC RESEARCH.

1118
00:49:44,560 --> 00:49:45,640
AND THIS IS PARTLY BECAUSE OF

1119
00:49:45,640 --> 00:49:50,360
THE SHARED COMPLEXITY, THE

1120
00:49:50,360 --> 00:49:53,560
INVESTMENT AND INFRASTRUCTURE

1121
00:49:53,560 --> 00:49:57,320
THAT IS REQUIRED TO TRANSLATE

1122
00:49:57,320 --> 00:50:00,000
THE FINDINGS FROM GENOMIC

1123
00:50:00,000 --> 00:50:03,080
RESEARCH TO CLINICAL OR

1124
00:50:03,080 --> 00:50:05,600
CLINICALLY ACTIONABLE

1125
00:50:05,600 --> 00:50:10,280
INTERVENTIONS, AND THAT'S WHY WE

1126
00:50:10,280 --> 00:50:14,480
EMPHASIZE THE ROLE OF THE

1127
00:50:14,480 --> 00:50:18,080
ECOSYSTEM IN WHICH PATIENTS AND

1128
00:50:18,080 --> 00:50:22,680
COMMUNITIES IN THIS ENVIRONMENT

1129
00:50:22,680 --> 00:50:27,320
EXISTS, BECAUSE IT IS BEYOND THE

1130
00:50:27,320 --> 00:50:32,200
ABILITY OF THE TYPICAL RESEAR

1131
00:50:32,200 --> 00:50:36,640
RESEARCHERS AND THEIR FUNDING TO

1132
00:50:36,640 --> 00:50:41,440
BE RESPONSIBLE FOR THE CONTINUUM

1133
00:50:41,440 --> 00:50:43,520
OF DISCOVERY TO CLINICAL

1134
00:50:43,520 --> 00:50:46,880
ACTIONABILITY.

1135
00:50:46,880 --> 00:50:48,560
PARTICULARLY BECAUSE THOSE KINDS

1136
00:50:48,560 --> 00:50:54,040
OF INTERVENTIONS HAVE A MORE

1137
00:50:54,040 --> 00:50:58,080
LOCAL BENEFIT THAN DISCOVERIES

1138
00:50:58,080 --> 00:51:07,000
THAT CAN FWELL NEW BIOMARKERS OF

1139
00:51:07,000 --> 00:51:08,120
DISEASE IN DEVELOPED COUNTRIES.

1140
00:51:08,120 --> 00:51:11,240
SO WE ASK OURSELVES, HOW ON THE

1141
00:51:11,240 --> 00:51:17,880
ONE HAND DO WE SOLVE THE PROBLEM

1142
00:51:17,880 --> 00:51:23,680
OF GENERATING MORE AND MORE

1143
00:51:23,680 --> 00:51:25,080
DIVERSE GENOMIC DATA FROM

1144
00:51:25,080 --> 00:51:30,200
AFRICAN POPULATIONS WHILE

1145
00:51:30,200 --> 00:51:32,320
SIMULTANEOUSLY DELIVERING THE

1146
00:51:32,320 --> 00:51:35,600
BENEFITS OF GENOMIC RESEARCH TO

1147
00:51:35,600 --> 00:51:39,800
THESE POPULATIONS.

1148
00:51:39,800 --> 00:51:41,800
SO IN THE PAST SEVERAL YEARS,

1149
00:51:41,800 --> 00:51:44,960
THE RESEARCH COMMUNITY HAS

1150
00:51:44,960 --> 00:51:48,040
CONFRONTED THIS KIND OF PROBLEM

1151
00:51:48,040 --> 00:51:52,520
AND DEVELOP A WHOLE FIELD CALLED

1152
00:51:52,520 --> 00:51:56,360
IMPLEMENTATION SCIENCE TO SPEED

1153
00:51:56,360 --> 00:51:59,880
UP THE DELIVERY OF

1154
00:51:59,880 --> 00:52:02,480
EVIDENCE-BASED INTERVENTIONS

1155
00:52:02,480 --> 00:52:04,720
INTO POPULATIONS.

1156
00:52:04,720 --> 00:52:06,880
THE FIELD OF IMPLEMENTATION

1157
00:52:06,880 --> 00:52:11,160
SCIENCE ENABLES US TO IDENTIFY

1158
00:52:11,160 --> 00:52:15,520
THE BARRIERS AND THE FACILIT 

1159
00:52:15,520 --> 00:52:16,960
FACILITATORS AND THE

1160
00:52:16,960 --> 00:52:22,400
DETERMINANTS OF THE ADOPTION AND

1161
00:52:22,400 --> 00:52:24,680
THE SUSTENANCE OF EVIDENCE-BASED

1162
00:52:24,680 --> 00:52:25,680
INTERVENTION IN ANY HEALTHCARE

1163
00:52:25,680 --> 00:52:28,840
SYSTEM.

1164
00:52:28,840 --> 00:52:35,160
SO WHAT WE'RE PROPOSING IS TO

1165
00:52:35,160 --> 00:52:39,000
CONSIDER GENOMIC RESEARCH THAT

1166
00:52:39,000 --> 00:52:40,320
INCREASES THE NUMBER AND

1167
00:52:40,320 --> 00:52:43,200
DIVERSITY OF GENOMIC DATA FROM

1168
00:52:43,200 --> 00:52:50,320
AFRICA AND THE IMPLEMENTATION OF

1169
00:52:50,320 --> 00:52:52,720
PROVEN GENOMIC MEDICAL

1170
00:52:52,720 --> 00:52:55,040
INTERVENTIONS IN THE CLINICAL

1171
00:52:55,040 --> 00:52:57,000
AND PUBLIC HEALTH PRACTICE IN

1172
00:52:57,000 --> 00:53:00,160
AFRICA AS EVIDENCE-BASED

1173
00:53:00,160 --> 00:53:02,480
INTERVENTIONS, AND IF WE

1174
00:53:02,480 --> 00:53:03,600
CONCEPTUALIZE THE PROBLEM IN

1175
00:53:03,600 --> 00:53:06,560
THIS FASHION, THEN WE ARE ABLE

1176
00:53:06,560 --> 00:53:09,160
TO BORROW FROM THE FIELD OF

1177
00:53:09,160 --> 00:53:12,720
IMPLEMENTATION AND DISSEMINATION

1178
00:53:12,720 --> 00:53:15,560
SCIENCE, AND USE THE TOOLS OF

1179
00:53:15,560 --> 00:53:18,120
THIS SCIENCE TO ADVANCE THE

1180
00:53:18,120 --> 00:53:21,680
GENOMIC RESEARCH AND CLINICAL

1181
00:53:21,680 --> 00:53:23,680
PRACTICE, NOT JUST IN AFRICA,

1182
00:53:23,680 --> 00:53:27,560
BUT IN OTHER LOW AND MIDDLE

1183
00:53:27,560 --> 00:53:32,600
INCOME COUNTRIES, AND SOME AREAS

1184
00:53:32,600 --> 00:53:34,320
IN HIGH INCOME COUNTRIES THAT

1185
00:53:34,320 --> 00:53:42,160
ARE RELATIVELY UNDERSERVED.

1186
00:53:42,160 --> 00:53:42,440
 BY

1187
00:53:42,440 --> 00:53:46,000
THE CURRENT SYSTEMS IN THOSE

1188
00:53:46,000 --> 00:53:47,760
ENVIRONMENTS.

1189
00:53:47,760 --> 00:53:50,040
SO AS EVIDENCE-BASED

1190
00:53:50,040 --> 00:53:53,280
INTERVENTIONS, THEREFORE, WE CAN

1191
00:53:53,280 --> 00:53:56,640
USE, FOR EXAMPLE, INTERVENTION

1192
00:53:56,640 --> 00:54:01,200
MAPPING IN ORDER TO CONDUCT A

1193
00:54:01,200 --> 00:54:03,600
SYSTEMATIC EVALUATION FOR THE

1194
00:54:03,600 --> 00:54:05,880
IMPLEMENTATION AND DISSEMINATION

1195
00:54:05,880 --> 00:54:08,440
OF RESEARCH THAT INCREASES THE

1196
00:54:08,440 --> 00:54:11,440
NUMBER AND DIVERSITY OF GENOMIC

1197
00:54:11,440 --> 00:54:15,160
DATA FROM AFRICAN POPULATIONS

1198
00:54:15,160 --> 00:54:17,920
AND IMPLEMENT GENOMIC MEDICINE

1199
00:54:17,920 --> 00:54:19,760
IN CLINICAL AND PUBLIC HEALTH

1200
00:54:19,760 --> 00:54:25,400
PRACTICE IN AFRICA BY TAKING

1201
00:54:25,400 --> 00:54:26,440
CONSIDERATION OF THE

1202
00:54:26,440 --> 00:54:28,760
DETERMINANTS AND THE MECHANISMS

1203
00:54:28,760 --> 00:54:32,600
AND STRATEGIES THAT WE NEED TO

1204
00:54:32,600 --> 00:54:35,880
IMPLEMENT TO EFFECT THE NEEDED

1205
00:54:35,880 --> 00:54:39,160
CHANGE.

1206
00:54:39,160 --> 00:54:40,720
INTERVENTION MAPPING ENABLES US

1207
00:54:40,720 --> 00:54:42,440
TO DESIGN AND IMPLEMENT MULTIPLE

1208
00:54:42,440 --> 00:54:48,640
OR MULTILEVEL INTERVENTIONS AND

1209
00:54:48,640 --> 00:54:50,040
IMPLEMENTATION STRATEGIES THAT

1210
00:54:50,040 --> 00:54:51,760
ENHANCE THE ADOPTION,

1211
00:54:51,760 --> 00:54:54,760
IMPLEMENTATION AND SUSTENANCE OF

1212
00:54:54,760 --> 00:54:57,080
THESE EBIs.

1213
00:54:57,080 --> 00:55:01,600
SO WE'RE NOT DEALING WITH THE

1214
00:55:01,600 --> 00:55:09,040
CHALLENGE IN THE TRADITIONAL WAY

1215
00:55:09,040 --> 00:55:11,640
OF JUST GRANTS AND CONTRACTS,

1216
00:55:11,640 --> 00:55:13,640
BUT WE'RE STEPPING BACK TO SAY

1217
00:55:13,640 --> 00:55:19,920
WHAT DO WE NEED TO DO TO ENHANCE

1218
00:55:19,920 --> 00:55:29,320
THE ADOPTION AND MAINTENANCE OF

1219
00:55:29,320 --> 00:55:30,720
BOTH GENOMIC RESEARCH AND

1220
00:55:30,720 --> 00:55:36,960
GENOMIC MEDICINE IN AFRICA?

1221
00:55:36,960 --> 00:55:39,480
SO IF WE TAKE THE INTERVENTION

1222
00:55:39,480 --> 00:55:42,640
MAPPING CONCEPT FURTHER,

1223
00:55:42,640 --> 00:55:46,000
INTERVENTION MAPPING HAS SIX

1224
00:55:46,000 --> 00:55:49,120
DOMAINS.

1225
00:55:49,120 --> 00:55:51,120
AND THESE DOMAINS, WHILE THEY

1226
00:55:51,120 --> 00:55:54,400
MAY APPEAR LINEAR, ARE ACTUALLY

1227
00:55:54,400 --> 00:55:57,160
ITERATIVE, SO ONE STEP FITS ON

1228
00:55:57,160 --> 00:55:58,600
THE OTHER, INFORMS THE OTHER,

1229
00:55:58,600 --> 00:56:02,960
AND YOU CAN GO BACK AND FORTH

1230
00:56:02,960 --> 00:56:06,000
AND BUILD AS YOU BETTER

1231
00:56:06,000 --> 00:56:07,040
UNDERSTAND THE LANDSCAPE.

1232
00:56:07,040 --> 00:56:11,440
SO WE NEED FIRST TO UNDERSTAND

1233
00:56:11,440 --> 00:56:12,960
WHAT THE NEEDS ARE, WHAT NEEDS

1234
00:56:12,960 --> 00:56:16,680
TO BE DONE AND FOR WHOM.

1235
00:56:16,680 --> 00:56:19,680
IN THIS CASE, FOR GENOMIC

1236
00:56:19,680 --> 00:56:20,680
RESEARCH, WE WANT TO INCREASE

1237
00:56:20,680 --> 00:56:23,520
THE NUMBER AND DIVERSITY OF

1238
00:56:23,520 --> 00:56:24,960
AFRICAN GENOMIC DATA IN GLOBAL

1239
00:56:24,960 --> 00:56:25,400
DATABASES.

1240
00:56:25,400 --> 00:56:27,600
THAT DEFINES THE EBI THAT WE

1241
00:56:27,600 --> 00:56:31,160
WANT TO IMPLEMENT.

1242
00:56:31,160 --> 00:56:33,960
THIS DOES NOT MEAN IT'S

1243
00:56:33,960 --> 00:56:37,000
EXCLUSIVE, BUT FOR THE

1244
00:56:37,000 --> 00:56:38,440
INTERVENTION MAPPING PROCESS, WE

1245
00:56:38,440 --> 00:56:43,440
HAVE TO DEFINE THE PROBLEM.

1246
00:56:43,440 --> 00:56:44,720
AND FOR GENOMIC MEDICINE, WHAT

1247
00:56:44,720 --> 00:56:48,840
WE WANT TO SEE IS THE

1248
00:56:48,840 --> 00:56:51,920
INTEGRATION OF GENOMIC MEDICAL

1249
00:56:51,920 --> 00:56:53,120
PRACTICE INTO CLINICAL AND

1250
00:56:53,120 --> 00:56:54,120
PUBLIC HEALTH.

1251
00:56:54,120 --> 00:56:58,120
NOW, IF WE SUCCEED IN DOING

1252
00:56:58,120 --> 00:57:02,760
THESE TWO THINGS, WE WILL BE

1253
00:57:02,760 --> 00:57:07,600
ABLE TO REGULARLY GENERATE HIGH

1254
00:57:07,600 --> 00:57:12,000
QUALITY GENOMIC DATA FROM AFRICA

1255
00:57:12,000 --> 00:57:14,200
WITHOUT THE NEED FOR THE

1256
00:57:14,200 --> 00:57:21,640
CONSORTIA PROJECTS AN AND THIS L

1257
00:57:21,640 --> 00:57:24,920
CREATE A SUSTAINABLE PATH SUCH

1258
00:57:24,920 --> 00:57:28,800
THAT THE INSTITUTIONS, THE

1259
00:57:28,800 --> 00:57:30,480
PERSONNEL AND THE COMMUNITIES,

1260
00:57:30,480 --> 00:57:32,200
THE STRUCTURES AND THE

1261
00:57:32,200 --> 00:57:35,720
GOVERNMENTS AND NON-GOVERNMENT

1262
00:57:35,720 --> 00:57:38,920
COMPLEMENTS CAN WORK TOGETHER

1263
00:57:38,920 --> 00:57:42,840
AND BRING THE BENEFIT OF GENOMIC

1264
00:57:42,840 --> 00:57:46,720
MEDICINE TO THESE POPULATIONS.

1265
00:57:46,720 --> 00:57:48,920
SO OF COURSE WE NEED TO CREATE

1266
00:57:48,920 --> 00:57:54,760
MA TRTRICES OF THE CHANGE WE WAT

1267
00:57:54,760 --> 00:57:57,280
TO SEE BY COMBINING PERFORMANCE

1268
00:57:57,280 --> 00:57:59,480
OBJECTIVES WITH THEIR

1269
00:57:59,480 --> 00:58:00,480
DETERMINANTS.

1270
00:58:00,480 --> 00:58:02,000
SO WE NEED FUNDING, BUT WHAT

1271
00:58:02,000 --> 00:58:03,280
KIND OF FUNDING?

1272
00:58:03,280 --> 00:58:07,320
HOW SHALL IT BE STRUCTURED?

1273
00:58:07,320 --> 00:58:08,280
WE NEED INFRASTRUCTURE.

1274
00:58:08,280 --> 00:58:11,440
WHAT TYPES OF INFRASTRUCTURE CAN

1275
00:58:11,440 --> 00:58:15,720
BE SUSTAINABLY INTRODUCED INTO

1276
00:58:15,720 --> 00:58:20,360
LOW AND MIDDLE INCOME COUNTRIES

1277
00:58:20,360 --> 00:58:29,800
THAT WILL CONTINUE TO SS SSH THE

1278
00:58:29,800 --> 00:58:31,320
POPULATION BEYOND THE RESEARCH

1279
00:58:31,320 --> 00:58:31,680
PROJECTS.

1280
00:58:31,680 --> 00:58:35,840
HOW DO WE CREATE CLINICAL AND

1281
00:58:35,840 --> 00:58:36,600
LABORATORY INFRASTRUCTURE TO

1282
00:58:36,600 --> 00:58:38,920
GENERATE AND CREATE VALIDATED

1283
00:58:38,920 --> 00:58:44,080
GENOMIC MEDICAL PRACTICE?

1284
00:58:44,080 --> 00:58:47,280
THEN IT'S NOT EVERY GENOMIC

1285
00:58:47,280 --> 00:58:49,160
INTERVENTION OR GENOMIC RESEARCH

1286
00:58:49,160 --> 00:58:51,880
PROJECT THAT IS GOING TO BE

1287
00:58:51,880 --> 00:58:55,080
FEASIBLE IN ALL COMMUNITIES,

1288
00:58:55,080 --> 00:58:55,960
SOCIETIES AND ENVIRONMENTS.

1289
00:58:55,960 --> 00:59:01,240
SO WE NEED TO SELECT WHAT

1290
00:59:01,240 --> 00:59:04,120
INTERVENTIONS WE BELIEVE WILL BE

1291
00:59:04,120 --> 00:59:09,880
MOST USEFUL, AND MATCH THEM WITH

1292
00:59:09,880 --> 00:59:13,720
THE APPLICATIONS  THAT WILL

1293
00:59:13,720 --> 00:59:14,800
SATISFY OUR PARAMETERS FOR

1294
00:59:14,800 --> 00:59:16,360
SUCCESS.

1295
00:59:16,360 --> 00:59:19,640
WHAT TYPE OF FUNDING?

1296
00:59:19,640 --> 00:59:23,480
IS IT AN R03 KIND OF FUNDING?

1297
00:59:23,480 --> 00:59:25,640
AN R21?

1298
00:59:25,640 --> 00:59:29,440
A U01?

1299
00:59:29,440 --> 00:59:30,800
ARE THOSE TYPES OF FUNDING

1300
00:59:30,800 --> 00:59:35,480
REALLY SUITABLE FOR THE

1301
00:59:35,480 --> 00:59:37,120
ENVIRONMENTS THAT WE'RE TALKING

1302
00:59:37,120 --> 00:59:37,640
ABOUT?

1303
00:59:37,640 --> 00:59:40,200
OR WE NEED TO, IN FACT, STEP

1304
00:59:40,200 --> 00:59:44,480
BACK AND UNDERSTAND THAT THOSE

1305
00:59:44,480 --> 00:59:45,520
FUNDING MECHANISMS AND THE

1306
00:59:45,520 --> 00:59:51,360
PROCESSES THAT SUPPORT THEM HAVE

1307
00:59:51,360 --> 00:59:55,200
BEEN DEVELOPED FOR A PARTICULAR

1308
00:59:55,200 --> 00:59:56,400
SOCIOECONOMIC CULTURAL AND

1309
00:59:56,400 --> 00:59:57,320
GOVERNMENTAL ENVIRONMENT AND

1310
00:59:57,320 --> 01:00:00,800
PERHAPS MAY NOT BE A GOOD FIT

1311
01:00:00,800 --> 01:00:07,280
WHEN WE APPLY THEM TO DIFFERENT

1312
01:00:07,280 --> 01:00:08,160
ENVIRONMENTS.

1313
01:00:08,160 --> 01:00:09,600
THEN WE NEED TO INTEGRATE ALL

1314
01:00:09,600 --> 01:00:11,120
THESE METHODS AND APPLICATIONS

1315
01:00:11,120 --> 01:00:16,280
INTO ORGANIZED PROGRAMS THAT CAN

1316
01:00:16,280 --> 01:00:18,360
OPERATIONALIZE IN SHORT, MEDIUM

1317
01:00:18,360 --> 01:00:21,520
AND LONG TERM FASHION.

1318
01:00:21,520 --> 01:00:24,440
ONCE WE HAVE ALL OUR DUCKS IN A

1319
01:00:24,440 --> 01:00:27,280
ROW, THEN WE BORROW FURTHER FROM

1320
01:00:27,280 --> 01:00:29,040
THE IMPLEMENTATION AND

1321
01:00:29,040 --> 01:00:33,000
DISSEMINATION SCIENCE FIELD TO

1322
01:00:33,000 --> 01:00:36,400
DO IMPLEMENTATION MAPPING, AND

1323
01:00:36,400 --> 01:00:40,880
INCLUDE WITHIN OUR WORK

1324
01:00:40,880 --> 01:00:43,720
EVALUATIONS OF THE EFFECTS AND

1325
01:00:43,720 --> 01:00:46,520
PROCESSES THAT WE ARE

1326
01:00:46,520 --> 01:00:48,280
IMPLEMENTING.

1327
01:00:48,280 --> 01:00:49,800
THE OUTCOMES AND THE PROCESSES

1328
01:00:49,800 --> 01:00:53,000
LEADING TO THOSE OUTCOMES.

1329
01:00:53,000 --> 01:00:54,680
HOW WELL ARE THEY WORKING, WHAT

1330
01:00:54,680 --> 01:00:59,360
DO WE NEED TO CHANGE?

1331
01:00:59,360 --> 01:01:02,560
SO IN ORDER TO GIVE US A BETTER

1332
01:01:02,560 --> 01:01:05,400
APPRECIATION OF THE CHALLENGES

1333
01:01:05,400 --> 01:01:09,800
AND PERHAPS THE OPPORTUNITIES IN

1334
01:01:09,800 --> 01:01:12,120
THESE ENVIRONMENTS, I WANT US TO

1335
01:01:12,120 --> 01:01:15,520
WALK IN THE SHOES OF A RECENTLY

1336
01:01:15,520 --> 01:01:18,920
DIAGNOSED BREAST CANCER PATIENT

1337
01:01:18,920 --> 01:01:24,720
WHO IS A PUBLIC ADVOCATE AS

1338
01:01:24,720 --> 01:01:26,920
SHARED ON FACEBOOK A RECENT

1339
01:01:26,920 --> 01:01:28,520
POSTING OF TWO OR THREE DAYS AGO

1340
01:01:28,520 --> 01:01:29,600
IS WHAT I'M SHOWING IN THE

1341
01:01:29,600 --> 01:01:32,680
PICTURE, AND OF COURSE CONSENTED

1342
01:01:32,680 --> 01:01:38,800
TO PARTICIPATE IN THIS PROGRAM

1343
01:01:38,800 --> 01:01:40,040
AND WE RECORDED OUR

1344
01:01:40,040 --> 01:01:42,120
CONVERSATIONS, WHICH I HAVE

1345
01:01:42,120 --> 01:01:44,200
EDITED.

1346
01:01:44,200 --> 01:01:45,200
SHE'S THE MOTHER OF TWO GIRLS

1347
01:01:45,200 --> 01:01:47,440
AND SHE HAS FIVE SISTERS.

1348
01:01:47,440 --> 01:01:51,480
SHE'S 40 YEARS OLD.

1349
01:01:51,480 --> 01:01:57,520
AND HAS HAD THE OPPORTUNITY TO

1350
01:01:57,520 --> 01:01:59,320
WORK IN SUCH RESEARCH PROGRAMS.

1351
01:01:59,320 --> 01:02:02,680
SO LET'S HEAR SOME OF THE

1352
01:02:02,680 --> 01:02:04,640
SNIPPETS FROM OUR TWO TO

1353
01:02:04,640 --> 01:02:05,360
THREE-HOUR-LONG CONVERSATION.

1354
01:02:05,360 --> 01:02:07,280
SO ONE OF THE CHALLENGES, OF

1355
01:02:07,280 --> 01:02:11,920
COURSE, THAT SHE EXPERIENCED IS

1356
01:02:11,920 --> 01:02:12,800
DIAGNOSTIC DELAY.

1357
01:02:12,800 --> 01:02:16,280
SO HOW LONG DID IT TAKE BETWEEN

1358
01:02:16,280 --> 01:02:19,400
WHEN YOU NOTICED THE DISCOMFORT

1359
01:02:19,400 --> 01:02:24,240
AND WHEN YOU FINALLY HAD A

1360
01:02:24,240 --> 01:02:26,680
DIAGNOSTIC CONFIRMATION?

1361
01:02:26,680 --> 01:02:30,040
>>THAT WAS FROM DECEMBER
TO

1362
01:02:30,040 --> 01:02:32,160
JULY.

1363
01:02:32,160 --> 01:02:41,360
>>SO THAT'S ABOUT EIGHT
MONTHS.

1364
01:02:41,360 --> 01:02:43,120
THEN SHE HIGHLIGHTED THE

1365
01:02:43,120 --> 01:02:49,680
CHALLENGE THAT SHE FACED FROM

1366
01:02:49,680 --> 01:02:51,560
HEALTHCARE PROFESSIONALS AND THE

1367
01:02:51,560 --> 01:02:54,480
LEVEL OF KNOWLEDGE THEY HAD

1368
01:02:54,480 --> 01:02:56,800
ABOUT HER DIAGNOSIS OF BREAST

1369
01:02:56,800 --> 01:02:58,520
CANCER AND TREATMENT.

1370
01:02:58,520 --> 01:03:01,080
>>I WENT TO THE HOSPITAL
TO

1371
01:03:01,080 --> 01:03:02,280
COMPLAIN.

1372
01:03:02,280 --> 01:03:09,320
I WAS TOLD THAT I WAS --

1373
01:03:09,320 --> 01:03:10,000
PSYCHOLOGICAL, THAT THERE'S

1374
01:03:10,000 --> 01:03:11,040
NOTHING, THAT MAYBE IT'S MY

1375
01:03:11,040 --> 01:03:12,560
PERIOD OR CHANGE OF HORMONE OR

1376
01:03:12,560 --> 01:03:12,960
SOMETHING.

1377
01:03:12,960 --> 01:03:15,120
I WAS LIKE, THIS THING HAS NEVER

1378
01:03:15,120 --> 01:03:18,000
BEEN HAPPENING TO ME.

1379
01:03:18,000 --> 01:03:19,600
IT KEPT COMING, IT'S NOT

1380
01:03:19,600 --> 01:03:21,160
SOMETHING THAT JUST HAPPENED

1381
01:03:21,160 --> 01:03:22,760
MAYBE ONCE IN A WEEK OR ONCE IN

1382
01:03:22,760 --> 01:03:23,720
TWO WEEKS.

1383
01:03:23,720 --> 01:03:30,440
AFTER LIKE TWO MONTHS, I NOTI 

1384
01:03:30,440 --> 01:03:34,040
NOTICED -- THERE WERE SO MANY

1385
01:03:34,040 --> 01:03:35,880
DIFFERENT COMPETING OPINIONS, SO

1386
01:03:35,880 --> 01:03:36,480
TO SAY.

1387
01:03:36,480 --> 01:03:39,320
THE NURSE THAT WAS TO TAKE MY

1388
01:03:39,320 --> 01:03:44,240
VITALS WAS TO TAKE MY VITALS AND

1389
01:03:44,240 --> 01:03:46,920
SEND ME TO THE ROOM WHERE I WAS

1390
01:03:46,920 --> 01:03:48,680
TO WAIT.

1391
01:03:48,680 --> 01:03:51,320
WHEN I GIVE HER MY FILE SHE SAID

1392
01:03:51,320 --> 01:03:53,400
OKAY WHAT ARE YOU HERE FOR, I

1393
01:03:53,400 --> 01:04:04,000
SAID I'M HERE FOR MY VITAL -- I

1394
01:04:05,200 --> 01:04:10,920
NEED TO PRAY AND I WANT TO

1395
01:04:10,920 --> 01:04:12,400
ASK -- REMOVE CANCER FROM MY

1396
01:04:12,400 --> 01:04:16,280
BODY WITHOUT ME DOING ANYTHING.

1397
01:04:16,280 --> 01:04:18,880
>>OF COURSE WITH FIVE
SISTERS

1398
01:04:18,880 --> 01:04:22,360
AND A DIAGNOSIS OF BREAST

1399
01:04:22,360 --> 01:04:24,400
CANCER, WE WERE INTERESTED IN

1400
01:04:24,400 --> 01:04:30,280
KNOWING HOW THE FAMILY RECEIVED

1401
01:04:30,280 --> 01:04:31,480
THE DIAGNOSIS AND POTENTIAL

1402
01:04:31,480 --> 01:04:33,840
IMPLICATION THAT IT HAS FOR

1403
01:04:33,840 --> 01:04:36,840
THEIR RISK OF BREAST CANCER.

1404
01:04:36,840 --> 01:04:38,960
>>YOU SAID THAT YOU'RE
FROM A

1405
01:04:38,960 --> 01:04:41,280
FAMILY OF SIX GIRLS.

1406
01:04:41,280 --> 01:04:43,160
YOU HAVE FIVE SISTERS?

1407
01:04:43,160 --> 01:04:44,440
>>YES.

1408
01:04:44,440 --> 01:04:45,160
YES, SIR.

1409
01:04:45,160 --> 01:04:50,560
>>AND IS THERE ANY FAMILY

1410
01:04:50,560 --> 01:04:54,600
HISTORY OF BREAST CANCER OR ARE

1411
01:04:54,600 --> 01:04:58,280
YOU AWARE OR DID YOU KNOW PEOPLE

1412
01:04:58,280 --> 01:04:59,240
BEFORE YOUR DIAGNOSIS AND

1413
01:04:59,240 --> 01:05:04,840
OUTSIDE OF YOUR WORK, YOU KNOW,

1414
01:05:04,840 --> 01:05:07,440
WHO HAD BREAST CANCER?

1415
01:05:07,440 --> 01:05:09,360
>>NONE THAT I KNOW.

1416
01:05:09,360 --> 01:05:12,400
>>SO YOU HAVE NO PREVIOUS

1417
01:05:12,400 --> 01:05:14,280
INTERACTION OR KNOWLEDGE OF THIS

1418
01:05:14,280 --> 01:05:17,520
DISEASE UNTIL YOU STARTED

1419
01:05:17,520 --> 01:05:19,640
WALKING IN THE LAB?

1420
01:05:19,640 --> 01:05:20,720
 -- CAUSED THE DIAGNOSIS WITH

1421
01:05:20,720 --> 01:05:24,760
YOUR SISTERS AND THE CONCERN

1422
01:05:24,760 --> 01:05:27,200
THAT THERE MAY BE A GENETIC

1423
01:05:27,200 --> 01:05:32,360
BASIS FOR THE DISEASE AND WHAT

1424
01:05:32,360 --> 01:05:35,360
THAT IMPLIES FOR THEM?

1425
01:05:35,360 --> 01:05:40,440
>>I'VE TRIED TO.

1426
01:05:40,440 --> 01:05:42,600
 -- IN DENIAL, DON'T WANT TO

1427
01:05:42,600 --> 01:05:47,480
ACCEPT -- WHEN I TOLD THEM ABOUT

1428
01:05:47,480 --> 01:05:49,680
MY DIAGNOSIS AND THAT I'M GOING

1429
01:05:49,680 --> 01:05:53,040
FOR MASTECTOMY, THEY DIDN'T

1430
01:05:53,040 --> 01:05:54,280
AGREE.

1431
01:05:54,280 --> 01:05:56,680
THEY DIDN'T EVEN WANT ME TO

1432
01:05:56,680 --> 01:05:59,640
START ON THE TO TOPIC, YOU KNOWO

1433
01:05:59,640 --> 01:06:02,040
TELL THEM TO EVEN CHECK

1434
01:06:02,040 --> 01:06:05,560
THEMSELVES WHEN I -- WHENEVER --

1435
01:06:05,560 --> 01:06:07,000
YOU'RE GOING TO REMOVE YOUR

1436
01:06:07,000 --> 01:06:08,640
BREAST, IN FACT, SOME DAYS THEY

1437
01:06:08,640 --> 01:06:14,680
WOULD CALL ME AND, YOU KNOW, --

1438
01:06:14,680 --> 01:06:17,520
THIS SURGERY WILL NOT HOLD.

1439
01:06:17,520 --> 01:06:21,080
SO AT THE END OF THE DAY, WHEN I

1440
01:06:21,080 --> 01:06:22,880
WANT TO BRING UP THE TOPIC THAT

1441
01:06:22,880 --> 01:06:26,040
PLEASE, EVEN IF IT'S JUST

1442
01:06:26,040 --> 01:06:28,160
SELF-EXAMINATION, DO IT.

1443
01:06:28,160 --> 01:06:30,480
NOBODY IS WILLING TO, YOU KNOW,

1444
01:06:30,480 --> 01:06:31,880
LISTEN TO ME.

1445
01:06:31,880 --> 01:06:38,400
SO IT'S BEEN LIKE A CHALLENGE,

1446
01:06:38,400 --> 01:06:38,840
BUT --

1447
01:06:38,840 --> 01:06:40,680
>>THEN BECAUSE SHE HAD
WALKED

1448
01:06:40,680 --> 01:06:44,520
ON PROJECTS THAT INCLUDED

1449
01:06:44,520 --> 01:06:46,880
GENOMIC EPIDEMIOLOGY OF BREAST

1450
01:06:46,880 --> 01:06:53,840
CANCER, WE WANTED TO KNOW ABOUT

1451
01:06:53,840 --> 01:06:55,080
GENOMIC TESTING FOR BREAST

1452
01:06:55,080 --> 01:06:55,280
CANCER.

1453
01:06:55,280 --> 01:06:57,560
>>DID YOU DO ANY GENOMIC
TEST?

1454
01:06:57,560 --> 01:07:00,880
>>I TRIED TO DO A GENOMIC
TEST,

1455
01:07:00,880 --> 01:07:03,960
BUT I FOUND OUT THAT THERE WAS

1456
01:07:03,960 --> 01:07:05,920
NO PLACE TO DO THAT IN NIGERIA,

1457
01:07:05,920 --> 01:07:10,560
SO THE PEOPLE -- TAKING MY

1458
01:07:10,560 --> 01:07:11,360
SAMPLE ABROAD.

1459
01:07:11,360 --> 01:07:14,960
>>WHICH -- WAS THIS?

1460
01:07:14,960 --> 01:07:17,280
>>THAT WAS BRCA.

1461
01:07:17,280 --> 01:07:18,920
>>YOU TALKED ABOUT THE
BRCA

1462
01:07:18,920 --> 01:07:21,120
TEST AND THAT IT WAS YOUR

1463
01:07:21,120 --> 01:07:23,640
INITIATIVE TO CONSIDER IT.

1464
01:07:23,640 --> 01:07:24,880
DID YOU DISCUSS IT WITH YOUR

1465
01:07:24,880 --> 01:07:27,640
CARE PROVIDERS?

1466
01:07:27,640 --> 01:07:31,120
>>OF COURSE I DID.

1467
01:07:31,120 --> 01:07:34,240
WHEN I OPTED TO DO THE -- REMOVE

1468
01:07:34,240 --> 01:07:38,600
BOTH BREASTS AND THEY TOLD ME

1469
01:07:38,600 --> 01:07:44,960
THAT IF I DO THE BRCA, IT

1470
01:07:44,960 --> 01:07:46,600
WILL -- GIVE THEM A BASIS TO DO

1471
01:07:46,600 --> 01:07:49,160
THE DOUBLE MASTECTOMY BUT IF I

1472
01:07:49,160 --> 01:07:50,840
DON'T DO IT THEY DON'T HAVE ANY

1473
01:07:50,840 --> 01:07:53,600
BASIS, BUT LIKE I SAID EARLIER,

1474
01:07:53,600 --> 01:07:58,120
IT COST --

1475
01:07:58,120 --> 01:07:59,920
>>WAS THERE ANY TIME THAT
YOU

1476
01:07:59,920 --> 01:08:03,480
WERE REFERRED TO, SAY, A GENETIC

1477
01:08:03,480 --> 01:08:03,760
COUNSELOR?

1478
01:08:03,760 --> 01:08:04,920
>>NOT AT ALL.

1479
01:08:04,920 --> 01:08:09,400
>>ARE YOU AWARE OF THAT
SERVICE

1480
01:08:09,400 --> 01:08:11,160
IN ANY HOSPITAL IN NIGERIA?

1481
01:08:11,160 --> 01:08:16,000
>>NO, SIR.

1482
01:08:16,000 --> 01:08:17,440
>>THROUGHOUT THE PERIOD
THAT

1483
01:08:17,440 --> 01:08:20,920
YOU ARE GOING THROUGH THIS

1484
01:08:20,920 --> 01:08:26,160
TREATMENT, DID YOU HAVE ANY

1485
01:08:26,160 --> 01:08:28,200
OPPORTUNITY TO PARTICIPATE IN

1486
01:08:28,200 --> 01:08:32,480
ANY RESEARCH, WHETHER IT'S

1487
01:08:32,480 --> 01:08:36,400
EPIDEMIOLOGY OR CLINICAL TRIALS?

1488
01:08:36,400 --> 01:08:39,040
>>NO, SIR.

1489
01:08:39,040 --> 01:08:44,320
>>I NOTE THAT YOU ARE
FANNING

1490
01:08:44,320 --> 01:08:46,920
YOURSELF A LOT.

1491
01:08:46,920 --> 01:08:47,560
>> --

1492
01:08:47,560 --> 01:08:50,040
>>OKAY.

1493
01:08:50,040 --> 01:08:52,720
THESE ARE ALL THE CHALLENGES.

1494
01:08:52,720 --> 01:08:56,440
SO THAT L

1495
01:08:56,440 --> 01:08:58,200
>>SO THAT LAST
CONVERSATION WAS

1496
01:08:58,200 --> 01:09:00,120
ABOUT POWER OUTAGE WHICH AFFECTS

1497
01:09:00,120 --> 01:09:03,240
PEOPLE'S LIVES, AFFECTS ACCESS

1498
01:09:03,240 --> 01:09:06,960
TO CARE, AND YOU KNOW, THE

1499
01:09:06,960 --> 01:09:10,480
MATERIALS AND RESOURCES,

1500
01:09:10,480 --> 01:09:11,520
RADIOTHERAPY AND THINGS LIKE

1501
01:09:11,520 --> 01:09:12,840
THAT, THAT PATIENTS LIKE THIS

1502
01:09:12,840 --> 01:09:13,920
NEED.

1503
01:09:13,920 --> 01:09:17,320
THEN I SPOKE TO HER ABOUT THE

1504
01:09:17,320 --> 01:09:20,360
COST AND THIS WAS QUITE

1505
01:09:20,360 --> 01:09:23,800
CHALLENGING.

1506
01:09:23,800 --> 01:09:27,200
SO HERE ARE THE EXPENSES THAT

1507
01:09:27,200 --> 01:09:36,200
SHE HAS INCURRED FOR HER CARE.

1508
01:09:36,200 --> 01:09:37,760
EVEN THOUGH THERE IS HEALTH

1509
01:09:37,760 --> 01:09:39,520
INSURANCE, ONCE SHE RECEIVED THE

1510
01:09:39,520 --> 01:09:41,160
DIAGNOSIS OF CANCER, THE HEALTH

1511
01:09:41,160 --> 01:09:42,480
INSURANCE COMPANY INFORMED HER

1512
01:09:42,480 --> 01:09:46,200
THAT THEY DON'T COVER ANY

1513
01:09:46,200 --> 01:09:48,120
TREATMENT FOR ANY TYPE OF

1514
01:09:48,120 --> 01:09:49,520
CANCER.

1515
01:09:49,520 --> 01:09:53,720
SO SHE HAD TO USE HER SAVINGS,

1516
01:09:53,720 --> 01:09:57,440
RESOURCES, FAMILY RESOURCES, TO

1517
01:09:57,440 --> 01:10:01,600
GET ALL OF THIS OUT OF POCKET

1518
01:10:01,600 --> 01:10:05,440
COSTS FOR HER TREATMENT.

1519
01:10:05,440 --> 01:10:07,120
THE BRCA TEST THAT SHE ALLUDED

1520
01:10:07,120 --> 01:10:11,840
TO, SHE HAS NOT DONE THAT.

1521
01:10:11,840 --> 01:10:14,200
BUT IT WOULD HAVE COST HER

1522
01:10:14,200 --> 01:10:18,640
$2,000 TO DO.

1523
01:10:18,640 --> 01:10:21,960
SO FOR PATIENTS LIKE THIS, IN

1524
01:10:21,960 --> 01:10:26,960
AFRICA, AND AS WE ALL KNOW, THE

1525
01:10:26,960 --> 01:10:30,880
FIELD OF CANCER AND CANCER CARE

1526
01:10:30,880 --> 01:10:36,000
IS PERHAPS MOST ACCESSIBLE IN

1527
01:10:36,000 --> 01:10:40,840
TERMS OF INTEGRATION OF GENOMIC

1528
01:10:40,840 --> 01:10:43,440
RESEARCH AND MEDICINE.

1529
01:10:43,440 --> 01:10:46,200
HOW DO WE INCREASE THE NUMBER

1530
01:10:46,200 --> 01:10:48,240
AND DIVERSITY OF GENOMIC DATA

1531
01:10:48,240 --> 01:10:52,000
DERIVED FROM PATIENTS LIKE THIS

1532
01:10:52,000 --> 01:10:54,120
WHILE SIMULTANEOUSLY DELIVERING

1533
01:10:54,120 --> 01:10:57,920
TO THEM THE BENEFITS OF GENOMIC

1534
01:10:57,920 --> 01:10:59,680
RESEARCH?

1535
01:10:59,680 --> 01:11:01,960
THOSE WHO ARE -- MAY HAVE

1536
01:11:01,960 --> 01:11:04,680
NOTICED THAT QUITE A FEW OF THE

1537
01:11:04,680 --> 01:11:09,800
THINGS THAT ARE LISTED AS

1538
01:11:09,800 --> 01:11:12,120
INTERVENTIONS THAT THE PATIENT

1539
01:11:12,120 --> 01:11:15,440
HAS SPENT MONEY ON, PERHAPS

1540
01:11:15,440 --> 01:11:20,040
COULD BE AVOIDED.

1541
01:11:20,040 --> 01:11:21,240
YOU ALSO HEARD HER TALK ABOUT

1542
01:11:21,240 --> 01:11:22,560
THE LIMITED KNOWLEDGE AMONG

1543
01:11:22,560 --> 01:11:26,480
HEALTHCARE PROVIDERS, SO WE NEED

1544
01:11:26,480 --> 01:11:28,880
TO CONTINUE TO BUILD TRAINING

1545
01:11:28,880 --> 01:11:31,920
PROGRAMS, NOT JUST ON GENOMICS,

1546
01:11:31,920 --> 01:11:36,360
BUT ON DISEASE-SPECIFIC TOPICS,

1547
01:11:36,360 --> 01:11:38,040
AND WE WANT TO MAKE SURE THAT WE

1548
01:11:38,040 --> 01:11:40,760
ALIGN THE GOALS OF TH THESE

1549
01:11:40,760 --> 01:11:44,040
TRAINING PROGRAMS WITH THE LOCAL

1550
01:11:44,040 --> 01:11:46,720
AND GLOBAL PUBLIC HEALTH

1551
01:11:46,720 --> 01:11:49,240
PRIORITIES SO THAT WE CAN ENSURE

1552
01:11:49,240 --> 01:11:55,800
SUCCESSFUL IMPLEMENTATION OF

1553
01:11:55,800 --> 01:11:59,560
WHAT WE DEFINED AS OUR EBIs.

1554
01:11:59,560 --> 01:12:03,120
THAT WAY, WE'LL BE SURE THAT THE

1555
01:12:03,120 --> 01:12:04,240
TRAINING PROGRAMS SERVE THE NEED

1556
01:12:04,240 --> 01:12:08,280
OF THE POPULATION.

1557
01:12:08,280 --> 01:12:10,120
THEN THE GENOMIC RESEARCH ITSELF

1558
01:12:10,120 --> 01:12:15,400
NEEDS TO BE BUILT IN WAYS THAT

1559
01:12:15,400 --> 01:12:18,520
DELIVER SHORT AND MEDIUM TERM

1560
01:12:18,520 --> 01:12:22,920
HEALTH BENEFIT TO THE POPULA 

1561
01:12:22,920 --> 01:12:25,200
POPULATION, AND AS I PREVIOUSLY

1562
01:12:25,200 --> 01:12:27,080
ALLUDED, SOME OF THE CURRENT

1563
01:12:27,080 --> 01:12:33,320
METHODS THAT WE'RE USING TO

1564
01:12:33,320 --> 01:12:34,880
CONDUCT GENOMIC RESEARCH, NOT

1565
01:12:34,880 --> 01:12:37,120
THE METHODS WHICH OF COURSE THE

1566
01:12:37,120 --> 01:12:38,320
SCIENTISTS ARE TYPICALLY

1567
01:12:38,320 --> 01:12:41,920
TOPNOTCH, BUT THE PROCESSES, THE

1568
01:12:41,920 --> 01:12:43,840
GRANT MECHANISMS, THE FUNDING,

1569
01:12:43,840 --> 01:12:47,520
THE ADMINISTRATION OF THE

1570
01:12:47,520 --> 01:12:50,480
GRANTS, THE SIZE OF THE GRANTS,

1571
01:12:50,480 --> 01:12:53,080
THE DURATION, MAY REALLY NOT BE

1572
01:12:53,080 --> 01:13:00,880
THE MOST APPROPRIATE FOR SUPP 

1573
01:13:00,880 --> 01:13:03,440
SUPPORTING SUSTAINED LONG TERM

1574
01:13:03,440 --> 01:13:07,800
ROBUST GENOMIC RESEARCH THAT

1575
01:13:07,800 --> 01:13:12,080
DELIVERS GENOMIC MEDICINE

1576
01:13:12,080 --> 01:13:14,760
BENEFITS IN CLINICAL PRACTICE

1577
01:13:14,760 --> 01:13:18,800
AND PUBLIC HEALTH TO LOW AND

1578
01:13:18,800 --> 01:13:21,560
MIDDLE INCOME POPULATIONS.

1579
01:13:21,560 --> 01:13:25,880
AND WE DO HAVE AGENCY, WE HAVE A

1580
01:13:25,880 --> 01:13:27,440
ROLE, IN LOOKING AT THIS PICTURE

1581
01:13:27,440 --> 01:13:29,240
AND ASKING WHAT IS WRONG, WHAT

1582
01:13:29,240 --> 01:13:32,440
IS WRONG WITH THIS PICTURE?

1583
01:13:32,440 --> 01:13:34,080
HOW SHALL WE ARRANGE THE

1584
01:13:34,080 --> 01:13:35,560
COMPONENTS, THE DIFFERENT

1585
01:13:35,560 --> 01:13:37,640
STAKEHOLDERS?

1586
01:13:37,640 --> 01:13:41,160
RECOGNIZING THEIR AGENCY.

1587
01:13:41,160 --> 01:13:44,560
DIFFERENT COUNTRIES NEED TO

1588
01:13:44,560 --> 01:13:45,960
ENGAGE THEIR GOVERNMENTS IN

1589
01:13:45,960 --> 01:13:51,760
MULTIPLE LEVELS, AND UNLESS WE

1590
01:13:51,760 --> 01:13:52,840
HAVE, ONE, THE RECOGNITION OF

1591
01:13:52,840 --> 01:13:54,560
THE AGENCY, OF THE INDIVIDUALS

1592
01:13:54,560 --> 01:13:57,960
AND INSTITUTIONS, AND ENGAGEMENT

1593
01:13:57,960 --> 01:14:01,240
OF THOSE INDIVIDUALS AND

1594
01:14:01,240 --> 01:14:04,240
INSTITUTIONS, WE ARE NOT LIKELY

1595
01:14:04,240 --> 01:14:10,720
TO BE ABLE TO BUILD THE KIND OF

1596
01:14:10,720 --> 01:14:14,400
SUSTAINABLE PROGRAMS THAT WILL

1597
01:14:14,400 --> 01:14:17,960
HELP TO CONTINUOUSLY GENERATE

1598
01:14:17,960 --> 01:14:22,320
HIGH QUALITY GENOMIC RESEARCH,

1599
01:14:22,320 --> 01:14:26,120
AND DELIVER THE BENEFITS OF

1600
01:14:26,120 --> 01:14:29,160
GENOMIC MEDICINE FOR THE

1601
01:14:29,160 --> 01:14:30,520
POPULATIONS IN LOW AND MIDDLE

1602
01:14:30,520 --> 01:14:31,040
INCOME COUNTRIES.

1603
01:14:31,040 --> 01:14:33,120
THIS IS THE CHALLENGE, THIS IS

1604
01:14:33,120 --> 01:14:34,560
THE PRIORITY.

1605
01:14:34,560 --> 01:14:39,160
THIS IS THE CONUNDRUM THAT WE

1606
01:14:39,160 --> 01:14:42,920
FACE AS SOME OF THE CONSORTIA

1607
01:14:42,920 --> 01:14:45,440
PROJECTS COME TO AN END, AND NOW

1608
01:14:45,440 --> 01:14:49,040
WE'RE TRYING TO FIGURE OUT WHAT

1609
01:14:49,040 --> 01:14:52,760
OUR NEXT STEPS SHOULD BE.

1610
01:14:52,760 --> 01:14:53,360
SO THANK YOU VERY MUCH FOR THE

1611
01:14:53,360 --> 01:15:01,960
OPPORTUNITY AND FOR LISTENING  

1612
01:15:01,960 --> 01:15:05,640
TO -- I'VE NOT PRESENTED ANY

1613
01:15:05,640 --> 01:15:09,640
DATA AND -- YOU HAVE HAD

1614
01:15:09,640 --> 01:15:11,640
DR. ROTIMI PRESENT

1615
01:15:11,640 --> 01:15:15,240
EXTRAORDINARILY COMPELLING

1616
01:15:15,240 --> 01:15:16,880
EVIDENCE FOR WHY GENOMIC

1617
01:15:16,880 --> 01:15:19,640
RESEARCH IN AFRICAN POPULATIONS

1618
01:15:19,640 --> 01:15:23,120
IS NECESSARY, IS COMPELLING, AND

1619
01:15:23,120 --> 01:15:27,480
LIKELY TO YIELD HIGHLY IMPACTFUL

1620
01:15:27,480 --> 01:15:27,760
OUTCOMES.

1621
01:15:27,760 --> 01:15:33,760
THANK YOU.

1622
01:15:33,760 --> 01:15:37,000
>>WELL, THANK YOU SO, SO
MUCH,

1623
01:15:37,000 --> 01:15:37,480
DR. ADEBAMOWO.

1624
01:15:37,480 --> 01:15:40,640
THAT WAS REALLY A VERY, VERY

1625
01:15:40,640 --> 01:15:43,720
MOVING PRESENTATION, I MUST SAY,

1626
01:15:43,720 --> 01:15:45,760
AND DR. ROTIMI, THANK YOU AS

1627
01:15:45,760 --> 01:15:48,840
WELL.

1628
01:15:48,840 --> 01:15:52,400
WE ARE OVERFLOWING WITH

1629
01:15:52,400 --> 01:15:54,800
QUESTIONS ACTUALLY FOR THE TWO

1630
01:15:54,800 --> 01:15:57,960
OF YOU.

1631
01:15:57,960 --> 01:15:59,520
SO WE'LL HAVE TO SEND OUT FOR

1632
01:15:59,520 --> 01:16:00,720
PIZZA PROBABLY IN ORDER TO GET

1633
01:16:00,720 --> 01:16:03,720
THROUGH ALL OF THESE QUESTIONS.

1634
01:16:03,720 --> 01:16:05,800
THIS AFTERNOON.

1635
01:16:05,800 --> 01:16:10,080
BUT IN ANY CASE, WE HAVE REALLY

1636
01:16:10,080 --> 01:16:14,040
LOTS OF THINGS TO TALK ABOUT.

1637
01:16:14,040 --> 01:16:19,240
SO MAYBE, CLEMENT, WE CAN START

1638
01:16:19,240 --> 01:16:20,680
WITH JUST ONE OF THE QUESTIONS

1639
01:16:20,680 --> 01:16:25,080
THAT COMES IN FROM THE AUDIENCE,

1640
01:16:25,080 --> 01:16:27,920
HAVING TO DO WITH JUST THE SORT

1641
01:16:27,920 --> 01:16:30,480
OF ALONG THE LINES OF WHAT YOU

1642
01:16:30,480 --> 01:16:35,640
WERE DISCUSSING, THE FACT THAT,

1643
01:16:35,640 --> 01:16:37,360
REALLY, THERE'S A REAL

1644
01:16:37,360 --> 01:16:40,240
DISCONNECT BETWEEN WHAT WE'RE

1645
01:16:40,240 --> 01:16:41,200
DOING IN THE DEVELOPED WORLD

1646
01:16:41,200 --> 01:16:43,600
WITH REGARD TO SOME OF THESE

1647
01:16:43,600 --> 01:16:45,440
GENETIC STUDIES, AND WHAT IS

1648
01:16:45,440 --> 01:16:47,560
BEING DONE AND CAN BE DONE AND

1649
01:16:47,560 --> 01:16:51,520
NEEDS TO BE DONE IN AFRICA.

1650
01:16:51,520 --> 01:16:58,200
SO THE QUESTION HAS TO DO WITH

1651
01:16:58,200 --> 01:17:01,080
THE FOUNDATION OF PHENOTYPING.

1652
01:17:01,080 --> 01:17:03,960
SO YOU KNOW, IN A COUNTRY LIKE

1653
01:17:03,960 --> 01:17:08,120
THE UNITED STATES, WHEN WE

1654
01:17:08,120 --> 01:17:13,680
ASSEMBLE THE GENOTYPES FROM A

1655
01:17:13,680 --> 01:17:14,720
THOUSAND INDIVIDUALS, OF COURSE

1656
01:17:14,720 --> 01:17:16,920
THERE'S A LOT OF PHENOTYPIC

1657
01:17:16,920 --> 01:17:19,040
INFORMATION THAT SORT OF COMES

1658
01:17:19,040 --> 01:17:21,960
JUST BY ENROLLING THOSE

1659
01:17:21,960 --> 01:17:23,040
INDIVIDUALS, BECAUSE THEIR

1660
01:17:23,040 --> 01:17:24,880
MEDICAL RECORDS ALREADY CONTAIN

1661
01:17:24,880 --> 01:17:29,160
A LOT OF PHENOTYPIC INFORMATION.

1662
01:17:29,160 --> 01:17:33,760
HOW IS THIS BEING HANDLED IN

1663
01:17:33,760 --> 01:17:35,120
GENOMIC STUDIES IN AFRICA, WHERE

1664
01:17:35,120 --> 01:17:37,960
THERE'S NOT NEARLY AS MUCH

1665
01:17:37,960 --> 01:17:39,880
PHENOTYPIC DATA, THE QUESTIONER

1666
01:17:39,880 --> 01:17:41,640
IS HYPOTHESIZING, AS WHAT WOULD

1667
01:17:41,640 --> 01:17:44,000
BE AVAILABLE IN THE U.S. OR SOME

1668
01:17:44,000 --> 01:17:47,200
OTHER DEVELOPED COUNTRY?

1669
01:17:47,200 --> 01:17:48,240
>>THANK YOU VERY MUCH FOR
THAT

1670
01:17:48,240 --> 01:17:49,000
QUESTION.

1671
01:17:49,000 --> 01:17:52,840
I THINK IT'S HIGHLY INSIGHTFUL

1672
01:17:52,840 --> 01:17:59,800
AND RECOGNIZES THE BIG CHALLE 

1673
01:17:59,800 --> 01:18:00,560
CHALLENGE, WHICH I THINK WE ARE

1674
01:18:00,560 --> 01:18:02,720
ABLE TO COMPREHEND FROM THE

1675
01:18:02,720 --> 01:18:06,240
EXPERIENCE OF THE PATIENT WHO

1676
01:18:06,240 --> 01:18:08,840
VOLUNTEERED TO SHARE HER BREAST

1677
01:18:08,840 --> 01:18:12,560
CANCER JOURNEY WITH US.

1678
01:18:12,560 --> 01:18:16,520
SO IT TURNS OUT THAT IN MOST

1679
01:18:16,520 --> 01:18:19,360
CASES, WHEN WE'RE DOING GENOMIC

1680
01:18:19,360 --> 01:18:23,000
RESEARCH IN AFRICA, THE

1681
01:18:23,000 --> 01:18:27,040
INVESTIGATORS ALSO HAVE TO BE

1682
01:18:27,040 --> 01:18:27,960
RESPONSIBLE FOR GENERATING THE

1683
01:18:27,960 --> 01:18:30,680
HIGH QUALITY PHENOTYPIC DATA

1684
01:18:30,680 --> 01:18:35,040
THAT NEEDS TO ACCOMPANY THE

1685
01:18:35,040 --> 01:18:36,800
GENOMIC DATA, AND THE

1686
01:18:36,800 --> 01:18:37,960
IMPLICATION OF THIS, OF COURSE,

1687
01:18:37,960 --> 01:18:41,720
IS THAT THE OVERALL COST AND

1688
01:18:41,720 --> 01:18:45,480
LABEL OF GENOMIC RESEARCH,

1689
01:18:45,480 --> 01:18:47,360
QUOTE-UNQUOTE, INCREASES

1690
01:18:47,360 --> 01:18:47,920
SUBSTANTIALLY.

1691
01:18:47,920 --> 01:18:51,920
AND THAT IS WHY I'VE ARGUED THAT

1692
01:18:51,920 --> 01:18:55,880
WE NEED A NEW PARADIGM THAT

1693
01:18:55,880 --> 01:18:58,800
ENSURES THAT WE ENGAGE ALL THE

1694
01:18:58,800 --> 01:19:02,400
STAKEHOLDERS BECAUSE THE CURRENT

1695
01:19:02,400 --> 01:19:05,080
METHOD IS NOT SUSTAINABLE.

1696
01:19:05,080 --> 01:19:08,600
THE INSTITUTIONS HAVE TO HAVE

1697
01:19:08,600 --> 01:19:13,000
THE RESOURCES AND GENERATE SOME

1698
01:19:13,000 --> 01:19:17,680
MINIMAL PHENOTYPIC DATA OF

1699
01:19:17,680 --> 01:19:19,280
SUFFICIENT QUALITY SO THAT WHEN

1700
01:19:19,280 --> 01:19:21,480
WE SAY THIS PERSON HAS BREAST

1701
01:19:21,480 --> 01:19:23,000
CANCER, THE PERSON DOES INDEED

1702
01:19:23,000 --> 01:19:27,200
HAVE BREAST CANCER, AND THOSE

1703
01:19:27,200 --> 01:19:33,160
WHO HAVE WALKED IN THESE

1704
01:19:33,160 --> 01:19:34,640
ENVIRONMENTS WILL READILY ATTEST

1705
01:19:34,640 --> 01:19:38,360
TO THE AMOUNT OF TIME AND

1706
01:19:38,360 --> 01:19:40,760
RESOURCES, THAT CHARACTERIZATION

1707
01:19:40,760 --> 01:19:44,160
OF PHENOTYPE, TAKES.

1708
01:19:44,160 --> 01:19:47,800
AND THIS FEEDS INTO THE ATTITUDE

1709
01:19:47,800 --> 01:19:49,840
OF BOTH THE STUDY PARTICIPANTS

1710
01:19:49,840 --> 01:19:53,880
AND THE LOCAL INVESTIGATORS IN

1711
01:19:53,880 --> 01:19:57,440
MERE YADZ OF WAYS, INCLUDING

1712
01:19:57,440 --> 01:20:01,800
ISSUES RELATED TO DATA SHARING,

1713
01:20:01,800 --> 01:20:05,640
COLLABORATIONS, AND

1714
01:20:05,640 --> 01:20:07,800
INTERNATIONAL TRANSFER OF

1715
01:20:07,800 --> 01:20:09,560
BIOLOGICAL SAMPLES.

1716
01:20:09,560 --> 01:20:11,520
SO THERE ARE CHALLENGES THERE.

1717
01:20:11,520 --> 01:20:13,280
THE GROUPS THAT HAVE BEEN

1718
01:20:13,280 --> 01:20:15,920
SUCCESSFUL HAVE CONFRONTED THOSE

1719
01:20:15,920 --> 01:20:20,320
CHALLENGES HEAD-ON, AND IT NEEDS

1720
01:20:20,320 --> 01:20:23,480
TO BE BETTER UNDERSTOOD SO THAT

1721
01:20:23,480 --> 01:20:27,400
IT CAN FEED INTO THE RESEARCH

1722
01:20:27,400 --> 01:20:27,760
ECOSYSTEM.

1723
01:20:27,760 --> 01:20:29,560
THAT'S WHY I HAVE CHOSEN TO BE

1724
01:20:29,560 --> 01:20:31,360
CALLING THIS THE ECOSYSTEM,

1725
01:20:31,360 --> 01:20:34,800
BECAUSE IT GOES BEYOND THE ONE

1726
01:20:34,800 --> 01:20:38,280
INVESTIGATOR AND THE ONE STUDY.

1727
01:20:38,280 --> 01:20:43,760
IT'S REALLY, YOU KNOW, WHAT TO

1728
01:20:43,760 --> 01:20:44,960
SUPPLY, CONSUMABLES IN THE

1729
01:20:44,960 --> 01:20:48,000
HOSPITAL, THE HOSPITAL JUST

1730
01:20:48,000 --> 01:20:51,160
FUNCTIONING IN ORDER TO LINK THE

1731
01:20:51,160 --> 01:20:53,920
STUDY PARTICIPANTS WITH SUITABLE

1732
01:20:53,920 --> 01:20:55,640
RESEARCH PROJECTS.

1733
01:20:55,640 --> 01:20:56,720
EXCELLENT QUESTION.

1734
01:20:56,720 --> 01:20:58,600
>>WELL, AND MAYBE TO
FOLLOW UP

1735
01:20:58,600 --> 01:21:01,960
ON MY QUESTION, I'M JUST SORT OF

1736
01:21:01,960 --> 01:21:05,360
PUTTING WORDS IN THE MOUTH OF

1737
01:21:05,360 --> 01:21:07,200
THE INTERROGATOR, BUT YOU KNOW,

1738
01:21:07,200 --> 01:21:10,840
IT WOULD SEEM THAT MAYBE IN

1739
01:21:10,840 --> 01:21:13,000
AFRICA, THERE WOULD BE SOME BIAS

1740
01:21:13,000 --> 01:21:17,280
IN TERMS OF WHAT POPULATIONS ARE

1741
01:21:17,280 --> 01:21:20,520
SAMPLED FOR GENOMIC TESTING JUST

1742
01:21:20,520 --> 01:21:23,480
BY VIRTUE OF THEIR PHYSICAL

1743
01:21:23,480 --> 01:21:26,400
LOCATION AND BY VIRTUE OF THE

1744
01:21:26,400 --> 01:21:28,360
HEALTHCARE SYSTEM THAT THEY LIVE

1745
01:21:28,360 --> 01:21:30,520
IN, YOU KNOW, THOSE WHO LIVE IN,

1746
01:21:30,520 --> 01:21:34,360
PERHAPS, CITIES OR IN APLACE

1747
01:21:34,360 --> 01:21:37,760
WHERE THERE'S AT LEAST SOME MORE

1748
01:21:37,760 --> 01:21:38,800
ADVANCED HEALTHCARE SYSTEM WOULD

1749
01:21:38,800 --> 01:21:41,880
BE MORE LIKELY, I WOULD THINK,

1750
01:21:41,880 --> 01:21:45,040
TO BE ENROLLED IN THE GENOMIC

1751
01:21:45,040 --> 01:21:46,160
STUDIES THAN THOSE WHO MIGHT

1752
01:21:46,160 --> 01:21:47,640
LIVE IN A RURAL AREA WHERE THEY

1753
01:21:47,640 --> 01:21:49,520
DON'T HAVE ACCESS TO GOOD

1754
01:21:49,520 --> 01:21:52,920
HEALTHCARE.

1755
01:21:52,920 --> 01:21:54,440
>>YOU'RE RIGHT, BUT I
THINK THE

1756
01:21:54,440 --> 01:21:57,720
WAY TO PUT IT IS THAT THERE IS

1757
01:21:57,720 --> 01:22:00,120
POTENTIAL BIAS, BECAUSE LIKE IN

1758
01:22:00,120 --> 01:22:02,640
ANY EPIDEMIOLOGIC STUDY, WE

1759
01:22:02,640 --> 01:22:05,680
CAN -- IF WE UNDERSTAND THE

1760
01:22:05,680 --> 01:22:08,440
STUDY AND THE DESIGN WELL ENOUGH

1761
01:22:08,440 --> 01:22:11,360
AND THE ENVIRONMENT, WE CAN

1762
01:22:11,360 --> 01:22:14,640
DESIGN OUR STUDY TO ADDRESS MANY

1763
01:22:14,640 --> 01:22:17,800
OF THESE BIASES BY USING

1764
01:22:17,800 --> 01:22:19,320
SAMPLING FRAMES THAT -- YOU

1765
01:22:19,320 --> 01:22:22,480
KNOW, BASED ON AN APPRECIATION

1766
01:22:22,480 --> 01:22:26,320
OF SOME OF THE VARIATIONS THAT

1767
01:22:26,320 --> 01:22:27,480
YOU'RE MENTIONING IN TERMS OF

1768
01:22:27,480 --> 01:22:30,560
WHO GETS TO COME TO THE HOSPITAL

1769
01:22:30,560 --> 01:22:32,120
AND EVEN AMONG THOSE WHO COME TO

1770
01:22:32,120 --> 01:22:35,360
THE HOSPITAL, WHO GETS SEEN BY

1771
01:22:35,360 --> 01:22:37,960
THE PHYSICIANS AND WHO GETS

1772
01:22:37,960 --> 01:22:39,360
INVESTIGATED.

1773
01:22:39,360 --> 01:22:44,320
AND SO WE UNDERSTAND AND FOR

1774
01:22:44,320 --> 01:22:46,200
PERHAPS INTERNATIONAL

1775
01:22:46,200 --> 01:22:49,120
INVESTIGATORS, THIS IS WHERE

1776
01:22:49,120 --> 01:22:52,800
HAVING A HIGH LEVEL OF LOCAL

1777
01:22:52,800 --> 01:22:54,440
INPUT AND KNOWLEDGE BECOMES

1778
01:22:54,440 --> 01:22:58,680
CRITICAL, OTHERWISE AS YOU

1779
01:22:58,680 --> 01:22:59,800
MENTION, THE RESULTS OF THE

1780
01:22:59,800 --> 01:23:04,280
RESEARCH WOULD BE QUITE BIASED.

1781
01:23:04,280 --> 01:23:05,360
AND, OF COURSE, THERE ARE OTHER

1782
01:23:05,360 --> 01:23:07,960
WAYS OF DEALING WITH THOSE

1783
01:23:07,960 --> 01:23:10,760
BIASES, AND I THINK

1784
01:23:10,760 --> 01:23:11,560
INVESTIGATORS SHOULD PAY

1785
01:23:11,560 --> 01:23:15,600
ATTENTION TO THOSE AND MAKE SURE

1786
01:23:15,600 --> 01:23:19,920
THAT TH THE ENTIRE METHOD OF

1787
01:23:19,920 --> 01:23:22,360
PARTICIPANT ENGAGEMENT,

1788
01:23:22,360 --> 01:23:25,000
RECRUITMENT, AND SAMPLING IS

1789
01:23:25,000 --> 01:23:27,920
SUFFICIENTLY WELL DESCRIBED FOR

1790
01:23:27,920 --> 01:23:31,040
READERS TO APPRECIATE THE

1791
01:23:31,040 --> 01:23:33,800
OUTCOMES AND THE FACTORS THAT

1792
01:23:33,800 --> 01:23:36,640
MAY INFLUENCE THE OUTCOMES OF

1793
01:23:36,640 --> 01:23:38,840
SPECIFIC STUDIES.

1794
01:23:38,840 --> 01:23:41,920
>>OKAY, SO I JUST WANTED
TO ADD

1795
01:23:41,920 --> 01:23:43,320
A LITTLE BIT TO THAT BECAUSE

1796
01:23:43,320 --> 01:23:45,560
THAT'S SUCH A POWERFUL QUESTION.

1797
01:23:45,560 --> 01:23:50,120
IN THE SENSE THAT IN POPULATION

1798
01:23:50,120 --> 01:23:54,880
GENETICS, FOR A VERY LONG TIME,

1799
01:23:54,880 --> 01:23:59,440
WIWE KEPT ANALYZING SAMPLE FROM

1800
01:23:59,440 --> 01:24:00,760
SOME VERY SPECIFIC AFRICAN

1801
01:24:00,760 --> 01:24:01,200
COUNTRIES.

1802
01:24:01,200 --> 01:24:02,960
ONE OF THE MAIN REASONS BEHIND

1803
01:24:02,960 --> 01:24:04,440
THAT WAS THERE WERE QUITE A FEW

1804
01:24:04,440 --> 01:24:06,200
COUNTRIES THAT WE COULDN'T GO TO

1805
01:24:06,200 --> 01:24:08,280
BECAUSE THERE WAS WAR GOING ON.

1806
01:24:08,280 --> 01:24:13,120
WAR THAT LASTED 15, 25 YEARS, SO

1807
01:24:13,120 --> 01:24:15,560
WHAT YOU KEPT SEEING WAS

1808
01:24:15,560 --> 01:24:17,200
UNDERSTANDING OF VARIATION AND

1809
01:24:17,200 --> 01:24:18,960
EVOLUTION FROM THE VERY

1810
01:24:18,960 --> 01:24:22,960
CONVENIENT SET OF SAMPLES THAT

1811
01:24:22,960 --> 01:24:24,160
WERE DRIVEN BY THE FACT THAT

1812
01:24:24,160 --> 01:24:25,360
SCIENTISTS COULD GO TO THOSE

1813
01:24:25,360 --> 01:24:27,440
PLACES AND SAMPLE.

1814
01:24:27,440 --> 01:24:29,160
YOU KNOW, SO EVEN BEFORE

1815
01:24:29,160 --> 01:24:32,880
CLINICAL MEDICINE, YOU HAVE THIS

1816
01:24:32,880 --> 01:24:34,520
POPULATION GENETIC BIAS, OTHERS

1817
01:24:34,520 --> 01:24:35,880
BEGINNING TO CHANGE SLOWLY, BUT

1818
01:24:35,880 --> 01:24:36,440
IT'S STILL THERE.

1819
01:24:36,440 --> 01:24:39,000
AND THAT PEOPLE ARE ANALYZING

1820
01:24:39,000 --> 01:24:40,480
SAMPLES THAT WE CONVENIENTLY

1821
01:24:40,480 --> 01:24:41,680
COLLECTED BECAUSE THERE ARE SOME

1822
01:24:41,680 --> 01:24:45,520
AREAS WE JUST COULDN'T GO TO.

1823
01:24:45,520 --> 01:24:47,120
>>YES, AND OF COURSE
READING

1824
01:24:47,120 --> 01:24:52,560
THE NEWS, THERE ARE AREAS EVEN

1825
01:24:52,560 --> 01:24:53,560
NOW, OF COURSE IT'S NOT JUST

1826
01:24:53,560 --> 01:24:54,360
RESTRICTED TO AFRICA.

1827
01:24:54,360 --> 01:24:57,200
>>NO, IT'S NOT.

1828
01:24:57,200 --> 01:24:59,080
WE'RE TALKING ABOUT AFRICA.

1829
01:24:59,080 --> 01:25:00,240
>>YES.

1830
01:25:00,240 --> 01:25:03,000
ABSOLUTELY.

1831
01:25:03,000 --> 01:25:06,040
WELL, SO NOW WE HAVE ANOTHER

1832
01:25:06,040 --> 01:25:09,640
PERSON FROM THE AUDIENCE WHO HAS

1833
01:25:09,640 --> 01:25:12,560
A QUESTION, I THINK IT'S FOR DR.

1834
01:25:12,560 --> 01:25:14,240
SO THE QUESTION HAS TO DO WITH

1835
01:25:14,240 --> 01:25:20,440
THE THE FACT THAT THERE HAS BEEN

1836
01:25:20,440 --> 01:25:22,080
SELECTION, AND I GUESS IT'S IN

1837
01:25:22,080 --> 01:25:26,240
EAST AFRICA, FOR THE VARIANT OF

1838
01:25:26,240 --> 01:25:28,800
APOL1, THAT IS PROTECTIVE FOR

1839
01:25:28,800 --> 01:25:31,120
AFRICAN SLEEPING SICKNESS, AND

1840
01:25:31,120 --> 01:25:33,640
THAT VARIANT APPARENTLY CONFERS

1841
01:25:33,640 --> 01:25:36,880
AT LEAST IN THE AFRICAN AMERICAN

1842
01:25:36,880 --> 01:25:40,640
POPULATION RISK FOR END STAGE

1843
01:25:40,640 --> 01:25:41,080
RENAL DISEASE.

1844
01:25:41,080 --> 01:25:43,640
SO THE QUESTIONER IS ASKING,

1845
01:25:43,640 --> 01:25:45,400
WELL, WHAT HAPPENS IN AFRICA

1846
01:25:45,400 --> 01:25:45,640
ITSELF?

1847
01:25:45,640 --> 01:25:49,560
IS THERE A HIGH FREQUENCY OF END

1848
01:25:49,560 --> 01:25:50,680
STAGE RENAL DISEASE IN THOSE

1849
01:25:50,680 --> 01:25:55,960
PARTS OF EAST AFRICA WHERE THE

1850
01:25:55,960 --> 01:25:58,240
SELECTION IS OPERATIVE?

1851
01:25:58,240 --> 01:25:59,160
>>ABSOLUTELY.

1852
01:25:59,160 --> 01:26:01,760
AS PART OF THE HISTORY OF AFR 

1853
01:26:01,760 --> 01:26:02,640
AFRICA, THERE WAS MAJOR FUNDING

1854
01:26:02,640 --> 01:26:05,920
TO LOOK AT KIDNEY DISEASE IN

1855
01:26:05,920 --> 01:26:09,600
PLACES LIKE NIGERIA AND GHANA.

1856
01:26:09,600 --> 01:26:13,080
AND MY GHANA COLLEAGUES ARE JUST

1857
01:26:13,080 --> 01:26:15,520
FLOORED BY THIS STORY THAT HAS

1858
01:26:15,520 --> 01:26:18,560
BEEN IN THE BACKGROUND FOR SO

1859
01:26:18,560 --> 01:26:22,000
LONG, BUT WE COULDN'T PUT AN END

1860
01:26:22,000 --> 01:26:22,280
TO IT.

1861
01:26:22,280 --> 01:26:25,760
SO THERE IS INDEED VERY HIGH

1862
01:26:25,760 --> 01:26:28,840
RATES OF KIDNEY DISEASE IN

1863
01:26:28,840 --> 01:26:34,360
PLACES LIKE GHANA, WHERE THERE

1864
01:26:34,360 --> 01:26:35,160
HAS BEEN SYSTEMATICALLY

1865
01:26:35,160 --> 01:26:36,320
DOCUMENTED TO THE POINT WHERE

1866
01:26:36,320 --> 01:26:37,600
THEY'RE ABOUT TO DO A CLINICAL

1867
01:26:37,600 --> 01:26:39,040
TRIAL NOW, LOCALLY, I HOPE IT

1868
01:26:39,040 --> 01:26:41,880
WORKS OUT, THIS SMALL MOLECULE

1869
01:26:41,880 --> 01:26:43,640
HAS NOW BEEN DISCOVERED THAT

1870
01:26:43,640 --> 01:26:46,360
WILL BLOCK THE APOL1, YOU KNOW,

1871
01:26:46,360 --> 01:26:48,840
AND WE ARE THINKING THAT MAY BE

1872
01:26:48,840 --> 01:26:50,520
EFFECTIVE AGAINST THE KIDNEY

1873
01:26:50,520 --> 01:26:51,960
DISEASE, BUT THAT IS SOMETHING

1874
01:26:51,960 --> 01:26:53,920
THAT IS JUST ABOUT TO START.

1875
01:26:53,920 --> 01:26:56,560
THE ANSWER TO THAT QUESTION IS

1876
01:26:56,560 --> 01:26:59,120
YES, THERE IS QUITE A HIGH RATE

1877
01:26:59,120 --> 01:27:00,000
OF KIDNEY DISEASE IN THAT PART

1878
01:27:00,000 --> 01:27:00,560
OF THE WORLD.

1879
01:27:00,560 --> 01:27:02,000
IT'S REALLY THOSE AREAS THAT

1880
01:27:02,000 --> 01:27:08,000
HAVE BEEN ENDEMIC -- INFECTION,

1881
01:27:08,000 --> 01:27:10,520
AND THAT'S -- IT'S NOT THE

1882
01:27:10,520 --> 01:27:11,280
CHARACTERISTICS OF BEING

1883
01:27:11,280 --> 01:27:12,080
AFRICAN.

1884
01:27:12,080 --> 01:27:15,640
IT'S THE CHARACTERISTICS OF

1885
01:27:15,640 --> 01:27:18,160
BEING -- HAVING LIVED IN AN

1886
01:27:18,160 --> 01:27:19,800
ENENVIRONMENT THAT WAS ENDEMIC

1887
01:27:19,800 --> 01:27:21,440
TO -- INFECTION AND THAT'S WHY

1888
01:27:21,440 --> 01:27:22,960
THERE'S VERY LITTLE -- IN AFRICA

1889
01:27:22,960 --> 01:27:24,680
OR NORTHERN AFRICA, BUT FROM

1890
01:27:24,680 --> 01:27:26,120
WEST TO SOME PARTS OF EAST

1891
01:27:26,120 --> 01:27:27,480
AFRICA, YOU DO HAVE A VERY HIGH

1892
01:27:27,480 --> 01:27:30,080
RATE.

1893
01:27:30,080 --> 01:27:33,480
SO NO LESS IN --

1894
01:27:33,480 --> 01:27:36,160
>>YES, INDEED.

1895
01:27:36,160 --> 01:27:42,160
AND SO I TAKE IT THAT AT THIS

1896
01:27:42,160 --> 01:27:44,000
POINT PROBABLY THERE'S NOT

1897
01:27:44,000 --> 01:27:46,360
TESTING THAT'S AVAILABLE TO SEE

1898
01:27:46,360 --> 01:27:47,600
WHETHER OR NOT YOU HAVE THE

1899
01:27:47,600 --> 01:27:48,400
VARIANT.

1900
01:27:48,400 --> 01:27:52,080
THAT WOULDN'T BE WIDELY

1901
01:27:52,080 --> 01:27:52,360
AVAILABLE.

1902
01:27:52,360 --> 01:27:54,360
>>I WOULDN'T SAY WIDELY,
BUT

1903
01:27:54,360 --> 01:27:54,920
IT'S THERE.

1904
01:27:54,920 --> 01:27:56,440
IT'S AVAILABLE.

1905
01:27:56,440 --> 01:27:58,000
HOWEVER, I WON'T SAY WIDELY

1906
01:27:58,000 --> 01:28:01,480
BECAUSE AS PART OF THE HISTORY

1907
01:28:01,480 --> 01:28:04,640
OF AFRICA WORK -- TYPING THESE

1908
01:28:04,640 --> 01:28:06,720
VARIANTS, SO THERE'S OPPORTUNITY

1909
01:28:06,720 --> 01:28:10,640
TO ACTUALLY UNDERSTAND YOUR

1910
01:28:10,640 --> 01:28:11,040
STATUS.

1911
01:28:11,040 --> 01:28:14,920
SO IT GETTING BETTER AND THE

1912
01:28:14,920 --> 01:28:17,160
POINT THEY'RE MAKING, IT IS NOT

1913
01:28:17,160 --> 01:28:18,160
REALLY CONSTITUTED IN A WAY

1914
01:28:18,160 --> 01:28:19,560
THAT'S PART OF THE CLINICAL

1915
01:28:19,560 --> 01:28:20,520
CARE, THAT IF YOU WALK INTO THE

1916
01:28:20,520 --> 01:28:21,640
HOSPITAL, YOU CAN GET TESTED,

1917
01:28:21,640 --> 01:28:24,240
YOU KNOW, WITHOUT NECESSARILY

1918
01:28:24,240 --> 01:28:25,640
HAVING TO FALL UNDER A

1919
01:28:25,640 --> 01:28:26,800
PARTICULAR RESEARCH UMBRELLA.

1920
01:28:26,800 --> 01:28:27,840
SO THAT'S SOME OF THE

1921
01:28:27,840 --> 01:28:28,880
CHALLENGES.

1922
01:28:28,880 --> 01:28:31,280
BUT IT IS THERE, YOU CAN DO IT.

1923
01:28:31,280 --> 01:28:32,440
AND IF YOU TALK WITH THE RIGHT

1924
01:28:32,440 --> 01:28:33,680
PEOPLE, YOU GO TO THE RIGHT

1925
01:28:33,680 --> 01:28:35,040
PLACES, YOU CAN GET IT DONE,

1926
01:28:35,040 --> 01:28:36,280
YES.

1927
01:28:36,280 --> 01:28:38,880
>>SO I'LL PUT ON MY

1928
01:28:38,880 --> 01:28:42,080
VENTRILOQUIST HAT AGAIN AND PUT

1929
01:28:42,080 --> 01:28:43,120
WORDS IN THE MOUTH OF THE

1930
01:28:43,120 --> 01:28:44,800
QUESTIONER.

1931
01:28:44,800 --> 01:28:47,960
ARE THERE OTHER PARTS OF THE

1932
01:28:47,960 --> 01:28:56,560
WORLD WHERE TRIPANOCIMIASIS OR

1933
01:28:56,560 --> 01:28:58,200
ARE THERE OTHER PARTS IN AFRICA

1934
01:28:58,200 --> 01:28:59,640
THAT IT'S SEEN?

1935
01:28:59,640 --> 01:29:01,600
LIKE WITH MALARIA, YOU MIGHT SEE

1936
01:29:01,600 --> 01:29:03,200
SELECTIVE PRESSURES FOR CERTAIN

1937
01:29:03,200 --> 01:29:04,200
VARIANTS IN OTHER PARTS OF THE

1938
01:29:04,200 --> 01:29:11,360
WORLD BESIDES AFRICA, IS

1939
01:29:11,360 --> 01:29:12,200
TRIPANOCIMIASIS COMMON IN OTHER

1940
01:29:12,200 --> 01:29:14,520
PLACES WHERE I MIGHT ALSO SEE

1941
01:29:14,520 --> 01:29:16,840
EITHER THE SAME APOL1 VARIANT

1942
01:29:16,840 --> 01:29:18,360
BEING SELECTED FOR OR MAYBE SOME

1943
01:29:18,360 --> 01:29:20,480
OTHER VARIANT THAT WOULD GET

1944
01:29:20,480 --> 01:29:23,400
SELECTED FOR JUST LIKE MALARIA

1945
01:29:23,400 --> 01:29:25,520
SELECTS FOR ALL SORTS OF

1946
01:29:25,520 --> 01:29:26,320
ERYTHROCYTE VARIANTS?

1947
01:29:26,320 --> 01:29:28,320
>>THAT'S AN EXCELLENT
QUESTION.

1948
01:29:28,320 --> 01:29:30,960
I DON'T THINK WE'VE ACTUALLY

1949
01:29:30,960 --> 01:29:36,720
LOOKED, BUT GIVEN THE WAY -- I

1950
01:29:36,720 --> 01:29:37,840
WOULD SAY THOSE ENVIRONMENTS

1951
01:29:37,840 --> 01:29:46,080
WHERE LIKE IN SOUTH ASIA, PLACES

1952
01:29:46,080 --> 01:29:50,120
LIKE THAT, THAT I WOULDN'T BE

1953
01:29:50,120 --> 01:29:51,560
SURPRISED, BUT I DON'T THINK

1954
01:29:51,560 --> 01:29:53,760
THERE'S ANY SYSTEMATIC

1955
01:29:53,760 --> 01:29:55,200
EVALUATION IN THAT PROCESS.

1956
01:29:55,200 --> 01:29:57,200
WHAT HAS BEEN SYSTEMATICALLY

1957
01:29:57,200 --> 01:30:00,280
DOCUMENTED IS THE SPREAD OF THIS

1958
01:30:00,280 --> 01:30:03,000
VARIANT THAT ORIGINATED FROM

1959
01:30:03,000 --> 01:30:06,840
SOME PARTS OF AFRICA OVER THE

1960
01:30:06,840 --> 01:30:09,800
WORLD.

1961
01:30:09,800 --> 01:30:11,080
WHETHER THERE'S A SELECTION

1962
01:30:11,080 --> 01:30:13,200
PRESSURE THAT HAS OCCURRED IN

1963
01:30:13,200 --> 01:30:14,520
OTHER PARTS OF THE WORLD, RILEY

1964
01:30:14,520 --> 01:30:15,840
DON'T KNOW THAT, BUT THAT'S AN

1965
01:30:15,840 --> 01:30:16,600
EXCELLENT QUESTION AND I'M GOING

1966
01:30:16,600 --> 01:30:19,000
TO TRY TO SEE IF THERE'S

1967
01:30:19,000 --> 01:30:20,280
ANYTHING PUBLISHED ON IT YET.

1968
01:30:20,280 --> 01:30:21,800
>>WELL, AND THEN HOLDING
YOU

1969
01:30:21,800 --> 01:30:24,800
GUYS TO THE TITLE OF YOUR

1970
01:30:24,800 --> 01:30:27,640
PRESENTATION, GENOMIC AND

1971
01:30:27,640 --> 01:30:28,320
ENVIRONMENTAL DETERMINANTS OF

1972
01:30:28,320 --> 01:30:29,120
GLOBAL HEALTH, SO NOW I'M GOING

1973
01:30:29,120 --> 01:30:30,560
TO REALLY PUT YOUR FEET TO THE

1974
01:30:30,560 --> 01:30:33,440
FIRE HERE.

1975
01:30:33,440 --> 01:30:36,760
 AND ASK THE QUESTION,

1976
01:30:36,760 --> 01:30:38,200
WELL, SO ARE THERE SPECIFIC

1977
01:30:38,200 --> 01:30:39,160
ENVIRONMENTAL FACTORS THAT IF

1978
01:30:39,160 --> 01:30:40,640
YOU HAVE THE VARIANT, YOU'RE

1979
01:30:40,640 --> 01:30:42,080
MORE LIKELY TO GET KIDNEY

1980
01:30:42,080 --> 01:30:42,320
DISEASE?

1981
01:30:42,320 --> 01:30:43,840
IN OTHER WORDS, IF YOU'RE

1982
01:30:43,840 --> 01:30:46,680
EXPOSED TO SOMETHING OR YOU HAVE

1983
01:30:46,680 --> 01:30:47,640
HIGH BLOOD PRESSURE, YOU HAVE

1984
01:30:47,640 --> 01:30:48,560
DIABETES OR, YOU KNOW, SOMETHING

1985
01:30:48,560 --> 01:30:53,000
LIKE THAT, YOU KNOW, THAT WOULD

1986
01:30:53,000 --> 01:30:54,440
SORT OF HAVE A MULTIPLIER EFFECT

1987
01:30:54,440 --> 01:30:55,600
ON THE RISK?

1988
01:30:55,600 --> 01:30:58,280
>>ABSOLUTELY.

1989
01:30:58,280 --> 01:31:02,680
I THINK IN MY TALK, I SAID

1990
01:31:02,680 --> 01:31:05,360
HYPERTENSIVE END STAGE KIDNEY

1991
01:31:05,360 --> 01:31:06,440
DISEASE, THE EFFECT OF THIS

1992
01:31:06,440 --> 01:31:10,720
VARIANT IS REALLY IN CONTEST OF

1993
01:31:10,720 --> 01:31:11,800
REPETITION OF KIDNEY DISEASE.

1994
01:31:11,800 --> 01:31:13,640
FOR WHATEVER REASON, IT'S NOT

1995
01:31:13,640 --> 01:31:16,960
BEEN DOCUMENTED AMONG KIDNEY

1996
01:31:16,960 --> 01:31:19,680
DISEASE THAT COMES FROM TYPE

1997
01:31:19,680 --> 01:31:22,000
2 DIABETES.

1998
01:31:22,000 --> 01:31:23,880
SO YES, THERE IS ENVIRONMENTAL

1999
01:31:23,880 --> 01:31:25,040
CONTEST WITHIN THAT, AND IT IS

2000
01:31:25,040 --> 01:31:26,920
ALSO TRUE THAT NOT EVERYBODY

2001
01:31:26,920 --> 01:31:29,200
THAT CARRIES THESE VARIANTS DIE

2002
01:31:29,200 --> 01:31:31,720
FROM KIDNEY DISEASE.

2003
01:31:31,720 --> 01:31:34,960
AND THEREFORE, THERE MUST BE

2004
01:31:34,960 --> 01:31:36,720
SOME FINE GENETIC BACKGROUND OR

2005
01:31:36,720 --> 01:31:40,120
ENVIRONMENT THAT MAY BE

2006
01:31:40,120 --> 01:31:42,240
PROTECTING SOME PEOPLE AND

2007
01:31:42,240 --> 01:31:43,480
PUTTING SOME PEOPLE AT REAL

2008
01:31:43,480 --> 01:31:45,200
EARLY RISK IN TERMS OF

2009
01:31:45,200 --> 01:31:48,520
DEVELOPING KIDNEY FAILURE.

2010
01:31:48,520 --> 01:31:51,080
SO ALL OF THOALS ARE

2011
01:31:51,080 --> 01:31:52,000
SYSTEMATICALLY STUDIED AND I

2012
01:31:52,000 --> 01:31:53,640
THINK THERE ARE DATA BEING

2013
01:31:53,640 --> 01:31:54,360
COLLECTED ON THEM.

2014
01:31:54,360 --> 01:31:55,000
>>ALL RIGHT.

2015
01:31:55,000 --> 01:31:56,320
WELL, THANK YOU.

2016
01:31:56,320 --> 01:32:00,400
SO NOW, I HAVE A QUESTION THAT I

2017
01:32:00,400 --> 01:32:02,080
THINK IS PROBABLY DIRECTED AT

2018
01:32:02,080 --> 01:32:07,520
BOTH OF YOU.

2019
01:32:07,520 --> 01:32:08,640
THAT IS FROM -- I GUESS IT WOULD

2020
01:32:08,640 --> 01:32:13,400
BE A DREAMER, A DREAMER

2021
01:32:13,400 --> 01:32:13,720
QUESTIONER.

2022
01:32:13,720 --> 01:32:15,640
AND SO THE DREAMER WANTS TO KNOW

2023
01:32:15,640 --> 01:32:19,160
WHETHER OR NOT THERE IS AN

2024
01:32:19,160 --> 01:32:20,240
ALL-OF-US PROGRAM, LIKE WHAT WE

2025
01:32:20,240 --> 01:32:23,240
HAVE IN THE UNITED STATES, IS

2026
01:32:23,240 --> 01:32:27,040
THERE AN ALL-OF-US PROGRAM THAT

2027
01:32:27,040 --> 01:32:31,160
IS EITHER ABOUT TO BE UNDERTAKEN

2028
01:32:31,160 --> 01:32:32,720
OR CONTEMPLATED FOR THE AFRICAN

2029
01:32:32,720 --> 01:32:37,640
POPULATION?

2030
01:32:37,640 --> 01:32:41,000
>>THE CLOSEST TO THAT IS
THE

2031
01:32:41,000 --> 01:32:45,280
RECENT FUNDING BY THE WELLCOME

2032
01:32:45,280 --> 01:32:47,000
TRUST OF WHAT IS CALLED

2033
01:32:47,000 --> 01:32:52,600
POPULATION COHORT ACROSS AFRICA.

2034
01:32:52,600 --> 01:32:53,360
AND THAT JUST STARTED.

2035
01:32:53,360 --> 01:32:56,240
IT'S NOWHERE NEAR ALL-OF-US TYPE

2036
01:32:56,240 --> 01:32:58,280
SIZE, BUT IT JUST STARTED SO

2037
01:32:58,280 --> 01:33:01,240
THAT'S A VERY GOOD ONE.

2038
01:33:01,240 --> 01:33:06,600
AND HISTORY AFRICA HAS INDEED --

2039
01:33:06,600 --> 01:33:07,360
OVER 100,000 AFRICANS FROM

2040
01:33:07,360 --> 01:33:10,200
DIFFERENT PARTS OF SPECIFICALLY

2041
01:33:10,200 --> 01:33:12,600
SUB-SAHARAN AFRICA FOR THE MOST

2042
01:33:12,600 --> 01:33:16,480
PART, AND THOSE ARE GOOD

2043
01:33:16,480 --> 01:33:18,880
EXAMPLES OF WHAT YOU MAY CALL

2044
01:33:18,880 --> 01:33:20,120
SOMETHING RESEMBLING THE

2045
01:33:20,120 --> 01:33:21,200
ALL-OF-US BUT THEY ARE REALLY

2046
01:33:21,200 --> 01:33:23,320
NOT OF THAT SIZE.

2047
01:33:23,320 --> 01:33:26,280
AND I THINK THERE NEEDS TO BE,

2048
01:33:26,280 --> 01:33:29,560
YOU KNOW, SOME WAY TO GET TO

2049
01:33:29,560 --> 01:33:33,160
THAT LEVEL, BUT TO GET TO THAT

2050
01:33:33,160 --> 01:33:38,000
LEVEL, -- THAT CLEMENT PRESENTED

2051
01:33:38,000 --> 01:33:39,640
IN HIS PRESENTATION, THE THINGS

2052
01:33:39,640 --> 01:33:40,800
WE NEED TO UNDERSTAND, SO

2053
01:33:40,800 --> 01:33:45,160
CLEMENT, TO YOU DO YOU WANT TO E

2054
01:33:45,160 --> 01:33:45,600
INTO THAT?

2055
01:33:45,600 --> 01:33:46,720
>>SO THANK YOU VERY MUCH.

2056
01:33:46,720 --> 01:33:47,560
THAT'S AN EXCELLENT QUESTION,

2057
01:33:47,560 --> 01:33:53,720
AND WHAT I WAS TRYING TO PUT OUT

2058
01:33:53,720 --> 01:33:58,000
THERE TO ADDRESS, I THINK, THE

2059
01:33:58,000 --> 01:34:01,920
RATIONALE FOR ASKING THAT

2060
01:34:01,920 --> 01:34:08,920
QUESTION, IS THE IDEA THAT BY

2061
01:34:08,920 --> 01:34:14,400
BRINGING GENOMICS TO CLINICAL

2062
01:34:14,400 --> 01:34:20,640
PRACTICE AND PUBLIC HEALTH, WE

2063
01:34:20,640 --> 01:34:22,920
CAN BEGIN TO HAVE A SYSTEM THAT

2064
01:34:22,920 --> 01:34:26,320
GENERATES GENOMICS DATA AND

2065
01:34:26,320 --> 01:34:34,280
MAKES IT AVAILABLE FOR RESEARCH

2066
01:34:34,280 --> 01:34:35,840
SEPARATE FROM AND IN ADDITION TO

2067
01:34:35,840 --> 01:34:38,040
FOCUSED INTERVENTIONS LIKE

2068
01:34:38,040 --> 01:34:39,680
H3 AFRICA AND CONSORTIA PROJECTS

2069
01:34:39,680 --> 01:34:44,480
LIKE, YOU KNOW, ALL-OF-US.

2070
01:34:44,480 --> 01:34:47,120
AFRICA'S POPULATION IS ABOUT

2071
01:34:47,120 --> 01:34:49,520
1.3 BILLION PEOPLE, AND THERE

2072
01:34:49,520 --> 01:34:55,080
ARE THOUSANDS OF ETHNIC GROUPS.

2073
01:34:55,080 --> 01:35:00,600
SOME OF THOSE ETHNIC GROUPS AND

2074
01:35:00,600 --> 01:35:01,400
POPULATIONS AS THEY'VE

2075
01:35:01,400 --> 01:35:03,600
INTERACTED WITH THE ENVIRONMENT

2076
01:35:03,600 --> 01:35:09,520
ARE GOING TO PROVIDE US WITH

2077
01:35:09,520 --> 01:35:13,680
OPPORTUNITIES TO LEARN UNIQUE

2078
01:35:13,680 --> 01:35:18,040
INSIGHTS INTO HUMAN POPULATION,

2079
01:35:18,040 --> 01:35:23,920
HUMAN HISTORY, DISEASE GENE

2080
01:35:23,920 --> 01:35:26,400
ASSOCIATION AND DRUG RESPONSE.

2081
01:35:26,400 --> 01:35:34,360
SO HOW DO WE BRING ABOUT A

2082
01:35:34,360 --> 01:35:38,160
SYSTEM THAT SYSTEMATICALLY

2083
01:35:38,160 --> 01:35:39,480
GENERATES GENOMICS DATA FROM

2084
01:35:39,480 --> 01:35:43,120
AFRICAN POPULATIONS AT THE LEVEL

2085
01:35:43,120 --> 01:35:48,920
THAT THE WORLD NEEDS?

2086
01:35:48,920 --> 01:35:52,520
WITHOUT FURTHER DELAY?

2087
01:35:52,520 --> 01:35:57,520
AND THAT'S THE CHALLENGE THAT

2088
01:35:57,520 --> 01:36:00,600
NOT JUST AFRICANS BUT THE WORLD

2089
01:36:00,600 --> 01:36:01,280
FACES.

2090
01:36:01,280 --> 01:36:03,360
AS DR. ROTIMI'S PRESENTATION

2091
01:36:03,360 --> 01:36:03,920
SHOWS.

2092
01:36:03,920 --> 01:36:07,960
FOR EXAMPLE, -- B WHICH WAS NOT

2093
01:36:07,960 --> 01:36:09,800
IDENTIFIED IN ANY OTHER

2094
01:36:09,800 --> 01:36:12,640
POPULATION, THAT DISCOVERY IS

2095
01:36:12,640 --> 01:36:17,880
NOT ONLY OF BENEFIT TO AFRICANS

2096
01:36:17,880 --> 01:36:20,080
BECAUSE IT LEADS OR YIELDS

2097
01:36:20,080 --> 01:36:21,800
INSIGHT INTO MECHANISM,

2098
01:36:21,800 --> 01:36:25,040
MECHANISM THAT CAN BE EXPLOITED

2099
01:36:25,040 --> 01:36:30,360
FOR BIOMARKER OR DRUGS, DRUG

2100
01:36:30,360 --> 01:36:31,880
DISCOVERY, WHICH WILL BE A VALUE

2101
01:36:31,880 --> 01:36:32,760
TO ANY POPULATION.

2102
01:36:32,760 --> 01:36:36,520
SO THERE IS NO ALL-OF-US KIND OF

2103
01:36:36,520 --> 01:36:39,400
PROJECT, AND WE NEED TO BE

2104
01:36:39,400 --> 01:36:41,480
THINKING ABOUT WHAT OTHER WAY

2105
01:36:41,480 --> 01:36:43,360
CAN WE GET THIS GOING?

2106
01:36:43,360 --> 01:36:47,640
BECAUSE IT'S AN URGENT TASK THAT

2107
01:36:47,640 --> 01:36:49,640
WE NEED TO DO.

2108
01:36:49,640 --> 01:36:54,000
SO SMALL GRANTS INTEGRATED INTO

2109
01:36:54,000 --> 01:36:55,200
HEALTHCARE SYSTEMS FOCUSED ON

2110
01:36:55,200 --> 01:36:58,680
THE DISEASES THAT WILL GIVE US

2111
01:36:58,680 --> 01:37:01,760
THE BIGGER BANG FOR THE BUCK IN

2112
01:37:01,760 --> 01:37:04,600
TERMS OF DISCOVERY AND

2113
01:37:04,600 --> 01:37:06,680
UNDERSTANDING OF DISEASE.

2114
01:37:06,680 --> 01:37:11,040
I APPRECIATE FULLY THAT THOSE

2115
01:37:11,040 --> 01:37:14,360
KINDS OF APPROACHES, THEY HAVE

2116
01:37:14,360 --> 01:37:17,840
THEIR DOWN SIDES, COMPARED TO

2117
01:37:17,840 --> 01:37:19,840
AGNOSTIC METHODS THAT CAN LEAD

2118
01:37:19,840 --> 01:37:22,480
TO REALLY UNEXPECTED FINDINGS,

2119
01:37:22,480 --> 01:37:26,280
BUT WE HAVE TO START SOMEWHERE.

2120
01:37:26,280 --> 01:37:27,280
>>YES.

2121
01:37:27,280 --> 01:37:28,120
WELL, THANK YOU VERY MUCH FOR

2122
01:37:28,120 --> 01:37:30,880
THAT.

2123
01:37:30,880 --> 01:37:33,360
SO NOW WE HAVE A PRACTICAL

2124
01:37:33,360 --> 01:37:35,560
QUESTION.

2125
01:37:35,560 --> 01:37:37,520
WE'VE HAD A DREAMER AND WHATNOT

2126
01:37:37,520 --> 01:37:38,760
BUT NOW A PRACTICAL QUESTIONER

2127
01:37:38,760 --> 01:37:40,720
WHO IS FOLLOWING UP ON SOME OF

2128
01:37:40,720 --> 01:37:44,600
YOUR COMMENTS, CLEMENT,

2129
01:37:44,600 --> 01:37:47,800
ACTUALLY, AND THIS PERSON IS

2130
01:37:47,800 --> 01:37:50,000
STATING THAT IT SEEMS LIKE IT'S

2131
01:37:50,000 --> 01:37:51,960
REALLY IN ALL OF OUR INTERESTS

2132
01:37:51,960 --> 01:37:55,680
AROUND THE WORLD TO SUPPORT

2133
01:37:55,680 --> 01:37:57,520
GENOMIC INVESTIGATION INTO

2134
01:37:57,520 --> 01:37:59,280
AFRICAN POPULATIONS.

2135
01:37:59,280 --> 01:38:03,760
WHAT CAN WE AS THE SCIENTIFIC

2136
01:38:03,760 --> 01:38:06,160
COMMUNITY OF THE UNITED STATES

2137
01:38:06,160 --> 01:38:09,080
DO TO FACILITATE THAT?

2138
01:38:09,080 --> 01:38:11,720
>>THAT'S A VERY
INTERESTING AND

2139
01:38:11,720 --> 01:38:15,760
VERY POWERFUL QUESTION, AND I'M

2140
01:38:15,760 --> 01:38:16,920
SURE CHARLES WILL HAVE SOMETHING

2141
01:38:16,920 --> 01:38:20,400
TO SAY BECAUSE OF HIS ROLE IN

2142
01:38:20,400 --> 01:38:21,160
MOTIVATING SOME OF THE THINGS

2143
01:38:21,160 --> 01:38:24,800
THAT WE HAVE DONE AND WE HAVE

2144
01:38:24,800 --> 01:38:28,600
ACHIEVED, INCLUDING H3 AFRICA,

2145
01:38:28,600 --> 01:38:32,120
AND HIS CURRENT POSITION TO A

2146
01:38:32,120 --> 01:38:34,400
CERTAIN DEGREE AS THE POLICY

2147
01:38:34,400 --> 01:38:39,480
MAKER IN THE NIH THAT CAN

2148
01:38:39,480 --> 01:38:40,840
INFLUENCE NIH AS ONE

2149
01:38:40,840 --> 01:38:44,120
INSTITUTION.

2150
01:38:44,120 --> 01:38:49,160
BUT GOING BEYOND NIH, AND

2151
01:38:49,160 --> 01:38:51,440
HOPEFULLY I WILL HAVE THE

2152
01:38:51,440 --> 01:38:52,120
OPPORTUNITY AS OTHERS DEFINITELY

2153
01:38:52,120 --> 01:38:57,640
WILL TO ELABORATE MORE ON THE

2154
01:38:57,640 --> 01:39:00,560
MECHANISMS THAT WE CAN BUILD

2155
01:39:00,560 --> 01:39:04,680
APPLYING THE IMPLEMENTATION

2156
01:39:04,680 --> 01:39:06,000
MAPPING STRATEGY WHICH IS A

2157
01:39:06,000 --> 01:39:08,400
SUBSET OF THE INTERVENTION

2158
01:39:08,400 --> 01:39:09,920
MAPPING STRATEGY THAT I

2159
01:39:09,920 --> 01:39:13,720
DESCRIBED, AND SOME OF THE IDEAS

2160
01:39:13,720 --> 01:39:18,920
INCLUDE IDENTIFYING AND -- IN A

2161
01:39:18,920 --> 01:39:20,560
LONG TERM FASHION, OFTENTIMES

2162
01:39:20,560 --> 01:39:24,840
BEYOND THE TYPICAL TIMELINE OF

2163
01:39:24,840 --> 01:39:30,640
AN NIH R OR U GRANT KIND OF

2164
01:39:30,640 --> 01:39:33,240
AWARD, ANOTHER WHICH I WAS

2165
01:39:33,240 --> 01:39:35,640
DISCUSSING JUST BEFORE WE

2166
01:39:35,640 --> 01:39:37,640
STARTED IS INSTITUTIONAL SUPPORT

2167
01:39:37,640 --> 01:39:41,280
AND MENTORING PROGRAMS THAT GO

2168
01:39:41,280 --> 01:39:43,880
BEYOND JUST SINGLE PROJECTS, BUT

2169
01:39:43,880 --> 01:39:47,720
HELP INSTITUTIONS TO GRADUALLY

2170
01:39:47,720 --> 01:39:50,360
SHIFT THE LANDSCAPE OF CLINICAL

2171
01:39:50,360 --> 01:39:53,320
AND PUBLIC HEALTH PRACTICE.

2172
01:39:53,320 --> 01:39:56,160
WE ALSO NEED TO BE STRONG

2173
01:39:56,160 --> 01:40:00,320
ADVOCATES, I MEAN, THERE'S A

2174
01:40:00,320 --> 01:40:01,280
TENDENCY FOR PEOPLE SOMETIMES TO

2175
01:40:01,280 --> 01:40:04,880
BE EXHAUSTED, BUT THE WORK THAT

2176
01:40:04,880 --> 01:40:08,640
HAS BEEN DONE HAS YIELDED

2177
01:40:08,640 --> 01:40:10,280
TREMENDOUS BENEFIT, AND IT IS

2178
01:40:10,280 --> 01:40:13,000
JUST THE BEGINNING, BECAUSE ALL

2179
01:40:13,000 --> 01:40:16,400
OF THESE PEOPLE ARE BUSY AND

2180
01:40:16,400 --> 01:40:20,240
WE'RE GOING TO SEE A WHOLE

2181
01:40:20,240 --> 01:40:22,160
SERIES OF PUBLICATIONS FROM SOME

2182
01:40:22,160 --> 01:40:23,920
OF THE PROJECTS.

2183
01:40:23,920 --> 01:40:27,640
AND I HOPE THAT THOSE

2184
01:40:27,640 --> 01:40:29,960
PUBLICATIONS WILL ENCOURAGE EVEN

2185
01:40:29,960 --> 01:40:32,680
MORE INTERNATIONAL INVESTIGATORS

2186
01:40:32,680 --> 01:40:36,200
TO OVERCOME THE CHALLENGES OF

2187
01:40:36,200 --> 01:40:37,960
INTERNATIONAL RESEARCH.

2188
01:40:37,960 --> 01:40:43,400
THOSE CHALLENGES ARE NO NOT

2189
01:40:43,400 --> 01:40:44,600
TRIVIAL, AND ENGAGE IN A DEEP

2190
01:40:44,600 --> 01:40:45,800
AND SUSTAINED FASHION.

2191
01:40:45,800 --> 01:40:49,720
AND BY SO DOING, I'M SURE WE

2192
01:40:49,720 --> 01:40:54,000
WILL ALL BENEFIT FROM THE

2193
01:40:54,000 --> 01:40:57,760
OUTCOMES OF THOSE PROJECTS, AND

2194
01:40:57,760 --> 01:40:59,040
CHARLES, YOU MAY HAVE ONE OR TWO

2195
01:40:59,040 --> 01:41:01,360
THINGS TO ADD.

2196
01:41:01,360 --> 01:41:03,600
>>YEAH, I THINK THAT IS A
VERY

2197
01:41:03,600 --> 01:41:05,080
POWERFUL QUESTION, AND WHEN I

2198
01:41:05,080 --> 01:41:16,040
GAVE MY PRECEDEN PRESIDENTIAL A,

2199
01:41:16,560 --> 01:41:18,840
THAT WAS -- ALSO THE SYMPOSIUM I

2200
01:41:18,840 --> 01:41:20,200
ATTENDED WITH FRANCIS COLLINS,

2201
01:41:20,200 --> 01:41:25,280
THAT WAS PART OF THE -- I WAS

2202
01:41:25,280 --> 01:41:25,880
TREMENDOUSLY PLEASED THAT A LOT

2203
01:41:25,880 --> 01:41:28,240
OF SCIENTISTS AROUND THE WORLD,

2204
01:41:28,240 --> 01:41:31,920
ESPECIALLY YOUNG SCIENTISTS,

2205
01:41:31,920 --> 01:41:33,560
WERE ASKING WHAT CAN I DO, HOW

2206
01:41:33,560 --> 01:41:34,920
CAN I JOIN, HOW CAN I MAKE

2207
01:41:34,920 --> 01:41:35,800
THINGS BETTER?

2208
01:41:35,800 --> 01:41:38,160
AND WE ARE TRYING TO CAPITALIZE

2209
01:41:38,160 --> 01:41:39,160
ON THAT.

2210
01:41:39,160 --> 01:41:41,920
ONE OF THE THINGS FIRST I WILL

2211
01:41:41,920 --> 01:41:42,600
SAY IS THIS.

2212
01:41:42,600 --> 01:41:45,080
IIF YOU HAVE OPPORTUNITY TO

2213
01:41:45,080 --> 01:41:46,160
COLLABORATE OR TO INITIATE

2214
01:41:46,160 --> 01:41:48,480
SOMETHING WITH AN AFRICAN

2215
01:41:48,480 --> 01:41:50,080
INVESTIGATOR OR IN DEVELOPING

2216
01:41:50,080 --> 01:41:54,160
PARTS OF THE WORLD, PERIOD, YOU

2217
01:41:54,160 --> 01:41:55,280
SHOULD ASSURE THAT YOUR

2218
01:41:55,280 --> 01:41:58,440
COLLABORATION IS FAIR, AND THAT

2219
01:41:58,440 --> 01:42:00,160
YOU RESPECT WHAT THOSE

2220
01:42:00,160 --> 01:42:02,520
INVESTIGATORS CAN BRING, AND TO

2221
01:42:02,520 --> 01:42:04,320
DEVELOP A STRATEGY THAT ENABLES

2222
01:42:04,320 --> 01:42:07,520
BOTH PARTIES TO HAVE A WIN-WIN

2223
01:42:07,520 --> 01:42:08,560
SITUATION.

2224
01:42:08,560 --> 01:42:10,160
I THINK WE ARE WAY PAST THE

2225
01:42:10,160 --> 01:42:12,640
SITUATION WHERE YOU COME IN, YOU

2226
01:42:12,640 --> 01:42:14,600
DETECT WHAT HAS TO BE DONE, AND

2227
01:42:14,600 --> 01:42:15,720
YOU LEAVE.

2228
01:42:15,720 --> 01:42:18,200
I THINK WE REALLY NEED TO DO A

2229
01:42:18,200 --> 01:42:20,400
LOT OF SOUL SEARCHING AND SAY

2230
01:42:20,400 --> 01:42:21,720
ARE WE DOING THE BEST SCIENCE

2231
01:42:21,720 --> 01:42:24,920
THAT WE CAN DO FOR THE PEOPLE

2232
01:42:24,920 --> 01:42:26,760
WHERE WE ARE GETTING THESE

2233
01:42:26,760 --> 01:42:27,280
RESOURCES FROM?

2234
01:42:27,280 --> 01:42:32,720
AND TO CONTINUE TO ANSWER THE

2235
01:42:32,720 --> 01:42:33,720
QUESTION, ARE YOU TRAINING

2236
01:42:33,720 --> 01:42:36,680
PEOPLE WHO CAN INDEED GO BACK

2237
01:42:36,680 --> 01:42:38,120
HOME, AND NOT ALWAYS DEPEND ON

2238
01:42:38,120 --> 01:42:39,200
THE FISH THAT YOU CATCH.

2239
01:42:39,200 --> 01:42:42,280
SO IT'S REALLY SORT OF A

2240
01:42:42,280 --> 01:42:43,680
DIFFERENT WAY OF MINDSET OF

2241
01:42:43,680 --> 01:42:44,440
LOOKING AT THINGS.

2242
01:42:44,440 --> 01:42:45,880
THE OTHER THING I WILL SAY IS,

2243
01:42:45,880 --> 01:42:49,480
AS PART OF WHAT WE'RE DOING, WE

2244
01:42:49,480 --> 01:42:50,600
ARE ALSO TRYING TO DEVELOP WHAT

2245
01:42:50,600 --> 01:42:52,360
WE ARE CALLING GENOMIC CENTERS

2246
01:42:52,360 --> 01:42:54,440
OF EXCELLENCE.

2247
01:42:54,440 --> 01:42:57,680
WHICH WE ARE HOPING, YOU KNOW,

2248
01:42:57,680 --> 01:43:00,960
TO ESTABLISH ACROSS THE AFRICAN

2249
01:43:00,960 --> 01:43:05,320
CONTINENT, TO HELP SITUATE SOME

2250
01:43:05,320 --> 01:43:06,560
OF THE THINGS CLEMENT IS TALKING

2251
01:43:06,560 --> 01:43:10,120
ABOUT IN TERMS OF LINING GENOMIC

2252
01:43:10,120 --> 01:43:11,680
CENTERS TO LIN CAL FACILITIES,

2253
01:43:11,680 --> 01:43:15,840
TO HOSPITALS, AND TO PUBLIC

2254
01:43:15,840 --> 01:43:18,160
HEALTH STRATEGY SO THAT AS THEY

2255
01:43:18,160 --> 01:43:20,840
ARE GENERATING GENETIC AND

2256
01:43:20,840 --> 01:43:21,840
GENOMIC INFORMATION, YOU ARE

2257
01:43:21,840 --> 01:43:23,160
IMMEDIATELY THINKING OF

2258
01:43:23,160 --> 01:43:23,600
TRANSLATION.

2259
01:43:23,600 --> 01:43:25,640
YOU ARE IMMEDIATELY THINKING OF

2260
01:43:25,640 --> 01:43:29,160
HOW CAN IT BENEFIT PEOPLE?

2261
01:43:29,160 --> 01:43:31,920
SO WE ARE WORKING ON THAT AS

2262
01:43:31,920 --> 01:43:33,560
PART OF THE MAYBE SPINOFF, IF WE

2263
01:43:33,560 --> 01:43:37,040
USE THAT PHRASE, OF HISTORY OF

2264
01:43:37,040 --> 01:43:40,120
AFRICA TO INDEED BEGIN TO CREATE

2265
01:43:40,120 --> 01:43:43,640
WONDERFUL EXAMPLES OF CENTERS

2266
01:43:43,640 --> 01:43:48,360
THAT CAN -- JUST LIKE WE HAVE

2267
01:43:48,360 --> 01:43:54,400
THE BROAD IN BOSTON, AND SANGER

2268
01:43:54,400 --> 01:43:57,000
IN UK, WE WANT TO CREATE SIMILAR

2269
01:43:57,000 --> 01:43:58,280
STRUCTURES WHERE YOU HAVE DIRECT

2270
01:43:58,280 --> 01:44:00,840
TIES TO HOSPITALS, TO PUBLIC

2271
01:44:00,840 --> 01:44:03,360
HEALTH STRATEGY, SO THAT WHEN

2272
01:44:03,360 --> 01:44:06,000
YOU'RE FINDING THINGS, YOU ARE

2273
01:44:06,000 --> 01:44:07,400
DEVELOPING STRATEGY TO BRING TO

2274
01:44:07,400 --> 01:44:09,080
THE CLINIC, TO BRING TO THE

2275
01:44:09,080 --> 01:44:10,800
PATIENT, AND THAT'S WHERE WE

2276
01:44:10,800 --> 01:44:14,320
ARE, AND WE'LL CONTINUE TO DO

2277
01:44:14,320 --> 01:44:16,280
THAT.

2278
01:44:16,280 --> 01:44:25,240
SO M ENGAGE, ENGAGE AND ENGAGE.

2279
01:44:25,240 --> 01:44:26,880
IF YOU KNOW, AND IF YOU DON'T

2280
01:44:26,880 --> 01:44:28,600
KNOW, SEND ME AN EMAIL, I CAN

2281
01:44:28,600 --> 01:44:30,000
DIRECT YOU TO SOMEBODY WHO YOU

2282
01:44:30,000 --> 01:44:32,240
CAN COLLABORATE WITH OR

2283
01:44:32,240 --> 01:44:33,040
COOPERATE WITH.

2284
01:44:33,040 --> 01:44:35,600
EVERY LITTLE BIT HELPS.

2285
01:44:35,600 --> 01:44:36,200
>>OKAY.

2286
01:44:36,200 --> 01:44:36,840
ALL RIGHT.

2287
01:44:36,840 --> 01:44:39,840
WELL, THANK YOU FOR THAT.

2288
01:44:39,840 --> 01:44:42,400
SO HERE'S ONE THAT IS NEAR AND

2289
01:44:42,400 --> 01:44:45,080
DEAR TO MY HEART, I GUESS.

2290
01:44:45,080 --> 01:44:50,120
BUT IT COMES FROM ONE OF OUR

2291
01:44:50,120 --> 01:44:50,360
LISTENERS.

2292
01:44:50,360 --> 01:44:51,840
AFRICAN AMERICANS SEEM TO HAVE

2293
01:44:51,840 --> 01:44:54,160
AN INCREASED FREQUENCY AND

2294
01:44:54,160 --> 01:44:58,320
SEVERITY OF AUTOIMMUNE DISEASE.

2295
01:44:58,320 --> 01:45:00,800
WHAT IS KNOWN ABOUT AUTOIMMUNE

2296
01:45:00,800 --> 01:45:04,640
DISEASE IN AFRICA ITSELF?

2297
01:45:04,640 --> 01:45:07,480
>>CLEMENT?

2298
01:45:07,480 --> 01:45:13,200
>>EXCELLENT QUESTION.

2299
01:45:13,200 --> 01:45:14,640
THAT REFLECTS ON COMMENTS THAT

2300
01:45:14,640 --> 01:45:17,480
HAVE BEEN MADE EARLIER.

2301
01:45:17,480 --> 01:45:21,640
AND ALSO FEED INTO SOME OF THE

2302
01:45:21,640 --> 01:45:26,560
MATERIALS I PRESENTED.

2303
01:45:26,560 --> 01:45:30,680
PHENOTYPING IS A HUGE CHALLENGE.

2304
01:45:30,680 --> 01:45:32,960
DIAGNOSING MANY OF THESE

2305
01:45:32,960 --> 01:45:38,200
CLINICAL CONDITIONS, ADEQUATELY

2306
01:45:38,200 --> 01:45:42,720
CHARACTERIZING BEYOND JUST THE

2307
01:45:42,720 --> 01:45:48,080
MOST MINIMAL EVALUATION

2308
01:45:48,080 --> 01:45:52,200
CONTINUES TO CHALLENGE MANY

2309
01:45:52,200 --> 01:45:59,120
AFRICAN HEALTH INSTITUTIONS, AND

2310
01:45:59,120 --> 01:46:02,960
IN ORDER TO BE ABLE TO ANSWER

2311
01:46:02,960 --> 01:46:05,040
QUESTIONS LIKE YOURS AND

2312
01:46:05,040 --> 01:46:09,840
QUESTIONS THAT MANY OTHERS HAVE,

2313
01:46:09,840 --> 01:46:13,800
WE NEED A MULTI-STAKEHOLDER,

2314
01:46:13,800 --> 01:46:16,760
MULTILEVEL INTERVENTION.

2315
01:46:16,760 --> 01:46:20,320
INDIVIDUAL RESEARCH PROJECTS ANN

2316
01:46:20,320 --> 01:46:25,080
ONLY DO SO MUCH, BUT COUNTRY

2317
01:46:25,080 --> 01:46:27,600
LEADERS, INSTITUTIONAL LEADERS,

2318
01:46:27,600 --> 01:46:32,120
PROFESSIONAL LEADERS, NEED TO

2319
01:46:32,120 --> 01:46:36,720
BUILD UP THE CAPABILITIES THAT

2320
01:46:36,720 --> 01:46:41,840
EXIST WITHIN THEIR COUNTRIES TO

2321
01:46:41,840 --> 01:46:44,280
IMPROVE DIAGNOSIS AND ACCESS TO

2322
01:46:44,280 --> 01:46:47,800
CARE.

2323
01:46:47,800 --> 01:46:48,840
BECAUSE THESE THINGS ARE

2324
01:46:48,840 --> 01:46:54,680
LACKING, WE OFTEN GET

2325
01:46:54,680 --> 01:46:56,240
INFORMATION SUGGESTING THIS

2326
01:46:56,240 --> 01:46:58,480
DISEASE IS NOT AS PREVALENT OR

2327
01:46:58,480 --> 01:47:01,480
THIS DISEASE HAS THIS UNIQUE

2328
01:47:01,480 --> 01:47:03,320
AFRICAN PATTERN OR THIS DISEASE

2329
01:47:03,320 --> 01:47:08,680
DOES NOT EXIST, BUT MANY TIMES,

2330
01:47:08,680 --> 01:47:12,280
THOSE KINDS OF REPORTS ARE A

2331
01:47:12,280 --> 01:47:15,160
REFLECTION OF THE UNDERLYING

2332
01:47:15,160 --> 01:47:19,120
WEAKNESSES WITHIN THE HEALTHCARE

2333
01:47:19,120 --> 01:47:19,560
INFRASTRUCTURE.

2334
01:47:19,560 --> 01:47:24,680
SO I'M NOT A SPECIALIST IN THIS

2335
01:47:24,680 --> 01:47:28,960
AREA, BUT I CAN EXPECT THAT IF

2336
01:47:28,960 --> 01:47:32,040
YOU WERE TO DIG INTO THE

2337
01:47:32,040 --> 01:47:34,960
LITERATURE, YOU WILL PROBABLY

2338
01:47:34,960 --> 01:47:40,880
NOT FIND SUFFICIENT HIGH QUALITY

2339
01:47:40,880 --> 01:47:42,440
INFORMATION ABOUT THE TRUE

2340
01:47:42,440 --> 01:47:47,120
NATURE OF THE PATTERN OF SOME OF

2341
01:47:47,120 --> 01:47:48,600
THE DISEASES THAT WE ARE TALKING

2342
01:47:48,600 --> 01:47:50,840
ABOUT.

2343
01:47:50,840 --> 01:47:55,040
SO WE NEED TO GO BEYOND THE

2344
01:47:55,040 --> 01:47:59,480
TRADITIONAL METHODS AND LOOK AT

2345
01:47:59,480 --> 01:48:03,040
BROADER TERMS OF ENGAGEMENT IN

2346
01:48:03,040 --> 01:48:06,520
ORDER NOT JUST TO ANSWER THIS TE

2347
01:48:06,520 --> 01:48:07,640
SPECIFIC QUESTIONS BUT OTHERS

2348
01:48:07,640 --> 01:48:08,000
GOING FORWARD.

2349
01:48:08,000 --> 01:48:10,280
THANK YOU.

2350
01:48:10,280 --> 01:48:11,000
>>ALL RIGHT.

2351
01:48:11,000 --> 01:48:13,600
WELL, THANK YOU.

2352
01:48:13,600 --> 01:48:15,600
SO HERE'S ONE THAT COMES FROM A

2353
01:48:15,600 --> 01:48:17,880
DIFFERENT ORIENTATION, PERHAPS.

2354
01:48:17,880 --> 01:48:21,640
THE QUESTIONER IS ASKING, I HAVE

2355
01:48:21,640 --> 01:48:22,920
HEARD THAT MENTHOL CIGARETTES

2356
01:48:22,920 --> 01:48:24,600
WERE BANNED, AT LEAST IN PART,

2357
01:48:24,600 --> 01:48:26,280
BECAUSE OF THEIR SIGNIFICANT USE

2358
01:48:26,280 --> 01:48:28,480
AMONG THE AFRICAN AMERICAN

2359
01:48:28,480 --> 01:48:28,800
POPULATION.

2360
01:48:28,800 --> 01:48:31,280
IS THERE A GENETIC OR GENOMIC

2361
01:48:31,280 --> 01:48:35,960
BASIS FOR THIS WILL PREFERENCE

2362
01:48:35,960 --> 01:48:40,960
FOR MENTHOL CIGARETTES?

2363
01:48:40,960 --> 01:48:41,960
CHARLES, YOU'RE MUTED.

2364
01:48:41,960 --> 01:48:43,040
>>YES.

2365
01:48:43,040 --> 01:48:46,960
THE ANSWER IS YES.

2366
01:48:46,960 --> 01:48:55,400
THERE IS A  IS A GEOGRAPHIC HAPE

2367
01:48:55,400 --> 01:48:59,400
THAT WAS DISCOVERED BY A GROUP

2368
01:48:59,400 --> 01:49:02,320
FROM NIH AND HOPKINS AGAIN THAT

2369
01:49:02,320 --> 01:49:12,520
SHOWED IT'S ABOUT -- IN AFRICAN

2370
01:49:12,520 --> 01:49:15,800
AMERICANS, AND IT ACTUALLY

2371
01:49:15,800 --> 01:49:17,560
ENHANCES MENTHOL CIGARETTE.

2372
01:49:17,560 --> 01:49:19,640
THE REASON PEOPLE PREFER MENTHOL

2373
01:49:19,640 --> 01:49:24,560
CIGARETTES IS IT IS SOOTHING,

2374
01:49:24,560 --> 01:49:26,080
AND FOR WHATEVER REASON, OVER

2375
01:49:26,080 --> 01:49:32,200
THE YEARS, WE HAVE INDEED KNOWN

2376
01:49:32,200 --> 01:49:35,720
IN TERMS OF -- DATA THAT ABOUT

2377
01:49:35,720 --> 01:49:37,680
80% OF AFRICAN AMERICANS WHO

2378
01:49:37,680 --> 01:49:40,880
SMOKE PREFER MENTHOL CIGARETTES.

2379
01:49:40,880 --> 01:49:42,200
WE DIDN'T KNOW THE REASON BEHIND

2380
01:49:42,200 --> 01:49:44,680
THAT.

2381
01:49:44,680 --> 01:49:48,520
AND MORE RECENTLY, DISCOVERY OF

2382
01:49:48,520 --> 01:49:50,640
THIS HAPLOTYPE THAT REALLY

2383
01:49:50,640 --> 01:49:52,800
DRIVES PREFERENCE FOR MENTHOL

2384
01:49:52,800 --> 01:49:55,680
CIGARETTES CLOSE TO EIGHT FOLD

2385
01:49:55,680 --> 01:49:57,360
REALLY PROVIDE SOME INSIGHTS AND

2386
01:49:57,360 --> 01:50:01,760
VERY STRONG EVIDENCE FOR

2387
01:50:01,760 --> 01:50:04,360
INSTITUTIONS LIKE -- TO SAY WE

2388
01:50:04,360 --> 01:50:05,200
HAVE TO DO SOMETHING LIKE THIS

2389
01:50:05,200 --> 01:50:06,840
IF WE TRULY WANT TO REDUCE

2390
01:50:06,840 --> 01:50:09,520
SMOKING IN THIS POPULATION.

2391
01:50:09,520 --> 01:50:11,120
SO AS TO THE PERSON ASKING THE

2392
01:50:11,120 --> 01:50:14,040
QUESTION, THE ANSWER IS INDEED

2393
01:50:14,040 --> 01:50:15,560
YES.

2394
01:50:15,560 --> 01:50:17,640
>>AND I PRESUME THAT THAT
--

2395
01:50:17,640 --> 01:50:18,920
MAYBE, I DON'T KNOW, I'M PUTTING

2396
01:50:18,920 --> 01:50:20,560
WORDS IN PEOPLE'S MOUTHS ALL THE

2397
01:50:20,560 --> 01:50:25,240
TIME NOW, BUT MAYBE IT WOULD

2398
01:50:25,240 --> 01:50:27,040
HAVE SOME EFFECT ON YOUR TASTE

2399
01:50:27,040 --> 01:50:28,360
FOR CERTAIN KINDS OF FOODS OR

2400
01:50:28,360 --> 01:50:29,760
SOMETHING LIKE THAT.

2401
01:50:29,760 --> 01:50:30,440
>>ABSOLUTELY.

2402
01:50:30,440 --> 01:50:31,520
ABSOLUTELY.

2403
01:50:31,520 --> 01:50:33,280
SO THE EVOLUTIONARY STORY BEHIND

2404
01:50:33,280 --> 01:50:36,000
THIS NEEDS TO BE TOLD.

2405
01:50:36,000 --> 01:50:38,120
IT MAY INDEED -- MAY NOT HAVE

2406
01:50:38,120 --> 01:50:39,960
ANYTHING TO DO WITH MENTHOL IN

2407
01:50:39,960 --> 01:50:43,040
TERMS OF SELECTION ON THAT.

2408
01:50:43,040 --> 01:50:44,800
IT MAY HAVE BEEN DRIVEN BY OTHER

2409
01:50:44,800 --> 01:50:45,200
PHENOMENON.

2410
01:50:45,200 --> 01:50:47,760
FOR EXAMPLE, WE KNOW THAT THERE

2411
01:50:47,760 --> 01:50:51,600
ARE NEW VARIANTS FOR BITTER

2412
01:50:51,600 --> 01:50:55,280
TASTE, FOR EXAMPLE, BECAUSE --

2413
01:50:55,280 --> 01:50:56,400
FROM POISON AND THINGS LIKE

2414
01:50:56,400 --> 01:50:57,080
THAT.

2415
01:50:57,080 --> 01:51:04,080
SO THE EVOLUTIONARY STORY BEHIND

2416
01:51:04,080 --> 01:51:05,520
THIS HAPLOTYPE NEEDS TO BE

2417
01:51:05,520 --> 01:51:07,000
STUDIED, LOOKED AT MORE, YES.

2418
01:51:07,000 --> 01:51:07,920
>>OKAY.

2419
01:51:07,920 --> 01:51:10,320
VERY GOOD.

2420
01:51:10,320 --> 01:51:13,080
SO WE'RE GETTING KIND OF CLOSE

2421
01:51:13,080 --> 01:51:15,200
TO THE FINISHING TIME.

2422
01:51:15,200 --> 01:51:18,360
THIS QUESTION MAY BE ONE THAT

2423
01:51:18,360 --> 01:51:19,440
CLEMENT WOULD WANT TO AT LEAST

2424
01:51:19,440 --> 01:51:22,080
TAKE A CRACK AT FIRST.

2425
01:51:22,080 --> 01:51:24,160
THE GUT MICROBIOME IS NOW KNOWN

2426
01:51:24,160 --> 01:51:25,800
TO PLAY AN IMPORTANT ROLE IN THE

2427
01:51:25,800 --> 01:51:26,920
DEVELOPMENT OF THE IMMUNE

2428
01:51:26,920 --> 01:51:28,120
SYSTEM.

2429
01:51:28,120 --> 01:51:31,600
ARE THERE ANY DATA SUGGESTING

2430
01:51:31,600 --> 01:51:33,880
THAT DIETARY DIFFERENCES IN

2431
01:51:33,880 --> 01:51:35,280
AFRICAN DIASPORA POPULATIONS

2432
01:51:35,280 --> 01:51:37,040
MIGHT AFFECT THE IMMUNE SYSTEM

2433
01:51:37,040 --> 01:51:40,240
IN THIS WAY?

2434
01:51:40,240 --> 01:51:42,200
>>THANK YOU VERY MUCH.

2435
01:51:42,200 --> 01:51:43,320
SO THAT'S A VERY INTERESTING

2436
01:51:43,320 --> 01:51:46,600
QUESTION.

2437
01:51:46,600 --> 01:51:48,680
YOU'RE RIGHT, THE GUT MICROBIOME

2438
01:51:48,680 --> 01:51:54,040
PLAYS A MAJOR ROLE, MUCH MORE

2439
01:51:54,040 --> 01:52:02,120
THAN WE ARE AWARE OF, IN MANY

2440
01:52:02,120 --> 01:52:04,960
ASPECTS OF HUMAN PHYSIOLOGY AND

2441
01:52:04,960 --> 01:52:07,080
DISEASE.

2442
01:52:07,080 --> 01:52:11,440
BUT THERE HAVE BEEN VERY FEW GUT

2443
01:52:11,440 --> 01:52:18,680
MICROBIOME STUDIES IN AFRICA, SO

2444
01:52:18,680 --> 01:52:20,120
WE AGAIN ARE UNABLE TO REALLY

2445
01:52:20,120 --> 01:52:24,360
ANSWER THAT QUESTION BECAUSE WE

2446
01:52:24,360 --> 01:52:27,240
NEED TO DO MORE RESEARCH USING

2447
01:52:27,240 --> 01:52:31,840
THE WHOLE WIDE RANGE OF TOOLS IN

2448
01:52:31,840 --> 01:52:33,840
THAT ENVIRONMENT AND CONTRIBUTE

2449
01:52:33,840 --> 01:52:36,680
THE DATA AND THE RESULTS TO THE

2450
01:52:36,680 --> 01:52:41,160
PUBLIC DOMAIN SO THAT IT CAN BE

2451
01:52:41,160 --> 01:52:47,080
OF GLOBAL BENEFIT, SO THE

2452
01:52:47,080 --> 01:52:48,840
QUESTIONER HAS HIT UPON A VERY

2453
01:52:48,840 --> 01:52:51,040
IMPORTANT COMPONENT OF CURRENT

2454
01:52:51,040 --> 01:52:53,280
GENOMIC METHODS, WHICH IS

2455
01:52:53,280 --> 01:52:54,680
DIFFERENT FROM, YOU KNOW, WHAT

2456
01:52:54,680 --> 01:52:57,200
WE'VE BEEN LOOKING AT IN TERMS

2457
01:52:57,200 --> 01:52:58,080
OF THE HUMAN GENOME AND ALL

2458
01:52:58,080 --> 01:53:03,280
THAT, BUT NOW EXPANDING TO THIS

2459
01:53:03,280 --> 01:53:07,120
INNOVATIVE AREAS OF MICROBIOME,

2460
01:53:07,120 --> 01:53:09,080
ME THAT GENOMICS AND SIMILAR

2461
01:53:09,080 --> 01:53:10,280
AREAS.

2462
01:53:10,280 --> 01:53:11,560
SO MORE WORK NEEDS TO BE DONE, I

2463
01:53:11,560 --> 01:53:12,680
THINK IS THE APPROPRIATE

2464
01:53:12,680 --> 01:53:14,120
RESPONSE THERE.

2465
01:53:14,120 --> 01:53:15,400
CHARLES, LOOKS LIKE YOU'RE

2466
01:53:15,400 --> 01:53:17,240
WARMING UP TO SAY SOMETHING.

2467
01:53:17,240 --> 01:53:19,040
>>I WAS GOING TO SAY AS
PART OF

2468
01:53:19,040 --> 01:53:23,320
OUR TYPE 2 DIABETES STUDY, IN

2469
01:53:23,320 --> 01:53:26,480
NIGERIA, WE ARE INDEED

2470
01:53:26,480 --> 01:53:29,760
COLLECTING TWO SAMPLES TO DO,

2471
01:53:29,760 --> 01:53:31,640
YOU KNOW, THE MICROBIOME.

2472
01:53:31,640 --> 01:53:33,200
AND WE HAVE ANALYZED IT, WE

2473
01:53:33,200 --> 01:53:35,480
CONTINUE TO ANALYZE IT.

2474
01:53:35,480 --> 01:53:38,880
SOME OF THE EARLY EVIDENCE SHOWS

2475
01:53:38,880 --> 01:53:41,840
VERY CLEARLY THAT THE MICROBIOME

2476
01:53:41,840 --> 01:53:44,240
ENVIRONMENT IN TYPE 2 DIABETES

2477
01:53:44,240 --> 01:53:49,160
AND CONTROLS ARE VERY DIFFERENT.

2478
01:53:49,160 --> 01:53:50,400
AND THAT BACKGROUND MAY INDEED

2479
01:53:50,400 --> 01:53:54,000
BE DUE TO THE DISEASE ITSELF OR

2480
01:53:54,000 --> 01:53:56,840
THE MEDICATION THAT THEY ARE

2481
01:53:56,840 --> 01:53:57,240
TAKEN.

2482
01:53:57,240 --> 01:53:59,480
SO THE CHALLENGE HERE FOR US,

2483
01:53:59,480 --> 01:54:01,040
AND THAT'S THE AREA WE'RE TRYING

2484
01:54:01,040 --> 01:54:04,840
TO GO INTO NOW, IS HOW DO WE DO

2485
01:54:04,840 --> 01:54:06,280
IT IN SUCH A WAY THAT WE ARE

2486
01:54:06,280 --> 01:54:10,360
ABLE TO IDENTIFY TYPE 2 DIABETIC

2487
01:54:10,360 --> 01:54:11,320
PATIENTS BEFORE THEY GO ON

2488
01:54:11,320 --> 01:54:14,920
MEDICINE.

2489
01:54:14,920 --> 01:54:20,880
AND COLLECT -- SAMPLES AND --

2490
01:54:20,880 --> 01:54:21,760
MICROBIOME COMPARE TO THE

2491
01:54:21,760 --> 01:54:22,960
CONTROLS, THEN YOU CAN ACTUALLY

2492
01:54:22,960 --> 01:54:24,080
MAKE A STATEMENT THAT IT'S

2493
01:54:24,080 --> 01:54:28,560
INDEED DUE TO THE DIABETES

2494
01:54:28,560 --> 01:54:29,320
CONDITION -- MEDICATION ON THEIR

2495
01:54:29,320 --> 01:54:29,640
OWN.

2496
01:54:29,640 --> 01:54:31,000
SO THAT IS ONGOING WORK IN OUR

2497
01:54:31,000 --> 01:54:32,960
LAB THAT WE ARE DOING, THE

2498
01:54:32,960 --> 01:54:34,280
COLLABORATION WITH CLEMENT, OF

2499
01:54:34,280 --> 01:54:37,600
COURSE, YOU KNOW, SO THE INITIAL

2500
01:54:37,600 --> 01:54:40,680
EVIDENCE SEEMS TO SUPPORT THE

2501
01:54:40,680 --> 01:54:42,680
IDEA THAT THE MICROBIOME IS

2502
01:54:42,680 --> 01:54:45,720
INDEED CRITICALLY IMPORTANT FOR

2503
01:54:45,720 --> 01:54:47,800
SOMEONE WITH THESE CONDITIONS

2504
01:54:47,800 --> 01:54:51,120
LIKE TYPE 2 DIABETES AND OBESITY

2505
01:54:51,120 --> 01:54:52,600
THAT WE ARE STUDYING.

2506
01:54:52,600 --> 01:54:54,160
>>THERE'S GOING TO BE AN

2507
01:54:54,160 --> 01:54:55,960
ELEMENT OF SORTING OUT WHAT'S

2508
01:54:55,960 --> 01:54:57,360
THE CART AND WHAT'S THE HORSE.

2509
01:54:57,360 --> 01:54:58,200
>>EXACTLY.

2510
01:54:58,200 --> 01:54:59,160
>>IN THIS PROCESS.

2511
01:54:59,160 --> 01:55:00,000
ALL RIGHT.

2512
01:55:00,000 --> 01:55:02,320
WELL, WE'RE DOWN TO OUR LAST

2513
01:55:02,320 --> 01:55:03,160
THREE MINUTES OR SO.

2514
01:55:03,160 --> 01:55:04,600
I DO HAVE ANOTHER QUESTION

2515
01:55:04,600 --> 01:55:11,040
THAT'S COME IN ABOUT --

2516
01:55:11,040 --> 01:55:11,720
DEFICIENCY AND WHETHER IT WOULD

2517
01:55:11,720 --> 01:55:13,680
BE USEFUL FOR TRACING THE

2518
01:55:13,680 --> 01:55:15,800
GENOMIC HISTORY OF AFRICAN

2519
01:55:15,800 --> 01:55:17,240
DIASPORA POPULATIONS.

2520
01:55:17,240 --> 01:55:20,000
>>YEAH, YEAH, YEAH, I WAS
-- I

2521
01:55:20,000 --> 01:55:21,520
WAS GOING TO BE SURPRISED THAT

2522
01:55:21,520 --> 01:55:24,280
QUESTION DIDN'T COME.

2523
01:55:24,280 --> 01:55:24,760
>>THERE IT IS.

2524
01:55:24,760 --> 01:55:27,000
>>YEAH, YEAH, YEAH.

2525
01:55:27,000 --> 01:55:30,960
BUT WHAT -- IT'S AN IMPORTANT

2526
01:55:30,960 --> 01:55:33,720
QUESTION, AND I DON'T THINK IT

2527
01:55:33,720 --> 01:55:38,400
WILL BE A VE VERY USEFUL IN TERF

2528
01:55:38,400 --> 01:55:38,800
MIGRATION.

2529
01:55:38,800 --> 01:55:42,440
WHAT IS VERY USEFUL FOR IS

2530
01:55:42,440 --> 01:55:50,400
IDENTIFYING THOSE AREAS THAT DID

2531
01:55:50,400 --> 01:55:53,600
SOME FARM BEING PRACTICES IN

2532
01:55:53,600 --> 01:55:55,240
ANIMALS, HAVING ACCESS TO MILK

2533
01:55:55,240 --> 01:55:57,320
AND THINGS LIKE THAT, OVER A

2534
01:55:57,320 --> 01:55:58,960
VERY LONG PERIOD OF TIME, BUT

2535
01:55:58,960 --> 01:56:00,520
THE STORY IS NOT

2536
01:56:00,520 --> 01:56:00,880
STRAIGHTFORWARD.

2537
01:56:00,880 --> 01:56:03,640
THERE ARE AREAS WHERE WE

2538
01:56:03,640 --> 01:56:04,360
EXPERIENCE THAT REALLY DON'T

2539
01:56:04,360 --> 01:56:05,720
HAVE THAT HISTORY.

2540
01:56:05,720 --> 01:56:09,160
SO I THINK IT AN ONGOING STORY,

2541
01:56:09,160 --> 01:56:12,520
AND THERE ARE VARIANTS THAT HAVE

2542
01:56:12,520 --> 01:56:15,920
BEEN SELECTED THAT ARE DIFFERENT

2543
01:56:15,920 --> 01:56:18,520
IN EUROPE OR IN AFRICA, SOUTH

2544
01:56:18,520 --> 01:56:19,440
AMERICA, SO THE STORY IS

2545
01:56:19,440 --> 01:56:21,760
ACTUALLY QUITE AN INTERESTING

2546
01:56:21,760 --> 01:56:23,480
ONE, SO THERE HAS BEEN SELECTION

2547
01:56:23,480 --> 01:56:24,800
PRESSURE THAT RESULTED IN

2548
01:56:24,800 --> 01:56:26,880
DIFFERENT VARIANTS IN DIFFERENT

2549
01:56:26,880 --> 01:56:28,120
PARTS OF THE WORLD.

2550
01:56:28,120 --> 01:56:30,720
AND I WON'T BE SURPRISED IF THE

2551
01:56:30,720 --> 01:56:34,160
SAME STORY IS TRUE ACROSS AFR 

2552
01:56:34,160 --> 01:56:35,720
AFRICA.

2553
01:56:35,720 --> 01:56:36,480
>>ALL RIGHT.

2554
01:56:36,480 --> 01:56:37,680
WELL, AT THIS POINT WE'RE DOWN

2555
01:56:37,680 --> 01:56:39,360
TO OUR FINAL MINUTE, AND I THINK

2556
01:56:39,360 --> 01:56:41,640
THAT I WILL CALL THINGS TO A

2557
01:56:41,640 --> 01:56:44,280
CLOSE IN THAT FINAL MINUTE BY

2558
01:56:44,280 --> 01:56:45,680
THANKING THE TWO OF YOU.

2559
01:56:45,680 --> 01:56:49,120
CHARLES AND CLEMENT, THIS HAS

2560
01:56:49,120 --> 01:56:50,760
BEEN JUST A REALLY SPECTACULAR

2561
01:56:50,760 --> 01:56:53,280
COUPLE OF HOURS HEARING YOU

2562
01:56:53,280 --> 01:56:55,320
PRESENT YOUR WORK, PRESENT SOME

2563
01:56:55,320 --> 01:56:59,440
OF THE CHALLENGES OF THE FIELD

2564
01:56:59,440 --> 01:57:01,600
AND TALK TO US A LITTLE BIT

2565
01:57:01,600 --> 01:57:04,120
ABOUT WHAT WE REALLY NEED TO DO,

2566
01:57:04,120 --> 01:57:06,200
IT HAS REALLY BEEN FANTASTIC.

2567
01:57:06,200 --> 01:57:08,240
AND I WANT TO THANK THE BOTH OF

2568
01:57:08,240 --> 01:57:10,440
YOU SO, SO MUCH FOR TAKING THE

2569
01:57:10,440 --> 01:57:12,760
TIME WITH US THIS AFTERNOON.

2570
01:57:12,760 --> 01:57:15,480
I DO HAVE SOME ADDITIONAL

2571
01:57:15,480 --> 01:57:17,640
QUESTIONS THAT WE DIDN'T GET TO

2572
01:57:17,640 --> 01:57:21,280
THAT I WILL PASS ON TO YOU A

2573
01:57:21,280 --> 01:57:22,040
LITTLE BIT LATER.

2574
01:57:22,040 --> 01:57:26,440
I DO WANT TO REMIND THOSE WHO

2575
01:57:26,440 --> 01:57:30,520
ARE WATCHING THIS FOR POSSIBLE

2576
01:57:30,520 --> 01:57:32,240
CME CREDIT THAT THE NUMBER, THE

2577
01:57:32,240 --> 01:57:37,000
PHONE NUMBER TO TEXT TO IS

2578
01:57:37,000 --> 01:57:38,480
443-541-5052, AND YOU HAVE TO

2579
01:57:38,480 --> 01:57:43,160
TEXT THE 45391 CODE IN ORDER TO

2580
01:57:43,160 --> 01:57:43,960
GET CREDIT.

2581
01:57:43,960 --> 01:57:46,440
BUT AGAIN, CLEMENT AND CHARLES,

2582
01:57:46,440 --> 01:57:49,400
THANK YOU SO MUCH FOR REALLY A

2583
01:57:49,400 --> 01:57:52,480
WONDERFUL COUPLE OF HOURS, AND I

2584
01:57:52,480 --> 01:57:55,280
WISH YOU BOTH A GOOD NIGHT.

2585
01:57:55,280 --> 01:57:57,560
>>THANK YOU VERY MUCH,
AND

2586
01:57:57,560 --> 01:58:06,480
>>BYE-BYE.