Hi, everyone.
Yeah. It's been,
Thank you so much for inviting me.
This is always a fun time of the year
when I get to speak to,
the NIH and, folks, taking this course.
So I wanted to start off by,
acknowledging the traditional homelands,
where I do my research at the University
of Washington or University of Colorado.
And Sheetz medical campus.
We also have a downtown campus shown here in the
picture.
But these are the traditional homelands
of the Apache
Ute, Cheyenne, Comanche, and Arapaho tribes.
And it's also home to many other indigenous peoples today.
So today, I hope to relay
the importance of thinking about diversity,
equity and equality and health care research and,
health, research and why it's imperative
to engage communities in their research.
First off, I'll
contextualize my experiences with some of that,
my journey in academia and motivations
for doing the work that I do.
I'll talk a little bit about indigenous ways of knowing
and then my research and precision
pharmacogenomics, as well as how I'm
moving towards community based research in my work.
So to start off, I grew up on the Navajo Nation,
which is shown here in the middle
of the four corners, or, so the Navajo Nation
spans across Arizona, New Mexico and Utah.
We have almost 500,000
enrolled members in the Navajo tribe.
And it's the largest tribal tribe,
tribal land base as well.
So this, black blob here
is about the size of West Virginia.
So I grew up here and,
went to high school here, and all of
my family still live on the Navajo Nation.
But I also did my
postdoc and my PhD at the University of Washington.
So I spent quite a few years there.
And I got my PhD in genome sciences,
and then I did a postdoc
with the Northwest Alaska pharmacogenomics Research
Network,
in which I had advisors
both in pharmaceutics and bioethics.
But what was really great about the NWA, PGR
and is that they had a really diverse team,
but they worked with tribal communities
and were at its core,
they were trying to do community engaged
research, as well as thinking about
the ethical and social implications
of that research in those communities.
So in 2019, I moved back to my beloved
southwest
and started my own research program
at the University of Colorado.
So I, I've always wanted to work with
my own tribe and other indigenous peoples.
And it's it's also, an ideal for many native elders and
families.
They always tell you,
go and get your education and then come back and help your
people.
So I hope that the work that I'm doing
now is affecting some of the work
that I do
with my own community, as well as other tribal nations.
But, growing
up, I did not know what research was.
And it wasn't until I conducted my own research in
high school
that I realized what it was and how far it could take me in
my career.
And then it wasn't until I was probably a late
undergraduate when I realized this could be a career for me.
But it was really because of the influential, attentive,
and supportive mentors and community
and family and many diversity programs
that I was a part of is that's why I'm here today.
And some of these mentors were scientists,
but also others were members
of my family who really saw my potential
and guided and supported me on onward.
So I wholeheartedly believe that science is not a solitary
effort,
but is one informed by your communities.
As I wanted to,
think more about genomic research
and move my research beyond genetic findings.
I found that,
there was a disconnect between genomic
research and indigenous communities.
I think many people think that Native Americans are
anti-science,
but really, we just want research
to be done on our own terms.
We have our own words for DNA.
So in Navajo, it's called not at all.
And we have our own ways of keeping track of our
genealogy
and social relationships and histories and family traits.
We have complex relationships with our environment and
ecologies,
and really, we just want our families
and future generations to be healthy
to something that many other communities also
feel.
But when the genomic revelation started
or a revolution started gaining momentum,
indigenous peoples were hesitant to participate because of past
historical abuse, research misconduct,
and concerns about helicopter science.
So this is
one example shown here of the Havasupai
tribal members
learning that their DNA samples that were intended for diabetes
research were instead used for to study
schizophrenia and human migration
research, things that they had not agreed to
initially.
So back in 2010, this was settled outside of
court
and the tribal members were able to receive their,
samples back.
But this has really affected that community.
That community is still very, very distrustful of researchers
coming into their community and taking samples and not
coming back.
So within my own tribal community,
genetic research is actually not even allowed.
So in back in 2002, right around the time
I was starting, college,
a moratorium or a ban on genetic research
was put in place on the Navajo Nation.
And this was because,
at that time, there was a lot going on with,
with different
projects trying to obtain samples
from indigenous peoples.
But for the Navajo people, they consulted with their tribal
leaders,
their traditional healers, and also Navajo
people with scientific training.
They realized that the Navajo Nation
lacked policies for genetic research protocols.
And over 20 years later, this moratorium
on genetic research is still in place.
So I think that it's I think it's ironic, sometimes
that my
I received my PhD in genome sciences
or genetics.
But I'm not able to conduct any genetic
research with my own tribal community.
But I think it's precisely because of this lack of Navajo
and other indigenous geneticist that I pursued this path.
So in a recent article that my lab
published, we looked at the literature.
We did a literature review
and we looked at studies that had been conducted in
Navajo people.
These are just a snapshot of some of the studies.
And just from the titles, you know that there a little
bit,
might have some issues.
So one of them was inbreeding coefficients
in the Navajo population.
Another was a study of blood groups
among American Indians and the Navajo.
But, for this study of the blood groups,
a lot of those samples were collected
from children who were in boarding schools
on the Navajo Nation.
So, and then this other study on colorectal cancer,
the the study published very detailed
pedigrees, and some of the community
members had issues with those detailed pedigrees
being published and made.
And since these are isolated community
is that had some issues.
But we we reviewed over 79 publications
with that involved
Navajo people from the early 1900s
and few studies.
May mentioned obtaining tribal IRB
approval.
And then, while standards have changed,
this reflects the trend
of how few studies involved communities
and respected tribal sovereignty.
So, more
broadly in American Indian Alaska Native communities.
These are some concerns about participation.
Participation and research.
There are many cultural and ethical concerns.
There's always, concerns about the lack of adequate
community consultations.
And specifically when we're in the genomic error,
there's,
concerns about long term data storage
and biological samples stewardship.
So as I continued my journey,
I wanted to focus on questions that mattered to my community.
Back when I started my postdoc, precision
and precise medicine was really a
a buzzword in the community, and I think it still, still is.
I decided to focus on pharmacogenomics
because I thought of that
as sort of the foundation of precision medicine.
And a lot of people thought that this was one of the low
hanging fruit
of how you could use genetics to inform
drug, drug dosage and drug,
which, prescriptions that you use.
Also, I was I was drawn to this area because
of,
traditional medicines and herbal remedies
that are still used in our communities
today.
And have informed a lot of the pharmaceutical
drugs
that has been created in modern times.
But of course, as you go through,
the Stem fields, there are definitely unequal,
any,
any quality inequalities that, you know, experience,
especially coming from a tribal community
and then,
being in a large institution.
Some of these included some sacrifices of being away
from home,
losing some of my language and not being able to,
be a part of our traditional events
and ceremonial,
events that follow.
There's a lot of self-doubt and imposter
syndrome.
Loneliness. And also, as I started getting,
into my postdoctoral position and faculty positions,
I realized there are not there are not equal networks.
I did not have those established networks
that a lot of those,
have if you have family members
who had gone through,
higher education training before.
So, a part of my motivations for my research program is really
supporting
equity and inclusion of diverse populations and genomic
research.
Also addressing health and health care disparities,
and then enhancing ethical research
with indigenous and other
historically underrepresented communities.
And I like to show this figure here
because,
this is the one of the Gwas monitor, so.
Daly. I think this was from two years ago.
So I have to update this, but it's it hasn't really
changed.
So if you look at this de la diversity
monitor.com,
you will see real time how many studies are involving
other populations by
far about 95% are European descent populations
who are involved in these large scale
genome, projects.
And then the rest of the five, 4 to 5%
are all of the other world populations,
and, indigenous peoples aren't on here,
but they're about .04
or 5.05% representation.
So that's why I have my lab
and it's specifically focused on working with indigenous
peoples.
So one part of my lab does pharmacy genomics research.
So we study the cytochrome P450 enzymes.
And then we also work
with tribal partners to determine
what what they're interested in.
So one of the areas that became,
interesting to tribal partners, we're looking at nicotine
metabolism
and how we can use that to create personalized,
pharmacotherapy for, people who wanted to stop
smoking.
The other aspect of my wet lab where understanding, trying to
understand
what these variants do in cell cultures
and then,
a part of my background is in evolutionary genomics.
So I'm really interested in seeing,
how these,
enzymes have changed over time.
And then the other part of my work,
sort of arose out of my efforts to do,
community, engage research with communities.
Sometimes communities were not ready
to jump into a full blown research study.
So, we stepped back and then we decided
to look using qualitative
and mixed methods of research, we decided to actually take a
look
at what's the landscape like in the communities.
So this is one of the projects that I'm doing with the Navajo
Nation,
where we are actually serving people about
what did they think about
genetic research?
What do they think about the moratorium?
Are they what are some big concerns
in their communities?
So I do this research with various communities
who really want to take a step back and,
talk, talk before you jump into the actual
research.
The other part of my work is looking at ancient DNA
ethics,
and then also mentoring, indigenous trainees
through the singing program as well as the prime program.
So I'm extremely thankful to all of my Chinese
collaborators and tribal partners
who really move this research forward.
The other
big part of my laboratory is bringing my culture into the
lab.
So this is, actual picture of my lab
back in 2020
when I, was able to move into the space.
But we had a, traditional ceremony
to open up the lab, before any samples were brought
in.
I also have a lot of indigenous trainees
who, work in my lab and often,
contact me to for training opportunities.
But, I wanted to switch gears
into this idea about,
indigenous science.
So indigenous people have always been
scientists,
from burning practices in some indigenous communities.
A lot of the, vegetables that we have today are,
were originally domesticated by indigenous peoples.
And even though there was not the
understanding of genetics as we have it
now, there was also there was definitely
an understanding of heritability
and how you were able to maintain balance
with the environment, but also cultivate,
domestic products or products that people could
eat.
And there's.
So within indigenous science, there are multiple ways of
knowing.
Sometimes people call this traditional knowledge
traditional ecological knowledge or indigenous knowledge.
Often these are passed on through oral
or written knowledge.
A lot of times it's orally transmitted.
Ceremonial practices and beliefs and also
general knowledge that is passed on from our
ancestors.
So recently. Well, not so recently.
It's five years ago, but we, colleague and I
published,
an indigenous science special issue in
human biology, where we highlight multiple
indigenous authors who are incorporating
indigenous science into their,
research protocols.
So take a look.
I think it's freely available if people are interested.
But moving into the work that I do.
So within the United States, there are over
574 federally recognized tribes.
About 70 to 80% of these tribal members
actually don't live in the rural tribal communities.
They actually live in cities.
So a lot of major cities Washington DC, Denver,
Phoenix, a lot of these cities have
native peoples.
And just to go back to some of the ethical,
regulations in place.
So I'm sure many of you have heard of the common
rule.
So the common rule upholds tribal
sovereignty.
So what does that mean?
That means that the, tribal sovereignty
is extended to recognize American Indian
Alaskan Native tribes. But,
this the common rule upholds the right of authority of U.S.
tribes to approve or disapprove of research in their
community.
So it is, legal,
thing where you do have to consult
with tribal communities
if you're planning to do research
with them.
So within my field, for science and precision medicine, this is
a field
that tries to use genetic information, environment
and lifestyle to,
aid in the diagnosis, prevention and treatment of diseases.
And I'm sure many of you have heard of,
some of these efforts, the all of us is one of the
most,
well known efforts, the Precision
Medicine Initiative, which was started,
or announced by, President Barack Obama
a couple years ago.
And then now there are other, biobanks
that are trying to do something similar
where they're collecting, samples
and hoping to use this information,
coupled with electronic health medical
records and very detailed surveys to
make this,
information available to researchers
who want to study,
different diseases and health conditions.
So within pharmacogenomics, their this field
aims to establish how genes affect
a person's response to drugs.
And pharmacogenomics guides
the selection of the best drug and dose for an individual.
And it's predicted to reduce the cost of adverse
drug reactions, which is actually quite
expensive in the,
right now in health care.
So if I go to this cartoon
and take a diverse population here,
sometimes if you treat a certain
population with a
particular medication, the vast majority
will have a favorable response.
So you're able to treat these people
in blue with a conventional drug or dose.
But there are other people who, because of their genetic
profile,
might not respond or they might have an adverse
effect.
And with these people who are in red
and purple, you will want to treat
with an alternative drug or dose.
But getting to this, population in the pink
and red is actually a really hard process,
because you have to have genetic
information available, you have to have
evidence behind the drug gene pairs,
and then you have to have a way to implement this in the
community.
So that's actually one of the
hardest things that was substrate
trying to do in precision health.
So one of the enzymes that I said
are a family of enzymes that I study
are the cytochrome P450 enzymes.
These enzymes are involved in drug metabolism.
There are 57, enzymes in the human body
that are all involved in some type of drug metabolism.
So, about, 75% of the drugs
that people take today are metabolized by this
gene family.
And then in terms of human genetic variation,
we look at single nucleotide variants.
Insertions and deletions are a big part of
why
we see some genetic variants or variants
and how people respond to medications.
And then interestingly,
there are also copy number variations
and structural variations.
So with one of the more common
enzyme Cyp2D6, we see a lot of non
allelic homologous recombination occurring
where you might get full gene deletions
or you might get hybrids.
And so the really interesting family to study.
So in terms of the actual gene.
So this is just an example of Cyp2D6.
I'm not going to go in depth, but it's a gene cartoon.
But with each and with different enzymes
or with different variants.
So this is called Cyp2D6.
Start to these nucleotide changes
will cause an amino acid change.
And these they might cause a change in enzyme activity.
So this one doesn't really change it.
But if we go back to this star ten variant, it decreased this
enzyme function, which has implications
for the dosage of the medications
or medicines that are metabolized by this
enzyme.
So just a big picture.
And then when we think about the applicability
of pharmacokinetic information, I wanted to go to this study
that was published, a couple years ago where they
did use it.
Pharmacokinetic algorithm based on two genes,
frequency one and 6 to 9.
And then they looked at people's genotype status,
and then they compared that to standard clinical care.
They did this in two cohorts that you pack
and their current cohorts
for one of the groups, they found that there was
a benefit for genotype guided warfarin dosing.
And warfarin is a blood thinner that is commonly prescribed,
also known as treatment in So they found that
this genotype guided care was actually beneficial for
people.
And then for Co-Lab, they actually found
no significant difference
between the groups.
And why do you think we have these conflicting results?
Well, when you look at the
composition of the cohorts, that you pack
was primarily European descent.
Koragg actually had 27% African-American,
representation.
And it is well known that in this
ship, 29 gene, African-Americans
have lower frequency of the two variants
that were put in this algorithm.
And, none of the other
29 alleles were considered in this
algorithm.
So it was excluding potentially important
variants, for a specific subgroup.
And so this is a part of the reason
why it's so important that we, look at,
characterize variation in different populations,
potentially clinically, there's the, potential for
phenotypic
mis classification.
This will end up contributing to, disparities.
And then there's missed opportunities
for optimizing care for people.
And the other part of my work is just interested.
It's interesting to look at, why we have the variation we do.
So this is just looking at,
populations and Oceana.
So looking at Polynesia, Melanesian,
Micronesia, and different,
geographic regions and ethnic ethnic groups,
but it's any, these for this,
2019 for metabolized status.
It varies really dramatically from like 71% in certain groups
to 8 or 7% in other groups.
And a lot of this is driven by the founder
effect.
So small populations,
keeping or
in small populations, some of the variance.
Well, there will be a loss of genetic
variants that occurs from a new population
being established from a smaller number
of people, or selective pressures.
There might be things in the environment
that are being selected for,
there might be geographic barriers as well.
And then genetic drift is just,
when nonrandom drift occurs due to small population size.
So I think that we see this all over
the world with these of set of enzymes.
And it's really interesting,
from my perspective, to look at why we see these
changes.
Are they cause is there a selective advantage
or
is there, our care,
genomes that are involved.
So one of the, another paper that I'm not going to talk about
today,
we looked at these variance in Neanderthal
individuals and Denisovan individuals.
And we were able to see that some of that
variation is shared from a long time ago.
Why why is this variation staying in the population?
But so this is just an example.
But and I think
that a lot of the work that I have done
and have been doing
with communities is was really a call to action
to me.
There is a definite bias in who is represented
in genomic and pharmacodynamic research.
There is a shocking lack of indigenous PhD
or principal investigators in the biomedical sciences.
Currently, there are very few
principal investigators who have research labs, much
less,
wet labs, and are able to do some of this work with tribal
communities.
So it really became,
a call or
a realization that we, I have to try to increase
the number of indigenous scholars
in the genomic workforce.
And then, one way to do this is working with communities
as partners, but also involving more
of the communities in research.
In the actual can,
start or doing the research.
So, now I'm going to switch gears
into some of the ethical research
approaches that I think of as I do
my research and I do this, I go through this process
with every project that I do and throughout the research
projects
I project, I also check myself and think about these questions.
Am I doing this?
Should I have done this?
How can I do it better?
So I think when we think about what it means to be an ethical
researcher,
what situates our ethical norms and beliefs?
I think the notions of
good and bad vary across communities.
Bioethics is a study of ethics and
medicine and research and often guidelines
and best practices are needed to ensure that
minimum standards are implemented.
So I won't talk a lot about this work.
So I do research with contemporary
indigenous peoples.
I also do research involving ancestors.
Some of the papers that I shared, will
give you more, ideas about what that means, what it
means.
But, either
whether I'm working with contemporary
indigenous peoples
or ancestors, a lot of the questions that I
think of,
kind of how I approach my research
are the same.
So I really love this quote by Doctor
Kim Tolman.
If you're going to work with indigenous
communities, you have, genetics.
You have to be willing to make lifelong relationships.
So CBR,
CBR is community based participatory research.
It's a collaborative, collaborative approach
to research that involves
community partners in the research process,
and it recognizes the strengths that each brings.
So community research
begins with a research topic of importance
to the community,
with the aim of combining knowledge
and action for social change
to improve community health and eliminate health
disparities.
Sorry, I keep pressing the wrong button.
So I think one thing that I love
everyone to think about is what would your study look
like when community is involved, or what does your study look
like?
And this can be whatever you're setting,
if it's public health, if it's qualitative
or if you're doing genetic research,
how would it look if you involve
community members?
So recently,
there have been many community specific research ethics
guidelines
that have come out, these this is a little bit older,
but these are a couple that I like
to highlight.
Actually Africa has a ethics and governance
framework.
You know, is a really great example
of a guidelines that were produced,
created and made by Maori, individuals.
So it really breaks down what genomic research
looks like from the Maori perspective.
And then this other publication, my colleagues
and I published back in 2018, it's still highly cited.
So I'm still going to talk about this
today.
But, in this framework, we, lay out,
a couple of principles, six principles
that, anyone can use in their research.
And I'll go through this a little bit more, after
I highlight some of the other upcoming
studies.
And then recently there's been a lot of,
work done
about indigenous data sovereignty and governance,
particularly in genomic research and precision medicine.
One of the principles that came out
were the care principles.
So this is collection, ownership and application of data and
specimens.
So the care principles for indigenous
data governance,
that's a really great paper to read.
And there is I'm not sure if folks have heard of the fair
principles
which are about data stewardship,
but there's a paper that links to care
and fair principles together, which I find really great.
And then there's also other studies
that think of DNA, online,
for in relation to data stewardship.
So the, from Laura Harper's group, and Canada.
But I also wanted to highlight, the paper
that my and my colleagues and I were able to put together.
So with this paper, we like to start from the
middle,
so understanding tribal sovereignty
and research regulations.
But the communities that you're working with before
starting
and then going outwards, to engaging the community
and then making sure that you're culturally competent
and then improving transparency in everything that you're doing.
Not only that starting the study,
but in your informed consent
and study documents and then supporting
capacity building within the communities,
so involving members of the community
and then distributing knowledge
in different ways.
And then throughout we have these
principles of respect to equity,
beneficence and reciprocity.
So with this, I'm just going to start from the
beginning
and tell people how I approach some of these research.
So in acknowledging sovereignty and research relations,
we're we're asking that
both tribal groups and individuals
consent.
Also, if you're working with urban
populations,
it becomes a little more, a little harder
because often there's not a single entity
that, can approve or disapprove of a study.
For for example, I'm going to highlight
the Pharmacogenomics Research Network.
So within this, partnership,
they had three tribal partners, listed here.
And then with the oversight of approval process for every
study
that was done as a part of this larger
grant, they went through the Alaska area
IRB and then the oversight committee
at Central Foundation,
and then for the Wiki Health Corporation.
They went through multiple levels of
review before, and this was for the study,
but also for any publications or presentations that happened.
And then same with the Salish and Kiwi
tribe in Montana.
There were multiple levels of review
from the community before this
ever got approved or started.
And then for, community engagement.
This is really, talking about building
long term
relationships and having some type of
engagement plan.
One really good way to do this is to have,
community advisory groups.
So, and all of most of the studies that I
do, I have a community advisory group.
This can be anywhere from five people to,
one of my groups.
We have 30 community members in that advisory group.
So, I think it just depends on what,
level of interest.
And, if you're able to,
organize folks, but often
the community advisory group meetings
are the, the best part of my job
because I get to connect with communities, learn
and talk about research together, and,
so the other cultural competency.
So, integrating cultural and traditional knowledge,
taking the views and perspectives
of tribal members into consideration,
and then also having reviewed by the IRB
and community researchers.
So, was one of the projects, I was lucky enough to be a part
of
was with the South Central Foundation
before we this, we moved forward
with doing a in-depth analysis of the CIP 2016.
One of the things we did first was exploring stakeholder
perceptions before embarking on this
project.
So we did a qualitative study of patients,
providers and healthcare system leaders
regarding pharmacogenetics use in tobacco decision
treatment.
So in the end, a lot of the folks
we who were interviewed supported
tobacco research, wanted collaboration
with existing tribal programs
and then wanted their results back.
So so this is one way you can do this.
Before embarking on a project
transparency.
Just making sure that the consent
and the process are shared and detailed,
making sure that storage of data
and samples is addressed and, the informed consent
and also made very clear to the community
and also future use of data and samples.
So this was an example of some of the language used
and then informed consent that was actually used.
It's anonymized here, but very clearly
it says your DNA and blood samples
belong to you.
Samples will be stored for the duration of study at this
university.
Samples will be sent to this place
for analysis without any identifying
information.
So it's very clear what happens to the sample, and it tells them
how long they will keep the samples
and what will happen afterwards.
So just being very clear in that process
and then capacity building,
making sure that you're trying
to include others and diversifying the workforce
and doing a collaborative analysis,
and then also sharing co-authorship
with community members as well as researchers.
So one way that I like to do this is,
I'm, a long time faculty member with the summer internship
for indigenous peoples in Genomics or housing.
And at this workshop, we're able to do
hands on training in genomics.
We talk about different Elsi issues.
We talk about indigenous knowledge
and decolonizing science.
And, this workshop has been around
since 2011,
and many of my tribal research partners have attended
same,
just because it was a great way to have them learn more about
genomics,
but also engage in discussion with other tribal community
members.
And so often we have
about 20 people who attend every year.
And these individuals are all from different tribal
indigenous
communities around around the US and around
the world.
So it's a really great way to, support capacity building.
And then, also inform people of what you're doing
and think has actually crossed international waters now.
So there's a saying Australia and New Zealand,
there's a shame Australia, there's a saying,
Canada.
So I think it goes under a different name now.
But all of from the original thing
that was in the USA,
all of these other groups have used sing in their own way
and created that we have for capacity,
capacity building
and then thinking about knowledge
and distributing knowledge.
Only very few people I found from the
community actually read your,
the academic publications.
So it's important to make the information
available through different
than for different areas.
So as a part of some of my research,
our research team
has presented at tribal community
meetings.
We've done forums on the local Navajo
radio station.
And also, I know other colleagues have created
pamphlets
and put things on social media to make it more easily
digestible.
So I think these are just some ideas
on how people can,
work with communities.
So that the knowledge is shared and people are excited about the
research
and don't feel like they're just being
used as a part of the research process.
So in pharmacogenomics specifically,
I think that
the future of pharmacogenomics is right.
I think that we have a lot of different
initiatives happening.
One of which I'm super proud of these folks
here
who have started for the Native Bio Data Consortium.
So this is the first nonprofit research
institute led by indigenous scientists.
And they are able to store,
data.
They're able to store bio specimens on tribal
lands. So,
if you're interested, Joe, your chat, here
and Marianne is the director,
the other initiative that I have been working with
is Doctor Erica Woodall at the University of Montana.
She has the Precision Medicine Project
where they are targeting rural
and indigenous communities and trying to implement
precision
medicine in those communities.
And also, I, I also work with many tribal
communities
trying to do precision, pharmacogenomics.
So, I work with, communities in British
Columbia and Arizona across the United
States.
So, I'm really excited to continue this work.
So I wanted to end with,
the next steps in precision pharmacogenetics.
So my colleagues and I and leading doctor
Erica Woodall
from University of Montana,
wrote this article earlier this year
about how to implement community engagement antigen.
And it's in indigenous research, and indigenous communities.
So, this is one of our figures.
We thought that this was a good way
of thinking
about all of the different components to,
taking a holistic healing approach.
So in the middle of these, share all of the key
people and stakeholders who are involved,
not only communities, but,
researchers, funders,
tribal health, traditional healers
and research participants.
And then we thought that increasing
knowledge and
pharmacokinetic knowledge,
using American Indian Alaska Native variation was super
important
because until we know this variation,
we're not able to implement it clinically.
And that was the other,
area that we thought was really important
in thinking about 24 implementation,
which is related to technical decision
support systems,
pharmacogenetics testing, and then also education and
resources,
for physicians who are working with native
participants or native,
patients.
And then lastly, traditional knowledge and
practices.
So this was and back a couple of years
ago, the,
Tribal Health Research Office
put together a summit, and it was held at University of
Colorado.
But this, report is available online.
But one of the quotes that I liked
is that it is important for researchers
to understand that there is an intersection between
health
research and spirituality in American Indian Alaska Native
health.
And so,
this goes back to what I said initially,
that a lot of our community members
are still using traditional herbs
and traditional ceremonies
when whenever something bad happens.
So if there's a diagnosis for a disease,
they often
go to the traditional people first
and then they go to the western,
western treatment option.
So, and it's there's a separation
that doesn't
need to be a separation, but we can,
do it together.
And one of the things in pharmacogenetics,
we have all of these guidelines that,
where we can establish a person's
dose and the medication to treat,
let's say depression, but then that's
just treating one aspect, one symptom.
Whereas, in order to treat the whole
person,
we need to take into account
the whole community, that environment
that the person mentioned.
So, with that, I will,
leave you with a couple points.
I think that knowledge, different knowledge processes
and some,
some systems can come in many different forms.
I think inclusion of the indigenous
perspective is important in research.
And we need to shift towards community
based
genomic research and holistic healing to,
ensure that people
are healthy, to the best that they can be.
And then we have to ensure that indigenous communities
govern and benefit from research.
And so that I will thank you.
I want to thank my lab members, current and past.
And also, I want to thank my tribal
partners
who have been amazing and supportive.
All of this would not be done without,
their input.
And then also my many collaborators
across,
across the world in the US.
But thank you everyone.