Waching daily Jan 6 2017

Joshua Henry to leave 'Hamilton'; is Wayne Brady the next Chicago Burr?

Chicago's production of "Hamilton" is to lose one of its stars — the critically acclaimed Joshua Henry, who plays the role of Aaron Burr.

Henry is to star in the upcoming national touring production of the hit musical. That tour begins March 10 in San Francisco.

The announcement was made Thursday by "Hamilton" producer Jeffrey Seller. Emmy Raver-Lampman,

an ensemble member and understudy, also is leaving the Chicago production.

Seller did not announce Henry's replacement. However, the actor and television host Wayne Brady has been spotted downtown in recent days.

Brady, the host of "Let's Make a Deal," has used material from "Hamilton" in that game show in the past.

Also a regular panelist on "Whose Line Is It Anyway?," Brady has Broadway credits,

beginning with an appearance as Billy Flynn in "Chicago" and, last winter, he was featured in a starring role in "Kinky Boots."

His addition to the Chicago cast likely would broaden its appeal even beyond its current smash-hit status.

A Broadway in Chicago spokesman would say only that replacement casting would be announced at a later date.

For more infomation >> Joshua Henry to leave 'Hamilton'; is Wayne Brady the next Chicago Burr? - Duration: 2:04.

-------------------------------------------

Aliens - Duration: 7:28.

:|

I'm so sorry if that is your actual fear o.o.... I feel you

Where???? HUH???!! O.O LEAVING US CURIOUS CHAZA!??

Oh sassy much?

Oh my goodness.... so immature! >.>

DAAAAMMMN GIRL!!!!!

Oh totally...

Yeah ....please go

For more infomation >> Aliens - Duration: 7:28.

-------------------------------------------

Woman claims she is being billed for tolls she already paid - Duration: 3:23.

TOLD TROUBLE ON THE SELMON

EXPRESSWAY.

A WOMAN TELLS US SHE PAID HER

TOLL BY PLATE BILL BUT THE

EXPRESSWAY AUTHORITY SAYS IT

HAS NO RECORD OF HER PAYING UP.

A HILLSBORO WOMAN DID GET THE

BILL FOR UNPAID TOLLS DATING

BACK NEARLY TWO YEARS.

THAT'S A LONG TIME.

SHE INSISTS THAT SOMEONE HAS

MADE A BIG MISTAKE.

SHE RAN INTO A DEAD-END TRYING

TO CORRECT IT HERSELF THAT'S

WHEN SHE CONTACTED SENIOR

INVESTIGATIVE REPORTER STEVE

ANDREWS.

DID YOU HELP GET SOME ANSWERS

FOR THIS WOMAN?

WE'RE STILL DIGGING INTO

THIS.

SHE GOT A BILL FOR 250 BUCKS.

HAPPY NEW YEAR.

HILLSBORO WOMAN CONTENDS SHE

PAID BUT THE COMPANY SHE SAYS

SHE HANDED THE MONEY TO CLAIMS

IT CAN'T ACCESS HER FILE.

TO FIGURE IT OUT.

IF YOU USE THE CROSSTOWN OR LEE

ROY SELMON EXPRESSWAY YOU NEED

TO CHECK YOUR BILL.

JULIE HAENER'S GOT THIS ONE FOR

$252.83.

NORMALLY I WOULD JUST PAY IT

BUT I WAS SHOCKED.

THIS DOESN'T MAKE ANY SENSE.

Reporter: THE AUTHORITY IS

CHARGING HER FOR TOLLS FROM

MARCH 2015 ALMOST TWO YEARS AGO

THROUGH FEBRUARY 2016.

DOESN'T MAKE ANY SENSE.

Reporter: JULIE INSISTS SHE

PAID HER FEES TO A COMPANY THAT

TAMPA HILLSBORO EXPRESSWAY

AUTHORITY USED TO COLLECT ALL

BILLS.

WHEN SHE GOT THIS ONE, SHE

CONTACTED THE EXPRESSWAY

AUTHORITY.

I WAS ON THE PHONE WITH THEM

20 MINUTES.

THEY WENT THROUGH ALL THE

RECORDS.

THEY DIDN'T SEE A SINGLE

PAYMENT.

AND IT WAS MY RESPONSIBILITY TO

PROVE THAT I PAID MY --

Reporter: SHE LEARNED IT NO

LONGER COLLECTS FOR THEO.

THEY HAD NO ACCESS TO ANY

RECORDS.

NO TOLL RECORDS.

NOTHING.

THEY COULD NOT EVEN PULL MY TAG

UP.

NOTHING.

Reporter: THE EXPRESSWAY

AUTHORITY CLAIMED IT HAD NO

RECORD SHE PAID ANYTHING IN

2015.

AND THE COMPANY SHE PAID CLAIMS

IT NO LONGER HAS ACCESS TO HER

RECORDS.

ACCORDING TO JULIE THE

COLLECTIONS ATTORNEY SENT HER

TO THE EXPRESSWAY AUTHORITY.

THE EXPRESSWAY AUTHORITY SENT

HER BACK TO THE ATTORNEY WHICH

SENT HER BACK HERE SO SHE

CONTACTED TARGET EIGHT.

I REACHED OUT TO THE EXPRESSWAY

AUTHORITY.

NOW IT'S LOCATED TO PAYMENT --

TWO PAYMENTS IN 2015 BUT

INSISTS SHE STILL OWES 252

BUCKS.

LATE THIS AFTERNOON JULIE TOLD

ME SHE PULLED HER BANK RECORDS

WHICH SHE SAYS A SHOW SHE MADE

SEVERAL PAYMENTS.

THAT ARE UNACCOUNTED FOR.

SHE WONDERS IF THIS IS GOING ON

MORE WIDESPREAD.

I'VE HAD A HICCUP WITH THEM

BEFORE.

AND I'VE WORKED IT OUT ONLINE.

IT IS A HASSLE TO SAY THE

LEAST.

BUT YOU'RE TALKING ABOUT TWO

YEARS.

ISN'T THERE SUPPOSED TO BE SOME

SORT OF A HOLD PLACED ON YOUR

REGISTRATION?

ACCORDING TO THE AUTHORITY,

IF A TOLL BILL IS NOT PAID

WITHIN 60 DAYS, IT GOES TO

COLLECTIONS.

COLLECTIONS SENDS OUT ANOTHER

NOTICE AND IF IS THAT NOT PAID

A HOLD IS PLACED ON

REGISTRATION.

NO HOLD WAS PLACED ON JULIE

HENNESSY'S REGISTRATION.

SO IF SHE PAID, WHY NO RECORDS?

IF SHE DIDN'T, WHY NO HOLD?

WAITING FOR ANSWERS.

THANKS, STEVE.

IF YOU HAVE A PROBLEM, YOU CAN

For more infomation >> Woman claims she is being billed for tolls she already paid - Duration: 3:23.

-------------------------------------------

GANTZ: O (2017) Super Shooter - Duration: 1:34.

For more infomation >> GANTZ: O (2017) Super Shooter - Duration: 1:34.

-------------------------------------------

'Putin Is Up To No Good' - Duration: 2:10.

DEREK AND MARIA BOUGHT THIS

$1.4 MILLION HOUSE TWO YEARS

AGO BUT WANTED TO TEAR IT DOWN

AND BUILD TWO HOUSES.

TOP U.S. INTELLIGENCE

OFFICIALS TESTIFIED ON CAPITOL

HILL TODAY WITH EVIDENCE THAT

RUSSIA INTERFERED WITH THE

ELECTION HERE CALLING THE

COUNTRY A MAJOR THREAT TO THE

UNITED STATES.

CBS 2'S JESSICA MOORE WITH A

BREAKDOWN OF THE FINDINGS.

Reporter: SENIOR MEMBERS OF

THE REPUBLICAN PARTY SENDING A

NOT SO SUBTLE MESSAGE TO

PRESIDENT-ELECT DONALD TRUMP TO

SUPPORT THE INTELLIGENCE

COMMUNITY WHEN HE TAKES OFFICE.

PUTIN IS UP TO NO GOOD AND

HE BETTER BE STOPPED!

AND MR. PRESIDENT-ELECT, WHEN

YOU LISTEN TO THESE PEOPLE, YOU

CAN BE SKEPTICAL.

BUT UNDERSTAND, THEY ARE THE

BEST AMONG US.

AND THEY ARE TRYING TO PROTECT

US.

Reporter: TOP INTELLIGENCE

OFFICIALS CONFIRM TWO DIFFERENT

RUSSIAN CIVILIAN AND MILITARY

INTELLIGENCE SERVICES

COMPROMISED INFRASTRUCTURE,

DEALING WITH THE ELECTION,

THROUGH CYBER ESPIONAGE AND

DATA LEAKING.

NATIONAL INTELLIGENCE DIRECTOR

JAMES CLAPPER SAYS HE IS

CONVINCED THE HACKS CAME FROM

THE HIGHEST LEVEL OF GOVERNMENT

IN RUSSIA, A COUNTRY WITH WHICH

TRUMP HAS PROMISED TO HEAL

RELATIONS.

ON TUESDAY EVENING, TRUMP

DEFENDED WIKILEAKS FOUNDER

JULIAN ASSANGE ON TWITTER

SAYING, QUOTE, JULIAN ASSANGE

SAID A 14-YEAR-OLD COULD HAVE

HACKED PODESTA THE FORMER

HILLARY CLINTON CAMPAIGN

CHAIRMAN.

WHY WAS DNC SO CARE LEST?

HE SAID RUSSIANS DID NOT GIVE

HIM THE INFORMATION.

Reporter: THE PRESIDENT-

ELECT WILL OVERHAUL THE TOP SPY

AGENCY WHEN HE TAKES OFFICE.

HOUSE SPEAKER PAUL RYAN TRIED

TO EASE CONCERNS THAT

OVERHAULING THE AFFORDABLE CARE

ACT WOULD INFLICT HARDSHIP ON

THE AMERICAN PEOPLE.

I THINK THEY ARE TRYING TO

MAKE AMERICANS THINK LIKE

SOMEDAY THIS FEBRUARY OR

SOMEDAY THIS MARCH YOU'RE GOING

TO WAKE UP AND YOU WON'T HAVE

HEALTH INSURANCE.

THAT AIN'T HAPPENING.

Reporter: REPUBLICANS VOWED

TO STRIP FUNDING FROM PLANNED

PARENTHOOD AS THEY DISMANTLE

ObamaCARE DRAWING REACTION FROM

THE ORGANIZATION.

THESE ATTACKS ON WOMEN'S

HEALTH ARE DANGEROUS AND

OVERWHELMINGLY OPPOSED BY THE

AMERICAN PEOPLE.

AND WE WILL FIGHT BACK WITH

EVERY, SINGLE THING WE'VE GOT.

Reporter: ALSO TODAY, TRUMP

NAMED FORMER SENATOR DAN COATS

AS HIS DIRECTOR OF NATIONAL

INTELLIGENCE.

TRUMP WILL BE BRIEFED ON THE

INTELLIGENCE FINDINGS DURING A

MEETING WITH THE NSA, DNI AND

For more infomation >> 'Putin Is Up To No Good' - Duration: 2:10.

-------------------------------------------

100-Year-Old Man Makes Skydiving History For His Birthday - Duration: 2:04.

For more infomation >> 100-Year-Old Man Makes Skydiving History For His Birthday - Duration: 2:04.

-------------------------------------------

What is your Religious Belief System and Cult ? - Duration: 1:22.

** Sir Ghamidi this question is regarding you

** What is your religious belief system and cult ?

There is a verse in The Holy Quran in which its been told

when the Council of Muslims was being corporated after The Holy Prophet (pbuh)

that your father Ibrahim (as) has named you as Musalman (Muslim)

So this is my name

my cult

** To be a Muslim is it important for a religious belief system and cult to be adherent ?

Muslim itself is a religious belief system and cult

Muslim means a person who believes in God, belives in His angels, believes in His prophets, believes in His books

admits that he will be answerable on the Day of Judgement

so this is what is known as a Muslim

being a Muslim is a religious belief system and cult

and we are Muslims

our name our prophet kept , the elders of our prophets kept as Muslim

and I have entreated to you that Muslim or Islam

is not the name of a place or a person or proportioning to something similar

it means that we have in front of the guidance from our Lord, surrendered

we have accepted it

so this is what is called Muslim

introduce yourself with this name

this is our name

so therefore , I'm foremost a Muslim and lastly a Muslim

I have no interest in any religious belief or cult other than this.

For more infomation >> What is your Religious Belief System and Cult ? - Duration: 1:22.

-------------------------------------------

Robert Rodriguez - The Pink Triangle project - Duration: 5:17.

My name is Robert Rodriguez,

and I'm a gay man.

I'm sure that has been said before,

but the thing that really shook

me to my core and made me realize that

you know although we've made a lot of

progress, there's a really long way to go

was the pulse massacre.

Prior to that

at least in America

I thought that aside

from a few isolated incidents,

we're more or less safe from physical violence.

We know now that we have to be vigilant and

we have to be able to target and find

these people that want to do that to us.

And want to cause pain because if we

don't we're going to be

vulnerable like that again.

That was just hatred because

he knew that he wanted to

hit us where it hurt.

All the reports coming out of

it about him after the fact have said

that you know he was upset by seeing two

gay men kissing in public.

To go and kill 50 people

because you see two people

expressing affection for each other in public,

is perverse an obscene.

And anything that we can do to change that

mindset in as many people as we can,

is I think more important than anything else.

We need to respect people's beliefs

whatever those beliefs maybe but we have

to communicate that this is a free

country and everyone can choose to think

and feel about things where they want.

Their beliefs should never negatively

impact other people's lives

however that it.

My dad believes that homosexuality is

wrong and there were a lot of rough

patches with him,

but he still treats me with respect.

Even though that opinion has not changed

and he's never been violent towards me.

Ellen DeGeneres said

she said

"when the message is that bad that

people are being killed over it,

we need to change the message and we

need to make sure that even if that is

how people feel, they don't feel

empowered to act on it.

They don't feel justified to act on it."

You know I went to school

at Channel Islands and I

had a really really bad semester,

so I ended up taking a semester off

and I went home to my junior college.

And I made a lot of new friends there.

I made a friend there

and his name was Eric.

He really saw right through me

and he understood me and he

was able to intuitively show that he

cared without actually hearing anything

directly from me about what was going on

or what was you know make me upset and

comfortable whatever it was.

It was an entirely platonic friendship, but he was

very effective at expressing love for

people who were struggling with

something, whatever it was.

And I know from hearing from others

that he's done that for many people.

He took his own life

a year and a half after I after I met him,

and I hadn't been keeping in touch.

But when I didn't know him,

I saw a person who looks strong

a person who was able to handle adversity

a person who was made a caring person

by his own struggles

because he had to work through

so many things.

Because he had so many

familial issues

or with peers that would would mistreat him.

He was able to empathize

with others and that's was

that was really valuable quality he had.

I'm just upset that he wasn't able to talk

to people the way that people were able

to talk to him and that he let something

get him get him down so much that he

felt the need to cut his life off

and to stop living.

He had dozens of people that

I can think of that loved him that

didn't understand it because they didn't

know what was going on if we thought

everything was fine.

I like to remember him as a person who

had a lot of hope.

And he gave me hope too,

I just wish I could have done the same.

I've met a great do people from

conservative families and they may still

be very conservative themselves, but

they've decided all on their own even

though they're taught to either think

being gay is wrong or disgusting or

being LGBT in any fashion is wrong or

disgusting or outside of the norm or

you know God doesn't like it.

Whatever they've been told,

they've decided that

we are good people and that we deserve

respect and most of them have even taken

that to its conclusion to say that

there's nothing wrong with the

way that we live

and I see that all the time.

I see that when I meet people in many

different social settings who I wouldn't

expect based on you know maybe some of

my own prejudices and

shortcomings in that way.

to be accepting of gay people

or to even have gay friends

whatever it is but they are.

And they are in spite of being

taught to be otherwise.

So I find that very inspiring.

Even though we've lost a battle, we

should also remember that only

twenty-five percent of voting age adults

voted for these people.

That's a minority in this country

and it's always been that way.

And the rest of us you know,

whether we voted or not either are

for or we are the social equivalent of

an undecided voter right.

Usually when people don't care one way

or the other they usually they will air

on the side of saying yeah let people do

what they want and live the way they want.

Don't think that because of this

loss that you will not be supported in

your community, that you will not find

plenty of people who don't feel that way.

That this is a short period of time in

the grand scheme of things.

Any decisions that are made

under their watch can be

reverted and they can be

righted and corrected.

And you can be a part of that.

Don't be defeated.

For more infomation >> Robert Rodriguez - The Pink Triangle project - Duration: 5:17.

-------------------------------------------

10 Ways To Protect Yourself From Energy Vampires - Duration: 8:44.

10 Ways To Protect Yourself From Energy Vampires

BY GOSTICA

We all have it and we all need it, yet many of us find ourselves lifeless and lethargic

by the end (and sometimes at the beginning), of the day.

Life is precious and unpredictably short-lived.

It�s no wonder then, that many of us drag ourselves through each day miserable and melancholic

with the thought that we could be living much better lives.

Throughout the ages, high-energy has been associated with happy, vivacious people, and

low-energy with depressed and apathetic people.

Unfortunately, psychosomatic medicine has shown a strong link between the mind and body,

meaning that the less energy we possess, the more prone we�ll be to suffer from illnesses

such as depression, anxiety and other mood disorders.

It�s true that the healthy and happy person is one filled with energy.

Without energy, how can we fulfill our dreams, pursue our goals and overcome our obstacles?

Without energy, how can we hope to truly achieve anything of meaning or significance in life?

It�s true that some people naturally possess more energy than others, but have you ever

considered why?

Certainly, genetics play a role, but more importantly the environment around us does

as well.

Everything Is Energy If you want to find the secrets of the universe,

think in terms of energy, frequency and vibration.

~ Nikola Tesla

At a sub-atomic level, all that exists in life is composed of vibrating atoms, or pure

energy.

Even incorporeal things such as our thoughts, emotions, instincts and sexual drives can

be said to be composed of energy.

So essentially, we live in an ocean of motion, and like in the ocean � or any environment

on earth for that matter � there are both predators and prey.

In life, there are just some people who tend to drain us of energy very quickly.

If you�re a Highly Sensitive Person like me, or an Empath, you will be very aware of

who sucks your energy and when

However, not all of us are as sensitive or in-tune with our bodies, and this can be difficult

and confusing to deal with.

While some people argue that Energy Vampires are people who can�t sustain their own life

force in a positive manner, others speculate that Energy Vampires are well-meaning and

normal, yet naturally overbearing people.

The point of this article, however, is not to delve into the psychology of the Energy

Vampire, but to identify and explore ways to strengthen and energize our lives in light

of them.

How To Identify The Energy Vampire You will experience the following symptoms

of being:

Overwhelmed Stressed

Physically ill (e.g. headaches, body aches, etc.)

Mentally or physically exhausted Irritable and/or anxious

You may notice that the Energy Vampire displays many of the following characteristics:

Big ego, e.g. loves to debate, argue and pick fights.

Aggressive or passive-aggressive tendencies.

Resentment and anger issues.

Narcissism.

Melodramatic behavior.

Whining and complaining.

Bitching and gossiping.

Insecurity, e.g. the constant need for reassurance and acceptance.

Manipulative behaviors, e.g. guilt tripping, emotional blackmail etc.

Energy Vampires are, in most cases, takers rather than givers who gain free therapy sessions

with their family, friends, lovers, colleagues and even children and strangers who are on

the receiving end.

It�s also good to realize that Energy Vampires are not always necessarily human beings.

They can also be situations or even physical objects in your life.

Examples include:

The internet.

The TV.

Other electronic devices (e.g. the radio, mobile phone, etc.)

Public situations (e.g. crowds, parties, train stations, shopping centers etc.)

Animals (e.g. neurotic pets) The hardest thing about suffering at the hands

of an Energy Vampire is when they are part of your family or friends circle.

How can we regain our vitality in such energy-sucking relationships?

10 Ways To Protect Yourself From Energy Vampires

Sure you may be the prey, but there�s no use in playing the role of the victim.

To better your life you need to do something.

Here are some suggestions:

1.

Stop Making Prolonged Eye-Contact.

I�ve personally found that this is one of the biggest energy absorbers.

The more eye-contact you make, the more you engage with the other person and what they

have to say.

Only occasional eye-contact is necessary in this instance.

2.

Set A Time Limit.

Your time is precious as well, and it�s not necessary for you to sit around for 1

or 2 hours having your energy zapped and brain numbed.

According to your energy level, set a limit of 5, 10, 15, 20 minutes where you can give

your focus to the person, and no more.

3.

Learn Not To React.

This is very important.

The Energy Vampire feeds off the reactions of others, fueling them to continue on interacting

with you.

It�s important for you to learn how to be neutral in your interactions with others,

meaning that the display of overly positive or negative emotions should be monitored carefully.

4.

Learn Not To Argue Or Contradict.

Yes it�s tempting, but in the long run you can�t change other people unless they change

themselves first � the more you resist them, the more they will resist (and drain) you.

5.

Go With Other People.

Approaching the Energy Vampire with 1, 2 or 3 other people will help decrease the level

of effort expended, and attention received.

For this to work you need to ensure that the additional people aren�t psychic leeches

either.

6.

Listen More Than Talk.

A lot of the time Energy Vampires simply want and need a listening ear.

The more you talk, the more energy you tend to lose (especially if you�re introverted).

Using words such as �why�, �when� and �how� will encourage the psychic sucker

to do most of the talking, which in turn will help preserve your energy.

7.

Try Sticking To Light-Hearted Topics.

Your conversations don�t need to be depressive and oppressive.

Take control when necessary and change the topic of conversation to something more light

and simple.

8.

Visualize.

Many people claim that visualizing protective light/energy shields around them helps to

deflect psychic fatigue, and maintain a neutral and calm state of mind.

Try it some time.

9.

Avoid When Possible.

This is not always possible, but is a simple and straight-forward technique to assist in

your self-preservation.

I don�t recommend this as a consistent resolution, as the less you come in contact with the Vampire/s

the less opportunity you�ll have to develop, and put into practice, a useful and necessary

life skill.

10.

Cut Off Contact.

This is the last resort.

Sometimes for your own health and happiness, you need to make difficult decisions regarding

who you choose to surround yourself with.

In the end, if you continue to suffer, the best option may be to simply cut ties and

move on.

For more infomation >> 10 Ways To Protect Yourself From Energy Vampires - Duration: 8:44.

-------------------------------------------

Genetics and Your Health | On Call with the Prairie Doc | Dec 29, 2016 - Duration: 55:19.

>> IN 1856, GREGOR MENDEL GAVE US OUR FIRST LOOK INTO THE IMPORTANCE OF GENES.

TODAY WE'RE ENTICED BY EXCITING NEW TREATMENTS FOR DISEASES.

"GENETICS AND YOUR HEALTH," TONIGHT, "ON CALL WITH THE PRAIRIE DOC."

>> GOOD EVENING, AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."

TONIGHT OUR EYES TURN TO THE RAPIDLY EVOLVING MEDICAL FIELD OF GENETICS.

OVER THE CENTURIES, SCIENTISTS HAVE DEVELOPED AN UNDERSTANDING

OF THE GENETIC CODE ENTWINED IN A DOUBLE HELIX WITHIN EVERY CELL.

IT IS THE TEMPLATE THAT MAKES EACH OF US LOOK AND ACT LIKE A

COMBINATION OF OUR MOTHER AND OF OUR FATHER.

NOW THE HUMAN GENETIC JIGSAW PUZZLE HAS BEEN PUT TOGETHER,

AND THERE ARE WONDERFUL MEDICAL CONSEQUENCES FOR SUCH KNOWLEDGE.

MORE ABOUT THIS TONIGHT.

FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.

WHO ESTABLISHED THE CONCEPT THAT EVOLUTION OCCURS AS A RESULT OF NATURAL SELECTION

AND SURVIVAL OF THE FITTEST? A. GREGOR MENDEL; B. CHARLES DARWIN; OR

C. JEAN-BAPTISTE LAMARCK? WE WILL GIVE THE ANSWER AT THE END OF THE SHOW.

JOINING US TONIGHT IS DR. CASSIE HAJEK, CHIEF OF THE DIVISION OF GENETICS MEDICINE

AT THE U.S.D. SANFORD SCHOOL OF MEDICINE.

ALSO WITH US IS DR. ERIK EHLI, SCIENTIFIC DIRECTOR WITH THE AVERA INSTITUTE FOR HUMAN GENETICS.

THANK YOU BOTH FOR JOINING US.

>> THANK YOU.

>> SO, CASSIE, TELL US A LITTLE BIT ABOUT YOURSELF. YOU DIDN'T START OFF AS THE CHIEF OF GENETICS.

WHERE DID YOU TRAIN AND WHAT DID YOU TRAIN AS?

>> SO I TRAINED AS AN INTERNIST. >> LIKE ME.

>> LIKE YOU, YES. AND I LOVE INTERNAL MEDICINE, I LOVE PRIMARY CARE, PREVENTIVE HEALTH,

BUT THAT WAS ALSO ONE OF THE THINGS THAT SORT OF DROVE AN INTEREST IN GENETICS. >> RIGHT.

>> STARTED TO KIND OF THINK ABOUT THINGS THAT MAYBE PRESENT LIKE A COMMON DISEASE THAT

AREN'T NECESSARILY A COMMON DISEASE, AND AS I WENT THROUGH GENETICS TRAINING AT UCLA,

I FOUND THAT THERE ARE A HANDFUL OF THINGS THAT ARE LIKE THAT SO IT JUST PIQUED MY INTEREST,

AND I ALSO HAVE AN INTEREST IN COMMON DISEASE GENETICS WHICH IS EVOLVING FIELD

BUT NOT QUITE READY FOR PRIME TIME, I WOULD SAY.

SO I WENT BACK WITH TRAINING AND HERE I AM PRACTICING ADULT GENETICS AND WORKING

WITH THE SCHOOL OF MEDICINE AND OUR RESIDENCY PROGRAM TO HELP INCREASE EDUCATION IN THAT AREA.

>> IT'S FASCINATING, AND IT'S GOING TO EVOLVE RIGHT BEFORE YOUR VERY EYES AND BLOSSOM AND

FLOWER AS YOU DEVELOP IN YOUR FIELD. I'M THRILLED FOR YOU.

>> YEAH, IT'S BEEN REALLY FUN. EVEN IN THE SHORT TWO YEARS OF MY TRAINING --

>> EVERYTHING'S CHANGED. >> EVERYTHING'S CHANGED. WHEN I GOT THERE, WE WERE LOOKING AT XSOMES,

AND WHEN I LEFT, WE WERE LOOKING AT GENOMES BUT TO SEE THE RAPID CLINICAL TRANSITION

WAS FASCINATING, AND IT CONTINUES TO BE.

>> RIGHT, WELL, AND THEN, ERIK, YOU'RE Ph.D. IN MOLECULAR GENETICS. >> RIGHT.

>> ORIGINALLY FROM SOUTH DAKOTA?

>> YEP, BORN AND BRED, RAISED IN ABERDEEN, SOUTH DAKOTA. >> AN ABERDONIAN.

>> ABERDEEN. AS A YOUNG BOY, I ALWAYS HAD A FASCINATION WITH MATH, SCIENCE,

AS I STARTED TO GET OLDER, I HAD A KEEN EYE TOWARDS HEALTH CARE AND REALLY WANTED TO UTILIZE

MY MATH AND SCIENCE KNOWLEDGE TO HELP PEOPLE SO ONE OF THE FIRST THINGS I DID WAS GET

A NURSING DEGREE AT SOUTH DAKOTA STATE UNIVERSITY, AND --

>> YOU WERE AT -- YOU'RE AN SDSU GRAD. >> I'VE BEEN THROUGHOUT THE REGENTIAL SYSTEM IN SOUTH DAKOTA.

>> AND THEN YOU WENT TO USD -- >> I WENT TO NORTHERN STATE, GOT MY BACHELOR'S DEGREE IN BIOLOGY

AND ACTUALLY WENT TO THE UNIVERSITY OF SOUTH DAKOTA AND GOT MY MASTER'S DEGREE IN MICROBIAL GENETICS,

AND THEN WENT TO SDSU AND GOT MY REGISTERED NURSING DEGREE AND WORKED AT AVERA McKINNON

AS A REGISTERED NURSE FOR A LITTLE OVER A YEAR, AND THEN REALLY, AT THAT TIME REALLY WANTED

TO HELP PEOPLE, AND GOT A JOB IN 2006, AND AT THAT TIME, I WENT TO USD AND GOT MY Ph.D.

IN MOLECULAR GENETICS AND HAVE BEEN WORKING THERE SINCE AND TRYING TO REALLY TRANSLATE IF --

AND WENT TO THE BENCH TO TRY TO WORK.

>> WE'VE LOT OF BENCH STUFF BUT WHAT CAN WE DO TO MAKE IT EM IS THE HOTTEST AREA.

WE TALKED A LITTLE EARLIER ABOUT CANCER THERAPY WITH FINDING A PARTICULAR PART OF A CANCER CELL

AND GIVING A VACCINE AGAINST IT. COULD YOU EXPLAIN THAT A LITTLE BIT?

>> WELL, CANCER IS A DISEASE OF THE GENOME. IN ORDER FOR A NORMAL CELL TO TURN INTO A CANCER CELL,

SOMETHING HAS TO HAPPEN TO THE DNA.

THERE HAS TO BE SOME SORT OF MUTATION, SOME SORT OF TRIGGER THAT CAUSES THAT DNA TO MUTATE

AND CAUSE THAT CELL TO GROW UNCONTROLLABLY.

IF WE CAN IDENTIFY WHAT THAT MUTATION IS, AND HOW THAT AFFECTS THE PROTEINS ON THE SURFACE OF THE CELL,

WE CAN UTILIZE OUR IMMUNE SYSTEM, OUR T-CELLS AND CHARGE THEM UP AGAINST THAT CERTAIN PROTEIN,

THAT FAULTY PROTEIN AND UTILIZE THEM AS ALMOST A VACCINE TO TARGET THOSE FAULTY CELLS,

AND TO REMOVE THEM FROM THE TUMOR ALMOST AS THEY WOULD REMOVE A BACTERIA OR A VIRUS --

>> THAT'S ACTUALLY HAPPENING, I MEAN, THAT'S KIND OF THEORETICAL STUFF, ISN'T IT?

>> IT'S THEORETICAL BUT IT'S BEING REALLY PUT INTO PRACTICE. PEOPLE ARE STARTING TO UTILIZE

THIS TECHNOLOGY IN CLINICAL TRIALS TO REALLY SEE WHAT THE EFFICACY OF THIS IS,

TO SEE IF THERE ARE ANY SIDE EFFECTS RELATED TO THIS TYPE OF THERAPY, AND HOPEFULLY IN THE FUTURE,

THIS WILL BE PART OF MEDICAL PRACTICE AND IT WILL BE FDA APPROVED TO UTILIZE

SOME OF THE THERAPIES TO HELP PATIENTS WITH CANCER.

>> BUT RIGHT NOW AT THE RESEARCH LEVEL. >> RIGHT NOW IT'S IN THE RESEARCH LEVEL.

>> CASSIE, ANY EXPERIENCE THAT YOU HAVE THAT'S SIMILAR? BECAUSE WE HAVE TWO-SYSTEMS,

WE HAVE THE AVERA SYSTEM AND THE SANFORD SYSTEM.

>> MY EXPERIENCE IS IN THE CLINICAL REALM WITH CANCER RISK PREDICTION, SO, FOR EXAMPLE,

ABOUT -- WE KNOW -- FROM WHAT WE KNOW NOW, ABOUT 5 TO 10% OF CANCERS ARE PROBABLY RELATED

TO A GENETIC PREDISPOSITION, MEANING WE CAN DO A TEST AND THERE MAY BE A GENETIC MUTATION

THAT HAS LED TO THE CANCER. FOR EXAMPLE, LIKE BRCA 1 AND TWO. >> BREAST CANCER --

>> BREAST CANCER PREDISPOSITION, BREAST AND OVARIAN CANCER -- >> RIGHT, THAT'S THE BRCA ONE AND TWO.

>> CORRECT, YEP. AND SO WE ARE ABLE TO DO THAT, BUT IT'S NOT FOR EVERYBODY, RIGHT?

IT'S FOR PEOPLE WHO MAYBE THERE ARE RED FLAGS, LIKE MULTIPLE FAMILY MEMBERS WITH EARLY ONSET

OF THE SAME TYPE OF CANCER, OR THE FAMILY MEMBERS THAT HAVE MULTIPLE PRIMARY TYPES OF CANCERS.

IN THOSE CASES, THAT KIND OF PUTS UP A RED FLAG, MAYBE THERE IS A GENETIC CONDITION HERE AND

THERE ARE GENETIC TESTS THAT WE CAN DO TO HELP IDENTIFY THAT.

>> BUT NOT EVERYBODY CAN -- I MEAN, HOW EXPENSIVE IS THAT TEST?

>> YOU KNOW, IT IS -- WELL, THAT'S AN INTERESTING THING. THOSE COSTS HAVE BEEN DROPPING SIGNIFICANTLY

SO AT THIS POINT, YOU KNOW, YOU CAN ACTUALLY GET AN OUT-OF-POCKET TEST PANEL FOR AS LOW AS $250

BECAUSE OF THE TECHNOLOGY HAS ADVANCED SO RAPIDLY AND WE'RE LEARNING SO MUCH.

AND THEN IN SOME CASES, INSURANCE COVERS IT, SO IT REALLY DEPENDS ON WHO YOUR INSURER IS AND --

>> WELL, IT'S PROBABLY NOT APPROPRIATE TO GET IT TESTED IF THERE'S JUST A GENERAL KIND

OF A SMALL -- I MEAN, THE COUNSELING IS THE IMPORTANT THING.

>> EXACTLY, IT'S DEFINITELY NOT APPROPRIATE FOR EVERYONE.

LIKE I SAID, THERE ARE CERTAIN SITUATIONS WHERE IF THE FAMILY HISTORY.

VERY STRONG FOR OVARIAN AND BREAST CANCER.

>> YEAH, OR EVEN JUST BREAST CANCER. SOMETIMES THIS -- THIS IS WHAT WE'RE LEARNING, THESE THINGS

DON'T ALWAYS PRESENT THE SAME IN EVERY FAMILY.

SOME FAMILIES WILL BE MORE BREAST HEAVY, SOME WILL BE MORE OVARIAN CANCER, IT'S JUST --

IT REALLY DEPENDS BUT WHEN YOU DO HAVE THOSE EARLIER ONSET CANCER, THAT'S WHEN YOU START

TO BE WORRIED ABOUT A GENETIC PREDISPOSITION. >> RIGHT.

>> AND THEN ONCE YOU KNOW YOU HAVE A RISK FOR THAT, THEN YOU CAN DO INCREASED SCREENING --

>> YEP. >> SCREEN THE FAMILY -- OTHER FAMILY MEMBERS.

>> SCREEN OTHER FAMILY MEMBERS. >> DO MAMMOGRAMS EARLIER.

>> YEAH, AND A LOT OF THESE GENETIC CONDITIONS HAVE ADDITIONAL CANCERS THAT PEOPLE ARE AT RISK FOR,

FOR EXAMPLE, BREAST CANCER, THE BRCA CANCERS, YOU MAY SEE AN INCREASE FOR MALE BREAST CANCER.

MELANOMA, PROSTATE CANCER AND SO IN THESE INDIVIDUALS, YOU WOULD REALLY -- TIMING THE MEN GET FORGOTTEN

IN THESE CASES AND YOU REALLY WANT TO MAKE SURE THAT THE FAMILY KNOWS THAT THERE ARE OTHER CANCERS THAT

ARE ASSOCIATED WITH THESE GENETIC MUTATIONS THAT YOU WANT TO SCREEN FOR.

AND SOMETIMES THE MOST POWERFUL THING IS IF YOU FIND A MUTATION IN A FAMILY MEMBER,

TESTING OTHER FAMILY MEMBERS AND IF THEY'RE NEGATIVE, THEN THEY'RE RELIEVED FROM THAT ADDITIONAL SCREENING

AND THEY CAN BE SCREENED FROM A POPULATION RISK.

>> RIGHT. SO SCREENING FOR CANCER IS ONE THING, TREATING CANCER IS ANOTHER.

AND COUNSELING IS ONE OTHER THING. WHAT ABOUT CHILDREN WITH UNUSUAL CHARACTERISTICS THAT WOULD

MAKE A PERSON WANT TO DO TESTING FOR THAT, FOR EXAMPLE? >> SO THAT'S A BROAD, BROAD CATEGORY.

I MEAN, WE STARTED WITH CANCER -- THERE ARE -- >> OTHER THINGS TO TEST FOR.

>> -- PEDIATRIC CANCERS, BUT OTHER THINGS TO TEST FOR, YOU KNOW, THERE ARE SEVERAL THOUSAND

RARE CONDITIONS THAT ALL HAVE A VARIES PHENOTYPE OR PHYSICAL FEATURES ASSOCIATED WITH THEM, BEHAVIORAL CHANGES.

SOME OF THE AUTISM SPECTRUM DISORDERS ARE NOW STARTING TO -- WE'RE STARTING TO SEE A GENETIC PREDISPOSITION

TO THOSE, ALTHOUGH IT'S A SMALL PERCENTAGE.

BUT IT'S A REASONABLE THING TO THINK ABOUT WHEN YOU HAVE SOMEONE WHO HAS A REAL DIAGNOSIS OF AUTISM SO --

FOR A GENETICS REFERRAL.

>> AND WE CAN CHECK FOR GENETICS ON THAT, THAT'S VERY INTERESTING.

>> WE'RE GOING TO TALK ABOUT PHARMACO GENETICS WHEN WE COME BACK.

>> GENETIC COUNSELORS USED TO BE A RARITY, BUT AS WE LEARN MORE ABOUT GENETICS,

THE NEED FOR GENETIC COUNSELORS HAS GROWN.

>> WHEN I TELL SOMEBODY I'M A GENET IF I CAN COUNSELOR, I GETS TONS OF QUESTIONS,

DO I HELP DESIGN HOW MANY BABIES AND THINGS LIKE THAT.

I LIKE TO DESCRIBE IT AS HAVING A GENETICS EDUCATION AND HELP PEOPLE UNDERSTAND WHAT'S GOING ON WITH THEM,

IF THEY HAVE A CERTAIN CONDITION OR IF THERE'S SOMETHING GOING ON IN THE FAMILY, TRYING TO HELP THEM UNDERSTAND THAT.

AND ALSO THE COUNSELING PIECE, HAVING A FAMILY DEAL WITH WHATEVER CONDITION IS GOING ON, MANAGE IT,

TELL FAMILY MEMBERS, GET RESOURCES. THEY'RE KIND OF BOTH THAT EDUCATION AND COUNSELING PIECES.

I THINK OUR FIRST GENETIC COUNSELORS WERE PROBABLY IN THE MID TO LATE '80s, AND THERE ARE ONLY ABOUT 30,

32 PROGRAMS TO TRAIN GENETIC COUNSELORS IN THE COUNTRY AND IT'S NUMBERS THAT ARE GROWING.

WE ARE UP TO ABOUT 4,000 GENETIC COUNSELORS NOW IN THE COUNTRY, BUT THE NEED IS GROWING

AS WE LEARN MORE ABOUT GENETICS, LEARN MORE ABOUT CONDITIONS THAT WE PREVIOUSLY WEREN'T AWARE OF.

SO A GENETIC TEST IS A BLOOD TEST. WE HAVE DNA IN OUR BLOOD CELLS AND WE SEND THAT BLOOD OFF

TO A LAB THAT CAN ISOLATE THE DNA AND THEN CHECK TO SEE IS THERE ANY PROBLEMS OR, AS I LIKE TO CALL THEM,

SPELLING ERRORS WITHIN THAT GENE THAT WE'RE CURIOUS ABOUT.

I WORK IN ADULT GENETICS SO I SEE A LOT OF FAMILY HISTORIES OF BREAST CANCER, COLON CANCER,

EXAMPLES BEING LYNCH SYNDROME OR THE BRCA GENE.

WE SEE A VARIETY OF DIFFERENT CONNECTIVE TISSUE DISORDERS AND HEART CONDITIONS, LIKE MARFAN'S SYNDROME.

GENETIC COUNSELING HELPS A FAMILY FIRST UNDER THEIR FAMILY HISTORY.

WE TAKE A VERY THOROUGH -- WE CALL IT A PEDIGREE, KIND OF LIKE A FAMILY TREE TO UNDERSTAND

WHAT THE DIFFERENT FAMILY MEMBERS HAVE, HOW OLD THEY LIVED, WHAT TYPES OF CONDITIONS ARE RUNNING IN THE FAMILY.

SO THAT'S THE FIRST PLACE I START WITH, PATIENTS I MEET WITH, GATHERING THAT INFORMATION AND ENCOURAGING THEM

TO REACH OUT TO THEIR FAMILIES TO GATHER THAT INFORMATION.

AND THEN HELPING INTERPRET THAT AND EXPLAINING WHAT IT MEANS TO THEM, WHAT THE RISKS ARE TO THEM,

WHAT THE RECURRENCE RISKS ARE, WHERE DO WE GO FROM HERE, HOW DO WE HELP MANAGE THAT.

AND THEN IS THERE ANY SORT OF TESTING WE SHOULD DO TO HELP CONFIRM THAT GENETICALLY.

WHAT WOULD YOU DO IF YOU DID FIND OUT YOU HAD THIS HER TEARED CANCER SYNDROME?

WOULD YOU THINK ABOUT HAVING A PROPHYLACTIC SURGERY, LIKE ANGELINA JOLIE DID,

OR SOME PEOPLE OPT FOR INCREASED SURVEILLANCE.

SO FIGURING OUT A PLAN THAT FEELS RIGHT TO THE PATIENT IS GOOD TO TALK ABOUT UPFRONT.

WHAT'S GOOD ABOUT IT IS PEOPLE COME IN FOR A TEST,

NOT JUST A BLOOD DRAW AND WE DO MORE THAN THAT.

NOT EVERY PATIENT THAT MEETS WITH ME NEEDS A GENETIC TEST

OR IS THE APPROPRIATE CANDIDATE SO IT REALLY IS JUST BASING OUR CONVERSATION OFF

THE FAMILY HISTORY AND WHAT'S GOING ON AND HELPING PROVIDE EITHER REASSURANCE OR DIRECTION

IN WHERE TO GO WITH WHAT'S GOING ON IN THE FAMILY.

>> SO THAT WAS VERY INTERESTING. THANK YOU SO MUCH, MEGHAN, WHO HAPPENS TO BE

A VERY DEAR FAMILY FRIEND BECAUSE HER GRANDPARENTS GREW UP IN DeSMET,

AND HER GRANDFATHER WAS MY HERO, MENTOR, Dr. BELL, G. ROBERT BELL FROM DeSMET.

SO WE'RE TALKING ABOUT GENETIC COUNSELING AND THERE'S DIFFERENT KINDS.

ERIK, YOU MENTIONED TO ME SIMPLE VERSUS -- MENDELIAN VERSUS COMPLEX.

>> WHEN WE TALK ABOUT GENETICS, WE CAN BREAK THAT DOWN INTO TWO PARTS.

THERE IS THE CLASSIC MENDELIAN GENETICS -- >> MENDELIAN MEANING AFTER... [Overlapping Conversation]

THESE TYPES OF DISORDERS ARE ONE GENE, ONE DISORDER, SO A GOOD EXAMPLE OF THAT IS CYSTIC FIBROSIS,

ANOTHER EXAMPLE IS HUNTINGTON'S DISEASE OR EVEN SICKLE CELL ANEMIA.

>> THAT'S ONE GENE, ONE DISORDER --

>> YOU HAVE THE MUTATION IN THAT GENE, YOU'RE GOING TO GET THAT DISORDER, 100%, NO QUESTIONS ASKED,

NO IFs, ANDS, ORs OR BUTTS ABOUT IT. YOU'LL GET THAT DISEASE AND WE CAN TEST FOR THAT.

Dr. HAJEK WAS JUST TALKING ABOUT HOW WE CAN FIX THE DNA AND LOOK FOR THAT MUTATION IN THAT GENE

AND WE'LL KNOW IF YOU HAVE THAT DISORDER. THAT'S IN STARK CONTRAST TO WHAT WE CALL COMPLEX GENETICS,

AND THE COMPLICATED DISORDERS ARE RARE, THEY AFFECT ONE IN 100,000 PEOPLE.

COMPLEX GENETICS, THE SECOND PART ARE MUCH DIFFERENT, THEY IN CODE FOR DISORDERS THAT ARE COMMON DISEASES.

>> DIABETES. >> DIABETES, HEART DISEASE -- >> CANCER.

>> YEP, CANCER, AND THAT'S NOT ONE GENE, THAT'S SEVERAL GENES,

MAYBE 50 DIFFERENT GENES, 100 DIFFERENT GENES, THAT EACH CONFER A REALLY SMALL RISK TO THAT DISORDER,

BUT MOST IMPORTANTLY, THERE'S ALSO AN ENVIRONMENTAL COMPONENT SO YOU HAVE AN INTERACTION BETWEEN

THE GENETICS AND THE ENVIRONMENT. A LOT OF TIMES IN GENETICS, WE'LL SAY THE GENETIC FACTORS WILL LOAD

THE GUN AND THE ENVIRONMENT WILL THEN PULL THE TRIGGER. [Laughter]

>> THAT'S A NICE -- NOT A NICE --

>> YOU KNOW, ADDICTION IS A GOOD EXAMPLE. YOU CAN HAVE ALL THE GENES, YOU CAN HAVE TEN GENETIC FACTORS

THAT PUT YOU AT RISK FOR NICOTINE ADDICTION BUT IF YOU NEVER TAKE THAT FIRST CIGARETTE

OR YOU NEVER ARE EXPOSED TO THAT ENVIRONMENTAL FACTOR, YOU WILL NOT BECOME ADDICTED TO THAT SO IT'S A CLASSIC GENE

AND ENVIRONMENT INTERACTION.

>> ADDICTION, THAT -- SEE, I WAS IMMEDIATELY INTO THINKING SMOKING AND CANCER OF THE LUNG

AND YOU HAVE THE POTENTIAL FOR CANCER OF THE LUNG BUT YOU'VE NEVER SMOKED SO YOU DON'T GET IT,

BUT YOU'RE TALKING ABOUT THE ADDICTION OF SMOKING.

>> IT COULD BE CANCER, TOO. YOU CAN HAVE GENETIC FACTORS THAT PUT YOU AT RISK FOR CANCER.

Dr. HAJEK WAS TALKING ABOUT THE 5 OR 10% OF CANCERS THAT ARE A GENETIC PREDISPOSITION.

IF YOU HAVE THAT GENETIC PREDISPOSITION, YOU STILL NEED THE ENVIRONMENTAL FACTOR TO MANIFEST THE DISEASE,

WHETHER FOR LUNG CANCER, THAT'S SMOKING, WHETHER FOR MELANOMA, THAT'S --

>> TOO MUCH SUN. >> TOO MUCH SUN, SO THE CANCERS ARE A GENE AND ENVIRONMENT, IT'S A COMPLEX GENETIC DISORDER.

>> JUST TAKING FAMILY HISTORY IS ONE OF THE THINGS THAT I THINK IS A GENERAL INTERNIST IS IMPORTANT.

>> OH, YEAH. YEAH, I THINK FAMILY HISTORY IS STILL PROBABLY THE BEST, YOU KNOW, PREDICTOR FOR VARIOUS CONDITIONS.

IT'S VERY HELPFUL, ESPECIALLY -- WELL, IN MANY DIFFERENT THINGS, I ALWAYS GO TO CANCER BECAUSE MANY PEOPLE

ARE AFFECTED BY CANCER, AT LEAST ONE PERSON IN THE FAMILY IS OFTENTIMES, BUT KNOWING, YOU KNOW,

BEING ABLE TO DETERMINE WHAT KIND OF CANCER, WHO'S AFFECTED, HOW OLD THEY ARE WHEN THEY WERE AFFECTED,

THAT REALLY IS VERY HELPFUL WHEN YOU'RE TRYING TO DETERMINE WHETHER OR NOT THERE IS A KNOWN SINGLE GENE,

GENETIC PREDISPOSITION, OR IF IT'S ON THE OTHER ENDS OF THE SPECTRUM, LIKE Dr. EHLI WAS EXPLAINING,

MORE OF A GENE ENVIRONMENT TYPE OF CAUSE, SO...

>> RIGHT. SO THAT'S INTERESTING THAT, YOU KNOW, I THINK ABOUT THOSE SINGLE GENES, MENDELIAN SITUATIONS

WITH HUNINGTON'S, AND YOU LOOK AT -- I TOOK CARE OF A WOMAN WAY INTO HER ELDER AGE, SHE HAD SEVERAL SIBLINGS

THAT HAD THE SAME DISEASE AND SOME DIDN'T.

SHE SAID IT WAS LIKE LIVING WITH A GUN TO MY HEAD MY WHOLE LIFE BUT, LOOK,

I'VE GONE ALL THESE YEARS AND I DIDN'T GET IT SO MY CHILDREN DIDN'T GET IT, EITHER.

>> THAT'S A TOUGH ONE, WHEN DETERMINING WHETHER OR NOT THEY WANT TO GET TESTING FOR HUNTINGTON'S, WHY KNOW?

WHY KNOW? AND I'VE EXPERIENCED VERY DIFFERENT REACTIONS, SOME OF WHICH I HAVEN'T EXPECTED WHEN DELIVERING RESULTS

FOR HUNTINGTON'S, AND PROBABLY THE MOST SHOCKING HAS BEEN WHEN I'VE GIVEN PATIENTS THE RESULTS

THAT THEY'RE NEGATIVE AND THEY COME BACK WITH SORT OF -- >> DISAPPOINTMENT.

>> KIND OF DISAPPOINTMENT BECAUSE THEY'VE LIVED THEIR LIVES BELIEVING THAT THEY HAVE A CONDITION

AND MAYBE NOT HAD KIDS OR MAYBE HAD TAKEN A DIFFERENT CAREER OR DONE SOMETHING COMPLETELY DIFFERENTLY BECAUSE

THEY HAD THIS IN THEIR MINDS, THEIR REAL-LIFE EXPERIENCE THAT THIS IS WHAT I'M GOING TO HAVE AND THEN THEY DON'T.

>> AND IT'S -- BUT I WOULD BE OVERJOYED NOT TO HAVE HUNTINGTON'S, THEY'VE WATCHED THIS.

IT'S THE WORST -- IT'S PRETTY BAD.

>> IT'S PRETTY BAD AND THEY'VE SEEN THE WORST OF IT AND MY RESPONSE IS THE SAME AS YOURS,

BUT IF YOU'VE LIVED YOUR LIFE THINKING YOU WERE GOING TO HAVE THIS DISEASE, YOU WON'T BE ABLE TO FUNCTION,

YOU'RE GOING TO HAVE THESE ISSUES -- >> THEY DIDN'T GO TO COLLEGE, THEY DIDN'T HAVE FAMILY --

>> YEAH, SO IT'S A VERY UNIQUE COUNSELING SITUATION, VERY DIFFICULT.

>> AS MEGHAN SAID, A LOT OF WHAT SHE DOES IS JUST COMMUNICATION AND SUPPORT, NOT REALLY SO MUCH,

HERE'S YOUR CHANCES AND SO ON, SO FORTH, IT'S A COUNSELING --

>> YEAH, A COUNSELING, AND ALL OF THOSE THINGS ARE IMPORTANT,

ALL THE RECURRENCE RISKS AND ADDITIONAL RISKS AND ALL THOSE

THINGS, BUT YOU'RE STILL TELLING SOMEBODY THAT POTENTIALLY THEY HAVE THIS HEALTH CONCERN THAT IS QUITE SERIOUS,

JUST HELPING THEM THROUGH THE WEIGHT OF THAT IS A BIG PART OF THAT COUNSELING. >> RIGHT.

>> AND THERE'S OTHER IMPLICATIONS, TOO, AND THAT'S WHY THE GENETIC COUNSELOR

REALLY COMES IN BECAUSE IF YOU KNOW YOUR RISK FOR HUNTINGTON'S DISEASE, THAT DOESN'T ONLY AFFECT YOU,

THAT AFFECTS YOUR CHILDREN, THAT AFFECTS MAYBE YOUR MOTHER OR YOUR SIBLING, SO EVEN THOUGH YOU KNOW YOUR RISK,

MAYBE YOUR SIBLING DOESN'T WANT TO KNOW THEIR RISK, OR MAYBE YOUR CHILDREN DON'T WANT TO KNOW --

>> THEY DON'T WANT TO KNOW -- >> OR MAYBE THEY DO, SO THAT TYPE OF GENETIC TESTING IS NOT ONLY FOR

BUT IT HAS IMPLICATIONS FOR OTHER PEOPLE AND THAT'S REALLY WHERE THE GENETIC COUNSELOR CAN EDUCATE

THE PATIENT AND REALLY EXPLAIN TO THEM THE IMPLICATIONS OF KNOWING OR NOT KNOWING, AND WHAT THEY CAN DO WITH THAT.

>> THEY'RE GOING TO BE -- THEY'RE TALKING ABOUT KNOWING IF A PERSON IS GOING TO HAVE ALZHEIMER'S DISEASE OR NOT,

AND THAT'S AN INTERESTING CONCEPT. MAYBE WE REALLY DON'T WANT TO KNOW WHETHER I'M GOING TO HAVE

ALZHEIMER'S DISEASE OR NOT. WHO WOULD WANT TO KNOW THAT, IF THERE'S NOTHING YOU CAN DO?

>> THAT'S HONESTLY THE NUMBER ONE QUESTION I GET, IF I GET TESTING, AM I GOING TO FIND OUT

IF I HAVE ALZHEIMER'S AS AN INCIDENTAL FINDING. NO, BECAUSE WE DON'T HAVE A TREATMENT FOR IT

AND MOST PEOPLE THAT'S REALLY THEIR NUMBER ONE FEAR.

RIGHT NOW IT'S IN A PLACE WHERE WE DON'T -- WE DON'T KNOW HOW TO TREAT IT SO WHAT DOES HAVING THAT INFORMATION DO?

>> NOT WORTH IT. IGNORANCE IS BLISS. THERE IS A TIME WHEN YOU JUST DON'T WANT TO KNOW.

WE TALKED ABOUT PHARMCOGENETICS EARLIER BEFORE THE SHOW. TELL US ABOUT WHAT WE'RE DOING WITH THOSE.

>> THAT'S A REALLY GOOD QUESTION. PHARMCO GENETICS IS A RELATIVELY NEW FIELD OF GENETICS

AND REALLY WHAT IT ENTAILS IS THE BODY'S GENES RESPONDS TO MEDICATION WE'RE TAKING.

EVERY MEDICATION HAS TO BE REMOVED FROM THE BODY.

MOST OF THESE MEDICATIONS ARE EXCRETED THROUGH THE LIVER OR THE KIDNEY WHERE CERTAIN GENES THAT MAKE PROTEINS MODIFY THESE

DRUGS AND WE RELEASE THEM FROM OUR BODY.

BUT THESE GENS COME IN DIFFERENT FORMS, SO YOU MAY HAVE PAY FORM OF THE GENE THAT MAKES YOU A POOR METABOLIZER

FOR MEDICATION OR YOU MAY HAVE A CERTAIN FORM THAT MAKES YOU ULTRA RAPID METABOLIZER OF A MEDICATION.

YOU CAN UNDERSTAND THE IMPLICATIONS IF YOU'RE A POOR METABOLIZER AND YOU GET THE STANDARD DOSE OF THE MEDICATION

FROM YOUR PHYSICIAN, THAT MEDICATION IS GOING TO BUILD UP IN YOUR SYSTEM AND YOU'RE GOING TO BE THE INDIVIDUAL

THAT HAS THE SIDE EFFECTS, THE ADVERSE EFFECTS, YOU'LL PROBABLY TAKE -- >> THE OVERDOSE, ACCIDENTAL OVERDOSE --

>> MAYBE NOT ACCIDENTAL OVERDOSE BUT YOU MAY HAVE THE SIDE EFFECTS, YOU MAY WANT TO THROW THE BILLS IN THE GARBAGE

BECAUSE YOU DON'T FEEL GOOD WHEN YOU TAKE THEM. >> BUT YOU COULD BE GETTING BY WITH ONE-QUARTER OF THE DOSE.

>> EXACTLY. SOME PEOPLE HAVE A FORM OF THE GENE THAT MAKES THEM AN ULTRA RAPID METABOLIZER WHERE YOU GET

THE STANDARD DOSE OF THE DRUG AND YOUR BODY CLEARS IT OUT OF YOUR SYSTEM SO QUICKLY THAT YOU DON'T HAVE ANY EFFICACY,

AT ALL, YOU HAVE NO RELIEF, FOR EXAMPLE, FOR PAIN, IF YOU'RE AN ULTRA RAPID METABOLIZER FOR A PAIN MEDICINE,

YOUR PAIN WON'T BE ALLIEVED BY THAT MEDICATION.

SO WHAT WE CAN DO IS TAKE DNA SAMPLE, WE DO IT PRETTY PAINLESSLY THROUGH A BLOOD DRAW AND WE EXAMINE THOSE GENES

THAT BREAK DOWN THOSE MEDICATIONS, AND WE CAN -- YOU KNOW, WE HAVE PHARMACISTS THAT LOOK AT SOME OF THAT INFORMATION

AND CAN DETERMINE WHETHER OR NOT YOU'RE AN TRAWL RAPID METABOLIZER, POOR METABOLIZER AND WHAT WE DO IS WE REALLY ENHANCE

THE TOOLBOX OF THE PHYSICIAN, YOU KNOW, AND WE CAN REALLY --

>> ENHANCING THE TOOLBOX OF THE PHYSICIAN, YAY, BECAUSE YOU GET -- I FIND OUT, THEN, THAT I CAN USE THIS MEDICINE,

IT WILL WORK BUT THIS ONE WON'T.

>> EXACTLY, AND IT MAY -- IT MAY EMPOWER YOU TO PICK A DOSE OF THE MEDICINE THAT WILL WORK BETTER FOR THAT PATIENT

AND YOU CAN PERSONALLY TAILOR THE MEDICATION TO THE INDIVIDUAL AND THAT'S REALLY WHAT WE'RE AIMING FOR WITH PHARMCO GENETICS.

HERE IN THE GENETICS LAB, WE WANT TO TRANSLATE WHAT WE DO AT THE BENCH TO THE BEDSIDE, AND ULTIMATELY HELP OUR PATIENTS.

>> SO WHAT DRUGS -- WHAT DRUGS ARE WE LOOKING AT MOSTLY, I MEAN PSYCHIATRIC DRUGS MOSTLY, RIGHT?

>> PSYCHIATRIC DRUGS. >> PLAVIX, WHICH IS A PLATELET INHIBITOR. SO WHEN -- THERE IS SOME VERY GOOD DATA

THAT WAS JUST RELEASED WHICH SHOWS THAT INDIVIDUALS WHO DO GET PHARMCO LOGICAL TESTING TO GET A --

TO DETERMINE WHETHER THEY'RE GOOD RESPONDSERS TO PLAVIX.

IF THEY HAVE THE TESTING AND ARE FOUND OUT THAT THEY DON'T RESPONDS WELL TO PLAVIX, THEY GET PUT TO A DIFFERENT DRUG

AND DATA HAS SHOWN THAT REDUCES THE STENT RETHROMBOSIS.

SO A HUGE FINDING AND THAT KIND OF CHANGE AFFECTS ABOUT 20% OF PEOPLE SO IT'S FAIRLY COMMON TO SEE THESE --

>> A HUGE THING RIGHT THERE, THE RISK OF HAVING A STROKE OR NOT.

>> SO IF WE CAN PREVENT THAT BY SIMPLE BLOOD TEST... [Overlapping Conversation]

>> WOW. >> THE -- PHARMCO GENETIC TESTING IS --

>> COST IS ABOUT IT, RIGHT? THOUGH WE'RE DOWN TO $250 OR SOMETHING LIKE THAT FOR A SCREENING?

OTHER DRUGS, I MEAN THE PSYCHO GENIC MEDICATIONS, THE PEOPLE WITH ANTIDEPRESSANTS.

>> ANTIDEPRESSANTS ARE A NICE TARGET BECAUSE THEY'RE -- THEY GO THROUGH A PATHWAY IN THE LIVER

THAT WE CAN LOOK AT THE GENES THAT BREAK DOWN THOSE MEDICATIONS. PAIN MEDICATIONS --

>> THAT'S HUGE, CERTAINLY IF YOU'RE A PERSON WHO'S IN PAIN.

>> YEAH. WE WANT TO MAKE THE PATIENT COMFORTABLE AFTER SURGERY, SO IN DOING THAT, LOOKING AFTER THEIR GENETICS.

>> I'M ALL IN FAVOR OF THAT. OKAY. SO WHAT IS THE PIECE OF GENETICS THAT MAKES TWINS ALIKE, OR DIFFERENT?

RESEARCH IS KEY TO THE ANSWER.

>> THE AVERA TWIN REGISTER BEGAN HERE BACK IN MAY, THAT'S OUR LAUNCH. HOWEVER, THE HISTORY OF THE TWIN REGISTRY

GOES BACK EIGHT, NINE YEARS WITH OUR COLLABORATION WITH THE SWEPT IN AMSTERDAM

AND A COLLABORATION WITH A LADY DOCTOR BOOMSMA, WE'VE BEEN DOING TWIN RESEARCH SINCE THEN

AND I THINK A NATURAL PROGRESSION FROM THEN WAS TO START OUR OWN TWIN REGISTRY HERE IN SOUTH DAKOTA AND THE MIDWEST.

>> AVERA LOOKS TO THEM AS A MODEL. THEY'VE BEEN IN EXISTENCE FOR 30 YEARS AND IT'S VERY SUCCESSFUL.

IF YOU LOOK AT THE WORK THAT Dr. BOOMSMA AND HER TEAM HAVE DONE IN THE NETHERLANDS AND THE IMPACT

IT'S HAD ON GENETIC DISEASE AND THAT SHE'S A CO-PARTNER AND AVERA IS GOING TO BE STARTING SIMILAR HERE IN THE UNITED STATES,

THAT'S WHY YOU SHOULD BE A PART OF IT IS THERE IS A VERY RICH RESEARCH OPPORTUNITY RIGHT HERE AT HOME.

>> WE ALSO KNOW THAT THE EXPRESSION OF THE GENOME AND EPIGENETICS DEPENDS ON ENVIRONMENT, SO IT'S ALSO FANTASTIC

TO HAVE AN OPPORTUNITY TO COMPARE RESULTS ACROSS TWO CULTURES THAT ARE

ONE IN THE NETHERLANDS AND ONE IN SOUTH DAKOTA.

>> WE HAVE A LOT OF PEOPLE COME IN WHO ARE TWINS AND DON'T REALIZE THAT THEIR FAMILY CAN BE

AND IT'S REALLY AN EXCITING THING TO BE AGE TO HAVE ALL THE SIBLINGS, ALL THE PARENTS, GRANDPARENTS,

IT'S IMPORTANT FOR RESEARCH BECAUSE GENETICALLY WE CAN LOOK AT THE LINKAGE BETWEEN THEM. GENETICALLY AND ENVIRONMENTALLY.

I MEAN, THOSE ARE THINGS LIKE WHAT'S THE -- OF DISEASE STATE, IF SHE WERE TO GET A BREAST CANCER,

SHOULD I BE WORRIED ABOUT IT. BUT A LOT OF OTHER THINGS ABOUT TWINS, WE'RE FASCINATED BY OUR CHILDREN

BECAUSE THEY LOOK ALIKE AND THEY RELATE MORE LIKE SIBLINGS, WHAT'S THE PIECE OF GENETICS THAT MAKES ME ME AND HER HER,

AND, LIKE, OUR PERSONALITIES ARE SOMEWHAT DIFFERENT BUT WE HAVE SO MANY THINGS THAT ARE --

LIKE WE BOTH LIKE MUSIC BUT WE PLAYED SEPARATE INSTRUMENTS. HOW DOES YOUR GENETICS DETERMINE THAT PATHWAY?

AND I THINK MOST TWINS REALLY, REALLY APPRECIATE THAT AND KNOW THAT IT'S A SPECIAL RELATIONSHIP,

SO THAT'S THE OTHER PEOPLE IS WHATEVER THEY FIND OUT FROM A RESEARCH STANDPOINT, IF WE CAN BE A PART OF THAT

JUST BECAUSE OF WHO WE ARE, I THINK WE'RE PRETTY EXCITED ABOUT THAT.

>> THIS IS ACTUALLY SOMETHING WE CAN MAKE A DIFFERENCE ABOUT, MAKE A DIFFERENCE IN HEALTH.

WE CAN PERSONALIZE MEDICINE BASED ON THE INFORMATION WE GET, PERSONALIZE DETERMINING WHETHER YOU'RE AT RISK

TO HAVE A CERTAIN DISEASE OR CERTAIN DISORDER, ACT EARLY ON THAT PREDICTION OR RISK.

>> I THINK I'VE ALSO SEEN IT REALLY HAPPEN IN A TREMENDOUS SENSE OF COMMUNITY AMONG FAMILIES WITH MULTIPLE --

FAMILIES WITH TWINS, BECAUSE IT SETS YOU YOU UP IN KIND OF A SOCIAL NETWORK THAT I THINK YOU MIGHT NOT QUITE OBTAIN

OR ACCESS IN THE SAME WAY WITHOUT THAT. IT BECOMES SORT OF A HUB FOR ALL THINGS RELATED TO LIVING AS A TWIN, AS AN IDENTICAL TWIN.

>> IN GENETICS, COLLABORATION NOW IS THE NORM. THE MODEL OF COMPETITION HAS BEEN TO A LARGE EXTENT REPLACED

BY A COLLABORATIVE MODEL BECAUSE EACH GROUP OF THEIR OWN SIMPLY DOESN'T HAVE THE POPULATIONS,

THE COHORTS AND RESOURCES TO ACHIEVE THE NEXT BREAK-THROUGH, SO WE HAVE TO WORK TOGETHER.

>> THAT WAS FASCINATING.

THE DATA I HAVE LEARNED FROM TWIN STUDIES IS WHEN I WAS DOING RESEARCH ON OBESITY, AN IN THE NETHERLANDS,

THEY HAD IDENTICAL TWINS THAT WERE SPLIT BETWEEN FAMILIES, RAISED IN DIFFERENT ENVIRONMENTS,

EVEN THOUGH THEY WERE IDENTICALLY -- IDENTICAL TWINS, AND THEY FOUND THAT IT WASN'T THE ENVIRONMENT

THEY WERE RAISED IN BUT IT WAS THE GENETICS.

THEY WEIGHED AS ADULTS WHAT THEIR BIOLOGIC PARENTS WEIGHED, NOT WHAT THEIR ENVIRONMENTAL PARENTS WEIGHED.

ISN'T THAT FASCINATING I MEAN, IT TELLS US THAT DESPITE OUR WISHING THAT WE COULD BE SOMETHING DIFFERENT,

YOU KNOW, THINNER OR HEAVIER, I MEAN, WE'RE GOING TO BE KIND OF WHAT OUR PARENTS TELL US.

IT'S MORE OF THE GENETICS THAN THE ENVIRONMENT.

>> IT IS FASCINATING WHAT TWIN STUDIES HAVE CONTRIBUTED TO THE UNDERSTANDING OF COMMON COMPLEX DISEASES,

WHERE YOU CAN -- LIKE THE ABILITY OF CORONARY DISEASE, WE KNOW THAT BECAUSE OF TWIN STUDIES,

FASCINATING THINGS FOR THE FIELD OF GENETICS.

>> TWINS ARE EXTREMELY VALUABLE TO DISEASE STUDIES, AND TO THE FIELD OF GENETICS.

WITH TWINS, YOU KNOW, WE CAN REALLY DETERMINE HOW MUCH, LIKE YOU SAID, IS RELATED TO GENETIC FACTOR

AND HOW MUCH OF A CERTAIN TRAIT OR DISORDER IS RELATED TO THE ENVIRONMENTAL FACTORS.

SO, FOR EXAMPLE, TWO PEOPLE, WON MAY HAVE HIGH BLOOD PRESSURE,

ONE MAY HAVE LOW BLOOD PRESSURE, WHAT'S CAUSING THAT? IS IT THE GENETICS?

OR IS IT THE ENVIRONMENT? ARE WE EATING TOO MUCH SALT?

WITH TWINS, WE CAN REALLY START TO ANSWER THAT QUESTION AND IT REALLY LIES IN THE FACT THAT THERE'S TWO TYPES OF TWINS.

THERE IS IDENTICAL TWINS, WHICH SHARE 100% OF THEIR DNA, AND THERE'S FRATERNAL TWINS

THAT SHARE 50% OF THEIR SEGREGATING DNA, AND THEY'RE NO DIFFERENT THAN BROTHER OR SISTER.

BUT IF WE COMPARE BLOOD PRESSURE BETWEEN IDENTICAL TWINS AND WE COMPARE THE BLOOD PRESSURES

BETWEEN FRATERNAL TWINS, IF GENETICS IS A LARGE COMPONENT OF THAT, YOU WOULD EXPECT THE IDENTICAL TWINS

TO HAVE EQUAL REALLY SIMILAR BLOOD PRESSURE READINGS WHEREAS THE DIZYGOTIC TWINS MIGHT NOT HAVE

AS CLOSELY MATCHING BLOOD PRESSURES, AND IF THE CORRELATIONS BETWEEN IDENTICAL TWINS AND FRATERNAL TWINS

ARE SIMILAR, THEN WE CAN SAY THE ENVIRONMENT IS INFLUENCING IT MORE THAN THE GENETICS.

>> AND WE KNOW THAT THEY BOTH DO, DON'T THEY? SO WE'RE ACTUALLY LOOKING FOR PEOPLE

WHO ARE TWINS OR KNOW OF TWINS THAT THERE IS A NUMBER THEY CAN CALL.

WE CAN PUT THAT ON THE TWIN REGISTRY HERE SO WE'LL GIVE YOU A TELEPHONE NUMBER TO LOOK AT AND -- WELL, THERE IT IS.

>> YEAH, AND EARLIER THIS SPRING, WE AT AVERA INSTITUTE FOR HUMAN GENETICS, WE INAUGURATED OUR OWN TWIN REGISTER

SO WE CURRENTLY HAVE APPROXIMATELY A LITTLE OVER 400 INDIVIDUALS ENROLLED IN OUR TWIN REGISTER AND, OF COURSE,

AS WE SAW, WE COLLABORATE WITH THE NETHERLANDS TWIN REGISTER, TOO, AND THAT GIVES US THE UNIQUE OPPORTUNITY

TO LOOK AT THAT ENVIRONMENT, THAT ENVIRONMENTAL COMPONENT AND HOW THAT INFLUENCES CERTAIN TRAITS AND DISEASES.

THE ENVIRONMENT IN THE NETHERLANDS IS SIGNIFICANTLY DIFFERENT THAN THE ENVIRONMENT HERE IN SOUTH DAKOTA.

>> IT'S DIFFERENT, THEY TALK DIFFERENT THAN WE DO.

>> THEY TALK DIFFERENT BUT THEY EXERCISE DIFFERENT, TOO. [Overlapping Conversation]

THEY EAT A LOT OF FISH AND HERRING AND CHEESE, AND HERE IN THE MIDWEST, WE'RE A LITTLE BIT MORE SEDENTARY,

WE ALL HAVE CARS, ALL DRIVE TO WORK.

>> WE STILL EAT A LOT OF CHEESE. >> CHEESE IS GOOD, YEAH.

>> IT'S NOT GOING TO COST ANYBODY TO CALL THAT REGISTRY --

>> THEN YOU CAN CONTRIBUTE TO SCIENCE. >> KNOWLEDGE.

>> KNOWLEDGE, AND ONE OF THE THINGS WE CAN DO WHEN WE COLLECT A DNA SAMPLE, WE LOOK AT THE DNA

AND ONE OF THE THINGS WE CAN PROVIDE IS WHAT WE CALL ZYGOTIC TESTING, YOU MAY WANT TO KNOW

IF YOU'RE IDENTICAL TWIN OR FRATERNAL TWIN.

THE ONLY WAY TO CONCLUSIVELY KNOW IS TO LOOK AT THE DNA, SO THAT'S SOMETHING WE PROVIDE ALL THE PARTICIPANTS IN...

>> PEOPLE SAY THIS IS A LOT OF DIFFERENCE BETWEEN PEOPLE, FOR EXAMPLE, WE HAVE A PICTURE HERE

OF WILT CHAMBERLAIN AND ANOTHER PERSON SO THEY MUST BE VERY DIFFERENT GENETICALLY, OR HOW DIFFERENT ARE THEY?

CASSIE, WHAT'S THE GENETIC DIFFERENCE, A LOT OF DIFFERENCE BETWEEN THOSE TWO PEOPLE?

>> WELL, WE ACTUALLY DO KNOW A FAIR AMOUNT ABOUT THE GENETICS OF HEIGHT.

IT'S NOT MY AREA OF EXPERTISE BUT THE MAJORITY OF THEIR GENOME IS THE SAME.

>> JUST EXACTLY THE SAME.

>> YEAH, BUT OBVIOUSLY THERE IS A LITTLE VARIATION THERE IN THE HEIGHT --

>> AND THE COLOR, TOO, I THINK -- THEIR SKIN COLOR AND EVERYTHING EXCEPT THAT THEY ARE

NECESSITY GETCALLY SO CLOSE, STILL -- THEY ARE GENETICALLY SO CLOSE --

>> WE ALL SHARE THE VAST MAJORITY OF OUR GENOME WITH EACH OTHER, AND THERE ARE TEENY, TINY VARIATIONS

THAT PROBABLY DON'T -- THAT MAKE US UNIQUE

>> THE FIRST HUMAN GENOME WAS SEQUENCED IN 2002, AND WHAT THAT MEANS IS PUTTING IN ORDER ALL THREE BILLION

NUCLEOTIDES THAT ARE IN OUR GENES, AND WHEN THE MAJOR TAKE-HOME MESSAGES OF THE HUMAN GENOME PROJECT

WAS HOW SIMILAR WE ARE.

SO IF YOU WOULD TAKE YOUR THREE BILLION As, Cs, Ts, AND LINE THEM UP AND PUT MINE UNDERNEATH THEM,

99.9% OF THEM WOULD BE EXACTLY THE SAME.

.1% WOULD BE DIFFERENT, AND THAT .1% IS WHAT MAKES WILT CHAMBERLAIN GROW TALL, WHAT MAKES WILLIE SCHUMACHER

THE JOCKEY A LITTLE BIT SHORTER, IT'S WHAT GIVES ME FRECKLES, IT'S WHAT -- BLUE EYES.

>> YOU HAVE BLUE EYES, I HAVE BROWN EYES, BUT OTHERWISE WE'RE JUST ABOUT THE SAME

>> AND UNFORTUNATELY, THAT .1% IS WHAT PUTS US AT RISK FOR DISEASE, WHAT MAKES US METABOLIZE DRUGS DIFFERENTLY,

AND AS GENETTISTS, THAT'S WHAT WE'RE INTERESTED IN. WE WANT TO STUDY THAT.

>> YOU KNOW, YOU WERE TALKING EARLIER ABOUT THE TWINS AND I WAS THINKING ABOUT A COMMENT

I HEARD ABOUT IF HE CAN CALL TESTING AND THE WHOLE THING ABOUT -- ABOUT FECAL TESTING

AND THE WHOLE BIOTESTING AND WE LIVE -- >> MICROBES.

>> MICROBES THAT SURROUND US, THERE ARE MORE MICROBES ON AND IN OUR BODY THAN THERE ARE CELLS OF US, RIGHT?

I MEAN, WE ARE A SLURRY OF THE ENVIRONMENT, AS WELL, SO HOW IMPORTANT IS THAT?

THAT'S AN ENVIRONMENTAL THING, RIGHT, NOT A GENETIC THING?

>> BOTH. SO YOU'RE REFERRING TO THE MICROBIOME, WHICH REALLY MEANS ALL THE MICRO-ORGANISMS IN AN ENVIRONMENT,

SO WE'RE TALKING BACTERIA, VIRUSES, YEAST, FUNGI, AND WE HAVE, YOU KNOW, TEN TIMES MORE CELLS

OF THOSE MICROBES THAN WE HAVE OUR OWN CELLS. >> GIVES ME THE HEEBEE JEEBIES.

>> AND 99% OF THEM ARE IN OUR GUT, ARE IN OUR INTESTINE.

>> THAT'S THE C. DIFFICILE OVERGROWTH WHOLE THING AND ANTIBIOTICS OVERGROWTH.

WHERE WOULD YOU GO WITH THAT, CASSIE?

THE C DIFFICILE IS SOMETHING WE REALLY FEAR, STRUGGLE WITH.

>> IT'S VERY COMMON, IT'S OUT THERE BUT WE HAVE MADE PEOPLE A LOT MORE SUSCEPTIBLE

THAN WE PROBABLY NEED TO BY USING A LOT OF ANTIBIOTICS, WHICH KILLS OUR

INTERNAL MICROBE -- OUR INTERNAL BIOME THAT PROTECTS US, SO -- >> RIGHT. >> SO IT'S, YOU KNOW...

>> AND THERE IS A WHOLE NEW ERA OF PROBIOTICS, SO YOU HEAR OF YOGURTS AND PILLS, WHERE YOU CAN,

YOU KNOW, ACTUALLY INGEST BENEFICIAL BACTERIA TO HELP CHANGE THAT ENVIRONMENT WITHIN OUR GUT,

SO THOSE BACTERIA IN OUR GUT, YOU KNOW, WE HAVE ABOUT 20,000 GENES BUT IF YOU ADD UP

ALL THE GENES OF THOSE MICROBES AND -- IN AND ON US, WE HAVE ABOUT 3.3 MILLION GENES OF THOSE,

AND THOSE ARE ALL -- AFFECT OUR APPETITE, THEY AFFECT OUR MOOD.

THERE'S REALLY PRELIMINARY EVIDENCE THAT THOSE GENES AND THE GENE PRODUCTS FROM THOSE MICROBES

THAT INHABIT US ALSO AFFECT OUR DEPRESSION WITH ANXIETY, SO IT'S REALLY NAIVE TO THINK

THAT ALL OF THOSE MICRO-ORGANISMS THAT ARE ON US AND IF YOU ACTUALLY WEIGHED THEM,

IT WOULD BE ABOUT THREE POUNDS, THE SIZE OF -- >> IS THAT RIGHT?

>> THE SIZE OF A HUMAN BRAIN, THEY HAVE A PHYSIOLOGICAL AFFECT ON OUR HEALTH AND DISEASE,

AND WHAT WE DO IS WE CAN ACTUALLY -- YOU MENTIONED TAKING A FECAL SAMPLE,

SO SOME OF THE PARTICIPANTS IN THE NETHERLAND TWIN REGISTER WILL PROVIDE THAT TO US

AND WE CAN TAKE THAT FECAL SAMPLE AND LOOK AT THE DNA OF THOSE MICRO-ORGANISMS

AND WE CAN THEN GET AN IDEA OF THE NUMBER OF MICRO-ORGANISMS, THE DIVERSITY OF MICRO-ORGANISMS,

ONE OF THE -- ONE OF THE THOUGHTS THAT THE MORE DIVERSE NUMBER OF MICRO-ORGANISMS,

THE MORE YOU HAVE OF THE DIFFERENT CLASSES, THE MORE HEALTHY YOU ARE. SO --

>> DIVERSITY IS HEALTH. >> YEAH, YEAH

>> WELL, THEY TALK ABOUT DIVERSITY BEING HEALTHY IN THE TREES OF A SMALL COMMUNITY.

IF ALL YOU HAVE IS DUTCH ELM IN THAT COMMUNITY, AND DUTCH ELM DISEASE COMES IN

THE TOWN IS WITHOUT TREES.

IF YOU'VE GOT A MIXTURE OF ALL SORTS OF DIFFERENT KINDS OF TREES, THE DUTCH ELM MAY COME IN

AND WIPE OUT ONE BUT IT'S NOT GOING TO BE SPREADING THAT EASILY THROUGH THE WHOLE TOWN.

IT WILL MAYBE HIT ONE OF THOSE, BUT A LOT OF DUTCH ELMS WON'T EVEN BE AFFECTED

BECAUSE THERE ARE ALL THESE OTHER TREES AROUND.

>> THAT'S A VERY GOOD EXAMPLE. >> YEAH, IT IS.

>> THAT'S A SOUTH DAKOTA DEAL BECAUSE DUTCH ELM DISEASE WIPED OUT MANY OF THE BEAUTIFUL TREES

IN SOUTH DAKOTA, IOWA, NEBRASKA AND SURROUNDING STATES.

THEY SAY THE MORE DIVERSE WE ARE, THE BETTER.

THAT LEADS TO WHAT IS -- WHERE IS THE GREATEST DIVERSITY IN THE GENETIC POOL OF THE WORLD?

HAVE YOU HEARD THAT DISCUSSION? THEY SAY IN THE MIDDLE OF AFRICA IS THE MOST DIVERSITY.

IF YOU GO UP TO NORTHERN EUROPEAN, WE ARE SO CLOSE THAT DUTCH ELM COULD WIPE US OUT IF...

ANY COMMENT --

>> BUT, YOU KNOW, AND THAT'S BEEN AN AREA WHERE SOME OF OUR UNDERSTANDING OF COMMON DISEASE IS LACKING.

MANY OF THE GENOME, MA'AM ASSOCIATION STUDIES THAT WE LOOK AT FOR THINGS LIKE HEART DISEASE AND DIABETES

AND HYPERTENSION REALLY DO FOCUS ON A WESTERN EUROPEAN, NORTHERN EUROPEAN POPULATION AND WE'RE JUST NOW

STARTING TO HAVE MORE STUDIES IN AFRICAN AMERICAN POPULATIONS, HISPANIC POPULATIONS, BECAUSE,

OBVIOUSLY, THE GENETIC PREDISPOSITIONS ARE GOING TO BE DIFFERENT AMONG THESE PEOPLE,

WE KNOW THAT BY A PREVALENCE OF DISEASE AND SO WE HAVE A LOT OF -- A LOT TO LEARN ABOUT

THE GENETIC COMPOSITION OF COMPLEX DISEASES IN SOUTH DAKOTA, THE MINORITY POPULATIONS

AND THE REST IS THE MAJORITY OF THE POPULATIONS, SO THAT'S AN AREA THAT'S GROWING RAPIDLY, I THINK, TOO.

>> WE HAVEN'T SAID A WORD ABOUT EPIGENETICS YET, THE NEW THING THAT'S BLOWN ME

OUT OF THE WATER IS TO REALIZE THAT THE TURNING ON AND OFF OF GENES CAN BE INHERITED,

AND THAT IF I WERE A SMOKER, MY GRANDCHILD WHO NEVER KNEW ME MIGHT BE INFLUENCED BY MY SMOKING.

COULD YOU EXPLAIN THAT A LITTLE BIT, CASSIE? TURNING TO THIS GUY?

>> WELL, EPIGENETICS IS A VERY HOT AREA OF GENETICS RESEARCH AND YOU HIT THE NAIL

ON THE HEAD, WHERE WE TALK ABOUT GENE ACTIVITY, YOU KNOW, TURNING GENES ON, TURNING GENES OFF,

AND WHAT THAT REALLY MEANS IS ALL THE CELLS IN OUR HUMAN BODY HAVE THE SAME DNA, HAVE THE SAME --

>> EVERY SINGLE CELL- >> EVERY SINGLE CELL. >> SAME DNA.

>> BUT WHAT MAKES A SKIN CELL DIFFERENT FROM A NERVE CELL, DIFFERENT FROM A SPLEEN CELL

DIFFERENT FROM A LIVER CELL ARE WHAT GENES ARE TURNED ON AND WHAT GENES ARE TURNED OFF.

AND THAT'S REALLY CONTROLLED BY EPIGENETICS, AND BY EPIGENETICS, WE MEAN -- EPI MEANS ON TOP OF,

SO EPIGENETICS IS, YOU KNOW, GENE ACTIVITY CHANGES THAT DON'T AFFECT THE SEQUENCE OF THE DNA

AND ARE INHERITED TO, YOU KNOW, SUCCESSIVE GENERATIONS.

AND THAT'S TYPICALLY ACCOMPLISHED BY LITTLE MARKS THAT SIT ON TOP OF THE DNA AND TELL THEM

TO TURN ON OR TELL THEM TO TURN OFF, AND THOSE MARKS ARE PLACED THERE THROUGH ENVIRONMENTAL SIGNALS,

SO YOU MENTIONED SMOKING, IT COULD BE PLAYING VIOLIN, YOU KNOW, IF YOU PLAY VIOLIN,

YOU MAY HAVE SOME MARKS THAT CHANGE THE DNA AND INFLUENCE, YOU KNOW,

NEUROTRANSMITTERS IN YOUR BRAIN -- >> THAT YOU CAN HEAR --

>> YOU MAY FOCUS A LITTLE BIT BETTER, YOU MAY HAVE MORE CONCENTRATION.

IMAGINE, YOU KNOW, HAVING, YOU KNOW, A VIOLIN AND BEING ABLE TO PUT THE BOW TO THAT

AND PLAY A NICE CLASSICAL PIECE OF MUSIC, THAT TAKES A LOT OF FOCUS, A LOT OF CONCENTRATION.

THAT CAN REALLY MODEL THE BRAIN AND CHANGE IT IN A WAY THAT'S BENEFICIAL.

ALTERNATIVELY, BY SMOKING OR BY EATING TOO MUCH OR BY NOT EXERCISING, YOU CAN ALSO AFFECT

THE GENE ACTIVITY CHANGES AND -- >> YOUR CHILDREN WILL INHERIT THESE THINGS

>> AND THERE'S ACTUALLY A CLASSICAL DUTCH STUDY WHERE THEY WENT THROUGH A PERIODS OF FAMINE

IN THE 1940s AND MOTHERS WHO WERE PREGNANT WHO DIDN'T HAVE A LOT OF FOOD, THEIR CHILDREN ACTUALLY,

THEN -- AND THE -- COMPARED THEM TO CHILDREN THAT WERE BORN IN TIMES OF PLENTIFUL FOOD,

THE CHILDREN THAT WERE BORN WHEN THERE WAS AMPLE FOOD ACTUALLY WERE MORE SUSCEPTIBLE TO HEART

DISEASE AND OTHER TYPES OF DISORDERS, AS WELL.

>> SO A LITTLE BIT OF STARVATION IN THOSE MOTHERS BENEFITED THE CHILDREN, GO FIGURE.

>> AND IT'S ALL THROUGH EPIGENETICS.

>> IT'S AMAZING, IN OUR WORLD, WE'VE -- WE SEEM TO BE HAVING MORE AND MORE OBESITY.

CASEY, DO YOU THINK THAT HAS AN EPP GENETIC RESULT? HAVING IT DOES.

>> OF COURSE IT DOES. WE KNOW THAT EPIGENETICS PLAYS A ROLE IN PROBABLY MOST OF OUR HEALTH

AND AS WE SEE OUR OBESITY RATES INCREASING, IT'S KIND OF EXCEEDED THE STAGE OF AN EPIGENIC,

MOST LIKE THE NORM, PEOPLE EXPECT OBESITY BUT THAT REALLY, TRULY WILL AFFECT OUR CHILDREN.

>> SO WHAT YOU EAT NOW DOESN'T ONLY AFFECT YOU, ALSO AFFECTS YOUR CHILDREN. >> WOW.

>> SO IF THAT'S NOT MOTIVATION FOR A HEALTHIER DIET --

>> LET'S GET EXERCISING, LET'S NOT EAT SO MUCH AND LET'S PLAY THE VIOLIN.

THAT'S WHAT I'VE LEARNED FROM THE SHOW TODAY.

>> AND NOW FOR THE ANSWER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.

WHO ESTABLISHED THE CONCEPT THAT EVOLUTION OCCURS AS A RESULT OF NATURAL SELECTION

AND SURVIVAL OF THE FITTEST?

A. GREGOR MENDEL; B. CHARLES DARWIN; OR C. JEAN-BAPTISTE LAMARCK?

THE ANSWER IS, B. CHARLES DARWIN. WE'LL BE RIGHT BACK AFTER THIS.

>> ALL AROUND TOWN, FROM STORES TO PLAYGROUNDS, BABIES ARE ON THE MOVE.

AND THERE ARE DISEASES THAT ARE ON THE MOVE, TOO, AND SOME OF THESE SPREAD EASILY.

TO BEST PROTECT HIM FROM 14 SERIOUS DISEASES BY THE TIME HE TURNS 2 YEARS OLD,

VACCINATE HIM ACCORDING TO THE RECOMMENDED SCHEDULE, SO HE CAN GO ON ABOUT HIS BUSINESS

AND YOU CAN HAVE PEACE OF MIND.

FOR MORE REASONS TO VACCINATE, TALK TO YOUR CHILD'S DOCTOR OR GO TO CDC.GOV/VACCINE.

>> WHEN DID WE FIRST UNDERSTAND WHAT DIRECTS THE SHAPE OF OUR NOSE, FOOT SIZE, PERSONALITY,

AND CHANCE OF SURVIVING IN A TOUGH WORLD?

THERE IS AN INTERESTING HISTORY ABOUT HOW WE LEARNED THAT OUR ANCESTRAL GENES AND ENVIRONMENT

ARE RESPONSIBLE.

HIPPOCRATES AND ARISTOTLE STATED THAT HEREDITY MATERIAL GATHERS FROM THROUGHOUT PARENTS'

BODIES AND MIX DURING THE SEXUAL ACT.

ABOUT THE SAME TIME, ANCIENT SCHOLARS FROM INDIA ADDED TWO MORE FACTORS OF HEREDITY.

THEY ADD THE SOUL, WHICH ENTERS THE BABY FROM SOME UNDEFINED PLACE,

AND THE DIET OF THE MOTHER.

IN THE MID-1700S, CARL LINNEAUS, A BRILLIANT SWEDISH BOTANIST/PHYSICIAN, BELIEVED

THAT BOTH SHARED PARENTAL FLUIDS AND ENVIRONMENTAL FACTORS INFLUENCED INHERITANCE.

LATE IN THE 1700S, JEAN-BAPTIST LAMARCK PROPOSED THAT ANIMALS CAN ACQUIRE CHARACTERISTICS

INFLUENCED BY THEIR ENVIRONMENT AND PASS THAT ON DIRECTLY.

HIS FAMOUS EXAMPLE WAS THE LONG NECK OF THE GIRAFFE THAT HE THOUGHT RESULTED

FROM PARENTS STRETCHING TO REACH LEAVES.

HE THOUGHT THIS CHARACTERISTIC WAS THEN DIRECTLY PASSED ON TO OFFSPRING.

IN THE MID-1800S, GENETIC UNDERSTANDING WAS GREATLY ADVANCED BY FRIAR GREGOR MENDEL,

WHO WORKED MOSTLY ON PEA PLANTS. HIS INFLUENCE IS STILL TAUGHT IN BIOLOGY CLASSES.

ABOUT THE SAME TIME, ENGLISH NATURALIST CHARLES DARWIN PUT TOGETHER OBSERVATIONS OF

ANIMALS AND PLANTS FROM A FIVE-YEAR AROUND-THE-WORLD SAILING EXPEDITION ON THE HMS BEAGLE.

HIS REVOLUTIONARY AND FAMOUS WORK CAME OUT IN 1859 ENTITLED, "ON THE ORIGIN OF SPECIES."

DARWIN DEFINED EVOLUTION AS THE RESULT OF NATURAL SELECTION ACTING ON RANDOM MUTATIONS.

PUT IT ANOTHER WAY, EACH SPECIES IMPROVES ONLY THROUGH SURVIVAL OF THE FITTEST

OF EACH SUBSEQUENT OFFSPRING.

FOR EXAMPLE, THE WEAKEST WOLF PUPS OF THE LITTER DON'T MAKE IT,

BUT THE STRONGEST ARE BEST ABLE TO REPRODUCE WITH A MATE AND HAVE OFFSPRING,

THUS PASSING ON THE ADVANTAGE THROUGH SELECTION.

DARWIN'S NATURAL SELECTION THEORY CLEARLY DISMISSED LAMARCK'S GIRAFFE ENVIRONMENTAL EXAMPLE.

SCIENTISTS FELT THAT WITH DARWIN, THEY FINALLY HAD THE ANSWER TO THE PUZZLE.

BUT CONTROVERSY FOLLOWED DARWIN LIKE A PACK OF WILD DOGS.

DARWIN WAS OPPOSED BY MANY RELIGIOUS LEADERS SINCE GOD SEEMED REMOVED FROM THE PROCESS.

DARWIN, A VERY RELIGIOUS MAN, BELIEVED THE HAND OF GOD WORKED THROUGH NATURAL SELECTION,

WHICH SOME MIGHT DEFINE AS DARWIN'S THEORY OF "INTELLIGENT DESIGN."

THAT DID NOT AND STILL DOES NOT SATISFY CERTAIN BELIEVERS, BUT THAT'S A DISCUSSION FOR ANOTHER TIME.

MOST RECENTLY, WE'VE DISCOVERED THAT ENVIRONMENT FACTORS LIKE STARVATION, SMOKING, OR STRESS

CAN ACTIVATE OR SUPPRESS GENETIC CODES, AND THOSE CHANGES CAN BE PASSED ON,

REVIVING LAMARCK'S IDEAS OF ENVIRONMENTAL INFLUENCE.

I DON'T HAVE TO STICK MY NECK OUT TOO FAR TO SAY THAT THERE IS GREAT CAUSE FOR EXCITEMENT

IN THE EMERGING FIELD OF GENETICS AND EPIGENICS.

>> WELL, WE HAVE A GREAT-BIG THANK YOU TO OUR GUESTS TONIGHT.

CASSIE HAJEK AND ERIK EHLI. THIS HAS BEEN A FASCINATING EXPERIENCE AND DISCUSSION.

THANK YOU FOR COMING HERE, FOR YOUR TIME SPENT JOINING US TONIGHT FOR THIS DISCUSSION ON GENETICS.

AND WE CAN'T REMIND YOU TOO OFTEN, THE FLU IS HERE! AND IT'S GOING TO GET WORSE.

GET YOUR FLU VACCINE NOW TO REDUCE YOUR CHANCES OF CATCHING THE FLU BUG THIS SEASON.

THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,"

UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.

>> CAN'T GET ENOUGH OF THE PRAIRIE DOC, VISIT OUR WEB PAGE AND OTHER ONLINE PROGRAMMING.

YOU WILL FIND EXTENDED INTERVIEWS WITH GUESTS AND MORE INFORMATION ON IMPORTANT MEDICAL SUBJECTS.

VISIT PRAIRIEDOC.ORG, OR FOLLOW US ON Facebook.

THE BEST WAY TO STAY HEALTHY OUT THERE.

>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" IS PROVIDED IN PART BY:

>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.

LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION"

AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.

AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,

THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.

AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...