 Carlos, the first comment I have for your postdoc, did you ask him to play the lottery? Did I what? Did you ask him to play the lottery? Did I ask him to play the lottery? You know, that kid is so extraordinarily bright. He had done his PhD in this area, but what he does now is actually grape breeding. His actual postdoc project was to develop a genetic map of grape that was successful for the future of the New York Times, for those of you who are interested in that kind of thing. Yes, I have no question we'll get posted. Yes. One first question here. She was actually first, but... Excuse me? She was first. Who? I hear. She came before me. Oh, okay. Go ahead, please. Okay, thank you. This is just, I'm blown because now I'm thinking, what about then climate and all the sort of discussions that had gone on to the early sort of adaptation to climate, which is associated with, you know, pigmentation, malaria, all of these things. Can you then kind of make that connection or disconnection so I could change some of the way I've been saying this when I sort of just say, oh, if you study genetics, you'll find this, if you study geography. Thank you. I can take it for you. Go ahead. So, I mean, it's interesting that, you know, I would say if there's any dogma out there, it's that vitamin D and folate are linked to skin pigmentation. But in fact, it still remains this area that we don't fully have the entire picture figured out. And I sit on the board of PLOS and we get many different hypotheses about, you know, trying to link the causal relationship. I think in this particular case, you know, it's one of those that there is an impact on skin pigmentation as well of this allele. No, but we also know that they, that at least in human skin pigmentation, that this has, there has been selection and climate and radiation has been a very, very important part of it. But I don't think one should look at any one of these as monocausal. You know, we are the results of forces that have gone on for a long period of time and presumably multiple ways of getting there. Next question. Hi, my question's for the entire panel. There's so much enthusiasm for people to go search for their roots, their genetic roots, because I think as in the last panel presentation, it helps them with their identity formation and with being part of a, I guess, shared identity, whether it's from Africa or with some, trying to trace their family lineage. And there's also evidence that this genetic stuff can be influential with health disparities research because I guess some, as the presentations mentioned, there's increased variation and people with a certain genetic expression respond differently to certain treatment compared to another population. But my question is, how are you gonna get some of these same populations to have the same enthusiasm for the clinical research needed? And specifically with the clinical research that a lot of you have done, how did you get so many people of, so many minorities to be, to do the clinical research that you have done and how can you continue that fire for all the other clinical research that's yet to be done? That was easy and I'm very proud of that because the NIH has been moaning and groaning that we don't get minorities in clinical trials and you go to the good old boy networks that have all the clinical trials and they're all non-minority physicians and they can't tap into it. And I was a young punk that came by in 1998 and I, being Hispanic myself, having grown up in Hispanic neighborhood, I just knew how to go, get all the Hispanics on my side and I just got off my butt and I went to minority serving clinics and lo and behold, we now have 9,000 kids. That's the largest pediatric study in the United States of asthma and the NIH just invested $60 million in the study called SOUL and they got 16,000 Hispanics but with my little study of $6 million, we got 7,000. So we're doing this, we're doing this in the minority community. The key thing I think was to have good connections, we had minority recruiters, we had minority physicians, I made millions of community presentations, we got community buy-in, we had the National Medical Association involved which is the largest and oldest black physicians group in the United States. They backed us, they're backing us now. It just makes common sense. It was easy for me. Yeah, I just like to add a little bit to that from my own experience in doing studies in the U.S. and outside of the U.S. I think it's important, the message we convey to people. So one of the ways I say, if you want your clothes to fit you, you have to show up at the tailor so you get measured. If you don't get measured, you're gonna rely on other measurements and you hope that these clothes will fit you. That's precisely what Carlos and others on the panel have showed, that there are certain genetic variation that are specific to populations and if those populations don't show up, guess what, those clothes will not fit. Yeah, we have to be mindful of Tuskegee and other atrocities. Exactly. And the Native American groups haven't participated, but the fact is the genetic train has left the station and there have been a million benefits that have derived from the Human Genome Project. Unfortunately, they're gonna be applicable to just a few populations and it is a civil right, in my view, to participate in clinical trials and an obligation to participate in clinical trials so that all of us benefit from the fruits of the Human Genome Project. So I'm gonna give you a somewhat more general answer. So over the last week, there's been a major report published on the status of U.S. health. Don't wanna get political, although there's nothing you can say in this town and not be political, so here goes. So I think the bottom line, despite whoever comes from any political persuasion, is that the U.S. among 14 other pure nations we have the worst health that we spend the most money. So whatever the wisdom is of whatever we are doing, it just doesn't work. And there are many reasons. Health disparities are a very big part of it. It appears that we all ingest too many calories. There's too much violence, meaning firearm induced violence at home and outside. And all of you should read this report. It's a sobering sort of view having nothing to do with being a geneticist or everything to do with being a geneticist or being a health expert, I think every American needs to read this report. So I agree with what Esteban just says. I think it's an obligation for us to hold all of our politicians accountable in the sense of, and for us to, but it means we need to participate. On the genetics equation, I think I have a broader view. I don't know what's gonna happen. I wish I knew. If I wish, if I could wish the answer, then I think I could design the studies in a much more simpler way. I really think I don't know. Genetics might be in many cases, and in some cases, like the example you saw on PCSK9, it's probably the easiest way for us to intervene and find a drug that could affect, in that particular case, are lowering the effects of the worst LDL, of the worst cholesterol and reducing heart attacks. But in many other cases, might not be the most effective way. There are other things we could do. We could vaccinate every child in this country, and that could prevent other kinds of illnesses. So I'm not a genetic exceptionalist. What I do is very near and dear to me, but I think we need to fit genetics into the larger healthcare equation, and in that, our ancestry will play a very strong role. Beat on the gene side, beat on the environment social side. And I said that what I'm gonna say is gonna be political because I think our healthcare system has to embrace both. There's no other way. We can't just hide our ignorance by saying it's only social factors or it's only genetic factors. We also gotta have academic community partnerships, because as you know, the number one cause of death in young black men is violence. And there are ways that we can get around it. We just started an academic community partnership at San Francisco General and UCSF to implement wrestling programs in elementary schools, which will allow kids to get out their aggression, to have positive thinking. And that's something that is near and dear to my heart. It's not genetics, doesn't get me funding, but it actually is an important contribution to public health. I think we'll take just two more questions. Yeah, we have the last two people. The last two people. And if we can keep it short, we'll move forward. Please. Well, it depends on their answer. How long it takes? Yeah. You've discussed genetics and health of Hispanics. Now, as far as I know, there's no genetic predilection for speaking Spanish. So what do you mean by Hispanic? And what is it that you really are looking for? What do you think that word Hispanic is standing in for? What is it you are actually studying? So because of the first slide I showed you about the significant differences in the rates, prevalence rates of asthma in the United States, highest in Puerto Ricans, highest in African Americans, lowest in Mexicans. When I was a young medical trainee in 1997, I was very inspired by that. And I made it my life's career goal to study that. So we only recruited individuals that self-identified themselves and their grandparents as being 100% Puerto Rican or 100% Mexican or other Latinos. Now, that is actually a beautiful population because, and I didn't show the data, but they're a tri-hybrid mix of Native American, European, and African. Now, we could look at it from the purely genetic factor and adjust for those racial differences and get down, and Chris Jean knew who's my graduate student here, just identified a gene, a novel gene for asthma that tended to be, had significant ancestry differences, African versus Native American versus European. I am mindful, and I tried to make that clear, that this identity, this social identity of being Puerto Rican or Mexican or African American is like a shopping cart of other social experiences. So like African Americans, it's not just about African ancestry, it's the social experiences of perceived discrimination, which might lead to increased stress, which might lead to increased blood pressure, which increases your risk for kidney disease and heart disease. So we tried to be very comprehensive, and that's when I started that large study, the Gala and Sage study. We measured all those factors. Charles here is a big proponent of looking at the whole picture, and I think I came to that first, and then you joined me, or... No, no, no, from an epidemiologic point of view, we try to look at the whole picture, not just are you Hispanic? There's genetic and social environmental factors. Last question. Yes, this has to do with what's happening now and moving forward in terms of training, the whole idea of who's coming through medical schools, who's coming through public health schools and universities, how do you see this information changing the way? Because it is slippery and it's moving, and it's messy in some ways because it's not just the science and it's not just the genetics, but it's also culture. How do you see this affecting the training of people whose job it will be to do this work in the next generation? I think it's super, sorry. Go ahead. No, I think it's fundamental, and one of the issues that, so I run one of our T32 training grants at Stanford and I'm also involved with some of the NIH decision-making around training grants, and in fact, that's a very political issue, right? The NIH is now rethinking, different institutes are rethinking where they're going to invest. There is the sequester, there's a reduction in NIH funding, training is unfortunately one of the areas that will also be impacted, and I don't think there's an easy answer except to say that if we do not train both a diverse workforce and a workforce that can think about these problems, we are going to be in a tremendous amount of trouble. Our, the proportion of GDP that gets spent on healthcare is just going up and up and it really is unsustainable, so. You know, in 1813, all, the number of black physicians in the United States was 4%, 2013 is 4%. We're doing a terrible job, a terrible job, and unfortunately, you guys are funding it and so we need to put political pressure not only on medical schools, not only on the NIH, but we also have to work, we have to address the pipeline issue. It begins in grammar school, begins in kindergarten, and we need those, the Head Start programs to keep going. So let me just add just one more thing. There's actually no doubt that we live in a much more complicated world, even a complicated academic world that alone the world outside. And I think there are three parts. The science is important, I agree with you, but I think our students are much more savvy and much more exposed to the societal aspects of at least the information. And the third part, which I think is really a part that's missing on much of the non-medical science or non-medical graduates is we teach human biology only to physicians anymore. We do not teach it to others. And I think this mixture of teaching human biology the much more detailed molecular science, by the way, that also includes quantitative thinking, as well as understanding how the information is relevant to the world outside. I think it's a new concept. It is changing, but change comes slowly. Even in Hopkins, we have a new curriculum that's called from genes to society. It's taken some time to get there. Some have said that changing curricula is like moving a graveyard. It's not easily done, but I think we are... There's a very, very important part. We are not so separated from our subjects or universal communities as we used to be. I also want to say two things. Number one is that one of the agencies that is particularly under fire is unfortunately the National Science Foundation. I think the National Science Foundation does extraordinary work. They are really the only agency that's taking on K to 12 training in STEM areas. I can say that the only reason I'm in science is I was part of a National Science Foundation program when I was in high school. If not, I was gonna be a lawyer. And also, I cannot fail to mention that I was an intern in this building. And so I think the Smithsonian and other institutions have an important role to play as well. And I think all STEM areas are important. All STEM areas are great. We should just be pushing and pushing and pushing and saying, look, you cannot cut in those areas. It really is about U.S. competitiveness. Every dollar that gets spent in STEM training is returned multi-fold, right? I mean, it's just absolutely crazy to not continue to invest. Thank you very much. We're gonna have to come to an end to this session. And I wanna thank the panel. And we're gonna move directly into our next panel on arts and culture and ancestry. And we will not be taking a break after that panel. We will move into the last panel and complete our day. So we will move the tables now and have a very different conversation with our moderator, Dr. Cole, the director of the African Art Museum.