 episode of In the Studio at Davis Media Access. I'm Lynn Weaver. Today I have a very special guest, Dr. Alexander Borowski. Thank you for coming in, Dr. Borowski. Thank you for inviting me, Lynn. It's a pleasure to be here. You are a professor of pathology and laboratory medicine at UC Davis but you also lead a very new research initiative founded by the National Institutes of Health which is called All of Us. That's right. Catch a title. What is All of Us? Well, All of Us is sort of a play on words. It intended to mean All of Us but also All of the U.S. This is a nationwide study and it's an ambitious undertaking. Very ambitious. But it's one that I think is very important in this day and age of medicine. The idea is rather than have very small research studies that are based in different areas of the country or in other countries, we can have one sort of large, massively parallel, if you will, study that occurs in individuals all over the United States representing all the different populations that make up our very complex background here in the United States. It's a very ambitious project. Could be akin to the mapping of the genome. It's very similar in scale to that. Yes. So the origins of this date back to an announcement made in January of 2015 by then President Obama who said we need to do a better job of having health recommendations both preventative and treatment-based recommendations for the whole population but in order to do that we need to study the whole population. And so he proposed then that we assemble this cohort of one million people across the United States. So the goal is one million volunteers. That's correct. So I've heard that the basis for this to some extent is this precision medicine. So what do you mean by precision medicine? Yeah, so precision medicine is a new term and it's one that is designed to capture the complexity of our current process in health care. And so it used to be for a given disease or even for a given nutritional recommendation we'd make a single recommendation that would apply to all. Cookie cutter. Yeah, that's right. Cookie cutter, one recommendation, one size fits all. But more and more we're learning that one size fits all is not appropriate that different recommendations need to be tailored to different unique individuals. And so that's the whole idea behind this is we want to understand that complexity and we want to understand which treatments or recommendations benefit which populations of people. So I'm trying to understand so what this the goal of this enormous mega study, a research study is to encompass include so many factors of a person's life I guess. Right. So if you really break it down into the very basics that apply to your health this is in some ways it's common sense to most of us. Yes. But it breaks down into your genetics, who are your parents and your ancestors that's going to play a role. But also playing probably an equal role is your environment. What are the exposures, whether they're toxic exposures or good nutrition exposures, they can be both good and bad. So what is your environment? And then finally what are your personal health habits? Do you exercise? Do you smoke? Do you drink? These questions can have actually different implications in different populations. Yes, of course. And so we're learning that and we're trying to tailor our recommendations to be the most beneficial to the individual. And also I think perhaps and contradict me if I'm wrong that knowing a lot more about the person will also prompt what medicine to give the patients. Absolutely true. Yes and the dose and all that and we're really just at the beginning of learning how to do that. That's precision treatment for different types of diseases and there are very important diseases that we're talking about that we know there are individual factors that are at least playing a role in and that goes into heart disease, very common and even cancer. Cancer treatment. And we know there are differences in cancer treatment responses for different populations now but we need to study that in more detail to be more precise about how we offer those treatments. So a couple of questions before we come to the point of why you're coming here because I believe you're hoping to have responses from people who would become volunteers to this study. Absolutely. But are you utilizing some of the data that was collected previously from other institutes or other regions of the country? Yeah so we're partnering with institutes and even private entities across the country in this endeavor. So our particular consortium is up and down the state of California so we are the California consortium for all of us. UC Davis. And it includes UC Davis with our partners UC San Diego, UC Irvine, USC, UC San Francisco and Cedar Sinai Hospital. So it's a great group, I've really enjoyed working with the group. We're all very enthusiastic and hard-working and getting along great. It allows us to recruit patients from up and down the coast and here in the Central Valley. Well what are the requirements or the eligibility to become a volunteer in this study? Could you give us an age, race, weight? Sure. Women, men, children. At the moment the study is open to individuals 18 and older. We are not yet recruiting children. We would like to include children because they have their own special needs when it comes to treatment and recommendations. But for the moment it's 18 and up but it's anybody in the state of California is eligible to join our consortium and then nationwide there's always a mechanism for any individual to become involved. And what would an individual have to do if he or she wants to join? I know that you have a website which is actually extremely well done. Thank you. I went there several times while I was preparing for this interview and it has videos and questions, frequently asked questions and it explains the goals and the mission of the study. So it's really very, very nicely done. Thank you. So say I wanted to join this. What should I do? So you visited the website and I would encourage everyone to visit the website. That's the portal of entry. So it's joinallofus.org. That's easy. Join all of us. Join all of us. All one word, no spaces, just joinallofus.org. We didn't get all of us.com. Somebody else had that I guess. So don't go to allofus.com but go to joinallofus.org. There's plenty of information about the study, everything involved in the study there but you can immediately click the button to join and the we call it an informed consent process is all done in the comfort of your home online at your computer. There's nice little videos prepared for that as well that I encourage everybody to go through. You can decide at any point that you're not interested and turn off the video and turn off the webpage but hopefully you'll be intrigued. Yes. And what we're going to be asking the individual is we are asking for a blood sample. The blood sample is going into our bank and it's going to be provided to researchers doing cutting-edge research in all kinds of things from genetics to metabolism, you name it. And all of the studies that get access to those will go through a rigorous process to make sure that they're the best possible studies. So how would they would I provide this blood sample? Right so you would go through the consent process online and you'd make an appointment with us and we've tried to make it very convenient for you to come in at your convenience because of some shipping things it's usually in the morning or early afternoon. We can't take samples later in the afternoon because we need to get them properly stored and it's hard to do that later in the day. And you don't need to be fasting for this? No it's not a fasting sample so it's come as you are. When you come in we're also going to take some measurements so we're going to take your weight and your blood pressure. We're also going to measure your waist and hip circumference. Some people don't want to know A their weight or B their hip circumference but we will tell you what our measurements show. Yes. And so that's part of the study and then we'll also ask for permission to keep track of you by monitoring your electronic medical record and so almost everybody has some form of an electronic medical record these days. Well I can understand that all these data points might be might bring a lot of concern to people about what are you going to do with that and who is going to use these these records. So data security is very important to us as well and so the goal of the study is to collect this data and we do have to keep track of you as an individual so we can monitor your health over time. Yes. And that's important to the outcomes in the study. Yes. But we still will whenever sharing a sample or sharing those data points we will keep your name and any other identifiers out of it so we'll it's called the identification of the data so that the researchers will have a large pool hopefully a million samples to deal with but they won't know any of the one million names in the that are attached to those samples. They in turn will provide the data back to the central data warehouse and you as an individual will be able to log on to your portal with your password and see what the results are on your sample. So we're reporting the data back to you. In some ways we're trusting you to be able to handle that right so we don't want you to be worried about a particular data point we'll give you as much information as we can. There will be unusual circumstances occasionally where something that we find is we think important to your health immediately and so in that context we will re-contact an individual and say we found out X, Y or Z and that should trigger you going to your doctor and talking about next options because of that. But that's a rare circumstance. Well that's very very interesting. So in a way you are guaranteeing the privacy of this data and who will be the ultimate user of this? Well ultimately the goal is for this to go into the medical literature and then provide the data that physicians need to treat people in the future and so probably this is not going to benefit you but it should benefit people like you in the future and that's why I always encourage people to think seriously about joining the study because you do want to represent your people if you will and your genetics, your environment, your neighbors are in your environment, you can represent your neighbor's environment, you can represent your family's genetics in the cohort to make their health better in the future. Yes well it's a type of immortality in some way. It is. But so that certainly is an incentive and of course you're giving each of your volunteers a million dollars. A million dollars no we do give a twenty five dollar gift card to either Amazon or Target for your time that you take to come and donate your sample and and our appreciation for that time. Well that's good. I wish we could give more. Of course and so is the NIH continuing to fund this project or they've already given the money? It's a feta complete. Yeah so the money is in a unique kind of mechanism at the NIH where renewal of the funding is contingent upon active participation and how much recruitment we do etc it's in some ways a little more like a contract from the National Institutes of Health. I understand yes. But but we are all on the same team and we're trying to solve the same problems. How to reach out to the community and how to encourage patients to participate, how to design the study so that data security and other concerns that patients may have are addressed and allow them to participate. Well that's great. How many volunteers do you have approximately now in California? We have just over 4,000 volunteers in California so far. We just started recruitment in earnest in May. That's right. So it's very early days and we anticipate this going on for five years maybe longer maybe as long as 10 years for a cruel of the million patient cohort. It sounds very excited. I'm afraid our time is up. Well it's been a pleasure. And I hope that this interview will clarify some of the concerns that people have had and maybe I'll join. I hope you do. Thank you very much for coming in Dr Borowski. We may get you back if you're willing to have a follow-up on this very important study and very much of interest to our community and thank you for watching all of you from all of us here at Davis Media. See you next time.