The future of genomics: A podcast featuring Stanford geneticists

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Image by Pat Lyn

Every living organism on Earth has a genome, the complete set of DNA containing all of the information needed to develop and maintain the organism. Humans inherit three billion long strings of DNA called chromosomes from each parent, so your genome can help identify your personal ancestry. But genomes can also identify the movement of human populations based on who is similar to whom.

Carlos Bustamante, PhD, a professor of biomedical data science, of genetics and of biology at Stanford, discusses the blossoming uses of genomes on a recent episode of “The Future of Everything” radio show.

For example, Bustamante told host Russ Altman, MD, PhD, a professor of bioengineering, of genetics, of medicine and of biomedical data science, about the genomic fingerprints of the history of slavery in the United States. As part of an international collaboration, he studied the DNA of modern individuals and individuals from slave cemeteries, tracing their history to particular tribal groups in Africa.

“A lot of that history has been lost and African Americans want to reclaim parts of that history using DNA,” Bustamante said. “What’s interesting, at least in the United States, is that most of the slave ships went first to the Caribbean and Brazil. Only a couple hundred thousand people came in straight to the Port of Charleston. So the history of the slave trade is actually written in the DNA of the Caribbean, Brazilian and U.S. African descendant populations.”

But that is only one of the many genomic applications discussed on the episode. Another important use is predicting disease risks. Genetic tests are now available for many hereditary conditions, including cancer risk assessment, at Stanford.

This raises a challenge, however, because our knowledge of DNA is primarily based on people of European descent. As Bustamante explained, this occurred because European countries were the first to recognize the potential impact that DNA sequencing could have on health care, once the cost of DNA sequencing technology plummeted.

“They invested quickly and by the year, say 2009, they’d done about a thousand studies and 95 percent of the participants in those studies were of European descent — be they from the countries in Europe or in Iceland.”

Since humans are 99.9 percent identical in their genetic makeup, maybe this doesn’t sound like a problem. But Bustamante said the differences may be important because they could help lead to improvements in health care. He described this lack of diversity as both a problem and an opportunity.

Take blond hair, for example. Bustamante explained that two main populations have blond hair: Europeans and Melanesians from the Solomon Islands. When the scientists started a research project, they hypothesized that a European went to Melanesia and had a lot of kids. But that isn’t what the genetics showed.

“The genetics of blond hair in Europe are different than the genetics of blond hair in Melanesia. They look the same, but it turns out that the underlying genes are different,” he said. “And why is that interesting? From the point of view of medical genetics, if this is true for blond hair — which is about as simple a trait as you can get — what about diabetes? Why would we assume the genetic basis of diabetes is the same in every population, when we know diabetes actually presents differently in different populations?”

He also argued that new drug discovery would be more successful if it was based on genetic leads. Cholesterol lowering drugs called PCSK9 inhibitors, for instance, were found by studying families with naturally high or low levels of cholesterol. Successes like these are the reason he thinks it’s important to study diverse populations.

“If we spread our bets across different human populations, we’re much more likely to find interesting biology that then benefits everybody,” he said. “Because these cholesterol lowering drugs aren’t just good for those people with high cholesterol for genetic reasons. That’s the key. You can mimic it in others and it benefits everybody.”

Of course, the potential for genomics goes beyond human applications. Altman and Bustamante also discuss plant and animal uses, including designing your dream dog.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford psychiatrist focuses on mental health needs of Muslims

Photo, of Rania Awaad giving a recent talk, by Anum Ahmad

Prior to studying medicine, Stanford psychiatrist Rania Awaad, MD, studied Islamic law. As a local religious leader, she said that many people in her community are actually surprised to learn that she’s also a physician.

However, this dual training is at the heart of Awaad’s research and clinical work, which focuses on the mental health needs of Muslims. I recently spoke with her to learn more.

What are the mental health challenges faced by Muslims?

“In our recent sociopolitical climate, there’s been quite a bit of negative focus on Muslims and other groups. And we have the highest level of hate crimes against Muslims ever in American history — about six times higher than post 9/11.

In the Bay Area, we have a consortium of mental health and general medical providers who are trying to figure out how Islamophobia — the fear of the Islam religion or Muslims — affects the general health of Muslims. So far, we’ve seen a lot of anxiety, depression and post-traumatic stress disorder.

There’s already quite a bit of PTSD within the community, because many Muslims that immigrate to America come from areas of conflict. Current policies can trigger immigrants’ underlying PTSD, anxiety and depression, as I recently described in the American Journal of Psychiatry.”

Are there barriers to mental health care for your patients?

“There’s a lot of paranoia about medical providers documenting their issues in an electronic medical record. They’re afraid this medical information will be combined with a Muslim registry. Initially we told patients not to worry, because unconstitutional things like that don’t happen here. But then the travel ban helped substantiated their fears.

There are also barriers directly tied to faith beliefs — concepts like the evil eye or spirits. If someone is having psychosis, for example, people may say he is possessed and should be taken to his religious leader instead of a mental health professional.”

What can you do to overcome these challenges?

“Mental health professionals can approach a patient’s faith leader for a religious consultation. I help train chaplains and imams and I’m also teaching doctors to engage with faith leaders. For many people, their faith is a source of strength and support. So leaving that out completely means that you’re not really providing adequate, holistic care.

There are a limited number of mental health professionals proficient in understanding the Muslim faith and culture. Through the Khalil Center, I’m working with other dual-trained practitioners to develop a manual, book and training seminar on Islamic psychology from a practical clinical perspective. We’re trying to provide guidance for practitioners without Islamic training to work with this unique minority group.”

How did you end up specializing in the mental health needs of Muslims?

“I thought I was going to be an ob/gyn. But during medical school, I married my husband who is an imam and a director of a nonprofit. At one point he told me what our community really needs is someone who can work in mental health, based on what he saw as a community leader. He inspired me to become a psychiatrist.

I also feel my dual training was meant to be. In high school I embarked on a lifelong journey of formal Islamic studies training. I’m currently a professor of Islamic Law at Zaytuna College, a Muslim liberal arts college in Berkeley. My dual training kickstarted the Stanford Muslim Mental Health Lab and Wellness Program that I founded and direct, and it has allowed me to lay the groundwork to train others.”

What are some other things you’re working on?

“The SMMH Lab is part of a consortium that is studying the effectiveness of integrating faith concepts with therapy for different faith communities — Muslim, Jewish and Christian groups. We’re using evidence-based, objective metrics like the depression inventory scale.

I also oversee the Bay Area Muslim Mental Health Professionals group, which has led to many other initiatives like a Bay Area Muslim mental health community advisory board and a crisis response team.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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