hello and welcome to HealthLine.

>> I'm Jennifer Blomquist.

I'm so glad you joined us tonight.

We have a lot of regulars who tune in every week and I really appreciate you coming back.

That's wonderful.

And we get some new people every week and so that is also great.

And for those of you who are new to our show, I want to remind you that we are live here in the studio and we have two great guests tonight we're going to be talking about something called Precision Health and they are more than happy to take any questions you may have.

This involves things like genetic testing and kind of being it's more of a proactive approach to keeping yourself healthy and avoiding maybe some serious issues down the road.

So call in if you have a question at any point we're going to start talking about the specialty of medicine but the phone lines are open now so there is the number at the bottom of your screen and we also have a text number that's something we just started a few months ago so you can call in and that number is (969) 27 two zero if you're outside of Fort Wayne it's still a free call.

Just put 866- in front of there and then that gets you through on the phone line texting is almost the same one digit difference (969) 27 three zero .

And I want to remind you that your text number your phone number will remain private so don't have any concerns about that.

All we ask is if you text if you feel comfortable giving us your name and maybe where you're calling from that would be great along with your questions.

So everything is good about your phone number.

It won't be displayed by any means.

>> We don't want you getting the whole Fort Wayne area calling you at home.

So let me explain how the phone thing works.

So if you call in on the phone my preference is that you stay on the phone line and you can ask the guests the question live that way they can talk back and forth with you.

You might be able to get a better answer that way because maybe they need more information to help you if you prefer not to do that.

I understand just tell the call screener your question and they will give me your question and we'll get it answered that way.

So one way or the other, lots of ways to get free advice tonight.

So let's go ahead and introduce you to our guests.

They are new.

They've never been with us before and we certainly hope you come back.

Sitting next to me is Dr.

Jamie Ranneberger and you are chief of precision health and academic medicine.

Yes.

And then next to you is Dr.

Emily Powell.

And Emily , your title is senior scientist Precision Health and I'm sure a lot of people at home like when I first got this topic I was like well I'm not sure if I'm familiar with precision health .

>> Can we just give a brief explanation of what it is?

Absolutely.

I me to start all right.

So Precision Health is something I'm just incredibly excited about.

I've been working in medicine for gosh over thirty years and and and really was in in my training when genomics you mentioned the word genomics.

Yeah.

Was really taking off the Human Genome Project and it had come to fruition right and and we started learning a lot about DNA and and how we can use DNA both to help us in predicting risk for developing certain diseases as a way to, you know, preemptively start medication and screen for certain health conditions like cancer as a way to either catch things early or prevent them altogether and allow people to stay healthy and and the other thing that that really falls under this umbrella of precision health is also using genomics or or other what we call biomarkers things that help us predict how somebody is going to respond to medication, OK, so that we can pick the best medicine for the right person at the right time at the right dose so that we're for using a medication.

>> We're using it as safely and effectively as possible.

I journal or research I read a quote from a doctor who said this is not a one size fits all type of specialty.

Don't just rubber stamp it.

It really heavily you know, emphasize the fact that everybody is different and so yeah, you don't think about you think oh well use this medicine to treat this disease but maybe that's not what's best for that individual.

Maybe there's something you have to look at which is interesting.

>> So absolutely.

Absolutely.

And you know there are just so many areas that precision health applies to and I think one of the wonderful things about Emily and I having the opportunity to work together is this is also an area that we're continuing to learn all of the all the time and so and make new discoveries that continue to push the field forward which is is really exciting and allows us opportunities to to incorporate research and learning into doing the best job we can taking care of patients.

>> So is this I was curious because we are doing next week we're doing a show we haven't done one for a while but we're doing a show on integrative medicine which that was a new thing in the last decade and the doctor that I've been working with like she had been an OBGYN and then took you know, you education to advance herself in this in this other field.

So is this kind of what's going to be happening with precision health ?

I mean will there be medical school students that will graduate in this specialty like integrated medicine is now or is this just something that maybe depending like your background was in hematology and oncology and then is that is this just something somebody may do along with another specialty?

>> Yeah, you know, it's a great question.

>> Great question.

And yet I would say what I would predict right is that genomics and precision health are really permeating every area of medicine and so as opposed to integrative medicine or some even something like cardiology or oncology you mentioned as opposed to precision health being a specific specialty area of medicine, what I anticipate is is that we will really work to to support providers of all kinds physicians and advanced practice providers of all kinds to really be empowered to integrate this information in the same kind of way they would integrate other lab you know, lab test patients, patients on or or scans radiology test patients get done into care right.

>> As opposed to it being sort of a separate specialty area.

OK, yeah.

That's what I would what I would yeah.

>> To just and it is fascinating I think people you know Dr.

Powell I think a lot of people started hearing about the you know the Broca you know Gene for women wanted to know or am I predisposed to getting cancer and they were taking some women were going as far as having a double mastectomy saying I don't I have that you know, they were testing positive for the gene and did not want to risk it.

>> And I think that got people start I mean that was my first introduction was to it through a family member who actually did that because there's so much cancer on my husband's side of the family and some of the women that they said I just got tired of going to every mammogram and thinking is this the one where they're going to find it?

>> And so they just opted to take a more proactive approach.

But that's probably you know, kind of I think spurred people's interest in this as it came from the cancer issue.

>> Sure.

Yeah, that's a really that's a really important example.

So it's you know, personalized medicine is kind of synonymous with precision health .

So it's taking an individual approach to your health based on your genetics but also your environment, your lifestyle, things like your diet.

And so you're right that you just like things like eye color and hair color tend to run in families risk for certain diseases like cancer can also run in families.

But just because you inherit a specific mutation in your DNA that might predispose you to developing a disease like cancer doesn't necessarily mean you are going to develop that disease.

>> So the whole point of taking this approach is to like you said, be proactive.

>> So to get those earlier screenings and really empower people to take charge of their health with the idea being that if you can can catch cancer like cancer early, you can get to it while it's still surgically removable and very treatable and you know, does environment play a role?

I mean you have no control over the genes you get per say but but can you change your lifestyle and even the environment in which you live, can that even overpower the you know what the gene brings to the equation or I think that, you know, it's not just a black or white thing for sure, but you it can definitely impact your risk.

So if you know that you carry a risk factor in your DNA, you can be more specific about the choices that you make like make sure you get your mammograms early, maybe eliminate alcohol from your lifestyle because that's a risk for cancer development in and of itself.

You know, things along those lines diet, exercise, all of that.

Right.

Interesting.

We do have somebody who sent the text so thank you Wesley from Fort Wayne .

He was asking how current is DNA testing and how are the results used?

So I yeah, I mean if somebody came to you know, to to your office and said you wanted to do DNA testing, I mean is that something that's on the cutting edge?

>> Yeah.

Universally would you say?

Yeah, absolutely.

Yeah, because sometimes I feel like it starts on either coast and then gravitates to the Midwest sometimes you know, we'll talk about certain fields of medicine.

They'll be like they've been doing this on the East Coast for a long time but here in the Midwest it it takes a while to be to become something and everyday use.

>> So yeah, I would say incorporating DNA information or incorporating genomics into care is really at the cutting edge of medicine particularly as it's integrated in with in the field of precision.

Right.

Certainly we've we've known about DNA for for decades and people have have used tests to look for very specific genetic changes associated with diseases for example like Down's syndrome or or even genes that predict risk for cancer in a very targeted way.

The current approach may approach that that we use both in our research and in our clinical testing very some on a case by case basis.

But a lot of the work that we're doing is is really looking at the entire genome or or what's called the X on the what the meaty part of the genome.

Right.

The the part where a lot of the actionable or most important information is is stored and and so that is really cutting edge care and and science and the information the second question was how is the information used or how are the results used?

And and again I would say that's that is the way that we do that is really on a very much a case by case basis.

So we're not mining the information for you know, super anything super secret but really looking at what we call clinically actionable or things that clinically make sense to look for and individual patients that makes sense.

>> Anything you want to add and I think it's also important to to kind of distinguish the a lot times when people think about DNA testing, they're thinking about things like ancestry results so you can go and kind of get a kit online anything now.

>> Yeah.

And so you can go buy those yourself and send in your DNA.

Is it just usually a inside of your mouth.

Yeah OK yeah but if you go to your doctor they're going to order a much more sophisticated test that will have a much more accurate result.

They will sequence more of the DNA or maybe even all of the genes like Dr.

Ranneberger said.

And so in those cases a medical expert is actually interpreting the results and making those clinical decisions accordingly.

>> That sounds so that would be the gold standard is to you know, because that is a big thing.

You mentioned the you know, the András ancestry types of kits and we just did a program a few weeks ago about colorectal health and some of those people hate getting a colonoscopy.

And so, you know, I think the Allura is oh, all I have to do is send it a little sample in this mail and mail in kit, you know, but even that physician was saying that's just not the gold standard.

The gold standard is going to a physician and having the official testing done so I just want to remind everybody because this is such a fascinating topic please feel free to interrupt us at any time we're going to keep talking about precision health and maybe some things you want to think about for yourself, your family and your loved ones.

But like I said, we'd love to have you call in or you can text in just like Wesley texted a message that worked out really well.

So the number again to call is (969) 27 to zero and if you want to text it in again, we keep your phone number private.

That doesn't show up on the screen.

It's (969) 27 three zero.

I wanted to ask about just how you know, how should people approach this?

Is there a certain age at which you might say you is it kind of like should you get a baseline screening done persay you know, like we talk about we've done hearing health programs and a lot of the audiologist will say, you know, when you're forty forty five you might want to get a baseline so that we know how it's changed as you age or things like that is does that apply to this field or do you only really pursue it if you perceive an issue or are you have a family history of something?

>> Think it's a great question.

I'll go ahead and start us off.

I feel free to chime in.

>> Emily , you know a lot of it you mentioned family history and certainly in individuals who have a strong family history of a life threatening or life altering illness.

Sure.

Cancer you mentioned being at high risk for cancer, heart heart cardiac events or at a individuals with a very high risk or a strong family history of heart disease or heart disease developing at an earlier age individuals again requiring a lot of more intensive care.

Those would certainly be clues that that might say testing doing precision health testing to evaluate you for specific risk can be could be really important and can help in preventing illness.

And that is one certainly one really important approach that we're taking.

We are also you know, as part of our program we also offer screening for certain very high risk conditions to genetic cancer predisposition syndromes as well as familial hypercholesterolemia.

And the reason that we do that is even in individuals who have no symptoms who or who otherwise seem healthy that we know that these particular conditions affect up to two percent of the population and and the vast majority of people 80 plus percent of people who carry one of these genes isn't aware that they you know, because they're because until they don't have a family history.

Exactly.

And so by by doing the screening testing, getting the information back, it's actually a way to to preemptively initiate screening or medical treatment or even as you mentioned early or preventive mastectomies as a way to keep somebody safe.

>> So you know and it's been years we had a geneticist 10 years ago who was talking about you know, because I would feel like that kind of falls under this umbrella that, you know, counseled a lot of parents, prospective parents maybe that had a history of Down's syndrome in their family and you know, all children are loved whether imperfect or not.

But you always want to do what's best to try and have a healthy child.

And so I wonder is that something that's going to become commonplace where people might look at their risk factors if nothing else to be prepared that we have a good chance of having a child with a certain kind of condition just to mentally prepare yourself for that?

>> Yeah, no, absolutely.

Yeah, I think so.

I think that's definitely the way that the field is going and I think even beyond just mentally preparing yourself, it allows you to take action to make sure that you are seeing the right specialists and you know, providing the right type of medical care if the child does have a rare disease or a predisposition for developing a disease like cancer, you're right.

We did get another text message so you don't want to ignore that.

This was from James in Fort Wayne .

So thank you, James.

He is asking how does DNA become damaged from things like smoking?

I guess I never thought about the lifestyle and environmental factors affecting your genes.

>> Yeah, yeah.

So cigaret smoke has hundreds and hundreds of carcinogens in them.

So those carcinogens are chemicals that either disrupt the ability of your cells to repair its DNA.

So every time your cell has to divide to make you heal a wound or replace itself, it needs to make another copy of its DNA and there is this machinery within our cells that make sure that that process is accurate and that mutations don't happen.

Mutations can be thought of like spelling mistakes in your DNA and so the way that carcinogens like those found in cigaret smoke or in UV radiation can prevent the ability of your cell to repair DNA or they actually physically damage the DNA directly so that eventually that repair machinery is not going to be able to catch up.

And so then when those spelling mistakes happen, if that happens in a gene that is important for something that keeps cancer at bay or is itself a process that is involved in repairing the DNA.

So if you have a mutation in a DNA repair gene, more and more and more mutations will happen and that can be how cancer can start.

And we did have another question from Tom that I will go ahead and address this right now I'm not sure if I'm pronouncing this correctly you I have to check my my pronunciation does Tom wanted to know if precision health if it checks methylation status, is that correct?

Yeah, OK, yeah.

So let me explain what methylation is so our DNA can be kind of decorated with different modifications and one of those modifications is called methylation and so what what methylation does is controls the expression of certain genes.

So if a gene is supposed to be off then it will have a lot of these decorations on it so that it doesn't turn on when it's not supposed to.

And so let's say that that gene makes the cell divide and methylation is disrupted and so that gene that's supposed to be off turns on and now that cell is told to divide and divide and divide.

>> That can be something that can lead to something like cancer.

So it's one of the newer areas of of genomics and omics in general and precision health that's very, very cutting edge and is coming to the forefront.

But it's not commonplace today in most areas.

Yeah, I'm just impressed that he knew that word so.

All right.

Thank so much, Tom.

I appreciate it.

Gosh, you guys are on a roll and a lot of calls tonight.

So Janice also called in.

>> She wanted me to ask the question for her.

She was no can test for Alzheimer's.

>> So I'm guessing that that transition happens.

>> Yeah.

Can it test for Alzheimer's disease?

Well, that's that's a great question.

And and what I would say is certainly there are genes that we know if they are mutated in an individual so if they're changed in an individual that they can be associated with increased risk for things like Alzheimer's disease or dementia similar to the cancer risk gene.

So just having the mutation by itself doesn't in everyone predict that that person will definitively get Alzheimer's disease.

So again, there are things you can you can do that may help to to modulate or attenuate your risk.

>> But certainly that that is a huge area of study and such an important you area that that would be wonderful if we could could identify those individuals.

>> Earlier I was going to say I was talking to a friend about what we were going to talk about in the show tonight and she said you know what, I don't know if I'd want to know.

You know, she said because she said I have so much anxiety anyway and and I said well in some cases it's nice.

You know, like I look we had a relative who when my cousin was pregnant they found out halfway through the pregnancy that their little girl had a cleft palate and she said I'm so glad we know they lined up a surgeon.

>> They went consulted with him beforehand because it was severe she couldn't eat when she was born and she said I can't even imagine trying to deal with that the minute she was born.

The emotion would get you know, just it would have been a disaster.

And so, you know, I've met people that are like no, I'm so glad I knew this is something that was going to happen or could happen so I can see where like I'm on the fence about it too.

You know, as much as I want to be as proactive as possible, I can see where it can be a little scary or people will just worry themselves into a frenzy about oh my gosh, you know, I'm going to have Alzheimer's some day.

Absolutely.

How do you how do you address the patient?

>> You know, I worry about so maybe it's just me.

We both are too.

>> Absolutely.

And it I would say it's a really personal decision I'm sure right.

Whether someone wants to have this kind of information or not is becomes is very personal.

You know the side of me that advocates for and the part of me that supported myself to go ahead and and have genetic testing is that by having the information I feel empowered right.

Similar to your friend with a child with a cleft palate, I feel empowered to be able to take action to to stay to support myself, to stay healthy.

You know, not having the information doesn't change your status.

It just change your changes, your ability to take action earlier.

>> So I don't want any advice from you to know exactly exactly.

I think that, you know, the idea is being proactive enough that you can in ideally prevent disease altogether but at least potentially catch it early.

So we know that when again to use the example of cancer when cancer is diagnosed late after it has already spread, it's tends to be a terminal diagnosis and so because it can no longer be surgically removed and all the there are too many genomic changes and therapies are less effective.

But if you know you have a risk factor and you do get into screening program sooner then you can potentially catch that disease while it is still in a curable stage or at least a very treatable stage.

And that's important especially because usually when screening programs like mammograms for example, those tend to be covered by insurance according to medical guidelines that say at age 40 women now qualify to get their mammogram.

But if a woman knows that she has a mutation BRCA one or BRCA two gene, then her insurance might actually pay for that mammogram before the age of 40 with the idea being that they can catch that cancer a little bit sooner.

>> It's a fascinating topic and sadly the show is already over so both of you need to come back.

>> We could do an hour long program easily so Dr.

Ranneberger, Dr.

Powell, thank you so much.

Pleasure to have you on.

So really I know I learned a lot and thank you so much to everyone watching.

We had some really good questions tonight too.

So I'm still impressed that the one guy do methyl methylation.

I already forgot it.

I'm Jennifer Bloomquist.

Have a great night and again we'll be back next week talking about integrative medicine.

>> Take care.

Bye bye