Implementing Physician Education Programs - Gene Passamani


Uploaded by GenomeTV on 11.05.2012

Transcript:
Dan Roden: So, the next talk is from Gene Passamani,
who has a long history of doing lots of stuff at NHLBI, NHGRI, physician education, and
is going to talk about physician education programs.
Gene Passamani: Well, good morning, and for those you who
I haven't met, I spent two decades at NHLBI mostly designing and running clinical trials
and trying to keep an extramural division together, a place where we could barely agree
where to go to lunch together much less anything else, so, Eric, I feel your pain. The second
two decades I spent in a community hospital as an executive, a director of cardiology
initially and as a chief medical officer later. So I know the enemy, which is the practice
community who are very, very different from Fruit Street in Boston or Monument Street
in Baltimore. I've dealt with a thousand of them and they are a different bunch.
I think it's appropriate that I come at the end of this meeting. Physician education is
way, way down on Eric's strategic plan. It's way, way to the right. Lots of things have
to happen before that can be done very well, although it seems like that's where we want
to end up. That's where the rubber meets the road, where patients derive benefit from all
your hard work.
Now, a couple of light motifs in this presentation I'm going to make and my hope is that I can
stimulate some discussion because we're going to have to grapple with this sooner or later,
and sooner's better. One is that specialty -- specialties march through that strategic
plan at different tempos. Infectious disease is really into this business, now I'm told.
In fact, I have it from an expert in infectious disease that infectious disease fellows no
longer do gram stains. They do genomes of bacterium to identify the organism and then
treat it appropriately. So, the ID folks are really into this in a big way, and further
along than, I think, most. Oncology seems like another one that's out in front as well.
So, all doctors are not equal in terms of physician education. You've got to sort of
temper your approach by where they are. The other part of that is, professional associations
are really the way to get at practicing docs. And they have an ability to do both general
literacy, which I think is really important to kind of at least have the sense of what's
going on in genomics, and also they carefully draft guidelines, which Paul quite appropriately
criticized, but some of them work pretty well. And I would assert that they're the better
-- the best except -- or the worst except for all the rest. And sometimes they really
work.
I just recently rotated off a professional education committee for the American Heart
Association, and I have some data from them. They have a professional education center,
and for the fourth quarter of 2011, 50,000 doctors went to that site, half of them cardiologists,
another bunch neurologists for stroke, family practitioners and emergency doctors. So, they're
doing something right and they have access to doctors. So I think we really have to think
hard about professional associations in trying to support physician education. Also, timing
for professional associations is really important. If they put something together for education
of physicians and it's too early, they irritate their physicians and nothing happens. If they
put it up too late, you've got an access problem, because you've got something that works that
doctors aren't using. And so, they really try hard to time that just right. And I actually
pitched them the notion of education in genomics with this group and that was their one concern.
They didn't want to get into the game too early, but they also didn't want to get in
too late. So anyway, that one, I think, is very important in terms of interacting with
these professional folks.
I'm not going to touch on training of students, residents, or fellows today. That's -- you
know more about that than I do, certainly, and I think that our speaker, who didn't make
it today, was going to talk about that and probably knows a lot about it. I hope when
we finish that we'll have good discussion about opportunities, because I think we have
to start this now. Because of what Eric said yesterday, this thing is really beginning
to move and move very rapidly.
Male Speaker: Sorry [inaudible]
Gene Passamani: So, just a few --
Male Speaker: [inaudible]
Gene Passamani: -- comments on the opportunity, and you all
know this stuff, there are rapid advances in your science, astonishing reductions in
costs and turnaround time, and increased public interest, and I think, as Pearl said, expectations
are high and I think they're probably way too high. This is a long-term slog for us,
I think, and patients aren't going to see this immediately. Seems like pharmacogenomics
is approaching the clinical horizon. We've got good work going on in clinical decision
support and medical leadership is very good, particularly at your centers. I think there's
a genuine interest and apprehension in practicing doctors. And I'll tell you an anecdote we've
put together with NHGRI, a lecture series at Suburban Hospital for clinicians. And at
the start, the initial lecturer in that, David Valle, gave a wonderful talk, and the clinician
sitting next to me at the end of it looked at me and said, "I don't understand anything.
What's a SNP?"
[laughter]
David Valle: If anybody else wants to hire me, feel free.
[laughter]
Male Speaker: Get that recommendation onto your LinkedIn
site, Dave.
[laughter]
Gene Passamani: I think it had to do with the reception rather
than the delivery, David. [laughs]
I guess the other thing you're all aware of is the successful and really informative New
England Journal of Medicine's series on genomics. Those who read it probably know more than
this clinician. But in fairness to clinicians, they knock it out hard every day and they're
not reading everything in the medical literature, that's for sure. And yet they're the folks
that are passing out this care to people that matter.
The barriers, largely innocent of genetics and genomics. Multiple categories of physicians
with different interests and needs. I think we need to really keep that in mind. And genomics
transcends specialty areas so it stretches across a whole different bunch of folks, some
of whom are really interested in this and sophisticated, others who aren't. And it seems
to me it's really important that we keep that in mind. As I mentioned, professional associations
worry about getting ahead of their members and this can cause an executive director his
job if he's not too careful about that. We've got lots of people interested in education,
no means to fund it. And it's difficult to monitor advances over so broad a piece of
science. And it seems to me that's a really big problem and one that we have to deal with.
A minute on physician statistics. There are 850,000 physicians licensed to practice in
this country. 624,000 of them do mostly clinical care. And of those, 209,000 are really primary
care physicians; that is, they deal with the general run of what wanders into a doctor's
office. I also wanted to mention, there is an estimated shortage coming up in the next
15 years of 150,000 by some experts, so we've got a real problem there as well. The other
piece about the general practitioners is, you all know that they slug it out in the
office every day and it's really tough. Every 15 minutes a patient with three systems down,
that's really -- that's really very difficult.
So, a few thoughts on the way forward. I guess we could do nothing and let the traditional
means of education sort of do their bit. It seems to me that's not very satisfying and
I think it's really irresponsible. I think the first thing is, I think this has already
been set in place, is to set up a process for review and consensus development. What
matters, what doesn't? How big a deal is it, how accurate is it?
And it seems to me that we ought to try for genomics literacy across the whole spectrum
of practicing physicians. They ought to know what a SNP is. And they ought to have some
sense of what's important, what's not important. They don't need to get into all the details,
but they really ought to have a sense of what's important in this field. Seems like pharmacogenomics
is going to be pretty close to what most physicians deal with since all of them use drugs. And
I mentioned to some of you, it seems to me that doctors who are in practice respond to
cases, that's where they live. And so I wondered whether it would be useful for us to collect
a vignette, a series of vignettes about where genomics matters today in patients. And I
think you all probably have some examples of that, and I would hope we could collect
that and use it.
I think we also have to rank order physician specialties and associations by the proximity
of the science to the clinical horizon and the likely number of patients involved. That
is, we ought to really focus on those where we have something really good to sell and
that it involves a lot of people. I think you have to -- we have to interact with these
professional societies, such that when a clinical science matures, that guidelines are prepared
and delivered just in time. I think physicians are not ready to accept that this is going
to be important someday. They need to have something that's important tomorrow.
I think public education has to go on in parallel because patients and doctors have to see the
same things. And I thought that New England Journal series was very good. I put this up
just to sort of show you at least a partial list of these associations and the number
of members they have, and they range from the biggest, which is the College of Physicians,
a very important part, the Academy of Pediatrics, and then smaller associations. And I'm sure
I left one out, I think I did leave out the Infectious Disease Society of America. But
these are the folks that I think we're going to have to strike out and --
Female Speaker: Yeah.
Gene Passamani: -- form some sort of communication relationship
with now so that when we're in the -- at the point when we really need to deliver some
of this stuff we've got the relationship. And I threw in these societies, which are
big and not necessarily physician societies alone, they're very large organizations which
have a different collection of practicing physicians and I think they're all really
important. So, that concludes what I had to say. I was hoping that we would get discussion
from this and I'll be happy to answer your questions or listen to your comments.
Dan Roden: Good. So, comments? Okay, David, Howard.
Male Speaker: Could you go back one slide? Yeah, so you
don't have American College of Medical Genetics and Genomics, which recently renamed itself
to reflect its interest in playing a major role in translating all of this into medicine.
And it's tiny, and the experience of the American College of Medical Genetics and Genomics is
the number of physicians entering our specialty is declining. But the number of master's degree
genetic counselors is increasing nicely, although can't possibly meet the need. And the number
of Ph.D. laboratory-trained people is increasing.
So, the laboratory component and the genetic counseling component are growing but need
to grow faster. The physician component is declining in the face of increased needs.
So, I think all of these education discussions need to be much broader in terms of physicians,
Ph.D.s, nurses, PAs, Pharm.D.s, all of the groups that need more genomic medicine education
in order to address these needs, because it's just not going to come from current physician
workforce.
Gene Passamani: Thank you. I didn't include them, I know they're
there and I know there very, very well aware of what's going on here. Other comments?
Dan Roden: Okay. So, Howard, I think, was next.
Howard McLeod: So, I'm wondering in the context of physician
education. I'm wondering whether we're trying too hard? Because the radiology community
didn't try to make generalists into biophysicists and we don't need to make generalists into
microbiologists, or geneticists even. And so, certainly, knowing what a SNP is would
be useful. But there are a lot of elements that can remain in the black box and they're
just fine with that. It's more of the usage part of it that's important. You know, most
generalists don't care how a bilirubin's measured, they want to use it.
So, there are nuances that we get really jumpy about, I mean, but at the end of the day,
I think if we maybe calibrated the need a little bit better, we might have more inroads,
especially with the initial stuff. Now, ACMG needs something different from the American
Academy of Pediatrics, but -- or some of these others, but, you know, I think in some ways
we need to lower our goals to something more achievable.
Gene Passamani: I think that's a good point. It does seem
to me that that's a part of a point that all physicians aren't created equal in this. I
mean, podiatrists are probably not much interested in it. But internists who deal with subspecialties
of medicine I think are very interested in it and they really ought to know the pharmacogenomics
pretty well, it seems to me, but I take your point. Other comments?
Male Speaker: There's a long speaker's list. I'm watching
you, don't worry.
[laughter]
Male Speaker: Okay, couple quick comments. First, having
done this kind of education for about 15 years, recently the American College of Physicians
has reached out to the American Society of Human Genetics, American College of Medical
Genetics, and a couple of other groups and said they're interested. And that's the first
thing I've found that's really, really helpful. It's now on their radar. And John Tooker,
who is their former executive director, is actually charged with that. So, I think that's
a huge opportunity there for us to reach out to them.
The second, you probably noticed, or you may not have, in Joanne Armstrong's presentation
yesterday, that Aetna has a focus on genetics education, actually has a budget for it. And
I think we really need to figure out how to partner with them, because they can actually
require the physicians in their system to do some Aetna education every year. And I
believe they reach one in 10 U.S. physicians, so huge thing.
And then my last comment is that there was a very successful program that the American
College of Medical Genetics did, probably 10 years ago, with endocrinology. And what
they did is they switched the paradigm a little bit in that they made the endocrinologists
a patient and took them through genetic testing. So, they really saw the power of genetic testing
and the effect that it could have on them and then took that back, and a lot of endocrinologists
started using genetic testing who hadn't before. So, that's a model I think we could replicate
in many professions.
Male Speaker: Yeah, we could all have 23andMe on ourselves.
[laughter]
Male Speaker: Well, but, yeah, but, I mean, when they really
-- what we did is, at their meeting, we set up where they had pre-testing and they had
short genetic counseling sessions and it was just eye opening. I was one of the counselors
there and talked to like 10 of these endocrinologists, and they didn't know what a genetic test was.
They didn't -- but it really became powerful when you made it something that would apply
to them and their family, and then used that in relation to their patients.
Female Speaker: Just curious, what genetic testing did they
have done? Like just some a couple candidate genes, or?
Male Speaker: MEN2 and some other things that had an endocrinology
basis --
Female Speaker: [inaudible]
Male Speaker: So we had a whole work, but we picked like
six conditions and --
Dan Roden: Did any of them have anything?
Male Speaker: Actually, yes.
Dan Roden: Oh, okay.
Male Speaker: [laughs] So --
Dan Roden: Say no more on that.
Male Speaker: Yeah.
[laughter]
Yeah, yeah, yeah. Physician-client privileges.
[laugher]
But I do think that's a powerful -- and you can even do it in an abstract where you set
up the whole process, but I think that would be something that would be really worth thinking
about doing with some of these other groups, because they just don't put genetics on their
radar and this got it on their radar.
Dan Roden: Michael, Josh, Pearl, Geoff. Everybody wants
to say something. So, Michael?
Female Speaker: Wait, I have --
Dan Roden: Okay --
Female Speaker: I have to say something.
Dan Roden: All right.
Female Speaker: [laughs] So I just --
Dan Roden: I just didn't see a hand down there --
[laughter]
Female Speaker: I know, I know, I just took over the mic.
Dan Roden: Go ahead.
[laughter]
Female Speaker: So, I just spoke at the American College of
Physicians. They invited us back for a second year. It was actually an ethics session, but
all on genetics, genomics. And I'm invited to speak at the American Geriatric Society
later this fall and I still haven't figured out what they want me to say. But, so I think
we do, I bet there are lots of people in the room who get those types of invitations. And
there is interest out there. Okay, go ahead, Michael. Oh and also I just have to say --
[laughter]
In response to Dr. Ledbetter, that I was just on the American Board of Medical Genetics
and actually the numbers of clinical geneticists and so forth has kind of leveled out. We're
no longer declining in our numbers of enrollees in the programs. So that's good news for us.
Male Speaker: I was going to say that the drivers of physician
education are CME credits, board certification, maintenance examination content, and patient
questions in the room. So, until those three things happen you're going to find a lot of
physicians not interested. And the other comment would be that the new way to deliver physician
education is in short, 10- to 20-minute interactive web-based CME credits. So, people that are
thinking about education and getting out to groups of practitioners, no matter doctors
or others, that's one thing to really think about in your design.
Gene Passamani: And those are really good ones for cases.
Like short cases.
Male Speaker: Right.
Dan Roden: Okay, Murray then Josh.
Murray Brilliant: At the --
Dan Roden: And Pearl and myself.
Murray Brilliant: -- Marshfield Clinic we've done just exactly
that. So, we have now a mandatory computer-based training in pain management that includes
a module on pharmacogenetics, and it's really quite nice. And so our physicians, all of
them now know about, you know, CYP2D6 and variants of that, so it's really nice. It's
worked quite well.
Male Speaker: [inaudible]
Female Speaker: Murray, is it possible to get access to that?
Murray Brilliant: I'm not sure if it's proprietary. I don't
think it is, but I could ask.
Gene Passamani: Sounds like a nice model.
Female Speaker: Yeah, if there's a way to do that and there's
information to try to facilitate it so that it's [inaudible]
Murray Brilliant: Okay, great.
Male Speaker: [inaudible]
Male Speaker: So, I was just going to say -- [laughs] we
should all raise our hands again.
[laughter]
The -- so, I think this is a real demonstration of a case where, you know, there's going to
be, you know, there's a fire hydrant, it's just going to get worse. And it's one of those
real opportunities that, as a representative informatics community for, I think, us to
engage, as meaningful use comes on board, more and more EMRs are out there, that we
can deliver that information just in time.
And if you could -- and this is what we're trying to do, it's one of our prospective
genotyping efforts in trying to, you know, test some of that in front of physicians,
what kind of language looks good and how do they respond? With progressive -- enabling
them to kind of click and learn more, just kind of as they need it. But we're never going
to build support and educate around everything. We can support and educate around the concepts
they need; then maybe we can do more and more just in time stuff with informatics.
Gene Passamani: I wouldn't sell specialists and subspecialists
short. Some of them are very smart and very able. And if you put it in front of them and
it seems like it's useful, they'll look it up and I don't think there's any question
about that.
Male Speaker: And, in fact, we actually have a link off
of our advisory on CYP2C19 where you can see all 60 articles that we've curated around
clopidogrel if they want to read it.
Gene Passamani: That's great.
Pearl O'Rourke: I know --
Gene Passamani: Knowledge map for genome education.
Pearl O'Rourke: I know that resident -- medical school and
resident education wasn't part of your talk, but is there any evidence that the younger
doctors are trained up adequately and, you know --
[laughter]
I know, not a -- I mean, if -- you look at the curriculum and it is a little scary. And
on one side there's a lot of concern that they're not being taught physical exams. And
my one [laughs] -- like, what are they being taught instead? I know, just anecdotally,
just going into the wards and seeing a person in shock and I thought, you know, I know how
to deal with this. You know, Valium, Valium, Valium, and pressors, and immediately went
off into what calcium channel blocker might be a mutation. And meanwhile, you know, the
patient's dying of hypotension.
So, my concern is, I mean, is there any data that the new wave can potentially educate
the -- our geezers, or is everybody in the same bad boat?
Gene Passamani: I guess I'll take -- I'll say a piece here.
I do think we run the risk of having sort of an intergenerational tussle here, but my
goodness, surgery is really suffering today. And the reason is that they're limited to
80 hours in the hospital. And I've seen residents in their second year who, I'm told, don't
know how to tie knots. So what happens to those residents is they go out and make the
mistakes while they're in practice that they should've made while they were in a more controlled
setting. Anybody else know about what's going on in medical schools?
Dan Roden: [inaudible] So, David and then [inaudible]
Male Speaker: So, a couple comments. First of all, the online
tools are great, but just a word of caution that our place, the current calculation of
the total hours required to be spent on online exams of various things, responsible conduct
of research, HIPAA, blah, blah, blah, blah, blah. And it was estimated to take about one
week of eight hours a day to complete the current online requirements. So, adding more
may not be received favorably. That's not to say there's still not a niche to fill.
We've changed our curriculum. We're trying to infuse a genetic thinking into the education
of medical students. It's too early to -- for us to know whether or not we've achieved any
kind of success. And the -- if you think about changing the curriculum as an experiment it's
a very hard thing to gauge the success of an experiment because the controls are very
difficult to come by.
So, it may be in the category of an experiment that you just get all the opinions in one
room and try to make your best choice, and go for it that way. The other thing that I'll
say, though, is that it's clear that medical education has different challenges at different
phases of the career. So you have the medical students and then you have the house staff.
And the house staff do a lot of educating of the medical students in the third and fourth
years. If you don't educate the house officers, anything you do to the medical students is
likely to get beaten out of them in years three and four. And then you have to educate
the practicing physicians and your academic colleagues. So I think it may be important
to think about different strategies for different levels of medical education. And, in a way,
I think they have to be taken on almost simultaneously so that you -- because the educational experience
goes on for such a long period of time.
Gene Passamani: Thank you, David. It seems to me that this
machine is going to deliver wonderful results and we don't know exactly where. We're going
to be in tough shape if we're not ready to deal with them.
Male Speaker: [inaudible]
Male Speaker: Two quick comments. One relative Andy's anecdote
about the endocrinologists. Susanne Haga, who could not be here today, has published
a paper that has shown, after surveying hundreds of primary care physicians, that those that
actually had genetic testing on themselves were 10 times more likely to order a genetic
for their patients. So that's a provocative piece of data that could be channeled constructively
into some educational programs.
Gene Passamani: We could offer it to our medical students.
Male Speaker: It's being done.
Male Speaker: Yeah, and so --
Male Speaker: But the --
Male Speaker: So --
Male Speaker: Okay, I have a second comment, do you want
to --
Male Speaker: You make your -- so I, well, so let me --
[laughter]
So, for the second year this year we engaged in an exercise at Vanderbilt, stolen from
the Stanford experience, so I make no apologies for that. We managed to get it into the curriculum,
they managed to get it as a summer optional course, where we offer, we offer 23andMe testing
to the medical school class. And we go through a long sort of pre-test exercise where we
discuss the ethical downsides and, you know, what an odds ratio of 1.2 actually means.
And then they go and pick up their kits and spit. I don't think anyone's had their dog
spit yet --
[laughter]
-- but, you know, who knows? And then we have a session where we deliver the results to
them and Josh actually organizes a survey that they fill out. And the survey is, sort
of, what was your odds ratio for developing type 2 diabetes? What was your odds ratio
for this and that? And then a whole session on ancestry and a whole session on rare things
that 23andMe looks at. And, you know, would you do this again? Do you feel like you're
smarter? Those kinds of things.
But I think it comes back to the point that you made, that when you do this on yourself
and you get the results it's sort of, "Oh, isn't that" -- there is sort of a resonance
of some kind that I think Susanne would've told us about and, you know, and I've certainly
felt when I looked at my own website. So, I think that's a tool and one of the things
that I hope I'll be able to do is interrogate the medical students who had it last year
and who are now coming into fourth year, and say, well, you know, "Do you remember that
session at all? Do you remember anything about it? Does it make you think differently about
a patient when you're sitting on the ward?"
So, those are the kinds of things that I'd like to hear. And Josh participates when he's
not travelling, which is not a criticism because I travel more, in delivering that kind of
information to the medical students --
Gene Passamani: It seems like that might also populate our
ranks with people who want to do this.
Male Speaker: So, I think the idea of, sort of, you know,
personalizing and somehow saying, "Remember?" And they know how it feels whether it's that
way or your way or our way, I don't what the right way -- probably any one of those experiences
is right. So, your other comment?
Male Speaker: Oh yeah, and my other comment is that I think
this guidelines topic, with all the caveats that Paul raised this morning, needs to be
an agenda item at our next meeting when we engage these professional organizations, because
my bias is that it's the equivalent of having primary care physicians review a genetics
grant. I mean, how are -- just -- well, it came up in the EGAPP discussion yesterday
about pharmacogenetics, I mean, the people that are making the guidelines are probably
not in this room. It would be my guess. Except for the CPIC group, which is sort of an interesting
way to approach it. And maybe we should even think about how CPIC could be a resource for
the professional organizations instead of having them reinvent the wheel?
Gene Passamani: I'm sure that most of them realize that they
need help and that we might be able to give it to them.
Dan Roden: Okay, there are lots of hands still. Behind
you, yes.
Male Speaker: So --
Dan Roden: Sorry, the Air Force goes first. This Air
Force goes first.
[laugher]
Female Speaker: It's just Cecelia. I just had a quick comment
about the National Coalition for Health Professional Education in Genetics. They were kind enough
to work with us in our symposium last September. And, in terms of our enrollment strategy for
our study, I made the decision to enroll people who are part of a health care team, because
although it's physicians in theory we're the leader of that team. I wanted to try to start
that genomic literacy effort for all of our providers, so in our system that's nurse practitioners,
physician assistants, nurses of course, and then our medical technicians as well, because
they do have increasingly independent roles, in terms of the that way they interact with
patients. Thanks.
Gene Passamani: And pharmacists. Very important.
Male Speaker: Sorry, if I could just throw one thing in
here real quickly. So, I surveyed --
Male Speaker: Yeah, okay --
Male Speaker: Oh --
Male Speaker: Go ahead.
Male Speaker: So, in the [inaudible] I created an educational
management system, and so I created -- I pulled up 400 concepts related to genetics and surveyed
10 years of our curriculum, and it actually has increased. Twenty-two lectures, about
hours of curriculum in 2002, and 147 in 2010.
Gene Passamani: Wow, thank you. Welcome to an informatics-rich
world.
Male Speaker: All right, then, on the informatics note.
So, clinical informatics was approved as a board-certified subspecialty last September,
the first exams will be in 2013. So, a few places are designing fellowships and rotations
for the residents. And so this is your chance to make sure that those rotations and fellowships
include exposure to genomics, not just to Microsoft Excel and SQL database.
Gene Passamani: So, clinical genomics is a subspecialty in?
Male Speaker: Clinical informatics, pathology.
Gene Passamani: Clinical informatics --
Male Speaker: In pathology.
Gene Passamani: And so, there's --
Male Speaker: There's also -- biomedical informatics is
a subspecialty in preventative medicine.
Male Speaker: Yeah, that's right.
Dan Roden: Okay, other comments? I saw lots of hands,
but they all just disappeared. Okay, yes?
Male Speaker: Okay, so two things. One is that one of the
other ways to go about this is actually to get the fellows as specialists to get take
a little bit of more interest in genetics. So, ACMG has worked on -- instead of going
through a genetics residency or fellowship, is actually have like a one-year course. So,
if somebody is a cardiologist and wants to specifically look at cardiovascular genetics,
have a program like that. And so you don't need to train everybody to be a general geneticist;
you just need to train them in a specialty that's applicable to them. And then hopefully
they'll be the leader as it's going out.
The other thing that -- doing student education, one of the things that I've started to do
is, how to teach the students how to look at uncertainty. And so these variants of unknown
significance, you know, these are common, we get them all the time. But, how do -- you
get the students to think about how do you critically analyze information? And this is
applicable to their regular life too. I mean, you get a lab result and you're like, "Well,
what am I supposed to do with this," you know, "potassium? Do I watch it, do I repeat it,
do I treat it right away?" But this is a good lifelong lesson, that if you can teach them
how to look at uncertainty, how to evaluate it, and how to react to it, that it's not
just hypo-genetics or genomics, but that it's everything else as well.
Gene Passamani: David, one more.
Male Speaker: Okay. Just to put in a plug, this summer will
be the 53rd annual short course in experimental and medical genetics at the Jackson Labs in
Bar Harbor. It's a two-week course, 53 lectures and eight workshops, lots of prominent speakers,
it's really pegged at just the right level for fellows, Ph.D. students, and young assistant
-- young faculty who are in various specialties but want to sort of get a two-week intensive
experience in genetics. I highly recommend it.
Gene Passamani: Thank you, David.
Dan Roden: Okay. I think we'll stop this part of the
discussion. The next discussion is for me, so you're going to have to bear with me while
I transfer the slides that I've been working on all morning onto a stick. I have to remember
where I put them first.
Female Speaker: Let me make a comment while you're doing that?
Dan Roden: Yes, please do. Do something to suck up the
dead air.
Female Speaker: Okay, in terms of, sort of an alternate thing.
We're constantly looking, from the IRB world, in terms of how do you present, you know,
probability, et cetera? And looking at recent literature on how numeracy in the U.S., it
was something like 50 percent of the public cannot tell you if 10 out of a thousand is
1 percent or 10 percent. And then they went to medical students and they were not much
better.
Female Speaker: Really?
Female Speaker: So, I think when we're talking about even
beginning to, you know, talk about relative versus absolute risk, we're talking just percentages.
I mean, so it's really scary that -- again, to end on a positive note.
[laughter]
Female Speaker: Someone's got to.
[laughter]
Female Speaker: It's our fault.
Female Speaker: It's scary, yeah.
Male Speaker: So what's the answer?
Female Speaker: The --
[laughter]
Dan Roden: The answer is for Eric to fix K through 12
education, we already -- we established that yesterday.
Female Speaker: So rather than watch Dan --
Dan Roden: Yeah.
Female Speaker: -- struggle his way through this, just a quick
question for folks. We will be talking about locations for meetings and that, but any thoughts
about this particular hotel? Is this a positive? If we come to Chicago, would you rather be
here, even though it tends to be a bit more expensive? Or, you know, we can go to an outlying
hotel, but you have to take a shuttle to get to it and that -- any strong feelings?
Male Speaker: The price was pretty good.
Male Speaker: Yeah.
Female Speaker: It's the convenience.
Female Speaker: Okay. So, no strong feelings?
Female Speaker: Yes, the O'Hare Hilton is my favorite place
in the whole world for a meeting.
[laughter]
Female Speaker: Well, there you are.
Male Speaker: It's my least favorite.
[laughter]
Male Speaker: [inaudible] is pretty nice, too.
[laughter]
Female Speaker: [inaudible]
Female Speaker: Thank you, [unintelligible].
[end of transcript]