- My name is Sam Hawgood
and I'm the chancellor here at UCSF.
It's just a thrill for me
to welcome you all here,
and for those that are
watching this via live stream
for our Stand Up For Science teach-in.
I'm not sure, I think it
would have to be exam finals
or a Stand Up For Science teach-in
that would get everyone out of bed
and here at 8:30 on a Saturday morning.
Thank you all for being here.
(applause)
So as a public university,
UCSF is firmly grounded
in the belief that the
expansion of knowledge
through scientific discovery is necessary
for our society's freedom and prosperity.
We also believe very
strongly that our strength
as a university stems from a culture
that embraces diversity and inclusion
and respects every individual
regardless of their
religion or national origin.
We've organized today's
Stand Up For Science teach-in
and the other events that
we'll be holding this morning
to reaffirm and celebrate
these core values.
We have a group of
scientists here this morning
who exemplify UCSF's mission
of advancing health worldwide.
They have taken on challenging
scientific questions
and dedicated their careers
to bettering the health of people locally
and around the globe.
These efforts have at times clashed
with political sentiments,
and this is what we're going
to focus on this morning.
I want to thank each of our speakers,
as well as the organizers
of today's events,
including the Gladstone Institutes
and the California Life
Sciences Association,
who are co-sponsoring
both the teach-in and
the rally afterwards.
Now, the teach-in itself
would not have been possible
without the vision and
leadership of Claire Brindis,
who's our professor and
director of UCSF's institute
for health policy studies.
Claire really conceived this idea
and has championed it throughout.
I'd also like to thank the staff
from both university relations,
the UDAR events team,
and from finance, administration,
and from the chancellor's office,
who have collaborated to
make these events possible
with relatively short notice.
I can only tell you, in my office,
the enthusiasm and passion
over the last few days
has really been quite remarkable.
So now I'm going to turn things over
to our moderator this
morning, Mike McCune.
Mike is a professor of medicine
in UCSF's department of
experimental medicine.
He's a basic science researcher
who has dedicated his career
to working on HIV,
its pathogenesis, prevention,
treatment, and cure.
Mike, I'll hand it over to you.
(applause)
- Thanks, Sam,
and thanks to all of you who are here
and those of you watching from afar,
it's great to see so
many people this morning.
It's a day, I think it's fair to say,
we're learning to do and to
teach things that we like to do,
and this has been something
that's particularly happy for me
to have an opportunity to do from UCSF.
I've been here for many years
with my wife, over 35 now,
we've loved every minute of it.
We particularly enjoy the commitment
that the institution has had
to excellence, to open
inquiry, to collaboration,
to tolerance of new ideas,
and most importantly, I
think to the application
of these ideas to the
betterment of the world.
This is really why we are
here to do what we do,
is it not? It is to discover nature,
the facets of nature, to
understand what they mean,
and then to apply that
knowledge to help the wellbeing
and the health of people around the world.
This is not an easy task, and
I think all of you know that.
It's something that takes a lot of time,
and effort, and patience, persistence,
a dollop of idealism,
and this is what we're
gonna talk about today
with the faculty members that
you see here in front of you.
These are some amazing people
that come from diverse disciplines
that are at the top of their game.
We're not gonna talk
about the nitty gritty
of the research today, that's
not what this is about.
What they're gonna tell you about is
how they've taken the
information that they've learned
and tried to apply it to
sensible practices and policies
that can benefit all.
All of them, as Sam had mentioned,
have run into obstacles along the way,
usually, it has to do with sentiments,
political sentiments that run counter
to the facts that they've uncovered,
but they have been
perseverant and persistent
and have tried to move those
facts to the light of day
and to allow sensible policies
and practices to emerge.
Now, in a university like UCSF
with thousands of faculty
members, you must realize
this is just the tip of the iceberg,
and there are many in the
university, many in this audience
I'm sure who have been
doing the same thing,
and if you're one of those,
you should pat yourself
on the back, I think,
and keep on.
And for those of you who are
relatively new to the game,
I think one of the main
goals of this day is to
teach you what it is that
we're doing and how to do it
so that you can continue to do
it going on into the future.
With that, I'll describe
the format of the day,
will be that we'll have
each of the speakers
spend about five to six minutes
talking about their experience,
after which we'll have an open period
for questions and answers,
so keep them in mind
and you can ask them at
the end of this time.
Our first speaker will be Dr. Susan Fisher
who is a professor of obstetrics,
gynecology, and reproductive sciences,
and who will talk about her advocacy
of human stem cell research.
Susan.
- Thank you.
(applause)
And I want to thank everyone
this morning for coming out
to Stand Up For Science so
early on a Saturday morning.
We're truly inspired.
I'm here to tell you about
the tremendous impact
that the federal grant system
that supplies money for our research
has had on my research program at UCSF.
I started receiving federal
support for my research
as an undergraduate.
I had an NSF fellowship to
support my undergraduate research
and I had NIH funding for my graduate
and postdoctoral fellowship.
Yay, NIH funding.
So when I came to UCSF,
I very much expected to write
grants to the government
to support my work here at UCSF,
and I want to say, at the outset,
how incredible grateful I
have been for this support.
It's made much of my work
possible here at UCSF.
But what I didn't expect
was the tremendous
influence that politics
and the sentiment about science would have
on funding for my work.
And a good example of this
is our work in stem cells.
We derive human embryonic stem cells
from human embryos that are left over
after the end of in vitro
fertilization treatments,
and it's important to
realize that these embryos
would degrade over a number
of years in frozen storage
if we did not use them for the purpose
of trying to help people.
They're a really important
tool for science,
but I think what most of
the public is interested in
is the fact that they can be used
for regenerative medicine therapies.
They're being differentiated
into cell types
that can replace those cells that go wrong
in chronic diseases, such as diabetes.
The federal government
has decided not to fund
work such as ours, which makes
it incredibly challenging.
We've had to get funds for this work
from non-traditional sources,
such as philanthropy,
and here in California
from the California Institute
for Regenerative Medicine,
which was funded by Prop 71,
which is really a good example
of what the citizens of our state can do
if we band together for science.
So this non-federal
nature of the work we do
has had tremendous implications
for what goes on in my lab,
and I'm going to tell you
three very short stories
about what's happened and
that really illustrates
some of the difficulties that we face.
The first is about a paper that
we published a few years ago
about the first step in
establishing human pregnancy,
which is called implantation.
This paper had data in
it from human embryos,
and it was published at
11 o'clock Eastern time.
By four o'clock Western
time in our time zone,
I had an email from the US Congress
listing all of my NIH grants
and asking me which one had supported
our embryo work.
So I was so surprised by this.
I was amazed that they were
watching what we did so closely,
and I was very surprised
that they would catch us out,
try to catch us out on rules
that we knew very well,
because we had abided by the rules
and used non-federal funds for this work.
The second story is about the fact that
since this work was
non-federal, it had to be done
off-campus, so we were
deriving our first lines
in a very substandard
lab away from our normal,
really wonderful facilities at UCSF.
We had our first stem cell lines growing,
and there was a big Pacific storm,
and we lost power in that lab.
So we had to sit idly by as
we watched these stem cells
slowly die in the
incubator that was keeping
them alive but no longer had power.
The third story is about
a new way we've come up
for deriving human embryonic stem cells.
We've been able to take one
cell out of a three-day embryo
and make a cell that we
think is a more potent
kind of stem cell.
But the federal definition
of a human embryonic stem cell line
is that it comes from a
five-day-old human embryo
and not a three-day-old human embryo,
which is what we used,
therefore, the government
won't register these lines
and, again, we can't get
NIH funding for them.
So I hope that my three
stories have inspired you
to stand up for science, and
thank you for your attention.
(applause)
- Thanks, Susan.
Our next speaker will
be Dr. Esteban Burchard,
a professor of bioengineering
in the schools of pharmacy and medicine.
He'll talk about
his work in advocating for
the scientific advantages
of including diverse populations
in the research that we do.
Esteban.
- Thank you.
Thank you, everyone, for coming on a
Saturday morning so early.
Since World War II, the
United States has been
at the forefront of
science and technology.
10% of all patents in the United States
have derived from the NIH.
30% of all patents have cited work
that was funded by the NIH.
I'm a physician scientist,
I study genetics in minority populations.
In the last 10 years,
we've identified more genes
than in the entire history
of modern genetics.
However, there's a law in the books
requiring the inclusion of
women and minorities that was
put in place in 1993,
and I'm sad to say that, as of today,
96% of all modern genetics
and biomedical research has focused in on
populations of European origin,
and we published that in Nature in 2011.
To have clinical relevance,
the number one blockbuster drug
for heart attack and stroke
doesn't work in 50% of Asians,
70% of Pacific Islanders.
If any of you that are Asian
have a heart attack today
and go to UCSF, you're
gonna get that drug,
and it's basically a placebo
and they're playing Russian
roulette with your life.
So that drug was made on
a formulary in Hawaii,
and I'll remind you that
Hawaii is a Pacific Island,
and a lot of Asians,
and so we assisted the
attorney general of Hawaii
to sue Bristol-Myers Squibb.
And that's some of the
advocacy that we do.
But I study asthma in children,
and there are tremendous
racial and ethnic disparities.
The biggest predictor of
drug response for albuterol,
which is the most commonly prescribed
asthma medication in the world,
is ethnic background,
and when we looked at the NIH,
because they do analysis of
us, I did analysis of them,
and we found that, in the last 20 years,
less than 5% of their
pulmonary research has focused
in on minority populations.
And so in some sense I've been
a gadfly to the NIH, and I
met with Congresswoman Lee,
she dragged in Francis
Collins to congress,
and because of that, the NIH has
dramatically improved their
portfolio with respect to
diversity, and I got on
the precision medicine team
with President Obama and was able to
increase the diversity
with respect to gender,
geographic diversity,
socioeconomic status,
as well as racial and ethnic diversity.
So this is an important time, though.
I want to tell you the
yin and yang of this,
because although I've been a gadfly,
I recognize that this is not the time
to cut the NIH.
We're making significant advances
in inclusion of diverse populations
and inclusion of globally
or geographically diverse populations,
and that's relevant
because one of the first
things that Trump cut
were the IDEA grants,
which fund the fly-over states,
the Oklahomas, the Puerto
Ricos, the Wyoming.
We have a lot of talented researchers,
but they just don't have the
infrastructure for NIH funding.
And also, this is not a time
to cut the NIH because of the
changing demographics
of the United States.
47% of the US population is non-European,
yet, like I said, most
of the research is done
in European populations and generalized,
and so we need to fund the NIH
and support them to keep up
with the changing demographics
of the United States.
So, what have I done to do this?
It's very important for
me to focus on my research
and staying funded, but I've
devoted a significant amount
of my time in the last
several months to advocate
on behalf of the NIH,
and that's the yin-yang
component of what I do.
I met with Congresswoman
Barbara Lee's staffers recently.
I met with Tom Price's
undersecretary, John Bardis.
Through my professional society, I
am going to try to get
a meeting with Congress
to educate them on the importance of
clinical and biomedical researches
that relate to all
populations in the world.
And that's forthcoming.
All of the people in my lab,
we have to focus on good science, but
we can't do science in a vacuum, and so
a big component of my work is advocacy,
advocacy for preserving the NIH,
preserving the Center for Disease Control,
and that funds the work
that we do and it's
important for not only us
as scientists but us as
a populace in the clinical
and biomedical world.
Thank you for the opportunity to speak
and I'm glad you came this morning.
(applause)
- Thanks, Esteban.
I'd like to introduce you
now to Rebecca Smith-Bindman,
who's a professor of
radiology, epidemiology,
and biostatistics, and who's worked hard
to establish standards in
the field of radiology,
and she'll talk to you about that.
- Good morning, everyone.
I, too, want to thank
you all for showing up,
but not because it's a Saturday morning,
I mean that's impressive, but I think
what I've learnt and what I want to share
are my experiences at showing up
and showing up at the right
table and taking advantage
of the right opportunities
is a really important part
of what we need to do as scientists
if we really want to get to
the goal of really improving
healthcare, which is what
we mostly want to do.
We don't want to just
publish important papers,
we want to have them change healthcare.
So I'm a radiologist.
Radiology is the area of medicine
that deals with medical diagnosis,
or CT scans, MR, ultrasound
is the area that I work in.
Medical imaging is extraordinary
and has really had a huge
impact on medical care.
I would guess, by a show
of hands, that probably
a third of the people in this room
have had an imaging test this year,
and if you look at CT scanning,
one in five people get
a CT scan every year.
So we use a lot of medical
imaging, I'm a fan of imaging,
doctors, patients are all fans of imaging.
But one of the things
that's happened with imaging
is it's grown so rapidly, 400%
in the last 15 or 20 years,
that we haven't really paid attention
to the fact that there are
trade-offs with imaging.
There are both risks and benefits.
Everyone knows that about,
let's say, a new medication
or a surgical procedure,
but we haven't really thought
about that so much in imaging,
we just thought it was perfect.
And, as a result, no one's
really quantified it,
and so my research lab
focuses on quantifying
the risks and benefits of imaging
so we can try to use
it more appropriately.
One of the harms of
imaging, or potential harms,
has to do with radiation exposure.
I'm gonna share a little bit
of my experience in that world.
CT scanning, fluoroscopy uses X-rays,
and X-rays are a known carcinogen.
Carcinogen is a big word
meaning it causes cancer.
It doesn't cause cancer
in a lot of patients,
but it's a very well carcinogen,
actually, no carcinogen has
been studied more than radiation
and that means that it will lead to cancer
and some patients will undergo it,
and not only is it a carcinogen,
there are very few standards about
how we do medical imaging.
So the radiation we use,
it's not really overseen by anyone,
and what that means is if you
go to an emergency department
with flank pain, back pain,
if you go to one emergency department,
you might get a dose of two millisieverts,
that's kind of the dose you get by walking
around the planet, there's
radiation all around us,
but if you go to a
different emergency room,
you might get a dose of 200 millisieverts,
so 100-fold higher,
and so that's what I learnt in my research
and that was what I
published, and I thought,
oh my goodness, look what
I found, we have to sort of
create some rules and regulations
and get my professional
society's interest in it.
And it turned out, well, a radiologist,
you know, of course want
what's best for our patients,
they weren't as interested as I tend to be
in having standards, and having
oversight, and having rules,
and not because they didn't
care about the topic,
but they didn't like the idea of bringing
attention to this region
because that might mean people might not
use as much imaging if they
knew it had a potential harm,
and 'cause, as physicians,
quite honestly, we like
to regulate ourselves.
We don't like oversight.
And so I realized quickly that publishing
the science in good medical journal
wasn't gonna get me where I wanted to go
to improve practice, and
so that really shifted,
not shifted, but required an extra step,
and that step was sort of
getting involved in advocacy.
I sort of split my time
between mostly running my lab
and having NIH grant,
and then really getting
involved in advocacy,
and what that meant for me was really
both accepting opportunities
when I was invited to participate
in areas to educate people,
but also seeking out those opportunities.
And so when I say opportunities,
it meant for me bringing
stakeholders on board,
bringing people to the table and saying,
this is an important topic.
It's sort of a very nuanced,
detailed topic that no one thinks about,
and I wanted people to think about it.
So as part of that, when
I published papers, I
would speak to the press a lot
and tell them about the issue.
I was invited to speak before
the US Congress several times,
and I jump at those opportunities,
and when I say jumped
at those opportunities,
"Rebecca, have you ever spoken?"
Like no.
"Would you like to?" Definitely.
And then I was like, "Oh my,
I don't know how to do this."
I have to learn how to do this,
this is way over my head.
But I've spoken to Congress,
I've spoken to state senators,
I've spoken to national
meeting state legislator,
I've spoken to the Center for Medicare
and Medicaid Services,
I've spoken to the FDA,
I've written quality measure,
you know, I'm a radiologist,
I'm not a quality measure writer,
but no one else was
writing quality measure,
so I've written quality measure.
I've worked through organizations
to get them to use those quality measures.
I've really started to realize that, while
the space that I'm most comfortable
in is crunching numbers,
I'm a numbers person, I
use big, large databases
and I evaluate, let's say,
radiation dose of millions of patients,
but that's not enough to change practice.
To change practice, I have to
get that information out there
in good scientific journals,
but I also need to make
awareness of this issue
outside of my small, insular community.
And I think I've had some success,
I've had some failures in that,
but it's really changing, in my mind,
what my role as a scientist is.
So my main identity is a
scientist, and I think you need
to be able to stand behind
really good science,
so I'm in no way saying
your science should suffer,
but I think if you really
want to change practice,
sometimes that means
going beyond the science
and really moving into a
world of teaching people
about what you do and the
importance of what you do, and
it's been a real honor to
get to do this at UCSF,
and a definite honor to
get to share it with you.
So, as I started showing up
and showing up at the right table
and learning what the
right table is I think
is part and parcel of what you need to do
if you really want to change practice.
For some of you, you
may not have to do that,
it may be that you'll publish a paper
and then it will be adopted widely
and everyone will change
their practice because of it.
I don't know anyone either
who's had that experience,
but for most people I know,
it's sort of a slog to do the science
and it's also a slog to get
people to listen to them.
Thank you for being able
to share my experience.
(applause)
- Thanks, Rebecca.
Cherrie Boyer will speak next.
Cherrie is a professor of pediatrics
and adolescent medicine, and she'll
talk about her efforts advocating
for work on the reproductive
health of military personnel,
particularly female recruits.
- Thank you.
Good morning.
Yes, my work is in reproductive health
for adolescents and young
adults, specifically
trying to prevent sexually
transmitted infections and HIV,
and I've been doing this for
two-and-a-half decades now.
So, what I was asked today
to speak specifically
about one experience, and
I'm conducting research,
particularly with the
Department of Defense.
So I'll give you a little
scenario by way of context.
Sexually transmitted
infections are epidemic among
adolescents and young adults.
Half of those that are diagnosed,
of the 20-million cases diagnosed annually
among 15 to 24-year-olds,
and about one quarter of all
sexually active adolescents
are diagnosed with an STD annually.
So, therefore, there is a dire
need to continue to focus on
sexually transmitted infection.
We know that it's important
because there are serious
and long-term consequences
to having an STI,
particularly an asymptomatic
STI for young women, including
ectopic pregnancy, chronic pelvic pain,
high risk of cervical cancer,
and increased risk of HIV transmission.
So, therefore, it is important to
address what might seem
as something as benign as a bacterial STI.
Also, in addition to focusing on STIs,
unintended pregnancies are very high
in young people, even though
the rates have declined,
they're higher in this country
among any other western
country in the world, and that,
also, there are consequences,
there are social and health consequences
for adolescent young women
who experience pregnancy
as a teen, including
lack of the ability to complete
high school or college,
having increased access to
having more reliability on
public assistance, for example,
and having a lower earning potential
over the course of her life.
So, therefore, it is
important to also focus on,
how do we prevent unintended pregnancies
in this young population?
And our group here at UCSF
have been on the forefront for many years
and working not only on
prevention, but also on diagnostics, on
non-evasive screening, and
we were doing that very well
and have been doing that
for many, many years,
and in doing so, we were contacted by
military medicine personnel
who were saying like,
"We're seeing these STIs
in these young people.
"They're coming in with high rates,
"they go out on deployment,
"and they're contracting infection.
"All we can do is to keep treating them,
"but we're not addressing the problem."
So they asked us to help
them think through this and
how they could impact
these high rates of STI
in their population.
After working with them for
a number of months on this
and engaging in some really
interesting research,
doing ship port studies on
young men who are deployed
and helping them to figure out ways
of doing actual prevention
that didn't involve just scare tactics.
We were helping them to think through that
and how they could use
their personnel to do that.
And, lo and behold, we sought funding
and got funding from the
Department of Defense,
but the biomedical branch,
and as you know, the
Department of Defense is huge
and there's a lot of activity there,
lots of different commands.
They don't all line up and
it's not one just unit,
it's a huge bureaucracy.
Not surprising.
So we got funding from
the biomedical branch
and we thought, okay, we could do this,
now we could go in and
implement the science we know
we were on the cutting edge
of work that was going on,
so we could go in and do this.
Not so easy.
It made more sense because young people
who are coming into the
military have higher rates
of STIs and unintended pregnancy than
the average civilian
population of peers their age.
So it made more sense to address this
when they came in, right
at recruit training.
But that was not so easy a task because
the mission of recruit training
is to train a troop of
combat-ready soldiers,
troops that are combat-ready,
that's their mission.
Health wasn't a part of that equation.
Needless to say, it
was an uphill battle to
convince the powers that
be that were in charge of
combat-ready soldiers, is to
take away any time away from
their training mission, right?
Because if they took those
10 to 13 weeks that they're being trained,
if they took an hour away
from that to focus on health,
that was one less hour
that they were gonna be
ready for combat duty,
even though we weren't in war at the time.
But, anyway, we had to
work with our colleagues
at the military preventative
medicine group got it,
they wanted this, so they
worked with us to get
an audience with admirals,
with generals, with
whomever would talk,
who owned the soldiers
of the training command,
who were up the chain of command for
the military preventative medicine group.
So not all of them on the same page.
So we spent months and
months, weeks and weeks
going around the country to East coast,
Japan, Hawaii, talking to
whomever would talk with us.
Finally, we had an opportunity
to meet with a woman
general who recognized, who was
in charge of training women,
and she recognized the importance of
the health of the women
that she was training,
and so she allowed us the
opportunity to come in,
to help with the screening,
to teach them about
non-invasive screening,
to allow us eight hours of
training for prevention,
which was the standard for our field
in terms of prevention education.
And fast-forwarding two years,
in doing so, we really did
come up with an efficacious
protocol for them,
and the one thing that we learned was,
one, being patient, being persistent,
fitting in, not really
trying to shake things up,
to make sure that we were
respectful of what existed
so that we were allowed to do science,
the really good science, and then so
that we can then leave something.
And so we wanted to train
those that were interested,
the preventative medicine
technicians, the doctors
on how to do this screening appropriately.
We provided a straightforward protocol
for the training instructors
to figure out how to do
prevention education
without using scare tactics
or using scare tactics alone,
which was the standard then.
And in doing that, we left behind
something that changed the way that
this particular branch of the military
dealt with reproductive
health of the women.
I can say that it's not true for men,
don't receive this type of prevention,
and not all the services receive it,
but what we know this, that
we changed the culture there
and that when we left,
there was something in
place for them to hold on to
and which they continue to do,
to my knowledge, to this day.
And, interestingly enough,
we've come full circle.
The Department of Health
and Human Services
Office of Adolescent Health
has utilized this particular
scientific intervention that
shows evident to be one of
their evidence base and convention
that they're funding for replication
for at-risk young people in the country.
So it's come full circle,
and by persistence, good science,
trying to figure out ways to
working with difficult cultures
that you can be successful
in changing something
as important as the
reproductive health of women.
Thank you for your time.
(applause)
- That's great, Cherrie.
Our next speaker is Jim Kahn,
who's a health economist
with the Institute of
Health Policy Studies.
Jim has also worked on efforts
to prevent HIV disease,
and he'll talk to us about those efforts.
- Good morning, and I'm pleased
to participate on the panel.
My work builds on the idea that
formal synthesis of scientific evidence
about health intervention,
efficacy, and cost
provides essential guidance to help us
effectively and efficiently fight disease,
to maximize health for the most people.
This philosophy turns out to
be surprisingly controversial.
In particular, when science runs up
against values or politics,
it can take a beating.
Luckily, in my experience,
careful analysis
often garners support that leads
to better health policies and programs.
I'll discuss three examples.
In 1992, HIV was spreading
quickly among drug users
through shared needles.
A few local needle exchanges were trying
to reduce this risk.
However, the White House refused
to officially state that needle exchange
reduces HIV transmission.
Moral opposition to drug use was spilling
into HIV prevention debates.
Many believed, despite
the available evidence,
that needle exchange encourages drug use.
So the CDC hired a team at UCSF to assess
the broad effects of needle exchange.
My responsibility was
to quantify the impact
on HIV infections and cost.
We found, and the federal
government ultimately accepted,
that needle exchange reduces
HIV infections and saves lives
at a very affordable cost
without encouraging drug use.
I want to convey a fascinating
experience that I had
in this project and I ponder to this day.
Early on, I interviewed
a minister from a church
in the black community in
New Haven, Connecticut.
He very thoughtfully but resolutely stated
that he was morally
opposed to needle exchange
because it seems to
condone drug injection.
End of discussion, apparently.
Yet, six months later, at a
meeting to present our results,
this minister looked
over at my laptop screen,
seeing a special technique
we call sensitivity analysis,
which showed that even allowing for the
substantial uncertainty in the evidence,
needle exchange saves
lives very efficiently.
He said, "Hm, in that case, I
can support needle exchange."
To my amazement, a profoundly humble idea,
documenting our uncertainty,
was the key to reaching
an absolute moral barrier.
What's the lesson here?
Perhaps that humility in science is
a better-selling strategy than certainty,
or perhaps that a persistent focus
on saving lives is what matters.
In 2005, I was drawn into another
fraught HIV-prevention debate,
voluntary adult male circumcision
to prevent HIV in Africa.
Despite being standard at
birth in some major religions,
male circumcision in adults
was perceived by some local critics
as a violation of human rights.
Clinical trials and associated analyses
were attacked as unethical.
I was invited to conduct
an economic analysis
by a French clinical
researcher who published
the first randomized trial of circumcision
for HIV prevention.
The trial found that
circumcision reduces HIV
infection risk by more than half.
We then estimated that
circumcision cost just
$174 per HIV infection averted.
Once again, we considered all
the uncertainty we could find.
Any way we looked at the evidence,
adult male circumcision
saved lots of lives.
My studies and others like it
led to a World Health
Organization recommendation
for widespread offering of circumcision.
And I'll end with the work
that got us the most attention,
both supportive and critical.
In 2002, we published a review in Lancet
that found that, per dollar
spent in Africa, HIV prevention
provides 30 times the health
benefit of HIV treatment.
We propose that if funds
are limited, as they were,
it's important to first
fund HIV prevention,
even if it delays scale up of treatment.
This view was endorsed by some in the
HIV policy and research
community, who said, more or less,
"No surprise here."
However, it was actively, indeed,
vociferously critiqued by some
prominent health advocates,
who accused us of, "Throwing
people out of lifeboats."
In the end, the global HIV
control effort shifted,
with impressive new funds
to a focus on treatment.
So, in a sense, our advice was ignored,
yet we were told that our paper
helped preserve an ongoing
role for prevention,
which is contributing meaningfully
to current epidemic control.
I'm very glad we provoked
a spirited discussion,
despite the attacks we received.
I encourage others to do the same.
Thank you.
(applause)
- Thank you, Jim.
Our next speaker is Andre
Campbell, a professor of surgery,
who will talk to us about
his efforts to influence
policy makers in the community
about the public health
problems of guns, violence, and trauma.
Andre.
- Now, good morning.
I didn't hear you, good morning.
- [Audience] Good morning.
- My name is Andre Campbell,
I am a trauma surgeon.
Also, some people know me as Dr. Dre.
Now, I was Dr. Dre before
Dr. Dre was Dr. Dre.
I'm older than he is.
I want to thank Claire Brindis,
these esteemed faculty
members who are here,
both the chancellor, dean,
and Mike for inviting me to speak today.
Now, this is a Stand
Up For Science session,
and I was wondering, why
would you invite a surgeon
to speak about that?
Isn't that like an oxymoron?
Surgery, science?
No, it's not.
But I'm honored to be here to speak.
So I'm gonna talk a little bit about
advocacy 101, and I'm gonna talk about
three types of advocacy
in the time I have today.
The first type is
advocating for your patients
and my experience with that,
advocating for issues,
including gun violence
and other things, and
advocacy for important institutions
that we have in our community.
So, the first thing is, as a physician,
I learned how to be an
advocate when I was a resident.
I had a very sick patient who had,
because of trauma,
he had jumped or fell four stories.
He was hurt really badly.
He ended up being in a hospital
for a prolonged period of time,
and it turns out that he was, let's say,
because of his visa status,
the hospital I worked at refused to
have me finish operating on him.
But it took me a few
months, but I beat them down
and I was able to do the
operation that had to be done.
So I say that if you're a physician,
make sure you advocate for your patients.
If you are not a physician,
advocate for your family members
who are sick, who are in
the hospital to do things.
So, I ended up joining the team
at San Francisco General Hospital
because I was very comfortable
because I had 1,300 other people
who were advocates like I was there,
and that's what I've been doing
for the last 20 years at San
Francisco General Hospital,
advocating for my patients
to make sure they get
the best care possible.
The second thing I want to talk about
is advocacy and gun violence
and kind of what has been done,
both locally and nationally,
as surgeons for this.
Now, you may or may not know this,
but over 20 years ago, as a result of the
Balanced Budget amendment in 1997,
they ceased funding
for science related to gun violence.
I mean, you have to understand that
8,000 people die,
eight to 10,000 people
die every day of homicide,
21,000 people die of suicide
related to a firearm,
and nobody's studying it.
Now, finally, after all this moratorium
and under the Obama years,
things started to change.
In 2013, NIH started to fund it again,
and slowly but surely,
we started to sort of get
data about, okay, well,
how can we predict
somebody's gonna be injured?
What's gonna do that?
So it's important that
we basically continue to study this.
Now, as the political climates change,
that is gonna be more of a
challenge, and that's why
we need to be here doing
what we're doing here today.
I'll say a few words about
the Sandy Hook massacre
and kind of how that has
affected our group as
trauma surgeons, nationally.
So it happened after that terrible day
of unspeakable violence
in 2012, December 14
at Sandy Hook, where 20 lovely children
and six teachers were killed.
What happened was there was
a group that was created
that had trauma surgeons, politicians,
public health advocates
that basically looked at
a way to stop this violence.
And what happened was the
Hartford Consensus project started,
and out of that, they
said, "Well, what can we do
"to sort of make a difference
"as healthcare providers
and trauma surgeons?"
And out of the Hartford Consensus process
and a lot of pushing by
one of my friends, Len Jacobs,
who headed the Hartford Consensus,
they started this campaign
called Stop the Bleed.
Now, Stop the Bleed is something that now
is a national effort that is going on,
and we're trying to
train every single person
in ways to stop people from bleeding.
That means that, because
of what they found, is that
people die after mass casualty situations
because they bleed out,
and if you put direct
pressure, you put a tourniquet,
or you use hemostatic dressings,
that you can make a
difference in doing that.
And the whole idea with
Stop the Bleed is that,
as well as CPR, where you have
automatic implantable defibrillators,
there should be a kit to
help stop the bleeding.
Now, I also has participated locally
in lobbying for a senate bill,
actually, it was assembly bill this week,
where we're basically trying
to make a difference here
and try to pass a bill in
California where we could do that.
But I've also advocated
the board of supervisors
with my congressman, my senator,
and it's important to sort of stand up
for something that's important, and
we have to, first of
all, get an answer for
why people hurt themselves
from gun violence
and also try to make a
difference in people's lives.
So, third thing I'm gonna
talk about is advocating for
institution that you work in,
and I'll go through this fairly quickly.
I've been fortunate to
work at a wonderful place,
the Zuckerberg San
Francisco General Hospital,
also known as The General, for many years.
Now, we were threatened a
number of years ago, where,
because of senate bill
1953, we had to put through
a proposition which was
the biggest proposition
in the history of San Francisco.
Now, I work with many other people,
some of them in this room,
to try to make a difference,
helping doing campaign stops with
the board of supervisors,
working with the mayor's office,
doing commercials and other things
to really help the cause,
and by doing that, we
were able to pass Prop A
and make sure we fund a new building,
which just opened within the last year.
The second experience I've
had with doing that is,
last year, we had Prop A again,
where we basically funded
retrofitted the building
that we're in now,
and that was quite interesting,
sort of being involved with
commercials and other things like that,
billboards and what have you,
but I've been very fortunate
to work at a great place
and I'm very passionate with
making sure that
we continue to do all
the great work we have.
So three messages.
Advocate for your patients, number one.
Number two, advocate for issues
that you're passionate about
that we need to learn more about,
and number three,
advocate for institutions
that you believe in strongly
that you can make a
difference in people's lives.
Thank you for your time this morning.
(applause)
- It's great, Andre.
Our next speaker is
Tracey Woodruff, who's the
director of the program
of reproductive health
and the environment, who will
talk to us about her work
on the impact of environmental
toxins on health and justice.
Tracey.
- I'm gonna stand up, too,
'cause we're all standing
up for science today, right?
So this is a great day.
I was talking to my husband
about this, and I'm like,
"You know, I'm gonna say
that today is Earth Day."
And he's like, "Isn't everyone
gonna talk about that?"
But, apparently, I'm the first,
so I just want to say
that today is Earth Day,
and you know what?
There's reason why
these are together, yes.
(applause)
So I had a little secret, I was like,
"Oh, what is the history of Earth Day?"
Anyway.
So, you know, Earth
Day was started in 1970
with thousands of teach-ins
all across the country
just like this one, but
Earth Day was very focused
on the environmental degradation
and its effects on human health,
and back in the 1970s, we saw
all these problems because,
I'll just give you one example, lead,
everyone knows that lead
hurts children's brains.
Lead was in gasoline,
lead was in food cans,
lead was in paint, lead was in children.
The average level of lead in children
in the 1970s we would
consider poisoned today.
Three times what we would
consider poison today.
So, what happened?
People talked about the science,
people advocated about the science,
people passed laws
and they advocated on
behalf of public policies
that took lead out of
gasoline, lead out of paint,
lead out of food cans, and now
children in the United States
have lead levels that were
inconceivable in the 1970s.
But we have a new challenge ahead of us
on the environmental threat
because at least we dealt
with some of these air
pollutants, but in the meantime,
we've seen a growth
in all the other types
of industrial chemicals
that are manufactured and
used in the United States.
So we've seen a growth since 1950s
in over 15-fold in these chemicals.
They're everywhere.
They're in air, they're in our
water, they're in our food,
we get exposed to them through
all these various products
that we have in our daily
life, whether they are things
that you've probably
heard about in the news,
like plasticizers like BPA,
or phthalates, or flame retardants.
The data show that, in
the United States alone,
there are 30,000 pounds, that's 15 tons,
that's a lot of elephants, for example,
of chemicals per person
that are manufactured and
imported in the United States.
So we're all exposed to these chemicals,
and when I came to UCSF,
it was kind of a transition time because
you're starting to see
these changing conditions
that were happening in children,
conditions like obesity, diabetes,
ADHD and autism
we now know have all increased in children
over a relatively short time.
What else is going?
It must be something that's
going on around the environment
that is impacting these children,
and environmental chemicals
have gone up, too,
and there must be a link between here.
So our goal at UCSF is
we focus on identifying, understanding
these exposures that happen during
developmental periods that
are sensitive to these
perturbations from these small molecules
and how that influences
health, but importantly,
it's not just science as
we're talking about today,
but how do we connect that science
to doing something about preventing these
harmful chemical exposures,
because when that child is sick,
it's too late for them,
it's too late to stop,
to solve the problem of
this environmental exposure.
So we're all about prevention,
and what we've done is,
when we got here, we said,
we should be working with
the clinical community
to advocate, like people like up here,
to advocate on behalf of children to
advance the public policies
that will prevent exposures
to everybody in the population,
no matter who's at risk.
So we said, well, who would
be our natural partner?
That would be obstetricians.
They work with pregnant patients,
we are studying pregnant patients.
They are advocates on
behalf of pregnant patients,
but also they have a personal
connection to their patients
and they speak with authority
in public policy arenas.
People listen to doctors.
I mean, they listen to scientists, too,
but they really like to listen to doctors.
So like, okay, who's a
society that represents OB/GYNs,
the American Congress,
obstetricians, and gynecologists?
What do they know about
environmental chemicals?
We look at their journals.
I think there was like one
paper on radiation risks
from flying in an airplane
when you're pregnant.
That's not a lot of information.
So they clearly didn't
really know about this,
so what do we do?
First, we did the size, we said, okay,
let's show that
this is an issue that
they should care about.
We did a study showing that pregnant women
across the United States
are exposed to at least
43 different industrial
chemicals, probably more,
that many of them at
levels that are associated
with adverse reproductive health
and developmental health.
Adverse pregnancy outcomes,
or childhood outcomes,
or even on into adulthood.
So we show that this is a problem.
Two, we talk to them in a
language that they understand.
We say, look, these chemicals,
they look and they act,
a lot of them look and act like hormones.
So if you mess with
hormones during pregnancy,
so OBs know, yup,
mess with hormones during
pregnancy, that's bad.
That's gonna be bad for
reproductive health outcomes.
That's gonna be bad for
developmental outcomes.
So if these chemicals look like hormones
and act like hormones, that must be bad.
So the third thing we
talked to them about is,
you know, you deal with drugs all the time
to prescribe them, and
you know that those are
regulated by the government,
but you know what?
Chemicals, they aren't
required to be tested
before they go on the marketplace.
There was no law,
I mean, there's an upgrade in the law now,
but there is no law
that makes sure that all these
chemicals that are everywhere
and measured in all of us,
that they're safe for use.
This a-ha moment was key to their saying,
"You know what? We should
care about this issue."
Dr. Jeanne Conry, who was
the president of the local
professional society, which
I'll call ACOG for short,
said, "You know what?
This is my signature issue
"when I'm president."
She became president of ACOG,
she made environmental reproductive health
her signature issue.
She, along with the American Society
of Reproductive Medicine, who
was being led at the time by
Dr. Linda Guidice who was here at UCSF,
along with our program of
reproductive health, we issued,
wrote a joint committee opinion that said,
science shows that environmental
chemicals are harming
reproductive health and development.
Secondly, it said we need to do more
to advocate on behalf of our patients,
including public policies that we need
to prevent exposures to
these harmful chemicals
in our environment.
And they have gone on
to be great advocates
in partnership with ourselves.
So what we're doing,
because, obviously, this administration is
a renewed threat to
environmental exposures
and their effects on us, so we have been
speaking up with our partners in ACOG
and other scientists,
and we just last week
or two weeks ago hosted
a legislative briefing
in Washington DC to
bring together scientists
to talk about why science matters,
why the environment matters,
and why it matters for
our health, and I know
that we've had some successes,
but we have many challenges ahead of us,
and I think all the words
that we have heard before
about being persistent and
talking about our science
will make a difference, though
it will be a long road ahead.
So, thank you.
(applause)
- Thanks, Tracey.
Our final speaker will
be Dr. Suneil Koliwad,
who's an assistant professor
in the department of medicine.
He's gonna talk about the
importance of basic research
in our efforts to prevent, and treat,
and cure human disease.
Suneil.
- Thanks, Mike, and thanks to
all of you for coming today.
It's a little bit later in the morning,
but good morning to all of you.
It would actually be
the beginning of my morning
if it wasn't this special day today.
With that, my job in the next few minutes
is to connect with you,
hopefully, in a different way
and to make a point
that leads to, hopefully,
a call to action.
The point starts with the fact that
I'm beginning in this
process as a scientist myself
and I think many of us,
even if we've been in
this game for a long time,
may, over the last year or so,
have felt a stirring, an inclination
that maybe we need to be doing more
than what we've been doing until now,
and I'm gonna share with you my story
and where I am right now
and why I've gotten to
the point I've gotten to.
I agree with everything
that the other panelists
have said so far,
specifically with respect
to making the argument
that basic science research
is a good investment.
If you look at every dollar
spent towards NIH funding,
there's an 8X return on
investment with respect...
Has been incredibly forceful
in making that point strongly to
legislators, both at the state
level and the federal level.
I think we should continue doing that.
I also received NIH funding
as an undergraduate.
I received an F32 as a graduate student
and a T32 NIH grant as
an endocrinology fellow.
And on my final go-around, got a K08,
which allowed me to have
a career development award
that then was the springboard for my
scientific position and faculty hire,
and I've received NIH funding...
One grant now, finally, since then,
and I feel like the commitment
that I've demonstrated
as a scientist, going back from
four years of undergraduate,
four years of residency, a
chief residency, a fellowship,
a PhD, a post-doc, and then
I finally get my first job
gives me a position...
Argue that NIH funding is important,
and we make that argument
sometimes to lawmakers and say,
you know, trust us, we know
what needs to happen.
I will tell you that, in the last year,
I've met with lawmakers for the first time
and I've found that there
are different tactics
that work perhaps better
than the usual tactics.
For whatever reason, we have
not been able to make the point
like NASA has made, that we
wouldn't have microwave ovens
if we didn't fund NASA.
The general population
doesn't even realize that.
You could talk to people
across the country,
and they say, "Yup, I get it."
Argument has not resonated as strongly
with the population as a whole,
and I'd like to tell you,
in the last few minutes,
I've come to realize my way to
get this point across better.
When I think about my area of
research, which is diabetes,
there are two points that
have resonated with lawmakers,
and I've met with all of ours locally,
all of ours at the state
level, our two senators,
and congressional leaders now on The Hill
in the last year as part of the
American Diabetes Association.
The two things that have
caused people to turn,
listen, and engage with me
that I think we could all tap into,
one, my mom has diabetes,
and so my link to studying diabetes
is fundamentally different
because it doesn't just excite me,
I can talk to you about glucose
and how it impacts cells
all day long, but I don't
think the general population
decides what they want to support
because I think glucose is cool.
I think that they would be more likely
to support my research
because diabetes affects
their families, and if I am like them
because diabetes affects my family,
then we have something in common,
and that's a point that I think
we need to make more strongly,
that basic research funds
initial insights into diseases
that we as scientists also
experience as human beings
and as members of society,
not just as scientists who think that
the molecular mechanisms are intriguing.
The second point I think
that is worth making,
whenever we get the chance,
and I would encourage us
to start making these points locally,
at the state level, and
nationally more and more,
and maybe even starting today,
and that is,
I experience life in
this country as a citizen
every bit as much as I
experience it as a scientist.
I play softball in my softball
league every Thursday night.
My kids have issues that my
wife and I have to attend to
on a weekly basis.
We worry about how to make ends meet.
We worry about how to fund college.
We worry about all the same things,
including health and disease,
that everybody else who lives
in this country worries about.
And I think that when we
make ourselves more human
as scientists, and when we
talk to our lawmakers and lobby
congress as people who experience
everything else that the
average citizen who is not
a scientist experiences,
then our arguments to fund science
hold weight on a different level.
And I feel like, right now, today,
we have an opportunity
to start thinking about
basic science research funding
from all of these perspectives,
and it is incumbent on
us to start doing that
because when we make the argument
on these multiple fronts,
as I had the experience
for the very first time
to know firsthand two weeks ago,
when I was on Capitol Hill
during ADA's call to congress,
I realized that people in
Congress don't fail to understand
the value of what we do
because they're dumb.
That is not the truth.
In fact, I met a lot of really
smart people in the offices,
most of whom are less than 25 years old,
just for your information,
that seem to be running
the show in Washington,
in the offices of all of
these congressional leaders.
They're smart kids and
they're smart people,
and when you make arguments
in ways that connect,
you can change people's minds,
and I saw people's minds being changed
because we had real conversations
on real levels as real people,
and I would encourage us to
utilize the fact that we're
human beings as much as we are scientists,
to make that point
as many times as we can going forward,
because when I was hired at UCSF in 2011,
there was another election
that happened right after I started,
and during that election, the
vice-presidential candidate
and the ticket that ultimately
ended up losing that campaign
made the point that NIH funding is suspect
because those individuals
work on fruit flies,
and worms, and things like that.
And even the tone of voice
suggested the skepticism
that we must all have
to fund something where
people do such things
with the money we give them.
Of course, they don't realize
that fundamental research into cells,
and flies, and model
organisms ultimately leads
to better understanding
in animal models that do resemble people
and ultimately in people themselves.
That's a tough argument to make,
when people who have a
microphone and an audience
make a counter-argument.
But if we can connect and say, look,
we're people, too, we have
these diseases in our families,
we live in communities that
are affected by diseases,
I also work at San
Francisco General Hospital,
and I've found that my
patients worked hard
for the money they earned.
See me in diabetes clinic
of the general hospital,
and they don't exhibit
any signs, or symptoms,
or indications of...
Or inability to warrant funding
because they don't deserve it
as much as anybody else does.
In fact, I've seen only
the contrary to that
over all of these years.
And so I can make a case
for funding basic
science research that has
nothing to do with talking about cells,
has nothing to do with
talking about molecules,
and I find that it might connect better
than the arguments that we
traditionally make, and so
I would like to leave you
with that encouragement
to go out, search yourself,
think about how you are parts of society
in ways that you may not
have considered yourselves as
being before today,
and use that understanding to connect
with your leaders in ways
that can couple with the
immense amount of expertise
we have as scientists and clinicians
and also the importance of these diseases
to the future of our country.
So, with that, thank you very much.
(applause)
- That's great, Suneil.
I would like to encourage
one more round of applause
for these amazing people.
(applause)
And all of you for being here
this morning to listen to it.
So, yes.
(applause)
So we have time now for questions,
and there will be answers.
There's a mic, this one,
that will be passed around.
I'm not quite sure who is moving them.
If I see any hands
raised, I'll point to you.
If I don't, I'll throw
in questions of my own,
which I will...
A-ha.
In the back, yes.
- [Audience Member] I
want to thank you for
all of the presentations,
I am totally amazed.
I feel so honored to be
in the presence of such
important people whose
contributions I really admire.
I have been a part of this institution
since my earliest
training over 35 years ago
in some various components of activity
in the department of psychiatry.
I think one of the things
that all of you have said,
which I think is so incredibly important,
is how we understand, from
a scientific point of view,
the challenges that we face in our world,
and each of you have spoken
in a very special way about that.
But one important topic that
hasn't been spoken to yet
is how we understand the scientific basis
and then the implications for that
for the most catastrophic health problem
that we face in the 21st century,
that of the impact of climate disruption
and global climate change,
and that needs to also
be an important area
where those of us who understand and apply
scientific understanding
to the advocacy work that
you have all spoken about
to do something about
this catastrophic threat
that we are facing.
My particular area is as a psychiatrist
to understand something about
the health impacts of climate change
and, specifically, the mental
health impacts of climate change,
which are quite ubiquitous.
I want to thank you particularly
for talking about speaking in
normal people language.
That is something that we
should all be able to do
about our understanding.
And I want to also say,
having been on The Hill
many times with legislators,
that speaking about that
in normal human language
does have an impact.
We have a lot of work, though, to do
as we translate our understanding
about science of climate change
to effective policies, and
we're all in danger of that now.
(applause)
- [Audience Member] Great talk,
thank you for your presentations.
So, I was wondering,
are there lobby groups
that solicit Congress
on behalf of scientists?
- All the time.
- All the time.
Do they throw money at the
issue, like support campaigns?
- Yes, all the time.
- The other thing is,
I dunno if you talked about this,
the first thing in Washington DC
is those congressional relations.
But I just would say that they facilitate,
if you go to DC
and you want to meet with
different representatives,
to help our skillset,
all those meetings up, when we were there,
to do our congressional briefing,
she and the person who also
runs congressional therapy,
University of California,
set up all these meetings
with different legislators,
staff, and the senate, and in the house,
did all our prep work.
So they encourage anybody
from this institution to go
and talk with people in DC
about the issues that
they are concerned about.
- In two weeks,
we have our annual lobby session
for the American College of Surgeons,
so I'm gonna go to DC and
meet with everyone, and
what he said is absolutely right,
the country and the
politicians offices are run by
25-year-old people who, basically,
you're told you walk
in, you talk with them,
you give them the briefing,
you let them know what's
going on, and you advocate
for the issues you have so that
our national organization, the
American College of Surgeons
has a whole program that they have,
that they put us through,
we meet with congresspeople,
the senators, and anyone
else that we can meet with
during that period of time.
It is striking because you'll walk around,
but there'll be thousands
of other people doing
exactly what you're doing, too,
and if you're lucky, you get
in to see a congressperson
and you get a chance to talk to them.
Sometimes you talk to a
staffer, but you make sure that
whatever arguments you
make, that you make it
aggressively and you let them know that
these are things that we found important,
for me in trauma and the impact
of trauma in people's lives,
diabetes or whatever the issue is.
You make sure they know
that this is an important
constituency for them.
So I will say I represent
50,000, 100,000 surgeons.
"Well, I just had somebody in here who
"represents two-million people."
Like so that's kind of the
thing that you're dealing with.
- [Mike] Before we move
to the third question,
I think there was some comments.
- In regards to your
climate change question,
we've taken that very seriously,
and I run the largest study
of minority children with
asthma in the United States.
We demonstrated, recently, that
for a given amount of air pollution,
African American children
were far more susceptible
to developing asthma than their peers,
their neighbors who were exposed
to the same level of air pollution.
The important thing is that
the level of air pollution was far below
current EPA standards,
and as my colleague to
my left had mentioned,
it was a nice publication,
but it's kind of like a
tree falling in the forest,
the academic forest.
So what we've gone to
do is public advocacy,
and I just did a public
service announcement for KBLX,
which is the largest minority-owned
radio station in the Bay
Area, announcing that
it's important for minority communities
to step up and be active.
Along the lines of advocacy,
we've demonstrated that the NIH
had had a poor track
record with the inclusion
of women and minorities,
particularly in clinical
biomedical research.
We've taken them to the mat.
It's interesting that
we've published articles
that fall on deaf ears
amongst our colleagues,
and that's why we went to
Congresswoman Barbara Lee
to force the NIH to make changes,
and that's something
that's very important,
the social advocacy of what we do
in addition to doing top-quality science.
So those are ways that we get involved.
And on a last note, the lack of diversity
in clinical biomedical
research, as I mentioned,
has real impacts,
and as the last speaker
had just mentioned,
it hits us personally.
I lived with a Chinese
family when I was younger,
and as I mentioned, the number one
drug doesn't work in 50% of Asians.
Unfortunately, on August 24th,
my younger brother, who's Asian,
passed away from an adverse drug reaction
to a cardiovascular medication.
My goal of advancing precision medicine,
not only for the sake of science,
but making precision
medicine socially precise,
has now hit home,
and I'm a big advocate,
I teach all my students
that you have to stand
up, you have to have
representation in clinical
and biomedical research.
Along the notes, and I want
to say that I'm very proud
to be part of UCSF, because
when we expose the NIH,
that they were falling down
on the job, that 10% of
investigators who applied for NIH grants,
if you were African American,
you had a 10% lower
likelihood of being funded,
if you're Asian, you had a 8%
lower likelihood of funding,
and we use Freedom of Information Act
over the last 30 years to expose that.
When we were about to publish that,
I received threats from the NIH,
and I went to the chancellor, Sam Hawgood,
I went to my dean, Talmadge
King, Joe Guglielmo, I said,
"Do you want me to publish this?
"Because it's gonna put us at risk."
Universally, they all said, "No,
"this is what we do, we're gonna back you,
"go ahead and publish what you do."
That's why I'm so proud
to be part of an institution
that has a moral spine in addition
to doing great science.
(applause)
- [Mike] We have another
question over here.
- [Audience Member] I just
wanted to say thanks again
for being here this morning.
This is an incredible way
to spend a Saturday morning,
and I'm so grateful that you are
giving your time to talk about this.
My question, the science of
making convincing arguments
and affecting change, and
my question for you all is,
to what extent did your training
provide that curricula about
making effective arguments,
affecting and sustaining change so that
the really amazing work that you all do
can have its maximum impact?
- I can take the first stab maybe at that.
From my standpoint, it did not.
My training did not provide me with
any real understanding
of how I might start
voicing myself in this regard.
And I think that that, I
found over the last year now,
as a relatively junior
faculty member here at UCSF,
that that's a fairly ubiquitous
sentiment that my colleagues hold.
We created a human obesity cohort at UCSF
that is noteworthy because
it is multi-ethnic,
and we took advantage
of the ethnic diversity
of our Bay Area in constructing it.
I only bring this up because
since we've developed this cohort,
no less than 10 different
basic science investigators
have contacted me very enthusiastically
to try to get samples,
connect with the cohort,
and why? Because they want to
show that the human relevance
of their own research
by using human samples,
human cohort members,
to try to take their research
up to the next level.
Everybody who's in science
understands that they want
to make their research
as applicable to people
at large as possible.
And what we need to learn
how to do is make that point,
which is true of all of us in science,
readily evident to average people
who are considering how they
are gonna view the scientific
enterprise in this country in general,
and we don't really learn
how to make that argument.
What I've learned over the
last several weeks now,
in talking to congressional
leaders, is just that
if you look inwardly, you
find a lot of those answers,
because they're in the way you
interact with your own community,
your own family, your own ethnicity,
outside of the fact
that you're a scientist,
and you draw from those
experiences, and you try to
create arguments that incorporate
that aspect of yourself
every bit as much as the
scientific expertise.
- I would add to that,
though, I agree with that,
I think we all know how to speak,
but we don't all know how to speak
to congressional staffers.
And I think creating expectation,
where we know how to do that
when our skills are derived from
a very different set is an
unreasonable expectation.
So I think, for the most part,
most of us have taught ourselves
and listen to other people
and, probably, we could do a better job
of educating our self as a community
on how do you do that.
- I want to add,
because this is another
great story about UCSF.
I went to Stanford, I went to Harvard,
I spent the last 20 years here at UCSF,
and I witnessed something
that was incredible
that has given me
permission to do what I do.
I'm a pulmonologist.
The number one cause of death
for HIV patients when
I was doing training,
lung disease, I watched
young men die left and right
when I was in training
here as a medical student
at Stanford and here
as a pulmonary fellow.
We have great HIV scientists here,
but like she said, it's one
thing to publish a paper
and have it fall on the
academic forest on deaf ears,
but we also are UCSF,
we're also San Francisco,
and we have great political activism.
And when ACT UP, the AIDS activist group,
paired up with UCSF scientists,
they were able to push pressure,
arm bar the NIH, the
FDA to fast track drugs.
So I watched HIV, in my
career, under my nose,
in the last 20 years go
from a death sentence
to a manageable disease like diabetes.
And that was great because
UCSF gave me the permission
to be a social advocate, push hard
on inclusion of diversity
in clinical and biomedical research
without feeling that I'd be
feel repercussions from the university.
And I could tell you, at
the other institutions,
I would have been silenced.
- [Audience Member] So
my question actually
deals exactly with that.
We've talked a lot about
federal government,
but we haven't talked
about the self-censorship
that happens within our
professional societies.
So I'm in the dermatology
department, and I haven't been
personally involved
with this, but I know of
an article that went
into JAMA dermatology,
about dermatology in immigrants,
and dermatology, for those
of you who don't know,
is essentially founded on
immigrants from Nazi Germany,
that's what American dermatology is.
So it went in, it was accepted,
the authors got the proofs,
and then it got pulled.
And so this issue doesn't even get
to the federal government.
We do this to ourselves, and
I'd be interested in how
the panel has dealt with
that kind of censorship.
- I've gone on the public radio airwaves.
I just did it.
- I mean, I think it's a challenge
because working within
our professional society
is really what we're taught to do,
and they're our largest advocate.
Having a group of 100,000 surgeons
try to advocate at congress
is a pretty powerful force,
and if you have someone who
has views that are contrary
to your professional society, it's a
vehemence that you have to argue against,
but the issue is really very
real, and I would say that
relying on good science is
what you can do to start.
And then just don't give up.
Realize that you have a message to tell,
and some people, be it the government
or your professional colleagues,
may not like that message.
And just be persistent
and keep telling them.
I think the airwaves are
a great way to tell it.
I think getting other groups
together to help become another
bringing together the
press, public other groups,
patient groups to help,
but I think my personal
conflict has been mostly
in the sphere that you were talking about.
- This may address that.
So there's been a big push in our society,
the trauma surgeons and
for the American College of Surgeons
to say something about
common sense, gun safety legislation.
And we actually did a
survey where we looked at
the surgeons who had guns.
They looked at non-surgeons
who didn't have guns
and they found that pretty
much 90% of the stuff like
basically not selling it to folks who have
psychiatric illnesses,
basically smaller clips,
they're not using lethal bullet,
all these things that,
actually, there was a lot of agreement.
So there was one group,
then the committee,
the American College of
Surgeons agree with it,
the governments agree with us
and the leadership of the college
that we put this whole product out
for the general membership,
and, of course, the first
thing that started happening
is that people said,
"Well, you're gonna take
my guns away from me."
And this has nothing to do with it.
This is just like, okay,
like we agree that the
time for common sense, gun safety
after Sandy Hook, after Orlando,
after all these things that
have happened to do with,
but then we're still
fighting amongst ourselves.
So, for me, these things are non-brainers
as somebody who lives in the
bluest part of the blue state
of California, right?
We talked to our
representatives, it's easy.
When you're talking to the
people who represent us,
in general, we may have some issues,
but it's quite different than
when you're in the red state
of Alabama or some other place
than the folks that we have here.
So they will actually listen to us,
you know, whether that's Nancy Pelosi, or
Jackie Speier, my congressperson,
or Senator Harris, or Senator Feinstein,
they'll listen to kind
of what we have because
what we're saying is fairly reasonable,
but we and our society,
we still have a struggle
with that because as soon as
we say this is common sense
thing that need to happen,
they're like, "Well you're gonna
take my guns away from me."
It's like, no we're not.
This is not about your
second amendment rights.
This is about doing
something that's sensible
so that people do not get killed.
So we do struggle in our own society.
- [Mike] We have a microphone
for a question over here,
and a very patient man over here.
- [Audience Member] I dunno
if the mic's on or not.
A few weeks ago, when the
house representatives was
beginning to work on the
replacement, or repeal,
of Affordable Care Act,
my daughter here in San
Francisco got very involved
and got me involved along with my wife.
And so we ended up going down
to meet with Kamala Harris'
aides, and I asked the question there,
how do I reach across?
How do I reach across to Congress?
Because my representatives agree with me.
How do I reach across?
And the reason I feel hopeful this morning
is not only for the
people that are facing me
on the panel,
but the people that are sitting
next to me in the seats,
who are all looking for ways to advocate,
which is really, really wonderful
to see at my point in life.
What the aides said is,
"Don't do all this emails."
I was sending out hundreds of emails
because it's so easy.
That's not what's read.
Get on the phone, call some
representative in another state,
their numbers are on the internet,
and give a personal story.
That's what was said,
the speaker to the right.
That's exactly it, the personal story.
Take one or two items on a particular bill
and tell your story about
that particular bill.
Now, how do you hear about these bills?
Through the lobbying groups,
through the advocate groups,
through the professional groups.
In my case, the American
College of Physicians,
some non-profits I give
to, Planned Parenthood.
These are groups that are going to tell me
what bills are coming before congress.
I can then find out what
community's dealing with it,
I can find out the representative's name,
I can call and give a personal story.
The people are much younger
than me, but they listen to me
and they really take it
in as a personal story.
Thank you all.
- Can I add to that real quick?
'Cause that's a great point.
(applause)
Personal stories.
If you go from Susan's three
stories all the way down,
it's the stories that made the point,
and I got exactly the same information
when I talked to Kamala Harris' staffers,
as well as all the other staffers.
And the other point is that
they use those personal stories,
even if you preach to the choir
as Andre just mentioned, you know,
living here where we do,
they take the personal
stories that we arm them with,
and they apply those personal stories
when they're reaching across the aisle
in contentious debates
that we're not a part of.
And so when we give them those stories,
we give them power in places
where we're no longer
standing next to them,
but they feel our presence
through those stories.
So I told a story of a kid
with type-two diabetes,
diagnosed with type-two
diabetes in an area
in the Inland Empire
of Southern California,
San Bernardino area, and in that county
of Southern California last year,
the rates of type-two diabetes
in children ages 14 to 19
were higher than the
rates of type-one diabetes
in that same age group,
which is a turning point,
and California's leading
the way because of our
ethnic diversity and finding
these pockets of risk.
And you can make that point statistically,
it doesn't resonate.
You talk about one kid
who's diagnosed with type-two diabetes
who shouldn't even have diabetes
at all, it's preventable,
it starts resonating.
And I think we need to do more of that,
put stories to the work we do.
- I want to follow up on that.
I mean, I completely agree
that these personal stories
are very compelling,
but I think the other thing that we have
that is unique to us is we do,
I mean, your information about statistics,
so it is true that most people who are
staffers in Washington DC are under 25,
but there are actually senior staffers
who work for the committee.
So like we went to go meet with
the committee representative
for environment and public works,
that's the committee that
deals with all of the
climate change, environmental regulations.
Those people have actually
been around for a long time,
and they're actually a little more steeped
in some of the nuances of public policy,
and precision, and data, and
they actually need the kinds of
stats and figures that
we've been talking about.
So, for example, one of the
things that we talked about is
this administration has said
that environmental regulations
are a cost industry.
What they're not saying is
environmental regulations
have a health benefit
for everybody in the United States
and that the benefits
far outweigh the costs
and that we've seen air pollution go down
while the economy has grown.
Those kinds of
quantitative information is actually
a good supplement to the
stories that people have
because then they can
say, when people are like,
"Oh, blah, blah, blah,
it costs the economy."
Or like, "Oh yeah, really?
"What about the health of the public."
Health of the public is
improved in these ways.
So I think you have to have both things,
and there are different
types of people in DC, too.
- I'd like to say, just briefly,
so this week when I was
helping to lobby for
AB909, Stop the Bleeding in California.
So we went back and forth with
membership of the American
College of Surgeons,
Northern California,
Southern California, us,
and the representative
who carried the bill
turns out to be a republican
from San Bernardino,
and I walk in his office, I meet him,
and I was talking to him,
he's actually a very reasonable guy,
and I'm just like, "Oh,
Jesus, he's very reasonable."
He carried the bill, it's like,
"Why are you carrying this bill?"
Because he's from San Bernardino,
and San Bernardino's where
this kid was just killed,
where the terrible thing happened
in the mental health facility where
multiple people were killed
and the terrorist attack
that happened a year ago,
and he's seeing that
this is an important bill
and what he's doing is
he's partnering with
other people, it's like,
"I need a partner."
Before I got in his office,
I didn't know he was a republican,
but I was just like, "Okay."
But he was terrific,
and he understood what
the problem was, and
he said, "I'm looking for a partner
"on the other side to walk this
legislation through because
"it makes so much sense."
There are people who are more moderate
who you can talk to about
sensible things to do.
So, after these things happen,
there are people who were just like,
"Wow, that's a great idea."
Whether at meetings, or the stuff I do,
or stuff that she's talked about, or HIV,
there's a lot of people who are sensible,
and we're gonna have to really
look for sensible people because
there's not a lot of sense
going on in DC right now.
Every day, I'm like,
Lord Jesus, what's gonna happen?
- [Mike] All right, we have time for one,
maybe two more questions here.
- The guy on the right.
- [Audience Member] Good morning,
my name's Annette Gardner,
I'm a political scientist here at UCSF,
and just a general shout-out
for social scientists,
we rock, too.
Just back to this question of learning
about advocacy resources and the like,
I just want to say that we do harbor
folks like myself who can actually
inform you as to what is
working and what is not, and
another shout-out,
Claire Brindis and I just came
out with a book on evaluating
advocacy and policy change.
So, yes, we have these
resources here at UCSF
to support your efforts,
because, like Tracey said, it is
not just about the personal stories,
but the data has to be in there somewhere,
and yes it is about
talking to the youngsters
and the staffers because you're
never gonna get to Nancy,
and Kamala, and Dianne.
So this is political
science, and we're here
to help inform your efforts.
Thanks.
(applause)
- [Mike] One last question.
- [Audience Member] Hi, good morning.
Thank you all for being here.
My question was about when
we have limited funding,
and limited mic time, and
limited public attention,
how the different scientific communities
I think that would agree with
a lot of the research that's
being done with each other,
for example, Dr. Kahn,
you were talking about HIV
prevention and treatment,
how we can manage the limited
resources that we have
and still be able to
create these conversations where
there is a lot of agreement
and there is a lot of
energy, even as our political
climate is encouraging
that we kind of fight
over the remaining times
and encouraging those divisions.
So I was hoping that you might share
examples or kind of
tips in helping keep the
conversation united as we go forward.
- That was not a planned discussion,
but that's regarding to
what I was just gonna say.
We all, I think, you know, are...
You have to keep on doing it.
And, you know, we're gonna
give you the opportunity,
and I think maybe
you would have collected
a card when you came in,
to write on that card what
you think should happen
and send that to your congressperson.
If you write on the card, you will
be able to drop those off
at the back of the room.
It's those connections over
and over and over again
which will make things change.
I mean, I'm as the, maybe
I think it's probably fair
to say, elder statesman,
the elder person here.
I mean, I remember back
in the '60s, you know,
we just had to keep on keep on going.
We're in no less of a crisis today,
and that is what has to happen.
So I know that the panel would,
and they will be outside,
but I'm supposed to now herd you
outside because we're gonna have a rally,
which is another thing you do,
and a march,
(applause)
is the third thing you would do.
So I hope that answered
your question a little bit.
Thanks for asking it.
So thank you all for coming.
The rally will be outside on the steps
at Genentech Hall right now.
(piano melody)
