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hello, everyone. i would like to welcome you to today'swebinar entitled using genomics, wearables andbig data to manage health and disease. my name is annette cruz and i'm theprogram manager of the stanford genetics and genomics certificate programat the stanford center for professional development. this webinar is brought to youby the stanford center for professional development and the stanfordgenetics and genomics certificate program. take online courses in genetics andgenomics and

gain a greater understanding of biology,human health and personalized medicine. happened through the world classresearch of stanford faculty and industry experts to acquire the skills and knowledge you need to succeed inthe rapidly evolving genetics industry. visit geneticscertificate.stanford.eduto learn more. before we begin, i would like to introduceyou to today's featured presenter, dr. michael snyder. dr. snyder is a stanford aschermanprofessor and chair of genetics and the director of the center of genomics andpersonalized medicine.

dr. snyder received ph.d training atthe california institute of technology and carried out postdoctoraltraining at stanford university. he is the leader in the fieldof functional genomics and proteomics and one of the majorparticipants of the encode project. his laboratory study was the first to perform a large scale functionalgenomics project in any organism. and has launched many technologiesin genomics and proteomics that have been used for characterizing genomes,proteomes and regulatory networks. i would like to turn it over to mike now.

>> great, well, thanks very much forhaving me on this program. i look forward to telling you about someof the things we're up to using data to help manage people's health. and ideally help manage their,ideally cure their disease. so this is an area, i think many of youappreciate, is incredibly hot these days and very topical and i think one of theevents that really launched this was when obama announced that we're going to havea major initiative in precision medicine. this was in his inauguraladdress in january 2015, and he pointed to this dna helix asthe way in which we're going to be able

to use genomics and information to beable to better manage people's health. well, i would argue this goeswell beyond just genomics. i think we're going to seean explosion of all kinds of data that will help managepeople's health and predict medicines they should use ata level that's never been done before. now, before we dive into this, let me first show you a little bitabout what frames our thinking. which is that your health,if you will, it's a state. and most of the time,we're healthy and in a healthy state.

but there are times in which we getdisease and we become unhealthy. when you get a viral infection orperhaps even other nastier diseases. and these states, they are influencedby many different things. they are influenced by your dna, your so called genome which is a collectionof all your dna molecules. and also, the various things you'reexposed to, the so called expose zones. that would be the foods you eat,pathogens you might be exposed to, various life stresses, exercise. we all know intuitively that thesewill contribute to your health.

and i would argue that a goal of uscollectively, is to try and understand, in quantitative terms,exactly how people, when they're born with a certain dna sequence, when theyare exposed to different molecules. what kind of healthoutcome we might predict? and i think this will occur in some,if you will, probabilistic fashion. some means in which wewould be able to predict whether someone might be healthy orget disease. in just as an example,if you're at risk for parkinson's, you probably don't wantto be a pesticide worker.

because that makes you at higher risk forgetting parkinson's. so, and there are dna variantsthat lead to parkinson's. so again i think this is wherewe're only we going to head. i do believe we're in a world wheresoon people will be getting their genome sequence before they're born. and that will actually make that all themore important we understand what kinds of exposures lead to whatkind of health outcomes. now i think many of you know it'spossible to sequence people's dna. so there's been a revolution of dnasequencing technology when it's at

the point where we can now sequencesomeone's dna for less than $2000. although to interpret that dnasequence costs a lot more. in fact, it can cost as much as 15 or$20,000. but that's not the only revolutionin technology that's occurring. there's other revolutions andadvanced technologies, mass spectrometry, the sorts of instrumentsthat you see in airports, there is very advanced instruments thatlet us measure tens of thousands of molecules inside of us that again ata level that has never been done before. so we can make measurementsof unprecedented scale and

be able to better define whatpeople's biochemical states are. so a number of years ago, we launched a large project whichwe call personal omics profiling, where the idea is to make verydetailed measurements of people. so we make literally billions ofmeasurements of people every time we sample them. so we analyze their dna, that'stheir genome, as i mentioned before. but we also analyze all theseother features as well. so something called the epigenome,which is your modified dna.

which we know is influenced by theenvironment and all those other things i, mentioned earlier. we also measure all your rna molecules. this is called your transcriptome. all your proteins, that's your proteome. special set of proteins called cytokines. they modulate your immune system. then we follow all your metabolites andsmall molecules, as well. or as many as we can measure.

we follow your antibody responses. you may have heard about thisnew area called microbiome. this is an area where we actually havemany, many cells that live in and on us that are really microbes that areactually very beneficial for our health. they digest our food andwe study that as well. so we actually measure,most of these we measure out of blood but some we measure out of urine andthe microbiome, we actually measure, believe it or not,out of your stool sample. between each measurements of allthese different things, again,

billions of measurementsevery time we sample people. and the idea is actually to sample peopleover time to see what keeps them healthy and what makes them,what goes wrong when they get sick. and we do standard medical tests over hereas well, we also have questionnaires. and i'm going to get back to thesewearable sensors at the end of the talk today. so basically, why are we doing all this? well we're trying to understand why peopleare healthy, what keeps them healthy. and by understandingthe biochemical measures of health.

we also wonder what happens when theydo get sick and when you do a get diseases what kinds of biochemicalevents change during that time. and then how can we better manage that. we want to understand how these different,i mentioned omes, so the proteome is your collectionof proteins and the metabolome is your collection of metabolites and yourmicrobiome is your collection of microbes. we want to understand howthey relate to one another. we know intuitively that the food youeat in combination with your genome and your biochemical marks on yourdna somehow affect your health.

but we don't really understandhow those rules work and we'd like to understand how they work sothat we'll be able to better manage your health, that is to say, that certain foodscan make you better by eating them, and they will be specific forsome individuals. we like people to eat those foods and not foods that make you unhealthy,and this can be very personalized. we're also trying to understandhow people react similarly and how they react differently when you'refaced with, say, adverse conditions. if you have a virus that comes along,most people respond somewhat similarly,

in the sense that they'llmount an immune response. but there will be personalaspects to this, as well. some people will make certain cytokines,and be able to better fend off that virus andothers, not so good. and we'd like to understandwhy that's the case. and perhaps, most importantly,one major reason we're doing this project is we're trying toidentify factors that can, basically, help managethe health of an individual. we can learn things about people thatwe hope will keep them healthy, and

you'll see evidence ofthat as we go along. so, basically, many of you mayhave known this already, but we actually started thisproject by studying me. looks like we lost some information here. but, basically, we've been profilingme for, now, over six and a half years, meaning we've taken over 200 time pointsfrom me, many samples at each time point. and during this time,i've been through ten viral infections, i've also had lyme disease. and we basically have,as i say, been analyzing me and

following me very closelyover this period. and we did this because we wanted to see,again, what happens when i'm healthy andwhat goes wrong when i get sick. so every one of these boxesis a viral infection. it's supposed to be a timeline,here, that somehow got lost. but, basically, during every one of theseviral infections, i have gotten sick. and we've take many, many samples. so, for example,these are all common colds i've had. this is a rhinovirus, hrv.

this is a respiratory syncytial virus,that's the common cold in kids. adenovirus is another one. and so we do a dense samplingwhen i get a viral infection. and then we typically give blood everytwo to three months when i'm healthy. and lately i've been trying differentdietary supplements that we've been sampling a lot. each of these is a day number,each of these numbers. and so, again, we're following what happens as igo through these various changes.

and the first thing we didwas actually sequence my dna. i'll go through this somewhat quicklybecause i'd like to talk about some new, exciting stuff. but from my dna sequence, we could predictmy risk for many different diseases. and most of this i knewfrom my family history or i know about myself already,meaning i was at low risk for obesity. nobody in my family hasever been overweight. i was at high risk for what's calleddyslipidemia and high cholesterol, that shows up here as high triglycerides.

i was at high risk for those. i knew that already because iknew my cholesterol was high, and i do take statins to manage that. high risk for coronary artery disease,that was done as well. one of the big surprises from my genome,though, was i was at high risk for type 2 diabetes. basically, i went from havinga 27% chance of having this in my lifetime to a 46% chance,so a huge increase. and we actually were following my glucose,

which is what happens when you getdiabetes, your glucose goes off. and, in fact, that did happen tome during the course of the study. my glucose had beenmarching along just fine. then it actually turns out rightafter this nasty respiratory syncytial virus infection,my glucose went quite off. it got very high to the point where i was,in fact, classified as diabetic. so when we first measured,it was on its way up at 127, a week later it was even higher. this is a better measure for steady stateglucose, it's called hemoglobin a1c.

it was right on the edge, it's arbitrary. but diabetes is classified as 6.5, hemoglobin a1c at a 6.4is right on the edge. and then five weeks later,we measure me again and, sure enough, i was actually diabetic. i had crossed the threshold, i was 6.7. and that was over five years ago,that was april 11, 2011 because up until then ihad the world's worst diet. i ate cake, sweets,i didn't know i had a problem.

i cut all that out,i doubled my biking and started running. and it took about eight months, buti brought it down under control. i got my glucose back together. so this made a big splashat the time because it's the first time someone used their genometo predict their risk for a disease. in my case, i got the disease. and in my case it was also manageable, and i was able to bring it under control,at least initially. and it was also quite intriguingbecause if notice when it occurred,

it occurred right after this nastyrespiratory syncytial virus infection. so what we think is that i'm geneticallypredisposed for type 2 diabetes, and then in conjunction with thisnasty viral infection, or its associated stress response,that's what's triggered the disease. now, you may think that this all has ahappy ending, and it's not completely so. it turns out that some people,in fact, criticize and say maybe, mike, that would have gone awayon its own, you don't know that. but we accidentally did the rightcontrol experiment, so to speak. that is to say, we kept profiling me,but we were doing so blindly.

it was actually when we scaled,you'll see in a minute, that we now follow 100people just like me. and when we scaled,we had stopped looking at the data, so we were doing this blindly. and then at this point here somebodylooked at my hemoglobin a1c, which turned out to be 7.0, and said,mike, you're 7.0, you're diabetic again. i said, i had no idea, so they sampled me. i'd stopped running, so i started running, and i could bring it a littlebit under control to 5.7.

but these days it's actually drifted up, in fact,when i got lyme disease it hit 6.5. and it's gone up high again recently. so these things,it hovers between 6.2 and 6.4. there's no question i havea metabolic disorder, and it's not fully under control because i'mright on the verge of being diabetic. so, again, this is hemoglobin a1c,this is glucose, and i'm way elevated over what i should be. and it's just not me, my brothers andsisters all have elevated glucose.

we're all fairly thin, soit's a little bit surprising. but it's pretty clear, then,that we have a genetic predisposition for and that's what the firstone is with type 2. so basically, again,this is a case where genomics and genetics actually predicted disease risk. in my case,i could always partially manage it. i'll probably be doing otherthings like taking drugs to get my glucose under control in the future. now, since that time,

we've actually carried outother kinds of assays, as well. we did an imax movie-typepicture of my biochemistry as it changes during the time i getsick to when we got type 2 diabetes. but we've actually been makingother measurements, as well. one very fascinating area is the fieldof epigenetics and epigenomics. epigenomics is a collection of yourmodifications to your chromosomes, if you will. and one important set ofmodifications is there's chemical modifications called dna methylation.

so what's interesting is thatwe know that your dna can get modified in response tovarious environmental cues. but we don't fully understand it,a very fascinating field. but we know that this one in particular,modification of your dna by genome methylation,which is a chemical modification, we know it's affected by nutrition andaffected by things like exercise, even your age and other environmental cuesall affect your epigenetic programming. we also know that it's associated withmodification with turning off your genes, so we don't how the whole thing works,but we do know it's very, very important,

and so, the things you do will directlyaffect your gene and your health. and there are now ways of mapping outall your modified dna sites, something called whole genome bisulfate sequencing,deferrals, in this case, i know. but you can actually map out allof the modifications in your dna, and there a millions ofthem using this technology. so, we've done this for me,and it's quite fascinating, you can see very interesting readsinto the genome that change. one area that we think isinteresting is trying to use your dna modification to predict whatdiseases you might be at risk for,

just like we used your genome sequencingto predict what diseases you might catch. we can also look at your modifieddna to try and do that, as well, to understand what diseasesyou might be at risk for. and this was just one example. i have a number of regionsof the genome like this, that are affected both genetically andepigenetically. so, this is a case where i havea change in this particular gene. it's called a phosphodiesterase gene. and the point out of allthis is that this gene,

turns out my father's copy isactually inactivated genetically. we all have these kinds of mutations,and then in my case, my father's gene has actually beeninactivated through a genetic change. and my mother's copy is actually shut offby epigenetics, so the control sequences are modified by this dna methylation imentioned earlier, until we get very few, very little activity from this gene,which we can measure by certain readouts, it's called rnac printing,we get very few rnas that come from this. so, the point out of all this is thatthis gene is then activated in two ways, one epigenetically, and one genetically.

and as a consequence, i actually havethis again, inaccurate about two methods. and it fact, i make more eosinophils, which are involved inyour immune response. i make more of thesethan i normally should. so, we think that getting your genomesequence is not only important, but we also would argue that getting yourepigenome determined as well is going to be just as important, possibly evenmore so, because that's something you might be able to modify through thefood you eat and your exercise and such. well, as i mentioned before,

we've actually scaled this nowto study 100 different people. we're following 100 people inincredible detail, just like me. we sample them every threemonths when they're healthy, and if something unfortunate happens,like a viral infection or stress response, we'll sample them more frequently. we'll take about five or so extra time points to see whathappens when people get sick. we've also been running people throughsome of these dietary protobations, these dietary changes to seethe affect of diet on people's health.

and so again, we've been doing thisin incredible detail to see exactly what happens when people take supplementsor certain other kinds of dietary changes. and so, we've actually been doing this fornow over three years, we've collected this,where we're at the beginning of summer, we've collected over 1500time points from people. so, we're really learningin incredible detail how people are when they're healthy, andwhat happens when they do get sick. and just to give you a few examples ofsome of the things we learned from this, it turns out we learned importanthealth information from almost

every single person we've studied. so, just to give you some examplesfrom the genome sequence for the first 100 people, we've looked at50 in detail, and three of them have mutations in their dna that are very veryimportant for them to know about, so. one individual had a mutation in thisgene which puts her at high frequency, or high risk forthis type of cancer called paraganglioma. and because she had her genome sequenced,a simple urine test to keep an eye out for that, which she would not havedone had we not sequenced her dna. she would have no idea thatshe was at risk for this.

another individual hasa protein c mutation, which puts him at high risk forcoagulation. and a third person actually has a mutationthat affects their heart rhythm, and possibility of heart attacks orheart failures, something called dilated cardiomyopathy. so they have a high risk for this, whichgot discovered partly through their family history, andpartly because we sequenced their dna. and in fact, they do have some hard issuesthat they're taking medications for. so, just from their dna alone fromthree people turned out to be very,

very useful information about thingsthey should do to keep an eye out for possible disease risk. and so, again, they will use thisinformation to better manage your health. it turns out we're also trying tounderstand what happens to people when they gain and when they lose weight, so. i think many of you, in fact, some of youmay be even experiencing this when people gain too much weight, and then [inaudible]what does that mean biochemically? well, we have looked at those,another group of folks, many of them i forgot to mention,but they are actually prediabetic,

and there's a certain type ofprediabetes called insulin resistances, it puts people at high risk fortype 2 diabetes. most of these folks willget type two diabetes. so we've been following them in detail through the same kind ofprofiling that i have mentioned. and as they say, this group of 24people went through a weight gain, weight loss study, and half of themare high-risk for type 2 diabetes, the other half are normal healthy folks. and they're matched for their height and

weight, called body mass index,they're matched for that. and so, basically, we wanted to see what happens to thesefolks when they gain or lose weight. and what we discovered,first of all, even at baseline, even before they gain or lose weight,we can tell the prediabetics apart from the diabetics basedon their molecular composition. so, this is by looking atall their rna molecules. it turns out the insulin resistantfolks are more elevated for certain kinds of biochemical pathways,like oxidative phosphorylation.

they actually have more of a certainplatelets, specific genes that are stressed and some other diabetesrelated genes that are often prediabetic relative to the insulinsensitive, these are the healthy folks. and the same is true for metabolites. i showed you the rna, buthere's the metabolites. so, it turns out the insulinresistant folks, the prediabetics are more likelyto have certain metabolites elevated relative to the sensitivefolks that have other ones. it correlates very sharply with theirlikelihood to get type 2 diabetes,

and so, what's interesting aboutthis metabolite is it actually comes from your microbiome of all things. so, the point out of all this is that yourmicrocomposition of people who are at risk for type 2 diabetes andthose who aren't are very, very different. what we found though is that aspeople gain and lose weight, their biochemistry doeschange dramatically. so, these are the moleculesthat do change. every row is a different molecule, andevery column, this is at the beginning, this is after they gain weight,this is after they lose weight.

so up here,the molecules will start out low, and then they get high when people gainweight, and they go back to low. and there are other molecules that arehigh when they're healthy, and when they gain weight they actually, these moleculesgo down and then they return to normal. and then there are other interestingones that makes their high go low but actually stay low. they don't quite come back andwe can actually identify these patterns systematically andsee the pathways to change. and the bottom line out of all this isthat when you're gaining weight actually,

one interesting finding was thatyour inflammation response goes up. so your immune response getsactivated when you gain weight and then it returns to normalafter you lose weight. another interesting pathway that changes, it turns out, is when yourhypertrophic cardiomyopathy pathway. that's a lot of mumbo-jumbo, but what thatmeans is that this pathway gets activated, which puts you at a very high risk forheart attack when you gain weight. so we have a biochemicalunderstanding now, how people might get heartattacks when they gain weight.

it comes from the fact that those pathwaysactivated when you gained weight. we've also found what turnsout to be really fascinating. we found that even at baseline, even when people are healthy at baseline,their profiles are very, very different. so these are some very fascinatingimmune molecules called cytokines. it turns out we all have differentlevels of these cytokines, even the baseline when we are healthy. this is a complicated figure buteach color is a different person. each name here around the outsideis the name of the cytokine.

this is high levels andthis is low levels. what we found for examples, of the blueperson has a lot of this one, il7. the light brown person has ip10. the orange person has this one mip1b andso on and so forth. we all have different levels of cytokinewhich probably puts us at risk for certain diseases differently. so some of us,if i were to throw a virus on a room and half the people might get sick and halfmight not, then that might be because we have different levels of cytokinethat help us fend off those diseases.

as it also turns out, you've heardabout your microbiome perhaps. your microbiome is very, very important. it's the collection of microbes in andon you and a lot of them are in your gut. and it's thought that we haveten times as many bacteria in our gut as we do humancells in our whole body. and so the microbiome is essential for digesting your food and making essentialvitamins and things like this. it's a very, very important good thing. it's not always bad likeyou might be worried about.

but it turns out,if we look at people's microbiome, everybody's microbiome is different. that's been known for some time thatwe all have different microbiome but some people can be differentin interesting ways. this is two people here who eat a lotof almonds and they're very different. this is a way of relating peopleto one another in this plot. if you're similar,you'll be very close to each other. well these two individualseat a lot of almonds. it's a family, the husband andwife, they eat a lot of almonds and

they were just very differentfrom everyone else. so your diet can really shape yourmicrobiome and long term changes. what we found is that forshort term perturbations, like the weight gain study i mentioned orviral infections, you will shift your microbiome but you actually look closestto your self rather than someone else. so this is just comparing peoplein different time points. every color is a different person and it turns out the people are like this redperson, if we ask who's closest to who, well even if you gain weight orhave a viral infection,

your microbiome will look closest toyourself, rather than someone else. so the point out of all this is that weall have personal microbiomes that shift when we do gain weight, orwhen we get a viral infection, and it's a short term perturbation. it will shift but you'll still lookclosest to you, your bacteria and things are very personalized. and that's probably because we tend toeat very similar diets and our genome and epigenome help control all of this. so this is really where ithink all this is going.

i see a world where we'll beable to understand where people, when they're faced with differentperturbation, so some people if they eat unhealthy they will gain weight andbecome metabolically a mess. other people, if they eat unhealthy, theyactually may gain weight or they may not. but, even if they gain weight,they can stay metabolically healthy. there are plenty of vary obese peoplewho don't have type 2 diabetes and we'd like to understand biochemically whythat is so we can better manage people. certainly we can try andmake sure that they eat healthy foods but we should make sure that theyeat healthy foods for them.

and the food can be very specific forindividuals. we're also trying tounderstand how certain people, when they get viral infections, someget sick but some others stay healthy. and, again, we'd like to try and keep people as healthy as possiblefrom these circumstances. this isn't the only study we're running. we're running another one, where once a year we're profilingpeople from around the world. actually it is part of a meetingthat i am involved in,

it is calledthe human proteome organization. we actually are, part of this weactually go around and sample people and follow their biochemical composition. we do this once a yearat the annual meeting. and, so we'll be running around the worldpicking out crops of people to see how biochemically differentthey are from one another. there's other projects out there as well,i've just listed a few here. so, there's one in seattle run bylee hood, another in sweden, and so on and so forth.

there's a number of projects nowerupting like this around the world. where people are trying to understandbiochemical detail, what it means to be healthy andwhat happens when people get sick. there's also a new exciting area that'sgoing to play into this in a big way and this is using wearables and sensors to beable to better manage people's health. so i mentioned all the biochemicalmeasurements but there's now getting to be devices that let you measure many, manydifferent physiological sorts of things. in fact, believe it or not,there's over 500 health related devices on the market that let you measureall kinds of different things.

and i don't have time tosummarize them all but i'll tell you about a few of these. the simple ones are things like scales that you can stand on that willactually measure your weight. and they will send thatinformation into your smart phone. there are continuous glucose monitorswhich is especially useful for type one and type two diabetics. these devices actually prick onto you and they will continuouslymeasure your glucose.

probably the most popular device thatyou're aware of, the smart watches, there's well over 50available on the market. they measure all kindsof interesting things. they measure your activity,how many steps, running, biking. they'll measure skin temperature. they can measure,it depends on the device, but they can measure your sleep,stress responses, and so on. they measure all kinds of things. and they're measuring, again,in a continuous fashion.

and what's important is that thesedevices collect information and they relay that back into your smartphone and what that means is in the future your smart phone is goingto be your nexus of health information. all this information is goingto relay back into you, into your smart phone, and collect this. and to be honest, i use eight of thesedevices everyday to collect information. it totals up to about two million datapoints per day that you can collect and even if you don't have time forall of those devices, you can actually downloadfree apps on your iphone.

and get some of these as well,this is one i use. it's a free app that lets youmeasure your steps, your biking, your running and also tells youwhere you are all at the same time. so again this information willall collect into your iphone and help manage it, so why is this important? well if you think about it,you probably go to a doctor at most, once a year if you're healthy. and they probably see you for about 15minutes, maybe 30 minutes if you're lucky. and so out of the 370,000waking minutes in a year.

the doctor just sees you for justthe tiniest possible fraction of them, a tiny drop in a very, very large bucket. so we think there's value to actuallybeing able to measure people all the time, collect a lot of data, and a lot of information about a personover a long period and not just in that 15 minutes where you wonder if that'srepresentative of your health state. but by collecting this all the time, youreally get a pretty good idea of what your baseline heart rate is andif it's changing and this sort of thing. i can tell you personally, what this isgoing to mean is that, in the future,

your smartphone, it's reallygoing to be your command center, your control center forcollecting all this information. and you [inaudible] biochemicalinformation in here too and that will be able to help youbetter manage your health. to give you a personal experience out ofthis, when i got lyme disease last summer in 2015, my wearables were actuallyincredibly valuable for discovering this. in fact because i discovered that myoxygen level is lower than it was supposed to be. my heart rate was elevated andi knew things weren't quite right.

and then i got a low grade fever forfour days and in the end i was able to figureout it was lyme disease. i was in norway so it's a big deal,they don't have much lyme disease there. in fact the person recommendedi got penicillin and i told them i think i need doxicyclin. and if i hadn't had the wearables, first of all the wearables helpedme find this in the first place. and then by taking command of my situationi was actually able to get the right drug. so, i think that's going to be oneof many examples in the future where

these wearables will feed directlyto you and then you'll use them and go to the doctor to helpbetter manage your health. and so, we'll not only havebiochemical measurements, we'll have all these physiologicalmeasurements as well. so, this is mike snyder's future. i envision a world where people will begetting their genome sequenced before they're born. in addition to all thesebiochemical measures, we're going to have wearable informationas well that all feeds back.

again ideally it would feed back toreal time release and short time. and with this, we'll be able tobetter predict disease risk, catch disease early, monitor disease and treat it all based on all thisinformation, the so-called big data. and the nice part about it is i hope inthe future, we'll be shifting medicine from being a reactive situation,where we react when people get sick. to proactive where we workto keep people healthy. that's really the goal. and so again, here's where we're at,personal genome sequencing is here.

all these other multi-omicsprofiling's really important. i think the longitudinalprofiles are very, very valuable. everyone is unique, so everyone's special,not just to the mother. they have different biochemical profiles. and i think we are all going to beresponsible for our own health. so that's wrapping it up,i'm going to turn back over to annette and yeah happy to take questionsif people have any. we have a wonderful lab andwonderful collaborators. these are the people whohelped out in the study.

so, back to you annette. >> great, thanks mike. so, before we do some quick questions, i'd like to tell you a little bitabout our program and our center. so, the stanford center for professionaldevelopment makes it possible for today's best and brightest professionals toenroll in stanford university courses and programs while theymaintain their careers. curriculum from stanford departmentsis delivered online at stanford, at company work sites, andinternational locations,

providing a global community of learnerswith flexibility and convenience and enabling them to apply theireducation to their work. additionally the stanford center for professional development has a longhistory of extending the world class teaching and research of stanford facultyto industry corporations of all sizes. from start ups to matureof successful enterprises. visit scpd.stanford.edu to learn more. so now we have a few questions, so mike, when will this becomeavailable to everyone?

>> well right now it's a researchproject so the way we carry it out, it really is just fora limited number of people, a hundred folks we're followingin incredible detail. but i think some form of thiswill come out in the future. obviously, the wearables are there now. i think we're going to see, they'restarting to be some companies forming in this area about measuring a lot more data,to be able to manage people's health. so i'm guessing, so some levels rolling out now, it's notcovered in a typical doctor's appointment.

but it wouldn't surprise meif from five to ten years, we'll see a lot of this activity. certainly, by ten years,i think we'll see a lot. it won't be quite as deep as what we'redoing on me and these 100 people. but i think it will stillhave a lot of data to be able to better manage people's health. and i didn't mention but imaging data, some of these other things are going tobe very, very important as well. >> great, so with that thought, is thatsuch a thing as too much information?

>> well from my standpoint my answer isno, some people maybe overwhelmed by this. but i think you can manage the kind ofinformation that you want to come to you. so yes it's billions of data points but in the end it always distills into a fewcommon themes like either you're sick or you're healthy oryou have a viral infection. maybe you have lyme disease. so it won't be like you'll getflooded with billions of data points. you'll get filled with possible thingsthat you should be on the alert for. and some people know theywon't want this information.

you don't want to wake upevery morning and worry. i'm going to get lyme disease,or i'm going to get cancer. that would not be a veryhealthy situation. so if you're a worrier and you're worriedabout this stuff, my recommendation would be that you just limit the informationthat comes back to you. only, it would pop up if it seems a verystrong likelihood that this'll happen, or there are certain simpletests you should be doing. so i think that threshold of whatinformation you want to come back to you will differ for different people.

and again worriers should probablyget less information, people who can handle lots of information, by all meanslet them have whatever they can handle. >> yeah great so with all the information,and all the different devices, and all these different collectionof data what about the privacy? who owns all of this information? >> yeah, well at the end of the dayi think you're the owner of your own information in my opinion. now you do have to be coachedabout this in a sense that we do have genetic counselors involvedwho let people know that they

may learn things they don'twant to hear about and such. so we do want to manage that. but as far as privacy in terms ofinsurance companies and things, at least in the us, you're not allowedto be discriminated for employment or health information. although, you can for long termdisability and for life insurance. so those two, you can be discriminatedagainst so that is a possible concern. i would still argue it's betterto know the information and stay healthy and possibly pay a littlemore for life insurance if you have to.

that would be better than the alternativewhich is to be unhealthy and not know. so it is a trade off. unfortunately, it'd be nice, obviously, if there wasn't any discrimination onthose things, but it's somewhat limited. i haven't heard any strong cases ofinsurance companies discriminating or people discriminating against othersbased on their genetic information. although, it is conceivable itcould happen in the future. but yeah, i think again, number onepriority would be to stay healthy. and i think the informationcan help you do that.

i think for privacy, we should try andmanage it as best we can. these days, i don't think you couldever say anything is completely secure. so even if you thought you were [laugh]storing it in a very, very safe place, there's a distinct chance that it will gethacked and somebody may have access to it. and that's why we'd like to avoidany discrimination based on this sort of information. >> yeah, thanks. this is very informative and i think everyone can really takefrom this talk so thank you.

so again, if you like this topic andyou're interested in more information, this webinar is presented by the stanfordgenetics and genomics certificate program. visit geneticscertificate.stanford.edu formore information. thank you everyone for listening. >> bye all.