Plenary Speakers

Genetics, Race and Ethnicity
This will be a two-part session discussing the interface between genetics, race, ethnicity and communities of color.

For the first part of the session, Prof. Merriwether will discuss the contribution made by genetics to the study of human population variation and evolution and demography.

For the second part of the session, Dr. Schulz and Prof. Caldwell will discuss the rationale and process for engaging communities of color in the development of policies and programs utilizing genetics in the public health context. They will share findings from a current research project involving African American and Latino communities in Michigan and Alabama, and will report on issues of concern and attitudes toward genetics expressed by members of these communities in a series of focus groups.

Genetics in Cancer Control Programs
Developing strategies to reduce the incidence and mortality of cancer is a tremendous challenge. Advances in genetics have provided powerful tools for identifying individuals at high risk, but is this good enough? Once populations and individuals at high risk are identified, what do we do? Currently four strategies dominate our approach to managing the risk of cancer: 1) reduce exposure to risk factors, 2) encourage surveillance, 3) offer effective chemoprevention, and 4) consider prophylactic surgery. This symposium focuses on the challenges and opportunities to integrate genetics and cancer control in clinical practice and population policy. Our panel of epidemiologists, oncologists, and geneticists will address the potential benefits and potential risks of current strategies to reduce the risk of cancer. The panel will offer perspectives using breast cancer, colon cancer, and lung cancer as representative examples of the complexity of human cancer. How effective are our current strategies? How will we develop new strategies? When is the evidence good enough to move a promising idea to practical reality? The genomics revolution is already here, but the difficult challenges remain ahead of us.

Genetics and the Media
Genetics is headline news. Media coverage of science and medicine is expanding almost as rapidly as the base of genetic knowledge. The popular media is an extremely powerful influence on what and how the public thinks about genetics. Through television, radio, newspapers, and now the Internet, people around the world are learning about genetic advances and the associated ethical, legal and social issues. Unfortunately, each news medium carries inherent limitations that often produce a distorted, sensationalized view of genetics. Increasing cooperation between science and the media is crucial to providing the public with access to accurate information. Recognizing the power of the media and learning to use its resources to educate people is an important challenge public health professionals must be prepared to face.

Public Policy on Antibiotic Resistance: The Role of Genetics
Widespread antibiotic use in animal husbandry, agriculture and medicine has led to the selection for and dissemination of antibiotic resistance. This increasingly limits our ability to effectively treat bacterial infections. We will examine the genetic mechanisms behind antibiotic resistance, and public policy strategies to address this public health threat.

Gene Therapy on Trial?
On September 17, 1999 Jesse Gelsinger, an 18 year old volunteer died in a gene therapy trial at the University of Pennsylvania in Philadelphia. A series of USDA and NIH investigations and congressional hearings followed, resulting in the end of all clinical trials at the University of Pennsylvania Institute for Human Gene Therapy and an increased scrutiny of gene therapy clinical trials nation wide. This panel discussion will address some of the important issues raised by these events.

Studying the Genetics of Complex Disease
Recent advances in genetics have enabled researchers to determine the genetic basis for many human diseases. Most of these successes have been for rare, single-gene disorders such as cystic fibrosis and Huntington disease. Current human genetics research focuses on common diseases that run in families, but which only in rare cases display single-gene inheritance. These complex diseases, which include essentially all common human diseases, are influenced not only by genes, but also by environmental and behavioral factors, and their interactions. In this session, we will discuss current methods to understand better the genetic predisposition to complex diseases, and application of these methods to several diseases.

Genetics Counseling: Myths and Realities
Genetic counseling is a communication process which deals with human problems associated with occurrence or risk of a genetic disorder in a family. This process involves an attempt by one or more appropriately trained persons to help the individual or family to:

1. comprehend the medical facts including the diagnosis, probable course of the disorder, and the available management,
   
   
2. appreciate the way heredity contributes to the disorder and the risk of recurrence in specified relatives,
   
   
3. understand the alternatives for dealing with the risk of recurrence,
   
   
4. choose a course of action which seems to them appropriate in view of their risk, their family goals, and their ethical and religious standards and act in accordance with that decision, and
   
   
5. to make the best possible adjustment to the disorder in an affected family member and/or to the risk of recurrence of that disorder (American Society of Human Genetics, 1975).

Today, genetic counselors provide information about potentially teratogenic or mutagenic exposures as well as common diseases of adulthood with heterogeneous etiologies. In the future, people are expected to seek counseling about genetic polymorphisms that could affect response to therapeutic drugs or specific environmental exposures, or even about the genetics of common behavioral and physical traits.

This session will include an overview of the condition Huntington Disease, including the gene discovery process, DNA-based testing, Huntington Disease Association of America testing guidelines, and ethical principles of patient care. After the overview, the audience will be divided into teams. Each team will review a different Huntington Disease case scenario with a pedigree. Each scenario contains a bioethical dilemma to be resolved by consensus of the team. Then the different cases and the decided courses of action will be discussed along with issues about the genetic counseling process.

Genetics and Infection in International Health
Infectious diseases are the most important causes of illness and death in developing countries. Recent studies have identified genetic polymorphisms in these populations that both increase and decrease susceptibility to these diseases. Furthermore, we have learned a great deal about the genetics of the pathogens themselves. We will discuss how this knowledge has affected our understanding of the epidemiology of malaria, HIV and tuberculosis.

Role of Genetics in Public Health Prevention Programs
This session concerns the public health policy dimension of genetic technology, with special application to newborn screening. A variety of experts from federal and state government will consider new policy dilemmas and opportunities created by new technologies for the detection and prevention of genetic disorders. All SPH students and faculty are welcome, regardless of previous background in genetic science or policy analysis.

Genetics Law and Policy
In this session, we will first engage attendees in a discussion of various scenarios likely to arise and how they should be resolved. The scenarios will involve issues of genetics law and policy, such as whether to disclose genetic screening results to a sibling or family member, and how to develop standards of care in a rapidly developing area. Second, Ed Goldman will describe the results and recommendations from his work as chair of the Governor's Commission on Genetics. Third, Peter Jacobson will provide an update of the legal issues in genetics that have been decided so far.

Gene-Environmental Interactions and Chronic Disease
Current thinking in chronic disease research emphasizes the importance of interactions between genetic and environmental factors in etiologic mechanisms, rather than the previous notion of nature (genetics) and nurture (environment) as distinct or competing forces. Research in gene-environment interactions aims to characterize the relationship between genetic susceptibility to disease and exposure to environments that induce disease, e.g. chemical, physical, biological, and social. For individuals with increased disease risk, this research holds the promise of improved disease prevention through the modification of environmental risk factors. Five primary models of interaction exist, but the pattern most often observed features an environmental exposure with a disease risk that is amplified by an underlying genetic susceptibility. Notable examples of gene- environment interactions will be given to provide a basis for understanding as an introduction to the talks by Drs. Brew and Omenn.

Dr. Brewer will first illustrate an example of applying gene-environment interaction to drug development. Environmental copper is used by simple organisms in growth regulation and may have evolved into regulation of angiogenesis and growth in higher organisms. The angiogenic function of copper is now the basis of an anticopper drug Dr. Brewer developed, tetrathiomolybdate, used in the treatment of diseases dependent upon angiogenesis, such as cancer. Second, Dr. Brewer will review the plethora of data emerging suggesting that certain dietary constituents are protective against cancer, and so me of his ideas about how testing the efficacy of dietary supplements could be expedited.

Dr. Omenn will introduce several topics in ecogenetics - the study of the genetic determinants of inter-individual variation in response to environmental agents. Genetic variation in biotransformation enzymes, for example, contributes to the risk of adverse effects from pharmaceuticals and environmental chemical exposures. In the realm of nutritional ecogenetics, the role of plasma homocysteine level as a risk factor for cardiovascular disease will be discussed. Levels of homocysteine are influenced by nutritional factors (folic acid, vitamin B12, vitamin B6) and by polymorphic variation in a key enzyme of folate metabolism (MTHFR). Profiles of multiple genetic variations are now being investigated with the tools of genomics and proteomics, as illustrated by recent differentiation of subtypes of large B-cell lymphomas. The importance of linking information about genetic variation with information about chemical and microbial exposures, lifestyle behaviors, and medical care in research in gene-environment interactions will be highlighted. Dr. Omenn will also discuss the ethical, legal, and social ramifications of using genetic information in medicine and public health.