WEBVTT - Ep 56 Sickle Cell Disease: Invisible Illness, Enduring Strength

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<v Speaker 1>My name's Marsha.

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<v Speaker 2>I lived in the UK, as you can tell by

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<v Speaker 2>my accent, and I pad super cell for the longest

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<v Speaker 2>time I can remember.

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<v Speaker 3>My parents found out when I was about six years old.

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<v Speaker 3>My mom knew she had the trade, but my dad

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<v Speaker 3>didn't know that he carried the trade. And obviously my

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<v Speaker 3>older sister was born and she just had a trade.

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<v Speaker 3>So it was my mom was like, okay, fine, and

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<v Speaker 3>she got that from me. But when I came about,

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<v Speaker 3>I was born with another sort of illness on top

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<v Speaker 3>of sickle cell, which is called the six deficiency, so

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<v Speaker 3>it kind of mossed the sickle cell. So over the

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<v Speaker 3>many years growing up, I was like becoming sick.

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<v Speaker 1>They couldn't quite work out. And then it was when

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<v Speaker 1>my younger.

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<v Speaker 3>Sister was born they said, you know, let's be tested

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<v Speaker 3>for sickle cell, and that's when they found out that

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<v Speaker 3>I had the full blown disease. I kind of understood

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<v Speaker 3>I had an illness much later on.

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<v Speaker 1>I would say, when I was about nine eight or nine.

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<v Speaker 3>Yes, I went to hospital appointments prior to that, but

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<v Speaker 3>it just didn't really sunking. I kind of let my

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<v Speaker 3>parents deal with it all, like, okay, well you.

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<v Speaker 4>Manage my health.

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<v Speaker 1>I managed being a child and playing with my friends

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<v Speaker 1>and stuff like that.

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<v Speaker 3>I didn't really understand it too, I think as I

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<v Speaker 3>went later on in my teenage years, when I went

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<v Speaker 3>started going to secondary school, that's when I started taking

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<v Speaker 3>more control over my illness and saying, Okay, well, you know,

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<v Speaker 3>I have to eat right, I have to dress right,

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<v Speaker 3>I have to make sure I get enough rest, and

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<v Speaker 3>you know, not overstress myself because I know if I don't,

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<v Speaker 3>these things can trigger off a crisis and I can

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<v Speaker 3>be left out of school for like weeks on end.

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<v Speaker 3>And it was only when I'm joined to sort of

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<v Speaker 3>like be positive choir that I actually came out and

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<v Speaker 3>a lot of my school friends, I was like, do.

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<v Speaker 4>You know what?

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<v Speaker 1>I did not know?

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<v Speaker 3>You heard sicker celt I didn't know how to explain

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<v Speaker 3>it to them in a way, and I didn't know

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<v Speaker 3>how they would receive me. I always think, like, you know,

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<v Speaker 3>if I said it, I would lose friends, which I

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<v Speaker 3>remember having a friend who said they didn't want to

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<v Speaker 3>be my friend because they.

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<v Speaker 1>Thought they could catch sickle cell if they held.

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<v Speaker 3>My hand, And I was like, it doesn't work that

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<v Speaker 3>way unless you're born with it.

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<v Speaker 1>Does not work that way, So it was very.

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<v Speaker 3>I shield myself just so I wouldn't have to face

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<v Speaker 3>that negativity, and that hurt.

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<v Speaker 1>Later on my adult years.

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<v Speaker 3>I was like, you know what, if you don't like

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<v Speaker 3>me the way I am, then that's fine.

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<v Speaker 1>Somebody else will. There's many people in this world that will.

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<v Speaker 3>And I grew that confidence and was able to mental

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<v Speaker 3>or talk toever teenager girls and boys who were in

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<v Speaker 3>my situation to say, you know, don't let super cells

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<v Speaker 3>stop you from doing what you want to do. When

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<v Speaker 3>I do get in a crisis and I'm in pain,

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<v Speaker 3>the best way to describe it it has to be

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<v Speaker 3>like when you get a really bad cold and you

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<v Speaker 3>have eggs and pains and all of your body hurts

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<v Speaker 3>on it ten times worse skill than aches and pains.

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<v Speaker 3>When you've got a cold and you just want it

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<v Speaker 3>to stop, and I've had it's brought me to tears

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<v Speaker 3>before many times, and it's brought me to the parts

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<v Speaker 3>where I'm like, do you know what, I don't want

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<v Speaker 3>to be here on this earth because I don't want

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<v Speaker 3>experience to pay.

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<v Speaker 1>Why do I have to go for it? You know?

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<v Speaker 5>Why?

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<v Speaker 1>Was I the unlucky one? And I did kind of go.

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<v Speaker 3>For the fase of blaming my parents, so to speak, saying,

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<v Speaker 3>you know, you should have checked each other before.

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<v Speaker 1>You had me, why didn't you do this?

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<v Speaker 3>And you know, your mind starts thinking loads of things

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<v Speaker 3>of you know, I if I wasn't here, would.

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<v Speaker 1>I be in a better place?

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<v Speaker 3>Or if I was born before my sister, would I

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<v Speaker 3>be in a better place?

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<v Speaker 1>And you just think many things.

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<v Speaker 3>Every day you wake up. You don't know if it's

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<v Speaker 3>going to be a good day, if it's going to

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<v Speaker 3>be a bad day. And I think that affects your

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<v Speaker 3>social life as well, because you're forever counseling on your friends.

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<v Speaker 1>And it's the same with relationships.

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<v Speaker 3>I've like broken up with a lot of partners because

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<v Speaker 3>they don't understand the extent of sick of self going

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<v Speaker 3>into hospital that's our last result on our mind. We

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<v Speaker 3>tend to not quite going into the hospital, but we

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<v Speaker 3>like we want to try and treat it the best

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<v Speaker 3>we can at home. Sometimes we don't like the hospitals

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<v Speaker 3>because of the stigma that we get. We get looked

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<v Speaker 3>upon as oh, we're drug addicts or you know, we're

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<v Speaker 3>not really in pain, we're just he because we need

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<v Speaker 3>to fix, and it's like I would don't want to

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<v Speaker 3>be in hospital.

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<v Speaker 1>This is the last place I want to be.

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<v Speaker 3>Lucky enough, my family are amazing, bless their hearts. I

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<v Speaker 3>have snapped up them many times, but it's not the

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<v Speaker 3>case that I mean to. It's just a case of

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<v Speaker 3>all I can feel is this pain, and I don't

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<v Speaker 3>want to feel the pain anymore. And I have apologized

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<v Speaker 3>to them afterwards, but now they kind of know my routine.

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<v Speaker 3>Not you know, when I say I'm in a crisis,

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<v Speaker 3>they don't answer silly questions.

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<v Speaker 1>They're just like pay.

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<v Speaker 3>Meds, heatpad or hot bath or if it's that bad,

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<v Speaker 3>do you need to go to the hospital. And obviously

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<v Speaker 3>I've got a son who is fantastic. I'll call him

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<v Speaker 3>a little Dr Quinn. The minute you know, I say

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<v Speaker 3>mummy's not feeling very well.

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<v Speaker 1>He's on it.

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<v Speaker 3>With the pain meds, the hot cups of tea, the

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<v Speaker 3>hot water bottle, everything you can think of to make

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<v Speaker 3>to cheer me up. He'll put my favorite movie on

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<v Speaker 3>and cuddles and there with me. So he is literally amazing.

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<v Speaker 3>But because it's just me and him that lived together,

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<v Speaker 3>I feel like that sometimes he feels his childhood got

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<v Speaker 3>robbed in. Sometimes he feels that he can't be a

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<v Speaker 3>child because he has to look after mummy and also

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<v Speaker 3>be himself, which is I knew was quite hard. And

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<v Speaker 3>I think that was the same thing when I knew

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<v Speaker 3>when I was going to have children. You know what

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<v Speaker 3>impact would my health have on him?

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<v Speaker 1>And for me?

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<v Speaker 3>When I felt pregnant. After my pregnancy, that's when my

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<v Speaker 3>sickle sell got worse. I had a minor stroke. More

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<v Speaker 3>things were happening to my body where I felt like

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<v Speaker 3>it was deteriorating, and I feel that that was not

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<v Speaker 3>made or where to me when I was thinking about

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<v Speaker 3>starting a family. So I'm now going over that hurdle

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<v Speaker 3>of experience and things where I feel that maybe I

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<v Speaker 3>could have been made more aware of and given that

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<v Speaker 3>option of what to do. But nevertheless, he's still a

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<v Speaker 3>blessing and I loven't pieces and I think now that

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<v Speaker 3>where I joined to be positive choir, it's a journey

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<v Speaker 3>that you don't want to end. Singing for Britain's got talent,

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<v Speaker 3>singing for the Queen, Meghan, Prince Harry, Prince William, everyone,

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<v Speaker 3>it was amazing.

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<v Speaker 1>It was like I was living a dream. I had

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<v Speaker 1>to keep saying pinch me. Somebody pinched me? Is that

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<v Speaker 1>Megan over there? No, So it was absolutely amazing.

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<v Speaker 3>And the way since we've come on that platform it's gone.

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<v Speaker 1>Viral, I think it's got more awareness.

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<v Speaker 3>Everybody's starting to get involved and starting to be more

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<v Speaker 3>clued up and taking notice of what sickle cell is,

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<v Speaker 3>and you know how they can go around helping to

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<v Speaker 3>spread the awareness.

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<v Speaker 1>And I feel that it's.

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<v Speaker 3>A way that brings the community together as well, because

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<v Speaker 3>in the choir there are many people who have the

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<v Speaker 3>illness and we share our stories. We've got you know,

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<v Speaker 3>everybody experiences sucle cell differently, so it's nice and where

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<v Speaker 3>we've become like a big unit and we get to

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<v Speaker 3>share it around the world, which is amazing, and we

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<v Speaker 3>have a laugh, we have a love and that's the

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<v Speaker 3>main thing. Yes, you have your down days, but also

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<v Speaker 3>you have your good days. But everyone always says, you know,

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<v Speaker 3>how is it You're always smiling, And I think I

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<v Speaker 3>look at the positive that now I don't see sickle

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<v Speaker 3>cell as a burden as I did before. I actually

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<v Speaker 3>see it as a gift and a blessing to have

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<v Speaker 3>because I can go out and spread the word about

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<v Speaker 3>six sol and make friends. Yeah, I'm happy, literally happy.

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<v Speaker 3>I couldn't be more happier.

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<v Speaker 4>So my name is Sheriff to sob them.

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<v Speaker 6>I was born in Kampala, Uganda, a small East African country,

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<v Speaker 6>and I have scle cell disease. So when I was born,

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<v Speaker 6>my mom and dad had a very love story. They

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<v Speaker 6>gave birth to the baby boy like all parents, so

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<v Speaker 6>very excited to have a baby boy. I think after

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<v Speaker 6>about four or five months after that, I started to

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<v Speaker 6>show up with I was very irritated. I was alreadys

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<v Speaker 6>crying and they told me I had all the my social.

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<v Speaker 4>In hands and didn't know. They didn't know what was

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<v Speaker 4>really going on.

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<v Speaker 6>And my mom kept on going to different health centers

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<v Speaker 6>and until the time one doctor did sugges said, no,

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<v Speaker 6>what we need to do a cyclo cell test to

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<v Speaker 6>be able to find out if this after has cell

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<v Speaker 6>and and so that was the change of their story

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<v Speaker 6>because once she told my dad, they actually broke up

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<v Speaker 6>and my dad left her because he's like, no, I've

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<v Speaker 6>not had any child or cicle cell and in my

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<v Speaker 6>family we don't have sicosle business. So my mom ended

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<v Speaker 6>up having to raised me as a single mother because

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<v Speaker 6>my dad had left. During that time, she was pretty

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<v Speaker 6>scared about what's going on. She didn't know what was

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<v Speaker 6>going on because at that time the ninety sicosa wasn't

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<v Speaker 6>really a very big thing. Most people who have cycle

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<v Speaker 6>cell To date in Uganda, we find that over ninety

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<v Speaker 6>percent of the babies who were born in shep was

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<v Speaker 6>Sel died before their fifth pack. So this is mostly

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<v Speaker 6>because we don't have a comprehensive for a program that

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<v Speaker 6>you're going to be diaganized and go to Cico cell

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<v Speaker 6>center and be followed up to sell the care.

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<v Speaker 4>All that has not been there if it has started

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<v Speaker 4>to come up.

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<v Speaker 6>I think in the last one one or two three

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<v Speaker 6>years we're starting to see scosol the centers across the

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<v Speaker 6>country in Uganda. So during that time when she was

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<v Speaker 6>pretty long, pretty scared, she named me to Suvida. So

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<v Speaker 6>my second name is Sheriff to Suvida to Subida means

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<v Speaker 6>we hope. So high institution with the names with them

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<v Speaker 6>was mostly because of the fact that she wanted to

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<v Speaker 6>have a way to always have some hope in her heart.

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<v Speaker 6>Because if everyone around you is trying to say your

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<v Speaker 6>baby's going to die, every mom will preace care. But

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<v Speaker 6>as a child growing up, I really I didn't know

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<v Speaker 6>what was going on, yes, or have pain and cry

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<v Speaker 6>and ask what's going on? And my mom didn't really

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<v Speaker 6>have a wolf explaining it to me until I think

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<v Speaker 6>to my six or seven years. But when I go

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<v Speaker 6>to play and kids have come to play, we'd say,

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<v Speaker 6>they would say and and I, which.

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<v Speaker 4>Means in my local anguage, you don't play with him.

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<v Speaker 4>He's sick.

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<v Speaker 6>So that that's why I start to realize that there's

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<v Speaker 6>something different about me. So that was my kind of

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<v Speaker 6>childhood experience. And this was the case whereby I'll be

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<v Speaker 6>on the pitch trying to pick the ball and I

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<v Speaker 6>feel pain in my leg, feel pain in my hand,

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<v Speaker 6>and said and sometimes I just couldn't walk. My friends

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<v Speaker 6>would have to carry me home. I'd always ask my mom,

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<v Speaker 6>what's going on?

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<v Speaker 4>Why me? Why am I feeling like this? Why I think?

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<v Speaker 6>I remember all the time after growing up, I asked

0:11:55.520 --> 0:11:57.280
<v Speaker 6>her for a knife slight that I could cut off

0:11:57.280 --> 0:11:59.280
<v Speaker 6>my hand and cut off my leg because it was

0:11:59.520 --> 0:12:01.640
<v Speaker 6>bringing too much pain for me. And they're like, no,

0:12:01.720 --> 0:12:04.319
<v Speaker 6>we can't do that. You can't just just can't just

0:12:04.440 --> 0:12:07.079
<v Speaker 6>cut off the leg because you took my pain. But

0:12:07.160 --> 0:12:10.400
<v Speaker 6>even then yes, I would feel very stigmatized and feel

0:12:10.480 --> 0:12:12.640
<v Speaker 6>very bad about it. And when it went when he

0:12:12.679 --> 0:12:14.720
<v Speaker 6>went to school, it was actually very different as well

0:12:14.720 --> 0:12:18.000
<v Speaker 6>at school because at school in the rainy season, the

0:12:18.000 --> 0:12:20.480
<v Speaker 6>extreme seasons, or being pained and I couldn't go to school,

0:12:20.480 --> 0:12:22.640
<v Speaker 6>so you missed like two weeks or three weeks of school,

0:12:22.679 --> 0:12:24.679
<v Speaker 6>and the teachers to say, where has he been, and

0:12:24.760 --> 0:12:27.200
<v Speaker 6>so often my mom would have to explain, you know

0:12:27.240 --> 0:12:29.160
<v Speaker 6>what he has cycle, sell if he has missed, if

0:12:29.160 --> 0:12:31.520
<v Speaker 6>he tells you his hands are sick, he can't write,

0:12:31.559 --> 0:12:32.840
<v Speaker 6>it's fine, you have to understand.

0:12:32.840 --> 0:12:35.040
<v Speaker 4>But it was really hard for the teacher to understand because,

0:12:35.080 --> 0:12:35.360
<v Speaker 4>like I.

0:12:35.320 --> 0:12:38.160
<v Speaker 6>Said, this disease is most partly nothing about like even

0:12:38.160 --> 0:12:41.320
<v Speaker 6>the teachers like this kid has just just has an excuse.

0:12:41.600 --> 0:12:44.240
<v Speaker 6>Every time I want him to come and drawn the blackboard,

0:12:44.280 --> 0:12:46.680
<v Speaker 6>he's saying his hand is hurting. You want him to

0:12:46.720 --> 0:12:50.920
<v Speaker 6>be part of the class activity, He's saying he feels

0:12:50.960 --> 0:12:52.720
<v Speaker 6>pain in his leg and feels pain and there.

0:12:53.040 --> 0:12:55.520
<v Speaker 4>So that was another issue because of my cycle.

0:12:55.559 --> 0:12:59.360
<v Speaker 6>So I had complications like John this in my eyes

0:12:59.360 --> 0:13:01.520
<v Speaker 6>and had the distant and prettish all those things that

0:13:02.440 --> 0:13:05.560
<v Speaker 6>made me look more of an outlier like you don't. Yes,

0:13:05.600 --> 0:13:07.920
<v Speaker 6>you look like everyone else, but you your eyes are

0:13:07.920 --> 0:13:09.840
<v Speaker 6>pretty yellow. So that's the thing that you have to

0:13:09.840 --> 0:13:12.480
<v Speaker 6>explain everyone why your eyes yellow. I didn't know how

0:13:12.559 --> 0:13:14.719
<v Speaker 6>much to break it down, but all I would say, yes,

0:13:14.720 --> 0:13:16.160
<v Speaker 6>I have cicle said it is a blood disease.

0:13:16.160 --> 0:13:16.839
<v Speaker 4>That's all I would say.

0:13:16.880 --> 0:13:19.760
<v Speaker 6>And when I get sick, and we had a school nuns,

0:13:19.800 --> 0:13:21.640
<v Speaker 6>I would go and get careful the nuns. So high

0:13:21.640 --> 0:13:24.160
<v Speaker 6>school was was a bit was a much better experience.

0:13:24.760 --> 0:13:27.079
<v Speaker 6>So during my second day and the university, I did

0:13:27.120 --> 0:13:29.199
<v Speaker 6>get sick, and I got sick and I missed I

0:13:29.240 --> 0:13:31.400
<v Speaker 6>think I missed almost three or four weeks of school.

0:13:31.800 --> 0:13:33.920
<v Speaker 6>So when everyone was asking why Sharif and I mean

0:13:33.960 --> 0:13:35.640
<v Speaker 6>and I didn't really do my disclosure. And that's the

0:13:35.679 --> 0:13:37.000
<v Speaker 6>time I had started to day, I was I was

0:13:37.040 --> 0:13:39.400
<v Speaker 6>taking a very before woman. And when I got to seek,

0:13:39.400 --> 0:13:41.280
<v Speaker 6>I was in the hospital and she tells me, you

0:13:41.280 --> 0:13:44.520
<v Speaker 6>know what, I can't do with you because of yoursical cell.

0:13:44.600 --> 0:13:48.240
<v Speaker 6>I mean, I've never seen myself with someone with That

0:13:48.360 --> 0:13:50.800
<v Speaker 6>was a tinning point for me. So that that was

0:13:50.840 --> 0:13:53.920
<v Speaker 6>my driving fact and now to make a change in

0:13:54.120 --> 0:13:56.080
<v Speaker 6>not only in my life but in the life of

0:13:56.080 --> 0:13:58.680
<v Speaker 6>all those people living so such that they don't have

0:13:58.760 --> 0:14:03.360
<v Speaker 6>to go through what had gone to. So it was me, myself, Ashoff,

0:14:03.520 --> 0:14:06.839
<v Speaker 6>and two other people, Evelyn and another guy's Aalim. We

0:14:06.920 --> 0:14:10.320
<v Speaker 6>agreed to create an organization called Scostal Network You. It

0:14:10.360 --> 0:14:12.480
<v Speaker 6>was the first cico cell and I profit that we

0:14:12.520 --> 0:14:16.920
<v Speaker 6>did register. Because of my background and stigma and experience,

0:14:16.920 --> 0:14:19.520
<v Speaker 6>I had. One of the first projects that implemented was

0:14:19.560 --> 0:14:23.680
<v Speaker 6>having psycoso concer training. When I looked at my background

0:14:24.120 --> 0:14:27.080
<v Speaker 6>of lavato science and the fact that in our market

0:14:27.160 --> 0:14:29.640
<v Speaker 6>you could have people test for HIV, I thought myself

0:14:29.640 --> 0:14:30.800
<v Speaker 6>and said, I think we should be able to test

0:14:30.800 --> 0:14:33.880
<v Speaker 6>for cico cell. We started out at all our community

0:14:33.920 --> 0:14:36.240
<v Speaker 6>events would have a team of lavaty people to do

0:14:36.280 --> 0:14:38.960
<v Speaker 6>the cicosol screening, our counselors to do the you know

0:14:39.080 --> 0:14:41.360
<v Speaker 6>have councilor cert that people could understand what it means

0:14:41.400 --> 0:14:43.720
<v Speaker 6>if you trade, what it means if you if you

0:14:43.800 --> 0:14:45.680
<v Speaker 6>have pico cell, and a lot of those things. And

0:14:45.920 --> 0:14:48.440
<v Speaker 6>after two years of this, our local meanings of Health

0:14:48.440 --> 0:14:53.200
<v Speaker 6>actually did accept and adopt this program. It's now been

0:14:53.440 --> 0:14:55.800
<v Speaker 6>rolled out and several health centers have these rapid co

0:14:55.880 --> 0:14:58.200
<v Speaker 6>celf testing kids and people know can be happy to

0:14:58.200 --> 0:15:01.200
<v Speaker 6>access the cicosol screen test whatever they are. So in Uganda,

0:15:01.240 --> 0:15:04.240
<v Speaker 6>we have a tribe called the Baganda. Tribe makes up

0:15:04.240 --> 0:15:07.040
<v Speaker 6>the biggest proportion of the population, but we did have

0:15:07.160 --> 0:15:09.440
<v Speaker 6>a local name for sicco cell. And this is not

0:15:09.480 --> 0:15:11.640
<v Speaker 6>only the Baganda, but most tribes in Uganda do not

0:15:11.720 --> 0:15:13.880
<v Speaker 6>actually do not actually have a local name for sco cell.

0:15:14.320 --> 0:15:16.320
<v Speaker 6>And the indicator for this means that if you don't

0:15:16.320 --> 0:15:17.720
<v Speaker 6>have the local name for something, it means you're not

0:15:17.720 --> 0:15:19.720
<v Speaker 6>talking about it. If you're not talking about it, then

0:15:19.800 --> 0:15:21.920
<v Speaker 6>then that explains all the stigma. So because people don't

0:15:21.920 --> 0:15:23.920
<v Speaker 6>talk about it is no name. But the biggest one

0:15:23.960 --> 0:15:25.760
<v Speaker 6>for me as the advocate is the fact that the

0:15:26.120 --> 0:15:28.240
<v Speaker 6>kingdom gave us a local name for sico cell. They

0:15:28.280 --> 0:15:31.000
<v Speaker 6>did say, now we pronounced that sico salling that we

0:15:31.120 --> 0:15:35.040
<v Speaker 6>just called Umbili. At least now somebody who's uneducated, somebody

0:15:35.040 --> 0:15:38.000
<v Speaker 6>who had never been to school, can have a word

0:15:38.080 --> 0:15:40.600
<v Speaker 6>that they can not to mean sico Cell, and that

0:15:40.680 --> 0:15:42.920
<v Speaker 6>in a way helps us beat the stigma because then

0:15:43.040 --> 0:15:45.240
<v Speaker 6>people can be able to talk about.

0:15:45.200 --> 0:15:46.000
<v Speaker 4>Their mother town.

0:15:47.000 --> 0:15:49.560
<v Speaker 6>Looking back on how the genius come from the time

0:15:49.600 --> 0:15:52.840
<v Speaker 6>when we introduced communitis Coroso screening. From the time when

0:15:52.880 --> 0:15:55.120
<v Speaker 6>we have a local name to the fact that we have,

0:15:55.160 --> 0:15:57.080
<v Speaker 6>we have not been able to support the imaginence of

0:15:57.120 --> 0:15:59.280
<v Speaker 6>so many Pico so nonprofities. And for example, the time

0:15:59.320 --> 0:16:02.360
<v Speaker 6>when we sarted, there was only one nonprofit in Uganda

0:16:02.640 --> 0:16:05.840
<v Speaker 6>working on SIICO so called Circnstatation of Uganda. Today, as

0:16:05.840 --> 0:16:08.240
<v Speaker 6>I speak, seven years later, we have over twenty five

0:16:08.640 --> 0:16:12.400
<v Speaker 6>cb odds committey best organization all working.

0:16:12.080 --> 0:16:13.640
<v Speaker 4>To CICO selling local communities.

0:16:14.120 --> 0:16:17.560
<v Speaker 6>I think in twenty nineteen I decided know what I've been,

0:16:18.000 --> 0:16:19.680
<v Speaker 6>I've been an advocate for the past few years. I

0:16:19.680 --> 0:16:22.280
<v Speaker 6>think I need to think of something much engine that's

0:16:22.280 --> 0:16:24.400
<v Speaker 6>a I fund. I thought of coming back to grad school,

0:16:24.720 --> 0:16:26.280
<v Speaker 6>and I decided to come back to the US for

0:16:26.360 --> 0:16:27.280
<v Speaker 6>my grad schools.

0:16:27.280 --> 0:16:27.720
<v Speaker 4>I came back.

0:16:27.760 --> 0:16:30.640
<v Speaker 6>I went to the University of Caansas as a peach student.

0:16:31.600 --> 0:16:33.200
<v Speaker 6>When I came to the US, I was hearing a

0:16:33.240 --> 0:16:35.680
<v Speaker 6>lot of this thing of the raciore, the racial bias

0:16:35.720 --> 0:16:38.360
<v Speaker 6>in terms of Icosa, and it had actually never happened

0:16:38.360 --> 0:16:40.600
<v Speaker 6>to me until one time. I think it may I

0:16:40.640 --> 0:16:42.440
<v Speaker 6>go to the er. I had a lot of pain

0:16:42.480 --> 0:16:44.040
<v Speaker 6>in my I was actually very sick.

0:16:44.040 --> 0:16:44.840
<v Speaker 4>I had a lot of pain.

0:16:45.400 --> 0:16:46.920
<v Speaker 6>I spent the whole thing in the r they give

0:16:46.960 --> 0:16:48.240
<v Speaker 6>me all the pain made that I was still in pain.

0:16:48.480 --> 0:16:51.400
<v Speaker 6>But guess what happened to me? The er doctor says,

0:16:51.640 --> 0:16:53.800
<v Speaker 6>you're fine. We have checked everything very normal. So we

0:16:54.080 --> 0:16:56.760
<v Speaker 6>can admit to one of the kid driving factors in

0:16:56.840 --> 0:16:59.680
<v Speaker 6>terms of why even as advocates living in the US,

0:16:59.680 --> 0:17:02.440
<v Speaker 6>we need to come out and promote more awareness and

0:17:02.480 --> 0:17:05.400
<v Speaker 6>boscle soucers that the doctors would have a more understanding.

0:17:05.520 --> 0:17:07.399
<v Speaker 4>I think one of the key in wantant aspects.

0:17:07.840 --> 0:17:09.480
<v Speaker 6>It's not it may not be so much of a

0:17:09.480 --> 0:17:10.919
<v Speaker 6>big deal in the US, but it's the big deal

0:17:11.040 --> 0:17:13.119
<v Speaker 6>is where in the world That part whereby people not

0:17:13.320 --> 0:17:16.960
<v Speaker 6>understanding and accepting scle celf having all these meats and beliefs.

0:17:16.960 --> 0:17:19.960
<v Speaker 6>So it still goes back to awareness people and having

0:17:20.119 --> 0:17:22.800
<v Speaker 6>understand that this is like any other blood disease. If

0:17:22.840 --> 0:17:24.679
<v Speaker 6>you can take good care of yourself, if you can

0:17:24.720 --> 0:17:26.720
<v Speaker 6>have a comprehence you follow up, if you can do

0:17:26.760 --> 0:17:29.199
<v Speaker 6>whatever we can do to stay healthy, then I can

0:17:29.320 --> 0:17:31.600
<v Speaker 6>leave like any anybody else. I shouldn't worry about death.

0:17:31.600 --> 0:17:33.720
<v Speaker 6>I shouldn't worry that will not be able to meet

0:17:33.720 --> 0:17:37.800
<v Speaker 6>my dreams. My story started out because of a heat break,

0:17:37.920 --> 0:17:40.239
<v Speaker 6>because of the love sad love story ended up being

0:17:40.280 --> 0:17:42.520
<v Speaker 6>a sipo's advocate today. I was able to find love,

0:17:43.400 --> 0:17:46.800
<v Speaker 6>married to Sophia and have two kids, Kneeman Shet, and

0:17:46.880 --> 0:17:48.960
<v Speaker 6>they're part of my support system to keep me healthy

0:17:48.960 --> 0:17:52.320
<v Speaker 6>and strong and going. So I appreciate them and everyone

0:17:52.320 --> 0:17:53.199
<v Speaker 6>who's supporting me.

0:17:53.359 --> 0:18:31.879
<v Speaker 7>Thank you.

0:18:37.840 --> 0:18:40.919
<v Speaker 8>Thank you so much Marcia and Shurie for sharing your

0:18:40.960 --> 0:18:44.520
<v Speaker 8>stories with us. We really really appreciate it and we

0:18:44.560 --> 0:18:47.840
<v Speaker 8>want to tell you a bit more about our amazing guests.

0:18:48.400 --> 0:18:50.800
<v Speaker 8>Marcia started her blog My Life was Sickle Cell in

0:18:50.840 --> 0:18:54.120
<v Speaker 8>twenty sixteen and has since been recognized for her awareness

0:18:54.200 --> 0:18:58.480
<v Speaker 8>raising efforts by appearing on TV programs, radio shows, newspapers,

0:18:58.640 --> 0:19:01.320
<v Speaker 8>you name it. And in her first hand she mentioned

0:19:01.359 --> 0:19:03.840
<v Speaker 8>being a member of the BE Positive Choir, which is

0:19:03.880 --> 0:19:06.359
<v Speaker 8>a choir made up of people with sickle cell disease

0:19:06.560 --> 0:19:09.879
<v Speaker 8>or those who have friends or family members affected and

0:19:09.920 --> 0:19:13.000
<v Speaker 8>the B Positive Choir has made amazing strides in raising

0:19:13.040 --> 0:19:16.399
<v Speaker 8>awareness of sickle cell disease as well as encouraging blood

0:19:16.400 --> 0:19:20.119
<v Speaker 8>donations and also, as you heard, they were on Britain

0:19:20.119 --> 0:19:23.520
<v Speaker 8>Scott Talent and performed in front of the Royal Family,

0:19:23.560 --> 0:19:24.960
<v Speaker 8>which is pretty dang cool.

0:19:26.119 --> 0:19:31.360
<v Speaker 9>That's amazing. Our other incredible guest, Sharif, has been instrumental

0:19:31.440 --> 0:19:34.600
<v Speaker 9>in a number of different advocacy and outreach efforts which

0:19:34.600 --> 0:19:37.359
<v Speaker 9>you heard a bit about in his first hand including

0:19:37.720 --> 0:19:41.159
<v Speaker 9>launching the East Africa Sickle Cell Alliance, working with the

0:19:41.240 --> 0:19:45.359
<v Speaker 9>Pan African Sickle Cell Federation International, and serving as the

0:19:45.400 --> 0:19:48.920
<v Speaker 9>first executive director of the Uganda Sickle Cell Rescue Foundation.

0:19:49.320 --> 0:19:51.200
<v Speaker 8>That's incredible, so amazing.

0:19:51.600 --> 0:19:55.520
<v Speaker 9>Sharif's amazing advocacy and outreach efforts have been recognized by

0:19:55.560 --> 0:19:59.719
<v Speaker 9>many organizations. In twenty seventeen, he was named Amandela Washington

0:19:59.720 --> 0:20:03.280
<v Speaker 9>Fellat through the Young African Leaders Initiative. In twenty eighteen,

0:20:03.359 --> 0:20:06.800
<v Speaker 9>he became a Telemachus Fellow under the Global Thinkers Forum,

0:20:06.920 --> 0:20:10.320
<v Speaker 9>and this year twenty twenty, he was named the International

0:20:10.359 --> 0:20:12.640
<v Speaker 9>Sickle Cell Advocate of the Year.

0:20:13.240 --> 0:20:14.920
<v Speaker 8>No big deal, No big deal.

0:20:15.680 --> 0:20:19.440
<v Speaker 9>Oh and he's just casually also getting his PhD studying

0:20:19.480 --> 0:20:22.560
<v Speaker 9>quantitative genetics at the University of Kansas, just like.

0:20:22.600 --> 0:20:28.240
<v Speaker 8>Casually casually getting a major degree. Right, Oh my goodness,

0:20:28.520 --> 0:20:31.800
<v Speaker 8>that's amazing. We will provide links to both Marsha and

0:20:31.840 --> 0:20:34.919
<v Speaker 8>Shreef's websites and social media handles on our website this

0:20:34.960 --> 0:20:37.200
<v Speaker 8>Podcast will Kill You dot com and in our show

0:20:37.200 --> 0:20:39.520
<v Speaker 8>notes if you'd like to learn more about these awesome

0:20:39.600 --> 0:20:40.639
<v Speaker 8>humans and their work.

0:20:41.040 --> 0:20:41.280
<v Speaker 9>Yeah.

0:20:42.200 --> 0:20:46.440
<v Speaker 8>Hi, I'm Aaron Welsh and I'm Erin Olman Updyke, and

0:20:46.480 --> 0:20:50.240
<v Speaker 8>this is this podcast will Kill You. This week we are,

0:20:50.359 --> 0:20:51.320
<v Speaker 8>as you may have guessed.

0:20:51.440 --> 0:20:54.879
<v Speaker 9>You might have figured it out by now covering sickle

0:20:54.920 --> 0:20:58.440
<v Speaker 9>cell disease. Yeah, this is a big one.

0:20:58.960 --> 0:21:02.880
<v Speaker 8>Obviously, this is a huge one. And we've been wanting

0:21:02.920 --> 0:21:05.720
<v Speaker 8>to do this one for a while and I'm very

0:21:05.960 --> 0:21:09.680
<v Speaker 8>excited now that we're finally doing it because there's so much.

0:21:09.760 --> 0:21:10.800
<v Speaker 8>There's so much to it.

0:21:11.080 --> 0:21:15.359
<v Speaker 9>Yeah. Absolutely, there's such fascinating biology. I can't wait to

0:21:15.440 --> 0:21:17.119
<v Speaker 9>learn about the history. I have a feeling it's going

0:21:17.200 --> 0:21:21.280
<v Speaker 9>to be equal parts fascinating and infuriating. That's my guess.

0:21:21.560 --> 0:21:24.399
<v Speaker 8>Oh why would say maybe not even equal parts? I

0:21:24.440 --> 0:21:28.280
<v Speaker 8>would say, oh, mostly infuriating. Yeah awesome. Okay, there are

0:21:28.359 --> 0:21:32.280
<v Speaker 8>some like you know, shining moments, but yeah, oh.

0:21:32.280 --> 0:21:34.800
<v Speaker 9>But I can tell you that there are some very

0:21:34.880 --> 0:21:37.760
<v Speaker 9>exciting things to talk about in the current events section,

0:21:38.440 --> 0:21:41.399
<v Speaker 9>for which we had the pleasure of speaking with a

0:21:41.480 --> 0:21:46.800
<v Speaker 9>very special guest, doctor Meghan Hawkstrasser, whose education programs manager

0:21:46.840 --> 0:21:49.200
<v Speaker 9>at Innovative Genomics Institute in Berkeley.

0:21:50.320 --> 0:21:53.639
<v Speaker 8>It's incredible. I'm sure that you may have heard the

0:21:53.680 --> 0:21:58.280
<v Speaker 8>word crisper or genome editing at some point and been like,

0:21:58.320 --> 0:22:01.280
<v Speaker 8>what the heck is that. Don't worry, We're going to

0:22:01.640 --> 0:22:04.440
<v Speaker 8>get into it at least a little bit, and it's

0:22:04.480 --> 0:22:07.520
<v Speaker 8>going to make you so thrilled and make you feel

0:22:07.560 --> 0:22:08.880
<v Speaker 8>like you're living in the future.

0:22:09.320 --> 0:22:12.040
<v Speaker 9>It's thrilling. But before we get into all of the

0:22:12.080 --> 0:22:14.160
<v Speaker 9>thrilling things that we're going to talk about today, erin

0:22:14.480 --> 0:22:15.360
<v Speaker 9>what time is it?

0:22:15.680 --> 0:22:18.760
<v Speaker 8>I believe aarin that it is quarantine any time.

0:22:19.320 --> 0:22:22.960
<v Speaker 9>You would be correct about that. What are we drinking today?

0:22:23.520 --> 0:22:28.399
<v Speaker 8>We are drinking the Witten lovely. Oh yes, And the

0:22:28.440 --> 0:22:33.080
<v Speaker 8>Witten is named for doctor Charles Witten, who, among many

0:22:33.119 --> 0:22:37.240
<v Speaker 8>other amazing accomplishments, was the co founder of the Sickle

0:22:37.280 --> 0:22:41.879
<v Speaker 8>Cell Disease Association of America, and he made amazing strides

0:22:41.960 --> 0:22:45.240
<v Speaker 8>in raising awareness of sickle cell throughout the seventies and

0:22:45.320 --> 0:22:48.800
<v Speaker 8>eighties and into the nineties as well. And he also

0:22:49.119 --> 0:22:53.320
<v Speaker 8>initiated a lot of programs that were designed to provide

0:22:53.359 --> 0:22:57.200
<v Speaker 8>more opportunities for those underrepresented in medical fields to actually

0:22:57.240 --> 0:23:00.600
<v Speaker 8>have medical school as an opportunity. So we wanted to

0:23:00.960 --> 0:23:04.320
<v Speaker 8>name our quarantini in the to honor this amazing human

0:23:04.440 --> 0:23:06.120
<v Speaker 8>in the tiniest possible way.

0:23:07.880 --> 0:23:09.000
<v Speaker 9>And to do so.

0:23:09.560 --> 0:23:15.359
<v Speaker 10>What is in this quarantini exactly the witten is strawberry

0:23:15.359 --> 0:23:19.600
<v Speaker 10>infused tequila, which is so good and also just really

0:23:19.640 --> 0:23:20.159
<v Speaker 10>easy to do.

0:23:20.640 --> 0:23:24.960
<v Speaker 8>Just takes patience and lime juice and agave syrup.

0:23:25.359 --> 0:23:28.560
<v Speaker 9>Fabulous. We'll post the full recipe for that quarantini as

0:23:28.560 --> 0:23:31.720
<v Speaker 9>well as our non alcoholic plus e verta on our website.

0:23:31.720 --> 0:23:33.960
<v Speaker 9>This podcast would kill you dot Com and all of

0:23:34.000 --> 0:23:36.760
<v Speaker 9>our social media channels, so make sure you're following us.

0:23:37.240 --> 0:23:40.280
<v Speaker 8>And we have one more piece of business before we

0:23:40.359 --> 0:23:44.800
<v Speaker 8>get into the business of sickle Cell, just.

0:23:44.720 --> 0:23:47.440
<v Speaker 9>A little one, which is a big news.

0:23:47.720 --> 0:23:52.280
<v Speaker 8>Actually we have new merch, new merch.

0:23:52.600 --> 0:23:55.040
<v Speaker 9>We've been waiting. We're so excited.

0:23:55.359 --> 0:23:58.159
<v Speaker 8>We have some really fun cool things, like we'll just

0:23:58.240 --> 0:24:00.720
<v Speaker 8>drop a few little hints. You want a hoodie, We

0:24:00.800 --> 0:24:01.399
<v Speaker 8>got a hoodie.

0:24:01.480 --> 0:24:05.920
<v Speaker 10>Oh, we got some socks, keep your toes warm.

0:24:07.080 --> 0:24:10.760
<v Speaker 8>Big shout out to Abigail Irvin Penner, who's always incredible

0:24:10.840 --> 0:24:13.879
<v Speaker 8>artwork is featured on so many of these Honestly, like

0:24:14.080 --> 0:24:15.240
<v Speaker 8>I'm I'm in love.

0:24:15.440 --> 0:24:18.760
<v Speaker 9>I can't wait to be tpwky head to toe baby,

0:24:18.960 --> 0:24:21.960
<v Speaker 9>I mean literally head to toe and for my SIPs.

0:24:22.359 --> 0:24:26.280
<v Speaker 8>Yeah. Okay, if you would like to see this new merch,

0:24:26.720 --> 0:24:28.960
<v Speaker 8>you can head to this podcast will Kill You dot

0:24:29.000 --> 0:24:31.240
<v Speaker 8>com and click on the merch tab at the top

0:24:31.240 --> 0:24:31.720
<v Speaker 8>of the screen.

0:24:32.240 --> 0:24:34.080
<v Speaker 9>All right, is that all our business eron?

0:24:34.400 --> 0:24:35.320
<v Speaker 8>I believe so.

0:24:35.880 --> 0:24:38.560
<v Speaker 9>Well, then let's take a quick break and dive straight

0:24:38.600 --> 0:24:40.240
<v Speaker 9>into the biology.

0:24:39.680 --> 0:24:41.880
<v Speaker 8>Of sickle cell let's do it.

0:25:03.760 --> 0:25:09.360
<v Speaker 9>So, sickle cell disease or sc D. I think it's

0:25:09.440 --> 0:25:14.000
<v Speaker 9>often taught as sickle cell anemia, right, this like one

0:25:14.119 --> 0:25:17.760
<v Speaker 9>particular illness, but in fact, sickle cell disease is a

0:25:17.840 --> 0:25:23.040
<v Speaker 9>group of disorders of red blood cells, and it's a

0:25:23.080 --> 0:25:27.040
<v Speaker 9>genetic disease, which means it's inherited, so it's caused by

0:25:27.240 --> 0:25:30.400
<v Speaker 9>a mutation. But as we'll see, it's not just one

0:25:30.440 --> 0:25:34.959
<v Speaker 9>single mutation, and there's not just one single manifestation. So

0:25:35.000 --> 0:25:37.760
<v Speaker 9>we're going to start from the very beginning before we

0:25:37.840 --> 0:25:41.840
<v Speaker 9>even get into sickle cell disease itself and talk about blood.

0:25:42.359 --> 0:25:42.639
<v Speaker 4>Cool.

0:25:43.200 --> 0:25:46.320
<v Speaker 8>Yes, okay, we've talked about blood before a little bit.

0:25:46.440 --> 0:25:50.280
<v Speaker 9>We have, but we've never talked about this.

0:25:52.280 --> 0:25:55.240
<v Speaker 8>We have talked about when we talked about blood hepatitis.

0:25:55.280 --> 0:25:56.040
<v Speaker 8>C Oh.

0:25:56.119 --> 0:26:00.600
<v Speaker 9>Yeah, this is a totally different blood discussion. Okay, okay,

0:26:01.240 --> 0:26:04.719
<v Speaker 9>So what we're going to talk specifically about is in

0:26:04.760 --> 0:26:09.240
<v Speaker 9>our red blood cells, the protein that is actually responsible

0:26:09.280 --> 0:26:14.959
<v Speaker 9>for carrying oxygen, and that protein is hemoglobin. Okay. So,

0:26:15.160 --> 0:26:19.399
<v Speaker 9>hemoglobin is a protein that's made up of four polypeptides,

0:26:19.680 --> 0:26:24.920
<v Speaker 9>two pairs of polypeptides, and these four polypeptides or strings

0:26:24.960 --> 0:26:29.000
<v Speaker 9>of amino acids form the protein that's in our red

0:26:29.040 --> 0:26:33.120
<v Speaker 9>blood cells that actually carries oxygen, which obviously our tissues

0:26:33.200 --> 0:26:38.520
<v Speaker 9>need in order to survive. So in most adult red

0:26:38.560 --> 0:26:44.719
<v Speaker 9>blood cells, hemoglobin is made up of two alpha chains alphas,

0:26:45.320 --> 0:26:49.480
<v Speaker 9>and two beta chains. So alpha, alpha, beta, beta, Okay,

0:26:50.400 --> 0:26:54.360
<v Speaker 9>sounds good. Now, we also have some other forms of hemoglobin,

0:26:54.800 --> 0:26:58.400
<v Speaker 9>like you can have two alpha chains and two delta chains.

0:26:58.600 --> 0:27:03.199
<v Speaker 9>That's another kind of adult hemoglobin. And then in a

0:27:03.320 --> 0:27:08.520
<v Speaker 9>fetus before we are born, the majority of our hemoglobin

0:27:08.640 --> 0:27:12.280
<v Speaker 9>is actually two alpha chains and two gamma chains, and

0:27:12.320 --> 0:27:18.240
<v Speaker 9>that's called fetal hemoglobin. Why great questions, So glad you asked.

0:27:19.040 --> 0:27:23.520
<v Speaker 9>So you know how fetuses are grown inside and all

0:27:23.560 --> 0:27:27.240
<v Speaker 9>of their blood comes from mom right, So that means

0:27:27.240 --> 0:27:29.040
<v Speaker 9>that all of the blood that a fetus is getting

0:27:29.080 --> 0:27:33.320
<v Speaker 9>is already partially deoxygenated. It doesn't have as much oxygen

0:27:33.440 --> 0:27:37.240
<v Speaker 9>as the blood in our bloodstream because we're breathing in air.

0:27:38.240 --> 0:27:42.040
<v Speaker 9>So because of that, fetal hemoglobin has to actually bind

0:27:42.200 --> 0:27:46.639
<v Speaker 9>oxygen more tightly than adult hemoglobin because it has to

0:27:46.680 --> 0:27:48.879
<v Speaker 9>be able to get all of that oxygen out of

0:27:48.920 --> 0:27:53.520
<v Speaker 9>mom's blood. Does that make sense? Okay? Now remember that

0:27:53.720 --> 0:27:56.760
<v Speaker 9>because it's going to become very important in our discussion

0:27:56.760 --> 0:28:02.080
<v Speaker 9>of sickle cell later. Okay, Okay, So now we understand

0:28:02.200 --> 0:28:06.880
<v Speaker 9>hemoglobin inside normal adult red blood cells. So what does

0:28:06.920 --> 0:28:09.040
<v Speaker 9>that mean for sickle cell disease? Why did I tell

0:28:09.040 --> 0:28:09.320
<v Speaker 9>you all?

0:28:09.320 --> 0:28:09.520
<v Speaker 3>That?

0:28:09.880 --> 0:28:15.280
<v Speaker 9>Turns out that sickle cell disease is produced by a

0:28:15.359 --> 0:28:21.320
<v Speaker 9>single amino acid change if anyone cares, it's a glutamic

0:28:21.359 --> 0:28:27.640
<v Speaker 9>acid to a vailian that in that beta hemoglobin chain. Okay,

0:28:27.920 --> 0:28:33.640
<v Speaker 9>So it's a single mutation in beta hemoglobin that results

0:28:33.680 --> 0:28:39.240
<v Speaker 9>in what's called like sickled beta hemoglobin, so hbs instead

0:28:39.280 --> 0:28:43.600
<v Speaker 9>of hb A for adult. That is the change that

0:28:43.800 --> 0:28:48.520
<v Speaker 9>if you have two copies of that mutated beta globin gene,

0:28:48.920 --> 0:28:54.160
<v Speaker 9>you have sickle cell anemia, the disease caused by two

0:28:54.280 --> 0:28:58.760
<v Speaker 9>copies of these sickle cell genes. So what happens if

0:28:58.760 --> 0:29:04.880
<v Speaker 9>you have these sickle cell versions of beta hemoglobin, Well,

0:29:05.560 --> 0:29:09.880
<v Speaker 9>what happens is that in your red blood cells at

0:29:09.960 --> 0:29:15.720
<v Speaker 9>low oxygen concentrations, like low overall oxygen concentrations in your blood,

0:29:16.440 --> 0:29:22.720
<v Speaker 9>the hemoglobin forms a polymer. So multiple subunits, like multiple

0:29:22.760 --> 0:29:27.440
<v Speaker 9>little globules of hemoglobin protein will link together inside the

0:29:27.480 --> 0:29:30.760
<v Speaker 9>red blood cell and form a linear chain.

0:29:30.800 --> 0:29:32.440
<v Speaker 8>Like a little string of beads, like.

0:29:32.440 --> 0:29:36.080
<v Speaker 9>A little string of beads exactly. And this becomes rigid

0:29:36.520 --> 0:29:40.080
<v Speaker 9>and causes a deformation in the whole red blood cell

0:29:40.320 --> 0:29:42.360
<v Speaker 9>so that it kind of sucks in on itself and

0:29:42.400 --> 0:29:46.960
<v Speaker 9>becomes sickle shaped or like a crescent moon shaped. So

0:29:47.240 --> 0:29:50.680
<v Speaker 9>a normal adult red blood cell, even a fetal red

0:29:50.680 --> 0:29:53.880
<v Speaker 9>blood cell, is shaped kind of like a doughnut, like

0:29:54.680 --> 0:29:56.960
<v Speaker 9>the you know the things you go down the lazy

0:29:57.000 --> 0:30:00.360
<v Speaker 9>river in those like inflatable tubes with like the in

0:30:00.360 --> 0:30:02.000
<v Speaker 9>the middle so your butt doesn't fall through.

0:30:02.640 --> 0:30:05.360
<v Speaker 8>Oh, I've never had one that had the mesh, but sure.

0:30:05.200 --> 0:30:07.840
<v Speaker 9>The fancy version. Okay, So that's kind of what a

0:30:07.880 --> 0:30:10.720
<v Speaker 9>normal red blood cell looks like. So when you have

0:30:11.160 --> 0:30:14.960
<v Speaker 9>two copies of this sickle cell beta hemoglobin gene, all

0:30:15.000 --> 0:30:18.120
<v Speaker 9>of your hemoglobins line up in the red blood cell

0:30:18.240 --> 0:30:21.560
<v Speaker 9>and cicicle it so instead of that nice donut, you

0:30:21.680 --> 0:30:25.120
<v Speaker 9>have a C shaped red blood cell. And that is

0:30:25.240 --> 0:30:31.920
<v Speaker 9>kind of the core problem that results from two copies

0:30:32.000 --> 0:30:36.080
<v Speaker 9>of this sickle cell gene. But how is that like? Okay,

0:30:36.120 --> 0:30:38.480
<v Speaker 9>it's just a different shape of your red blood cell.

0:30:38.480 --> 0:30:42.280
<v Speaker 9>Why is that so bad? So these sickled cells are

0:30:42.440 --> 0:30:45.800
<v Speaker 9>very rigid, okay. Normal red blood cells are kind of

0:30:46.360 --> 0:30:50.560
<v Speaker 9>like an inflatable donut. They're kind of squishy and squashy, okay,

0:30:51.040 --> 0:30:54.440
<v Speaker 9>So as they move through your blood vessels through from

0:30:54.560 --> 0:30:57.560
<v Speaker 9>larger vessels to smaller vessels like your capillaries, they can

0:30:57.600 --> 0:31:01.440
<v Speaker 9>squash and deform and scoot through small vessels and then

0:31:01.520 --> 0:31:05.040
<v Speaker 9>pop back out on the other side. Sickled cells are

0:31:05.040 --> 0:31:08.640
<v Speaker 9>more rigid, so they can't do that as well. So

0:31:08.800 --> 0:31:11.840
<v Speaker 9>what happens is these cells can start to get stuck,

0:31:12.080 --> 0:31:18.120
<v Speaker 9>especially in small vessels. Okay, but it's not just the

0:31:18.240 --> 0:31:24.400
<v Speaker 9>rigidness of the sickled red blood cells. So it turns

0:31:24.440 --> 0:31:27.080
<v Speaker 9>out that once a red blood cell sickles like this,

0:31:27.440 --> 0:31:31.800
<v Speaker 9>they're also literally stickier, like proteins on the outside of

0:31:31.840 --> 0:31:35.920
<v Speaker 9>them become more sticky, so that they get stuck to

0:31:36.000 --> 0:31:40.440
<v Speaker 9>the walls of your vessels, and they get stuck to

0:31:40.760 --> 0:31:43.880
<v Speaker 9>other like white blood cells and things that are rolling

0:31:43.960 --> 0:31:48.360
<v Speaker 9>along in your vessels. Okay, and imagine what happens if

0:31:48.400 --> 0:31:51.160
<v Speaker 9>you have a bunch of cells starting to stick to

0:31:51.200 --> 0:31:52.640
<v Speaker 9>one another inside of your.

0:31:52.560 --> 0:31:54.600
<v Speaker 8>Blood vessels, or you get a blood clot.

0:31:54.680 --> 0:31:57.360
<v Speaker 9>You're gonna get a blood clot exactly, and so kind

0:31:57.400 --> 0:32:01.200
<v Speaker 9>of the hallmark of sickle cells that we'll talk a

0:32:01.240 --> 0:32:02.960
<v Speaker 9>little bit more about in a minute when we talk

0:32:02.960 --> 0:32:07.120
<v Speaker 9>about the symptoms are what's called vasoeclusive crises. So you

0:32:07.240 --> 0:32:12.280
<v Speaker 9>literally have occlusion or blockage of your vessels small vessels

0:32:12.320 --> 0:32:16.000
<v Speaker 9>like capillaries, but even larger vessels like in your brain,

0:32:16.200 --> 0:32:17.000
<v Speaker 9>leading to stroke.

0:32:17.520 --> 0:32:19.000
<v Speaker 8>That sounds terrible.

0:32:19.400 --> 0:32:24.080
<v Speaker 9>It's not great, that's for sure. And there's more. Okay,

0:32:24.320 --> 0:32:26.800
<v Speaker 9>So now we know that these sickled cells, they get

0:32:26.800 --> 0:32:29.200
<v Speaker 9>more sticky, they can get stuck in places. But on

0:32:29.240 --> 0:32:33.040
<v Speaker 9>top of that, so red blood cells only sickle at

0:32:33.120 --> 0:32:37.040
<v Speaker 9>lower oxygen concentrations. Okay, So for the most part, in

0:32:37.080 --> 0:32:40.440
<v Speaker 9>your arteries, even if you have sickle cell disease, your

0:32:40.440 --> 0:32:42.320
<v Speaker 9>red blood cells are going to be in normal shape.

0:32:42.520 --> 0:32:45.480
<v Speaker 9>It's not until you reach the capillaries or the veins

0:32:45.560 --> 0:32:50.920
<v Speaker 9>where oxygen concentration is lower that these the hemoglobin will

0:32:50.960 --> 0:32:53.680
<v Speaker 9>form those chains and then cause the red blood cell

0:32:53.760 --> 0:32:57.480
<v Speaker 9>to sickle. But this is reversible, but there's two problems

0:32:57.520 --> 0:33:00.760
<v Speaker 9>with it. First of all, this tends to happen in

0:33:01.160 --> 0:33:06.160
<v Speaker 9>microvessels like your capillaries and small veins, because that's where

0:33:06.880 --> 0:33:13.280
<v Speaker 9>both oxygen concentration is low and you have slow flow,

0:33:13.720 --> 0:33:16.120
<v Speaker 9>so the red blood cells in there for a long

0:33:16.520 --> 0:33:20.880
<v Speaker 9>time comparatively, and so those two things combined lead to sickling.

0:33:21.600 --> 0:33:24.880
<v Speaker 9>And in small vessels, if you sickle and you get stuck,

0:33:25.040 --> 0:33:27.320
<v Speaker 9>then you can block those small vessels directly.

0:33:27.680 --> 0:33:28.080
<v Speaker 8>Gotcha.

0:33:28.560 --> 0:33:34.240
<v Speaker 9>Now, another thing happens over time, this constant sickling and unsickling.

0:33:34.440 --> 0:33:38.160
<v Speaker 9>Sickling and unsickling causes damage to the red blood cell

0:33:38.200 --> 0:33:41.120
<v Speaker 9>membrane itself, so like the outer shell of the red

0:33:41.120 --> 0:33:45.640
<v Speaker 9>blood cell, and this can cause an irreversible sickling. So

0:33:45.720 --> 0:33:48.960
<v Speaker 9>now it's just stuck sickled all the time. And those

0:33:49.200 --> 0:33:53.840
<v Speaker 9>sickled cells in particular are very very sticky, so that

0:33:53.880 --> 0:33:57.200
<v Speaker 9>can cause sticking on the inside of vessel walls. And

0:33:57.400 --> 0:34:00.680
<v Speaker 9>to white blood cells in larger vessels, which can eventually

0:34:00.840 --> 0:34:04.680
<v Speaker 9>lead to blockage of even larger vessels, not just small ones.

0:34:05.160 --> 0:34:07.920
<v Speaker 8>Right, and it seems like the white blood cell thing

0:34:08.160 --> 0:34:10.920
<v Speaker 8>then will play a role in immune system function.

0:34:11.120 --> 0:34:15.480
<v Speaker 9>Oh, you're so accurate, Aerin, here's a question.

0:34:15.680 --> 0:34:19.000
<v Speaker 8>Yeah, and maybe it's jumping the gun, but your body,

0:34:19.840 --> 0:34:22.120
<v Speaker 8>as we talked about in the hepatitis C episode, your

0:34:22.120 --> 0:34:25.720
<v Speaker 8>body makes a lot, like makes new red blood cells

0:34:26.080 --> 0:34:30.879
<v Speaker 8>very frequently, and so what does it do, like does

0:34:30.920 --> 0:34:34.400
<v Speaker 8>it attack the sickled cells in any way, or like

0:34:34.560 --> 0:34:35.799
<v Speaker 8>what is their lifespan?

0:34:36.320 --> 0:34:38.319
<v Speaker 9>I'm so glad that you asked, Aaron. It's totally jumping

0:34:38.400 --> 0:34:40.040
<v Speaker 9>the gun, but it's the perfect question.

0:34:40.719 --> 0:34:41.279
<v Speaker 8>I love it.

0:34:41.600 --> 0:34:44.759
<v Speaker 9>So yeah, okay, I'm going to answer that question in

0:34:44.800 --> 0:34:47.480
<v Speaker 9>a couple parts. Okay, So, first of all, you're right

0:34:47.560 --> 0:34:49.759
<v Speaker 9>that white blood cells and things play a big role.

0:34:49.840 --> 0:34:53.520
<v Speaker 9>And overall, even though this is technically a disease of

0:34:53.719 --> 0:34:56.680
<v Speaker 9>just red blood cells, right, it's just hemoglobe and being

0:34:56.719 --> 0:35:00.560
<v Speaker 9>messed up, it's not just a disease that affects your

0:35:00.560 --> 0:35:04.440
<v Speaker 9>red blood cells. Overall, there's an increase in inflammation and

0:35:04.560 --> 0:35:10.040
<v Speaker 9>inflammatory state in sickle cell disease and the more inflammation.

0:35:10.160 --> 0:35:13.520
<v Speaker 9>So the higher people's leukocyte counts or white blood cell counts,

0:35:13.880 --> 0:35:16.680
<v Speaker 9>the worse off their disease tends to be. And as

0:35:16.760 --> 0:35:20.080
<v Speaker 9>we'll see, there's huge variation in disease severity, and that's

0:35:20.160 --> 0:35:23.279
<v Speaker 9>one factor that plays a role. Now in terms of

0:35:23.320 --> 0:35:26.160
<v Speaker 9>how long these blood cells last, that's a perfect question

0:35:26.239 --> 0:35:29.680
<v Speaker 9>to ask. A normal, healthy red blood cell has a

0:35:29.719 --> 0:35:32.840
<v Speaker 9>lifespan of about one hundred and twenty days. In someone

0:35:32.880 --> 0:35:35.959
<v Speaker 9>with sickle cell disease, that lifespan is reduced by over

0:35:36.040 --> 0:35:39.839
<v Speaker 9>seventy five percent. So some estimates that I saw were

0:35:39.840 --> 0:35:41.880
<v Speaker 9>the life span of a red blood cell in a

0:35:41.920 --> 0:35:45.040
<v Speaker 9>person with sickle cell disease, so that's two copies of

0:35:45.040 --> 0:35:47.840
<v Speaker 9>that sickle cell gene is about sixteen days.

0:35:48.600 --> 0:35:53.800
<v Speaker 8>Oh wow. And so even if your body is producing blood,

0:35:53.920 --> 0:35:57.000
<v Speaker 8>it's not enough to make up for the loss.

0:35:57.120 --> 0:36:01.959
<v Speaker 9>Oh you're getting the perfect yes, hundred percent. So there's

0:36:02.040 --> 0:36:04.280
<v Speaker 9>two ways that you get anemia. One, like you said,

0:36:04.320 --> 0:36:08.440
<v Speaker 9>you just can't make enough because you need to constantly

0:36:08.480 --> 0:36:10.880
<v Speaker 9>make more red blood cells and more red blood cells.

0:36:10.960 --> 0:36:13.680
<v Speaker 9>But on top of that, as those cells sickle and

0:36:13.760 --> 0:36:17.960
<v Speaker 9>unsickle and become damaged, that leads to hemolysis. So red

0:36:18.000 --> 0:36:22.520
<v Speaker 9>blood cells actually breaking open within your vasculature. So not

0:36:22.600 --> 0:36:26.000
<v Speaker 9>only can you have anemia from lack of production, you

0:36:26.040 --> 0:36:29.680
<v Speaker 9>can also have a hemolytic anemia. So breaking open those

0:36:29.719 --> 0:36:34.279
<v Speaker 9>red blood cells, now, that leads to even more problems

0:36:34.560 --> 0:36:37.480
<v Speaker 9>because when you burst open red blood cells, all that

0:36:37.520 --> 0:36:41.080
<v Speaker 9>hemoglobin that's inside those red blood cells is now released

0:36:41.080 --> 0:36:44.840
<v Speaker 9>into the blood stream, and this causes like a whole

0:36:45.040 --> 0:36:48.239
<v Speaker 9>host of biochemistry reactions I'm not going to get into,

0:36:48.320 --> 0:36:51.719
<v Speaker 9>but one thing that it does is it scavenges up

0:36:51.800 --> 0:36:55.120
<v Speaker 9>all of the nitric oxide, which is an important molecule

0:36:55.680 --> 0:37:00.799
<v Speaker 9>that helps with things like vasodilation. So as your hemoglobin

0:37:00.960 --> 0:37:04.720
<v Speaker 9>sucks up all that nitric oxide, now you have increased

0:37:04.800 --> 0:37:10.320
<v Speaker 9>vasoconstriction as well as damage to like the epithelium of

0:37:10.080 --> 0:37:14.600
<v Speaker 9>the lining of your blood vessels, which causes even more stickiness. Okay,

0:37:14.800 --> 0:37:19.080
<v Speaker 9>so it's like these horrible feedback loop, if that makes sense,

0:37:19.440 --> 0:37:23.240
<v Speaker 9>where you have smaller vessels because you have less nitric oxide,

0:37:23.760 --> 0:37:29.000
<v Speaker 9>you have damage to the inner layer, which increases the stickiness,

0:37:29.320 --> 0:37:32.680
<v Speaker 9>you have inflammation. So there's white blood cells rolling around

0:37:32.800 --> 0:37:37.360
<v Speaker 9>picking things up, and it's it's bad. It's a mess. Okay.

0:37:37.560 --> 0:37:42.000
<v Speaker 8>Yeah, that's like a from one, I mean no acid substitution.

0:37:42.960 --> 0:37:46.200
<v Speaker 8>This systemic these systemic problems.

0:37:46.320 --> 0:37:50.520
<v Speaker 9>Isn't that it's fascinating that you can have so many

0:37:50.560 --> 0:37:54.440
<v Speaker 9>effects from one single and I mean it's a single nucleotide.

0:37:54.440 --> 0:37:56.279
<v Speaker 9>It's a single base pair change.

0:37:56.120 --> 0:37:59.800
<v Speaker 8>Right right, It's wow, yeah, man.

0:38:00.200 --> 0:38:02.600
<v Speaker 9>Okay, So let's talk about what these symptoms then look like.

0:38:02.680 --> 0:38:05.200
<v Speaker 9>So now we know like what's happening in your blood vessels,

0:38:05.200 --> 0:38:07.920
<v Speaker 9>and it kind of all boils down to like increased

0:38:07.960 --> 0:38:13.520
<v Speaker 9>inflammation and blocking your vessels. Okay, so I said this already,

0:38:13.520 --> 0:38:18.279
<v Speaker 9>but the main complication are these vasoeclusive crises, and so

0:38:18.400 --> 0:38:21.560
<v Speaker 9>these can manifest, as you can probably imagine, in so

0:38:21.640 --> 0:38:25.360
<v Speaker 9>many different ways depending on what vessels are getting blocked up. Okay,

0:38:26.440 --> 0:38:29.920
<v Speaker 9>So in small children, especially tiny babies like under the

0:38:29.960 --> 0:38:35.759
<v Speaker 9>age of two, the most common presentation is when the

0:38:35.920 --> 0:38:39.239
<v Speaker 9>small blood vessels in their hands and feet get clogged up.

0:38:40.080 --> 0:38:43.799
<v Speaker 9>This causes swelling of the hands and the feet, and

0:38:43.840 --> 0:38:46.440
<v Speaker 9>this is really really painful as well, because you're literally

0:38:46.480 --> 0:38:50.000
<v Speaker 9>blocking blood flow to your hands and feet. And so

0:38:50.400 --> 0:38:55.040
<v Speaker 9>in small babies that for example, didn't have a newborn

0:38:55.080 --> 0:38:58.399
<v Speaker 9>screen done, so they didn't know their parents maybe didn't

0:38:58.440 --> 0:39:00.560
<v Speaker 9>know that they had sickle cell anemia. This is a

0:39:00.600 --> 0:39:03.200
<v Speaker 9>really common way that they would come into the emergency

0:39:03.239 --> 0:39:05.880
<v Speaker 9>room and be identified as having sickle cell anemia.

0:39:06.239 --> 0:39:09.480
<v Speaker 8>Okay, is there a treatment for that aspect of it

0:39:09.640 --> 0:39:10.080
<v Speaker 8>or is it?

0:39:11.000 --> 0:39:14.640
<v Speaker 9>So we'll talk about treatment more later, but for the

0:39:15.120 --> 0:39:22.840
<v Speaker 9>for the most part, not really Okay, yeah, God yeah, okay.

0:39:23.160 --> 0:39:26.480
<v Speaker 9>So then as you can imagine, as you get older,

0:39:27.040 --> 0:39:32.040
<v Speaker 9>these pain crises, these vasoeclusive crises, just kind of keep happening,

0:39:32.080 --> 0:39:37.200
<v Speaker 9>and they can happen almost anywhere. So it's very common

0:39:37.280 --> 0:39:40.640
<v Speaker 9>for people to come in with massive, massive amounts of

0:39:40.680 --> 0:39:45.160
<v Speaker 9>pain without any kind of you can't see anything wrong

0:39:45.200 --> 0:39:48.600
<v Speaker 9>with them because it's these tiny blood vessels in your

0:39:48.640 --> 0:39:53.080
<v Speaker 9>abdomen or your legs, in your arms, anywhere that get

0:39:53.160 --> 0:39:55.880
<v Speaker 9>clogged up. This causes a huge amount of pain. If

0:39:55.920 --> 0:39:59.840
<v Speaker 9>you imagine, like a heart attack happens when you have

0:40:00.200 --> 0:40:03.400
<v Speaker 9>a blockage of blood flow to your heart. Heart attacks

0:40:03.440 --> 0:40:07.440
<v Speaker 9>are extremely painful. This is happening in small vessels throughout

0:40:07.480 --> 0:40:11.560
<v Speaker 9>somebody's body during a sickle cell crisis. This is a

0:40:11.920 --> 0:40:16.440
<v Speaker 9>disease that is I think often very misunderstood, and the

0:40:17.560 --> 0:40:21.759
<v Speaker 9>pain I think can be minimized by people because it's

0:40:21.840 --> 0:40:24.399
<v Speaker 9>not visible it's another kind of disease, like we've talked

0:40:24.440 --> 0:40:29.400
<v Speaker 9>about before, where you don't look sick necessarily, and so

0:40:29.440 --> 0:40:31.799
<v Speaker 9>I think it's really important to get across just how

0:40:31.960 --> 0:40:35.239
<v Speaker 9>debilitating the pain associated with these can be.

0:40:36.360 --> 0:40:39.960
<v Speaker 8>It's funny that you're using the phrases invisible and visible,

0:40:40.040 --> 0:40:43.480
<v Speaker 8>because I that's like, that's my theme, and when I

0:40:43.520 --> 0:40:45.080
<v Speaker 8>talk about the history.

0:40:44.800 --> 0:40:49.560
<v Speaker 9>Of it, Yeah, yeah, it's really it's bad. Okay. So

0:40:49.680 --> 0:40:53.520
<v Speaker 9>then you also can have additional symptoms or sort of

0:40:53.560 --> 0:40:57.880
<v Speaker 9>more specific symptoms, depending on where you have these blockages.

0:40:59.239 --> 0:41:01.719
<v Speaker 9>It can happen in people that have a penis, it

0:41:01.840 --> 0:41:04.960
<v Speaker 9>can happen and you can get what's called priapism, which

0:41:05.000 --> 0:41:09.160
<v Speaker 9>is a long lasting and very painful erection. If it

0:41:09.239 --> 0:41:13.279
<v Speaker 9>happens in the blood vessels under your skin, especially in

0:41:13.320 --> 0:41:16.560
<v Speaker 9>your legs, which is really common, it can cause chronic ulcers,

0:41:16.760 --> 0:41:20.200
<v Speaker 9>so open wounds on your legs that are unable to

0:41:20.360 --> 0:41:23.279
<v Speaker 9>heal because they're not getting good blood flow over time.

0:41:24.400 --> 0:41:27.120
<v Speaker 9>If it happens in your eyes, it can lead to

0:41:27.200 --> 0:41:33.359
<v Speaker 9>blindness because the vessels in your retina become blocked. God,

0:41:33.960 --> 0:41:37.720
<v Speaker 9>it can happen in your bones, and this is very

0:41:37.760 --> 0:41:43.880
<v Speaker 9>serious because your bones are also alive. They need blood flow,

0:41:44.280 --> 0:41:47.120
<v Speaker 9>So when you block off the vessels to your bones,

0:41:47.160 --> 0:41:51.000
<v Speaker 9>you get what's called a vascular necrosis. So that means

0:41:51.360 --> 0:41:54.879
<v Speaker 9>tissue death because of lack of blood flow. So your

0:41:54.960 --> 0:41:59.480
<v Speaker 9>bone marrow will literally die. Oh my god, yep, So

0:41:59.480 --> 0:42:02.120
<v Speaker 9>that's pretty bad as you can imagine. That can also

0:42:02.280 --> 0:42:06.960
<v Speaker 9>lead you susceptible to like osteomyelitis, which is infection of

0:42:07.000 --> 0:42:10.800
<v Speaker 9>your bone, like a bacterial infection of your bone, because

0:42:10.800 --> 0:42:14.279
<v Speaker 9>you don't have good blood flow to that bone. It

0:42:14.320 --> 0:42:17.799
<v Speaker 9>can happen in your spleen, which is very common, and

0:42:17.840 --> 0:42:20.680
<v Speaker 9>with your spleen kind of two different things can happen,

0:42:21.120 --> 0:42:23.960
<v Speaker 9>so you can have like an what's called an acute

0:42:24.239 --> 0:42:29.040
<v Speaker 9>splenic crisis. So all of a sudden your spleen, like

0:42:29.040 --> 0:42:31.919
<v Speaker 9>blood flow to your spleen gets blocked. This can cause

0:42:31.960 --> 0:42:36.480
<v Speaker 9>your spleen to enlarge very rapidly, and that can kill you,

0:42:36.520 --> 0:42:41.520
<v Speaker 9>like right, that alone can kill you. Your spleen is

0:42:41.800 --> 0:42:45.040
<v Speaker 9>an organ where a ton of blood flows through it

0:42:45.280 --> 0:42:47.879
<v Speaker 9>because it's a lymphatic organ, so all of your white

0:42:47.880 --> 0:42:50.279
<v Speaker 9>blood cells kind of hang out in your spleen and

0:42:50.360 --> 0:42:54.600
<v Speaker 9>are responsible for like gobbling up bacteria and cleaning your bloodstream.

0:42:54.760 --> 0:42:59.560
<v Speaker 9>Of infection. Okay, so because it has such huge volumes

0:42:59.560 --> 0:43:02.880
<v Speaker 9>of blood, if you block that blood flow, then you

0:43:02.960 --> 0:43:07.440
<v Speaker 9>can die just from that alone. But it can also happen,

0:43:07.520 --> 0:43:11.160
<v Speaker 9>and it commonly does happen where over time, small vessels

0:43:11.239 --> 0:43:15.799
<v Speaker 9>get blocked little by little in your spleen, leading to

0:43:16.320 --> 0:43:20.680
<v Speaker 9>long term death of your spleen. What's called auto infection, right,

0:43:21.200 --> 0:43:23.760
<v Speaker 9>so that a person, even though they have a spleen

0:43:23.840 --> 0:43:27.279
<v Speaker 9>in their body, it's essentially non functional. It's like you

0:43:27.360 --> 0:43:32.200
<v Speaker 9>removed it. So that leaves you very susceptible to infection,

0:43:32.600 --> 0:43:35.680
<v Speaker 9>especially bacterial infections, because you don't have a spleen to

0:43:35.760 --> 0:43:39.320
<v Speaker 9>take care of all those bacteria. So it's very common

0:43:39.360 --> 0:43:44.560
<v Speaker 9>for people, especially young children, to die not from sickle

0:43:44.600 --> 0:43:47.799
<v Speaker 9>cell anemia or sickle cell disease itself, but from an

0:43:47.840 --> 0:43:54.040
<v Speaker 9>overwhelming bacterial infection because their spleen is nonfunctional. God, another

0:43:54.120 --> 0:44:00.440
<v Speaker 9>really horrible outcome would be stroke. And this is actually

0:44:00.520 --> 0:44:03.840
<v Speaker 9>what is so tragic is that stroke is very common

0:44:03.880 --> 0:44:10.319
<v Speaker 9>in young kids with sickle cell anemia. And so that's

0:44:10.440 --> 0:44:13.799
<v Speaker 9>essentially not just from small vessels being blocked, but from

0:44:13.920 --> 0:44:17.520
<v Speaker 9>larger blood vessels in your brain that get blocked, and

0:44:17.600 --> 0:44:22.000
<v Speaker 9>then overall the most common cause of death and the

0:44:22.080 --> 0:44:26.879
<v Speaker 9>second most common cause of emergency room visit for someone

0:44:26.960 --> 0:44:29.680
<v Speaker 9>with sickle cell anemia at least in this country, is

0:44:29.680 --> 0:44:33.759
<v Speaker 9>what's called acute chest syndrome or ACS. And this is

0:44:33.800 --> 0:44:37.280
<v Speaker 9>when you essentially get those crises in your lungs.

0:44:38.040 --> 0:44:38.640
<v Speaker 8>Oh my god.

0:44:39.520 --> 0:44:44.400
<v Speaker 9>Yeah. And what is awful and also very interesting about

0:44:44.560 --> 0:44:48.800
<v Speaker 9>ACS is that the trigger for that can be almost anything,

0:44:49.120 --> 0:44:53.000
<v Speaker 9>So it doesn't necessarily start with just these sickled cells

0:44:53.160 --> 0:44:56.719
<v Speaker 9>blocking blood vessels. It can be a viral infection that

0:44:56.760 --> 0:45:00.880
<v Speaker 9>causes inflammation that then triggers all these events. It could

0:45:00.920 --> 0:45:04.239
<v Speaker 9>be an asthma attack, because you can have asthma and

0:45:04.400 --> 0:45:08.399
<v Speaker 9>sickle cell that triggers all of these events. It can

0:45:08.480 --> 0:45:13.880
<v Speaker 9>be fat embolism because if you have, for example, necrosis

0:45:13.920 --> 0:45:16.840
<v Speaker 9>of your bones, your bone marrow is full of fat,

0:45:17.120 --> 0:45:19.760
<v Speaker 9>little pieces of that fat can break off and travel

0:45:19.800 --> 0:45:23.160
<v Speaker 9>to your lungs, and then those little emboli they're called,

0:45:23.719 --> 0:45:26.879
<v Speaker 9>can cause a blockage that can then trigger all these

0:45:26.920 --> 0:45:32.160
<v Speaker 9>downstream effects. So a cute chest syndrum ACS is it's

0:45:32.160 --> 0:45:38.200
<v Speaker 9>basically a triad of extreme chest pain infiltrates so fluid

0:45:38.320 --> 0:45:41.919
<v Speaker 9>and junk all over your lungs and then what's called

0:45:42.120 --> 0:45:46.040
<v Speaker 9>arterial hypoxemia, So not able to get oxygen in your

0:45:46.160 --> 0:45:49.839
<v Speaker 9>arteries because of all this fluid and junk in your lungs.

0:45:49.840 --> 0:45:56.279
<v Speaker 9>It's horrible, it's really really awful. So yeah, that's kind

0:45:56.320 --> 0:46:01.440
<v Speaker 9>of the overall symptom picture of what happens with sickle

0:46:01.480 --> 0:46:03.520
<v Speaker 9>cell anemia or sickle cell disease.

0:46:04.120 --> 0:46:08.279
<v Speaker 8>And so these happen, like you talked about, these tend

0:46:08.320 --> 0:46:11.920
<v Speaker 8>to happen at different stages of someone's life. So what,

0:46:12.719 --> 0:46:14.560
<v Speaker 8>like why is that? Is it just a matter of

0:46:15.280 --> 0:46:19.160
<v Speaker 8>like your body growing and like certain things growing at

0:46:19.200 --> 0:46:22.080
<v Speaker 8>certain times more Like, yeah, it's.

0:46:22.160 --> 0:46:24.839
<v Speaker 9>It's a really good question. It's not. I don't fully know,

0:46:25.000 --> 0:46:28.240
<v Speaker 9>but it is the case that people tend to present

0:46:28.320 --> 0:46:31.960
<v Speaker 9>differently at different ages. So like in very young kids,

0:46:32.400 --> 0:46:36.080
<v Speaker 9>the first presentation might be that hand and foot swelling

0:46:36.320 --> 0:46:39.680
<v Speaker 9>right in like a very young baby. As they get older,

0:46:39.920 --> 0:46:44.640
<v Speaker 9>especially under five, it's very common to have bacterial infections

0:46:45.400 --> 0:46:48.759
<v Speaker 9>that can end up becoming very serious. Then at a

0:46:48.760 --> 0:46:53.440
<v Speaker 9>certain age, stroke is a common manifestation. And then after

0:46:53.480 --> 0:46:59.160
<v Speaker 9>that these pain crises and acute chest syndrome, right gosh, yeah,

0:46:59.280 --> 0:47:01.279
<v Speaker 9>and then on top of that, like we said, kind

0:47:01.280 --> 0:47:04.440
<v Speaker 9>of already you have kind of chronic anemia, so not

0:47:04.719 --> 0:47:08.680
<v Speaker 9>enough red blood cells, this homolysis, which leads to fatigue,

0:47:09.120 --> 0:47:13.320
<v Speaker 9>it leads to jaundice. You can have gallstones very commonly

0:47:13.600 --> 0:47:16.520
<v Speaker 9>because of all this hemoglobin in your bloodstream. It can

0:47:16.600 --> 0:47:19.360
<v Speaker 9>cause the formation of gallstones. So you can have huge

0:47:19.400 --> 0:47:24.480
<v Speaker 9>pain from that. It's it's very bad. Kidney failure is

0:47:24.480 --> 0:47:28.239
<v Speaker 9>really common. If you block the kidneys the bloodstream to

0:47:28.320 --> 0:47:30.560
<v Speaker 9>your kidneys, you can have kidney failure. That's really common.

0:47:30.600 --> 0:47:33.240
<v Speaker 9>I mean, it's it's everything, I meanwhere your blood flows.

0:47:33.320 --> 0:47:34.240
<v Speaker 8>Yeah, exactly.

0:47:35.800 --> 0:47:38.399
<v Speaker 9>And what I also want to mention that I think

0:47:38.480 --> 0:47:42.240
<v Speaker 9>is often glossed over is the huge amount of mental

0:47:42.320 --> 0:47:46.239
<v Speaker 9>and behavioral health complications from this. Depression and anxiety are

0:47:46.480 --> 0:47:50.240
<v Speaker 9>very very high among people living with sickle cell because

0:47:50.680 --> 0:47:55.080
<v Speaker 9>they have chronic pain. Not only are they living with

0:47:55.160 --> 0:47:58.640
<v Speaker 9>chronic pain, not only do they have a reduced life expectancy,

0:47:59.160 --> 0:48:02.840
<v Speaker 9>they're frequently in the emergency room, they're frequently being hospitalized.

0:48:02.920 --> 0:48:06.719
<v Speaker 9>That's a massive amount of financial cost that's incurred. And

0:48:06.800 --> 0:48:09.480
<v Speaker 9>on top of that, there's a long standing history of

0:48:09.600 --> 0:48:13.840
<v Speaker 9>medical professionals not believing or not taking seriously the pain

0:48:14.160 --> 0:48:19.319
<v Speaker 9>that you're in. So, yeah, this is a very it's

0:48:19.360 --> 0:48:26.440
<v Speaker 9>a single mutation that leads to so very many complications.

0:48:27.000 --> 0:48:32.960
<v Speaker 8>Oh yeah, oh yeah, yeah.

0:48:31.080 --> 0:48:38.080
<v Speaker 9>Well is it a single mutation at bench there's my transition. Okay,

0:48:38.200 --> 0:48:40.600
<v Speaker 9>So all of that is kind of the description of

0:48:40.680 --> 0:48:44.719
<v Speaker 9>sickle cell anemia, which is when you have two copies

0:48:44.800 --> 0:48:48.759
<v Speaker 9>of that mutated beta globin gene, so that you have

0:48:49.160 --> 0:48:52.560
<v Speaker 9>messed up hemoglobin. That's not the only way that you

0:48:52.600 --> 0:48:57.319
<v Speaker 9>can have sickle cell disease. There are a number of

0:48:57.440 --> 0:49:02.120
<v Speaker 9>other mutations that can result in sickle cell disease that

0:49:02.320 --> 0:49:06.640
<v Speaker 9>is usually less severe than sickle cell anemia, although in

0:49:06.680 --> 0:49:10.200
<v Speaker 9>some cases it's almost as severe. So if you have

0:49:10.760 --> 0:49:15.920
<v Speaker 9>one copy of the sickle like HBS, that sickle cell allele,

0:49:16.600 --> 0:49:20.560
<v Speaker 9>and then you have one copy of a beta thallasmia allele.

0:49:20.680 --> 0:49:23.640
<v Speaker 9>So beta thallasemia is something most people might have heard of,

0:49:23.760 --> 0:49:27.880
<v Speaker 9>or thallasmia maybe you've heard of. This is another entirely

0:49:28.000 --> 0:49:31.960
<v Speaker 9>separate mutation of your beta globin gene. Right, you can

0:49:32.000 --> 0:49:35.839
<v Speaker 9>have one copy of HBS and one copy of beta thallasmia,

0:49:36.880 --> 0:49:39.839
<v Speaker 9>then you kind of have thallasmia and you kind of

0:49:39.840 --> 0:49:42.640
<v Speaker 9>have sickle cell disease. You have like a combination of both.

0:49:42.920 --> 0:49:45.680
<v Speaker 9>So typically your symptoms aren't going to be as severe

0:49:45.840 --> 0:49:49.399
<v Speaker 9>as someone with two copies of sickle cell, but you're

0:49:49.400 --> 0:49:51.279
<v Speaker 9>still going to have some of that. You can still

0:49:51.280 --> 0:49:56.040
<v Speaker 9>have some cells that stickle essentially, Okay, gotcha. Yeah, there's

0:49:56.120 --> 0:50:00.640
<v Speaker 9>another gene called HBC that's like another form of sickle cell,

0:50:00.719 --> 0:50:04.839
<v Speaker 9>so you can be HBS HBC. That's a whole nother one.

0:50:05.880 --> 0:50:09.879
<v Speaker 9>There's another type of thallacemia called alpha thallasmia, So that's

0:50:09.880 --> 0:50:13.319
<v Speaker 9>where those alpha polypeptides are messed up rather than the

0:50:13.360 --> 0:50:18.200
<v Speaker 9>betas in your hemoglobin, and that typically leads to actually

0:50:18.239 --> 0:50:22.080
<v Speaker 9>like a less severe form of sickle cell anemia or

0:50:22.120 --> 0:50:23.040
<v Speaker 9>of sickle cell disease.

0:50:23.120 --> 0:50:25.440
<v Speaker 8>Why, like, what's the difference between the alpha and the

0:50:25.480 --> 0:50:27.200
<v Speaker 8>beta that it would be a different.

0:50:27.080 --> 0:50:30.160
<v Speaker 9>So it's actually this is very complicated, but it's actually

0:50:30.200 --> 0:50:34.000
<v Speaker 9>because instead of only two copies of alpha, we have

0:50:34.120 --> 0:50:37.400
<v Speaker 9>four copies of alpha. So if you have just one mutation,

0:50:37.520 --> 0:50:39.000
<v Speaker 9>you still have three good copies.

0:50:39.520 --> 0:50:39.880
<v Speaker 8>Gotcha.

0:50:40.120 --> 0:50:42.759
<v Speaker 9>So what's I think really important to kind of that?

0:50:42.880 --> 0:50:44.640
<v Speaker 9>It's a good question. I'm glad you asked that, Aaron,

0:50:44.640 --> 0:50:48.000
<v Speaker 9>because what's important about this is that if you have

0:50:48.080 --> 0:50:51.200
<v Speaker 9>one copy of this HBS, this sickle cell a wheel

0:50:51.760 --> 0:50:56.920
<v Speaker 9>you're still gonna make that kind of messed up beta hemoglobin,

0:50:57.560 --> 0:51:01.279
<v Speaker 9>but you'll make enough normal that you won't have these

0:51:01.360 --> 0:51:07.200
<v Speaker 9>sickling events. Okay, you make enough normal hemoglobin that they

0:51:07.280 --> 0:51:11.200
<v Speaker 9>can't form those chains and sickle unless you have like

0:51:11.440 --> 0:51:18.680
<v Speaker 9>extremely low oxygen concentrations. Okay, So in rare instances you

0:51:18.760 --> 0:51:20.920
<v Speaker 9>can still get sickling, but in general it's going to

0:51:20.960 --> 0:51:22.920
<v Speaker 9>be a lot less. It's not going to be nearly

0:51:22.960 --> 0:51:25.400
<v Speaker 9>as many of your red blood cells. If you have

0:51:25.520 --> 0:51:30.120
<v Speaker 9>two copies, all you make is a messed up beta hemoglobin. Okay,

0:51:30.200 --> 0:51:32.960
<v Speaker 9>So all of your red blood cells have this messed

0:51:33.040 --> 0:51:34.680
<v Speaker 9>up hemoglobin okay.

0:51:34.560 --> 0:51:38.279
<v Speaker 8>Right, And this is where, like the language around it

0:51:38.360 --> 0:51:42.280
<v Speaker 8>is so important to remember, like the difference between sickle

0:51:42.280 --> 0:51:45.840
<v Speaker 8>cell disease, sickle cell trait, and sickle cell anemia exactly,

0:51:45.960 --> 0:51:49.000
<v Speaker 8>And that's led to a lot of confusion. Yeah, in

0:51:49.040 --> 0:51:50.920
<v Speaker 8>the history of it as all talk about.

0:51:51.120 --> 0:51:53.200
<v Speaker 9>Yeah, and so sickle cell trait would be if you

0:51:53.280 --> 0:51:55.960
<v Speaker 9>have one copy of HBS and one copy of a

0:51:56.200 --> 0:52:03.319
<v Speaker 9>normal HbA or normal adult hemoglobin right right, Oh gosh,

0:52:04.120 --> 0:52:08.280
<v Speaker 9>So yeah, Okay, I think that's all about those types

0:52:08.320 --> 0:52:11.839
<v Speaker 9>of things. What else do you want to know about

0:52:11.840 --> 0:52:13.600
<v Speaker 9>the biology. Arin, I've got more for you.

0:52:16.080 --> 0:52:17.920
<v Speaker 8>Well, I want to know about treatments.

0:52:18.160 --> 0:52:20.000
<v Speaker 9>Okay, let's talk about it.

0:52:20.000 --> 0:52:22.760
<v Speaker 8>It's not great, Okay.

0:52:22.480 --> 0:52:26.799
<v Speaker 9>There are some good things. So remember how, especially for

0:52:26.880 --> 0:52:30.520
<v Speaker 9>young kids, most common cause of like death is overwhelming

0:52:30.520 --> 0:52:35.799
<v Speaker 9>bacterial infection. So in many countries in the world, we

0:52:35.920 --> 0:52:41.480
<v Speaker 9>now screen for sickle cell disease in newborns, and if

0:52:41.520 --> 0:52:44.400
<v Speaker 9>you identify somebody with sickle cell disease, you can start

0:52:44.400 --> 0:52:48.319
<v Speaker 9>treating them prophylactically so before they ever get sick with penicillin.

0:52:48.400 --> 0:52:51.600
<v Speaker 9>So these kids get penicillin just every day for like

0:52:51.680 --> 0:52:54.399
<v Speaker 9>the first five years of their life. So that has

0:52:54.440 --> 0:52:57.200
<v Speaker 9>reduced the death rate to like less than three percent

0:52:57.280 --> 0:52:59.160
<v Speaker 9>compared to over twenty five percent.

0:53:00.239 --> 0:53:00.760
<v Speaker 8>That's great.

0:53:00.840 --> 0:53:06.520
<v Speaker 9>So that's great. Vaccinating babies is massively helpful in preventing

0:53:06.600 --> 0:53:10.000
<v Speaker 9>overwhelming infection because we have vaccines for a lot of

0:53:10.000 --> 0:53:15.080
<v Speaker 9>the things that commonly cause infection in these kids. But

0:53:15.320 --> 0:53:17.800
<v Speaker 9>beyond that, so that's kind of like we can prevent

0:53:17.920 --> 0:53:21.120
<v Speaker 9>kids from dying at a very young age from sickle

0:53:21.160 --> 0:53:25.840
<v Speaker 9>cell but beyond that, we really have cruddy treatment for

0:53:26.040 --> 0:53:29.880
<v Speaker 9>sickle cell disease and sickle cell anemia. If somebody comes

0:53:29.880 --> 0:53:32.840
<v Speaker 9>in with one of these acute crises of pain. There's

0:53:32.880 --> 0:53:36.440
<v Speaker 9>not much more to do besides pain control, which I'm

0:53:36.480 --> 0:53:41.200
<v Speaker 9>sure you'll talk more about later. Is like, yeah, the problems,

0:53:41.680 --> 0:53:46.920
<v Speaker 9>so many problems. You can give transfusions, so you can

0:53:46.960 --> 0:53:49.680
<v Speaker 9>do an exchange transfusion where you take out their blood

0:53:49.719 --> 0:53:53.320
<v Speaker 9>and give them new blood essentially, so that can decrease

0:53:53.360 --> 0:53:55.719
<v Speaker 9>the amount of sickled cells in their blood, which can

0:53:55.760 --> 0:54:00.760
<v Speaker 9>be very helpful. But the only actual treatment like drug

0:54:00.840 --> 0:54:06.680
<v Speaker 9>that we have is hydroxyurea, which this is so fascinating.

0:54:06.760 --> 0:54:11.120
<v Speaker 9>We have no idea how it does this, but what

0:54:11.160 --> 0:54:15.919
<v Speaker 9>it does is it increases the amount of that fetal hemoglobin,

0:54:16.080 --> 0:54:20.160
<v Speaker 9>that gamma hemoglobin. I see your confused.

0:54:19.719 --> 0:54:24.240
<v Speaker 8>Face, Saran, Yeah, how why? Why is how okay?

0:54:24.280 --> 0:54:25.319
<v Speaker 9>How can we have a.

0:54:25.400 --> 0:54:28.400
<v Speaker 8>Normal amount Do we have, like any amount of gamma

0:54:28.440 --> 0:54:30.680
<v Speaker 8>hemoglobin just circulating at any given time?

0:54:30.960 --> 0:54:36.399
<v Speaker 9>Yes? So okay and great question. Potentially yes. And there's

0:54:37.000 --> 0:54:40.560
<v Speaker 9>massive amounts of variation in how much fetal hemoglobin a

0:54:40.680 --> 0:54:45.320
<v Speaker 9>non sickle cell disease person produces, and even within someone

0:54:45.360 --> 0:54:49.080
<v Speaker 9>with sickle cell disease, how much fetal hemoglobin they have

0:54:49.960 --> 0:54:52.640
<v Speaker 9>correlates to how severe their disease is. So the more

0:54:52.719 --> 0:54:56.319
<v Speaker 9>fetal hemoglobin, the less severe their disease tends to be.

0:54:57.200 --> 0:55:03.319
<v Speaker 9>So giving somebody hydroxyurea in increases the production of fetal hemoglobin,

0:55:03.719 --> 0:55:05.960
<v Speaker 9>decreases the severity of disease.

0:55:07.160 --> 0:55:12.000
<v Speaker 8>That's fascinating, fascinating, And I have a question, Okay, do

0:55:12.120 --> 0:55:16.919
<v Speaker 8>you know is there any sort of elevational or altitudinal

0:55:17.040 --> 0:55:20.480
<v Speaker 8>gradient in terms of like, let's say, if populations whose

0:55:20.480 --> 0:55:24.879
<v Speaker 8>ancestral history has been mostly like high elevation, do they

0:55:24.920 --> 0:55:29.360
<v Speaker 8>produce more gamma hemoglobin than those lower elevations.

0:55:29.440 --> 0:55:32.359
<v Speaker 9>That's such a good question, and I can't remember. That

0:55:32.440 --> 0:55:36.719
<v Speaker 9>is such a good questionnairein I can't remember. I don't

0:55:36.719 --> 0:55:39.120
<v Speaker 9>know if people tend to have higher fetal hemoglobin, but

0:55:39.120 --> 0:55:42.360
<v Speaker 9>there are certainly adaptations in populations that have lived for

0:55:42.400 --> 0:55:45.359
<v Speaker 9>a long time at high altitudes where their hemoglobin has

0:55:45.400 --> 0:55:49.040
<v Speaker 9>a higher affinity so it binds tighter to oxygen the

0:55:49.080 --> 0:55:52.080
<v Speaker 9>way that fetal hemoglobin does the same way.

0:55:52.080 --> 0:55:52.719
<v Speaker 8>Interesting.

0:55:52.960 --> 0:55:56.040
<v Speaker 9>Yeah, there's there's so much more to that whole, like

0:55:56.200 --> 0:56:00.600
<v Speaker 9>the whole oxygen thing and altitude get into it.

0:56:00.640 --> 0:56:03.480
<v Speaker 8>But I know, I mean, there's we really should do

0:56:03.600 --> 0:56:07.960
<v Speaker 8>like an episode on blood ooh, because I also want

0:56:07.960 --> 0:56:09.640
<v Speaker 8>to talk about blood groups at some point.

0:56:09.760 --> 0:56:11.920
<v Speaker 9>Oh, I know we've never done that. That would be super fun.

0:56:12.200 --> 0:56:15.719
<v Speaker 9>I'd love to talk about blood even more. Okay, people

0:56:15.719 --> 0:56:17.799
<v Speaker 9>will be experts by then because we did it in

0:56:18.120 --> 0:56:20.760
<v Speaker 9>hepatitis and now we're doing hemoglobin. It's cool.

0:56:22.600 --> 0:56:22.960
<v Speaker 8>Okay.

0:56:23.120 --> 0:56:28.200
<v Speaker 9>So that's hydroxyurea. So that is considered a disease modifying agent.

0:56:28.239 --> 0:56:31.480
<v Speaker 9>It's the only one we have because it actually improves

0:56:32.280 --> 0:56:37.680
<v Speaker 9>your functioning essentially by increasing the amount of fetal hemoglobin.

0:56:38.400 --> 0:56:41.040
<v Speaker 9>But the only cure, and I'm going to put that

0:56:41.120 --> 0:56:44.840
<v Speaker 9>in air quotes, is bone met or chansplant.

0:56:45.239 --> 0:56:47.920
<v Speaker 8>But that has its own suite of problems.

0:56:47.480 --> 0:56:51.600
<v Speaker 9>Absolutely always does. Yeah, So it has to be, you know,

0:56:51.760 --> 0:56:55.120
<v Speaker 9>a perfectly or very well matched donor, which is very

0:56:55.120 --> 0:56:59.440
<v Speaker 9>difficult to find. It requires that you wipe out somebody's

0:56:59.640 --> 0:57:03.760
<v Speaker 9>entire bone marrow first, which leads them very susceptible to infection.

0:57:04.480 --> 0:57:07.560
<v Speaker 9>Then once you put in the new bone marrow, you

0:57:07.560 --> 0:57:12.239
<v Speaker 9>can have auto rejection, et cetera. And so because the

0:57:12.320 --> 0:57:16.120
<v Speaker 9>severity of sickle cell disease and sickle cell anemia is

0:57:16.240 --> 0:57:20.760
<v Speaker 9>so it ranges so much, transplants are not generally done

0:57:20.800 --> 0:57:23.840
<v Speaker 9>except in very severe cases, and even then only in

0:57:23.920 --> 0:57:26.880
<v Speaker 9>high income countries like the US or the UK. So

0:57:27.040 --> 0:57:31.520
<v Speaker 9>it's very rare essentially, which is problematic since that's the

0:57:31.560 --> 0:57:33.680
<v Speaker 9>only curative treatment that we.

0:57:33.720 --> 0:57:37.160
<v Speaker 8>Have, right, and it's like curative is in like gets

0:57:37.920 --> 0:57:38.880
<v Speaker 8>done forever.

0:57:39.160 --> 0:57:41.280
<v Speaker 9>Like you're if yeah, as long as your body doesn't

0:57:41.320 --> 0:57:44.280
<v Speaker 9>reject it, then yes you have you have brand new

0:57:44.320 --> 0:57:47.080
<v Speaker 9>bone marrows, so you no longer make these sickled cells.

0:57:47.200 --> 0:57:50.000
<v Speaker 9>You could still pass that on, right, You would still

0:57:50.040 --> 0:57:52.080
<v Speaker 9>be able to if you had a kid, they could

0:57:52.120 --> 0:57:55.920
<v Speaker 9>have either sickle cell trait or sickle cell anemia because

0:57:56.800 --> 0:58:02.640
<v Speaker 9>but but yeah, you would be cured. Yeah. I think

0:58:03.320 --> 0:58:05.560
<v Speaker 9>that's all the major things I wanted to talk about

0:58:05.560 --> 0:58:06.480
<v Speaker 9>for the biology.

0:58:07.280 --> 0:58:11.240
<v Speaker 8>Okay, gosh, this is a big one.

0:58:11.320 --> 0:58:15.600
<v Speaker 9>It's a big one, Aaron. Where did this come from?

0:58:15.960 --> 0:58:19.280
<v Speaker 9>Why does anyone have to live with sickle cell disease?

0:58:19.520 --> 0:58:22.000
<v Speaker 9>And what the heck is up with this mutation?

0:58:22.200 --> 0:58:25.400
<v Speaker 8>Tell me about it, Okay, as soon as we take

0:58:25.520 --> 0:58:58.720
<v Speaker 8>a short break. Okay, So to tell the history of

0:58:58.880 --> 0:59:02.640
<v Speaker 8>sickle cell trait and sickle cell anemia. For this, I'm

0:59:02.680 --> 0:59:07.000
<v Speaker 8>going to concentrate primarily on the HB S form, not

0:59:07.080 --> 0:59:09.800
<v Speaker 8>talk about thalacmia. This is just about sickle cell anemia

0:59:09.800 --> 0:59:12.400
<v Speaker 8>and sickle cell trait. I think that the best place

0:59:12.440 --> 0:59:16.919
<v Speaker 8>to start is in the name itself, because, aside from

0:59:16.920 --> 0:59:19.360
<v Speaker 8>being one of my favorite things to learn about and

0:59:19.440 --> 0:59:23.720
<v Speaker 8>talk about for any disease, it can also be incredibly revealing,

0:59:24.240 --> 0:59:28.439
<v Speaker 8>especially in the case of sickle cell because the name

0:59:28.560 --> 0:59:31.920
<v Speaker 8>tells us not only what those who named it saw

0:59:32.000 --> 0:59:34.800
<v Speaker 8>and what was important to them in describing this disease,

0:59:35.320 --> 0:59:39.400
<v Speaker 8>but it also makes us consider what discovery is like,

0:59:39.440 --> 0:59:42.840
<v Speaker 8>what does discovery mean, and how often that term is

0:59:42.960 --> 0:59:47.640
<v Speaker 8>misapplied to something that could more accurately be called a development.

0:59:47.960 --> 0:59:48.280
<v Speaker 9>Ooh.

0:59:49.240 --> 0:59:53.640
<v Speaker 8>So, when the term sickle cell anemia was first used

0:59:53.640 --> 0:59:57.560
<v Speaker 8>by Western medicine in nineteen twenty two, named by doctor

0:59:57.760 --> 1:00:01.960
<v Speaker 8>Verna Reem Mason, the medical field was still in the

1:00:02.000 --> 1:00:05.560
<v Speaker 8>midst of this big rush of new technology and new

1:00:05.640 --> 1:00:09.160
<v Speaker 8>theories and new hypotheses that led to enormous leaps forward

1:00:09.360 --> 1:00:14.840
<v Speaker 8>in the understanding of disease, both infectious and non infectious,

1:00:15.440 --> 1:00:21.840
<v Speaker 8>and with huge improvements in microscopic, surgical and other medical tools,

1:00:22.360 --> 1:00:25.200
<v Speaker 8>physicians could now get a much more detailed look at

1:00:25.200 --> 1:00:28.480
<v Speaker 8>what was going on inside the human body, and among

1:00:28.520 --> 1:00:31.720
<v Speaker 8>other things, this led to a shift in how diagnoses

1:00:31.720 --> 1:00:36.400
<v Speaker 8>were made so previously doctors may have had to rely

1:00:36.640 --> 1:00:39.680
<v Speaker 8>solely on symptoms of disease as described by the patient,

1:00:40.080 --> 1:00:44.600
<v Speaker 8>but with these new tools, it allowed for measurements and observation.

1:00:45.320 --> 1:00:47.720
<v Speaker 8>So the art of medicine was becoming a science, and

1:00:47.720 --> 1:00:52.080
<v Speaker 8>this is something that we've kind of talked about before. Yeah,

1:00:52.120 --> 1:00:56.960
<v Speaker 8>And the vast increase in knowledge of medicine and the

1:00:57.040 --> 1:01:00.880
<v Speaker 8>human body also changed the medical field in terms of

1:01:00.920 --> 1:01:06.440
<v Speaker 8>specialization because with the volume of information that was growing

1:01:06.720 --> 1:01:10.000
<v Speaker 8>day by day, it was nearly impossible for one person

1:01:10.120 --> 1:01:13.600
<v Speaker 8>to learn it all and retain it all, and so

1:01:14.200 --> 1:01:17.120
<v Speaker 8>there was not only the capacity, but also the need

1:01:17.200 --> 1:01:21.880
<v Speaker 8>for specialists in certain fields. Okay, interesting, and so both

1:01:21.880 --> 1:01:24.880
<v Speaker 8>of these shifts were enormously beneficial to the people being

1:01:24.960 --> 1:01:28.600
<v Speaker 8>treated because with an accurate diagnosis, you had a greater

1:01:28.720 --> 1:01:33.040
<v Speaker 8>chance of getting appropriate treatment and care. But there were

1:01:33.080 --> 1:01:38.320
<v Speaker 8>also some unintended consequences. So in some ways, medicine became

1:01:38.440 --> 1:01:42.400
<v Speaker 8>more about the body and less about the person, and

1:01:42.480 --> 1:01:46.560
<v Speaker 8>the heightened attention paid to measurements or direct observation could

1:01:46.600 --> 1:01:50.440
<v Speaker 8>sometimes take away from the experience of the person receiving treatment,

1:01:51.040 --> 1:01:55.960
<v Speaker 8>and this is reflected in the naming of sickle cell anemia.

1:01:56.040 --> 1:01:59.880
<v Speaker 8>As you mentioned, The term sickle cell describes the shape

1:01:59.920 --> 1:02:02.920
<v Speaker 8>of the affected cells, which is a direct result of

1:02:02.960 --> 1:02:05.760
<v Speaker 8>the mutated allele, and it was given that name by

1:02:05.800 --> 1:02:08.760
<v Speaker 8>the physicians who first observed these types of cells under

1:02:08.760 --> 1:02:13.640
<v Speaker 8>a microscope. But the condition, the experience of sickle cell

1:02:13.680 --> 1:02:18.520
<v Speaker 8>anemia had been known long before the nineteen hundreds, thousands

1:02:18.560 --> 1:02:22.200
<v Speaker 8>of years before, and people who lived in areas of

1:02:22.320 --> 1:02:25.640
<v Speaker 8>high prevalence, notably in parts of Africa, had names for

1:02:25.680 --> 1:02:30.000
<v Speaker 8>the disease as well. And I have a list of

1:02:30.000 --> 1:02:33.600
<v Speaker 8>these names, but I don't want to butcher them entirely.

1:02:34.160 --> 1:02:37.040
<v Speaker 8>But one of the commonalities of these names is that

1:02:37.120 --> 1:02:42.640
<v Speaker 8>they have sort of this onomatapia, this automatapoetic like rhythm

1:02:42.720 --> 1:02:47.440
<v Speaker 8>to them, And that's because it represented the repetitive, gnawing

1:02:47.560 --> 1:02:52.120
<v Speaker 8>pain of sickle cell anemia rather than the cellular morphology, right.

1:02:52.000 --> 1:02:54.680
<v Speaker 9>So it's like a description of what people were going through,

1:02:54.760 --> 1:02:59.080
<v Speaker 9>not just exactly this what the cell looks like, exactly fascinating.

1:02:59.360 --> 1:03:01.640
<v Speaker 8>And there was also another name that was reported in

1:03:01.680 --> 1:03:05.160
<v Speaker 8>the African medical literature in the late eighteen hundreds. It

1:03:05.320 --> 1:03:09.800
<v Speaker 8>was a term agwanges, meaning children who come and go,

1:03:10.360 --> 1:03:14.200
<v Speaker 8>which is in reference to the high childhood mortality. Yeah,

1:03:14.240 --> 1:03:17.600
<v Speaker 8>and so yeah, these names describe someone's experience with the

1:03:17.600 --> 1:03:21.439
<v Speaker 8>disease and perhaps how they would define it, rather than

1:03:21.480 --> 1:03:25.480
<v Speaker 8>a cellular observation which was completely removed from the experience.

1:03:25.920 --> 1:03:27.520
<v Speaker 8>I mean, if you think about it, if you have

1:03:27.600 --> 1:03:31.480
<v Speaker 8>sickle cell anemia, you are probably familiar with these extremely

1:03:31.560 --> 1:03:34.880
<v Speaker 8>painful episodes characteristic of the disease, but you may have

1:03:34.960 --> 1:03:38.840
<v Speaker 8>never seen your own sickle shaped cells under a microscope. Right,

1:03:39.520 --> 1:03:41.680
<v Speaker 8>So I just think that was a very yeah.

1:03:42.320 --> 1:03:46.120
<v Speaker 9>Oh, I love that, Aaron. That's so so interesting and important,

1:03:46.560 --> 1:03:48.560
<v Speaker 9>and I don't think I ever would have thought about

1:03:48.600 --> 1:03:49.760
<v Speaker 9>about it, quite honestly.

1:03:49.800 --> 1:03:52.760
<v Speaker 8>Well, and this is not my observation, this is something

1:03:52.800 --> 1:03:54.560
<v Speaker 8>I've read in a book, but I think it also

1:03:54.640 --> 1:03:56.960
<v Speaker 8>it did make me think about other diseases that we

1:03:57.040 --> 1:03:59.680
<v Speaker 8>have talked about. And you know, there is a lot

1:03:59.720 --> 1:04:01.840
<v Speaker 8>of me in a name, whether it's a specific to

1:04:01.840 --> 1:04:04.120
<v Speaker 8>a location and we've talked about the issues with that,

1:04:04.720 --> 1:04:08.840
<v Speaker 8>and or whether it's these this very clinical, detached way,

1:04:08.920 --> 1:04:13.360
<v Speaker 8>objective way of looking at a condition. And I think that.

1:04:13.440 --> 1:04:16.320
<v Speaker 8>I mean, there are some other ones that have that

1:04:16.400 --> 1:04:19.280
<v Speaker 8>are more about the experience itself, like Dengey, I remember,

1:04:19.800 --> 1:04:24.880
<v Speaker 8>may have some link to the painful bone breaking sensation.

1:04:25.120 --> 1:04:26.320
<v Speaker 8>But yeah, it's a.

1:04:27.000 --> 1:04:28.120
<v Speaker 9>That's very interesting.

1:04:28.200 --> 1:04:28.880
<v Speaker 8>It's interesting.

1:04:29.040 --> 1:04:30.200
<v Speaker 9>Yeah.

1:04:30.440 --> 1:04:34.080
<v Speaker 8>And also, as the author of one of the books

1:04:34.080 --> 1:04:38.440
<v Speaker 8>I read pointed out, the sharp contrast between the visible,

1:04:38.680 --> 1:04:43.520
<v Speaker 8>the sickle shaped cells, and the invisible the excruciating pain

1:04:43.760 --> 1:04:47.080
<v Speaker 8>endured in the various names of sickle cell anemia. In

1:04:47.200 --> 1:04:51.400
<v Speaker 8>many ways, it mirrors the history of the disease, particularly

1:04:51.440 --> 1:04:54.400
<v Speaker 8>throughout the twentieth and twenty first centuries in the US.

1:04:54.600 --> 1:05:00.680
<v Speaker 8>Oh Okay, So, though there were some brief descriptions of

1:05:00.720 --> 1:05:04.040
<v Speaker 8>what was likely sickle cell anemia since the eighteen hundreds

1:05:04.080 --> 1:05:07.280
<v Speaker 8>the mid eighteen hundreds, the first clinical description of the

1:05:07.320 --> 1:05:10.280
<v Speaker 8>disease was made in nineteen oh four by the University

1:05:10.280 --> 1:05:15.600
<v Speaker 8>of Chicago physician James Herrick, who reported quote peculiar elongated

1:05:15.640 --> 1:05:20.280
<v Speaker 8>and sickle shaped red blood corpuscles in a twenty year

1:05:20.320 --> 1:05:23.920
<v Speaker 8>old patient of his named Walter Clement Nole, who was

1:05:23.960 --> 1:05:27.920
<v Speaker 8>originally from Grenada and the only person of African descent

1:05:28.000 --> 1:05:30.920
<v Speaker 8>to be accepted into the Chicago College of Dental Surgery

1:05:31.000 --> 1:05:31.439
<v Speaker 8>that year.

1:05:31.640 --> 1:05:32.160
<v Speaker 9>Wow.

1:05:32.520 --> 1:05:36.280
<v Speaker 8>Yeah, so Noel had some I don't know if it's

1:05:36.320 --> 1:05:39.880
<v Speaker 8>Noel or Nol. So I'm just saying Noel. Noel had

1:05:39.920 --> 1:05:43.680
<v Speaker 8>some ulcers on his leg and described painful episodes and

1:05:43.760 --> 1:05:47.720
<v Speaker 8>other symptoms of anemia, and so Herrick drew some blood

1:05:47.760 --> 1:05:50.560
<v Speaker 8>and gave it to his interurn named Ernest Irons to

1:05:50.640 --> 1:05:54.560
<v Speaker 8>check it out, and Irons made the actual observation like

1:05:54.840 --> 1:05:58.920
<v Speaker 8>that description, but Herrick reported his findings at a conference

1:05:59.120 --> 1:06:02.800
<v Speaker 8>in nineteen ten, and then Irons was given no credit

1:06:03.360 --> 1:06:07.840
<v Speaker 8>as per USh as per usan And although Walter Clement

1:06:07.880 --> 1:06:11.440
<v Speaker 8>Knole recovered from his illness after his visit to Herrick,

1:06:11.640 --> 1:06:14.439
<v Speaker 8>he did die at a young age at thirty two

1:06:15.400 --> 1:06:19.440
<v Speaker 8>of pneumonia twelve years after that visit. And this first

1:06:19.440 --> 1:06:23.200
<v Speaker 8>description of sickle cell anemia was closely followed by many

1:06:23.240 --> 1:06:26.800
<v Speaker 8>others who noted that it primarily affected black Americans of

1:06:26.880 --> 1:06:31.000
<v Speaker 8>African descent. These were all American physicians, and that complications

1:06:31.040 --> 1:06:34.080
<v Speaker 8>arising from the condition often led to death at an

1:06:34.080 --> 1:06:38.360
<v Speaker 8>early age. And despite these warning bells going hey, we

1:06:38.440 --> 1:06:40.800
<v Speaker 8>have a serious disease here on our hands. Maybe we

1:06:40.840 --> 1:06:43.160
<v Speaker 8>should learn more about it and how to treat it,

1:06:43.560 --> 1:06:46.960
<v Speaker 8>sickle cell anemia remained largely invisible for a couple of

1:06:47.000 --> 1:06:52.440
<v Speaker 8>decades before finally gaining some recognition in the nineteen thirties. Wow. Okay,

1:06:52.560 --> 1:06:57.720
<v Speaker 8>so why was sickle cell anemia obscured for so long?

1:06:58.680 --> 1:07:05.240
<v Speaker 8>I think many reasons. Yeah. Part of it was the

1:07:05.360 --> 1:07:09.720
<v Speaker 8>pre antibiotic high prevalence of acute infectious diseases, and also

1:07:09.760 --> 1:07:14.240
<v Speaker 8>pre vaccine, some of which mimicked the symptoms of sickle celenemia,

1:07:14.280 --> 1:07:16.960
<v Speaker 8>such as malaria, and made it more difficult to see

1:07:16.960 --> 1:07:23.080
<v Speaker 8>this disease underneath. And when antibiotics, vaccines, and infectious disease

1:07:23.120 --> 1:07:27.400
<v Speaker 8>control policies were implemented in the early decades of the

1:07:27.520 --> 1:07:31.800
<v Speaker 8>twentieth century, other chronic diseases became much more visible.

1:07:32.240 --> 1:07:34.240
<v Speaker 9>So it was like kids were just getting sick and

1:07:34.360 --> 1:07:37.320
<v Speaker 9>dying from sickle cell anemia before they knew that it

1:07:37.360 --> 1:07:40.360
<v Speaker 9>was because of sickle cell anemia exactly. Okay, that makes

1:07:40.360 --> 1:07:41.080
<v Speaker 9>sense exactly.

1:07:42.640 --> 1:07:47.080
<v Speaker 8>But of course, the other enormous component was the inherent

1:07:47.160 --> 1:07:48.600
<v Speaker 8>racism in medicine.

1:07:48.760 --> 1:07:49.000
<v Speaker 9>Yeah.

1:07:49.360 --> 1:07:52.960
<v Speaker 8>Higher rates of disease, higher infant mortality, and lower life

1:07:53.000 --> 1:07:57.440
<v Speaker 8>expectancies overall in Black Americans compared to white Americans was

1:07:57.520 --> 1:08:00.360
<v Speaker 8>dismissed by the vast majority of those in the medical field,

1:08:00.400 --> 1:08:04.800
<v Speaker 8>which of course were primarily white, as either evidence for

1:08:04.840 --> 1:08:08.680
<v Speaker 8>a biological basis of race or they said, oh, that

1:08:08.800 --> 1:08:13.280
<v Speaker 8>this is just indicating that, you know, there's large, widespread

1:08:13.320 --> 1:08:18.280
<v Speaker 8>ignorance of medical practices. Oh and essentially the fact that

1:08:18.320 --> 1:08:22.679
<v Speaker 8>Black Americans faced worse health outcomes was seen as normal,

1:08:22.800 --> 1:08:24.280
<v Speaker 8>as an inevitability.

1:08:24.479 --> 1:08:28.519
<v Speaker 9>I would say, unfortunately, that still is the bias in medicine.

1:08:28.560 --> 1:08:33.720
<v Speaker 8>Oh yeah, oh yeah, yeah. And this false concept of

1:08:33.800 --> 1:08:38.439
<v Speaker 8>racial superiority in biology is so longstanding and insidious and

1:08:38.680 --> 1:08:43.800
<v Speaker 8>is still, like we talked about, very present today in medicine. So,

1:08:43.920 --> 1:08:47.679
<v Speaker 8>following the American Civil War, some opponents of emancipation claimed

1:08:47.720 --> 1:08:49.720
<v Speaker 8>that the black race would die out and that the

1:08:49.800 --> 1:08:53.519
<v Speaker 8>high rates of disease and poverty among black people were

1:08:53.560 --> 1:08:58.360
<v Speaker 8>evidence that enslavement was a good thing. And these paternalistic

1:08:58.560 --> 1:09:03.320
<v Speaker 8>beliefs bled into policy policies which were designed to uphold

1:09:03.400 --> 1:09:06.599
<v Speaker 8>these divisions of class and privilege and prevent any movements

1:09:06.640 --> 1:09:11.320
<v Speaker 8>across those invisible but very real lines. In addition, there

1:09:11.400 --> 1:09:14.439
<v Speaker 8>was the bigger issue of how risks of disease overall

1:09:14.640 --> 1:09:17.679
<v Speaker 8>were perceived. So in much of the American South, for instance,

1:09:17.760 --> 1:09:22.320
<v Speaker 8>discussions about disease were framed as the dangers posed by

1:09:22.479 --> 1:09:26.479
<v Speaker 8>black people, rather than the dangers the diseases posed to

1:09:26.680 --> 1:09:27.320
<v Speaker 8>black people.

1:09:27.920 --> 1:09:28.120
<v Speaker 6>Wow.

1:09:28.160 --> 1:09:30.519
<v Speaker 8>So this is something that, like I've talked about before

1:09:30.840 --> 1:09:34.280
<v Speaker 8>in the context of syphilis, to berculosis, hookworm, and so on.

1:09:34.720 --> 1:09:37.280
<v Speaker 8>So high rates of disease among black people were not

1:09:37.320 --> 1:09:41.679
<v Speaker 8>seen as worrisome because they were directly damaging the health

1:09:41.840 --> 1:09:45.559
<v Speaker 8>and shortening life expectancy of black people. It was more, oh, well,

1:09:45.560 --> 1:09:48.280
<v Speaker 8>we don't want white people to get sick from black people.

1:09:48.439 --> 1:09:52.200
<v Speaker 8>So that is where the focus primarily was.

1:09:52.240 --> 1:09:54.599
<v Speaker 9>How can we prevent white people from getting sick with

1:09:54.640 --> 1:10:00.000
<v Speaker 9>what the black people have? Exactly yeah, exactly yeah.

1:10:00.400 --> 1:10:03.360
<v Speaker 8>And this shaped policy and attitudes toward public health and

1:10:03.439 --> 1:10:07.000
<v Speaker 8>access to health care. Basically, the only way a public

1:10:07.040 --> 1:10:10.120
<v Speaker 8>health policy was going to be enacted or research funds

1:10:10.160 --> 1:10:13.599
<v Speaker 8>awarded was if the disease affected or threatened to affect

1:10:13.720 --> 1:10:18.600
<v Speaker 8>white Americans in some way, okay. And so when antibiotics

1:10:18.600 --> 1:10:21.799
<v Speaker 8>and vaccines became more widely available throughout the nineteen thirties

1:10:21.840 --> 1:10:25.920
<v Speaker 8>and forties, the widespread prevalence of chronic diseases such as

1:10:25.920 --> 1:10:31.519
<v Speaker 8>sickle cell anemia was revealed. At the same time, the

1:10:31.600 --> 1:10:35.920
<v Speaker 8>commodification of health and people's bodies had really ramped up.

1:10:36.760 --> 1:10:40.280
<v Speaker 8>And what I mean by that is that basically, alongside

1:10:40.320 --> 1:10:43.360
<v Speaker 8>the medical developments of the late nineteenth century and early

1:10:43.400 --> 1:10:47.519
<v Speaker 8>twentieth century, people's health and bodies began to be assigned

1:10:47.600 --> 1:10:51.640
<v Speaker 8>a monetary value. How much did this procedure cost, how

1:10:51.760 --> 1:10:55.000
<v Speaker 8>much did that medicine cost, how much did someone's poor

1:10:55.080 --> 1:10:56.919
<v Speaker 8>health limit their productive output?

1:10:57.720 --> 1:11:00.240
<v Speaker 9>Disability adjusted life years and yep.

1:11:00.479 --> 1:11:00.679
<v Speaker 3>Right.

1:11:01.200 --> 1:11:04.880
<v Speaker 8>The medical profession contributed to this, not just through the

1:11:04.920 --> 1:11:09.320
<v Speaker 8>exchange of money for treatment, but also by assigning intrinsic

1:11:09.479 --> 1:11:13.679
<v Speaker 8>values to certain conditions. People with rarer diseases were seen

1:11:13.720 --> 1:11:18.479
<v Speaker 8>as valuable to the medical profession. Hospitals in poverty stricken,

1:11:18.680 --> 1:11:22.360
<v Speaker 8>densely populated urban areas were considered to be great places

1:11:22.400 --> 1:11:26.040
<v Speaker 8>to get experience in training as a medical student, and

1:11:26.120 --> 1:11:30.479
<v Speaker 8>the term clinical material was frequently used as a way

1:11:30.680 --> 1:11:35.880
<v Speaker 8>to even further remove the person from the medical experience,

1:11:36.320 --> 1:11:40.040
<v Speaker 8>as in whatever general hospitals supplied an adequate amount of

1:11:40.080 --> 1:11:43.040
<v Speaker 8>clinical material to train students at not one, but two

1:11:43.080 --> 1:11:44.200
<v Speaker 8>medical schools.

1:11:44.320 --> 1:11:47.879
<v Speaker 9>I'm sorry, so that means clinical material meaning humans? Humans?

1:11:48.200 --> 1:11:53.040
<v Speaker 8>Yeah, humans, or like different cases or like different surgeries.

1:11:53.360 --> 1:11:57.120
<v Speaker 8>I mean, and this is like still, this is still today.

1:11:57.439 --> 1:11:57.799
<v Speaker 6>People.

1:11:58.439 --> 1:12:01.120
<v Speaker 8>It's very much like, oh, you should do you should

1:12:01.120 --> 1:12:03.800
<v Speaker 8>you get experience there because you're likely to see more

1:12:04.320 --> 1:12:05.240
<v Speaker 8>of these diseases.

1:12:05.400 --> 1:12:07.639
<v Speaker 9>The amount of times I heard, oh, we've got really

1:12:07.640 --> 1:12:12.160
<v Speaker 9>interesting pathology at this residency program, I'm like, Wow, that's

1:12:12.560 --> 1:12:16.120
<v Speaker 9>horrible for the people in that area, but yeah, yeah.

1:12:17.080 --> 1:12:21.240
<v Speaker 8>And employers also played a large role and continue to

1:12:21.240 --> 1:12:24.760
<v Speaker 8>play a large role in the commodification of health. Maximize

1:12:24.760 --> 1:12:28.400
<v Speaker 8>profits and productivity by ensuring that your employees are well

1:12:28.520 --> 1:12:31.120
<v Speaker 8>enough to work, and of course, if your health can't

1:12:31.120 --> 1:12:36.000
<v Speaker 8>be improved, consider dropping them. Against this backdrop of this

1:12:36.320 --> 1:12:40.040
<v Speaker 8>enormous growth of medical knowledge, reduction of infectious disease, and

1:12:40.080 --> 1:12:44.080
<v Speaker 8>commodification of health and disease awareness of sickle cell anemia

1:12:44.320 --> 1:12:48.639
<v Speaker 8>rose greatly, and in the coming decades this fame would

1:12:48.680 --> 1:12:51.320
<v Speaker 8>grow to become in some ways a double edged sword.

1:12:52.320 --> 1:12:54.960
<v Speaker 8>So on the one hand, the adoption of sickle cell

1:12:55.000 --> 1:12:59.759
<v Speaker 8>anemia throughout the nineteen fifties, sixties seventies as a cause

1:12:59.800 --> 1:13:02.799
<v Speaker 8>by many social groups and the increase in research funding

1:13:02.880 --> 1:13:05.759
<v Speaker 8>for it led to a great deal of important knowledge

1:13:05.800 --> 1:13:11.440
<v Speaker 8>being gained and in a raising awareness overall. Researchers fascinated

1:13:11.479 --> 1:13:14.800
<v Speaker 8>by the puzzle that the disease posed not necessarily by

1:13:14.840 --> 1:13:20.280
<v Speaker 8>the people experiencing the disease, they had uncovered that certain

1:13:20.320 --> 1:13:23.920
<v Speaker 8>conditions like low oxygen and high acidity could induce sickling

1:13:23.960 --> 1:13:26.679
<v Speaker 8>of cells, and they had also observed that sickling could

1:13:26.680 --> 1:13:29.519
<v Speaker 8>also result in people who did not have the disease

1:13:29.600 --> 1:13:33.800
<v Speaker 8>but were relatives of those that did. In nineteen forty nine,

1:13:33.920 --> 1:13:38.000
<v Speaker 8>two papers published nearly simultaneously by doctor James Neil and

1:13:38.080 --> 1:13:42.240
<v Speaker 8>Colonel ea Beat presented the hypothesis that the disease was

1:13:42.280 --> 1:13:46.719
<v Speaker 8>an autosomal recessive trait, meaning that it was inherited, and

1:13:46.920 --> 1:13:49.719
<v Speaker 8>like you said, the two copies were required for disease

1:13:49.760 --> 1:13:54.120
<v Speaker 8>to be present. I also want to note that, once

1:13:54.160 --> 1:13:59.000
<v Speaker 8>again discovery versus development, that the inheritability of sickle cell

1:13:59.000 --> 1:14:02.160
<v Speaker 8>anemia had long recognized in some groups where the disease

1:14:02.360 --> 1:14:06.480
<v Speaker 8>was especially prevalent, such as among certain populations in GHANAA

1:14:06.680 --> 1:14:10.479
<v Speaker 8>makes sense. Yeah. And also in nineteen forty nine, doctor

1:14:10.640 --> 1:14:14.360
<v Speaker 8>Harvey Etano and doctor Linus Pauling demonstrated that the sickling

1:14:14.560 --> 1:14:19.040
<v Speaker 8>was caused by an abnormality in the hemoglobin molecule, prompting

1:14:19.080 --> 1:14:22.080
<v Speaker 8>them to call it a molecular disease. I think it

1:14:22.160 --> 1:14:25.519
<v Speaker 8>might actually be the first disease described as a molecular disease.

1:14:26.120 --> 1:14:29.920
<v Speaker 8>A few years later, the individual amino acid substitution leading

1:14:29.920 --> 1:14:34.200
<v Speaker 8>to the structural change in hemoglobin was identified, teaching researchers

1:14:34.240 --> 1:14:37.920
<v Speaker 8>that that single mutation could be responsible for this whole

1:14:38.000 --> 1:14:40.240
<v Speaker 8>suite of systemic effects on the body.

1:14:40.400 --> 1:14:41.960
<v Speaker 9>Yeah, which is pretty incredible.

1:14:42.320 --> 1:14:45.120
<v Speaker 8>Oh yeah. But a huge shift in the notion or

1:14:45.200 --> 1:14:49.320
<v Speaker 8>representation of sickle cell trait or that sickle cell that

1:14:49.439 --> 1:14:52.720
<v Speaker 8>mutated allele as a disease condition came about with the

1:14:52.800 --> 1:14:56.640
<v Speaker 8>hypothesis first floated in like the mid nineteen forties that

1:14:56.680 --> 1:14:59.439
<v Speaker 8>the sickle cell trait so again, one copy of that

1:14:59.520 --> 1:15:04.880
<v Speaker 8>mutated actually provided a level of protection against the falciparum

1:15:04.960 --> 1:15:10.920
<v Speaker 8>malaria parasite, giving insight into why the allele was present

1:15:10.960 --> 1:15:15.519
<v Speaker 8>at relatively high rates despite its deliterious effects. And so

1:15:15.600 --> 1:15:19.160
<v Speaker 8>this is an example of what is called a balanced polymorphism.

1:15:20.040 --> 1:15:24.000
<v Speaker 8>And this turned the the dichotomy or this long standing

1:15:24.080 --> 1:15:28.080
<v Speaker 8>dogma of normal equals good and abnormal equals bad on

1:15:28.200 --> 1:15:28.679
<v Speaker 8>its head.

1:15:28.960 --> 1:15:32.200
<v Speaker 9>Yeah, it's why the term normal is stupid.

1:15:32.920 --> 1:15:37.800
<v Speaker 8>Yeah, it's it's yeah, it's it's inadequate.

1:15:37.880 --> 1:15:40.120
<v Speaker 9>It doesn't, it doesn't. I mean, what is normal?

1:15:40.360 --> 1:15:40.640
<v Speaker 5>Like it?

1:15:40.800 --> 1:15:43.680
<v Speaker 9>That's not it? And sometimes it's hard, like I'm like,

1:15:43.760 --> 1:15:45.599
<v Speaker 9>I don't I don't know what other word to use,

1:15:45.680 --> 1:15:47.360
<v Speaker 9>but that it's not a good word.

1:15:48.280 --> 1:15:51.880
<v Speaker 8>I know, because we need to improve our vocabulary. Yeah

1:15:52.000 --> 1:15:58.559
<v Speaker 8>for that. So, but these these scientific breakthroughs, particularly in

1:15:58.600 --> 1:16:02.599
<v Speaker 8>its labeling as a molecular disease, and all the hype

1:16:02.600 --> 1:16:06.799
<v Speaker 8>that that generated, it got a lot of researchers super

1:16:06.840 --> 1:16:10.360
<v Speaker 8>excited to jump on the sickle cell train, which was

1:16:10.680 --> 1:16:16.920
<v Speaker 8>also pulled forward by the increasing interconnectedness of hospitals, research institutions,

1:16:16.960 --> 1:16:21.040
<v Speaker 8>public health departments, and outreach groups. And this wealth of

1:16:21.080 --> 1:16:23.600
<v Speaker 8>new information about the nature of sickle cell trait and

1:16:23.640 --> 1:16:28.519
<v Speaker 8>sickle cell anemia did not, though necessarily, translate directly into

1:16:28.640 --> 1:16:33.080
<v Speaker 8>lives saved, because in much of the South, racial segregation

1:16:33.360 --> 1:16:37.880
<v Speaker 8>still prohibited Black Americans from seeking care at the highest

1:16:37.920 --> 1:16:41.200
<v Speaker 8>funded hospitals, which were of course white only.

1:16:41.479 --> 1:16:43.000
<v Speaker 9>Yeah wow.

1:16:43.880 --> 1:16:46.680
<v Speaker 8>In addition, and here comes the other side of that

1:16:47.160 --> 1:16:50.400
<v Speaker 8>double edged sword. Despite these advancements in the understanding of

1:16:50.479 --> 1:16:55.920
<v Speaker 8>the disease outside of academia, such as in political discussions

1:16:56.120 --> 1:17:00.320
<v Speaker 8>or debates, clear knowledge about the exact nature of cell

1:17:00.320 --> 1:17:04.719
<v Speaker 8>anemia lagged far behind, especially in understanding the difference between

1:17:04.920 --> 1:17:09.920
<v Speaker 8>sickle cell trait and sickle cell anemia. For instance, during

1:17:09.960 --> 1:17:15.719
<v Speaker 8>World War Two, a controversial debate arose about whether sickle

1:17:15.760 --> 1:17:19.120
<v Speaker 8>cell trait, so having the one copy posed a threat

1:17:19.120 --> 1:17:21.920
<v Speaker 8>to the health of soldiers who had the trait, in

1:17:21.960 --> 1:17:24.799
<v Speaker 8>other words, posed a threat to war efforts. Oh gosh,

1:17:25.240 --> 1:17:28.479
<v Speaker 8>suddenly this disease that had been invisible for so long

1:17:28.680 --> 1:17:31.719
<v Speaker 8>was now visible and could be used to discriminate against

1:17:31.760 --> 1:17:35.960
<v Speaker 8>those with the disease or even just the trait. After

1:17:36.080 --> 1:17:38.240
<v Speaker 8>four people in the Marine Corps with sickle cell trait

1:17:38.479 --> 1:17:42.280
<v Speaker 8>died after a training exercise at a high elevation, strict

1:17:42.400 --> 1:17:45.080
<v Speaker 8>limits were placed on whether those with sickle cell trait

1:17:45.160 --> 1:17:49.600
<v Speaker 8>could become pilots either in the armed forces or commercial airlines,

1:17:49.760 --> 1:17:53.639
<v Speaker 8>or hold other positions. So not just in armed forces,

1:17:53.680 --> 1:17:57.920
<v Speaker 8>so there was like a huge, huge restrictions placed on that,

1:17:58.000 --> 1:18:01.040
<v Speaker 8>but also in other parts of the workforce, so like

1:18:01.120 --> 1:18:04.759
<v Speaker 8>flight attendants. There was a lot of issues with health

1:18:04.760 --> 1:18:08.840
<v Speaker 8>insurance carriers dropping people who were found to have sickle

1:18:08.880 --> 1:18:10.679
<v Speaker 8>cell trait or sickle cell anemia.

1:18:10.960 --> 1:18:11.799
<v Speaker 9>Oh my god.

1:18:13.040 --> 1:18:17.679
<v Speaker 8>And so these restrictions were instances of racial discrimination, since

1:18:17.720 --> 1:18:21.400
<v Speaker 8>the overwhelming majority of those forbidden from entering the armed forces,

1:18:21.439 --> 1:18:24.400
<v Speaker 8>for instance, due to sickle cell trait were black, and

1:18:24.960 --> 1:18:28.240
<v Speaker 8>class action lawsuits led to the removal of some of

1:18:28.240 --> 1:18:30.960
<v Speaker 8>these restrictions, but only decades after they were first put

1:18:30.960 --> 1:18:31.400
<v Speaker 8>in place.

1:18:31.479 --> 1:18:32.240
<v Speaker 9>Oh my god.

1:18:32.880 --> 1:18:35.559
<v Speaker 8>But of course, just because restrictions are gone does not

1:18:35.640 --> 1:18:39.719
<v Speaker 8>mean the racial discrimination and the workplace was gone. And

1:18:39.880 --> 1:18:41.960
<v Speaker 8>whether it was because the parent of a child with

1:18:42.000 --> 1:18:44.479
<v Speaker 8>sickle cell anemia was more likely to miswork or if

1:18:44.520 --> 1:18:47.920
<v Speaker 8>they themselves were affected, there was simply no shortage of

1:18:47.960 --> 1:18:53.839
<v Speaker 8>ways for people to be discriminated against. Into the nineteen

1:18:53.880 --> 1:18:56.960
<v Speaker 8>sixties and nineteen seventies, sickle cell trait and sickle cell

1:18:56.960 --> 1:19:01.040
<v Speaker 8>anemia moved or was pulled even for into the spotlight

1:19:02.560 --> 1:19:05.800
<v Speaker 8>in academic circles. Sickle cell became the focus of narratives

1:19:05.800 --> 1:19:10.759
<v Speaker 8>that interwove of biology, anthropology, and history to explain whatever

1:19:10.840 --> 1:19:14.759
<v Speaker 8>story was the goal of the author, and these narratives

1:19:14.800 --> 1:19:18.680
<v Speaker 8>were sometimes criticized for their tendency to make sweeping generalizations

1:19:19.080 --> 1:19:23.920
<v Speaker 8>about entire groups of people or entire places, or for

1:19:23.920 --> 1:19:26.840
<v Speaker 8>forcing the facts to fit the story, making it sort

1:19:26.880 --> 1:19:30.240
<v Speaker 8>of a just so story. Other researchers finally began talking

1:19:30.680 --> 1:19:34.360
<v Speaker 8>about how sickle cell disease and inadequate medical care may

1:19:34.479 --> 1:19:37.519
<v Speaker 8>lead to poverty rather than poverty being the cause of

1:19:37.560 --> 1:19:40.720
<v Speaker 8>disease and ill health, and understanding the more of the

1:19:41.200 --> 1:19:45.760
<v Speaker 8>cycle of poverty and access to healthcare. And in the

1:19:45.800 --> 1:19:49.280
<v Speaker 8>socio political sphere, sickle cell disease took on new meaning

1:19:49.439 --> 1:19:52.840
<v Speaker 8>during the civil rights movement of the nineteen sixties. It

1:19:52.920 --> 1:19:55.680
<v Speaker 8>was held by some civil rights groups to be symbolic

1:19:55.760 --> 1:19:59.320
<v Speaker 8>of the long standing invisible or ignored pain and suffering

1:19:59.439 --> 1:20:02.960
<v Speaker 8>experience by so many who had long been racially discriminated

1:20:02.960 --> 1:20:06.920
<v Speaker 8>against and whose access to healthcare had always been restricted.

1:20:08.400 --> 1:20:11.879
<v Speaker 8>Despite the increased awareness of sickle cell, it's still lagged

1:20:11.920 --> 1:20:16.840
<v Speaker 8>behind other genetic diseases in terms of funding, particularly those

1:20:16.920 --> 1:20:21.640
<v Speaker 8>that disproportionately affected white people, such as cystic fibrosis. Oh yeah, So,

1:20:21.720 --> 1:20:24.599
<v Speaker 8>For example, in nineteen sixty seven, there were roughly the

1:20:24.640 --> 1:20:28.280
<v Speaker 8>same new number of cases of cystic fibrosis and sickle

1:20:28.320 --> 1:20:32.800
<v Speaker 8>cell anemia, but the difference in funding from volunteer organizations

1:20:33.080 --> 1:20:38.679
<v Speaker 8>was staggering. For cystic fibrosis, these organizations raised one point

1:20:38.800 --> 1:20:42.680
<v Speaker 8>nine million dollars, and for sickle cell that number was

1:20:42.760 --> 1:20:45.400
<v Speaker 8>fifty thousand. Uh.

1:20:45.479 --> 1:20:47.200
<v Speaker 9>Do you want some current numbers or do you want

1:20:47.240 --> 1:20:48.240
<v Speaker 9>me to tell you those later?

1:20:48.360 --> 1:20:50.960
<v Speaker 8>Because tell me those later but I'm yeah, I'm sure

1:20:50.960 --> 1:20:54.479
<v Speaker 8>that they're not any better at all. Yep, yep. But

1:20:54.720 --> 1:20:58.400
<v Speaker 8>there was a lot of charitable work being done and

1:20:58.720 --> 1:21:02.679
<v Speaker 8>awareness efforts that were made. So the Black Panther Party,

1:21:02.720 --> 1:21:06.200
<v Speaker 8>among other groups, organized and created a massive network of

1:21:06.240 --> 1:21:09.400
<v Speaker 8>healthcare centers across the country where one of the goals

1:21:09.479 --> 1:21:14.240
<v Speaker 8>was to raise sickle cell awareness and funding. Doctor Charles Witten,

1:21:14.400 --> 1:21:17.240
<v Speaker 8>for whom our drink is named, started the Sickle Cell

1:21:17.280 --> 1:21:20.439
<v Speaker 8>Detection and Information Center in Detroit in nineteen seventy one

1:21:21.000 --> 1:21:25.080
<v Speaker 8>and also helped found the Sickle Cell Disease Association of America,

1:21:25.479 --> 1:21:29.719
<v Speaker 8>which has been instrumental not only in their educational efforts,

1:21:29.760 --> 1:21:32.439
<v Speaker 8>but also in assisting families who have been impacted by

1:21:32.479 --> 1:21:35.360
<v Speaker 8>sickle cell disease. And also he did a lot of

1:21:35.360 --> 1:21:38.160
<v Speaker 8>work in terms of lowering barriers for people who were

1:21:38.240 --> 1:21:42.320
<v Speaker 8>underrepresented in medicine to be able to go to medical

1:21:42.320 --> 1:21:46.439
<v Speaker 8>school and have that as an option. Federal funds also

1:21:46.600 --> 1:21:49.800
<v Speaker 8>poured in as Nixon signed into law the Sickle Cell

1:21:49.840 --> 1:21:53.639
<v Speaker 8>Anemia Control Act in nineteen seventy two, and so this

1:21:53.800 --> 1:21:58.160
<v Speaker 8>act included increased funds for research as well as healthcare

1:21:58.200 --> 1:22:02.720
<v Speaker 8>for those impacted. It also required genetic screening to be

1:22:02.880 --> 1:22:07.439
<v Speaker 8>voluntary rather than mandatory, which had been a huge issue

1:22:08.240 --> 1:22:12.160
<v Speaker 8>previously because that just like paved the way for discrimination,

1:22:13.360 --> 1:22:19.320
<v Speaker 8>and it also included support for reproductive counseling. And during

1:22:19.479 --> 1:22:22.960
<v Speaker 8>the seventies our understanding of the disease itself became more

1:22:23.040 --> 1:22:26.559
<v Speaker 8>nuanced as well. So first, new research about the possible

1:22:26.640 --> 1:22:30.040
<v Speaker 8>origins of the allele showed that it likely emerged in

1:22:30.240 --> 1:22:34.960
<v Speaker 8>four different mutational events between seventy one hundred and fifty

1:22:35.000 --> 1:22:38.639
<v Speaker 8>thousand years ago, three events that took place in Africa

1:22:38.680 --> 1:22:41.080
<v Speaker 8>and a fourth that took place in either Saudi Arabia

1:22:41.200 --> 1:22:45.120
<v Speaker 8>or Central India. This allele emerged in different places around

1:22:45.120 --> 1:22:49.120
<v Speaker 8>the world, it's not just from one origin event. Secondly,

1:22:49.160 --> 1:22:52.439
<v Speaker 8>there was the growing awareness of other hemoglobin disorders and

1:22:52.520 --> 1:22:54.920
<v Speaker 8>the fact that sickle cell trade was found in non

1:22:55.000 --> 1:22:59.000
<v Speaker 8>black people as well, which threw some complexity into the discussion.

1:22:59.040 --> 1:23:03.519
<v Speaker 8>In the seventies, representation of sickle cell anemia and popular

1:23:03.600 --> 1:23:07.479
<v Speaker 8>media also increased, as characters with the disease were featured

1:23:07.520 --> 1:23:11.160
<v Speaker 8>in a couple of movies or TV episodes, and magazines

1:23:11.200 --> 1:23:16.120
<v Speaker 8>featured articles about the condition. But once again, here comes

1:23:16.120 --> 1:23:19.680
<v Speaker 8>the other side of that double edged sword. Yeah, The

1:23:19.800 --> 1:23:23.080
<v Speaker 8>prominence of sickle cell anemia and political discussions of this

1:23:23.240 --> 1:23:26.559
<v Speaker 8>time meant that some politicians felt as though they could

1:23:26.640 --> 1:23:30.400
<v Speaker 8>use the disease to symbolize whatever they wanted to in

1:23:30.520 --> 1:23:33.120
<v Speaker 8>order to drive their own narrative about race relations in

1:23:33.160 --> 1:23:36.760
<v Speaker 8>the US, and sometimes it was used. Sometimes that was

1:23:36.840 --> 1:23:40.080
<v Speaker 8>used to bring about real positive change, but other times

1:23:40.120 --> 1:23:43.960
<v Speaker 8>it was twisted to halt forward progress. Let's take genetic

1:23:44.040 --> 1:23:48.719
<v Speaker 8>screening and reproductive counseling as an example. Okay, the push

1:23:48.760 --> 1:23:51.400
<v Speaker 8>for genetic screening for sickle cell anemia and sickle cell

1:23:51.439 --> 1:23:55.120
<v Speaker 8>trait came at a time when genetic screening in general

1:23:55.160 --> 1:23:59.320
<v Speaker 8>had greatly increased, and when discussion of reproductive rights was

1:23:59.360 --> 1:24:03.080
<v Speaker 8>at the forefront, especially issues of birth control and abortion.

1:24:04.200 --> 1:24:07.120
<v Speaker 8>Genetic screening to look for sickle cell trait or sickle

1:24:07.200 --> 1:24:10.360
<v Speaker 8>cell anemia, although it was helpful in terms of getting

1:24:10.360 --> 1:24:13.519
<v Speaker 8>people the medical attention that they may need, it often

1:24:13.600 --> 1:24:18.280
<v Speaker 8>did an inadequate job of explaining what exactly the difference

1:24:18.320 --> 1:24:22.559
<v Speaker 8>between sickle cell trait and sickle cell anemia was. And

1:24:22.640 --> 1:24:28.240
<v Speaker 8>this inadequate explanation may have been unintentional or intentional at times.

1:24:28.240 --> 1:24:32.360
<v Speaker 8>It appears so people who had the trait just one

1:24:32.400 --> 1:24:36.120
<v Speaker 8>copy of the allele, were often openly discouraged from having

1:24:36.280 --> 1:24:41.800
<v Speaker 8>children and urged to have abortions or undergo sterilization procedures

1:24:41.840 --> 1:24:47.240
<v Speaker 8>that were sometimes made free as an incentive. Uh yeah.

1:24:47.520 --> 1:24:50.439
<v Speaker 8>And then the concept of mandatory screening for this and

1:24:50.520 --> 1:24:55.160
<v Speaker 8>other genetic disorders was floated, and Linus Pauling, the Nobel

1:24:55.200 --> 1:24:57.920
<v Speaker 8>Prize winner and whose name I mentioned earlier as being

1:24:58.040 --> 1:25:01.960
<v Speaker 8>the scientist yep, he suggests, did that everyone who had

1:25:01.960 --> 1:25:04.519
<v Speaker 8>the sickle cell trait should have it tattooed on their

1:25:04.560 --> 1:25:07.919
<v Speaker 8>forehead so that when they see another person with the tattoo,

1:25:08.040 --> 1:25:10.360
<v Speaker 8>they can avoid falling in love and wanting to have

1:25:10.479 --> 1:25:14.880
<v Speaker 8>children with them. What mm hmmm mm hmm.

1:25:15.640 --> 1:25:19.040
<v Speaker 9>Oh.

1:25:19.160 --> 1:25:25.200
<v Speaker 8>And these acts, these discussions, of course, resulted in accusations

1:25:25.560 --> 1:25:30.880
<v Speaker 8>of restricting black fertility, racial genocide, and new eugenics. And rightfully, so.

1:25:31.200 --> 1:25:33.360
<v Speaker 9>Yeah, that's what sounds like to me.

1:25:33.920 --> 1:25:38.160
<v Speaker 8>Oh yeah, And this misleading reproductive counseling for sickle cell

1:25:38.280 --> 1:25:42.320
<v Speaker 8>was just one way that reproductive restrictions were intentionally or

1:25:42.360 --> 1:25:47.439
<v Speaker 8>forcefully placed upon Black people. I really recommend Killing the

1:25:47.479 --> 1:25:50.400
<v Speaker 8>Black Body by Dorothy Roberts to read more about that topic.

1:25:52.160 --> 1:25:55.840
<v Speaker 8>And so, before wrapping up with the history of sickle

1:25:55.840 --> 1:25:58.599
<v Speaker 8>cell in the nineteen eighties and nineteen nineties. I want

1:25:58.640 --> 1:26:00.320
<v Speaker 8>to read a quote by the author of Dyeing in

1:26:00.360 --> 1:26:02.320
<v Speaker 8>the City of the Blues that I think does a

1:26:02.360 --> 1:26:04.920
<v Speaker 8>really good job of summing up the nineteen seventies and

1:26:04.960 --> 1:26:08.840
<v Speaker 8>sickle cell perfectly. The story of sickle cell disease in

1:26:08.880 --> 1:26:12.120
<v Speaker 8>the early nineteen seventies also revealed the ways in which

1:26:12.120 --> 1:26:16.360
<v Speaker 8>the political process both channeled and deflected the popular activism

1:26:16.439 --> 1:26:19.880
<v Speaker 8>of the time. It was a time of grudging recognition

1:26:20.000 --> 1:26:23.360
<v Speaker 8>of the black experience, but it proved difficult to translate

1:26:23.400 --> 1:26:27.639
<v Speaker 8>that awareness directly into health policy without creating enormous new,

1:26:27.720 --> 1:26:32.360
<v Speaker 8>stigmatizing burdens for Black Americans and without fostering growing cynicism

1:26:32.439 --> 1:26:37.720
<v Speaker 8>about racial politics. Yep, yep. And so that brings us

1:26:37.720 --> 1:26:40.680
<v Speaker 8>to the nineteen eighties and nineteen nineties. I don't want

1:26:40.680 --> 1:26:43.479
<v Speaker 8>to step on your toes too much, Aaron, about whatever

1:26:43.520 --> 1:26:45.080
<v Speaker 8>you're going to talk about. So I'm just going to

1:26:45.120 --> 1:26:48.599
<v Speaker 8>go over a few big developments or patterns that emerge

1:26:48.680 --> 1:26:52.400
<v Speaker 8>during this time with regard to sickle cell that I

1:26:52.439 --> 1:26:54.400
<v Speaker 8>have a feeling you'll talk more about.

1:26:54.600 --> 1:26:55.759
<v Speaker 9>Okay, let's see.

1:26:56.160 --> 1:27:00.439
<v Speaker 8>Yeah, So, as you mentioned pain management is a huge

1:27:00.439 --> 1:27:04.559
<v Speaker 8>component of sickle cell anemia, and the sympathy for people

1:27:04.800 --> 1:27:09.000
<v Speaker 8>with sickle cell that seemed characteristic of the nineteen sixties

1:27:09.000 --> 1:27:12.400
<v Speaker 8>and nineteen seventies kind of gave way to this disturbing

1:27:12.479 --> 1:27:17.840
<v Speaker 8>trend of cynicism and stigma. More and more healthcare providers

1:27:17.880 --> 1:27:20.639
<v Speaker 8>seem to simply not believe that people with sickle cell

1:27:20.640 --> 1:27:25.120
<v Speaker 8>anemia were experiencing a true painful episode, and there were

1:27:25.280 --> 1:27:29.040
<v Speaker 8>increasing reports of healthcare providers accusing their sickle cell anemia

1:27:29.120 --> 1:27:33.640
<v Speaker 8>patients of faking it, of exhibiting drug seeking behavior and

1:27:33.760 --> 1:27:39.000
<v Speaker 8>correspondingly limiting the pain medication prescribed. And earlier, when you

1:27:39.040 --> 1:27:42.719
<v Speaker 8>talked about the different timeline of when at different ages

1:27:42.720 --> 1:27:45.639
<v Speaker 8>you experience you're more likely to experience one symptom over another,

1:27:46.360 --> 1:27:51.080
<v Speaker 8>that the increase in painful episodes in late adolescents and

1:27:51.200 --> 1:27:56.559
<v Speaker 8>early adulthood is something that also made this whole made

1:27:56.560 --> 1:27:58.120
<v Speaker 8>this whole thing worse. They were like, oh, well, you're

1:27:58.160 --> 1:28:00.439
<v Speaker 8>a young adult, you're just seeking drugs, not going to

1:28:00.439 --> 1:28:03.439
<v Speaker 8>give you any Oh my god, And this is you know,

1:28:03.920 --> 1:28:06.680
<v Speaker 8>this is despite the fact that there was research indicating

1:28:06.920 --> 1:28:09.800
<v Speaker 8>that this wasn't going on, that people with sickle cell

1:28:09.800 --> 1:28:12.400
<v Speaker 8>anemia were just as worried about their own, you know,

1:28:12.520 --> 1:28:17.760
<v Speaker 8>narcotic consumption or pain medication consumption as as anyone else.

1:28:17.800 --> 1:28:21.240
<v Speaker 8>And it was it's just like it didn't seem to

1:28:21.280 --> 1:28:23.840
<v Speaker 8>make a difference. Yeah, it's like it seemed to be

1:28:24.000 --> 1:28:27.960
<v Speaker 8>like this this belief that became so embraced and like

1:28:28.000 --> 1:28:29.160
<v Speaker 8>so difficult to get rid of.

1:28:29.320 --> 1:28:32.080
<v Speaker 9>It's so frustrating that in so many papers that you read,

1:28:32.479 --> 1:28:35.719
<v Speaker 9>it's still something that is mentioned like, oh, you often

1:28:35.800 --> 1:28:38.880
<v Speaker 9>have to use opioids to treat pain, which can lead

1:28:38.920 --> 1:28:41.679
<v Speaker 9>to addiction. It's like that's true in anyone. And there's

1:28:41.760 --> 1:28:44.719
<v Speaker 9>no higher rates of opioid addiction in people with sickle

1:28:44.760 --> 1:28:47.719
<v Speaker 9>cellinemia than in the general population, Like there just isn't.

1:28:47.760 --> 1:28:51.719
<v Speaker 9>So it's it's infuriating that you'd be like withholding treatment

1:28:51.800 --> 1:28:52.720
<v Speaker 9>that is necessary.

1:28:53.120 --> 1:28:53.320
<v Speaker 5>Ough.

1:28:54.439 --> 1:28:56.640
<v Speaker 8>Yeah, well, and there's also there was also something that

1:28:56.720 --> 1:28:59.040
<v Speaker 8>was mentioned in this book about how there was research

1:28:59.120 --> 1:29:04.519
<v Speaker 8>indicating that opioid addictions starting from hospital treatments or medical

1:29:04.520 --> 1:29:08.040
<v Speaker 8>treatments is extraordinarily low. That is not the way that

1:29:08.080 --> 1:29:11.880
<v Speaker 8>the vast majority of opioid addictions begin. And so but

1:29:12.000 --> 1:29:14.960
<v Speaker 8>despite all this, this enormous bias still remains and this

1:29:15.040 --> 1:29:19.080
<v Speaker 8>is I mean, this is a larger issue. Yeah, the

1:29:19.080 --> 1:29:24.160
<v Speaker 8>invisibility of pain in medicine. We can't measure it, and

1:29:24.200 --> 1:29:27.559
<v Speaker 8>I think that that makes people trust it less, trust

1:29:27.760 --> 1:29:29.960
<v Speaker 8>the person less. And it sort of goes back to

1:29:30.000 --> 1:29:32.280
<v Speaker 8>what I was saying earlier about how like medicine became

1:29:32.320 --> 1:29:34.760
<v Speaker 8>more about the body and measurements and these things that

1:29:34.800 --> 1:29:37.920
<v Speaker 8>you could, you know, you could put on a chart.

1:29:37.960 --> 1:29:41.120
<v Speaker 8>Then it became about the person's experience itself.

1:29:41.200 --> 1:29:41.400
<v Speaker 3>Yeah.

1:29:41.439 --> 1:29:45.920
<v Speaker 8>So yeah, yeah, but you know, in this context, what

1:29:45.960 --> 1:29:51.080
<v Speaker 8>this meant, this this increasing you know, disbelief, was that

1:29:51.200 --> 1:29:54.559
<v Speaker 8>people with sickle cell anemia were at renewed risk for

1:29:54.840 --> 1:29:59.640
<v Speaker 8>their pain, their experience to once again be neglected, ignored,

1:29:59.840 --> 1:30:07.520
<v Speaker 8>and made invisible. And this persists today. This issue and

1:30:07.920 --> 1:30:11.800
<v Speaker 8>these decades also brought the promise of many different therapies

1:30:11.840 --> 1:30:15.120
<v Speaker 8>for sickle cell anemia, such as hydroxyurea as you mentioned,

1:30:15.120 --> 1:30:22.040
<v Speaker 8>and bone mirror transplantation, which didn't necessarily uphold the shiny

1:30:22.080 --> 1:30:25.200
<v Speaker 8>promises that had been made about them in their first introduction.

1:30:26.400 --> 1:30:30.680
<v Speaker 8>But I'm really hopeful to hear more about new approaches.

1:30:31.280 --> 1:30:34.320
<v Speaker 8>But I want to end now again with another quote,

1:30:34.680 --> 1:30:37.600
<v Speaker 8>again from Keith Wailu. The author of Dying in the

1:30:37.640 --> 1:30:42.000
<v Speaker 8>City of the Blues. For liberals, moderates, and conservatives alike,

1:30:42.080 --> 1:30:45.559
<v Speaker 8>the history of neglect and the disease's chronic, painful character

1:30:45.920 --> 1:30:49.120
<v Speaker 8>seemed to reflect White America's neglect and misunderstanding of black

1:30:49.160 --> 1:30:53.680
<v Speaker 8>health concerns and demanded attention. The disease became a multipurpose

1:30:53.760 --> 1:30:57.599
<v Speaker 8>metaphor a proxy in social, economic, and political debates about

1:30:57.600 --> 1:31:02.040
<v Speaker 8>a wide range of seemingly unrelated issues. Ye okay, erin,

1:31:02.600 --> 1:31:04.479
<v Speaker 8>bring me up to speed on what's going on with

1:31:04.560 --> 1:31:05.519
<v Speaker 8>sickle cell today.

1:31:05.840 --> 1:31:42.840
<v Speaker 9>Okay, let's take a quick break first, all right, So

1:31:43.720 --> 1:31:49.000
<v Speaker 9>we'll talk first about numbers, how many people are being

1:31:49.000 --> 1:31:52.800
<v Speaker 9>affected by sickle cell in the US and in the

1:31:52.800 --> 1:31:55.360
<v Speaker 9>world today, and then we'll touch a little bit more

1:31:55.400 --> 1:31:58.720
<v Speaker 9>on why that is and the malaria connection, because I

1:31:58.720 --> 1:32:00.759
<v Speaker 9>do think that's a really interesting part of the story.

1:32:01.760 --> 1:32:05.559
<v Speaker 9>And then we'll talk about current research. Does that sound good?

1:32:05.880 --> 1:32:06.439
<v Speaker 8>Sounds great?

1:32:06.600 --> 1:32:11.280
<v Speaker 9>Okay? So we'll talk first about the US and then globally.

1:32:13.040 --> 1:32:17.200
<v Speaker 9>So in the US, newborn screening is conducted since two

1:32:17.200 --> 1:32:19.200
<v Speaker 9>thousand and six or two thousand and seven across the

1:32:19.240 --> 1:32:21.559
<v Speaker 9>board in all states plus Puerto Rico, and the US

1:32:21.600 --> 1:32:25.920
<v Speaker 9>Virgin Islands, so we know the rates of sickle cell

1:32:26.000 --> 1:32:30.080
<v Speaker 9>allele in the population. So one copy having one copy

1:32:30.120 --> 1:32:34.040
<v Speaker 9>of the sickle cell trait okay. So overall in the

1:32:34.160 --> 1:32:38.720
<v Speaker 9>US in twenty ten, the incidence was fifteen per one

1:32:38.760 --> 1:32:43.800
<v Speaker 9>thousand babies born trait trait okay. But this is a

1:32:43.920 --> 1:32:48.120
<v Speaker 9>huge range, from seventy three per one thousand among black

1:32:48.160 --> 1:32:54.120
<v Speaker 9>newborns to two per one thousand in Asian, Native, Hawaiian

1:32:54.160 --> 1:32:59.799
<v Speaker 9>and Pacific Islander newborns, three in white babies, and seven

1:33:00.040 --> 1:33:03.479
<v Speaker 9>per one thousand in Hispanic newborns.

1:33:03.560 --> 1:33:06.400
<v Speaker 8>And this is voluntary or mandatory screening.

1:33:06.560 --> 1:33:11.200
<v Speaker 9>So newborn screening is generally it's universal. I think it

1:33:11.320 --> 1:33:14.960
<v Speaker 9>is possible to opt out of it, but in general

1:33:15.040 --> 1:33:18.360
<v Speaker 9>it's universal and kind of recommended. I think most of

1:33:18.360 --> 1:33:21.080
<v Speaker 9>the time they don't want to let you leave the

1:33:21.080 --> 1:33:25.200
<v Speaker 9>hospital without newborn screening because it doesn't only screen for

1:33:25.240 --> 1:33:27.960
<v Speaker 9>sickle cell. This screen's for a whole bunch of different

1:33:28.439 --> 1:33:31.880
<v Speaker 9>We talked about this in the cystic fibrosis episode as well,

1:33:31.960 --> 1:33:36.120
<v Speaker 9>right right, because you're also identifying then those newborns with

1:33:36.200 --> 1:33:39.080
<v Speaker 9>sickle cell anemia. But what's interesting is that it's actually

1:33:39.200 --> 1:33:42.240
<v Speaker 9>hard to get a number on the number of babies

1:33:42.720 --> 1:33:45.479
<v Speaker 9>in the US born with sickle cell anemia, which I

1:33:45.520 --> 1:33:47.879
<v Speaker 9>think is interesting. So let's talk about the whole globe.

1:33:48.120 --> 1:33:50.479
<v Speaker 9>How many people are born every year with sickle cell

1:33:50.600 --> 1:33:56.760
<v Speaker 9>anemia globally. Estimates are about three hundred thousand, just over

1:33:56.840 --> 1:34:01.080
<v Speaker 9>three hundred thousand babies born every year with sickle cell anemia.

1:34:01.600 --> 1:34:02.839
<v Speaker 8>That's a huge number.

1:34:03.360 --> 1:34:06.880
<v Speaker 9>It's a massive number, and I want to point out

1:34:06.880 --> 1:34:10.640
<v Speaker 9>that that number is the number of babies born with

1:34:10.880 --> 1:34:16.519
<v Speaker 9>sickle cell HBSS. But remember that there are other ways

1:34:16.560 --> 1:34:19.080
<v Speaker 9>that you can have sickle cell anemia, right. You could

1:34:19.120 --> 1:34:22.439
<v Speaker 9>have it with one copy of HBS and one copy

1:34:22.520 --> 1:34:25.240
<v Speaker 9>of beta thalacemia. You could have it with one copy

1:34:25.280 --> 1:34:30.960
<v Speaker 9>of HBS and one copy of HBC. Those aren't included

1:34:31.000 --> 1:34:34.639
<v Speaker 9>in that estimate of three hundred thousand. So it's thought

1:34:34.720 --> 1:34:37.640
<v Speaker 9>that that total number accounts for about seventy percent of

1:34:37.680 --> 1:34:40.880
<v Speaker 9>the total amount of sickle cell disease, so that whole

1:34:41.000 --> 1:34:47.519
<v Speaker 9>range of clinical disease worldwide. And it's also estimated that

1:34:47.560 --> 1:34:52.040
<v Speaker 9>about half of these babies worldwide are born in Nigeria,

1:34:52.439 --> 1:34:57.519
<v Speaker 9>the Democratic Republic of Congo, and India, and that in

1:34:57.600 --> 1:35:03.360
<v Speaker 9>many parts of Sub Saharan Africa, sickle cell anemia might

1:35:03.400 --> 1:35:07.080
<v Speaker 9>be responsible for as much as six percent of all

1:35:07.160 --> 1:35:12.519
<v Speaker 9>childhood mortality. Six percent, Oh my god, just from sickle

1:35:12.520 --> 1:35:15.920
<v Speaker 9>cell anemia. Because in many places, in many parts of

1:35:15.920 --> 1:35:20.080
<v Speaker 9>the world, under five mortality from sickle cell anemia, so

1:35:20.200 --> 1:35:22.639
<v Speaker 9>dying before your fifth birthday can be as high as

1:35:22.720 --> 1:35:27.280
<v Speaker 9>fifty to ninety percent, which is atrocious.

1:35:27.800 --> 1:35:28.240
<v Speaker 8>Wow.

1:35:28.640 --> 1:35:35.479
<v Speaker 9>Yeah, wow, yeah yeah. And that's because if babies aren't

1:35:35.520 --> 1:35:41.120
<v Speaker 9>identified by newborn screening, then they don't receive penicillin prophylaxis,

1:35:41.240 --> 1:35:44.880
<v Speaker 9>or they don't receive adequate vaccinations, then it's very common

1:35:44.920 --> 1:35:48.400
<v Speaker 9>that they will die from overwhelming infection before they turn five.

1:35:49.560 --> 1:35:52.760
<v Speaker 9>So that's why newborn screening is so important and has

1:35:52.800 --> 1:35:55.800
<v Speaker 9>been so helpful. Like it's only worth screening if you

1:35:55.800 --> 1:35:58.040
<v Speaker 9>can do something about it, right, So we screen for

1:35:58.120 --> 1:36:02.719
<v Speaker 9>things that we can prevent death if we identify them early.

1:36:02.880 --> 1:36:04.799
<v Speaker 9>And so that's what we can do with newborn screening.

1:36:05.160 --> 1:36:07.639
<v Speaker 8>Yeah, I think it's just been It's like I mean,

1:36:07.680 --> 1:36:10.400
<v Speaker 8>and this is in general. Newborn screening or any kind

1:36:10.439 --> 1:36:14.639
<v Speaker 8>of genetic screening is such a touchy issue because it

1:36:14.680 --> 1:36:17.320
<v Speaker 8>can so easily lead to you know, who has that

1:36:17.400 --> 1:36:20.960
<v Speaker 8>information and how can I use it against you absolutely.

1:36:21.000 --> 1:36:23.519
<v Speaker 9>I mean, plus it gets into so many things of

1:36:24.080 --> 1:36:27.439
<v Speaker 9>So if you identify a newborn with a genetic trait,

1:36:28.080 --> 1:36:31.720
<v Speaker 9>that had to come from either mom or dad, right,

1:36:32.160 --> 1:36:34.240
<v Speaker 9>so now you know that either mom or dad has this.

1:36:34.400 --> 1:36:36.240
<v Speaker 9>Maybe they didn't want to know that. Like, there's a

1:36:36.280 --> 1:36:40.240
<v Speaker 9>whole the ethics of all of that is wide ranging

1:36:40.280 --> 1:36:43.000
<v Speaker 9>and more than we can talk about in this episode. Yes,

1:36:43.160 --> 1:36:46.960
<v Speaker 9>but identifying babies with sickle cell anemia prevents them from dying,

1:36:47.080 --> 1:36:50.960
<v Speaker 9>So in that way it's extremely important and helpful. But

1:36:51.120 --> 1:36:54.919
<v Speaker 9>despite the fact that this is a very common disease

1:36:55.040 --> 1:36:59.800
<v Speaker 9>and a very common trait among the population, like you said,

1:37:00.000 --> 1:37:04.439
<v Speaker 9>funding discrepancies remain, which is why to date we have

1:37:04.640 --> 1:37:10.880
<v Speaker 9>only one disease modifying treatment, that is hydroxyurea. So I

1:37:10.920 --> 1:37:13.120
<v Speaker 9>want to talk I want to give some more specific numbers.

1:37:13.160 --> 1:37:15.640
<v Speaker 9>You mentioned them from I think the sixties and seventies,

1:37:16.000 --> 1:37:19.000
<v Speaker 9>so let's talk about the last decade, from two thousand

1:37:19.000 --> 1:37:20.280
<v Speaker 9>and eight to twenty eighteen.

1:37:20.600 --> 1:37:22.320
<v Speaker 8>Is that I was hoping you would do this.

1:37:22.320 --> 1:37:24.280
<v Speaker 9>This paper just came out in March of this year.

1:37:26.200 --> 1:37:31.640
<v Speaker 9>So we'll compare federal funding per person between cystic fibrosis,

1:37:31.840 --> 1:37:34.880
<v Speaker 9>which we did an episode on and sickle cell disease. So,

1:37:34.880 --> 1:37:38.439
<v Speaker 9>cystic fibrosis is another genetic disorder. It's also identified on

1:37:38.479 --> 1:37:41.839
<v Speaker 9>newborn screens. It's also like the most common genetic disorder

1:37:41.920 --> 1:37:48.639
<v Speaker 9>among white babies. So compared with cystic fibrosis, per person

1:37:48.720 --> 1:37:53.400
<v Speaker 9>with the disease. In the US, cystic fibrosis received two thousand,

1:37:53.560 --> 1:37:58.679
<v Speaker 9>eight hundred dollars in federal funding compared to eight hundred

1:37:59.040 --> 1:38:02.800
<v Speaker 9>for sickle cell. Wow, that's two thousand dollars more. And

1:38:02.920 --> 1:38:07.080
<v Speaker 9>it's even worse if you look at charitable foundation expenditures

1:38:07.520 --> 1:38:12.880
<v Speaker 9>cystic fibrosis seven thousand, six hundred dollars per person with

1:38:12.960 --> 1:38:16.120
<v Speaker 9>cystic fibrosis compared to one hundred.

1:38:16.520 --> 1:38:18.840
<v Speaker 8>Oh my god, oh my for sickle cell.

1:38:20.960 --> 1:38:25.200
<v Speaker 9>Which I mean this directly leads to a discrepancy in

1:38:25.280 --> 1:38:28.679
<v Speaker 9>the number of new drug approvals. In that same time period,

1:38:28.880 --> 1:38:32.640
<v Speaker 9>four new drugs were approved for cystic fibrosis, one for

1:38:32.800 --> 1:38:33.360
<v Speaker 9>sickle cell.

1:38:33.680 --> 1:38:35.680
<v Speaker 8>I mean, it just it just trickles down and down

1:38:35.720 --> 1:38:38.800
<v Speaker 8>and down. Like you have the research money, you have

1:38:39.080 --> 1:38:43.400
<v Speaker 8>treatment accessibility, you have new treatments being developed, you have healthcare,

1:38:43.560 --> 1:38:46.680
<v Speaker 8>access to healthcare, like all of these different components to it,

1:38:46.760 --> 1:38:48.840
<v Speaker 8>which is yeah.

1:38:48.280 --> 1:38:50.640
<v Speaker 9>And so to put like a specific number two on

1:38:50.880 --> 1:38:54.120
<v Speaker 9>the difference in terms of overall prevalence of sickle cell

1:38:54.840 --> 1:38:58.160
<v Speaker 9>versus cystic fibrosis in the US. This paper reported the

1:38:58.320 --> 1:39:02.080
<v Speaker 9>US birth rate of stickle cell disease is one in

1:39:02.320 --> 1:39:08.120
<v Speaker 9>three hundred and sixty five black babies. For cystic fibrosis,

1:39:08.200 --> 1:39:12.840
<v Speaker 9>it's one. It's very high. That's scary high. For cystic fibrosis.

1:39:12.920 --> 1:39:17.760
<v Speaker 9>It's one in twenty five hundred white babies, which is

1:39:17.800 --> 1:39:20.640
<v Speaker 9>also you could say, very high, but one in three

1:39:20.760 --> 1:39:22.519
<v Speaker 9>sixty five is a lot higher.

1:39:23.600 --> 1:39:25.760
<v Speaker 8>But yeah, when you when you put the numbers side

1:39:25.800 --> 1:39:28.959
<v Speaker 8>by side, it is very I mean, it's not surprising,

1:39:29.000 --> 1:39:34.560
<v Speaker 8>but it is appalling that I know there's such unequal support, yeah, funds.

1:39:34.520 --> 1:39:36.800
<v Speaker 9>And so I think it kind of leads to a

1:39:36.840 --> 1:39:40.400
<v Speaker 9>really important question about why is it that this is

1:39:40.439 --> 1:39:42.599
<v Speaker 9>such a prevalent disease. Because a lot of times when

1:39:42.640 --> 1:39:46.840
<v Speaker 9>we have genetic diseases that are recessive, so you have

1:39:46.880 --> 1:39:52.240
<v Speaker 9>to have two copies of that allele in theory evolutionarily

1:39:52.280 --> 1:39:55.720
<v Speaker 9>that that allele that mutation should die out right if

1:39:55.760 --> 1:39:58.120
<v Speaker 9>it's so bad that if you have two copies of

1:39:58.160 --> 1:39:59.960
<v Speaker 9>it you end up dying before the age of five,

1:40:00.640 --> 1:40:02.519
<v Speaker 9>You're not going to be reproducing, so you're not going

1:40:02.600 --> 1:40:05.000
<v Speaker 9>to be passing on that allele. So why is it

1:40:05.040 --> 1:40:10.479
<v Speaker 9>at such high prevalence in the black population. Here's why,

1:40:11.200 --> 1:40:15.800
<v Speaker 9>or at least what we think. It turns out that

1:40:15.880 --> 1:40:19.280
<v Speaker 9>if you have one copy of this allele, it's very

1:40:19.320 --> 1:40:25.559
<v Speaker 9>protective against dying from malaria. It's very protective against infection

1:40:26.040 --> 1:40:32.080
<v Speaker 9>severe infection with Plasmodium falciparum malaria. So in regions where

1:40:32.160 --> 1:40:35.640
<v Speaker 9>Plasmodium falciparum malaria, so that one species of malaria is

1:40:35.880 --> 1:40:41.519
<v Speaker 9>very very prevalent, the prevalence of this specific mutation is

1:40:41.640 --> 1:40:45.200
<v Speaker 9>also very prevalent. What I think is so interesting is

1:40:45.240 --> 1:40:48.000
<v Speaker 9>like this has been kind of an epidemial. We've shown

1:40:48.000 --> 1:40:53.599
<v Speaker 9>this epidemiologically in so many many studies just how massive

1:40:53.600 --> 1:40:57.440
<v Speaker 9>the protection is. But there's still not a clear molecular

1:40:57.520 --> 1:41:01.960
<v Speaker 9>answer as to how one copy of this allele protects

1:41:02.040 --> 1:41:06.639
<v Speaker 9>you against dying from malaria. Overall, it seems like if

1:41:06.680 --> 1:41:12.360
<v Speaker 9>you have some of that HBS beta hemoglobin, then your

1:41:12.400 --> 1:41:16.160
<v Speaker 9>cells can eventually sickle, and then those cells that are

1:41:16.200 --> 1:41:21.320
<v Speaker 9>infected with plasmodium, the plasmodium doesn't replicate, so essentially malaria

1:41:21.360 --> 1:41:24.559
<v Speaker 9>can't grow as well in those cells for like a

1:41:24.640 --> 1:41:27.960
<v Speaker 9>number of different reasons that we still don't fully understand.

1:41:27.560 --> 1:41:30.080
<v Speaker 8>Right, But it's it's only in the cells that have sickled.

1:41:30.760 --> 1:41:34.960
<v Speaker 9>Yeah, And so it turns out that infected cells tend

1:41:35.000 --> 1:41:40.080
<v Speaker 9>to sequester in certain organs that have low oxygen concentration. Right,

1:41:40.360 --> 1:41:43.200
<v Speaker 9>So then those cells something yeah, spleen and liver. So

1:41:43.240 --> 1:41:46.000
<v Speaker 9>then those cells end up sickling because of that. So

1:41:46.040 --> 1:41:49.240
<v Speaker 9>whereas normally, if you just have one copy, your cells

1:41:49.280 --> 1:41:53.160
<v Speaker 9>wouldn't sickle very often, but these infected cells get sequestered

1:41:53.240 --> 1:41:56.439
<v Speaker 9>under low oxygen concentration and then end up sickling, and

1:41:56.479 --> 1:41:58.439
<v Speaker 9>then the plasmodium can't replicate.

1:41:58.920 --> 1:41:59.839
<v Speaker 8>That's really interesting.

1:42:00.080 --> 1:42:02.400
<v Speaker 9>Yeah, it's pretty interesting. So I'll post a paper, one

1:42:02.400 --> 1:42:05.000
<v Speaker 9>of the more recent papers I found, going into more

1:42:05.000 --> 1:42:10.240
<v Speaker 9>detail on that if you're interested. But yeah, so then

1:42:10.280 --> 1:42:12.360
<v Speaker 9>I guess the question is where do we go from here?

1:42:12.400 --> 1:42:16.439
<v Speaker 9>And even though we only get what one hundred or

1:42:16.640 --> 1:42:20.760
<v Speaker 9>eight hundred research dollars per twenty eight hundred versystic virosis,

1:42:21.280 --> 1:42:24.720
<v Speaker 9>is their research going on about more treatments? And the

1:42:24.760 --> 1:42:29.479
<v Speaker 9>answer is yes, there's actually some pretty exciting in terms

1:42:29.520 --> 1:42:35.200
<v Speaker 9>of technology treatments on the Horizon. So we have a

1:42:35.320 --> 1:42:38.520
<v Speaker 9>very special guest on today to talk about the wonderful

1:42:38.560 --> 1:42:43.920
<v Speaker 9>world of genome editing and specifically CRISPER as it relates

1:42:43.960 --> 1:42:48.880
<v Speaker 9>to treatment options for sickle cell disease and other genetic disorders.

1:42:49.880 --> 1:42:54.120
<v Speaker 9>So let me introduce doctor Meghan Hawkstrasser, the Education Programs

1:42:54.200 --> 1:42:58.200
<v Speaker 9>Manager at Innovative Genomics Institute in Berkeley, who's here to

1:42:58.280 --> 1:43:01.160
<v Speaker 9>tell us in much greater detail than I ever could,

1:43:01.560 --> 1:43:04.800
<v Speaker 9>what CRISPER is, a little bit about genome editing, and

1:43:04.840 --> 1:43:07.200
<v Speaker 9>what that even means, how we can use it for

1:43:07.280 --> 1:43:10.280
<v Speaker 9>diseases like sickle cell, what some of the drawbacks might be,

1:43:10.760 --> 1:43:13.680
<v Speaker 9>and how far away we are from technology like this

1:43:13.880 --> 1:43:16.040
<v Speaker 9>being in everyone's life.

1:43:16.520 --> 1:43:17.040
<v Speaker 8>Excellent.

1:43:18.280 --> 1:43:20.720
<v Speaker 5>My name is Megan Hawkstrasser, and I work for the

1:43:20.720 --> 1:43:25.360
<v Speaker 5>Innovative Genomics Institute or IGI, at UC Berkeley. I am

1:43:25.360 --> 1:43:29.519
<v Speaker 5>the education program Manager, so I basically try to talk

1:43:29.560 --> 1:43:32.080
<v Speaker 5>to people about all of the research that our institute

1:43:32.120 --> 1:43:34.640
<v Speaker 5>does and the science behind it and help them understand

1:43:34.680 --> 1:43:37.559
<v Speaker 5>what it means and what it's all about. So the IGI,

1:43:37.720 --> 1:43:40.599
<v Speaker 5>or the Innovative Genomics Institute, is a partnership between UC

1:43:40.760 --> 1:43:43.520
<v Speaker 5>Berkeley and you see San Francisco, So we're a nonprofit

1:43:43.840 --> 1:43:48.400
<v Speaker 5>research group doing academic research trying to use genetic engineering

1:43:48.439 --> 1:43:52.439
<v Speaker 5>tools like Crisper to solve big world problems. So we

1:43:52.479 --> 1:43:57.320
<v Speaker 5>work in biomedicine and human health. We work in sustainable agriculture,

1:43:57.800 --> 1:44:01.840
<v Speaker 5>and we basically try to improve based and other technologies

1:44:01.880 --> 1:44:05.160
<v Speaker 5>that are used to manipulate DNA in different ways, improve

1:44:05.200 --> 1:44:07.959
<v Speaker 5>the tools and then apply them to solve different problems.

1:44:08.320 --> 1:44:13.160
<v Speaker 9>Oh my gosh, that's amazing good. Oh that is so cool. Well,

1:44:13.200 --> 1:44:15.439
<v Speaker 9>so could you start off just by telling us what

1:44:15.640 --> 1:44:19.120
<v Speaker 9>exactly CRISPER is. I think that people have heard that term,

1:44:19.160 --> 1:44:21.240
<v Speaker 9>but a lot of us don't know what it means.

1:44:21.960 --> 1:44:24.719
<v Speaker 5>Sure, I mean I got my PhD study in CRISPER,

1:44:24.720 --> 1:44:27.719
<v Speaker 5>and I still am behind the times and understanding every

1:44:27.800 --> 1:44:32.320
<v Speaker 5>little bit about it. It's really complicated, and actually there's

1:44:32.400 --> 1:44:36.000
<v Speaker 5>new Crisper tools and Crisper news like every other day,

1:44:36.080 --> 1:44:39.840
<v Speaker 5>so it's hard to keep up with. But at the core, Crisper,

1:44:39.880 --> 1:44:42.839
<v Speaker 5>in the most basic terms, is a way of changing DNA.

1:44:43.280 --> 1:44:46.680
<v Speaker 5>So it's a tool that scientists can use to make targeted,

1:44:46.800 --> 1:44:50.360
<v Speaker 5>precise changes in the sequence of DNA that's in a

1:44:50.400 --> 1:44:54.919
<v Speaker 5>living cell or organism. So this is really impactful because

1:44:55.200 --> 1:44:58.920
<v Speaker 5>previously we were kind of limited to, you know, making

1:44:58.960 --> 1:45:01.880
<v Speaker 5>synthetic DNA in a tube or something in the lab

1:45:01.960 --> 1:45:04.959
<v Speaker 5>and kind of adding that to a cell, or breeding

1:45:05.080 --> 1:45:07.720
<v Speaker 5>two plants together to try to change the DNA in

1:45:07.800 --> 1:45:11.840
<v Speaker 5>the plant, the progeny plant, the child plant. But now

1:45:11.840 --> 1:45:14.559
<v Speaker 5>we can take something that is alive, like a human being,

1:45:15.040 --> 1:45:18.519
<v Speaker 5>make changes in their cells to change the DNA sequence,

1:45:18.560 --> 1:45:20.519
<v Speaker 5>and they will continue to be alive. So that's a

1:45:20.560 --> 1:45:25.120
<v Speaker 5>really amazing advancement. Actually, so genome editing is actually the

1:45:25.560 --> 1:45:29.320
<v Speaker 5>bigger category. So crisper is one type of genome editing tool.

1:45:30.080 --> 1:45:33.040
<v Speaker 8>It is. So it's like, I feel like I'm living

1:45:33.080 --> 1:45:33.719
<v Speaker 8>in the future.

1:45:34.320 --> 1:45:34.720
<v Speaker 6>It is.

1:45:35.120 --> 1:45:39.360
<v Speaker 8>It's incredible. So specifically, you know this in this episode,

1:45:39.360 --> 1:45:43.000
<v Speaker 8>we're focusing on sickle cell disease, and recently in the

1:45:43.040 --> 1:45:46.960
<v Speaker 8>news there was you know, stories about using genome editing

1:45:47.320 --> 1:45:51.400
<v Speaker 8>to treat sickle cell disease, and could you maybe walk

1:45:51.479 --> 1:45:55.240
<v Speaker 8>us through how that is done, Like what in the

1:45:55.280 --> 1:45:58.559
<v Speaker 8>case of sickle cell how crisper was used to treat

1:45:58.600 --> 1:45:59.120
<v Speaker 8>the disease.

1:45:59.600 --> 1:46:03.000
<v Speaker 5>Sure. Yeah, So it's been a really exciting time to

1:46:03.120 --> 1:46:06.240
<v Speaker 5>be in the crisper field because I was there kind

1:46:06.280 --> 1:46:08.400
<v Speaker 5>of before it was used as a genomeediting tool, and

1:46:08.479 --> 1:46:11.479
<v Speaker 5>I was just interested in what it's normally doing, which

1:46:11.520 --> 1:46:13.519
<v Speaker 5>I don't have to get into because it's a long story.

1:46:13.520 --> 1:46:16.599
<v Speaker 5>But crisper actually comes from bacteria, and it's just this

1:46:17.080 --> 1:46:20.559
<v Speaker 5>system that bacteria used to fend off viruses that infect them,

1:46:20.680 --> 1:46:24.160
<v Speaker 5>which sounds so obscure and not interesting, but we were

1:46:24.200 --> 1:46:26.640
<v Speaker 5>able to take this tool from bacteria and kind of

1:46:26.680 --> 1:46:28.680
<v Speaker 5>steal it and use it for our own purposes. So

1:46:29.040 --> 1:46:31.439
<v Speaker 5>I've been watching the development of this field since the

1:46:31.520 --> 1:46:35.559
<v Speaker 5>very beginning, and it's been amazing actually to see when

1:46:36.160 --> 1:46:39.559
<v Speaker 5>patients like the person who's been covered in NPR who

1:46:39.560 --> 1:46:43.120
<v Speaker 5>has sickle cell talking about how they have been essentially

1:46:43.200 --> 1:46:47.120
<v Speaker 5>cured fingers crossed. It seems like she's really been cured

1:46:47.120 --> 1:46:49.160
<v Speaker 5>of the disease. So it's been incredible to watch from

1:46:49.200 --> 1:46:52.599
<v Speaker 5>the beginning, so it's very exciting. I guess I would

1:46:52.640 --> 1:46:56.960
<v Speaker 5>say there are two general approaches to using crisper to

1:46:57.040 --> 1:47:00.920
<v Speaker 5>treat sickle cell disease, and they're really different in a

1:47:00.960 --> 1:47:04.440
<v Speaker 5>conceptual way. So the most straightforward way you can imagine

1:47:04.479 --> 1:47:07.040
<v Speaker 5>to fix a genetic disease would be to go in

1:47:07.200 --> 1:47:10.320
<v Speaker 5>and change whatever the mutated letter is in the DNA

1:47:10.680 --> 1:47:14.760
<v Speaker 5>to the correct letter, right, And that's what our institute

1:47:14.800 --> 1:47:17.559
<v Speaker 5>is trying to do for sickle cell disease. That's our approach.

1:47:17.600 --> 1:47:22.679
<v Speaker 5>It's kind of conceptually straightforward and understandable. The approach being

1:47:22.800 --> 1:47:25.479
<v Speaker 5>used to treat the patients who are now in the

1:47:25.479 --> 1:47:28.479
<v Speaker 5>news being treated for sickle cell disease with Crisper is

1:47:28.520 --> 1:47:31.639
<v Speaker 5>a little bit different. So instead of trying to fix

1:47:31.720 --> 1:47:35.280
<v Speaker 5>the mutation in the hemoglobin gene that is causing their disease,

1:47:35.800 --> 1:47:40.719
<v Speaker 5>instead those clinicians are editing cells to start producing something

1:47:40.760 --> 1:47:44.880
<v Speaker 5>called fetal hemoglobin. So instead of fixing the broken hemoglobin,

1:47:45.120 --> 1:47:48.000
<v Speaker 5>they actually turn back on this other hemoglobin that all

1:47:48.040 --> 1:47:50.400
<v Speaker 5>of our cells have the instructions to make but is

1:47:50.560 --> 1:47:55.040
<v Speaker 5>turned off, and that hemoglobin can compensate for the damaged one.

1:47:55.880 --> 1:48:00.320
<v Speaker 8>That is so amazing, it's so incredible. Wow. And is

1:48:00.360 --> 1:48:03.439
<v Speaker 8>this like a treatment like Crisper? Does it fall under

1:48:03.479 --> 1:48:05.360
<v Speaker 8>the category of treatment or cure?

1:48:05.880 --> 1:48:06.120
<v Speaker 1>Right?

1:48:06.320 --> 1:48:09.439
<v Speaker 5>So, in theory, Crisper could be a one time fix

1:48:09.520 --> 1:48:12.240
<v Speaker 5>for something like sickle cell disease. I think we're not

1:48:12.320 --> 1:48:14.880
<v Speaker 5>going to know how long things like this last until

1:48:14.880 --> 1:48:17.840
<v Speaker 5>we actually try them in a person, because we can

1:48:17.880 --> 1:48:19.840
<v Speaker 5>test something in a mouse, but mice live for a

1:48:19.880 --> 1:48:22.080
<v Speaker 5>couple of years and then you don't know right. So

1:48:22.160 --> 1:48:25.120
<v Speaker 5>I think it remains to be seen how long lasting

1:48:25.160 --> 1:48:27.519
<v Speaker 5>the effects are, and it also remains to be seen

1:48:27.560 --> 1:48:29.799
<v Speaker 5>whether or not there are side effects that will pop

1:48:29.960 --> 1:48:32.479
<v Speaker 5>up later that we haven't been able to detect early on.

1:48:32.920 --> 1:48:35.880
<v Speaker 5>But so far it seems like things are going well. Again,

1:48:35.960 --> 1:48:39.080
<v Speaker 5>this is only like two patients for which there are data,

1:48:39.640 --> 1:48:43.519
<v Speaker 5>but I think it's really promising. And that's what's exciting

1:48:43.520 --> 1:48:46.760
<v Speaker 5>about genomediting in general to me, is that you could

1:48:46.760 --> 1:48:49.080
<v Speaker 5>do a one time treatment because you're not treating the

1:48:49.160 --> 1:48:51.800
<v Speaker 5>symptoms of a disease. You're not doing some kind of

1:48:53.080 --> 1:48:55.880
<v Speaker 5>lateral approach to kind of helping the person but not

1:48:55.920 --> 1:49:00.400
<v Speaker 5>actually fixing the underlying cause. With genomeeditting, we can in theory,

1:49:00.560 --> 1:49:04.680
<v Speaker 5>correct the underlying mutations. We can change someone's DNA in

1:49:04.720 --> 1:49:08.320
<v Speaker 5>their cells and keep them from having any kind of symptoms,

1:49:08.400 --> 1:49:12.320
<v Speaker 5>basically wiping out whatever the disease is. So it's super promising.

1:49:13.120 --> 1:49:15.479
<v Speaker 5>I think one thing to note is that for some

1:49:15.520 --> 1:49:19.760
<v Speaker 5>conditions you've already done damage, Like just living with some

1:49:20.080 --> 1:49:22.320
<v Speaker 5>of the genetic diseases that are out there, like sickle

1:49:22.360 --> 1:49:25.200
<v Speaker 5>cell causes a lot of damage to your tissues, and

1:49:25.280 --> 1:49:28.040
<v Speaker 5>there are things that you can't change once they've already happened.

1:49:28.080 --> 1:49:32.360
<v Speaker 5>They're irreversible. But in theory, with sickle cell, you could

1:49:32.400 --> 1:49:36.400
<v Speaker 5>stop future crises like pain crises where the cells pile

1:49:36.560 --> 1:49:38.280
<v Speaker 5>up and get stuck in a cell and cause really

1:49:38.439 --> 1:49:40.680
<v Speaker 5>horrible pain and more damage. So you could kind of

1:49:41.040 --> 1:49:45.000
<v Speaker 5>halt the progression of the disease permanently. But that still

1:49:45.000 --> 1:49:45.960
<v Speaker 5>remains to be tested.

1:49:46.479 --> 1:49:49.360
<v Speaker 9>So I guess that kind of leads into our next question,

1:49:49.400 --> 1:49:52.160
<v Speaker 9>which is how close are we to this being something

1:49:52.280 --> 1:49:55.400
<v Speaker 9>that you know is more commonly used beyond just a

1:49:55.439 --> 1:49:56.480
<v Speaker 9>couple of patients.

1:49:57.520 --> 1:50:00.519
<v Speaker 5>I think we're farther away than I would want to be,

1:50:01.000 --> 1:50:03.480
<v Speaker 5>So I think it's going to be a slow process.

1:50:03.560 --> 1:50:05.920
<v Speaker 5>And this is something I have to deal with all

1:50:05.960 --> 1:50:07.800
<v Speaker 5>the time when I'm talking to people I know who

1:50:07.840 --> 1:50:10.559
<v Speaker 5>have various diseases or I'm giving public talks, is that

1:50:10.640 --> 1:50:14.560
<v Speaker 5>everyone wants their disease to be cured today or yesterday,

1:50:15.240 --> 1:50:19.160
<v Speaker 5>and it's just a very slow process. So sickle cell

1:50:19.439 --> 1:50:24.040
<v Speaker 5>is one of the most mechanically treatable diseases, so there's

1:50:24.080 --> 1:50:26.280
<v Speaker 5>just details about the way it works that make it

1:50:26.439 --> 1:50:30.280
<v Speaker 5>treatable using genetic engineering or genome editing, and there are

1:50:30.280 --> 1:50:33.040
<v Speaker 5>a couple of other conditions that are also possible to

1:50:33.040 --> 1:50:35.719
<v Speaker 5>do with our current technologies, and so they're coming first.

1:50:36.120 --> 1:50:39.360
<v Speaker 5>But there are thousands of genetic diseases out there, and

1:50:39.439 --> 1:50:41.599
<v Speaker 5>all of those deserve to have some sort of treatment.

1:50:41.720 --> 1:50:45.000
<v Speaker 5>So I think it's going to be probably a couple

1:50:45.120 --> 1:50:51.320
<v Speaker 5>decades before we start having really common treatments using genome editing.

1:50:52.160 --> 1:50:55.519
<v Speaker 5>Right now, we have I guess maybe three or four

1:50:55.760 --> 1:50:59.040
<v Speaker 5>genetic diseases are in clinical trials using CRISPER, and the

1:50:59.080 --> 1:51:02.280
<v Speaker 5>clinical trial process us takes years. But I think I

1:51:02.320 --> 1:51:04.600
<v Speaker 5>would be shocked if you had told me when I

1:51:04.640 --> 1:51:08.000
<v Speaker 5>was in graduate school that just, you know, six years later,

1:51:08.080 --> 1:51:11.200
<v Speaker 5>basically someone would be cured of a disease using CRISPER.

1:51:11.400 --> 1:51:13.879
<v Speaker 5>I would be stunned. I wouldn't have thought that was possible.

1:51:13.960 --> 1:51:17.120
<v Speaker 5>So I think it is moving very fast in scientific terms,

1:51:17.160 --> 1:51:20.040
<v Speaker 5>but it can be kind of slow in human terms.

1:51:20.320 --> 1:51:23.439
<v Speaker 8>Mm hm, that makes sense, yeah, yeah, And so I guess,

1:51:23.600 --> 1:51:27.720
<v Speaker 8>speaking of clinical trials and you know why, there might

1:51:27.800 --> 1:51:30.800
<v Speaker 8>be potential for this to take a little bit longer

1:51:30.840 --> 1:51:34.240
<v Speaker 8>than other traditional treatments. Are there or have there been

1:51:34.320 --> 1:51:39.839
<v Speaker 8>observed any downsides to Crisper either in the technology itself,

1:51:39.880 --> 1:51:43.040
<v Speaker 8>whether it's like expensive or in sort of like the

1:51:43.120 --> 1:51:44.840
<v Speaker 8>you know, side effect kind of way.

1:51:45.400 --> 1:51:49.439
<v Speaker 5>Yes, for sure. So I think as fast as we

1:51:49.520 --> 1:51:53.760
<v Speaker 5>can move scientifically, we're still a long way from figuring

1:51:53.800 --> 1:51:59.240
<v Speaker 5>out a societal level solution to rolling out Crisper based therapies.

1:51:59.680 --> 1:52:03.000
<v Speaker 5>There's a big gap between a scientific solution to a

1:52:03.080 --> 1:52:06.680
<v Speaker 5>disease and a societal solution. Because we can make the

1:52:06.720 --> 1:52:09.200
<v Speaker 5>greatest scientific tool we can come up with that works

1:52:09.200 --> 1:52:12.280
<v Speaker 5>really efficiently and it's accurate and there's no side effects,

1:52:12.680 --> 1:52:16.000
<v Speaker 5>but if we can't make that affordable or accessible to people,

1:52:16.280 --> 1:52:19.479
<v Speaker 5>it's not going to have any impact. So the cost

1:52:19.520 --> 1:52:23.479
<v Speaker 5>in particular of genetic therapies is a huge issue, and

1:52:23.520 --> 1:52:25.040
<v Speaker 5>it's something we talk about all the time at our

1:52:25.080 --> 1:52:28.000
<v Speaker 5>institute and are trying to strategize and come up with

1:52:28.080 --> 1:52:32.320
<v Speaker 5>ways to get around this. But it's enormously expensive. So

1:52:33.080 --> 1:52:36.280
<v Speaker 5>there's a similar technology called gene therapy that is a

1:52:36.320 --> 1:52:38.880
<v Speaker 5>little bit different from crisper. You could kind of call

1:52:38.960 --> 1:52:41.400
<v Speaker 5>crisper a gene therapy, but at its base, a gene

1:52:41.400 --> 1:52:45.320
<v Speaker 5>therapy is using a virus to add in a gene.

1:52:45.400 --> 1:52:48.360
<v Speaker 5>So instead of making a precise change in DNA like Crisper,

1:52:48.560 --> 1:52:51.280
<v Speaker 5>you're just throwing a gene in somewhere into the genome

1:52:51.479 --> 1:52:53.880
<v Speaker 5>that will be helpful, and actually you can't. There's a

1:52:53.880 --> 1:52:56.360
<v Speaker 5>gene therapy for sickle cell disease. You could throw in

1:52:56.400 --> 1:52:59.080
<v Speaker 5>a copy, a healthy copy of the beta globin or

1:52:59.080 --> 1:53:02.400
<v Speaker 5>hemoglobin gene to help people, and that's under development. But

1:53:02.479 --> 1:53:06.759
<v Speaker 5>gene therapies are kind of an emerging approach to genetic

1:53:06.800 --> 1:53:10.639
<v Speaker 5>disease that have only recently started being approved by the FDA.

1:53:11.000 --> 1:53:14.160
<v Speaker 5>So they've been in development for a couple decades now

1:53:14.200 --> 1:53:17.960
<v Speaker 5>and are finally starting to reach patients or real people.

1:53:18.320 --> 1:53:22.160
<v Speaker 5>But their price tags have been whopping, So they've been

1:53:22.400 --> 1:53:26.120
<v Speaker 5>a couple hundred thousand dollars to millions of dollars per treatment,

1:53:26.560 --> 1:53:30.479
<v Speaker 5>which is more money than I have. I don't know

1:53:30.520 --> 1:53:34.679
<v Speaker 5>about you, but that's a lot of money. And I think,

1:53:35.040 --> 1:53:38.599
<v Speaker 5>on the one hand, we talked about how these approaches,

1:53:38.640 --> 1:53:41.320
<v Speaker 5>since they're fixing the underlying cause of a disease, could

1:53:41.400 --> 1:53:45.000
<v Speaker 5>be a single treatment. So if you compare the lifetime

1:53:45.120 --> 1:53:50.760
<v Speaker 5>cost of treating something like sickle cell disease or data

1:53:50.800 --> 1:53:53.640
<v Speaker 5>th allacmia or these other blood disorders, that's going to

1:53:53.640 --> 1:53:55.839
<v Speaker 5>be a lot of money, and then in theory, perhaps

1:53:55.880 --> 1:53:58.120
<v Speaker 5>paying half a million dollars once is actually going to

1:53:58.120 --> 1:54:01.600
<v Speaker 5>be cheaper than the long term cost, But if you

1:54:01.640 --> 1:54:05.680
<v Speaker 5>can't afford that upfront, it's a moot point. And I

1:54:05.680 --> 1:54:07.840
<v Speaker 5>think right now we're kind of trying to figure out

1:54:08.040 --> 1:54:09.960
<v Speaker 5>if this is something that's going to be covered by

1:54:10.040 --> 1:54:15.120
<v Speaker 5>insurance companies. I think it's an issue in America that

1:54:15.280 --> 1:54:18.760
<v Speaker 5>is kind of broader than the science. But we've been

1:54:18.760 --> 1:54:22.400
<v Speaker 5>trying to think if there are scientific solutions, So hopefully

1:54:22.439 --> 1:54:26.360
<v Speaker 5>someone will figure out some social solutions to healthcare. But

1:54:26.400 --> 1:54:28.320
<v Speaker 5>in the meantime, we're trying to figure out if there

1:54:28.320 --> 1:54:29.840
<v Speaker 5>are ways that we can change the way we do

1:54:29.920 --> 1:54:33.760
<v Speaker 5>the science that will actually change the outcome when things

1:54:33.760 --> 1:54:37.520
<v Speaker 5>are priced eventually. So that's one thing that we're working

1:54:37.560 --> 1:54:40.640
<v Speaker 5>on that I'm kind of hopeful about. One of the

1:54:40.640 --> 1:54:43.000
<v Speaker 5>big issues with sickle cell disease that's going to make

1:54:43.040 --> 1:54:46.400
<v Speaker 5>this so expensive is that we're doing all of this

1:54:46.480 --> 1:54:49.480
<v Speaker 5>gene editing. I'm talking about in patient cells that we've

1:54:49.520 --> 1:54:52.040
<v Speaker 5>taken out of a patient, So we're not putting a

1:54:52.080 --> 1:54:54.840
<v Speaker 5>shot in someone's arm or giving them a pill, we're

1:54:54.880 --> 1:54:59.360
<v Speaker 5>taking their cells, extracting cells from their bone, marrow editing

1:54:59.440 --> 1:55:01.480
<v Speaker 5>them in the last and then putting them back into

1:55:01.520 --> 1:55:05.960
<v Speaker 5>the patient's body. And that's really complicated and expensive. It

1:55:06.000 --> 1:55:09.320
<v Speaker 5>requires people with a lot of expertise to handle the cells,

1:55:09.720 --> 1:55:12.120
<v Speaker 5>and it just jacks up the price by a lot.

1:55:12.640 --> 1:55:14.880
<v Speaker 5>And there's also this requirement in a lot of these

1:55:14.920 --> 1:55:18.080
<v Speaker 5>cases for using a virus to deliver the crisper tools

1:55:18.720 --> 1:55:23.440
<v Speaker 5>and manufacturing this virus is really expensive and difficult as well,

1:55:23.640 --> 1:55:26.240
<v Speaker 5>So there are a lot of steps and compounding steps

1:55:26.280 --> 1:55:28.920
<v Speaker 5>potentially that add costs. So we've been trying to think,

1:55:29.120 --> 1:55:31.800
<v Speaker 5>are there ways to do this in vivo? So instead

1:55:31.800 --> 1:55:33.560
<v Speaker 5>of having to take cells out and put them back,

1:55:33.800 --> 1:55:36.720
<v Speaker 5>can we just do the fix directly in a patient's body.

1:55:37.080 --> 1:55:39.880
<v Speaker 5>So I think there are potential scientific solutions to some

1:55:39.960 --> 1:55:43.640
<v Speaker 5>of these problems, but they're really really hard problems and

1:55:43.880 --> 1:55:46.600
<v Speaker 5>they'll take a lot of investment. You said you've talked

1:55:46.600 --> 1:55:51.320
<v Speaker 5>in this episode about kind of historic marginalization of people

1:55:51.360 --> 1:55:55.000
<v Speaker 5>with sickle cell and the way there's racism and medicine

1:55:55.320 --> 1:55:58.440
<v Speaker 5>manifests and this disease. I think one of the promising

1:55:58.560 --> 1:56:02.320
<v Speaker 5>things that's been happening lately is one this kind of

1:56:02.400 --> 1:56:06.920
<v Speaker 5>reckoning amongst the white scientific community and others about how

1:56:07.200 --> 1:56:10.520
<v Speaker 5>black communities have been affected by the practice of science

1:56:10.560 --> 1:56:14.000
<v Speaker 5>and government funding and medicine and all of that. And two,

1:56:14.840 --> 1:56:18.400
<v Speaker 5>we were recently told that the nih and Gates Foundation

1:56:18.600 --> 1:56:22.360
<v Speaker 5>are now investing one hundred million dollars towards doing in

1:56:22.480 --> 1:56:27.520
<v Speaker 5>vivo therapies or potentially other therapies, but particularly in vivo

1:56:27.600 --> 1:56:31.000
<v Speaker 5>therapy is using genomediting for sickle cell So that's a

1:56:31.080 --> 1:56:33.560
<v Speaker 5>huge investment of money that I think could make a

1:56:33.560 --> 1:56:35.640
<v Speaker 5>really big difference in how we're able to treat this

1:56:35.680 --> 1:56:39.040
<v Speaker 5>disease and actually making it an affordable treatment for people.

1:57:11.080 --> 1:57:14.960
<v Speaker 8>What an awesome interview. Thanks again so much Megan for

1:57:15.000 --> 1:57:18.080
<v Speaker 8>taking the time to chat Crisper and genome editing with us.

1:57:18.560 --> 1:57:21.640
<v Speaker 8>We loved it, and Aarin, we should definitely do an

1:57:21.760 --> 1:57:25.520
<v Speaker 8>entire episode on Crisper someday. Oh yeah, all right, should

1:57:25.560 --> 1:57:32.480
<v Speaker 8>we do sources? Yes? Absolutely? Okay, So for my sources,

1:57:32.560 --> 1:57:35.320
<v Speaker 8>I read a few books. One is called Body and Soul,

1:57:35.480 --> 1:57:38.400
<v Speaker 8>The Black Panther Party and the Fight Against Medical Discrimination

1:57:38.560 --> 1:57:42.320
<v Speaker 8>by Alandra Nelson. Also, as I mentioned earlier, Killing the

1:57:42.360 --> 1:57:46.000
<v Speaker 8>Black Body by Dorothy Roberts and Dying in the City

1:57:46.040 --> 1:57:49.920
<v Speaker 8>of the Blues by Keith Waylou and also I have

1:57:50.000 --> 1:57:53.160
<v Speaker 8>a few other books and papers that I will link to.

1:57:53.400 --> 1:57:55.080
<v Speaker 8>A couple of papers I want to shout out are

1:57:55.440 --> 1:57:58.839
<v Speaker 8>by Steinsma at all, Walter Clement Nole, first patient described

1:57:58.840 --> 1:58:03.360
<v Speaker 8>with sickle cell disease, and by Barrash in nineteen ninety

1:58:03.400 --> 1:58:07.320
<v Speaker 8>eight Sickle Cell Trait Policy and Research Paradigms awesome.

1:58:07.880 --> 1:58:10.120
<v Speaker 9>I read a few good book chapters that I will

1:58:10.200 --> 1:58:13.360
<v Speaker 9>link to as well as there is a great sickle

1:58:13.400 --> 1:58:17.920
<v Speaker 9>cell disease in Nature Reviewed Disease Primers that was from

1:58:17.960 --> 1:58:19.960
<v Speaker 9>twenty eighteen if you want just kind of a nice

1:58:20.000 --> 1:58:23.360
<v Speaker 9>overview of the biology of sickle cell disease. And then

1:58:23.440 --> 1:58:27.720
<v Speaker 9>if you want that paper on the comparison of funding

1:58:27.800 --> 1:58:31.400
<v Speaker 9>between sickle cell and cystic fibrosis was by Fahim Farak

1:58:31.520 --> 1:58:35.560
<v Speaker 9>at All published in jama in twenty twenty. Just earlier

1:58:35.640 --> 1:58:38.240
<v Speaker 9>this year. We post all of these sources, as well

1:58:38.240 --> 1:58:40.360
<v Speaker 9>as the sources from every one of our episodes on

1:58:40.360 --> 1:58:42.600
<v Speaker 9>our website This Podcast will Kill You dot Com. Just

1:58:42.640 --> 1:58:44.080
<v Speaker 9>click on the episodes tab.

1:58:44.480 --> 1:58:44.720
<v Speaker 3>Well.

1:58:44.760 --> 1:58:47.800
<v Speaker 8>Thank you again so much to the amazing Marsha and

1:58:47.840 --> 1:58:51.320
<v Speaker 8>Shari for sharing your experiences with us, and also to

1:58:51.520 --> 1:58:55.280
<v Speaker 8>Megan for walking us through the incredibly cool world of

1:58:55.400 --> 1:58:56.600
<v Speaker 8>Crisper technology.

1:58:57.000 --> 1:58:59.400
<v Speaker 9>Yeah, thank you all so much, and thank you to

1:58:59.440 --> 1:59:02.080
<v Speaker 9>Blood will Be for providing the music for this episode

1:59:02.120 --> 1:59:03.440
<v Speaker 9>and all of our episodes.

1:59:03.680 --> 1:59:07.760
<v Speaker 8>And thank you to you listeners for listening. We love you,

1:59:07.840 --> 1:59:10.720
<v Speaker 8>we appreciate you. We hope you liked this episode.

1:59:10.960 --> 1:59:13.400
<v Speaker 9>Yeah, it was really fun, so we hope you had

1:59:13.400 --> 1:59:13.840
<v Speaker 9>fun too.

1:59:15.120 --> 1:59:17.200
<v Speaker 8>Until next time, wash your hands

1:59:17.520 --> 1:59:18.760
<v Speaker 9>You filthy animals.