Dr. Keith Yamamoto, Vice Chancelor for Science Policy and Strategy at UC San Francisco

[Music]

Mark Masselli: This is Conversations on Health Care I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret there is much change focused in on health care or health
reform and health policy.

Margaret Flinter: Well indeed there is and in the aftermath of the election president
elect Trump and the republican majority and congress are making much of the notion
that the Affordable Care Act needs to be repealed and in short order. But most expert s
say it's not going to be easy to pull the plug on the full legislation without a sound
replacement strategy which under any circumstances it's kind of hard to undo legislation
Mark isn't it?
Mark Masselli: No it isn't and many of the nation's health car e CEOs are uncertain how
a change in federal policy will affect their bottom lines until they know what Medicare
and Medicaid reimbursements will look like in the years ahead, a majority are certainly
urging the Trump Administration to proceed cautiously b efore greatly disrupting the
policies that had been in place for several years now.

Margaret Flinter: And there's also concern about how that Trump Administration will
mean for things like scientific and biomedical research and progra ms like the Cancer
Mo onShot the precision medicine initiative and these are the things our guest today is
very involved with.
Mark Masselli: Dr. Keith Yamamoto is the Vice - Chancellor for Science Policy and
Strategy at the University of San Francisco School of Medicine, he has some unique
insights in what may lie ahead for biomedical research.
Margaret Flinter: Of course Lori Robertson will be checking in with us the Managing
Editor of FactCheck.org on the hunt for misstatement spoken about health policy in the
public domain.
Mark Masselli: But no matter what the topic you can hear all of our shows by going to
chcradio.com and as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter we love h earing from you.

Margaret Flinter: We'll get to our interview with Keith Yamamoto in just a moment.

Mark Masselli: But first here our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I'm Marianne O'Har e with these Health Care Headlines. There's
growing unease within the health care community as well as the health industry
regarding the future of health care in America and exactly what policies are going to
drive it forward. The nation's 3.5 trillion dollar health care i ndustry has recalibrated
these past six years since the passage of the Affordable Care Act and most industry
insiders were not anticipating a Trump win in the presidential election. The president
elect has vowed to repeal and replace the law while keeping in place some of the more
popular aspects such as young adults staying on their parent's plans to age 26 and
exemptions for preexisting conditions. The hospital industry is particularly concerned
over the potential of millions of Americans losing health coverage the law greatly
reduced hospital reliance on charity funds to cover the uninsured and need of hospital
care.

Women's health services coverage are mandatory under the ACA those services could
also be at risk. Some attempt to privatize Medicaid is likely an attempts to expand
private Medicare advantage programs, look to be fairly certain. 1964 seminal moment
in the history of the US surgeon general's office smoking was then directly related to a
number of deadly conditions including cancer, it has led over the decades to more
targeted health policies that have curtailed the smoking habit significantly in this
country. 2016 may prove to be a pivotal year for the nearly 21 million Americans set by
addition. Surgeon General Vivek Murthy issued a repo rt detailing addiction is a medical
condition and one that's far under treated and cause the nation some 420 billion dollars
a year in lost revenue, accrued health cost and incarceration expenses.

Dementia is now down among the nation's seniors according t o a study conducted by
the National Institutes of Health. Dementia has seen a 24% decline in Americans over
age 65, the study suggest perhaps advances at heart health through better
hypertension management and diabetes management may play a role. Still th e
numbers are staggering currently 5 million Americans suffer from dementia that number
expected to triple by 2050. And study on screen time in a developing brain was a topic
for discussion at the annual gathering of the nation's neuroscientist the study found
mice brains exposed to six hours of lights and noises similar to video games had much
more need for excitable stimulation than their counterparts or more likely to exhibit high
risk behavior and had symptoms of ADD. But they were also less likely to become
distressed in noisy over stimulating environments that would have set those mice who
weren’t exposed. The report the report comes on the hills of the American Academy of
Pediatrics relaxing its earlier stands on babies and screen time, their previ ous
recommendation was none before the age of 2, either way the study showed significant
rewiring of brain circuitry in the over exposed mice. I'm Marianne O'Hare with these
Health Care Headlines.

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Mark Masselli: We're speaking today with Keith Yamamoto PhD Vice - Chancellor for
Science Policy and Strategy and Director and Precision Medicine at University of
California, San Francisco School of Medicine. Dr. Yamamoto is also a leader in science
policy serving as cha irman of the board on life sciences at the National Academy of
Science, numerous government and public adv isory boards including the NIH Center for
Scientific Review Advisory Council. Dr. Yamamoto is an elected member of the
National Academy of Medicine a nd is a fellow of the American Association for the
Advancement of Science. He earned his doctorate in biochemical science at Princeton
University, Dr. Yamamoto welcome to Conversations on Health Care.

Dr. Keith Yamamoto: Welcome, pleasure to join you.

Ma rk Masselli: You know, you've had just an incredible career in biomedical research
as well as a solid role as a thought leader in the world of national health and research
policy and you recently participate in a panel at Faster Cures Conference where you
weigh in on the opportunities and challenges for the president elected, and I'm
wondering if you could just share your views on the expectations that you might have
coming out of a Trump Administration around biomedical research.

Dr. Keith Yamamoto: Well I think there's a lot of uncertainty, there are concerns of
things that Trump said and did that might be cause for worry amongst scientist which --
with respect to his using evidence as a basis for decisions and so forth. But I think that
-- that what yo u heard was a level of cautious optimism that it's important for us to sort
of backup take a deep breath sit down and talk with the new administration. You know,
I think there are many things that they need to know about scientific research
biomedicine he alth, health care that we don’t know how familiar they are with it, you
know, among them prompt deployment of NIHM and national cancers directors really
being able to draw for them the direct connection between biomedical research and
health and health car e and health care costs including drug cost. The comparatives
that the federal government have to do basic research really opening the door for the
private sector to be able to apply that new knowledge, there's opportunity that the
administration has to s upport grant challenges to annunciate big goals that scientific
community might take on with federal support that would have impacts on really urgent
societal issues. And just the importance of maintaining US leadership in biomedical
research enterprise a s a whole, maybe just pointing out the importance and role of
biomedical research in medicine as an economic driver in our present economy. And
it's really crucial that we sort of start with a blank slate sit down and try to talk about
those needs.

Margar et Flinter: Well Dr. Yamamoto I'm sure there's always a interesting array of
thought leaders gathered at the Faster Cures Conference I know Dr. Francis Collins
head of the National Institutes of Health who oversaw the human general project was

there certa inly he's been a very vocal advocate for more federal money earmarked for
st
biomedical research so the 21 Century Cures Act we know is a bipartisan build that's a
good thing right there, launched in congress but what is the importance of that
legislation?
st
Dr. Keith Yamamoto: Yeah 21 Century Cures has been long in the making
congressman Fred Upton who's the chairman of the Energy and Commerce Committee
in the house has been assembling and promoting this legislation for a couple of years,
version of that a ctually pass the house last year but didn’t proceed through the senath
st
and it's been rewritten as we speak. And 21 Century Cures carries a -- a broad
spectrum of matters of support and regulation of research drug discovery drug testing
and drug approval FDA research the NIH that I think capitalize well on the opportunities
that have opened up with the big research adv ances that have been made over the past
decade or two. That kind of research you would move the NIH budget which as you
know has been in spaces for over a decade we finally being able to allow scientist to try
to capitalize upon some of the advances they' ve made. So a big bill covering
fundamental science and then moving drug development device development and
approval more briskly through the FDA.

Mark Masselli: Margaret just mentioned Dr. Collins heading up NIH and he is also
taken on the president's l atest research initiative the precision medicine initiative and
you are as well a leader in this area at the University of California, San Francisco am I
wrong to say that you all have your own initiative open to all of the 20,000 plus
employees that the i nstitute maybe you can share with us what you are doing then the
university around precision medicine.

Dr. Keith Yamamoto: You know, it's -- actually worth backing up a step and talking
about the overall scope of precision medicine. I was the chair of th e Board on Life
Sciences of the National Academy of Sciences that sanction this report and that was
beautifully shared by the new UCS C h ancellor Su Desmond - Hellmann and Charles
Sawyers. It was a great report made a series of recommendations that they real ly --
maybe three things that -- to try to build a continuum of research so that all of biological
information from fruit flies through populations of people could actually be used in
decision making about advance in further research in one ha nd and about diagnosis
and treatment and prevention and cure of diseases in people. Secondly to define
disease mechanisms so that we could actually classify diseases according to
mechanisms instead of symptoms and organs and things of that sort. We're seeing
examples already being able to come across diseases that [inaudible 11:16 ] there's no
present therapy and then find that oh the mechanism is the same as this disease over
here that looked unrelated but now there's already a therapy already there. And then
finally to be able to discern all the factors that contribute to disease so that prevention
diagnosis treatment cure can be focused all the way down to the level of the individual,

those are grand goals and that's what precision medicine really does it's a -- it' s in
revolutionary approach to research, health, health care that seeks to integrate vast
amounts of data in order to achieve those ends.

Margaret Flinter: Well Dr. Yamamoto you have made the point so often that we're at a
crossroads and that the academic world of biomedical research is also an important
pivot point. You supported the notion that the world of academia has to be redesigned
st
in some ways to reflect the 21 century arrow of scientific advancement. You wrote a
very compelling piece about the university of the future and why that is to be given
serious consideration and what you think it would look like.

Dr. Keith Yamamoto: You know, what's happened with these remarkable advances and
research is that the sort of the lights have come on betwee n fields that were thought not
to be related between ideas that weren't connected. And when those lights come on the
possibility of doing something really bold of asking a big question that we hadn't been
able to see before becomes evident. And so this u niversity further idea speaks to the
fact that the traditions and policies for funding research and on the other hand amongst
us academia are conservative force that there's actually inhibiting the capacity or at
least not encouraging the capacity for scie ntist to ask these bold questions because
they don’t get rewards for them. So that's what university of future says is what if we
put together a system the self - assembly of teams of scientist who choose to go after a
head problem from multiple disciplines , teams to come together that say hey, you know,
we work together, we have an opportunity to nail this problem and we all know that
there's no way we could do it individually. So the system of focusing on individual
achievements in academia is holding bac k that possibility of groups of people getting
together choosing the problem by themselves and going after it as teams. And the
precision medicine approach as you know proposes building a huge computational so
called knowledge network that links together all kinds of information about biological
processes about disease, about people and that will allow sort of visualization of these
possibilities that -- that, you know, a single human brain can't really put all the stuff
together but a computer can. And s o the idea is that in the university of future
increasely we'll be able to sort of sit down at our terminals over lunch hour and find
investigators who could working together go after a problem and solve it a really bold
idea. So we need to build a system that recognizes the value of that kind of team effort
and rewards it.

Mark Masselli: We're speaking today with Keith Yamamoto PhD Vice - Chancellor for
Science Policy and Strategy, executive vice dean for research at the school of medicine
at the Universit y of California, San Francisco School of Medicine. You really had a
revolutionary approach to this whole concept of how we should start conceptually
thinking about where our research dollars go and so much of the resource the funding

really aligned with s omething that is really a siloed approach. But how do you sort of
square that up with sort of the political funding aspects of the research community?

Dr. Keith Yamamoto: Mm - hmm, you know, when resources are limited and they are
then intrinsic weakness our system for funding research emerges that the peer review
system which is the -- the best way in the world to allocate research funds becomes
conservative. The research has been reviewed by peers and their first line of defense is
to defend the prevail ing paradigm in a given area. And so research grant application
that comes in and with a wild crazy idea that's going to show that, that paradigm is
wrong is not going to be welcomed with open arms right away and of course bold ideas
have a risk for failu re. The university of future idea says that this idea of research
teams would be stamped out multiple times per faculty member. Let's say that
established lab of faculty member might be involved in 10 teams would be fantastic, you
know, wake up every mor ning thinking about 10 problems that I know that I couldn’t
work on by myself but because of these teams that I'm in we're doing things that are
really fantastic. Well let's imagine team 4 fails because the technology we needed to
developed that we though t we could develop we couldn’t. Team 10 fails because in fact
the idea is fantastic as it was, was wrong. So now 2 out of 10 have gone down in
flames. But, you know, you know, three other of the teams are really going great guns,
they're goi ng to really do something fantastic and maybe two others look pretty good
and so failure becomes an option. And we're not so afraid to ask bold and crazy things
because there are -- some of those things going to hit. If we can destigmatize failure in
academic resear ch then the opportunity to ask and answer the really big questions
opens up much more.

Margaret Flinter: Well Dr. Yamamoto I think there's probably some parallels there from
the way we approach educating the research professionals to thinking about the wo rld
of health care professional workforce training. What are your thoughts about the
principles for transforming academia from the perspective of how we train the health
care workforce of the future, how is that training evolving at your institution?

Dr. Keith Yamamoto: Actually there is n ew medical curriculums called Bridges UCSF
Bridges that has many elements of integration that I've been talking about built in where
the students began to define and then act upon their refine interest in the medical
pro fession. And so the opportunity for medical students at UCSF to be able to integrate
with that world is greatly increased. But, you know, we're a long way from being there
on the PhD training side there are still many programs around the country that kin d of
continue to use the conventional standup and lecture and then examine the students to
see how much they remember approach. You know, we're sort of past that now we
have in our pockets little devices that can remember everything. So being able to bui ld
concepts and use them effectively is really critical and increasing number of programs
including ours are beginning to build programs that's focused on that sort of hands - on

learning biological sciences has become a quantitative endeavor of changing ove r from
a long successful period as a descriptive endeavor so understanding the quantitation,
statistics, computation, is really important. Developing a broad literacy across the
spectrum of scientific approaches is really important and we're -- we have a very rich
research environment here that does that. But integration as I've been saying is really
key and so now we're trying to develop ways to get first trainees together so they can
see each other, talk to each other, see how their different approaches and aspirations
can meld to be able to -- to inform each other and to do really bold things and I think
that's the next frontier.

Mark Masselli: We've been speaking today with Keith Yamamoto PhD, Vice - Chancellor
for Science Policy and Strategy, executive vice dean for research at the School of
Medicine and director of the Precision Medicine at the University of California, San
Francisco School of Medicine. You can learn more about his work by going to
Yamamoto Lab.UCSF.EDU, Dr. Yamamoto thank you so much for joining us today on
Conversations on Health Care.

Dr. Keith Yamamoto: Thank you, pleasure.

[Music]

Mark Masselli: At Conversations on Health Care we want our audience to be truly in the
know when it comes to the facts about healthcare reform and pol icy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertso n: House speaker Paul Ryan falsely claim that quote, because of Obama
Care Medicare is going broke. What actually improved Medicare's financing and the
program isn't going broke. Ryan made the remark in an interview on Fox news a few
days after the pres idential election and Ryan's remark took us back to the 2012 election
which was filled with scary Medicare claims. As we said back that both the Romney
and Obama campaigns have proposed ways to shore up Medicare's shaky financing but
they disagreed on how best to that.

Let's start with the idea that Medicare is going broke, it isn't. One part of Medicare
though is expected to face financial shortfalls in the future without changes to either
revenues or spending or both, that's part A which covers payments to hospitals and it's
funded by a payroll tax that goes into a trust funds. It's that part A trust fund that's
expected to run out of money. The current exhaustion date is 2028 according to the
latest report from the Medicare trustee, but part A would s till have revenue through
payroll tax receipts. Those revenues would cover 87% of expenditures in 2028 as for
Ryan's claim that Obama Care has worsened Medicare's financing that's not the case

either, in the fact the law both expended Medicare funding and cut the growth of future
spending. The trustees 2010 report estimated that the ACA had added 12 years to the
life of the part A trust fund postponing the exhaustion date from 2017 to 2029 or 2028
under an alternative scenario in which not all of the ACA change are enacting. Cutting
future growth and spending improve Medicare's financing that's the opposite of what
Ryan claims, and that's my fact check for this week I'm Lori Robertson Managing Editor
of FactCheck.org.

Margaret Flinter: FactCheck.org is com mitted to factual accuracy from the country’s
major political players, and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us at
www.chcradio.com. We will have Fact Check.org’s Lori Robertson check it out for you
here on Conversations on Health Care.

[Music]

Margaret Flinter: Each week, Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. As the saying goes music
soothes the savage beast, and according to a recent study conducted by Queen's
University in Belfast, Ireland, there is some empirical data to back that up. C hildren
suffering from a variety of behavioral and emotional conditions who were exposed to
music therapy in addition to traditional therapies had far better outcomes than those
children i n a control group that offered traditional therapy without music therapy.

Dr. Sam Porter: It’s not a matter of them being given music or choosing music; they
actually make music along with music therapist assisting them. So the idea is for them
to express themselves through music.

Margaret Flinter: Lead researcher Dr. Sam Porter said there has been anecdotal
evidence that music improves mood in children and adolescents as well as adults, but
his study revealed just how effective the music therapy was.

Dr. S am Porter: Our primary items was an improvement in communication. Now there
were two very interesting secondary outcomes, levels of depressions and levels of self -
esteem, and in the secondary outcomes we found a statistically significant difference
between the control group and the intervention group.

Margaret Flinter: It showed overtime more interaction with their surroundings, and a
better response to the traditional therapies as well .

Dr. Sam Porter: I mean that's one of the marvelous things about musi c therapy. There
are no side effects than it is a productive way of getting kids to improve their health so
it's really satisfying to know that it also an effective way of doing it.

Margaret Flinter: The study was conducted in conjunction with the Northern Ireland
Music Therapy Trust which sees the promising findings as an incentive to incorporate
this relatively low cost therapy to enhance outcomes for the youth population a simple
targeted music therapy approach, age appropriate and showing great efficacy in
improving outcomes for young patients with minimal side effects and lasting benefits,
now that’s a bright idea.

[Music]

Margaret Flinter: This is Conversations on Health Care, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and heal th.

Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.