“Translational Research and Health Disparities: The Nation’s Imperative” by

1. “Translational Research and Health Disparities: The Nation’s Imperative” by Sidney A. McNairy, Jr., Ph.D., D.Sc.,LHD Former: Associate Director, NCRR and Director Capacity Building Branch National Institutes of Health, DHHS

2. Seminal Events in Translational Medicine

3. Seminal Events in Translational Medicine • 1952 -Watson and Crick showed that each strand of the DNA molecule was a template for the other. • During cell division-alpha helix the two strands separate and on each strand a new "other half" is built, just like the one before. This way DNA can reproduce itself without changing its structure -- except for occasional errors, or mutations.

4. Seminal Events in Translational Medicine • 1963 the first descriptions of the self-renewing activities of transplanted mouse bone marrow cells stem (cells found in the bone marrow and blood of mice can "restock" a depleted ovary with new egg cells within weeks) • transplant of adult stem cells – have been used in patients receiving radiation and chemotherapy since the 1950’s. • developments in biotechnology in the 1980s and 1990s saw the introduction of techniques for targeting and altering genetic material and methods for growing human cells in the laboratory (opened the doors for human stem cell research).

5. Seminal Events in Translational Medicine • in 1998 James Thomson, a scientist at the University of Wisconsin in Madison, successfully removed cells from spare embryos at fertility clinics and grew them in the laboratory. This launched stem cell research into the limelight, establishing the world’s first human embryonic stem cell line which still exists today.

6. Seminal Events in Translational Medicine (cont’d) • Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health. • During the early years of the HGP, the Wellcome Trust (U.K.) became a major partner; additional contributions came from Japan, France, Germany, China, and others.

7. 21st Century Medicine Predictive Personalized Preemptive

8. WHAT CREATED MY INTEREST IN TRANSLATIONAL RESEARCH

9. What created my interest in translational Research 1. Synthesis of Quionoline2. 1963 March on Washington for jobs/freedom2. Isolation and characterization of triterpinoid glycosides3. Biochemical Basis of Sickle Cell Disease lecture –Grand Rounds lsu/tulane4. Member of the American Heart association of louisana5. Development of Radioimmunological assays for pro-insulin and tri-iodthyronine6. an Over three decade career at nih as a member of the Senior Executive service

10. Quinoline Synthesis: condensation of unsubstituted anilines (1) with β-diketones (2) to form substituted quinolines (4) after an acid-catalyzed ring closure of an intermediate Schiff base (3).[1][2] Liver tumors (adenomas and hepatomas) were observed in newborn CD-1 mice Exposed to quinoline via i.p. injection (LaVoie et al., 1987, 1988; Weyland et al. , 1993).

11. Saponins or Triterpinoid glycosides* *During my graduate career at Purdue University my research focused on isolation, chemical and biological characterization of tri-Triterpinoid glycosides or saponins.

12. Some Health benefits of Saponins • Studies have illustrated the beneficial effects on blood cholesterol levels, cancer, bone health and stimulation of the immune system.

13. “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy” Dr. Martin Luther King, Jr.

14. NIH Mission: Uncover new knowledge that will lead to better health for everyone27 Institutes and CentersMore than $29 Billion

15. NIH MISSION Uncover new knowledge that will lead to better health for everyone. NIH conducts research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. It is one of eight health agencies of the Public Health Services which, in turn, is part of the U.S. Department of Health and Human Services. Comprised of 27 separate components, mainly Institutes and Centers, NIH has 75 buildings on more than 300 acres in Bethesda, MD. From a total of about $30 K in 1887, the NIH budget has grown to more than $31 billion in 2009. This was augmented with 10.3 billion via the ARRA supplement

16. NIH improves the health of the Nation by Conducting and Supporting Research: Studying the causes, diagnosis, prevention, and cure of human diseases; Investigating the processes of human growth and development; Determining the biological effects of environmental contaminants; Understanding of mental, addictive and physical disorders; and Directing programs for the collection, dissemination, and exchange of information in medicine and health

17. IDeA COBRE INBRE Lariat and Co-funding My Career Other RCMI RCMI RCRII/CCRE CCHD CRECD Co-funding RFIP AFIP SCORE SEPA NARCH Opportunities for Translational Research

18. IDeA IDeA RCMI C06 Some of The Grantees 335 NCRR and 7 NIAID C06 awards IDeA Program: INBRE- 23 statewide research networks; COBRE- 76 thematic research centersRCMI- 18 sites including 5 clinical research centers; IDeA + RCMI sites include 28 medical schools (8 GCRCs, 3 partner with CTSAs) = CT, DC, MA, MD, NH, NJ, VT,

19. INBRE SCORE NARCH RIMI RCMI T1→T3 Clinical Research COBRE The TRANSLATIONAL RESEARCH Paradigm: Programs that I Developed while at NIH Basic Research

20. From Basic Discovery to Translation to Improve Patient Care Basic Research DNA→ RNA→ Protein Effectiveness Community based Research Community Improved patient care Efficacy Pre-clinical Clinical Research Clinical Trials animal models

21. Secretary’s Task Force on Black and Minority Health….1985 The 1985 Report of the Secretary's Task Force on Black and Minority Health released by then Secretary of Health and Human Services, Margaret Heckler, documented significant disparities in the burden of illness and mortality experienced by Blacks and other minority groups in the US population.

22. Secretary’s Task Force on Black and Minority Health…..1985 The report laid out an ambitious agenda, including improving minority access to high quality health care, expanding health promotion and health education outreach activities, increasing the number of minority health care providers, and enhancing Federal and State data collection activities to better report on minority health issues.

23. Why Health Disparities • Provides the greatest opportunity for understanding factors that influence clinical outcomes in real life settings (gender, ethnicity, age, environment, etc.) • Translate those findings into strategies to improve clinical outcomes for all persons • Opportunity to reduce health care system costs

24. Unequal Access to Health Care* • Language barriers • Inadequate insurance coverage • Bias among doctors and nurses • Lack of minority physicians * Institute of medicine “unequal treatment: confronting racial and ethnic disparities in health care”

25. USA POPULATIONYEAR 2050

26. Ten Leading Causes of DeathUSA Suroce: National Vital Reports Volume 60, Number 3, December 29, 2011. USDHHS, Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

27. America’s Health Rankings State Cardiovascular Diabetes Idaho 13 21 Oregon 12 19 Washington 20 17 Montana 15 6 TEXAS 30 34 La/Miss 46/50 46/50Minnesota 1 3Utah 4 1

28. 10 Leading Causes of DeathFor African Americans in 2009: Heart Disease Cancer Stroke Unintentional Injury Diabetes Kidney Disease Chronic Lower Respiratory Disease Kidney Disease Homicide HIV/AIDS

29. 10 Leading Causes of death for Hispanics/ Latinos in 2009 Cancer Heart Disease Stroke Unintentional Injuries Diabetes Chronic Liver Disease and Cirrhosis Chronic Lower Respiratory Diseases Influenza and Pneumonia Homocide Nephritis, Nephrotic Syndrome & Nephrosis

30. 10 Leading Causes of Death Asian American & Pacific Islander Population, U.S., 2007 Cancer Heart Disease Stroke Unintentional injuries Diabetes Influenza and pneumonia Chronic lower respiratory disease Suicide Nephritis, Nephrotic syndrome, and Nephrosis Alzheimer’s Disease

31. Other At Risk / Vulnerable Populations Other At Risk / Vulnerable Populations Other vulnerable populations as defined by socio-economic status (social determinants of health, poverty, and education), geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities

32. The Prevention Imperative: Protecting the Health and Well-Being of America’s Families http://www.americashealthrankings.org/Downloads.aspx

33. The Big Three Threats OBESITY CHRONIC DISEASE SMOKING

34. Obesity: The Biggest Threat to Our Health 1990-2011 27.5% 11.6% *Source: The Future Costs of Obesity; Dr. Kenneth E. Thorpe • Obesity is one of the fastest growing health issues in our nation • Obesity contributes to variety of diseases • Heart disease • Diabetes • General poor health • 27.5% of Americans are obese compared to almost 11.6% in 1990 • This is the first year where no state has under 20% obesity • If current trends continue, 43% of the population will be considered obese by 2018*

35. Chronic Disease: Growing Obstacle to Health 1995-2011 8.3% 4.4% Source: The United States of Diabetes, UnitedHealth Group • Health not only means living longer but living healthier and without the presence of disease.  • Diabetes is one major chronic disease that increasingly is getting in the way of our healthiness. • Diabetes continues to increase, now at 8.7% of the adult population. • It was 4.4% of the adult population in the 1996 and 8.3% of the adult population in 2010. • According to a report published in 2010, the U.S. was set to spend $208 billion on diabetes and pre-diabetes in 2011. • If we don’t turn this around, we will spend $500 billion in 2020

36. Smoking in USA: A Tough Habit to Kick1990-2011 Prevalence of Smoking Since 1990 29.5% 17.3% • Smoking has been the biggest health battle of the past 40+ years • Over the past year, the prevalence of smoking decreased from 17.9% to 17.3% • The lowest in 22 years • Adverse impact on overall health • Respiratory diseases • Heart disease • Stroke • Cancer • Despite improvements, more than 1 in 6 people smoke

37. The Full 50: This Year’s Rankings

38. Causes of Death in the United States(Most Common, 1999*) *All data are age adjusted to 2000 total U.S. population.

39. U.S. Infant Mortality Rates, by Race/Ethnicity of Mother, 1998 Source: CDC, National Center for Health Statistics.

40. Age-Adjusted Death Rates for Diseases of the Heart* Among Women, by Race/Ethnicity,1996–1998 *Average annual deaths per 100,000 women, age adjusted to 1940 U.S. standard population, International Classification of Diseases, 9th Rev., codes 390–398, 402, and 404– 429. Source: Journal of Women’s Health and Gender-Based Medicine, Vol. 10, No. 8, 2001. pp. 717–24.

41. Stroke • According to the Centers for Disease Control and Prevention: “Southerners and Blacks are more likely to die of Stroke than other Americans.” • Blacks are 40 % more likely to die of stroke than whites (hypertension, less access to health care, obesity, smoking and lack of physical activity)

42. Type 2 Diabetes • Native Americans, Hispanics, African Americans, and Asian Americans and Pacific Islanders are at particular high risk of developing type 2 diabetes. • The prevalence of diabetes is nearly 70 percent higher in African Americans than in Caucasians.

43. End Stage Renal Disease • In 1997, the incidence rates were 218 per million population in Caucasians, as compared to 586 in Native Americans and Alaska Natives, and 873 in African Americans. • The leading cause of ESRD is type 2 diabetes.

44. ESRD Incidence Rate per Million By Race/Ethnicity (2001) * *P < .0001 * * * Ref Ref Odds Ratio 1 3.89 2.74 1.56 1 1.45 USRDS. Annual Data Report. 2003; adjusted for age and gender.

45. Annual Fiscal Impact of Racial/Ethnic Disparities in ESRD Gross Estimate of ESRD Cost in 2001 Due to “Excess” Minority ESRD Population Dollars (Billions) USRDS. Annual Data Report. 2003; adjusted for age and gender. Estimated excess costs if minority ESRD point prevalence rate= White ESRD point prevalence rate based on 2001 point prevalence counts and adjusted point prevalence rates (not adjusted for estimated changes in transplant and other ESRD specific costs)

46. Cancer continues to be the leading cause of death in the U.S. Only a slight decline in cancer deaths in the last 20 years

47. CDC estimates that if tobbacco use, poor diet and physical activity were eliminated, 40 % of cancers would be eliminated

48. 2013 Estimated US CancerCases* Men854,790 Women805,500 29% Breast 14% Lung & bronchus 9% Colon & rectum 6% Uterine corpus 4% Thyroid 4% Non-Hodgkin lymphoma 4% Thyroid 4% Melanoma of skin 3% Ovary 3% Kidney & renal pelvis Prostate 28% Lung & bronchus 14% Colon & rectum 9% Urinary bladder 7% Non-Hodgkin 6% lymphoma Melanoma of skin 5% Kidney & renal pelvis 5% Oral cavity 3% Leukemia 3% Pancreas 3% *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2013

49. HIV and AIDS • HIV incidence is growing at a faster rate in minority women than in any other group. • In 1998, more than 77 percent of the women infected with AIDS were from minority groups, with 57 percent African American and 20 percent Hispanic.

50. HIV and AIDS • An estimated 42 M people around the world will be living with HIV/AIDS by the end of 2002 according to the U.N. Program on AIDS and WHO. • 29.4 M in sub-Sahara Africa; 6 million south and southeast Asia; Ca 1.0 M in north America • About half the people infected with the AIDS virus world-wide are women (19.2 m); 3.2 M children (under the age of 15).