Regenerative & Personalized Medicine: Science Fiction or 21st Century Biomedical Innovation with Stephen Duncan, PhD

It is springtime, which means we are on the verge of regeneration of nature, our enthusiasm and enjoyment of warmth and beauty. And so it is appropriate to turn our attention to regeneration as it translates to biomedical research and precision medicine as a tool in that research.

Dr. Stephen Duncan is a professor and the chair in the Department of Regenerative Medicine and SmartState chair in liver development and disease. A native of Glasgow, Scotland in the United Kingdom, Dr. Duncan received his PhD and doctorate in Philosophy from Wolfson College at Oxford University in 1992. He then moved to the Rockefeller Center in New York City to undertake a post-doc fellowship. He transferred to the Medical College of Wisconsin in Milwaukee in 1997, where he moved through the ranks to become the Marcus Professor in Human and Molecular Genetics in the Department of Cell Biology, Neurobiology and Anatomy. In 2007, he accepted a position as the founding director of the Medical College of Wisconsin’s program in regenerative medicine. He joined MUSC in 2015.

Read The Transcript

[00:00:03] Loretta Lynch-Reichert: Hello and welcome back to the Medical University of South Carolina Science Never Sleeps podcast. It is springtime, which means we are on the verge of regeneration of nature, our enthusiasm and enjoyment of warmth and beauty. And so, it is appropriate to turn our attention to regeneration as it translates to biomedical research and precision medicine as a tool in that research.

Today our guest is Dr. Stephen Duncan, a professor and the chair in the Department of Regenerative Medicine and SmartState chair in liver development and disease. A native of Glasgow, Scotland in the United Kingdom, Dr. Duncan received his PhD and doctorate in Philosophy from Wolfson College at Oxford University in 1992. He then moved to the Rockefeller Center in New York City to undertake a post-doc fellowship. He transferred to the Medical College of Wisconsin in Milwaukee in 1997, where he moved through the ranks to become the Marcus Professor in Human and Molecular Genetics in the Department of Cell Biology, Neurobiology and Anatomy. In 2007, he accepted a position as the founding director of Medical College of Wisconsin’s program in regenerative medicine. In 2015, we were lucky to get him at MUSC and we are thrilled to have him join us today. Welcome, Dr. Duncan.

[00:01:31] Stephen Duncan, DPhil: Hi, Loretta.

[00:01:33] Lynch-Reichert: I’d like to begin with your definitions of both regenerative medicine and precision medicine. Could you share with us?

[00:01:41] Duncan: Yeah, so regenerative medicine is quite a broad discipline, there are many sort of subsets of science fall within this overall idea. Regenerative medicine has been around for actually a really long time, it started with the whole tale of Prometheus back in Ancient Greece. Prometheus stole fire from Zeus, apparently, and was subjected to everlasting torture by having an eagle eat his liver, and the Greeks knew that the liver regenerated, so the liver regenerated after the eagle ate Prometheus’ liver and that gave the eagle an everlasting meal and Prometheus everlasting torture, so it’s a really good way of punishing somebody.

But yeah, so nowadays obviously the discipline has obviously progressed a little bit from tying people up and feeding them livers. Nowadays we really think – and the official definition of regenerative medicine really explains how damaged organs or tissues within the body can be replaced or treated such that they become functional again. So if you think of that as an umbrella, that gives you an idea of what regenerative medicine is.

Personalized medicine is a little bit different. It’s really a description of how we treat patients as an individual rather than as a group. So if you think about the normal way we treat patients at the moment, if somebody has, for example high cholesterol, they’re probably going to get a statin because that’s the way most people would respond positively and reduce their cholesterol levels. The problem with that approach is that everybody is a bit different, they have different genes that cause different responses and so, although statins are excellent drugs, they’re not necessarily the best for use in an individual and you may outlie the general response as a patient. And so what personalized medicine does is it takes information about your genome, your DNA sequence, and uses our understanding of the code that’s within the genome to really prescribe the best fit for you, the best treatment that fits you best considering your lifestyle, your genetics, and the gene sequence that you have in the cells of your own body.

[00:04:01] Lynch-Reichert: So would CRISPR be a precision or personalized medicine tool?

[00:04:07] Duncan: It is a tool, but we wouldn’t generally think of it as a part of the personalized medicine repertoire. What CRISPR does is allows you to very accurately audit the genome so you can make changes within people’s cells using CRISPR as a molecular biology tool. But it’s a way of treating mutations, but it’s not necessarily part of the toolbox that we would use to decide what types of treatments somebody should have.

[00:04:40] Lynch-Reichert: Gotcha. That makes sense. Your department and specifically your lab have done some remarkable work in these areas of regenerative medicine. Would you share with our listeners some highlights of that work?

[00:04:53] Duncan: Yeah sure, so the department is split up into two major areas. About half of the department has investigators that work on cardiovascular disease, primarily looking at how defects in valves occur and that’s been a very active area within the department for many years and when I took it over it was already a strength within the department. When I came, I introduced a second arm of research within the department which is digestive disease. So like cardiovascular disease, digestive disease affects a broad range of people and it’s actually very understudied, especially given how many people it affects. So over the last five years or so I’ve been recruiting some young faculty that have established their own research programs looking at everything from colon cancer to stem cell repair of disease, of digestive disease, to various aspects of liver disease. So that’s within the department.

My own lab, which is housed within the department, focuses on trying to find new treatments for rare diseases that affect the liver. Most of these diseases affect children, so they manifest in kids, and most of these diseases, they really don’t occur that frequently but when they do occur, they’re pretty devastating and most of them don’t really have any options to treat the kids that are out there. So what my lab does is we’re able to take adult cells from people and change them into liver cells and that ends up being really important because if you imagine, if somebody has something that’s wrong with their liver, trying to do experiments in that person’s liver is close to impossible. You would have to go in and take a biopsy of the liver and then try to grow the cells in the culture dish. What this stem cell approach allows you to do is to basically draw an unlimited amount of cells that can be turned into a person’s liver cells and then basically use that as a platform to identify treatments that can reverse any disease that is associated with the liver cells from the patient and so if we find a drug it opens up the possibility then of treating the patient.

So it really is an example of personalized medicine because by generating the stem cells from the individual, you are generating that person basically in a dish and then you are, under ethical acceptable ways, able to do experiments on that person’s cells. That really opens up the possibility of then tailoring specific therapeutics to whatever disease that person has.

[00:07:43] Lynch-Reichert: I’m going to ask you a little bit about something very spectacular that you were engaged with in a moment, but I want to go back to take the cells... adult stem cells and making them into liver cells. Totally out of ignorance I’m asking this question, but those liver cells would be provided or that liver would be provided to a child? So adult stem cells can become... you know, it’s kind of confusing to me and maybe to our audience that adult stem cells can then be put... can make a liver for a child.

[00:08:19] Duncan: Yeah, so there’s two things it can be used for. Let’s make it more personal. So imagine you come to your hepatologist, there’s something wrong with your liver, you’re not quite sure what it is and as the hepatologist talks to you it becomes apparent that maybe people in your family have had history of some aspect of liver disease and so what we can then do is, we can take a very small skin punch biopsy, so we can take a little bit of your skin cells – we can even take a blood draw – and these cells are not liver cells, but we can use pretty advanced molecular biology techniques to trick your skin cells into becoming the equivalent of a fertilized egg, very similar to an embryonic stem cell.

Now that’s important because embryonic stem cells and these induced pluripotent stem cells, that’s what we call them, they can replicate indefinitely, and they stay relatively normal. Because they’re the earliest type of stem cell, they actually have the capacity to differentiate and form all of the cells that make you up as an individual. Now that ends up being important because if within your genes you have a mistake that causes a disease in your liver and we make stem cells from your skin cells, we then have... we’re able to grow literally billions of cells in the laboratory. If we’re then able to take these cells, these stem cells, and convert them into liver cells, we basically now have your liver cells in our tissue culture laboratory and we can do experiments on them.

These experiments can be multiple things. One possibility is what you raised, is the possibility of taking the cells, fixing the genetic defect, and putting them back into people, including children. That’s still very very experimental, there’s a lot of roadblocks before that becomes a practical approach, but that philosophically is something we’re really excited about where you could use these cells basically as a source of spare parts. What we can do now though is, because we can now have your liver cells in the laboratory, we can add basically every drug that is on the market and try to find an off-target effect for an existing drug that now gratuitously fixes the defect that is associated with the cells we regenerated that represent your liver cells. And so, if we find one of these drugs then it opens up the possibility of giving you that drug and hopefully reversing the disease you have in your liver.

[00:10:48] Lynch-Reichert: That is absolutely amazing, it’s almost science fiction and I love it. Let’s go... let’s get to something that’s really an example of what you do and the good fortune of working with people internationally. So you had an incredible experience just a few years ago when you were able to make a lifesaving difference for a family who had come to the end of their rope. Would you share that with us?

[00:11:16] Duncan: Yeah, sure. So this was a series of coincidences actually and we just happened to be at the right place at the right time. One of the diseases that we work on in the laboratory is a very rare mitochondrial disease, so the mitochondria are really important because they provide the fuel for your cells to work, so if your mitochondria don’t work, you don’t get enough fuel and your cells die and so there is a disease that affects children called mitochondrial DNA depletion syndrome and in these children, their mitochondria fail to produce enough energy and one of the things that happens is that their livers die and because their livers die they then can’t support all of the activities that the liver provides and they end up succumbing to that disease.

There’s no treatment available and so we had been working in that disease and we used the same approach that I just described to you where we had stem cells that we had generated and we had put in the mutation that the children have, we converted the stem cells to liver cells and sure enough, under normal circumstances, the liver cells died in the culture dish. So what we did was we screened a library, a collection of 2,000 drugs that are currently on the market that basically represent every drug that’s available to us and what we found was that actually a very common drug called NAD which is a form of vitamin had this miraculous effect on these stem cell derived liver cells that were dying because of the mutation the children had.

So we got very excited about that, we did a lot of investigation, we worked out how the drug works and why it rescues the cells and we also found that if we put the drug into animals that have the same mutation, these also have defective mitochondria, that the drug really improved the performance of the liver in these children. And so we had published that work and I had been in contact with a group in the UK led by a young mother called Connie and Chris Gard, and Connie had a baby that also had this syndrome and unfortunately died and she ended up developing a foundation to try to raise money for research to help kids that were in the same... help parents and kids that were in the same predicament.

So she actually contacted me and said ‘you know, there’s a baby that has been diagnosed with this mutation that you’ve published this cure for and I’ve sent your paper to the doctors that are managing the child and they’ve given the drug to the child and the child’s responding really well’ so it turned out the child was given the drug – the child was also given a liver transplant – but even more remarkable than that, the baby who had this incredibly rare disease – there's only about 300 people worldwide ever have this at one time – but the baby was actually at MUSC which was pure coincidence and I found out about this from this woman in the United Kingdom that told me all about it.

So I did some searching and found out that sure enough the baby had this mutation and was on the drug and so we got permission to meet the parents, and this was like a few days before Christmas in 2019 and I got a chance to meet the little baby and the parents. And then the baby was doing really well and was then discharged and is back home in South Carolina. I haven’t been able to follow up on how things are going but it was such a wonderful story, especially as a basic scientist, you’re involved in the nitty gritty of how cells work and it’s not that common that you actually see that you can have a positive impact.

So we were really excited about this, not only was it just fantastic to be able to make a difference, what it told us was that this really complicated approach that we use of using these stem cells and modeling these diseases, it could be really fruitful and apply to a whole range of diseases and so now the laboratory is now looking at a very broad range of disorders that affect the liver and using the same approach where we’re looking for drugs that can be used to support these patients.

[00:15:29] Lynch-Reichert: I think it’s kind of important to note that you know, the work that you do and what we talk about all the time on these podcasts is the beauty of an academic health center is the opportunity for folks like you, the basic scientists who are doing all sorts of innovation and discovery to be able to have that time where, you know, you reach out to others, it can be translated to, at some point in time, practiced healthcare. And I don’t know that that poor baby would’ve had a chance anywhere else.

What I’d love also, for those people who are not familiar with doing biomedical research and having to publish papers and all that, this is a practical benefit that we’re talking about right now about what you guys do. You do the research, it gets reviewed by your peers to make sure it’s good, it gets tested to make sure it’s replicated and then the world can see what you’ve done and then the world can take action on it and I think that’s - what you’ve just told us, the story is a very practical example of the beauty that we do and the absolute miracle of the application of your work in the laboratory so if anybody ever questions why we spend so much money, NIH money and otherwise well there you go. What do you put a price on a baby, on a child, on a human being, the life of a human being? So I think that’s a beautiful thing. How does regenerative medicine inform opportunity for precision medicine and what do you see as reachable goals in the next five years?

[00:17:20] Duncan: Yeah, you know, the field is moving at breakneck speed. It’s really interesting because it’s brought together these different disciplines that brings bioengineering which is the creation of organs and things like that, tissues in the laboratory, it brings in stem cell biology, it brings in genetics and genomics and sequencing technologies and all of these areas have really rapidly expanded and become very very advanced over the last five years and it’s now that we’re really starting to see the practical applications of these investments from 10, 15 years ago.

You know, all of these new applications they take time to develop a proven track record and we’re really seeing it now with how we identify new diseases. It used to take decades to try to track down a mutation that affected an individual and caused the disease, but now sequencing technology has become so inexpensive that many of us have now had our genome sequenced. And that information really gives us the blueprint for how a person works so if somebody’s not working, you can go back to that blueprint and really read what’s wrong with them and once you understand what’s wrong with them, it gives you new opportunities to fix them.

And so I think from a personalized medicine standpoint or a precision medicine standpoint, having the whole genome, the ability to sequence everybody’s genome and see these blueprints really allows us to tailor new treatments for you as an individual rather than as a statistic which is historically how we had to do things. We really were - this drug affects the majority of the people that have this problem and let's hope that you fall into that category. Now we can actually look at the blueprints that govern how you work and say ‘well this drug will help this person and therefore we should give it to the,’ it also tells us that if we have a drug that may have side effects, by understanding the individual, we can understand that this individual may not necessarily respond positively if given that drug so we avoid that treatment and that’s been applied to a huge array of diseases. Cancer has become a really big field where personalized medicine and understanding the person’s disease allows tailormade treatments. Another example is CAR-T cells where we’re using a person’s own immune stem cells to be able to attack the cancers and that’s just really a form of regenerative medicine.

So we’re really seeing the techniques that have been developed over the last two or three decades come to fruition. And we’re just constantly be seeing this weekly, new ideas coming out, new drugs, new approaches, new types of gene therapy – CRISPR-Cas that you brought up – by understanding the genes that are mutated we can start to fix some of these... so it’s an incredibly exciting time in science and we will see a lot of breakthroughs over the next five or ten years.

[00:20:21] Lynch-Reichert: So I have a question for you. You talk about that partnership between the laboratory and testing with various pharmaceuticals, and the way I understand it, you take pharmaceuticals that have already been approved by the FDA and maybe do what they call a one-off kind of use for them. So do you think that as we get more engaged in personalized medicine, will that... how does that affect the pharmaceutical industry? In other words, they can mass produce stuff now like statins, but then if they’re going to narrow it down to your particular needs or DNA, how does that... I may be speaking about something that you really can’t speak to right now, but I’m just curious how that is going to affect the pharmaceutical industry and their relationship with academic health.

[00:21:15] Duncan: I think overall it’s positive. You know the patents that are intellectual property that surrounds a given drug is only available for a relatively short time frame before that patent is lost. However, by using repurposing type of approaches where we can find new indications that the drug can be used for, it opens up new opportunities for a company to protect its intellectual property based on these types of findings.

That’s one thing, but secondly, you know, there’s still a very limited number of drugs on the market, there really aren’t that many. And so although we always start with repurposing because we can get into the patients very quickly because these drugs have already been tested, they’ve been through clinical trials, we know they’re safe so we can get them into a patient population rapidly, many times we don’t find anything when we start with that relatively small number of drugs. So under these circumstances, we work, in our case, we’re lucky because through the MUSC Drug Discovery Center we have access to a really nice drug library and that has 150,000 compounds and so when we don’t find something that’s ideal we then start to screen the drug discovery compound library and so if we find something new there, it opens up the new possibility for protecting intellectual property which means companies can then get involved in turning these from compounds into drugs and they can then make money in the long run doing that.

So I think overall it’s a positive, I think it’s... anything that opens up new possibilities for finding new drugs, the pharmaceutical company will be supportive of. Yeah, that’s generally been our experience, it’s been positive.

[00:23:06] Lynch-Reichert: Okay, it just sounds like it’s an exciting new development in the whole pharmaceutical industry, actually. You had mentioned previously about picking some of my skin and making a liver or whatever out of that. Is there a way to store this stuff in case I need it down the road? Let’s just say I’m perfectly healthy, but you know, I want to just in case... you know, how does that work? Is that even plausible at this point?

[00:23:36] Duncan: It’s beyond plausible, it’s trivial. So when we... so it’s a little bit complicated but it’s very very easy to do. So basically, if I take some of your skin cells, these skin cells are basically adult cells. They’re what we call terminally differentiated, they’re specialized cells. And if we put them in tissue culture, they’ll double about 25 to 35 doublings and then they become senescent, just like the rest of us, they get old

[00:24:08] Lynch-Reichert: [laughter] Of course.

[00:24:10] Duncan: And so, you really can’t keep these types of cells around in the culture dish for very long, but stem cells are very very different. These IPS cells that you make from the skin cells, so you turn the skin cells into IPS cells, they have mechanisms that keep them young forever, so they don’t age. And you can have hundreds and hundreds of doublings of these cells and if you take care of them, they maintain a normal genetic profile, they grow normally and they retain their capacity to form all of these cell types that make up you as an individual.
Now the stem cells are very easy to freeze, we freeze these all the time, and so as long as you’ve got the source cells and we grow these up and because they grow forever we can just double them and double them and double them until we have enough for what we want to do and then turn them into the liver cells – and it doesn’t have to be liver cells, we can make heart cells we can make brain cells, neurons, pancreatic cells, you know basically it is a toolkit to make all of the cells that make you up as an individual.

[00:25:10] Lynch-Reichert: Okay so I have to ask you if this is so plausible, for you no big deal, is there an industry growing up to you know, harvest those stem cells for individuals, like especially the wealthy where they’re stored in case they need it someday?

[00:25:27] Duncan: I think there have been industries growing up. Honestly there’s no point really because it’s so easy to make the stem cells from you, it’s pretty much routine at that point. Anytime you want to have stem cells, as long as we have IRB approval, I can make some for you, it takes a couple of weeks and it’s just not that difficult a thing for us to do at this point. In the beginning, we ended up – so in the beginning I’m talking about five years ago [laughter]. We’re part of a large consortium that was funded by the National Institutes of Health to make literally thousands of patient lines from individuals that have different forms of cardiovascular disease and we ended up making about three or four thousand different patient lines and these are all banked and publicly available, so if anyone really wants to do some research on a given disease, they can just purchase these cells at this point.

So there are so many of these cells around, it’s just very very easy to do and as I said, it’s become pretty much routine. In the laboratory, there are always complications because of ethical oversight, so protecting patients as individuals, and so really the biggest challenge is making sure that we have IRB oversight to make cells from individual people and the reason for that, and it’s important, is that by making that person’s cells you have their DNA, you have any disease that’s associated with them, and so you have a lot of information that could potentially be exploited and so that all has to be protected.

And so a lot of the things we do is we don’t actually anymore make cells from individuals, what we have are cells that have already been given approval for us to work on and then we use genetic engineering, we use CRISPR-Cas9 to introduce specific mutations that we know cause a person’s disease into that cell background and in that way we’re not making hundreds of thousands of cells from individuals, we really have unique lines that we can work on and genetically engineer.

[00:27:36] Lynch-Reichert: You make a very good point and I think it’s one to emphasize with the public that you take your job and the federal government and our academic institutions take their jobs seriously to protect and do no harm with regard to the type of research that you do so that... you know there may always be risk everywhere but we are obligated to make sure that we keep secure anything to do with patients being engaged in clinical trials or even in the basic research where you use those cell lines, so I think that’s a very important thing to say and I know that you take that very seriously.

Before I go to the next question, which actually does talk a little bit about ethics a little bit, it sounds like the beauty of what you do and it can also become a tool again for you know, organ donations and that sort of thing where right now it’s such a paucity of donors, it sounds like there may be a time in the near future – not maybe the near future but in the future where one can have an organ developed and then replace a dysfunctional organ. Is that a fair thing to say?

[00:29:02] Duncan: Yeah, I think that’s absolutely fair. That’s the sort of holy grail of what much of the field is trying to do but it’s not going to be that far in the future. We’re already seeing clinical trials where these stem cells have been turned into a cell type called the pigmented retinal epithelial cell, so that’s a cell that when it goes wrong it causes macular degeneration, and so there are already late phase trials where the stem cells have been turned into these cells and injected into people’s eyes that have lost their vision and have been successful and been beneficial to the patients.

And so we’re starting to see this for many types of diseases. Some of these will work and some of them won’t. Putting cells into people is always complicated, it’s a very very complicated procedure. One of the real things that we would really like to see is to be able to use neurons that are designed, that are generated from such cells as a way of treating spinal cord injuries from car crashes and stuff, where people have lost use of their limbs. And so there have been experimental trials going on there and there have been some positive results; they’re very early but it is complicated because for example, in a neuron, you don’t just put in a cell and it works on its own, it’s part of a community so it has to be communicating with many other cells and so it has to make these connections and that can be really challenging from a surgery standpoint, just how do you get the cells to integrate in the right place at the right time to rescue the disease that's associated with the damage.

[00:30:43] Lynch-Reichert: That’s fascinating. I’m going to talk a little bit about what I consider an ethical issue, maybe it’s not, but I’ve shared with you that I’ve seen a lot of advertisements recently about regenerative medicine, you know there's all these places where they tout some cures and solutions to things and they have people that come on and say ‘hey I’ve had it done and I’m in great shape’. So how would you advise the public on understanding or considering the myriad offerings out in the public domain?

[00:31:17] Duncan: There will be some people out there that are genuine and are really trying to help and believe in what they’re doing. However, it’s just so difficult to work out who’s a snake oil salesman and who’s really Bonafide. There are certainly examples where people have had stem cells injected into them, for example, baseball injuries that have resulted in improvement. We don’t really know why it improves them but there’s certainly evidence out there that in some circumstances it can be beneficial.

But that doesn’t mean that everything everybody says is true and honestly if you’re, as a patient, considering a state-of-the-art approach that isn’t mainstream, I really advise the individual to go to an academic medical center because it’s these centers that are conducting, under controlled fashion, the most cutting-edge techniques. They’re the ones who are scientists and physician scientists who are skilled in the art of being able to use these treatments and you’re going to be in a much safer environment there. You brought up the point of oversight; we have very very strict oversight over everything we do and that’s important.

But that means that the public can trust that we’re not going to be cutting any corners, we will be conducting any trial in the way we’re saying we’re conducting them, and we’ll have people independent of the research group making sure that we stick to what we’re saying, so people can feel safe entering the trial, knowing what the risks are and knowing what the potential benefits are. And that’s because that’s what academic medical centers, academic medical centers do for a living. That’s the difference between an academic medical center and a hospital or your local physician. And so, places like MUSC, if you need to be involved in a clinical trial or experience one of these cutting-edge techniques, that’s just a place where you really want to go.

[00:33:14] Lynch-Reichert: That’s sound advice. So just following along with that, so what concerns, when you’re talking with professionals in your field, what are some of the concerns about the ability to access precision medicine as it becomes more routinely used? Is that – you guys have a whole separate group that discusses how we, how do we make sure... I’ll give you an example. I was reading an article about CRISPR and of course in China, there was a physician who, you know, made some claims about what he was able to do with the CRISPR tool and the Chinese government itself took a look at this and said, ‘this isn’t right’ and put the guy in jail.

But, you know, as this – it seems to me sometimes that innovation rapidly proceeds any kind of legal infrastructure or safety net for us. So, you know, take a look at Google, Facebook and how data is used now, all that sort of thing. So how you as a professional, how would you like to see the movement of regenerative medicine and precision medicine as it moves out into the public domain? Or what are your concerns about it?

[00:34:31] Duncan: I mean I don’t have a lot of concerns that are germane specifically to regenerative medicine, it’s more just healthcare in general – we're constantly making advances and the public more than ever get access to that information very very early in its lifetime. So as soon as something is coming out of the lab, the public usually know about it, either from Google or Facebook or whatever – through podcasts like this – but this is really important because we really want the public to understand what we do. The problem is that a lot of the times, the stuff we’re doing is highly experimental and we don’t know whether it will ultimately translate into something that’s going to be beneficial.

Most of the stuff we do ends up hitting a roadblock. I mean you’ve got to keep in mind that what we’re all doing is so incredibly complicated. We can make it sound simple but on a day-to-day basis what we’re doing is just incredibly difficult and to get it to the point where you’re going to use it on a patient, it has to be rock solid, reproduceable, safe and as a physician, you have to have a lot of confidence in it. So again because the type of work we’re doing is done at these academic medical centers, and that’s true throughout the country, it’s not just MUSC, we have tremendous amount of oversight at every level, all the way through the development of an idea there are bodies that are reviewing our work and making sure what we’re doing is ethically sound. We have ethicists on these panels, we have members of the public on these panels, we have scientists on the panels, physicians on the panels and their job is to make sure we don’t do what was done in China, which is for someone to have a rouge idea and really go nuts with it.

I think as a scientist it’s just drummed into us very early that ethics is everything and that’s true whether you’re reporting results or generating data, you know, you’re only as good as your word. And the other thing that is drummed into us, you know, because you can do something, doesn’t mean you should do it and I think that’s a really important philosophy to maintain as a physician as well as a research scientist, that you have to stand back and sometimes it’s very complicated and you really need to have people outside your field to explain maybe why it’s not a good idea, because you can get very excited about something and think ‘man this is great, I can fix these genes and embryos and then we can culture them in the laboratory’ and you don’t necessarily take the time to look at the impact that could have on a broader society.

And so, you need to make sure that there’s checkpoints along the way, and I think we have that especially in the United States, we’re very strictly governed as to what we can and can’t do and there’s constant discussion at every level about the types of experiments that we work on.

[00:37:34] Lynch-Reichert: Yeah. I love hearing this stuff. I see your passion and I see your caution and your thoughtfulness and you know, I say this almost every podcast but what I love about the faculty at MUSC that I interview is that y’all really have... you know what your purpose is and you know that you’re there to serve the public with your skillset, with your creativity, it’s... we’re very very lucky. The conversation we just had, it almost seems like fairytale stuff so I’m going to try to tamper down my own enthusiasm and ask you is precision medicine the antidote for all types of diseases and wellness?

[00:38:20] Duncan: In reality it’s not. It definitely is not. It’s another tool that we have that goes along with all the other tools that we’ve developed over the years and the consequence we see as we have a new set of tools, it effects another group of people and allows them to have healthier, longer lives, hopefully that are continually productive and honestly there’s a lot of the simple stuff still holds true. I keep telling people that if we could bottle diet and exercise, then half of the drugs we discover you wouldn’t need, because that really helps an awful lot, just looking after yourself.

And so yeah, it’s going to have a really positive beneficial effect on society. There will always be questions. There’s always questions about healthcare. Can we make it available to a lot of people? How expensive is this stuff going to be? Should we be doing it to everybody? And these are conversations that you have that sort of level of politics and ethics, and you know outside of necessarily my domain, but we see our job as really trying to generate these tools and hopefully the politicians, etc. can find a way to make them accessible to everybody, to large numbers of the population so that everybody can benefit from them.

[00:39:44] Lynch-Reichert: I think they... I hope that the public, the legislators, the think tanks start thinking about all this stuff because the way it sounds from you, a lot of this stuff will come to fruition a lot sooner than we might possibly think and so I hope they are ready and prepared. Dr. Duncan, as always, it is a great pleasure to talk with you. You explain these complex ideas and innovations in a way that really informs and entertains and I always leave our discussions with a smile on my face and a renewed sense of what’s possible, so I want to thank you for your generosity of time, your diligence in working toward discovery in the lab that could one day change the way medicine is practiced or pharmaceuticals are designed and I think it’s important for folks to note that you probably spend 12 hours a day in the lab doing the hard work and watching you mentor young... I understand you just won a T32, you mentor people to be that next generation that are working in the lab, and I think it’s important for folks to know this is hard work that you do. It’s complex as you noted but it’s really hard and it’s every day, going in there and doing that microscopic work that could one day change lives, so I really want to thank you for that and for your... you’re always willing to talk to folks and that’s what I love about folks like you. You really do make a difference and we're so grateful to have you so thank you so much for being on today’s podcast.

[00:41:11] Duncan: Thanks for having me and it’s always great talking science with you and hopefully we’ll be able to do it in person in not too long.

[00:41:17] Lynch-Reichert: I hope so too. And to our viewers, thank you again for your interest and support of our research mission at the Medical University of South Carolina. It is no exaggeration to say we can’t do it without you. Until next time, stay healthy and safe.