Myriad Live episodes are recordings of an open-forum webinar hosted by Dr. Thomas Slavin. The opinions and views expressed in this recording do not necessarily represent those of Myriad Genetics or its affiliates. To participate in a future recording, visit myriad-oncology.com/myriad-oncology-live for a list of dates, times, and subjects.
Myriad Live episodes are recordings of an open-forum webinar hosted by Dr. Thomas Slavin. The opinions and views expressed in this recording do not necessarily represent those of Myriad Genetics or its affiliates. To participate in a future recording, visit myriad-oncology.com/myriad-oncology-live for a list of dates, times, and subjects.
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0:00:13.3 Dr. Thomas Slavin: Welcome. This episode of Inside the GENOME is a recent recording on Myriad Oncology Live, a webinar hosted by me, Dr. Thomas Slavin, Chief Medical Officer for Myriad Genetics. The opinions and views expressed in this recording do not necessarily represent those of Myriad Genetics or its affiliates. To participate in a future recording, please visit Myriad Live for a list of dates, times, and subjects. I look forward to exploring the world of genetics with you all.
0:00:40.9 DS: Hello everyone. Welcome to Myriad Oncology Live. Thank you for joining us today during this, sometimes, hectic week for many. And this is our last Myriad Oncology Live of the year. I'm gonna start out with a little housekeeping, so I'm... If this is your first time, I'm Slavin, TJ, Thomas Junior, and I am the Chief Medical Officer of Myriad Genetics. We've had a great year with Myriad Oncology Live, the format's changed over time, we have settled more into more of an expert guest type webinar format with a great Q and A, we've also started recording these for people that can't make them in person on request of many that are doing clinic and different things, so they all are now posted up on the Inside the GENOME. Guys, usually, we're putting up within a month or so, but actually, yeah, I think, yeah, the last two are already up. And so we had a great meeting with the National Ovarian Cancer Coalition. That was probably two weeks ago. And then before that, we had, at first, ACMG variant classification, so anything on the podcast... And you can get this podcast anywhere. Anything that says Myriad Live is the recording of these talks. And then anything that... You can say Myriad Oncology Live is me sitting down just one-on-one with a guest and in a regular 15 minuteish podcast. So plenty to look at over the holidays here, if you are looking for something to do. [chuckle]
0:02:24.2 DS: But today, we are talking about DEI, so diversity, equity, inclusion in genetics care. So I appreciate everyone coming on. We have some special guests. I will be running the chat today because our normal Shelly Cummings is indispose doing a few other things. So if you have questions, feel free to send them to me in the chat. We are joined by expert special guests. We have two. We have both Gwen Turner, so she is the head of our DEI at Myriad Genetics. And then we also have Tyrone Quarterman, who is the senior manager of health, equity, and diversity for Myriad Genetics. He is also a former football player as I learned last week meeting him for the first time.
[laughter]
0:03:20.5 DS: So thank you both Tyrone and Gwen for coming on. I'm gonna stop sharing this screen, and... And yeah, we just wanted to get right into it. I know you've prepared a little bit, but first off, just to kinda show off, I just wanted... If you could give a little overview of what your job is, what you do around DEI, health equity, what we hope our impact will be, your impact on the company, what you could see a large genetic company... Their impact in the field over the next few years. Probably a good place to start just as we warm up. Again, feel free to... Anyone can unmute themselves. If this is your first time, you can ask any questions. Feel free to interrupt, we love this to be interactive. Again, I will monitor the chat, so if you wanna send me messages in the chat, we can talk there too. I'll read them all.
0:04:22.8 Gwen Turner: Yes. So TJ, thank you so much for having us today. I am honored that you asked us to come on to talk about health equity, but also some of the work that we're doing around DEI at Myriad Genetics, and this is an exciting time for our organization because we are not only going through this transformation, but we're looking for ways to be able to integrate health equity in all the work that we're doing. So it's not a matter of just work sitting alone by itself, it's about taking this work and infusing it into everything that we do. So we are plenty excited about this opportunity for growth for the organization. My role is not only DEI, but it is also ESG. Our investors are asking more and more, what are we doing in DEI, but what are we also doing in terms of environmental impact? Because what we learned is that even the environment has such a big... Kind of a big stake in health equity, and so we wanna ensure that we're doing everything we can from an environmental perspective in order to serve our communities. And so I've been working very closely with our teams on our messaging in terms of ESG for our organization so that it is aligned as well, and then also doing some cultural work, but I will tell you that as we look at DEI, we're looking at our workforce, we're looking at our mission, and we are also looking at community, right? All those things that we can do within our community in order to go and serve them in a better way.
0:06:07.4 DS: Yeah, that's great. And when did you start here?
0:06:11.9 GT: So I started with the organization in April.
0:06:14.4 DS: Yeah, and...
0:06:14.9 GT: So I've not been here a year yet.
0:06:17.1 DS: And I guess just from a historical perspective, what did you see before and after? There was clearly a desire to try to find someone like you to fit the role, how have you seen your role transform and where have you seen the company focus changed now? This is one of the larger GI companies.
0:06:38.8 GT: Yeah, so I will say that in joining this organization, there was already a great foundation that was created by our colleagues, there are clearly people who care about this work, who work at Myriad Genetics, so there was already a really nice foundation, although there was not someone here leading this work full-time, we had a... We had a collection of people cross-functional that have already come together to start work around representation, ensuring that we have a diverse workforce, and then there were also people who came together around our products, we have RiskScore for all our ancestries. So we have so many great things happening that there was already a focus, so I've seen a growth in this space since April, I've seen the enthusiasm for it grow, I've also seen the fact that we've been able to... Again, infuse the DEI into the culture and also into our business, and so I would say that the future is bright for us. The sky is the limit, and this is really an opportunity for us to all come together to determine what DEI will look like for us in the future, so I'm excited.
0:07:52.5 DS: Yeah, yeah. No, that's good. And have you seen what are some of the other life science companies in our space doing and then kind of a following question, how do you feel, from what you've seen, life science companies are... What can they bring to the table versus other companies in the DEI arena?
0:08:15.2 GT: You know...
0:08:15.2 DS: And environmental, I should say. Yeah...
0:08:17.0 GT: And environmental.
0:08:17.5 DS: Since you do both.
0:08:18.7 GT: Yeah, yeah, so interestingly enough, when I hadn't joined... When I was deciding on whether or not to join our organization, my previous company was a great company to be a part of. I really enjoyed being there, but as I was evaluating Myriad Genetics, one of the things that stood out for me was that even as a patient, I wasn't aware of genetic testing, I wasn't aware of Myriad, nor our competitors, and so just going through the process of learning about our organization, opened my eyes to opportunities that were not just available for me, but for my family members. And one of the reasons that I joined this organization was because, I know and understand that there are a lot of people just like me, who look like me, who are from similar backgrounds, who had the same life experience, who are not familiar with genetic testing, or they may even have some myths about what it is.
0:09:20.0 GT: And so what was important for me was to be able to knock down some of those barriers and work with our teams in order to educate our patients, to connect with our providers, to give them more information about what can... What the possibilities are. Again, for people who look like me. And so that was really important for me. And so I would say that in terms of our competitors, they're in this space, they're doing a lot of work in sort of the DEI and health equity, but the difference for us at Myriad genetics is that we don't just wanna throw money at it, right, or make a donation here or there, we really wanna get involved because we know that the only way to really move this rock is to have a partnership between community and our providers and really get involved in the work that's being done there, and then also to use our marketing in order to get out to our patients to talk about some of our products.
0:10:21.5 DS: Yeah, yeah.
0:10:23.7 GT: Yeah.
0:10:23.9 DS: No, that's great. And so, Tyrone, thank you for coming on as well, I wanted to pick your brain a little bit. What... How should we be defining health equity? That's kind of a big one, and it's a huge category, just what makes it up in your mind?
0:10:46.4 Tyrone Quarterman: Yeah, definitely. Thanks for having me. First of all, TJ and Gwen, thanks for allowing me to be a part of this conversation. I think it's important conversation, brief background on myself, so I started with the company in October, so I'm even newer than Gwen. I'm very excited to be a part of the team, I came from the clinical research space, and I have my Masters in Public Health, so health equity is something I'm very excited about and very passionate about, but to the point of defining health equity, I think there's a lot of answers, but the answer I like to go with is, it's fluid, as long as you continue to realize the main answer is in equity, so that sounds really simple, but I say that because you can go to any well-known source, right, of what you might consider in the authority on healthequity, you can go to the CDC.
0:11:34.2 TQ: You can go to the American Public Health Association, you can go to the World Health Organization, you can go to small organizations, everybody's gonna have a slightly different definition, but everything centers around achieving equity in different categories, whether that be race, sex, gender, age, etcetera, and at the end of the day, I think that's important because one of the things that people always wanna know is, okay, I need to know this definition, so I know how to address it, well as long as you're aiming for equity in different categories, you can take that step, so that's where I would put the definition of health equity at.
0:12:07.0 DS: Yeah, no, that's good. And what are you... What brought you into this field, and your interests?
0:12:18.0 TQ: Yeah, so for me, I've always been interested in health care since day one, and it was a matter of figuring out where can I use my talents and where do my passions really lie, and I've always been a community-based person. I think I've gotten my experience from the ground up, so to speak, and really listening to community voices and really helping out communities, and I realized the best way to marry those two is in the health equity space, there's a lot of different communities out there, especially our underrepresented are minority communities, for many different reasons, they don't have access so they don't have the literacy that other communities do, and it's important to have people like you, I, Gwen, everyone involved, to fight for those voices and to provide resources and to do the work. So once I realized that's where I can bring my talents to the table best, it was a no-brainer.
0:13:11.2 DS: Yeah, no, that's great. Alright, I'm gonna pause here for any questions for the... For Gwen and Tyrone.
0:13:22.7 Suzanna: Hi, TJ, this is Susana with the MIL team. Can you hear me?
0:13:26.8 DS: Yes. How are you doing Susana?
0:13:29.0 Suzanna: Okay. Thank you so much for putting this talk together. So...
0:13:34.0 DS: For those that don't know, the MIL team is Myriad's peak for Information Liaison. [chuckle] 'Cause actually most people on here are not people that work for Myriad.
0:13:45.5 Suzanna: Yes, so I provide support to both providers and patients about MyRisk, primarily. And I love this thought about equality and reaching communities that have historically been marginalized in the healthcare space. I have encountered some resistance in the company. And these are just some things that we could be better and maybe we can keep top of mind moving forward. So in a lot of our... So I'm from Mexico, so I talk to a lot of our Spanish-speaking patients, and in the eight years that I've been here, there haven't been any initiatives to translate reports to other languages, even Spanish where a big number of our customers are Spanish-speaking only. And I think that should be our priority, because a lot of these people have very low health literacy.
0:14:54.9 GT: Right.
0:14:55.0 Suzanna: And they don't speak English either, so I think that is an important thing moving forward. Gwen, were you gonna say something, or add something?
0:15:07.7 GT: I was going to say, thank you so much for your comments and for your recommendation, because I think that it's so super important that we do that. A part of this conversation around health equity is providing language and providing services for diverse patient population. I have had experience working with physicians on translation services, and they are so important. It is unacceptable that an eight-year-old or a 10-year-old family member has to go in to do a translation for her grandparent, and so we need to find ways in order to make sure that translation services are available to any patient that needs them. But I think, in particular for us that, that is something that we need to, for sure, tackle, and we need to add that to something... Add that to one of our deliverables for next year.
0:16:12.0 Suzanna: I'm so glad to hear that. And we do offer a translation service for calls for any language, which I think is great. And I saw Beta...
0:16:23.7 DS: You're saying for patients or providers, or both?
0:16:27.4 Suzanna: For patients, these are patients that are calling in. We have translators in Farsi and really any language. It doesn't matter how small the community presence is in the United States. And Beta just put in the chat that she would like to see informational materials to be translated as well. We have a service that is new, right? When we're able to translate patient-facing resources, which maybe we can increase awareness so that those genetic counselors like Beta who is in California, who sees a lot of Spanish-speaking, probably other languages, can also take advantage of.
0:17:14.5 DS: Yes, I was... Choate is on the line too. I was... Oh, it looks like you have your hand up, so feel free to unmute yourself.
0:17:26.4 Choate: No, I was just gonna...
0:17:27.3 DS: I was just gonna say what we were talking about at dinner.
0:17:29.4 Choate: Yeah, no, go ahead. I won't cut you off. I'll speak later.
0:17:32.2 DS: No, no, go for it.
0:17:33.0 Choate: Yeah, I was just gonna say to Susana's point. I think it's not just the... I think the report is incredibly important, because I've often hesitated to do my own translations because of the liability, and so knowing that a translated report is coming from a laboratory, where it's been vetted and appropriately done, is... I think is a huge plus. And there are some of those resources, like when you get your results, there's a positive packet or a negative packet or a VUS packet, and those can be downloaded in other languages, which is great, but it's the report itself that needs to be disseminated in the family. And when you're dealing with families that have family members in other countries, the power of being able to provide resources in their primary language for the providers that see them in those other countries, I think is incredibly helpful. And I'm handing people stuff in English that I know they can't read, and while I talk to them about it in Spanish, what they take home, other than my family member letter is all in English.
0:18:41.0 Choate: And so I think that that would be a powerful step forward to back up Beta, and I think TJ, this is what you were alluding to, is that, I think those informational materials, if they're truly patient facing need to be written with the patient in mind, and not a lot of what's available. I am a fan of the old pit pets that were amazing educational tools, but they disappeared. And now everything is very much a marketing tool, even if it's in another language, it's not a good educational or patient-facing tool. So I would just to add my obnoxious and voice to the crowd to say that, if there are... And Myriad has put a lot into it. There are... It's one of the few labs where I can get things in Mandarin characters and Korean characters. But again, they're very complex tools that are great for marketing, but not good for patient education, so that's just my thoughts.
0:19:34.9 Suzanna: Yeah.
0:19:36.7 TQ: If I may, I think, this is a great topic. I'm very thankful that both of you brought this up. Coming from the clinical research space where something like this is, in my opinion...
0:19:49.4 TQ: Not even a concern because they're so strict about making sure that language is not one of the barriers that would allow somebody or not allow someone to get into research studies. I see this as a very, very big opportunity to not only keep progressing and keep advancing, but to really move from, this is a point to advance on to the state of this is the standard. We shouldn't even have to have this conversation, and it's crazy to think that even in this year and this date in this time, we're still having this conversation, so I 100% agree. And I think that it's okay to, as you said, give Myriad the props for what they've done, but to also wanna continue to push and create a standard of excellence.
0:20:39.4 DS: Yeah, so what can be done today? It sounds like Suzanna, there is some... Frits going on that you brought put up, to help art A, I mean, is there anything we can do to move for materials on the education front?
0:21:00.8 Suzanna: Yes, I think there should be a closer relationship between our genetic counseling resources and marketing, currently, our marketing team doesn't have a big genetic counseling presence other than... I think Amanda Anglin is a great resource there, Praveen Kaushik, he left and he was one of our representatives there, so in our team, we spend a lot of... We allocate a lot of our time in projects, we answer calls, but we also have these projects where we can help with language, we can help with educational tools, and that would be a great use of our time. We're always looking for new projects, and I would be more than happy to connect us or ask around to see who else would be interested. We have some international presence in the team too, so I think that's a great conversation to have.
0:22:04.0 Suzanna: I'm also going to rep for my friends in the Latin American space, Ricardo Camillo is our... He's on the call, he's our contact, he manages Latin America, and we... Lately, we're creating a webinar for riskScore for all ancestries, which has been such an important product for an entire... For many countries, we're talking half a continent, and getting a webinar translated to Spanish for them was not possible. We couldn't get it to work. It's a very expensive... I'm gonna start by saying that it's so expensive, good translation services are very expensive, but I'd like to invite Ricardo to maybe give us some of his ideas where we can be better in serving some of our international customers that are becoming very important, especially with our Japan involvement and Latin America.
0:23:17.6 Ricardo: Thank you. Yes, we have that issue with the webinar, I'm still looking forward to put some subtitles for the Spanish physicians to be able to watch it. We have, of course, some physicians that know to speak English, but I think half of them or a little bit less than half can't follow a webinar. And the distributors also, and they need to be trained to give a good support for the physician as well. And to have the reports in Spanish is something that we wait for a long, we have for some products already like EndoPredict, we have Portugese and Spanish, but for riskScore and other ones that we are waiting for, it's really important. Now, the structure of international... Myriad International is changing. So a good part is that we are going to have more access to the literature for the physicians, but this literature is in English. Usually, we... I have translated for Spanish and Portugese and send back to Myriad to approve the translations and sent to distribute to that physician, but to be able to have that done already in Spanish you would be much, much helpful.
0:24:46.3 GT: Yeah. And I agree with that, and I wanna take you up on the offer to pull a small team together to talk about this and to act on it, so that we're always focused on it with our marketing materials as well as any instructions that we have, for after visit, so that would be really good to be able to bring us together to put together some action.
0:25:08.5 Ricardo: This is nice because this way we just don't depend on just about our distributor because the physicians and patient can go to web page and search for information in their own language, is very, very helpful, mainly for patients.
0:25:31.4 GT: Very helpful, I agree.
0:25:34.0 DS: This is great.
0:25:34.5 Ricardo: Thank you very much.
0:25:35.6 DS: No, thank you.
0:25:36.9 GT: Thank you.
0:25:37.1 DS: I love the action, [laughter] seeing the action plans emerge, and I know we're working on evaluating right now our gender-inclusive language, that's on our request, really all of our Myriad work, so that's another process going on at the moment, but yeah, both are incredibly important, and in a sense, similar efforts where we just wanna make everything completely right for all patients and providers to an extent possible.
0:26:14.5 DS: No great. I also wanna correct, just for the audio, I think I said Myriad Information Liaison, I should say, Medical Information Liaison, just for the record. And so Gwen, I wanted to come back to you, thinking about all the, bias that's been in healthcare building into some of this structural racism, what are some of the proactive stances going on that you're driving to work better with communities and practices against the bias?
0:26:54.7 GT: Wow. So that's a great question, in terms of the proactive stances that we're taking within our organization is, one being aware of that bias. I think that that's really key, because we talk about the bias of a lot of providers, as well as people who are on the commercial side as well. And we really don't understand what we're talking about when we talk about bias. And I think it's really important to understand that in terms of health equity, that these conversations are happening, but time will tell whether or not we've made progress in terms of health equity and understanding that bias that exists. Research tells us that physicians spend more time with patients who are whites, so when they come in for a visit, they spend more time there, they receive more resources than people of color. And we wanna make sure that we're on the frontlines of educating our providers around being able to talk to their patients about the work that we do at Myriad. I think that's really, it's super important that we are on the frontlines of tackling that bias, whether it's within our organization or outside of our organization, one of the things that we are doing proactively is that there are only 2% of the genetic counselors in our country are people of color.
0:28:21.4 GT: And we know that in order to be able to attack that bias, we need to start there, that we need to start with really grooming and educating this next generation of genetic counselors, so that they are willing to go into communities and talk to people about the work that we do. And so I think that our partnership with Xavier University is historic, in that we've never partnered with a historically black college or university before. The partnership there is historic because it is the first of its time they are creating a genetic counseling program. And they have tremendous interest from students as well as partners in New Orleans to really help them with this program. And so I think that in order to really uncover that bias, and we make a difference, particularly in this space, it's important for us to be able to identify this next new generation of talent coming into genetic counseling.
0:29:26.3 DS: Yeah. I was just looking for something that come across my desk this week. It was in San Antonio press yeah. One up here. There was a real world at a points the racial disparity among in BRCA one and two testing among triple negative breast care patients. And it showed this was... Yeah, many centers, Henry Ford Health System in Michigan, Aurora health session in Wisconsin, and health in Florida, looking at the differences of testing for individuals for triple negative breast cancer, and they found about a, I'm looking through it real quick, I thought it was about a 10% differential. It was an abstract, so it's not published yet. So be on the lookout for that. But it also follows similar to some of the work published earlier in the year by Susan Don Chex group, there's been numerous papers and a lot of it is really getting to access. So is that what you're starting to see on your end, is one of the bigger things you're working with your team to try to tackle?
0:30:39.5 GT: Yeah, so I think that that access is really important. And I know that Tyrone is working on a number of things for our marketing and really getting the Myriad name out there so that people understand who we are. And so Tyrone may wanna talk about some of those things.
0:30:57.3 TQ: Yes, definitely. So from the standpoint of marketing and access, I think the first thing is, as Gwen mentioned, the internship program. The partnership with Xavier is historical and it's monumental, but it also opens doors for us to expand into the academic network. So one of the big things when you're working in the industry or working in healthcare is that school to industry pipeline and it's important to build the name in that realm, because how are you going to build and train and cultivate the next generation if you don't have a direct line of communication and interaction with them. So that's one front. The other front is our ongoing and new partnerships with other minority focused and diverse organizations, for example, National Medical Association, National Hispanic Medical Association, just to name a few bit. But being able to partner, support and really interact and engage with organizations such as that it serves a dual purpose, on one hand, it allows us to do exactly what we mentioned earlier in the podcast, which is to directly impact health equity, diversity, addressing bias, but also, again, from the marketing perspective of presenting Myriad in the positive light that it should be, we're not... We make no mistake about it. We're not here to cover up anything or make something better than what it is. We're simply here to highlight what's being done. Good things are being done, and it deserves to be highlighted.
0:32:25.4 DS: Yeah. I'm just trying to get, what do you think are the big either or anyone on the call, some of the bigger barriers and some of the access at the moment, it sounds like just education providers having open channels. Are there other major things that people see on the their radar?
0:32:49.7 Suzanna: I think that it's not just about providers, it's about where providers are situated... I mean, genetic counselors don't tend to be at facilities where patients of diverse background and who have been marginalized tend to be cared for, so there's... I think there's, often, the types of centers where patients who have limited access are cared for, or usually community centers, safety net hospitals, they're busy, they're overwhelmed by their patient populations, and so providers are often not genetics providers who are dealing with those patients, and so I think efforts to educate community providers, I think will have a greater long-term impact. I would love to think that we live in a world where everybody had access to genetic counseling in their own language, with materials in their own language. [chuckle] And all of those things would be ideal, but I think that we're a long way from there. And where patients are being cared for right now are usually not places where genetics is easy to get to, either virtually or in person, and so I think there's work that has to be done in the places where patients are cared for.
0:34:08.8 DS: Yeah, good...
0:34:10.2 TQ: If I may... Oh, sorry, go ahead.
0:34:12.8 DS: Oh, I was just saying, good point, yeah.
0:34:14.4 TQ: I was gonna say, I think the question and the response is a great leeway into a point of the social determinants of health for those who are familiar with it, great for those who aren't, there's a few different categories of social determinants that impact health outcomes, and I'm not gonna go through a history lesson, but... [chuckle]
0:34:36.0 DS: Honestly, yeah. I mean, if you could... I really don't know a lot of the background so, yeah, feel free.
0:34:41.3 TQ: Okay. Well, I'll give the elevator.
0:34:42.5 DS: I've heard the term thrown around before, but I really don't know personally what it gets out at the core.
0:34:45.9 GT: Okay, great.
0:34:49.2 TQ: Sure, so again... And this is in context of the question being asked too. Social determinants of health is essentially a few different categories, so economic stability, neighborhood and physical environment, education, food and access of better health, community and social context in healthcare system, the traditional categories of social determinants, which have been shown historically to directly impact health related outcomes, so with that in mind, to your point about barriers in access and the response given, I've always said, I've always been a firm believer that you don't have to address every single one of these. In fact, you probably can't. That's... That's really where government's supposed to step in, but in general, it's hard to impact every area of the social determinants of health, but it's not hard. In fact, it's hard to not address at least one of those when you think about change and treatment courses.
0:35:49.0 GT: Right.
0:35:50.0 TQ: So let's say, for example, if you wanna impact economic stability or you wanna impact education, it's very easy to just have a mindset and be open-minded to say, "Okay, how are we going to come at this from a lens of... " Let's take education, for example. We're addressing education by trying to establish the pipeline for the next generation of students. That's impacting the social determinants of health that's related to education. So these are some of the barriers that exist, and these are areas of where you can focus your attack when addressing those inequalities.
0:36:27.9 GT: Yeah. And you know, I like that... Go ahead.
0:36:31.0 DS: I was just saying, thank you for elaborating. [chuckle]
0:36:34.8 GT: Yeah.
0:36:34.9 DS: I see an SDO... What is it? SDO...
0:36:36.6 GT: SDO...
0:36:38.7 DS: H. So I feel like anything that has an acronym, I should probably understand a bit better.
[chuckle]
0:36:46.1 GT: You know, it's interesting because we focus a lot on behavior and biology, but that's not enough, we need to also focus on those systems that impact our healthcare. I know that's kind of where the social determinants of health come in... Come into play. I'm originally from Chicago, from the West of Chicago. I'm from an area where it was traditionally redlined. So in my community, there are no hospital or clinics, you have to travel to get to those places. And so as we talk about the social determinants of health, when we talk about health inequity, one of the inequities is that major centers are not located in these communities, and they're not there because of historical things that have happened in those communities, they have been told to stay out of those communities. And so I think that now what we're seeing is that a lot of times when I go home to Chicago, I'm seeing larger institutions now creating pop-up clinics, or they have centers that they're creating right in the community. So you don't have to take three buses, and get off work or miss work to take your child to the hospital or take your child to the doctor. And so I think that what we're seeing is this trend where larger institutions are saying, "We need to go to people, we can't have them come to us, because that is really impacting their care."
0:38:20.0 GT: I would also say that one of the other barriers that is not one of the social determinants of health, but it is trust. We're going through a big trust issue now in healthcare, right? And I think that because of COVID, we've had a lot of misinformation in the marketplace, either from healthcare providers or from politicians or whomever, or even community leaders. They have put out a lot of information that's just not right. And so, I think that it's really important for us to be able to go in to regain that trust now. And a part of regaining that trust is being able to mobilize not just as Myriad Genetics, but as a coalition of healthcare providers and institutions. So we're not gonna be able to... I mentioned this before, we cannot solve this problem alone. This is not something that we will be able to do in a vacuum. We have to be able to connect with providers and major institutions in order to really share this message of health equity, talk about prevention, and we also talk about treatment and do it in a way that is not... It's self-serving, right? So it always just serves us, but then it serves everyone. So I think that that's one of the things that I like to leave with this group.
0:39:45.7 DS: Yeah, yeah, well said. Yeah, so as a whole, where do you see all this going? I mean, for Gwen or Tyrone, or anyone really, what's kind of perfect in this scenario and are... And does anyone see that coming anytime soon?
0:40:05.9 TQ: Well, for me, I mean, what I would like to see, and I think what will happen is that much as Gwen alluded to, the collaboration aspect can should and will increase. You know, I think... Actually, before this I gave a presentation on this disorder thing, and the idea that people have to collaborate and stop conflicting from the different stakeholder's perspective, whether you're a healthcare provider or you're a patient, or you're political, whoever you are, and whatever your role is in this, you're going to realize that, well, we have to come together, I have certain resources, I have certain things that I can provide to aid in this battle, right? And again, trust is a big thing. There's no way around it, especially in certain populations, there's always gonna be a mistrust and a lower level of trust in the medical community, but the more we continue to address that by coming together, pooling resources, coming up with meaningful and achievable steps towards change, not trying to eat the whole pie at one time, piece by piece, I think that's where we will be going in the next year, two years, five years, 10 years, whatever timeline.
0:41:20.1 DS: Mm-hmm.
0:41:21.1 GT: So I can't say enough about something that I'm passionate about, and that's STEM education, and how STEM education is really exploding in our schools. We have our little girls who are interested in being doctors and we have people of color who are interested in being physicians and how we have physicians going into schools, mentoring students. I see so much there, so much opportunity. So again, that next generation of physicians, next generation of providers, I think will be so much more diverse than they are today. I live in an area that's not very diverse. I live in Portland, Oregon, and my husband was with me looking for a cardiologist, and he was looking for a person of color. And he went on this hunt looking for someone that he could relate to. And that was very difficult for him to do.
0:42:16.0 GT: And I know some people who will decide until I find someone that's when I'll go, right? Or that's when I'll really take the advice and heed their advice. And so, it's really important that we cultivate this diverse group of professionals, not just from a provider perspective, but even people like me who work in this space, who are passionate about this work, that we're cultivating those as well, so that they're diverse. And again, I mentioned earlier, this connection between the work that we do and community, and community-based organizations, I think we're gonna see much more, much much more of that. And then I also believe that we will see more collaboration between patients and institutions like Myriad where they're giving us feedback and advice, and perhaps even patient panels where they come into advisory groups that come in to give us advice on things that we can do to become better.
0:43:20.2 DS: Yeah. And that did charge in the chat brought up yeah, the pipeline, which is what you're getting into here. Yeah, incredibly important, build it out. And we need reserves. It can't just be one doctor, 'cause a doctor retires or something, and I just got a letter last week from my PCP who's stepping down and yeah, just so now I gotta find somebody else, is the same. And then, so it's gotta be a robust system.
0:43:44.3 Choate: EJ, can I say something before we close?
0:43:47.6 DS: Sure. Yes.
0:43:48.0 Choate: Okay. So I just wanted to say that, I'm also optimistic about the future. I see millennials being a lot more open about gender equality, about race equality. So I think we're heading in the right direction. Like Gwen said more women are enrolling in medical school in law school, than men, and I think eventually is gonna become a necessity to have race equality. For example, I remember going to a genetics conference. There are projections, estimating that in 40 years, there will be more Latinos in the United States, than individuals of European ancestry.
0:44:36.0 GT: Mm-hmm.
0:44:37.7 Choate: At that point, it's gonna become an absolute necessity. We're not gonna have conversations about oh, how can we help. It's gonna be how do we stay in business? How do we stay relevant to adjust to these natural population changes. So, overall, I think I'm optimistic and I've been here for eight years, like I said, and seeing now having these DEI group is very encouraging because like Gwen said we, one of the best things about Myriad are the people that work here and having Gwen's leadership and Tyrone's leadership, we can actually materialize some of these ideas that might already exist.
0:45:26.6 DS: Mm-hmm.
0:45:29.3 GT: Mm-hmm.
0:45:29.4 DS: Yeah, and I'm so appreciative for Gwen and Tyrone coming on today just because I mean... Yeah, just to have this resource and pipeline directly of we don't have a ton of external people on but at least some good discussion was had and you can see immediately some of the needs around patient access materials and things like that, for education and test results, this is all great.
0:45:52.7 DS: I wanted to...
0:45:53.9 DS: Go ahead, was someone gonna say something.
0:45:57.9 DS: I just wanted to switch gears briefly, because we didn't really get to talk about the environmental side of things, and that's a really interesting... I really don't know... [chuckle] So maybe in the last few minutes, we could talk about that a bit. So what's going on on the... Gwen, you said in the beginning there's... Investors are looking into companies to have an environmental reduced impact, things like that, what... Can you give kind of an overview there? I'm just so curious what else's going on, because I don't hear about that side of things as much.
0:46:30.1 GT: Yeah, so this is defined very different for different organizations, and we are right now in the process of defining what does it really mean to us, so from our environmental impact. The great thing about Myriad is that before any of our employee resource groups were formed, we had a Green Team. We have a Green Team that's focusing on... They were advocates for the solar panels at our home office, they are also linear effort around recycling in our facilities, and they are measuring recycling, and so we have that... We have that figure to live up to each year, but they're also focused on waste in our labs, so they are measuring waste there as well, and there are various certifications that you can receive for environmental practices within your labs, and so we are focusing on those as well.
0:47:27.7 GT: So from an environmental perspective, those are the types of things that we are focused on at Myriad. However, from a health equity perspective, as you think about environmental impacts and you talk about... You think about water and having fresh water, fresh air, things that our patients are really talking about, we want to start to become a part of that discussion too with our suppliers. How can we ensure that people who are living in a certain area who may not have access to some environmental resources, they have those? And we're doing all the things that you can in order to provide those resources for them. And then also better educating our patients on what they can do from an environmental perspective. So the things that we do, we wanna be able to translate back to our patients so that they understand those as well.
0:48:18.2 DS: Do we even look at things like the kit materials, what's being shipped out and how collection... Does it go that deep?
0:48:25.4 GT: It will go that deep.
0:48:26.7 DS: Okay, yeah.
0:48:26.8 GT: We will start to partner with our suppliers on the makeup of our kits and measuring the makeup of the kits and then understanding what's there so that it will go that far as well.
0:48:42.1 DS: Yeah.
0:48:43.4 GT: Yeah, so it's exciting... It's exciting work. I think it's a good work and it's something that we can amplify in the future.
0:48:49.4 DS: Yeah.
0:48:51.5 GT: Mm-hmm.
0:48:52.1 DS: Well, thank you. So any other further questions? We covered a lot of ground. Exciting to see all this moving. I see Choate, you have your hand up.
0:49:05.1 Choate: Sorry, I'll lower it. Beda told me that I had it up forever all the time.
[laughter]
0:49:09.2 Choate: Like I was just so anxious to keep talking.
[laughter]
0:49:13.9 Choate: So this is a question, and I'm saying it with lots of love in my heart, so... But I really would like to hear kind of... I think this is something that I kinda struggle with as a clinician, in that, I work with patient populations who are poorly represented in all genetics databases, including testing databases at Myriad. And I am getting individuals who have variants that have been identified once or twice at Myriad, and y'all test how many millions of people? [chuckle]
0:49:47.9 Choate: And then they're tested at Invitae who've seen it once or twice. And I struggle really with the fact that there's not more collaboration going on with... And I know Myriad does share some, but it still really kind of wiggles at me that that data isn't being contributed to ClinVar because it'll be forever till y'all have enough to reclassify it, or be forever until Invitae have enough, till Ambry, but if we were playing together in the same variant game, then... And maybe I'm naive to think that that would get us there sooner, but it feels like it could. And so that's just something that... Like, I have patients with variants identified at other laboratories, that I know y'all have enough data to classify, but... And so we retest them, which is wasted resources, and I tell the other laboratory, they're like, "Well, but we don't have access to that information," so that's not something that they can just say, "Oh, Myriad said so," so we change our classification. So... And it works both ways, right? I'm not saying that it's just y'all, but as the field of testing has gotten bigger, it's something that has become... I don't know. I feel like a bit of a sticking point for me. So I would like to hear how y'all think about that in the context of equality and equity as far as testing interpretation, and I'll shut up, so...
0:51:33.5 DS: Yeah, no, that's good. So I can definitely take some of that. I think overall, I can say the company has been looking at different options, we have some efforts going on with Sear, California-Georgia link with some other laboratories. We've been talking... Even me personally, I've been talking with some of the ClinGen leadership over the last year, I would say, and yeah, I can say, as we're evaluating it at the moment, it's definitely seen as an important issue, so I don't want to downplay it. You're definitely 100% spot on that you're seeing higher VUS rates, particularly in some of these rare mutations that are discrete and of rare ancestries that we're not doing a ton of testing. And yeah, we just need to try to contribute wherever we can, so... We've been working hard at least on the publication front, some of these other efforts, and I think that at the end of the day a lot of people really wanna see this translate into some ClinGen or ClinVar opportunities, so, yeah, we're definitely evaluating. Yeah, it's a good question. Alright. Anything else?
0:53:13.3 GT: Thank you so much TJ.
0:53:14.9 DS: Yeah, no, thanks. Tyrone and Gwen.
0:53:16.3 TQ: Definitely.
0:53:16.9 GT: I think Susannah was clapping.
0:53:20.2 DS: What did you say? Oh, "Susannah is clapping."
0:53:23.7 TQ: Oh, I was just clapping.
0:53:25.3 Suzanna: Oh.
0:53:25.9 Suzanna: I was just clapping. Thanks, Gwen.
[laughter]
0:53:28.4 GT: Thank you.
0:53:29.6 DS: Yeah, no, thanks for everyone coming on, and yeah, this was a nice collective conversation. We had good feedback from Choate, Richardo, thank you. Susannah, Beda, who was on, so, yeah, it's...
0:53:41.1 Choate: And we have a work group that we've created. [laughter]
0:53:43.5 DS: Yeah, it sounds like we [laughter] honed in on one issue, so...
0:53:48.9 TQ: That's the problem too.
0:53:50.4 Choate: I'm glad my patient didn't show up to clinic so I could join. [laughter]
0:53:53.7 Suzanna: Yeah, thank you, Choate.
0:53:56.9 Choate: Now I have to figure out, when we will see her, but at least I got to participate, so thanks for hosting this, and I really appreciate it. Thanks.
0:54:01.2 DS: Yeah, yeah. No, certainly important topic, and we'll continue to circle back to it on culture library a few months or so, just because it's... We gotta keep the awareness going and do what we can where we can do it. So...
0:54:15.5 GT: Yeah.
0:54:16.7 GT: Take care, everybody. Happy Holidays.
0:54:18.5 Choate: Happy Holidays, everyone.
0:54:20.1 DS: Yeah, great.
0:54:21.3 DS: Well, thanks everyone. And... Oh, just one more thing of housekeeping as people are getting off, so I'll put... I have not posted next year's Myriad Oncology Live. We're working a little bit. We'll probably start more in late January, so just in case people are looking for them, don't expect them in early January, and we're... And then this was the last one of the year, so thanks, and Happy 2022!
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