The Ethics of Genetic Testing with Dr. Stuart Kim _ Neil deGrasse Tyson

0:04 This is StarTalk Sports Edition. Neil deGrasse Tyson here, your personal astrophysicist. And today, we're on the topic of genetics. And I got with me my co-host, Gary O'Reilly.

0:19 Gary. Hey, Neil. All right.

0:21 Former soccer pro over in the UK, turned announcer. And he's sharing his time with us.

0:27 Yes.

0:28 And I still can't stop thinking of your wiki page. A great shot of you and with your sexy legs playing soccer.

0:35 That scar you for life.

0:38 And of course, Chuck, nice. Chuckie baby, how you doing, man? Hey, Neil. What's happening? All right. No pictures of my sexy legs.

0:45 And Chuck has no sports street cred.

0:50 At all.

0:50 Yeah, he does.

0:51 It's a big fan, fan of sports. That's all right. That's enough.

0:55 No sport without the fans.

0:57 Very good. The whole thing, without me, it doesn't exist. Thank you.

1:02 So Gary, you and your producers came up with this genetics theme.

1:08 Yes. So where are you going to take us with it?

1:09 All right. So it's always in the back of our mind as to, you know, how do we do this?

1:16 How do we make it go faster?

1:17 How can we make these things better? And so we landed in the field of genetics, but sports genetics. Now, analyzing your own genetics, we know can give you access to your ancestry, et cetera, et cetera. But what if genetic analysis could help predict vulnerability to certain illnesses, to certain injuries? What if the data could help naturally enhance our strength and conditioning by tailoring specific programs of exercise for you? Now, Line these two things up and you're getting what some people are dubbing right at this moment a new money ball.

1:57 Right.

1:57 We'll get into that aspect later on in the show. We'll either explode that theory as bunkum or we'll embrace it and see how we take that forward.

2:06 What you're saying is a person could be really good at a high school or college, but I look at their genetic profile and they have a tendency to drop a tendon. And so they could be on the injury list and I don't have to pay for that.

2:21 And see, the thing is that everyone's treating your injury, but you don't know that you've got in your internal structure an exposure to having this injury. So you need to do specific things that help ward off that potential injury.

2:38 Or I'm not hiring you.

2:39 Right?

2:40 I mean, that's an ethical thing.

2:41 Oh, now we're into the ethics.

2:43 Are we going to go in there too? Starting to get dangerously close to sports eugenics. There you go.

2:49 Okay, so now you've jumped to chapter four.

2:52 Okay, all right, gotcha, gotcha.

2:53 We're still on the preface.

2:54 It's all there. It's all there.

2:56 It's all there. Now, we're going to need someone with some serious chops to guide us through this particular area. And it is a particular area with an awful lot into it. So that expert is Dr. Stuart Kim.

3:07 Now, if you remember, Dr.

3:08 Kim has been with us before a couple of times. So we're honored to have him back. He is considered to be one of the world's leading experts in the genetics of musculoskeletal injuries. former professor of genetics and developmental biology at Stanford University. He's also co-founder and CEO of AxGen, a sports genetics business. So please, let's meet again, Dr.

3:32 Stuart Kim.

3:33 Yes, Stuart, welcome back to StarTalk.

3:36 Thank you very much. It's a pleasure.

3:38 Man, you're into some stuff here. I mean, who would have thought that this is even something that you could be.

3:45 An expert in? a few decades ago.

3:48 Just remind me, in your background, did you grow up saying, gee, I want to do sport genetics?

3:54 I mean, how do you land where you did? Did you have posters of Watson and Crick on your wall?

4:01 No.

4:01 Yeah.

4:06 Well, yeah, exactly. My entire life, I was a hardcore geneticist. So in a way, Neil, I think of athletes as... The new mouse. They're a great model organism.

4:22 Yeah.

4:23 Oh, I mean, the thing is that, you know, for now athletes, I know an incredible about their phenotype. I know how fast they are, how strong they are, how tall they are. And, you know, if you're a professional like Gary, you know, they poke and prod you all these different ways, which for us scientists is just data.

4:46 And so for most people, I don't know very much about them. But for an athlete, in principle, I could interrogate all of their medical records and find out what causes them to do it.

5:01 Now you're getting creepy.

5:04 But this is it, Neil. You see, if I am the 2% of the 2%, the real high-end, the Usain Bolts, the guys who shit.

5:14 LeBron James.

5:14 LeBron. The Brady.

5:17 That's right.

5:19 If I'm in that caliber, I have a need to know.

5:25 And like Stuart said, we have more data on you than we would ever have on most people ever in the history of the world. So this is an amazing... amazing fact.

5:36 All right.

5:36 So where do we start here, Gary? What's our first question to the good doctor?

5:40 All right.

5:41 So if we look at detection of specific markers as kind of being the precursor to prevention, right, how long has science been able to get into this area of analysis and identify vulnerabilities or to be an illness or to be an injury? So how long have we been here, doctor?

6:01 I would say in 2015, Everything before 2015 is obsolete. So in 2015, something new happened. It's really fascinating. So the Brits came along and really paved the way. They made this giant data bank that all scientists all over the world can use called the UK Biobank.

6:26 Let me guess. Let me guess. If it's British... They learned how to colonize the double helix.

6:37 Somewhere along the line, that's going to cost us, isn't it?

6:39 Yeah, yeah, yeah. This can't end well, I'm pretty sure. All right, go on. Go on.

6:46 So I guess that started probably around 2015. By 2017, all the scientists, lots of the scientists were accessing it. That led to. Up the ante. And so now the results started to become pretty serious and significant starting around 2016, 2017. So by significant, like a million fold more significant than in 2015.

7:13 So basically I ignore everything.

7:15 That much level of knowledge just in the course of two years.

7:20 Oh, it gets better. In 2018, around that time, scientists figured out a new way to think about genetics that just blew my mind. And everything I was taught about genetics only explains like a small fraction of what you really want to know. So basically before this revolution, all the genetics is what we call Mendelian genetics. Mendelian genetics is like Mendel's gene that causes a pea to be wrinkled. It's, you know, it can cause, it explains why some flies have white eyes. Or it explains, again, a mutant. And it explains why some people have a disease like cystic fibrosis.

8:10 What happened in 2018 is geneticists figured out something called complex genetics. And they can now explain height. So height isn't due to one gene or even a small number of genes. It's a million different changes in your genome that really dial in your height to within an inch or so. So most of your height is genetic. A little bit is, you know, how well you eat. But now it's clear that there's something like a million inputs into your height. Each input gives you a millimeter plus minus in your height.

8:48 All right, so doctor, if I gave you- Wait, wait, wait.

8:50 That means I'm a million millimeters tall?

8:55 No, sometimes it's minus a millimeter.

8:57 Minus a millimeter. Plus a millimeter. Plus 10, minus 10. It's the net. It's a game of tennis. It's like genetic tennis, back and forth, plus and minus. Plus and minus. Plus and minus.

9:11 And don't you know the statisticians and mathematicians of going nuts and trying to figure out the best way to add a million different things together.

9:21 All right.

9:21 So just to be clear, what you're saying is up until 2015, the Mendelian.

9:28 Yeah.

9:29 Um, understanding had to, it was stuck on the, there being one gene for one.

9:37 Yeah.

9:38 And, but we've always known that many effects are more complex than that. Are you saying that in 2018, we, figured out how to get there.

9:48 Exactly.

9:49 Oh, gotcha. Yeah, the Brits gave us the data, and then the Brits and the Australians and a couple Americans figured out how to analyze the data, and now they can actually prove, they can predict our height if they have a million data points.

10:06 Just to be clear, just so we're on the same page here, statistically, for every new variable you want to calculate, corral and contain, you need manifold more data to do that. In order to contain two variables relative to one variable, and for every add-on variable, you need that much more data. And so this is all playing into what you're saying here, Stuart, right?

10:31 Yeah, they didn't screw up. It's not overfitting. It can really predict the height of a new person never before seen.

10:39 So what methods are we using for screening? I mean, I give you someone's genome, you know, whoever it is, me, Chuck, Neil, LeBron James.

10:47 Yeah.

10:48 So what method is now the go-to method for your screening? Because there's something called a CGS candidate gene studies.

10:57 Yeah.

10:57 And there's something I think it's called a polygenetic risk score. Yeah. Now, what's the difference between them and which one came out as the best? screening process to use and why.

11:09 Right. The candidate gene studies is this before 2015 thing that I'm going to argue is obsolete. I'll give you an example. Let's say you want to know how strong a person is at first. And in the 2000s, they figured out that there was a gene called like 10 and 3 muscle protein. And depending on which type you had, you know, it kind of inched you towards an endurance athlete versus a power athlete. The thing is that it has an incredibly tiny effect. Now, I think it's of all of your genes, of all of these markers that inform about how much endurance and power you have, I think it's number 30,000 on the list. So I could tell you your actinine 3 genotype, 23andMe will sell you your actinine information, but it's number 30,000 on your list

12:07 in terms of the genetics of whether you're powerful or long-lasting. So then, you know, in 2015, you could do a study and look for the most significant genes in your genome, the top one. So I tended to be at number 30,000. 2015, you got the top one. And then now they have the top 175. That's where polygenic risk score comes in.

12:41 And the best way to do it is to add together all hundreds. It's like a vote. You get all 175 of these top hits and have them all vote. And together, they give you a much better idea of your muscle strength.

12:56 So where does injury come into this? Is that risk score? Is that a risk of injury? What is the risk measuring here?

13:03 Well, I just talked about strength. So this is just how much strength. Injury is not how strong you are, but you take everybody that got hurt and everybody that didn't get hurt and see if there's a genetic difference. And that's what was done. And so now you can look at for 13 different injuries. You know, you can see if they have the marker for, and these would be the strongest markers in the genome. So these are the kinds that are a million times stronger than the candidate gene studies.

13:37 Well, wouldn't you need a huge data set in order to make that determination? Because there are so many variables that go into injury itself.

13:49 So this is prime field for AI, surely. You must be. Using algorithms all day long because there's no one individual or a team of individuals sitting there scouring through all of these variables. This has to be fodder for AI, surely.

14:06 AI and then the statisticians are all having a... They're really paving the way.

14:13 That makes sense. That makes sense because really what you want to look at is a probability more than... You know, it's more of a likelihood than anything else. Exactly. Yeah. So you take your circumstances, you look at the likelihood, and then you change your circumstances based on that likelihood.

14:32 Exactly. Okay.

14:34 So who got here first, Doctor? Elite sport, which is possible, or general medicine? Because I'm guessing that general medicine would be searching for these answers as well as the elite athletes.

14:46 Oh, yeah.

14:46 Organizations there.

14:47 Yeah, yeah. What got there first is height, Gary. And then once they figured out height, a heart doctor from Harvard figured out, oh, we can do heart disease. And now once the heart disease doctor, you know, made a really, he had a really influential publication and everybody says, yeah, let me do it for my disease. And so there are hundreds, thousands of polygenic risk scores for lots and lots of different diseases, type two diabetes, all sorts of different diseases. This all is from the UK Biobank. It was like a gift to scientists all across the world.

15:27 The problem is that there aren't very many elite athletes in UK Biobank. What you really want is a lot of athletes. Then we could do the genetics of athletes. But until you start to get a lot of data, it's hard to do this type of statistics.

15:45 But the UK list was like an existence proof. that it's something that.

15:49 Can be done.

15:50 Exactly.

15:51 And the UK, were those just UK athletes?

15:55 No, it was UK citizens. 500,000 people, I think 600 professional athletes.

16:02 So they weren't even real athletes because they were British. Stop.

16:06 Stop. Stop.

16:10 Stop. I'm sorry, Gary. I had to do it. I know. I had to do it. I couldn't. I couldn't just let it sit there.

16:18 It was a dangling. As a comedian, it's dangling there. You can't let that go.

16:21 I heard a knock on the door and I thought, this is going to be Chuck.

16:25 Yeah, it's going to be Chuck. This is definitely going to be Chuck.

16:28 So, all right, Doc. So let's take a specific injury risk here. So if we look to ACL, PCL injuries, which is anterior cruciate ligament, posterior cruciate ligament, if you're not familiar or if you've never had that kind of knee smash up, Um, what are you looking for? Um, what is it that says, you know, is it ligament strength?

16:51 Is it bone density? Is it, well, are there other variables in there that we really, really need to be aware of?

16:59 Um, maybe, but the first thing you do is you just take something like in, in, you know, in this data bank from the UK, there was something like 10,000 people who had an ACL tear. Oh yeah. And then you take all of those people and compare it to all the people that didn't have an ACL tear and say, what's the difference? You don't have to make any presuppositions.

17:20 And you just come up with two genes that really seem to be different a little bit. It's not a lot. It's not going to, you know, but if you're a pro athlete, and this is the type of injury that can injure a career, you know, it will sideline you for a year at least, and it might be worse. Yes. So there you have an incredibly valuable commodity, your ability to perform as an elite athlete versus a tiny effect, a small effect on whether or not you're going to get it. But it's still worth integrating that into your training regimen since it's so easy to do.

18:04 So wouldn't it benefit me, not even from a genetic standpoint, couldn't I achieve almost the same thing by creating a data set where I, because everything is filmed now, everything, where I just looked at every single ACL injury, and then every single circumstance where an ACL in that very similar circumstance did not tear, and wouldn't I be able to deduce some best practices from that data set?

18:40 Well, that's been done.

18:41 I mean, you know, people look and I'm in the.

18:44 Wrong damn business. Right.

18:48 So there's a there's a there's a training regimen well known. It's called the FIFA 11 plus, I think. And so, you know, the trainers all tell mostly soccer players on how to not get an ACL. Dr.

19:02 FIFA being the International Football Association being soccer. So the world governing body, so as everybody sort of works out what that acronym is.

19:10 Right, right. So Chuck, if you look, I mean, if you look at an athlete and you see how they move, that's a lot of information. That's really strong at predicting. And, you know, there are some organizations around that are really good at this. And they put the biosensors up and down the athletes and they say, you know, are you jumping?

19:31 When you jump, do you land on one foot or do you land funny? They say that's really bad. They can train basketball players and volleyball players how to jump. So I'm talking about DNA. And I just want to know, when you were born, was there something about how your femur? and how your ligaments are all attached?

19:53 So it's everything we can see, right? With the naked eye or with this high speed cameras that we can use now. in terms of your technique. I jump, I land in a certain way. If I don't land in a certain way, well, guess what? Ankles, knees, hips, everything structurally is going to have an issue.

20:11 That's okay.

20:12 I might have the 10 out of 10 perfect Nadia Comaneci technique. But if it's going wrong inside where we can't see, I'm getting problems. I am going to get compound problem after problem after problem and There's nothing that can be solved. It's because I'm always getting torn up from the inside out, not the outside in.

20:33 That kind of makes sense. Like, okay, this is anecdotal and I'm not sure if it applies at all, but Dr. Kim, you can tell me. So I had a root canal done on my front left tooth. My father had a root canal done on his front left tooth. His father had a root canal dug on the front. Now, I'm thinking like what Gary just said, like, you know, maybe that's coincidence or maybe that's one of these things where there might be a genetic marker at a certain age.

21:09 It was the same dentist and it was the only surgery he knew how to do. Guys, we've got to take a quick break.

21:16 Look at Neil. Neil's on fire today, people.

21:19 What is happening?

21:21 What is going on? My Netflix special is coming out.

21:25 No.

21:25 No. So we take a quick break.

21:28 We're going to find out how much this genetics, my knowledge of this genetics, can be exploited to boost our own performance in whatever it is we do when StarTalk Sports Edition returns with Dr.

21:41 Stuart Kim.

21:44 We're back, StarTalk Sports Edition. This is an entire episode on genetics with a genetics expert, Dr. Stuart Kim. And Stuart, what is the, either the ethics, or before we get to the ethics, how much are people invoking your data, your analysis, your knowledge of their genetics to, uh, enhance their performance in ways that they could not have otherwise done without that information?

22:21 Well, that's a great question. My feeling is it's hard to beat a stopwatch. So I don't think it's hard for genetics to be what Gary already knows about how fast and how strong he is. So I've tried hard to find something about genetics that would tell you, but... You know, these athletes know exactly how fast they are.

22:45 They know exactly how much weight they can lift. And not only that, but they're already trying their best to be fast and strong. So it's kind of not easy for genetics to really add in that arena. What you don't know at all is where you're going to get hurt. You don't know if you're liable for a shoulder injury, which a soccer player doesn't care about, but a knee injury or ankle injury. And if you couldn't know if you were, you know, if you had a knee injury issue, you know, you might want to try to train that down so that you're less likely to get a knee injury.

23:23 So that's, it's easier to.

23:25 Okay.

23:26 But that's, it's one thing to just not mess up, do all you can to not die and do all you can to not break. But I'm talking about, I'm completely healthy and I want to use your information to break my own record. Is there something you can tell me that can make that happen? For example, is there something as prosaic as, does my chemistry differ from yours in how I metabolize sugar to draw energy from it?

23:54 Or is that just something I trained to do rather than was born with the genetics to enable?

24:00 Well, there's lots of theoretically possible. So in principle, there could be information today. You know, I'm trying hard to try to find an instance. You know, the best example, but it only affects a few people in Finland, is Iro Monteranga. Oh, yeah. Gary, you know about this guy. So he was a Finnish cross-country skier. He was the world's best. He won, you know, Olympic medals, world championships by a lot. And then along comes the anti-doping association who took a look at him and said, you must be doping because nobody has red blood cells as much as you do. And athletes try their hardest to get a lot of red blood cells because it helps you ski, oxygen, you know, bicyclists try hard to get either, you know,

25:00 some of them cheap to try and be able to ride for a long time.

25:05 Well, that's blood doping.

25:08 Yeah. Well, Uro got, you know, accused of blood doping. And he said, no, no, no, no, I don't, I don't dope. And finally, it was another, a British geneticist came to the, came to his rescue. And he found out that Uro had a mutation, a natural mutation. One was born with, from his mom and his dad, that activated something called an eporeceptor. So the dopers give inject EPO.

25:38 Eero had always turned on the EPO receptor. So it was always a zip. He had EPO in his blood. And so his stem cells were making red blood cells to the max. And he became world champion. So that's one example where if you were born with Eero's mutation, I would say just go for something where, you know, climb Mount Everest, Fight Bob Tour de France and cross-country speed because you have a really good chance of being good at it.

26:10 Wait, so maybe we can save this for section three, Gary, you tell me. But let me just ask, that means he's genetically cheating because he's not on the level playing field with the other competitors. So therefore, let me dope my blood so that it does what his blood does. And that way we got apples and apples here. And we have a level playing field.

26:39 No, there's no, it's not level. It's not level. If this is a naturally occurring situation, it's like someone who's born and all of a sudden they develop this massive, immense muscle mass.

26:49 I'm telling you that Stuart Kim has knowledge of genetics that in the future, I'm going to say, I want to be cross country skier champion. Give me this genetic anomaly. in utero okay all right that's different.

27:04 That's a different thing altogether near when when you're looking at someone who is born with as someone who has then gone away and gone you know what this is.

27:12 Exactly this is my shopping list what if you're born with because someone put it there thank you it's not the it's not just a random occurrence someone put it there now you're born with it Well.

27:24 This becomes a doping program in utero, obviously, but this is genetics.

27:30 Oh, the Russians will do it. The Russians are going to do it.

27:33 This is engineering. We're in the field of engineering. I mean, it's different, Neil, to the point you were making earlier on where all I'm trying to do is stay alive, which in sporting terms is all I'm trying to do is perform at my best. You see, I might be training in a certain way in terms of developing certain muscle strength in a certain way, which once I go to someone like Dr. Kim's organization says to me, you know what? That's detrimental. You've got an exposure to this kind of injury where this is debilitating this. It's taking away.

28:02 You need to strengthen certain areas. This strengthening, muscle strengthening, hips, and it might be muscles around your hips that align the way that you actually run on your gait, something along those lines. That then gives you that ability. Now, what you're saying here, if you go in utero and start to change these things, then Well, this is malice of all thought.

28:22 Well, Gary, I'm just trying to be blunt here.

28:24 No, that's fine. I get it.

28:26 If you come out genetically different from me that gives you an advantage, that's not a level playing field. And the whole point of anti-doping laws is so that everyone is on a level playing field.

28:39 But you can't get that because people are naturally born with, like Hiro, the Nordic cross-country skier, who are naturally born with this going on. They've not gone out of their way to have it engineered. So the playing field is as level as possible, but it's never going to be there.

28:56 Then what you're saying is you're projecting a future. And let me get, we're talking, I want to, we got Stuart here to talk about.

29:05 Stuart, Stuart, Stuart.

29:07 Please, yeah, jump in, because my knowledge is minimal.

29:10 The point is, what you're saying, in the limit of this, every winner of every sport is going to be a genetic freak with genetic profile that favors their performance in that event relative to everyone else. And so we're cheering genetics, not hard work, not... Oh, because they grew up in a way and they ran up the mountain to go to school and it's in, no, we're just, it's the genetic freak Olympics. That's what you're telling me in the limit here. Stuart, is that what the future of this is?

29:49 I don't think that's exactly.

29:50 So it's part nature, part nurture.

29:54 I'm exaggerating, of course.

29:56 So hero, like, His mutation is in all of his relatives. So his sisters and his brothers had the same mutation. Eero won the gold medals. That's because he was out skiing all the time. So it's part how you train and part how you were born. And then part of it is this Eero thing I brought up because it's this Mendelian type. I think most of athleticism is going to be this complex type. So if you want to ask about Why is LeBron so great? I mean, I think it might be a million inputs about what makes him great, not just one mutation. And then a geneticist doesn't believe all people are created equal. And so when a sports geneticist will just point out that there's gotta be differences based on your ethnicity. So Asians, African-Americans, Caucasians,

30:49 you know, we're not created equal and there was nothing I could ever do in training that would let me play in the NBA.

30:58 Me neither. Yeah.

31:00 So, but, but I don't have the, you could, oh, you could.

31:06 It's not, it's not to my mind, having been a professional athlete and I've been around all different shapes and sizes in my own particular sport and gone.

31:14 You know what?

31:14 You don't look like you're the kind of identikit shape to be an elite soccer player.

31:20 Yeah. Yeah.

31:21 Look at Messi.

31:22 You surprised me, you know, and then it, and so this thing is, okay, so you, you've got the ideal body shape. You've got technique that is mind boggling yet. You drink all night and you smoke 60 cigarettes a day.

31:36 You still got to want to do it.

31:38 So it becomes environmental. Then it becomes a mental thing. The dangerous space is the bit between your ears. It goes on in there that allows you. I mean, there's this kind of sort of urban myth that there's probably sprinters in Jamaica that are faster than Usain Bolt. They just never got into the program.

31:54 So, all right.

31:55 So let me just bring some focus to this. So, yes, every human is unique. Genetically unique. No one is disputing that.

32:06 And we have.

32:08 No end of systems in place in society to sort us based on some ability or talent. And in any meritocracy, this is foundational in how they work. So no one is arguing that. What I just wonder is, what is the value of you to say, to go up to someone, you have the genetics to be a world-class whatever. And then the person says, well, I don't feel like it.

32:36 I wanna read. So then what good are you? What is the value of your advice here? So in other words, you're gonna tell people you should or shouldn't do something in their lives if they wanna excel in the way you think they will. I heard long ago, a geneticist is someone who tells you why you look like your parents And if you don't, they tell you why you should have looked like your parents.

33:02 Right? So what good are you? I don't need you.

33:06 It's my ambition between me and what I want to achieve.

33:10 Then it becomes personal, Neil. I mean, I've been around a lot of guys growing up who were so talented, silly talented. They never got into a professional system, even through the academies.

33:20 For example, right?

33:22 So are you going to run after them and say, you should do this because our genetic profile showed it?

33:26 Personal choice.

33:27 Personal choice. Personal choice. Yeah, and you look at it.

33:30 And go, thank you for that information. You run after them and you tell them, this is why your father never loved you. Look at what you're doing. Look at how you are.

33:41 Just wasting all of this great class talent.

33:45 This is why your dad hates you.

33:47 Just one way.

33:50 I think I said this last time you were on. My father in gym class in high school said, was pointed out by the gym instructor when they were transitioning to the track and field unit. And he pointed out and said, Cyril Tyson, for example, has the kind of body that would never excel at track. And my father heard that and he said, no one is going to tell me what I cannot do in my life.

34:14 You crack ass cracker. Stop.

34:19 So on that day, he took up running. And he became world-class with the fifth fastest time in the world in his event, a middle-distance event. And so I'm just wondering, why do we need geneticists? If all you're going to do is tell me what I should do, and if I don't do it, you tell me why I should have done it, and you're not measuring my ambition.

34:44 See, people now are coming along, and they are data-hungry. They want to know. They need to know. you think about all of the things people access in terms of information about themselves now, not just ancestry. They want to know about this. They want to know about that. They want to be able to do this. They want to be able to do that. And now all of a sudden, you know what, what is my tolerance for caffeine? Am I that sort of person that can metabolize caffeine quickly or slowly? Am I the sort of person that, you know what, needs vitamin B12? But do you know what?

35:16 I don't have a really good capacity to metabolize that quickly. I need to know that. So I People want this information. They're not just there to be elite athletes. This is there for general consumption of understanding of an intimate self.

35:33 Yeah, but what I'm saying is if you're going to use the genetics to sort people, not just to show that we're different because we know that. We get more detail for why we're different. We can do it to sort people for who's going to get access to opportunity and who is not. and in that equation is not their ambition to achieve, then that's like eugenics at that level.

35:59 So Stuart, getting back to Chuck's earlier point, are you skirting the line.

36:06 Between sort of moral.

36:09 Invocation of genetics and what the eugenics folks did a century ago?

36:14 No. And, you know, everybody but me is an elite athlete. So we're all player-centric. You know, the simple idea is to help them not get hurt so they get to win more and they get a better career at the end of the day.

36:35 That's interesting that you say that because what you're saying is, what you're dealing with are people who already made it to an exact level. Exactly.

36:44 Exactly.

36:45 Yeah. It has nothing to do with what, what a choice starting from scratch, starting from scratch. They're already there. Got it.

36:53 And the thing is Chuck, they want to stay there. I remember listening to a radio interview with an Olympic gold medal, long jumper.

36:59 Right.

37:00 And he obviously wasn't bad, but jumping into the sand from a long distance away, However, he went to a university in the US, and I do not remember which one it was, and investigated his own self through the genetics. Because long jump, the pounds per square inch through your thing when you're landing, the sprinting, everything about you. So he needed to go away and find that information so as he could train better because it's all about sprinting.

37:31 Okay.

37:31 So he needed to improve his sprinting. And therefore, were there ways for him to train and develop so as he could actually gain that extra bit and stay at the very top of long jump? So yes, it is elite athletes who wish to stay elite. It is these guys that, you know what, they want to extend the bell curve of their career. They don't want a Mount Everest peak. They want a nice long plateau before it sort of just tapers away. So, and I don't know, we think we'll get into this in the next section, but I think Maybe Dr. Kim will enlighten us. Are athletes like LeBron, are athletes like Chuck's friend Tom Brady, who may or may not have retired this time, are they at the vanguard of where athletes are going now

38:18 in the future? Or are these just, you know what? These are outliers, dude. These guys just come around. They're like hen's teeth. We see them every so often, but not very often.

38:27 All right, so we're going to take a break. And when we come back, we're going to see how Dr. Stuart Kim's expertise might just be adopted into better living through the knowledge of our genetics when StarTalk Sports Edition returns. We're back, the third and final segment of StarTalk Sports Edition Genetics with Dr. Stuart Kim, who specializes in how understanding your genetics can change how you live and what you do and improve your risks of injury or reduce your risk of injury in whatever is your walk in life.

39:08 And in this segment, we just want to ask whether, Stuart, whether your knowledge, a person's knowledge of their own genetic profile, how can they take that into their twilight years? Either as an athlete prolonging their, how long they can be at the top of their game or in their game at all, or for the rest of us who just want to live along healthy life?

39:31 Well, there is the Hero Project. Let me tell you about the Hero Project. Athletes are at really one end of a distribution. They're faster, they're stronger. So our cross-country runners, our endurance runners, They are thin. They will never be obese. They will not get type two diabetes. Our NFL players will not get weak muscle disease called sarcopenia. And so there's diseases like, you know, all of us are worrying about putting on weight and type two diabetes or losing our strength as we get older. And the athletes might have clues about how they were so strong. And some of these endurance runners we know They eat 6,000 calories a day and they cannot put on weight. And it's not just because they're running so much. But what if

40:25 we could learn from them and figure out either mental or physical, what is it that lets you stay so thin or dial in your weight to within a pound? I mean, what if we all had the mental fortitude to control our diet like Tom Brady? So that, I mean, there's no way I could, I could, you know, be that kind of regiment, but he can stick to, you know, his, his regiment and, That's.

40:53 Because he rightfully hates himself. And so that's why he's able to do that. He hates himself? Thank you, Chuck, for your Tom Brady analysis.

41:00 How could Tom Brady hate himself?

41:03 What more could that guy want that he doesn't have? Oh, that's the whole point. He's totally overcompensating for his self-hatred and self-loathing.

41:11 So, okay, we said at the top of the show, Dr. Kim, about what people are calling this kind of area where you've got injury and illness issues. potentially being able to be detected in advance of it happening because of something that's going on in your genes. And then, you know what, we're analyzing foodstuffs and lifestyles and environments that may impact upon you as an individual and how this could be the new money ball for sports organizations, for athletes themselves.

41:42 Is that just a false dawn or is this actually got a legitimate backup to it being the new level and new generation of analytics?

41:53 Well, in Moneyball, the Oakland A's in 2001 said they had a different way of evaluating athletes. Not, you know, RDIs and averages. They said, you know, they came up with all these other stats and they tried to find value, how to evaluate a player that wasn't in their traditional stats. And so I think genetics is a way that you could evaluate people with a new kind of stats and it could give you an edge one way or another.

42:28 In this case, you know, the edge would be to not get hurt. So you play more games and win more games.

42:34 That makes sense. I mean, you're not looking at it. It's really because when you look at those markers, it doesn't mean that it's going to happen.

42:44 Exactly.

42:44 It means that it's far more likely to happen.

42:47 Exactly.

42:48 So if you start taking preventative measures to keep it from happening, then you're ahead of the game, right? Yeah. Yeah, that's simple.

42:56 This is the LeBron Brady scenario. I mean, they've tapped into this situation where they've gone, you know what, if they've done this analysis and the data's come back and they've gone, all right, I need to work this way and I need to be able to do this. I mean, the great thing is we've always said it, knowledge is power. Now, who has control.

43:16 Of this power?

43:17 We know the athlete will know their own profile and how they can possibly go about working, developing, training, strengthening, and conditioning. But what if the coach has this power? What if the coach goes, you know what? His cruciate ligaments could explode at any moment. I better not play him.

43:36 You know what?

43:37 Trade him. And this becomes an ethical situation. Who's allowed to keep this data? How much of this data can get out? Because it's personal. This becomes a data protection issue.

43:49 So in short, Stuart, do you have an ethicist in your lab looking over your shoulder? That's what this comes down to.

43:57 Not in my lab, but I have lawyers that I collaborate with and are writing the ethics. I mean, this is an incredibly important point. you know, it's genetic discrimination. So for normal people, you know, I have a law that says my genes can't prevent my insurance company from insuring me. So it's called the Genetic Information Non-Discrimination Act.

44:24 So we need the same thing for athletes. We need something that, you know, your DNA cannot let the owners discriminate against you in your contract. And then It's still a good idea because everybody wins. The owners should like this because their players, if they have their coaches and trainers have this information in principle, they could train the players in a smarter way and the players wouldn't get so correct. And then they wouldn't have to pay for injured players. They would win more. Their team would be up in value. The owners are going to win anyways.

45:00 They don't have to screw around with contracts. And so there's a way to set this up, just like our health care is set up, that there's no discrimination in professional sports. And that's only for team sports with owners. So the tennis players should love this. And, you know, they should know about shoulder injuries and knee injuries.

45:21 OK, so we're at this point now and you've got ahead of the game in terms of, you know, what we need to protect genetic profiles, etc.

45:29 etc.

45:31 Where are we going to go with this moving forward? I mean, are we done now? I mean, this biobank guarded by corgis and butlers in the UK with a very, very crystal cut accent sounds fabulous. But where do we go? Because I can't imagine people said, oh, we've learned enough now. That's not how this works. So what are we going to get exposed to? What are people going to be looking for in the future?

45:56 Plus, Brady and LeBron, aren't they each over 40?

46:01 No, Brady's 45, I believe. And LeBron is ancient. He's 38.

46:08 Oh, he's only 38. Okay.

46:09 But still, I mean, so we're talking about bringing this into our twilight years.

46:15 Yeah. So what does the research say on that? Well, it's not Brady.

46:18 And LeBron that we want to think about. It's a guy named Robert Griffin III. You remember him?

46:24 Yes. RG3. RG3.

46:27 He was a superstar quarterback, and he tore up his knee in his first year.

46:31 And he never heard of him.

46:32 So it's like, it's like, he was like a Tom Brady to be, but he got hurt. I mean, you know, he's not, he never had a professional career. So it's really for all of the best that never were, that we're trying to, we're trying to work with. Tom Brady didn't get hurt mostly. And LeBron had a successful career, but what if they got hurt in college or high school and never got a, you know, never got a scholarship.

46:59 You never would have heard of him.

47:00 So are high schools looking at this kind of analytics and using it for their athletes? Are we seeing this at college level as well?

47:11 Not yet.

47:12 I mean, this is brand new and it's going to take a while for it to filter down. But, you know, the younger you get, the more useful this is. Like, you know, if you were a high school athlete wannabe and you said, who knows what my operand is going to be, I could make it into the Premier League. but only if you don't get hurt. The younger you are, the more potential you have to protect. And then, you know, doing this training or that training, you, if you had a personalized training regimen from young, that would optimize your chance of staying injury free. At least you have a chance to go as far as you want. You could go in your, in your professional career.

47:56 See, I'll speak to that, Neil. And, If you sort of found this program at age 28, 29, what you'll have to do first is undo all of the bad stuff you've done prior. And rather than tapping into this, it's like 15, 16 years of age and gone, you know what? I'm still growing, but we can work with that. We can build in all of the good stuff that will protect me going forward and enable me to have a potentially better career if that's what it is I want to do. Because as I said before, you know what?

48:28 I might turn around and go, nah, I'm going to walk away and do something else.

48:32 But there's another side of this, by the way. We've had Lindsey Vonn as a guest on StarTalk Sports Edition. And I was just dumbstruck when she described that she took a spill on one of her downhill races and had to be airlifted off the side of the mountain, was taken to the hospital. And she said, I don't want to lose any time in this tournament or whatever they call them. And She, I don't know what she, they taped her up or something and she was skiing again the next day. And I'm trying to think to myself, beyond injury, there is the drive where you don't care, just, you know, I got a broken bone, just tape, you know, duct tape it, whatever, whatever doctors use. And then you go back out and there's a whole, other mental state.

49:21 Can you genetically code for mental states?

49:25 You can. You know, one of the most, there's all sorts of, and they're fairly controversial studies. There's genetics for, they call it educational attainment. So they take everybody that has a PhD and compared to everybody else and they could find the genes for that. And, you know, and it's kind of controversial about whether at birth you can figure out what your, what your, you know, educational attainment could be. And yeah.

49:57 So this is like a temperament. It's kind of like a temperament for one thing versus another in a sense.

50:03 Right.

50:04 Yeah. It's, you know, from the athletes I know it's clear they have a different temperament. They can just control their whims and urges and things so that they can get out and do this exercise every day. They can control their diet. They can really sculpt themselves in a way I cannot.

50:24 So the thing is, you know, grit. Yeah, there is that.

50:27 Angela, what's her name?

50:28 Duckworth.

50:29 Angela Duckworth. The doctor that we had on talking about grit.

50:33 Yeah. Mm-hmm.

50:34 The coach can work with you. The strength and conditioning guys can work with you. All of that side of the sport can be can be controlled to a certain extent. I don't know when the athlete walks into the stadium. What's going on in here?

50:51 Yeah.

50:52 As the coach, am I going to get game ready, Gary, or am I going to get Gary who's got six girlfriends? a problem in over there and this there, and they're all arguing, they're all going to turn up to the game and I've got to try and put them all in different boxes so they don't get together. And I mean, I don't, where?

51:09 Gary, you came up with that example way too easily. Yeah, I was going to say.

51:13 Can I say?

51:14 Game ready, Gary, I lost out to horny giddy Gary.

51:18 So this is, this is the thing, right? My, my head's not in my game.

51:23 My head's somewhere else.

51:24 It might be a business that I've got back, you know, somewhere that's failing. So that's now, you know, there's something, there's a lawsuit going on. It could be a number of things, right? So all of a sudden, if I can have that kind of alchemy as a coach to know, you know what, this guy's going to be predisposed to going AWOL. Now, sometimes, you know, from behavior that you have observed during camp, during training, during games, that certain players, certain athletes are going to be a little bit more vulnerable.

51:52 That's just, acquired knowledge through observation. You're being their parent. Yeah, totally.

51:58 But if you can get into that point where you can, apart from what we can see visually from an athlete, go back to the jumping scenario, that might be perfect. But the stuff that's going on inside we can't see, that's the stuff that's really scary.

52:12 Yeah, but I'm sure there's something that you can quantify there to like holding fast to focus. Well, I'm getting there. I'm getting there.

52:21 So Stuart, take us into the future. So obviously height is a very measurable thing that where there's no ambiguity what it means, how to measure it, and you've got your genetic factors that contribute to it. Part of what we're describing here is a person's drive, such as what my father exhibited when he said he was told he couldn't run, what Lindsey Vonn exhibited when she was airlifted off the mountain and returned the next day. There are people who have focus Is there a future of genetic knowledge that can tell you about a person's personality, a person's motives, a person's morality, any of this? And if there is, what kind of future is that? Now I fear you and the power that you'll have over us all.

53:22 Well, there's a lot packed into that, Neil. I mean, part of what you're asking is, is knowledge always power or is it always going to sometimes be evil? That's one question. The other thing about these things is if you can quantify it and you can get enough people into a data bank, we in a genesis can know it.

53:44 So let's imagine you quantify drive in everything. And it's not just athlete drive to be able I mean, these athletes are incredibly driven. Everyone that's a long-distance runner has a drive to just get.

54:00 Up and exercise a lot.

54:01 But it could be Oscar businesses. They need a drive to make it through that or to make it to be in all these different everywhere. You could quantify drive, and you could take everybody with a lot of drive versus everybody who didn't have a lot of drive. Eventually, if you had enough people, you'd be able to figure out the DNA They gave some people inherently more joy.

54:24 And then the other part is going to be parenting, how much your parents influenced your joy. But you could know it.

54:33 Well, what about this? Let's say I were able to create some kind of biological surgery, okay, where I could restore anyone to perfect health. using whatever, some type of cellular manipulation, right? So I can go in, I can rebuild a knee, I can do whatever, like that. Would that eliminate the need to know the information that we're talking about right now?

54:59 Well, you'd think you'd want to know what you're at, and then that would tell you how you could change it. You know, there's this New gene editing technology that's coming online.

55:08 That's where I was going next.

55:09 That's where you're going. And so now you can't do it, but in the future you could, you know, change your DNA. You could, you know, change your EPO receptor to look like a romantic rock and then go out running. And it's not going to make you a world-class skier, but it's going to get you a lot closer. It's going to give you a potential you didn't used to have.

55:32 And then that's where these Mendelian things, it's got to be way, I don't know what you would do if it's a million things. That's the difference between us and Tom Brady. I don't know how you would change your DNA, but the difference between us and Euro, Monty Rumpkin is one nucleotide. And so you just have to go in and change that one thing.

55:50 Put one in.

55:52 Yeah.

55:53 It's literally cut and paste.

55:55 Cut and paste. And we know exactly, you know.

55:59 Stuart, did you, did you, create your kids? Well, I did.

56:07 He's my kid.

56:08 Okay.

56:08 I was letting you answer that in whatever way you felt that you were comfortable.

56:14 All right.

56:16 So this is clearly, as Thomas Huxley once said, a brave new world on a whole other level with this knowledge of genetics. And I think we have enough historical cautions en route to just keep an eye on this because humans, if they get the chance, will sort you in such a way that oppression follows immediately after. The Nazis did it. The eugenicists did it. The anthropologists did it.

56:49 The European anthropologists. So, yeah, it's got a really ugly past. And so one would have to tread carefully here, I think. to not repeat the errors of the ways of our predecessors.

57:04 I think the past is ugly because we're ugly. So, you know, if- Yeah, yeah. And what means we're capable of doing it again. Again. That's right. That's right.

57:13 But we'll note, Stuart, that if your kids start winning cross-country tournaments.

57:17 And things- I had nothing to do with it. We got an eye on you, Stuart. Why does your son run as fast as that.

57:29 Kid in the Incredibles movie? All right, we got to end it there. Stuart, great to have you back on StarTalk.

57:38 Thank you so much.

57:39 We love finding out all these inroads onto what it is we talk about and how it could be influenced now and in the future.

57:46 All right, Chuck, always good to see you. Always a pleasure. All right, Gary.

57:50 Thank you.

57:51 You've been listening to and possibly even watching StarTalk Sports Edition, all about genetics, with our friend, Dr.

57:58 Stuart Kim. I'm Neil deGrasse Tyson. Keep looking up.