Resonance is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields.
Dr. Daryl Scott discusses tell us about how he uses genomics to diagnose multifactorial diseases such as autism, as well as rare diseases managed by the Undiagnosed Diseases Network.
All of the SNPs | Transcript
Erik: And we are here!
Brandon: We are here!
Erik: This is the Baylor College of Medicine Resonance Podcast I am one of your hosts, Erik Anderson.
Brandon: … and I'm your other host, Brandon Garcia.
Erik: And, we're going to be talking to Dr. Daryll Scott today, who is a clinical geneticist, and we're going to be talking about clinical genetics. So, Brandon, I believe you were taking the lead on this one, right?
Brandon: Oh yeah absolutely, I'm actually really stoked for this episode because I like Dr. Scott a lot- not that I don't like everyone else we've interviewed- but he's he went to BYU like I did and he's someone I've really clicked with here at Baylor. He's just like you said. He's clinical geneticists, a pediatric geneticist, at Texas Children's Hospital and with Baylor College of Medicine (and we'll read through all of his couldn't his credentials and stuff like that later). He gives us a really good snapshot of what life as a clinical geneticist is like. Which I think is really cool, especially for us who were going into clinics and thinking about residency's and stuff like that. And while he does a really good job explaining that, what I didn't realize is that the field itself is really new. Genetics as a research field has been around for a couple centuries (with people like Gregor Mendel and things like that) but actually applying it to clinic…
Brandon: yeah as far as like actually adding that to the clinic and trying to use it that's only been around for like 70 years- like 1948 is when they created an American clinical geneticists Association.
Brandon: Yeah. So initially, it was something that started out with Pediatrics that has grown over time.
Erik: Why pediatrics?
Brandon: Well I think it's I think it's because a lot of these congenital defects and diseases and stuff like that you see when patients are really young- when they're toddlers, when they're young. Kid’s parents start seeing something that's not usual and they bring them to the doctor and say “What's going on?” And when we started realizing that we could use genetics as an answer, that's when we started to see clinical genetics. And it just started with Pediatrics because these patients tend to be super young.
Brandon: Yeah so, the key to the growth of clinical genetics is the same thing that like we've mentioned a dozen times on this podcast already, it's the growth of technology. We've got the internet; we've got computers that can compute massive amounts of the information. Now we've got genomics and the ability to look at the whole sequence of a person, and that's allowed us to just explode the field of clinical genetics.
Erik: Yeah, well, and it's especially fitting to be talking about this at Baylor College of Medicine because of our history with the human genome project as being one of the sequencing centers for that. There's just so many great faculty members who are working on genetics and are leaders in the field probably due to this one thing- we have the infrastructure. And that's an important thing, you need servers to put all this sequencing data on and so it, you know, takes a lot of behind the scenes, I guess you could say, “stuff” that maybe other places don't necessarily have, but we are privileged enough to have available to us here.
Brandon: Yeah speaking of that, we've been in this game (I say we, but the college has been in this game) since 1971, when they decided to add a genetics division to their internal medicine and pediatrics department. Then it became its own department in 1994, which makes it one of the few departments that is actually kind of younger than we are. Then like just like what you said, in 1996 we created the Human Genome Center which became part of the Human Genome Project and we stuck with it we were one of three organizations that stayed with it all the way through to the end and because of that we have that infrastructure (we have the technology, we can rebuild them). I mean we can do genetics.
Erik: And how about funding for this
Brandon: As of 2018, we're the number one ranked department in the U.S. for NIH funding.
Erik: Yeah, that's amazing!
Brandon: Yeah and it's allowed us to do things like create a genetic counseling program
Brandon: As far as a note too, Medical Genetics is great in the fact that it's changed in what it's been able to do over the past couple of decades. We now have the ability to meet with you, meet with patients, and actually be able to tell them a little bit more about what's going on in their lives and why they have whatever they have. Whether it's a defect or a disorder or anything like that. In short, genetics is awesome, and it has allowed us to learn a lot of things.
Erik: Yeah definitely so without further ado we will be talking to Dr. Daryl Scott, as I've already said, and Dr. Scott got his undergraduate at Brigham Young University…
Brandon: Go Cougs!
Erik: …and he completed his MD PhD at the University of Iowa. His residency was in Pediatrics at the University of Utah, and he actually did another residency in clinical genetics here at Baylor College of Medicine. He stayed on as faculty studying congenital diseases, like diaphragmatic hernias and congenital heart defects, so here is our interview with Dr. Scott.
Brandon: Dr. Scott, thank you so much for coming with us today. I really appreciate you meeting and letting us interview you. To get things started let's go ahead and just talk about your journey. Where did you start, how'd you get into medicine, and how did you end up here at Baylor?
Dr. Scott: That's kind of an interesting question. My pathway into Baylor- pathway into medicine- was not exactly the typical one. I always had an interest in genetics which probably started in seventh grade when my seventh-grade science teacher indicated that we were going to put aside all the regular curriculum and spend an entire week talking about genetics. I was fascinated by the things that he talked about, especially the fact that you could take just even a single letter change could cause an individual to be dramatically different as far as their health goes. And so, from that point forward, I always had in the back of my mind that maybe I would like to be a geneticist, but, at that point or that period of time, there really wasn't a lot of clinical genetics that could be done. And so, I toyed around with thinking about making pharmaceuticals and bacteria and other stuff, but I always had a focus on being a scientist and it was only when I was at my undergraduate university that accidentally walked into the wrong counseling office. Instead of going to the biology office, I walked into the pre-medical/pre-dental office and that is where I found out about a program called the MD Ph.D. program, or the medical scientist training program. I was absolutely overwhelmed that this was exactly what I wanted to be, but I still saw this as a pathway to being a scientist not a doctor and the descriptions said, you know, “You will go to medical school to be a scientist working on human diseases.” I said this would be great, so I called my wife and said “Would you mind if I went to medical school?” and she literally said “Sure, you can do whatever you want” and so I dramatically changed my course and said “Oh, I'm going to go to medical school and be a genetic scientist.” And it was only on my first interview that someone asked me, “So what kind of doctor are you going to be?” I said “I'm not going to be a doctor; I'm going be a genetic scientist. And I'm going to go to med school to know how I'm going to do that.” and they said “Well, isn't that kind of a waste of going to medical school?” And, I had never thought of that. I said, “well how long does it take to be a doctor,” and he said “Well, it will take you a couple more years.” I said, “Well, a couple of more years isn't that big a deal.” And so, then I found out that, well, you go to med school and then there's residency, and then there's fellowship, and all this. Thankfully, my wife only learned about this a little bit by bit, but ultimately that’s how I ended up becoming both a doctor and a scientist. And to tell you the truth, there was no better path for me.
Brandon: Oh, that's awesome! Real quick, where did you go for your training?
Dr. Scott: So I did an MD PhD at the University of Iowa, and then I went to do Pediatrics residency at the University of Utah, and after- that's when I came here to Baylor- I was a clinical genetics resident here at Baylor, and, after my residency, I stayed on in his faculty.
Brandon: Oh, what about your residency made you want to stay here as faculty?
Dr. Scott: By the time you're in residency -or at least at that time- residency was highly focused on research. And so, most of the people who were doing genetics, our clinical genetics residency, wanted to be geneticists, but almost all of us were very interested in doing research as well. And so, in my residency, I already began to work with mouse models trying to understand how human diseases can be modeled in mice, and then finding ways to understand those diseases and perhaps even cure them using these mouse models. By the time I was done with my two years of residency here, we were well on our way to identifying some important things about how the diaphragm works and the genes that cause diaphragmatic hernia, which is a very common problem in in pediatrics, but was not really known to be genetic at that time. And so, from there I looked at many different places, but there was there was no one who had the facilities, and especially the clinical understanding, and contact with clinical patients. There wasn’t anything similar to what we could find at Baylor, and it was just obvious that to stay here would be far better than to move because I would be able to not only pursue my scientific interest but also mesh that with the clinical patients that I was seeing in clinic on a regular basis.
Brandon: Gotcha, I really get that. When I was preparing to come to Baylor, one of the things that really attracted me was the genetics program. And the fact that, here at the Texas Medical Center, we have all kinds of opportunities, and I don't think there's many places else in the world where you can get the kind of work and opportunity that you get here.
Dr. Scott: One of the things that's very different about Baylor and Genetics, is most places have a division of genetics. In other words, it's part of a clinical department and it shares a very small piece of the medical school. Here we have a genetics department, and so that actually includes, under one umbrella, both researchers and clinicians. And, we also have our own genetics laboratory, so we do genetic tests here. That triad of doctors, physicians, and laboratory individuals all working together is extremely powerful and allows us to move and do things much faster here than perhaps anywhere else I’m aware of.
Erik: Did you see the genetics program and pathway change a lot in your career then? Just, I know that it's changed a lot even in just the past, probably, 15 years and especially with the emphasis on personalized medicine.
Dr. Scott: Yeah! One of the things that's really made a big difference is the technology that we used when we were first starting out as genetics residents. We would go to clinic and we would diagnose perhaps five percent of the patients that we saw. And so, I would go home on a regular basis and my wife would say “So how was clinic today?” And I would just say “I feel extremely humble because every single patient I saw I could not diagnose it.” That was just because we didn't have the tools to do so. Right now, we have the genetic tools to be able to diagnose perhaps 40 to 50 percent of the kids that we see. The need for clinical Genetics has also gone way up.
Dr. Scott: And so, we see far more people interested in becoming clinical geneticists with the idea of not just doing research, but also just doing clinical medicine because they will have the tools to be able to help patients. And, we can really significantly help not only individuals, but families with the diagnosis that we make and, in some cases, the treatments that we can offer. That has been probably the biggest change and it's so much nicer to be able to go home and tell my wife that “Yes, actually could diagnose them today.”
Erik: Well, by tools do you mean just the fact that we can sequence a lot more readily? I mean, probably with the human genome sequence and so now we're starting to find more genes that actually correlate with these diseases or…
Dr. Scott: Yeah, so probably the most important tools that we have are genetic tests. One is called a chromosome microarray analysis. it’s been around for a significant amount of time, but was a huge breakthrough. It basically allowed us to look for big pieces of DNA that are missing, or extra, and that was something we could not do across the entire genome in the past. When we could do that, awesome! We had a whole new area of genomic disorders that we could diagnose and we went again from going, let’s say, from 5% of the patients that we saw we could diagnose to maybe 10 or 15. I mean that may not sound like a big jump, but that's three times more. And all of a sudden, we had that ability/then we were able to do exome sequencing, which allows us to check the letter codes of all 20,000 genes at once and that technology again boosted our ability to diagnose more children. Not only that, we're also finding that same data sometimes gave us clues on brand-new genes and brand-new diseases that have never been described before. That's perhaps one of the things that I enjoy the most. If you said, “Well what would you classify yourself as far as a researcher goes?” More and more [I would say that] I am gene hunter. In other words, we look for new disease genes and we do so across a wide variety of children. I started here looking at diaphragmatic hernia. Then I became interested in heart defects, but now we are able to do this for eye defects, lung abnormalities, autism, developmental delay, intellectual disability, and we can find new genes for all the different types of children I see in clinic.
Brandon: That's awesome! I like that term! Gene hunter- that makes me think of like something like Animal Planet.
Dr. Scott: It's a little bit addicting. I often tell peoples most doctors go to a clinic and they hope they find something they've never seen before and they'll be able to diagnose some child with a rare disorder that they've heard about, but never seen. We go to clinic literally thinking that we might diagnose someone with a disease that has never been described before. Now that sounds a little bit wild, [but] we do this on a regular basis. This is actually quite a project to do one of these. First of all, l we have families that are very interested in trying to identify what is the cause of their child’s medical problems. When we can offer them a possible solution, or a possible answer, to that question they’re very interested in working with us. We then work with a network of doctors all over the world to try to identify more patients that have changes in that same gene. And so, we're very, I guess we'd say, gene-centric, or we look at genes as a way of trying to understand what they are doing and how many patients can they describe, or help us understand. Often, we will gather sometimes three or four, sometimes ten, sometimes dozens of patients that have changes in specific genes and then we see common patterns and that was from those patients. It opens up, again, a brand-new genetic disorder there's not only an answer for all the patients that have been working with us (and their families). But we recognize that as soon as we do so, all the tests that are being done, the world will also change. In other words, now those tests, or the people who read that in the laboratory, will be on alert that that is a disease-causing gene. And so, you have a very fast ripple effect where people are being diagnosed all over the world with that disease, and your understanding more and more about it as each new report comes in.
Brandon: What do you mean by fast? Are we talking weeks, months, years?
Dr. Scott: So, the fastest we've ever done this was it about eight hours.
Dr. Scott: There was a time when I was preparing for clinic, and I typically prepare in the morning, so I come in really early in the morning and I go through all the different patients I'm going to see that day. There was one patient that already had a genetic test result, but the laboratory did not flag it as being the cause of this child's problems because it involved genes that were not known to cause disease. But by looking at animal models for those diseases, I could see that these genes actually played a role in the pathways that might be affected in this child. I went and saw the child in clinic, and noted that he had some very unusual features. Probably the most unusual was that he had super flexible joints. It's unusual we actually have a way of scoring that and this child had the maximum score possible. And so, extremely flexible. After that clinic visit we had already sent out feelers I already sent out feelers that morning to ask if other people had had patients who had deletions- so some pieces were this these genes were missing, or changes in those genes- and when I got back to my office that afternoon there was an email from a physician in England saying that he also had a family that had almost the exact same change that was seen in my patient. I asked him what his family members, or the family members not in that family, had and he said all the same features is my patient including the hyper flexibility that I noted in my child, or my patient. Anyway, I was quite surprised because now we had three patients with the same disorder. Just after that email exchange a person came in and asked if I could take a phone call from another physician (this time in Dallas.) When I talked to her, she had another patient which also had the same type of medical problems and hyper flexibility to the point where he was having a difficult time actually holding a pencil because his fingers were so flexible. And so, literally within eight hours we had four patients on two different continents. All of whom had the same new genetic disorder. And again, that was done in in eight hours.
Brandon: Wow okay, so a couple follow-ups on that (because that in and of itself is just fascinating.) First of all, once people have this information, once these families know of this new genetic disorder, what are the next steps for them? Is it just letting them know for future family planning, or is there a treatment option?
Dr. Scott: So, every gene is going to be different. I wish we had more treatment options that were obvious from the genes that we find. Many of these genes work very early in embryology. And so, they actually make structural changes to the body even before a child is born. So, for example, to find a new gene for a heart defect; it's very unlikely we’re going to be able to treat that child’s heart defect because it's already in play. In other words, all the changes that that gene may have done in heart development have already taken place. There are other genes though- For example, genes that cause problems with nerves which may we may be enabled to prevent or preventive measures. This may be especially true for kids who have neurological deficits that change over time, and others they are born perfectly fine or perhaps have some deficit but then over time they have more and more problems for them- that it may be possible to actually alter or treat them so they can avoid these type of problems. Probably the most common examples of that are metabolic disorders. So, every child that's born in the United States is screened for a certain set of genetic problems that cause metabolic disorders, or a problem with the way the body uses or breaks down metabolites or like your food or substances that are in your food or perhaps substances that are made by your own body. Children who are missing enzymes that break those things down have problems with accumulation of these products in their tissues. And so, overtime they have more and more problems. Those are sometimes very amenable to dietary changes or sometimes to enzyme therapy where we can give them back the things that they need to break those products down, or we can eliminate them from their diet, and you can have a child who was destined to have major medical problems and you can actually transfer that that child into a position where they should live essentially a normal life (with again these dietary modifications). Other things that are helpful though too, is families do want to know if this is something that might reoccur in a family member. Often people say “Well, we're not going to have any more children, so we're not particularly interested in identifying a genetic cause for our child's medical problems.” But often they don't recognize that even individuals in their family may be carrying something that puts them at risk, or their children at risk, for having other medical problems and so often when we make these diagnoses and end up providing information not only to parents but also to siblings who may be at higher risk.
Erik: It sounds like when you make these diagnoses though you’re working with a team of physicians. Is that correct, or do they generally come and find you and then you just relay it to the patient?
Dr. Scott: So especially with new disease genes we are working with groups and so almost no one publishes new genes or new diseases by themselves anymore. It's almost always an international or at least a national collaboration between lots of different families and physicians to make that happen. Once the disease is known, well then an individual doctor working anywhere could understand that diagnosis, get the information about the disease, and then give that to the patient. And so, we’re actually, again, just describing these new genes. We can make this possible for anyone in the world to be able to diagnose on a regular basis. I go to different countries to teach about genetics, so I go to Guatemala on a regular basis (I also have gone to Kazakhstan) to teach genetics to doctors there. In each of those places, I see patients that have genetic diagnosis that have been properly made in their home country. Some of those whose use specific genetic tests that they have available and in other cases it's done on a clinical basis but that's always because of the work that's already gone before in describing these diseases and then they can reference that and make those diagnoses. And I recognize that’s happening, of course, all around the world and sometimes in places where genetics is not very strong. And so, when we go, we try to teach doctors how to be even more effective geneticists. In a lot of places that we go, genetics is not really considered a major player in their healthcare system because they don’t realize how big of an impact it's having on the patients that they're seeing.
Erik: So, because we know about, you know, the Human Microbiome Project, and the Human Genome Project, and The Undiagnosed Disease Network. Correct me if I'm wrong, but those are all American based, or is there similar body for the world that sort of allows you to communicate these and maybe get more investigators working together?
Dr. Scott: So, there's many things that are paralleled. So, for example, one of the things is required in order to do research is to be able to have funding of some kind to actually fund that research. So, for example, the Undiagnosed Diseases Network is funded by the National Institutes of Health and it would be an American organization. A lot of times, we have similar bodies that are doing the same thing in other countries. For example, in the European Union or in other countries and scientists from both camps work together. Okay, and I especially enjoy something that was a simple technology, but has proven very powerful. There's a website called GeneMatcher.com. It has a very simple process, or a way of working. You can go into Gene Matcher as a scientist, or a physician, or anyone who has a specific interest and record your interest in a gene. In other words, I see a patient in the clinic who has a change in this gene I think it might be the cause of their medical problems. I can say I'm going to put that gene into Gene Matcher and say I have an interest in that. Gene Matcher then gives back to me all the email addresses of anybody else who’s registered an interest in that gene. And so, immediately I have perhaps the names of a dozen or sometimes fewer. It just depends on people who also potentially hold patients, or work on mouse models, or have learned something important, or have a special interest in this gene. We then can begin to collaborate immediately to say “Well, what are you seeing?” or “What do you see in your patients and does that match with what I see in mine?” Sometimes, there is no match and we quickly realized that we don't understand enough about what this gene is really doing just yet. Other times, the matches are strikingly similar and that allows us to do this. That is a system that can be used and accessed by anyone in the world. And so, we literally get hits from all over the world with the different physicians having patients that may be useful in finding new genes.
Erik: That's amazing! And the internet, I assume, has probably helped us along, yeah ?
Dr. Scott: It's actually really funny because a lot of the projects I'm doing right now I spend most of my time Googling different terms and identifying patients that may already be published, but they are hidden inside articles. For example, if I can go back into those articles, I can actually find patients that sometimes have already been described, but no one has put all the links together. And so, typically when we put these things together we'll have three or four patients that have been published, but no one has ever really wrapped their minds around the fact that they all have the same pattern and then we add additional patients to that and we have a new disease gene.
Brandon: Wow that's awesome! So, one of the things we will also really wanted to talk to you about is in one of the classes that you taught us you went into depth a little bit about autism and we've seen a rise in the diagnosis of autism in the past few years, and there's a ton of different ideas and speculations (some more scientific than others), and why we have autism occurring so much in our society. I wanted to get your perspective on what you've seen in the clinic, if there's any kind of genetics involved with autism, and things like that.
Dr. Scott: So, remember how we talked about how genetics has changed over the last let's say 15 years since I became a geneticist? One of the things we see that's just dramatically changed is the type of patient I see in clinic. It used to be that only the patient's I saw in clinic were children with multiple congenital anomalies and others who have many birth defects and (because of that) a doctor suspected they might have a genetic syndrome. That has changed over time, again, because of the techniques we have and the patients I see most often in clinic are now patients that have one of three diagnoses: autism, developmental delay, or intellectual disability. Those three things actually kind of come together. In other words, they're all signs that the brain is either not formed correctly or is not functioning correctly, and we actually find that individual genes often can cause all three of those problems. In other words, some children will be diagnosed with developmental delay while a subset will be diagnosed with autism and some will be having two of the disabilities, or some will have all three. Well, for a long-time people have thought that maybe autism was not genetic (probably that's because we often saw families where there was only one child that was affected with autism, but they're certainly plenty of families where there are more than that). Many scientists felt that most cases of autism would be multifactorial. In other words, a combination of many different genes and environmental factors perhaps all playing together in one child to give them autism. The shocking thing that we've learned over the last few years is that actually many of those children that have autism have changes in specific genes that are causing that autism. And so, if you take a child who comes in with autism into the clinic, or developmental delay, or intellectual disability. We will probably find the answer in forty percent of kids who come and visit us. In others will actually find a molecular diagnosis for them. I think if you ask people ten years ago if that would be possible, they would have laughed at you, but now it's a reality. The difficulty is that most people do not know that. And so, I go around the state of Texas talking to families and they are shocked to learn that autism is actually genetic (or when I say genetic that doesn't mean the same thing as inherited because sometimes these children have brand-new changes in genes that cause autism), but they're shocked to learn that you could do genetic tests that would actually give you the answer to why that child has that that problem. Sometimes, people also want me to tell them whether because of a genetic test their child has autism. As it turns out, that that doesn't quite work the same way. Autism is actually a diagnosis that's usually made by developmental pediatricians or other people who are trained to be able to diagnose autism. It's a pattern that we see in behavior and language development. And so, our genetic tests again can't tell us whether a child has autism instead it says why is the autism being caused in this child. But yes, we can we have dramatically changed the way we think about and look at children with autism and our ability to help them or their families know the cause.
Brandon: That's amazing! We've talked a lot about genetics, and I imagine a lot of this is implied, as well, in understanding genomics (looking at the entire sequence of the human body). When you when you have a child coming into the clinic and you're making these diagnoses do \you just look at specific genes or do you look at their whole genetic code and then try to find something what do you do there?
Dr. Scott: Yeah, so often when one of the things that we try to teach to our trainees is to try to identify what is the best genetic test to use. There are some diseases where we can walk into the room and we can make a diagnosis just clinically. In other words, I can look at a child and say this child has this disorder. In most cases, especially when we can identify a specific genetic syndrome, there may only be a few genes that cause that syndrome, but they that can range from just one gene to sometimes a dozen or more. And more and more often we're using a combination of identifying single genes then testing those, or testing panels of genes that can cause similar diseases. For example, one of the panels that we use very often is a panel that tests for all known hearing loss genes. It's a very powerful panel. And when we do that, we can identify the great majority of children with hearing loss and can identify the genetic cause. At the same time, we recognize that some kids aren't diagnosed that way, and it could be that they have some type of environmental cause for their hearing loss or maybe their genes that are not known (and certainly there are). But that would be a panel test, and it may test ninety different genes. Other times we go in and there's not enough of a pattern to be able to make a clinical diagnosis, or maybe we don't recognize the pattern. In those particular cases, I don't know what this child has and if I don't know and others around me, when we try to share this information amongst doctors, no one can see the pattern then we go to these genomic tests. Those are the tests I was talking about before- that chromosome microarray analysis (it looks at all the genome for those big pieces that are missing, or extra) Whole exome sequencing or whole genome sequencing is another way of looking across all the genome. Seeing are there changes in the letter codes these become our go-to tests again when there's one we have to find an answer and the and the clinical exam does not give it to us. This is very powerful because we can use these tests sometimes when a child is very small, sort for even amongst newborns and we may not have seen the full effects of all the changes that are happening. So, for example, in a newborn with a heart defect and maybe some other change, we don't know how their brain will work, or how will they develop, or will they have difficulties. And yet, we can use these wide tests to then identify the genes and then kind of work backwards and saying children with changes in these genes typically have problems with their kidneys or with their development. And then, we can send them to the correct specialist so they can watch their kidneys and make sure that kidney function remains healthy, or we can send them to early therapy so that they can begin to maximize their ability to grow and develop normally. And so, these are going to become very powerful, but it's a mixture and every different patient will need a specific test that's kind of matched to the things that we see in clinic.
Brandon: Thank you so much. I want to bring this all back around to the first couple of minutes and ask you one last question. You said, that this whole journey started with a seventh-grade teacher that wanted to talk about genetics. My question for you is have you ever followed up with that teacher and told him, or her, just how much of an impact that had on your life and how you've been able to impact medicine in the lives of dozens of others?
Dr. Scott: So, I haven't personally talked to Mr. Aldridge because that was back in seventh grade and by the time I really was well onto this path we had lost communication. I have gone back to some of the other teachers I had in high school and said “Hey, this is the things that are going on and I thank you for the for the encouragement that I received to do great things.” A lot of times people have dreams and they're told this is impossible. I was blessed with teachers that said “sure you can do these things and this is how you get them done.” And so, I would say yes parents, siblings, all these individuals have been key to me having what I consider a really great life. I appreciate my family. I try to balance all the things that I do, but I think in that balance we can do many great things in many different areas of our life. So, I try not to sacrifice family for my career, I try not to sacrifice what would be good for my career and sacrifice that things would be important for my patients. So, all these things we find a balance and we try very hard to focus on all these things and do the things that are the most important, but I must admit I am very grateful that I am both a scientist and a doctor, and that I get to be that in this particular time when so much is happening. It's a wonderful time to be a clinical geneticist.
Brandon: All right! Thank you so much!
Erik: Thank you!
Brandon: All right! That is it, for now. Erik and I would like to thank everyone out there who took the time to listen to this episode of the podcast. Thank you to our faculty advisor, Dr. Poythress for helping us out put everything together. Thank you to Baylor Communications Department for help with the production and website, and thank you again to Dr. Scott for taking the time to interview with us. We hope everyone enjoyed it and hope you tune in again soon. Goodbye for now