Scientific Drivers for Diplomacy The China Syndrome

John I Allen MD, MBA, AGAF President: American Gastroenterological Association

Clinical Chief of Digestive Diseases - Yale University

The Science

East Meets West: The rising incidence of IBD in Asia as a paradigm for

environmental effects on the pathogenesis of immune-mediated diseases

Scientific Advisory Board for the AGA Center for Gut Microbiome for

Research and Education

Inflammatory Bowel Disease

Chronic inflammatory conditions of the digestive track Traditionally associated with… Western industrialized nations Caucasians from Northern, Central or Eastern Europe Ashkenazi Jewish people Immigrants to high risk regions

Etiologies and Treatments based on White Populations Incidence increasing in ethnicities and populations in whom these diseases were historically rare Mirrors experience in the West from 60 years ago

The Opportunity: Changing Epidemiology of IBD

..

Ouyang Q. Falk Symposium http://www.drfalkpharma.com/fileadmin/media/praesentationen/fs1

63/S1_P4.pdf

Loftus EV. Gastro 2004; 126:1504

Yang SF Inflamm Bowel Dis. 2001; 7:260

USA 1950’s

Japan 1970’s

China - Now

Inflammatory Bowel Disease – The Basics

Ulcerative Colitis Crohn’s Disease

1-2 per 1000

“How to Light a Fire in the Body”

Wajahat Mehal - Scientific American. June 2015

Theories “Westernization” of low incidence regions alters the microbiome and in people with a permissive genotype triggers chronic inflammation

Kostic AD et al. Gastroenterology 2014; 146:1489

Chassaing B and Darfeuille-Michaud A. Gastroenterology 2011; 140:1720

Sample Management

Kostic AD et al. Gastroenterology 2014; 146:1489

The Diplomacy

Yunsheng Yang MD – President Chinese Society of Gastroenterology

John Allen MD – President American Gastroenterological Association

October 2014 3-year Memo of Understanding to Build Scientific Partnerships

Confluence of Favorable Factors (With a Caveat)

AGA: • International Committee • Professional Conferences

• National GI Meetings • Mutual Support for Young

Investigators • Center for Gut Microbiome

China: • 4 Phases (Blumenthal and Hsiao) • Medical Societies • Young Investigators • Hospital Governance and Staff • Rise of Middle and Upper Classes • Cultural Differences Remain

Funding: • Pharmaceutical and Medical Device Companies • Philanthropic Foundations

• Sir Run Run Shaw - Hangzhou, China • Fox Chase Cancer Center: Academic Network MOU

Blumenthal D, Hsiao W. Lessons from the East – China’s Rapidly Evolving Health Care System. New England Journal of Medicine. 2015; 372:1281

Conclusion: Can Science Drive Diplomacy?

Scientific tools available Next Gen Sequencing Big Data – Registries

Changing Face of Medicine in China AGA’s Focus on International Medicine Favorable Funding Pharmaceutical and Medical Device American and Chinese Foundations