--:-- [Theme music fades out]
--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
--:-- Noel King: And I'm Noel King. Remind me what we did on Today Explained This Week.
--:-- Sean Rameswaram: This week. It's Friday. Certainly. Monday? Elon Musk.
--:-- Noel King: Monday was machine guns. We started the week by saying America has all of these machine guns on its hands now.
--:-- Sean Rameswaram: Great show. And then Tuesday was about another thing in news. Roe v. Wade.
--:-- Noel King: It was the thing. Roe v. Wade. Yes. Oh, my God. The biggest story in a generation.
--:-- Sean Rameswaram: We had to throw out all our plans. Yes. To talk about. The leak. The leak.
--:-- Noel King: Which then you did again on Wednesday. Yes. And then Thursday... Kids, little kids. Always remember the little kids.
--:-- Sean Rameswaram: Little kids who still don't have vaccines. That's right. It's a lot of grim news. It's a lot of grim news, dude.
--:-- Noel King: What do you say we end the week with a positive jam? Oh my God, can we please?
--:-- Sean Rameswaram: We have one, Noelle. What is it?
--:-- Noel King: We got a possible cure for sickle cell disease. No kidding! Coming up on Today Explained.
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--:-- Noel King: That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform.
--:-- Sean Rameswaram: Didn't know that. While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business.
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--:-- Sean Rameswaram: I've never met an AI agent. Learn how ServiceNow puts AI to work for people at servicenow.com.
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--:-- Sean Rameswaram: Support for this show comes from strawberry.me. Be honest. Are you happy with your job? Or are you stuck in one you've outgrown? Or never wanted in the first place?
--:-- Noel King: Sure, you can probably list the reasons for staying. But are they actually just excuses for not leaving?
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--:-- Sean Rameswaram: Today, today explained. Today Explained, I'm Sean Rameswaram, and you'll be relieved to know that there's a doctor in the house.
--:-- Noel King: It's Dr. Dhruv Kular. I'm a physician at Weill Cornell in New York and a writer for The New Yorker.
--:-- Sean Rameswaram: where he recently wrote about a potential cure for sickle cell disease.
--:-- Dr. Dhruv Kular: Yeah, so sickle cell disease is a disorder of the blood, and specifically the red blood cells, which carry oxygen to our entire body, to all organs in our body.
--:-- Sean Rameswaram: And in most of us, these red blood cells are kind of like little saucers. You know, they can move around the body easily.
--:-- Dr. Dhruv Kular: They have no problem kind of dropping off their transport of oxygen. What happens with people in sickle cell disease is that a specific protein within the red blood cell, it's called hemoglobin, this is the protein that actually carries the oxygen, it's defective in some way.
--:-- Sean Rameswaram: And so what it starts to do is instead of, you know, if you can think about the red blood cell as kind of a bag with a bunch of little confetti inside and kind of move around okay, what happens with sickle hemoglobin is that it congeals into these long strands.
--:-- Dr. Dhruv Kular: And so it kind of stretches out the balloon of the red blood cell. It starts to look like what we call a sickle or kind of a crescent moon, and that causes all sorts of problems.
--:-- Sean Rameswaram: These types of red blood cells are fragile. They can't move their way through the body's blood vessels as easily.
--:-- Dr. Dhruv Kular: They cause kind of traffic jams. And the end result is that oxygen doesn't get to where it needs to be.
--:-- Sean Rameswaram: And so as you can imagine, that can cause all sorts of problems, strokes and joint damage and abdominal pain and bone pain.
--:-- Dr. Dhruv Kular: And the basic idea is that you're not getting enough oxygen to your different organs of your body.
--:-- Sean Rameswaram: So sickle cell disease has been around forever. It was first kind of described in the early 1900s.
--:-- Dr. Dhruv Kular: And so in the article, I talk about a patient named Walter Clement Noeau. And he's a gentleman from Granada.
--:-- Sean Rameswaram: He comes to the United States to study dentistry at the University of Chicago.
--:-- Dr. Dhruv Kular: And he has all sorts of medical problems. He has trouble breathing. He has pain in his abdomen. He has pain in his joints.
--:-- Sean Rameswaram: He ends up seeking care at a hospital in Chicago. It was by chance that Noel happened to consult James Herrick, a doctor with an interest in hematology, the study of blood.
--:-- Dr. Dhruv Kular: They look under the microscope and his blood has, it doesn't look like, you know, normal red blood cells. It looks like all these little sickles.
--:-- Sean Rameswaram: They follow him for three years. They can't figure out what it is, but they write a report.
--:-- Dr. Dhruv Kular: And in the coming decades, doctors around the country start to look at this report. They report similar types of symptoms in their own patients.
--:-- Sean Rameswaram: And then in 1949, Linus Pauling describes what he calls the first molecular disease.
--:-- Dr. Dhruv Kular: I believe that this is the disease of the molecule and that if we look at the blood of these patients, we shall find that the hemoglobin molecules are different from those of other people.
--:-- Sean Rameswaram: So sickle cell disease was actually the first disease that we knew the exact protein, the exact molecule that was defective.
--:-- Dr. Dhruv Kular: So, Drew, why did you want to write about sickle cell right now?
--:-- Sean Rameswaram: I mean, in my practice as a physician in the hospital, I often see patients who have sickle cell disease, and they come into the hospital, and they're in terrible pain often.
--:-- Dr. Dhruv Kular: It feels like somebody's hitting you with a hammer. They have all sorts of complications. They can have strokes and joint destruction, and they're in the hospital, they're getting blood transfusions, and they need lots of pain medications.
--:-- Sean Rameswaram: It is a really devastating disease. You know, anyone who kind of cares for patients in the hospital probably has experienced that.
--:-- Dr. Dhruv Kular: A lot of these patients are in and out of the hospital every few months. Some of them are in and out of the hospital every few weeks.
--:-- Sean Rameswaram: Nobody else but us people that have pain knows how it feels.
--:-- Dr. Dhruv Kular: And now, in the past few years, there's been these gene therapy trials which seem incredibly promising.
--:-- Sean Rameswaram: And so there have been dozens of patients treated through these types of gene therapies, which come in different kind of flavors that we can talk about.
--:-- Dr. Dhruv Kular: And many of these patients have had complete resolution of their symptoms. So they're not on pain medications. They don't have any further issues.
--:-- Sean Rameswaram: So I thought this was a really interesting set of potential therapies. And I wanted to learn more about it.
--:-- Dr. Dhruv Kular: And it turns out they seem to be quite effective. But there's also a lot of challenges that may come up in terms of getting them to people.
--:-- Sean Rameswaram: Unfortunately, for all sorts of reasons, sickle cell was underfunded for many years, and it didn't have any treatments for the next 50 years.
--:-- Dr. Dhruv Kular: And only now are we kind of getting to the point where we really starting to get a handle on potentially transforming the care for people with sickle cell disease.
--:-- Sean Rameswaram: What are some of the reasons it was so underfunded for so long?
--:-- Dr. Dhruv Kular: Yeah, so sickle cell disease affects predominantly people of African ancestry, and there's an important kind of reason for that.
--:-- Sean Rameswaram: If you have one sickling gene, you have what's called sickle cell trait, and that affords a certain degree of protection against malaria.
--:-- Dr. Dhruv Kular: And so this gene kind of evolved in places in the world where malaria had a high prevalence.
--:-- Sean Rameswaram: So in Africa, in southern Europe, in parts of Asia, in the United States at least, the vast majority of people who have sickle cell disease are black.
--:-- Dr. Dhruv Kular: It's estimated that there's probably around 100,000 people in the U.S. with sickle cell disease.
--:-- Sean Rameswaram: One in every 365 black births has sickle cell.
--:-- Dr. Dhruv Kular: And so it's really a problem that is related. You can't disentangle it from history of systemic racism and discrimination and bias within the medical system and the funding for various treatments within the U.S. healthcare system.
--:-- Sean Rameswaram: And for those reasons, it has been understudied and underfunded.
--:-- Dr. Dhruv Kular: So you're basically saying that the reason this hasn't really been addressed or a top priority is because it was mostly devastating black communities. It's one of the reasons.
--:-- Sean Rameswaram: Cystic fibrosis, for instance, it affects about a third as many patients as sickle cell disease, but it receives much more in foundation funding than does sickle cell disease.
--:-- Dr. Dhruv Kular: I talk about the ice bucket challenge you might remember back in 2014.
--:-- Sean Rameswaram: Yo, maniacs, this is Hulk Hogan here, and this is the ALS challenge.
--:-- Dr. Dhruv Kular: Regrettably, I do remember that. It raised something like 100 times as much funding as sickle cell gets from foundations in a typical year.
--:-- Sean Rameswaram: And so there was a real lack of funding for a very long time for this disease.
--:-- Dr. Dhruv Kular: So what you gonna do? When it runs frozen on you.
--:-- Sean Rameswaram: And so previously, what tools have doctors had available to treat sickle cell disease?
--:-- Dr. Dhruv Kular: In 1998, there was the first medication that was improved. It was called hydroxyurea is approved by the FDA.
--:-- Sean Rameswaram: As hematologists were frequently asked whether or not hydroxyurea is the best drug that we have available to treat our patients.
--:-- Dr. Dhruv Kular: The truth is, it's really the only drug we have available to treat our patients, which makes it the best choice.
--:-- Sean Rameswaram: And it's a medication that tries to shift some of the body's production from this abnormal sickle hemoglobin to a different type of hemoglobin, which is actually present just after we're born.
--:-- Dr. Dhruv Kular: And that seems to help some people, and it can reduce the number of times that people have sickle-in crises and the severity of those.
--:-- Sean Rameswaram: You know, it has some side effects. It doesn't work for everyone.
--:-- Dr. Dhruv Kular: That was the mainstay of treatment. There were some other adjunct therapies that people would use, like kids would get penicillin prophylaxis to guard against some infections.
--:-- Sean Rameswaram: You'd want to make sure that they have their vaccines. But in terms of targeted treatment for sickle cell, that was the main one.
--:-- Dr. Dhruv Kular: And then a lot of patients, unfortunately, have to be on chronic pain medications, opioids often to control kind of the severe pain that they have.
--:-- Sean Rameswaram: And so those were kind of a set of therapies that doctors have been using and continue to use to care for patients with sickle cell.
--:-- Dr. Dhruv Kular: And now there's a game-changing treatment. There may be a game-changing treatment.
--:-- Sean Rameswaram: We're on kind of the precipice, potentially, if these gene therapies are as effective as we think they are, of transforming care for patients with sickle cell disease.
--:-- Dr. Dhruv Kular: And there are a number of companies that are in clinical trials with gene therapies.
--:-- Sean Rameswaram: And those trials seem to be going quite well.
--:-- Dr. Dhruv Kular: Two of the companies that I've spoken with expect to submit their data for FDA approval at the end of this year or early next year.
--:-- Sean Rameswaram: So it's possible that a year from now we'll have several gene therapies for sickle cell disease on the market.
--:-- Dr. Dhruv Kular: And for people who don't know how gene therapies work, how do they work?
--:-- Sean Rameswaram: It's hard to talk about them in general because for different diseases, there's different techniques.
--:-- Dr. Dhruv Kular: But for sickle cell disease, I can tell you how it works.
--:-- Sean Rameswaram: So for sickle cell disease, you know, you can think of it almost like a stem cell transplant that you might have heard about for cancers or for other diseases.
--:-- Dr. Dhruv Kular: And so what happens is you take the patient's blood cells, you treat them in a lab, you edit the DNA of those blood cells.
--:-- Sean Rameswaram: Meanwhile, the patients in the hospital, they've gotten chemotherapy to try to wipe out most of their bone marrow, both red blood cells and white blood cells.
--:-- Dr. Dhruv Kular: So during that period, they're at high risk for infection and other complications.
--:-- Sean Rameswaram: And then you infuse their own blood cells back into them.
--:-- Dr. Dhruv Kular: These are now the edited blood cells. The idea is that those blood cells will take up residence in the patient's bone marrow and start creating more of the hemoglobin afterwards.
--:-- Sean Rameswaram: So this approach has kind of a few advantages as compared to traditional stem cell transplants.
--:-- Dr. Dhruv Kular: In a traditional transplant in the past that's been used for sickle cell as well, you need to find a donor, first of all.
--:-- Sean Rameswaram: And not a lot of people have donors.
--:-- Dr. Dhruv Kular: So the estimates are, you know, less than one in five sickle cell patients can find a suitable sibling donor to go through this process.
--:-- Sean Rameswaram: Even if you do find a donor, you end up having to take pretty powerful immunosuppressive medications because there's a risk that those new cells from someone else might be rejected by your body.
--:-- Dr. Dhruv Kular: And so you need to take these immunosuppressive medications that in and of itself can put you at risk for other types of infections.
--:-- Sean Rameswaram: And so this is one of the reasons that these new gene therapies are so kind of exciting, is that everyone is their own donor.
--:-- Dr. Dhruv Kular: There's very low risk of rejection going forward.
--:-- Sean Rameswaram: And at least in the few dozen patients that we've seen, they've had quite good outcomes for the most part.
--:-- Dr. Dhruv Kular: Tell us about one of them.
--:-- Sean Rameswaram: You know, one of the patients I spoke with was a woman named Victoria Gray.
--:-- Dr. Dhruv Kular: She was the first patient who got the CRISPR gene therapy in 2019.
--:-- Sean Rameswaram: And I'm 36 years old from Forest, Mississippi.
--:-- Dr. Dhruv Kular: Right now, I consider myself to be cured of sickle cell disease, but I will always consider myself to be a sickle cell patient.
--:-- Sean Rameswaram: Well, I first started having sickle cell crisis at the age of three months old.
--:-- Dr. Dhruv Kular: So for me, it's been hospital stays my whole childhood in and out of the hospital with frequent blood transfusions and a lot of pain.
--:-- Sean Rameswaram: And it's a pain that I couldn't rub and make feel better.
--:-- Dr. Dhruv Kular: I couldn't relieve it. Nothing helped except for high dose pain medicines.
--:-- Sean Rameswaram: And sometimes that didn't even help and I would get pain in my chest that felt like lightning strikes that it would take my breath away.
--:-- Dr. Dhruv Kular: I had a crisis during testing and I had to be hospitalized in Nashville so Dr Frangu came to my bedside and he said Victoria have you ever heard of something called CRISPR.
--:-- Sean Rameswaram: And I said no.
--:-- Dr. Dhruv Kular: And he said it a new therapy And if you agree to do it you would be the first
--:-- Sean Rameswaram: If I hadn't went through 34 years of sickle cell disease, I wouldn't even know or relate to being a sickle cell patient now.
--:-- Dr. Dhruv Kular: You know, I don't have any of the symptoms at all.
--:-- Sean Rameswaram: I'm able to do all the things I dreamt of doing.
--:-- Dr. Dhruv Kular: I don't have pain prices at all.
--:-- Sean Rameswaram: I was released from the hospital in September of 2019.
--:-- Dr. Dhruv Kular: And I haven't had a hospital admission since then.
--:-- Sean Rameswaram: And my favorite thing has been being there for my kids.
--:-- Dr. Dhruv Kular: And that's being in the audience, in the crowd, is the football games.
--:-- Sean Rameswaram: Watching my daughter here and my boys on the field, even smiling when they're on the bench.
--:-- Dr. Dhruv Kular: So that's been the greatest part.
--:-- Sean Rameswaram: And as I can say, when I speak to other sickle cell patients who are considering this, I can dream again.
--:-- Dr. Dhruv Kular: I stopped dreaming as far as my future. Because all I saw was pain, devastation, and failed dreams.
--:-- Sean Rameswaram: So I stopped. Now I can dream. I can plan and look forward to life and growing old.
--:-- Dr. Dhruv Kular: As you might remember from recently, even when science delivers a cure, not everyone always wants it.
--:-- Sean Rameswaram: How to deal with that in a minute on Today Explained.
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--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards.
--:-- Dr. Dhruv Kular: These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars.
--:-- Sean Rameswaram: But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head.
--:-- Dr. Dhruv Kular: Not anymore, says Built Rewards.
--:-- Sean Rameswaram: Built Rewards says it lets you earn points on your rent.
--:-- Dr. Dhruv Kular: By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
--:-- Sean Rameswaram: Your home isn't just where you sleep, it's your community.
--:-- Dr. Dhruv Kular: And Built wants you to go out and do things in the community.
--:-- Sean Rameswaram: You can eat at your favorite local restaurants, then earn more points.
--:-- Dr. Dhruv Kular: You can get VIP treatment at certain fitness studios.
--:-- Sean Rameswaram: You can enjoy exclusive experiences just for Built members. every month.
--:-- Dr. Dhruv Kular: When you're ready to travel, they say Built Points can be converted to miles or hotel points all around the world.
--:-- Sean Rameswaram: You can earn points on rent and around your neighborhood wherever you call home by joining built.com slash explained.
--:-- Dr. Dhruv Kular: That's J-O-I-N-B-I-L-T dot com slash explained.
--:-- Sean Rameswaram: Support for this show comes from Macy's.
--:-- Dr. Dhruv Kular: It's almost fall, and that means it's time to cycle your wardrobe to the cold setting.
--:-- Sean Rameswaram: Because while everyone loves a breezy summer outfit, let's be real, layering is even more fun.
--:-- Dr. Dhruv Kular: That's why Macy's Fall Fashion Guide has everything you need to piece together the perfect look for you.
--:-- Sean Rameswaram: It's your one-stop shop for fall's latest trends and must-haves, curated by their experts.
--:-- Dr. Dhruv Kular: Add a statement shoe to your collection, like the calf hair loafers from Steve Madden.
--:-- Sean Rameswaram: Or tap into your romantic side with flowy dresses from Cece and sheer pieces from INC.
--:-- Dr. Dhruv Kular: You can even throw in some textural layers for contrast, like a faux fur bomber jacket from Karl Lagerfeld Paris.
--:-- Sean Rameswaram: Whether your old favorite sweater or coat is on its last threads, or you're just craving a new vibe to switch things up, Macy's has got you covered this season.
--:-- Dr. Dhruv Kular: Find the perfect layering pieces for you by exploring the Macy's Fall Fashion Style Guide.
--:-- Sean Rameswaram: Shop in-store or online at Macy's.com.
--:-- Sean Rameswaram: So what you're gonna do we're back today explained hulk hogan sean ramis from dr droove coulard who practices medicine but also finds time to write for the new yorker extremely annoying but he's a good guy who's been telling us about what seems like a potential miracle treatment for sickle cell disease.
--:-- Dr. Dhruv Kular: Unfortunately, this is America, so I had to ask Dr. Dhruv what this treatment costs.
--:-- Sean Rameswaram: They're not on the market yet, but the expectation is that each treatment is going to cost $1 to $2 million per patient.
--:-- Dr. Dhruv Kular: So these are going to be incredibly expensive treatments.
--:-- Sean Rameswaram: I should note that the lifetime costs of someone with sickle cell disease, because it's such a treatment-intensive condition, already are in that neighborhood, $1 to $2 million.
--:-- Dr. Dhruv Kular: So it's not clear how this will shake out in terms of just dollars and cents.
--:-- Sean Rameswaram: But obviously, if you're able to avert all the human costs and the human toll of going through a lifetime of treatment and a lifetime of hospitalization, that's clearly a net benefit.
--:-- Dr. Dhruv Kular: And I'm guessing that makes sickle cell disease treatment cost prohibitive for a lot of Americans.
--:-- Sean Rameswaram: You know, that's a complicated question because a lot of these costs will be borne by insurers and not necessarily by the individuals who are getting the treatment.
--:-- Dr. Dhruv Kular: About half of patients in the United States who have sickle cell disease are on Medicaid.
--:-- Sean Rameswaram: Medicaid eligibility and benefits vary a lot state to state.
--:-- Dr. Dhruv Kular: And so a lot of the states that have the highest African-American populations also have the most restrictive Medicaid program.
--:-- Sean Rameswaram: So there's a lot of concern in the sickle cell community and among physicians and patients that these therapies will be restricted.
--:-- Dr. Dhruv Kular: You know, a Medicaid agency might say you have to be this old, you have to have this much disease, but you can't have that much disease to get these therapies.
--:-- Sean Rameswaram: And so the high price of these therapies, I think, will be a real issue from a policy perspective, and we need to figure out how we're going to make sure that it's accessible to patients.
--:-- Dr. Dhruv Kular: Are there challenges aside from cost to making this kind of groundbreaking treatment available to as many people as possible?
--:-- Sean Rameswaram: Absolutely. I mean, cost is a huge problem, but I think there's a number of other things that we going to have to grapple with in the coming years
--:-- Dr. Dhruv Kular: I mean one is just this infrastructure problem
--:-- Sean Rameswaram: And so you know right now a lot of patients in the U who have sickle cell disease they don have a regular source of care
--:-- Dr. Dhruv Kular: They don have a hematologist They not even getting the treatments that are kind of the basic standard of care that people with sickle cell disease should get
--:-- Sean Rameswaram: So getting them this wildly expensive, very resource intensive new therapy, that's a whole another level of challenge that I think our health system has to grapple with.
--:-- Dr. Dhruv Kular: And we need to really invest in making sure that people are connected to health care, that they're connected to the specialists that they need, that they're able to get to the centers that are doing this type of therapy.
--:-- Sean Rameswaram: Not every hospital will obviously be doing this.
--:-- Dr. Dhruv Kular: So there's a real infrastructure challenge.
--:-- Sean Rameswaram: There's also a real trust challenge.
--:-- Dr. Dhruv Kular: I mean, many people with sickle cell have been treated very poorly.
--:-- Sean Rameswaram: Black Americans have faced discrimination. They've faced medical experimentation that's been unethical.
--:-- Dr. Dhruv Kular: They've been denied treatment. As a result, you know, Black Americans have lower levels of trust in health care than do white Americans.
--:-- Sean Rameswaram: In having sickle cell disease, when I would go to receive treatment, a lot of times I was labeled as a drug seeker.
--:-- Dr. Dhruv Kular: So that would delay my treatment.
--:-- Sean Rameswaram: And there have been times where I waited in pain in the emergency room for over six hours before I received treatment.
--:-- Dr. Dhruv Kular: And I spoke to nurses, and some of them were good nurses, and they would tell me not to repeat what they said.
--:-- Sean Rameswaram: But it's like the main reason you're not getting treated is not because of your disease, but because of your skin color.
--:-- Dr. Dhruv Kular: And I even had a friend she was the first person I ever met that had sickle cell disease other than myself you know she was a few years older than me by the time I made it to 18 I think she was had turned 21 and she had her own place it was my first year in college and I planned to stay the summer with her.
--:-- Sean Rameswaram: But before summer came, she passed away.
--:-- Dr. Dhruv Kular: She had a sickle cell crisis. She didn't want to go to the emergency room because of the treatment, and she tried to treat herself at home by taking Tylenol, and specifically Tylenol PM.
--:-- Sean Rameswaram: She ended up going into a coma and never woke up.
--:-- Dr. Dhruv Kular: That was because the helpful, when you go there and you're in pain and the people you're looking to for help are the ones who judge you.
--:-- Sean Rameswaram: I've been speaking to sickle cell patients and they call me brave for even trusting the process to doing it because it's like you didn't feel like they were just going to experiment on you.
--:-- Dr. Dhruv Kular: There has to be open communication there and trust. They have to trust us if they want us to trust them.
--:-- Sean Rameswaram: On top of the challenges with trust, with cost, with infrastructure, there's our recent experience with the COVID-19 vaccines, which a lot of people famously didn't want to get.
--:-- Dr. Dhruv Kular: It makes me feel sort of skeptical about gene therapy for sickle cell disease.
--:-- Sean Rameswaram: That's one of the real kind of insights that I was trying to bring out in this article, an incredible therapy that exists is not the same as one that actually helps people.
--:-- Dr. Dhruv Kular: And so, you know, as you mentioned, we've had these extraordinarily effective COVID vaccines that came to market within a year of the pandemic starting, and they're free.
--:-- Sean Rameswaram: You can get them while you're waiting for your train. It takes a minute to get.
--:-- Dr. Dhruv Kular: And yet, millions of people have chosen not to get them.
--:-- Sean Rameswaram: With sickle cell gene therapies, the situation is much, much more complex.
--:-- Dr. Dhruv Kular: This is a therapy that requires, you know, prolonged hospital stay.
--:-- Sean Rameswaram: It's one that costs millions of dollars.
--:-- Dr. Dhruv Kular: It's one that you're literally editing people's genes.
--:-- Sean Rameswaram: And so the ideas of mistrust and trust are going to be incredibly important.
--:-- Dr. Dhruv Kular: And we need to take kind of steps now.
--:-- Sean Rameswaram: We need to think ahead about, it's not just going to be sickle cell disease, but hopefully in the coming decade, there will be gene therapies for other diseases as well.
--:-- Dr. Dhruv Kular: And how do we start to socialize some of these kind of innovative therapies?
--:-- Sean Rameswaram: How do we get people to start to feel comfortable with them?
--:-- Dr. Dhruv Kular: How do we talk honestly about the risks, but also the tremendous benefits?
--:-- Sean Rameswaram: Dr. Dhruv Kular, he recently wrote about sickle cell disease in The New Yorker.
--:-- Dr. Dhruv Kular: His article is titled, Are We About to Cure Sickle Cell Disease?
--:-- Sean Rameswaram: Miles Bryan produced our show today.
--:-- Sean Rameswaram: Laura Bullard fact-checked it.
--:-- Sean Rameswaram: Ifeem Shapiro, Mixed and Mastered.
--:-- Sean Rameswaram: Paul Mounsey chipped in on the engineering too.
--:-- Sean Rameswaram: Matthew Collette edited.
--:-- Sean Rameswaram: The rest of our team here at Today Explained includes Amina Alsadi.
--:-- Sean Rameswaram: She's our supervising producer.
--:-- Sean Rameswaram: Noelle King, you know who she is.
--:-- Sean Rameswaram: We got producers Halima Shah, Heidi Mawagdi, Victoria Chamberlain.
--:-- Sean Rameswaram: We got VP of Audio Liz Kelly Nelson.
--:-- Sean Rameswaram: Lots of help this week from Lauren Katz, Ode White.
--:-- Sean Rameswaram: Music from Breakmaster Cylinder and Noam Hassenfeld on the radio across these United States in partnership with WNYC.
--:-- Sean Rameswaram: I'm Sean Rameswaram for him.
--:-- Sean Rameswaram: Today Explained is part of the Vox Media Podcast Network.
--:-- Sean Rameswaram: Thank you. We'll see you next time.
