Bridging the Gaps

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• Mika Ono- [email protected]

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Within the last generation, life-changing technologies such as the internet, smart phones, genetic engineering and artificial intelligence have become commonplace. But many questions about these developments remain unanswered: What are their effects, positive and negative? How can we maximize benefits while minimizing dangers? What values should we draw on when faced with balancing these choices? And how can these answers be translated into public policy?

These are the types of issues that fascinate Cinnamon Bloss, who holds positions at the University of California (UC) San Diego including tenured professor and associate dean in the Herbert Wertheim School of Public Health and Human Longevity Science, associate director of the Institute for Empathy and Compassion, and Qualcomm Institute (QI) affiliate.

"At a high level, I am a clinical psychologist by training," says Bloss. "So I certainly describe my work as having a health-related focus, but I tend to think about health pretty broadly. I don't think only about specific diseases or disorders, but also about how new technologies can promote or undermine health or mental health."

An Unusual Journey

A native of Seattle, Washington, and graduate of Smith College, Bloss earned her doctorate in clinical psychology and neuropsychology from a joint program of UC San Diego School of Medicine and San Diego State University.

Her interest in interdisciplinary work was apparent early on. For her thesis topic, Bloss looked at the effects of the Apolipoprotein E-4 (APOE4) gene, which is linked to Alzheimer's disease, from a new angle. While Alzheimer's typically occurs in later life, Bloss and her colleagues wondered if any effects showed up earlier, much earlier.

To find out, they collected data on middle school children through parent surveys, cognitive testing, achievement test scores and family history questionnaires. The data showed kids with one or both APOE4 alleles or whose parents reported a family history of dementia had significantly lower achievement test scores.

"The results were surprising," she says. "You wouldn't really expect an effect to be all that strong at that age. It wasn't to the extent that those students were in an impaired range, but there was a statistically significant difference."

Graduating in the Age of Genomics

When Bloss graduated with her doctorate in 2007, scientists had already declared victory in the race to sequence the human genome. From this information, genome-wide association studies (GWAS) were starting to emerge, introducing a whole new lens to look at human health and disease.

"I naively thought to myself, 'Why study one gene when you could study the whole genome'?" Bloss says.

Against the advice from some trusted mentors, who thought she shouldn't stray too far from her roots in clinical psychology, Bloss chose to do postdoctoral work in bioinformatics. In the Scripps Research lab of Professor Nick Schork (now deputy director and distinguished professor of quantitative medicine at The Translational Genomics Research Institute), she built up her statistical expertise making sense of large sets of genetic data.

Once the postdoctoral position ended, Bloss stayed on as a research scientist and was able to circle back to questions about how technologies like human genomics intersect with behavior and psychology. One study from this period looked at the effects of emerging consumer genetic testing to assess disease risk.

When Scripps Health created its first-ever faculty positions, Bloss was among those appointed. In this role, she collaborated frequently with Eric Topol, director and founder of what was then called the Scripps Translational Science Institute (now Scripps Research Translational Institute), as director of social Sciences and bioethics. She felt in her element.

"There were all these people with different disciplinary backgrounds working together in an agile way," she recalls. "I found that very exciting."

Interdisciplinary Perspective, Outsized Impact

In 2014, she had the opportunity to return to UC San Diego, this time as a faculty member. But she hesitated: "I had a concern about coming to a more traditional academic institution, given that academia is traditionally much more siloed by discipline."

But when she learned she could be housed in UC San Diego's Qualcomm Institute (QI), an interdisciplinary institute on the campus that brings together technology with fields including health, culture, energy and the environment, she was sold.

"QI was key in my decision to accept the UC San Diego position," she says. "Being in an environment that promotes interactions across disparate disciplines, points of view and thoughts about how to tackle big problems has been essential for our work to have a large impact."

At UC San Diego, Bloss expanded her work to include technology's impact at the community level. One topic that captured her attention was the proposal to use genetically engineered mosquitos to reduce mosquito-borne diseases like malaria and dengue fever. Funded by grants from Defense Advanced Research Projects Agency (DARPA) and the National Institutes of Health (NIH), Bloss began researching different strategies for engaging members of the public in authentic conversations about this complex new technology.

While some scientists assume that educating laypeople is the primary objective in a situation like this, Bloss and her colleagues emphasized communication that goes both ways. For example, in their work they found that in terms of releasing genetically modified insects into an environment, community members' concerns can include the possibility of tax increases, intensified public health monitoring, growth in the number of flying bugs around living spaces, and changes to cherished ecosystems such as fields and gardens.

"People in the community bring their own values, circumstances and interests to these questions," she says. "We need to meet people where they are."

A Wider World

Bloss's work in stakeholder engagement led to an invitation to join the NIH's Novel and Exceptional Technology and Research Advisory Committee, which provides recommendations to the NIH Director and a public forum for the discussion of emerging biotechnologies' scientific, safety, and ethical issues. Bloss has chaired the committee for the last three years.

The work has focused on how the NIH can solicit public engagement to help make decisions about research policies and practices, and the kinds of studies the agency should be funding in emerging biotechnology.

"One long-standing problem in this space is getting an accurate impression of a community's views," she says. "The opinion of the vocal minority isn't necessarily the same as the silent majority. We are exploring creative ways of conducting authentic stakeholder and public engagement."

There is no shortage of new questions to address. Recently, with funding from the National Institute of Mental Health, Bloss has begun looking at the phenomenon of digital surveillance of students by primary and secondary schools. For about a decade, she explains, schools have increasingly hired private companies to do online surveillance of students, including of their social media and email accounts, to a range of degrees.

"There are a lot of stakeholders in the school ecosystem-students, parents, teachers and administrators," she says. "They all want the same thing: to avoid school-based violence and to promote a healthy environment for youth in schools. But, in its most extreme form, the surveillance can become quite invasive; there's not a lot of evidence it works; and questions include what kinds of students tend to get flagged for disciplinary action."

As part of the research, Bloss and her colleagues are interviewing about 30 school administrators; deploying a survey to a representative sample of more than 1,000 young people, ages 13 to 17, nationwide; and conducting in-depth focus groups with parents. The researchers aim to uncover not only the extent of surveillance practices, but also what values various groups hold, and how the technology promotes or undermines those values.

"What we're hoping to do is be in a position to offer student-centered policy recommendations," she says.

The Ripple Effect

Alongside research and public service, another thread in Bloss's career is mentorship, as her recent American Society of Human Genetics Mentorship Award attests. Like research and service, Bloss finds teaching enhances other aspects of her work.

"I have been fortunate at UC San Diego, in part through QI, to be able to work with students and trainees from a lot of different kinds of backgrounds," Bloss says. "I've had students from the Communications Department, Ethnic Studies, Public Health, and the School of Medicine. One of the best things about being at UC San Diego and QI is the enrichment that comes from having all of these different lenses on the work."

In turn, Bloss has contributed to the Herbert Wertheim School of Public Health, not only teaching courses, but also creating curriculum reflecting her interdisciplinary expertise. She founded a course called Technology and Precision Health for Public Good, as well as a new concentration within the Master of Public Health degree called Technology and Precision Health.

Bloss hopes her teaching will play a small part in steering the use of technology in the right direction, as graduates of the Master of Public Health program make their way into the workforce, including at technology companies and regulatory agencies.

She knows they will face a steady stream of new issues: "One of the exciting aspects of studying new technologies and their implications is that it's always changing."