Demystifying Genetics with Lucinda Freeman

Lucinda is a fabulous genetic counsellor who I was lucky enough to study with back in 2004. We attended a conference last year in Cambridge, UK and before the start of the conference we spent a few days in Paris together where this photo was taken. Lucinda was granted a Churchill Fellowship in 2016. She spent a number of weeks visiting clinical genetics services in the USA and UK in 2017 and the report, which Lucinda authored is entitled “To gain a strong evidence base for counselling patients about whole genome testing - USA, UK”. 

Transcript

Matt Burgess (00:08):

So, my name's Matt Burgess. I am a genetic counselor. You're listening to Demystifying Genetics, and today I am demystifying genetics with Lucinda Freeman, senior Genetic counselor in Sydney, Australia. Lucinda graduated with a bachelor of Science from the University of New South Wales and went on to do a graduate diploma of genetic counseling at the University of Newcastle in 2004. And in this podcast, we will cover topics such as family communication genomic testing, especially the new type of sort of genomic testing in, in the new sort of current era and preconception screening. So today I have a Lucinda Freeman. Lucinda is not only one of my favorite people in the world. She's one of my favorite genetic counselors in the world. And today, Lucinda, I'd really like to talk to you about your Churchill Fellowship and yeah, if we can sort of chat about that. Does that sound okay?

Lucinda Freeman (01:16):

Yeah, that sounds great, Matt. I'm happy to talk about the opportunity. Yeah.

Matt Burgess (01:22):

Excellent. So a couple of years ago you were awarded a, a Churchill fellowship, and just wondering if you can tell us a little bit about that for people that don't know what that is.

Lucinda Freeman (01:36):

Yeah, so the Churchill Fellowship was set up as a memorial Trust Winston Churchill, after he passed away from, from the people of Australia. So the people of Australia collected together and they all donated funds into this trust. And the trust is now used to reward individuals from all different walks of life to go overseas and learn about their particular area of interest and bring those skills back to Australia. The, the real sort of crux of the being awarded a fellowship is the responsibility to help disseminate that through Australia. So I was awarded this in 2016, and then I went overseas to the US and the UK to go and learn more about the provision of genetic counselors for patients who are accessing genomic technologies.

Matt Burgess (02:27):

Yeah, so in genetic counseling, like when we so we went to uni together, it feels like a, a very long time ago now to study genetic counseling. I don't think we even said the word genomics. Whereas now sort of 15, 16 years later where as a community wondering whether we should call ourselves genomic counselors or you know, sort of with the, the onset of cloning our genome or, you know, sequencing our genome. How, how was the topic that you came up with, how, how did that sort of, how did you come up with that?

Lucinda Freeman (03:10):

Particularly because Matt, the, the reason why I went into applying for one of these fellowship was, like you said, our area has just changed so much. The field of genetic counseling has just evolved, but also just moved forward at such a rapid pace that the technology is allowing patients so much more access to information. And our role as genetic counselors, which you've explored with previous podcasts, is really to help patients understand what that technology means for them. And I just felt like it was important for us to learn from others and overseas, particularly in the US a much even and even faster uptake of genomic technologies. So I wanted to go and learn about the role of genetic counselors in helping patients understand what that information meant for them to identify different strategies that we could use as genetic counselors in providing clinical care. And when I say different strategies, I really wanted to look at what was innovative over there, what were some new techniques that genetic counselors were using to help families understand the information, but also to help families process what it meant for them and to create a improved understanding of genomics within the family setting.

Matt Burgess (04:36):

Mm-Hmm. Yeah. Okay. So the title of your the, the report that you published or that you, you authored after coming back was to gain a strong evidence base for counseling patients about new genomic technologies. I don't know if this is sort of just a little naive or you know, I, when I think back to finishing uni and getting my first job as a genetic counselor, I, I really underestimated how our job would evolve. And I think that I mean sort of probably like every area and every other job, like things change over time. And it sounds like for you that that was really what you were looking into with this, with this work that you were doing.

Lucinda Freeman (05:28):

Certainly. Like when I, when I think about what I do every day, and I know that healthcare is about the individual, and I, I quote this in my, in my report because it's so important for me to help patient and that yes, they're usually coming forward because it's something about themselves or planning for a pregnancy that themselves or their child, but genomics is going to reveal important information for the individual, but also their family. And that that concept of family health, of family management really challenges the sort of modus operandi for most medical practitioners,

Matt Burgess (06:12):

Uhhuh, <affirmative>.

Lucinda Freeman (06:13):

And the more we find out about genomics, the more there's going to be available for relatives. There's more messages that are gonna be spread out. And I just wanted to look at other people's experience in communicating this information, other people's experience in how individuals respond to those results, whether they're positive or negative, and what evidence there is to, to help people adapt to that information. Because when, like you said, when we started this was, this was all just talking, it was all just telling people about risks and uncertainty, but there wasn't much more that we could offer at that time. And now there's so much more we can offer, but also so much more of those basic concepts that we can investigate with patients.

Matt Burgess (07:08):

Uhhuh <affirmative>. And I, I know sort of one of the themes that I, I've had good discussions with you about in the past is more isn't always better. You know, genetic testing is getting cheaper and the technology is moving in leaps and bounds and we can get access to, to more and more data. But you are sort of one of the points that you've said is that you know, really we should be thinking about the utility of genetic testing and, and what is actually necessary. And I was just wondering if you can sort of comment on that in a little bit more detail.

Lucinda Freeman (07:46):

Yeah. So you, you've touched on one of the themes certainly that I picked up from my time overseas and something which resonates with me working in the public health system here in Australia is that genetic tests can tell us a lot of information, but like, like you said, more isn't always better. And I'm very mindful that when I practice as a genetic counselor, I remain patient-centered and that the patient's needs always come first. But part of that is also understanding, well, what's the utility of a test? What benefit is that test going to offer to the patient or to their family? And how's that gonna achieve an improved health outcome? You know, the purpose of genetic testing can, can be multifaceted. The purpose of genetic testing can help make a diagnosis for a family, which can reduce a diagnostic odyssey. It can provide information on how to manage that or family members.

(08:47):

 And it can also help with future family members. So in the realm of reproductive decision making, so there's a lot can get out of genetic testing. However, today in 2018, we just need to be mindful that genetic testing doesn't always give the answers to everything. And that sometimes we can find results which we don't understand. Mm-Hmm. <affirmative> and this area, this area of uncertainty can create a lot more anxiety for families. And we, when we can't interpret what results mean, we have to be careful of just casting our net too wide. Yeah. When maybe there's actually a better health outcome to be achieved for that patient by following a different pathway. And maybe genomics isn't gonna provide the answer right now. I'm not saying it's not gonna provide the answer in the future, but right now we can only rely on what medical information, sort of medical literature is out there and how we can interpret it. And sitting with uncertainty can be difficult for families.

Matt Burgess (09:53):

Yes. Now you've just mentioned about three or four things that I wanna go back and and cover, but I think the first thing was, you said the words genetic odyssey. I know that that is a term that working in genetics we sort of talk about a little bit about, just wondering if you can sort of define that for us.

Lucinda Freeman (10:12):

So the diagnostic odyssey is when patients, whether they, whether it's for themselves as adults or whether it's for their child, they're really going through a difficulty trying to understand what symptoms they have and why this could have happened there. There's a lot of sadness that can come from what, why did this happen to me? Or why wasn't I told about it? And as part of the understanding and an adaption adaptation to a constellation of symptoms or to a health problem is having an answer, having an answer can not only allow patients to go through further investigations and testing, but it can also allow them to connect with other families or other individuals. Mm. And the power, the power of that, Matt, the power is just increased now with social media. I find families that have such positive experiences from connecting through Facebook with other families overseas for really rare diseases. And if they didn't have a name for it, they couldn't search for it, they couldn't connect with these other families. Mm-Hmm. And even though individuals still might have something different, like they might be experiencing different symptoms, it's just that connectivity that can come from a diagnosis.

Matt Burgess (11:34):

Mm-Hmm. And I think also connected to that that idea of diagnostic odyssey is the length or of time that it can take to actually make a diagnosis. Like from the point of where mum may be concerned about something, you know, with her child and you know, speaks to her partner and then maybe speaks to some of her friends that are also mums and then you know, waits a little while, then sees the GP and then maybe nothing happens. And then the GP may refer to the pediatrician and then the pediatrician may refer to genetics and, you know, sometimes this can take months or, or even years and

Lucinda Freeman (12:15):

Or even years. Yeah.

Matt Burgess (12:17):

Yeah. And we're just seeing that maybe sometimes with this new testing technology, that that can be shortened.

Lucinda Freeman (12:26):

Yeah. And isn't that fantastic that it can be shortened? That it, it's got the possibility now of giving families hope, not only short and for their own wellbeing, but also if they wanna have other children that they might have an answer to know that the chance of this happening again is very low.

Matt Burgess (12:43):

Mm-Hmm. And the other thing that you sort of brought up was the idea of sort of managing people's expectations. And it's something that I really struggle with in my industry. Like, I think wouldn't it be lovely to be able to sit down and talk to every single person about every single test a test in depth and talk about like the pros and cons of testing and, and sort of what might come up. But, you know, that is completely not feasible and people are having tests all the time for things that have major implications. And most of the time the tests come back normal and, you know, that's fine. But when the tests come back positive or, or something's found, the, the thing that we hear quite often is, why didn't I know about this? Or, you know, I, I didn't realize. And is that sort of what you meant when you, you said can't remember what your exact words were, but was that sort of the feeling you were thinking

Lucinda Freeman (13:48):

About managing expectations? Mm-Hmm.

(13:52):

 there, there, there were two things. That's, that's, that's one of the feelings, Matt, is this I idea that when a result comes back that it's unexpected. And I've wondered about this whilst I was overseas and talking to other providers as well as back here in Australia and linking with the local genetic counseling group is, was it like, could we prepare people better or is it always going to be a shock when a positive result comes back? And partly today with all of the genetic information that's out there, I suspect it is going to be a shock. Mm. And I suspect for those families who have been on, just like we talked about that diagnostic odyssey, cuz usually they come to genetic counseling later in the process of finding an answer is sometimes it's just a whole combination of overwhelm, sort of emotional overwhelm that they finally got an answer.

(14:51):

And it might be a good answer. It might explain things and give opportunities for treatment. It might give opportunities for other family members to have predictive testing. But sometimes just, just knowing it can overwhelm patients so much that maybe we can never prepare them from that perspective. But I certainly believe that it's our role as genetic counselors to spend some time with patients explaining the limitations of genetic testing and explaining that sometimes we do find things that were unexpected. Sometimes we find something that has an impact on their health care as well as their relatives that we weren't going to look for. And that's tricky.

Matt Burgess (15:34):

And so are you saying that this conversation should happen before or after the actual test?

Lucinda Freeman (15:42):

I, I do believe, I've looked at this a long time and I've thought about it because when I went overseas initially I was going to find out about the conversations about consent and how could we do informed consent better. And I came to the same realization as what you've talked about is we can't possibly talk to everybody about everything. But the two messages that I really want practitioners who are talking to patients about genetic diseases to convey to their patients, the two messages are that sometimes if we don't get an answer, and also sometimes we find something which we don't understand. I'm gonna correct myself there, Matt, cuz there's three things. One is sometimes we don't get an answer because even in 2008, we know everything. Sometimes we get an answer, which we don't know what it means, and it's this variant of uncertain significance and that patients might have to sit with that for another couple of years till it can be clarified. Mm-Hmm. <affirmative>. And the other message that I really still think it's important for patients to understand is that if they're going to do a genetic test and they, their practitioner, whoever their clinician is who's ordering the test, is gonna cast their net wide, sometimes we get either an incidental finding or a secondary finding, which wasn't what was gone to be what was sought out. It wasn't the initial indication to do a test, but we find something else out which is going to impact their health management.

Matt Burgess (17:11):

I I might just sort of give an example there. So an an an incidental finding or a secondary finding. So an example would be if a child has epilepsy and developmental delay or intellectual disability and they're looking for genes associated with that, and then they find that the child has a gene that predisposes to breast cancer. Is that sort of the, the thing that you were thinking of there?

Lucinda Freeman (17:44):

Yeah, that, I mean, that's a good, that's a good example because you're doing a test for a reason to try to find what's caused this in the child. And no doubt in those situations, parents really wanna understand why this has happened. Maybe they wanna have other children, maybe they just need an answer. And so by doing one of these genomic tests, and not just limiting it to those genes associated with epilepsy, but going as wide as you sometimes find something out just like that. And that can be more worrying for the family because it, it's not the answer for the epilepsy, but it's, it's found out or it's identified something which affects that child in their future, but also one of the parents might have it and then their siblings and a whole lot of other people that then the focus of that genetic test result has moved from the reason for doing the test into something which affects a lot of people. And the family now have the burden of communicating that information to everybody else.

Matt Burgess (18:52):

Okay. So with your fellowship that you were awarded, you, you've mentioned a few times that you went overseas. So I understand that you went to the United States first. Can you tell me sort of how the trip started and, and where you went and and and what you did when you went over to America?

Lucinda Freeman (19:14):

Yeah, so the, the start, the fellowships awarded to go over to centers of Excellence. So really I spent some time looking at the different genetics units who were publishing on how to integrate genomic testing into clinical services. And I went to spend some time at the Stanford University Medical Center mm-hmm. <Affirmative> over in

Matt Burgess (19:40):

California, the

Lucinda Freeman (19:40):

West coast. Yeah. And I went there because they, they have just launched, and it would be the end of last year that they'd launched a, a new genomic center where they were doing the genomic testing on site. They were also staffing it with genetic counselors to help with mainstreaming of genomics. And so this is a term which is used quite a lot now, either in the media or just within the field of genetics is mainstreaming genomics mm-hmm. <Affirmative>. And the idea behind that is that because genomics is so wide and everybody's gaining an understanding of it now, lots of disciplines are gonna want to understand what it means for their patients. And that's very good because different specialists, so for example, cardiologists or neurologists want to help their patients understand why they've got symptoms or the disease that they do. And that the real sort of crux to this new gen genomic center in Stanford University was that there were genetic counselors employed to go and sit with patients and sit with specialists to explain what was unique about the genetic test. So not to take over the management, not to step on toes of other specialists, but actually to help the patient understand that if a result came back, then it told them something about themselves, but also about their genetic relatives. Mm-Hmm.

Matt Burgess (21:07):

<Affirmative>. So I think, you know, what people may not sort of understand or appreciate, but usually in a, in a large hospital, the department of Clinical Genetics have the, the team of genetic counselors, like, so all of the genetic people kind of sit together. But this new idea that's coming out is that maybe in each sort of other area they actually employ a genetic counselor so that that genetic counselor becomes part of cardiology or becomes part of neurology. And is that sort of what you mean, like that's what you've observed in in North America?

Lucinda Freeman (21:50):

Yes, yes. Definitely Matt, that's, that's exactly the sort of description that I was coming towards was that a genetic counselor can be there to help guide ordering of the right test as well because it speaks to what we just were discussing is that more isn't always better and a genetic counselor is across different sorts of genetic tests, such panels of genetic tests or looking wider at the whole genome, or actually just looking at single genes. And a genetic counselor can help guide the right test for the right patient as well as looking at it from a cost benefit analysis. And then also helping the patient understand what that result might mean for them and that it's something that they want to know. Because in some circumstances, if there's no treatment available or if it's not gonna change their management, some patients don't wanna know that some patients actually just want to go on with what's happening in their life and they don't want to worry their young children or they, they're not ready to find out information just yet. And so a genetic counselor embedded in different disciplines of the hospital is a really, I think a really positive move forward for healthcare.

Matt Burgess (23:09):

Mm-Hmm. And I saw also in your report there was a genetic counselor that was employed I think it was somewhere in America where they worked with pathology and their, their role was to review all of the genetic tests being ordered. And you sort of mentioned that that can help with efficiency and it can help save money and it can help mean that the patient has the right test. And I think when I first sort of thought about this or heard it, like I was sort of surprised, like, you know, well, what do you mean doctors don't order the right tests or you know, what, people are having tests done several times when it only ever needs to be done once. And is that sort of what you saw when you went to that clinic?

Lucinda Freeman (23:59):

Yes. So I visited a couple of two places overseas to look at that. Seattle, Seattle at Seattle Children's Hospital and also within Stanford. And the third was the Mount Sinai Hospital in New York. And all three of them have what's termed a genetic stewardship program, which is looking at the ordering of genetic tests to make sure that they're the right test for the right person for the right reason. It can save huge amounts of money by having a genetic counselor just look at the indication for testing and also look at what's out there on the market. There are so many thousands and thousands of more genetic tests coming up all the time, particularly in where this is just a boom industry. And some tests are good, some laboratories are better than other laboratories. Some laboratories will be accredited whilst others might not. And what's important is that, like you said, a patient's genetic information is going to stay the same.

(25:02):

It's how it's interpreted and how it's understood that we need to make sure is done properly. And also just the communication side of it, because even evident here in Australia where we have a really good healthcare system, patients can go shopping, they can go to different genetics units, uhhuh and try and get access to different genetic tests. And the the sad part of that is that if a genetic test has been done, it's just a waste of money to do the same test on that patient or a relative of theirs. If we already have a genetic cancer, it's not gonna change.

Matt Burgess (25:40):

Yes. Yeah. Yeah. Mm-hmm. <Affirmative>. And if there was some way, you know, like in Australia the health system is quite good, but it's state based and there are differences between the states and, and, and that sort of can raise sort of difficulties sometimes.

Lucinda Freeman (25:58):

Yeah. And sometimes we can't all speak to each other if we don't know who's in whose family.

Matt Burgess (26:03):

Mm-Hmm. Mm-hmm.

Lucinda Freeman (26:05):

So there's a shared responsibility between patients, families and us as genetic counselors to really help spread the word to other relatives and to each other.

Matt Burgess (26:16):

Mm-Hmm. <affirmative>. And I think that that idea of you know, familial communication is, you know, it's something that is explored with with a lot of different studies in genetics. But one of the highlights that I've sort of taken from, from reading your report is you mentioned the, the need for really good quality genetic counseling research. And I was just wondering if you can sort of tell me a little bit more about what you think, you know, what sort of research do you think needs to happen or where genetic counseling research should be going?

Lucinda Freeman (26:55):

Yeah. as I said, as we talked about at the beginning, mate, genetic counselors really are a new field. And we relied a lot just on sort of basic counseling skills. We relied a lot on what had been done before in medicine, but certainly we've got an opportunity now to really spend some time looking at how we work with patients, asking patients what they want from us, and also looking at our interventions and how beneficial they are to patients. We're unique in the field of healthcare in that we bridge medicine as well as communication. And that's a unique opportunity to help patients move forward and move on with understanding their health information. You know, specifically genetic health information, but understanding what that means for them. We have time, so I know this is something you've touched on before in other podcasts as well, is that genetic counseling has genetic counseling takes time and we have the opportunity to sit down with patients for around an hour to really go through what their results mean or what's happening in their family.

(28:09):

And no, not many other healthcare practitioners can have that much time with patients. So the opportunity to do some studies, like you said, the opportunity to do some research in saying, well, what benefit are we to really prove that to the rest of the healthcare system is going to be important because I believe we're valuable. I believe patients get a lot out of that opportunity and we need to have that research to back up what I say when I want to go to the other disciplines and say, you need a genetic counselor, you need someone who can sit down with the patient and communicate their results. Mm. you need someone who's gonna follow up with the family. So research I think is just gonna be invaluable. Particularly one of my areas which I'm looking into now is family communication of results.

(29:01):

Yeah. And how can we, how can we do that better? I know that the individuals seeking testing for themselves, but we know in the past research has shown that patients do not always communicate their results with all at-risk relatives. And this can be something as serious as an increased risk for getting cancer or cardiac disease and cardiac diseases which are inherited can be fatal. Mm. If, if it's not identified. And the same with then if they're not screened for, if they're not known about, some people might get diagnosed at a late stage, which isn't treatable. And we, we rely a lot on patients to tell their relatives. You, you might have talked about before, or patients out there listening might have heard about the term notification letters. Yes. Which is what we give patients to go and tell their relatives. But research has shown that that's not very good and patients don't always know how to give that result, that letter over to their relatives. And without that information, relatives can be left in the dark and they're, if they're left in the dark, then they're unable to make informed decision about their own testing or what's preventative treatment they should have.

Matt Burgess (30:20):

So I know some of the research I was involved with in Melbourne looking at that area was really interesting that I guess it kind of makes sense, but people would share the information in their families with people that they felt close to. But people that they weren't close to, even though they were the same sort of relatives, like, you know, maybe it was their sibling or their first cousins that information didn't get across and it's kind of like they felt that because they weren't as close to that person, they weren't as genetically close to the person which Mm. From a genetic point of view is not the case whatsoever. But I think just with family dynamics and logistics and, you know, it's a really interesting thing to explore.

Lucinda Freeman (31:06):

It's, it is, and family dynamics and communication within family is going to be different all the time and individuals are gonna be closer to some relatives and feel more open with sharing information with those relatives that they connect with. But I do think there's a responsibility on genetic counselors to really help patients be be empowered to share that information. And whilst we've done some interventions such as that one that you've been involved with in the past and the letters we do, none of them I feel have been effective enough. Mm-Hmm. <affirmative>, and I really think there's an opportunity to ask patients and explore with them what would help motivate them to share that information. What would be a helpful motivator, but also how can we ameliorate those psycho psychosocial concerns, how can we s help them understand that those psychosocial concerns around communication can be overcome by just telling their relatives.

Matt Burgess (32:17):

And do you think that there's a role for like new technology? Like, you know, you, you kind of mentioned the advantage of social media before, and I know there have been some studies looking at sharing genetic results on Facebook. But yeah, like, I don't know, like maybe if we came up with an app that sort of helps us communicate with our family that sends out a, an auto email or, you know,

Lucinda Freeman (32:44):

Don't, don't laugh about it, Matt, because that's what I wanna do. Mm-Hmm. I think that there's definitely an opportunity for an online intervention. That's how we all communicate these days. Mm-Hmm. If I need to tell my mum something and I wanna organize a big family dinner with cousins or relatives, you know, online is the way to go to share that information. Yeah. It's like, enough. And that's how we hear about everything. It's not as scary anymore. Yeah. Yes. Some, some of the information we might tell people is going to upset them. I, I know that, I know that if you, if a relative hears that there's an increased risk for breast cancer or ovarian cancer, that's gonna upset some people. And some people are gonna be scared and there are others who don't wanna know that. But if you don't tell them the information, they don't have an opportunity to make that informed choice. Mm-Hmm. <affirmative>, and I guess there's the concern of doing harm for relatives, but in my mind, the opportunity to screen for these diseases or to undertake preventative treatment far outweighs that. And that we need to give people choices.

Matt Burgess (33:53):

Mm-Hmm. <affirmative>. So I know that we don't have too much longer to chat today. And I, I think this conversation has been really fantastic. But one of the last recommendations that you had was that you believe that genetic counselors should take on a key role in advocating on behalf of patients just getting access to that new sort of genomic technology. And, and one of the examples that you mentioned is promoting the availability of preconception screening. It's something that I have touched on you know, during another podcast, but just wanted to get your idea on, on how that would work. Or if you could sort of talk to me a little bit more about what you're thinking about with preconception screening

Lucinda Freeman (34:42):

Preconceptions carrier screening or reproductive carrier screening. Is it's being re termed within the field is a topic which is very close to me. I, I have had couples who said to me, why wasn't I told, or why didn't I know about this? And 10 years ago, all I could say is this is really tough. And the, you couldn't have been told about anything. Whereas today the story's very different and there is a lot of information out there and there's genetic testing for patients. So nobody should be saying, why wasn't, I told, everybody should be told what's out there and they should be allowed to make their own informed choice about whether they want testing and whether they would use that in reproductive decision making. Everybody wants a healthy baby. I, I don't think that's debatable. I think what each couple need to consider to them, what's something that they could cope with or what do they consider is something that they would do testing for because it reaches their sort of threshold of healthiness or capabilities within their own family structure. And that's gonna be different for each couple, but I strongly believe everybody should have that information. Mm-Hmm. <affirmative>, I think there needs to be universal reproductive carrier screening. I would love if there was never a couple who said why wasn't I told that I could have a child with this condition? Mm. When in 2018 we can do screening for these things.

Matt Burgess (36:14):

It, it sounds like there, you know, if that takes place, there'll be a huge need for genetic counselors in the future. Yes.

Lucinda Freeman (36:22):

<Laugh>. Yeah, they will. And you might have seen Matt, I dunno if you have been on Twitter over the last 24 hours, but there's been a recurrent tweet about a group in the US who are a career scanning group. So they look at career options and what's coming up as boom career industries. And the post this week was to say that genetic counselors were the top career choice for 2018.

Matt Burgess (36:50):

I, I must say I did see that. I, I thought it was really exciting. <Laugh> <laugh>. It's like our profession that's gonna make it. And I think

Lucinda Freeman (36:58):

Exactly,

Matt Burgess (36:58):

You know, like Australia has what, like 25 million people or something and we have a between 300 and 400 genetic counselors. Like Yeah. I think that, you know, for, for us to really be able to, to move things forward with how at the level that it should be you know, there really is a need for, for more genetic counselors out there.

Lucinda Freeman (37:21):

Yes. I agree, Matt.

Matt Burgess (37:22):

So on that note I would just like to say thank you very much. I know we could talk about these issues and themes all day <laugh>, that would be really interesting. But I, I should let you go. 

Lucinda Freeman (37:38):

Thanks Matt <laugh>.

Matt Burgess (37:39):

And just to say that if you've got any questions about the podcast today or what you've heard RA and I talk about I will be creating a fact sheet that's on my, my website. So that is@insightgenomica.com au slash podcast. But yeah, thank you very much, Lucinda.

Lucinda Freeman (38:01):

All right. It's been a pleasure, Matt. Enjoy your day.

Matt Burgess (38:03):

I'll talk to you later. Bye-Bye.

Lucinda Freeman (38:05):

Okay, bye.