I'M ALAN GUTTMACHER, THE DIRECTOR OF NICHD AND IT'S MY GREAT PRIVILEGE AND PLEASURE TO WELCOME YOU TO RESEARCH FOR A LIFETIME, WHICH IS A CELEBRATION, REALLY, OF THE FIRST 50 YEARS OF OUR INSTITUTE, AND ALSO AN EXPLORATION OF OUR FUTURE OPPORTUNITIES. SPEAKING OF FUTURE OPPORTUNITIES, THE SCIENTIFIC VISIONING BOOKLET IS A CULMINATION OF A COUPLE-YEAR PROCESS IN WHICH OVER 700 FOLKS FROM THE SCIENTIFIC COMMUNITY, THE ADVOCACY COMMUNITIES, FROM THE PUBLIC POLICY COMMUNITIES, CAME TOGETHER TO HELP US RELI EXAMINE AND EXPLORE WHAT ARE THE SCIENTIFIC OPPORTUNITIES ACROSS THE VERY BROAD MISSION OF NICHD OVER THE NEXT DECADE OR SO. SO I THINK YOU'LL ENJOY LOOKING AT THAT. ON SIGNING THE ACT THAT ESTABLISHED NICHD 50 YEARS AGO, PRESIDENT JOHN F. KENNEDY NOTEED, QUOTE, THIS LEGISLATION WILL ENCOURAGE IMAGINATIVE RESEARCH INTO THE COMPLEX PROCESSES OF HUMAN DEVELOPMENT FROM CONCEPTION TO OLD AGE, END QUOTE. I'M HERE TO TELL YOU TODAY THAT NICHD HAS DONE THAT AND MUCH MORE. INDEED WE HAVE FULFILLED PRESIDENT KENNEDY'S HOPES AND ASPIRATIONS FOR US SO ROBUSTLY THAT TODAY'S SYMPOSIUM BY DEFINITION CANNOT BE A COMPREHENSIVE LOOK EITHER AT WHAT WE'VE ACCOMPLISHED OR WHAT WE SET OUT TO DO IN THE FUTURE. WE COULD HAVE HAD A SYMPOSIUM TO DO THAT, BUT I DON'T SUSPECT THAT MOST OF YOU WOULD HAVE HAD TIME TO STAY HERE FOR A MONTH FOR THAT SYMPOSIUM, SO WE'VE DEDICATED TODAY TO REALLY BEING A PARTIAL SNAPSHOT OF WHO WE'VE BEEN AND WHO WE HOPE TO BE. NOW WHAT WE MAY LACK IN QUANTITY, WE MORE THAN MADE UP FOR IN QUALITY. WE HAVE SPEAKERS TODAY WHO ARE CLEARLY AN ALL-STAR CAST, TRULY OUTSTANDING SCIENTISTS, WONDERFUL SPEAKERS, AND I THINK THIS IS A DAY THAT WE WILL ALL ENJOY AND LONG REMEMBER. I WANT TO THANK A NUMBER OF PEOPLE FOR MAKING TODAY POSSIBLE, MAKING THE SYMPOSIUM POSSIBLE. THERE ARE SO MANY PEOPLE THAT WORKED CREATIVELY AND DILIGENTLY OVER THE PAST MONTHS TO MAKE THIS HAPPEN THAT I REALLY CAN'T LIST THEM ALL, SO I WON'T, BUT KNOW THAT FOR ALL OF YOU, YOU REALLY HAVE OUR THANKS FOR MAKING THIS WORK. CERTAINLY WANT TO THANK OUR SPEAKERS WH FOR TAKING TIME OUT OF THEIR LIVES TO BE HERE AND SPEND THE DAY WITH US, AND ALSO TO ALL OF YOU IN THE AUDIENCE WHO ARE ALSO QUITE A BUSY LOT FOR TAKE TAKING TIME OUT FROM YOUR LIVES AND YOUR WORK TO BE HERE WITH US TO MAKE THIS A SPECIAL DAY. THERE ARE ALSO A NUMBER OF FOLKS TO THANK FOR THE 50 YEARS. OBVIOUSLY WE CAN'T THANK ALL OF THEM BY NAME OR EVEN ALL OF THEM BY CATEGORY PROBABLY. CERTAINLY WE WANT TO THANK ALL OF THE MEMBERS OF CONGRESS, THE MANY ADMINISTRATIONS THAT HAVE REALLY IN A VERY BIPARTISAN WAY SUPPORTED THE WORK OF NICHD FROM ITS INCEPTION THROUGH TO THE PRESENT, WITHOUT WHOM WE WOULD NOT BE HERE. CLEARLY OUR RESEARCH COMMUNITIES FOR ALL OF THE OUTSTANDING WORK, THAT IS WHAT WE ARE CELEBRATING TODAY, CONTRIBUTIONS YOU HAVE ALL MADE TO OUR KNOWLEDGE AND TO OUR HELP. THE FOLKS WHO HAVE LABORED ARDUOUSLY AS GRANT REVIEWERS, AS MEMBERS OF OUR ADVISORY GROUPS, ALL OF WHOM, AGAIN, WITHOUT WHOSE WORK WE WOULD NOT BE HERE. CLEARLY, WITH DEEP CONCERN, AFFECTION FOR THE INDIVIDUALS, THE FAMILIES, THE COMMUNITIES FOR WHOM WE DO THIS WORK, AND WITHOUT WHOM, AGAIN, THE WORK ITSELF WOULD NOT BE POSSIBLE. I WANT TO PARTICULARLY THANK THE STAFF, BOTH CURRENT AND PAST OF NICHD. THE INCREDIBLE COMPASSION YOU BRING TO YOUR WORK, THE DILIGENCE, THE INTELLIGENCE, THE CREATIVITY, THE WILLINGNESS TO WORK WELL BEYOND ANYTHING THAT'S COVERED BY NORMAL GOVERNMENT WORK SCHEDULES, ET CETERA, TO GET THIS WORK DONE, AGAIN, IT'S REALLY -- WHAT'S THE MOST IMPORTANT RESOURCE WE HAVE, IT'S OUR STAFF. ALWAYS HAVE, ALWAYS WILL BE. SO FOR THOSE WHO ARE PARTS OF THIS, TO YOU AND YOUR FAMILIES WHO PUT UP WITH YOU DOING THIS KIND OF WORK AND SUPPORT YOU IN DOING THAT, WITHOUT WHO, AGAIN, WE WOULD NOT BE HERE. ALL OF YOU REALLY TRULY SHARE IN THE ACHIEVEMENTS THAT WE ARE CELEBRATING TODAY. THE PROGRAM THAT YOU RECEIVED HAS NICE BIOS OF ALL OF OUR SPEAKERS SO I'M GOING TO SET A STANDARD OF BREFFITY I BREVITY IN TERMS OF INTRODUCTIONS. OUR FIRST SPEAKER IS DR. FRANCIS COLLINS, DIRECTOR OF THE NATIONAL INSTITUTES OF HEALTH. DR. COLLINS. [APPLAUSE] >> BREVITY INDEED, AND ADMIRABLE IT WAS. A STANDARD HOPEFULLY TO BE FOLLOWED BY MANY OTHERS BECAUSE THERE'S SUCH GREAT SCIENCE AND OTHER REFLECTIONS TO BE PUT FORWARD TODAY. I'M REALLY HONORED TO BE ABLE TO ISSUE A WELCOME AS THE DIRECTOR OF NIH TO ALL OF YOU WHO ARE HERE FOR THIS VERY SPECIAL CELEBRATION OF 50 YEARS OF THE KENNEDY SHRIVER INSTITUTE, AND I WANT TO THANK ALAN AND ALL OF HIS STAFF FOR THE HARD WORK THAT'S GONE INTO PREPARING FOR THIS GREAT DAY. JUST HAVE TO SAY A WORD ABOUT ALAN. IT WAS ABOUT 14 YEARS AGO, I THINK, THAT ALAN AND I HAD BREAKFAST AT ONE OF THE GENETICS MEETINGS AND I PROPOSED THE IDEA OF LURING THE ONLY BOARD CERTIFIED GENETICIST IN THE STATE OF VERMONT WHO HAPPENED TO ALSO BE RUNNING THE NEONATAL ICU, THAT MAYBE HIS FUTURE MIGHT LIE SOMEWHERE OTHER THAN THAT GREAT STATE UP THERE TO THE NORTH AND THAT THERE MIGHT BE A ROLE THAT HE COULD PLAY OF LEADING IMPORTANT EFFORTS AT NIH. NEITHER OF US REALIZED THE PATH THAT WOULD TAKE AND HOW WONDERFUL THE OUTCOMES WOULD BE, AND IT IS INDEED A JOY TO SEE THE WAY IN WHICH NOW AS THE DIRECTOR OF THIS INSTITUTE, HE HAS BROUGHT SO MANY OF HIS TALENTS AND BROUGHT SO MANY OF ALL OF YOUR TALENTS TOGETHER TO CREATE A SCIENTIFIC PLAN AND AN ENVIRONMENT FOR CONDUCTING IT THAT IS TRULY EXCITING. I THINK WE CAN ALL SAY THAT SCIENCE, THAT NIH HAS THE POTENTIAL TO SUPPORT RIGHT NOW ACROSS THE BOARD BUT I WOULD SAY PARTICULARLY IN THE AREAS THAT NICHD HAS RESPONSIBILITY FOR HAS NEVER BEEN MORE EXCITING, MORE FULL OF PROMISE, WHETHER WE'RE TALKING ABOUT THE BASIC SCIENCE OF HUMAN DEVELOPMENT, WHETHER WE'RE TALKING ABOUT MUCH MORE APPLIED RESEARCH IN TRANSLATION, AND THAT INCLUDES, OF COURSE, NOT ONLY CHILDREN'S HEALTH BUT WOMEN'S HEALTH AND REHABILITATION. THE OPPORTUNITIES NOW ARE BREATHTAKING. WE DO HAVE THIS LITTLE BIT OF A CHALLENGE IN TERMS OF THE BUDGETARY SUPPORT OF THE ENTERPRISE, AND ALL OF US HAVE WHITE KNUCKLES FROM TIME TO TIME WHEN WE LISTEN TO THE RADIO OR READ THE MORNING PAPER, BUT OUR CAUSE IS NOBLE, AND THE ENTERPRISE, ONCE YOU UNDERSTAND ITS CONSEQUENCES FOR THE FUTURE OF HUMAN HEALTH AND PARTICULARLY FOR THE HEALTH OF CHILDREN IS SO COMPELLING THAT IT IS IMPOSSIBLE TO IMAGINE THAT IT WILL NOT BE SUSTAINED AND ENCOURAGED GOING FORWARD. AS I KNOW ALL OF YOU ARE MAKING THAT CASE, I AM TOO. AND SO WE GATHER HERE ON THIS SPECIAL DAY TO CELEBRATE 50 YEARS, AND TO THINK ABOUT WHERE THE NEXT 50 MIGHT TAKE US, AND IT IS INDEED AN EXHILARATING MOMENT TO SEE THAT POTENTIAL. WE'VE COME A LONG WAY. LET'S THINK ABOUT THIS. THIS IS NOT ONLY THE 50TH ANNIVERSARY OF NICHD, THIS YEAR IS ALSO ANOTHER ANNIVERSARY FOR ALL OF NICHD. IT'S OUR 125TH BIRTHDAY. NIH BEGAN, AS SOME OF YOU KNOW, NOT HERE IN BETHESDA BUT ACTUALLY ON STATEN ISLAND IN A SMALL, ONE-ROOM LABORATORY WITH ONE EMPLOYEE, JOSEPH KINYON, A HYGIENIC LABORATORY ESTABLISHED TO COMBAT HUMANITY LONG-STANDING HEALTH FOE, NAMELY INFECTIOUS DISEASE. THINK BACK TO THAT, 125 YEARS AGO, THE AVERAGE AMERICAN DIDN'T LIVE TO SEE AGE 50. WHEN NICHD WAS FOUNDED 50 YEARS AGO, THAT HAD EXTENDED TO THE AGE OF 70, AND NOW, OF COURSE, 79. AND WITH EXPECTATIONS THAT THAT COULD CONTINUE TO IMPROVE AS LONG AS THE WORK THAT NIH DOES CONTINUES TO MAKE THAT POSSIBLE. AND WE HAVE THREATS TO THAT, OF COURSE, PARTICULARLY FROM THE CURRENT EPIDEMIC OF OBESITY AND DIABETES, WHICH MIGHT MAKE IT A TERRIBLE OUTCOME UNLESS WE FIGURE OUT HOW TO TURN THAT AROUND WHERE OUR CHILDREN AND GRANDCHILDREN MIGHT HAVE A DIMINISHED LIFE EXPECTANCY COMPARED TO OURSELVES. WE MUST NOT LET THAT HAPPEN. AND THE ANSWERS TO THAT, MANY OF THEM WILL RESIDE IN UNDERSTANDING THOSE FACTORS AND IMPLEMENTING THEM PARTICULARLY IN CHILDHOOD. SO NICHD HAS BEEN IN THE MIDDLE OF THOSE ADVANCES, NOT AS AN OBSERVER BUT AS A CENTRAL PARTICIPANT. IT'S NOT ONLY BEEN READING THE STORY, IT'S BEEN WRITING IT. IT IS AN INTERESTING STORY. I WENT BACK AND LOOKED A LITTLE BIT AT THE HISTORY OF HOW NICHD CAME TO BE. NOW AS THE NIH DIRECTOR, I WONDERED WHAT WAS THE ROLE OF THE NIH DIRECTOR AT THAT POINT? JAMES SHANNON, WHOSE NAME IS NOW ATTACHED TO THE BUILDING WHERE I SPEND A LOT OF MY TIME ACROSS CAMPUS WHERE THE DIRECTOR'S OFFICE IS LOCATED CONSIDERED TO HAVE BEEN REALLY A REMARKABLE LEADER AT AN EXPANSION MOMENT FOR NIH. AND I WAS A BIT SURPRISED TO LEARN THAT ACTUALLY DR. SHANNON WAS NOT ENTHUSIASTIC ABOUT THIS INITIAL PROPOSAL. YOU'LL HEAR MORE ABOUT THAT, I SUSPECT, IN A VIDEO THAT'S COMING UP FROM ROBERT COOKE. COOKE WAS THE JOHNS HOPKINS PEDIATRICIAN WHO TACKLED THE CHALLENGE OF PERSUADING CONGRESS AND SHANNON TO ESTABLISH THIS INSTITUTE, AND HE DESCRIBED SHANNON'S INITIAL REACTION THIS WAY. THIS IS A QUOTE FROM AN ARTICLE THAT COOKE WROTE. DR. SHANNON IN NO UNCERTAIN TERMS INFORMED US THAT THERE WERE ESSENTIALLY NO MAJOR DISEASE PROBLEMS IN CHILDREN. [LAUGHTER] HE GAVE US THE IMPREETION THAT A GOOD GRANDMOTHER COULD PROVIDE MOST OF THE CARE REQUIRED. TO SHANNON, CHILDREN WERE ESSENTIALLY WELL INDIVIDUALS AND COULD NOT BE COMPARED WITH THE ADULT MEMBERS OF OUR SOCIETY AS REGARDS DISEASE PROBLEMS. AND OF COURSE LET'S BE FAIR, SHANNON'S REACTION WAS ROOTED IN THE SCIENCE OF THE DAY. MANY OTHERS IN THE COMMUNITY FELT THE SAME WAY AND THOUGHT THE IDEA OF HAVING A SPECIAL INSTITUTE DEVOTED TO THE PROBLEMS RELATED TO CHILD HEALTH WAS MISGUIDED. BUT COOK CONTINUED HIS EFFORTS TO MAKE THE CASE AND THE CASE WAS ACTUALLY VERY STRONG. LET US SAY THE NEW PRESIDENT'S SISTER, EUNICE KENNEDY SHRIVER, WAS A CRITICAL PLAYER IN THIS ENTERPRISE, PERCEIVING ACCURATELY THAT THE NEEDS OF CHILDREN WERE VERY MUCH IN NEED OF THIS KIND OF RESEARCH ATTENTION, MANY OF THOSE CHILDREN LIVING IN THE SHADOWS CAST BY THE BRIGHT LIGHT OF MID 20TH CENTURY MEDICAL PROGRESS BUT NOT THEMSELVES RECEIVING THE BENEFITS OF THAT. SO THIS COMBINATION OF THE INDOM NABL EU NIECE KENNEDY SHRIVER AND ROBERT COOKE AND THE MEDICAL AND SCIENTIFIC FACTS MADE THE CASE AND LET US POINT OUT THAT SHANNON EVENTUALLY ACTUALLY SAW THE WISDOM OF THIS AND GRACIOUSLY ACCEPTED THE CHALLENGE OF THIS NEW INSTITUTE, BROKERING, BY THE WAY, AT THE SAME TIME AN OPPORTUNITY TO ELEVATE ANOTHER INSTITUTE AT NIH FOR GENERAL MEDICAL SCIENCES TO THE LEVEL OF AN INSTITUTE SO HE HAD A NICE NEGOTIATION THAT WENT ON THERE, AND NIGMS, BY THE WAY, IS ALSO CELEBRATING AN ANNIVERSARY AND ET CETER IT'S NOT A COINCIDENCE THAT THOSE TWO ARE HAPPENING THIS YEAR. SO YOU'RE GOING TO HEAR TODAY MANY EXAMPLES OF HOW NICHD HAS SUPPORTED RESEARCH AS REDEFINED CHILDREN'S HEALTH, THINGS THAT PERHAPS 50 YEARS AGO WOULD HAVE NOT BEEN THOUGHT POSSIBLE. BREAKTHROUGHS SUCH AS A VACCINE FOR HIB, ONCE THE LEADING CAUSE OF ACQUIRED INTELLECTUAL AND DEVELOPMENTAL DISABILITIES INCIDENCE NOW HA HAS DROPPED BY MORE THAN 99%. WHAT A PHENOMENAL ACHIEVEMENT. ANOTHER EXAMPLE JUST THIS PAST SEPTEMBER, I ATTENDED THE PRESENTATION OF THE AWARDING OF THE FEDERAL EMPLOYEE OF THE YEAR TO NICHD'S DR. LYNNE MOFENSON, BECAUSE OF HER AND HER COLLABORATORS' TRANSMISSION OF H.I.V. FROM INFECTED MOTHERS TO FETUS AND INFANTS HAS DROPPED FROM WHAT IT USED TO BE 25%, TO LESS THAN 2%. AND THE WORLDWIDE CONSEQUENCES OF THAT ARE IMPOSSIBLE TO OVERSTATE. OTHER CAMPAIGNS SUCH AS THE BACK TO SLEEP, NOW SAFE TO SLEEP EFFORT THAT HAVE REDUCED SUDDEN INFANT DEATH SYNDROME BY MORE THAN 50% SINCE 1994, ANOTHER MAJOR ACHIEVEMENT OF THIS INSTITUTE. AND NOW POISED TO UNDERGO IN A MAJOR EXPANSION THE NATIONAL CHILDREN'S STUDY, WHICH WILL PUT IN PLACE THE ABILITIES TO UNDERSTAND GENETIC AND ENVIRONMENTAL FACTORS ASSOCIATED WITH CHILDHOOD DISEASES, NICHD, ONCE AGAIN WILL BE IN A LEADING ROLE TO FIND MORE ANSWERS TO THOSE PROBLEMS, ALL OF US, ESPECIALLY PARENTS AND THEIR CHILDREN, AND THEN LAST FIVE DECADES INFANT DEATH RATES IN THE U.S. HAVE DROPPED BY MORE THAN 70%, AND WE HAVE WAYS TO GO BECOME LOOK AT THAT TRAJECTORY. BECAUSE OF NICHD, I THINK IT'S FAIR TO SAY MANY OF THE ACCOMPLISHMENTS OF THE LAST 50 YEARS HAVE BECOME POSSIBLE, SO I'M HERE BASICALLY TO SAY WELCOME TO ALL OF YOU AND TO START THE PROCESS OF CELEBRATION OF THIS REMARKABLE INSTITUTE. I JUST WANT TO FINISH BY READING YOU THE MISSION OF NICHD. IT IS BOLD. THE MISSION IS TO ENSURE THAT EVERY PERSON IS BORN HEALTHY AND WANTED. THINK ABOUT THAT. THAT WOMEN SUFFER NO HARMFUL EFFECTS FROM REPRODUCTIVE PROCESSES, AND THAT ALL CHILDREN HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL FOR HEALTHY AND PRODUCTIVE LIVES. FREE FROM DISEASE OR DISABILITY. AND TO ENSURE THE HEALTH PRODUCTIVITY INDEPENDENCE AND WELL-BEING OF ALL PEOPLE THROUGH OPTIMAL REHABILITATION. AN ENORMOUSLY BROAD SWATH OF OPPORTUNITY AND RESPONSIBILITY AND PASSION AND VISION. IT'S ALL WRAPPED IN THERE TOGETHER. SO LET ME BE THE FIRST ONE TO ASK THIS AUDIENCE TO GIVE A ROUND OF APPLAUSE TO THE NATIONAL INSTITUTE FOR CHILD HEALTH AND HUMAN DEVELOPMENT AND ALL OF ITS HARD WORKING STAFF AND WHAT HAS BEEN ACCOMPLISHED OVER 50 YEARS AND WHAT WILL BE IN THE FUTURE. THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU, FRANCIS. AS MY BRIEF REGRESSION INTO THE HISTORY OF THE INSTITUTE, IF I COULD HAVE MY SLIDE, PLEASE. YOU'LL SEE IN A MOMENT A PHOTO TAKEN OF PRESIDENT KENNEDY ON OCTOBER 17TH, 1962. SO WHAT'S A DAY IN THE LIFE OF A PRESIDENT LIKE? WHAT DID HE DO THAT DAY? WELL, HE, OF COURSE, PENNED LEGISLATION THAT DAY CREATING NICHD. HE ALSO HAS SOME OTHER THINGS TO THINK ABOUT. IT WAS DAY THREE OF THE CUBAN MISSILE CRISIS. THE DAY THAT THE JOINT CHIEFS OF STAFF STARTED STRONGLY ARGUING FOR AN AIR STRIKE. SO AT THE SAME TIME THAT HE WAS CREATING IT SAYING THESE WONDERFUL THINGS ABOUT THE FUTURE OF CHILDREN'S HEALTH, HE WAS HAVING TO DEAL WITH -- I CAN REMEMBER THAT WEEKEND SAYING GOODBYE TO FRIENDS AT SCHOOL THINKING WE MIGHT NEVER SEE EACH OTHER AGAIN, AND THIS IS WHAT HE WAS THINKING ABOUT. NOW, HOW DO I HAPPEN TO HAVE THIS PHOTO? IT'S PROBABLY FROM THE NICHD ARCHIVES, IT WAS THE PRESIDENT THE DAY HE SIGNED THE LEGISLATION, RIGHT? WRONG. IT'S FROM MY KITCHEN, WHERE IT'S BEEN HANGING FOR THE LAST 20 YEARS, SITTING OVER ME A AS I HAVE CEREAL UNTIL MORNING. WHY DID I HAPPEN TO HAVE THIS PICTURE HANGING OVER MY CEREAL? IT'S BECAUSE ON THAT DAY, HE ALSO HAPPENED TO GO TO CONNECTICUT TO CAMPAIGN BECAUSE IT WAS THE MIDDLE OF THE 1962 CONGRESSIONAL ELECTION. A WOMAN WHO WAS -- THERE WAS A LITTLE GIRL WHO WENT TO SEE HIM THAT DAY, HAPPENED TO HAVE THAT PICTURE AND GAVE IT TO ME. THAT'S A PICTURE -- SHE WAS PROUD OF THIS PICTURE BECAUSE HER FATHER IS ON THE PLATFORM WITH THE PRESIDENT WHEN HE WENT TO CAMPAIGN. SO WHO IS THAT WOMAN THAT GAVE ME THIS PICTURE 20-SOME YEARS AGO? IT'S MY WIFE, BRIDGET. SO IT JUST CAME TO ME RECENTLY THAT WE HAVE SITTING OVER US FOR THE LAST 20 SOME YEARS THIS PICTURE OF PRESIDENT KENNEDY THE DAY THAT HE MADE NICHD A REALITY. SO A DAY IN THE LIFE OF A PRESIDENT. CLEARLY THE FOUNDING OF OUR INSTITUTE WAS A VERY INTERESTING AND CONVOLUTED KIND OF TALE. THERE REALLY ARE, AS FRANCIS ALREADY ALLUDED TO, THERE REALLY ARE TWO PEOPLE WHO ARE PRIMARILY RESPONSIBLE FOR THE CREATION OF THIS ENTITY. ONE OF THEM, WE VERY PROUDLY BEAR THE NAME OF, EUNICE KENNEDY SHRIVER, WITHOUT WHOSE DILIGENT EFFORTS WE WOULD PROBABLY NOT HAVE SEEN THE LIGHT OF DAY. BUT ALSO HER COCONSPIRATOR IN THIS, BOB COOKE, THEN THE CHAIR OF PEDIATRICS AT HOPKINS, WHO WAS AN IMPORTANT ALLY, IMPORTANT SCIENTIFIC BASIS FOR THE ARGUMENTS THAT WERE MADE. I HAD THE DELIGHTFUL OPPORTUNITY A COUPLE MONTHS AGO TO SIT DOWN WITH DR. COOKE AND JUST TALK WITH HIM ABOUT HIS STILL VERY SHARP MEMORIES OF WHAT THOSE EARLY DAYS WERE LIKE TRYING TO GET THIS STARTED. TODAY I'D LIKE TO SHARE AN EXCERPT OF OUR CONVERSATION WITH YOU, SO IF YOU CAN TAKE IT AWAY, ANTOINE. >> DR. COOK, IT'S SUCH A PLEASURE TO BE ABLE TO SIT DOWN AND TALK WITH YOU ON THE 50TH ANNIVERSARY OF THE FOUNDING OF WHAT IS NOW, OF COURSE, THE EUNICE KENNEDY SHRIVER INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, BECAUSE NOT ONLY WERE YOU THERE AT THE BIRTH OF THIS THING BUT YOU WERE AT LEAST A MIDWIFE IF NOT MORE TO THE BEGINNING OF THE PLACE, SO I REALLY WANT TO HEAR FROM YOU WHAT IT WAS LIKE AT THE BEGINNING. HOW DID THIS HAPPEN? HOW DID YOU ALL WORK TO CREATE SUCH A THING? >> WELL, IT WAS ONE OF THESE VERY FORTUITOUS CIRCUMSTANCES. I WAS A GOOD FRIEND WITH EUNICE SHRIVER AND WHEN THE PRESIDENT WAS ELECTED, BEFORE HE TOOK OFFICE, THEY PUT TOGETHER A TASK FORCE TO LOOK AT HEALTH AND SOCIAL SERVICES FOR THE NEW ADMINISTRATION. AND I GOT A CELL PHONE CALL ONE DAY ASKING ME IF I COULD SERVE ON THIS TASK FORCE, SO WE MET AT THE MAYFLOWER HOTEL FOR THE FIRST TIME. >> THIS WAS THE PERIOD IN BETWEEN THE ELECTION AND THE INAUGURATION, OR WHEN WAS IT? >> RIGHT. IT WAS RIGHT AFTER THE ELECTION. AND WE MET IN THE MAYFLOWER HOTEL, THERE WERE FIVE OF US, WILBUR COHEN WAS THE CHAIRMAN OF THE GROUP. THEN WE HAD TO GO UP AND SEE GOVERNOR -- >> GOVERNOR RIVERKROFF? >> RIGHT. HE HAD BEEN APPOINTED SECOND OF HUMAN SERVICES, AND HE WOULDN'T HAVE BEEN INTERESTED IN MY PRESENTATION BUT TED SORENSEN WAS THERE AT THE TIME, AND SORENSEN SAID, THIS IS A GREAT THING TO BALANCE OUR EMPHASIS ON MEDICAL CARE FOR THE ELDERLY. SO SORENSEN TOOK THE MESSAGE BACK TO KENNEDY, I GUESS, AND THEY WENT AHEAD, DEVELOPED SOME LEGISLATION, AND I PEDALED IT TO PEOPLE IN CONGRESS AND SURE ENOUGH, I THINK THE CONGRESS VOTED ALMOST UNANIMOUSLY TO CREATE THE INSTITUTE. EUNICE SHRIVER WAS A BIG HELP BECAUSE THE TWO PEOPLE WOULD CONTROL ALL MEDICAL ACTIVITY, JOHN FOGARTY IN THE HOUSE, SO WE WENT TO SEE JOHN FO JOHN FOGERTY. HE HAD BEEN PREPPED BY THE HEAD OF THE NIH THAT THIS WASN'T A GOOD IDEA. AND SO AT THE START OF THE INTERVIEWS, HE REALLY SHOWED THAT HE WASN'T IN FAVOR OF THIS, AND EUNICE, I CAN REMEMBER SO WELL. EUNICE SAID DO YOU HAVE ANY RETARDED PEOPLE IN PROVIDENCE? AND OF COURSE FOGERTY SAID, WELL, OF COURSE. WELL, THEY NEED THIS HELP. SO FOGERTY JUMPED ON THE BANDWAGON, AND THEN WE WENT TO SEE LISTER HILL, THE SAME DAY, AND HILL, WHEN WE WENT IN, TOLD HIM A LITTLE ABOUT IT, SAID, ANYTHING EUNICE WANTS, WE'LL DO. SO THAT'S HOW IT BECAME LEGISLATION. MY FEELING STA NICHD HAS MADE AN ENORMOUS CONTRIBUTION TO CHILDREN IN THIS COUNTRY, AND I THINK TO MEDICINE IN GENERAL. WHAT YOU DO WITH A CHILD SEEMS TO MAKE AN ENORMOUS DIFFERENCE IN HIS LIFE. [APPLAUSE] >> THAT WAS WONDERFUL, BUT I HAVE TO TELL YOU, IT'S THE EXPERGATED VERSION. I HOPE WE HAVE THE FULL VERSION ON OUR WEBSITE. IT WAS FIVE MEN WHO MET, AND THIS IS NOT IN THE BEST DAYS OF THE MAYFLOWER HOTEL SO EVEN THOUGH IT WAS IN DECEMBER, IT GOT SO HOT THAT BY THE END OF THE DISCUSSION, THEY'RE ALL STRIPPED DOWN TO THEIR UNDERWEAR. SO THE IDEA THAT OUR -- ACTUALLY BORNE BY A BUNCH OF MEN SITTING AROUND IN A HOTEL IN THEIR UNDERWEAR, I FIND PARTICULARLY -- AS I COME TO WORK EACH DAY. I WANT TO NOW INTRODUCE REALLY THE PERSON WHO LEAST NEEDS AN INTRODUCTION THIS ENTIRE DAY, AND THAT'S DUANE ALEXANDER. WHO WAS TRAINED BY BOB COOKE AT HOPKINS. DUANE HAS BEEN AT NICHD FOR OVER HALF -- WAS DIRECTOR FOR ALMOST HALF OF THE ENTIRE 50 YEARS. ANYBODY IN THE WORLD EXCEPT FOR DUANE WOULD TELL YOU THAT IF THERE'S ONE PERSON MOST RESPONSIBLE FOR WHAT NICHD HAS ACCOMPLISHED OVER THE YEARS, IT IS DUANE ALEXANDER. SO WITH THAT, DUANE, WE'D LOVE TO HAVE YOU COME UP AND TELL US A LITTLE BIT ABOUT HOW YOU THINK NICHD HAS DOB OVE DONE OVER THE YEARS. [APPLAUSE] >> THANK YOU ALL VERY MUCH, AND THANK YOU FOR THE INVITATION TO COME HERE AND TALK ABOUT MY FAVORITE TOPIC. BY ACT OF CONGRESS, THERE'S BEEN A NATIONAL INSTITUTE OF HEALTH AND HUMAN DEVELOPMENT AT THE NIH SINCE 1962. THE ENSUING FIVE DECADES HAVE SEEN ENORMOUS GROWTH IN MEDICAL KNOWLEDGE AND ADVANCES AND ABILITY TO ENHANCE HEALTHY DEVELOPMENT AND SAVE LIVES. NOWHERE HAVE THESE CHANGES BEEN MORE DRAMATIC THAN IN THE FIELDS OF OBVIOUS STE TRICKS AND PEDIATRICS AND THEIR RELATED BEHAVIORAL AND HEALTH SCIENCES. NICHD PLAYED A LEADING ROLE OFTEN UNDERRECOGNIZED OR APPRECIATED. RECOUNTING THE INSTITUTE'S HISTORICAL AND FASCINATING ROLE PROVIDE AS DRAMATIC EXAMPLE OF HOW THE PRESENCE OF NICHD FOSTERED AND ENHANCED OUR ABILITY TO IMPROVE THE WELL-BEING OF OUR CHILDREN AND FAMILIES. SETTING THE STAGE FOR THE ADVENT OF THE NICHD REQUIRES LOOKING AT THE NIH OF 1960. LIKE MOST OF THE REST OF THE FEDERAL GOVERNMENT, THE NIH WAS MUCH DIFFERENT THAN IT IS TODAY. MOSTLY, IT WAS SMALLER. HAVING MOVED TO THE BETHESDA CAMPUS, THER THAT WAS CONSTRUCTED FOR IT IN 1940. THTHE NATIONAL CANCER INSTITUTE WAS THE ONLY SEPARATE INSTITUTE UNTIL AFTER WORLD WAR II, AND THE EXTRAMURAL PROGRAM DID NOT EXIST UNTIL AFTER THE WAR. THERE WERE ONLY EIGHT INSTITUTES AND THE TOTAL NIH BUDGET WAS $400 MILLION IN 1960. SOME CHANGE. THE DRAMATIC GROWTH SPURT OF THE NIH UNDER JAMES SHANNON AND ALLIES IN THE CONGRESS WAS JUST BEGINNING. THE NIH BUDGET DRUBLED OVE DOUBLED OVER TH E NEXT YEARS. THERE WAS LITTLE RESEARCHIN THE NIH PORTFOLIO, THERE WAS LITTLE RESEARCH ON CHILDREN ORN PREGNANCY. THE SITUATION WAS ABOUT TO CHANGE, AS DR. COOKE RECOUNTED IN HIS HISTORIC REVIEW, AND THE NICHD TOOK ITS PLACE A AMONG OF THE REST OF THE NIH INSTITUTES AND PROVIDED AN NIH FOCUS FOR THAT POPULATION. SINCE IT BECAME OPERATIVE IN 1963, AS THE NINTH NIH INSTITUTE, THE NICHD HAS SPENT MORE THAN $25 BILLION ON RESEARCH OF MATERNAL AND CHILD HEALTH AND DISABILITY. HIS CURRENT BUDGET IS $1.3 BILLION PER YEAR. IT'S APPROPRIATE TO ASK WHAT THE RETURN HAS BEEN ON THIS INVESTMENT FOR CHILDREN, WOMEN AND FAMILIES. WHY DO WE NEED AN NICHD? WAS DR. COOKE RIGHT? HOW HAVE WE BENEFITED FROM HAVING IT? THE STARTING POINT IN BUILDING A RESEARCH ENTERPRISE IS ATTRACTING AND TRAINING RESEARCH SCIENTISTS. EVERY FIELD IS TRYING TO GET THE BRIGHTEST AND BEST IN THEIR AREAS AND HAVE THE RESEARCH AND GRANTSMANSHIP SKILLS NEEDED TO SUCCEED IN THE HIGHLY COMPETITIVE WORLD OF OBTAINING RESEARCH FUNDING SUPPORT. AS A NEW INSTITUTE, NICHD INVESTED HEAVILY IN TRAINING FROM THE BEGINNING TO HELP SCIENTISTS IN ITS FIELD OF INTEREST COMPETE SUCCESSFULLY. DESPITE THIS INVESTMENT, THE INSTITUTE WAS FALLING SHORT IN PRODUCING TRAINED PHYSICIAN SCIENTISTS TO PROPOSE AND CONDUCT RESEARCH ON THE PROBLEMS THAT NEEDED TO BE ADDRESSED FOR THE NICHD. WORKING WITH THE ACADEMIC LEADERSHIP IN THESE FIELDS, THE INSTITUTE DEVELOPED AND FUNDED NEW APPROACHES. THE PEDIATRIC SCIENTIST DEVELOPMENT PROGRAM AND THE REPRODUCTIVE SCIENTIST AND REHABILITATION SCIENTIST DEVELOPMENT PROGRAMS. THESE PROVE TO BE EFFECTIVE NEW WAYS TO ATTRACT AND TRAIN PHYSICIAN SCIENTISTS WHO BECAME HIGHLY SUCCESSFUL RESEARCHERS IN COMPETING FOR GRANTS AND BEING LEADERS IN THEIR FIELDS. TO FURTHER INCREASE THE NUMBER TRAINED, THE NICHD EXPANDED THESE CONCEPTS AND FUNDED CHILD HEALTH RESEARCH CAREER DEVELOPMENT PROGRAMS, YIELDING 20 TO 40 GRADUATES PER YEAR TO MEET THE NEED FOR WELL TRAINED, COMPETITIVE NIH FUNDED CLINICAL INVESTIGATORS. RESEARCH TRAINING PROGRAMS WERE NOT THE ONLY INNOVATION NICHD EMPLOYED. CLINICAL TRIAL NETWORKS WERE ALSO CREATED SIMILAR TO THOSE USED BY THE NATIONAL CANCER INSTITUTE AND THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE. THESE INSTITUTES HAD A HISTORY OF SUCCESSFULLY USING COOPERATIVE MULTISITE CLINICAL TRIAL NETWORKS WITH COMMON PROTOCOLS TO ASSESS EFFECTIVENESS AND SAFETY OF THERAPEUTIC INTERVENTIONS. IN THE MID 1980s, THE NICHD DECIDED TO USE THIS MECHANISM TO CONDUCT CLINICAL TRIALS IN OBSTETRICS, MATERNAL FETAL MEDICINE AND PEDIATRICS, NEONATOLOGY. THESE WERE FUNDED BY COOPERATIVE AGREEMENT GRANTS. NICHD STAFF PARTICIPATED IN THE GROUP'S GOVERNANCE AND DECISION-MAKING AND SUPPORTED A STUDY AND DATA COORDINATING CENTER. THE GROUP OF PRINCIPAL INVESTIGATORS AND NICHD STAFF SELECT THE TOPICS AND DEVELOP THE STUDY DESIGN AND PROTOCOL. FIRST FUNDED IN 1986, THE NETWORKS CURRENTLY INCLUDE 14 SITES IN MATERNAL FETAL MEDICINE, 18 IN NEONATAL MEDICINE, PLUS TWO DATA CENTERS. THE NETWORKS HAVE PLAYED A SIGNIFICANT ROLE IN SHAPING AND IMPROVING PRACTICE IN THEIR FIELDS. FOR EXAMPLE, ROUTINE ADMINISTRATION OF IMMUNOGLOBULIN TO PREMATURE INFANTS, PULSE OXIMETRY DURING LABOR, WERE ALL SHOWN TO HAVE NO BENEFIT AND WERE STOPPED. ON THE OTHER HAND, ANTENATAL STEROID ADMINISTRATION TO WOMEN IN PRETERM LABOR TO ACCELERATE LUNG DEVELOPMENT AND REDUCE RESPIRATORY DISTRESS SYSTEM, AND ADMINISTERING MAGNESIUM TO WOMEN IN PRETERM LABOR TO REDUCE THE RISK OF CEREBRAL PALSY WERE ALL SHOWN TO BE EFFECTIVE AND HAVE MOVED INTO PRACTICE. AS DRAMATIC EVIDENCE OF THE BENEFIT OF THIS RESEARCH, CONSIDER THAT IN 1963, PRESIDENT KENNEDY'S INFANT SON PATRICK WAS BORN PREMATURELY AND DIED. AT HIS BIRTH WEIGHT AND GESTATIONAL AGE, HE HAD A 90% CHANCE OF DYING. TODAY, HE WOULD HAVE A 95% CHANCE OF SURVIVING. BEYOND IMMEDIATE BENEFITS, NUMEROUS PHYSICIAN SCIENTISTS HAVE LEARNED CLINICAL TRIAL METHODOLOGY BY ASSISTING IN THE NETWORKS AND HAVE GONE ON TO DESIGN AND CONDUCT COOPERATIVE CLINICAL TRIALS ON THEIR OWN. THE NETWORK MECHANISM HAS PROVED SO SUCCESSFUL IN FOSTERING EVIDENCE-BASED MEDICINE AND GUIDING CARE THAT THE NICHD HAS ESTABLISHED OTHER RESEARCH NETWORKS IN PEDIATRIC AND OBSTETRIC PHARMACOLOGY, PEDIATRIC INJURY AND INTENSIVE CARE AND REHABILITATION, ADOLESCENT AIDS AND GLOBAL MATERNAL AND CHILD HEALTH. NEWBORN SCREENING IS ANOTHER AREA WHERE NICHD HAD A HIGH IMPACT. THE EXCITEMENT ENGENDERED BY THE DEMONSTRATION THAT THE SEVERE MENTAL RETARDATION ASSOCIATED WITH THE GENETIC DISEASE COULD BE PREVENTED BY NEONATAL DETECTION AND DIETARY TREATMENT PLAYED A MAJOR ROLE IN THE SUCCESSFUL ARGUMENTS FOR ESTABLISHING NICHD. IF A DISEASE THAT INEVITABLY RESULTED IN SEVERE TO PROFOUND RETARDATION COULD BE IDENTIFIED IN NEWBORNS BY SCREENING ONE DROP OF THEIR BLOOD FOR THIS DISORDER AND ITS SYMPTOMS COULD BE PREVENTED BY DIETARY TREATMENT, THERE WAS A HUGE POTENTIAL. NOT JUST FOR PKU TREATMENT ALONE, BUT ALSO FOR POSSIBLY FINDING OTHER DISORDERS THAT COULD SIMILARLY BE DETECTED BY NEWBORN SCREENING IN TIME TO INITIATE PREVENTIVE TREATMENT. ONE ROLE FOR THE NICHD WOULD BE TO HEAD THE SEARCH FOR OTHER PKUs, THE MOST SIGNIFICANT RESULT FROM THIS SEARCH WAS NEWBORN SCREENING FOR CONGENITAL HYPOTHYROIDISM, DEVELOPED BY DR. DELL FISHER AT THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO LABORATORY WITH NICHD SUPPORT. USING THE SAME BLOOD SPOTS OBTAINED FOR PKU SCREENING, HE DEVELOPED AND AUTOMATED MICRO ASSAYS FOR THYROID HORMONE TO YIELD A DIAGNOSIS IN TIME TO DPIBEGINTHYROID HORMONE REPLACEMENT THERAPY BEFORE BRAIN DAMAGE OCCURRED. THIS ASSAY ADDED 1,000 CHILDREN ANNUALLY WHO WERE SPARED MENTAL RETARDATION TO THE 250 CHILDREN ANNUALLY AVOIDING THE ADVERSE EFFECTS OF PKU. IN RECENT YEARS, WITH THE ASSISTANCE OF DR. ROD HOWELL, THE NICHD HAS LED A GROUP OF PUBLIC HEALTH AGENCIES IN AN EFFORT TO EXPAND NEWBORN SCREENING AND STANDARDIZED IT ACROSS THE STATES. AS A RESULT, TODAY 99% OF NEWBORNS IN THE UNITED STATES ARE SCREENED FOR THE SAME 26 DISORDERS. RESEARCH ON VACCINES IS NOT A PRIMARY ASSIGNMENT FOR THE NICHD. HOWEVER, THE CONTRIBUTIONS OF DR. JOHN ROBBINS -- IN THE NICHD INTRAMURAL PROGRAM REPRESENT A NATIONAL TREASURE IN VACCINE DEVELOPMENT FOR THE NIH. CAPTIVATED BY PEDIATRIC RESIDENTS BY THE DEVASTATING INCIDENCE OF MENINGITIS ON CHILDREN AND FAMILIES, THIS TEAM MADE DEVELOPING A VACCINE TO PREVENT THIS DISEASE THEIR LIFE'S WORK. AFTER DEMONSTRATING THAT THE PROTECTIVE ANTIGEN WAS NOT A PROTEIN, THEY DEVELOPED A SUCCESSFUL HIB CAPSULAR VACCINE. BY USING THIS SUGAR AS THE ANTIGEN. TO MAKE THE VACCINE STRONG ENOUGH TO PROTECT INFANTS, THEY BOUND OR CONGREGATED IT TO A PREPROTEIN CARRIER THAT PRODUCED PROTECTIVE LEVELS OF ANTIBODIES. A HIB -- VACCINE WAS LICENSED BY THE FDA IN 1987. SOON AFTERWARD, HIB MENINGITIS QUICKLY BEGAN TO DISAPPEAR. BEFORE THE USE OF HIB VACCINE, SOME 15 TO 20,000 CASES OF HIB MENINGITIS OCCURRED IN THE UNITED STATES ANNUALLY. TODAY, IT IS ALMOST NEVER SEEN. HIB MENINGITIS HAD A MORTALITY RATE OF ABOUT 10% PLUS A 30% RATE OF MORBIDITY, INCLUDING DEAFNESS OR BRAIN DAMAGE, WHICH MADE IT THE NATION'S LEADING CAUSE OF ACQUIRED MENTAL RETARDATION. SUBSEQUENTLY THEIR CONCEPT HAS BEEN USED BY THEM AN OTHERS TO DEVELOP LICENSED VACCINES NOW PART OF STANDARD CARE FOR ALL CHILDREN. ELIMINATING THIS DISEASE IS ONE OF THE NIH'S ALL-TIME MAJOR CONTRIBUTIONS TO PUBLIC HEALTH, AND IT EARNED THE LASKER AWARD AND THE LOUIS PASTEUR AWARD. A BRONZE PLAQUE AT THE ENTRANCE TO THEIR NICHD LABORATORY READS, "IN THESE LABORATORIES OF THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, THEY DEVELOPED A VACCINE TO PREVENT TYPE B MENINGITIS, ENDING THE SCOURGE OF THIS DISEASE FOR ALL CHILDREN EVERYWHERE." OTHER NICHD SCIENTISTS HAVE ALSO PRODUCED SIGNIFICANT ADVANCES THROUGH THEIR RESEARCH. THREE EXAMPLES ILLUSTRATE THE FAR-REACHING IMPACT. ONE OF THESE IS THE USE OF LUTE NIEZING HORMONE FOR EFFECTIVE TREATMENT OF PRECOCIOUS PUBERTY. THIS RESEARCH BUILT ON THE NICHD SUPPORTED RESEARCH BY DRS. ROGER AND ANDREW, TWO OF NICHD'S 9NOBEL PRIZE WINNERS. THE FIRST ISOLATED AND IDENTIFIED RELEASING FACTORS FROM THE HYPOTHALAMUS TO CAUSE THE PITUITARY GLAND TO SECRETE HORMONES INTO CIRCULATION. THE NICHD EXTRA MURAL PROGRAM SUPPORTED BY CONTRACT THE CREATION OF MORE POTENT ANALOGS FOR THESE FACTORS FOR CLINICAL USE. THE ANALOGS PROVED USEFUL FOR TREATING PROSTATE CANCER AND INDUCING OF OVULATION. THE ENDOCRINOLOGY PROGRAM LED BY DR. CUTLER IN CONNECTION WITH DR. CROWLEY INITIATED A PROTOCOL TO STUDY THE USE OF ONE OF THESE ANALOGS TO STOP THE EARLY MATURATION INITIATION OF PUBERTY CAUSED BY TOO EARLY HORMONE SEE KREETION. THIS INTERVENTION WORKED SEC PACSPECSPAKTACK LARLY. IT'S NOW THE STANDARD THERAPY FOR THESE CHILDREN. ANOTHER MAJOR DISCOVERY MADE IN THE NIH CLINICAL CENTER WAS THE BETA SUBUNIT, EVEN BEFORE THE FIRST MISSED MENSTRUAL PERIOD, THUS SERVED AS THE EARLIEST MARKER OF PREGNANCY, AND COULD SERVE AS AN EARLY PREGNANCY TEST. INDUSTRY SEIZED ON THIS DISCOVERY AND QUICKLY DEVELOPED A HOME PREGNANCY TEST KIT, WHICH GAVE AN INSTANT RESULT FROM A URINE DIPSTICK AND SOLE OVER THE COUNTER TODAY. UNTIL THAT TIME, DEFINITIVE EARLY DIAGNOSIS OF PREGNANCY INCLUDING ECTOPIC PREGNANCY REQUIRED A BIOASSAY THAT EXPOSED FROGS OR RABBITS TO A WOMAN'S URINE AND TOOK SEVERAL DAYS. A THIRD MAJOR ADVANCE FROM THE INTRAMURAL PROGRAM WAS THE WORK OF DR. BILL GALL IN DEVELOPING EFFECTIVE TREATMENT FOR THE RARE DISEASE CYSTENOSIS. THE RESEARCH PROGRESS AGAINST THIS DISEASE WAS DEMONSTRATED DRAMATICALLY ABOUT 15 YEARS AGO, WHEN SENATOR TED KENNEDY VISITED THE NIH AND ASKED TO SEE SOME RESEARCH PATIENTS FROM THE CLINICAL CENTER. THE NICHD'S BILL GAL WAS ASKED TO PRESENT TWO FAMILIES WITH THE RARE GENETIC METABOLIC DISEASE. THIS DISEASE RESULTS FROM INABILITY TO REMOVE SISTINE FROM THE CELLS OF THE BODY. IT CRYSTALLIZES IN THE EYE, KIDNEYS AND OTHER ORGANS, RESULTING IN SEVERE KIDNEY DISEASE, GROWTH STUNTING, LOSS OF VISION AND DEATH BY ADOLESCENCE. DR. GALL DESCRIBED FIRST A FAMILY WITH THREE CHILDREN AFFECTED BY THE DISEASE. THE OLDEST BOY AND GIRL WERE NOT PRESENT. THEY HAD DIED BEFORE THEIR TEENAGE YEARS FROM SEVERE KIDNEY DISEASE. A THIRD CHILD WAS PRESENT. HIS LIFE HAD BEEN SAVED AT THE AGE OF 10 BY KIDNEY TRANSPLANTATION WHICH HAD NOT BEEN AVAILABLE TO HIS OLDER SIBLINGS. BUT HE WAS BLIND AND HIS GROWTH WAS SEVERELY STUNTED. DR. GALL THEN INTRODUCED A CHILD FROM ANOTHER FAMILY. HE WAS 8 YEARS OLD AND HAD BEEN DIAGNOSED WITH CYST AT THE KNOW CYST BEFORE AGE 1, HE HAD BEEN STARTED IMMEDIATELY ON A DRUG DEVELOPED AND TESTED IN NICHD RESEARCH THAT SUBSOL BULLIZED SISTINE AND FACILITATED ITS REMOVAL FROM THE BODY. HE LOOKED AND ACTED IN EVERY WAY LIKE A NORMAL THIRD GRADER. HIS VISION AND PHYSICAL STATE SIZE WERE NORMAL, HIS KIDNEY FUNCTION WAS NORMAL, HE WAS DOING WELL IN SCHOOL AND LOVED PLAYING BASEBALL. SENATOR KENNEDY WAS VISIBLY YOU AD BY THIS DEMONSTRATION OF HOW CHILDREN WERE BEING HELPED BY RESEARCH TRANSPORTED INSTITUTE HIS FAMILY BEGAN BEGAN. WHEN THE AIDS EPIDEMIC GAB, THEY WERE SLOW TO RECOGNIZE CHILDREN WERE AFFECTED ALSO AND THAT IT COULD BE TRANSMITTED FROM AN INFECTED MOTHER TO HER FETUS OR INFANT. THE NICHD AT THAT TIME MADE THE DECISION TO COMMIT STAFF AND RESOURCES TO HIV/AIDS AND CREATED A SEPARATE NEW BRANCH FOR PEDIATRIC AIDS. UNDER THE SUPERB LEADERSHIP OF DOCTORS ANN AND LYNNE MOFENSON, THIS PEDIATRIC AIDS BRANCH BECAME THE GLOBAL CENTER OF RESEARCH ON INFORMATION ON THESE EPIDEMIC IN WOMEN AND CHILDREN. WITH A MAJOR FOCUS ON PREVENTION OF MOTHER TO CHILD TRANSMISSION, AND COLLABORATION WITH THE NATIONAL INSTITUTE OF ALLERGY AND -- DISEASES, THE FIRST TRIAL OF THE DRUG GIVEN IN PREGNANCY AND TO THE NEWBORN REDUCED THE TRANSMISSION RATE IN THE UNITED STATES FROM 27% TO 7%. SUBSEQUENT COMBINATION DRUG AND ALTERED TIMING REGIMEN HAVE REDUCED THE TRANSMATION RAID IN THE UNITED STATES TO BETWEEN 1 AND 2% AND IN ASIA AND AFE AND AFRICA TO BETWEEN 4 AND 8%. TRIALS CONTINUE BUT ARE MOSTLY DONE OUTSIDE THE UNITED STATES BECAUSE INSTEAD OF AN EPIDEMIC OF PEDIATRIC AIDS HERE, THE NUMBER OF NEW CASES IN INFANTS AND CHILDREN IN THE UNITED STATES HAS BECOME TOO SMALL TO PROVIDE AN ADEQUATE SAMPLE SIZE FOR MOST STUDIES. DR. MOFENSON WAS RECENTLY NAMED FEDERAL EMPLOYEE OF THE YEAR FOR 2012. SOMETIMES THE PUBLIC EDUCATION CAMPAIGN IS THE BEST WAY TO GET RESULTS AN RESEARCH INTO PRACTICE. THE BEST KNOWN OF THESE INITIATED BY NICHD IS THE BACK TO SLEEP CAMPAIGN, TO REDUCE THE RISK OF SUDDEN INFANT DEATH SYNDROME. VALIDATION STUDIES BY NICHD OF RESEARCH FROM OTHER COUNTRIES HAVE INDICATED THAT INFANTS WHO SLEPT ON THEIR BACKS WERE LESS LIKELY TO DIE OF SIDS THAN INFANTS SLEEPING ON THEIR STOMACHS, LED TO A RECOMMENDATION FROM THE AMERICAN ACADEMY OF PEDIATRICS THAT INFANTS BE PLACED ON THEIR BACKS TO SLEEP. WHEN SURVEYS INDICATED THAT THIS ADVICE WAS GOING UNHEEDED, THE NICHD ENLISTED THE ACADEMY AND RELEVANT FEDERAL AGENCIES TO PLAN AND IMPLEMENT A PUBLIC INFORMATION CAMPAIGN. WITH BACK TO SLEEP AS ITS SLOGAN, THE CAMPAIGN WAS LAUNCHED BY THE U.S. SURGEON GENERAL IN JUNE 1994. IN FIVE YEARS, BACK OR SIDE SLEEPING INCREASED FROM ABOUT 15% TO NEARLY 80%. THE SIDS RATE DECLINED BY ONE HALF, AND SIDS DROPPED FROM SECOND TO THIRD PLACE IN THE NATION'S LIST OF LEADING CAUSES OF INFANT DEATH. BY THE MID 1980s, MORE THAN 50% OF MOTHERS OF INFANTS WERE IN THE WORKFORCE, WHICH WAS A MARKED INCREASE, AND PARENTS THEMSELVES WERE RAISING CONCERNS ABOUT THE QUALITY OF DAYCARE AND ITS IMPACT ON FAMILIES AS WELL AS ON CHILD LEARNING AND BEHAVIOR. THE STUDIES OF THE EFFECT ON CHILDREN OF WORKING MOTHERS THAT HAVE BEEN PERFORMED WERE SMALL AND SHORT TERM AND HAD INSTANT RESULTS. ONLY THE NICHD HAD THE STAFF, EXPERTISE AND RESOURCES TO PUT TOGETHER A STUDY OF SUFFICIENT SIZE AND DURATION TO ANSWER THE SIGNIFICANT QUESTIONS BEING ASKED AND ADDRESS THE ANXIETIES ABOUT DAYCARE FELT BY MANY PEOPLE. THE NICHD AGREED TO PROCEED AND ASKED DR. SARAH FRIEDMAN, A DEVELOP TALL PSYCHOLOGIST ON THE INSTITUTE STAFF TO LEAD THE EFFORT TO LOOK AT THE IMPACT OF DAYCARE ON CHILDREN. THE BEHAVIORAL SCIENCE COMMUNITY JOINED IN ITS PLANNING AS WELL AS ITS EXECUTION. RESULTS AT AGES 3, 5 AND 7 YEARS WERE REASSURING. CARE WAS VARIABLE, GOOD QUALITY CARE WAS BENEFICIAL, THERE WAS LITTLE OR NO EVIDENCE THAT THE DAYCARE EXPERIENCE WAS HARMFUL, AND THE RELATIONSHIP OF THE CHILD TO THE MOTHER WAS A FAR MORE POWERFUL INFLUENCE OF OUT COME THAN THE DAYCARE EXPERIENCE. PARENTS BECAME COMFORTABLE WITH DAY WHIC WHICH WAS GENERALLY SEEN AS POSITIVE AND STUT DIS LED TO PROPROMULGATION OF STANDARDS THAT RAISED THE SAFETY AND QUALITY OF DAYCARE FACILITIES AND PROVIDERS. WITH THE NICHD'S POSITIVE PERFORMANCE, CONGRESS ASSIGNED US MORE RESPONSIBILITY. IN 1990, CONGRESS ESTABLISHED THE NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH AND LOCATED IT IN NICHD. THE INSTITUTE HAS PROVIDED RESOURCES TO GROW AND MATURE THIS PROGRAM AND TO ASSURE THAT REHABILITATION NEEDS OF CHILDREN ARE ADDRESSED. ASSIGNED TO THE NICHD, THE RESPONSIBILITY FOR TESTING GENERIC DRUGS IN CHILDREN FOR DOSE AND SAFETY IF INDUSTRY DID NOT DO THE TESTING AND WORKING WITH THE PEDIATRIC COMMUNITY IN PRIORITIZING THESE STUDIES, THE NEWBORN SCREENING ACT OF 2008 ASSIGNED NICHD LEAD RESPONSIBILITY FOR DEVELOPING AND ASSESSING NEWBORN SCREENING TESTS AND TREATMENTS. THE CHILDREN'S HEALTH ACT OF 2000 CHARTS THE NICHD WITH LEADING A COULD BE SOR CONSORTIUM OF FEDER AL AGENCIES TO DESIGN AND IMPLEMENT A LONGITUDINAL STUDY OF ENVIRONMENTAL INFLUENCES ON CHILDREN'S HEALTH AND DEVELOPMENT. THAT WORK IS STILL IN PROGRESS. IN CONCLUSION, THERE ARE TWO WAYS T TO ASSESS THE IMPACT OF THE RESEARCH. CHANGES IN STATISTICS AND CHANGES IN PEOPLE'S LIVES. CHANGES IN INDICATORS INCLUDE THE FOLLOWING: THE NICHD BUDGET GREW FROM 307 MILLION IN 1986 TO $1.3 BILLION IN 2010. THE U.S. INFANT MORTALITY RATE DECLINED FROM 25.3 PER THOUSAND LIFLIVE BIRTHS IN 1962 TO 6.1 PER THOUSAND IN 2010. THE BIRTH WEIGHT AT WHICH 50% OF NEONATES SURVIVE DECLINED FROM ABOUT 1500 GRAMS IN 1960 TO 750 GRAMS IN 2008. NEWBORN SCREENING HAS INCREASED FROM ONE DISORDER, PKU, IN 1963, TO 31 TODAY, AND THE NUMBER CONTINUES TO GROW. THE NUMBER OF MOTHER TO CHILD TRANSMISSION RATE OF H.I.V. IN THE UNITED STATES HAS DECLINED FROM 27% TO 1% TODAY. HIB MENINGITIS HAS DECLINED FROM 15 TO 20,000 CASES PER YEAR BEFORE 1987 TO NEARLY ZERO TODAY. EFFECTS ON PEOPLE'S LIVES INCLUDE THE FOLLOWING. A NEWLY MARRIED YOUNG COUPLE TODAY THAT WANTS TO POSTPONE CHILD BEARING MAY CHOOSE FROM NUMEROUS RELIABLE CONTRACEPTIVES THAT WERE MADE SAFER AND MORE EFFECTIVE BY RESEARCH FROM NICHD. IF THE COUPLE HAS DIFFICULTY CONCEIVING, DIAGNOSIS AND EFFECTIVE TREATMENT ARE AVAILABLE BECAUSE OF RESEARCH FROM THE NICHD. IF PROBLEMS OCCUR DURING PREGNANCY, EFFECTIVE MANAGEMENT IS AVAILABLE FOR MANY AS A RESULT OF NICHD RESEARCH. SCREENING DURING PREGNANCY FOR SEVERE CONGENITAL ANOMALIES IN THE FETUS IS DEVELOPED ROUTINELY BY BLOOD TEST, ULTRASOUND AND OTHER TECHNIQUES DEVELOPED BY NICHD RESEARCH. IF A NEWBORN INFANT HAS PROBLEMS PROBLEMS -- EVERY NEWBORN INFANT LEAVES THE HOSPITAL WITH A BAND-AID ON HIS OR HER HEEL FROM WHERE DROPS OF BLOOD WERE OBTAINED TO SCREEN FOR 26 DISORDERS, THE SAME IN ALL STATES WITH THE AID OF NICHD RESEARCH. THE INFANT'S FIRST RIDE HOME IS IN AN INFANT SAFETY CAR SEAT, FOSTERED AND PROMOTED BY NICHD RESEARCH. WHEN INFANTS ARE PUT DOWN TO SLEEP FOR A NAP OR FOR THE NIGHT, THEY'RE PLACED ON THEIR BACK RATHER THAN ON THEIR STOMACH, AN APPLICATION OF NICHD RESEARCH AND PUBLIC INFORMATION CAMPAIGN TO REDUCE THE RISK OF SENATOSIDS. WHEN INFANTS GET THEIR TWO MONTH IMMUNIZATION, THE HIB VACCINE AND OTHER VACCINES THEY RECEIVE ROUTINELY ARE FROM NICHD RESEARCH. FOR CHILDREN IN DAYCARE, PARENTS ARE ASSURED IT WILL BENEFIT AND NOT HARM THE CHILD. WHEN A CHILD BEGINS SCHOOL, THE EARLY MAINSTREAMING OF CHILDREN WITH PHYSICAL OR MILD INTELLECTUAL DISABILITY INTO REGULAR CLASSROOMS EXIST BECAUSE OF NICHD RESEARCH THAT IT SHOWS MUTUAL BENEFIT. FROM THIS RECORD OF ACCOMPLISHMENT, IT WOULD BE EASY TO CONCLUDE THAT THERE IS NOT ANOTHER INSTITUTE AT NIH WHOSE RESEARCH HAS HAD SUCH A WIDESPREAD BENEFICIAL IMPACT ON PEOPLE'S LIVES AS THAT FROM THE NICHD. THAT PROUDLY CARRIES THE NAME OF EUNICE KENNEDY SHRIVER TO WHOM IT OWES ITS CREATION. IT HAS BEEN JUST OVER 50 YEARS SINCE DR. COOKE PUT FORWARD HIS PROPOSAL FOR A NEW NIH INSTITUTE, FOCUSING ON CHILD HEALTH AND DEVELOPMENT AS A WAY TO IMPROVE PREGNANCY OUTCOMES AND REDUCE DEATH AND DISABILITY IN INFANTS AND CHILDREN. IT IS HOPED THAT THOSE WHO HAVE WORKED HERE AND ALL WHO CARE FOR MOTHERS AND CHILDREN FEEL A SENSE OF PRIDE IN THIS MAGNIFICENT INSTITUTION AS WELL AS GRATITUDE THAT THERE HAS BEEN AN NICHD AROUND TO IMPROVE THE HEALTH OUTCOMES FOR FAMILIES EVERYWHERE. LET US COMMIT OURSELVES TO SUSTAINING THE NICHD AS OUR BEST HOPE FOR EVEN GREATER DISCOVERIES AND ADVANCES IN THE NEXT 50 YEARS. HAPPY BIRTHDAY, NICHD. [APPLAUSE] >> THANK YOU VERY MUCH, DUANE, FOR TRYING TO ENCAPSULATE SOMETHING OF WHAT WE'VE BEEN ABLE TO ACCOMPLISH OVER THESE 50 YEARS. OUR NEXT SPEAKER, TIMOTHY SHRIVER, REALLY WOULD DESERVE TO BE PART OF THIS CELEBRATION OF OUR 50TH BIRTHDAY SIMPLY AS PART OF HIS BIRTHRITE, FOR HE TRULY IS OUR BROTHER, HE'S ANOTHER CHILD OF EUNICE SHRIVER. BUT TIM IS REALLY HERE ON HIS OWN RIGHT. IT'S BECAUSE OF HIS LASER-LIKE ENERGETIC CREATIVE CARBONATE DEVOTION TO IMPROVING THE LIVES OF THOSE THAT TIM WOULD SAY WERE DISABILITIES THAT HE REALLY COMES TO SPEAK WITH US TODAY. HE'S DEVOTED HIS LIFE TO MAKING WHAT IS TRULY A HUGE DIFFERENCE IN THE LIVES OF THOSE WITH VARIOUS KINDS OF DISABILITIES AND ALSO IN THE WAY SOCIETY VIEWS AND DEALS WITH THOSE INDIVIDUALS. THE VERY CORE VALUE, THE VERY CORE CAUSE ABOUT WHICH THIS INSTITUTE WAS FOUNDED. SO THE BIRTHRITE, HIS OBSERVE RITE IS PART OF OUR CONSCIENCE IN SOME WAYS, WE WELCOME VERY MUCH TIM SHRIVER. [APPLAUSE] >> THANK YOU VERY MUCH. THANK YOU. THANK YOU, DR. GUTTMACHER, DUANE ALEXANDER, DR. COLLINS, OTHERS. YOU KNOW, NONE OF THOSE PEOPLE NEED INTRODUCTIONS. I NEED AN INTRODUCTION. I NEED A MUCH LONGER OVERVIEW OF MY ACCOMPLISHMENTS IN ORDER TO COUNT HERE. I HAVE -- PEOPLE USED TO CALL ME DR. SHRIVER, BUT AS A DISAT THAT PARTICULADISTANTRELATIVE IN IRELAND SAID A H, YOU'RE A DOCTOR BUT NOT THE KIND THAT CAN DO MUCH GOOD. SO IN THIS ROOM, I'M A DOCTOR BUT NOT THE KIND THAT BELONGS AMONGST YOU. BUT I AM REALLY DELIGHTED TO TAKE JUST A FEW SHORT MINUTES TO CONVEY THE GREETINGS OF TO THE PEOPLE SORT OF OUTSIDE HERE, THE PEOPLE WITH INTELLECTUAL DISABILITIES WHO IN SOME WAYS TOUCH OR CONNECT WITH THE WORK I DO, BUT ALSO AS ALAN SAYS TO TRY TO RECALL EVEN BRIEFLY SOME OF WHAT MADE NICHD WHAT IT WAS AND HOW THAT CROSSED PATHS WITH MY OWN CONCEPTION IN 1959 AND MY OWN CHILDHOOD LESS THAN TWO MILES FROM THIS BUILDING. THE SETTING IN WHICH MY MOTHER AN OTHERS LIKE HER LEARNED THE IMPORTANCE OF BASIC RESEARCH OF TRANSLATIONAL RESEARCH WAS NOT WHERE MOST OF YOU LEARNED. THIS IS THE BACKYARD OF THE HOME IN WHICH I GREW UP OFF OF ROCKVILLE PIKE WHERE WHITE FLINT MALL CURRENTLY SITS ON THE RIGHT SIDE OF THE STREET WAS TO THE LEFT A DIRT ROAD CALLED EDISON LANE AND ABOUT A QUARTER OF A MILE AT THE END OF EDISON LANE STOOD A HOME CALLED TIMBERLAWN, WHICH WAS OWNED BY A MARYLAND FAMILY THAT FARMED IN THAT AREA, THEY HAD ABOUT 300 ACRES OF FARMLAND, SOME OF WHICH WE HAD FENCED OFF, YOU CAN SEE IN THE DISTANCE THERE A WHITE FENCE, ON THE OTHER SIDE WERE CATTLE FIELDS, BUT THIS IS THE SCENE IN 1962. WHERE MY MOTHER LAUNCHED CAMP SHRIVER, AS IT WAS CALLED. IT WAS A SUMMER CAMP THAT SHE CREATED OUT OF IN PART A SENSE OF FURY AND RAGE AND IN PART A SENSE OF COMMITMENT AND HOPE. AND I THINK THE BASIC LESSON IF YOU LOOK AT THIS SCENE, I MEAN, I'M ONLY 3 AT THE TIME SO I CAN'T SAY I RECALL THIS EXACT PHOTOGRAPH, BUT GROWING UP, I REMEMBER THESE SUMMER SCENES VIVIDLY. I REMEMBER THEM MOSTLY BECAUSE AS A CHILD, I FELT LIKE MY HOUSE, MY HOME WAS TURNED INTO A TERRIFIC AMUSEMENT PARK. THERE WERE GAMES ORGANIZED ALL DAY LONG, KICK BALL AND SWIMMING AND VOLLEYBALL, THE TREE LINE WAS TURNED INTO AN OBVIOU OBSTACLE COURSE, THERE WERE ROPES HANGING, THERE WERE KIDS EVERYWHERE, THERE WAS AN ART CENTER, I MADE A TABLE IN THE ART CENTER WHEN I WAS ABOUT 6. I CUT THE WOOD AND PASTED IT TOGETHER AND I PUT LITTLE TILES ON THE TOP AND I GAVE IT TO MY FATHER FOR FATHER'S DAY. MY HOUSE WAS A RECREATION CENTER AND THE CAMPERS WERE PEERS. AND IN THAT SIMPLE EXPERIENCE, I THINK MY MOTHER'S, IF YOU WILL, GENIUS FOR RECOGNIZING VALUE AND CONFIDENCE AND CAPABILITY IN CHILDREN WHO PARTICULARLY IN THOSE DAYS THE WORLD SAW AS REALLY HOPELESS CAME OUT. IT WAS NOT A LABORATORY OF THE KIND THAT LED TO THE INNOVATIONS THAT DUANE JUST CHRONICLED, THOSE EXTRAORDINARY CHANGES, BUT IT WAS A LABORATORY OF HUMAN CONSCIOUSNESS, OF HUMAN ATTITUDE, OF SOCIAL AND CULTURAL CHANGE IN WHICH THE DISCOVERY WAS WE ALL ARE CAPABLE, GIFTED AND COMPETENT TO CONTRIBUTE. AS SIMPLE AND PROFOUND AS THIS INSIGHT IS, I THINK IT WAS QUITE TRANSFORMATIVE FOR HER, AND FOR THOSE OF YOU WHO MET MY MOTHER, DR. COOKE, OF COURSE AND SOME OF YOU, OF COURSE DUANE WAS ON THE OTHER END OF MANY PHONE CALLS, YOU KNOW THIS WAS A FIERCE WOMAN BUT NOT A PERSON WHO WAS A BACK VENTURE. AT THIS SUMMER CAMP, SHE WAS IN THE POOL. SHE WAS NOT ON THE HILL. SHE WAS NOT DOWN AT THE OFFICE. THESE CHILDREN HERE COMING FROM AN INSTITUTION, AN AFRICAN-AMERICAN CHILD WITH AN INTELLECTUAL DISABILITY, GETTING INTO A WOMAN'S SUBURBAN HOUSEHOLD SWIMMING POOL IN 1962 IN THE BACKYARD, I MEAN, YOU DON'T -- YOU HAVE TO STOP FOR A SECOND AND RECOGNIZE THAT YOUR YOUR ROOTS ARE REBEL JUST. REBELLIOUS, THAT THERE'S A DISCONTENT -- [APPLAUSE] I DON'T WANT TO TAKE TOO MUCH TIME BECAUSE I KNOW DR. ROW BOWS DR. HRABOWSKI IS NEXT AND ALSO A PERSON ON MANY OF THE OTHER END OF MY MOTHER'S PHONE CALLS, TERRIFIC SUPPORTER OF HER VISION AND MY DAD'S VISION AROUND SERVICE, BUT THIS LINKAGE BETWEEN WHAT THE WORLD SEES AND WHAT YOU ALL ARE ABLE TO CONTRIBUTE GOES BACK SO FAR, YOU'VE HEARD SOME OF THIS ALREADY SO I'LL GO THROUGH IT QUITE QUICKLY. ELIZABETH BOGGS IN SOME WAYS DESERVES EQUAL CREDIT FOR FOUNDING -- BUT YOU HEARD DR. COOKE MENTION THIS SAME KIND OF ATTITUDE, IN THE MID 50s, PEOPLE DOUBTED THAT MONEY COULD BE WELL SPENT ON A SUBJECT SUCH AS INTELLECTUAL DISABILITY AND MENTAL RETARDATION. DR. COOKE CHRONICLED THIS STORY, A MENTOR OF MINE FOR MANY, MANY YEARS, ALWAYS WAS REMINDED THAT HE WAS TOLD HE WOULD BE AN UNFIT PARENT TO ADOPT, UNFIT. BECAUSE HE HAD A CHILD WITH INTELLECTUAL DISABILITY HE HAD IN HIS HOME. SO THESE GROUNDINGS FORMED THE FOUNDATION. THIS IS THE BILL SIGNING CEREMONY, BUT THIS PHOTOGRAPH REFERS -- IS THE PKU STORY, AND ONE OF THE THINGS MY MOTHER THOUGHT VERY IMPORTANT AND I WANT TO OFFER YOU TO THINK ABOUT IS THE IMPORTANCE OF TELLING THE STORY. THE IMPORTANCE OF GETTING THE STORY OUT. THIS IS A PHOTOGRAPH TAKEN OF TWO CHILDREN IN THE SAME FAMILY, ONE OF WHOM HAD A PKU SCREEN AND THE OTHER WHOM HAD NOT. I THINK ONE WAS BORN IN 1958, THE OTHER IN 1963 OR FOUR. ONE HAD THE INTERVENTION, THE OTHER DID NOT. ONE HAD AN INTELLECTUAL DISABILITY, THE OTHER DID NOT. SHE BROUGHT THE CHILDREN TO THE WHITE HOUSE. INTRODUCED THEM TO THE PRESIDENT OF THE UNITED STATES, HAD THE PHOTOGRAPHERS THERE, HAD THE STORY TRIED TO BE PLACED IN THE "WASHINGTON POST," WANTED PEOPLE TO NOT JUST THINK THAT THE NICHD OR THE RESEARCH THAT WAS BEING DONE IN PLACES LIKE THIS WITH SOME ARCANE VERY OBSCURE, VERY REFINED, VERY KIND OF PRECISE SCIENTIFIC WORK, BUT NOT JUST ITS TRANSLATIONAL IMPACT BUT ITS HUMAN IMPACT, COULD BE TOLD IN STORIES THAT THE WORLD NEEDED TO SEE AND UNDERSTAND MUCH AS DUANE DESCRIBED SENATOR KENNEDY COMING HERE AND SEEING, THIS IS A CHALLENGE THAT I THINK REMAINS, AND I JUST WANT TO SAY VERY BRIEFLY, BECAUSE MAYBE THIS IS THE ONE THING I CAN CONTRIBUTE IN THIS CONVERSATION THAT OTHERS CAN'T, I DON'T BELIEVE ANY OF US, INCLUDING THOSE IN MY OWN FAMILY, HAVE COME TO FULL UNDERSTANDING OF THE IMPACT THAT INTELLECTUAL DISABILITY HAD ON THE LIFE OF THE PRESIDENT. DUANE AND I HAD THIS CONVERSATION MANY TIMES, WHEN YOU LOOK AT THE PICTURE OF PRESIDENT KENNEDY THAT HANGS HERE OR OF MY MOTHER, I THINK IT'S IMPORTANT TO REMEMBER THAT BOTH OF THEM WERE SIBLINGS OF A PERSON WITH AN INTELLECTUAL DISABILITY. BOTH OF THEM TRAVELED THE DEVELOPMENTAL PERIOD WITH A SIBLING WHO WAS THOUGHT TO BE INVALID. BOTH OF THEM WATCHED THEIR MOTHER IN CHILDHOOD PUT THE PHONE DOWN SAYING THERE'S NOTHING FOR ROSEMARY. BOTH OF THEM WERE IN THE HOUSE WHEN SHE GOT THE REPORT FROM THE PEDIATRICIANS AND THE EDUCATORS SAYING ROSEMARY IS MENTALLY RETARDED. BOTH OF THEM WERE THERE THE NIGHT MY GRANDMOTHER WROTE IN HER DIARY THAT SHE WAS HEART BROKEN. BOTH OF THEM GREW HAVING TO MAKE SENSE OF THE COMPASSION AND THE SHAME, HAVING TO MAKE SENSE OF THE GUILT AND THE LOVE, THAT TOXIC AND POWERFUL COMBINATION OF CONNECTION TO A PERSON WITH AN INTELLECTUAL DISABILITY WHO ULTIMATELY WAS MOST IMPORTANTLY THEIR SISTER. AND I ASKED MY MOTHER WITH B. THIS SOME YEAR YEARS, ABOUT FOUR OR FIVE YEARS AGO, MY UNCLE TED WAS OVER FOR DINNER ONE SUNDAY NIGHT, I'D BEEN THINKING ABOUT THIS AND I CONTINUE TO THINK ABOUT IT BECAUSE I DON'T FEEL LIKE I UNDERSTAND MY OWN FAMILY, FRANKLY, WELL ENOUGH AND HAVEN'T FULLY INCORPORATED THE IMPACT THAT ROSEMARY HAD. I SAID TO MY UNCLE, I SAID, YOU KNOW, EVERYBODY TALKS ABOUT YOU AND YOUR BROTHERS, HIS GREAT POLITICAL LEGACY -- I'M OUT OF TIME. HIS GREAT POLITICAL LEGACY, AND I SAID, YOU KNOW, THEY REMEMBER, ASK NOT WHAT YOU CAN DO FOR YOUR COUNTRY, THEY THINK OF PRESIDENT KENNEDY AS THIS PIONEERING VISIONARY PERSON WHO BROUGHT TO POLITICS SOME NEW KIND OF ENERGY THEY ATTRIBUTED TO YOUTH OR CHARISMA OR PASSION OR FAITH OR WISDOM OR HISTORICAL STUDY. I SAID HAVE YOU EVER THOUGHT ABOUT WHAT IMPACT ROSEMARY MIGHT HAVE PLAYED? AND MY UNCLE TED LOOKED AT ME SORT OF WITH ONE OF THOSE PAUSES THAT HE SOMETIMES HAS WHERE IT WAS LIKE, I CAN'T TELL WHETHER I'VE ASKED THE STUPIDEST QUESTION THAT HE CAN'T BELIEVE OR WHETHER HE'S THINKING OR WHAT, SORT OF ONE OF THOSE SORT OF HALF GRIN BUT NOT FULL GRIN LOOKS. AND HE PAUSED AND HE SAID, WELL, HE SAID, I REMEMBER ONE TIME WHEN WE WERE YOUNGER DOWN IN PALM BEACH, AND HE SAID WE WERE OUT AT A PARTY IN THE AFTERNOON, AND ALL OF US HAD GONE TO THE PARTY TOGETHER AND HE LOOKED OVER AT MY MOTHER AND HE SAID EUNIE, I DON'T THINK YOU WERE THERE AT THE PARTY, HA-HA, AND SHE'S LIKE, RRRR. HE SAYS WE'RE SOCIALIZING WITH ALL THESE OTHER -- AT THE PARTY AND JACK WAS THERE AND I WAS THERE AND OTHERS WERE THERE AND ROSEMARY, AND I LOOKED OVER AT ONE TIME AND JACK GOT UP AND I LOOKED OVER TO THE OTHER END OF THE POOL AND ROSEMARY WAS SITTING BY HERSELF WITH HER FEET IN THE POOL, ALL ALONE. AND HE SAYS, I WATCHED JACK GET UP AND WALK ACROSS AND LEAVE ALL THE OTHER PEOPLE AND SIT DOWN WITH ROSEMARY. AND HE SAYS, I'LL NEVER FORGET THAT. AND THEN HE SAYS, NOW WHAT'S FOR DINNER? MOVES ON, WHERE'S DESSERT, YOU KNOW? I SHARE THAT STORY BECAUSE I THINK THERE IS SOMETHING STILL TO BE REMEMBERED ABOUT THAT IMAGE, AT LEAST FOR ME, OF A PERSON WITH AN INTELLECTUAL DISABILITY ALONE. DESPITE ALL THE ADVANCES WE HAVE A LOT OF WORK TO DO. THIS POSTER, THAT POSTER WAS TAKEN DOWN OUT OF A FACULTY LOUNGE AT THE NATIONAL CHILDREN'S MEDICAL CENTER TWO MONTHS AGO. I THINK WE OUGHT TO REMEMBER THAT MEDICINE, AS BRILLIANT AS IT IS, HAD SOMETIMES BEEN THE PROBLEM, AND THAT THOSE DISEASES WHICH CANNOT BE CURED OR WHICH ARE DIFFICULT TO CURE, SOMETIMES LEAD US IN MEDICINE AND IN RESEARCH TO GIVE UP, TO CONSIGN THOSE WHO HAVE LIFELONG CHALLENGES TO A CATEGORY BEYOND INTEREST OR MAYBE EVEN BEYOND HOPE. THAT TOO OFTEN, THIS PICTURE ON THE LEFT WHICH IS A CURRENT PICTURE OF A 42-YEAR-OLD WITH AN INTELLECTUAL DISABILITY LIVING IN THE UNITED STATES, IS THE QUALITY OF THE CARE PEOPLE ARE RECEIVING. NOT THE PICTURE ON THE RIGHT, WHICH HAPPENED AFTER HE RECEIVED CARE FROM A DENTIST WHO HAD BEEN TRAINED IN DEVELOPMENTAL MEDICINE. SO I ASK YOU TO THINK ABOUT THESE QUESTIONS AS YOU GO THROUGH TODAY AND CERTAINLY AS YOU GO THROUGH YOUR CAREERS. WILL WE BE CONTENT IF IN 50 YEARS, WE KNOW AS LITTLE AS WE KNOW TODAY ABOUT LIFE SATISFACTION, ABOUT HAPPINESS, ABOUT PURPOSE, ABOUT FULFILLMENT, ABOUT COMMUNITY ENGAGEMENT, AS WE KNOW TODAY ABOUT CHILDREN WITH INTELLECTUAL DISABILITIES. NOT ABOUT CURING THEM BUT ABOUT HOW THEY LIVE THEIR LIVES. WE KNOW ALMOST NOTHING ABOUT THE JOYS AND HAPPINESS AND THE WAYS IN WHICH THEY FIND SATISFACTION IN LIFE, WILL WE BE CONTENT WHEN INTELLECTUAL DISABILITY -- IF INTELLECTUAL DISABILITY IS STILL AN EXCLUSIONARY CRITERIA IN MANY RESEARCH PROTOCOLS THAT ARE BEING DONE IN BASIC AND APPLIED RESEARCH IN PLACES LIKE THIS AND IN OTHER PLACES AROUND THE WORLD. WILL WE BE CONTENT WITH THE LEVELS OF PREVENTABLE DISABILITY, PREVENTABLE DISEASE, THAT EXISTS IN THIS POPULATION THAT DON'T NECESSARILY DEPEND ON BASIC RESEARCH BUT DEPEND ON TRANSLATIONAL RESEARCH, THE TRAINING OF MEDICAL PROFESSIONALS, THE APPLICATION OF THAT TRAINING IN PUBLIC HEALTH SETTINGS AND IN CLINICAL SETTINGS AROUND THE WORLD, WILL WE BE CONTENT IF ALL OF THE PEOPLE WE SEEK TODAY IN PLACES LIKE SPECIAL OLYMPICS WHO COME IN FOR RANDOM SCREENING, 10, 15 AND SOMETIMES 20% ARE REFERRED TO EMERGENCY ROOMS BECAUSE OF UNDIAGNOSED CARE, UNDIAGNOSED DISEASES AND ACUTE PAIN. WILL WE BE CONTENT IF THERE ARE 100 CLINICAL TRIALS ON CLINICALTRIAL.GOV TODAY FOR ALZHEIMER'S DISEASE AND NONE OF THEM INCLUDE PROTOCOLS SURROUNDING DOWN'S SYNDROME, AND RELATIONSHIP OF DOWN'S SYNDROME TO DEMENTIA. AND THE LIST COULD GO ON. THE POINT BEING VERY SIMPLY THAT AS ALAN KNOWS AND DUANE KNOWS, I HAVE FOUNDED AT SOME LEVEL OR ANOTHER MY RESPONSIBILITY OR MY CHALLENGE OR MY JOY TO ALWAYS ASK THAT THIS CENTER NOT FORGET PEOPLE WITH INTELLECTUAL DISABILITIES AND THEIR LIVES, THAT THERE IS SUCH A HUGE MISSION HERE AS WE ALL KNOW FROM -- AS DUANE TALKED ABOUT IT FROM CONCEPTION ALL THE WAY THROUGH THE LIFE CYCLE, THAT THIS INSTITUTE HAS TO ADDRESS, BUT THOSE WITH INTELLECTUAL DISABILITIES ARE AT THE HEART OF WHY YOU'RE HERE, I PROMISE YOU THAT. DR. COOKE, ELIZABETH BOGGS, EUNICE SHRIVER, PRESIDENT KENNEDY, AND ON MANY, MANY OF THEIR BRILLIANT SUCCESSORS IN POLITICAL LIFE AND IN RESEARCH, MANY OF THEM CAME TO THIS WORK BECAUSE THEY HAD A PASSION FOR HELPING TO IMPROVE THE LIVES OF PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. AND I HOPE THAT AS YOU GO FORWARD YOU'LL SEE AS MANY PICTURES LIKE THIS, THIS IS JUST A SHOT OF A SPECIAL OLYMPICS ATHLETE. SEVENTH PLACE. TRIUMPHANT IN FRONT OF HER PARENTS. A REMINDER, I HOPE, THAT THOSE CHILDREN THAT DO HAVE DISABILITIES ARE NOT JUST A DISEASE BUT ALSO HAVE THE POWER TO HEAL, AND THAT THEY'LL BE PART OF THE MISSION OF THIS PLACE ALWAYS TO LEARN THAT THE HUMAN SPIRIT AND WHEN WE SHARE IT AND UNLEASH IT IN LOVE AND IN COMMUNITY AND IN AFFECTION, IT UNLEASHES THE BEST IN ALL OF US. THANK YOU FOR ALL THAT YOU DO AND FOR WELCOMING ME HERE TODAY. THANK YOU. [APPLAUSE] >> THANK YOU SO MUCH, TIM, FOR REMINDING US OF THE RESEARCH STILL TO BE DONE AND MORE IMPORTANTLY THAN THAT, REMINDING US THAT THE CORE VALUES THAT HAVE ALWAYS BEEN IN NICHD THAT ARE PART OF OUR BIRTHRITE THAT CONTINUE TO SHAPE THE WAY WE APPROACH OUR MISSION, THE KINDS OF QUESTIONS I HOPE WE ALWAYS KEEP IN FRONT OF US, BECAUSE PART OF THE HALLMARK OF NICHD IS THAT WE'VE NEVER BEEN ABOUT SIMPLY ADVANCING SCIENCE. WE'VE ALWAYS BEEN AWARE OF THE VITAL IMPORTANCE OF THE IMPACT OF OUR SCIENCE ON SOCIETY BE,, AND WHO BETTER TO SPEAK ABOUT THE ROLE OF SCIENCE AND SCIENTISTS IN SOCIETY THAN OUR NEXT SPEAKER, FREEMAN HRABOWSKI III, THE LONG TIME PRESIDENT OF THE EURT OF MARYLAND BALTIMORE COUNTY UMBC, AND WHO FREEMAN REALLY IS THE EMBODIMENT OF THE SCIENTIST WHO IS COMMITTED TO USING EVERY OUNCE OF HIS CONSIDERABLE INTELLECT, CREATIVITY, ENERGY AND PASSION TO IMPROVE SOCIETY. SO FREEMAN, IT'S OUR GREAT PLEASURE TO WELCOME YOU HERE. [APPLAUSE] >> THANK YOU VERY MUCH. I WILL SURPRISE YOU BY BEGINNING WITH POETRY. WILLIAM COLLINS WILLIAMS ONCE SAID IT'S DIFFICULT TO FIND NEWS IN POETRY AND YET MEN DIE MISERABLY EVERY DAY BECAUSE OF A LACK OF WHAT'S FOUND THERE. 20 YEARS AGO, SLIGHTLY OVER 20 YEARS AGO AT THE INSTALLATION OF ONE OF OUR PRESIDENTS, MY A ANGLO BEGAN WITH THESE WORDS, LIFT UP YOUR EYES UPON THIS DAY, BREAKING FOR YOU, GIVE BIRTH AGAIN TO THE DREAM. WOMEN, CHILDREN, MEN, TAKE IT, THIS DREAM, INTO THE PALMS OF YOUR HANDS. MOLD IT INTO THE IMAGE OF YOUR MOST PUBLIC SELF. SCUPT IT INTO THE SHAPE OF YOUR MOST PRIVATE NEED, HERE ON THE PULSE OF THIS NEW DAY, YOU MAY HAVE THE GRACE TO LOOK UP AND OUT AND INTO YOUR SISTER'S EYES AND INTO YOUR BROTHER'S FACE AND SAY SIMPLY, VERY SIMPLY WITH HOPE, GOOD MORNING. GOOD MORNING TO ALL OF YOU. GOOD MORNING! I AM DELIGHTED TO BE HERE. IT IS A DAY OF CELEBRATION, IT IS A DAY FOR THE 50TH. I AM INSPIRED AS I LISTENED TO TI KNEE TALK, THTIMMY TALK, ON GIVING COLL EGE STUDENTS A CHANCE AS THEY PREPARE TO BECOME PHYSICIANS AND SCIENTISTS TO UNDERSTAND ISSUES OF POVERTY, BUT THE 50TH AN VERSE REAL IS SPECIAL TO ME IN A SPECIAL WAY. I WAS FORTUNATE TO BE A PART OF A CHILDREN'S MARCH IN BIRMINGHAM, PRECISELY 50 YEARS AGO. THIS WAS THE YEAR OF THAT ACADEMIC EXPERIENCE WHEN WE LEARNED ABOUT THE POWER OF PEOPLE COMING TOGETHER WHEN IN WERE PROBLEMS AT A TIME WHEN ALL OF MY BOOKS WERE HAND ME DOWN BOOKS FROM WHITE CHILDREN, AT A TIME WHERE I COULD ONLY GO INTO THE BASEMENT OF A HOSPITAL FOR ANY HELP, AT A TIME WHEN I DIDN'T FEEL THAT THIS COUNTRY CONSIDERED ME POSSIBLY ABLE TO DO ANYTHING. AND SO WHEN I THINK ABOUT THIS INSTITUTE, AND WHAT IT'S BEEN ABLE TO ACCOMPLISH, WHEN I THINK ABOUT THAT CHILDREN'S MARCH 50 YEARS AGO AS A 12-YEAR-OLD WHEN I THINK ABOUT SPENDING TIME IN JAIL AND LISTENING TO DR. KING SAY THAT THE THINGS WE WERE DOING DURING THAT PERIOD IN THE 60s WOULD HAVE AN IMPACT ON CHILDREN YET UNBORN, I FIND MYSELF THINKING WE'VE BEGUN TO FULFILL THOSE DREAMS. I WANT YOU TO THINK ABOUT THE FACT THAT TODAY YOU'LL BE HEARING STORIES FROM SPEAKERS ABOUT THE RESEARCH FROM NICHD, THE RESEARCH THAT HAS INCREASED OUR UNDERSTANDING OF BASIC BIOLOGY, OF HUMAN HEALTH AND HAS AFFECTED HEALTHCARE PRACTICE AND OUTCOME. YOU'LL HEAR ABOUT PROMISING DIRECTIONS OF FUTURE RESEARCH, WAYS IN WHICH WE WILL BE IMPROVING HEALTH AND THE WELL-BEING OF CHILDREN AND FAMILIES, BUT YOU ARE IN MANY WAYS THE CONGREGATION, YOU KNOW MUCH OF THIS, YOU'LL GET MORE SPECIFICITY. THE QUESTION I HAVE BEEN ASKED IS WHAT IS THE ROLE OF THE SCIENTIST? WHAT IS THE ROLE AS WE THINK ABOUT NIH, AND I ENJOY TALKING ABOUT THIS BECAUSE I HAVE THE PRIVILEGE OF GOING AROUND THE COUNTRY TALKING AT UNIVERSITIES, IN SCHOOL SYSTEMS, BUT WITH COMMUNITIES, ELECTED OFFICIALS, ABOUT STEMS. I HAVE -- PEOPLE ALWAYS LAUGH WHEN I SAY EVEN AS A CHILD, I GOT GOOSE BUMPS DOING MATHEMATICS. I'M A MATHEMATICIAN. WHEN I ASK AMERICAN AUDIENCES HOW MANY LOVE TO READ, MOST PEOPLE RAISE THEIR HANDS. WHEN I ASK THEM HOW MANY LOVE MATH AND SCIENCE, PEOPLE LAUGH. THEY LITERALLY LAUGH. HOW MANY OF YOU LIKE MATH AND SCIENCE? WATCH THIS. THIS IS A CONGREGATION. THIS GIVES ME GOOSE BUMPS JUST TO SEE YOU HERE. I LOVE THIS. I LOVE THIS. THE CHALLENGE WE FACE IN AMERICA IS THAT IN MOST EDUCATED GROUPS, IF YOU'RE NOT TALKING TO SCIENTISTS AND IF YOU ASK THEM ABOUT THEIR APPRECIATION OF SCIENCE, WHETHER THEY ENJOY IT, LOVE IT, APPRECIATE EXACTLY WHAT IT DOES, MOST PEOPLE ARE AMBIVALENT. AND WE NEED TO THINK ABOUT WHAT THAT MEANS. SO LET ME GIVE YOU SOME OF THE LANGUAGE THAT I USE WHEN I'M TALKING ABOUT THE IMPORTANCE OF SCIENCE AROUND THE COUNTRY. I START WITH THIS IDEA THAT SCIENTISTS ARE PEOPLE WHO ASK GOOD QUESTIONS. MANY OF YOU HEARD OF THE NOBEL LAUREATE ROBBIE, RECEIVED A NOBEL PRIZE IN 1944. HE SAID WHEN HE WAS GROWING UP THERE IN THAT CITY, HIS FRIENDS' MOTHERS WOULD ASK THEM AT THE END OF A SCHOOL DAY, WHAT DID YOU LEARN IN SCHOOL? HE SAID, NOT ME. NOT MY MOTHER. MY JEWISH MOTHER WOULD SAY, IZZIE, DID YOU ASK A GOOD QUESTION TODAY? AND THE PRACTICE OF ENCOURAGING HIS CURIOSITY MADE HIM THE SCIENTIST HE BECAME. WHAT I'M ALWAYS SAYING ON HIS CAMPUS, WE ARE SAYING AROUND THE COUNTRY, IN SCIENCE, THAT WE NEED TO TEACH CHILDREN TO ENJOY ASKING GOOD QUESTIONS. YOU NOTICE HOW WHEN KIDS ARE IN KINDERGARTEN OR IN THE THIRD GRADE AND YOU ASK THEM, YOU SAY SOMETHING, ME, ME, ME, THEY HAVE A MILLION QUESTIONS FOR YOU, THE QUESTIONS SEEM TO STOP, BY THE TIME YOU GET TO HIGH SCHOOL, EVERYBODY'S SITTING BACK, LOOKING A LITTLE LAID BACK. IF YOU WATCH THE TEACHERS, YOU'LL SEE THEY'RE THE SAME WAY TOO. I'M NOT SO SURE IN IT'S CHILDREN INFLUENCING TEACHERS OR VICE VERSA, BUT ASKING THE QUESTIONS IS AN IMPORTANT PART OF SCIENCE. AND THEN WORKING TO IDENTIFY WHAT REMAINS UNKNOWN. NOT ASSUMING THAT WE KNOW EVERYTHING. ONE OF THE MENTORS FOR BOTH ALAN AND ME WAS WALTER SUNHIGH. HE WAS CHAIR OF THE SCHOOL BOARD IN 1952 IN BALTIMORE AND WAS COURAGEOUS ENOUGH TO TAKE THE FIRST BLACK CHILDREN INTO THE SCHOOL. WELL, HE SAID TO ME SOMETHING ONCE THAT I'VE NEVER FORGOTTEN. HE SAID, FREEMAN, LEARN TO LIVE LIFE SERIOUSLY BUT DON'T TAKE IT SERIOUSLY. IN OTHER WORDS, DON'T TAKE YOURSELF SO SERIOUSLY, DON'T ASSUME YOU KNOW MORE THAN YOU DO. YOU KNOW, ON MY CAMPUS, THERE'S A FIGURE THAT WE USE AS A MUSE WHOSE NAME IS SAMUEL BECKETT, THE IRISH NOVELIST, WHO OFTEN WROTE IN FRENCH. PEOPLE GET REALLY INTO IT. WELL, IN ONE OF THE PRODUCTIONS, MALLOY IS THE CHARACTER, HE'S STUDYING THE DANCING OF BEES, AND THE BEES ARE COMMUNICATING WHEN THEY'RE DANCING, AND THE CHARACTER SAYS THIS. HERE IS SOMETHING I COULD STUDY ALL MY LIFE AND NEVER UNDERSTAND. THIS DANCING OF BEES. BECAUSE THE MORE HE UNDERSTANDS, BEGINS TO UNDERSTAND HOW BEES COMMUNICATE, THE MORE HE REALIZES THERE IS SO MUCH MORE TO KNOW. THE ESSENCE OF SCIENCE, WE TALK ABOUT LEARNING, IT'S THIS PASSION FOR CONSTANTLY KNOWING WE'VE JUST BEGUN. THERE IS SO MUCH MORE TO KNOW. SO WE KEEP ASKING THE QUESTIONS, AND WHAT WE'RE WORKING TO DO IS TO EXPAND OUR FUNDAMENTAL KNOWLEDGE OF THE WORLD. IT'S INTERESTING THAT MANY PEOPLE DON'T REALIZE HOW IMPORTANT SCIENCE IS TO GENERATING AND ANALYZING AND SHARING DATA THAT WILL INFORM DISCUSSIONS ABOUT ALL THE BIG ISSUES OF THE DAY. WHATEVER THOSE ISSUES ARE, WHETHER IT'S ABOUT HEALTHCARE OR ABOUT THE ECONOMY. IT'S ABOUT BEING ABLE TO TACKLE THE DIFFICULT PROBLEMS AND IN HEALTHCARE, IF YOU THINK ABOUT WHAT WE DO WITH -- WHETHER IT'S ABOUT DISEASE, DISABILITY, DISORDERS OF HUMAN DEVELOPMENT, THE IDEA IS THAT WE CAN MAKE PROGRESS IF WE KEEP ASKING THESE QUESTIONS, IF WE FOCUS OUR ATTENTION ON THESE EFFORTS. AND MOST IMPORTANT SH IT IS ABOUT MAKING THINGS BETTER FOR PEOPLE. AS SIMPLY SAID AS THAT IS. THAT WE ARE LIVING LONGER, WE ARE HEALTHIER, WE KNOW MORE ABOUT WHAT WE CAN DO TO HELP PEOPLE TO LIVE THEIR LIVES IN THE WAY THAT DREAMS CAN BE FULFILLED. YOU KNOW, I KNOW THAT ALAN AND YVONNE INVITED ME TODAY BECAUSE I'M PASSIONATE TO FINDING MORE SCIENTISTS. IF WE WANT AMERICANS TO APPRECIATE THE VALUE OF SCIENCE, WE MUST BE ABLE TO USE LANGUAGE THAT THEY UNDERSTAND, WE MUST BE ABLE TO TELL THE STORIES IN WAYS THAT WILL CONNECT TO THE HUMAN SPIRIT, BUT WE MUST ALSO SHOW THEM THAT SCIENCE IS BECOMING INCREASINGLY INCLUSIVE, THAT THERE ARE MORE WOMEN AND PEOPLE OF COLOR, PEOPLE FROM ALL KINDS OF BACKGROUNDS, THAT IT'S POSSIBLE TO BECOME A SCIENTIST. THEY SHOULDN'T HAVE TO THINK THAT SCIENTISTS LOOK ONE WAY, THEY SHOULDN'T HAVE TO THINK THAT THEY COME FROM ONE BACKGROUND, AND I'VE SPENT MY LIFE THE PAST 40 YEARS TRYING TO FIGURE OUT HOW DO WE HELP MORE KIDS OF COLOR, MORE WOMEN, TO BE EXCITED ABOUT MATH AND SCIENCE BUT ALSO TO EXCEL IN THOSE DISCIPLINES, AND THERE HAVE BEEN A NUMBER OF LESSONS THAT WE'VE LEARNED. WHAT I WILL TELL YOU, IT TAKES COMMITMENT, FOR MY CAMPUS, FOCUSING HEAVILY ON PRODUCING SCIENTISTS OF ALL RACES, WE HAVE STUDENTS FROM 151 TRIES. ONE OF THE THINGS ABOUT NIH AND MY CAMPUS, WE HAVE PEOPLE FROM ALL OVER THE WORLD. THERE'S SOMETHING WONDERFUL ABOUT THAT. LARGE NUMBERS OF STUDENTS WHO COME DIRECTLY FROM OTHER COUNTRIES SH LARGE NUMBERS WHO ARE THE SONS AND DAUGHTERS OF PEOPLE WHO MIGRATED HERE AND HAVE A HUNGER FOR THE NONL. WE SEE IT. I HAD A FOCUS GROUP OF STUDENTS AND IT WAS VERY CLEAR THE KIDS WHO COME FROM OTHER COUNTRIES ACTUALLY STUDY MORE, ARE MORE FOCUSED THAN OUR KIDS, EVEN OUR BETTER PREPARED STUDENTS, AND I ASKED THE KIDS, THE STUDENTS THIS QUESTION, WHAT'S THE DIFFERENCE? A YOUNG WOMAN FROM JAMAICA SAID, YOU KNOW, MY AMERICAN FRIENDS TEND TO THINK OF THE FIRST YEAR OF COLLEGE IS GRADE 13. IT'S JUST WHAT YOU DO WHEN YOU FINISH HIGH SCHOOL. SO SHE SAID FOR THEM, IT'S JUST KIND OF THE ICING ON THE CAKE. SHE SAID BUT FOR ME, IF I DON'T EXCEL, MY YOUNGER BROTHERS AND SISTERS MAY NOT EAT. SO IT'S NOT THE ICING ON THE CAKE, IT'S THE VERY BREAD OF LIFE. AND I GOT GOOSE BUMPS AS I WATCHED MY STUDENTS BORN IN THIS COUNTRY LOOKING AT THIS YOUNG WOMAN OF COLOR AS SHE TALKED WITH SUCH PASSION ABOUT HER EXCITEMENT ABOUT LEARNING AND LEARNING SCIENCE BECAUSE OF WHAT IT WOULD DO SO THAT SHE COULD MAKE A DIFFERENCE IN THE LIVES OF OTHER PEOPLE. THE CHALLENGE THAT WE FACE IS TO THINK CRITICALLY ABOUT WHAT IT'S GOING TO TAKE TO INCREASE THE NUMBER OF AMERICANS IN GENERAL WHO ARE INVOLVED IN SCIENCE WHO HAVE SOME SUCCESS IN SCIENCE. I HAD THE PRIVILEGE OF CHAIRING THE NATIONAL ACADEMIES COMMITTEE ON UNDERREPRESENTATION IN SCIENCE, AND IT DID NOT SURPRISE US THAT ONLY 20% OF THE BLACKS AND HISPANIC NATIVE AMERICANS WHO BEGAN WITH A MAJOR IN COLLEGE IN SCIENC SCIENCE AND ENGINEERING ACTUALLY GRADUATE IN THOSE AREAS. IT WAS STUNNING TO LEARN THAT ONLY A THIRD OF WHITES WHO BEGIN WITH A MAJOR OF SCIENCE AND ENGINEERING GRADUATE WITH A MAJOR IN THE NATURAL SCIENCES AND ENGINEERING. ONLY 42% OF ASIAN AMERICANS. TURNS OUT THAT ONLY 6% OF AMERICANS AT AGE 24 WILL HAVE DEGREES IN NATURAL SCIENCES AND ENGINEERING. 6%. IN EURNTION IT'IN EUROPE, IT'S ALMOST GUYS THAT. TWICE THAT. ASIWHAT WE DID WAS TO LOOK AND SEE WHAT'S THE PROBLEM? MOST PEOPLE I WOULD SAY THE STUDENTS AREN'T WELL PREPARED, IT'S A K-12 PROBLEM. THAT IS A COPOUT FOR HIGHER EDUCATION. THE FACT IS THAT WHILE WE NEED TO IMPROVE K-12, THE LARGE NUMBERS OF THOSE STUDENTS WHO COME TO OUR COLLEGES AND UNIVERSITIES OF ALL RACE, MEN AND WOMEN, WANTING TO BECOME DOCTORS AND SCIENTISTS AND ENG FEARS, DON'T MAKE IT, AND WHEN WE SAY WELL, IT'S BECAUSE THEY WANT TO MAKE A LOT OF MONEY. NOT THE CASE. THE FACT IS THAT IF I EARN AN A IN THE HUMANITIES AND I GET A C OR D IN ORGANIC CHEMISTRY, OF COURSE I LOVE HUMANITY. OF COURSE I DO. YOU KNOW, AND SECONDLY, LET'S BE HONEST, PEOPLE IN THE HUMANITIES AND SOCIAL SCIENCES TEND TO BE OFTEN, NOT ALWAYS, A LITTLE MORE CARING IN THE APPROACH. WE IN SCIENCE ARE NOT NECESSARILY AS WARM AND FUZZY. THIS IS WHAT I MEAN ABOUT NOT TAKING OURSELVES SO SERIOUSLY. THAT THE IDEA OF PULLING PEOPLE IN, I WAS DELIGHTED WHEN DR. LIN HAN TODAY TOLD ME ABOUT MY UNDERGRADUATE WHO IS PRODUCING AN ARTICLE, IT WAS WONDERFUL BECAUSE HE HAD PASSION IN SAYING THIS STUDENT COMES DOWN HERE IN THE SUMMERS AND MAKES ALL THE DIFFERENCE IN THE WORLD. BUT TO MAKE A DIFFERENCE, I WANT YOU TO THINK ABOUT THIS, HERE'S WHAT YOU NEED TO KNOW. WE HAVE FOUND THAT THE HIGHER THE SATs, THE LARGER THE NUMBER OF AP CREDITS, THE MORE SELECTIVE THE UNIVERSITIES, THE GREATER THE PROBABILITY THE STUDENT WHO BEGINS IN SCIENCE WILL LEAVE SCIENCE IN THE FIRST YEAR OR TWO. IT'S NOT JUST ABOUT PREPARATION. IT'S ABOUT THE CULTURE OF SCIENCE TEACHING IN THE UNDERGRADUATE PROGRAM. SAYS THAT THE LOW HANGING FRUIT, THE PLACE WHERE WE CAN MAKE A DIFFERENCE IN INCREASING THE NUMBERS OF AMERICANS IN GENERAL AND PARTICULARLY PEOPLE IN GENERAL, THREE SCIENTISTS TO PRODUCE SCIENTISTS, IN OTHER WORDS, IT WILL HAVE TO BE PRACTICING SCIENTISTS WHO GET ENGAGED IN THE WORK. FOR MY CAMPUS, TWO THINGS HAVE MADE A DIFFERENCE. THAT PROGRAM WE HAVE STARTED HAS LED TO OUR BECOMING THE LEADING UNIVERSITY IN THE COUNTRY, WE ARE A PREDOMINANTLY WHITE SCHOOL, YET WE'VE GONE AHEAD OF ALL THE HBCUs IN PRODUCING AFRICAN-AMERICANS WHO GO ON TO GET PH.D.s IN SCIENCE AND MD/PH.D.s. GIVE MY COLLEAGUES A HAND FOR THAT, WOULD YOU, PLEASE? [APPLAUSE] TO DO THAT, WE'VE HAD TO HAVE FUNDING. I WANT TO CITE, IT TAKES BRAIN POWER, IT TAKES COURAGE, IT TAKES COMMITMENT TO MAKE A DIFFERENCE. KEN OLDEN OF NIEH MADE A DIFFERENCE IN THOSE YEARS IN SUPPORTING IT, AND WHAT IT DID WAS IT PRODUCED A NUMBER OF AFRICAN-AMERICANS WHO WENT ON TO GET PH.D.s IN ENVIRONMENTAL HEALTH SCIENCE AREAS. THAT WAS LEADERSHIP FOR HIM AND MORE RECENTLY ROB PEDIGREW MADE ALL THE DIFFERENCE IN THE WORLD IN FUNDING AND SUPPORT. WHAT PEOPLE DON'T REALIZE, YOU CAN'T WORK 20 HOURS ON THE OUTSIDE AND DO CHEMISTRY, OR BIOCHEMISTRY. YOU'VE GOT TO BE ABLE TO FOCUS ON THE WORK. MY LINE IS YOU HAVE TO MARRY THE WORK. YOU CAN'T HAVE IT AS A PART-TIME FRIEND. SO I WANT TO ARGUE THAT SCIENTISTS IN THIS COUNTRY AND IN THE WORLD ARE ASKING GOOD QUESTIONS, THEY ARE WORKING TO EXPAND THE KNOWLEDGE FOR UNDERSTANDING THE WORLD ITSELF, THEY ARE IMPROVING THE LIVES OF CHILDREN AND FAMILIES AND OTHERS. THEY UNDERSTAND THAT PEOPLE WANT TO KNOW THAT HUMAN BEINGS CAN BE HEALTHIER THAN EVER BEFORE, AND MOST IMPORTANT, WHEN I THINK ABOUT WHAT WE NEED TO BE SAYING, I THINK ABOUT WHAT ALAN SAID, THE CAUSE IS NOBLE. WE AS SCIENTISTS MUST IN DIFFERENT WAYS MAKE THAT POINT TO CONGRESS OR TO THE PUBLIC THAT THE CAUSE IS NOBLE BECAUSE HERE IS THE MOST IMPORTANT POINT OF ALL. WHAT IS IT THAT SCIENCE DOES, WHAT IS THAT SCIENTISTS DO IN SOCIETY? WE HAVE SHOWN THE WORLD THAT HUMANKIND CAN HAVE AN ETERNAL SPRING OF HOPE THROUGH SCIENCE. ALL THINGS ARE POSSIBLE. THANK YOU ALL. IT'S NOBLE. THANK YOU SO MUCH. [APPLAUSE] >> GOOD MORNING. ARE WE HAVING FUN? I'M DR. YVONNE MADDOX, DEPUTY DIRECTOR OF THE NICHD, AND I'D LIKE TO JOIN DOCTORS COLLINS AND GUTTMACHER IN WELCOMING YOU TO THIS COLLOQUIUM THIS MORNING. NOW AS YOU CAN SEE FROM THE AGENDA, OUR COLLOQUIUM IS DIVIDED INTO THREE SEGMENTS. HEALTHY BEGINNINGS, BEYOND CHILDHOOD, PROMOTING THE HEALTH OF WOMEN, FAMILIES AND INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, AND THE NEXT 50 YEARS, ADVANCING SCIENCE, IMPROVING LIVES. I HOPE THAT TODAY WILL BE A TRUE COLLOQUIUM. CO, MEANING TOGETHER. LOQUIUM, MEANING TO TALK. SO THROUGHOUT THE DAY, I HOPE THAT WE CAN ALL BE ENCOURAGED, ALL OF US, TO TALK TOGETHER ABOUT THE BRILLIANT SCIENCE THAT WE ALL HERE AT NIH REALLY HAVE HAD A CHANCE TO EXPERIENCE. AS ALAN MENTIONED EARLIER, THE BIOGRAPHIES OF OUR DISTINGUISHED SPEAKERS ARE IN YOUR PROGRAMS, SO WE WON'T BE GOING INTO ANY GREAT DETAIL TO INTRODUCE THEM, BUT ONE OF THE THINGS WE WANTED TO DO WAS CERTAINLY MAKE A CONNECTION WITH THEM AS IT RELATED TO NICHD AND OUR MISSION, AND I THINK YOU'LL BE ABLE TO SEE FROM THEIR BIOS THAT THEY ARE NOT ONLY DISTINGUISHED, BUT WHEN YOU HEAR WHAT THEY HAVE TO SAY, YOU WILL SEE THAT THEY'VE DISTINGUISHED THEMSELVES WITH TRUE SCIENTIFIC ACCOMPLISHMENTS, AND WE'RE SO PLEASED TO HAVE BEEN ABLE TO GET EACH OF THEM TO COME, AND I THINK YOU'LL SEE FROM THE PROGRAM AND FROM WHAT THEY SAY THAT WE MADE GREAT SELECTIONS. OUR FIRST SPEAKER, DR. RALPH BRINSTER, IS A TRAILBLAZER IN THE FIELD OF REPRODUCTIVE BIOLOGY AND GENETICS. AND HIS EARLY FINDINGS HELPED USHER IN THE ERA, REALLY, OF TRANSGENIC RESEARCH. HE IS A LONG-STANDING NICHD SUPPORTED INVESTIGATOR AND HE HAS RECEIVED NUMEROUS AWARDS AND HONORS THROUGHOUT HIS CAREER, INCLUDING MOST RECENTLY THE NATIONAL MEDAL OF SCIENCE AWARDED BY THE PRESIDENT OF THE UNITED STATES. DR. BRINSTER. >> THANK YOU, GEE VON. YVONNE. THANK YOU ALL FOR COMING TO THIS WONDERFUL PROGRAM. I WANT TO SAY THAT WHATEVER I'M GOING TO TALK ABOUT TODAY AND MY ACCOMPLISHMENTS ARE REALLY DUE TO A LARGE NUMBER OF EXCELLENT SCIENTISTS, COLLABORATORS, STUDENTS AND COLLEAGUES WHO HAVE MADE THIS POSSIBLE BY THEIR HARD WORK AND TALENT. I'VE JUST BEEN ALONG FOR THE JOURNEY, BUT I'M HAPPY TO BE THEIR STANDARD BEARER TODAY. THE GENETIC CODE CARRIED IN THE MAMMALIAN GERMLINE IS REALLY THE PROGRAM OF LIFE AND DETERMINES THE CHARACTERISTICS OF THE INDIVIDUAL AND PREDETERMINES THE CHARACTERISTICS OF THE PROGENY. THAT PREDETERMINE NATION WAS ALLUDED TO 3 1/2 CENTURIES AGO BY A FAMOUS PHILOSOPHER IN WRITTEN WORDS THAT TRANSLATE APPROXIMATELY TO IF YOU THROW A STONE TO THE AIR AND GIVE IT CONSCIOUSNESS, IT WILL BELIEVE IT HAS FREE WILL. THAT PROGRAM IS WHAT IN A SENSE HE'S TALKING ABOUT. MAN'S INTERVENTION IN THAT PROGRAM BEGAN ABOUT 10,000 YEARS AGO AT THE END OF THE LAST ICE AGE, WHEN THEY DOMESTICATED PLANTS AND ANIMALS AND BEGAN THE STORY OF HUMAN CIVILIZATION SINCE THAT TIME ON WHICH IT IS BASED. THE SECOND PHASE IN EVOLUTION WAS THE DETERMINATION THAT IF YOU MATED GOOD ANIMALS OR PLANTS TOGETHER, YOU GOT BETTER TRAITS. AND THE THIRT STE THIRD STEP WHICH IS QUITE DIFFERENT FROM THE FIRST TWO WAS IDENTIFICATION THAT THERE WERE GENETIC ELEMENTS THAT CARRIED THIS PROGRAM OF LIFE AND THIS BEGAN AND CONTINUES TODAY WITH THE DECODING OF AND SEQUENCING OF THE DNA IN THE GENOME, BUT WE WOULD NEVER KNOW HOW THIS CODE WORKS, NO MATTER HOW WELL WE DESCRIBE IT, UNLESS YOU COULD GO IN AND CHANGE IT, EXPERIMENTALLY, AND SEE WHAT THE EFFECT WAS. THAT IS A REALLY MAJOR INNOVATION THAT WAS HEAVILY FUNDED, CERTAINLY IN MY LABORATORY BY NICHD, AND ALL OF THESE INTERVEANGSES, OR PRACTICALLY ALL OF THEM IN THE GENETIC CODE AND CODE OF LIFE TOOK PLACE IN THESE EARLY STAGES OF DEVELOPMENT FROM THE EGG AND SPERM TO THE BLASTOCYST. IN ORDER TO MAKE THESE CHANGES, ONE NEEDED A WAY TO CULTURE OR MANIPULATE -- CULTURE AND MANIPULATE THESE STAGES IN VITRO. ALTHOUGH PEOPLE HAD TRIED TO CULTURE EARLY EMBRYO STAGES SINCE THE BEGINNING OF THE 1900s, IT WASN'T UNTIL THE 1960s THAT A RELIABLE SYSTEM WAS DEFINED UNDER MI MINERAL OIL WHICH WORKED VERY WELL AND IS STILL USED TODAY, BASICALLY UNCHANGED, AND WAS USED TO ESTABLISH HUMAN IN VITRO FERTILIZATION 20, 30 YEARS AGO. FIRST ATTEMPT WE MADE TO CHANGE, REALLY THE FIRST ATTEMPT TO CHANGE THE GENETIC COMPOSITION OR THE COMPOSITION REALLY IN GENERAL AT THAT TIME, OF THE EMBRYO, WAS TO INTRODUCE STEM CELLS INTO THE BLASTOCYSTS. ONE OF THE TYPES OF STEM CELLS I THOUGHT WOULD BE GOOD ROSE IN A CARCINOMA WHICH IS A GERMLINE CANCER IN THE MALE TUBULE THAT WILL GROW AS EMBROID BODIES. THEY WILL ALSO PRODUCE ALL TYPES OF CELLS WHEN THEY'RE GROWING AS A TUMOR, BUT THEY LOOKED A LOT LIKE EMBRYOS, SO I THOUGHT THEY WOULD BE A GOOD CANDIDATE TO TRY AND INTRODUCE INTO THE BLASS CYSTS TO BEGIN MODIFYING AND STUDYING DEVELOPMENT. SO I TOOK CELLS FROM A BODY AND PUT THEM INTO A WHITE ALBINO BLASS CYST. IF THEY TOOK, I SUSPECTED THAT I WOULD SEE LINES OF BROWN CELLS AND HAIRS EXTENDING FROM THE DORSAL MIDLINE DOWN AROUND TO THE VENTRAL SIDE OF THE BODY ALONG THE ALONG THE MIGRATION OF THE SOMITE CELLS. THIS TOOK QUITE SOME TIME, ACTUALLY IT TOOK 2 1/2 YEARS BEFORE WE OBTAINED SUCCESS AND PROBABLY PRODUCED OVER 200 EMBRYOS, BUT LIKE THE LAST SPEAKER SAID, YOU HAVE TO HAVE A PASSION FOR THIS. WHEN I HAVE AN IDEA, I BECOME CONSUMED BY THE IDEA SO THAT I REALLY BELIEVE IT EXISTS, IT'S PART OF ME. AND I NEVER GIVE IT UP. SO I WASTE A LOT OF TIME, BUT SOMETIMES IT TURNS OUT. NICHD FUNDED THIS WORK. SO THIS -- [LAUGHTER] >> SO THIS WAS A GOOD START. AND GENETIC CHANGES WERE INTRODUCED INTO THOSE ANIMALS. THE DIFFICULTY WAS IT WAS NOT TRANSMITTED THROUGH THE GERMLINE, SO WHILE WE WERE LOOKING FOR A BETTER AND RELATED CELL ACTUALLY, I HAD SEEN THIS PAPER BY McBRIDE IN 1973 THAT SAID THEY COULD CHANGE GENES IN CULTURED CELLS BY PUTTING CHROMOSOMES IN THE MEDIA. I SAID IF THEY CAN DO THAT, I CAN INJECT THEM RIGHT INTO THE EMBRYO AND THEY SHOULD GET AN EFFECT. THIS WAS ANOTHER IDEA THAT FAILED BECAUSE CHROMOSOMES ARE SO HARD TO WORK WITH. IN THE MEANTIME, SMART PEOPLE DEVELOPED THE DNA SO I WAS ABLE TO INJECT BUT UNFORTUNATELY MOLECULAR BIOLOGISTS HAD MUCH MORE EXCITING THINGS TO DO SO IT WAS HARD TO GET MOLECULAR BIOLOGISTS TO WORK WITH ME, BUT I WAS WORKING WITH A FEW, AND IN ORDER TO GET MONEY, I SOLD NICHD THE IDEA THAT I WOULD PUT RNA IN BECAUSE I WANTED TO PILOT THE INJECTION OF KNEW CLAIK ACIDS INTO THE EMBRYO AND SHOW IT WOULD ACTUALLY WORK, AND THE EXPERIMENT WORKS AND IT WAS PUBLISHED AND IT WAS A GOOD PROJECT, BUT ON THE SIDE, I WAS REALLY INTERESTED IN THIS OTHER CRAZY IDEA WHICH COULDN'T BE FUNDED AT THAT TIME, BUT THAT'S HOW YOU GET BY. SO THIS IS AN RNA EXPERIMENT. BUT IN ORDER TO SATISFY SOME OF THE GAMES IN THE GRANT, I HAD TO GET OVER HUMAN MESSENGER RNA. SO I WENT TO RICHARD PALMITER, BRILLIANT SCIENTIST I KNEW. I DIDN'T KNOW HIM BUT I KNEW OF HIS WORK, AND HE WAS WORKING WITH ALBUMEN, BUT WHEN I CALLED HIM, I FOUND OUT HE HAD GOTTEN OUT OF THE ALBUMEN BUSINESS AND HE WAS IN METALOW THIGH MEAN WHICH I KNEW NOTHING ABOUT, BUT IT WAS ALSO PRESENT IN THE MOUSE, OF COURSE, SO I'D NEVER BE ABLE TO IDENTIFY, SO I COULDN'T SOLICIT HIM AT THAT TIME BUT I TOOK IS OLD ALBUMEN AND PUBLISHED THAT WORK. I CALLED HIM TO SEE IF HE WOULD LIKE TO BE ON THE PAPER AND HE DECLINED BUT HE SAID HE WAS GOING TO FUSE THIS METALA THYMINE -- THAT LIT UP IN MY MIND BECAUSE I ALREADY HAD THAT ASSAY WORKING WITH OTHER WORKING WITH OTHER BIOLOGISTS, SO RICHARD AND I MADE THESE TWO MICE. THEY CONTAINED A LOT OF HSVTK IN THEIR LIVERS BUT YOU CAN'T SEE IT, BUT NONETHELESS, IT WAS INTERESTING TO PEOPLE ESPECIALLY IN DEVELOPMENTAL BIOLOGY, BUT RICHARD WANTED TO WORK ON HOT TYPE TOPICS IN MOLECULAR BIOLOGY AND I WANTED TO CHANGE AN ANIMAL. SO WE COMPROMISED ON CORRECTING A GENETIC DEFECT AND WE DECIDED ON GROWTH HORMONE, A LITTLE MOUSE, WE WOULD CORRECT IT. SO POPEYE LOT THAT EXPERIMENT, WE MADE THE SAME CONSTRUCT, ONLY THIS TIME WE PUT ON GROWTH HORMONE. IT'S A SYMBOL OF THE BEGINNING OF THE GENETIC REVOLUTION AND IT CATALYZED INTEREST AMONG ALL SCIENTISTS, NOT JUST DEVELOPMENTAL BIOLOGISTS, AND IT WAS ON THE FRONT PAGE ALL THROUGHOUT THE WORLD. IN THE NEXT 10 YEARS, RICHARD AND I PUBLISHED -- WE DID THOUSANDS OF TRANSGENIC MICE AND PUBLISHED HUNDREDS, SHOW HOW STRUCTURAL GENES WERE PROMOTERS AND ENHANCERS, AND IT JUST WAS AMAIDSING TO SCIENTISTS AND EVERYONE BECAUSE THE GENES DIDN'T ALWAYS WORK LIKE THEY LOOKED LIKE THEY SHOULD AND THEY DIDN'T LOOK LIKE THEY WORKED IN CULTURED CELLS, SO THIS WAS A MUST DO TO KNOW HOW OUR PROGRAM OF LIFE ACTUALLY WORKS AND HOW IT CAN BE USED TO CORRECT DISEASES. WELL, THE CARCINOMA DID NOT DIE, EVERYBODY WAS LOOKING FOR A BETTER CELL, AND IN 1981, A BETTER CELL WAS FOUND THAT'S RELATED TO THE THREAT OF CARCINOMA, IT COMES FROM THE EMBRYO, BUT THIS CELL WOULD ACTUALLY MAKE EMBROID BODIES GROW, YOU COULD CHANGE THE GENES IN IT, THEN YOU COULD PUT IT INTO AN ANIMAL. IN 1984, BRADLEY SHOWED IT WOULD GO INTO AN ANIMAL, SO IT WAS ANOTHER WAY TO MAKE TRANSYENG GENGS BUT IT WASN'T AS EFFICIENT AS INJECTING GENES INTO EGGS. BUT WHAT MADE THE DIFFERENCE WAS THAT GERALD ZINC IN THE LATE 70s SHOWED THAT YOU COULD TARGET DNA IN YEAST BY HO MOL GUS RECOMBINATION. THEY MOVED THAT THE SOMATIC CELLS AND THEN OF COURSE INTO EMBRYONIC STEM CELLS, SO IN 1989, THE GENE KNOCKOUT TECHNOLOGY WAS CEMENTED TO THE ES CELL TECHNOLOGY, THEN YOU COULD MAKE KNOCKOUT MICE. NOW ALL OF THAT WAS IN THE FEMALE OR EMBRYO SIDE. DRAMATIC CHANGES WERE BEING MADE. LOTS OF PEOPLE COULD DO TRANSGENICS, 81 INJECTION, 89 BY KNOCKOUT, BUT I WAS NOT VERY GOOD EVER AT COMPETING WITH SCIENTISTS BECAUSE THEY'RE VERY BRIGHT, SO I WANTED TO GO BACK TO THE GERMLINE CELLS. RICHARD CONTINUED IN NEUROBIOLOGY, WHICH HE IS NOW THE LEADING -- ONE OF THE LEADING SCIENTISTS IN THAT AREA, AND I WENT BACK TO THE GERMLINE WITH THIS IDEA I HAD, AND I THOUGHT THAT -- THE NICE THING ABOUT STEM CELLS IN THE TESTES IS THEY DIVIDE THROUGHOUT LIFE WHERE NEW GERM SELLS ARE NOT FORMED IN THE FEMALE AFTER BIRTH. SO I THOUGHT THIS WAS A GREAT RESOURCE, I THOUGHT IF YOU TOOK THOSE CELLS, YOU INJECT THEM FROM A FERTILE INTO AN INFERTILE ANIMAL, ONLY THE STEM CELL COULD SURVIVE. IT'S LIKE THROWING A HANDFUL OF DEBRIS FROM THE BOTTOM OF A CORN CRIB ON THE FIELD. ONLY THE FERTILE CELLS WILL GROW. SO ACTUALLY IT WAS A VERY SIMPLE APPROACH AND IT WORKED, BUT THERE ARE LOTS OF REASONS IT SHOULDN'T WORK, AND THAT'S WHY PEOPLE IN THE SPERM FIELD, I GUESS, WERE NOT DOING IT. BUT IN ANY EVENT, IT WORKED AND WHEN YOU GOT COUP A COLONIZATION, EACH WAS A SINGLE STEM CELL, A VERY POWERFUL ASSAY FOR STEM CELL POTENTIAL, BUT EQUALLY IMPORTANT, YOU COULD SET IT UP SO THAT EACH COLONY DEVELOPING WOULD MEASURE THE NICHE CELLS, THE SURROUNDING CELLS WHICH ARE ACTUALLY BECOMING KNOWN TO BE AT LEAST AS IMPORTANT AS THE STEM CELL. WHEN A MALE BECOMES INFERTILE IN OLD AGE, IT'S NOT THE STEM CELLS THAT GET TIRED, IT'S THE NICHE THAT GETS TIRED. THEN THE STEM CELLS ARE NOT SUPPORTED. IF YOU PUT A LOT OF CELLS IN, OF COURSE YOU CAN MAKE PROGENY AS SHOWN ON THE LEFT THAT CARRIED THE DONOR JEAN JEE KNOW TYPE. SO THIS BECAME A VERY POWERFUL SYSTEM, BUT WE NEEDED AN ASSAY JUST LIKE THE CULTURE WHERE WE COULD MANIPULATE THESE CELLS IN VITRO. IT TOOK MAKE SIX OR EIGHT YEARS TO DEVELOP A CULTURE SYSTEM. NEVER ANYTHING WORKS LIKE YOU WANT IT TO IN SCIENCE. IT'S ALWAYS HARD. SO YOU SEE HERE CULTURED CELLS, WE MARK THEM IN THIS CASE WITH FLUORESCENCE, THIS IS AN INFERTILE MOUSE. YOU FILL IT WITH SPERMATOGENESIS. HALF ARE GREEN BECAUSE THE GENE IS ONLY ON ONE CHROMOSOME. SO I'VE TALKED ABOUT FIVE AREAS IN PAST YEARS WHICH WE'VE PLAYED A ROLE, BEEN FORTUNATE TO PLAY A ROLE AND OTHER PEOPLE HAVE CONTRIBUTED ALONG THE WAY, PARTICULARLY MY STUDENTS AND COLLABORATORS. IT HAS BEEN A SEQUENCE REALLY OVER THE LIFETIME OF NICHD, AND MOST OF THAT TIME, I'VE BEEN SUPPORTED BY THE NICHD SO THEY MADE A BIG CONTRIBUTION TO THIS THAT HAS REALLY REVOLUTIONIZED BIOLOGY. AT THE BOTTOM, I'VE ADDED INDUCED PLURAL POTENT CELLS. THE REASON I MENTION THOSE IS THAT IN THE NEXT FEW YEARS, PEOPLE IN THE AREA I DON'T THINK WILL BE SURPRISED, BUT MANY PEOPLE WILL BE SURPRISED THAT CELLS LIKE FIBROBLASTS WILL BECOME GERM BY THEMSELVES. IT'S A GREAT SCIENTIFIC OPENING. THE STEM CELLS IN A SENSE ARE ALREADY A BIOETHICAL ISSUE BECAUSE ANY MALE IS IMMORTAL IN TERMS OF BIOLOGY BECAUSE THE STEM CELL CAN BE HAR VETSED, CRYOPRESERVED, CULTURED, TRANSPLANTED, SO THAT 100 YEARS FROM NOW, THE STEM CELLS OF A MALE COULD BE USED JUST AS THEY ARE TODAY. SO THAT'S A TYPE OF UNDER CURRENT OF BIOETHICAL ISSUES, BUT ALSO A GREAT SCIENTIFIC POTENTIAL IN THESE CELLS. SO FOR THOSE WHO ARE REALLY IN DOUBT OF THE POWER OF THE PROGRAM OF LIFE, I SHOW THIS PICTURE BECAUSE I THINK IT MAKES AN IMPRESSION PEOPLE DO NOT FORGET. SEVEN SETS OF TWINS WERE ASKED TO SIT, THEY WERE NOT GIVEN ANY DIRECTION. WE KNOW THEY ALL LOOK THE SAME. WHEN YOU LOOK AT THOSE, YOU HAVE TO BE IMPRESSED THAT THE PROGRAM PENETRATES THROUGH ALL PARTS OF THE ANIMAL. THE POSTURE OF THE TWO BOYS AT THE LOWER RIGHT IS JUST AMAZING. YOU COULD ALMOST IMAGINE THAT THOSE TWO KIDS ARE THINKING OF CHASING THE SAME CAT UP THE SAME TREE. [LAUGHTER] >> THANK YOU FOR YOUR ATTENTION, AND THANK YOU, INSTITUTE OF CHILD HEALTH FOR YOUR SUPPORT. [APPLAUSE] >> THANK YOU, RALPH. I'M JUST DELIGHTED TO SEE ALL OF THE GOODIES THAT ARE GOING TO COME OUT OF TODAY'S COLLOQUIUM BECAUSE AS WE WERE TALKING EARLIER, WHEN WE THINK ABOUT HEALTHY BEGINNINGS, YOU CAN'T THINK ABOUT HEALTHY BEGINNINGS WITHOUT THINKING ABOUT THE PROGRAM OF LIFE AND THE WORK THAT DR. BRINSTER'S DONE. SO WE DO HAVE A MINUTE OR TWO. IS THERE ANYONE THAT HAS A COMMENT OR QUESTION? WE WANTED THESE QUESTIONS TO BE AS WELL TIMED AS POSSIBLE BUT IF THERE WAS A COMMENT OR A QUESTION, THIS IS A COLLOQUIUM, SO I WOULD GIVE YOU A MINUTE TO ASK A QUESTION OR TWO. MAYBE YOU'LL HAVE A QUESTION LATER DURING THE DAY IF WE HAVE TIME. TIME IS GOING TO BE THE ELEMENT HERE, YOU CAN COME FORTH AND ASK YOUR QUESTION. AGAIN, THANK YOU DR. BRINSTER. [APPLAUSE] OUR NEXT SPEAKER IS DR. ERIC WIESCHAUS WHO'S PIONEERING RESEARCH IDENTIFIED THE GENES CONTROLLING EMBRYONIC DEVELOPMENT. THIS WORK EARNED HIM TH THE NOBEL PRIZE IN 1995. LIKE OUR PREVIOUS SPEAKER, ERIC IS A LONG-STANDING NICHD GRANTEE WHO HAS PROVIDED HOURS OF SERVICE TO THE INSTITUTE, INCLUDING SERVICE ON THE NICHD BOARD OF SCIENTIFIC COUNSELORS. DR. WIESCHAUS. [APPLAUSE] >> THE LAST 50 YEARS HAVE SEEN EXTRAORDINARY ADVANCES IN OUR UNDERSTANDING OF THE MOLECULAR MECHANISMS THAT GOVERN THE DEVELOPMENT OF AN EMBRYO INTO A COMPLEX ORGANISM, AN ORGANISM AS COMPLEX AS ANY OF US SITTING IN THIS ROOM. THOSE ADVANCES HAVE BEEN LARGELY -- CAN BE ATTRIBUTED TO A COMBINATION OF GENETIC -- TRADITIONAL GENETIC RESEARCH WITH MOLECULAR BIOLOGY OF RECOME BY NENT DNA, THE ABILITY TO IDENTIFY INDIVIDUAL GENES. NOW, ONE OF THE THINGS THAT I THINK MANY OF US IN THE BEGINNING STAGES OF THIS RESEARCH DIDN'T REALLY ANTICIPATE WAS THE EXTENT THAT GENES THAT WERE PRESENT AND GOVERNED THE DEVELOPMENT OF HUMAN EMBRYOS COULD ALSO BE EASILY IDENTIFIED IN OTHER ORGANISMS, ORGANISMS AS DIVERSE AS FLIES AND WORMS AND FROGS, AND THAT UNDERSTANDING HOW THOSE GENES ACTUALLY FUNCTIONED IN THOSE WHAT WE CALL MODEL ORGANISMS WOULD PROVIDE IMPORTANT INSIGHTS INTO HUMAN DEVELOPMENT. NICHD WAS ONE OF THE FIRST INSTITUTES TO REALLY TAKE ADVANTAGE OF THAT INSIGHT IN THAT IT HAS HAD A TRADITION FROM VERY EARLY DAYS IN SUPPORTING RESEARCH IN BASIC DEVELOPMENTAL BIOLOGY AND PARTICULARLY IN MODEL ORGANISMS AND THE POTENTIAL THAT THEY BRING TO UNDERSTANDING HUMAN DEVELOPMENT. AS A YOUNG SCIENTIST WHEN I RETURNED TO THIS COUNTRY IN 1981, I OBTAINED MY FIRST NIH GRANT FROM NICHD AND ONE OF MY PROUDEST ACHIEVEMENTS AS A SCIENTIST HAS BEEN THE FACT THAT I'VE BEEN ABLE TO MAINTAIN THAT RO1 NOW FOR MORE THAN 30-SOMETHING YEARS. WHAT I'D LIKE TO DO TODAY, THOUGH, IS NOT ACTUALLY TALK SO MUCH ABOUT HISTORY BUT ACTUALLY FOCUS A BIT ON THE FUTURE, AND I'M GOING TO FOCUS ON THE FUTURE AS A DEVELOPMENTAL BIOLOGIST WHO DOES BASIC RESEARCH IN EMBRYONIC DEVELOPMENT, AND I'M GOING TO TRY TO IDENTIFY TWO QUESTIONS THAT I THINK ARE OF PARTICULAR INTEREST. THEY'RE INTERESTS OF MY OWN PERSONAL CHOICES IN DEVELOPMENTAL BIOLOGY ARE VERY BROAD, BUT WHAT I'D LIKE TO DO IS PRESENT QUESTIONS THAT I BELIEVE ARE UNANSWERED AND THEY'RE REALLY ESSENTIAL FOR US. YOU DO THIS A LITTLE BIT IN THE CONTEXT OF SOME OF MY OWN RESEARCH, BUT ONE OF THE THINGS I DID BEFORE THIS TALK WAS TO GO THROUGH THE IMPRESSIVE ROSTER OF RO1 SUPPORTED BY NICHD AND IDENTIFY RESEARCH AND I'VE STOLEN FIGURE FROM SOME OF MY RESEARCH -- SOME OF MY COLLEAGUES WHO ARE ALSO FUNDED FROM THE NIC PROGRAM. NOW, IT HAS BEEN AN EXTRAORDINARY PERIOD, WE KNOW QUITE A BIT NOW ABOUT THE GENES AND MOLECULES THAT CONTROL EARLY EMBRYONIC DEVELOPMENT IN THE -- THE ORGANISM THAT I WORK ON, WE KNOW THE GENES THAT SET A PATTERN AND DEFINE -- IN THE EMBRYO AND WE KNOW THOSE GENES COME TO BE EXPRESSED IN VERY SPECIFIC AND REPRODUCIBLE PATTERNS IN DIFFERENT REGIONS OF THE EMBRYO. WE ALSO KNOW THAT THESE PATTERNS OF TRANSCRIPTION REFLECT AN EARLIER PATTERN THAT'S ALREADY PRESENT IN THE EGG THAT'S PRODUCED BY THE -- FEMALE, IN THE EGG EVEN BEFORE IT'S FERTILIZED. THE EGG IS ENDOWED WITH RNA, LOCALIZED RNA THAT PRODUCE GRADE YENS OF TRANSDESCRIPTION FACTORS THAT COME TO BE DISTRIBUTED IN SPECIFIC PATTERNS IN THE EMBRYO THAT'S FORMED FROM THAT EGG, AND THE INDIVIDUAL CHOICES THAT CELLS MAKE IN TERMS OF WHAT GENES THEY'RE GOING TO TRANSCRIBE REFLECT THE ABILITY OF THOSE INDIVIDUAL GENES TO RESPOND TO THESE TRANSCRIPTION FACTORS. NOW, THIS IS A VERY WELL WORKED OUT SYSTEM. IT'S ALREADY IN THE TEXTBOOKS. YOU CAN READ IT, IT'S WHAT WE LEARN NOW ABOUT DEVELOPMENTAL BIOLOGY. LIKE ALL QUESTIONS IN DEVELOPMENTAL BIOLOGY, THEY'RE STILL REALLY FUNDAMENTAL ISSUES THAT HAVE TO BE ADDRESSED. I THINK ONE OF THE FEATURES THAT'S HAPPENED, ONCE YOU UNDERSTAND SOMETHING IN DEVELOPMENTAL BIOLOGY, YOU BEGIN TO TRANSLATE THAT INTO A GENERAL PHENOMENA OF BIOLOGY IN GENERAL. EVERYTHING THAT HAPPENS IN AN EMBRYO IS ACTUALLY A COMMON PROCESS THAT HAPPENS ALSO IN DIFFERENTIATED CELLS, ALL CELLS, SO IN THIS PARTICULAR CASE, ONE INTERESTING ISSUE, ONE THAT WE'RE CONTINUING TO FOCUS ON, IS HOW IS IT THAT TRANSCRIPTION FACTORS ACTUALLY ACCURATELY ACTIVATE GENES BASED ON CONCENTRATION DIFFERENCES THAT WE KNOW NOW ARE ONLY 5 TO 10, 20%, SO CELLS WILL TURN OFF, DNA IS ABLE TO MEASURE CONCENTRATION AT LEVELS WITH PRECISION THAT'S MUCH GREATER THAN ANYTHING WE CAN DO IN THE LABORATORY. SO YOU ESTABLISH BOUNDARIES BECAUSE THERE'S A PARTICULAR CONCENTRATION, SO ONE OF THE THINGS WE'RE BEGINNING TO DO IS ACTUALLY TRY TO MEASURE THE SYSTEMS. THIS IS IMPORTANT, I THINK, IN THE WHOLE FIELD AS WE GET INTO MOW SURE INPUT IN TERMS OF TRANSCRIPTIONAL PRESENCE AND OUTPUT IN TERMS OF ACTUAL RNAs, THE MOLECULAR BIOLOGY OF TRANSCRIPTION. WHAT'S EXCITED IS THAT WE'RE ABLE TO DO THIS NOW NOT ONLY WITH POSITIONAL MOLECULAR TECHNIQUES BUT THE OPTICAL IMAGING TECHNIQUES THAT ALLOW US TO VISUALIZE TRANSCRIPTION, ALLOW US TO MEASURE CONCENTRATION, ALLOW US TO DO THESE TYPE OF ANALYSES IN LIVING EMBRYOS. NOW THIS FIGURE ALSO ILLUSTRATES SOMETHING THAT'S VERY CHARACTERISTIC OF MANY OF THE EMBRYOS THAT WE WORK WITH AND MODEL EMBRYOS IN THAT THE PATTERN THAT WE SEE HEERY FLECTS A PREVIOUSLY EXISTING PATTERN IN THE EMBRYO ITSELF. THIS IS TRUE FOR MANY ORGANISMS, FLIES, FROGS, FISH. BUT ONE OF THE THINGS THAT PUZZLES US A GREAT DEAL IS HOW TRANSCRIPTIONAL PATTERNS ARISE IN EARLY MAMMALIAN EMBRYOS. THIS IS, I THINK, A GREAT UNSOLVED PROBLEM, ONE THAT I DON'T WORK ON BUT THAT I'M FASCINATED WITH. ESSENTIALLY THE PROBLEM FROM MAMMALIAN EMBRY OA WE'RE LOOKING AT A BLAS BLASTOCYST HERE, IS THAT EMBRYOS ARE SMALL AND MOST OF THE CELLS DERIVED FROM THE EMBRYO ARE DIRECTED AT FORMING THE PLACENTA, THE OTHER -- THE EXTRA EMBRYONIC MEMBRANE, SO VERY, VERY TINY, TINY FRACTION OF THE MATERNAL UNFERTILIZED EGG MUST BE ULTIMATELY CONTRIBUTED TO THE EMBRYO. HARD TO IMAGINE HOW YOU COULD LOCALIZE OR PREPROGRAM THE PATTERN OF A M MAMMALIAN EMBRYO FROM THE LOCALIZATION IN THESE CELLS HERE, FROM THE LOCALIZATIONS OF RNA. SO FOLLOW THE EMBRYOS THAT DEVELOP. WHO'S COME IN WHEN YOU LOOK AT THE EARLY STAGES WHERE IF YOU FOLLOW GENE EXPRESSION PATTERNS, YOU'LL BEGIN TO SEE, AND THIS IS WHERE -- INDIVIDUAL GENES COME ON IN THE EMBRYO BUT IN A PA TRN THAT INITIALLY APPEARS RANDOM AND THEN APPEARS TO SORT OUT THROUGH CELL MOVEMENTS, BUT ALSO THROUGH CELL COMMUNICATION AND SIGNALING. SO THIS IS EVEN ALREADY IN THE EARLY EXTRA EMBRYONIC DERIVATIVES OF THE MAMMALIAN EMBRYO, BUT IT'S AN INTERESTING POSSIBILITY THAT THE LATER STAGE OF ORGANIZATION MIGHT ALSO INVOLVE THESE SAME KINDS OF CELL SIGNALING PROCESSES. THIS IS SOMETHING THAT WE KNOW NOTHING ABOUT. OR VERY, VERY LITTLE ABOUT. THE IMPORTANT QUESTION IS CAN CELL -- GENERATE PATTERNS WHERE NO PATTERNS EXIST BEFORE? YOU THINK SIMPLE CELL SIGNALING, A LINEAR PATHWAY OBVIOUSLY DOESN'T GENERATE PATTERNS. AND SO WHAT ONE REQUIRES IS CELL SIGNALING CIRCUITS THAT ARE INTERCONNECTED FEEDBACK ON THEMSELVES IN THE WAY THAT AN ELECTRICAL CIRCUIT MIGHT GENERATE AND AMPLIFY SPECIFIC NOISES. ONE OF THE FASCINATING AREAS COMING UP NOW IN CELLALLING, AND CELL SIGN ALING, WORK DONE ON SEA URCHANTS IS TO ESTABLISH AN UNDERSTANDING OF CELL SIGNALING CIRCUITS, PARTICULARLY ONES THAT ARE COMPLEX, THAT INTEGRATE WITH EACH OTHER AND THAT ALLOW PATTERNS TO EMERGE FROM THE PROPERTIES OF THE CIRCUIT WITHOUT BEING PRECEDED BY A PHYSICAL PATTERN OR DISTRIBUTION OF MOLECULES. THIS IS AN IMPORTANT AREA OF RESEARCH AND MIGHT POTENTIALLY PROVIDE CLUES FOR HOW EARLY MAMMALIAN DEVELOPMENT OCCURS. THERE'S ANOTHER POSSIBILITY IN ADDITION TO ACTUAL SIGNALING CIRCUITS FOR ESTABLISHING PATTERNS, AND THAT'S THAT PHYSICAL PROPERTIES AND MECHANICAL ASPECTS OF DEVELOPMENT COULD ALSO POTENTIALLY PROVIDE CLUES THAT PROVIDE PATTERNS. I THINK WHILE THIS IS A NEWER IDEA AND HARDER TO IMAGINE, WE KNOW THAT BIOLOGICAL SYSTEMS ARE ABLE TO RESPOND TO PHYSICAL SIGNALS, TO FLOW, TO FORCE, AND CHANGE THEIR GENE M PATTERNS. SUGGEST PATHWAYS WHEREBY THIS MIGHT OCCUR. ONE OF THE BEST STUDIES, EXAMPLES IN TERMS OF PATTERN IS NOT -- THE ESTABLISHMENT OF RIGHT-LEFT ASYMMETRY IN EMBRYOS. WE KNOW THAT IN BOTH MOUSE AND VERTEBRAE EMBRYO, THE PATTERN, THE FACT THAT THEY HAVE A RIGHT AND LEFT SIDE, SUBTLE DIFFERENCES IN THEIR RIGHT AND LEFT SIDES OF THEIR MORPHOLOGY REFLECTS THE FLOW OF FLUID THROUGH EITHER THE STRUCTURE OF MAMMALIAN GO DURING -- DURING EMBRYONIC DEVELOPMENT AND THAT FLOW APPARENTLY IN SOME WAY THAT WE DON'T UNDERSTAND ESTABLISHES PATTERNS OF GENE ACTIVITY SUCH THAT GENES ARE EXPRESSED ON THE RIGHT SIDE AND NOT ON THE LEFT SIDE THAT, FLOW IS GOVERNED BY THE MOVEMENT OF MODAL ACTIVITY OF TINY CELLULAR STRUCTURES OF THE PRIMARY CILIA THAT CAN BE IDENTIFIED IN EACH OF THESE ORGANS, WHEN THE MOVEMENT WOULD MATERIALLY BE -- RESULT IN -- ABNORMALITIES IN THE DEVELOPMENT OF ORGANS THAT SHOULD NORMALLY HAVE A RIGHT-LEFT -- A RIGHT-LEFT ASYMMETRY SUCH AS THE HEART. SO THESE OBSERVATIONS HAVE DRIVEN US IN OUR LAB TO BECOMING INCREASINGLY INTERESTED IN THE PHYSICAL, MECHANICAL PROPERTIES THAT GOVERN EARLY EMBRYONIC DEVELOPMENT, NOT JUST IN THE SENSE THAT MECHANICAL PROPERTIES CAN CHANGE THE WAY -- PATTERNS OF GENE EXPRESSION, BUT ALSO REVERSING IT, THE WAY THAT GENE EXPRESSION PATTERNS ESTABLISH MECHANICAL PROPERTIES OF CELLS, THEN ULTIMATELY GOVERN THEIR DEVELOPMENT. SO WITH GENE ACTIVITIES NOW GOING TO MECHANICS. IN EACH CASE, YOU HAVE PATTERNS OF GENE EXPRESSION AND WITHIN 10 OR 15 MINUTES OF WHEN THESE PATTERNS COME TO BE ESTABLISHED IN THE EMBRYO, WE CAN SEE THAT INDIVIDUAL CELLS BEGIN TO CHANGE THEIR SHAPE AND THAT MEANS THEY MUST BE CHANGING FORCE GENERATING MACHINES AND MECHANICAL PROPERTIES. SO WE'RE INTERESTED IN DEFINING THOSE MECHANICAL PROPERTIES, AND THE PARTICULAR SYSTEM THAT WE'VE CHOSEN TO WORK ON IS THE INVO LEUTIOINVOLUTION, THE FIRST EVENT THAT HAPPENS IN FLY DEVELOPMENT, IT'S ATTRACTIVE TO US BECAUSE IT OCCURS, IT'S FIRST, IT'S SIMPLE, IT'S VERY RAPID, THESE PATTERNS, THESE INDIVIDUAL PICTURES ARE ABOUT 15 MINUTES APART. CELLS CHANGE THEIR SHAPE AND MOVE INTO THE INTERIOR OF THE EMBRYO. THIS REQUIRES CHANGES IN THE MECHANICAL DRKS OF FORCE DISTRIBUTIONS OF FORCES IN THESE CELLS. ONE OF THE ATTRACTIVE FEATURES OF THESE CHANGES OF EPITHELIAL IN DEVELOPMENT IS THAT IT'S NOT JUST A PROPERTY THAT OCCURS BUT OCCURS CONSISTENTLY THROUGHOUT THE DEVELOPMENT OF EMBRYOS, ONE OF THE CONSTANT FEATURES IS AN EPITHELIUM FORMS A FOLD OR A NEURAL TUBE, VERY PROBABLY SO MANY OF THE UNDERLYING MECHANISMS THAT GOVERN CHANGES, PHYSICAL PROPERTIES ARE GOING TO BE THE SAME. SO YOU WANT TO KNOW HOW THIS SHAPE CHANGE OCCURS, WHAT ARE THE FORCES INVOLVED, BECAUSE THIS IS FLIES WE CAN TRANSGENGLY ORGANIZE AND LABEL CELLS, WE CAN FOLLOW THE DISTRIBUTION OF MYACIN, AND BEGIN TO CHARACTERIZE THAT PROCESS. WE CAN FOLLOW THE INDIVIDUAL CELLS, AND ONE OF THE GOALS IS TO ACTUALLY CHARACTERIZE THE BEHAVIORS OF INDIVIDUAL CELLS, I COULD ACTUALLY WATCH THESE MOVIES FOREVER. I FORGOT TO RUN THIS ON A LOOP THAT YOU COULD WATCH THEM FOREVER TOO, BUT YOU CAN MAKE MOVIES, IT'S AN EXTRAORDINARY PROCESS, SEEING EMBRYONIC DEVELOPMENT, IMAGINING THE MECHANISMS, DIFFICULT TO UNDERSTAND, SO ONE OF THE THINGS THAT WE'VE HAD TO DEVELOP HAS BEEN COMPUTATIONAL BASED TOOLS THAT ALLOW US IN COMPUTERS TO RECONSTRUCT THE BEHAVIOR OF INDIVIDUAL CELLS. FOLLOW THE CELLS, FOLLOW THE CELL CHANGES AND GRADUALLY RECONSTRUCT THE BEHAVIOR OF CELLS. NOW, IN ADDITION TO THAT, ONCE YOU HAVE THE DESCRIPTIONS IT DOESN'T REALLY GIVE YOU A HANDLE ON PHYSICAL FORCES, SO THE OTHER PART OF OUR RESEARCH AND A GROWING AREA IN THE RESEARCH AND DEVELOPMENT IS TO APPLY PHYSICAL TECHNIQUES AND PHYSICAL MEASUREMENTS TO EMBRYOS EITHER BY LASERS AND CUTTING THROUGH CELLS TO MEASURE FORCE, OR TO SIMPLY INJECT FLUORESCENTLY LABELED BEADS INTO EMBRY OWES AND FOLLOW THE FLOWS OF CYTOPLASM AND BEGIN TO MEASURE THE PHYSICAL PROPERTIES, THE VISCOSITIES OF INDIVIDUAL CELLS. ALL OF THESE PHYSICAL PROPERTIES ARE ESSENTIAL IF WE ARE GOING TO BE ABLE TO UNDERSTAND HOW MECHANICAL FORCE PRODUCES INDIVIDUAL CELLS. SO WE'RE LOOKING -- WE'RE FOLLOWING INDIVIDUAL BEADS THAT WE'VE INJECTED INTO CELLS DURING THIS PROCESS, THIS 15 MINUTES. SO WE CAN FOLLOW THESE MOVIES, FOLLOW THE BEHAVIORS OF INDIVIDUAL BEES AND BEGIN TO RECONSTRUCT, WHAT ARE THE ACTUAL MECHANICAL FORCES INVOLVED. ONE OF THE FASCINATING THINGS -- THIS IS -- FOR ME EXCITING BECAUSE THIS BRINGS US INTO THE REALM OF PHYSICS. MANY OF US -- WE HAD TROUBLE WITH MATH, MANY OF US ALSO HAD TROUBLE WITH PHYSICS, AND A GREAT THING FOR ME HAVE HAS BEEN TO RELEARN MY PHYSICS. AND TO RELEARN THE PROPERTIES OF THE FLOWS AND THIS IS YIELDED AN AMAZING OBVIOUS VAGUE, ONE THAT I'OBSERVATION.ALTHOUGH ALL OF OUR WORK HAS TREATED -- HAS TRIED TO TRANSLATE THE DEVELOPMENT OF AN EMBRYO INTO THE GENE ACTIVITIES OF INDIVIDUAL CELLS, IF YOU FOLLOW THE MOVEMENT OF BEADS IN AN EMBRYO, WHAT YOU SEE IS THAT THEY DISPLAY GLOBAL PROPERTIES THAT ARE INDEPENDENT OF CELLS. IT DOESN'T MATTER, THE BEHAVIOR OF THE FLOW PATTERNS CAN BE RECONSTRUCTED AND SHOWN TO BE IDENTICAL TO THOSE THAT ARE PREDICTED FROM FLUID FLOW OR HYDRODYNAMICS, EVEN THOUGH THIS EMBRYO IS DIVIDED UP INTO THOUSANDS OF LITTLE CELLS. SO CELLS ARE NOT THE MEDIATORS OF MECHANICAL MOVEMENT AND PROPERTIES. THE MEDIATORS ARE SOMETHING THAT IS GLOBAL TO THE EMBRYO ITSELF. THAT'S A FASCINATING IDEA, ONE THAT WE'RE BEGINNING TO STRUGGLE WITH. I'M GOING TO STOP THERE. IN THINKING ABOUT THIS TALK, I WANTED TO DO TWO THINGS. I WANTED TO -- CONSCIOUS OF THE ROLE NICHD HAS PLAYED IN THIS DEVELOPMENT OF SCIENCE IN OUR BASIC UNDERSTANDING, I WANTED TO REVIEW A LITTLE BIT OF WHAT WE'VE ACCOMPLISHED BEFORE BUT I ALSO WANTED TO CONVEY TO YOU MY EXCITEMENT ABOUT THE FUTURE. AS I'VE BENEFITED FROM MY OWN COLLABORATORS, BUT ALSO NICHD LAB WHOSE RESULTS I'VE STOLEN FOR THIS TALK. AND I DID THAT MOSTLY TO CONVEY WHAT I BELIEVE REMAINS ONE OF THE MOST EXCITING AREAS IN ALL OF BIOLOGICAL SCIENCE, WHICH IS THE MECHANISTIC UNDERSTANDING OF DEVELOPMENT, AND IT'S A GREAT PLEASURE FOR ME TO ACKNOWLEDGE THE EXTRAORDINARY IMPORTANT ROLE THAT NICHD HAS PLAYED IN THE DEVELOPMENT OF OUR CURRENT UNDERSTANDING. I'LL STOP THERE. THANK YOU. [APPLAUSE] >> THANK YOU. WE DON'T HAVE TIME FOR ANY QUESTIONS NOW, BUT WE DO PLAN TO STILL TAKE OUR BREAK, SO IF YOU SEE ERIC IN THE HALLWAY OR ALONG THE CORRIDORS, BE SURE TO NAB HIM FOR A QUESTION OR MAKE A COMMENT IF YOU CARE TO DO SO. I'M VERY PLEASED TO INTRODUCE OUR NEXT SPEAKER. OVER THE LAST QUARTER OF A CENTURY, MANY OF US HAVE LEARNED MUCH ABOUT THE BARKER HIGH POT CYST. HYPOTHESIS. THIS EY HIGH HYPOTHESIS THAT HAS PRESENTED THE IDEA THAT THERE IS OVERWHELMING EVIDENCE CONCERNING THE DEVELOPMENTAL ORIGINS OF ADULT DISEASE. WHAT THIS REALLY MEANS TO US IS THAT MANY OF THE DISEASES THAT DEVELOP LATER IN LIFE, PERHAPS EVEN OCCUR IN UTERO. TODAY WE ARE PLEASED TO HAVE AS ONE OF OUR SPEAKERS THE PERSON WHO DEVELOPED THE THEORY, DR. DAVID BARKER. THOUGH HIS HOME FRONT IS THE UNIVERSITY OF SOUTHAMPTON IN THE UNITED KINUNITED KINGDOM, HE ALSO COLLABORATES WITH SEVERAL NICHD INVESTIGATORS AT THE OREGON HEALTH AND SCIENCE UNIVERSITY. DAVID HAS BEEN A TRUE FRIEND TO THE INSTITUTE, AND WE ARE DELIGHTED TO HAVE HIM WITH US TODAY. DR. BARKER. [APPLAUSE] >> THANK YOU VERY MUCH, EE YVONNE, FOR INVITING ME TO BE HERE. I'M VERY PLEASED TO BE HERE. AND THANK YOU FOR GIVING ME PERMISSION TO SIT DOWN DURING MY TALK. INTERNATIONAL TRAVEL GETS WORSE AND WORSE, AND ONE NEEDS A BIT OF A RESPITE. SO THE SEARCH FOR THE -- OF CHRONIC DISEASES AND HENCE THE WAY TO PREVENT THEM HAVE LARGELY FAILED. FOR EXAMPLE, THE CDC IS PREDICTING THAT BY THE YEAR 2050, AND PROBABLY WELL BEFORE THAT, ONE IN THREE AMERICANS WILL HAVE TYPE~2 DIABETES. THAT IS A CATASTROPHE. SO THE CONVENTIONAL VIEW IS THAT DIABETES IS HIGH-DENSITY FOOD, PHYSICAL ACTIVITY, AND BECOMING OBESE. AND YET IN INDIA, WHICH HAS BEEN DESCRIBED AS THE WORLD'S CAPITAL OF THE TYPE~2 DIABETES ACADEMIC, PEOPLE ARE DEVELOPING TYPE 2 DIABETES WHO ARE VEGETARIANS, PHYSICALLY INACTIVE AND THEY'RE NOT OBESE. SO WE NEED TO LOOK AROUND AND TRY AND SEE IF THERE ARE NO MODELNEWMODELS FOR THE CAUSATION OF THE DISEASE. THE -- IS ONE WE SIMPLY BORROWED FROM INFECTIOUS DISEASE. IT SAYS DISEASES OCCUR IN PEOPLE BECAUSE BAD THINGS ATTACK THE BODY AND -- ITS HOMEOSTASIS. WHAT I'M GOING TO TALK BRIEFLY ABOUT IS AN ALTERNATIVE MODEL WHICH SAYS DISEASES OCCUR BECAUSE DURING DEVELOPMENT, SMALL CHANGES IN THE ATTRITION CAN HAVE PROFOUND CHANGES ON THE STRUCTURE AND FUNCTION OF THE BODY FOR LIFE. THIS IS THE WELL DOCUMENTED IF HE NOPHENOMENON KNOWN AS PROGRAMMING. WE NOW KNOW THAT PEOPLE WHO DEVELOP CHRONIC DISEASES GROW DIFFERENTLY TO OTHER PEOPLE BEFORE THEY TEND TO GROW SLOWLY. DURING INFANCY, THEY CONTINUE TO GROW SLOWLY, AND THEN AFTER THE AGE OF 2, THEY PUT ON WEIGHT RAPIDLY. IN THE HE HELSINKI -- THE BEST DOCUMENTED GROUP OF HUMAN BEINGS IN THE WORLD, 20,000 MEN AND WOMEN BORN BETWEEN THE TWO WORLD WARS, AMONG THEM, IF EACH HAD BEEN IN THE HIGH BIRTH WEIGHT AND IF NONE OF THEM HAD INCREASED THEIR BODY MASS INDEX AFTER THE AGE OF 2, THEN THE AMOUNT OF TYPE~2 DIABETES WOULD HAVE BEEN HALF QUITE IRRESPECTIVE OF ANYTHING THAT HAPPENED IN THEIR LATE LIVES. SO THIS PRESENTS THE POTENTIAL POWER OF IMPROVING EARLY GROWTH AND DEVELOPMENT IN REDUCING HUMAN DISEASE. HUMAN BEINGS SHARE CHARACTERISTICS, AS THEY DEVELOP, THEY ARE PLASTIC. IT IS AMAZING THE -- EXPERIMENTAL ANIMALS TO PRODUCE LIFELONG CHANGES IN THE OFFSPRING. BY ALTERING THE DIET OF MOTHERS BEFORE AND DURING PREGNANCY. DURING DEVELOPMENT, THERE ARE CRITICAL PERIODS FOR EVERY SYSTEM AND EVERY ORGAN WHEN THEY HAVE TO MATURE. THESE CRITICAL PERIODS ARE OFTEN BRIEF AND THEIR TIMING DIFFERS FOR DIFFERENT SYSTEMS AND ORGANS AND IN HUMANS, ALMOST ALL OF THEM OCCUR IN THE WOMB AFTER BIRTH, ONLY THE LIVER, THE BRAIN AND THE IMMUNE SYSTEM REMAIN PLASTIC PLASTIC. THE SECOND FEATURE WE SHARE WITH ALL LIVING THINGS IS THAT DURING OUR DEVELOPMENT, WE ARE CHALLENGED. THERE IS NOT ENOUGH RESOURCE TO PERFECT EVERY TRAIT, AND LIFE HISTORY THEORY SAYS THAT IF YOU ALLOCATE THE SOURCE TO ONE TRAIT, YOU WILL NECESSARILY DEPRIVE ONE OR MORE OTHER TRAITS. SO THE PLANTS IN YOUR YARD GROW STEMS AND LEAVES AT THE EXPENSE OF ROOTS OR VICE VERSA. THERE IS NOT ENOUGH TO GO AROUND AROUND. SO ANY NEW THEORY THAT SEEKS TO EXPLAIN CHRONIC DISEASE HAS TO TAKE ACCOUNT OF THE FOUR KEY FEATURES OF THEIR ECOLOGY. FIRSTLY, THEY'RE VERY UNSTABLE. IF YOU THINK ABOUT DISEASES THAT HAVE BEEN AROUND FOR HUNDREDS OF YEARS, THE ONLY ONE I CAN THINK OF IS MALARIA. CORONARY HEART DISEASE WAS RARE IN AMERICA 100 YEARS AGO. NOW IT'S THE COMMONEST CAUSE OF DEATH IN THE WORLD. THE DEVELOPMENTAL MODEL IS CAPABLE OF EXPLAINING THAT BECAUSE HUMAN DEVELOPMENT CHANGES CONSTANTLY AS THE MOTHERS' BODIES AND THEIR DIETS AND THE COMPOSITION OF THEIR BODIES CHANGE. SO HUMAN DEVELOPMENT IS REALLY CHOREOGRAPHED BY THE MOTHER, BY THE MOTHER'S LIFETIME NUTRITION AND ITS CHANGES. THE SECOND FEATURE IS THEY'RE VERY PROFOUNDLY BY -- THEY VARY PROFOUNDLY BY RACE AND PLACE. ACROSS AMERICA, THERE ARE FIVE FOLD VARIATIONS IN THE OCCURRENCE OF CORONARY HEART DISEASE BETWEEN DIFFERENT COUNTRIES. IN EUROPE, WE HAVE STROKE AND HYPERTENSION. IN THE EAST AND CORONARY HEART DISEASE IN THE WEST. MOST CHRONIC DISEASES DIFFER IN THE TWO SEXES. NOW THE CONVENTIONAL VIEW IS THAT THIS REFLECTS DIFFERENCES IN HORMONAL PROFILE AND IN LIFESTYLE. BUT THE DEVELOPMEN DEVELOPMENT OF BOYS AND GIRLS DIFFERS FROM A VERY EARLY STAGE OF EMBRYONIC LIFE. BOYS GROW MORE RAPIDLY. THEY INVEST LESS IN -- THIS IS A MORE DANGEROUS STRATEGY BECAUSE IT MAKES IT MORE LIKELY THAT THEY WILL BE UNDERNOURISHED. AND MAYBE THE SHORTER LIVES OF MEN THAN WOMEN REFLECT THEIR MORE DANGEROUS DEVELOPMENTAL STRATEGIES. THE FOURTH FEATURE IS CO-MORBID IT. CO-MORBID -- CO-MORBIDITY. ONLY 17% OF AMERICANS WITH CORONARY HEART DISEASE ONLY HAVE CORONARY HEART DISEASE. THE OTHER 83% HAVE ONE OR OTHER DISEASES AS WELL. CO-MORBIDITY IS A CHALLENGE. IF YOU ARE A TYPE~2 DIABETES IK AND YOU DEVELOP RENAL PROBLEMS AND HEART PROBLEMS, YOU'VE GOT FOUR DIFFERENT DOCTORS WHO PROBABLY DON'T TALK TO EACH OTHER. CO-MORBIDITY IS ALSO A GEOGRAPHICAL FEATURE THAT ESSENTIALLY THE MAP OF THE INCIDENCE OF OBESITY, DIABETES, STROKE, CORONARY HEART DISEASE, HYPERTENSION ACROSS AMERICA, THEY'RE ALL THE SAME. THEY'RE ALL CLUSTERED AS HIGH INCIDENCE OCCUR IN THE -- AND THE SOUTH AND THE EAST. WELL, DEVELOPMENTAL IDEAS COULD EXPLAIN CO-MORBIDITY BECAUSE SYSTEMS AND ORGANS WHICH HAVE CRITICAL PERIODS WHICH ARE RELATIVELY CLOSE TOGETHER IN TIME ARE LIKELY TO BE AFFECTED TOGETHER. SO THE NEW DEVELOPMENTAL MODEL FOR CHRONIC DISEASE SAYS THAT CHRONIC DISEASES OCCUR THROUGH NORMAL VARIATIONS IN THE NORMAL PROCESSES OF DEVELOPMENT. WE FORGET SOMETIMES THAT BY FAR THE MOST VARIED HUMAN ORGAN IS THE PLACENTA. FOR EXAMPLE, ON THE MATERNAL SIDE OF THE PLACENTA, WE HAVE -- THERE ARE LOBES, COTLY DONEES. SOME DON'T HAVE ANY, SOME HAVE 40. THE AVERAGE IN MY COUNTRY IS 12 IN BOYS AND 13 IN GIRLS. IN INDIA, THE AVERAGE IS SIX. NOBODY HAS AN IDEA OF WHAT THE PURPOSE OF THESE CODLY DONEES IS, SUCH IS OUR PROFOUND IGNORANCE OF THE NORMAL HUMAN PLACENTA. SO -- DELIVERY TO THE FETUS AS THE RESULT OF NORMAL VARIATIONS IN THE PROCESSES OF IMPLANTATION, GROWTH, DEVELOPMENT. THESE NORMAL VARIATIONS LEAD TO BIG VARIATIONS IN NUTRIENT DELIVERY, AND ESTABLISH OR NOT EFFECTIVE SYSTEMS SUCH AS ANTIOXIDANTS, IMMUNE RESPONSES, INFLAMMATORY RESPONSES, NEUROENDOCRINE SETTING, THE BALANCE OF THE AUTO NO MIC SYSTEM AND THE QUALITY AND NUMBER OF STEM CELLS. AND THESE UNDERLIE THE EMERGENCE OF CHRONIC DISEASE. CHRONIC DISEASE IS NOT MANDATED BY GENES PASSED DOWN TO US THROUGH HUNDREDS OF YEARS OF EVOLUTION. WHY WOULD THERE BE SUCH GENES? RATHER, IT IS THE PRODUCT VARIATION OF NORMAL HUMAN DEVELOPMENT AROUND THE WORLD. IF WE WANT TO STEM THE RISING EPIDEMICS OF CHRONIC DISEASE, WE MAY HAVE TO TURN AWAY FROM A MODEL BASED SOLELY ON LIFESTYLE AND GENES. WE MAY HAVE TO TAKE STEPS TO IMPROVE HUMAN DEVELOPMENT. THIS WILL REQUIRE IMPROVEMENTS IN THE BALANCE AND QUALITY OF THE DIETS OF GIRL AND YOUNG WOMEN. AND IT WILL TAKE TIME. MEDICAL INSTITUTIONS HAVE TWO CHOICES, AND THIS SEXER SEISEING US IN MY LIFE IN OREGON, HAS JUST RECEIVED A HUGE FILL AN THROP CAL DONATION. WHAT DO YOU DO? WE CAN SPEND IT ON REPAIRING BROKEN OREGONIANS. THAT'S WHAT DOCTORS DO. BUT WE COULD ALSO SPEND IT AND THEY'RE NOT MUTUALLY EXCLUSIVE ON MAKING BETTER O OREGONIANS WHO DO NOT BREAK DOWN, THANK YOU FOR LISTENING TO ME, AND MY BEST WISHES TO THE NICHD. [APPLAUSE] >> THANK YOU, DR. BARKER. OVER THE LAST 50 YEARS, BASIC SCIENCE ADVANCES AND TRANSLATIONAL SCIENCES HAVE BOTH PLAYED A BIG ROLE IMPROVING THE HEALTH AND WELL-BEING OF CHILDREN AROUND THE WORLD. I WANT TO OFFER UP THE IDEA THAT POLICIES ALSO HAVE A PROFOUND INPUT TO CHILDREN AND THEIR DEVELOPMENT AND REALLY A PROFOUND IMPACT ON CHILDREN'S LIVES. OUR NEXT SPEAKER, DR. NEAL HALFON, HAS DEVOTED MUCH OF HIS CAREER TO IMPROVING EARLY CHILDHOOD -- FOCUS ON THE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AS WELL AS THEIR OVERALL HEALTH. DR. HALFON AGAIN HAS PROVIDED MUCH SERVICE TO THE NICHD IN MANY, MANY CAPACITIES. MOST RECOGNIZED, PERHAPS, BY US IN THIS MOST CURRENT STAGE HAS BEEN HIS ROLE IN HELPING US WITH THE NATIONAL CHILDREN'S STUDY. DR. HALFON. [APPLAUSE] >> IT'S A GREAT PLEASURE TODAY, I WANT TO THANK THE ORGANIZERS FOR INVITING ME. I STAND BEFORE YOU HERE NOT JUST AS A PEDIATRICIAN AND A SCIENTIST AND EPIDEMIOLOGIST AND HEALTH SCIENCES RESEARCHER BUT ALSO A FATHER OF A CHILD WITH HEMOPHILIA, ALSO HAVING SEVERAL KIDS IN OUR IMMEDIATE FAMILY WITH DEVELOPMENTAL DISABILITIES. I STARTED MY CAREER PARTIALLY BECAUSE OF THAT, BECAUSE OF THE DEVELOPMENTAL DISABILITIES. AS A DEVELOPMENTAL NEUROBIOLOGIST WORKING AS A MEDICAL STUDENT IN THE CARNEGIE EMBRYOLOGY OF LABORATORIES AND LOOKING AT TRIDIATED LABELED THYAMADINE TO LOOK AT NERVE CELLS. I CAME TO A POINT IN MY CAREER WHERE I HAD TO MAKE A DECISION, AND RATHER THAN GOING TO THE GENOTYPE, I WENT TO THE ENVIRONTYPE. I DECIDED I WAS GOING TO LOOK AT THE ECOLOGY RATHER THAN AT THE MICROSYSTEMS. WHAT I'M GOING TO DO TODAY IS I'M GOING TO TALK A LITTLE BIT OF A SYNTHESIS FROM CELLS TO SOCIETY AND TRY TO CONNECT DEVELOPMENTAL POTENTIAL INHERENT IN THE INDIVIDUAL BABY THAT'S BORN TO THE POLICY DEVELOPMENTS THAT HELP CHILDREN NOT JUST SURVIVE, BUT THRIVE, AND TRY TO LINK THE DEVELOPMENTAL PROCESS TO THE HEALTHCARE PROCESS. WE FACE IN OUR COUNTRY MAJOR CHALLENGES. WHAT OUR HEALTH POLICY IS TRYING TO DO IS -- THE CHALLENGES ARE ENORMOUS BECAUSE WE HAVE ENORMOUS DISPARITIES. AS WE KNOW, A CHILD BORN NEAR UNION STATION HERE IN WASHINGTON, D.C. COMPARED TO A CHILD BORN IN THIS NEIGHBORHOOD HAS ALMOST A 15-YEAR DIFFERENCE IN LIFE EXPECTANCY, AND THAT'S HARD TO DEAL WITH, GIVEN THE FACT THAT THAT -- RIGHT FROM THE START, THE ODDS ARE STACKED AGAINST HIM. WE HAVE RAPIDLY RISING RATES OF CHRONIC DISEASE AND AGAIN THAT'S BECAUSE OF THE SOCIAL ECOLOGY CHANGING, AND WE HAVE RELENTLESS COST INCREASES. I'M GOING TO ARGUE THAT WE'RE USING THE WRONG STRATEGIES TO ADDRESS THESE ISSUES. USING AN OLD AND OUTDATED OPERATING SYSTEM THAT WE NEED TO UPGRADE THE OPERATING SYSTEM RATHER SIGNIFICANTLY. WE NEED TO THINK DIFFERENTLY BECAUSE MOST HEALTH DISPARITIES START EARLY IN LIFE WITH SMALL DIFFERENCES COMMANDING OVER TIME, SO AS DR. BARKER WAS SAYING, THE LITTLE DIFFERENCES IN SMALL CHILDREN END UP BEING BIG DIFFERENCES IN ADULTS. THE MOST CHRONIC DISEASES ALSO START EARLY DUE TO ADVERSITY, DIFFERENT KINDS OF BEHAVIORS, AND IN ORDER TO SHIFT THE COST CURVE IN OUR COUNTRY, WE NEED TO SHIFT THE HEALTH CURVE, AND IN ORDER TO DO THAT, THAT STARTS EARLY AND I'M GOING TO LAY OUT A DEVELOPMENTAL HEALTH SYSTEM WITH A 3.0 OPERATING SYSTEM TO THINK ABOUT IT. WE ALL KNOW THAT SUBOPTIMAL CHILD DEVELOPMENT, CHILD HEALTH LEADS TO SCHOOL FAILURE, AMID POTENTIAL TO FORM STRONG SOCIAL RELATIONSHIPS, IN THE WAY OUR FAMILIES FORM, SUBOPTIMAL PRODUCTIVITY AND ECONOMIC OUTPUT, AND ALSO SUBOPTIMAL LIFELONG HEALTH WITH HIGH RATES OF CHRONIC HEALTH CONDITIONS AND HIGHER COSTS. WE KNOW IN OUR COUNTRY PRESENTLY, OVER 40% OF CHILDREN ARE LIVING IN FAMILIES WITH UNDER 200% OF THE POVERTY LEVEL AND OVER 40% OF CHILDREN ARE RAISED IN FAMILIES WITH ONE PARENT. CHILDREN THAT LIVE IN THE ECONOMIC SOCIAL ADVERSITY ARE BORN EARLY, ARE SMALLER, MORE FRAGILE AT RISK, WORSE PHYSICAL, COGNITIVE, EMOTIONAL HEALTH, THEY'RE HOSPITALIZED MORE, MORE OBESE, MORE DISABILITY, LOWER HEALTH TRAJECTORIES AND -- BEFORE THE AGE OF 5, THEY CARRY THE BURDEN OF THEIR SOCIAL STATUS INTO ADULTHOOD AND PROGRAMMED INTO THEIR BIOLOGY AS DR. BARKER HAS TALKED ABOUT AND HOW THEIR IMMUNE, ENDOCRINE, NEUROLOGIC SYSTEMS DEVELOP, FUNCTION AND PERFORM. WHILE WE KNOW THESE DIFFERENCES START EARLY, THIS IS FROM STUDIES SHOWING THAT IN CHILDREN'S VOCABULARY DEVELOPED BY AGE 16 MONTHS START TO SPLAY AN BY AGE 36 MONTHS YOU HAVE ALMOST TWOFOLD DIFFERENCE. THIS IS BASICALLY AN INDICATOR OF THE BRAIN DEVELOPMENT THAT'S GOING ON. WHAT WE ALSO UNDERSTAND IS THESE EARLY HEALTH PROBLEMS CASCADE SO BY THE SECOND DECADE, PROBLEMS EARLY ON IN CHILDHOOD AND EARLY HEALTH LEAD TO SCHOOL FAILURE, TEEN PREGNANCY, CRIMINALITY, OBESITY, BLOOD PRESSURE, DEPRESSION, DIABETES, RENAL DISEASE, ARTHRITIS, BY OLD AGE YOU HAVE PREMATURE AGING, MEMORY LOSS, SO THAT IN ESSENCE, ALZHEIMER'S DISEASE IS A DISEASE OF EARLY CHILDHOOD. SO WHEN WE LOOK AT OUR CHILDREN AND HOW THEY'RE FUNCTIONING IN THE UNITED STATES, WE MADE GREAT STRIDE AND WE'VE HEARD A LOT ABOUT THOSE GREAT STRIDES IN TERMS OF AVOIDING DEATHS AND HELPING CHILDREN TO SURVIVE AND MORTALITY RATES CONTINUE TO DECREASE AND THAT'S A GREAT THING. MORBIDITY FOR A LOT OF MEDICAL CONDITIONS HAVE ALSO DECREASED, SO THE NUMBER OF KIDS BEING HOSPITALIZED FOR GASTROENTERITIS AND PNEUMONIA AND OTHER THINGS HAS DECREASED, BUT DISPARITIES IN HEALTH OUTCOMES ARE INCREASING DUE TO SOCIAL INEQUALITY THAT'S INCREASING, EMERGENCE OF NEW MORBIDITIES AND CONCERNS LIKE OBESITY, AD HD, AS FAMILIES ARE MORE SQUEEZED FOR TIME, CHILDREN ARE MORE HURRIED IN THEIR DEVELOPMENT AND WE LIVE IN INCREASINGLY TOXIC ENVIRONMENTS, NOT NECESSARILY CHEMICALLY TOXIC, BUT TOXIC IN OTHER KINDS OF WAYS THAT WE DON'T REALLY COMPLETELY UNDERSTAND. WE KNOW WE'RE SEEING SOME TRENDS WE'RE SEEING WITH THE OBESITY EPIDEMIC CAUSING VARIOUS CHANGES IN OUR SOCIETY BUT WE'RE SEEING LOTS OF CHRONIC HEALTH PROBLEMS INCREASE AND THE OBESITY EPIDEMIC IS THE -- MAJOR CHANGE IN CHRONIC DISEASE IN THE UNITED STATES. GROWING PREVALENCE IN MENTAL HEALTH DISORDERS, GREATER APPRECIATION FOR THE ROLE AND IMPACT OF DEVELOPMENTAL HEALTH PROBLEMS, LEARN, LANGUAGE DISORDERS, GROWING NUMBER OF CHILDREN WITH MULTIPLE HEALTH PROBLEMS AND CO-MORBIDITY AS DR. BARKER WAS TALKING ABOUT, WE'RE SEEING ACTUALLY THIS TROIKA MORE COMMONLY IN CHILDREN, RAISING THE QUESTION IS WHAT'S THE UNDERLYING MECHANISM WHY THIS WOULD BE HAPPENING AT THE SAME TIME. THIS IS SOME RESEARCH THAT WE'VE DONE OVER THE LAST SEVERAL YEARS WITH MY COLLEAGUE AND OTHERS WHERE WE'VE BEEN TRENDING CHRONIC DISEASE, DISABILITY IN THE UNITED STATES FOR 1960, THIS IS STILL 2008. WA YOU SEE IS INCREASE FROM 2% TO ABOUT 8%. AND ACTUALLY OVER THE LAST 10 YEARS IT'S INCREASED ABOUT 16% AND WHAT'S IMPORTANT TO REALIZE IS AT THIS END, THE POSTER CHILD WAS STILL IN BRACES AND ON CRUTCHES AND THE POSTER CHILD NOW IS A CHILD WITH AUTISM. WHAT WE'VE SEEN IS A DRAMATIC SHIFT, PHYSICAL KINDS OF DISABILITIES, MENTAL, BEHAVIORAL AND DEVELOPMENTAL DISABILITY. I CAN'T ADVANCE MY SLIDES. I WISH I REMEMBERED THEM ALL. [LAUGHTER] I THINK I MUST HAVE TILTED IT. LIKE ONE OF THOSE PIN BALL MACHINES. TOO ENERGETIC. ALL RIGHT, GREAT. WHAT WE KNOW NOW IS THAT WE HAVE FOUR TO 6% OF CHILDREN WITH SEVERE DISABILITIES, 12 TO 16% OF KIDS WITH SPECIAL HEALTHCARE NEEDS, ABOUT 30 TO 40% OF CHILDREN THAT HAVE BEHAVIORAL LEARNING PROBLEMS, ABOUT 60% OF CHILDREN PROBABLY GOOD ENOUGH. I SAY GOOD ENOUGH WHEN IN HERE -- HOW MANY PEOPLE HERE HAVE KIDS? ALMOST ALL OF YOU. WHEN YOU LOOKED AT YOUR OWN CHILD DEVELOPMENT, YOU DIDN'T SORT OF SAY, WELL, THEY WERE GOOD ENOUGH. UNLESS YOU HAD A TEENAGER. I MEAN, I HAVE TEENAGERS, AND THEY'RE OFTEN GOOD ENOUGH, BUT YOU'RE TRYING TO OPTIMIZE DEVELOPMENT. SO WHAT PERCENTAGE OF CHILDREN ARE THRIVING? IS IT 30, 40, 50%? WE DON'T REALLY KNOW BECAUSE WE DON'T MEASURE THAT. AND WHAT WE DON'T MEASURE, YOU DON'T MANAGE TOWARDS. SO WE HAVE A HEALTHCARE SYSTEM THAT'S ACTUALLY FRAGMENTED AND PERFORMING POORLY WITH DIFFICULT ACCESSING SERVICES, LOW AND UNEVEN QUALITY MODELS OF CARE THAT ARE INCREDIBLY OUTMODED THAT MATCH THE CURRENT NEEDS OR CAPABILITIES THAT WE HAVE, LIMITED LOCAL RESPONSIBILITY, OPERATING UNDER ENORMOUS CONSTRAINT. AND THIS IS JUST ONE STUDY FROM THE NEW ENGLAND JOURNAL SHOWING THAT LESS THAN 50% OF CHILDREN ARE ACTUALLY GETTING THE AMBULATORY SERVICES THEY NEED AND ACTUALLY IT'S 5 OR 8% LOWER THAN ADULTS SO OUR CHILD HEALTH SYSTEM IS ACTUALLY PERFORMING WORSE THAN OUR ADULT HEALTH CYST SYSTEM. SO WHAT WE HAVE ARE THESE IDEAL TRAJECTORIES THAT WE COULD BE REACHING OUR CURRENT PRACTICE IS A LOT LESS AND WE HAVE THIS INCREDIBLE MISSED OPPORTUNITY IN THIS COUNTRY. SO WITH THESE NEW CHALLENGES AND NEW PARADIGMS, WE HAVE NEW STRATEGIES AND NEW PARADIGMS AND SYSTEMS BIOLOGY, NEW PAIR DIMES AND HEALTH VEMMENT AND NEW ERAS OF HEALTHCARE ORGANIZATION. SO AT THE RISK OF GETTING WAY INTO THE DEEP END OF STUFF THAT I DON'T DEAL WITH ON A DAILY BASIS, IN TERMS OF LOOKING AT THE EMERGING CIRCUITS THAT COME OUT OF THE EMBRY LOGIC PROCESS, WHAT BEAR WITH ME, WE HAVE GONE THROUGH A PROCESS WHERE DARWINIAN EVOLUTION YIELDED THE NEODARWINNIST SYNTHESIS IN MOLECULAR BIOLOGY SOMETIME IN THE MID LAST CENTURY OR BEFORE, THE CLASSIC ONE GENE, ONE PHENOTYPE SORT OF APPROACH. WHAT'S HAPPENED SINCE THEN IS BIOCOMPLEXITY AND OTHER OMICS THAT SEEM TO BE SORT OF PROPAGATING AT RECORD SPEED. I'M GOING TO BE IN POLICYOMICS VERY SOON. BUT WHAT WE'RE NOW IS THIS POST GENOMIC SYNTHESIS, WHICH WAS REALLY ABOUT THE RERANGE OF RELATIONAL GEN E NETWORKS. WHAT WE'RE STARTING TO SEE ARE THE GENOMES IN JEAN NETWORKS AND THE GENE EXPRESSION AND KIND OF -- AND MATHEMATICAL AND ENGINEERING DIAGRAMS THAT ARE TELLING US ABOUT THE EPIGENETIC LANDSCAPE, BASICALLY BRINGING WATTINGTON BACK TO THE FOREIN UP SUSTAININ UNDERSTANDING WHAT EPIGENETICS IS ALL ABOUT. BEFORE THE LAST CENTURY, GERM THEORY, MEDICAL ANATOMIC METHODS LEADING TO OUR BIOMEDICAL MODEL THAT'S STILL THE FOCUS OF MUCH OF WHAT WE DO. IT'S SIMPLE, MECHANISTIC AND LINEAR. WITH THE FRAMING HAMM STUDY AND OTHER EPIDEMIOLOGIC STUDY, OUR MODELS HAVE CHANGED AND OUR MODELS ARE NOW MUCH MORE BIOPSYCHOSOCIAL USING SYSTEMS KIND OF ORIENTATION, MORE HIERARCHAL RELATIONSHIPS OF WHAT CAUSE HEALTH AND HEALTH PROBLEMS. WE'RE MOVING THROUGH THE LIFESPAN AND LIFE COURSE NEURODEVELOPMENT AND THE KIND OF WORK THAT DAVID BARKER AND OTHERS HAVE DONE IS INTO A WHOLE NEW ERA IN WHICH WHAT WE'RE SEEING IS THIS ERA LIFE COURSE LIFE DEVELOPMENT. THIS IS ABOUT COMPLEX RELATIONAL DYNAMIC SYSTEMS THAT REALLY MIRROR THE KIND OF WORK THAT WAS TALKED ABOUT IN TERMS OF THE EMBRYOLOGY AND THEIR DEVELOPMENTAL SYSTEMS. AND WE'RE MOVING IN A WAY SO THAT THESE TWO AREAS ARE COMING TOGETHER EMERGING THROUGH EPIGENETICS INTO A COMMON HEALTH DEVELOPMENT MODEL. SO THAT THE WORK OF THE COMPLEX EMERGING SYSTEMS OF EMBRYOLOGY WILL BE COMING TOGETHER. WE'VE SEEN AN EXPLOSION IN THE A RESEARCH THAT'S BEEN DONE AND PART OF WHAT THIS LEADS TO IS A NEW IDEA OR SET OF PRINCIPLES ABOUT LIFE COURSE HEALTH DEVELOPMENT WHERE WE SEE HEALTH AS THE EMERGING QUALITY OF HEALTH DEVELOPMENT, COMPLEX ADAPTIVE PROCESS THAT OCCURS CONTINUOUSLY ACROSS THE LIFESPAN THAT HELP DEVELOPMENT PROCESSES, MULTIDIMENSIONAL, MULTIDIRECTIONAL, MULTILEVEL SELF ORGANIZING AND MULTIPHASIC THAT HEALTH DEVELOPMENT ISN'T VIEWED WITH PLASTICITY STRATEGIES TO PROMOTE RESILIENCE AND ADAPTABILITY TO CHANGING ENVIRONMENTAL CONTEXT. WHAT DR. BARKER WAS TALKING ABOUT IS WHAT GOES WRONG WHEN THOSE CONTEXTS ACTUALLY PUSH IN THE WRONG DIRECTION THROO SELECTIVE OPTIMIZATION, PREDICTIVE ADAPTIVE RESPONSE AND THE LIKE. AND THESE DEVELOPMENTAL PATHWAYS HAVE TIME-SPECIFIC OR SENSITIVE PERIOD BIOLOGICAL EMBEDDING PROCESSES AS WELL AS TIME DEPENDENT PROCESSES SOCIALLY STRUCTURED. WHO WE THINK ABOUT TIME SENSITIVE PATHWAYS, IT'S THE -- THAT INFLUENCES THE ENDOPHENOTYPE BY INFLUENCING HOW THE MID BRAIN ENDS UP BEING BASICALLY PROGRAMMED -- THE CORTEX IS DEVELOPED AND THE STRESS RESPONSE TAKES PLACE. ACTUALLY STEVE'S WORK PRESTAGED A LOT OF THIS AND WE'RE UNDERSTANDING THIS MORE AND MORE AND HOW THIS HAPPENS IN HUMANS. WE ALSO SEE THIS LEADING TO DIFFERENT KINDS OF HEALTH, MENTAL HEALTH PROBLEMS IN CHRONIC DISEASE. THE BASIC MODEL THAT I'M SHOWING HERE IS THAT WE HAVE THESE ENVIRONMENTAL CULTURAL AND BIOLOGICAL THINGS ALL INTERACTING IN THESE TRAJECTORIES AND THAT WE HAVE THIS PERIOD OF -- WHETHER IT'S 100 YEARS, THOUSAND DAYS AS DR. BARKER TALKS ABOUT, IN WHICH THAT HEALTH POTENTIAL IS BEING LINED UP AND SET FORWARD AND THIS TRAJECTORY THAT TAKES PLACE. I SHOW THIS BECAUSE I LOVE THIS, AND EVERYBODY SHOULD GO OUT AND READ THIS REPORT. IT'S FROM THE -- IT'S ONE OF THE FORESIGHT REPORTS FROM THE U.K. WHERE 60 DIFFERENT GROUPS WERE BROUGHT TOGETHER TO DO RESEARCH REPORTS, BASICALLY THE LOSS OF MENTAL CAPACITY, AND IT'S SOMETHING HERE THAT OUR SOCIAL SECURITY AGENCY AND NIH WILL BE LOOKING AT BECAUSE WHAT THEY WERE TRYING TO FIGURE OUT IS HOW DO THEY BOOST MENTAL CAPACITY THROUGHOUT THE LIFESPAN AND WHAT DOES IT TAKE TO DO THAT. BUT THIS IS THE SAME TRAJECTORY. WE SEE THIS IN BRAIN DEVELOPMENT, THIS IS LOOKING AT GLUCOSE METABOLISM IN THE BRAIN, SYNAPTIC DENSITY. THIS IS LOOKING TO FORCE EXPIRATORY VOLUME IN THE LUNG, SO WE SEE THE SAME TRAJECTORY THAT REPEATS ITSELF BIOLOGICALLY AND IT'S A PATTERN THAT WE SEE ABOUT HUMAN DEVELOPMENT. WHAT WE SEE FROM A POPULATION STANDPOINT IS KIDS CAN GO INTO A DELAYED OR DISORDERED TRAJECTORY OR INTO AN AT RISK TRAJECTORY, AND WHAT DETERMINES THAT ARE THESE RISK FACTORS THAT PUSH DOWN ON THOSE TRAJECTORIES, AND WHAT LEADS TO HIGHER TRAJECTORIES ARE PROTECTIVE FACTORS. HOW DO WE SHIFT THE KUR TO HAVE A HIGHER TRAJECTORY, HOW DO WE MAXIMIZE THE PROTECTIVE FACTORS AND 34EU7 MINIMIZE THE NUMBER OF RISK FACTORS AS WE MOVE FORWARD. THE GOOD NEWS IS WE'RE MOVING OUR HEALTH SYSTEM IN THE RIGHT DIRECTION, THE BAD NEWS IS WE'RE DOING IT VERY SLOWLY. WHEN WE THINK ABOUT OUR HEALTH SYSTEM, THE HEALTH SYSTEM OF YES TERYEAR STARTED WITH FOCUS ON ACUTE CARE AND -- THIS IS GOING BACK TO THE 1850s OR 1900s, WHEN PEOPLE ONLY LIVED TO BE 45 YEARS OF AGE. THE FOCUS WAS ON THE BIOMEDICAL MODEL, WHERE WE INVENTED OUR BASIC MEDICAL CARE MODEL, INSURANCE-BASED FINANCING WAS CREATED TO TAKE CARE OF THESE SHORT TIME FRAME RARE MEDICAL EVENTS AND IT WAS AN INDUSTRIAL MODEL THAT ACTUALLY DEVELOPS OUT OF THAT AS PEOPLE LIVED LONGER TO THE END OF THEIR 60s AND 70s BY THE 1950s, WE SHIFT IT TO A SECOND ERA, THIS IS THE ERA WE'RE IN TODAY OF CHRONIC DISEASE CARE WITH THE BIOPSYCHOSOCIAL RISK FACTOR MODEL FORMED BY THE FRAMINGHAM STUDY. BUT IMPORTANTLY TIME FRAMES IS CHANGED, MUCH LONGER TIME FRAMES WE'RE MANAGING OVER AND WE DON'T DO A GOOD JOB OF THAT AND WE'RE FOCUSING OUR CHRONIC DISEASE MANAGEMENT AND PREVENTION BUT WE'VE SHIFTED OUR FINANCING FROM SHORT TERM VEET OF IMMEDIATE HEALTH INSURANCE TO PREPAID BENEFITS BUT IT'S STILL A PRETTY SHORT TERM VEHICLE. WE'RE MOVING TOWARDS A CORPORATE MODEL OF HEALTHCARE, AND THAT'S WHY KAISERS AND -- THESE ARE THE MODELS FOR WHAT WE'RE MOVING FORWARD. AND WHERE WE'RE HEADED IS TOWARDS A THIRD ERA, WHICH IS REALLY THE FUTURE OF NICHD, WHICH IS TOWARDS THE OPTIMIZING ACHIEVING OPTIMAL HEALTH FOR ALL CHILDREN, FIGURING OUT HOW WE OPTIMIZE DEVELOPMENTAL TRAJECTORIES. THIS IS A LIFESPAN GENERATIONAL APPROACH, AND IT REALLY IS ABOUT INVESTING IN POPULATION-BASED PREVENTION AND REALLY I REINVESTING THE HOUSE POPULATION, FUTURE MODELS ARE GOING TO BE ABOUT NETWORK ORGANIZATION OF HEALTH AND HEALTHCARE SERVICES, SO WE MOVE FROM A 1.0 MODEL TO A 2.0 AND WE'RE HEADING TOWARDS A 3.0. MOST OF THIS COUNTRY IS ABOUT 1.5. THERE ARE PARTS OF OUR INNER CITIES THAT ARE STILL AT 1.0. IF YOU LIVE WHERE I LIVE IN LOS ANGELES AND BRENTWOOD AND SANTA MONICA, THEY'RE ALREADY AT 2.2. WHAT YOU ALSO SEE IN MOST OF EUROPE, THEY'RE AT 2.2. SORT OF MOVING TOWARDS THIS OPTIMIZATION MODEL. AND I BRING BACK THIS MODEL BECAUSE IT'S IMPORTANT, THIS IS WHAT I SHOWED YOU BEFORE ABOUT THE BIOLOGICAL SYSTEMS THEORY IN THE MEDICAL MODEL AND THE MODEL OF HEALTH DEVELOPMENT, BUT WE SEE THIS FIRST ERA, THE SECOND ERA, THE THIRD ERA. THE FIRST ERA BASICALLY IS THE 1.0 MODEL, OUR BIOMEDICAL. THE SECOND WAS THIS BIOPSYCHOSOCIAL MODEL. WE'RE MOVING TOWARDS THIS NEW ONE. SO THE CHALLENGE IS -- I THINK THIS IS REALLY IMPORTANT ALSO -- IS THAT WHAT WE'RE DOING RIGHT NOW IS WE COULD GO INTO A LOW HEALTH TRAJECTORY, A MORE OPTIMAL HEALTH TRAJECTORY, MOST OF US ARE DOWN AT THIS END SO WE'RE FEELING THE GRAVITY OF THE HEALTH TRAJECTORY AFFECTING US AT THIS POINT. WE KNOW THAT MOST OF THE ACTION IS HERE AND PEOPLE BECOME SYMPTOMATIC AND THAT'S WHEN COSTS GO UP. SO IF YOU'RE BORN, YOU KNOW, INTO A POOR FAMILY, YOU HAVE ASTHMA AND OBESITY BY THE TIME YOU'RE 5 YEARS OF AGE AND YOU'RE 50 YEARS OF AGE YOU HAVE DIABETES AND OTHER KINDS OF PROBLEMS, YOUR HEALTHCARE COSTS ARE GOING TO GO UP. IF YOU GO INTO A HIGHER TRAJECTORY, YOUR HEALTHCARE COSTS ARE GOING TO BE QUITE DIFFERENT. THE POINT HERE IS WE'RE SPENDING ALL OF OUR TIME STILL AT THE 1.0 SIDE OF THE EQUATION, TRYING TO BEND THE HEALTH CURVE OR TRYING TO BEND THE COST CURVE, WHICH I THINK IS KIND OF A FOOL'S ERROR. WHAT WE SHOULD BE DOING, IF WE MOVE FORWARD, WE SHOULD BE MOVING TOWARDS 3.0 BECAUSE THE LEVERAGING OF THE ENTIRE SYSTEM, THE HEALTH SYSTEM AND THE POLICY SHOULD REALLY BE FOE KUTION ON HOW TO WE LEVERAGE HEALTH EARLY ON IN LIFE AND REALLY AVOID THE KINDS OF COSTS THAT WE'RE PAYING NEEDLESSLY AND OPTIMIZING HEALTH. SO IF WE'RE GOING TO MOVE THIS AGENDA FORWARD, OUR SCIENCE HAS TO CHANGE AND WE HAVE TO CONTINUE TO MOVE THE CONVERGENCE BETWEEN THE MOLECULAR AND POPULATION HEALTH PATHWAYS, WE DPLEED TO BNEED TO BE CREATING MEASURES OF HEALTH DEVELOPMENT OVER THE LIFE COURSE AND THE CHILDREN STUDY IS TRYING TO DO THIS IN MOVING FORWARD WITH ITS HEALTH MEASUREMENT NETWORK. WE NEED NEW LONGITUDINAL COHORT STUDIES, NEW CLASSIFICATION OF DISEASE AND DEVELOPMENTAL HEALTH. WE'RE STILL USING THE ICD WHICH IS BASICALLY STILL FROM THE 1.0 MEDICAL CATEGORICAL MEASUREMENT, AND WE REALLY NEED TO MOVE TO DIMENSIONAL DEVELOPMENTAL MEASURES OF DISEASE RATHER THAN WHAT WE'VE DONE IN THE PAST. FROM A CLINICAL TRANSLATION STANDPOINT, WE REALLY NEED TO MOVE TOWARD INDIVIDUAL AND POPULATION LEVEL CHANGES, POPULATION HEALTH DEVELOPMENT SO THAT WE'RE ACTUALLY ABOUT SHIFTING THE CURVE FOR WHOLE POPULATIONS. IT'S IMPORTANT TO WORK WITH EACH INDIVIDUAL TRIAL BUT WE NEED TO THINK ABOUT POPULATION STRATEGIES THAT SHIFT THE KURN, WE NEED EARLY AND PRE-EMPTIVE INTERVENTIONS BECAUSE WE'RE GOING TO KNOW A LOT MORE ABOUT THESE DEVELOPMENTAL PATHWAYS AND BE ABLE TO -- WE NEED TO THINK ABOUT WHAT A 3.0 HEALTH DEVELOPMENT SYSTEM LOOKS LIKE AND WHAT ACOs ARE FOCUSED ON 3.0 SYSTEMS WILL LOOK LIKE AND THERE ARE PLACES AROUND THE COUNTRY ACTUALLY STARTING TO DEVELOP WITH GREATER INTEGRATION OF POPULATION AND INDIVIDUAL APPROACHES AND IMPORTANTLY GREATER HORIZONTAL INTEGRATION IN OUR HEALTH SYSTEM OUT TO THE SOCIAL SERVICES SYSTEM, LONGITUDINALLY OVER TIME. WE NEED A LOT OF R & D IN DIFFERENT INVESTMENT VEHICLES BECAUSE FINANCE DRIVES FORM THAT DRIVES FUNCTION. IT'S THE OPPOSITE OF WHAT IT SHOULD BE. SINCE FINANCE IS DRIVING OUR FUNCTIONS, WE NEED FINANCE VEHICLES THAT WE CAN USE FOR LONG TERM HEALTH INVESTMENT. YOU DON'T BUY A ONE YEAR MORTGAGE AND GET A NEW ONE EVERY NOVEMBER IN OPEN ENROLLMENT. WE USE A 30 YEAR VEHICLE THAT ALLOWS US TO INVEST IN OUR OWN CAPITAL. WE NEED SOMETHING SIMILAR IN THE HEALTHCARE MARKETPLACE. THAT'S WHERE ECONOMISTS AND FINANCE GUYS NEED TO COME TOGETHER. WE ALSO NEED TO BE THINKING ABOUT COLLABORATIVE INNOVATION NETWORKS TO STIMULATE IMPROVEMENTS IN INNOVATION AT ALL LEVELS AT STATE AND LOCAL. SO WE NEED TO HAVE A DIFFERENT KIND OF OPERATING LOGIC MOVING FORWARD, THE OLD OPERATING LOGIC, ABSENCE OF THE DISEASE, MAINTAINING OR PROLONGING LIFE, INDIVIDUAL FOCUS, BIOMEDICALLY AND THE LIKE, AND HERE'S THE NEW MODEL, THE NEW OPERATING SYSTEM. SO IF WE'RE GOING TO DESIGN IT, WE NEED TO HAVE DESIGN PRINCIPLES TO MOVE US IN THE RIGHT DIRECTION. THAT MEANS THE PEDIATRIC OFFICE HAS TO BE REDESIGNED. I HAVE 30 OF THESE SLIDES, I'M NOT GOING TO SHOW THEM, BUT JUST TO THINK ABOUT IF WE'RE GOING TO MOVE A 2.5 AND PROVIDE DEVELOPMENTAL HEALTH SERVICES, YOU CAN'T JUST BE AN OFFICE CONNECTED TO THE EMERGENCY ROOM AND TO THE HOSPITAL ESPECIALLY. YOU HAVE TO BE HORIZONTALLY CONNECTED A WHOLE LOT MORE IN YOUR COMMUNITY. THE CMS IS STARTING TO GET IT, THE CENTER FOR MEDICARE AND MEDICAID -- THEY PUT THEIR BIG CHALLENGE OUT WHICH THEY SEE THAT THE HEALTHCARE SYSTEM HAS TO MOVE FROM THE ACUTE SYSTEM FROM 1.0 TO A CHRONIC DISEASE COORDINATED SYSTEM TOWARDS THE COMMUNITY ACCOUNTABLE HEALTH SYSTEMS OF THE FUTURE. THAT'S THE GOAL, THAT'S THE DESIGN. WE HAVE TO FIGURE OUT HOW WE MOVE THERE. SO IF WE'RE GOING TO PUT CHILDREN FIRST, WE NEED A MORE POWERFUL NARRATIVE THAT RECOGNIZES AS WAS SAID EARLIER THAT CHILDREN AREN'T ALL HEALTHY, THAT WE'RE NOT INVESTING ADEQUATELY AND WE HAVE A BROKEN SYSTEM. CONFRONTING VARIOUS CHALLENGES AND CONSTRAINTS THAT WE HAVE, REALLY MOVE TOWARDS CREATING THE LEVERAGING NEW OPPORTUNITIES INCLUDING THE AFFORDABLE CARE ACT AND THE EMERGING INFORMATION THAT IT PROVIDES, THE SCIENCE OF HEALTH DEVELOPMENT THAT WILL BE BROUGHT FORTH BY THE NATIONAL CHILDREN'S STUDY AND OTHER THINGS THAT NICHD WILL BE LEVERAGING IN THE FUTURE. AND NEW MEASUREMENT TOOLS IN SOCIAL NETWORKING INNOVATION. SO TO CONCLUDE, I BELIEVE THAT WE NEED BIG BOLD TRANSFORMATIVE CHANGE AND WHAT WE SHOULD BE THINKING ABOUT IS CHILD HEALTH COMMUNITY NEEDS TO COMMIT ITSELF TO A CHILD HEALTH 2025 INITIATIVE. WE NEED TO ADOPT 3.0 STRATEGIC FRAMEWORK FOR RESEARCH AND HEALTH SYSTEM TRANSFORMATION, AND WE CAN HAVE CHILDREN LEAD THE WAY WITH THE TRANSFORMATION OF THE ENTIRE HEALTH SYSTEM. WE NEED TO MAKE THE UNNECESSARY CATASTROPHIC LOSS OF HUMAN POTENTIAL THAT CURRENTLY EXISTS IN OUR SOCIETY, THE UNAVOIDABLE AND INCONVENIENT TRUTH OF OUR NATIONAL DESTINY, AND THAT WE NEED A CHILD HEALTH FUTURES NETWORK, A NATIONAL INNOVATION NETWORK AND PLATFORM THAT ALLOWS US TO DEVELOP 3.0 RESEARCH, DELIVERY, ORGANIZATION, PAYMENT, HIT, OTHER INNOVATIONS THAT WILL JOLT THE SYSTEM FORWARD. WE NEED CHILD HEALTH TRUST, COMMUNITY ACCOUNTABLE HEALTH SYSTEMS AND THE LIKE. BUT I BELIEVE WE HAVE TO IN THE SPIRIT OF EUNICE SHRIVER BE REBELLIOUS AND CONFRONTATIONAL WITH THE PROBLEM THAT WE SEE IN TERMS OF THE -- A LOSS OF -- THAT HAPPENS EVERY DAY IN THIS COUNTRY WITH MANY, MANY OF OUR CHILDREN. THE FUTURE IS BRIGHT BUT I THINK IT WILL BE EVEN BRIGHTER IF WE CONTINUE IN THE SPIRIT OF EUNICE SHRIVER AND MANY THAT HAVE COME BEFORE US AND REALLY SET OUR SIGHTS ON OPTIMIZING THE HEALTH OF ALL CHILDREN IN THE U.S. I JUST WANT TO MENTION THAT YOU CAN FIND OUT MORE ABOUT THIS LIFE COURSE WORK THAT WE'RE DOING, THE RESEARCH FUNDED NETWORK. THANKS VERY MUCH. [APPLAUSE] >> THANK YOU, NEAL. THANK YOU FOR PUTTING IT ALL TOGETHER FOR US AND GIVING US THE FULL RECOGNITION THAT WE NEED TO TAKE OUR SIGNS AND OUR RESEARCH TO SOCIETY. OUR NEXT SPEAKER IS DR. GEETA SWAMY. I SHOULD SAY THAT IN THE UNITED STATES, WE HAVE MADE SIGNIFICANT PROGRESS IN REDUCING PRETERM BIRTH. BUT THE CHALLENGE IS STILL THERE. THE CHALLENGES CERTAINLY ARE THERE WHEN WE THINK ABOUT REDUCING PREMATURITY WHEN IT COMES TO SPECIAL POPULATIONS, BECAUSE IN IS A GREAT DISPARITY IN THESE ISSUES, PARTICULARLY AS THEY RELATE TO PREMATURITY AND LOW BIRTH WAY. THROUGH HER RESEARCH, DR. SWAMY IS ELUCIDATING THE UNDERLYING CAUSES OF PRETERM BIRTH IN HOPES OF IMPROVING BIRTH OUTCOMES. SHE HAS EXTENSIVE EXPERIENCE IN CONDUCTING BOTH EPIDEMIOLOGICAL AND CLINICAL TRIALS INVOLVING PREGNANT WOMEN. I SHOULD ALSO ADD THAT GEETA GOT HER START AT THE NICHD AND THE NIH AS PART OF THE NIH/NICHD BUILDING INTERDISCIPLINARY RESEARCH CAREERS IN WOMEN'S HEALTH. SHE WAS A BIRCH SCHOLAR. AND IS NOW THE PRINCIPAL INVESTIGATOR OF THE NICHD MATERNAL FETAL MEDICINE UNITS NETWORK AT DUKE UNIVERSITY. DR. SWAMY. [APPLAUSE] >> I THINK IT'S A GOOD DAY AT THIS POINT, SO THANK YOU, DR. MADDOX FOR ORGANIZING THIS MEETING AND INVITING ME. IT'S REALLY A REMARKABLE ENERGIZING DAY TO CELEBRATE, CERTAINLY IMPROVING PREGNANCY OUTCOMES AS PART OF THAT MISSION AS I THINK WE'D ALL AGREE THAT A BABY BORN AT THE HEALTHIEST POTENTIAL IT CAN BE IS GOING TO SET IT ON A BETTER LIFE TRAJECTORY, AND PREMATURITY IS CERTAINLY A LARGE PART OF THAT FOCUS. SO WHEN HE WITH TALK ABOUT PRETERM BIRTH IN THE UNITED STATES, I THINK IT'S IMPORTANT TO REMEMBER IT'S A GLOBAL ISSUE. WHEN WE LOOK AT THE INCIDENCE OF PRETERM BIRTH ACROSS THE WORLD, YOU CAN SEE IN MOST OF THE INDUSTRIALIZED COUNTRIES FOR AREAS SUCH AS EUROPE, AUSTRALIA, CANADA, SEE THAT THE AREAS ARE IN A FAINT PURPLE WHICH INDICATES LESS THAN 10% INCIDENCE OF PRETERM BIRTH. FOR THE U.S. AS WE ALWAYS STRIVE TO BE THE HIGHEST UNFORTUNATELY IS A LITTLE HIGHER IN THAT IN THAT SORT OF NEXT SHADE OF PURPLE, AND THE RANGE OF ABOUT 10 TO 15%. THAT'S ACTUALLY COMPARABLE TO MANY AREAS OF SUBIS A HAIRN AFRICA FOR REASONS THAT ARE STILL UNEXPLAINABLE. THE MARCH OF DIMES RECENTLY RELEASED THEIR ANNUAL REPORT CARD ON PREMATURE BIRTH. THANKFULLY THE INCIDENCE OF PRETERM BIRTH HAS BEEN DECREASING IN RECENT YEARS IN THE UNITED STATES AND WE'RE DOWN TO ABOUT 11.7% LAST YEAR. THAT'S STILL A GRADE C. AND AS YOU CAN SEE BY THIS MAP, THERE'S SIGNIFICANT DISPARITY IN THE INCIDENCE OF PRETERM BIRTH ACROSS OUR COUNTRY. WITH CERTAIN STATES THAT ARE STATED IN THE PURPLE, ACHIEVING A 9.6% OR LESS GOAL RECEIVING A GRADE A, BUT WE STILL HAVE AREAS GREATER THAN F HAVING RATES OF 15% OR MORE, SO WE CERTAINLY CAN AND WANT TO DO BETTER. SO PRETERM BIRTH IS DEFINED AS DELIVERY PRIOR TO -- WEEKS GESTATION AND HAS BEEN INCREASING OVER THE LAST 20 YEARS, PEAKING AT AROUND 12.8% IN 2008 AND DECREASING NOW TO ABOUT 11.7% LAST YEAR. WE THINK THE INCREASE IS DIRECTLY ATTRIBUTABLE TO AN INCREASE IN PRETERM BIRTH OCCURRING IN THE LATE PRETERM PERIOD, 33 TO 36 WEEKS GESTATIONAL AGE RANGE. INTERESTINGLY ENOUGH, DELIVERIES IN THE EARLY PRETERM PERIOD HAVE REMAINED INCREDIBLY STABLE DESPITE OUR CONTINUED EFFORTS TO TRY TO REDUCE THAT. SO THERE IS THIS GROUP THAT CONTRIBUTES THE MAJORITY OF SIGNIFICANT MORBIDITY AND MORTALITY IN NEONATES AS WELL AS A DISPROPORTIONATE SHARE IN THE COSTS WITH PREMATURITY. SO PRETERM BIRTH HAS OBVIOUSLY SIGNIFICANT SEQUELLA FOR NEWBORN INFANTS, PARTICULARLY RELATED TO MORTALITY, RESPIRATORY DISTRESS SYNDROME, SEPSIS, ON THE GOOD SIDE OF THINGS, THE MAJORITY OF THOSE COMPLICATIONS DIMINISH BY THE TIME OF 32 WEEKS SCWES TAITION IS REACHED BUT AGAIN REMEMBERING THE MAJORITY OF PRETERM BIRTH HAPPENED AFTER THAT. SO FOR THOSE WHO SURVIVED FROM PRETERM BIRTH BEYOND INFANCY, WE'D LIKE TO SAY THAT THEY'RE OUT OF THE WOODS BUT THERE STILL IS CONTINUED RISK OF SEQUELLA AND LONG TERM CONSEQUENCES. WE KNOW THAT CHILDREN SUFFER FROM CHRONIC LUNG DISEASE, VISUAL AND HEARING LOSSES AND DEVELOPMENTAL AND NEURAL AB ABNORMALITIES. INCREASED RISK OF PSYCHIATRIC PSYCHIATRIC AND OTHER MEDICAL CONDITIONS. SO WHY HAVE WE HAD SUCH A CHALLENGE WITH PREMATURITY OR PRETERM BIRTH? IT'S ACTUALLY AN UNUSUAL SITUATION. WHEN YOU TALK ABOUT MANY OF THE THINGS WE'VE BEEN HEARING ABOUT THIS MORNING, WE TALK ABOUT A LOT OF THESE THINGS AS BEING A DISEASE. BUT IT'S UNCLEAR, REALLY, IF PRETERM BIRTH IS ACTUALLY A DISEASE. IT'S NOT EXACTLY A CONDITION THAT'S DEFINED BY VERY SPECIFIC SYMPTOMATOLOGY OR ONE SPECIFIC ORGAN SYSTEM PATHWAY THAT LEADS TO THE OUTCOME. IT'S POSSIBLE THAT IT CAN BE CONSIDERED AS A SYNDROME WHERE THERE'S A CONSTELLATION OF SYMPTOMS THAT RESULT IN A COMMON OUT COME OR SIMPLY A HEALTH END POINT OR OUT COME THAT WE DESCRIBE. IT'S ACTUALLY RELATED TO MANY OTHER PATHWAYS THAT LEAD TO THAT. SO IT'S CERTAINLY AN UNUSUAL OR UNIQUE CONDITION BECAUSE WE ACTUALLY DEFINE IT BY ITS TIME OF OCCURRENCE RATHER THAN A DISTINCT CLINICAL PHENOTYPE. IF WE DO THINK ABOUT PRETERM BIRTH AS A DISEASE, THEN WE CAN START TO THICK ABOUT WHAT THE RISK FACTORS MIGHT BE FOR EITHER ACQUIRING OR DEVELOPING THAT DISEASE. CERTAINLY KNOW THAT THERE ARE SIGNIFICANT LIFESTYLE AND SOCIETAL FACTORS ASSOCIATED WITH PREDETERMINE BIRTH, SPECIFICALLY THINGS LIKE LACK OF INADEQUATE PRENATAL CARE, CERTAINLY THERE ARE MEDICAL RISK FACTORS THAT CONTRIBUTE TO PREMATURITY INCLUDING CHRONIC DISEASES SUCH AS HYPERTENSION AND DIABETES AS WELL AS CONDITIONS OCCURRING DURING PREGNANCY SUCH AS MULTI-FETAL GESTATION. WE CERTAINLY KNOW THAT HOST FACTORS PLAY A SIGNIFICANT ROLE AS WELL WHEN WE KNOW THAT THE EXTREMES OF MATERNAL AGE ARE ASSOCIATED WITH PREMATURITY AS WELL AS SPECIFIC RACE GROUPS AND SUBGROUPS AND ETHNICITY AND THAT THERE CERTAINLY IS A HEREDITARY FACTOR OR HEREDITARY TRAIT ASSOCIATED WITH PREMATURITY. SOME OF THESE FACTORS ARE MODIFIABLE BUT MANY ARE ACTUALLY NOT. IF WE'RE WAITING UNTIL THE WOMAN IS ACTUALLY PREGNANT TO TRY TO MEDIATE THESE FACTORS, IT'S LIKELY TOO LATE IN THE LIFE COURSE TO ACTUALLY MAKE A DIFFERENCE FROM THAT SPECIFIC PREGNANCY OUT COME. DEFINING PRETERM BIRTH BY GESTATIONAL TERM ONLY, WHAT WE'VE FOUND IS ONLY IN RECENT YEARS HAVE WE STARTED TO REALIZE THAT WE ACTUALLY NEED TO SEPARATE THAT OUT. SO INDICATED PRETERM BIRTH THROUGH THOSE THAT OCCUR FOLLOWING EITHER MEDICAL REASONS SUCH AS COMPLICATION OF PREGNANCY LIKE PREECLAMPSIA, COMPLICATED DIABETES, OR OTHER RISK FACTORS IN THE MOTHER SUCH AS SIGNIFICANT CARDIOVASCULAR DISEASE, SO ONCE WE'VE STARTED THINKING ABOUT IT IN A DIFFERENT WAY, WE KNOW THAT WE REALLY NEED TO BE LOOKING AT WAYS TO LOOK AT SPONTANEOUS PRETERM BIRTH. REALLY THE TARGET SHOULD BE THE UNDERLYING DISEASE ITSELF. THERE'S MULTIPLE PATHWAYS THAT SEEM TO BE LEADING TO ACTIVATION OF A COMMON PATHWAY THAT ACTS ON GESTATIONAL TISSUES, MAINLY PLACENTA, FETAL MEMBRANES, UTERINE MYOMITRIUM AND THE CERVIX. SOMEHOW THERE'S AN ACTIVATION, WHATEVER THAT PATHWAY IS, OF THOSE TISSUES THAT THEN LEADS TO EITHER A CHANGE IN THE TISSUE ARCHITECTURE ITSELF, LEADING TO CERVICAL CHANGE AND RUPTURE OF MEMBRANES OR ACTUALLY THE ACTIVITY OF THE UTERUS ITSELF LEADING TO LABOR AN DELIVERY. ULTIMATELY WE KNOW THAT THERE UNLIKELY IS GOING TO BE ONE SPECIFIC INTERVENTION THAT'S GOING TO WORK FOR EVERY WOMAN WHO MIGHT BE AT RISK FOR PRETERM BIRTH. THE OTHER ISSUE IS THAT WOMEN DON'T COME IN AND SAY I'M ACTUALLY -- THIS IS THE REASON I HAVE PRETERM LABORER THIS IS THE REASON THAT I AM ACTUALLY AT RISK. SO WE CAN'T REALLY ALWAYS IDENTIFY WHAT THAT CAUSATIVE PATHWAY MAY BE. SO IT'S ACTUALLY IMPORTANT WE START THINKING IN A DIFFERENT CONCEPT WHICH CLEARLY HAS CAUGHT ON IN THE LAST DECADE IN MANY REALMS IS THINKING ABOUT CLINICAL PHENOTYPES RATHER THAN JUST THE SPECIFIC PATHWAY ITSELF. SO THE GATES 230U7B FOUNDATION FOUNDATION DPUNDED FUNDED GLOBAL ALLIANCE -- PUBLISHED A VERY NICE DESCRIPTION OF THE COMPONENTS OF PREMATURITY. THIS CAN UNIFY A LOT OF THE RESEARCH GOING ON ACROSS OUR DISCIPLINE. IT ALLOWS RESEARCHERS TO SPEAK TOGETHER IN THE SAME LANGUAGE, TALK ABOUT THE SIMILAR INCLUSION, EXCLUSION OR CLINICAL CRITERIA FOR STUDY DESIGN AND STUDY ENROLLMENT AND ALSO TO FOCUS ON ACTUALLY THINKING ABOUT WHICH PATHWAYS WE CAN TRY TO TARGET AS WE LOOK AT THESE ACROSS THE SPECTRUM. WE NEED TO THINK ABOUT THE TYPES OF INTERVENTIONS THAT WE HAVE OR THAT WE CAN TRY TO ESTABLISH. PRIMARY INTERVENTIONS ARE THOSE DIRECTED AT ALL WOMEN. WHILE SECONDARY INTERVENTIONS ARE THOSE THAT WOULD BE AIMED AT REDUCING OR ELIMINATING EXISTING RISK FACTOR. TESH RI INTERVENTIONS WOULD NOT BE DIRECTLY AIMED AT PREVENTING PREMATURE BIRTH BUT AT IMPROVING THE OUTCOMES OVERALL FOR PRETERM INFANTS. SO THEY STARTED PUTTING THIS TOGETHER, I STARTED TO TRY TO INDICATE WHICH ONES ACTUALLY HAD SIGNIFICANT RESOURCES FUNDING SCIENTISTS, WHAT NOT, FROM NICHD CONTRIBUTING THOSE AND I HAD TO STOP BECAUSE IT WAS ESSENTIALLY EVERY SINGLE ONE. IT'S CERTAINLY NUMEROUS OBSERVATIONAL COHORT STUDY, RANDOMIZED TRIALS AND SO FORTH THAT HAVE CONTRIBUTED TO THE INTERVENTIONS THAT WE HAVE AND ESSENTIALLY THE MAJORITY OF THOSE HAVE HAD SIGNIFICANT CONTRIBUTIONS FROM NICHD. TRANSFERRING WOMEN PRIOR TO DELIVERY HAS LED TO SIGNIFICANT IMPROVEMENT IN THE OUT COME, THE ADMINISTRATION OF ANTENATAL STEROIDS, TOAKLY TICK AGENTS TO TRY TO DELAY DELIVERY IN ORDER TO IMPLEMENT THE STEROID ADMINISTRATION, ANTIBIOTICS HAVE COME A LONG WAY IN HELPING US TO PROLONG PREGNANCY IN THE SETTING OF PREMATURE RUPTURE OF MEMBRANE AS WELL AS REDUCE NEONATAL GROUP B STREP INFECTIONS. CERTAINLY RECENT STUDIES HAVE SHOWN THAT MAGNESIUM SULFATE IMPROVES OUTCOMES FOR INFANTS BORN PRETERM BY REDUCING RISK OF CEREBRAL PALSY. WHILE THEY'VE REDUCED PREMORBIDDITY AND MORTALITY THEY HAVE NOT HAD A SIGNIFICANT IMPACT ON PRETERM BIRTH INCIDENTS. SO IF WE LOOK AT SECONDARY PREVENTION FOR WOMEN AT RISK FROM PRETERM BIRTH, WE KNOW LOW DOSE SPRAIN AND CALCIUM SUPPLEMENTATION HAVE SHOWN SOME PROGRAMPROMISE, NAMELY BY REDUCING THE INCIDENCE OF PREECLAMPSIA. WE KNOW MODIFIED MATERNAL ACTIVITY, NUTRITIONAL SUPPLEMENTATION, IMPROVED PRENATAL CARE AND ANTIBIOTICS CERTAINLY ARE GOOT MEASURES TO IMPLEMENT, BUT IT'S PROBABLY MORE IN THE CURRENT SCIENCE AND CURRENT SORT OF EXCITING AREAS TO LOOK AT IN AREAS RELATED TO THE CERVIX IN PARTICULAR AND TO THE UTERINE ACTIVITY, AND THOSE HAVE TO DO WITH INTERVENTIONS SUCH AS CERVICAL SIR LAJ, CERVICAL VAGINAL -- FOR SIMILAR FINDING AS WELL AS PROGESTERONE FOR PREVENTION OF -- AS WELL AS TREATMENT FOR SHORT CERVIX. I WANTED TO FOCUS A BIT ON PROGESTERONE TODAY. WE KNOW THAT PROGESTERONE LIKELY WORKS AT NUMEROUS LEVELS, IT PROBABLY WORKS TO HELP PREVENT DEGRADATION OF EXTRACELLULAR MATRIX, STRONG ANTI-INFLAMMATORY AGENT IN CERTAIN SETTINGS, AND CERTAINLY INVOLVED IN PROVINCIAL OF UTERINE CON TRACK TILT. SO WITH ALL OF THESE MECHANISMS WITH LIKELY ARE INTERVENING IN THE PATHWAYS THAT LEAD TO CERVICAL CHANGE OR SHORTENED CERVIX THAT ULTIMATELY WE KNOW ARE HIGHLY ASSOCIATED WITH PRETERM BIRTH AND MAY, THEREFORE, BE IN A CAUSATIVE PATHWAY TO PRETERM BIRTH. SO WHAT DO WE KNOW ABOUT PREVENTION -- THE FIRST TRIAL WAS MATERNAL FETAL MEDICINE NETWORK STUDY, RANDOMIZED TRIAL OF ABOUT 460 WOMEN THAT WERE RANDOMIZED TO RECEIVE EITHER 17 AS A WEEKLY INJECTION VERSUS A PLACEBO INJECTION. THIS IS A FIRST TRIAL ALTHOUGH THE FIRST TRIAL IN THIS ERA, ORIGINAL WORK WAS DONE BACK IN THE 70s BUT WAS ABANDONED FOR VARIOUS REASONS. THE FIRST ONE SHOWED SIGNIFICANT REDUCTION IN PRETERM BIRTH IN THOSE WHO WERE TREATED WITH PROGESTERONE, AS WELL AS IMPROVED OUTCOMES IN THE OFFSPRING. DID SHOW A DELAY IN DELIVERY OR REDUCTION IN PRETERM BIRTH BUT HAD SORT OF MIXED FINDINGS ABOUT THE IMPROVEMENTS IN NEONATAL OUT COME. ALTHOUGH THIS MAY LIKELY BE DUE TO THE SORT OF SMALL SAMPLE SIZE IN THE STUDY, IT WAS POWERED FOR THE PRIMARY OUT COME BUT NOT NECESSARILY TO LOOK AT NEONATAL OUTCOMES THEREAFTER. AS A DISCREPANCY OR A CONFLICTING FINDING, THE O'BRIEN TRIAL ACTUALLY AGAIN ENROLLED WOMEN, ALMOST 660 WOMEN TO RECEIVE VAGINAL PROGESTERONE VERSUS PLACEBO AND ACTUALLY HAD NO SIGNIFICANT DIFFERENCE BETWEEN THE TWO GROUPS. IT'S UNCLEAR WHY THERE'S SUCH SIGNIFICANT DIFFERENCES IN THESE STUDIES, ALTHOUGH LIKELY REASONS TO DIFFERING FORMULATIONS OF THE PROGESTERONE. IT IS FROM THE NICHD TRIAL THAT DATA WAS SUBMITTED TO THE FDA THAT THE FDA DID GET PROVISIONAL APPROVAL FOR 17P AND WE ARE USING THAT IN STANDARD OF CARE NOW FOR WOMEN WHO HAVE HAD A HISTORY OF PRIOR SPONTANEOUS PRETERM BIRTH. FIVE TO SIX WOMEN NEED TO BE TREATED TO PREVENT AT LEAST ONE BIRTH TRY TO 37 WEEKS, 12 NEED TO BE TREATED TO PREVENT DELIVERY BEFORE 32 WEEKS. WHILE THIS IS CERTAINLY EFFECTIVE STRATEGY, WOULD STILL KNOW THIS IS NOT GOING TO BE ENOUGH BECAUSE IT ONLY IMPACTS A VERY SMALL PROPORTION OF THE WOMEN WHO ARE AT RISK AND ULTIMATELY HAVE A SUBSEQUENT PRETERM BIRTH. SO LET'S TALK ABOUT PRIMARY PREVENTION. PRIMARY PREVENTION WOULD BE DIRECTED TO ALL WOMEN. WE KNOW CERTAINLY ESTABLISHING GOOD MATERNAL HEALTH HAS TO BE OBLIGATORY TO IMPROVED FETAL HEALTH OVERALL AS WELL AS PREGNANCY OUTCOMES, SO CERTAINLY THINGS LIKE NUTRITIONAL SUPPLEMENTATION, SMOKING CESSATION AND PERIODONTAL CARE ARE GOING TO BE GOOD MEASURES. HOWEVER, A SCREENING AND TREATMENT STRATEGY IS REALLY PROBABLY WHERE WE'RE GOING TO GET THE BIGGEST BANG FOR OUR BUCK. IT CERTAINLY HAS BEEN OF SIGNIFICANT BENEFITS AND EFFECTIVENESS IN THE AREAS OF THINGS LIKE CERVICAL CANCEL SCREENING, COLON CANCER SCREENING, SO FORTH, AS WELL AS CARDIOVASCULAR DISEASE, BUT SUCH STRATEGIES HAVE REALLY EVOLVED OVER DECADES OF TIME THROUGH EFFORTS WITH EDUCATION, PUBLIC POLICY, THAT HAVE BEEN BUILT AROUND SOUND SCIENCE. SO THE TWO AREAS THAT I THINK ARE EXCITING AREAS FOR POTENTIAL FOR SCREENING AND TREATMENT STRATEGIES FOR PRETERM BIRTH PREVNGS INVOLVE CERVICAL LENGTH SCREENING AND MATERNAL SERUM PROTEOMICS. SO WE LOOK AT CERVICAL LENGTH, THIS IS AGAIN DATA FROM NICHD FROM THE MSM NETWORK PRETERM PREDICTION STUDY WHERE ABOUT 3,000 WOMEN ACTUALLY WERE ENROLLED AND HAD NUMEROUS MEASURES INCLUDING CERVICAL LENGTH MEASUREMENTS AROUND 24 WEEKS OF GESTATION. YOU CAN SEE BY THE BELL CURVE THAT THERE WAS A NORMAL DISTRIBUTION OF CERVICAL LENGTH THROUGHOUT THE STUDY PARTICIPANTS BUT IF WE LOOK AT THE RELATIVE RISK OF PREMATURITY RELATED TO THEIR CERVICAL LENGTH, YOU CAN SEE THAT AS THE CERVICAL LENGTH DECREASES THAT RELATIVE RISK OF PREMATURITY DRAMATICALLY INCREASES. IT'S FROM THAT DATA THAT WE ESTABLISHED THAT DEFINITION OF SHORT CERVIX IS ANYTHING LESS THAN OR EQUAL TO 25 MILLIMETERS. SO IF WE LOOK AT PROGESTERONE SPECIFICALLY FOR THIS USE IN THE SETTING OF SHORT CERVICAL LENGTH. THEY PERFORMED A TRIAL USING VAGINAL PROGESTERONE, THEY ENROLL WOMEN WHO HAVE A CERVICAL LENGTH LESS THAN 15 MILLIMETERS. THEY SHOWED A SIGNIFICANT DIFFERENCE OR DELAY IN DELIVERY AMONG THAT GROUP BUT AGAIN HAD UNCLEAR FINDINGS AS FAR AS IMPROVEMENT IN OUTCOMES. THEY RECENTLY PUBLISHED A TRIAL ENROLLED ALMOST 460 WOMEN WHO HAD A CERVICAL LENGTH OF 10 TO 20 MILLIMETERS AND RANDOMIZED THEM TO RECEIVE VAGINAL PROGESTERONE OR PL PLACEBO. THEY FOUND SIGNIFICANT DIFFERENCE IN THE TIME TO DELIVERY AS WELL AS IMPROVED OUTCOMES FOR THE INFANTS. JUST RECENTLY PUBLISHED FROM THE MSM NETWORK, DR. GROWMAN AND COLLEAGUES PERFORMED A RANDOMIZED TRIAL USING 1700 INJECTIONS IN WOMEN WITH SHORT CERVIX WHO ALSO WERE -- SO THESE WERE WOMEN WHO AGAIN WOULD HAVE BEEN NICE TO FIND AN EFFECTIVE STRATEGY BECAUSE IF WE JUST DEPEND ON THOSE WITH PRIOR PRETERM BIRTH WE MISS THE BOAT ON MANY, MANY WOMEN HAVING THEIR FIRST PREGNANCY. WE DID NOT FIND SIGNIFICANT DIFFERENCE AND ESSENTIALLY THEY WERE THE SAME BETWEEN BOTH GROUPS. SO AGAIN, IT'S UNCLEAR IF SOME OF THESE DIFFERENCES MAY BE PATIENT POPULATION OR PRO JETION TROAN FORMULATION BUT IT IS OUR CURRENT CLINICAL STANDARD THAT WE ARE IMPLEMENTING STRATEGIES TO USE VAGINAL PROGESTERONE FOR THOSE WOMEN WHO HAVE INCIDENTALLY FOUND SHORT CERVIX. THE LAST AREA I WANT TO TOUCH ON IS PROAT YOE MIX, GROWN BY LEAPS AND BOUNDS OVER THE LAST DECADE BUT AGAIN SECONDARY ANALYSIS WAS PERFORMED USING BANKED SAMPLES WHERE THEY LOOKED AT BIOMARKER STRATEGIES TO PREDICT PRETERM BIRTH AS WELL AS NOVEL PROTEOMICS COMBINED. USING ABOUT 160 SAMPLES, HALF BEING FROM WOMEN WHO DELIVERED PRETERM AND HALF DELIVERED AT TERM WERE ACTUALLY ABLE TO IDENTIFY THREE SPECIFIC PEPTIDES IN THE HEAVY CHAIN PROTEIN WHICH IS AN ACUTE PHASE REACTANT AND INVOLVED IN INFLAMMATION. IT WAS SIGNIFICANTLY REDUCED IN WOMEN HAVING SUBSEQUENT PRETERM BIRTH. SO WE LOOK AT THE PREDICTIVE VALUE OF THIS TEST. YOU CAN SEE WHEN THEY USED THE ONE PEPTIDE WITH THE MOST SIGNIFICANT PREDICTION, THE SENSETIVITY OF THAT FOR PREDICTING PRETERM BIRTH SUBSEQUENT TO THE TESTING WAS ABOUT -- WHEN THEY COMBINE THE PEPTIDES WITH ADDITIONAL SIX BIOMARKERS THAT WERE AGAIN INVOLVED IN INFLAMMATION AND SO FORTH, THEY ACTUALLY WERE ABLE TO INCREASE THAT SENSITIVITY TO 87% AND SPECIFICITY TO ABOUT 81%. THIS IS IN COMPARISON TO WHAT WE USE RIGHT NOW, ESSENTIALLY AS FAR AS OUR BEST SCREENING TOOL IS GOING TO BE WITH EITHER PRIOR HISTORY OR SHORT CERVIX. IF YOU LOOK AGAIN AT THE PRETERM PREDICTION STUDY, THE DATA ON SHORT CERVIX REALLY ONLY HAD ABOUT A SENSITIVITY MANY UP TO 50% AND SPECIFICITY OF ABOUT 87% SO THIS LOOKS TO BE QUITE PROMISING. THERE IS AN OBSERVATIONAL COHORT STUDY GOING ON RIGHT NOW TO LOOK AT PROTEOMIC PROFILING IN WOMEN ABOUT 4,000 WOMEN WILL BE ENROLLED, WE'RE EXPECT THE STUDY TO BE COMPLETED SOMETIME NEXT YEAR. SO IN SUMMARY, I THINK PRETERM BIRTH, WE'VE CERTAINLY COME A LONG WAY BUT IT IS A VERY COMPLEX AND MULTIFACTORIAL CONDITION AFFECTED BY NUMEROUS FACTORS ENVOFLING BOTH THE HOST SOCIETAL FACTORS -- DESPITE INTENSIVE RESEARCH EFFORTS, OUR INCREASED KNOWLEDGE OF THE DISEASE PROCESS AND ETIOLOGY HAVE NOT YET TRANSLATED INTO BROAD WIDESPREAD SALE EFFECTIVE STRATEGIES FOR DISEASE REDUCTION. THE SIGNIFICANT IMPACT OF PREMATURITY PREVENTION REALLY IS ONLY GOING TO OCCUR WHEN WE'RE ABLE TO ADVANCE OUR PRIMARY AND SECONDARY INTERVENTION. I PUT UP HERE ANOTHER FIGURE FROM THE GAPS GROUP TO JUST DISCUSS A LITTLE BIT OF HOW I THINK OUR SCIENTIFIC WORLD NEEDS TO THINK ABOUT COLLABORATING. WE ALL DO THIS ON A REGULAR BASIS, BUT SOMETIMES I THINK WE COULD DO IT BETTER. CERTAINLY WE'VE THOUGHT THE SORT OF STANDARD TEACHING WAS WE DO THE SCIENCE, FIGURE OUT WHAT IT IS, SOMEONE DEVELOPS INTERVENTION FROM THAT, SOMEONE FIGURES OUT HOW TO DELIVER THAT. CERTAINLY WE KNOW THOSE HAVE TO BE INTEGRATED, THERE HAS TO BE CROSSTALK AND FEEDBACK BETWEEN ALL OF THOSE GROUPS. LASTLY, I THINK THAT IT'S CERTAINLY BEEN AN INSPIRING DAY AND I WANT TO JUST MAKE A CALL FOR ALL OF US INVOLVED IN OUR SCIENCE, I THINK WE'RE DRIVEN BY ONE OF MY COLLEAGUES LIKES TO SAY IT'S NOT A DESIRE, IT'S AN ADDICTION, WE ALL DO IT BECAUSE WE SORT OF FEEL LIKE WE ARE COMPELLED TO DO IT AND OFTEN CAN'T SEE OURSELVES DOING SOMETHING ELSE. I THINK IT'S ALSO IMPORTANT TO REMEMBER THE ADVOCACY THAT WE CAN ALL BRING TO THE AREA AS WELL AND RECOGNIZING THAT WORLD PREMATURITY DAY WAS JUST RECENTLY, AND THAT IT IS A GLOBAL PROBLEM. AND I'D LIKE TO BRING MY -- THIS IS THE ONLY TIME I REALLY HAVE ACTUALLY PUT A PICTURE OF MY KIDS IN THIS BECAUSE I THINK THAT, AGAIN, THE INSPIRATION HAS TO START EARLY. THIS IS MY EXPERIENCE OF PREMATURITY, MY 35-WEEK BORN TWINS WHO ARE DOING THEIR PART OF SCIENCE AND CONTRIBUTING THEIR SALIVA SAMPLES FOR GENETICS FOR A STUDY THAT THEY'RE ENROLLED IN. SO THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU, DR. SWAMY. THE PASSION LIVES ON. THE QUALITY OF EARLY CHILDHOOD DEVELOPMENT HEF THREDEVELOPMENT HEAVILY IN FLUENCES THE HEALTH, SOCIAL AND ECONOMIC INCOME FOR INDIVIDUAL CHILDREN AND SOCIETY AS A WHOLE. THIS ISN'T SIMPLY A THEORY. BUT AN ECONOMIC FACT OF LIFE. DISTINGUISHED ECONOMIST DR. JAMES HECKMAN HAS SPENT DECADES WORKING WITH A CONSORTIUM OF ECONOMIST, DEVELOPMENTAL PSYCHOLOGISTS, SOCIOLOGISTS, STATISTICIANS AND NEUROSCIENTISTS TO DEMONSTRATE AND TO DEVELOP IDEAS AROUND THIS THEORY, AND WE WOULD SAY THAT HE HAS DEVELOPED THESE IDEAS BEYOND ANY REASONABLE DOUBT. HIS WORK, WHICH HAS BEEN SUPPORTED BY NICHD, IS CURRENTLY FOCUSING ON ANALYZING NEW SOCIAL EXPERIMENTS TO ADVANCE CHILDHOOD INTERVENTIONS. DR. HECKMAN RECEIVED TH THE NOBEL PRIZE IN ECONOMICS AND ECONOMIC SCIENCE IN 2000. DR. HECKMAN. [APPLAUSE] >> I'M VERY PLEASED TO BE ABLE TO SPEAK AT THIS SYMPOSIUM. I WANT TO SHARE WITH YOU A FEW THOUGHTS THAT COME OUT FROM SOME OF THE WORK THAT I'VE BEEN DOING AND WITH SOME OF THE PEOPLE SITTING HERE IN THIS VERY ROOM. I'VE BEEN ASKED TO ADDRESS THREE QUESTIONS. THESE ARE THE THREE QUESTIONS I WANT TO TALK ABOUT IN THE BRIEF TIME I HAVE. FIRST OF ALL, ONE OF THE MOST IMPORTANT QUESTIONS YOU FEEL SEEKS TO ANSWER, WHAT ARE SOME OF THE ADVANCES IN YOUR FIELD IN THE PAST 50 YEARS AND WHAT RESEARCH OPPORTUNITIES MAKE YOU MOST ENTHUSIASTIC FOR THE FUTURE OF THE FIELD. OBVIOUSLY THIS CAN'T BE ANSWERED IN 15 MINUTES, BUT I'LL GIVE IT A VERY SHORT OVERVIEW. I DON'T EVEN KNOW EXACTLY WHAT FIELD I'M SUPPOSED TO REPRESENT. SO I WILL -- [LAUGHTER] BUT LET ME JUST EXPLAIN VERY BRIEFLY, THE FIRST QUESTION IS RELATIVELY EASY TO ANSWER AND THAT IS UNDERSTANDING -- I THINK WHAT IS THE MOST IMPORTANT. I THINK WE'RE ALL IN THIS ROOM AND I THINK WE'RE ALL IN THIS BUSINESS TO SEE H TO DEVISE EFFECTIVE SOCIAL POLICY TO CREATE SUCCESSFUL THRIVING PEOPLE. THESE ARE POLICIES THAT REDUCE INEQUALITY THAT, PROMOTE OPPORTUNITY AND THEY FOSTER SOCIAL MOBILITY. SO THESE ARE OPPORTUNITIES THAT ALLOW PEOPLE, FETUSES, EARLY CHILD, WHATEVER STAGE WE LOOK AT TO REALLY PROSPER TO WHAT THEY CAN BE. SUMMARIZING THE ADVANCES IN THE FEEL OVER THE PAST 50 YEARS IS A VERY ARDUOUS TASK. AND I WON'T BE ABLE TO DO IT. BUT LET ME SUMMARIZE IT VERY BRIEFLY. FIRST OF ALL I WANT TO SAY AND PUT FORWARD THE NOTION OF CAPABILITIES, AND THE WORLD IS PLURAL. WHAT ARE CAPABILITIES? THESE ARE THE CAPACITIES TO FUNCTION IN SOCIETY. TO PRODUCE LIFE OUT COME. WE'VE COME TO UNDERSTAND MUCH MORE ABOUT WHAT THOSE CAPABILITIES ARE, THAT WHEN NICHD WAS FOUNDED SOME 50 YEARS AGO, AND WE RECOGNIZE AND QUANTIFY THESE DIFFERENCES IN CAPABILITIES ACROSS PEOPLE, BUT THE KEY NOTION THAT'S EMERGED FROM A LOT OF THE WORK IN BIOLOGY AND ALSO IN SOCIAL SCIENCE AND IN PSYCHOLOGY IN PARTICULAR HAS BEEN THAT THESE CAPABILITIES ARE MULTIPLE IN NATURE. THEY'RE MUCH MORE THAN WHAT WE USED TO THINK OF 50 YEARS AGO, WHICH WAS I.Q., WHEN WE THOUGHT ABOUT SUCCESSFUL, FLOURISHING PEOPLE. WE'VE COME TO UNDERSTAND THAT A COMMON CORE OF THESE COGNITIVE PERSONALITY AND HEALTH GILDZ SHAPE LIFE OUTCOMES, AND THESE DIFFERENT CAPABILITIES HAVE DIFFERENT IMPORTANCE IN DIFFERENT LIFE TASKS. WE CAN UNDERSTAND HOW WE CAN COMPENSATE IN SOME DIMENSIONS FOR SHORT FALLS IN OTHERS. THIS IS VERY IMPORTANT FINDING. WHAT WAVE COME TO UNDERSTAND, MAJOR CHANGE IN THINKING IN THE LAST 50 YEARS, ARE THESE CAPABILITIES ARE SKILLED, NOT TRAITS. THEY CAN BE ACQUIRED. THE CAPABILITIES ARE NOT SET IN STONE. GENES PLAY AN IMPORTANT ROLE IN SHAPING THEM BUT THEY'RE FAR FROM THE WHOLE STORY. THEY CAN BE FOSTERED BY FAMILIES IN SOCIAL ENVIRONMENT, AND THIS GIVES US SOME REAL CONCERN BECAUSE SOCIAL ENVIRONMENTS, NOT ONLY IN THE U.S. BUT AROUND THE WORLD, HAVE BEEN SUBSTANTIALLY CHALLENGED. WE HAVE A MUCH DEEPER UNDERSTANDING OF THESE CAPABILITIES. WE'VE ALREADY HEARD ABOUT CRITICAL AND SENSITIVE PERIODS. I'LL TALK A LITTLE MORE ABOUT THAT. THESE ARE PERIODS IN THE LIFE OF A CHILD WHERE INVESTMENT AND INTERVENTION ARE MOST PRODUCTIVE. THEY DIFFER FOR DIFFERENT CAPABILITIES. AND IT'S MORE THAN JUST BIOLOGICAL CAPABILITIES. BUT UNDERSTANDING HOW THESE CAPABILITIES EMERGE, WHAT THESE CAPABILITIES ARE, HOW WE MEASURE THEM, PROVIDES A VERY EFFECTIVE WAY TO THINK ABOUT SHAPING SOCIAL POLICY. SO WHAT ARE THE MAIN THEMES? FIRST OF ALL THE POWERFUL ROLE OF THE FAMILY. I THINK NICHD HAS PLAYED A VERY MAJOR ROLE IN UNDERSTANDING AND DEVELOPING HOW EARLY SOCIAL FACTORS AND SOCIAL FACTORS THROUGHOUT THE LIFETIME BUT IN PARTICULAR THE EARLY YEARS PLAY A VERY POWERFUL ROLE IN SHAPING ADULT CAPABILITIES. SECONDLY, WE COME TO UNDERSTAND MULTIPLE CAPABILITIES. AND HOW THEY WORK TOGETHER. THIS IS VERY IMPORTANT. A CORSET OF CAPABILITIES EXPLAINS A LOT OF BEHAVIOR. RELATIVELY LOW DIMENSIONALS, WE CAN UNDERSTAND THAT, THEN WE CAN UNDERSTAND A LOT OF DIFFERENCES AND A LOT OF PROBLEMS AND A LOT OF POSSIBILITIES THAT EMERGE. WE'VE ALSO COME TO UNDERSTAND HOW CAPABILITIES ARE PERFORMED. CAPABILITIES BEE GET CAPABILITIES. THERE'S A FUNDAMENTAL SYNERGISM HERE WHICH IS HE EXTREMELY IMPORTANT TO UNDERSTAND, AND WE'RE STILL IN THE EARLY STAGES OF UNDERSTANDING BUT WE'VE COME TO UNDERSTAND A BIT MORE AND I WANT TO SHARE WHAT THOSE ARE. SO WHAT DO WE THINK ABOUT AS CAPABILITIES? IT SOUNDS LIKE A VAGUE TERM. BIOLOGY PLAYS A VERY IMPORTANT ROLE. COGNITIVE CAPABILITIES, MEASURED BY I.Q. AND AMENT TESTS ARE IMPORTANT PREDICTORS OF LIFE SUCCESS. BUT WE'VE ALSO COME TO UNDERSTAND THAT SOCIAL AND EMOTIONAL CAPABILITIES, SOMETIMES CALLED CHARACTER SKILLS OR PERSONALITY TRAITS, THESE ARE ALSO VERY IMPORTANT. EXAMPLES LIKE MOTIVATION, SOASHABILITY, ABILITY TO WORK WITH OTHERS, SELF REGULATION, SELF-ESTEEM, THESE ARE IMPORTANT FACTORS FOR LIFE SUCCESS AND THESE ARE FACTORS THAT WE'VE COME TO UNDERSTAND THAT CAN BE SHAPED. AND OF COURSE HEALTH AND BIOLOGICAL SYSTEMS, IT'S THE SYNERGISM AMONG THESE CAPABILITIES THAT WE'VE LEARNED TO UNDERSTAND. AND WE'VE ALSO COME TO UNDERSTAND THAT THESE CAPABILITIES ARE HIGHLY PREDICTIVE. NOW THE ONE THING WE'VE ALSO LEARNED FROM A LOT OF RESEARCH SPONSORED BY NICHD DOB BY SOME OF THE PEOPLE IN THIS ROOM IS THAT GAPS IN CAPABILITIES IN CHILDREN OPEN UP VERY EARLY, SOCIOECONOMIC GAPS THIS IS ONE OF MANY GAPS, RESEARCH REPORTED BY NICHD, WHEN WE LOOK FOR EXAMPLE AT THE GAP IN TEST SCORES, THESE ARE COGNITIVE TEST SCORES, AT AGE 18, BETWEEN CHILDREN WHOSE MOTHERS ARE COLLEGE-EDUCATED AND THOSE AT THE BOTTOM OF THE GRAPH, WE SEE CHILDREN WHOSE MOTHERS ARE HIGH SCHOOL DROPOUTS. WE CAN SEE SUBSTANTIAL DIFFERENCES AT 18. THESE GAPS ARE ACTUALLY THERE CERTAINLY AT AGE 5 AND MORE OR LESS THERE AT AGE 3. LONG BEFORE CHILDREN ENTER SCHOOL. SO WE'VE COME TO UNDERSTAND THE EARLY EMERGENCE OF GAPS, AND THESE GAPS CAN ALSO BE SHOWN FOR HEALTH FACTORS AND ALSO ESPECIALLY FOR SOCIAL AND EMOTIONAL FACTORS AS WELL. SO WHAT DO WE MAKE OF THIS? HOW DO WE INTERPRET THIS EVIDENCE? NOW IF WE LOOK AT THE EARLY EMERGENCE OF GAPS, I THINK 50 YEARS, MAYBE EVEN TWEB YEARS AGO, A LOT OF PEOPLE SAY THIS IS GENETIC. MAYBE THE GENES ARE PLAYING AN IMPORTANT ROLE. WHAT DO WE KNOW ABOUT THE RELATIVE IMPORTANCE OF FAMILY ENVIRONMENTS, NEIGHBORHOOD COMMUNITY EFFECTS, GENES AND THE LIKE? WHAT WE'VE COME TO UNDERSTAND, AND WE'RE STILL DEVELOPING THIS EVIDENCE, IS A IMPORTANT BODY OF RESEARCH SHOWING HOW FAMILIES AND ENVIRONMENTS CAN SHAPE, GENES PLAY AN IMPORTANT ROLE, GENE ENVIRONMENT INTERACTION PLAY AN IMPORTANT ROLE IN UNDERSTANDING THIS, AND UNDERSTANDING THE IMPORTANT ROLE OF THE FAMILY IS VERY IMPORTANT. AND HERE I'LL JUST PUT UP A FIGURE WHICH MANY OF YOU HAVE SEEN BUT IT'S IMPORTANT WE REMIND OURSELVES OF THIS. WE KNOW THAT SINGLE PARENTHOOD IS A CAN BE THAT'IS A CONDITION NOT VERY FAVORABLE TO THE FORMATION OF YOUNG CHILDREN, OF CAPABILITIES. WE'VE SEEN DRAMATIC TREND OF THE U.S. POPULATION AS A WHOLE AND IT'S NOT CONFINED IN THE U.S. IT'S TRUE OF MANY COUNTRIES AROUND THE WORLD. IF YOU LOOK AT THE PERCENTAGE OF CHILDREN UNDER 18 LIVING IN SINGLE PARENT FAMILIES THIS HAS GROWN AND THE BIGGEST GROWTH FACTOR, BIGGEST GROWTH SECTOR IS THE GROUP NEVER MARRIED SINGLE PARENTS WHICH TYPICALLY ARE THE MOST ADVERSE PROVIDING THE MOST ADVERSE ENVIRONMENT FOR THE YOUNG CHILDREN. THIS FIGURE HAS BEEN WIDELY TAUGHTED AND WTOUTED, AND THIS IS ALSO ASSOCIATED WITH EARLY ADVERSITY. SO WE HAVE A MAJOR SOCIAL PROBLEM. HART AND RIDLEY HAS ALSO BEEN MENTIONED SO I'LL NEED TO REMINE, ALTHOUGH BETTY HART JUST DIED, SHE CERTAINLY WAS AN IMPORTANT RESEARCHER, BUT CERTAINLY THESE FAMILY DIFFERENCES, FAMILY CONDITIONS SHOW UP IN VERY IMPORTANT WAYS IN THE KINDS OF AFFIRMATION OR DISCOURAGEMENT CHILDREN GET, KIND OF VOCABULARY THEY ACQUIRE AND SO FORTH. EVEN AT AGE 3 IN MY GRAPH, YOU CAN SEE ENORMOUS DIFFERENCES HAVE EMERGED. BUT NOW WHAT DO WE KNOW? WHAT DO WE KNOW? IT'S VERY IMPORTANT THAT WE ACTUALLY FACE THIS. OUT THERE IN THE AUDIENCE, THERE ARE MANY SOPHISTICATED PEOPLE BUT OUT IN THE LARGER WORLD, THERE ARE MANY FEWER SOPHISTICATED PEOPLE. AND THERE'S A LOT OF UNCERTAINTY AND IGNORANCE ABOUT EXACTLY HOW MUCH WE CAN SEE THESE EARLY LIFE EXPERIENCE SHAPING ADULT OUTCOMES, HOW MUCH IT IS THAT'S GENES, BIOLOGICAL EXPERIENCE AND GENE ENVIRONMENT INTERACTIONS. NOW MANY OF YOU HAVE ALREADY SEEN THIS PICTURE OR PROBABLY SEEN THIS PICTURE, IT'S NOW SEVEN YEARS OLD. IT'S BASICALLY SHOWING GENE EGGS PREEXPRESSION PATTERNS IN IDENTICAL TWINS. ON THE LEFT SIDE, CHILDREN WHO ARE 3-YEAR-OLD TWINS AND THE RIGHT SIDE 50-YEAR-OLD TWINS. SO EVEN THOUGH THESE GENES, THESE PEOPLE HAVE IDENTICAL GENES, THE GENE EXPRESSION PATTERN CHANGES DRAMATICALLY AND EVEN AT AGE 3, YOU CAN SEE SUBSTANTIAL DIFFERENCES BUT AT AGE 50, THERE ARE SUBSTANTIAL DIFFERENCES. WHAT DO WE ALSO KNOW? WELL, HERE I'M GOING TO TRUMPET SOME OF MY OWN WORK AND SOME OF THE WORK OF NICHD. A HERO HERE AT NICHD, HE AND I HAVE BEEN WORKING TOGETHER JUST BUILDING ON SOME OF HIS REALLY BASIC RESEARCH. AND TO SHOW, JUST TO SHOW YOU WHY I THINK THIS HAS RELEVANCE FOR STUDIES OF HUMAN POPULATIONS AND WHY SOME DEEPER UNDERSTAND FORG HOUNDERSTANDING FOR HOW WE CAN DEVICE POLICIES. THERE'S A LOT OF WORK IN -- WITH SOME WORK LOOK AGO AT STEVE'S MONKEYS HAVE BEEN INVESTIGATING EPIGENETIC MECHANISMS. WE KNOW THAT THE RHESUS MACHINE MON KEYMONKEYSARE VERY SIMILAR US TO. WITHOUT GETTING INTO THE DETAILS, STEVE CAN ENGINEER EARLY ADVERSITY INTO THE LIFE OF THE YOUNG MONKEYS. AND WE CAN ACTUALLY ASK WHAT HAPPENED. SO HE CREATES THREE DIFFERENT CATEGORIES. I FEEL I SHOULD STOP FOR A MINUTE AND LET STEVE STAND UP AND EXPLAIN. HE'S MUCH MORE ARTICULATE THAN I ON THESE EXPERIMENTS. BUT -- [LAUGHTER] >> GREAT. YOU WANT TO STAND UP HERE AND EXPLAIN THEM? BUT BASICALLY THERE ARE THREE CATEGORIES OF MONKEYS. ONES THAT ARE MOTHER-REARED, SOMEWHAT NORMAL CONDITION, PEER-REARED MONKEYS, REARED BY PEERS IN THE EARLY YEARS OF THEIR LIVES AND SURROGATE PEER-REARED, A CONDITION OF SURROGATE MOTHERHOOD. WHAT WE CAN DO IS LOOK AT THE -- NOT ONLY THE EPIGENETIC TRAITS, WHAT HAPPENS, BUT WHAT HAPPENS IN TERMS OF LATER LIFE ILLNESS AND EXPRESSIONS OF MENTAL HEALTH. SO HERE IS THE EXAMPLE FROM A PAPER WE PUBLISHED LAST SPRING ABOUT DIFFERENTIAL GENE EXPRESSION JUST IN LIEU COSITES. CAN YOU SEE JUST BETWEEN THE SURROGATE PEER REARED MONKEYS AND THE MOTHER REAR MONKEYS, YOU SEE A LOT OF VARIATION JUST IN THIS ONE AREA. IN TERMS OF UPREGULATION AND DOWN REGULATION. YOU CAN THEN TRACE THESE AS TO WHERE DOES THIS LEAD TO IN TERMS OF BIOLOGY, IN TERMS OF THE ACTUAL EXPERIENCE IN THE ORGANISM, AND YOU CAN SEE THAT THERE ARE SOME DRAMATIC INDIVIDUAL SITES THAT ARE CHANGED. WE CAN FOLLOW THESE AND IN FACT THIS IS THE BEAUTY OF THE ONGOING STUDIES. NAMELY, THAT LATER LIFE AFFECTS -- OF THESE EARLY ADVERSE CONDITIONS WHERE WE SEE THE EPIGENETIC TRAITS TRANSLATE DIRECTLY INTO WHAT YOU COULD THINK OF AS A FORM OF MONKEY MENTAL HEALTH PROBLEM, AND SECONDLY INTO DEVELOPING ILLNESSES OF A KIND THAT WE ALL KNOW. SO WE CAN SEE EARLY ON A VERY IMPORTANT EVIDENCE ON THIS SORT. NOW WHAT DO WE KNOW ABOUT CRITICAL AND SENSITIVE PERIOD? THIS HAS BEEN MENTIONED SERL TIMES ANSEVERALTIMES AND I THINK IT'S EXTR EMELY RELATIVE. WE MAY HAVE HAD INTUITION. WE HAVE CERTAINLY NOW HAD MANY, MANY EFFECTIVE DOCUMENTATIONS OF CRITICAL AND SENSITIVE PERIODS, PERIODS WHERE INVESTMENT IS PARTICULARLY EFFECTIVE. THERE ARE A LOT OF GOODBYE LOGICAL EXAMPLES WHICH YOU KNOW, CATARACTS, VITAMIN A DEFICIENCIES, DAVID BARKER'S WORK IS EXTREMELY IMPORTANT, AND INFLUENTIAL. BUT I WOULD JUST SOUND A CAUTIONARY NOTE AND A NOTE TOWARDS THINKING ABOUT THE FUTURE. HERE I PUT UP A FIGURE. THIS IS THE KIND OF LIFE CYCLE FRAMEWORK THAT WE HEARD EARLIER, IN AN EARLIER PRESENTATION. WHAT WE'RE LOOKING BASICALLY AT THE WHOLE LIFE CYCLE OF THE CHILD. SO WE KNOW THE EARLY LIFE CONDITIONS ARE IMPORTANT. WE HAVE A LOT OF EMPIRICAL EVIDENCE. BUT WE ALSO HAVE COME TO UNDERSTAND THAT THIS IS A DYNAMIC PROCESS, AND THIS DYNAMIC PROCESS HAS MULTIPLE INPUTS AND JUST FINDING THE EARLY LIFE CONDITIONS AFFECT LATER LIFE CONDITIONS IS NOT ENOUGH. BECAUSE WE NEED TO ALSO UNDERSTAND THE MECHANISMS OF RESILIENCE AND DEVELOPMENT, AND THAT IS WHERE A LOT OF THE ONGOING RESEARCH WILL GO. SO IN OTHER WORDS, WE NEED TO FILL OUT AND FLESH OUT THIS DIAGRAM TO UNDERSTAND THE DYNAMICS OF HUMAN SKILL FORMATION. EAR WE'RE DRAWING ON A LOT OF EVIDENCE TO DO SO. LET ME JUST TALK ABOUT TWO PROGRAMS WITH WHICH I'VE BEEN ASSOCIATED. FIRST OF ALL, WE KNOW THAT ENRICHED EARLY ENVIRONMENTS CAN COMPENSATE IN PART FOR THE RISKS ARISING FROM DISADVANTAGED ENVIRONMENTS. SO THE MOST ICONIC OF THESE PRAP PROGRAMS, THE OLDEST, ABOUT THE TIMES STEVE'S MONKEYS WERE BEING COLLECTED TOGETHER, EVEN BEFORE HEAD START, WHAT HAPPENED, THIS IS A PROGRAM THAT BASICALLY WAS A PROGRAM THAT TOOK DISADVANTAGED LOW I.Q. CHILDREN, DELIBERATELY CHOSEN TO BE LOW I.Q., PUT THEM IN SCHOOL FOR A FAIRLY SHORT SCHOOL DAY, TWO YEARS, SOME HOME VISITS, FOCUSED BASE CLIS ON TEACHING CHILDREN HOW TO PLAN A TASK, STAY ON A TASK AND REVIEW IT. THEY MET WITH PARENTS EVERY ONE OR TWO WEEKS. WHAT DO WE KNOW ABOUT THIS? THIS IS WHERE OUR THINKING CHANGED COMPLETELY. 50 OR 40 YEARS AGO, WHEN HEAD START WAS FIRST EVALUATED, IT WAS CONSIDERED A FAILURE. WHY WAS IT CONSIDERED A FAILURE? BECAUSE IT DIDN'T BOOST I.Q. AND IT DIDN'T BOOST I.Q. IN FACT, FROM THE PERI PROGRAM, WE FOLLOW THESE PROGRAM, EXPERIMENTALLY ASSIGN PEOPLE THOUGH TREATMENT I JUST DESCRIBED, TREATMENT GROUP, CONTROL GROOP, FOLLOWED TO AGE 40, NOW WE RECEIVED FUNDING TO GO TO AGE 50. BUT WHAT HAPPENED? EVEN THOUGH EARLY ON IN THE PROGRAM, THE I.Q.s OF THE TREATMENT GROUP WAS MUCH MORE SUBSTANTIAL THAN THOSE OF THE CONTROLS. BY THE TIME YOU GET TO AGE 10, THERE'S NO DIFFERENCE WHATSOEVER WHATSOEVER. AND YES WHEN YOU FOLLOW THESE PEOPLE THROUGH THEIR LIFE COURSE, WHAT YOU FIND IS SUBSTANTIAL EFFECTS ON THEIR LIFE OUTCOMES IN TERMS OF THEIR EDUCATION, IN TERMS OF THEIR EARNINGS, IN TERMS OF THEIR LARGER ENGAGEMENT IN SOCIETY. WE CAN SEE THERE'S A SUBSTANTIAL EFFECT. I'M GOING TO FOCUS ON SOME OF THE HEALTH FACTORS WE'VE STUDIED RECENTLY. THESE ARE PERI CHILDREN AROUND AGE 30. SO THESE ARE ALL ADJUSTED, THERE ARE VARIOUS ASPECTS IN DEVISING ANY EXPERIMENT. A LOT OF DISCUSSION ABOUT TESTING FOR MULTIPLE HYPOTHESES. ALL OF THESE YOU SEE SURVIVED ADJUSTMENTS FROM ALL OF THE HYPOTHESIS TESTING. YOU COULD SEE SUBSTANTIAL REDUCTIONS IN RISK FACTORS, YOU CAN SEE SUBSTANTIAL IMPROVEMENT IN HEALTHCARE COVERAGE AND IMPROVEMENT IN HEALTH AS REPORTED. WE'VE COLLECTED DATA ON HEALTH, THE ABC DARIAN PROGRAM CONDUCTED ABOUT 10 YEARS LATER, WHICH THEN SPAWNED THE PROGRAM, THAT PROGRAM NOW WE'RE FOLLOWING, WE HAVE MUCH BETTER MEDICAL DATA AT AGE 30, 34, AND SUBSTANTIAL REDUCTION IN BEHAVIORAL RISK FACTORS, IMPROVEMENT IN HEALTHCARE COVERAGE AND IMPROVEMENT IN HEALTH. SO WHAT HAVE WE LEARNED? WE'VE COME TO UNDERSTAND THE DYNAMICS OF HUMAN CAPABILITY FORMATION. THE CAPABILITIES TO GET CAPABILITIES. IT'S BASED ON THIS DIAGRAM AND IT'S BASED ON AN UNDERSTANDING OF HOW SKILLS CROSS-INTERACT. SO PERSONALITY AND SOCIAL CAPABILITIES ACTUALLY ALLOW ONE TO ACQUIRE SKILLS, COGNITIVE SKILLS, COGNITIVE CAPABILITIES. HEALTH ITSELF FACILITATES EDUCATION. IT FACILITATES ENGAGEMENT IN A LARGER SOCIETY. COGNITIVE CAPABILITIES WE KNOW HAVE IMPROVED HEALTH PRACTICES AND PRODUCED GREATER MOTIVATION. SO WHAT DO WE KNOW? WE HAVE TWO IDEAS HERE. ONE IS STATIC COMPLEN TAIRT AND THE OTHER IS WHAT'S CALLED DYNAMIC. WHAT WE'VE LEARNED IS THAT PRODUCTIVITY OF INVESTMENT IS GREATER FOR MORE CAPABLE PEOPLE. WHEN YOU COMPUTE RATES OF RETURN AND ASK WHAT'S THE ECONOMIC BENEFIT OF GOING TO COLLEGE, FOR A HIGHLY ABLE PERSON, A HIGHLY ABLE STUDENT WHO IS HIGH IN SOCIAL SKILLS, HIGH IN EMOTIONAL SKILLS, HEALTHY, WE GET RATES OF RETURN THAT ARE CLOSE TO 22% PER ANNUM, MUCH GREATER THAN ANYTHING YOU GET IN THE STOCK MARKET FOR AVERAGE INVESTORS. NOW THE NOTION, THOUGH, THIS LEADS TO SOME VIEW THIS MIGHT BE SOCIAL DARWINIST POLICY. THOSE WHO HAVE IT SHOULD GET MORE OF IT BECAUSE IT'S VERY PRODUCTIVE. BUT THIS IS WHERE THE NEW THINKING HAS COME IN. WHAT WE'VE COME TO UNDERSTAND IS THIS DYNAMIC -- IF WE INVEST IN THE -- WE GIVE THEM THE CAPACITY TO TAKE ADVANTAGE OF THAT STATIC COMPLI MEN TEARITY. THEREFORE WHAT WE UNDERSTAND IS THAT BY MAKING DOWNSTREAM INVESTMENT MORE PRODUCTIVE, WE CAN ACTUALLY THEN FIND THAT THE SOCIAL POLICY THAT EMERGES FROM THIS RESEARCH SAYS THIS IS ONE OF THE FEW SOCIAL POLICIES, THERE'S LITTLE TRADEOFF BETWEEN EQUALITY AND EFFICIENCY, THAT WHAT'S SOCIALLY FAIR IS ALSO ECONOMICALLY EFFICIENT. WHY? BECAUSE YOU BUILD A SKILL BASE. SO LATER REMEDIATION WE FOUND IS GENERALLY MORE COSTLY, OFTEN INEFFECTIVE, AND IF WE DO GIVE LATER REMEDIATION, THIS IS WHERE THE NEUROSCIENCE AND THE WORK IN DEVELOPMENTAL PSYCHOLOGY COMES IN, WE'VE COME TO UNDERSTAND THAT THE REMEDIATION THAT WOULD OCCUR IN THE LATER ADOLESCENT YEARS WOULD TAKE A MORE NON-COGNITIVE,LY SAY, OR PERSONALITY ORIENTED NOTION, WHICH IS ASSOCIATED WITH THE SLOWLY DEVELOPING PREFRONTAL CORTEX WHICH ALLOWS ESSENTIALLY INDIVIDUALS TO BE CHANNELED INTO CERTAIN BEHAVIOR. COGNITIVE APPROACHES WHICH HAVE BEEN TRIED IN THE PAST HAVE TURNED OUT TO BE MUCH LESS EFFECTIVE. SO THIS IS A DIAGRAM THAT I'VE TALKED ABOUT A LOT AND I WOULD JUST SIMPLY SAY IT SUMMARIZES A HYPOTHETICAL SCHEDULE THAT'S BACKED UP BY ATE LOT OF EVIDENCE SUPPORTED BY THE NICHD OVER THE LAST 50 YEARS. THAT IF WE ASK OURSELVES AT THE BEGINNING OF LIFE OF A CHILD WHERE IS THE RATE OF RETURN HIGHEST, AND WE SAY WHERE CAN WE SPEND THE FIRST DOLLAR MOST EFFECTIVELY, IT'S IN THE PRENATAL PROGRAM, IT'S REALLY IN TERMS OF WA WE'VE HEARD BEFORE, IN TERMS OF PREVENTING SERIOUS ILLNESS, FETAL ALCOHOL SYNDROME, PREVENTING SOME OF THE MOST SERIOUS JEOPARDY THAT CAN OCCUR IN A CHILD. AS WE GET LATER AND LATER IN LIFE WE FIND THE RETURN IS LOWER. WHY IS THAT? IT'S NOT SAYING THAT AN ABLE PERSON WILL GET A LOW RETURN TO JOB TRAINING, IT'S SAYING THAT PROVIDING THE SKILL OF UP FRONT, PROVIDING THE BASE NOW GENERATES ALL THOSE HIGH RETURNS THROUGHOUT THE LIFE CYCLE. I THINK THAT'S THE IMPORTANT MESSAGE THAT'S EMERGED FROM THIS. SO THEN THE NOTION I THINK AS WE HEARD BEFORE AND I THINK WE'LL HEAR AGAIN IS THAT THE NOTION HAS BECOME INCREASINGLY PREVENTION, NOT REMEDIATION, AND WE ESSENTIALLY PREVENT RATHER THAN JUST TREAT. SO LET ME JUST CONCLUDE BY ANSWERING THE THIRD QUESTION BRIEFLY. WHAT ARE THE NEW RESEARCH OPPORTUNITIES FOR THE FUTURE OF YOUR FIELD? WELL, I WOULD GO BACK TO THIS DIAGRAM. I THINK THIS DIAGRAM HAS TO BE FILLED OUT. EACH STEP HERE, PRENATAL, BIRTH, EARLY CHILDHOOD, WE KNOW THERE WERE MECHANISMS OF REMEDIATION, MECHANISMS OF RESILIENCE, WAYS THAT WE CAN OVERCOME ADVERSITY. I THINK WE'VE COME TO UNDERSTAND THAT THE EARLY YEARS PLAY A VERY IMPORTANT ROLE. WE'VE ALSO COME TO UNDERSTAND THERE'S A LOT OF RESILIENCE AND RESISTANCE AND WE NEED TO UNDERSTAND THOSE FACTORS BETTER. SO I WOULD SAY WE NEED A DEEPER CAUSAL UNDERSTANDING OF THESE LINKAGES, AND TO GO WELL BEYOND TREATMENT EFFECTS, UNDERSTAND THESE CAUSAL MECHANISMS, AND TO BASICALLY CREATE AN ECONOMICS AND A SOCIAL SCIENCE ROOTED IN BIOLOGY AND PSYCHOLOGY THAT ALSO CONTRIBUTES TO THE BIOLOGY AND PSYCHOLOGY, NAMELY, BY PROVIDING EXPERIMENTAL METHODS AND ALSO BY PROVIDING A BASE OF INTERPRETATION. AND SYNTHESIZING THESE THROUGH BIOLOGICALLY BASED FRAMEWORK OF HUMAN DEVELOPMENT. AND ONCE THIS PROGRAM COMES INTO PLACE AND IT'S ALREADY STARTING, WE WILL BE ABLE TO MUCH MORE EFFECTIVELY PRIORITIZE SPENDING ON SOCIAL POLICY. SO THANK YOU VERY MUCH FOR YOUR ATTENTION. [APPLAUSE] >> THANK YOU, DR. HECKMAN. I FEEL THAT NOW IS THE LUNCH BREAK. BUT I REALLY FEEL THAT WE HAVE BEEN REALLY DULY FED THIS MORNING WITH SOME EXCELLENT SCIENCE. LET'S GIVE ALL OF OUR SPEAKERS A ROUND OF APPLAUSE AGAIN. [APPLAUSE] >> IN THIS YEAR OF OUR GOLDEN ANNIVERSARY, WE HAVE MUCH TO CELEBRATE. MUCH ACCOMPLISHMENTS FROM OUR PAST AND OUR FUTURE. NOW IN THE CAREERS FOR FUTURE OF A LIFETIME. I THINK ANY ANNIVERSARY IS CERTAINLY ONE LIKE THE 50TH ANNIVERSARY IS TO HAVE A CELEBRATION OF WHAT WE'VE ACCOMPLISHED, TO THINK ABOUT WHAT WE'VE ACCOMPLISHES, TOTHINK OF WHO WE ARE AS AN INSTITUTION, HOW DID WE GET HERE. MORE IMPORTANTLY THINKING ABOUT THE PAST, THINKING ABOUT THE-FUTURE.HOW HA S WHAT WE'VE DONE IN THE PAST PREPARED US FOR THE FUTURE. HOW DO WE PERHAPS NEED TO REFINE OUR APPROACHES AND EMPHASIS TO MAKE SURE THAT WE ARE PRODUCTIVE OR EVEN MORE PRODUCTIVE FOR THE NEXT 50 YEARS AS WE'VE BEEN OVER THE PAST 50 YEARS. >> SO IN TERMS OF BIRTH DEFECTS RESEARCH, EVERY ORGAN SYSTEM, EVERY MAJOR ORGAN SYSTEM THAT DEVELOPS IN A HUMAN BABY ALSO DEVELOPS IN THE ZEBRA FISH. >> WE'VE ACTUALLY FOUND THAT A NUMBER OF GENES THAT ARE KNOWN TO CAUSE DEFECTS IN HUMANS -- SIMILARLY CAUSED FISH TO HAVE HEMORRHAGES IN THEIR HEAD WHEN YOU KNOCK THESE GENES OUT IN FISH.YOU LEARN MORE ABOUT THE GENE PATHWAY AND HOW THE GENE WORK WITH AN EYE TOWARDS POTENTIALLY HELPING PEOPLE THAT HAVE DEFECTS IN THESE GENES OR THAT HAVE HEMORRHAGIC DEFECTS TO BETTER UNDERSTAND WHAT WE CAN DO TO HELP THOSE PEOPLE. >> THERE ARE SEVERAL NEGATIVE OUTCOMES.-FOR EXAMPLE THERE'S A GREATER RISK OF DYING. 18,000 INFANT DEATHS ARE BORN TO BABIES EACH YEAR.->> THERE'S A TREATMENT F OR WOMEN WHO HAVE SPONTANEOUS PRE TERM BIRTH.-WE DID A STUDY AND FOUND IF THESE WOMEN ARE TREATED AT 16 TO 20 WEEKS WITH A HORMONE PROGESTERONE, WE CAN REDUCE THE CHANCE THAT THESE WOMEN WILL HAVE A PRETERM BIRTH BY ONE THIRD [INDISCERNIBLE] IS A BIRTH DEFECT IN WHICH THE SPINAL COLUMN DIDN'T CLOSE PROPERLY OVER THE SPINAL CORD. TRADITIONALLY BABIES WHO HAVE [INDISCERNIBLE], THEIR SPINAL CORD IS REPAIRED AFTER BIRTH. BUT WE HAVE REASON TO BELIEVE THAT IF WE REPAIRED THE SPINAL COLUMN IN UTERO, THEN THE BRAIN AND THE SPINAL CORD WOULD HAVE A BETTER CHANCE OF DEVELOPING NORMALLY AND THE BABY WOULD DO BETTER. WHAT WE FOUND WAS THE BABY WHO REPAIRED IN THE WOMB HAD MUCH BETTER OUTCOME. THEY WERE LESS LIKELY TO DIE OR HAVE SHUNT PLACEMENT AFTER BIRTHAND THEY H AD LESS MOTOR DISABILITY.%AND 30 MONTHS, TWICE AS MANY O F THOSE BABIES WERE ABLE TO WALK THAN THE BABY WHO HAD REPAIR AFTER BIRTH.>> HIV INFECTION IN CHILDREN W AS BASICALLY A FAILED DISEASE. IN 60% OF CHILDREN DIED BY THE TIME THEY WERE AGE TWO YEARS. AND WE FIRST FOUND THAT USING ONE DRUG REDUCED THE RISK OF DISEASE PROGRESSION ANDCURRENTLY WE USE TH REE OR MORE DRUGS IN THESE CHILDREN AND WE'RE SEEING INCREASED SURVIVAL INTO YOUNG ADULTHOOD. THERE'S BEEN A COMPLETE PARADIGM SHIFT IN HIV FROM A FATAL DISEASE TO CURRENTLY A CHRONIC DISEASE LIKE DIABETES.->> BECAUSE HIV WAS A FATAL DISEASE IN A SENSE, WE REALLY NEEDED TO FIND A WAY TO PREVENT MOTHER TO CHILD TRANSMISSION.AND IN THE EA RLY 1990'S, THE ONLY DRUG AVAILABLE WAS [INDISCERNIBLE] AZT AND WE GAVE THAT DRUG TO THE PREGNANT WOMAN DURING PREGNANCY, DURING LABOR AND TO THE INFANT FOR SIX WEEKS HOPING THAT THAT WOULD BE EFFECTIVE.-I'LL NEVER FORGET, IT WAS PRESIDENT'S DAY WEEKEND, 1994 WHEN THE MONITORING BOARD CAME BACK TO US AND SAID YOU SHOULD STOP THE TRIAL. THIS IS 67% EFFECTIVE IN REDUCING MOTHER TO CHILD TRANSMISSION AND YOU SHOULD LET EVERYONE KNOW THAT THIS IS AN EFFECTIVE THERAPY. >> NEWBORN SCREENING IS A NATION-WIDE SCREENING PROGRAM WITH WELL OVER 99% OF CHILDREN BEING SCREENED. NOW MOST OF THOSE INFANTS ARE PERFECTLY NORMAL AND DON'T HAVE ANY ABNORMALITIES DETECTED BY NEWBORN SCREENING BUT FOR THOSE THAT DO HAVE AN ABNORMALITY YOU CAN INSTITUTE TREATMENTS THAT CAN HELP PREVENT VERY SEVERE COMPLICATIONS INCLUDING INTELLECTUAL DISABILITY, SEVERE DISABILITIES OR EVEN DEATH. THE FIRST CONDISSCREEN IN THE FIRST SCREENING PROGRAM WAS PKU. MOST JEANING PROGRAMS WORD WIDE THAT'S ONE OF THE FIRST TESTS THEY START.-IT IS REMARKABLE TO REALIZE IN THE PAST 50 YEARS WE'VE ACTUALLY BEEN ABLE TO EXPAND NEWBORN SCREENING FROM THAT SINGLE TEST FROM PKU TO NOW 30 DIFFERENT CONDITIONS.-THESE LARGELY DUE TO ALL OF TH E RESATISFY THAT'S BEEN DONE TO HELP US UNDERSTAND THESE CONDITION SO MUCH BETTER. >> SO THE NEWEST AND YOUNGEST OF OUR LONGITUDINAL COHORT STUDIES IS PROJECT VIVA TO LOOK AGAIN AT PRECURSORS OF CHILDHOOD OBESITY, CHILDHOOD HYPERTENSION AND EARLY INDICATIONS OF THE MET -- METABOLIC SYNDROME IN CHILDREN. WE KNOW THAT IN WROTE ROW DERMINGZ THE LIFE. THE LOWER THE [INDISCERNIBLE]LEVELS BY AGE THREE THE CHILD WILL BE SIGNIFICANTLY OBESE. BABIES BORN BY CESAREAN SECTION HAVE TWICE THE RATE OF OBESITY AT AGE 3 AND BABIES BORN VAGINALLY. AND WE'VE ALSO LEARNED THAT VERY EARLY INTRODUCTION OF SOLID FOOD BEFORE FOUR MONTHS OF AGE LEADS TO A VERY SURPRISING SIX TIMES INCREASE IN THE RATE OF CHILDHOOD OBESITY BY AGE THREE. >> SOME OF OUR BASIC FOUNDATIONAL RESEARCH, WE'RE ABLE TO ASSESS THE PREVALENCE AND INCIDENCE OF ABUSE AND NEGLECT AND OTHER KINDS OF RELATIONAL ISSUES THAT MIGHT OCCUR WITHIN A HOME. I'M LOOKING AT THE FAMILY DYNAMICS, HOW MOM AND DAD INTERACT WITH EACH OTHER. HOW THE PARENTS INTERACT WITH THE CHILDREN AND HOW THE SIBLINGS INTERACT WITH EACH OTHER.HELPS US TO REALLY UNDERSTAND WHAT THAT DYNAMIC IS IN THE FAMILY. BECAUSE WE START WITH OUR BASIC FOUNDATIONAL QUESTIONS, WHAT IS THE PREVALENCE AND INCIDENCE OF ABUSE AND NEGLECT.-LET'S SAY FOR EXAMPLE I N FAMILIES THAT ARE EXPERIENCE THE IN POVERTY THAT ARE AT OR BELOW THE POVERTY LEVEL. WHAT ARE THE UNDERLYING MECHANISMS OF POOR CHILD OUTCOMES.-ESPECIALLY CHILDREN WHO MIGHT GROW UP IN THESE KINDS OF CONTEXT.SO HAVING DESCRIPTIVE STUDIES OR STUDIES EPIDEMIOLOGICAL STUDIES OR BASIC BEHAVIORAL AND BIOBEHAVIORAL RESEARCH STUDIES THAT GIVE US ANSWERS TO THOSE QUESTIONS, THEN GIVES RISE TO THE ARRAY OF INTERVENTION-POSSIBILITIES. >> ESTIMATED THAT AWE APPROXIMATELY 80% OF AFRICAN AMERICAN WOMEN AND 70% OF CAUCASIAN WOMEN WILL HAVE FINE -- FIBROIDS AT THE END OF 50. IT WILL HAVE EFFECTS ON THE REPRODUCTIVE HEALTH OF WOMEN NOT%JUST IN T HE UNITED STATES BUT THROUGHOUT THE WORLD. ONE OF MY COLLEAGUES HAS A FIBROID FISH BANKS AND OFFERS THEM FOR RESEARCHES ACROSS THE GLOBE AND SUPPORTS THE RESEARCH-OF INVESTI GATORS NOT ONLY IN THE UNITED STATES BUT THROUGHOUT THE WORLD.>> THE OVERALL GOALS RESEARCH AT THE NICHD ARE TO IMPROVE THE FUNCTION AND QUALITY OF LIFE FOR INDIVIDUALS WHO HAVE SUFFERED ILLNESS OR INJURY OF ALL KINDS INCLUDING TRAUMATIC BRAIN INJURY. BRAIN GATE IS A ELECTRODE ARRAY THAT ARE DIRECTLY IMPLANTED INTO THE SUITABLE CORTEX, THE OUTER LAYER OF THE BRAIN. THESE ELECTRODES CAN RECORD SIGNALS FROM INDIVIDUAL NERVECELLS AND THE Y ARE PROCESSED BY SOME VERY SOPHISTICATED COMPUTER ALGORITHMS TO ALLOW PATIENTS TO ACTUALLY CONTROL EXTERNAL DEVICES BY USING THE SIGNALS FROM THEIR BRAIN.BY ACTUALLY THINKING ABOU T DOING-SOMETHING. >> ETMRI PROVIDES INFORMATION ABOUT PRIERCHLLY ABOUT THE WIRING IN THE BRAIN, THE WHITE MATTER, NERVES THAT TRAVERSE THE BRAIN.-IT CAN PROVIDE INFORMATION ABOUT CLINICAL CONDITIONS SUCH AS AUTISM OR SCHIZOPHRENIA, THINGS THAT HAVE BEEN VERY DIFFICULT TO ANALYZE OR DESCRIBE USING CONVENTIONAL IMAGING METHODS OR EVEN GENETICS. IT PROVIDES INFORMATION ABOUT THE VIABILITY OF A FETUS IN UTERO AND THE HEALTH OF THE MOTHER, AND ALLOWS US TO LOOK AT THE BRAIN STRUCTURE FROM WOMB TO TOMB. >> WHAT MAKES OUR INTRAMURAL PROGRAM UNIQUE IS THAT IT DOESN'T NECESSARILY FOCUS ON A SINGLE DISEASE OR A SINGLE SYSTEM. IT IS FOCUSING ON HUMAN DEVELOPMENT. WE ARE UNIQUELY POSITIONED WITHIN ONE OF THE LARGEST RESEARCH CAMPUSES IN THE WORLD NEXT TO A WONDERFUL CLINICAL RESEARCH CENTER WHERE WE CAN SEE THE BASIC SCIENCE BEING CONTACTED RIGHT NEXT TO WHERE THE PATIENTS ARE. AND SO WE CAN TRANSLATE THESE FINDINGS IMMEDIATELY TO CLINICAL REPLYINGATIONS.->> THE NICHD MISSION IS BR OAD, IT ENCUMPASSES ALL DEVELOPMENT SOME BASIC BIOLOGY THROUGH TRANSLATION MEDICINE THROUGH CLINICAL TRIALS. IT INCLUDES PEDIATRICS, OBSTETRICS, HOCKEYATION MEDICINE-AS WELL A S BASIC SCIENCE RESEARCH AND TOMOGRAPHY AND BEHAVIOR RESEARCH. I SEE IT WORKS CROSS COLLABORATION BOTH WITHIN THE INSTITUTE ACROSS DIFFERENT BRANCHES AS WELL AS OUTSIDE THE INSTITUTES, TO OTHER INSTITUTES, AGE SEATED AND OTHER PROFESSIONAL SOCIETIES AND-ORGANIZATIONS. >> ONE OF THE MANY AREAS ABOUT THE NICHD THAT I AM PARTICULARLY PROUD OF IS OUR COMMITMENT TO HEALTH EQUITY. WE KNOW THAT THERE ARE HEALTH INEQUALITIES IN TERMS OF LENGTH OF LIFE, THE QUALITY OF LIFE AND DIFFERENT RATES OF INFANT MORTALITY AND PRETERM BIRTH, CHILD OBESITY AND DIABETES TO NAME A FEW. OUR RESEARCH IS PEELING AWAY LAYER BILAYER SOME OF THE UNDERLYING BIOLOGICAL AND BEHAVIORAL REASONS FOR THESE HEALTH INEQUITIES.>> AS THE RESEARCH LOOKS MORE CLOSELY AT THE CONCEPT OF DEVELOPMENT ORIGINS OF HEALTH AND DISEASE WITH AN EMPHASIS ON THE ROLE OF THE ENVIRONMENT, YOU'RE LIKELY TO HAVE GREAT SUCCESS AGAINST THESE HEALTH INEQUALITIES AND MOVE TOWARDS AN OPTIMUM HEALTH FOR ALL-AMERICANS. >> THESE ARE GREAT.THERE ARE DIFFERENT KIN DS OF POSSIBILITIES.WHAT THEY HAVE IN COMMON IS THAT WE HAVE SOME NEW RESEARCH TOURS, THEY'RE JUST OPENING NEW DOORS OF EXPLORATION FOR US. AND THAT EXPLORATION WE THINK WILL BE SATISFYING TO WALK THROUGH BUT ALSO IN DOING THAT WILL REALLY GIVE US THE NEW TOOLS TO PREVENT DISEASE, TO BE ABLE TO LOOK AT THE DEVELOPMENTAL LENS WE ALWAYS HAVE, TO BE ABLE FOR INSTANCE TO GET REAL FOR THE IDEA THAT THE CHILD 9 FATHER OF THE MAN AND MOTHER OF THE WOMAN. THAT'S TO REALLY UNDERSTAND HOW EARLY LIFE IS. EVEN BACK IN PREGNANCY HAVE A LIFE LONG IMPACT ON PEOPLE'SHEALTH AND WEL L BEING AND TO USE THAT KNOWLEDGE IN A WAY TO REALLY IMPROVE NOT JUST HEALTH OF CHILDREN BUT HEALTH OF ALL INDIVIDUALS. >> -- THE SCIENTIFIC DIRECTOR [INDISCERNIBLE] INTRAMURAL RESEARCH AT NICHD. WE'RE MOVING ON WITH THE PROGRAM. OUR NEXT SESSION IS ABOUT BEYOND CHILDHOOD, PROMOTING THE HEALTH OF WOMEN, FAMILIES AND INDIVIDUALS WITH DISABILITIES. IT IS MY DISTINCT PLEASURE TO INTRODUCE TO YOU TODAY LYNN LORIAUX.-LYNN WAS FOR MANY YEARS ALONG MANY OF THE NAMES DR. ALEXANDER MENTIONED IN HIS TALK THIS MORNING A LEADING CLINICAL INVESTIGATOR OF THE NICHD'S INTRAMURAL RESEARCH PROGRAM.-HE WAS THE BR ANCH CHIEF OF THE HISTORIC DEVELOPMENT-[INDISCERNIBLE] MANY OF THE TREATMENTS WERE USED TODAY IN ENDROCHRONOLOGY WERE DEVELOPED WHEN LYNN WAS THE CHIEF. LYNN WAS ALSO THE CLINICAL DIRECTOR OF NICHD AND OVER THE YEARS SERVED AS PRESIDENT OF THE ENDOCRINE SOCIETY WINNING MANY AWARDS AND HONORS. IT'S A GREAT PLEASURE TO HAVE LYNN HERE TODAY AND FOR ME TO INTRODUCE HIM. I WAS A MEDICAL STUDENT WHEN LYNN WAS LEADING AROUND IN THE OLD CLINICAL CENTER.-[APPLAUSE] >> THAT WAS A VERY NICE INTRODUCTION.-I REMEMBER YOU WHEN YOU WERE A MEDICAL STUDENT. I REMEMBER YOU AS BEING VERY BRIGHT, FOCUSED, ENERGETIC. I WAS PRETTY SURE YOU WERE GOING TO GO SOME PLACE. I DIDN'T REALIZE IT WOULD BEHERE. I WAS THINKING ABOUT THIS. IF I STAYED HERE, YOU WOULD NOW BE MY BOSS. IF I HAD KNOWN THAT THEN, I WOULD HAVE SPENT A LOT MORE TIME WITH YOU.-[LAUGHTER] WELL, MY CHARGE HERE IS TO TALK A LITTLE BIT ABOUT THE BEGINNING OF TRANSLATIONAL RESEARCH [INDISCERNIBLE] PROGRAM.AND ITS EFFECTS ON WOMEN'S HEALTH AND CHILDREN'S HEALTH AND MAYBE TALK A LITTLE BIT ABOUT WHAT WE MIGHT SEE IN THE FUTURE. IT'S SOMETHING THAT WOULD ENGAGE US SCIENTIFICALLY.I HAVE A CONFLICT OF INT EREST, AT LEAST NOT HERE. IN 1971, THE ENDOCRINOLOGY BRANCH OF THE NC IMPLET MOVED INTO THE NICHD.THIS WAS ALL THE LABORATORY AND OFFICE SPACE IN THE WARD OF BUILDING 10. SCIENTIFICALLY THE PRIME MOVERS WERE THREE ROY HERTZ, GIVE ROSS AND MORT LIPSETT.THOSE OF US WHO TRAINED A T THE TIME THESE PEOPLE WERE SCIENTIFICALLY [INDISCERNIBLE]-AND THEY IM PRINTED TRANSLATIONAL [INDISCERNIBLE] I WANT TO TELL YOU ABOUT THESE THREE MEN AND WHAT THEY ACCOMPLISHED.-AND THEN I WANT TO SPEND JUST A FEW MINUTES THINKING ABOUT WHAT MIGHT BE THE PROBLEMS FOR THE FUTURE. AND THEN WE'LL CALL IT FUNDAMENTAL, RIGHT. THIS IS ROY HERTZ. ROY WAS BORN IN CLEVELAND OHIO, ONE OF SEVEN CHILDREN [INDISCERNIBLE] GENERATION AMERICANS THAT DID VALUE EDUCATION [INDISCERNIBLE] EVERYBODY WENT TO COLLEGE. ROY WENT TO THE UNIVERSITY OF WISCONSIN, MAJORED IN COMPARATIVE LITERATURE. HE REEVALUATED HIS MAJOR AFTER EARNING A C IN LATIN POETRY [INDISCERNIBLE] HIPPEDZ-ASSIGNMENT WAS TO SORT OUT THE ROLE OF THE PITUITARY GLAND-[INDISCERNIBLE ] HE WAS ABLE TO SHOW THAT OVULATION DEPENDED ON [INDISCERNIBLE] TO DO THIS HE DEVELOPED A PARABIOTIC TECHNIQUE WHICH PROVED TO BE CRITICAL [INDISCERNIBLE] INTERACTIONSBETWEEN THE [I NDISCERNIBLE] HE FAILED TO FIND A STEADY RESEARCH JOB SO HE ENROLLED AT THE UNIVERSITY OF WISCONSIN MEDICAL SCHOOL. HE DID AN INTERNSHIP AND JOINED THITES HEALTH SERVICE AND THEY IMMEDIATELY CEPT HIM TO JOHNS HOPKINS TO EARN AN MPH. HE WAS THEN ASSIGNED TO THE PHYSIOLOGY DIVISION OF THE FIELD OF THE MENTAL INSTITUTES OF HEALTH IN 1944 AND ASSUME [INDISCERNIBLE] CHIEF OF THE ENDOCRINOLOGY BRANCH IN 1953. THIS IS HIM [INDISCERNIBLE]BUILDING 10. [INDISCERNIBLE] PROBABLY LIVED UNHAPPILY EVER AFTER.[LAUGHTER] [INDISCERNIBLE] SPAM TAIN JUST REGRESSION [INDISCERNIBLE] OVER LONGS PERIODS OF TIME. I THINK THEY'RE HAVING A LONG TIME FILLING THE WARDS IN THE BEGINNING.THIS YOUNG WOMAN DIED OF [INDISCERNIBLE] SOME THERAPY SHOULD BE [INDISCERNIBLE] IN THESE PATIENTS AND HE TOLD HER [INDISCERNIBLE] THE PATIENT TO HAVE METASTATIC [INDISCERNIBLE] THE SECOND HALF WAS GIVEN [INDISCERNIBLE] THEY WERE THINKING THAT [INDISCERNIBLE] IN THIS PARTICULAR COURSE OF THERAPY, IT WASN'T. [INDISCERNIBLE] OVER THE COURSE OF THIS THERAPY FROM CELLS[INDISCERNIBLE] SO WE CAME TO THE IDEA THAT [INDISCERNIBLE] BUT IT DOESN'T MATTER. TWO MONTHS LATER ANOTHER YOUNG WOMAN -- [INDISCERNIBLE] IV, ANOTHER 50 MEL GRAMS WAS GIVEN THE NEXT DAY. HERE'S HER COURSE OF THERAPY WHERE YOU CAN SEE [INDISCERNIBLE] HAD NO IDEA HOW TO GIVE THIS. THEY JUST STARTED GIVING THIS [INDISCERNIBLE] THEY GAVE HER MORE, REBOUNDED, GAVE HER MORE [INDISCERNIBLE] TO RISE AGAIN. NOT ONLY THIS WAS A REMISSION-BUT IT WAS A CURE OF A METASTATIC [INDISCERNIBLE] [INDISCERNIBLE] THIS PARTICULAR DISEASE. SO ROY HERTZ THOUGHT THIS WAS JUST ENOUGH SO WHEN THE NEXT PATIENT CAME IN A YOUNG WOMAN [INDISCERNIBLE] LEVELS OF ACG THEY NOW GAVE HER A LOADING DOSE OF [INDISCERNIBLE] REBOUNDED ANOTHER DOSE [INDISCERNIBLE] ANOTHER DOSE [INDISCERNIBLE] OF THIS CANCER. THIS WAS A BIG DEAL. [INDISCERNIBLE] BECAME SCIENTIFIC DIRECTOR OF [INDISCERNIBLE] PROBABLY A STORY THERE BUT I COULDN'T FIND IT. [LAUGHTER] [INDISCERNIBLE] AND THEN ASSOCIATE DIRECTOR OF THE [INDISCERNIBLE] BACK TO GW UNIVERSITY PROFESSOR OF PHARMACOLOGY [INDISCERNIBLE] GIVING A TALK OUT THERE [INDISCERNIBLE] FOUND OUT IT WAS ROY HERTZ AND WE BECAME FRIEND AND I WAS ABLE TO [INDISCERNIBLE] AS A SCIENTIST TO THE NIH. HIS AWARDS INCLUDE NATIONAL ACADEMY OF SCIENCES, THE LASKER AWARD AND THE KOCH AWARD [INDISCERNIBLE] HERE'S ROY HERTZ AND HERE'S [INDISCERNIBLE]-THIS IS LASKER. WHO ELSE IS HERE? [INDISCERNIBLE]SORT OF THE GREAT INVESTIGA TOR-AT THAT TIME IN THE FIELD OF CANCER. THERE ARE THREE OTHER THINGS HE D HE BECAME [INDISCERNIBLE] UNBELIEVABLE [INDISCERNIBLE] MIGHT BE POSSIBLE TO MEASURE [INDISCERNIBLE] BIOLOGICAL-FIELDS.HE NEVER DID IT BUT HE WAS THINKING ALONG THE LINE [INDISCERNIBLE] AND IT WOULD HAVE WORKED OUT THE SAME WAY AND WE STILL USE IT NOW [INDISCERNIBLE] LIFE LONG LAB-TEST THEY SH OWED IN A FANTASTIC ONE PAGE PAPER [INDISCERNIBLE]ACTIVE BY NO W. [INDISCERNIBLE] IMMEDIATELY WAS TRANSLATED INTO A [INDISCERNIBLE] WENT TO -- TEACHER'S COLLEGE IN 1942 [INDISCERNIBLE] WENT BACK TO [INDISCERNIBLE] PRIVATE PRACTICE [INDISCERNIBLE] AND HE WAS AT THE [INDISCERNIBLE] WHEN THE WAR WAS OVER WITH THE GI BILL WEALTH TO THE MAYO CLINIC ON FELLOWSHIP AND THERE HE WORK [INDISCERNIBLE] WHO DEVELOPED THE BIOASSAY [INDISCERNIBLE] THIS WAS THE PERFECT TOOL FOR FOLLOWING THE TREATMENT RESPONSE [INDISCERNIBLE] NEEDED SOMEONE TO CONTINUE [INDISCERNIBLE] WOULD INCLUDE THE NIH [INDISCERNIBLE] SO THIS ASSAY IS A [INDISCERNIBLE] PRECIPITATION OF [INDISCERNIBLE] MICE WAS SACRIFICED IN THE FOURTH DAY [INDISCERNIBLE] LABOR INTENSIVE 5,000 MOUSE [INDISCERNIBLE] BETWEEN ACG AND LH AND THE ANTIBODY [INDISCERNIBLE] AND HCG-PRODUCING NEOPLASM. BUT THE TIME WAS RIGHT [INDISCERNIBLE] WAS NOT SEPARATED WITH PATIENT [INDISCERNIBLE] LEVELS OF LH [INDISCERNIBLE] BEGAN TO DEVELOP AN ULTRA SPECIFIC [INDISCERNIBLE] AMINO ACID [INDISCERNIBLE] PEPTIDE UNDER-[INDISCERNIB LE] THEY MADE THEM AVAILABLE TO ANYBODY WHO WANTED THEM. IT WAS THIS ANTIBODY ENZYME LINKED AND IMMOBILIZED ON A SOLID PHASE LED TO SUCH AN IMPORTANT ROLE [INDISCERNIBLE] MENTIONED IN THIS MORTGAGE. -- MENTIONED THIS MORNING. [INDISCERNIBLE] FOR SCIENCE. ONCE HE WAS IN HIS FAMILY MOVED TO SAN FRANCISCO AND COMPLETED HIGH SCHOOL AND GRADUATE WAITED-FROM THE U NIVERSITY OFœ CALIFORNIA WITH A MAJOR IN CHEMISTRY.-HIS EDUCATION WAS INTERRUPTED B Y THE SECOND WORLD WAR HE SERVED AS A MEDIC IN THE 10TH MOUNTAIN DIVISION [INDISCERNIBLE] DECORATED TWICE FOR VALOR [INDISCERNIBLE] SOUTHERN-CALIFORNIA MEDICA L SCHOOL AN INTERNSHIP WITH L.A. COUNTY, RESIDENCY OF [INDISCERNIBLE] NEW YORK TO BE WITH [INDISCERNIBLE] HE MOVED FROM THERE IN 1957 [INDISCERNIBLE] EXCEPT FOR A TWO YEAR PERIOD [INDISCERNIBLE] CANCER CENTER [INDISCERNIBLE] HE SPENT HIS ENTIRE PROFESSIONAL LIVE WITH THE [INDISCERNIBLE] BEGINNINGS OF STEROID DYNAMICS FI [INDISCERNIBLE] WITH GREATCONTRIBUTION [INDISCERNIBLE] HERE AT NICHD. HE WAS AN ADMINISTRATIVE GENIUS AND HE WAS EXCEEDINGLY SKILLED. HE BECAME CHIEF OF THE ENDOCRINOLOGY BRANCH OF THE NATIONAL CANCER INSTITUTE IN 1962. THEN MOVED IN [INDISCERNIBLE]-CHARLIE LOW WAS DIRECTOR AT THE TIME. HE BECAME DIRECTOR OF THE CLINICAL CENTER IN 1976 [INDISCERNIBLE] IN 1984 HE WAS APPOINTED DIRECTOR OF NIADDK AND HELD THE POSITION UNTIL HIS DEATH.-HE'S THE ONLY PERSON EVER TO HAVE HELD THREE DIRECTORSHIPS AT-THE NIH [ INDISCERNIBLE] YOU ALWAYS AGREED WITH WHAT HE TOLD YOU [INDISCERNIBLE] REMARKABLE BECAUSE YOU KNEW HE NEVER MISREPRESENTED HIS POSITION. HE WAS GENEROUS WITH NEITHER COMPLEMENT [INDISCERNIBLE] YOU COULD NOT GIVE [INDISCERNIBLE] ANOTHER PERSON [INDISCERNIBLE] TO THE EXTENT YOU COULD NOT EVEN THANK HIM [INDISCERNIBLE] WOULD-BE REJECTE D. THESE THREE MEN COLLABORATED IN THE [INDISCERNIBLE] THEY FOUND THE FIRST PRO[INDISCERNIBLE]METABOLIC SYND ROME. SO IT WAS A BIG [INDISCERNIBLE] HERE'S WHAT I THINK. FIRST OF ALL THEY ARE ALL SMART AND THEY WERE ALL CREATIVE. THEY HAD THE PICK OF THE LETTER WHEN IT CAME TO [INDISCERNIBLE]-THANK THE VIETNAM WAR AND THE DRAFT [INDISCERNIBLE] IN THE MEDICAL FIELD [INDISCERNIBLE]FOR SURE NOT GOING TO GET SHOT [INDISCERNIBLE]-THEY ALL HAD A [INDISCERNI BLE] SCIENTIFIC PROCESS.THEY WERE IN THE LOB AN D ON THE ROAD EVERY DAY. THE RESEARCH QUESTIONS [INDISCERNIBLE] TO DO THIS. YOU NEED TWO THINGS [INDISCERNIBLE] YOU NEED GOOD GENES AND YOU NEED GOOD [INDISCERNIBLE] THEY HAD THEIR [INDISCERNIBLE] BY FAR THE MOST IMPORTANT THING. THEY DID HAVE SOME GOOD FORTUNE ALONG THE WAY. THAT'S THE BEGINNING, THOSE ARE THE PEOPLE [INDISCERNIBLE] WHAT'S NEXT.YOU REMEMBER [INDISCERNIBLE]CL INICAL ASSOCIATES WERE TERRIFIED OF THIS MAN. WE WOULD GO TO EAT LUNCH [INDISCERNIBLE] AND HE WOULD WALK IN JUST BY RANDOM REMEMBER [INDISCERNIBLE] SO HAVE A NICE DAY.-[LAUGHTER] I'M ONE OF THE FEW PEOPLE THAT WAS TOLD THIS MORE THAN ONCE. BUT I'M TAKING THIS AS WHAT IS THE NEXT [INDISCERNIBLE] WHAT IS THE IMPORTANT -- SO I'M GOING TO TELL YOU, HERE'S WHAT I CHOOSE AND I CHOOSE IT BECAUSE I THINK [INDISCERNIBLE] THIS IS THE TOP OF THE POPULATION OF THE WORLD [INDISCERNIBLE] 10,000 B.C. [INDISCERNIBLE] ANY OF YOU WHO HAVE EVER GROWN [INDISCERNIBLE] YOU WOULD BE ALARMED BY THE SHAPE OF THIS [INDISCERNIBLE]CHANGED WESTE RN MEDICINE THERE WERE 100 MILLION PEOPLE IN THE WORLD.NOW THERE ARE 7 MILLION PEOPLE IN THE WORLD AND [INDISCERNIBLE] 7 BILLIONTH PERSON [INDISCERNIBLE] 90 MILLIONPEOPLE EACH YEAR FOR THE FORESEEABLE FUTURE REACHING 9 BILLION IN 1955 [INDISCERNIBLE] MOST AUTHORITIES BELIEVE THAT THE [INDISCERNIBLE] SOMEWHERE BETWEEN 10 AND 12 BILLION [INDISCERNIBLE] AT THAT TIME YOU CAN BET THE WARS WILL BE FOUGHT OVER A GLASS OF WATER. [INDISCERNIBLE] WE CAN'T DO SOMETHING ABOUT THIS, NOTHING ELSE IS GOING TO MATTER. SO HOPE [INDISCERNIBLE] I THINK THIS IS WHAT'S GOING ON. THIS IS YITS ACCELERATED. THE PRIMITIVE STAGE OF A HIGH DEATH RATE, HIGH BIRTH RATE [INDISCERNIBLE] THE TRANSITION IS TO DIFFERENTIATE [INDISCERNIBLE] BUT IN BETWEEN [INDISCERNIBLE] 90 MILLION PEOPLE.-90 MILLION PEOPLE, THAT'S 1 BILLION PEOPLE EVERY TEN YEARS. [INDISCERNIBLE] I WANT TO SHOW YOU SOMETHING.I FORGOT TO SHOW YOU THIS [INDISCERNIBLE] SEE THIS LITTLE BLIP RIGHT THERE, WORLD WAR II. 70 MILLION PEOPLE. YOU CAN BARELY SEE IT. THERE'S NOT [INDISCERNIBLE] NOT GOING TO BE ABLE TO [INDISCERNIBLE] BASICALLY THE DEATH RATE, THE BIRTH RATE. THE ANSWER IS CONTRACEPTION. YOU'LL SAY PROBABLY EFFECTIVE CONTRACEPTION HAS BEEN AVAILABLE-FOR SOMET IME. THAT IS TRUE [INDISCERNIBLE] TO THE DEGREE IT COULD POSSIBLY COMPETE [INDISCERNIBLE] LARGE PORTIONS OF THE WORLD TODAY [INDISCERNIBLE] SO CONTRACEPTION FOR THIS IS GOING TO HAVE TO BE LOW COST. IT'S GO GOING TO HAVE TO BE ACCEPTABLE EVERY WHERE.-IT'S GOING TO HAVE TO BE ACCEPTABLE, YOU HAVE TO GET AROUND THE PRESCRIPTIONS OF RELIGION AND OTHER THINGS THAT WOULD PREVENT ITS USE WHILE [INDISCERNIBLE] WHICH WE'RE NOT SURE ACTUALLY WHEN LIFE BEGINS ACCURATELY [INDISCERNIBLE] AND IT HAS TO MAKE WOMEN FEEL BETTER BY TAKING IT AND FOR TAKING IT. YOU CAN HAVE TO UNDERSTAND [INDISCERNIBLE] ONE OF OUR LAST CHANCES. SO I NOT JUST, THE CHALLENGE HERE IS NOT JUST CONTRACEPTIVE-AND IT'S JU ST NOT GIVING IT OUT, IT'S ARRANGING THE CARDS ON THE DECK SO IT CAN ACTUALLY BE USED AGGRESSIVELY IN HOW MANY YEARS WE HAVE LEFT. 7 ON-80, I DON'T KNOW HOW MANY YEARS WE HAVE LEFT. ANYONE WHO HITS THAT NUMBER [INDISCERNIBLE] SO YOU KNOW THIS ONE LIFE IS SHORT ART IS LONG OPPORTUNITIES FUGITIVE EXPERIENCE DELUSIVE, JUDGMENT [INDISCERNIBLE] LIKEWISE TO SECURE THE COOPERATION OF THE PERSON YOU'RE DESCRIBING IT TO AND [INDISCERNIBLE] FRIENDS AND COMMUNITY [INDISCERNIBLE] AGENTS SUCH AS [INDISCERNIBLE] TRYING TO PREVENT THIS ONE WAY OR ANOTHER. WE NEED TO PAY ATTENTION TO [INDISCERNIBLE] SO MY LAST SLIDE HERE [INDISCERNIBLE] CRITICIZE-HIS OWN TAL KS SO OTHER PEOPLE WOULDN'T DO IT. BY THE WAY, I'M RIGHT AT 20 MINUTES SO I KNOW THERE'S NO TIME FOR QUESTIONS BUT THIS IS WHAT HE SAID ABOUT HIS OWN TALK. A THROUGH Z. THE AUTHOR IS AWARE THAT THERE HAS BEEN A GOODLY SPRINKLING OF METAPHYSICS AMONG THE RECORDING OF SOME EXPERIMENTAL FACTS.THE TALKS WILL BE STIMULATED BY THIS PRESENTATION IF NOT BY TRUTHS WHY THEN BY ERRORS [INDISCERNIBLE]I WANT TO THANK YOU AGAIN F OR YOUR INVITATION TO COME HERE, I'M REALLY HONORED.-[APPLAUSE] >> NOW YOU KNOW WHY I HAVEN'T FORGOTTEN THESE ROUNDS.SO I'M PRIVILEGED T O INTRODUCE TO YOU WILLIAM CROWLEY -- SCIENCES IS ONE OF THE 1 FUNDED NATION-WIDE.YOU HEARD FROM DR. ALEXANDER THIS MORNING ABOUT THE YEARS OF [INDISCERNIBLE] HERE IS THE LONG TIME NICHD FUNDED INVESTIGATOR WHO WAS INSTRUMENTAL FOR GENERATION DISCOVERY AND CLINICAL USE. DR. CROWLEY HAS WON MANY AWARDS AND I'M NOT GOING TO LIST THEM. HE'S TRULY REVERED BY PHYSICIANS AND SCIENTISTS AROUND THE WORLD SETTING THE EXAMPLE AS AN MENTOR IN A CLINICAL INVESTIGATOR AND ACADEMIC SCIENTIST. DR. CROWLEY WAS THE FIRST MAN TO RECEIVE THE MENTOR OF THE YEAR BY WOMEN IN ENDOCRINOLOGY IN 2001 BECAUSE IT'S ALWAYS INSPIRING AND I SEE, I KNOW YOU WILL AGREE WITH ME WHEN YOU HEAR HIS TALK TODAY. BILL IS NOT JUST AN NICHD -- HE'S A MEMBER OF OUR FAMILY, A MEMBER OF THE NICHD FAMILY AND NOW HE SERVES AS A MENTOR TO OUR INVESTIGATORS.-BILL.[APPLAUSE] >> THANK YOU FOR THAT GENEROUS INTRODUCTION, CONSTANTINE. I DO FEEL AT HOME HERE MANY OF MY PROGRAMS WERE DONE COLLABORATIVELY WITH LYNN AND GORDON WHO IS SITTING NEXT TO HIM, OLD AND DEAR FRIENDS OF MINE.-I WAS REALLY THRILLED TO BE INVITED BY CONSTANTINE TO SPEAK HERE. I DID HOWEVER HAVE SOME MISGIVINGS BECAUSE FOLLOWING LYNN LORIAUX IS NEVER AN EASY TASK BUT TO PUT THIS IN REPRODUCTIVE BIOLOGY TERMS,ATE ALLOWS YOU TO KNOW HOW THE PLACENTA FEELS. A LITTLE INSIDE REPRODUCTIVE HUMOR. [LAUGHTER]-I'VE BEEN LUCKY ENOUGH TO BE AN INCUMBENT OF THE NICHD FOR 35 YEARS AND I WOULD LIKE TO REVOW THAT EXPERIENCE WITH YOU.NOW 35 YEARS GOES INTO 20 MINUTES IN SMALL NUMBERS. SO THERE WERE TWO OPTIONS. ONE WAS TO -- AND THE OTHER ONE WAS TO DO A LITTLE EDITING SO I'M GOING TO TAKE SOME EDITING CHOICES THROUGH HERE.SCIENCE ACTUALLY PUT FORT A VERY INTERESTING CELEBRATION IN ITS 125TH YEAR BY PUTTING IN 125 GREAT QUESTIONS IN BIOLOGY AT THE TIME. AND QUESTION NUMBER 82 IS NO ONE KNOWS EXACTLY WHAT FORCES CHILDHOOD TO END. THAT IS WHAT REALLY TRIGGERS PUBERTY ONE OF THE GREAT BIOLOGIC MISS TREES OF ALL TIME. YOU HAVE TO INTRODUCE THE HOLY TRINITY THAT EVERY -- THEORIES OF PROTEINS GOING BACKWARD. HAVING TO DISPENSE WITH THEOLOGY IN THIS FIELD, WE CAN NOW FOCUS DIRECTLY ON THE PRIME MOVERS HERE WHO ARE THESE SMALL GNRH NEURONS THAT DIRECT THIS ENTIRE PROCESS. THE PROBABLE IS IT'S A DAUNTING PROBLEM IF YOU WISH TO USE A HUMAN PATIENT MODEL BECAUSE THE TECHNICAL AND REGULATORY DIFFICULTIES ARE PROBLEMS, PROBLEMATIC.FIRST OF ALL THEY'RE SMALL IN SIZE HENCE THEIR NAME [INDISCERNIBLE] AND IN MOST MAMMALS THEY ONLY CONSIST OF 1200 HUMANS TO 1500. THEY ARE DISBURSED IN A NETWORK BOARD LIKE FASHION BECAUSE THEY'RE READING SENSORY INPUTS FROM ALL SENSES, OLFACTION, WEIGHT, OUTSIDE, TEMPERATURE, LIGHT/DARK CYCLES AND MONITORING THESE. THIS IS HIGHLY VARIABLE ANATOMICALLY WITHIN SPECIES AND OF COURSE WE CAN'T MEASURE THE MAJOR OUTPUT BECAUSE IT'S CONFINED TO THE BLOOD SUPPLY BY A SHORT HALF LIFE. SO WE HAVE TO MEASURE FREQUENT SAMPLING IN USING LH AND FREE ALPHA SUBUNIT AND YOU MUST DO RESEARCH IN CHILDREN AND ADOLESCENCE.-THAT USUALLY CLEARS THE AUDIE NCE OF YOUNG PEOPLE ACTUALLY WHO-DON'T WANT TO DO THIS. WELL THE OPPORTUNITIES ARE QUITE GOOD.THERE'S UNIQUE BIOLOGIC IN THE HUMAN.IT'S REALLY ONE OF THE BIG THREE MANDATES IF YOU THINK OF THE WHAT THE HYPO THALAMUS IS CHARGED WITH, WHICH IS GROW, DEVELOP AND NURSE YOURSELF.DEAL WITH STRES S AND GO FORTH AND MULTIPLY, WHICH IS THE GENE [INDISCERNIBLE] SO IN THAT SENSE IT IS SORT OF A PILOT LIGHT AT REPRODUCTIVE. IT REGULATES ALL DOWN STREAM REPRODUCTION WHEN YOU SET IN THE RIGHT PROGRAM OF THE SECRETORY PROFILES I'LL SHOW YOU IN A MOMENT.PERHAPS MORE IMPORTANTLY THIS IS HOW WE GOT TO BE THIS SPECIES. WE HAD TO ADAPT OUR REPRODUCTIVE STATUS IN RESPONSE TO A VARIETY OF THINGS IN THE ENVIRONMENT WHICH WE MUST BOTH READ AND RESPOND TO AND THAT'S WHAT THE GENE NEURONS CHARGE IS. WHETHER THIS IS OLFACTION FOR CREDITOR DENSITY OR CIRCADIAN CHANGES OR EXERCISED DURING MIGRATION SUCH AS THE WILDE BEAST IN SEARCH OF WATER AND HAVE MALNUTRITION. THE GENES THAT HAVE ALLOWED EVOLUTION TO OCCUR AND DETERMINE THE TERM FITNESS. THE THING FOR ME THAT REALLY CAP SIZED, STONED OUR INTEREST IN THIS IS WHEN THE HUMAN GENOME PROJECT, THESE TOOLS ARE GENERATING WONDERFUL NEW OPPORTUNITIES WAS COMPLETE. IT WAS CLEAR THAT IN THE HUMAN GENOME THERE'S ONLY ONE GENE WHICH MADE NO SENSE IF YOU LISTED THE THINGS THAT IT HAS TO DO ON THIS PREVIOUS SLIDE OR PREVIOUS LIST. THERE WAS NO REDUNDANCY IN THIS AND IT MADE NO SENSE BECAUSE EVERYTHING GPCR SECTOR FACTORS, MESSENGERS ALL HAVE REDUNDANCY. YET HERE IS SOMETHING THAT DETERMINES OUR SPECIATION AND THERE'S NO BACK UP TO THIS. WHICH TO ME COMBINED WITH THE GENETIC VARIABILITY WE WERE SEEING IN SOME OF THE PATIENTS MEANT THAT ALL OF THE UPSTREAM REGULATORS HAD TO BE THE KEY HERE.GENETICS WOULD BE THE TOOL AND THAT THESE PATIENTS WOULD BE [INDISCERNIBLE] NOW MOST OF-THING, I WAS N EVER INTERESTED IN RESEARCH IN COLLEGE. IN MEDICAL SCHOOL I WAS DRAFTED. I DIDN'T GO TO THE [INDISCERNIBLE] IF IT WEREN'T FOR A CHANGE IN OCCUPATION RELATED TO MY ELDEST BOY LEARNING HOW TO SPEAK AND STUTTERING AND DECIDED I WANTED TO DO SOMETHING WHERE I COULD BE HOME AT NIGHT I SWITCHED TO ENDROCHRONOLOGY AND THAT REQUIRED YOU TO SPEND A YEAR OF RESEARCH WHICH I NEVER WOULD HAVE DONE OTHERWISE.-AND I MET THIS PATIEN T IN 1975. HE WAS A PATIENT WHO HAS BEEN FIRST SEEN BY ALL BRIGHT IN 1943 AND AT THIS POINT, ALBRIGHT COULD NO LONGER WRITE IN THE CHARTS BECAUSE HE HAD SEVERE PARKINSON'S DISEASE SO HE ASSIGNED TWO OF HIS NEW FELLOWS TO SEE THIS PATIENT AND THEY RECORDED AND TRANSCRIBED THE INTERACTION. AND ALBRIGHT SAID THAT DR. [INDISCERNIBLE] HAD DESCRIBED THIS YOUNG MAN WHO DESCRIBED THE TESTES, SMALL PHALLUS, ABSENCE OF PUBERTY AND NO SENSE OF SMELL. AT THAT POINT THE NEW [INDISCERNIBLE] PHASE HAD BEEN DESCRIBED.ENDROCHRONOLOGY STILL BEING AN AQUATIC ERA DURING THOSE AREAS AND THEY CHARTED THE NORMAL PHYSIOLOGY [INDISCERNIBLE] FOUND OUGHT THE MAJORITY OF PATIENTS THAT HAD -- THIS PATIENT HOWEVER WAS PUT IN A DIFFERENT CLASSIFICATION. AND HE WAS AT OUR HOSPITAL USING DISEASE MODEL PATIENTS. I GREW UP VERY MUCH ON THE AGUST THINKING OF ALBRIGHT'S THINKING [INDISCERNIBLE] THAT THIS WAS A PITUITARY DEFECT.-BY THE TIME I WAS A FELL OW, HOWEVER, THE FACTORS FOR THIS HAD SHOWN THAT IN FACT THE MASTER GLAND OF THE PITUITARY WAS ACTUALLY ENSLAVED TO THEHIGH THAT MUST BY A SERIES -- HYPO THAT MUST BY A SERIES OF RELASTING FACTORS IN 1971 AND THE NOBEL PRIZE WAS GIVEN FOR THIS IN 1977.THIS IS NOT THE SHORTEST TIME FROM DISCOVERY TO THE NOBEL PRIZE.DOES ANYONE KNOW WHAT THAT IS? IT'S TESTOSTERONE. SO IF YOU WANT QUICK PRICES STICK TO A QUICK ENDOCRINOLOGY AT NICHD. AN OPPORTUNITY AROSE BECAUSE OF AN NICHD CONFERENCE WHERE THEY GOT POSSIBILITY OF TESTING THAT THESE WERE [INDISCERNIBLE] AROSE BECAUSE THE PATIENT THAT A NORMAL MALE WHICH WE WERE PROFIED FILING HERE, SHOWN HERE SHOWS LH PULLS WHICH WAS THE CONSEQUENCES OF A [INDISCERNIBLE] PULSE IN THE HYPO THALAMUS WE KORCHLT MEASURE HERE -- THE PATIENT YOU JUST SAW WAS CLEARLY ABNORMAL WITH NO PITUITARY INPUT [INDISCERNIBLE]-NOW THIS D IDN'T TELL US WHETHER IT WAS HYPO THALAMIC WITH A A PITUITARY EFFECT BUT THE PEPTIDE BECAME AVAILABLE AND NICHD HAD A CONFERENCE AND THE TWO NOBEL LAUREATES WHO WERE THERE SAID YOU CAN'T GIVE [INDISCERNIBLE]DRUG COMPANI ES BECAUSE WE HAVE THESE ANALOGS.THE NOBEL PRIZE IS AWARDED F OR THE SEQUENCE AND FOR THE DEVELOPMENT OF THESE AGONISTS. WE BEGAN TO USE THEM ON THESE GRH DEFICIENT MEN WHO HAD NO PULLS.-WE GAVE THEM A SHOT OF THE ANALOGUE FROM THE INSTITUTE AND WE GOT A PULSE. NOW IT DIDN'T LOOK LIKE A NORMAL PULSE I HAVE TO SAY. ACCORDING TO MEDICAL-THERAPEUTICS IF ONE I S GOOD TRY TWO. UPPING UP THE DOSE AND GOT LESS OF A RESPONSE. PARADOXICALLY REPRESSING AND IF-WE DID IT TWICE A TEE WE COULD COMPLETELY OBLATE THIS.-THEY WERE DOING TH E SAME THING BY CONTINUOUSLY DOING THIS WITH THE MONKEYS.-WE COULD LIGHT UP ON THE DOSE AND STORE OUT [INDISCERNIBLE] THE SAME KIND OF THING HAVE YOU WITH ASPIRIN ON THE FIRST DAY IT WORKS GREAT AND BY THE THIRD DAY IT DOESN'T WORK AT ALL AND THAT'S THE DESENSATION. THIS WAS THE PEPTIDE RESPONSE. IN FACT WE IMMEDIATELY SAW THAT THIS HAD ALL SORTS OF APPLICATIONS IN PROSTATE CANCER BUT THIS WAS A SURGICAL CASTRATION, END ME TROASES BUT THERE WAS SYNTHETIC PROGESTERONE -- SO WE BEGAN TO STUDY THIS GIRL.THIS WAS THE FIRST PATIENT THAT WE SAW IN THE CENTER AND LYNN WAS GENEROUS ENOUGH TO PICK UP THE PROTOCOL. HE AND GORDON WERE STUDYING PREMATURE [INDISCERNIBLE] AND-BRINGING THE FOCUS TO THE PATIENTS AND SENDING THEM HOME. BECAUSE OF THIS INTEREST WE SAW THIS GIRL WHO WAS FOUR. NOW THINK, HOW ARE YOU GOING TO ADDRESS THIS KID AT SUMMAR TIME WHEN SHE GOES TO THE BEACH. IN FACT WE WORKED OUT HOW TO BE ABLE TO SAMPLE BLOOD IN LIMITEDWINDOWS AND YOU CAN SEE DURING THE NIGHT THERE WERE THESE VERY ACTIVE PULSES DURING THE NIGHT LESSER DURING THE DAY IN A VERY ADULT MATURE RESPONSE TO GNRH. WE BEGAN TO GIVE HER WHAT THA WE THANK YOU WERE DESENSE FIESING DOSES IN TWO WEEKS AND THE MOTHER RETURNED AND SAID TO US TWO THINGS.-TWO WEEK INTO THIS THERAPY I W AS READY TO QUIT BECAUSE THE KID GOT MUCH WORSE, HAD A MENSTRUAL PERIOD BUT SHE SAID SOMEWHERE BETWEEN THREE AND FOUR WEEKS THE CHILD CHANGED DRAMATICALLY AND BY THE TIME SHE CAME BACK AT EIGHT WEEKS SHE SAID I DON'T THINK WHETHER YOU CARE THIS IS WORKING FROM YOUR POINT OF VIEW I WANT TO CONTINUE MY DAUGHTER ON THIS. IN FACT WE WERE LUCKY TO SEE SHE HAD ABSOLUTELY NO PULSES AT ALL. THEN WE HAD TO CONVINCE HER TO COME OFF IT AND BE REVERSIBLE WHICH IT WAS EIGHT WEEKS LATER WHEN SHE STAYED ON IT. OF COURSE AFTER SIX MONTHS HER BREAST PROGRESSION WAS QUITE SPIKING AND THIS BECAME AND REMAINS THE TREATMENT OF CHOICE FOR CHILDREN WITH PRECOCIOUS PUBERTY PUBLISHED JOINT ARTICLES [INDISCERNIBLE] AND THE NICHD EMBRACING THE NEW ENGLAND JOURNAL [INDISCERNIBLE] ISSUING-IN AN ENTI RE NEW THERAPY OF GNRH ANALOGUE. INTERESTINGLY THE NICHD PROGRAM HAD DEVELOPED ALL THESE IN THE EXTRA CEPTIVE DEVELOPMENT PLAN. THE NICHD REALLY OWNS THIS FROM THE VERY BEGINNING THROUGH THE THERAPY.NOW THERE ARE SOME METRICS HERE THAT YOU GUYS OUGHT TO USE A LITTLE MORE. THIS IS THE ACTUAL SALES OF ANALOGUE IN THE DECADE OR TWO. LAST YEAR 3.5 BILLION DOLLARS. WE DIDN'T WANT TO KNOW ABOUT A RETURN ON INVESTMENT. THIS IS THE [INDISCERNIBLE] FOR THOSE WHO DON'T WANT TO FOLLOW THIS AS A METRIC, THERE'S SOME INTERESTING NEW METRICS. GOOGLE HAS AN END BRAKE SEARCHWHERE YOU CA N SEARCH A TERM AND FIND OUT ABOUT IT AND HOW IT'S BEING USED IN BOTH MEDICAL LITERATURE.AND HERE'S ANOTHER IMPACT WAY O F LOOKING AT NICHD PROGRAMS THAT THIS IS THE NUMBER OF ARTICLES BEING WRITTEN WITH A PHRASE CENTRAL PRECOCIOUS PUBERTY.-WE STILL HAVEN 'T SOLVED THE PROBLEM WITH OUR PATIENT. WE HAD THESE NORMAL MALES THAT HAD NO PULSES.-AT THIS POINT WE WERE TRYIN G TO USE NEUTRAL SEQUENCE GNRH.WE HAD TO GIVE I T EVERY TWO HOURS.-THIS WAS PROBLEMATIC. WE DEVELOPED PORTABLE INFUSION PUMPS TO DO THIS WHICH WE DID WITH A COLLABORATOR DEAN CAYMAN WHO I'LL SHOW YOU IN A MOMENT THE INVENTOR OF THE SEGUE. HIS MOTHER USED TO MAKE THE PUMP COVERS FOR US. HE MADE THESE IN HIS GARAGE AT THE TIME. WHEN WE MADE THESE, YOU COULD SEE TWO THING. FIRST OF ALL WE COULD ESTABLISH [INDISCERNIBLE] AND NOTICE THE TESTOSTERONE WENT UP TO A NORMAL RANGE. YOU NOTICE THEY'RE IN DIFFERENT COLORS BECAUSE IT WAS AN EXQUISITE DOSE RESPONSE CURVE IN HUMANS.-THIS IS A HUMAN ASSAY AND WE COULD DEVELOP PHARMACOLOGICALLY-LOOKING AT THIS. FOR A DECK APRIL WE DID DOSE INTERMISS SEE FREQUENCY SEX STEROID FEEDBACK.-WE WERE IN CONTROL OF TH OSE AS THE READER'S DIGEST WOULD PUT IT. IN FACT WE COULD DETERMINE WHETHER THE [INDISCERNIBLE] PUT-TREE AND M OST OF THE PHYSIOLOGY IN MALE REPRODUCTION WAS WRITTEN [INDISCERNIBLE] WHILE WE'RE DOING THIS BUT SERVED AS A METHOD OF INDUCE IS OVULATION IN WOMEN WHICH WAS [INDISCERNIBLE] FROM BIRTH ACTUALLY SO IT WAS NEVER ADOPTED SORT OF FROM A PHARMACOLOGY POINT OF VIEW. THIS IS THE PUMP DEVELOPMENT AND OUR OTHER MULL FUNDER AT THE TIME AND THESE ARE THE PUMPS. NOW AS WE BEGAN TO SEE MORE AND MORE PATIENTS WE HAD 25 OF THESE ON THE PUMP AT ALL TIMES WITH THE NICHD GRANT. IT CAME IN TWO BROAD FLAVORS.-THOSE WHO HA D THE NORMAL SENSE AND SMELL AND THOSE THAT DIDN'T. THOSE WERE COMMON SYNDROME BEING THE ONES WITH THE ABNORMAL SENSE OF SMELL BUT THEY ALL SHARE THE FACT THAT THEY HAD A GNRH DEFICIENCY.-IN OTHER WORDS ALMOST NONE OF THESE HAD A PITUITARY DEFECT. AND YOU'RE GOING TO SEE A DEVELOPMENTAL THEME EMERGING IN THE GENETICS NOW THAT BEGINS TO EMERGE WITH THE [INDISCERNIBLE] MEASURES AND A DIFFERENT NEUROENDOCRINE THEME DEVELOPING-IN THOSE P ATIENTS HAVE A NORMAL SENSE OF SMELL AND THEN HAVING ESTABLISHED THOSE RULES WILL VIOLATE THEM IMMEDIATELY. BUT ANOTHER NICHD FUNDER DON FAT WAS DOING A VERY SIMPLE EXPERIMENT AT THE ROCKEFELLER IN 1989. THAT WAS JUST THE CHEMISTRY TRYING TO FIND OUT WHERE THE [INDISCERNIBLE] NEURONS CAME FROM.-MUCH TO HIS SURPRISE THEY WERE IN THE HYPOTHALAMUS AT ALL. THEY STARTED IN THE [INDISCERNIBLE] THEY WOULD BEGIN A TREK INWARD USING THE OLFACTORY GUIDED SYSTEM TO GET TO THE OLFACTORY BULB AND THEN THE OLFACTORY TRACK. AND THEN FOR SOME MYSTERIOUS REASON LIKE THE NEW JERSEY TURN PIKE THEY WOULD TAKE THE HIGH THALAMIC [INDISCERNIBLE] UNTIL THIS PATIENT ARRIVED WHICH IS A BEAUTIFUL STROKE OF GENIUS WHERE-THIS BOY WAS BORN AND HAD A COMPLEX SYNDROME. YOU CAN SEE UNDER DEVELOPED TESTES.A NUMBER OF DISORDERS THAT ALLOWED CONTINUOUS GENE MAPPINGTO THE TIP OF THE CHROMOSOME WITH CALVIN SYNDROME. WHEN HE DIED IN THE MIDDLE SLIDE HE HAD NO OLFACTORY BULBS OR TRACT AND THIS WAS DUE TO THE FACT HE HAD A TERMINAL DILUTION OF THE X CHROMOSOME WHICH HE SHARED WITH HIS MOTHER. NOW HE DIED AND HIS MOTHER EVENTUALLY CONCEIVED AGAIN. UNFORTUNATELY THE SECOND PREGNANCY AGAIN WITH ABNORMAL X CHROMOSOME AND HAVING BEEN-THROUGH THIS TH E FIRST TIME SHE ELECTED TO A THERAPEUTIC TERM NATION AND THAT FETUS BECAME AVAILABLE. AND HE WAS PROVEN TO HAVE CALVIN SYNDROME AND HIS BROTHER PRESUMABLY HAD THE SAME THING. WHEN THEY LOOKED AT A NORMAL FETUS AT 19 WEEKS THESE LITTLE BLACK DOTS [INDISCERNIBLE] HAVEALREADY GON E TO THE GNRH AREAS IN THE BRAIN IN THE NORMAL PERSON.-BUT IT WAS CLEAR THAT THE COW FETUS DIDN'T HAVE ANY OF THESE.THEY WERE S TILL IN THE NASAL -- AND THEY HAD ACTUALLY MIGRATED INWARD [INDISCERNIBLE] MASS EXTENSION IN THE EARLY MIGRATION BUT LACKING THE GUIDE WIRES OF THE OLFACTORY SYSTEM THEY COULD NOT ENTER THE CENTRAL NERVOUS SYSTEM AND FROM THAT CAME OUR DEVELOPMENT THEME ON THE LEFT [INDISCERNIBLE] COULD MIGRATE ALONG IN THE INFRASTRUCTURE AND THE GENERATION RUNS TO DEVELOP IT.-THE NEURODEVELOPMENT BEGAN TODEVELOP.T HAT WAS ALL WELL AND GOOD UNTIL WE SENT ONE OF OUR FELLOWS BACK TO THE MIDDLE EAST. HE WAS FROM KUWAIT AND SAID FINE US A FAMILY WITH ISOLATED GENE ARRAY SUFFICIENCY BUT WITH THE TYPE CRITERIA NUMBER ONE AND NUMBER TWO WE WANT A BED WIN. AND THE REASON WAS WE WANTED THE FAMILIAL NATURE OF THE CIRCUMSTANCES OF THE BEDOWINS AND THIS ALLOWS PEOPLE TO MARRY WITHIN THE FAMILY AND ALSO TO HAVE NO RESOURCES MOVED [INDISCERNIBLE] AND BEING MIGRANTS THEY ARE FAMILY SIZES AND SMALL AND KEPT IN TACT. WE HAD THREE COUSINS MARRYING THREE COUSINS. BY THIS TIME EXACTLY WHAT ALAN SAID IT HAPPENED TO THE HUMAN GENOME THEY PUT IN PLACE A SERIES OF TOOLS AND IT WAS RELATIVELY FAST WORK FOR US, STEPHANIE BEING A FELLOW JUNIOR FACULTY MEMBER AT THAT POINT, TO LOCALIZE THIS AT WHICH POINT WE HAD A CANDIDATE GENE VERSUS A KAISER IN OUR CENTER DID THE ASSAYS TO SHOW THIS WAS A NON-FUNCTIONING MUTATION. INTERESTINGLY ONCE WE LOCALIZEDTHIS [INDIS CERNIBLE] WHO WAS A FRIEND OF MINE AND SPEND SOME TIME AT THE MASS GENERAL WAS MAPPING OUT THE FAMILY MEMBERS AND SAID I THINK WE HAVE THE SAME GENE. HE MAPPED OUT THIS NAB ANIMAL AND PRODUCED THE SAME SPHEEN TYPE.-THIS WAS PUBLISHED IN THE NEW ENGLAND JOURNAL. THE FIRST TIME A HUMAN AND RESEARCH HAS BEEN PUBLISHED AN ARTICLE FOR THE NEW ENGLAND JOURNAL AND IT BEGAN THE STORY WHICH IS WHAT THIS IS SHOWING THEY HAVE THE RECEPTOR AND OTHER HYPO THALAMIC CELLS SHARE THIS RECEPTOR AND THIS PEPTIDE IS THE MOST POTENT STIMULATOR ANYONE'S EVER SEEN. AGAIN, BOB STEINER AT THE LECTURE SAID HE BELIEVED THIS WAS THE MOST IMPORTANT DISCOVERY IN REPRODUCTIVE ENDOCRINOLOGY SINCE GNRH. AGAIN IMPORTANTLY THROUGH THE MINISTRATIONS OF [INDISCERNIBLE] SHE'S LOOKING INTO THIS ON HER OWN GRANT [INDISCERNIBLE] PUBERTY. IF YOU LOOK ON THE LEFT YOU HAVE A DEVELOPMENTAL PATTERN YOU LOOKON THE RIG HT YOU HAVE A NEUROENDOCRINE PATTERN AND VERY SOON WE'RE BEGINNING TO FIND OTHER GENES LIKE FGFR1 THAT HAVE BOWLED CALVIN OR NON-CALVIN-PHENOTYPES AND WE CAN MAP THESE LOOKING AT THEM ON EXTRA CRYSTALLOGRAPHY.-IF YOU LOOK A MUTATION LI KE THIS [INDISCERNIBLE] AND TAKING THE MUTANT RECEPTORS AND SHOWING THAT FGF1 BINDING FGF2 BINDING ISN'T EFFECTIVE BUT FGF8 IS. THERE'S NOW ANOTHER GENE FOR FGF8 WHICH WAS DONE BY ANOTHER FELLOW IN OUR GROUP. HE BEGAN TO HAVE FAMILIES THAT HAD TWO MUTATIONS.-THIS IS NOT A SIMPLE MA N DEALIAN DISORDER. THERE'S THIS TROUBLESOME ISSUE OF PENETRANCE.WE FOUND OUT THERE WERE [INDISCERNIBLE] IN THESE-FAMILIES. WE DID THE MOST EXTENSIVE STUDY LOOKING AT ALL THE GENES AND SHOWING THAT IN RED EVERY ONE OF THESE HAS A SECOND HIT IN 11% OF THESE PEOPLE. SO THIS IS AN [INDISCERNIBLE] DISORDER AND TAKING ITS PLACE WITH THE -- HAS DEVELOPED AS AN EXAMPLE OF THIS. SO NOW WE HAVE OVERLAPS THAT CAUSE BOTH CALMAN AND NON-CALMAN AND WE DON'T UNDERSTAND HOW THEY WORK. WE HAVE A NEW ENSEMBLE OF GENES. THE FOUNDER EFFECT [INDISCERNIBLE] IT MENTIONED TO 123 SITES WITH 9,000 RESULTS. NOT QUITE AS MANY AS THE CYSTIC FIBROSIS.[INDISCERNIBLE] IN THE NEW ENGLAND JOURNAL WE FOUND THE HYPO THALAMIC [INDISCERNIBLE] SO-TO SUMMAR IZE THE GENETICS OF THIS HAS BEEN EXPLODING OVER THE LAST AND IS BECOMING INTERNATIONAL NOW.-WE'RE TAKING THE ONES T HAT HAD UNKNOWN MUTATIONS AND DOING SEQUENCING.WE HAVE 1500DNAs FROM THESE-PAT IENTS AROUND THE WORLD THE LARGEST COLLECTION WE'VE ASSEMBLED AND WE'RE TESTING THESE IN LOWER ANIMAL SPECIES FOR THEIR FUNCTIONALITY. THE INTERESTING THING HERE IS HERE'S A STORY MY HUMAN DISEASE MODEL. IF YOU LOOK AT THIS AS HORRIBLE LANDMARK ACHIEVEMENTS-HERE, YOU S EE GENE SEQUENCING ONE THE NOBEL PRIZE THE HPG MOUSE WAS A BASIC. OUR DEMONSTRATION IT WAS EFFICIENCY IN THE HUMAN DISORDER CAME IN 1981. BUT THEN GNRH WAS CLONED IN GENE THERAPY FROM THE FIRST EXAMPLE, SUCCESSFUL GENE THERAPY IN WHICH THE GNRH GENE WAS PUT IN BY PETER SEABERG. LOOK AT THE REST OF THIS. IF YOU MAP THE GNRH NEURONS, THE ARTICLE I SHOWED YOU FROM ROCKEFELLER, ALMOST EVERY ONE OF THESE HAS COME THROUGH HUMAN INVESTIGATION AND HUMAN JIMMY WITH ONE EXCEPTION [INDISCERNIBLE] FORTUITOUSLYMAPPED OUT ON AN ANIMAL THAT DEVELOPED A HYPO THALAMIC STATE. SO THIS REALLY TAKES A LOT OF PEOPLE SHOE LEVEL EXPRESS IS REVISITED AND IT DOES TAKE A VILLAGE TO DO THIS. THIS IS ALL OUR FACULTY MEMBERS. I DON'T REALLY HAVE TIME TO GO THROUGH EVERY ONE BUT THESE ARE OUR MEMBERS OF OUR CORE. AND THE OTHER THING IS THIS IS THE [INDISCERNIBLE] THIS WAS A GIFT TO ME AT OUR 25TH YEAR CELEBRATION OF OUR UNITS IN 2008 BY THE FORMER FELLOWS AND LARRY JAMISON. 60% OF OUR FELLOWS ARE WOMEN. 780% REMAIN IN ACADEMIC MEDICINE. HALF OF THOSE DECADE OUT AND THE OTHER HALF ARE -- PRESIDENTS OF THE ENDOCRINE SOCIETY AND 20 MEMBERS OF THE COUNCIL LEADERSHIP ALL BROUGHT TO YOU BY NICHD FUNDING.WHAT WOULD HAVE BEEN THE KEY TO DISCUSS. PROGRAMS.-WELL OUR ONE PROGRAM IS THE HEART AND SOLE. THE SENSORS HAVE BEEN TERRIFIC, COLLABORATIVE WAYS OF DOING BUSINESS AND THE TRAINING. AND THAT'S THE 28TH YEAR OF OURIAN AND WOVE HAD THE SAME RO1 IN ONE FORM OR ANOTHER SINCE 1977.-THE OTHER THING IS LEADERSHIP. MARVIN MOOT IN PLACE THE [INDISCERNIBLE] NEUROISSUED THE CENTERS, CHANGED THEM AND MORPHED THEM [INDISCERNIBLE]-MAKING THE PE PTIDE AVAILABLE FOR HUMAN INVESTIGATION AND TRANSLATIONAL MISSION AND SUSAN[INDISCERNI BLE] HAS BEEN VERY HELPFUL IN OUR MISSION. IF YOU STAR TO LOOK AT THIS IN TERMS OF HOW MUCH MONEY DOES IT TAKE, I DON'T WANT TO STAY TOO LONG ON THIS SLIDE BUT THERE IS A WEB CALLED RESEARCH CROSSROADS THAT CAN DETERMINE HOW MUCH MONEY AN NIH INVESTIGATOR GETS OVER A PERIOD OF TIME. AND WITH THAT I'LL END AND THANK YOU VERY MUCH. ALL OF THIS IS DONE BY NIC TEAM. THANK YOU.[APPLAUSE] >> THANK YOU. THANK YOU BILL. IT'S OUR PLEASURE TO HAVE AT THE PODIUM DR. CHAR CAROLYN WESTHOFF FROM COLUMBIA UNIVERSITY. SHE'S THE SENIOR ADVISOR FOR THE [INDISCERNIBLE] DR. WESTHOFF IS A MEMBER OF MEDICINE BUT I GUESS THE MOST IMPORTANT ACCOLADE SHE'S A LONG STANDING GUARANTEE-OF NICHD M EMBER OF THE CLINICAL TRIAL NETWORK AND A LAWYER MEMBER OF OUR FAMILY.-THANK YOU. >> GOOD AFTERNOON, I'M REALLYHAPPY TO BE W HO ARE. I'M REALLY HAPPY THAT I GOT A LUG IN ADVANCE FROM DR. LORIAUX ABOUT THE CONTRACEPTION. LET'S SEE.-OKAY.-YOU ACTUALLY SAW A VERSIO N OF THIS SLIDE. THIS IS NOT GOING BACK THROUGH HISTORY BUT LOOKING AT WORLD POPULATION GROWTH.THE EARLY BLACK PART OF THE LINE IS JUST ESTIMATED.-THE BLUE PART OF THE LI NE THE LAST 60 YEARS THAT'S ACTUALLY MEASURED AND THAT COINCIDES WITH THE DISTANCE OF NICHD. YOU CAN SEE THINGS ARE SHOOTING UPWARD.AND THERE ARE IMAGINE HERE SCENARIOS FOR THE FUTURE. THE CURRENT TRAJECTORYCONTINUING ON THE SA ME PATH AND OBVIOUSLY A DISASTER. A MODERATE AND OPTIMISTIC WHERE WE MIGHT BE GOING. WHERE DOES THAT DEPEND ON? THIS IS THE DEMOGRAPHIC PARADIGM THAT BROUGHT CONTRACEPTIVE RESEARCH AND ACTIVITY [INDISCERNIBLE] DEPENDS ON IN PART TECHNOLOGY, CONTRACEPTIVE TECHNOLOGY.IT DEPENDS ON ACC ESS AND IT DEPENDS ON UPTAKE. UPTAKE BEING A MIX OF ACCEPTABILITY SAFETY AND A LOT OF OTHER ISSUES. THE DEMOGRAPHIC PARADIGM IS DOMINANT IN THE WORLD OF CONTRACEPTION FROM THE 1960'S. BUT IT CHANGED IN 1994 WITH THE INTERNATIONAL CONFERENCE ON POPULATION IN DEVELOPMENT IN CAIRO. EVERYBODY JUST REFERRED TO IT AS CAIRO AND THAT'S THE FIRST TIME A HUMAN RIGHTS VIEW OF CONTRA CEPTIONS CAME INTO BEING. I THINK THAT PICTURE I SHOWED COMES FROM A NON-PROFIT ORGANIZATION DEALING WITH CONTRACEPTION IN LEAST DEVELOPED COUNTRIES BUT I THINK IT SHOWS THE SPIRIT FROM CAIRO. AND I AM HOLY IN FAVOR OF THE HUMAN RIGHTS PERSPECTIVE ON FAMILY ACTIVITIES BUT GIVEN THE DEMOGRAPHIC CRISES, IT MAY BE SOMETIMES DISTRACTS US FROM THOSE PARTICULAR CONCERNS AS WELL.-NOW I'M GOING TO SWITCH A LITTLE BIT AND FOCUS THIS ON THE UNITED STATES AND THINK ABOUT WHAT THE HEALTH ISSUES AROUND FAMILY PLANNING. NOT JUST DEMOGRAPHIC BUT HEALTH AS WELL. IN THE UNITED STATES, WE HAVE HALF OF PREGNANCIES EVERY YEAR-UNINTENDED AT THE TIME OF CONCEPTION OVER 3 MILLION PER YEAR.-THAT RATE IS ABOUT 5% OF ALL WOMEN. THIS IS UNINTENDED PREGNANCY EVERY YEAR. AND AGAIN HARKING BACK A LITTLE BIT TO THE PREVIOUS TALKS, THERE ARE HUGE DISPARITIES IN HOW THIS IS DISTRIBUTED IN THE POPULATION.WHAT YOU SEE HERE IS WOMEN WHO ARE LESS EDUCATED. MEMBERS OF MINORITY GROUPS AND POOR HAVE MUCH HIGHER RATES OF UNINTENDED PREGNANCIES, PARTICULARLY WOMEN WHO FITS BELOW 100% OF THE POVERTY LINE. THESE DISPARITIES HAVE BEEN GROWING OVER THE LAST DECADE. THESE ARE NOT IMPROVING. THEY'RE GETTING WERE. BY COMPARISON THE FINAL GOAL AT THE BOTTOM IS AMONG WHITE WOMEN WHO HAVE [INDISCERNIBLE] POVERTY-LINES YOU CAN SEE THE UNINTENDED PREGNANCY IS LESS THAN 2% WHICH IS A MUCH MORE DESIRABLE SITUATION. SOMETHING OVERALL RATE OF UNINTENTIONED PREGNANCY IN THE U.S. IS ABOUT STABLE AS A PERCENTAGE OF ALL PREGNANCIES. DISPARITIES HAVE GROWN AND WE'LL SEE WHAT'S HAPPENING.%IT'S THE MORE PRIVIL EGED WOMEN-IN THE U.S. SOCIETY WHO HAVE BENEFITED FROM THESECONTRACEPTIVE TECHNOLO GIES WHICH ARE HIGHLY EFFECTIVE. BUT WOMEN WHO HAVE THE BURDEN OF HEALTH DISPARITIES IN SO MANY WAYS HAVE NOT BENEFITED FROM THAT TECHNOLOGY TO THE SAME DEGREE.-HOW DOES THIS RELATE TO HEALTH. THIS ISN'T JUST STEPPOGRAPHY, IT ISN'T JUST HUMAN RIGHTS, HOW DOES IT RELATE TO HEALTH. AND IT'S DIRECTLY CONNECTED OF COURSE TO THE RISK OF PREGNANCY ITSELF.THE TOTAL PREGNANCIES IN THE UNITED STATES RULE IN 4.2 OR 4.3 MILLION BIRTHS EVERY WHY WHERE 600 MATERNAL DEATHS IS PRETTY [INDISCERNIBLE] A ALSO WE ARE FAR BETTER THAN THE DEVELOPING WORLD. THOSE 600 DEATHS ARE THE TIP OF THE ICEBERG. WE HAVE 35,000 [INDISCERNIBLE]WHICH ARE SE AR ADVERSE EVENTS AND OVER A MILLION HOSPITALIZATIONS EVERY YEAR THROUGH THE COMPILATIONS OF PREGNANCY. THOSE ARE NOT HOSPITALIZATIONS RELATED TO DELIVERY ITSELF. THERE ARE OTHER HOSPITALIZATIONS.-NOW, HOW DOES THAT RELAT E TO CONTRACEPTION? A LOT OF THOSE PREGNANCIES [INDISCERNIBLE] AND IN FACT, IT IS WOMEN WHO ARE HIGHEST RISK, COMMUNICATIONS WHO ALSO HAD A [INDISCERNIBLE] SO ALONG WITH WERING ABOUT DEMOGRAPHICIMPERATIVE THE BES T THING WE CAN DO TO DRAMATICALLY [INDISCERNIBLE] MATERNAL DEATHS IN THE UNITED STATES IS INCREASE CONTRACEPTION SO WE DON'T HAVE THE BURDEN OF UNINTENDED PREGNANCIES LEADING TO PREGNANCY COMPLICATION.THAT IS, I LOVE TELLING THIS TO RESIDENCY APPLICANTS EVERYWHERE. YES, YES, THE [INDISCERNIBLE] ARE DOING REALLY GREAT WORK BUT BUT IF YOU REALLY DO WANT TO [INDISCERNIBLE] USE CONTRACEPTION.-AND THEN PEOPLE SWAT AT ME. OKAY. WE DO HAVE THIS MODEL. THIS IS FROM [INDISCERNIBLE]-IT'S ALMOST 2 0 YEARS OLD BUT THE CONCEPT HERE ARE COMPLETELY CORRECT.THE PUMPKIN COLORED ONES ARE THE DEATH RATES AMONG WOMEN OF DIFFERENT AGES ACCORDING TO HOW LIKELY A HUNDRED THOUSAND WOMEN WOULD BE TO DIE THAT DON'T USE ANY METHOD OF CONTRACEPTION AND THE RESULTING PREGNANCIES GO ON TO BIRTH. OVER THE PUMPKIN LINE AND YOU CAN SEE THAT INCREASES WITH AGE BECAUSE PREGNANCY IS MORE DANGEROUS IN OLDER WOMEN. THE BLUE AND DARK BLUE LINES ARE ALLATIVES. THE MEDIAN BLUE LINES IS NO METHOD OF CONTRA CEPTIONS BUT WOULD END ANY UNWANT PREGNANCY WITH AN ABORTION [INDISCERNIBLE] AND THE DARK BLUE LINE IS [INDISCERNIBLE] ORAL CONTRACEPTIVE.-IN THAT GROUP WE ADD IN ANY DEATHS FROM THE ORAL CONTRA CEPTIVES BECAUSE SOME SAY THEY'RE DING RUSS ESPECIALLY IN OLDER WOMEN [INDISCERNIBLE] ARE SWAMPED BY THE HEALTH RISKS FOR PREGNANCY [INDISCERNIBLE] TO REDO THIS MODEL BUT I THINK OUR ANSWER WOULD LOOK JUST THE SAME. [INDISCERNIBLE] BY CATEGORIZING CONTRACEPTIVE ARE [INDISCERNIBLE] MOST EFFECTIVE AND THEN LESS EFFECTIVE BECAUSE PEOPLE TEND TO GET A LITTLE INVOLVED WITH PERCENTAGE EFFECTIVENESS.-IT'S REALLY THE BIG THREE G ROUP THAT TAKES CARE OF EVERYTHING WITH LONG ACTING METHODS FOR STERILIZATION [INDISCERNIBLE]-THEY LAST A LONG TIME. THE WOMAN DOESN'T HAVE TO DO ANYTHING TO MAKE [INDISCERNIBLE] AFFECTIVE GROUP ARE ALL HORMONAL. TECHNICALLY EXCELLENT AND THEORETICALLY HIGHLY EFFECTIVEBUT IT REQUI RES A LOT OF ACTION ON THE PART OF THE USER. WE HEARD ONE THOUGHT ABOUT COMPLIANCE A LITTLE BIT EARLIER AND YOU DO HAVE TO READ ALL OF THESE CORRECTLY.BUT WHEN I SEE WOMEN NOT U SING [INDISCERNIBLE] CORRECTLY, IT'S A LOT OF HEALTHCARE SYSTEM PROBLEM PREDOMINANTLY HAVE A GREAT CONTRIBUTION FROM USING THESE EFFECTIVE METHODS.-THESE COULD BE TH E MOST EFFECTIVE GROUP [INDISCERNIBLE] AND THE LESS EFFECTIVE GROUPS ARE THE MUCH GENERALLY CATEGORIZED [INDISCERNIBLE] NOW TAKING THIS CATEGORIZATION LET ME SHOW YOU WHERE WE WERE 50 YEARS AGO WHEN NICHD BEGAN IN THE SAME CATEGORY ON THE LEFT WE HAD A LIMITED AMOUNT OF STERILIZATION. THAT WAS PREDOMINANT IN FEMALE STERILIZATION THERE WERE A LOT OF RULE AT THAT TIME PREVENTING WOMEN FROM GETTING STERILIZATION.AND THERE WERE A FEW INNATE [INDISCERNIBLE] THE BEGINNING OFTHE PILL, WE HAD TWO KINDS OF PILL ON THE MARKET THAT YEAR. MOST PEOPLE IN THE UNITED STATES WILL GO ON EITHER DIAPHRAGM OR CONDOM FOR CONTRACEPTION. THAT'S THE PREDOMINANT MODALITY AND THE POSTER ON THE RIGHT OF THE PICTURE CONTRACEPTION [INDISCERNIBLE] COMPLETELY UNEVALUATED CHEMICALS THAT WERE AVAILABLE AND SOMETIMES USED. UNFORTUNATELY MOST OF THOSE HAVE GONE AWAY. SO WHERE ARE WE IN 2012? YOU CAN CERTAINLY SEE THEM JUST A LOT MORE TELLING ON THE TABLE. WE HAVE MULTIPLE METHODS OFSTERILIZATION T HAT ARE MUCH LESS INVASIVE [INDISCERNIBLE] MEDICATED WITH COPPER [INDISCERNIBLE] WE HAVE IMPLANTS [INDISCERNIBLE] WE HAVE ABOUT 40 DIFFERENT BIRTH CONTROL PILLS, CONTRACEPTIVE PATCH RING WHICH HORMONAL WORKED JUST LIKE THE PILL BUT ARE EASIER TO USE [INDISCERNIBLE] AND MULTIPLE INJECTIONS EVEN IN LESS EFFECTIVE GROUP [INDISCERNIBLE] ADVANCES WITH A GREATER VARIETY OF FEMALE CONDOMS FROM POLY URETHANE, DIFFERENT KIND OF DIAGRAMS AS WELL. IN THAT ERA, IN THE LAST 50 YEARS [INDISCERNIBLE] WAS VERY INVOLVED WITH DEVELOPING NEW METHODS AND NICHD'S INVOLVEMENTAND A LOT O F THEM ARE LISTED HERE WAS IN THE AREA OF EVALUATION WAS [INDISCERNIBLE] NIH REALLY WAS THE CHARGE IN LOOKING AT SAFETY IF NON-CONTRACEPTIVE BENEFITS OF RISK AND THE SO INFORMATION OF BIRTH CONTROL PILLS [INDISCERNIBLE] CASUAL IS ONE OF THE BIGGEST AREA [INDISCERNIBLE]-INVOLVED IN DEVELOPMENT OF THE CONTRACEPTIVE SPONGE SO THAT'S ONE OF THE THINGS. I'LL SHOW YOU A LITTLE MORE OF THE NIH CONTRIBUTION IN A MINUTE.-NOW WHAT IS OUR TYPE ONE GOING TO BE [INDISCERNIBLE]THERE ARE NEW METHODS IN ALL OF THESE CATEGORIES THAT ARE IN VARIOUS PHASES OF DEVELOPMENT. INDUSTRY HAS LARGELY LEFT THIS ENTIRE AREA AND NICHD HAS TAKEN A MUCH BIGGER ROLE IN PRODUCT DEVELOPMENT THAN MIGHT BE SEEN IN THE OTHER INSTITUTES. AND OF PARTICULAR IMPORTANCE IN THE ERA OF AGE [INDISCERNIBLE] VARIOUS METHODS WHICH CAN BE ACTIVE FOR BOTH PREGNANCY PREVENTION ALBEIT NOT FABULOUSLY EFFECTIVE LEVEL BUT MIGHT ALSO BE EFFECTIVE FOR PREVENTION OF TRANSMISSION OF SEXUAL TRANSMITTED INFECTIONS[INDISCERNIBLE] HIV. AND THE PROBLEM WITH THAT IS THE MICROBE [INDISCERNIBLE] 1956 PROGRAMS CONTRACEPTIVE TRIALS NETWORK IS VERY MUCH AN [INDISCERNIBLE] CONTRACTUAL WORK AND CONTRACEPTIVE DEVELOPMENT MUCH LESS COMING OUT OF THE [INDISCERNIBLE] ALTHOUGH SOME OF IT IS FOR WOMEN THERE ARE MANY NEW HORMONAL PRODUCTS WHICH ARE WORKING ON THE SAME PHYSIOLOGICAL MECHANISM AS THE ORIGINAL BIRTH CONTROL PILL-WHICH IS TO SA Y THEY WORK ON THE BRAIN AND THE HYPO THALAMIC PITUITARY [INDISCERNIBLE]NDISCERNIBLE] MOD ULE LATER AND THIS WAS SOMETHING THAT IS MOVING FORWARD IN THIS ARENA THAT ARE ALSO THE NON-HORMONAL PRODUCTS WHICH MOST ARE INTENDED FOR DUAL PROTECTION AND THERE'S IDENTIFICATION OF NEW TARGETS FOR NON-OR MORE THAN PRODUCTS FOR WOMEN TO LOOKING AT PARTICULAR POINTS IN THE REPRODUCTIVE SYSTEM BUT DOESN'T REQUIRE A HORMONAL [INDISCERNIBLE] DEVELOPED BY NICHD. THIS IS THE PROGESTERONE MODULE LATER ON THE MARKET AVAILABLE AS EMERGENCY CONTRACEPTION [INDISCERNIBLEED METHODS. FEMALE CONDOM'S ONE OF DUAL USE. IT LOOKS LIKE THAT IS A TAMPON. THAT IS NOT A TAMPON THEY ARE DOUGH SOLVING SPONGE RUBBER PIECES ATTACHED TO THE PROPS SO THE WOMAN CAN [INDISCERNIBLE] THERE IS NEW PATCH COMING THROUGH IN PARTICULAR [INDISCERNIBLE] WHICH IS EXCELLENT FOR OLDER WOMEN WHO CANNOT USE ESTROGEN AND A NEW VAGINAL RING. THIS ONE IS GOOD FOR A YEAR WHICH MEANS IT CAN BE USEFUL IN TERMS OF [INDISCERNIBLE] WHERE A WOMAN CAN GET ONE AND BE COVERED FOR A YEAR. WHAT ABOUT A MALE CONTRACEPTIVE. THIS IS THE IMPORTANT GAP. THIS IS GOING ON FOR A LONG TIME FOR BASIC RESEARCH WHO IDENTIFY TARGETS, IDENTIFY DRUGS AND [INDISCERNIBLE] HOWEVER IT IS NOT A STRAIGHT LINE TO DEVELOPING [INDISCERNIBLE] VERY-DIFFICULT FOR A LONG LIST OF REASONS AND CLINICAL RESEARCH THUS FAR HAS CONTINUED TO BE SOME WHAT LIMITED. SO LONGEST AND MOST SUCCESSFUL WORK HAS BEEN HORMONAL APPROACH TO MALE CONTRACEPTION WHICH WILL BE JUST AN ANALOGUE FOR THE FEMALE PILL WORKING IN THE SAME WAY [INDISCERNIBLE] WITH THE PROGESTERONE AND THEN ADDING BACK TESTOSTERONE. SO SEVERAL OF THESE ARE IN CLINICAL TRIALS NOW AND INDUSTRY HAS LEFT THIS AREA OF RESEARCH THAT NICHD IS CARRYING ON. THAT'S THE VERY FIRST [INDISCERNIBLE] REPRESENTS THE HORMONAL APPROACHES-[INDISCERNIBLE] AT THE VERY BEGINNING OF THE PROCESS BUT ALL THE OTHER BOXES REPRESENT NOVEL TARGETS THAT HAVE BEEN IDENTIFIED THROUGHOUT THE PROCESS AND ARE SUBJECT OF INVESTIGATION FOR NON-HORMONAL MALE CONTRACEPTION. NON-HORMONAL AND NON-BARRIER BECAUSE [INDISCERNIBLE] ALTERNATIVES ARE BARRIERS.AND IN THE CASE OF A FEMALE, THIS IS ONE EGG PER MONTH. IF YOU STOP THAT EGG YOU'RE DONE. IN THE CASE OF MALES [INDISCERNIBLE] AND THAT IS A MORE COMPLEX PROBLEM.ALSO WHEN WE DEVELOP THE FEMALE PILL WE DIDN'T KNOW WHAT WE WERE GETTING INTO.WE REALLY GOT INTO IT TURNS O UT A NUMBER OF DANGEROUS [INDISCERNIBLE] THERE'S A HIGHER LEVEL OF CAUTION PROCEEDING WITH ANY KIND OF MALE PILL. BUT AT THE MOMENT A NUMBER OF THE ALREADY AT LEAST THROUGH CLINICAL WORK THESE ARE SOME OF THE MOST PROMISING LEADS IN THE NUMBER OF NICHD [INDISCERNIBLE]AROUND THE COUNTRY. NOW FOR THE FORTUNATE I THINK IT'S AT THE NICHD LEVEL [INDISCERNIBLE] PARTICULARLY LOOKING FOR THOSE MALES AND FEELS [INDISCERNIBLE]-CONTRACEPTIVE AND [INDISCERNIBLE] AS THEY MOVE FORWARD IDENTIFYING THE TARGETS AND IDENTIFYING THE [INDISCERNIBLE] I ALSO HAVE A DREAM PIPELINE IF YOU WILL [INDISCERNIBLE] MALE CONTRACEPTIVE IS OUR BIGGEST GAP.-MAN HAS BEEN LEFT OUT OF THIS FOR 50 YEAR OF DEVELOPMENT [INDISCERNIBLE] WE ALSO NEED TO HAVE HORMONAL CONTRA CEPTIVES FOR WOMEN WITHOUT [INDISCERNIBLE] IS MUCH MORE COMMON DURING PREGNANCY [INDISCERNIBLE] AND IT CASTS A HUGE SHADOW AGAINST THE [INDISCERNIBLE] TO STOP THE PILL BECAUSE THEY ARE SO AFRAID OF IT. AND I THINK TESTIMONY HOW MUCH WOMEN WANT TO AVOID PREGNANCY BUT THEY TAKE THE PILL EVEN WHEN THEY BELIEVE IT IS [INDISCERNIBLE] BUT WE NEED TO HAVE [INDISCERNIBLE] THAT'S ON THE TECHNOLOGY SIDE. IN TERMS OF ACCESS, SUSCEPTIBILITY UPTAKE WHATEVER ARE ALL THESE ISSUES. MOST OF THESE, NOT THE SORT OF THINGS THAT ARE GOING TO BE ADDRESSED BY NICHD. UNIVERSAL COVERAGE IS MORE COMPLICATED THAN IT LOOKS AND WE SHALL SEE HOW THAT EVOLVES IN THE NEXT COUPLE YEARS. I MADE THIS [INDISCERNIBLE] OR THE COUNTER LEADS TO SUBSET OF [INDISCERNIBLE] HELPFUL TO IMPROVE ACCESS AND UNLIMITED RESOURCE.-INJECTIONS CAN BE SELF ADMINISTERED, YOU CAN WORK ON THAT [INDISCERNIBLE] GIVE-THEMSELVES INJEC TIONS.-YOU CAN DO THE SAME WITH CONTRA CEPTIONS.-YOU CAN GET RID OF THE MYTHOLOGY OF THAT [INDISCERNIBLE] [INDISCERNIBLE] ANOTHER MAGAZINECOVER THIS IS A PERSON TAKING A BIRTH CONTROL PILL SAYING THE KISS OF DEATH [INDISCERNIBLE]HASN'T BEEN F OR 50 YEARS BUT WE NEED TO DO EVEN A BETTER JOB WITH COMMUNICATION AND WITH-GETTING RID OF THE MYTH. THANK YOU.[APPLAUSE] >> THANK YOU. AND THE LAST SPEAKER FROM OUR ASSOCIATION DR. SELZER FROM THE TEMPLE UNIVERSITY SCHOOL OF MEDICINE.HE SERVED AS A DIRECTOR OF REHABILITATION RESEARCH AND DEVELOPMENT AT THE DEPARTMENT OF VETERANS AFFAIRS.AND HE'S THE IMMEDIATE VI CE PRESIDENT OF THE WORLD FEDERATION FOR [INDISCERNIBLE] REHAB TAWTION.HIS OWN RESEARCH FOR MANY YE ARS HAS BEEN A NEUROOWN ACTION REGENERATION AND HE'S PART OF THE CENTRAL [INDISCERNIBLE] THAT IS FUNDED BY THE NATIONAL ASSEMBLY FOR MEDICAL REHABILITATION RESEARCH AT NICHD.-YET ANOTHER MEMBER OF OUR EXTENDED FAMILY. >> THANK YOU VERY MUCH AND THANK YOU TO THE ORGANIZERS FOR INVITING ME TO THIS EXCITING COLLOQUIUM.-I HAVE NO DISCLOSURES AND MY OFFICE IS ON THE 6TH FLOOR OF THIS BRAND NEW MEDICAL SCHOOL BUILDING TEMPLE AND OUR CENTER OCCUPIES THAT WHOLE FLOOR. BEFORE I WENT TO TEMPLE, I SPENT ALMOST ALL OF MY CAREER AT THE UNIVERSITY OF PENNSYLVANIA WHERE IN THE 1980'S THEY DECIDED THAT THEY WANTED TO ELIMINATE THE DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION. THE IDEA WAS THAT REHABILITATION REALLY WASN'T A SCIENCE. THERE WAS NO ACADEMIC CONTENT, AND WE COULD FIND SOME WAY TO TREAT IT AS A KIND OF HOSPITAL SERVICE. FORTUNATELY THAT PLAN DIDN'T GO THROUGH AND WHAT I WOULD LIKE TO TELL YOU TODAY IS THAT IN THE PAST DECADE OR DECADE AND-A-HALF, ACTUALLY COINCIDING WITH THE ESTABLISHMENT OF THE NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH AND MIKE WINE RICH WAS THE DIRECTOR AND IS STILL THE DIRECTOR. THAT THERE HAS BEEN A TOTAL TRANSFORMATION OF AN ENTIRE FIELD OF MEDICINE. AND IT'S NOT OFTEN YOU GET TO REPORT ON THAT. SO INSTEAD OF JUST BEING THE FIELD THAT MAKES DO WITH WHAT'S LEFT AFTER EVERYONE ELSE HAS HAD A DISEASE, WE DEFINE REHABILITATION AS ANYTHING NECESSARY TO RESTORE FUNCTION TO PEOPLE DISABLED BY DISEASE OR INJURY. AND THE SCOPE OF REHABILITATIONRESEARCH WH EN YOU THINK ABOUT IT THAT WAY INCLUDES BASIC RESEARCH TO A PAIR OF ORGANS AND TISSUES AND TRANSLATIONAL RESEARCH TO BRING THESE BASIC DISCOVERIES TO CLINICAL USE. PROCESS THAT HICS AND ROBOTICS RESEARCH TO REPLACE WHAT CAN'T BE REPAIRS AND METHODS TO PRODUCE PHYSIOLOGICAL FUNCTION AND SOCIAL REINTEGRATION AFTER YOU HAVE DONE ALL OF THESE MIRACULOUS THINGS THAT INCLUDE CURE WHICH IS ABSOLUTELY ESSENTIAL IF YOU'RE GOING TO RECRUIT THE BEST AND BRIGHTEST TO A MEDICAL TEAM. AND SO WHAT HAS HAPPENED IN THE PAST DECADE THAT WE CAN POINT TO AS A RESULT OF THESE NEW FOCUSED AND EXPANDED VIEW. WE HAD THE APPLICATION OF EVIDENCE-BASED PRACTICE TO REHABILITATION.EXPANDED BRAIN COMPUTER INTERFACE AND ROBOTICS RESEARCH THAT YOU SAW AND I'LL SHOW YOU A LITTLE BIT LATER BUT YOU SAW IN THAT VIDEO. WE HAVE ADAPTATION OF MULTICENTER PERSPECTIVE RANDOMIZED CONTROL CLINICAL TRIALS FOR REHABILITATION TREATMENTS.WE NEVER HAD THAT IN PHYSICAL THERAPY MODALITIES BEFORE AND WE HAVE ADOPTION OF THE BASIC SCIENCE UNDERPINNING INPLASTICITY AND REPA IR OF THE INJURED NERVOUS SYSTEM. WE EVEN HAVE CLINICAL TRIALS OF REGENERATION PRODUCING THERAPIES, THERE'S PLENTY OF CAVEATS IN HERE WHICH I WILL TELL YOU ABOUT IF THERE IS TIME. BUT IF THERE IS NO TIME BECAUSE I WANT TO MAKE UP A LITTLE TIME AND GET YOU ALL TO SOME COFFEE, YOU KNOW, THIS IS THE BOTTOM LINE OVER HERE. REMEMBER THIS AND ALL OF THE REST YOU CAN FALL ASLEEP OR YOU CAN [INDISCERNIBLE] SO WE CAN REPLACE FROM BOTTOM TO TOP IN REVERSE ORDER WHAT CANNOT BE REPAIRED. AND HERE IS A LITTLE CLOSE UP OF A BRAIN COMPUTER INTERFACE CHIP WITH A HUNDRED ELECTRODES THAT WAS USED IN JOHN -- LAB AND YOU AT THIS TIME EARLY ON IT WAS USED EXCLUSIVELY FOR COMMUNICATION. BUT THE IDEA NOW IS THAT ONCE YOU TEACH THE BRAIN TO TEACH A COMPUTER TO GIVE INSTRUCTIONS, WHY CAN'T YOU CONTROL ELECTRICALLY DRIVEN DEVICES THAT ACTIVATE PARALYZED MUSCLES,BLADDER THAT ON E CONTRACTS AND SO ON. AND SO YOU'LL RECOGNIZE THIS PATIENT FROM THE VIDEO THAT YOU JUST SAW. AND FOR THE SECOND TIME I'LL MENTION DEAN CAYMAN BECAUSE THE ARM THAT IS BEING CONTROLLED BY THIS WOMAN WHO IS PARALYZED AND ALSO CAN'T SPEAK BECAUSE OF THE BRAIN STEM STROKE, WAS DEVELOPED BY THE DECA, CALLED THE DECA ARM BY DEAN CAYMAN'S GROUP. WITH HELP FROM MICHD AND THE DEPARTMENT OF VETERANS AFFAIRS. AND SO WE ARE HOPING TO BRING UP TO, NOW THIS WOMAN ISN'T AN AMPUTEE, SO THIS ARM WAS TO PROVE THE PRINCIPLE BUT THE NEXT-THING WE' RE GOING TO DO IS TO HOOK IT UP TO A PROSTHETIC ARM WORN BY AN AMPUTEE. AND THE DEPARTMENT OF VETERANS AFFAIRS HAS BEEN WORKING ON THAT. SO FINALLY, REPAIRING THE INJURED SYSTEM. THIS IS THE HOLY GRAIL. AND HERE I WANT TO FOCUS ON THE CHALLENGES AND WHAT WE DON'T KNOW AND THE QUESTIONS WE WANT TO ASK RATHER THAN WHAT WE DO KNOW AND WHAT WE HAVE ACCOMPLISHED. FIRST PROBLEM IS THE ONE OF EXPERIMENTAL PARADIGMS OF AXONGROWTH. THIS IS ONE PROBLEM. THE SECOND IS THE SCALE. WE DO ALL OF OUR EXPERIMENTS ON MICE AND RATS BUT WE GOT TO MAKE REGENERATION INTO PEOPLE. AND IT TURNS OUT THAT THIS IS NOT JUST A THEORETICAL, YOU KNOW, PROBLEM. IT MAY BE A VERY REAL PROBLEM. WE HAVE TO COME TO GRIPS WITH THE FACT THAT CLINICAL TRIALS IN THIS AREA WITH HIGHLY INVASIVE THERAPIES ARE APPROVED INITIALLY JUST FOR THE MOST SEVERELY AFFECTED PATIENT BECAUSE THEY'RE THE ONES WHO HAVE THE LEAST TO LOSE IN CASE YOU DO SOMETHING TO MESS IT UP. BUT THOSE ARE ALSO THE PEOPLE WHO ARE LEAST LIKELY TO RESPOND AND THAT COULD CLEAR THE DEAL FOR DRUG COMPANIES. AND FINALLY, A LOT OF DISEASE CATEGORIES MAY BE VERY IMPORTANT BUT THE INDIVIDUAL DISEASES MAY BE VERY RARE AND THAT MAKE IT DIFFICULT TO FUND. SO WHY DO I SAY THAT WE MAY BE INVESTIGATING THE WRONG MODELS OF AXON GROWTH.-WELL, BECAUSE THERE'S MORE THAN ONE TYPE OF AXON GROWTH. THERE'S MORE OF THE SAME BUT WE TEND TO DO EXPERIMENTS AS IF THEY WERE. SO EARLY IN DEVELOPMENT AXONS ARE GUIDED TO THEIR TARGETS BY GROWTH CONES THAT USE AN [INDISCERNIBLE] MOLECULAR MOTOR TO SNIFF OUT THE ENVIRONMENT AND TO TURN THEM IN THE RIGHT DIRECTION. BUT AFTER THE TARGETS HAD BEEN FOUND IN AN INSTANT, THESE ARE STILL GROWING. AND IF YOU THINK ABOUT A WHALE WHOSE AXON, WHOSE SPINAL CORD IS ELONGATING, AXONS HAVE TO GROW AFTER THEY REACH THEIR TARGET UP TO 3 CENTIMETERS A DAY WHICH IS MUCH MUCH FASTER THAN THE FASTEST KNOWN GROWTH OF AXONS IN TISSUE CULTURE. FINALLY IN THE MATURING OF THE SYSTEM INJURED PATHWAYS MAY BE PARTURELY INJURED AND SO THE AXONS THAT ARE NOT INJURED CAN SPROUT COLLATERALS BY THE INTERRUPTED AXONS BUT THE INTERRUPTED AXONS HAVE TO TRY TO GROW. AND WHY IS THIS IMPORTANT? THINK OF A PARTIAL SPINAL CORDINJURY I JUS T SHOWED YOU THAT AND YOU CAN PARTIALLY COMPENSATE FOR THE COLLATERAL SPROUTING. WHAT ABOUT IN THE COMPLETE SPINAL CORD INJURY THE KIND OF PATIENT THAT IS GOING TO BE THE SOME OF THESE CLINICAL TRIALS. WELL, THERE ARE NO SPARED FIBERS IF THE INJURY IS COMPLETE, THERE ARE NO SPARED FIBERS TO SPROUT. SO YOU NOW ARE DEALING WITH TREATMENTS SUCH AS NEUTRALIZING THE GROWTH INHIBITING MYELIN ASSOCIATED.I'M GOING TO SKIP THIS SLIDE BECAUSE IT'S TIME. BUT THE BOTTOM LINE IS THERE'S ALREADY A CLINICAL TRIAL THAT WAS STARTED TO NEUTRALIZE NOGO. AND THE PROBLEM IS NO GO NEUTRALIZATION HAS RESULTED IN INCREASED COLLATERAL SPROUTING BUT IN THE CORTICO SPINAL TRACT WHICH IS EXTREMELY IMPORTANT IN HUMANS.AND YET WE DO NOT HAVE REALLY GOOD EVIDENCE THAT THERE IS INCREASED REGENERATION OF THE INJURED AXONS. SO SPROUTING IN THE UNINJURED AXONS.BUT ALL OF THE PATIENTS THAT ARE BEING USED IN THE INITIAL PHASE ONE AND TWO CLINICAL TRIALS ARE COMPLETE SPINAL CORD INJURIES. SO THOSE ARE OUR CONCERNS. AND THE SAME CAN BE RAISED IN THESE OTHER TRUE MODALITIES.SO FOR EXAMP M ODALITIES.-SO FOR EXAMPLE, THE AXONS THAT YOU SEE ON THE LEFT ARE THE GROWTH CONES OF EMBRYONIC CHIPS GROWING IN TISSUE CULTURE. THEN ON THE RIGHT YOU SEE A LIVE GROWING AXON TIP IN THE SPINAL CORD OF MY ANIMAL [INDISCERNIBLE] AND I WON'T TELL YOU ALL THE WAYS IN IN THIS CLEARLY IS NOT THE SAME AS A GROWTH CONE ASOUGH WHEN WE DEVELOP THERAPIES WE USE GROWTH CONE COLLAPSING AS THE HALLMARK OF INHIBITION OF AXON REGENERATION. SO WE HAVE ALL OF THESE SIGNALING PATHWAYS AND WE USED THE ABILITY TO GENERATE THE PUSH PULL BETWEEN INHIBITORY AND FACILE TORY ENVIRONMENTAL VIEWS AND WE HAVE TUMA ANY LATE INTRINSIC FACTORS, INTRINSIC GROWTH ABILITY OF NEURONS. I'LL POINT OUT THIS ONE MOLECULE B10 WHICH IS A TUMOR SUPPRESSOR THAT IF YOU CAN KNOCK IT OUT IN THE CONDITION OF KNOESSOUT. YOU'RE SEEING A PICTURE OF A YOUNG INVESTIGATOR IN OUR CENTER WHO HAS SHOWN THAT IF YOU DO A CONDITIONAL KNOCKOUT, HE DID THIS IN THE LABORATORY AT HARVARD BEFORE HE CAME TO UIEW THAT YOU CAN GET REGENERATION OF AXONS IN THE OPTIC NERVE WHICH WE CONSIDER A PART OF THE CENTRAL NERVOUS SYSTEM. SO ONE EXPERIMENTAL PARADIGM.-WHAT ABOUT T HE SCALE OF THE ANIMAL? SO I'M NOT GOING TO BOTHER DESCRIBING THIS EXPERIMENT, BUTTHE FACT OF THE MATTER IS THAT EVEN IN THE PERIPHERAL NERVOUS SYSTEM WHERE WE KNOW THAT AXONS CAN GROW, IN THE ADUS THEY DON'T GROW FOREVER. THE AXONS KEEP OUT. AND IN A MOUSE, THE DISTANCES THAT THEY HAVE TO, THE AXONS HAVE TO COVER BEFORE THEY, LET'S SAY GET BACK TO THEIR TARGET IN THE SKIN OR IN THE MUSCLE IS SO SLOW THAT THE AXON CAN REACH ITS TARGET. BUT IN A HE TAN BEING BECAUSE THE WEIGHT OF AXON GROWTH IS ABOUT THE SAME IN ALL THE SPECIES. THE DISTANCES THAT THEY'RE GOING TO HAVE TO COVER ARE SO LONG THAT IF YOU HAVE A FAI WOY PROXIMAL INJURY, EVEN IF YOU DO THE BEST SEW UP JOB, THE AX ALWAYS KEEP OUT BEFORE THEY GET TO THEIR TARGETS.-SO THERE ARE LIMITS AND IT TURN OUT THAT IN THIS CASE THE LIMITS HAVE TO DO WITH THE WAY THE SCHWANN CELLS STOP WORKING. BUT THERE ARE LIMITS TO THAT. AND THEM FINALLY, SYSTEMATIC, SYSTEMICALLY DELIVERABLE BLOCKERS OF GROWTH ILAPIBITION. I'VE JUST MENTIONED THAT WE USUALLY HAVE TO START EXPERIMENTAL TRIALS WITH SPINAL CORD INJURY WITH HIGHLY INVASIVE PROCEDURES TO DELIVER BLOCKERS OF BOTH ILAPIBITORY MOLECULES BUT-WE HAVE TO DO IT IN THE MOST SEVERELY AFFECTED PATIENTS. AND THOSE ARE THE PATIENT LEAST LIKELY TO BE HELPED BY THE THERAPY. SO ANOTHER INVESTIGATOR IN OUR CENTER DEVELOPING METHODS TO MIMIC THE BINDING SITES OF THESE GROWTH INHIBITORS AND DEVEL.-SO A SHORT PEPTIDE MOLECULES THAT CAN GET ACROSS THE BLOOD BRAIN BARRIER AND NEURONS IF NECESSARY THAT COULD BE SYSTEMICALLY DELIVERABLE AND THEREFORE MIGHT BE USED IN COMPLETE PATIENT, PATIENTS WHO ARE MORE LIKELY TO RESPOND TO THE THERAPY. AND THEN I'M GOING TO SKIP THE LAST PART WHICH IS PARTNERTESIPS BETWEEN OUR GROUP AND FAMILIES OF CHILDREN WITH RARE DISEASEIEW A WAY OF GETTING AROUND THE LACK OF FUNDING FOR RARE DISEASES. I KNOW THAT NIH HAS A INITIATIVE ABOUT RARE DISEASES BUT THERE-ARE DISEASES THAT ARE PART OF LARGE FAMILIEIEW MANY GENETIC DEES CTIEW EACH WITH A DIFFERENT PHENOTYPE. SO IN AGGREGATE, THEY'RE IMPORTANT BUT INDIVIDKERLLY IT'S ONLY A HANDFUL OF FAMILIES. AND SO MAYBE WE CAN GET THAT. [INDISCERNIBLE] SO THE ENCOURAGE IN THE MCRR AND VA PARTICULARLYNEUROREHABI LITATION HAS EOT GANDED ITS MEANING TO INCLUDE THE APPLICATION OF RESEARCH ON NEUROREPAIR AND PLASTICIT, THE A TO RESTORE FUNCTIOELI ACKIENTIFIC FIELDS INCLUDE ROBOTIC EVIDENCE-BASED MEDICINEAND SO OELI AND THE BENEFITS OF SCIENTIFIC RESEARCH ARE BOTH DIRECT AND INDIRECT.-AD.SO ATION OF THE BASIC SCIENCE FRAMEWORK HAS ENCOURAGED EVIDENCE BASED CLINICAL PRACTICE AND RAISED THE IMPACT OF THE FIELD LIKE REHABILITATION MEDICINE.AND CAN NOW ATTRACT THE BEST AND EPIGHTEST TRAINEES AND AGAINTHANK YOU VERY MUCH AND LET'S HAVE SOME COS THAEE.-[LPLAUSE] >> THANK YOU TO ALL OUR SPEAKERS. A ROUND OF APPLAUSE FOR ALL OF OUR SPE-HERS. WE WILL T-HE 15 MINUTE BREAK AND BE BACK HERE AT 3:00. WE HAVE COME TO OUR FINAL SEGMENT THIS AFTERNOON. THANK YOU. IT'S ENTITLED THE NEXT 50 YEAR, ADVANCING SCIENCE AND IMPROVING LIVES.-I'M KATHERINE SPONG AND THE DIRECTOR OF THE DIVISION OF EXTRAMURAL RESEARCH AT NICHD AND I'M HONORED TO BE YOUR MODERATOR FOR THIS FINAL SESSION. FIRST WE WILL HEAR FROM DR15TERESA WSEAT HOUFF IN-CUSATING LEADERS FOR THE NEXT GENERATION OF BIOMEDICAL RESEARCH. TESE'S A WATKINS CHAIR AT THE FEINBERG SCHOOL OF MEDICINE NORTH WESTERN UNIVERSITY IN CHICANYO. TESCUS BEEN CONTI-THALLY FUNDED BY THE NICHD, ANOTHER MEMBER OF OUR FAMILY SINCE SHE JOINED HER FA.FS POSITION AT NORTH WESTERN FOLLOWING A POST DOC AND STAFF SCIENTIST POSITION TINV GENENTECH.FOR PHYSIOLOGY OF THE OVARY, WOMEN'S HEALTH AND STEM EDUCATIOELI- HO15WOODRUS THA.[APPLAUSE] -> > THANK YOU. THANK YOU VERY MSCH, KATHERINE AND CONGRATULATEON ON YOUR NEW POSITION. WE REALLY WELCOME YOU AS OUR N.W BOSS. IT'S REALLY A DELIGHT AND REALLY TERRIFIC THAT THIS TOPIC WAS SELECTED ON THIS DAY SO I'M PARTICULARLY HONORED TO REPRESENT BY PROXY THE KINDS OF THINGS I THIY M RTHESRODUCTIVEACKIENTISTS DO EVERY DAY IN THEIR LABORATORIES AND THAT IS TO DEVELOP MECHANISMS AND METHOER I TO ENSURE THERE ARE REPLACEMENTS FOR ALL OF US AS WE MOVE OUT OF THE FITES BOWL. SO I'M GANYONG TO START WITH A LITTLE BIT OF THE GAP AND WE HEARD SOME OF THAT TODAY. I BELIEVE REALLY THAT REPRODUCTIVE SCIENCE AND REPRODUCTIVE MEDICINE CAN IMPR AT E HEAS OVER THE ENTIRE LIES TIME WHICH HAS BEEN THE SCENE OF THE DAY TODAY. WE CERTAINLY HAVE SIGNIFICANTCHALLENGES TH AT WE'VE HEARD ABOUT TODAY AS WELL WHICH INCLVA E THE SLIDING EPIDEMIC OF DIABETES, OBESITY AND THE POPULATION EXPLOSION, THE SILENT KILLERS AND INFECTIOUS DISEASEIEW MATERNAL MORTALITY. WE ALSO KNOW THAT THERE ARE PRESSURES ON OUR HEASCARE FROSTEM THAT HAVE COME TO THE FORE IN PARTICULAR IN THE LAST SEVERAL YEARS AND ENORMOUS DISTRIBUTION ISSUES WITH A UNEVEN CARE BASED ON RELIGIOUS PROCLAMATIONS AND OTHER REASONS-THAT WOMEN IN PARTI.-FLAR ARE NOT AFFORDED THE KIND OF CARE THAT WE PLEA THAT THEY NEEHEI AND WITHIN THIIEW WE ALSO BELIEVE THAT THERE ARE SIGNIFICANT SCIENCE KNOWLEDGE GLS THAT INFLRNANCE SOME OF THESE HEALTH AND DECISIONING PROBLEMS THAT NEED TO BE ADDRESSED IN ORDER FORSILS TO AS A P.-SO AULATION BECOME HEALTHIER OVER THE NEXT 50 YEARS.-AND IED S IMPORTANT TO NOTE THAT-EV EN THOUGH MOST OF MY SLIDES WILL HAVE ONLY WOMEN ON THEM OR ONLY, THAT THIS T.%SO AIC IS REALLY IMPORTANT TO BOTH SEXES. SO FOR RIGHT NOW I'M TRYING TO AFTET FOR BOTH SIDES OF THE SLATE. LET ME START MY TALK, WHICH IS ABOUT SCIENCE EDUCATION WITH A HYPOTHESES.-I THIY M THAT ADVANCES IN 21ST CENTURY MEDICINE REALLY REQUIRES-OF ALL OF SILS A WELL TRAINED CA HOE OF BASIC SCIENCES AND INVESTIGATORS WHICH REALLY REPRESENTS A MAJORITY OF SCIENCE EDSCATION THAT GOES ON BOTH HERE AT THE NIH AND IN NICHD SPONSORED LABORATORIES. THEY MUST STUDY RTHESRODUCTIVE SCIENCE AND MEDICINE IN PARTNERSHIP WITH A WELL-NO ANDEDPUBLIC AND SO IED S INCE TBENT ON ALL OF US TO INVEST IN THE EDUCATION OVER THE NEXT GENERATION OF INN AT ATORS WHO NOT ONLY WILL BECOME THE NEXT GENERATION OF SCIENTISTS AND CLINICIANS BUT ADINO THAT WELL-INFORMED PUBLIC THAT WILL HELP IN THE IMPROVEMENT OF AT ERALL HEAS.SO TODAY I'M GOING TO SPEND THE NEXT FEW MINUTES WITH YOU TACRING AROUND THREE STHESARATE TOPICS FINDING THE PUMP HOW DO WE GET STARTED AND JUST SOME OF THE ABNDS OF THINGS THAT WE'VE-BEEN DOING IN ORDER TO ADDRESS THIS PARTICULAR ISSUE. TESOWINSTSTEACHERS HOW TO SCALETHESE KINDS OF EFFORTS AND THEN FINALLY HOW DO WE SUSTAIN THESE -ABNDS OF EDUCATIONAL ES THAORTS. %IREALLY WANT TO GIVE A SHOUT OUT TO THE REPRODUCTIVE SCIENCE-EPANCH AND ISILNDERSTAND THEIR NAME IS DIFFERENT BUT I CAN'T REMEMBER THEIR NAME IS REPRODSCTIVE SCIENCE BRANCH YOUKNOW WHO YO U ARE AND [INDISCERNIBLE] IN PARTICULAR WHO HAS CHAMPIONED THE CENTERS FOR RTHESRODUCTION AND FERTILITY -- COOPERATIVE AND ONE OF THE KEEPS THAED S BEEN A PART OF OUR CENTER AT NORTH WESTERN AND MANY OTHER CENTERS IS THAT WE COMBINED REALLY THE CUTTING EDGE RTHESRODUCTIVE RESEARCH THAT WAS INTERDISCIPLINARY, WE USE THAT TO TRANSLATE THOSE FINDINGS TO WOMEN'S HEALTH IN VERY PRAGMATIC WAYS.WESPEE GENERATE THE KINER I OF PATIENT MATERVE ARE NECESSARY TO EDUCATE THOSE WHO HAVE TO M-HE CHOICES VERY TRYICKLY ABOUT THEIR FACILITIES, ALTOGETHER WITH THE EDUCATION THAT'S NECES ATRY TO ENSURE THAT EVERYBODY AROUNDSILS KNOWS WHAT WE'RE DOING. AND I THINK THAT IT IS THE FACT THAT THESE KIND OF EDUCATION PROGRAMS ARE IMBEDDED WITHIN THE FABRIC OF GREAT SCIENCE TRANSIONATIONAL MEDICINES AND PATIENT DECISIONING, THAT I THINK THIS WORKS SO WELL. SO ONE OF THE PROGRAMS I'LL TELL YOU ABOUT [INDISCERNIBLE] ONCOFERTILITY IS FOR YOUNG CANCER PATIENTS. ONE OF THE WAYS WESILSED THIS IS TO DRIVE INNOVATION EDUCATION PROGRAOFE TO BRING HIGH SCHSEATL HERE RLS INTO NORTH WESTERN. I'LL TELL YOU ABOUT THE NORTH WESTERN STORY AND WHAT WCUVE DON BEYOND NORTH WESTERN FROM THE CITY OF CHICAGO WHERE WE HAVE A 50/50 CHANCE OF GRADUATING FROM HIHES SCHSEATS A BRING THESE GIRLS INTO THE UNIVERSITY WHERE THEY GET HANER I ON LABORATORY AND CLINICAL ACTIVITY.WE CLICK WITH THE FOLK IN THE LAB ISOLATING FOLLICLES AS WELL AS THE DA VINCI ROBOT. WE WORKED WITH THEM ON CAREER AND CERE LEGE CHOICES. WE DEVEL.SO A A RELATIONSHIP NOT WITH SCIENTISTS AND DOCTORS BUT WITH PEERS, THE AMERICAN WOMEN ASSOCIATION MCIABERS OF THE MEDICAL SCHOOL CLASSES WITH GRADUATE STUDENTIEW WITHSILNDER GRADROBTES.AND WE TRY TO EMPOWER THEM WITH WOMEN'S HEALTH KNOARE NEDGE. IT'S AN EXCLUSIVE AIMS AND GOADIN FOR THESE COHORTS OF GIRL THAT COME INTO THE PROGRAM ON AN AN-THAL BASIS. WE ADINO HAVE VERY EXCLUSIVE ROLES FOR THE PARENTS AND GUARDIANS OF THE HIGH SCHSEATL HERE ISIS. THESE ARE OFTEN TIMES VERY FRAGMENTED FAMILIES, SOMETIMES THERE ISNN BIOLOHERE C PARENT. THERE ARE GUARDIANS, AUNTS, GRAN MOTHERS, THERE ARE SPLINTERED FAMILY.THERE ARE A LOT DEVELOPING THIS-INT ERESTING SCIENCE IN ORDER TO AND PPORT THEM ALONG THE WAY. WHEN THEIR DAUGHTERS GO TO COLLEGE THEY MIGHT NOT KNOW WHAT TO EXPECT SO WE TRY TO PROVIDE NOT ONLY TOURS OF THE DORMS FOR THE YOUNG WOMEN BUT SEPARATELY TOURS FOR THE PARENTS. SO QRNASTIONS THAT NEED TO GET ASKED IN THIS CONTEXT. WE ADINO HAVE GDADIN FOR THE HIGH ARYHOERE TEACHERS WHERE THESE STUDENTS COME FROM AS WELL AS FOR THE STAS THA.AND WE KNOW THAT HIGH ARY HOERE TEACHERS PARTICULARLY IN THE PUBLIC SCHOOL SYSTEM WERE IN LOVE WITH SCIENCE WHEN THEY WERE IN HIGH SCHOOL AND COLLEGE. THEY PROBABLY WERE THE ONE OUT DOINSTSGREAT SCIENCE FAIR PROJECTS AND THEY REALLY HAD THAT PASSION THAT ALL OFSILS TESARE AND THAT CURIOSIING. FOR UNDERSTANDING BASIC PRINCIPLES-OF SCIENCE. BUT AS THEY GO TIAOUHES TEACHING AT ER THE YEARS AND WITHOUT ADDITIONAL OPPORTUNITIES THEY DOVE AWAY FROM THE CUTTING EDGE OF SCIENCE AND SOME GET BEATEN DOWN BY THE SYSTEM. WE WANT TO ENGANYE THE HIGH ARYHOERE TEACHERS IN THE LABORATORIES.-WE WANT TO DEVELOP CURRI.-FN TIIS IEND LINWITH BACK TO THE CLASSROOM AND THE WORK AND WE'LL SHOW YOU A FEW EXAMPLES OF THOSE. WE WANT TO RECONNECT THEM WITH-THE LOVE OF AND THE REASON FOR TEACHING. AND I CANN TELL YOU HOW MANY TIMES TEACHERS COME AND SAY I WAS READY TO GIVE UP, I WAS READY TO LEAVE THE TEACHING PROFESSION.-AND NOW I'M READY TO GO BACK A ND REENERGIZE AND TEACH THE NEXT GENERATION.-THIS IS A NECESSARY PART OF TH IS EQUATION.WE WANTED TO CREATE A NETWO%W OF TEACHERS LIKE A THET WORK OF STUDENTS ALL ACROSS THE UNITED STATES WE WANT TO NETWO%W THE ARYIENCE TEACHERS. THEN WE HAVE A GOAL FOR OUR COMMUNITY THE CHICAGO PFRLICCOLCHSEATDIN A ND BWELOND WHICH IS TO REALLY CREATE A NEXT GENERATION BIOLOGY CURRI.FNTIM THAT IS RELEORTHOU KNOW, RELEVANT SKILL BASED AND INTELLECTUALLY BASED.-WE WANT TO HAVE SCIENCE IN THAT AS WELS A-AND WE WANT TO PROVIDE A CONTINUUM ENGAGEMENT BWELOND THE HIHES SCHSEATL DIVERLOMA. SO OUR PROGRAM, THE ONCOFERTILITY ACADEMY IS A TWSE.-- YEAR MODEL. THIS IS ONE EXAMPLE OF ON THE HIGH SCHOOL PROGRAMS WE RUN. IT'S A TWO YEAR MODEL, JUNIOR ONCOES RTILITY ACADEDEC FOR 11TH GRADERS, SENIOR ONCOFERTILITY SENIOR ARE FOR 12TH GRADERS. THERCUS A VERY RIGOROUS STUDENTœ SELECTION PROCESS QUHS VERY MUCH LICE I THE STUDENTS COMING IN TOSEE YOU FO R AASEDOB. THEY GIVE A RESUME, A LETTER, THEY GET DRESSEDSILP AND THEY COME AND INTERVI.WSILS. THERE ARE INFORMATIONAL MEETINGS FOR THE PARENTS SSE.THWEL REALLY UNDERSTAND WHAT IS GOING ON IN THE LABORATORY SETTING.-THERE'S A SERIES O F MODULES THEY HAVE TO COMPLETE WITH AFTER SCHOOL WORK SHOPS, WITH SATURDAY SESSIONS GROBL PROHOECTS. ULTIMATELY A CELEBRATOULT-GRADUATION THAT INCLUDES ALL OF THEIR FAMILY MEES AND MCIABERS OF THE COMEENENIING.. AND FOR OUR SATURDAY PROGRAMS,THESE GIRLS HAVE TO BE AT NORTH WESTERN BY 8:00 WHICH MEANS THEY HAVE TO BE AT THEIR SCHOOLS BY 7:30 IN THE MORNING AND YOU KNOW IF YOU HAVE TEENAGERS YOU KNOW THAT MOST OF THEM DON'T LIKE TO GET UP AT ALL. ONE OF THE REALLY GREAT METRICS OF SUCCESS I BELIEVE FOR THIS PROGRAM IS THAT THESE GIRDIN ALL ATTEND OR PROGRAM, THEY'RESILP EARLY AND THEY'RE AT THE SCHOOL READY TO GO. SO THESE ARE SOME OF THE MODULES FOR THE JOSA AND SOSA FOR 11TH GRADERS IS FOR BASIC SCIENCE AND PSIC REPRODUCTIVE SCIENCE. SOSA IS CLINICAL MEDICINE. YOU HAVE TO LEARN THE BASIC ARYIENCE BITIOORE YOU CAN GRA OF THEATE TO THE CLINICAL MEDICINE.-WE THINK THIS IS A GREAT WAY TO CONNECT THE DSENS AND NSEN ONS,Y THE GIRLS' MINDS BUT IN THEIR FAMILIES MINDS. SO WE HAVE MODULES ON REGO.LATIONS FOR OORTHAN FUNCTION, ONCOFERTILITY AND SURGERY, EGGS AND SPE ANDS OH DEC AND DOCTOR FOR A DAY. DOCTOR FOR A DAY IS A PINNACLE EXPERIENCE FOR THESE YOUNG WOMEN-TO T-HE O N KIND OF A MANTLE OF THE CLINICIAN AND IT'S A VERY EXCITING TIME FOR THETAN IT'S NSENASEDUST D.-YTORS FOR A DAY, IT COULD BE NURSES OR TAs OR SCRUB NURSES OR TECHNICVE. WO%WERS WITHIN THE ANIMAL COMMUNITY, THE VETERINARY STAFF. WE HAVE A LOT OF DULTRENT WAYS THAT THESE YOUNG WOMEN WHO ARE FOR THE FIRST TIME TOUCHING A MICROSCOPE OR A DADCI ROBSEN WHICH OUR FELLOWS DONN GET TO DO. SO POSA IS PARENTAL INVOLVEMENT ACADCIAY AND THAT SBLPORTS THE FAMILY MCIABERS. OUR PROGRAMS HAVE VERY GUIDING QUESTIONIEW HOW CAN WE PRESERVE-THE IF YOU ARE SILLIING. OF CANCER PATIENTS PARTICULARLY FOR YOUNG WOMEN.THIS BECOMES A PROBLCIA THAT THE-GIR LS HAVE NEVER THOUGHT ABOUT. MOST OF THE REPRO OF THECTIVE SCIENCE OR RST RO OF THECTION IS TF' T FROM THE PERSPECTIVE OF DON'T HAVE-SEX WHICH I THIY M IS ADY INITIOES CTIVE KIND OF DOR ACTIC TO USE. AND SO HOW CAN WE GET THESE HERE ISIS TSE.TACE I ON MORE OF THE ATME INFORMATION, INTERNALIZE IT AND THEN USE IT IN A DIFFERENT WAY.IT TURNS OISIS IF THEY ALL OF A SUDDEN START THINKING NOT ABOUT THIS WOMAN WANTS ME TO NSEN HAVE SE OUBUT RATHER WANTS ME TO THINK ABOUT SOME YOUNG WOMAN WHO HAVE A CANCER DVEGN-7IS AND IS GGRADNG TO L-7E HER FERTILIING., THAT CHANGES THE DYNAMIC RADICALLY. I THIY M AAS IN THESE PROGRAMS ARE WHAT WE RUN.I KNOW WE'RE A PROXY FOR WHAT MANY OF YOU RUN AS WELL. THIS PRESENTS A REALLY N AT EL WAY I THINK OF TALKING ABOUT MITOSIS AND MEIOSIS.ALL THE THINGS THEY HAVE TO LEARN IN GENERAL BIOLOGY. BUT UNDER A RUBRIC THAT THEY CAN UNDERSTAND AND THEN THEY HAVE A STRRATIVE. WHEN THEY GO BACK TO SCHOOL OR WRITINIENCOLLS'E APPLICATIONIEWTHWEL CAN T ELL A STOULT ABOUT THE TIME THEY MET A YOUNG CANCER PATIENT WHO HAD A FERTILIING. THREAT. WHEN THEY ISOLATE FOLLICLES AND-THIS BEGIN TO BE PART OF THE FABRIC OF WHAED S NECES ATULT TO MOVE THEM OUT OF POSITION OF A STATISTIC, ON 50/50 PERCENT OF GRADROBTION ON TO SSCCESS1THL GRADUATION. SO WE ALSO ENGAGE IN THE ETHICS OF BIOMEDICAL RESEARCH. OUR IED S BELIEF WE SHOULD START TO DISPEL ANY MYTHS THAT MIGHT THERIST RIGHT FROM THE OISISSECE. ANYAIN THE GIRDIN HAVE A DIALOGUE THAT THEY CAN USE AS THEY MOVE INTO BIOMEDICAL SCIENCES. ABOUTHAY CONCERNS, RELIGIOUS CONSTRAINTS.-OF THEM HAVE GENERIC NSENIONS OF WHAT THEIR RELIGION MIGLIC SAY ABOUT REPRODUCTIVE INTERVENTION-AND IT'S G SEATD FOR THEM TO TALK ABOUT IT AND KIND OISIS WHAT THE BOUNDARIES OF KNOWLEDGE ARE AND WHAT REALLY SOME OF THESE WORAND TH ACFEREALLY MEAREN-AS WE DO THIS, WE HOPE T O EDUCATE BEYOND JUST THE HIGH MOVHOERE LFL. WE ADINO HAVE A SERIES OF ETHICS DISCUSSIONS WHICH ALLOWS THE HERE ISIS TO REALLY THIY M DEEN UY AND BEHERE N TO FIND WITHIN THEMSELVES WHAT I CALL VERTICAL LEARNING, WHERE THWEL M AT E FROM HOR GUONTALLEARNIN G WHERE THE BACK OF THE BOOK TELLS THEM THE ANSWERS AND THWEL SIMN UY HAVE TO LEAEDU THETAN VERTICAL LEARNING IN A CURIOSITY BASE WAY WHAT THEY MIGLIC THIY M-AND H REA L THEY MIGLIC SERE VE THE PROBLEMS FOR THEMSELVES.-WE HAVE A NUMBER OF METRIC ON THE OISISCOMEIEW SOME ARE XCALITATIVE AND YOU CAN SEE SOME OF THE PICTURES HERE. AND I THIY M THE BRI' T SHINY WELES AAS IN AT 7:30 ON A SATURDAY MORNING ARE REALLY IMPORTANT BISIS THWEL ADINSE.HERE VE HEOU SOME OF THE XCALITATIVE ASSESSMENTS THAT THE GIRLS HAVE AS THEY'RE M AT ING THROUGH THESE PARTICULARPR SCRAMS. FOR THE FAMILY ACADEMY WE HAVE LABORATOULT WORK SHOP AS I MENTIONED.-WE ALSO BRING THE PARENTS INTO CLINICAL WORK SHOPS. FOR EXAMPLE WITH BREAST EERE V, WE'LL HAVE THE GIRLS IN OUR STIMULATION LAB SHOW THEIR DOTHERS ABOISIS BREAST EERE V, AND THIS BECOMES A VERY IMPORTANT DIALOGUE IN RETURNING SOME OF ANHE KNOWLEDGE BACK TO THE COMMUNITY IN A HEALTHY WAY WHEN THE GIRLS REALIZE THEY'VE BEEN AN F' T THAT THERE SHOULD BE FREQRNANT BREAST EXAMS AND NOW THEIR MOTHER SAYS WELL I HAVEN'T HAD A BREAST EERE VM BISIS SHE'S ALREADY HAD AN INCIDENCE OF BREAST CANCER. SO IT CAN GET TO BE MADE FAIISIY READILY IN THESE SFEREDIES AND IT'S AN IMPORTANT PART OF THE DIALOGRNA.-WE PROVIDE ACADEMIC AND CLEAR WORK SHOPS AGAIN FOR THE FAMILY MEMBERS, SO THEY UNDERSTAND WHAT-MI' T BE IN FRONT OF THEM AND WE HAVE OPEN FORUMS AND EVALUATIONS AND WE'VE HAD KWELNOTE SPE-HERS THAT HAVE BTHEY CAN OS THA SCALE AND ONE OF WHICH WAS DR. [INDISCERNIBLE]-ONE OF MY PERSO STL HEROES CAME AND GAVEASEDUST AN OISISSTANDING TALK THAT REALLY GALVANIZED THE ENTIRE COMEENENIING.. AND I STILL HEAR FROM MANY O THESE INDIVIDUALS ABOUT DR. PINN .-I HERE V,E HEOUAL LE STILL HERE. I WILL RETURN TO THEM AND TELL THEM YOU'RE WELL AND GOOD. WEALIPDATED OVER THE HEEARS THESE PR SCRA, WITHALINDER PROGRAMS WITH NEAR -- TURN BACK AND GRAB THE HAND BEHIND HEOU BECFSE THE ONLY WAY WCURE STRONG IS IF WE'RE ALL LINKED TOGETHER. SO THIS IS AN IMPORTANT PRINCIPAL OF NEAR PTHEY CAR THAT THESE GIRLS ARE TAKING ON. WE'VE N REAL DE NELERE V,ED AN O AT ALEL NI BDARD SO THEY CAN COME BACK TO A NORMALIZED SETTING AND DEVELOP NEW PROGRAMS THAT THEYTHINK WILL B E IMPORTANT FOR THEIR COMMUNITIES. PARENTS ARE LEADING PARENT WORK HAERE V,S.WEIONSE HAD PARENTS WHO HAVE GO NE THROUGH THE PROGRAM.PARENTS WHO HAVENNONE TO COLLS'E HEET BISIS STILL ARE PART OF THE LEADERSHIP OF THE PROGRAM.DEVELOP FAIISIY NULTSITE ANDTHIS P ROVIDES EVERYBODY IN THE COMMUNITY WITH ALL OF OUR HEMTHESICULAR M CLULES IN WHAT WE CALL LITTLE BOOKS, THE LIBRARY OF CURRICULA, YOU CAN PULL IT OFF THE BSEATWHELF AND HEOU CAN DOVE IT TO YOUR CENTER IF THAT HELPS YOU. WEIONSE INVESTED A GREAT DEAL IN HEALTHY FITNESS AND MEAL DIDACT-PARTICULAR S WITHIN OUR PROGRAM SO THAT EVEULT MEAL HAS A DI REACTIC PART TO IT SO THE GIRLS CAN THINK BETTER ABOUT THEIR HEALTH OVERALL LIFETIME OF HEALTH IS IS AN IMPORTANT PART OF WHAT WCUVE A.FED RECEN-THAOE WE HAVE VERY FORMALIZED ASSESSMENTS AND EVALUATIOHEA ANDWE HAVE PA PERS THAT ARE PUBLISHED ON THIS SO I'M NOT GOING TO GO THROUGH THIS IN DETAIL BISIS WE DO KNOW WCUVE IMPACTED CONTENT AND KNOWLEDGE. WE HAVE A SISTER HOOD THAED S BEEN CREATED THROU' THIS PR SCRAM, AND WE NOW HAVE CREATED A GLOBAL PROGRAM FOR THE ONCOES RTILITY NATIO STL SCIENCE-EDSCATION NETWORK.-SO KNOWING THAT WE HAVE CREATED A PROGRAM AT CHICAGO IS NSEN ENOU' .-WE HAVE TO MAKE SURE THAT IT IS MOVING OUT INTO AS MANY OTHER COT 7UNITIES AS P-7SIROVDE. SO NOW WE HAVE PROGRAMS AT PENNSYLVANIA SAN DIEGO AT OREGON HEALTH SCIENCESALINIVERSITY AND-THIS SUMME R THEY'LL HAVE A PROGRAM AT COLORADO. ULTAS WHBOILL IN THE RSEATM WANTS AS WH OF THIS CURRICULUM, YOU'RE VERY WELCOME TO HAVE IT. ENJOYING OUR WONDERFUL CONEB OF HERE ISIS CONNECTED AROUND THE NAIG AS WELL AS OUR FACULTY. SO THE BWELOND INEAONEDES AONEMNI RELATIONS WITH GROUPS COMING BACK TOGETHER AND GRADUATING RE ROM IN THIS CASE NICERE E MILES RE ROM SMITH COLLEGE WHICH WAS REALLY AN EXCITING DAY FOR ALL OFALIS. AND S OTRAASEDECTIING. I DONN KNOW SHE WOULD ALLOWED US HERSELF WHEN SHE FIRST CAME INTO THE O AT PR SCRAM AS AASEDUNIOIMPO SINCE WE STARTED THE FACILITY ACADEMY PROGRAMS WCUVE INEAREASED OUR IMPACT AS WCUVE INEAREASED NUMBERS OF CITIES.-YOU CAN SEE THE IMPACT AND ACFEREAL NEL BERS IS L REAL. IT'S HIGH IMPACT HIGH TOUCH KIND OF ORGANIZATION. SOMETHING THAT I ENEAOURAGE EVEULT-ONE OF HEOU TO DEA3 IN TERMS OF SUSTAINABILITY WE REALLY HAVE TO M-HE AN IMPACT AS WE GO OVER THE FUNDING CLIFF. THIS FISCAL CLIFF FOR US WAS WHEN THE ONEAOIF HEOU ARE SILLIING. E-TANIS I ENDED.-WE'VE BEEN PLANNING FOR H OW WE CAN CONTINUE TO IMPACT SFEREDENTS E NEN AFTER THAT FISCAL CLIS THA WAS PASSED. SO OUR STRATEGY IS TO GO FROM BENEAH TO CLASSROOM AND TO LIE-TARIES AND MUSEUMS WITH CURRICULUM THAT CAN BE SCALED OUGPRERE V,RIATELY OISIS OF THE LABORATOULT AT A HIGHER RESOURCEENVIRONMEN T TO AN OUT OF SCHOOL ENROVRONMENT.-SO THE FIRST PROGRAM IS OUR NORTH WESTERN UNIVERSITY BIOLOGY INVESTIGATES AND ONEAOFERTILIING. USING THE PRINEAIPLES OF ONCOFERTILITY AGAIN TO ENGAGE WITHIN THE CURRIHEMONEM OF THE HI' SIS ISEATL AND MORE AISISHORIING. AND ENGAGING WAY ALL THE PRINCIPALS THEY NEED TO UNDERSTAND THE ESSENTIAL D SCMA. THIS CURRICULUM INCLUDES BIOMATERIAL LABS, MALE HORMONE LA AND T CALLED HEOUIONSE GSEN MAIL, 28 REAYS LATER, WHY ARE WE DIFFERENT, ALL OF THESE ARE HEM-THESICULS OARE THAT ARE N REAL IN THE HI' SCHOOL SETTING IN CHICAGO. WE'VE HAD SEVERAL LFNEAHES. ERSHM G AONG TO HAVE HEOU LISTEN TO A LITTLE CLIP FROM ONE OF OUR TEACHERS.>> ERSHM KIND OF, I DO FTHEY CAL MFOR UELF SOMEBODY WHO KNOWS A GOOD DEAL ABOUT [INDISCERNIBLE] WE DO STHEY CA THE LESSON PLAHEA AND EVEULTTHINFOR THE F IN THE CLASSROOMS AND THE LABS. WE'VE BEEN REALLY REALLY AND CCESSFUL GETTING THE KIDS INTERESTED.%WE HAVE [INDISCERNIBLE] ON VID EO TALKINTHETHE KRONS IN THE IMPOAS%ESEAT AND T SHOWS A BIG DEAL LISTEN ING TO HER. ROO SO THE P AONT IS NSEN FOR HEOU TO HEAR IHOWS A BIG DEAL. [LAUGHTER] THE POINT IS TO SAY THAT HEOU ARE A BIG DEAL. THAT IN FACT FOR EVERY ONE OF THESE TEACHERS AND KIDS, ANY AMOUNT OF TIME HEOU SPEND WITH TH-BA MEAHEA THAT YOU WILL BE THE BIG DEAL TO THAT KID, AND RE RANCIS CERE LIHEA, HEOU KNOW, IS A NCG DEAL TO ROCK STAR OF SCIENCE BUT EACH ONE OF YOU ARE ROCK STARS TO THESE KRONS AND TO THESE TEACHERS. WE'VE HEARD TODAY ABOUT HOW IMPORTANT IMPRINTOO ETU GENETICIMPRINTS AR E IN EARLY LULTE AND HOW THEY IMPACT ADULT HEALTH. I BELIE NE THAT EACH ONE OF HEOU CAN HAVE AN IMPRINT ON A YOUNG PERSON'S LIFE AND THAT PERSON WILL GO ON TO CHANGE THEIR IVEAJECTOULT.WE DON'T KNOW BY HOW MUCH, MA YBE A LITTLE BIT, MAYBE A WILL HEOU TELL.AND THAT IMPRINT WILL FOREVER ALTER THAT INDIVIDUAL'S OUTCOME IN LULT SO THE NEW BIO IS OVER 1300 STUDENTS I THINK WE'RE UP TO OVER 3300 STUDENT.WEIONSE HAD A NEL BER OF TEAIS IERS IVEAINED BECAUSE WE THINK EVERY TEACHER IMPACT OF COURSE IMPACTS FAR MORE THAN THE SFEREDENT ITSELF AND YOU CAN SEE THE SCALABILITY GETS MUCH BIGGER AS WE GET TO TH7E PROGRAMS.MY FINAL PROGRAM I'LL TELL Y OU IS ABOUT [INDISCERNIBLE] THAT'SREALLY GREA T THAT WE CAN START TO HAVE THIS KIND OF IMPACT WITH TEACHERS BUT WE REALLY WANT A WE DIS I BIGGER IMPACT. AS INVESTIGATORS OVER THE NEXT 50 YEARS WE HAVE FAR BIGGER AMNCTIONS TO IMPACT OUR WORLD. ULT GOING TO CHANGE THAT POPULATION RAW JECT TREE OR IS IANGE OBESIING. AND MET BALL I THE METABOLIC -- HEALTHCARE-DISTRIBUTION Y OU REALLY HAVE GOT TO GET OISIS FURTHER. SO FUSE SAYS WCURE REALLY GOING TO FUSE ALL OF THIS INTO A WAY THAT WE CAN GET INTO THE CO A WUNITY COLLEGES AND TO THE LIBRARY AND THE PUBLIC AREAS SO THAT AS WHBOILL CAN GET THIS KIND OF CURRIHEMONE AND T -AND I THINK THIS IS ONE OF THE PLACES WHERE WCUVE BTHEY CAN M7T IS IALLENGED BECFSE WE HAVE TO TAKE AGAIN THESE LABORATORY-BASE ACTIROVTIES AND REALLY THIGAI-ABOUT H REAL TO M%STE THBA SOMETHING THAT YOU CAN DO IN A MUSEUM THE SETTING.IT'S BTHEY CAN REALLY AN THERCITIN GTHING AND YOU CAN SEE HOW WE CAN IMAGINE SCALING. I THIGAI THIS IS TRA TOCTORY BECAUSE WE DON'T HAVE 42,000 YET BUT WE REALLY HAVE AMBITIONS TIGG GET THERE.-Y.BORBOUT T HAVE TIME T CLAY TO TALK ABOUT SOME OF THE YOU THING WE'VE DONE LIKE RCHAROANGCTP TE THEY FOR THE PUBLIC. OUR OSO COLORING BOOK, DELIVERY IS HERE AND WE HERE V,E TO HAVE A PBS SHORT HERE V,EFULLY WCULL BE ABLE TO DO AUTHORIZED UNDER OUR NEW -- WE HAVE BLOGS AND S8L MEDIA.-ANY WAY WE CAN WE'RE GOING TO TRY TO GET THIS INFORMATION OUT TO PATOLIC INEAONEDING EANGCATING-MEN. SO THERE YOU GO. EVERYTHING ELSE IS WOMEN BISIS WE DCHOHAVE MEN IN THE LAB AS WELEY SO I STARTED THIS TIME WITH YOU REALLY WITH A HYPSENHESES SAYING THAT WE REALLY HAVE TO THIGAI ABOUT NOT POSSIBLE OF ONLY EDUCATING BASIC SCIENTISTS AND IMPOEA WHIIS I ARE REALLY CRITICAL BUT WE ALSO HAVE TO HAVE A WELL INFORMED PATOLIORS AND IF WE CAN REALLY GET THESE EDUCATION MOTIONITIES RIGHT, IF WE CAN LINK OUR ARMS AND SHARE BEST PRACTICES, I REALLY THIGAI WE'LL IMPROVE THE HEALTH OF OUR GLOBE NOT OTHEY CANY RIGSET N REAL BISIS F OR MAS WH HEEARS TCHOCOME. SO MY SLIDE ISN'T MOVING. SO THE NEXT GENERATION OF IMPOA, ONE OIENTISTS ANDLEADERS WILL BE AM ONG US. AND I HOPE TO SEE THIS YOUNG WOMAN IN MY LAB WHIIS I IS HER HEMRRENT CAREER GOAL WHICH IS A VERY EXCITING THING. I WANT TO THAT NICHD AND IHOWS ECHOING EVEULTONE ELSE IN THE STUDY SAID TODAY CONGRATULATIONS ON 50 HEEARS AND HERCUS TORE A0 I TRE HEEARS OF DISCOVERY. IN FACT I THINK THESE KIDS WILL BE AI TNG US OVER THOSE NTHERT YOU A ARE RARS.SO THANK YOU VERY MUCH FOR INCLUDING THIS TOPIC AT THIS REALLY IMK TRTANT FORU AND T THANK YOU. >> WOW. THAT'S HARD TO FOLLOW.AS WE COME TO THE EN D OF OUR PR SCRA WE'RE GOING TO CONCLUDE WITH A PANEL DISCUSSION IVEANSFORVERY.NG THE CULFERERE OF ONE OIENEAE.-I WOULD LIKE TO FIRST INTRODU CE ALL OF OUR PANEL MEMBERS, AND THEN DR. GIUDICE WILL QGERFY WITH SOME BACKGROUND. I WANT TO INVITE THE PANEL METHINK ERS TO COME AND HAVE A SEAT AT THE TABLE OVER TO MY RIGHT. THE PANEL CHAIR IS DWEL LIN REA USE AWE RICE, SHE THE CHAIR OBSTETRICS, GYNECOLOGY AND REPRODUCTIVE SCIENCES AT THE UNP TERSIING. OF CALULTORNIA IN SAN RE RANCISCO. SHE'S A BIOCHEMIST, GYNECOLOGIST AND RCHAROANGCTP TE END CRABUTINULL USE AST WHO HAS BTHEY CAN WELL FUNDED BY THE NIH AND SERVED ON NUMEROUS REROV SO PANELOO RE NIEW GRO-RS AND IS IAIRED STEERING COMMITTEES. DR. WENDY BALDWIN IS THE PRESRONENT AND DHEAF EXEHEMTIVE OFTCER OF THE POPULATION REFERENCE BUREAU. TRAINED AS A S8LTHL DHOR SCRAPHER, HACUS A PAST BRANEAH CHIELL AND DEPUTY DIRECTOR OF NICHD AS WELL AS DCHAISISY DIRECTOR FOR THERXEAMURAL RESEARCH AT NIH. DR. JOAN REEDE IS THE DEAN FOR DIVERSITY AND COM WE DLL BEING. PARTNERSHIP AND A'RE GO8TE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL. HACUS MENTORINGGSNDER REPRESENTED MINORITY STUDENTS AND TRAINEES. DR. ART LE NINE.-Y THE SENIOR VICE CHANEAE LLOR FOR THE HEALTH SCIENCES AND THE DEAN OF THE SCHOOL OF MEDICINE AT THE UNP TERSIING. OF PITTSON'RGFERER HE'S ALSO A PROFESSOR OF MEDICINE IN MOLECULAR GENETICS. HE'S AN ONEA-WE SCIST AND CONTIER GES TO HAVE A RESEARCH LABORATORY FOCUSED ON DNA DAMSEUE AND REPAIR. AND HE WAS FORMERLY THE SCIENTIFIC DIRECTOR OF NICHD FROM 1982 TOELO998. AND OF NSENE HE TED OVER HALF OF THE CURRENT SENIOR STAFF OF THE DIR, INCONEDING THE CURRENT ONE OIENTULT DIRECTOR AND NTRSELFAS YOUNG INVESTIGATORS. I WOULD LIKE TO INVITE THE PANEL TO THE TABLE. AND DR. GIUDICE TO GIVE US SOME BACKGROUND INFORMATION. ROOORMATCUSE.-I WOUUSE AW LCKE TCHOTHANK T HE ORGANIZERS TO BE HERE AND PARTICIPATE NOT OTHEY CANY ON THE PANEL BISIS FOR THIS DAY LONG CELEBRATION.MY ROLE IS TO LEAD THE PANEL DIONE OUSSION ON TRAHEAFORENING THE HEMDAY CURAL SCIENCE AND LOOKING TO THE NICHD'S ROLE IN THE NEXT 50 ARE RARS. ON'T I DRON WANT TO JUST TOUIS I BRIEFLY ON A LITTLE BIT OF HISTORY, AND WCUVE ALREAILL HEARD ABOUT THE N SEL PRIDR. THAT WENT THROUGH ROGER [INDISCERNIBLE] AND INELO977. FOR THEIR WORK ON GNRFERER ON'T THE OTHER HALF OF THAT PRIZE WAS SHARED BY -- FOR THE DEVELOPMENT OF THE [INDISCERNRS,LEEAIFOR PEPTIDE HORMONES WHICH REALLY BROUGHT IN A MAJOR HAY DAY FOR NIC.-M RESEARIS I IN THEELOEAL0'S AND 80'S. AND THEN MORE RECENTLY THE NOBEL PRING. E IN PCUSESI-WE SCY AND MEDICINE [INDISCEOLIBLE] YOU'LL SEE [INDISCERNIBLE] A NUMBER OF ARE RARS AND WCUVE AERE VEAILL HEAES. RE ROM SE NERAL NOBEL LAUREATES BUT I DID WANT TO HIGHLIGHT THE NOBEL PRIDR. [INDIONE OERLL BECATFOR THE B ISIS ALSO N REAL ENABLING ONCOFERTILITY [INDISCERNIBLE] GENETIC DISEUNOSIS IS A.->IN BURLL BENG IN THE FIEUSE AW AND NICHD HAS PLAYED A MAJOR ROLE IN THIS. WHEN WE LOOK AT THE COMTORSTHERITY OF HANKAN RCHAROANGCTION AND HUMAN DEVELOPMENT, IT'S ACTUALLY I THINK AMAZING THAT WE REPRROUGSCE AT ALL. THERE ARE SO MANY LEVELS OF [INDISCERNIBLE] AND WE HAVE LEARNED OVER THE LAST SE NERAL DECADES IN THE NICHD AND THROUGH NICHD-SPONSORED RESEARIS I RWEES A LOT ABOISIS THE M-WEECULAR BASIS OF MANY OF THE [INDISCERNIBLE] SHOWN HERE. IN ADDITION I THI REALLY IGHSDAY ERY IMK TRTANT TO PUT ALL OF THIS INTO PERSPECTIVE WITH REGARD TO THE EFFECTS OF EE BUIRONMENT, WHETHER IT IS NUTRITION OR STRESS OR CHEMICALS OR LIULAOVERING.LE BECTIDSE ALL OF THOSE CAN HAVE PROFOUND IMPACT NOT ONLY UPON REPRODUCTIVE [INDISCEOLRS,LEEAION'T ATTO REPRROUGSCTIVE BEHAVIOR AND OTHER BEHAVIOR.NICHD CERTAINLY HAS BTHEY CAN A LEADER IN THAHIG ALSO NIC.M AS WE HEARD FROM [INDISCERNIBLE] ABOUT CONTRACEPTION WANTEDGSNWANTED PREGISINEAAN HEADAY CH BABIES AND HEALTHY FAMILIES AND IT'S BEEN TRANSFORMATIVE AND IMPORTANT TIGG HAVE IE BUESTI.->TED EITHER AT INVESTIGATOR AS WE REALLY OF THE MORE TRA DHEE. THE L SYPSENHESES TERRAIN USAGE WHICH IS CRITICAL TO SCIENTIFIC INQUIRIEOO THERE'S ATTO THE WH-WEE PIECE OF DISCOVERY DRIVEN RESEARCH THAT HAS OPPED SO MANY RDORS AND AT-TO HAS PROROVDEDGSS WITH LSENS AND LOTS OF DOORS. AND IT'S NOT ONLY DATA WITH RE.>ES. TO MWEECULAR MECHALL BESMS ON'T IGHS ATTCHO REATA WITH REGARD TO THE SO-CALLED [INDISCERNIBLE] AND IT'S CRITICAL THAT WE HAVE THE RIGSET TEAMS IN PLACE, MULTIDISCIPLINARY TEAMS THAT ARE COYOU'RISED OF BASIC SCIENTISTOO IMPOINICAL SCIENTISTS, QUANTITATIVE SCIENTISTS [INDISCEOLRS,LE] AND OTHER HEALTHCARE PROULA'RE GOIOISIT-T WHOACTUALL Y BE PATIENT AND ASK THOSE IMPORTANT QUESTIOHEA TO GET OUT TO THE NTHERT LE NEL IN TERMS OF INTERPRETING GENOME-WIDE ASSOCIATION STWE RIES AND ALL OF THE DATA THAT ARE CURRENTLY BEING DRIVEN BECAUSE WE NEED THAT IN OES.ER TO INTROANGCE THE GEREN.IN AROLITION NICHD AND NIH HAVE PIONEERED WITH REGARD TO BENIS I TO BEDSIDE, BEDSIDE TO COM WE DLL BEING. AND IT'S EXTREMELY IMPORTANT WE ENGAGE OUR COMMUNITY LEADERS AND COH HUNITY ADV8 OF COURSE OUR PATIENT ADVOCATES FOR RESEARCH FOR THE FISISURE. WITH RHEEARD TO LE NELOO HANKAN REPRODUCTION ON HUMAN DEVELOPMENT WE'LL SEE THE NEXT VERE NERAL DECADES CONTIER GING IN THE BASIC BIOLOGY RESEARCH BUT ALSO TRANSLATING IT TO PERSONALING. ED MEDICINE HEA THE GENETIC BASIS OF HUMAN REPRODUCTIVE AND DEVELOPMENT DISOES.ERS AND PREEAL0ANCY OUTCOMES, EE BUIRONMENTAL BASIS OF HUMAN REPRODUCTIVE DISORDERS, PRHEEISINEAY OISISCOMES AND CHIUSE AWHOROU G DISEASES AND PERSONAL HEALTH. AND THEN ALSO PREVENTING BUT ALSO DLTHEAL0OSING AND MONITORING AND TREATING RCHARODUCTIVE AND DEVELOPMENTAL DISORDERS, MILL BEVERY.DR. RISKS AND IYOU'ROVE HEALTH AND IMPRMY RE KIALITY OF LIFE. WE LOOK TO THE FUTURE WE SEE BIG ONE OIENEAE, TTHEY CAN SEAL0OENCE, COYOU'REHENSIVE DATABASES, COMPREHENSIVE BIO DEPOSIT THERESETHINGINDIONE OERLL BECATFOR THE [INDISCEOLRS,LE] AS MUCH AS WE CAN AND YEAR AFTER YEAR. IMPO C-WELABORATION MAOM WE DLL BEING. ENDPAIJMENT AND OFCOURSE THE IMPORTANT ROLE OF ETHICS AND LABOR AS HE SCI BERRA SAID THE FISISURE AIN'T WHAT IT USED TO BE. I WELCOME THE OPPORTUNIING. N REAL TO EN.->GE THE NTHERT PANELIST TO GSO MAE SOME ADDITIONAL WORDS IN THIS REGARD. THANK YOU VERY MSCFERER [AURLLAUSFOR THE >> THANK YOU. WE'RE GOING TO DO THIS BY WAY OF A PANEL DISHEM'RE GOION AND MY TRACIC IS ABOUT LARGE DATA SETS AND [INDISCERNIBLE] GRAVITATE TO LAINTE DATA SETS. WE HEAES. AERE VEAGE D TROUGAY SO MANY SITUATIONS WHERE IT'S IMPORTANT TOGSNDERSTAND WCUSE WE STILL HAVE SOEAL0OAL GRADIENTS [INDISCERNIBLE]CONTEXT IS AND I KNOW AS A DEI TGR BEHER H REAL FAR ATELD WE CAN GO IF WE FALL INTO HIS [INDISCERNIBLE] LARGE REPRESENTATIVE DATA SETS. I THI REALLY THERE'S THRTHEY CA IMAUSE ANE SHERE THAT I WANT TO LEAVE YOU WITH.ONE IS H REAL DATA SHARING FOR LAINTE REATA SETS REALLY IS A CULTURAL PHENOMENA IS SO IMK T-AANTTHINGINDIONE OERLL BECATFOR THE I LMY RE THE IS IANGEOO SO CHANGE IS IMPORTANT.SECOND IS THESE LARGE DATA SETS CAN BETHINGINDIONE OERLL BECATFOR THENGING THE FEEDS TOGETHER AND INTERDISCIPLINARY RESEARIS I,-XEULY DISEAL 0OTORSINARY RESEA3-SH IS BETTER EXAMPLES [INDISCERNIBLE]ARE REALLY, THEY ARE THE MUIT THEREAL0OTING AND THEY CAN BE A TOOL. AND THIRD, LARGE DATA SETS AND SHARING OF THOSE DATA SETS ARE AN AMAZING TNTAL FOR THE S-RPORT FOR YOUNG INVESTIGATORS.-SO I'M GOING TOGS SE AN EXAYOU'LE OF DATA SETSTHINGINDIONE OERLL BECATFOR TH E FIRST IS THE [INDISCERNIBLE] DATA FROMELOEAL9.-THIS IS LONG TIME AS THE AND HEET THAT'S A SIGN WHEN WE WERE TOTALLY OBSESSED WITH UNDERSTANDING THE CHANGES IN ADWEESCENT SEXUAL BEHAVIOR. NOW MOST OF THAT UNDERSTANDING WAS BEING DRAWN FROM ANECDSENES ANDTHINGINDISCERNIBLE] AND NOT MUCH ELSE -- WERE TWO INVESTIGATORS KSOM JOHHEA HRACKIHEA WHO DJM THE FIRST NATIONALLY REPRESENTATIVE STUDY OF SEXUAL BEHAVIOR AI TNG UNMAAND HEOUNG WOMEN IN THE UNITED STATES."TIME" MAGAZINE SAID THIS IS A IS IANCE TO SUBSTITISISE GUISIP, SU%>TIATE DATA FOR GOSSIP ON THIS IMPORTANT TOPIC. AND SO THEY DJM. THIS IS AN AMA ONNG SAGE D, AND YET THE FIELD STARTED TO GO YES BUT THEY KIND OF HAVE THE DATA. AND THE DATA WERE NSEN AVAILABLE TO OTHERS.-IT'S THE REQUIREMENTS AND THEY WEREGEDED TO DO IT. LL BEIS ID REALLY STEPPED IN AND SAID IT SHOULD BE AVAILABLE, HEOU'RE XEYING TO MAKE IT AFAO MABLE AND THEY WERE WILLING AND SO WE DID SOMETHING THAT I THI REALLY N REAL HEOU CAN PR SABLY D REALN LOAD THE DATA ON YOUR iPHONE BUT THEN IT WAS A DATA TAPE AND A CROUGE BNTAK AND IF HEOU WANTED TOGSSE IT TODAY SENE IN AND SAID WHAT YOU WERE GOING TO USE IT FOR AND AGRTHEY CAD TO PRSENECT IT WAS SENT TO IT AND YOU COPIED IT AND THEN MAILED IT BACK. SO THE NTHERT PERSON [INDISCEOLF LE] BUT WHY DID IT CHANGE THE CULTURE? THE FIEUSE AW STA-AED TO STHEY CA THE BENETT OF THIOO THE FIELD START TO SAY WE ALL SHOULD BE DOING THIS.THEY STAAED TO, IAZESTI.>TORS-STARTED TO WRITE IT IN DIFFERENT [INDISCERNIBLE] REVEUES.Z STAAED TO RESPECT IIEN AND EVEN THE LINE [INDISCERNIBLE] YOU NEVER HAVE TO SHARE HEOUR DATAGSNTO M HEOU'VE HAD A CHANEAE TO PUBLISH IT WAS BROKEN BY THE UNIVERSITY OF WIONE OONSIN RESEA3SHERS WHO MADE HER HEIR DATPLAVAILABLE AS SOON AS THEY WERE OUT OF THE FIELD BEFORE THEY HAD PURLLLI HAED IIEN IT CHANGED THE CULTURE. FORTUNATELY THE TOOLS FOR SHARING DATA IYOU'ROVED BISIS THE UNDERLWHENG CULARE WHAT COMMUNITY HAS TO SAY, THIS IS A WEIRD THING IF HEOU HAVE THE WHWEE COH HUNITY B ROIND IIEN THE SECOND EXAMPLE I WANT TO USE IS A NATIOISIL LONGITUBLINAL'RE GOINRV-I. AND THAT WAS THE DEPARTMENT OF LABOR STUDY THAT HAD THERCRSCLTHTING DETAIL ABOISIS HEOUNG ADULTS TRANSITIONING INTO THELABOR MARKET. VERY IMPORTANT TO THE DO MAARTMENT OF LABOR. AND YET RESEARCHERS AND POPULATION DESPERATELY WANTED TO SEE H REAL HEOUTHS WERE MKNING THOSE ARCINT DECISIONS ABOUT FERTILITY, FAMILY AND LABOR FORCE. AND SO THE IEVETIATE S-RK TAED THE COLLECTION OF FERTILITY DATA AS PART OF THE DEPARTMENT OF LABOR SAGE D. TH-I WERE VESH NERVOUS.THEY HAD NEVER DONE THIS. THEY HAD ASKED INEAREDICATE DETAIL ABOUT EVESHSEA S AAGONE HAD EVER HAD AND NOW THE INSTITUTE WANTED TH-W TO AFE ABOISIS STHER AND CONTRACEPTION.-AND GUESS WHAT. IT MADE THE SURVEY MORE [INDISCEOLF LE] IMAUSE ANE THAIEN H H-MM. BUT WHAT WAS GENERALLY I THINK REVOLUTIONARY ABOUT THIS AND IT CAME TO ME TFOR THOUTED CHICAS THE IS HAVE THE RESEARCHERS LOOKED AT DATA SAYING H REAL DO HEOUNG PEOTORSE MAREA THOSE DECISIOEVE ABOISIS WORK AND FAMILY. GUESS WHAT, THEY WERE HAVING IS IO MESSEN.-AND EVESHBOGE D WANTED TO KN OW HOW THOSE [INDISCERNIBLE] INFLUENCED-HOW WELL THOSE CHIUSE AWREN WERE ABLE TO DRS LELRAC AND YET THE CHILD DEVELOPMENT COMMUNITY HAD WONDERN TL MEA'RE GOINRES ONDAY ERY THERSENFAMI AND SMALL BIOSAMPLES. THE SOCIAL SCIENCE COMMUNITY HAD MA FRELOUS SAMTORSES AND GREAT FL ABGROUND INFORMATION AND ITS HORRIBLE OUTCOME MEASURES. SO THE RRS LWEISISIOISISH SA GR WAS TO BRING THE CHILD DEVELOPMENTœ COMMUNITY AND SAY WHAT ARE THE MEASURE YOU WOULD EXPECIEN IT COUUSE AW BE DONE IN THE HOME BY AN INTERVIEWER AND SO EVERY IS IO MD BOOL AS ONE OF THE HEOUNG ADULTSTHINGINDIONE OERNIBLE] WAS THEN ACTUALLY OBSESSED WITH THEIR DEVELOPMENIEN WHAT DJM IT DO? IT MEANT TWO COMMUNITIES HAVE TO COME AND WORK TOGETHER BECAUSE THE IS IO MD DRS LELRACMENT P-- TORSE DJM NOT UNDERSTAND SAMPLES OF SIX OR 7,000 WOMEN AND THEN THE IS IO MESSEN AMA'RE GOED THE SAMTORSES AND WAITING AND THEY DIDN'T UNDERSTAND IT AND THE SCATELTHL ONE OIENTISTS DJM NSENGSNDERSTAND THE CHILD DEVELOPMENT MEASURE. AMAZING TEAMS WERE BORN OISIS OF-THE FHT T HERE WAS A DATA SET THERE THAT WAS SO GOOD BOTH TEAMS BOTH SIDE WANTED IIEN THETHINGINDIONE OERLL BECATFOR THEMANY P-- TORSE HEARD ABOUT ADD HEALTH. IT'S A WONDERFUL STUDY N REAL. ABOUT 20,OLS0 STAAED WITH HIGH ONE OHOOL STUDENTS. THEY'RE NOW IN THEIR 30'S. AND WCUSE WOUUSE AW THAT RRS LWEISISIOISIS H IS IANGE THE CULTURE. IT DOESN'T CHANGE THE CULTURE I THINK IY OFNE OF THE BEST THERAMTORSES OF H REAL AISTARGE DATA SET AND HAVING IT WIDELY AVAILABLE WELL DCATEDEVELENTED WELL CONSTGE CTEDMARE AS IT AFAO MABLE TO SUCH AN ARRAY OF RESEARCHERS. AND THAT MEAN HEOUNG INVESTIGATORS. YOUNG INVESTIGATORS HAVE AN OPPORTUNITY [INDISCERNIBLE]ABSOHEY TELY WO RUSE AW QONE OOLIS O DATA AT PRHTICALLY NO PRICE AND ARE ABLE TO DO WORK IN THESE FIEUSE AWS ON THEIR OWN AND BTHSIN THEIR CAREERS WITHOUT HAVING TO MAKE ENORMOUS INVESTMENTS THENT TO ELVES IN SELECTINTHEATA. THERE ARERS A00 FUNDED PROJECTS USING THOSE DATA [INDISCERNIBLE] OVER A THOUSAND RESEARIS I RO MAORTS AND THERE ARE OVER 5,000 INVESTIGATORS WHO HAVE HAD [INDISCEOLF LE] THOSE DATA. TH-I BRING IN GENETIC INFORMATION, THEY BRING IN HEALTH INETORMATION ALONG WITH SOEAL0OAL AND ECONOMIC INDICATORS. IT'S AN OPPORTUNITY FOR PEOPLE TO HAVE THE BEST DATA AT THEIR TNGER TRIPS BECNASE SOME TEAM WAS WILLING TO MAKE THAT INVESTMENT AND DEDFAMIATIONGSSE DN AN IEVETIATE WO MLING TO MAKE THAT DEDICATION OF RESOURCES AND COH HITMENT OVER AISTONG PERHOWCT OF TIME SO THAT RESOURCE COULD BE THERE. WHEN YOU LOOK AT LAINTE DATA SETS AND THE I'RE GOSTG OF DATA SHARING THERE'S REALLY THREE WAYS OF CHANGING THE CULARAL SEAL0OENCE.-TST OF AL L IT HAS TO ATSRE'RE GO THE CULTURE ISSUE OF MAKING DATA AVAILABLE. SECOND THEY HAVE TO MKNE AVAILABLE DATA THAT CAN FOSTER NEW CAREERS AND FOSTER A BROAD HCE'RE GO TO THE SEAL0OENCE.'REND THEN IF IT IS DONE CORRECTLY AND FOR ME BRINGING THE SOCIAL ONE OIENEAES AND THE GENOMFAMIS TOGETHER IS THE CUTTING EDGE FOR IF IT WAS DONE CORRECTLY IT DOES HAVE THE PSENENTIAL TCEPOF TELDS TOGETHER IN A WAY THAT IT'S SORT OF THE HOLY GRAO M H REAL DONE HEOU GENUINELY SUPSE D-A INTEES.ISCIPLINARY RESEARCH BUT PROVIDING DATA THAT'S SO [INDISCEOLF LE] INEAREDICATY FAHEY ABLE IS REALLY ONE OF THE BEST [INDISCERNIBLE] >> THANK HEOU.-WHAT WE WO ML DCEPIS HAVE E HH OF THE PANELISTS PRESENT AND THEN ENTERTAIN SOMEAND THENSTGSTIOEVE. THANK HEOU, DR. BALDWIN. THE NEXT IS DR. JOAN REEDE. >> GOOD AFTERNOON. I WANT TCEPSTART BY S[ING THAIDE YOOPLFOR INVITING ME TO BE PART OF THIS WONDERFUL CELEBRATION.REND I'VE BT HEY CAN AFEED TO ATSRE'RE GO ISCEPIES AROUND HEALTH HE CAN A AND WORK FORCE AND I WANT TO BEUSE AN BY AFEING AAND THENSTGSTION. DONE WE AND WILL WE HAVE THE WORK FORCE NEEDED TO SUSTAIN U.S. COONE OFETITIVENESS AND INNHEALTATION IN BIOMEDICAL RESEARCH. AND TO MEET THESE HEALTHCARE NEEDS OF AN INEAREASINGLY DRCERSE SE DCEPSLATION.THE WORK FORCE PREPARED TO CARRY FORWARD THEISTTHSHY OF DISCOVESH, INNOFATION, EXCELLENCE AND IMPROVEMENT OF HEALTH THAT WE'VE SEEN DISE W'RE GOED HERE T BRI[. THERE WERE TWO RO MAORTS RELEASED BY TWO WORKING GROUPS OF THE ADSCIENSOSHTHINGINDIONE OERLL BECATFOR THE RS WOMEDFAMIAL RESEA ROH WORK REPORT. THE REPORTS AND RECOMMENDATIONS STATED THAT THERE ARE GAPS IN OURGSNDERSTANDING, LACK OF COMPREHENSIVE DATA REGARDING THE BIOMEDFAMIAL AND SEAL0OENCE WORK FO ROE WITH AN IISIBILITY TO ADEQUATELY TRACK INDIVIDUALS AND THFOR E BEERIENEAES AT MULTITORSE LEVE ME ACRUIS THE ACADEMIC AND CAREER SPECTRUM. THERE'S A NTHEY CAD FOR PROGRAMHEALTANG THAT PROSCIENDES SND ISE DA FOR A CAREER PREPARATION AND RETENTION AND IONE OFORTANTLY THERE IS A NTHEY CAD FOR PROGRAMHEALTANGTHINGINDISCERNIBL E] OF TRANSITION. OUR ABILITY TO SUSTAIN THE ONE OIENEAE AND IH HEDLTHTE CR FOR SO MANY WILL REQUIRE CONSIDERATIONFOR DIFFERE NT I'RE GOSTGS AND COLLABORATIOEVE AEAL0OAUIS FEDERAL AND STATE AGENCIES, ACADEMIC INSTITUTIONS, SCIENEAEDIONE OWO LINEREED T HE PST LIC AND THE PRIVATE SECTOR. WE AS A NATION WILL NEED TO ADESSESS IISIDE-THHIES IN OUR EDSCATION S OF THETEM THAT LIMITS STUDENTS' PREPARATIONS TO CEPICCESSFULLYTHINGINDIONE OERLL BECATFOR THEWELL ASISTHK OF STUDENT AWARENESS OF CAREER PATHS, OPPORTUNITIES FOR TRAINING AND MENTORINC ANDISTIMITATIONS IN WORK FORCES THAT ENABLE OUR STUDENN AD TRAINTHEY CAS TO STAY THE COURSORK AS WE MOVE FORWARD, AS WE MOVE TOWARD BIG SCIENCE AND THINKING THE NEED FOR A WORK FORCE BECOMES DERARE ESCIENDENT.THEY CADT THERE'S AAND T HENSTGSTION OF WHAT ARE WE ASKING DIVERSITY TO DO. I WANT TO MENTION THRTHEY CA THINGS. ONE, REALIZING OURADALUES. TWO, ADDRESSING COMPLEX PROBLEMS, AND TBESTHEY CA, ARE ENHANEAINTHE-ADLTHFOR THELIS O.-REALIZING OUR VALUES, I WANT TO TURN TO THE CHARTER OF MEDFAMIAL PROFESSIONALS AND IT TKNESGSS THROUGH THE PRINCIPLES OF PATIENT WELFARE [INDIONE OERLL BECATFOR TH E-SOEAL0OAL JUSTICE. SOEAL0OALWHAUSTICE IS ABOUT PROMOTION OF JUSTICE IN THE HEALTHCARE S OF THETEM AND ELIMINATION OF HEA CARH-DISPARITIES.I WANT TO TALK ABOUT OUR VALSTGS NCHAT ARE EMBEDDED IN THE IOM EAL0OAUISING THE QUALITY CABIN REPORT. IT STATED THAT HEA CARHCARE SHOULD BE SAF>> RESPECTED, PATIENT-CENTERED, TIMELY, EFFICIENT AND EQUITABLE. FAHEY ES IWILLEDDED IN THE NIH HEALTASSION WHO SEEK FUNDAMENTAL KNOWLEDGE ABOUT THE NATURE AND BEHASCIENOR OFISTRCING S OF THETENT TO AN D APPLICATION OF THAT KNOWLEDGE TO ENHANCE HEALTH, LENGTHENISTIFE AND RULES THE BURDEN OF [INDISCERNIBLE] DISABILITY, IMPROVING THE HEALTH OF OUR ANAL OF THEIS.THEY CADT I WOUUSE AW S-[ TH IS IS ABOUT OPTIMAL HEALTH AND EQUITY IN HEALTH FOR ALL. REND-ADALSTGS IWILLEDDED IN THE MISSION OF NICHD COULD SPEAK TO ALL CHILDREN HAVING A CHANEAE TO N TWHEO MPARTTHFORPSENENTIAL. IT'S ABOUT EQUITY AND VALUE. WE'RE ASKING DIVERSITY TO HELP US TO ATSRE'RE GO COMTORSTHER PROCATWS AND HERE I'M GOING TO TURN TO SOME OF THE WORK OF SCOTT PAIC REND THELEDNP HNIBNG OF THE DIVERSITY TOOLBOX. IT TALKS ABOUT DIVERSITY HAVING THE CORTHITY TO BRING TO BEAR DIVERSE PERSPECTIVES, THE WAY REPRESENTING SITUATIONS AND PROBLENT TO .DIVERSE INTERPRETATIOEVE, THE WAYS OF CATEGORIZING AND PARTITIONING.DIVERSETHINGINDIONE OERLL BEC ATFOR THE-[-TO GENERATE SOLUTIONS TO OUR PROBLEMS AND DIVERSITY OF DERADE ME , THE W[ WE ENTER CAUSE AND E GRECT. CAPTURING THESE MODES AND COMPONENTS OF THESE DRCERSIS O TO OF C BOXES ALL REALLEDS TO THKLE DIFFICULT PROBLEMS. DIFFICULT PROBLEMS SSCH AS HEALTH DISPARITIES. DI GR OF C ULT PROBLEMS IN ISSUES THAT NICHD IS UNDERTAKING IN ITS ISITIONAL CHIUSE AWREN'S SADIES. AND H REAL WILL THIS STUDY CAPTURE A FULL BENEFIT OF DIVERSITY. A THIES. AREA IS ABORSE ENHANEAL0ONG OUR VIABILITY.œ OUR ABILITY TO MAXIMIZE OUR RESOURCEREED OUR HUMAN, OUR SOEAL0OAL, OUR INTELLECT-I L AND CAPITAL, OUR WAYS TO TRANSFORM OUR OINTANOLBATIOEVE, TO MAXIMOLBE OUR CORTHITIES. DIVERSITY ABOUT MAXIMIZING CAPACITIES TO ACHIEVE MISSION AND GOA ME . THIS RSUE RERES MOVING BEYOND NUMBER CAPTURING THE FULL BENET AND PSENENTIAL OF DIVERSITY INEAHEY DING A MULTIPLE DIMENSIONS OF DIVERSITY. RECOGNOLBING THAT DRCERSIS O THERTENDS B3 ND SNIBN COLOR, BEYOND RACE AND ETHNICITY AND GENDER ANDISTANGU3TE AND DIITY FOR THELIS O.AND TKNE INTO CONSIDERA TION DIFFERENCES IN VALUES AND PR OF C UERENCEREED FEO M ME E BEERIENEAES , NETWORK, CULTURE. THE QUESTION AND CHALLENGE BECOMES H REAL DOES DRCERSIS O, H REAL DONETHINGINDIONE OERLL BECATFOR THE EGENCO NSIONMENTS, HOW DOES DIVERSITY [INDISCERNIBLEO MPHERE DRCERSIS O INCLUSION IGEN OF CVES PROPHECIES%THAT GAR NER THE FULL BENEFIT OF DIVERSITY TBESOUNTE INEAREASED ORDIELL BEZATION CORTHIT THAT LHOW DID WE ENHANCE OUR SYSTEM'S ABILITY TO ADDRE'RE GO [INDISCEOLF LE] HEA CARH, ELIMINATE THE DISPARITY AND MOVEMENT TOWARDS EQUITY. ANSWERING THEAND THENINASTION AND GORALLENGES HAMPERED BY DIVERSITY-RELATED PROGRAMMING.œ P OF C OF C IES AND PRACT OF C E THAT ARE OFTEN D3CAPELRACED AND IMPLEMENTED IN CONTEXT WITH LIMITATIONS IN 3CAPJMENCE,ISTARGELY REL[ED TNG O LHK OF DATA. THERE ARE NO AGREED UPON METRICS. THERE AREADERY -THAW AISILYTIC TO OF CS.-THERE IS SELDOM CONSIDERATION OF CONTEXT AND EXPRE'RE GOED-THEORETICAL BASI S FOR THE WORK THAT IS DONE. MOVING FORWARD, THIS BEGS THE NEED FOR RESEA ROALT A GENERATION OF INEAREDICATE AND WELL-SUPPORTED EVIDENCE THAT IS PRODUCED FOR THE EXPERIMENTAL ANDNON-THERPERIMENTAL DES IGN.-RESEARCH THAT IS BOTH BASIC AND ORTTORSIE'S S IT TKNES INTNG O LT ONSIDERATION THE COMTORSTHERITY OF THE REAL WORLD THAT INFORMS USERS AND THATLEDSERS IVERSORM THAT IS NSENWHAUST CRO'RE GO SECTION BUT LONGITUDINAL.-THE DEVELOPMENT METRIMPL THA T ARE N TLLYADETTE'S S CREDICATE AND ACTIONABLE. CREATION, EXPANSION OF DATABASES THAT ARE NATIOISIL IN SCOPE. AND A CREATION OF TOOLS SUCH AS THE HARVARD MEDICAL SCHOOL QUATHW-[S PROGRAM THAT IS FUNDED THROUGH THE NIH PATH FINDER AWARD WITH NEW DATA COLLECTION ANAL OF THEIS HYPSENHESES GENERATION AND INTERVENTION. POTENTIAL WILL INCLUDE ORGANIC TIONAL ACCOUNTABO MITY DERARE E GR OF C IENT AND E GRECTIVE RESOURCE ALLOCATION AND EVALUATION IN D3CAPELRACMENT OF PROGRAM, P OF C OF C IES AND PRACT OF C ES THAT ADDRESS CLIENTS AND HEALTH WORK FORCE D3-CAPELRACMENT AND RETENTION OF INDRCJMI ME . THIS DOES NOT MEAN THAT WE SHOULD TURN AWAY FRO'RE GOUR REALENT PROGRAMHEALTANG THAT IS PROVEN AND SUCCESSFUL.WHEN I THINK OF THE WORK WE UNDE-AKNEN AT HARFAES. MED OF C AL ONE OHO OF C SINCE I STARTED AT MINORITY DEVELOPMENT FACULTY PRURIRAM IN 1990, THERE ARET OF85 UNDER RRELRESENTED MINORITIES TO 670.WHEN I THINK ABORSE OUR PRURIRAERE AING THAT IGEN OF CVES OUR COMMUNITY AND COMMUNITY ENGAGEMENT AND [INDISCERNICATE] 4,000 SADENTS. OUR PROGRAMS THAT INVOLVE COLLABORATIONS OF PARTNERSHIPS WITH INDUSW BIOMEDICAL SEAL0OENCE CAREERS PRURIRAM THAT REACH MORE THAN 7500 STUDENTS IN MORE THAN 30 STATES AFORS THE COUNTINAS. AND OURISTEADERSHIP PROGRAM, LEADERSHIP PROGRAM IS TO HELP PRRELARE INDRCJM-I ME PHYSIEAL0OANSAND C LILL BECIANS WHO CAN BECOME LEADERS AND HEALTH POLICIES. THE PRURIRA'RE GLL BEGORD HAS BTHEY CAN-AD ERY E OGOR IGENOLVED IN HELPING US TO TRAIN THESE PEOPLE. PERACLE WHO READ HEAGOR H P OF C OF C Y ADSCIENSORSTHINGINDIONE OERNIBLE] NIH PROGRAM DIRECTOR, ALL OUR THALL REALS HAVE SSUEINANEAE FHULS O AND MED OF C AL SGOR TO [INDISCERNIBLE] ACROSS THE COUNTRY.SO AS A NATION AND OINTANOLBATION, WE TRIED BUT NOT SO SUCCESSFUL IN ACHIEVING OUR DIVERSITY LTALS.-SO I PRSE TO YOU THAT MHEALTING FORWARD WE NEED TO BE BOLD, WE NEED TO BE FORTIVE, WE NTHEY CAD TO BE AWESOME, WE NEED TO BE B REAL DAISHZ.-[INDISCERNIBLE] WHO TALKED ABOUT RECOGELOLBING OURTHINGINDIONE OERLL BECAT- [NOT TO WAIT FOR CHANGE BUT TO BE THE CREATORS OF CHANGORKTHANLITYYOU. >> THAIDEDIVERSIOUADERY MSCH. AND NOW DR. ART LEVINE. >> I WAS LEFT CHAINTE TO ADESSESSING THE IVERSORMATION OF THE CULTURE OF CISE [INDISCERNIBLE] AND I WOULD GO BEYOND THAT TO NSENE THAT [INDISCEOLIBLE] OF THREE THEMES [INDISCERNIBLE] TRANSFORMATION HAS REAGORED A TISE MSNG POINT PERHORTS EQUAL TO THAT OF ABRAHAM [INDISCERNIBLE] REPORT A HUNESSED YEARS ALT.-THE TBESTHEY CA THINGS ARE HEAL THCARE REFORM, THE INTENT OF WHICH IS TOIST REALER THE C-ET OF HEAGOR CE,ARNCE I IMPRHEALTE ITSAND THENUALITY. THE SECOND THEME IS THE EMERGENEAE OF IVERSOMAT OF C S AND REATAWE THE THIES. THEME IS PERSONALIZED OR PHYSICIANMEDICINE.-I CAN G RCEDIVERSIOU ONE EXAULE OF HOW THEY RELATE. AS WE AGE, THE LIKELIHOOD OF OUR DEVELO MSNGTHINGINDIONE OERLL BECAT-[INFOR ND IT IS A FACT THAT VERY FEW METASTATIC [INDIONE OERLL BECAT[ OF AS ANDGOR S WO ML BE CUREDTHINGINDIONE OERLL BECAT-[ BUT AS A GENERALITY MOST METASTATIC SOLID ADERARS IN AS ANDGOR S WO ML NSEN SSF REAL DURABLE RWISSION WHERE THEY'RE TREAT WITH INTENSIVE GOR-WSENHERAPY AND IN FHT MANY PATIENWHE TREATED WITH INTENSIVE CHEMOTHERAPY WILL EVENTUALLYWILL BE IN THE INTENSIVE CARE UNIT MSCH THAT WO ML COMPROMISE-THE QUALIT Y OF THE REMAINING LI-THA AND WO ML A ME O C-ET A GREAT IF WE COULD IDENTIFY THE GENES WHO WILL RESPOND TO GORWSENHERADIS, WHO WO ML GO INTO REMISSION AND WHO WILL NOT. OBVIOUSLY A GREAT DEAL TO IMPRHEALTE THEAND THEN-I LIS O OF HEALTHCARE AND A GREAT DEAL TO REDUCE [INDISCERNIBLE] PERSONALOLBED MED OF C INE COMPRISES OF A S RETE OF DEALS.THE IF YOU ARE IS TO IDENTIFY THE R TO OR M OF CECULAR CAUSE OF THIS DISORDER AND TO HOPEFULLY PREVENT THAT DISEASE AND DISOES.ER. YOENTIHEARD THE EWILL EULE THIS MORNING OF TKU. IF YOU CAN'T PREVENT THE DISEASE OR DISORDER,DIVERSIOU CAN [INDISCEOLAGELE] P-ESIBLY IDENTIFY A DRUGGABLE MOLECULAR TAINTET FOR TREATING THAT DISEASORK NOW, THAT'S A COMPLICATED IDEA BECAUSEN'T WHEN WE KNOW A G TO ESS,0 OR AN INDRCJMI L,DIVERSIOU HS TO DEAL WITH PHARMACOGENETICS [INDISCERNIBLE] SAFELY AND OF C U-THACTRCELHEM PERSONALOLBED MED OF C INE BECOMES ADDITIONALLY COMPLICATED WHEN WE THINLITYABOUT THE GENOME FOR THERAMIMPE OF THE TMOVOR OR EVEN THE PEPSIS TUMORS [INDISCERNIBLE] AS TH3 MRSEATE COMEADERGENEAE OF THEIR MRSEABILITY. SO IF THERE'S A SOLID TUMOR AND A BIOCHIYDIVERSIOU MIGHT S-[ THE PRURINOSIS IS G TO IF YOU BIOPSIED THE BOTTOM YOU MIGHT SAY IT'S BAD. THIS MAKES THE S MSRE SIT-I TION OF THE TUMORS WHEN I SPEAK ABOUT THEM AS AN ONCOLOGIST PA-A OF C ULARLY CHALLENTO HNG WITHINTHIS OVERALL GROUP OF PERSONALIZED MEDICINE.-DERAREHEALTER, THER E WAS O GREN A GORT BETWTHEY CAN GENSENYPE AND PHENOTYPE. NO MATTER HOW MUCH DEEP SEQUENEAL0ONG WE DO, WE M[ IN FHT STO ML NSEN BE ABLE TO FULLY CORRELATE GENOTYPE AND PHENSENTH PORK THERAMIMPNCE I THERE ARE EGENCONSIONMENTAL INFLUENCES. THERE WAS ACUTE MUTATION THAT MATE ONE SUSCE ACRAGELE TOISTUNG CANEAER IFDIVERSIOU SMOKED. IN YOU DIDN'T SMOKE THERE WAS A [INDISCEOLAGELE [YOU WOUWESN TT DEVELOPISTUNG CANCER. BEYOND THAT, THE FACT IS THAT AT THIS PY FNT IN TIMNCE I WE KNOYD WE UNDERSTAND GENES AND FUNCTIONS OF ABOUT 23,000 GENES MOST OF WH OF C H HAS BTHEY CAN ILLMOVINATED IN THE PAST00 5DIVERSIEARS [INDISCERNIBLE] SINGLE GENE [INDISCERNIBLE] IDENTEASES ANDGCATE- IDTAT IONS. ANLT IN FHT GENOMICS ARE CALCULATED BY EPI GENOMICS [INDISCEOLAGELE] WE HS COMPE] OATORY IDTATIONS.HARVARD HAS BEEN STUDYING A LARGE COHORT OF PATIENTS WITH [INDISCEOLAGELE] HE'S IDENTEASEIED THE MUTATION OF THAT DISEASE. A THIRD OF THOSE P[INDISCERNIBLIMPE WHO HS THE SAME MRSEATION NNTAER BECOME ILL BECAUSE SOMEWHERE DEEPLY IMBE-THED IN THE GENE THERE'S COUEN-OTOINAS MRSEATION.AND THEM FINALLY Y OU HAVE THE CHALLENGE OF NONS OF ODING DISI WH OF C H HISTORICALLY IS-[INDISCERNIBLE] THE FACT OF THE MATTER IS MOST OF THAT NONS OF S. DISI THEY'RE NOT CODING FOR PROTEINS THEY'RE CODING FOR RNAs. MANY SPEEAL0OES OF RISIs INEAODDING A THOUSAND M OF C RO RNAs. RNAs ARE SO-CALLED ELEMENTS [INDISCEOLAGELE [THIS IS-PAA OF C ULAR IN HMOVANS FOR 90% OF OUR DNA IS NON-[INDISCERNIBLE] THERE'S AN ALM-ETISTINEAR REAS ATIONSSFISE ILXEN DNTAELME COMPLEXITY AND THE AMOUNT OF NON-CODING DISI.-HMOVANS HAVE MSCH MORE TH AN OF IT THAN GEESE AND GEESE HAVE MORE OF IT [INDISCERNIBL[ CMORSETERS ANDG.-SO G ENE ILXPREOFN ISADERY COMPLEX. EVEN BEYOND THE ISSUE OF GENE THERPRESSION IS THE IOF OF PRSENOLV] O.CONFIRMATIONS OF PROTEINS, PROTEIN FOLDING AND UR A OF CDING, REAL TIMETHINGINDITATIOERLL BECAT-[ PROTEIN PROTEIN INTERACTIONS AT AN INSTANT IN TIME. ALL THE ILLEMENTSTHINGINDITATIOERLL BECAT [ SO GENE EXPRESSION IS FURTHER-COMPLICATED BY THE FACT THAT IT OC% RS IN A G, CELL AT A NCESECIFIC TIME AT A SPECIFIC STAGE OF DIFFERENTIATION AT A NCESECEASE OF C DNTAELMENTAL STAGE. TO HVEN THIS TREMENDOUS-INTELLECTUAL CHALL ENGE[INDISCEOLAGELE] THE P REALER OF COULICATIONAL BIOLOGY AND ASSISTANCE BIOLOGY TO GENERATE THE MS.ING BASED ON THEORY, WED ON DATA, BASED ON ITERATIVE APPROACHES TO SOLVING THE PUZZLE.-BAS OF C ALLY BIOLOGY COUWES B E LOOKED AT IN FACT VERY MUCH LIKE A PICTURE OR PUZZLE SOMETHING WE CAN TGENCE APA-A AND PRSE BZZLK TOGETHER UNTIL WE GET IT RIGHT. WHEN WE GET IT RTTE MU, THE NTHERT ISTHINGINDITATIOERLL BECAT-[ HTH PER TTHER T PATHOLOGY COMPLICATED PHARMACOLOGY AND THE LIKORK TO DO ALL OF THIS AND HERE WE GO TO THE ROOT OF THE TRANSFORMATION OF THE CULTURE OF TATIOIENEAE WE NTHEY CAD BTTE SEAL0OENCE. TEAMS. TEAMS OF PEOPLE EACH WITH A PARTICULAR PERNCESECTIVE AND HABIT OF MIN M EAGOR WITH A PARTICULAR SKILL SET. TECHNICIAN OFSTUST OFPARTI. I WANT TO ILUHASIZE P OF C UIPARTI IN PARTICULAR AS [INDISCERNIBLE]DID THIS MORL L BENG BECDEAL SE WE HS TO THIIDE ABORSE DYNAM OF C S [INDISCERNIBLE] IN THE CYTOSOL [INDISCEOLAGELE] BIOLOTO HST OF NTA OF CRSEIOISIINAS BIOLOTO HST OF MOLECULAR AND CELL BIOLOGISTS, CRYOPHYSICS AND ILVEN ON OO FASION ENTO HNEERS. ALPARTOF THOSE PEOPLE WOULD BE NECESSARY FOR US TO REALLY O MODISTUISITE I THIIDE THE DRIHOUNG TH-WES OF THE DAY PARTICULARLY WITH RESPECT TO COMMON CHRON OF C O MLNESSESISTTATIOIE CANCER ANDISTTATIOIE THE DISORDERS OF MOOD AND AFFECT AND BEHAVIOR AND SO FORTH. ALL OF THIS INPRSE ISDIVERSIIEWESING MEGA DATABASES IN WHICH WE ARE INTEGRATING CLINICAL MOLECULAR AND HME UULLY ILGENCONSIONMENTALTHERPOSURE S.AND BECAUSE IN THE ERA OF HEALTH TEFUR R OF C UORM THE FINANEAL0OAL-CO] OSU EEALNEAES OF WHAT WE DO OR WHAT WE FAIL TO DO ALSO. THIS PROVOASSS ILVEN MORE [INDISCEOLAGELE] IOFIDERSCYISSUES.-HOW ARE WE GOING TO MAKE IN-THARENEAES FROM THESE GS ANDGNT F TTAWER INDIVIDUALS.-THESE ARE MATTERS OF SOCIAL DEELIVO, ILCONOISTUPARTI, GREAT DEELITICAL CHALLENGES AND SO FORTH. NOW IN FACT, I TALKED ABOUT ENHOURONMENTAPARTTHERDEEY FORE.WEYINOW MSC H MORE ABOUT ENVIRONMENTAL EXPOSURES OF HUMAN BEINGS AND PERHACHI MORING KN REALLEDGING WHENEVER YOU GO TO A GIANT SUPERMARKET IT WILL BE SEEN WITHDIVERSIOUR GS ANDGNT CAR M THE TO HANTYINOWS HOW MANY THINGS YOU ORDERED THAT WEEK. IFDIVERSIOU OES.ER THINGS FROM AMAZON.COM, AMAD B FOCOMYINOWS EXACTLY WHAT YOU ORDER. IF YOU GOOGLE, GO MLYIMEYINOUP WHAT YOU'VE SEARCHED FOGE SO IF WE WERE TO HAVE ACCESS TO ALL OF THIS DATA IF SOME MAISIGEABLE FORM COUIMPED WITH GENOMICS AND THE SYSTEMS BIOLOGY, WE KNOW A TREMENDOUS AMOUNT OF H REAL TO DEAL WITH WOMEN HEALTH AND ILLNESS.-BECAUSE I REPRESENT TH E UN,I WOUWES PY FNT ORSE THAT ATISTEAST AT OUR UNIVERSITY, WE ARE SHINED AWAY FROM THE ESTACATISHMENT OF DRELARTMENWHE AND THINNIBNG ABOUT INSTITUTES. I HAVE TO SAY THAT PERHAPS I WAS OLVTHER ILNEAOURAGED AND TAINTED BY-MY MAN Y YEARS AT THE NIH. I TRULY BELIEVE THAT THE WAY TO ADDRESS SOME OF THESE VERY GORALLENGING [INDISCERNIBLE] IS TO PUT PEOPLE WITH DIFFERENT -PO ML SETS AND PERNCESECTIVES TOGETHER IN ONE PLACE [INDISCERNIBLE] AND BASICALLY USE DRELAR RIENWHE ORTHOLL BEVERSITIES BECAUSETHOLL BEVERSITIES REQUIRE ACADEMIC STRUCTURE. INTELLECTI LLY THEHERREANTI MORHETICAL TO THE WORK THAT NEEDS TO BE DONE. THE [INDISCERNIBLE] IS A GO MLD EWILL EULE FORASSD BY THE NIH. WHAT WE REALLY NEED TO DO TRANSLATIONAL SCIENCE AWARDS HAS ALLOWED MANY OFTHOS [INDISCEOLAGELE] DISCIPLINARY THEAMEDZ ACROSS INSTITUTIONS WH OF C H ARE ALREADY HAVING ADATERY AS ARGE PAYOFF. WE NEED TO GO EVEN BEYOND INDIVIDUAL I] OTIS.TTIONS AND THINK ABORSE MULTICENTERED BOLVNGS INCLUDING INTERNATIONAL.WE NEED TO INTROFT CE THE WORK FOMYE FOR A REASON THAT I THINK IS IMPORTANT FOR ME AND THAT IS THAT PEOPLE WHO MERGE FROM ENHOURO, IENWHE IN WHIGOR SEAL0OENCE AND MATH HAS BEEN RARE, THEY CAPTURED THAT PARTI% AS AR ABO MIT OF C A THAT PARTI% AS AR MSENOR FORCE, IT SEEMS TO ME THAT THEY HAVE A PASSION FOR SEAL0OENCE AND A DETEFURINATION WH OF C H ISDATERYDATERY SPECIAL. SO IN ADDITION TO ALL THE OTHER REASONS FOR THIING TING ABORSE DIVERSITY, I THINK THAT'S A CRITICAL ONE. FIISILL OF C A WITH RESPECT THAVITHE CONTINISR A OF CDING OF THE CULTURE OF SCIENCE, WE NEED TO TAKE SERIOUSLY THE ACADETUT, THE FOGVEOLMENT AND INDUSTH AY. IT CANNOT BE PUT OFF BY CONFLICT OF INTERESWHE, BY BUREASCRAVO AND RISTING ALISPARTIC.-WE'VE GOT TO TAKE A RI SK. IF WE DON'T TAKE A RISK AND IF WE'RE NOT SEAL0OENTIST ENTH AEPRENEURS, WE ARE NEVER GOING TO ACCOMPLISH THE FOMPRMEET OF C S THATISTEAD-TO A] OWERS TO SOME OF THE QUESTIONS THAT I POSE. WE NTHEY CAD [INDITATIOERLL BECAT[ AT A TIME WHEN THE ACADETUT AND THE GOVERNMENT AND INDUSTRY ARE ALL ON THE FINANEAL0OAL WAN. WAIT DONORSOPLINDITATIOERLL BECAT-[ HAVE TO STEP UP TO THE PLATE AS WELL. WE NTHEY CAD NEW FUNDING MECHALL BESMS AND FINALLY WE NTHEY CAD NEW CRITERIA FOR [INDISCERNIBLE] UNIVERSITIES OR ILVEN THE I] OTIS.-TTIONS SSCH AS RI-PS.-HAVING SAID ALL THAT ABOUT BIG DATA AND BTTE SEAL0OENCE, I DON'T WANT TO IGNORE THE FZZLT THAT WHAT WE NEED MOST OF ALL IS CREATIVITY.-THE FZZLT OF THE MATTER IS THA T IQ PERSONALITY AND CREATIVITY ARE PROBABLY NOT [INDISCERNICAT-[IYINOW AI STSEN OF P[INDISCERNIBLIMPE WHO H ARE BEEN EXTRAORDINARILY CREATIVE IN SCIENCE WHO DIDN'T GET GO MLD GRADES AND SGORO MLL AND WHO H ARE A LOT IN PERSONNITIES.-[LAUGHTER] SO WE DONAN. WANT TO FORGET ABORSE THE FZZLT THAT IT'S OFTEN INDIVIDUALS, SINGLE PEOPLE WHO MAASS THE MWE ART I-FOORTANT OBSERVATIO] O IN SEAL0OENCE. JUST IN RECENT TIMES I WOULD POINT OUT THE DISCOVEI L OF [INDISCEOLAGELE] R OF C UODORESCENT PROTEIN. I THINK YOU SAW DR. [INDISCEOLAGELE]'S GREEN M OF C E G% MORHIS MORLL BENGOPLINDITATIOERLL BEBLE]NO BEL PRIZE THAT THEY WERE ALL DITATIOULAERIES OF SINGAL INDIHOUFTALS.-AND THEM FINALLY I DON'T KNO W HOW MANY OF YOU READ TIME MAGAZINE IF YOU DO, YOU WOULD HAVE READ ABOUT THE BUDGET MINUTE BRSETON JELLY FISE TO THE BENJAPROTEN BUTTON JELLY FISH KNOWN AS [INDISCERNIBLE] IS D HTATIOINATING. IT MTTERATES FROM P OF CYP TO ACATING TO NEAR DEATH.œ JUST AS IT'S ABOUT TO DIE IT FOGES BZZLK TO BOLVNG A P OF CZE AND IT STARTS ALL OVER AGAIN. IT ISN'T THAT IMMORTAL. THE BEN.-THPROTEN BRSETONINK YELLY FISH WAS DISCOVERED BY A MARINE BIOLOGIST IN JAPAN WHO SPEND NGLERY MORLL BENG COMO GNG THE SEA COASTISTO MLKING FOR ODD FORMED OF SEA LIFE AND CAME UP WITH THIS THERTH AREALES.INARY ALL BEMAL MS.. ITO HAANNOT THINK OF A MORE IMPORTANT MODEL NOW WITH WHICH WETO HAAN ILXPLORE THE STHEY CAPROTENGLY INTH AZZLTACATE CAUSES OF SENESCENCE PARTICULARLY WHEN IT'S [INDISCEOLAGELE-TO ONE MAN WORKS BY HIPARTICELF NO TEAM NOT A LOT OF EQUIPMENT, NO [INDISCERNIBLE] ST WITH CTUREINK YUSTTO HAOMO GNG THE SEA COAST ANDISTOOKING FOR ODD CREATURES.SO WE ARE IN THE MISH ST OCERTHE TH AANSFORM OCEAN OF THETO HAULS.-TRAL CISE, ALSO THE MIDST OF THE TRANSFORMATION OF SEAL0OENTISTS AND THE TRA] OFOFURATION OF THE PUBLIC. YOU HEARD A LOT TODAY ABOUT TATIOIENEAE AND MATH, ILFTCATION, H REAL WE H ARE TO START WHENEVER LIFE BEGINS. DR. LORIAUX PY FNTED ORSE WE DONAN. EN REAL WHEN LIAP BING IN-AR WHENEVER IT IS, WHATEVER YOU BELIEVE THAT'S WHEN WE H ARE TO STASCI THINNIBNG ABORSE H REAL WE'RE GOING TO EDUCATE HUMAN BEINGS SO THAT THEYTO HAONTIEIN.E TO ILTARLOIT THIS THERTH AREALES.INARY TRA] OMET INRIATION THAT WE'RE WITNESSING IN SCIENCE.-IT'S DISCOURAGING THAT ILVEN IF PEOPLE KNOW THEIR RISKS, THEY MAY WELL TO ACT, THEY OFTEN [INDISCEOLAGELETO IN THEINK YOUOLAL A LITTLE WHILE AGO LOOKING AT WHAT HAPPENED TO THE PEOIMPE THAT Y FOCIPENAGEED TO 23 AND ME AND LEARNED THEIR GENETIC RISK FOR 23 ILLNESSES AS A CONSE[INDISCERNIBLE] IEN CE. AND THOSE WHOYINEW OF THEOF RISKS DIDN'T DO ANYTHING ABOUT IT. THEY DISH N TT H ARE AIO] MORE TATIOREENING, THEY DISH N TTTO HAHANGE THEIR DIET, THEY DIDN'T CHANGE THEIR ILXEMYISTON THEY DISH N TT COMP AN NEHING THAT MTTEHT H ARE AMELIORATED THEIR PARTICULAR RISKS. SO WE H ARE A TREMENDOUS GORALLENGE IN HO THAN BEHAVIOR THAT HAS TO CONFRONT THE TRAN ARE ORMATION OF THETO HAULS.-TRE OF TATIOIENEAFOFFINALLY LET ME POINT OUT THAT THE BIGGEST MISTAKE WE O H EN MAASS IN S NEHENCE IS THETO HAONFUSED CAUSATION WITH CORRELATION. ANOTHER GOOD PAPER IN THE GERMAN OF MED OF C INE RECEN WHEY THAT A LOVELY -- JOURNAL OF MEDICINE RECENTLY THAT COUNTI L BY COUNTH AY, THE WINNER WAS SWISCIS LUN WHICH HAD MORE NOBEL LAUREATES AND MORE CHUCKISTSEN WITH THE ILXCEPTION OF SWEDEN WH OF C H IS AN OUT LIAR WHICH IS WHERE THE NOBEL PRIZE ARE %ARDE PERHAHOUNG SAID ALL THAT IISTEAVE IT TO YOU TO DETERMINE WHICH IS CAUSE AND WHIGOR IS COHAVE ELATION.THANACT YOU.-[APPLAUSE] >> THANK YOU VERY MUCH TO ALL OF THE PANELISWHE.-LL BENWOULDISTIKE TO STASC I OFF WITH ADDRESSING THE ISSUE OF DATABASES AND DATA SETS. AND PERHAPS DGE BALDWIN,ARTOU COULD SHARE WITH US YOUR THOUGHTS ABOUT SOME OF THE O GGGESTTO HAHALLENGES AND WHAT WE PROTEGHT DO STRAIGHT AWAY TO OVERCOME THOSE CHALLENGES ESPE NEHALLY INISTONTO HS.-TDIISIL ST AS AIES WHERE WE'RE TRYING TOENCOMPASS ALL OF THE ASPECTS THAT DGE OPLINDITATIOERLL BECAT-[DETATIORI BE PER >> OKAY. [INDISCERNIBLE] I WOULD SAY EACH OFDIES H ARE HXE THRTHEY CA THINGS IN OUROPLINDISCERNIBLE] THREE EL ELEMENTS HERE.THE O GG ONE OFTO HAOURSE IS Y FOCNEATION ANDTO HAOMPROTE RIENT THAT IN ORDER TO SUSTAIN LONG TO DO IF YOU COHTAUCKSES THERE HAS TO BE AN FOMPRLL TSKSTION OF THEOF VALUE A WILLINGNESS TO BACK THEIR FUND. THS.TR ARE ILTARENSIVE BRSE IT'S THE COMMITMENT THAT IS THE FIRST STEP BECAUSE SOMETIMES TO BRING SOMETHING-TOGETHER SHODE OF IT. THE MEDIUM ONE IS THEDATALL THAT I THINK COMES FROM [INDISCERNIBLE] AND THIS IS WHAT IT'S TALNIBNG ABORSE. I WASN TT ACTUALLY THINKING OF [INDISCERNIBLE] PURCHASES BUT THAT'S OELAY. WEISTO MLK AT HEALTE TOHETERO ISN'T JUST A STUDY OF YOUNG PEOPLE, IPROTEGSARTOUNG P[INDISCERNI BLIMPFOF IT'S THEOF PARENWHE, IPROTEGS THEOF SCHOOLS. IT'S THEIR GEOGRAPHY. IT'S G[INDISCERNIBLTO HAS. DATA THATISTETS YOU PULL IN OTHER DATA. IT'S DATA ABOUT THEM. IT IS NETWORK BLL T WHEYSE OF THE W-[ IT'S STH ASCS.TRE PERIT'S HARNESSING OF PO WER OF LINKING DATA, AND THERE ARE ENDLESSOPLINDITATIOERLL BECAT[ THATARTOU CAN LINK DATA WHICH PROBABLY WOULD BE A GOOD IDEA TO H ARE PRSENLL TTION IN PH TOCE OR PRI SHCY AND CONFIDENTIALITY BEFORE YOU DO THAT. IT WOUPLA BE A N OF C E ISH EA [INDISCEOLAGELETO WHATARTOU WERE-GOING TO DO WITH IT BUT THERE ARE CESCI BUNLY ILXAENCOLES [INDISCEOLAGELETO OFDATERY THER NEHTINGPRO JECTS THAT COULD BE DONE BECAUSE THEYTO HAOUPLAISTINK DATA. WE'RE NSEN QE YTE THEREARTET. WE DON'T HAVE THE LEGAL PROTECTION, I DONAN. THIING T, IN IMPZZLE TO MAKE THAT IF WETO HAOUPLA. BUT I THINK THAT'S ONE OF THE THINGS THAT WOU WLL SUSTAIN LONGIT AS AINAL DATA SETS WOUPLA BE THAT ABILITY TO CREATE DATA THAT ALREADY THERISWHE, ADMINISTH AATPLAIE RECOPLA.S.-THS.-TRDYE A NIGHTMARE.IF WE HA D A MORE ORGANIZED SHALL I S[ MORE ORGANUAED HEAS HHCARE SYSTWARTOU COULD PROBABLY DO THAT BETTER [INDISCERNIBLE] AND-THEN THE S MALLISTNGLEL IS THAT I THINK IT'S JUST INCREDIBLE FUN IS LONGITUDINAL DATA REQUIRES THATARTOU TRAUE P[INDISCERNIBLIMPE OVER TI ME AND HAS IT EVER BEEN EASIER. JUST THE POTENTIAL NOW, H REAL MANY PEOPLE HERE H ARE HXE SOMEBS. FROM YOUR PAST POP UP ON LINKEDIN OR FACEBOOK OR SOME IMPZZLE BLL T WHEYSE THEY TRAUEEDARTOU COMPWN. THE POTENTIAL NOW IS WHAT IT WAS EVEN TENARTEARS A[I, ALMWE ART 30 YEARS A[IOPLINDITATIOERLL BECATE] I'D SAY START WITH FUNDING, FIGURE OUT H REAL TOISTTHEY CAFNG THAVIMAGNORAY T HE URWER OF THE DATPLAND THEN[INDISCERNIBLE] >> THANK YOU. ARE THERE AIO] OTHERTO HAOMMENTS? SK I WOULD MAKE ONE THING ABOUT THE DATABASES. HERE I WANT TO APPH TO AS A THE INTH AAMURAL ILLEMENTS OF THE NIH WHICH I THINK IS MOST IMPORTANT AND THAT IS THEOPLINDITATIOERLL BECAT[ ISITIONAL FOR BIOTECHNOLOGIES-[INDISCERNIB LE] WHEN I THINK ABOUT WL O THERE SHOULD BE AN INTH AAMURAL PROLLY AM AT THE NIH, MY ANSWER RESOLVES AROUND THREE, ONE IS THETO HALILL BECALTO HAENTER THE SECOND IS THE NCDI AND THE THIRD IS THE INTRAMURAL PROGRAM THAT IS IENCOORTANT THATTO HAOUPLARAM T UROPLINDISCERNIBLE] SO THE NCBI [INDISCERNIBLE] HAS COENCOAND ALEBUNDRAISTAGERAB OF COHTA.AND THE DATA BUILDS LITERALLY BY THE MOMENT IT GETSTO HAALLED, IT GEWHETO HAURATED, IT GETS ANNSENATED, IT GETS SHORTED. IT IS AN EXTRAORDIISIB RESOUMYEANDOPLINDIT ATIOERLL BECAT-[ IINK YUST STEPPED DOWN FROM BEING THE CHAIR OF THE SCIENTI PROC BOAPLA. OF TATIOIENTORA OF C TO HAOU] OELORS.THE FACT OF THE MATTER IS THAT IF THERE'S ANYTHING WE NTHEY CAD TO Y FOCND IN THISTO HAOUNTB AS TATIOIENTISTS IT'S THE NCBI [INDISCERNIBLE] MAKE SURE I PUT IN THAT PODG. I THIING T THAT THE WHOLE ISSUE OF WHAT WE CAN LEARN ABOUT HUMAN BEINT THEM AND ABORSE P-PRULATIO] O COHOSCIS WHAT IS AICHEADY IN THE DATABASES, I GAVE SOME EXAMPLES, THS.-TR M-[ BEOPLINDITATIOERLL BECAT[ TO TADIB ADVANTAGE OF ALL THAT DATA AND TRY TO FIGURE OUT HOW TO ANONYMUAE IT, DTHE MADENTORAY ID USE IT IN MEANINGFUL WAYS [INDISCERNIBLE] I THINK IS A TH AWENCOMPUSTO HAHALLENGE.->> ALL RTTEHT. I THINK AS WE TALK ABOUT USING THIS DATA IN TERMS OIOT IOERLL BECAT-[ THEISTIMITED INFORMATION THAT WE HAVE IN OUR WORK FORCE AND THE CAPA NEHOF OFISTEADERS OF OUR INSTITRSEION TO REALLY KNOW WHAT'S GOING ON [INDISCERNIBLE] FOR ME IPROTEGSDATERY MSCHISTIKE [INDISCEOLAGELETO CLINICAL CARE IF YOU GO BACK 30 YEARS OR SO PEPRLE WERE ATAG BUD OF DATA [INDISCEOLAGELETO WHAT WILL HAPPEN IF WE KNOW ABOUT WHAT HAPPENED WITH OUR FAMAND THS.-TRDYE AFRAISH OPLINDITATIOERLL BECAT[ AMAZING HOW THESE ACADEMIES WOULD BE ATAG BUD OF DATA AND NGLISH ENCE AND ILHOUDENEAE-UCKSED-DECISIO N-MAKING. WE HAVE A MULTIPLE MISSION TASK FOMYES REPORT THAT SPEON-S TO A CONTINUING PROBLEM WITH OUR WORK FORCE TO BE ABLE TO DO SOMETHING ABOUT IT BRSE WE WENTYINOW WHAT TO DO IN THAT REQUIRED DATA%[INDISCERNIBLE ] SK THAING TARTOU. ANSENHER ITAUL I THIING T THAT WE HAVEN'T REALLY TOUCHED UPON, WE'VE TOURE'EDDIEUR IT FT NSEN IN SO MSCH DTHE TH IS THE NEXT GENERATION OF RESEARCHERS AND SCIENTORA OF C WORK FORCE. AND SO I OPEN THE DISRKION TO THE PANEL MEMBERS ABOUT WHAT CHALLENGES DO AND WHAT PRURLATED TO THE [INDISCERNIBLE] SCIENCE THAT WILL AFFECT THE FRSEURE GENERATIONS OF NEW INVESTIDO TORS[INDISCER NIBLE] WORK FORCE. >> JUST ONE POINT [INDISCEOLAGELETO ASY FOPROTENG THAT [INDISCERNIBLE] WE ARE BLESSED IN THIS COUNTRY STILL OF HAVING A HUGE IS-ODXOPLINDITATIOERLL BECAT[SENHER COUNTRIES WHO HAVE NOT [INDISCERNIBLE] IN OUR SOCIEOF AS ATO HAULTURE. G% SO WITH REGARD TO THE CONDUCT OF SCIENCE, EACH CHALLENGE WE HAVE IS HELPING TO DNGLEL-PR THE SAME HAO GTED MIND IN PEOPLE AWE BRA THAT WE EXPECTED [INDISCERNIBLE] THS.TRF CAN IL WHACATED DIFFEREN WHEY OR IS THERE DIFFERENT AGE OF DEVELOPMENT. THERE AREISTANITTIOE PROCAT-WIR O RKURAL PROCAT-WS. ALL OF THESE THEMES HAVE TO BE ADDRESSED IF WOU WRE GOING TO TON-E Y FOCLL A,TAGE OF THESE REMARKABLE RESOURCE AMERICA HAS. >> THANK YOU. I WONDER IFARTOU MTTEFOTO HAOMMENT ALSO ON HOW DO WE REALLY ENABLE THE CURRENT GENERATION THAT IS INDIELL BEVERSITY OR IN TRADE TATIOHOOLS LOOKING FOR TECHNICAL SUPPORT TO HAVE FAITH IN THE ABAND OF S NEHENCE TO STHEY CA THAT AS A CAREER THAT'S REVERSING ESPECIALLY, AND BASICALLY THAVIGET BEYOND SOME OF THETO HAURRENT ERATONOMIC ISSUES OR EVEN WITH THE CONSTRAINTS OF ECONOM OF C ITAUL IR O-HOP ARCOMPARTOU THIING T ILITHER OUR GENERATION OR OTHER MECHANISMS TO MOTIVATE AND TO ILNGTIOE WE HOPE FROM TERESA GESODWELL HPARC SHE HAS HER SCIENCE ACADEMIES ON SATURDAYS AND M-[BE THIS SHOULD BECOME A NSENE WORK APENWE ARS THE COUNTRY BUT I'M WONDERING IN YOUR EXPERIENCE HOW% TIOERLL BECAT[ MOT I THIING T A FEW POINTS. I TOTALLY ACKNOWLEDGE AND RERSE ERATT THE IENCOORTANEAE OF OUR INTELLY ATION P OF C OF C Y [INDISCERNIBLE] OUR CAPACITY IS DIFFERENT [INDITATIOERLL BECAT[ IS IMURD [INDISCERNIBLE] IT'S EQUALLY IMPORTANT [INDISCERNIBLE] WHEREI H-E A GRE AT GREAT GRANDT INTHER [INDISCERNIBLE] SHOULD ALSO HAVE THE OPPORTUNITY TO BECOME [INDISCEOLAGELE] ILSCEE NSENINK YUST HOW WE BASICALLY [INDISCERNIBLE] HOW DO WE MAKE SUREIOERLL BECAT-[ FOR ME IT RANGES FROM ILVERYTHING DO THEY HAVE THE ROLE MODEL, DO THEY H ARE THE OIT ORNOF DO THCUR H ARE THE IL WHACATION, DO THEY EVEN UNDERSTAND [INDISCERNIBLE]-HOWTO HAOU PLA ONEISTESOK AFTER A DOSRESOM THESE KIDS CAN SEE WHAT IS POSSIBLE AND BE ALLOWED TO ASK QL STIO] O THAT IS A PO WCE WHERE THEY COULD TAKE THEIR QUESTIONS I THINK THEY COULD BECOMEOPLINDITATIOERLL BECAT[ IT'S THETO HACTEBLEY OF [INDISCERNIBLE] TO CHANGE AND TO MADIB A DORAIKRENEAE [INDISCEOLAGELE] REFLECTION AND ACTION [INDISCERNIBLE] IT WAS BORNE OUT OF ANDIENDERSTANDING YO3-WTHINK ABORSE THETO HAY FANDRTTE-FOS MOVEMENT. WE OFTEN TALK ABOUT IT AS THE SCIENCMEN ANDTO HAHIPLAREN ISTI OF CVED [INDISCERNIBLE] THIS IDEA OF CIVIC ENGAGEMENT AND SOCIAL G% JUSTICE. AND THATARTOUTO HAAN MON-E A DIFFERENCE.AND WHAT WE FIND IS OUR REASON ORA FOROPLINDITATIOERLL BECAT[ S NEHENCE AND 4E89 WITH HEALTH ISSUES IN YOUR COMMUNITY. WHAT WE FIND IS NIBITH TO HAOME ORSE OF THE WESOIN TORK INTERESTED.-THEY CARE ABOU T WHAT'S HAPPENING IN THE FAMANDIR O THEYTO HAARE ABORSE WHAT'S HCTEPELL BENG IN THOSE COMMUNITIES.THEY WANT TO HEAR ABORSE IT AN D THCUR WANT TOABOUT WHNOW IF THEYTO HAAN MAKE A DIFFERENCE. THEY WILL PROBABLY TRANSO WTE-THAT.IOERLL BECAT-[ THE THIRD THING IS TO START TO EXAMINE [INDISCERNAGELE] WHAT-HAIT ENS IN THETO HAULN OF OUR ACADEMIC INSTITUTIONS. IT'S NOT ALWAYS POSITIVE FOR NGLERYONE.NOT ILVEBONE HAS THE BECME EXPERIENCE [INDISCERNIBLE] THERE'S A SN RTTE-FO NPARC THAT OUR OF PROCEOPLINDITATIOERLL BECAT[ DON'T ALL HAVE THE SAME EXPERIENCE. WHAT ARE THE ITAUL S THAT RELATE TO A,CEMENT AND RETENTION.-BECAUSE THE KID S THAT ARE COMING BEHIND STHEY CA WHAT WOU WRE ERERIEN NEHNG NPARC. AND IT'S GOING TO DETERMINE [INDISCERNIBLE] MOT NIH HAS AYS SEN OIOT IOERLL BECAT-[ WHAT I FOUND IN EXTRAMURAL IS THAT WHEN THOSEARTOUNG DY FORCES SEE THEY GET THE FOFST STH AAND BUT THEY DON'T SEE IT AS A VIABLE CAREER BERAT QSE IT'S Y FOIT WE ARETO HAOMPETITIVEYS ATER AS A OTHERWISE IN-- DISINCENTIVE [INDISCERNIBLE] ISTIESTIDO TOR PROBLEM THEY SEE THTHE MA-[INDINERNIBLE] THAT'S NOT A SOLUTION, THAT JUST MADIBS IT WORSE.->>FTEUST TO BRINGTO HALOY FORE TO THAT PARTICULAR POINT PERHAPS THIS IS WHERE THE TRI-E OF ACADEPROTEA IN [IVEOLMENTS AND INDUSTRIES THINKING OF A NEW PARADIGM FOR INNONEITIVE PAR-ETTEM OF F NG RESEARRE' M%[ THEN ENCOURAGE OUR INVESTIGATORS TO SAY THAT THEY CANEAELED THEOF WORK. SO I REALLY WANT THAVITHANK THE PANEL VERY MUCH FOR ALL OF YOUR THOUGHTS AND INPRSE AND I'LL TURN THIS OVER NOW TO ALAN. THANK YOU. [APPLAUSE] MOTOPLINDITATIOERLL BECAT[ TO SUMDIEP THE ALSOD THE HECK WITH [INDISCERNIBLE]-THE SUMMARY OF THE D[ IS WPARC. THIS WASFTEUST SSCH AN INEAREDICATE DEMONSTRATION, I THINK, OF THE BREADTH AND DTHE TH OF WHAT LL BERE'D-DOES . AND D-ES ILVERY DAY FOR 50 YEARS. FIRST I WOULD LIKE TO THANK TIO BUN THE F OF CKS WHO ORGANIZED THIS, PARTICULARLY HOW WELL IT TURNED OUT TO REALLY THANK YOU FOR SURPATAUINGTO HAERTAINLY MY VERY HIGH EXPECTATIONS FOR IT. AND AS WELL, TO THANK AGAIN ALL OF THE SPEON-ERS WHO WERE , DOST Y FOPERB. SO THANK YOU ALL. [APPLAUSE] WHARING THEOPLINDITATIOERLL BECAT-[ WHATD ID THIS REMIND ME OF. IT WAS REALLY A UNIQUE EVENT BUT IT IN SOME WAYS REMINDED ME OF THANKSGIVING. THIS WAS A GATHERING OF A NICHD FAMILY