>> GOOD MORNING, EVERYONE. LET ME BRING US TO ORDER FOR THE 109TH MEETING OF THE ADVISORY COMMITTEE TO THE DIRECTOR. I DON'T KNOW IF THERE'S ANYBODY HERE WHO'S BEEN TO ALL 109. PROBABLY NOT. BUT THOSE OF US -- [LAUGHTER] PRETTY CLOSE. WELL, THIS IS GOING TO BE A HOT ONE, BECAUSE WE HAVE A LOT OF VRY INTERESTING AND TIMELY TOPICS, AND OF COURSE WE'RE GATHERED AT A PARTICULARLY INTERESTING MOMENT CONSIDERING THAT WE DO DEPEND UPON THE UNITED STATES CONGRESS TO FUND WHAT WE DO HERE, AND THEY'RE TRYING TO FIGURE OUT WHAT TO DO HERE TODAY ABOUT THE FACT THAT AS OF MIDNIGHT TONIGHT, THE GOVERNMENT WILL SHUT DOWN UNLESS THERE IS SOME OTHER PLAN. I THINK I CAN REASSURE YOU THAT A SHUTDOWN IS UNLIKELY AND I THINK WE WILL BE HERE TOMORROW, BUT EXACTLY HOW THAT'S GOING TO PLAY OUT IS A LITTLE UP IN THE AIR, AND WE'LL COME TO THAT IN A BIT BECAUSE I'M SURE YOU WILL BE INTERESTED TO KNOW ABOUT ALL THOSE MANEUVERS AND PARTICULARLY WHAT THE IMPLICATIONS ARE FOR NIH. SO BEFORE WE GET STARTED, I'D LIKE TO REMIND EVERYONE OF A FEW LOGISTICAL ITEMS, SO THIS MEETING IS OPEN TO THE PUBLIC. THAT INCLUDES MEMBERS OF THE PRESS. WE ARE BEING WEBCAST. WE'RE ALSO TRANSCRIBING THE MEETING, SO IT WILL BE VERY IMPORTANT TO SPEAK INTO THE MICROPHONES WHEN YOU HAVE SOMETHING TO CONTRIBUTE, OTHERWISE PEOPLE CAN'T HEAR WHO ARE LISTENING TO THE WEBCAST. ALL OF YOU HAVE NOTEBOOKS AT YOUR PLACE AND THEY CONTAIN ALL THE MATERIALS THAT YOU SHOULD NEED FOR THE NEXT DAY AND A HALF. RECOGNIZING THAT YOU PROBABLY HAVE PLENTY OF LUGGAGE ALREADY, WE WILL BE GLAD TO MAIL YOUR NOTEBOOKS BACK TO YOU AT THE END OF THE MING S MEETING SO YOU DON'T HAVE TO CARRY THEM OFF. JUST LET US KNOW. AS IS TRADITION, WE'LL TAKE A GROUP PHOTOBACK OVER THERE IN THE CORNER SO DON'T RUN OFF TO LUNCH WITHOUT THE PHOTOOP BECAUSE WE WANT TO CAPTURE THAT. I THINK THERE IS ONE MEMBER STUCK IN TRAFFIC, MONCEF SLAOUI, AND DAVID GINSBURG FLYING IN EARLY THIS MORNING, WILL BE HERE IN A BIT. FIVE MEMBERS NOT ATTENDING AT ALL, THAT INCLUDES LISA COOPER, ERIC GOOSBY, HE LE HOBBS, MIKE WELSH AND CHRIS WILSON. I KNOW IAN IS ONLY HERE FOR TODAY AND NOT TOMORROW AND RICK LIFTON WHO'S HERE TODAY, NOT HERE TOMORROW, FEAR NOT, WE HAVE A QUORUM FOR ALL THE THINGS WE WANTED TO TALNEED TO TALK ABOUT, WE WANTED TO MAKE SURE OF THAT. I WANTED TO TAKE A MINUTE TO RECOGNIZE THAT FOUR OF OUR MEMBERS ARE SCHEDULED TO ROTATE OFF THE ACD AFTER THIS MEETING, AND THEY HAVE BEEN WONDERFUL CONTRIBUTORS AND WORKED QUITE HARD IN MANY WAYS OVER THE COURSE OF OUR TIME WITH US THAT. INCLUDES DAVID GINSBURG, BOB HORVITZ, RENEE JENKINS, AND REED TUCKSON, EACH OF YOU PUTTING A LOT OF TIME AND EVIDENT INTO THE GENERAL ACTIVITIES OF THE ACD BUT ALSO VERY SPECIAL WORKING GROUP ASSIGNMENTS THAT YOU HAVE HAD, AND IT IS HARD FOR ME TO IMAGINE ACTUALLY GATHERING AROUND THIS TABLE WITHOUT THOSE FOUR FOLKS BECAUSE YOU HAVE BEEN SO CENTRAL TO MUCH OF WHAT WE HAVE DONE. YOU HAVE GUIDED ME WITH MANY IMPORTANT DECISIONS OVER THE YEARS, ALTHOUGH IF I'VE MADE THE WRONG DECISIONS, IT'S NOT YOUR FAULT, AND IT'S REALLY BEEN AN AMAZING TIME FOR NIH AND EVEN MORE SO BECAUSE OF YOUR DEDICATION AND SERVICE, SO COULD WE PLEASE GIVE A ROUND OF APPLAUSE TO OUR FOUR FOLKS. [APPLAUSE] IF THEY WANTED TO MAKE ANY BRIEF SPEECHES, I DON'T SUPPOSE WE WOULD STOP THEM AT THIS POINT. ANY COMMENTS YOU ALL WANT TO MAKE, FEEL FREE. >> I'LL JUST REITERATE WHAT I SAID TO YOU, FRANCIS, A FEW MOMENTS AGO. WHICH IS THAT THESE HAVE BEEN INTERESTING TIMES AND PROMISE TO BE SO IN THE FUTURE, AND GOOD LUCK TO ALL. IT'S BEEN GREAT. I'VE REALLY ENJOYED GETTING TO KNOW THE FOLKS THAT I HAVE KNOWN BEFORE, AND THANK YOU FOR THE OPPORTUNITY. >> WELL, DO NOT BELIEVE THAT JUST BECAUSE YOU'RE ROTATING OFF THE ACD THAT WE'RE DONE WITH ASKING YOUR ADVICE. WE'LL COME UP WITH OTHER WAYS, I'M SURE, FOR EACH OF YOU. RENEE? >> SO IT'S BEEN AN AMAZING EXPERIENCE THAT THIS, YOU KNOW, PROVIDES TO MANY OF US WHO GET INTO AREAS THAT ARE NOT OUR HOME AREAS, BUT I THINK WE BRING A DIFFERENT PERSPECTIVE TO IT. I THINK IT'S BEEN AN AMAZING EXPERIENCE, JUST AMAZING. SO THANK YOU VERY MUCH FOR FOR ENGAGING ALL OF US AND, YOU KNOW, BREAKING THROUGH TO NEW AREAS. >> AND I WOULD JUST COMMIT, IT'S BEEN SUCH A PRIVILEGE TO BE PART OF THIS, AND I WILL DO EVERYTHING I CAN CAN DO TO TRY TO LET PEOPLE IN THIS COUNTRY KNOW JUST HOW TERRIFIC THE SCIENTISTS ARE THAT ARE ASSOCIATED WITH NIH. I THINK IT'S STILL AN UNDERAPPRECIATED RESOURCE IN AMERICAN LIFE, AND EACH ONE OF THE PEOPLE THAT ARE PART OF THIS EFFORT REALLY ARE AMERICAN HEROS, AND I'M GOING TO CERTAINLY CONTINUE AS I ROTATE OFF TO MAKE THAT MESSAGE AS LOUD AS I CAN SCREAM IT. >> SO THANKS TO ALL OF YOU. MAYBE I WILL BRIEFLY SORT OF HIGHLIGHT FOR YOU WHAT OUR AGENDA CONTAIN, THEN WE'LL MOVE INTO THE ALWAYS MUCH ANTICIPATED DIRECTOR'S REPORT. WHICH AGAIN, I HOPE WE CAN HAVE NOT JUST A LECTURE BUT A CONVERSATION BECAUSE THERE ARE A LOT OF THINGS WE CAN TALK ABOUT ALONG THE WAY. TO QUICKLY HIGHLIGHT THINGS ON THE AGENDA, WE WILL THIS MORNING, IN ADDITION TO DIRECTOR'S REPORT, HEAR FROM TONY FAUCI AT 10:45. TONY, WHO HAS BEEN ABSOLUTELY IN THE CENTER OF THE EFFORTS AT NIH TO DEAL WITH THE VERY TROUBLING EBOLA OUTBREAK IN WEST AFRICA, INCLUDING ALSO SOME CONCERNS HERE IN THE U.S., AND TONY IS PROBABLY THE BEST PERSON THAT I CAN POSSIBLY THINK OF TO UPDATE YOU ON WHERE THAT STANDS. SO HE WILL BE HERE AT 10:45. THEN WE WILL HAVE A PHOTOAND LUNCH. THEN IN THE AFTERNOON, WE WILL ENGAGE IN THESE ACD WORKING GROUP REPORTS. THESE ARE FOLLOW-UPS TO THINGS YOU HAVE HEARD ABOUT IN PREVIOUS ACD MEETINGS BUT GIVING YOU AN UPDATE ON WHERE THAT STANDS, BEGINNING WITH THE HELA WORKING REPORT, AND WHICH WILL REFLECT ON A MEETING WE HAD YESTERDAY IN BALTIMORE, INCLUDIVE MEMBERS OF THE FAMILY OF HENRIETTA LAX, WHICH IS QUITE AN INTERESTING AND MEMORABLE DAY. WE WILL HEAR TWO DIFFERENT REPORTS ABOUT THE DIVERSITY EFFORTS, AND ONE IS ON WHAT WE ARE DOING WITH REGARD TO PEER REVIEW TO ADDRESS THE CONCERNS ABOUT SUCH THINGS AS UNCONSCIOUS BIAS. THAT WILL BE RICHARD KNOC NOKARURA, THEN HANNAH VALANTINE WILL TELL US ABOUT EFFORTS WE'RE MAKING RATHER BOLDLY TO EXPAND THE DIVERSITY OF OUR BIOMEDICAL RESEARCH WORKFORCE AND ATTRACT INDIVIDUALS FOR -- FROM UNDERREPRESENTED GROUPS TO COME AND JOIN US. WE'LL HAVE A BREAK, THEN AFTER THAT, SALLY ROCKEY WILL UPDATE US ON WHERE WE ARE WITH THE PHYSICIAN SCIENTIST WORKFORCE IMPLEMENTATION WORK GROUP, WHICH YOU HEARD ABOUT AT THE LAST MEETING, AND DAVID GINSBURG NO DBT COMMENT AS WELL BECAUSE HE WAS CO-CHAIR OF THAT EFFORT. AND FOR EACH OF THESE, WE'VE SORT OF ALLOWED, I THINK, ENOUGH TIME FOR BOTH THE PRESENTATION AND THE DISCUSSION, AND I HOPE THE DISCUSSIONS WILL BE VIGOROUS. AT 4:30, WE WILL HAVE A NEW PRESENTATION, CATO, WHO HAS WORKED LONG AND HARD WITH LARRY TABAK AS HIS CO-CHAIR, WILL PRESENT TO YOU THE RESULTS OF A WORKING GROUP THAT HAS BEEN LOOKING AT THE NIH INTRAMURAL RESEARCH PROGRAM, COMPLICATED AND IMPORTANT ISSUE, AND I'M SURE THIS WILL GENERATE A LOT OF DISCUSSION. SO I HOPE NOBODY WILL IMAGINE THAT THEY CAN LEAVE EARLY BECAUSE IT THIS WILL BE A REALLY RICH PART OF THE DAY. WE WILL AIM TO CLOSE THE MEETING AT 6:00, AND AT THAT POINT, WE HAVE A SHUTTLE BUS ARRANGED TO CARRY YOU OFF TO KATHY HUDSON AND JOE'S HOUSE WHERE YOU WILL BE TREATED TO YET ANOTHER EXAMPLE OF THE HOME COOKING TRADITION THAT WE HAVE TRIED TO LIVE UP TO HERE FOR ACD, AND IT WAS KATHY'S TURN, SO SHE'S BEEN COOKING ALL WEEK, I IMAGINE. >> MY HUSBAND LEFT TOWN. >> HE EVEN LEFT THE COUNTRY, I THINK. SO WE WILL HAVE AN OPPORTUNITY THIS EVENING FOR SOME SOCIALIZATION AND CATCHING UP IN A MORE INFORMAL WAY. AND WE WILL THEN ARRANGE FOR ALL OF YOU TO MAKE IT BACK TO YOUR HOTEL WITH STAFF FROM NIH PROVIDING THAT TRANSPORTATION. TOMORROW WE WILL START AT 8:00 BECAUSE WE WANT TO MAKE SURE TO MAKE THE MOST OF THE MORNING AND KNOW THAT MANY PEOPLE WILL BE TRYING TO GET BACK TO WHEREVER THEY CAME FROM BY THE AFTERNOON SO 8:00 SHARP, WE WILL HAVE SOME LOGISTICAL ISSUES ABOUT AWARDS. WE TRADITIONALLY ASK ONE OF OUR RELATIVELY NEW INSTITUTE DIRECTORS TO GIVE A SCIENTIFIC PRESENTATION AND YOU WILL, I'M SURE, WANT TO HEAR JON LORSCH, DIRECTOR OF NIGMS, WHO IS GOING TO TALK ABOUT WHAT'S HAPPENING IN HIS INSTITUTE. HE'S BEEN A WONDERFUL ADDITION TO OUR LEADERSHIP SINCE HE CAME HERE A LITTLE MORE THAN A YEAR AGO. KATHY HUDSON WILL COVER AREAS IN SCIENCE POLICY INCLUDING CLINICAL TRIALS AND DATA SHARING, AND THEN AT 9:45, WE WILL HAVE A VERY IMPORTANT PRESENTATION AND DISCUSSION FROM THE NATIONAL CHILDREN'S STUDY WORKING GROUP THAT'S BEEN CO-CHAIRED BY RUSS ALTMAN, THANK YOU, RUSS, AND PHIL PISO. WE MAY SEE PHIL THIS EVENING AT DINNER, IF YOU WANT TO SAY HELLO TO HIM THEN. AND THAT WILL, I'M SURE, GENERATE A LOT OF DISCUSSION AMONGST THE ACD. WE WILL FINISH WITH A REPORT ON WHAT NIH IS DOING ABOUT THIS VERY IMPORTANT ISSUE OF REPRODUCIBILITY, AND LARRY TABAK WHO HAS VERY MUCH LED THAT EFFORT FOR US WILL FILL YOU IN ON WHERE THAT ALL STANDS. AND WE AIM THEN TO ADJOURN BY 1:00 TOMORROW. IN AN EARLIER VERSION OF THE AGENDA, YOU MIGHT HAVE SEEN THE POSSIBILITY OF PRESENTATION ON OUR HIV/AIDS PORTFOLIO. A LOT OF HARD WORK HAS BEEN DONE ON THAT BY JACK WHITESCARVER, THE OFFICE OF AIDS RESEARCH AND OTHERS, BUT WE THOUGHT WE ARE NOT QUITE READY YET TO HAVE THAT INFORMATION PUT FORWARD, THERE'S STILL A LOT OF DATA WE NEED TO DIG UP SO THAT IS GOING TO GET PUT BACK PROBABLY FOR A LITTLE LATER TIME. SO AGAIN, I DON'T KNOW THAT SINCE I'VE BEEN HERE, THERE HAVE BEEN ANY ACD MEETINGS THAT WERE SLEEPY. THIS ONE IS CERTAINLY NOT GOING TO BE. AND AGAIN, I'M RELIEVED AND DELIGHTED TO HAVE PEOPLE AROUND THE TABLE WITH SUCH EXPERIENCE AND WISDOM BECAUSE WE'RE GOING TO NEED THAT IN EVERY WAY HERE AS WE GO THROUGH THESE DISCUSSIONS. OKAY. WELL, LET ME NOW TELL YOU ABOUT SOME THINGS THAT I THOUGHT WOULD BE APPROPRIATE TO SHARE WITH YOU FROM MY PERSPECTIVE AS THE NIH DIRECTOR. MAYBE BEGINNING WITH CHANGES AS FAR AS PEOPLE THAT ARE COMING AND GOING. THAT ARE SIGNIFICANT IN LEADERSHIP ROLES. OF COURSE IN ONE VERY SIGNIFICANT CHANGE SINCE THE JUNE MEETING HAS BEEN THAT MY BOSS, THE SECRETARY OF HEALTH AND HUMAN SERVICES, HAS CHANGED WITH WITH THE DEPARTURE OF KATHLEEN SEBELIUS AND THE ARRIVAL OF A REALLY EXPERIENCED LEADER FROM HER PREVIOUS ROLE AS OMB, SYLVIA MATTHEWS BURWELL. IT'S BEEN GREAT FUN WORKING WITH WITH SYLVIA, SHE'S VERY ENGAGED IN THE DETAILS OF WHAT HAPPENS HERE AND IN THE OTHER PARTS OF THE DEPARTMENT. SOME OF US HAVE BEEN HAVING ALMOST DAILY PHONE CALLS ABOUT EBOLA, WHERE SHE PERSONALLY PARTICIPATES AND TAKES GREAT INTEREST IN LEADING THE EFFORT RK PLUS SHE IS INTENSELY INTERESTED AND SUPPORTIVE OF NIH, AND IT'S BEEN ROWLY QUITE A DELIGHT HAVING HER COME INTO THAT LEADERIP ROLE, ALTHOUGH WE ALSO HAD A WONDERFUL RELATIONSHIP WITH KATHLEEN, AND WE'VE BEEN FORTUNATE, I THINK, IN THIS ADMINISTRATION TO HAVE TWO SUCH REMARKABLE SECRETARIES. WITHIN NIH, ONE PERSON THAT YOU OFTEN HEARD FROM IN THESE MEETINGS, PAT WHITE, WHO WOULD GIVE YOU ALWAYS AMUSING AND INFORMATIVE DESCRIPTION ABOUT WHAT WAS HAPPENING ON THE HILL DEPARTED AND TOOK UP A NEW ROLE FOR AN ORGANIZATION THAT HE'S ESSENTIALLY FOUNDED CALLED ACT FOR NIH. ACT STANDING FOR ADVANCING CURES TODAY. WHERE PAT HAS BEEN WORKING VERY HARD TO TRY TO RAISE CONSCIOUSNESS ABOUT THE IMPORTANCE OF SUPPORT FOR BIOMEDICAL RESEARCH AT THIS TIME WHERE, OVER THE LAST 10 YEARS, WE HAVE BEEN STEADILY LOSING PURCHASING POWER, AND PAT IN THAT ROLE, WHERE HE'S NO LONGER IN THE GOVERNMENT, IS ABLE TO MAKE THAT CASE IN WAYS THAT WE'RE SOMEWHAT CONSTRAINED WHEN ONE IS OTHERWISE LOCATED WITHIN THE NIH ITSELF. SO WE GRIEVED HIS DEPARTURE BUT ALSO UNDERSTOOD THE PASSION THAT HE FELT FOR THIS NEW ROLE AND WISHED HIM WELL. OTHER CHANGES, AMY PATTERSON WHO HAS SERVED NOBLY AND ABLY AS THE HEAD OF THE OFFICE OF SCIENCE POLICY WAS ASKED TO TAKE ON A NEW ROLE ABOUT BIOSECURITY AND BIOSAFETY, AS THE DIRECTOR OF A PROGRAM ON BIOSECURITY AND BIOSAFETY POLICY, REPORTING TO LARRY. I'LL SAY MORE IN THE COURSE OF SOME OF THESE SYNOPSES ABOUT ACTIVITIES THAT SHE HAS BEEN HELPING US WITH IN A VERY SIGNIFICANT WAY. ALSO IN KATHY'S OFFICE, THE SCIENCE OUTREACH AND POLICY GROUP, WE HAVE A NEW OUTREACH OFFICE, WHICH HAS BEEN SUCCESSFUL IN RECRUITING AS ITS LEADER JANET LAMBERT AND SOME OF THE THINGS THEY'VE BEEN ABLE TO DO, I'LL ALSO TOUCH ON HERE IN A BIT, GIVING US A BIT MORE OF AN OPPORTUNITY TO CARRY OUT ACTIVITIES THAT WE WERE TRYING TO SQUEEZE INTO OTHER NOOKS AND CRANNIES, AND NOW WE ACTUALLY HAVE A LOCUS FOR THEM. GIVEN WHAT I TOLD YOU ABOUT PAT DEPARTING AND AMY TAKING ON A NEW ROLE, WE HAVE BEEN IN THE PSS OF SEARCHING FOR NEW DIRECTORS FOR SCIENCE POLICY AND FOR THE POLICY AND LEGISLATIVE ANALYSIS POSITION, AND WE DECIDED BECAUSE THESE ARE AREAS OF SOMEWHAT INTERDIGITATED ACTIVITIES, THAT IT WAS REASONABLE TO HAVE THE SAME SEARCH COMMITTEE CONDUCT THE SEARCH. THEY HAVE DONE SO, CO-CHAIRED BY ERIC GREEN AND JOHN BERKLOW, AND WE HAVE NOW CANDIDATES THAT WE ARE VERY MUCH STRONGLY CONSIDERING FOR EACH OF THOSE POSITIONS BUT NOT READY TO SAY ANYTHING TODAY ABOUT HOW THAT'S GOING TO TURN OUT. MEANWHILE DAVID HAS COME IN TO SERVE AS ACTING OFFICE OF SCIENCE POLICY DIRECTOR FROM NCAM, HAS DONE A GREAT JOB OF THAT, AND LAUREN HIGGINS HAS STEPPED UP AS ACTING DIRECTOR OF OPA, SO WE HAVE PLENTY OF TALENT TO KEEP US GOING WHILE THE SEARCHES CONTINUE. THEN WHEN IT COMES TO INSTITUTE DIRECTORS, WE HAVE HAD ALSO SOME INTERESTING DEVELOPMENTS. SINCE WE HAVE 27 INSTITUTES AND CENTER, IT WOULD BE UNLIKELY THAT WE WOULD GO FOR MORE THAN A WEEK WITHOUT HAVING SOMETHING GOING ON THERE IN TERMS OF DEPARTURES AND ARRIVALS, AND THIS IS NO EXCEPTION. YOU MAY RECALL JOHN RUFFIN RETIRED AS DIRECTOR OF THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITY LAST SPRING, AND I ASKED YVONNE MADDOX TO STEP IN AS ACTING DIRECTOR AND SHE DID SO BACK IN APRIL. SHE HAS BEEN WORKING EXTREMELY HARD IN THAT ROLE, AND I'M VERY GRATEFUL TO HER FOR HER SERVICE, AND WE ARE NOW APPROACHING THE POINT, I THINK, OF NARROWING DOWN POTENTIAL CANDIDATES OF A PERMANENT DIRECTOR THANKS TO THE HARD WORK OF TONY FAUCI AND GARY GIBBONS, WHO HAVE CO-CHAIRED A REALLY HIGH LEVEL SEARCH COMMITTEE INVOLVING A LOT OF PEOPLE WHOSE NAMES YOU WOULD KNOW, AND WE HAVE NOW THREE CANDIDATES THAT HAVE BEEN PUT FORWARD WHICH ARE NOW IN THE PROCESS OF GETTING SCHEDULED FOR THE SORT OF DIRECTOR LEVEL INTERVIEWS AND WE'LL SEE WHERE THAT TURNS OUT. I'M VERY PLEASED TO ACTUALLY SEE THE RESPONSE TO THIS AND THE TALENT OF THE CANDIDATES THAT HAVE BEEN PUT FORWARD. THE NEUROLOGY INSTITUTE ALSO NOW VERY MUCH IN THE SPACE OF LOOKING FOR A NEW DIRECTOR SINCE STORY LANDIS, WHO HAS SO ABLY LED THAT ENTERPRISE FOR A LONG TIME, RETIRED ON OCTOBER 3RD. WALTER KOROSHETZ STEPPED IN AS ACTING DIRECTOR, AND THE DEADLINE FOR SUBMISSION OF INTERST HAS JUST PASSED. I THINK LAST WEEK. SO WE WILL SEE HOW THIS PLAYS OUT, THE SEARCH COMMITTEE WILL NEED TO CONDUCT THEIR INTERVIEWS, THEN WE WILL MOVE THAT FORWARD. I'M VERY HOPEFUL THAT FOR NINDS AND NIMHD, WE WILL BE ABLE TO NAME NEW DIRECTORS IN THE COMING MONTHS. THEN ANOTHER ANNOUNCEMENTS THAT INVOLVES SOMEBODY WHO'S RIGHT THERE IN THE ROOM, IN EARLY NOVEMBER, DON LIN BURG ANNOUNCED HIS INTENTION TO RETIRE AT THE END OF MARCH 2015. DON HAS BEEN AN INCREDIBLE LEADER OVER A LONG PERIOD OF AMAZING GROWTH OF WHAT'S HAPPENED AT THE NATIONAL LIBRARY OF MEDICINE. SENATOR HARKIN TOOK TO THE FLOOR TO SAY SOMETHING ABOUT THIS RECENTLY ON THE HILL, POINTING OUT THAT DON IS A GREAT MIC SERVANT AND A TRAILBLAZER IN MEDICAL INFORMATICS, REFLECTING ON THE FACT THAT WHEN DON JOINED NLM IN 1984, THE LIBRARY HAD NO ELECTRONIC JURMS JOURNALS, PERSONAL PERSONAL COMPUTER, AND RELATIVELY A SMALL NUMBER OF RESEARCH INSTITUTIONS HAD ACCESS TO THE INTERNET, BUT NOW LOOK WHERE WE ARE, PUBMED, MEDLINEPLUS, CLINICALTRIALS.GOV AND ON AND ON. SO WE SHOULD BECAUSE FOR A MOMENT, I THINK, TO GIVE THANKS TO DON FOR HIS LEADERSHIP OVER THOSE YEARS. [APPLAUSE] SO DON WILL CONTINUE AS THE DIRECTOR UNTIL THE END OF MARCH, AT WHICH POINT BETSY HUMPHRIES, WHO'S SITTING RIGHT HERE, HAS AGREED TO SERVE AS THE ACTING DURING A SEARCH PROCESS. THINKING ABOUT JUST HOW CRITICAL NLM IS FOR THE FUTURE OF WHERE WE'RE GOING, NLM, SERVICES IN VARIOUS DATABASES THAT THEY OATE ARE REALLY THE WINDOW IN WHICH THE WORLD COMES TO FIND OUT WHAT NIH IS UP TO. CERTAINLY THIS IS AN OPPORTUNITY, IT SEEMS, TO THINK A BIT ABOUT WHERE THAT'S GOING OVER THE NEXT DECADE OR SO. AND I THOUGHT AS PART OF THINKING ABOUT HAD THIS TRANSITION INTO NEW LEADERSHIP, IT WOULD BE HELPFUL TO HAVE SOME INPUT ABOUT EXACTLY WHERE THE AREAS OF EMPHASIS MIGHT MOST APPROPRIATELY BE, SO I HAVE ASK ASKED HARLAN CRUMB CAN HOLZ AND -- TO CO-CHAIR OVER THE NEXT FEW MONTHS ABOUT WHAT WOULD BE A VISION FOR THE KIND OF NLM THAT WE ALL ARE GOING TO NEED TO SEE EMERGE OVER THE NEXT DECADE, AND HARLAN GRACIOUSLY AGREED. I'VE ALSO ASKED HAROLD VARMUS TO SERVE AS A MEMBER OF THAT GROUP AND HE HAS ENTHUSIASTICALLY AGREED, WE'RE IN THE PROCESS OF BRAINSTORMING FOR POSSIBLE MEMBERS WITH APPROPRIATE EXPERTISE TO ASSIST IN THAT PROCESS. SO I GUESS I'M, THEREFORE, ANNOUNCING WE HAVE YET ANOTHER WORKING GROUP, AND YOU CAN COUNT ON IN JUNE WHEN YOU HAVE OUR NEXT MEETING, THEY'LL BE COMING FORWARD WITH SOME PRETTY INTERESTING STUFF. >> WOULD IT BE FOBL FOR US ON POSSIBLE FOR US ON THE COMMITTEE IF WE HAVE POTENTIAL CANNE CANDIDATES WE MIGHT FEEL WOULD BE GOOD IN THIS ROLE TO NOMINATE TO YOU SM >> ABSOLUTELY. PLEASE, ALL OF YOU, IF YOU HAVE GOOD IDEAS FOR PEOPLE WITH EXPERTISE AND VISION IN THAT SPACE, THE EASIEST WAY IS TO SUBMIT THEM TO ME OR GRETCHEN WOOD WHOSE NAME YOU MUST HAVE FROM LOTS OF YOUR INTERACTIONS, SO YES, PLEASE, LOVE TO HEAR T IF YOU'RE THINKING ABOUT THEM DURING THE COURSE OF TODAY OR TOMORROW, MENTION THEM TO ME OR TO HARLAN. OKAY. NOURISH SO THOSE ARE PERSONNEL CHANGES AND SENIOR LEADERSHIP. SOME OTHER THINGS TO TELL YOU ABOUT THAT WE'VE BEEN UP TO SINCE THE JUNE MEETING. I DO HAVE TO TELL YOU, WE HAD A REALLY EXCITING WEEK LAST WEEK WITH THE VISIT BY THE PRESIDENT TO NIH, ACCOMPANIED BY SECRETARY BURWELL, AND BY RON KLANE, WHAT WE CALL THE EBOLA CZAR APPOINTED BY THE WHITE HOUSE TO COORDINATE ALL OF THE EBOLA EFFORTS. THE PRESIDENT'S VISIT WAS FOCUSED PARTICON THE EBOLA EFFORTS THAT COINCIDED WITHIN A FEW DAYS OF THE PUBLICATION IN THE NEW ENGLAND JOURNAL THAT I'M SURE TONY WOULD TELL YOU ABOUT OF THE RESULTS OF THE PHASE ONE TRIAL OF THE NIH DESIGNED VACCINE FOR EBOLA. IT ALSO COINCIDED WITH AN OPPORTUNITY FOR THE PRESIDENT TO ECOURAGE THE CONGRESS TO PASS SUPPLEMENTAL FUNDING TO SUPPORT ALL OF THE EFFORTS THAT NEED TO BE TAKEN FORWARD TO HAVE US HELP OUT IN THE WAY THAT WE WOULD LIKE WITH THIS OUTBREAK, PARTICULARLY IN WEST AFER CAR, BUT ALSO DOMESTICALLY. THE PRESIDENT SPENT ABOUT AN HOUR AND A HALF AT NIH, I HAD HAD THE PRIVILEGE OF WALKING AROUND WITH HIM AND BEING INVOLVED IN THE PRESENTATIONS THAT HE HEARD, BUT IT WAS QUITE REMARKABLE TO SEE HIS ABILITY TO IMMEDIATELY ZERO IN ON THE SCIENCE THAT'S BEING PRESENTED AND TO ASK REALLY THOUGHTFUL QUESTIONS ABOUT WHAT ARE THE NEXT STEPS, SO HE CAME FIRST TO THE VACCINE RESEARCH CENTER, WHICH WAS SPECIFICALLY PUT IN PLACE A KUSM OF DECADE COUPLE OF DECADES A GO BY BILL CLINTON TO TRY TO PROVIDE AN OPPORTUNITY ON THE INTRAMURAL CAMPUS FOR FOCUSING ON HIV VACCINES BUT HAS CERTAINLY DEVELOPED VACCINES IN MANY OTHER PLACES AS WELL. HE HEARD -- THE PRESIDENT HEARD FROM NANCY SULLIVAN, A VERY IMPRESSIVE AND DOWN TO EARTH WONDERFUL PRESENTER OF WHAT HER WORK HAS BEEN ON THE EBOLA VACCINE BECAUSE SHE''S REALLY -- GOING BACK TO MICHIGAN AND GARY'S LAB IN THE EAR EARLY 1990s. HE ASKED HER WHAT IT'S A IT LIKE WHEN YOU REALIZE THAT SOMETHING HAS ACTUALLY STARTED TO WORK? SHE PULLED OUT HER NOTEBOOK FROM 1999, WHEN SHE WAS WORKING AT MICHIGAN, WHERE IT WAS THE FIRST TIME IN THE FIRST GENERATION OF THIS VACCINE, SHE'S NOW AT THE FIFTH GENERATION, FIRST GENERATION, SHE HAD ACTUALLY TRIED IT OUT TO SEE IT IF ANTIBODIES WERE PRODUCED, AND THERE ON HER NOTEBOOK WAS A PAGE THAT HAD A BUNCH OF NUMBERS AND A PRINTOUT, WHICH WAS CLEARLY INDICATING THAT SOMETHING WAS HAPPENING, AND SHE'D WRITTEN IN THE MARGIN IN LARGE CAPITAL LETTERS, "YAHOO." [LAUGHTER] AND THE PRESIDENT WAS QUITE TAKEN BY THAT. NOURISH OHOH, THAT'S THE MOMENT THAT SCIENTISTS TALK ABOUT, THE YAHOO MOMENT. SO HE WAS -- SHE EXPLAINED TO HIM THEN THE CURRENT VACCINE WHICH I'M SURE TONY WILL TELL YOU MORE ABOUT, WHICH IS BUILT ON THE CHIMP ADENOVIRUS BACKBONE AND ALL OF THE EFFORTS THAT HAD BEEN MADE TO SEE WHETHER THIS WORKS IN ANIMALS, WHICH IT WORKS REALLY WELL, EXPLAINING HOW YOU DO ANTIBODY TEST ITING, AND THEN ACTUALLY WE TOOK HIM UPSTAIRS TO THE FANSIEST FAX MACHINE YOU'LL EVER SEE IN YOUR LIFE WITH WITH ABOUT 12 DIFFERENT LASERS THAT WAS USED THEN TO ASSESS THE CELL -- IMMUNITY RESPONSE WHICH WAS ALSO REPRESENTED. SO HE LOVED THAT. AND HE CAME OVER TO OUR MAIN AUDITORIUM IN THE CLINICAL CENTER AND GAVE A ROUSING SPEECH OF ABOUT 20, 25 MINUTES, WHICH INCLUDED MUCH ENDORSEMENT OF THE VALUE OF MEDICAL RESEARCH, A STRONG ENDORSEMENT OF THE VALUE OF BASIC SCIENCE. HE REALLY HEARD THAT LOUD AND CLEAR FROM NANCY AND OTHERS AND GOT A NICE ROUND OF APPLAUSE AS A RESULT FROM ALL OF US. IF YOU HAVEN'T HAD A CHANCE, I'M SURE THAT SPEECH IS STILL UP THERE ON WHITEHOUSE.GOV. IT WOULD BE WORTH LISTENING TO AS AN INDICATION OF WHERE HIS HEAD IS AT, AND OBVIOUSLY MUCH OF THE SPEECH WAS THINGS WE ASKED FOR HELP WITH, BUT HE EX-TEM PORIZED AS WELL THINGS HE HAD SEEN AND HEARD IN THIS DEMONSTRATION. SO IT WAS A VERY WONDERFUL DAY FOR NIH HAVING THAT KIND OF A BOOST IN OUR MORALE BY HAVING SUCH A STRONG VOICE OF SUPPORT FOR EVERYTHING THAT WE DO. SOME THINGS YOU'LL BE INTERESTED IN BECAUSE THEY RELATE TO TOPICS WE'VE DISCUSSED BEFORE. THE BRAIN INITIATIVE. I THINK FULLY AWARE OF WHERE THIS IS GOING AS IS PETER BUT MAYBE NOT ALL OF YOU ARE AWARE OF WHAT'S HAPPENED WITH THE BRAIN INITIATIVE. JUST TO REMIND YOU, BACK A YEAR AGO THIS, GROUP, THE ACD, APPROVED THE BRAIN WORKING GROUP INTERIM REPORT, AND THAT MADE IT POSSIBLE FOR US TO ISSUE SIX FUNDING ANNOUNCEMENTS FOR THE BRAIN INITIATIVE FOCUSING PRIMARILY ON NEW TOOLS AND TECHNOLOGIES FOR UNDERSTANDING HOW NEURAL CIRCUITS FUNCTION. THEN THE LAST TIME WE MET IN JUNE, YOU APPROVED THIS BOLD AND WELL CONSTRUCTED 12-YEAR SCIENTIFIC PLAN FOR BRAIN, CARRYING US FORWARD TO 2025 WITH LOTS OF COMPONENTS AND EVEN AN ESTIMATED BUDGET TRAJECTORY, WHICH I THINK WAS REALLY QUITE A MOMENT, AND I MUST SAY, THAT REPORT HAS BEEN EXTREMELY WELL RECEIVED EVER SINCE THEN IN TERMS OF THE WAY IN WHICH THE COMMUNITIES, NEUROSCIENCE COMMUNITY, OTHERS AS WELL, HAVE SEEN THE VISION THAT WAS PUT FORWARD THERE. GIVEN THOSE SIX FUNDING ANNOUNCEMENTS THAT WE HAD PUT OUT BACK IN JANUARY, WE WERE THEN RUSHING THROUGH AT RECORD SPEED HERE GETTING APPLICATIONS, AND DID DID ANNOUNCE THE FIRST WAVE OF INVESTMENTS IN SEPTEMBER. WE HAD PUT ASIDE $40 MILLION, THE SCIENCE WAS SO COOL THAT WE HAD TO SCRAPE AROUND A LITTLE BIT AND FIND SOME MORE AND ENDED UP BEING ABLE TO INVEST $46 MILLION ON 58 AWARDS THAT WILL SUPPORT MORE THAN 100 INVESTIGATORS TO DEVELOP REALLY TRANSFORMATIVE TECHNOLOGIES. I PROBABLY SHOULDN'T TRY TO GO THROUGH ALL 58 AWARDS, BUT THEY ARE QUITE EXCITING IF YOU HAVE A CHANCE, THEY'RE ALL NOW, OF COURSE, ISSUED. EXAMPLES THOUGH, DEVELOPMENT OF A WEARABLE P PE PET SCANNER SO THAT YOU COULD ACTUALLY MEASURE BRAIN ACTIVITY DURING DAILY ACTIVITIES, WHICH IS SOMETHING THAT RIGHT NOW YOU CAN'T DO. DEVELOPING NEXT GENERATION OF MICRO ELECTRODES THAT COULD DEVELOP -- COULD DELIVER SMALL DOSES OF DRUGS AND RECORD ACTIVITY FROM THOUSANDS OF NEURONS FOR MONTHS AT A TIME. TRACKING REALTIME MOVEMENTS OF NEUROTRANSMITTERS, INVOLVED IN DISEASES LIKE ALZHEIMER'S, PARKINSON'S, SCHIZOPHRENIA AND DEPRESSION AND MANY OTHER THINGS THAT ARE HERE. BUT AGAIN, MOST OF THE FOCUS ON TECHNOLOGY DEVELOPMENT TRYING TO REALLY LEARN WHAT WE NEED ABOUT THE FUNDAMENTALS. SOMEBODY SAID TO ME THE OTHER DAY, YOU KNOW, IT'S GREAT THAT YOU'RE DOING THIS BECAUSE WITH NEUROSCIENCE OF THE BRAIN AND HOW THE CIRCUITS WORK, THEY'RE PROBABLY SOME MAJOR PRINCIPLES YET TO BE DISCOVERED THAT WE DON'T KNOW. IT'S NOT JUST FILLING OUT DETAILS. LIKE MAJOR UNDERLYING FUND MENTAL PRINCIPLES. THIS PERSON WHO WAS MAYBE OVERDOING IT A BIT SAID THIS IS LIKE GENETICS BEFORE MENDEL. OKAY, I DIDN'T THINK YOU'D LIKE THAT SO WELL. WE'RE A LITTLE PAST THAT POINT. >> [INAUDIBLE] >> OKAY. GENETICS BEFORE AVERY McCARTY MCCLOUD. I'LL TAKE THAT ONE. SO WE AIM TO MAKE THOSE DISCOVERIES. SO FOR FY15 WEE PLANNING TO FUND RESEARCH IN NEW AREAS ALONG WITH CURRENT ONES, EXPANDING THE BRINT AS YOU'LL HEAR WHEN WE GET TO TALKING ABOUT APPROPRIATIONS, WE HAVE NOT RECEIVED THE STEEP RAMP WE HAVE FOR THOSE BUT A SMALLER RAMP AND WE'LL MAKE THE MOST OF THAT. IN ADDITION, WE HAVE BEEN FOCUSED ON A FEW OTHER AREAS AND NEUROETHICS IS ONE OF THEM. WE HAD HAD A VERY INTERESTING MEETING ON NOVEMBER 4TH IN THE PORTER NEUROSCIENCE BUILDING FOCUS ON WHAT OUR PRIORITY AREAS SHOULD BE FOR RESEARCH THAT WILL INFORM POLICIES PERTAINING TO EITHER THE ETHICAL CONDUCT OF RESEARCH WITHIN THE BRAIN INITIATIVE OR OTHERWISE OUTSIDE OF NEUROSCIENCE OR THE ETHICAL USE OF NEUROSCIENCE RESEARCH. AND AGAIN, WHILE THIS MAYBE IS A BIT TRIGGERED BY BRAIN, THE QUESTIONS ARE MUCH BROADER THAN THAT. WONDERFUWONDER GROUP OF PEOPLE TURNED UP, SCIENTIST, ETHICIST, PATIENT GROUPS, BRAIN FUNDERS, PARTNERS. ON NOVEMBER 2021, WE ACTUALLY BROUGHT TOGETHER ALL OF THE BRAIN AWARDEES FOR A KICKOFF MEETING. THAT'S NOT SOMETHING WE HAVE TRADITIONALLY ALWAYS DONE BUT IT SEEMED LIKE A GREAT OPPORTUNITY TO TRY TO BUILD THOSE CONNECTIONS AND IDENTIFY COLLABORATIVE OPPORTUNITIES. WE CAN DID THIS WITH NSF AS WELL. AND I THINK THAT WAS A GREAT MOMENT FOR PEOPLE TO KIND OF GET TO KNOW EACH OTHER AND IDENTIFY AREAS OF SHARED INTEREST. AND OF COURSE THE BRAIN INITIATIVE IS NOT JUST NIH, IT'S INVOLVED NSF, DARPA, AND THE FDA, AND WE ARE WORKING REALLY QUITE CLOSELY WITH ALL OF THOSE ENTERPRISES TO MAKE THE MOST OF THOSE SYNERGIES. SO I WOULD SAY SINCE THE PRESIDENT'S ANNOUNCEMENT ABOUT BRAIN, WHICH WAS LESS THAN TWO YEARS AGO, WE'VE REALLY COME A LONG WAY. AND MORE TO COME, BUT I THOUGHT YOU ALL WOULD BE INTERESTED IN HEARING THAT. CORY, I DON'T KNOW IF YOU HAVE ANY COMMENTS FROM YOUR PERSPECTIVE, HAVING PLAYED SUCH AN ARCHITECTURAL ROLE IN GETTING US HERE ABOUT WHAT YOU'RE HEARING IN THE COMMUNITY OR HOW YOU SEE THIS SHAPING UP, IT WOULD BE GREAT TO HEAR THAT IF YOU DO. >> I THINK BOTH THERE WAS THE MEETING AT THE WHITE HOUSE ON SEPTEMBER 30TH, SO THE SAME DAY THE NIH ANNOUNCED ITS AWARDS, A LARGE NUMBER OF PEOPLE MET AT THE WHITE HOUSE TO SORT OF HAVE A FORMAL KICKOFF, AND A NUMBER OF OTHER GROUPS HAVE EXPRESSED INTEREST IN GETTING INVOLVED, OTHER FOUNDATIONS LIKE THE SIMONS FOUNDATION, SORT OF THE PRIVATE SECTOR, THE NATURAL FOE TO NICKS INSTITUTE, SEVERAL OF THE GROUPS HAD REP OFTIVE THERE IS, GOOGLE, FACEBOOK, INTEL. SO I THINK THAT KIND OF BROAD SUPPORT IS PROBABLY REALLY GOOD FOR THE BRAIN NICHE OFTIVE, BECAUSE IT'S NOT JUST NEUROSCIENTISTS SAYING IT'S A GOOD IDEA, BUT OTHER PEOPLE FROM OTHER RESPECTED COMMUNITIES SAYING IT'S A GOOD IDEA, A AND THAT WILL HAVE TO BE GOOD FOR NIH AND NSF SORT OF CREDIBILITY IN MAKING THIS CASE AS WELL. >> I ALSO WANTED TO ADD, I KNOW OF SO MANY UNIVERITIES WHO HAVE STARTED LOCAL INITIATIVES OR STATE INITIATIVES THAT HAVE KIND OF BEEN INSPIRED BY THE BRAIN INITIATIVE, BUT WHERE THEY'RE INVESTING FUNDS IN A DIFFERENT WAY BECAUSE THEY'RE TRYING TO HONE IN ON THE TECHNOLOGY ASPECT AND BRING TOGETHER SCHOOLS OF ENGINEERING, PHYSICISTS, MATHEMATICIANS, SO IT HAS REALLY KIND OF PENETRATED INTO THE VERY FABRIC OF A LOT OF ACADEMIA, AT LEAST, AND ALSO INTERFACES BETWEEN ACADEMIA AND TECHNOLOGIES OF DIFFERENT KINDS, SPREAD IN A VERY NICE WAY. >> YOU'VE HELPED A LOT WITH THIS, I DON'T KNOW IF YOU HAVE OBSERVATIONS OF HOW THIS IS SHAPING UP. >> WELL, THE AREA OF BIG DATA IS SOMETHING THE COMMITTEE TALKED A LOT ABOUT, AND I IT THINK THAT HAS BROAD IMPLICATIONS AND WE'LL WORK COLLABORATIVELY WITH THE DATA SCIENCE INITIATIVE, AND I THINK THAT'S A BRAND NEW PIECE OF SCIENCE THAT WE REALLY HAVEN'T APPRECIATED AT THIS POINT. >> I TOTALLY AGREE. AND WE ARE TRYING TO WORK HARD TO BE SURE THAT THOSE OPPORTUNITIES DON'T GET MISSED. MONCEF, WELCOME. WELL, SPEAKING OF BIG DATA, THE NEXT THING I WAS GOING TO MENTION BUT BRIEFLY IS THAT WITH PHIL BOURNE'S ARRIVAL AS THE ASSOCIATE DIRECTOR FOR DATA SCIENCE AND THE FORMATION WITHIN NIH OF THE SCIENTIFIC DATA COUNCIL AND EFFORTS TO BEGIN TO FUND REALLY BOLD STEPS IN THE DIRECTION OF WHAT WE CALL BD2K, THERE'S A LOT GOING ON HERE AS WELL. WE TENTATIVELY THOUGHT ABOUT HAVING A PRESENTATION AT HAD THIS MEETING FROM PHIL, BUT I THINK WE HAVE SUCH A FULL SCHEDULE THAT WE WILL PUT THAT OFF UNTIL THE NEXT MEETING, BUT IN JUNE, I'M GOING TO ASK PHIL, WHO WILL HAVE BY THEN HAVE GOTTEN EVEN MORE INTERESTING THINGS UP AND GOING, TO FILL YOU IN ON WHERE WE ARE WITH BD2K, WITH SUCH THINGS AS A DATA COMMONS, WHICH PHIL IS WORKING ACTIVELY ON. JUST BRIEFLY, BD2K HAS ALSO FUNDED ITS FIRST SET OF GRANT AWARDS AT THE END OF SEPTEMBER, WHICH HAD SEVERAL COMPONENTS BUT MAYBE THE MOST VISIBLE ONE ARE CENTERS OF EXCELLENCE, WHICH HAVE A VARIETY OF DIFFERENT THEMES AND LOOK LIKE A PRETTY INTERESTING COLLECTION OF VISIONARY FOLKS IN THIS SPACE. THERE'S A LOT OF INTEREST ACROSS THE WHOLE GOVERNMENT IN BIG DATA, AND WE ARE VERY MUCH PLAYING A ROLE IN STAYING CONNECTED WITH THAT. NOW WITH MEGAN SMITH HAVING ARRIVED AT THE WHITE HOUSE AS THE CHIEF TECHNOLOGY OFFICER COMING FROM GOOGLE, AND HER DEPUTY, ALEX FROM TWITTER, THERE'S QUITE AN INTERESTING NEW KIND OF DYNAMIC GOING ON IN DATA SCIENCE AND OSTP IN THE WHITE HOUSE, SOMETHING WE'RE EXCITED ABOUT BEING A PART OF. I THINK AT LEAST AT THE MOMENT, MUCH OF WHAT THE GOVERNMENT IS UP TO IN DATA SCIENCE IS KIND OF LOOKING AT NIH AS BEING OUT IN FRONT. WE'D LIKE TO THINK WE'RE REALLY OUT IN FRONT BUT WE KNOW WE'VE STILL GOT A LOT OF WORK TO DO TOO. AGAIN, SOME OF THIS COMES BACK TO OUR N. NLM DISCUSSION BECAUSE A LOT OF THE REASONS WE'RE OUT IN FRONT ARE BECAUSE OF SUCH THINGS AS PUBMED. OTHER SCIENCE TO TELL YOU ABOUT, WE HAD A VERY PRODUCTIVE TWO-DAY MEETING IN JULY, JOINTLY BETWEEN NIH AND THE BILL AND MELINDA GATES FOUNDATION. WE'D NEVER DONE THIS BEFORE. THERE'S OBVIOUSLY VERY CLOSE RELATIONSHIPS IN VARIOUS AREAS OF RESEARCH BETWEEN NIH AND THE GATES FOUNDATION, MAYBE PARTICULARLY IN THINGS LIKE HIV/AIDS, BUT WE'D NEVER ACTUALLY HAD THE SENIOR STAFF OF BOTH INSTITUTIONS GATHER TOGETHER TO LOOK AT THE WHOLE PORTFOLIO AND SAY ARE THERE WAYS THAT WE COULD BE WORKING TOGETHER EVEN MORE EFFECTIVELY. BILL WAS EXCITED ABOUT THAT, SO WERE SENIOR LEADERS HERE AT NIH. WE HAVE 22 PROGRAM OFFICIAL FROM THE GATES FOUNDATION HERE, LED BY TREVOR AND CHRIS. I'M SORRY CHRIS IS NOT HERE FOR THIS ACD MEETING BECAUSE HE COULD TELL YOU MORE ABOUT THIS. WE HAD HAD HAD A COMPARABLE NUMBER OF NIH MANAGERS FROM SEVEN DIFFERENT ICs INCLUDING SEVERAL DIFFERENT IC DIRECTOR, AND WE BASICALLY BOTH HAD PLENARIES BUT THEN BROKE INTO SPECIFIC GROUPS TO TALK ABOUT MATERNAL AND NEWBORN HEALTH, CHILD HEALTH AND DEVELOPMENT, HIV, MALARIA, AND TB, NEGLECTED TROPICAL DISEASES, AND NEW TECHNOLOGIES, POINT OF CARE DIAGNOSTICS. ALL OF THOSE, I THINK MADE SUBSTANTIAL HEADWAY. IT WAS CLEAR THAT SOME AREAS LIKE HIV/AIDS WERE ALREADY QUITE CLOSELY LINKED, BUT IT WAS STILL USEFUL THAT WE GOT TOGETHER AND FIGURED OUT SOME NEW APPROACHED LIKE HOW COULD WE WORK TOGETHER TO PRODUCE A WELL CHARACTERIZED ENVELOPE FROM THE IMMUNOAGAINS -- ANTIBODIES FOR PREVENTION AND TREATMENT. SOME OF THE OTHER AREAS, THERE WAS GOODWILL IN THE PAST BUT THERE HADN'T BEEN THIS KIND OF CLOSE CONNECTION ABOUT HOW WE COULD DO THINGS TOGETHER. SO EACH ONE OF THOSE AREAS THEN WAS CALLED UPON TO COME UP WITH SPECIFIC ACTIONS THAT THEY WOULD NEED TO TAKE AND TIM TIMETABLES FOR DOING SO. WHEN I MET WITH BILL GATES IN EARLY OCTOBER IN SEATTLE AT THEIR GRAND CHALLENGES MEETING, WE WENT OVER ALL OF THAT. HE WAS QUITE ENTHUSIASTIC TO SEE THE WAY IN WHICH THIS HAD LINKED OUR EFFORTS TOGETHER. WE'VE SUBSEQUENTLY HAD ONE LONG CONFERENCE CALL TO ASSESS OUR PROGRESS AND WE'LL HAVE ANOTHER ONE PROBABLY IN FEBRUARY, AND THEN WE WILL PLAN TO DO THIS MEETING AGAIN NEXT SUMMER, BECAUSE IT DOES SEEM LIKE A REALLY USEFUL CONNECTION BETWEEN OUR GROUPS. WHEN YOU CONSIDER, IF YOU LOOK ACCORDING TO THE GLOBAL FUNDING ANALYSES THAT GROUPS HAVE DONE, THE FUNDING OF GLOBAL RESEARCH, WHEN YOU PUT TOGETHER NIH AND THE GATES FOUNDATION, THAT'S 54% OF THE TOTAL, JUST BETWEEN OUR TWO ORGANIZATIONS. >> [INAUDIBLE] WELCOME TRUST IS THE SORT OF NEXT ONE DOWN THE LINE AND THERE'S A LONG LIST OF OTHERS THAT THAT CONTRIBUTE, BUT GATES AND NIH ARE THE BIG PLAYERS, AL THE ALL THE MORE REASON WE SHOULD MAKE SURE WA WE'RE DOING IS SYNERGISTIC. SO I'M GRATEFUL TO THAT AND I SEE COLLEAGUES WHO HAVE REALLY PUT A LOT OF TIME AND EFFORT IN TRYING TO MAKE THE MOST OF THIS. IF YOU HAVE COMMENTS OR OBSERVATIONS OR QUESTIONS, JUMP IN. >> FRANCIS, YOU MENTIONED WELCOME TRUST. WHY NOT ENGAGE THEM TOO? >> WELL, I THINK WE ARE, IN A SORT OF BILATERAL WAY. A TRILATERAL WAY IS MAYBE WHAT YOU'RE TALKING ABOUT. SINCE JEREMY MOVED INTO THE ROLE OF WELCOME TRUST, HE'S OBVIOUSLY SOMEBODY WITH ENORMOUS INTEREST AND EXPERIENCE IN GLOBAL HEALTH FOR ALL THE TIME HE SPENT IN VIETNAM. HE AND I ACTUALLY HAVE REGULAR INTERACTIONS ABOUT LOTS OF THINGS, ESPECIALLY RIGHT NOW, EBOLA. NEXT WEEK, THERE THERE WILL BE THE MEETING OF THE HEADS OF NATIONAL RESEARCH ORGANIZATIONS, THE HEROS, AND OUR MAIN TOPIC IS GOING TO INCLUDE WHERE ARE WE GOING WITH GLOBAL HEALTH RESEARCH. SO IT IS AN OPPORTUNITY. NOW WHETHER WE COULD PUT ALL THREE ORGANIZATION TOGETHER IN THE SAME ROOM AT THE SAME TIME, MAYBE THAT'S WHAT YOU'RE SUGGESTING, HASN'T YET BEEN FLOATED BUT MAYBE IT'S WORTH THINKING ABOUT THAT, GIVEN THEIR SIGNIFICANT ROLE AS WELL. >> I KNOW JEREMY VERY WELL. I THINK HE'D BE VERY OPEN TO THAT. >> THAT'S A GOOD IDEA. LET ME EXPLORE THAT. >> OKAY. ANOTHER SCIENCE PROJECT WHICH WAS DESCRIBED IN OUR JUNE MEETING, BECAUSE IT HAD LAUNCHED A FEW MONTHS OF BEFORE THAT, IS THE ACCELERATING MEDICINES PROJECT, AMP. JUST TO REMIND YOU, THIS IS A FAIRLY UNPRECEDENTED KIND OF PARTNERSHIP BETWEEN NIH AND ITS GRANTEES AND PRIVATE SECTOR, PARTICULARLY 10 PHARMACEUTICAL COMPANIES INCLUDING GSK, AND 13 NON-PROFITS, AND THE FDA. AND THE PROJECT THEN BEING MANAGED BY THE FOUNDATION FOR NIH, WHICH IS IN A GREAT POSITION TO BRING TOGETHER THESE VARIOUS SUPPORTERS. THIS WAS THE RESULT OF A THREE-YEAR PROCESS OF THINKING ABOUT HOW WE MIGHT TACKLE THE IDENTIFICATION OF DRUG TARGETS AND BIOMARKERS FOR DISEASES WHERE WE REALLY NEED NEW IDEAS, BUT TO DO SO IN A WAY THAT'S FOCUSED ON PART OF THE ENTERPRISE THAT COULD BE CONSIDERED PRECOMPETITIVE SO THE DATA COULD BE ALL OPEN ACCESS, BECAUSE FOR NIH, THAT'S CRUCIAL. WE HAD A LONG DELIBERATION OVER THOSE THREE YEARS ABOUT EXACTLY WHICH DISEASES WERE MOST WELL POSITIONED FOR THIS KIND OF APPROACH AND CONCLUDED THAT WE COULD START WITH THREE, ALZHEIMER'S DISEASE, TYPE 2 DIABETES, AND THE AUTOIMMUNE DISEASES, RHEUMATOID ARTHRITIS AND LU PUS. AND THE AMP PROJECT DID GET LAUNCHED LAST FEBRUARY BASED UPON DETAILED WORK PLANS THAT HAD ALREADY BEEN WORKED OUT BY SCIENTISTS FROM BOTH SECTORS SITTING AROUND THE TABLE TOGETHER TO FIGURE OUT HOW TO DO THIS, AND WITH THE AGREEMENT THAT THE COSTS WERE GOING TO BE 50/50 SHARED BETWEEN THE COMPANIES AND NIH. I'M NOT AWARE THAT ANYTHING QUITE LIKE THIS HAS BEEN TRIED BEFORE. HAPPY TO TELL YOU THIS IS GOING REALLY WELL. THE CO-CHAIRS OF THE EXECUTIVE COMMITTEE ARE MYSELF AND MICHAEL BOLSTON OF PFIZER WITH AN EXTENDED EXECUTIVE COMMITTEE THAT INCLUDES THE LEADERS OF THE PHARMACEUTICAL COMPANES AND SEVERAL INSTITUTE DIRECTORS THAT ARE PART OF THIS, AND I PARTICULARLY WANT TO SAY THANK YOU TO STEVE KATZ, WHO HAS BEEN VERY MUCH INVOLVED IN THE RHEUMATOID ARTHRITIS LUPUS PART TO RICHARD HODES AND GRIFF RODGERS FOR THE DIABETES PART, THEY HAVE PUT A LOT OF TIME AND EFFORT OF SENIOR STAFF INTO THIS. THE SPECIFIC GOALS OF EACH OF THESE PROJECTS ARE EXCITING AND I THINK QUITE BOLD AND THEY ARE ALL AT LEAST ON SCHEDULE AND MAYBE EVEN IN ONE INSTANCE A LITTLE AHEAD OF THE SCHEDULE WHERE THEY THOUGHT THEY WOULD BE IN TERMS OF GETTING THE SCIENCE GOING, MAKING AWARDS BOTH THROUGH FNIH, WHO ARE DOING THE RFAs FOR THE PHARMACEUTICAL DOLLARS, AND FOR NIH, FROM OUR PART OF IT. IT IS BOTH AN INTERESTING SCIENTIFIC EXPERIMENT AND AN INTERESTING CULTURAL EXPERIMENT, PUTTING TOGETHER THE VIE POINTS. VIEWPOINTS. I THINK IT'S BEEN GOOD FOR ALL PARTIES TO HAVE THAT PART OF IT HAPPEN. OUR MOST RECENT EXTENDED EXECUTIVE COMMITTEE MEETING WAS NOVEMBER 21ST, WE LOOKED AT THE PROJECT PROGRESS AND WERE QUITE HAPPY WITH HOW THINGS WERE GOING. I WOULD LOVE PERSONALLY TO CONSIDER THE POSSIBILITY OF ADDING ONE OR TWO OTHER PROJECTS IN OTHER AREAS THAT WOULD ALSO BENEFIT FROM THIS, SCHIZOPHRENIA IS ONE THAT'S BEEN DISCUSSED. WE HAVEN'T QUITE GENERATED THE SUFFICIENT MOMENTUM TO DO THAT BECAUSE OUR ROLE GENERALLY HAS -- UNLESS YOU CAN FIND THREE OR FOUR COMPANIES THAT ARE WILLING TO SAY WE'RE GOING TO TAKE PART, THAT THAT ONE IS NOT READY YET. THAT'S SORT OF THE DEFINING MOMENT WHERE YOU SAY THIS IS READY TO GO. ANYWAY, THAT'S BEEN REALLY QUITE GRATIFYING. SPENT A LOT OF MY OWN TIME ON THIS, BUT IT'S BEEN QUITE REWARDING TO DO SO. SPEAKING OF AREAS WHERE WE NEED A LOT OF REALLY EFFECTIVE RAPIDLY MOVING RESEARCH, I WANT TO SAY A LITTLE BIT ABOUT THE WHOLE AREA OF ANTIMICROBIAL RESISTANCE. I THINK ALL OF US LOOKING AT THE TRENDS CAN'T HELP BUT BE EE LARMED AT THE WAY OF WHICH BACTERIA ARE RESISTANT TO VIRTUALLY ALL APPROVED ANTIBIOTICS IS BECOMING MORE AND MORE OF A PROBLEM INTERNATIONALLY, BUT VERY MUCH DOMESTICALLY AS WELL. ESTIMATES ARE SOME 23,000 PEOPLE DIED LAST YEAR BECAUSE OR AT LEAST CONTRIBUTED TO BY INFECTIONS FOR WHICH ANTIBIOTICS WERE NOT USEFUL, PARTICLY INDIVIDUALS IN ICUs, SOME OF THOSE ARE FAMILIAR LIKE MRSA, MAYBE SOME ARE LESS FAMILIAR. THE ONES I FIND MOST ALARMING ARE ACTUALLY THE GRAM-NEGATIVES, WE'VE HAD HAD OUR OWN EXPERIENCE WITH AN OUTBREAK IN OUR CLINICL CENTER WITH ONE OF THOSE WHICH ONLY GOT PUT TO A STOP BY SOME VERY SOPHISTICATED GENOMIC ANALYSIS TO TRACK DOWN HOW THIS WAS BEING PASSED FROM PATIENT TO PATIENT, EVEN THOUGH THOSE PATIENTS WERE NEVER IN THE SAME ROOM. SO WE NEED CLEARLY TO MAKE THIS A PRIORITY. THE PRESIDENT HAD IDENTIFIED THAT AS SOMETHING THAT HE WANTED TO SEE SOMETHING DONE ABOUT. THERE WAS A VERY VIGOROUS EFFORT Y THE PRE' THE PRESIDENT'S COUNCIL TO COME UP WITH WITH RECOMMENDATION, AND IN PARALLEL, A GOVERNMENT EFFORT, THE NATIONAL STRATEGY FOR COMBATING ANTIBIOTIC RESISTANT BACTERIA, CARB, CAME UP WITH A RATHER SIMILAR -- WHICH WAS GOOD BECAUSE THEY WERE HAVING THE SAME KINDS OF IDEAS -- PLAN ABOUT WHAT TO DO IN TERMS OF PREVENTION, DEVELOPING NEW ANTIBIOTICS AND VACCINES, THERAPEUTICS, BETTER DIAGNOSTICS AND SO ON, BETTER WAYS TO TRACK THESE ORGANISMS. SO AS A RESULT OF THOSE TWO REPORTS, A TASK FORCE FOR COMBATING THIS PROBLEM IS NOW IN PLACE TO SUBMIT AN ACTION PLAN BY FEBRUARY OF NEXT YEAR: WE'RE ALSO VERY -- A PRESIDENT ADVISORY COUNCIL. WHAT OUR ROLE IS HERE, YOU CAN IMAGINE, CERTAINLY TO ACCELERATE BASIC AND APPLIED RESEARCH, TO ADVANCE THE DEVELOPMENT OF NEW IDEAS ABOUT DRUG TARGETS, BECAUSE WE ALREADY SPEND HUNDREDS OF MILLIONS OF DOLLARS IN THAT SPACE. THIS HAS NOT BEEN A PARTICULARLY ATTRACTIVE SPACE FOR COMPANIES BECAUSE OF THE LIMITED MARKET AND THE LIABILITY ISSUES, AND SO NIH HAS CERTAINLY BEEN ALREADY PUTTING A LOT OF EFFORT INTO THE FRONT END OF THE PIPELINE, AND WE'RE NOW BEING ASKED TO DO EVEN MORE OF THAT. WE ALSO WILL WAND TO PLAY A ROLE IN IMPROVING DIAGNOSTICS. IF WE HAD AN ABILITY TO KNOW WHEN SOMEBODY TURNS UP WITH WITH AN INFECTION RIGHT AWAY, THAT THIS IS A HIGHLY RESISTANT ORGANISM AS OPPOSED TO FINDING THAT OUT 48 TO 72 HOURS LATER. SO WE'RE ACTUALLY LAUNCHING A -- TO SEE IF THERE'S A WAY TO INSPIRE SOME COMPETITION HERE. DOING THIS JOINTLY WITH BARTA AND CDC, WITH A PRIZE OF PERHAPS SOMETHING LIKE $20 MILLION, WHICH WE WILL HAVE MORE DETAILS ABOUT FORTHCOMING EARLY NEXT YEAR. THE IDEA, RAPID POINT OF CARE DIAGNOSTICS, SOMETHING LIKE A FOUR-HOUR TURNAROUND, WHICH WILL TELL YOU IF SOMEBODY HAS SEPSIS OR PNEUMONIA OR A URINARY TRACT INFECTION. BY, THIS IS A BAD ONE, THIS ORGANISM, IT'S THIS LEVEL OF RESISTANCE. THAT WOULD BE A GAME CHANGER. THE OTHER THING WE'RE BEING ASKED TO DO IN THIS SPACE IS TO EXPAND A NATIONAL CLINICAL TRIAL NETWORK. NIAID HAD ALREADY PUT IN PLACE THE ANTIBIOTIC RESISTANCE LEADERSHIP GROUP, ARLG, BUT BASED UPON A VERY INTERESTING WORKSHOP WE HELD JOINTLY WITH FDA, I THICK THERE WAS A CONCLUSION AT THE MANY COMPANIES PRESENTED AT THAT WORKSHOP THAT A REALLY SERIOUS NEED, IF YOU HAVE DEVELOPED AN ANTIBIOTIC THAT LOOKS LIKE IT MIGHT BE USEFUL IN A SITUATION OF VERY ILL INDIVIDUALS WITH A HIGHLY RESISTANT ORGANISM, YOU CAN'T DECIDE AT THAT POINT, OH, I NEED TO SET UP A NETWORK. YOU NEED TO HAVE IT IN PLACE. BECAUSE YOU DON'T KNOW WHERE THOSE PATIENTS ARE GOING TO BE UNTIL ALL OF A SUDDEN YOU MEADE TO KNOW WHERE THEY ARE. SO THE IDEA OF HAVING SUCH A NETWORK THAT COMPANIES COULD, IF THEY HAD A CANDIDATE DRUG, KNOW HOW TO TAP INTO QUICKLY, ALREADY, WITH PROA PROTOCOLS AND CONSENTS IN PLACE WOULD BE A BIG ADDITION TO THE PATH FORWARD, AND WE AIM TO TRY TO EXPAND OUR ARLG MODEL TO TRY TO DO THAT FOR RAPID RESPONSE OF TESTING NEW ANTIBIOTICS ON INDIVIDUALS WITH INFECTED WITH HIGHLY RESISTANT STRAINS. >> IS THE FOCUS ON MORE RESEARCH ONLY ON ANTIBACBACTERIALS OR VACCINES ALSO? >> VACCINES ARE VERY MUCH ALSO ON THE LIST, YES. THAT IS EXPLICITLY INCLUDED. FINALLY, THE OTHER THING THAT WE WOULD VERY MUCH LIKE TO SEE DONE IN WHICH IS PART OF THIS PLAN IS TO TAKE THE NEW TOOLS OF GENOMICS AND APPLY THEM IN A CREATIVE WAY TO REALLY TRACKING WHAT'S HAPPENING WITH HIGHLY RESISTANT ORGANISMS, SO IF YOU HAVE A CASE WITH HIGHLY ACCURATE GENOME SEQUENCES ALREADY PLACED IN PUBLIC VIEW AND NCBI IS NICELY POSITIONED TO DO IT THIS AND YOU MIGHT THEN BE ABLE TO SAY, OH, WOW, THAT LOOKS VERY MUCH LIKE SOMETHING THAT HAPPENED IN TENNESSEE LAST MONTH AND MAYBE WE COULD FIGURE OUT SOMETHING ABOUT THE TRANSMISSION PATTERN AS A RESULT, AS WELL AS MAYBE FIGURE OUT SOMETHING ABOUT WHAT TO EXPECT IN TERMS OF THE RESPONSE TO VARIOUS MEDICAL INTERVENTION. THAT KIND OF GENOMIC APPROACH HAS NOT BEEN APPLIED AT THIS SCALE IN THIS SITUATION AND IT NEEDS TO BE, AND NCBI IS VERY MUCH POSITIONED TO BE THE HOME FOR THAT. THE OTHER IS TO TAKE THE REFERENCE STRAINS FOR THIS RESISTANT ORGANISM, THERE ARE HUNDREDS OF THEM THAT CDC CURE RATE, AND GET THEM TO VERY HIGH ACCURACY SO YOU HAVE THAT AS YOUR DATABASE THAT YOU CAN DO COMPARISONS TO WHEN SOMETHING POPS UP. SO ALL THAT'S GOING TO HAPPEN. >> I THINK IT'S ALSO GOING TO BE IMPORTANT TO HAVE SPECIMEN REPOSITORIES THAT PEOPLE CAN ACCESS, AND ANTICIPATING WHAT AMY IS GOING TO HAVE TO ADDRESS, IF THESE ARE GOING TO BE DISTRIBUTED, THEY'RE GOING TO HAVE TO BE VERY CLOSELY TRACKED. >> YES. BOTH TRUE. THAT WE NEED THE REPONS TR REPOSITORY AND NEED TO KNOW WHERE YOU'RE GOING VERY QUICKLY. SPEAKING OF WHICH, YOU GIVE ME THE BEST SOMETHING WAYS, OH, MY GOSH. SO YEAH, THERE'S HAD THIS THING CALLED DUAL USE RESEARCH OF CONCERN. DURC. WHICH HAS BEEN OF CONCERN FOR SOME TIME. CERTAINLY WHERE NIH HAS ASKED TO PLAY A VERY SIGNIFICANT ROLE BECAUSE A LOT OF THE RESEARCH IS THINGS WE FUND PARTICULARLY IN NIAID WE HAVE BEEN INTENSIVELY -- AMY PATTERSON HAS BEEN VERY MUCH OUR LEAD HERE, TRYING TO DEVELOP THE APPROPRIATE POLICIES THAT WOULD NOT SLOW DOWN VALUABLE RESEARCH, BUT WOULD ALSO PUT IN PLACE PROCEDURES TO BE SURE THAT WE HAVE APPROPRIATE OVERSIGHT. AND THAT LED TO TWO YEARS AGO, ALMOST -- NO, ACTUALLY IT WAS TWO YEARS AGO, THE GOVERNMENT POLICY FOR FEDERAL OVERSIGHT BY WHICH AGENCIES LIKE US HAVE TO PERIODICALLY INVENTORY OUR INTRAMURAL AND EXTRAMURAL PROJECTS TO IDENTIFY AND MANAGE ANY RESEARCH ON ORGANISMS THAT MIGHT BE POTENTIALLY AT USE FOR DUAL USE. THIS PAST SEPTEMBER, AFTER MUCH DISCUSSION, THE GOVERNMENT ISSUED AN INSTITUTIONAL POLICY ABOUT DIRK, WHICH CALLS UPON UNIVERSITIES TO ALSO LOOK AT THEIR OWN SITUATION IN TERMS OF OVERSEEING THIS KIND OF RESEARCH. THIS IS PRESENTLY FOCUSED PARTICULARLY ON 15 SELECT AGENTS OF TOXINS, AND THERE ARE ONGOING DISCUSSIONS ABOUT WHETHER THAT LIST NEEDS TO BE REA ADVISED, WHICH I WON'T CARRY YOU THROUGH, BUT THERE CERTAINLY ARE ARGUMENTS PRO AND CON EX-PNG THIS A BIT. SO MEANWHILE, THERE HAVE BEEN ONGOING DISCUSSIONS ABOUT WHETHER CERTAIN TYPES OF RESEARCH, PARTICULARLY GAIN OF FUNCTION EXPERIMENTS, ON VIRUSES THAT CAN BE TRANSMITTED BY THE RESPIRATORY ROOT OUGHT TO BE PARTICULARLY CAREFULLY OVERSEEN. THIS ALL GOT A LOT OF ATTENTION A COUPLE YEARS AGO FROM A COUPLE EXPERIMENTS BEING DONE, ONE IN THE NETHERLANDS AND ONE IN WISCONSIN LOOKING AT INFLUENZA AND IF THERE WERE WAYS THE FERRET MODEL COULD BE USED TO DO MUTATIONAL ANALYSIS AND IDENTIFY WAYS THAT AN ALREADY SOMEWHAT DANGEROUS VIRUS COULD BECOME MORE WORRISOME BY EXPANDING ITS RESPIRATORY TRANSMISSION. YOU MAY KNOW THAT LED TO A PRETTY INTENSE DISCUSSION, A MORATORIUM FOR A WHILE ON THOSE KINDS OF EXPERIMENTS, A NEW POLICY PUT IN PLACE. THE NEW POLICY WAS BASED UPON A RISK BENEFIT CALCULATION. NATURALLY THAT'S WHAT ONE DOES, AND THE ASSUMPTION WAS THAT THERE WERE SIGNIFICANT BENEFITS BY KNOWING WHAT NATURE MIGHT BE UP TO BEFORE NATURE ACTUALLY SHOWED ITS HAND, BASICALLY DISCOVERING WHAT KINDS OF MUTATIONS MIGHT LEAD AN INFLUENZA VIRUS TO BECOME PANDEMIC AND BEING PREPARED, THEREFORE, IN OUR SURVEILLANCE MECHANISMS TO IDENTIFY IF THAT WAS STARTING TO HAPPEN AND ACT QUICKLY. THE RISKS WERE FELT TO BE, ON THE ONE HAND, THAT PUBLISHING THE DATA MIGHT MAKE IT POSSIBLE FOR A BAD GUY TO SYNTHESIZE AN EVEN MORE DANGEROUS VIRUS OR ALTERNATIVELY, THAT THERE MIGHT BE AN INADVERTENT LABORATORY ACCIDENT AND ESCAPE OF A NEWLY CREATED PATHOGEN THAT WAS WORSE THAN WHAT NATURE HAD ALREADY MANAGED TO CREATE ITSELF. NONETHELESS, I THINK THE ORIGINAL GUIDELINES ATTEMPTED TO BALANCE THAT. WITH DISCOVERIES THIS THIS PAST SUMMER, I THINK THE CONCERN ABOUT LAB ACCIDENTS WENT UP. YOU MAY KNOW THAT WE HERE AT THE NIH CAMPUS, AS PART OF CLEARING OUT A BUILDING OCCUPIED BY THE FDA, DISCOVERED VIAL OF, GUESS WHAT, SMALLPOX VIRUS THAT HAD BEEN THERE FOR SEVERAL DECADES, TO THE IN THE FASHION THATWAS REQUIRED FOR STORAGE AND HIDDEN AWAY IN A COLD ROOM. ABOUT THE SAME TIME, CDC REVEALED THAT THAT HE HAD HAD AN UNFORTUNATE CIRCUMSTANCE OF SENDING OUT A FAIRLY PATHOGENIC INFLUENZA VIRUS, WHICH WAS ADVERTISED AS BEING A DIFFERENT STRAIN SO THEY HAD ALSO HAD ONE AND MAYBE A COUPLE LABORATORY EPISODES THAT REDUCED CONFIDENCE IN WHETHER, IN FACT, ONE COULD CATEGORICALLY -- THAT LAB ACCIDENTS WERE NOT A RISK. THIS THEN RAISED THE WHOLE QUESTION AGAIN ABOUT GAIN OF FUNCTION RESEARCH. I CAN'T TELL YOU HOW MANY HOURS WERE SPENT BY DR. TABAK, DR. ROCKEY, MYSELF, AND PARTICULARLY DR. PATTERSON IN TRYING TO FIGURE OUT WHERE TO TAKE THIS. THE NATIONAL SCIENCE ADVISORY BOARD FOR SECURITY WAS CONVENED TO LOOK AGAIN AT THIS SET OF RISKS, BUT ONLY AFTER THE GOVERNMENT HAD ACTUALLY ISSUED A NEW SET OF RECOMMENDATIONS. THOSE DISCUSSIONS ARE ACTUALLY GOING ON AS SOON AS NEXT WEEK. MONDAY AND TUESDAY, THE IOM IS HOLDING ANOTHER MEETING TO TALK ABOUT GAIN OF FUNCTION RESEARCH TO LOOK AT WHAT THE GOVERNMENT RECOMMENDRECOMMENDATIONS HAVE BEEN. I GUESS WE'RE CALLING IT A PAUSE THIS TIME, NOT A MORATORIUM. I'M NOT QUITE SURE WHAT THE DIFFERENCE IS. AND WE WILL SEE OVER THE COURSE OF THE NEXT FEW MONTHS HOW THAT PLAYS OUT. THERE IS, I THINK AT THIS POINT, AN EFFORT TO TRY TO GET MUCH MORE QUANTITATIVE ASSESSMENTS ABOUT REALLY WHAT ARE BENEFITS AND RISKS THAN WHAT WE'VE HAD IN THE PAST, RECOGNIZING THAT THAT'S NOT AN EASY THING TO DO. SO I COULD GO ON AT MUCH GREATER LENGTH ABOUT THIS AS COULD LARRY, BUT I THINK UNLESS YOU WANT TO ASK FURTHER QUESTIONS WITH ABOUT DURC AND GAIN OF FUNCTION -- IAN? >> I'D LIKE TO SAY A FEW THINGS BECAUSE I'VE BEEN INVOLVED IN THIS FOR A LONG TYPE. >> YES. >> THE MAJOR CHALLENGE THAT MANY OF US SEE IS THAT THERE'S BEEN A GROWTH IN THE NUMBER OF LABORATORIES THAT DO THIS KIND OF WORK. >> YES? >> THIS REALLY FOLLOWED 9/11, WHEN WE EXPANDED OUR BSO4s AND OUR BSO3s. IT DIDN'T HELP THAT WE FOUND THESE THINGS IN OUR OWN THEORETICALLY WELL REGULATED LABORATORIES, BUT I DO IT THAT WITH THE REVELATION LAST WEEK THAT SIMILAR PROBLEMS IN THE U.K., THE MAJOR ISSUE IS NOT SO MUCH THE DISCLOSURE OF THE GENOMIC INFORMATION AS IT IS INADVERTENT RELEASE. MUCH OF FOLLOWED THAT IN ONE DISCUSSION THAT CAME OUT OF WISCONSIN AND THE NETHERLANDS WAS BECAUSE OF HIG HYPERBOLE BECAUSE OF THE MER MISSABILITY AND TRANSMISSIBILITY OF THESE AGENTS. FRANKLY THE WORK THAT WAS DONE IN THE FERRET DIDN'T IMPRESS MANY OF US. AND IT WAS EXAGGERATED BECAUSE IT LED TO HIGHER LEVEL PUBLICATION, BUT IT DIDN'T HELP THE FIELD. THERE'S A LOT OF OPPORTUNITY FOR MISLEADING INFORMATION AND FOR INADVERTENT RELEASE, AND IT'S GOING TO BE VERY IMPORTANT TO MONITOR THIS VERY CLOSELY, AND PERHAPS SAY THIS IS IMPORTANT GAIN OF FUNCTION WORK TO BE DONE, BUT MAYBE WE SHOULDN'T BE DOING IT IN 30 DIFFERENT SITES. WE SHOULD CONCENTRATE IT, SO WE CAN MONITOR IT. >> APPRECIATE THOSE COMMENTS. AND YOU'RE OBVIOUSLY VERY MUCH A KNOWLEDGEABLE EXPERT IN THIS SPACE. WELL, SOMEWHAT RELATED TO THAT FOG THE DISCOVERY ON JULY 1ST OF THOSE SEALED VIALS CONTAINING SMALLPOX IN THE FDA COLD ROOM ON OUR CAMPUS, WE WANTED TO BE SURE THERE WERE NO OTHER SURPRISES LURKING IN OUR FACILITIES. SO NIH INITIATED WHAT WE CALLED A CLEAN SWEEP PROGRAM. AND RAN FROM JULY THROUGH THE END OF SEPTEMBER, GOING THROUGH COUNTLESS FREEZERS AND COLD ROOMS, MILLIONS AND MILLIONS OF VIALS TO SEE WHAT WAS THERE. WE DID FIND A FEW OTHER SURPRISES THAT WERE ALL STORED IN WAYS THAT THEY SHOULDN'T HAVE BEEN BUT FORTUNATELY WE'RE NOT PLACING ANYBODY AT RISK, NOW HAVE BEEN ENTERED IN A CENTRAL DATABASE AND DESTROYED, FOR INSTANCE, WE FOUND SAMPLES IT THAT HAD BEEN AROUND A LONG TIME OF TULAREMIA, PLAGUE, BOTULINUM, AND EVEN A BOTTLE OF RICIN. WHICH WE ESTIMATED WAS BETWEEN # BETWEEN 85 AND 100 YEARS OLD, HAD BEEN SEALED AND NOT OPENED FOR MOST OF THAT TIME, SITTING ON THE SHELF IN A LABORATORY OF SOMEBODY WHO DIDN'T KNOW THEY HAD IT. SO THERE YOU GO. AGAIN HAPPILY NO RISKS TO ANY INDIVIDUALS. WE DISCLOSED ALL OF THIS SO I'M NOT TELLING YOU ANYTHING THAT HAS NOT BEEN REVEALED PUBLICLY A FEW MONTHS AGO. I THINK WE CAN NOW SAY WE HAVE REALLY DONE THE CLEAN SWEEP, AND IF THERE WAS STUFF THERE, WE HAVE FOUND IT, AND WE HAVE ALSO PUT IN PLACE MORE RIGOROUS PROCEDURES FOR MONITORING SELECT AGENTS AND WHO HAS THEM AND HOW THEY'RE STORED THAN WE HAD BEFORE. AGAIN, IT'S A GOOD THING TO DO. AND I GUARANTEE YOU, AT EVERY UNIVERSITY ON THIS PLANET, THERE ARE PROBABLY THINGS IN COLD ROOMS AND FREEZERS THAT PEOPLE AREN'T QUITE SURE ABOUT AND WE ARE NOW ASKING FOR THAT TO BE LOOKED AT AS WELL, NOT JUST IN OUR OWN CAMPUS, BUT AROUND. >> FRANCIS, THIS IS SO INTRIGUING, IF I COULD JUST ASK ONE FOLLOW-UP BRIEFLY. ARE THESE AGENTS LABELED AS SUCH, LIKE DO YOU SEE THE WORD RICIN, OR DOES IT HAVE TO BE IN A NOTEBOOK SOMEWHERE? I'M JUST INTRIGUED BY THESE DISCOVERIES. >> THEY'RE VERY NICELY LABELED, YES. IT'S A GOOD THING THAT THE PERSON CLEANING OUT THE FDA COLD ROOM KNEW WHAT VARIOLA MEANT. BECAUSE IT DIDN'T SAY "SMALLPOX." AND HOW MANY PEOPLE WOULD ARE CLEANING OUT A COLD ROOM WOULD HAVE DONE, WAIT A MINUTE, PONZIING THAT PARTICULAR LATIN WORD. >> YOU KNOW, EVERY 10 YEARS, WE REVISIT WHETHER OR NOT ALL STOCKS OF SMALLPOX SHOULD BE DESTROYED. AND WE ARGUE FOR DAYS ABOUT EXTINCTION OF A LIFE FORM. AND IT ISN'T EVEN A LIFE FORM, A VIRUS, SO THE IRONY. AND THERE'S PROBABLY MUCH MORE OF IT. >> WE FIGURED OUT AT THE TIME THIS WAS PUT IN THE VIAL, THERE WERE NO REGULATIONS TO PREVENT THAT. EVERYBODY WAS VACCINATED, NOBODY WORRIED ABOUT WORKING WITH SMALLPOX AS LONG AS YOU WERE IN THAT LAB. TIMES HAVE CHANGED. >> IT JUST SEEMS IN THIS ERA, EVERYTHING WOULD BE BAR CODED AND WE'D BE ABLE TO DO IT. IS THAT WHERE WE ARE NOW? >> I THINK EVERYTHING THAT PEOPLE ARE DOING TODAY THAT THEY'RE STICKING IN THE FREEZE ARE, UNLESS YOU'RE DOING VERY SMALL SCALE STUFF, BAR CODES ARE CERTAINLY THE ROUTINE. THEY ARE IN MY LAB. BUT A LOT OF THIS IS STUFF THAT'S LEGACY FROM LONG TIME BACK. CERTAINLY ALL OF THE SURPRISES WE MADE WERE MATERIALS THAT HAD BEEN AROUND FOR AT LEAST 10 OR 20 YEARS, SOME MORE. >> ANY POSITIVE SURPRISES? >> LIKE A VIAL HA SAYS "THIS IS THE CURE FOR CANCER"? >> SOME VERY RICH MATERIAL OF SOME SORT. >> I DIDN'T HEAR ABOUT THAT. THEY MIGHT HAVE KEPT THAT TO THEMSELVES. I DON'T KNOW. OKAY. I'M STILL MOVING ALONG HERE. HOW ARE WE DOING? I GUESS OKAY. AGAIN, SO PLEASE JUMP IN. I WANT TO TELL BUT SOME OUTREACH STORIES THAT WE'VE BEEN INVOLVED IN. I THINK CONSTANTLY, WE ARE REMINDED ABOUT HOW IMPORTANT IT IS FOR THE WORLD TO FIND OUT HOW MEDICAL RESEARCH IS SO SIGNIFICANT RIGHT NOW. AND HOW PEOPLE CAN GET MORE OF A SENSE OF WHAT RESEARCHERS ARE LIKE. ONE DOCUMENTARY THAT YOU MIGHT HAVE SEEN OR HEARD ABOUT THAT JUST AIRED ON NOVEMBER 30TH WAS A PARTNERSHIP WITH "NATIONAL GEOGRAPHIC." ABOUT RESEARCH IN SLEEP DISORDERS AND ALL OF THE CONSEQUENCES OF SLEEP DEPRIVATION. SO THIS IS CALLED SLEEPLESS IN AMERICA. WHICH I PROPOSED WAS ACTUALLY A BIOPIC ABOUT TONY FAUCI BECAUSE OF ALL OF THE THINGS HE'S BEEN INVOLVED IN IN THE LAST FEW MONTHS. BUT TILELY IT WA ACTUALLY IT WAS A PRE PRE TTY SERIOUS -- ABOUT SLEEP DEPRIVATION. THE SAME PRODUCER WHO PUT ON WHAT I THINK WAS A VERY EFFECT ITTIVE SERIES ON ALZHEIMER'S DISEASE, AND ON OBESITY, JOHN HOFFMAN, AND ON DRUG ABUSE. RIGHT, NORA? JOHN HOFFMAN DID THIS ONE FOR SLEEPLESS IN AMERICA. AND I THINK IT GOT GOOD REVIEWS AND GOT PEOPLE INTERESTED IN WHAT RESEARCH CAN TELL YOU. IT'S BEEN PRETTY INTERESTING IN THE LAST YEAR, I MUST SAY, WITH MAYBE SOME OF THE NEW DATA SUGGESTING WHY DO WE HAVE TO SLEEP. I'M FASCINATED BY HAD QUESTION MYSELF. WHY WOULD EV COLLUSION NOT HAVE COME UP WITH A WAY TO ALLOW PEOPLE OR AT LEAST SOME KIND OF MAMMALS OR AT LEAST INDIVIDUALS WITH A COMPLEX NERVOUS SYSTEM TO JUST KEEP GOING 24 HOURS A DAY. THERE'S NO REASON I CAN THINK OF WHY THAT WOULDN'T BE AN ADVANTAGE IF YOU HAD THE ABILITY TO DO SO, BUT AS SOON AS YOU GET A COMPLEX NERVOUS SYSTEM, THEN SLEEP SEEMS TO ARRIVE AS A REQUIREMENT. SO THIS DISCOVERY THAT WAS IN SCIENCE, AND I DON'T KNOW, MAYBE CORI YOU CAN UPDATE ME, WHETHER -- OR PETER, WHETHER THERE IS CO CONFIRMATION OF THIS THAT SLEEP IS ACTUALLY A REAL CLEAN-UP OPPORTUNITY FOR ALL OF THE THINGS THAT HAVE DEPOSITED IN THOSE BETWEEN THE NEURONS AND THE GLIA TO KIND OF GET CLEANED OUT. THAT WAS PRETTY EXCITING AS A NEW INSIGHT. IS THAT HOLDING UP? ARE PEOPLE BELIEVING IT? >> TALKING ABOUT -- THE LIMB NATICK SYSTEM? >> RIGHT. >> IT'S A REALLY INTERESTING PAPER. I HAVEN'T SEEN OTHER PEOPLE LOOK AT IT. IT'S SORT AFTER FASCINATING IDEA THAT THE INTERSTITIAL FLUID, BASICALLY THE NEURONS EFFECTIVELY SLEEP AND ALLOW CLEARANCE DURING SLEEP AND ABETA PEP TIED AMONG OTHER THINGS, SO IT'S A REALLY INTERESTING OBSERVATION, AND I THINK IT'S WORTH -- BUT THERE'S LOTS OF OTHER EVIDENCE FOR THE IMPORTANCE OF SLEEP FOR OTHER REASONS. FOR PSYCHIATRIC DISORDERS, PROBABLY ONE OF THE -- LIKE A VERY STRICT SLEEP SCHEDULE IS ONE OF THE BEST THINGS YOU CAN DO IN ADDITION TO ANTIDEPRESSANTS TO INCREASE THEIR RATE OF EFFECTIVENESS. THERE'S LOFTS GOOTHERE'S LOTS OF GOOD REAS ONS TO GET ENOUGH OF IT. >> -- THE BRAIN HAS A -- PATHWAY -- ACTUALLY WHAT'S -- MANY YEARS AGO. >> I'M JUST GETTING HANDED A NOTE SO JUST TO LET YOU KNOW BECAUSE NOW THE WORLD IS ABOUT TO HEAR THAT WE'RE RECEIVING AN EBOLA PATIENT SOMETIME LATER TODAY AT THE NIH CLINICAL CENTER. THIS IS AN EXPOSED INDIVIDUAL WHO'S NOT CURRENTLY SYMPTOMATIC BUT WHO SUFFERED A NEEDLE STICK IN SIERRA LEONE AND WILL BE ARRIVING HERE SOMETIME THIS AFTERNOON. AN AMERICAN CITIZEN. SO WE ARE VERY WELL SITUATED TO TAKE CARE OF THIS, TONY WILL TELL YOU MORE ABOUT THAT, BUT JUST TO LET YOU KNOW IN CASE YOUR CELL PHONE WAS GOING OFF WITH A MESSAGE AND YOU'RE WONDERING WHY YOU DIDN'T HEAR ABOUT IT, NOW YOU HEARD. OTHER OUTREACH THINGS, WE'VE BEEN WORKING WITH JAY WALKER, WHO'S THE FOUNDER OF TED MED, AND ALSO THE FOUNDER OF PRICELINE, ON SOMETHING CALLED LAB TV. I THINK I PIET HAVE MENTIONED THIS TO ACD PREVIOUSLY BUT IT IS REALLY NOW DPINNING TO MATURE, AND JAY WAS HERE A COUPLE DAYS AGO AND I SAW SOME OF THE EXAMPLES HE PUT TOGETHER. HIS IDEA IS THAT IF YOU REALLY WANT TO HIGH PRESSURE PEOPLE UNDERSTAND WHY MEDICAL RESEARCH IS SO EXCITING, HAVE TO GIVE THEM AN OPPORTUNITY TO HEAR FROM PARTICULARLY EARLY STAGE INVESTIGATORS, GRADUATE STUDENTS, POSTDOCS WHO ARE REALLY EXCITE PD ABOUT WHAT THEY'RE DOING AND FILM THEM IN THEIR OWN LABORATORY ENVIRONMENT. MAKING THEM HUMAN BUT ALSO GIVING THEM A CHANCE TO TELL THEIR STORIES. HIS IDEA IS ALSO HE WOULD TRY TO CONNECT THE YOUNG SCIENTIST WITH A FILM STUDENT WHO WOULD MAKE THE WHOLE THING MORE INTERESTING AND ARTISTIC, AND AS OF NOW, THERE ARE SEVERAL HUNDRED OF THESE VIDEOS THAT HAVE BEEN PRODUCED, INCLUDING 130 FROM HERE IN THE INTRAMURAL PROGRAM BECAUSE THEY WERE ABLE TO COME HERE AND GET A LOT DONE IN A SHORT PERIOD OF TIME. THEY'VE ALSO INVOLVED CORNEL, GEORGETOWN, NYU, UCSF AND QUITE A NUMBER OF OTHERS AND HOPE TO LAUNCH THIS BY THE FIRST OF THE YEAR. AND AGAIN, THIS IS ALL GOING TO BE TOTALLY AVAILABLE AND FREE UP ON YOUTUBE. THE ONES I'VE SEEN, THEY'RE ALL LIKE 4 MINUTES LONG, AND YOU REALLY GET A SENSE OF WHAT THE INVESTIGATOR IS WORKING ON, BUT WHO THEY ARE AS AN ATTRACTIVE HUMAN BEING WITH OTHER FEATURES THAN JUST BEING A GEEK SCIENTIST. THINK THIS IS GOING TO BE SOMETHING WE CAN POINT PEOPLE TO THAT WILL GET SOME EXCITEMENT GOING ABOUT WHY THIS IS SUCH AN AMAZING TIME TO BE DOING SCIENCE. SO THAT'S CALLED LAB TV. ONCE IT LAUNCHES, YOU'LL BE HEARING MORE ABOUT IT. THEN JUST IN THE LAST FEW DAYS, THOSE OF YOU WHO LISTEN TO NPR PROBABLY HAVE HEARD FROM TIME TO TIME, I THINK USUALLY ON FRIDAYS, THESE BRIEF INTERVIEWS BETWEEN TWO INDIVIDUALS WHO KNOW EACH OTHER, CALLED STORY CORE. SO IT'S OFTENTIMES A PRETTY POWERFUL NARRATIVE ABOUT SOMETHING THAT'S HAPPENED IN THE INDIVIDUAL'S LIFE, OFTENTIMES BEING INTERVIEWED BY ANOTHER FAMILY MEMBER OR FRIEND. OUR NEW OUTREACH OFFICE HAS PARTNERED WITH STORY CORE TO BE HERE ON THE NIH CAMPUS, AND TO BE ACTUALLY ENGAGED IN GETTING SOME OF THOSE KINDS OF STORIES RECORDED INTO THIS FORMAT. SO THEY'RE INFORMAL CONVERSATIONS, SOME OF THEM ARE PATIENTS BEING INTERVIEWED BY A FAMILY MEMOS, SOME ARE RESEARCHERS, NURSES. I THINK IT'S GOING TO BE A NICE CONTRIBUTION TO THE AUDIO FILE, AND ALL OF THESE END UP AT THE LIBRARY OF CONGRESS. WE HAVE THE OPPORTUNITY TO UTILIZE THE SHORT VERSION. THE INTERVIEWS GO ON FOR HA MINUTES BUT WHAT STORY CORE TRIES TO DO IS FIND A PARTICULARLY COMPELLING TWO OR THREE MINUTE COMPONENT OF THAT, WHICH TELLS THE STORY THAT OFTENTIMES CAUSES YOU TO STOP IN YOUR DRIVEWAY AND HEAR THE END OF IT, BECAUSE THESE ARE QUITE WELL DONE. SO WE'RE EXCITED ABOUT HAVING THAT PARTNERSHIP. THEY'RE ALSO GOING TO BE GOING AT OTHER NIH SITES AROUND THE COUNTRY, I DON'T ACTUALLY KNOW WHICH ONES, THEY'LL BE BACK HERE IN THE SPRING FOR SOME MORE RECORDINGS, AND WE'LL TRY TO DISTRIBUTE THOSE AS MUCH AS POSSIBLE. ANOTHER WAY OF TELL AGO STORY ABOUT WHY THIS IS SUCH AN EXCITING TIME AND WHAT WE DO HERE. OKAY. MOVING INTO THE CONGRESSIONAL ZONE, NEIL, THAT'S YOUR CURE TO BE GETTING READY HERE. A POSITIVE THING, A BIT FROM THE PAST BUT ALSO THE PRESENT, WE RECENTLY OBTAINED SECRETARIAL APPROVAL TO NAME BUILDING 4 THE LOWELL WIE KER BUILDING. YOU MIGHT WONDER, DIDN'T WE HAVE A WIEKER BUILDING? WAN DID, BUT OF COURSE WE'RE CONSTANTLY TRYING TO UPGRADE OUR PHYSICAL FACILITY, AND THE ORIGINAL WIEKER BUILDING WAS ACTUALLY KNOCKED DOWN TO MAKE ROOM FOR THE PORTER NEUROSCIENCE BUILDING. SO WE NEED A NEWWIEKER BUILDING. SO WE ARE GOING OH IT PLAN A DEDICATION SPARE KNOW KNEE EARLY HAD IN 2015, AND SENATOR WIE KER SEEMS PLEASED WITH THIS, I SPOKE WITH HIM ON THE PHONE. CONGRESSIONAL INTERACTIONS. AS YOU HEARD IN THE PAST FROM PAT, I SPEND A LOT OF MY TIME ON THE HILL. I WON'T GO THRAW ALL OF THE FAIR VUS INTERACTIONS WE'VE HAD SINCE WE LAST MET. I WAS IN SEATTLE WITH SENATOR MURRAY, PATTY MURRAY, AT THE UNIVERSITY OF WASHINGTON ON AUGUST 12TH. I WENT TO ST. LOUIS WITH SENATOR ROY BLUNT AND SPENT TIME AT WASH-U, WHICH WAS I THINK A REALLY GOOD VISIT FOR HIM TO SEE THE EXCITING STUFF THAT'S GOING ON THERE. AND I'VE BEEN SPEAKING, WHEN ASKED TO, AT BRIEFINGS AND MEETINGS WITH MEMBERS ON THE HILL INCLUDING PEOPLE LIKE RICHARD DURBIN, JACK REED, PATRICK TOOMEY, CHRIS VAN HOLLAND, MICHAEL MCCALL, AND ON AND ON, AND I GUESS I WOULD SUMMARIZE ALL OF THOSE VISITS BY SAYING THEY'VE ALL GONE REALLY WELL, THAT PEOPLE REALLY SEE THE VALUE OF WHAT MEDICAL RESEARCH CAN DO, THEY SEE THE EXCITEMENT ABOUT THE POTENTIAL RIGHT NOW, WITH ALL THE ADVANCES THAT HAVE BEEN HAPPENING. THEY GET IT, THAT MEDICAL RESEARCH IS NOT JUST A BENEFIT TO HEALTH BUT ALSO TO THE ECONOMY. THE PROBLEM ALWAYS IS THAT AFTER THOSE STATEMENTS ARE MADE, AND THE HOPE TO TURN AROUND THIS 10-YEAR SLIDE IN OUR PURCHASING POWER GETS RAISED, THAT OTHER THINGS SEEM TO GET IN THE WAY. THE THINGS THAT GET IN THE WAY ARE GENERALLY FAMILIAR TO YOU, MOST OF THEM HAVE TO DO WITH OUR UNRESOLVED DEBATE IN THIS COUNTRY ABOUT WHERE OUR PRIORITY SHOULD BE AS FAR AS OUR FISCAL INVESTMENTS AND BECAUSE WE AT NIH ARE LOCATED IN THE DISCRETIONARY BUDGET, AND THE DISCRETIONARY BUDGET IS WHERE THE SQUEEZE HAS BEEN APPLIED, WE ARE IN THE SQUEEZE. I'LL TELL YOU IN A MINUTE WHEN'S HAPPENED OR WHAT MIGHT HAPPEN BY MIDNIGHT TONIGHT OR MAYBE THE NEXT DAY WITH REGARD TO THE FUNDING FISCAL YEAR 15. IT WILL FALL SHORT OF WHAT CERTAINLY MANY OF US WOULD HAVE HOPED, ALTHOUGH IT IS CERTAINLY BETTER THAN IT MIGHT HAVE BEEN OTHERWISE, SO IT'S ALWAYS THIS SORT OF OKAY, IS THE GLASS HALF FULL OR HALF EMPTY. WITH REGARD TO CONGRESSIONAL INTERACTIONS, THERE'S BEEN LOTS OF CONGRESSIONAL INTEREST IN EBOLA. I WON'T GO THROUGH ALL OF THE HEARINGS THAT HAVE TAKEN PLACE. MOST OF THEM, TONY FAUCI HAS BEEN A WITNESS. LEGISLATION HAS BEEN INTRODUCED IN VARIOUS WAYS, THE PRESIDENT ASKING FOR THE CONGRESS TO APPROVE AN EBOLA IS UPMEN IS EBOLA SUPPLEM ENT OF $6.2 BILLION, FOLDED INTO THE CONSIDERATION IN THE HOUSE TODAY, AND IS LIKELY TO GET SUPPORTED, INCLUDING $238 MILLION FOR NIH. SO LET ME ASK NEIL SHAPIRO, OUR ABLE BUDGET OFFICER, IT IF HE WOULD TELL YOU WHERE WE ARE WHERE THE APPROPRIATIONS ACT OF 2015. AGAIN, IT'S AN INTERESTING MOMENT BECAUSE IT HASN'T QUITE PASSED. SOMETHING HAS TO PASS BY MIDNIGHT. EITHER A VERY SHORT TERM CONTINUING RESOLUTION, OR GE OF MOTIONS BILL ITSELF. ACTUALLY THE APPROPRIATE PROAP I DON'T KNOW, NEIL, IF YOU HAVE THE LATEST SINCE 8:00 ABOUT WHICH OF THOSE OPTIONS IS LIKELY TO HAPPEN, BUT PLEASE TELL US WHERE WE ARE AND PARTICULARLY WHAT THIS BILL CONTAINS AS FAR AS NIH IS CONCERNED, WHICH IS VERY NEW NEWS. WE ONLY REALLY GOT THIS INFORMATION ABOUT 24 HOURS AGO. >> FIRST LET HE ME GIVE A QUICK UPDATE OF WHAT'S HAPPENED SINCE THE LAST ACD MEETING, THEN WE'LL TURN TO THE DETAILS OF WHAT HAS HAPPENED IN THE LAST TWO DAIS AND WE CAN EXPECT OVER THE NEXT DAY OR SO. SO YOU MAY RECALL BACK IN JUNE, THE 2015 BUDGET HAS COME OUT. THERE HAD BEEN APPROPRIATIONS COMMITTEE HEARINGS. WE KNEW A GOOD BIT ABOUT THE HIGH LEVEL FUNDING SITUATION FOR 2015 BECAUSE LAST YEAR'S BUDGET DEAL HAD COVERED BOTH 14 AND '15, SO THERE WERE EXISTING DEFENSE AND NON-DEFENSE DISCRETIONARY CAPS THAT WOULD BE APPLIED, SO EFFECTIVELY LIKE HAVING A BUDGET RESOLUTION BUT A LOT OF THE DETAILS REMAIN TO BE WORKED OUT. SO AT THAT POINT, THE NEXT STEP WAS FOR THE PROAP PRAY TORES TO WORK ON THEIR INDIVIDUAL BILLS, INCLUDING THE LABOR HEALTH AND HUMAN SERVICES AND EDUCATION BILL, WHICH INCLUDES NIH, AND THEY STARTED TO WORK, THE SENATE HAD SUBCOMMITTEE MARK UP SHORTLY AFTER THE ACD MEETING IN JUNE, BUT THAT BILL DID NOT GET THROUGH THE FULL SENATE APPROPRIATIONS COMMITTEE AND THE HOUSE DIDN'T HAVE A SUBCOMMITTEE BILL SO BASICALLY NOTHING THAT CAME OUT OF THE HOUSE FOR 2015 UNTIL AS YOU'RE SEEING JUST NOW. SO THEY DID PASS A CONTINUING RESOLUTION IN SEPTEMBER, SO TO AVOID A SHUTDOWN, AND THE CONTINUING RESOLUTION THAT RUNS THROUGH TODAY, SO THAT'S WHAT HAS BROUGHT US TO THE POINT WHERE WE ARE. WHAT YOU'VE HEARD A LITTLE BIT ABOUT IN THE PRESS AND WHAT THE HOUSE IS SCHEDULED TO DEBATE TODAY IS A BILL THAT CONTAINS FUNDING FOR THE WHOLE GOVERNMENT, SO RATHER THAN INDIVIDUAL BILL, ONE FOR EACH SUBCOMMITTEE, THEY'VE PUT TOGETHER WHAT'S NORMALLY CALLED AN OMNIBUS. IN THIS CASE, IT'S BEEN REFERRED TO AS THE CROMNIBUS BECAUSE IT INCLUDES NOT EVERY SINGLE SUBCOMMITTEE'S BILL, BUT THE HOMELAND SECURITY BILL IS INSTEAD A CONTINUING RESOLUTION THAT WILL LAST THROUGH FEBRUARY, AND THAT IS THE RESULT OF PEUTS BETWEEN CONGRESS AND THE ADMINISTRATION OVER IMMIGRATION POLICY, WHICH YOU'VE PROBABLY HEARD IN THE NEWS. SO WHAT WE HAVE IN THE OMNIBUS, HOT OFF THE PRESS, WE JUST SAW IT FOR THE FIRST TIME TUESDAY NIGHT, STILL BEING REVIEWED AND STUDIED, SO WILL THIS IS SOME ELEMENT OF UNCERTAINTY OF EVERYTHING THAT IS IN THERE THAT WILL EMERGE IN THE COMING DAYS. WHAT WE'VE SEEN IN OUR PORTION OF THE BILL INCLUDES SOME ELEMENTS THAT WERE IN THE SENATE SUBCOMMITTEE MARK, BUT THERE ARE OTHER ELEMENTS THAT WERE NOT HAD IN THERE AND ARE BRAND NEW THAT WE HAVEN'T SEEN BEFORE, SO THAT'S PART OF THE INTERESTS AND EXCITEMENT AS WE GO FORWARD TO FIND OUT EVERYTHING THAT'S IN THIS BILL. SO THIS IS A QUICK SUMMARY OF NUMBERS AND WHAT THE BILL DOES OR DOESN'T DO. IN TERMS OF THE BIGGEST PORTION OF OUR FUNDING THAT COMES AS DISCRETIONARY FUNDING THROUGH THE LABOR LHHS WE CALL IT SUBCOMMITTEE, THERE'S AN INCREASE OF ABOUT $150 MILLION OVER WHAT THEY ENACTED IN 2014, ABOUT HALF A PERCENT. SO TO PUT THAT IN CONTEXT, THE OVERALL FUNDING FOR THAT SUBCOMMITTEE IS ACTUALLY A BIT LOWER THAN IT WAS IN 2014, SO WHILE THE INCREASE IS MODEST, IN ORDER TO GIVE NIH MORE MONEY, THAT MEANS THAT OTHER ACCOUNTS IN THE BILL RECEIVED LESS MONEY THAN THEY DID DID IN 2014. SO A VERY TIGHT SITUATION AND WE'RE FORTUNATE TO HAVE GOTTEN THIS INCREASE. AS FRANCIS MENTIONED, THERE'S ALSO $238 MILLION FOR EBOLA FUNDING THAT IS THE FULL ADMINISTRATION REQUEST. I WON'T GET INTO THE DETAILS VERY MUCH SINCE YOU'LL HEAR FROM DR. FAUCI ABOUT IT BUT IT COVERS A TWO-YEAR PERIOD SO WE CAN SPEND THAT MONEY OVER TWO YEARS, '15 AND '16, AND BECAUSE IT'S DESIGNATED AS EMERGENCY, IT DOESN'T COUNT AGAINST THE DID DISCRETIONARY SPENDING CAPS THAT WERE PASSED FOR 2015. >> SO IT'S NOT INCLUDED IN THAT 30 MILLION -- 30 BILLION NUMBER THAT YOU SEE THERE. IT'S ON TOP OF THAT. >> RIGHT. IT'S IN ADDITION TO THE 30 BILLION. AND THEN IN TERMS OF SMALL A MANDATORY FUNDS THAT WE HAVE FOR TYPE 1 DIABETES, THIS FUNDING IS ACTUALLY A LITTLE BETTER THAN LAST YEAR BECAUSE THE BUDGET DEAL THAT SET THE DISCRETIONARY CAPS DID NOT APPLY TO MANDATORY SPENDING, SO SEQUESTRATION WAS STILL IN EFFECT FOR MANDATORY FUNDING IN 2014. AS A RESULT OF THAT, WE HAD 11 MILL YONDZ SEQUESTERE$11 MILLION SEQUESTER ED THAT WE WERE NOT ABLE TO SPEND FOR DIABETES. THE AUTHORIZATION FOR THAT FUNDING, BECAUSE IT'S CONSIDERED MANDATORY, IT'S NOT PART OF THE APPROPRIATIONS BILL, IT GETS DONE SEPARATELY IN AN AUTHORIZATION BILL. THE AUTHORIZATION WAS EXPIRING IN 2014. IT DID NOT GET RE-AUTHORIZED, ONLY FOR ONE YEAR, I'M AFRAID, FOR '15, BUT THAT RE-AUTHORIZATION DEPARTMENT OCCUR UNTIL AFTER THE SEQUESTRATION AMOUNT HAD HAD BEEN DETERMINED, SO AS A RESULT, WE GOT AN EXEMPTION BASICALLY FROM THE SEQUESTER OF IT DIABETES FUNDS IN 2015, SO WE'LL HAVE THE FULL $150 MILLION TO SPEND THIS YEAR. AND THAT INCREASE IS AGAIN ON TOP OF THE 150 MILLION INCREASE. FINALLY THE LAST PORTION OF OUR FUNDING WHICH IS IN A DIFFERENT SUBCOMMITTEE FOR NIH AS THE SUPERFUND AMOUNT IS FLAT FROM 14 TO 77. SO IN TERMS OF THE 150, HOW IT'S ALLOCATED THROUGHOUT NIH, THE MOST PART THE INCREASES ARE THE SAME, PROPORTIONATE LEVEL, COMPARED TO WHAT WAS NATTED LAST YEAR FOR MOST OF OUR INSTITUTES AND CENTERS. THERE WERE A COUPLE EXCEPTIONS, FORKFOR EXAMPLE, ADDITIONAL AMOUNTS WERE PROVIDED FOR NCI, FOR NIA, FOR AGING RESEARCH WITH THE EXPECTATION THAT A SIGNIFICANT PORTION OF THAT COULD BE AVAILABLE FOR ALZHEIMER'S DISEASE RESEARCH. IF JUSTIFIED THROUGH OUR NORMAL PROCESS. AS WELL AS THE BILL REFLECTED THE SUBCOMMITTEE SUPPORT FOR THE BRAIN INITIATIVE AND THE TWO LEADING INSTITUTES FOR THAT INITIATIVE EACH RECEIVED A TOTAL OF 17 MILLION WOL ABOVE THE 2014 LEVEL. TO GIVE YOU AN IDEA OF WHAT THAT REPRESENTS IN PROPORTION FOR THE NIA FUNDS, THE 20 MILLION, HAD THEY NOT RECEIVED THIS ADDITIONAL FUNDING, THAT WOULD HAVE BEEN 3 MILLION BECAUSERE WAS AN EXTRA 25 ADD FOR HIV RESEARCH IN THAT CASE, SO IT GIVES YOU AN IDEA OF WHAT THE PROPORTION WAS IN TERMS OF SOME OF THESE ADDITIONAL FUNDS. AND THEN FINALLY, THE LAST ONE ON THIS LIST IS A BIT OF A COMPLICATED ISSUE, BUT CONGRESS CHANGED A PROCESS THAT'S CALLED THE PHS EVALUATION SETASIDE. THIS HAS BEEN IN PLACE FOR A NUMBER OF YEARS, AND IT IS A PROCESS WHERE FUNDS ARE AVAILABLE FOR TRANSFER WITHIN THE PHS ACT AGENCIES. IT ORIGINALLY WAS DEVELOPED FOR PROGRAM EVALUATION, HENCE THE TITLE, BUT IN RECENT YEARS, MOST OF THE MONEY HAS BEEN DESIGNATED FOR SPECIFIC AGENCIES WITHIN THE BILL AND IS NOT LIMITED TO SPENDING ON EVALUATION. THERE IS A SMALL PORTION THAT DOES GET SPENT ON EVALUATION INCLUDING WITHIN NIH, BUT MOST OF THOSE FUNDS ARE AVAILABLE FOR OTHER PURPOSES WHEREVER CONGRESS DESIGNATES THEM AND THERE HAS BEEN SOME CONTROVERSY IN THE PAST THAT A LOT OF THE FUNDS THAT WERE TRANSFERRED FROM NIH USING HAD THIS PROVISION WERE GOING TO OTHER PARTS OF HHS, AND SO THE APPROPRIATE TORES CHANGED THAT THIS YEAR, SO THAT BASICALLY IN CONCEPT, THE FUNDS BEING TRANSFERRED FROM OUR INSTITUTES AND CENTERS WOULD GO TO ONE OF OUR OTHER -- NIGMS, THE RECIPIENT OF THOSE FUNDS, AND IT WAS DESIGNED, THE INTENTION OF CONGRESS WOULD THAT IT WOULD BE -- SO THAT THE AMOUNT RECEIVED BY NIGMS WOULD EFFECTIVELY BE SOMEWHAT MORE T THE AMOUNT TRANSFERRED FROM OUR INSTITUTES UNDER THIS PROVISION. >> IF YOU UNDERSTOOD THAT, YOU, TOO, CAN BE A GOVERNMENT BUDGET OFFICER. [LAUGHTER] >> SO -- BUT IN TERMS OF THE TOP LINE THAT YOU SAW BEFORE, THESE FUNDS ARE INCLUDED SO THERE'S -- INSTEAD OF GETTING DIRECT FUNDS AS IT DID IN THE PAST, THE NIGMS FUNDS COME INDIRECTLY THROUGH THIS PROCESS, SO SOME OF THE OF THE AGENCIES THAT USED TO GET THE FUNDS INDIRECTLY WILL NOW GET THEM DIRECTLY. OVERALL, IT WAS INTENDED TO BE HELPFUL TO US. AND WE WILL WORK TO MAKE IT SO. THERE'S ANOTHER PROVISION, AND THIS IS BASED ON A BILL THAT HAD PASSED EARLIER THIS THIS YEAR CALLED THE GABRIELLA MILLER KIDS FIRST RESEARCH ABT, AND THAT ACT, AND THAT PROVIDED A 10-YEAR FUND THAT HAD PREVIOUSLY BEEN SET ASIDE FOR TAXPAYER FINANCING OF POLITICAL PARTY CONVENTIONS. AND THAT WAS INTENDED TO BE AVAILABLE FOR USE BY THE NIH CMON FUND FOR PEDIATRIC RESEARCH. THERE WAS A LITTLE CONFUSION EARLIER IN THE YEAR BECAUSE WHILE THE BILL CREATED THIS FUND AND PUT THE FUND IN NIH, IT DID NOT ACTUALLY PROVIDE FUNDING FOR US TO SPEND ON PEDIATRIC RESEARCH, SO IT'S NOT LIKE THE TYPE 1 DIABETES FUNDS WHERE THE BILL BOTH CREATES AND GIVES US THE ABILITY TO SPEND. THESE FUNDS HAD TO BE APPROPRIATED AND THEY DO COUNT AGAINST THE TOTAL SO IT'S PART OF THAT $150 MILLION, NOT ON TOP OF IT, BUT CONGRESS DID PROVIDE THAT WE COULD SPEND MONEY FROM THIS FUND AND IT'S EXPECTED TO BE UP TO $12.6 MILLION EACH YEAR FOR 10 YEARS, AND THAT WILL NOW BE PART ONCE THE OMNIBUS -- ASSUMING THE OMNIBUS PASSES, THAT WILL BE PART OF OUR SPENDING FOR THE COMING YEAR. SO IN TERMS OF WHAT'S LEFT TO DTHE HOUSE IS DEBATING THE BILL AND IS EXPECTED TO PASS THE BILL TODAY. THERE IS CONCERN THAT THE SENATE MAY NOT BE ABLE TO PASS IT TODAY, IN WHICH CASE THE HOUSE WILL ALSO PASS A VERY SHORT CONTINUING RESOLUTION, I BELIEVE IT'S TWO DAYS, SO THAT WOULD GIVE THE SENATE TIME TO DEBATE AND VOTE AS WELL. BUT OUR HOPE IS THAT WITHIN THE NEXT DAY OR TWO, WE WILL HAVE OUR APPROPRIATIONS FOR WEN 15 AND CAN MOVE ON WITH ALL THE GOOD WORK THAT DR. COLLINS HAS BEEN DESCRIBING. >> THANKS, KNEEL. ANY QUESTIONS? >> SO WHAT DO YOU THINK ARE THE POLITICAL CONSEQUENCES OF IF THEY CAN'T REACH THIS DEAL AND A NEW CONGRESS COMES INTO PLAY? WHAT ARE THE THOUGHTS THERE ABOUT WHAT MIGHT HAPPEN? >> I THINK THE BIGGEST CONCERN HAS BEEN AVOIDING A GOVERNMENT SHUTDOWN. I THINK BOTH PARTIES AND BOTH HOUSES SEEMED DETERMINED TO AVOID THAT. I THINK IT'S JUST A MATTER OF HOW LONG IT WOULD TAKE TO REACH AN AGREEMENT, AND IN THE CASE OF HOMELAND SECURITY, IT MAY TAKE SOME -- BUT ESSENTIALLY THE OMNIBUS THAT IS ON THE FLOOR -- THAT'S COMING TO THE HOUSE TODAY IS A AGREEMEN A, BIPARTISAN AGREEMENT WITH THE HOUSE AND THE SENATE, SO I THINK THE EXPECTATION IS UNLESS THERE IS SOMETHING IN THERE THAT REDUCES THE SUPPORT THAT THEY NEED TO PASS THE BILLS, THAT IT WILL GET ENACTED AS AND THE PRESIDENT WOULD HAVE TO SIGN IT, OF COURSE. >> AS YOU KNOW THE OBJECTIONS FROM THE DEMOCRATS RELATE TO THINGS IN THE BILL THAT RELIEVE SOME OF THE REQUIREMENTS OF DODD-FRANK ON TH BANKING INDUSTRY, WHICH PEOPLE LIKE ELIZABETH WARREN ARE WORRIED ABOUT WHAT THAT MEANS, AND ALSO AIN CREASE IN THE LIMIT THAT'S ALLOWED FOR INDIVIDUAL DONATIONS TO POLITICAL PARTIES FROM A MILLION UP TO 3 MILLION, WHICH ALSO HAS CAUSED SOME CONCERN IN SOME QUARTERS. AND ON THE REPUBLICAN SIDE, I THINK IT CONTINUES TO BE CONCERN THE ABOUT WHETHER ANY DOLLARS ARE GOING TO BE SPENT IN SUPPORT OF THE PRESIDENT'S EXECUTIVE ORDER FROM IMMIGRATION, BECAUSE SOME OF THE REPUBLICANS ARE STRONGLY OPPOSED TO THAT. SINCE I HAVE, AND THIS IS ENCOURAGED A BIT BY A PHONE CALL YESTERDAY FROM SENATOR MIKULSKI WHO CALLED TO REPORT ON THINGS WERE, WAS THAT THESE ARE PROBABLY NOT INSURMOUNTABLE BUT PEOPLE NEED A CHANCE TO MAKE SOME SPEECHES AND EXPRESS SOME CONCERNS AND THEN WE WILL SEE THIS OMNIBUS PASSED. ALTHOUGH IT SOUNDS FAIRLY UNLIKELY THAT THEY COULD GET ALL OF THIS DONE IN TERMS OF GOING FROM A HOUSE TO THE SENATE TO THE PRESIDENT BY MIDNIGHT TONIGHT, SO I WOULDN'T BE SURPRISED IF THERE WAS A CR OF A A -- >> -- THE NEW CONGRESS, EVERYBODY'S NEW AND -- >> WE WOULD THINK THAT'S PRETTY UNLIKELY, HAVING COME THIS FAR, I THINK THE MOST THAT WOULD HAPPEN IF YOU HAD TO DELAY WOULD BE A SHORT-TERM CONTINUING RESOLUTION OF ONE DAY OR MAYBE THROUGH THE WEEKEND AT THE MOST BUT THEN GETTING THE BILL PASSED. I MUST SAY, RIGHT AFTER THE ELECTION, MANY PEOPLE THOUGHT THAT WILL WOULD BE A HIGH LIKELIHOOD OF A CONTINUING RESOLUTION THAT WOULD SIMPLY KEEP US AT THE CURRENT LEVEL UNTIL THE NEW CONGRESS CAME IN, THEN THEY WOULD MAKE THEIR OWN DECISIONS. BUT THAT IS NOT THE WAY IT HAS SHAPED UP. AGAIN, I'VE GOT TO SAY, HATS OFF TO HAL HAL RODGERS FROM THE HOUSE, BARBARA MIKULSKI IN THE SENATE, WHO HAVE WORKED REMARKABLY TOGETHER IN A BIPARTISAN, BUY CAMERA SORT OF WAY TO DO EXACTLY WHAT PROAP PRAY TORES ARE SUPPOSED TO DO, APPROPRIATE. AND CONVINCE OTHERS TO GO ALONG WITH IT. SO WITHOUT THAT LEADERSHIP, I'M SURE WE WOULD BE FACING YET ANOTHER C.R. THEY HAVE DONE A GREAT JOB. OKAY, THANKS, NEIL. LET ME TELL YOU A FEW OTHER THINGS ABOUT THE BILL THAT ARE NOT SPECIFICALLY ABOUT BUDGET BUT ABOUT POLICY, BECAUSE APPROPRIATE TORES CANNOT ONLY PUT DOWN DOLLAR FIGURES, THEY CAN SAY SOME LIMITATIONS OR EX-HOR TAITIONS ABOUT HOW YOU'RE SUPPOSED TO SPEND IT. AND THIS ONE IS NO EXCEPTION. SOME OF THESE ARE IN WHAT ALL'S CALLED BILL LANGUAGE, WHICH MEANS WE REALLY HAVE TO DO THEM, SOME OF THEM ARE IN REPORT LANGUAGE, SLIGHTLY LESS CONSEQUENCE BUT WE'RE TO PAY ATTENTION T ANY IN ANY WAY, AND WITH WE DO. SO I JUST MENTION A FEW THINGS THAT ARE IN THERE. BEFORE I DO, HAVING HAD HAD THE CHANCE TO SPEAK WITH SENATOR MIKULSKI YESTERDAY, SHE HAD HAD TRIED VERY HARD TO HAVE THE PROVISIONS OF A PLAN THAT TOM HARKIN HAD PUT FORWARD INCLUDED IN THIS APPROPRIATION. TOM'S BILL PROPOSED THAT IN THE CASE OF NIH, THAT THE INVESTMENTS ARE SO IMPORTANT THAT THE CAPS ON THE OVERALL DISCRETIONARY BUDGET PLACED THERE BY THE RYAN MURRAY AGREEMENT OUGHT THE NOT TO APPLY, THAT THERE OUGHT TO BE AN EXCEPTION MADE, AND THAT NIH APPROPRIATIONS COULD BE DONE ABOVE THE CAPS. AND THERE WAS A PRETTY GOOD A MOMENTUM BEHIND THAT, AGAIN, BECAUSE OF BIPARTISAN SUPPORT FOR THE IDEA THAT MEDICAL RESEARCH REALLY MATTERS AND THAT IT'S UNDER AN UNFORTUNATE SQUEEZE RIGHT NOW. BUT SHE TOLD ME THAT WHEN IT CAME DOWN TO IT, THOSE BUDGETEERS, WHO ARE VERY MUCH DETERMINED TO STICK TO THE CAPS COULD NOT BE CONVINCED THAT AN EXCEPTION OF THIS SORT SHOULD BE ALLOWED. SO I GATHER FAIRLY RECENTLY, JUST IN THE LAST FEW DAYS, THAT OPPORTUNITY WAS LOST. AND SHE CLEARLY TRIED REALLY HARD TO GET THAT THROUGH AND MUCH CREDIT TO HER AND TO TOM HARKIN, WHO NOW IS RETIRING FROM THE SENATE. THIS IS HIS SORT OF LAST COUPLE OF DAYS AS A REMARKABLE LEADER, SOMEBODY THAT WE HAVE ALL GROWN IT TO GREATLY ADMIRE AND SHOULD BE SURE TO TELL HIM SO AS HE HEADS BACK TO IOWA. SO, I AGAIN WAS VERY TOUCHED THAT SENATOR MIKULSKI WOULD PICK UP THE PHONE HERSELF IN THE MIDDLE OF EVERYTHING THAT'S GOING ON AND CALL TO SPEND 15 OR 20 MINUTES ON THE PHONE EXPLAINING WHAT HAD HAPPENED SO THAT ALL OF US AT NIH WOULD KNOW. SHE HAS BEEN A WONDERFUL LEADER IN THIS SPACE. I ALSO WANT TO GIVE A SHOUT OUT TO THE FOUR CORNERS, WE WORK VERY CLOSELY WITH THEM, WE DON'T ALWAYS AGREE ON EVERYTHING, BUT THEY'RE INCREDIBLY HARD WORKING. THEY LISTEN TO OUR NEEDS, TRY TO HELP SOLVE PROBLEMS, FIGURE OUT COMPROMISES, AND THERE ARE ASPECTS OF THE LANGUAGE THAT APPEARED IN THE BILL THAT ARE EXTREMELY HELPFUL TO US, AND MUCH CREDIT TO THE FOUR CORNERS FOR MAKING THAT POSSIBLE. SO A FEW FEATURES IN TERMS. LANGUAGE. ONE IS WE HAVE A NEW NAME FOR ONE OF OUR 27 INSTITUTES AND CENTERS. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE WILL NOW BECOME THE NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH. A CHANGE THAT JOSIE BRIGGS WAS VERY ANXIOUS TO SEE HAPPEN, BECAUSE ALL TERPTIVE MEDICINE CARRIED A CERTAIN KIND OF GUT RESPONSE THAT MAYBE SHE THOUGHT WOULD BE BETTER TO PUT ASIDE AND INCLUDE THIS WORD "INTEGRATIVE HEALTH," AND THAT'S WHERE WE WILL BE. THERE ARE INSTRUCTIONS IN THE BILL THAT WE SHOULD WORK HARD TO DO SOMETHING ABOUT THE FACT THAT THE AVERAGE AGE OF AN NIH INVESTIGATOR AT THEIR FIRST AWARD IS HUNG UP AT AGE 42 AND HAS BEEN THERE FOR MANY YEARS. SOMETHING THAT WE'RE QUITE WORRIED ABOUT, AND THEY'RE CERTAINLY PUSHING US TO DO SOMETHING ABOUT THAT AND WE HAVE SOME INTERESTING IDEAS BASED UPON WORK THAT'S BEEN DONE BY THIS GROUP AND PARTICULARLY BY THE GROUP THAT SALLY ROCKEY AND SHIRLEY TILLMAN CO-CHAIRED, AND WHICH WE HAVE NOW BROUGHT FORWARD IN SOME IDEAS AND MORE IT TO COME. THEY SUPPORT THE GOALS OF THE NATIONAL CHILDREN'S STUDY, REQUIRING US TO INFORM THE COMMITTEES OF THE PLANS GOING FORWARD. WE'LL TALK ABOUT THE NATIONAL CHILDREN'S STUDY TOMORROW. THE LANGUAGE IS ACTUALLY PRETTY FLEXIBLE HERE SO IT WILL NOT INTERFERE WITH THE DISCUSSION WE HAVE TOMORROW, AND WE'RE GRATEFUL THAT THEY HAVE THOUGHT CAREFULLY ABOUT THAT, KNOWING THAT WE HAD A WORKING GROUP WOULD WAS LOOKING AT THIS ISSUE QUITE CAREFULLY AND DIDN'T WANT TO TIE OUR HANDS. THEY WILL GIVE OUR INSTITUTES MAYBE SOME RELIEF FROM SOME ADMINISTRATIVE CHALLENGES ABOUT CONFERENCES, BUT I DON'T WANT TO GO INTO THE DETAILS THERE BECAUSE WE'RE STILL TRYING TO SORT THEM OUT AND IT'S CERTAINLY NOT THE KIND OF RELIEF THAT ULTIMATELY WE HOPE WE WILL GET. THEY WILL ALLOW -- AND THE NCI WILL LIKE THIS -- PAYMENTS FOR RESEARCH ORGANISMS OR SUBSTANCES TO COME BACK TO THE FOFT. SO NCI, FOR INSTANCE, HAS BEEN SENDING OUT MICE TO LOTS OF INVESTIGATORS, AND FOR SOME OBSCURE REASON, WE'RE NOT ALLOWED TO CHARGE FOR THAT, AND THIS WILL ALLOW THAT TO HAPPEN. THEY'RE REQUIRING US TO SUBMIT WHA'S EFFECTIVELY A BYPASS BUDGET FOR ALZHEIMER'S DECEMBER. THERE'S BEEN A BYPASS BUDGET FOR CANCER ALL ALONG. THEY WANT TO SEE A SEPARATE BUDGET OF WHAT IT WOULD TAKE TO ACTUALLY MEET THE GOALS OF THE NATIONAL ALZHEIMER'S PLAN. THEY ARE ASKING THE NATIONAL ACADEMY OF SCIENCES, OR ASKING US, TO PROVIDE FUNDS FOR THE NATIONAL ACAD MEEF SCIENCES TO ESTABLISH A BLUE RIBBON COMMISSION ON SCIENTIFIC LITERACY AND STANDING, CHARGED WITH DISCERN AMERICAN PUBLIC OPINION ON UNDERSTANDING OF AND ACCEPTANCE OF SCIENTIFIC RESEARCH. I THINK THIS IS COMING FROM SENATOR HARKIN. TO EXAMINE THE PRESENT STATE OF SCIENTIFIC REPUTATION IN AMERICA AND PRESENT RECOMMENDATIONS ABOUT HOW TO IMPROVE SCIENTIFIC LITERACY. INTERESTING. THEY ARE ASKING NIH TO PRODUCE AN NIH-WIDE FIVE-YEAR SCIENTIFIC STRATEGIC PLAN, AND SUBMIT IT TO CONGRESS NO LA LATER THAN ONE YEAR AFTER THIS PLAN IS ENACTED. GULP. [LAUGHTER] HOW MANY OF YOU REMEMBER 1991, 1992? THE HEEL EE STRATEGIC PLAN WHICH GOT EVERYTHING SO ROYALED? YOU WERE ON IT? OKAY. YOU COULD TELL STORIES, NO DOUBT. THERE'S SOME LANGUAGE IN HERE ALSO ASKING NIH TO DEVELOP AN NIH-WID APPROACH TO IMPROVE THE SPEED AND VALIDITY OF PERSONALIZED MEDICINE THROUGH THE CONVERGENCE OF TECHNOLOGY AND BIOMEDICAL SCIENCE. OKAY, WE LIKE TO DO THAT. AND THEN OTHERS, VARIOUS STATEMENTS OF CONCERN ABOUT ISSUES THAT AFFECTS US AS WELL, CLINICAL TRIALS, DATA AVAILABILITY, PEDIATRIC CANCER, REPRODUCIBILITY, RESEARCH RESULTS, WHICH WE'LL HEAR ABOUT TOMORROW, AND INCREASING INCLUSION OF WOMEN IN CLINICAL RESEARCH, CONSIDERING SEX AS A BIOLOGICAL VARIABLE AND RELEVANT RESEARCH ON ANIMALS. I THINK WE'RE VERY STRONGLY PUSHING THAT. PAYING ATTENTION TO HEALTH DISPARITIES AND A WIDE VARIETY OF OTHER ITEMS IN A 12-PAGE SINGLE-SPACED SUMMARY OF WHAT'S IN THE REPORT LANGUAGE. IT GOES ON QUITE A DISTANCE. BUT ANYWAY, AGAIN, MUCH CREDIT TO THE FOUR CORNERS FOR THE THOUGHTFUL WAY THAT THEY HAVE GENERALLY TRIED TO HELP US EVEN THOUGH WE DON'T ALWAYS QUITE COME TO THE SAME PLACE. SO FINALLY BEFORE I WRAP UP, AND I THINK WE MIGHT JUST BE CLOSE TO BEING ON TIME BUT AGAIN, I HOPE WE CAN HAVE DISCUSSION OF OTHER ITEMS. WANT TO MENTION ONE OR CONGRESSIONAL EFFORT WHICH SOME OF YOU, I THINK, HAVE BEEN INVOLVED IN WHICH IS THE 21ST CENTURY CURES INITIATIVE. THIS IS AN EFFORT IN THE HOUSE LED BY HOUSE ENERGY AND COMMERCE CHAIRMAN FRED UPTON, REPUBLICAN FROM MICHIGAN, AND DEMOCRAT FROM COLORADO, SO A BIPARTISAN EFFORT IN THE HOUSE. THEY HAVE BEEN HOLDING A SERIES OF ROUNDTABLE HEARINGS TO TRY TO SOLICIT IDEAS ABOUT WHAT WE COULD DO THAT WOULD ACTUALLY FACILITATE THE DEVELOPMENT OF MEDICAL ADVANCES FOR THOSE THOUSANDS OF DISEASES THAT ARE STILL WAITING FOR ADVANCES TO HAPPEN. I'VE BEEN INVOLVED IN FOUR OF THEIR EVENTS. TWO OF THEM ON THE HILL, AND ONE, I WENT TO LANCASTER, PEIA FOR A ROUNDTABLE THAT JOE PITS HELD, THEN I WENT TO KALAMAZOO, MICHIGAN WITH FRED UPTON, BECAUSE THAT'S HIS DISTRICT, BACK IN SEPTEMBER WHERE A ROUNDTABLE WAS HELD AS WELL. THEY'VE HAD MANY OTHER OF THESE EVENTS. CHRIS AUSTIN WENT TO ONE IN NEW YORK. THE NCATS DEPUTY DIRECTOR PAM MCGINNIS WENT TO PITTSBURGH AND CAROL OF NIAID WENT TO RTP IN NORTH CAROLINA. WE HAVE BEEN ASKED TO PUT FORWARD IDEAS ABOUT THINGS THAT WOULD HELP US, AND WE HAVE BEEN DOING SO MOSTLY INFORMALLY BUT THEY ARE NOW DOWN TO SORT OF RUBBER MEETING THE ROAD, WHERE THEY WOULD LIKE TO HAVE MORE SPECIFICS AND I WAS WITH UPTON AND DEGETT AS RECENTLY AS DAY BEFORE YESTERDAY GOING THROUGH SOME OF THOSE IDEAS. AND I VIEW THIS AS REALLY A VERY HELPFUL EVIDENT ON THEIR PART TO TRY TO BOTH GIVE US FLEXIBILITIES THAT WE NEED AND ALSO IT'S AN OPPORTUNITY TO STRIP AWAY SOME OF THE THINGS THAT HAVE FOUND THEIR WAY INTO LEGISLATION OVER MANY YEARS THAT ACTUALLY AREN'T VERY HELPFUL AND THAT WE COULD BENEFIT FROM BEING RELIEVED FROM. AND WE'RE MAKING SUGGESTIONS OF BOTH SORTS. SO THE PLAN, AGAIN, FRED UPTON VERY STRONGLY DOCUMENTED INTENTIONS YESTERDAY THAT THEY WOULD ININTRODUCE A BILL IN THE NEW CONGRESS AND MOVE IT THROUGH HIS COMMITTEE THIS SPRING, AND WITH A SPONSOR I SENATE ALREADY TENTATIVELY LINED UP BUT I'M NOT SUPPOSED TO SAY WHO IT IS, LOOKS AS IF THEY DO HAVE A PRETTY SIGNIFICANT EFFORT UNDERWAY. THEY ACTUALLY INTEND TO TRY TO PUT FORWARD A DRAFT BILL SOMETIME IN MIDDLE TO LATE JANUARY, SO THIS IS COMING ALONG QUITE QUICKLY. THEY OBVIOUSLY ARE NOT JUST INTERESTED IN NIH, THEY'RE INTERESTED IN THE WHOLE ECOSYSTEM, THEY'RE PARTICULARLY INTERESTED IN FDA. I CAN TELL YOU SECRETARY BURWELL IS VERY ENGAGED IN THIS PROCESS, AS ARE PEOPLE IN THE WHITE HOUSE. EVERYBODY IS SEEING THIS AS A PRETTY SIGNIFICANT LEGISLATIVE MOMENT. ONE THAT WE HOPE TURNS OUT REALLY WELL. YOU CAN IMAGINE THEY ARE SOLICITING INPUT FROM LOTS OF OTHER PERSPECTIVES AS WELL. SO FINALLY, JUST IN TERMS OF THE NEXT CONGRESS, THE 114TH -- YES, BOB. >> I JUST WANTED TO BACK UP FOR A MOMENT TO ASK A QUESTION, PLEASE. YOUR GULP, THE NIH FIVE-YEAR STRATEGIC PLAN. CAN YOU GIVE US A LITTLE FLAVOR AROUND THAT, BECAUSE ONE COULD INTERPRET IT AS A PENALTY OR AS AN OPPORTUNITY. BEING SOMEWHAT OPTIMISTIC, I WOULD LIKE TO THINK OF THIS AS AN INVITATION TO BASICALLY ALLOW CONGRESS TO TAKE A CONCERTED LOOK AT WHAT WE ARE AND WHERE WE'RE GOING WITH THE EYE TO USING THAT AS A BASIS FOR DOING SOMETHING GOOD. AM I TOO OPTIMISTIC? [LAUGHTER] >> OH, I'D LOVE TO BE OPTIMISTIC TOO AND I'LL TRY. SO EACH ONE WITH OF THE 27 INSTITUTES AND CENTERS HAS A STRATEGIC PLAN, AND WE WERE ASKED BY THE CONGRESS TO PRODUCE THOSE OVER THE COURSE OF THE LAST YEAR AND DID SO. SO THE QUESTION NOW IS, CAN WE HAVE AN NIH VERSION WIDE VERSION THAT'S NOT JUST STAPLING THESE TOGETHER BUT TURNING THEM INTO SOMETHING THAT SPEAKS ABOUT THE WHOLE INSTITUTION, AND I THINK WE CAN MAKE A VERY SERIOUS SHOT AT DOING THAT. IT WILL, OF COURSE, INVARIABLY COME OUT IN WAYS THAT SOME PEOPLE ARE HAPPY WITH AND SOME PEOPLE ARE UNHAPPY WITH WITH. IT WILL RUN THE RISK, PERHAPS, OF MAKING IT SOUND AS IF IF OVER FIVE YEARS, WE HAVE MORE THAN CERTAINTY THAN WE DO ABOUT WHERE SCIENCE IS GOING, CONSIDERING HOW RAPIDLY THINGS HAPPEN THESE DAYS, IT'S HARD TO IMAGINE A FIVE-YEAR PLAN THAT WOULD NOT BE PRETTY LIKELY TO GET BLOWN UP BY THE SECOND OR THIRD YEAR. BUT IN AN OPTIMISTIC VEIN, IT COULD BE, AS YOU'RE SUGGESTING, I THINK, A GOOD TOOL TO EXPLAIN WERE THIS IS SUCH AN EXCITING TIME SCIENTIFICALLY AND WHY NIH INVESTMENTS ALL THE WAY FROM VERY BASIC SCIENCE TO CLINICAL APPLICATIONS ARE CRITICAL FOR PROGRESS TO BE MADE AND POINTING OUT WHY ALL OF THOSE AREAS SUPPORT. >> SO I WAS ACTUALLY ALSO THINKING THAT IT MIGHT BE A GOOD POINT OF INTERFACE WITH THE EDUCATING THE PUBLIC ASPECT OF THINGS, AND THAT PART OF THE EDUCATION MIGHT BE THE VERY CAUTION THAT YOU JUST EXPRESSED ABOUT HOW SCIENCE IS UNPREDICTABLE BOTH IN GOOD AND BAD WAYS, AND THE PLAN SHOULD BE PERCEIVED THAT WAY, AND I THINK BOTH FOR CONGRESS, FOR THE, YOU KNOW, BODY POLITICS AND THE PUBLIC, WE MIGHT TRY AND BE KIND OF MORE REALISTIC AND NOT OVERPROMISED AND THAT MIGHT BE A REALLY GOOD MOVE FOR ALL OF US. >> WELL, FINALLY TO SORT OF WRAP UP THE CONGRESSIONAL THING AND TO GET US TO OUR BREAK, FOR THE 114TH CONGRESS, WE ALREADY HAVE A PRETTY GOOD IDEA ABOUT WHAT THE LEADERSHIP WILL LOOK LIKE FOLLOWING THE NOVEMBER ELECTIONS, SO FOR APPROPRIATIONS, HALL RODGERS WILL CONTINUE AS CHAIR FROM KENTUCKY, SOMEBODY THAT I THINK HAD GREAT ADMIRATION FOR, HAVE TRAVELED WITH WITH HIM AND FOUND HIM TO BE A VERY THOUGHTFUL LEADER. NITA LOEHE WILL BE THE RANKING MEMBER AS WILL BE THE CASE. ON THE SENATE SIDE, OF COURSE, WITH THE CHANGEOVER, APPROPRIATIONS CHAIR WILL NOW BE THAD COCHRANE, A REPUBLICAN FROM MISSISSIPPI, AND BARBARA MIKULSKI WILL NOW STAY ON BUT AS RANKING MEMBER. IN TERMS OF THE SUBCOMMITTEES, ON THE HOUSE SIDE, WE HAVE HEARD THAT TOM COLE, REPUBLICAN OF OKLAHOMA, WILL BE THE SUBCOMMITTEE CHAIR. JACK KINGSTON, WHO HAS BEEN OUR SUBCOMMITTEE CHAIR, IS LEAVING THE CONGRESS, SO THEY HAD TO IDENTIFY A NEW LEADER. WE ALSO EXPECT THAT REPRESENTATIVE ANDY HARRIS, WHO'S A PHYSICIAN WHO'S ONCE BEEN AN NIH GRANTEE WHEN HE WAS AT HOPKINS, WILL CONTINUE TO BE A VERY SIGNIFICANT MEMBER OF THAT SUBCOMMITTEE, BECAUSE HE HAS GREAT INTEREST IN WHAT WE DO. IN THE SENATE SIDE, THE SUBCOMMITTEE, WE DO NOT KNOW WHO WILL BE, IN FACT, THE SUBCOMMITTEE CHAIR. THERE HAVE BEEN DISCUSSIONS BUT THAT HAS NOT BEEN PUBLICLY CONFIRMED. IN TERMS OF OUR AUTHORIZING COMMITTEE WHICH ON THE HOUSE SIDE IS ENERGY AND COMMERCE, THE RETIREMENT OF HENRY WAXMAN MEANS THAT WE NEED A NEW RANKING MEMBER ON THE DID DEMOCRATIC SIDE, AND THAT WILL BE FRANK PALLONE, DEMOCRAT OF NEW JERSEY. BUT FOR THE HEALTH SUBCOMMITTEE, JOE PITTS WILL CONTINUE TO CHAIR THE SUBCOMMITTEE. OF COURSE FOR THE FULL COMMITTEE, FRED UPTON WILL CONTINUE AS CHAIR. IN TERMS OF AUTHORIZING ON THE SENATE SIDE, LAMAR ALEXANDER WILL BECOME CHAIR OF THE HELP COMMITTEE. AND PATTY MURRAY, WE BELIEVE IS LIKELY TO BE NAMED AS THE RANKING MEMBER. I DON'T THINK THAT'S OF YET BEEN CONFIRMED. SO OF THOSE PEOPLE, I WILL TELL YOU THOSE ARE ALL FOLKS WHO ARE PRETTY FAMILIAR WITH NIH, AND WE WILL CONTINUE EVER EVERY EFFORT AND HOPE YOU DO TO PROVIDE INFORMATION WHENEVER THEY'RE LOOKING FOR IT ABOUT WHATEVER BIOMEDICAL RESEARCH IS UP TO, BECAUSE IT IS A GOOD STORY. SO ARE THERE OTHER QUESTIONS THAT PEOPLE WANT TO POSE ABOUT ANY OF THIS WIDE RANGE OF MATERIALS THAT I HAVE DROPPED IN FRONT OF YOU OVER THE LAST HOUR AND A HALF? HARLAN? >> THANKS, FRANCIS. IT'S A BREATHTAKING TOUR. JUST HEARING ABOUT THE BUDGET AND THE .5%, CAN YOU JUST REFLECT A LITTLE BIT ON WHAT PRESSURES THAT'S GOING TO PUT ON THE INSTITUTE? I KNOW IT'S BETTER NEWS THAN THE CUT, BUT TO ME, IT SOUNDS REALLY DISAPPOINTING AND CONCERNING, GIVEN THE DIRECTION WE'VE BEEN GOING IN, AT LEAST FOR US TO THINK ABOUT HOW WE SEND OUT THE WORD ABOUT WHAT THE IMPLICATIONS OF THIS ARE. IT'S A BALANCE, RIGHT? IT'S A CELEBRATION THAT WE DIDN'T GET -- I THINK FOR A COUNTRY WHERE THERE IS APPARENTLY BIPARTISAN SUPPORT FOR RESEARCH, THERE'S BUY-IN TO THE IDEA THAT THIS IS THE PATH TO THE FUTURE IN TERMS OF GENERATING JOBS IN A COUNTRY THAT'S VIBRANT AND FORWARD LOOKING, IT SEEMS THAT THIS IS A PROBLEM, I KNOW RESEARCHERS IN AMERICA AND YOU AND EVERYBODY HAS WORKED HARD TO GET THE WORD OUT, BUT I THINK THE PEOPLE IN THE COUNTRY NEED TO RECOGNIZE THAT THIS IS NOT EXACTLY WHAT MANY OF THE LEADERS IN THE THE COUNTRY THINK WE NEED. BUT CAN YOU REFLECT A LITTLE BIT ON WHAT YOU THINK ARE THE IMPLICATIONS? WHAT ARE THE COSTS OF THIS FOR US AS A NATION AND AT NIH WITH ONLY A 4.5% INCREASE? >> SO THE BIOMEDICAL RESEARCH AND DEVELOPMENT PRICE INDEX, THE BIRD PIE WITH IS SORT OF WHAT WE HAVE TO LIVE WITH IN TERMS OF THE COST OF DOING REACCEPT TENDS TO RUN AROUND 2 OR 3%. SO A HALF% INCREASE, ALTHOUGH CERTAINLY BETTER THAN A CUT OR FLAT BUDGET, IS NOT GOING TO KEEP UP WITH WHAT HAPPENS IN THIS YEAR IN TERMS OF THE COST OF DOING RESEARCH, SO WE'RE GOING TO LOSE MORE GROUND IN THAT REGARD AS FAR AS OUR PURCHASING POWER. THAT THEENS THAT SUC MEANS THAT SUCH THING S AS SUCCESS RATES THAT PEOPLE SUBMIT FOR GRANTS ARE GOING TO BE AFFECTED. OF COURSE SUCCESS RATES ARE WHAT A FRACTION OF WHAT GETS APPROACHED OVER WHAT GETS SUBMITTED, AND WE DON'T EXACTLY KNOW AT THE BEGINNING OF THE YEAR WHAT THE APPLICATION NUMBERS WILL LOOK LIKE, BUT WE HAVE NOW BEEN IN A SUB20% SUCCESS RATE FOR THE LAST THREE YEARS, AND THIS WILL NOT ALLOW US TO RECOVER FROM THAT. HAD THE HARKEN PROPOSAL OF GIVING A CHANCE TO GET BACK ON A STABLE TRAJECTORY ACTUALLY MADE IT THROUGH, WE WOULD HAVE SEEN A REALLY SIGNIFICANT UPTICK IN THE ABILITY TO FUND THE NEW AND COMPETING GRANTS, AND THAT WOULD HAVE, I THINK, BEEN A BIG SHOT IN THE ARM FOR A COMMUNITY THAT'S CLEARLY PRETTY STRESSED. BUT WE DIDN'T GET THAT. AND AGAIN, I THINK THE ONLY WAY WE WOULD HAVE HAD THAT SUCCESS WAS THIS AGREEMENT ABOUT BUSTING THE CAPS, BECAUSE AS MOST OF YOU KNOW, FOR FY15, THERE WAS A PRIOR AGREEMENT TO LIVE WITHIN THE RYAN MURRAY ENVELOPE, AND YOU HEARD ALREADY FROM NEIL THAT THE ALLOCATION THAT THE LABOR H COMMITTEE HAD TO WORK WITH WAS LESS THAN THE YEAR BEFORE, SO THEY COULD ONLY COME UP WITH A SLIGHT UPTICK FOR US BY HITTING OTHER PLACES EVEN HARDER. SO THE REALITY IS PRETTY CLEAR ABOUT WHY THEY HAD TO DO WHAT THEY HAD HAD HAD TO DO. THINK ALL THE MORE IT PUTS THE ONUS UPON US TO TAKE THE RESOURCES WE HAVE, WHICH IS 30 BILL YONDZ, WHICH IS A PRETTY NICE AMOUNT OF FUNDS, AND MAKE SURE WE'RE BEING AS CREATIVE AS POSSIBLE IN THE WAY THOSE DOLLARS ARE BEING EXPENDED. ONE OF THE THINGS THAT WE ARE GOING TO DO MORE OF, PARTICULARLY NIGMS AND NCI, BUT OTHER INSTITUTES ARE LOOKING AT THIS AS WELL, IS TO MOVE A LARGER PROPORTION OF OUR PORTFOLIO INTO GRANTS THAT ARE LONGER IN DURATION, BUT OFFER GREATER FLEXIBILITY FOR THE INVESTIGATOR AND LESS OF A DEMAND ABOUT HAVING A VERY HIGHLY TUNED RO1-STYLE APPLICATION WHERE YOU HAVE TO LAY OUT EVERY DETAIL OF YOUR EXPERIMENTAL APPROACH. IT DO SEEM THAT IN THIS KIND OF CLIMATE IN PARTICULAR, THIS IS A GOOD WAY TO AVOID WHAT OTHERWISE BECOMES A VERY CONSERVATIVE APPROACH TO SCIENTIFIC APPLICATIONS AND TO PEER REVIEW. THAT'S UP WITONE OF A NUMBER OF THINGS. WE ARE HAVING INTENSE DISCUSSIONS ABOUT WHAT WE CAN DO FOR EARLY STAGE INVESTIGATORS, BECAUSE WE ARE LOSING, CAREERLY, SOME OF THOSE INDIVIDUALS WHO ARE SIMPLY GETTING DISCOURAGED AND DECIDING TO DO SOMETHING ELSE OR GO TO SOME OTHER COUNTRY. THAT IS A RESOURCE THAT, ONCE IT'S GONE, WE CAN'T JUST BRING I BACK AGAIN, AND THAT BECOMES A VERY HIGH PRIORITY. LARRY AND SALLY AND I AND OTHERS, ALL THE INSTITUTE DIRECTORS HAVE BEEN TALKING ABOUT WAYS THAT WE MIGHT EVEN GO BEYOND WHAT WE'VE BEEN DOING ALREADY IN TERMS OF GIVING THEM AN EXTRA BIT OF SUPPORT, BUT NOT SETTING THEM UP SO THAT YOU GET THE FIRST GRANT AND THEN YOU HIT THE WALL, BECAUSE THAT'S NOT A GOOD OUTCOME EITHER. FRANKLY ONE OF THE THINGS WE HAVE TO NOW LOOK AT IS THE WHOLE DEMOGRAPHIC OF OUR WORKFORCE, AND THE FACT THAT MANY INSTITUTIONS ARE NOT HIRING VERY MANY NEW FACULTY BECAUSE THEIR RANKS ARE ALREADY FULL AND THE COST OF DOING RESEARCH IS CONSIDERABLE AND GRANTS ARE HARD TO COME BY. WITH WE HAVE MORE PRINCIPAL INVESTIGATORS OVER 65 THAN UNDER 35. MAY NEED TO BE SOME THOUGHT GIVEN TO WHETHER THE SENIOR END OF THAT DISTRIBUTION IS HEALTHY AT THIS POINT CONSIDERING HOW MUCH STRESS IS BEING PLACED ON THE JUNIOR END. SO WE ARE WONDERING, JUST AS HOWARD HUGHES HAS TAKEN STEPS TO PROVIDE SORT OF A TRANSITION FOR SENIOR INVESTIGATORS THAT IS SUPPORTIVE BUT ALSO PROVIDES SORT OF A NATURAL WAY TO MOVE OUT OF A FULLY FUNDED RESEARCH LABORATORY INTO OTHER ACTIVITIES, MAYBE WE SHOULD BE CONSIDERING SUCH KINDS OF AWARDS OURSELVES. THAT WILL BE CONTROVERSIAL, NO DOUBT. BUT I THINK IN THIS CIRCUMSTANCE, WHEN YOU LOOK AT THE DEMOGRAPHICS, WHEN OUR WHOLE PRINCIPAL INVESTIGATOR COHORT HAS BEEN SHIFTING IN THE DIRECTION OF MORE AND MORE SENIORITY, AT THE EXPENSE, PERHAPS, OF BEING ABLE TO BRING IN MORE INDIVIDUALS AT THE FRONT END, WE HAVE TO THINK ABOUT WHETHER THAT'S THE RIGHT WAY TO MANAGE THE MOST EXCITING SCIENCE AND THE MOST EXCITING PLACE. THAT MAY BE MORE THAT YOU WANTED TO HEAR BUT THERE'S MORE STUFF THAN YOU WANT TO PAY ATON TO IN THIS CLIE THE MATT, AND, OF COURSE, THE CAPS WERE FOR '14 AND '15. ALREADY PEOPLE WERE THINKING WHAT ABOUT FY '16? THE BAD NEWS THERE IS THAT THE SEQUESTRATION IS STILL IN FORCE. IF NOTHING GETS DONE, ACTIVELY BY THE CONGRESS, '16 COULD BE EVEN WORSE. BUT IT'S ALSO AN OPPORTUNITY TO SAY WE DON'T HAVE A CAP THAT WE HAVE TO LIVE IN, MAYBE WE OUGHT TO THINK ABOUT, WITH THE ECONOMY COMING BACK, OR WITH THE ARGUMENT ABOUT MEDICAL RESELF AND ITS BENEFITS TO THE ECONOMY AND TO HEALTH BEING MORE WIDELY AED AND AGREED TO THAN EVER, MAYBE IT'S A CHANCE TO REALLY CHANGE THE CONVERSATION. LEAVE ME, WE NEEBELIEVE ME, WE NEED TO DO THAT. RENEE. >> IS THERE ANY REASON TO BE OPTIMISTIC ABOUT THE EFFORTS THAT YOU HAVE GOING FORWARD NOW IN COLLABORATION WITH FOUNDATIONS AND EXTERNAL PEOPLE THAT, THERE MAY BE SOME RELIEF AFFORDED IN SOME OF THESE AREAS? >> I THINK THAT'S ANOTHER AREA WE IS V. TO LOOK AT JUST AS VIGOROUSLY AS POSSIBLE, THAT WE'RE NOT MISSING OUT ON MOVING SCIENCE FORWARD THAT DON'T REQUIRE EVERY DOLLAR TO BE A FEDERAL DOLLAR. YOU CAN SEE EXAMPLES OF THAT. I MENTIONED THE AMP PROGRAM, WE WE'RE DOING THIS JOINTLY WITH PHARMACEUTICAL COMPANIES AND SPLITTING THE COST 50/50. I WAS DELIGHTED TO SEE PAUL ALLEN ANNOUNCING THAT HE'S PUTTING $100 MILLION INTO A CELL BIOLOGY INSTITUTE. HE'S ONE OF THE FEW PEOPLE THAT IS PUTTING FUNDS OF THIS SORT INTO REAL BASIC SCIENCE. MOST OF THE REST OF WHAT YOU SEE IN PHILANTHROPY AND DISEASE IS MORE TARGETED, BUT HE HAS THIS VISION WHICH IS GREAT TO SEE BOTH FOR THAT AND OF COURSE THE ALLEN INSTITUTE FOR BRAIN SCIENCES, AN AMAZING CONTRIBUTION AS WELL. BUT THERE AREN'T A LOT OF FLAN THOUGH P.S.I.S WHO PHILANTHROPISTS THAT AR E IN THAT SPACE. IF YOU ADD UP THE TOTAL OF WHAT IT P PHILANTHROPY CONTRIBUTES TO BIOMEDICAL RESEARCH IN THE U.S., IT IS STILL ON THE ORDER OF 2 OR $3 BILLION, SO IT IS NOT GOING TO MAKE UP FOR THE FACT THAT WE'VE ESSENTIALLY LOST $11 BILLION NOW IN PURCHASING POWER OVER THE LAST 10 YEARS. IT HELPS A BIT, BUT THE SUM TOTAL IS STILL GOING THE WRONG WAY. >> SAY THAT AGAIN. IF YOU JUST LOOK AT THE CURVES BASED UPON THE INFLATIONARY DAMAGE THAT'S BEEN DONE TO OUR PURCHASING POWER, IF WE'D MAN ANLED TWE'DMANAGED TO STAY ON THE TRAJECTORY WE WERE IN THE PAST, WE WOULD NOW BE SOMEWHERE AT AROUND 41, $42 BILLION OF S YEAR AS OPPOSED TO WHERE WE ARE NOW, WHICH IS AT 30. >> [INAUDIBLE] >> ABOUT A QUARTER. >> ARE YOU INVOLVED -- I KNOW YOU MUST HAVE INVOLVED IN THE DISCUSSIONS WITH THE SCIENCE PHILANTHROPY ALLIANCE. NOW TRYING TO GET AN INFRASTRUCTURE. AND I UNDERSTAND THAT THAT ALLIANCE IS NEVER GOING TO TAKE THE PLACE OF NIH, BUT ANYTHING THAT WE CAN DO TO REALLY GET THE FOUNDATION WORLD TO UNDERSTAND THAT WHILE IT'S VERY ATTRACTIVE TO THINK ABOUT TRANSLATIONAL MEDICINE AND TO THE BEDSIDE, IF WE NEGLECT THE BASIC PART, THEN IN 20 YEARS, WE'RE NOT GOING TO HAVE THAT. SO THAT'S ANOTHER INITIATIVE THAT I THINK CAN AT LEAST HEIGHTEN AWARENESS OF THE IMPORTANCE OF BASIC RESEARCH. >> I DON'T THINK WE HAVE A TIGHT -- AT LEAST I DON'T -- A TIGHT CONNECTION WITH THAT ALLIANCE, AND I'D LIKE TO TALK TO YOU MORE ABOUT HOW WE MIGHT DEVELOP THAT. >> I MEAN, I THINK AT LEAST IT'S ANOTHER WAY TO BEGIN TO GET THESE CONNECTIONS THAT MIGHT BE HELPFUL. >> WELL, I'M SORRY WE'RE ENDING ON A SOMEWHAT DOWN NOTE, BUT IT IS WHAT IT IS. THIS IS SUCH AN EXAMPLE OF THE LIFE OF ALL OF US AT NIH, THIS SENSE OF OH, WE COULD DO SO MUCH MORE. WE'RE DOING COOL STUFF ANYWAY, LET'S NOT FORGET ABOUT THAT, THE AMAZING THINGS THAT GET GENERATED BY OUR AMERICAN TALENT AND THE STUFF WE DO ABROAD IS STILL THE THING THAT WAKES ME UP FEELING EXCITED EVERY DAY, AND I HOPE YOU FEEL THAT AS WELL. SO LET'S TAKE A BREAK. >> BEFORE WE BREAK, DAVID HAS ARRIVED. >> YES. >> SO HE CAN GIVE US A SORT OF A NICE SEND OFF. >> WE APPLAUDED YOU BEFORE YOU GOT HERE BECAUSE YOU -- [LAUGH YOU, RENEE, BOB AND REED ARE HERE FOR YOUR FINAL MEETINGS UNTIL WE FIGURE OUT A WAY TO DRAG YOU BACK. SO I SAID WORDS OF THANKS AND VARIOUS WORDS CAME BACK, WHICH WERE BRIEF BUT LOVELY. SO I DON'T KNOW IF YOU WANT TO ADD -- TURN ON YOUR MIC SO EVERYBODY CAN HEAR. >> IT REALLY HAS BEEN A PRIVILEGE TO SERVE. THIS IS OBVIOUSLY SOMETHING WE ALL THINK IS INCREDIBLY IMPORTANT, AT LEAST FOR ME, PROBABLY THE GREATEST PART OF ALL IS TO BE ABLE TO BE WITH THIS GROUP OF COLLEAGUES AND SHARE IDEAS AND THOUGHTS. I FEEL LIKE I'VE GOTTEN AT LEAST AT MUCH OUT OF IT AS I'VE GIVEN, SO THANK YOU FOR THE OPPORTUNITY. >> THOSE WERE GOOD WORDS. ALL RIGHT. [APPLAUSE] SO WE WILL TAKE A BRIEF BREAK, AND TONY WILL BE ARRIVING HERE SHORTLY SO MAYBE WE COULD HOLD THIS TO ABOUT 10 MINUTES, AND TRY TO REGATH MINUTES OF 11. WE'LL ONLY BE FIVE MINUTES BEHIND THAT WAY. THOSE ARE REALLY THE LIMITS, BUT VIRTUALLY ALL OF THE ONES THAT WE'VE HAD EXPERIENCE WITH WITH OUR COLLEAGUES THAT HAVE NOW GONE AND VOLUNTEERED AND WE HAVE SEVERAL NIH CLINICIANS WHO HAVE GONE OVER THERE AND VOLUNTEERED, IS THAT IT CLUSTERS VERY HEAVILY IN THE 8 TO 10 DAY PART, SO IT ISN'T AN EVEN DISTRIBUTION FROM 2 IT TO 21 DAYS. THERE ARE A COUPLE OF OUTLIERS ON ONE END AND THE OTHER, BUT THE VAST, VAST MAJORITY ARE AT 8 TO 10 DAYS. SYMPTOMS BEGIN AND YOU HAVE 1 TO 3 DAYS WHERE IT REALLY IS INDISTINGUISHABLE FROM A FLU-LIKE SYNDROME, AND AT TA POINT, WHEN YOU TRY AND TEST FOR THE VIRUS, YOU DON'T TEST POSITIVE OR IF YOU DO, IT'S VERY, VERY, VERY LOW TITER. THEN ABOUT 4 TO 7 DAYS, WHEN PEOPLE START TO GET GASTROINTESTINAL SYMPTOMS, VOMITING, DIARRHEA, HYPOTENSION, THEN YOU WIND UP WITH THE MULTIPLE ORGAN SYSTEM DYSFUNCTION, WHICH IS GENERALLY DUE, WHEN YOU DIE, ORGAN SYSTEM FAILURE DUE TO HYPOVOLEMIC SHOCK AND ELECTROLYTE IMBALANCE. AND IF YOU DON'T HAVE THE CAPABILITY OF EXTENSIVE I.D., REPLACEMENT OF LITERS AND LITERS OF DIARRHEA, THE DIFFERENCE BETWEEN THIS AND CHOLERA, CHOLERA IS FUNDAMENTALLY A DISEASE IN WHICH YOU HAVE DIARRHEA, THIS IS A SYSTEMIC DISEASE WHERE YOU HAVE MULTIPLE ORGAN SYSTEM DYSFUNCTION, AND WE'RE NOW FOLLOWING, BECAUSE THEY'RE HERE IN THE UNITED STATES, THE PEOPLE WHO SURVIVED IN THE UNITED STATES. WE TALK ABOUT POST VIRAL AS THEEN YA AFTER FLU, YOU FEEL TERRIBLE FOR A WHILE, THAT IS MAGNIFIED IMMENSELY IN THE PEOPLE WHO ARE CURRENTLY RECOVERING FROM EBOLA WHO ARE NOW HERE IN THE UNITED STATES. WE HAD ONE OF OUR CLINICIANS IN OUR INTENSIVE CARE UNIT, DAN CHERTOW, GO OVER AND VOLUNTEER IN AUGUST TO OCTOBER. THEY HAD EXPERIENCE WITH 700 EBOLA PATIENTS, AND THEIR EXPERIENCE WITH INCUBATION PERIOD, WITH CLINICAL SYMPTOMS, ET CETERA, WAS VERY, VERY MUCH LIKE WHAT THE ORIGINAL REALLY GOOD PAPERS FROM 1976, 1995, A REALLY GOOD PAPER THAT WAS REPORTED IN 1999 ON THE KICKWICK EXPERIENCE IN 1995, YOU GO BACK AND YOU READ THAT, IT'S A VERY, VERY GOOD DESCRIPTION OF WHAT WENT ON. THE INTERESTING THING IS, AND THIS HAS TO DO WITH WHAT WE WERE DEALING WITH ABOUT THE HEIGHTENED CONCERN, THAT IS A EUPHEMISM FOR KIND OF A LITTLE BIT OF HYSTERIA THAT WAS GOING ON IN THIS COUNTRY, ABOUT WHETHER A PERSON COULD OR COULD NOT TRANSMIT. POINCARE FULL HISTORY TAKING, IN TIS STUDY FROM WEST AFRICA, NO PATIENT WHO GOT EBOLA VIRUS DISEASE FROM AN INIT FECTED PERSON WAS EXPOSED TO THAT PERSON DURING THE EARLY FEBRILE ILLNESS. EVERYONE WHO GOT EBOLA HAD PERSONAL CONTACT WITH A PERSON WOULD WAS SICK, NOT SOMEONE, WELL, I RAN INTO HIM OR HER THE FEW DAYS BEFORE THEY WERE HOSPITALIZED WHEN THEY WERE FEELING A LITTLE WEAK. THAT'S BEEN BORNE OUT BY EXPERIENCES HERE, WHERE DUNCAN WAS WITH HIS FAMILY, AND HE INFECTED NURSES WHEN HE WAS SICK BUT HE DIDN'T INFECT ANY OF HIS FAMILY. SO THERE'S A LOT OF ACCUMULATING DATA ABOUT THE FACT THAT YOU DON'T TRANSMIT IT EVEN IF YOU'RE INFECTED I AND MILDLY SYMPTOMATIC. AGAIN, I SAY THAT AND I HAVE TO PAUSE, BECAUSE THEY BEAT US UP AT CONGRESSIONAL HEARINGS. IN BIOLOGY, YOU NEVER SAY NEVER AND YOU NEVER SAY ALWAYS. NOTHING IS A HUNDRED PERCENT, AND NOTHING IS ZERO PERCENT. BUT THE CLINICAL EVIDENCE THUS FAR STRONGLY ARGUES THAT A PERSON WHO ISN'T TRULY ILL WILL TRANSMIT THE VIRUS. SO LET'S TAKE A LOOK AT THE CURRENT OUTBREAK IN WEST AFRICA. THIS IS REALLY INTERESTING IN THE SENSE OF IT'S THE FIRST TIME IT OCCURRED IN WEST AFRICA, THE FIRST CASE WAS IN A CHILD FROM GUINEA WHO WAS INFECTED AND THE FIRST EXPERIENCE WITH FUNERAL TRANSMITTED. AGAIN, I HAD NO WAY OF KNOWING THIS, I'VE LEARNED IT ONLY BECAUSE HI TO LEAR I HAD TO LEARN IT, IS THAT THE PEOPLE IN THAT REGION OF THE WORLD, THEY ARE A VERY TOUCHY FEELY AFFECTIONATE PEOPLE. AND THIS PARTICULARLY GETS TRANSLATED WHEN YOU HAVE A FUNERAL SERVICE. IT IS TOTAL CUSTOM TO SPEND A COUPLE OF DAYS WASHING, PREPARING, TOUCHING, KISSING AND HUGGING THE BODY. THAT'S PART OF THEIR TRADITION, IT'S PART OF THE LOVING IN THE SOCIETY THAT UNFORTUNATELY TURNS AGAINST THEM AND MAKES THEM HIGHLY SUSCEPTIBLE TO TRANSMISSION. ANYWAY, THIS PERCOLATED ALONG FOR A WHILE, WAS NOT REALLY ON ANYBODY'S RADAR SCREEN UNTIL MARCH OF 2014, AS SHOWN ON IT THIS SLIDE. AND ANOTHER THING I IT DID NOT APPRECIATE, BUT YOU GET TO BE SECOND NATURE, IS LOOK AT THE WAY GUINEA WRAPS ITSELF AROUND SIERRA LEONE AND LIBERIA. AND RIGHT AT THIS INTERSECTION, YOU HAVE THREE BORDERS THAT ARE VERY POROUS. THEY'RE POROUS BECAUSE PEOPLE HAVE COUSINS AND UNCLES AND AUNTS AND RELATIVES THAT LIVE ON THE OTHER SIDE OF THE BORDER, SO IT ISN'T A REMOTE PLACE LIKE THE PRIOR OUTBREAKS, ALL OF WHICH WERE CONTROLLED. AND ALSO AS YOU'RE GOING TO SEE NOW, ONCE IT WENT FROM HERE, WHEN IT GOT INTO THE CITY, SO I WANT YOU TO FOLLOW ON THE NEXT FEW SLIDES. BOTH THE MAP IN WHICH THE RED SHOWS THE DISTRICTS AND THE SUSPECTED CASES, AND THEN TAKE A LOOK AT THE RELATIVE NUMBER OF SUSPECTED AND CONFIRMED CASES ON THE RIGHT HAND PANEL. MARCH OF 2014, MAY, JULY, SEPER, NOW WE'RE STARTING TO SEE THIS, OCTOBER, WE'RE STARTING TO SEE THIS, AND THIS WAS THE POINT WHERE LIBERIA WAS OUT OF CONTROL MUCH MORE SO THAN THE OTHER COUNTRIES. AND THEN WE HAVE NOVEMBER, WHEN WE'RE STARTING TO SEE SIERRA LEONE CATCH UP, AND NOW WE'RE IN DECEMBER, AND YOU'RE READING IN THE NEWSPAPERS THAT THERE ARE DECREASES IN CASES IN LIBERIA, AND A VERY, VERY SHARP INCREASE IN CASES IN SIERRA LEONE WITH BOTH MONROVIA NOW BEING MUCH, MUCH MORE DAMPENED IN EFFECT, WHERE MAJOR, MAJOR OUTBREAKS AROUND FREETOWN AND OTHER AREAS. SO IT'S STILL NOW AN OUT OF CONTROL -- WE'VE GOT TO BE REALLY CAREFUL BECAUSE UNLIKE OTHER INFECTIONS, YOU HAVE JUST AN AMBER IN THE PERIPHERAL AREAS, AND YOU COULD HAVE ANOTHER OUTBREAK IN AN AREA THAT YOU THOUGHT WAS UNDER CONTROL. THE OTHER INTERESTING THING HISTORICALLY IS THAT -- AND I'VE TAKEN THIS FROM A PAPER IN "NATURE." THE RED IS THE NUMBER OF DEATHS AND THE SIZE OF THE CIRCLE IS THE NUMBER OF CASES. THER HAVE BEEN 24 OUTBREAKS SINCE 1976. THE FIRST ONE OF WHICH WAS IN THE FORMER ZAIRE CURRENT DEMOCRATIC REPUBLIC OF THE CONGO, ALMOST SIMULTANEOUSLY WITH AN OUTBREAK IN SUDAN. AND I ONLY WAS ABLE TO PLOT LESS THAN TWO DOZEN BECAUSE SOME OF THE OUTBREAKS WERE SO SMALL, YOU WOULDN'T SEE THE CIRCLE. SO I'VE ONLY DONE THE ONES WHERE YOU CAN ACTUALLY VISIBLY SEE THE CIRCLE. BUT IF YOU LOOK AT THE TOTAL OF 24 OUTBREAKS, THERE WERE 2400 CASES AND 1200 DEATHS. SO ALREADY THIS OUTBREAK IS ABOUT SIX FOLD GREATER THAN ALL OF THE OTHER OUTBREAKS COMBINED. SO THIS IS CLEARLY A HISTORIC OUTBREAK. AND THE QUESTION IS, HOW AND WHY DID THAT HAPPEN, AND THERE ARE A NUMBER OF REASONS FOR THAT. FIRST OF ALL, WE'RE DEALING WITH POOR NATIONS WITH LIMITED HEALTH INFRASTRUCTURE. I DIDN'T REALLY FULLY APPRECIATE WHAT LIMITED HEALTH INFRASTRUCTURE IS UNTIL WE FOUND OUT THAT THEY HAVE ONE TO TWO DOCTORS PER 100,000 PEOPLE. THAT IS EXTRAORDINARY. SO THERE ARE MORE DOCTORS ON ONE FLOOR OF A BUILDING ON K STREET NORTHWEST THAN IN THE ENTIRE COUNTRIES THAT ARE THERE. THAT'S REALLY BIZARRE, BUT IT'S ABSOLUTE LEA TRUEABCLY TRUE. FOR THOSE OF YOU THAT DON'T KNOW, K STREET IS WHERE ALL THE DOCTORS ARE IN WASHINGTON. IF YOU'RE NOT AN NIHER. SO THEY DIDN'T HAVE ANY PRIOR EXPERIENCE WITH EBOLA, IT WAS MOSTLY IN CENTRAL AND SUB-SAHARAN AFRICAN, THEY HAVE FEW HEALTH OFFICIALS. THEY HAVE MULTIPLE OTHER HEALTH THREATS. MMALARIA IS HUGE. THERE'S LIMITED COOPERATION, EVEN THOUGH THERE ARE TRIBAL SIMILARITIES AND POROUS BORDERS, THE GOVERNMENTS DON'T COOPERATE VERY WELL AND WE ALL KNOW THERE IS A HISTORY OF VERY SERIOUS REGIONAL CONFLICTS WHICH LED TO A GREAT DISTRUST IN AUTHORITY. AND MEDICAL PERSONNEL ARE CONSIDERED AUTHORITY THERE, WHICH IS ONE OF THE REASONS WHY IT'S BEEN VERY DIFFICULT TO GET PEOPLE TO COME IN TO HOSPITALS AND THEN THERE WAS A VERY UNFORTUNATE SITUATION WHERE HEALTHCARE WORKERS WERE ACTUALLY ATTACKED AND KILLED BECAUSE THEY REPRESENTED AUTHORITY. AND I ALREADY MENTIONED THE BURIAL PRACTICES. NOW, IT WAS VERY INTERESTING, THERE'S A PAPER THAT CAME OUT IN SCIENCE ABOUT THE FACT THAT THERE WERE MUTATIONS IN THE VIRUS. WELL, THAT'S NOT SURPRISING. IT'S AN RNA VIRUS, THERE'S MUTATIONS IF INFLUENZA, THERE'S MUTATIONS IN NIH. ARE THE MUTATIONS FUNCTIONALLY RELEVANT IN THE SENSE OF WILL THEY OR WILL THEY HAVE AN EFFECT ON A FUNCTION. THAT WAS, I BELIEVE, INTERPRETED BMISINTERPRETED BY PEOPLE THAT LOOK AT THE VERY, VERY EXTREMES, AND IT'S FELT THAT, WELL, IT IF IT'S MUTATING, THE BIG QUESTION, THE WAY I GOT ASKED WITH WITH HIV 30 YEARS AGO, IS GOING TO TATE TO BMAWTATE TON RESPIRATORY-TRANSMITTED? IS EBOLA IN THE AIR, A NIGHTMARE THAT COULD HAPPEN? WHAT WOULD HAPPEN IF IT'S MUTATED TO THE POINT OF TRUE AEROSOL TRANSMISSION? AND THE FACT IS THAT THIS IS A LIKELIHOOD THAT IS EXTRAORDINARILY UNLIKELY, AND AS I SAID, AND THIS IS A PICTURE OF ALL OF US, OF ONE OF THE SEVEN OR SO CONGRESSIONAL HEARINGS THAT I HAD TO ATTEND DURING THAT FEW-WEEK PERIOD, AND THIS IS ALL OF THE PLAYERS, TOM FRIEDEN, SYLVIA BURWELL, JAY JOHNSON, LUMPKIN FROM THE DEPARTMENT OF DEFENSE, ET CETERA, ET CETERA. AND THE POINT THAT I MADE IS THAT ALTHOUGH ANYTHING IS POSSIBLE, THERE REALLY ARE NO EXAMPLES OF A VIRUS THAT HAS COMPLETELY CHANGED ITS MODALITY OF TRANSMISSION BY MUTATION. YOU CAN GET A LITTLE BIT MORE VIRULENT, A LITTLE BIT LESS VIRULENT, A LITTLE MORE EFFICIENT IN TRANSMISSION, BUT YOU DON'T COMPLETELY CHANGE YOUR METHODOLOGY OF -- OR YOUR MODALITY OF TRANSMISSION. SO LET'S TAKE A LOOK AT SOME OF THE DATA THAT WOULD UNDERSCORE THIS. THIS IS THIS TERRIFIC PAPER IN 1999 ON THE KICKWICK OUTBREAK IN THE DEMOCRATIC REPUBLIC OF CONGO. THERE WERE 17 173 HOUSEHOLD CONTACTS OF THE PATIENTS. EVEN THE PEOPLE WHO LIVED IN THE SAME HOUSE WITH AN EBOLA PATIENT, VERY SIMILAR TO DUNCAN, WHO WAS IN HIS APARTMENT IN DALLAS WITH HIS FAMILY BEFORE HE ACTUALLY WENT TO TEXAS PRESBYTERIAN HOSPITAL. THERE WERE NO TRANSMISSIONS IN THOSE WHO DID NOT HAVE DIRECT PHYSICAL CONTACT WITH THE PATIENT. SO THAT'S SOME OF IT IN A QUICK NUTSHELL. WHAT ABOUT THE PUBLIC HEALTH RPONSE IN THE AFFECTED COUNTRIES? WHY IS IT THAT THERE IS NOW A DOWNTICK IN LIBERIA, BECAUSE A LOT OF THINGS WENT ON FROM A NUMBER OF DIFFERENT SOURCES, THE UNITED STATES PLAYED A MAJOR ROLE BUT THERE WERE A VARIETY OF OTHER NON-NGOs AND OTHERS. EDUCATION, HYGIENE PRACTICES, IDENTIFICATION, AND THIS IS REALLY THE BIG ONE: CONTACT TRACING. THE PROPER PERSONAL PROTECTIVE EQUIPMENT, PROMPT ICE LAYING, AGGRESSIVE SUPPORT OF CARE, AND ABOVE ALL, SAFE BAR BURIAL. ASKED IF IT WAS MOST INFLUENCE, IT WAS SAFE BURIAL, TO GET PEOPLE TO REALIZE THAT, IN FACT, TRADITIONAL BURIAL CUSTOMS WOULD ACTUALLY PUT THEM IN HARM'S WAY. AS YOU KNOW, THE PRESIDENT HAD BEEN QUITE THE LEADER IN THIS IN HAVING MANY, MANY MEETINGS AT THE WHITE HOUSE. I HAVE ANOTHER ONE TOMORROW ACTUALLY ON THE RESPONSE. WE HAVE TROOPS THERE, WE'VE CONSTRUCTED EBOLA TREATMENT UNITS, THERE'S A 25-BED FACILITY FOR HEALTHCARE WORKERS THAT'S MANNED BY THE PUBLIC HEALTH SERVICE OFFICER, SEVERAL OF WHOM ARE EMPLOYEES OF THE NATIONAL INSTITUTES OF HEALTH, AND THE CDC AND USAID HAVE ACTUALLY PUT AN EFFORT THAT HAS COMPLETELY SURPASSED ANY OTHER PUBLIC HEALTH EFFORT. SO THE CDC HAS HUNDREDS OF PPLE THERE THAT GOES WELL BEYOND ANYTHING THEY'VE DONE WITH ANY OTHER PUBLIC HEALTH EFFORT. YOU'VE PROBABLY READ IN THE NEWSPAPERS, WE ASKED FOR -- "WE" BEING THE FEDERAL GOVERNMENT -- $6.18 BILLION. THE NIH'S REQUEST WAS QUITE MODEST, $238 MILLION, OF WHICH WE GOT OF NEW MONEY, THANK GOODNESS IT WAS NEW MONEY BECAUSE WE TEND SOMETIMES TO MOVE MONEY AROUND. THEY DIDN'T GET ALL 6.18, THEY GOT ABOUT 5 OF THAT. AND THAT'S MOSTLY FOR BUILDING UP A VARIETY OF APPROACHES. SO LET'S LOOK NOW AT EBOLA IN THE UNITED STATES. WHICH HAS REALLY BEEN A VERY INTERESTING EXPERIENCE FROM A NUMBER OF STAND POINTS, AND I'LL GET BACK TO THAT IN A MOMENT AND MAYBE WHEN WE HAVE QUESTIONS, I COULD ANSWER IT. I THINK ONE CAN CHARACTERIZE IT IN A NON-SAFICIOU WAY IS THAT FEAR CERTAINLY SPREAD MUCH FASTER THAN THE VIRUS DID IN THE UNITED STATES, BECAUSE THERE WAS REALLY, I THINK, A PANIC AND WHAT IT WAS, NOW THAT I CAN RETROSPECTIVELY ANALYZE IT, WAS A FAILURE TO PUT INTO THE PROPER COMPARTMENTS WHAT EBOLA IN THE UNITED STATES MEANS. SO THE GENERAL PUBLIC LOOKS AT THE FRONT PAGE OF THE "WASHINGTON POST" AND "THE NEW YORK TIMES" AND ON CNN, ON 24/7, THEY SEE PICTURES OF THE HORRIBLE SUFFERING AND PAIN OF BES IN THE STREET IN WEST AFRICA, AND WHEN THEY HEAR EBOLA IN THE UNITED STATES, THEY IMMEDIATELY MAKE A MAYBE UNDERSTANDABLE BUT COMPLETELY INAPPROPRIATE EXTRAPOLATION OF THAT TO THE UNITED STATES. AND THAT'S WHAT WE WERE FACED WITH FOR A VERY INTENSIVE PERIOD OF TIME IN OCTOBER TO TRY AND ESSENTIALLY PUT THAT KIND OF RESPONSE DOWN. SO LET'S LOOK AT IT IN THREE SEPARATE WAYS. FIRST OF ALL IS WHEN YOU DELIBERATELY AIR-EVACUATE AN IDENTIFIED OR SUSPECTED EBOLA PATIENT. WE HAVE HISTORY OF THAT. KENT BRANTLEY, NANCY, ALL OF THE OTHERS WE'VE HEARD ABOUT BROUGHT OVER O UNDER CONTAINMENT CONDITIONS ON PLANES SPECIALLY EQUIPPED TO HOSPITALS THAT HAVE BEEN SPECIALLY TRAINED. THAT'S NOT AN OUTBREAK. IT'S EBOLA IN THE UNITED STATES. BUT IT'S NOT AN OUTBREAK THE NEXT IS THE VERY RARE EVENT OF THE INADVERTENT IMPORTATION OF AN INFECTED PERSON. I'LL SHOW YOU HAD IN A MOMENT WHY NUMERICALLY THAT'S SUCH A RARE EVENT. OBVIOUSLY THE FAMOUS THOMAS DUNCAN, WHO WENT FROM LIBERIA TO BRUSSELS, BRUSSELS TO TEXAS, AND TRIGGERED THE SITUATION THAT I'LL DESCRIBE BRIEFLY IN TEXAS. THE OTHER IS A HEALTHCARE WORKER. CRAIG SPENCER. PROBABLY NOW THE MOST FAMOUS NEW YORK BOWLER IN THE WORLD, BECAUSE HE CAME HOME, HE WAS TIRED. INDEED, HE WAS TIRED. HE HAD JUST GOT OFF AN 18-HOUR TRIP. AND DECIDED HE WAS GOING TO GO OUT FOR A RUN AND THEN GO BOWLING, TO DINNER. AS SOON AS HE GOT A FEVER, HE IMMEDIATELY WENT INTO THE PROPER PROTOCOL, WAS ADMITTED TO BELLEVUE HOSPITAL, AND ALL WENT WELL, HE WAS DISCHARGED. THEN, THERE IS THE THING THAT IS LIKELY THE MOST DISTURBING, WAS THE HEALTHCARE WORKERS WHO WERE INFECTED, TAKING CARE OF DUNCAN. AND ONE OF THEM WAS NINA PHAM, WHO WE TOOK CARE OF HERE AT THE NIH, AND THE OTHER WAS AMBER VINSON. WE CAN GET INTO THE QUESTION PERIOD OF THE SITUATION OF WHY WE THINK THEY GOT INFECTED. BUT YOU DON'T CON FLATE THESE. THESE ARE NOT OUTBREAKS. I CAN'T TELL YOU HOW MANY TIMES IN THE CONGRESSIONAL HEARINGS THAT I TESTIFY WHERE PEOPLE -- HOW DO YOU EXPLAIN THE OUTBREAK IN THE UNITED STATES? IT'S NOT AN OUTBREAK. IT WAS NOT AN OUTBREAK. BECAUSE THERE WAS CONTACT TRACING. AND THAT'S THE PERFECT STORM ISSUE WHEN I SAY THAT ACTUALLY A PERSON WHO GETS INFECTED, IF YOU DO PROPER IDENTIFICATION, ISOLATION, AND CONTACT TRACING, IT IS VERY UNLIKELY THAT YOU'LL HAVE AN OUTBREAK. YOU CAN HAVE A CASE, AND IN FACT, WE HAVE SOMEONE THAT I'M GOING TO SEE IN ABOUT AN HOUR AND A HALF WHO'S BEING FLOWN HERE FROM SIERRA LEONE, WHO HAD A NEEDLE STICK HIGH RISK INJURY. SO WE'RE GOING TO GO AND FIND OUT, A, DOES SHE HAVE EBOLA, AND IF SHE DOES, WE'LL TAKE CARE OF HER. THAT'S NOT AN OUTBREAK. OKAY. SO WHAT ABOUT MEDEVAC? WE'RE NOT THE ONLY COUNTRY THAT HAVE MEDEVACS. THERE HAVE BEEN MEDEVACS TO A VARIETY OF OTHER COUNTRY, SHOWN HERE OF THEIR CITIZENS WHO VOLUNTEERED AS OURS DO, WE'RE NOT THE ONLY ONES THAT VOLUNTEER, OTHER COUNTRIES HAVE VOLUNTEERED, AND SOME OF THEM HAVE GOTTEN INFECTED. AS I MENTIOED, THE TWO THAT WERE THE MOST FAMOUS WERE KENT BRANTLEY AND NANCY WRITEBOL. NOW, THERE ARE OTHER MEDEVAC CASES SHOWN HERE. WE NOW LEARN FROM THESE INDIVIDUALS THAT THE POST INFECTION RECOVERY PERIOD IS VERY DIFFICULT. THERE WAS A VERY INTERESTING ARTICLE ABOUT IAN CROZIER, WHO CAME BACK AND WAS TREATED AT EMORY, WHO IS WELL, HE'S CERTAINLY SURVIVED, BUT HE'S HAVING CONSIDERABLE POST VIRAL SYMPTOMATOLOGY. IT'S NOT AN EASY VIRUS TO RECOVER FROM. A BIT JUST HISTORICALLY TO REFRESH YOUR MEMORY ABOUT WHEN DUNCAN CAME FROM LIBERIA TO DALLAS. VERY INTERESTING. DEPARTED IN MONROVIA THE 19TH, ARRIVED IN BRUSSELS, FLEW THE SAME DAY TO DALLAS. HE WENT FOUR DAYS WITHOUT SYMPTOMS. THE REASON I WANT TO POINT THIS OUT IS THAT HAVING GONE THROUGH TRYING TO EXPLAIN THIS TO THE CONGRESS WAS THE CONCERN THAT DURING THIS PERIOD, FROM HERE TO THERE, HE WAS ASYMPTOMATIC. HE WAS ASYMPTOMATIC O ON THE PLANE. HE PRESENTED TO AN E.R., AND UNFORTUNATELY HE WAS NOT ADMITTED. HE WENT HOME, GOT REALLY SICK, AND THEN CAME IN VERY SICK TO THE HOSPITAL, TESTED POSITIVE FOR EBOLA, AND THEN HE DIE. SO THE QUESTION IS, WAS HE INFECTING PEOPLE IN THE UNITED STATES, AND THAT WAS THE MAJOR CONCERN THAT THERE WERE NOW HUNDREDS OF PEOPLE HE MAY HAVE COME INTO CONTACT WITH. BUT WE KNOW NOW THAT SINCE HE WAS WITHOUT SYMPTOMS, IT WAS EXTREMELY UNLIKELY THAT HE WOULD TRANSMIT IT. WE KNOW NOW BECAUSE WE FOLLOWED ALL OF HIS CONTACTS FOR 21, NOW IT'S 40 SOME ODD, 50, 60 DAYS, AND NOP O NONE OF THEM HAVE GOTTEN INFECTED. SO AGAIN, IT DOESN'T MEAN THAT IT'S IMPOSSIBLE, BUT IT'S UNLIKELY. OKAY. AND THEN THINGS STARTED TO GET INTO A PROBLEM. NAMELY, THE TWO NURSES WHO WERE INFECTED WHILE IN THE UNITED STATES. AS SOME OF YOU MAY KNOW, TH THE NIH EMORY IN NEBRASKA ARE PART OF THE THREE CORE HOSPITALS IN THE CLINICAL CENTER THAT WE BUILT AT THE END OF 2010 INTO EARLY 2011. AND IN CASE YOU DON'T RECOGNIZE, THIS IS WHAT I'M GONNA LOOK LIKE IN ABOUT 2 1/2 HOURS. WHEN I GO OVER THERE. BUT THERE'S GOOD NEWS, NINA PHAM, DISCHARGED AFTER BEING THERE FOR EIGHT DAYS, THESE ARE OUR CREW OF PHENOMENAL NURSES THAT YOU DON'T HEAR MUCH ABOUT AT THE ACD MEETING, BUT WE HAVE AN EXTRAORDINARY CREW OF PEOPLE OVER IN THE CLINICAL 16ER IT, AND THESE ARE OUR INTENSIVE CARE, AND SPECIAL CLINICAL UNIT INDIVIDUALS. OKAY. NOW, THE FACT IS, WHEN THIS HAPPENED, THERE WAS A BIG DISCUSSION ABOUT SHOULD WE BAN AIR TRAVEL FROM WEST AFRICA. WE MADE A VERY STRONG ARGUMENT THAT THE BEST WAY TO SUPPRESS THE VIRUS IN THE UNITED STATES, IN FRANCE, IN THE U.K., IS TO SUPPRESS IT IN WEST AFRICA, AND NOT TO ISOLATE THAT COUNTRY TO THE POINT WHERE THEY COULD COLLAPSE AND THEN IT WOULD SPREAD TO MOLI, SO WHAT WAS INSTITUTED WAS EXIT SCREENING AND ENTRY SCREENING. VERY BRIEFLY, YOU GO TO THE AIRPORT AND IF YOU HAVE A FEVER OR SYMPTOMS OF CON TACK, YOU CONTACT, YOU DON'T EACH GET ON THE PLANE. US A ENTER, ONLY THROUGH FIVE AIRPORTS NOW, YOU CAN'T GET FROM ANY OF THOSE COUNTRIES EXCEPT IF YOU LAND IN ONE OF FIVE AIRPORTS HERE. NEWARK, JFK, INTERNATIONAL AIRPORT AT DULLES, CHICAGO, AND ATLANTA. IF YOU DON'T GO INTO ANY OF THOSE, YOU CAN'T GET INTO THE COUNTRY. SAME THING. NOW, TWO DAYS AGO, THE CDC -- YOU MAY NOT HAVE SEEN IT YET -- CAME OUT WITH THE DATA OF EXIT AND ENTRY SCREENING. BECAUSE I GOT ASKED THE QUESTION MANY TIMES, I'M SORRY, I HAVE TO DO THIS TO YOU BECAUSE I WANT TO YOU FEEL MY PAIN, WE GET BEAT UP FOR EIGHT DAYS IN A ROW BY THE CONGRESSIONAL COMMITTEES -- IS THERE'S GOING TO BE A MASSIVE NUMBER OF PEOPLE WHO ARE GOING TO WANT TO COME TO THE UNITED STATES FOR CARE WITH EBOLA. I'M TRYING TO SAY, WELL, YOU DON'T KNOW YOU HAVE EBOLA AND IF YOU DO, THAT'S THE LEAST THING ON YOUR MIND, IS GOING TO THE AIRPORT. ANYWAY, FROM AUGUST TO OCTOBER OF 2014, 80,000 TRAVELERS WERE SCREENED ON EXIT FROM THESE COUNTRIES, 12,000 CAME -- COMING TO THE UNITED STATES. OF THE PASSENGERS DENIED BOARDING, DUE TO SYMPTOMS OF HIGH RISK EXPOSURE, NONE OF THEM WERE ULTIMATELY DIAGNOSED WITH EBOLA. SO THOSE WHO WERE SUSPECTED, MOST OF THEM HAD MALARIA WHEN THEY HAD FEVER. IF YOU LOOK AT THE ENTRY SCREENING, 1993 PERSONS WERE SCREENED. NONE WERE SYMPTOMATIC DURING TRAVEL. 86 WERE REFERRED TO THE CDC OFFICES AT THE AIRPORT. SEVEN OF THE 86 WERE FOUND TO BE SYMPTOMATIC AND REFERRED FOR FURTHER MEDICAL TREATMENT. NONE OF THEM HAD EBOLA. SO AGAIN, WE WITH MAY HAVE ANOTHER CASE THAT SLIPPED TH. IT IS ENTIRELY POSSIBLE. BUT THERE AREN'T HORDES OF PEOPLE TRYING TO GET INTO THE UNITED STATES. AGAIN, THIS IS THE PHYSICIAN, CRAIG SPENCER, WHO WAS INFECTED WHILE SERVING IN AN EBOLA TREATMENT UNIT AND THE ONE THAT GOT A LOT OF PUBLICITY, AND THAT LED TO THE FAMOUS ARGUMENT OF SHOULD WE QUARANTINE EVERYONE. AND WE ARGUED FORCEFULLY NOT TO. AND THE REASON IS, THERE'S SCIENTIFIC EVIDENCE I'VE JUST GIVEN YOU OVER THE LAST 20 MINUTES OR SO. THE REASON WHY NOT. THE OTHER REASON IS, IF YOU QUARANTINE FOR 21 DAYS, YOUR HEALTHCARE WORKERS, YOU WILL VERY RAPIDLY RUN OUT OF HEALTHCARE WORKERS WHO ARE GOING TO BE ABLE TO TAKE CARE OF PATIENTS. SO THAT JUST DIDN'T MAKE ANY SENSE. AND WHAT PEOPLE DIDN'T SEEM TO UAND WAS THE DIFFERENCE BETWEEN ISOLATION, WHERE YOU SEPARATE A SICK PERSON WITH A CONTAGIOUS DISEASE, FROM QUARANTINE, WHICH SEPARATES PEOPLE WHO ARE EXPOSED BUT ARE NOT NECESSARILY INFECTED. SO WE HAD TO DO A CORRECT BALANCE. NAMELY, THE RIGHTS AND THE AVAILABILITY OF HEALTHCARE WORKERS, AND THE UNINTENDED CONSEQUENCES FOR OUTBREAK CONTROL BALANCED AGAINST THE RISK TO THE AMERICAN PUBLIC. SO WORKING CLOSELY WITH WITH FRIEDEN, WE PUT TOGETHER WHAT I CALL A STRATIFICATION OF RISK. SO INSTEAD OF SAYING A HEALTHCARE WORKER OR A PERSON IS ALL OR NONE, IT'S WHAT IS THE LEVEL OF YOUR RISK AND BALANCE THE LEVEL OF YOUR RISK AGAINST, A, HOW INTENSIVELY YOU'LL BE MONITORED, AND B, HOW RESTRICTED YOUR TRAVEL WOULD BE. SO FOR EXAMPLE, HIGH RISK, DIRECT CONTACT WITHOUT PROPER PPE WITH BODY FLUIDS, OR A NEEDLE STICK. SO THAT'S WHY OUR PERSON IS A HIGH RISK. SOME RISK, CLOSE CONTACT WITHOUT PROPER PPE, DIRECT CONTACT WITH PROPER PPE, BUT IN AN AREA WHERE THERE'S VIRUS ALL AROUND YOU, OR LOW BUT NOT ZERO RISK, ET CETERA, ET CETERA. SO I DON'T WANT TO GO THROUGH ALL OF THEM, BUT THEY'RE STRATIFIED. AND BASED ON THIS, THEN YOU DO THIS. WHAT IS THE KIND OF MONITORING, DIRECT ACTIVE MONITORING, ACTIVE MONITORING IS I TAKE MY TEMPERATURE AND I RECORD IT TO SOMEBODY. DIRECT ACTIVE MEANS SOMEBODY TAKES MY TEMPERATURE, DOESN'T BELIEVE ME, ANSI AND SEES THE THERMOMETER AND RECORDS IT AND EITHER RESTRICTS ME CASE BY CASE OR NO RESTRICTION BUT -- SO HERE'S WHERE I WAS AFTER TAKING CARE OF NINA PHAM. BECAUSE I TOOK CARE OF HER BUT I WAS IN A SETTING THAT WASN'T A WIDE OUTBREAK SETTING. I WASN'T IN SIERRA LEONE, I WAS IN THE NIH. SO I WAS LOW BUT NOT ZERO RISK. SO I HAD DIRECT ACTIVE. NAMELY SOMEBODY TOOK MY TEMPERATURE FOR 21 DAYS, AND THAT WAS IT. AND I HAD NO RESTRICTIONS. IF WE DO THAT, WE FEEL WE CAN FAIRLY AND SAFELY MONITOR. SO LET ME CLOSE BY TALKING A LITTLE BIT ABOUT THE ROLE OF RESEARCH AND DEVELOPMENT. DIAGNOSTICS, WE'RE WORKING VERY CLOSELY WITH THE CDC. TWO CHALLENGES OF DIAGNOSTICS. ONE, A POINT OF CARE THAT YOU GET THE RESULTS RIGHT AWAY. THE OTHER, A SENSITIVE ONE THAT GETS THE VERY LOWEST LEVEL OF TITER OR VIRUS, EVEN AT A POINT WHERE THE -- THERE ARE TWO TYPES NOW, AND WE'RE WORKING ON BOTH, AND THE CDC AND THE NIH ARE WORKING VERY CAREFULLY ON THAT. WITH REGARD TO VACCINES, THERE ARE ABOUT FIVE VACCINE CANDIDATES. THE ONES THAT ARE TEMPORALLY AND WITH REGARD TO DATA FURTHEST AHEAD IS THE NIAID GSK EBOLA VACCINE, WHICH IS A CHIMP ADENO3 WITH THE INSERT OF A GLYCOPROTEIN. WE'VE HAD GREAT COLLABORATION FROM GSK WORKING ON THIS IN A PHASE ONE TRIAL DONE RIGHT HERE ON CAMPUS. IT LOOKED GOOD, IT WAS RECENTLY PUBLISHED IN THE NEW ENGLAND JOURNAL. THE PHASE ONE TRIAL, I SAY UNDERWAY. WE'RE GOING TO FOLLOW THEM OUT FOR 48 WEEKS. THERE ARE OTHER TRIALS WITH MONO VAI LEN VERSUS BI VAI LEN BEING DONE IN OTHER COUNTRIES US OTHER CONTINENTS. THEN THERE'S THE VSV, WHICH IS THE SAME PRINCIPLE EXCEPT THIS IS A LIVE VIRUS, AND AGAIN WE'RE DOING THIS TRIAL, TWO DAYS AGO WE JUST GAVE IT TO THE LAST PATIENT IN OUR PHASE 1, SO WE'RE NOW OBSERVING IT TO SEE IF THERE ARE ANY ADVERSE EVENTS AND/OR WHAT THE IMMUNOITY IS. SO THIS ONE HERE HAS A STRONG HISTORY. THE CHIMP DATA RECENTLY CAME OUT SHOWING THAT IT WAS QUITE GOOD IN PROTECTION. THE ISSUE IS GOING TO BE THAT THE PROTECTION DURABILITY, AT THE DOSE WE GAVE, IT PROTECTED VERY WELL. HOW LONG IS IT GOING TO PROTECT IT MIGHT REQUIRE A BOOST. AND WE'RE CONSIDERING THAT IN COLLABORATION WITH OTHER GROUPS. THIS IS THE NEW ENGLAND JOURNF MEDICINE PA PER THAT WAS PUBLISHED JUST A COUPLE OF WEEKS AGO. AGAIN, VERY SUCCESSFUL PHASE 1 TRIAL. IT'S A HIGH DOSE, THERE WAS VERY ROBUST ANTIBODY RESPONSES COMPARABLE TO THE ANIMAL MODELS THAT WERE PROTECTED, AND GOOD CD8 RESPONSES. THIS IS INTERESTING FOR THE IMMUNOLOGISTS IN THE GROUP, THAT IT MAY BE THAT CD # RESPONSES8 RESPONSES PLAY A MAJOR ROLE IN PROTECTION. WITH REGARD TO THERAPEUTICS, THESE ARE SOME OF THE THERAPEUTICS THAT ARE BEING TESTED. THE REAL IMPORTANT THING THAT I WANT TO EMPHASIZE TO THIS GROUP BUT I THINK YOU KNOW ENOUGH ABOUT THESE ISSUES THAT YOU DON'T NEED TO LEARN IT, YOU JUST NEED TO UNDERSCORE IT. AND THAT IS THAT WE DON'T KNOW IF ANY OF THESE WORK. THEY'VE ALL BEEN GIVEN ON A CATE BASIS TO SEVERAL OF THE PEOPLE UNDER CONDITIONS THAT WERE COMPLETELY NOT CONTROLLED. SO OUR CHALLENGE NOW IS TO DETERMINE WHICH OF THESE WORK. BE IT ZMAPP, THE TRIPLE ANTIBODY NOW, THE SMALL INTERFERING RNA PRODUCTS THAT WERE MADE FOR OTHER VIRUSES LIKE BRINCIDOFOVIR AND OTHERS, WE'VE DONE A PROTOCOL HERE AT NIH IN COLLABORATION WITH OTHER INSTITUTIONS SEEING PATIENTS AND HOPEFULLY WE'LL GET AN ANSWER. IT'S NOT EASY TO GET AN ANSWER OF EFFICACY WHEN YOU'RE IN THE MIDDLE OF AN OUTBREAK WHICH THERE'S NO EFFECTIVE THERAPY. IT'S REALLY A CHALLENGE IN A CLINICAL TRIAL. THE OTHER THING THAT'S BEING DONE IS THE IDEA OF PASSABLE CONVALESCENT TRANSFER OF SERUM, OF PEOPLE WHO HAVE RECOVERED. YOU KNOW FROM THE PAPERS THAT KENT BRANTLEY HAS GIVEN UNITS OF PLASMA MATCHED TO MY PATIENT, TO OUR PATIENT, AS WELL AS TO A NUMBER OF OTHER PATIENTS. SO THIS IS SOMETHING AGAIN THAT NEEDS TO BE DETERMINED. SO LET ME CLOSE BY THIS LAST SLIDE, WITH WHICH I CALL LOOKING AHEAD, TO RE-EMPHASIZE AGAIN AND AGAIN, IT'S VERY IMPORTANT TO CONTINUE TO FOCUS ON WHAT THE PROBLEM IS, AND THE PROBLEM IS A MASSIVE OUTBREAK IN WEST AFRICA. FEAR IN THE UNITED STATES, FEAR IN THE DEVELOPED WORLD, BUT AN OUTBREAK IN WEST AFRICA. THE OTHER IS THAT MANY COUNTRIES THROUGHOUT THE WORLD ARE IN PARTNER WITH US ABOUT WHAT'S CALLED A GLOBAL HEALTH SECURITY AGENDA. NAMELY, TO HAVE THE SURVEILLANCE AND INFRASTRUCTURE CAPABILITY THROUGHOUT THE WORLD SO THAT YOU COULD PICK UP THESE THINGS ON THE GROUND WHEN THEY HAPPEN. IF WE HAD HAD AN EVEN MODICUM OF A GLOBAL HEALTH SECURITY AGENDA IN WEST AFRICA, WE WOULD HAVE NOTICED THE INITIAL CASE IN GUINEA AND PUT A MASSIVE EFFORT TO TRY AND CONTROL THAT. AND THEN FINALLY, THE REASON WHY I CHOSE THE WORD THE PERFECT STORM IS THAT WE NEED TO MOVE TO ELIMINATING TO THE EXTENT POSSIBLE, BECAUSE OBVIOUSLY IT'S NOT EASY, THE EXTRAORDINARY DISPARITIES IN HEALTHCARE INFRASTRUCTURE THAT EXIST IN THE DEVELOPING WORLD BECAUSE IF WE DID NOT HAVE THAT KIND OF DISPARITY, I THINK MANY OF THESE OUTBREAKS, I DON'T THINK NECESSARILY COULD BE PREVENTED BUT THEY CERTAINLY COULD BE CONTROLLED. SO I'LL STOP THERE AND ANSWER ANY QUESTIONS. [APPLAUSE] >> TONY, THANK YOU FOR AN ELEGANT TOUR THROUGH AN AWFUL LOT OF MATERIAL. CAN YOU SAY A LITTLE BIT ABOUT WHERE THINGS STAND WITH THE VACCINE TRIAL? THERE'S SEVERAL CHALLENGES HERE WITH THE EPIDEMIC IT SELF EVOLVING AND PARTICULARLY WITH THE PLANS TO CONDUCT A LOT OF THE TRIAL IN LIBERIA, WHERE THINGS NOW SEEM TO BE GETTING A LITTLE BETTER. HOW DOES ONE ACTUALLY PLAN IN THE FACE OF SUCH UNCERTAINTY AND WHERE DOES THAT ALL STAND? >> FRANCIS HAS JUST ASKED A CRITICAL QUESTION. THERE ARE A NUMBER OF DIFFERENT CHALLENGES AT DIFFERENT LEVELS OF TRYING TO PROVE THE EFFICACY OF A VACCINE IN THE MIDDLE OF AN OUTBREAK IN WHICH YOU REALLY DON'T HAVE ANY INTERVENTION. THE CLASSIC TRIED AND TRUE WAY, AND REALLY THE -- PROBABLY THE ONLY WAY THAT THE FDA WILL APPROVE A VACCINE IS A RANDOMIZED CONTROL TRIAL. IN WHICH THERE ARE EMOTIONAL REASONS ON THE PART OF SOME NOT TO DO THAT, AND I'LL ADDRESS THOSE IN JUST A SECOND. THE OTHER IS TO PLAN IT IN A COUNTRY IN WHICH AN EPIDEMIC IS ROARING AND THEN BY THE TIME YOU GET THE VACCINE PAST A PHASE 1, THERE ARE VIRTUALLY NO INFECTIONS OR VERY FEW INFECTIONS IN THAT COUNTRY AND THEY'RE EXPLODING IN THE OTHER COUNTRY. SO WE'RE PLANNING A RANDOMIZED CONTROL TRIAL WITH THE GLAXOSMITHKLINE PRODUCT IN LIBERIA, AND THE CDC IS -- TOGETHER WITH VSV, IT'S GOING TO BE A PLACEBO AND TWO CANDIDATES. THE CDC TOGETHER WITH US IS PLANNING TO DO A DIFFERENT DESIGN, WHAT'S CALLED A STEP WEDGE IN SIERRA LEONE, WITH THE SAME VACCINE CANDIDATES. SO RIGHT NOW, WE'RE GOING TO HAVE TO POSSIBLY MODIFY OUR SCHEDULES IN THE SENSE OF FIND OUT, CLIFF LANE, MY DEPUTY, IS LEAVING IN ABOUT FOUR HOURS TO GO TO LIBERIA, TOM FRIEDEN IS LEAVING TOMORROW EVENING TO GO TO SIERRA LEONE AND LIBERIA AND IS GOING TO MEET UP WITH CLIFF AND TRY AND FIGURE OUT WHAT WE CAN DO VIS-A-VIS THAT. SO IT'S THE DESIGN, IT'S THE INCIDENCE, AND IT'S THE EMOTIONAL BLOWBACK ABOUT HOW CAN YOU THINK ABOUT EFFICACY. SO I HAVE TO TELL YOU A VERY QUICK STORY THAT'S REALLY RELEVANT THAT WE DON'T OFTEN GET A CHANCE TO SAY. SO COMPARE HIV WITH EBOLA. SO THERE ARE MANY PEOPLE, GOOD PEOPLE OF GOODWILL, HIGHLY QUALIFIED, WHO ARE SAYING YOU JUST SHOULD DISTRIBUTE THE VACCINE TO EVERYBODY, THERE'S NO ROOM FOR DOING A TRIAL. THIS IS OPEN ACCESS, IT'S BETTER THAN NOTHING. OKAY. WELL, LET'S GO BACK A FEW YEARS TO THE HIV VACCINE, BECAUSE THIS VACCINE IS GOOD IN AN ANIMAL, PASSED PHASE 1, AND MANY PEOPLE SAY LET'S GO AND JUST GIVE OPEN ACCESS. BECAUSE 6,000 PEOPLE HAVE DIED, AND 17,000 PEOPLE HAVE GOTTEN INFECTED. SO A FEW YEARS AGO, WE HAD A VACCINE CANDIDATE WITH HIV. IT WAS THE STEP TRIAL THAT WE DID COLLABORATION WITH MERCK. IT HAD REALLY GOOD DATA IN THE ANIMAL MODEL. IT HAD A REALLY GOOD PHASE 1 SAFETY PROFILE, AND IN PHASE 2A, IT ACTUALLY WAS EVEN MORE SAFE AND GOOD IMMUNOGENETICS -- IMMUNOJGENICITY. OVER THE LAST THREE DAYS, 12,000 P HAVE DIED FROM HIV/AIDS. THAT'S TWICE AS MANY AS ALL OF THE PEOPLE WHO DIED OF EBOLA IT IN THE LAST SEVERAL MONTHS. SO YOU CAN MAKE THE ARGUMENT, IT'S AN EMERGENCY, JUST GIVE OPEN ACCESS TO THE HIV VACCINE IN SUB-SAHARAN AFRICA. HOWEVER, WE DID A RANDOMIZED DOUBLE BLIND CONTROLLED TRIAL, AND WE FOUND OUT THAT THE VACCINE CANDIDATE RESULTED IN A 41% INCREASE IN RISK OF INFECTION COMPARED TO THE PLACEBO. COULD YOU IMAGINE WHAT WOULD HAVE HAPPENED IF WE HAD WIDELY DISTRIBUTED AN HIV VACCINE IN AFRICA THAT ACTUALLY ENHANCED INFECTION? SO AGAIN, UNDERSTANDING FRANCIS' QUESTION ABOUT THE CHALLENGES, THAT WE UNDERSTAND THE NEED TO GET IT OUT THERE, BUT YOU ALSO HAVE TO UNDERSTAND THE ISSUE OF DO NO HARM. AND THAT'S THE THING THAT'S DRIVING THESE TRIALS. >> TONY, IT'S HARD TO BELIEVE I HAVE ANYTHING MORE TO TALK WITH YOU ABOUT ON EBOLA, BUT I DO. SO THE FIRST ONE, THE EASY ONE, IN TERMS OF MESSAGING, I THINK ONE OF THE PROBLEMS WE HAVE IS THAT AIR AND AEROSOL AND AIR AND AIR BORNE SOUND TOO SIMILAR. >> YEAH. YOU'RE RIGHT. >> IF WE TALK ABOUT DROPLET TRANSMISSION VERSUS AIRBORNE TRANSMISSION, WHICH IMPLIES 2 METERS DISTANCE, THEN IT SEEMS TO BE CLEAR EVEN IN PEOPLE LIKE BILL O'REILLY, WHICH IS WHAT I'VE TRIED TO HAMMER ON. SO MAYBE WE SHOULD TALK ABOUT DROPLETS VERSUS AIR BORNE. >> RIGHT. >> THERE WERE TWO OTHER THINGS I WANTED TO SAY BUT I'LL ONLY TALK ABOUT THE LAST ONE AND LET SOMEBODY ELSE GET IN. I DON'T THINK THE HIV-EBOLA COMPARISON RESONATES WITH ME, AND THERE ARE A COUPLE OF REASONS FOR THAT. ONE IS THAT EBOLA IS AN ACUTE DISEASE, AND IT DOESN'T EVOLVE AS RAPIDLY AS HIV AND IT DOESN'T LURK IN INTRACELLULAR LOCATIONS. AND I, FOR ONE, HAVE CHAMPIONED THE VSV VACCINE, BECAUSE MY CONCERN IS THAT IT'S GOING TO BE DIFFICULT ENOUGH TO GET PEOPLE TO TAKE ONE DOSE OF VACCINE TO GET THEM TO COME BACK FOR A BOOSTER IS GOING TO BE EVEN MORE CHALLENGING. AND I THINK GIVEN THAT WE KNOW SINCE 2004 THAT THE VSV VACCINE IS PROTECTED IN NON-HUMAN PRIMATES AND IT'S PROTECTED IN OTHER SPECIES AS WELL, I FOR ONE WOULD FAVOR MAKING THAT VACCINE AVAILABLE, I'M NOT COMFORTABLE WITH A CONTROLLED TRIAL ALTHOUGH I APPRECIATE THAT IT'S IDEAL, I THINK IN THIS CIRCUMSTANCE, I'M WITH JEREMY ON THIS. I REALLY THINK -- >> I STILL LIKE YOU. >> I KNOW. [LAUGHTER] >> OKAY. SO THERE ISN'T AN ARGUMENT AS THERE IS A DISCUSSION. I WOULD NOT SAY -- YOU KNOW, HAVING DEVELOPED -- YOU'VE BEEN WITH ME THROUGHOUT THESE DECADES -- MULTIPLE VACCINES. I REALLY FALL VERY SHORT OF PREDICTING ONE IS GOING TO BE BETTER THAN THE OTHER UNTIL YOU TEST THEM. YOU'VE GOT TO BE REALLY CAREFUL ABOUT THAT. THAT'S THE FIRST THING. THE SECOND THING IS THAT IF WE HAD DISTRIBUTED ANY VACCINE IN THE END OF OCTOBER, THE BEGINNING OF NOVEMBER, WHEN LIBERIA WAS WAY UP HERE, AND THEN LIBERIA CAME DOWN, WHAT WOULD HAVE BEEN THE CONCLUSION? THE VACCINE DID IT. AND IT WASN'T THE VACCINE. IT WAS BURIAL PRACTICES, IT WAS ISOLATION, IDENTIFICATION, CONTACT TRACING. SO I UNDERSTAND WHAT YOU'RE SAYING. AND THEY ARE DIFFERENT IN THE SENSE OF ONE IS A LIVE VIRUS, YOU KNOW, WITH ONE MIGHT REQUIRE A BOOST FOR DURABILITY, NOT NECESSARILY A BOOST TO GET TO THE LEVEL THAT YOU WANT, BECAUSE IN OUR TRIAL HERE, WE GOT VERY GOOD IMMUNOGENICITY AT ONE TIMES 10 TO THE 11. NOW THEY'RE TESTING FIVE TIMES 10 TO THE 10TH IN THE U.K. AND WE'RE WAITING TO SEE WHAT ADRIAN HILL'S DATA ARE ON THAT, BUT I'M NOT SURE YET WHAT THE RIGHT DOSE IS, SO BEFORE WE START TALKING ABOUT ONE BEING BETTER THAN THE OTHER, WE NEED TO GET ALL THE DATA. >> I'M NOT SUGGESTING THEY'RE BETTER FROM A HYPOTHETICAL VANTAGE POINT. I'M THINKING ABOUT THIS PURELY IN TERMS OF LOGISTICS. >> RIGHT. >> IF SOMEONE GETS ONE DOSE OF THIS VACCINE AND DOESN'T RETURN, AND THEY THEN BECOME INFECTED AND DIE OF EBOLA, THEN THEY'RE GOING TO SAY THE VACCINE DOESN'T WORK AND ALL THE VACCINES -- BECAUSE I KNOW YOU'VE TALKED ABOUT THIS WITH POLIO, AND THIS IS A HUGE RISK THAT WE HAVE. SO I'M VERY CONCERNED ABOUT THE BOOST REQUIREMENT. IF THAT PROVES TO BE TRUE, THEN I MAY BE VERY DIFFICULT FOR -- >> YOU'RE ABSOLUTELY RIGHT. >> BUT REMEMBER THE AIRBORNE DROPLET THING. THE LAST THING I WANTED TO SAY IS ABOUT THE DIAGNOSTICS. SO PEOPLE DRAW A ML OF BLOOD. BY THE TIME YOU FINISH WITH ALL THE PREPARATION, NUCLEIC ACID, SO ON, YOU WIND UP ANALYZING ABOUT 50 MICRO LITERS OF BLOOD AND PROBABLY THE EASIEST SOLUTION FOR INCREASING THE SENSITIVITY YOU COULD GET A 40 FOLD INCREASE IN SENSITIVITY, WOULD BE BY PROCESSING A LARGER VOLUME, AND PEOPLE AREN'T APPROACHING IT FROM THAT VANTAGE POINT BECAUSE THERE'S AN ENORMOUS AMOUNT OF MATERIAL THAT'S PRESENT IN BLOOD AS YOU SEE, SAY, BY DAY THREE POST INFECTION. AND WE'RE STILL MISSING IT BECAUSE WE'RE ONLY ASSAYING ABOUT A 40TH OF WHAT WE COULD IT ACTUALLY ASSAY. >> SO NOT TO PROLONG A LITTLE BIT OF AN INSIDE BASEBALL DISCUSSION FOR THE GROUP, BUT LET ME JUST RESPOND. I RESPECT AND ACCEPT EVERYTHING YOU SAY. BUT YOU COULD STILL PROVE THAT A VACCINE LIKE THE NIAID/GSK VACCINE AT THE PROPER DOSE CAN BLOCK INFECTION FOR A LIMITED PERIOD OF TIME, AND YOU COULD GET AN FDA APPROVAL ON THAT AND ADDRESS DURABILITY LATER. SO I WOULD NOT BE AT ALL UNHAPPY IF WE WENT IN THERE AND SHOWED THAT IN THE ACUTE STAGE OF X NUMBER OF MONTHS THAT ARE LEFT THAT, WHATEVER VACCINE, AND I'M NOT PICKING A FAVORITE, ACTUALLY HAS A POSITIVE IMPACT ON PREVENTING INFECTION. NOW YOU SAY YOU DON'T NEED THE BOOST FOR DEGREE OF PROTECTION, YOU NEED THE BOOST FOR DURABILITY, SO IF, IN FACT -- YOU SAY NO. >> I'M NOT SURE. >> WELL, I'M NOT SO SURE EITHER, BECAUSE IF YOU LOOK AT THE 1 TIMES 10 TO THE 11TH, IAN, THE RESPONSES WERE REALLY ROBUST. ANYWAY, IT'S A GOOD SCIENTIFIC DISCUSSION. GO AHEAD, FRANCIS. ONE OF THE CHALLENGES IS OF COURSE TO MAKE THE VACCINE, SO PARTICULARLY GIVEN THE PROCESS WHAT IT IS, I THINK IT'S KEY TO IT AVOID DISCUSSIONS LIKE THE ONE THAT JUST HAPPENED, WOULD BE MY ADVICE, BECAUSE WHAT WE NEED IS AS MANY VACCINES AS POSSIBLE. >> RIGHT. >> I THINK IT WOULD BE A MISTAKE TO PREJUDGE WHAT THE OUT KS COME IS. IF YOU HAVE A LOOK -- I SAW THE VSV TRIAL HAS BEEN PUT ON HOLD TODAY BECAUSE OF SIDE EFFECTS. SIDE EFFECTS. MAYBE IT WAS A DOSE-RELATED EVENT? I DON'T KNOW EXACTLY. >> I TELL YOU, WE'RE GETTING REALLY DETAILED HERE. >> I'M SAYING, WE DON'T KNOW. >> YOU'RE RIGHT. I TOTALLY AGREE WITH YOU. >> WHAT THE COMMUNITY AND THE WORLD NEEDS IS AS MANY VACCINES AS POSSIBLE THAT WE CAN ADVANCE AS MUCH AS POSSIBLE AND BASE OUR -- DATA, IN FACT, AND THAT'S REALLY WHAT -- >> I AGREE TOTALLY. >> -- I RECOMMEND. OTHERWISE WE'RE GOING TO CREATE CONFUSION INTO THE SYSTEM THAT IS NOT CONSTRUCTIVE, WE JUST DON'T KNO KNOW IT'S GOING TO WORK. >> THAT'S THE REASON WE'RE TAKING THE APPROACH THAT MONCEF SAYS, IT'S NOT ONLY VSV, GLAXOSMITHKLI-- THE POINT THAT MONCEF JUST MADE IS WE'RE REALLY LOOKING INTO THAT, BECAUSE IT'S TALKING ABOUT MILD AARTHRALGIAS AND MYALGIAS ASSOCIATED WITH IT, AND IT DEPENDS ON WHO'S CALLING IT. BECAUSE WE JUST FINISHED 39 PEOPLE AND WE HAD A CERTAIN PERCENTAGE WITH MYALGIAS THAT WERE MILD AND REALLY CLEARED UP. THAT'S NOT UNEXPECTED WITH A LIVE VIRUS VACCINE. SO THE QUESTION IS, ARE THEY REALLY BEING CAUTIOUS OR NOT? WE DON'T KNOW, MONCEF. I DON'T KNOW. I HAVE TO LOOK AT THE DATA, JUST LIKE YOU. I'M SORRY. YES. >> MY QUESTION WAS ACTUALLY YOU MENTIONED 5 BILLION FOR EBOLA AND THAT 5% OF THAT IS GOING TO THE NIH. SO WHERE IS THE OTHER -- >> --, HOSPITAL PREPARATION, EBOLA TREATMENT EVALUATION -- TREATMENT UNITS IN AFRICA, CDC'S PREPAREDNESS, USAID. INTERESTINGLY DEFENSE IS REPROGRAMMING MONEY AND DIDN'T ASK FOR ANYTHING. SO IT'S MOSTLY BARTER WHICH IS GOING TO HELP IN THE PRODUCTION OF VACCINES. THE NIH HAS YO AS YOU MENTIONED IS A RELATIVELY MILD AMOUNT. >> I WINT TO A SEMINAR AND HEARD THAT THE VIRUS CAN BE FOUND IN -- FOR MANY MONTHS AFTER THE -- >> UP TO 80 DAYS. >> [INAUDIBLE] >> WELL, THE ANSWER IS WE DON'T KNOW BECAUSE IT HAS NOT BEEN TRANSMITTED, BUT PEOPLE HAVE, IN FACT, EXAMINED IT. MOST OF IT IS PCR, ONE OR TWO CASES WITH ACTUAL ISOLATION. AND THE RECOMMENDATION OF THE CDC AND THE WHO IS THAT FOR AT LEAST THREE MONTHS FOLLOWING RECOVERY, THAT YOU PRACTICE SAFE SEX AND USE A CONDOM, BUT THERE'S NO DOCUMENTATION OF TRANSMISSION THROUGH SEMEN. >> WHEN YOU LOOK AT THE MAP YOU SHOWED US ABOUT THE STATE OF THE OUTBREAK, THERE -- WAS FOR THE MOST PART CONTIGUOUS AREAS, BUT THEN YOU SEE THIS LITTLE AREA UP IN MALI THAT'S NON-CONTIGUOUS. IS THAT OF CONCERN? >> THAT'S A GOOD QUESTION. I DIDN'T GO INTO THAT. WHAT HAPPENED IS THAT SOMEONE WHO WAS IN GUINEA, WHO WAS AN IMAM, A VERY IMPORTANT PERSON, WENT UP TO SEE SOME RELATIVES BY BUS TO MALI, HAD HAD CONTACT WITH A BUNCH OF PEOPLE. NONE OF THEM GOT INFECTED. MALI, WHICH DOES HAVE A MUCH BETTER INFRASTRUCTURE DUE TO COLLABORATIONS ACTUALLY WITH THE CDC AND THE NIH AND OTHERS, DID THE CONTACT TRACING AND WERE ABLE TO ISOLATE PEOPLE WHO WERE SUSPECTED AND THERE WERE NO SECONDARY CASES. IT WAS SORT OF SIMILAR TO THE SENEGAL SITUATION. SOMEBODY FLEW TO SENEGAL. >> JUST AS A FOLLOW-UP TO THAT BECAUSE THESE MAPS ARE GREAT AND YOU CAN STARE AT THEM A LOT. IS KNOWING NOW WHAT A PERFECT STORM LOOKS LIKE OR A LITTLE BIT WHAT IT LOOKS LIKE, ARE WE LOOKING AT ANY PERFECT STORM ON THE BOUNDARIES HERE OR ARE THERE HOT SPOTS THAT ARE -- AND THIS IS NOT JUST OUT OF INTEREST BECAUSE I'M THINKING ABOUT YOUR PROBLEM OF THE VACCINE TRIALS AND IF THERE WERE A PERFECT STORM, THAT HASN'T HAPPENED YET, THAT MIGHT BE A PLACE FOR THE VACCINE TRIAL. >> RIGHT. IN FACT, WE'RE DOING A PHASE # TRIAL IN MALI RIGHT NOW. WE ARE. WE'RE DOING A PHASE 1 TRIAL IN MALI RIGHT NOW. >> YOU HAD SAID IN THE TALK YOU WERE GOING TO TELL US HOW YOU THOUGHT THE INFECTION HAPPENED WITH THE TWO NURSES AT PRESBYTERIAN. COULD YOU TELL US HOW YOU THINK IT HAPPENED? >> YEAH, YOU KNOW, I WAS ONLY ABLE TO FIND THIS BECAUSE I'M -- I'VE DEVELOPED A CLOSE DOCTOR-PATIENT RELATIONSHIP WITH NINA PHAM AND THERE'S A LOT OF TRUST THERE AND SHE TOLD ME WHAT ACTUALLY HAPPENED. IT'S AN INTERESTING STORY. AND IT HAS TO DO WITH THE DIFFERENCE BETWEEN TAKING CARE OF EBOLA IN THE FIELD, AND TAKING CARE OF EBOLA IN AN INSIVE CARE SETTING. SO IF YOU LOOK AT WHAT GOES ON THAT HAS BEEN THE TRIED AND TRUE WAY OF TAKING CARE OF EBOLA AMONG THE 24 OUTBREAKS, IT IS NOT COMPLETE NO SKIN EXPOSED. IT'S A --, BOOTS, TBLOFS, BUT A FACE MASK THAT LEAVES YOUR HAIR, THE BACK OF YOUR NECK, AND YOUR EARS EXPOSED. AND THAT WAS ORIGINALLY ON THE WEBSITE OF THE CDC. THAT THESE PEOPLE, WHEN THESE NURSES -- THAT'S THE REASON WE GOT VERY UPSET WHEN THEY SAID THEY BROKE PROTOCOL. THEY DIDN'T BREAK ANY PROTOCOLS. SO WHAT HAPPENED, WHEN THE PERSON CAME IN, THEY WERE COMPLETELY UNPREPARED. UNDERSTANDABLY. WHY WOULD SOMEBODY IN DALLAS BE THINKING THAT THERE WAS GOING TO BE AN EBOLA CASE? SO AS SOON AS SOMEBODY CAME IN WITH SUSPECTED EBOLA, THEY WENT ON TO THE WEBSITE AND SAID, WELL, PUT THIS ON AND THIS ON AND THIS ON, AND THEY WENT IN, BUT IT WASN'T LIKE IN THE ETUs IN SIERRA LEONE, WHERE THERE'S ONE DOCTOR WALK IN, SOMEBODY'S FAR GONE, THEY DON'T DO ANY INTENSIVE CARE, THEY JUST TRIAGE THEM OUT. YOU LOOK OKAY, WE'LL GIVE YOU SOME FLUIDS. MAYBE AN I.V. THEY RARELY DO I.V.s IN AFRICA. SHE WENT IN IMMEDIATELY, INTUBATION, HEMODIALYSIS, FLASHINSPLASHING ALL OVER THE PLACE, AND IT WAS ONLY TWO DAYS LATER DID WE COMPLETELY CHANGE THE RECOMMENDATIONS FOR PPE THAT WE HAVE VERY, VERY STRICT PROTOCOL NOW. THERE'S NO SKIN THAT'S EXPOSED. >> I'M STRUCK BY HOW MUCH LACK OF CONFIDENCE AND TRUST IN IN MEDICAL AND SCIENTIFIC PROFESSIONALS IS BECOMING AN IMPEDIMENT IN TREATING THIS. WE CAN DEVELOP ALL THE INTERVENTIONS AND VACCINES THAT WE WANT, BUT IF THE PUBLIC DOESN'T HAVE FAITH HERE AND AFRICA OR GLOBALLY, IT'S GOING TO BE DIFFICULT. SO WHAT ARE YOUR THOUGHTS ON HOW TO ADDRESS THAT ASPECT OF THE PROBLEM? >> YOU KNOW, THAT'S A DISCIPLINE INTO AND OF ITSELF, IT REALLY IS, AND IT HAS TO BE CONTINUALLY TRYING TO EDUCATE THE PUBLIC, GETTING PEOPLE TO -- AND THAT GETS BACK TO THE STUFF THAT FRANCIS TALKS ABOUT ALL THE TIME, INCREASE SCIENCE LITERACY, INCREASE UNDERSTANDING OF WHAT EVIDENCE-BASED ISSUES ARE, AND I -- THE WAY I DESCRIBE IT, BECAUSE I'VE BEEN THROUGH THIS MULTIPLE TIMES OVER THE YEARS WITH HIV, WITH THE ANTHRAX ATTACKS AND NOW WITH THIS, AND IT'S THAT THE GENERAL PUBLIC WILL ACCEPT A CERTAIN LEVEL OF RISK THAT THEY'RE USED TO. WHEN A NEW RISK COMES IN, THEY DON'T DO A PROBABILITY ANALYSIS OF IT. IT'S A NEW RISK. SO IMMEDIATELY, IT BECOMES MORE RISKY THAN ANYTHING ELSE THAT THEY ACCEPT. SO THEY'LL ACCEPT GOING ON THE BELTWAY AND MAYBE TH GETTING IN AN ACCIDENT BUT THEY WON'T ACCEPT THAT GETTING ON A PLANE IN SAN FRANCISCO HAS NOTHING TO DO WITH A PATIENT IN DALLAS WHO HAS EBOLA. AND YET WE WERE GETTING CALLS, CAN I GET ON THE PLANE? I'M GOING FROM SAN FRANCISCO TO SEATTLE. WHAT ARE YOU TALKING ABOUT? OF COURSE YOU CAN GET ON THE PLANE. YOU'RE RIGHT, THEY DON'T STRATIFY THE RISK. A NEW RISK ALWAYS SUPERSEDES EVERYTHING ELSE. REID. >> GIVEN THE INTENSITY OF YOUR CONVERSATIONS WITH THE LEGISLATORS AND THE CONGRESS, DID YOU FIND NOW, DO YOU THINK, THAT THE FUNDING CLIMATE FOR NIH IS SOMEHOW IMPROVED BECAUSE NOW THEY APPRECIATE IN A GREATER MORE IMMEDIATE WAY THE IMPORTANCE OF WHAT YOU DO HERE, OR DID YOU FIND THE OPPOSITE OCCURS WHERE THERE IS THIS FOLLOW-ON TO THE QUESTION THAT'S RAISED, THE SENSE OF DISTRUST AND CONFUSION OF SCIENCE, DOES THAT CLOUD THINGS AND MAKE IT MORE DIFFICULT TO GET SUPPORT FOR NIH? >> YOU KNOW, REED, IT'S A COMPLICATED ISSUE. THERE IS SOME SMALL POCKET OF DISTRUST, BUT WHAT WE'RE SEEING IS THAT WHEN WE GO IN FRONT OF THE CONGRESS, BE IT THE REPUBLICANS OR THE DEMOCRATS, THEY KNOW HOW GOOD THE NIH AND WHAT THE NIH STANDS FOR IS. THE QUESTION IS, THERE'S THIS ROADBLOCK LOCK JAM WHERE THE REPUBLICANS TELL US, WE WOULD LOVE TO GIVE YOU MORE MONEY, BUT WE WILL NOT UNTIL THE OTHER SIDE DECREASES SPENDING AND CUTS DOWN ON ENTITLEMENT. THAT'S WHAT THEY SAY. THEY DON'T SAY, YOU GUYS ARE A BUNCH OF BOZOS, GO AWAY. THEY ACTUALLY WILL HAVE US. YOU SHOULD COME TO A HEARING AND HEAR SOME OF THE REPUBLICANS TALK TO FRANCIS AND I AND HAROLD AND OTHERS. THEY REALLY LIKE US, LOVE US, AND LIKE WA WE DO. BUT THEY SAY YOU KNOW, WE'RE SORRY, WE CAN'T GIVE YOU A 5, 6, 7, 8% INCREASE WHEN YOUR BUDDIES ON THE OTHER SIDE OF THE AISLE DON'T WANT TO CUT ENTITLEMENTS. IT'S VERY SIMPLE. I DON'T THINK THERE'S A CONGRESSIONAL FEELING NEGATIVELY AGAINST NIH AT ALL. >> I TOTAL LIE AGREE. TOTALLY AGREE. I THING EBOLA HAS IMPROVED THE SENSE OF WHAT WE NEED HERE. >> ACTUALLY MAYBE FRANCIS TOLD BUT IT, BUT THE PRESIDENT'S SPEECH WHEN HE WAS HERE A FEW DAYS AGO WAS ABSOLUTELY SPECTACULAR IN THAT HE INSERTED IN THERE AFTER WE SHOWED HIM ONE OF OUR LABS WHERE THE VACCINE WAS DEVELOPED, MONCEF, NANCY SULLIVAN AND OTHERS, WE BROUGHT HIM UP THERE, HE WAS VERY TAKEN UP, INTERESTINGLY, BY NANCY'S NOTEBOOK FROM 1999, WHEN SHE FIRST -- YOU KNOW, IT WAS LIKE HE GOT IT, THAT HE UNDERSTANDS WHAT YEARS OF BASIC SCIENCE MEANS. AND HE GOT UP THERE AND HE SAID IT IN HIS SPEECH, AND I KNOW IT WASN'T IN THE SPEECH BECAUSE I READ HIS SPEECH BEFORE HE GAVE IT TO MAKE SURE HE DIDN'T SAY ANYTHING SCIENTIFICALLY INACCURATE, AND IT WASN'T IN THE SPEECH. HE AD-LIBBED IT. HE AD-LIBBED IT. >> IF I COULD PUT YOU ONE MORE STEP ON THIS, FRANCIS EARLIER TALKED TO US ABOUT CONVERSATIONS HE'S HAVING WITH GATES AND OTHER FOUNDATIONS. I'M REALLY STRUCK BY THE DICHOTOMY BETWEEN THE INTENSITY OF THE VACCINE AND RESEARCH CONVERSATION, AND NOT -- AND MORE DOCTORS ON THE ONE FLOOR OF THE K STREET OFFICE BUILDING THAN IN THE ENTIRE COUNTRY. I'M VERY MUCH STRUCK BY THE FACT THAT THE WORLD IS VERY SMALL. >> RIGHT. >> SO HOW, IN A WORLD OF INCREASINGLY AND ALWAYS LAMENTED LIMITED RESOURCES, WHERE WE PUT OUR MONEY IN THIS WORLD, HOW DO YOU SORT OF START TO THINK ABOUT THIS -- WHERE DO YOU FOCUS YOUR MONEY IN THE WORLD TODAY? MORE AND MORE RESEARCH, MORE AND MORE JUST IV SOLUTIONS IN POOR COUNTRIES, HOW DO WE THINK THROUGH THE DISTRIBUTION OF RESOURCES IN THIS WORLD? >> YOU KNOW, THE WAY I THINK ABOUT IT, REED, I DON'T PUT THEM INTO BUCKETS THAT ARE ARE JOINED AT YOU TAKE OUT OF ONE AND YOU'RE TAKING AWAY FROM THE OTHER. I THINK THE RESPONSIBILITY AT A GLOBAL LEVEL THAT GOES WELL BEYOND RESEARCH OF TRYING TO HELP BUILD UP AN INFRASTRUCTURE IN A COUNTRY THAT CAN START AND KEEP AN I.V. GOING TO SAVE SOMEBODY'S LIFE IS ABSOLUTE LEET ABSOLUTEL Y CRITICALLY IMPORTANT. I GET REALLY CONCERNED WHEN WE DO EITHER A VACCINE OR THAT. I THINK WHAT WE NEED TO DO IS THAT IF WE DON'T HAVE THE BASIC AND THE CLINICAL SCIENCE, WE'RE NEVER GOING TO BE ABLE TO IMPLEMENT THAT, BUT THE IMPLEMENTATION OF THAT IS A DIFFERENT STORY. IT'S GOT TO BE DONE AT THE COUNTRY LEVEL. AND SOME COUNTRIES ARE DOING THAT. I MEAN, RWANDA IS A PHENOMENAL EXAMPLE OF WHAT THEY'RE DOING THERE WITH REGARD TO HEALTH. YOU KNOW, A SMALL COUNTRY THAT HAD A TERRIBLE SUFFERING HISTORY IS DOING A GREAT JOB. I DON'T THINK IT SHOULD BE PITTED AGAINST -- >> I'M TOTALLY IN AGREEMENT. I JUST WANT TO SAY, THERE ARE OTHER WAYS TO SUPPORT BOTH OF THOSE THINGS AND I JUST WANTED TO MENTION ONE. I'M SORRY ERIC GOOSBY IS THE NOT HERE BECAUSE WHEN HE WAS HEADING UP PEPFAR HE STARTED THIS THING CALLED THE MEDICAL EDUCATION PARTNERSHIP INITIATIVE, MEPI, AND INVITED NIH TO TAKE PART IN IT, AND THERE IS AN EFFORT TO BUILD CAPACITY BOTH FOR HEALTHCARE THRIFER RE, WIT DELIVERY, BUT A LSO TO ENCOURAGE RESEARCH IN A WAY THAT MIGHT REVERSE SOME OF THE BRAIN DRAIN AND REALLY PROVIDE CAPABILITIES IN AFRICAN UNIVERSITIES TO BEGIN TO BUILD THEIR SKILLSET, AND THAT WAS A PRETTY SIGNIFICANT RISK HE TOOK, TAKING PEPFAR AND MOVING IT IN THAT DIRECTION, BUT YOU KNOW, IF WE DON'T WANT TO SEE OURSELVES 20 YEARS FROM NOW IN THE SAME PLACE WE ARE NOW, WHERE IT SEEMS AS IF WE ARE SOMEHOW SWOOPING IN TO TRY TO SAVE COUNTRIES FROM THEMSELVES, BUT THEY HAVE BUILT THE KIND OF SKILLS AND CAPABILITIES, THIS IS THE KIND OF THING WE SHOULD DO. BUT I'D BE THE FIRST TO AGREE WITH TONY, YOU DON'T WANT TO HAVE THAT COMPETING WITH THE NEED TO BUILD A VACCINE IN THIS CRITICAL MOMENT. >> THE 2005 INTERNATIONAL HEALTH REGULATIONS THAT WE SIGNED ON TO REQUIRE THAT EVERY COUNTRY HAVE THE ABILITY TO DO DIAGNOSIS AND SURVEILLANCE AND -- WITHIN THEIR OWN BORDERS. SO THIS IS NOT A NEW CONCEPT. >> NO. >> AND IT WAS THE NATIONAL -- SET UP BY BUSH AND RENEWED BY OBAMA THAT REVIEWED ALL OF THESE ISSUES, AND ACTUALLY SUGGESTED T WE DO ALL OF THIS, AND THE BIG CONCERN THAT MANY OF US HAVE IS THAT WHEN THIS WANES, THAT WE'RE GOING TO GO BACK TO BUSINESS AS USUAL. SO I HAD A LAB IN SIERRA LEONE THAT WAS FUNDED BY GOOGLE.ORG THROUGH 2007 THAT HAD MULTIPLEX DIAGNOSTICS TO PICK UP ALL OF THESE HEMORRHAGIC FEVERS AND IT WAS SHUT DOWN FOR LACK OF FUNDING. SO WE CAN SEE THIS HAPPENING AGAIN. >> YEAH. >> OBVIOUSLY THESE VACCINE TRIALS WILL BE VERY VISIBLE, BOTH NATIONALLY AND INTERNATIONALLY. AND THAT MAKES ME WONDER ABOUT MANAGING THE MESSAGE, BOTH BEFORE AND AFTER, IN THE CONTEXT OF THE CONTINUING, I WOULD SAY, IRRATIONAL STRONG RESPONSES THAT SOME PEOPLE HAVE AGAINST VACCINES IN GENERAL AS BEING DANGEROUS. >> RIGHT. >> AND AS WE KNOW AND WE'VE ALREADY TALKED ABOUT, IN ANY TRIAL, THE REASON TO DO A CONTROLLED TRIAL IS BECAUSE YOU CAN'T KNOW AHEAD OF TIME IF IT'S GOING TO WORK BUT ALSO, YOU CAN'T REALLY KNOW BETTER OR WORSE. AND I'M WONDERING HOW TO, YOU KNOW, BASICALLY MANAGE THE MESSAGE. MAYBE BEFOREHAND, I MEAN, IDEALLY NOTHING IS GOING TO GET WORSE, BUT ONE DOESN'T KNOW, AND HOW DO MANAGE THE MESSAGE AHEAD OF TIME TO GUARD AGAINST POSSIBLE REPERCUSSIONS THAT RESULT FROM THE TRIALS THAT THEN ONE CAN HAVE A RESPONSE TO AFTERWARDS, BUT THEN YOU'RE RESPONDING. >> VERY GOOD POINT. W'RE TRYING, BOB, TO DO THAT. THAT'S THE REASON WHY WE GIVE THE RATIONALE FOR WHY YOU WANT A CONTROLLED TRIAL. IT'S WORSE THAN YOU THINK. T ARE SOME WHO HAVE PUBLICLY SAID THAT A CONTROLLED TRIAL IS UNETHICAL. COULD YOU IMAGINE THAT? TO SAY THAT A CONTROLLED TRIAL IS UNETHICAL? I MEAN, AND JUST THE POINT -- AND THEN ALL OF A SUDDEN, YOU GO TO AN AFRICAN-AMERICAN CAN COUNTRY AND GIVE SOMETHING THAT PEOPLE EVEN IN THE UNITED STATES HAVE TREPIDATIONS ABOUT, AND THINGS GO SOUTH ON YOU AND GO BAD, THAT WOULD BE THE END OF ANY VACCINE PROGRAM. I'M VERY CONCERNED ABOUT THAT. >> CAN I ADD TO THAT? SO IT'S A MAJOR CONCERN OF COMPANIES THAT ARE MAKING THESE VACCINES, OF COURSE, TRYING ALL THE TIME TO PUT THE BRAKES ON WELL INTENDED EP THEUS YASM TO INTRODUCE THE VACCINE AND RAISE EXPECTATIONS. FOR INSTANCE, ONE OF THE THINGS WE DON'T KNOW IS HOW WILL THE SAFETY OF THESE VACCINES BE -- IN THE ACTIVE POPULATION. THAT'S THE REASON WE'RE RUNNING A TRIAL IN MALI AND WEST AFRICA, BECAUSE ANY ONE OF THESE VACCINES COULD HAVE A DIFFERENT BEHAVIOR IN THEIR POPULATION, AND THAT'S THE REASON WHY THE TRIALS ARE DESIGNED IN A WAY WHERE A FEW HUNDRED INDIVIDUALS ARE IMMUNIZED FOR A WHILE BEFORE YOU GO FURTHER, IF IF SOMETHG UNTOWARD HAPPENS, YOU CAN CONTROL IT. BUT IT'S KEY THAT WE EXEUN KATE, WE ALWAYS BRING BACK, THE KEY TO HAVE AS MANY VACCINES AS POSSIBLE TO VERY THOROUGHLY PRODUCE THEM AND LAY JUDGMENT -- WE'LL SEE WHAT WILL HAPPEN. >> CAN I JUST FOLLOW UP WITH ONE DETAILED QUESTION? >> SURE. >> IS ANYTHING OF THIS DING THING DONE -- DESIGN? IS THAT WORTH THINKING ABOUT FOR VACCINES? PERSONALLY I'VE NEVER HEARD THAT. >> YOU COULD DO THAT ON -- DEFINITION. EFFECTIVELY IN THE SETTING -- I MEAN, YOU NEED TO KNOW ALL THESE VACCINES NEED TO BE MAINTAINED AT MINUS 80 DEGREES -- IN THE JUNGLE. IT'S A BIG PROBLEM. >> I HATE TO KEEP HARPING ON THIS BUT I HAVE TO REPRESENT THE OTHER VIEWPOINT. SO I AGREE COMPLETELY WITH YOU, MONCEF, WE NEED TO HAVE A PHASE ONE TRIAL TO MAKE CERTAIN THAT IN THIS POPULATION, IT IS SAFE. I'M NOT CONCERNED, AND I THINK TONY ALLUDED TO THIS EARLIER, THERE'S A SYSTEMIC RESPONSE TO WHY -- YOU'VE GOT -- I DON'T KNOW, AND I'M ALSO HAPPY WITH THE IDEA OF COMPARING HEAD TO HEAD, YOU KNOW, THE VIEW OF THE ADENOVACCINE VERSUS THE VSV VERSUS VACCINE VERSUS A ANOTHER VACCINE AS WELL. WHAT I AM SOMEWHAT UNCOMFORTABLE WITH, IF WE HAVE ANIMAL DATA, INCLUDING NON-HUMAN PRIMATE WITH THE NOTION THAT THERE WILL BE A PLACEBO ON, BECAUSE I THINK WE HAVE HISTORICAL DATA FROM THIS PCULAR VIRUS THAT SUGGESTS WE UNDERSTAND WHAT THE MORBIDITY AND MORTALITY IS IN THE ABSENCE OF A VACCINE AND WE CAN VERY RAPIDLY SORT OUT WHETHER OR NOT THERE'S GOING TO BE ANY SORT OF PROTECTIVE EFFECT. I'M VERY CONCERNED ABOUT THE IDEA THAT WE MIGHT BE DENYING PEOPLE ACCESS TO SOMETHING THAT MIGHT, IN FACT, BE LIFE-SAVING. BECAUSE WE WANT TO DO THE BEST POSSIBLE VACCINE TRIAL. >> ARE YOU WORRIED AT ALL ABOUT ANOTHER ASPECT OF THIS, WHICH IS IF YOU HAVE OPEN LABEL TRIAL, PEOPLE WHO ARE GETTING IMMUNIZED BELIEVE THAT THEY ARE PROBABLY BEING HELPED, ES ESH P PLY IF YOU'RE TELLING THEM THAT IT'S SUCH A GOOD VACCINE THAT WE DON'T NEED OH DO A RANDOMIZED TRIAL, THEN THOSE HEALTHCARE WORKERS OR FAMILY MEMBERS OR PEOPLE INVOLVED IN BURIALS START TO RELAX A LITTLE BIT IN TERMS OF HOW CAREFUL THEY ARE ABOUT PPE. ALTHOUGH IT'S NOT A BIOLOGICAL EFFECT OF THE VACCINE, IT'S A BEHAVIORAL EFFECT, ACTUALLY INCREASE THE NUMBER OF INFECTIONS AND DEATHS. >> I APPRECIATE THAT, FRANCIS, BUT THEORETICALLY, UNLESS THESE PEOPLE ARE -- IF THEY'RE PROTECTED BY THIS VACCINE, THEN THEY THEORETICALLY ARE NOT GOING TO BE BURIED. SO WE'RE TALKING ABOUT PEOPLE PARTICIPATING THAT ARE NOT GOING TO BE INVOLVED IN THE BURIALS THEMSELVES. THAT IS A CONCERN. THE ONE THING WE DON'T HAVE TO BE CONCERNED ABOUT IS A PLACEBO EFFECT, RIGHT? I MEAN, THIS IS A VERY DRAMATIC ILLINOISNESS AND IT WILL BILLNESS AND I TH INK IT WILL BE FAIRLY CLEAR RAPIDLY 50 WE'RE GETTING ANY PROTECTION. BUT THERE ARE PEOPLE ON BOTH SIDES OF THE ISSUE. >> THERE ARE DIFFERENT RESULTS IN DIFFERENT EBOLA TREATMENT UNITS. ONE HERE, ONE THERE. THE VARIABILITY, IAN, IS SO GREAT THAT YOU REALLY HAVE GOT TO BE CAREFUL TO THINK THAT YOU COULD EVEN IMAGINE A HISTORICAL CONTROL. THERE REALLY ISN'T A HISTORICAL CONTROL. IT VARIES FROM UNIT TO UNIT. THAT'S THE REASON WHY -- AND AGAIN, YOU'RE RIGHT, THERE ARE GOOD PEOPLE AND I RESPECT THEM ON BOTH SIDES. THE ONLY THING IS THAT UNLESS YOU HAVE A SITUATION WHERE WITHIN EXACTLY THE SAME SETTING, YOU'RE COMPARING A VACCINE FOR PEOPLE WHO DO NOT KNOW THEY'RE GETTING A VACCINE OR PLACEBO. THAT'S THE ONLY WAY YOU'RE GOING TO BE ABLE TO KNOW. ANYWAY, SORRY. >> SO ONE OR TWO MORE QUESTIONS THEAND WE'LL BREAAND THEN WE'LL BREAK FOR LUNCH. >> I'M GOING TO SWITCH GEARS. I WAS STRUCK BY YOUR BURIAL COMMENT, THE ROLE OF THE CUSTOMS IN THE SETTING, THE ILLNESS. MAYBE IT'S BECAUSE I COME FROM A THIRD WORLD COUNTRY, I REALIZE THE CULTURAL SETTINGS FOR BOTH -- BEHAVIOR AND WHAT PEOPLE SOMETIMES MAYBE EVEN ARE WILLING TO SACRIFICE, THEY BELIEVE THEY'RE DOING THE RIGHT THING AND THAT WE'D BE WRONG NOT TO -- OR HANDLE THE BODY IN A CERTAIN WAY. THAT'S -- SO I UNDERSTAND HOW THAT MIGHT AFFECT ONE COMMUNITY VERSUS ANOTHER, INFECTION, SPREADS, ALL OF THOSE, AND SO I WAS WONDERING IF PART OF THIS BIG EFFORT HAS A SOCIAL CULTURAL PARTNERSHIP KIND OF COMPONENT, MAYBE SOMETHING NIH CAN DO WITH OTHER FOUNDATIONS, FOR EXAMPLE, THAT WOULD PARTNER WITH THE LOCAL PEOPLE TO FIND WAYS AROUND ALL OF THESE ISSUES THAT CONTRIBUTE TO THE -- >> THAT'S A VERY GOOD POINT, AND THE ACTUAL CHANGE IN THE BURIAL CUSTOMS WAS DONE WITH VERY INTENSIVE INTERACTION AT THE COMMUNITY LEVEL. THEY CAN DID NOT JUST GO IN AND SAY OKAY, WE'RE GOING TO IT TAKE THE BODIES, CREMATE THEM, DON'T TOUCH THEM, WE'LL PUT THEM IN A BAG. WORKED OUT VERY CAREFULLY WITH COMMUNITY INPUT. PEOPLE HAVE ACTUALLY REALIZED THAT THEIR COMMUNITY IS FALLING APART BECAUSE THAT'S WHERE ALL OF THE -- I WOULD -- WITH THE CHANGES. >> AVAILABILITY OF CELL PHONES DESPITE LIMITATIONS OF MANY OTHER SORTS I THINK HAS REALLY HELPED IN TERMS OF GETTING THOSE MESSAGES OUT THERE IN PLACES THAT OTHERWISE WOULDN'T BE ABLE TO HEAR THE INFORMATION. TONY, THANK YOU VERY MUCH FOR A FASCINATING INSPIRATIONAL PRESENTATION, AND GETTING US UP TO DATE ON A RAPIDLY MOVING STORY AND YES, GOOD LUCK WITH THE LATEST PATIENT, THE CONGRESS AND EVERYTHING ELSE. [APPLAUSE] >> ALL RIGHT. AND BEFORE WE DASH OFF TO LUNCH, IT'S TIME FOR THE PHOTO, SO WE'RE GOING TO ASK EVERYBODY WHO'S A MEMBER OF THE ACD TO WANDER OVER TO THE CORNER THERE. AFTER THAT, WE'LL BREAK FOR LUNCH AND COME BACK AT 1:15. >> TO BEGIN OUR AFTERNOON ACTIVITIES, WE'RE GOING TO HEAR HEAR ABOUT THE ACD WORKING GROUP THAT'S BEEN OVERSEEING DECISION AND POLICIES AND IMPLEMENTATION ABOUT HeLa CELLS AND GENOME SYSTEMS FROM THEM AND I'LL INTRODUCE RENEE JENKINS IN A MOMENT. SHE AND KATHY HUDSON HAVE WORKED HARD ON THIS BUT FIRST I WANT TO JUST SPOIL MYSELF A LITTLE BIT BY TELLING YOU ABOUT AN INSPIRING MEETING THAT WE HAD YESTERDAY THIS WHOLE ENTERPRISE CAME ABOUT IN THE WAKE OF A FIRST SUBMISSION OF A COMPLETE GENOME SEQUENCE OF HeLa CELLS, ORIGINAL SUBMISSION FROM A GERMAN GROUP FOLLOWED SHORTLY BY OUR FINDING OUT ABOUT ANOTHER IMMINENT SUBMISSION FROM SEATTLE FROM JAY SHANDURI, AND A REACTION FROM THE FAMILY, OKAY, WHAT ARE YOU DOING TO IT AT THIS TIME, CLEARLY THERE ARE IMPLICATIONS FOR US AS RELATIVES. SO KATHY AND I JOURNEYED TO BALTIMORE ON SEVERAL OCCASIONS, IN THE SUMMER OF 2013, TO LISTEN TO THE FAMILY'S CONCERNS, AND I CAN TELL YOU THE FIRST MEETING OR TWO WERE KIND OF TENSE, IN THE SENSE THE FAMILY HAD THAT THIS, FROM THE VERY BEGINNING, BACK IN 1951, HAD BEEN A CIRCUMSTANCE WHERE HENRIETTA LACKS AND THE REST OF THEM HAD BEEN TAKEN ADVANTAGE OF, THINGS WERE DOWN WITHOUT THEIR KNOWLEDGE OR CONSENT, AND HERE WE GO AGAIN, WHEN THEY HEAR THE GENOME SEQUENCE IS ABOUT TO APPEAR. BUT I LEARNED A LOT IN THOSE DISCUSSIONS FROM THIS VERY WELL-SPOKEN AND CLEARLY VERY PASSIONATE GROUP OF FAMILY MEMBERS, THE CHILDREN AND GRANDCHILDREN OF HENRIETTA LACKS, AND I'VE CONTINUED TO LEARN. OUT OF THAT CAME, AS YOU KNOW FROM HAVING BEEN AT THE WORKING GROUP PRESENTATIONS BEFORE, A PROCESS WHICH AIMS TO RESPECT THEIR WISHES, AND TO MAKE SURE THAT AS THEY WOULD WANT, SCIENCE IS NOT SLOWED DOWN UNNECESSARILY, BUT THINGS THAT MIGHT PRESENT PARTICULAR RISKS NAMELY ASSEMBLED GENOME SEQUENCES NEED TO BE DEALT WITH WITH PARTICULAR CARE. AND MAKE SURE THAT THE USE OF THAT INFORMATION IS CONSISTENT WITH PROTECTION OF THEIR CONFIDENTIALITY PRIVACY AND THEIR WISHES ABOUT HOW IT SHOULD BE HANDLED. RENEE HAS DONE A WONDERFUL JOB OF LEADING THIS EFFORT AND WILL TELL YOU SHORTLY ABOUT WHERE WE ARE AS OF TODAY. I DID WANT TO REFLECT ON YESTERDAY, ANOTHER ITERATION IN THIS REMARKABLE EXPERIENCE, SO THIS IS A PICTURE FROM YESTERDAY. WE MED IN THE BERMAN INSTITUTE, AND RUTH FADEN IN THE BACK WAS OUR HOST AND HAS BEEN PART OF THE INTERACTIONS WITH THE LACKS FAMILY, BUT THE FRONT ROW IS PEOPLE TO PAY ATTENTION TO REALLY. SO THAT IS GOING FROM LEFT TO RIGHT SHIRLEY, KIMBERLY, DAVID, VERONICA, I'M SORRY, GERRI IS NEXT TO THE LEFT AND KIMBERLY ON THE RIGHT, ALL OF WHOM CAME TO THIS MEETING AND WERE INTENSELY INTERESTED IN THE DISCUSSION, AND THE APPRECIATION THEY EXPRESSED FOR THE WAY IN WHICH THEIR CONCERNS HAD BEEN TAKEN WITH SUCH SERIOUSNESS WAS REALLY QUITE TOUCHING TO HEAR, AND I THINK AT THIS POINT THEY ARE VERY MUCH PART OF THIS PROCESS IN THE MOST SUBSTANTIVE WAY. DAVID AND VERONICA ACTUALLY ARE ON THE WORKING GROUP. THEY COME TO THE MEETINGS. THEY EXPRESS THE FAMILY'S PERSPECTIVES. SO THIS GAVE ME A CHANCE TO TALK WITH THE FAMILY AGAIN WHICH I FOUND QUITE REWARDING, AND WE ALL REALLY DO NOW KNOW EACH OTHER IN WAYS THAT ONLY SOMETHING LIKE THIS MIGHT HAVE MADE POSSIBLE. IT'S REALLY QUITE REMARKABLE. THE OTHER THING THAT I WANTED TO CONSULT WITH THEM WAS THE OUTCOME OF THE WORKSHOP THAT WAS HELD BACK IN MAY, AND TO REMIND YOU, BECAUSE YOU HEARD ABOUT THIS PREVIOUSLY, THE WORKSHOP WAS HELD TO DEBATE WHETHER IN FACT AND WITH FAMILY MEMBERS PRESENT WHETHER SEQUENCES THAT WENT BEYOND ASSEMBLED GENOMES OUGHT TO ALSO BE IN SOME PLACE WHERE THERE WAS RESTRICTED ACCESS OR CONTROLLED ACCESS TO THAT INFORMATION. CLEARLY ASSEMBLED GENOMES WERE THE ATTENTION INITIALLY GIVEN WHEN THE WORKING GROUP WAS SET UP BUT WHAT ABOUT OTHER KINDS OF EXPERIMENTS, RNA-Seq, FOR INSTANCE, WHERE YOU HAVE LOTS OF RNA INFORMATION, OR EPIGENOMIC STUDIES WHERE YOU'RE MAYBE LOOKING AT WHERE DOES THIS PARTICULAR TRANSCRIPTION FACTOR BIND AND THOSE KINDS OF EXPERIMENTS. SHOULD THOSE ALSO BE CONSIDERED FOR SOME KIND OF CONTROLLED ACCESS? YOU MAY REMEMBER THE OUTCOME OF THE WORKSHOPACK IN MAY, THAT WAS A GENERAL SENSE THAT TO EXTEND TO THOSE MIGHT IN FACT NOT BE A GOOD IDEA BECAUSE IT WOULD LIMIT THE AMOUNT OF ACCESS TO INFORMATION THAT MANY SCIENTISTS WOULD WANT, WITHOUT NECESSARILY PROVIDING SIGNIFICANT ADDITIONAL PROTECTION. BUT, AGAIN, THIS WAS PRESENTED TO YOU ALL, YOU ENDORSED THAT PERSPECTIVE, AND MADE THE RECOMMENDATION TO ME THAT WE SHOULD GO FORWARD IN THAT VEIN, BUT I WANTED TO TALK TO THE FAMILY FIRST ABOUT MAKING A DECISION ABOUT THAT. A BIG PART OF YESTERDAY'S MEETING WAS TO GO THROUGH THOSE RECOMMENDATIONS AND KATHY WENT THROUGH WHAT THE WORKSHOP HAD BEEN ABOUT AND WHAT THEIR RECOMMENDATIONS WERE AND WHY, AND THEN WE HAD A REALLY INTERESTING CONVERSATION WITH THE FIVE OF THEM, EACH OF THEM SPEAKING AND CLEARLY THOUGHT A LOT ABOUT THIS, ABOUT THEIR PERSPECTIVES, AND ULTIMATELY RECOMMENDING UNANIMOUSLY THOSE RECOMMENDATIONS WORKSHOP BE ACCEPTED AND WHAT YOU RECOMMENDED TO ME BE ACCEPTED, AND THEY ALSO MADE A POINT, GERRI IN PARTICULAR, SAYING, AND WE HAVE COME HERE AS REPRESENTATIVES OF THE FAMILY. YOU'RE JUST SEEING FIVE OF US BUT WE'RE REALLY THE WHOLE LACKS FAMILY SO DON'T FEEL LIKE YOU HAVE TO GO AND ASK ANY OF THE OTHER FOLKS THAT WE'RE RELATED TO. WE'RE HERE TO REPRESENT THEM. THEY TALKED ABOUT HOW PROUD THEY ARE, THE ADVANCES FROM HeLa CELLS, KIMBERLY SAYS IT'S GREAT THEY ARE OUT THERE WORKING, AND THEY REALLY ARE AS WE'LL HEAR IN A MINUTE. EVEN TODAY. I CAN'T TELL YOU ENOUGH HOW UNIQUE AND INSPIRING THIS EXPERIENCE HAS BEEN. AND IT'S THE WORK OF THIS WORKING GROUP I THINK IS PRETTY HISTORIC, SENDING A MESSAGE TO ALL SCIENTISTS THERE ARE INDIVIDUALS BEHIND THOSE SAMPLES AND DATA, EVEN IF IT'S CELLS IN A PETRI DISH YOU'VE BEEN DOING FOR YEARS. THIS IS A HUMAN CONNECTION. SO KNOWING THIS FAMILY HAS BEEN A VERY IMPORTANT PART OF MY TIME AS NIH DIRECTOR, WHEN I LOOK BACK ON THE THINGS THAT HAPPENED IN THE LAST FIVE YEARS THIS REALLY STANDS OUT AS A REMARKABLE WAY THAT SCIENCE AND HUMAN INTERESTS AND ETHICAL CONCERNS AND HEALTH DISPARITIES AND JUSTICE AND EQUITY HAVE ALL KIND OF COME TOGETHER, AND THAT HAS REALLY BEEN QUITE REMARKABLE. WELL, JUST TO MAKE IT EVEN MORE PERFECT, AT NOON TODAY, A PAPER WAS RELEASED FROM "CELL," DETAILED MAP OF CHROMATIN LOOPING IN THE CELL NUCLEUS, IN EIGHT CELL LINES, ONE OF THEM HeLa. IT'S QUITE A REMARKABLE PAPER. IT'S FUNDED BY OUR COMMON FUND AND BY A NEW INNOVATOR AWARD TO A REMARKABLE YOUNG SCIENTIST WHO I MET FOR THE FIRST TIME WHEN HE WAS GETTING A P-CASE AWARD, USING HIGH C TO LOOK IN GREAT DETAIL ABOUT THE THREE FOLDED GENOME IN THE NUCLEUS INTERFACE AND COMING UP WITH NEW PRINCIPLES ABOUT HOW THAT'S PUT TOGETHER THAT I WAS SURPRISED BY AND YOU CAN READ ABOUT. VERY INTERESTING, OF COURSE, THAT HeLa WAS, ONCE AGAIN, IN THE MIDDLE OF A BIG STEP FORWARD. THE HeLa SEQUENCE THAT WAS GENERATED FOR THAT PARTICULAR PAPER IS BEING DEPOSITED IN DB GAP WHERE THERE BE THE APPROPRIATE CONTROL AXIS BECAUSE THIS IS A VAST AMOUNT OF GENOME SEQUENCING, YOU'LL BE HEARING MORE. THAT WILL BE FOURTH HeLa SEQUENCE THAT ENDS UP IN DB GAP FOLLOWING AFTER THE OTHER THREE THIS GROUP HAS CAREFULLY CURATE AND THOUGHT ABOUT. TO YOU NOW LET ME TURN IT OVER TO RENEE TO TELL US WHAT THE WORKING GROUP HAS BEEN UP TO. >> I SHOULD HAVE COME UP EARLIER. I'M SORRY. SO WHAT I'M GOING TO DO IS FIRST OF ALL, OUR BUSINESS TO HAVE DONE IS FOR THE ACD TO HEAR THE MOST RECENT REQUEST AND THEN TO VOTE ON A RECOMMENDATION TO DR. COLLINS, BUT IN PREPARATION FOR THAT, I'LL JUST WALK YOU THROUGH YET AGAIN HOW WE WORK AND WHAT ARE THE CHARACTERISTICS WE WERE LOOKING AT IN TERMS OF THE REQUEST. SO JUST TO BRIEFLY GO THROUGH THE DATA USE AGREEMENT YOU SEE, WHERE THERE HAS TO BE AN APPLICATION FOR THE WHOLE GENOME SEQUENCE, THE REQUIREMENTS ON THE APPLICATION ARE THAT THEY HAVE TO TELL US WHAT IT'S GOING TO BE USED FOR, BIOMEDICAL RESEARCH. THE REQUESTORS ARE NOT TO MAKE CONTACT WITH THE LACKS FAMILY, THEY ARE TO DISCLOSE ANY COMMERCIAL PLANS AND ALSO TO INCLUDE ACKNOWLEDGEMENT IN PUBLICATIONS AND PRESENTATIONS OF THEIR ACCESS TO THIS DATA AND IF THEY GENERATE SEQUENCE DATA THEY SHOULD DEPOSIT THAT INTO DB GAP. THE ROLE OF THE PEOPLE ON THE WORK GROUP ARE TO EVALUATE THE REQUEST, BASED ON THE DATA USE AGREEMENT, THE CONSISTENCY WITH THE DATA USE AGREEMENT. IT IS NOT TO EVALUATE THE SCIENTIFIC ELEMENTS OF IT, ALTHOUGH WE DO HAVE EXPERTISE ON THE COMMITTEE TO SORT OF TELL US WHAT THE SCIENCE ELEMENTS ARE, AND THEN WE ARE TO MAKE RECOMMENDATIONS TO YOU TO THIS BODY, TO GO TO DR. COLLINS. SO HERE AGAIN IS THE GROUP. WE HAVE I THINK A REALLY GREAT GROUP. LISA COOPER IS A NEW MEMBER FOR THIS COMMITTEE. BUT RICK MYERS, BOB NUSSBAUM AND RUSS ALTMAN CARRY THE WATER WITH THE SCIENCE PART, KATHY, AND ART, AND DINA. I AM ROLLING OUT ACD, IN FACT KATHY HUDSON AND CLYDE YANCY WILL TAKE OVER AS CO-CHAIRS STARTING IN JANUARY, AND SO KATHY HAS BUN THE ENGINE AND THE PASSION IN THIS FOR OUR GROUP ON A REGULAR BASIS, I WANT TO EXPRESS MY APPRECIATE TO HER FOR ALL THAT WORK. SO HERE ARE THE CRITERIA. AGAIN, IS IT FOCUSED ON HEALTH, MEDICAL OR BIOMEDICAL RESEARCH OBJECTIVES? ARE THERE PLANS TO DEVELOP INTELLECTUAL PROPERTY? IF SO, ARE YOU MAKING US AWARE OF THOSE PLANS? IF YOU DON'T HAVE PLANS, ARE YOU AGREEABLE TO NOTIFY NIH IF IN FACT YOU DO WANT TO PLAN FOR PROPERTY APPLICATION? AND THEN ARE THERE ANY PLANS TO PUBLISH OR PRESENT THE FINDINGS? SO ONCE WE GO OVER THESE CRITERIA, WE THEN PUT THEM INTO ONE OF THESE FOUR CATEGORIES. THE FIRST, IT'S COMPLETELY CONSISTENT WITH THE DATA USE AGREEMENT. TWO, IS IT INCONSISTENT WITH THE DATA USE AGREEMENT? FOR EXAMPLE, WE HAD ONE PROJECT THAT SAID THEY DIDN'T WANT TO REPORT THE RESEARCH FINDINGS, THAT WAS INCONSISTENT, AND WHEN WE GAVE THE APPLICANT AN OPPORTUNITY TO MODIFY THAT, THEY CHOSE NOT TO, AND SO THEY WERE INCONSISTENT WITH THE DATA USE AGREEMENT. CONDITIONAL MEANS THERE MAY BE A MINOR ELEMENT IN IT THAT WE FEEL THAT THE ADMINISTRATIVE SUPPORT CAN COMMUNICATE WITH THE APPLICANT AND THEN RECTIFY, WITHOUT US HAVING TO SEE IT AGAIN IN THE WORK GROUP. AND THEN PENDING MEANS THERE IS A SIGNIFICANT ENOUGH GAP. >> WHAT WITH THE REQUIREMENTS ARE THAT ARE NOT FEATURED IN THIS APPLICATION, AND THAT HAS TO COME BACK TO THE WORK GROUP ONCE WE EXPLICITLY STATE WHAT THE CORRECTIVE ACTIONS SHOULD BE. SO THOSE ARE OUR FOUR CHOICES. AND I THINK WE FINALLY HAVE GOTTEN THEM COMPLETELY DESCRIBED AND WE'RE WORKING WELL WITH THEM. SO FAR, WE'VE HAD 25 REQUESTS APPROVED BY DR. COLLINS, ONE WAS DISAPPROVED, AS I MENTIONED BEFORE, BECAUSE THE ISSUE AROUND PUBLICATION. AND THEN THERE ARE FOUR THAT REQUIRE REEVALUATION FROM THE WORK GROUP THAT THE ADMINISTRATIVE STAFF IN THE OFFICE ARE WORKING ON. OF THE 25 APPROVED, SO FAR 13 APPLICANTS HAVE DOWNLOADED THE DATA, AND WE'VE RECEIVED FIVE ANNUAL REPORTS, WE'VE BEEN DOING IT FOR THAT LONG, WHICH IS REALLY HARD TO BELIEVE, AND ONE OF THEM IS PARTICULARLY OUTSTANDING, I DON'T KNOW IF KATHY WOULD WANT TO MAKE COMMENTS ABOUT THAT. THEN WE HAVE ONE PENDING REQUEST THAT WE'RE GOING TO SHOW YOU TODAY THAT YOU'LL VOTE ON. THIS IS THE PENDING REQUEST. AND IT'S ON HeLa CELLS REPETITIVE ELEMENTS. ROB SNYDER FROM FRANCE, AND RUSS, WILL BE HAPPY TO ANSWER ANY QUESTIONS IF YOU HAVE ANY, RELATIVE TO THE CONTENT OR SCIENCE OF IT, OKAY? WHEN WE REVIEWED IT, IT SEEMED TO BE CONSISTENT WITH THE ONE REALLY IMPORTANT ELEMENT THAT I THINK RUTH BADEN REALLY HAMMERS INTO US, WHICH IS THE ELEMENT OF THE NONTECHNICAL SUMMARY. AND I THINK WE'VE HAD A NUMBER OF COMMENTS TODAY ABOUT HOW IMPORTANT IT IS TO BE ABLE TO COMMUNICATE. IN ADDITION TO THE ELEMENTS THAT THE APPLICATION HAS THAT ARE THE SCIENTIFIC -- I'LL USE THE TERM WE USE, JARGON, YESTERDAY, THAT'S FINE. BUT THEY HAVE TO BE JARGONIZED, THE TERM THAT WE'RE QUOTING FROM DR. COLLINS FROM YESTERDAY, OKAY? WRITE THAT DOWN. THAT'S GOING TO BE IN THE URBAN DICTIONARY. JARGONIZED. AND THIS REQUESTER HAD ONE SENTENCE IN THE NONTECHNICAL SUMMARY WHICH WE COULD NOT DECIPHER. AND SO CLEARLY IT WAS NOT A NONTECHNICAL SUMMARY, JUST BECAUSE IT WAS ONE SENTENCE. SO THERE WAS QUITE A LIVELY DISCUSSION ABOUT THAT, AND IN FACT THE RECOMMENDATION I THINK LED BY CLYDE YANCY IS THAT, ONE, WE GIVE THEM EXAMPLES OF WHAT IT LOOKS LIKE TO HAVE A NONTECHNICAL SUMMARY. AND THEN RUTH BADEN ASKED US TO CONSIDER LANGUAGE THAT SAYS NONTECHNICAL BECAUSE THE LACKS FAMILY IS PART OF THE LAY TEAM THAT LOOKS AT THIS AND MAY NEED TO UNDERSTAND, AND SHE FELT THAT WOULD AT LEAST GIVE THEM AN UNDERSTANDING WHY WE'RE ASKING FOR A SERIOUSLY NONTECHNICAL SUMMARY. SO WE'LL SEE HOW THAT WORKS BUT I THINK THE STRUGGLE GOES ON FOR US TO BE ABLE TO DO THIS. SO THE WORK GROUP BASED ON THE ISSUE OF THE NONTECHNICAL SUMMARY FELT THAT WE WOULD PUT FORTH TO YOU THAT YOU CONSIDER A RECOMMENDATION FOR CONDITIONAL APPROVAL. AND THAT'S IT. SO BEFORE -- WELL, I GUESS THE ISSUE IS NOW TO VOTE. DON'T KNOW IF YOU WANT TO GO BACK TO THE DESCRIPTION OF THE APPLICATION, OR YOU WANT TO ASK ANY SPECIFIC QUESTIONS THAT RUSS -- YES, ARE YOU? >> I JUST WANT TO EXPAND ON THIS ISSUE OF THE LAY SUMMARY, NONTECHNICAL SUMMARY, BECAUSE THIS IS PROBABLY THE NUMBER ONE REASON WHY WE MAKE CONDITIONAL >> RIGHT. >> IT GOES FROM, YOU KNOW, RIDICULOUS TO INSULTING, SOMETIMES THEY JUST COPY AND PASTE THE EXACT SAME TEXT THAT'S IN THE TECHNICAL SUMMARY AND IT REMINDS ME OF THE RELEVANT SECTIONS WE KNOW VERY WELL IN OUR NIH PROPOSALS WHICH I ALSO FIND TO BE HORRIBLE VERY OFTEN, AND YET I FIND IT TO BE ONE OF THE FUNNEST PARTS OF A PROPOSAL TO WRITE, WHICH IS THE TWO TO THREE SENTENCE THINGS YOU WOULD TELL YOUR GRANDMOTHER ABOUT WHY YOU'RE DOING THIS RESEARCH. AND SO I JUST WANT TO UNDERSCORE YOUR POINT THAT THIS IS A SKILL WE PROBABLY NEED TO WORK ON MORE GENERALLY BECAUSE PEOPLE ARE NOT GOOD AT IT AND IT GOES RIGHT TO THE ISSUES WE DISCUSSED THIS MORNING. >> THANK YOU. OKAY. IF THERE'S NO FURTHER DISCUSSION, WE SHOULD ENTERTAIN A MOTION FOR A CONDITIONAL APPROVAL. DO I HEAR SOMEONE? >> SECOND. >> OKAY. IS IT PROPERLY MOVED AND SECONDED? ALL IN FAVOR? >> AYE. >> ANY OPPOSED? GREAT, ALL RIGHT. LET ME JUST ALSO JOIN IN ON THE DESCRIPTION THAT DR. COLLINS SAID YESTERDAY, THE FAMILY WAS JUST SO THRILLED TO REALLY BE THERE, AND THEY ARE SO ATTENTIVE. THEY ASK GREAT QUESTIONS. IT WAS JUST A TREMENDOUS MEETING. AND I THINK, FIRST OF ALL, THEY ARE JUST SO IMPRESSIVE, THE DIRECTOR OF NIH WOULD COME AND SPEND PERSONAL TIME WITH THEN COMMUNICATING AND DOING A CONSULTATION, THEY TRULY APPRECIATED THAT AND EXPRESSED THAT, FRANCIS, AFTER YOU LEFT ALSO. I THINK THE WHOLE ISSUE OF WHEN PEOPLE TALK THE TALK, DO THEY REALLY WALK THE WALK, AND THIS HeLa CELL WORK GROUP IS ABOUT WALKING THE WALK AND THEY APPRECIATE THAT. WHEN YOU HEAR ABOUT THE OTHER THINGS THEY ARE DOING IN THE BALTIMORE COMMUNITY, THIS IS A GROUP OF RESEARCH ACTIVISTS, AND IN A MINORITY COMMUNITY, YOU NEED THESE KIND OF PEOPLE TO GIVE THAT POSITIVE MESSAGE ABOUT THE BENEFITS OF RESEARCH, SO I THINK THERE'S SO MUCH WE COULD LEARN FROM THEM, AND TO HELP THEM CONTINUE THE KIND OF MESSAGES THAT THEY ARE DELIVERING TO THEIR COMMUNITY. THE OTHER ELEMENT OF IT IN TERMS OF THE IMPACT ON THE SCIENTISTS, FRANCIS ALLOWED ME TO BE ABLE TO READ THE "CELL "PAPER ACKNOWLEDGEMENT BECAUSE IT CAPTURES OF THE FLAVOR OF WHY WE'RE DOING THAT IN THE WORK GROUP. THE ACKNOWLEDGEMENT GOES AS SO. SOME OF THE GENOME SEQUENCES DESCRIBED IN THIS RESEARCH WERE DERIVED IN A HeLa CELL LINE. HENRIETTA LACKS WITHOUT HER KNOWLEDGE OR CONSENT IN 1951 HAS MADE SIGNIFICANT CONTRIBUTIONS TO SCIENTIFIC PROGRESS AND ADVANCES IN HUMAN VELLET. WE'RE GREAT FOLLOW TO HENRIED A LACKS, NO DECEASED, AND HER FAMILY. THE HeLa CELLS WERE SUBMITTED AS A SUBSTUDY UNDER A SESSION NUMBER AND THEN IT GIVES THE SESSION NUMBER. SO JUST THAT FLAVOR AND ACKNOWLEDGEMENT THAT, YOU KNOW, WE'RE NOW DOING GOOD WORK WITH THAT, BUT THE PROCESS, ALTHOUGH FLAWED IN THE BEGINNING, WE'RE NOW STARTING TO AT LEAST DO SOME CORRECTIVE ACTION AND SHOW AND ACKNOWLEDGE OUR APPRECIATION. I THINK THAT'S IT. THANK YOU VERY MUCH. IT'S BEEN A WONDERFUL EXPERIENCE. THANK YOU, FRANCIS, AND THANK YOU, KATHY. >> THANK YOU, MY GOSH, WHAT A WONDERFUL THING YOU'VE DONE BY LEADING THIS EFFORT. WE MIGHT ALSO BRIEFLY MENTION THE FAMILY'S INTEREST IN THE IDEA OF A SYMPOSIUM. I WAS TAKEN BY THAT AS WELL. BECAUSE AGAIN THEY HAVE BECOME REAL RESEARCH SUPPORTER ACTIVISTS AND ANXIOUS TO SEE AS MUCH INFORMATION AS POSSIBLE SHARED ABOUT WHAT'S COME OUT OF THIS. WE FLOATED THE CD OF PERHAPS HAVING A SYMPOSIUM ON WHAT'S BEEN LEARNED FROM HeLa CELL RESEARCH, NOT AS A SEPARATE ENTERPRISE BUT PERHAPS PULLING INTO THE AMERICAN SOCIETY FOR CELL BIOLOGY OR AAAS MEETING OR HUMAN GENETICS MEETINGS OR MAYBE EACH OF THOSE IN VARIOUS ROTATIONS, AND THEY LOVED THAT IDEA. AND THEY ALSO CAME BACK IMMEDIATELY, WOULDN'T IT BE EVEN BETTER IF THE INFORMATION THAT'S SHARED IN THOSE SCIENTIFIC JARGONIZED MEETINGS COULD ALSO BE DEJARGONIZED AND FOLDEDs INTO A PUBLIC PRESENTATION? HOPKINS HAS AN ANNUAL HENRIETTA LACKS LECTURE, ONE POSSIBILITY WOULD BE TO TRY TO DISTILL WHAT MIGHT COME OUT OF A SCIENTIFIC SYMPOSIUM INTO A MORE PUBLIC SPIRITED PRESENTATION INCLUDED THERE OR IS IN SOME OTHER WAY OTHER WE WERE GOING TO THINK ABOUT THAT. T IT WAS REMARKABLE TO SEE THE TRANSFORMATION IN THEIR THINKING FROM THE ORIGINAL UNCERTAINTY ABOUT WHETHER THIS WAS GOOD AT ALL, TO NOW THEY ARE OUT THERE, AND THEY -- VERONICA TALKED ABOUT GOING TO TALK IN HIGH SCHOOLS, DAVID IS OUT THERE GIVING PRESENTATIONS, AND GERRI AS WELL. THEY ARE REALLY MAKING A REMARKABLE STEP IN THEIR OWN WILLINGNESS TO PUT THEMSELVES OUT THERE ON THE FRONT LINES. >> DO YOU WANT TO COMMENT ON YOUR FEEDBACK FROM SCIENTISTS AT THE WORK GROUP THAT THEY SHARED WITH YOU? >> SO, YEAH, I THINK, AGAIN SCIENTISTS WHO WORK WITH HeLa CELLS MOST OF THE TIME DON'T THINK ABOUT WHERE THEY CAME FROM, AND TO HAVE THE OPPORTUNITY TO HAVE THAT PRESENTED AND ACTUALLY INTERACT WITH PEOPLE WHO ARE CONNECTED IN A VERY SIGNIFICANT WAY WITH THE ORIGINAL DONOR CHANGES THEIR WHOLE PERSPECTIVE. RICK MYERS TALKED ABOUT THAT ON THE PHONE WHEN HE WAS CALLING FROM ALABAMA YESTERDAY. ARE BEING GIVEN BY HAVING THAT OPPORTUNITY TO MAKE THIS NOT JUST AN ABSTRACT EXPERIMENT, BUT A CONNECTION TO A HUMAN BEING. >> IN CLOSING, KATHY, ANY OTHER COMMENTS? OKAY, RUSS. >> HUDA HAD A COMMENT. >> IT'S FANTASTIC. WHAT YOU READ, TO ME, IT'S VERY MOVING TO SEE THE FACT THAT IT ACTUALLY SAID THAT IT WAS WITHOUT HER PERMISSION, AND HER FAMILY GAVE THE PERMISSION. SO IN REFERENCE TO YOUR COMMENT ABOUT HOW TO MAKE THE PUBLIC AWARENESS GREATER, I WAS -- YOU MENTIONED AAAS, I FEEL LIKE THERE'S GOOD MEDIA PRESENCE THERE, AND I'M WONDERING IF THERE IS A WAY THAT -- WHERE YOU CAN ACTUALLY GIVE A SCIENTIFIC TALK BUT ALSO HAVE INTERACTION WITH THE PRESS LIKE A SEPARATE EVENT? AND I'M WONDERING WHETHER THIS COULD BE PART OF MAYBE THE EDUCATIONAL MISSION OF THE PUBLIC BY TALKING ABOUT THE PARTNERSHIP BETWEEN SCIENCE AND THE PUBLIC IN ADVANCING SCIENCE, AND HAVE THEM BE FEATURED AND CREATE SOME MEDIA INTEREST IN THAT, YOU KNOW. >> YEAH, THERE'S NOT BEEN MUCH. THERE WAS A PIECE IN "NATURE" WHEN WE FIRST SET UP THIS GROUP, BUT THAT'S A COUPLE YEARS AGO AND PRETTY MUCH FOR THE SCIENTIFIC AUDIENCE. I'M NOT SURE THERE'S BEEN MORE PUBLIC VISIBILITY OF THIS SORT OF UNIQUE EXPERIENCE, AND CERTAINLY A AAAS SETTING WOULD WORK WELL, ESPECIALLY IF WE COULD GET SOME FAMILIES MEMBERS THERE. ARE WE TOO LATE? >> WE ALSO GO, IN ADDITION TO THOSE THOUGHTS, HAVE TO THINK ABOUT THE POINT WITH THE MINORITY PUBLIC, BECAUSE GIVEN THE NEED TO HAVE MORE PEOPLE OF COLOR TO PARTICIPATE IN CLINICAL TRIALS AND TO SIGN UP, THAT IN ADDION TO GENERIC AND AAAS, I THINK OBVIOUSLY WITH YOUR CONTACTS, RENEE, THE PRESENTATION FIRST OF ALL TO THE NATIONAL MEDICAL ASSOCIATION, AT THE NEXT ANNUAL MEETING, WOULD BE A TERRIFIC OPPORTUNITY PERHAPS, BUT WHAT I'M ALSO TRYING TO THINK OF IS WITH THE PUBLISHER OF THE BOOK, IS THERE A WAY TO -- I'M TRYING TO THINK OF A WAY TO GET SOME CO-JOINED EFFORT WITH SOMEBODY LIKE "EBONY." EBONY MIGHT BE A PITCH BECAUSE YOU'RE STARTING TO THINK ABOUT IT BEING A HUMAN INTEREST FEATURE, AND THE IDEA OF THIS FAMILY, LIKE THAT PICTURE YOU JUST SHOWED IN A WAY, WITH YOU AND CLYDE BEING -- WE CAN TALK OFFLINE BUT I'M THINKING ABOUT EBONY WOULD BE AN INTERESTING PITCH AND FRANKLY A CALL FROM THE HEAD OF NIH TO THE PUBLISHER OF "EBONY" WOULD BE LIKE -- YOU NO, WAIT A MINUTE! THIS IS A CALL I GOT TO TAKE! YOU KNOW, IT WOULD BE ODD, YOU KNOW WHAT I'M SAYING? SO ODD IT WOULD BE COMPELLING. WE CAN TALK MORE OFFLINE. >> YES. >> BUT MY POINT BEING TRYING TO GET SOMETHING WITH THAT FAMILY, YOU GOT THIS BLACK FAMILY, YOU'VE GOT THIS POPULAR BOOK THAT'S KNOWN BY THE PUBLISHER, YOU'VE GOT TWO YOUNG BLACK SCIENTISTS, YOU AND CLYDE -- >> I DIDN'T THINK BIT THAT WAY. >> JUST A THOUGHT. WE CAN TALK OFFLINE. >> ALL RIGHT. AGAIN, I THINK THEY ARE INCREDIBLE MESSENGERS FOR THE POSITIVE ASPECT OF RESEARCH IN THE AFRICAN-AMERICAN COMMUNITY, MINORITY COMMUNITIES, TRYING TO THINK ABOUT HOW TO MOVE AROUND THE IDEA BECAUSE TO ME THAT'S WHAT YOU'RE SAYING, IT'S AN OPPORTUNITY TO DO TH. PETER, I DON'T KNOW DO YOU WANT TO -- >> YEAH, I THINK AN ELEMENT THAT WILL BE HARMONIOUS WOULD BE SOMETHING LIKE A HeLa SCHOLARS PROGRAM WHERE AN ENDOWMENT IS ESTABLISHED, $5, FOR EXAMPLE, THAT WOULD GENERATE $500,000 A YEAR, THE FAMILY WOULD SELECT POSTDOCTORAL FELLOWS TO STUDY CANCER, AND WHATEVER. ITS JUST PUTS IN PERPETUITY SOMETHING THAT I BELIEVE WILL PULL ALL THESE ELEMENTS TOGETHER, AND HAS A SCIENTIFIC OUTPUT. >> A SCHOLARSHIP PROGRAM -- [LOW AUDIO] >> YOUR MICROPHONE, SIR. >> THERE'S A SCHOLARSHIP PROGRAM, REBECCA PUT IN PLACE, BUT IT'S FOR I THINK LACKS FAMILY MEMBERS. IT'S WRITTEN IN AN EXTENSIVE WAY FOR COLLEGE EDUCATION. BUT YOU'RE TALKING ABOUT A DIFFERENT KIND OF CANDIDATE, RESEARCH FELLOW, POSTDOC. IT'S AN INTERESTING IDEA. ALL WE NEED IS $5 MILLION. >> TALK TO ATCC. THEY ARE SETTING UP FOR CELLS, THEY MIGHT BE IN A POSITION TO SEED SOMETHING. >> INTERESTING. >> GOOD IDEA. >> FRANCIS, I THINK YOUR IMPREMATUR, RITA IS TALKING ABOUT GETTING THE IMPREMATUR OF THE NIH TO GET THINGS MOVING. >> WE HAVE TO THING ABOUT USING THE FOUNDATION FOR NIH OR OTHERWISE I'LL GO TO JAIL. THE CONCEPT I'M GETTING, YEAH. >> SCIENTIFIC FRIENDS AND INSTITUTIONS. >> SO THE WORK OF THE WORK GROUP IS NOT JUST DOING THE REVIEWS. WE ALSO MAKE RECOMMENDATIONS AND SO THERE WILL BE CONTINUED DIALOGUE ABOUT HOW TO GET THE WORD OUT THERE AND HOW TO TAKE THIS PROCESS AND BE ABLE TO SHARE IT MORE PUBLICLY FOR THE REASONS THAT MANY OF YOU HAVE ALREADY MENTION. >> HARLAN? >> SO THIS IS -- EVERY TIME I HEAR ABOUT IT, I'M JUST SO INSPIRED BY THE NOTION OF REMEDY SOMETHING THAT WAS WRONG BUT ALSO JUST THE IDEA OF THE POWERFUL NIH AND PEOPLE REPRESENTING THE POWERFUL RECOGNIZING THE RESPONSIBILITY AND SHARING, YOU KNOW, IN THAT WAY. AND I WAS SAYING SEEING FRANCIS TAKE THE TIME TO COME TO THIS MEETING IS REALLY IMPRESSIVE. I THINK ONE OF THE THINGS ABOUT LEADERSHIP IS KNOWING WHAT REALLY DOES REQUIRE YOUR PERSONAL ATTENTION, BECAUSE THERE'S -- YOU CAN'T GIVE PERSONAL ATTENTION TO EVERYTHING. AND TO ME, THE CHOICE OF ALLOCATING SOME OF YOUR TIME TO THIS IS JUST SO WISE AND SO IMPORTANT AND IT MEANS A LOT TO ALL OF US AND FAR BEYOND, I THINK IT'S A WISE CHOICE. ONE QUESTION FOR THE COMMITTEE, OBVIOUSLY THIS IS A UNIQUE CIRCUMSTANCE, BUT IN PART BECAUSE THE HeLa CELLS BECAME SO POPULAR, BUT ARE THERE OTHER SITUATIONS LIKE THIS WHERE THINGS LIKE THIS HAPPENED AND WE DIDN'T GET A BOOK WRITTEN ABOUT THEM, BUT THAT WE SHOULD BE AWARE OF? IS THIS REALLY A ONE-OFF OR IS THERE A PROCESS IS SOMEBODY IS AWARE OR CAN FUNNEL UP THERE ARE CONCERNS THAT THAT HAPPENS? HAS ANYONE EVER LOOKED INTO THAT? SORT OF LIKE THE RICIN ON THE SHELVES, NO ONE IS AWARE SOMETHING ELSE IS GOING ON. >> WHAT ELSE IS HANGING OUT? >> MAYBE THAT WAS BAD. >> WE DID, WITH REGARD TO CELL LINES, TRY TO SEE WHETHER OTHER BROADLY USED CELL LINES DERIVED FROM PEOPLE WHO COULD BE IDENTIFIED AND FROM WHOM NO CONSENT WAS OBTAINED, THE ONLY ONE AS I RECALL THAT FIT THAT DESCRIPTION WAS DERIVED FROM A CLOISTERED NUN, LONG SINCE GONE WITH NO OFFSPRING. WE DID SOME LOOKING. THE WHOLE EXPERIENCE GOING THGH THIS WITH THE FAMILY AND WITH THE SCIENTIFIC COMMUNITY THINKING MORE DEEPLY ABOUT THE WHOLE ISSUE OF CONSENT HAS PLAYED OUT QUITE USEFULLY AND SIGNIFICANTLY AND WHAT IS CURRENTLY UNDERWAY, THE REVISION OF THE COMMON RULE, COMMON RULE, YOU KNOW, HAS NOT GONE THROUGH A REVISION SINCE 1991 OF THIS ENTERPRISE THAT OVERSEES EVERYTHING WE DO IN HUMAN SUBJECT RESEARCH. AT THE BEGINNING THE OBAMA DECISION, A DECISION WAS MADE TO SEE WHAT COULD BE DONE TO COME UP WITH NEW INTERPRETATIONS IN THE FACE OF SO MUCH SCIENTIFIC ADVANCEMENT. THAT HAS BEEN MOVING ALONG. IN THE NOT TOO DISTANT FUTURE A NOTICED OF PROPOSED RULE MAKING WILL APPEAR WITH THE LATEST VERSION OF WHAT THE COMMON RULE MIGHT LOOK LIKE. IT WAS SPECIFICALLY INFLUENCED BY THIS EXPERIENCE WITH HeLa CELLS AND WHAT THAT TELLS YOU ABOUT WHAT CONSENT OUGHT TO INCLUDE. >> GREAT. >> KATHY, YOU MISSED THE QUESTION. WERE THERE LARGER LESSONS BEYOND THIS UNIQUE SITUATION OF AN IDENTIFIED FAMILY WITH A UNIQUE CELL LINE. >> ANY OTHER COMMENTS OR QUESTIONS? GREAT. I'M HEARING NONE. THANK YOU. >> WELL DONE. THANK YOU, RENEE. [APPLAUSE] >> SO WE NOW HAVE TWO REPORTS THAT ARE IN THIS VERY IMPORTANT SPACE OF DIVERSITY, AND WE'RE GOING TO FLIP THE ORDER FROM WHAT'S IN YOUR AGENDA, AND HAVE HANNAH VALANTIN FIRST BEFORE RICHARD NAKAMURA, BUT FIRST WE HAVE REID, OVER THE COURSE OF THREE YEARS SINCE THE PUBLISHING OF THE PAPER AND MANY OTHER THINGS THAT HAPPENED IN THE WAKE OF THAT, REID WORKED WITH INCREDIBLE PASSION AND INTENSITY WITH MY GOOD FRIEND LARRY TABAK AND MANY OTHERS TO TRY TO ASK AND ANSWER THE QUESTION ABOUT WHAT WE COULD DO AT NIH TO ADDRESS THIS IMPORTANT AND CHALLENGING ISSUE, AND I PROMISED HIM WHEN I ASKED HIM TO DO THIS, BECAUSE HE WAS BUSY, THAT HIS RECOMMENDATIONS AND RECOMMENDATIONS OF THE GROUP WOULD BE TAKEN WITH GREAT SERIOUSNESS. I HOPE YOU'LL HEAR TODAY THAT WILL BE THE CASE BUT I APPRECIATE, REID, YOUR WILLINGNESS TO HOLD US ACCOUNTABLE IN THE PROCESS OF DOING SO, TO LEAD THIS PART OF OUR ACD MEETING AND PLEASE TAKE IT WHEREVER YOU THINK IT SHOULD GO. >> THANK YOU. IT COULDN'T BE A BETTER SEGUE FROM THE LAST CONVERSATION, I THOUGHT THAT HARLAN'S COMMENT ABOUT THIS JUXTAPOSITION BETWEEN POWER AND POWERLESS, AND HOW YOU PROTECT THE RIGHTS OF THE POWERLESS AND HOW PEOPLE WITH POWER RESPOND IS AN ENORMOUSLY IMPORTANT ISSUE. I WILL QUICKLY HASTEN TO SAY THAT THE THING I KEPT THINKING, RENEE, AS YOU PASSED THE BATON, IT'S STILL ALIVE, I CAN'T TELL YOU HOW OFTEN I GET IT WITH THE ISSUE OF TUSKEGEE SYPHILIS STUDY. PEOPLE ASK ME ARE THERE OTHER BIG TOPICS? IT'S STILL THERE, STILL IS A RATE-LIMITING STEP WHEN YOU TRY TO TALK ABOUT HIV DISEASE, TALK ABOUT THINGS, AND OF COURSE WITH THE ISSUES THAT ARE HAPPENING ACROSS OUR SOCIETY RIGHT NOW, THIS IS SUCH AN INCREDIBLY INTENSE CONTEXTUAL MOMENT TO HAVE THESE CONVERSATIONINGS WITH WHAT'S GOING ON IN ST. LOUIS, IN NEW YORK. THERE IS THIS ENORMOUS FRUSTRATION IN THE LAND BETWEEN THOSE WHO ARE POWERLESS AND WHO FEEL POWERLESS AND THEIR RELATIONSHIP TO AMERICA'S ELITE AND THOSE WITH POWER. AND SO IT IS NOT TRIVIAL, AND I'M NOT TRYING TO -- DO IT WANT FRANCIS TO BECOME EMBARRASSED BY THIS CONVERSATION, WE CAN'T ALLOW YOU TO BE EMBARRASSED BY WHAT WE'RE SAYING TO YOU, BUT IT'S NOT TRIVIAL THAT YOU WOULD SPEND YOUR TIME, YOU KNOW, AS WAS SAID, THAT YOU'VE GOT A LOT OF THINGS TO DO AND PEOPLE PULL ON YOU TO DO A LOT OF THINGS, AND RESPONSIBLE LEADERSHIP HAS GOT TO DECIDE WHERE YOUR PRIORITIES ARE. AND IF YOU DON'T WALK THE WALK OR TALK THE TALK, YOU'RE NOT GOING TO GET PEOPLE TO CHANGE. THEY ARE NOT GOING TO BEHAVE IN THE WAY YOU WANT. THE FACT THAT YOU WOULD SIT QUIETLY IN A ROOM WITH PEOPLE, IN A FAMILY, FAR AWAY FROM YOUR LABORATORY, WHERE YOU'RE EXCEEDINGLY COMFORTABLE, IS AN IMPORTANT -- IT'S BEYOND . THE REASON I'M SAYING THESE THINGS IS BECAUSE IT IS INEVITABLE THAT THE WORK THAT LED TO THIS WORK GROUP AND THE REPORT IN "SCIENCE" NOW A FEW YEARS AGO, THERE ARE SO MANY PEOPLE WHO ARE SO CYNICAL, WHO WILL NEVER BELIEVE THAT THIS INSTITUTION WOULD EVER REALLY CARE. IT'S LIKE, OKAY, THEY ARE GOING TO PUT SOME MORE BAND-AID ON THE PROBLEM, YOU KNOW, LIPSTICK ON THE PIG, IT'S GOING TO BE A PUBLIC RELATIONS THING. AND SO WHAT YOU HAVE IS A FUNDAMENTAL ELEMENT OF TRUST. AND I TOOK THIS ON BECAUSE I BELIEVED NOT ONLY WAS THE IT RIGHT THING TO DO BUT BECAUSE I BELIEVED IN FRANCIS. YOU HAVE TO THEN SAY THAT YOU HAVE TO DELIVER HERE, AND I'M SAYING THIS, I GUESS, BECAUSE I KNOW A LOT OF PEOPLE FROM THE NIH FAMILY ARE HERE THIS DOESN'T WORK IF IT'S ONLY FRANCIS. YOU SEE WHAT I'M SAYING? IT CAN'T WORK. IF Y'ALL LEAVE THIS DUDE HANGING OUT THERE, SHAME ON YOU, BECAUSE NIH IS NOT GOING TO GET ANOTHER BITE AT THIS APPLE. YOU BLOW IT THIS TIME, YOU BLOW IT FOR A LONG TIME, BECAUSE NOBODY IS GOING TO TRUST YOU. AD THE POLITICAL WORLD OUT THERE IS SO HEIGHTENED AND SENSITIVITIES ARE SO GREAT YOU CANNOT SCREW THIS UP. I'VE ALSO SPREAD MY PERSONAL REPUTATION OVER THIS BECAUSE I BELIEVE IN FRANCIS. AND SO WE'VE GOT TO BELIEVE IN EVERYBODY. SO HANNAH IS HERE, AND HANNAH HAS TAKEN THIS THINK ON. BY THE WAY, YOU GOT TO ALSO KNOW, I'LL BE DONE WITH MY INTRODUCTION BECAUSE I'M USING UP ALL MY TIME, BUT TABAK IS CRITICAL. YOU'VE GOT TO KNOW THAT INSIDE OF THIS ORGANIZATION, THERE ARE PEOPLE LIKE TABAK WHO YOU CAN CALL WHEN EVERYTHING LOOKS DISMAL, OR YOU'RE CONCERNED, AND HE WILL GET ON IT AND HE WILL WORK IT OUT IN A WAY THAT'S GOOD. SO YOU'VE GOT TO APPRECIATE IN INSIDE OF A BIG MACHINE LIKE NIH THAT YOU'VE GOT A GUY LIKE TABAK INSIDE OF THIS THING. AND WE OWE TABAK A GREAT DEAL. THAT'S WHY I'M GIVING HIM GRIEF. NOW, HANNAH IS HERE, AND SO SHE'S GOING TO GIVE YOU THE UMBRELLA PRESENTATION. THE REASON WHY THEY SWITCHED THE ORDER IS BECAUSE THE PEER REVIEW IS A COMPONENT OF THE UMBRELLA. WE DON'T WANT TO HAVE ONE SPOKE HANGING OUTSIDE THE UMBRELLA LEST YOU THINK THIS IS A DISORGANIZED CHAOTIC AND NONINTEGRATED OR LEVERAGED ACTIVITY. WHICH WOULD BE THE WORST THING FOR YOU TO THINK. SO, HANNAH IS GOING TO I THINK GIVE YOU GOOD NEWS. LET ME FINALLY SAY THIS. THERE IS NO WAY YOU CAN DO ANY OF THIS WORK AND NOT STEP ON A LAND MINE. YOU WILL PISS SOME OFF IF YOU JUST -- BECAUSE YOU DIDN'T TURN LEFT OR BECAUSE YOU TURNED RIGHT. SOMEBODY GOT SOME MONEY, SOMEBODY DIDN'T. SOMEBODY WON, SOMEBODY LOST. SOMEBODY WENT TOO FAR, SOMEBODY DIDN'T GO FAR ENOUGH. SO WE'RE BIG BOYS AND BIG GIRLS, WE'RE GROWNUPS IN THIS WORLD, AND YOU JUST CANNOT BE SCAREDY-FRAIDY. YOU HAVE TO CHARGE FORWARD. MEMBERS OF THE ADVISORY COMMITTEE, HANNAH IS GOING TO GIVE YOU NEWS. NOT EVERYBODY WILL THINK THE NEWS IS GOOD ENOUGH. AND SOME WILL BE MAD BECAUSE IT'S TOO MUCH GOOD NEWS. THE WOULD YOU PLEASE RALLY AROUND THE WORK AND SUPPORT THE EFFORT? BECAUSE WE NEED YOU TO BE WITH US AND PUSH THIS THING FORWARD. HANNAH, GIVE US SOME GOOD NEWS. >> GREAT, NO PRESSURE. LET ME OPEN COMMENTS BY THANKING REID FOR HIS TREMENDOUS SUPPORT SINCE I GOT HERE. REID IS THE CONSUMMATE COACH, AND I'M SO DISAPPOINTED THAT YOU'VE COME TO THE END OF YOUR TERM BUT WHAT YOU DIDN'T REALIZE IS I'VE BEEN DISCUSSING WITH FRANCIS HOW TO KEEP YOU ON FOR ANOTHER FIVE YEARS SO THAT YOU CAN COACH ME THROUGH THESE LANDMINES. SO ONWARD WITH THE PRESENTATION. WHAT I'D LIKE TO DO IS TO FRAME IT IN THE CONTEXT OF THE RECOMMENDATIONS THAT WERE MADE BY THE ORIGINAL ATD, FOLLOWING THE GINSA REPORT. AND AS YOU ALL KNOW, THERE WERE 13 RECOMMENDATIONS AROUND INFRASTRUCTURE, CREATING NEW MODELS OF MENTORING AND REALLY FOCUS ON THIS AREA WITH INTENSITY THAT HAD NEVER BEEN DONE BEFORE. AT THE CORE OF ALL OF THAT WAS THE CREATION OF THIS OFFICE THAT I HAVE BEEN ASKED TO LEAD, AND THE INTENT OF IT WAS COORDINATION, EVALUATION, LEADERSHIP AND ACCOUNTABILITY. IF I CAN SPEAK FOR THE ACD, IT WAS RECOGNIZED THOSE PARTICULAR ELEMENTS HAD PREVIOUSLY NOT EXISTED IN THE DIVERSITY EFFORTS THAT CAME ABOUT, AND IT WAS THOUGHT THAT WITH THAT KIND OF APPROACH, THAT INCLUDED A SCIENTIFIC APPROACH TO ALL OF THIS, WE WOULD REALLY HAVE A GOOD CHANCE OF PUSHING THE NEEDLE VIS-A-VIS SCIENTIFIC WORK FORCE DIVERSITY. WHAT I'M GOING TO BE TALKING ABOUT IS THE ENHANCING THE DIVERSITY IN THE NIH-FUNDED WORK FORCE. THIS IS A PROGRAM THAT HAS LAUNCHED WITH GREAT EXCITEMENT IN OCTOBER, AND THE GOOD NEWS ABOUT THAT IS THAT THE MANAGEMENT IS NOW VERY MUCH COORDINATED THROUGH MY OFFICE, AND I'LL TALK A LITTLE BIT ABOUT THAT. AT THE SAME TIME, WE'RE MAKING EFFORTS TO ENHANCE THE DIVERSITY IN THE NIH INTRAMURAL PROGRAM, AND I'LL TALK ABOUT WHAT WE'RE DOING THERE. I THINK WHAT WE ALL REALIZE THAT IN ORDER TO HAVE THE LARGE SUSTAINED CHANGE THAT WE WANT NATIONALLY, IN DIVERSIFYING OUR SCIENTIFIC WORK FORCE, WE'LL REALLY NEED TO DEVELOP A NATIONAL STRATEGY, AND THIS IS ANOTHER ELEMENT THAT I'VE BEEN WORKING ON WHICH WE'LL TALK ABOUT BRIEFLY. SO THE ENHANCING DIVERSITY IN THE SCIENTIFIC WORK FORCE REALLY FOCUSES ON THE PIPELINE, CREATING NEW MENTORING MODELS, AND EVALUATION. AND THIS IS A PROGRAM THAT WAS SUPPORTED BY THE COMMON FUND, SO IT WAS ALL SORT OF PUT TOGETHER AND CONCEIVED EVEN BEFORE I GOT HERE, IN A VERY THOUGHTFUL AND HIGHLY AMBITIOUS WAY BECAUSE AT THE CORE OF IT IS REALLY A LARGE EXPERIMENT. AND THE IDEA IS THAT THERE WILL BE A CONSORTIUM OF THREE HIGHLY INTEGRATED PROGRAMS, THE BUILDING INFRASTRUCTURE LEADING TO DIVERSITY, I'LL TELL YOU A LITTLE BIT ABOUT THOSE, BUT THEY WILL BE CLOSELY INTEGRATED WITH A NATIONAL MENTORING NETWORK, AND AT THE CORE OF IT, I MENTIONED, WAS EVALUATION, THE CENTER FOR EVALUATION AND COORDINATION, WHICH WILL PULL THE WHOLE THING TOGETHER SO THAT WE CAN REALLY LEARN WHAT WORKS AND FOR WHOM. AND NOW, OF COURSE, ALL OF THAT WILL HAVE THE OVERSIGHT AND THE EVALUATION FOLLOW-UP AND ACCOUNTABILITY THROUGH THE COSWD OFFICE. HERE IS THE GOOD NEWS BEFORE I GIVE YOU DETAILS AND SPECIFIC EXAMPLES, THIS WAS A HIGHLY COMPETITIVE AWARDS PROGRAM, IT WAS PRECEDEDDED BY PLANNING GRANTS WHICH WENT TO A NUMBER OF INSTITUTIONS AND ULTIMATELY MULTI-YEAR AWARDS WERE REVIEWED. HERE IS WHAT WE HAVE. TEN SITES WERE AWARDED THE BUILD AWARD, ONE NATIONAL MENTORING NETWORK, ONE CENTER FOR EVALUATION AND COORDINATION. AND I'VE LISTED HERE THE RECIPIENTS OF THE BUILD SITES, THERE ARE TWO HISTORICALLY BLACK COLLEGES, THERE ARE FIVE HISPANIC SERVING INSTITUTIONS AMONGST THEM. SO I THINK THIS WAS WHAT REID WAS ALLUDING TO, WE MADE SOME PROGRESS IN THAT, BUT SOME MIGHT SAY IT'S NOT ENOUGH. THE NATIONAL MENTORING NETWORK WENT TO THE PRIMARY INSTITUTION OF BOSTON, AND BEFORE YOU DRAW A GASP, ACTUALLY THIS IS CORED BY A CORE THAT INCLUDES MOREHOUSE MEDICAL SCHOOL, UNIVERSITY OF MINNESOTA, AND WISCONSIN AS SHOWN HERE, THAT ARE GOING TO DO THIS VERY WORK OF THE NATIONAL MENTORING NETWORK AND WE'LL SHOW YOU WHAT THAT MEANS AND CENTER FOR EVALUATION AND COORDINATION TO UCLA. THE GOAL WAS TO MERGE SOCIAL SCIENCE WITH BIOMEDICAL APPROACH AND DEVELOP NEW APPROACHES TO TRAINING AND MENTORING. WHY DO WE WANT TO DO THAT? CLEAR IN THE PAST, MANY OF THE MENTORING PROGRAMS HAVE NOT TAKEN TO ACCOUNT SOME SOCIAL AND PSYCHOLOGICAL FACTORS THAT ARE IN FACT BARRIERS TO NOT ONLY RECRUITING STUDENTS FROM UNDERREPRESENTED GROUPS BUT FROM ALSO ACTUALLY HAVING THEM SUSTAIN AND PERSIST IN THE PROCESS. SO WHAT YOU SEE HERE IS THE BUILD WHICH PROVIDES INFRASTRUCTURE FOR THAT TRANSITION, FROM UNDERGRAD THROUGH TO GRADUATE AND POSTDOCTORAL TRAINING. THE NATIONAL MENTORING NETWORK, WHICH WILL PROVIDE MENTORING, AND NETWORKING IN A NEW WAY, AND THE CEC. AND HERE ARE SOME DETAILS ABOUT THOSE PROGRAMS. THE BUILD PROGRAM REALLY IS A SET OF EXPERIMENTAL TRAINING AWARDS, OF HOW TO ATTRACT AND RETAIN STUDENTS FROM A WHOLE RANGE OF BACKGROUNDS, INCLUDING THOSE FROM UNDERREPRESENTED GROUPS. HOW DID WE CAPTURE THAT? WELL, TO BE ELIGIBLE FOR EVEN APPLYING FOR THESE AWARDS, INSTITUTIONS HAD TO BE RECEIVING NO MORE THAN $7.5 MILLION IN NIH FUNDING AND AT LEAST 25% OF THE STUDENTS RECEIVING PELL GRANTS. NOT ONLY THAT, THEY WERE REQUIRED TO PARTNER WITH RESEARCH INTENSIVE INSTITUTIONS AS TO BE ABLE TO PROVIDE THAT CRITICALLY IMPORTANT ELEMENT OF HANDS-ON RESEARCH EXPERIENCE FOR THEIR STUDENTS. SO THIS WAS A FAIRLY COMPLEX SORT OF SET OF REQUIREMENTS, SUCH THAT EMBEDDED IN IT WAS TO DEMONSTRATE INNOVATION, AND I'LL SHOW YOU SOME OF THE METRICS THAT WE USED. THE NATIONAL MENTORING NETWORK WOULD THEN PROVIDE A NATIONAL NETWORK OF MENTORS, FROM A VARIETY OF DISCIPLINES, AND HAVE A WAY OF LINKING MENTOR AND MENTEE, AND ONE NEW ELEMENT IS TRAINING OF MENTORS, IT HAS BEEN ASSUMED FOR THE LONGEST TIME JUST BECAUSE YOU WERE A SUCCESSFUL RESEARCHER YOU KNOW HOW TO MENTOR. TURNS OUT THIS IS ACTUALLY VERY INCORRECT. AND SO WE WERE -- THE REVIEWERS WERE LOOKING FOR THAT ELEMENT OF TRAINING OF MENTORS IN THE PROGRAMS AS THEY WERE PROPOSED. IT WILL ALSO PROVIDE NETWORKING AND PROFESSIONAL DEVELOPMENT FOR MENTEES. AS I MENTIONED AT THE CORE OF ALL OF THIS IS THIS CENTER FOR COORDINATION AND EVALUATION, THAT WILL RIGOROUSLY EVALUATE THE BUILD AND THE NRMN PROGRAMS TO DETERMINE WHAT WORKS AND FOR WHOM. A SECOND ELEMENT OF THE RESPONSIBILITY THAT IS CRITICAL IN THE CEC IS DISSEMINATION. WE DON'T WANT THE KNOWLEDGE TO PROGRAM, BUT REALLY TO BEGIN TO BE DISSEMINATED OUT SO THAT IT WILL REACH AS MANY OF OUR STUDENTS AS POSSIBLE. AND AS I MENTIONED, A KEY ELEMENT TO ALL OF THIS IS THAT THIS IS A CONSORTIUM AGREEMENT IN THAT THE AWARDEES WILL WORK AS A CONSORTIUM IN PARTNERSHIP WITH NIH SO THAT NIH EXPERTISE WILL COME TO BEAR AT EACH LEVEL OF THE PROGRAMS. SO IT'S OFTEN SAID, WHAT'S DIFFERENT ABOUT THIS? YOU KNOW, WE HAD A WHOLE 30, 40 YEARS OF DIVERSITY PROGRAMS, WHY IS THIS DIFFERENT? AND I THINK I WOULD SAY THERE ARE THE THREE ELEMENTS THE CONSORTIUM ELEMENT, THE EVALUATION AND THE DISSEMINATION. WHAT THE CONSORTIUM WILL DO IS IDENTIFY WHAT ARE THE HALLMARKS OF SUCCESS, MEANING THOSE INTERMEDIATE MEASURES OF SUCCESS. SUCCESSFUL PROGRESSION TOWARDS BIOMEDICAL RESEARCH. THEY WERE ACTUALLY IDENTIFIED NOT ONLY ACADEMIC METRICS OF SUCCESS, HALLMARKS OF SUCCESS, BUT SOME OF THOSE IMPORTANT SOCIAL AND PSYCHOLOGICAL FACTORS INCLUDING STEREOTYPE THREAT, UNCONSCIOUS BIAS AND SCIENCE IDENTITY AND I'LL THOUGH YOU WHY THAT IS IMPORTANT IN A MOMENT. THEY WILL ADJUST SPECIFIC PLANS TO WORK TOWARDS THIS CONSORTIUM-WIDE METRICS, SO YOU HAVE THE INDIVIDUAL METRICS, AND THEN THE CONSORTIUM-WIDE METRICS, AND WITH THE HOPE THAT WE'LL GET NEW WAYS OF TRAINING AND MENTORING. THE EVALUATION PIECE IS CRITICAL AND IT'S IN REALTIME, SO IF YOU CAN IMAGINE, TESTING THINGS AS WE GO ALONG, WE DISCOVER CERTAIN HALLMARKS OF SUCCESS AND WE GET THE BUILD PROGRAM INDIVIDUALLY TO ADJUST THEIR PLANS TO FIT WITH THESE NEW METRICS, SO THAT WE IMPROVE CONTINUALLY IN THIS ITERATIVE DESIGN WAY. DISSEMINATION IS KEY. THIS IS THE WAY IT WAS DESIGNED, REALLY THIS IS VERY DIFFERENT FROM PRIOR PROGRAMS IN DIVERSITY. SO THE NEXT FEW SLIDES I'LL GIVE OU A SENSE OF WHAT WAS ACTUALLY FUNDED. THE NATIONAL MENTORING NETWORK WAS FUNDED REALLY BECAUSE OF THE CERTAIN ELEMENTS WH WERE DEEMED TO BE INNOVATIVE, AND HERE THEY ARE. THE LEADERSHIP OF THE FOUR CORES IS DIVERSE IN REGION AND GENDER, AND THERE'S THE MENTORING CORE, NETWORKING CORE, AND THE PROFESSIONAL DEVELOPMENT CORE, AND NOW THE OUTREACH CORE, ALL WHICH WE TH OUGHT WAS VERY INNOVATIVE. IT HAS A REGIONAL ELEMENT, STRUCTURED THAT THE COUNTRY IS COVERED WITHIN THESE FIVE HUBS, IT HAS PARTNERSHIPS THAT RANGE FROM A RANGE OF TYPES OF INSTITUTIONS WHICH YOU SEE LISTED THERE, AND IT HAS THIS PORTAL MECHANISM FOR CONNECNG MENTORS AND MENTEES. THERE'S ANOTHER FOCUS HERE THAT IS REALLY NOT COVERED VERY MUCH IN THE BUILD PROGRAM, AND THAT IS THE ATTENTION TO THE VERY ISSUE THAT INITIATED THIS NEW EFFORT IN THE NIH, THIS LOW REPRESENTATION OF RECIPIENTS OF RO1 AWARDS BY AFRICAN-AMERICAN TRAINEES. AND THIS IS REALLY -- THIS PIECE OF -- THIS FOCUS ON POSTDOCS AND JUNIR FACULTY TO PREPARE THEM IN A WAY THEY ARE MUCH MORE LIKELY TO BE SUCCESSFUL IN GETTING RO1 GRANTS, THERE'S A WHOLE PLAN THERE TO BE ABLE TO DO THAT AND DO THAT SUCCESSFULLY. AND THEN THE FINAL ELEMENT, WHICH WAS THOUGHT TO BE INNOVATIVE, WAS THIS WAY OF USING THE TRAINER MODEL TO SCALE UP AND THE IMPLEMENTATION OF MENTORING IN A WAY THAT HAS NEVER BEEN DONE BEFORE, AND IN PARTICULAR INCLUDING CULTURAL RESPONSIVENESS AND COMPETENCIES. SO HERE IS A BRIEF SCHEMA OF THE FIVE CORES, FIVE CORES, EACH WILL HAVE RESPONSIBILITY FOR EACH OF THESE AND THEY WILL BE NICELY INTEGRATED IN A WAY THAT WE THINK ABOUT WORK EXTREMELY WELL. A FEW EXAMPLES OF WHAT WAS SUPPORTED IN THE BUILD PROGRAM, THIS ONE FROM UMBC, WE'RE FAMILIAR WITH THE MEYERHOFF PROGRAM AND ITS SUCCESS. WE DIDN'T WANT TO FUND EXISTING PROGRAMS. REMEMBER, WE WANTED SOMETHING INNOVATIVE AND NEW. AND THIS WAS IN A WAY FRAMED IN A WAY THAT IT WAS INDEED KNEW IN THAT IT WAS USING SOME OF THE TECHNIQUES THAT HAD BEEN USED IN THE MEYERHOFF PROGRAM, BUT ACTUALLY TARGETING STUDENTS WHO ARE AT RISK FOR NOT PERSISTING, MEANING STUDENTS WITH ACTUALLY A LOWER GPA, IT'S OFTEN BEEN SAID, WELL, MEYERHOFF PROGRAM TARGETS THE MOST SUCCESSFUL STUDENTS, THE BEST ONES, WHAT ABOUT THE OTHERS LEFT BEHIND? THIS IS EXACTLY WHAT THIS IS DOING, AND THIS RECEIVED A GREAT DEAL OF SUPPORT. THIS PARTICULAR PROGRAM THAT IS TARGETED THROUGH THE INTEGRATION THROUGH THE UNIVERSITY OF ALASKA FAIRBANKS IS A VERY INTERESTING APPROACH BECAUSE THIS IS ATTEMPTING TO TARGET RURAL STUDENTS WHO OFTEN DON'T HAVE THE OPPORTUNITY TO PARTICIPATE IN RESEARCH AND SO WE'RE MISSING OUT ON THAT PARTICULAR GROUP OF STUDENTS TO BE ENGAGED IN BIOMEDICAL RESEARCH. IT FOCUSES ON ACADEMIC ENRICHMENT ACTIVITIES AND INCLUDES A LARGE NUMBER OF DISADVANTAGED STUDENTS FROM LOW INCOME AND FIRST GENERATION STUDENTS. SO THAT WAS THOUGHT TO BE VERY INTERESTING. AND THE THIRD EXAMPLE THAT I WANT TO JUST POINT OUT IS ONE THAT ACTUALLY UTILIZES A SOCIAL PSYCHOLOGICAL THEORY, CRITICAL RACE THEORY, TO ACTUALLY FRAME AND DESIGN THEIR EXPERIMENT FOR EXPANDING DIVERSITY AS HAS EMPHASIS ON SOCIAL JUSTICE, THEIR GOAL ULTIMATELY WOULD BE TO CREATE A NEW HEALTH AND HEALTH DISPARITIES RESEARCH CENTERS, AND WHAT THEIR PUSH IS THAT YOU GET THE STUDENTS REALLY VERY KNOWLEDGEABLE OF WHAT THE MIGHT BE IN THE FUTURE, AND THAT IS A WAY TO ACTUALLY RECRUIT AND RETAIN AND PERSIST, WHILE ALSO TRAINING THEM IN FUNDAMENTAL BASIC SCIENCE. AND SO THIS ONE WAS WHY IT WAS ALSO SUBMITTED. SO LET ME NOW TURN TO THE SECOND AREA IN WHICH I'VE BEEN WORKING, WHICH IS WITHIN THE INTRAMURAL PROGRAM HERE. I THINK I MENTIONED THIS THE LAST TIME WHEN I SPOKE WITH YOU THAT MY REAL VISION IS TO BUILD A TRANS-NIH SCIENTFIC WORK FORCE AS A MODEL FOR CAPTURING THE MOST TALENTED BIOMEDICAL RESEARCH AND HOW DO WE DO THAT? AND I FIRMLY BELIEVE THAT IF WE TAKE THE SCIENTIFIC APPROACH TO THIS, AND TAKE IT IN THE SAME WAY AND SERIOUSNESS AS WE APPROACH ALL OF OUR SCIENCE, WE WILL HAVE AN OPPORTUNITY TO MOVE THE NEEDLE AND BE SUCCESSFUL IN A WAY THAT WE HAVE BEEN, WHEN WE'VE HAD OTHER SCIENTIFIC PROBLEMS TO BE CHALLENGED. AND SO WHAT I HOPE TO DO IS TO BUILD THE CENTER OF INNOVATION FOR SCIENTIFIC WORK FORCE DIVERSITY AS A PRIMARY GOAL. I ALSO -- A SECOND GOAL WOULD BE TO INCREASE THE CLIMATE OF INCLUSION AND SENSE OF BELONGING, AND MY STRATEGY THERE IS TO ADDRESS THE ISSUE OF UNCONSCIOUS BIAS IN THE WAY IT AFFECTS EVERYTHING THAT WE DO. AND TO DO THAT OF COURSE I WILL NEED TO BUILD AN INTERDISCIPLINARY TEAM WHICH I'M IN THE PROCESS OF DOING. WHAT ARE THE ACTION AREAS I'VE ENGAGED IN OVER THE LAST FEW MONTHS OF BEING HERE? TARGETED RECRUITMENT AND REESSENTIAL INTO THE NIH TENURE TRACK, TECHNICAL SCIENTIST ROLES, FOR TARGETED SEARCHES, LEADERSHIP AND PROFESSIONAL DEVELOPMENT FOR POSTDOCS, WE'RE NOW DESIGNING PILOT PROGRAMS WHILE WE'RE COGNIZANT OF WHAT'S GOING ON WITHIN THE DIVERSITY TRAINING PROGRAMS THAT ALREADY EXIST. WE DON'T WANT TO REINVENT THE WHEEL. WE'RE SETTING UP A PROGRAM FOR A PROGRAM ON UNCONSCIOUS BIASED DESIGNED AS AN EXPERIMENT, BUILDING PARTNERSHIPS AND LEVERAGING NEW DISCIPLINES SUCH AS THEY DESIGN TO INCREASE THIS RECRUITMENT FOR DIVERSITY. SO WHY TARGET AND START WITH INTRAMURAL PROGRAM? I THOUGHT I WOULD REMIND YOU OF THE DEMOGRAPHIC HERE, OF OUR INVESTIGATOR WORK FORCE. AS YOU CAN SEE THERE, THIS IS DATA THAT'S HOT OFF THE PRESS. 38% WOMEN. 1.4% AFRICAN-AMERICAN. 4.7% HISPANIC. THIS ACTUALLY MIRRORS ANY OF THE INSTITUTIONS OUT THERE, AND WHAT I HOPE TO BUILD IS SOMETHING THAT WILL BE A SHINING STAR TO OTHER INSTITUTIONS TO FOLLOW. SO HOW ARE WE GOING ABOUT DIVERSIFYING THESE AFRICAN POOLS? WE FOE FROM I.C. DIRECTORS THERE'S A LACK OF DIVERSITY IN THE CANDIDATE POOLS, AND WE'RE TOLD THERE ARE MANY LIMITATIONS, NOT KNOWING WHERE TO OUTREACH, KNOWLEDGE OF TARGETED RECRUITMENT, AWARENESS OF SOCIAL AND PSYCHOLOGICAL FACTORS AND MANY OTHERS. SO THE PROCESS THAT WE ARE TAKING IS TO ACTUALLY WORK WITH INDIVIDUAL ICs AND SCIENTIFIC DIRECTORS, HAVE THEM GUIDE US, OR GUIDE ME, AS TO WHERE THEY SEE THE OPPORTUNITIES FOR NEW HIRES, AND ACTUALLY BE PRO-ACTIVE USING VARIOUS ROSTERS TO SEE WHO IS OUT THERE IN THE POOL, THAT WE CAN ACTUALLY PRESENT AS POTENTIAL CANDIDATES, AND THEN GET THE OUTREACH ACTUALLY DONE BY THE SCIENTISTS THEMSELVES. AT THE BOTTOM WHICH WE ARE LOOKING AT NATIONAL DATA, AND TOP 20 INSTITUTIONS, I WOULD ADD THERE, A LOT OF THE MINORITY-SERVING INSTITUTIONS WE CAN LOOK IN THERE TO SEE WHAT THE POOLS ARE LIKE. TO DATE, WE'VE ASSISTED IN SEVEN IC SEARCHES, THE STADTMAN SEARCH WE IDENTIFIED 10 POTENTIAL CANDIDATES, WE DON'T KNOW WHETHER THEY APPLIED AND THIS IS THE FOLLOW-UP WE NEED TO DO. THE NEXT STEP IS BUILD AN INSTRUMENT TO OPERATIONALLIZE THE SEARCH, LINKING THE ROSTERS WITH USING SOCIAL MEDIA TO ACTUALLY IDENTIFY WHERE PEOPLE ARE THAT WE CAN DO TARGETED OUTREACH. SO WHAT ABOUT LEADERSHIP AND PROFESSIONAL DEVELOPMENT FOR POSTDOCS? SO HERE IS JUST A SCHEMA TO REMIND YOU THERE'S A LOT GOING ON IN THE OFFICE OF TRAINING AND EDUCATION HERE TO INCREASE DIVERSITY, LOTS OF PROGRAMS HERE THAT HAVE BEEN SUCCESSFUL AND AS I REVIEWED ALL OF THAT, AND TALKED WITH SHARON MILLGRAM, IT'S CLEAR THE GAP IS POSTDOCTORAL TO EARLY CAREER INVESTIGATOR POOL. THE PROGRAM THAT'S CURRENTLY BEING DESIGNED IS ONE I'M CALLING DIVERSIFYING AND ACCELERATING RESEARCH EXCELLENCE, IT'S MODELED AFTER A PROGRAM AT STANFORD WHICH HAS A NUMBER OF COMPONENTS LISTED HERE. I THINK ONE OF THE KEY ONES IS THIS TRAINING ON STRATEGIES TO SUPPORT ONE ANOTHER, PEER MENTORING, SENIOR AND GROUP MENTORING, DESIGNING AND IMPLEMENTING COMPONENTS TO TRACK AND MEASURE OUTCOMES OVER TIME. AND YOU WILL HEAR MORE ABOUT THIS IN DUE COURSE. SO IT'S ONE THING TO BRING PEOPLE HERE, THEN IT'S ANOTHER THING TO ACTUALLY CREATE THIS CLIMATE OF INCLUSION. AND WHAT I THINK IS VERY APPARENT, THAT THERE IS AN ELEMENT OF UNCONSCIOUS BIAS THAT GETS IN THE WAY IN A LOT OF OUR DECISIONS. AND BY THE WAY, IT'S NOT JUST THOSE WHO ARE MAKING DECISIONS ABOUT WHO WILL BE IN THIS ENTERPRISE. IT'S ABOUT THE SCIENTISTS YOURSELF. HOW WELL DO YOU SEE YOURSELF AS A SCIENTIST, DO YOU SEE YOURSELF AS BELONGING, AND SUCH THAT YOU'RE ABLE TO PERSIST, WHEN FACED WITH CHALLENGES. AND I JUST SHOW YOU THIS AS AN EXAMPLE, BECAUSE WHAT YOU SEE HERE IS A VERY SIMPLE EXPERIMENT, THAT WAS CARRIED OUT WHERE CHILDREN WERE ASKED TO DRAW SCIENTIST. WHAT YOU SEE IS THE STEREOTYPIC SCIENTIST, A WHITE MALE BY 60% OF CHILDREN K THROUGH SECOND GRADE. WHAT HAPPENS IS THAT AS YOU CAN SEE HERE, THE PERCENTAGE INCREASES WITH TIME. WHAT THAT MEANS IS SOMETHING IN OUR CULTURES AND OUR ENVIRONMENTS THAT IS PERPETUATING THE STEREOTYPE OF WHO IS A SCIENTIST. AND WE BELIEVE, THERE'S DATA OUT THERE, THAT YOU CAN ACTUALLY HAVE INTERVENTIONS TO OVERCOME THIS AND THIS IS WHAT I INTEND TO DO WHILE I'M HERE, BASED ON A PROTOCOL THAT I RAN AT STANFORD WHICH WAS HIGHLY SUCCESSFUL. AND THEN FINALLY, WHAT IS THERE GOING TO BE AFTER BUILD? WHERE DO WE GO NOW? HOW DO WE HAVE A NATIONAL STRATEGY THAT WILL BE DEEP AND SUSTAINING THAT WILL ULTIMATELY CHANGE THE FACE OF THE BIOMEDICAL WORK FORCE? WELL, HERE IS A PROPOSAL THAT I'VE BEEN WORKING ON TOGETHER WITH HELP FROM LARRY TABAK AND FRANCIS COLLINS. THIS IDEA OF CREATING HUBS OF INNOVATION DIVERSITY WOULD CREATE NETWORKS AND STRONG INFRASTRUCTURE TO SUPPORT CAREER DEVELOPMENT. THE FOCUS HERE IS CREATING SEAMLESS TRANSITION ACROSS THE CAREER PATH, BECAUSE WE KNOW PEOPLE DROP OUT CONSISTENTLY. I THINK THAT IT WILL REQUIRE PARTNERSHIPS, AND YOU CAN IMAGINE THE SITUATION, WITH A CENTER OF THE HUB BEING THE RESEARCH INTENSIVE INSTITUTIONS, AND WITH STRONG PARTNERSHIPS WITH A WHOLE SET OF DIFFERENT KINDS OF INSTITUTIONS, INCLUDING THOSE THAT ARE FOCUSED PRIMARILY ON EDUCATION, AND OTHER KINDS OF INSTITUTIONS. AT THE CORE OF IT WILL BE THE SCIENCE OF DIVERSITY. WE WILL BE TESTING THINGS AND IN A WAY THAT THEY CAN BE EVALUATED FULLY TO SEE WHAT REALLY WORKS. CRITICAL TO THIS, TO BE OCCURRING AT THE SAME TIME, WILL BE IMPLEMENTATION, DRAWING ON THE SCIENCE OF IMPLEMENTATION, TO BE ABLE TO DEVELOP SCALING TECHNIQUES, AND THEN TRACKING EVALUATION AND INSTITUTIONAL COMMITMENT. AND HERE IS WHERE SOMETHING THAT IT MIGHT LOOK LIKE, SCHEMEATICALLY, MENTORING, TRAINING, PARTNERSHIP, RESEARCH INTERVENTION, FULL COURSE PRESS EVALUATION AND IMPLEMENTATION, INCLUDING ACADEMIA AND MANY OTHER TYPES, IN RECOGNITION OF THE FACT WE NEED TO BE TURNING THE BIOMEDICAL RESEARCH FOR ALL WHERE THESE STUDENTS ULTIMATELY WILL WORK. HERE ARE SOME OF THE DELIVERABLES WE THINK THIS MIGHT BE. AND THEY ARE LISTED THERE. IMPORTANTLY, THE DEVELOPMENTAL TOOLS AND RESOURCES TO CAPITALIZE AND SUSTAIN THIS SUCCESS. AND THEN FINALLY, WE'VE HAD A COUPLE OF WEBINARS TO GET FEEDBACK FROM THE ACADEMIC COMMUNITY, AND THE KEY THEMES THAT YOU MIGHT IMAGINE, WE'VE GOT FEEDBACK ON, IS HOW ARE YOU GOING TO EVALUATE THIS FULLY? HOW WILL IT LINK WITH WHAT ALREADY IS GOING ON? MULTIPLE PROGRAMS IN DIVERSITY, INCLUDING THE MOST RECENT, THE BUILD PROGRAM, WHAT ARE THE SCOPE OF MENTORING, WHAT ARE THE CURRENT MODELS OUT THERE, CAN WE USE SOME OF THEM, AND HOW DO WE INTEGRATE THEM? AND WHO WILL BE THE PARTNERS AND HOW WILL WE DEVELOP THOSE PARTNERSHIPS? THIS IS WORK IN PROGRESS. I WANTED TO PRESENT IT BECAUSE I THINK WE WILL -- I HOPE WE WILL YOU TO KNOW THAT WE DON'T VIEW WHAT WE ALREADY HAVE, THE BID AND NRMN, AS THE ONLY THING THAT'S GOING TO HAPPEN, THIS IS GOING TO BE WORK IN PROGRESS WITH MUCH MORE TO COME. SO I THANK YOU FOR YOUR ATTENTION. I'LL BE HAPPY TO TAKE QUESTIONS. >> THE SUMMARY TAKEHOME AS YOU QUERY THIS AGAIN, IS THAT THE WORK GROUP THAT PRESENTED, THE ORIGINAL WORK GROUP ON IMPROVING DIVERSITY, IN THE WORK FORCE, HAD A SERIES OF RECOMMENDATIONS BUT THE CORE OF THE RECOMMENDATIONS WAS TO CREATE AN ENVIRONMENT WHERE MINORITY -- WHERE RESEARCH INSTITUTIONS THAT DID NOT HAVE A GREAT TRACK RECORD IN BEING ABLE TO HAVE THEIR GRADUATES ACHIEVE SUCCESS IN THE RO1 PROCESS, THAT THOSE RESEARCH-POOR INSTITUTIONS WERE TO PARTNER WITH RESEARENSE INSTITUTIONS AND WE WERE TO DO THAT ALL AROUND THE COUNTRY, MAKING THIS MARRIAGE BETWEEN THOSE THAT NEEDED HELP AND THOSE THAT HAD HELP TO SPARE AND SHARE. THAT WAS A KEY COMPONENT. WHAT YOU'VE HEARD NOW IS THAT THOSE GRANTS HAVE BEEN GIVEN OUT. AND THAT IS NOW MOVING FORWARD THROUGHOUT THE LAND. SO THERE IS THIS MARRIAGE BROKERING GOING ON, YOU CAN ASK DETAILS FROM HANNAH. NUMBER TWO, THERE WAS A SENSE OF CREATING A MENTORING NETWORK, THAT WAS THE SECOND BIG PROPOSAL, THAT WAS -- THAT WAS RECOMMENDED. AND THIS MENTORING NETWORK WOULD BE THERE TO GIVE THIS SORT OF INDIVIDUAL PERSONAL FEEDBACK TO CANDIDATES, AS THEY WENT THROUGH THE PROCESS, AND/OR AS THEY FAILED IN THE PROCESS, AND GOT THEIR REVIEW SCORES AND THEIR TO PEOPLE WHO WERE IN A GOOD POSITION TO BE MENTORS. AND IN FACT, WHAT YOU'VE SEEN NOW IS THAT GRANT HAS BEEN GIVEN OUT, THERE ARE MULTIPLE INSTITUTIONS THAT ARE A PART OF THE UMBRELLA PROPOSAL, AND I WILL TELL YOU FROM MY UNDERSTANDING THAT THAT UMBRELLA IS ACTUALLY GOING TO GET BIGGER. THAT THE NUMBER OF PLAYERS THAT YOU HAVEN'T SEEN THE LAST YET OF ALL THE PLAYERS THAT ARE GOING TO BE IN THE DRAMA, PARTICIPATING IN THIS MENTORSHIP NETWORK. WE WERE INSISTENT ON AN EVALUATION PROGRAM. YOU DON'T NEED TO DO THE SAME DAMN THINK OVER AND OVER AGAIN SO THE EXAMPLES WHEN WE STARTED HEARING ABOUT PEOPLE AT THE UNIVERSITY OF MARYLAND BALTIMORE, UMBC, THOSE SMART PEOPLE WITH INNOVATIVE PROPOSALS THAT WILL BE EVALUATED, COMING INTO A LEARNING LABORATORY THAT GETS CONSOLIDATED. THE LAST THING YOU HEARD THAT WAS IMPORTANT IS THAT INSTEAD OF HAVING ADMINISTRATIVE INFRASTRUCTURE FOR ALL OF THIS SCATTERED ALL OVER THE THE GIGANTIC CAMPUS, IT'S NOW BEEN CONSOLIDATED AND SMASHED TOGETHER IN HANNAH'S OFFICE SO THAT YOU NOW CAN -- >> SMASHED BEING THE OPERATIVE WORD. >> YOU NOW CAN GET SOME KIND OF ORGANIZATIONAL VISIBILITY AND CONSISTENCY BETWEEN THE STRATEGIC PLANNING, THE POLICY PEOPLE, BUT ALSO OPERATIONS, BEING CONNECTED TO IT ALL. SO THAT'S THE STORY. NOW, HAVE AT IT. [LOW AUDIO] >> YES, YES. >> FIRST OF ALL, CONGRATULATIONS. I'M SORRY. I'M OVER HERE, HANNAH. THANK YOU FOR THAT. WE WERE SAD TO MISS YOU FROM STANFORD BUT IT SOUNDS LIKE THIS IS REALLY VERY EXCITING. TWO SMALL POINTS THAT I'M VERY EXCITED ABOUT. YOU TALKED VERY BRIEFLY ABOUT SOME SORT OF DASHBOARD OR SOMETHING FOR HELPING WITH SEARCHES BECAUSE THIS IS WHERE AFFECTS OUR LIVES, ESPECIALLY THOSE WHO WANT TO DO THE RIGHT THING. I WANT TO UNDERSCORE YOUR IDEA OF SOCIAL NETWORK IS RIGHT ON. WE'VE ALL HAD THIS EXPERIENCE, I'VE FIRST FIRST GRADE CLASSMATES WHO MOVED AWAY, AT THE END OF FIRST GRADE. IF I CAN DO THAT ONE EVENING IN LINKED IN AND FACEBOOK, I'M SURE WE CAN FIND ALL THE GOOD CANDIDATES WHO SHOULD BE CONSIDERED IF AREA X OF BIOMEDICAL SCIENCE, WHO HAVE BEEN PUBLISHING, HAVE LINKED IN PAGES, WHO MAY TWEET, IT ALL SOUNDS FRIVOLOUS AND AS YOU KNOW I'VE DRUNK FROM THE BIG DATA KOOL-AID BIG TIME BUT THIS IS A VERY GOOD USE OF THE NEW CAPABILITIES THAT WERE NOT EVEN HERE FIVE YEARS AGO. >> I COULDN'T AGREE MORE. THIS IS GOING TO BE A BIG FOCUS OF US TO BE ABLE TO BUILD THIS INSTRUMENT. IT DOESN'T EXIST. >> AND YOU WILL HAVE CUSTOMERS. THE SECOND THING IS JUST HAVING BENEFITED FROM BEING YOUR COLLEAGUE AND BEING EXPOSED TO THE UNCONSCIOUS BIAS ISSUE, I WANT TO HIGHLIGHT THAT BECAUSE AS YOU KNOW THERE ARE ONLINE TOOLS WHICH I WOULD RECOMMEND TO MY COLLEAGUES, ESPECIALLY IF YOU THINK YOU DON'T HAVE UNCONSCIOUS BIAS, BECAUSE THESE ARE VERY EASY TO DO SURVEYS THAT KIND OF OPEN YOUR EYES TO ALL KINDS OF THINGS THAT YOU MAY BE ASSUMING ABOUT YOURSELF AND OTHERS THAT MIGHT NOT BE TRUE, SO I'M GLAD TO KNOW THAT AGENDA IS PRIME. >> YES, THANK YOU. THE EXPERIMENT THAT WE'RE GOING TO DO HERE IS TO TEST THE IDEA THAT BY RAISING AWARENESS YOU CAN ACTUALLY OVERCOME SOME OF THE UNCONSCIOUS BIAS WHICH WE ACTUALLY SHOWED THAT COULD BE THE CASE AND WHETHER IT AFFECTS YOUR DECISION-MAKING PROCESS. >> REID MENTIONED WE HAVE TO MENTOR PEOPLE WHEN THEY FAIL. THE HARDEST MENTORSHIP IS WHEN THEY DIDN'T DO ANYTHING WRONG BUT GOT THEMSELVES INTO A SITUATION WHERE ALL KIND OF BIAS WERE PLAYING AGAINST THEM AND IN UNFAIR WAYS, A HARD MESSAGE TO DELIVER, THAT'S WHY I THINK THIS IS SO IMPORTANT. >> THANKS. SOME TIME AGO WE HAD A DIUT UNCONSCIOUS BIAS AT THE LEVEL OF GRANT REVIEWS, AND I'M WONDERING WHETHER OR NOT YOU HAVE ANY SENSE OF PROPORTION THAT ACCOUNTS FOR DIFFICULTY IN PEOPLE GETTING EITHER APOINTED OR PROMOTED, OR RECEIVING AWARDS, HAVE YOU BEEN ABLE TO TEASE THAT APART? THE SECOND QUESTION, WHICH IS RELATED TO THAT, IS WE ALSO HEARD ABOUT THESE ONLINE PROGRAMS WHICH WILL BE USEFUL IN ASSESSING UNCONSCIOUS BIAS. IS THERE ANY EFFORT TO PROMOTE TO USE OF THESE FOR PEOPLE PARTICIPATING IN STUDY SESSIONS, FOR EXAMPLE? >> YES, YOU'VE JUST TALKED ABOUT TWO OF THE PROJECTS THAT WE INTEND TO LAUNCH EARLY NEXT YEAR. RICHARD WILL TALK IN A MOMENT ABOUT WHAT'S GOING ON IN PEER REVIEW, RICHARD NAKAMURA, BUT IF YOU BRIEF STUDY SECTION COMMITTEES ABOUT THE ISSUE OF UNCONSCIOUS BIAS, ALONG WHICH EVER DOMAIN, WOMEN IN SCIENCE, WOMEN IN LEADERSHIP, UNDERREPRESENTED, YOU CAN GET SOMETHING RATHER DIFFERENT. THE PATHOPHYSIOLOGY, ONCE RISING ABOVE THAT SYSTEM ONE, YOU KNOW, AUTOMATIC RESPONSE TO MAKING DECISIONS. >> WELL, THIS IS REQUIRED, FOR EXAMPLE, WITH IRB TRAINING, IBC TRAINING, ITC, A WHOLE HOST OF THINGS THAT ONE HAS TO TAKE, GOING TO MOST INSTITUTIONS, AND IT WOULD SEEM FAIRLY STRAIGHTFORWARD TO INCORPORATE THAT INTO THE TRAINING YOU MUST HAVE, IF YOU'RE GOING TO BE PARTICIPATING IN PEER REVIEW. >> SO THE SCIENTIST IN ME COMES , I'D LIKE TO SET UP AN EXPERIMENT AROUND THAT TO SEE IF REALLY THAT IS TRUE BEFORE MAKING IT A REQUIRED TRAINING, AND SO TO TEST THAT HYPOTHESIS, DOES THAT TRAINING MAKE ANY DIFFERENCE, I MEAN, WHEN I TAKE THE SEXUAL HARASSMENT COURSE FOR, YOU KNOW, THAT TAKES ME THREE HOURS TO GET THROUGH OR 2 1/2 HOURS, YOU KNOW, I'M PRETTY UPSET AND MAD BY THE END OF DOING IT, HAVING TO DO IT OVER AGAIN, WITHOUT KNOWING THAT THE EXPERIMENT WAS NEVER DONE. I'D LIKE TO DO THE EXPERIMENT BEFORE. >> WE HAVE THAT TYPE OF TRYING AT NISF, THERE MIGHT BE A WAY TO USE THAT IN OUR EXPERIMENTS. >> THOSE OF US WHO ARE MINORITY AND AFRICAN-AMERICAN, OR LATINO, WHATEVER, NOT TO THINK YOU DON'T HAVE YOUR OWN BIAS ALSO. OKAY. EVERYBODY SHOULD BE EXPOSED TO THAT. BUT MY QUESTION IS REALLY, FIRST OF ALL, IT'S VERY COMPREHENSIVE, YOU KNOW, YOU THOUGHT THIS THROUGH SO VERY WELL. I CONGRATULATE YOU ON THAT. BUT NOW WE'VE GOT PEOPLE OVER AT NIMHD, I KNOW YOU SPOKE THERE LAST WEEK, LIKE THE RESEARCH CENTERS AND MINORITY INSTITUTIONS, THEY ARE THEIR GROUP OF POSTDOCS AND YOUNG FACULTY, HOW HAVE YOU SEEN KIND OF THAT HOST OF CHARACTERS KIND OF INVOLVED? YOU KNOW, ESPECIALLY LOOKING AT THE SPECIAL WAY. SOME OF THEM ARE IN BUILD. >> YEAH, SO THE CRITICAL AREA, FIRST AREA OF INVOLVEMENT, WILL BE IN THE NATIONAL MENTORING NETWORK, BECAUSE AS YOU QUITE RIGHT ALLUDE TO, THE RCMI HAS AN ESTABLISHED TRACK RECORD OF TOOLS AND APPROACHES TO DOING THIS AND DOING THIS SUCCESSFULLY. AND WE PERCEIVE THAT THAT WAS A LITTLE BIT OF A GAP IN THE ORIGINAL NRMN AS DESCRIBED, SO THAT IS WHY WE'RE HOPING TO INTEGRATE THAT FULLY. THAT'S NUMBER ONE. LEARN A LOT OUTSIDE OF THAT CONTEXT, FROM THAT GROUP, THROUGH PARTNERSHIPS. AND THIS IS WHAT I'M HOPING TO BUILD. YES? >> THIS IS A WONDERFUL PRESENTATION, VERY EXCITING. YOU PRESENTED SOME WONDERFUL OPPORTUNITIES FOR ALL OF US TO BENEFIT FROM. I'M VERY EXCITED BY YOUR LEADERSHIP AND EXPERTISE YOU'RE BRINGING. THREE COMMENTS. THE FIRST, I'M GLAD TO SEE YOU'RE USING A SYSTEMS APPROACH. IF YOU LOOK AT THE NUMBER FOR MINORITIES, THEY ARE WHAT THEY WERE IN THE 70s, LIKE THERE'S A HOMEOSTASIS IN THE SYSTEM, LIKE IT'S A SET POINT IN THE SYSTEM. IT DOESN'T BUDGE. WHY DO SYSTEMS HAVE THAT AND IF YOU KNOW ANYTHING ABOUT THE BODY YOU SHIFT NO ANOTHER SUBPOINT, IT'S USUALLY REVOLUTIONARY. OKAY. >> THE SECOND POINT, A LOT OF THIS FOCUSES ON EDUCATION. THERE'S ANOTHER COMPONENT INCENTIVE. A LOT OF THIS INFORMATION IS OUT THERE. WHAT INCENTIVIZES A FACULTY MEMBER TO INDEED IMPLEMENT A MENTORING PACKAGE? WHAT ARE THE CONSEQUENCES? WE'RE NOT GOING THERE BUT THERE'S NO CONSEQUENCE IN FACT IF YOU DON'T MENTOR WELL, AND IF YOU DON'T MENTOR A MINORITY STUDENT, WHAT CONSEQUENCES ARE THERE FOR CAREER FUNDING? AND THE THIRD, I'M VERY EXCITED BY YOUR DARE INITIATIVE. I THINK THAT'S FANTASTIC. WE NEED THAT. I WOULD LIKE TO POINT OUT THAT THERE'S NOW IMPACT FOR MINORITY STUDENTS BECAUSE OF THE FUNDING FALLOUT THAT MINORITY GRADUATE STUDENTS LIKE OTHER GRADUATE STUDENTS ARE HAVING A DIFFICULT TIME SECURING A POSTDOC, AND WE ARE NOW SEEING THAT GRADUATE PROGRAMS HAVE FEWER TAs IN POSITIONS. IT LOOKED GOOD BUT THE SQUEEZE IN THE PIPELINE IS GOING TO HAPPEN AGAIN. >> THANK YOU FOR THE COMMENT ALSO. YOU'RE INVITED TO JOIN OUR WORKING GROUP. NO, THESE ARE REALLY SUPERB COMMENTS. AND, YOU KNOW, THERE ARE LOTS OF THINGS THAT I THINK WE SHOULD TAKE HEED TO THAT YOU MENTIONED, AND I WILL BE DOING SOME. >> MY QUESTION IS, FIRST I WANT TO ECHO EVERYBODY'S SENTIMENT THAT THIS IS WONDERFUL TO SEE AND IT'S ALSO A REMARKABLE PROGRESS IN A SHORT PERIOD OF TIME. I REALLY DO MEAN THIS. THE QUESTION I HAVE, HOW MUCH OF A COST OF THE LIFESPAN OF THE SCIENTIST ARE WE THINKING? I'M THINKING ABOUT A PARTICULAR GRADUATE STUDENT OF MINE, AN AFRICAN-AMERICAN, WHO SEEMED TO STRUGGLE, AT LEAST A VERY TALENTED PERSON, WHO IS NOW SORT OF IN MID-CAREER AND IS STRUGGLING YET AGAIN, AND IN EVERY CASE I HAVE FOUND MYSELF LOOKING FOR STRATEGIES AND RESOURCES TO HELP HIM, AND IT'S EVEN HARDER, I FIND, IN MID-CAREER THAN WHEN HE WAS A GRADUATE, HE HAS EVEN LESS OF A COMMUNITY, AND MORE OF A SENSE OF DISCOURAGEMENT, ESPECIALLY IN THESE HARD TIMES, REALLY MAKING ME VERY SAD, AND MY QUESTION IS HOW IS THIS GOING TO PLAY UP FOR PEOPLE WHO ARE VERY GOOD, VERY TALENTED, BUT ARE FACING CHALLENGES NOT JUST EARLY ON BUT AFTER YOU ENCOURAGE SOMEONE INTO THE SYSTEM. >> ONE OF THE POINTS ABOUT THE NEW THINKING AND HUBS IS REALLY TO FOCUS ON THIS PROXIMAL PHASE YOU'RE TALKING ABOUT, WHICH IS REALLY NOT COVERED VERY MUCH IN THE BUILD AND NRMN PROGRAM. OF COURSE, THAT IS A TRUE REALITY. WHEN YOU'RE THERE, AND YOU ARE THE ONLY, AND THERE IS A STRUGGLE, AND IT'S A STRUGGLE FOR EVERYONE, BUT FOR THE UNDERREPRESENTED GROUP, THE PERSON FROM THE UNDERREPRESENTED GROUP, IT FEELS EVEN GREATER BECAUSE YOU HAVE THE SENSE OF NOT BELONGING. I THINK IT'S AT LEAST TWO-FOLD. ONE IS THE RESOURCES OF PRACTICAL RESOURCES TO COME TO BEAR, TO HELP THIS INDIVIDUAL, BUT ALSO THE OTHER SIDE OF THE COIN OF HOW YOU GET PEOPLE REFRAMING THE SITUATION SUCH THAT IT IS ONE THAT THEY SEE NOT NECESSARILY AS A REFLECTION OF, YOU KNOW, THEIR IDENTITY, BUT REALLY AS PART OF THE WHOLE ISSUE, AND GIVING THEM TOOLS TO OVERCOME IT. AND THAT'S THAT WHOLE ISSUE OF SENSE OF BELONGING, AND THERE'S A LOT OF RESEARCH GOING ON THAT WILL LEAD US TO BELIEVE YOU CAN ACTUALLY MAKE A DIFFERENCE IN PEOPLE'S SENSE OF BELONGING WHICH TRANSLATES INTO GREATER PERSISTENCE. SO IT'S NOT ALL ABOUT THE INDIVIDUAL AND IT'S NOT ALL ABOUT THE INSTITUTIONS. AND BOTH HAVE TO COME TO BEAR. >> GREAT PRESENTATION. A COUPLE QUICK COMMENTS. THAT SEEMED LIKE WHAT'S GREAT IS YOU'RE ADDRESSING VARIOUS ASPECTS OF THIS, THE BARRIERS WHICH INCLUDE THE IMPLICIT BIAS AND IMPEDIMENTS, AND THEY ARE MANY. ONE IS A SENSE OF BELONGING, ALSO THE SENSE OF -- WE DID A QUALITATIVE STUDY, WE TERMED IT RACIAL FATIGUE, THE BURDEN ON AN INDIVIDUAL WHO REPRESENTS ONE OF THE FEW PEOPLE OF THAT GROUP IS PUT ON EVERY COMMITTEE, ACTUALLY ACCELERATED IN LEADERSHIP ROLE BEFORE THEY ARE READY AND THEIR SCIENCE IS READY SO THEY ARE PROGRESSED TO A CERTAIN LEVEL OF RESPONSIBILITY AND JURISDICTION BECAUSE THEY WANT TO HAVE SOMEONE IN THAT ROLE BEFORE THE PERSON HAS SOLIDIFIED THE BASIC OF THEIR RESEARCH PROGRAM SO THEY ARE IN A POSITION WHERE THEY ARE ALMOST SET TO FAIL BECAUSE THEY CAN'T TAKE CARE OF BUSINESS WITH REGARD TO THE RESEARCH PROGRAM. SO IT SEEMS A LOT IN THE QUALITATIVE RESEARCH, I THINK, TO COMPLEMENT THE QUANTITATIVE RESEARCH IS REALLY IMPORTANT HERE SO WE CAN BRING OUT THE SORT OF WAY IN WHICH PEOPLE ARE EXPERIENCING THINGS. I FIND THE QUALITATIVE RESEARCH TO BE HELPFUL ALSO BECAUSE THE STORIES WITH HELP SENSITIZE EVERYONE IN THE ENVIRONMENT TO REALITIES OF WHAT THAT IS LIKE. OUR GOAL SHOULDN'T BE TO PROMOTE PEOPLE WHO ARE DOING INFERIOR SCIENCE. THE GOAL IS TO REDUCE IMPEDIMENTS AND HELP PEOPLE GET TO ACHIEVE THEIR POTENTIAL AND THERE ARE TRULY TALENTED PEOPLE WHOSE POTENTIAL IS NEVER REALIZED BECAUSE OF STRUCTURES AROUND THEM, THE WAY THE INSTITUTIONS MAKE IT SORT OF PUT THEM IN A POSITION TO MAKE IT MORE DIFFICULT. BRINGING OUT THESE THINGS. THERE'S ONE OTHER THING, CAN YOU PUT THE SLIDES UP AGAIN? OH, SLIDES UP AGAIN? ONE THING THAT'S TRUE IN THE COUNTRY, NO MATTER WHAT METRIC YOU USE, TWO THINGS GOING ON, ONE IS INCREASE DIVERSITY -- >> YOU NEED TO USE THE MICROPHONE. >> I'M JUST SHOWING A MAP. I'M JUST SAYING TWO THINGS GOING ON HERE. ONE IS TRYING TO PAY ATTENTION TO THE DIVERSITY ISSUE, BOTH RELEASING BARRIERS TO PEOPLE'S PROGRESSION AND ALSO BEING ACTIVE IN RECOGNIZING DIVERSITY IN ITS OWN RIGHT TENDS TO IMPROVE THE FUNCTIONING OF A GROUP. THERE'S A LOT OF SCIENCE EMERGING AROUND THAT, SO THAT PART OF THIS IS THIS RECOGNITION TEAMS GET STRONGER WHEN THERE'S DIVERSITY OF VIEW POINTS, INDIVIDUALS, CONVERSATION CHANGES ISSUES STRENGTHENS, SO IN ITS OWN RIGHT THAT'S USEFUL, BUT ONE THING THAT KEEPS COMING BACK TO ME OVER AND OVER AGAIN IS THERE'S ONE AREA OF THE COUNTRY THAT BEARS A DISPROPORTIONATE AMOUNT OF DISEASE, POOR QUALITY OF CARE, A WHOLE RANGE OF THINGS. IF I WAS ONLY GOING TO DEVOTE MONEY IN THE COUNTRY TO ONE AREA, IT WOULD BE -- >> I KNOW WHAT YOU'RE GOING TO SAY. >> RIGHT HERE. THAT AREA, THERE'S A DISPROPORTIONATE NUMBER OF PEOPLE ARE POOR, AFRICAN-AMERICAN RACE AND ETHNICITY, IT'S AN AREA THAT WE OUGHT TO BE CONCENTRATING ON ALSO. I'VE OFTEN WONDERED WHETHER NIH WOULD CONSIDER TARGETED CALLS. SO YOU SAID YOU WANTED PARTNERSHIPS, BUT SOMETIMES, YOU KNOW, YOU'RE GETTING FROM ATLANTA OR, YOU KNOW, DIFFERENT PLACES IN THE COUNTRY. THE QUESTION IS WHETHER A PARTNERSHIP CAN OCCUR IN THIS AREA OF THE COUNTRY WHERE PEOPLE ARE SUFFERING MOST, FROM HEALTH PROBLEMS, WHERE STIMULATING THE TALENT -- I BELIEVE FIRMLY THERE ARE PEOPLE JUST AS SMART AS PEOPLE IN OTHER PARTS OF THE COUNTRY. I DID NOT BELIEVE ONLY -- THAT SMART PEOPLE AVOIDED LIVING IN THOSE AREAS. [ LAUGHTER ] BUT I THINK THAT THE PEOPLE THERE WHO HAVE THE POTENTIAL TO MAKE GREAT CONTRIBUTIONS ENCOUNTER IMPEDIMENTS IN MENTORSHIP, A WHOLE RANGE OF ISSUES, THAT MAKE IT HARDER IN THOSE AREAS, AND DON'T LEAD TO THE INSTITUTIONS -- THEY HAVE GREAT INSTITUTIONS BUT THEY COULD BE STRONGER. THAT WOULD BE A PLACE WHERE A LOT OF ATTENTION IS DRAWN. THAT'S ONE THING I WANTED TO MENTION. >> YEAH, YOUR POINT IS WELL TAKEN. THE HOPE IS PARTNERSHIPS WILL DEVELOP, EVEN WITHIN THE BUILD PROGRAMS, THAT WILL COVER THOSE AREAS NOT ALREADY COVERED, PLUS THERE ARE OTHER NIH PROGRAMS THAT ACTUALLY ADDRESS EXACTLY WHAT YOU'RE TALKING ABOUT, THE IDEA PROGRAM, FOR EXAMPLE, THAT IS SPECIFICALLY GOING TO AREAS WHERE THERE HAS NEVER BEEN NIH FUNDING, THAT'S SET UP AS A HUB DESIGN, AND I HEARD THE REPORT OF THAT FROM NIGMS, IT'S FABULOUS WHAT IS HAPPENING THERE. I THINK THESE IDEAS ARE GETTING HOLD. >> WE'VE GOT -- BY THE WAY, TIME FOR ONE MORE QUESTION, BUT I WANT TO MAKE SURE, HARLAN, THAT YOU'RE ARTICUATE PREAMBLE TO OUR POINT AROUND THE IMPORTANCE OF MULTI-PERSPECTIVES LEADING TO BETTER SCIENTIFIC OUTCOMES WAS BEAUTIFULLY WRITTEN, ALSO IN THE ORIGINAL WORK GROUP REPORT, CONTRIBUTED BY THE MEMBERS OF THE WORK GROUP, AND IF ANYBODY EVER ALSO WANTS TO GET ADDITIONAL FLAVOR FOR THAT AND BE ABLE TO QUOTE THE IMPORTANCE OF DIVERSITY IN PRODUCING BETTER RESEARCH, THERE'S ACTUALLY A DOCUMENT THAT HAS THAT EMBEDDED IN IT. YOU SAID IT AS WELL AS THEY DID. ONE AND THEN TWO. I INTERRUPTED YOU. >> I'VE ALREADY ASKED A QUESTION IF SOMEBODY ELSE HAS ONE. >> YES, HARLAN, I'VE BEEN AT ONE OF THOSE PLACESES FOR 20 YEARS AND CAN SPEAK TO GREAT AUTHORITY. IT IS THEORETICAL CONSTRUCT. IT HAS HAPPENED. I'VE HAD OPPORTUNITIES TO SUPPORT MINORITY SCIENTISTS, WE'RE AT 70% SUCCESS RATE FOR R 01s, SO IT IS POSSIBLE. I'VE GOT IDEAS, I'VE SHARED THEM WITH LEADERSHIP AND WOULD LIKE TO KEEP -- MAYBE THIS IS NOT THE TIME TO RAISE THEM, BUT I WILL NOT STOP DOING WHAT WE'VE BEEN DOING. >> ALL I WAS SAYING IS WE SHOULD DOUBLE DOWN IN THOSE AREAS, WHERE THERE IS STRENGTH, RECOGNIZE THAT'S THE AREAS OF THE COUNTRY WHERE THE GREATEST BURDEN OF HEALTH PROBLEMS EXIST AND WHERE IT WOULD BE GREAT TO HELP BRING OUT MORE TALENT AS MUCH AS WE COULD. >> I WAS JUST AGREEING WITH YOU SAYING WE'VE DONE THE EXPERIMENTS. [LOW AUDIO] >> THERE IS IT A PRACTICE OF GIVING A SHORT WINDOW BEFORE AN INSTITUTION CAN SUBMIT AN AWARD, SIX TO TEN WEEKS, THAT MIGHT BENEFIT FOR GREATER REPRESENTATION IF THAT WINDOW WERE EXTENDED BECAUSE OF THE KIND OF INSTITUTIONS AND GRANTS AND CONTRACT OFFICES, GIVE MORE TIME FOR MORE PEOPLE TO PUT TOGETHER AN APPLICATION. >> FRANCIS? >> I WANTED TO ADD A COMMENT, AGAIN, IT'S REALLY WONDERFUL TO SEE THE WAY THIS PROGRAM IS SHAPING UP AND TO HAVE HANNAH HERE AS OUR LEADER IN THIS NEW POSITION WHICH OF COURSE WAS ANOTHER RECOMMENDATION OF THE WORKING GROUP TO CREATE THIS POSITION. I THINK IT HAS ENERGIZED AND INSPIRED A LOT OF THE INSTITUTES TO THINK ABOUT WHAT WE MIGHT BE ABLE TO DO TOGETHER THAT WOULD NOT HAVE HAPPENED IF WE HAD 27 DIFFERENT APPROACHES TO THIS. I ALSO WAS ASKED BY SECRETARY BURWELL TO MAKE A PRESENTATION AT HER LEADERSHIP MEETING THREE WEEKS AGO. SHE HEARD WE WERE UP TO SOMETHING, AN AREA SHE CARES ABOUT QUITE DEEPLY. SHE WANTED TO KNOW SORT OF WHAT HAD WE PLANNED TO DO TO ADDRESS THE ISSUE AT NIH, AND MAYBE OTHER PARTS OF HHS WOULD WANT TO HEAR ABOUT IT. SHE WAS VERY ENTHUSIASTIC ABOUT THE PRESENTATION IN TERMS OF THE BOLDNESS OF THE PROGRAMS RECOGNIZING THEY ARE EXPERIMENTS AND WE WILL NEED TO FOLLOW THEM CLOSELY. SHE'S A QUANTITATIVE PERSON AND GLAD WE WERE GOING TO FOLLOW THEM CAREFULLY AND THAT EVALUATION WAS BASED INNED THIS IN EVERY POSSIBLE WAY SO WE'LL KNOW WHAT WORKS AND WHAT DOESN'T WORK AND ADJUST ACCORDINGLY. AND SHE EVEN THOUGHT BASED ON WHAT SHE HEARD THIS IS A SET OF INITIATIVES THAT WE SHOULD BE SURE THE CONGRESS IS ALSO HEARING ABOUT AND PARTICULARLY THE CONGRESSIONAL BLACK CAUCUS, CONGRESSIONAL HISPANIC CAUCUS AND SHE VOLUNTEERED IF WE WOULD MAKE SUCH A PRESENTATION SHE WOULD WANT TO COME ALONG HERSELF. IT'S WELL RECEIVED IN THE >> ONE OF THE MAJOR -- FIRST OF ALL, THIS GIVES ME THE OPPORTUNITY TO ALSO PUBLICLY THANK THE MEMBERS OF THE WORK GROUP WHO ARE -- THEY HAVE BEEN REALLY DEDICATED. WE HAVE A TERRIFIC WORK GROUP, AND THEY ARE ALL FULLY IN ON THIS THING, AND THEY HAVE GIVEN US GREAT LEADERSHIP AND GUIDANCE. ONE OF THE ELEMENTS -- CAN'T HELP BUT NOTICE ROD PETTIGREW IS ALSO HERE, WE APPRECIATE EVERYTHING YOU'VE DONE TO GET US TO THIS POINT. THE POINT I'M QUICKLY MAKING, FRANCIS, ONE OF THE THINGS WE WORRIED ABOUT WAS WHERE DOES THE NIH IMPROMPTUT BEGIN AND END? WE MADE DECISIONS ON HE CAN TO USING ON WHAT THE NIH HAD STATUTORY AND LEGITIMATE AUTHORITY OVER. WE BUILT A RECORD THE LEADERSHIP THROUGH THE BULLY PULPIT AND THIS PUBLIC ROLE WHOEVER THAT HAPPENED TO BE SHOULD BE ENGAGING UPSTREAM WITH OTHER PLACERS. WE CAN'T PULL YOU INTO EVERYTHING. SO WHAT I LIKE ABOUT THIS, IF HHS AND THE SECRETARY IS ACTUALLY ENGAGED, I CAN'T HELP BUT PUSH HARD THAT SHE WOULD BE IN TOUCH INTENSELY WITH THE SECRETARY OF EDUCATION. AND LET'S TRY TO GO UPSTREAM AND REALLY HAMMER IT, BECAUSE SHE SHOULDN'T HAVE OPENED TO DOOR TO THAT ONE, I'M GOING TO BE ALL OVER THIS. WITH THAT, LISTEN, TERRIFIC. HANNAH, WOULD YOU NOW INTRODUCE UNDER YOUR LEADERSHIP OUR NEXT REPORT, THIS PEER REVIEW UNCONSCIOUS BIAS CONVERSATION, I WANT TO REMIND EVERYTHING AGAIN FOR THOSE THAT ARE NEW TO THIS, WE ALWAYS WANT TO BE EXTREMELY CAUTIOUS IN TERMS OF THE HANDOFF ON THIS THING. WE HAVE -- THE ORIGINAL RECOMMENDATIONS FROM THE ORIGINAL COMMITTEE AND CURRENT COMMITTEE HAS ALWAYS BEEN THAT WE NEVER WANTED TO CAST DISPERSIANS ON THE FANTASTIC VOLUNTEER SCIENTISTS WHO GIVE OF THEIR TIME AND EXPERTISE ON BEHALF OF THE RESEARCH ENTERPRISE OF THE NATION. THESE ARE NOT BAD PEOPLE WHO COME TO NIH TO DO MEAN AND INSENSITIVE THINGS. FOR THOSE IMPARROT FOR CHANGE, WE NEVER WANTED TO DO THINGS OFF THE CUFF AND SCREW IT UP WORSE THAN IT IS NOW, BY IMPLEMENTING SOMETHING THAT DIDN'T HAVE A DOGGONE SCIENTIFIC BASIS. WE'RE NOT SCAREDY-FRAID, WHY, WE'RE MARCHING FORWARD. WITH THAT, HANNAH, INTRODUCE THE NEXT COMPONENT. >> RICHARD NAKAMURA FROM THE CENTER OF SCIENTIFIC REVIEW. I'M EXCITED TO WORK WITH RICHARD, HE ORGANIZES THE SUBCOMMITTEE OF THE ACD WORKING GROUP, AND THAT SUBCOMMITTEE IS COMPOSED OF SOME REALLY ALSO OUTSTANDING MEMBERS WHOSE WORK OVER THE LAST 18 MONTHS HAS BEEN REALLY QUITE IMPRESSIVE, AS YOU WILL HEAR ABOUT, AND REALLY ROOTED IN IT IS SCIENCE, AND THIS IS WHAT EXCITES ME. RICHA'S HEAR WHAT YOUR REPORT IS. >> THANK YOU, HANNAH. IT'S A TREMENDOUS PRIVILEGE TO BE WORKING WITH HANNAH, AND THE WORKING GROUP, BUT I'D ALSO LIKE TO ACKNOWLEDGE THE LEADERSHIP OF THE ACD UNDER REID AND ALSO I'D LIKE TO ACKNOWLEDGE LARRY TABAK'S PUSHING TO MAKE A LOT OF THIS HAPPEN, BOTH TO HELP GET RESOURCES, ET CETERA, AND FRANCIS HAS CLEARLY PLAYED A KEY ROLE IN ENCOURAGING ALL OF THIS. I'LL REMIND YOU THAT THE CENTER FOR SCIENTIFIC REVIEW'S MISSION IS TO PROVIDE FAIR, INDEPENDENT, EXPERT AND TIMELY REVIEWS FREE FROM INAPPROPRIATE INFLUENCES, SO NIH CAN FUND THE MOST PROMISING RESEARCH. THAT IS AN IMPORTANT MISSION AND ONE OF THE KEY ROLES IS THE IDEA OF A LEVEL PLAYING FIELD, WHERE ALL SCIENTISTS CAN COMPETE FOR FUNDING. WHEN THE GINTHER REPORT CAME OUT INDICATING DIFFERENCE IN AWARDS RATE WITH AFRICAN-AMERICAN AND OTHER SCIENTISTS THIS WAS FRANKLY NOT A MAJOR SURPRISE BECAUSE THERE HAD BEEN A FEELING THAT IS THERE WAS SOME DIFFERENCE, BUT A 50% DIFFERENCE WAS A SHOCK. AND THAT BECAME ONE OF MY EARLY RESPONSES, RESPONSIBILITIES, UNDER THE GUIDANCE OF THE ADVISORY COMMITTEES OF THE SO I WANTED TO BRING YOU UP TO DATE, AND TO JUST GIVE YOU AN IDEA OF THE MAGNITUDE OF THE CENTER'S RESPONSIBILITIES, WE REVIEW 84,000 -- ABOUT 84,000 APPLICATIONS A YEAR COME TO US, 73% ARE REVIEWED WITHIN THE CENTER. THE REST ARE REVIEWED WITHIN THE INSTITUTES. I'LL REMIND YOU THAT WHAT WE DO IS LARGELY -- IT MAKES IT IMPOSSIBLE FOR 2/3 OF SCIENTISTS INSTITUTES MAKE A DECISION ABOUT THE AWARDS, AND PICKING THROUGH ABOUT 1/3 OF APPLICATIONS. THE CENTER HAS 173 STANDING STDY SECTIONS, WE WORK THROUGH 236 SCIENTIFIC REVIEW OFFICERS. WE HAVE 1500 REVIEW MEETINGS A YEAR. THE CLOSURE OF THE GOVERNMENT REALLY WAS A MAJOR DISRUPTION, AND LED TO A CANCELLATION OF HUNDREDS OF REVIEW MEETINGS. WE USED ABOUT 17,000 REVIEWERS A YEAR, WHICH IS THE MAJORITY OF THE PEOPLE WHO ARE ELIGIBLE TO DO REVIEW. I WANT TO REVIEW SOME OF OUR EFFORTS TO TRY AND FIGURE OUT WHAT IS THE REASON FOR SOME OF -- FOR THE DISPARITIES THAT WE'RE SEEING, BEFORE I DO THAT I WANTED TO QUICKLY GO OVER AN OVERWHELMING ISSUE FOR US. AND THAT IS THIS LONG-TERM GRAPH OF SUCCESS RATES WITHIN NIH. AND WE'RE NOW ON THE RIGHT AT HISTORIC LOWS, ACTUALLY THIS YEAR WE'RE EXPECTING IN 2014 THAT IT WILL BE A SLIGHT BUMP UP. BUT IT WILL STILL BE AT A HISTORICALLY LOW LEVEL. AND SO ALL SCIENTISTS ARE REALLY STRUGGLING RIGHT NOW. ONE OF THE REASONS FOR THIS IS EY A 12-YEAR SCIENTIFIC RECESSION IF THE OVERALL RESOURCES AVAILABLE TO NIH. ANOTHER PART OF THIS IS THAT IN RESPONSE TO DIFFICULTIES IN FUNDING, APPLICATIONS CONTINUE TO RISE, WE'RE EXPECTING THAT IN 2014 THERE WILL BE ANOTHER BUMP UP, AND CSC IS -- CSR IS EXPERIENCING A 10% INCREASE IN NUMBER OF APPLICATIONS ITS DEAL WITH, THAT IS REDUCING THE SUCCESS RATES BY ITSELF. SO I WANT TO GO OVER WITH YOU HOW WE'RE TRYING TO ANALYZE BOTH THE PROBLEMS AND ULTIMATELY FIGURE OUT WHAT WE CAN DO TO INTERVENE TO CHANGE THIS LARGE DIFFERENCE IN AWARD RATES ACROSS POPULATIONS. PART OF OUR EFFORT HAS BEEN TO DEVELOP MEASURES, TOOLS AND METHODS OF SOLICITING APPLICATIONS. ONE OF THE THINGS THAT WE DID WAS TO DO SOME ACTIVITIES WHICH ARE SHORTER TERM, IN ORDER TO MAKE SURE THAT THE -- BOTH THE PUBLIC AND SCIENTIFIC COMMUNITY WAS AWARE THAT WE WERE TAKING THIS PROBLEM SERIOUSLY AND AS WELL AS HAVING SOME LONGER TERM ACTIVITIES. SOME OF OUR STUDIES WILL REQUIRE YEARS TO ACTUALLY COME TO FRUITION, SO WE WANTED TO MAKE SURE THERE WERE SHORTER-TERM ACTIVITIES AS WELL. ONE WAS A SET OF CHALLENGE AWARDS JUST TO FIND OUT IF WE AS WELL AS THE ACD WERE THINKING ABOUT ALL THE TOOLS AND TECHNIQUES THAT MIGHT BE NEEDED IN ORDER TO DETECT ANY POSSIBLE FORM OF BIAS THAT MIGHT BE GOING ON, WITHIN OUR PROCESS OF PEER REVIEW. I'LL REMIND YOU THAT GIVEN THE SCORE THAT SCIENTISTS RECEIVE, THE AWARD RATE WAS APPROPRIATELY DISTRIBUTED ACROSS ALL POPULATIONS, WHICH MEANT THAT THE REASON FOR THE DIFFERENCE IN AFRICAN-AMERICAN SCIENTISTS WAS THE DIFFERENCE IN THE SCORE. THAT MEANT THAT THE PROBLEM HAD TO EXIST AT THE PEER REVIEW STAGE OR BEFORE, SO RECOGNIZING THAT, AND USING THAT AS PART OF THE CHALLEE, WE ASKED THE SCIENTIFIC COMMUNITY AND THE PUBLIC TO SEE IF THEY COULD COME UP WITH DIFFERENT IDEAS ABOUT HOW TO DETECT BIAS ACROSS NOT JUST RACE BUT ACROSS ETHNICITY, GENDER, ET CETERA. AND HOW TO DEVELOP INTERVENTIONS TO ELIMINATE BIAS ULTIMATELY. THESE WERE JUDGED BY A TECHNICAL EVALUATION BY A SUBCOMMITTEE ON PEER REVIEW, WITH FINAL DECISIONS DETERMINED BY CO-CHAIRS MYSELF AND JOAN REEDE. DANA TAKAGI SERVED ON THE TECHNICAL EVALUATION GROUP. FOR THIS PART OF THE CHALLENGE AWARD, THERE WERE 42 SUBMISSIONS, THREE PRIZES WERE ULTIMATELY GIVEN. I WANT TO QUICKLY SUMMARIZE WHAT THOSE AREAS ARE. BECAUSE THEY OVERLAP A LOT WITH WHAT THE ADVISORY COMMITTEE TO THE DIRECTOR INITIALLY RECOMMEN, BUT WITH SOME WRINKLES WHICH MADE THEM WORTHY OF AN AWARD, SO THEY SUGGESTED LOOKING AT APPLICATIONS THAT WERE FURTHER ANONYMIZED. ALREADY OUR APPLICATIONS DO NOT PROVIDE INFORMATION ON RACE, ETHNICITY, BUT MANY -- A MAJORITY OF SCIENTISTS BELIEVE THAT CAN BE DEDUCED FROM THE CVs AND OTHER ASPECTS ON THE GRANT APPLICATION. AND THE FACT THAT MOST OF OUR COMMITTEES ARE HIGHLY FAMILIAR WITH MOST OF THE APPLICANTS THAT THESE ARE NOT VERY LARGE COMMUNITIES, AND SO VERY OFTEN EVEN POSTDOCS ARE KNOWN TO THE COMMITTEE MEMBERS, ONCE YOU KNOW THE INDIVIDUAL YOU KNOW THEIR DEMOGRAPHICS. IS IT POSSIBLE TO FURTHER ANONYMIZE? THE ADVISORY COMMITTEE HAD SUGGESTED THAT THINKING ABOUT ANONMYZATION, THE WINNING SUBMISSION HAD SOME SPECIFIC SUGGESTIONS ABOUT HOW TO ANONYMIZE, IMPROVING THE PRACTICALITY WITH WIN A DESIGN COULD WORK. IN ANOTHER WINNING APPLICATION, THEY SUGGESTED THAT THE PROBLEM -- ONE OF THE PROBLEMS MAY BE COMMENSURATION BIAS, ESSENTIALLY LOOK AT THE VARIOUS CRITERION SCORES INITIALLY GIVEN BY A COMMITTEE WERE ADDED TO TOGETHER TO PRODUCE AN IMPACT SCORE. PSYCHOLOGISTS HAVE REALIZED FOR A WHILE THAT THERE IS A PSYCHOLOGICAL MECHANISM IN PUTTING TOGETHER ANY SET OF CRITERIA INTO A LARGER SCORE THAT IF YOU DON'T HAVE A SYSTEMATIC OR CODED WAY OF DOING THAT, IT REALLY ALLOWS THE BACKGROUND BIAS, EVEN UNCONSCIOUS BIASES TO COME IN. WE DIDN'T REALIZE THAT PSYCHOLOGISTS HAD A WORD FOR THIS, COMMESURATION BIAS, AND THEY HAVE RESEARCH BEHIND IT THAT DISCUSSES MECHANISMS BY THIS THIS OCCURS. WE'RE HOPING TO GET THOSE INVESTIGATORS INVOLVED IN AN EXAMINATION OF THIS ISSUE. NOW, IT TURNS OUT NIH AND THE OFFICE OF EXTRAMURAL RESEARCH HAD ALREADY DONE AN UNPUBLISHED INTERNAL EXAMINATION OF THIS ISSUE. AND IN FACT, DEMONSTRATED THAT THERE IS COMMENCEURATION BIAS, AND IF YOU CONTROL FOR THE SCORES, CRITERION SCORES, THERE IS A DIFFERENCE IN AFRICAN-AMERICANS' TOLD IMPACT SCORES COMPARED TO OTHERS, AND AFRICAN-AMERICAN SCIENTISTS GET ON AVERAGE WORSE SCORES. WE'RE HOPING TO USE THESE SCIENTISTS TO HELP US BUILD THE KNOWLEDGE BASE AND PSYCHOLOGICAL MECHANISMS THAT MIGHT BE BEHIND THIS. FINALLY, ANOTHER GROUP SUGGESTED NOT ONLY MIGHT THERE BE BIAS ABOUT THE RACE OF INDIVIDUAL SCIENTISTS, BUT THERE COULD BE BIAS RELATED TO THE RESEARCH TOPICS THAT THEY GO TO, THAT THE TOPICS THAT EMPHASIZE PARTICULAR RACES OR CULTURES MAY NOT BE AS ACCEPTABLE TO REVIEW COMMITTEES THAT TEND TO WANT TO LOOK AT THE BROADER PICTURE OF RESEARCH. BUT ONE OF THE REASONS THAT MINORITY SCIENTISTS COME INTO THE FIELD, SO BECAUSE THEY MAY BE INTERESTED IN HELPING WITH DISPARITIES THAT EXIST, HEALTH DISPARITIES THAT EXIST, AND IF THEY ARE NOT ALLOWED TO PURSUE ACTIVITIES IN WHICH THEY INVESTIGATE DISPARITIES RELATED TO THEIR RACE, CULTURE, GENDER, THEN THERE MAY BE A BIAS INVOLVED IN THAT PROCESS AS WELL. SO ALL OF THOSE WE THINK MERIT FURTHER RESEARCH AND DISCUSN, AND THAT WAS THE REASON THEY WERE GIVEN CREDIT. IN ADDITION, WE HAVE JUST HAD T DRAFT REPORT ON A SURVEY AND FOCUS GROUP OF NEW INVESTIGATORS. IN ORDER TO TRY AND UNDERSD WHERE NEW INVESTIGATORS, PARTICULARLY NEW MINORITY INVESTIGATORS, WERE COMING FROM, WE FELT WE NEEDED TO UNDERSTAND THEIR PERSPECTIVE ON THEIR SITUATION. THIS IS INFLUENCED IN A LARGE WAY BY THE GRAPHIC ON SUCCESS RATES OVERALL, IN THAT ALL SCIENTISTS RIGHT NOW AT THIS NEW INVESTIGATIVE STAGE ARE FEELING VERY -- I GUESS LIKE THEY HAVE JUMPED INTO THE CABBAGE SHREDDER, THAT THIS WAS NOT NECESSARILY THE WISEST CAREER CHOICE, BECAUSE THE TIMES ARE SO DIFFICULT. I WAS JUST AT A SCIENTIFIC MEETING IN WHICH ONE OF THE MAIN QUESTIONS I WAS GETTING ARE WHAT ARE THE ALTERNATIVES TO RESEARCH THESE DAYS? AND SO THIS WAS A MAJOR THEME FOR THIS SURVEY AND FOCUS GROUP, THAT IS A MAJOR THEME OF RESPONSES OF NEW INVESTIGATORS ARE OF DIFFICULTIES ON MOVING FORWARD. ON TOP OF THAT, AFRICAN-AMERICAN SCIENTISTS KNOWING THE DATA FROM GINTHER, ET AL, FELT THEY HAD A DOUBLE HILL TO CLIMB DEALING WITH POTENTIAL BIAS AND DISCRIMINATION, HOW TO DEAL WITH BEING VERY MUCH UNDERREPRESENTED WITHIN THEIR INSTITUTIONS, AND HAVING A LOT OF EXTRA ACTIVITIES BECAUSE EVERYBODY WANTED TO HAVE A MINORITY SCIENTIST OR MINORITY MEMBER OF THE COMMUNITY ON THEIR COMMITTEE SO THEY FELT THAT THEY HAD LESS TIME THAN OTHER SCIENTISTS IN ORDER TO DO RESEARCH. THEY ALSO FELT THAT THEY WERE LOOKED TO AND ASKED TO DO MORE MENTORING AND OTHER KINDS OF ACTIVITIES WHEN THEY DIDN'T FEEL AS IF THEY WERE IN THE STRONGEST POSITION TO PROVIDE THAT. INTERESTINGLY, LATINA SCIENTISTS, THOUGH, DO NOT HAVE A SIMILAR AWARD DISPARITY, ALSO FELT IN A SIMILAR KIND OF SITUATION THAT THEY HAD A DIFFICULT PATH AT THEIR UNIVERSITIES. NOW, THE REASON I DIDN'T COME UP HERE WITH A SET OF SLIDES ON THIS REPORT IS BECAUSE WE HAVE A LOT OF QUESTIONS AND CONCERNS ABOUT THIS REPORT, AND THERE ARE SOME INTERACTIONS GOING ON RIGHT NOW WITH THE CONTRACTOR, BUT I WANTED TO GIVE YOU A SENSE OF WHAT WAS GOING ON. I ALSO WANTED TO GIVE YOU THE ENCOURAGING SENSE THAT DESPITE THIS LARGER SENSE OF DISCOURAGEMENT, AFRICAN-AMERICAN SCIENTISTS FEEL AS COMPETENT, AS POSITIVE ABOUT THE IDEA THAT THEY WILL ULTIMATELY GET SUPPORT AND BE ABLE TO CONTINUE THEIR SCIENCE AS OTHER SCIENTISTS, SO THEY DON'T LOSE THAT SENSE DESPITE THE STATISTICS. WE ARE PURSUING THE IDEA OF A ANONMYZING EXPERIMENTS, DOES THE DIFFERENCE, BE IT GENDER, RACE, OR THE INSTITUTION MAKE A DIFFERENCE. SO AWAY CAN DO PARTIAL ANONYMIZATIONS, TAKING AWAY THE BIOSKETCH AND DEMOGRAPHICS, OR FULLER THAT INCLUDES UNIVERSITY REFERENCE LISTS, ET CETERA. WE'RE CURRENTLY UNDERGOING DISCUSSIONS ON HOW TO DO THAT, IDEA OF USING ARR APPLICATIONS, KNOWING WE HAVE MANY MORE FROM OTHER GROUPS OF SCIENTISTS AS A PILOT STUDY AND DO AS A FULLER STAGE ACROSS CSR. WE WILL WANT TO HAVE A DISCUSSION ABOUT HOW TO DO THIS WELL, AND ONE OF THE CONCERNS FROM THE SUBCOMMITTEE ARE, ONE, WE PROBABLY HAVE TO DO -- GET IRB APPROVAL FOR THIS. IF WE GET CONSENT TO DO -- PARTICULARLY AN ANONYMIZATION STUDY USING REAL APPLICATIONS WILL WE UNDERMINE OUR ABILITY TO DETECT DIFFERENCES AMONG GROUPS OF SCIENTISTS BECAUSE DISCUSSING WHY WE'RE DOING THIS STUDY. WE'RE EXPECTING TO DO THIS CONTRACT, SOMETHING I HAVEN'T MENTIONED, OUR SUBCOMTEE WAS SET UP AS A TEMPORARY COMMITTEE, AND OUR PLAN IS TO GO OUT OF EXISTENCE AFTER THESE CONTRACTS ARE SET UP AND THEN WE HOPE WE WILL CONTINUE THE WORK MORE DIRECTLY WITHIN HANNAH VALANTINE'S GROUP. >> TO WHAT EXTEND ARE YOU REPEATING THE INITIAL EXPERIMENTS TO DETERMINE WHETHER BIAS IS PERSISTING, HOW ARE YOU ASSESSING TRENDS, EVEN THE PUBLICATION OF THE ARTICLE, THE STRONG STATEMENTS FROM LEADERSHIP ARE AN INTERVENTION? I CAN IMAGINE HAVING A PARALLEL ANONYMIZATION REVIEW WHERE WE'RE SEEING HOW REVIEWS COMPARE TO WHAT THE STUDY SECTION CAME UP WITH. THERE'S LOTS OF WAYS TO DO IT BUT IT'S IMPORTANT ENOUGH THERE'S SOMETHING IN PLACE SO YEAR IN, YEAR OUT, YOU CAN HAVE A SENSE OF WHETHER THIS IS GETTING BETTER, STAYING THE SAME, EVEN AS YOU'RE WORKING SO HARD TO MAKE THESE KIND OF DIFFERENCES BUT THERE SEEMS TO BE NOTHING MORE IMPORTANT THAN PROMOTING AND ENSURING FAIRNESS OF THE REVIEW PROCESS ITSELF. I MEAN, THERE'S NOTHING MORE DAMAGING THAN FEELING YOU ARE BEING DISCRIMINATED AGAINST BASED ON SOMETHING EXTRINSIC TO YOUR SCIENCE, AND SO, YOU KNOW, I'M JUST WONDERING WHILE ALL OF THIS IS GOOD, WHAT CAN YOU TELL ME ABOUT WHAT HAPPENED LAST YEAR, AND HOW DO WE KNOW THAT THINGS ARE -- WHETHER THINGS ARE BETTER OR WORSE? >> THERE IS AN ONGOING SET OF STATISTICS THAT COME FROM THE OFFICE OF EXTRAMURAL RESEARCH. >> YOU WERE ABOUT TO SAY THAT -- >> YEAH. >> YES, THE DATA OF THE RATES, FUNDING RATES, ARE BEING TRACKED ANNUALLY ACTUALLY BY SALLY'S OFFICE, AND I'VE REVIEWED THOSE, AND I WOULD SAY THERE'S BEEN A SLIGHT IMPROVEMENT. IT'S NO LONGER 1.1. IT WAS MORE LIKE 2.1% OF FUNDING RATES, DIFFERENT FROM WHAT WAS ACTUALLY REPORTED IN GINTNER, WHICH WAS JUST Ph.D.s, AND THERE WAS A SUBSEQUENT ANALYSIS THAT WAS PUBLISHED IN NNIC WHAT LOOKED AT THE M.D.s. >> THE FUNDING RATE IS EASILY CALCULATED BUT WHAT GINTHER STUDIED WAS PROBABILITY OF RECEIVING YOUR SCORE, AND SO THAT IS INFINITELY MORE DIFFICULT TO DO ON A REGULAR BASIS, BECAUSE THERE WAS 70 VARIABLES TAKEN INTO ACCOUNT, HOWEVER WE HAVE PROCESSES IN PLACE THAT WE CAN REPLICATE THE STUDY AS WE GO FORWARD, DONNA IS STILL ON BOARD WORKING WITH HANNAH AND HER GROUP AND OUR GROUP TO LOOK AT THIS BECAUSE WHEN WE -- AS WE -- IT'S ONE THING TO LOOK AT FUNDING RATE, AND THAT'S IMPORTANT, AND IF WE SEE THAT INCREASE, THAT'S OUR ULTIMATE GOAL, BUT WE STILL WANT TO UNDERSTAND HOW THIS TRANSLATES INTO BIAS IN THE REVIEW. THAT PROBABILITY OF GETTING FUNDED IS STILL IMPORTANT. YOUR FUNDING RATE IS ONE MEASURE, BUT THAT PROBABILITY IS ANOTHER. >> YEAH, WE'RE ALSO RECOGNIZE THAT A HARDER WAY OF STUDYING THIS ISSUE TO GET AT THE ISSUE, ANOTHER WAY TO STUDY THIS ISSUE TO GET AT THE ISSUE OF BIAS IS TO DO A STUDY IN WHICH YOU TAKE THE SAME APPLICATIONS, PUT A BLACK FACE AND WHITE FACE ON IT AND ASK FOR REVIEWS AND THOSE KINDS OF STUDIES HAVE ALWAYS, WITHIN THE UNITED STATES, SHOWN BIAS IN THE PAST. AND WE HAVE FUNDED A SCIENTIST TO DO THAT STUDY AS WELL. WE'VE DIDN'T THINK IT WAS AS EASY FOR CSR TO DO THAT PARTICULAR STUDY. >> CAN I SAY THE N NEEDS TO BE LARGE BECAUSE TO SHOW ANYTHING RELIABLE, JUST BECAUSE I PERSONALLY HAVE HAD THE EXPERIENCE OF SUBMITTING A GRANT AS PART OF A PPG AND AS A STANDALONE RO1, I WATCHED THE REVIEWS, THERE'S SOMETIMES HARDLY ANY OVERLAP TO SUBMIT, SO I'M NOT CONVINCED IN THE REVIEW PROCESS HOW PREDICTABLE IT IS, PURELY BASED ON THE SCIENCE. THEY HAVE MY NAME, THEY KNOW WHO I AM, TWO DIFFERENT COMMITTEES, HARDLY OVERLAPPING. TO ME THE LEVEL OF NOISE IN THE SYSTEM THAT'S NOT DETERMINED BY THE SCIENCE, BUT WHO THE REVIEWERS ARE, THE CONTEXT, ALL OF THAT, WE CAN'T KIND OF IGNORE IT AND FIX ONE AT A TIME. >> THAT'S WHY AT LEAST THE -- TO GET THE STRONG RESULT HERE, IT'S GOING TO TAKE A LONG TIME. WHAT ABOUT INTERVENTION STRATEGY? HANNAH MENTIONED ONE OF THE INTERVENTIONS SHE WORKED ON AT STANFORD, WHIC WAS TO TIE IN WORK DIRECTLY ON THE PROBLEM OF IMPLICIT BIAS. AND SO AS PART OF THE CHALLENGE COMPETITION THAT WE HAD, THERE WAS AN ADDITIONAL SUGGESTION OF REVIEWERS PLEDGES, IN ORDER TO TRY AND USE, FOR INSTANCE, SOMETHING SIMILAR TO CONFLICTS OF INTERESTS, PLEDGES, TO MAKE SCIENTISTS MORE AWARE OF THE PROBLEM OF BIAS AND PROMISE NOT TO DO IT. WITHIN OUR SUBCOMMITTEE OF CONSULTANTS THERE IS A FAIR AMOUNT OF CONCERN THERE'S A FINE LINE YOU HAVE TO WALK IN ORDER TO AVOID MAKING THE PROBLEM WORSE. THAT YOU CAN EASILY STIMULATE BY INAPPROPRIATE ATTENTION TO THE ISSUE OF BIAS MAKING IT WORSE. SO THAT'S WHY WE'D LIKE TO USE THE FACT WE HAVE SO MANY COMMITTEES AND SCIENTISTS WHO WORK WITH CSR, THAT WE COULD TRY POSSIBILITY OF AN EXPERIMENT, TRY THE IMPLICIT BIAS INTERVENTION THAT HANNAH HAS USED OR TRY A PLEDGE AND SEE WHETHER THAT WORKS, THAT WE CAN REALLY POTENTIALLY HAVE AN EVIDENCE-BASED INTERVENTION. EARLY CAREER REVIEWER PROGRAM, MANY SCIENTISTS COMPLAINED THEY DON'T REALLY UNDERSTAND HOW THE PEER REVIEW PROCESS WORKS OR WHAT THEY NEED TO DO TO WRITE A COMPETITIVE APPLICATION. SO WE STARTED THIS PROGRAM, MANY PEOPLE HAVE VOLUNTEERED. WE'VE BEEN ABLE TO TRAIN 1200, ALMOST 1300 SCIENTISTS, SO FAR THIS IS ENRICHED FOR UNDERREPRESENTED MINORITY SCIENTISTS, 30% FROM UNDERREPRESENTED GROUPS, ALL OUR OUTREACH WEBINARS, FOR INSTANCE, FOR AREA R-15 SCHOOLS, LESS RESEARCH INTENSEIVE SCHOOLS HAVE BEEN DONE TO ENCOURAGE THEM TO APPLY TO THIS PROGRAM, AS WELL AS APPLY FOR RESEARCH. WE'VE BEEN THROUGH NINE CYCLES, WE'LL HAVE THAT READY FOR YOU THIS YEAR. NOW, I ALSO WANT TO ANNOUNCE A GOOD AND BAD THING THAT'S HAPPENED, MONICABASCO HAS BEEN HEADING UP THIS EFFORT FOR C SR, FOR A WHILE NOW AND HAS BEEN BE A IMPORTANT DRIVER OF THE SUBCOMMITTEE AND SHE GOT AN OPPORTUNITY TO WORK AT THE WHITE HOUSE OFFICE OF SCIENCE AND TECHNOLOGY POLICY WHERE SHE'S THE ASSISTANT DIRECTOR FOR NEUROSCIENCE -- SORRY, I MISSPELLED, BROADENING PARTICIPATION OF SCIENCE DIVISION, OFFICE OF SCIENCE AND TECHNOLOGY POLICY AT THE WHITE HOUSE. THIS IS A CRITICAL POSITION FOR NIH, I ALSO THINK THAT SHE COULD HAVE AN IMPORTANT INFLUENCE ON OUR ABILITY TO TOUCH THE REST OF THE GOVERNMENT. WE CONGRATULATE HER ON THIS BUT IT'S ALSO MEANT THAT WE HAVE A HICCUP IN OUR MOVING FORWARD, AND WE WILL TRY AND CARRY ON. I WOULD LIKE TO EMPHASIZE THIS IS THE SUBCOMMITTEE, DANA TAKAGA AND REED CO-CHAIR, MONICA, DENISE AND LEE HAVE ALSO B EEN WORKING IN AN OFFICE. I'M SORRY I'M OVER TIME. >> WE'RE RIGHT ON THE MONEY. QUESTIONS. >> DO YOU THINK THE NEW NIH BIOSKETCH FORMAT WHERE YOU MAKE THE CASE FOR THE IMPACT AND SIGNIFICANCE OF OF YOUR ACHIEVEMENTS AND YOUR CHOICE OF RESEARCH QUESTIONS IS GOING TO AMELIORATE THE SITUATION WITH BIAS OR MAKE IT WORSE? >> WELL, I THINK THEY ARE TWO ASPECTS OF IT. ONE OF THE THINGS THAT WE'VE NOTICED, AND THAT ALSO JIM ANDERSON HAS SOME DATA ABOUT, THAT WHEN SCIENTISTS TODAY IN REVIEW LOOK AT A CV, THERE SEEMS TO BE A VERY HIGH CORRELATION, LIKE .9, WITH THE CALCULATION OF JOURNAL IMPACT FACTOR TIMES A NUMBER OF ARTICLES. SCIENTISTS TODAY SEEM TO BE GETTING A LITTLE LAZY ABOUT NOT READING THE ARTICLES BUT LOOKING AT THE JOURNAL IMPACT FACTOR. WE THOUGHT IT WOULD BE HELPFUL TO HAVE A LITTLE BIT MORE IN THE BIOSKETCH THAN JUST THE C.V., THAN JUST THE RECENT PUBLICATIONS, TO TRY AND GET THE SCIENTISTS TO FOCUS ON WHAT HAS BEEN CONTRIBUTED. NOW, AS HAS BEEN POINTED OUT OVER AND OVER, THE YOUNGER SCIENTIST MAY BY HAVING A SHORTER LIST, MAY APPEAR TO SUFFER IN THAT REGARD AND ONE OF THE THINGS THAT FRANCIS AND LARRY ARE REALLY MAKING SURE OF IS THAT THERE'S A PORTION OF THE RESEARCH BUDGET SET ASIDE FOR YOUNGER INVESTIGATORS, AND WE IN CSR ARE SEPARATING THOSE OUT SO WE CLUSTER EARLY CAREER INVESTIGATORS AND WILL LOOK AT THEM SEPARATELY, SO THAT WE DON'T THINK THAT THEY WILL BE HURT BY THIS PROCESS. WE'LL HAVE TO PAY ATTENTION TO THE DISTRIBUTION ALONG RACIAL AND ETHNIC LINES. >> I COULD JUST MENTION ONE OTHER THING IS THAT THIS SUMMER WE PILOTED THE BIOSKETCH IN A COUPLE PEER REVIEW PANELS AND DID AN EVALUATION BASED ON THE SURVEY OF IMPACT OF THE BIOSKETCH ON THINGS LIKE NEW INVESTIGATOR, AND ONE OF THE BIGGEST CONCERNS FOR THE NEW BIOSKETCH IS THE QUESTION OF WHETHER OR NOT NEW INVESTIGATORS WILL HAVE ENOUGH OF A RECORD TO BE ABLE TO USE THE BIOSKETCH IN SUCH A WAY THAT IT WILL PROMOTE THEIR ABILITY TO CONDUCT THE RESEARCH, AND ACTUALLY WE WERE QUITE PLEASED ONE OF THE THINGS THE REVIEWER HAS POINTED OUT IS THEY THOUGHT THE NEW INVESTIGATOR HAD AN EASIER TIME PORTRAYING THEIR SKILL SET AND ALSO THEIR ACCOMPLISHMENTS AND IT HELPED THE NEW INVESTIGATORS IN THE REVIEW OF THOSE APPLICATIONS, SO I WAS REALLY HAPPY TO SEE THAT. >> ANY OBJECTIVE DATA TO SUPPORT THAT? >> NO, WE ASKED AT EVALUATION. WE'LL BE MONITORING AS IT ROLLS OUT. >> DID YOU MAKE ANY EFFORT TO DO A COMPAISON BETWEEN THEM, PILOT, YOU KNOW, LOOK AT IMPACT ON REVIEW, ON GRANT REVIEW OR ANYTHING OF THAT SORT OF THING BEFORE IT WAS IMPLEMENTED OR WE JUST -- >> WE DID PILOTS ON IT. SO WE ASKED TWO QUESTIONS. WE ASKED APPLICANT AND REVIEWER, HOW DIFFICULT IT WAS TO PUT TOGETHER A BIOSKETCH, WHAT WAS THE IMPACT OF THE NEW FORMAT OF THE BIOSKETCH ON REVIEW, ET CETERA, SOMEWHAT OF AN EXPERIMENT. IT WILL BE AN EXPERIMENT GOING FORWARD, WE'LL BE ABLE TO HAVE SOME DATA ON THE COMPARISON BETWEEN THE TWO, BECAUSE OUR FIRST ROUNDS WILL HAVE A MIXED BAG OF BIOSKETCH, OLD AND NEW, BUT THEN WE'LL BE GOING TO THE -- WE'LL BE ABLE TO MONITOR IT. IF THERE'S ISSUES THAT ARISE AS WE GO FORTH WE'LL KEEP TRACK OF THAT. >> THOSE WON'T BE CONTROLLED. >> NO, WE WON'T HAVE A CONTROL. >> THE SAME PEOPLE BEING EVALUATED. >> NO. >> WITH REAL OBJECTIVE COMPARISON. >> NO. >> HANNAH HAD SOMETHING TO SAY. OH, OKAY. PARDON ME. >> I'M TRYING TO THINK ABOUT HOW TO SAY THIS IN THE LEAST INFLAMMATORY WAY. [ LAUGHTER ] >> GO AHEAD, I'M USED TO THIS. >> WHAT THE PREVIOUS REPORT SAYS AND WHAT I'M HEARING HAS NOT REALLY CHANGED IS THAT THERE'S REASON TO BELIEVE THERE'S A SYSTEMATIC ISSUE AT THE MOMENT, WITH HOW THE SCORES ARE MADE BASED ON OBJECTIVE CRITERIA, THAT THE SCORES SEEM TO BE -- THINGS LIKE THIS ISSUE OF THE IMPACT FACTOR SEEM TO SUGGEST THE SCORES ARE COMING OUT OF THE STUDY S, WITH A SLANT TO THEM. NOW, IT'S MY UNDERSTANDING, I BELIEVE IT'S TRUE, THAT NONE OF THE INSTITUTES AND PROGRAM , WHEN THEY ARE MAKING DECISIONS, ARE FOLLOWING SCORES IN A ONE FOR ONE WAY, WE ALL KNOW THERE ARE MANY INSTITUTIONAL PRIORITIES THAT ARE USED TO CONSIDER THAT, BUT WHAT I HEARD ALSO FROM THE PREVIOUS REPORT WAS THAT THERE WAS NO -- WAS THAT AT THE INSTITUTE LEVEL THERE WAS NO CORRECTIONS FOR THE FACTOR AT ALL, THE SCORES ERE JUST BEING FOLLOWED IN A STRAIGHTFORWARD FASHION. GIVEN THE INSTITUTE -- NO, BUT THERE WAS NO CORRECTION -- IN OTHER WORDS, THE PROBLEM AROSE IN THE SCORES THAT CAME OUT OF CSR AND THEN -- BUT THEN THAT NUMBER WENT FLAT OVER THE INSTITUTE, THERE WAS NO COMPENSATION, EITHER UP OR DOWN, FROM THAT NUMBER. IT WAS MY UNDERSTANDING OF WHAT THAT REPORT SAID. >> I'VE GOT THE MIC. SORRY. WHAT THE GINTHER PAPER INDICATED WAS IN FUNDING DECISIONS THERE DID NOT APPEAR TO BE BIAS, OR AT LEAST -- >> CORRECT, EXACTLY. >> THERE WAS NOT CHANGE OF PROBABILITY OF FUNDING BASED ON RACE. >> EXACTLY. >> POSITIVE OR NEGATIVE. >> THAT'S MY EXACT POINT. THAT'S MY EXACT POINT. SO GIVEN THAT THE INSTITUTE EVALUATES THINGS LIKE THE NEED TO FUND JUNIOR INVESTIGATORS AS THEY HAVE BEEN ENCOURAGED TO THINK MORE ABOUT BY OUR ELECTS OFFICIALS, GIVEN THEY THINK ABOUT DIFFERENT TOPICS OF IMPORTANCE TO THE INSTITUTES, ARE THEY FULLY AWARE OF THIS ISSUE THAT MAY BE COMING OUT OF CSR AND CAN THEY BE MADE AWARE OF THAT AS THEY THINK ABOUT WHAT THEY ARE DOING IN THEIR FUNDING DECISIONS? >> I'LL TAKE IT. THEY CERTAINLY ARE AWARE. BEING AWARE BUT BEING CONVINCED IS TWO DIFFERENT THINGS. I SUSPECT THAT IN SOME INSTANCES, AGAIN, THE METAPHORICAL EVERYTHING IS EQUAL, THAT DECISIONS ARE BEING MADE WITH THIS ISSUE IN MIND, OKAY? AND WHEN YOU'RE ONLY FUNDING -- WHAT ARE YOU, 17, 18%? THEY WERE ALL THE SAME. LET'S BE HONEST HERE. SO I DO THINK THAT AT SOME LEVEL THIS IS HAPPENING, BUT IF YOU TAKE IT TO THE NEXT LOGICAL STEP, YOU WOULD HAVE TO DECIDE WHETHER IT MADE SENSE TO HAVE AN AUTOMATIC MODIFICATION TO REDRESS WHATEVER THE PERCEIVED, REAL, YOU KNOW, WHATEVER IT IS DIFFERENCE IS. SO I THINK AT THE MOMENT, BECAUSE AS WE CONTINUE TO UNPACK THIS, IT IS COMPLICATED FOR SAFETY, OBVIOUS, AND TO DO IT ROTELY, I THINK ISN'T REASONABLE, BUT TO DO IT ON A, YOU KNOW, APPLICATION BY APPLICATION BASIS IS. NOW, I DON'T THINK THAT WE HAVE CALLED THE QUESTION, IF THAT'S WHAT YOU'RE ASKING, BUT I DO KNOW FROM SPEAKING WITH COLLEAGUES THAT THIS IS TAKEN INTO ACCOUNT, AT LEAST IN MANY INSTITUTES, I CAN'T SAY THAT IT IS DONE UNIFORMLY, SO PART OF THE PROBLEM IS THAT PERHAPS, BUT PART OF THE PROBLEM, THIS WAS ALSO UNDERSCORED BY THE GINTHER REPORT, ALTHOUGH NOT ARTICULATED AS SUCH, THERE ARE SO FEW APPLICANTS FROM THE COMMUNITY THAT TINY CHANGES UP OR DOWN LEAD TO THESE ENORMOUS SWINGS. SO, AGAIN, YOU'VE ASKED A SERIOUS QUESTION. I'M TRYING TO GIVE YOU A SERIOUS ANSWER. FOR NOW, AT LEAST, I THINK THE BEST APPROACH IS APPLICATION BY APPLICATION. >> YEAH, YOU KNOW, I AGREE WITH YOU THAT I DON'T BELIEVE THAT ROTE ANSWERS OR, YOU KNOW, SPECIFIC NUMBERS ARE THE RIGHT ANSWER BUT I DO THINK, FOR EXAMPLE, WE HAVE HEARD FROM HANNAH'S WORK, AMONG OTHERS, JUST MAKING PEOPLE AWARE, ACUTELY AWARE OF THE KIND OF BIASES THAT GOING INTO DECISION MAKING CAN HELP PEOPLE MAKE DECISIONS THAT HAVE LESS OF THAT COMPONENT IN IT. AND TO THE EXTENT THAT THE INSTITUTES AND PROGRAM OFFICERS CAN RAISE AWARENESS OF THE FACT THAT WE HAVE A SHORT-TERM PROBLEM TO WHICH WE HOPE THERE WILL BE A TRUE LONG-TERM SOLUTION, BUT MAYBE THERE ARE SHORTER TERM SOLUTIONS AT THE POINT WE KNOW THEY ARE NOT FIXED >> IN FAIRNESS TO YOUR COMMENT, YOU'VE ACTUALLY -- I MEAN, GENERALLY IT'S VERY IMPORTANT BUT THE SPECIFIC SUGGESTION THAT YOU'VE JUST RESTATED IS EQUALLY IMPORTANT, BECAUSE I DON'T THINK THAT WE -- SO THERE'S AWARENESS, BUT THEN THERE IS AWARENESS CRAFTED IN A WAY TO GET THE MESSAGE ACROSS, AND I'M NOT CERTAIN THAT WE HAVE DONE THE LATTER. I THINK WE'VE -- YOU KNOW, THERE'S BEEN GENERAL AWARENESS BUT I DON'T THINK WE'VE HAD SPECIFIC INTERVENTIONS TO DO WHAT YOU JUST SUGGESTED. SO THANK YOU, THAT'S REALLY A GOOD OBSERVATION. >> I WANT TO POINT OUT WE'VE TAKEN THIS VERY SERIOUSLY, AMONG PROGRAM OFFICERS IN PARTICULAR. WE HAVE A GROUP OF OUR -- ALL OUR PROGRAM OFFICERS ARE COMPOSED, WE HAVE A GROUP CALLED PROGRAM LEADERSHIP COMMITTEE AND THROUGH THAT COMMITTEE WE HAD A THREE-DAY SEMINAR ON WHAT THE RESPONSIBILITIES IN UNDERSTANDING A PROGRAM OFFICERS ARE IN THIS VERY ISSUE ABOUT UNDERREPRESENTED DIVERSITY, WHAT ARE THE THINGS IN THE INTERVENTIONS, ALSO WHAT THEIR RESPONSIBILITIES ARE IN THIS ISSUE. IT WAS REALLY A FANTASTIC EVENT. WE HAD A COUPLE HUNDRED OF OUR PROGRAM OFFICERS TOGETHER ON THIS. WE BROUGHT IN EXPERTS FROM AROUND THE COUNTRY TO GIVE US INFORMATION ABOUT SOME OF THE SCIENTIFIC ASPECTS, AND IT WAS REALLY GREAT. IT'S A START. I THINK IT IS TRUE THAT JUST -- WE MIGHT ACTUALLY, LARRY OR MICHAEL MIGHT WANT TO TALK ABOUT THE LASKER SCHOLARS, RAISING AWARENESS LED TO A MORE DIVERSE GROUP OF CANDIDATES BY JUST RAISING AWARENESS OF THE REVIEWERS. >> BUT, SALLY, I WANT TO CLARIFY ONE THING. I THINK I ASKED THE SAME QUESTION EARLIER, AND HANNAH SAID PERHAPS THAT WE DIDN'T -- IN FACT I THINK YOU SAID WE DON'T -- I'M GOING TO PUT ON MY SCIENTIST HAT, WE DON'T REALLY HAVE THE DATA. I'M GETTING TWO MESSAGES. EITHER WE HAVE THE DATA AND TRAINING MAKES A DIFFERENCE, OR WE DON'T. I UNDERSTAND THAT, BUT I'M NOT CLEAR ON THE TAKEHOME. >> WE HAVE DATA FROM OTHER CONTEXT WHERE RAISING AWARENESS HAS BEEN SHOWN TO MAKE A DIFFERENCE IN ONE'S DECISION-MAKING PROCESS, IN TERMS OF SEARCH COMMITTEE, FOR EXAMPLE, THE ORIGINAL SET OF STUDIES CAME OUT OF THE UNIVERSITY OF MICHIGAN, AND IT'S THERE, BUT TO SAY THAT ACTUALLY IT CAN BE TRANSLATED TO PEER REVIEW, IT'S TEMPTING, AND I WOULD PREDICT THAT IT CAN BE, BUT, GOSH, WE'RE SCIENTISTS. LET'S DO THE EXPERIMENT. IT WON'T TAKE LONG. TO LARRY'S POINT, WHEN YOU MAKE THAT AWARENESS, IT'S REALLY CRITICALLY IMPORTANT. SO THIS GENERAL SORT OF AWARENESS ACTUALLY IS NOT ENOUGH. IT HAS TO BE DONE IN THE CONTEXT OF MAKING THAT DECISION, AND WHAT HAS BEEN SHOWN IS THAT THE BIAS ACTUALLY GO DOWN BUT IN FACT THE AFFECT GETS LOST OVER TIME AND SOMEHOW NEEDS A BOOSTER. >> IT'S CLEARLY A LEVEL OF PRIORITY AT THE STUDY SECTION. >> THE CONVERSATION, I SEE I WANT TO MAKE SURE THAT I DO NOT INCUR THE IRE COMMITTEE AS YOU USE YOUR BREAK FOR THIS CONTINUING DIALOGUE. WHATEVER HAPPENS FROM THIS POINT ON IS NOT MY RESPONSIBILITY. CATO? >> JUST A POINT. MAY THE FORCE BE WITH YOU. [ LAUGHTER ] THIS IS DEFINITELY GOING TO BE A VERY TOUGH ASSIGNMENT, TOUGH JOB, GOD BLESS YOU FOR PURSUING IT. A COUPLE THOUGHTS, ONE THAT IN THE UNIVERSITY COMMUNITY ONE THING THAT'S DONE IN TERMS OF GETTING PEOPLE TO BE A PART OF WHAT'S GOING ON IS TO PLACE DIVERSITY AND TO PLACE ISSUES OF THE RESULTS THAT YOU WOULD LIKE TO ENCOURAGE INTO THE FORMULA FOR THEIR EVALUATION AND INTO THEIR FORMULA FOR THEIR COMPENSATION. NOW, THE INSTITUTE OF DIRECTORS, I BELIEVE, RECEIVED BONUSES, AND TO A CERTAIN AMOUNT, EVEN THAT BECOMES IMPORTANT. SO, YOU KNOW, MAKING THE BONUS, 100% BASED ON THEIR EFFORTS AND DIVERSITY, I WOULD THINK WOULD BE AN ENCOURAGING FACTOR FOR THE INSTITUTIONS TO MOVE FORWARD IN PROGRAMS DIVERSITY AND WOULD SUGGEST THAT WOULD HAVE A MAJOR IMPACT IN TERMS OF DIRECTION OF DIVERSITY, I'LL PUT THAT OUT THERE. THE SECOND IS THAT, AGAIN, THIS MAY BE, YOU KNOW, JUST IN FOLLOW-UP TO THE EARLIER COMMENTS THAT WERE MADE, YOU KNOW, THERE IS THE ISSUE OF THE SELECT PAY MECHANISM, SPECIAL PAY MECHANISM THAT ALL INSTITUTE DIRECTORS HAVE BETWEEN FIVE AND SOME INSTITUTES 15% OF THEIR EXTRAMURAL FUNDS THAT ARE ON A DECISION-TYPE BASIS. AND SO I WOULD LIKE TO PUT OUT ONE PROPOSAL TO CONSIDER. AND THAT PROPOSAL IS THE FACT THAT IF A SELECT PAY OR SPECIAL PAY IS GIVEN, IS PROVIDED TO AN INDIVIDUAL WHO IS NONMINORITY, WHO HAS AN INFERIOR SCORE, TO SOMEONE WHO IS A MINORITY PERSON, THAT THE MINORITY PERSON IS FUNDED TOO. A SIMPLE CONCEPT IN THEORY THAT MAY CREATE CHANGE. FOR INSTANCE, IF AS YOU KNOW AT THE END OF SELECT PAY COMES UP, THERE ARE THE NEXT PERSON TO BE FUNDED, MAYBE IT'S A MINORITY PERSON, IF THE SELECT PAY DECISION IS TO FUND SOMEONE BELOW THAT MINORITY PERSON, THAT MINORITY PERSON SHOULD BE INCLUDED TOO. AND I'M JUST SAYING THAT'S A CASE IN WHICH YOU'VE GOT A MINORITY PERSON WITH A SUPERIOR SCORE, NOT BEING FUNDED, IF THOSE CASES TAKE PLACE, THAT MINORITY PERSON SHOULD BE FUNDED. IT'S A STEP, OR IF NOT THERE SHOULD BE STRONG JUSTIFICATION IN TERMS OF THE MINORITY PERSON NOT BEING FUNDED OVER A PERSON WITH AN INTERIOR SCORE WHO IS NONMINORITY. >> AGAIN, I'M GOING TO TAKE THIS ONE. SO WHILE WE MAY IN MANY INSTANCES KNOW WHO IS A MEMBER OF AN UNDERREPRESENTED GROUP, THERE ARE NO IDENTIFIERS, THERE ARE NO LEGAL IDENTIFIERS ON A GRANT APPLICATION, ABOUT RACE OR ETHNICITY. YOU KNOW THAT. SO I THINK THE NOTION -- I MEAN WE HAD THIS CONVERSATION, THIS IS WHAT THE CONVERSATION WAS ABOUT. SO I THINK TO DO IT, MY TERM WAS ROTELY, YOU KNOW, BUT TO DO IT FORMULAICLY I THINK IS NOT THE WAY TO DO IT. YOU NEED TO REVIEW APPLICATION BY APPLICATION, YOU NEED -- BECAUSE AGAIN, IT'S CONCEIVABLE THAT YOU WON'T KNOW IF THE INDIVIDUAL IS A MEMBER OF AN UNDERREPRESENTED GROUP OR NOT. >> I'VE BEEN ON A COUPLE COUNCILS. WE TALK ABOUT THE PERSONALS AND WE TALK ABOUT IN TERMS OF INDIVIDUAL GRANTS FUNDED, AND THEY MAKE UP IN -- AND THE MA IN TERMS OF MINORITY GROUPS. >> THE DATA AREN'T -- IT'S SEPARATED. IT'S SEPARATED OUT. IT'S STRIPPED OUT. >> WHEN YOU ARE -- WHEN YOU VOLUNTARILY CAN SUBMIT YOUR RACE AND ETHNICITY AND YOU DO THAT AS PART OF YOUR PROFILE, SO THAT'S HOW WE GET THOSE DATA, WE UNDERSTAND THEY ARE IN THERE, AND SO THEN THAT IS NOT A PIECE OF THE ACTUAL APPLICATION THAT'S THEN SEEN BY THE REVIEWER BUT IT DOES BECOME PART OF THE PROFILE. SO WHEN WE DO ANALYSES, WE'RE ABLE TO DO ANALYSES BY RACE, IT'S VOLUNTARY OF COURSE, THROUGH THE PROFILES IN THE SYSTEM. >> DO PROGRAM STAFF HAVE ACCESS THEY WANT TO LOOK AT THAT INFORMATION? >> BUT IT'S VOLUNTARY. >> WHAT PROPORTION OF APPLICANTS CHECK IT? >> IT'S PRETTY HIGH. I DON'T KNOW, DO YOU KNOW, SHERRY? I THINK I WOULD SAY WE PROBABLY GET ABOUT 90% WILL GIVE US THEIR RACE. >> IT'S A BASIS OF ALL OUR WORKING GROUP REPORTS WHEN WE SHOW YOU A GRAPH THAT SHOWS GRANTS. THAT'S WHERE ALL THAT COMES. IF YOU CAN DO IT THERE, IT'S CLEARLY IN THERE. >> BUT CATO, I GUESS I GOT TO PUSH BACK. GOODNESS KNOWS I'VE SPENT A FAIR AMOUNT OF TIME WORKING ON THESE ISSUES. BUT I DON'T THINK THAT'S THE SOLUTION. I THINK WE'VE GOT TO FIGURE OUT WHY, NOT PUT A BAND-AID ON SOMETHING. >> HE'S NOT PROPOSING A SOLUTION. CAN WE EVEN GET THE DATA? SIMPLY TO KNOW THE DATA BY INSTITUTION OF HOW MANY PEOPLE ARE FUNDED OUT OF ORDER AND THEN COULD WE FIND OUT THE SELECT PAY, WHAT OF THE PEOPLE WHO ARE GIVEN SELECT PAY, WHAT'S T HEIR RACIAL AND ETHNIC MAKEUP? WHAT IF IT TURNS OUT WE FUND THEM AT A LOWER RATE? >> YOU KNOW THAT'S NOT THE CASE. THE GINTHER PAPER SAID ONCE YOU HAVE THE PRIORITY SCORE NOTHING HAPPENS AFTER THAT CHANGES YOUR LIKELIHOOD OF GETTING FUNDED. YES, WHO GOT PAID, WHO GOT A GRANT. >> SELECT PAY IS DIFFICULT TO EVEN QUANTITATE. IF YOU DO A SELECT PAY YOU HAVE TO DOCUMENT THAT. THAT DOESN'T GO INTO THE SYSTEM SO WE HAVE DATA WITHIN THE SYSTEM THAT WILL TELL US WHAT'S SELECT PAY AND WHAT'S NOT. SECONDLY, INSTITUTES ARE ALL DIFFERENT. SO SOME INSTITUTES HAVE NO PAY LINES. SO IT'S ESSENTIALLY ALL SELECT PAY. SOME INSTITUTES HAVE VERY SMALL PAY LINES AND THEN THEY DO A LARGE -- THE MAJORITY OF THEIR GRANTS ARE THROUGH SOME SORT OF SELECT PAY. SO IT WOULD BE HARD -- >> IS THERE ANY WAY OF KNOWING BY INSTITUTION? >> NO. >> DARK MATTER? >> IT MAY CHANGE YEAR TO YEAR, DEPENDING ON THE DESIRE OF THE IC DIRECTOR AND THAT TYPE OF THING. HAROLD HAS A ZONE EVER UNCERTAINTY. >> THE EXTRAMURAL COMMUNITY, IN THE INTEREST OF TRANSPARENCY, THAT OUGHT TO BE OUT THERE. EVEN IF IT'S -- HOWEVER IT'S CATEGORIZED, CAN'T YOU GO THROUGH ALL THE GRANTS FROM A GIVEN INSTITUTES AND LOOK AT ALL THE SCORES THAT EVERYBODY GOT AND WHERE IT'S CONTINUOUS AND THEN WHERE IT STOPS BEING CONTINUOUS AND WHAT PERCENTAGE ARE ABOVE THAT LINE AND WHAT ARE BELOW THAT LINE? >> WE ALREADY KNOW. DONNA DID THAT IN THE ANALYSIS. DONNA DID THAT IN THE ANALYSIS. ONCE YOU GO TO THE FUNDING DECISION, WE DID NOT SEE THE SAME TYPE OF DISPARITY WE SAW IN THE PROBABILITY OF YOUR SCORE IN THE REVIEW. SO I MEAN IT WOULD BE ONOROUS TO DO IT. YOU COULD DO IT INSTITUTE BY INSTITUTE BUT IT'S NOT SOMETHING WE COLLECT ROUTINELY OR IS IN A STRUCTURED FORM FORMAT. SO IT WOULD BE AN INDIVIDUAL BY INDIVIDUAL CASE. THAT'S WHAT WE DID GOOD THE GINTHER PAPER, FUNDING WITH EVERY INDIVIDUAL -- WHETHER OR NOT THEY WERE SCORED OR NOT. >> ROBERT, REAL QUICK. WE'VE GOT TO BRING THIS TO CLOSURE. >> I UNDERSTAND, BUT THERE IS ONE THING SAID THAT I WOULD LIKE TO REVISIT. AND THAT'S THAT PERCENT OF PEOPLE WHO ANSWER WHAT RACE ETHNICITY REALLY IS. I'VE SEEN THIS DATA IN A DIFFERENT COMPLEX WHERE THE NUMBER OF PEOPLE WHO SAID PREFERRED NOT TO SAY ON A PERCENTAGE BASIS WAS NOT HIGH, BUT KNOWING THE POPULATION THAT ANSWERED, IT WAS CLEAR THAT WAS NOT A RANDOM SAMPLE OF THE PEOPLE TO WHOM THE QUESTIONNAIRE WAS GIVEN, AND IN FACT THOSE WHO WERE IN THE MINORITY POPULATION CLEARLY SYSTEMATICALLY WERE FOUND IN THE PREFERRED NOT TO SAY. >> RIGHT. ONE THING THAT HAPPENED WAS THAT THE WAY THAT WE USED TO HAVE STRUCTURED IN THE COMMENTS WHERE YOU PUT THAT IN ON YOUR PROFILE, WE HAD IT SUCH THAT YOU COULD JUST SKIP IT. NOW WE HAVE IT SO THAT YOU HAVE TO ACTUALLY MARK, I DO NOT WANT TO PROVIDE THIS INFORMATION. WHEN WE DID THAT THE PROPORTION OF PEOPLE THAT TELL US RACE OR ETHNICITY SKYROCKETED. BEFORE PEOPLE WERE SKIPPING IT BECAUSE THEY DIDN'T HAVE TO AFFIRMATIVELY SAY I DON'T WANT TO PROVIDE IT BUT NOW THEY DO. >> THAT'S A SLIGHTLY DIFFERENT QUESTION. WHAT I'M ASKING IS IF THERE'S A WAY TO FIND OUT REALLY WHAT THE NUMBERS ARE, BEYOND WHATEVER THAT EMPTY SET IS. >> SO THAT 10%? >> YES, WHO ARE THEY. >> LARRY? IT. >> SO, AGAIN, LET ME RETURN TO CATO TO MAKE SURE WE'RE TALKING ABOUT THE SAME THING. EVEN IN COUNTING SELECT PAY, ONCE THE INSTITUTES GET THE THING, THERE'S NO DIFFERENCE BETWEEN MAJORITY, MINORITY, ALL RIGHT? RESTATE YOUR PROPOSAL FOR ME. I WANT TO MAKE SURE -- MAYBE I DIDN'T GET IT. WORLD OF SELECT PAY, IF WE'RE TRYING TO MOVE THE DIAL, MOVE THE DIAL FORWARD, THAT IF THERE IS A SELECT PAY THAT'S PROVIDED, IN SAY SOMEONE DECIDES TO FOR PROGRAMATIC REASONS THEY WANT TO GO DOWN FOUR NOTCHES, YOU KNOW, THE NEXT FOUR NOTCHES DOWN TO THE NEXT PERSON, IF THERE IS IT A MINORITY PERSON THAT'S ABOVE THAT LINE, ABOVE THAT PAY LINE, THAT'S IN THE ZONE, THAT HAS A SUPERIOR APPLICATION, IT'S SKIPPED BECAUSE, AND IT'S SUPERIOR APPLICATION, WITH A MINORITY INVESTIGATOR WITH A SUPERIOR APPLICATION, OVER THE NONMINORITY INVESTIGATOR, THAT THE MINORITY INVESTIGATOR IS FUNDED, OR STRONGEST OCCASION FOR THAT NOT HAPPENING BECAUSE IF WE WERE REALLY TRYING TO FUND THE BEST SCIENCE, AND TO INCREASE DIVERSITY, THAT'S A WAY TO APPROACH THE SITUATION AND TO MOVE THE DIAL. IF WE'RE LOOKING AT WAYS TO MOVE THE DIAL. >> WHAT ABOUT SIMILAR APPROACH TO WHAT MANY INSTITUTES DO WITH YOUNG OR NEW INVESTIGATORS, RIGHT? WHERE WE DO THIS ALL THE TIME. IS THAT CONSIDERED PART OF SELECT PAY, IF WE GO AN EXTRA COUPLE OF PERCENTAGE POINTS FOR A NEW INVESTIGATOR? SO WHY NOT APPLY THOSE STANDARDS IN IN EFFECT YOUR PROPOSAL WOULD DO THAT, TO WHATEVER THE LEVEL THE YOUNG INVESTIGATOR GETS A MINORITY IN THAT GAP WOULD BE FUNDED. [LOW AUDIO] >> SO WE'VE GOT ONE URGENCY. >> NOT URGENT. >> MAKE IT PLEASE. >> HAS ANYONE DONE THE EXPERIMENT OF SCOING THE ABSTRACT, AIMS AND BACKGROUND AND NOTHING ELSE AND COMPARING THAT TO THE SCORE WHEN YOU DO EVERYTHING ELSE, INSTITUTION, BIOSKETCH AND EVERYTHING ELSE? DO THEY DIFFER THAT MUCH? BECAUSE THAT WOULD HAVE A WHOLE LOT LESS BIAS OF ALL KINDS. >> THAT'S ACTUALLY PART OF THE PROCESS, AND NSF ALSO HAS DONE SOME OF THE EXPERIMENTS, THERE'S ALSO A SIMPLE EXPERIMENT YOU CAN DO, WHETHER OR NOT YOU LOOK AT INVESTIGATOR AND INSTITUTION FIRST, OR WHETHER OR NOT YOU LOOK AT APPROACH AND SIGNIFICANCE AND INNOVATION FIRST. THAT REALLY CAN MAKE A DIFFERENCE IN JUDGING THE APPLICATION AND BASED ON WHAT THEY KNOW ABOUT THE INVESTIGATOR. SO SOMETHING AS SIMPLE AS ORDER IN WHICH YOU JUDGE AN APPLICATION CAN MAKE A DIFFERENCE IN HOW IT'S VIEWED. >> WE DIDN'T MENTION CATO'S FIRST RECOMMENDATION, WHICH WAS AROUND ACCOUNTABILITY AND REWARDS FOR BEING SUCCESSFUL IN DIVERSIFYING YOUR SCIENTIFIC WORK FORCE AND THIS IS SOMETHING WE SHOULD BE THINKING ABOUT A LOT. I SEE SOME ELEMENTS OF METRICS WITHIN PERFORMANCE EVALUATION OF EXECUTIVES, PEOPLE OF EXECUTIVE LEVELS, THAT CAN BE BUILT IN MORE STRONGLY, AND THEN WHEN WE GO TO EXTRAMURAL FUNDING, AND I BROUGHT THIS A FEW TIMES TO SALLY'S ATTENTION, WHEN WE REVIEWED BIG GRANTS RECEIVING HUGE AMOUNTS OF DOLLARS, WHAT IS THE EVALUATION ABOUT HOW THAT INSTITUTION IS DOING VIS-A-VIS DIVERSIFYING ITS WORK FORCE? >> SO LET ME -- >> IS THAT BEING EVALUATED AND REWARDED AND PERHAPS THERE MIGHT BE AN OPPORTUNITY. >> LET ME BRING US TO CLOSURE BY SAYING THIS, FIRST OF ALL, THIS IS TERRIFIC. THIS IS JUST WHAT IS NECESSARY FROM THE COMMITTEE. IT IS. IT'S KILLING US ALL BUT IT'S GOOD. THIS IS SOMETHING THAT SHOULD BE GONE THROUGH WITH PAIN BECAUSE IT'S SO IMPORTANT. THIS IS AN AN UNSATISFACTORY RESOLUTION. WE'RE LEAVING TOO MANY BALLS UNDEALT WITH AND DON'T HAVE TIME AND STRUCTURE OF THIS MEETING TO DO JUSTICE. WHAT I THINK I WOULD PROPOSE IS, A, THAT STAFF WILL REVIEW THE TRANSCRIPT CAREFULLY, THERE ARE A NUMBER OF QUESTIONS THAT ARE BEING RAISED. I WOULD THINK WITHIN THE RULE BOOK, WHICH THE RULE BOOK OF NIH IS MORE COMPLEX THAN I WILL EVER UNDERSTAND, BUT WITHIN THE RULE BOOK, I THINK THAT STAFF HAVE THE RESPONSIBILITY TO SUBMIT IS A RESPONSE ON THESE THINGS BACK TO THE COMMITTEE AND IN BETWEEN THE MEETING. WE SHOULD NOT LET THIS LIE UNTIL THE NEXT MEETING. SO YOUR ADVISORY COMMITTEE HAS MADE IT CLEAR THAT THEY HAVE SEVERAL QUESTIONS THAT THEY WANT BETTER ANSWERS TO, AND THAT THEY EXPLORED. I THINK STAFF SHOULD ANSWER THOSE QUESTIONS WHICH CAN BE ANSWERED, OR GIVE US THE BEST INFORMATION, AND FOR THOSE THINGS THAT THEY WANT TO EXPLORE, WHEN THEY ARE BEING EXPLORED IN OTHER PROJECTS WE SHOULD INDICATE WHERE THOSE THINGS ARE BEING EXPLORED AND IF THERE NEED TO BE NEW EXPLORATORY EFFORTS TO THE EXTENT YOU CAN DO THAT, DO THAT. IF YOU CAN'T BE BE TRANSPARENT THAT SAYS WE JUST DON'T HAVE THE ABILITY TO THAT AT THIS TIME. WE'LL HAVE TO ADDRESS IT ANOTHER TIME. WE HAVE TO BE TRANSPARENT. SO THAT'S WHAT I WOULD EXPECT. I'M SEEING FRANCIS NOT GAVEL ME TO SUBMISSION ON THIS. THIS MUST BE WITHIN THE RULE BOOK. SO WE WILL GET THAT FORWARD BACK TO YOU AND -- SIR? >> I KNOW YOU WANT TO COME TO CLOSURE. >> GO AHEAD. >> I LIKE THE IDEA OF DEALING WITH SELECT PAY. MY SELECT PAY IS TO REACH CERTAIN KINDS OF NEEDS, SCIENTIFIC NEEDS, THAT CAN'T BE ALTERNATIVE SOLUTION MIGHT BE TO LOOK AT THE COMMON FUND AS A WAY TO PROVIDE ADDITIONAL RESOURCES TO HIT THE INVESTIGATORS WHO WOULD OTHERWISE BE FUNDED IN A BETTER FORUM. >> LET ME TAKE THE SPIRIT OF THAT IN TWO WAYS AS WE COME TO CLOSURE. COME ON, GUYS. FIRST, THAT WHAT'S GOOD IS YOU GOT ANOTHER THING FOR THE STAFF TO LOOK AT. BUT NUMBER TWO, WHAT YOU'VE ALSO SAID IS THAT I'M GOING TO AMEND MY REQUEST TO MANAGEMENT. IF YOU WOULD IN SENDING YOUR RESPONSE BACK, WOULD YOU ALSO THEN PROVIDE THE INVITATION FOR MEMBERS TO RESPOND BACK WITH ALTERNATIVE SUGGESTIONS AND, AND LET THIS BE A CONTINUING CONVERSATION. BY THE TIME WE GET TO THE NEXT MEETING THERE WILL BE A VERY ROBUST UNDERSTANDING AND CONVERSATION THAT NEEDS OCCUR. THERE'S NO REASON THIS CAN'T BE FLUID. ALL RIGHT. SO AN UNSATISFACTORY CONCLUSION TO A TERRIFIC PRESENTATION. BUT A PROCESS OF DEALING WITH IT GOING FORWARD. THANK YOU ALL VERY MUCH. [APPLAUSE] >> WE'LL TAKE A QUICK BREAK AND TRY TO REASSEMBLE AT 4:00. >>> LET'S COME BACK TO ORDER. WE'RE NOT GIVING YOU MUCH TIME TO STRETCH YOUR LEGS. WE STILL HAVE WORK TO DO. BOY, DO WE EVER. ACD MEMBERS, WHERE ARE YOU ALL? >> TO THE FEW ACD MEMBERS HERE, BECAUSE WE REALLY WANT TO GET TO THE DISCUSSION OF INTRAMURAL AND WE COULD HAVE A CONVERSATION ABOUT THIS, THAT WOULD PROBABLY GO ON FOR A COUPLE HOURS AS WELL, WE'RE GOING TO OFFER JUST TO GO THROUGH OUR SLIDES IF WE HAVE A MINUTE OR TWO AT THE END TO TALK TO YOU ABOUT THEM AND T WE'RE WILLING AND ABLE TO TALK WITH YOU FURTHER VIA E-MAIL OR SOME OTHER MECHANISM TO TALK MORE ABOUT OUR IMPLEMENTATION PLANS FOR THE PHYSICIAN SCIENTIST WORK FORCE. JUST WANT TO REMIND YOU THAT WE HAD A REPORT OUT FROM THE PSW AS WE CALL IT THAT WAS ABLY CHAIRED BY DAVID GINSBERG AND SHERRY MILLS AND SUSAN SUREN. WE HAVE SINCE THE SUMMER MEETING BEEN WORKING ON IMPLEMENTATION PLANS. SHERRY IS HEADING UP THE IMPLEMENTATION TEAM, I WANT HER TO TALK ABOUT THE RECOMMENDATIONS FOR IMPLEMENTING MANY OF THE ULTIMATE RECOMMENDATIONS. WANT TO REMIND YOU ABOUT THE RECOMMENDATIONS FROM THE REPORT WHICH WAS JUST IN GENERAL TERMS TO SUPPORT TRAINING OF M.D./Ph.D.s TO SUPPORT MORE PHYSICIAN SCIENTK FORCE THROUGH INDIVIDUAL FELLOWSHIPS RATHER THAN TO GAPS, TRACKING THE WORK FORCE, THIS IS A FOLLOW-ON TO THE BMW, BIOMEDICAL WORK FORCE COMMITTEE AND BOTH IN THIS REPORT AND IN THE PREVIOUS REPORT THERE IS A NEED TO TRACK AND HAVE BETTER DATA ON OUR WORK FOCE. TO ESTABLISH A NEW GRANTEE MECHANISM TO THAT FACILITATE PSW, WE'RE GOING TO GIVE YOU A FEW OPTIONS, DEVELOPING MECHANISMS, MODIFYING EXISTING, EXPAND THE REASON REPAYMENT PROGRAM, AN IMPORTANT WAY TO INCENTIVIZE PEOPLE TO STAY IN RESEARCH. SUPPORT NOVEL APPROACHES TO SHORTEN TRAINING, AND INCREASE DIVERSITY OF WORK FORCE AND ALSO LEVERAGE SOME EXISTING PROGRAMS SUCH AS CTSA PROGRAM WHICH CLEARLY HAVE AS ONE OF ITS FOUNDATIONS PHYSICIAN SCIENTISTS. I'LL LET SHERRY GO THROUGH WITH YOU SOME ACCOMPLISHMENTS SINCE THE REPORT. >> THANK. I OPEN EVERYBODY IS IN A BETTER FRAME SINCE THE LAST 15 MINUTES. JUST SO I KNOW, FRANCIS, HOW LONG DO I HAVE? 17? OKAY. 4:20? I CAN DO IT. I'M ORIGINALLY FROM NEW YORK, THAT MEANS NO QUESTIONS. A COUPLE THINGS SINCE WE MET, WE STOOD UP A NEW DIVISION OF BIOMEDICAL RESEARCH WORK FORCE. WE'RE DOWN TO THE FINAL FIVE CANDIDATES THAT WE'VE BEEN GIVEN TO INTERVIEW, A COMMITTEE WAS HEADED TO SEARCH NATIONWIDE FOR THAT. WE HIRED A LABOR ECONOMIST, A RECOMMENDATION ACTUALLY FROM THE BMW RECORD. HE'S HERE WITH US. THERE WAS AN MD/ECONOMIST, DAVID MELTZER, WHO CAME LAST MONDAY AND WILL BE WITH US FOR TWO YEARS WORKING TO HELP TO FIND AND CONSTRUCT BIOMEDICAL WORK FORCE MODELS. I PARTICULARLY PUT THIS SECOND BULLET UP HERE BECAUSE AT OUR LAST MEETING IN JUNE THERE WAS A WHOLE DISCUSSION ABOUT BEING ABLE TO LINK THE AMERICAN BOARD OF MEDICAL SPECIALTIES WITH OUR ADMINISTRATIVE DATABASE. I THINK WE CAN SAY WE HAVE FOUND A WAY, I HAVEN'T RUN THE DATA, BUT NOW I HAVE THE AGREEMENT WHETHER WE CAN MAKE THAT WORK, SO, DAVID, PUT THAT IN MY PLUS COLUMN. THERE WE GO. WE'VE CREATED THE IMPLEMENTATION GROUP SO WE PUT TOGETHER SENIOR LEVEL FOLKS FROM MANY RELEVANT ICs, WORKINCE SEPTEMBER TO DEVELOP RECOMMENDATIONS, EACH OF THOSE MEMBERS FORMED SUBGROUPS AROUND SEVEN OF THE EIGHT RECOMMENDATIONS. RECOMMENDATION THREE IS A DIFFERENTIALAL PAY LINE, THAT DIDN'T REQUIRE AN INVESTIGATIONAL ITEM. YOU'LL SEE THE PRELIMINARY RECOMMENDATIONS FROM THE COMMITTEE, HOPEFULLY DEPENDING ON ENTHUSIASM DR. COLLINS WILL THINK ABOUT THAT. WHEN WE LOOK AT THE TYPE OF THINGS THE REPORT TALKED ABOUT THEY FELL IN THREE BUCKETS. WE'RE GOING TO TALK ABOUT THEM IN THOSE BUCKETS. RECOGNIZING FROM MULTIPLE ACD COMMITTEES THERE'S A HUGE DATA GAP, I THINK WE CAN GO TO THE LAST DISCUSSION, TO TALK ABOUT WHAT WE KNOW AND WHAT WE DON'T KNOW, AND FOLLOWING UPON RECOMMENDATION FROM DR. COLLINS AT THE JUNE MEETING, WE'LL REALLY START TO THINK ABOUT HOW WE WOULD FORMULATE A DATA WORK GROUP WHICH WE'RE ENVISIONING AS A VIRTUAL COMMITTEE OF EXPERTS IN DATA COLLECTION, WORK FORCE ISSUES, ANALYSIS, ET CETERA, I WON'T USE THE WORD ADVISORY BECAUSE THAT HAS IMPLICATIONS THAT WE WOULD BE ABLE TO USE FROM OUTSIDE NIH BUT IN YOUR REALM TO HELP US THINK ABOUT THE KINDS OF DATA WE ARE MISSING, THE KINDS OF DATA THAT WE WOULD LIKE OTHER PEOPLE TO GATHER THAT WE COULD USE, THE KINDS OF WAYS WE COULD LOOK AT THE DATA WE HAVE, AND HELP INFORM ISSUES AROUND WORK FORCE, AND SO WE'RE SORT OF FORMULATING AN IDEA OF HOW THAT WOULD BE, WHO WE WOULD INVITE TO PARTICIPATE AND HOW WE COULD UTILIZE THEM MOST EFFICIENTLY. WE TALKED IN THE LAST MEETING ABOUT CREATING A DASHBOARD TO LOOK AT THE KINDS OF THINGS THAT YOU SEE HERE. AND IF ALL GOES WELL -- >> I DON'T THINK YOU'RE ON THE LINE. >> OH, SORRY. THAT MIGHT BE WHY. SO WE'VE GOT A MOCKUP OF WHAT THIS WOULD LOOK LIKE, SO WHAT YOU CAN SEE HERE IS THIS IS A DASHBOARD THAT YOU ALL WOULD CREATE YOURSELVES, FOR INFORMATION THAT YOU WOULD LIKE TO LOOK AT, AND SO THERE ARE TWO PARTS TO THIS THAT ARE LIVE, BASED ON DATA FROM OUR DATA BOOK. SO THE Ph.D. AND MDs ARE LIVE DATA. SAY YOU WANT TO LOOK AT MDs FROM LET'S SAY 2008 TO 2012, YOU HAVE THE INFORMATION, THE APPLICATION RATE, THE AWARD RATE NUMBER OF APPLICATIONS, AWARD RATE, YOU WOULD HAVE THAT INFORMATION IN A VARIETY OF WAYS, GRAPHICALLY REPRESENTED, YOU COULD EXPORT IT TO EXCEL, TO WORD, POWERPOINT. EVENTUALLY THESE COLUMNS WILL BE WITH LIVE DATA, AND OUR GOAL IS TO NOT ONLY USE THE DATA YOU NORMALLY WOULD FIND IN OUR DATA BOOK TO CONNECT WITH DATA FROM OTHER SOURCES INCLUDING, SAY, THE BUREAU OF LABOR STATISTICS WHEN YOU LOOK AT THE BIOMEDICAL WORK FORCE. THIS IS A MOCKUP. YOU WOULD BE ABLE TO COLLAPSE, YOU WOULD BE ABLE TO MOVE, AND CREATE A DATA DASHBOARD THAT'S TAILORED FOR THE THINGS YOU'RE INTERESTED IN, WHETHER THAT'S PSW, Ph.D.s, ET CETERA, ET CETERA. SO I'M HOPING THAT OVER THE NEXT FEW MONTHS THAT WE'LL ACTUALLY HAVE A MORE LIVE ACTIVITY FOR YOU TO LOOK AT, BUT THAT'S THE MOCKUP OF WHAT IT'S GOING TO LOOK LIKE. AND IT WILL BE SOMETHING THAT WILL BE OUTWARDLY AND INWARD FACING SO YOU AT HOME CAN LOOK AT A NUMBER OF THOSE PIECES OF INFORMATION. ALL RIGHT. IS THAT ONE ON? >> NUMBER 7. >> YEAH, NUMBER 7. >> OH, 7. THERE WE GO. SO WE TALK ABOUT FACILITATING TRAINING AND CAREER DEVELOPMENT OF THE PSW, WHAT WE DID WAS WE WANTED TO GET SOME INFORMATION FROM THE PUBLIC SO IF YOU REMEMBER FROM THE REPORT IT TALKED REALLY ABOUT A MODIFICATION OF WHAT WE FINALLY CALL THE K-9 REWARD. WE ISSUED AN RFI IN OCTOBER, WE HAD ABOUT 200 RESPONSES, 160-SOME FROM INDIVIDUALS, AND ABOUT 40 FROM ORGANIZATIONS. THERE WERE A FEW THEMES THAT CAME FORTH THAT REALLY THERE WAS AN OVERALL SUPPORT FOR THE IDEA THAT WE NEEDED TO LOOK AT NEW WAYS TO SEND OUR PHYSICIAN SCIENTISTS TO INDEPENDENTS IN A SIMILAR SPIRIT WE CREATED KANGAROO AWARD AND Ph.D.s WERE EMBRACING IT. THERE WERE A FEW THINGS THEY IDENTIFIED, SALARY CAP BEING TOO LOW COMPARED TO WHAT FOLKS WERE BEING PAID AT UNIVERSITIES, THAT THEY REALLY NEEDED TO HAVE SOME WAY TO ENFORCE THE PROTECTED TIME THAT THEY OFTEN SAID IT WAS WRITTEN BUT NOT ACTUALLY EXECUTED, TO PROVIDE A BRIDGE BETWEEN WHEN THEY HAVE A K 080 OR K23 AND DON'T GET IT IS THERE A WAY TO OFFER BRIDGE SUPPORT, THAT COMES OUT AS ONE OF THE TOP RECOMMENDATIONS FOR SUSTAINING PHYSICIANS IN RESEARCH. SO THAT PROBABLY IS OUR HIGHEST RECOMMENDATION THAT WE CREATE AN ACTIVITY CODE THAT WOULD BE A A BRIDGE AWARD BETWEEN THE K08 AND RO1, THE K23 AS IT IS NOW WITH AN INCREASE IN SALARY CAP WITH DOCUMENTATION FROM THE INSTITUTIONS ON HOW FOLKS ARE SPENDING THEIR TIME IN A WAY FOR THE IC SELECTIVELY TO PROVIDE BRIDGE FUNDING TO FOLKS BETWEEN K AND R. ANOTHER IS TO EXPAND THE MSTP PROGRAM, AND TO CREATE SOME OPPORTUNITY FOR INDEPENDENCE, DVM, Ph.D. PROGRAMS AT VETERINARY SCHOOLS NOT ASSOCIATED WITH CURRENT MEDICAL SCHOOLS. WE TALKED ABOUT SUSTAINING GUY COME UP FROM DUKE WHO SOME OF YOU MAY KNOW FROM THE CELEBRATION ALSO OF SCIENCE, A HIM TO TALK, WORKING WITH DUKE. TO DATE THE TRADITIONAL PATH WOULD LEAVE A GAP BETWEEN TRAINING, NO MATTER HOW YOU PUT TOGETHER YOUR MD/Ph.D. PROGRAM. HE WORKED OUT AN ARRANGEMENT WITH NIMH AND HIS INSTITUTION, DUKE, WHERE THIS IS TRAINING IS BROKEN UP WHERE HE WILL GO TO' WARDS FOR FOUR WEEKS AND GOES BACK TO HIS LAB FOUR WEEKS, SPENT A YEAR GETTING HIS LAB STOOD UP AND DID A RESIDENCY CLEARLY MORE CHOPPED UP THAN MANY OF US WOULD HAVE DONE. IT'S PROVING TO BE SUCCESSFUL. HE HAS ONE RO1 AND R21. THERE ARE THREE OTHER SCHOOLS LOOKING AT THIS, AND SO THE RECOMMENDATION IS TO LOOK AT AND PILOT NONTRADITIONAL PERHAPS TO COMBINE CLINICAL AND RESEARCH TRAINING THAT DOESN'T HAVE SUCH A LARGE GAP BETWEEN YOUR CLINICAL WORK AND RESEARCH. THE OTHER RECOMMENDATION THAT CERTAINLY CAME FROM THE RFI WAS WHAT WE ARE CALLING AN INCUBATOR OR PRE-K AWARD. I TOOK THAT OFF BECAUSE IT SOUNDED LIKE BEFORE KINDERGARTEN BUT IT'S TO GIVE FOLKS A GAP BETWEEN THEIR END OF THEIR TRAINING AND THEIR FIRST K AWARD, AND SO TO OFFER THEM PROTECTED TIME, OPPORTUNITY AND MONEY TO FINISH UP WHATEVER TRAINING THEY MIGHT NEED SPECIFICALLY AROUND RESEARCH, AND THEN TO BE ABLE TO APPLY FOR A K. ONE OF THE THINGS YOU HEARD DR. VALANTINE TALK ABOUT IN HER PRESENTATION WAS THE NRMN, SO THIS IS ACTUALLY SORT OF A COROLLARY OR SUBSET, DEPENDING ON YOUR ORIENTATION, BECAUSE THE PHYSICIANS -- SO WE DID A SMALL QUALITATIVE STUDY, LED BY THE GENTLEMAN WE SPOKE ABOUT FROM DUKE. THEY SAID THERE WASN'T A NETWORK FOR THEM TO THINK ABOUT FOLKS TO TALK TO WHEN THEY WERE JUNIOR FACULTY OR JUST STARTING OUT, AND SO THE IDEA THAT WE WOULD PERHAPS LINK TO SOMETHING THAT WAS ALREADY GOING ON IN INFRASTRUCTURE SETTING PERHAPS WITH NRMN TO MAKE INFRASTRUCTURE SO THAT FOLKS WHO ARE IN THE ASSISTANT PROFESSOR STRATA HAVE SOMEONE TO TALK TO AND MENTORS THAT CAN REACH OUT TO THEM WAS FELT TO BE A CRUCIAL AND MISSING POINT FROM THOSE UNDERREPRESENTED PHYSICIAN SCIENTISTS. I KNOW WE SPECIFICALLY TALKED ABOUT CREATING K AND RO 00 AWARDS. WHAT WE'VE DECIDED IS THAT'S NOT A PRUDENT RECOMMENDATION GIVEN THE NUMBER OF CHANGES THAT WOULD HAVE TO OCCUR TO THE K PARTS AND CONCURRENT CHANGES THAT WOULD HAVE TO HAPPEN WITH THE KO 8 AND K 23 BECAUSE SOMEONE'S NOT GOING TO JUMP OUT AND GO TO THIS AWARD. THEY HAVE TO DO SOMETHING IN BETWEEN. SO THE FIRST RECOMMENDATION WE HAD THAT OFFERS THE BRIDGE BETWEEN THE K08 AND R IS THE ONE WE WOULD RECOMMEND HIGHLY. WE TALKED ADDITIONAL INCENTIVES FOR THE PHYSICIAN SCIENTIST WORK FORCE, SO RIGHT NOW MANY OF YOU MAY NOT KNOW THE LOAN REPAYMENT PROGRAMS ARE CONGRESSIONALY MANDATED. WE'VE INITIATED A WAY TO FIND A WAY TO MODIFY LANGUAGE SO WE WOULD HAVE MORE FLEXIBILITY IN CHANGING THE UPPER LEVEL OF THE CAP BECAUSE RIGHT NOW WE'RE CONGRESSIONALLY STUCK WITH 35K. THE MANDATED PROGRAMS ARE FOR PHYSICIAN SCIENTISTS, FOLKS WHO TOUCH HUMANS, HAVE INTERACTION WITH HUMAN AND DEDICATE 50% OF TIME IN A NONPROFIT ENVIRONMENT TO DO SO BUT THAT LEAVES OUT COLLEAGUES IN VETERINARY SCIENCE WHO MAY BE DOING BIOMEDICAL RESEARCH AND THEY WOULD BE INELIGIBLE FOR LOAN REPAYMENT PROGRAM SO WE'RE SUGGESTING OUR RECOMMENDING TO CREATE A PROGRAM TO SEND ELIGIBILITY FOR VETERINARIANS WHO WOULD BE INTERESTED IN A LOAN REPAYMENT PROGRAM. WE THINK ABOUT LEVERAGING THE CURRENT NIH RESOURCES, SO WE TALK ABOUT IMPROVIN COORDINATION OUTREACH AND COMMUNICATION OF OUR DUAL DEGREE PROGRAM, WE HEARD THAT THERE WAS A LOT OF SUPPORT. WE SAW THE FOLKS WHO WERE IN THOSE PROGRAMS ARE SUCCESSFUL, AND SO THE IDEA WOULD BE TO CREATE A TRANS-NIH COORDINATING GROUP FOR DUAL DEGREE TRAINING, EMPHASIZING THAT. I THINK WITH THE MOST RECENT NCATS FOAs THERE HAVE BEEN A SIGNIFICANT NUMBER OF CHANGES TO THE PROGRAM, SPECIF AROUND TRAINING, SO IN OUR ORIGINAL REPORT WE TALKED ABOUT INCLUSION OF ENTIRE PHYSICIAN SCIENTIST WORK FORCE, MD, Ph.D., VETERINARIANS, NPS INTO THE EXISTING NCATS PROGRAMS. AND HOW DO WE DISSEMINATE THAT SO IF YOU'RE NOT NCATS PROGRAM AND HAVE OPPORTUNITY TO DO THOSE TYPES OF PROGRAMS IN YOUR OWN INSTITUTIONS, ARE THEY TRANSLATABLE, ABLE, ET CETERA. THOSE DISCUSSIONS AND THOSE PLANS ARE KIND OF WHERE WE'RE THINKING THAT WE WOULD LIKE TO BE . I ORIGINALLY WROTE THIS TALK, I WAS FOLLOWING DR. VALANTINE SO IF YOU THINK BACK ONE TALK AGO YOU HEARD HER SPECIFICALLY TALK ABOUT THE DEVELOPMENT OF A STRATEGIC PLAN, AND I THINK OUR COMPONENT WOULD BE TO THINK ABOUT IN THIS CONTEXT OF DIVERSITY AND PHYSICIAN SCIENTISTS WORK FORCE TO THINK ABOUT THE UNDERREPRESENTED AND INTEGRATING INTO THE PLANS IN GENERAL. AND FINALLY TO THINK ABOUT ALL THE IMPLEMENTATION ACTIVITIES THAT WE'RE DOING, ANALYSIS, DASHBOARD, PILOT PROGRAM, THAT WE LOOK AT THE SORT OF UNIQUE NEEDS OF UNDERREPRESENTED PHYSICIAN SCIENTISTS, THINK ABOUT THEIR BARRIERS AND CHALLENGES AND UNDERSTAND SUCCESSFUL STRATEGIES THAT WOULD LEAD TO THE INCREASING DIVERSITY. THE COMMITTEE HAS NOT FINALIZED , THE COMPONENT PARTICULARLY OF MID-CAREER THAT WE HAVEN'T ACTUALLY TACKLED. SO THE POINT EARLIER, I DIDN'T PLANT THAT QUESTION FROM HERE, WE'RE AWARE THERE'S THIS GAP FOR MID-CAREER FOLKS AND HOW DO WE ADDRESS THAT FOR THE PHYSICIAN SCIENTIST, SOMETHING WE HAVEN'T GOTTEN TO WITH OUR IMPLEMENTATION COMMITTEE BUT IT IS ON OUR THINKING. AND THEN OUR NEXT PLAN IS TO SORT OF ASSESS YOUR ENTHUSIASM FOR MANY OF THESE, CREATE A MORE SOLID IMPLEMENTATION PLAN AND ALIGN IT WITH RESOURCES IN THE TIME LINES. OH, I DID IT. >> WE HAVE A FEW MINUTES TO TALK ABOUT SOME OF YOUR IMPRESSIONS AND THEN WE'LL GO ON AND WE'LL START DOWN WITH CATO AND COME BACK AROUND. >> OH, THANK. YOU MENTIONED NURSE, DOCTORATE, BUT NOT WITH RESPECT TO LOAN REPAYMENT PROGRAM. >> THEY ARE ALREADY ELIGIBLE AND THEY PARTICIPATE AND THEY ARE SUCCESSFUL. IT'S NOT A PROBLEM BECAUSE MOST OF THEIR INTERACTIONS ARE ALL WITH PATIENTS SO IT'S USUALLY NOT A PROBLEM. >> THANKS FOR THE REPORT. TWO THINGS. ONE IS OUR TRANSLATIONAL SCIENCE INSTITUTE AT U-CONN HAS STARTED TWO PROGRAMS THAT YOU'RE THINKING ABOUT. ONE IS WE'VE CREATED THE M-1 AWARD, MENTORING AWARD, AWARD FOR MENTORING, PROVIDED PROTECTED TIME FOR INDIVIDUALS FOR MENTORING ARE UNDERREPRESENTED PHYSICIANS, SCIENTISTS, THROUGHOUT THE UNIVERSITY. WE HAVE THREE OF THESE M-1 MENTORS ACROSS THE CAMPUS AND UNIVERSITY. THEY SPEND TIME WITH SENIOR PEOPLE AND PART OF THEIR TIME WITH JUNIOR, GRADUATE STUDENTS AND FELLOWS IN TERMS OF MENTORING, THE PIPELINE. SO WE CAN GIVE YOU THE INFORMATION BUT WE'RE HOPING IT MIGHT BECOME AN NIH AWARD, LIKE A K AWARD, IN TERMS OF MENTORING FOR UNDERREPRESENTED MINORITIES, IT'S WORKED WELL IN THE ITEMS OF THE FIRST TWO YEARS. >> THAT'S IMPORTANT TO WORK THAT INTO OUR WORK THAT WE'RE DOING NETWORK. >> THE SECOND PROGRAM IS THAT WE HAVE -- WE ACTUALLY DID INSTITUTE A PRE-K PROGRAM, SO WE ARE IN OUR THIRD YEAR OF THE PRE-K AWARD. AND PEOPLE DON'T MIND BEING CALLED PRE-K WHEN YOU GIVE THEM A LOT OF MONEY. [ LAUGHTER ] AND SO BECAUSE, AGAIN, IN TERMS OF OUR UNIVERSITY, IT'S SMALL IN TERMS OF NUMBER OF K ELIGIBLE INVESTIGATORS, IT'S BEEN A CRITICISM. WE SAID FINE, WE'LL BUILD OUR CADRE OF INDIVIDUALS WHO WILL HAVE A K AWARD AND THEY ARE PRE-K, A SMALLER AMOUNT OF MONEY BUT THEY DO HAVE DEDICATED PROTECTED TIME FOR THEIR RESEARCH AND THE PLAN IS THAT WITHIN TWO YEARS THEY ARE ACTUALLY ELIGIBLE TO APPLY FOR A K AWARD. >> I THINK NINDS HAS A PRE-K PROGRAM AS WELL. THAT'S MY PERSONAL BIAS. I THINK WE HEARD FROM THE RFI THAT WAS AN IMPORTANT COMPONENT. SO IT'S INTERESTING. YOU'RE NOT FUNDED BY NINDS, BY CHANCE, ARE YOU? >> NO. >> OKAY. BUT YOU COULD BE. GREAT. OTHER THOUGHTS, COMMENTS? MOST OF YOU ARE HERE TO HEAR THE INTRAMURAL STORY. [LOW AUDIO] >> IT'S STILL EARLY, AND IT'S GOING TO BE A WHILE BEFORE WE CAN REALLY SEE THE FRUITS OF ALL THIS, BUT I'M MOST ENCOURED BY THE ISSUES, TO ME, THAT WE FOLKS AREN'T GATHERING GOOD DATA. THAT WAS OUR MOST IMPORTANT AND MAYBE AT SOME LEVEL DISAPPOINTING FINDINGS OF OUR WORKING GROUP THAT WE JUST DIDN'T HAVE THE DATA WE NEEDED TO ANSWER THE QUESTION, AND SOME OF THESE THINGS IN PARTICULAR, THIS ISSUE OF MESHING, SO WE'LL KNOW PHYSICIAN SCIENTISTS IN RESEARCH, WHAT AREAS ARE THEY, ARE THEY BO ARD CERTIFIED, MAINTAINING CERTIFICATION, THINGS THAT ARE REALLY IMPORTANT TO KNOW. >> I THINK OUR INITIAL ONE WILL BE POINT PREVALENCE, AND IDEAS TO LOOK AT TRENDS OVER TIME. >> RIGHT. AND THEN THE DASHBOARD TO OPEN THIS UP FOR OTHER PEOPLE TO BE ABLE TO QUERY THE DATA. >> SOME OF THAT IS IN THE DATA BOOK, HONESTLY YOU COULD SEE IT NOW. IT JUST DOESN'T LOOK AT PRETTY. >> THAT AND EVENTUALLY SOME OF THESE OTHER DATA SETS BECOME ACCESSIBLE, HOPEFULLY PEOPLE WHO DO THIS KIND OF RESEARCH -- >> THAT'S OUR GOAL TO MAKE IT AS TRANSPARENT AS WE CAN. >> THAT WILL HELP INFORM WHAT WE OUGHT TO BE DOING IN THE FUTURE IN TERMS OF SPECIFIC PROGRAM, SHOULD MSTP GROW OR SHRINK. >> WE'RE HAVING A LARGER EFFORT ACROSS NIH REGARDING WAYS TO BUILD PLATFORMS TO BRING DATA TOGETHER FOR PURPOSES INCLUDING LOOKING AT HOW WE VIEW OUTCOMESES AND ACCOMPLISHMENTS. SHERRY AND MISTY HAVE HAD TO GET ACCESS, IT'S NOT ALWAYS EASY, THEY ARE NOT ALWAYS AGREEABLE TO SHARE DATA. SO GREAT JOB, GUYS, BECAUSE IT'S BEEN PARTICULARLY DIFFICULT IN SOME CASES. >> I LEARNED ABOUT THAT FROM OUR WORKING GROUP, FOR SURE. >> THANK YOU. >> THAT'S CLEARLY AN ISSUE. >> I JUST WANT TO COMMEND THE GROUP. IT'S REALLY DIFFICULT, THE TOPIC. I CAN'T HELP BUT THINKING WE'RE MERGING INTO A DIFFERENT MODEL ALTOGETHER AND IT'S NOT GOING TO BE A MATTER OF HOW WE HOLD ON TO AN OLD MODEL, AND IT'S DIFFERENT THAN THE CONVERSATION WE HAD IN THE PREVIOUS ITERATION TALKING ABOUT THE NEED TO MAKE SURE THERE'S NO IMPEDIMENTS TO CERTAIN GROUPS THAT HAVE MAYBE HISTORICALLY ENCOUNTERED IMPEDIMENTS. THIS ISN'T ABOUT SAVING THE PHYSICIAN SCIENTIST, IT'S ABOUT TRYING TO UNDERSTAND THE PLACE OF THE PHYSICIAN SCIENTIST IN THE FUTURE. ROGER BANISTER BROKE THE FOUR-MINUTE MILE, HE WAS A MEDICAL STUDENT. YOU CAN'T BE THE FASTEST HUMAN IN THE WORLD NOW UNLESS IT'S A FULL-TIME JOB. THE WORLD HAS CHANGED TO COMPETE IN SCIENCE NOW, IT REQUIRES A LOT DIFFERENT LEVEL OF FOCUS, AND ATTENTION NOW THAN I THINK IT DID IN THE BEGINNING, AND ON THE CLINICAL SIDE, KEEPING UP WITH THE ELECTRONIC HEALTH RECORD, YOU'RE GOING TO COME ON AWARDS FOR A COUPLE WEEKS A YEAR AND TRY TO HAVE FACILITY, LET ALONE CONTINUING OBLIGATIONS IN REQUIRINGMENTS THAT ARE BEING PLACED ON US WITH REGARD TO MEASUREMENT AND QUALITY WHICH IS TRYING TO MAKE THE CLINICAL SIDE AS PROFESSIONAL ALSO, AND I'M SEGUEING NOT INTO SOMETHING DEPRESSING BUT THINKING BUT TEAM SCIENCE AND FOSTERING TEAM SCIENCE WHERE THERE IS SOMETHING VERY IMPORTANT AND INTEGRAL A PHYSICIAN SCIENTIST CAN CONTRIBUTE. HOW DO WE BUILD TEAMS SO PEOPLE HAVE ROLES WHERE THEY CAN NOT BE MASCOTS ON THE TEAM BUT ACTUALLY BE INTEGRAL CONTRIBUTORS TO THE TEAM IN WAYS THAT ARE GOING TO MAKE SENSE IN THE 21st CENTURY WHERE THE PRESSURES ARE COMING IN A LOT OF WAYS AND WE DON'T WANT PEOPLE TO FEEL LIKE MY LIFE IS UNTENABLE BUT THERE'S A WAY FOR ME TO PARTICIPATE IN SOMETHING THAT'S IMPORTANT TO ME AND STILL MAINTAIN A PRESENCE IN A PLACE THAT ALLOWS ME TO BRING THAT PERSPECTIVE BACK TO THE TEAM. I THINK ULTIMATELY WE'LL NEED TO BE THINKING ABOUT HOW THAT WORKS TOO, NOT JUST SINGULAR RO1s PROGRESS BUT AS A TEAM. >> THAT WAS A DISCUSSION ON OUR COMMITTEE AND THEN WITH THE IMPLEMENTATION GROUP AND NOW WITH ECONOMICS GROUP TO THINK ABOUT HOW MODELING A WORK FORCE PER SE. >> I'LL TALK OFFLINE ABOUT THAT. IT WAS A BIG TOPIC YOU WOULD HAVE ENJOYED SOME OF THESE DISCUSSIONS BUT ONE OF THE BIG ISSUES, YOU KNOW, SORT OF ABOUT WHERE THE PHYSICIAN SCIENTIST TS IN THIS IS AS A BILINGUAL PERSON, HAVING GROUPS OF SCIENTISTS TOGETHER, GROUPS OF PHYSICIANS TOGETHER WHO DON'T SPEAK THE SAME LANGUAGE, WHICH IS WHAT A LOT OF TEAMS END UP BEING, AND HAVING DUALLY EDUCATED FULLY BILINGUAL PEOPLE IS THE GROUP WE'RE CONCERNED ABOUT BUT I'LL TALK MORE OFFLINE. >> OKAY, GREAT. >> THANK YOU VERY MUCH. AND THANK YOU FOR COMPRESSING YOUR PRESENTATION. [APPLAUSE] TO MAKE IT POSSIBLE FOR US TO GET BACK ON TIME. SO WE ARE NOW GOING TO CURRAN TO A REPORT FROM THE WORKING GROUP ON THE INTRAMURAL RESEARCH PROGRAM, AND CATO LAURENCIN, WHO CO-CHAIRED THIS WITH LARRY TABAK, IS GOING TO GIVE THE PRESENTATION. JUST A LITTLE BIT OF BACKGROUND HERE. MOST OF YOU KNOW THAT NIH HAS MAINTAINED A ROBUST INTRAMURAL RESEARCH PROGRAM, OVER DECADES, IT CONDUCTS A WIDE VARIETY OF MEDICAL RESEARCH TO ADVANCE UNDERSTANDING OF BIOLOGY AND HUMAN DISEASE, YOU HEARD THIS MORNING FROM TONY FAUCI HOW THAT PLAYED OUT IN A SPECIFIC WAY IN TERMS OF DEVELOPMENT IN TESTING AN EBOLA VACCINE BUT THERE'S AN ARRAY FROM BASIC SCIENCE TO CLINICAL TRIALS AND EVERYTHING IN BETWEEN. INTRAMURAL HAS A LONG TRADITION THROUGHOUT THE CAREER PATHWAY, AT VARIOUS LEVELS, PARTICULARLY PHYSICIAN-SCIENTISTS. THERE HAVE BEEN REVIEWS OF THE INTRAMURAL PROGRAM OVER THE COURSE OF YEARS, AND CATO WILL REMIND YOU WHAT SOME OF THOSE HAVE BEEN BECAUSE THEY HAVE INFORMED THIS EFFORT, BUT IT'S BEEN QUITE A WHILE. THE LAST ONE WHICH WAS UNDERTAKEN BY IOM TO REVIEW THE ENTIRE NIH ORGANIZATIONAL STRUCTURE WAS COMPLETED IN 2003. AND THE LAST ONE FOCUSED SOLELY ON THE INTRAMURAL PROGRAM THAT FAMOUS MARKS CASSELL REPORT IN 1994, EXACTLY 20 YEARS AGO. SO LOOKING AT THE CURRENT CIRCUMSTANCE AND RECOGNIZING SCIENCE IS MOVING QUICKLY, THAT BUDGETARY CONSTRAINTS ARE MAKING EVERYTHING THAT WE DO SOMEWHAT STRESSFUL, AND THAT THEREFORE WE HAVE TO LOOK CAREFULLY AT HOW WE SPEND OUR RESOURCES, I DID IN AUGUST ASSEMBLE AND CHARGE THIS WORKING GROUP TO EXAMINE THE INTRAMURAL PROGRAM IN AN EFFORT TO GUIDE ITS LONG-TERM PLANNING GOALS. AND BASICALLY TO TRY TO THINK TEN YEARS INTO THE FUTURE, WHAT DO WE WANT THIS INTRAMURAL PROGRAM TO LOOK LIKE? SO I ASKED THEM TO IDENTIFY AREAS OF OPPORTUNITY, TO RECOMMEND HOW TO ENHANCE THE UNIQUENESS OF THE INTRAMURAL PROGRAM AND EVALUATE THE SUSTAINABILITY OF THE CURRENT APPROACHES AND OVERALL GUIDE A FUTURE VISION. CATO AND LARRY SKILLFULLY CHAIRED THIS WORKING GROUP, BUT THIS IS ONLY A FOUR-MONTH EFFORT WITH A VERY LARGE TASK, SO MUCH CREDIT TO THEM FOR ROLLING UP THEIR SLEEVES AND TACKLING THIS IN SUCH A SHORT PERIOD OF TIME. I WANT TO THANK THEM AND THE WORKING GROUP MEMBERS FOR THIS EFFORT AND I THINK THIS IS GOING TO LEAD TO A LOT OF INTERESTING DISCUSSION, SO ALTHOUGH WE'RE LATE IN THE DAY I HOPE IT'S NOT LATE IN YOUR BRAIN BECAUSE WE REALLY HOPE TO HAVE FULL ENGAGEMENT HERE OF THE ACD ON CATO'S PRESENTATION. CATO NEEDS NO PRODUCTION TO THIS COMMITTEE, YOU KNOW HIM WELL RIGHT NOW, I REMIND YOU HE'S THE DISTINGUISHED PROFESSOR OF ORTHOPEDIC SURGERY AND CHEMICAL AND BIOMOLECULAR MATERIAL AND MATERIAL SCIENCE AT THE UNIVERSITY OF CONNECTICUT. AND ALSO SERVES AS DIRECTOR OF THE INSTITUTE FOR REGENERATIVE INSTITUTION AND CEO OF THE INSTITUTION FOR CLINICAL SCIENCE, HE HAS A LOT OF HATS AND WE ASKED HIM TO WEAR A CHALLENGING ONE AS PART OF THIS. CATO, THANK YOU FOR THE WAY IN WHICH YOU HAVE CO-LED THIS EFFORT AND I TURN IT OVER TO YOU. >> GREAT, THANK YOU. FIRST, FRANCIS, I WANT TO THANK YOU FOR APOINTING ME TO BE A CO-CHAIR. IT WAS A GREAT EXPERIENCE AND WORKING WITH THE WORKING GROUP COMMITTEE WAS JUST A PHENOMENAL TIME. I WANT TO THANK YOU, THANK MY CO-CHAIR, DR. LARRY TABAK, WORKING WITH LARRY WAS GREAT. IT WAS A FOUR-MONTH EXPERIENCE BUT WE WERE TALKING ALMOST EVERY OTHER DAY, IT WAS A GREAT EXPERIENCE TO GET TO KNOW HIM. I ALSO WANT TO PUT MY ACKNOWLEDGEMENT AT THE FRONT OF MY TALK, AGAIN THE WORKING GROUP MEMBERS, THE OFFICE OF INTRAMURAL RESEARCH, WE ASKED FOR A LOT OF INFORMATION FROM THEM OVER THE COURSE OF FOUR MONTHS AND THEY WERE VERY GOOD. THE IC DIRECTORS, WE HAD A COUPLE MEETINGS WITH IC DIRECTOR PROVIDING GREAT INFORMATION. I'D LIKE TO ALSO GIVE A SPECIAL MENTION AND SHOUT OUT TO THOSE WHO WORKED TIRELESSLY IN DR. TABAK'S OFFICE, IT'S REMARKABLE WE WOULD E-MAIL AT MIDNIGHT, THEY WOULD E-MAIL BACK AT 1:00 A.M., AND ALSO OTHER ANY STAFF WHO WERE IMPORTANT IN TERMS OF WORKING WITH US. I WANT TO THANK THE FELLOW WORKING GROUP MEMBERS, CHARGED TO BEGIN OVER REALLY A RELATIVELY SHORT PERIOD OF TIME AND THEY REALLY RESPONDED WITH A NUMBER OF MEETINGS, AND PROVIDED A LOT OF CRITICAL INPUT IN MOVING THE AREAS FORWARD. THE BACKGROUND, WE WERE PROVIDED A NUMBER OF REPORTS FROM THE PAST BUT IN TERMS OF THE INTRAMURAL PROGRAM THERE HAVE BEEN ACTUALLY VERY FEW REPORTS FOCUSED ON THE INTRAMURAL PROGRAM, IN 1988 THERE WAS INSTITUTE OF MEDICINE REPORT, 1994 A MARKS CASSELL REPORT SO IT'S BEEN 20 YEARS. WE WERE HAPPY TO SEE IN THESE REPORTS, THE RECOMMENDATIONS THAT WERE SET FORTH ALMOST TO THE LETTER A NUMBER OF THESE RECOMMENDATIONS WERE FOLLOWED AND SO I THINK IT REALLY HELPED CHARGE AND EXCITE THE WORKING GROUP IN TERMS OF MOVING FORWARD. WE ALSO HAD ADDITIONAL REPORTS, IOM REVIEW OF THE NIH ORGANIZATIONAL STRUCTURE IN 2003, REPORT ON CLINICAL RESEARCH, BLUE RIBBON REPORT IN 2004 AND REVIEW OF THE CLINICAL RESEARCH CENTER FROM 2010 THAT HELPED INFORM US IN TERMS OF A NUMBER OF ISSUES WE WERE ABOUT TO TAKE ON. JUST TO REVIEW, DR. COLINS GAVE THE CHARGE TO THE WORKING GROUP ON AUGUST 1 OF THIS YEAR. AND THE CHARGE IT TO RECOMMEND HOW THE INTRAMURAL RESEARCH PROGRAM, I'LL CALL IT THE IRP, THE ROLE IN MOVING FORWARD DIFFERING FROM THE EXTRAMURAL RESEARCH INSTITUTIONS AND THE COMPONENTS OF THE IRP AND COMPONENTS THAT SHOULD BE MODIFIED, ARTICULATE POTENTIAL BARRIERS, DEFINE WHAT CHANGES ARE NEEDED OR SHOULD BE AVOIDED TO ACHIEVE THE VISION, THE SECOND AREA TO EXAMINE THE AREAS OF OPPORTUNITY TO FOCUS ON THE NEXT TEN YEARS TO TAKE ADVANTAGE OF THE IRP'S DISTINCTIVE FEATURES. IDENTIFY STEPS TO ENSURE THE SUSTAINABILITY OF THE IRP'S FEATURES INCLUDING THE CLINICAL RESEARCH CENTER AND MAKE SURE OUR RECOMMENDATIONS WERE ALIGNING WITH THE OTHER WORK GROUPS CURRENTLY WORKING WITH THE ACD. SO WE ACTUALLY HAD FIVE MEETINGS DURING THIS PERIOD FROM AUGUST TO NOW, THREE TELECONFERENCES, TWO FACE TO FACE MEETINGS. WE HAD TWO CAMPUS SITE VISITS WE THOUGHT WAS IMPORTANT TO ENGAGE THE INTRAMURAL COMMUNITY AND SO A SUBSET OF THE WORKING GROUP ACTUALLY CAME TO NIH, MET WITH A NUMBER OF THE ICs AND MET WITH A NUMBER OF THE INTRAMURAL INVESTIGATORS. AGAIN, WE HAD OUR BACKGROUND MATERIALS THAT WE HAVE BUT WE RECEIVED A SYNTHESIS REPORT FROM THAT CAME THROUGH THE I.T. DIRECTORS AND WORKING GROUP REPORTS WE COULD REFER TO SO WE WOULD BE APPRISED OF OTHER AREAS THAT THE ACD WAS WORKING ON. SO WHAT WE FOUND WAS THERE WERE A NUMBER OF DISTINCTIVE FEATURES OF THE INTRAMURAL RESEARCH PROGRAM, AND I THINK I SHOULD PREFACE MY REMARKS BY SAYING THE WORKING GROUP BELIEVES THE INTRAMURAL PROGRAM IS A TREASURE OF OUR COUNTRY. IT'S AN EXTREMELY IMPORTANT AND VALUABLE RESOURCE AND THE LARGEST BIOMEDICAL SCIENCE ENTERPRISE IN THE COUNTRY, PERHAPS IN THE WORLD, AND WE WERE HIGHLY IMPRESSED BY WHAT WE SAW. THE DISTINCTIVE FEATURES THAT WE POINTED OUT IN THE REPORT WERE THE RIGOROUS AND MAINLY RETROSPECTIVE PEER REVIEW PROCESS. THE FACT IT WAS REALLY A VERY ESTABLISHED AND STABLE INFRASTRUCTURE FOR SO MANY YEARS, THE LARGE CADRE OF PIs AND FOCUS ON RESEARCH AND MENTORING THAT WAS EXCELLENT. THE FACT THAT IT'S A REALLY STILL A LARGE TRAINING GROUND, POPULATION FOR TRAINEES AT A NUMBER OF LEVELS AND CLINICAL RESEARCH CENTER, A GREAT RESOURCE, THE LARGEST HOSPITAL FOR CLINICAL RESEARCH IN THE COUNTRY, PERHAPS IN THE WORLD. THESE ARE THE ISSUES AND CHALLENGES. THE ISSUES THAT WE WERE TACKLING WERE IN THE AREAS OF RESEARCH, AREAS OF WORK FORCE, AREAS OF TRAINING, AND AREAS OF INFRASTRUCTURE. WE HAD SOME OTHER ADMINISTRATIVE CONCERNS WE TALKED ABOUT THAT ARE NOT RECOMMENDATIONS BUT THOSE WERE THE FOUR MAIN AREAS THAT WE CONCENTRATED IN TERMS OF OUR DISCUSSION. IN THE AREA OF RESEARCH THERE WAS A QUESTION ABOUT THE STANDING OF THE INTRAMURAL RESEARCH PROGRAM, AND I THINK IT WAS THE FEELING OF THE WORKING GROUP THAT THE STANDING OF THE IRP OVER THE LAST 20 TO 30 YEARS HAS DECREASED IN A NUMBER OF AREAS AND WAYS. THERE WAS AN IMPRESSION THAT THE IRP EXISTED AND WORKED IN ISOLATION WITH THE SCIENTIFIC COMMUNITY AND WAS SILOED FROM THE SCIENTIFIC COMMUNITY ACROSS THE ICs AND ALSO WITHIN THE EXTRAMURAL COMMUNITY. AND IT WAS ALSO THE FEELING OF THE WORKING GROUP THAT THERE WASN'T THE FULL AMOUNT OF INCLUDING THE CRC. THOSE WERE THE ISSUES ON THE RESEARCH SIDE. RECOMMENDATIONS FOLLOW FROM THAT. THE FIRST RECOMMENDATION WAS THAT THE IRP SHOULD FOCUS ON GREAT SCIENTIFIC CHALLENGES AND THERE SHOULD BE A STANDING COMMITTEE OF THE IRP AND OUTSIDE EXPERTS THAT WOULD ADVISE THE NIH DIRECTOR ON IMPORTANT FUTURE RESEARCH AREAS OF CHALLENGES. THE IRP HAS THE ABILITY TO BE ABLE TO, BECAUSE IT IS SO BROAD IN TERMS OF ITS AREA OF SCIENCE AND SO DEEP, CAN IDENTIFY GREAT IC CHALLENGES AND TAKE AS A FOLLOW ON TO THAT, THE CONCEPT OF BOLSTERING SUPPORT FOR INNOVATIVE RESEARCH SHOULD BE SOMETHING THE IRP IS INVOLVED IN. WE PROPOSE TO BE ESTABLISHED WAS THE TRANS-NIH INNOVATION FUND, PERHAPS RESEARCHING APPROXIMATELY 1% OF THE IRP'S BUDGET TO FUND AND ADDRESS THESE GREAT SCIENTIFIC CHALLENGES THAT WE TALKED ABOUT. WE BELIEVE THERE SHOULD BE A COMPETITIVE APPLICATION PROCESS OVERSEEN BY THE DEPUTY DIRECTOR WITH PROPOSALS FROM TEAMS IN THESE GREAT SCIENTIFIC CHALLENGES. I CALLED THESE EB HAGS, GREAT BIG SCIENTIFIC CHALLENGES THAT COULD BE EXPLOITED BY THE INTRAMURAL PROGRAM AND THE UNIQUENESS OF INTRAMURAL PROGRAM. SO THE -- WE ALSO THOUGHT THERE SHOULD BE AN ENCOURAGEMENT FOR THE FORMATION OF OPTIONAL IC-BASED INNOVATION FUND RESERVING 5% OF THE BUDGET AND COMPETITIVE APPLICATION PROCESS. WE THOUGHT IT WOULD BE GOOD FOR THE INVESTIGATORS TO BE INVOLVED IN THE COMPETITIVE PROCESS THAT'S DONE IN THE EXTRAMURAL COMMUNITY TO OBTAIN FUNDING. THE SECOND WAS ENCOURAGING INTERDISCIPLINARY AND TEAM SCIENCE. WE DIDN'T SAY THAT THE INTRAMURAL COMMUNITY COULD ONLY BE FOCUSED ON THIS BUT THERE'S A GREAT OPPORTUNITY FOR THE IRP TO WORK IN THE AREA OF TEAM SCIENCE IN COLLABORATION. WE WERE IMPRESSED WHEN WE VISITED THE PORTER BUILDING AND APPROACH TO NEUROSCIENCE, A NUMBER OF ICs ARE COLLABORATING IN THE RESEARCH, AND SO WE WOULD LIKE THE IRP TO EVALUATE THE PORTER APPROACH AND ANALYZE BENEFITS OF THE INTEGRATIVE APPROACH DETERMINING HOW THIS COULD BE EXPANDED TO OTHER FIELDS. WE ALSO THOUGHT IT WOULD BE IMPORTANT TO DEVELOP A MECHANISM TO RESPOND TO HEALTH CRISES, AND USING RECENT NIH RESPONSE TO THE EBOLA CRISIS AS A MODEL DEVELOP A TRANSIRP MECHANISMS TO PREPARE THE IRP TO BE REALLY WHAT WE CALL THE FIRST LINE OF RESEARCH FOR EMERGENT HEALTH THREATS. AGAIN, IN THINKING ARE THE IRP IN THE FUTURE, ONE OF THE GUIDING PRINCIPLES IS DOING THINGS AND ENGAGING IN WAYS AND METHODS THAT CANNOT BE ENGAGED IN THE EXTRAMURAL COMMUNITY. WE BELIEVE A MECHANISM TO RESPOND TO HEALTH CRISES QUICKLY AND WITH FORCE IS SOMETHING THAT THE IRP COULD DO. WE THOUGHT IT WAS IMPORTANT TO EXPAND THE INTERACTIONS, AND TO REVIEW THE CURRENT IRP EXTRAMURAL PARTNERSHIPS THROUGH THE CRADAs AND UO1S AND EXPANDING THE VISITING SCIENTIST PROGRAM THAT'S CURRENTLY IN PLACE AND ALSO CREATING EVEN THINKING ABOUT NEW MECHANISMS TO COMBINE INTRAMURAL FUNDS AND EXTRAMURAL FUNDS TO BE ABLE TO SUPPRT COLLABORATIONS AND GRANTS CAN HARNESS THE INTRAMURAL INFRASTRUCTURE FOR THE PROJECTS TO TAKE PLACE. WE'VE THOUGHT HOSTING FOUR TO SI ANNUAL SCIENTIFIC MEETINGS AT NIH, HIGH PROFILE, WOULD BE IMPORTANT FOR A NUMBER OF REASONS. FIRST, ONE COULD PARTNER WITH ASSOCIATIONS AND SOCIETIES TO ADDRESS THESE GREAT SCIENTIFIC CHALLENGES THAT ARE TAKING PLACE THAT WE TALKED ABOUT BEFORE IN TERMS OF LOOKING AT NEW RESEARCH INITIATIVES. SECOND, BRINGING SCIENTIST TO MEET INTRAMURAL SCIENTISTS TO LOOK AT AREAS OF SYNERGY AND COLLABORATION THAT WOULD BE IMPORTANT. AND THE RESEARCH AREA REFOCUS MISSION IN THE FUNCTIONAL RESEARCH SEARCH. TIME WAS SPENT THINKING ABOUT THE CLINICAL RESEARCH CENTER AND THE FOCUS, IT'S BEEN A GREAT FOCUS ON RARE AND UNDIAGNOSED DISEASES, WE BELIEVE THAT SHOULD CONTINUE BUT ALSO THERE ARE A NUMBER OF COMMON PUBLIC HEALTH CHALLENGES THAT ARE THERE IN TERMS OF DIABETES, HEART DISEASE, FRACTURES THAT ARE PRESENT THAT NEED TO BE EXAMINED AND THE THOUGHT WOULD BE TO THE CLINICAL RESEARCH CENTER COULD HAVE A ROLE IN ADDRESSING THEIR AREAS. EMPHASIZED WORK IN TERMS OF GENOTYPE AND PHENOTYPE CORRELATION AND IMPORTANCE OF THAT AREA AND CONTINUE TO FOCUS ON AREAS OF VACCINE DEVELOPMENT AND DRUG RESISTANCE OF PATHOGENS IN CANCER AREAS, AREAS OF STRENGTH THE CLINICAL RESEARCH CENTER HAS NOW. IN THE AREAS OF WORK FORCE, THE THOUGHT WAS THAT -- WE HAD A -- WE SPENT A GOOD AMOUNT OF TIME TALKING TO MEMBERS OF INTRAMURAL RESEARCH COMMUNITY AND EXAMINED THE NUMBERS OF INDIVIDUALS P.I.s, AND THE NUMBERS HAVE BEEN GRADUALLY DECREASING WITH A NET OF 2 TO 3% LOSS ANNUALLY WITH INCREASING NUMBER OF STAFF SCIENTISTS PRESENT. WHAT WAS MOST STRIKING WAS THE LACK OF DIVERSITY THAT WAS THERE. I THINK DURING MY ENTIRE TRIP, MY ENTIRE FOUR MONTHS OF ENGAGEMENT, I DON'T THINK I MET ONE AFRICAN-AMERICAN OR LATINO INVESTIGATOR DURING MY ENTIRE 4 1/2 MONTHS ON THIS LOOKING AND EXAMINING THE INTRAMURAL RESEARCH PROGRAM. AND THERE SEEMED TO BE A NEED FOR ALTERED REVIEW PROCESS AND DISCUSSION OF THE FLAT OR DECLINING BUDGETS IN THE CONTEXT OF INCREASING RESEARCH COSTS. THIS IS AN ISSUE NOT JUST IN TERMS OF INTRAMURAL PROGRAM BUT ALSO EXTRAMURAL PROGRAM. RECOMMENDATIONS, I WANT TO MAKE IT CLEAR WE DECIDED TO STRUCTURE THESE IN THE ORDER OF PRIORITY. THE FIRST WAS INCREASING DIVERSITY AND ADDRESSING THE ISSUE OF DIVERSITY. AND WE BELIEVE IT'S IMPORTANT TO DEVELOP NEW AND INNOVATIVE MODELS TO DIVERSIFY THE WORK FORCE AND IF IT CAN'T BE DONE IN THE INTRAMURAL PROGRAM AT NIH WITH SO MUCH CONTROL IN TERMS OF PROCESS AND YOUR ENVIRONMENT IT WON'T BE ABLE TO BE DONE ANYWHERE. THIS IS SHOULD BE THE PLACE WHERE THERE SHOULD BE NEW TEST PROGRAMS FOR SUPPORT OF THOSE FROM UNDERREPRESENTED GROUPS. THE CHIEF OFFICER, WE HEARD HER GREAT REPORT, AND A GREAT DEAL OF WORK IS TAKING PLACE BUT INDEPENDENTLY THE WORK GROUP BELIEVES THERE SHOULD BE A COMPETITIVE PROGRAM TO INCREASE THE EARLY STAGE INVESTIGATOR RECRUITMENT MENTORSHIP AND SPONSORSHIP FROM INDIVIDUALS FROM THE UNDERREPRESENTED GROUPS, THIS IS THE FIRST PRIORITY AND SHOULD BE THE FIRST PRIORITY FOR THE WORK FORCE. THE SECOND AREA RESTRUCTURING THE REVIEW PROCESS, THE BOARD OF SCIENTIFIC COUNSELORS REVIEW PROCESS. THE WORKING GROUP FELT THERE SHOULD BE A TRANS-NIH REVIEW PROCESS AND THE PI SHOULD REVIEW IT EVERY 5 TO 7 YEARS BY A MAJOR SCIENTIFIC FIELD BY INDIVIDUALS NOT ONLY IN THEIR IC BUT INDIVIDUALS OF THEIR SAME SCIENTIFIC AREA ACROSS ICs, EVEN FROM THE EXTRAMURAL COMMUNITY. ALSO SOMETIMES IF ONE IS REVIEWING AN INDIVIDUAL, THEY ARE WORK IN TEAM SCIENCE IS SHORT SHRIFTED, WE THOUGHT IT WAS IMPORTANT TO EMPHASIZE IMPORTANCE OF TEAM SCIENCE WHERE APPROPRIATE AND REWARD THOSE WORKING IN TEAM SCIENCE. WE ALSO FOCUSED IN THE AREA OF STAFF SCIENTISTS, THERE IS A GROWING NUMBER OF STAFF SCIENTISTS, MANY MORE STAFF SCIENTISTS THAN PRINCIPAL INVESTIGATORS AND NUMBERS HAVE INCREASED. THERE NEEDS TO BE A PROCESS FOR RECRUITMENT AND RETENTION, I'LL TALK ABOUT THAT IN A MOMENT. SECOND, THERE WAS A THOUGHT THAT THESE SHOULD UNDERGO A RIGOROUS REVIEW IN ADDITION TO PRINCIPAL INVESTIGATORS. THERE SHOULD BE AN EXPANSION IN PUBLICITY WITH CURRENT RECRUIT OF THE EFFORTS, CONSIDERING INCLUSION OF THE BOARD OF SCIENTIFIC COUNSELORS AND PIs AND ICs. THERE ARE WERE A NUMBER OF INCENTIVES THAT WOULD BE VERY ATTRACTIVE TO INDIVIDUALS COMING TO THE INTRAMURAL PROGRAM. ONE THE LOAN REPAYMENT PLAN. THESE INCENTIVES SHOULD BE FOCUSED ON AND DISCUSSED. FOCUS ON EARLY STAGE INDIVIDUALS IS IMPORTANT. WE WERE PARTICULARLY IMPRESSED WITH THE STEDMAN PROGRAM BRINGING HIGH QUALITY INVESTIGATORS TO THE INTRAMURAL PROGRAM THAT SHOULD CONTINUE TO BE EVALUATED AND EXPANDED. THE NEXT AREA WAS RECRUITING TO A NATIONAL AND INTERNATIONAL PROCESS. MANY ARE NOT RIGHT NOW RECRUITED THROUGH ANY PROCESS. I HAD A COLLEAGUE INTERESTED AND COULDN'T FIND A SEARCH IN HIS AREA ALTHOUGH THERE ARE A NUMBER OF STAFF SCIENTISTS BEING HIRED, AND MANY STAFF SCIENTISTS, THE MAJORITY, ARE NOT HIRED THROUGH A COMPETITIVE NATIONAL PROCESS. AGAIN, IF WE'RE THINKING ABOUT GETTING THE BEST INDIVIDUALS, NUMBER ONE, AND NUMBER TWO ABOUT A DIVERSE WORK FORCE, WE NEED TO RECRUIT THROUGH A NATIONAL AND INTERNATIONAL PROCESS. THERE WAS THOUGHT TO BE A NEED TO EXPAND THE CLINICAL INVESTIGATOR PROGRAM, INCREASE ITS PROGRAM AND VISIBILITY, WORK TOWARD TRANS-NIH RECRUITMENT SUCH AS THE LASKER PROGRAM, AND ANALYZE THE LASKER PROGRAM TO DETERMINE HOW TO IMPROVE IT. IT WAS SEEN TO BE ON PAPER A GOOD PROGRAM BUT THE NUMBER OF INVESTIGATORS HIRED OVER THE YEARS WAS CONSIDERED TO BE VERY, VERY LOW. WE TACKLED AND LOOKED AT THE CONCEPT OF THE WORK FORCE SIZE, AND WE HEARD FROM INDIVIDUALS IN THE INTRAMURAL RESEARCH PROGRAM THE WORK FORCE SIZE WAS SHRINKING, ONE SAID IT'S SO SMALL WE'RE NOT ABLE TO CARRY OUT MEANINGFUL RESEARCH HERE AT NIH, WE HAVE A THOUSAND INVESTIGATORS, MAYBE TEN TIMES THE AVERAGE MIDDLE-SIZED UNIVERSITY DOING RESEARCH, SO WE -- THERE IS A QUESTION, WHAT IS THE OPTIMAL SIZE OF THE INTRAMURAL PROGRAM? IN A FOUR-MONTH PERIOD WE WEREN'T ABLE TO DETERMT. SO THERE SHOULD BE AN EVALUATION THAT SHOULD BE MADE TO DETERMINE THE OPTICAL CRITICAL MASS NEEDED BY THE -- THAT SHOULD BE DONE BY THE INTRAMURAL RESEARCH OFFICE, ALONG WITH EXTERNAL ADVISORS TO THINK ABOUT THIS. SOME CONSIDERATIONS ARE THE -- IT'S EXAMINE THE CURRENT INVESTIGATOR COHORT BY YEARS OF SERVICE, TO LOOK AT THE WORK FORCE DYNAMICS IN SIZE, THERE'S A WORK FORCE GROUP, AN OLDER GROUP, MY DEFINITION OF OLDER CHANGES ON A DAILY BASIS, A GROUP OF INDIVIDUALS THAT'S MOVING THROUGH THE PIPELINE OF AGE AND SO MODELING WHAT THE INTRAMURAL PROGRAM WILL LOOK LIKE IN 5, 10, 15 YEARS IS IMPORTANT IN TERMS OF WORK FORCE DYNAMICS, IDENTIFY OPTIMAL DISTRIBUTION OF I.T. SUPPORT LOOKING AT THE SCIENTIFIC AREAS BEING COVERED BY EXTRAMURAL RESEARCH VERSUS INTRAMURAL PORTFOLIOS AND EXPERTISE AND LOOK AT STRENGTH AND WEAKNESS IN TERMS OF WHAT'S BEEN CONDUCTED BY THE INTRAMURAL PROGRAM OVER THE YEARS AND WORK TO EMPHASIZE THOSE AREAS OF STRENGTH. AND REALLY DETERMINE WHAT'S THAT RATIO OF BASIC TRANSLATIONAL AND POPULATION BASED RESEARCH CONSTRUCTED IN THE INTRAMURAL PROGRAM, AGAIN FAR BEYOND WHAT WE COULD DO IN THIS 4-MONTH PERIOD BUT SHOULD BE UNDERTAKEN. FINALLY SUPPORTING PROGRAMS THAT WILL ALLOW POSSIBLY PARTIAL RNT FROM FEDERAL SERVICE, AND PROVIDE WAYS FOR INVESTIGATORS WHO ARE REACHING THE POINT WHERE THEY LIKE TO CONTINUE DOING RESEARCH BUT NOT AT A FULL-TIME LEVEL TO BE ABLE TO ENGAGE IN A PARTIAL RETIREMENT PROGRAM WITH THE INTRAMURAL PROGRAM SHOULD BE CONSIDERED. IN THE AREA OF TRAINING, AGAIN WE SAW THAT THE LACK OF DIVERSITY WAS PRESENT, THIS IS REALLY A NATIONAL IMPERATIVE TO ADDRESS ON A NUMBER OF DIFFERENT LEVELS AND DIFFERENT REASONS. THERE WAS A NEED FOR SUPPORT IN MENTORING, DIVERSE INDIVIDUALS, AND WE SAW A DECLINE OF M.D. INVESTIGATORS THAT WE SEE BOTH INTRAMURAL AND EXTRAMURALLY, AND THAT NEEDS TO BE ADDRESSED. AGAIN, THE FIRST PRIORITY WE BELIEVE IN TRAINING WAS ENHANCEMENT OF DIVERSITY OF IRP TRAINEES, WE HEARD THE REPORT BY DR. VALANTINE BUT EXPAND THE CURRENT DIVERSITY EFFORTS, CONTINUE TO BUILD PARTNERSHIPS WITH OTHER RESOURCE INSTITUTIONS, CONTINUE TO BUILD -- PROVIDE MENTORING AND BROAD CAREER RESOURCES, ENHANCE COLLECTION OF DATA. THE SECOND AREA OF SUPPORT, WE BELIEVE BROADENING THE MSPT BECOMES IMPORTANT. PROVIDE OPPORTUNITIES FOR STUDENTS TO PARTICIPATE IN CLINICAL RESEARCH WOULD BE IMPORTANT. AND MANY ON THE WORKING GROUP BELIEVED EXPLORING BROADENING SUPPORT BEYOND NIGMS IN TERMS OF OTHER INSTITUTES IN TERMS OF SUPPORTING MSTP TYPE PROGRAMMING, INCREASING SIZE IS IMPORTANT IN TERMS OF BEING ABLE TO HAVE SUFFICIENT CADRE OF INDIVIDUALS WHO ARE MEDICAL SCIENTISTS. ALSO, TO PROVIDE AN INCREASING AWARENESS OF EXISTING PROGRAMS, MASTER'S DEGREE PROGRAM WITH DUKE, LOAN REPAYMENT PROGRAM, ET CETERA, TO ATTRACT INDIVIDUALS, CLINICIANS, TO COME TO THE CLINICAL RESEARCH CENTER FOR RESEARCH OPPORTUNITIES. SO ON THE INFRASTRUCTURE FACILITIES SIDE, IN OUR READINGS AND ALSO AGAIN WE HAD SITE VISITS. THERE ARE AREAS OF IRP ISOLATION WITHIN THE SCIENTIFIC COMMUNITY AND SILOS THAT HAVE BEEN BUILT OVER TIME. THIS IS THOUGHT TO BE ACROSS THE ICs AND ALSO WITH THE EXTRAMURAL COMMUNITY. THERE WAS THOUGHT TO BE AN ISSUE OF INSTABILITY OF FUNDING FOR THE FUNDING STRUCTURE FOR CLINICAL RESEARCH CENTER AND DATA AND COMPUTER ISSUES, THESE ARE THREE MAJOR ISSUES AND CHALLENGES THAT WE SOUGHT TO EXAMINE. THE FIRST RECOMMENDATION WAS TO DEVELOP JOINT CLINICAL INITIATIVES WITH THE EXTRAMURAL COMMUNITY. THE CLINICAL RESEARCH CENTER IS A FANTASTIC RESOURCE. WHEN WE WERE THERE IT APPEARED TO BE VERY MUCH UNDERUTILIZED IN TERMS OF PATIENT BEDS. SO WE BELIEVE THERE SHOULD BE AN EVALUATION OF THE FEASIBILITY OF CREATING A PHASE 1 CLINICAL TRIAL UNIT IN THE CLINICAL RESEARCH CENTER AVAILABLE TO THE EXTRAMURAL COMMUNITY. AND NOT ONLY WOULD THIS BE A GREAT SOURCE TO RESORT TO A NUMBER OF INSTITUTIONS ESPECIALLY INSTITUTIONS THAT DON'T HAVE ADEQUATE CLINICAL TRIALS UNITS, BUT IN LOOKING AT FUNDING MODELS FOR RESEARCH AND FUNDING MODELS FOR THE CLINICAL RESEARCH CENTER THIS MAY BE ONE CLINICAL RESEARCH CENTER. THE SECOND AREA IN TERMS OF THIS WAS DEVELOPING JOINT INITIATIVES WITH LOCAL PARTNERS AND TO CONSIDER ADDITIONAL PARTNERSHIPS WITH LOCAL PEDIATRIC HOSPITALS, SOME IN THE D.C. AREA TO TARGET TAL PEDIATRIC RESEARCH AND DEPARTMENT OF DEFENSE, VETERANS AFFAIRS, OTHER UNITS THAT WOULD BE ABLE TO UTILIZE THE CLINICAL SPACE AND SHARE IN THE FUNDING OF THE CLINICAL RESEARCH CENTER. IN THE AREA OF THE INTRAMURAL PROGRAM IN TERMS OF ACCESS, THE WORKING GROUP BELIEVED THERE SHOULD BE OPEN ACCESS TO ALL SHARED RESOURCES, INCLUDING UNIQUE EQUIPMENT AND FACILITIES THAT ARE AT THE IRP, DURING OUR TRAVELS WE EXAMINED SITES THAT HAD SIMILAR EQUIPMENT AND SIMILAR RESOURCES, AND WHEN WE ASKED ABOUT A RESOURCE, SOMEONE WOULD SAY THIS PERSON HAS THE NEWER ONE, I HAVEN'T BEEN ABLE TO USE THIS, IN THE INTRAMURAL RESEARCH COMMUNITY WE BELIEVE THERE SHOULD BE OPEN ACCESS TO ALL SHARED RESOURCES. PART, THERE SHOULD BE A GUIDELINE FOR EVALUATING WHEN A NEW RESOURCE SHOULD BE OPENED, CLOSED, HOW IT SHOULD BE MANAGED AND RESOURCED, REIMBURSED FOR DIFFERENT SHARED RESOURCES, IT SHOULD BE, WE BELIEVE, NOT -- - SHOULD BE ACROSS THE IC TYPE PROCESS MAKING THAT DETERMINATION. THERE WAS THOUGHT BY THE WORKING GROUP THAT THERE NEEDED TO BE ACCELERATED EFFORTS, ONE IS TO DEVELOP A COMPREHENSIVE DATA AND STORM IMAGINE AND PARTNER CAN OF TO P-CORY DATABASES. AND WE WERE IMPRESSED BY THE USE OF LAB NOTEBOOKS. THIS IS NOT BEING USED THROUGHOUT THE IRP AND WE BELIEVE THERE SHOULD BE EXPANDED PILOT PROGRAMS FOR ELECTRONIC LAB NOTEBOOKS FOR -- BECAUSE AGAIN THIS ALLOWS A BROAD SHARING OF THE RESULTS OF RESEARCH. FINALLY IN TERMS OF INFRASTRUCTURE AND FACILITIES, CONVENING A PANEL TO DETERMINE THE FEASIBILITY OF A CENTRALIZED BIOBANK, WE HEARD FROM INDIVIDUALS THERE WAS A NEED FOR CENTRALIZED BIOBANK AND CENTRALIZED BIOBANK MIGHT BE A GREAT RESOURCE NOT ONLY FOR THE INTRAMURAL COMMUNITY BUT ALSO EXTRAMURAL COMMUNITY TO COLLABORATE. ON THE ADMINISTRATIVE END, WE WERE CONCERNED, WE MADE A NUMBER OF RECOMMENDATIONS AND THERE WERE CONCERNS ABOUT TRANSPARENCY OF IMPLEMENTATION, WE BELIEVE IT'S IMPORTANT TO HAVE IMPLEMENTATION OF THE RECOMMENDATIONS THAT ARE FINALLY ACCEPTED AND WE MOVE FORWARD WITH, WILL BE MONITORED, SO WE RECOMMENDED THAT A FORMAL IMPLEMENTATION REPORTING PLAN BE STRUCTURED INCLUDING THE METRICS TO EVALUATE THE PROGRESS, EFFICACY, AND ALSO A TIMING OF PERIODIC REPORTS ON THE STATUS OF THE IMPLEMENTATION OF RECOMMENDATIONS COMING IN THE REPORT. THE LAST AREA WAS -- NOT REALLY RECOMMENDATIONS, BECAUSE RECOMMENDATIONS IS SOMETHING WE THOUGHT IF WE MAKE THAT RECOMMEACCEPT IT, PUT FORTH, IT WOULD BE AN IMPLEMATION PLAN, THESE ARE AREAS WE RECOGNIZE NIH HAS NO CONTROL OF BUT WE INCLUDE THIS BECAUSE IN OUR DISCUSSIONS THESE ARE IMPORTANT AREAS WE BELIEVE NECESSITATE DISCUSSION. FIRST AREA IS BUDGET. CURRENTLY THE PROCESS, THE CURRENT BUDGETING PROCESS INTRODUCES A GREAT DEAL OF BUDGETARY UNCERTAINTY, AND THE WORKING GROUP SUPPORTS A TWO-YEAR BUDGET FOR NIH FOR ADDED FLEXIBILITY, THERE'S SOME AGENCIES WITHIN THE GOVERNMENT THAT HAVE TWO-YEAR SPENDING PLANS AND PROGRAMS FOR BUDGETS THAT WOULD HELP THE NIH IN TERMS OF FLEXIBILITY. AND WE CONSIDERED THE CURRENT IRP BUDGET PERCENTAGE AT 11% AND THOUGHT IT WAS APPROPRIATE AND WANTED TO MAKE A STATEMENT WE BELIEVE THE 11% NUMBER WHEN WE THINK ABOUT THE INTRAMURAL AND EXTRAMURAL COMMUNITY WE BELIEVE THAT THAT NUMBER SHOULD NOT GO UP HIGHER THAN 11%. WE BELIEVE IN TERMS OF WANTED TO MAKE THAT COMMENT. THE SECOND AREA OF CONCERN IS THE AREA OF TRAVEL RESTRICTIONS. WE HEARD A LOT OF INFORMATION REGARDING THAT, AND THE FACT THAT IT'S BURDENSOME, HINDERS COLLABORATION. THE WORKING GROUP WANTED TO EMPHASIZE TRAVEL IS NOT FOR FUN, TRAVEL IS PART OF THE LIFE OF AN INVESTIGATOR IN TERMS OF SCIENTIFIC EXCHANGE, REPORTING FINDINGS, AND GROWING AS A SCIENTIST AND GROWING SCIENCE AND THE FIELD, SOMETHING THAT'S A NECESSITY AND NOT SOMETHING T'S A LUXURY FOR SCIENTISTS, AND THE WORKING GROUP FULLY BELIEVES THAT THE FEDERAL CONFERENCE AND TRAVEL LEGISLATION THAT IS CURRENLY HINDERING INTRAMURAL INVESTIGATORS FROM BEING ABLE TO TRAVEL SHOULD BE AMENDED TO EXCLUDE NIH TO ALLOW THESE INVESTIGATORS TO BE ABLE TO TRAVEL. WITH THE PROPER APPROVAL TAKING PLACE AT THE NIH LEVEL. AGAIN, THE WORKING GROUP FELT VERY STRONGLY ABOUT THIS, WANTS TO MAKE A CLEAR STATEMENT THAT WE BELIEVE THIS SHOULD OCCUR. THE THIRD AREA, CONFLICT OF INTEREST, THE CONFLICT OF INTEREST POLICIES IN TERMS OF OUR DISCUSSIONS WITH INTRAMURAL INVESTIGATORS IN MANY CASES INHIBITS RECRUITMENT AND HIRE AND IS IMPORTANT TO ENSURE TRANSPARENCY IN TERMS OF RESEARCH AND ALSO TRANSPARENCY IN TERMS OF ADMINISTRATIVE DECISIONS. BE SOME CHANGES IN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES POLICIES TO BE ABLE TO ALLOW SENIOR INVESTIGATORS TO BE HIRED WHO MAY HAVE CONFLICTS THAT NEED TO BE MANAGED, AS WE DO IN THE EXTRAMURAL COMMUNITY. AGAIN, I WANT TO THANK AND ACKNOWLEDGE THE WORKING GROUP MEMBERS WHO REALLY WORK TIRELESSLY ON THIS REPORT FOR A PERIOD OF FOUR TO FIVE MONTHS, I WANT TO THANK THE INTRAMURAL RESEARCH PROGRAM FOR ITS TIME IN ALLOWING US TO BE ABLE TO PROBE AND TO DISCUSS WITH THEM THE FUTURE OF THE INTRAMURAL RESEARCH PROGRAM. THANK YOU. >> CATO, THANK YOU VERY MUCH. [APPLAUSE] WE'RE OPEN FOR QUESTIONS, AND YOU CAN CALL ON PEOPLE THAT YOU CAN SEE. >> YES, THANK YOU VERY MUCH FOR REALLY INTERESTING REPORT WHICH I ENJOYED READING AND WAS INTERESTED IN LOTS OF THE O TO LEARN ABOUT THIS FAMOUS CENTER THAT I HEARD ABOUT FOR SO LONG. TWO POINTS, ONE IS A BRIEF ONE. IN MY CAPACITY AS FDA SCIENCE BOARD CHAIR, I WROTE A LETTER ON BEHALF TO COMMISSIONER HAMBURG ON THE EXACT SAME TRAVEL ISSUE. SO I GUESS THIS IS JUST A NOTE TO THE STAFF AND TO THE DIRECTOR THAT DR. HAMBURG HAS A LETTER, AND YOU'LL HAVE -- I WOULD BE SHOCKED IF THE CDC HASN'T RECEIVED A LETTER, AND THE ISSUE OF TRAVEL OF GOVERNMENT SCIENTISTS TO MEETINGS IS REALLY CRITICAL, BECAUSE THAT'S PART OF THEIR MISSION, JUST AS YOU SAID, OF OUTREACH TO THEIR FELLOW SCIENTISTS, PEER REVIEW, WE ALL KNOW WHY IT'S CRITICAL AND I THINK I WOULD LIKE TO HIGHLIGHT THAT POINT. EVEN THOUGH IT WAS ON YOUR LIST OF THINGS YOU CAN'T REALLY RECOMMEND ABOUT. EXCUSE ME. THE SECOND POINT IS I WAS -- I NOTICED TWO RECOMMENDATIONS, THE RECOMMENDATION ABOUT TEAM SCIENCE AND THE RECOMMENDATION ABOUT INTERACTIONS WITH EXTRAMURAL SCIENTISTS. BOTH IN PRINCIPLE ATTRACTIVE IDEAS BUT IF SOMEBODY SAID THAT TO ME VERY STRESSFUL BECAUSE THEY HAPPEN BY HAPPENSTANCE AND THE RIGHT COLLABORATION AT THE RIGHT TIME, SO I GET VERY WORRIED ABOUT TELLING SCIENTISTS TO DO TEAM THINGS WHEN THAT'S NOT THE RIGHT ANSWER. I WAS WONDERING IF YOU GOT ANY FEELING FOR THE DEGREE TO WHICH RECOMMENDATIONS MIGHT BE STRESSFUL TO IRP SCIENTISTS. >> ALL RIGHT. WELL, THANKS. WELL, FIRST, FROM YOUR FIRST POINT, I DIDN'T MENTION THIS IN THE TALK BUT WE ACTUALLY SPOKE TO -- WHEN WE HAD DISCUSSIONS WITH SOME ADMINISTRATORS IN THE IRP, WE WERE TOLD THAT FOR EVERY DOLLAR SPENT ON TRAVEL, A DOLLAR IS SPENT IN THE BUREAUCRACY FOR THE APPROVAL. AND WHICH IS AN AMAZING NUMBER OF TRIUMPH OF BUREAUCRACY OVER REASON. SO REALLY SOMETHING NEEDS TO BE DONE IN THAT AREA. IN THE AREA OF TEAM SCIENCE, OBVIOUSLY IT COULD BE STRESSFUL BUT I THINK THAT WHAT WE HEARD FROM SCIENTISTS WAS THAT SOME DON'T ENGAGE IN INTERDISCIPLINARY WORK AND TEAM SCIENCE BECAUSE NUMBER ONE THERE'S NOT A STRONG MANDATE TO TWO, THE REVIEW COMING UP, HOW IS THEIR WORK IN TEAM SCIENCE RECOGNIZED IN TERMS OF THEIR REVIEW? AND SO I THINK PART OF THE ANGST WILL DECREASE, THIS IS SOMETHING THAT IS IMPORTANT IN TERMS OF THE INTRAMURAL IMPORTANT, AND NUMBER TWO WE'LL FIND THE WAYS TO BE ABLE TO TAKE INTO ACCOUNT YOUR WORK IN TEAM SCIENCE AS PART OF YOUR REVIEW PROCESS. AND INCIDENTALLY THIS IS SOMETHING THE EXT3 COMMUNITY IS GRAPPLING WITH TOO, AND WE'RE WORKING IN TERMS OF TENURE AND PROMOTION POLICIES TO EXAMINE HOW INTERDISCIPLINARY WORK AND TEAM SCIENCE WORK AND CREDIT FOR MULTI-AUTHORED PAPERS AND GRANTS TAKE PLACE. >> YEAH, IN FACT, I ALSO HAD A COMMENT ABOUT TEAM SCIENCE, AND I THINK THAT THE INTRAMURAL PROGRAM WOULD BE A GREAT TEST BED FOR SYSTEMATICALLY LOOKING AT WHAT WORKS AND HOW TO BEST MAKE IT WORK GIVEN HOW WE ARE TRAINED IN THE UNITED STATES, THE VALUES THAT WE'RE GIVEN, THE OVERALL CULTURAL SETTING FOR IT. AND IN A SORT OF SOMEWHAT SAFE EVERY ENVIRONMENT THAN UNIVERSITIES, AS LONG AS IT IS NOT FORCED UPON PEOPLE BUT SOMEHOW INCENTIVIZED AND I WANTED TO MOSTLY ADD EVALUATED, WHAT ASPECTS WORK? I'M ON THE NRC RESEARCH REVIEW BOARD, I REVIEW ALL KINDS OF COOL STUFF LIKE THE INFLUENZA WHATEVER THING, YOU KNOW, TO THE SCIENCE OF TEAM SCIENCE, WHICH IS A REVIEW THAT WE'RE LOOKING AT RIGHT NOW. AND BASICALLY, THE BOTTOM LINE IS THERE ISN'T A SCIENCE OF TEAM SCIENCE, THAT ARE SOCIAL SCIENTISTS WHO HAVE STUDIED OTHER KINDS OF TEAMS BUT WE DON'T UNDERSTAND IF THERE'S ANYTHING SPECIAL DRIVEN BY THE FACT THAT IT'S A SCIENCE AND SO IT'S NOT THE SAME AS LET'S COLLABORATE ON SAVING SOMEBODY'S LIFE EVEN AND WHETHER DIFFERENT HIERARCHICAL STRUCTURES DEMAND DIFFERENT PHILOSOPHIES, DIFFERENT STRATEGIES AND SOLUTIONS TO CONFLICT, HOW YOU ENABLE ALL OF THAT IN SCIENCE IS INTRINSICALLY A VERY IMPORTANT AND INTERESTING QUESTION THAT WE DON'T UNDERSTAND AND THE INTRAMURAL WOULD BE A GREAT TEST BED. DEGREE. WHEN WE THINK ABOUT THE NEXT TEN YEARS HOW THE IRP CAN HAVE DISTINCTIVENESS, THIS IS A SAFE THE TERM WE USED, WE FINISHED AN IOM STUDY ON THIS AREA, IT'S CALLED CONVERGENCE, WHERE WE BRING THESE DISPARATE AREAS TO CREATE NEW SCIENCE, BUT IN BRINGING THOSE AREAS TOGETHER WE LEARN FROM EACH OTHER WHAT WORKS AND WHAT TECHNOLOGIES WORK FROM THE OTHER AREA, AND BRING THAT TO BEAR AND BRING THAT INTO OUR OWN PORTFOLIOS OF SCIENCE. YES? >> I'D LIKE TO COMMENT IN THEY AREAS. FIRST OF ALL, THE LITANY OF THINGS AT THE END, CLEARLY OPERATIONALLY IMPORTANT FOR PEOPLE HERE, BUT ALSO ARE FUNDAMENTALLY IMPORTANT IN TERMS OF RECRUITMENT AND RETENTION OF GOOD PEOPLE. THE WHOLE LEVEL OF THE OPERATION IS DEPENDENT ON HAVING THE ENVIRONMENT THAT'S CONDUCIVE TO OPERATING TO PEOPLE WHO ARE SERIOUS SCIENTISTS AND TRAVEL RESTRICTIONS ARE ONE, UNAMBIGUOUS, CONFLICT OF INTEREST ALSO, THERE ARE HISTORY AND COMPLICATIONS, YOU USED THE KEY WORD, MANAGING CONFLICTINGS OF INTEREST, THAT COULD BE DONE. OTHER INSTITUTIONS SOLVED THAT. NIH SHOULD GET ON BOARD AND FIND A WAY WITH THE REST OF THE GOVERNMENT TO MAKE THAT POSSIBLE. THE LONGER TERM FUNDING FOR STABILITY IS MOTHERHOOD AND APPLE PIE, COMPLICATED, BUT STILL GOOD. IN ANY WAY, THAT'S WONDERFUL. COMMENT ONE. COMMENT TW IS THE REST OF YOUR REPORT, I HAVE TO SAY, IS ADMIRABLE BEYOND IMAGINATION GIVEN THE TIME LINE. FOUR MONTHS GOING THROUGH ALL OF THAT GIVEN COMPLEXITIES, NUMBER OF INSTITUTES AND WHAT THE INTRAMURAL PROGRAM DOES, IT'S AMAZING YOU COULD WRAP YOURSELVES AROUND THAT THE WAY YOU DID AND MANY OF THE CONCLUSIONS THAT YOU'VE COME TO AND RECOMMENDATIONS ARE INSIGHT FULL AND IMPORTANT AND THEY ARE A WORK IN PROGRESS. YOU DIDN'T HAVE TIME TO DO ALL THE HOMEWORK AND SO I'M SURE THAT WHAT WILL HAPPEN, I WANT TO SAY I THINK WHAT SHOULD HAPPEN, FROM HERE IT GOES INTERNAL, THE PEOPLE LIVING WITH THIS FIGURE OUT WHAT'S GOOD AND DRAW UPON THE EXTRAMURAL COMMUNITY TO GIVE HELP AND ADVICE AND PERSPECTIVE FROM OTHER EXPERIENCES. BUT I THINK IT'S A REALLY GREAT START. THE THIRD COMMENT IS I WANT TO EXPAND ON THE IDEA OF TEAM SCIENCE BECAUSE I THINK TEAM SCIENCE IS ONE OF A VARIETY OF AREAS THAT ACTUALLY ADDRESSES WHAT WAS IN FRANCIS' ORIGINAL MANDATE TO THE COMMITTEE, AND THE FIRST POINT WAS WHAT'S SPECIAL ABOUT THE NIH INTRAMURAL PROGRAM, WHAT CAN BE SPECIAL, WHAT CAN DISTINGUISH IT FROM UNIVERSITIES AND MEDICAL SCHOOLS AND HOSPITALS? THE TEAM SCIENCE OPPORTUNITY IS ONE POSSIBILITY. ANOTHER POSSIBILITY AND THERE ARE A LITANY OF THEM, ALL I REALLY WANT TO SAY IS I HOPE GOING FORWARD PEOPLE WILL REALLY THINK ABOUT OTHER POSSIBILITIES. ANOTHER THAT COMES TO MY MIND IS THE WHOLE NOTION OF HIGH RISK, HIGH RETURN RESEARCH WHICH ALSO MIGHT BE WELL SITUATED IN THIS CONTEXT, AND THAT COULD BE TEAM, IT MIGHT NOT BE TEAM. O TEAM COULD MEAN PEOPLE WHO ARE INTERNAL, PEOPLE ARE INTERNAL INTERACTING WITH PEOPLE WHO ARE EXTERNAL BUT ANOTHER WAY TO THINK ABOUT THE TEAM OVER A 10-YEAR PERIOD IS BRING TOGETHER WHO WANT TO BE TOGETHER BUT ARE NOT NOW, GIVES THEM AN OPPORTUNITY TO EXPLORE SOMETHING THAT'S DRIVING THEM AND THAT'S SOMETHING THAT COULD BE DONE HERE, IT WOULD BE VERY DIFFICULT TO DO IN ANY OF A VARIETY OF OTHER INSTITUTIONS. THE THIRD AREA THAT AT LEAST DURING THIS CONVERSATION CAME TO MY MIND AS SOMETHING THAT COULD BE DIFFERENT HERE, AND I'LL JUST GIVE A QUOTE FROM ONE OF THE PEOPLE AT THE M.I.T. MEDIA LAB, AND THE MEDIA LAB AT M.I.T., IT'S UNUSUAL. AND THEY PRIDE THEMSELVES ON BEING UNUSUAL. THE QUOTE IS, WE ARE ALL FOLKS HO DON'T FIT IN ANYWHERE ELSE. [ LAUGHTER ] OKAY? WELL, NIH COULD DO SOMETHING LIKE THAT AND BRING TOGETHER PEOPLE WHO WOULDN'T FIT IN A STANDARD UNIVERSITY MEDICAL SCHOOL OR HOSPITAL, AND GIVE THEM THE OPPORTUNITY TO EXPLORE IN A VARIETY OF WAYS AMONGST DISCIPLINES AND DIFFERENT AREAS AND PEOPLE WHO CAN'T BE LABELED SO SIMPLY MIGHT NEVER BE HIRED, MIGHT NEVER THRIVE IN A STANDARD ACADEMIC COMMUNITY, MAKE A HOME FOR THEM HERE, AND THESE ARE SPECIFIC EXAMPLES BUT WHAT I REALLY WOULD LIKE TO ENCOURAGE IS THINKING OUTSIDE THE BOX OF HOW TO TAKE ADVANTAGE OF THE ESSENTIALLY INFINITY OF OPPORTUNITIES THAT THE INTRAMURAL PROGRAM CAN BE HERE AND GIVEN THE FREQUENCY OF REVIEWS, EVERY FEW DECADES, I WOULD SAY THIS IS THE MOMENT. >> ONE OF THE COMMENTS THAT WE MADE, THE WORKING GROUP MADE, FIRST OF ALL THANK YOU FOR YOUR COMMENTS, AGAIN I WANT TO APPLAUD THE WORKING GROUP MEMBERS BECAUSE THEY WERE ALL SUPER BUSY PEOPLE WITH THEIR ENTIRE NEXT FOUR MONTHS MAPPED OUT ALMOST TO THE DAY AND SO THEY REALLY CHANGED THEIR SCHEDULES TO BE PART OF THIS AND DID A GREAT JOB. BUT ONE OF THE COMPONENTS THAT WE TALKED ABOUT IN THE REPORT WAS THE POSSIBILITY OF I.C. INNOVATION FUND THAT MIGHT LOOK AT THIS AREA OF TEAM SCIENCE, ENCOURAGE GROUPS TO WORK TOGETHER FOR MORE FUNDING, TO WORK ON PROJECTS AS TEAMS, ENCOURAGE THE TEAM SCIENCE CONCEPT. >> I WANT TO REALLY COMMEND YOU ALL FOR REALLY THOUGHTFUL WORK, ESPECIALLY UNDER THE TIME LINES. I THINK THAT AS YOU CONTINUE TO MOVE THIS THING FORWARD, YOU GUYS CAN STILL DRILL A LITTLE DEEPER INTO WHAT ARE THE REAL SPECIAL CORE COMPETENCIES THAT EXIST HERE NOW. THE SLIDE THAT'S THERE NOW, IT'S STILL HARD TO GET A GOOD ENOUGH SENSE OF EXACTLY WHAT IS THE -- ARE WE LOOKING TO DO SOMETHING UNIQUE? OR ARE WE TRYING TO FIND A BETTER THING FOR SOMETHING THAT ALREADY EXISTS? IT'S LIKE IS THIS TRYING TO JUSTIFY WHAT ALREADY IS THERE VERSUS TAKE ON SOMETHING THAT DOES NOT -- THAT IS NOW SUBOPTIMAL THAT NEEDS TO BE ADDRESSED, AND THAT'S WHAT I THINK WE'VE GOT TO BE CAREFUL ABOUT BECAUSE I DON'T WANT THIS TO COME OFF AND LOOK LIKE WE'RE TRYING TO FIND A WAY TO JUSTIFY SOMETHING THAT ALREADY IS, AND MAKE IT ALL OF A SUDDEN OKAY, IT'S ACCEPTABLE THAT WE'RE GOING TO SPEND THIS MUCH MONEY. AND IT'S A NUANCE. WHAT I DO ENJOY IS THEN THE OPPORTUNITY TO CARVE OUT, I LIKE THIS IDEA OF SETTING OUT A NOVEL RESEARCH AGENDA THAT SAYS, THESE ARE IMPORTANT WE NEED ADDRESSED, AND CAN BE ADDRESSED BECAUSE OF THE ATTRIBUTES OF HAVING SOMETHING HERE COMBINED WITH INTERDISCIPLINARY SCIENCE. ARE WE TALKING METHODOLOGIES, WHAT CAN ANSWER NOVEL QUESTIONS? AND THE LAST PIECE I ENJOYED WAS YOUR DATA, WHETHER IT'S P-CORY OR NOT, WE CREATED A HUGE DATA INITIATIVE. IT'S THE ABILITY TO TAKE AND MINE THE IDEA TO PLAY WITH NOVEL HYPOTHESIS GENERATION THAT COMES FROM THAT AND FEED THAT INTO AN ALL-STAR TEAM OF PEOPLE WHO ARE YOUR -- THAT CAN UNIQUELY COMBINE DISCIPLINES TO LOOK AT NOVEL HYPOTHESES IN A NEW WAY, THAT GETS MY MOTOR RUNNING, REALLY EXCITEDLY. BUT I COMMEND YOU. >> I WANTED TO SAY, I AGREE WITH BOB. WHAT'S DONE HERE SHOULD BE SOMETHING SPECIAL. PEOPLE AT THE NIH ARE NOT ON THE TREADMILL. THEY HAVE FREEDOM. THEY SHOULD BE ABLE TO TAKE RISKS AND DO SOMETHING DIFFERENT THERE ARE PEOPLE DOING WORK WHICH COULD BE DONE IN THE EXTRAMURAL PROGRAM, I DON'T THINK THEY SHOULD BE DISCOURAGED FROM CONTINUING THAT LINE OF WORK PARTICULARLY IF THEY HAVE BEEN DOING IT FOR A LONG TIME BUT NEW PEOPLE SHOULD BE PEOPLE THAT DON'T FIT IN ELSEWHERE, PEOPLE WITH SOMETHING UNIQUE TO CONTRIBUTE WHO CAN TAKE ADVANTAGE OF UNIQUE ENVIRONMENT WE HAVE HERE. >> DISCUSSION, YES? >> SO I'M ON A BSE, ONE OF THE TOPICS WAS THE REVIEW PROCESS. YOU MENTIONED IT'S RETROSPECTIVE, 60/40, AND WE COULD NOT UNDERSTAND THAT. WE FELT THAT WAS NOT A FORWARD-LOOKING WAY OF STIMULATING RESEARCH, AND DID YOUR COMMITTEE DISCUSS THIS RETROSPECTIVE WAY OF THE REVIEW PROCESS TAKING PLACE? >> YOU KNOW, I THINK THERE WAS A MIXTURE IN TERMS OF LOOKING AT HOW MUCH SHOULD BE RETROSPECTIVE VERSUS PROSPECTIVE. WE ALSO TALKED WITH THE COMMUNITY OF SCIENTISTS IN THE L RESEARCH PROGRAM THAT FELT THEY LIKED THE RETROSPECTIVE COMPONENT AND THOUGHT IT WAS ACTUALLY A CHANGE OVER THE YEARS TO BE LESS RETROSPECTIVE, AND SO THEY HAD SOME CONCERNS. I THINK THAT THE MAIN THING THAT CAME OUT OF THE COMMITTEE IN TERMS OF REVIEW PROCESS WAS CONCEPT OF ONE BROADENING THE GROUP OF PEOPLE TO INCLUDE EXTRAMURAL COMMUNITY, A LARGER COMMUNITY OF INDIVIDUALS IN TERMS OF REVIEW PROCESS, AND ALSO FOR INSTANCE NEUROSCIENCE THERE ARE INDIVIDUALS ALL OVER THE INTRAMURAL PROGRAM, BRING THEM TOGETHER IN TERMS OF REVIEW GROUPS, VERSUS A GROUP JUST IDE OF ONE INSTITUTE. OTHER QUESTIONS? COMMENTS? >> I'VE ALWAYS BEEN IMPRESSED. ARE THERE PLANS TO CAPTURE DATA ON TRAINING AND RETENTION OF BIOMEDICAL RESEARCHERS, HOW MANY PEOPLE PARTICIPATED IN NIH RESEARCH, WHETHER VISITING OR TAKING A WORKSHOP OR BEING TRAINED. >> IT IS ENORMOUS. 10 OR 15 YEARS AGO MOST WERE TRAINED AT NIH. WE STILL HAVE THE CAPABILITY BUT THE IMPACT IS LESS. WE'RE INTERESTED IN PILOTING NEW APPROACHES TO TRAINING. [LOW AUDIO] >> ANY OTHER -- YES? >> I DON'T KNOW HOW YOU DID THIS IN FOUR MONTHS. IT MAKES ME NERVOUS ABOUT THE NLM, REACHING THE SAME LEVEL OF THE REPORTS WE HEARD TODAY, OUTSTANDING WORK. DID YOU THINK ABOUT WHAT THE DASHBOARD IS THAT SHOWS WHAT TRACKING THE PERFORMANCE OF THE INTRAMURAL? BECAUSE I'M JUST TRYING TO WRAP MY HEAD AROUND THIS, AT THE END OF THE DAY WHEN YOU BOIL IT DOWN, IMMEASURABLE, 11% OF THE BUDGET, I WAS HOPING TO SEE GIVING FRANCIS THE DASHBOARD, THE KEY INDICATORS HE NEEDS TO BE AWARE OF TELLING HIM WHETHER OR NOT THIS IS PERFORMING AT AN OPTIMAL LEVEL, 11% OF THE BUDGET. IF YOU START OVER, I WONDER IF YOU HAD SOME WAYS OF SAYING NOT THAT YOU WOULDN'T DO IT TOMORROW BUT IF YOU HAD THAT MUCH MONEY TRYING TO GENERATE THE MOST KNOWLEDGE FOR THE BEST GOOD, WOULD THIS BE HOW YOU WOULD DO IT? IN REALITY YOU'VE GOT ACTUALLY SOMETHING TO BUILD ON, GREAT PRODUCTS HERE, BUT I JUST DIDN'T KNOW, THOSE ARE THE TWO THING I WONDERED, WHETHER WAS A DASHBOARD AND SECOND OF ALL IF YOU WERE TO START OVER, I'M NOT SUGGESTING STARTING OVER, IF YOU WORK, DID YOU PLAY THAT OUT TO SAY WHAT WOULD YOU DO WITH THAT MUCH MONEY? >> WE HAD AN EXPERIENCE, IN THE BEGINNING WE WERE, YOU KNOW, WANTED TO GET ALL THE DATA. WE GOT ALL THE DATA ABOUT THE INTRAMURAL PROGRAM, THEN WE SAID, WELL, WHAT WE WANT TO DO IS TAKE THE DATA AND COMPARE IT TO SCHOOLS THAT ARE ABOUT THE SAME SIZE AND WE WANT TO SAY, LET'S GET HARVARD, HOPKINS, LET'S DO PROPORTIONS BASED ON FUNDING AND THE NUMBERS OF IOM AND NAE AND NAS MEMBERS, AMOUNTS OF GRANTS, NUMBERS OF PUBLICATIONS, IMPACT, WE GOT ALL THIS DATA TOGETHER AND FELT GOOD AND SUDDENLY WE ALL HAD A WAIT-THOUGH MOMENT. WE'RE NOT TRYING TO CREATE ANOTHER EXTRAMURAL PROGRAM HERE. WE'RE TRYING TO CREATE SOMETHING THAT'S UNIQUE AND SO TRYING TO HAVE A DASHBOARD OF METRICS THAT SAYS WE'VE GOT THIS NUMBER OF IOM AND NAS MEMBERS AND THIS NUMBER OF PAPERS AND THIS SORT OF IMPACT, WHILE OBVIOUSLY THE ANSWER WAS ZERO, IF THERE WERE ZERO NAS MEMBEROR PAPERS THERE WOULD BE A PROBLEM BUT THE METRICS, BECAUSE WE'RE LOOKING AT SOMETHING THAT'S UNIQUELY DIFFERENT, THE SAME DASHBOARD METHODS WERE NOT THERE. >> YOU'RE DEFAULTING TO THE IDEA THOSE SHOULD HAVE BEEN THE METRICS. I WAS WONDER IF YOU THOUGHT WHAT INDICATORS SHOULD BE. I AGREE YOU'RE NOT TRYING TO CREATE ANOTHER HARVARD. >> WE THOUGHT ABOUT METRICS, BROUGHT DATA IN TO LOOK AT METRICS. AT THE END WE SAID WE'RE NOT GOING TO MAKE THE METRICS -- WE'LL MAKE THIS A METRICS-BASED SYSTEM BECAUSE WE'RE NOT NG THAT, WE DON'T WANT TO ENCOURAGE FOR THE NEXT TEN YEARS THAT METRICS IN TERMS OF NUMBERS BE LOOKED AT IN TERMS OF THE RATING THE PROGRAM. [LOW AUDIO] IN SOME WAYS. >> WE COULD HAVE A LONG DISCUSSION ABOUT THE RIGHT METRICS FOR THE EXTRAMURAL COMMUNITY, WHAT DO WE REALLY ACCEPT AS A MEASURE OF SUCCESS? PEOPLE HAVE ALL KINDS OF PROPOSALS FOR THAT, MOST OF THEM ARE DEEPLY THOUGHT, SO IT'SREALLY A CHALL ENGE IN THE OVERALL LANDSCAPE TO DECIDE MUCH LESS TO SAY FOR THIS SPECIAL NATURE WHERE YOU WANT TO AVOID SOME OF THE MORE TRADITIONAL ONES WHAT WOULD YOU DO INSTEAD? IT'S A GREAT QUESTION, HARLAN. I'M STRUGGLING A BIT WITH WHAT KINDS OF THINGS WOULD MAKE SENSE. >> WELL, I MEAN, JUST TO FINISH THIS THOUGHT, JUST BECAUSE YOU COULD, FOR EXAMPLE, SAY -- IT'S ALL ABOUT JUST LIKE A FINANCIAL PORTFOLIO, RIGHT? YOU'RE VESTING ACROSS A RANGE OF DIFFERENT AREAS AND YOU COULD SAY WHAT I WANT AT THE END OF THE DAY IS THREE HOME RUNS. THREE HOME RUNS. THIS IS WHAT A HOME RUN LOOKS LIKE. EVERYTHING ELSE CAN FAIL. I DON'T CARE. THAT'S WHAT THIS EXISTS FOR IS HOME RUNS. FOR SINGLES, OR PROMOTING EVERYONE ELSE'S GOOD WORK SO THE WHOLE THING IS I ACTUALLY DON'T EXPECT ONE THING TO COME OUT OF HERE EXCEPT IT BE THE ACKNOWLEDGEMENT IN A THOUSAND ARTICLES OTHER PEOPLE WRITE PRODUCES A SUBSTRATE. I DON'T KNOW THE RIGHT ANSWER BUT JUST AS I'M THINKING ABOUT IT, IT OCCURS TO ME IF YOU SAY IT'S UNMEASURABLE, I REALLY DON'T KNOW, THEN YOU'RE LEFT IN A VERY DIFFICULT POSITION OF TRACKING, ENCOURAGING, INCENTIVIZING AND EVALUATING WHETHER YOU GOT WHAT YOU WANTED. IF YOU SAY LET'S CREATE AND SEE WHAT COMES OUT, WE CAN SAY WHETHER WE LIKE IT OR NOT, THAT'S A LITTLE BIT HARDER WITH REGARD TO PLANNING AND BEING A DIRECTOR TO RUNNING. >> YES? >> SO SINCE PEOPLE ARE GOING TO BE DRILLING DOWN BY INSTITUTES OR AREAS OR WHATEVER, BY SPECIFIC, THAT'S THE PLAN, RIGHT? IT MIGHT BE GOOD TO ADDRESS SOME OF THE QUESTIONS THAT HAVE COME UP HERE ABOUT BOTH THE FOR WAR AND BACKWARD LOOKING, INCLUDING ALMOST CASE STUDIES OF GREAT SUCCESSES, OR EVEN GREAT FAILURES, BUT INSTEAD OF JUST KIND OF ASKING THEM TO -- I MEAN, I'VE BEEN ON A BLUE RIBBON COMMITTEE THAT REVIEWED ONE OF THE INTRAMURAL PROGRAMS, FIRST INSTINCT IS TO JUSTIFY YOUR EXISTENCE. WE ALL DO THAT. ONE COULD FRAME IT IN THE CONTEXT OF LESSONS LEARNED ABOUT WHAT WORKS AND DOESN'T WORK ESPECIALLY WELL AND ALSO ENVISIONING DIFFERENT KIND OF FUTURE. IF PEOPLE COULD COME UP WITH SOME OF THAT AS PART OF THEIR EXERCISE, IT MIGHT TURN OUT TO BE RELATIVE. >> IF YOU'RE GOING TO BE DEVELOPING AN NIH-WISE STRATEGIC PLAN ISN'T THIS EXACTLY WHAT YOU HAVE TO GRAPPLE WITH? I FOUND THIS INTERESTING. HARLAN, I AGREE. ANSWERS SHOULD BE THAT WE KNOW WHAT THE OUTCOME IS GOING TO BE AND THEN -- BUT I DON'T THINK YOU CAN SAY IT'S UNMEASURABLE. IF YOU HAVE TO DO THIS, FRANCIS, IT MIGHT BE SOME BRAINSTORMING NEEDS TO OCCUR. OKAY, IF THIS IS THE TEST BED FOR ALL SORT OF THINGS THEN THE A LEAST IT'S ONE PLACE IN THE COUNTRY WHERE IT CAN HAPPEN. I'VE BEEN THINKING ABOUT HOW ARE YOU GOING TO PUT THIS TOGETHER. IT'S A BIG CHALLENGE FOR YOU. >> I TOTALLY AGREE WITH THAT PART. [ LAUGHTER ] YOU ALREADY HIGHLIGHTED IN YOUR REPORT MAYBE AN EXAMPLE OF A HOME RUN WHICH WE'VE TALKED ABOUT A COUPLE TIMES TODAY, WHICH IS THE EBOLA VACCINE, TO HAVE THE CAPABILITY AND WORKING OUT OVER MANY YEARS TO BE WHERE WE ARE RIGHT NOW IN A TIME OF GREAT NEED ACROSS THE WORLD. ANOTHER THING I GUESS I SHOULD POINT OUT, WE ACTUALLY HAD THE CHANCE TO DISCUSS THE BASICS OF WHAT RECOMMENDATION WAS GOING TO BE MADE BY THIS DISTINGUISHED WORKING GROUP, THIS PAST MONDAY WITH THE INSTITUTE DIRECTORS, AND YOU SHOULD KEEP IN MIND INSTITUTE DIRECTORS HAVE THEMSELVES A DIVERSITY OF VIEWS ABOUT WHAT THEIR INTRAMURAL PROGRAMS SHOULD BE, AND I WOULD ARGUE STRONGLY THAT'S A GOOD THING, SO IF YOU TALK TO TONY FAUCI, WHO IS PRESIDING OVER THIS RECENT VACCINE EFFORT FOR SOME MAJOR UPHEAVAL TO HAPPEN IN WHAT IS A REALLY IMPRESSIVE PUBLIC HEALTH ORIENTED VACCINE DEVELOPMENT LABORATORY WOULD NOT WARM HIS HEART, I CAN TELL YOU. OTHER INSTITUTES PERHAPS MORE BROAD IN THEIR REACH, NOT NECESSARILY FEELING THE NEED TO FOCUS IN A PARTICULAR WAY, ARE MUCH MORE EXCITED ABOUT SOME OF THESE IDEAS LIKE LET'S HAVE SOME BIG HOME RUN TARGETS, LET'S THINK ABOUT WHAT THOSE WOULD BE AND HOW WE WOULD ORGANIZE AND NOT WORRY ABOUT WHAT INSTITUTE IS DOING WHAT AND EVERYTHING IN BETWEEN, THAT'S PROBABLY RIGHT. PART OF THE CHALLENGE FOR US IS TO TAKE WHAT I THINK IS A VERY IMPRESSIVE AND THOUGHTFUL SET OF RECOMMENDATIONS AND TRY TO FIGURE OUT HOW TO YOU MAP THAT ACROSS AN INSTITUTION THAT HAS PART OF ITS STRENGTH BEING ITS HETROGENEITY, AND WE THEREFORE PROBABLY WANT TO PRESERVE THE PARTS OF THAT HETROGENEITY THAT ARE PART OF THE STRENGTH BUT WATCH OUT FOR THE ONES THAT AREN'T AND IT'S NOT ALWAYS OBVIOUS WHICH IS WHICH SO THIS WILL BE AN INTERESTING EXERCISE TO BE SURE. IT'S JUST THE RIGHT TIME TO DO IT. THAT'S WHY WE PUT THIS ON THE TABLE. THINK ABOUT THE NEXT TEN YEARS. IMAGINE ALL THE THINGS THAT WILL BE POSSIBLE SCIENTIFICALLY. IMAGINE THAT THE RESOURCE STRESSES THAT WE'RE EXPERIENCING ARE PROBABLY NOT GOING TO GO AWAY, AT LEAST NOT IMMEDIATELY OR AS QUICKLY AS WE WOULD LIKE. WHAT SHOULD WE BE DOING HERE TO MAKE THE MOST OF THAT CIRCUMSTANCE? I DIDN'T MEAN TO CUT OFF OTHER QUESTIONS. I WAS SORT OF RESPONDING TO MARY SUE. AND WE STILL HAVE MORE TIME IF PEOPLE HAVE OTHER COMMENTS TO MAKE ABOUT THIS VERY INTERESTING SET OF PROPOSALS. DAVID? >> JUST TO ECHO, IT'S A GREAT JOB, AMAZING IN THE SHORT TIME FRAME. AS THE NUMBER OF PEOPLE SAID THIS ALREADY, I PARTICULARLY LIKE THIS IDEA OF USING THE INTRAMURAL PROGRAM AS SORT OF A BETA TEST SITE FOR THINGS BECAUSE YOU HAVE SUCH ABILITY TO MOVE RESOURCES RELATIVELY QUICKLY WITHOUT THE SAME -- YOU KNOW, YOU'RE NOT GOING TO GRANT TO GRANT. YOU DID HAVE THIS ON ONE OF YOUR SLIDES, THE WHOLE ISSUE OF TRAINING MINORITY, ATTRACTING MORE MINORITY SCIENTISTS SCIENCE, IT SEEMS LIKE THIS IS SUCH A UNIQUE WAY AND PLACE TO DO THAT, YOU COULD ENABLE THAT, YOU KNOW, IMAGINE THE SORT OF YELLOW BERETS OF THE GENERATION BEFORE US, MAYBE WE COULD CHANGE THIS WHOLE NEXT GENERATION OF UNDERREPRESENTATIVE PEOPLE -- UNDERREPRESENTED PEOPLE, GIVE THEM A START. POTENTIAL TO USE THIS AS A LAB AND GET DATA AND SEE WHAT DOES AND DOESN'T WORK WOULD BE A GREAT USE OF THIS RESOURCE. [LOW AUDIO] >> YOU MAY REMEMBER HANNAH SAYING THIS IS ONE OF THE THREE MAJOR AREAS SHE'S PUTTING HER EFFORTS INTO, TO DO SOMETHING ABOUT THAT. WE RECOGNIZE WE HAVE A LONG WAY TO GO. OTHER COMMENTS? SINCE THIS IS A REPORT COMING FORWARD FROM A WORKING GROUP IT IS USUAL FOR THE PARENT GROUP, YOU ALL, TO DECIDE TO ACCEPT THE REPORT, TO ACCEPT THE WORK, YOU THINK IT'S THOUGHTFUL, AND CREDIBLE, NOT THAT EVERYTHING SHOULD BE IMPLEMENTED TOMORROW. IT WAS SAID BY BOB THE IDEA OF SUBSTANTIVE AND LENGTHY LIST NEEDS TO COMINTERNALLY COME, INTERNALLY, BY A GROUP I'M CHARGED TO PUT TOGETHER, A RESPONSE TO EACH AND HOW COULD WE IMPLEMENT THAT. AND THE PLAN WOULD BE TO BRING BACK TO YOU IN JUNE, SIX MONTHS FROM NOW, IT WILL TAKE TIME TO GO THROUGH THAT PROCESS, THAT KIND OF RESPONSE. WE GAVE OURSELVES TWO MORE MONTHS THAN WE GAVE YOU. JUST TO LET YOU KNOW, THAT WOULD BE MY GENERAL RESPONSE IN THIS PARTICULAR SITUATION TO A VERY THOUGHTFUL SET OF RECOMMENDATIONS. BUT I WOULD LIKE TO HEAR FROM THIS ACD WHETHER YOU ARE COMFORTABLE ACCEPTING THE REPORT FROM YOUR OWN WORKINP HERE AND THEREFORE PASSING IT ON TO ME. >> MOVE TO ACCEPT. >> THERE'S A MOTION. THERE'S A SECOND. ANY FURTHER DISCUSSION OF THAT PLAN? IN FAVOR -- >> AYE. >> ANYWAY OPPOSED? ANY ABSTENTIONS IN OKAY. I INVITED LARRY TO SPEAK. THANK YOU. BECAUSE HE FELT THIS WAS SO NICELY PRESENTED AND THE DISCUSSION WAS ON TARGET. YOU'VE GIVEN US A LOT TO THINK ABOUT, WHAT I HOPED WOULD HAPPEN AND THERE ARE A NUMBER OF INSTITUTE DIRECTORS WHO TURNED UP AS WELL AS SENIOR STAFF, THERE'S INTENSE INTEREST ABOUT THE REPORT THAT YOU JUST PRESENTED AND HOW WE GO FORWARD. MICHAEL GOTTESMAN WILL NO DOUBT PLAY A CRITICAL ROLE. MICHAEL, YOU AND I NEED TO TALK SINCE THIS LANDS IN YOUR WHEELHOUSE AND WE'LL COME UP WITH A PROCESS. WHEN IT COMES TO RESPONDING, THESE ARE BIG IDEAS AND BIG CHALLENGES AND IMPLICATIONS, WE WANT THE GROUP TO BE OF HIGH LEVEL FOLKS TO HAVE THE CONFIDENCE OF ALL OF THE INSTITUTE DIRECTORS AND OF LARRY AND MYSELF AND MICHAEL, SO WE'LL HAVE TO THINK HARD ABOUT HOW TO POPULATE THAT LIST, EXACTLY THE RIGHT ROSTER OF EXPERTS, BUT WE'LL DEFINITELY DO THAT. >> COULD WE HEAR FROM MAYBE MIKE OR SOME OTHER IC DIRECTORS AS TO THEIR THOUGHTS ON MOVING FORWARD? I'M SURE THIS IS ON YOUR MINDS. >> OH, ABSOLUTELY. FIRST OF ALL, I WOULD LIKE TO THANK THE WORKING GROUP AND THIS IS A THOUGHTFUL REPORT AND INCREDIBLY INTERESTING DISCUSSION TO ME. I'M NOT MAYBE EVERYTHING BUT I'M CERTAINLY A GOOD LISTENER AND ENJOYED THE DISCUSSION. WE'VE BEEN HAVING A SERIES OF DISCUSSIONS INTERNALLY AS WELL, SOME ARE PARALLEL TO WHAT YOU'VE HEARD, SOME ARE DIFFERENT. I THINK FRANCIS' SUGGESTION TO GET A SENIOR GROUP TOGETHER AND COME UP WITH WAYS TO MAKE YOU PROUD AS WE ARE OF THE RAL. THAT'S THE INTENT AND I'M GREAT FOR FOR THE INPUT WE'VE GOTTEN. >> ANY OTHER SENIOR LEADERS? QUESTION, MAYBE IN TERMS OF THE PART OF CATO'S REPORT THAT WASN'T PART OF THE FINAL REPORT, DO YOU THINK, YOU KNOW, TO ME AS TO RUSS IT SEEMS LIKE THE MOST SERIOUS IMPEDIMENT TO THE TRAINEES IN THE INTRAMURAL PROGRAM IS THEIR INABILITY TO GO TO MEETINGS WITHOUT THE SORT OF VERY DIFFICULT PROCESS, EVEN IF IT'S THE SOCIETY FOR NEUROSCIENCE MEETING IN WASHINGTON, D.C. THERE'S A HUGE PROCESS OF GETTING APPROVED TO GO. IS IT POSSIBLE TO THINK OF WAYS OF, SAY, HAVING A CERTAIN NUMBER OF MEETINGS, EASTERN LIKE THE GORDON CONFERENCES THAT WERE OUTSIDE OF THAT, IS THAT DOABLE OR COMPLETELY HOPELESS? IN NO ONE ON THE STAFF SIDE RESPONDED. >> YOU UNDERSTAND WE'RE RESPONDING TO LAW. THIS IS NOT SOMETHING THAT ANYBODY HERE OR AT HHS DREAMT UP. WE HAVE WORKED VERY CLOSELY WITH HHS, WHEN THIS ALL FIRST STARTED, SOME OF YOU MAY KNOW THAT STUDY SECTIONS WERE INCLUDED, AND SO FORTUNATELY WE WERE ABLE TO -- WHEN I SAY WE, I MEAN COLLEEN BARROWS WHO CARRIED THE WATER, WE CONTINUE TO WORK WITH HHS TO LOOK AT WAYS TO STREAMLINE THE PROCESSING. WE HAVE CUT IT EVERY CONCEIVABLE WAY TO THINK OF, EVERY PERMUTATION, EVERY COMBINATION, TO WHAT MAKES SENSE TO RATIONALIZE AS TO WHY THIS SUBSET OF MEETINGS SHOULD OR SHOULD NOT BE SCRUTINIZED IN THE WAY THAT THEY PRESENTLY ARE. AND SO THIS IS A WORK IN PROGRESS. I REMEMBER VIVIDLY THE SOCIETY FOR NEUROSCIENCE MEETING. OKAY? EVERY -- SO IT TOOK LONGER THAN WE WOULD HAVE LIKED, BUT EVERYTHING WAS APPROVED AT THE END OF THE DAY. SO THE NOTION -- [LOW AUDIO] I'M SORRY? [LOW AUDIO] WELL, BUT, WALTER, YOU KNOW -- BUT, WALTER, HONESTLY, IT MAKES SENSE TO EVERYBODY IN THIS ROOM BUT TO, YOU KNOW, JOHN AND JANE Q. PUBLIC WHO DOESN'T KNOW THE DIFFERENCE BETWEEN A SCIENTIFIC MEETING AND THE SILLINESS THAT HAPPENED WITH WHATEVER THE ORGANIZATION WAS, THEY SAY, OH, A TRIP, OH, PARTY TIME! AND WE ALL KNOW HOW HARD EVERYBODY WORKS AT SCIENTIFIC MEETINGS TO THE AVERAGE PUBLIC IT'S NOT PART OF WHAT THEY UNDERSTAND. YES, IT WAS IN WASHINGTON, D.C. AND THAT'S WHY WE WERE ABLE TO TAKE ADVANTAGE OF THAT AND HAVE SO MANY PEOPLE GO, SO IT'S NOT THAT WE'RE NOT TRYING, WHEN I JUST DO INCREDIBLE WORK AT THIS, AND HOPEFULLY AS TIME GOES FORWARD WE'LL BE ABLE TO PICK AWAY AT THIS. >> I GUESS YOU HEAR IN LARRY'S VOICE HOW HARD IT'S BEEN TO TRY TO PUSH BACK ON THIS, BELIEVE ME WE HAVE PUSHED IN EVERY PATH THAT WE COULD IDENTIFY AND MADE SOME HEADWAY INCLUDING IN THE APPROPRIATIONS BILL THAT I MENTIONED THIS MORNING WHICH HAS A TECHNICAL CHANGE IN IT THAT WILL ACTUALLY MAKE THINGS A LITTLE EASIER, WE STILL HAVE TO GO THROUGH THINGS BUT IT'S NOT QUITE AS OBNOXIOUS. AND BELIEVE ME, IN WE SEE ANY AVENUE FOR A LEGISLATIVE FIX, FOR SCIENTIFIC MEETINGS TO BE MADE EXEMPT FROM THIS KIND OF ONOROUS OVERSIGHT WE'LL JUMP IN AND ASK OTHERS TO HELP US TO GET IS DEMORALIZING, INCREDIBLY WASTEFUL OF RESOURCES. COLLEEN, WE FIGURED OUT WE SPEND $12 MILLION ON THE PROCESS OF GOING THROUGH THE TRAVELING CONFERENCE REPORT OCCUPYING THE TIME OF 200 EMPLOYEES TO MAKE THIS COME TOGETHER. FOR WHAT? AS FAR AS I CAN TELL IS ZERO ADDED VALUE. WE OUGHT TO BE ABLE, IT SEEMS TO ME, TO HAVE THE TRUST OF OTHERS TO MANAGE OUR OWN BUDGETARY AFFAIRS, TO FOCUS ON GETTING SCIENCE DONE IN THE BEST WAY POSSIBLE, A LOT OF TIMES THAT MEANS LETTING YOUNG SCIENTISTS GO TO MEETINGS AND PRESENT DATA AND RUB SHOULDERS AND BIG RELATIONSHIPS AND COME UP WITH COLLABORATIONS, IT'S OFFENSIVE THAT'S PERCEIVED AS SOME PERK WHERE EVERYBODY'S GOING TO HAVE A GOOD OL' TIME. ENOUGH OF MY SPEECH. BUT WE HEAR YOU. BELIEVE ME, THE AMOUNT OF TIME THAT GETS SPENT ON THIS ISSUE PARTICULARLY BY COLLEEN AND HER TEAM AND LARRY AND MYSELF IS PROBABLY MORE THAN YOU WOULD WANT TO THINK ABOUT IN TERMS OF PEOPLE WHO OUGHT TO BE ABLE TO DO OTHER THINGS BUT IT MATTERS. I THINK, AGAIN, I'M ALWAYS THE OPTIMIST. I THINK WE'RE GETTING SOME TRACTION WITH PEOPLE WHO HAVE THE OPPORTUNITY TO GIVE US GRADUALLY SOME RELIEF, THEY GET IT THIS IS NOT SERVING THE NEEDS OF THE COUNTRY OR ANYONE ELSE. NOW THAT I BERATED THE STATE OF THE POLITICAL SITUATION, I HAVE TO TELL YOU WHAT'S HAPPENING ON HILL. IT'S NOT BEEN A GOOD DAY. WE'RE NOW SIX HOURS AND 15 MINUTES AWAY FROM WHAT COULD BE A GOVERNMENT SHUTDOWN BECAUSE THE OMNIBUS BILL HAS NOT MADE IT THROUGH THE HOUSE, THEY HAD TO RECESS AT 2:00. AT 5:30, 15 MINUTES AGO, THE DEMOCRATS WENT INTO A CLOSED MEETING TO DECIDE WHAT STANCE THEY ARE GOING TO TAKE BECAUSE THEY ARE PARTICULARLY INCENSED ABOUT FEATURES OF THIS BILL THAT INVOLVED THE STEPPING BACK FROM SOME DODD-FRANK CHARACTERISTICS IT'S THE NOT CLEAR WHAT MIGHT BE HAPPENING. ONE OF THE OTHER THINGS BOEHNER SAID, IF WE CAN'T GET IT DONE WE MIGHT HAVE TO DO A WEEK-LONG CONTINUING RESOLUTION IN ORDER TO SORT THAT OUT, AND THEN TRY TO FIX THIS BEFORE THEY REALLY GO HOME. THEY HAD PLANNED TO GO HOME SOONER. THERE ARE ALSO OCCASIONAL NOISES OUT THERE ABOUT MAYBE THIS WILL MEAN THEY WILL PASS A THREE-MONTH CR FOR THE ENTIRE GOVERNMENT AND OUR OMNIBUS WILL DISAPPEAR AND I DEEPLY HOPE THAT DOES NOT HAPPEN BECAUSE THAT WOULD BE FROM OUR PERSPECTIVE A REAL LOST OPPORTUNITY AND I HOPE THAT ALMOST EVERYBODY SEES THAT AS A NEGATIVE, BUT IN THIS PARTICULAR CHESS GAME, IT'S HARD TO KNOW WHO IS MAKING WHICH MOVES. SO WE'LL HAVE AN INTERESTING EVENING WONDERING WHETHER WE'RE COMING BACK TOMORROW MORNING OR NOT. IF THERE WERE A GOVERNMENT SHUTDOWN WE WOULD NOT BE ABLE TO HAVE THE SECOND DAY OF THE MEETING. I THINK THAT'S VERY UNLIKELY BECAUSE NOBODY WANTS THAT. >> ARE OUR RIDES HOME FROM DINNER IN JEOPARDY? [ LAUGHTER ] >> NOT TO WORRY. WE'LL STILL HAVE A LOVELY EVENING AND YOU'LL STILL BE SLEEPING IN YOUR BEDS AT MIDNIGHT, MOST OF YOU WILL, WHEN THE DEADLINE IS REACHED. THEN THE ALARM WILL GO OFF. SO -- [LOW AUDIO] >> YOU ALL HAVE WORKED HARD TODAY AND YOU HAVE NOW EARNED AN EVENING THAT'S MORE RELAXED AND INFORMAL. WE'RE AT A PRETTY GOOD MOMENT. MY UNDERSTANDING IS IN 13 MINUTES THERE WILL BE A SHUTTLE BUS AT THE C ENTRANCE, RIGHT? YOU FIND ARE YOU WAY TO THAT DOOR. IF YOU GO TO THE MAIN ENTRANCE YOU WILL NOT FIND A SHUTTLE BUS SO GO TO THE C WING, WHICH IS THE ONE WE'RE IN. THE SHUTTLE WILL TAKE YOU THAT KATHY HUDSON'S HOME FOR DINNER AND DRINKS AND THEN WE'LL GET YOU BACK TO THE HOTEL. WE'RE ADJOURNED.