GOOD MORNING. MY NAME IS MUIN KHOURY, I RUN THE EPIDEMIOLOGY PROGRAM AT THE CANCER CONTROL POPULATION SCIENCES ON BEHALF OF NCI, EXCITED TO INTRODUCE Y'ALL TODAY. COHORT CONSORTIUM SYMPOSIUM, IT'S GREAT TO BE HERE. GREAT TO SEE EVERYONE THIS MORNING. I'M GOING TO BE VERY BRIEF BECAUSE THERE IS A FULL DAY WORTH OF STUFF. I WOULD LIKE TO SAY A FEW WORDS ON BEHALF OF THE PROGRAM AND INTRODUCE A CONVERSATION WE'RE HAVE ABOUT THE FUTURE OF EPIDEMIOLOGY SO THIS SYMPOSIUM FITS NICELY INTO THE DISCUSSION WE'RE HAVING. AS YOU CAN SEE WE'RE AT THE CROSS ROADS IN THE DESIGN OF COHORTS AND CONSORTIA IN THE NEXT DECADE. EMERGING COHORTS HAVE HAD LOTS OF DISCUSSIONS WITHIN THE NIH COMMUNITY. AND OTHER INSTITUTES WERE QUITE WELL REPRESENTED HERE HAVE BEEN ENGAGING IN A FAR-REACHING EFFORT TRYING TO MAP OUT THE FUTURE ACROSS MULTIPLE DISEASES. BEFORE WE GET TOO FAR, THERE ARE LOTS OF PEOPLE TO THANK, NOT GOING TO READ EVERY SINGLE NAME ON THIS SLIDE. THIS COHORT CONSORTIUM HAS BEEN A REAL PARTNERSHIP BETWEEN INTRAMURAL AN EXTRAMURAL FOR SO MANY YEARS NOW AND OUR FRIENDS IN THE DIVISION OF CANCER GENETICS HAVE BEEN AN INTEGRAL PART OF THIS CONSORTIUM FOR MANY, MANY YEARS. LIKE TO -- I DON'T WANT TO SINGLE OUT TOO MANY PEOPLE EXCEPT TO SINGLE OUT PERHAPSTRY SHAH FOR HER TIRELESS WORK IN THIS ENDEAVOR. LOTS OF PEOPLE FROM EGRP HAVE BEEN INVOLVED. THANK YOU FOR YOUR EFFORTS, DEBBIE WINN AND DANIELA AND A FEW OTHERS. SO JUST TECHNICAL SUPPORT, WE CAN'T DO THIS MEETING WITH A LOT OF PEOPLE WHO ARE AROUND THIS HALLWAY AND OUTSIDE. NOT GOING TO TALK ABOUT THE CONSORTIA, IT'S BIG ENTERPRISE NCI FUNDS SOME OF IT AND IT'S REALLY AN EXCITING TIME TO GET TOGETHER TO SEE WHERE WE'RE GOING AND WHERE WE HAVE BEEN IN THE PAST. WHAT I WOULD LIKE TO DO IS SORT OF SET THIS CONVERSATION IN TERMS OF WHAT THE FUTURE HOLDS FOR EPIDEMIOLOGY IN THE 21st CENTURY. WE HAVE ALREADY BEGUN WHAT I CALL A LONGITUDINAL MEETING, LONGITUDINAL MEETING THAT STARTED WHEN WE PUBLISHED AN EDITORIAL IN JUNE IN CANCER EPIDEMIOLOGY AND BIOMARKERS. WE STARTED A VERY ACTIVE BLOG CALLEDDED CANCER EPIDEMIOLOGY MATTERS BLOG. AND I KNOW OTHER INSTITUTES HAVE BEGUN DOING THE SAME NHLBI ON DIGITAL CONVERSATION ABOUT THE FUTURE OF EPIDEMIOLOGY. WHY DO WE DO THIS? THIS IS A TIME OF CHANGE, TIME OF SCIENTIFIC EXCITEMENT, LOTS OF THE TECHNOLOGY. BUT ALSO THE POTENTIAL FOR RESTRICTION OR CONSTRICTION AND RESOURCES. SO WE HAVE TO BE VERY WISE AND SAVVY ON HOW WE BUILD EPIDEMIOLOGIC INFRASTRUCTURE FOR THE FUTURE. THIS IS THE COMMENTARY WE JUST PUBLISHED. WE CALL IT A CHALLENGE BUT IT'S MORE OF A CONVERSATION AND THE BLOG HAS BEEN VERY ACTIVE, SOMEBODY TOLD ME YESTERDAY WE HAVE ALREADY HAVE MORE THAN, I DON'T KNOW, 10, 15,000 HITS ON THE BLOG BUT I WOULD LIKE TO HAVE MORE CONVERSATION, I WOULD LIKE PEOPLE TO ACTUALLY COMMENT ON WHAT'S GOING ON. THERE ARE LOTS OF TOPICS ALREADY -- WITHIN THE CONVERSATION. FEEL FREE TO COME IN, GIVE US YOUR THOUGHTS ABOUT HOW TO SHAPE THE FUTURE OF EPIDEMIOLOGY. SO THAT THE CHALLENGES WE FACE ARE ACTUALLY EXCITING BECAUSE WE LIVE IN ANKER RA OF LOTS OF DATA AND LOTS OF DATA WE CAN COLLECT, LOTS OF DATA THAT'S AVAILABLE AND WE CAN COIN OUR OWN IF YOU WANT TO DEFINE YOUR SUCCESS IN SCIENCE. IT'S TOUGH BECAUSE SOME OF THESE TOOLS HAVE THEIR OWN LIMITATIONS, THEY'RE NOT CHEAP. WHAT WE NEED TO DO IS TRY TO CHANNEL THEM IN A WAY THAT WOULD MAKE SENSE FOR UNDERSTANDING POPULATION HEALTH. SO I GUESS WELCOME TO THER RA OF WHAT I CALL INCIDENTAL OMIC EPIDEMIOLOGY. THE QUESTION THAT'S -- THAT I HAVE BEEN THINKING ABOUT OVER THE LAST YEAR SINCE I JOINED THE EPIDEMIOLOGY AND GENOMIC RESEARCH PROGRAM AT NCI, WHICH BRAND OF EPIDEMIOLOGY WOULD SHOW UP IN THE 21st CENTURY. THIS IS ONE BRAND OF EPIDEMIOLOGY AS SOMEBODY SAID, A FEW YEARS AGO EPIDEMIOLOGISTS DRIVE US CRAZY, THE REASON THEY DO THAT IS BECAUSE OF THINGS LIKE THAT. THIS IS A FICTITIOUS PAY FRESH THE NEW ENGLAND JOURNAL OF PANIC INDUCING THAT SHOWS THAT COFFEE CAUSES DEPRESSION ONLY IN TWINS. YOU KNOW WHAT I'M TALKING ABOUT HERE, A LOT OF PEOPLE IN THIS ROOM CAN IDENTIFY WITH THE CHALLENGES OF TYPE 1 ERRORS, TOO MUCH DATA TO MINE, TOO MANY EAGER STUDENTS AND FELLOWS TO WRITE PAPERS AND TOO MANY OBSERVATIONS THAT END UP REFUTED BY OTHER OBSERVATIONS OR IN CLINICAL TRIALS LATER ON. THAT'S ONE BRAND OF EPIDEMIOLOGY, I WOULD LIKE US TO TRY TO AVOID IN OUR CONVERSATION. BUT THE OTHER BRAND IS SORT OF A FORWARD LOOKING BRAND. SORT OF THE TRANSLATIONAL BRAND. THIS PAPER ACTUALLY WAS WRITTEN BY THE DIRECTOR OF CDC JEFF COPELAND BACK IN 1999 WHERE HE TALK ABOUT EPI IN THE 21st CENTURY AND APPLIED SETTING. CDC IS A VERY APPLIED AGENCY, ABOUT CALCULATION COMMUNICATION AND INTERVENTION. AND OF COURSE THE CITATION HERE IS FROM SPIELBERG, UNIVERSITY OF PITTSBURGH ABOUT THE HUMAN GENOME SEQUENCE AND THE PUMP, ANYBODY HAS BEEN THROUGH EPIDEMIOLOGY 101 COURSE KNOWS ABOUT JOHN SNOW AND THE STREET PUMP IN LONDON AND THE CHOLERA EPIDEMIC. THE IMAGE HERE IS THAT OF MOVING FORWARD WITH DISCOVERIES THAT TRANSLATE. MY FRIEND JOHNNY JUANITA WHO ALWAYS SEEMS TO BE IN THE HEADLIGHT, IN THE SPOTLIGHT, HE HAS A PAPER THIS WEEK IN JAMA, SORT OF ALWAYS -- SORT OF POINTING OUT THE OBVIOUS IN RESEARCH AND META RESEARCH. THERE ARE TWO QUOTE FROM THE PAPER THAT HAVE BEEN CIRCULATED A LOT. THIS IS IN THE CONTEXT OF MEDICAL INTERVENTIONS BUT I THINK IN PREVENTION AND PUBLIC HEALTH, THE PICTURE IS NOT THAT DIFFERENT. SO THE ONE ON THE LEFT-HAND SIDE SAYS 101 PROMISING CLAIMS OF NEW DISCOVERIES WITH CLEAR CLINICAL POTENTIAL ONLY FIVE RESULTED IN INTERVENTIONS WITH A LICENSE CLINICAL USE 20 YEARS LATER. SO THERE IS THIS DROP OFF FROM INITIAL DISCOVERIES TO CHARACTERZATION ALL THE WAY TO INTERVENTIONS. THE OTHER MORE CHALLENGING DATA POINT WHICH IS OF A NON-REFUTED INTERVENTIONS HIGHLY CITED IN RANDOMIZED CLINICAL TRIALS TO SUPPORT THEM, THE MEDIAN TRANSLATION TO PRACTICE IS ABOUT 16, 17 YEARS. SO IT'S A LONG ROAD AHEAD OF US. EPIDEMIOLOGY, EPIDEMIOLOGISTS HAVE I THINK A LONG WAY AND IMPORTANT ROLE IN DOING THIS. I THINK THE COHORTS OF THE FUTURE, WHICH WILL BE DISCUSSING TODAY THE COHORTS OF THE PAST AND FUTURE AND ALL OF THEM WILL HAVE TO HAVE A STRONG TRANSLATIONAL COMPONENT TO JUSTIFY THE VIABILITY OR HEAVY INFRASTRUCTURE THAT GOES ALONG WITH SETTING THEM UP. OF COURSE, DR. ZERHOUNI HONEY WAS DIRECTOR HERE MANY YEARS AGO, ALWAYS TALKING TRANSLATIONAL RESEARCH IN THE CONTEXT OF SETTING UP THE CTSAs AND THIS RECENT PAPER HE PUBLISHED IN SCIENCE TRANSLATION MEDICINE. WE HAVE ALWAYS KNOWN ABOUT CROSSING THE VALLEY OF DEATH. BUT THAT VALLEY OF DEATH IS REALLY A SMALL BET FROM BENCH TO BEDSIDE. SINCE HAROLD VARMUS BECAME NCI DIRECTOR A COUPLE OF YEARS AGO HIS FIRST TOWN HALL MEETING WHICH I DIDN'T ATTEND BUT READ THE TRANSCRIPTS AND SAW VIDEOS ON THE WEBSITE EVEN HAD SOMETHING GOOD TO SAY ABOUT THE FUTURE OF EPIDEMIOLOGY HE HAS REQUEST FOR TRYING TO EVALUATE THE ACCOMPLISHMENTS OF NCI AND TRYING TO COME UP WITH PROVOCATIVE QUESTIONS FOR THE FUTURE. HE WAS THINKING THAT EPIDEMIOLOGY WILL HAVE A DRAMATIC RESOLUTION. I THINK HE'S REVOLUTION. HE'S COMING FROM THE BASIC SCIENCE PERSPECTIVE OF MOLECULAR TOOLS THAT COULD HELP US IN OUR QUEST FOR PREVENTION DIAGNOSIS AND TREATMENT AND SO ON. SO I HAVE BEEN THINKING ABOUT THIS OBVIOUSLY FOR MANY YEARS BECAUSE I COME FROM A MORE APPLIED WORLD WHICH IS CDC AND PUBLIC HEALTH GENOMICS. I HAVE WRITTEN THIS PAPER A COUPLE OF YEARS AGO ABOUT TRANSLATIONAL EPIDEMIOLOGY AND I KIND OF TOOK TRANSLATION A LITTLE BIT FURTHER THAN THE WAY WE THINK ABOUT TRANSLATION PERHAPS AT NIH WHICH IS THE BENCH TO THE THE BEDSIDE MODEL. THERE IS A LIFE CYCLE OF RESEARCH THAT STARTS WITH DISCOVERY BUT THEN ENDS UP WITH POPULATION HEALTH METRICS AND HEALTHCARE AND PUBLIC HEALTH PRACTICE. EACH STEP OF THE WAY I THINK EPIDEMIOLOGISTS HAVE A MAJOR ROLE IN DOING THE STUDIES THAT LEAD TO PROMISING INTERVENTIONS AND THEN EVALUATING THESE INTERVENTIONS LEADING TO EVIDENCE-BASED POLICIES OR GUIDELINES AND RECOMMENDATIONS. AND THEN IMPLEMENTING THESE THINGS IN PRACTICE. THE WAY EPIDEMIOLOGY MORPHS ACROSS THE CONTINUUM IS CALLED DIFFERENT THINGS. DIFFERENT PARTS OF THE CYCLE WHEN YOU GET TO THE T-3 WE CALL IT APPLIED RESEARCH OR HEALTH SERVICES RESEARCH, WE CALL IT DIFFERENT THINGS. OUTCOMES RESEARCH OR SURVEILLANCE BUT THE EPIDEMIOLOGIC WAY OF THINKING PERHAPS IF THERE ARE COHORTS THAT TELL THAT STORY OF MOVING FROM THE F-0 TO TO THE T-4 WORLD, TO ME, THAT WOULD EXEMPLIFY THE SUCCESS OF THE EPIDEMIOLOGIC ENTERPRISE. WHAT I WOULD LIKE TO SEE FROM THIS MEETING WHICH FEEDS TO THE DECEMBER WORKSHOP, I THINK JULIE IS ONE OF OUR SPEAKERS, WE HAVE A WHOLE SESSION ON COHORTS, A SERIES OF PAPERS AND RECOMMENDATIONS THAT WILL COME OUT OF OUR DECEMBER WORKSHOP. BY THE WAY, THE WORKSHOP IS KIND OF OPEN ON THE WEB, IF YOU COME TO BETHESDA YOU CAN PARTICIPATE IN SO MANY WAYS. YOU CAN SEND YOUR QUESTIONS AND COMMENTS. AS PART OF THIS DISCUSSION, THERE ARE DRIVERS OF EPIDEMIOLOGIC RESEARCH, WOULD LIKE TO EXPLORE MORE IN DEPTH THAT TAKE INITIAL DISCOVERIES AMOVE THEM FROM T-1 TO T-4 PATHWAY. THESE DRIVERS REALLY HAVE BEGUN OVER THE LAST FEW YEARS MOVING THE WHEELS SO TO SPEAK, COLLABORATION AND TEAM SCIENCE IS WHAT DRIVES THE COOR CONSORTIUM HAS DRIVEN IT FOR MANY, MANY YEARS. TECHNOLOGY. I'M NOT JUST TALKING OMICS BUT ALL KINDS OF TECHNOLOGIES, TECHNOLOGIES TO COLLECT DATA AND INVOLVE PEOPLE IN THE SCIENCE AND TRANSLATION. THE MULTI-LEVEL ANALYSIS AS IT MOVES ACROSS WE CALL IT DIFFERENT THINGS, WHEN WE TALK GENE ENVIRONMENT INTERACTION BUT THEN WHEN HE GET TO IMPLEMENTATION WE TALK ABOUT HEALTH SERVICE SYSTEMS AND POPULATION POLICIES, ET CETERA. AND THEN WHAT TIES IT ALL TOGETHER IS THE ABILITY TO SYNTHESIZE INFORMATION FROM BASIC CLINICAL AND POPULATION SCIENCE USING TOOLS OF META ANALYSIS AND OTHER THINGS IN MODELING. I WOULD LIKE TO SEE MORE OF THESE THINGS MOVING OUR AGENDA FORWARD IN A TRANSLATIONAL FASHION OVER THE NEXT FEW YEARS. IN CLOSING, I THINK FIRST I'M LOOK FORWARD TO THIS EXCITING DAY, I WOULD LIKE TO SEE MORE DELIBERATIONS AN DISCUSSIONS FEEDING INTO SHAPING THE FUTURE OF EPIDEMIOLOGY, IN PARTICULAR THE FUTURE OF COHORT STUDIES AND HOW THEY CAN CONTRIBUTE TO HOUR OUR KNOWLEDGE AND ETIOLOGY, TREATMENT OUTCOMES AN SURVIVORSHIP. WITH THAT INTRODUCTION I WOULD LIKE TO INVITE JIM CERHAN TO TAKE IT FROM HERE. THANK YOU FOR BEING HERE. LOOK FORWARD TO THE REST OF THE DAY. JIM. [APPLAUSE] >> THANK YOU, MUIN. I'M JIM CERHAN, CHAIRMAN OF THE SECRETARY, ON BEHALF OF THE SECRETARY I WELCOME YOU HERE TO THIS SYMPOSIUM. WHY ARE WE DOING THIS, PART HAS COME FROM CONVERSATIONS THAT HAVE BEEN OCCURRING AT THE ANNUAL CANCER COHORT CONSORTIUM MEETING, REALLY KIND OF HIT A FEVER PITCH LAST YEAR AND IT FELT THE TIME TO THINK OUTSIDE OUR OWN INSTITUTE, OUTSIDE OUR OWN DISEASE BASED COHORTS WAS RIPE O SO THE SECRETARIATE RESPONDED TO THAT, THAT'S HOW THE SYMPOSIUM CAME TOGETHER. LOTS OF OTHER THINGS HAVE BEEN GOING ON. THERE WAS A COMMON FUND INITIATIVE ANNOUNCEMENT THAT ACTUALLY RICHARD SUZMAN WHO WILL BE TALKING SOON TOOK THE REED ON FROM NIA'S PERSPECTIVE ON SYNTHETIC COHORTS. THE NHGRI PUT ON A WORKSHOP TO TALK SEQUENCING IN COHORTS. WE'LL HEAR A LITTLE BIT ABOUT THAT. AND I THINK AS MUIN POINTED OUT, THAT'S WHERE THE SCIENCE IS GOING. WE HAVE NEW TECHNOLOGIES, NEW BIOLOGY, WE HAVE NEEDS FOR LARGER SAMPLE SIZE AND MANY QUESTIONS WE WANT TO ASK. SO THAT'S BEEN WHAT'S DRIVING THIS AND KIND OF WHAT PULLED THIS TOGETHER. SO OUR OBJECTIVES ARE IN YOUR HAND OUTS BUT REALLY THIS IS MEANT TO -- WHAT ARE THE OBSTACLES AND OPPORTUNITIES, PARTICULARLY NOW TO THINK OUTSIDE AND ACROSS INSTITUTES, THAT'S WHY WE HAVE SPEAKERS FROM MULTIPLE INSTITUTES HERE. WHAT ARE ADVANTAGES AN CONSTRAINTS. WE NEED TO BE THINKING SHORT TERM IN THE NEXT YEAR, MEDIUM TERM NEXT FIVE YEARS AN LONG TERM. LAUNCHING THE COHORTS WILL -- IS A 20 TO 50 YEAR PROPOSITION. WHAT ARE THE PRACTICAL ISSUES OF MAINTAINING A PORTFOLIO. WE BROKE INTO THREE SESSIONS. THIS IS THE OPENING SESSION. WE'LL MOVE INTO SORT OF A SPECTRUM OF EXPERIENCES, ACROSS FOUR INSTITUTES. THESE TALKS WILL BE ABOUT 20 MINUTES THEN THERE WILL BE TIME FOR QUESTIONS. SO WE WANT TO MAKE IT AS INTERACTIVE AS POSSIBLE. THERE ARE MICROPHONES OUT IN THED AUDIENCE. AFTER THAT SESSION WILL WILL BE BREAK. IT'S ABOUT 15 MINUTES. WE'RE IN TIME OF CONSTRAINT, THERE'S NOT COFFEE OUTSIDE, IF YOU WANT COFFEE YOU HAVE TO MOVE OVER TO THE CAFETERIA AND GRAB IT BUT WE'LL MAKE SURE EVERYBODY CAN GET THEIR COFFEE AND BACK. RESTROOMS ARE OUT OPT SIDES. WE'LL RECONVENE HERE THEN HAVE A MODERATED PANEL WITH PANELISTS KIND OF REFLECTING ON WHAT THEY HEARD BUT THEN OPENING UP WITH THE AUDIENCE. WITH THAT, WE'LL MOVE TO OUR FIRST TALK. [APPLAUSE] >> I WOULD LIKE TO INTRODUCETRY SHAH HEARCHEE WHO HAS BEEN A FORCE BEHIND THIS SYMPOSIUM. WELCOME,TRY SHAH. >> THANKS, JIM. IT'S A GREAT PLEASURE TO BE HERE. I'M GOING TO GIVE A LITTLE FLAVOR REALLY, A LITTLE OVERVIEW OF JUST WHAT WE HAVE BEEN ABLE TO ACCOMPLISH IN THE MANY CONSORTIUM STUDIES THIS YEAR, MY FOCUS WILL BE ON 20126789 AS I WAS PICKING WHICH HIGHLIGHTS TO SHOW YOU, I'M ESSENTIALLY HAVING IN MIND OUR AUDIENCE OF GUESTS OUTSIDE OF THE CANCER COHORT CONSORTIUM BECAUSE YOU MIGHT NOT BE AS FAMILIAR WITH WHAT WE'RE UP TO. BUT THEN I REALIZE NOW THAT WE ARE FOUR DOZEN COHORTS AND 30 PROJECTS WE OURSELVES CAN NOT POSSIBLY KNOW WHAT THE OTHER GUY IS UP TO. SO I APOLOGIZE IF I HAVEN'T PUT IN THE VERY IMPORTANT PUBLICATION YOUR GROUP CAME OUT WITH THIS YEAR BUT I THINK BY TAKING A LITTLE SMATTERING ACROSS THE PROJECTS THAT WE'RE WORKING ON, YOU CAN GET A GOOD IDEA OF WHERE WE ARE, WHAT WE'RE ABLE TO DO. I HOPE THAT WILL INFORM SOME OF THE CONVERSATION ABOUT WHAT WE MIGHT WISH TO DO GOING FORWARD. YOU HAVE A WONDERFUL HAND OUT AVAILABLE. THE PROJECTINGS THE SECRETARIATE HAS APPROVED THAT ARE ON GOING. FOR DETAILS I WOULD REFER YOU TO THAT AND ALSO IT'S AVAILABLE EASILY ON THE WEB. OUR STUDIES BROADLY SPEAKING FALL INTO THREE CLASSES, GENOMIC WORK, WORK USING BIOLOGICAL MARKERS COLLECTED BEFORE DIAGNOSIS, AND WORK LOOKING AT BEHAVIOR AND ENVIRONMENT USING PRINCIPALLY QUESTIONNAIRES. IT WAS AS I'M SURE IS THE CASE WITH MANY OTHER CONSORTIA, IT WAS THE GENOMICS THAT BROUGHT US TOGETHER AND MOTIVATEDDED EVERYBODY TO DO A CONSORTIUM. IT'S HARD WORK BUT THE STATISTICAL POWER REQUIREMENTS GENOME WIDE ASSOCIATION STUDIES ARE IN EFFECT, NOT NEGOTIABLE. SO IT WAS GWAS THAT BROUGHT US TO THE DANCE, I WOULD SAY IT'S BEEN MASSIVELY, STUNNINGLY SUCCESSFUL, WE HAVE MADE A LOT OF DISCOVERY, WE HAVE AVOIDED ERRORS FROM UNDERSIZED STUDIES AND I THINK WE SAVED A LOT OF TIME. BUY LONGCAL MARKER STUDIES ARE IN A SENSE THE MOST OBVIOUS REASON FOR HAVING A COHORT CONSORTIUM, NAMELY, YOU HAVE TO HAVE PROSPECTIVE COHORTS TO ANSWER MANY OF THE QUESTIONS THAT ARISE ABOUT WHAT'S THE BIOLOGICAL STATE WELL BEFORE DIAGNOSIS, WE'RE FORTUNATE THAT MANY COHORTS FUNDED BY THE CANCER INSTITUTE AND MANY COHORTS IN GENERAL, HAVE BANKED BIOSPECIMENS AND THEREFORE CAN LINK THEM TO EVENTS THAT HAPPEN LATER IN TIME. THE BIG PROBLEM IS USUALLY COMPARABILITY. WE HAVE HAD A FEW EXPERIENCES THAT SHOW WHEN IT'S POSSIBLE TO OVERCOME THOSE CHALLENGES. I WOULD SAY BECAUSE OF THE EXPENSE INVOLVED THAT REMAINS -- REMAINS A BIG HURDLE. WE HAVE FEWER STUDIES IN THE ZONE OF PRE-DIAGNOSTIC MARKERS AND THE OTHER TWO AREAS. IN OUR BEHAVIORAL ENVIRONMENTAL WORK WE'RE FOLLOWING A LONG TRADITION IN EPIDEMIOLOGY OF POOLING STUDIES FOR POWER. OFTEN WITH THE AIM TO INFORM PUBLIC HEALTH BUT ALSO PARTICULARLY TO FEEDBACK INTO OUR OWN WORK ON ENVIRONMENT BIOMARKERS AND GENOMICS. WE HAVE QUITE A FEW ONGOING GENOMIC STUDIES, THAT IS GWAS, THE FIRST OUR SIGNATURE INITIATIVE WAS THE BREAST AND PROSTATE CANCER COHORT CONSORTIUM AND I THINK THAT THEY HAVE PUBLISHED MAYBE 60 PAPERS. THE GLIOMA SCAN PUBLISHED THIS YEAR, I'LL GIVE A FEW HIGHLIGHTS, MANY OF THESE ARE ONGOING. THIS IS NOT A SURPRISE TO ANYBODY IN THE WORLD OF GWAS. THIS IS WHAT A AUTHORSHIP PAGE CAN LOOK LIKE. HERE IS ALSO A KIND OF SIGN OF THINGS TO COME. THIS LARGE CON SOURCEIAL LOOK AT THE GENETIC ARCHITECTURE OF ER NEGATIVE BREAST CANCER, INVOLVED NOT JUST OUR CONSORTIUM BPC-3 AND TRIPLE NEGATIVE BREAST CANCER CONSORTIUM AND BCAC BREAST CANCER CONSORTIUM. 'S IN PRESS, VERY EXCITING. I'LL GIVE YOU A TINY FLAVOR. IT IDENTIFIES FOUR NEW LOCI FOR ER NEGATIVE BREAST CANCER. ER NEGATIVE BREAST CANCER IS MAYBE A QUARTER OF DISEASE BUT IT'S MUCH MORE -- HAS MUCH WORSE PROGNOSIS THAN ER POSITIVE SO IT'S GREAT INTEREST. POOLING ALL THESE GROUPS TOGETHER GAVE 4,000 CASES AND 35,000 CONTROLS THE FOUR LOCI, TWO ARE QUITE CLOSE BUT THEY'RE VERY DISTINCT. AND ONE IS IN FTO WHICH WE NOW KNOW IS RELATED TO A LOT OF OTHER CONDITIONS. IN ESOPHAGEAL CANCER GWAS ALSO HAS ITS PAPER OUT THIS YEAR. HERE IS ONE THAT'S INTERESTING, SPECIFICALLY BECAUSE NOT ONLY DID THEY DISCOVER MANY NEW LOCI INDEPENDENTLY EFFECTIVE BUT ALSO THEY FOUND PRETTY STRIKING INTERACTIONS WITH ALCOHOL. THAT WAS ONE OF THE GREAT HOPES THAT WE HAD IN FORMING THE COHORT CONSORTIUM, THAT WE WOULD BE ABLE TO DO TRULY GENE ENVIRONMENT. I THINK THERE ARE MAYBE SOMEWHAT FEWER EXAMPLES DISCOVERIES THAN I MIGHT HAVE PREDICTED 15 YEARS AGO BUT THERE ARE SEVERAL, VERY INSTRUCTIVE AND THIS ONE IS INTERESTING BECAUSE WHEN WE ARE DEBATING WHICH CANCERS ARE MOST SUITABLE FOR GWAS SOMETIMES WE WONDER IF THERE IS VERY LARGE ENVIRONMENTAL CONTRIBUTION THAT SORT OF IN FAVOR OR NOT IN FAVOR OF DOING A GWAS, HERE IS ONE WHERE THERE IS CLEARLY HUGE ENVIRONMENTAL CONTRIBUTION, HUGE GENETIC CONTRIBUTION AND SUBSTANTIAL EVIDENCE OF INTERACTION. GLIOMA PAPER TOUCHES ON AN AREA WE HAD HOPED TO BE ABLE TO EXPLORE, AND HAVE BEEN ABLE TO AS IN THE CASE OF THE ER NEGATIVE, WE FIND THE LOCI CLEARLY ASSOCIATED WITH GLIOMA RISK ACTUALLY THEMSELVES VARY SOMEWHAT BY SUBTYPE. THIS IS ONE WHERE WE FIND A SOMEWHAT STRONGER SIGNAL IN DATA THAT COME FROM COHORTS FROM PROSPECTIVE DATA THAN CASE CONTROL. WE'RE NOT SURE BUT WE THINK THAT'S POSSIBLY BECAUSE THE LEETALTY OF THE DISEASE MAKES IT HARTGE TO GET THE CASES ELIGIBLE IN CASE CONTROL STUDIES. THIS IS INTERESTING FOR SHOWING THAT AS WE GO WE TRY TO CONTRIBUTE METHODOLOGY. HERE I HAVE PICKED OUT MY IDIOSYNCRATIC POLL FROM THESE PAPERS BUT I PULLED OUT FROM THIS PAPER WITH WHICH USES THE PROSTATE CANCER DATA FROM BPC-3, SOMETHING THAT I THINK IS KIND OF INTERESTING CONTRIBUTION. WE CAN MAKE TO THE REST OF THE SCIENTIFIC COMMUNITY. WE CAN GIVE THEM SOME GUIDANCE DEPENDING ON THE PRICE OF SEQUENCING DEPENDING ON HOW -- WHAT FUTURES MIGHT LOOK LIKE, HOW TO PLAN FOR THE NEXT ROUND OF GWAS. THEN FOR SEVERAL GWAS PROJECTS, WE'RE ABLE THEN TO SAY HOW MUCH HAVE WE PUSHED OUR ABILITY TO DO RISK PREDICTION. THIS IS VERY NATURALLY DONE IN THE COHORT SETTING, CERTAINLY CAN BE DONE IN OTHERS. WHAT YOU SEE HERE I'LL TAKE THE TOP LINE, IT'S NOT SO MUCH THE CONTRAST IN THE FOUR BUT YOU CAN TELL FROM TOP LINE THAT FOR MEN UNDER 65, IF YOU ADD GENETICS, FAMILY HISTORY AND OTHER PREDICTORS, YOU DO BEGIN TO EXPLAIN AND FRACTION OF RISK BUT CERTAINLY DON'T RISE UP TO WHAT LOOKS LIKE A PREDICTION CURVE READY FOR CLINICAL TRANSLATION. ON THE OTHER HAND WHEN YOU THINK ABOUT THE CONTROVERSY AND UNCERTAINTY WHO SHOULD GET PSA AND MAMMOGRAPHY, RISK MODELS THAT MAY HELP INFORM WHERE TO DO WHAT BEGIN TO BE THE KIND OF TRANSLATIONAL INFORMATION THAT MUIN ENCOURAGED US TO GET. JUMPING TO THE REALM OF BIOLOGICAL MARKER STUDIES, WE HAD WONDERFUL EXPERIENCE WITH OUR VITAMIN D PROJECT. WE HAVE SEVERAL STUDIES ONGOING. YOU'LL HEAR MORE ABOUT THEM LATER THIS AFTERNOON. AND A NUMBER OF THE CONSORTIA HOPE TO PLAN TO INCORPORATE IN THE FUTURE BIOMARKERS AS WELL. BRENDA BURMAN FOR THE MULTIPLE MYELOMA CONSOR YUM HAS IN PRESS A PAPER, I SHOULD BE OUT IN BLOOD SOON LOOKING AT INSULIN RELATED FACTORS IN RELATION TO MULTIPLE MYELOMA. THE SCIENCE HERE IS INTERESTING AND I THINK ALSO SHOWS THE NECESSITY OF PUTTING TOGETHER EIGHT COHORTS AND EVEN WITH EIGHT COHORTS THIS IS AN UNCOMMON DISEASE, YOU'LL WIND UP WITH 500 CASES. SO YOU CAN'T TO SEE A LITTLE BIT MORE ABOUT IT BUT INTERESTING HERE WAS THE EFFECTS VARYING BY THE LENGTH OF TIME BETWEEN THE BLOOD DRAW AND THE OCCURRENCE OF THE MULTIPLE MYELOMA DIAGNOSIS. THIS IS NOT THIS YEAR BUT JUST TO REMIND THOSE WHO HAVEN'T BEEN INTIMATELY INVOLVED WITH THE CONSORTIUM WE DID A VITAMIN D STUDY FOR SIX CANCERS AND PUBLISHED THEM AT ONCE IN 2010 WHICH WAS OUR FIRST REAL EXPERIENCE IN SUCCESSFULLY DOING THIS ACROSS TEN COHORTS WITH ONE LABORATORY. >> OUR POOLING DATA AGAIN WE HAVE QUITE A VARIETY GOING ON, SO I'M ONLY MENTIONING A FEW THE AFRICAN BODY MASS INDEX PROJECT IS ROLLING ALONG, HAS PRELIMINARY DATA AND I THINK YOU'LL SEE A PAPER SOON. WITHIN THE BMI AND MORTALITY ORIGINAL POOLING PROJECT WE EXTENDED OUT TO LOOK AT WAIST CIRCUMFERENCE, THERE'S PAPER TOBACCO I CAN ONLY ALLUDE TO BECAUSE IT'S IN PRESS, UNDER ONLY BAR GOAL AN INTERESTING ONE ALSO COMING TO FRUITION IS THE MALE BREAST CANCER POOLING PROJECT. HERE IS THE CLASSIC THAT REQUIRES A CON SOURCE UPBECAUSE THE DISEASE IS SO EXTREMELY RARE. WE'RE GETTING INTERESTING PRELIMINARY DATA FROM MY FIRST EFFORT LOOKING AT DIAGNOSIS, RISK FACTORS FOR SECOND CANCERS IN THESE PROSPECTIVE COHORTS WE ENCOURAGE METHODS WORK LIKE THE DIET AND ACTIVITY PROJECT. THIS IS A PAPER OUT OF PANCREATIC CANCER CONSORTIUM. WE GOT TOGETHER TO DO A PAN SCAN, TO DO A GWAS. WITH THE HOPE THAT WE WOULD BE ABLE TO DO GENES AND ENVIRONMENT, WE ALSO ANALYZED MANY RISK FACTORS AND THIS IS THE LAST ONE THAT WE HAVE FINISHED. DIABETES, WE SHOW AS OTHER PEOPLE HAVE THAT THERE'S AN INCREASED RISK OF PANCREATIC CANCER AFTER DIABETES BUT TENDS TO ATTENUATE WITH LONG TIME. THESE ARE THE OLD DATA, BECAUSE I DIDN'T HAVE TIME TO TUCK IN THE PAPER AND PRESS WHICH WE TAKE OUR EXISTING GWAS DATA AN SHOW A RELATIONSHIP WITH SURVIVOR FROM PANCREATIC CANCER, THIS IS WORK OF PETE CRAFT. THAT'S SOMETHING AGAIN THAT MANY OF THE GROUPS ARE DOING. I WAS ACTUALLY A BIT SURPRISED THAT WE WERE ABLE TO SEE SOMETHING. WE ALSO TAKE THE EXISTING DATA AND THEN GOING BACK TO THE OBSERVATION OF DIABETES, WE TAKE THE SNPs THAT ARE KNOWN IN THE LITERATURE TO BE RELATED TO DIABETES, OR TO OBESITY, EACH WHICH IS A RISK FACTOR FOR PANCREATIC CANCER WELL KNOWN AND IN OUR DATA AND ASK DOES IT PREDICT RISK IN OUR DATA. IT ACTUALLY DOES. THIS IS RATHER SURPRISING BUT GENETIC MARKERS ARE ASSOCIATED AS WE HOPE WITH THE CONDITION THEY WERE DISCOVERED FOR, OBESITY OR DIABETES THAT ALSO SURPRISINGLY WITH A LITTLE ASSOCIATION WITH PANCREATIC CANCER. THIS IS A PAPER THAT THOSE OF YOU WHO ARE LAST -- WHO WERE HERE LAST YEAR WOULD HAVE SEEN FROM JIM CERHAN AND AMY BARINGTON, THIS IS NOT PUBLICKED YET BUT WE HAVE HIGH HOPES THAT IT -- THE RIGHT JOURNAL WILLhR YES SOON. IS VERY -- IT'S VERY IMPORTANT I THINK, I SHOW YOU HERE ONLY WOMEN. EXCUSE ME. THE EFFECT IN WOMEN AND ADJUSTED FOR BMI AND SURPRISING SIMILARITY SURPRISINGLY STRONG EFFECT OF WAIST CIRCUMFERENCE IN BMI PRESENT IN MEN AND WOMEN, SOME ATTENUATION WITH AGE, BASED ON A VERY LARGE NUMBER OF PEOPLE FROM 11 COHORTS. 11 COHORTS ARE THAT SUBSET OF THE TOTAL GROUP WHERE WE DID HAVE WAIST CIRCUMFERENCE DATA AVAILABLE. THIS IS A PAPER COMING OUT SOON FROM THE PHYSICAL ACTIVITY AND MORTALITY GROUP SHOWING -- SORRY, SHOWING THE FALL AND HAZARD RATIO AS YOU MOVE FROM VERY LITTLE ACTIVITY. THIS IS LEISURE TIME PHYSICAL ACTIVITY AS YOU MOVE TO MORE AND CORRESPONDING GAIN IN YEARS OF LIFE. WE HAVE A PAPER IN PRESS THAT IS VERY IMPORTANT TOBACCO LOOKING -- MICHAEL TUNE LED THAT LOOKS AT THE EFFECT OF TOBACCO OVER A VERY LONG PERIOD OF COHORT OF TIME OF CALENDAR TIME. I HOPE YOU'LL SEE THAT SOON. IT WAS A HARD ONE TO DO IN THE SENSE IT REQUIRED A FAIR AMOUNT OF HARMONIZATION. YOU KNOW FROM YOUR OWN EXPERIENCE AND YOU WILL HEAR REPEATEDLY THE DISADVANTAGE OF COMBINING COHORTS AS OPPOSED TO DESIGNING THEM IS YOU HAVE TO HARMONIZE DATA COLLECTED SOMEWHAT DIFFERENTLY. BUT OUR OVERALL EXPERIENCE HAS BEEN THAT IF YOU'RE SENSIBLE ABOUT IT AND YOU CHOOSE WIDELY, THERE ARE EXPOSURES WHERE YOU CAN. THEN THERE'S A FAIR AMOUNT OF WORK TO DO BUT HARMONIZATION IS POSSIBLE. THIS PAPER ILLUSTRATES IT AND I THINK IT'S PARTICULARLY WORTHYING ABOUT NOW BECAUSE THE NIH FDA PARTNERSHIP ALLOWS FDA TO FUND RESEARCH, ENCOURAGES THEM TO DO SO, ALLOWS US TO GENERATE RESEARCH THAT COULD BE RELEVANT TO TOBACCO CONTROL. WE THINK THAT WE WANT TO CONTINUE. THIS IS ALONG THE LINES THAT CAME OUT LAST YEAR, LAST FEW YEARS TO EXPLORE WHAT WE CAN DO IN SECOND CANCERS, BEGIN TO EXPLORE SURVIVAL AND WE HAVE A GREAT INTEREST IN LOOKING AT BOTH CANCER AN NON-CANCER OUTCOMES WHICH IS A REASON WE'RE GRATE OFFUL TO HAVE PEOPLE WHO HAVE SIMILAR EXPERIENCES WITH COHORTS AND CONSORTIA FROM THE OTHER DISEASE INSTITUTES HERE WITH US TODAY. I'M -- I HAVE TO THANK ALL THE COHORTS, I REALLY WISH I COULD THANK PEOPLE INDIVIDUALLY. BUT THIS IS A GOOD TIME TO THANK ONE PERSON INDIVIDUALLY WHO HAS DONE SO MUCH FOR THE CONSORTIUM. SO COULD I ASK DR. CROYLE AND DR. CERHAN AND DR. COLINELL. THERE YOU ARE. YOU'RE BEING SHY. LARRY COLINEL IS A PI ON THE MULTI-ETHNIC COHORT. HOW MANY PEOPLE IN THE ROOM HAVE EVER HEARD OF THE MULTI-ETHNIC COHORT? RAISE YOUR HAND. SO WHAT IS IT -- WHAT DOES IT TAKE TO MAKE A SUCCESSFUL COHORT CONSORTIUM STUDY? IT TAKES SOMEBODY WHO HAS ENORMOUS PATIENCE, ENORMOUS VISION, ENORMOUS GENEROSITY, IT ALSO TAKES SOMEBODY WHO HAD A LOT OF SENSE AND VISION 20 YEARS AGO. SO YOU HAVE TO HAVE VISION FOR A VERY LONG TIME AND THE PROJECTS THAT WE DO IN THE CONSORTIUM ARE OBVIOUSLY ONLY AS STRONG AS COHORTS UNDER THEM. SO IT SEEMED LIKE A GOOD TIME IN THE LIFE OF THE CONSORTIUM. THE SECRETARY HAD WANTED PARTICULARLY TO ABSOLUTE A COHORT -- SALUTE A COHORT AND VISIONARY WHO GOT IT GOING. SO I HOPE WE SURPRISED YOU. I DON'T KNOW IF WE HAVE. [LAUGHTER] >> THIS IS THE FIRST TIME WE HAVE GIVEN THIS PARTICULAR AWARD. WE'RE VERY GRATEFUL AND WE'RE REALLY APPRECIATIVE OF THE WORK THAT IT TAKES TO KEEP THE COHORTS GOING. THAT'S CRITICAL. AND THE SCIENTIFIC VISION TO REALIZE WHEN THE BEST THING TO DO IS TO GET TOGETHER WITH OTHER PEOPLE WITH COHORTS AND LAUNCH SOMETHING. WOULD YOU LIKE TO SAY A FEW WORDS? >> WELL, I'M SO SURPRISED, I'M SPEECHLESS. OBVIOUSLY I'M ONLY ONE OF MANY, MANY PEOPLE, 48 I THINK YOU SAID, COHORTS PART OF"sw THIS GROUP. IF I CAN'T SPEAK FOR EVERYONE I WANT TO SAY I THINK ONE OF THE BEST EXPERIENCES OF MY CAREER HAS BEEN THE FORMATION OF THE MULTI-ETHNIC COHORT WITH BRIAN HENDERSON AND OTHER COLLEAGUES (INAUDIBLE) IN THE AUDIENCE HERE AS WELL. IT'S BEEN A MARVELOUS OPPORTUNITY TO FORWARD THE RESEARCH THAT WE HAD BEEN CONDUCTING FOR MANY YEARS BEFORE WE STARTED THE COHORT. AND EVEN THOUGH WE STARTED IT WITH THE IDEA PRIMARILY OF JUST A SELF-CONTAINED COHORT THAT WOULD HOPEFULLY MAKE ADVANCES IN OUR KNOWLEDGE, OF ENVIRONMENTAL OR LIFESTYLE CAUSES OF CANCER, THE IDEA OF FORMING CONSORTIA WITH OTHER COHORTS IS REALLY SOMETHING THAT HAS ENHANCED WHAT WE ENVISIONED DOING WHEN WE STARTED AND HAS REALLY MADE IT POSSIBLE TO MAKE THE ADVANCES BEYOND WHAT WE HAD EVER HOPED TO DO. SO I'M PLEASED TO HAVE BEEN INVOLVED WITH THE MULTI-ETHNIC COHORT AND CONSORTIUM AND THANK THE IDEA WHOEVER GOT THE IDEA BRINGING ME UP HERE FOR DOING SO. [APPLAUSE] >> I'LL READ IT IT SAYS NATIONAL CANCER INSTITUTE CAREER ACHIEVEMENT AWARD LARRY -- LAWRENCE ROLIN,EL FOR EXCEPTIONAL COHORT LEADERSHIP AND SCIENTIFIC VISION. CONGRATULATIONS, LARRY. O THAT'S A WARNING TO -- THAT'S A WARNING TO THE STAY AWAKE OUT THERE BECAUSE WE MAYBE RANDOMLY CALLING OTHER PEOPLE. MOVE TO THE NEXT SESSION, NUMBER TWO, AND I WOULD LIKE TO INVITE DEBBIE WINN CANCER AND POPULATION SCIENCES. >> THANK YOU. IN THIS SESSION WE'LL BE HEARING FROM SOME OF OUR COLLEAGUES FROM OTHER NIH INSTITUTES. I'LL HAVE THEM -- I'M GOING TO INTROTUESDAY THEM BRIEFLY RIGHT NOW THEN WHAT WE WILL BE DOING IS HAVING THEM COME UP ONE AT A TIME SO THEY DON'T HAVE TO SIT UP HERE AND STRAIN THEIR NECKS AND LOOK BACK AND AT THE END THEY WILL BE AVAILABLE FOR QUESTIONS AND DISCUSSION. I'LL GO FIRST TO BAYOUS. -- BIOS. WE'LL HAVE TWO PEOPLE FROM THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE, NHGRI. THEY'RE GOING TO FOCUS ON GENOMIC MEDICINE AND SCIENCE. DR. HINDORFF IS EPIDEMIOLOGIST IN THE DIVISION OF GENOME MEDICINE AT NHGRI, THAT GROUP DIRECTS AND FACILITATES MULTI-DISCIPLINARY RESEARCH TO IDENTIFY GENETIC CONTRIBUTIONS TO HUMAN HEALTH TO ADVANCE APPROACHES IN THE USE OF GENOMIC MEDICINE TO IMPROVE DIAGNOSIS TREATMENT AN PREVENTION OF DISEASE. WE ALSO HAVE ADAM FELSENFELD, PROGRAM DIRECTOR IN DIVISION OF GENOME SCIENCES AT NHGRI. THAT GROUP PLANS AND DIRECTS AND FACILITATES MULTI-DISCIPLINARY RESEARCH TO UNDERSTAND THE STRUCTURE AND FUNCTION OF GENOMES IN HEALTH AND DISEASE. DR. DIANE BILD COMES TO US FROM THE DIVISION OF CARDIOVASCULAR SCIENCE AT THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE NHGRI. SHE'S ASSOCIATE DIRECTOR OF THE PROGRAM AND PREVENTION AND POPULATION SCIENCES. THAT GROUP PROVIDES LEADERSHIP FOR POPULATION AND CLINIC BASED RESEARCH ON CAUSES, PREVENTION AND CLINICAL CARE OF CARDIOVASCULAR, LUNG AND BLOOD DISEASES AND LEAP DISORDERS. RICHARD SUZMAN, DR. RICHARD SUZMAN IS DIRECTOR OF DIVISION OF BEHAVIORAL AND SOCIAL SCIENCE RESEARCH AT THE NATIONAL INSTITUTE ON AGING NIA. THAT -- HIS PROGRAM FOCUSES ON SUPPORTING SOCIAL BEHAVIORAL AND ECONOMIC RESEARCH AND RESEARCH TRAINING ON THE PROCESS OF AGING FROM THE INDIVIDUAL AND SOCIETAL LEVELS. WE HAVE INVITED THESE INDIVIDUALS TO GIVE TALKS BECAUSE THEY ARE REPRESENT THE LEADERSHIP AND FOSTERING COHORTS IN LEADING THEM, IN SUPPORTING THEM, ENCOURAGING THEM AND REMOVING OBSTACLES TO -- TO THEM AT MANY DIFFERENT LEVELS. WE'RE REALLY PLEASED TO HAVE THEM WITH US TODAY. I WANT TO MENTION A COUPLE OF DEVELOPMENTS FROM -- THAT WE AT NCI ARE ENGAGED IN, ACTUALLY EVERYTHING THAT I'M GOING TO MENTION IS SOMETHING WE'RE WORKING TOGETHER ACROSS AGENCIES AND ORGANIZATIONS BOTH AT NIH AND OTHER ORGANIZATIONS ACROSS THE GOVERNMENT AND IN THE NON-GOVERNMENTAL ORGANIZATION ARENA. I THINK WE'RE MAKING -- I THINK WE MADE A LOT OF PROGRESS IN THE PAST YEAR. ONE THING I WANT TO MENTION IS THE NATURAL VIRTUAL CANCER REGISTRY RESOURCE. THE GOAL OF THIS EFFORT IS TO PROVIDE A SINGLE APPLICATION AND SINGLE DATA LINKAGE TO RETRIEVE INCIDENT CANCERS OCCURRING AMONG STUDY PARTICIPANTS AND COHORTS FROM ALL U.S. CANCER REGISTRIES. RIGHT NOW IF YOU ARE -- LOAD A COHORT AND YOU WANT TO FIND OUT ABOUT INCIDENT CANCERS, YOU ACTUALLY HAVE TO APPLY TO 50 STATES WHICH HAVE DIFFERENT PROCESSES, DIFFERENT APPLICATIONS, DIFFERENT RULES, REGULATIONS, GOVERNING THEM, THERE'S COSTS ASSOCIATED WITH ALL THIS AND WHAT OUR GOAL HERE IS TO ACHIEVE IS TO MAKE THAT STREAMLINED AND EASY AND WORKABLE FOR ALL. WHAT WE'RE NOT TRYING TO DO IS DO SOMETHING LIKE THE NATIONAL DEAF INDEX WHERE ALL THE DATA COMES IN TO A CENTRAL PLACE AN INVESTIGATORS CAN LINK -- RANGE FOR LINKAGES WITH THAT. WE'RE TRYING TO DO IT IN A VIRTUAL WORLD WHERE THERE WILL BE REQUESTS FROM INVESTIGATORS THAT COME TO A CENTRAL COORDINATING CENTER, SHIPPED OUT TO 50 STATES, GET LINKED. COME BACK. AND REQUIRING NO CENTRALIZED STORAGE OF THE DATA. I HAVE TO SAY THAT DENNIS DEEPEN HAS BEEN A TREMENDOUS LYDDANE THIS EFFORT. HE'S AT THE LA CANCER SURVEILLANCE PROGRAM AND HE'S JOINED BY BETSY COLER, EXECUTIVE DIRECTOR OF THE NATIONAL ASSOCIATION OF CENTRAL CANCER REGISTRIES THAT ALL THE CANCER REGISTRIES, SERE AND CANCER REGISTRIES CDC ALL WORK WITH. AND NCI IS PROVIDING FULL SUPPORT FOR A PILOT STUDY THAT WILL TEST THIS PLAN OUT IN -- WITH COMPLETION WE HOPE IN 2013 THAT WILL INVOLVE 5 TO 7 STATES, WILL BE ENGAGED IN SEVERAL CANCER EPIDEMIOLOGY COHORTS. FORTUNATELY A DIFFERENT EFFORT IN CDC WILL BE BENEFICIAL AND THAT EFFORT IS A CONTRACT THEY HAVE TO COMPILE INFORMATION ABOUT FEDERAL AND STATE CANCER REGISTRY RULES AN POLICIES REGARDING LINKAGE AND INVESTIGATE METHODS FOR STREAMLINING IRB PROCESSES SO THEY'RE COLLECTING A VAST AMOUNT OF INFORMATION HOW THIS REALLY WORKS IN THE DIFFERENT STATES, THAT'S COMPLIMENTARY TO THIS EFFORT. SO IT'S -- THIS IS ALL A GREAT DEVELOPMENT. SOME THINGS THAT HAVEN'T BEEN SO GREAT, THIS YEAR INCLUDED SOME CHANGES IN THE AVAILABILITY OF THE DEAF MASTER FILE THAT COMES FROM THE SOCIAL SECURITY ADMINISTRATION. BASICALLY A RULING CAME DOWN THAT INVOLVED REMOVAL OF ONE-THIRD OF THE DEATHS FROM THE SOCIAL SECURITY MASTER FILE AND THAT INVOLVED DEATHS WHICH THE STATES OF THE REPORTING SOURCE THIS RESOURCE COMPLIMENTS BUT IT HAS GREAT FEATURES THAT IT'S MORE OR LESS CONTINUALLY UPDATED, MORE CURRENT MORE RECENT DEATHS AND IT IS A MAIN STAY OF THE WORK OF CANCER EPIDEMIOLOGISTS AN EPIDEMIOLOGIST THROUGHOUT NIH AND ELSEWHERE ON ALL SORTS OF DISEASE CONDITIONS. WE HAVE WRITTEN ABOUT THIS IN A BLOG THAT YOU CAN ACCESS IF YOU WOULD LIKE. ONE THING THAT'S HAPPENED IS THAT DR. RICHARD SUZMAN OF NIA IS A LEADER IN TRYING TO ADDRESS THIS PROBLEM BY WORKING VERY CLOSELY WITH NIH WITH THE DEPARTMENT OF HEALTH AND HUMAN SERVICES WITH OMB, IN TRYING TO FIND WAYS TO ADDRESS THE SERIOUS ADVERSE CONSEQUENCES OF THIS. HE IS HOPING THAT IN 2013, HE WILL BE ABLE TO FIND WAYS OF ALLOWING FOR A REGISTRY OF -- THAT THE GOVERNMENT WOULD HOLD AND ALLOW INDIVIDUAL INVESTIGATORS TO LINK TO THAT. SO HE WILL BE WORKING VERY HEAR ON THAT TO THE FUTURE. BASICALLY IT'S AN ENCLAVE OPTION FOR GRANTEES TO USE. I HAVE BEEN VERY GRATEFUL AND I KNOW HE'S BEEN GRATEFUL FOR GETTING INFORMATION FROM COHORTS WHO ACTUALLY USE THESE RESOURCES AND HAVING THEM TELL US WHAT ADVERSE CONSEQUENCE OF THIS ARE. I'M ESPECIALLY GRATEFUL TO MEYER STANFORD, GARY CHASE, FRANCIS ROSS FOR EXCELLENTING ON THE BLOG. THIS TYPE OF INFORMATION WHEN THESE SORTS OF CRAZY THINGS HAPPEN WE APPRECIATE HEARING FROM YOU AND GIVING US CONCRETE EXAMPLES OF WHAT'S WORKING, WHAT ISN'T, AND THAT ENABLES US TO HELP WORK THROUGH OUR GOVERNMENT CHANNELS THE TO TRY AND GET THESE THINGS ADDRESSED. IN FACT, MOST RECENTLY THERE WAS A NEW YORK TIMES ARTICLE, GARY CHASE WAS ONE OF THE PEOPLE WHO COMMENTED ALONG WITH A NUMBER OF OTHER RESEARCHERS, ADVERSELY IMPACTED BY THIS DECISION. SO WE'RE LOOKING FORWARD TO EFFORTS TO ADDRESS IT. FINALLY, DR. SUZMAN HAS ALSO BEEN LEADING AN EFFORT TO IMPROVE THE NATIONAL DEATH INDEX WHICH HAS LAG BEHIND BY QUITE A LONG PERIOD OF TIME AND THERE ARE A NUMBER OF AGENCIES CONTRIBUTING TO NEW INTERAGENCY AGREEMENT WITH THE NATIONAL CENTER FOR HEALTH STATISTICS TO PROVIDE MORE RAPID AS CERTAINMENT OF DEATHS AND STREAMLINE THE APPLICATION PROCESS. SO THAT NEA LEADING THAT EFFORT IN CRIB CONTRIBUTORS TO INTERAGENCIER AGREEMENTS INCLUDE NATIONAL CANCER INSTITUTE, NATIONAL HEART LUNG AND BLOOD INSTITUTE. AGENCY FOR HEALTHCARE QUALITY AND RESEARCH AND ANOTHER DIVISION OF CENTERS FOR DISEASE CONTROL AND PREVENTION. THAT WILL BE COMPLETED IN 2014 SO YOU CAN LOOK FORWARD TO IMPROVEMENT THERE. I THINK WE'RE NOW READY TO HEAR FROM OUR SPEAKERS. FIRST IS DR. LUCIA HINDORFF. >> I'M HERE TO REPRESENT THE PERSPECTIVE OF THE NHGRE. A LITTLE CONTEXT FOR THE TALK. ADAM FELSENFELD ARE TAG TEAMING THIS TALK. MINE IN TWO PARTS, GENERAL LESSONS LEARNED FROM COLLABORATIVE SCIENCE AT NHGRI AND I WILL ALSO GO INTO SOME PRELIMINARY DETAILS ON A COHORT WORKSHOP REP SENLY ORGANIZED ON BEHALF OF NIH. ADAM WILL THEN TALK ABOUT YET ANOTHER WORKSHOP ON DATA AGGREGATION THAT WAS ORGANIZED BY NHGRI. I WANT TO ALSO THANK THE PREVIOUS SPEAKERS FOR SETTING UP THE CONTEXT FOR MY TALK SO NICELY. I THINK THAT WE ALL SHARE A LOT OF THE SAME CONCERNS AND JOYS ABOUT COLLABORATIVE SCIENCE. I THINK ESPECIALLY FROM THE PERSPECTIVE OF NHGRI WHERE WE'RE APPLYING GENOMICS AND SEQUENCING TECHNOLOGY TO EXISTING COHORTS, I WANT TO SAY THAT VERY MUCH OUR COHORTS ARE YOUR COHORTS. ON BEHALF OF THE INSTITUTE OR THE COMMON FUND. NOT ALL THESE ARE COHORTS. BUT THE IDEA OF COLLABORATION IS ONE THAT WE SPEND TIME THINKING ABOUT, WE'RE ON A LOT OF CALLS WITH SCIENTIFIC INVESTIGATORS. WE CO-PUBLISH WITH THEM AND WE SPENT A LOT OF TIME AN EFFORT HOW TO FACILITATE THIS KIND OF SCIENCE. MANY OF YOU KNOW THAT GENOME WIDE ASSOCIATION STUDIES HAVE BEEN A BOON FOR COLLABORATIVE SCIENCE, ONE SUCH PROGRAM WE HAVE AT NHGRI IS GENEVA, A COLLABORATION OF 16 GW AS STUDIES ON A RANGE OF PHENOTYPES. I'M SHOWING YOU ONE CANCER PUBLISHED BY CHRIS HIGHMAN AND THE MEC. THIS WAS A STUDY OF PROSTATE CANCER AND AFRICAN AMERICANS AND THE INVESTIGATORS IDENTIFIED A NEW LOCUST FROM GENOME WIDE ASSOCIATION STUDIES AND THE POINT HERE I WANT TO MAKE IS THIS WAS THE ONE STUDY FUNNED BY NHGRI AND GENEVA. A DECENT SAMPLE SIZE, THE OR WAS SIGNIFICANT AND THE P VALUE WAS DECENT BUT ON A GENOME WIDE SCALE IT'S NOT ENOUGH TO GO ON WANNEST CAN DE. THIS PARTICULAR EFFORT INVOLVED TEN OTHER STUDIES AND YOU CAN SEE THEY TRIPLED THEIR SAMPLE SIZE, FOR THIS PARTICULAR LOCUST ON 17 THROUGH 21, WE'RE ABLE TO GET A MORE SIGNIFICANT P VALUE IN COMBINATION WITH ADDITIONAL COHORTS ENDED UP WITH A P VALUE OF THREE TIMES TEN THE MINUS 13 WHICH IS GENOME WIDE SIGNIFICANT AND HINT TO NEW POTENTIALLY INTERESTING BIOLOGICAL DISCOVERY IES. IN FACT THE OTHER POINT FROM THIS PAPER WAS THE LOCUST WAS APPEARED TO BE POPULATION SPECIFIC SO MINOR ALLELE FREQUENCIES WAS 5% IN AFRICAN AMERICANS AND ONLY LESS THAN 1% IN OTHER POPULATIONS. SO POTENTIALLY THIS COULD BE A VERY INTERESTING STUDY TO FOLLOW-UP, FINDING TO FOLLOW-UP. ANOTHER CONSORTIUM IS CALLED POPULATION ARCHITECTURE USING GENOMICS AND EPIDEMIOLOGY, IT'S A CONSORTIUM OF FOUR SITES AND COORDINATING CENTER, THAT'S FOCUSED ON POPULATIONS BROAD ETHNIC DIVERSITY AND BROAD DEEP PHENOTYPING. HERE ARE THE FOUR SITES, YOU'RE FAMILIAR WITH THE MEC AND WHI EAGLE IS A SITE THAT INCLUDES THE NHAYNES POPULATION AND VANDERBILT BIOREPOSITORY. IT'S IN AND OF ITSELF NHLBI FOCUSING ON CARDIOVASCULAR Vc$W MAKE SHEER IS THAT IF YOU LOOK AT THIS BROAD RANGE OF DIFFERENT KINDS OF OUTCOMES, NOT TALKING ABOUT MEASURES, WE'RE TALKING SPECIFIC CATEGORIES OF DISEASE AND TRAITS, MOST COHORTS CONTRIBUTE TO NEARLY ALL THESE CATEGORIES. COHORTS ARE FUNED TO DO CANCER RESEARCH CAN REALLY CONTRIBUTE ADDITIONAL INFORMATION TO STUDIES OF ANTI-METRICS AN NUTRITION. SO I THINK THE POINT HERE IS THAT WE NEED TO THINK HOW TO USE EXISTING RESOURCES AND HOW WE'RE RESOURCEFUL AND COLLABORATIVE AND INCREASE SCIENCE BEYOND WHAT WAS ORIGINALLY ENVISIONED FOR THE COHORTS. SO JUST TO PUT A FINER POINT ON THIS, THERE ARE OBVIOUSLY MANY PRACTICAL BENEFITS OF CLAN RATION SO WE HAVE TOUCHED ON -- COLLABORATION SO TOUCHED ON LARGER SAMPLE SIZES FOR NEW SCIENTIFIC FINDINGS. I THINK ESPECIALLY WITH THE FUNDING CLIMATE THE WAY IT IS, THERE'S A NOTION THAT YOU HAVE A FIXED FUNDING AMOUNT FOR A CON SOURCE JUDGE AND YOU DIVVY UP ACCORDING TO SITES. IN THE AREA OF COLLABORATIVE SCIENCE IF YOU HAVE THE RIGHT GROUP TO WORK TOGETHER YOU CAN EXPAND THE PIE. PEOPLE ARE SORT OF ANTICIPATING AND TRYING TO SOLVE COMMON PROBLEMS, YOU CAN LEVERAGE THE SYNERGY OF RESOURCES AND PEOPLE. AND I THINK FROM THE FUNDING AGENCY STANDPOINT WHAT YOU CAN DO IS TAKE ADVANTAGE OF THAT EXISTING INFRASTRUCTURE SO THAT PERHAPS A LITTLE BIT OF EXTRA FUNDING CAN GO A LONG WAY WITH A GROUP THAT'S ALREADY WORKING VERY WELL. SO I THINK ONE ADDITIONAL BENEFIT IS IF THERE ARE UNANTICIPATED ISSUES THAT COME UP, IF YOU HAVE PEOPLE THINKING ABOUT THEM, THERE CAN BE CREATIVE APPROACHES OR THINGS THAT YOU MIGHT NOT HAVE THOUGHT INITIALLY THAT COME UP, OTHERS HAVE HIGHLIGHTED THIS BUT OBVIOUSLY THE DEVELOPMENT OF STANDARDIZED APPROACHES PARTICULARLY FOR GENOMIC STUDIES IS EXTREMELY IMPORTANT. THAT TAKES A LOT OF GROUP EFFORT AND HELPS IF IT'S BUILT INTO THE STRUCTURE, THE CONSORTIUM, AS YOU ALL KNOW. WHAT WE ALSO FOUND IS A BENEFIT, AT LEAST FROM NHGRI, THE DISSEMINATION OF BEST PRACTICES SO IF U WHERE FUND A GROUP TO COME TOGETHER AND THINK CAREFULLY ABOUT DOING COLLABORATIVE SCIENCE, MAKING NEW DISCOVERIES AN EVALUATING THE PROCESS OF DOING SUCH THEN THE PROCESS OF PUTTING TOGETHER LESSONS LEARNED AN BEST PRACTICES CAN BE USEFUL FOR THE BROADER SCIENTIFIC COMMUNITY. WHAT A PARTICULAR CONSORTIUM FIGURES OUT MAY NOT BE P FOR EVERYBODY BUT SHARING THOSE LESSONS WITH THE COMMUNITY IS VERY HELPFUL. FROM THE FUNDING AGENCY PERSPECTIVE, ONE IMPORTANT COMPONENT OF COLLABORATIVE SCIENCE FROM THE STANDPOINT OF COOPERATIVE AGREEMENTS IS THAT IT HELPS MOBILIZE THE SCIENTIFIC COMMUNITY IN A WAY THAT CAREFULLY ALIGNS WITH THE MISSION OF A PARTICULAR INSTITUTE. IN FACT, WHEN YOU DO THIS, I THINK AT ITS BEST, YOU HAVE ESSENTIALLY A BUILT IN INVESTMENT OF ALL THE KEY STAKEHOLDERS PEOPLE DOING THE RESEARCH, PEOPLE PARTICIPATING IN THE RESEARCH, PEOPLE FUNDING THE RESEARCH TO AT LEAST HAVE A COMMON AGREEMENT THEY WILL ADDRESS CERTAIN SCIENTIFIC AND PERHAPS POLICY ISSUES UP FRONT. WE ARE ALL AWARE THERE ARE CHALLENGES TO COLLABORATION AS WELL. ONE PRIMARY ONE IS THE HETEROGENEITY OF STRENGTH AND INTERESTS THIS OCCUR WHEN DIFFERENT GROUPS COME TOGETHER. THEY DON'T NECESSARILY HAVE TO BE OPPOSING INTERESTS BUT GROUPS PARTICULARLY FOCUSED ON ONE ISSUE TO THE EXCLUSION OF EVERYTHING ELSE IT CAN BE A CHALLENGE TO GET EVERYONE ON A COMMON PAGE. YOU ALL AWARE OF HOW FRUSTRATING THE LACK OF INFRASTRUCTURE CAN BE COMMON RESOURCES ESPECIALLY THINGS PERCEIVE AS UNFUNDED MANDATES. THAT'S SOMETHING WE THINK ABOUT AS WELL. THE CONGRESS, IS SOMETIMES THERE CAN BE TOO MUCH INFRASTRUCTURE. IF YOU'RE TRYING TO GET A NEW COLLABORATION OF EXISTING CONSORTIA OFF THE GROUND, YOU'RE DEALING WITH LONG STANDING POLICIES, CULTURE, PEOPLE THAT HAVE BEEN ENGRAINED IN OTHER COHORTS. SOMETIMES IT'S CHALLENGING TO GET SOMETHING NEW OFF THE GROUND. OF COURSE LACK OF SHARED VISION AND PRIORITIES CAN BE PROBLEMATIC AS WELL, PEOPLE WORKING IN DIFFERENT AREAS WHEN THERE'S A LOT OF REDUNDANCY AND EFFORTS BETTER IN A MORE CONCERTED WAY. SO LESSONS LEARNED. FROM MANY OF OUR CONSORTIA NHGRI, STANDARDZATION IS IMPORTANT. FROM THE GWAS END GOAL, WE SPEND A LOT OF EFFORT DOING PHENOTYPE HARMONIZATION AT INDIVIDUAL MEASURE LEVEL THAT'S VERY TIME CONSUMING AN INTENSIVE. IN TERMS OF ANALYSIS METHODS, GWAS IS MORE OR LESS FRAMEWORK FOR ANALYSIS BUT THERE ARE DIFFERENCES IN WAYS THAT PEOPLE CAN ANALYZE DATA ESPECIALLY WHEN YOU INCORPORATE THE DIMENSIONALITY OF GENE ENVIRONMENT AND MORE COMPLICATED ANALYSES. ONE THING WE FIND HELPFUL IS TO SHARE PROCESSES OR DATABASES AS RESOURCES FOR THE SCIENTIFIC COMMUNITY BECAUSE PEOPLE CAN SORT OF -- THAT PARTICULAR RESEARCH DOESN'T WORK FOR THEM THEY CAN CONSIDER AND EVALUATE WHY IT WON'T WORK AND GIVE FEEDBACK WHAT COULD MAKE IT BETTER. IN THE FORM OFFICE OF$0t POPULATION GENETICS WHERE I SIT, WE MADE IT A POINT TO FUND NEARLY ALL COOPERATIVE AGREEMENTS WITH A COORDINATING CENTER RECOGNIZING THAT CENTRAL COORDINATION IS EXTREMELY IMPORTANT. AND THAT THE CONSORTIA REALLY CAN BENEFIT FROM A SCIENTIFIC PARTNER THAT HAS THE ABILITY TO COMMUNICATE AN UNDERSTAND WHAT THE SCIENTIFIC CONCERNS ARE BUT REALLY HAVE THE EFFORT TO DEVOTE TO THE LOGISTICS AND THE OUTREACH TO THE IMMUNITY AND SO FORTH AND DATA DISSEMINATION BEING AN IMPORTANT PORT PART OF THAT AS WELL. I ALLUDED TO THIS BUT US PARTNERING WITH OTHER ICs IS CRUCIAL, NO WAY WE CAN TAKE ON ALL THE GENOMIC RESEARCH THAT THE NIH CAN DO, SO WE APPRECIATE THE OPPORTUNITY TO TALK WITH FOLKS FROM OTHER ICs AND PARTNER WITH THEM IN OUR INITIATIVES. SO LET ME HIGHLIGHT A COUPLE MORE RESOURCES AND PAPERS THAT MAYBE OF INTEREST TO THE GROUP. THIS IS THE PHOENIX PROJECT WHICH IS A TOOL KIT FOR RESEARCHERS TO USE. IT INCLUDES SEVERAL STANDARD PHENOTYPE APPROXIMATE ENVIRONMENTAL EXPOSURE MEASURES FOR USE IN COHORTS SO IF YOU ARE JUST STARTING TO GET -- INITIATE A COHORT OR STILL DOING DATA COLLECTION AND YOU WANT TO ADD MEASURES IN A VARIETY OF AREAS, THIS TOOL KIT PROVIDE A PLACE TO FIND MEASURES THAT HAVE BEEN ESSENTIALLY AGREED UPON BY EXPERTS IN THE FIELD BY CONSENSUS. RIGHT NOW THE SCOPE IS ABOUT FIVE -- 15 HIGH PRIORITY AND ESPECIALLY IMPORTANTLY LOW BURDEN MEASURES FOR RESEARCH DOMAINS SO YOU DONE HAVE TO BE AN EXPERT IN EVERY DOMAIN, PHOENIX HAS DONE A LOT OF WORK FOR YOU HIGHLIGHTING THE MEASURES YOU MAY WANT TO CONSIDER IN YOUR OWN STUDY. I ALSO WANT TO EMPHASIZE THAT WE DO TRY AND FOCUS ENCOURAGE OUR INVESTIGATORS TO FOCUS ON THE PROCESS OF DOING COLLABORATIVE SCIENCE. FOR EXAMPLE, THIS IS A DESIGN PAPER FOR THE PAGE THAT SORT OF EXPLAINEDD WHAT THE GOALS OF THE PAGE OR HOW IT MIGHT CONTRIBUTE TO THE FIELD AND WHAT OUR PLANS WERE. THIS IS AN EXAMPLE FROM THE EMERGE NETWORK WHICH IS A CONSORTIUM OF BIOREPOSITORIES THAT ARE FOCUSED ON FIGURING HOW TO DERIVE PHENOTYPES FOR GENERAL TECH ANALYSIS FROM THE ELECTRONIC MEDICAL RECORDS. THEY ALSO HAVE A STRONG ETHICAL LEGAL AND SOCIAL COMPONENT AND THEY HAVE PUBLISHED A PAPER ON THEIR EXPERIENCE IN RETURNING INDIVIDUAL RESEARCH RESULTS. THEN FINALLY EVEN SOMETHING AS SEEMINGLY MUNDANE AS CALL CONTROL GENOME WIDE ASSOCIATION STUDIES CAN BE COMPLEX IN TERMS OF HOW THE PROCESS WORKS AND ESPECIALLY DOING LARGE SCALE SO THE GENEVA COORDINATING CENTER DRAFTED THIS MANUSCRIPT WHICH RECEIVED FAVORABLE ATTENTION. SO TO BRING THIS PART OF MY TALK TO A CLOSE, I THINK FROM THE NHGRI PERSPECTIVE WAYS THAT WE CAN THINK ABOUT PARTNERING WITH OTHER INSTITUTES ARE TO FIRST FACILITATE BROAD DATA SHARING BOTH WITHIN CONSORTIA AND DB GAP AND BY BROAD DATA SHARING I'M REFERRING TO WIDESPREAD AVAILABILITY OF DATA AS WELL AS BROADLY CONSENTED INDIVIDUALS. THAT'S GOING TO BE KEY IN BEING ABLE TO BE RESOURCEFUL WITH EXISTING COHORTS AND USING THE EXISTING RESOURCES FOR PURPOSES BEYOND THE ORIGINAL ONE. THERE ARE A LOT OF COMPLICATIONS I DON'T HAVE TIME TO GET INTO AT THIS MOMENT. AS WE MOVE FROM GENOME WIDE ASSOCIATION STUDY GENOTYPING TO SEQUENCING, IT WILL BE PARTICULARLY IMPORTANT TO IDENTIFY COHORTS OR POPULATIONS THAT ARE WELL SUITED FOR STUDIES OF FUNCTIONAL GENOMIC ELEMENTS IN RELATION TO DISEASE, THE N CODE PROGRAM AND OTHER EFFORTS UNDERWAY TO IDENTIFY KIND OF THE SCOPE AND THE FUNCTIONALITY OF THESE ELEMENTS. THE GENOMIC ARCHITECTURE OF COMMON DISEASE I THINK IS AN AREA WE ALL THINK ABOUT ESPECIALLY IN TERMS OF HOW WE'RE GOING TO GO FROM ANALYZING THE RELATIVELY COMMON VARIANTS FROM GWAS TO RARER VARIANTS MORE APPROPRIATE FOR SEQUENCING AND OTHER TECHNOLOGIES. OBVIOUSLY THE HOLY GRAIL IS INTEGRATING GENOMIC CLINICAL CARE, WE WANT TO SEE OUR WORK HAS AN IMPACT IN TERMS OF HOW PEOPLE'S HEALTH IS AFFECTED AND HOW WE MIGHT BE ABLE TO FURTHER IMPROVE THAT HEALTH. THAT'S ANOTHER AREA WE VERY MUCH APPRECIATE PARTNERSHIP WITH OTHER INSTITUTES T. LAST POINT HERE IS SOMETHING WE ALSO SPEND TIME THINKING ABOUT. HOW DO WE CONSOLIDATE H THE USEFUL GENOMIC INFORMATION WE HAVE? I KNOW PEOPLE AT THIS INSTITUTE IN PARTICULAR HAVE BEEN GOOD ABOUT THINKING ABOUT CRITERIA HOW YOU EVALUATE LEVELS OF EVIDENCE. I THINK IN THE NEXT FEW YEARS YOU'LL SEE EFFORTS IN THIS AREA FROM OUR INSTITUTE AND OTHERS. THERE WILL BE ADDITIONAL GENOMIC INFORMATION THAT WE HAVE YET TO COLLECT THAT SHOULD BE WORKED IN AS WELL. SO FOR THE SECOND PART OF MY TALK I'LL HIGHLIGHT A WORKSHOP HELD IN JUNE THAT TERRY MANOLIO ORGANIZED ON BEHALF OF NHGRI. SEQUENCING COHORT STUDIES IN LARGE SAMPLE SELECTIONS. THE GOAL WAS THE RECOGNIZE THE NIH ALREADY HAS A PRETTY EXTENSIVE AMOUNT OF LARGE SAMPLE COLLECTIONS. THE PHRASING WAS DELIBERATE INTO COLLUDE COHORTS AS WELL AS OTHER SIMPLE COLLECTIONS SUCH AS CLINICAL TRIALS OR OTHER STUDIES. THE GOAL IS TO UNDERSTAND HOW SEQUENCING THESE COLLECTIONS MIGHT FURTHER UNDERSTAND -- FURTHER OUR UNDERSTANDING OUR UNDERSTANDING OF COMPLEX TREATMENTS AND THESE DISEASES. THERE ARE TWO MAIN OBJECTIVES. ONE TO IDENTIFY THE KEY SCIENTIFIC QUESTIONS ADDRESSABLE BY SEQUENCING, NOT EVERY SCIENTIFIC QUESTION IS WELL SUITED FOR SEQUENCING SO THE PARTICIPANTS TRIED TO FOCUS ON THE KEY ONES. THEN TO DEFINE A CRITERIA FOR SELECTING SAMPLES TO ADDRESS THESE QUESTIONS. SO THESE ARE VERY MUCH PROCESS QUESTIONS, IT WASN'T FOCUSED SO MUCH ON WHICH COHORTS WOULD BE WELL SUITED. I WANT TO SAY IF YOU GO TO GENOME.GOV AND TYPE IN SEQUENCING COHORT STUDIES WORKSHOP YOU SHALL BE ABLE TO GET A YOUTUBE PLAY LIST OF TALKS THAT WERE PRESENT AT THIS WORKSHOP SO I ENCOURAGE YOU TO VISIT THAT IF YOU WEREN'T ABLE TO ATTEND. SO TO SUMMARIZE, A BRIEF -- BRIEFLY WHAT THIS WORKSHOP COVERED, THERE WERE SEVERAL OBJECTIVES AN QUESTIONS IDENTIFYD BY THE GROUP AS ALL OF THESE BEING AREAS THAT WERE POTENTIALLY ADDRESSABLE BY SEQUENCING. THE FIRST BEING A WHOLE HOST OF QUESTIONS UNDER THE GENETIC ARCHITECTURE OF HUMAN DISEASES RELATING TO RARE VARIANTS, RISK IN PROTECTIVE ALLELES, PLEA OWETROPEIA, ET CETERA. THESE ARE PROBABLY THINGS THAT YOU THINK ABOUT AS WELL, LONGITUDINAL CHANGE IN PHENOTYPES AN DISEASE, HEALTH DISPARITIES IN DIVERSE POPULATIONS, NOVEL DRUG TARGETS. AND PHARMACOGENOMICS AND HOW SEQUENCING CAN SORT OF HELP US IDENTIFY NEW VARIANTS WE DIDN'T -- PATHWAYS WE DIDN'T NECESSARILY KNOW ABOUT BEFORE. EPIGENETICS AND SOMATIC VARIATION BEING A HUGE BLACK BOX THAT WE HAVE YET TO APPLY TO POPULATION BASED COHORTS. FINALLY ANNOTATION OF THE GENOME. THIS PLANNING COMMITTEE FOR THIS WORKSHOP IS STILL MEETING TO DISCUSS THE OUTPUT OF THE WORKSHOP AN WORKING TOGETHER TO PRODUCE A MANUSCRIPT, BUT SOME OF THE CRITERIA THEY IDENTIFIED AT THE WORKSHOP ARE SHOWN HERE. THERE WERE SEVERAL LARGE SIZE PHENOTYPING, MORE OR LESS NECESSARY FOR EFFORTS SUCH AS SEQUENCING LARGE COHORTS TO GET OFF THE GROUND. OTHER IMPORTANT FACTORS INCLUDED HAVING MULTIPLE DISEASE OUTCOMES, LONGITUDINAL DATA, BROAD CONSENT AND ABILITY TO RECONTACT PARTICIPANTS, BROAD ANCESTRAL DIVERSITY TO EXTEND IMPLICATIONS TO MORE CLINICAL, THE CLINICAL REALM AVAILABILITY OF ELECTRONIC RECORD, OTHER ELEMENTS FAMILY DATA AND TO GET AT THE UNDERSTANDING OF THE BIOLOGY OF THE DISEASE, THE COMPASSIONTY FOR DEEP PHENOTYPING WHEN NEEDED. SO PARTICIPANTS HAVE TAKEN A STAB AT IDENTIFYING THE MISSION CRITICAL FEATURES OF THE COHORTS THAT ARE NECESSARY TO ADDRESS SCIENTIFIC QUESTIONS. THIS IS A VERY, VERY SMALL SNAP SHOT OF A TABLE THAT GOES ON LIKE DOZEN COLUMNS AN TWO PAGES, I'M SHOWING A SENATE SHOT HERE. IDEALLY YOU WOULD LOVE TO SEE ALL THESE CRITERIA PRESENT IN ALL THE COHORTS THAT YOU WOULD ADDRESS FOR EVERY SCIENTIFIC QUESTION BUT THAT'S PROBABLY NOT FEASIBLE SO FOR A GIVEN SCIENTIFIC QUESTION WHAT ARE THE MOST IMPORTANT AND ABSOLUTELY CRUCIAL FEATURES OF COHORTS THAT MIGHT BE IMPORTANT. SO I WON'T WALK THROUGH THE ENTIRE TABLE BUT LEAVE YOU TO PERUSE THE TABLE. THE WORKSHOP PARTICIPANTS ARE FORTHCOMING WITH A MANUSCRIPT THAT HOPEFULLY WILL BE ABLE TO GET AT THIS TABLE IN MORE DETAIL TO BE ABLE TO SHARE WITH THE COMMUNITY. BEFORE I TURN IT TO ADAM, I WOULD LIKE TO ACT KNOW LEDGE THE WORKSHOP PARTICIPANTS, SOME IN THIS ROOM FOR CONTENT IN THE PREVIOUS SLIDES AND LIKE TO ACKNOWLEDGE VARIOUS NHGRI STAFF WHO CONTRIBUTED TO THE SLIDES RELATING TO THE VARIOUS PROGRAMS THAT I MENTIONED. SO ADAM DECIDED TO GO THROUGH OUR TALKS AND TAKE QUESTIONS AT THE END. [APPLAUSE] >> THANKS, LUCIA. THANK YOU FOR INVITING ME TODAY. I WANT TO SAY A LITTLE BIT ABOUT WHAT I DO AND HOW IT INFLUENCES MY PERSPECTIVE TALK. OUR PROGRAM AT THIS POINT IS 80% DEVOTED TO COMPLEX DISEASE SEQUENCING. SINCE TWO OR THREE YEARS AGO. WE'RE STILL AT THE POINT OF REALLY UNDERSTANDING HOW TO DESIGN THESE KINDS OF STUDIES. BUT MOSTLY WHERE I SEE THE PIs THAT ARE INVOLVED WITH THE COHORTS DIRECTLY IS AT THE POINT WHERE THEY COME AND SAY THERE'S VALUE IN SEQUENCING SOME OF THOSE COHORTS AT THIS POINT WE START COLLABORATION WITH LARGE SCALE CENTERS TO GET SOMETHING DONE. THIS IS A TWO PART TALK. I SHOULDN'T SAY IT -- AN EXTREME POINT OF VIEW I SHOULD SAY IT'S AN AMBITIOUS POINT OF VIEW. EXTREME IS PROBABLY A BADLY CHOSEN WORD. OF THIS ISSUE TODAY THAT'S AN OVERVIEW OF ANOTHER WORKSHOP LUCIA MENTIONED WHICH IS DATA AGGREGATION. THE SECOND PART, IS THIS A LITTLE SUMMATION OF THE MAJOR LESSONS THAT I HAVE TAKEN AWAY FROM SOME OF THESE INDIVIDUAL LARGE COLLABORATIONS I HAVE BEEN INVOLVED WITH, ESPECIALLY AS COHORTS BRING THEIR STUDIES TO US TO BEGIN SEQUENCING. SO IN A NUTSHELL, THIS MOST AMBITIOUS VIEW IS WHAT -- THAT WE CAN DO A LOT, WE CAN DO A LOT WITH JUST SEQUENCE DATA PLUS WHATEVER OTHER DATA ARE AVAILABLE. IF WE CAN CAPTURE AN AGGREGATE EVERYTHING. THAT WAS THE THEME OF THIS MEETING. NIH FUNDS AN AWFUL LOT OF STUDIES AND IT WOULD BE GREAT IF THE DATA FROM ALL THESE STUDIES WAS AN ESSENTIAL RESOURCE. THIS WORKSHOP TOOK PLACE JUNE 5 AND 6 THIS YEAR, THERE WILL BE A PUBLICATION FORTHCOMING. SO I THINK THE SUCCESS AT THIS POINT OF SEQUENCING IS PRETTY EVIDENT. BY THE END OF THIS YEAR WE WILL HAVE FOLLOWING DATA. WE EXPECT TO HAVE THE FOLLOWING DATA IN GEN BANK AVAILABLE THROUGH DB GAP SO 18,000 WHOLE GENOMES, ABOUT 15,000 EXONLIES ON TOP -- EXOMESK ON TOP OF 500,000 SAMPLES GENOTYPED IN 200 STUDIES OR MORE IN DB GAP. THIS IS JUST TO REINFORCE DEPOSITION OF SEQUENCE DATA, HUMAN SEQUENCE DATA IN DB GAP CONTINUES TO GROW EXPONENTIALLY. BE WITH ALL THESE DATA, IF IF IT WERE -- THE DATA WERE EASILY ACCESSIBLE OR READILY ACCESSIBLE TO THE MEMBERS OF THE COMMUNITY AND IT WAS AND YOU CAN COMPUTE ACROSS IT, THERE'S A LOT YOU CAN DO, EVERYTHING TALKED ABOUT TODAY VALIDATION OF RESULTS, LARGE SCALE GWAS, GENE BY GENE DEPENDING ON DATA ACCOMPANYING SAMPLES BY ENVIRONMENT INTERACTIONS. ONE THAT INTERESTS ME QUITE A BIT IS THE IDEA OF VARIANTS THAT ARE SHARED. ACROSS DIFFERENT DISEASES, GETTING OUT OF THE NOTION OR BLURRING BOUNDARIES BETWEEN DISEASES IS PROBABLY WHAT THE BIOLOGY -- WHERE THE BIOLOGY IS LEADING US. OTHER KINDS OF APPLICATIONS, THESE HAVE BEEN STARTED. YOU CAN LOOK ACROSS THE DATABASE OF INDIVIDUALS CARRYING LOSS OF FUNCTION IN GENES. THEN YOU CAN LOOK AT PHENOTYPES. YOU CAN DO IT THE OTHER WAY AROUND TOO. IF YOU HAVE EXTREME PHENOTYPES GOING WITH GENOTYPES. YOU CAN DO THIS ACROSS EVERYTHING THAT WAS DEPOSITED. THERE ARE CHALLENGES TO DOING THIS. DATA ACCESS PROCESSES NOW ARE NOT REALLY ADAPTED TO THIS. THE COST OF THE NEEDS FOR PROTECTION OF HUMAN SUBJECTS AND CONDITIONS OF CONSENT, BETA RELEASE HAS TO BE REGULATED. THE CURRENT SYSTEM HOWEVER CAN BE STREAMLINED QUITE A BIT. IT WOULD BE GREAT TO HAVE SOMETHING LIKE A RESEARCH COMMONS WHERE THEY'RE PRE-REGISTERED USERS, IT WOULD BE GREAT TO HAVE CENTRAL DATA SERVERS THE PROVIDE RESULTS AN SUMMARIES BUT NOT UNDERLYING DATA. THERE ARE PROBLEMS WITH THE MOST BASIC PARTS OF ANALYSIS OF THESE DATA. APPROACHES TO CALLING VARIANTS, THAT'S NOT A SOLVED FIELD YET. THE MOST DIFFICULT THING, OBVIOUSLY JUST GLOSSING OVER THIS, HARMONIZING PHENOTYPE AND ENVIRONMENT DATA ACROSS STUDIES, EASY TO SAY IN ONE LINE AND MAKE BOLD. BUT IT'S I THINK THE WORK OF LIFETIMES. COMPETING ON LARGE DATA SETS AND DOING ANALYSIS. WE JUST HAVEN'T HAD THE LARGE DATA SETS, WE HAVEN'T BUILT TOOLS. WHAT ELSE CAN BE DONE TO MAKE THIS EASIER? I THINK THE MAIN THING, ONE MAIN CONCLUSION OF THIS WORKSHOP IS, IT'S EASY TO GET FIXATED ON MAKING EVERYTHING PERFECT. IN FACT, EVEN A PARTIAL SOLUTION, CAPTURING A MAJORITY OF DATA, 90% SOLUTION WOULD BE FANTASTIC. I THINK EVEN 50% SOLUTION, IF YOU COULD CAPTURE 50% OF THE DATA THIS WAY, IT WOULD BE WONDERFUL. THE RECOMMENDATIONS FROM THE WORKSHOP. THIS SEEMS OBVIOUS THAT ALL THESE DATA SETS SHOULD BE DEPOSITED IN CENTRAL DATABASES. I CAN SAY THAT EVEN WITH THE BEST OF INTENTIONS THIS DOESN'T HAPPEN. IT DOESN'T HAPPEN FOR A LOT OF REASONS. AND THIS IS EVEN ASSUMING THAT EVERYONE IS ON BOARD WITH DEPOSITING DATA. THERE ARE MULTIPLE PLACES THESE DATA GO. THEY COORDINATE WITH EACH OTHER. BUT EACH ADDED ONE ADDS THE BURDEN OF COORDINATION TO THE EXTENT THEY CAN BE CENTRALIZED FOR EXCHANGE DATA BETTER. CONSENT PROCEDURES SHOULD SEEK PERMISSION FOR BROAD DATA USE. VERY OFTEN, VERY OFTEN WE SEEK TO COMBINE AND ANALYZE DATA ACROSS A NUMBER OF DIFFERENT COHORTS, THEY'RE CONSENTED FOR USE, MANY SAMPLES ARE CONSENTED FOR USE FOR ONLY ONE DISEASE. BUT IF THEY WERE CONSENTED FOR BROAD DATA USE STREAMLINING THE FIRST STAGE OF STREAMLINING COULD HAPPEN QUICKLY AND FOR THOSE CONSENTED FOR BROAD USE, DB GAP IS PUTTING THEM INTO A SINGLE -- ESSENTIALLY A SINGLE CONSENT GROUP SO WHEN YOU ACCESS RECEIVE THOSE DATA YOU ONLY NEED ONE HOPEFULLY ONLY ONE KIND OF PERMISSION. ALONG WITH ALL THIS, WILL COME THE NEED FOR GOVERNANCE PROCEDURES FOR THE CENTRAL DATABASES, THE ONES WE HAVE NOW ARE SORT OF IMPROVISED AS THOSE DATA RESOURCES WERE BUILT. SUMMARY STATISTICS LIKE ALLELE FREQUENCIES GWAS AND SEQUENCE BASED ASSOCIATION STUDIES ARE PUBLISHED. WHEN SUMMARY STATISTICS WERE FIRST DERIVED THERE WAS A LOT OF DISCUSSION AND OUT OF ABUNDANCE OF CAUTION, THESE KIND OF DATA VERY OFTEN ARE NOT PUBLICLY RELEASED, YOU STILL HAVE TO GET PERMISSION TO SEE THEM AN RECOMMENDATIONS WORKSHOP, TIME TO CONSIDER WHETHER THOSE CAN BE PUBLICLY RELEASED. THE PROCESS FOR ACCESSING DATA FROM DB GAP SHOULD BE STREAMLINED. IF YOU WANT DATA FROM A PARTICULAR SAMPLE SET, YOU VERY OFTEN HAVE TO GO TO EACH ONE, ACCESS IS CONTROLLED BY AN INDIVIDUAL DATA ACCESS COMMITTEE. AND THERE'S MULTIPLE ACROSS NIH. MAYBEITE TIME TO CONSIDER HAVING A SINGLE DATA ACCESS COMMITTEE ACROSS NIH. MAYBE OTHER WAYS TO STREAMLINE IT. ANOTHER RECOMMENDATION IS NIH SHOULD DEVELOP REGISTERED USER SYSTEM, AGAIN, WE'RE USERS OF NON-USER CAN ACCESS MULTIPLE DATA SETS IN ONE STEP, ONE POSSIBLE IMPLEMENTATION OF THIS MIGHT BE TO GET INSTITUTIONS TO SUPERVISE THE PRE-APPROVAL, ESSENTIALLY THE TRAINING AND PRE-APPROVAL OF INVESTIGATORS TO HAVE ACCESS TO SOME OF THESE DATA SETS WITHOUT NEEDING SECOND APPROVAL FROM NIH, MAYBE THERE COULD BE SYSTEM OF WELL QUALIFIED REGISTER USERS. OTHER RECOMMENDATIONS. THERE IS NO SINGLE APPROACH BEST APPROACH THAT WE KNOW RIGHT NOW FOR AGGREGATING AND DOING ANALYSIS OF THOSE DATA SETS SO NIH WILL HAVE TO SUPPORT MULTIPLE ALTERNATIVE WAYS TO DO THIS. CENTRAL PROCESSING OF WHATEVER CAN BE CENTRALLY PROCESSED, INCLUDING SEQUENCING DATA TO VARIANTS SHOULD BE ENCOURAGED. I HAVE BOLDED AND ITALICIZED THIS, IT'S EASY TO SAY ONE STEP BUT PROBABLY HARDER THAN EVERYTHING ELSE HERE COMBINED. HARMONIZATION AN PHENOTYPE EXPOSURE DATA RETROSPECTIVELY AND PROSPECT TVLY SHOULD BE ENCOURAGED SO PROBABLY TEN TIMES MORE EXPENSIVE THAN EVERYTHING ELSE HERE. HOW TO START IMPLEMENTATION. THERE ARE SOME EARLY STEPS THAT CAN BE TAKEN. WE ARE DISCUSSING POLICY CHANGES RELATED TO DATA ACCESS AND RELEASE OF SUMMARY DATA. THERE'S ALREADY ONGOING DISCUSSION WITHIN THE NIH ABOUT CENTRAL DATABASES AND BROAD CONSENT. IN FACT, EVERY TIME THAT I WORK WITH THE DISEASE COHORT TALK COMES TO DISCUSSION COMES TO WHAT TO DO WITH THE DATA AND EACH -- SEEMS TO BE EMERGING THAT PEOPLE ARE WILLING TO DEPOSIT DATA, EAGER TO DEPOSIT DATA IN CENTRAL PLACE BUT THEY ALSO WANT THEIR OWN DISEASE SPECIFIC DATABASE. I THINK THERE ARE MERITS TO BOTH AND HOW TO IRON THAT OUT WILL BECOME A TOPIC OF SOME INTEREST IN THE NEXT FEW YEARS. IF WE DO THIS, IT WILL BE SUFFICIENT FOR MANY DIFFERENT KINDS OF ANALYSES BUT NOT ALL, THE WEAKEST POINT OF THIS WORKSHOP IS GLOSSING OVER HARMONIZING OF PHENOTYPE AND EXPOSURE DATA BUT EVEN SO, DOING PART CAN MAKE DISEASE COHORTS EASIER WITH STREAMLINED DATA ACCESS AT LEAST. SO SWITCHING GEARS O LESSONS LEARNED BY MYSELF FROM SEVERAL INHERITED DISEASE PROJECTS, ABOUT HOW TO GET TO THE POINT OF SEQUENCING. I HAVE MADE THESE ANONYMOUS BECAUSE THEY'RE ALL ONGOING, EACH ONE HAS ITS -- HAS ITS UPS AND DOWNS, SOME -- AND EACH ONE IS QUITE UNIQUE. BUT ISSUES THAT COME UP OBVIOUSLY POWER NUMBER OF SAMPLES NEEDED, EXPECTED ARCHITECTURE OF THE DISEASE AND HOW IT UNPIPELINESES THE DESIGN. PHENOTYPING, ACCURACY, RICHNESS, CONSISTENCY, ORGANIZATIONAL ISSUES AS YOU KNOW. SO HAVE THE PARTICIPANTS OFTEN COMING FROM COMPOSED OF MULTIPLE SMALL CONSORTIA, DO THEY HAVE A COMBINED DATABASE OF EXISTING SAMPLE DATA. WHERE THE SAMPLE IS, HOW TO GET IT, WHAT OTHER DATA EXISTS, CONSENT DATA, HOW MUCH DNA IS ASSOCIATED WHETHER IT COMES FROM CELL LINES, BLOOD, ET CETERA. ARE SAMPLES TRULY AVAILABLE? THIS IS THE BIGGEST SINGLE ISSUE IN MY EXPERIENCE, THE DELAY CAN BE CONSIDERABLE. GROUPS CAN BE ENTHUSIASTIC, WELL ORGANIZED, HIGHLY MOTIVATED, AND THE DELAY FROM GETTING TOGETHER AND PEOPLE THINKING THAT THEY HAVE THE SAMPLES AVAILABLE TO ACTUALLY HAVING SAMPLES THAT CAN GO INTO SEQUENCING PIPELINE. THAT DELAY EVEN UNDER BEST CIRCUMSTANCES IS OFTEN A YEAR. PEOPLE OFTEN HAVEN'T ANTICIPATED THIS. MAYBE THIS IS A PROBLEM THAT WILL GO AWAY BECAUSE THIS IS A PROBLEM THAT WAS FRANKLY ENCOUNTERED IN THE FIRST TWO OR THREE YEARS OF REALLY LARGE SEQUENCING APPLICATION. MAYBE THINGS WILL CHANGE BUT IT'S IT WILL A SENSITIVE POINT IN EVERY STUDY THAT I HAVE BEEN INVOLVED WITH. OF COURSE, THERE'S SOCIOLOGICAL ISSUES WHICH I'M SURE YOU'RE FAMILIAR WITH. ARE ALL PARTIES READY TO COLLABORATE? WHO IS LEADING? IS EVERYTHING FLEXIBLE ENOUGH? THAT'S THE MAIN THING, IT REQUIRES FLEXIBILITY AND PATIENCE. THERE ARE OFTEN DISAGREEMENTS OR MISMATCHES ABOUT COMMON UNDERSTANDING OF THE SCIENCE AND STATE-OF-THE-ART. THE GENETICISTS AN COHORT ALSO HAVE A CLEAR IDEA OF WHAT THEY WANT DONE WITH SEQUENCING AND THE PEOPLE WHO HAVE EXPERIENCE SEQUENCING IN LARGE COHORTS WILL HAVE A DIFFERENT IDEA, DIFFERENT UNDERSTANDING OF THE SCIENCE. IT TAKES TIME TO GET THOSE VIEW POINTS TOGETHER A LOT BECAUSE SCIENCE IS CHANGING VERY QUICKLY. A LOT IS FRANKLY FROM MY POINT OF VIEW A LOT OF EXCITEMENT ABOUT SEQUENCING IS THAT MORE IS ALWAYS BETTER. PEOPLE COME TO US AND THEY SAY WELL, JUST WHAT WE REALLY WANT IS WHOLE GENOMES. THAT'S WHAT WE NEED. IT MAY TURN OUT DEPENDING ON WHAT THE QUESTIONS ARE AND WHAT THE COHORTS LOOK LIKE AND WHAT THE DISEASE ARCHITECTURE, THAT MIGHT NOT ALWAYS BE THE RIGHT ANSWER. NOT ONLY THAT, TO MAKE IT LESS EASY, IF YOU CAME BACK SIX MONTHS LATER THE ANSWER MIGHT BE DIFFERENT BECAUSE THE STATE OF THE ART WILL HAVE CHANGED. EVEN IF JUST THE COST SHIFT, SEQUENCING COST SHIFT ENOUGH, IT CAN CHANGE WHAT DO YOU WANT DO VERY OFTEN THERE'S DIFFERENT IDEAS ABOUT DETAILS ABOUT DATA SHARING WITHIN AN OUTSIDE CONSORTIUM. THERE'S ISSUES OF SHARING OF DATA WITHIN THE CONSORTIUM OF DATA PRODUCED BEFORE COLLABORATION EVEN HAPPENED BUT WHICH ARE NEEDED FOR THE COLLABORATION. AND DIFFERENT EXPECTATIONS ABOUT DATA RELEASE. YOU KNOW GENOMIC SEQUENCERS ARE HARD CORE ABOUT RAPID DATA RELEASE AN HAVE BEEN AS PART OF THE CULTURE FROM THE BEGINNING. THAT SOMETIMES DOESN'T MESH WITH THE WAY INVESTIGATORS FROM COHORTS HAVE BEEN THINKING ABOUT THINGS. SO HOW DOES THIS SORT OF GRANDIOSE TOTAL DATA AGGREGATION AN REALITY OF INDIVIDUAL PROJECTS MEET? THAT IS I THINK STILL ONE PROJECT AT A TIME BUT AS FAR AS POSSIBLE IT WILL HELP IF EACH PROJECT AS THEY'RE PUTTING THINGS TOGETHER CONSIDERS ALL ANALYSES DONE IN EVERYTHING THEY DO. NOT JUST ANALYSES THAT THEY WANT TO DO BUT THE ANALYSES OTHER PEOPLE COULD WANT TO DO IN THE FUTURE ONCE DATA ARE DEPOSITED. THAT'S REALLY ALL I HAVE TO SAY RIGHT NOW. IF YOU HAVE ANY QUESTIONS ABOUT -- I THINK LUCIA DID YOU WANT TO TAKE QUESTIONS FROM THE PANEL? (OFF MIC) >> THANK YOU. (INDISCERNIBLE) RETIRED FROM NCI. I'M IN MOLECULAR BIOLOGIST AND IMMUNOLOGIST WHO WAS INVOLVED IN MANY PROJECTS YOU BRIEFLY MENTION DESIGN OF COHORT STUDIES AND SO FORTH. I THINK WHEN YOU MENTION LACK OF SHARED VISION BY DIFFERENT SCIENTISTS, CAN BE A LITTLE BIT MORE DETAILED THAT WE HAVE DEVELOPED DOUBLE VISION FOR MISSION OF CANCER. I HAVE DETAILED THIS IN A RECENT ARTICLE AND THE TWO BOOKS THAT I HAVE EDITED IN 2012 REGARDING THE ROLE OF INFLAMMATION AND CHRONIC INFLAMMATORY DISEASES. AND CANCER. I ENCOURAGE YOU TO LOOK AT IT. WHAT WE NEED TO DO, I BELIEVE, SINCE YOU ENCOURAGED TO MAKE COMMENTS IS THAT WE NEED TO REDUCE THE DIVISION WHICH THE POLITICS ON BUSINESS OF CANCER OVERWHELMS THE MISSION OF CANCER. DESPITE THE FACT THAT WE HAVE BEEN RECEIVING MORE THAN A TRILLION DOLLARS OVER THE LAST FOUR DECADES AND WE HAVE PUBLISHED LIKE 20 MILLION ARTICLES OR WE HAVE NOT BEEN WINNING THE WAR ON CANCER, I'M TALKING AS A SCIENTIST ON BEHALF OF THE PUBLIC. WHAT I HAVE MENTIONED IN THE COMMENTARY THAT WAS PUBLISHED IN CELL BIOCHEMISTRY AN BIOPHYSICS, IS THAT WE HAVE BEEN ABLE TO PRODUCE FUZZY SCIENCE, PARTICULARLY WHEN IT COMES TO TARGETED THERAPY. AND WE HAVE IGNORED THE FACT THAT CANCER WHICH IS USUALLY, WE ARE TALKING ABOUT ADULT CANCER, WHICH IS USUALLY DEVELOPED DURING AGING PROCESS, WE HAVE TOTALLY IGNORED THE BODY'S ABILITY, IMMUNE SURVEILLANCE, TO BE THE DRIVING FORCE BEHIND DEVELOPING TECHNOLOGIES AND PROJECTS. UNFORTUNATELY THE DECISION MAKERS ARE POLITICIANS AND THEY EXCLUDE REAL SCIENTISTS WHICH HAVE PRODUCED REAL SCIENCE AND CONCEPT AND PROPOSAL FOR FOR THE BUSINESS OF MAINTAINING CANCER. >> THANK YOU VERY MUCH. I'M NOT A CANCER BIOLOGIST AND I CAN'T ANSWER YOUR QUESTION DIRECTLY THEY'RE CLEAR THERE'S MORE THAN DOUBLE VISION ACROSS SCIENCE BUT I THINK THERE ARE STRENGTHS TO THAT. BECAUSE WE DON'T KNOW IT'S GOING TO TURN OUT TO BE THE RIGHT ANSWER AND DOES UNDERSCORE BUT I DIDN'T MEAN FROM MY VIEWPOINT WAS THE ONLY RIGHT VIEWPOINT. AND OVER CENTRALZATION HAS BEEN ITS PITFALLS TOO. >> TWO THINGS. ONE IS THE ONCOLOGISTS FOLLOWING UP ON THE LAST COMMENT IT'S RACIALABLE TO SEE THAT WE HAVE GONE FROM LESS THAN 10% SURVIVAL TO GREATER THAN 65% SURVIVAL IN THE LAST 30 YEARS SO I THINK THERE IS PROGRESS GOING FORWARD. BUT I WANTED TO P COME BACK TO A POINT THAT YOU RAISED ADAM, AND JUST ADD SOMETHING, I THINK THAT ARE RELEVANT TO THIS GROUP WORKING IN THIS, ABOUT THE DATA SHARING THAT THERE HAVE BEEN CHANGES TO THE SENIOR OVERSIGHT COMMITTEE AND THERE'S A CENTRALIZED DB GAP RESOURCE FOR AGGREGATE DATA FOR STUDIES THAT ARE BROADLY CONSENTED, THIS IS IMPORTANT AND NOW BEING LAUNCHED. SO YOU'LL BE ABLE TO SEE AGGREGATE DATA FOR A NUMBER OF STUDIES BUT THE STUDIES BY DEFINITION HAVE TO HAVE INFORMED CONSENT. THAT GIVES BROAD DEFINITION. THE NURSE STUDY PART OF CGENS OR BREAST CANCER GOING INTO THAT. IN ONE OF THE STUDIES FOR EXAMPLE. THE OTHER STUDIES WE HAVE IN THIS ROOM HAVE DIFFERENT DEGREES OF CONSENT RESTRICTION, THESE THINGS BEING WORKED OUT SO WE HOPEFULLY CAN MOVE MORE TOARDS CENTRALIZED PROCESSES. I THINK THE SECOND IS A GENOME POLICY COMING DOWN THE ROAD VERY BROAD FOR SON COURSE YUM TO BE ABLE TO SHARE THEIR DATA POTENTIALLY NOT JUST DB GAP BUT CLOUDS AND THE LIKE WHICH ARE IMPORTANT AGGREGATION POINTS TO BE ABLE TO DO THE KINDS OF COMMON ANALYSES AND BRING INFORMATION DEMAND OUT, PHENOTYPES AN GENOTYPES. THIS IS SOMETHING COMING VERY QUICKLY I THINK TO THE RESEARCH COMMUNITY, SO I WANTED TO POINT THOSE OUT. BUT THANK YOU. >> THANKS, STEVE. [APPLAUSE] >> GOOD MORNING. I REALLY THANK THE ORGANIZERS FOR INVITING ME TO SPEAK ON BEHALF OF NHLBI. I THINK THIS IS -- IT'S TIMELY BECAUSE WE'RE HAVING A LOT OF DISCUSSIONS WITHIN NHLBI, ESPECIALLY IN MY DIVISION, ABOUT THE FUTURE OF EPIDEMIOLOGY, MEGA COHORT, AND WE'RE ENGAGED IN DISCUSSIONS WITH NCI MAKE THIS TIMELY. I'M GOING TO TALK A LITTLE BIT ABOUT WHERE NHLBI HAS BEEN WITH REGARD TO COHORT STUDIES. BECAUSE I THINK THAT REALLY INFORMS OUR PERSPECTIVE AS WELL AS WHERE WE HOPE TO GO. THE CHARGE I WAS GIVEN WAS TO DISCUSS OPPORTUNITIES AND OBSTACLES FOR MEGA COHORT, COLLABORATION, TO DISCUSS A LITTLE BIT ABOUT THE ISSUE OF COMBINING VERSUS DESIGNING COHORTS. THIS IS WHERE WE COME FROM BASICALLY, OUR GINS IN THE FRAMINGHAM HARTGE STUDY WHICH STARTED IN 1948. SINCE THEN WE USE THAT AS PRIMARY MODEL, FRAMING, FRAMINGHAM OFFSPRING IN 19 80 ET CETERA, WE LAUNCHED STUDIES BASED ON SPECIFIC AGE GROUPS, DIFFERENT ETHNIC GROUPS AND WOMEN'S HEALTH INITIATIVE WHICH IS CLINICAL -- SET OF CLINICAL TRIALS AS WELL AS VERY LARGE COHORT STUDY. OUR MOST RECENT EFFORT IN THE STUDY OF LATINOS JUST LAUNCHED IN 2006 EARLY ON THE OBJECTIVES OF SEVERAL STUDIES I PULLED OUT BASICALLY HAVE TO DO WITH EPIDEMIOLOGY OF ATHEROSCLEROSIS AND CLINICAL CARDIOVASCULAR DISEASE, SOMEWHAT SIMILAR FOR SEVERAL STUDIES. I THINK THESE COHORTS HAVE ENJOYED A LARGE MEASURE OF SUCCESS ON THE BASIS OF SEVERAL METRICS, THEY'RE VERY PRODUCTIVE, WE'VE DESCRIBED THE EPIDEMIOLOGY AND ABLE TO PREDICT CARDIOVASCULAR DISEASE. ONE REASON WHY WE'RE SUCCESSFUL IS BECAUSE THERE IS A HIGH PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN THE POPULATION, THIS SLIDE JUST SHOWS IN THE RED AND THE YELLOW LESS THAN OPTIMAL RISK FACTORS. AND MANY OF THESE ARE QUITE POTENT. DO I HAVE A POINTER? POINTER FOR CARDIO VASCULAR DISEASE, ALSO POINT OUT SEVERAL ARE SHARED WITH CANCER EPIDEMIOLOGY. WE HAVE SOME MAYBE MORE SPECIFIC FOR CARDIOVASCULAR DISEASE. SOME WOULD SAY WE ARE ABLE TO EXPLAIN IN THE POPULATION A VERY LARGE PROPORTION OF CORONARY HEART DISEASE. IN LATER YEARS OUR COHORTS HAVE TURNED MORE TOWARDS VERY IN DEPTH CHARACTERZATION QUESTIONNAIRES, GENETICS, IMAGING, ENVIRONMENTAL ASPECTS, AIR POLLUTION, ET CETERA. THIS IS ALSO BEEN FRUITFUL BUT IT'S VERY EXPENSIVE WE TALK ABOUT COMBINING COHORTS, AND I HAD PUT THIS SLIDE TOGETHER. OF COURSE, BEFORE I SAW THE 48 COHORTS IN YOUR CONSORTIUM, WE'RE RUNNING A LITTLE CONSORTIUM ENVY HERE, BUT WE HAVE ABOUT 67,000 PARTICIPANTS, IF WE DON'T INCLUDE WHI, AND MUCH MORE IF WE DO INCLUDE WHI. IN FACT PHENOTYPES AN GENOTYPES FROM 41,000 OF PARTICIPANTS IN THESE STUDIES HAVE BEEN DEPOSITED IN THE BIOPROJECTS PORTION NCBI WITH SOME EXOME SEQUENCING AND GENOTYPES AN PHENOTYPES AS I SAID. SO THAT IS ONE OF OUR FOR RAYS INTO MEGA EPIDEMIOLOGY IF YOU WILL. THIS PROPOSAL HAS BEEN ALLUDED TO EARLIER, ANOTHER EXAMPLE OF A COMBINING OR SYNTHETIC COHORT. I DON'T ACTUALLY KNOW THE CURRENT STATUS OF THIS, THIS WAS FROM THE WEBSITE, IT WAS POSTED IN THE SUMMER OF 2011. SOME OTHER EXAMPLES THAT NHLBI HAS WITH LARGER COHORTS, I'M GOING TO LIST A FEW OF THEM, SOME DON'T THINK OF THIS STUDY SO MUCH AS A COHORT STUDY BUT IT WAS STARTED IN THE 1970s, IT'S A SIMPLE LINKAGE OF CENSUS DATA WITH MORTALITY DATA AND INCLUDES 3 MILLION RECORDS. THE NURSE'S HEALTH STUDY AND HARVARD COHORTS, I KNOW THEY HAVE BEEN SUPPORTED BY NCI BUT WE ALSO FEEL PROUD OF THEM, THEY HAVE DONE CONTRIBUTED A LOT TO THE UNDERSTANDING OF CARDIOVASCULAR DISEASE. I WANT TO SAY ONE THING ABOUT THE NURSE'S HEALTH STUDY, THAT THAT MODEL IS PREDOMINANTLY DONE THROUGH THE MALE AND QUESTIONNARIES SO IT TENDS TO BE VERY INEXPENSIVE ON A PER PARTICIPANT BASIS. ANOTHER MODEL IS REGARDS WHICH IS PRIMARILY SUPPORTED BY NINDS, IT'S A STUDY OF THE EPIDEMIOLOGY OF STROKE, RISK FACTORS FOR STROKE PARTICULARLY LOOKING AT THE STROKE BELT BUT IT'S A NATIONWIDE STUDY, 30,000 INDIVIDUALS, AND THEY'RE USING ESSENTIALLY INSURANCE HEALTH NURSES WHO GO INTO THE HOMES, DO EXAMINATION, DRAW BLOOD. THEY TELL US THEY DO THAT FOR $300 A PARTICIPANT. MORE RECENTLY, WE HAVE SUPPORTED PART OF AN HMO NETWORK CALLED THE CARDIOVASCULAR RESEARCH NETWORK. OVER 7 MILLION MEMBERS IN 15 HMOs, EEL TALK MORE ABOUT THAT IN A MOMENT. AND AGAIN, THIS IS ANOTHER EXAMPLE, ONE MIGHT NOT THINK OF THIS AS A COHORT BUT BEEN VERY BENEFICIALLY FOR CARDIOVASCULAR RESEARCH, 40 MILLION MEDICARE BENEFICIARIES AND I HAVE LITTLE EXAMPLE HOW THAT'S BEEN USED. WHY DO WE NEED SAMPLES IN THIS DAY AN AGE? ONE MIGHT SAY LOW HANGING HAS BEEN HARVESTED IN CARDIOVASCULAR DISEASE. WHENEVER WE TRY TO TEASE APART THE DATA AND EVEN WHAT WE HAVE CONSIDERED IN THE PAST LARGE COHORTS, WE QUICKLY RUN OUT OF SAMPLE SIZE IN ORDER THE ANALYZE SUBGROUPS. WE'RE INTERESTED IN MODEST BUT INSIGHTFUL ASSOCIATIONS AN TRENDS, LARGE SAMPLE SIZES FOR THAT. WE ARE DISCUSSING -- WE HAVE MORE INTEREST IN INTEGRATING EPIDEMIOLOGY, CLINICAL CARE CLINICAL TRIALS, THE IMPACT OF THE HEALTH SYSTEM, AND PUBLIC HEALTH. THAT KIND OF AN EFFORT REQUIRES ACCESS TO LARGE POPULATIONS. MORE AND MORE WE'RE UNDERSTANDING THE NEED TO HAVE DATA COLLECTED AT MULTIPLE LEVELS IN ORDER TO LOOK AT COMPLEX INTERACTION. I JUST WANT TO POINT OUT THESE ARE LIKELY SHARED GOALS AMONG MULTIPLE ICs. SOMETHING WE CAN WORK ON MOVING FORWARD. JUST A FEW EXAMPLES OF HOW LARGE SAMPLE SIZES HAVE HELPED US. THIS IS FROM THE PROSPECTIVE STUDIES COLLABORATION WHICH WAS -- THIS IS PUBLISHED IN 2002 AND INCLUDES I BELIEVE 61 COHORTS HERE WITH A MILLION PEOPLE. AND ABLE TO DESCRIBE THE RELATIONSHIP BETWEEN BLOOD PRESSURE AND STROKE MORTALITY AND STRATIFIED BY AGE. SO THAT'S SOMETHING LARGE SAMPLE SIZE DOES FOR YOU. THIS COLLABORATION HAS BEEN AROUND FOR A WHILE. THIS IS JUST A GENERIC EXAMPLE OF GWAS AND I THINK EVERYBODY HERE KNOWS THIS, THE GENETICS FOR COMPLEX DISEASES WE HAVE LARGELY FOUND MODEST ASSOCIATIONS SO WE NEED LARGE SAMPLE SIZES, WE'LL NEED LARGER SAMPLE SIZES IF WE WANT TO LOOK AT MULTIPLE GENE EFFECT AND GENE, GENE, GENE ENVIRONMENT INTERACTIONS. THE KEISER HMO PUBLISHED THIS ANALYSIS BASED ON 46,000 HOSPITALIZATIONS. WE'RE DOCUMENTS TRENDS IN MYOCARDIAL INFARCTION CONTINUEED TO DECLINE. THEY HAVE BEEN DECLINING DRAMATICALLY SINCE THE 1950s BUT THIS SHOW AS DECLINE OVER LAST TEN YEARS. THIS IS JUST AN EXAMPLE FROM USING CMS DATA, HEART FAILURE, IN OUR INSTITUTE HAS BEEN ONE OF THE EPIDEMICS OF RECENT INTEREST. WE HAVE SEEN HEART FAILURE HOSPITALIZATIONS GREATLY INCREASING BUT AGAIN IN THE CMS DATA WE'RE NOW SEEING SOME PERHAPS TURNAROUND IN THAT. AND THEY WERE ALSO ABLE TO ANALYZE BY RACE HERE AN SHOW STEEPER DECLINE IN WHITES THAN BLACKS. WE PUBLISHED AN RFA RECENTLY THAT SPEAKS TO TAKE THIS A STEP FURTHER THESE ARE EXAMPLE OF RESEARCH AREAS IN THAT RFA, ONE IS TO TRY TO REPLICATE CLINICAL TRIALS USING OBSERVATIONAL DATA. RESEARCH LOOK AT EPIOLOGY AN SECULAR TRENDS OVER TIME, TESTING QUESTIONS WE CAN'T DO A RANDOMIZED TRIAL, ET CETERA. SO AGAIN, THIS IS SOMETHING THAT IS FACILITATED BY VERY LARGE SAMPLE SIZES. I MENTIONED THE IDEA OF STUDYING COMPLEX INTERACTIONS. THIS IS A FIGURE I HAVE SEEN POPPING UP SEVERAL SLIDES OF LATE. THIS IS THE CONCEPT OF STARTING WITH MOLECULAR CELLULAR LEVEL LOOKING AT DISEASE AND CO-MORBIDITY. ALSO TAKING INTO ACCOUNT SOCIAL NETWORKS, THE ENVIRONMENT AND IDEALLY WE WOULD LIKE TO HAVE A REALLY COMPLETE DATA SET SO WE CAN LOOK AT INTERACTIONS AMONG THESE. WE HAVE A SMALL EXAMPLE OF THIS IN OR INSTITUTE BUILT ON THE FRAMINGHAM HEART STUDY WHICH HAS MANY FEATURES INCLUDING SOCIAL NETWORK ANALYSIS, AND A MORE RECENT EFFORT IS TAKING THE BLOOD SAMPLES AND MEASURING HUNDREDS TO THOUSANDS OF MOLECULAR SIGNATURES AND BIOMARKERS AND PUTTING THEM INTO PUBLIC SPACE FOR -- FOR THE RESEARCH COMMUNITY TO ANALYZE. BUT AGAIN, THIS IS A WONDERFUL PROJECT. IT'S RELATIVELY EXPENSIVE. SOME OF THE MODELS WE HAVE BEEN TALKING ABOUT IN OUR INSTITUTE, I HAVE ALREADY ALLUDED TO, INCLUDING THE HMOs, ANOTHER IS THE CTSAs WIDOW HAVE A POPULATION COMPONENT. THERE ARE SOME STATES THAT ARE DEVELOPING THEIR OWN DATA SETS USING MULTIPLE HEALTHCARE SYSTEMS LINKAGES. OR IN WISCONSIN WE SUPPORTED WORK WHERE THEY HAVE BEEN DONE POPULATION SURVEY, LINKED THAT TO THE HEALTHCARE SYSTEM, SO THOSE ARE EXAMPLES TO LOOK TO PERHAPS. THIS IS THE NATIONAL CARDIOVASCULAR DISEASE REGISTRY WHICH IS SUPPORTED BY THE AMERICAN COLLEGE OF CARDIOLOGY. THIS IS WITH THE GUIDELINES, WHICH IS SUPPORTED BY THE AMERICAN HEART ASSOCIATION THEY'RE ABLE TO LINK HEALTHCARE DATA AND OUTCOMES FOR RESEARCH PURPOSES AS WELL AS IMPROVING CARE. THESE ARE EXAMPLES I'LL TALK ABOUT MORE IN A MOMENT THAT ARE IMBEDDED IN NICE HEALTHCARE SYSTEMS IN OTHER COUNTRIES, VERY LARGE SAMPLE SIZES PROBABLY PEOPLE HERE ARE AWARE OF THOSE. AND WE ALSO THINK ABOUT WHETHER WE TALKED ABOUT LEVERAGING OUR COHORT, N HAYNES I CONSIDER ONE OF THE BEST EPIDEMIOLOGY STUDIES IN OUR COUNTRY AND WHERE WHETHER THAT'S SOMETHING WE COULD EXPLOIT MORE OR EVEN THE HEALTH INTERVIEW SURVEY, CLAIMS DATA FOR CMS, CMS OR OTHER INSURANCE COMPANIES, THEN PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE WHICH IS PUTTING OUT FUNDING ANNOUNCEMENTS AND FOSTERING HEALTHCARE RESEARCH. SO THESE ARE SOME THINGS TO KEEP OUR EYE ON. I'M GOING TO RAISE NOW SOME ISSUES AND QUESTIONS. FOR OUR INSTITUTE WE HAVE DABBLED IN SOME MEGA COHORT AREAS AND LOOKED BEYOND AND ARE ASKING QUESTIONS HOW TO ENABLE THEM AS WELL AS SOME THINGS WE NEED TO BE AWARE OF, WE WANT TO HAVE VISION BUT WE ALSO WAN OUR EYES WIDE OPEN. SO THERE'S QUESTION ABOUT THE PRECISION, LEVEL OF PRECISION IN THE DATA, WHEN THEY COME FROM FOR EXAMPLE, ELECTRONIC MEDICAL RECORDS OR CLAIMS DATA. SOME METHOD LOGICAL WORK THAT SHOWS ENCOURAGING RESULTS AS WELL AS CAUGHTS ALONG THE WAY. SOMETHING I THINK ABOUT, WE ALSO KEEP THE OBJECTIVES OF THE RESEARCH IN MIND AND MATCH IT TO THE METHODS. SO I HAVE MENTIONED THIS VERY DENSE STANDARDIZED CHARACTERZATION OF INDIVIDUALS, WHICH WE MAY CALL THICK PHENOTYPING. TO SOMETHING YOU CAN SIT DOWN ON YOUR COMPUTER AND DO THIS LITTLE EPI STUDY ON THE FLY, IT WOULDN'T BE CONSIDERED A COHORT STUDY BUT THAT'S THIN PHENOTYPING. THE ONTARIO HEART STUDY IS COMBINING THOSE TWO CONCEPTS, THEY ARE RECRUITING NINE 1/2 MILLION ADULTS IN WHAT THEY CALL A SIN DATA COLLECTION WITH QUESTIONNAIRES, AND SOME QUESTIONNAIRES WE WOULD TRADITIONALLY USE IN OUR STUDIES. THEN WE HAVE THE THIN PLUS DATA COLLECTION WITH BLOOD SAMPLES, PLANNING TO TARGET DOWN TO 50,000 INDIVIDUALS FROM WHOM THEY WOULD COLLECT A LOT OF DATA, IT'S A MODEL THAT WOULD SEEM TO BE EFFICIENT IN TERMS OF RESEARCH QUESTIONS AND COST. THE UK BIOBANK, MY FORMATTING GOT MESSED UP HERE IS A SIMILAR EXAMPLE. THEY RECRUITED OVER 500,000 MEN AN WOMEN OVER THREE YEAR PERIOD OF TIME. THEY HAVE EXTENSIVE QUESTIONNAIRE DATA THAT'S COLLECTED ON COMPUTERS VERY STANDARDIZED. BUT THEN GO INTO MORE DETAIL IN SUB SETS, PLANNING TO REPEAT A ASSESSMENTS OVER TIME, THEY HAVE PLANNEDS TO DO IMAGING IN ABOUT 100,000. IT'S ANOTHER VERY ATTRACTIVE MODEL. IT'S IMBEDDED IN A HEALTHCARE SYSTEM THAT ALLOWS THEM TO OBTAIN OUTCOME WHICH SOMETHING A LITTLE MORE CHALLENGING HERE. SO AGAIN, THE IDEA OF MATCHING THE OBJECTIVES WITH THE DESIGN, THIS IS A TEXTBOOK OF EPIDEMIOLOGY. I USED IT TO THINK ABOUT HOW THE DESIGN CHANGES ACCORDING TO DIFFERENT OBJECTIVES. IF YOU FIND THE OBJECTIVES OF EPIDEMIOLOGY ARE TO IDENTIFY ETIOLOGY, MEASURE THE BURDEN OVER TIME, DESCRIBE NATURAL HISTORY AND PROGRESS NOSESIS WHICH REQUIRES -- PROGNOSIS WHICH REQUIRES LONGITUDINAL FOLLOW-UP IN INDIVIDUALS. EVALUATE PREVENTATIVE AND THERAPEUTIC MEASURES AND HEALTHCARE DELIVERY AND DEVELOP PUBLIC POLICY. VERY BRIEFLY, YOU MIGHT HAVE A THIN OR A THICK DATA COLLECTION TO DESCRIBE ETIOLOGY. YOU MAY HAVE A THIN LARGE SAMPLE SIZE JUST TO GET US THINKING ABOUT HOW WE MATCH THESE ONTIVES AND DESIGNS. COSTS MAY NOT BE AN ISSUE FOR OTHER INSTITUTES BUT IT IS FOR US CERTAINLY. OUR TRADITIONAL MODEL THIS IS A FIGURE FROM TERRY MANOLIO, WE HAVE ACADEMIC MEDICAL CENTERS THAT MEDICAL DATA, SENT TO A COORDINATING CENTER. THIS IS THE UK BIOBANK MODEL WITH ASSESSMENT CENTERS AND THEN ONE COORDINATING CENTER. THIS IS A ROUGH COST PARTICIPANT PER YEAR, THIS IS ABOUT $66 FOR THE UK BIOBANK. THIS OF COURSE IS REALLY NOT A FAIR COMPARISON BECAUSE IMBEDDED IN THESE COSTS ARE PAYING FOR DATA ANALYSIS. AND GREAT PRODUCTIVITY OF STUDY OVER TIME, THE UK BIOBANK DOESN'T HAVE THOSE COSTS BUILT IN. STILL, IT'S SOMETHING THAT IS IMPORTANT TO CORE GOING FORWARD. ANOTHER THING TO KEEP IN MIND IS THE REPRESENTATIVENESS OF THE SAMPLES THAT WE WANT TO COLLECT ON A MEGA BASIS. FOR EXAMPLE, WE ARE THINKING OF HOW WE USE NEW TECHNOLOGY, MANY BUSINESS DEVICES AND WE KNOW THE PENETRATION OF DIFFERENT MOBILE TECHNOLOGIES FOR EXAMPLE MAY NOT BE THE SAME AMONG ETHNIC GROUPS. I JUST PULLED UP THIS DATA A FEW DAYS AGO FROM THE PEW RESEARCH CENTER. THERE AREN'T HUGE ETHNIC DIFFERENCES HERE BUT WE KNOW THAT FOR EXAMPLE, THE ELDERLY DON'T HAVE AS MUCH ELECTRONIC ACCESS AS YOUNGER PEOPLE DO. ALSO JUST SOMETHING SIMPLE LIKE THE TIME OF DAY YOU DO DATA COLLECTION MAY HAVE IMPACT ON THE KIND OF PEOPLE YOU GET YOUR SAMPLE, THERE'S OVERLAPPING INTEREST BETWEEN INSTITUTES. WE HAVE SOME COMMON DISEASE RISK, SOCIAL CONDITIONS, SMOKING BIOLOGY, ET CETERA. OF COURSE, GENETIC AND OMIC EPIDEMIOLOGY CAN USE THE SAME LARGE POPULATION FOR MULTIPLE CONDITIONS, AND WE CERTAINLY SHOULD DO THAT. MULTIPLE ICs ARE INTERESTED IN HEALTHCARE DELIVERY SCREENING. CHRONIC DISEASE CARE AND COMORBID CONDITIONS. WE ARE FINING DIRECT LINKS BETWEEN CARDIOVASCULAR DISEASE AND CANCER, FOR EXAMPLE. THERE ARE SOME DIFFERENCES TO CONSIDER ANY COLLABORATION GOING FORWARD. I'M GOING TO MENTION A COUPLE OF THEM. CANCER, WE HAVE GOT THE LEADING CAUSE OF DEATH AND CANCER IS THE SECOND LEADING CAUSE OF DEATH. BUT FROM MY UPPING YOU NEED TO BREAK THE CANCERS INTO INDIVIDUAL CANCERS IN GENERAL, NOT TREAT THEM AS A LUMP. SO I PULLED OUT SERE DATA ON CANCER OF THE LUNG AN BRONCHUS VERSUS HOSPITALIZED MI. THERE'S ABOUT A SIX FOLD DIFFERENCE IN INCIDENCE. JUST THAT INFORMS YOUR SAMPLE SIZE. ANOTHER DIFFERENCE BETWEEN OUR CONCERNS HAVE TO DO WITH HOW WE DIAGNOSE OR CLASS½u OUTCOMES IN GENERAL. CANCER WOULD BE DONE ON THE BASIS OF PATHOLOGY, WHEREAS WE HAVE A SOMETIMES MESSY CLINICAL DIAGNOSIS. HERE'S MORE QUESTIONS WE ARE ASKING GOING FORWARD. WHAT ARE KEY ROLE FOR EPIDEMIOLOGY NOW? I PUT IT IN QUOTE BECAUSE THE WAY THE WORLD HAS MOVED FORWARD IT'S THE EDGES ARE BLURRED. THAT'S PROBABLY THE WAY IT OUGHT TO BE. HOW DO WE ENABLE WHATEVER THOSE ROLES ARE THAT WE THINK ARE MOST IMPORTANT THAT WE ENVISION? HOW SHOULD WE PRIORITIZE MEGA EPIDEMIOLOGY? HOW DO WE ENABLE THE STUDY OF MULTI-LEVEL PLEXTY? HOW CAN WE LEVERAGE EXISTING COHORTS. WHAT METHOD LOGICAL WORK IS NEEDED FOR MORE CONFIDENCE IN WHAT WE'RE DOING. HOW DO WE GET FROM WHERE WE ARE TO WHERE WE WANT TO GO. HOW DO WE EVALUATE PROGRESS ALONG THE WAY, HOW CAN WE PARTNER WITH OTHER GROUPS. FINALLY, IN PUTTING THIS TALK TOGETHER, I CONSULTED PEOPLE, TALKED TO PEOPLE, GOT SOME INFORMATION FROM PEOPLE BOTH IN MY INSTITUTE AND AT NCI, I WILL LIKE TO THANK THEM. AND I THANK YOU FOR YOUR ATTENTION. [APPLAUSE] >> ONE BRIEF COMMENT, JOHN KING FROM NATIONAL INSTITUTE ON AGING. WHEN RICHARD AND I PUT IN SYNTHETIC PROPOSAL IN COMMON FUND IN 2012 WE WERE HOPEFUL WE WOULDKNOW WHAT WAS HAPPENING BY NOW. I DON'T THINK THERE'S ANYTHING PUBLICLY AVAILABLE YET BUT WE'RE HOMOFUL. >> I WAS GOING TO ASK SOMEBODY HERE THAT QUESTION. I DON'T KNOW. >> IF YOU KNOW BETTER PEOPLE THAN I DO, THEY MAY KNOW. >> VERY INTERESTING STUDY. REGARDING THE GRAPH YOU SHOWED ON TIME TENSION AND P STROKE INCIDENT, THE BASELINE FOR THE LOWER AGED POPULATION IS 120. THOSE HIGHER AGE DID YOU FIND THAT THEY WERE TAKING MEDICATION OR ARE WE ALLOWING THE NORMAL AGING WHICH IS CHANGING IN VASCULAR TONING TO BE INCLUDED IN THE GRAPH YOU SHOWED? >> I WAS ACTUALLY JUST USING THAT AS AN EXAMPLE OF HOW ALREADY LARGE SAMPLE SIZE ALLOW US TO STRATIFY AND LOOK AT EXTREMES. I'M NOT PREPARED TO COMMENT ABOUT THE DETAILS OF THAT PAPER. >> IT'S A VERY INTERESTING DATA. >> DIANE, THANK YOU, WONDERFUL OVERVIEW. I WANT TO PUT TOGETHER TWO OF THE QUESTIONS OR TWO OF THE IDEAS THAT YOU RAISED AND ASK IF YOU HAVE HAD EXPERIENCE COMBINING THEM. THE CONCEPT OF THE ONTARIO COHORT THAT WE GET SOME THINGS THIN AND SOME THINGS MEDIUM, A FEW THINGS THICK SEEMS TO FIT PERFECT WITH YOUR OBSERVATIONS WHICH IS MORE COMMON THAN COMMON CANCERS SO VERY POWERFUL STUDIES, SIZE FOR HEART DISEASE CAN BE 10,000 AS OPPOSED TO 100,000 FOR CANCER. DO YOU HAVE ANY MODELS GOING NOW WHERE IN EFFECT THE WHOLE COHORT IS NOT DOING HEART DISEASE EPIDEMIOLOGY AN DEATH BUT SOME PIECE OF IT, 10%, IS GETTING THAT THICKER DATA NECESSARY TO DO THE HEART? LET'S SAY CANCER COHORT OR SOMETHING. I WAS TRYING TO THINK OF ONE AND NOTHING CAME TO MIND BUT THOUGHT YOU GUYS MAY HAVE -- YOU MAY HAVE FOUND A FRACTION OF A LARGE COHORT THAT IS NOT DOING HEART IN DEPTH GIVEN THE MONEY TO GO AFTER 10% OF THE PEOPLE IN DEPTH. DO YOU HAVE LIKE THAT GOING ON? >> VERY GOOD QUESTION. OUR TRADITIONAL MODEL HAS NOT BEEN THAT WAY. WE HAVE TENDED TO BRING THE WHOLE COHORT IN AND PHENOTYPED THE SAME WAY, MEASURE EXPOSURES. THE ANCILLARY STUDIES THAT TAG TO THESE CONTRACT FUNDED COHORT COHORTS, MAY BE MORE ALONG THOSE LINES. THEY'RE INTERESTED IN SUBSET AND WILL COME WITH ADDITIONAL FUNDING TO DO DETAILED CHARACTERZATION. THAT'S WHAT POPS INTO MY MIND RIGHT NOW. SOME OF MYE AUDIENCE AND MAYBE ABLE TO REMEMBER SOME OTHER EXAMPLES. BUT IN GENERAL I THINK IT'S NOT A MODEL WE HAVE TENDED TO USE AND PERHAPS WE SHALL IN THE FUTURE MORE. >> BESIDES USING JUST AS OUTCOME, WE DO A GREAT JOB VERIFYING VERIFYING THE CANCER OUTCOME, HAVE YOU BEGUN TO THINK HOW WE MIGHT BE ABLE TO GO ABOUT VERIFYING THESE CARDIOVASCULAR OUTCOMES THAT ARE COST EFFECTIVE OR AT A COST THAT'S AFFORDABLE, IF YOU WILL? >> YES, SOME IS ONGOING. THE QUICK SLIDE THAT I SHOWED WITH SOME OF THE QUESTIONS BOTH PAPERS THAT WERE MENTIONED THERE WERE USING EITHER ELECTRONIC HEALTH RECORDS OR CLAIMS DATA AND DOING SOME VALIDATION SOMETIMES THROUGH SIFTING THROUGH THE FREE TEXT OR DOING MORE DETAILED ADJUDICATION. SO WE ARE DOING SOME OF THAT WORK. THAT'S PROBABLY WHAT WE NEED TO, AS I SAID, FEEL CONFIDENT WITH GOING AHEAD WITH EASIER KINDS OF END POINTS. >> (INDISCERNIBLE) IMPERIAL COLLEGE, LONDON. THANK YOU FOR A VERY, VERY EXCELLENT INSIGHT ON WHAT ARE THE CHALLENGES NOW. I HAVE JUST THROUGH THE -- QUESTION, COMMENTS, VERY BRIEFLY. ONE, IT REECE VERY IMPORTANT WHAT YOU SHOW ABOUT COST AND EFFICIENCY OF LARGE CO-STUDIES USING THE UK BIOBANK IN WHICH WE ARE INVOLVED. INDICATING $1,100, 100 POUNDS PER SUBJECT, 63 MEDIAN POUNDS ACTUALLY. EPIC BY COMPARISON WAS ABOUT THE SAME COST. WE SPENT ABOUT 60 MILLION EUROS TO COLLECT DATA AND BIOLOGICAL SAMPLES FROM HUMAN SUBJECTS. SO ROUGHLY TODAY EPIC AND UK BIOBANK DEMONSTRATE THAT WITH SOMEWHERE AROUND THE 100 EUROPE SUBJECT YOU CAN GET DETAILED DATA, GOOD PHENOTYPING AND BLOOD WITH EPIC WE EXPERIENCE WITH THE FEW ADDITIONAL EURO PER SUBJECT YOU CAN DO FOLLOW-UP FOR 15 YEARS. SO THE FOLLOW-UP YOU GO FOR RECORD LINKAGE IS VERY,VERY COST EFFECTIVE. THE SECOND POINT IS ABOUT THE SAMPLE SIZE. YOU ARE PERFECTLY RIGHT IN THE DIFFERENCE IN INCIDENCE BETWEEN CARDIOVASCULAR AN CANCER, CARDIOVASCULAR EVENTS AND CANCER. HOW FAR WE HAVE GIGANTIC HEALTHY VOLUNTEER EFFECT. SO MYOCONSIDEREDIAL INFARCTION WE HAVE EPI CART PROGRAM, WE HAVE 14,000 CASES OF MYOCARDIAL INFARCTION, SAME NUMBER Z BREAST CANCER CASES. FOR BREAST CANCER WE GET 110% OF THE EXPECTED CASES. 50% OF THE EXPECTED CASES. BECAUSE THOSE WHO COME TO OUR COURSE ARE MUCH, MUCH MORE HEALTHY. SO THAT IS SOMETHING WHICH IS VERY, VERY TRICKY TO TAKE INTO ACCOUNT. >> INTERESTING POINTS. THANK YOU. >> (INDISCERNIBLE) FROM WOMEN'S HEALTH INITIATIVE. TO FOLLOW-UP ON TRISH'S QUESTION, YOU -- WE ARE DOING THAT A LITTLE BIT IN WHI. IN THE ORIGINAL DESIGN IT WAS A FULL FOLLOW-UP EVERYONE BUT IN EXTENTED FOLLOW-UP WE HAVE ABOUT 22,000 WOMEN THAT WE'RE FOLLOWING UP COMPLETELY FOR CARDIOVASCULAR ENPOINTS AND NCI KICKED IN FUNDING TO DO THE CANCER AS CERTAINMENT ON THE COHORT BECAUSE WE NEED THAT FOR THE RARE CANCERS. COUPLE OTHER POINTS MAKE, NHLBI HAS DONE A NICE JOB IN TERMS OF ARRANGING FOR THE LINKAGE TO MEDICARE DATA. FOR THOSE WHO HAVEN'T TRIED THAT, EIGHTY AN EXPENSIVE PROPOSITION, IT'S LIKE $15,000 PER YEAR OF CALENDAR YEAR OF DATA THAT YOU WANT TO OBTAIN FOR YOUR COHORT. IF YOU HAVE TO BUY IT YOURSELF. NHLBI ARRANGED FOR ALL COHORTS AS MY UNDERSTANDING TO HAVE THAT LINKAGE THROUGH AN INTERAGENCY AGREEMENT, I WOULD LIKE TO TAKE THIS OPPORTUNITY TO SUGGEST THAT NCI MIGHT WANT TO FOLLOW SUIT FOR THESE COHORTS TO HAVE THAT ACCESS. WITH REGARD TO LAST SPEAKER COMMENTS, WE IN WHI NOTICE THE HEALTHY VOLUNTEER EFFECT HAD A LARGE EFFECT IN OUR CARDIOVASCULAR DISEASE EVENT RATES EARLY ON SO OUR BREAST CANCER RATES AND MI RATES ARE ABOUT -- THE NUMBER WE ACCUMULATED FOR THE FIRST EIGHT YEARS ARE ABOUT THE SAME BETWEEN BREAST CANCER AND NLA WHICH IS KIND OF STRANGE. THE GENERALIZABILITY IS ALWAYS A QUESTION BUT IN DESIGNING THESE, IT'S HARD TO KNOW HOW MUCH HEALTHY VOLUNTEER EFFECT TO TAKE INTO ACCOUNT. ARE THERE -- SO FOR OUR CANCER POWER CALCULATIONS WE HAVE SERE RATES THAT WORKED WELL, BUT CURIOUS TO KNOW WHETHER THERE ARE BETTER POPULATION RATES THAT WE CAN USE FOR CARDIOVASCULAR DISEASE IN TRYING TO DESIGN COHORTS. THAT'S A VERY GOOD QUESTION AND IT'S A PROBLEM WE HAVE DEALT WITH OVER AND OVER AGAIN. WHEN FOR EXAMPLE DESIGNING CLINICAL TRIALS WE'RE ALMOST EXPECTING THAT THE RATES PEOPLE EXPECT TO HAVE FOR CARDIOVASCULAR OUTCOMES ARE GOING TO BE HALF WHAT THEY PREDICT AND WE HAVE HAD SAME EXPERIENCE WITH COHORT STUDIES. PART IS HEALTHY VOLUNTEERS, PART MAYBE THESE SECULAR TRENDS WHICH ARE GOOD. IT IS FRUSTRATING TO GET GOOD CURRENT INCIDENCE DATA ON CARDIOVASCULAR DISEASE, A FEW YEARS AGO OUR INSTITUTE DID PUBLISH INCIDENCE AN PREVALENCE DATA AND IT CAME OUT A FEW YEARS AGO, PROBABLY NEEDS TO BE UPDATED, IT'S A NICE RESOURCE, I BELIEVE IT'S ON THE WEB SOMEWHERE. AND THE AHA AND OUR GROUP ALSO COLLABORATES ON A STATISTICAL UPDATE EVERY YEAR. I HAVE ENCOURAGED THAT GROUP TO PUT IN MORE INCIDENCE DATA BUT IT'S SURPRISINGLY DIFFICULT TO COME BY. OKAY. [APPLAUSE] >> WELL, THE NIA REALLY CAN'T COMPETE IN BUDGET WITH NCI. WE'RE ABOUT A 6TH, OR IN TERMS OF CAUSE OF DEATH BUT PROBABLY IN DISABILITY AND COST OF DISEASE WE'RE UNFORTUNATELY ON COMPARABLE FOOTING WITH BOTH CANCER AND HEART DISEASE SINCE ALZHEIMER'S AT -- COST OF ALZHEIMER'S WHICH ARE HEAVILY LONG TERM CARE DO APPROXIMATE COST OF CANCER AND HEAR DISEASE. -- HEART DISEASE. THERE WAS SOME MENTION OF SYNTHETIC COHORT THAT WE HAD PUT IN I THINK IN 2011, IT WAS UP ON THE WEB AS A COMMON FUND ACTIVITY, THERE ARE LOTS OF POSITIVE COMMENTS. THERE WAS A SMALL GROUP THAT MET DIRECTORS OF NIA, GENOME AND ACTING DIRECTOR OF HEART. IT KIND OF GOT -- WE MET ARE FEW TIMES THEN IT GOT PEOPLE CAPTURED IN PHARMACEUTICAL INDUSTRY AND DRUG TARGETS. THERE'S SUPPOSED TO BE A NEW WORKING GROUP TO MEET BUT I DON'T THINK IT'S MET YET. CANCER, NCI DIDN'T JOIN THE INITIAL COMMON FUND ACTIVITY BUT THEN THANKS, PATRICIA AND DEBBIE CAME AND SPOKE TO ME AND THAT'S WHY I'M HERE TODAY I THINK. I THINK WE HAVE A LOT OF COMMON INTEREST. SO WHY DO WE NEED SYNTHETIC COHORT? WE HAVE ALREADY HEARD LARGE ENDS FOR DOSE DISCOVERY, FROM OUR PERSPECTIVE WE SEE HIGH VALUE IN COMPARATIVE ACROSS NATIONAL STUDIES. I ALSO ADD IT'S IMPORTANT FOR REPLICATION, OBSERVATIONAL STUDIES HAVE GOTTEN A PERHAPS RATHER BAD NAME FROM SOME THINK MYSTERIOUSLY THAT RCTs ARE THE GOAL STANDARD AND I THINK HAVING LOTS OF REPLICATION, HELPS THEIR MANY FINDINGS REPLICATED 50 TIMES IN DIFFERENT COHORTS OF THE LAST HUNDRED YEARS. THE ISSUE IS AS LAST SPEAKER SAID, TO TRY TO INTEGRATE THE TWO. SO WHY BEHAVIORAL SYNTHETIC COHORT? BEHAVIORAL PATENTS AND SOCIAL FACTORS ARE THE LARGEST PERCENT CONTRIBUTION TO PREMATURE DEATH, STEVE SCHROEDER NEW ENGLAND JOURNAL ARTICLE. IN GWAS DISCOVERED RISK VARIANTS AFFECT GENES THAT HAVE INFLUENCE THROUGH BEHAVIOR OR BEHAVIORAL PHENOTYPES EPOE. I WOULD ALSO LIKE TO MENTION THAT GENERAL FIR HARRIS AN JOHN KING IN THE AUDIENCE PLAYED A SIGNIFICANT ROLE IN THE IDEA OF SYNTHETIC COHORT. WE HAVE SEEN ALREADY, WE HAVE HEARD YOU NEED LARGE NUMBERS OF CASES ON THIS, ESPECIALLY FOR GENE LIFESTYLE AND GENE GENE INTERACTIONS. I NEED TO PUT UP THIS ICONIC CHART THAT POOR HEALTH BEHAVIORS KILL FROM SCHROEDER ET AL NEW ENGLAND JOURNAL ARTICLE, BEHAVIORAL PATENTS AND SOCIAL CIRCUMSTANCES PLAY A LARGE ROLE THOUGH GENETIC DETERMINANTS OF THOSE BEHAVIORAL PATENTS AND SOCIAL CIRCUMSTANCES ARE, IS STILL AN INTERESTING QUESTION. HERE IS A MAP OF SOME OF OUR NATIONAL COHORTS. COME BACK TO THIS BUT COUPLE OF FAMILIES OF STUDIES INVOLVED, FUNNED OUT OF OUR DIVISION, THERE ARE OTHER DIVISIONS IN THE INTRAMURAL HAVE COHORTS BUT FOCUS TO SOME EXTENT ON THESE. SO NIA FUNDS MANY NATIONAL COHORTS, THE ONES IN RED I TALK ABOUT. THE ONES IN THE RETIREMENT STUDY HRS AND 35 INTERNATIONAL HRS LIKE IN VARYING DEGREES COHORTS. THEN ALSO FROM A DIFFERENT DIVISION, THE NORTH CALIFORNIA KEISER PERMANENTE UCSF COHORT FUNDED THROUGH OUR LARGE -- A VERY LARGE RC-2. THEN THE INTRAMURAL DIVISION, THE AFRICAN AMERICAN LOW INCOME IN BALTIMORE BUT I OWN TALK ABOUT THOSE. THERE ARE COHORTS, PANEL 18 CO-FUNDED WITH NICHD, ALSO INTERESTED IN IN THE U.S., IT HAS AN ARRAY OF PHYSIOLOGICAL MEASURES TO SHOW HOW SOCIAL EXPERIENCES GET UNDER THE SKIN N HAYNES THE SUBSTITUTE NOW FOR THE NATIONAL LONG TERM CARE SURVEY AN FOCUSES SPECIFICALLY ON DISABILITY IN THE ELDERLY. N HAPPEN WHICH FOCUSES ON SOCIAL INTIMACY AND SEXUAL ACTIVITY, SO IF YOU'RE INTERESTED IN SEX AND CANCER THAT'S A GOOD STUDY THERE. PROJECT TALENT WHICH IS IN DEVELOPMENT IS POTENTIAL COHORT OF ALMOST 400,000 RANDOM SAMPLE OF ALMOST 400,000 HIGH SCHOOL AN JUNIOR HIGH SCHOOL STUDENTS, TWO DAYS OF TESTING IN 1961 AND WE'RE TRYING TO FOLLOW-UP. THEN REGIONAL COHORT SUCH AS WISCONSIN OR LONGITUDINAL STUDY WHICH STARTED AT HIGH SCHOOL. THE HLS STUDY DESIGN IS NATIONALLY REPRESENTED PROBABILITY SAMPLE OF THE U.S. POPULATION AGE 51 PLUS. SIGNIFICANT OVERSAMPLES OF MINORITIES, LONGITUDINAL REFRESHED EVERY SIX YEARS SO IT'S ALWAYS EVERY SICK YEARS, IT'S REPRESENTATIVE OF 51 PLUS. INTERVIEWS BOTH MEMBERS OF COUPLES, SAMPLE SIZE 25,000, 12,000 DEATHS, 38,000 EVER INTERVIEWED AND ABOUT 4500 INCIDENT CASES OF DEMENTIA. ADMINISTRATIVE LINKAGE INCLUDES SOCIAL SECURITY EARNINGS AN BENEFITS, THAT'S THE BASICALLY THE W-2 DATA, LINKED WITH PERMISSION, MEDICARE, MEDICAID RECORDS WE HAVE GOT CLEANED UP MEDICARE USER FRIENDLY FILES INITIALLY DEVELOPED BY MARK MCCLELLAN AT STANFORD. THE NATIONAL DEATH INDEX UNTIL RECENTLY, WE DO HOPE THAT WILL COME BACK. AT THE MOMENT I THINK WE PRESERVED IT EXCEPT FOR THE THE STATE DATA, THERE'S A BIG HOLE. THEN WE ARE IN THE PROCESS OF LIPOING CHARTS FROM THE VA FOR ALL VETERANS WHICH WILL BE VALUABLE IN GIVING A SENSE OF SOME OF THE SELF-REPORT AND MEDICARE VARIABLES AND THEN LOTS OF LINKAGE, PENSION AN HEALTH PLANS, THIS WAS INITIALLY DESIGNEDDED BY ECONOMISTS. SO CONTENT AREAS INCLUDE THE MAYOR CHRONIC CONDITIONS, HEALTH BEHAVIORS, SIGNIFICANT FOCUS ON COGNITION MEMORY ATTENTION LANGUAGE, HEALTH SERVICES UTILIZATION. LOTS OF LABEL FORCE AND ECONOMICS OCCUPATION DISABILITY, LOTS ON ECONOMIC STATUS INCOME WEALTH 27 DIFFERENT KINDS OF WEALTH. EPIDEMIOLOGISTS HEARD THAT WE ARE CONNECTING WEALTH THEY TURNED PALE AND WHEN ECONOMISTS HEARD WE WANT TO COLLECT BLOOD THEY ALSO TURNED PALE. WEALTH IS MORE STRONGLY RELATED TO HEALTH THAN IS INCOME FAMILY STRUCTURE, HOUSING, TIME USE, ET CETERA. AND THEN IN TERMS OF PSYCHOLOGY PERSONALITY, SUBJECTIVE WELL BEING BASED ON MOMENTARY RATHER THAN EVALUATIVE MEASURE, MOMENT TEAR WELL BEING, STRESS, SOCIAL SUPPORT AND VARIOUS TYPES OF RISK TAKING AND TIME VALUE AND DISCOUNTING. IN TERMS OF BIOLOGY, PHYSICAL PERFORMANCE, GATE SPEED GROUP STRENGTH, BALANCE, TESTING ACTTIGRAPHY BECAUSE SELF-REPORT IS LOUSY ON ACTIVITY, PHYSICAL ACTIVITY, BLOOD PRESSURE, DRIED BLOOD SPOTS WITH VARIOUS MEASURES BUT WE'RE TRYING TO MOVE TO VENUS BLOODS, ALSO INTEREST NOW IN NEUROIMAGING PROCEDURE. IN TERMS OF THE GENETICS, THE ALUMINA 2.5 STEP. GETTING THE 75 -- 750K EXOME AND TELOMERE LENGTH ROUGHLY JUST ABOUT 13,000 ARE IN DB GAP AND ANOTHER 7,000 TO COME. I WANT TO SWITCH TO EXPLAIN HOW WE -- WHY WE WENT INTERNATIONAL. IF YOU LOOK -- THIS IS A STUDY -- THESE ARE STUDIES OF TRENDS IN OLD AGE DISABILITY, 65 PLUS. BETWEEN 1984 AND ROUGHLY 2000 FROM THE NATIONAL LONG TERM CARE SURVEY, DISABILITY DROPPED IN THE ELDERLY, THE PREVALENCE OF DISABLE DROPPED ABOUT 25%. UP FORTUNATELY IT HAS NOT CONTINUED TO GO DOWN WE THINK IN PART BECAUSE OF OBESITY. WE IT CHANGED OUR VIEW OF AGING UNTIL ONE THOUGHT OF ONE COULD PROLONG LIFE BUT NOT DO ANYTHING ABOUT DEGENERATIVE CHRONIC DISEASES. WE WANT TO FIND OUT IF SAME THING WAS HAPPENING IN OTHER COUNTRIES. YOU CAN SEE SAME FINDENING HEALTH INTERVIEW SURVEY, HRS AND MEDICARE CURRENT BENEFICIARY SURVEY, ONE FEATURE IS THE LEVELS ARE DIFFERENT BUT THE TREND IS SOMEWHAT THE SAME. SO WE ESTABLISHED A SERIES OF COMPARABLE TO VARYING DEGREES STUDIES AROUND THE WORLD. LONGITUDINAL STUDY OF AGING, TILDA, WHICH WE DON'T FUND BUT IS COMPARABLE IN IRELAND, SHARING IN 11 COUNTRIES IN THE EU AND NOW I THINK ABOUT 1920 SOUTH KOREA, CHINA, CHARLES, MEXICO, JAPAN, J STAR WE DON'T FUND BUT IS MODERATELY COMPARABLE AND NEW ONES DEVELOPING IN INDIA AND BRAZIL. KEY FEATURES OF THE GLOBAL MODEL, AGAIN NATIONALLY REPRESENTATIVE, SOME START AT AGE A LITTLE EARLIER AT 40, SOME START AT AGE 18, BY ANNUAL INTERVIEWS EVERY TWO YEARS, INTERVIEWS BOTH MEMBERS OF COUPLE MULTI-DISCIPLINARY IN CONTENT. DRIED BLOOD SPOTS BUT SOME HAVE NOW VENUS BLOOD DNA THEY'RE STARTING TO COLLECT THROUGH SALIVA, YOU WANT TO GET DIFFERENT INFORMED CONSENT. LINKAGES TO ADMINISTER RECORDS WHERE THEY'RE AVAILABLE. AND VERY RAPID PUBLIC RELEASE OF DATA BEFORE THE INVESTIGATORS REALLY WRITE ANYTHING. SO THIS AGAIN, IS THE MAP AND DIFFERENT FAMILIES HERE. BRAZIL IS STARTING, ARGENTINA, PLANNENING AUSTRALIA, INDIANAIA IS IN PILOT -- INDIA IS IN PILOT PHASE MOVING TO FULL PHASE. WE ALSO HAVE SOMETHING CALLED IN DEPTH WHICH I'LL GET INTO LATER WHICH ARE DEMOGRAPHIC SURVEY LENS UNITS IMBEDDED IN SOME OF THESE COUNTRIES. INDONESIA IS ALSO -- SHOULD BE A FAIRLY COMPARABLE STUDY IN INDONESIA. THIS IS JUST THE MAP OF SHARE IN THE EU, IT ALSO INCLUDES ISRAEL AND GREECE AT THE MOMENT MAY DROP OUT BECAUSE OF ECONOMIC PROBLEMS AND THEN COME BACK AGAIN IN A WHILE. WE SET UP A SERIES OF R-24 NETWORKS TO HARMONIZE ACROSS NATIONAL RESEARCH AND DATA. THERE'S ONE ON NETWORK AND MEASUREMENT BIOLOGICAL RISK AT USC AND UCLA. THAT'S ONE IN THE HARMONIZATION ACROSS NATIONAL STUDIES OF AGING TO THE HRS AT BRAND. AND WE HAVE SET UP A SURVEY METADATA REPOSITORY AT RAND WHICH IS REALLY A CONCORDANCE OR SEARCH ENGINE TO SUPPORT CROSS NATIONAL RESEARCH IN THE HRS FAMILY. YOU CAN SEARCH FOR COMPARABLE QUESTIONS ACROSS SURVEYS OR DEVELOP A VERY EASY SET OF IDENTICAL VARIABLES ACROSS COUNTRY ANALYSIS. THAT'S JUST THE FACE OF IT, I DON'T THINK IT TELLS YOU THAT MUCH. A FEW EXAMPLES OF COMPARATIVE RESEARCH WAS HARMONIZED COHORTS, HEALTH DIFFERENCES AND THE IMPACT OF RETIREMENT ON COG ANYTHING. ONE STUDY THAT WAS FROM BANKS ET AL PUBLISHED IN JAMA IN 2006, COMPARED THE HRS NON-HISPANIC WHITE MEN WITH ELSA IN ENGLAND. AND THE REPORTED HYPOTENSION, DIABETES, CANCER, LUNG DISEASE, MI STROKE WAS ALL WORSE IN THE U.S., EVEN THOUGH THEY SAID SELF-REPORTED HEALTH WAS BEAR. MARTIN BROWN ARGUED THE KAREN, SHOE IS ONE OF DETECTION DIFFERENCES IN DETECTION IS PROBABLY RIGHT. WHEN YOU CONTROL FOR SERIES OF USUAL RISK FACTORS, YOU STILL LOOK BAD AND IF YOU BEGIN THE LOOK AT SOME OF THE PHYSIOLOGICAL MEASURES GLYCOSYLATED HEMOGLOBIN, BLOOD PRESSURE CRP, CHOLESTEROL, U.S. LOOKED BAD. STILL LOOKS BAD. WHAT'S WORSE WHEN YOU COMPARE TO ENGLAND, TO THE CONTINENT, EUROPE ENGLAND LOOKS BAD COMPARED TO THE CONTINENT MAKING THE U.S. LOOK EVEN WORSE. WHAT IS INTERESTED IS IT'S UNCLEAR WHAT IS GOING ON WHEN YOU CONTROL, THIS IS FOR HEART DISEASE PREVALENCE, CONTROL FOR WEALTH IN EUROS, RANGE FROM 100,000 TO 900,000, YOU STILL GET THE SAME PATENT, SO IT'S NOT JUST SES DIFFERENCES. IT'S PROBABLY ALSO NOT HEALTH INSURANCE DIFFERENCES. SO U.S. LAGS BEHIND MOST OTHER HIGH INCOME NATIONS IN LIFE EXPECTANCY. THIS IS THE U.S. SINCE 1980 COMPARED TO OTHER HIGH INCOME COUNTRIES. I FIRST DISCOVERED THIS, SHOULD HAVE KNOWN IT BEFORE BUT I WAS LISTENING TO A SENATE SPECIAL COMMITTEE HEARING A DEMOGRAPHER PRESENTED THIS DATA WHICH I FOUND STARTLING SO WE STARTED CORRESPONDING. AND IT TURNS OUT THAT IT'S MAINLY WOMEN NOT MEN WHETHER HAVE DIVERSION TRENDS IN ADULT LIFE EXPECTANCY NOT SHOWN HERE WHEN YOU BREAK IT DOWN FURTHER IT'S WHITE WOMEN RATHER THAN BLACK WOMEN. I THOUGHT THIS WAS IMPORTANT. SO WE CALL NATIONAL ACADEMY PANEL ON THIS, THE IT WAS CHAIRED BY SAM PRESTON AN EILEEN CREMONS. HLS SHARE FEATURE IN THE REPORT. WHAT CAME OUT IS SOMETHING SAM PRESTON ARGUED THAT LIFETIME SMOKING MAY HAVE BEEN THE BIG FACTOR THAT WASN'T CAPTURED BY THE SMOKING QUESTIONS, O BOASETY HAD AN EFFECT BUT IT SEEMS TO HAVE DIMINISHED OVER TIME AND WASN'T NEARLY AS STRONG AS LIVE TIME SMOKING. I THOUGHT I WOULD BRING TO BE CO-IN. THAT'S WHY I PUT THIS IN. THERE'S ANOTHER PANEL GOING ON LOOKING AT THIS IN MORE DETAIL. LET ME TURN TO COGNITION THIS IS A STUDY BASICALLY SHOWS PUBLIC PENSION DETERMINE HOW LONG YOU STAY MANY THE LABEL FORCE WHEN YOU RETIRE, JAPAN, U.S., SWEDEN, YOU WORK A LONG TIME, BELGIUM, ITALY, FRANCE, NETHERLANDS, YOU GET OUT EARLY. AND THIS IS GOING ON MAYBE 30 YEARS AND IS FUNCTION IN PART OF TRADE UNION STRENGTH AND LEGISLATION. WE CAN USE IT WHAT ECONOMISTS CALL AN STRUM TO LOOK AT USING DATA IN CON IN ADDITION FROM STUDIES, IT SHOWS CROSS SECTION THAT IN COUNTRIES WHERE PEOPLE RETIRE EARLY, THERE'S A BIGGER DROP BETWEEN AGE 50 TO 54 AND 60 TO 64 IN COGNITIVE PERFORMANCE, MAIN HI MEMORY AS I REMEMBER. SHOULD BE ABOUT A THIRD OFFER THAT BUT IT'S STILL A STRONG EFFECT. THAT'S THE SORT OF THING YOU CAN DO WITH HARMONIZED COHORTS. SAGE IS A SURVEY, IN MEXICO SOUTH AFRICA, INDIA, CHINA, AND RUSSIA. IT WAS BASED ON THE 2002, 2003 WORLD HEALTH STUDY. AND COORDINATED WITH SERIES OF DEMOGRAPHIC SURVEILLANCE UNITS, MORE EPIDEMIOLOGICAL, IT'S GOT FOR EXAMPLE, DRIED BLOOD SAMPLE FROM 45,000 RESPONDENTS. MOST WERE FASTING AND ABOUT TO COLLECT DNA. I WANT TO MOVE QUICKLY TO THE NORTHERN CALIFORNIA KEISER PERMANENTE DATABASE. THEY GOT SALIVA FROM 110,000 OF THE HMO. THEY YOURSELF CUSTOM WIDE GENOME WIDE SNP ARRAYS FOR MAJOR RACE ETHNICITY GROUPS. THEY'RE GETTING TELOMERE LINKS. AND MERGING WITH GWAS AND TELOMERE DATA WITH KEISER PERMANENTE ELECTRONIC HEALTH INFORMATION SURVEY DATA AND GEOCODED ENVIRONMENTAL DATA INTO A DATABASE FOR GENERAL USE. I THINK THIS GOES INTO DB GAP EARLY NEXT YEAR. THERE WAS A NETWORK ON HARMONIZATION TOPICS SUCH AS SLEEP, TIME USE, FURTHER RESEARCH TO ESTABLISH CROSS STUDY COMPARISONS. DEPRESSION, DISABILITY ARE EASY TO TO. PROBLEM IS QUESTIONNAIRES ARE VERY FULL STUDIES MORE FOCUSED ON MAINTAINING COMPARABILITY OVER TIME. WE HELD A WORKSHOP ON THE SAME ISSUE TO EXPLORE HARMONIZATION STRATEGIES TO ACT SEMIRATE INTEGRATING THE DATA WITH GENETIC AND GENOMIC INQUIRY. WE PUT MANY COHORT STUDIES INTO A PHOENIX MATRIX WE FOUND USEFUL THOUGH IT HAS MANY BIG GAPS. SOME OF THE RECOMMENDATIONS IS THERE NEEDS TO BE ENOUGH HARMONIZATION AMONG STUDIES TO FACILITATE COMPARATIVE RESEARCH AND WE SHOULD PERFORM THE EX-POST HARMONIZATION SUCH AS THE CANADIAN STUDY P-3G TO HAIR MOBBIZE WHAT'S ALREADY BEING COLLECTED. HOW MUCH HARMONIZATION IS DESIRABLE, I THINK THIS ALSO GETS DOWN TO THE ISSUE OF THE GRANULARITY YOU NEEDTOR BEHAVIORAL PHENOTYPES IN GENETIC RESEARCH YOU DON'T WANT EVERYTHING HOMOGENIZED TO IMPROVE MEASURES AND YOU HAVE GOT TO -- YOU CAN'T IGNORE COUNTRIES SPECIFIC VARIATION SOME OF THE TOPICS AN PHENOTYPES CONSIDERED WELL BEING PERSONALITIES CONSCIENTIOUSNESS, HEALTH OUTCOMES, COGNITIVE FUNCTIONING, HEALTH BEHAVIORS, RISK TAKING, TIME DISCOUNT FUNCTION VERY IMPORTANT IN TERMS OF CLASS DIFFERENCES SOCIAL STRESSORS AN CHILDHOOD EXPERIENCES. IN TERMS OF COLLABORATION POTENTIAL WITH NCI, ONE POSSIBILITY IS TO ADD MODULES TO THE HRS STUDIES WE DO PUT PILOT MODULES IN A 10% OF THE SAMPLE, PERHAPS HEALTH DEVELOP RELIABLE BLOOD SPOT ASSAYS EASY TO DO IN LOW INCOME COUNTRIES THOUGH WE ARE NOW TRYING TO MOVE TO VENUS BLOOD AND HARMONIZATION OF VARIABLES. IN TERMS OF STUDIES THAT CAN BE DONE WITH CANCER, OBESITY AND ALL CANCER OCCUPATION CATEGORIES, WE HAVE PRE-KAREN MEDICATION USE, WE -- IT'S CERTAINLY THE HRS IS LINKED TO MEDICARE PART D DATA WHICH NOT ALL IS THERE. LONG TERM NON-CANCER DISEASE ON CANCER RECURRENCE, MULTI-MORBIDITY. HEALTH SERVICES KNOW, HEALTH INSURANCE, TYPES OF CARE INSTITUTIONS, POST DOC COMPLICATIONS, END OF LIFE AND PAIN, AND THE QUALITY OF BEREAVEMENT IN CANCER DEATH FROM THE COUPLINGS DATA. THANK YOU. -- COUPLES DATA. THANK YOU. [APPLAUSE] >> I THINK PEOPLE NEED TO GET UP, WALK AROUND A LITTLE AND HAVE A BREAK. WE'LL BE BACK HERE TO START UP THE PAM AT 11:20. SO AGAIN, RESTROOMS TO THE SIDE AND REFRESHMENTS IN THE CAFETERIA. >> OKAY. IF WE CAN HAVE EVERYONE TAKE THEIR SEATS, WE'LL MOVE TO THE NEXT SESSION. FOR THIS SESSION WE HAVE ASKED SOME OF THE PEOPLE THAT HAVE BEEN INVOLVED WITH THE COHORT CONSORTIUM. I BELIEVE LOOKING DOWN HERE, MANY OF YOU SINCE THE VERY INITIATION OF IT BUT DEFINITELY ALL LONG TERM INVOLVED AND WE WANTED THEM FIRST TO SORT OF SPEND SOME TIME, NO SLIDES, REFLECTING ON THE DISCUSSION THAT OCCURRED THIS MORNING, SOME OF THE ISSUES THEY THOUGHT ABOUT, DIRECTIONS THEY MIGHT GO. SO WE'LL GO THROUGH THE PANEL AND THEN WE'LL OPEN IT UP FOR QUESTIONS AND BACK AND FORTH. DID ANYBODY DRAW STRAWS WHO WANTS TO GO FIRST? DO WE START WITH BOB AND MOVE DOWN -- >> WITH THE ALPHABET. FIRST SAY THANK YOU TO THE THE SPEAKERS THIS MORNING, I THOUGHT IT WAS A VERY INTERESTING SET OF PRESENTATIONS. TO COVER THE WATER FRONT WHAT'S GOING ON WITH THE CANCER COHORTS AND AN OPPORTUNITY FOR US CANCER EPIDEMIOLOGISTS TO HEAR ABOUT ACTIVITIES IN DISEASE DEMENTIA AN GENOMICS. I THINK A KEY ADVANTAGE OF THIS SYMPOSIUM IS ACTUALLY FURTHERING THE DIALOGUE BETWEEN INSTITUTES. WE TEND TO WORK IN OUR OWN GROUPS AND OUR OWN SILOS AND EVEN WITHIN THE CANCER COMMUNITY, IT'S OFTEN DIFFICULT TO TALK TO INDIVIDUALS IN A DIFFERENT DISCIPLINE. THEN TALKING DIFFERENT PHENOTYPES, DIFFERENT DISEASES, IT'S RARE FOR CANCER EPIDEMIOLOGIST, AT LEAST IN MY EXPERIENCE TO REACH OUT FOR COLLABORATION WITH FOLKS IN OTHER FIELDS. I HI THIS SYMPOSIUM PROVIDES A START OR MAYBE NOT START IS NOT QUITE THE RIGHT WORD HAVE BEEN COLLABORATIONS BUT AN IMPETUS TO PUSH THAT ALONG. OUR CANCER COHORTS ARE NOT CANCER COHORTSTHEY EAR LARGE NUMBER OF INDIVIDUAL WHOSE FOLLOW FOR CANCER, BECAUSE THEY ARE COHORT STUDIES WE CAN LOOK AT MULTIPLE DISEASE END POINTS AND EVEN THOUGH OUR INTEREST AND EMPHASIS AND MOST HERE ARE FUNDING IT, IT IS FROM NCI FOR LOOKING AT CANCER. WE HAVE SEEN IN THE SECRETARY CANCER COHORT CONSORTIUM, THE OPPORTUNITY TO TRY TO EXPAND THE UTILITY OF THE COHORTS TO LOOK AT OTHER PHENOTYPES. THE ADVANTAGE THAT WE HAVE BEING STUDIED EXAMINING CANCER, IS THAT THE STUDIES TEND TO BE LARGE. DIANE MENTIONED THIS MORNING THAT IN TOTAL IF YOU EXCLUDE WHI THE NUMBER OF INDIVIDUALS INVOLVED IN THE CARDIOVASCULAR DISEASE COHORT IS 67,000 OR SOMETHING LIKE THAT. THAT'S THE TYPICAL SIZE OF THE CANCER COHORT. I'M INVOLVED WITH THE OTHER IMMUNITY COHORT STUDY WHICH IS AN INVESTIGATION THAT HAS ENROLLED ALMOST 86,000 PEOPLE, MOST LOW INCOME UNDERSERVED INDIVIDUALS, TWO-THIRDS AFRICAN AMERICAN, ONE-THIRD WHITE. THAT'S THE TYPICAL SIZE OF THE CANCER COHORTS. I THINK WE CAN OFFER THE OPPORTUNITY TO -- BECAUSE OF OUR SIZE, TO EVALUATE OTHER DISEASE EXPOSURE ASSOCIATIONS WITH GREATER POWER, DIANE ALSO USED THE TERM THICK VERSUS THIN. WE MAYBE -- WE PROBABLY TEN TO BE ON THE THIN SIDE FOR ROOKING AT NON-CANCER OUTCOMES BUT NEVERTHELESS, THERE ARE OPPORTUNITIES FOR US TO EXAMINE THESE NON-CANCER OUTCOMES, WHERE WE CAN GET FAIRLY DETAILED DATA ON THE DISEASE ITSELF, ONE OTHER INTERESTING THING WITH COHORT IN THE UNITED STATES IS THE ABILITY TO LINK WITH CENTERS FOR MEDICAID AND MEDICARE SERVICES. AND OUR COHORT WE LINK WITH MEDICARE AND BECAUSE WE HAD INDIVIDUALS WITH LOW INCOME WITH MEDICAID AND THE COHORT IN ENROLLMENT WAS 40, 79 WITH MEDIAN IN THE 50s, EVEN WITH WITH THAT RELATIVELY YOUNG AGE OVER HALF THE COHORT HAS HAD SOME ENCOUNTER IN EITHER MEDICAID OR MEDICARE AND WE'RE JUST NOW BEGINNING TO TRY TO EXPLOIT THAT TO LOOK AT CO-MORBIDITYIES FOR DISEASES THAT MIGHT INFLUENCE CANCER AND LOOK AT THOSE DATA TO EVALUATE DISEASES IN THEIR OWN RIGHT. ONE OF THE OTHER POINTS I HEARD THIS MORNING, HOPE IT'S TRUE AND EXPORTABLE, WAS THAT THERE MAYBE SOME COST REDUCTION IN HAVING NIH BE A LIAISON WITH CMS FOR GETTING ACCESS TO THE MEDICARE DATA BECAUSE WE HAVE -- AS WAS MENTIONED, IT'S VERY EXPENSIVE FOR US TO LINK, WE PAID OVER $100,000 TO LINK OR COHORT. WITH NUMBER OF YEARS I THINK 7, 8 YEARS WORTH OF MEDICARE, MEDICAID DATA. FROM IS A MECHANISM AVAILABLE ELSEWHERE WHERE WE CAN WORK WITHIN NIH TO GET A KISS POINT AND -- DISCOUNT AND CONSIDER ALL U.S. COHORTS COMBINING INFORMATION TO GO, GET FURTHER DISCOUNT, IT WOULD BE A SIGNIFICANT ADVANTAGE FOR US. I HAVE A COLD AND SORE THROAT. SO I THINK I'LL CONCLUDE MY REMARKS. >> I WANT TO EXTEND FOR A SECOND THE LINE OF THINKING THAT BILL WAS TAKING ABOUT. I BECAME MORE ENTHUSED THAN I ALREADY AM AND WAS ABOUT POTENTIAL FOR EXTENDING THE CONTRIBUTIONS OF THE CANCER COHORTS TO ADDRESSING NON-CANCER CONTROL COMES. I THINK AS DIANE SAID IN HER TALK WE HAVE SHARED GOALS REGARDLESS OF THE INSTITUTE THAT WE'RE COMING FROM. IF YOU LOOK AT OUR COHORTS, MORE THAN HALF OF OUR COHORTS STUDIES WERE DESIGNED FROM THE BEGINNING TO LOOK AT MORE THAN CANCER. AS PRIMARY ENPOINT. NOT BECAUSE WE'RE INTERESTED IN LOOKING AT THE RELATIONSHIP OF CANCER AN ANOTHER DISEASE LIKE CARDIOVASCULAR DISEASE, BUT ACTUALLY BECAUSE WE WERE INTERESTED IN LOOKING AT THOSE OTHER OUTCOMES FOR THEMSELVES. SO WHETHER IT WAS MULTIPLE OUTCOMES FOR A SINGLE EXPOSURE, MULTIPLE EXPOSURES AND OUTCOMES THAT WERE GOING TO BE OF INTEREST TO IT, IT TURNED OUT TO BE A VERY,VERY COST EFFICIENT WAY TO LOOK AT MULTIPLE OUTCOMES FOR THE SAME INFRASTRUCTURE COSTS. IN FACT, PROBABLY FOUR TO FIVE COHORTS ARE ACTUALLY JOINTLY FUNDED BY VARIOUS NIH INSTITUTES. SO I HAPPEN TO REALLY BE CONVINCED THIS IS A VALUE-ADDED SITUATION. USING INFORMATION THAT WE HAVE GOTTEN IN SUCH A COST EFFICIENT WAY TO COST EFFICIENTLY LOOK AT OTHER OUTCOMES TO SEE -- SEEMS TO ME A VERY IMPORTANT THING TO CONSIDER. SO WHEN I THINK ABOUT IT, I THINK THERE'S TWO DIFFERENT GROUPS. THERE ARE THOSE COHORTS WHO HAVE THIS INFORMATION ON OTHER OUTCOMES AND I GUESS I REALLY BELIEVE THOSE COHORTS SHOULD GET TOGETHER, TAKE THE LEAD, WORK WITH A COMBINATION OF INSTITUTES AND REALLY IDENTIFY A QUESTION THAT WE CAN ADDRESS EITHER ALONE OR WORKING WITH OTHER CONSORTIA IN THOSE PARTICULAR CONTENT AREAS THAT ARE NON-CANCER. THE OTHER ISSUE IS NOT ALL COHORTS CAN DO THAT. WHAT WE WANT TO DO IS INCLUDE AS MANY COHORTS AS POSSIBLE BECAUSE THE STRUCTURE IS THERE. AND STAY COST EFFECTIVE IN TERMS OF DOING IT. SO THAT'S ONE I THINK THAT UNDERSCORES THE WORK THAT RICHARD SUZMAN, DEBBIE WINN ARE DOING BECAUSE YOU GET IT SELF-REPORT OR WE HAVE TO COME UP WITH SOME EASILY ACCESSIBLE COST EFFECTIVE WAY TO GET THE INFORMATION. WHETHER THAT BE IMPROVEMENTS ON NDI OR SSDI OARIER ACTUAL CANCER REGISTRIES OR ELECTRONIC MEDICAL RECORDS, THAT'S WHY WHEN YOU TALK ABOUT THAT, IT'S SO IMPORTANT TO BASICALLY MOVE US FORWARD IN THAT WAY. SO I HAPPEN TO BELIEVE IT'S DIFFICULT BUT I HAPPEN TO BELIEVE IT'S A VERY WORTHWHILE GOAL FOR US AND WOULD HELP OUR CONTRIBUTIONS. >> I THINK IT WAS A VERY EXCITING EXTREMELY INFORMATIVE SET OF PRESENTATIONS LAID OUT WHAT ARE VERY SIMILAR OVERLAPPING VISIONS FROM OTHER INSTITUTES THAT ARE COMMITTED TO THE SAME KINDS OF QUESTIONS. I THINK THIS GROUP IS COMMITTEDDED TO. AND IT UNDERSCORE AS TREND IN THE AIR FOR A PEERED IDEA OF TIME, THAT REALLY IS SYNTHETIC COHORTS AND YOU HEARD FROM BILL AND JULIE WORKING ON CANCER AND NON-CANCER. AND THERE'S NO QUESTION THE OPPORTUNITIES ARE THERE. AND I THINK AS WE CONTINUE TO FACE RESTRICTIVE GROWTH IF THERE IS GOING TO BE ANY GROWTH AT HIPPOOVER NEW PROJECTS ARE OBVIOUSLY VERY DIFFICULT TO LAUNCH. WITH EXTRAORDINARY RESOURCES WE HAVE TO FOCUS ON HOW AND IN WHAT WAY WE CAN ADDRESS THESE, I THINK THERE ARE A NUMBER OF TECHNOLOGICAL THINGS THAT ARE CHANGING. AND THERE'S AS CERTAINMENT, DIFFERENT WAYS TO IDENTIFY OUTCOMES THAT ARE CRUCIAL. AND WE REALLY ARE AT A FORMATIVE TIME WITH RESPECT TO GENETICS. AND METABALOMEICS AND SOMEynO„ THINGS MICROBIOMEICS ARE REALLY BEGINNING TO HAVE TRACTION SO TECHNICAL CAPACITIES ARE BEGINNING TO STABILIZE SO THAT WE CAN IMAGINE AND SEE ON THE NEAR HORIZON THE SUPER SIZING OF THOSE KINDS OF TECHNOLOGIES TO APPLY SLIGHTLY DIFFERENT QUESTIONS THAN THE GERM LINE GENETICS. IT'S GOING TO BE IMPORTANT TO REACH INTEGRATIVE ANALYSIS. WE ALSO HAVE TO LOOK AND TAKE STOCK AT WHERE WE ARE SO THE POINT ABOUT THE AGE GWAS HAS BEEN VERY EXCITING BUT THERE'S A LOT OF UNFINISHED BUSINESS THERE, NOT ONLY PURSUIT OF THE VARIANTS WE KNOW BUT SOMETHING NOT NECESSARILY POPULAR IN STUDY SECTIONS AND THAT IS THE DESIRE TO CONTINUE TO IDENTIFY WHAT WOULD BE THE COMPREHENSIVE SET OF VARIANTS THAT ARE PART OF A PARTICULAR GENETIC ARCHITECTURE AND THIS IS SOMETHING THAT LARGE CONSORTIUM THAT CAN DO AND SHOULD DO. AND I REALLY THINK THIS IS A VERY IMPORTANT PART OF THE PORTFOLIO THAT I PERSONALLY PROFESSIONALLY DON'T WANT TO SEE LOST IN THE SHUFFLE. I HAVE REASON TO BELIEVE IT WON'T GET LOST BECAUSE THE NCI IS RELOOKING AT ITS GENOMIC PORTFOLIO AND IS TARGET PEDIATRIC SEQUENCING PROJECT AND PCGA ARE LINED UP AND AT THIS MOMENT THE LARGE SCALE CANCER GENOMICS THAT GOES ON FOR PRIMARILY SEMATIC AND WITH GERM LINE AS AN AFTER THOUGHT IS SHIFTING THE GERM LINE NOW IN THE FUTURE FOR THE POST TARGET POST TCGH STUDIES WILL HAVE GERM LINE AN EPIDEMIOLOGY AS CENTRAL PARTS OF TRYING TO ADDRESS VERY SPECIFIC QUESTIONS PARTICULARLY AS CANCER GENOMICS 2014 SHIFTS INTO CLINICAL MODE. JUST AS IMPORTANT AS OUTCOME AND TREATMENT BEING ABLE TO APPLY THE TOOLS THAT WE HAVE DEVELOPED FOR GENOMICS AND LARGE SCALE SEQUENCING ADAM WAS TALKING ABOUT. WE HAVE TO THINK ABOUT THIS IN THE CONTEXT OF WHAT CAN WE LEARN DIRECTLY OR INDIRECTLY BASED ON BIOLOGY THAT WE DISCOVERED, IT WOULD BE OF IMMEDIATE OR LONG TERM PREVENTION CAPABILITIES. SO I THINK THIS IS HOPEFULLY AN EXCITING TIME AND AS WE CONSTRUCT THE IN NEXT SET OF STUDIES TO FOLLOW ON TCGA, THERE'S EPIDEMIOLOGISTS AN GERM LINE EXPERTS AT THE TABLE MAKING MANY CONTRIBUTIONS AND DECISIONS SPECIFICALLY FOR CANCER AN CANCER RELATED OUTCOMES. I CAN GUARANTEE THEY WILL BE AT THE TABLE AND WILL BE SPEAKING LOUDLY. IT IS ALSO IMPORTANT TO RECOGNIZE THIS CONSORTIUM IS FOCUSED PRIMARILY ON GERM LINE, THERE'S MAJOR TECHNICAL SOLUTIONS TAKING PLACE AS WE SPEAK RIGHT NOW. THE IDEA SURVEYING TUMORS AND DOING WHOLE GENOME RNA, DNA, HAD FORMIDABLE BARRIERS WE HAD DIFFICULT TIME MOST OF THE STUDIES THAT ARE PART OF THE COHORT CONSORTIUM BEING ABLE TO ADDRESS. NOT HAVING LITERALLY GRAMS OF FRESH FROZEN TUMOR THAT WAS NOT POSSIBLE TO GO IN TO THE QUEUES FOR THE LARGE SCALE SEQUENCING. SEQUENCING CENTERS AND OTHER GROUPS MOVED THE BAR QUITE A BIT WITH THE ADVENT OF USING FFPE SAMPLE, FORMALIN FIXED MATERIAL TO DO BOTH RNA AND DNA SEQUENCING. SO I THINK WE HAVE TO NOW BROADEN THE CHARGE OF GENETIC CONTINUE POINT TO CONSIDER HOW AND WHAT WAYS TO CAPTURE THAT SEMATIC INFORMATION. THAT'S A FIELD OUT THERE IN MY MIND THAT HASN'T BEEN TAPPED. THAT IS THE FIELD OF SEMATIC MOLECULAR EPIDEMIOLOGY. WHAT IS THE RELATIONSHIP BETWEEN THE DISTRIBUTION OF MUTATIONS WE SEE, THE EXPOSURES THOSE INDIVIDUALS HAVE IN THE PROBABLE LIKELIHOOD OF INTERACTION BETWEEN EXPOSURES AN SEMATIC MUTATIONS THAT MAYBE IMPORTANT DRIVERS OR MARKERS OF OUTCOME FOR THERAPEUTIC RESPONSE AND THE LIKE. I THINK IN THE NEXT YEAR WE ARE GOING TO SEE THIS NEXT GENERATION REVOLUTION I THINK COME TO LIFE, CORRECT, ADAM? THAT WE REALLY WILL SEE THE CAPABILITIES OF JUST SPECTACULARLY OPEN, GO BACK INTO THE FREEZER, GO INTO PATHOLOGY LABS AND BE ABLE TO ADDRESS THESE THINGS. SO IT'S NOT ONLY LOOKING SOMATIC TISSUES FOR CANCER BUT IMPORTANT IN AGING AND OTHER PLACES AS WELL. SO GENETICS ALLOW US TO PARTNER WITH OTHER INSTITUTES ADDRESSING THE REAL PROBLEMS OF AGING WHICH ONE OF THE MOST IMPORTANT RISK FACTORS FOR ALL DISEASES WE HAVE TALKED ABOUT THIS MORNING. THE OTHER THING I WANT TO BRING UP TWO MORE POINTS. ONE, WE FACE DATA CRISES, CRISES WE GENERATE A LOT, NOT ALWAYS HARMONIZED, VERY ELEGANTLY PRESENTED EARLIER TODAY, ADAM EMPHASIZED THAT. BEING ON THE SAME PAGE COMING UP WITH COMPARABLE WAYS TO HAVE COMPARING OUTPUTS AND CO-VARIANTS AND OUTCOMES WE HAVE. BUT THE SHEER MAGNITUDE TO PUSH US INTO RELATIONSHIPS USING SHARED STRUCTURES SO WE WOULD IN GROUPS COMPETE OVER DAYS OF IN ONE CENTER, I THINK IS GOING TO BE STRESSED BUT WOULD HAVE MUCH LARGER DATA SETS, THE PREPPY MYCATION AS WELL AS DAY GENERATION WE CONTINUE TO FIND IS CENTRAL QUESTION T. THE OTHER DATA QUESTION CHALLENGING THE EPIDEMIOLOGY COMMUNITY HERE IS TO GET FAMILIAR WITH THE NEW EXCITING TOOLS SUCH AS N CODE. BEGINNING TO GIVE US THE SAME KINDS OF GRANULARITY ELEMENTS IN THE GENOME AND METABALOME AND HOW WE CAN BEGIN TO INTERPRET THINGS WE SEE AND COME UP WITH MORE COGENT AND INSIGHTFUL APPROACHES TOWARDS WHAT WE DO IN IN FOLLOWING UP THE NEXT EPIDEMIOLOGIC STUDY OR SUBSET STUDY OR GOING TO SET OF LABORATORY INVESTIGATORS TO PURSUE THAT PARTICULAR BIOLOGY. I THINK THAT'S A REALLY KEY ISSUE. THE OTHER THING I WANT TO COME AND RAISE IS A VERY UNCOMFORTABLE ONE IN THIS GROUP, THAT IS THE WORLD OF GENETICS IS MOVING VERY FAST. ACADEMICS ARE GETTING LESS BEHIND. THE COMMERCIAL SECTORS MOVING VERY,VERY QUICKLY, 23 ME, GURGE L, MICROSOFT, YOU CAN NAME A NUMBER OF -- GOOGLE, A NUMBER OF COMPANIES NOT FAR AWAY FROM BEING ABLE TO HAVE TOOLS AND KITS AND ANALYTIC THINGS THAT PEOPLE MAY VERY WELL CHOOSE TO TAKE THEIR PERSONAL GENOMES AND PERSONAL INFORMATION AND METABOLIC PROFILE AND GO TO COMMERCIAL SECTOR WHICH THEY MAKE IT SOME KIND OF ADVICE, IT'S DIFFERENCE THAN WHAT'S OUT OF THE CLASSICAL RESEARCH-DRIVEN ACADEMIC,#– ENVIRONMENTS. WE HAVE TO I THINK BE CLEVER AND WANT TO BE SURE WE HAVE A HIGH STANDARD OF WHAT WE CONSIDER TO BE SCIENTIFICALLY CREDIBLE TO BE ACTIONABLE OR PURSUED. WE CAN'T IGNORE THAT SECTOR. WE HAVE TO HAVE SOME KINDS OF DIALOGUES WITH THAT SECTOR. WE CAN'T LET THOSE TWO PARALLEL WORLDS STAY NOT SYNCHRONIZED IN TERMS OF THE DATA STREAMING OUT SO THIS IS KIND OF -- I HOPE IT'S NOT A CRISIS BUT RATHER THAN OPPORTUNITY FOR ACADEMIC TO START TO GO TO SOME OTHER MORE CONVENTIONAL SOURCES WHETHER CROWD SOURCING, GENETIC INFORMATION, FACEBOOK OR 23 ME, TO SOMETIMES PURSUE THE HYPOTHESES AND CONFIRMATIONS AND THINGS THAT WERE SEEN. I THINK WE SO THIS VERY MUCH COMING DOWN THE ROAD AND THE SOONER WE START TO HAVE PILOTS WHERE WE GET COMFORTABLE WITH THAT INFORMATION, THEY GET COMFORTABLE WITH THE KIND OF RIGOR THAT A GROUP LIKE THIS BRINGS TO IT, THE BETTER OFF THE COMMUNITY IS AT LARGE. SO I'LL STOP THERE AND TURN IT TO BOB. >> I AGREE WITH COMMENTS FROM ALL THREE SPEAKERS ON SOME OF THE ISSUES, I WAS GOING TO MENTION I WON'T REPEAT THOSE BUT THE -- THE DATA LIP DAMAGE ISSUE WHICH I THINK A GREAT EXAMPLE OF GREATER EFFICIENCY, COST EFFECTIVENESS IN TERMS OF CLAIMS DATA BUT THERE'S A LOT OF OTHER DATA LINKAGE GOING ON FOR OTHER DATA SETS AND SOME OF THE PARTICULAR PROJECTS AN COHORTS SO THAT'S SOMETHING WE CAN CERTAINLY HELP WITH AND WILL DO THAT. I WANTED TO MENTION A COUPLE OF RELATED INITIATIVES THAT I THINK WE CAN STRENGTHEN THE LYNCHING OR CONNECTIONS -- LEVERAGING OR CONNECTIONS BECAUSE IN TERMS OF LOOKING AT THE WAVE OF PUBLICATION COMING OUT, AND STRUGGLE FOLKS HAVE COMMONALTIES, ONE IS THE STRUGGLE AROUND BIOMARKERS THE PEOPLE THAT ARE LOOKING AT ASSAYS BEING USED AND THE LAST TWO YEARS I THINK WE HAVE SEEN A LOT OF STRUGGLE AND FLOWNING ARE AROUND IN THE AREA OF EPIGENETIC AND WHAT'S A MEANINGFUL ASSAY AND STABLE TO A PATHWAY OR MECHANISM, THIS IS GOING TO BE -- THESE ISSUES ARE RELEVANT TO A LOT OF BIOMARKER WORK. WE CAN STRENGTHEN RELATIONS AND INTERACTIONS FOR EXAMPLE BETWEEN THE COHORT CONSORTIUM AND OTHER INVESTMENT INITIATIVES LIKE EARLY DETECTION RESEARCH NETWORK IN TERMS OF ISSUE CLINICAL EPIDEMIOLOGY AND VALIDATION MARKERS. BECAUSE A LOT OF AREAS THAT EVERYBODY IS GETTING INTERESTED IN ARE ONES WHERE THERE'S A LOT OF AREAS STILL IN EARLY DEVELOPMENT. ONE OF THE KEY PARTS THAT CAN FACILITATE THIS IS THE RECENT INVESTMENT NIH HAS MADE IN THE METABALOMEICS COMMON FUND INITIATIVE WHICH HAS DIFFERENT COMPONENTS TO IT INCLUDING THE CREATION OF NEW RESOURCE CENTERS THAT CAN PROVIDE EXPERTISE AN CONSULTATION. I THINK METABALOMEICS IS A GOOD EXAMPLE A SHORTAGE OF EXPERTISE, RESEARCH INFRASTRUCTURE AN SHARED TECHNOLOGY AND (INAUDIBLE) IS HERE HE REPRESENTS US ON METABALOMEICS COMMON FUND INITIATIVE AND I KNOW SOME DISCUSSIONS WILL START TO TAKE PLACE AT THIS MEETING BUT I WOULD EXPECT THAT TWO YEARS FROM NOW TWO OR THREE YEARS FROM NOW THIS CORE CONSORTIUM MEETING THERE WILL BE A LOT OF FLOWERING OF NEW PROJECTS AND COLLABORATIONS IN THAT DOMAIN AND KIND OF INCREASING THE RIGOR OF WHAT WE DO IN THAT AREA. ANOTHER DOMAIN HAS TO DO WITH THIS OTHER AREA OF INFRASTRUCTURE AND COHORT INFRASTRUCTURE SO THIS IS SOMETHING AS FUNDER WE STRUGGLED WITH. SO IF YOU LOOK OUT 10, 15 YEARS, WHAT THE EVOLUTION WE'RE LIKELY TO SEE, YOU SAW EXAMPLES OF THIS DISCUSSED EARLIER TODAY, IS THAT COHORTS WILL BE LESS LIKELY OVER TIME TO BE THEIR OWN INFRASTRUCTURE. THE COHORTS WE SUPPORT NOW ARE INCREDIBLY EXPENSIVE IN PART BECAUSE MOST ARE BUILT AROUND CONSTRUCTING THEIR OWN INFRASTRUCTURE TO DEVELOP, CONDUCT AND FOLLOW-UP A COHORT. SO WHAT THING WE LOOKED FORWARD TO OVER THE NEXT SEVERAL YEARS, NOT A RAPID EVOLUTION, IS PIGGY BACKING COHORTS TO OTHER INFRASTRUCTURE. THIS IS ALREADY HAPPENING AND PEOPLE ARE DOING THAT AND SOME OF THE FOLKS IN THIS ROOM, SO CANCER SURVIVORS COHORTS LIKE LARRY (INAUDIBLE) AND KEISER OR PIGGY BACKING ON TO TRIALS FOLLOWING UP IN PHASE 3 TRIALS DISCUSSED EARLIER. BUT ALSO HEALTHCARE. SO WE'RE CONSTANTLY GETTING QUESTIONS ABOUT ELECTRONIC MEDICAL RECORDS, WHAT'S THE STATUS, WHAT'S THE TRAJECTORY FOR GROWTH. I THINK IT'S LOWER THAN PEOPLE CORPORATE EXPECTED AND IT'S MORE DIFFICULT THAN SOME OF THE POLICY OR POLITICAL TYPES A COUPLE OF YEARS AGO. BUT THAT'S CLEARLY HOW THINGS ARE MOVING. I THINK OFTENTIMES THE INTERNATIONAL COMPARISON THERE'S AN ASSUMPTION NOW THAT THE U.S. IS GETTING LEFT BEHIND WITHOUT AN INTEGRATIVE HEALTHCARESwP SYSTEM, THERE'S NO WAY TO COMPETE IN TERMS OF HEALTHCARE DELIVERY INFRASTRUCTURE VERSUS UK OR EUROPEAN COUNTRIES. BUT I THINK WHAT WE'RE SEEING IN THE PAST YEAR, WE'RE PROBABLY UNDERESTIMATING THE DEGREE TO WHICH THERE IS RAPID CONSOLIDATION OF U.S. HEALTHCARE HAPPENING AS WE SPEAK. PART OF THAT MOTIVATED BY THE AFFORDABLE CARE ACT SO IF YOU TALK TO PRACTITIONERS ACADEMIC RESEARCH CENTERS ARE EXTENDING THEIR NETWORKS AND COLLABORATING WITH PAYERS AN PROVIDERS AND NETWORKS HOSPITALS HIRING PHYSICIAN, GROUP PRACTICES GOING AWAY, AND A LOT IS AROUND THE ECONOMICS OF PAYMENT REFORM. THAT IS THAT THERE'S A LOT OF SIN TENTATIVES NOW IN THE U.S. FOR HEALTHCARE TO INTEGRATE AND CONSOLIDATE AS PEOPLE FORM ACCOUNTABLE CARE ORGANIZATIONS. THAT MEANS THAT UNIT OF ANALYSIS ANNETTE WORKS THAT EPIDEALOLOGISTS PIGGY BACK ARE CHANGING RAPIDLY AS WELL. SOME BRIEF MENTION OF THIS EARLIER, BUT I THINK AS WAS MENTIONED AS A UNIT, AS A NETWORK FOR HEALTH INFORMATION EXCHANGE AN REGISTRIES AND FOR INTEGRATION OF CLINICAL RESEARCH NETWORKS AND CLAIMS DATA, THAT TREND IS GOING TO CONTINUE IN THE US. AS GOVERNORS DEAL WITH MEDICAID ESPECIALLY THERE ARE REASONS AND CMS IN THE U.S. IS PROVIDING A LOT OF INCENTIVES FOR DATA CONSOLIDATION AN LINKAGE. I THINK THIS RESEARCH COMMUNITY HAS BEEN A LITTLE BIT SLOW TO TAKE ADVANTAGE OF THAT IN TERMS OF WHERE THAT'S HEADING. BECAUSE IT'S MOVING MORE QUICKLY THAN APPRECIATED IN THE RESEARCH COMMUNITY. WE JUST HAD AN NIH LEADERSHIP MEETING WITH THE DIRECTOR OF THE OFFICE OF NATIONAL CENTER FOR HEALTH IT AND HERE IN THE U.S. THE CMS PROVIDING INCENTIVES FOR WHAT'S CALLED MEANINGFUL USE, THE IMPLEMENTATION OF HEALTH IT AND METRICS AND MEASURES AND FOLLOW-UP. AND LOCAL CARE SETTINGS. THERE'S TREMENDOUS AM OF ATTENTION BEING PAID TO THIS IN THE PROVIDER COMMUNITY AND WAY TOO LITTLE ATTENTION IN THE RESEARCH COMMUNITY. SO WE NEED TO GET THE RESEARCH COMMUNITY LINKED UP TO THIS PROCESS BECAUSE THIS IS THE TIME TO GET RESEARCH AT THE TABLE. AND HEALTH IT OF THE PATIENT. SO IN ABOUT TWO WEEKS OFFICE OF NATIONAL COORDINATOR WILL PUT OUT A CALL, NUMBER OF REQUEST FOR INPUT OR COMMENT ON PHASE 3 OF THE MEANINGFUL USE ABOUT WE'RE -- IT'S GOING TO BE REALLY IMPORTANT RESEARCH COMMUNITY PARTICIPATE IN THAT. IN A SUBSTANTIVE MEANINGFUL LEVEL. THAT CAN REALLY AFFORD AND CROW UNITE A LOT OF INCREDIBLE OPPORTUNITIES FOR COST EFFECTIVE RESEARCH. ALSO I THINK DOMAINS OF WHAT COHORTS ARE COVERING, WE LOOK AT THE CURRENT COHORTS, WHAT POPULATIONS ARE COVERED, WHAT REGIONS OF THE COUNTRY, WHAT DISEASES ARE COVERED AND CLEARLY IT'S NOT EQUALLY DISTRIBUTED. THERE'S SOME DISEASES THAT ARE HEAVILY COVERED, SOME POPULATIONS THAT ARE MORE CAPTUREED IN THE CURRENT COHORTS AND SO WE ARE INTERESTED AND WE HAVE TALKED TO MANY PEOPLE OVER THE LAST FEW YEARS ABOUT COHORTS CAPTURING OTHER POPULATIONS REGIONS, WE HAVE HAD A LONG NON-SUCCESSFUL STRUGGLE TO CAPTURE NATIVE AMERICAN POPULATIONS, AMERICAN INDIAN POPULATIONS WITH THE PREVIOUS ATTEMPTS TO DO THAT. THAT IS A SLOW PAINFUL PROCESS, FROM A PUBLIC HEALTH AND POLICY PERSPECTIVE, THAT'S ONE POPULATION THAT IS MASSIVELY UNDERSERVED BY CURRENT INFRASTRUCTURE. AGAIN, TRYING TO GET TRIBAL ORGANIZATIONS TO AGREE ON ANYTHING AND THE RATE WHICH YOU CAN BUILD UP IN INFRASTRUCTURE WE HAVE SHOWN IS A HARD SELL IN PEER REVIEW BECAUSE THAT'S A SLOW PROCESS. SIMILARLY, A LOT OF SCIENTIFIC INTEREST, WE HAVE HAD WORKSHOPS THAT SOME PARTS IT PATED IN EARLY EXPOSURE. A HUGE GAP IN CANCER EPIDEMIOLOGY AND EXPOSURE ASSESSMENT, ACTIVE COHORTS RECRUITED. PEOPLE AND COHORTS LATER, IT'S A LONGER TIME TRAJECTORY. IF THERE'S SOME KIND OF CAREER DISINCENTIVES BUT THERE HAS BEEN GROWTH IN THAT AREA, ONE OF THE NEW COHORTS WE FIND WAS LEGACY COHORTS LED BY MARY DAILY AND MANY OTHERS. IT'S THE OFFSPRING OF BREAST CANCER FAMILY REGISTRY. SO WE'LL HAVE LESSONS LEARNED FROM THAT BUT I THINK AS YOU HAVE SEEN IN FRAMINGHAM AND MANY OTHER INFRASTRUCTURES THAT WE ARE DISCUSSED TODAY, KIND OF SECOND AND THIRD GENERATION TYPE STUDIES, I THINK DOING THAT RECRUITMENT DE NOVO, YOU GET SELECTION BIASES WHEN YOU DEPEND ON OFFICE FROM PARTICIPANTS. THAT'S AROUND THE NATIONAL CHILDREN STUDY IS FRONT AN CENTER ISSUE THAT WE'RE STILL STRUGGLING WITH WITH IN TERMS OF LONG TERM FINANCIAL COMMITMENT, BUT ALSO A SENSE OF EXPOSURES MISSING BY NOT HAVING THOSE DATA IN HAND. IMPORTANT SOCIAL DETERMINANTS OF HEALTH THAT ARE CAP CHUED TO RARE SRIING DEGREES BUT NOT SUFFICIENTLY IN THE NCI FUNNED COHORTS. THAT IS UPSTREAM SOCIAL DETERMINANTS OF HEALTH. SO WE'RE SEEING THAT MORE IN THE NEWER COHORTS LIKE BILL'S COHORT BUT EVEN SOME OF THE CONSTRUCTS OF SOCIAL DETERMINANTS THAT RICHARD TALKED ABOUT, MEASURING WEALTH AS OPPOSED TO INCOME, AND A NUMBER OF GREAT PAPERS PUBLISHED RECENTLY ON SUBSTANTIALLY DIFFERENT RESULTS FROM DATA ANALYSES YOU GET IF YOU LOOK AT WEALTH, FOR EXAMPLE, HOUSEHOLD VALUE OR PROPERTY VALUE AS WAS SHOWN RESHIN IN THE STUDY IN SEATTLE L. THE OTHER ISSUE I THINK NOT APPRECIATED WITHIN THE NIH IS THESE STUDIES WE HEARD ABOUT TODAY THAT ARE BEING PUBLISHED THE - COUPLE OF YEARS, THE BIG LARGE SCALE CON SOURCEIAL STUDIES HAVE MASSIVELY INCREASED POWER AND VALUE EPIDEMIOLOGICAL RESEARCH. I DON'T THINK THAT'S QUITE WIDELY APPRECIATED. SO WITHIN THE BROADER SCIENTIFIC COMMUNITY THERE'S STILL AN OLD VIEW OF EPIDEMIOLOGY OF WHAT IT WAS A DECADE AGO AND THERE'S KIND OF BEEN A SLOW UPTICK IN APPRECIATING HOW THE RIGOR AND IMPACT AND VALUE OF EPIDEMIOLOGISTS HAS RADICALLY CHANGED IN THE PAST FIVE YEARS AS A RESULT OF THESE LARGE SCALE CON SOURCEIAL STUDIES. STEVEN MENTIONED THAT IN TERMS OF GERM LINE AND SOMATIC. I WOULD SAY, AGREE WITH STEVEN, THE MOST IMPORTANT METHODOLOGICAL DEVELOPMENT OVER THE PAST 6 TO 8 MONTHS IS THE NEWLY DISCOVERED UTILITY OF FFPA SAMPLES IN CANCER CAPTURED MANY EPIDEMIOLOGICAL STUDIES, AND THAT -- THOSE SAMPLES, NOT FRESH TUMOR SAMPLES IS THE PRIMARY REASON FOR THE LACK OF ENTHUSIASM FOR CANCER EPIDEMIOLOGY OVER BASIC AND CLINICAL SCIENCE OVER THE PAST DECADE. SO THAT'S UTILIZED IN RNA SEQUENCING AND ET CETERA, THAT'S A MASSIVE CHANGE AND GOING BACK AND UTILIZING THOSE PRE-EXISTING SAMPLES TO DO PATHWAY RELEVANT STUDIES I THINK IS HUGE. YOU SAW EXAMPLES THAT CHRIS MENTIONED OF SOME OF THE SIGNATURE EXAMPLES OF RARE CANCER, SOMETIMES OBVIOUSLY IN CANCER THE DILEMMA WE HAVE THAT IS NOT SEVERE WITH OTHER DISEASE DOMAINS IS AS OTHERS HAVE MENTIONED, EVERY WEEK WE DISCOVER NEW SUBTYPES. CANCERS ARE GETTING RASHER AN RARER. SO I THINK THE EXAMPLE OF TRIPLE NEGATIVE CANCER AND THAT PAPER AND PROJECT, VITAMIN D STUDIES OR PANCREATIC CANCER PROJECT ARE EXTREMELY ENCOURAGING BECAUSE AS WE IDENTIFY MORE SUBTYPES OF BREAST CANCER AND COMMON CANCERS, WE'RE GOING TO HAVE TO GO BACK AND REDO A LOT OF STUDIES FROM 5, 10, 8 YEARS AGO, INCLUDING THE GWAS STUDIES THAT CONGLOMERATED A LOT OF BROAD CATEGORIES THAT TAKE INTO CONSIDERATION SUBTYPES. WE CAN DO THAT, WE HAVE THE NUMBERS TO DO THAT. AND I THINK THAT'S ALSO GOING TO GREATLY INCREASE THE IMPACT OF POPULATION SCIENCE IN THE CANCER DOMAIN AND ANOTHER CHRONIC DISEASE AS WELL. THE ISSUE IN TERMS OF REGULATORY SCIENCE, THERE WAS DISCUSSION ABOUT FDA FUNDING, LEVERAGING COHORTS AND WE'RE INVOLVED IN THAT, THAT'S A NEW FUNDING OPPORTUNITY. BACK TO HEALTHCARE PAYMENT AND REFORM AND PRESSING NATIONAL ISSUE, PHARMACOEPIDEMIOLOGY AN REVISITING HOW WE UTILIZE COHORT S IN THAT I'M CONCERNED ABOUT BECAUSE OUR TREATMENT DATA AND COMPLETENESS OF TREATMENT DATA AND VERY HETEROGENEOUS SO OBVIOUSLY ANOTHER ARGUMENT FOR PIGGY BACKING ON TO THE HMO RESEARCH NETWORK OR VA OR HEALTHCARE SYSTEMS, WE'RE PRESSING HEAVILY ON THAT MORE OVER THE NEXT COUPLE OF YEARS BECAUSE AS BIG SCIENCE IS ASKED TO BE MORE RELEVANT TO DECISIONS ABOUT HEALTHCARE, IT WILL PRESS PHARMACO EPI STUDIES AS A HIGHER PRIORITY, THE ISSUE HOW TO EFFICIENTLY CAPTURE THAT CLEARLY CLAIM STRATEGY LIKE CLAIMS DATA, PRESCRIPTION DATA, THERE'S EXAMPLES OF THAT, NIH WE'RE LOOKING AT DATA ANALYTICS WORK THAT HAPPENS IN PRIVATE SECTOR LARGELY FUNDED BY PHARMACEUTICALS. A LOT IS NOT WHAT WE CONSIDER RESEARCH QUALITY DATA. BUT THAT'S NOT TO SAY WE CAN'T GO BACK TO THESEED MINUTE STRAYTIVE DATABASES AND ENHANCE THEM AN IMPROVE THEM IN UNDERSTANDING THE RELIABLE AROUND THOSE. THEN FINALLY I'LL MENTION ANOTHER ISSUE WE HAVE BEEN DISCUSSING WITH CMS RELATED TO CLAIMS DATA IS EXPANDING BEYOND MEDICARE CLAIMS AND OTHER DOMAINS. SO BILL MENTIONED THIS WITH THE COHORT STUDY BUT WE HAVE GOT A REALLY STRONG SKILLS DEFICIT IN THE -- EPIDEMIOLOGY COMMUNITY UTILIZING THESE KINDS OF DATA. BECAUSE IT'S DIFFICULT, COMPLEXER, WE NEED TECHNICAL ASSISTANCE AN TRAINING, THAT'S PARTLY OUR RESPONSIBILITY AT NIH. BUT THINKING BEYOND THE CURRENT LINK DATA SETS AND BECAUSE IN CANCER WE HAVE SERE WE CAN DO MORE DATA LINK IN OTHER DISEASE DOMAINS SO THAT ALLOWS THE CANCER COMMUNITY TO LEAD THE WAY IN TERMS OF MASSIVE AGGREGATION OF MOLECULAR DATA, CLINICAL DATA AND CLAIMS AND LINKAGE AN HEALTHCARE DELIVERY DATA. WE'RE AT THE FRONT END OF THAT, THAT'S TERRIBLY EXCITING. WHAT YOU NEED TO DO IS HELP US WITH THE PRACTICAL HANDS-ON IN THE LEAVES LESSONS LEARNED FROM USING ALL THESE TYPES OF DATA SO WE CAN MAKE THE BEST DECISIONS HOW TO ADVANCE ALL THE OPTIONS WE HAVE >> ALL RIGHT. I'M GOING TO TAKE PREROGATIVE BEING THE LAST P ONE TO COMMENT TO BE MORE PHILOSOPHICAL AN LESS SPECIFIC. I THINK CLEAR THAT EVERYBODY IN THIS ROOM RECOGNIZES THE TREMENDOUS PROMISE FOR THE FUTURE IN BOTH CLASSICAL AND MOLECULAR EPIDEMIOLOGY BECAUSE OF THE REVOLUTION AND SCIENCE AND TECHNOLOGY THAT'S HAPPENED. AND THE NEED TO DO QUITE OFTEN LARGE STUDIES THAT TAKE ADVANTAGE. THE RUB COMES IN AS HOW DO WE DO THAT, AND WE DO THAT BY CONSORTING, CONSORTING WITH OTHER DISEASE STATES AND WITH EACH OTHER. MY OPINION IS DO WE HAVE A CHOICE. THAT'S THE ONLY THING WE CAN DO RIGHT NOW. IT IS PRETTY CLEAR THAT THE REST OF THE WORLD HAS SEEN THE OPPORTUNITIES AND MOVED TO INVEST IN IT IN ALL THE BIOBANKS GOT STARTED, SOME OBVIOUSLY WENT INTO TEMPORARY MODE, TERM RARE STALLED MODE WITH ECONOMIC DOWNTURN BUT I'M SURE THEY WILL GET BACK ON TRACK AGAIN WHEN THEY WHEN THE ECONOMIES GET BETTER. WE HAVEN'T DONE ANYTHING. AS YOU KNOW, FRANCIS TRIED FOR A WHILE AND WAS UNSUCCESSFUL. THAT'S KIND OF REALLY FOR TWO REASONS, ONE IS AS BOB MENTIONED WE DON'T HAVE THE KIND OF INFRASTRUCTURE THAT MAKES IT EASY PARTICULARLY FOR OUTCOMES AND DOING LINKAGE, SO IT WILL BE EVEN IF WE HAD ONE, SUCH STUDY WAS GOING TO BE HARDER AND MORE EXPENSIVE. THE OTHER IS THE HISTORIC I WON'T CALL IT BIAS. I WILL CALL IT LACK OF APPRECIATION OF POPULATION STUDIES. PARTICULARLY WHEN MOST OF THE PEOPLE WHO MAKE -- WHO ARE LEADERS IN THE RESEARCH FIELD AND FUNDING FIELD ARE BASIC OR CLINICAL SCIENTISTS OR MORE ENAMORED OF THOSE DISCIPLINES AN DON'T HAVE A GOOD GRASP OF WHAT WE DO. I DON'T THINK THAT'S GOING TO CHANGE IN THE NEAR FUTURE. I HAVE BEEN -- USED THE TCGA AS AN EXAMPLE. I THINK CERTAINLY ALL THESE ADVANCES IN SCIENCE, TECHNOLOGY ARE -- CUT ACROSS ALL SCIENCE AN PROVIDINGING OPPORTUNITIES AND THE INSTITUTE WAS QUITE ON TOP OF THE FACT THAT THIS WOULD ALLOW US NOW ALLOW US TO SEQUENCE TO IDENTIFY TARGETS AND PHENOTYPING AT A LOWER LEVEL AND INVESTED WHAT IS PREDICTED TO BE ONE AND A HALF TO $2 BILLION DOING THAT IN THE NEXT -- TART AD COUPLE OF YEARS AGO. AND -- STARTED A COUPLE OF YEARS AGO. I THINK THAT WAS A WISE INVESTMENT, BUT WHEN HOOVER GOES TO THE LEADERSHIP AND SAYS FOR FIVE TO 10% OF THAT, WE CAN GIVE YOU COHORT OF 5 HAD BEEN THOUSAND TO A MILLION PEOPLE WITH MULTIPLES SERIAL SPECIMENS AND GIVE YOU THE INFRASTRUCTURE FOR QUITE A LONG TIME TO TAKE ADVANTAGE OF EMERGING TECHNOLOGIES. WHAT I GET, WHAT BOB GETS TOO IS YOU GUYS HAVE WAY TOO MANY COHORTS NOW. ALL I DO IS SEE ANOTHER COHORT. I DON'T SEE US CHANGING THAT PARADIGM EASILY. SO I THINK WE ARE STUCK WITH HAVING TO COBBLE TOGETHER. IT'S COBBLED VERY WELL BUT IT'S COBBLED TOGETHER AND WE TALK ABOUT HARMONIZATION, THEY ARE REALLY TOUGH ISSUES. I THINK THAT'S CLEARLY WHAT WE HAVE TO DO, EVEN IF TOMORROW STEVEN'S ENTHUSIASM CARRIES OUT AND TOMORROW THERE'S A E PITCHNY IN LEADERSHIP ABOUT WHAT THE VALUE OF -- EPIPHANY ABOUT WHAT EPIDEMIOLOGY IS AND TO GET THAT VALUE OUT, AS YOU ALL KNOW BECAUSE YOU HAVE DONE COHORTS, GOING TO BE TEN YEARS BEFORE YOU CAN ACTUALLY GET IT ASSEMBLED AND GET ENOUGH CASES TO OCCUR, IT STARTED TO BEGIN TO MAKE SOME HEAD WAY. SO I THINK IN THIS COUNTRY IT'S NOT LIKE WE HAVE A CHOICE. WE HAVE TO CONSORT TOGETHER. GET EVERYBODY DOING POPULATION STUDIES AN FIGURE IS THERE SOME WAY TO COBBLE TOGETHER THE DEFICIENCIES IN ONE VERSUS THE OTHER. I DON'T KNOW WE HAVE ANY COHORTS THAT ARE SUBSTANTIAL SIZE COHORTS THAT HAVE THE SEQUENTIAL BLOOD SAMPLES TO DO METABALOMEICS RESEARCH. MAY HAVE THE CHALLENGE TRYING TO FIGURE THAT ONE OUT TOO. SO I'M PLEASED THAT THE CONSORTIUM IS AS BIG AS IT IS NOW AND THAT WE'RE AT THE POINT OF DIALOGUING AND HOPEFULLY INVITING PARTNERS FROM ALL THE OTHER INSTITUTES BECAUSE THEY HAVE THE SAME ISSUES WE DO. AND I THINK WE NEED TO GET ON WITH IT. IF WE'RE GOING TO BE PLAYER IN THE WORLD IN THE NEW -- WITH ANY SCIENCE, WE HAVE TO GET GOING. AS CHAIR I GET A COUPLE OF MINUTES. THESE ARE GREAT COMMENTS. I'M GOING TO HAVE THREE COMMENTS ON MY OLE UNDERGRADUATE TRAINING AN ANTHROPOLOGY, OBSERVATIONS THAT CAME FROM THE DIFFERENT TALKS IN THE PANEL DISCUSSIONS THAT I DON'T KNOW IF THESE ARE BARRIERS BUT PROBABLY THINGS WE NEED TO INVITE INTO THE ROOM. ONE IS SOCIOLOGY OF THE PIs AND SIGN ACTIVIC COMMUNITY. YOU SAW DIFFERENT EXAMPLES OF HOW THE OTHER INSTITUTES WORK. THEIR COHORTS TEND TO BE MORE CENTRALLY FUNDED THROW CONTRACTS. THEIR -- THROUGH CONTRACTS. THEY'RE DATA IS AGGRAVATED UP FRONT. WE EVEN HEARD I THINK RICHARD GAVE A COMMENT, HRS DATA IS PUBLICLY UP BEFORE INVESTIGATORS GET IT WHICH IS A DIFFERENT MODEL BUT AS MUCH SOMETHING WE HAVE TO WORK THROUGH AS CONSORTIUM AND A FEEL. HOW DO WE BUILD LINKAGES. SECOND BARRIER I SEE A LITTLE BIT AT THE NIH. THE INSTITUTE ARE DISEASE SPECIFIC, STUDY SECTIONS ARE DISEASE SPECIFIC, WHICH CAN LEAD TO SILOS. SO WHAT STUDY SECTIONS, THEY WANT TO THE HEAR ABOUT THEIR DISEASE, THEY DON'T ALWAYS REALLY TAKE CO-MORBIDITY AND THE DISEASE SPECTRUM THAT PATIENTS DON'T SHOW UP WITH CANCER THEY ALSO HAVE PRE-EXISTING DIABETES OR HEART DISEASE. EITHER THAT'S CONFOUNDING, THAT'S SECONDARY, THEY HAVEN'T -- DON'T ALWAYS WANT TO TAKE IT SERIOUS, NOT SURE HOW TO DO THAT, GENOMICS IS PUSHING US THERE BECAUSE WE'RE SEEING GENOMIC ARCHITECTURE MAKING US RETHINK WHAT DISEASE IS. IT'S HARD TO BUILD SYNTHETIC THINGS BECAUSE IT'S EASY TO KNIT PICK WHAT'S THERE VERSUS I PROMISE TO BUILD THE NEW THING. SOMETHING TO TAKE ON T. OTHER IS THE CANCER SPECTRUM. SO A LOT OF THE EPIDEMIOLOGY STUDY SECS ARE FOCUSED ON ETIOLOGY. THAT'S FINE CONTINUUM IS BIGGER THAN THAT. SO A LOT OF EPIDEMIOLOGY HAS A LOT TO TALK ABOUT SURVIVORSHIP, A LOT TO TALK ABOUT HEALTH SERVICES RESEARCH, A LOT TO TALK ABOUT COMPARATIVE EFFECTIVENESS RESEARCH. BUT THOSE AREN'T GETTING REVIEWED, PEOPLE ARE STRUGGLING SO THEY THROW UP THEIR HANDS. SOY THINK WE MAY NEED TO RETHINK THE ANTHROPOLOGY SOCIOLOGY OF THAT. THEN THE THIRD ONE I THINK, IT'S ALL SCARY BUT THER RA OF BIG SCIENCE, HOW DO WE MAINTAIN INNOVATION AND AWE AUTONOMY AT THE SAME TIME WE TAKE ON BIG SCIENCE PROJECTS. I DON'T THINK THAT'S BEEN TOTALLY FIGURED OUT YET IN EPIDEMIOLOGY. OTHER SCIENCES FIGURED THAT OUT, MAYBE THAT'S SOMETHING WE LOOK TO. THOSE ARE THREE BARRIERS I SAW AS BROADER THEMES, NOW BACK TO OPEN UP TO THE PANEL TO CROSS COMMENT ON ANYTHING OR DOES ANYBODY IN THE AUDIENCE WOULD LIKE TO MAKE A OBSERVATION OR ASK A QUESTION TO THE PANEL? >> JUST TO PICK UP ON WHAT BOB WAS SAYING. SCIENCE IS A COMPLEX PROCESS OF PORTFOLIO WHERE WE HAVE SOME THINGS IN HAND THOSE NEAR TERM AN THOSE FAR TERM. I THINK CASE FOR DEVELOPING LONG TERM COHORT IS STILL VERY, VERY DIFFICULT. AND WE HAVE TO CONTINUE TO MAKE THE CASE FOR WHY IT'S IMPORTANT TO DO THAT. I THINK EVERYONE RECOGNIZES IN THIS ROOM, THEY PROBABLY WOULDN'T BE IN THIS ROOM BUT THERE ARE OTHERS WHO WE HAVE TO CONVINCE THIS OF, THAT WE CAN GO WITH THE 4 MILLION WE HAVE AND LEARN A TREMENDOUS AMOUNT DISCOVERY BUT TO CARRY THROUGH IN THE MORE DETAILED ANALYSIS OF WHAT ARE THE ACTUAL DYNAMICS, THE TIMING, THE SERIAL SAMPLES AND OUR UNDERSTANDING OF THOSE RELATIONSHIPS OF BIOMARKERS GENETICS WITH THINGS COME BACK TO ARGUMENT OF LONG TERM AND WHERE I THINK EPIDEMIOLOGY HAS A HARD TIME CONVINCING ELEMENTS LEADERSHIP IN CLINICAL RELEVANCE, THERE'S FEET ON THE DOOR NCI AT WHAT POINT IS SEQUENCING OR EPIDEMIOLOGY CLINICALLY RELEVANT THAT YOU HAVE SOMETHING ACTIONABLE YOU CAN DO. THAT IS THE MANTRA OVER AND OVER IN THE BACKGROUND. AND WE HAVE TO THINK OF DELIVER WAYS, THE CLINICAL IMPLEMENTATION OR PUBLIC HEALTH IMPLEMENTATION. >> HE WOULD LIKE FOLLOW-UP ON EWELY'S COMMENTS ABOUT UNDERUTILIZATION OF COHORTS IF YOU ONLY LOOK AT IS A SINGLE OUTCOME. THINK ABOUT COHORTS HAVE DIFFERENT ORGANIZATIONAL BASIS. IF YOU'RE IN A SCHOOL OF PUBLIC HEALTH OR DEPARTMENT OF MEDICINE AND MEDICAL SCHOOL IT'S PERFECTLY APPROPRIATE LOOK AT RAREIOUS DISEASE OUTCOMES. BUT IF YOU'RE IN CANCER CENTER, FREE STANDING NOT MEDICAL SCHOOL EVEN, WE'RE PRECLUDED BY OUR INFAMOUS DIRECTOR. FROM LOOKING AT ANYTHING THAT'S NOT CANCER. SO WE HAVE A DILEMMA HOW TO LOOK AT OTHER OUTP COMES WE BELIEVE VERY STRONGLY AND NOT USING NCI FUNDING OF COURSE, BUT HOW TO ORGANIZATIONALLY OR STRUCTURALLY ENGAGE IN THOSE KINDS OF RESEARCH. SO I WONDER IF MAYBE BOB CAN GIVE US SOME SUGGESTION. WE DON'T WANT TO USE THE NCI FUNDING WHICH SET UP THE COHORT TO STUDY OTHER DISEASE OUTCOMES. I JUST LIKE TO MENTION ONE INTERESTING EXAMPLE THAT I HAVE FORGOTTEN ABOUT. BUT NHLBI FUNDD THE HONOLULU HEART PROGRAM IN HAWAII BASED IN A HOSPITAL IN 1968. 25 YEARS BEFORE THE MEC WAS SET UP. AND IN 1974 WHEN NATIONAL CANCER ACT WAS PASSED INVESTIGATORS REALIZED THAT COHORT COULD BE USED TO LOOK AT CANCER OUTCOMES SO THEY GAVE IT ANOTHER NAME, CALL IT JAPAN HAWAII CANCER STUDY. AND THEY GOT FUNDING FROM NCI INITIALLY THE CONTRACT AND SUBSEQUENTLY RO-1 GRANT. AND STUDIES TWO DIFFERENT OUTCOMES WITH TWO SOURCES OFpx– FUNDING PRESENTLY AND THAT WORKED WELL. NHLBI PAID FOR INITIAL BLOOD COLLECTIONS AND NCI PAID FOR SECOND ROUND OF BLOOD COLLECTIONS A FEW YEARS LATER. THAT FUNDING WENT ON FOR MAYBE 25 YEARS. THEN MOST RECENTLY IT'S FUNDED BY NIA TO STUDY AGING. SO IT'S A GOOD EXAMPLE THAT GOT WELL UTILIZED. s JUST ABOUT AT THE END NOW BECAUSE ALL THEY HAVE LEFT ARE A FEW CENTENARIANS BUT THEY OTHER INTERESTING TO STUDY AS WELL. ANYHOW, I WOULD LIKE TO KNOW HOW BEST TO STUDY OUTCOMES IF YOUR COHORT IS BASED IN A CANCER CENTER WHERE CERTAIN RESTRICTS ARE IMPOSED ON YOU. >> I THINK JUST LIKE WE HAVE 27 ICs IN EVERY DIRECTOR HAS DIFFERENCE OPINION ABOUT COHORTS, EVERY DIRECTOR HAS AN OPINION ABOUT THE ISSUE YOU MENTION SO IT'S EXTREMELY HETERO GENERALIOUS IN TERMS OF THAT APPROACH. I THINK FOR A LOT OF ISSUES, I THINK WE COUNTER IN TERMS OF ACADEMIA AND ORGANIZATION STRUCTURE AND SIGH LOWS, USUALLY WHAT NIH CAN DO IS DECIDE LOW ITSELF HOW THINGS ARE FUNDED AND FUNDING MECHANISMS. TO THE DEGREE WE CAN MOVE TOWARDS POPULATION SCIENCE INFRASTRUCTURE, THAT IS CO-FUNNED BY MULTIPLE INSTITUTES AT THE SAME TIME. THAT IS THE STRONGEST LEVER LONGER TERM WE HAVE AS FUNDER. IF YOU SAY THIS IS A PROJECT, THAT'S CO-FUNNED BY NHLBI AND ET CETERA, IN ORDER TO COMPETE EFFECTIVELY YOU HAVE MULTIPLE END POINTS ACROSS MULTIPLE DEPARTMENTS UNIVERSITY AND INSTITUTION, THAT'S WHAT'S WORKED WELL IN NUMBER OF DOMAINS THAT WE FUNDEDDED WORK IN, WHETHER TOBACCO CONTROL RESEARCH OR SCREENING, EARLY DETECTION. SO I THINK THE INSTITUTIONAL ISSUES TEND TO BE OFTENTIMES LOCAL AN SPECIFIC TO STRUCTURE PERNALTY, HISTORY. BUT LONGER TERM, NIH RELATED TO JIM'S COMMENTS ABOUT SILOING, POPULATION SCIENCE HAS COME PELLING ARGUMENTS KNOWN WELL IN RISK FACTORS DOING A BLENDED FUNDING. WE HAVE A SIGNATURE EXAMPLE OF WOMEN'S HEALTH INITIATIVE. THEREFORE THIS ISSUE WHERE IT COMES FROM WILL BE MINIMIZE. BUT I WAS AT A MEETING THE OTHER DAY THE SAME ISSUE ABOUT CANCER CENTERS WHERE WE'RE WORKING WITH A COUPLE OF INSTITUTES ON AN INITIATIVE WHERE SOME FOLKS SAY IF WE GET FUNDED BUT THIS INITIATIVE ISN'T GOING TO COUNT IN TERMS OF BEING FROM NCI THAT'S SOMETHING WE HAVE TO -- OUR RESPONSIBILITY TO MINIMIZE OVER TIME. AND A LOT OF OTHER DOMAINS OF CANCER CONTROL THE WAY WE HAVE BEEN DOING IT IS BY HAVING CO-FUNDED INITIATIVES THAT CLEARLY SAY GOALS AN OBJECTIVES TO WORK ACROSS DISEASE DOMAINS. >> JIM'S LAST COMMENT UNCOMFORTABLE RELATIONSHIP BETWEEN INNOVATION AN BIG SCIENCE, I THINK THE NUMBER PANELISTS COMMENTED ON EFFORTS TO ENTRY GRATE SOMATIC MUTATIONS, METABALOMIC AND APPROACH INTO STUDIES BUT WONDER IF THE COHORT CONSORTIUM PLAYS A ROLE. ACCELERATING THE USE OF TECHNOLOGY. SO FOR EXAMPLE, EVERYONE IN THIS ROOM CARRIES AROUND A CELL PHONE, CELL PHONES CAN EITHER PASSIVELY COLLECT OR THERE ARE APPLICATIONS THAT CAN TAKE IN INFORMATION ON PHYSICAL ACTIVITY, SLEEP, LIGHT EXPOSURE, PORTION SIZE, A NUMBER OF EXPOSURES DIFFICULT TO CAPTURE BY CONVENTIONAL QUESTIONNAIRES OR BIOMARKERS. SO I WONNER IF THERE CAN BE SOME KIND OF TOP DOWN HELP FROM THE CONSORTIUM TO HELP ADOPT SOME OF THESE TECHNOLOGIES MORE RAPIDLY INTO SMALLER STUDIES. >> YOU'RE FAMILIAR WITH THE PHOENIX PROJECT EARLIER A PIECE OF THAT. BUT IN TERMS OF SPEAKING ABOUT MOBILE TECHNOLOGY, ANOTHER MEETING I ATTENDED ON THE WHO'S JOB IS IT IN TERMS OF THE ADAPTATION OF MOBILE HEALTH TECHNOLOGY FOR RESEARCH PURPOSES. SO THERE'S A MOBILE HEALTH CONSORTIUM BETWEEN THE DEPARTMENT AND TECHNOLOGY CENTER, NOKIA, CALL COME AND ALL THOSE PLAYERS. SO WE HAVE BEEN DISCUSSING THIS BECAUSE THINGS YOU IDEALLY WANT TO DO AS RESEARCHER IMPACT ON INFRASTRUCTURE, BANDWIDTH P AND DECISIONS THAT THE MOBILE HARDWARE AND SOFTWARE SERVICE PROVIDERS MAKE THAT OFTEN TIME VERSUS DOWNSTREAM CONSEQUENCES TO EITHER ENABLING OR COMPLETELY CONSTRAINING WHAT YOU WANT TO DO USING MOBILE HEALTH AS RESEARCH TOOL. SO AS YOU KNOW, MANY OF YOU KNOW FROM THE GENES ENVIRONMENT INITIATIVE AND OTHER RELATED ONES AT NCI AND ELSEWHERE, THE LAST FEW YEARS WE FUNDED A LOT OF PROJECTS ON MOBILE TECHNOLOGY FOR ENVIRONMENTAL DOMAIN, ENVIRONMENTAL HEALTH, PHYSICAL ACTIVITY, BEHAVIOR, ET CETERA. BUT IT'S -- WE'RE STILL JUST AT THE STAGE OF DOING A LOT OF CRITICAL VALIDATION OF THOSE. SO A LOT OF PEOPLE DEVELOPED STUFF BUT IN TERMS OF ADEQUATE EMPIRICAL PSYCHOMETRIC VALIDATION, AND A LOT OF UNINTENDED OR ANCILLARY ART FACTS THAT CAN OCCUR, BECAUSE OF CONTEXT PEOPLE ARE USING, HOW THEY USE THOSE, THERE'S A LOT WE STILL DON'T KNOW COMPARED TO SELF-REPORT QUESTIONNAIRE WHERE IS WE HAVE A 50 YEAR METHODOLOGICAL HISTORY IN TERMS OF SOME OF THE DATA QUALITY ISSUES. CLEARLY THE ADVANCES OF DATA CAPTURE MOMENTARY ANALYSIS, PROMPTING AND MAKING IT EASIER TO COLLECT LOTS OF DATA, STATISTICCAL ISSUES, ANALYTIC ISSUES, BUT ALSO ISSUES ABOUT HOW PEOPLE SELF-REPORT OF SIMILAR CONSTRUCTS CHANGES WHEN IT'S DONE THROUGH THAT MODALITY, WE'RE NOT QUITE THERE YET IN TERMS OF EVIDENCE BASED RECOMMENDING BROAD ADOPTION PARTICULAR TOOLS. SOME OF THE DOMAINS LIKE DIETARY ASSESSMENT WITH AING ISA 24, THERE'S -- ASA 24, THERE'S A LOT OF WORK BUT MORE LIMITED FOR RESEARCH FOR PURPOSES OF SUBCOMITTEE. >> THIS ALSO RAISES A VERY IMPORTANT ISSUE MADE REFERENCE EARLIER TO GROSS MARGINNIC SHARING DATA POLICY BUT CONSIDERING A LARGER BROADER CONTEXT FOR SHARING OF DATA THAT COMES OUT OF POPULATION BASED RESEARCH IN WHICH GENETICS IS PART OF IT. BUT IMAGING IS ANOTHER PART. INDEED WE GET TO STUDIES PEOPLE ARE PHOTOGRAPHING THEIR MEALS AND CAPTURING SLEEP OR EKG PATTERNS, THIS IS SOMETHING THAT IS ACTIVELY UNDER CONSIDERATION TO BE PART OF POLICY HOW AND WHAT WAY NIH REPORTED RESEARCH WOULD BE RAILABLE AT SOME POINT TO OTHER INVESTIGATORS BEYOND THE PRIMARY RECIPIENT OF THAT GRANT TO LOOK AT THIS IN CROSS STUDIES AND HAVE OTHER WAYS OF LOOKING AT THAT DATA. SO THE LARGE DATA ISSUE IN SHARING GOES WELL BEYOND GENOMICS, IT'S BEING LOOKED AT NOW AND SHOULD COME ALONG QUICKLY. SO WE THINK ABOUT THINGS IT COMES BACK TO POINTS TRISH STATED EARLIER AND I DIDN'T MEAN EMPHASIZED THE WAY TO SHARE AND WORK WITH EACH OTHER IS CRUCIAL ACROSS NOT JUST GENETIC OR HIPAA IDENTIFIERS BUT MANY OTHER KINDS OF END POINTS WE'RE CAPTURING. >> THANK YOU. >> ONE MORE QUICK QUESTION. >> THANK YOU, VERY MUCH, IT'S GOING TO BE QUICK. WE HAVE APPRECIATION OF ALL THE GOOD INTENTION THAT MANY OF THE PROFESSIONALS HAVE EXPRESSED IN DOING SOMETHING FOR PUBLIC. I HAVE A SUGGESTION AND IT POTENTIAL GUARANTEE. IF YOU GUARANTEE, YOU BRING BACK THE COFFEE BREAK WITH COFFEE I WOULD GUARANTEE POTENTIALLY IF I AM ALLOWED TO CUT DOWN BILLIONS OF DOLLARS FROM THE PROJECTS FAR TOO MANY SUPPORTED PROJECTS THAT ARE OUT OF FOCUS AND HAS PUT USE VERY LETHAL AND IT'S LIKE BRIDGE TO NOWHERE. WITH SOME REAL SCIENCE I HAVE PROPOSED AND THEN DOCUMENTED SINCE 1998 WHICH IS -- AGREED WITH MANY THAT IT'S REAL SCIENCE AND PRODUCE CONSTRUCTIVE SCIENCE. SENIOR COLLEAGUE RECENTLY TOLD ME -- >> DO YOU HAVE A QUESTION FOR US? >> YES. >> COULD YOU WE'RE SHORT ON TIME. >> MY QUESTION THEN I PROPOSE THIS WAY. IS WORSE THAN BEING FIVE YEARS BEHIND SCIENCE BEING FIVE YEARS AHEAD OF SCIENCE? THAT'S WHAT THE OTHER QUESTIONER WAS IN A WAY ASKING. SERIOUS SCIENCE ARE BEING IGNORED. >> ANYONE WANT TO COMMENT? >> I THINK CATALOGING CAPTURING AN ARM CHIEFING OF INFORMATION, THINGS WITH CAPTURED YEARS AGO BECOME IMPORTANT WITH NEW OBSERVATIONS, THAT'S THE CREATIVE AND EXCITING PART ABOUT SCIENCE, CERTAINLY POPULATION BASED STUDIES HAVE THE OPPORTUNITY TO KEEP LOOKING AND LOOKING IN NEW AND NOVEL WAYS. >> YES. >> SO MY NAME IS JENNIFER HARRIS FROM THE NORWEGIAN INSTITUTE OF PUBLIC HEALTH IN OSLO BUT I'M A CONSUL AT THAT PARTICULAR TIME TO THE NATIONAL INSTITUTE ON AGING. AND I HAVE BEEN WORKING FOR MANY YEARS IN INTERNATIONAL BIOBANK HARMONIZATION BUT MORE UNDER THE MODEL THAT ROBERT HOOVER DESCRIBED FROM THE EUROPEAN SIDE. WHERE THE AGENDA AND WAY OF SETTING UP THE INFRASTRUCTURES ARE QUITE DIFFERENT THAN IN THE US. AND YOU TALK ABOUT COBBLING TOGETHER THE CONSORTIUM PROJECTS BECAUSE THAT'S WHAT PEOPLE CAN DO RIGHT NOW. MY QUESTION TO THE PANEL IS, AT WHAT LEVEL SHOULD WE HAVE THIS DISCUSSION? I THINK THERE ARE SO MANY WAYS -- THERE ARE WAYS WE CAN COBBLE THINGSING TO TO MAKE IT BETTER THAN WHAT IT IS NOW AND ALL CONSORTIA FACE THE SAME ISSUES WE SAW TODAY. SO SOME THINGS COULD BE DONE BUT AT WHAT LEVEL SHOULD WE BE AIMING THIS DIALOGUE? SEEMS TO ME IF WE COULD PUT TOGETHER DB GAP WHICH IS AN INFRASTRUCTURE, THAT THERE'S OTHER PIECES OF THIS COBBLING INFRASTRUCTURE THAT COULD BE PUT TOGETHER AT A MUCH HIGHER LEVEL WITHIN THE NIH. ARE THOSE DISCUSSIONS TAKING PLACE? HOW IS IT GOING FORWARD? THERE'S SO MUCH CONFUSION WITH DUPLICATIVE EFFORT AND EVERYBODY NEEDING THE SAME THING AND EACH INSTITUTE DOING IT FOR THEMSELVES. WHERE DO WE AIM THE DISCUSSION SO WE CAN MOVE IT FORWARD? AND ONE OF THE BIGGEST THINGS THAT COULD BE DONE IS JUST CATALOGING THE DATA THAT ARE AVAILABLE IN THE NIH COHORTS NOW USING THE SYSTEMATIC WAY OF CATALOGING IT SO PEOPLE CAN JUST RUN INQUIRIES ABOUT WHAT SAMPLE AVAILABILITY IS THERE, WHAT DATA ARE THERE. WE KNOW THAT THIS THING ABOUT THE SILOS BETWEEN THE INSTITUTES IN SOME WAYS WILL BREAK DOWN WITH THINGS LIKE PRECISION MEDICINE BECAUSE PEOPLE WILL BE INTERESTED MANY THE MOLECULAR PROFILES AND MOLECULAR TAXONOMIES. SO WHERE SHOULD WE AIM THIS? IT'S NOT JUST AN NCI ISSUE, IT'S NOT Y AN NIA ISSUE, IT'S AN NIH WIDE ISSUE. I KNOW IT'S A BIG QUESTION FOR THE END. >> I THINK THE FACT THERE'S 27 INSTITUTES AN CENTERS AT NIH MAKES IT INCREDIBLY HARDER THAN IT SHOULD BE. BECAUSE YOU HAVE 27 OPINIONS ABOUT WHETHER TO DO SOMETHING, HOW TO DO IT, WHAT FUNDING MECHANISM, CENTRALIZE, DECENTRALIZE, SILO, DECIDE LOW. THAT'S WHEN WE HAVE THESE DISCUSSIONS AT NIH, THAT'S THE DEBATE THAT BREAKS OUT. THE NCI EPI COHORTS, WE DON'T HAVE A COORDINATING CENTER FOR EXAMPLE. FOR SOME PEOPLE OTHER INSTITUTES WE'RE INSANE FOR NOT HAVING THE CENTER FOR THE EPI COHORTS. SO THERE'S HUGE VARIATION AS YOU HEARD FROM THE DIFFERENT STRUCTURES AND FUNDING MODELS, PART IS HISTORIC TO THE INSTITUTE, PART IS DIFFERENT CULTURES WITHIN DIFFERENT SUB FIELDS OF BIOMEDICAL RESEARCH, PART IS IT'S NOT A LEVEL PLAYING FIELD BECAUSE WHEN YOU MOVE ACROSS DISEASE DOMAINS THERE'S INCREDIBLE VARIATION IN PRE-EXISTING RESEARCH INFRASTRUCTURE. SO IT'S GREAT IF YOU'RE IN CANCER AND YOU HAVE THE Z REGISTRIES BUT IF YOU HAVE ANOTHER DISEASE DOMAIN REGISTRY SYSTEM AS WE HER ABOUT CARDIOVASCULAR DISEASE PARCEL REGISTRY AND YOU GO FROM NO TO SOME REGISTRIES TO A DISEASE WHERE YOU HAVE NATIONAL REGISTRY, THAT'S THOSE VARIATIONS AND PRE-EXISTING INFRASTRUCTURE FORWARD ENTIRELY DIFFERENT OPPORTUNITIES AND OPTIONS FOR SCIENCE. SO WE STRUGGLE WITH THIS BEING ONE BIGGER FUNDER AT NIH, DO YOU JUST CHARGE AHEAD IN THE SILO OF CANCER RESEARCH BECAUSE WE HAVE 67 CANCER CENTERS AND WE HAVE COHORTS AND CLINICAL TRIALS NETWORKS THAT ARE EYE NOR MOUSE, OR DO YOU SAY OOZE CANCER FUNNER, LET'S SLOW DOWN AND ALLOW SMALLER ORGANIZES AND INSTITUTES AND FUNDERS TO CATCH UP TO DEVELOP UNIFIED STRUCTURE THAT FLOW FLOATS ALL BOATS. RIGHT NOW WE DO BOTH BECAUSE THE COMMON FUND INITIATIVE AT NIH ARE MOTIVATED IN PART TO EPIABLE SMALL INSTITUTES TO BE PART OF BIG SCIENCE. THAT'S A CONSTANT TENSION WITHIN THE DIFFERENT DISEASE DOMAINS, THAT COLLEAGUES OF MINE WILL SAY YEAH, YOU CAN DO THAT IN CANCER BECAUSE YOU HAVE X, C AND D, WE JUST WANT TO HAVE SURVEILLANCE, POPULATION SURVEILLANCE, WE JUST WANT TO HAVE A CLINICAL TRIALS NETWORK. WE JUST NEED SOME BASIS RESEARCH IN PROTEOMICS AND GENOMICS CAPACITY IN OUR DISEASE. SO WE HAVE A MIXED MODEL WHERE WE HAVE INCREDIBLE VARIATION S THAT'S WHY IT MAKES IT HARDER TO SAY LET'S DO ONE APPROACH. FRANCIS COLLINS AS MANY OF YOU KNOW HAS PITCHED MANY TIMES A TRANS-NIH APPROACH TO COHORT INFRASTRUCTURE TO CLINICAL TRIALS INFRASTRUCTURE, TO BASIC SCIENCE INFRASTRUCTURE, GENOMICS, PROTEOMICS, METABALOMIC. ONE OF THE TOUGH THINGS IS IF YOU'RE DIRECTOR OF A SMALL INSTITUTE, AS PART OF NIH INITIATIVE YOU'RE ASKING TO CONTRIBUTE SUBSTANCE, PROPORTION OF YOUR BUDGET TO AN NIH-WIDE INFRASTRUCTURE WHEN YOUR DISEASE ALREADY HAS A VERY SMALL BUDGET. IT'S REALLY HARD TO SELL INFRASTRUCTURE TO ACROSS THE ENTIRE NIH COMMUNITY. WHEN THAT GETS PROPOSED, THERE'S A LOT OF EFFICIENCY, THERE'S CENTRAL COORDINATION, BUT OFTENTIMES FOR MANY INSTITUTES THEY LIT ALLEY DON'T OR CAN'T CONTRIBUTE TO AN INFRASTRUCTURE INITIATIVE WHEN THEIR GRANTEES ARE GETTING FUNDED AT THE 7TH PERCENTILE FOR RO-1s. ONE LAST QUESTION. >> PAUL STAR LEE, EPIDEMIOLOGY BRANCH NHLBI. I THINK THE ISSUE OF ASKING AND ANSWERING AS MANY QUESTIONS AS POSSIBLE IN A COHORT STUDY IS EXTREMELY IMPORTANT, EXAMPLE FROM HONOLULU IS A GOOD ONE. A CURRENT ONE WE'RE DOING IS THE LAST EXAMPLE THAT DIANE GAVE ON THE HISPANIC STUDY. WHILE WE'RE THE PRIMARY FUNDER NIDDK FUNDS A PIECE FOR DIABETES AND LIVER DISEASE, HEARING INSTITUTE FUNDS A PIECE FOR HEARING EXAM. DENTAL FOR DENTAL EXAM, NEUROLOGY FOR COGNITIVE ASSESSMENT, IT'S A WAY WHERE WE HAVE BUILT THIS TOGETHER. THE PROBLEMS. THE PROBLEMS ARE -- WE HAVE TO BEG. EVERY INSTITUTE. HOW TO GET INSTITUTES INVOLVED TO ACTUALLY COMMIT BOTH SCIENCE AND THEIR DOLLARS IS REALLY HARD. THE SECOND IS THE LEADERSHIP, WHILE WE HAVE TAKEN THIS PRIMARILY AS A -- VERY IMPORTANTLY AS HEART LUNG AND BLOOD INSTITUTE ISSUE, HOW TO GET OTHER INSTITUTES ACTUALLY INVOLVED SO THEY WILL CONTRIBUTE AND WANT THE SCIENCE. BUT THEY DON'T OWN IT IN THE SAME WAY WE MIGHT HAVE IF IN FACT WE'RE THE STUDY. IT MAKE AS CONFLICT FOR THEM AND HOW INSTITUTES SPENT THEIR MONEY IN THIS KIND OF COLLABORATIVE STUFF. ANY COMMENTS WOULD BE HELPFUL. >> I THINK THAT'S AN EXCELLENT POINT AND IT ACTUALLY IMPINGES ON SOMETHING THAT I THINK THE COHORT CONSORTIUM AND OTHER PEOPLE WANT TO JOIN IN SHOULD ACTUALLY DISCUSS BECAUSE IT RELATES NOT ONLY SOMETHING BIG, NEW, WHATEVER, AND SMALL SCALE, DOES ONE SIZE FIT ALL. I THINK THE IDEA BEHIND THE BRITISH BIOBANK IS YES, WE CAN GET ALL ENPOINTS AND EXPOSURES. I DON'T THINK THAT PROBABLY IS GOING TO BE WHAT THEY FIND. THOSE -- AS YOU KNOW, DO COHORT STUDIES YOU WORRY SERIOUSLY ABOUT PEOPLE TOPPING OUT OF YOUR STUDY, IF YOU HAVE THEM DO TOO MANY THINGS, OR YOU ASK THEM TO DO TOO MANY THINGS. AND YOU FEEL LUCKY IF HE CAN GET BLOOD OUT OF THEM AND THEN YOU START COMING BACK FOR ANOTHER BLOOD AND ANOTHER BLOOD AND THAT DIDN'T BUY INTO THIS. SO I THINK WE HAVE TO THINK A LITTLE BIT BOTH IN TERMS OF HOW WE DO OUR COLLABORATING AND CONSORT WITH AS WELL AS FUTURE ABOUT WHAT DOES GO TOGETHER, WHAT CAN WE FOR CANCER, WE HAVE -- POINTED OUT BY DIANE, I THINK WE HAVE A GREAT END POINT. WE GOT PATHOLOGY THAT NAILS IT FOR US. WE DON'T HAVE TO EXAMINE PEOPLE. BUT IF YOU'RE IN THE ARTHRITIS INSTITUTE, I HAVE HAD DISCUSSIONS WITH THEM OVER THE YEARS, MOST OF THE PEOPLE WITH ARTHRITIS AREN'T DIAGNOSED. THEIR END POINTS HAVE TO INCLUDE AN EXAM. SO I THINK IT IS -- WILL BE, I DON'T KNOW THE ANSWER TO THIS, BUT IT IS A MATTER OF TRYING TO DECIDE AT LEAST IN POPULATION STUDIES WHAT GROUPINGS OF DISEASES WOULD GO TOGETHER IN TERMS OF THE AMOUNT OF BURDEN YOU CAN PUT ON THE RESPONDENTS AS WELL AS GETTING -- BEING ABLE TO DO RESEARCH YOU'RE LOOKING AT. I SUSPECT I'M NOT SMART ENOUGH TO KNOW THAT RIGHT NOW. BUT I THINK IT MIGHT GIVEN THE FACT THAT WE -- I THINK NEED TO DO THINGS TOGETHER IN ORDER TO MAKE IT FUNDABLE IS WE NEED TO TALK ABOUT THINGS WE DO TOGETHER. >> THIS OFFICIALLY CLOSES THE SYMPOSIUM. I WANT TO THANK THE SPEAKERS AND WE WILL BE TRYING TO PULL THIS TOGETHER IN TO SOME TYPE OF REPORT BECAUSE DR. CORRY REQUESTED THAT. THANK YOU FOR THOSE OF YOU STAYING ON FOR THE BUSINESS MEETING, WE WILL RECONVENE AT ONE O'CLOCK AT ROOMS E-1 AND E-2. IF YOU DID PREPAY FOR BOX LUNCH THAT'S ROOM F-1, F-2, OTHERWISE THE CAFETERIA IS AVAILABLE. THANKS, EVERYBODY. [APPLAUSE] THE HOSPITAL. >> Reporter: SHE SAYS THEY'VE RUN OUT OF FOOD AID AND REPEATED CATTLE RAIDS AND DROUGHTS HAVE DECIMATED THEIR LIVESTOCK. >> WHEN TIMES ARE TOUGH, THEY DEPEND ON ELA MASH, THIS WILD FRUIT, BUT IT HAS LITTLE NUTRITIONAL VALUE, ESPECIALLY FOR CHILDREN. ONE-THIRD OF KIDS IN KENYA ARE STUNTED AND THAT HAS HUGE IMPLICATIONS FOR THE COUNTRY. >> Reporter: THE KENYAN GOVERNMENT ESTIMATES THAT MALNUTRITION WILL COST ITS ECONOMY $38 BILLION IN THE NEXT TWO DECADES. >> STUNTING IS PERMANENT. IF THE CHILD IS STUNTED, THAT MEANS THEY'LL GROW UP TO BE A STUNTED ADULT. WE ARE LOOKING AT THE STUNTED CHILDREN WHO ARE NOT EVEN ABLE TO PERFORM WELL IN SCHOOL. THEN THAT MEANS WE WILL NOT BE ABLE TO RAISE UP A SOCIETY THAT IS ACTUALLY VERY WELL EDUCATED. >> Reporter: DESPITE THE HUGE HUMAN AND ECONOMIC AFFECT, CRITICS SAY GOVERNMENTS AND AID ORGANIZATIONS AREN'T DOING ENOUGH TO GET CRUCIAL NUTRITION TO CHILDREN AT AN EARLY AGE WHEN STUNTING CAN BE PREVENTED. FOR AN AFRICAN ARTIST IT'S DEEPLY DISTURBING. >> SOMETIME I GET ANGRY AND FRUSTRATED. I REALLY DO BECAUSE THERE ARE SOLUTIONS, BUT THE WAY OF USING THE SOLUTION IS ALWAYS TOO MUCH WRAPPED IN POLITICAL REASONS. I KNOW THE RESILIENCE OF MY PEOPLE, AND I KNOW THAT IF WE EMPOWER THE PEOPLE, WE EDUCATE THE WOMEN, AFTER CAN WILL BE TRANSFORMED WITHIN TEN YEARS, AND THE FACT THAT WE ARE NOT THE LEADERS OF AFRICA AND AREN'T MAKING PROMPT CHANGES FAST ENOUGH FOR THE PEOPLE IS SOMETHING THAT IS JUST -- I CAN'T TAKE IT. IT JUST EAT ME FROM INSIDE. >> WE STILL HAVE CHILDREN WHO ARE STUNTED AND CHILDREN WHO ARE NOT STUNTED. >> Reporter: TRAGICALLY THE SOLUTIONS TO STUNTING ARE SIMPLE. BREAST FEEDING, IMMUNIZATIONS, ADEQUATE NUTRITION AND ACCESS TO HEALTH CARE. WHERE GOVERNMENTS HAVE FAILED, SOME OTHERS ARE SUCCEEDING. ORGANIZING WOMEN'S GROUPS TO EDUCATE EACH OTHER ABOUT RAISING HEALTHY CHILDREN. THE KNOWLEDGE TRANSFORMS THE LIVES OF THESE MOTHERS AND THEIR FAMILIES. BUT FOR INGA AND MILLIONS OF OTHER CHILDREN, THE KNOWLEDGE AND HELP CAME TOO LATE. IAN McKENZIE, CNN, KENYA. >> HE IS A MAN WITH A MISSION. HE WANTS TO BRIGHTEN UP THE WORLD. WHAT DO WE MEAN BY THAT? LITERALLY BRIGHTEN IT UP. WE'LL SHOW YOU HOW YOU CAN HELP. [ Female Announcer ] GROSS -- I'LL TELL YOU WHAT'S REALLY GROSS: USED DISHCLOTHS. THEY CAN HAVE A HISTORY THAT THEY DRAG AROUND WITH THEM. FOR A CLEANER WAY TO CLEAN TRY BOUNTY EXTRA SOFT. IN THIS LAB DEMO, ONE SHEET OF BOUNTY EXTRA SOFT LEAVES THIS SURFACE 3 TIMES CLEANER THAN A DISHCLOTH. IT'S SUPER DURABLE TOO. IT'S THE CLEANER WAY TO CLEAN. BRING IT WITH BOUNTY EXTRA SOFT. IN THE PINK PACK. AND TRY BOUNTY NAPKINS. [ Male Announcer ] WHEN THESE COME TOGETHER, AND THESE COME TOGETHER, ONE THING YOU CAN DEPEND ON IS THAT THESE WILL COME TOGETHER. DELICIOUS AND WHOLESOME. SOME COMBINATIONS WERE JUST MEANT TO BE. TOMATO SOUP FROM CAMPBELL'S. IT'S AMAZING WHAT SOUP CAN DO. QUESTIONS? ANYONE HAVE OCCASIONAL CONSTIPATION, DIARRHEA, GAS, BLOATING? YEAH. ONE Phillips' Colon Health PROBIOTIC CAP EACH DAY HELPS DEFEND AGAINST THESE DIGESTIVE ISSUES WITH THREE STRAINS OF GOOD BACTERIA. APPROVED! [ Female Announcer ] LIVE THE REGULAR LIFE. Phillips'. [ Male Announcer ] IMAGINE FACING THE DAY WITH LESS CHRONIC OSTEOARTHRITIS PAIN. IMAGINE LIVING YOUR LIFE WITH LESS CHRONIC LOW BACK PAIN. IMAGINE YOU, WITH LESS PAIN. CYMBALTA CAN HELP. CYMBALTA IS FDA-APPROVED TO MANAGE CHRONIC MUSCULOSKELETAL PAIN. ONE NON-NARCOTIC PILL A DAY, EVERY DAY, CAN HELP REDUCE THIS PAIN. TELL YOUR DOCTOR RIGHT AWAY IF YOUR MOOD WORSENS, YOU HAVE UNUSUAL CHANGES IN MOOD OR BEHAVIOR OR THOUGHTS OF SUICIDE. ANTIDEPRESSANTS CAN INCREASE THESE IN CHILDREN, TEENS, AND YOUNG ADULTS. CYMBALTA IS NOT APPROVED FOR CHILDREN UNDER 18. PEOPLE TAKING MAOIS OR THIORIDAZINE OR WITH UNCONTROLLED GLAUCOMA SHOULD NOT TAKE CYMBALTA. TAKING IT WITH NSAID PAIN RELIEVERS, ASPIRIN, OR BLOOD THINNERS MAY INCREASE BLEEDING RISK. SEVERE LIVER PROBLEMS, SOME FATAL, WERE REPORTED. SIGNS INCLUDE ABDOMINAL PAIN AND YELLOWING SKIN OR EYES. TELL YOUR DOCTOR ABOUT ALL YOUR MEDICINES, INCLUDING THOSE FOR MIGRAINE AND WHILE ON CYMBALTA, CALL RIGHT AWAY IF YOU HAVE HIGH FEVER, CONFUSION AND STIFF MUSCLES OR SERIOUS ALLERGIC SKIN REACTIONS LIKE BLISTERS, PEELING RASH, HIVES, OR MOUTH SORES TO ADDRESS POSSIBLE LIFE-THREATENING CONDITIONS. TALK ABOUT YOUR ALCOHOL USE, LIVER DISEASE AND BEFORE YOU REDUCE OR STOP CYMBALTA. DIZZINESS OR FAINTING MAY OCCUR UPON STANDING. ASK YOUR DOCTOR ABOUT CYMBALTA. IMAGINE YOU WITH LESS PAIN. CYMBALTA CAN HELP. GO TO CYMBALTA.COM TO LEARN ABOUT A FREE TRIAL OFFER. >>> A YOUNG HAITIAN MAN WAS SO INSPIRED BY THE COLORFUL HOMES THAT HE SAW WHEN HE VISITED SOUTH FLORIDA -- YOU KNOW THOSE HOMES -- HE DECIDED START A PAINT CHARITY. THE PAINT HE COLLECTS IN ATLANTA GOES TO BEAUTIFY COMMUNITIES IN THE DEVELOPING WORLD. HE SAYS A COAT OF PAINT ACTUALLY MATTERS. >> Reporter: HE WANTS YOUR PAINT. HE ALREADY HAS THREE STORAGE UNITS FULL, BUT HE IS STILL COLLECTING MORE. >> PAINT, OH. >> Reporter: DEL GARD IS FOUNDING FOR GLOBAL PAINT FOR CHARITY IN ATLANTA. HE PICKS UP PAINT DONATIONS FROM HOMEOWNERS AND BUSINESSES WHO WANT TO RECYCLE THEIR PAINT. THEY'RE HAPPY TO DONATE IT, AND DEL GARD IS THRILLED TO GET IT. >> WOW. >> WE'RE CLEANING OUT PART OF OUR BASEMENT TO PUT SOME OTHER THINGS IN THERE, AND WE HAD THIS PAINT THAT WE DIDN'T KNOW WHAT TO DO WITH IT. >> Reporter: HIS OBSESSION WITH PAINT BEGAN 12 YEARS AGO WHEN HE CAME TO THE UNITED STATES FROM HAITI. >> LOOK AT THOSE STARS. >> MY IMPRESSION OF THE UNITED STATES OH, THANK GOD. I LANDED AT MIAMI INTERNATIONAL AIRPORT. I SAW SO MANY BEAUTIFUL PAINTED HOUSE IN FLORIDA. THE PEOPLE PAINT THEIR HOUSE YELLOW, RED, WHITE, BLUE. WOW. JUST SO MUCH PAINT IN THIS COUNTRY. I SAID, WELL, WHEN I GET MONEY IN THIS COUNTRY, I'M GOING BUY PAINT AND TAKE PAINT BACK HOME. >> Reporter: AND FROM THAT IDEA GLOBAL PAINT CHARITY WAS BORN. DEL GARD COLLECTS PEOPLE'S LEFTOVER PAPT, REPROCESSES IT, AND HITS SLIPS IT TO ORGANIZATIONS IN DEVELOPING COUNTRIES. >> WHENEVER I RECYCLE WE CAN CHANGE PEOPLE'S LIFE IN AFRICA AND HAITI, ALL OVER THE WORLD, AND TO BEAUTIFY THEIR HOMES, BEAUTIFY THEIR COMMUNITIES, AND CHANGE THE WORLD WITH ONE GALLON OF PAINT AT A TIME. >> THAT'S EXACTLY WHAT HE HAS DONE. DONATING 6,000 GALLONS OF PAINT SO FAR TO HAITI, KENYA, AND UGANDA. HE HAS RECENTLY RETURNED FROM ECUADORAL GUINEA WHERE HE DONATED PAINT TO AN ORPHANAGE WHO LOST THEIR PARENTS TO HIV AIDS. >> WE LOOK AT SCHOOLS, HOSPITALS, CHURCHES, AND FAMILY HOMES THAT WERE NOT PAINTED, AND THEY TOUCHED MY HEART TO SEE THE BACTERIA ON THE WALLS THAT WERE NOT PAINTED. I SAID WE HAVE TO DO SOMETHING. >> HE IS DIAGNOSE A LOT. IF YOU WOULD LIKE TO DONATE YOUR PAINT, GO TO THE WEBSITE WWW.GLOBALPAINT.ORG. * >>> 12 DAYS LEFT TO GO. CANDIDATES FOCUSSING ON A HANDFUL OF STATES. IT'S LIKELY GOING TO DETERMINE WHO WINS THE WHITE HOUSE. PRESIDENT OBAMA WRAPPING UP A 48-HOUR MARATHON STOPS TODAY IN TAMPA, FLORIDA, RICHMOND, VIRGINIA, CLEVELAND OHIO ALTHOUGH WAY FROM RICHMOND TO CLEVELAND. HE STOPS IN CHICAGO TO VOTE. >>> MITT ROMNEY FOCUSSING ON A MAKE OR BREAK STATE OF OHIO TODAY. STARTING WITH A RALLY JUST A COUPLE OF HOURS AGO IN CINCINNATI. THIS NEXT STOP IS GOING TO BE WORTHINGTON, AND HE ENDS THE DAY IN DEFIANCE, OHIO. IT HAS -- WHO HAS THE BEST PLAN TO GET THE ECONOMY GOING AGAIN, THAT IS ONE OF THE DEFINING ISSUES OF THIS PRESIDENTIAL RACE? CRITICS SAY THE CANDIDATES, THEY ARE LONG ON PROMISES AND SHORT ON DETAILS. JUST 12 DAYS TO GO BOTH PRESIDENT OBAMA AD MITT ROMNEY PUSHING THEIR PLANS TO FIX THE ECONOMY. LET'S BRING IN OUR POLITICAL DIRECTOR MARK PRESTON. MARK, WOW, JUST DAYS. IT IS FLYING BY HERE, AND WE'VE GOT PRESIDENT OBAMA NOW. HE IS PUTTING OUT THESE PLANS. HE SAYS, LOOK, THIS IS WHAT I'M GOING TO DO IF I GET A SECOND TERM. HERE'S WHAT HE SAID IN TAMPA. >> I'VE GOT A PLAN THAT WILL ACTUALLY CREATE JOBS. A PLAN THAT WILL ACTUALLY CREATE MIDDLE CLASS SECURITY, AND UNLIKE MVR, I'M PROUD TO TALK ABOUT THAT PLAN. BECAUSE THE MATH ACTUALLY ADDS UP. I WANT YOU ALL TO TAKE A LOOK AT IT. YOU CAN GO TO BARACKOBAMA.COM/PLANS, AND I WANT YOU TO SHARE THOSE PLANS WITH YOUR FRIENDS AND NEIGHBORS AND CO-WORKERS. >> ALL RIGHT. SO, MARK, I HAVE A COUPLE OF QUESTIONS FOR YOU. FIRST OF ALL, IF YOU GO TO THE WEBSITE, IFYOU HEARD THE PRESIDENT BEFORE, EVEN IF YOU GO TO THE WHITE HOUSE WEBSITE, NOT A LOT OF THIS IS REALLY NEW MATERIAL HERE, SO HOW MUCH OF IT IS REALLY MORE INFORMATION AND HOW MUCH OF IT IS SIMPLY REPACKAGING AND FOCUSSING ON, LOOK, I GOT SOMETHING TO GIVE YOU, I GOT SOMETHING TO OFFER FOR A SECOND TERM? >> AND I GOT SOMETHING TO TELL YOU WHAT I HAVE DONE IN MY FIRST TERM AS WELL, WHICH IS WHAT HE HAS DONE IN THIS PLAN AND IN THIS BOOKLET WHICH NOT ONLY IS HE TELLING PEOPLE TO GET IT FROM THE WEBSITE, BUT HE HAS ALSO PRINTED MILLIONS OF COPIES AND THEY'RE HANDING IT OUT. LOOK, BARACK OBAMA IS RUNNING ON ONE ISSUE AND ONE ISSUE ALONE IN MANY WAYS, AND THAT'S THE ECONOMY AS IS MITT ROMNEY. IT'S BEEN ISSUE NUMBER ONE SINCE 2008. IT'S GOING TO DECIDE WHAT HAPPENS IN THIS ELECTION, AND THAT'S WHY WE SAW RIGHT AFTER THE DEBATE EARLIER THIS WEEK FIRST THING HE DID IN HIS FIRST CAMPAIGN RALLY WAS TO TALK ABOUT HIS PLAN TO TRY TO TURN THE ECONOMY AROUND. NOW, PART OF THE DIFFICULTY FOR BARACK OBAMA IS THAT HE INHERITED A VERY BAD SITUATION. IT HASN'T GOTTEN MUCH BETTER. I DON'T THINK MANY PEOPLE COULD HAVE THOUGHT IT COULD BE TURNED AROUND IN FOUR YEARS. HE IS ASKING OR FOUR MORE. THE QUESTION IS WILL THE VOTERS THINK THAT HE DESERVES IT, AND THAT'S WHY THIS RACE WAS SO TIGHT RIGHT NOW, SUZANNE. >> WHAT'S THE POLITICAL CALCULUS HERE? IN SOME WAYS "THE DES MOINES RGISTER" HE LAYS OUT THESE PLANS. WE TALKS ABOUT IMMIGRATION AND DEFENSE SPEND, THESE KINDS OF THINGS. PEOPLE ARE GOING TO HOLD HIM TO ACCOUNT. DO THEY THINK IT'S WORTH THE RISK HERE TO JUST PUT THIS OUT HERE NOW? >> YEAH. NO QUESTION BECAUSE THEY'RE GOING TO HOLD HIM TO ACCOUNT, BUT LET'S ASSUME THAT HE GETS ELECTED AND, YOU KNOW, WHAT HAPPENS? HE DOESN'T HAVE ANOTHER TERM TO RUN FOR, SO THE PROMISES THAT HE MAKES RIGHT NOW, LOOK, HE -- I'M SURE HE IS SAYING -- HE HOPES THAT HE CAN ENACT THEM, BUT HOW DOES HE -- HOW IS HE GOING TO BE HELD ACCOUNTABLE? TWO YEARS, AND LET ALONE HOW IS MITT ROMNEY GOING TO BE REALLY HELD ACCOUNTABLE IF HE WERE TO WIN? THE FACT OF THE MATTER IS THEY ARE MAKING CAMPAIGN PROMISES, AND THEY'RE ABOUT TO TRY TO FULFILL THEM. THE PROBLEM IS HERE IN WASHINGTON IT ISN'T JUST WHAT THE PRESIDENT DECIDES TO DO. IT'S WHAT HAPPENS IN CONGRESS AS WELL WHERE THE HOUSE OF REPRESENTATIVES AND WILL THE SENATE GO ALONG WITH IT. AS MUCH AS OUR FOCUS IS ON THE PRESIDENTIAL CAMPAIGN, THESE RACES ARE VERY, VERY KEY TO WHAT HAPPENS FOR THE NEXT FOUR YEARS. >> WHAT CAN THE PRESIDENT DO WITHOUT THE BALANCE OF POWER WORKING IN HIS FAVOR? I WANT TO BRING UP MITT ROMNEY HERE. HE HAS A FIVE-POINT PLAN. HE OUTLINED IT AGAIN TODAY. THIS WAS IN CINCINNATI. >> THE PRESIDENT HAS BEEN LOOKING FOR A PLAN. HE HAS BEEN LOOKING FOR SOME WAY TO HELP THE GENTLEMAN I SPOKE ABOUT, SOME WAY TO HELP THE 23 MILLION PEOPLE THAT ARE OUT OF WORK. >> I'M GOING TO HELP THAT MAN WHO NEEDS THAT GOOD JOB. >> WE STILL HAVE NOT HEARD SOME OF THE SPECIFICS ABOUT WHAT THE TAX LOOPHOLES ARE GOING TO BE IN ORDER FOR HIM TO COME UP WITH MAKING HIS OWN PLAN WORK HERE. IS THIS WHAT THE CAMPAIGN NEEDS TO PUT OUT, AND THIS IS WHAT YOU'RE GOING TO GET. MAKE UP YOUR MINDS. MAKE YOUR DECISION BASED ON WHAT WE'RE PUTTING OUT THERE NOW. >> WE TALK ABOUT MITT ROMNEY TALKING ABOUT THE HOME DEDUCTION, AND THAT FELL FLAT, YOU KNOW, ABOUT A MONTH AGO OR A COUPLE OF MONTHS AGO, AND I HEARD JUST THIS WEEK WHERE HE TALKED ABOUT HOW HE WAS GOING TO CAP DEDUCTIONS AT A CERTAIN NUMBER, WHICH WOULD THEN ALLOW PEOPLE WHO WERE LOOKING FOR THAT DEDUCTION ON THEIR HOME TO BE INCLUDED IN THAT CAP. YOU DON'T WANT TO BE ABSOLUTELY SPECIFIC BECAUSE IF YOU ARE, YOU ARE JUST INVITING PEOPLE TO CRITICIZE YOU EVEN MORE. IF YOU OFFER A BROAD IDEA, A BROAD PATHWAY TO SUCCESS, YOU ARE BETTER OFF. YOU WORRY ABOUT LOSING YOUR HOMES. MANY N SOME WAYS, TO BE SUCCESSFUL IN A CAMPAIGN. YOU DON'T HAVE TO SELL YOUR SPECIFIC PLAN. >> GOOD TO SEE YOU, AS ALWAYS. WE'LL BE WATCHING VERY CLOSELY. >> FLORIDA'S 29 ELECTORAL VOTES ONE OF THE BIGGEST PRIZES IN THE CAMPAIGN. WELL, RIGHT NOW THE STATE IS STILL A TOSS-UP. THE CAMPAIGNS ARE HONING IN ON SWING COUNTIES LIKE ORLANDO'S ORANGE COUNTY. NOW, ORANGE COUNTY, THIS IS PART OF THE CRUCIAL I-4 CORRIDOR. THIS IS WHERE CLOSE ELECTIONS ARE OFTEN DECIDEED IN FLORIDA. 27% OF THE POPULATION IS HISPAN HISPANIC, AND ALMOST 22% AFRICAN-AMERICAN. THAT IS WHERE WE FIND OUR OWN ALI VELSHI AND JOHN AVLON. THEY ARE ON THE BATTLEGROUND BUS TOUR THROUGH SOME OF THE 109 MOST CONTESTED COUNTIES. >> SUZANNE, WE ARE IN ORLANDO. ORLANDO IS INTERESTING BECAUSE IT IS A STORY WHICH REPEATS ITSELF NATIONALLY ABOUT WHAT IT IS VERSUS WHAT IT FEELS LIKE. IT IS MEASURABLY BETTER THAN IT WAS AT THE WORST OF THE FINANCIAL CRISIS. NOT THAN IT WAS FOUR YEARS AGO, BUT BETTER THAN IT WAS AT THE WORST. WE ARE RUNNING INTO A LOT OF PEOPLE WHO DON'T CONNECT TO THAT REALITY. >> THAT'S EXACTLY RIGHT. LOOK, THE ECONOMY IS ONLY AS GOOD OR BAD AS IT IS FOR YOU AND YOUR -- THERE'S NO QUESTION. ORLANDO, LIKE IN FLORIDA AND MANY PARTS OF THE COUNTRY, WE'RE THROUGH THE WORST OF IT, BUT UNEMPLOYMENT IS ROUGHLY WHERE IT WAS WHEN OBAMA TOOK OFFICE. SDOO RIGHT. >> FOR MONTHS AND MONTHS IT WAS IN LOW DOUBLE DIGITS. WE'VE COME OUT OF THAT. YOU'RE STARTING TO SEE REAL BRIGHT SPOTS IN THE ECONOMY, BUT WE HAVEN'T MADE SOME IMPROVEMENT THAT PEOPLE ARE GOING TO GIVE THE CREDIT TO PRESIDENT OBAMA SNES NECESSARILY. >> FLORIDA WAS ONE OF THE PLACES THAT WAS GROUND SFWLER FOR THE HOUSING CRISIS. THIS IS WHERE PRICES JUST PLUMMETED. BELIEVE IT OR NOT, MORE AND MORE CONSTRUCTION OF NEW HOUSES EVERY MONTH IN THE LAST FEW MONTHS IN ORLANDO. >> WE WONDER WHEN THEY'RE GOING TO GET SOME RELIEF, BUT THERE ARE SIGNS OF IMPROVEMENT. THEY ARE REAL. THEY ARE MEASURABLE. THEY ARE NOT PERVASIVE OR DEFINING THE LOCAL COMMUNITY. A FEW INDUSTRIES AND THEN THOSE INDUSTRIES START TO FAIL AS A LOT OF THINGS DID AROUND HERE. FOR THE FIRST FEW MONTHS YOU HOPE IT'S GOING TO COME BACK, AND APPROXIMATE THEN YOU START TO REINVENT, AND ORLANDO IS STARTING TO GO THROUGH THAT EXPERIENCE OF CREATING NEW INDUSTRIES OR HELPING OUT OTHER INDUSTRIES IN THE AREA. IT'S VERY DIVERSE. IT'S LATIN AMERICAN. EVEN PUERTO RICAN CITIZENS ARE LIVING HERE. IT HAS A DIFFERENT TONE AND TENOR. IT WAS TIGHT IN 2004. OBAMA WON IT BY 20 POINTS GOING AWAY IN 2008. IT'S NOT GOING TO HAPPEN THIS TIME BECAUSE THIS RACE IS TIGHT EVEN HERE. >> AND AS MUCH AS SOMEBODY MIGHT SWING IT ONE WAY OR THE OTHER OVER THE COURSE OF THE NEXT TWO WEEKS, THE REALITY IS THE OBAMA OPERATION IN PARTICULAR IS SHIFTING TO ITS GET OUT THE VOTE JOB. >> THAT'S RIGHT. THIS IS SO TIGHT IT'S ALL GOING TO COME DOWN TO GROUND GAME. GET OUT THE VOTE EARLY VOTING. THAT'S A MAJOR MESSAGE. ON SIMPLY THE ISSUE OF LOCAL HEADQUARTERS, THE OBAMA TEAM HAS AN EDGE HERE. AROUND 2-1 FOR ROMNEY. IT'S A SIGNIFICANT METRIC. THEY'VE BEEN INVESTING HEAVILY IN LOCAL GROUND GAME SINCE THE BEGINNING. >> WE'RE GOING TO JACKSONVILLE, AND THEN WE'RE GOING TO HEAD NORTH. SUZANNE. >> THANKS, GUYS. >>> HERE'S WHAT WE'RE WORKING ON FOR THIS HOUR. >> A MOVIE ABOUT THE DEATH OF OSAMA BIN LADEN WILL HIT THE AIRWAVES JUST TWO DAYS BEFORE THE ELECTION, AND THE PRESIDENT PLAYS A KEY ROLE. AND THE FIGHT FOR WOMEN VOTERS HITS A BOILING POINT. DEMOCRATS HOPE ABORTION RIGHTS TIP THE POLLS. THEN LADY LIBERTY JUST GOT A LITTLE WORK DONE. NOW AFTER BEING CLOSED FOR A YEAR, HER CROWN IS ABOUT TO REOPEN TO THE PUBLIC. WE'LL GET AN INSIDE LOOK AT THE CHANGES. WHAT IF THERE WAS A NEW WAY TO DEAL WITH MONEY THAT FOCUSED LESS ON FEES AND MORE... ON WHAT MATTERS? MAYBE YOUR BANK ACCOUNT IS TAKING TOO MUCH TIME AND MAYBE IT'S COSTING TOO MUCH MONEY. INTRODUCING BLUEBIRD BY AMERICAN EXPRESS AND WALMART. YOUR ALTERNATIVE TO CHECKING AND DEBIT. IT'S LOADED WITH FEATURES, NOT FEES. BECAUSE WE THINK YOUR MONEY SHOULD STAY WHERE IT BELONGS. WITH YOU. THE VALUE YOU EXPECT. THE SERVICE YOU DESERVE. IT FEELS GOOD TO BLUEBIRD. GET IT AT YOUR LOCAL WALMART. YOU SEE US, AT THE START OF THE DAY. ON THE COMPANY PHONE LIST THAT'S A FEW NAMES LONGER. YOU SEE US BANK ON BUSIER HIGHWAYS. ON ONCE EMPTY FIELDS. EVERYDAY YOU SEE ALL THE WAYS ALL OF US AT US BANK ARE HELPING GROW OUR ECONOMY. LENDING MORE SO COMPANIES AND COMMUNITIES CAN EXPAND, GRO STRONGER AND GET BACK TO WORK. EVERYDAY YOU SEE ALL OF US SERVING YOU, AROUND THE COUNTRY, AROUND THE CORNER. US BANK. [ Female Announcer ] TODAY, JASON IS HERE TO VOLUNTEER TO HELP THOSE IN NEED. WHEN A TWINGE OF BACK PAIN SURPRISES HIM. MORNING STARTS IN HIGH SPIRITS, BUT THERE'S A GROWING PAIN IN HIS LOWER BACK. AS LINES GROW LONGER, HIS PAIN CONTINUES TO LINGER. BUT AFTER A LONG DAY OF HELPING OTHERS, HE GETS SOME HELPFUL ADVICE. JUST TWO Aleve HAVE THE STRENGTH TO KEEP BACK PAIN AWAY ALL DAY. TODAY, JASON CHOSE Aleve. JUST TWO PILLS FOR ALL DAY PAIN RELIEF. TRY Aleve D FOR STRONG, ALL DAY LONG SINUS AND HEADACHE RELIEF. SO WHAT DO YOU THINK? BASIC. AT Meineke I HAVE OPTIONS... LIKE OIL CHANGES STARTING AT $19.95. MY MONEY. MY CHOICE. MY Meineke. >>> TWO LIVES EVENTS GOING ON AT ¨ THE SAME TIME. PRESIDENT OBAMA IN RICH MOPPED, MISSOURI, AND IN BRISTOL, VIRGINIA, THIS IS PAUL RYAN SPEAKING LIVE. THE VICE PRESIDENTIAL CANDIDATE OF COURSE TRYING TO PUT THE STATE BACK IN REPUBLICAN HANDS. IT'S NOVEMBER. IT WAS A REPUBLICAN STRONGHOLD UNTIL THE PRESIDENT WON, OF COURSE, VIRGINIA, BACK IN 2008. LET'S LISTEN IN FIRST. >> WE'RE GOING REAPPLY THEM TO THE PROBLEMS OF THE DAY. WE'RE GOING TO GET THIS COUNTRY BACK ON TRACK, AND WE'RE GOING TO HELP GOOD JOB TRADERS GET BACK IN THE BUSINESS OF TRADING JOBS AND GET BACK ON THE PATH OF PROSPERITY. THAT'S THE CHOICE IN FRONT OF US. YOU KNOW, PRESIDENT OBAMA REALLY HASN'T GIVEN US A VISION FOR A SECOND TERM AGENDA? JUST A COUPLE OF DAYS AGO HE CAME UP WITH A SLICK NEW BROCHURE. IT'S A SLICK COMIC BOOK THAT -- TO ME A SLICK REPACKAGING OF MORE OF THE SAME. LOOK AT WHAT IT'S GOTTEN US. YOU SEE, WHERE WE ARE TODAY IS OUR ECONOMY IS BARELY LIMPING ALONG. IT'S SLOWER THIS YEAR THAN IT WAS LAST YEAR. LAST YEAR WAS SLOWER THAN THE YEAR BEFORE. FOR OCTOBER 25th IT'S PRETTY DARN WARM OUT HERE. WE GET SNOW SOMETIMES THIS TIME OF YEAR IN WISCONSIN. BUT LOOK AT WHERE WE ARE. WE'RE HEADED IN THE WRONG DIRECTION. YOU SEE, THE OBAMA ECONOMIC AGENDA FAILED NOT BECAUSE IT WAS STOPPED. IT FAILED BECAUSE IT WAS PASSED. HE CONTROLLED ALL OF GOVERNMENT. LET'S NOT FORGET THAT HIS PARTY WAS IN FIRM CONTROL OF WASHINGTON WHEN HE CAME IN, SO HE COULD DO EVERYTHING HE WANTED TO DO. THAT'S WHAT GAVE US ALL THIS STIMULUS, AND IF YOU LOOK AT THE PROMISES MADE WHEN HE PASSED ALL THIS BORROWING AND SPENDING, GIVEN WHAT HE HAS GIN TO CORPORATE CONTRIBUTE ORZ AND COMPANIES LIKE CYLINDRA, HE SAID OUR ECONOMY WOULD BE GROWING AT 4.3%. WE'RE AT 1.3% TODAY. WE'RE ABOUT NINE MILLION JOBS SHORT OF WHAT HE SAID WE WOULD BE IF WE JUST PUT THIS PROGRAM IN PLACE. HIS PROGRAM WAS -- >> ALL RIGHT. LET'S GO ALSO TO VIRGINIA IN RICHMOND. THAT'S WHAT THE PRESIDENT IS SPEAKING. >> THAT WAS HIS PHILOSOPHY IN THE BOARDROOM. THAT WAS HIS PHILOSOPHY AS GOVERNOR. IF IT SOUNDS FAMILIAR, IT'S BECAUSE THAT'S EXACTLY WHAT WE TRIED IN THE LAST DECADE. BEFORE I CAME INTO OFFICE, IT LED TO FALLING INCOME AND RECORD DEFICITS AND THE SLOWEST JOB GROWTH IN HALF A CENTURY AND THE WORST ECONOMIC CRISIS SINCE THE GREAT DEPRESSION. WE HAVE NOW BEEN WORKING FOR FOUR YEARS TO CLEAN UP THE MESS THOSE POLICIES LEFT BEHIND. HE NOTES THEY'RE PROBABLY NOT THAT POPULAR. HE KNOWS HIS PLAN ISN'T ANY DIFFERENT THAN THE POLICY THAT IS GOT HIM IN TROUBLE. A WEEK FROM THIS ELECTION, HE IS COUNTING ON YOU. HE IS HOPING THAT YOU COME DOWN WITH A CASE OF WHAT WE CALL ROMNESIA. HE IS HOPING YOU WON'T REMEMBER THAT HIS ECONOMIC PLAN IS MORE LIKELY TO CREATE JOBS IN CHINA THAN IT IS IN AMERICA. BECAUSE IT ACTUALLY REWARDS COMPANIES THAT SHIP JOBS AND PROFITS OVERSEAS. HE IS HOPING YOU WON'T REMEMBER THAT HE WANTS TO GIVE MILLIONAIRES AND BILLIONAIRES A $250,000 TAX CUT BECAUSE THE ONLY WAY HE CAN PAY FOR THAT TAX CUT IS BY RAISING YOUR TAXES OR BLOWING A HOLE IN THE DEFICIT. IN THAT CASE HE COMES DOWN WITH A SOUTHEAST CASE OF ROMNESIA BEFORE YOU CAST YOUR BALLOT. BUT RICHMOND, I WANT YOU TO KNOW THIS. THIS IS A CURABLE DISEASE. IF YOU FEEL ANY SYMPTOMS COMING ON, IF YOU ARE STARTING TO GET A LITTLE WOOZY, YOUR EYES ARE GETTING A LITTLE BLURRY, SOME RINGING IN YOUR EARS, IF YOU CAN'T REMEMBER WHAT YOU SAID JUST A WEEK AGO IF YOU CAN'T REMEMBER THE PLANS ON YOUR OWN WEBSITE AND YOU'RE WORRIED YOU MIGHT BE COMING DOWN WITH A CASE OF ROMNESIA, I WANT YOU TO KNOW OBAMA CARE COVERS PREEXISTING CONDITIONS. WE CAN MAKE YOU WELL. WE CAN FIX YOU UP. >> ALL RIGHT. PRESIDENT OBAMA TAKING A HIT ON MITT ROMNEY THERE. TALKING ROMNESIA, AS HE CALLS IT, ABOUT MITT ROMNEY AND HIS PLANS OR POSITIONS CHANGING. A MOVIE ABOUT THE DEATH OF OSAMA BIN LADEN IS GOING TO HIT THE AIRWAVES, AND THE PRESIDENT IS PLAYING A KEY ROL. THERE'S A HEALTH COMPANY THAT CAN HELP YOU STAY THAT WAY. WHAT'S HEALTHIER THAN THAT? JACK, YOU'RE A LITTLE BORING. BORING. BORING. [ Jack ] AFTER LAUREN BROKE UP WITH ME, I WENT TO THE CITI PRIVATE PASS PAGE AND DECIDED TO BE...NOT BORING. THAT'S HOW I MET MARILYN... GIADA... REALLY GOOD. YES! [ Jack ] ...AND ALICIA. * THIS GIR IS ON FIRE [ Male Announcer ] USE ANY CITI¨ CARD TO GET THE BENEFITS OF PRIVATE PASS. MORE CONCERTS. MORE EVENT. MORE EXPERIENCES. [ Jack ] HEY, WHO'S BORING NOW? [ Male Announcer ] GET MORE ACCESS WITH A CITI CARD. [ crowd cheering, mouse clicks ] >>> U.S. MILITARY MISSION THAT KILLED OSAMA BIN LADEN, WELL, TWO MOVIES, THEY'RE IN THE CAN. THEY'RE PREMIER DATES ALREADY SET. IN TEN DAYS THE MOVIE "SEAL TEAM SIX" DEBUT ON CABLE TV. REPUBLICANS NOT SO HAPPY ABOUT IT. IT'S NOT ABOUT THE CONENT, BUT ABOUT THE TIMING. HERE'S BRIAN TODD. >> WE'RE GOING TO BE THE TEAM THAT TAKES OUT OSAMA. >> IT HAS THE REAL LIFE PLOT THAT CAN CERTAINLY DRAW VIEWERS. THE NAVY S.E.A.L.'S RAID THAT KILLED OSAMA BIN LADEN, BUT CAN IT ALSO DRAW VOTERS, AND IS IT DESIGNED TO? S.E.A.L. TEAM 6, A NEW TV DRAMA ABOUT THE BIN LADEN MISSION, IS SET TO AIR ON THE NATIONAL GEOGRAPHIC CHANNEL JUST TWO NIGHTS BEFORE THE ELECTION. IT'S GOT SOME REAL NEWS CLIPS OF PRESIDENT OBAMA IN IT, DESPIKTING THE PRESIDENT IN THE DAYS SURROUNDING THE RAID, AND THE FILM IS BACKED BY HOLLYWOOD MOGUL HARVEY WEINSTEIN. ALL THOSE FACTORS HAVE CONSERVATIVES SAYING THE MOVIE IS A POLITICAL STUNT. >> GET DOWN! >> ANY TIME YOU'VE GOT A MOVIE COMING OUT TWO NIGHTS BEFORE THE ELECTION AND BEING MADE BY HARVEY WEINSTEIN, WHO IS A PROMINENT DEMOCRAT AND A HUGE SUPPORTER OF PRESIDENT OBAMA'S, OF COURSE, IT RAISES EYEBROWS. >> DIRECTOR JOHN STOCKWELL SAID IT WAS WEINSTEIN WHO SUGGESTED ADDING MORE ACTUAL NEWS FOOTAGE, INCLUDING FOOTAGE FROM THE WHITE HOUSE AFTER HE SAW AN EARLY VERSION OF THE MOVIE. >> IT WAS NOT DONE TO, I GUESS, PLAY UP THE PRESIDENT'S ROLE OR MAKE HIM LOOK PARTICULARLY GOOD? >> NO, NOT AT ALL. WE DON'T PRETEND TO SORT OF GET INSIDE THE PRESIDENT'S HEAD. HARVEY WEINSTEIN CAME IN TO THE EDITING ROOM VERY EARLY ON, AND HIS ONLY QUESTIONS TO ME WERE HOW DID YOU KNOW THIS? ARE YOU SURE THIS HAPPENED? HE WAS REALLY ATTEMPTING TO GET TO THE VERACITY OF THE STORY. >> Reporter: STOCKWELL ALSO SAYS THERE'S LESS FOOTAGE OF THE PRESIDENT IN THE FINISHED CUT AS THERE WAS IN AN EARLIER VERSION. CONTACTED BY CNN, HARVEY WEINSTEIN REJECTED THE IDEA THAT THE FILM HAS A POLITICAL AGENDA, SAYING IT'S ABOUT HISTORY. KEN ROBINSON HAS BEEN IN BOTH WORLDS. A FORMER SPECIAL FORCES OFFICER, HE WAS CREATOR AND WRITER OF E RAN, AN NBC DRAMA ABOUT THE INNER WORKINGS OF THE PENTAGON. >> IN THE PRODUCTION OF MOVIES LIKE THIS, IS THERE OFTEN PRESSURE TO MAYBE PUT IN A POLITICAL SLANT, SUBTLE MAYBE? >> I HAVE NEVER SEEN THAT. I HAVE BEEN ON THE FOX LOT, THE WARNER LOT, THE PARAMOUNT LOT. I'VE NOT SEEN THAT. THE CREATIVE PROCESS IS PRETTY PRIZED. >> THE TIMING OF THE FILM'S RELEASE ON NOVEMBER 4th STILL RANKLES SOME CONSERVATIVES WHO HAS THIS SUGGESTION. >> IT DOESN'T HAVE A POLITICAL POSITION, AS THEY SAY IT DOESN'T, THEN SIMPLY PUT IT OFF BY TWO DAYS. >> Reporter: NOW, IN RESPONSE TO THAT, A SPOKESPERSON FOR NATIONAL GEOGRAPHIC SAYS THEY HAVE TO AIR THIS MOVIE ON NOVEMBER 4th BECAUSE THEY HAVE TO GIVE IT TO NETFLIX BY NOVEMBER 5th. BOTH NATIONAL GEOGRAPHIC AND, AGAIN, THE FILMMAKERS DENY THERE WAS ANY POLITICAL MOTIVATION IN THIS MOVIE, SUZANNE. >> YOU MENTIONED THE PRODUCERS DECIDED CUT OUT SOME OF THE FOOTABLE FROM THE PRESIDENT AND, I GUESS THERE WAS ALSO SOME EDITING RARMING MITT ROMNEY AS WELL. CAN YOU EXPLAIN THAT? >> THAT'S RIGHT. THE DIRECTOR JOHN STOCKWELL SAYS THERE WAS A CLIP IN THERE OF MITT ROMNEY AT SOME POINT OPPOSING THE U.S. TAKING ACTION IN PAKISTAN TO GO AFTER BIN LADEN. THAT WAS PLANNED TO BE PART OF THE MOVIE, BUT THEY EDITED THAT OUT. THEY SAID FOR BALANCE AND ACCURACY AND THINGS LIKE THAT. THEY'RE CLAIMING THAT EVERY EDIT THEY MADE WAS REALLY FOR HISTORICAL ACCURACY AND NOT FOR POLITICAL PURPOSES. >> ALL RIGHT. BRIAN, THANK YOU. APPRECIATE IT. >>> PRESIDENT OBAMA DOESN'T HOLD BACK IN AN INTERVIEW IN "ROLLING STONE MAGAZINE." IT HITS THE STAND TOMORROW, BUT POLITICO GAVE US A SNEAK PEEK GIVING US CANDID MOMENTS BETWEEN THE PRESIDENT AND ERIC BAITS WHEN BAITS TELLS THE PRESIDENT THAT HIS 6-YEAR-OLD DAUGHTER IS ROOTING FOR HIM. HE GRINZ AND SAYS, YOU KNOW, KIDS HAVE GOOD INSTINCTS. THEY LOOK AT THE OTHER GUY AND SAY, WELL, THAT'S A BS'ER, I CAN TELL." YES, HE USED THE WHOLE WORD. >>> WE ARE NOW GOING TO BE TALKING TO THE MAN WHO CONDUCTED THE INTERVIEW. PRESIDENTIAL HISTORICAL DOUGLAS BRINKLEY WILL JOIN US TOMORROW NOON EASTERN TO TALK MORE ABOUT THAT INTERVIEW. AND WOMEN VOTERS COULD BE KEY IN THE VICTORY ON ELECTION DAY. WHAT IS GOING TO DO THE JOB TO WIN THEM OVER? MONEY. WE'RE GOING TO EXPLAIN HOW. I can't stop eating 'em! What's...that... on your head? Can curlers! Tomato Basil, Potato with bacon... we've got a lot of empty cans. [ Male Announcer ] Progresso. You gotta taste this soup. [ Male Announcer ] Alka-Seltzer Plus PRESENTS THE COLD TRUTH. I HAVE A COLD, AND I TOOK NYQUIL, BUT I'M STILL STUBBED UP. [ Male Announcer ] TRUTH IS, NYQUIL DOESN'T UNSTUFF YOUR NOSE. WHAT? [ Male Announcer ] IT DOESN'T HAVE A DECONGESTANT. NO WAY. [ Male Announcer ] SORRY. Alka-Seltzer Plus FIGHTS YOUR WORST COLD SYMPTOMS PLUS HAS A FAST-ACTING DECONGESTANT TO RELIEVE YOUR STUFFY NOSE. THANKS. [ Male Announcer ] YOU'RE WELCOME. THAT'S THE COLD TRUTH! [ Male Announcer ] Alka-Seltzer Plus. * OH WHAT A RELIEF IT IS! [ Male Announcer ] TRY NEW Alka-Seltzer Plus Severe Allergy TO TREAT ALLERGY SYMPTOMS PLUS SINUS CONGESTION AND PAIN. [ Ross ] IN THE TAIHANG MOUNTAINS OF CHINA, HAND-CARVED ON THE SIDE OF A CLIFF IS THE GUOLIANG TUNNEL. WHAT?! YOU'VE GOT TO BE KIDDING ME. [ Derek ] I'VE NEVER SEEN A ROAD LIKE THIS. THERE'S JAGGED ROCK ALL THE WAY AROUND. THIS IS REALLY GONNA TEST THE ATS ON ALL LEVELS. [ Derek ] THIS ROAD IS THE MOST UNEVEN SURFACE, AND IT GETS VERY NARROW. MAGNETIC RIDE CONTROL IS GOING TO BE WORKING HARD. THE SHOCK ABSORBERS REACT TO THE ROAD 1,000 TIMES A SECOND. IT KEEPS YOU FIRMLY IN CONTROL. WHOA! >>> PRESIDENTIAL CANDIDATES IN A FIERCE BATTLE FOR THE FEMALE VOTE. FOR 34 WOMEN IT IS ABOUT THE MONEY. A NEW STUDY BY THE AMERICAN ASSOCIATION OF WOMEN REVEALS THAT WOMEN EARN $8,000 LESS THAN MEN ONE YEAR AFTER GRADUATING FROM COLLEGE. AN EARNINGS GAP CONTINUES THROUGHOUT THEIR PROFESSIONAL CAREERS. KRISTEN IS CHAIRWOMAN AND ASSOCIATE PROFESSOR OF HISTORY AT FORDHAM UNIVERSITY. HER ACADEMIC WORK FOCUSSING ON WOMEN, CULTURE, AND WORK. IN AN OP ED PIECE FOR CNN.COM, SHE WRITSZ. S "WOMEN ARE THE VOTERS MOST LIKELY TO MATTER ON NOVEMBER 6th. THEY MAKE UP THE MAJORITY OF UNDECIDED VOTERS AND THEY OUTVOTE MEN." WELL, PROFESSOR, GOOD TO SEE YOU. THANK YOU. IT WAS VERY PROVOCATIVE AND A REFRESHING PIECE, REALLY, WHEN YOU LOOK AT IT BECAUSE ONE OF THE THINGS YOU TALK ABOUT IS THE PAYCHECK FAIRNESS ACT. HOW IMPORTANT THAT IS FOR BOTH OF THE CANDIDATES TO TALK ABOUT IT. >> WELL, I THINK IT COULD BE REALISTIC IF MADE THE CASE THAT PAYCHECK FAIRNESS HAS EVERYTHING TO ON WITH FAMILY WELL BEING. THAT PAY EQUITY IS NOT SIMPLY A GENDER EQUITY ISSUE, BUT THE PAY EQUITY IS SOMETHING THAT WOMEN NEED TO PROVIDE WELL BEING FOR THEIR FAMILIES. WOMEN ARE BREAD WINNERS AND CO-BREAD WINNERS IN TWO-THIRDS OF AMERICAN HOUSEHOLDS, AND WHEN THEY'RE MAKING $10,000 ON AVERAGE LESS PER A YEAR THAN THEIR MALE COUNTERPARTS, THOSE $10,000 HIT THE FAMILY POCKETBOOK, AND THAT MEANS LESS HEALTH CARE, LESS EDUCATION, LESS GOOD CHILD CARE, AND THOSE THINGS MATTER TO WOMEN'S DAILY LIVES. >> SURE. >> YOU ALSO TALK ABOUT A COUPLE OF OTHER THINGS THAT YOU MENTIONED THAT YOUR STUDENTS TALK ABOUT, AND THAT IS WORKPLACE FLEXIBILITY AND PAID SICK DAYS. >> WATCHING PARENTS DEAL WITH THE SQUEEZE ON TIME. THEY'VE WATCHED THEIR PARENTS DEAL WITH BALANCING FAMILY AND EARNINGS, AND THEY WANT GOOD ANSWERS. THEY WANT WAYS TO A SUSTAINABLE LIFE FOR THEMSELVES AND THEIR PARTNERS. IT DOESN'T REQUIRE THEM TO WAKE UP AT 4:00 IN THE MORNING EVERY DAY AND SQUEEZE IN A LOAD OF LAUNDRY AND RUSH OFF TO WORK. THEY WANT ANSWERS THAT CREATE WORKABLE LIVES FOR THEMSELVES AND FOR THEIR PARTNERS AND THEIR WHOLE FAMILIES. >> I WANT YOU TO LISTEN TO THIS HERE. THIS IS THE OBAMA CAMPAIGN QUIETLY THAT PUT OUT THIS AD. THIS IS DEALING WITH ROMNEY'S STAND ON ABORTION. I WANT YOU TO LISTEN. * >> EVEN WHEN LIFE BEGINS IN THAT HORRIBLE SITUATION OF RAPE THAT IT IS SOMETHING THAT GOD INTENDED TO HAPPEN. >> WHEN IT COMES TO RAPE, SHOULD IT BE LEGAL FOR A WOMAN TO BE ABLE TO GET AN ABORTION? >> WELL, SO I'M VERY PRO-LIFE, AND I HAVE ALWAYS ADOPTED THE IDEA THE POSITION THAT THE METHOD OF CONCEPTION DOESN'T CHANGE THE DEFINITION OF LIFE. >> SO, PROFESSOR, IN LIGHT OF YOUR EMPHASIS ON THE STATE OF THE ECONOMY, HOW IMPORTANT THAT IS TO WOMEN, ARE THESE TYPE OF ADS DEALING WITH ABORTION, DEALING WITH RAPE, ARE THEY EFFECTIVE? >> I THINK THEY'RE EFFECTIVE IN ONE SENSE. IN THE SENSE THAT IT'S VERY CLEAR THAT THE ISSUE OF REPRODUCTIVE RIGHTS IS KIND OF FUNDAMENTAL TO THE WOMEN I SEE IN MY CLASSROOM, TO THEIR SENSE OF EQUITY AND THEIR PROSPECTS FOR THEIR FUTURE LIFE. BUT ABORTION ALONE ISN'T THE ANSWER TO THE PROBLEM. THEY SEE REPRODUCTIVE RIGHTS AS LINKED TO A LARGER VISION FOR THEMSELVES FAMILIES THAT THEY WANT TO BRING UP. YOU KNOW, IT'S NOT ENOUGH TO TALK ABOUT ABORTION. WHAT I SEE MY STUDENTS WANTING IS A FAR MORE COMPLICATED CONVERSATION ABOUT WHAT WOMEN CARE ABOUT. THANK YOU SO MUCH FOR GOING BEYOND THE TALKING POINTS. IT'S REFRESHING TO THIS CONVERSATION. WE'LL BRING YOU BACK ON AS WELL. THANKS AGAIN. >> OKAY. MY PLEASURE TO BE HERE. THANK FOR HAVING ME. >> THANK YOU. >>> PRESIDENT OBAMA AND PAUL RYAN BOTH FIGHTING FOR VIRGINIA VOTERS TODAY. WE'RE GOING TO TELL YOU WHAT'S ON THE LINE. * >>> THE PRESIDENT IS CAMPAIGNING IN VIRGINIA TODAY. SO IS REPUBLICAN VICE PRESIDENTIAL CANDIDATE PAUL RYAN. WHY ALL THE LOVE FOR VIRGINIA? THIS STATE HAS 13 ELECTORAL VOTES AND WAS A REPUBLICAN STRONGHOLD UNTIL BARACK OBAMA, THE PRESIDENT, CARRIED THE STATE FOUR YEARS ARK BUT NEITHER PARTY CAN ASSUME ANYTHING HEADING INTO THE ELECTION. OUR CHIEF NATIONAL CORRESPONDENT JOHN KING EXPLAINS WHY. >> Reporter: YOU KNOW, IN TEN STRAIGHT PRESIDENTIAL ELECTIONS VIRGINIA HAD BEEN RELIABLY RED, AND THEN 2008 CAME ALONG. YOU SEE IT BLUE FOR PRESIDENT OBAMA. LET'S POP IT UP BECAUSE I WANT TO SHOW YOU SOMETHING. SEE WHERE I JUST DREW IN? THE NORTHERN VIRGINIA SUBURBS. EVERYWHERE ELSE IN THE STATE JOHN McCAIN AND BARACK OBAMA RAN EVEN. THE PRESIDENT'S BIG MARGIN WAS 234,000 VOTES STATEWIDE. ALL OF THIS CAME FROM RIGHT HERE. >> 12615. >> Reporter: URGENCY IN A PLACE THAT ONCE WAS RELIABLY RED. >> Reporter: MITT ROMNEY'S PATH TO THE WHITE HOUSE RUNS THROUGH VIRGINIA AND TO WIN IT HE MUST RUN STRONG IN THE FAST-CHANGING SUBURBS WITHIN AN HOUR'S DRIVE OF WASHINGTON. >> IT'S ALL ABOUT NORTHERN VIRGINIA. THERE HAVE BEEN SO MANY PEOPLE WHO MOVED INTO NORTHERN VIRGINIA, PARTICULARLY FROM THE NORTHEAST, FROM DEMOCRATIC AREAS, THAT THEY HAVE TURNED A SOLID RED STATE INTO A PURPLE STATE. >> Reporter: RECENT POLLS SHOW A DEAD HEAT. REPUBLICAN POLLSTER WIT AIRS LIKES THE TREND LINE. >> IF YOU LOOK AT THE DOZEN POLLS IN VIRGINIA TAKEN BEFORE THE FIRST PRESIDENTIAL DEBATE ON OCTOBER 3rd, OBAMA WAS AHEAD IN ALL 12. IF YOU LOOK AT THE EIGHT POLLS TAKEN AFTER THE FIRST PRESIDENTIAL DEBATE, ROMNEY WAS AHEAD IN SIX OUT OF THE EIGHT, AND IT'S NOW A DEAD EVEN TIE. >> Reporter: TO PROVE ITS 2008 WIN HERE WAS NO FLUKE, PRESIDENT OBAMA'S TEAM NEEDS TO RUN UP THE VOTES IN THE NORTHERN VIRGINIA SUBURBS. IF IT DELIVERS, IT CAN RUIN GOVERNOR ROMNEY'S NIGHT BEFORE THE POLLS EVEN CLOSE IN THE MIDWEST. >> THE EPICENTER OF THIS OUTCOME IS GOING TO BE RIGHT HERE IN VIRGINIA. >> Reporter: DEMOCRATIC CONGRESSMAN JERRY CONLEY KNOWS THE MORE MODERATE TONE OF LATE FOR MITT ROMNEY IS AIMED AT THE SUBURBS. HE IS BET IT WON'T WORK. >> I THINK THERE'S A TRUST FACTOR. MY CONSTITUENTS REMEMBER THE REPUBLICAN PRIMARIES. THEY DON'T SUFFER FROM AMNESIA, AND I THINK THAT'S A TOUGH SUBJECT FOR MITT ROMNEY. >> Reporter: A LUNCHTIME VISIT TO HAROLD AND CATHY'S SHOWS THAT -- THERE ARE SOME CRACKS. THIS WOMAN IS A REGISTERED DEMOCRAT BUT SAID SHE WILL VOTE REPUBLICAN FOR PRESIDENT AS SHE DID LAST TIME. >> I'M FROM A THE GET GO MR. OBAMA PROMISED SO MANY THINGS THAT I DIDN'T BELIEVE HE COULD DO IT, AND HE HAS PROVEN THAT HE COULDN'T DO IT. >> Reporter: ROBERT STEVENS AN INDEPENDENT AND OBAMA 2008 SUPPORTER. >> IT WAS SOMETHING DIFFERENT FOR THE COUNTRY, SOMETHING THAT HADN'T HAPPENED BEFORE, ELECTING A BLACK PRESIDENT, SO I WAS CAUGHT UP IN THAT A LITTLE BIT. I THINK HE IS A DISAPPOINTMENT. >> Reporter: YOU DON'T LIKE WHAT YOU GOT, BUT YOU'RE NOT SOLD ON THE ALTERNATIVE? >> ABSOLUTELY NOT. AT THIS POINT I DON'T KNOW WHO I'M GOING TO VOTE FOR. >> Reporter: IN A PLACE LONG KNOWN FOR ITS HISTORIC BATTLE FIELDS, BUT A NEWCOMETORY THE WORLD OF PRESIDENTIAL BATTLE GROUNDS. >> WHERE JOHN KING SAYS THE KEY IN THE FINAL DAYS BOTH PARTIES HAVE FOCUSED ON THE EARLY VOTING AND REGISTERING THOSE NEW VOTERS AS WELL. >>> THE RACE FOR THE WHITE HOUSE ISN'T THE ONLY BIG ELECTION BATTLE. WE'RE TALKING ABOUT KEY SEATS IN CONGRESS ALSO UP FOR GRABS. THE OUTCOME OF THOSE RACES COULD SHIFT THE BALANCE OF POWER, AND THE DEMOCRATS MAJORITY IN THE SENATE, ESPECIALLY VULNERABLE. TED ROLANDS TAKES A LOOK AT ONE PIERCE FIGHT IN WISCONSIN WES. >> HERE IN WISCONSIN IT IS KNOWN AS THE SENATE RACE BETWEEN TAMMY AND TOMMY. IT HAS BEEN CONTENTIOUS, AND IT IS EXTREMELY CLOSE. >> AE 14-YEAR VETERAN OF THE HOUSE OF REPRESENTATIVES. UP FOR GRABS IS THE SENATE SEAT LEFT OPEN BY RETIRING DEMOCRAT HERB COLE, WHICH REPUBLICANS DESPERATELY WANT TO HELP THEM WIN A MAJORITY. >> I AM TOMMY THOMPSON ZSH I'M TAMMY BALDWIN. >> Reporter: BOTH SIDES ARE POURING IN CASH. STATE RECORD $40 MILLION HAS BEEN SPENT SO FAR ON THIS ELECTION. ALMOST THREE-FOURTHS OF IT COMING FROM GROUPS NOT DIRECTLY ASSOCIATED WITH THE CANDIDATE, BUT ARE VERY INTERESTED IN THE OUTCOME. >> YOU CAN'T TURN ON YOUR TV RIGHT NOW WITHOUT RUNNING INTO ADS FOR TAMMY AND TOMMY. >> Reporter: DANIEL BICE HAS BEEN COVERING WISCONSIN POLITICS FOR MORE THAN 20 YEARS. THIS RACE HE SAYS IS ALL ABOUT ATTACKING THE OPPONENT. >> NO LONGER SUPPORTS THE INTEREST OF WISCONSIN. HE IS TRYING TO DEFINE HER NOT AS THE NICE TAMMY BALDWIN YOU SEE ON TV, BUT AS AN EXTREME LIBERAL WHO VOTES IN A WAY THAT PEOPLE IN WISCONSIN WOULD NOT SUPPORT. >>> EACH AGREE EACH CANDIDATE HAS A WIN. POLLS CONDUCTED BY MARK KENT LAW SCHOOL HAVE SHOWN THEM BOTH AHEAD AT TIMES, BUT NOW -- >> RIGHT NOW WE'RE AT A TIED RACE. IT'S NECK AND NECK. THE PRESIDENTIAL RACE IS ALSO LOS HERE. MANY BELIEVE IT WILL BE VERY DIFFICULT FOR TOMMY THOMPSON TO WIN IF MITT ROMNEY DOESN'T. >> YOU DON'T HAVE AS MANY TICKET SPLITTERS AS I THINK THOMPSON CAMPAIGN THOUGHT YOU MIGHT HAVE HAD. >> Reporter: WHAT YOU DO HAVE IS A SMALL PERCENTAGE OF UNDECIDEDS WHOSE VOTES WILL LIKELY DETERMINE THE WINNERS IN BOTH THE PRESIDENTIAL AND SENATE RACES. >> AND BOTH CANDIDATES WILL HAVE AN OPPORTUNITY TO GRAB SOME OF THOSE UNDECIDED VOTERS ON FRIDAY WHEN THEY SQUARE OFF FOR THE THEIR THIRD AND FINAL DEBATE. >> HURRICANE SANDY COULD HIT THE EAST COAST. TWO PEOPLE HAVE ALREADY DIED IN THE STORM. WE'RE ABOUT TO GET THE VERY LATEST. AT SHELL, WE BELIEVE THE WORLD NEEDS A BROADER MIX OF ENERGIES. THAT'S WHY WE'RE SUPPLYING NATURAL GAS TO GENERATE CLEANER ELECTRICITY... THAT HAS AROUND 50% FEWER CO2 EMISSIONS THAN COAL. AND IT'S ALSO WHY, WITH OUR PARTNER IN BRAZIL, SHELL IS PRODUCING ETHANOL - A BIOFUEL MADE FROM RENEWABLE SUGARCANE. >>A MINUTE, MOM! LET'S BROADEN THE WORLD'S ENERGY MIX. LET'S GO. ALLY BANK. WHY THEY'RE ALWAYS THERE TO TALK. I LOVE YOU, JAMES. DON'T YOU LOVE ME? I'M A ROBOT. I KNOW. I KNOW YOU'RE A ROBOT! BUT THERE'S MORE IN YOU THAN JUST CIRCUITS AND WIRES! UHHH. (CRIES) A MACHINE CAN'T GIVE YOU WHAT A PERSON CAN. THAT'S WHY ALLY HAS KNOWLEDGEABLE PEOPLE THERE FOR YOU, NIGHT AND DAY. ALLY BANK. YOUR MONEY NEEDS AN ALLY. >>> HURRICANE SANDY GAINING STRENGTH MOVING QUICKLY ACROSS THE WARM WATERS OF THE CARIBBEAN SEA TOWARDS THE BAHAMAS. NOW, THE STORM SLAMMED INTO SOUTHEASTERN CUBA. THAT HAPPENS EARLY TODAY AS A CATEGORY TWO HURRICANE WITH WINDS 10 MILES PER HOUR. TREES ARE DOWN. POWER IS OUT ACROSS PARTS OF CUBA. THE LATE SEASON STORM ALSO BROUGHT HEAVY RAIN TO CUBA'S CAPITAL, HAVAN, I CAN'T, AND SANDY FLOODED STREETS, DAMAGED HOMES, AND CAUSED WIDESPREAD POWER OUTAGES. AT LEAST ONE PERSON WAS KILLED NEAR KINGSTON. ANOTHER HAS DIED IN HAITI. I WANT TO BRING IN CHAD MYERS TO TALK ABOUT THIS TRACKING THE STORM. IS IT HEADING TO THE UNITED STATES? WHAT IS THE PATH, AND HOW SEVERE COULD THIS BE? >> IT APPEARS, YES, IT WILL HIT SOME PART OF THE EAST COAST OF NORTH AMERICA. THAT INCLUDES CANADA. IT COULD SLIDE ALL THE WAY UP TO ATLANTIC CANADA AND NOVA SKOECHA AND NEWFOUNDLAND. IT COULD HIT AS FAR SOUTH AS THE CAROLINAS. THAT'S A HUGE WINDOW WE HAVE NOW. THE CONE IS STILL VERY WIDE BECAUSE THE COMPUTER MODELS ARE STILL NOT AGREEING. 105-MILE-PER-HOUR STORM. I SAW WIND GUSTS ON CUES CUBA. 118 OVERNIGHT. IT DIED A LITTLE BIT AS IT WENT OVER CUBA. THAT'S ALWAYS THE CASE. THESE STORMS GET BIGGER WHEN THEY'RE OVER WATER. IT'S NOW OVER WATER AGAIN. IT IS STILL GOING TO GET BIGGER AS LONG AS IT STAYS IN THE WARM WATER, AND, YES, THERE MAY BE SOME LAND IN THE BAHAMAS, BUT THERE'S MORE WATER THAN LAND. A CATEGORY ONE HURRICANE OFF THE EAST COAST MAKING TREMENDOUS WAVE ACTION HERE. JUST WAVES COMING ON SHORE. ERODING THE BEACHES, MAKING HUGE REP CURRENTS. DON'T BE IN THE WATER AT ALL. THEY ARE GOING TO BE AS BAD AS WE'VE SEEN ALL YEAR LONG. ALL THE MODELS YESTERDAY, EXCEPT FOR A COUPLE, HAD THEM DOING THIS. THEN ONE IS OVER HERE, AND ANOTHER -- NOW ALL THOSE MODEL ADVISORY ALL CHANGED THEIR MIND THAT WERE GOING THAT WAY, AND NOW THEY ARE COMING BACK. WILL IT BE NEW YORK CITY? YOU KNOW, PROBABLY NOT, BECAUSE EVEN THOUGH THAT'S THE MIDDLE OF THE CONE, THE CONE GOES ALL THE WAY FROM MAINE TO THE CAROLINAS. THERE'S A FORECAST FOR A SIGNIFICANT STORM WHEN IT MAKES LANDFALL, IT COULD BE VERY, VERY LARGE. LET ME SHOW YOU THESE MODELS. WE DON'T HAVE MUCH TIME LEFT. LET ME GIVE YOU AN IDEA. THE MODELS HERE, THE SPAGHETTI MODELS ARE ALL TURNING AWAY FROM NORTH AMERICA YESTERDAY. NOW THEY'RE ALL TURNING BACK TO NORTH AMERICA AND SETTING RIGHT ON TOP OF THE NORTHEAST. WHETHER WE GET SLAMMED BY A HURRICANE OR WHETHER THIS THING JUST SITS THERE AND SPINS FOR A FEW DAYS, THIS IS GOING TO HAVE A TREMENDOUS IMPACT ON THE NORTHEAST. MONTREAL, ATLANTIC CANADA ALL THE WAY DOWN TO WASHINGTON. I DON'T KNOW YET. THAT'S STILL FOUR TO FIVE DAYS AWAY. THIS WILL HAVE A TREMENDOUS IMPACT FOR MILLIONS OF PEOPLE THERE TRAVELING, TRYING TO GET OUT OF THERE IN A HURRICANE. 85-MILE-PER-HOUR WINDS WHATEVER THEY MAY BE. IT WILL BE VERY, VERY DIFFICULT COMING UP. THIS IS MONDAY AND TUESDAY BEFORE IT ACTUALLY GETS HERE. WE HAVE A COUPLE OF DAYS TO PREPARE. I DON'T WANT YOU TO PANIC. I WANT TO YOU PREPARE. >> SO, CHAD, EWE TALKING ABOUT THE WORST OF THIS HITTING SOMETIME MONDAY OR TUESDAY. PEOPLE HAVE THE WEEKEND TO ESSENTIALLY GET READY. >> YEAH. IT MATTERS WHERE YOU ARE BECAUSE IF IT HITS THE CAROLINAS, THAT WOULD BE MONDAY AND MAYBE EVEN SUNDAY NIGHT BECAUSE IT'S NOT VERY FAR OF A DRIVE FROM WHERE IT IS NOW. IF IT GOES ALL THE WAY UP TO HALIFAX, THAT'S A TWO-DAY TRIP IN THE WATER. THAT WOULD BE WEDNESDAY AND THEN SOMEWHERE IN HERE PROBABLY TUESDAY MORNING IF IT DOES TRY TO MAKE ITS WAY TO THE NEXT -- >> WE'LL BE WATCHING REAL CLOSELY. THANK YOU VERY MUCH. APPRECIATE IT. >> LADY LIBERTY GOT SOME WORK DONE AFTER YEARS OF RENOVATIONS. THE STATUE IS ABOUT TO REOPEN NOW TO THE PUBLIC. WE'RE GOING TO GET AN INSIDE LOOK. UP NEXT. EED. WHEN A TWINGE OF BACK PAIN SURPRISES HIM. MORNING STARTS IN HIGH SPIRITS, BUT THERE'S A GROWING PAIN IN HIS LOWER BACK. AS LINES GROW LONGER, HIS PAIN CONTINUES TO LINGER. BUT AFTER A LONG DAY OF HELPING OTHERS, HE GETS SOME HELPFUL ADVICE. JUST TWO Aleve HAVE THE STRENGTH TO KEEP BACK PAIN AWAY ALL DAY. TODAY, JASON CHOSE Aleve. JUST TWO PILLS FOR ALL DAY PAIN RELIEF. TRY Aleve D FOR STRONG, ALL DAY LONG SINUS AND HEADACHE RELIEF. JACK, YOU'RE A LITTLE BORING. BORING. BORING. [ Jack ] AFTER LAUREN BROKE UP WITH ME, I WENT TO THE CITI PRIVATE PASS PAGE AND DECIDED TO BE...NOT BORING. THAT'S HOW I MET MARILYN... GIADA... REALLY GOOD. YES! [ Jack ] ...AND ALICIA. * THIS GIRL IS ON FIRE [ Male Announcer ] USE ANY CITI¨ CARD TO GET THE BENEFITS OF PRIVATE PASS. MORE CONCERTS. MORE EVENTS. MORE EXPERIENCES. [ Jack ] HEY, WHO'S BORING NOW? [ Male Announcer ] GET MORE ACCESS WITH A CITI CARD. [ crowd cheering, mouse clicks ] WHAT IF THERE WAS A NEW WAY TO DEAL WITH MONEY THAT FOCUSED LESS ON FEES AND MORE... ON WHAT MATTERS? MAYBE YOUR BANK ACCOUNT IS TAKING TOO MUCH TIME AND MAYBE IT'S COSTING TOO MUCH MONEY. INTRODUCING BLUEBIRD BY AMERICAN EXPRESS AND WALMART. YOUR ALTERNATIVE TO CHECKING AND DEBIT. IT'S LOADED WITH FEATURES, NOT FEES. BECAUSE WE THINK YOUR MONEY SHOULD STAY WHERE IT BELONGS. WITH YOU. THE VALUE YOU EXPECT. THE SERVICE YOU DESERVE. IT FEELS GOOD TO BLUEBIRD. >>> IF YOU'RE TRYING TO VIZ -- STATUE OF LIBERTY THIS PAST YEAR YOU WERE PROBABLY DISAPPOINTED. IT'S BEEN CLOSED FOR MILLIONS OF DOLLARS IN UPGRADES BUT REPORTING THAT IT REOPENS SUNDAY AND THE WAIT MIGHT BE WORTH IT. ESPECIALLY FOR THE WHEELCHAIR BOUND. CHECK IT OUT. * >> Reporter: THE STATUE OF LIBERTY'S CROWN AND INTERIOR HAVE BEEN CLOSED FOR A YEAR BUT FOR RETIRED MARINE CORPS LARRY HUGHES IT'S SEEMINGLY LONGER BECAUSE THE OBSERVATION LEVEL OF THIS ICONIC SYMBOL OF FREEDOM WAS NOT WHEELCHAIR ACCESSIBLE UNTIL TODAY. >> WOW! >> HOW'S THE RIDE? >> AMAZING. >> Reporter: HUGHES, A VIETNAM VET IS TAKING THE INAUGURAL RIDE IN A NEWLY INSTALLED ELEVATOR. >> JUST TO BE HERE WAS SOMETHING THAT NEVER REALLY ENTERED IN TO MY MIND BECAUSE SIMPLY I HATE TO BE TURNED DOWN. I HATE TO BE REJECTED. SO, I'M NO LONGER BEING REJECTED. I'M BEING HERE. >> Reporter: THE NEWELL VA OR THE IS JUST PART OF A YEARLONG $30 MILLION RENOVATION WITH UPGRADING STAIRWELLS AND SAFELY IMPROVEME IMPROVEMENTS. THE END RESULT, A MORE ACCESSIBLE LADY LIBERTY TO ALLOW AN ADDITIONAL 26,000 VISITORS EACH YEAR A CHANCE TO ENJOY HER SPECTACULAR VIEWS. >> IT OPENS UP TREMENDOUS OPPORTUNITIES FOR ALL OF US. >> Reporter: AMONG THE FIRST TO SEE THE NEW RENOVATIONS, TWO GENERATIONS OF WOUNDED WARRIORS. I JOINED KIRK BAUER WHO LOST HIS NA LEG IN VIETNAM AND JESSE ACOSTA WHO SUFFERED INJURIES TO HIP IN IRAQ. ON THE 146-STEP CLIMB TO THE TOP. SO YOU STUCK YOUR HEAD OUT OF -- >> THE CROWN! >> Reporter: THE CROWN. VERY COOL. WHAT DO YOU THINK? IS THIS WHAT YOU'RE EXPECTED? >> FANTASTIC. IT IS MORE TIGHT BUTS IN JUST INCREDIBLE VIEW. >> Reporter: THE RENOVATION WAS FULL OF CHALLENGES BECAUSE OF THE STATUE'S LOCATION AND BECAUSE THEY HAD TO DO IT ALL WITHOUT DRILLING IN TO ANY PART OF THE HISTORIC STRUCTURE. >> IT WAS A CHALLENGE, A HUGE CHALLENGE BECAUSE WE HAD TO ENVISION ALL OF THIS, MAKE THIS BUILDING MORE SAFE, MORE CODE COMPLIANT, MORE ACCESSIBLE, MORE WELCOMING AND DO IT IN A WAY THAT RESPECTED THE HISTORIC FABRIC. >> IT IS IMPRESSIVE THAT THEY DID. TO SEE THE INVEST INDEPENDENT A WORLD HERITAGE SITE, TO ALLOW THOSE WITH PERCEIVED DISABILITIES, THOSE THAT NEED ACCESS TO SEE THE HISTORICAL SITES TO SEE IT, TOUCH IT THAT MUCH CLOSER. >> HAVE YOU BEEN DOWN HERE? >> Reporter: FOR THE SUPERINTENDENT WHO'S LIVED ON LIBERTY ISLAND FOR MORE THAN THREE YEARS, THIS MOMENT AMONG THE MOST MEMORABLE. >> TO BE ABLE TO WELCOME OUR VETERANS HOME AND WELCOME THEM HERE AND ACTUALLY GET VETERANS UP IN TO THE CROWN AND UP IN TO THE OBSERVATION DECK IS JUST AMAZING. >> Reporter: GRATEFUL CONSTRUCTION WORKERS SALUTING AMERICA'S HEROES ON THEIR HISTORIC VISIT. >> WE WANT TO GIVE YOU A TOKEN OF THANKS FIRST FOR COMING OUT AND VISITING WITH US BUT MOST IMPORTANTLY FOR THE SERVICE AND THE DEDICATION THAT YOU'VE DONE FOR OUR COUNTRY. >> THEY WERE THANKING US. WE SHOULD BE THANKING THEM BECAUSE THEY'RE THE ONE THAT IS ARE MAKING IT POSSIBLE. THEY'RE THE ONES, THE HANDS THAT MADE THIS MONUMENT OPEN TO EVERYONE INCLUDING THOSE WITH DISABILITIES. >> Reporter: A RESTORED LADY LIBERTY, TRULY REPRESENTING A SYMBOL OF FREEDOM TO ENJOY. >> THAT'S BEAUTIFUL. >>> PRESIDENT OBAMA, HE SAT DOWN WITH JAY LENO LAST NIGHT. HE WASN'T FRAID TO MAKE FUN OF HIMSELF, AS WELL. NYQUIL (STUFFY): HEY, TYLENOL. YOU KNOW WE'RE KINDA LIKE TWINS. TYLENOL: WE ARE? NYQUIL (STUFFY): YEAH, WE BOTH RELIEVE COUGHS, SNEEZING, ACHES, FEVERS. TYLENOL: AND I RELIEVE NASAL CONGESTION. NYQUIL (STUFFY): OVERACHIEVER. ANNCR VO: TYLENOL COLD MULTI-SYMPTOM NIGHTTIME RELIEVES NASAL CONGESTION... NYQUIL COLD & FLU DOESN'T. AMERICANS ARE ALWAYS READY TO WORK HARD FOR A BETTER FUTURE. SINCE AMERIPRISE FINANCIAL WAS FOUNDED BACK IN 1894, THEY'VE BEEN COMMITTED TO PUTTING CLIENTS FIRST. HELPING GENERATIONS THROUGH TOUGH TIMES. GOOD TIMES. NEVER TAKING A BAILOUT. THERE WHEN YOU NEED THEM. HELPING MILLIONS OF AMERICANS OVER THE CENTURIES. THE STRENGTH OF A GLOBAL FINANCIAL LEADER. THE HEART OF A ONE-TO-ONE RELATIONSHIP. TOGETHER FOR YOUR FUTURE. * [ Woman ] Ring. Ring. Progresso. I just served my mother-in-law your Chicken Noodle soup but she loved it so much... I told her it was homemade. Everyone tells a little white lie now and then. But now she wants my recipe [ clears his throat ] [ softly ] She's right behind me isn't she? [ Male Announcer ] Progresso. You gotta taste this soup. >>> TAKE A LOOK AT WHAT CAUGHT OUR EYE ON TWI> THIS DATES BACK TO WHEN WE WERE GROWING UP TOGETHER IN KENYA. >> YEAH. GOT TO GIVE YOU THAT ONE. GOT TO GIVE YOU THAT ONE. >> WE HAD -- YOU KNOW, CONSTANT RUN-INS ON THE SOCCER FIELD. >> YEAH. >> YOU KNOW? HE WASN'T VERY GOOD. >> RIGHT, RIGHT. >> RESENTED IT. >> YEAH, YEAH. >> WHEN WE FINALLY MOVED TO AMERICA I THOUGHT IT WOULD BE OVER. >> NO, NO. >> GOOD SENSE OF HUMOR ABOUT IT ALL TOO. HI, BROOKE. >> HI, SUZANNE, HI, EVERYBODY. HUGE SHOW FOR YOU ON THIS THURSDAY. WE'RE WATCHING HURRICANE SANDY. IT'S BARRELLING NORTH RIGHT NOW. THE MID-ATLANTIC REALLY IN THE BULL'S EYE ZONE FOR THIS WEEK. IN A MOMENT, THE NEWS UPDATE. ALSO, DEFENSE SECRETARY PANETTA ALONG WITH THE CHAIRMAN OF THE JOINT CHIEFS SET TO ADDRESS REPORTERS AT THE PENTAGON. WE'RE THERE. WE'RE LISTENING. WE'LL SEE IF THE NEW DEVELOPMENTS ON THE BENGHAZI ATTACK COME UP. >>> FIRST, WE TALK POLITICS AN THE FIRST THING TO TELL YOU THIS HOUR IS THAT MITT ROMNEY RAISING A BOATLOAD OF CASH. A BOATLOAD OF CASH FOR THE SPRINT TO NOVEMBER 6th. $112 MILLION JUST IN THE FIRST HALF OF OCTOBER ALONE. $112 MILLION. AT LEAST THIS IS WHAT THE CAMPAIGN SAID THIS MORNING. JUST TO COMPARE THIS NUMBER FOR YOU, THE ROMNEY EFFORT COLLECTED $170 MILLION FOR THE ENTIRE MONTH OF SEPTEMBER WHEN THE PRESIDENT BEAT HIM BY $11 MILLION THERE. WANT TO LISTEN QUICKLY TO MITT ROMNEY. HE WAS SPEAKING THIS MORNING IN CINCINNATI. >> YOU KNOW SOMETHING'S WRONG ABOUT THE DIRECTION WE'RE HEADED RIGHT NOW. YOU KNOW THAT WE DON'T WANT TO KEEP GOING IN THE SAME PATH WE'VE BEEN ON FOR FOUR YEARS. YOU KNOW WE CAN'T AFFORD FOUR MORE YEARS LIKE THE LAST FOUR YEARS. YOU WANT -- I MEAN, DO YOU WANT REAL BIG CHANGE IN THIS COUNTRY? WELL, YOU'RE GOING TO GET IT ON NOVEMBER 6th. YOU'RE GOING TO MAKE IT HAPPEN. WE'LL GET AMERICA ON TRACK AGAIN. >> ROMNEY BLITZING OHIO TODAY. HEARING FROM HIM LATER THIS HOUR LIVE SPEAKING TO A TOWN OUTSIDE OF COLUMBUS. MEANTIME, PRESIDENT OBAMA AY TWO OF HIS EIGHT-STATE TOUR. HERE E IS ARRIVING IN RICHMOND, VIRGINIA. THIS IS JUST EARLIER THIS AFTERNOON. SPEAKING OF RICHMOND, VIRGINIA, THIS IS WHERE WE FIND JESSICA YELLIN. SHE'S ON THE PHONE WITH US FROM THE BUS. SO JESSICA HERE, FOUR MORE STATES FOR THE PRESIDENT TODAY. AFTER FOUR STATES YESTERDAY. LET'S TALK ABOUT THE PACE THE PRESIDENT'S KEEPING. KEEPING IT UP FOR 12 DAYS UNTIL NOVEMBER 6th? >> Reporter: NO. NOT CONTINUOUSLY. I DON'T THINK ANY OF US COULD DO THAT. WE WERE CLEARED EARLY. I WAS SUPPOSED TO BE ON CAMERA FOR YOU AND THEY SAID WE'RE GOING. SO WE ARE ON OUR WAY NOW TO OHIO. I'M HAVING A LITTLE BIT OF YELLINESIA AND CAST HIMSELF IN CHICAGO AND THEN, BROOKE, THE PRESIDENT WILL HEAD BC TO THE WHITE HOUSE AND HAVE A IT OF A REST. AND THEN HE HITS THE TRAIL AGAIN. HE DID HAVE A BIT OF A BOUNCE TODAY, A BIT OF GOOD NEWS FOR HIMSELF WHEN HE GOT AN UNEXPECTED ENDORSEMENT WITH NO FOREWARNING FROM GENERAL COLIN POWELL. HE LEARNED ABOUT IT WHEN THE REST OF THE WORLD DID WITH THIS ANNOUNCEMENT. LISTEN TO THIS. >> I WAS PROUD AND HUMBLED TO LEARN THAT WE HAVE COLIN POWELL'S SUPPORT IN THIS CAMPAIGN. I'M GRATEFUL TO HIM FOR HIS LIFETIME OF SERVICE TO HIS COUNTRY BOTH AS A SOLDIER AND A DIPLOMAT AND EVERY BRAVE AMERICAN WHO WEARS THIS UNIFORM OF THIS COUNTRY SHOULD KNOW THAT AS LONG AS I'M YOUR COMMANDER IN CHIEF WE'LL SUSTAIN THE STRONGEST MILITARY THE WORLD HAS EVER KNOWN. >> Reporter: SO, NOW LET'S BE HONEST. HIS STRATEGY IS ENDORSEMENTS DON'T MOVE VOTES AND WON'T APPLY HERE BUT THE REASON IT MIGHT BE HELPFUL TO THE PRESIDENT, BROOKE, IS BECAUSE THE WAY POWELL ENDORSED THE PRESIDENT IS ECHOED OF THE SAME THINGS THE PRESIDENT IS SAYING ABOUT MITT ROMNEY, CHANGING THE POSITIONS SO THAT COULD BE A HELPFUL THING FOR THE PRESIDENT TO REITERATE ON THE TRAIL, BROOKE. >> NOW THAT HE HAS COLIN POWELL'S ENDORSEMENT LOCKED UP, THE LATEST NUMBERS OF THE CNN POLL OF POLLS AND WE LOOK AT THIS. 47%, 47%. THIS IS DEAD EVEN. JUST YESTERDAY, WE HAD JUST  ONE-POINT SPREAD IN FAVOR OF ROMNEY. IS THERE ANY WORRY, JESSICA, JUST WITHIN THE CAMPAIGN THAT THE TRAVEL, THE SPEAKING AND SOUNDED LIKE THE PRESIDENT LOSING HIS VOICE A BIT, RUNNING FOR RE-ELECTION COULD PERHAPS CREATE AN IMPRESSION THAT THE PRESIDENT IS RUNNING FROM BEHIND? >> Reporter: WELL, THEY -- YOU KNOW, KNOW THAT THAT'S A NARRATIVE IN THE MEDIA TO SOME EXTENT AND TALK TO US ABOUT BLUFF TO ALL THIS MOMENTUM. THEY THINK THAT ROMNEY MOMENTUM. BUT THEY POINT OUT THAT THEY THINK IF YOU LOOK AT THE STATES THEY THINK THAT THE MATH ADDS UP FOR THE PRESIDENT. AND THOSE POLLS, NATIONAL POLLS, LOOKING AT THE STATES THERE'S STILL A DOGFIGHT IN THE STATES AND THE PRESIDENT IS ON THE TRAIL RIGHT NOW. IT'S VERY CLEAR BECAUSE HE'S GETTING OUT THE EARLY VOTE AND IT'S INTERESTING. YOU HIM AT EVERY STATE AND TELL THEM TO VOTE NOW. THERE WAS A BUS AT THE LAST ONE OF THE STOPS WE WERE IN AT ANOTHER STATE SAYING, GET IN THE VAN AND DRIVE YOU TO DO YOUR -- CAST YOUR EARLY VOTE AND WHAT THIS IS REALLY ABOUT. THEY FEEL LIKE THE ORGANIZATION TO MOVE AND MEASURE THE EARLY VOTERS SO IT'S A WHOLE DIFFERENT BALL GAME THIS YEAR WHERE YOU CAN REALLY MEASURE THAT KIND OF MOVEMENT, BROOKE. >> OKAY. JESSICA YELLIN ON THE BUS BETWEEN VIRGINIA AND OHIO, WE APPRECIATE THAT. WE JUST MENTIONED THIS ENDORSEMENT OF COLLIN POWELL. THE PRESIDENT DIDN'T ASK FOR THAT ENDORSEMENT AND NO DOUBT HE'S GLAD HE GOT IT. HERE'S MORE OF WHAT COLIN POWELL TOLD CBS THIS MORNING ON WHY HE WON'T BE SUPPORTING MITT ROMNEY. >> NOT ONLY AM I NOT COMFORTABLE WITH WHAT GOVERNOR ROMNEY IS PROPOSING FOR HIS ECONOMIC PLAN, I HAVE CONCERNS ABOUT HIS VIEWS ON FOREIGN POLICY. THE GOVERNOR SPEAKING ON MONDAY NIGHT AT THE DEBATE WAS SAYING THINGS THAT WERE QUITE DIFFERENT FROM WHAT HE SAID EARLIER AND NOT SURE WHICH GOVERNOR ROMNEY WE WOULD BE GETTING WITH RESPECT TO FOREIGN POLICY. >> I WANT TO GO TO CNN POLITICAL CONTRIBUTOR JOHN AVALON ON A BUS AND, JOHN, WE KNOW THAT THIS ENDORSEMENT IS SIGNIFICANT. TELL ME WHY THIS IS SO SIGNIFICANT FOR TEAM OBAMA. >> BROOKE, NOT ONLY ENDORSEMENTS ARE EQUAL BUT COLIN POWELL'S IS ONE THAT MATTERS. HE WORKED FOR PRESIDENTS AND SECRETARIES OF GENERAL AND ENDORSED BARACK OBAMA IN 2008 AND IT WAS AN IMPORTANT SIGNIFY SIGNIFIER. A SIGN TO INDEPENDENT VOTERS THAT BARACK OBAMA COULD BE TRUSTED ON NATIONAL SECURITY. AND COLIN POWELL PLAYED THAT ROLE IN A LOT OF ELECTIONS. HE IS SORT OF A BAROMETER OF INDEPENDENT SUPPORT. WHO'S THE MOST RESPONSIBL CANDIDATE IN THE RACE? NOT SHY OF CRITICIZING PRESIDENT OBAMA IN THE COURSE OF THE TERM. AND SOME FOLKS THOUGHT HE MIGHT RETURN HOME AND ENDORSE MITT ROMNEY THIS TIME AROUND, PARTICULARLY WITH ROMNEY ATTEMPT TO RECENTER THE CAMPAIGN. THE FACT THAT THIS MORNING COLIN POWELL ENDORSED PRESIDENT OBAMA AGAIN IS ENORMOUSLY VALUABLE FOR PRESIDENT OBAMA IN THIS VERY TIGHT TOUGH RACE. THIS IS ONE ENDORSEMENT THAT MATTERS BIG TIME BECAUSE WHEN A REPUBLICAN ENDORSES YOU THAT'S A SIGN THAT PRESIDENT OBAMA STILL HAS THE POTENTIAL, THE CAPACITY TO BUILD CROSS AISLE COALITIONS AND SOMETHING TO DO NOT ONLY TO WIN THE ELECTION BUT TO GOMPB EFFECTIVELY IN A SECOND TERM. BROOKE? >> THANK YOU. >>> WE'LL HEAR THIS HOUR FROM MITT ROMNEY AS HE CRUISES ACROSS OHIO PROMISING BIG CHANGE TO VOTERS. CNN'S JIM ACOSTA WITH THE ROMNEY CAMPAIGN. JIM? >> Reporter: BROOKE, WITH THE POLLS SHOWING PRESIDENT OBAMA LEADING MITT ROMNEY BY A SLIM MARGIN HERE IN OHIO, THE GOP NOMINEE TRAVELING ACROSS THE STATE BY BUS IN THE HOPES OF CLOSING THAT GAP. ROMNEY KNOWS AND HIS CAMPAIGN KNOWS IF HE CAN BEAT OBAMA IN OHIO AS WELL AS SEVERAL OTHER BATTLEGROUND STATES HE COULD DELIVER A KNOCKOUT PUNCH TO THE PRESIDENT ON ELECTION DAY. HERE IN CINCINNATI, AND SEVERAL OTHER CAMPAIGN STOPS IN THE LAST 24 HOURS, ROMNEY REPACKAGING HIS STUMP SPEECH AS A CHOICE FOR AMERICAN FAMILIES AND HERE AT THE FIRST STOP, ON THIS BUS TOUR IN CINCINNATI, HE DEBUTED A NEW CATCH PHRASE FOR WHAT THE CAMPAIGN WOULD BRING TO THE COUNTRY. BIG CHANGE. >> THE OBAMA CAMPAIGN DOESN'T HAVE A PLAN. THE OBAMA CAMPAIGN IS SLIPPING BECAUSE HE'S TALKING ABOUT SMALLER AND SMALLER THINGS. DESPITE THE FACT THAT AMERICA HAS SUCH HUGE CHALLENGES AND THIS IS SUCH AN OPPORTUNITY FOR AMERICA. AND THAT'S WHY ON NOVEMBER 6th I'M COUNTING ON OHIO TO VOTE FOR BIG CHANGE. >> Reporter: BUT THERE IS ONE DISTRACTION FOR THE ROMNEY CAMPAIGN HERE IN OHIO. IT IS THE SUBJECT OF RICHARD MOURDOCK, THE REPUBLICAN SENATE CANDIDATE WHO MADE CONTROVERSIAL COMMENTS ON THE SUBJECT OF RAPE AND ABORTION. ROMNEY TAPED A TV AD FOR MOURDOCK AND THE CAMPAIGN SAYS THEY'RE NOT ASKING THE MOURDOCK CAMPAIGN TO PULL THAT AD AND THE GOP NOMINEE NOT WITHDRAWING THE SUPPORT OF MOURDOCK. EMERGENCY ROOMIER THIS MORNING AT A CAMPAIGN STOP AT A BREAKFAST STOP IN CINCINNATI, REPORTERS TRIED TO ASK ROMNEY ABOUT THE MATTER BUT HE DID NOT ANSWER THOSE QUESTIONS. BROOKE? >> JIM ACOSTA, THANK YOU. >>> COMING UP, WE'LL BREAK DOWN OHIO AND REALLY GO IN DEPTH ON WHICH COUNTIES WHICH CAMPAIGNS ZERO IN ON. DO NOT MISS THAT. >>> UP NEXT, BRACING FOR HURRICANE SANDY. THE STORM EXPECTED TO MOVE UP THE ATLANTIC AND THREATEN MAJOR PARTS OF THE EAST COAST. WE'LL HAVE A BRAND NEW UP DATE FOR YOU COMING UP. >>> ALSO, THE GIRL SHOT BY THE TALIBAN IS ABOUT TO GET SOME VERY SPECIAL VISITORS. TENDS TO STAY IN MOTION. STAYING ACTIVE CAN ACTUALLY EASE ARTHRITIS SYMPTOMS. BUT IF YOU HAVE ARTHRITIS, STAYING ACTIVE CAN BE DIFFICULT. PRESCRIPTION CELEBREX CAN HELP RELIEVE ARTHRITIS PAIN SO YOUR BODY CAN STAY IN MOTION. BECAUSE JUST ONE 200MG CELEBREX A DAY CAN PROVIDE 24 HOUR RELIEF FOR MANY WITH ARTHRITIS PAIN AND INFLAMMATION. PLUS, IN CLINICAL STUDIES, CELEBREX IS PROVEN TO IMPROVE DAILY PHYSICAL FUNCTION SO MOVING IS EASIER. CELEBREX CAN BE TAKEN WITH OR WITHOUT FOOD. AND IT'S NOT A NARCOTIC. YOU AND YOUR DOCTOR SHOULD BALANCE THE BENEFITS WITH THE RISKS. ALL PRESCRIPTION NSAIDS, LIKE CELEBREX, IBUPROFEN, NAPROXEN, AND MELOXICAM HAVE THE SAME CARDIOVASCULAR WARNING. THEY ALL MAY INCREASE THE CHANCE OF HEART ATTACK OR STROKE, WHICH CAN LEAD TO DEATH. THIS CHANCE INCREASES IF YOU HAVE HEART DISEASE OR RISK FACTORS SUCH AS HIGH BLOOD PRESSURE OR WHEN NSAIDS ARE TAKEN FOR LONG PERIODS. NSAIDS, INCLUDING CELEBREXÖ INCREASE THE CHANCE OF SERIOUS SKIN OR ALLERGIC REACTIONS OR STOMACH AND INTESTINE PROBLEMS, SUCH AS BLEEDING AND ULCERS, WHICH CAN OCCUR WITHOUT WARNING AND MAY CAUSE DEATH. PATIENTS ALSO TAKING ASPIRIN AND THE ELDERLY ARE AT INCREASED RISK FOR STOMACH BLEEDING AND ULCERS. DO NOT TAKE CELEBREX IF YOU'VE HAD AN ASTHMA ATTACK, HIVES, OR OTHER ALLERGIES TO ASPIRIN, NSAIDS OR SULFONAMIDES. GET HELP RIGHT AWAY IF YOU HAVE SWELLING OF THE FACE OR THROAT, OR TROUBLE BREATHING. TELL YOUR DOCTOR YOUR MEDICAL HISTORY AND FIND AN ARTHRITIS TREATMENT FOR YOU. VISIT CELEBREX.COM AND ASK YOUR DOCTOR ABOUT CELEBREX. FOR A BODY IN MOTION. SO WHAT DO YOU THINK? BASIC. AT Meineke I HAVE OPTIONS... LIKE OIL CHANGES STARTING AT $19.95. MY MONEY. MY CHOICE. MY Meineke. >>> JUST ONE WEEK BEFORE NEXT WEEK'S BIG JOB REPORT, OPTIMISTIC NEWS. THE NUMBER OF PEOPLE FILING FOR UNEMPLOYMENT LAST WEEK DROPPED, DROPPED BY 23,000. THAT NUMBER NOW AT LATE 2007 LEVELS. THE OCTOBER JOBS REPORT, OF COURSE, YOU KNOW WHEN THAT COMES, NEXT FRIDAY. THAT FINAL, FINAL ONE BEFORE THE NOVEMBER 6th ELECTION. AND NOW LET'S TAKE A LOOK AT THE BOARD. UP A SMIDGE AT ONE POINT, 13,000. QUITE A BIT BETTER THAN THE LAST COUPLE OF DAYS ON THE DOW. AS INVESTORS WAITING ON EARNINGS REPORTS OF AMAZON AND APPLE. THE NUMBERS EXECED AFTER TODAY'S CLOSING BELL. >>> NOW, TO THE SCHOOLGIRL WHO SCARES THE TALIBAN SO MUCH THEY SHOT HER IN HER HEAD. SHE'S ABOUT TO GET SOME SPECIAL VISITORS HERE. MALALA'S PARENTS FLEW IN TODAY TO SEE THEIR LITTLE GIRL. THE 15-YEAR-OLD ASKED HER FATHER TO BRING HER SCHOOL BOOKS. SCHOOL BOOKS. SO FAR, SIX PEOPLE HAVE BEEN ARRESTED IN CONNECTION WITH MALALA'S SHOOTING AND PAKISTANI POLICE ARE LOOKING FOR THIS MAN, THIS IS THE MAIN SUSPECT. LISTEN TO WHAT THEY HAVE LEARNED ABOUT HIM. >> Reporter: POLICE OFFICIAL TELLS ME THAT THE MAIN SUSPECT IS A YOUNG MAN THAT'S JUST 23 YEARS OLD AND STUDIED FOR A BACHELOR OF SCIENCE IN PHYSICS AT THIS COLLEGE. HE THEN WENT ON TO STUDY FOR A MASTER'S OF SCIENCE IN CHEMISTRY, TOO. >> 23 YEARS OLD. SHE SAYS. POLICE ARE HOLDING THAT MAN'S MOTHER, BROTHER AND FIANCEE FOR QUESTIONING. >>> AND WE ARE CLOSELY WATCHING HURRICANE SANDY. SHE IS A CATEGORY 2 RIGHT NOW. BUT GROWING STRONGER AND FASTER THAN EXPECTED. STILL HAS A WAYS TO GO HERE BEFORE IT REACHES THE U.S. COAST BUT TAKE A LOOK AT THIS BOAT. THIS IS MIAMI. YOU CAN ALREADY SEE A LITTLE BIT OF WAVES PICKING UP, CHURNING HERE. BUT LOOK AT THIS. PICTURES FROM JAMAICA. SANDY IS BEING BLAMED FOR ONE DEATH THERE AND ANOTHER IN HAITI. THIS COULD DEVELOP IN TO A VERY DANGEROUS STORM ALONG THE U.S. STORM. CHAD MYERS, YOU HAVE BEEN WATCHING THIS. I'M READING ABOUT IT.