I WANT TO THANK OVER FOR BEING HERE. THIS HAS BEEN AN INTERESTING THING TO ORGANIZE. I'M LOOKING FORWARD TO THE DISCUSSIONS WE WILL HAVE. WE HAVE A FEW OPENING THINGS ABOUT THE MEETING. SO FIS IS THE THIRD MEETING OF THE GEROSCIENCE INTEREST GROUP. THE THIRD SUMMIT. THE FIRST WAS IN 2013, WHEN WE FIRST STARTED AND I'D LIKE TO GIVE A BIG THANKS TO ALL THE ORGANIZING COMMITTEE. THERE'S PEOPLE FROM MULTIPLE I.C.s. THIS IS A TRANS-NIH GROUP THAT WORKED HARD TO DO THESE THINGS AND IT'S NOT THEIR JOB SO I APPRECIATE THEIR HELP. ALSO TO THANK PEOPLE FROM THE NIA AND FNIH. SO WHAT ARE WE DOING? BASICALLY GEROSCIENCE TRIES TO JOIN AGING AND DISEASE. THE FIRST SUMMIT WAS INTRODUCING THAT CONCEPT. AGING IS A MAJOR RISK FACTOR FOR DISEASE AND THEREFORE ADDRESSING AGING IS LIKELY TO PRODUCE A BETTER OUTCOME THAN ADDRESSING DISEASE INDIVIDUALLY. THREE YEARS LATER WE DECIDE TO GO THE OTHER SIDE OF THE COIN AND ANALYZE HOW SOME DISEASES CAN ACCELERATE THE STAGES OF AGING HIV AND DIABETES AND OTHERS HOW THEY ACCELERATE AGING. SO WHAT DO WE DO? WE DECIDE TO FOCUS ON THE DISEASES THEMSELVES. WE HAVE INVITED PEOPLE INTERESTED IN THE DISEASES, PROFESSIONAL SOCIETIES, ADVOCATES AND OTHERS TO TELL US ABOUT THEIR DISEASES AND TO LEARN WHAT AGING CAN PROVIDE TO THEIR EFFORTS. THE WORK IS AVAILABLE BECAUSE OF THE CONTRIBUTIONS IN THE AGENDA. A FEW RULES OF ENGAGEMENT. SO THE MAIN GOAL IS TO OPEN THE DIALOGUE AND THAT'S VERY IMPORTANT. YOU'LL SEE I'M VERY STRICT ABOUT TIME. YOU'LL SEE THAT CERTAINLY. I'M VERY STRICT. BECAUSE THE POINT IS TO HAVE THE DIALOGUE. I WANT A LOT OF TIME FOR CONVERSATION NOT JUST MATCHED FOR PRESENTATION. THE PRESENTATIONS THEMSELVES NEED TO BE CONCEPTUAL AND THEY SHOULD BE SIMPLE AND NOT RUSHED BECAUSE THEY'RE ALWAYS VARIED. THERE'S A LOT OF PEOPLE HERE WITH DIFFERENT BACKGROUNDS AND KNOWLEDGE AND THINGS. WE WANT SIMPLE CONCEPTS. THE SLIDES FOR THE MOST PART ARE ALREADY LOADED TO FACILITATE TIME. I'M VERY STRICT ABOUT TIMING. IF YOUR 12 DU-- YOUR TALKED IS SUPPOSED TO BE 12:00, YOU'LL BE REMOVED. AND PEOPLE WHO KNOW ME KNOW I'LL DO IT AND QUESTIONS NEED TO BE SHORT AND TO THE POINT. WE HAVE LOTS OF PEOPLE GIVING LECTURES AND IN ADDITION TO THOSE IN PERSON AND I HAVE TO SAY HELLO TO EVERYBODY ELECTRONICALLY PRESENT. WE HAVE TWO WAYS OF JOINING. ONE ALOU -- ALLOWS YOU TO ASK A QUESTION AND HAS A THUMBS UP APP YOU CAN PRESS THE THUMBS UP AND RAISES THE QUESTION UP IN IMPORTANCE SO IT'S MORE LIKELY TO BE ANSWERED. SO THIS IS THE PROGRAM THAT WE'RE GOING TO BE HAVING IN THE NEXT TWO DAYS. AND THE SESSION IS ABOUT TWO HOURS EACH. THE OPENING REMARKS WILL BE BY DR. FRANCIS COLLINS AND THE CONCLUDING REMARKS BY DIRECTOR OF THE NIA. DR. FRANCIS COLLINS, DIRECTOR OF THE NIH DOESN'T REALLY NEED TO BE INTRODUCED. EVERYBODY KNOWS WHO HE IS. HE AGREED GRACIOUSLY TO GIVE US THE PRESENTATION. WITHOUT FURTHER ADO, DR. COLLINS. >> GOOD MORNING, EVERYONE. IT'S A PRIVILEGE TO BE HERE THE THIRD MEETING OFF THE GEROSCIENCE INTEREST GROUP BRINGING TO THE RUTH KIRSCHSTEIN AUDITORIUM AND INTERESTING PEOPLE TO HAVE A SERIOUS CONVERSATION ABOUT WHERE WE ARE IN THIS FIELD OF GEROSCIENCE. FOR ME PASSING THE 10-YEAR MARK AS THE NIH DIRECTOR IT'S BEEN WONDERFUL TO WATCH THE WAY IN WHICH THIS FIELD HAS EMERGED AND EVOLVED. I THINK YOU HAVE TO BE SUCCESSFUL IN CONVINCING PEOPLE THAT AGING ITSELF IS A CONDITION THAT DESERVES INTENSE STUDY AND THAT IT'S CONSEQUENCES FOR MULTIPLE CHRONIC DISEASES WILL BE IMPORTANT TO UNDERSTAND OPPOSED TO STUDYING THE CHRONIC DISEASES ONE AT A TIME AS IF THEY OCCURRED IN ISOLATION. MY OWN RESEARCH LABORATORY WORKS IN A WAY IN THE FIELD OF AGING BECAUSE WE STUDY HUTCH INSON GILLFORD PROGERIUM AND YOU HAVE A PROTEIN PROGERO-N AND YOU SEE THE FIBROBLASTED WHICH IS TURNS INTO PREMATURE AGING FOR CHILDREN WHO HAVE THIS CONDITION. WE LEARNED A LOT ABOUT IT IN THE COURSE OF THE LAST 17 YEARS INS CAUSING MUTATION. PEOPLE ARE WONDERING DOES IT HAVE RELATIONSHIP TO THE NORMAL AGING PROCESS AND THE JURY IS STILL OUT ABOUT THAT BUT YOU CAN POINT IT'S A PART OF WHAT WE CONSIDER NORMAL AGING IN THAT THE PROTEIN, PROGERON IS MADE IN ALL OF US AS CELLS APPROACH THEIR NORMAL LIFE STAN. AND IN DATA SEEING IN SOME INDIVIDUALS AND EXPOSED AREAS THE AM OF PROGERON IS SIMILAR TO A CHILD WITH PROGERIA AND IT MAY CAUSE CELLS TO HEAD FOR THE EXIT INSTEAD OF LINGERING TOO LONG WHEN THEY MAY GET IN TROUBLE WITH OTHER MUTATIONS THAT COULD RESULT FOR INSTANCE IN MALIGNANCY. I WATCHED THIS FIELD WITH GREAT INTEREST AND TRIED TO UNDERSTAND WHERE THINGS ARE GOING IN THE WHOLE FIELD OF GEROSCIENCE AND IT IS REMARKABLE THE ADVANCES THAT HAVE EMERGED IN THE LAST DECADE. MANY SINCE THE FIRST MEETING OF THIS SORT WHEN ONE SEES WHAT WE ARE REBEGINNING TO LEARN ABOUT THAT THEY SEIZED THEIR ABILITY TO DIVIDE AND BEGAN TO UNDERTAKE EFFORTS AND THEY'RE INFLUENCING THEIR NEIGHBORS IN WAYS THAT COULD BE IMPORTANT TO UNDERSTAND AND THE MOUSE MODELS AND IN OTHER APPLICATIONS USING DRUG THERAPY TO HUMANS IS A BIG BREAKTHROUGH IN THE FIELD OF INFORMATION THE PROCESS OF AGING THAT CAME AS A SURPRISE TO MANY OF US AND FOR MANY AREAS OF CHRONIC RESEARCH REPRESENTED AT THE MEETING SO THERE'S OPPORTUNITY TO TALK ABOUT SINNOLITICS AND ON TOP OF THAT WE'RE GETTING CLOSER TO THE POINT WHERE THE BASIC SCIENCE UNDERSTANDINGS ABOUT THE AGING PROCESS ARE LEADING TO CLINICAL TRIALS. THE TAME TRIAL THAT'S GOING TO LOOK AT THE EFFECT OF METPHORMAN AND TRIPPING EMORASIN AND RESULT OF BENEFIT SUGGESTING IT DID IN FACT IMPROVE VACCINE RESPONSE IN ELDERLY INDIVIDUALS AND WE THINK OF RAFOMYSIN SO IT'S AN OPPORTUNE MOMENT WITH THE MANY CHRONIC DISEASE RESEARCH ORGANIZATIONS AND ADVOCACY GROUPS REPRESENTED AT THIS MEETING TO FIGURE OUT WHETHER WE'RE BRINGING THOSE AREAS OF INSIGHT TOGETHER ALL WE WAY FROM THE MOST BASIC SCIENCE TO THE POTENTIAL CLINICAL TRIALS AND THAT'S WHAT I HOPE WILL COME FROM THIS 48 HOURS OF YOU ALL GATHERING AND TRYING TO ASSESS WHAT WE'RE NOT DOING THAT WE COULD BE. I'M HOPING FROM THIS MEETING THERE'LL COME NEW IDEAS AND COLLABORATIONS AND RESEARCH DIRECTIONS. WE'RE FORTUNATE AT NIH WE HAVE OVER THE COURSE OF THE LAST FOUR YEARS SEEN A 30% INCREASE IN OUR OVERALL BUDGET. WE'RE HOPING FOR A FIFTH YEAR FOR THAT TO HAPPEN THOUGH THINGS ARE DICEY RIGHT NOW IN TERMS OF WHETHER WE'LL GET A BUDGET OR NOT IN THE NEAR FUTURE. I DON'T EVEN WANT TO GO THERE WITH YOU ALL BUT IT'S FAIR TO SAY WE'RE IN A GOOD POSITION TO TAKE ON SOME BOLD IDEAS AND PURSUE RESEARCH THAT IS HIGH RISK BUT HIGH REWARD. I THINK A LOT OF THE AREAS OF GERE -- GEROSCIENCE WILL FALL IN THAT AREA AND ON BEHALF OF MYSELF AND OTHER INSTITUTE DIRECTORS HERE AND DR. BRENNAN, DIRECTOR OF NATIONAL OF LIBRARY MEDICINE AND DR. BIANCHI AND DR. LONGEVINE ARE ALL HERE TO SOAK THIS UP AND I HOPE I'M NOT MISSING ANY OTHER INSTITUTE DIRECTORS I'M NOT SEEING. DR. TUSI OUR NEW DIRECTOR OF THE NATIONAL INSTITUTE OF DEAFNESS AND COMMUNICABLE DISORDERS. I THINK THAT REFLECT THE INTEREST THAT EXISTS ACROSS THE LEADERSHIP OF HIRN. -- NIH. DR. BURNS THE DIRECTOR OF THE CENTER FOR SCIENTIFIC REVIEW WHO REALLY CONTROLS WHAT WE FUND SO BE NICE TO HER. OKAY, THE DIRECTOR OF THE NIDDK. THEY DON'T COME TO ALL THESE MIGHTINGS SO THIS IS A BIG THING. BOB CARTER, ACTING DIRECTOR OF AMIS. AND DESPITE THE WARNING THAT PEOPLE SHOULD NOT RUN OVER THEIR TIME OR BAD THINGS WILL HAPPEN AND I WAS SUPPOSED TO GIVE SOMETHING SIMPLE AND STRAIGHTFORWARD. I HOPE I LIVED UP TO THOSE EXHORTATIONS AND I CAN LET -- GET OUT OF THE WAY. THANK YOU FOR BEING HERE. I LOOK FORWARD TO THE OUTCOME. GOOD MORNING, EVERYONE. MY NAME IS PAGE GREEN AT THE NATIONAL CANCER INSTITUTE. IT'S MY PLEASURE TO SERVE WITH FELIPE IN THE FIRST SESSION THE PRINCIPLES OF GEROSCIENCE. THE REAL PURPOSE IS TO INTRODUCE THE MAJOR CONCEPTS OF GEROSCIENCE WITH THE GOAL OF INSTRUCTING DISEASE-FOCUSSED PARTICIPANTS ON THE CONCEPTS AND STATUS OF THE FIELD. SO WE ARE GOING TO KICK OUR SESSION OFF WITH FOUR EXPERTS IN THE FIELD. DR. FELIPE SIERRA WILL TALK ABOUT THE HYPOTHESIS OF GEROSCIENCE AND HIGHLIGHT THE INTERNAL WORK WE'VE BEEN DOING. DR. GORDON LIDGE -- LITHGOW WILL TALK WITH THE CONCEPT AND DR. ANN NEWMAN WILL ADDRESS THE CLINICAL AND GEROLOGICAL PRINCIPLES AND DR. TERRIE MOFFITT WILL RELATE TO MORE BEHAVIORAL AND SOCIAL CONSEQUENCES OF CHANGING THE HEALTH CARE PARADIGM TO A GEROSCIENCE-BASED APPROACH. SO AS FELIPE HAS INSTRUCTED US, THE SPEAKERS WILL HAVE EXACTLY 10 MINUTES AND THEN WE WILL HAVE A VERY ENGAGED DISCUSSION. WITHOUT FURTHER ADO LET ME INTRODUCE DR. FELIPE SIERRA. >> I'LL TALK ABOUT THE PRINCIPLES OF GEROSCIENCE TO GET US START. WE KNOW THE WORLD IS AGING. IT'S IMPRESSIVE TO SEE THE TWO LINES PEOPLE OVER 65 AND OVER 5 CROSSED. THAT'S NEVER HAPPENED BEFORE. WE KNOW DISEASE INCREASES WITH AGE AND SO THAT'S HARDER ON THE SYSTEM AND THE MORE OLD PEOPLE WE'LL HAVE THE LESS YOUNG PEOPLE WORK WILL BE ABLE TO SUPPORT THOSE WHO RETIRE. THAT'S A BIG PROBLEM ACTUALLY AND PERCEIVED AS SUCH BUT I'M AN OPTIMISTIC PERSON SO THE QUESTION IS IS IT REALLY A BIG PROBLEM OR IS THERE A SILVER LINING THERE? SOMETHING WE'RE NOT SEEING? THE PROBLEMS IS SORRY, YES, IT IS A BIG PROBLEM. BUT IT'S A BIG PROBLEM ONLY IF WE CONTINUE ADDRESSING HEALTH THE SAME WAY WE SUCCEED IN THE 20th CENTURY. WE HAVE TO CHANGE THE PARADIGM. IN THE 20th CENTURY WE WERE SUCCESSFUL AND THAT'S HOW WE HAVE INCREASED THE LIFE SPAN. BY ADDRESSING THIS RELATIVELY SIMPLE IDEOLOGY AND IMPROVING PUBLIC HEALTH, VACCINES AND HEALTH SERVICES ALLOWS US TO GET TO WHERE WE ARE. HOWEVER, THAT APPROACH WILL NOT WORK WITH THE CHRONIC DISEASES IN THE 21st CENTURY WHICH ARE NOT EXTENDED TO OUR OWN WAY TO PERFORM. IT'S A DIFFERENT TYPE OF DISEASE SO WE NEED A DIFFERENT APPROACH. THE PROBLEM WHERE HE IS -- YOU SEE THOSE WHO GET NEW CORONARY ARTERY DISEASE IT'S ABOUT 3%. HOWEVER, THE PEOPLE WHO HAVE ONE DISEASE, WHATEVER DISEASE, WHO GET A SECOND DISEASE, WELL, THAT'S 200 PER 10,000. SO COMORBIDITIES SO STUDYING ONE AT A TIME IS NOT THE WAY TO DO IT. AND AGEING IS NOT SO SIMPLE. AS RECENTLY THE EFFECT OF AGE AND ALL 10 MAJOR RISK FACTORS. 26.84% IS THE RISK COMPARED TO THE NEXT RISK FACTOR OF DISEASE. AND ACTUALLY 1.12 FOLD AND AGING IS A MAJOR RISK FACTOR. THESE ARE MAJOR RISK FACTORS OF CANCER AND TOBACCO, ALCOHOL, DIET, INFECTION. IT DIDN'T COUNT AGING. IF YOU ADD AGING TO THE EQUATION THIS IS HOW THIS LOOKS. ALL THESE THINGS DISAPPEAR. FOR ALZHEIMER'S AND EVEN APE BASICALLY DISAPPEARS COMPARED TO AGING. AGING IS A MAJOR RISK FACTOR. IT'S NOT JUST THE PASSING OF TIME IT'S DIFFERENT THINGS. THEY ALL HAVE THE SAME GENETICS WITH AGING. IN THE CASE OF ALZHEIMER'S, ACCOMMODATION FOR ABETA OCCURS LATE IN LIFE WE NORMALLY DON'T SEE ANYTHING HAPPEN EARLIER. FIT WAS THE PASSAGE OF TIME IT WOULD BE A LINEAR ACCUMULATION. NO, WHAT HAPPENS IS YOU PRODUCE THE BAD PROTEINS THROUGHOUT YOU'RE LIFE AND WHEN YOUR YOUNG, YOU'RE RESILIENT AND FIGHT THEM. AS YOU GET OLD THE RESILIENCE GOES DOWN AND YOU GET THE DISEASE. SO AGING IS INDEED THE MAJOR RISK FACTOR. SO WHAT'S A CHALLENGE WE'RE FACE DISEASE OFTEN STUDIED SEPARATELY BY DIFFERENT PEOPLE. YOU TALK ABOUT THE IDEOLOGIES. HEART RESEARCHER, CANCER, THEY'RE STUDIED SEPARATELY AND YET AGING IS A MAJOR RISK FACTOR. THIS IS WHERE THE GEROSCIENCE COMES. THE MAJOR RISK FACTOR IS AGING. THERE'S SPECIFIC BIOLOGY OF THE DISEASE OKAY. AND THIS IS NOT JUST ONE DISEASE IT'S TRUE FOR MANY DISEASES. SO BASICALLY, WHEN WE'RE PUTTING THIS IS YOU'RE GENES AND YOUR ENVIRONMENT DETERMINE WHICH DISEASE YOU GET BUT AGING DETERMINES WHEN YOU GET IT. AND IF YOU'RE LUCKY YOU'RE GOING TO GET IT AFTER YOUR DEAD AND YOU DON'T HAVE TO WORRY ABOUT YOUR GENES AND YOUR ENVIRONMENT. THE CONCEPT IS GEROSCIENCE IS TO ANALYZE THIS INTERRELATIONSHIP. AND THE HYPOTHESIS OF THE CONCEPT IS IF YOU ACKNOWLEDGE AGING IS AT THE CENTER OF ALL THESE DISEASES AND MANY OTHERS, ALL THE DISEASES AND CONDITIONS, IF YOU NOTICE THAT AGING IS AT THE CORE, IF WE CAN REDUCE THE RATE OF AGING, WE WILL REDUCE AT THE SAME TIME ALL OF THOSE DISEASES. NOT JUST ONE BUT ALL OF THEM AND NOT JUST DISEASES BUT CONDITIONS THAT ARE USUALLY NOT CONSIDERED A MATCH LIKE SLEEP DISORDERS. ALL THOSE ARE CAUSED BY THE PROCESS OF AGING AND WHY WE SHOULD PUT OUR EFFORT ON AGING ITSELF. AS DR. COLLINS INDICATED, WHAT MAKES GEROSCIENCE VALUABLE NOW? THE FACT IT'S A MAJOR RISK FACTOR FOR DISEASE HAS BEEN KNOWN FOR AGES. WHAT MAKES IT VALUABLE NOW IS WE HAVE A LOT OF PLAYERS IN THE AGING FIELD THAT HAVE BEEN IDENTIFIED. MANY ARE FAMILIAR WITH IT AND WORK FROM THE EUROPEAN GROUP. THIS IS A SIMILAR IMAGE WE GET FROM THE GEROSCIENCE INTEREST GROUP. WE CANNOT HAVE THE SAME. IT'S A HANDFUL OF PATHWAYS THAT DELIVER THE MOLECULAR PATHWAYS OF AGING AND AGING IS MALLEABLE. IT'S MORE MALLEABLE THAN WE THOUGHT. WE HAVE KNOWN FOR ALMOST A CENTURY NOW THAT WE CAN MODIFY AGING BY DIETARY RESTRICTION. WE EAT LESS, WE LIVE LONGER. IT DOESN'T FEEL VERY GOOD THOUGH BUT YOU LIVE LONGER NOW, THERE'S NEW PARADIGMS COMING UP WHICH ARE EXCITING LIKE INTERMITTENT FASTING AND OTHER PARADIGMS THAT MODIFY THIS INITIAL FINDING. USING THE SAME PARADIGM OF CALORIE RESTRICTION IT'S BEEN ABLE TO IDENTIFY HUNDREDS OF GENES THAT CONTROL THE PROCESS OF AGING. IN WORMS, YEAST, AND MANY OF THESE GENES HAVE BEEN CONFIRMED IN OTHER ANIMALS INCLUDING MICE AND IN SOME CASES EVEN HUMANS. BECAUSE THE GENES FALL INTO JUST A NUMBER OF CERTAIN GROUPS OF PATHWAYS, WE HAVE ALSO BEEN ABLE TO DEVELOP DRUGS TO PHARMACOLOGICALLY AFFECT THE PROCESS OF AGING. THE MOST IMPORTANT THING IS WHEN WE DO THAT, WHEN WE INCREASE LIFE SPAN WE OFTEN ALSO INCREASE HEALTH. THIS IS JUST TO SHOW YOU A GROUP OF MICE. THESE ARE 38-MONTH-OLD MICE. THESE ARE EXTREMELY OLD MICE. THEY'RE CENTENARIANS IN HUMAN TERMS. THEY DON'T LOOK NICE. THIS ONE HAS A TUMOR, THIS ONE CANNOT MOVE ITS BACK LEGS. THE MICE ON TOP HAVE BEEN GIVEN RAPOMYCIN AND LOOK BETTER AND HAVE BETTER COATS AND MOVE AROUND AND EXPLORE. THEY'RE MUCH MORE ACTIVE. IN OTHER WORDS, THEY'RE PHYSIOLOGICALLY YOUNGER AND THAT'S THE PURPOSE OF THE WHOLE THING. THANK YOU, NEXT SPEAKER IS DR. NEWMAN. >> THANK YOU. I'M ANN NEWMAN AND EPIDEMIOLOGIST AND GERONTOLOGIST AND I THOUGHT IT'D BE USEFUL TO SHOW THE THINKING IN WHAT CLINICAL TARGETS ARE FOR THERAPIES THAT MIGHT BE GUIDE GEROSCIENCE. LIKE TO START WITH THIS PROGRAM CALLED THE AGE OF AGING TRYING TO LAUNCH THE TAME TRIAL ON THE WEBSITE FOR NATIONAL GEOGRAPHIC WHICH SPONSORED THIS. WE SEE AGAIN THE CHANGE IN THE PORTION OF THE POPULATION AT EACH AGE. AND IT REALLY IS A NUMBERS GAME THAT AS WE GO THROUGH TIME WITH THE DROPPING NUMBER OF CHILDREN BEING BORN AND THE RISING NUMBER ADULTS AND THE NUMBER OF THE OLDEST OLD IS RISING AND I WANT TO CENTER ON WHAT'S MOST IMPORTANT FOR OUR GRANDPARENTS, PARENTS, OURSELVES AND CHILDREN. DO WE WANT TO HAVE AN OLD AGE THAT ENDS WITH DISABILITY AND DEMENTIA OR CAN WE MAINTAIN OUR HEALTH AND HEALTH SPAN INTO MUCH LATER IN LIFE? AS FELIPE DISCUSSED, WHAT IF WE COULD CURE CANCER OR HEART DISEASE. IN THE GREEN LINE YOU SEE WHAT HAPPENS IF WE CAN DELAY HEART DISEASE WE WILL PROLONG LIFE SPAN BUT WE DON'T DO AS MUCH FOR THE OTHER CONSEQUENCES OF AGING AND DISABILITY. YOU CAN MEASURE THE DISTANCE BETWEEN THE TWO AS THE HEALTH SPAN OF THE INDIVIDUAL AND IF WE CAN ADVANCE AGE IN MULTIPLE CHRONIC DISEASES WE GET AN INCREASE IN HEALTH SPAN. IT'S NOT JUST LONGEVITY BUT WE'RE INTERESTED IN INCREASING THE HEALTH SPAN IN THE POPULATION. THIS PERIOD CAN BE CALLED ACTIVE LIFE EXPECTANCY OR HEALTH SPAN. WELL, THERE'S MANY WAYS TO CONCEPTUALIZE HEALTH SPAN AND HEALTHY AGING AND THESE ARE EXAMPLES OF WHAT PEOPLE HAVE TALKED ABOUT. BEING FREE OF ANY AGER DISEASE CAN BE INTERESTED -- FREE ANY DISEASE IS BEING FUNCTION OR HAVING DISABILITY FREE HUR CIVIL AND SOMEONE IN SPITE OF HAVING DISEASE PEOPLE DOING BETTER THAN YOU'D EXPECT HAVING A BURDEN OF DISEASE AND THESE INDIVIDUALS MAY BE CALLED RESILIENT. ANOTHER CONCEPTUALIZATION OF HEALTHY AGING. IT MAY BE AN INDIVIDUAL HAS A PHYSIOLOGICAL TEST OF A YOUNGER PERSON TO CHARACTERIZE THAT PERSON BEING AS YOUNGER THAN THEIR CHRONOLOGIC AGE. THERE ARE PEOPLE UNUSUALLY HEALTHY. PEOPLE AT THE LEFT TAIL OF THE DISTRIBUTION. IF YOU HAVE A NORMAL L SHAPED CURVE. THE SUPER HEALTHY ARE OF INTEREST. THEN FINALLY, THERE'S A LOT OF INTEREST IN AMERICA THE RATE OF AGING. YOU CAN THINK OF THAT AS THE DOTTED LINE HERE ON THE GRAPH IF WE COULD MEASURE THIS, THE DOTTED LINES SHOWS A RATE OF AGING. THIS IS DIFFERENT THAN AMERICA -- MEASURING AGING AT ANY WASN'T POINT OR TO A HEALTH EVENT AND UNDERSTANDING WHAT PEOPLE ARE TALKING ABOUT IS CRITICAL FOR DEVELOPING TRIES THAT ARE DESIGNED TO IMPROVE HEALTHY AGING. WHAT DO OLDER ADULTS CARE ABOUT? THEY TALK ABOUT INDEPENDENCE, PHYSICAL AND COGNITIVE FUNCTION AND THEY'RE ABOUT FUNCTION NOT DISEASES. FUNCTION IS MULTIDIMENSIONAL. IT'S LESS OFTEN EASILY DICHOTOMIZED AND REQUIRES A COMPOSITE OF MEASURES. SO CLINICAL TRIALS THAT ADDRESS GERE OWE -- GEROSCIENCE IS THE PERSON WHO HAD A TUMOR REMOVED OR BIOPSY SURGERY. THOSE ARE SOFT OUTCOMES. SOME ARE TIME TO EVENT ANALYSES OR TIME TO A GIVEN STATE AN AREA UNDER A CURVE. THERE MAY BE A COGNITIVE BATTERY OR PHYSICAL FUNCTION BATTERY OR THE PHYSICAL PERFORMANCE BATTERY, SPPB OR THE TIME TO ONE EVENT. THE FIRST M.I. OR FIRST STROKE AND THE NEXT EVENT A DIFFERENT DISEASE. IT'S ALSO A COMPOSITE. IT MAY BE A DISEASE-SPECIFIC COMPOSITE OR A GLOBAL COMPOSITE SUCH AS MULTI-MORBIDITY AGAINST DISABILITY AND THERE'S A NEED FOR CLINICAL OUTCOMES USED TO TELL US IF WE'RE ON THE RIGHT TRACK WHEN WE'RE INTERVENING OR MEASURES OF IMMEDIATE OUTCOMES WHICH MAY BE EARLY MANIFESTATIONS OF DISEASE WHICH MAY NOT BE CLINICALLY MANIFEST. I LIKE TO TALK ABOUT THE WOMEN'S HEALTH INITIATIVE AS WHAT I SEE AS AN EXAMPLE OF THE FIRST GEROSCIENCE TRIAL AND IT WAS THOUGHT WOMEN IN MENOPAUSE MAY BENEFIT FROM HORMONES AND THEY LOOKED AT SEPARATE END POINTS. WHAT IS VERY INTERESTING THAT'S OFTEN OVERLOOKED ABOUT THE TRIAL IS THAT THEY CAME UP WITH A COMPOSITE OUTCOME TO TRY TO WEIGH THE TOTAL SUM EFFECT OF HORMONE REPLACEMENT THERAPY AND CAPE UP WITH A GLOBAL -- CAME UP WITH A GLOBAL INDEX WHERE EACH EVENT WAS COUNTED AS EXCESS OR LESS THAN EXPECTED. AS YOU KNOW, OVERALL, THERE WAS AN EXCESS OF ADVERSE EVENTS COMPARED TO BENEFICIAL EFFECTS WHICH IS OPPOSITE OF WHAT WAS HYPOTHESIZED AND IN THE BALANCE OF ALL THE POSSIBLE BENEFITS OF HORMONE REPLACEMENT THERAPY, THERE WAS GREATER RISK THAN BENEFIT. THE TAME TRIAL IS A TRIAL OF MET METPHORMEM IT HAS A LOT OF ADVANTAGES BECAUSE WE WANT TO SEE BROAD EFFECTS ACROSS DISEASES ASCRIBED TO AGING. AND IT'S BEEN SHOWN TO BE FEASIBLE AN APPROACH. THERE ARE CHALLENGES WITH THE COMPOSITE. IT'S POSSIBLE PARTS COULD BE INFLUENCED MORE THAN OTHER PARTS AND HOW DO YOU INTERPRET THAT AND HOW DO YOU DECIDE ON STOPPING ROLES. NEVERTHELESS, IT'S THE OUTCOME AS THE TAME TRIAL IS GETTING STARTED IN 2020. THIS LOOKS AT OUTCOMES DEFINED BY MEASURES OF FUNCTION. THE COMPOSITE WAS MORTALITY, PHYSICAL DISABILITY OR DEMENTIA REMAINING FREE OF THESE CONDITIONS AND ASPIRIN DID NOT PROVE TO PROLONG HEALTH SPAN THANE TRIAL BUT OPERATIONALIZED HOW HEALTH SPAN CAN BE DEFINED IN A CLINICAL TRIAL. THE LIFE SPAN USED MOBILITY DISABILITY. IT WAS OPERATIONALIZED THE AINABILITY TO WALK 400 METERS AND USED MEDICAL RECORDS TO DETERMINE IF SOMEONE WAS DISABLED FOR MOBILITY AND PHYSICAL ACTIVITY CAN PROLONG THE TIME BEFORE AN OLDER ADULT DEVELOPS MOBILITY DISDISABILITY AND THERE'S MORE INTERMEDIATE OUTCOMES. GAIT SPEED, MUSCLE STRENGTH, EXERCISE CAPACITY WITH OXYGEN CONSUMPTION MEASURED ON A TREADMILL OR A LONG-DISTANCE WALK DOWN THE CORRIDOR OR HIGHWAY. AND THEY STRONGLY PREDICT MORTALITY. SOME CAN BE DETECTED TO CHANGE AT MIDLIFE AND STRENGTH AND OXYGEN CONSUMPTION AND WE HAVE GOOD DEFINITIONS OF WHAT SAY MEANINGFUL CHANGE IF IT'S USED TO GUIDE THERAPY. AND IT WAS SUCCESSFULLY USED IN A PILOT OF SINOLYTIC DISEASE COMPONENT. SO IT'S A NEW FRONTIER TO THINK ABOUT AGING AS A CLINICAL OUTCOME. THE CLASSIC RULES APPLY WE NEED MEASURABLE AND HARD OUTCOMES BUT IN THE FIELD WE'VE COME UP WITH STRONG COMPOSITE OUTCOMES THAT DEFINE VARIOUS ASPECTS OF HEALTH SPAN AND WE'RE READY TO GO SO BRING ON THE THERAPIES. THANK YOU. >> GREETINGS TO EVERYONE. I'M TERRIE MOFFITT AND I'M A CLINICAL PSYCHOLOGIST FROM DUKE UNIVERSITY. I'D LIKE TO BEGIN BY REMINDING US WHAT GEROSCIENCE MEANS THE SLOWING OF AGING WITH PREVENTING DISEASE AND EXTENDING THE LIFE SPAN. I'M HERE TO TALK TO YOU ON BEHALF OF THE BEHAVIORAL AND SOCIAL SCIENCES. YOU MAY BE FORGIVEN FOR THINKING IT DOES NOT HAVE A ROLE IN THE GEROSCIENCE AGENDA. FAIR ENOUGH. UP UNTIL NOW IT'S NOT PLAYED A BIG PART BUT BEHAVIORAL AND SOCIAL SCIENCE IS GOING TO BE NECESSARY TO ACCELERATE THE GEROSCIENCE AGENDA FROM HERE ON OUT. THIS WORK WILL TAKE MANY FORMS AND I'LL TELL YOU ABOUT FOUR OF THEM TODAY. FIRST, WE NEED TO ACCELERATE THE MOVE FROM ANIMAL MODELS TO HUMAN. GEROSCIENCE BEGAN AT THE CELLULAR LEVEL AND HAS BEEN HUGELY SUCCESSFUL AT THE ANIMAL MODEL LEVEL. HOWEVER, IT'S NOW MOVING TO APPLICATION TO HUMANS. AND THERE'S UNIQUELY HUMAN CAUSES DIFFERENT FROM THE AGING IN CELLS AND ANIMALS. ANY HUMAN THAT BEGINS A THERAPY THAT AIMED TO SLOW AGING WILL BRING TO THE TREATMENT SITUATION THEIR OWN PERSONAL BEHAVIORAL AND SOCIAL BACKGROUND. THESE FACTORS WILL PROBABLY AFFECT HOW WELL THE GEROSCIENCE THERAPIES ARE ABLE TO WORK FOR PEOPLE. CELLULAR HALLMARKS OF AGING THIS MORNING. SUCH AS MIDCHONDRIAL AND SENESCENCE AND NOW I'D LIKE TO THINK ABOUT THE SOCIAL HALLMARKS OF AGE. THEY'RE FACTORS SUCH WHICH HAVE BEEN PROVEN TO ALTER THE PACE OF AGING AMONG HUMANS. PEOPLE HAVE LOW SOCIOECONOMIC STATUS BACKGROUNDS AGE FASTER AND DIE YOUNGER AS DO MEMBERS OF MINORITY ETHNIC GROUPS, PEOPLE WHO ENGAGE IN ADVERSE BEHAVIORS SUCH AS SMOKING OR PHYSICAL INACTIVITY OR EXPERIENCE ADVERSE PSYCHOLOGICAL STATES SUCH AS MENTAL ILLNESS AND PEOPLE WHO EXPERIENCED ADVERSE LIFE EVENTS SUCH AS BEING MALTREATED AS A CHILD. I'D LIKE TO YOU NOTICE THE REFERENCE AT THE BOTTOM RIGHT CORNER. I'LL GIVE A REFERENCE ON EVERY SLIDE AND HAPPY TO HELP YOU GET ACCESS TO THESE PAPER IF YOU CONTACT ME. THERE'S SEVERAL UNIQUELY HUMAN FACTORS THAT PROLONG LIFE SPAN. A CONSCIENTIOUS PERSONALITY STYLE, INTELLIGENCE AND CONNECTION TO OTHER PEOPLE. THE STRONGEST KNOWN REDUCERS OF HUMAN HEALTH SPAN ARE POOR HEALTH BEHAVIORS, ADVERSE CHILDHOOD EXPERIENCES AND A HISTORY OF SEVERE STRESS. THESE FACTORS WILL DETERMINE WHO VOLUNTEERS FOR CLINICAL TRIALS OF GEROSCIENCE AND ADHERES TO REGIMENTS AND IMPORTANTLY WHO DROPS OUT OF CLINICAL TRIALS. THE SECOND OPPORTUNITY TO ACCELERATE THE GEROSCIENCE AGENDA IS WE NEED TO ACCELERATE THE MOVE FROM STUDYING OLDER ADULTS TO STUDYING YOUNGER PEOPLE. MOST HUMAN GEROSCIENCE TODAY HAVE ENROLLED PARTICIPANTS OVER 60 BUT AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE. IF THE AIM IS TO PREVENT THE ONSET OF DAMAGE TO ORGANS BEFORE IT BEGINS, EVENTUALLY GEROSCIENCE THERAPIES FOR YOUNG TO MID-LIFE ADULTS WILL BE NEEDED AND STUDYING YOUNGER PEOPLE WILL HELP US IDENTIFY NEW INTERVENTION AR -- TARGETS IN EARLY LIFE TO AFFECT AGING. HERE'S ONE EXAMPLE YOU MAY NOT HAVE THOUGHT OF. MENTAL ILLNESS. IT'S PEAK IN THE TEENS AND 20s AND PEOPLE WHO HAVE THEM LATER GO ON TO DEVELOP AGE-RELATED DISEASES SUCH AS CARDIOVASCULAR DISEASE AND DEMENTIAS AT VERY HIGH RATES. AND THEY ALSO DIE YOUNGER COMPARED TO THE REST OF THE POPULATION. BEHAVIORAL AND SOCIAL RESEARCHERS ARE HARD AT WORK ON THIS PREVENTION TARGET TO ACCELERATE THE GEROSCIENCE AGENDA. AND BEHAVIORAL AND SOCIAL RESEARCH REVEALS CONNECTIONS FROM CHILDHOOD TO LATER AGING. THERE ARE LONGITUDINAL STUDIES THAT STUDIED CHILDREN AND FOLLOWED THEM FROM FIVE TO EIGHT DECADES SO FAR. IN THESE STUDIES PEOPLE WHO PERFORMED POORLY ON BEHAVIORAL TESTS GIVEN IN EARLY CHILDHOOD ALSO TEND TO NOW PERFORM POORLY ON TESTS USED IN GERIATRIC MEDICINE TO TEST FOR FRAILTY AND RISK OF EARLY DEATH. HERE YOU SEE THE CONNECTION FROM THIS LITTLE GIRL BRAIN FUNCTION AT 3 TO HER WALKING SPEED IN HER GAIT SPEED ASSESSMENT DECADES LATER. THE THIRD OPPORTUNITY TO ACCELERATE THE GEROSCIENCE AGENDA IS MOVE FROM USING CLINICAL OUTPOINTS IN CLINICAL TRIALS THERAPIES TO USING MEASURES OF THE PACE OF AGING AND HERE ANN NEWMAN AND I AGREE QUITE WELL. THEY NEED TO BE TRIED -- TRIALED IN YOUNGER ADULTS BUT IF WE DO THIS HOW DO WE KNOW THE THERAPIES WORK? WE HAVE TO WAIT 20 YEARS OR MORE TO SEE IF IT DELAYED ONSET OF DIG -- DIAGNOSED DISEASE AND WE NEED TO LOOK AT PRE-TREATMENT BASELINE AT TREATMENT AND DURING TREATMENT AND AT OUTCOME. ONE APPROACH BEING USED TO SOLVE THE PROBLEM IS TRACK THOSE MEMBERS OF LONGITUDINAL COHORT STUDIES AND MEASURING MARKERS FOR AGING. THIS PARTICULAR STUDY I'M SHOWING COLLECT THE SAME PANEL OF BIOMARKERS AT AGE 26, 32, 38 AND 45 YEARS TO MODEL AN ALGORITHM TO THE EXTENT TO WHICH DECLINE IN DIFFERENT ORGAN SYSTEMS OF THE BODY IS HAPPENING I A WAY THAT'S COORDINATED ACROSS THE ORGAN SYSTEMS. THIS COORDINATED DECLINE MODEL FITS THE DEFINITION OF AGING AND IT'S A GOOD PREDICTOR OF PHYSICAL AND COGNITIVE FUNCTION DECLINE. THESE PHOTOGRAPHS SHOW COMPOSITE FACES DRAWN FROM THE LONGITUDINAL STUDY COHORT. THE TWO PHOTOS REPRESENT THE 10 WOMEN AND MEN AGEING THE FASTEST THE PAST TWO DECADES FROM 26 TO 32 TO 38 TO 45. THEY WERE SELECTED ACCORDING TO THEIR SCORES ON THE BIOMARKER ALGORITHM. THE PARTICIPANT PHOTOS WERE ALL TAKEN WITHIN 66 DAYS OF THEIR 45th BIRTHDAYS. THE PHOTOGRAPHS ON TOP WERE ALSO TAKEN WITHIN TWO MONTHS OF THE PARTICIPANTS 45th BIRTHDAYS. THE REPRESENT THE 10 WOMEN AND 10 MEN IN THE LONGITUDINAL COHORT AGING THE SLOWEST OVER THE PAST TWO DECADE FROM AGE 26 TO AGE 45. SELECTED ACCORDING TO THE BIOMARKER ALGORITHM. THESE PEOPLE HAD NOT HAD GEROSCIENCE THERAPY BUT WHAT WE LEARN FROM THE WORK IS IF THE PERSON UNDER AGE 45 IS GIVEN A THERAPY TO SLOW AGING IT WILL BE POSSIBLE TO MEASURE ITS AFFECTS. THIS SLIDE SHOWS YOU EXAMPLES OF HOW LONGITUDINAL BEHAVIOR AND SOCIAL STUDIES ARE WORKING TO DEVELOP OUTCOME MEASURES FOR GEROSCIENCE TRIALS. OUTCOME MEASURES USED FOR YOUNG AND OLD. THE NEXT STEP WILL BE TO MOVE TO EPI GENETIC METHYLATION METHODS ON THE LOWER LEFT. IT WILL ALLOW CAPTURING THE PACE OF BIOLOGICAL AGING OVER SEVERAL YEARS IN A SINGLE BLOOD TEST USING DNA METHYLATION PROFILES. IT'S GOING TO ACCELERATE THE GEROSCIENCE AGENDA BY MAKING IT POSSIBLE TO CARRY OUT RANDOMIZED CLINICAL TRIALS OF GEROSCIENCE THERAPIES IN YOUNGER ADULTS. THIS IS MODERN BEHAVIORAL AND SOCIAL SCIENCE. THE FOURTH IS MOVING FROM DOING OUR RESEARCH IN WELL AND IT REPRESENT THE WHOLE AMERICAN POPULATION. THIS MOVE HAS GOT TO BE A PRIORITY FOR US BECAUSE JUST THINK ABOUT WHO NEEDS ANTIAGING PREVENTION THERAPIES MOST. CLEARLY, IT'S THE PEOPLE WHO HAVE THOSE SOCIAL AND BEHAVIORAL HALLMARKS OF AGING I MENTIONED 10 MINUTES AGO. THESE ARE PEOPLE WHO AGE FASTER AND DIE YOUNGER. PEOPLE FROM LOW SOCIOECONOMIC BACKGROUNDS AND ETHNIC GROUPS AND WHO EXPERIENCE ADVERSITY. AND IT'S IMPORTANT TO ASK IF GEROSCIENCE THERAPIES PROVE EFFECTIVE, WILL DISADVANTAGED GROUPS HAVE EQUAL ACCESS TO TECHNOLOGIES? WE DON'T WANT THIS TO MAKE THE HEALTH DISPARITIES WORSE THAN THEY ALREADY ARE IN AMERICA. IT WILL BE ESSENTIAL TO INCLUDE THE FASTEST AGING SOCIAL GROUPS IN GEROSCIENCE RANDOMIZED CLINICAL TRIAL. IT'S NOT GOING TO BE EASY BUT BEHAVIORAL AND SOCIAL SCIENCE IS WORKING TO MAKE IT HAPPEN. MY LAST SLIDE, MANY HERE TODAY WILL HAVE QUESTIONS ABOUT THE ETHICAL ISSUES IN RELATION TO THE GEROSCIENCE AGENDA AND BEHAVIORAL AND SOCIAL SCIENTIST ARTICULATING THESE QUESTIONS AND STARTING TO DEBATE THEM. THIS SLIDE SHOWS YOU A GREAT EXAMPLE OF A RESOURCE ON TOPIC RELATED TO ETHICS. THANK YOU VERY MUCH. >> GOOD MORNING. IF YOU'RE NOT CONVINCED ALREADY, I'M GOING TO TRY TO HELP CONVINCE YOU THAT WE ARE AT A SPECIAL TIME IN BIOMEDICAL RESEARCH AND THE PRACTICE OF MEDICINE AND INTRODUCE YOU TO THE TIME LINE AND THERE'S MANY WE CAN DRAW AROUND GEROSCIENCE AND ITS FORMULATION. THIS DESCRIBES CRITICAL INFLECTION POINTS. I WANT TO GO BACK TO THE LATE 1980s AND EARLY 1990s WHERE PEOPLE IN THIS ROOM DISCOVERED MUTATIONS IN GENES IN SIMPLE LABORATORY ANIMALS AND IT RADICALLY ALTERED THE WAY THE ANIMALS AGED. WE SAW RADICAL LIFE SPAN EXTENSIONS TO THE EXTENT THAT IT SEEMED UNBELIEVABLE 70%, 100%, EVENTUALLY INCREASES IN LIFE SPAN AND THIS CHANGE THE MIND SET OF THE SCIENTISTS LOOKING AT THE ANIMALS AND LOOKING AT THE DATA INTO THINKING AGEING WAS NOT INEVITABLE BUT PLASTIC AND WE SAW THE ANIMAL, NOT ALWAYS BUT SOMETIMES WERE HEALTHIER FOR LONGER. THAT WAS PARTICULARLY EXCITING. THEN WE CAME ON TO THE EARLY 2000s WHERE THE SAME OBSERVATIONS WERE BEING MADE WITH SMALL DRUG-LIKE MOLECULES. THAT MAKES YOU THINK, IS IT POSSIBLE WE COULD DO THIS IN MAMMALS AND HUMANS. WHEN WE GET TO THE MID 2000s WE HAD THE CONCEPT OF GEROSCIENCE ARISING AND THAT'S A WORD WE STARTED TO USE AT THE BUCK INSTITUTE IN CALIFORNIA TO ENCAPSULATE A CONCEPT GOING ON SINCE THE 1930s. WHEN HAVE YOU AN INTERVENTION THAT INCREASES LIFE SPAN, THERE IS THE POSSIBILITY YOU COULD INCREASE THE HEALTH SPAN AS WELL. THIS IS A DATA DRIVEN CONCEPT THAT GEROSCIENCE WAS INCAPSULATING THE RESEARCH BETWEEN THE BIOLOGY OF AGING AND TRYING TO UNDERSTAND THE BASIC PRINCIPLES OF AGING AND THOSE PEOPLE WHO ARE INTERESTED IN AGE-RELATED DISEASE, ALZHEIMER'S, CANCERS, PARKINSON'S AND SO ON AND THERE WAS A SCIENCE EMERGING BETWEEN THE FIELD AND IT WAS EXCITING TO THINK IF AGEING IS MECHANISTICALLY COUPLED TO DISEASE AS IT SEEMED TO BE BUT WE HAD INTERVENTIONS IN AGING, THAT WAS AN IMPORTANT CONCEPT YOU COULD PERHAPS INVENE NOT JUST IN AGE -- INTERVENE IN AGING BUT CHRONIC DISEASE. NOW I GO FORWARD TO NOW AND THERE'S A MAJOR INFLECTION POINT AND ACCELERATOR. YOU HEARD HOW THIS SCIENCE IS REALLY GOING FROM A SCIENCE PROJECT TO BIOMEDICINE. TRANSLATION IS HAPPENING AS YOU SPEAK AND MANY ARE INVOLVED IN THE ROOM IN MAKING THAT HAPPEN. ANOTHER COUPLE OF POINTS TO MAKE AT THIS TIME IS WE'RE SEEING A RADICAL INCREASE IN THE NOTION THAT SCIENCE CAN BE COMMERCIALIZED. THERE'S HUNDREDS OF COMPANIES FOCUSS FOCUSSED ON THE SCIENCE OF AGING AROUND THE WORLD. THE THIRD IS ENGAGEMENT. IT'S TIME THAT GEROSCIENCE AND THE BIOLOGY OF AGING BECOMES ENGAGED WITH THE WIDER BIOMEDICAL EVENT AND IT'S AN ATTEMPT TO DO THAT. SO WHAT DO WE HAVE? RIGHT NOW, IN LABS AROUND THE WORLD WE HAVE INTERVENTIONS THAT EXTEND LIFE SPAN IN LABORATORY ANIMALS. FLIES, WORMS, MICE. IN MANY CASES THE INTERVENTIONS SEEM TO EXTEND HEALTH SPAN AS WELL. THAT'S INCREDIBLY IMPORTANT. THE THIRD POINT IS THAT HEALTH SPAN ALONE IS NOT THE WHOLE THING. WE HAVE TO THINK ABOUT THE PERIOD OF ILLNESS AND WE HAVE UNPUBLISHED DATA AS DO OTHERS YOU CAN COMPRESS THE PERIOD OF ILLNESS LATE IN LIFE. THAT'S WASN'T NECESSARILY AN OUTCOME OF WHAT WE WERE THINKING ABOUT UNTIL NOW BUT IT SEEMS TO BE THE CASE YOU CAN EXTEND THE HEALTH SPAN AND COMPRESS THE PERIOD OF ILLNESS. AND WE HEARD THERE ARE SUPER AGERS WHO ARE ALREADY DOING THIS. THERE'S THE CENTENARIANS OUT AND VOLUNTEERING IN THEIR LOCAL COMMUNITIES. THEY'RE UP LADDERS AND PRUNING THEIR ROSES IN THE GARDEN. THERE ARE PEOPLE, EXCEPTIONAL PEOPLE WHO DON'T FALL INTO THE CATEGORY OF MULTIPLE DISEASES INNING -- IN LATE LIFE AND THE IDEA WE CAN COMPRESS THIS IS REAL AND IN LABORATORIES. AGING IS AIN'T -- AN INTERDISCIPLINARY I WANT TO FOCUS ON ONE HERE THAT'S EXCITING TO US AT THE MOMENT. THAT IS THE FEMALE REPRODUCTIVE LONGEVITY. IT'S AN UNDER STUDIED AREA IN THE BIOLOGY OF AGING AND SURPRISINGLY SO. IF YOU THINK ABOUT MENOPAUSE IS ONE OF THE FIRST SIGNS OF AGING AND IS ACTUALLY A PREDICTOR OF OTHER AGING OUTCOMES. AND OVARIAN AGING IS UNDER STUDIED AND UNDER FUNDED AND OF EXTREME INTEREST OF AGING BIOLOGY. I WANT TO POINT OUT THAT AGAIN, ENGAGEMENT IS REALLY IMPORTANT AND WE RECENTLY AT THE BUCK INSTITUTE RECEIVED FUNDING TO ESTABLISH A CENTER ON FEMALE REPRODUCTIVE LONGEVITY AND THIS IS THROUGH PHILANTHROPY AND I THINK PHILANTHROPY AND WE HOPE IT WILL HELP TRANSFORM MEDICINE. WE ALSO ESTABLISHED A FUND FOR FEMALE REPRODUCTION AND LONGEVITY. IT WASN'T ON THE RADAR. THREE YEARS AGO WE WEREN'T THINKING ABOUT THIS. VERY FEW SCIENTISTS HAVE BEEN THINKING ABOUT MENOPAUSE AND REPRODUCTIVE AGING AS THE BIOLOGY OF AGING AND IT CLEARLY IS. IT'S AN EXAMPLE OF WHAT IS HAPPENING FOR MANY DISEASES AND OTHER MEDICAL CONDITIONS. YOU UNDERSTAND THE AGING IS THE BIGGEST RISK FACTOR BUT MORE THAN THAT WE UNDERSTAND THE AGING IS A CAUSE AND A DRIVER OF DISEASE. AND WITH THAT I'LL STOP. >> SO FELIPE WOULD YOU LIKE TO ENTERTAIN A FEW QUESTIONS FROM THE AUDIENCE OR DO WE WANT TO LAUNCH INTO THE PANEL DISCUSSION? ARE THERE FOLLOW QUESTIONS FOR ANY OF THE PRESENTERS' PRESENTATIONS. PLEASE APPROACH THE MICROPHONE BEHIND YOU IF YOU DON'T MIND. THE SESSIONS ARE BEING WEBCAST. WE NEED TO USE THE MICROPHONES. >> THIS QUESTION IS FOR DR. NEWMAN BUT ANYONE ELSE WHO WANTS TO ANSWER. IF YOU WERE FDA COMMISSIONER FOR A DAY, ARE THERE THINGS YOU CAN DO IN TERMS OF WHAT FDA CALLS REGULATORY GUIDANCE OR REGULATO REGULATORY YOU THINK WOULD INCREASE INVESTOR CLINICAL AND SURROGATE END POINTS? >> I THINK WORK WITH THE FDA BY INVESTIGATORS IN THE TAME TRIAL HAS ENGAGED FDA AROUND THE CONCEPT OF MULTI-A -- MULTI-MORBIDITY AND TARGETS OF REGULATORY OUTCOME. THE IMMEDIATE OUTCOMES OF PHYSICAL AND COGNITIVE FUNCTIONING ARE HARDER TO SELL. I THINK WHEN YOU USE THE DICHOTOMOUS DISABILITY, DISABILITY-FREE SURVIVAL, I DON'T KNOW WHAT WOULD BE NECESSARY. I HAVE NEVER WORKED WITH THE FDA. I THINK AS WHAT WAS USED IN THE SPREE TRIAL AND THAT IS ALSO GOING TO BE USED IN THE NEW STATIN TRIAL CALLED PREVENTIBLE WHICH A LARGE PRAGMATIC TRIAL OF STATINS IN PEOPLE OVER 75, I THINK THAT COULD BE USED. >> AS PART OF THE GEROSCIENCE INTEREST GROUP WE ORGANIZED A MEETING WITH THE FDA YEARS AGO AND CONVERSATIONS ARE STILL GOING ON AND I'D LIKE TO INVITE DR. HOTTIS OR DR. EVANS TO GIVE US AN UPDATE OF WHERE WE ARE. IF IT'S APPROPRIATE OR IF IT'S STILL NOT FOR PUBLIC CONSUMPTION, THAT'S FINE. >> I'M INTERESTED AND VERY EXCITEDED. >> I PUT YOU ON THE SPOT. >> I THINK WHAT WE CAN SAY IN TERMS OF INTERACTIONS WITH THE FDA AS ALLUDED TO, FELIPE, RON AND OTHERS HAVE HAD A SERIES OF MEETINGS WITH FDA LEADERSHIP AND HOPEFULLY WE'LL SOON BE ISSUING A DOCUMENT OF GUIDANCE. THE MECHANISMS DO EXIST AND HOPE TO FARM -- FORMALIZE THAT TO YOU IN THE VERY NEAR FUTURE. >> I'M EXCITE ABOUT THE POTENTIAL OF THE METHYLATION CLOCKS THE NEW ONES DEVELOPED BY HORVATH AND THE LAB AT UCLA. THERE ARE CLEARLY EPI GENETIC CHANGES WITH AGING AND THE BIG QUESTION FOR US IS ARE THESE RESPONSES TO THE DAMAGE OF AGING OR ARE THEY THE CAUSES OF AGING OR SOME MIXTURE OF THE TWO? AND I'M INTERESTED WHETHER YOU KNOW OF RESEARCH TO SEPARATE, WHICH METHYLATION SITES ARE CAUSES OF AGING AND THOSE WE WANT TO BE EXPRESSING AND WHICH METHYLATION SITES REPRESENT RESPONSES TO AGING AND PERHAPS IF WE SLOW THE AGING CLOCK IN THOSE AREAS, WE WILL BE ACCELERATING TIME TO DEATH NOT -- SO THE AGING CLOCK IS POTENTIALLY A GREAT TOOL BUT WE HAVE TO KNOW WHETHER INTERVENTION SET BACK THE AGING CLOCK ARE REALLY INCREASING OUR LIFE EXPECTANCY. WHAT IS THE STATE OF RESEARCH IN THAT AREA AND WHO IS WORKING ON THAT? >> I THINK WITH ANY BIOMARKER OF AGING WHETHER IT'S EPI GENETIC OR PROTEOMIC, WE'LL SEE A MIXTURE, AS YOU SUGGEST. THERE'S BE DRIVERS OF AGING REPRESENTED BY THE CHANGES AND ALSO RESPONSES TO THE ACCUMULATION OF DAMAGE OR OTHER EFFECTS ON AGING AND I THINK TERE ARE MANY MANY PEOPLE WORKING ON THIS. OBVIOUSLY, THE IDENTIFICATION OF GOOD BIOMARKERS IS A CRITICAL PROBLEM IN THE FIELD RIGHT NOW. WE NEED TO BE ABLE TO SEE RESPONSES RAPIDLY TO INTERVENTIONS AND THE EPI GENETIC CLOCK IS GREAT AND MANY PEOPLE ARE WORKING WITH THIS RIGHT NOW. BUT WE NEED OTHERS INCLUDING PROTEOMIC CHANGES THAT REPRESENT THE PHENOTYPE OF SENESCENT CELLS AND THERE'S LOTS OF OPPORTUNITIES THERE AND PEOPLE WORKING ON THIS. AS YOU SAY, THINK WE'LL SEE A BLEND OF RESPONSE TO CHANGE DURING AGING AND DRIVERS OF AGING AND I THINK IT WILL BE DIFFICULT TO IT'S OUT WHO THOSE ARE. WE STILL NEED TO INVEST IN THE BASIC BIOLOGY OF AGING AND THINK OF IT AS A PIPELINE FROM BIOLOGY TO INVENTIONS WE NEED TO KEEP FEEDING THE PIPELINE BY DOING THE BASIC RESEARCH. >> THAT'S A GREAT QUESTION. CAN >> I CAN TRY TO ADD A LITTLE BIT. FOR PEOPLE WHO AREN'T THAT FAMILIAR WITH THE EPI GENETIC CLOCKS, TO GIVE A BIT OF BACKGROUND, THESE ARE CLOCKS THAT ARE BUILT BY TRAINING, EPIGENETIC METHYLATION PATTERNS ON A PERSON'S DATE OF BIRTH. USUALLY THEY TAKE A LARGE SAMPLE OF PEOPLE OF DIFFERENT DATES OF BIRTH. PEOPLE FROM AGE 18 TO 80 AND TRAIN THE EP EC GENETIC -- EPIGENETIC PROFILES TO OBTAIN THE ALGORITHM. ONE OF THE CHALLENGES WITH THIS IS THIS KIND OF TRAINING CAPTURES ALSO COHORT DIFFERENCES IN WHAT PEOPLE WERE EXPOSED TO AS THEY WERE GROWING UP. SO PEOPLE WHO ARE IN THE OLDER AGED GROUPS, THEY'RE DNA METHYLATION PATTERNS HAVE BEEN INFLUENCED BY AIRBORNE LED AND TOBACCO SMOKE NOT AGING. THERE'S A BIT OF NOISE IN THERE AND WE DON'T KNOW HOW MUCH. THE MODEL ALGORITHM I SPOKE ABOUT IS QUITE DIFFERENT IN THAT IS IT'S NOT TRAINED ON DATA OF BIRTH. IT'S TRAINED IN A SAMPLE OF 1,000 INDIVIDUALS ALL BORN IN THE SAME YEAR ON HOW THEY SCORE ON A PANEL OF BIOMARKERS TAKEN IN THEIR 20s, 30s AND 40s AND SOON IN THEIR 50s. SO WE'RE ACTUALLY STUDYING ACTUAL CHANGE IN BIOLOGICAL AGE. THAT'S WHY WE CALL IT THE PACE OF AGE INSTEAD OF AN EPIGENETIC CLOCK. WHETHER IT WILL DO BETTER OR NOT IS SOMETHING WE WILL BE FINDING OUT. WHAT WE DO HAVE IS METHYLATION DATA COLLECTED AT EACH OF THOSE AGES. WE CAN LOOK AT WHETHER THE METHYLATION PROFILES CHANGE ALONG WITH THE BIOMARKER PROFILES AND THAT'S THE WORK WE'RE DOING NOW. IT'S TOO EARLY DAYS TO TELL YOU ABOUT IT NOW BUT I WANT TO MAKE SURE PEOPLE UNDERSTAND THERE'S CLOCKS AND THEN PACE OF AGING AND BOTH USE DNA METHYL BUT DIFFERENT TECHNOLOGY. >> IF I CAN FOLLOW-UP. THANK YOU, IT'S IMPORTANT TO RECOGNIZE AND IN CASE YOU'RE NOT FAMILIAR OR SOME OF THE AUDIENCE ISN'T FAMILIAR THE LATEST GRIM AGE CLOCK 2019 IS DEVELOPED BY LOOKING AT BLOOD SAMPLES, HISTORICALLY FROM PEOPLE 20 YEARS AGO, LOOKING AT WHAT HAPPENED TO THOSE PEOPLE DURING THE INTERVENING 20 YEARS. SO IT IS AN AGE COHORT AS YOU DESCRIBE AND IT IS PREDICTIVE, SPECIFICALLY DESIGNED TO BE PREDICTIVE OF HEALTH OUTCOMES AS WE CAN SEE RETROSPECTIVELY BECAUSE WE HAVE 20-YEAR-OLD BLOOD SAMPLES AND KNOW WHAT HAPPENS TO THE PEOPLE DURING THE INTERVENING 20 YEARS. >> THANK YOU. >> I'M CYNTHIA CANYON. SO YES, I'M GLAD YOU SPOKE BECAUSE I WANT TO ADDRESS THE SAME TOPIC. IF THERE'S SOMETHING THAT CORRELATES WITH CHRONOLOGICAL AGE LIKE THE METHYLATION PATTERN TO DETERMINE IF IT'S CAUSAL YOU HAVE TO CHANGE IT AND IF YOU CHANGE THE PATTERN YOU CHANGE SOME BIOLOGICAL PARAMETER WITH AGING AND THAT'S ACTUALLY BEEN DONE. IT'S NOT PROOF BUT THERE'S A PAPER FROM DAVID SINCLAIR'S LAB AND HASN'T BEEN PEER-REVIEWED. IT'S ONLY ON ARCHIVE YET BUT IT'S KIND OF ENCOURAGING. THEY USED PULSES OF YAMONACA FACTORS THAT CAN REVERSE SIGNS OF AGING. THEY LOOKED AT ADULT MICE AND CRUSHED THE OPTIC NERVE AND IF YOU DO THAT IN AN OLD MOUSE IT DOESN'T GROW BACK BUT IF YOU GIVE THEM THAT FACTOR IT GROWS BACK WHICH IS BY ITSELF ASTOUNDING AND MEASURED THE METHYLATION PATTERN BEFORE AND AFTER THE TREATMENT. THEY SHOWED IT REVERTED TO A PATTERN CHARACTERISTIC OF A YOUNGER TIME. AND ACTIVATED ENZYMES IN THE ANIMAL THAT EFFECT THE METHYLATION PATTERN SO A CAUSE AND EFFECT AND IF THEY ALTER THE PATTERN FROM CHANGE NEVER GOT THE REGROWTH OF THE OPTIC NERVE. I'M BRINGING IT UP, MAYBE IT'S NOT EVEN TRUE BECAUSE IT'S NOT TRUE BECAUSE IT HASN'T BEEN PIER REVIEWED BUT IT'S A -- PIER PEER-REVIEWED AND IT'S A HINT THIS MAY BE CAUSAL. >> I'VE BEEN TOLD LOBSTERS AGE DIFFERENTLY AND HARDLY AT ALL. IS THAT CORRECT? IF SO, WHAT DO THEY HAVE WE HAVEN'T? >> YES, THERE'S LITTLE EVIDENCE THAT LOBSTERS DEATH AIN'T AND THE CLAM HOLDS THE RECORD FOR THE LARGEST LIFE SPAN. IT LIVES AT LEAST 500 YEARS. THE RECORD IS 507 WHICH IS ASTONISHING IF YOU THINK ABOUT IT IN HUMAN TERMS. WE'RE THINKING ABOUT CLAMS IN THE OCEAN NOW THE MAY FLOWER SAILED OVER AND A COMPLEX ANIMAL. THE CLAM HAS A BEATING HEART AND SIR CULE ATRY CIRCUIT AND IF YOU'RE INTERESTED IN CARDIOVASCULAR DISEASE YOU'RE INTERESTED IN THAT EXAMPLE. THERE'S EXAMPLES OF LONGEVITY IN THE ANIMAL KINGDOM CONFUSING TO US AND IT'S AN UNDER STUDIED AREA. THE BIOLOGY OF AGING HAS SECRETS WE SHOULD TRY TO UNCOVER. >> I'M A GEAR YA TRIGS AND SOCIAL -- GER GEAYOU COMMENTED THAT YOUNGER PEOPLE WHO HAVE THESE DISABILITIES IS WHERE WE SHOULD MOVE THE RESEARCH. MY QUESTION IS, SHOULD WE STUD DIED YOUNGER PEOPLE -- STUDY YOUNGER PEOPLE FACING DISCRIMINATORY SITUATIONS OR STUDY THE OLDER PEOPLE WHO HAVE MANAGED TO SURVIVE THAT WHO KNOW LONGER HAVE BEEN AS VICTIMIZED BY IT. WOULD WE CHOOSE ONE OR THE OTHER AND I'M CONCERNED ABOUT AGING BEING EITHER A DISPARITY OR SOMETHING ELSE IF WE'RE GOING TO GO TO YOUNGER PEOPLE NOW TO STUDY AGING. SFWLAJ BEGINS >> AGING BEGINS AT BIRTH OR EVEN YOUNGER DEPENDING ON THE MOTHER'S OVUM. THE ISSUE OF DISPARITIES WE SEE EVERY DAY IN THE COUNTRY WHEN YOU LOOK AT DIFFERENCES IN BIRTH OUTCOMES AND OLDER AGE AND MIDDLE AGE. THERE'S GROUPS IN THE UNITED STATES THAT HAVE LIFE SPAN AND LIFE SPAN SIMILAR TO DEVELOPING COUNTRIES. SO THERE'S HUGE SOCIAL DISPARITY IN AGING FROM THROUGHOUT THE LIFE SPAN. I THINK IT HAS A DISPARITY ISSUE THAT IF WE COULD DO WHAT WE ALREADY KNOW FOR THE WHOLE POPULATION, A LIFE SPAN AND HEALTH SPAN COULD BE TREMENDOUSLY IMPROVED. >> I HAVE NOTICED BECAUSE I'M 64, ACCESS TO MEDICARE AND SOCIAL SECURITY IS BASED ON OUR CHRONOLOGICAL AGE. BECAUSE I SPENT THE FIRST HALF MY CAREER STUDYING CHILD DEVELOPMENT, WE DON'T DO THAT IN CHILD DEVELOPMENT. AND WE LOOK TO ACCESS TO SCHOOLING WHEN THEY'RE DEVELOPMENTALLY READY OR WE DON'T JUST SAY BECAUSE YOU ARE THIS AGE YOU MUST DO THIS THING. AND BECAUSE WE'VE BEEN STUDYING THE BIOLOGICAL AGING, BY MID LIFE THERE'S ENORMOUS VARIATION IN HOW PEOPLE ARE AGE AND HOW FIT THEY ARE AND PAIN AND HOW COGNITIVE FUNCTION HAS DECLINED AND HOW MUCH THE IF I FI -- PHYSICAL FUNCTION IS STARTING TO DECLINE AND STARTED TO WORRY ABOUT PEOPLE WHO WAY NOT MAKE IT UNTIL THEY COME TO THE CHRONOLOGICAL AGE AND THEY CAME FROM HISTORIES OF MINORITY GROUP OR HISTORIES OF MALTREATMENT OR POOR FAMILIES. THERE'S PEOPLE WHO NEED TO BE ABLE TO ACCESS RETIREMENT SERVICES YOUNGER THAN THE REST OF US. I THINK WE'LL BE MORE AWARE THAT BUY LOD BIOLOGICAL AGING IS VERY DIFFERENT AND IT DOESN'T ALWAYS HAPPEN ON OUR 65th BIRTHDAYS. >> AGING IS A UNIVERSAL PROCESS. EACH PERSON AGES IN HIS OR HER OWN WAY. SHOULD GEROSCIENCE BEING PERSONALIZED AND WHAT IS YOUR OPINION. >> I THINK THE POINT YOU MAKE IS AN ABSOLUTELY FUNDAMENTAL TRUTH OF THE AGING PROCESS BEING HETEROGENEOUS ACROSS INDIVIDUALS. I THINK IT'S THE PERFECT SUBJECT FOR TARGETED PERSONALIZED THERAPY. >> AND WE KNOW FROM THE ANIMAL MODELS THAT INTERVENTIONS THAT WORK IN ONE GENETIC BACKGROUND DO NOT NECESSARILY WORK IN ANOTHER AND ACTUALLY CAN BE HARMFUL IN CERTAINLY GENETIC BACKGROUNDS AND INDIVIDUALIZED APPROACHES WILL BE NECESSARY. >> I'LL ADD GENETIC BACKGROUND IS IMPORTANT AND SOCIAL AND EVERYTHING. YES, IT HAS TO BE PERSONALIZED SO ONE WAY WE ENVISION THIS IS BY FOCUSSING ON THE PILLARS OR HALLMARKS OF AGING AND MEASURING FOR INDIVIDUALS HOW THEY'RE DOING. BASICALLY, WHAT HAPPENS IS WE'RE TALKING ABOUT THINGS BEING DONE EARLY AS PREVENTION NOT AS TREATMENT. SO WE'RE NOT TALKING ABOUT DISEASE. WE'RE NOT TALKING ABOUT PEOPLE ALREADY SICK. AND THEREFORE HOW DO WE INDIVIDUALIZED THAT IF WE HAVE NO SYMPTOMS. ONE WAY OF GOING BEFORE THE SYMPTOMS IS TO LOOK PRECISELY AT THE HALLMARKS OF AGING. MAYBE I HAVE GOOD STEM CELLS AND ANOTHER PERSON MAY BE DIFFERENT. THAT'S ONE WAY IN WHICH WE ENVISION IT FOR THE FUTURE BUT WE'RE NOT THERE YET. WE NEED MORE OF THE BIOMARKERS OF AGING AND MORE OF THE CLOCKS AT DIFFERENT LEVELS. >> CAN I ASK THE PANEL THOUGH TO SORT OF SAY MORE WITH THE METHOD LOGICAL APPROACHES ESPECIALLY IF WE THINK OF DR. MOFFITT'S PERSPECTIVE ABOUT ELEVATING THE STUDY OF GEROSCIENCE TO WHOLE POPULATIONS. WHAT ARE THE PARTICULAR METHOD LOGICAL APPROACHES THAT WOULD ALLOW US TO DO THAT IN A VERY MORE PERSONALIZED OR INDIVIDUAL MANNER TO CAPTURE THE IMMENSE HETEROGENEITY? >> MAYBE I CAN SAY SOMETHING INTELLIGIBLE HERE. BECAUSE MY RESEARCH PROGRAM FOLLOWS DIFFERENT DISEASES AND I LOOK AT HOW DIFFERENT PEOPLE ARE IN BIOLOGICAL AGE AGED 45 CHRONOLOGICALLY BUT RANGE FROM 35 TO 65, THAT KIND OF RESEARCH TELLS ME THE PERSONALIZED MEDICINE APPROACH IS SPOT ON CONCEPTUALLY. HOWEVER, WHAT I HAVE NOTICED BY OBSERVING THE PERSONALIZED MEDICINE APPROACH IS IT TENDS TO WORK BEST WHEN HAVE YOU A THERAPY OR THERAPEUTIC AGENT THAT'S MATURE IN THE PROCESS THAT WE KNOW WELL HOW IT WORKS AND HOW INDIVIDUALS RESPOND TO IT. WE KNOW WHAT THE SIDE EFFECTS ARE. THE BUGS ARE REALLY WORKED OUT. SOMETHING THAT'S A MATURE AND ADVANCED THERAPEUTIC APPROACH. THE STAGE WE ARE IN GEROSCIENCE IS WE'RE REALLY AT AN EARLY STAGE THAN THAT IN THE CLINICAL TRANSLATION PROCESS. SO I WOULDN'T PUSH TOO HARD IN JUMPING TO THE PERSONALIZED APPROACH TOO SWIFTLY UNTIL WE GET THE BUGS OUT. WHAT I'M MORE CONCERNED ABOUT IS THAT WHAT WE KNOW IS THE INDIVIDUALS WHO HAVE A BACKGROUND OF ADVERSITY. INDIVIDUALS WHO HAVE NOT A NON-CONSCIENTIOUS PERSONAL AND LACK FITNESS THESE PEOPLE ARE DIFFICULT TO GET TO TAKE PART IN CLINICAL TRIALS AND IT'S DIFFICULT TO GET THEM TO ADHERE TO MEDICATION REGIMENTS CLOSELY AND THEY TEND TO DROP OUT OF CLINICAL TRIALS AND THAT BIASES THE INITIAL RANDOM ASSIGNMENT. I'M MORE CONCERNED AT THIS STAGE OF GEROSCIENCE TRANSLATION WHERE HETEROGENEITY AND FACTORS WILL SPOIL OUR TRIALS AND OUR CHANCES OF FINDING TREATMENT WORK. BEHAVIORAL AND SOCIAL SCIENCES CAN DO AT THIS POINT IS AT AN EARLIER STEP THAN WHAT I HOPE THE PERSONALIZED MEDICINE FOLKS WILL DO LATER ON. >> I'M DIANA BIANCHI THE DIRECTOR AND I'M NOT SURE WHAT YEAR AGING BECAME A SEPARATE INSTITUTE BUT I'D LIKE TO ARGUE FOR AT LEAST CONCEPTUALLY IN THINKING ABOUT GEROSCIENCE WE NEED TO THINK ABOUT AS SOME PEOPLE HAVE SAID, PRENATAL DEVELOPMENT, PRECONCEPTUAL DEVELOPMENT. I'M SURPRISED THIS MORNING NO ONE HAS MENTION THE BARKER HYPOTHESIS WHICH IS THE BIRTH WEIGHT IS A STRONG PREDICTOR OF CARDIOVASCULAR DISEASE. WITH AND WE KNOW THERE ARE BABIES BORN VERY GROWTH RESTRICTED AND HYPERMATURE IN MANY WAYS WE INVESTED $87 MILLION IN THE PLACENTA PROJECT AND THERE'S AMYLOID PRECURSOR PROTEINS EXPRESSED. I THINK THERE'S A GREAT OPPORTUNITY. I'VE BEEN TRYING TO THINK THIS MORNING OF A CLEVER WAY OF PUTTING THE CONCEPTS TOGETHER, NEOSCIENCE NEEDS GEROSCIENCE OR SOMETHING LIKE THAT BUT WHAT WOULD IT TAKE TO THINK MORE HOLISTICALLY FROM THE MOTHER'S AGE AT THE TIME HER EGG IS OVULATED AND PREGNANCY AND COMING INTO THE WORLD WITH STRESS AND DIFFERENCES IN BIRTH WEIGHT? >> SO A LOT OF WHAT WE KNOW ABOUT THAT IS LOOKING BACK IN TIME AND WHAT IS REALLY NEEDED IS TO START PRE CONCEPTION AND LOOK FORWARD AND THAT'S BEEN A DIFFICULT STUDY DESIGN TO ESTABLISH AND IT REQUIRES A MULTIGENERATIONAL INVESTMENT. I DO THINK PEOPLE INTERESTED IN AGING ARE VERY WELL AWARE THAT AGING HAS EVERYTHING TO DO WITH THE QUALITY OF THE PREGNANCY THAT GAVE BIRTH TO THE CHILD AND THE STRESS IN UTERO. HOW TO BRING THAT TOGETHER REQUIRES TREMENDOUSLY LONG TERM STUDIES AND AN INVESTMENT IN A BIRTH COHORT. >> WE HAVE BEEN ING IN CO-- INVESTING IN COHORT ARE AGING AND NOW HANDING THEM TO THE AGING INSTITUTE. THERE'S OPPORTUNITIES. >> THANK YOU. >> I'M FROM GERMANY AND I HAVE A QUESTION TO THE PANEL BECAUSE IT'S ABOUT PRINCIPLES OF GEROSCIENCE AND MY QUESTION IS DO WE HAVE NOW IN MUNICH A DEFINITION OF WHAT A HEALTH SPAN IS? FOR ME AS CLINICIANS, I'M LOOKING MAYBE IN A DIFFERENT WAY ON ALL THE PERSONS AS A BIOLOGIST AND EPIDEMIOLOGISTS AND BEHAVIORAL AND SOCIAL SCIENTISTS. ARE WE COME STEP FURTHER WHERE WE HAVE A DEFINITION FOR EVERY DISCIPLINE? >> I DON'T THINK WE HAVE A UNIFIED DEFINITION OF HEALTH SPAN OR CLOSE TO GET ONE. DIFFERENT PEOPLE WILL USE DIFFERENT APPROACHES. IT'S A MATTER OF OPERATIONALIZING THESE AND AGREEING ON THE COMPONENTS OF IT. >> HOW DO YOU MEASURE IT IN THE CLINIC? I DON'T SEE IT CHANGING IN THE FUTURE. DO YOU, ANN? >> I'M EXCITED THE PREVENTIBLE TRIAL IS USING DISABILITY-FREE SURVIVAL AS A METRIC OF HEALTH SPAN AND WE'LL OPERATIONALIZE THAT IN A 20,000 PERSON STUDY AND WILL HELP DRIVE MEASURES OF FUNCTION INTO CLINICAL PRACTICE. ONE CHALLENGE IS WE DON'T HAVE ROUTINE STANDARD MEASURES OF PHYSICAL AND COGNITIVE FUNCTION IN PRACTICE RIGHT NOW THAT ALL CLINICIANS USE. THERE'S VARIATIONS, DIFFERENT TYPES. TO PUT IT ALL TOGETHER NOBODY HAS COME UP WITH THE AGREEMENT OF ONE WAY OF DOING IT BUT THE PREVENTIBLE TRIAL WILL DO IT IN 20,000 PEOPLE I THINK THAT WILL HELP WITH A MORE CONSENSUS APPROACH. >> LIZ NEILSON FROM THE NATIONAL INSTITUTE ON AGING AND WOULD LIKE TO FOLLOW-UP ON DR. BIANCHI'S COMMENTS THERE'S ANOTHER GROUP THE DEVELOPMENT ORIGINS OF HEALTH AND DISEASE INTEREST GROUP WHICH LINK MANY OF THE GROUPS GATHERED HERE. TRADITIONALLY WE'RE FOCUSSED ON THE EARLY LIFE ORIGINS OF DISEASES IN CHILDHOOD BUT INCREASINGLY, TAKING A LIFE SPAN PERSPECTIVE AND WE'VE JOINED THAT GROUP PARTLY BECAUSE TWO OF OUR DIVISIONS THE GERIATRICS AND CLINICAL GEAR -- GERONTOLOGY ARE INTERESTED IN FACTORS THAT LEAD TO LATER LIFE DISEASE PROFILES AND IN OUR OWN GROUP WE'RE INTERESTED IN THINKING OF WHAT WE CAN UNDERSTAND FROM HOW DEVELOPMENT GETS PROGRAMMED EARLY AND WHAT WE CAN DO IN LATER LIFE AND MIDLIFE AND WE STARTED AN INTERDISCIPLINARY SCIENCE REVERSIBILITY NETWORK TO TRY TO UNDERSTAND THE MALLEABILITY OF PROCESS HAS TO GET GOING EARLY IN LIFE OR PRE-NATALLY. I THINK THERE'S COOPERATION BETWEEN THE GROUPS THAT COULD POTENTIALLY ADVANCE SOME OF THE DIALOGUE. >> THANK YOU. >> ONE MORE. >> WHEN WE THINK ABOUT AGING AND AGE IS A UNIT OF TIME AGING HAS ALREADY BEEN MENTIONED HERE AS BIOLOGICAL AND SOCIAL AGING AND PSYCHOLOGICAL AGING, AND I IS IT LIMITED TO THE BIOLOGICAL AGING OR WIDER. ALSO, TWO MONTHS AGO I WAS IN ISRAEL AND I'M A PSYCHOLOGIST AND SCIENTIST AND CLINICIAN AND WE HAVE LOOKED AT ALL THE DIFFERENT CLOCKS. WHAT'S THE UNITS OF THIS TIME IF& YOU USE CLOCK, IT'S A METAPHOR OR IF YOU HAVE SOME SPECIAL UNIT FOR TIME. WE NEED TO UNDERSTAND WHAT IS THE BIOLOGICAL TIME MEAN. AND WHAT'S IT TEACHING IN OUR BUCKET OR ORGANISM TO MACHINE BIOLOGICAL AGE. IS IT A METAPHOR OR SOMETHING MORE TANGIBLE. WHAT'S THE UNITS OF THE BIOLOGICAL TIME. MY LAST COMMENTS IS IN PSYCHIATRY YOU HAVE DIFFERENT TIMES AND THEY'LL DISEASE AND PROBLEMS ARE DIFFERENT CLOCKS ARE NOT SYNCHRONIZED. THEN THE BIOLOGICAL CLOCK AND BIOLOGICAL AND OTHER CLOCKS ARE SI SYNCHRONIZED. IF NOT THERE'S ALL KINDS OF PROBLEM. I'M TOO YOUNG FROM ONE POINT OF VIEW BUT TOO OLD FROM ANOTHER POINT OF VIEW. I'M TOO YOUNG FROM ANOTHER. MY BRAIN IS AND KIDNEYS IS DIFFERENT AND MY SITUATION IS DIFFERENT BUT IT'S A QUESTION ON THE UNITS OF DIFFERENT TIMES. WHAT IS THE UNIT OF BIOLOGICAL TIME AND SOCIAL TIME. UNITS OF PSYCHOLOGICAL TIME AND ETCETERA UNTIL WE DO NOT UNDERSTAND. THERE'S HUGE AMOUNT OF DATA WITH NO UNDERSTANDING WHAT IT'S ABOUT. >> THAT'S GIVE THE PANEL AN OPPORTUNITY TO ADDRESS THAT IF ANYONE CAN TAKE THAT VERY FULL QUESTION. >> THE PROBLEM IS WE'RE NOT TALKING ABOUT TIME BUT PHYSIOLOGY AND BIOLOGY AND IT CHANGES WITH TIME BUT THAT'S WHY WE MAKE THE DIFFERENCE BETWEEN CHRONOLOGICAL AND PHYSIOLOGICAL AGE BUT THE QUESTION'S TOO LONG TO ANSWER NOW. IT'S POSSIBLE THERE ISN'T SIN CROW ANY BETWEEN DIFFERENT SYSTEMS. SOME PEOPLE WILL HAVE ACCELERATED DESIGN IN KIDNEY FUNCTION OR BRIAN FUNCTION WHICH IS -- BRAIN FUNCTION AND MOST PEOPLE LOOK TO COMPOSITES AND IF THERE'S AN INTERVENTION IT AFFECTS ALL THESE ELEMENTS IN A POSITI POSITIVE DIRECTION BUT NOT AT THE SAME RATES. SO WE USE COMPOSITE FOR THAT REASON. >> I'M FROM WASHINGTON UNIVERSITY AND SHRINER'S HOSPITAL IN ST. LOUIS. I WANT TO FOLLOW-UP ON THE COMMENT BEEN THE DOHED TO INTERGENERATIONAL TRANSMISSION OF ALL THE RISK FACTORS STUDIED MOST LIN MICE BUT ANIMALS BECAUSE THEY'RE DIFFICULT TO DO IN HUMANS, TWO, THREE, EVEN FOUR GENERATIONS OF EPI GENETIC OR POSSIBLY MICROBIOME CAN ALTER YOUR AGING PROCESS EVEN BEFORE CONCEPTION. FACT THAT AGING CAN ACTUALLY START THREE GENERATIONS BACK I THINK IS SOMETHING WE NEED TO LOOK AT AS A TARGET FOR FUTURE THERAPIES. I'D LOVE TO HEAR WHAT YOU HAVE TO SAY IN THE AREAS YOU'RE WORKING ON AND HOW WE MIGHT BRING THAT TO A DIAGNOSTIC OR THERAPY. >> I'M NOT WORKING IN THAT AREA BUT I THINK FROM ALL THE OTHER COMMENTS WE AGREE IT NEEDS TO HAVE A LIFE SPAN PERSPECTIVE AND INTERGENERATIONAL ONE. >> DR. MOFFITT. I BELIEVE YOUR GROUP HAS WORKED ON INTERGENERATIONAL TRANSMISSION ADVERSITY AND OTHER THINGS LIKE THAT. DO YOU HAVE A PARTICULAR RESPECTIVE? >> WE HAVE IN THE COHORT OF PEOPLE WE STUDY. WE HAVE INCLUDED ALL THREE GENERATIONS. AND IT'S CLEAR THAT ADVERSITIES AND DISADVANTAGE ARE CONCENTRATED IN FAMILIES AND CROSS GENERATIONS. PEOPLE HAVE NOT JUST THEIR OWN HISTORY BUT FAMILY HISTORY. WHAT YOU'RE SAYING IS ABSOLUTELY RIGHT. I THINK WHEN I FIRST CAME TO THIS IDEA OF GEROSCIENCE ONE OF THE FIRST PAPER I READ IN 2013 OR 2012 AND THOUGHT THIS IS CHANGING EVERYTHING. THIS IS SUCH AN INTERESTING IDEA. THEN I BEGAN TO CONTACT PEOPLE IN GEROSCIENCE AND TALK TO THEM ABOUT FAMILY HISTORIES OF ADVERSITY AND THEY SAID THAT'S NOT AGING. WE HAVE THE CELLULAR HALLMARKS OF AGING IF THERE'S ANYTHING THAT CHANGES, AGING THAT IS SOCIAL IT'S NOT AGING. NOTHING TO DO WITH US. SO WHAT'S INTERESTING IS HOW MUCH THAT HAS CHANGED. NOW HERE I SIT AT THIS TABLE. WHAT YOU'RE SAYING IS RIGHT AND I THINK THE GEROSCIENCE COMMUNITY IS TO BE APPLAUDED AND CONGRATULATED FOR THESE IDEAS AND IT BRINGS ALL KINDS OF WONDERFUL QUESTIONS TO BE ASKED ACROSS GENERATIONS BOTH WITH BIOLOGICAL AND SOCIAL MEASURES. I'M QUITE THRILLED ABOUT IT. THANKS FOR BRINGING THAT UP. >> WE CAN EVOLVE AT THE RIGHT PROBLEM. >> I HAVE A QUESTION FOR DR. MOFFITT ALSO. FIRST, I'M GLAD YOU'RE HEAR AND I APPRECIATE YOUR PERSPECTIVE. IT'S GREAT. >> ONE OF THE PHYSIO LOGIC RESPONSES TO AGEING IS CORTISOL. I'M WONDERING TO WHAT EXTENT THIS AGING DOES TO CORTISOL. THERE'S EXPERIMENTS IN MICE SHOWING RAPAMYCIN CAN HAVE AN EFFECT SO IF IT'S CORT SOL -- CORTISOL AND IS THERE AN ANIMAL MODEL. I KNOW BABOONS CAN BE STRESSED BUT IS THERE WHERE YOU CAN TEST INTERVENTIONS AND IF PEOPLE MEASURE CORTISOL LEVELS IN YOUR COHORTS IN THESE PEOPLE. >> WE HAVE NOT MEASURED CORTISOL LEVELS SIMPLY BECAUSE OF TECHNICAL AND VEG TERRY CONSTRAINTS. WHEN OUR MEMBERS WERE CHILDREN GROWING UP, CORTISOL WAS A NEW FIELD AND IT COST ABOUT $25 A SAMPLE AND UNDERSTOOD YOU NEEDED TO SAMPLE REPEATEDLY ACROSS A CHALLENGE PARADIGM AND MAYBE COLLECT MANY EVENTS PER KIND -- CHILD. WE COST RAISE THE MONEY BUT YOUR IDEA WOULD CALL FOR SECONDARY ANALYSIS OF AGING OUTCOMES IN ALL THE COHORTS IT HAS FUNDED CORTISOL DATA COLLECTION IN OVER THE YEARS. THAT WOULD BE GREAT RFA. >> THANK YOU FOR A WONDERFUL PANEL. GOT MIGRAINE GOING IN DIFFERENT DIRECTIONS. DRUG AND ALCOHOL USE AND TOBACCO USE IN PARTICULAR ARE THOUGHT AS A NUISANCE IN TERMS OF AGING RESEARCH. WE KNOW THESE ARE BAD FOR OUR BODIES IN SO MANY WAYS. WHERE THERE WAYS WE THINK OF THE MECHANISTIC ACTIONS OF THESE SUBSTANCES AS WAYS OF STUDYING THE APPROACHES IN NOVEL APPROACHES AND RATHER THAN A NUISANCE SOMETHING TO CONTROL FOR IN THE LONGITUDINAL STUDIES AND MAYBE THEY WERE SMOKERS, FOR EXAMPLE. BUT WAYS TO HELP US UNCOVER THE SOURCES OF THIS AND MAYBE NEW TREATMENTS EVEN. >> WE DO CONSIDER BECAUSE ACTUALLY ALCOHOL SUBSTANCE ABUSE LIKE OBESITY AND OTHERS ARE AGING ACCELERATOR. HOW DOES TOBACCO AFFECT AGING? IT'S NOT JUST THE CARCINOGEN IN YOUR LUNG, IT AFFECTS YOUR RATE OF AGING. AND THAT'S PART OF WHAT WE DISCUSSED IN THE SCOREBOARD SUMMIT OF GEROSCIENCE. WE DIDN'T USE TOBACCO IN THE EXAMPLE. I THINK IT WOULD HAVE BEEN A BETTER IDEA I JUST DIDN'T THINK ABOUT IT THEN. >> ONE THING I WANT TO HIGHLIGHT I'M TAKING FROM THE MEETING IS THE IMPORTANCE OF COMMON WE'RE PARTNERING WITH FDA IN A LONGITUDINAL COHORT STUDY AND LOOKING FOR BUILDING MEASURES YOU ASCRIBED INTO THE 40,000 PERSON COHORT. THANK YOU VERY MUCH. >> I'D LIKE TO MAKE ONE MORE COMMENT ABOUT THE SMOKING. THERE'S A LOT OF INTEREST IN THE ANIMAL LITERATURE ABOUT USING TOXINS AND ABILITY TO RECOVER FROM A TOXIN AS A MEASURE OF RESILIENCE AS AN INDICATOR OF THE AGE OF THE ORGANISM. I ALWAYS THOUGHT OF CIGARETTE SMOKING AS OUR NATURAL EXPERIMENT IN HUMANS EQUIVALENT TO ANIMAL STUDIES LIKE TOXICITY AND RESILIENCE. HOW DO WE ACCELERATE OUR PACE OF DISCOVERY? DR. LITHGOW YOU TALKED ABOUT CRITICAL ACCELERATORS. DO YOU ENVISION THIS PUSHING GEROSCIENCE TO THE POINT WHERE WE ARE INTERVENING ON THE THREE INTERVENTION TYPES YOU SMOKE OF AND I'LL ALSO ASK THE OTHER PANEL MEMBERS TO COMMENT AS WELL. >> I GUESS WE ALWAYS THINK ABOUT RESOURCES AND WHAT WE HAVE TO DRIVE THE TRANSLATION RESEARCH AND POPULATION STUDIES. I THINK BEYOND RESOURCES IT'S AN ISSUE OF COMMUNICATION. I THINK THIS FORM IS WONDERFUL IN THAT REGARD. WE HAVE TO GET THE WORD OUT. I THINK THE BIOLOGISTS HAVE NOT BEEN GOOD AT SHOWING WHAT'S GOING ON IN THE LAB AND REALLY OPENING THE DOORS AND SAYING THIS COULD CHANGE EVERYTHING AND TRANSFORM MEDICINE. THAT'S A COMMUNICATIONS ISSUE. I THINK IT'S SOMETHING WE'RE ALL GETTING BETTER AT BUT IT'S STILL A CHALLENGE. >> ANYONE ELSE? >> I THINK FOR PEOPLE WHO ARE STUDYING DISEASES, THERE'S ALWAYS BEEN THE CONCEPT OF THE DISEASE AND THE SIDE EFFECTS OF ANY APPROACH TO THERAPY. I THINK THAT WHAT I HOPE GEROSCIENCE DOES IS TO GET PEOPLE TO REFRAME THE IDEA AND THINK ABOUT THE WHOLE PERSON AND ALL THE CONSEQUENCES OF A THERAPY SO WE DON'T HAVE PROBLEMS, FOR EXAMPLE, LIKE GIVING ANTI-INFLAMMATORIES FOR ARTHRITIS AND FINDING OUT IT CAUSES A HEART ATTACK AS A SIDE EFFECT. THEY NEED TO BE COUNTED AND STUDIED TOGETHER. >> ONE OF THE THINGS IS WE HAVE SEEN IT WITH PRESENTATIONS WITH DR. MOFFITT AND NEWMAN THAT THE FOCUS AWAY FROM DISEASE AND MORE INTO HEALTH AND FUNCTION, I THINK THAT'S AN IMPORTANT THING WE HAVE TO DRIVE THAT AT THE CLINICAL LEVEL AND POLICY LEVEL AND WHOLE PERSON LEVEL AND UNDERSTAND THE IMPORTANT THING IS NOT TO AVOID A PARTICULAR DISEASE. THE IMPORTANT THING IS TO REMAIN FUNCTIONAL AND ENJOYING LIFE. AND I THINK THAT'S CRITICAL IN THAT WE HAVEN'T CHANGED THE CONVERSATION REALLY. >> CAN I ASK YOU AS A PANEL TO SORT OF COMMENT ON THE INSTITUTE OF MEDICINE'S NEW PERSPECTIVE OR EFFORT IN PROMOTING RESEARCH EFFORTS AS IT RELATES TO HEALTHY LONGEVITY. ARE YOU ALL INVOLVED IN THOSE EFFORTS AND DO YOU HAVE ANY PERSPECTIVES ON WHAT SORT OF GRAND CHALLENGES OR WHAT SORT OF BIG IDEAS, WOULD MOVE US TO KNOWING MORE ABOUT HOW WE CHANGE THE WAY PEOPLE AGE AND LIVE LONGER. THAT'S A PRETTY BIG QUESTION. I'M TRYING TO FILL UP ANOTHER 10 MINUTES. IF NOT, I'M SURE THERE'S A MORE SPECIFIC QUESTION FROM THE AUDIENCE. >> AND JUST TO FOLLOW-UP ON THE LAST COMMENT BY DR. SIERRA. THE FOCUS ON HEALTH OBVIOUSLY SO IMPORTANT. THERE'S SUBTLE DIFFERENCES AND WE'RE THINKING ABOUT INTERVENTIONS TO SLOW DOWN AGING AND IF WE CAN SLOW DOWN AGING SUCCESSFULLY THEN THERE'LL BE CONSEQUENCES FOR HEALTH. WHAT ABOUT THE OTHER WAY AROUND? IMPROVING HEALTH OVER THE COURSE OF THE LIFE SPAN COULD THAT SLOW DOWN AGING? IT SOUNDS LIKE SEMANTICS BUT IF WE WOULD APPLY THE MEASURES, THE BIOLOGICAL MEASURES AGING PROCESS TO SAY MEASURE THAT DURING SAY A BEHAVIORAL INTERVENTION LIKE THE ONE ABOUT EXERCISE OR DIET OR WHATEVER. IS, HAS THAT BEEN PLANNED ALREADY? IS THAT SOMETHING WE SHOULD BE DOING? >> YEAH, SO WITH WHAT CAN IMPROVE YOUR RATE OF AGING IS WHAT WE'RE LOOKING FOR. WE HAVE TO MAKE THE DISTINCTION BETWEEN THE INTERVENTIONS THAT AFFECT THE PARTICULAR DISEASE WHICH I THINK DR. NEWMAN SHOWED REDUCING CANCER BY ITSELF OR CARDIOVASCULAR DISEASE BY ITSELF WILL NOT EFFECT THE POPULATION LEVEL. IT DOESN'T PRODUCE THAT MUCH OF AN IMPACT TO IMPROVE THOSE DISEASES, HOWEVER, INTERVENTIONS THAT APPROACH THE INDIVIDUAL AS A WHOLE AND IMPROVE HEALTH WILL LEAD TO LONGER LONGEVITY. AND THERE COMES ANOTHER ISSUE THAT I'VE BEEN THINKING ABOUT LATELY WHICH IS WHEN WE TALK ABOUT AGE, WE ALWAYS WORRY ABOUT THE DISEASES AND FRAILTY AND SO ON. AS I MENTIONED EARLIER, I'M VERY OPTIMISTIC PERSON. I'M STARTING TO THINK GOOD GEROSCIENCE SUCCEEDS, WHAT WE'LL FIND IS WE'LL BE IN A WORLD WITH LOTS AND LOTS OF 90-YEAR-OLDS THAT ARE EXTREMELY HEALTHY AND WILLING TO PRODUCE AND WORK AND PARTICIPATE IN SOCIETY AND IT'S VERY IMPORTANT WE MAKE A SPACE FOR THEM. >> I AGREE. THANK YOU. >> DR. MOFFITT. >> I WANTED TO BRING YOUR QUESTION ABOUT IS THERE SOMETHING WE CAN DO ABOUT HEALTH AND EARLY LIFE TO IMPROVE HEALTH SPAN AND SLOW AGING AND THAT APPLIES TO MENTAL HEALTH. I'M DISAPPOINTED TO SEE WE DON'T HAVE THE DIRECTOR OF THE NIMH HERE BUT MAYBE HE'LL COME TOMORROW. AS I SAID, SWIFTLY IN ONE OF MY SLIDES THERE, MENTAL HEALTH PROBLEMS ARE VERY COMMON. THEY TEND TO PEAK IN ADOLESCENTS AND YOUNG ADULTHOOD AND THEN THE PREVALENCE GOES WAY DOWN. THERE'S NOW BEEN QUITE A COMPELLING SERIES OF LARGE STUDIES THAT HAVE FOLLOWED PEEP -- PEOPLE UP AND FOUND PEOPLE WHO HAVE DISEASE IN EARLY AND MENTAL LIFE APPEAR WITH PHYSICAL HEALTH PROBLEMS AND DISEASES AND SHORTER LIFE SPAN IN LATER LIFE. THEY'RE DEATHS ARE FROM ALL CAUSES. IT'S NOT A SUICIDE EFFECT. I DO THINK THAT IF WE HAVE AN OPPORTUNITY IN EARLY LIFE WHERE WE CAN REALLY DO SOMETHNG AT THE POPULATION LEVEL TO IMPROVE AGING, IT WOULD BE IN THE MENTAL HEALTH FIELD. I'D LIKE TO SEE NIMH GET AS EXCITED ABOUT THIS AS NICHD IS. THAT WOULD BE COOL. >> WE HAVE FIVE MINUTES BEFORE OUR BREAK. I THINK WE ARE LIMITED TO ONE MORE QUESTION UNLESS IT'S SHORT. >> I BELIEVE IT'S SHORT. THIS IS PATTY BRANNEN, DIRECTOR OF NATIONAL LIBRARIES OF MEDICINE. I HAVE A CHALLENGE BACK TO THE COMMITTEE AND EVERYONE IN THE AUDIENCE. ACCELERATING DISCOVERY REQUIRES SHIFTING COMMUNICATION. WE NEED TO KNOW FROM YOU HOW SHOULD THE NATIONAL LIBRARY OF MEDICINE BE COLLECTING JOURNALS, MAKING JOURNALS AVAILABLE AND MOVING TOWARDS INFORMATION SHAFRG -- SHARING SO THEY GET PROPERLY OUT TO THE COMMUNITY TO ACCELERATE DISCOVERY. THAT'S A QUESTION. >> WE HAVE TIME FOR ONE LAST QUESTION. >> I KNOW THE COMMUNITY IS GOING TO BE VERY CAREFUL ABOUT NOT GETTING AHEAD OF THE SCIENCE BUT WHAT DOES THE COMMUNITY FEEL ABOUT THE INEVITABILITY OF REVERSING AGING? >> FROM A SOCIETAL ASPECT? >> EQUITABLE ACCESS AND SOCIAL IMPLICATIONS BUT JUST A QUESTION ON THE SCIENCE. >> THERE'S DATA SUPPORTING THE IDEA RENUF NATION IS A WAY -- RENUF JAGS IS A WAY FORWARD -- REJUVENATION IS A WAY FORWARD. REVERSAL IS IN FRONT OF US RIGHT NOW. >> WE'LL LEAVE IT THERE. >> WE HAVE A REPRESENTATIVE -- NO, OKAY. LET'S GIVE OUR PANELISTS A ROUND OF APPLAUSE AND HOPE IT WILL SET THE STAGE FOR THE HOURS WE'LL SPEND TOGETHER PRODUCTIVELY. THANK YOU FOR YOUR INTEREST AND QUESTIONS. NOW IT'S TIME FOR A WELL-DESERVED BREAK. THE SECOND SESSION IS BASED ON THE RESEARCH INTO BIOLOGY OF AGING WHATEVER CLOCKS ARE USED HAS LED TO AN IDENTIFICATION OF CELL BIOLOGICAL CHANGE CONTRIBUTE TO AGING. THESE ARE COLLECTIVELY KNOWN AS THE HALLMARKS OF AGING WHICH FELIPE SIERRA SPOKE ABOUT AND BECAUSE WE CONSIDER THE HALLMARKS OF AGING AS PRIME TARGETS FOR INTERVENTIONS THAT MIGHT SLOW THE RATE OF AGING OR INVOLVED IN RENUF -- REJUVE NATION AND MINIMIZING THE IMPACTS OF AGING. PROGRESS HAS COME FROM DISCOVERIES ON THE INTER INTER INTERACTIONS BETWEEN THEAL MARKS OF AGING -- THE HALLMARKS OF THE INTERVENTIONS OF DISEASE. AFTER THE SESSION WE HOPE THE AUDIENCE HAS APPRECIATION THAT DISEASES OF AGING MAY INVOLVE SOME GENE BY HALLMARK INTERACTIONS AND OTHER FEATURES OF THE HALLMARKS OF AGING. WE HOPE THIS STIMULATES INTEREST IN LOOKING AT INTERACTIONS AND SEEKING THERAPEUTICS FOR DISEASES OF AGING IN DISSATISFACTION TO TARGETING THE RISK ALLELES ASSOCIATED WITH THE DISEASES. WITH THAT, WE WELCOME DR. LUIGI FERUCCI TO THE STAGE. >> THANK YOU FOR ORGANIZING THIS VERY IMPORTANT MEETING AND I'M EXCITED TO BE OPENING THE SESSION. I WANTED TO GIVE A TALK THAT WILL GIVE YOU THE FRAMEWORK OF HOW A CLINICIAN AND THE FIELD OF GEROSCIENCE AND HOW IT CAN APPLY TO HUMANS. BELIEVE OR NOT I WANTED TO WELCOME THE PEOPLE COMING FROM OUTSIDE. THE WAY THE DOCTOR IS EDUCATED TO THINK ABOUT DISEASE AND HEALTH CAN BE SUMMARIZED UP THIS SIMPLIFIED FORM IN THIS SLIDE. GENETIC PREDISPOSITION AND RISK FACTORS AND THE CONJUNCTION OF RISK FACTOR AND DISPOSITION THAT LEADS TO PATHOLOGY ACCUMULATION AND WHEN EACH MEETS A THRESHOLD THERE'S A CLINICAL MANIFESTATION OF FUNCTIONAL CONSEQUENCE. WHAT WE DO IS TO IDENTIFY PEOPLE WITH GENETIC DISPOSITION AND DETECT PATHOLOGY ACCUMULATION AND DOING INTERVENTION THAT SLOW DOWN OF LEGAL MANIFESTATION AND IF WE CAN'T, WE ACT IN ANOTHER WAY. THIS IS WHAT WE HAVE BEEN TOLD IN THE SIXTH YEAR OF MEDICAL TRAINING AND WE DISCOVERED THE PARADIGM IS A LITTLE BIT MISLEADING AND MAYBE A LITTLE BIT REDUCTIVE. FOR EXAMPLE, IF WE LOOK AT GENETIC PRE DISPOSITION WE SEE THAT IF YOU LOOK AT THE LITERATURE CAREFULLY THERE'S A NUMBER OF GENES THAT ARE ASSOCIATED BOTH WITH LIFE SPAN AND MULTIPLE CHRONIC DISEASES. AND THESE MULTIPLE CHRONIC DISEASES ARE ASSOCIATED WITH GENES THAT MAKE SENSE BECAUSE THEY SEEM TO BE ASSOCIATED WITH THE HALLMARKS OF AGING. I'LL JUST MENTION THE CDK2AMB THE GENES THE HALLMARK OF CELLULAR SENESCENCE. I COULD GO ON AND ON BUT I DON'T HAVE THE TIME NOW. AND WHEN WE LACK THE RISK FACTOR THAT'S THE WAY WE'RE LEARNING TO PREVENT HEART DISEASE YOU NEED TO TREAT CHOLESTEROL, HYPERTENSION, HAVE BETTER DIET AND FIGHT INACTIVITY AND OBESITY. THEN AGAIN YOU LOOK AT THE LITERATURE CAREFULLY AND YOU FIND IN FACT THERE ARE THE MOST IMPORTANT FACTORS THAT AFFECT MULTIPLE CHRONIC DISEASE. CHRONIC LUNG DISEASE, STROKE, DEMENTIA AND DIABETES. IN FACT, THE PARADIGM THAT IS EMERGING FROM THIS IS THAT IT IS ALTOGETHER. THERE'S SOME SORT OF AN EFFECT ON PRE-DISPOSITION TO THE RISK FACTOR AND IT CAN BECOME BLURRED IN THE LITERATURE. THEN WE START LOOKING AT THE PATHOLOGY ACCUMULATION. WHEN I WAS A STUDENT, WHEN I STARTED PATHOLOGY I WAS STRUGGLING BECAUSE I WAS LOOKING FOR DIFFERENT DISEASES, CANCER, CARDIOVASCULAR DISEASE AND OTHER DISEASE. WHAT I FOUND WAS EVERYTHING WAS THE SAME. THE ACCUMULATION OF THE SAME PATHOLOGY WAS CHARACTERIZED IN MULTIPLE DISEASE. IN FACT, THE CONCEPT OF THE HALLMARKS OF AGING IN ENVIRONMENTAL AND GENETIC RISK FACTOR WE SEE THE CLINICAL EMERGENCE OF DIFFERENT DISEASE DUE TO THE COMBINATION OF EXTREME FACTORS. AND IF WE LOOK AT THE EXAMPLE OF THAT, THE STRONGEST RISK FACTOR FOR COMORBIDITY. WELL, ONE OF THE CHARACTERISTICS OF RISK FACTOR IS ACCUMULATION OF DISEASE AND EACH REPRESENTS A COHORT AND THIS LINE IS THE INCREASED LEVEL OF MULTIPLE MORBIDITY ASSOCIATED WITH INFLAMMATION. INFLAMMATION, THE STRONGEST AND UNIQUE RISK FACTOR WE KNOW ASSOCIATED WITH RISING LEVEL OF COMORBIDITY. FINALLY, IF WE LOOK AT THE FUNCTIONAL CONSEQUENCE. I'LL SHOW ONE EXAMPLE. WE CAN SHOW YOU HOW POWERFUL IS THE FUNCTIONAL AND PHYSICAL AND COGNITIVE PERFORMANCE. THIS A -- IS A STUDY IF YOU MEASURE WALKING SPEED AND MORTALITY OF THE SIX-YEAR FOLLOW-UP THOUGH WHO WALK AT 0.8 METERS PER SECOND HAVE A MORTALITY HIGHER THAN HAVING A DIAGNOSIS OF MALIGNANT CANCER. YOU HAVE SUCH AN INCREDIBLE PROGNOSTIC INFORMATION WITHIN THE FUNCTIONAL MEASURE AND THE QUESTION IS UNDERSTANDING WHY. HOW DO WE UNDERSTAND THAT AND APPROACH THIS TYPE OF NEW MEDICINE THAT'S COME TO US. OVER THE LIFE SPAN I SEE THE CONTRAST OF CONFLICTING FORCES. ONE IS PATHOLOGY AND RESILIENCY. IN THE BEGINNING OF LIFE AND THAT'S VERY IMPORTANT AND AT THE BEGINNING OF LIFE YOU HAVE AGING BUT YOU'RE RESILIENCY'S SO STRONG, THAT AGING DOESN'T HAVE REALLY STRONG MANIFESTATIONS. THEN OVER TIME RESILIENCE SHRINKS AND PATHOLOGY INCREASES AND HAVE YOU AN ACCUMULATION OF DAMAGE THAT RESULTS IN THE END INTO FRAILTY. AND FRAILTY IS REALLY THE INABILITY TO COPE WITH THE CHALLENGE OF BEING ALIVE. YOU CANNOT DEAL WITH EVERY DAY LIFE. HAVE YOU ACCUMULATION TO THE DAMAGE THAT IS ACCELERATED AN IT LEADS TO ACCELERATED AGING OR YOU CAN HAVE A SHRINKING OF THE RESILIENCE STRATEGY THAT IS ACCELERATED AND THAT GIVE THE SAME RESULT. I THINK THIS SCHEME IS VERY IMPORTANT TO ME BECAUSE WHILE WE ARE FOCUSSING IN ACCUMULATION OF DAMAGE, WE CAN AVOID LOOKING AT RESILIENCE STRATEGIES. WE REALLY DON'T KNOW HOW TO MEASURE HOW RESILIENCE IS IN AN INDIVIDUAL. SOMEBODY APPEARS TO BE HEALTHY MAY HAVE STRONG RESILIENCY PREDICTIVE OF A LONG HEALTHY LIFE AND MAY HAVE A VERY LITTLE RESILIENCE LEFT SO THAT IS AN IMPENDING CONDITION OF PRECIPITATING HEALTH. UNLESS WE DO THAT THIS DREAM IS DIFFICULT TO APPROACH. HOW DO WE DO THIS? WE HAVE HAD PROGRESS IN THE FIELD. THIS MORNING SOMEBODY WAS TALKING ABOUT THE EPI GENETIC CLOCK. THIS IS MY FRIENDS THAT IS BELOW A CLOCK. I LOVE THIS PICTURE. WHAT'S DEMONSTRATED IS I DON'T KNOW WHETHER IT'S BIOLOGICAL AGING BUT WE KNOW WE CAN TAKE A DROP OF BLOOD AND KNOW THE AGE OF THAT PERSON. 10 YEARS AGO THIS CONCEPT WAS UB BELIEVABLY IMPOSSIBLE. PEOPLE WOULD TELL YOU WERE CRAZY IF A DROP OF BLOOD COULD GIVE YOU INFORMATION ABOUT AN INDIVIDUAL. BUT WE STILL DON'T KNOW WHETHER WHAT WE SEE IS PATHOLOGY OR WHAT WE SEE IS RESILIENCY. IT'S POSSIBLE THAT THE EPI GENETIC MODIFICATION RESPONDS TO ACCUMULATION OF DAMAGE AND HAVE NO ROLE INTO THAT ACCELERATED AGING AND THAT'S SOMETHING THAT WE NEED TO STUDY. THE PROBLEM WITH REGULATION FOR ME IS THAT IT'S DIFFICULT TO GO BACK TO THE CAUSAL PATHWAY TO MECHANISM. WE DON'T KNOW HOW EPI GENETICS WORK AND MODULATE EXPRESSION WE HAVE SOME HINTS BUT NOT A GENERAL RULE. ONE POSSIBILITY IS WE DO WHAT SCIENCE HAS DONE IN THE PAST AND WE HAVE RELIED ON HYPOTHESIS IN MANY SIN STANCES AND -- IN MANY INSTANCES AND WE LOOKED EIGHT -- AT A GROUP OF HEALTHY INDIVIDUALS AND WHEN YOU LOOK AT PROTEINS IN THE BLOOD YOU CAN PREDICT CHRONOLOGICAL AGE. BUT WHEN YOU LOOK AT THE PROPROTEINS THAT SEEM TO BE ASSOCIATED WITH AGING, MOST THE PROTEINS ARE SENESCENCE OF A PHENOTYPE. SUGGESTING BY LOOKING IN THE BLOOD WE KAY -- MAY BE ABLE TO QUANTIFY THE SENESCENCE ACROSS DISH USE. IF YOU -- TISSUES. IF YOU LOOK AT THE PROTEOMIC AGE AND INSTEAD OF IN A HEALTHY POPULATION, IN A NON-HEALTHY POPULATION AND A RANDOM POPULATION REPRESENTATIVE THE GENERAL POPULATION SOMETHING INTERESTING OCCURS. FIRST, THIS IS THE DATA COEFFICIENT BY AGE FOR TWO DIFFERENT POPULATION. ONE IN ITALY, ONE IN THE UNITED STATES. YOU CAN SEE THE PROTEIN CORRELATED WITH AGING IS EXACTLY THE SAME. HIGHLY CORRELATED. AND THE PROTEOMIC AGE, LONGITUDINALLY PREDICT THE ACCUMULATION OF MULTIMORBIDITY IS ASSOCIATED WITH MORTALITY. AND MORE THAN ANYTHING ELSE, WHEN YOU LOOK AT THE DIRECTION OF THE POPULATION, THE DISTRIBUTION IN THE POPULATION, THE RED ARE THE HEALTHY INDIVIDUALS AND THE BLACK ARE THE INDIVIDUALS THAT HAVE AT LEAST ONE MORBIDITY. THEY SHOW A PROTEOMIC AGE LARGER THAN PREDICTED. IT IS POSSIBLE IN THE FUTURE BY CONTINUING THE STUDY YOU'LL WANT TO APPLY THE GEROSCENCE CONCEPT TO THE CLINICAL CARE OF OUR PATIENTS AND MAYBE SAY TO SOMEBODY, YOU LOOK LIKE YOU'RE VERY HEALTHY, YOU DON'T HAVE ANY PATHAL PATHAL -- PATHOLOGY THAT IS EVIDENT BUT YOUR SENESCENCE SHOWS MAYBE THERE'S SOMETHING WE SHOULD DO. THANK YOU FOR YOUR ATTENTION. >> NEXT WE'LL HEAR FROM DR. HELEN BLAU. >> THANK YOU. >> I'LL TALK ABOUT REJUVENATION TO MUSCLE THROUGH STEM CELLS. MUSCLE IS CENTRAL TO EVERYTHING WE DO IN LIFE WHETHER YOU'RE A DANCER IN THE BALLET OR RODAN'S THINKER, YOU'RE USING YOUR DIAPHRAGMS TO BREATHE AND IF YOU'RE STEPH CURRY, YOU'RE USING EVERY MUSCLE IN YOUR BODY TO STHEET THREE-POINT -- SHOOT THE THREE-POINTERS SO IT'S CRUCIAL. WE'RE LIVING LONGER AS YOU HEARD. OUR LONGEVITY IS LONGER. BUT OUR HEALTH SPAN IS NOT. SO WHAT WE'RE GAINING IS MORE TIME WITH HEALTH RELATED DISEASE. CHRONIC DISEASE. WHAT WE WANT TO DO WITH REGENERATIVE MEDICINE AND STAR GETTING STEM CELLS IS TO OBTAIN MORE LIFE WITH QUALITY SO YOU CAN RUN AND SKI AND DO ALL THE THINGS YOU LOVE TO DO THAT REQUIRE YOUR MUSCLES. AND THERE'S A MAJOR UNMET NEED NOR SARK YO PENA -- FOR SARCOPENIA. THAT IS THE MUSCLE WASTING THAT ACCOMPANIES AGING. AFTER A TEAR MUSCLES BECOME WEAKER OR CARPEL TUNNEL OR URINARY INCONTINENCE. SARCOPENIA IS THE LOSS OF MUSCLE MASS AND STRENGTH WITH AGING. PHEE 5% OF PEOPLE 5% OF PEOPLE 65 ARE AFFECTED AND PEOPLE 85 AND OLDER HAVE A HIGHER PERCENTAGE. LOSS OF MUSCLE MASS AFFECTS YOUR ABILITY TO HAVE DAILY TASKS LIKE WALKING AND GETTING UP OF A CHAIR AND FALLS ARE MORE COMMON AND IF THEIR MUSCLES HAVE NOT STRONG THEY MAY NEVER WALK AGAIN AND THERE'S ENORMOUS COST TO THE HEALTH CARE SYSTEM FOR INABILITY WHICH THEN LEADS TO DISABILITY, DEPENDENCY, THE NEED FOR INSTITUTIONALIZATION AND HEALTH CARE COSTS GO UP THAT OF COURSE. AND MORTALITY IS INCREASED. SO SARK OWE PENA LEADS TO -- SAR SAR SARCO PENA LEADS TO AN INCREASED CAUSE OF DEATH. THESE SATELLITE CELLS WERE FIRST DEFINED IN 1961 BY ALEXANDER MOREAU WHERE HE PREDICTS THESE CELLS FOULED BE STEM CELLS. CAN YOU IMAGINE ONE FIGURE IN THE ERA OF SUPPLEMENTAL FIGURES. ALL HE DID WAS PREDICT IT COULD BE THE STEM CELL AND HE WAS RIGHT. IN THIS CELL RESIDES IN A LITTLE NICHE, A COMPARTMENT BELOW THE BASAL LAMINA AND THERE IN A DORMANT STATE UNTIL THERE'S INJURY AND THERE'S A SATELLITE CELL MARKED BY THE HALLMARK TRANSCRIPTION FACTOR AND YOU SEE THE STRIATIONS OF THE MUSCLE FIBER. THESE ARE DEDICATED STEM CELLS AND THEY'RE THERE TO THE POINT IN WHICH THERE'S INJURY TO WHERE THEY SPRING INTO ACTION AND THE QUIESCENT CELL BECOME COMMITTED PROGENITORS AND FUSE INTO THE MUSCLE AND PRE -- REPLENISH IT. WHAT HAPPENS TO REGENERATION WITH AGING? AS PEOPLE BECOME OLDER THEIR STEM CELL NUMBER DECLINES, THEIR STEM CELL FUNCTION DECLINES AND SARCOPENIA INCREASES SO YOU HAVE AN INCREASE IN MUSCLE WASTING AND IF THERE'S AN INJURY TO THE ISSUE, THE CELLS ARE LESS ABLE TO SURMOUNT THAT INJURY AND REPAIR IT BECAUSE OF THE REDUCTION IN STEM CELLS AND REDUCTION IN STEM CELL FUNCTION. SO I'M JUST GOING TO TELL YOU AN EXAMPLE FROM OUR LAB OF THE KIND OF RESEARCH THAT IS BEING DONE TO OVERCOME THIS. WHAT WE DID WAS CALLED AN "IN- "IN-SILICO" SCREEN. WE KNOW AFTER INJURY THE FIRST THING THAT HAPPENS IS A WAVE OF INFLAMMATION FOLLOWED BY A WAVE OF FIBER ADIPOSECYTES AND WHEN AS THE CHRONIC IT'S NOT GOOD. A PEAK MAY BE IMPORTANT TO THE STEM CELLS. SO WHAT WE DID WAS LOOK SPECIFICALLY FOR INFLAMMATORY REGULATORS OR MEDIATORS OF THE INFLAMMATORY RESPONSE. WE CALLED THE DATABASE AND LOOKED FOR GENES ACTIVATED IMMEDIATELY ON INJURY ON MUSCLE STEM CELLS AND LOOKED AT THE DATABASES OF TWO OTHER GROUPS AS WELL AND FOCUSSED ON INFLAMMATION. CYTOKINES WERE ONE TYPE AND OF THESE EP4 SURFACES AS ONE OF THE TOP HITS. WHAT IS EP4? IT'S THE RECEPTOR FOR PROS PROSTIGLAND AND IT WAS FOUND ON A TRANSCRIPTOME ANALYSIS. THIS GOT THE ATTENTION OF THE NEW YORK TIMES AND SO WHAT DO WE KNOW ABOUT PROSTIGLAND IT'S REACHED FROM AN ACID -- DERIVED FROM ACID AND IT COMES FROM LIPIDS AND CONVERTED BY A COUPLE ENZYME TO PGE2 AND THAT CAN ACT ON ANY ONE OF FOUR RECEPTORS EP4 ONLY ONE IN STEM CELL AND FIBERS. AND IBUPROFEN INHIBIT PGE2 AND THAT'S IMPORTANT BECAUSE IT'S YOUR NATURAL HEALING RESPONSE. WHEN THERE'S AN INJURY TO THE MUSCLE, THERE'S A SURGE OF PGE2 WE WERE SURPRISED TO FIND HOW IMPORTANT THIS WAS TO MUSCLE FUNCTION AND REGENERATION. WE DID AN ABLATION EXPERIMENT WHERE WE REMOVED THE RECEPTOR SPECIFICALLY IN THE MUSCLE STEM CELLS OF YOUNG MICE. YOU SEE THE DECLINE IN STRENGTH WHEN HAVE YOU A KNOCK-OUT, CONDITIONAL KNOCK-OUT OF THE RECEPTOR AFTER INJURY WHEN THE MUSCLES TRY TO PREPARE IN THE ABSENCE OF SIGNAL FROM THE RECEPTOR TO THE STEM CELLS THERE'S A DECLINE IN STRENGTH BY 50%. IMPORTANTLY, ALSO IF AN INJURED LYMPH A MOUSE IF YOU TREAT AFTER AN INJURY WITH SAIDS WITH IBUPROFEN YOU SEE A DECLINE. YOU NEED PGE2 TO STIMULATE THE STEM CELLS, HENCE, NO PAIN, NO GAIN. MOST PEOPLE AFTER THEY WORKOUT OR JOG AND FEEL ACHY AND POP AN IBUPROFEN. IF YOU DO THAT, THE DATA SUGGESTS YOUR NEGATING ALL THE GOOD YOU DID AND THE ACHINESS, THE NATURAL INJURY WHICH IS PART OF WORKING OUT AND EXERCISE, IS A BENEFICIAL THING. WE WANTED TO KNOW HOW PGE2 WORKS. ONE OF THE MOST STRIKING FINDINGS WAS SHOWN HERE IN A TIME-LAPSE VIDEO. YOU CAN SEE ON THE LEFT A SINGLE AGED MUSCLE STEM CELL VISUALIZED BY TIME LAPSE IN THE ABSENCE OF PGE2 AND IN THE PRESENCE. AND ON THE LEFT HAVE YOU MANY MORE CELL DEATH EVENTS AND MUCH LESS PROLIFERATION WHEREAS IN THE PRESENCE OF PGE2 THE AGED MUSCLE STEM CELL IS PROLIFERATING, DIVIDING MORE FREQUENTLY AND THE VIABILITY GOES UP AND THAT'S SHOWN HERE WHEN YOU LOOK AT THE ACCUMULATION OF DEAD CELLS OVER TIME. THEY'RE GREATLY REDUCED. SO PGE2 IS A PROSURVIVAL DRUG. WHAT DOES IT DO IF YOU TREAT A GERIATRIC MOUSE? YOU GET A LOGS OF FUNCTION IN PGE2 AND MUSCLES GET WEAKER AFTER INJURY? CAN YOU INCREASE STRENGTH? AND THIS IS MICE THAT ARE EQUIVALENT TO AN 82-YEAR-OLD PERSON AND GAVE THEM A SNAKE VENOM TOXIN AND A FEW DAYS LATER GAVE THEM PGE2 AND WITHIN WEEKS WE SAW A STRIKING INCREASE IN MUSCLE STRENGTH. YOU SEE THE MALES AND HERE'S THE FEMALES. AND THE MALES ARE ON PAR WITH UNTREATED YOUNG MICE. SO THEY RESTORED THEIR STRENGTH AFTER TWO WEEKS AFTER A SINGLE INJECTION OF PGE2 WHICH IS QUITE A REMARKABLE EFFECT. FURTHER, WE WERE INTERESTED IN KNOWING ABOUT A MORE NATURAL INJURY. SOMETHING WE ENCOUNTER IN OUR LIVE MORE OFTEN THAN SNAKE VENOM. WE TEST THE EFFECTS OF PGE2 ON MICE SUBJECTED TO DOWNHIL RUNNING. AND THESE AGED MICE RAN DOWNHILL FOR 10 MINUTES A DAY EVERY DAY FOR FIVE DAYS AND THEY RECEIVED PGE2 ON EACH OF THE DAYS AND ON THE SECOND DAY RECEIVED PGE2 FOR FIFE EACH OF FIVE DAYS AND THEN MEASURED THEIR STRENGTH AFTER A MONTH. WHAT WE SAW WAS A DRAMATIC INCREASE IN TWITCH FORCE AND IN TATANNIC FORCE. IT'S A SIGNIFICANT INCREASE IN MUSCLE STRENGTH IF PGE2 IS GIVEN IN CONJUNCTION WITH DOWNHILL RUNNING A FORM OF EXERCISE-INDUCED INJURY. WHAT I SHOWED IS A WAY TO TAKE ADVANTAGE OF THE STEM CELLS YOU HAVE IT'S ENDOGENOUS TISSUE PRESENT IN YOUR BODY AND IN THE MUSCLES AND USE DRUGS TO STIMULATE THEM IN VIVO. AND I WANT TO REITERATE WHAT WE DISCOVERED AS A PARADIGM, AS AN EXAMPLE OF WHAT CAN BE DONE WITH RESEARCH ON STEM CELLS WITH A VIEW TO IMPROVING QUALITY OF HEALTH AND HEALTH SPAN. SO WHAT WE FOUND IS THAT PGE2 IS PART OF THE NATURAL HEALING MECHANISM IT'S AN ESSENTIAL INFLAMMATORY METABOLITE IN MUSCLE REGENERATION. IT'S REQUIRED AND SUFFICIENT FOR MUSCLE STEM CELLS ENGRAPHMENT. IF YOU LOOK THE EPG2 AND BLOCK IT IN RESPONSE TO INJURY, SIMILARLY REGENERATION IS IMPAIRED AND STRENGTH IS IMPEDED AND PGE2 ALTER THE FUNCTION. IT'S A PAINFUL MEMORY IN THE PGE2 IS A PRO-INFLAMMATORY AND THE CELLS HAVE A MEMORY. THE CHROMATIN IS ALTERED LONG TERM AND WE'RE STUDYING THE MECHANISMS BY WHICH THAT HAPPENS. PGE2 EXPANDS AND REJUVENATE THE STEM CELL POPULATION AND CAN BE VIEWED AS A THERAPY FOR GENETIC DISORDERS YOU CAN TAKE CELLS AND EXPAND THEM AND RE-INTRODUCE THEM OR AS A SMALL MOLECULE THERAPY FOR TREATING ATROPHY, MUSCLE WASTING IN AGING. AND WE ARE VERY EXCITED ABOUT THESE POTENTIALS AND HOPING TO TRANSLATE THEM TO THE CLINIC, AUGMENT THEM TO A MODULATOR TO HAVE A THERAPEUTIC EFFECT. >> THE NEXT SPEAKER IS DR. MICHA MICHAEL KODOR. >> GREETINGS FROM CANADA. I'LL REPRESENT YOUR NEIGHBORS TO THE NORTH. WE HEARD EIGHT ABOUT EPIGENETICS IN THE PREVIOUS TALKS AND DISCUSSION. I'D LIKE TO GIVE MY VIEW OF HOW EPE -- EPIGENETICS CAN AFFECT HOW WE AGE. I'LL DO IT IN TWO PARTS. FIRST, WORK THAT SHOWS IT'S A VESTIGE OF OUR EARLY LIFE ENVIRONMENT AND TALK ABOUT EPIGENETICS AND BIOLOGY AND PERHAPS PROVIDING A SLIGHTLY DIFFERENT OPINION. THIS IS VERY MUCH LIKE WE HEARD IN THE BREAK IN THE CONTEXT OF THE DEVELOPMENT ORIGINS OF HEALTH AND DISEASE BY WHICH EARLIER EXPERIENCES GET UNDER OUR SKIN TO AFFECT HEALTH AND BEHAVIOR ACROSS THE LIFE SPAN. I GREW UP IN GERMANY AND WE'RE SUPPOSED TO LOVE DEFINITIONS AND I HATE THEM BUT THIS IS THE MOST COMMON DEFINITION OF EPIGENETICS THE ASPECT WE WERE INTERESTED IS HOW OUR ENVIRONMENT IN PARTICULAR, OUR SOCIAL ENVIRONMENTS AND LIFE EXPERIENCES CAN AFFECT AND INFLUENCE THE WAY OUR GENES ARE EXPRESSED. THE PARADIGM BY WHICH WE OPERATE THAT A CERTAIN EXPERIENCE AND PRIMARILY THOSE IN EARLY LIFE THAT AFFECT BIOLOGICAL PATHWAYS AND THEN DRILL DOWN INTO THE NUCLEUS TO EFFECT THE EXPRESSION OF A GENE AND IN SOME CASES IT DOES SO LONG AFTER THE INITIAL EXPERIENCE HAS PASSED AND IT'S VERY PERSISTENT. THIS IS NOT A ONE-WAY ROAD. IT ALSO GOES UP. WHEN WE TALK ABOUT EPIGENETICS WE HEARD ABOUT METHYLATION IF WE TAKE A PSEUDOMICROSCOPE AND GO IN THE NUCLEUS OF THE CELL WE REALIZE DNA IS NOT IN ITS NAKED FORM LIKE HERE BUT PACKAGED IN MANY MULTIPLE WAYS. ALL OF WHICH ULTIMATELY CONSTITUTE WHAT'S IS KNOWN NOWADAYS AND THIS HIGHLIGHTS THE VARIOUS PLAYERS AND WHAT MARKS THE EPI GENOME AND THE MECHANISMS INVOLVED. EACH HAS A STORY TO TELL AND WHEN WE TALK ABOUT HUMAN POPULATION WE'RE TALKING ABOUT THIS METHYLATION UP HERE. METHYLATION COMES IN MANY DIFFERENT FLAVORS AND EACH HAS A WONDERFUL STORY TO TELL BUT FOR TODAY'S STORY I'LL STICK WITH THE CANONICAL METHYLATION AND HOW IT MY EXPLAIN EXPERIENCES IN ENVIRONMENTS HAVING A LASTING EFFECT ON OUR BIOLOGY. THERE'S A NUMBER OF EXCELLENT EXAMPLES THAT HIGHLIGHT THE PERVASIVE POWER OF EARLY LIFE EXPERIENCES. PERHAPS NONE STRONGER THAN THE EPIDE EPIDEE EPIDEEM -- EPI-DEMEO LOGICAL STUDIES AND WHERE WOMEN HERE IN THE NETHERLANDS WERE LIVING ON LESS THAN 1800 KILOCALORIES A DAY AND SOME BECAME PREGNANT. SIX YEARS LATER THERE'S MANY DNA METHYLATION MARKS THAT CAN BE SEEN IN THE OFF-SPRING OF THE WOMEN AND LIFESTYLE HAVE A POWERFUL EFFECT ON THE EFFECT OF THE LIFE OF THE CHILD. EPIGENETICS HAVE BEEN POPULAR IN THE NEWS AND WITHIN FAMILIES AND THE PUBLIC. SOME STUDIES INCLUDING SOME BY MY GOOD FRIEND SUGGEST THERE'S A POWERFUL ASSOCIATION OF THE QUALITY OF THE MATERNAL CARE ASSOCIATE WITH THE EPIGENOME OF THE CHILD AND MAIT MAY BE ASSOCIATED WITH SUICIDE BEHAVIOR IN ADULTS. PERHAPS THE CLOSEST WE CAN GET TO ANIMAL STUDIES WE HEARD EARLY IDENTICAL TWINS. THEY'RE MORE OR LESS GENETICALLY IDENTICAL AND YOU SEE THIS CUTIE HERE AND THE CHRIS ONE HERE. TURNS OUT IDENTICAL TWINS HAVE FAIRLY SIMILAR EPIGENOMES LATER IN LIFE BUT THEY BECOME DISCOR DANT IF THEY HAPPEN TO BE SEPARATED EARLY IN LIFE OR HAVE DIFFERENT DISEASES INCLUDING CARDIOVASCULAR DISEASE AND DIABETES AND THE LIKE. SUGGESTING THESE EXPERIENCES CAN GET UNDER THE SKIN AND HAVE A LONG LASTING EFFECT ON OUR HEALTH. WE TRY TO LINK IT TO THE POSSIBLE START TO OUR CHILDREN AND PREVENT DISEASE AND DO IT IN OUR OWN ENVIRONMENT. OVER THE YEARS WE HAVE COME TO APPRECIATE IT ALSO NEEDS TO BE LOOKED AT IN THE DEVELOPMENTAL CONTEXT. WHAT WE HAVE PROPOSED IN REVIEWS IS THE EXPOSURE PARTLY TO DAMAGE WHEN IT'S BROUGHT ABOUT IN A SENSITIVE PERIOD FOR EXAMPLE, EARLY IN LIFE BUT NOT WHEN IT'S LATER. YOU CAN SEE THIS EXPOSURE CHANGES THE EPIGENOME TO LEAD TO A HIGH-RISK SITUATION EARLY IN LIFE SUCH AS THE COMBINED OF EXPOSURE WE HEARD FROM DR. MOFFITT BUT NOT IF IT HAPPENS LATER OR THE EPIGENOME STAYS THE SAME AND IT'S A DIFFERENT FROM THE GENOME THAT'S STEADY ACROSS THE LIFE SPAN. THAT BEING SAID THE COMMUNITY HAS BECOME VERY AWARE OF THE FACT THAT GENOTYPE DOES AFFECT WITH THE EPIGENOME IN WAYS THAT PERHAPS 10 YEARS AGO WERE NOT APPRECIATED. SO WE NEED TO PUT TOGETHER THE GENOTYPE AND ENVIRONMENT TO UNDERSTAND OUTCOMES IN A SOPHISTICATED WAY. THIS IS A LONG UNDERPINNING HYPOTHESIS BUT MY FRIEND AND LATE MENTOR 15 YEARS AGO PUT THIS IN CONTEXT FROM SOCIAL SCIENCE WORLD AND HYPOTHESIZED IT WAS EARLY LIFE EXPERIENCE THAT AFFECTED US IN HEALTH AND ADULTHOOD. I WANT TO HIGHLIGHT STUDIES WHERE WE LOOKED AT ONE POWERFUL EXPOSURE EARLY IN LIFE AND THAT'S POVERTY. POVERTY IS VERY DETRIMENTAL TO OUR HEALTH. WE HEARD SOME OF THE CORRELATIONS THIS MORNING. WHAT PERHAPS IS LESS WELL KNOWN EARLY LIFE POVERTY STICKS WITH US FOR THE REST OF OUR LIFE IN MANY CASES. IN THE SUITE OF STUDIES WE SHOWED A LOWER SOCIAL CLASS LEAVES A RESIDUE WE CAN MEASURE IN THE WHITE BLOOD CELLS AND CAN SEE IT IN THE LEVELS OF GENE EXPRESSION AND IMMUNE FUNCTION AND SEE IT AT THE LEVEL OF CORTISOL OUTPUT. SUBSEQUENTLY, WE ALSO SHOWED THAT IN THE SAME COHORT WE CAN SEE AN ASSOCIATION OF EARLY LIFE POVERTY WITH METHYLATION IN ADULTHOOD AND WITH ASSOCIATION WITH CURRENT SOCIOECONOMIC STATUS. IN RELATED WORK WITH SOME AT NORTHWESTERN WE HAVE SHOWN IT HOLDS TRUE WHEN YOU LOOK AT DIFFERENT COUNTRIES. IN WORK SHOWN HERE WE HAVE SHOWN THERE'S SOCIAL AND PHYSICAL ENVIRONMENTS AND EARLY DEVELOPMENT THAT PREDICT INFLAMMATORY GENES IN YOUNG ADULTHOOD AND CAN EXPAND IT TO LOOK AT SOCIOECONOMIC STATUS AND LOK AT NUMEROUS ASSOCIATION EVEN OUTSIDE THE SYSTEM. SO AS WE HAVE DONE THERE'S WORK WE'VE BEEN DOING TRYING TO FIGURE OUT HOW CAN WE DEAL WITH THE ONE BAIN OF OUR EXISTENCE THE DNA METHYLATION BECAUSE OUR TISSUES ARE PART OF IT. AND WE ENDED UP GETTING INVOLVED IN AGING RESEARCH. I WANT TO JUST HIGHLIGHT ONE WORK WE DID WHERE WE USED POST MORTEM TISSUE TO COMPARE THE METHYLATION PROFILES OF THREE CARRIERS AND WHAT WE FOUND IN THE STUDY PUBLISHED THREE YEARS AGO EVEN FOR A SIMPLE EPIGENETIC ASSOCIATION SUCH AS AGING WE CAN SEE TWO SIGNATURES. ONE WE CAN SEE ONLY IN BRAIN AND A SECOND IN BRAIN AND BLOOD AND CAN REPLICATE IT AS AN INDEPENDENT COHORT SUGGESTING WHEN WE TALK ABOUT AGING IT'S VERY COMPLEX AND WE MIGHT NEED TO LOCK AT DIFFERENT -- LOOK AT DIFFERENT TISSUES IN DIFFERENT WAYS. WHAT I'VE SHOWN HERE IS AN ASSOCIATION OF EVERYTHING WE HAVE DONE IN MANY WAYS WE LOOK FOR ASSOCIATION OF EARLY LIFE SOCIOECONOMIC STATUS WITH VARIOUS DNA GENE METHYLATION EXPRESSION AND IT'S WONDERFUL BECAUSE IT SHOWS US THE IMMUNE PATHWAYS THAT MAY BE REGULATED BUT ALSO TISSUE SPECIFIC AS I SHOWED YOU AND OF COURSE IT REQUIRES COMPLEX STATISTICS BECAUSE WE'RE AMERICA RESILIENCE OF MANY MILLIONS OF MARKS AND WE NEED TO STATISTICALLY ACCOUNT FOR THIS. AND WE HEARD ABOUT AN ALTERNATIVE BY WHICH WE CAN EXPLORE THE INFLAMMATION OF THE EPIGENOME AND THAT'S THE EPIGENETIC AGE POPULARIZED AND IT'S AN EPIGENETIC CLOCK THAT STARTS WHEN WE ARE BORN AND ENDS WEN WHEN HE DIE AND IT'S IT'S TISSUE AGNOSTIC AND WE LOOK AT THE DEVIATION OF YOUR EPIGENETIC AND CHRONOLOGICAL AGE SO EVEN I CAN DO IT IN EXCEL. WE ALSO REALIZED WHEN WE LOOK AT THE EPIGENETIC CLOCK IT'S ONLY ONE WAY BY WHICH OUR EPIGENOME AGES. AND THE IDEA OF THE EPIGEN ETIC RIFT AND BECOMES MORE NOISE I'LL COME BACK TO THIS AT THE END OF MY TALK. WE EXPLORED THIS PHENOMENON AND PROPOSED THAT MOST FOLKS WILL FALL INTO THE CONCORDANCE BETWEEN WHERE THE CHRONIC LOGICAL AGE IS SIMILAR TO THE EPIGENETIC AGE AND SOME ARE EPIGENETICALLY OLD AND YOUNG AND IT TRANSLATES TO DIFFERENT HEALTH OUTCOMES IF THEY HAD A HEALTH MUCH MORE COMPROMISED THAN THE EPIGENETICALLY YOUNG. IT'S THE IDEA AS WE HEARD ABOUT THIS MORNIN ALREADY. BOTH IN TERMS OF EXPOSURES AND HEALTH OUTCOMES AND MORTALITY. STEVE HAS A REVIEW WHERE HE COMPARED THE ORIGINAL CLOCK WITH DIFFERENT CLOCKS WITH BIOMARKER AND CHRONOLOGICAL CLOCK AND THE ONE IN MORTALITY. WE USE THIS IN OUR PARADIGM OF SOCIOECONOMIC STATUS AND WE SHOWED FOLKS WHO GREW UP IN LOW SOCIOECONOMIC STATUS HAVE AN ACCELERATED EPIGENETIC AGE SUGGESTING DISADVANTAGE IN EARLY LIFE PREDICTS EPIGENETIC AGING TO SOME DEGREE AND WE LOOKED IN POPULATION HAVE BEEN EVOLVED THERE OVER CENTURIES AND MANY MANY YEARS AGO AND WE FOUND IF YOU LIVE IN THE FOREST IT'S MUCH MORE DETRIMENTAL TO YOUR EPIGENETIC AGE THAN IF YOU LIVE IN AN ORDINARY AREA. THERE'S A FOUR-YEAR DIFFERENCE THAT SUGGESTS IF YOU LIVE IN THE FOREST YOU'RE EPIGENETICALLY OLDER THAN IF YOU LIVE IN THE CITY WHICH IS SURPRISE. WE LOOKED AT THE BLUE ZONE EPIGENETIC AREAS WHERE FOLKS LIVE LONG AND HEALTHY LIVES AND PRIMARILY IN COSTA RICA AND WHEN WE COMPARED SO HERE YOUR YOUNG TO 65 AND YOU'RE OLD IF YOU'RE BETWEEN 95 AND 105. WE FOUND THERE WAS NO DIFFERENCE IN ANY OF THE EPIGENETICS CLOCKS WE TESTED WHEN WE COMPARED SIMILAR AGE NON-ACOYANCE AND IT MUST GOOD-BYE TO BE FROM LATIN AMERICA. WHAT WE FOUND IS THERE WAS A PREDICTED IMMUNE PHENOTYPE WITH MUCH LESS MEMORY T CELLS AND A WANT TO CLOSE WITH WHAT I THINK COMES BACK TO THIS THIS COHORT THE FOLKS GROWING UP THEY HAVE LESS VARIABILITIES IN THE METHYLATION AND THE DNA IS LESS NOISY. THANK YOU SO VERY MUCH. >> THE LAST PRESENTATION IS BY DAREN BAKER. >> YOU FOR WEDGE -- WITH THE ABILITY TO SPEECH WITH SO MANY FROM DIVERSE BACKGROUND AND A HOPE TO CONVEY INFORMATION PEOPLE CAN TAKE HOME TO UNDERSTAND WHAT WE'RE WORKING ON IN THE LAB FOR QUITE SOME TIME. I ALWAYS START WITH THE SAME DISCLOSURE STATEMENT THAT WE A NUMBER OF YEARS AGO THERE WAS A COMPANY IN BIOTECHNOLOGY THAT BECAME INTERESTED IN THE CONCEPT THAT SIN OWE -- SIN OWE SENESCENCE MAY BE AVAILABLE TO THEM AND NOTHING IS SPONSOR UNITY BUT THIS IS EVERYTHING I ALWAYS DO TO STAY COMPLIANT WITH THE MAYO'S CONFLICT OF INTEREST POLICIES. WE'VE SEEN VARIATIONS SO FAR. I WANT TO THINK ABOUT AGE-RELATED DISEASE IN A LITTLE BIT OF A DIFFERENT CONCEPT. I THINK IF WE LOOK WITHIN HUMANS AS WELL AS ANY OTHER ORGANISM THERE ARE TWO PHASES OF OUR LIFE THAT ARE NOT VERY ARGUABLE WHERE WE HAVE A STAGE WHERE WE'RE EITHER BEING BORN OR WE ARE DYING. THOSE ARE INEVITABLE. THERE'S DISTINCT PHASES WHERE WE THINK WITH THE EARLY STAGE AND REPRODUCTIVE STAGE BEFORE WE GIVE RISE TO OFFSPRING TO ABOUT 14, 15, OBVIOUSLY THIS CAN MOVE IN DIFFERENT DIRECTIONS BUT HISTORICALLY THAT'S WITH THE TYPE. THEN WE HAVE A PERIOD WHERE WE STAY REPRODUCTIVELY ACTIVE TO ABOUT 50. THERE'S OBVIOUSLY EXCEPTIONS. THERE COULD BE PEOPLE PRODUCING LONG. I WAS INTERESTED IN HEARING ABOUT DR. LITHGOW'S VIEW OF FERTILITY FOR FAYE -- FEMALES AND IF WE THINK ABOUT GENES INVOLVED IN THE PROCESSES ESPECIALLY IN THE PROCESS OF NATURAL SELECTION WE HAVE THE HIGHEST SELECTIVE PRESSURE EARLY ON IN LIFE IF WE HAVE A PARTICULAR MUTATION IT'S NEGATIVE TO OUR OVERALL HEALTH AND FITNESS WE CAN'T GIVE RISE TO NEW PROGENY. IF YOU HAVE A HOM HOMO ZYGOUS MUTATION AND WHEN WE GET TO THE POST PART OF OUR LIFE WE HAVE GIVEN RISE TO THE NEW GENERATION AND THEY'LL BE GIVING RISE TO THE NEXT GENERATION AND SO FORTH. THERE'S OF NUMBER OF THINGS THAT HAVE PARTICULAR SELECTION FOR GENES THAT MAY BE CAUSING OUR DEATH OR OUR DYSFUNCTION. ALTERNATIVELY THERE MAY BE GENES SITTING HERE THAT MAY HAVE INFLUENCE OF BEING BENEFICIAL TOWARDS OUR LATER LIFE. ONE CLEAR EVIDENCE IS CENTENARIANS. IF YOU LOOK WITHIN THE OFFSPRING OF CENTENARIANS THEY USUALLY HAVE A LONGER LONGEVITY THAN WHAT A NORMAL PERSON WOULD HAVE AND THERE'S A COMPONENT CAPABLE OF MOVING THIS BUT THEY'RE NOT NECESSARILY SELECTED FOR IT, PER SE. THE IMPORTANCE OF THE AGE OF 50 IN 1900 THAT WAS THE AVERAGE. 120 YEARS AGO THE AGE OF 50 IS WHAT WE WERE EXPECTED TO LIVE AND THERE'S BEEN A NUMBER OF THINGS WE CHANGED THAT MODIFIED THE RATE AT WHICH WE'RE DYING SO VARIOUS HEALTH IMPROVEMENT MEASURES WHETHER THINGS MORE MEDICAL BASED OR THINGS IN OUR ENVIRONMENT, MANY THING WE'VE BEEN ABLE TO DO MAKING US LIVE LONGER THAN WHAT WE HAVE BEFORE. AS A CONSEQUENCE WE HAVE ESSENTIALLY THE CONSEQUENCE OF BEING SUCCESSFUL AGERS WE NOW HAVE THE ACCUMULATION OF AGE-RELATED DISEASES. MANY CAN THINK ABOUT THIS AND WHY WE'RE INTERESTED IN WORKING ON BECAUSE WE'RE INTERESTED IF WE'RE ABLE TO MODULATE THE RATE OF AGING WE CAN MODULATE THE RATE OF DISEASE AS A WHOLE. THE IDEA OF IMPROVING HEALTH BY SLOWING AGING. MANY OF THE THINGS WE'VE BEEN WORK ON AND STUDYING WE THINK ABOUT BIOLOGY WHERE MOST ANIMAL MODEL SYSTEMS WE WORK WITH MUTANT MODELS AND MICE FOR INSTANCE WHERE WE WORK WITH THEM WITH YOUNG MOU -- MUTANTS. YOU CAN THINK A LABORATORY MOUSE CAN TRANS POSE ON TO THE SAME GRAPH. MANY OF THE THINGS THAT WE'RE MODELING WITHIN LABORATORY MICE ARE LONG AFTER THEY'RE DEAD IN THE NATURAL CONTEXT. SO KEEP THAT IN MIND. WE'VE BEEN INTERESTED IN THE THEORY OF SEN HE IS -- SENESCENT CELLS. USUALLY THEY ARISE IN A PARTICULAR POINT FOR A PARTICULAR PURPOSE. THEY'RE INDUCED IN AN ACUTE RESPONSE FOR MODULATING USUALLY FOR A BENEFICIAL RESPONSE AND DON'T SEE THOSE RESIDING LONG TERM. AS WE GO ON IN THE LIFE WE START TO SEE ACCUMULATION OF THE CELLS NATURALLY AND AT SITES OF AGE-RELATED DISEASE AND WITH THE OLDEST WE SEE A LARGE BURDEN OF SENESCENT CELLS. THE BEAUTY OF THE SYSTEM IS SOMETHING I CAN EXPLAIN TO MY PARENTS. I'VE ALWAYS HAD THAT IN TERMS OF TRYING TO MAKE SOMETHING TANGIBLE MY PARENTS CAN UNDERSTAND WHERE THE IDEA IS SENESCENT CELLS WE THINK ARE BAD AND ACCUMULATE AND DRIVE AGE-RELATED DISEASE. IT'S SIMPLE AND WHAT CAN WE DO ABOUT THAT? THAT'S WHERE WE STARTED IN THE IDEA. THERE'S STRESSORS THAT WILL DRIVE CELLS INTO THE STATE OF SENESCENCE. MANY ARE TUMOR-PROMOTING EVENTS THROUGH TUMOR DAMAGE OR OXIDATIVE DAMAGE OR DNA OR OTHER SIGNALLING WE THINK CAN PROMOTE THE PROCESS OF TUMOR GENESIS. WHEN WE THINK ABOUT ENGAGING THE SENESCENCE MECHANISM OF STOPPING THE CELLS ARISES ON TWO MAIN TUMOR SUPPRESSER PATHWAYS. THEY'RE THE MOST COMMON PATHWAYS IN HUMAN CANCER. YOU BASICALLY ARREST THE PROCESS TO GET TUMORS TO FORM. THE IDEA IS WITH THE SENESCENCE ENGAGEMENT YOU CAN HAVE TRANSIENT ARRESTS TO MODULATE THE DAMAGE AND OVER TIME CAN BECOME A LONG-TERM GROWTH ARRESTED STATE. IMPORTANTLY THE CELLS START TO ACQUIRE A DIFFERENT PHENOTYPE AND START TO BECOME PROINFLAMMATORY, SECRETE A NUMBER OF FACTORS WE THINK ARE NEGATIVE IN THE OVERALL STRUCTURE AND FISH -- FISH YOU FUNCTION. IT'S A -- TISSUE FUNCTION AND IF YOU CAN PREVENT THE CELL THAT WOULD BE GREAT BUT IT COMES WITH THE CONSEQUENCE OF DRIVING THE PATHOLOGIES OF AGING. THAT'S THE IDEA. WHEN WE FIRST GOT INTO THIS, THIS IS MORE THAN 20 YEARS AGO WE STARTED WITH THE LABORATORY MOUSE THAT BASICALLY GOT SICK QUICKLY. WE START WITH THE PREMATURELY AGED MOUSE HODDEL AND STARTED -- MODEL AND THIS HAD A LARGE NUMBER OF SENESCENT CELLS THAT WERE REPOPULATING TISSUES EITHER STEM CELLS LIKE DR. BLAU MENTION ORDER OTHERS IMPORTANT FOR MAINTAINING THE OVERALL TISSUE. AFTER THAT THEY DEVELOPED THE IDEA AND DEMONSTRATED SENESCENT CELLS DIDN'T JUST SIT AS CELLS BEING INTRINSICALLY ARRESTED THEY HAVE THIS EFFECT THAT CAN INFLUENCE OTHER CELLS IN THE ENVIRONMENT. THAT LED US TO UNDERSTAND WHAT WE COULD THINK ABOUT WHAT SENESCENT CELLS THAT WOULD BE MORE AMPLIFIED IN TERMS OF THEM CAUSING DYSFUNCTION OF OTHER CREM -- STEM CELLS THROUGH FIBROSIS AND THE STATE OF MORE CHRONIC INFLAMMATION BECAUSE OF I LIKE TO THINK OF SENESCENCE FROM A COUPLE ANGLES. IF YOU THINK ABOUT WHAT THIS IS AND THE PROGRAM'S BEEN RUNNING FOREVER, IT'S THE NEIGHBOR OF THE SIMPSONS, NED FLANDERS. THERE'S BEEN A NUMBER OF THINGS KNOWN AS BENEFICIAL. THE GOOD SIDE OR BRIGHT SIDE OF SENESCENCE. THEY'RE INDUCED AT PARTICULAR POINTS IN TIME FOR A PARTICULAR PURPOSE IN AN ACUTE PHASE AND THERE'S RESOLUTION INDUCED IN THE RESPONSES YOU DON'T SEE THEM MAINTAINED MORE LONG TERM. THE TAKE-HOME MESSAGE FROM OUR STUDIES IS THE OPPOSITE OR THE BAD SIDE OF SENESCENCE OR THE DARK SIDE OR ZOMBIE CELLS OR OTHER NOMENCLATURES PEOPLE USE ABOUT SENESCENCE AND THINGS SENESCENT CELLS THEY HAVEN'T DONE BEFORE THAT ARE DETRIMENTAL MORE THINGS WE THINK IN THE CHRONIC STATE OR ACCUMULATING WITH ADVANCING AGE. A NUMBER OF YEARS AGO WE AND OTHERS AT THE MAYO CLINIC THOUGHT WHAT CAN WE DO TO KEEP THE TUMOR SUPPRESSIVE ARREST MECHANISM TO ENGAGE IN THE RESPONSE AND REMOVE THEM FROM THE BODY SO YOU DIDN'T HAVE THEM MAINTAINED LONG TERM AND CAUSING DETRIMENT OR DYSFUNCTION OF OTHER CELLS AND LED TO THE MODEL SYSTEM KNOWN AS THE INCOTACT MODEL. WE USED ONE MARKER THEY CELLS EXPRESSED TO DRIVE THE EXPRESSION OF THE DRUG INTO A MECHANISM. AS THE CELL WAS BECOMING SENESCENT IT WOULD EXPRESS THE KAS 8 MOLECULE AND IT ENGAGES IN ARREST BUT THERE WAS DIE MERIZATION OF THE CAS 8 AND IT WAS TRIEDER APOPTOSIS. THE IDEA WAS YOU KEPT THE ARREST MECHANISM INTACT BUT MADE THEM SUSCEPTIBLE TO ELIMINATION WITH THE DRUG. WE WERE ABLE TO PREVENT THE AGE-RELATED DISEASES WE HAD SEEN. YOU CAN MAKE A MOUSE SICK AND WHAT'S THE ROLE IN CONTEXT. WE SAW ULTIMATELY IF THE VIDEO PLAYED THE MOUSE RECEIVING THE DRUG IT LOOKS HEALTHIER AND MORE MOTION FILLED. AND WE SAW A DIFFERENT. WE FOUND WE HAD AN EXTENSION OF LIFE SPAN IN THE MICE PRIMARILY BECAUSE WE WERE ABLE TO STAVE OFF THE GENESIS. THE MICE STILL DEVELOPED THE SAME TYPE OF TUMORS BUT IN A REDUCED RATE OF TIME AND WE SAW THE SLOW DOWN OF FROM THE REMOVAL OF SENESCENT CELLS. WE PUBLISHED A REVIEW LOOKING AT UNIVERSAL AGING TRAITS AND I'M STARTING TO RECOGNIZE MANY OF THESE THINGS IN MYSELF ARE OCCURRING. WE DON'T KNOW IF THE SENESCENCE PLAYS A ROLE IN THESE PATHOLOGIES BUD FOUND THERE WERE HINTS -- BUT FOUND HINTS OF DISEASE AND MAYBE CHRONIC INFLAMMATION AND IT'S BEEN SURPRISING HOW MANY DISEASES WE'VE BEEN ABLE TO SEEN MODULATED BY THE GENETIC REMOVAL OF SENESCENT CELLS AND THE APPROACH AS WELL AS OTHER DISEASE MODELS AS WELL AS VARIOUS DRUGS AND PHARMACOLOGIC AGENT THAT CAN REMOVE SENESCENT CELLS. I'LL CONCLUDE HIGHLIGHTING SOME OF THESE SHOWING WE CAN ATTENUATE CATARACTS AND YOU CAN SEE THE BURDEN OF FLAK PLAQUE AND IN JOINTS AND TREATMENT WITH DISABILITIES AND CHEMO THERAPIES CAUSE DYSFUNCTION IN MICE TO FEEL TERRIBLE IF YOU REMOVE THE SENESCENCE CELLS AND PARKINSON'S DISEASE IS ANOTHER NEURODEGENERATIVE AND OBESITY RELATED FUNCTION AS BEEN SHOWN TO HAVE EFFECT AND I'LL END WITH STUDIES FROM MY LAB IN ALZHEIMER'S DISEASE. WE REMOVED SENESCENT CELLS PRIOR TO THE CONCEPT AND NEURODEGENERATION MODEL AND LABORATORY MICE RECOGNIZE A NEW OBJECT AND I'M PAYING MORE ATTENTION TO THIS AND MICE DO THE SAME THING AND THEY'LL INVESTIGATE THINGS MORE READILY AND STAY LONGER AT THE THINGS. THE DEGENERATION MODEL DOESN'T REMEMBER WHAT'S NEW VERSUS OLD AND GO BACK BETWEEN THE TWO OBJECTS EQUALLY AND THE MICE WHERE WE WHERE HE MOVE SENESCENT CELLS LOOK MORE LIKE WILD FIVE AND STAVE OFF THE PROCESS BY REMOVING THE SENESCENT CELLS. I'LL HAD THANK MY LAB AND THE FUNDING IMPORTANTLY THE NIH BECAUSE LABORATORY MOUSE STUDIES ARE NOT INEXPENSIVE APPROACHES. THANK YOU VERY MUCH. >> THANK YOU. >> I'M A PROGRAM OFFICER AT THE HEART LUNG AND BLOOD INSTITUTE. WE HAVE ABOUT 30 MINUTES. IF YOU HAVE A QUESTION, COME TO THE MICROPHONE AND YOUR NAME AND AFFILIATION OR INSTITUTE. THIS WILL BE A PANEL DISCUSSION. WE HAVE. SO FIRST QUESTION IS IF REGENERATION CAN BE ACTIVATED OR REACTIVATED IN OLDER PEOPLE, WHAT IS MISSING FROM THE ACTIVATION OR WHAT IS PRESENT THAT INHIBITS REGENERATION? >> THE QUESTION IS IF REGENERATION CAN BE ACTIVATED OR REACTIVATED IN OLDER PEOPLE, WHAT IS MISSING FROM THE ACTIVATION OR WHAT IS PRESENT THAT INHIBITS REGENERATION? >> IT'S A COMPLEX QUESTION. FIRST OF ALL, WE NEED TO ESTABLISH WHETHER REGENERATION IS THE PROBLEM OR NOT. I'M NOT SURE THAT IS THE REAL ISSUE. THE SECOND IS THAT MY VIEW WOULD BE THAT EVERY SINGLE BIOLOGICAL MECHANISM IS THAT OCCURS IS TIGHTLY REGULATED. SO I THINK THE ISSUE IS WHETHER WE'RE LOST THROUGH THE REGENERATION AND GENERATION OR NOT. AND IT'S INCREASING REGENERATION WOULD NOT BE THE SOLUTION IN A WAY CANCER IS THE REGENERATION THAT CAUSES PROBLEMS BECAUSE IT'S NOT CONTROLLED OR TIGHTLY REGULATED. WE LIKE TO REACTIVATE THE SATELLITE CELL BUT IT NEEDS TO OCCUR IN THE CONTEXT OF THE BIOLOGICAL AND HIGHLY CONTROLLED MECHANISM. >> THAT'S TRUE. IN THE CASE OF MUSCLE ONE FORTUNATE THING WE DON'T UNDERSTAND IS IT'S AN ANTI-TUMOR ENVIRONMENT. IN WITH MOST TISSUES YOU GET AN INCREASE IN CANCERS IN MUSCLES LATER IN LIFE.CERS IN MUSCLES - THERE'S SOMETHING IN MUSCLE THAT'S ANTI-TUMOR GENIC. EXPANDING THE STEM CELLS HAS MINIMAL RISK IN MUSCLES IN OTHER TISSUES IT MAY NOT BE THE CASE BUT THE ROLE OF HOMEOSTASIS AND RENEWING TISSUES IS A VERY IMPORTANT ONE AND THERE'S CHECKS AND BALANCES. >> DOES DR. BAKER HAVE THOUGHTS ON THOUGHTS ON BIOMARKERS OF SEN SEN -- SEN -- SENESCENCE. >> WE'VE BEEN REALLY BENEFITTED BY ABLE TO WORK WITHIN THE LABORATORY MOUSE WE HAVE A PRETTY GOOD ABILITY TO CONTROL THEM AS WEL AS CONTROL THEY'RE COMPLIANT WITH THEIR TREATMENT PROTOCOL AND SHOW FOR ALL THE APPOINTMENTS ON TIME. IT'S SPACE THAT'S BEEN GENERATED FOR INTEREST AND WHAT'S IMPORTANT TO TAKE NOTE OF IS THE FIELD IS STILL RELATIVELY NEW ABOUT SENESCENT CELL BIOLOGY IN VIVO. IF YOU TALKED ABOUT CELLS BEING IMPORTANT FOR IN VIVO PEOPLE WOULD LOOK AT THE IMPORTANT OF THE BIOLOGICAL AGE. THERE WAS NOT A LOT OF INTEREST FOR A LONG PERIOD OF TIME WHERE IT WAS MORE ON THE EDGE OF SOMETHING WE THOUGHT WAS IMPORTANT IT WASN'T UNTIL WE COULD ACCOUNT FOR BURDEN OF SENESCENT CELLS AND MODULATING THEIR FUNCTION. WE'RE STILL IN THE UNFANCY OF THE IMPORTANCE -- IN THE INFANCY. IT'S AN INTERESTING SPACE AND SPACE THAT WILL BE DEVELOPING IN THE SHORT-TERM FUTURE. >> THIS IS IS -- >> I AGREE WITH WHAT YOU SAID. ONE ISSUE WHILE THE IDEA OF THE SENESCENCE IS A WELL DEFINED TRANSFORMATION THE CELL CAN GO THROUGH IS FALLING APART. THERE'S A NUANCE OF MANY TYPES OF SENESCENCE AND PHENOTYPES WHERE IT MAKES THE STUDY MORE DIFFICULT AND ALSO THE WINDOW OF OPPORTUNITY AND FIT EXPRESSES A DIFFERENT BIOMARKER WE HONE -- HOPE IT ALLOWS US TO REALIZE THE SENESCENCE AND WHERE IT COMES FROM AND WHAT IS THE TRIGGER. WE ARE SCRATCHING THE SURFACE OF THIS PHENOMENON. >> WE THROW A SIMPLISTIC TERM OF SENESCENCE UNDER MANY THINGS AND WHERE WE DON'T HAVE A GOOD UNDERSTANDING IN VIVO OF A SENESCENT HEPATOCYTE. DO WE SEE THAT IN IN VITRO WHERE YOU KEEP THEM ININVEST WE HAVE NO IDEA WE HAVE NO IDEA HOW COMPLEX THE PHENOTYPE OF SECRETION CHANGES OVER TIME IF THERE ARE THINGS IN THE EARLY STAGE MORE BENEFICIAL. MAYBE IN THE LATER STAGES THEY BECOME MORE DETRIMENTAL. PEOPLE HAVE DONE CHARACTERIZATION BEING ABLE TO TAKE A PARTICULAR CELL LINE FOR INSTANCE FOR 100% AND CULTURE THROUGH MECHANISMS TO SEE DIFFERENCES IN THE PHENOTYPE HOW IT'S GIVEN RISE TO THAT STATE. IT'S JUST TALKING ABOUT ONE CELL TYPE VERSUS OUR BODIES AND ORGANISMS ARE BUILT OF DIFFERENT CELLS AND HOW IT'S CHANGED OVER TISSUES IS VERY MUCH WE HAVE BEEN REALLY HANDCUFFED BY NOT HAVING THE RIGHT TYPES OF TOOLS. >> LET'S GO TO THE MIC. >> I HAVE A QUESTION FOR YOU. WE KNOW LONGEVITY IS A TRAIT AND FOR YOU THEN THE SIGNATURE YOU IDENTIFIED OR THE MUSCLE CREM STEL AND FOR DR. BAKER THE ISSUE OF DIMORPHISM AND YOU SUGGESTED TO IT. HAVE YOU SPECIFICALLY LOOKED AT DIFFERENCES IN YOUR SOCIAL EPIGENETIC BLOCK WITH SEXUAL DIMORPHISM. WOULD HAD DONE A COMPLICATED STUDY AND WE STARTED WITH A GENETICALLY DIVERSE GROUP OF ANIMALS AND IT LOOKED LIKE WE WERE LOOKING AT AGING WITH THAT PARTICULAR STRAIN AND WENT INTO A DEFINED STRAIN TO DO THE SAME TYPE OF ILLUMINATION. WE SAW A BENEFICIAL IMPROVEMENT IN THE FEMALES IN THE MEDIAN LIFE SPAN EXTENSION. WE LAD -- HAD NO STRONG IMPACT IRRESPECTIVE OF GENE OR GENETIC BACKGROUND OR STRAIN OF LABORATORY MICE. WE MAY HAVE BEEN UNDERPOWERED. WE'RE FLYING BLIND A LITTLE BIT IN TERM OF THINKING SENESCENCE WAS DOING SOMETHING IN A NORMAL MOUSE. WHAT I THINK IS IMPORTANT, OUR MICE WHEN WE WERE DOING THE EXPERIMENT, WE WERE DOING THINGS WHERE WE WERE PROBABLY OVERBURDENING THE MICE WITH DRUGS TO REMOVE THE SENESCENCE CELLS TRYING TO PREVENT DYSFUNCTION. THE COMPANY SAID THE AP DRUG HAD A HALF LIFE OF 24 HOURS. THERE'S ALWAYS A BURDEN OF THE DRUG THERE. WHEN WE'RE DOING THE ADMINISTRATION WE'RE NOT ONLY RESTRICTING THE ANIMALS AND DOING I.P. ADMINISTRATION OF THE DRUG. WE'RE ADDING ON THE STRESSED-INDUCED EFFECT BY RESTRICTING THEM AS WELL. >> WE HAVEN'T GONE INTO DEPTH TO UNDERSTAND THE BASIS BUT IT'S AN INTERESTING AND IMPORTANT POINT. >> AND SO MANY DRAMATIC DIFFERENCES. >> COLONEL ON THE LEVEL OF EPIGENETIC AGE THERE COULD BE DIFFERENCES. NOBODY HAS LOOKED VERY CAREFULLY IN RELATION TO MALES VERSUS FEMALES. AND WHETHER CHANGES ARE LINKED TO THE EPIGENETIC AGE. WE HAVE A STUDY ON THE REVISION WHERE WE LOOK AT EPIGENETICS IN PUBERTY AND WE SEE FAIRLY STRONG CHANGES STRONGER WHEN YOU COMPARE PUBERTY VERSUS BOYS VERSUS GIRLS. I'M GOING TO GIVE YOU TWO EXAMPLES. I'VE STUDIED THE INFLAMMATION AS A RISK FACTOR FOR A RISK OF ALZHEIMER'S IN OLD AGE THOUGH MEN TO HAVE A HIGHER LEVEL OF INFLAMMATORY MARKER COMPARED TO WOMEN THE ASSOCIATION OF THEM WE DON'T UNDERSTAND WHY BUT IN GENERAL THAT'S WHAT EVERYBODY IS FINDING. WHAT IS LESS BIOLOGICAL BUT IS IMPORTANT TO UNDERSTAND THE CONCEPT OF GEROSCIENCE IS THE MECHANISM BY WHICH WE DEVELOP MOVEMENT. FOR EXAMPLE, RECENTLY WE STARTED LOOKING AT MUSCLE STRENGTH FROM THE POINT OF VIEW OF MAXIMUM STRENGTH BUT DEVELOPMENT AND IF YOU HAVE TO JUMP BECAUSE A CAR IS COMING TO YOU, HOW FAST YOU CAN MOVE YOUR MUSCLE BECOMES VERY IMPORTANT. SO IN MEN, PEAK FORCE IS THE STRONGEST PREDICTOR OF WALKING PERFORMANCE. IN WOMEN, IT'S NOT. IT'S RELATED TO FORCED DEVELOPMENT THAT'S THE STRONGEST PREDICTOR OF WALKING PERFORMANCE. THE WAY MEN AND WOMEN DEVELOP SKILLS IN TERMS TERMS OF HOW THEY LIVE THE LIFE IS DIFFERENT. IN MEN DECLINE OF MUSCLE STRENGTH IS IMPORTANT BECAUSE THAT'S WHAT THEY RELY ON. IN WOMEN, A LACK OF COORDINATION AND THE ABILITY TO RECRUIT THE MYOCIDE IS IMPORTANT. THE IDEA THAT WE AGE IN THE WAY WE COME FROM BECOMES IMPORTANT AND IS CLEARLY IN MEN AND WOMEN. >> IT THE MICROPHONE TO THE LEFT AND RIGHT. >> I'M OLIVIA BRIAR. I WAS CURIOUS IF YOU'D TRIED OTHER PAIN KILLERS OTHER THAN NSAID IN THE CONTEXT OF THE OPIOID EPIDEMIC WHERE THERE'S A BIG PUSH TOWARDS USING ALTERNATIVE PAIN KILLERS AND THE EFFECTS OF OPIOID ARE VERY DETRIMENTAL BUT WHAT WAS THOUGHT AS A SAFER ALTERNATIVE MAY NOT BE AS BENEFICIAL AS WE HAD THOUGHT. THAT'S A REALLY INTERESTING QUESTION. THE PGE2 PATHWAY AND THERE'S ANTI-INFLAMMATORIES TARGET AND OPIOIDS PLAY A DIFFERENT MECHANISM. IT'S NOT TOTALLY RELEVANT BUT IMPORTANT. >> I WORK IN THE OSTEOARTHRITIS FIELD AND PAIN IS AN IMPORTANT CONSIDERATION. IF YOU COULD COMMENT BECAUSE I FOUND IN THE LAST SESSION NOBODY REALLY TALKED ABOUT PAIN AND CHRONIC DISEASES THAT COULD BE AN IMPORTANT CONSIDERATION. MOST OF THE PAIN MEDICATIONS ARE PROBABLY DEALT DETRIMENTAL TO HEALTH IN THE LONG RUN. I DID WORK ON COLLEGE AND GENE TRANSCRIPTION AND CARTILAGE CELLS. WE FOUND THE NON-STEROIDAL INFLAMMATORY DRUGS WERE INHIBITORY TO COLLAGEN GENE EXPRESSION AND SYNTHESIS AND WHEN YOU THINK ABOUT HOW IN OSTEOARTHRITIS THE DEFAULT THERAPY TARGET IS PAIN BECAUSE IF NOT THEY'LL USE THE DRUG AND ONCE THE PATIENT COMES WITH SYSTEMS THEY'RE PROBABLY TOO FAR GONE AND IMPACTS CHRONIC DISEASES. IT CAN THINK OF PROREGENERATIVE DRUGS WHILE TRY TO TREAT INFLAMMATION AND PAIN. >> THAT'S AN IMPORTANT POINT AND PGE2 IS IMPORTANT FOR BONE AND OTHER FUNCTIONS. THERE NEEDS TO BEST TOE -- TO DESIGN DRUG TO MORE SPECIFIC AND IMPACT PAIN PATHWAYS AND MAY BE POSSIBLE YING WITH STRUCTURE STUDIES AND UNDERSTANDING THE MOLECULES. I THINK A BIG EFFORT IS WARRANTED IN THAT AREA. WE NEED DRUGS TO AFFECT THE PAIN. QUE DON'T HAVE GOOD WAYS TO CONTROL PAIN. WE SHOULDN'T FORGET, OSTEOARTHRITIS IS THE NUMBER ONE CAUSE OF DISABILITY IN AGING. THAT'S MOSTLY THROUGH PAIN. I THINK WHAT WE HAVE AVAILABLE HAS LONG-TERM TOXICITY IT'S GOOD FOR ACUTE PAIN AND BAD FOR CHRONIC PAIN. THERE'S A LOT OF WORK BOILING IN THE FIELD ESPECIALLY IN THE CLASS OF LIPIDS. THEY'RE IMPORTANT IN PAIN MODULATORS AND THEY'VE PROMISING FOR PHARMACOLOGIC TARGETS THAT MAY ADDRESS THE ISSUE IN THE FUTURE. >> I COME THROUGH THIS BY EPIDE EPI-DEMEO LOGICALLY DEVELOPMENT. EVOLUTION IS TO REPRODUCE. IF I TOLD YOU AGING SENESCENCE ARE AN EVOLVED EPIGENETIC PROGRAM YOU WOULD SAY YOU DON'T UNDERSTAND ANYTHING ABOUT EVOLUTION. YEARS AGO EVOLUTION BIOLOGISTS SAID AGING CANNOT BE ADAPTIVE. THERE'S MANY WHO BELIEVE IN GROUP SELECTION AND BELIEVE TRAITS CAN BE EVOLVED FOR THE GOOD OF THE COMMUNITY AND AMONG THOSE IS AGING. AND THIS HAS THE POTENTIAL TO GIVE US A NEW INSIGHT TO REBOOT THE WAY WE LOOK AT AGING. SUPPOSE WE THINK THAT THE EXISTENCE OF THIS SENESCENT CELLS MAY BE A REPURPOSING OF CELL SENESCENCE WHICH HAS LEGITIMATE FUNCTIONS IN YOUTH OR REPURPOSING JUST TO KILL US. IF WE LOOK AT THE STRAIGHT LINE IN SOME OF THE HORVATH METHYLATION SITES THAT JUST PROGRESS WITH AGE AND HOW DID THAT HAPPEN, MAYBE THIS IS AN AGING PROGRA MAYBE THIS IS EVOLVED TO KILL US AND MAYBE IT'S THE BEST THING WE CAN DO. >> I THINK YOU BRING UP AN IMPORTANT CONCEPT. SOMETHING BACK WHEN I WAS A JUNIOR SCIENTIST AND INTERESTED IN ANIMAL BEHAVIOR AND THERE'S PROBABLY A NUMBER OF THINGS PROGRAMMED EVENTS AT SOME POINT IN TIME WILL BE BENEFICIAL FOR THE LATER STAGE AND THE WHOLE IDEA OF EPIGENETIC AND THE ATROPHY ACTIVITY AND WHAT SENESCENT CELLS ARE DOING THAT ARE BENEFICIAL TO PREVENT TUMOR GENESIS THEN YOU HAVE THE POTENTIAL OF DRIVING IT WITH AGE AND THE OTHER OPTION OF THEM BEING SOMETHING THAT IS INHERENTLY SELECTED FOR OR AS PART OF THE PROCESS WE REALLY HAVEN'T THOUGHT OF IT IN THAT WAY BUT PLAYING AROUND WITH THE ACQUISITION OF THE SENESCENT CELLS WE'RE ABLE TO STAVE OFF THINGS HAPPENS IN THE DETRIMENTAL SIDE SO IT LENDS CREDENCE TO THE IDEA AND WHAT ROLE EPIGENETICS HAS IN THAT WHOLE STATE WILL BE INTERESTING TO UNDERSTAND FOR SURE. >> THERE'S EVIDENCE THAT WHAT HAPPENS EARLY IN LIFE CAN AFFECT LIFE LATER AND THE ONLY MECHANISM IS THIS CAN HAPPEN IS EPIGENETIC WHETHER THERE'S METHYLATION OR ANOTHER TYPE OF EPG -- EPIGENETIC WE DON'T KNOW. TO ME EPIGENETIC HAS EVOLVED TO MATCH OUR GENE EXPRESSION TO THE EXCHANGE OF THE INTERNAL ENVIRONMENT. PURPOSELY EPIGENETIC IS A MECHANISM BUT IT'S POSSIBLE LATER IN LIFE THE COMPENSATIONS HAVE AN AFFECT EARLY AND BECOME DELETE -- DELETERIOUS AND WHEN IT MATCHES OUR GENE EXPRESSION TO THE ENVIRONMENT, NOBODY AS ANY IDEA THE SENSE OF THE ENVIRONMENT ARE. THE BIOLOGICAL SENSE OF THE ENVIRONMENT ARE COMPLETELY UNKNOWN. UNLESS WE STUDY BETTER THE TRANSLATION OF THE INFORMATION FROM THE ENVIRONMENT TO OUR INTERNAL PROGRAM WE'LL NOT KNOW WHETHER EPIGENETIC IS E PREPROGRAM ORDER REACTIVE AND IT MAY NOT BE TRUE THAT IT'S AN EVOLUTIONARY NATURE. >> TWO COMMENTS. FIRST, AS YOU PROBABLY KNOW, THEY SHOWED THE CHANGE IN METHYLATION WHEN YOU EXPOSE THE CELL SUGGESTING SOMEHOW THEY LI LISTEN TO STRESS, IF YOU WISH. SECONDLY, EVOLUTIONARY BIOLOGISTS ARE TAKEN WITH THE IDEA OF EPIGENETICS AND IN TOUCHING ON THE RAIN FOREST AND THE RURAL FOLKS IN WESTERN AFRICA WHAT WE FOUND ON COMMUNICATIONS WAS THERE WAS STRONG ENRICHMENT IN SITES LINKED TO UNDERPINNING GENETICS WHEN WE COMPARED THEM TO THE FOLKS THAT SEPARATED 60,000 YEARS AGO. WHEN WE COMPARED THEM TO THE PIG PYGMIE TERRITORY THEY ADAPTED BUT THERE WAS A BIGGER RESPONSE THAT WAS RELATED TO THE ENVIRONMENT THEY LIVED IN AND IN RESPONSE TO YOUR LOVE FOR EPIGENETICS WHEN YOU TALK TO PEOPLE WHO STUDY THE MICROBIOME THEY'LL TELL YOU THE SAME WITH THE MICROBIOME. >> INTERESTING TOPIC. >> WILLIAM SMITH WITH UNIFORM SERVICES UNIVERSITY. ON THE CLINICAL SIDE, WE ARE ENGAGED IN A BIG EXPERIMENT REGARDING THE USE OF ANDROGENS AND GROWTH HORMONE IN PROFESSIONAL SPORTS AND IN YOUTH CLINICS AROUND THE COUNTRY. AND THERE'S BEEN TALK ABOUT SARK OWE PENA AND LOSS OF MUSCLE MASS AND THE AFFECT OF HORMONAL ACCESS WITH AGING BEEN AUTO ELUCIDATE -- BEEN ELOOSE GAITED THAT YOU CAN -- E ELUCIDATED YOU CAN SPEAK TO. >> WHAT WE SEE IN THE COHORT IS THE DECLINE IN MUSCLE STRENGTH IS OVER AND BEYOND WHAT SHOULD BE CALCULATED WITH THE MUSCLE MASS. . TO ME EXPANDING THE MUSCLE IS NOT A GOOD IDEA AND THE PROOF OF THAT ATTEMPT IN NOT PROVIDING GOOD RESULTS. WE NEED TO UNDERSTAND WHY THE MUSCLE DOES NOT WORK IN AGING AND WHAT HAPPENED TO THEM AND WHY THEY CANNOT GENERATE FORCE. THAT'S A BETTER APPROACH TO REDUCE THE BURDEN OF SARCOPENIA. >> MUSCLE MASS IS NOT ALWAYS CORRELATED WITH STRENGTH BUT DOES AID IN STRENGTH AND THERE'S SUFFICIENT STUDIES TO SHOW THAT. IF YOU CAN BUILD THE MUSCLE MASS AND THE FUNCTION OF THE MUSCLE, YOU CAN INCREASE QUALITY OF LIFE AND MOBILITY WITH AGING. >> IN TERMS OF GROWTH FACTOR SIGNALLING, SOME OF OUR FIRST LABORATORY MICE WE KNEW ADD EXCEPTIONAL LONGEVITY WERE MUTANT IN SIGNALLING PATHWAYS. MANY ARE DWARF NICE TO THEY'RE SMALLER BY COMPARISON TO THEIR PROFICIE PROFICIENT COUNTERPARTS BUT HAVE EXCEPTIONAL LONGEVITY AND IF YOU DO A CROSS-SECTIONAL ASSESSMENT AT ANY WIN POINT IN TIME IN THEIR LIVES THEY HAVE A LOWER BURDEN OF SENESCENT CELLS BUT IS NOT A CAUSATION. JUST MORE A CORRELATION THAN ANYTHING AT THE MOMENT. >> OKAY. AT THIS TIME I'D LIKE TO CLOSE THE SESSION. WE'LL HAVE ONE-HOUR BREAK AND GET BACK TO THE ROOM BY 1:15 AND YOUR PRE-ORDERED LUNCHES ARE AVAILABLE UPSTAIRS. LET'S GIVE THE SPEAKERS IN THE SESSION A ROUND OF APPLAUSE, PLEASE. THANK YOU. >> WELCOME TO THE NEXT SESSION. WE'RE KIND OF TRANSITIONING A LITTLE BIT IN TERMS OF CONTENT, SO MY NAME IS KRISTIN ABRAHAM, I'M FROM THE NIDDK. AND WHAT WE'RE GOING TO BE MOVING TOWARDS NOW IS, AFTER WE'VE HEARD A LOT OF INTERESTING BIOLOGY AND PHYSIOLOGY AROUND AGING, WE'RE GOING TO HAVE SOME REPRESENTATIVES FROM SOME AGENCIES THAT ARE THERE TO HELP FACILITATE GETTING PROJECTS ON THE GROUND. SO WE'RE GOING TO BE TALKING ABOUT AGENCIES AND MECHANISMS THAT WE CAN USE TO FACILITATE COLLABORATIONS THAT ARE GOING TO BE REQUIRED TO TRY TO ACTUALLY MOVE SOME OF THESE CONCEPTS SO THE FIRST SPEAKER, I'M REALLY HAPPY TO PRESENT IS JOE MENETSKI, WHO IS THE ASSOCIATE VICE PRESIDENT FOR RESEARCH PARTNERSHIPS AT THE FOUNDATION FOR NIH. HE'S GOING TO TALK TO US ABOUT WHAT THE FNIH DOES AND HOW IT OPERATES. >> I AM THRILLED TO BE HERE AS A SPEAKER ON THIS PANEL, AND EVEN MORE THRILLED TO BE PART OF THIS AND WISH YOU ALL -- BE ABLE TO TELL YOU A LITTLE BIT ABOUT WHAT THE F NIH DOES, BECAUSE I'M VERY PROUD OF IT. SO I WORK AT THE FNIH, I'VE BEEN THERE FOR YEARS. I GUESS THE CONFLICTS OF INTEREST, I HAVE NO REAL CONFLICTS OF INTEREST. BUT LIKE HAS BEEN SAID FROM OTHERS, A LOT OF WHAT WE DO IS FUNDED BY EXTERNAL COMPANIES AND AGENCIES AND THINGS LIKE THAT, BUT NONE OF THEM ACTUALLY DIRECT WHAT WE DO SPECIFICALLY OR DIRECT WHAT I DO SPECIFICALLY, SO I STILL FEEL LIKE I DON'T HAVE MUCH OF A CONFLICT. SO WHAT I'M GOING TO DO, THIS IS THE AGENDA FOR MY 20, 19 MINUTES AND 5 SECONDS. I'M GOING TO TELL YOU A LITTLE BIT ABOUT FNIH, ABOUT FNIH PARTNERSHIPS AND EXAMPLES OF THEM, AND THEN TRY TO GET TO WHAT WE'VE LEARNED. THE "ABOUT THE FNIH" PART, AT NIH, WOULD SEEM LIKE SOMETHING THAT WOULD BE UNNECESSARY BUT I THINK IT'S ALWAYS GOOD TO BE REMINDED THAT THE FNIH WAS SET UP BY AN ACT OF CONGRESS, KIND OF LIKE WHAT IS REQUIRED TO BUILD A NEW BUILDING ON THE NIH CAMPUS. BUT IT WAS SET UP IN 1990, AND MEANT TO PUT TOGETHER AND FACILITATE THE INTERACTIONS BETWEEN THE PUBLIC SECTOR AND NIH AND THE PRIVATE SECTOR. AND WE DO THAT IN THE FORM OF PARTNERSHIPS. ALL DIFFERENT KINDS OF PARTNERSHIPS. BUT I'LL GO INTO THEM IN A FEW MOMENTS. SO FNIH IS A VERY SEPARATE 501(C)3 NOT FOR PROFIT ORGANIZATION. IT IS NOT THE NIH. THAT'S VERY IMPORTANT, IT IS NOT A GOVERNMENT AGENCY, IT WAS SET UP BY CONGRESS BUT IT IS A SEPARATE AGENCY. AND IT RAISES MONEY TO SUPPORT THE MISSION OF NIH, AND OVER THE PAST 20-SOME YEARS, 25 AND A COUPLE, WE'VE RAISED OVER A BILLION DOLLARS FOR THAT. AND OF THAT BILLION DOLLARS, ALMOST 90 CENTS OF EVERY DOLLAR GOES TO RESEARCH. SO WE HAVE VERY LITTLE OVERHEAD -- WELL, WE HAVE OVERHEAD BUT WE HAVE -- WE DON'T CHARGE VERY MUCH OVERHEAD. AND WE'RE VERY EFFICIENT AT WHAT WE DO. OVER THE PAST 20-SOME YEARS, WE'VE HAD MORE THAN 600 PROGRAMS, WE CURRENTLY HAVE 123 ACTIVE PROGRAMS, AND AS SOME OF YOU KNOW WHO ARE IN THE NOT FOR PROFIT OR AWARE OF THE NOT FOR PROFIT SPACE, CHARITY NAVIGATOR IS ONE OF THESE WATCHDOG KIND OF SPACES THAT LOOKS AND SEES HOW PEOPLE ARE DOING AND FOR THE PAST 16 YEARS, WE'VE GOTTEN AN OUTSTANDING CHARITY NAVIGATOR RATING. WHICH WE'RE ALSO VERY PROUD OF BECAUSE IT MEANS WE'RE GOOD AT WHAT WE DO. SO WHAT DO WE DO? WE DRIVE PUBLIC-PRIVATE PACK NER PARTNERSHIPS TO SUCCESS. I LIKE TO SAY THAT WITH A GREAT DEAL OF GLEE. WE HELP DEFINE THE GOVERNANCE AND WE'VE BEEN DOING THIS FOR LONG ENOUGH NOW THAT WE CAN HELP PUT TOGETHER A GOVERNANCE THAT SUITS BOTH OUR PUBLIC AND PRIVATE PARTNERS, IT DOESN'T GET ANYBODY INTO TROUBLE, NOBODY GOES TO JAIL, IT ALL WORKS WELL. WE DO THE POLICY MANAGEMENT WHERE WE PROVIDE A SAFE HARBOR FOR INTERACTIONS BETWEEN NIH AND PRIVATE INDUSTRIES, AND WE CAN COLLABORATE TO IDENTIFY WHERE AND WHAT KIND OF WORK GETS DONE, BUT IT KEEPS EVERYBODY SAFE IN THE SENSE OF NOT INTERFERING WITH ANY POTENTIAL LAWS. THE OTHER THING WE DO A LOT OF IS PROGRAM MANAGEMENT. SO AS I WILL SHOW IN A FEW MOMENTS, NONE OF OUR PARTNERSHIPS ARE ONE COMPANY AND ONE INVESTIGATOR. IN FACT, QUITE FREQUENTLY HALF A DOZEN COMPANIES, HALF A DOZEN INVESTIGATORS AND NOT ONLY COMPANIES BUT FOUNDATIONS AND OTHER PRIVATE ENTITIES, AND ALL OF THEM HAVE THEIR OWN NEEDS AND EXPECTATIONS AND WE HELP BOTH MANAGE THOSE AS WELL AS MANAGE THE ACTUAL WORK TO DRIVE TO MILESTONES AND GET THINGS DONE. SO PROGRAM MANAGEMENT, PROJECT MANAGEMENT, THAT GETS DOWN TO THE NITTY GRITTY DID YOU MAKE THE MILESTONE? ARE YOU GOING TO GET YOUR NO-GO DECISION MADE? IS THIS PROJECT ACTUALLY GOING TO GENERATE SOMETHING IN THE TIME FRAME THAT WE DESCRIBED? AND WE ALSO MANAGE THE INTELLECTUAL PROPERTY DISCUSSIONS ANYWAY. WE DON'T ACTUALLY OWN ANY OF THE œINTELLECTUAL PROPERTY WHEN IT IS NECESSARY. BUT WE DO ALL OF THIS IN A PRECOMPETITIVE SPACE, SO THE GOAL OF ALL OF OUR PROJECTS IS TO PUT THE DATA OUT, THE RESULTS OUT INTO THE PUBLIC DOMAIN FOR EVERYONE TO USE AS ABSOLUTELY FAST AS WE CAN. AND ALL OF THIS, AND THE ABILITY TO DO THAT, IS PREDICATE ON THE FACT THAT YOU HAVE TO HAVE ALL OF THESE RULES AND POLICIES AND UNDERSTANDINGS FIGURED OUT BEFORE THE PROJECT STARTS. IF YOU START DOING THIS WHILE YOU'RE MOVING THROUGH YOUR PROJECT KIND OF ON THE FLY, IT CAN REALLY GO BAD VERY QUICKLY. SO WE TRY TO AVOID THAT AND I THINK WE HAVE, IN MANY WAYS. SO THE NEXT SLIDES ARE ABOUT SOME PARTNERSHIPS, SOME EXAMPLES. THESE ARE JUGS JUST A FEW EXAMPLES, NOT ALL BUT ONES THAT ARE IN THE RESEARCH PARTNERSHIP SPACE WHERE WE'RE ACTUALLY HELPING GENERATE NEW DATA, NEW INFORMATION, NEW RESULTS, AND THOSE THAT ARE HERE, ACTUALLY A NUMBER OF THE DIRECTORS WHO WERE HERE THIS MORNING AND A FEW THAT ARE STILL HERE, ARE INTIMATELY INVOLVED IN BECAUSE IT'S A LOT OF WHAT WE DO, IS DIRECTLY WITH OUR INSTITUTES, SO OUR BIGGEST PARTNERSHIP THAT WE'VE BEEN RUNNING FOR THE PAST SIX YEARS, FIVE OR SIX YEARS IS THE ACCELERATED MEDICINES PARTNERSHIP. WE ALSO JUST RECENTLY, ABOUT A YEAR AND A HALF AGO, STARTED A PARTNERSHIP ON CANCER THERAPEUTICS AS KIND OF AN ADJUNCT TO THE MOONSHOT. THE GRAND CHALLENGES IN GLOBAL HEALTH WAS SOMETHING THAT REALLY KICKED THE FNIH OFF, WITH A GRANT FROM THE BILL AND MELINDA GATES FOUNDATION. ANOTHER PROJECT THAT'S BEEN GOING ON FOR QUITE SOME TIME IS LUNG MAP, WHICH IS A MASTER LUNG PROTOCOL TRIAL. SO YOU KNOW, NOW WE SAY A MASTER PROTOCOL TRIAL, AND EVERYBODY PRETTY MUCH KNOWS WHAT THAT MEANS. IN THE YEARS WHEN LUNG MAP WAS STARTING AND ACTUALLY PRIOR TO LUNG MAP WHEN WE WERE PUTTING TOGETHER I SPY, THAT WAS A BRAND NEW CONCEPT. AND SO IN REALITY, I THINK SOME OF THE EARLIEST EXAMPLES OF MASTER PROTOCOLS ARE ACTUALLY FROM PARTNERSHIPS WITH NIH AND THE FNIH. ONE OF OUR OLDEST PARTNERSHIPS IS THE ALZHEIMER'S DISEASE NEUROIMAGING INITIATIVE. THIS IS A PROJECT THAT IS PRIMARILY RUN OUT OF NIA, BUT IT WAS RECOGNIZED EARLY ON THAT THERE WERE MORE THINGS THAT COULD BE DONE THAT COULDN'T BE DONE WITH NIAID FUNDING ALONE, SO THERE'S A NUMBER OF COMPANIES THAT HAVE ADDED ADDITIONAL SUPPORT FOR THE IMAGING INITIATIVE, AND IT HAS ALLOWED THE ACCUMULATION OF EVEN MORE DATA THAT'S OUT THERE NOW IN THE PUBLIC DOMAIN. THE BIOMARKERS CONSORTIUM IS A LONG RUNNING PROJECT THAT I HAVE VERY CLOSE TIES WITH, SO I'LL TRY NOT TO TALK ABOUT THAT TOO MUCH BECAUSE IF I GET ON TO IT, I FEEL LIKE THEY'LL DEFINITELY KICK ME OFF THE STAGE. AND THEN FINALLY, WE HAD A PRETTY BIG LEVEL OF INTEREST OR WORK WITH WHAT IS NOW THE HEAL PARTNERSHIP. THE HEAL, THE HELPING END ADDICTION LONG TERM, THAT IS ADDRESSING THE OPIOID CRISIS, STARTED OUT AS A NUMBER OF CONFERENCES THAT DR. COLLINS STARTED AND THEN THAT DEVELOPED INTO BIGGER AND BIGGER PROJECT THAT ENDED UP WITH A LOT OF WHAT CAME OUT OF THOSE DISCUSSIONS IN THE CURRENT HEAL PROGRAM. SO THESE ARE THE KIND OF RESEARCH THINGS BUT BY NO MEANS THEY'RE THE ONLY KIND OF THINGS WE DO. ACTUALLY, WE ARE HELPING SPONSOR SOME OF THIS MEETING, SO PULLING THIS TOGETHER, SO THAT TELLS US IT'S NOT JUST THAT, BUT WE ALSO HAVE HAD SOME WORK IN EDUCATION, BRINGING IN RESEARCH FELLOWS, AND ADDITIONALLY SOME WORK IN GLOBAL HEALTH AND EVEN MOSQUITO-BORNE DISEASES, LOOKING AT GENE DRIVE FOR GENETICALLY MODIFIED MOSS. SO THAT'S A PRETTY BROAD MANDATE, BUT THAT MAKES SENSE BECAUSE THE NIH HAS A BROAD MANDATE. SO WE WORK IN MANY OF THOSE CASES. OKAY. SO WHERE DID THESE PARTNERSHIPS COME FROM? PRETTY MUCH MOST OF THEM START IF NOT ALL OF THEM START SOMEPLACE AT NIH. AND THE NIH CURRENTLY HAS ESTABLISHED A STREAMLINE REVIEW PROCESS, BUT REALLY WHAT HAPPENS PROJECT COMES UP IN AN IC IN ONE OF THE INSTITUTES OR CENTERS, AND THAT GOES THROUGH A SCIENTIFIC REVIEW, IT'S SIGNED OFF ON BY THE INSTITUTE DIRECTOR, IT THEN GOES TO AN OFFICE OF THE DIRECTOR STEERING COMMITTEE, MAKE SURE IT FITS IN WITH WHAT'S GOING ON AT NIH, IT REALLY IS A PRIORITY, AND THEN IT GETS PROPOSED TO THE FNIH BOARD, AND IF THE FNIH BOARD, AND GENERALLY WHEN THERE'S A COUPLE OF IC DIRECTORS AND DR. COLLINS SAY THIS IS SOMETHING WE SHOULD BE DOING, WE NORMALLY DO IT. BUT THOSE PROPOSALS COME IN TO& FNIH AND WE FIGURE OUT HOW TO MAKE THEM WORK. WE WORK WITH THE NIH FOLKS, WE WORK WITH EXTERNAL FOLKS AND MAKE SURE HOW TO DETERMINE HOW WE CAN GET THEM TO WORK IN A WAY THAT IS BENEFICIAL AND IMPACTFUL FOR THE COMMUNITY. SO NOW WE'RE JUMPING TO THE EXAMPLES, AND I'VE GENERATED THREE EXAMPLES FOR THE THREE GENERAL MODELS FOR HOW WE MANAGE RESEARCH PARTNERSHIPS. AND THESE ARE SHOWN HERE. SO IT'S KIND OF WHERE IS THE MONEY COMING AND GOING, AND THEN HOW MUCH INVOLVEMENT FNIH HAS IN ACTUALLY THE MANAGEMENT OF THE PROJECT. SO NIH CAN COLLECT SPONSOR MONEY, FUNDING, IN KIND, IT DOESN'T HAVE TO BE ACTUAL DOLLARS, IT CAN BE DRUGS, IT COULD BE IN-KIND ANALYSIS TECHNIQUES AND WHAT HAVE YOU. AND THEY CAN JUST GIVE THAT TO NIH, AND THEN NIH MANAGES THE ACTUAL RESEARCH PROGRAM, AND THAT'S SOMETHING LIKE ADNI, THE ALZHEIMER'S DISEASE NEUROIMAGING INITIATIVE. THAT'S A SITUATION WHERE WE HELP COLLECT SUPPORT AND THEN PROVIDE TO NIA AND THEN NIA USES THAT TO EXPAND ON WHAT WE COULD BE DOING IN ADNI. ANOTHER IS TO TAKE KIND OF A BALANCED APPROACH WHERE THERE IS SOME OF THAT FUNDING AND SOME OF THAT IN KIND GOES DIRECTLY TO RESEARCHERS AND SOME OF IT POTENTIALLY GOES TO NIH, BUT THEN ALSO THE NIH IS USING THEIR OWN FUNDS TO GRANT -- FOR THEIR OWN GRANTS AND WE COORDINATE THAT. SO THAT'S SOMETHING LIKE ACCELERATING MEDICINES PARTNERSHIP. BOTH OF THESE THINGS HAVE BEEN EXTREMELY IMPACTFUL, HAVE HAD A MAJOR EFFECT ON THE SCIENTIFIC COMMUNITY, AND THEN THE FINAL IS SOMETHING LIKE THE BIOMARKERS CONSORTIUM, WHICH WAS SET UP IN COLLABORATION WITH NIH AND WITH THE INSTITUTES BUT IS NOW KIND OF OPERATING IN A SPACE WHERE WE MANAGE PRETTY MUCH EVERYTHING. WE HAD A LOT OF THE NIH FOLKS INVOLVED BUT IT'S REALLY MOSTLY FNIH MANAGED PROJECT. SO WHAT I JUST SAID FITS INTO THIS KIND OF PICTURE WHERE WE HAVE PRIVATE PARTNERS, THEY GIVE SOMETHING TO THE FNIH AND THEN WE FIGURE OUT HOW TO DISTRIBUTE IT. SOMETIMES IT'S NIH, STIEMENTS IT'S DIRECTLY TO THE SPONSORS. SO THE FIRST ONE I'M GOING TO DO VERY QUICKLY IS ADNI, THE ALZHEIMER'S DISEASE NEUROIMAGING INITIATIVE. THIS STARTED IN 2004. IT IS IN ITS -- DEPENDING ON HOW YOU COUNT, THREE, SIX ITERATIONS. IT'S GENERATED AN INCREDIBLE AMOUNT OF DATA, DATA THAT HAS BEEN ACCESSED MANY TIMES, 50 MILLION MORE BY ALZHEIMER'S DISEASE RESEARCHERS. THEY'VE PUBLISHED -- THERE HAVE BEEN OVER A THOUSAND, ALMOST 2,000 PAPERS THAT HAVE BEEN PUBLISHED FROM THIS DATA AND THIS TRIAL ACTUALLY IS ESTABLISHED KIND OF THE WAY ALZHEIMER'S TRIELSZ ARE RUN, RIGHT? I MEAN, THIS HAS HAD A HUGE EFFECT ON THE FIELD, AND WHAT'S INTERESTING IS IT'S BEEN USED TO OPTIMIZE AND STANDARDIZE AND VALIDATE IMAGING BIOMARKERS BUT WHAT'S REALLY AMAZING, AND ACTUALLY WHEN YOU TALK TO THE PEOPLE WHO WERE ON THIS AT THE BEGINNING, BUT THERE'S VIRTUALLY NO EMBARGO OF THE DATA, SO IT GOES IN, EVERYBODY SEES IT AT THE SAME TIME, THE PEOPLE WHO PUT IT THERE AS WELL AS INTERESTED RESEARCHERS WHO COULD ANALYZE IT. SO IT'S ACTUALLY A FANTASTIC RESOURCE AND HAS BEEN, WILL CONTINUE TO BE, I'M SURE. SO THE NEXT IS THE ACCELERATED MEDICINES PARTNERSHIP. THIS IS NIH HAS PARTNERED WITH THE FDA IN THIS CASE, SO WE DO A LOT OF THINGS WITH THE FDA, AND MULTIPLE LIFE SCIENCE FIRMS, NOT FOR PROFITS, THE INITIAL PROJECTS IN ALZHEIMER'S DISEASE, TYPE~2 DIABETES AND AUTOIMMUNE DISORDERS, PARTICULARLY R.A. AND SLE, AND WE JUST RECENTLY LAUNCHED A PARKINSON'S DISEASE PROJECT. SO THESE PROJECTS WERE DIRECTED AT TARGET IDENTIFICATION AND TARGET VALIDATION, SO IN ORDER TO HELP US GET DRUGS THAT ACTUALLY COULD HELP THESE PEOPLE MORE EFFICIENTLY. THIS IS A NICE PICTURE TO SHOW YOU THAT THE KINDS OF COLLABORATION AND THE TYPES OF PEOPLE, THE TYPES OF ORGANIZATIONS THAT ARE INVOLVED IN ALL OF THESE PROJECTS, BUT THE THING THAT I WANT TO REALLY SAY HERE IS THIS HAS BEEN A PROJECT THAT'S COMING TO ITS FIRST ITERATION END OF LIFE AT FIVE YEARS AS IT'S CERTAINLY NOT SENESCENT AT THIS POINT, BUT WHAT THE PROJECT HAS GENERATED IS JUST AN UNPARALLELED ACCESS TO DETAILED RAW UNPROCESSED DATA, A SCALE THAT'S JUST NEVER SEEN BEFORE. AND IT'S ALL PUBLIC, AND IT'S ALL SHARED. INDIVIDUAL PROJECTS HAVE GENERATED, YOU KNOW, INCREASED IMAGING DATA, DEFINE NEW TARGETS FOR ALZHEIMER'S DISEASE THAT HAVE BEEN EVALUATED BOTH IN HUMANS AND IN HUMAN KIND OF OMICS APPROACHES AS WELL AS ANIMALS, TYPE 2 DIABETES HAS GENERATED SOME AMAZING ANALYTICAL TOOLS FOR ANALYZING GENETIC DATA AS WELL AS NEW GENOMIC AND TARGET ANNOTATION DATA AND THE RNA LUPUS PROJECT HAS GENERATED -- THEY'VE REALLY FOCUSED ON SINGLE CELL ANALYSIS AND THEY'VE GENERATED A VISION INTO A RHEUMATOID JOINT WHERE A LUPUS KIDNEY THAT IS JUST UNPARALLELED. STARTING TO SEE CELLS THAT WE DIDN'T EVEN KNOW EXISTED AND WERE PART OF THE DISEASE. SO THIS IS GOING TO HAVE A HUGE IMPACT IN THE FUTURE. IT'S REALLY AN ABILITY TO DO SOMETHING THAT'S NEVER BEEN DONE BEFORE. THE FINAL IS THE BIOMARKERS CONSORTIUM, AS WE SAY, IT'S A BIOMARKET DIRECTED, TO LEAD CROSS SECTOR EFFORTS TO LEAD BIOMARKERS AND OTHER DRUG DEVELOPMENT TOOLS BECAUSE BIOMARKERS ARE CLEARLY THINGS THAT ARE NECESSARY FOR PRECISION MEDICINE AS WELL AS DRUG DEVELOPMENT BUT THEY DON'T INCLUDE THINGS LIKE -- IF YOU SAY BIOMARKER FROM THE FDA POINT OF VIEW THEY DON'T SEE THAT AS THE SAME AS A CLINICAL OUTCOME ASSESSMENT SO THAT'S WHY WE EXPANDED TO DRUG DEVELOPMENT TOOLS. SO OVER THE 12 YEARS OR SO THAT THE BIOMARKERS CONSORTIUM HAS BEEN TOGETHER, WE'VE GENERATED SEVERAL OF THESE PROJECTS THAT LOOK SOMETHING LIKE THIS. SO WHERE WE HAVE MULTIPLE PEOPLE IN THE PRIVATE SECTOR GENERATING -- GIVING BOTH DATA AND FUNDING, WE HAVE MULTIPLE ORGANIZATIONS FROM THE PUBLIC SECTOR WHO HAVE EXPERTISE IN VARIOUS SPECS OF WHAT IS NEEDED AND THEN FNIH KIND OF PULLS THIS TOGETHER WITH FDA AND NIH TO GENERATE A BIG PROJECT TEAM. THESE PROJECTS OVER THE 12 YEARS HAVE GENERATED 14 THERAPEUTICS THAT HAVE BEEN ADVANCED THROUGH THE TOOLS THEY'VE GENERATED. IN 12 YEARS, 14 DRUGS IS PRETTY AMAZINGS. AMAZING. NINE CLINICAL TOOLS CURRENTLY BEING USED IN DEVELOPMENT. FDA GUIDANCE DOCUMENTS INCLUDING ONE CLINICAL SAFETY BIOMARKER QUALIFICATION. QUALIFICATION IS A FORMAL RESPONSE FROM THE FDA THAT SAYS A PARTICULAR BIOMARKER IS FIT-FOR-PURPOSE FOR A SPECIFIC -- IN THIS CASE CLINICAL SAFETY OUTCOME. GENERATED A NUMBER OF PUBLICATIONS AND NUMBER OF CITATION. CURRENTLY WE'RE ALMOST AT 60 ORGANIZATIONS. I HAVE 23 SECONDS SO I CAN TELL YOU WHAT WE'VE LEARNED. KEY SUCCESSES OF PARTNERSHIP IS YOU NEED SO HAVE AN UNMET NEED, ROBUST SCIENTIFIC RSH NEAL, WILLING AND INNOVATIVE PARTNERS. WILLING PARTNERS IS VERY IMPORTANT. LEADERSHIP, AND A CHAMPION AND REALLY A LOT OF WORK. WHAT DOESN'T GENERATE MUCH OF A SUCCESSFUL PROJECT ARE THINGS THAT ARE PRIMARILY FOCUSED ON TECHNOLOGY, INFRASTRUCTURE VERSUS HYPOTHESIS-DRIVEN SCIENCE, SINGLE PIs OR SMALL TEAMS, IF THERE'S NO COMPANY PARTICIPATION OR IF IT DOESN'T ALIGN WITH STRATEGIC PRIORITIES WITH ALL STAKEHOLDERS INVOLVED. SO I'M A LITTLE LATE, BUT I'M DONE. THANK YOU. [APPLAUSE] >> NEXT UP, I'M HAPPY TO INTRODUCE CYNDY CORDELL FROM THE GLOBAL ALZHEIMER'S PLATFORM FOUNDATION AND SHE'S GOING TO TALK ABOUT THEIR WORK IN TRYING TO DEVELOP STRATEGIES TO DO ADVANCED CLINICAL TRIALS. >> THANK YOU. I DO APPRECIATE BEING HERE TODAY. I'M A LITTLE BIT DIFFERENT KIND OF TALK AND I'M GETTING OVER A COUGH SO I HOPE YOU CAN HEAR ME OKAY. I DON'T HAVE ANY CONFLICT OF INTEREST BUT I DO WANT TO SAY OUR FOUNDATION IS SUPPORTED BY SEVERAL PHARMACEUTICAL COMPANIES, AND WHAT I WANT TO -- WHY I WANT TO SAY THIS IS THEY ACTUALLY CAME IN A PRECOMPETITIVE SPACE TO FORM OUR FOUNDATION WITH BASICALLY PRETTY MUCH A SINGLE FOCUS, IS TO JUST ACCELERATE ALZHEIMER'S DISEASE CLINICAL TRIALS AND MAKE THEM MORE MORE EFFICIENT IN THEIR PROCESSES. AND WE FOCUS STRICTLY ON THERAPEUTIC TRIALS, THE LARGEST DRIVERS OF LONG TRIALS IS THE STUDY STARTER PROCESS. WE HAD SOME ACADEMICS OF THE CENTERS TAKING OVER A YEAR TO GET THROUGH CONTRACTING AND THEN HOW DO YOU GET RECRUITMENT AND PEOPLE INTO TRIELSZ FOR TRIELTS FOR ALZHEIMER'S BECAUSE THESE ARE SENIORS, MOVING FROM SYMPTOMATIC PATIENTS TO THOSE AT RISK OR EVEN PREVENTION TRIALS, WHICH YOU'RE TRYING TO FIND OUT PEOPLE IN THE WELLNESS SPECTRUM. THIS IS OUR GOAL. I WILL SAY, YOU KNOW, WE'VE HIT THE WAY OUR FUNDING WORKED IS WE HAD TO HIT CERTAIN MILESTONES AND ONE OF OUR FIRST MILESTONES WAS TO SET UP A NETWORK OF CLINICAL TRIAL SITES THAT DO ALZHEIMER'S DISEASE RESEARCH. AND WE MADE A CONSCIOUS DECISION TO MAKE SURE IT WASN'T JUST ACADEMICS. THERE ARE OTHER TRIALS, ONE OF THE KEY THINGS TO BECOME PART OF OUR -- IN OUR NETWORK IS YOU WOULD AGREE WITH A CENTRAL IRB. THIS WAS HUGE, ESPECIALLY FOR SUMMER AK ACADEMICS, WE'VE HIT ALMOST 90% ON CENTRAL IRBs. SOME SPONSORS SPECIFICALLY CAME TO US AND SAID CAN YOU HELP WITH SOME SPECIFIC TRIALS. SO OUR FUNDING COMES FROM KIND OF UNRESTRICTED GRANTS AND THEN ALSO THERE ARE CERTAIN MILESTONES WE HAVE TO HIT. SO I THINK THIS CROWD HERE PROBABLY KNOWS WHY IS THERE URGENCY, WHY IS THIS HAPPENING, IS THAT WE KNOW THAT ALZHEIMER'S IS THE SIXTH LEADING CAUSE OF DEATH WITH NO CURE OR TREATMENT, ONE IN THREE SENIORS RIGHT NOW WILL DIE OF ALZHEIMER'S OR SOME OTHER FORM OF DEMENTIA. WE ALSO -- YOU KNOW, I THANK NIH AND NIA WHO HAS SIGNIFICANTLY INCREASED FUNDING FOR RESEARCH BECAUSE WE KNOW RESEARCH DOLLARS HELP. IF YOU LOOK AT WHERE HEART DISEASE WAS 20 YEARS AGO, VERSUS ALL THE RESEARCH, ALL THE ADVANCES, THAT WAS ONLY THROUGH RESEARCH AND FUNDING FROM THE FEDERAL GOVERNMENT. WHERE IN MARYLAND, RIGHT HERE IN THE STATE, THERE'S OVER 110,000 LIVING WITH ALZHEIMER'S DEMENTIA AND IT'S JUST GOING TO INCREASE. THROUGH THE NATIONAL ALZHEIMER'S PROJECT ACT, THE GOVERNMENT DID PUT A STAKE IN THE GROUND, SAID WE WOULD LIKE TO HAVE A TREATMENT OR A CURE BY 2025. IT'S NOT THAT FAR AWAY. I WOULD SAY FOUR WEEKS AGO, I SAY WE'RE NEVER GOING TO HIT IT, BUT THERE'S BEEN SOME DEVELOPMENTS JUST RECENTLY AT ACADAMAM COMING BACK FROM SAYING NO TO YES, AND THEN A SYMPTOMATIC DRUG WAS APPROVED OVER IN CHINA. I'M ASSUMING THEY'RE GOING TO DO SOME GLOBAL TRIAL BUS NONETHELESS, THE HORIZON IS LOOKING MUCH DIFFERENT. THIS IS DR. JEFF CUMMINGS, WELL-KNOWN IN THE FIELD. HE WENT OUT AND LOOKED AT WHAT IS OUT THERE IN THE DIFFERENT TRIALS, WHETHER IT'S FOR DISEASE MODIFYING, DIFFERENT TYPES OF MOLECULES, SO THE PIPELINE IS VERY RICH. WHEN YOU HAVE A RICH PIPELINE, YOU ALSO HAVE TO HAVE A LOT OF PEOPLE THERE TO DO THE TRIALS. AND THAT'S WHERE OUR FOUNDATION COMES IN. TO TRY AND DEFINE THIS PROBLEM, THERE'S A LOT OF THE BACK OF THE MAP CALCULATIONS BUT DIRECTIONALLY THIS FUNNEL IS VERY GOOD. ESPECIALLY I'VE BEEN WORKING WITH THESE DIFFERENT RESEARCH CENTERS FOR OVER THREE YEARS NOW. YOU HAVE TO TOUCH A LOT OF PEOPLE, AND I MEAN A LOT, JUST TO GET THEM TO CONSENT FOR A STUDY. BECAUSE THERE'S SO MANY REASONS WHY THEY MAY OR MAY NOT JOIN A STUDY, SO BASICALLY JUST ALL THOSE MOLECULES OUT THERE TO BE TESTED, YOU HAVE TO TOUCH OVER 37 MILLION PEOPLE. BECAUSE BY THE TIME YOU FILTER THEM DOWN ON WHO'S ACTUALLY GOING TO SAY I WILL CONSENT TO GET IN THIS TRIAL AND THEN WHO CONSENTS, ALL ALZHEIMER'S HAS A PRETTY SIGNIFICANT SCREEN PERIOD WITH MULTIPLE TESTS TO SCREEN TO SAY THIS IS THE RIGHT PERSON FOR THE TRIAL, THE SCREEN FAIL RATES CAN BE UP INTO 95% EVEN AFTER CONSENT. SO YOU HAVE TO GET SO MANY PEOPLE IN THIS FUNNEL TO ACTUALLY GET DOWN TO THE NUMBER OF PARTICIPANTS THAT COULD PARTICIPATE IN THE TRIAL. SO WE ALL THIS OUR NOVEL REVIEW RECRUITMENT MODEL. I'M PLEASED TO SAY IT'S WORKING. WE BASICALLY SAY WE NEED TO BUILD COMMUNITIES THAT SUPPORT A.D. RESEARCH. A LITTLE BIT DIFFERENT THAN ECOLOGY, YOU HAVE A SPECIALIST THAT USUALLY KNOWS THE TRIALS IN THE COMMUNITY, THEY'RE SPECIALISTS BUT IN THE ALZHEIMER'S WORLD, YOU KIND OF MAKE A DIAGNOSIS BY A NEUROLOGIST WHO MAY OR MAY NOT TALK ABOUT TRIALS. IT'S A VERY DIFFERENT INFRASTRUCTURE OUT THERE. SO WE BASICALLY KNEW WE HAD TO GET PRINCIPAL INVESTIGATORS THAT BELIEVED THAT YOU HAVE TO DO SOMETHING DIFFERENT. WE WORK WITH THE PAYORS/PROVIDERS, THAT'S NOT THE HEALTH INSURER, YOUR MEDICARE ADVANTAGE PROGRAMS. MINORITY RECRUITMENT, WE ALL STRUGGLE WITH THAT, OF COURSE, ALL DISEASES, WE FELT IT'S SO KEY. AFRICAN-AMERICANS ARE TWICE AS LIKELY TO GET ALZHEIME'S AS CAUCASIANS AND WE WANT TO MAKE SURE THE MEDICINES WOULD WORK FOR THEM, WE INVOLVE FEDERAL, STATE AND LOCAL GOVERNMENT BUT NOT NECESSARILY THE HEALTHCARE PEOPLE. GOVERNORS, THEIR CONSTITUENTS COMPLAIN ABOUT ALZHEIMER'S. SENATORS, ALL SORTS OF THINGS. WE GET THEM INVOLVED. COMMUNITY LEADERS. THERE'S A LOT OF PEOPLE IN MANY COMMUNITIES THAT ARE VERY INVESTED IN THEIR COMMUNITY, THEY'VE BEEN TOUCHED BY ALZHEIMER'S. FIND OUT WHO THEY ARE. OUTREACH AND ENGAGEMENT, DEFINITELY NECESSARY. MANY OF OUR RESEARCH CENTERS, I CALLED IT ONE AND DONE. THAT'S ALL THEY DID FOR 12 MONTHS. SO THAT'S NOT BUILDING A RELATIONSHIP. AND MEDIA RELATIONS. WE ARE FINDING THAT ESPECIALLY SENIORS, THEY KNOW FACEBOOK. WE ARE PACKING SOME OUTREACH EVENTS THROUGH FACEBOOK ALZHEIMER'S DISEASES TO GET THEM TO EVENTS. YOU'RE NOT PRINTING, YOU'RE NOT PUTTING ALZHEIMER'S DISEASES IN PAPERS. WE WANT TO GET YOU INTO THESE EVENTS SO YOU CAN LEARN ABOUT THE RESEARCH LOCAL COMMUNITY OPPORTUNITIES. AS I SAID, WE HAVE RESEARCH WHAT HAVE WE DONE? MANY PEOPLE OUT THERE TRYING TO REACH SENIORS TO TALK ABOUT RESEARCH. THEY MIGHT BE DONE IN AN ACADEMIC CENTER, A SENIOR CENTER, AND WE STARTED GOING TO VENUES THAT SENIORS WANT TO GO TO. THERE'S A WORLD WAR I MUSEUM IN KANSAS CITY. THERE'S ALSO A WONDERFUL ALZHEIMER'S DISEASE RESEARCH CENTER IN KANSAS CITY. SO WE DID HAVE AN EVENT AT THE WORLD WAR I MUSEUM. 9 INCHES OF SNOW THE DAY OF THE EVENT. WE THOUGHT NOBODY WAS GOING TO DOM. WE HAD ABOUT 100 PEOPLE COME UP SHOW UP FOR THAT EVENT. I THINK IT WAS PARTIALLY THEY WANTED TO GO TO THE WORLD WAR I MUSEUM BUT THEY ALSO WANTED TO LEARN ABOUT BRAIN HEALTH RESEARCH. WE ALSO DID AN ICE CREAM SOCIAL. THEY DON'T HAVE TO BE EXPENSIVE EVENTS TO GO OUT AND REACH PEOPLE. SENIORS LIKE TO COME AND SOCIALIZE. IT WAS A PARTNERSHIP THAT WE DID DEVELOP WITH A NEW NEUROLOGY GROUP UP IN CAPE COD THAT CONNECTED WITH BRIGHAM WOMEN'S, WE HAD AN ICE CREAM SOCIAL, INTRODUCED THE COMMUNITY TO THESE RESEARCHERS, MAKE RESEARCH AND REALLY FET THE PEOPLE GET TO SEE THE PEOPLE YOU'RE GOING TO BE TAWING TO. TALKING TO. SO WE'VE REALLY GONE OUT AND LOOKED AT THE COMMUNITY FROM THAT TYPE OF SITUATION. I THINK I GAVE YOU BACK SOME TIME, I WENT A LITTLE FASTER BUT I DO THINK LESSONS LEARNED, ONE THING I SAID IN THE BEGINNING AS WE WERE BUILDING THIS NETWORK, I SPENT A LOT OF TIME HELPING ACADEMIC INSTITUTIONS TALKING TO WHAT I CALL PRIVATE INSTITUTIONS. THEY TYPICALLY DIDN'T DO A LOT OF TALKING. THERE'S A LOT OF REASONS. ONE THING I HAVE LEARNED IS A LOT OF DATA THAT THE FDA RECEIVES FOR GETTING A DRUG APPROVED COMES FROM PRIVATE SITES. THEY ARE TYPICALLY HIGHER PERFORMING FROM NUMBER OF ENROLLMENTS AND ALL SORTS OF REASONS. SO THEY DO RECRUITMENT A LITTLE BIT DIFFERENT. I CALL THE PRIVATE SHEETS REALLY HIGH SCREENERS. THEY CALL IT SHOTS ON GOAL. THEY'LL TEST THEM, THEY'LL CONSENT THEM, YOUR ACADEMIC CENTERS ARE MUCH MORE METHODICAL. THEY DO A LOT OF TOUCHES DURING THAT PRE-SCREEN PERIOD SO BY THE TIME THEY GET SOMEBODY TO CONSENT FOR A STUDY THEY HAVE A REALLY GOOD CONFIDENCE LEVEL THIS PERSON IS PROBABLY GOING TO GET THROUGH MY SCREEN PROCESS. I SAY BOTH THOSE PHILOSOPHIES -- YOU KIND OF NEED THEM BOTH, BUT LET'S TALK, WHAT'S WORKING FOR YOU. WE FOUND A LOT OF TIMES PEOPLE WERE JUST PUTTING THE SAME TYPE OF INSTITUTIONS TOGETHER, WHERE WE WOULD HAVE RECRUITMENT SUPPLEMENTS, SIX-PERSON PRIVATE SITES WITH A 30-PERSON PRIVATE SITE AND THREE ACADEMICS IN THE ROOM, AND THE CONVERSATIONS WERE SO RICH AND SO FANTASTIC BECAUSE THEY ALL HAD THE SAME BARRIERS, HOW CAN WE GET PEOPLE TO GET INTERESTED. WE DID GET IN SOME SPECIFIC STUDIES DOWN -- THEY WEREN'T TALKING TO EACH OTHER OR THEY DIDN'T KNOW WHO TO TALK TO. SO OUR FOUNDATION REALLY TRIES TO KEEP THESE COLLABORATIONS AND WE KEEP THEM LOCAL. I'VE SEEN MANY CAMPAIGNS, THAT'S VERY DIFFERENT THAN WHEN I GO TO EVENT AMEND AND SAY, BY THE WAY, YOU ARE SO FORTUNATE IN THIS COMMUNITY TO HAVE THIS WONDERFUL RESEARCH CENTER, LITERALLY SIX BLOCKS AWAY. MOST OF THE PEOPLE IN THE COMMUNITY HAD NO IDEA. SO JUST GETTING THE WORD -- A LOT OF THE COMMUNITY MEMBERS THOUGHT EVERY RESEARCH CENTER HAD THE SAME STUDIES. WE WOULD SAY, OH, NO, EVERYBODY HAS A DIFFERENT PORTFOLIO OF STUDIES. WONDERFUL OBSERVATION STUDIES, FOR SOME, OUR GOAL, OUR GAP, BUSINESS TO BUSINESS. WE DON'T TELL PEOPLE WITH US, WE WANT TO CONNECT THEM WITH OUR RESEARCH CENTERS BECAUSE THAT IS WHO CONNECTS WITH THEM. ONE THING ABOUT OUR OUTREACH I SHOULD HAVE SAID ON THE CHEVRON SLIDE FOR . WE REALLY WORK IN COMMUNITIES OR WHO IS ALREADY TOUCHING THESE PEOPLE AND WHO THEY HAVE RELATIONSHIPS WITH. THERE'S NO WAY WE'RE GOING TO MAKE A GOOD RELATIONSHIP WITH THE GUADALUPE ASSOCIATION IN KANSAS CITY. WE MAKE RELATIONSHIPS WITH THEIR LEADERSHIP TOWARD THEM OF THE RESEARCH SITE. NOW WE'RE TALKING TO THE PEOPLE THAT COME TO THEIR CENTER AND THEY'VE REALLY BEEN ABLE TO INCREASE THEIR LATINO OUTREACH, ESPECIALLY IN THEIR OBSERVATION STUDIES AND ALSO SOME STAFF. SO WE TRY AND GO AT DIFFERENT ANGLES TO CREATE THESE DIFFERENT PARTNERSHIPS. STAKEHOLDERS WITH DIVERSE BACKGROUNDS ARE OFTEN THE BEST. DEFINITELY THE STUDY COORDINATORS, IT WAS FASCINATING TO ME WHEN WE GO IN SORT OF CONTRACTING THOSE FOR ALL SORTS OF DIFFERENT PEOPLE AND THEN YOU'VE GOT YOUR PRINCIPAL INVESTIGATOR, I'D WALK IN AND SAY WHAT'S YOUR GOAL FOR HOW MANY PEOPLE ARE ON A ROLL? THEY LOOK AT ME AND THEY GO, I DON'T KNOW. THIS IS THE PERSON THAT'S RESPONSIBLE, SO WE WOULD HELP THEM GO, DO YOU KNOW YOUR GOAL IS FIVE? AND SHE GOES WE ALWAYS PUT FIVE. SO THINGS LIKE THIS THAT RILEY HELP PEOPLE UNDERSTAND FROM RUNNING A STUDY IF YOU'RE COUNTING ON 30 SITES TO EACH GIVE YOU FIVE PATIENTS, YOU HAVE TO MAKE SURE EVERYBODY IS TRYING TO GET THAT. THERE ARE STATISTICS OUT THERE THAT MANY, MANY SITES GO THROUGH ALL THIS WORK AND THEY RANDOMIZE ZERO OR ONE PATIENT. IT'S NOT GOOD FOR ANYBODY. FOR THE SITES, THE SPONSOR, CONSISTENCY. THE LAST TRIAL THAT NONE OF OUR SITES ENROLLED LESS THAN THREE PARTICIPANTS. THE SPONSORS SAID THEY'D NEVER SEEN THAT IN THEIR ENTIRE CAREER. BECAUSE WE GO, IT'S NOT GOOD FOR YOU, YOU HAVE TO LEARN YOUR SCHEDULE FOR ONE PATIENT VERSUS IF YOU HAVE THREE IN A SYSTEM. IT JUST HELPS IN A LOT OF REASONS. AND CONNECTING THOSE WITH SIMILAR CONCERNS. THAT GOES BACK TO -- PEOPLE WILL SAY, WE'LL CONNECT THE TWO SMALL SITES TOGETHER. WE SAID WHAT'S YOUR ISSUE? SO THAT'S WHERE WE HELPED CONNECT BASED ON WHAT THE ISSUE IS NOT BASED ON THE SIZE. YOU HAVE TO CONSTANTLY LOOK AT WHAT'S CHANGING WITH YOUR PARTNERS BECAUSE ENVIRONMENTS CHANGE, THEIR FUNDING CHANGES, LEADERSHIP CHANGES. YOU REALLY HAVE TO FOLLOW THROUGH WITH ALL THAT. WITH THAT, I'LL PASS IT ON TO THE NEXT SPEAKER. PLAWB [APPLAUSE] >> THANKS. SO OUR NEXT SPEAKER COMES TO US FROM PCORI, HOPEFULLY EVERYBODY KNOWS WHAT PCORI IS, BUT HE'S GOING TO TALK TO US A LITTLE BIT ABOUT COMPARATIVE EFFECTIVENESS. >> THANK YOU VERY MUCH, IT'S A PLEASURE TO BE HERE TODAY. WHAT I WANT TO DO IS TAKE JUST A COUPLE MINUTES JUST TO INTRODUCE YOU TO PCORI IN CASE THERE'S A FEW PEOPLE OUT THERE THAT ARE UNFAMILIAR WITH THE PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE AND I WANT TO SPEND MOST OF MY TIME TALKING A LITTLE BIT ABOUT OUR FOUNDATIONAL APPROACH TO PARTNERSHIPS IN RESEARCH AND THAT 16 IS ENGAGING PATIENTS AND OTHER STAKE HOLD RS DIRECTLY AFFECTED BY THAT RESEARCH AND THEN FINALLY TALK ABOUT SOME OF THE WORK WE'RE DOING WITH OTHER FUNDERS IN PARTNERSHIP STRATEGIES REALLY TO FACILITATE THE KINDS OF STUDIES WE COULD NOT DO ON OUR OWN. THIS IS OUR MISSION AND STRATEGIC GOALS THAT HAVE BEEN INTRODUCED BY OUR BOARD OF GOVERNORS, BUT I WANT TO MAKE SURE YOU RECOGNIZE THAT PCORI IS NOT A FEDERAL AGENCY, WE'RE A PRIVATE NON-PROFIT RESEARCH INSTITUTE, INDEPENDENT BOARD OF GOVERNORS, AND OUR BOARD OF GOVERNORS HAS LAID OUT THREE CHALLENGING STRATEGIC GOALS FOR OUR INSTITUTE. ONE IS TO INCREASE THE QUANTITY, QUALITY AND TIMELINESS OF USEFUL TRUSTWORTHY RESEARCH INFORMATION TO SUPPORT HEALTHCARE DECISION-MAKING. WE TAKE THE QUALITY OF OUR SCIENCE VERY SERIOUSLY, WE HAVE BEEN AUTHORIZED BY CONGRESS AND PART OF THAT ORGANIZATION, THEY DEVELOPED A METHODOLOGY COMMITTEE WHICH IS APPOINTED BY THE GENERAL ACCOUNTING OFFICE AND THEY SET STANDARDS FOR INVESTIGATORS AND PROJECTS THAT WE FUND IN TERMS OF SCIENTIFIC INTEGRITY AND QUALITY. THE SECOND IS SPEEDING THE IMPLEMENTATION AND USE OF PATIENT-CENTERED OUTCOMES RESEARCH. EVIDENCE, THIS IS REALLY AN EMPHASIS WITH OUR BOARD OF GOVERNOR, IS THAT WE WANT INFORMATION THAT IS NOT ONLY GOING TO CONTRIBUTE TO SCIENCE BUT IT'S REALLYING REALLY GOING TO ADD VALUE TO PATIENTS' EXPERIENCE AND TO IMPROVE THE WAY THE HEALTHCARE SYSTEM OPERATES. AND THIRD, WE HOPE TO INFLUENCE RESEARCH FUNDED BY MORE PATIENT CENTERS. AND I'LL DESCRIBE WHAT I MEAN BY THAT IN A MINUTE. OKAY. EVEN THOUGH WE'RE A PRIVATE RESEARCH FOUNDATION WE TAKE OUR CONGRESSIONAL MANDATE VERY SERIOUSLY. THIS IS RESEARCH THAT GENERATES AND SYNTHESIZES EVIDENCE, COMPARING BENEFITS AND HARMS OF AT LEAST TWO DIFFERENT METHODS TO PREVENT DIAGNOSIS, TREATMENT AND MONITOR CLINICAL CONDITION, OR EVEN IMPROVE HEALTHCARE DELIVERY. SO WE'RE ABOUT COMPARING A TO B. BUT ALSO, IT'S IMPORTANT TO NOTE THAT THE TYPES OF COMPARISONS WE DO IS QUITE A WAYS DOWN THE EVIDENCE CHAIN FROM WHAT WE'VE BEEN TALKING ABOUT THIS MORNING, AND THAT THESE COMPARISONS WE MAKE ARE OF WELL ESTABLISHED INTERVENTIONS THAT EITHER HAVE LARGE, HIGH QUALITY EVIDENCE BACKING THEIR EFFECTIVENESS OR ARE IN WIDESPREAD USE IN COMMUNITIES AROUND THE COUNTRY. NOW, USUAL CARE SOMETIMES CAN BE PERMISSIBLE METHOD. IF JUSTIFIED, MEASURED, AND THAT'S PARTICULARLY THE CASE IF THE QUESTION IS, WELL, HOW MUCH BETTER IS ARB? NOW, THE OTHER THING ABOUT OUR TYPES OF RESEARCH IS THAT IT'S BEEN AWFULLY CHARACTERIZED AS KIND OF PRAGMATIC AND IT DIFFERS IN VARIOUS WAYS FROM WHAT YOU WOULD THINK OF CLASSIC EFFICACY-BASED CLINICAL TRIALS. FIRST OF ALL, WE TRY TO MEASURE BENEFITS IN -- POPULATIONS SO IF YOU LOOK AT THE KIND OF INCLUSION AND EXCLUSION CRITERIA THAT WE HAVE, THEY TEND TO BE MUCH LESS RESTRICTIVE THAN YOU SEE IN CLASSIC CLINICAL TRIALS. TRYING TO MIRROR THE PATIENT POPULATION THAT ACTUALLY RECEIVES THOSE SERVICES IN THE REAL WORLD. ALSO OUR STUDIES ARE TYPICALLY FAIRLY LARGE IN THAT WE TRY TO LOOK AT SUBGROUPS OF PEOPLE IN OUR STUDIES, WHETHER IT'S DIFFERENCES BY GENDER, RACE AND ETHNICITY OR EVEN CLINICAL CHARACTERISTICS OF POPULATIONS TO REALLY TRY TO HAVE OUR RESEARCH MIRROR MORE THOSE CRITICAL QUESTIONS TO ANSWER THE QUESTIONS TO PATIENTS, HOW THIS RESEARCH AFFECTS SOMEONE LIKE ME. AND THIRD, WE CONDUCT OUR STUDIES TYPICALLY IN COMMUNITY SETTINGS OR IN SETTINGS WHERE PATIENTS WOULD ROUTINELY BE EXPECTED TO GET THIS CARE SO THAT WE MIGHT MIRROR THOSE RESULTS IN DISSEMINATION/IMPLEMENTATION, AND FINALLY, WE FOCUS ON WHAT'S CALLED DECISIONAL DILEMMAS. THOSE ARE WHERE THESE DECISIONS ABOUT A VERSUS B REALLY HAVE AN IMPACT ON CLINICAL DECISION-MAKING. BY PATIENTS, BY CLINICIAN ORGANIZATIONS OR EVEN BY -- THAT HATION TO MAKE CHOICES IN TERMS OF STRATEGIES USED TO IMPROVE PATIENT OUTCOMES. I JUST NOTE THAT WE DON'T FUND COST-EFFECTIVENESS RESEARCH, THAT IS A PROHIBITION IN OUR STATUTE. NOW, PCORI -- WE HAD OUR VERY FIRST EFFECTIVENESS STUDY IN FALL OF 2012 AND DURING THAT TIME, WE'VE BEEN BUSY. WE HAVE NOW OVER 1400 AWARDS, WE'VE AWARDED MORE THAN $2.4 BILLION IN RESEARCH, BUT THE OTHER THING I THINK WE'RE MOST PROUD OF IS A REACH IN SUCH A SHORT PERIOD OF TIME, NOW INVOLVED IN 49 OR 50 STATES, SO IF WE'RE GOING TO HAVE TO HAVE IMPACT ON CARE, WE REALLY HAVE TO MAKE SURE IT REFLECTS THE DIVERSITY OF CIRCUMSTANCES THAT EXIST IN THE UNITED STATES. NOW, THE TOPIC OF THIS SESSION IS REALLY ABOUT PARTNERSHIPS. SO WHAT I WANT TO TALK ABOUT IS OUR FOUNDATIONAL PARTNERSHIPS. ALL WE DO IN RESEARCH BEGINS WITH PATIENTS AND STAKEHOLDERS WOULD ARE DIRECTLY IMPACTED BY THAT RESEARCH. PCORI FIRST OF ALL CONSIDERS THAT FUNDAMENTAL PRINCIPLE AN ETHICAL THING TO DO BY CONSIDERING PATIENTS' NEEDS AND PREFERENCES AND THE OUTCOMES THAT THEY BELIEVE ARE THE MOST IMPORTANT TO THEM IN DESIGNING RESEARCH, BUT WE ALSO THINK OF THE POTENTIAL OF SOME SORT OF SCIENCE OF THIS PROCESS BECAUSE IT HELPS FORMULATE AND REFINE QUESTIONS THAT HELPS US ANSWER QUESTIONS ABOUT WHAT REALLY WORKS BEST AND UNDER WHAT CIRCUMSTANCES. WE HOPE BY DOING THIS, WE WILL HELP PATIENTS AND OTHER DECISION MAKERS TO MAKE BETTER INFORMED DECISIONS ABOUT THEIR HEALTH AND HEALTHCARE OPTIONS. NOW THERE'S TWO KIND OF PRINCIPLES IN THE WAY WE APPROACH THIS KIND OF PATIENT-CENTERED OUTCOMES RESEARCH. FIRST IS THE COP SIPT CONCEPT OF PATIENT-CENTERS IN. BASICALLY THERE ARE TWO PRINCIPLES INVOLVED IN EVERY APPLICATION WE RECEIVE. FIRST OF ALL, THEY MUST PROVIDE EVIDENCE THAT THE TYPES OF OUTCOMES THAT THEY HAVE CHOSE, PARTICULARLY THEIR PRIMARY OUTCOME, HAS BEEN VETTED WITH PATIENTS AND STAKEHOLDERS IN THE CONTEXT OF PATIENT PREFERENCES, AND SEC, THAT THE RESEARCH QUESTIONS THEMSELVES REFLECT WHAT'S IMPORTANT TO PATIENTS AND/OR CAREGIVERS IN THE CONTEXT OF THEIR RESEARCH. TO GIVE YOU AN EXAMPLE OF HOW THAT'S PLAYED OUT IN ONE OF OUR PORTFOLIOS IS THIS AREA CALLED CARE TRANSITIONS, MOVING PATIENTS FROM THE HOSPITAL TO THE COMMUNITY AFTER DISCHARGE. HISTORICALLY MUCH OF THAT RESEARCH IS REALLY FOCUSED ON TWO THINGS. ONE IS ON UTILIZATION, PARTICULARLY AVOIDING READMISSIONS AND ON COST. WELL, WHEN WE WENT OUT AND TALKED TO PATIENTS ABOUT THIS AREA TO START OUT AND ADVOCACY GROUPS, WE HEARD A CONSISTENT THEME THAT WAS REFLECTED THIS MORNING. WE WERE TALKING ABOUT WHAT AGING PEOPLE REALLY CARE ABOUT, AND THAT WAS, WELL, YOU KNOW, WE CLEARLY DON'T WANT TO GO BACK IN THE HOSPITAL, THAT'S TRUE, BUT WE REALLY CARE ABOUT FUNCTION, WE CARE ABOUT BEING INDEPENDENT IN THE COMMUNITY AFTER WE'VE HAD THAT HOSPITALIZATION, AND WE ALSO CARE ABOUT SUPPORTS THAT OUR CAREGIVERS HAVE TO ALLOW US TO BE PRESERVED IN THE COMMUNITY. THAT REALLY INFLUENCED THE NATURE OF THE TYPE OF RESEARH AND QUESTIONS THAT WE'VE DONE, AND WE'VE REALLY KIND OF SPAWNED, I BELIEVE, A WHOLE NEW AREA OF RESEARCH INQUIRY ABOUT HOW CAN THESE DISCHARGE PLANNING STRATEGIES REALLY PROVIDE INDEPENDENCE TO PATIENTS AND HOW CAN WE ACTUALLY TARGET INTERVENTIONS TO CARE CAREGIVERS TO TRY TO IMPROVE THEIR OUTCOMES? THE AREA OF STAKEHOLDER ENGAGEMENT, THAT'S ABOUT HOW THE SEARCH IS CONDUCTED. HERE PATIENTS MUST BE EVIDENCED AS PARTNERS IN THE RESEARCH AND NOT JUST SUBJECTS. THERE'S MANY WAYS TO DO THAT, BUT SOME OF OUR RESEARCHERS HAVE ACTUALLY MADE PATIENTS WITH LIVED EXPERIENCE ACTUALLY COINVESTIGATORS ON SOME OF THESE STUDIES, SO THEY'RE VERY ENGAGED IN THIS KIND OF RESEARCH. ALSO THERE ACTIVE AND MEANINGFUL ENGAGEMENT BETWEEN PATIENTS, SCIENTISTS AND OTHER STAKEHOLDERS, AND THIS MUST BE REFLECTED IN ANOTHER PLAN THAT IS IN THE APPLICATION THAT SHOWS EXACTLY THE ENTIRE PLAN, AND HOW THESE STAKEHOLDERS AND PATIENTS WILL BE INVOLVE ED IN THAT PROCESS. NOW, WHO ARE STAKEHOLDERS? IN ADDITION TO PATIENTS AND CAREGIVERS, WHICH ARE A WE DO, THEY REALLY ARE KIND OF FIT-FOR-PURPOSE, IT REALLY DEPENDS ON YOUR STUDY IN TERMS OF WHO IS REALLY RELEVANT HERE, BUT I WANT TO POINT OUT A COUPLE THINGS THAT HAVE REALLY INFLUENCED US IN THE LAST FEW YEARS IN TERMS OF WHAT WE'RE REALLY LOOKING FOR IN THESE ENGAGEMENTS. FIRST OF ALL, NOT JUST PATIENTS WITH LIVED EXPERIENCE BUT ALSO PATIENT AND CAREGIVER ADVOCACY ORGANIZATIONS. WE FOUND ARE VERY, VERY VALUABLE IN TERMS OF TRYING TO SPEAK TO SOME OF THESE BROADER ISSUES ABOUT PATIENTS AS A COMMUNITY CAN REALLY INFLUENCE RESEARCH AND CAN HELP REFINE QUESTIONS AND THE IMPLICATIONS FOR IMPLEMENTATION OF SOME OF THIS RESE. ANOTHER AREA IS NOT JUST INCLUDE CLINICIANS WHO ACTUALLY PRACTICE WITH THESE PATIENTS BUT ALSO THEY'RE MEDICAL AND SPECIALTY SOCIETIES, PARTICULARLY WHEN WE'RE TALKING ABOUT STUDIES THAT MIGHT HAVE AN INFLUENCE ON PRACTICE GUIDE PLIENS. SO WE'RE TRYING TO ENCOURAGE MEDICAL SOCIETIES TO REALLY BE PART OF THESE PROJECTS. AND FINALLY, MOST RECENTLY WE'VE REALLY BEGUN FOCUSING ON PAYORS. PAYORS ULTIMATELY ARE THE LAST STEP BETWEEN SOMETHING ACTUALLY DOES GET IMPLEMENTED IN THE SYSTEM, BECAUSE OFTEN EITHER IT'S PAID FOR OR IT DOESN'T HAPPEN. AND WE HAVE REALLY BEEN WORKING VERY DILIGENTLY WITH PAYORS TO TRY TO GET THEM MORE ENGAGED IN OUR RESEARCH AT THESE FORMATIVE LEVELS. WELL, WE TAKE THIS IDEA OF ENGAGEMENT SERIOUSLY NOT ONLY IN OUR RESEARCH BUT IN EVERYTHING WE DO IN PCORI. IF YOU START HERE AT ABOUT 9:00, ON THIS CHART, RIGHT IN HERE, WE GO THROUGH A VERY DELIBERATE AND ACTIVE PROCESS TO TALK TO STAKEHOLDERS, PATIENT AND ADVOCACY, PAYORS, INDUSTRY AND OTHERS, TO SYSTEMATICALLY LOOK FOR THE TYPES OF TOPICS AND RESEARCH QUESTIONS THAT THEY THINK ARE MOST IMPACTFUL TO THEIR ORGANIZATION, AND WITH STAKEHOLDER DRIVEN FUNDING OPPORTUNITIES, PARTICULARLY IN TERMS OF AREAS THAT ARE VERY, VERY RECENT AND VERY CURRENT. YOU MIGHT REMEMBER ISSUES OF THE EMERGENCE OF CURATIVE THAIMPS FOR HEPATITIS C, ISSUES RELATED TO THE OPIOID CRISIS. WE'VE BEEN VERY, VERY ACTIVE IN DOING TARGETED ANNOUNCEMENTS BASED ON INFORMATION WE HAVE RECEIVED AS STAKEHOLDERS, BUT ALSO IF YOU 50 FROM NOON TO ABOUT 3:00, WE ALSO TAKE THIS WORK VERY SERIOUSLY IN TERMS OF HOW WE ACTUALLY EVALUATE APPLICATIONS. THIS PATIENT-CENTEREDNESS AND STAKEHOLDER ENGAGEMENTS ARE ACTUALLY EVALUATION CRITERIA THAT INVESTIGATORS MUST ADDRESS IN THEIR APPLICATIONS. WE HAVE PATIENTS AND STAKEHOLDERS THAT SIT ON OUR PANELS IN ADDITION TO SCIENTISTS THAT ACTUALLY REVIEW AND ACTUALLY SCORE THESE. THEN FROM 3:00 TO 6:00, WE'RE VERY INVOLVED IN WORKING WITH OUR STAKEHOLDERS IN TERMS OF DISSEMINATION/INTERPRETATION OF THESE RESULTS, TRYING TO UTILIZE THEM EITHER THROUGH EXTENSIONS OF FUNDING OR THROUGH OTHER TYPES OF MECHANISMS TO TRY TO GET OUR RESEARCH INTO PRACTICE. AND FINALLY, FROM ABOUT 6:00 TO 9:00, WE'RE CONTINUING EVALUATING THE QUALITY OF OUR THEM AND SAYING ARE WE ANSWERING THE QUESTIONS THAT ARE IMPORTANT TO YOU, WHAT OTHER KINDS OF PRODUCTS MIGHT BE USEFUL IN INFORMING THE NEEDS YOU HAVE WHERE COMPARATIVE EFFECTIVENESS RESEARCH CAN BE VALUABLE. OKAY. I WANT TO TAKE JUST A LITTLE AT THE END TO TALK ABOUT OUR FORMER PARTNERSHIP. IT IS TO ACCESS AND ENHANCE EXPERTISE, IN PARTICULAR, PRIMARY CARE RESEARCH NETWORKS, PCORI IS KIND OF AN EMERGING FUNDING IN THE AREA TO REALLY ACCESS. SECOND, HAVE YOU BEEN ABLE TO AUGMENT STUDIES IN CERTAIN WAYS. AND THIRD, TO ACCESS SPECIALTY CARE RESEARCH NETWORK, WHICH IS ANOTHER AREAS THAT HAS BEEN DONE FOR SOME OF OUR WORK. THE FIRST STUDY I WANT TO GO OVER A LITTLE BIT IS OUR WORK WITH THE NATIONAL INSTITUTE ON AGING. THIS IS IN THE AREA OF FALL PREVENTION, STRATEGIES TO REDUCE INJURIES AND DEVELOP -- HARVARD MEDICAL SCHOOL IS THE PARTNER P.I. 5,451 PATIENTS IN 86 PRIMARY CARE PRACTICES, AND THESE ARE IN 10 HEALTHCARE SYSTEMS ACROSS THE UNITED STATES. WHAT THIS PROJECT IS TRYING TO DO IS LOOKING AT THE COMPARATIVE EFFECTIVENESS OF THE NURSE COMANAGEMENT WITH THE PRIMARY CARE PHYSICIAN OF FALLS RISK FACTORS, VERSE RISK FACTORS IN THE PRACTICE. BY ENANSED, EVIDENCE-BASED MATERIAL FROM CDC AND THE UNIFORM PREVENTIVE SERVICES TASK FORCE THAT ARE WIDELY AVAILABLE BUT CAN BE USED TO GIVE PATIENT INFORMATION TO IMPROVE THEIR OWN HEALTH. THIS PROJECT HAS A MAJOR INVOLVEMENT WITH ENGAGEMENT, IT HAS A NATIONAL PATIENT STAKEHOLDER COUNCIL WHICH IS VERY ACTIVE IN THE PROJECT, AS WELL AS LOCAL COUNCILS AT EACH HEALTH SYSTEM OF THE 10 THAT WE HAVE IN OUR PROGRAM. AND THE NATURE OF THIS PARTNERSHIP IS, WE WERE ABLE TO PROVIDE MONEY BUT WE KNEW WE COULDN'T REALLY LAUNCH A PROJECT OF THIS SIZE AND COMPLEXITY WITHOUT THE EXPERTISE AND ADMINISTRATIVE STRENGTH AND EXPERIENCE OF AN ORGANIZATION LIKE THE NATIONAL INSTITUTE ON AGING. SO WHAT HE WE DID IS CREATED A MEMORANDUM OF UNDERSTANDING. NIA WAS WILLING TO WORK WITH US, WHICH CAME IN TO NIH WERE COMPETITIVELY REVIEWED TO INCLUDE BOTH PATIENT AND STAKEHOLDER MANAGEMENT AND A REQUIRED STUDY ELEMENT IN THE DESIGN. THE NEXT ONE I WANTED TO SHOW IS A DIFFERENT APPROACH, AND THIS IS WITH AGAIN THE NATIONAL INSTITUTE ON AGING, A DEMENTIA STUDY, HIT SYSTEM BASED VERSUS COMMUNITY-BASED SYSTEM OF HEALTHCARE. THREE ARM RANDOMIZED CONTROL TRIAL, 2150 PATIENT CARE GIVER DIADS ACROSS THE COUNTRY, AND THIS IS TRYING TO DETERMINE WHETHER CURE MANAGEMENT FOR PERSONS WITH DEMENTIA AND THEY'RE SUPPORTED BY A MODEL BASED IN THE HEALTH SYSTEM OR A MODEL BASED IN THE COMMUNITY IN TRYING TO REDUCE THOSE -- WHAT IS THAT? I'M DONE? OKAY. I WASN'T SURE. ALL I WANT TO SAY ABOUT THAT PROJECT WAS WE WERE ABLE TO REALLY WORK WITH THEM TO GET A GRANT TO PROVIDE A USUAL CARE ARM SO WE THEN ASKED THE QUESTION OF HOW MUCH MORE EFFECTIVE IS THIS STUDY. AD THE FINAL ONE IS A STUDY THAT TIME I THINK IS GETTING AWAY ME HERE SO I'LL JUST SAY THIS IS WITH THE NATIONAL CANCER INSTITUTE TO REALLY DO A VERY INTERESTING STUDY TRYING TO LOOK AT IMPROVING THE SCRIBING OF STIMULATING BANK FACTORS IN CANCER CHEMOTHERAPY. THIS IS A STUDY THAT WE WORKED VERY CLOSELY WITH THE AMERICAN SOCIETY OF CLINICAL -- AND THE AMERICAN CANCER SOCIETY TO TAKE A PREFERENCE SENSITIVE DECISION BUT WHERE THERE ARE REAL IMPLICATIONS FOR PATIENT OR HIGH RISK FOR THE KINDS OF SIDE EFFECTS FROM CHEMOTHERAPY, THAT COLONY STIMULATING FACTORS ARE EFFECTIVE FOR BUT ALSO TO STUDY THIS LARGE INTERMEDIATE RISK GROUP TO TRY TO FIND OUT WHERE WITHIN THAT CATEGORY MIGHT STIMULATING FANNING TORES BE MORE OR LESS EFFECTIVE. FINALLY, I JUST WANT TO SAY WE REALLY VAL UTE PARTNERSHIP OF OTHER FUNDERS, IT'S REALLY HELPED US ENHANCE CAPABILITIES OF STUDY, LEVERAGE LARGE ACCESS AND INTRODUCE OTHER FUNDERS TO OUR CONCEPTS, AND JUST THE THREE LESSONS ARE ESTABLISH CLEAR ROLES AND RESPONSIBILITY, EXPECTED UNEXPECTED, I THINK THE ONE THING WE'VE LEARNED IS YOU'VE GOT TO PUT A LOT OF TIME UP FRONT BECAUSE THAT PAYS OFF MUCH LATER, AND PARTICULARLY, YOU HAVE TO DELIVER ON YOUR PROMISE, AND I FEEL THAT IN THE CONTEXT OF SOME OF THESE VERY CHALLENGING STUDIES, THEY'RE ALL ON SCHEDULE AND WE HOPE TO GET THE RESULTS FROM THE FALLS PREVENTION STUDY EARLY NEXT YEAR. THANK YOU. [APPLAUSE] >> SPEAKING OF PAYORS, WE HAVE AN INTERESTING SPEAKER COMING UP HERE, DEBRA REED-GILLETTE, FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO TALK TO YOU ABOUT AN OPPORTUNITY POTENTIALLY TO GET MORE INFORMATION ABOUT CURRENT CARE AND WHAT'S GOING ON IN THE MEDICARE GROUPS. >> THANK YOU ALL VERY MUCH. SO FOR THOSE OF YOU WHO LIKE TO HEAR ABOUT SOCIAL DETERMINANTS THAT MAY BE AFFECTING AGING, THIS IS A DATA SOURCE FOR YOU. THE MEDICARE BENEFICIARY SURVEY IS A CONTINUOUS IN-PERSON SURVEY OF THE MEDICARE POPULATION, AND IT IS A REPRESENTATIVE POPULATION OF MEDICARE BENEFICIARIES AGE 65 AND OLDER AND ALSO THOSE WITH CHRONIC DISEASE WHO MAY BE ELIGIBLE FOR MEDICARE BECAUS OF DISABILITY. IT SUMMON SPONSORED BY THE OFFICE FOR DATA ANALYTICS AND WE CONDUCT IT THROUGH A PARTNERSHIP CONTRACT THROUGH NORC AT THE UNIVERSITY OF CHICAGO. WOOR WE'RE DESIGNED TO HELP CMS IN MONITORING AND EVALUATING MEDICARE PROGRAMS AS WELL AS TO DEVELOP NEW POLICY INITIATIVES, BUT IT'S ALSO A VERY RICH DATA SOURCE ON STUDYING THE AGING POPULATION. SO FROM THE TIME MEDICARE WAS DEVELOPED IN THE 1960s, 1970s, THROUGH 2019, THERE WAS SEEN TO BE A NEED FOR INCREASED DATA ABOUT OUR MEDICARE BENEFICIARY COHORT. SO THE SURVEY WAS DESIGNED IN 1991 AND HAS BEEN COLLECTING DATA EVER SINCE TO HELP WITH ADMINISTERING THE PROGRAM AND ALSO SEEING WHAT TYPES OF ADDITIONAL PROGRAMS MIGHT BE IMPLEMENTED BY MEDICARE TO HELP MEDICARE BENEFICIARIES INCREASE THEIR HEALTH AND FOR THE MEDICARE PROGRAM TO UNDERSTAND THE NEEDS OF THE AGING POPULATION. CURRENTLY RIGHT NOW, WE ACTUALLY HAVE CONDUCTED OVER 1 MILLION INTERVIEWS OF A VERY LARGE POPULATION OF MEDICARE BENEFICIARIES. SO IT IS A ROTATING PANEL DESIGN, WHICH IS REPRESENTATIVE OF THE MEDICARE POPULATION AS I'VE SAID, EACH YEAR WE SAMPLE NEW BENEFICIARIES EVERY FALL TO ENTER AND ENROLL IN THE STUDY, AND WE WILL THEN INTERVIEW THEM IN THEIR HOMES OR INTERVIEW THE FACILITY IN WHICH THEY RESIDE THREE TIMES A YEAR FOR FOUR YEARS, SO IT IS A LONGITUDINAL STUDY OF THAT POPULATION. WE COLLECT INFORMATION ON SOCIODEMOGRAPHICS, THEIR HEALTH INSURANCE COVERAGE, UTILIZATION OF HEALTHCARE SERVICES, THE COST AND PAYMENTS WHICH ARE OF COURSE A SIGNIFICANT INTEREST TO THE MEDICARE PROGRAM, THEIR HEALTH STATUS AND FUNCTIONING, THEIR EXPERIENCES WITH CARE AND CARE TRANSITIONS, AND OTHER CONTENT. WE ALSO LOOK AT THEIR INPATIENT AND OUTPATIENT UTILIZATION OF CARE, THEIR USE OF PHYSICIAN SERVICES, HOME HEALTH, WHETHER THAT'S PAID FOR OR WHETHER THAT'S BY SUPPORTS BY NEIGHBORS OR FAMILY, THEIR USE OF EQUIPMENT FOR FUNCTION, SKILLED NURSING AND HOME SERVICES, HOSPICE CARE AND ANY OTHER MEDICAL SERVICES. SO WE RELEASED THE DATA SO THAT THE DATA IS VERY USABLE FOR OUR DATA RESEARCHERS. AS YOU CAN SEE, WE DO INCLUDE A LOT OF INFORMATION THAT WE'VE DISCUSSED EARLIER TODAY, INCLUDING THEIR GENERAL HEALTH STATUS, CHRONIC CONDITIONS, MENTAL HEALTH, VISION AND HEARING, FACILITY ASSESSMENTS DONE WHILE THEY ARE INPATIENT IN FACILITIES, WHETHER OR NOT THEY HAVE ASSISTANCE IN THEIR HOME, ABOUT THEIR FALLS, THEIR MOBILITY, TRANSPORTATION SERVICES, DISABILITY INFORMATION, THEIR USE OF PREVENTIVE SERVICES AND INFORMATION ON NICOTINE AND ALCOHOL USE AS WELL AS FOOD INSECURITY. WE ALSO LOOK AT THEIR DENTAL CARE. ARE THEY USING DENTAL CARE SERVICES, WHETHER THEY'RE SATISFIED WITH THEIR CARE, AND WHETHER OR NOT THEY'RE EXPERIENCING A SATISFACTORY RELATIONSHIP WITH THEIR PRIMARY SOURCE OF CARE. WE ALSO COLLECT DATA ON THEIR COST AND UTILIZATION OF THEIR CARE, WHETHER OR NOT IT'S COVERED OR NOT COVERED BY MEDICARE BECAUSE WE WANT TO UNDERSTAND WHAT ELEMENTS OF CARE THEY'RE EXPERIENCING THAT AREN'T COVERED BY MEDICARE. LIKE VISION, DENTAL, HEARING, WHICH ARE VERY LARGE OUT OF POCKET EXPENSES FOR THE POPULATION. HOW DO WE PARTNER AND GET INFORMATION FOR OUR SURVEY TO ADD ADDITIONAL CONTENT? ANNUALLY, WE PUT OUT A CAL FOR CONTENT TO THOSE WHO HAVE EXPRESSED AN INTEREST IN PUTTING CONTENT ON THE SURVEY. IT ALLOWS US TO STAY RELEVANT FOR POLICY AND PROGRAM CHANGES, IT ALLOWS US TO ADD NEW COULD CONTENT FOR RESEARCHERS WHO FOCUS ON THE ELDERLY AND THE AGED, AND IT ALLOWS US TO STAY IF ALIGNMENT WITH OTHER FEDERAL HEALTH SURVEYS. THE MAJORITY OF OUR POLICY CONTENT COMES FROM WITHIN CMS FROM THE OFFICE OF ACTUARY AND FOR THE CENTERS FOR MEDICARE AND MEDICAID INNOVATION IN DISCOVERING AND DEVELOPING NEW PAYMENT MODELS. THE ANNUAL CONTENT CALL GOES OUT AND WE THEN WILL BUILD OUT A TIMELINE TO GAIN COMPLEERNS. ALL CLEARANCE. ALL OF OUR CONTENT HAS TO BE CLEARED THROUGH OMV AND FOR INSTANCE, OUR 2019 CALL FOR CONTENT HAS JUST BEEN COMPLETED. WE'VE BEEN EVALUATING THAT CONTENT AND THAT DATA, THOSE ADDITIONAL QUESTIONS AND POLICY RELATED CONTENT WILL BE IMPLEMENTED IN 2021. SO FOR EXAMPLE, THESE ARE SOME OF THE ADDITIONAL CONTENT WE'VE RECEIVED AND IMPLEMENTED IN THE PAST SEVERAL YEARS. WE'VE REVISED OUR MENTAL HEALTH, NICOTINE AND ALCOHOL USE QUESTIONS TO BE IN ALIGNMENT WITH OTHER FEDERAL SURVEYS, WE'VE ADDED ADDITIONAL QUESTIONS ABOUT THE SHINGLES VACCINE, REASONS WHY BENEFICIARIES CANNOT COMPARE THEIR MEDICARE PLANS, LOOKING AT THINGS LIKE LIMITED ENGLISH PROFICIENCY AND CAREGIVER ALIGNMENT, WHETHER OR NOT THEIR CAREGIVER CAN SPEAK THEIR NATIVE LANGUAGE, IN 2017, WE'RE ALSO LOOKING AT MEDICATION ADHERENCE OR NON-ADHERENCE DUE TO COST, EXPERIENCES WITH MEDICAL DEBT, AND WHETHER OR NOT THEY HAVE FOREGONE MENTAL HEALTHCARE BECAUSE THEY COULD NOT AFFORD IT. IN 2018, WE ADDED A DEPRESSION SCREEN, WE LOOKED AT WHETHER OR NOT THEY ARE TAKING ADVANTAGE OF COUNSELING ABOUT SMOKING CESSATION AND WEIGHT LOSS TO THINGS THAT HAVE A VERY HIGH IMPACT ON HEALTH, AND WE ARE ALSO LOOKING AT THEIR COMMUNICATION WITH THEIR HEALTHCARE PROVIDERS. IN 2019, WE WERE VERY EXCITED TO ADD A CHRONIC PAIN SEGMENT WHERE WE ASK ALL OF OUR BENEFICIARIES WHETHER OR NOT THEY EXPERIENCE PAIN ON A DAILY BASIS AND HOW THAT PAIN INTERFERES WITH THEIR FUNCTION, WHETHER IT PROVIDES THEM LIMITATIONS IN MOBILITY AND HOW MUCH IT INTERFERES WITH THEIR DAILY LIVING. WE ALSO HAVE ADDED HIV SCREENING AND ADDITIONAL QUESTIONS ABOUT VISION AND HEARING EVENT BECAUSE THOSE ARE VERY HIGH OUT OF POCKET COSTS AND NOT HAVING THOSE SERVICES HAS A VERY HIGH IMPACT ON HEALTH. IN 2020, WE BEGAN ADDING PHYSICAL AND COGNITIVE MEASURES TO THE SURVEY. QUESTIONS ON COST TRANSPARENCY, THE USE OF ELECTRONIC HEALTHCARE RECORDS AND ALSO CARE COORDINATION, ESPECIALLY WITH REGARD TO TRANSITIONS OF CARE AND ALSO MAKING SURE THAT THEY'RE USING THEIR ANNUAL WELLNESS VISIT BENEFIT. WE HAVE OTHER EXAMPLES OF COLLABORATION NOT ONLY WITHIN CMS BUT WE ALSO HAVE FORMAL COLLABORATIONS WITH FEDERAL PARTNERS. THOSE USUALLY INVOLVE FUNDING AND INTERAGENCY AGREEMENT, AND THESE WE ALSO USUALLY HAVE INFORMAL COLLABORATORS WHO WILL SUGGEST CONTENT FROM RESEARCH ORGANIZATIONS, AND WE WILL TAKE THOSE UNDER ADVISEMENT IF WE CAN IMPLEMENT THEM EASILY INTO THE SURVEY IF THEY'RE COMING FROM -- WITH VALID MEASURES AND THAT THEY DO NOT COST US A LOT TO IMPLEMENT. THOSE COLLABORATORS HAVE INCLUDED, FOR EXAMPLE, RESEARCHERS FROM KAISER FAMILY FOUNDATION, HARVARD, YALE, NORTHWESTERN AND OTHERS. WE ARE A VERY LARGE PART OF A VERY SMALL RESEARCH BUDGET AT CMS, AND WE HAVE BEEN BASICALLY FLAT LINED IN OUR FUNDING SINCE PRIOR TO 2014, AND WE ARE SPLIT-FUNDED BETWEEN THAT RESEARCH BUDGET AND THROUGH 3021 MONEY. ONE OF OUR VERY CONSISTENT FEDERAL PARTNERS HAS BEEN THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THEY DO PROVIDE AT LOI LOT OF COLLABORATION FOR US ABOUT VACCINES, PREVENTIVE VACCINES FOR THE ELDERLY. WE ALSO HAVE INFORMAL COLLABORATIONS WITH THEM ABOUT LOOKING FOR SELF-REPORTED RESPONSES FOR THE UTILIZATION OF PREVENTIVE VACCINES AND LOOKING AT THE FEE FOR SERVICE CLAIMS. ADDITIONALLY, CDC HAS PROVIDED FUNDING THROUGH AN INTERAGENCY AGREEMENT, WHILE WE LOOK FOR HOW OUR MEDICARE BENEFICIARIES ARE GETTING PLACES PRIMARILY TO THEIR DOCTORS' VISITS AND OTHER HEALTHCARE PROVIDERS AND THEIR USE OF TRANSPORTATION. THIS HAS BEEN A VERY SUCCESSFUL INDICATOR AND HAS PROVIDED A LOT OF RESEARCH INTEREST FOR GROUPS, INTERAGENCY GROUPS THROUGHOUT THE FEDERAL GOVERNMENT. WE ALSO HAVE OTHER EXTERNAL COLLABORATORS, FOR INSTANCE, IN 2016 AT THE NIA FUNCTIONAL LIMITATIONS MEETING, PARTICIPANTS THERE HAD SUGGESTED TO ME WHILE I WAS THERE THAT WE SHOULD BEGIN ADDING ITEMS TO HELP IN THE EVALUATION OF OF FRAILTY IN THE MEDICARE POPULATION SO IN INFORMAL COLLABORATION WITH YALE, WE BEGAN TO LOOK AT A SUBSET OF MEASURES TO INCLUDE ON THE SURVEY AND AS OF FALL NEXT YEAR, WE'LL BE ADDING GATE SPEED, A BALANCE TEST AND A CHAIR STAND, AS WELL AS COGNITIVE MEASURES BACKWARDS COUNTING, OBJECT NAMING, AND THE NAMING OF THE PRESIDENT AND VICE PRESIDENT. THESE ITEMS WERE CHOSEN BECAUSE THEY DO REQUIRE VERY MINIMAL EQUIPMENT AND HAD A MINIMAL COST IMPLICATION AND WE WERE ABLE TO PUT THEM INTO THE SURVEY WITHOUT A LOT OF RESPONENT BURDEN AND WE WERE ABLE TO GET CLEARANCE JUST THIS YEAR. AND JUST THIS PAST YEAR, THE OFFICE OF DIETARY SUPPLEMENTS DECIDED THAT THEY WOULD LIKE TO PARTNER WITH US AND THROUGH AN INTERAGENCY AGREEMENT, WE WERE ABLE TO GET EQUIPMENT TO ALSO ADD IN MEASURE HEIGHT AND WEIGHT AS WELL AS GRIP STRENGTH AND ADDITIONAL QUESTIONS ON MALNUTRITION AND THE USE OF DIETARY SUPPLEMENTS. SO WE'RE VERY HAPPY THAT WE'LL ACTUALLY BE ABLE TO IMPLEMENT THE MEASURED HIELT AND WEIGHT ALSO IN THE FALL OF 2020 THROUGH A NON-SUBSTANTIVE CHANGE, AND ONCE WE HAVE ALL OF THESE MEASURES IN PLACE, WE'LL HAVE THE MAJORITY OF THE INDICES THAT PEOPLE USE IN THE MEASURES OF FRAILTY. THESE MEASURES WILL BE DONE AT BASELINE INTERVIEW FOR ALL OF OUR BENEFICIARIES AND DONE ANNUALLY FOR UP TO FOUR YEARS SO YOU'LL BE ABLE TO LOOK AT THOSE MEASURES OVER TIME. WE FOUND THAT OUR SUCCESSFUL COLLABORATIONS DO ALLOW US TO LOOK CAREFULLY AT OUR TIMING OF IMPLEMENTATION. WE DO HAVE TO HAVE ALL CHANGES TO THE SURVEY APPROVED THROUGH OMB, ENSURING THAT AN ITEM HAS A VALID PROTOCOL THAT'S ALREADY BEEN OUT THERE OR BEEN IMPLEMENTED IN ANOTHER SIMILAR SURVEY, HELPS US TO GET THROUGH THE CLEARANCE PROCESS, AND WE NEED TO MAKE SURE THAT WE CAN JUSTIFY THAT WE'RE THE BEST PLACE FOR THIS DATA ITEM, THAT IT SHOULDN'T BE PLACED IN ANOTHER FEDERAL SURVEY TO MAKE SURE THERE'S NOT A LOT OF OVERLAP. WE ALWAYS NEED TO BALANCE OUR EXISTING CONTENT ALONG WITH THE NEW CONTENT TO MAKE SURE THAT WE'RE ALWAYS POLICY-RELEVANT AND ALSO RELEVANT TO OUR EXTERNAL RESEARCHERS. FUNDING THROUGH INTERAGENCY AGREEMENTS CAN BE DIFFICULT BUT ALSO CAN HELP US TO ADD ITEMS THAT WE OTHERWISE WOULD NOT BE ABLE TO PUT INTO THE SURVEY. ALTHOUGH WE ARE ALL IN HHS, 1HHS DOES NOT MEAN ONE SET OF PROCESSES. WE ALL HAVE OUR OWN PROCESSES AND SYSTEMS, AND SOMETIMES THE DEADLINES, INTEGRATING AND NAVIGATING THOSE POLICIES AND PROCESSES CAN BE DIFFICULT AT TIMES, BUT WITH CAREFUL PLANNING, WE'VE BEEN ABLE TO MANAGE TO HAVE THESE INTERAGENCY AGREAMENTS IN PLACE AND ALSO THROUGH OUR IB FORMAL PROCESSES, WE'VE BEEN ABLE TO ACTUALLY ININCLUDE A LOT OF CONTENT THAT HAS BEEN SUGGESTED TO US BY EXTERNAL RESEARCHERS. SO I'D JUST LIKE TO THANK YOU. [APPLAUSE] >> DEBRA, I THINK YOU ALSO MENTIONED TO ME A COUPLE DAYS AGO THAT WHAT'S THE RESPONSE RATE AGAIN FOR YOUR SURVEY? >> ONCE SOMEONE HAS ENROLLED IN THE SURVEY, WE'RE RUNNING JUST ABOUT 86% RESPONSE RATE FOR THOSE TO RETAIN IN THE SURVEY, OUR BASELINE IS HOVERING AT AROUND 60%. THAT'S WHERE WE GO OUT AND TRY TO RECRUIT PEOPLE, SO THAT'S AT ABOUT 60%, BUT ONCE THEY'VE ENROLLED, IT'S VERY HIGH. >> CONGRATULATIONS. I'M JOHANNA DWYER FROM THE OFFICE OF DIETARY SUPPLEMENTS, AND WE'RE OPEN NOW FOR QUESTIONS. WE'VE GOT LOADS OF QUESTIONS BUT I'M SURE YOU DO IN THE AUDIENCE TOO. OH, WE HAVE ONE ALREADY. I THINK THIS IS FOR EVERYBODY. IT'S WHAT COMMUNICATIONS TACTICS ARE IMPORTANT FOR SUCCESSFUL PARTNERSHIPS? SHALL I START WITH CYNDY AND THEN GO DOWN THE LIST? >> IT REALLY DEPENDS ON THE CONTEXT OF THE COMMUNICATION. WE DO -- OUR FOUNDATION WHEN WE SUPPORT TRIALS, WE ACTUALLY HAVE FACE TO FACE MONTHLY, WE VISIT SITES, SO THERE'S FACE TO FACE COMMUNICATIONS, WHICH IS A TACTIC. I ALREADY TALKED ABOUT, YOU KNOW, FOR PROMOTING, SOCIAL MEDIA IS HERE TO STAY AND IT'S VERY EFFECTIVE IF USED APPROPRIATELY. WE HAVE LEARNED THAT PRINT MATTERS WHAT DAY OF THE WEEK YOU PRINT. QUICKLY CASE STUDY, WE HAD ONE SITE THAT USED TO SPEND MORE MONEY FOR THE SUNDAY NEWS, THEY FIGURED THAT'S WHERE THEIR ALZHEIMER'S DISEASES WOULD BE ALZHEIMER'S AD WOULD BE MOST READ. THEY HAPPENED TO RUN IT ON A WEDNESDAY AND THEY GOT SO MANY MORE CALLS AND THEY COULDN'T FIGURE IT OUT, IT WAS COUPON DAY IN THE LOCAL NEWSPAPER SO MORE SENIORS WERE BUYING WEDNESDAY PAPERS THAN SUNDAY PAPERS. SO I'LL JUST PASS IT ON, BUT I THINK TO ME, COMMUNICATION IS RESPOND, WHETHER IT'S GOOD, BAD OR INDIFFERENT, BUT MAKE SURE YOU RESPOND, AND MAKE SURE NO QUESTION IS INAPPROPRIATE OR ANYTHING LIKE THAT, AND JUST MAKE SURE YOU CAN HELP PEOPLE AND IF YOU DON'T KNOW THE ANSWER, IT'S OKAY TO SAY YOU DON'T KNOW AND REFER THEM TO SOMEBODY ELSE. >> TO FOLLOW ON WITH WHAT CYNDY WAS SAYING, I THINK THE TIMING OF THE COMMUNICATION IS REALLY IMPORTANT BECAUSE THEY'RE DIFFERENT DEPENDING ON WHERE YOU ARE IN A PROJECT. WE DO THINGS IN PROGRAMS THAT EARLY ON, THE COMMUNICATION IS REALLY WITHIN THE FIELD, LOOKING FOR PARTNERS, LOOKING FOR THAT THAT -- THAT KIND OF COMMUNICATION IS VERY MUCH A -- IS SOMETHING THAT'S INTERESTING TO YOU, IS THIS SOMETHING THAT YOU WOULD BE WILLING TO WORK ON, WHAT KIND OF THINGS ARE YOUR GAPS, YOUR OBSTACLES IN THE WAY OF GETTING SOMETHING DONE. BUT AS I SAID, AT THE END OF THE PROJECT, OR TOWARDS THE END OF THE PROJECT, WE LIKE TO HAVE A IMPACTFUL RESULT THAT IS USABLE, AND THAT BECOMES A MUCH MORE OUTWARD AS OPPOSED TO INWARD KIND OF DISCUSSION WHERE WE WANT EVERYONE TO KNOW. SO WE'LL DO PUBLICATIONS, YOU KNOW, IN SCIENTIFIC JOURNALS BECAUSE PEOPLE READ SCIENTIFIC JOURNALS BUT WE ALSO WANT THE SOCIAL MEDIA AS WELL AS DISCUSSIONS IN -- LOCAL COMMUNITY DISCUSSIONS SO IS THAT PEOPLE UNDERSTAND WHAT THIS MEANS TO THEM, YOU KNOW, WHATEVER FS THAT WE'VE DONE MEANS TO THEM, THAT LOCAL COMMUNITY COULD BE -- PATIENTS COULD BE PHYSICIANS, HEALTHCARE. SO I THINK IT DEPENDS A LOT ON WHERE YOU ARE IN THE SPACE. WE SPEND A LOT OF TIME WITH OUR COMMUNICATIONS FOLKS AT THE FOUNDATION FOR THAT REASON BECAUSE IT HAS TO BE TAILORED. >> THANK YOU. PCORI. >> TERMS OF PATIENT STAKEHOLDERS, THE COMMUNICATION REALLY HAS TO BE ON THE TERMS OF THE STAKEHOLDER THAT YOU'RE ENGAGING IN THE RESEARCH. WE'VE FOUND THAT CONSIDERABLE TIME HAS TO BE PUT IN TRYING TO PUT INTO PLAIN LANGUAGE, SOMETIMES VERY COMPLICATED SCIENTIFIC CONCEPTS, PARTICULARLY FOR PATIENTS BUT NOT JUST PATIENTS, ALSO EVEN PAYORS SOMETIMES, THERE'S A COMMUNICATION LANGUAGE BARRIER THAT HAS TO BE WORKED THROUGH AND THAT DOES TAKE TIME, YOU'VE GOT TO INVEST IN THAT UP FRONT, THEN TO BUILD THAT KIND OF COMMUNICATION WHERE THEY CAN ACTIVELY BE ENGAGED IN THE WORK, ALSO YOU HAVE TO COMMUNICATE ON THEIR PREFERENCES. IF YOU'RE GOING TO ENGAGE THESE TYPES OF INDIVIDUALS, THEY'VE GOT FULL TIME JOBS. YOU'RE GOING TO HAVE TO HOLD MEETINGS WHEN THEY'RE AAVAILABLE, NOT JUST WHEN THE RESEARCH STAFF IS AVAILABLE. THAT IS A LEARNING PROCESS THAT'S TAKEN SOME TIME TO KIND OF WORK THROUGH IN THESE PROJECTS. BUT IF YOU SET IT UP RIGHT, THEY REALLY CAN BE VERY, VERY EFFECTIVE IN ADDING VALUE TO YOUR STUDY. >> THANK YOU. DEB? >> FOR THE PAST FIVE YEARS, WE'VE BEEN SPENDING CONSIDERABLE TIME MAKING SURE WE KNOW WHO OUR STAKEHOLDERS ARE, AND WHO THE RESEARCHERS ARE WHO USE THE DATA THAT WE PUT OUT, KNOWING THOSE PEOPLE AND HOW TO REACH THEM HAS BEEN OUR MAIN FOCUS. ALSO KNOWING THAT WHEN WE'RE SENDING REQUEST FOR INFORMATION, FRIDAY IS NOT A GOOD DAY. SO TIMING IS KEY, AS FAR AS ESPECIALLY WITH FEDERAL PARTNERS WHERE EVERYBODY IS DOING BUDGETS, ET CETERA, BUT PREDOMINANTLY FOR US, IT'S BEEN IN TRYING TO FIND OUT WHO OUR STAKE STAKEHOLDERS ARE, GETTING THE RIGHT ONES AND MAKING SURE WE'RE CONTINUALLY COMMUNICATING WITH THEM ABOUT THEIR OPPORTUNITIES AND THEN ALSO WHERE WE ARE IN THE PROCESS AND WHETHER OR NOT THEIR SUGGESTIONS HAVE BEEN AGREED UPON AND CLEARED. >> THERE'S ONE QUESTION HERE FOR YOU, DEB, WE'LL GO TO THAT AND THEN GO TO THE FLOOR, AND WHOEVER IS IN CHARGE OF THIS, IT'S STOPPED RESPONDING. BUT THE QUESTION BEFORE IT STOPPED RESPONDING WAS, HOW DO YOU GET THESE FRAILTY MEASURES AND WHEN WILL THEY BE READY? >> THE FRAILTY MEASURES WILL FIRST GO IN IN THE FALL OF 2020, AND THEN IT'S ABOUT 18 MONTHS AFTER WE FINISH OUR DATA COLLECTION THAT THE FILES ARE AVAILABLE FOR RESEARCHERS, AND YOU CAN GO TO THE CMS RESEARCH DATA PAGE AND LOOK AT HOW YOU CAN GET A DATA USE AGREAMENT TO USE THE DATA AND IF YOU KNOW ANYTHING ABOUT THE CMS VIRTUAL REA SOURCE DATA CENTER THROUGH THE CCW, YOU ALSO CAN GET THE DATA THAT WAY IF YOU HAVE A SEAT BUT IT'S ABOUT 18 MONTHS FROM THE TIME WE BEGIN COLLECTING THE DATA UNTIL THE DATA IS READY FOR THE PUBLIC. WE'RE PRETTY FAST. >> INDEED YOU ARE. >> I THINK I SEE A QUESTION OVER THERE. >> SO I'M KAREN, A POSTDOC IN NICHD, AND I GUESS THIS IS SORT OF ALONG THE LINES OF THE COMMUNICATION PROBLEM BUT MAYBE AT A HIGHER LEVEL, DO YOU GUYS HAVE ANY HURDLES OR PROBLEMS IN TERMS OF DATA CURATION, VALIDATION AND SHARING WHEN YOU ARE WORKING IN THESE PARTNERSHIPS? AND HOW DO YOU WORK WITH THAT DATA VALIDATION AND CURE RANGE OF MOTION? >> YOU'RE GOING TO GO DOWN THE LINE, HUH? >> THAT IS ALWAYS AN ISSUE. INTO WE DO HAVE TO SIGN CONFIDENTIALITY AGREEMENTS AND IT DOES GET TRICKY FOR OUR FOUNDATION BECAUSE WE SUPPORT MORE THAN ONE TRIAL FOR OUR SPONSOR. THEY WILL TELL US HOE HOLISTICALLY WHAT'S GOING ON IN THEIR RESEARCH CENTER WHERE THEY WILL NOT SAY THAT TO A SINGLE SPONSOR BECAUSE IT MIGHT NOT BE GOOD FOR THEM OR THE RELATIONSHIP WITH THEIR CLINICAL RESEARCH ORGANIZATION OR EVEN THEIR GOVERNMENT GRANTER. SO WE HAVE TO BE VERY JUDICIOUS ON WHAT WE SHARE AND DON'T SHARE, AND WE ARE UNDER CONFIDENTIALITY AGREEMENTS AND IF I CAN SAY ANYTHING, BE MORE CONSERVATIVE BECAUSE YOU NEVER WANT TO SHARE SOMETHING THAT MAYBE SOMEBODY IS TELLING YOU IN CONFIDENCE, ESPECIALLY IF YOU HAVE REALLY GOOD RELATION SHIPTS, SOMETIMES THINGS WILL BE SAID THAT YOU KNOW PROBABLY SHOULDN'T BE SAID. I WILL SAY WE NEVER TOUCH ANY PATIENT INFORMATION, SO WE DON'T HAVE TO WORRY ABOUT THAT EVER. BUT IF YOU ARE TOUCHING PATIENT INFORMATION, THEN IT EVEN GETS MORE COMPLICATED ON WHAT YOU'RE DOING AND WHAT YOU'RE SHARING, SO IT'S ALWAYS A VERY FINE BALANCE AND I THINK YOU JUST HAVE TO PERFORM AT THE HIGHEST ETHICAL STANDARD POSSIBLE. >> ANYBODY ELSE WANT TO COMMENT ON THAT ONE? >> SURE. SO IT'S AN IMPORTANT QUESTION AND IT ALSO BECOMES AN ISSUE AGAIN DEPENDING ON WHERE YOU ARE IN THE PROJECT AND KIND OF WHAT YOU'RE DOING. SO YOU ASKED ABOUT DATA VALIDATION AND SHARING, AT LEAST THAT'S WHAT I REMEMBER. SO DATA VALIDATION, WE WORK WITH A LOT OF -- AT LEAST IN OUR PROJECTS, EACH PROJECT HAS ITS OWN KIND OF UMBRELLA OF HOW IT DOES THINGS, AND WE WORK OUT ALL OF THE AGREEMENTS AND WHAT YOU HAVE, AND SOMETIMES 30 AND 40 FOR A SINGLE PROJECT. AND WE TRY TO WORK THAT OUT SUCH THAT THE DATA THAT'S SHARED IS -- THE RESULTS, AT LEAST, CAN BE PUBLICLY RELEASED, SO WE START OUT WITH -- WE ALSO START OUT WITH NO IP, THAT ALSO HELPS DRIVE A MORE OPEN DISCUSSION. THE PLACES AND THE INSTITUTIONS, ORGANIZATIONS THAT WE WORK WITH TEND TO HAVE A FAIR AMOUNT OF DATA VALIDATION AS PART OF THEIR INHERENT WORK, SO -- AND WE DO GET A LOT OF DATA FROM INDUSTRY, THE PHARMACEUTICAL INDUSTRY. WELL, THAT'S REGULATED BY THE FDA, WHAT KIND OF DATA THEY HAVE AND HOW IT'S DONE, AND SO WE ARE KIND OF THE BENEFICIARY OF THAT LEVEL OF RIGOR. SO THAT ACTUALLY MAKES THAT SOMEWHAT EASIER. BUT EVEN SO, IN A GIVEN PROJECT, THE ONE THAT I VERY QUICKLY WENT THROUGH, WE HAD DATA FROM SEVEN DIFFERENT -- SIX DIFFERENT COMPANIES, TWO DATASETS OF PHASE III DATA THAT HAD BEEN SUBMITTED TO THE FDA, AND SO AGAIN, THAT HAD A LOT OF RI DOOR BUT IT WAS SIX DIFFERENT COMPANIES AND EACH COMPANY HAS ITS OWN THING, YOU KNOW, ABOUT WHAT THEY WANT TO DO AND HOW THEY WANT TO SHARE THINGS. THAT ACTUALLY WENT TO -- THAT RAW DATA WAS ACTUALLY REANALYZED BY MULTIPLE DIFFERENT INSTITUTIONS IN THE PUBLIC SPACE TO KIND OF BRING IT ALL UNDER ONE UMBRELLA IN THAT INSTANCE. IN TERMS OF SHARING, AGAIN EACH PROJECT IS THE SAME, BUT MOST OF THE TIME, THE RAW DATA SHARING IS FOR THAT PROJECT AND FOR THAT PARTICULAR QUESTION. WE WERE VERY FOCUSED ON KIND OF "THE QUESTION." WHEN THAT -- SO IF WE TAKE DATA FROM SIX DIFFERENT COMPANIES AND 12 DIFFERENT TRIALS FROM THOSE COMPANIES AND WE MIX IT ALL TOGETHER, NOT ENTIRELY TRUE, BUT MIX IT ALL TOGETHER, THE ANALYSIS WILL BE FOR THAT PROJECT. ONCE THAT PROJECT IS OVER, THE DATA KIND OF GOES BACK TO THE SPONSORS IN MOST CASES. IF WE GENERATE THE DATA, LIKE IS DONE IN ADNI, THE ADNI SAMPLES ARE THERE, BUT IF WE GENERATE NEW DATA WITH THOSE SAMPLES, IT GOES BACK TO ADNI AND WE SEE AT THE SAME TIME EVERYBODY ELSE DOES. SO 18 MONTHS IS ACTUALLY -- FOR ADNI IS A LONG TIME, BUT ALL OF THAT IS WORKED OUT BEFORE ANYONE STARTS COLLECTING ANYTHING. SO EVERYBODY KNOWS WHAT'S GOING ON. BUT IT'S LIKE WHAT WE SPEND MORE THAN A THIRD OR FOURTH OF OUR TIME DOING, IS TRYING TO WORK ALL THAT OUT. THANK YOU. >> ANYBODY ELSE WANT TO COMMENT, THEN WE'LL GO ON TO THE NEXT ONE. >> I JUST WANT TO SAY, THE DATA WE COLLECT UNDER THE SURVEY AND AS WELL AS THE RESEARCH CLAIMS FROM MEDICARE, THOSE ARE ALL COVERED UNDER HIPAA, SO WE DO HAVE TO HAVE DATA USE AGREEMENTS AND THERE ARE A FEW DATA ITEMS THAT GO OUT PUBLICLY BUT PREDOMINANTLY MOST OF THEM GO OUT THROUGH A DATA USE AGREEMENT WITH REQUIREMENTS AND VERY STRICT ENCRYPTION AND CLOSE HOLD ON THE DATA. >> THANK YOU. WE HAVE TWO QUESTIONS FOR DR. CLAUSER. TWO. THE FIRST IS, CAN YOU GIVE AN EXAMPLE WHEN PATIENTS AND STAKEHOLDERS INPUT TOGETHER INTO A STUDY ACTUALLY IMPROVED THE QUALITY OF THE STUDY? >> WHAT WE FOUND AS AN EXAMPLE, ONE OF THE AREAS OF RESEARCH THAT I'M RESPONSIBLE FOR IS OUR ADDRESSING DISPARITIES IMPROVING HEALTH EQUITY. THESE ARE SOME OF THE MOST CHALLENGING TRIALS ANYONE HAS THROUGHOUT WHOEVER FUNDERS BECAUSE YOU'RE DEALING WITH PATIENTS AND PATIENT GROUPS AND CULTURES THAT TRADITIONALLY HAVEN'T BEEN PART OF RESEARCH BEFORE, AND WE'VE REALLY FOUND THAT THE ENGAGEMENT OF PATIENT GROUPS IN PARTICULAR HAVE REALLY FACILITATED GETTING OVER ENROLLMENT BARRIERS TO TRY TO COME UP WITH STRATEGIES TO TRY TO IMPROVE THAT THROUGH EITHER TAILORING MATERIALS OR ACTUALLY RECOMMENDING, YOU KNOW, THE TYPES OF CRITERIA THAT ARE APPROPRIATE FOR THE KINDS OF PEOPLE THAT ACTUALLY ARE ON THE FRONT LINES TRYING TO GET PATIENTS INTO THESE TRIALS. SINCE MANY OF THESE KINDS OF TRIALS, THE RECRUITMENT STRATEGIES DON'T TRADITIONALLY GO THROUGH YOUR TRADITIONAL HEALTHCARE MECHANISMS OF CLINICAL PRACTICES AND INSTITUTIONS, THEY REALLY GO THROUGH COMMUNITY ORGANIZATIONS AS MUCH AS ANYTHING ELSE. AND IN ANOTHER EXAMPLE, JUST SIMPLY IN OUR NIA STRIDE TRIAL, WHERE THERE WAS REAL CHALLENGES TRYING TO IDENTIFY EVIDENCE-BASED EXERCISE PROGRAMS IN SOME OF THESE DIVERSE COMMUNITIES WHERE THE TRIAL IS BEING HELD, AND SOME OF THESE LOCAL STAKEHOLDER GROUPS REALLY WERE INSTRUMENTS TALL INSTRUMENTAL IN GOI NG OUT AND FINDING THESE ORGANIZATIONS SO THAT THEY WERE AVAILABLE THEN FOR PATIENTS TO TAKE ADVANTAGE OF AT TRIAL. >> GREAT. THE SECOND PART OF THE QUESTION WAS, CAN YOU COMMENT ON HOW PCORI'S APPROACH TO PATIENT CENTERED OUTCOMES RESEARCH HAS INFLUENCED RESEARCH SPONSORED BY OTHER FUNDERS? >> THAT'S A GOOD QUESTION. ONE EXAMPLE THAT I THINK IS VERY RECENT IS THAT WE'RE INVOLVED IN ANOTHER COLLABORATION WITH THE NIDDK AND THE CDC ON NATURAL EXPERIMENTS LOOKING AT POLICY INTERVENTIONS THAT STATES AND FEDERAL GOVERNMENT DO TO TRY TO IMPROVE DIABETIC OUTCOMES FOR PATIENTS FOCUSING ON ISSUES EITHER RELATED DIRECTLY TO DIABETES CARE ITSELF OR EVEN OBESITY, AND THAT WAS A COLLABORATION THAT WAS STRUCTURED WHERE CDC AND NIDDK AWARDED FIVE SITES AND THEN WE AWARDED THREE SITES, AND OUR THREE SITES, BECAUSE OF OUR MANDATE, WE HAD PATIENT AND STAKEHOLDER ENGAGEMENT AS A CORE ELEMENT OF THAT ACTIVITY, AND THE OTHER SIDE STARTED TO SEE WHAT OUR THREE SITES WERE DOING, AND EVEN THOUGH IT WASN'T IN THEIR GRANT, THEY JUST DID IT AND PICKED IT UP AND HAVE CONTINUED IT ALL THE WAY THROUGH THE FIVE-YEAR STUDY. SO THAT IS QUITE AN EXAMPLE OF THE SUCCESS IN THAT REGARD. >> THANK YOU. GOOD ANSWER. CYNDY, ONE FOR YOU. HOW ABOUT MATCHING GRANTS. YOU MENTIONED THAT YOU HAVE TO HAVE MATCHING GRANTS BUT WHAT ABOUT HELPING THE PEOPLE TO GET THE MATCHING GRANTS? >> WE ARE A VERY SMALL FOUNDATION, BUT OVER THE COURSE OF THE PAST THREE YEARS, WE HAVE GIVEN OUT ABOUT $4 MILLION IN WHAT I CALL KIND OF MICRO GRANTS. IT REALLY IS A SPECIFIC GRANT TO A RESEARCH CENTER ON HOW CAN YOU IMPROVE YOUR EFFICIENCY, HOW CAN YOU HELP STARTUP, WHAT THEY WERE GOING TO USE THE MONEY FOR, AND WE STARTED INITIALLY FINDING THAT THEY TOOK THE MONEY AND THEY DID SOME THINGS, A LOT OF TIMES IT WENT TO A RECRUITMENT COORDINATOR, BUT WE STARTED SAYING, YOU NO HE, WE FEEL WE KNOW, WE FEE L WE CAN SEED OTHER -- CAN YOUR COMMUNITY MEMBERS WE'VE CONNECTED YOU TO THROUGH THAT WHOLE CHEVRON SLIDE I SHOWED YOU, CAN YOU USE OUR SMALL GRANT TO GET MORE MONEY? WE FOUND THIS WAS VERY EFFECTIVE IN MANY OF OUR RESEARCH CENTERS THAT THEY SAID GAP HAS SUPPORTED US, THEY LET US IN THEIR NETWORK, THEY'RE GOING TO GIVE US A GRANT OF $60,000, IF YOU MATCH IT. WE'VE HAD VERY INTERESTING MATCHES FROM BLUE CROSS/BLUE SHIELD IN SOME COMMUNITIES, FROM A PHILANTHROPIST IN ANOTHER COMMUNITY AND IT JUST GAVE THE RESEARCH CENTER THAT LITTLE BIT OF SUPPORT TO SAY WE'VE GOT SOMEBODY THAT'S TRYING TO HELP US BUT WE'RE REALLY TIED WITH WHAT WE CAN DO WITH IT. SO IT REALLY HELPED THE MONEY THAT WEIGH WE GAVE TO OUR RESEARCH CENTERS TO GO YOU THE OH AND GET MORE MONEY. SOME HAD BEEN GOING AFTER PHILANTHROPISTS AT UNIVERSITY HOSPITALS IN CLEVELAND FOR YEARS, WE HAD A LOT OF ALZHEIMER'S, AND JUST WOULDN'T REALLY GIVE, AND THEN OUR SMALL $80,000 GRANT THAT ENDED UP PARLAYING INTO OVER $100,000 AND THEY'RE OPENING A WHOLE NEW WING FOR ALZHEIMER'S. SO DON'T BE AFRAID MAYBE IF YOU GET SOME SMALL MONEY OR YOU'RE GOING AFTER SOME GOVERNMENT FUNDS, I THINK IT SUPPORTS ANY GRANT APPLICATION TO SAY -- IF YOU HAVE SOMEBODY ELSE SAY WE WANT TO MEET THIS SAME GOAL, IF YOU HAVE THE SAME OBJECTIVE, TWHA YOU MIGHT THAT YOU MIGHT BE ABLE TO PARLAY SOME SEED MONEY INTO MORE MONEY AS LONG AS YOU SHARE THOSE COMMON GOALS. >> THE VIRTUE OF COMPOUNDING OR WHATEVER THEY SAY IN THE FINANCIAL INDUSTRY. DEB, THERE'S ONE FOR YOU. HOW CAN CVS DATA BE OBTAINED FOR RESEARCH? I'M NOT SURE WE'RE CLEAR ON THAT. >> YES, YOU CAN GET THE DATA FOR THE CURRENT MEDICARE BENEFICIARY SURVEY BY GETTING A DATA USE AGREEMENT. THE ACTUAL FORMS AND PROCESS IS OUTLINED ON THE CMS RESEARCH SITE, AND BASICALLY THE DATA IS FREE, YOU JUST PAY ADMINISTRATIVE COSTS FOR GETTING THE DI DA THE DATA DISSEMINATED TO YOU BUT ALSO WITH THE DATA USE AGREEMENT. >> THE QUESTION IS, WHY IS COST-EFFECTIVENESS -- WHY ARE THOSE COST-EFFECTIVENESS STUDIES PROHIBITED? A LOT OF PATIENTS WANT TO KNOW ABOUT COST-EFFECTIVENESS. >> I DO KNOW I WASN'T HERE AT PCORI'S ORIGINATION SO I'M NOT SURE EXACTLY WHY THE RESEARCH LEGISLATION CAME OUT THE WAY IT DID. IT WAS IN STATUTE VERY CLEARLY STATED -- IT'S ONE THING -- I THINK WHAT THE INTENT WAS, THEY REALLY WANTED US TO FOCUS -- THERE'S SO MUCH FOCUS IN THE SYSTEM ON COST THAT THEY REALLY WANTED US TO FOCUS ON QUALITY AND IN TERMS OF REALLY UNDERSTANDING TRUE BENEFIT AND HARMS FROM DIFFERENT STUDIES, PARTICULARLY AS IT RELATED TO CLINICAL AND PATIENT-REPORTED OUTCOMES THAT WERE IMPORTANT. WE'LL SEE WHAT HAPPENS WITH THE NEXT REORGANIZATION, BUT THAT IS RE-AUTHOR IZATION BUT THAT'S WHERE WE ARE RIGHT NOW. >> THANK YOU. A GENTLEMAN OVER THERE. >> I HAVE A SHORT QUESTION FOR CORDELL. >> CAN YOU TELL US YOUR NAME? >> OH. DALE LISTATA. SHORT QUESTION AND THEN A SUGGESTION. IS THE ALZHEIMER'S ASSOCIATION INVOLVED WITH YOUR FOUNDATION AT ALL? >> NO, WE'RE A SEPARATE FOUNDATION. WE DO WORK WITH THE LOCAL ALZHEIMER'S ASSOCIATION CHAPTERS IN CERTAIN COMMUNITIES BECAUSE THEY'RE VERY INTEGRATED IN OUR RESEARCH CENTERS. WE DO BELIEVE THAT WHAT'S BEST FOR ANY RESEARCH PARTICIPANT -- ALL SOURCES. SO OUR FOUNDATION DOESN'T SUPPORT SUPPORT GROUPS OR DEMENTIA CARE, BUT WE FEEL THAT'S VERY IMPORTANT IN ANYBODY'S PROCESS WITH THE DISEASE. SO WE ACCEPT ANYBODY IN THE COMMUNITY THAT SUPPORTS ALZHEIMER'S, AND VERY OPEN BUT AS FAR AS DO WE HAVE A DIRECT PARTNERSHIP RELATIONSHIP WITH THE ALZHEIMER'S ASSOCIATION, WE DON'T. >> OKAY. AND THEN I HAVE A SUGGESTION THAT I'D LIKE TO GET YOUR REACTION TO IT. IN LIGHT OF ALZHEIMER'S AND EDUCATING THE PUBLIC AS TO WHAT IT IS AND WHAT'S TRANSPIRING, THINK WITH ME FOR A MOMENT ON THE HISTORY CHANNEL, WE LEARN HOW THE UNIVERSE WORKS, ABOUT DARK MATTER AND WE LEARN ABOUT DARK ENERGY AND BLACK HOLES AND VERY COMPLICATED STUFF. MAYBE LIFE IN THE UNIVERSE, SOMEWHERE ELSE. THAT'S MACRO. NOW LET'S TURN THAT TO MICRO AND LOOK AT THE SPACE BETWEEN OUR EARS. WHAT IS THE ROLE OF HOW THE BRAIN WORKS, AND WHAT IS THE ROLE OF HOW THE MICROGLIA CELLS WORK, THE PHYONS, THE PROTEINS OF TAU AND BETA AMYLOID AND SO FORTH THAT GETS WRAPPED UP IN THIS DASTARDLY DISEASE WHICH HAS GOT A 445% INCREASE SINCE 2000, IT'S RUNNING RAMPANT. BUT I WOULD SUGGEST THAT THE RANK AND FILE PUBLIC DOESN'T UNDERSTAND WHAT THAT IS. SO I WOULD SUGGEST IF YOU COULD PUT OUT ON BIDS, FOR EXAMPLE, USING HOW THE UNIVERSE WORKS AS A MODEL AS TO WHAT'S HAPPENING INSIDE OUR HEADS, AND THEN WHAT'S HAPPENING AS FAR AS THAT DISEASE IS CONCERNED SO THEY CAN UNDERSTAND AND PROBABLY EVEN MAKE CONTRIBUTIONS, YOU'RE LOOKING FOR FINANCES ALL THE WAY THROUGH THIS THING. WHAT'S YOUR RESPONSE TO MY SUGGESTION? >> SO MY RESPONSE IS, THIS IS WHERE -- THE ALZHEIMER'S ASSOCIATION DOES A GREAT JOB IN WHAT I CALL CONCERN AND AWARENESS, KIND OF WHAT'S GOING ON WITH A.D. AND THINGS LIKE THAT. OUR FOUNDATION REALLY DOES FOCUS ON WHAT DIFFERENT COMMUNITIES HAVE AS RESOURCES, AND TO YOUR POINT, WE HAVE SOME COMMUNITIES WHERE THE PRINCIPAL INVESTIGATOR CAN GO TO VERY AFFLUENT COMMUNITIES AND CAN TALK VERY HIGH LEVEL, AND I THINK I ALWAYS SAY, KNOW YOUR AUDIENCE, AND THEY'LL BRING THEIR MATERIALS AND THEIR POWERPOINT SLIDES AND THEY'LL GET DOWN DEEP AND THE AUDIENCE ASKS QUESTIONS THAT WILL JUST TOTALLY AMAZE ME FOR LAY PEOPLE TO ASK THESE VERY HIGH LEVEL SCIENTIFIC QUESTIONS. FIRST AS OTHER COMMUNITIES MAY NOT HAVE HAD THAT LEVEL OF BASELINE, YOU REALLY MAY HAVE HAD TO START SMALL ABOUT BRAIN HEALTH, WHAT YOU CAN DO AND WHAT'S A CLINICAL TRIAL. SO THIS IS WHERE I THINK JUST A NATIONAL PROGRAM MAY NOT BE AS EFFECTIVE FOR ACTUALLY WHAT I CALL CALL TO ACTION. OUR CALL TO ACTIONS, WE WANT THEM TO GO TO THE RESEARCH CENTER AND TALK TO THEM. THEY HAVE DIFFERENT NAMES FOR THEM, THERE'S RESEARCH INFORMATIONAL SESSIONS, FREE MEMORY SCREENS, YOU KNOW, HOW TO GET PEOPLE TO UNDERSTAND WHAT'S GOING ON, SOME OF THE RESEARCH CENTERS HAVE ACTUALLY CREATED FOR THEIR OWN RESEARCH CENTER LIKE INTRO VIDEOS ON HERE'S THE PI THAT WILL BE WORKING WITH YOU, HERE'S HOW THE BRAIN WORKS, ESPECIALLY IF THEY'RE GOING TO GET AN ANTIAMYLOID AGENT, WHY DO YOU WANT AN ANTIAMYLOID AGENT. THEY EVEN GET IN MORE SOPHISTICATION. PEOPLE THAT ENTER TRIAL THES REALLY LEARN A LOT. YOU MIGHT HAVE NEW TAU POSITIVITY TO GET IN ONE AND NOT THE OTHER. THEY HAD TO REALLY TALK THINGS THROUGH WITH THEIR PATIENTS THAT TAKE TIME BECAUSE OF THE DIFFERENT SCIENCE. SO I AGREE WITH YOU, THERE'S PEOPLE THAT REALLY WANT TO KNOW DEEP DOWN INTO ALL THE DIFFERENT NUANCES ON WHAT'S HAPPENING IN THE BRAIN, AND THERE'S OTHERS THAT JUST SAY, HEY, DOC, I REALLY TRUST YOU, IF THIS IS WHAT YOU THINK I SHOULD DO, I'LL DO. SO THERE'S WONDERFUL TOOLS ON NIA'S WEBSITE NOW FOR PROFESSIONALS. WHAT I SAY IS THERE'S HUNDREDS OF TOOLS BETWEEN THE ALZHEIMER'S ASSOCIATION, NIA, NIH, AND THAT'S PART OF OUR JOB, IS TO HELP THESE RESEARCH CENTERS TO KNOW THESE TOOLS ARE THERE, THESE INDIVIDUAL KNOWS ARE THERE, AND THEN IF YOU HAVE A PATIENT THAT REALLY WANTS TO UNDERSTAND DEEPLY, HERE'S WHERE YOU GO, AND SO ON, SO FORTH. SO I GUESS MY ANSWER, IT'S NOT SHORT, IT'S A LITTLE LONG, BUT THERE ISN'T A MAGIC BULLET. YOU REALLY HAVE TO KNOW YOUR COMMUNITY, YOUR RESOURCES AND WHO YOU'RE TALKING TO BE MOST EFFECTIVE, BECAUSE NOT EVERYBODY WANTS TO KNOW THE DETAIL AND SOME DO, SO YOU SHOULD REALLY HAVE ENOUGH TOOLS IN YOUR TOOLBOX TO ADDRESS ALL THOSE QUESTIONS. >> THANK YOU SO MUCH. AND WOULD YOU GIVE A HAND TO THIS WONDERFUL PANEL. [APPLAUSE] GOOD AFTERNOON. I'M JOVIER EVANS, I'M CO-CHAIRING SESSION IV WITH KEVIN HOWCROFT FROM THE NATIONAL CANCER INSTITUTE. DIFFERENTLY. SESSION IV IS OPPORTUNITIES AND/OR ISSUES THAT MAY BE RAISED BY DIFFERENT ADVOCACY GROUPS. SO GIVEN THAT WE ARE VERY SHORT ON TIME, I'M JUST GOING TO GO AHEAD AND START WITH OUR FIRST SPEAKER, PATRICIA. >> GOOD AFTERNOON, EVERYONE. YOUR PROGRAM SAYS RUSS SHILLING BUT I BRING REGRETS FROM DR. SCHILLING, HE WAS UNABLE TO JOIN US TODAY SO I'M SUBSTITUTING. I'M HERE TODAY REPRESENTING THE AMERICAN PSYCHOLOGICAL ASSOCIATION. AS YOU CAN SEE FROM THE SLIDE, APA IS A BIG ASSOCIATION WITH A BIG MISSION: TO PROMOTE THE ADVANCEMENT, COMMUNICATION AND APPLICATION OF PSYCHOLOGICAL SCIENCE AND KNOWLEDGE TO BENEFIT SOCIETY AND IMPROVE LIVES. TO ADDRESS THAT MISSION, APA'S ORGANIZED IN DIRECTORATES THAT FOCUS ON SCIENCE, PRACTICE, EDUCATION, AND PUBLIC INTEREST. APA MEMBERS WORK IN VARIOUS SETTINGS IN RESEARCH AND ACADEMIA, CLINICAL PRACTICE, CONSULTING IN INDUSTRIES AND NON-PROFITS. APA IS HEADQUARTERED IN WASHINGTON. IT'S A MAJOR PUBLISHER. AS YOU CAN SEE, WITH OVER 90 PEER REVIEWED JOURNALS. THE NEWEST IS TECHNOLOGY MIND AND BEHAVIOR, WHICH WILL DEBUT NEXT YEAR. APA PUBLISHES SCIENTIFIC BOOKS AND LIBRARY PRODUCTS LIKE DATABASES. APA ALSO DEVELOPS AND DISSEMINATES CLINICAL PRACTICE GUIDELINES. SO FAR, THERE ARE GUIDELINES FOR TREATMENT OF DEPRESSION, PTSD, AND OBESITY, AND THOSE FOR CHRONIC PAIN ARE IN PROCESS. IN APA, THE DIVISIONS ARE THE EQUIVALENT OF SPECIAL INTEREST GROUPS. SEVERAL APA DIVISIONS HAVE INTERESTS IN AGING. PRIMARILY THE ONES LISTED HERE, BUT ALSO I WOULD ADD THE DIVISION OF CLINICAL NEUROPSYCHOLOGY. EACH OF THE DIVISIONS IS ALLOTTED PROGRAMMING HOURS AT APA'S ANNUAL MEETING, WHICH WILL COME UP THIS YEAR IN AUGUST OF 2020. IN D.C. . ONE PATHWAY I THINK TO ADVANCE GEROSCIENCE PARTNERSHIPS WITHIN THE APA MEMBERSHIP WOULD BE THROUGH PROGRAMMING AT THE ANNUAL MEETING WITH MEMBERS OF THOSE DIVISIONS. APA HAS AN OFFICE ON AGING, DIRECTED BY DEB AND A COMMITTEE ON AGING THAT ADVISES THE OFFICE. ITS SPEARHEADED THE DEVELOPMENT OF A SPECIALTY CERTIFICATION OF GERO PSYCHOLOGY FOR THOSE WHO SERVE OLDER ADULTS AND HAS DEVELOPED A NUMBER OF USEFUL PRODUCTS. THROUGH A PARTNERSHIP WITH THE AMERICAN BAR ASSOCIATION, APA'S RELEASED GUIDES ON THE ASSESSMENT OF COGNITIVE CAPACITY THAT CAN BE USED BY PSYCHOLOGISTS, LAWYERS AND JUDGES. THE OFFICE HAS DEVELOPED PUBLIC FACING PRODUCTS INCLUDING LIVE PLAN FOR THE LIFESPAN, A PLANNING GUIDE FOR OLDER ADULTS AND HAS PUBLICATIONS ON CAREGIVING AND END OF LIFE ISSUES. APA DOESN'T FUND MUCH RESEARCH DIRECTLY. THERE ARE AWARDS INCLUDING FOR INTERDISCIPLINARY TEAM SCIENCE, STUDENT TRAVEL AWARDS AND OTHER PRIZES. THE SCIENCE DIRECTORATE GIVES GRANTS FOR ADVANCED TRAINING INSTITUTES WHICH ARE SHORT TERM TRAINING OPPORTUNITIES AND FOR SUMMER UNDERGRADUATE EXPERIENCES IN PSYCH LABS. A PSM. A ALSO MANAGES GRANTS FROM THE CENTERS FOR DISEASE CONTROL, SAMHSA AND OTHER FEDERAL AGENCIES FOR SPECIFIC TRAINING PURPOSES. FOR EXAMPLE, THE MINORITY FELLOWSHIP PROGRAMS, YEARLONG AND A SUMMER PROGRAM OF TRAINING AND MENTORSHIP TO ENHANC RETENTION OF STUDENTS AND EARLY CAREER PROFESSIONALS FROM UNDERREPRESENTED POPULATIONS. THE APA ADVOCACY AGENDA IS BROAD IN KEEPING WITH THE MISSION, BRINGING RESEARCH FINDINGS FORWARD TO ADVOCATE IN SUPPORT OF ADEQUATE MEDICARE REIMBURSEMENT FOR PSYCHOLOGICAL SERVICES, IN SUPPORT OF GUN VIOLENCE PREVENTION POLICIES. IN OPPOSITION OF FAMILY SEPARATION AT THE BORDER AND IN SUPPORT OF THE USE OF NON-HUMAN ANIMAL MODELS IN RESEARCH WHERE APPROPRIATE. MY COLLEAGUES AND I ARE ACTIVE IN LOTS OF ADVOCACY COALITIONS TO EXPAND RESEARCH FUNDING. OF COURSE FRIENDS OF NIA IS ONE EXAMPLE, AND NIH CENTERED GROUPS LIKE THE AD HOC GROUP AND THE COALITION FOR HEALTH FUNDING. AND APA IS PARTICIPATING IN A NEW COALITION THIS YEAR TO ADVANCE POLICIES THAT COMBAT SOCIAL ISOLATION AND LONELINESS, WHICH ARE OBVIOUSLY BIG ISSUES IN THE OLDER POPULATION. WE WANT MEMBERS OF CONGRESS TO KNOW WHAT RESEARCH LOOKS LIKE AND UNDERSTAND WHAT AN ASSET IT IS IN THEIR HOME DISTRICTS. THIS SUMMER WE WORKED WITH THE COMMITTEE ON AGING TO ORGANIZE SOME VISITS TO PSYCHOLOGY LABS BY MEMBERS OF CONGRESS AND THEIR STAFF, FOR EXAMPLE, CONGRESSMAN TED YOHO VISITED SEVERAL LABS AT THE UNIVERSITY OF FLORIDA. WE ORGANIZED A LOBBY DAY AROUND PAA'S NEW TECHNOLOGY MIND AND SOCIETY CONFERENCE AND BROUGHT PSYCHOLOGISTS TO THE HILL TO TALK ABOUT ARTIFICIAL INTELLIGENCE AND HUMAN CENTERED DESIGN. IN OUR GROUP WERE SEVERAL SCIENTISTS WHO WORK WITH TECH AND OLDER ADULTS. I'LL JUST CLOSE BY MENTIONING THAT APA HAS A BIG PUBLIC COMMUNICATIONS APPARATUS TO GET THE WORD OUT ABOUT PSYCHOLOGICAL RESEARCH FINDINGS AND THEIR APPLICATION TO EVERYDAY LIFE. YOU CAN FIND US AT APA.ORG AND ON TWITTER AT APA. THANKS. [APPLAUSE] >> THANK YOU VERY MUCH. OUR NEXT SPEAKER IS DIANE BOW BOVENKAMP FROM THE BRIGHTFOCUS FOUNDATION. >> HI. I'M THE VICE PRESIDENT SCIENTIFIC AFFAIRS AT BRIGHTFOCUS FOUNDATION. AND JUST WANTED TO PUT UP THE SUMMARY SLIDE AND REALLY EMPHASIZE THAT OUR MISSION IS TO DRIVE INNOVATIVE RESEARCH WORLDWIDE AS WELL AS PROMOTING AWARENESS OF ALZHEIMER'S DISEASE, MACULAR DEGENERATION AND GLAUCOMA, BUT WHAT'S REALLY RELEVANT TO TODAY IS THAT AGE IS A THE NUMBER ONE RISK FACTOR FOR ALL THREE OF THOSE DISEASES. WE FUND INTERNATIONALLY, SO SINCE OUR INCEPTION IN THE 1970s, WE'VE FUNDED MORE THAN $206 MILLION TOWARDS RESEARCH IN 24 COUNTRIES. DOES NOT NEED TO BE COLLABORATING WITH ANY U.S. INSTITUTION. AND FOR WHAT WE FUND, THE WHOLE GAMUT FROM BASIC RESEARCH, TRANSLATIONAL AND CLINICAL STUDIES. SO FOR OUR INVESTIGATOR INITIATED GRANTS, IT'S ABOUT $100,000 A YEAR, SO WE HAVE STANDARD AWARDS OF 300,000 FOR THREE YEARS FOR ALZHEIMER'S DISEASE AS WELL AS FELLOWSHIPS OF $200,000 OVER TWO YEARS, AND OUR VISION PROGRAMS IN GLAUCOMA AND MACULAR DEGENERATION ARE $200,000 OVER TWO YEARS. THEY'RE INTERNATIONAL SO DISEASES HAVE NO BOUNDARIES, AND WE ENLIST THE USE OF WORLD CLASS SCIENTIFIC REVIEW COMMITTEE TO ADVISE ON WHAT TO FUND THERE. WE ALSO WANT TO SUPPORT EARLY CAREER INVESTIGATORS, SO WE ACTUALLY PUT ON A MASTER CLASS EVERY YEAR CALLED BRIGHTFOCUS ALZHEIMER'S FAST TRACK, AND WE GLAUCOMA FAST TRACK AND WE'RE GOING TO START IN 2020 THE MACULAR FAST TRACK AS AN INCUBATOR FOR INNOVATIVE IDEAS AND NETWORKING OPPORTUNITIES FOR EARLY CAREER INVESTIGATORS AND WITH THOSE WHO ARE LEADERS IN THEIR FIELD, AS WELL AS GIVING THEM AN OPPORTUNITY TO LEARN HOW TO WRITE GRANTS SO THAT THEY CAN GET ENOUGH FUNDING TO MOVE FORWARD. THERE ARE SOME PROGRAMS RELATED TO TRYING TO TRAIN OR MAKE AWARE THE HEALTHCARE PROFESSIONALS WE HAVE BEEN GOING AROUND THE COUNTRY WITH THIS SCREENING OF TURNING POINT VIDEO AND AS PART OF A PARTNERSHIP, A FUNDING PARTNERSHIP WITH GATES FOUNDATION, FOR A PROGRAM TO EDUCATE INDIVIDUALS, THREE TARGET GROUPS ARE THE HEALTHCARE PROFESSIONALS, RESEARCHERS IN THE FIELD, AND THE AFFECTED FAMILIES THEMSELVES ON THE IMPORTANCE OF CLINICAL TRIALS AND FOR ENROLLMENT IN CLINICAL TRIALS. SO WE ARE INVOLVED WITH A NUMBER OF COALITIONS AND PARTNERSHIPS, BOTH WITH RESEARCH FUNDING AS WELL AS AN EXAMPLE OF HOME INSTEAD ANTIDOTE, WE ENLIST THEM TO HAVE CREATED A SPECIFIC CLINICAL TRIAL SEARCH ON OUR WEBSITE FOR THE THREE DISEASES. DEMENTIA-FRIENDLY AMERICA IS A PARTNERSHIP WITH THE LOCAL AND STATE OFFICIALS AS WELL AS OTHER FOUNDATIONS AND WE'VE HELPED TO PROVIDE EDUCATIONAL MATERIALS AND CREATING A FRIENDLY ENVIRONMENT FOR THOSE WHO DO HAVE DEMENTIA AND EDUCATING FIRST RESPONSE TEAMS AND OTHER PEOPLE WHO HAVE PEOPLE WHO HAVE DEMENTIA IN THEIR LIVES. WE DO PROVIDE IN ADDITION FOR THE FUNDING TRAVEL FELLOWSHIPS FOR EARLY CAREER SCIENTISTS AND CLINICIANS, AND PUBLIC EDUCATIONAL MATERIALS, ANYONE IN THE WORLD CAN CALL UP OUR 1-800 NUMBER TO GET ADVICE, THEY CAN DOWNLOAD WITH A PDF OR REQUEST BY PRINT INFORMATION ON ALL THREE OF THE DISEASES OR EMAIL US FOR SUPPORT. WE'RE ALWAYS OPEN TO NEW MUTUALLY BENEFICIAL PARTNERSHIPS. ONE INTERESTING THING TO CLOSE OUT IS THAT WE DON'T NECESSARILY HAVE ON OUR MISSION STATEMENT THAT WE'RE FUNDING OF AGING DISEASES, BUT LOOKING AT THE PORTFOLIO SINCE AGE IS A NUMBER ONE RISK FACTOR, A LOT OF THE ORGANIZATIONS HERE ARE ALREADY PROBABLY FUNDING IN THE GERONTOLOGY AGING SPACE, AND IT WILL BE INTERESTING TO SEE WHAT PARTNERSHIPS COME AS A RESULT OF THIS EVENT. THANK YOU. >> OUR NEXT SPEAKER IS WHY THE OLIVIA OKEREKE, REPRESENTING THE AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY. >> THANK YOU. SO I SHOULD JUST MAKE A QUICK MENTION, THE CREDENTIALS I THINK WILL BE UPDATED FROM WHAT'S IN YOUR WRITTEN BOOK ONLINE, BUT I'M A GERIATRIC PSYCHIATRIST, I'M AN M.D. WITH A MASTER'S IN SCIENCE AND EPIDEMIOLOGY BY TRAINING BUT I DON'T HAVE A PH.D. OKAY. SO I REPRESENT A NATIONAL ASSOCIATION REPRESENTING AND SERVING ITS MEMBERS AND THE FIELD OF GERIATRIC PSYCHIATRY SO OUR MISSION STATEMENT IS WE PROMOTE THE MENTAL HEALTH AND WELL-BEING OF OLDER PEOPLE THROUGH PROFESSIONAL EDUCATION, PUBLIC ADVOCACY AND SUPPORTIVE CAREER DEVELOPMENT FOR CLINICIANS, EDUCATORS AND RESEARCHERS IN GERIATRIC PSYCHIATRY AND MENTAL HEALTH. SO OUR AREAS OF INTEREST ARE FAIRLY BROAD, TYPICALLY WITH ANXIETY DISORDERS, COGNITIVE DISORDERS INCLUDING DEMENTIA AND ALZHEIMER'S DISEASE, PHYSICAL FUNCTIONS INTERFACE WITH PSYCHOLOGICAL FUNCTION, PSYCHOSOCIAL RISK FACTORS FOR ADVERSE AGING OUTCOMES AND MEDICAL CO-MORBID. CO-MORBIDITY, GERIATRIC PSYCHIATRISTS AS WELL AS NON-GERIATRIC CREDENTIALED, NON-PSYCHIATRISTS PHYSICIANS, NURSES, SOCIAL WORKERS, PSYCHOLOGISTS, AND NON-CLINICIAN RESEARCHERS. OUR STRUCTURE IS BOARD OF DIRECTORS, AND A VARIETY OF COMMITTEES REPRESENTING RESEARCH, CLINICAL PRACTICE, PUBLIC POLICY AND OTHERS, AND CAUCUSES, AND WE PRIME PRIMARILY COMMUNICATE THROUGH OUR ANNUAL MEETING BUT WE HAVE A WEBSITE WHICH IS WHERE WE HAVE A NEWSLETTER AS WELL AS WE PUBLISH THE JOURNAL, AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY, THE EDITOR AND CHIEF OF WHOM IS CHIP REYNOLDS, DR. CHIP REYNOLDS, CHARLES RE NONLDZ RE REYNOLDS AND PITTSBU RGH. SO CURRENTLY WITH REGARD TO OUR PARTNERSHIPS, WE DON'T FUND RESEARCH BUT WE DO SUPPORT A FEW THINGS. THE DONOR LED -- SUPPORTS THE SCHOLARS PROGRAM, VERY CRITICAL ELEMENT WHICH SUPPORTS ABOUT THREE DOES MEDICAL STUDENTS AND RESIDENTS WHO ATTEND OUR ANNUAL MEET EVERY YEAR. THIS IS INCREDIBLY IMPORTANT SINCE MANY OF YOU KNOW GERIATRIC PSYCHIATRISTS ARE PRETTY THIN ON THE GROUND SO WORKFORCE DEVELOPMENT IS A VERY IMPORTANT PART OF WHAT WE DO. WE DO HAVE PARTNERS IN TERMS OF SUPPORTERS ON OUR CORPORATE ADVISORY COUNCIL WHICH LARGELY CONSISTS OF PHARMACEUTICAL AND MANUFACTURING INDUSTRY REPRESENTATIVES AND PARTICIPANTS AND THEY HAVE A PRESENCE AT OUR EXHIBIT HALL AT OUR ANNUAL MEETING AND ALSO LEARN FROM ORGANIZATION ABOUT HOW THEY CAN MEET THE NEEDS OF AGP AND ITS MISSION, ADVOCACY WORK IS DONE BY MEMBERS WHO ARE FOR EXAMPLE DELEGATES AT THE AMERICAN MEDICAL ASSOCIATION WHO PARTICIPATE IN OUR GRASS ROOTS NETWORK AND PUBLIC POLICY COMMITTEE ADVOCATING FOR OLDER ADULT MENTAL HEALTH ISSUES IN D.C. . WITH REGARD TO GEROSCIENCE, WE REPRESENT A LOT OF THE PEOPLE DOING RESEARCH IN THIS AREA, PARTICULARLY AS IT INTERFACES WITH DEPRESSION AND MOOD DISORDERS IN LATER LIFE, OUR RESEARCH COMMITTEE HAS A LOT OF INPUT INTO THE PROGRAM INCLUDING SCIENTIFIC SESSIONS THAT REPRESENT GERO SCIENCE TOPICS, WE HOST NETWORKING EVENT AND, FOR EXAMPLE, WE ARE A HOME BASE FOR ANNUAL NETWORKING AND CAREER-RELATED EVENT FOR TWO DIFFERENT NIMH-FUNDED R25 PROGRAMS THAT GET TOGETHER EVERY YEAR SPONSORED BY THE RESEARCH COMMUNITY. WE INVITE NIH PROGRAM OFFICERS TO PRESENT, DR. EVANS PRESENTED FOR NIMH FOR EXAMPLE LAST YEAR SWELTS DR. MOLLY WAGSTRIT AT NIA TO MAKE SURE THAT THE OPPORTUNITIES AS THEY PERTAIN TO GEROSCIENCE OR OTHER TOPICS OR PRIORITIES, AREAS OF INTEREST, REPRESENTED BY THE ICs ARE MADE KNOWN TO OUR MEMBERS, ESPECIALLY THOSE CONDUCTING RESEARCH. WE ALSO HAVE THE GREAT PLEASURE OF HOSTING THE ANNUAL NEUROSCIENCE TEACHING DAY, A SEPARATE TICKETED EVENT WHICH IS ALWAYS VERY WELL ATTENDED AND THIS YEAR'S THREEM IS ACTUALLY THE BIOLOGY OF AGING, WHICH WE HAD DECIDED ON QUITE A WHILE AGO BEFORE WE KNEW ABOUT THE GEROSCIENCE SUMMIT 3 OR WERE INVITED TO PARTICIPATE IN IT SO THE ENTIRE FOCUS OF OUR NEUROSCIENCE TEACHING DAY AND OUR SPEAKERS WILL BE ON A LOT OF THE THEMES THAT WE TALKED ABOUT EARLIER OR HEARD FROM OTHER PARTICIPANTS EARLIER. SO THAT IS AGP AND SO THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU VERY MUCH. OUR NEXT SPEAKER -- WELL, I SHOULD CHECK. IS ALISON STEIBER IN THE ROOM OR IN THE AUDIENCE? OKAY. GOING ONCE, GOING TWICE. THEN WE WILL MOVE ON TO SHELLEY FULD NASSO FOR THE NATIONAL COALITION FOR CANCER SURVIVORSHIP. >> HELLO, THANK YOU SO MUCH. I'M REALLY GLAD TO BE HERE. THIS HAS BEEN A REALLY INTERESTING DAY, I'VE LEARNED SO MUCH. I THINK THAT SOMETIMES I KNOW THAT WE IN THE CANCER COMMUNITY TEND TO BE PRETTY SILOED AROUND CANCER SO I THINK IT'S REALLY HELPFUL TO BE LOOKING AT THESE DISEASES FROM SO MANY DIFFERENT ANGLES AND SEEING THE COLLABORATION ACROSS INSTITUTES AND ACROSS RESEARCHERS FROM VARIOUS DIFFERENT DISCIPLINES SO I'M REALLY GRATEFUL TO SEE THAT, I KNOW THAT THAT CAN BE REALLY BENEFICIAL TO THE PATIENTS THAT WE SELF. SO I'M ACTUALLY GOING TO DO MY SLIDES OUT OF ORDER AND START WITH WHY THIS IS IMPORTANT AND I KNOW WE'VE TALKED A LITTLE ABOUT CANCER TODAY, BUT WHEN YOU LOOK AT THE NUMBERS BECAUSE CANCER IS A DISEASE OF AGING AND WE HAVE ALMOST 17 MILLION CANCER SURVIVORS IN THE UNITED STATES SURVIVORS OF 10 YEARS OR MORE SO THEY'VE LIVED WITH THIS DISEASE AND HAVE THE COLLATERAL DAMAGE OF THE TREATMENTS. SO WE KNOW CANCER IS A DISEASE OF AGING BUT ALSO CANCER TREATMENTS FURTHER THE AGING PROCESS FOR PEOPLE WHO HAD CANCER. AND THEN BY 2040, THE NCI ESTIMATES THEY'LL HAVE 26 MILLION CANCER SURVIVRS WITH 73% OVER AGE 65 AND ONLY 8% UNDER AGE 50. SO OBVIOUSLY THIS IS REALLY IMPORTANT TO US. WE REPRESENT CANCER SURVIVORS OF ALL AGES, ALL STAGES OF DISEASE, WE CONSIDER SOMEONE A SURVIVOR FROM DIAGNOSIS SO WE AREN'T JUST ADVOCATING FOR PEOPLE WHO HAVE COMPLETED THEIR TREATMENT AND MOVED ON TO POST TREATMENT LIFE BUT REALLY THROUGHOUT THE COURSE OF THEIR CANCER EXPERIENCE. NOW I'M GOING TO SEE IF I CAN GO BACK SINCE I WENT OUT OF ORDER. I THOUGHT I WOULD STARRED WITH THE WHY AND THEN START WITH THE WHY AND THEN TALK A LITTLE ABOUT OUR ORGANIZATION. SO WE ADVOCATE TO IMPROVE QUALITY OF CANCER CARE FOR EVERYONE TOUCHED BY CANCER AND WE DO THAT THROUGH POLICY, THROUGH EDUCATING CANCER SURVIVORS AND EMPOWERING THEM, AND THEN ALSO THROUGH EDUCATING AND SUPPORTING ADVOCATES IN THEIR EFFORTS TO REPRESENT CANCER PATIENTS ACROSS THE SPECTRUM REALLY IN BOTH THE LOCAL COMMUNITIES AND SUPPORT GROUPS AND IN PUBLIC POLICY EFFORTS AND ALSO IN RESEARCH. SO OUR PUBLIC POLICY ADVOCACY FOCUSES ON THE QUALITY OF CARE, WE DON'T SPEND A LOT OF TIME ON APPROPRIATIONS FOR RESEARCH FUNDING NOT BECAUSE WE DON'T THINK IT'S IMPORTANT BUT BECAUSE WE KNOW THERE ARE SO MANY OTHER WONDERFUL ORGANIZATIONS DOING THAT AND WE TRY TO FOCUS OUR EFFORTS ON LESS -- I GUESS AREAS OF PUBLIC POLICY THAT MAYBE HAVE LESS ATTENTION INCLUDING THE SURVIVORSHIP ISSUES THAT CANCER SURVIVORS FACE. THERE WAS A REPORT IN 2004 CALLED LOST IN TRANSITION DETAILING THE EXPERIENCE OF CANCER SURVIVORS AFTER THEIR TREATMENT AND UNFORTUNATELY 15 YEARS LATER, WE'VE MADE SOME PROGRESS BUT WE'VE NOT MADE ENOUGH AND WE OFTEN HEAR FROM CANCER SURVIVORS THAT THE FIRST YEAR AFTER TREATMENT WAS HARDER THAN THE TREATMENT ITSELF BECAUSE THEY'RE THRUST INTO THIS TREATMENT OF A CANCER TRYING TO GET THEIR LIVES BACK WITHOUT THE SUPPORT THAT THEY NEED BECAUSE THE FOCUS RIGHTLY IS ON CURING OR TREATING THE DEEDS, BUT WE HAVEN'T SPENT ENOUGH TIME AND FOCUS ON HELPING PEOPLE AFTER TREATMENT, SO THAT'S REALLY WHERE WE FOCUS A LOT OF OUR PUBLIC POLICY EFFORT IN TERMS OF REIMBURSEMENT ISSUES, IN TERMS OF FOSTERING THE QUALITY CARE THAT CANCER SURVIVORS THAT THEY WANT TO SEE AND THAT THEY FEEL LIKE THEY'RE NOT GETTING OFTEN TIMES IN VARIOUS DIFFERENT SETTINGS. SO WE HAVE CANCER POLICY ROUNDTABLES TWICE A YEAR, OUR ROUNDTABLE THAT WE HAD IN THE SPRING OF THIS YEAR FOCUSED ON CANCER IN OLDER ADULTS, AND WE HAVE DIFFERENT TOPICS EVERY TIME WE HAVE A ROUNDTABLE TWICE A YEAR AND FOCUS ON DIFFERENT TOPICS RELATED TO CANCER SURVIVORS AND OUR POLICY ROUNDTABLE NEXT WEEM NEXT WEEK, THE TOPIC S VARY, BUT AGING AND THE SPECIAL ISSUES THAT CANCER, OLDER CANCER PATIENTS FACE HAS BEEN A PART OF THAT, OF THOSE EFFORTS. WE HAVE A CANCER POLICY AND ADVOCACY TEAM WHICH IS ABOUT 400 ADVOCATES AROUND THE COUNTRY OF ALL DIFFERENT KINDS OF CANCERS, WHO WORK WITH US ON DIFFERENT TYPES OF ADVOCACY, PUBLIC POLICY ADVOCACY BUT ALSO MANY OF THEM ARE VERY ENGAGED IN RESEARCH ADVOCACY. THEY PARTICIPATE AS ADVOCATES ON GRANTS FUNDED BY PCORI ON NCI-FUNDED CLINICAL TRIALS WITH COOPERATIVE GROUPS AND EVEN JUST WITH THEIR INSTITUTIONS THEY MAY BE AFFILIATED WITH WHERE THEY RECEIVE TREATMENT. SO WE TRY TO EDUCATE THEM AND MATCH THEM WITH ENGAGEMENT OPPORTUNITIES AND WE ALSO BRING THEM TO WASHINGTON, D.C. IN JUNE EVERY YEAR FOR TRAINING AND HILL DAY. ELEVATING SURVIVOR SHIP IS OUR PROGRAM TO TRY TO IMPROVE CARE AT THE LOCAL LEVEL AND WE HAVE ADVOCATES AROUND THE COUNTRY WHO ARE WORKING ON PROJECTS IN THEIR COMMUNITIES TO TRY TO IMPROVE SURVIVORSHIP CARE AND WE HAVE DEVELOPED A CANCER SURVIVORSHIP CHECKLIST THIS YEAR, ONE OF OUR EDUCATIONAL EFFORTS. THE LAST ITEM I WANTED TO MENTION IS QUALITY MEASUREMENT BECAUSE WE'VE DONE WORK ON TRYING TO DEFINE FROM A CANCER PATIENT PERSPECTIVE WHAT RETIRING TO FUNCTIONAL STATUS AFTER CANCER TREATMENT MEANS TO THEM AND WE CAN MEASURE THAT, SO THAT'S A PROJECT WE'RE COMPLETING THIS YEAR. THANK YOU. [APPLAUSE] >> OUR NEXT SPEAKER IS FROM THE AMERICAN DIABETES ASSOCIATION, DR. RITA KALYANI. >> GOOD AFTERNOON. IT'S MY PLEASURE TO BE HERE REPRESENTING THE AMERICAN DIABETES ASSOCIATION. I'M AN ASSOCIATE PROFESSOR OF MEDICINE AT JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE AND PAST CHAIR OF THE CLINICAL GUIDELINES COMMITTEE OF THE PROFESSIONAL PRACTICE COMMUNITY FOR THE AD ASM. ADA. SO JUST TO GIVE A LITTLE BACKGROUND OF DIABETES IN OLDER ADULTS, WE KNOW THAT MORE THAN 30 MILLION PEOPLE IN OUR COUNTRY HAVE DIABETES. THAT'S ALMOST 1 IN 10 OF THE U.S. ADULT POPULATION. OF GREATER CONCERN AND PARTICULAR RELEVANCE FOR OUR CONFERENCE TODAY IS THAT ONE QUARTER OF OLDER ADULTS HAVE DIABETES, OF WHICH ALMOST HALF IS UNDIAGNOSED. WE'VE DONE STUDIES ON OLDER WOMEN WITH FRAILTY IN THE WOMEN'S HEALTH AND AGING STUDY AND UP TO HALF OF THOSE WOMEN HAD UNDIAGNOSED DIABETES THAT WAS ONLY PICKED UP WITH A GLUCOSE TOLERANCE TEST. WE KNOW AS PEOPLE AIRNLINGS PERIPHERAL INSULIN RESISTANCE DETERIORATES SO THERE ARE PARTS OF THE AGING PROCESS THAT MAKE OLDER ADULTS MORE VULNERABLE TO DEVELOPING DIABETES AND ALSO PREDIABETES. ABOUT HALF OF THE OLDER ADULT POPULATION HAS PREDIABETES, WHICH IS A CONDITION THAT IF NOT TREATED, WILL LEAD TO DIABETES. SO IN SUM, TWO THIRDS, ONE IN THREE OLDER ADULTS HAS DIABETES OR PREDIABETES. SO THE NUMBERS ARE CLEAR, THIS IS A GREAT PROBLEM FOR OLDER ADULT POPULATION. THIS IS TWICE THE PREVALENCE IN YOUNGER ADULTS AND WE KNOW THAT PEOPLE WITH DIABETES, PEOPLE ARE AGING, THEY'RE LIVING LONGER LIVES SO THE COMPLICATIONS OF DIABETES NEED TO BE ADDRESSED EVEN MORE SO IN OLDER ADULTS. AND THOUGH COMPLICATION RATES IN GENERAL HAVE GONE DOWN FOR PEOPLE WITH DIABETES, THEME THAT ARE IN THE OLDEST AGE CATEGORIES CONTINUE TO HAVE THE HIGHEST RATES OF COMPLICATIONS INCLUDING VASCULAR COMPLICATIONS, HEART DISEASE AND STROKE AND PERIPHERAL ARTERIAL DISEASE, AND ALSO KIDNEY DISEASE AS WELL. AND SO UNTIL WE ADDRESS THIS GROWING BURDEN, THIS WILL ONLY& CONTINUE TO GROW. SO THE AMERICAN DIABETES ASSOCIATION IS THE NATION'S LEADING VOLUNTARY HEALTH ORGANIZATION DEDICATED TO THE MISSION OF PREVENTING AND CURING DIABETES, AND DEDICATED TO IMPROVING THE LIVES OF ALL PEOPLE AFFECTED BY DIABETES. IT'S A NETWORK OF OVER 500,000 VOLUNTEERS, INCLUDING PATIENTS AND THEIR CAREGIVERS AND THEIR FAMILY MEMBERS, AND IT ALSO INCLUDES 20,000 HEALTHCARE PROFESSIONALS AS WELL. THERE ARE MANY DIFFERENT ACTIVITIES THAT THE ADA CONDUCTS THAT INCLUDE AGING-RELATED THEEMENTS. THE ANNUAL ADA MEETING, THE SCIENTIFIC SESSIONS WHICH OCCUR IN JUNE, USUALLY HAVE AT LEAST ONE IF NOT MORE AGING-RELATED SESSION. THE ADA STANDARDS OF CARE ARE CLINICAL PRACTICE GUIDELINES WHICH ARE PUBLISHED EVERY JANUARY AS A 100-PAGE SUPPLEMENT TO DINE CARE, INCLUDE A WHOLE CHAPTER ON DIABETES MANAGEMENT IN OLDER ADULTS. THERE'S ALSO MANY RESEARCH OPPORTUNITIES AND IN PARTICULAR, THE ADA OFFERS TARGETED FUNDING FOR COLLABORATIVE RESEARCH WITH OTHER ORGANIZATIONS WHICH WOULD LEND ITSELF VERY WELL TO THE KINDS OF DISCUSSIONS WE'RE HAVING TODAY. IN ADDITION, DIABETES CARE WHICH IS ONE OF THE FLAGSHIP JOURNALS OF THE ADA HAS HAD A THEME ISSUE ON AGING IN APRIL OF 2017 FOR WHICH I SERVED AS GUEST EDITOR, AND IN THAT JOURNAL, WE HAVE 12 DIFFERENT ARTICLES HIGHLIGHTING THE CURRENT NEEDS FOR THE OLDER ADULT POPULATION WITH DIABETES. SOME OF THESE UNIQUE CONSIDERATIONS INCLUDE THE TRADITIONAL EXCLUSION OF OLDER PARTICIPANTS FOR MOST LANDMARK DIABETES RANDOMIZED CONTROL TRIALS INCLUDING THE UNITED KINGDOM PROSPECTIVE DIABETES STUDY WHICH IS OFTEN CONSIDERED THE HALLMARK FOR ESTABLISHED THAT INTENSIVE GLUCOSE MANAGEMENT OR A1C LOWERING IS IMPORTANT EXCLUDED PEOPLE OVER THE AGE OF 65. WE ALSO KNOW THAT WE NEED COMPARATIVE EFFECTIVENESS STUDIES, OVER THE LAST 10 YEARS WE'VE SEEN EXPLOSION IN THERAPY OF DIABETES HOWEVER, NOT ALL OF THESE STUDIES HAVE BEEN PERFORMED IN OLDER ADULTS. WE ALSO KNOW GERIATRIC -- INCLUDING FALLS, DEPRESSION AND POLYPHARMACY AND OTHER IMPORTANT CONSIDERATIONS INCLUDE HYPOGLYCEMIA, WHICH OLDER ADULTS WITH DIABETES ARE PARTICULARLY VULNERABLE TO, NEUROCOGNITIVE DYSFUNCTION WHICH MAKES IT MORE DIFFICULT TO SELF-MANAGE DIABETES, DRUG SIMPLIFICATION, MANAGEMENT OF DIABETES AND LONG-TERM CARE IN SKILLED NURSING FACILITIES AND END OF LIFE CARE. WE ALSO KNOW THAT PEOPLE WITH DIABETES HAVE GREATER DECLINES IN THEIR FUNCTIONAL STATUS AND ACCELERATED LOSS OF MUSCLE AND IN PARTICULAR THIS IS AN AREA OF MY RESEARCH. SO IN CONCLUSION, OLDER ADULTS WITH DIABETES ARE A HETEROGENEOUS POPULATION FROM THE ROBUST TO FRAIL AND PRESENT UNIQUE CHALLENGES FOR THE CLINICIAN AND RESEARCHER THAT NEED TO BE ADDRESSED. THANK YOU FOR YOUR ATTENTION. [APPLAUSE] >> OUR NEXT SPEEMER IS DR. HEIDI KLEPIN REPRESENTING THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY. >> THANK YOU VERY MUCH. PRIVILEGED TO BE HERE. I'M A GERIATRIC ONCOLOGIST AND IMMEDIATE PAST CHAIR OF AS CO'S CANCER RESEARCH COMMUNITY, I DO HAVE A DISCLOSURE, I HAVE IN THE PAST BEEN FUNDED BY AFAR. AND I WANTED TO START BY HIGHLIGHTING SOME OF THE RECENT ACTIVITIES OF THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY AS IT RELATES TO CANCER AND AGING. ASCO HAS HAD A DEEP INTEREST IN CANCER AND AGING. THIS MOST RECENTLY HAS LED TO A SERIES OF ONGOING ACTIVITIES IN THE CANCER RESEARCH COMMITTEE OF ASCO, WHICH IS REALLY PRECIPITATED BY THE INSTITUTE OF MEDICINE REPORT IN 2013. WHICH CAME OUT AND HIGHLIGHTED THAT OUR CANCER CARE DELIVERY SYSTEM WAS IN A CRISIS BECAUSE WE'RE UNDERPREPARED TO CARE FOR THE OLDER ADULT POPULATION THAT WE'RE SEEING WHICH WILL BE EVER INCREASING IN OUR PRACTICES. AND SO BOTH DOCTORS WERE ON THE COMMITTEE AND PARTICIPATED IN THAT REPORT AND WERE ALSO ON THE CANCER RESEARCH COMMITTEE AND BROUGHT THIS TO ASCO AND REALLY PRECIPITATED LEADERSHIP IN THIS AREA. THEY'VE PUT TOGETHER A WORKING GROUP THROUGH THE CANCER RESEARCH COMMITTEE TO TAKE ON THIS ISSUE WHICH THEN RESULTED IN ASCO'S FIRST PUBLICATION ON CANCER AND AGING WHICH CAME OUT IN 2016, HIGHLIGHTING BOTH THE ISSUE, THE FACT THAT AGAIN SIMILAR TO WHAT WE HEARD WITH RESPECT TO DIABETES CLINICAL TRIALS THAT OLDER ADULTS ARE UNDERREPRESENTED ON CANCER CLINICAL TRIALS AND OUTLINED SEVERAL STRATEGIES INCLUDING DESIGNS IN PARTICULAR THAT COULD HELP ADDRESS THIS ISSUE. THIS WAS QUICKLY FOLLOWED BY A COLLABORATION THAT DEVELOPED BETWEEN ASCO AND THE FDA RELATED TO INCREASING THE EVIDENCE BASE FOR OLDER ADULTS WHICH LED TO A ASCO FDA CO-SPON TORED WORK SHON ON THIS TOPIC IN 2017, WHICH BROUGHT TOGETHER MULTIPLE STAKEHOLDERS TO HELP ADDRESS THE ISSUE FS CLINICAL TRIAL RECRUITMENT, CLINICAL TRIAL DESIGN FOR OLDER PATIENTS, THE USE OF REAL WORLD EVIDENCE TO ADDRESS THE GAP IN EVIDENCE THAT WE HAVE FOR OLDER PATIENTS AS WELL AS TALKING ABOUT ADVOCACY AND POLICY SOLUTIONS. SO THIS LED TO ANOTHER PUBLICATION THAT OUTLINED RECOMMENDATIONS FROM THAT WORKSHOP. THIS CAME OUT JUST LAST YEAR, 2018, AND THIS PARTICULAR PUBLICATION REALLY OUTLINED ACTIVITIES OR ACTIONS THAT COULD BE TAKEN BY THE KEY STAKEHOLDERS, ASCO, FDA, NCI AND INDUSTRY THAT WERE REPRESENTED AT THE WORKSHOP THAT CHANGES THAT COULD BE MADE THAT WOULD RAPIDLY CLOSE THE EVIDENCE GAP BACK FOR OLDER ADULTS. ANOTHER TOPIC THAT ASCO HAS BEEN VERY INVOLVED IN IS TAKING THE EVIDENCE THAT ALREADY DOES EXIST AND TRYING TO TRANSLATE THAT INTO PRACTICE, SO ASCO HAS RECENTLY PUBLISHED ITS FIRST GUIDELINE FOR OLDER ADULTS,& WHICH IS A GUIDELINE DOCUMENT THAT SPECIFICALLY STATES AND RECOMMENDS THAT FOR EVERY OLDER ADULT 65 AND OLDER, STARTING CHEMOTHERAPY, A GERIATRIC ASSESSMENT SHOULD BE DONE TO HELP PERSONALIZE CARE. SO THOSE ARE SOME OF THE ACTIVITIES ASCO HAS BEEN ENGAGED IN. I WANTED TO SPEND THE LAST FEW MINUTE TALKING ABOUT OPPORTUNITIES. SO THERE ARE A NUMBER OF OPPORTUNITIES, I THINK, THAT ASCO AND ITS PARTNERS AND COLLABORATORS HAVE BEEN TALKING ABOUT TO HELP AGAIN IMPROVE CARE FOR OLDER ADULTS WITH CANCER AND GIVE US MORE EVIDENCE FOR THOSE PATIENTS WE SEE IN PRACTICE. ONE IS TO CONTINUE TO INCREASE ADVOCACY, ASCO HAS BEEN VERY INVOLVED IN THIS FRONT BUT CONTINUING TO DO MORE WORK TO IDENTIFY PARTNERS AND OPPORTUNITIES TO INFLUENCE POLICY. SO ONE EXAMPLE OF THIS WAS A RECENT IN-PERSON MEETING THAT WAS HELD AT ASCO HEADQUARTERS THIS SUMMER WHICH INCLUDED STAFF AND KEY LEADERSHIP FROM NCI, NIA, ASCO AND FDA TO TALK ABOUT THESE ISSUES. ANOTHER OPPORTUNITY IS TO PARTNER WITH THE NIH AND FDA TO FACILITATE THE DEVELOPMENT AND INTEGRATION OF CORE GERIATRIC MEASURES AT THE CLINICAL TRIAL. SO WE TALK ABOUT THIS A LOT BUT WE HAVE ALMOST NO CHARACTERIZATION OF OUR OLDER PATIENT THAT DO GET ON CLINICAL TRIALS, SO WE KNOW NOTHING ABOUT THEIR COMORBIDITIES, THEIR PHYSICAL FUNCTION, THESE VERY BASIC PHENOTYPIC DESCRIPTORS THAT IF WE HAD SOME CORE MEASURES OF IN EVERY TRIAL, WE WOULD BE ABLE TO REALLY ADVANCE OUR KNOWLEDGE FOR OLDER PATIENTS. WE ALSO NEED TO CONTINUE TO WORK TOGETHER TO ADDRESS CLINICAL TRIAL ENROLLMENT, THE BARRIERS TO CLINICAL TRIAL ENROLLMENT AND STRATEGIES TO OVERCOME THOSE BARRIERS. ASCO HAS TALKED A LOT ABOUT MEASURING THE IMPANGT OF THEIR RECOMMENDATION SO IT'S NOT ENOUGH TO PUBLISH A SET OF RECOMMENDATIONS BUT IT'S VERY IMPORTANT TO ACTUALLY MEASURE WHETHER OR NOT THOSE RECOMMENDATIONS HAVE MADE A DIFFERENCE. ONE EXAMPLE OF THAT IS ASCO AND FDA AND FRIENDS OF CANCER RESEARCH'S WORK ON MODERNIZING ELIGIBILITY CRITERIA, WHICH WE HOPE WILL TRANSLATE INTO MORE OLDER ADULTS GETTING ON TO CLINICAL TRIALS, BUT THERE NEEDS TO BE MEASUREMENT OF THE EFFECT. ANOTHER OPPORTUNITY IS TO CONDUCT RESEARCH USING UNIQUE DATA SOURCES THAT ASCO HAS, SO ONE IS CANCER LINK, SO THAT'S ASCO'S REAL WORLD DATA, EMR BASED DATASET THAT CONTINUES TO GROW AND THERE ARE OPPORTUNITIES THERE TO LEARN ABOUT OUR OLDER PATIENTS, AND THEN FINALLY JUST ADVANCING EXPOSURE TO EDUCATION TO ASCO'S MEMBERSHIP. TWO EXAMPLES OF THAT, ONE IS THAT ASCO THIS YEAR -- I GOT DISTRACTED BY THE RED. I'M ALMOST DONE. TWO POINTS. ONE EXAMPLE IS ASCO THIS YEAR LISTED RESEARCH CONDUCTED IN OLDER ADULTS TO IMPROVE OUR KNOWLEDGE OF HOW TO CARE FOR OLDER PATIENTS AS ONE OF ITS TOP 10 RESEARCH PRIORITIES SO THAT TRANSLATES TO ITS FUNDING PRIORITIES FOR ITS OWN PORTFOLIO, AND ANOTHER EXAMPLE RELATED TO RESEARCH AND EDUCATION IS SOME OF THE WORK THAT'S GOING ON IN THE HEALTH EQUITY COMMITTEE, SO THE HEALTH EQUITY COMMITTEE OF ASCO NOW HAS A TASK FORCE FOR OLDER ADULTS THAT HAS A STRATEGIC PLAN FOR RESEARCH AND EDUCATION LED BY DR. WILLIAM DALE WHO'S IN THE AUDIENCE TODAY, AND THAT COMMITTEE AND TASK FORCE HAS JUST SURVEYED ASCO'S MEMBERSHIP TO ASK ABOUT THEIR KNOWLEDGE OF THE GUIDELINE TO PERFORM GERIATRIC ASSESSMENT IN OLDER ADULTS, WHAT THEIR PRACTICES AND BARRIERS ARE WHICH CAN LEAD TO BOTH THE KNOWLEDGE OF WHAT'S HAPPENING IN THE PRACTICE LEVEL AND THEN ALSO EDUCATION TO HELP OVERCOME ANY BARRIERS. THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU. OUR NEXT SPEAKER IS DOUGLAS KIEL, REPRESENTING THE AMERICAN SOCIETY OF BONE AND MINERAL RESEARCH. >> THANK YOU. ONE DISCLOSURE BEFORE WE GO, I ANSWERED THE QUESTIONS THAT WERE POSED OF ALL OF OUR MEMBER ORGANIZATIONS HERE, AND SO MY TWO SLIDES WHICH WE WERE RESTRICTED TO SPECIFICALLY TARGET THE QUESTIONS THAT WE WERE ASKED. JUST A LITTLE WORD ABOUT THE AMERICAN SOCIETY FOR BONE AND MINERAL RESEARCH, IT'S A PROFESSIONAL SCIENTIFIC AND MEDICAL ORGANIZATION ESTABLISHED IN 1977 TO PROMOTE EXCELLENCE IN BONE AND MINERAL RESEARCH AND TO FACILITATE THE TRANSLATION INTO PRACTICE. WE HAVE ABOUT 4,000 MEMBERS, AND THE FOUR QUESTIONS WE WERE ASKED ABOUT, NUMBER ONE IS HOW WE INCORPORATE AGING AS AN UNDERLYING FACTOR IN DISEASE, ONSET, PROGRESSION OR TREATMENT RESPONSE. OUR SOCIETY HAS RESEARCH FOCUSED SPECIFICALLY ON AGE-RELATED DISEASES SUCH AS OSTEOPOROSIS, LOSS OF MUSCLE, AND WE HAVE BASIC SCIENTISTS, TRANSLATIONAL AND CLINICAL SCIENTISTINGS AS MEMBERS. WE HAVE ANNUAL MEETINGS WITH ACTUAL ABSTRACT CATEGORIES ON MUSCULOSKELETAL AGING, AND WE HAVE INCREASED RESEARCH ON MANY OF THE PILLARS OF AGING THAT YOU HEARD THIS MORNING, INCLUDING SENESCENCE, STEM CELLS, EPIGENETICS, NUTRIENT SENSING, AND CLINICAL TRIALS IN OLDER PARTICIPANTS. GEROSCIENCE DOES FACTOR IN ASBMR'S DECISION-MAKING WHEN WE INTERACT WITH STAKEHOLDER COMMUNITIES SUCH AS PATIENTS, ADVOCATES AND GOVERNMENT AND RESEARCH ORGANIZATIONS. WE HAVE PATIENT GROUPS FOR OSTEOPOROSIS THAT OFTEN HAVE A LOT OF OLDER ADULTS. WE ALSO HAVE A LOT OF ADVOCACY EFFORTS THAT FOCUS ON THESE SPECIFIC GROUPS, AND OUR CLOSEST ALLIANCE IN THE NIH IS WITH THE NATIONAL INSTITUTE ON ARTHRITIS MUSCULOSKELETAL AND SKIN DISEASES AND THE NIA. WE WERE ASKED TO TALK ABOUT DEVELOPING PARTNERSHIPS FOCUSED ON CHRONIC DISEASES. WE HAVE A SPECIFIC INITIATIVE RIGHT NOW CALLED THE SECONDARY FRACTURE PREVENTION INITIATIVE, WHICH HAS REACHED OUT TO OLDER ADULT GROUPS, OTHER GROUPS THAT ARE REPRESENTED TODAY SUCH AS THE NATIONAL COUNCIL ON AGING, WHO'S A MEMBER, AND WE WILL BE REACHING OUT TO OTHER ORGANIZATIONS AND ALSO WE HAVE PARTNERED AS AN ORGANIZATION WITH CDC BUT WE THINK THAT COULD BE EACH A GREATER PARTNERSHIP IN THE FUTURE. OUR SECONDARY FRACTURE INITIATIVE HAS REPRESENTATION FROM THE FEDERAL GOVERNMENT, FROM CORPORATE INDIVIDUALS, AS WELL AS OUR PATIENT AND OTHER HEALTHCARE PROVIDER GROUPS. WHAT ARE THE MAJOR UNMET NEEDS IN OUR FIELD AND HOW CAN WE ADDRESS THEM? WELL, IN OUR SPECIFIC FIELD OF OSTEOPOROSIS, ONLY 23% OF PEOPLE OVER THE AGE OF 65 OR WITH A HIP OR VERTEBRAL FRACTURE ARE EVEN TREATED FOR THEIR DISEASE. AND WE FEEL ADDRESSING THIS GAP IS A TOP STRATEGY FOR OUR SOCIETY. WE HAVE THE POTENTIAL TO FACILITATE EVEN MORE ATTENTION ON THE GEROSCIENCE INITIATIVE. IN FACT, NEXT YEAR WE HAVE AN ENTIRE PRE-ANNUAL MEETING FOCUSED SPECIFICALLY ON THE BIOLOGY OF SKELETAL AGING THAT WILL EXPOSE OUR MEMBERSHIP TO GERO SCIENCE. IN FACT, MANY OF THE TOPICS OF THIS MEETING ARE BASED ON THE PILLARS OF AGING. SO I'LL STOP THERE AND HAVE AN EXTRA MINUTE TO DEVOTE TO THE NEXT SPEAKERS. THANK YOU. [APPLAUSE] >> THANK YOU VERY MUCH. OUR NEXT SPEAKER IS JENNIFER WESTENDORF WHO WILL BE REPRESENTING THE ORTHOPEDIC RESEARCH SOCIETY. >> GOOD AFTERNOON. I'M HERE TO -- PLEASED TO REPRESENT THE ORTHOPEDIC RESEARCH SOCIETY OR THE ORS. THE MISSION OF THE ORS IS TO ACCELERATE MUSCULOSKELETAL DISCOVERY TO IMPROVE HEALTH, OVERALL HEALTH AS WELL AS MUSCULOSKELETAL HEALTH. IT'S A SOCIETY OF OVER 4,000 MEMBERS, THIS INCLUDES -- IT'S VERY HETEROGENEOUS EXPERTISE THAT INCLUDES BIOLOGISTS, ENGINEERS, CLINICIANS AND OR THE ORTHOPEDIC SURGEONS, AS WELL AS MANY OTHER HEALTHCARE PROVIDERS AND SCIENTISTS. SO IF YOU CAME TO AN ORS MEETING, YOU WOULD SEE SCIENCE RELATED TO STEM CELL BIOLOGY, TO TISSUE ENGINEERING, TO FUNCTIONAL ANALYSES OF GAIT AND AS WELL AS BIOMECHANICS. WE KNOW AGING IS A NUMBER ONE RISK FACTOR FOR MUSCULOSKELETAL DISEASES AS HAS BEEN MENTIONED EARLIER TODAY. WITHIN MUSCULOSKELETAL DISEASES IS ALSO A HETEROGENEOUS GROUP OF DISEASES THAT INCLUDES OSTEOARTHRITIS, OSTEOPRO VIS, FRACTURES, FRACTURE REPAIR, SPONDYLITIS, BACK PAIN, SARCOPENIA AND MANY OTHER DISEASES. WE KNOW MUSCULOSKELETAL DISEASES OR CHRONIC DISEASES THAT ARE VERY PREVALENT IN OUR SOCIETY AND IN THE WORLD. THE WORLD HEALTH ORGANIZATION HAS MUSCULOSKELETAL DISEASES LISTED AS NUMBER TWO OF LIST OF YEARS WITH DISABILITIES. WE KNOW MUSCULOSKELETAL DISEASES HAVE BEEN TARGETED WITH THERAPIES AND OTHER ANTI-AGING THERAPIES AND WE DO FEEL THAT THEY ARE PRIME TARGETS FOR ANTI-AGING TRIALS. THE ORTHOPEDIC RESEARCH SOCIETY HAS A NUMBER OF OPPORTUNITIES TO FACILITATE PARTNERSHIPS. WE HAVE TWO JOURNALS, THE JOURNAL OF ORTHOPEDIC RESEARCH AND JOR SPINE WHICH SPECIFICALLY FOCUSES ON SPINAL RELATED PUBLICATIONS. WE HAVE AN ANNUAL MEETING, THE NEXT ANNUAL MEETING WILL BE IN PHOENIX IN FEBRUARY. WE HAVE AN ABSTRACT CATEGORY CALLED AGING AND WE HAVE ABOUT 200 ABSTRACTS SUBMITTED PER YEAR INTO THAT CATEGORY. THAT'S PROBABLY AN UNDERESTIMATE OF THE NUMBER OF ABSTRACTS AND POSTERS AND PRESENTATIONS RELATED TO AGING BECAUSE THEY MAY GO INTO OTHER CATEGORIES RELATED TO CERTAIN TISSUE PHENOTYPES. THE ORS ALSO SPONSORS A NUMBER OF SATELLITE MEETINGS OUTSIDE OF ITS ANNUAL MEETING. RIGHT NOW, IN FACT TODAY THERE'S PHILADELPHIA SPINE RESEARCH SOCIETY'S INTERNATIONAL SPINE RESEARCH MEETING UNDERWAY IN PENNSYLVANIA, WE SPONSOR A MUST CLOA BIOLOGY WORKSHOP THAT'S BEEN IN SUN VALLEY, IDAHO FOR A NUMBER OF YEARS. WE HAVE AMBASSADORS FOR THE ORS, ALL AROUND THE WORLD, WHICH SPONSOR REGIONAL AND INTERNATIONAL MEETINGS THAT BRING CONCEPTS AND IDEAS FROM THE ORS INTO LOCAL COMMUNITIES. WE ALSO HAVE A NUMBER OF SECTIONS WITHIN THE ORS, OUR FOCUS GROUPS ON PARTICULAR DISEASE TOPICS OR INTERESTS SUCH AS FRACTURE REPAIR, MENISCUS RESEARCH, SPINE RESEARCH AND TENDON, AND THEY HAVE THEIR OWN LOCAL MEETINGS AND SYMPOSIA. WE KNOW THAT OSTEOPOROSIS AND MUSCUOSKELETAL DISEASE IS JUST STATES OR NORTH AMERICA, THERE ARE REALLY PROBLEMS RELATED THROUGHOUT THE DEVELOPING WORLD, DEVELOPED WORLD, SO WE HAVE A NUMBER OF INTERNATIONAL COLLABORATIONS INCLUDING THE INTERNATIONAL FEDERATION OF MUSCULOSKELETAL RESEARCH SOCIETIES, AND THROUGH THE IFMRS, WE'RE INVOLVED IN A MUST SCHOA SCEL AT THAT TIME GENOMICS PORTAL TO MAKE SURE PEOPLE CAN ACCESS THE GENOMIC INFORMATION THAT'S AVAILABLE TO BRING TO THEIR RESEARCH AND LIKING TO SPECIFIC PHENOTYPES. WE ALSO HAVE AN ONLINE LEARNING ENVIRONMENT CALLED HUBBL, AND FINALLY THE COMBINED ORTHOPEDIC RESEARCH SOCIETIES. SO THANK YOU VERY MUCH. [APPLAUSE] >> NOW OUR LAST SPEAKER IS SUE PESCHIN, THE ALLIANCE FOR AGING RESEARCH. >> GOOD AFTERNOON, EVERYBODY. THANK YOU SO MUCH FOR HAVING ME HERE, AND CONGRATULATIONS TO PHILLIPPE AND THE NATIONAL INSTITUTE ON AGING AND ALL PART OF THE GEROSCIENCE INTEREST GROUP, WE'RE THRILLED TO SEE THIS THIRD SUMMIT. SO FOR THOSE NOT FAMILIAR WITH US, THE ALLIANCE FOR AGING RESEARCH WAS FOUNDED IN 1986, WE'RE LOCATED HERE IN WASHINGTON, D.C., AND WE'RE THE LEADING NATIONAL NON-PROFIT ORGANIZATION DEDICATED TO PROMOTING RESEARCH TO IMPROVE AGING AND HEALTH. AND WE DO THIS BOTH THROUGH PUBLIC POLICY AND HEALTH EDUCATION ACTIVITIES. WE FOCUS A LOT ON POLICY-RELATED ISSUES AT FDA, CMS. WE'RE CURRENTLY CO-LEADING A COALITION TO RE-AUTHORIZE THE PATIENT-CENTERED RESEARCH INSTITUTE AND WE ALSO WORK A LOT EVERY YEAR ON ENSURING AN INCREASE IN NATIONAL INSTITUTES OF HEALTH FUNDING. THERE'S A NUMBER OF WAYS THAT WE HAVE BEEN INVOLVED IN GEROSCIENCE AND ALSO IN THE PROMOTION OF HEALTH SPAN AND I GUESS THE MESSAGE THAT I HAVE TODAY IS THERE'S A LOT OF OPPORTUNITY FOR ALL OF YOU AND THAT WE NEED YOU. WAWS THE BECAUSE THE AGING COMMUNITY IS ONLY SO BIG AND THIS IMPACTS AS YOU'VE ALL HEARD TODAY MULTIPLE TIMES DISEASES ACROSS THE SPECTRUM, BOTH CHRONIC AND INFECTIOUS, AND WE ALL NEED TO BE WORKING TOGETHER. THIS IS A GREAT OPPORTUNITY FOR US TO DO THAT. IN TERMS OF THE WAYS THAT WE'VE BEEN INVOLVED PREVIOUSLY, BACK WHEN THE VERY FIRST SUMMIT OCCURRED, WE WERE LUCKY TO PARTNER WITH THE GERONTOLOGICAL SOCIETY OF AMERICA, AND THE FOUNDATION FOR THE NIH ON THE FIRST EVER GEROSCIENCE INTEREST GROUP SUMMIT, AND THERE WERE RECOMMENDATIONS THAT CAME OUT OF THAT FIRST SUMMIT THAT LED TO THE SECOND AND NOW THE THIRD, AND WE HAVE ALSO HELPED FUND RESEARCH TO SHOW THE ECONOMIC BENEFIT OF INCREASING THE NUMBER OF HEALTHY YEARS OF LIFE THAT OCCURRED IN HEALTH AFFAIRS THAT WAS PUBLISHED IN HEALTH AFFAIRS, AND WE ALSO STARTED SOMETHING CALLED THE HEALTH SPAN IMPERATIVE WHICH WAS MORE OF AN EDUCATIONAL CAMPAIGN TO EDUCATE FOLKS ABOUT A LOT OF THESE CONCEPTS. SO I TEND TO THINK THAT WHEN YOU'RE CHANGING A PARADIGM, YOU HAVE TO TALK ABOUT SOMETHING FIRST. AND THIS HAS BEEN TALKED ABOUT NOW FOR A NUMBER OF YEARS, AND IT'S FINALLY BECOMING, I THINK, A PART OF THE LEXICON. IT'S REALLY A BIG DEAL THAT DR. COLLINS SPOKE HERE AGAIN AND JUST WANT TO PUT A SHOUT OUT TO HIM TO THANK HIM FOR DOING THAT BECAUSE THAT MEANS A LOT. BUT PEOPLE CARE ABOUT WHAT THEY EXPERIENCE, SO THE DISEASE-SPECIFIC FOCUS THAT YOU ALL HAVE IS VERY IMPORTANT. THERE IS AN INITIATIVE THAT THE EMA HAS RUN, THE EUROPEAN MEDICINES AGENCY, FOR A NUMBER OF YEARS NOW CALLED THE GERIATRICS MEDICINES INITIATIVE. A LOT OF THE PHARMAS THAT MAY BE IN THE ROOM TODAY ARE ALREADY COMPLYING WITH REGULATIONS THAT WERE FORMULATED UNDER THIS GERIATRIC MEDICINES INITIATIVE, AND THAT WOULD BE A REALLY IMPORTANT STEP HERE IN THE UNITED STATES FOR THE FDA TO INCORPORATE A GERIATRIC MEDICINES INITIATIVE HERE. BECAUSE IT ADDRESSES A LOT OF WHAT WE'RE TALKING ABOUT, HAVING PEOPLE WITH MULTIPLE CHRONIC CONDITIONS IN THE TRIALS, HAVING MORE OLDER ADULTS REPRESENTATIVE POPULATIONS IN THE TRIALS, INSTEAD OF THE PEER GROUPS THAT WE TRY TO LIMIT OURSELVES TO NOW, AND WHAT I THINK IS IMPORTANT IS THAT ALL THE NIH INSTITUTES ARE DOING THIS TYPE OF AGING BIOLOGY RESEARCH IN INFLAMMATION, IN SENESCENCE, IN GENETICS AND EPIGENETICS, AND I THINK THERE'S AN OPPORTUNITY TO CREATE MORE OF A SHARE AND EFFICIENCY ACROSS THE INSTITUTES. IT'S BEEN AN INCREDIBLE OPPORTUNITY, BUT TO KIND OF TAKE THAT TO THE NEXT LEVEL AND TO FIGURE OUT WHAT MAKES THE MOST SENSE IN TERMS OF WHO'S FOCUSED ON WHAT, SO THAT THAT INFORMATION CAN BE SHARED. WE NEED AS BIG A TENT AS POSSIBLE HERE. WE NEED TO DISCUSS COORDINATION AND FUNDING. I THINK PUBLIC/PRIVATE PARTNERSHIP IS KEY, AND ACTUALLY DR. COLLINS TALKED ABOUT AT THE BEGINNING, WHEN HE HAD HIS REMARKS ABOUT THE FIXED AMOUNT OF MONEY, THERE'S ONLY SO MUCH MONEY, AND I DO WANT TO SAY THAT THIS TYPE OF INITIATIVE IS NOT ABOUT TAKING MONEY AWAY FROM ANY OTHER INSTITUTE TO SAY, HEY, NOW YOU HAVE TO PUT IT INTO THIS BIGGER POT, BUT TO THINK BIGGER THAN THAT, TO THINK PUBLIC, PRIVATE, TO THINK COORDINATING COMMITTEE LIKE WE'VE DONE ACROSS FEDERAL AGENCIES FOR ISSUES LIKE AUTISM AND BREAST CANCER, BUT WE HAVE TO DO THAT ALL TOGETHER. WE'VE DONE LITTLE BITS HERE AND THERE WITH GETTING REPORT LANGUAGE TO MAKE THESE THINGS HAPPEN, AND I WANT TO PRAISE THE ORGANIZATIONS LIKE ASCO, WHO HAVE DIRECTLY CONFRONTED THIS ISSUE AROUND OLDER ADULTS IN CLINICAL TRIALS AND LOOKING AT THESE SORT OF MORE GERIATRIC ISSUES BECAUSE WE NEED TO ALL BE THE LAST COMMENT I WANT TO MAKE ON THIS IS WE NEED LEADERSHIP OWNERSHIP. AND I WANT TO STRESS THAT WE NEED TO STEP AWAY FROM COMPETING AROUND THIS, I THINK A LOT OF TIMES WITH NEW THINGS, WHEN THERE'S ONLY SELECT POTTS OF MONEY, IT TENDS TO BE COMPETITIVE. THIS IS AN AREA FOR COORDINATION, FOR COLLABORATION. WE WANT TO DO IT WITH YOU. PLEASE STAY FOR ALL THE SESSIONS FOR THE EXECUTIVE SESSIONS, THIS IS SO IMPORTANT, THIS IS NEXT LEVEL STUFF. THANKS FOR BEING HERE. [APPLAUSE] >> GOOD AFTERNOON. MY NAME IS KEVIN HOWCROFT FROM THE NATIONAL CANCER INSTITUTE, TAG TEAMING WITH JOVIER EVANS ON HOSTING THIS SESSION. I WANT TO THANK ALL OF THE SPEAKERS FOR STAYING ON TIME AND TAKING YOUR FIVE MINUTES. YOU MADE PHILLIPPE VERY HAPPY AND THAT'S IMPORTANT, WE ALL TRY TO MAKE HIM HAPPY. SO NOW I'D LIKE TO OPEN THE FLOOR FOR ANY QUESTIONS FOR THE SPEAKERS. INTO I THINK THEY WERE ALL FANTASTIC TALKS AND JUST REALLY SHOW THE GREAT BREADTH OF DIVERSITY BUT ALSO SOME COMMONALITIES THAT WILL BE INTERESTING TO EXPLORE. >> THANK YOU. I APOLOGIZE IN ADVANCE FOR PERHAPS MAKING A PRO VACTIVE OR ASKING A PRO VACTIVE QUESTION. I AM A MEMBER OF THE ADA, THE AMERICAN DIABETES ASSOCIATION, AND DR. KALYANI DID A WONDERFUL JOB OF OUTLINING ALL THE WONDERFUL WORK THAT THE ADA DOES. I NOTICE THEY TEND TO RELATE TO HOW DIABETES AFFECTS THE EDERLY, AND THE GEROSCIENCE HYPOTHESIS FLIPS IT ON ITS END AND SAYS HOW DO ADVANCES IN THE BIOLOGY OF AGING HELP DIABETICS AND CANCER PATIENTS AND A BUNCH OF OTHER PATIENTS SUFFERING FROM OTHER DISEASES. I WILL SAY THAT IN MY PERSONAL EXPERIENCE, MEMBERS OF THE ADA SEEM VERY INTERESTED IN THE NEXT INSULIN ANALOG OR THE ONE ANALOG, ET CETERA, AND DIDN'T SEEM TO GET A GENERAL UNDERSTANDING OF THE PROMISE OF GEROSCIENCE IN HELPING DIABETES AS A NEW MODALITY, IF YOU WILL, NOT JUST ANOTHER VARIATION IN INSULIN AVALONS AND SO FORTH. AND THIS IS ALSO TO ASCO, I THOUGHT THE BONE, DR. KIEL, WAS VERY RESPONSIVE TO THE PROMPT AND I APPRECIATE THAT BUT I WONDER IF YOU CAN SPEAK TO THE ADA, THE ASCO, AS HOW THOSE ASSOCIATIONS CAN HELP BRING THE PERSPECTIVE OF GERO SCIENCE, THAT'S NOT YOUR JOB, BUT THE QUESTION IS WHETHER THAT'S HELPFUL FOR THE RESEARCH AGENDA FOR THOSE ORGANIZATIONS, AND ALSO FOR EDUCATING PRACTITIONERS ABOUT THE PROMISE OF THE GEROSCIENCE HYPOTHESIS. >> THANK YOU SO MUCH FOR THAT, IT'S SUCH A GREAT COMMENT. YOU'RE RIGHT, I THINK IN GENERAL, THE FOCUS HAS TRADITIONALLY BEEN ON MANAGEMENT OF DIABETES IN THE ELDERLY, HOW DO THERAPIES DIFFER IN TERMS OF THEIR EFFICACY IN OLDER ADULTS, NOT NECESSARILY AS YOU SAID THE FLIP, WHICH IS WHAT IS THE AGING PROCESS AND HOW DOES THAT RELATE TO THE DEVELOPMENT OF INSULIN RESISTANCE AND KIND OF PREDICTERS OF DIABETES. I THINK THAT'S WHERE THE FIELD IS GOING, THAT'S WHAT WE WOULD LIKE TO SEE MORE. I THINK COLLABORATIONS SUCH AS THIS CAN REALLY FACILITATE THOSE CONVERSATIONS BECAUSE THE PEOPLE THAT USUALLY PRESENT OR COME TO THOSE MEETINGS ARE THOSE THAT HAVE BEEN TRAINED MAYBE IN THAT SUBSPECIALTY BUT WHAT WE REALLY NEED IS A BROADER BASE OF KNOWLEDGE. AND A SPECIAL THEME ISSUE THAT I MENTIONED IN DIABETES CARE IN THE EDITORIAL WE WROTE, WE HIGHLIGHTED EXACTLY WHAT YOU SAID. THAT WAS TWO YEARS AGO. SO WE DEFINITELY -- YOU'RE PREACHING TO THE CHOIR FOR ME, BUT WOULD LOVE TO HAVE MORE OF A VOICE IN TERMS OF RELAYING THAT TO THE BROADER COMMUNITY. SO IT WILL BE GREAT TO CONNECT AFTERWARDS. THANK YOU. >> I'LL MAKE A COUPLE OF COMMENTS RELATED TO ASCO. OBVIOUSLY WHAT I PRESENTED TODAY IS A LOT OF THE WORK THAT HAS BEEN ONGOING BUT I THINK THERE ARE A COUPLE OF AREAS WHERE AGING RESEARCH WITH RESPECT TO THE WORK AT ASCO IS FOCUSED PRIMARILY IN THE CANCER RESEARCH COMMITTEE ITSELF AND THEN MOVING SOME OF THAT RESEARCH OUT INTO PRACTICE FOR THOSE PATIENTS WHO NEED CARE RIGHT NOW, SO THAT'S WHERE A LOT OF THE EMPHASIS HAS BEEN, BUT THERE IS I THINK A LOT OF OPPORTUNITY FROM THE PREVENTION STANDPOINT SO WITHIN ASCO ITSELF, THE CANCER PREVENTION COMMITTEE IS ONE AREA WHERE THINKING ABOUT GERO SCIENCE AND ITS IMPLICATIONS AND MANY OF THE THINGS WE'VE TALKED ABOUT THIS MORNING WOULD BE RELEVANT. I THINK THE OTHER AREA IS IN SURVIVORSHIP, EACH THOUGH THAT'S NOT A PREVENTION MODEL, IT'S SORT OF A SECONDARY PREVENTION MODEL AND ALSO THE IDEA OF CANCER AND ITS TREATMENTS AS SOME MIGHT SUGGEST ACCELERANTS OF THE AGING PROCESS, SO THOSE ARE TWO AREAS WHERE I THINK THERE'S A LOT OF OPPORTUNITY. >> DOES ANYONE ELSE ON THE PANEL WANT TO COMMENT? JUST JUMP RIGHT IN. >> OKAY. SO I MEAN, A LOT OF THE RISK FACTORS FOR CARDIOVASCULAR DISEASE, DIABETES, CANCER, THEY'RE ALSO FOR SOME OF THE -- WE FUND RESEARCH FOR ALZHEIMER'S DISEASE, GLAUCOMA, MACULAR DEGENERATION, A LOT OF THE FUNDAMENTALS OF EPIGENETICS AND INFLAMMATION AND VASCULAR CONTRIBUTIONS THAT ARE COMMON ACROSS ALL OF THE DEEDS, SO I THINK IT WILL BE GOOD TO TRY AND FOCUS ON EARLY DETECTION FOR US LIKE TIME LOST IS VISION LOST AND COGNITION LOST, SO EARLY DETECTION AND PREVENTION, AND I THINK THAT BRINGING IT IN UNDER THE -- WHAT WE'RE FUNDING ALREADY AND ADDING A LITTLE BIT OF SPICE TO THE MIX WITH THE JERO GEROSCIENCE POINT OF VIEW WILL BE LOOKING FORWARD TO FUTURE COLLABORATIONS. >> OUR PANEL TODAY REPRESENTS AN ORGAN-SPECIFIC CULTURE. ALL OF US HERE FROM THE BRAIN TO THE EYES TO THE BONE, CANCER DISEASE, DIABETES, WE'RE ALL DISEASE-FOCUSED, AND THAT'S THE WAY PROFESSIONAL SOCIETIES AND ORGANIZES SEEM TO BE ORGANIZED. WE DO HAVE AN AGING ORGANIZATION THAT IS TRANSCENDENT ACROSS ALL OF OUR ORGAN SYSTEMS, BUT WE ALL WORK SEPARATELY, WE HAVEN'T EVEN MET BEFORE, AND WE'RE HERE IN THIS GEROSCIENCE MEETING. SO I THINK THERE'S A LOT OF INTEGRATION TO GET GEROSCIENCE AT THE NIH IS PROBABLY A BIG TASK, BUT TO GET AGING EMBEDDED ACROSS ORGANIZATIONS IN SOME SORT OF WAY THAT UNITES US IS ALSO A BIG ITEM. TO OVERCOME THESE ORGAN-SPECIFIC DIVISIONS. >> ANY OTHER THOUGHTS ON THE PANEL? AND THE BONUS HERE IS, YOU CAN TAKE LONGER THAN FIVE MINUTES IF YOU WANT. [LAUGHTER] THIS IS OPEN QUESTION AND ANSWER. >> SURE. I'LL JUST PUT A PLUG IN SORT OF FOLLOWING UP THAT WE HEARD FROM HEIDI AND OTHERS THAT I THINK IT'S IMPORTANT TO THINK ABOUT HOW GEROSCIENCE NOT ONLY HAS AN INFLUENCE ON DISEASE INCIDENCE SO WE THOUGHT ALLOWT ABOUT HOW IT MAY BE UNDERLYING THE DEVELOPMENT OF INCIDENCE DISEASES THAT ARE COMMON IN AGING, BUT I THINK IT'S IMPORTANT THAT WE'RE ALWAYS THINKING ABOUT HOW GEROSCIENCE MAY BE PLAYING A ROYAL OR GEROSCIENCE PROCESSES MAY BE PLAYING A ROLE IN THE TRAJECTORY OF DISEASES SO I THINK ABOUT, FOR EXAMPLE, ONE AREA OF INTEREST FOR US AT AGP IS OBVIOUSLY ALZHEIMER'S DISEASE, BUT A BIG PART OF OUR ROLE IN IT IS THAT SO MUCH OF THE ACTUAL MORBIDITY FROM THE DISEASE IS NOT FROM MEMORY LOSS, IT'S NOT FROM COGNITIVE DYSFUNCTION, IT'S FROM BEHAVIORAL PROBLEMS. IT'S FROM EXTREME NEUROPSYCHIATRIC DISTURBANCE THAT DOESN'T NECESSARILY HAPPEN IN AN AGE-DEPENDENT WAY BUT IT IS SOMEHOW PART OF THE DISEASE. WHAT CAN WE LEARN, FOR EXAMPLE, ABOUT HOW GEROSCIENCE INFLUENCES WHY SOME DISEASE PRESENTATIONS IN AGING ARE SO MUCH MORE EXTREME AND SEVERE THAN OTHERS. I THINK THAT'S AN UNCHARTED AREA THAT WE CAN HAVE SOME REALLY NOVEL CONTRIBUTIONS TO. SO I'LL JUST PUT A PLUG IN FOR THAT. >> FROM THE ORTHOPEDIC RESEARCH SOCIETY STANDPOINT -- I THINK THERE'S A COUPLE UNIQUE AREAS THAT WE CAN BRING TO THE TABLE. I AGREE WITH DOUG AND THE OTHER PANELISTS THAT MORE COLLABORATION AND WORKING TOGETHER IS IMPORTANT, BUT WITH THE ENGINEERS IN OUR SOCIETY, DEVELOPING ACCELEROMETERS WHERE WE CAN REALLY ACCURATELY MEASURE STEPS AND GATES IN THE ELDERLY OR PEOPLE WHO ARE ILL SO WE KNOW THAT FITBITS AND APPLE WATCHES DON'T REALLY WORK OR AREN'T AS ACCURATE IN PEOPLE WHO ARE WALKING WITH SLOWER STEPS OR WITH DISEASES OR WITH AGING OR HAVE SHORTER STEPS, SO WE NEED TO DEVELOP TOOLS TO MEASURE FRAILTY AND GATE GAIT ANALYSIS MORE ACCURATELY SO THAT'S WHERE THE ORS CAN CERTAINLY CONTRIBUTE TO FRAILTY AND AGING. I ALSO THINK THE ROLE OF THE MICROENVIRONMENT AND THE EXTRACELLULAR MATRIX THAT THE CELLS ARE INVOLVED WITH IS VERY IMPORTANT AND MECHANOBIOLOGY COULD POTENTIALLY BE AN ADDITIVE TO THE GEROSCIENCE PORTFOLIO. >> AND ACTUALLY TO JUMP IN HERE ON THE COMMONALITIES, EVERYTHING THAT YOU JUST MENTIONED, WE'RE FUNDING ALREADY AND WE WOULD LIKE TO, HAVING GAIT ISSUES IS AN ISSUE WITH ALZHEIMER'S DISEASE AS WELL, AND FRAILTY AND A LOT OF PEOPLE DO FALL AND BREAK THEIR HIPS, . >> I WAS JUST GOING TO ADD, I THINK THESE ARE ALL GREAT COMMENTS. WE'RE ALL SORT OF CONNECTED MUCH MORE THAN WE THINK WE REALIZE ON A DAY-TO-DAY BASIS BECAUSE WE ARE IN OUR RESPECTIVE SILOS, BUT WHEN I THINK ABOUT CANCER AND FOLKS WE KNOW IN THE SURVIVORSHIP COMMUNITY, WHO HAVE EXPERIENCED GERIATRIC CARDIOLOGY ISSUES AS A RESULT OF CANCER TREATMENT OR PEOPLE WITH DIABETES WHO HAVE GONE ON TO DEVELOP ALZHEIMER'S DISEASE, AND I THINK THE POINT THAT YOU MAKE ABOUT SERIOUS MENTAL ILLNESS OR NEUROPSYCHIATRIC SYMPTOMS ASSOCIATED WITH ALZHEIMER'S IS ALSO REALLY INTERESTING, THE NIMH GAVE ONE OF WHAT I THINK WAS ONE OF THE MOST FASCINATING GEROSCIENCE TALKS, THEY'VE HAD TALKS THROUGHOUT THE LAST FEW YEARS, AND THEY LOOKED INTO THE ORIGINS, AND WHAT I THINK IS SO FASCINATING IS A LOT OF THE DISEASES THAT WE'RE TALKING ABOUT HAVE STIGMA ATTACHED TO THEM, AND WHEN YOU LOOK AT THE ROOT OF THE CONDITIONS AND YOU SEE THEM FROM A BIOLOGICAL STANDPOINT, IT KIND OF IS A LEVEL SETTER TO A CERTAIN DEGREE AND CAN HAVE THE POTENTIAL TO HOW FAMILIES SEE IT, AS IT IS A BIOLOGICAL PROCESS. SO I THINK THERE'S JUST A LOT OF POTENTIAL IN TERMS OF THE PHRASE THAT PHILIPPE USED THAT MADE US GIGGLE WHEN WE WERE MAKING A VIDEO ABOUT THE HEALTH SPAN INITIATIVE, AND HE SAID GEROSCIENCE GETS AT THE -- HE CALLED IT THE WACC AMOLE, WHICH IS YOU HAVE ONE DISEASE, ANOTHER ONE POPS UP AND YOU'VE GOT TO HIT THE OTHER ONE THAT POPS UP, AND THAT IS A LOT OF WHAT WE'RE TALKING ABOUT HERE. SO IT CRIES OUT FOR COLLABORATION. >> ON THAT, WE'LL TRANSITION TO THE NEXT QUESTION, PLEASE. >> THANK YOU. I AM INTERESTED IN SORT OF YOUR IMPRESSION OF WHAT YOU SEE FROM YOUR CLINICAL STUDIES, SO WHEN WE DO THESE AINGING AGING STUDY, I WOULD ARGUE THAT AGING RESEARCH, IF WE MOVE OUT OF THE DISEASE-SPECIFIC INDICATIONS, WE'RE KIND OF BACK TO SQUARE ONE WHERE CANCER WAS, LET'S SAY, 15 YEARS AGO, WE KNOW VERY LITTLE ABOUT IT, WE'RE TRYING TO COME UP WITH DEFINITIONS, WE'RE TRYING TO CHARACTERIZE THINGS, SO WHEN THEY PRESENT THESE STUDIES TO PATIENTS AND YOUR PATIENT ADVOCACY GROUPS, DO THEY SOUND SUPER BASIC LIKE WE DON'T KNOW ANYTHING ABOUT AND PEOPLE INTERESTED IN PARTICIPATING OR DO THEY GET THE FACT THAT -- I MEAN, HOW BASIC, HOW DISCOVERY DOES IT SOUND, AND IS THAT THE PROBLEM FOR ENROLLMENT? I KNOW IT'S A BIG QUESTION. >> WHO WANTS TO TAKE FIRST CRACK? >> I DON'T KNOW IF I CAN ANSWER IT VERY WELL BUT I THINK DOUG TOUCHED ON IT IN TERMS OF MUSCULOSKELETAL DEEDS, MUSCULOSKELETAL DISEASE, LIKE OSTEOPOROSIS, PEOPLE THINK IT'S A DISEASE OF AGING AND THEY DON'T GET TREATED FOR IT. FIDZS AND EVEN PHYSICIANS AND SURGEONS, IF SOMEBODY HAS A FRACTURE, THEY DON'T TREAT IT. PEOPLE DO THINK IT'S JUST PART OF AGING AND MAIN MAYBE WE DO NEED MORE SOPHISTICATED DEFINITIONS OF WHAT'S ACTUALLY GOING ON, IF WE HAVE THERAPIES, WE CAN TELL YOU THIS WILL DO THAT AND IT WILL -- SO I THINK WE NEED TO KIND OF REVERSE PEOPLE'S NATURAL INCLINATION JUST TO BLAME IT ON AGING AND TO SAY THAT WE COULD POTENTIALLY TREAT IT AND HAVE YOU LIVE HEALTHIER. >> SO DO YOU SEE THAT SORT OF PEOPLE ARE SORT OF PLIABLE TO THAT THINKING OR HOW HARD IS THAT SWITCH? >> I THINK PROBABLY DEPENDS BUT I THINK IT'S POSSIBLE. >> WELL, TALKING ABOUT AGING AND NATURAL PRO SERS, I PROCESSES, ALZHEIMER' S FOR A LONG TIME, PEOPLE THOUGHT THAT ALZHEIMER'S WAS A NATURAL PART OF AGING. WE'RE TRYING TO GET PEOPLE OUT OF THINKING ABOUT THAT. IT IS NOT A NATURAL COURSE OF AGING AND SO -- BUT YOUR RISK DOES INCREASE AS YOU GET OLDER, AND SO YEAH, THERE'S THIS FINE LINE FOR EDUCATION AS YOU'RE TALKING ABOUT. IT'S ALL ABOUT COMMUNICATION. >> MAY I ASK, SO ONE THING WE THINK YES IT'S NATURAL FOR AGING AND WE SHOULD CONVINCE THAT'S SO. YES, IT IS AGING, AND JUST LIKE IF YOU WERE DIAGNOSED WITH DIABETES OR ANY OTHER DISEASE, YEAH, WE HAVE THINGS WE CAN DO ABOUT IT. LET'S NOT TRY TO PRETEND THERE THAT IT IS NOT DUE TO AGING. IT IS. MANY OF THESE DISEASES ARE PRIMARILY DUE TO AGING. AND THAT'S A FACT. SO LET'S ACCEPT IT, BUT LET'S INFORM THE PATIENTS THAT, YES, BUT WE CAN DEAL WITH IT. THAT'S THE IDEA IS WE ARE ADDRESSING -- NOT THAT WE'RE DENYING THAT THE PROBLEM EXISTS. >> ABSOLUTELY. JUST TRY TO EMPOWER PEOPLE AND I THINK WE NEED TO HAVE MORE EVIDENCE-BASED RESEARCH ON PREVENTIONS AND HOW TO EMPOWER PEOPLE TO TAKE CONTROL OF THEIR OWN HEALTH. AND THAT IT'S NOT A HELPLESSNESS, THAT IT'S INEVITABLE THAT TIME IS RUNNING OUT, I THINK THAT THAT'S THE KIND OF PIVOT WE NEED TO DO. >> PART OF MY DAY IS SPENT AS A CLINICIAN AND IN GERIATRICS, SO ALL MY PATIENTS ARE ALWAYS OLDER THAN ME. THROUGHOUT MY CAREER. AND THAT'S ONE OF THE REASONS I WENT IN TO JAIR NA TRICKS. GERIATRICS. WHEN I TALK TO PATIENTS, THE ONLY THING THEY KNOW ABOUT THE BIOLOGIC PROCESS OF AGING THAT'S REALLY COMMUNICATED IN THE LAY PRESS AND BEYOND IS LONGEVITY. THERE'S A LOT OF HYPE ABOUT LIVING LONGER, BUT NOT MANY PEOPLE UNDERSTAND THAT THERE ARE UNDERLYING BIOLOGIC PROCESSES THAT LEAD TO A LOT OF THE DISEASES THEY HAVE ON THEIR PROBLEM LIST. SO I THINK THERE'S A GAP. WE'VE GOTTEN PEOPLE WANT TO LIVE LONGER, BUT THEY DON'T UNDERSTAND THAT THERE COULD BE A FUNDAMENTAL PROCESS UNDERLYING MANY OF THEIR MULTI-MORBIDITY PROCESSES. SO I THINK WE HAVE A LONG WAY TO GO. IT'S JUST PERMEATING THE SCIENTIFIC COMMUNITY AND THE LAY PUBLIC DOESN'T REALLY UNDERSTAND THE CONCEPT, BUT I THINK AS THIS BECOMES MORE EXCITING AND THERE ARE SOME INTERVENTIONS, I THINK IT WILL BE OUR DUTY TO PROMULGATE THIS EDUCATION. >> THANKS. >> ANY OTHER COMMENTS? >> I WAS JUST GOING TO JUMP IN, AND I DON'T KNOW IF I'M AT ALL ADDRESSING YOUR QUESTION BUT I'M JUST GOING TO MAKE A STATEMENT. BUT I THOUGHT A PART OF YOUR QUESTION RELATED TO WHETHER OR NOT PATIENTS WOULD BE INTERESTED AND AMENABLE TO CERTAIN TYPES OF RESEARCH STUDIES LOOKING AT ALTERING PROCESSES OF AGING OR JUST TRYING TO UNDERSTAND THEM BETTER. AS A CLINICIAN, I WOULD SAY, AGAIN, I PRACTICE ONCOLOGY WITH GERIATRIC OLDER PATIENTS, 75 AND ABOVE, SO IT IS IN THE CANCER SETTING, BUT IN GENERAL, WHAT I'VE FOUND, I THINK THIS HAS BEEN BORNE OUT IN A LOT OF RESEARCH AS WELL IS THAT MOST PATIENTS ARE REALLY AMENABLE TO CLINICAL TRIALS AND OPEN TO THAT AND VERY INTERESTED CERTAINLY IF YOU'RE TALKING ABOUT THINGS THAT REALLY RESONATE LIKE ISSUES RELATED TO COGNITION OR FUNCTION OR JUST UNDERSTANDING WHAT MAY HAPPEN TO THEM BETTER, THE CHALLENGES OFTEN COME IN WHEN THE TRIALS ARE DESIGNED WITH A GREAT DEAL OF COMPLEXITY THAT INVOLVES A LOT OF MAYBE SEEMINGLY NECESSARY, LET'S SAY, BIOPSIES AND SPECIMENS AND SCANS AND TRIPS BACK AND FORTH AND THEY LIVE THREE HOURS AWAY, AND THAT'S WHERE OFTEN I LOSE PEOPLE WHEN WE'RE HAVING A CONVERSATION, THEY'RE INTERESTED CONCEPTUALLY AND THEN THE REALITIES OF WHAT THEY'D HAVE TO GO THROUGH IS A BIT TOO MUCH FOR WHAT THEY MIGHT GET OUT OF IT, OR WHAT THEY PERCEIVE, SO THAT'S JUST A COMMENT. WE SEE THAT A LOT IN ONCOLOGY TRIALS IN PARTICULAR. >> WE'LL GO TO THE NEXT QUESTION OVER THERE, PLEASE. >> HI. I'M KAREN, A POSTDOC IN NICHD. AND I'M SORT OF GOING BACK TO THE PREVIOUS QUESTION A LITTLE BIT. IT SOUNDED LIKE YOU GUYS WERE REALLY EXCITED ABOUT THE COMMONALITIES BETWEEN THE DIFFERENT SOCIETIES EVEN THOUGH IT'S A TISSUE-SPECIFIC SOCIETY. CAN YOU TELL YOU TALK A LITTLE ABOUT WHAT YOU SEE AS POTENTIAL FOR FUTURE COLLABORATIONS OR JOINT MEETINGS OR SOMETHING THAT YOU CAN SEE EACH OF THE SOCIETIES MAYBE WORKING TOGETHER ON THIS ISSUE? I KNOW THIS IS A HYPOTHETICAL BUT I WAS JUST CURIOUS. >> ONE THING THAT BRIGHTFOCUS HAS BEEN DOING IN 2017 AND IN 2019, WE ACTUALLY PUT IN A ONE-DAY WORKSHOP ON THE COMMON FEATURES OF NEURODEGENERAL DEGENERATIVE DISEASES. WE PUT TOGETHER EXPERTS IN GLAUCOMA, MACULAR DEGENERATION AND ALZHEIMER'S, THE INTERNATIONAL ALZHEIMER'S DISEASE PARKINSON'S DISEASE MEETING, AND YEAH, SO I THINK THAT HAVING MEETINGS LIKE THIS TO TRY TO CATALYZE OUT OF THE BOX THINKING, IT'S BEEN VERY INTERESTING TO HAVE SCIENTISTS COMING FROM DIFFERENT DISEASE PERSPECTIVES AND COMING TOGETHER AND REALIZING THAT THEY'RE REALLY WORKING ON THE SAME PROBLEM, JUST FROM A DIFFERENT ANGLE, AND THAT THEY CAN ACTUALLY JOIN FORCES AND MAYBE HELP TO ACCELERATE PREVENTIONS AND MAYBE TREATMENTS FOR ALL OF THE DISEASES TOGETHER, SO COMMON LEARNINGS. >> I THINK THAT CLEARLY THERE'S MANY OPPORTUNITIES TO COLLABORATE ON RESEARCH, PARTICULARLY IN ANNUAL MEETINGS OR OTHER WORKSHOPS THAT ARE HELD TO HAVE JOINT WORKSHOPS OR THINK ABOUT HOW WE MIGHT MORE FOCUS ON TRADITIONAL GEROSCIENCE ISSUES THAT HAVEN'T BEEN HIGHLIGHTED, FOR INSTANCE, BUT I THINK THE NEED FOR MORE EVIDENCE-BASED RESEARCH PARTICULARLY IN OLDER ADULTS WITH DIABETES IN PARTICULAR IS INCREDIBLY IMPORTANT TO FORM THE FOUNDATION FOR CLINICAL MANAGEMENT, BUT THEN ALSO TO SPUR OTHER CLINICALLY RELEVANT RESEARCH THAT PEOPLE WOULD BE INTERESTED IN. >> I THINK THERE'S A COUPLE OF DIFFERENT OPPORTUNITIES THAT ARE REALLY EXCITING. THERE ARE CERTAINLY OPPORTUNITIES ON THE SCIENTIFIC SIDE AS FOLKS ARE TALKING ABOUT. I THINK THAT IT CAN BE A LOT BIGGER THAN IT'S BEEN SO FAR, AND I THINK THERE CAN BE ECONOMIES OF SCALE BECAUSE I REMEMBER HEARING AND I DON'T KNOW IF THIS IS STILL TRUE, KEVIN, BUT YEARS AGO, THAT THE NATIONAL CANCER INSTITUTE WAS DOING FUNDED STUDIES ON INFLAMMATION THAN ANY OTHER INSTITUTES AT NIH. SO THAT WOULD BE REALLY INTERESTING, WHAT ARE THEY FINDING, YOU KNOW, IS THERE REPLICATION GOING ON IN OTHER INSTITUTES THAT ARE LOOKING AT INFLAMMATION, ARE THERE INSTITUTES MORE FOCUSED ON SENESCENCE OR ON STRESS RESPONSE? HOW CAN WE KIND OF GET THOSE ECONOMIES OF SCALE SO THAT WE'RE LEARNING FROM EACH OTHER IF WE'RE THEORIZING THAT STRESS RESPONSE MAY CREATE A NUMBER OF DIFFERENT CONDITIONS, DO WE REALLY NEED TO STUDY IT IN EVERY SINGLE CONDITION INDIVIDUALLY. SO I THINK THERE'S A LOT OF POTENTIAL THERE. THEN I THINK THERE'S POTENTIAL ON THE LOGISTICS SIDE OF THINGS IN TERMS OF JUST ORGANIZING TOGETHER AND THE DISEASE-SPECIFIC COMMUNITY, I MEAN, WE'RE ORGANIZED WITH THEM AS AN AGING GROUP ON NIH FUNDING ANNUALLY, BUT ALSO ON JUST SORT OF BROADER ISSUES AROUND NOW DRUG PRICING AND A WHOLE BUNCH OF DIFFERENT THINGS, THERE'S TREMENDOUS LIKE ADVOCACY POWER THERE, SO THAT THE AGING COMMUNITY, I DON'T THINK WE CAN PULL IT OFF JUST BY OURSELVES, SO LOOKING AT CAN WE CREATE A COORDINATING COMMITTEE FOR A LARGER SORT OF POT OF MONEY, CAN WE ALL KIND OF PUT PRESSURE ON INDUSTRY TO DO A PUBLIC-PRIVATE PARTNERSHIP TOGETHER. SO THERE ARE THOSE TYPES OF OPPORTUNITIES THAT I THINK ARE WIDE OPEN. >> AND JUST TO JUMP OFF OF THAT, ONE OF THE FOUR QUESTION, WHAT'S A BIG UNMET NEED IN THE FIELD, AND SO IF WE PULL OUT ALZHEIMER'S AS ONE, CLINICAL TRIAL RECRUITMENT REALLY BIG AND CLINICAL TRIAL DESIGN, SO I THINK THAT'S WHERE IF WE CAN JOIN FORCES AND MAKE SURE THAT THE CLINICAL TRIALS ARE DESIGNED IN A PARTICULAR WAY TO ANSWER THE QUESTION THAT WE NEED AND TAKE INTO ACCOUNT THE COMORBIDITIES. >> IF HAD A COORDINATED EFFORT IN CLINICAL TRIAL DESIGN WHEN WE WERE DESCRIBING PATIENTS IN THE DIABETES TRIALS AND THE HEART FAILURE TRIALS AND THE CANCER TRIALS IN A SIMILAR MANNER, THE BREADTH OF KNOWLEDGE, THEY MAY BE THE SAME PATIENT. WE THINK OF EACH PATIENT AS EXISTING ONLY IN OUR WORLD BUT WHAT WE COULD LEARN BY BEING ABLE TO IPT CONNECT THE DATA OVER TIME WOULD BE REALLY TREMENDOUS, AND IT WOULD GIVE EACH OF US A LITTLE BIT MORE -- IF I GO BACK NOT JUST MYSELF BUT MANY OF US GO BACK TO ADVOCATE FOR THE DESIGN OF ONE SINGLE TRIAL IN ONCOLOGY, YOU'RE STUCK TRYING TO DEFEND, HERE'S WHAT I WANT TO INCLUDE EVEN IF IT DOESN'T TAKE VERY MUCH ADDITIONAL TIME AND MONEY, BUT IF THERE'S A STANDARD SET OF APPROACHES TO HELP US GENERALIZE OUR DATA MORE QUICKLY, THAT WOULD HELP ALL OF US. >> GO TO OUR NEXT QUESTION. >> I THINK IT'S MORE OF A COMMENT AND IT REALLY BEARS ON AGING VERSUS AGE-RELATED DISEASES IN PRE-CLINICAL WORK, IN MOUSE MODELS, FOR EXAMPLE. SO A LOT OF THE INTERVENTIONS THAT COME TO CLINICAL TRIALS IN HUMANS ARE DEVELOPED IN LABORATORIES USING MICE, AND CULTURED CELLS AND THINGS LIKE THAT. AND MOST OF THE TIME, PEOPLE STUDY THE PRE-CLINICAL MODELS THAT THEY USE TO EVALUATE THEIR INTERVENTIONS ARE YOUNG MICE. AND YOUNG MICE AND OLD MICE ARE REALLY DIFFERENT. THE IMMUNE CELLS, THE ADAPTIVE IMMUNE CELLS DON'T WORK VERY WELL IN OLD ANIMALS, IN OLD PEOPLE, THERE'S A LOT MORE INFLAMMATION IN OLD ANIMALS AND OLD PEOPLE, THE MITOCHONDRIA DON'T WORK AS WELL IN OLD MICE AND OLD PEOPLE, AND YET, IF SOMEONE WANTS TO DO A CANCER TRIAL IN A MOUSE, THEY'LL TAKE A YOUNG MOUSE AND THEY'LL PUT SOME CANCER CELLS IN HIS UNIGRAPH FROM HUMAN PATIENTS OR TO TEST DIABETES, THEY'LL TAKE A YOUNG MOUSE, PUT IT ON A HIGH FAT DIET, DO A FEW MORE THINGS, ORCID KNEE DISEASE, OR KIDNEY DISEASE, AND THEN THEY'LL COMPLAIN ABOUT THE FACT THAT MICE AREN'T ALL THAT PREDICTIVE FOR HUMANS. PEOPLE JUST DON'T GET IT. IT'S MORE DIFFICULT TO DO YOUR TRIAL IN OLD ANIMALS BECAUSE YOU HAVE TO GET THE OLD ANIMALS. EITHER YOU HAVE TO BUY THEM AND THEY'RE IN SHORT SUPPLY OR YOU HAVE TO AGE THEM, WHICH TAKES A LONG TIME, BUT I THINK JUST THE CONCEPT THAT IF YOU'RE STUDYING SOMETHING THAT'S, YOU KNOW, A THOUSAND FOLD MORE PREVALENT IN THE AGED, THERE'S SOME REASON FOR IT THAT'S GOING TO BE MIMICKED IN AN OLD PRE-CLINICAL MODEL. AND OBVIOUSLY WHEN YOU DO TRIALS IN PEOPLE, YOU WRITE DOWN THE AGES OF THE PATIENTS THAT GET THE INTERVENTION BUT, I MEAN, IT'S REALLY POSSIBLE THAT AN INTERVENTION MIGHT HAVE A HUMELY DIFFERENT EFFECT IN AN OLD PERSON IT WILL HAVE IN A YOUNG PERSON FOR THE SAME REASON. >> I THINK THE RESPONSE TO THAT WOULD BE, AND I THINK EVERYBDY HERE, FOR FUNDING AGENCIES AND SOCIETIES WITH SCIENTISTS IN IT, FOR US, WE HAVE THREE SCIENTIFIC REVIEW COMMITTEES AND THEY LOOK FOR THAT. THEY MAKE SURE THAT THE PROJECTS THAT THEY RECOMMEND FOR FUNDING, THE MICE ARE TWO YEARS OLD, OR THAT THEY'RE THE OLDER MICE. >> THEY RECOMMEND IT, BUT A LOT OF PEOPLE DON'T DO IT. >> YEAH, YEAH, AND SO THE FUNDING -- YOU KNOW, AS FUNDING AGENCIES, WE CAN TRY AND INSIST THAT IF THEY'RE LOOKING AT OLDER -- BUT ALSO I THINK MAYBE IF WE WANTED TO, LOOK AT OUR PROGRAM, YOU KNOW, FOR VISION PROGRAMS, IT'S TWO YEARS. MAYBE WE SHOULD BE EXTENDING IT ANOTHER YEAR, IF THE RESEARCHERS NEED TO AGE OUT THEIR MICE, MAYBE THE GRANTS NEED TO BE A LITTLE BIT LONGER, BUT THAT'S JUST THINGS THAT WE CAN THINK ABOUT. >> I JUST WANTED TO POINT OUT THAT THE GEROSCIENCE INTEREST GROUP IN THE VERY FIRST SUMMIT CAME OUT WITH A RECOMMENDATION AROUND AGED MICE AND IT WAS APPROVED BY THE ADVISORY COUNCIL ON AGING AND SO I MEAN, IT'S BEEN OUT THERE, BUT I AGREE WITH YOU, CYNTHIA, THAT IT'S NOT WIDELY -- AS WIDELY ADOPTED AS IT COULD BE BUT SOME OF THE INSTITUTES REALLY HAVE TAKEN IT UP SO THERE HAS BEEN MOVEMENT ON IT AND I THINK THIS IS LIKE THE NEXT STEP TO KIND OF GET MORE AWARENESS OF IT AND GET ALL OF US BEHIND TO GET MORE FOLKS DOING IT. >> THE COUNCIL APPROVED IT, THE RFA WAS PUT OUT BUT AS WAS JUST MENTIONED, IT TAKES FOUR YEARS TO AGE A MOUSE. SO WE DON'T HAVE THE RESULTS YET BUT THEY SHOULD COME SOON. I JUST WANTED TO MAKE ONE POINT, THE COUNTER ARGUMENT TO WHAT CYNTHIA SAID, WHICH OF COURSE I 100% AGREE WITH, THE COUNTER ARGUMENT IS, IT'S SO EXPENSIVE AND IT TAKES SO LONG, HOW DO YOU GET A GRADUATE STUDENT TO COMMIT TO THAT? MY ANSWER IS, YEAH, IF YOU WANT TO DO RESEARCH ON CANCER OR WHATEVER THIS IS, DO IT IN YOUNG MICE, THAT'S FINE. BUT THE MOMENT YOU SAY THE WORD TRANSLATION, THAT'S WHEN YOU HAVE TO USE AN OLD MOUSE. SO A LOT OF WORK CAN BE DONE, THE BASIC WORK, WHETHER YOUR PROTEIN GETS PHOSPHORYLATED IN -- OR NOT, DO IT IN A YOUNG MOUSE. BUT THE MOMENT YOU SAY TRANSLATION, A YOUNG MOUSE IS NO GOOD AND THAT'S WHEN YOU HAVE TO CHANGE. BY THE WAY, FINDING OUT AT THAT STAGE THAT YOUR TREATMENT DOES NOT REALLY WORK IS A LOT CHEAPER AND A LOT FASTER THAN GOING THROUGH THE CLINICAL TRIAL AND FINDING OUT THAT IT DOESN'T WORK. >> SO PHILLIPPE HAD THE LAST WORD ON THAT QUESTION SO WE'LL GO TO THE NEXT QUESTION OVER THERE. >> WILLIAM DELL. I JUST WANT TO ASK THE PANEL, WE TEND TO TALK ABOUT THESE COLLABORATIONS IN TIME, LIKE LET'S GET AT A CONFERENCE TOGETHER AND TALK, BUT IT SEEMS LIKE THE CHANGE IN POLICY, FOR EXAMPLE, AT THE FDA AND THE NIH FOR CHANGING THE ELIGIBILITY CRITERIA OR REDEFINING AGE IN SPECIFIC WAYS THAT MATTER BEYOND JUST PUTTING DOWN A NUMBER BUT CHARACTERIZING IT IN SOME WAY, AS THOSE POLICY CHANGES HAPPEN, CAN WE THINK OF WAYS TO COORDINATE OVERTIME SO NEXT YEAR IF WE'RE ALL WORKING ON THE SAME PROBLEM, EVEN IF IT'S NOT ALL AT THE SAME TIME, SO I WONDER ABOUT -- WE ALL GO TO WAY TOO MANY CONFERENCES, MAYBE I'M SPEAKING FOR MYSELF BUT YOU SEE THIS SAME THING KIND OF OVER AND OVER, BUT NOBODY SEQUENCING WHAT THEY DO ACROSS THE DIFFERENT EFFORTS. SO I JUST WONDER, CAN WE THINK OF WAYS TO DO THAT SO WE'RE AT A CONFERENCE LIKE THIS BUT IN DIFFERENT DISEASE TYPES. SO I'LL THROW TO THE GROUP TO THINK ABOUT THAT. I KNOW OF ONE GOING ON BETWEEN CANCER AND CARDIOLOGY UNDER A U13 GRANT WHICH THEY'RE GOING TO LOOK AT THOSE COMMONALITIES. THAT SEEMED LIKE A SMART WAY TO START BRINGING THESE DISEASES TOGETHER. THESE SMALL POTTS OF MONEY AT ONE POINT IN TIME FEELS LIKE WE'RE ALWAYS GOING TO BE DOING SMALL THINGS RATHER THAN A BIGGER COORDINATED THING ACROSS A GROUP OF PEOPLE WHO ARE ALL INTERESTED IN THE SAME ISSUES. >> -- THAT RELATED TO THE POLICY TYPES OF POSITIONS, EACH YEAR WE'VE BEEN HAVING A ROUNDTABLE PRIOR TO OUR ANNUAL DINNER, AND EACH YEAR THE HEAD OF THE CENTER FOR DRUG AND EVALUATION RESEARCH, DR. JANET WOODCOCK, HAS BEEN AT THIS EVENT AND EACH YEAR I HAVE ASKED HER A QUESTION RELATED TO GEROSCIENCE AND ALSO TO THE GERIATRIC MEDICINES INITIATIVE AT THE EMA AND MY STRIKE STRATEGY HAS BEEN TO GRADUALLY WEAR HER DOWN. SHE HAS ABSORBED IT OVER THE YEARS, BUT I DO THINK THAT, YOU KNOW, SO I THINK THERE'S -- AND THERE'S CERTAINLY BEEN OTHER EFFORTS WITH THE FOLKS WHO ARE SUPPORTIVE OF LOOKING AT METFORMIN, ORGANIZED A MEETING WITH FDA, EIA HAS HAD DIRECT MEETING WITH FDA AS WELL BECAUSE THERE ARE FRAMEWORK IRK EUS HERE THAT WE HAVE TO WORK ON TOGETHER. BUT PART OF THE PURPOSE OF THIS MEETING AND I THINK OF THE EXECUTIVE COMMITTEE IS TO KIND OF COME TOGETHER AROUND THESE THINGS AND FIGURE OUT WHAT CAN WE DO IN THE NEXT COUPLE OF STEPS TO OPERATIONALLIZE THESE THINGS. I THINK IN TERMS OF LIKE A GERIATRIC MEDICINES INITIATIVE, FOR EXAMPLE, THAT CAN BE DONE LEGISLATIVELY TO SORT OF PUSH THE AGENCY AND I THINK CHANGING LIKE SOME OF THE QUALIFICATIONS AROUND CLINICAL TRIALS, THEY'RE GOING TO NEED THAT NUDGE TO GET RID OF AGE RESTRICTIONS AND ALL THAT. SOME OF THE OTHER ISSUES COULD BE ADDRESSED IN LIKE THE CREATION OF A COALITION. I THINK EVEN IF YOU'RE NOT GOING TO THE EXECUTIVE COMMITTEE MEETINGS, THEY'RE A PART OF THIS MEETING, IF YOU EXPRESS YOUR INTEREST TO THE FOLKS AT THE REGISTRATION TABLE AND SAY YOU WANT TO STAY IN TOUCH AND TRY TO BE HELPFUL, LET FOLKS NOW AND AS RECOMMENDATIONS COME OUT AND EFFORTS START TO GEL, WE'LL GET IN TOUCH. >> ONE OF THE COMMENTS I WANTED TO MAKE, MANY RARE DISEASES ARE RELATED, FOR INSTANCE, PEOPLE WITH DIABETES ARE MORE LIKELY TO HAVE DEPRESSION OR DEMENTIA, MORE LIKELY TO HAVE CANCER, MORE LIKELY TO HAVE BONE DISEASE, WE TALK ABOUT, ALZHEIMER'STHAT DISEASE, SO IN SOME WAY, THESE ARE ALREADY DISCUSSED BUT PERHAPS NOT IN THE PARADIGM THAT WE'RE TALKING ABOUT OF TODAY AS PART OF OF GEROSCIENCE, MAYBE SOMETHING MORE OF A PARADIGM SHIFT, THEY'RE ALL RELATED THROUGH THIS PROCESS THAT'S CENTRAL AND IN THAT WAY, WE CAN ADDRESS ALL OF THEM IN A UNIFIED WAY. SO I THINK KEEPING THE DISCUSSIONS GOING OVER TIME AND CONTINUING TO EDUCATE OUR COLLEAGUES ALSO WHO AREN'T HERE TODAY OR WATCHING US THROUGH THE TELESCREEN TODAY ABOUT WHAT GEROSCIENCE IS SO THEY CAN UNDERSTAND AS WELL THE PRINCIPLES THAT WE'RE TALKING ABOUT. >> THIS IS A QUESTION FOR SUE. WHAT CHALLENGES AND OPPORTUNITIES DO YOU SEE FOR FORGING WITH INDUSTRY BASIC AND TRANSLATIONAL RESEARCH? MY ORGANIZATION HELPED ORGANIZE A CONFERENCE A FEW WEEKS AGO HERE IN WASHINGTON ON OBESITY. WE HAD A COUPLE BIG PHARMA AND COUPLE NUTRITION COMPANIES SHOW UP BUT GENERALLY WHEN WE TALK TO BIG PHARMA, THEY SAY WAKE US UP WHEN THERE'S A CLEAR REGULATORY PATHWAY, WHERE WE KNOW WHICH SALES FORCE DEVELOPMENT BAG WE PUT IT IN. IT SOUNDS LIKE A WONDERFUL THING TO DO, DO YOU HAVE ANY THOUGHTS ABOUT HOW TO PROMOTE THAT WITH INDUSTRY, AT THIS STAGE? >> WE DO. ACTUALLY A MEETING DID OCCUR WITH THE FOUNDATION FOR THE NIH AND SOME OF THE COMPANIES, WITH SOME OF THE REPRESENTATIVES FROM THE GEROSCIENCE INTEREST GROUP I THINK MAYBE TWO YEARS AGO NOW, AND THERE WERE SOME REQUESTS MADE BY THE COMPANIES OF THINGS THAT THEY'D BE INTERESTED IN. THERE WERE LARGE PHARMACEUTICAL COMPANIES THERE AND SMALLER BIOTECHS THAT WERE THERE. THERE'S TREMENDOUS OPPORTUNITY FOR PUBLIC PRIVATE PARTNERSHIP IN THIS AREA. UNFORTUNATELY THERE WAS NOT FORWARD MOVEMENT ON THAT EFFORT AND I WOULD REALLY LIKE TO SEE THAT REJUVENATED AGAIN, SO HOPEFULLY MAYBE ONE OF THE THINGS THAT COMES OUT OF THIS SUMMIT IS THAT WILL BE REJUVENATED. I KNOW THAT THERE ARE SOME COMPANIES HERE AND THEN THERE ARE A LOT OF OTHERS THAT ARE NOT IN THE ROOM, MAYBE HOPEFULLY WATCHING, CERTAINLY TUNED IN IN TERMS OF THEIR CLINICAL DEVELOPMENT INTO THESE ISSUES, AND THERE IS WIDESPREAD INTEREST SO THERE'S A LOT OF OPPORTUNITY THERE. >> SO I'D LIKE TO FOLLOW UP ON THAT, JOE MENETSKI FROM FNIH. PRIVATE PARTNERS DON'T HAVE TO BE BIG PHARMA. AND SO YOU KNOW, WHEN YOU JUST TALK ABOUT PRIVATE PARTNERS GOING INTO INDUSTRY AND NEEDING A REGULATORY PATH, YOU'RE ABSOLUTELY RIGHT. IF YOU WANT TO GET, YOU KNOW, A DRUG, YOU'VE GOT TO HAVE A PATH. THAT'S WHO YOU GO TO. BUT IN ORDER TO HELP PEOPLE, WHICH IS WHAT I THINK WE'RE HERE TO DO, YOU HAVE TO SEE THE COMMITMENT OF THE -- IN THIS CASE, AND I WAS SITTING HERE THINKING, THE FOLKS THAT ARE ON THE DAIS NOW, TO SAY I'M GOING TO COMMIT MY SOCIETY OR MY ASSOCIATION TO WORK TOGETHER IN ORDER TO DO THIS, AND SO I DON'T MEAN TO TOSS IT ALL BACK TO YOU GUYS, AND I JUST DID, I'M SORRY, BUT, YOU KNOW, IN ORDER TO -- SOMETIMES IN ORDER TO GET THESE THINGS STARTED, YOU NEED TO HAVE THAT COMMITMENT, WHAT YOU'D CALL THE GROUND ROOTS, THE FOLKS WHO ARE ACTUALLY THERE DEALING WITH PATIENTS AND SAYING THIS IS A PORTION OF MY INTEREST AND I'M GOING TO MAKE SURE WE DO THIS TOGETHER. I MEAN, FNIH IS OBVIOUSLY HAPPY TO ENTERTAIN THINGS, BUT WHEN IT COMES RIGHT DOWN TO IT, THERE HAS TO BE A VERY CLEAR, DIRECT END POINT FOR A PUBLIC PRIVATE PARTNERSHIP, BUT THE PRIVATE FOLKS CAN BE -- IT'S NOT JUST -- IT COULD BE INSURER, IT COULD BE MICROSOFT FOR -- I MEAN, APPLE, YOU KNOW, IT'S NOT LIMITED TO JUST THAT SPACE. >> NEXT QUESTION, PLEASE? >> HI THERE. I'M A DNP AND A PH.D. STUDENT OVER AT THE SCHOOL OF NURSING AT JOHNS HOPKINS. IT'S A LITTLE BIT TWO PRONGED OF A QUESTION, BUT IT ENCOMPASSES THE WORKFORCE DEVELOPMENT THAT A FEW OF YOU HAVE MENTIONED. IN ORDER TO GET A FOUNDATION IN TRAINING BOTH SCIENTIFIC DISCOVERY AS WELL AS BEING A NURSE PRACTITIONER IN GEROSCIENCE, ARE THERE DIFFERENT GRANTS COMING FROM YOU GUYS? I KNOW WE HAVE THE F30 AND THE F31 FOR DISSERTATION GRANTS WITH THE NIH, BUT DO YOU GUYS SEE ANY DIFFERENCES IN FUNDING NURSE PRACTITIONERS OR FUTURE PH.D.s IN THAT SENSE FOR GERO SCIENCE? AND ARE TRAINING TO MAKE SURE THAT WE CAN GIVE OUR PATIENTS THE BEST GERIATRIC CARE? WHETHER THAT BE TRAVEL FUNDING, THINGS LIKE THAT. >> SO QUESTION IS ABOUT FUNDING, I GUESS I CAN TAKE THAT. SO FIRST OF ALL, IT WAS VERY IMPORTANT TO POINT OUT THAT THE WHOLE CONCEPT OF GERO SCIENCE WAS CREATED AS A WAY OF COLLABORATING BETWEEN DIFFERENT INSTITUTES WITH THE PROMISE THAT WE DON'T WANT ANYBODY'S MONEY. SO BASICALLY TO INCREASE THE FUNDING IN GEROSCIENCE AS SUCH, IT WOULD NEED COMMITMENT BY THE OTHER INSTITUTES WHICH AT THE MONEY LEVEL IS NOT THERE YET. SO SORRY TO SAY THAT. HOWEVER, HAVING SAID THAT, IF YOU ARE -- THE WAY THAT WE CALL HOW OUR GRANTS -- WHAT AREAS THEY COVER, IF WE LOOK AT AGING FUNDING, BY INSTITUTES THAT ARE NOT THE NIA, IN THE FIRST FIVE YEARS OF THE GEROSCIENCE GROUP, THAT FUNDING DOUBLED, EXACTLY DOUBLED, ACTUALLY. SO WHAT OTHER INSTITUTES WE'RE FUNDING IN TERMS OF AGING, WAS TWICE AS MUCH. I DON'T KNOW WHAT IT IS NOW. SO THERE IS HOPE, YES, THAT BY THE TIME YOU FINISH, EVERYTHING SHOULD BE OKAY. BUT IT IS A SLOW PROCESS. >> AND ALSO, IF YOU WANT TO GO INTO THE GEROSCIENCE FIELD, DON'T LIMIT APPLYING FOR GRANTS THAT HAVE GEROSCIENCE IN THE TITLE OF THEIR FOUNDATION. SO AT BRIGHTFOCUS, AS LOOKING BACK IN THE PORTFOLIO, I THINK WE HAVE A NUMBER OF PEOPLE WHO ARE IN -- I THINK I COUNTED AT LEAST 10 IN THE LAST FEW YEARS, WE WERE FROM EITHER GEROSCIENCE DEPARTMENTS OR WHO ARE GEROSCIENTISTS THEMSELVES AND LOOKING AT PARTICULAR HYPOTHESES AND SO I THINK THAT YOU CAN -- YEAH, DON'T DISCOUNT PULLING THAT IDEA FROM ANOTHER FUNDING AGENCY. >> AND JUST A FOLLOW-UP ON YOUR QUESTION PERTAINING TO WORKFORCE DEVELOPMENT, YES, THAT IS DEFINITELY SOMETHING THAT'S VERY IMPORTANT TO AGP RECOGNIZING THERE'S A SHORTAGE IN THE WORKFORCE FOR MANY OF THE ISSUES WE'RE TALKING ABOUT TODAY. SO AGP DOES NOT FUND RESEARCH LIKE YOU'RE TALKING ABOUT, THE PREDOCTORAL F32 POST DAK TO RECALL. HOWEVER, AAGP MEMBERS, AS I ALLUDED TO DURING MY PRESENTATION, HAVE BEEN VERY MUCH AT THE FOREFRONT OF LEADING NIH-FUNDED R25 TRAINING PROGRAMS SPECIFICALLY FOR DEVELOPMENT OF YOUNG RESEARCHERS. SO PEOPLE COMING FROM POSTDOC, LOOKING TO GET K AWARDS, PEOPLE GOING FROM K TO R, AND SO THAT'S WHY WE HOST A LOT OF EVENTS EVERY YEAR AT OUR MEETING TO PUT ALL OF THOSE PEOPLE TOGETHER NOT ONLY TO INTRODUCE NEW PEOPLE INTO THE PROGRAMS BUT TO HELP PEOPLE WHO ARE CURRENTLY IN THE PROGRAMS TALK TO EACH OTHER AND FORGE COLLABORATIONS. I KNOW ONE OF THE GRADUATES FROM THAT PROGRAM IS MY COLLEAGUE DR. DINEZ WHO IS NOW VERY WELL FUNDED BY TO DO GEROSCIENCE MENTAL HEALTH RESEARCH, THEY DON'T NECESSARILY COME WITH THE LABEL OF GEROSCIENCE BUT IT'S A PLATFORM FOR PEOPLE TO GROW THEIR CAREERS IN THAT REGARD. SO I THINK OUR ORGANIZATION IS AN EXAMPLE OF HOW YOU CAN SUPPORT THAT WITHOUT NECESSARILY FUNDING GRANTS DIRECTLY. >> THIS MIGHT SEEM LIKE ANOTHER SHAMELESS PROMOTION OF WHAT WE OVER BUT IF I'M USING MYSELF AS DB OUR ORGANIZATION AS AN EXAMPLE, WE HAVE OUR ALZHEIMER'S FAST TRACK OR GLAUCOMA FAST TRACK AND NOW MACULAR FAST TRACK THAT'S GOING TO HAPPEN IN 2020, SPECIFICALLY FOCUSED ON EARLY CAREER SCIENTISTS, ALTHOUGH SEASONED INVESTIGATORS CAN COME AS WELL, AND YOU WILL BE ABLE TO LEARN ABOUT THE DIFFERENT DISEASES ON WHICH THEY'RE PARTICULARLY FOCUSING. WE HAVE ACTUALLY HAD PEOPLE IN GERONTOLOGY AND NURSE PRACTITIONERS COME TO SOME OF OUR PAST FAST TRACKS JUST TO GET A LITTLE BIT OF A BOOT CAMP ON THOSE DIFFERENT DISEASES AS WELL, SO DON'T DISCOUNT THAT. >> SO I GUESS MY QUESTION IS, WITH THE EARLY SCIENTIST, THOUGH, DOES THAT INCLUDE PREDOCTORAL OR IS THAT JUST FOR >> OH, YEAH, WE'VE ACTUALLY HAD SOME UNDERGRADUATE STUDENTS COME TO IT TOO, SO JUST BECAUSE IT SAYS GRADUATE STUDENTS DOESN'T MEAN THAT YOU CAN'T APPLY. >> I THINK JUST ABOUT EVERY PROFESSIONAL ORGANIZATION HAS PROGRAMS TO INVEST IN THE NEXT GENERATION SCIENTISTS, OTHERWISE THE ORGANIZATION WON'T LAST SO YOU NEED TO FEED THE ORGANIZATION WITH YOUNG PEOPLE. AND SO THAT'S REALLY AN IMPORTANT REASON WHY YOU SHOULD GO TO THESE PROFESSIONAL SOCIETY MEETINGS, WHATEVER INTERESTS YOU, BECAUSE THERE WILL BE GRANT WORKSHOPS YOU CAN PARTICIPATE IN, YOUR NETWORK, MOST ORGANIZATIONS WILL OFFER TRAVEL AWARDS TO TOP RATED ABSTRACTS AND SO IN THAT WAY, IT'S PROMOTING BUT IT'S NOT AT THE LEVEL OF -- FOR MOST ORGANIZATIONS, THE F31 OR F32-TYPE FUNDING. >> GREAT. WE HAVE ANOTHER QUESTION. >> LET'S . A FOLLOW-UP COMMENT. IT SEEMS LIKE A TREMENDOUS -- IT'S VERY, VERY DIFFICULT FOR US TO BREAK DOWN THESE SILOS BETWEEN THE TISSUE DISEASE, THE ORGAN DISEASE, THE NIH FUNDING MECHANISMS, BUT I WANTED TO ADD THIS OPTIMISTIC NOTE, AND THAT IS WHEN STUDENTS USED TO COME TO INTERVIEW FOR OUR PH.D. PROGRAM, I WOULD SPEND -- OR ABOUT 15 MINUTES TO EXPLAIN TO THEM THE GEROSCIENCE CONCEPT, THE IDEA THAT AGING WAS THE UNDERLYING CAUSE OF MULTIPLE AGE-RELATED DISEASES AND IF YOU INTERVENE ON AGING, YOU MIGHT SEAT RESULTS IN BONE AND BRAIN AT THE SAME TIME. THE STUDENTS THAT COME THROUGH NOW FOR INTERVIEW SAY, YEAH, I KNOW, THAT'S WHY I'M HERE. THERE IS A GENERATION OF STUDENTS COMING THROUGH WHO COMPLETELY GET THIS, AND I WOULD IMAGINE IN A FEW YEARS TIME, THE HEADS OF THESE WONDERFUL ORGANIZATIONS WILL CALL THEMSELVES GEROSCIENTISTS. >> AGREE. I JUST HAD A CONVERSATION WITH DR. BAKER ABOUT THAT EARLIER TODAY. SO I THINK ES -- THE STUDENTS GET IT, THAT'S WHY THEY COME AND INTERVIEW AT OUR GRADUATE PROGRAMS. WE SEE THE SAME THING IN REGENERATIVE MEDICINE, REGENERATIVE SCIENCES, SO MAYBE THERE'S TWO SIDES OF THE SAME COIN A LITTLE BIT, BUT THE YOUNG PEOPLE ARE ATTUNED, JUST LIKE THOSE THAT COME TO MAJOR ACADEMIC MEDICAL CENTER, THEY GO THERE BECAUSE OF THE RESEARCH AND EXPERTISE THAT'S THERE SO FOLLOWING UP ON AN EARLIER QUESTION, THAT'S WHY THERE'S A LOT OF EXPECTATIONS ON US. TO CHANGE THE WAY WE TYPICALLY DO THINGS AND EVOLVE AS THE SCIENCE EVOLVES. >> IF I THINK I WOULD LIKE TO ADD ONE THING I MIGHT DO DIFFERENTLY WHEN WE'RE THINKING, I'M GOING TO DEFINITELY THINK ABOUT HAVING A SPEAKER TALK ABOUT GEROSCIENCE AT THESE FAST TRACKS IN THE FUTURE, SO THAT'S ONE DIFFERENT OUTCOME FROM HAVING THIS MEETING. >> JUST A WORD FROM TRAINING CLINICIAN SCIENTIST. WE HAVE A LONG WAY TO GO IN THE WORKFORCE TO ATTRACT THE NEXT GENERATION OF GEROSCIENTISTS FROM THE CLINICAL REALM. THEY'RE STILL VERY DISEASE-FOCUSED, AND WHEN WE'RE OUT THERE TALKING ABOUT AGING, IT'S FAR INTO THEM, SO I THINK THE EDUCATION NEEDS TO 50 BACK, GEROSCIENCE NEEDS TO PERMEATE INTO THE FUNDAMENTAL TRAINING OF CLINICIANS, NURSE CLINICIANS, PHYSICALLY NICHES, IN ORDER TO HAVE A FOUNDATION, OTHERWISE IT'S VERY FOREIGN WHEN THEY SEE SPECIALISTS WHO ARE ORGAN-SPECIFIC SPECIALISTS AND THEY STILL THINK THAT WAY. SO I THINK THAT'S A REAL AVENUE FOR GETTING THE GEROSCIENCE EDUCATION TO BE DISSEMINATED A LITTLE BIT INTO THE FORMATIVE YEARS. >> GORDON, I AGREE WITH THE COMMENT THAT YOU MADE BUT I WOULD SAY WE'RE NOT AS SILOED AS YOU MAY THINK, AT LEAST NOT IN WASHINGTON, D.C. OR AT THE NATIONAL LEVEL, A LOT OF THE GROUPS WORK TOGETHER, I DON'T KNOW IF YOU HEARD ABOUT 21ST CENTURY CURES LEGISLATION, THERE'S NOW A 2.0 THAT'S BEING CONSIDERED, AND THE HOUSE SIDE, THE USER FEE LEGISLATION THAT WRAPS AROUND VERY PATIENT CENTRIC PROVISIONS EVERY FEW YEARS FOR THE GOOD AND DRUG INFORMATION, FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH ACTUALLY WOULDN'T HAPPEN AND WOULDN'T HAVE INCREASED SO SIGNIFICANTLY IF ALL THESE DIFFERENT DISEASE-SPECIFIC GROUPS DIDN'T WORK TOGETHER. SO THE SILOS DO BREAK DOWN. I UNDERSTAND WHAT YOU'RE TALKING ABOUT RELATED TO GEROSCIENCE BUT THE ONE OTHER THING I DO WANT TO SAY IS THE DISEASE-SPECIFIC RESEARCH IS ALWAYS GOING TO BE IMPORTANT. YOU DON'T GO TO THE DOCTOR AND THE DOCTOR SAYS TO YOU, I'M DIAGNOSING YOU WITH AGING. THEY DIAGNOSE YOU WITH CANCER OR HEART DEEDS DISEASE OR DIABETES, AND THE DYNAMIC BETWEEN THE TWO, I THINK WE'RE JUST SORT OF WALKING A VERY IMPORTANT LINE, AND WE HAVE TO BOOST EACH OTHER UP AND THAT'S HOW THIS IS GOING TO EVENTUALLY HAPPEN TOGETHER. THAT'S HOW WE'LL BE SUCCESSFUL. >> OKAY. MAYBE ONE MORE BRIEF QUESTION. I'LL POINT OUT THAT WE'RE NOW 8 MINUTES OVER OUR ALLOTTED TIME, BUT DON'T WORRY, WE'RE BEING PAID OVERTIME, WE'LL TAKE CARE OF IT. >> PERSONAL DISCOVERY FOR ME THIS YEAR, 2019, SIXTH INTERNATIONAL GEROSCIENCE MEETINGS WAS AROUND -- CALIFORNIA, MOVING TO AUSTRALIA, CHINA, ISRAEL, CHILE, ET CETERA. FIRST MY DISCOVERY, I DIDN'T KNOW ABOUT THIS. BEFORE I KNEW, GERONTOLOGY, BUT GEROSCIENCE WAS NEW FOR ME TOO. MY QUESTION IS SIMPLE, DO WE HAVE ANY INTERNATIONAL GEROSCIENCE SOCIETY? IF NO, WHAT DO YOU THINK ABOUT THIS? >> SINCE I WAS THE CO-ORGANIZER OF THIS SIXTH OR SEVENTH -- ACTUALLY IT WAS MEANT TO BE SEVENTH BUT THE ONE IN CHILE THE NEXT COUPLE OF WEEKS WAS CAP SELLED CANCELED BECAUSE OF THE TURMOIL THERE, SO SIX MEETINGS. SO NO, THERE'S NO INTERNATIONAL SOCIETY FOR GEROSCIENCE, HOWEVER, THAT WAS THE PURPOSE OF HAVING THESE MEETINGS AND WE ARE WORKING ON HOW TO CONDITION THAT AND THANKS FOR THE SUGGESTION ACTUALLY FORMING AN INTERNATIONAL COALITION MIGHT BE THE RESPONSE. >> THANK YOU. SO AS THE CHAIR, I'M GOING TO MAKE THE FINAL QUESTION. FIRST I WANT TO THANK ALL THE SPEAKERS. I REALLY ENJOYED ALL OF YOUR TALKS, I WAS REALLYIMPRESSED BY ALL THE ACTIVITIES THAT THE SOCIETIES YOU'RE REPRESENTING ARE ACCOMPLISHING AND DOING IN THE AGING SPACE, AND EVERYTHING THAT YOU ARE DOING. IT REALLY WAS WONDERFUL TO HEAR. BUT NOTHING IS PERFECT, RIGHT? WHAT I WANT TO HEAR NOW ARE YOUR COMPLAINTS. WHAT DO YOU SEE AS A CHALLENGE OR A BARRIER IN YOUR ACTIVITIES TO BRING AGING AND YOUR DISEASE TOGETHER >> IF YOU COULD BE KING OF THE WORLD FOR A DAY, WHAT WOULD YOU LIKE TO BE SEEING DONE IN ORDER TO MORE RAPIDLY ADVANCE RESEARCH IN THIS AREA? DOUGLAS, I'LL START WITH YOU FIRST. AND MAYBE A POSSIBLE SOLUTION, WHETHER THE NIH PERHAPS COULD SERVE A ROLE OR SOME OTHER ENTITY SERVE A ROLE IN HELPING CATALYZE MAKING MORE RAPID PROGRESS. >> IT'S A DIFFICULT QUESTION TO END THE SESSION ON. >> AND LET ME SAY, MAYBE YOU SAID THAT BEFORE, BUT SAY IT AGAIN, BECAUSE THE MORE TIMES WE HEAR IT, IT SINKS IN, AND AS YOU GO DOWN THE PANEL HERE, IT'S OKAY TO REPEAT THE -- IF YOU HAVE THE SAME CONCERN AS SOMEONE ELSE, THAT'S OKAY TOO, BECAUSE THAT MAKES US -- IT REGISTERS THAT IRN EU EVEN MORE SO -- >> SO WHAT WOULD BE OUR -- JUST ONE MORE TIME, WHAT IS THE QUESTION? >> WHAT DO YOU SEE AS YOUR BIGGEST CHALLENGE? >> BIGGEST CHALLENGE. >> IN BRINGING THE AGING BIOLOGY AND DISEASE FOCUS TOGETHER IN THE SOCIETY YOU REPRESENT, AND WHAT COULD YOU DONE TO HELP MEND THAT? >> WELL, IN THE AMERICAN SOCIETY FOR BONE AND MINERAL RESEARCH, AS I POINTED OUT, THERE ARE ALREADY QUITE A LOT OF ACTIVITIES AND SO I DON'T SEE THIS AS A DESERT IN OUR SOCIETY, I SEE A LOT OF INTEREST IN THIS AREA. OUR PREMEETING IS FUNDED BY A MEETING GRANT, AND ONE OF THE TOPICS IS ON AGING IN THE SKELETON, SO I THINK WE ARE ON A GOOD TRAJECTORY, I THINK ADDITIONAL FUNDING ALWAYS GOES A LONG WAY, AND THAT CAN COME FROM WITHIN OUR INDIVIDUAL ORGANIZATIONS AS WELL AS FROM EXTERNAL FOUNDATIONS, ET CETERA. SO I THINK WE'RE ON THE RIGHT ROAD, AND I WOULD JUST WISH THAT WE KEEP THIS MOMENTUM GOING IN OUR OWN SOCIETY. >> SO I WAS VERY STRUCK BY A COMMENT THAT WAS MADE NOT LONG AGO ABOUT HOW THE YOUNG PEOPLE GOING INTO GRADUATE PROGRAMS NOW, THEY SORT OF GET IT WHEN IT COMES TO GEROSCIENCE AND JUST SORT OF THINKING ABOUT WHY THAT MIGHT BE, AND THEY'RE PART OF A GENERATION THAT'S BEEN RAISED ENTIRELY WITH THE INTERNET, AND THEY THINK IN TERMS OF INTERCONNECTIONS NETWORKS, INTEGRATION, THAT'S HOW THEIR BRAINS ARE WIRED. AND I DON'T THINK THEY'RE GOING TO BE AS SILOED AND DISEASE-FOCUSED BECAUSE OF HOW THEY'VE BEEN BROUGHT UP, FROM THE GROUND UP. AND I THINK THAT THAT IS AN ISSUE THAT CERTAINLY AFFECTS GERIATRIC PSYCHIATRY OR THINK HAS BEEN A BARRIER IN TERMS OF INTEGRATING GEROSCIENCE CONCEPTS TO THE EXTENT THAT THERE STILL IS VERY MUCH A TRADITION NA IS ALL THAT IS ALL ABOUT THE BRAIN, AND I THINK GETTING PEOPLE TO BELIEVE THAT YOU CAN PULL IN THESE MORE SYSTEMS-ORIENTED GEROSCIENCE CONCEPTS INTO ADDRESSING WHAT WE THINK OF AS BRAIN DISORDERS, DEPRESSION AND OTHER PSYCHIATRIC DISORDERS AND NEURODEGENERATIVE DISEASES, IS SOMETHING THAT'S STILL A BIT OF A BARRIER, SO I THINK FOR OUR ORGANIZATION, CERTAINLY COMMUNICATING INTEREST AND THE RELEVANCE OF GEROSCIENCE IS IMPORTANT, AND THAT IS PART OF WHY IT ENDED UP BEING FRONT AND CENTER AS THE BIOLOGY OF AGING WAS OUR NEUROSCIENCE TEACHING DAY TOPIC FOR THE DAY. AND PROMOTING THAT KIND OF THING, I THINK IS GOING TO BE VERY IMPORTANT FOR OVERCOMING THOSE BARRIERS. CERTAINLY HAVING OBVIOUSLY FUNDING, OPPORTUNITIES ADDRESSING CERTAINLY WILL STIMULATE THAT AS WELL, BUT I THINK OVERCOMING THE SORT OF MENTAL HURDLE, I THINK IS GOING TO BE IMPORTANT. >> THANK YOU. >> OKAY. SO I DON'T KNOW IF I'M ANSWERING THE QUESTION RIGHT, BUT I'LL SAY I THINK ONE OF THE BIGGEST CHALLENGES TO REALLY -- AT LEAST AS IT RELATES TO THE AMERICAN SOCIETY OF CLINICAL PSYCHOLOGY, BEING A CLINICAL SOCIETY WITH A FOCUS ON PRIMARILY THE LARMEST LARGEST FOCUS IS ON TREATING CANCER AND TAKING CARE OF THE COMMUNITY OF CANCER PATIENTS DURING THEIR CANCER TREATMENTS DURING THEIR SURVIVOR SHIP PERIOD, THERE IS A FOCUS ON PREVENTION. THAT BEING SAID, AGING ACROSS THE ENTIRE CANCER CARE CONTINUUM AS YOU THINK ABOUT CANCER RESEARCH IS REALLY, I THINK, STILL THOUGHT OF AS POTENTIALLY A BARRIER POTENTIALLY TO A RAPID PACE OF DISCOVERY WITH RESPECT TO PARTICULARLY NEW CANCER TREATMENTS. SO THERE'S A BIT OF A DISINCENTIVE TO FOCUS ON THE COMPLEXITY OF THE OLDER PATIENT, THE OLDER PATIENT POPULATION. I REALIZE THAT THAT DOESN'T QUITE ADDRESS THE GEROSCIENCE ISSUE BUT AS A CLINICAL SEE IT SOCIETY IS LOOKING AT THIS AS WE THINK ABOUT ITS MEMBERSHIP AND HOW EVERYONE'S BEEN TRAINED, AGING IS STILL PUT OVER HERE IN THE CORNER. AND ALSO WE HAVE THE OLDER ADULTS. SO I GUESS WHAT I WOULD LIKE TO SEE PIE IN THE SKY IS THAT AGING RESEARCH OVERALL IN ANY OF OUR SOCIETIES AND CERTAINLY AT ASCO GETS AS MUCH ATTENTION AS AGING ITSELF AFFECTS THE COMMUNITY, WHICH MEANS IT SHOULD REALLY THE PREDOM NAPT DISCUSSION PREDOMINANT DISCUSSION WE'RE HAVING, AGAIN STARTING WITH PREVENTION, AND THAT'S WHERE I REALLY SEE GEROSCIENCE BEING ABLE TO INFLUENCE THOUGHT PATTERNS IF WE MOVE A GEROSCIENCE DISCUSSION INTO THE PREVENTION SETTING AND THEN IT INFILTRATES THROUGHOUT THE CANCER CARE CONTINUUM ALL THE WAY THROUGH SURVIVORSHIP. SO THAT WOULD BE MY PIE IN THE SKY. I REALIZE WE'RE WORKING ON THAT AND THEN, OF COURSE, MY PERSONAL GOAL WOULD BE AS WE MENTIONED, I'M JUST GOING TO SAY IT AGAIN, YOU SAID I CAN REPEAT MYSELF AND I DO, A LOT, BUT IF WE COULD JUST ENROLL SOME MORE PATIENTS THAT ARE OLDER ON CLINICAL TRIALS AND COLLECT SOME CORE MEASURES ON THOSE PATIENTS SO WE CAN INCREASE THE DEPTH AND BREADTH OF DATA COLLECTED, I'D BE ABLE TO BETTER TAKE CARE OF MY PATIENTS. >> MY ORGANIZATION AMONG THESE GROUPS IS PROBABLY THE BROADEST IN TERMS OF MISSION AND IN TERMS OF THE DEVELOPMENTAL STAGES AT WHICH WE FOCUS, AND ALSO BEING AN ORGANIZATION THAT IS INCLUSIVE OF SCIENTISTS AND PRACTITIONERS ACD AND CONSULTANTS, THE BREADTH IN SOME WAYS IS PROBABLY AT WAR WITH THE DEPTH THAT'S REQUIRED FOR SOME OF THE CONVERSATIONS THAT WE HAVE HERE, BUT I'VE BEEN REALLY VERY EXCITED ABOUT THE IDEAS THAT MY PANELISTS HAVE MENTIONED. THERE REALLY ARE LOTS OF WAYS WITH WORK TOGETHER NOW AND WITHIN -- WITHIN APA, AGING IS REALLY A VERY IMPORTANT FOCUS SO I LOVE THE IDEA OF FOCUSING ON IMPROVING CLINICAL TRIALS AND IMPROVING THE ACCESS OF AGING PATIENTS TO CLINICAL TRIALS. I THINK THAT'S A PLACE WHERE WE COULD REALLY CONTRIBUTE. >> SO I THINK FROM THE PERSPECTIVE OF DIABETES, THERE CLEARLY NEEDS TO CONTINUE TO BE AN EMPHASIS ON THE FACT THAT THE OLDER ADULT WITH DIABETES IS NOT THE SAME AS THE YOUNGER ADULT WITH DIABETES. WE DON'T JUST LIVE WITH THE DISEASE LONGER BUT THERE IS SOMETHING ABOUT THE AGING PROCESS THAT IS INTERTWINED, THE DISEASE TIMES AGE INTERSECTION, BUT THE CLINICAL TREATMENT AND ALSO THE PROGNOSIS FOR THESE PATIENTS. OUR CLINICAL CARE GUIDELINES FOR OLDER ADULTS, WE TALK ABOUT FUNCTION AND STAY STATUS, COGNITIVE STATUS, FRAILTY, HOW THE CLINICIAN ACTUALLY ESTIMATES THE CLINICAL PRACTICE CONTINUES TO BE A CHALLENGE. AND I THINK THAT'S WHERE WE CAN USE SOME OF THE PRINCIPLES OF GEROSCIENCE SCIENCE IN SOME OF OUR COLLEAGUES HERE TO REALLY INFORM CLINICAL PRACTICE. THE OLDER ADULT WITH DIABETES HAS DIFFERENT EDUCATIONAL NEEDS THAN THE YOUNGER ADULT WITH DIABETES, SOCIAL SITUATIONS ARE DIFFERENT, SOCIAL NETWORKS ARE DIFFERENT, THE FAMILIARITY AND EASE OF USING SOME OF OUR NEW TECHNOLOGIES MAY BE DIFFERENT AS WELL. AND THEN FROM THE RESEARCH PERSPECTIVE, CLEARLY AS I PRESENTED, THE NUMBER OF PEOPLE WITH DIABETES IS GREATEST IN OUR OLDER AGE GROUP AND WE STILL DON'T UNDERSTAND WHY AND WE DON'T UNDERSTAND IF THE COMPLICATIONS PRESENT DIFFERENTLY, FUNCTIONAL STATUS, SARCOPENIA WHICH IS ALSO VERY COMMON, AND SO REALLY HAVING MORE OPPORTUNITIES TO COLLABORATE WITH THOSE COLLEAGUES WHO HAVE EXPERTISE IN MEASURING THOSE OUTCOMES AND DESIGNING THOSE KINDS OF CLINICAL TRIALS FOR OLDER ADULTS HAVE BEEN EXCLUDED WOULD BE PARTICULARLY IMPORTANT. >> WHAT'S INTERESTING I THINK FOR ALZHEIMER'S DISEASE, GLAUCOMA AND MACULAR DEGENERATION WHICH ARE I GUESS THE DISEASE SILOS WE'RE CURRENTLY IN WITH BRIGHTFOCUS, ACTUALLY A LOT OF THE CLINICAL TRIALS DO HAVE THE OLDER INDIVIDUALS WHO HAVE BEEN RECRUITED AND THE MOVEMENT NOW IS TO MAYBE RECRUIT INDIVIDUALS TO TRYING TO USE ALZHEIMER'S AS AN EXAMPLE THAT THE PATHOLOGY FOR THAT STARTS MAYBE 20 YEARS BEFORE THE COGNITIVE SYMPTOMS OCCUR. AND SO I THINK WHAT REALLY STRUCK ME WITH PHILIPPE WITH YOUR DEFINITION AT THE BEGINNING WHERE THERE'S THE GENES AND THE ENVIRONMENT THAT CAN DICTATE THE RISK THAT YOU HAVE AND DETERMINE RISK FOR WHAT DISEASE BUT AGING CAN DETERMINE WHEN YOU'LL GET THIS. AND I THINK WE'VE BEEN FUNDING A LOT OF RESEARCH IN THE FIRST TWO, THE GENES AND ENVIRONMENT AND NOT NECESSARILY ON THE AGING, AND THEN IT STRUCK ME ABOUT THE RESILIENCE, THERE WAS THE OTHER SPEAKER ABOUT THE AGE OF 50 AS A DIVIDING LINE. AND SO I THINK THAT JUST WITH THE AGING SOCIETY, JUST ONE DISEASE ALONE, ALZHEIMER'S COULD BANKRUPT OUR SOCIETY SO I THINK THAT IF WE CAN LOOK AT MORE SYSTEMS BIOLOGY, MORE RESEARCH AS A WHOLE TO TRY AND HELP SHRINK THE RISK FOR THESE AGE-RELATED DISEASES, THEN THAT COULD HELP. I THINK ONE THING THAT -- ANOTHER THING THAT'S COME UP THAT I CAN DO NOW IS SPECIFICALLY TARGET GEROSCIENCE DEPARTMENTS AND INSTITUTIONS AND RESEARCHERS TO APPLY TO US TO BRING THEIR INNOVATIVE IDEAS, WE DO HAVE LAST YEAR ALONE, WE PUT UP $16.2 MILLION FOR FUNDING ALL THREE OF OUR PROGRAMS AND WE'RE EXPECTING TO DO THE SAME AGAIN AND SO I THINK THERE'S A LOT OF FUNDING OUT THERE AND ANOTHER CONSIDERATION THAT WE COULD MAKE IS IF WE DO WANT TO HAVE OLDER ANIMALS, YOU WANT TO MAKE SURE THAT MAYBE WE NEED TO INCREASE THE TERMS OF OUR TWO YEARS OF FUNDING TO THREE YEARS OF FUNDING FOR SOME OF OUR VISION PROGRAMS. SO I THINK THAT, YOU KNOW, ONE OF THE BIGGEST CHALLENGES FOR A LOT OF US BUT FOR US IS FOR CLINICAL TRIAL RECRUITMENT. >> SO OSTEOARTHRITIS IS THE MOST COMMON MUSCULOSKELETAL DISEASE AND THERE ARE NO BIOMARKERS FOR THE DISEASE AND NO DISEASE MODIFYING DRUGS SO DISEASE MODIFYING DRUGS WON'T WORK IF THE JOINT IS DESTROYED AND IT HAS TO BE REPLACED, RIGHT, SO WE NEED TO HAVE EARLY BIOMARKERS AND SO COULD SOME OF THE DIFFERENTLY PANELS RELATED TO GEROSCIENCE BE USED TO DETECT BIOMARKERS OF NOT ONLY OSTEOARTHRITIS AND JOINT DISEASE BUT COULD THERE BE A PANEL THAT WOULD LOOK AT MULTIPLE DISEASES TOGETHER, I THINK IS WHAT UNMET NEED. DOUG AND I -- PART OF THE FEDERATION OF MUSCULOSKELETAL RESEARCH SOCIETIES AND WE'RE ACTUALLY PART OF A BIG DATA GROUP AS WELL, AND ONE OF THE THINGS WE'RE CHALLENGED WITH IS THAT MUSCULOSKELETAL TISSUES LIKE BONE, CARTILAGE, TENDON, AREN'T IN GTEX, THEY AREN'T IN THE UNC BIOTRACKS IF YOU'RE LOOKING AT EPIGENETICS, SO IF THERE'S SOME HELP THAT NIH CAN GIVE US TO RAISE AWARENESS OF THE IMPORTANCE OF THESE TISSUES AS AN AGING DISEASE, THAT WE CAN INCORPORATE SOME OF THESE DATASETS THAT WE HAVE AND GET PEOPLE TO THINK ABOUT THAT AS THEY'RE THINKING ABOUT OTHER DISEASES AND OTHER TISSUES AS WELL, I THINK THAT WOULD BE A GREAT HELP TO US. >> AND ACTUALLY I KNOW I'M JUST JUMPING BACK HERE AND I'LL SEE IT IN A SECOND BUT YOU REALLY BROUGHT TO MIND SOMETHING ABOUT TISSUES, TISSUE BANKS. I KNOW WITH BRAIN BANKS, PEOPLE WILL KEEP THE BRAINS AND THROW AWAY THE EYES, BUT THE EYES AS EXTENSION OF THE BRAIN COULD BE REALLY IMPORTANT SO WE COULD BE LOOKING AT A HOLISTIC -- MANY DIFFERENT ORGANS OF ONE PERSON TO CREATE A BUY HE BIOBANK FOR THAT. >> SO I'M GOING TO STEP BACK AND SAY ONE OF THE BIGGEST UNMET NEEDS IS THAT WE DON'T TREAT PEOPLE HOLISTICALLY AS A PERSON, AND I REALLY LOVED WHAT YOU SAID ABOUT WE DON'T DIAGNOSE THEM WITH AGING, WE DIAGNOSE THEM WITH CANCER OR WHATEVER DISEASE IT MAY BE, AND I THINK A LOT OF THAT STEMS FROM THE WAY WE PAY FOR CARE, SO I KNOW WE'RE TALKING ABOUT RESEARCH HERE BUT I'M KIND OF A POLICY NERD SO I LOOK AT THE WAY WE PAY FOR CARE, DEVISE THE DELIVERY OF CARE WHICH MEANS THE SPECIALTIES WHERE WE HAVE ALL THE SILOS OF PEOPLE WORKING IN THEIR SILOS AND PATIENT ADVOCACY GROUPS AND THEIR SILOS SO I THINK UNTIL -- I'M FEELING HOPEFUL FROM THIS CONVERSATION THAT MAYBE GE. GERO SCIENCE CAN BE A WAY OF BRIDGE THAT LOOKING AT THE WHOLE PERSON, THE PERSON THAT'S AGING, THE BIOLOGY OF AGING THAT'S AFFECTING ALL OF THESE DISEASES. BECAUSE YOU MENTIONED THAT PEOPLE DON'T GET CERTAIN THINGS TREATED BECAUSE THEY ASSUME IT'S JUST AGING. WELL WITH CANCER, WE TREAT IT NO MATTER WHAT, EVEN IF THERE MAY BE OTHER THINGS GOING ON THAT ARE MORE LIFE-THREATENING FOR THE PERSON. ONE OF OUR ADVOCATES HAD A MOTHER WHO WAS END STAGE ALZHEIMER'S DISEASE AND HAD TO REALLY FIGHT NOT TO HAVE HER CANCER AGGRESSIVELY TREATED BECAUSE AS SOON AS YOU HEAR THE WORD CANCER, IT'S LIKE WE MUST AGGRESSIVELY TREAT THAT, SO MAYBE WORKING TOGETHER, GEROSCIENCE CAN HELP US BRIDGE SOME OF THAT AND LOOK MORE HOLISTICALLY AT HOW WE TAKE CARE OF PEOPLE INSTEAD OF ALL THESE SILOS AT THE DIFFERENT DISEASES AND BODY PARTS. AND I'M SORRY, JUST ONE MORE THING. ON THE CLINICAL TRIALS, I WOULD JUST SAY IF WE CAN INVOLVE PATIENTS IN DESIGNING THE TRIALS, IT WILL HELP US IN RECRUITING PATIENTS TO PARTICIPATE IN THE TRIALS. BECAUSE I THINK THAT, YOU KNOW, ESPECIALLY WHEN YOU'RE TALKING ABOUT RECRUITING OLDER PARTICIPANTS, THE BARRIERS THAT WE PUT UP TO PARTICIPATE IN THESE TRIALSS ARE NOT FEASIBLE FOR THEM TO PARTICIPATE, BUT IF YOU INVOLVE THEM IN THE DESIGN AND THINK ABOUT HOW CAN WE MAKE THIS AS EASY AS POSSIBLE FOR PEOPLE TO PARTICIPATE IN, I THINK IT WILL IMPROVE PARTICIPATION. >> THIS IS GREAT. I'M VERY ENERGIZED BY ALL OF YOU, AND I THINK THERE'S A HUGE AMOUNT OF WILLINGNESS HERE AND A BIG BARRIER HAS BEEN PUSHED DOWN TODAY SO I THINK THAT WAS A BIG FIRST STEP. I DO JUST WANT TO GO BACK AND I DON'T MEAN TO, LIKE, PUSH THE THE DUDE FROM FNIH ON THE SPOT, BUT I DO THINK REINVIGORATING THAT PUBLIC-PRIVATE EFFORT BECAUSE EXACTLY SOME OF THE THINGS THAT WERE BROUGHT UP HERE AROUND THE BIOMARKERS OF AGING AND TISSUE BANKS WERE EXACTLY WHAT WERE BROUGHT UP IF I'M RECALLING CORRECTLY AT THE END OF THAT MEETING, AS FIRST STEPS, FOR THOSE COMPANIES. AND THE FACT OF THE MATTER IS BIG COMPANIES, I'M GOING TO NAME A COUPLE BY LIKE PFIZER, AND OTSKA AND REGENERON THAT WERE PARTICIPATING IN THIS MEETING ARE LOOKING AT THIS TYPE OF RESEARCH AS A WAY TO DO THE RESEARCH THAT THEY'RE DOING IN DISEASE-SPECIFIC AREAS. SO THEY'RE DOING STUFF, AND TO GET YOUR CMOs IN THE ROOM TOGETHER BACK WITH THE FOLKS THAT WERE AT THAT MEETING BACK WITH FNIH AND WITH SOME OF THE INSTITUTES THAT WERE PART OF GSIG, I THINK THAT WOULD BE A HUGE NEXT STEP AND I WANT TO SEE IT HAPPEN. >> GREAT. THANK YOU SO MUCH. THIS WAS REALLY TREMENDOUS. WE WENT OVER TIME, I APOLOGIZE, PHILLIPE, BUT I THOUGHT THE DISCUSSION WAS WELL WORTH THE EXTRA TIME PUT IN, I'VE BEEN TOLD THE SHUTTLE IS GOING TO BE OUTSIDE WAITING FOR YOU RIGHT AWAY. THANK YOU ONCE AGAIN, SO GIVE A BIG HAND.