>> I'M WALTER KOROSHETZ.
OUR STAFF IS HERE, A BEAUTIFUL
DAY IN WASHINGTON, D.C.,
SPRING-LIKE.
I WANT TO RECOGNIZE THE WORK --
OH.
I WANT TO RECOGNIZE ALL THE WORK
THE STAFF HAS DONE IN TERMS OF
GETTING US READY FOR COUNCIL AND
DAY TO DAY AND PROUD OF WHAT THE
INSTITUTE HAS ACCOMPLISHED.
I HAVE TO START BY SAYING IN THE
PURSUIT OF OUR MISSION, THE
ADVANCED UNDERSTANDING OF THE
BRAIN, NERVOUS SYSTEM, TO USE
THAT KNOWLEDGE TO REDUCE
SUFFERING DUE TO NEUROLOGICAL
DISORDERS, THERE ARE A LOT OF
PEOPLE OUT THERE WHO WE HAVEN'T
DEVELOPED TREATMENTS THAT ARE
NEEDED AND WANT FOLKS TO KNOW
WE'RE WORKING HARD WITH URGENCY
TO TRY TO IMPROVE THE TREATMENT
OF NEUROLOGICAL DISORDERS AND
STROKE.
SO, WE HAVE A NUMBER OF COUNCIL
MEMBERS WHO ARE HERE ON ZOOM,
ALSO WE HAVE WHAT WE CALL AD HOC
COUNCIL MEMBERS AWAITING
CONFIRMATION FROM THE SECRETARY.
FIRST A DAN, THE FOUNDER AND ON
THE BOARD OF -- CHAIR OF TARGET
ALS, A MEDICAL RESEARCH
FOUNDATION WHICH HE FOUNDED IN
2010 TO DEVELOP BETTER
TREATMENTS FOR ALS.
A DISTINGUISHED BACKGROUND,
PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF BLOOMBERG AP,
UNFORTUNATELY DEVELOPED ALS
HIMSELF, HAD A FAMILY HISTORY OF
ALS AND THEN DEVELOPED SPORADIC
FORM, HE'S A PERSON WITH LIVED
EXPERIENCE ON OUR COUNCIL.
HE ATTENDED A LAW SCHOOL
UNIVERSITY OF CHICAGO 1984,
DOCTOR OF LAW, AND I THINK WE
MAY HAVE OVERLAPPED BY ONE YEAR,
DAN, BUT I WAS ON THE MEDICAL
SIDE.
FLORIAN IECHLER, DIRECTOR OF
NEUROGENICS AND GENE THERAPY
HARVARD MEDICAL SCHOOL,
ASSOCIATE PROFESSOR.
FOCUSES ON GENETICS OF
PAROXYSMAL DISORDERS, LIVER
METABOLISM, ENGAGED IN
DEVELOPMENT OF NEW THERAPY,
GENOMIC THERAPIES FOR
LEUKODYSTROPHY, M.D. 1997
UNIVERSITY OF VIENNA SCHOOL OF
MEDICINE, TRAINED AT MASS
GENERAL IN NEUROLOGY.
ROBERT GERAU IS NEXT, VICE CHAIR
FOR RESEARCH AND DIRECTOR OF
WASHINGTON UNIVERSITY PAIN
CENTER.
VERY WELL KNOWN RESPECTED
RESEARCHER IN THE PAIN FIELD.
HE IS ON THE HEAL INITIATIVE
MULTI-DISCIPLINARY WORKING GROUP
WHICH GOES OVER ALL THE ASPECTS
OF "HEAL," PRIOR TO THEIR COMING
TO THE COUNCIL.
SO HE'S A LINK BETWEEN THE
"HEAL" MULTI-DISCIPLINARY
WORKING GROUP, LANDIS AWARD,
Ph.D. IN NEUROSCIENCE FROM
EMORY UNIVERSITY IN 1995.
NEXT FRANCES JENSEN, PROFESSOR
AND CHAIR OF NEUROLOGY AT
UNIVERSITY OF PERSON.
SHE TRAINED AND WORKED FOR A
LONG TIME AT CHILDREN'S HOSPITAL
IN BOSTON BEFORE MOVING TO U
PENN, BUILT A TREMENDOUS PROGRAM
THERE AT U PENN, ON THE CLINICAL
AND RESEARCH SIDE.
SHE'S A HIGHLY RESPECTED
RESEARCHER IN EPILEPSY AND
JAVITS AWARD RECIPIENT.
M.D. FROM CORNELL 1983.
NEXT AMY McGWIRE, PROFESSOR OF
BIOMEDICAL ETHICS, BAYLOR
COLLEGE OF MEDICINE, A MEMBER OF
THE NATIONAL ADVISORY COUNCIL,
HUMAN GENOME RESEARCH, NUMEROUS
TEACHING AWARDS AT BAYLOR
COLLEGE OF MEDICINE, EARNED HER
J.D. FROM UNIVERSITY OF HOUSTON
LAW SCHOOL IN 2000, Ph.D. FROM
UNIVERSITY OF TEXAS IN 2004.
NEXT IS KATE NICHOLSON,
EXECUTIVE DIRECTORY AND FOUNDER
OF NATIONAL PAIN ADVOCACY
CENTER, NATIONAL NON-PROFIT
DEDICATED TO ADVANCING HEALTH
AND HUMAN RIGHTS OF PEOPLE IN
PAIN, SHE'S A CIVIL RIGHTS
ATTORNEY, NATIONALLY RECOGNIZED
EXPERT ON AMERICANS WITH
DISABILITIES, AND SHE RECEIVED
HER J.D. WITH HONORS FROM
HARVARD LAW SCHOOL IN 1992.
THOSE ARE THE FOLKS THAT ARE
JOINING US.
AS YOU CAN SEE, TREMENDOUS
EXPERTISE COMING TO THE COUNCIL
ON THIS ROUND, AND LOOK FORWARD
TO THEIR INPUT TODAY AND IN THE
FUTURE.
THANKS TO THE SITTING COUNCIL
MEMBERS AS WELL.
I'LL TURN IT OVER TO DAVE OWENS,
ACTING DIRECTOR OF EXTRAMURAL
ACTIVITIES.
>> I'M EXECUTIVE SECRETARY OF
COUNCIL, I WANT TO WELCOME OUR
AD HOC MEMBERS AND I WANT TO SAY
WELCOME TO THE PREVIOUS AD HOC
MEMBERS, WHO ARE NOW APPROVED BY
THE SECRETARY, NOW FULL VOTING
MEMBERS OF COUNCIL.
I WANT TO REMIND EVERYONE WE'RE
VIDEOCASTING, LIVE, FOLKS IN THE
WORLD CAN SEE US ALL.
NOW IT'S A REMOTE MEETING.
WE WANT EVERYONE TO HAVE THEIR
COMPUTERS ON AND MUTED AND THEIR
SPEAKERS OFF SO WE CAN SEE YOUR
FACES.
AND THEN THERE WAS FINALLY ONE
HOUSEKEEPING ITEM BEFORE I GO
ON.
THIS TIME -- I'LL NEED TO UNMUTE
MYSELF, I DON'T THINK I'LL DO
THAT.
WE'RE GOING TO BE USING THE
ELECTRONIC COUNCIL BOOK FOR
VOTING THIS TIME.
THIS IS A BETTER WAY TO APPROACH
THE WHOLE PROCESS TO VOTING IN
ZOOM, FOR EXAMPLE, BUT IT IS
NEW.
SO WE MAY BE WORKING OUT SOUGHT
KINKS IN THE PROCESS.
THE KEY VARIABLES NOW ALL THE
COUNCIL MEMBERS SHOULD BE LOGGED
INTO THE ECB.
WE'VE SENT INSTRUCTIONS ON HOW
TO VOTE.
AS I SAID, THIS IS NEW, SO TIM
LIEDEN NEXT TO ME AND CHERYL
WILL BE ASSISTING US WITH THIS
AS WE WORK THROUGH THIS.
FOR THOSE WHO MAY BE IN
CONFLICT, YOU CAN SEE YOU WILL
BE UNABLE TO VOTE ON SOMETHING,
THAT'S TAKEN CARE OF THERE.
NOW, WE DO BELIEVE THIS IS GOING
TO BE A BETTER WAY FORWARD BUT
WE'LL HAVE SOME PATIENCE AS WE
WORK THROUGH THIS FOR THE FIRST
TIME.
SO ARE THERE ANY QUESTIONS ABOUT
THAT?
HEARING NONE, I'LL MOVE ALONG.
FIRST THING WE NEED TO CONSIDER
IS PREVIOUS MINUTES.
WE DID HAVE AN OFF-SCHEDULE
AUGUST 23 COUNCIL MEETING.
WE HAVE THE MINUTES, IN THE ECB.
IF YOU'VE REVIEWED THOSE ARE
THERE ANY QUESTIONS ON THOSE
MINUTES?
HEARING NONE I WOULD LIKE A
MOTION TO APPROVE THOSE MINUTES.
>> SO MOVED.
>> SECOND?
>> SECOND.
>> OKAY.
NOW I'M GOING TO PASS TO TIM,
WE'LL VOTE ON THOSE IN THE BOOK.
FIRST HISTORIC VOTE IN ECB.
>> YOU CAN LOOK IN THE VOTING
TAB, THE FIRST TAB IN THE ECB.
YOU JUST CLICK ON COUNCIL
MEETING MINUTES, AND THEN YOU'LL
SEE BOTH THE AUGUST AND FALL
COUNCIL MEETING MINUTES AND YOU
CAN VOTE, YES, YOU CAN SEE AN
OPTION TO VOTE YES TO ALL.
AND THEN MAKE SURE YOU HIT VOTE
AND SUBMIT.
CHIME IN IF YOU HAVE ISSUES.
>> WE'LL MADE TO GET THE VOTE
BEFORE MOVING FORWARD.
>> TO CLARIFY AD HOC MEMBERS
SHOULD NOT VOTE?
>> CORRECT.
I SHOULD HAVE MENTIONED.
AS AD HOC YOU CAN PARTICIPATE IN
ALL DISCUSSIONS, WE ENCOURAGE
YOU TO DO SO, YET YOU CANNOT
VOTE.
>> I WAS AD HOC AT THE LAST
MEETING.
DOES THAT MEAN I SHOULDN'T VOTE?
>> YOU CAN VOTE.
>> OKAY.
>> DON'T EVEN HAVE A TAB.
>> AD HOCS CANNOT VOTE.
IF YOU'VE BEEN OFFICIALLY A
COUNCIL MEMBER YOU CAN VOTE.
IF YOU SEE THE VOTING TAB, YOU
CAN VOTE.
AND WE HAVE QUORUM.
>> A QUORUM AND VOTE.
EXCELLENT.
WE'LL MOVE TO THE NEXT SET FROM
THE FALL 23 COUNCIL MEETING.
FIRST I WILL SAY ARE THERE ANY
QUESTIONS ON THOSE MINUTES?
HEARING NONE, IS THERE A MOTION
TO APPROVE THOSE MINUTES?
>> I MOTION TO APPROVE.
>> SECOND?
>> SECOND.
>> TAKE IT AWAY.
>> TIM, SOMEHOW I'M NOT ABLE TO
ACTIVATE YES OR NO ON MY --
>> DID YOU ALREADY VOTE ONCE?
YOU MIGHT HAVE ALREADY VOTED.
THEY ARE SEPARATE TABS I TAKE
IT.
IT'S THE SAME TAB, LIST THE
RIGHT UNDERNEATH EACH OTHER.
>> QUESTION.
>> YES.
>> DOES IT MATTER THAT THE TOTAL
VOTE TAB WE'RE SEEING IS NOT
VERY LARGE?
IT SAYS FIVE VOTES SO FAR.
>> WHEN WE GET A QUORUM VOTE,
WE'RE FINE TO MOVE FORWARD, MY
UNDERSTANDING AT LEAST ON
PREVIOUS MINUTES WE HAD REACHED
THAT THRESHOLD.
THAT IS CORRECT.
>> I MEAN THAT'S FINE?
IT SAYS TOTAL YES, FIVE?
I WANT TO MAKE SURE THERE'S NOT
SOME GLITCH THAT WILL FOUL UP
YOUR COUNTING WHEN YOU LOOK
BACK.
>> I'M SEEING NONE.
>> I SEE EIGHT.
>> BOB, ON OUR END IT LOOKS
FINE.
SO I THINK WE'RE GOOD.
>> THANK YOU.
>> LET ME KNOW --
>> WE'RE GOOD?
>> WE'RE GOOD.
WE TOOK CARE OF THE MINUTES.
VERY GOOD.
THANK YOU, EVERYONE.
THE NEXT ITEM IS CONFIRMATION OF
FUTURE COUNCIL MEETINGS, SHOULD
ALSO BE IN THE ECB.
WHAT WE'RE ASKING IS FOR FOLKS
TO SET THAT ASIDE AND BLOCK THEM
OFF ON YOUR CALENDAR.
I DON'T THINK I'LL READ THEM BUT
WILL MENTION THE NEXT COUNCIL
MEETING IN MAY WILL BE LIVE, OR
FACE TO FACE.
IT WILL NOT BE VIRTUAL.
OKAY.
AND THEN MOVING ALONG --
>> SORRY, WHERE IS THAT
INFORMATION?
>> I DON'T SEE IT EITHER.
>> THERE'S NO VOTE.
WE'RE JUST ASKING YOU TO BLOCK
YOUR CALENDARS.
THEY SHOULD BE IN THE ECB, THOSE
MEETING DATES.
>> WHERE IN THE ECB?
>> IT'S LISTED ON THE AGENDA
DOCUMENT.
>> WHERE IS THE AGENDA DOCUMENT?
>> IT'S IN THE GENERAL
INFORMATION TAB.
>> TIM OR DAVID?
>> YES?
>> FOR THOSE THAT ARE SUPPOSED
TO ROTATE OFF AFTER MAY DO YOU
WANT US TO KEEP A HOLD ON
SEPTEMBER BECAUSE OF THE DELAYS
IN GETTING PEOPLE TO REPLACE US?
>> YES.
>> YEAH, I THINK THAT WOULD BE A
GOOD IDEA.
WE WOULD APPRECIATE THAT.
YOU NEVER KNOW
>> DO YOU KNOW HOW MUCH WE LOVE
NIH SERVICE?
>> YES, IT'S A WONDERFUL
EXPERIENCE.
I'M GOING TO GIVE EVERYONE A
MINUTE SO WE ALL GET ORIENTED.
>> I HAVE TO ASK, WHERE IS THE
GENERAL INFORMATION TAB?
I HAVE MISCELLANEOUS, ET CETERA.
DON'T SEE INFORMATION.
>> IT'S WINTER 2024 COUNCIL,
RIGHT NEXT TO THE CLOSED
SESSION.
>> THANK YOU.
GOT IT.
PERFECT.
THANKS.
>> RIGHT.
AND, AGAIN, IT'S FIND THAT WE
WORK THROUGH THIS.
OKAY.
SO THE NEXT ITEM IS THE
EXPEDITED REVIEW PROCESS.
WHAT THIS IS IS EACH ROUND WE
IDENTIFY CERTAIN GRANTS THAT WE
CAN EXPEDITE AND GET OUT THE
DOOR QUICKER.
GENERALLY WHAT THESE WILL COVER
ARE R01s WITH NO
ADMINISTRATIVE ISSUES.
THIS TIME AMY, TIM, LOUISE.
WE APPRECIATE YOUR WORK.
AND THIS IS A TESTAMENT TO OUR
GRANTS MANAGEMENT DIVISION,
CHAIRED OR LED BY SHELLY WILBURN
AND PROGRAM STAFF WHO MAKE SURE
Is ARE DOTTED AND Ts ARE
CROSSED TO GET THESE GRANTS OUT
FAST.
OKAY.
NOW I'M GOING TO MOVE TO THE
SECTION OF EXTRAMURAL
ANNOUNCEMENTS.
WE HAVE A SLIDE FOR THAT.
THIS IS GOING TO BE OUR -- THE
BIOS FOR OUR STAFF ARE IN THE
ECB AND WE HAVE NOT ENOUGH TIME
TO ESSENTIALLY GO THROUGH EACH
ONE SO WE'RE GOING TO PUT UP A
SLIDE AND ALL TAKE A LOOK AND
SEE THE STAFFING UPDATES.
WE ENCOURAGE YOU TO READ ABOUT
THIS IN THE BOOK.
>> IS THAT IT?
JUST ONE SLIDE?
THAT'S WHAT I THOUGHT.
NEXT?
THERE WE GO.
SUPER, THANKS.
OKAY.
SO NOW WE'RE GOING TO TALK ABOUT
THE COUNCIL OPERATING
PROCEDURES.
THESE ARE ESSENTIALLY THE RULES
OF OUR INTERACTIONS, GUIDING
INTERACTIONS WITH COUNCIL, HOW
WE DO BUSINESS WITH YOU.
THEY ARE IN THE ECB, FOR THE
MOST PART WE'VE NOT MODIFIED
EXCEPT FOR ONE THING WHICH I
WANT TO MENTION AND DO WANT TO
HEAR IF THERE'S ANY QUESTIONS ON
THAT.
SO, WE HAVE DELEGATED AUTHORITY
TO ISSUE, FOR EXAMPLE,
ADMINISTRATIVE SUPPLEMENTS BELOW
$100,000 IN DIRECT COSTS WITHOUT
COUNCIL CONCURRENCE.
AND THAT HELPS US MOVE THINGS
FORWARD QUICKLY.
WE CAN DO CO-FUNDS OF LIMITED
AMOUNT.
WHAT WE WOULD LIKE TO ADD ARE
R13 CONFERENCE GRANTS THAT
SUPPORT A CONFERENCE, USUALLY A
ONE-YEAR AWARD, OUR
CONTRIBUTIONS ARE QUITE MODEST.
FOR EXAMPLE, IN THE LAST YEAR I
THINK THE AVERAGE AMOUNT WE
AWARDED WAS $16,000 FOR A
CONFERENCE.
WE DO HAVE AN INTERNAL PROCESS
WHERE IF THE AMOUNT OF THE AWARD
IS HIGH, OR RELATIVELY HIGH,
AND/OR IF THERE'S ISSUE WITH THE
SUMMARY STATEMENT BECAUSE THEY
ARE PEER REVIEWED BY OUR REVIEW
BRANCH OR SEVERAL OTHER THINGS
WE DO VET THESE.
HOWEVER, WE HAVE RUN INTO ISSUES
BECAUSE WE CAN'T MAKE AWARDS
UNTIL WE HAVE COUNCIL APPROVAL,
AND IF THE MEDIAN ALREADY
OCCURRED WE CANNOT SUPPORT IT
ANY LONGER, SO CONSIDERING THESE
ARE PRETTY STRAIGHTFORWARD, NOT
A LOT OF MONEY, THERE'S USUALLY
FEW IF ANY ISSUES WITH THEM, WE
WOULD LIKE TO ADD THESE TO OUR
DELEGATED AUTHORITY TO UP TO
$50,000.
AND THEN WOULD GIVE US THE
ABILITY WHEN THERE'S NO ISSUES
TO GET AN AWARD OUT TO THE
CONFERENCE QUICK SO WE WOULDN'T
EVER MISS THIS FUNDING DEADLINE.
WE WOULD LIKE TO ADD THAT ON OUR
DELEGATED AUTHORITY BUT I WOULD
LIKE TO HEAR IF THERE ARE ANY
QUESTIONS ABOUT THAT.
>> HOW OFTEN DO YOU HAVE GRANT
FUNDS REQUEST FOR THESE
MEETINGS, $50?
YOU MENTIONED THEY ARE TYPICALLY
$16,000.
IS THAT A RARE THINK?
>> YES, EXTREMELY RARE.
IN FACT WHEN I LOOKED, I LOOKED
AT THE LAST YEAR NUMBERS, THE
HIGHEST WE EVER AWARDED WAS
$30,000, AND THAT WAS JUST FOR
ONE.
ALL THE OTHER ONES WERE BETWEEN
$5,000 AND $25,000.
>> WHY ARE YOU SETTING IT FOR
$50,000?
>> IN CASE IT CAME UP THAT WE
WOULDN'T NECESSARILY WANT TO
HOLD IT UP.
NOW, ONE THING EVEN WHEN WE HAVE
A DELEGATED AUTHORITY I WOULD
SAY IF THERE WAS ANY ISSUE WE
THOUGHT WE WOULD LIKE TO DISCUSS
WITH COUNCIL, WE CAN.
AND WE WOULD.
SO IT'S JUST I THINK MAYBE AN
UPPER THRESHOLD JUST TO BE ON
THE SAFE SIDE.
>> THANK YOU.
THAT'S HELPFUL.
>> ANY OTHER QUESTIONS ON THAT?
IF NOT IS THERE A MOTION TO MOVE
FORWARD AND APPROVE OPERATING
PROCEDURES?
>> I MOVE.
>> SECOND?
>> SECOND.
>> GO TO THE VOTING TAB.
IF YOU RECALL, IT'S THE VOTE
TAB.
AND VOTE YES OR NO.
>> I'M NOT -- IS THIS OPERATING
PROCEDURES?
>> YES.
>> OKAY.
>> THANK YOU.
AND WITH THAT I BELIEVE IT'S MY
OPPORTUNITY TO PASS TO OUR
DIRECTOR, WALTER KOROSHETZ, FOR
HIS DIRECTOR'S REPORT.
>> THANK YOU VERY MUCH, DAVID.
AND HOPEFULLY EVERYBODY IS
GETTING USED TO THE NEW FORMAT.
SHOULD WORK.
COULD I HAVE THE SLIDES PLEASE?
THIS IS THE DIRECTOR'S REPORT.
THE DIRECTOR'S REPORT, WHAT I
LIKE TO DO IS TRY TO GET ACROSS
INFORMATION THAT I THINK MAY BE
IMPORTANT TO THE COUNCIL, BUT
ALSO TO THE GENERAL PUBLIC, WHO
MAY BE VIEWING THIS REMOTELY.
IN ADDITION, THESE -- I WILL GO
THROUGH THE SLIDES BUT YOU WILL
MAKE TAKEHOME POINTS BASICALLY,
AND NOT GO THROUGH ALL THE
MATERIALS ON THE SLIDE BUT THE
SLIDES WILL BE AVAILABLE FOR
PEOPLE TO SEE IF THEY ARE
INTERESTED IN THE DETAIL.
NEXT SLIDE PLEASE.
SO, I THINK MOST IMPORTANTLY,
FOR NIH, WE ARE REALLY GRATEFUL
TO HAVE MONICA BERTAGNOLLI
CONFIRMED AS THE NIH DIRECTOR.
AND SHE MOVES FROM THE NCI TO
THE NIH DIRECTOR POSITION, AND
HAS REALLY TAKEN OVER.
HAS BEEN A GREAT ADVOCATE FOR
NIH.
SHE HAS A NUMBER OF ITEMS THAT
SHE WANTED US TO COMMUNICATE TO
YOU.
AND THAT IS THAT SOME OF HER
GUIDING PRINCIPLES ARE SHE
REALLY WANTS TO IMPROVE THE
INCLUSION OF PATIENTS AND
SUBJECTS FROM ALL AREAS OF THE
COUNTRY INTO OUR RESEARCH.
AND SECONDLY, NEXT SLIDE, SHE
WISHES TO REALLY BRING IN THE
NEW TOOLS THAT ARE COMING, TO
HELP ANALYZE LARGE AMOUNTS OF
DATA FROM ARTIFICIAL
INTELLIGENCE, AND MACHINE
LEARNING.
>> WALTER, WE'RE NOT SEEING ANY
SLIDES.
>> ALL RIGHT.
HOLD ON ONE SECOND, GUYS.
HOW ABOUT NOW?
DO YOU SEE SLIDES?
OKAY.
NEXT SLIDE HAS THE PICTURE OF
OUR NEW DIRECTOR, VERY GOOD.
AND THE NEXT SLIDE HAS ANOTHER
PICTURE OF OUR NEW DIRECTOR,
WITH THE MAJOR POINT BEING HER
EFFORT TO BRING A NEW ANALYTICAL
TECHNIQUES TO INCREASE THE VALUE
OF NIH-FUNDED DATA.
NEXT SLIDE.
TARA SCHWETZ, WHO WAS THE ACTING
DEPUTY DIRECTOR, HAS NOW MOVED
TO BECOME THE DIRECTOR OF THE
DIVISION FOR PROGRAM
COORDINATION PLANNING AND
STRATEGIC INITIATIVES.
AND YOU CAN SEE HERE THE VARIETY
OF OFFICES SHE OVERSEES.
I THINK TO COME ON SOON IS HER
OVERSIGHT OF THE COMMON FUND
WHICH A NUMBER OF US ARE
INVOLVED IN.
NEXT SLIDE.
ANOTHER MAJOR LEADERSHIP CHANGE
AT NIH HAS BEEN RECRUITMENT OF
KIM RATHMELL TO RUN THE NATIONAL
CANCER INSTITUTE.
SHE WAS CHAIR OF MEDICINE AT
VANDERBILT, AN EXPERT IN KIDNEY
CANCER, HAS A LOT OF WISDOM AND
I THINK IS GOING TO BE A
TREMENDOUS DIRECTOR FOR THE
CANCER INSTITUTE AND LOOKING
FORWARD TO TALKING TO HER AS I
DO EVERY TIME THEY GET A NEW NCI
DIRECTOR ABOUT HOW WE CAN MAKE A
BIGGER DIFFERENCE TO IMPROVE THE
LIVES OF PEOPLE WITH BRAIN
TUMORS, PARTICULARLY
GLIOBLASTOMA.
I BROUGHT THAT UP.
HOPEFULLY WE'LL GET TOGETHER
SOON.
NEXT SLIDE.
THE OTHER LEADERSHIP CHANGE IS
THE VERY RECENT RECRUITMENT SEAN
MOONEY FROM THE UNIVERSITY OF
WASHINGTON WHO RAN THEIR
BIOINFORMATICAL INFORMATICS
PROGRAM TO BECOME THE DIRECTOR
OF THE CENTER FOR INFORMATION
TECHNOLOGY HERE AT NIH, CIT, I
SUSPECT HE WILL HAVE AN
IMPORTANT ROLE IN DR.
BERTAGNOLLI'S WORK TO BRING
THESE NEW ANALYTIC TOOLS TO
INCREASE THE VALUE OF NIH-FUNDED
RESEARCH.
NEXT SLIDE SHOWS LEADERSHIP
CHANGES HERE WHICH YOU'VE
ALREADY SEEN SOME OF.
AND THAT IS THAT WITH THE
DEPARTURE OF DR. FINKELSTEIN,
DAVID OWENS HAS ABLY TAKEN OVER
AS ACTING DIRECTOR OF THE
DIVISION OF EXTRAMURAL
ACTIVITIES, AND DR. ANNA TAYLOR
HAS MOVED IN, GRATEFUL FOR THEIR
WORK MOVING US FORWARD, NOT
LOSING A STEP.
NEXT SLIDE IS A LITTLE BIT OF AN
ADVERTISEMENT, AN IMPORTANT ONE
TO MENTION THAT IS THAT THE --
WE HAVE A CENTER FOR ALZHEIMER'S
AND RELATED DEMENTIAS HERE ON
THE INTRAMURAL CAMPUS, AND WE'RE
CURRENTLY LOOKING FOR A CLINICAL
DIRECTOR, ANDY SINGLETON RUNS
THE CENTER, IT HAS A NEW
BUILDING.
IT'S VERY WELL RESOURCED, AND WE
WOULD REALLY LIKE TO BRING IN
SOMEONE WHO CAN DEVELOP AN
AMBITIOUS CLINICAL PROGRAM, TO
USE ALL THE RESOURCES OF THE
CLINICAL CENTER, THE LARGEST
RESEARCH HOSPITAL IN THE WORLD,
TO ADVANCE OUR TREATMENTS FOR
PEOPLE WITH ALZHEIMER'S AND
RELATED DEMENTIA.
IF PEOPLE COULD MESSAGE THAT
AROUND, FEEL FREE TO GIVE ME A
BUZZ, APPLICANTS.
NEXT SLIDE.
I WANT TO TALK AS I DO ABOUT THE
BUDGET.
AND THIS SLIDE BASICALLY SHOWS
WHAT WE CALL THE BASE NINDS
BUDGET, SO OUR BUDGET IS
COMPOSED OF THE BASE MONEY BUT
THEN THERE ARE ALSO MONEY THAT
COMES FOR SPECIAL PROGRAMS, THIS
IS THE BASE MONEY, AND CURRENTLY
WE'RE OPERATING INTO WHAT'S
CALLED A CONTINUING RESOLUTION.
OTHERWISE KNOWN AS A C.R.
AND UNFORTUNATELY THIS IS --
MULTIPLE C.R.s THIS YEAR,
POTENTIALLY FACING IF CONGRESS
CANNOT DO A BUDGET A YEAR-LONG
C.R.
SO, THAT GENERALLY WOULD MEAN
THAT WE HAVE A FLAT BUDGET BUT
THAT IS NOT NECESSARILY THE CASE
THIS YEAR, BECAUSE IN THE BUDGET
DEAL AN AUTOMATIC 1% CUT GOES
INTO EFFECT IN MAY SHOULD THERE
NOT BE A BUDGETS BY JANUARY 1
AND OF COURSE THERE WAS NOT A
BUDGET BY JANUARY 1.
A 1% DROP WOULD DROP AVAILABLE
FUNDS BY $21 MILLION, AND THEN
THERE'S ALSO THE POSSIBILITY
THAT ALTHOUGH IT COULD BE A FLAT
BUDGET TO THE AGENCY, THAT MONEY
COULD BE REDISTRIBUTED AMONG THE
DIFFERENT NON-DISCRETIONAL
AGENCIES.
SO, WE'RE STILL IN THE SPOT
WHERE WE DON'T EXACTLY KNOW HOW
MUCH FUNDING WE WILL HAVE GOING
FORWARD, AND NEXT SLIDE, JUST TO
TALK MORE ABOUT THIS ON THE NEXT
SLIDE, SHOWS SOME OF THE OTHER
SOURCES FOR FUNDING THAT NINDS
MANAGES OR GETS THEIR
APPROPRIATION.
WE SEE A $280 MILLIONS FOR THE
HEAL INITIATIVE, HELPING TO END
ADDICTION LONG TERM.
WE'LL TALK ABOUT THAT LATER.
$75 MILLION FORS ALZHEIMER'S AND
RELATED DEMENTIAS, IN CONCERT
WITH NATIONAL INSTITUTE OF AGING
MANAGE $300 MILLION A YEAR FOR
ALZHEIMER'S DISEASE AND
ALZHEIMER'S-RELATED DEMENTIA
FUNDING, SOME FUNDS THAT CENTER
IN THE INTRAMURAL PROGRAM.
WE ALSO DIRECT THE UNDIAGNOSED
DISEASE NETWORK, AND RECEIVE $75
MILLION UNDER THE ACT FOR ALS
FOR PARTICULAR TYPES OF ALS
RESEARCH.
SO WE'RE VERY BUSY HERE MANAGING
WHAT WE THINK IS REALLY
FANTASTIC PROGRAMS, AND HATS OFF
TO OUR STAFF FOR TAKING UP ALL
THESE EXTRA -- NOT QUITE EXTRA
BUT ADDITIONAL WORK TO MAKE THE
MOST OF THE TAXPAYERS'
INVESTMENT IN NINDS.
ON THIS SLIDE I DID WANT TO
SHOW, WE'LL TALK ABOUT THIS IN A
SECOND, THAT THERE IS A VERY
SIGNIFICANT RISK THAT WE'RE
WORRIED ABOUT WITH REGARD TO THE
BRAIN INITIATIVE.
THE BRAIN INITIATIVE MONEY CAME
IN TWO BUCKETS.
ONE CAME UNDER THE BASE, WHICH
IS HERE ON THE ROW LABELED
BRAIN, THE UNDER LABELED 21ST
CENTURY CURES ACT MONEY.
THE CURES ACT MONEY GOES UP AND
DOWN EACH YEAR.
THE BASE MONEY HAD BEEN GOING UP
EACH YEAR UNTIL 2022.
BUT IN 2023 THE CURES ACT MONEY
WENT REALLY HIGH FROM $76
MILLION TO $225 MILLION, AND TO
KEEP OUR BUDGET FLAT THE BASE
BUDGET FOR "BRAIN" TO THE
INSTITUTES, A THAT'S US AND
NIMH, WAS REDUCED TO $63 MILLION
FROM $182 MILLION.
AND THE PROBLEM GOING FORWARD IS
THE HOUSE MARK DID NOT INCREASE
THE BASE TO WHERE IT HAD BEEN
PREVIOUSLY, AND THAT HAPPENS
WHEN THE CURES MONEY DROPS
SIGNIFICANTLY.
SO THE BRAIN INITIATIVE, UNLESS
THERE'S AN INCREASE TO THE BASE,
WOULD BE CUT BY $278 MILLION IN
24, WHICH OF COURSE WOULD BE
CATASTROPHIC TO THEIR PROGRAMS.
SOME OF WHICH WE'LL TALK ABOUT
COMING UP.
SO, NEXT SLIDE, WE'RE OPERATING
UNDER DIFFERENT SCENARIOS OF A
1% CUT OR POTENTIALLY 3 OR 5%
CUT AS POSSIBILITIES.
THIS IS OCCURRING IN THE CONTEXT
OF INCREASING COSTS OF RESEARCH,
AND THAT'S OF COURSE BECAUSE
INFLATION HAS INCREASED THE
COST OF DOING RESEARCH,
SALARIES, SUPPLIES, EQUIPMENT.
THE BLACK LINE IS APPLICATIONS
COMING IN, YEAR-TO-YEAR CHANGE
IN COST.
SO THE COSTS ARE GOING UP IN 24,
THEY WENT UP BY ALMOST 13% OVER
THE PRECEDING YEAR.
THE AVERAGE REQUESTED COST OF
GRANTS IS A LITTLE LESS STEEP
BUT STILL GOING UP EACH YEAR.
AND THE NUMBER OF COMPETING
APPLICATIONS IS ALSO GOING UP.
THE REASON IS THAT THERE'S BEEN
AN INCREASE IN THE NUMBER OF
NON-MODULAR GRANTS, BETWEEN 20
AND 24 THERE WERE 800 ADDITIONAL
APPLICATIONS FOR NON-MODULARS,
MIRRORED BY DECREASE IN MODULAR
GRANTS WHICH ARE THE LEAST
EXPENSIVE GRANTS IN GENERAL, AND
THERE WAS A DECREASE OF 460 OF
THOSE BETWEEN 20 AND 24, ALSO AN
INCREASE IN APPLICATIONS
MULTI-P.I. GRANTS WHICH
GENERALLY ARE MORE COSTLY.
SO, THE TAKEHOME POINT HERE IS
THAT IN A PERIOD, NEXT SLIDE,
WHERE WE THINK THAT THERE WILL
BE VYING PRIORITIES FOR
NON-DISCRETIONAL FUNDS IN THE
U.S. CONGRESS, WE HAVE TO REALLY
PREPARE FOR POTENTIALLY, YOU
KNOW, A FLAT OR HOPEFULLY NOT
ANYTHING WORSE THAN A FLAT
BUDGET IN 24, AND ALSO THE
BUDGET DEAL INDICATES THAT 24
WILL BE REFLECTED IN THE 25
BUDGET.
SO WE AT LEAST HAVE TO PREPARE
FOR TWO YEARS OF THIS KIND OF
MORE STRINGENT BUDGETING FROM
CONGRESS, IN THE FACE OF THE
INCREASING COSTS.
NEXT SLIDE.
SO, I THINK I WANTED TO JUST
MENTION THE FACT THAT IT'S
REALLY IMPORTANT AT THIS POINT
IN TIME WITH ALL THESE BUYING
PRIORITIES FOR CONGRESS THAT WE
DO ACTUALLY MAKE A CASE FOR THE
VALUE OF NIH RESEARCH, AND THIS
IS JUST A PICTURE TO SHOW THAT
THERE HAVE BEEN A NUMBER OF
INSTANCES WHERE WE'VE BEEN
INVITED TO CONGRESSIONAL
BRIEFINGS.
WE CANNOT CALL CONGRESS BUT IF
INVITED WE ALWAYS SHOW UP.
SO JUST WANTED TO MENTION THAT
AND THANKS TO THE FOLKS THAT PUT
TOGETHER THESE BRIEFINGS IN
EPILEPSY, SPINAL MUSCULAR
ATROPHY, BRAIN INITIATIVE AND
HEAL INITIATIVE, BUT I ALSO WANT
TO SAY THAT, YOU KNOW, MESSAGING
THE VALUE OF NIH RESEARCH, THE
GOVERNMENT CAN GO SO FAR,
PROBABLY NOT VERY FAR, BUT
REALLY THE PEOPLE DOING THE
RESEARCH, THE UNIVERSITIES THAT
ARE EMPLOYING RESEARCHERS I
THINK SHOULD REALLY BE THINKING
ABOUT JOINING IN THIS MESSAGING
OF THE VALUE OF NIH RESEARCH.
PARTICULARLY AT THIS POINT IN
TIME.
OKAY.
NEXT SLIDE.
I WANT TO REVISIT WHAT WE TALKED
ABOUT AT THE LAST COUNCIL WITH
REGARD TO OPTION FOR MORE
STRINGENT BUDGET.
DIVISION DIRECTORS GOT TOGETHER
AND FORCED THEM TO COME UP WITH
CUTS AND IDENTIFIED ABOUT $35
MILLION IN CUTS OVER WHAT WAS
PLANNED FOR 2024.
WE ALSO ARE NOW FUNDING THE
NON-COMPETING GRANTS, OUT-YEAR
GRANTS, NOT BEING FULLY FUNDED,
ONLY TO 90%, WHICH IS STANDARD
FOR WHEN YOU'RE OPERATING UNDER
CONTINUING RESOLUTION BECAUSE
SHOULD YOU GET A BUDGET, SAY IN
MARCH, LESS THAN THE CONTINUING
RESOLUTION YOU WOULD NOT BE ABLE
TO PAY ALL YOUR COMMITMENTS SO
90% IS PAID NOW, 10% WITHHELD,
HOPEFULLY WE CAN RESTORE THAT
10% GOING FORWARD ONCE WE GET A
BUDGET.
BUT SHOULD WE GET A CUT IN OUR
BUDGET WE'LL HAVE TO PASS THAT
CUT ON TO SO THE TOTAL WILL NOT
BE RESTORED AND THE AMOUNT
RESTORED WILL DEPEND A LITTLE
BIT ON -- ENTIRELY ON THE AMOUNT
OF THE CUT TO OUR BUDGET.
WE ARE CURRENTLY ALSO FUNDING
THE NEW AWARDS WITH 20.5%
ADMINISTRATIVE CUT, THIS IS A 3%
INCREASE OVER STANDARD.
AND FOR THE SAME REASON, AND WE
MAY BE ABLE TO RESTORE THESE,
DEPENDING WHAT THE BUDGET IS,
BUT THAT STILL GIVES US THAT
BUFFER AND WE ALSO HAD TO LOWER
OUR PAY LINE TO 11 PERCENTILE.
WE TALKED ABOUT A COUPLE THINGS
GOING FORWARD THAT MIGHT HELP
US.
WE TALKED ABOUT LOWERING THE
LEVEL WHICH GRANTS HAVE TO COME
IN FOR PRE-APPROVAL TO COME IN,
CURRENTLY AT $500,000, TURNS OUT
WE CAN'T REALLY DO THAT ON OUR
OWN AS AN INSTITUTE, HAS TO BE
AN NIH POLICY CHANGE.
WE TALKED ABOUT UPDATING THE SCR
POLICY WHICH IS ON THE NEXT
SLIDE.
WE WILL DO THAT.
WE TALKED ABOUT IMPLEMENTING A
SPLIT PAYLINE, AND THE PROBLEM,
DON'T GO YET.
GO BACK.
WE TALKED ABOUT IMPLEMENTING
SPLIT PAYLINE, BUT THE TROUBLE
WITH THAT HOW TO GET EQUITABLE
DECISIONS MADE, GIVEN THE FACT
THAT SOME TYPES OF RESEARCH IS
INHERENTLY MORE EXPENSIVE THAN
OTHERS.
COUNCIL PUT UP A GREAT
SUGGESTION WHICH IS TO INCREASE
ADMIN CUTS TO APPLICATIONS OF
HIGHER PERCENTILES.
SO WE LOOKED CAREFULLY AT THAT.
THE PROBLEM IS THAT IF WE'RE
GOING TO ACTUALLY GENERATE THE
FUNDS TO PAY HIGHER PERCENTILES
BY CUTTING BETTER PERCENTILES,
GIVEN THE FACT WE'RE ALREADY AT
20.5% CUT, WE WOULD REALLY HAVE
TO MAKE DRASTIC CUTS TO REALLY
HIGH-SCORING GRANTS POTENTIALLY
GOING DOWN TO THE SIXTH OR FIFTH
PERCENTILE TO GENERATE THOSE
KINDS OF FUNCTION.
SO WE'RE HOLDING ON THAT AT THIS
POINT IN TIME.
NEXT SLIDE.
IN TERMS OF THE SPECIAL COUNCIL
REVIEW POLICY WE ARE MAKING A
CHANGE.
SO PEOPLE MAY RECALL THE SPECIAL
COUNCIL REVIEW POLICY IS THAT
NIH INSTITUTES HAVE TO LOOK AT
GRANTS, GRANTEES, WHO HAVE OVER
$2 MILLION IN TOTAL COSTS, IN
THEIR NIH SUPPORT.
AND WE HAVE THE ABILITY TO MAKE
OUR OWN POLICY, WE'RE HOPING NOW
TO REDUCE THAT TO $1.5 MILLION
IN TOTAL COSTS, AND THIS IS
EQUIVALENT TO $1 MILLION IN
DIRECT COSTS.
SO ANYONE COMING IN WITH GRANTS,
AND THEY ALREADY HAVE, SAY, A
MILLION DOLLARS IN DIRECT COSTS,
THEY WILL BE -- THEY WILL HAVE
TO ACHIEVE A GREATER PERCENTILE
SCORE THAN THE OVERALL
PERCENTILES OF PAYLINE TO GET
FUNDED.
SO CURRENTLY THE PAYLINE IS AT
11 PERCENTILE SO IF SOMEONE
MEETS THE SCR CRITERIA THEY WILL
HAVE TO GET FIFTH PERCENTILE OR
BETTER TO BE PAID.
THERE ARE SOME EXCEPTIONS TO
THOSE, PARTICULARLY IN THOSE
AREAS THAT WHERE FUNDS ARE
COMING TO THE INSTITUTE FOR
PARTICULAR PURPOSES SO THOSE
FUNDS WOULD NOT ACTUALLY HELP
THE PAYLINE AT ALL.
BUT THAT'S WHAT WE'RE DOING WITH
SCR POLICY GOING TO A
$1.5 MILLION TOTAL COST, IF YOU
COME IN AND ALREADY HAVE THAT
AMOUNT OF MONEY YOU'LL BE
REQUIRED TO HIT THAT BETTER
PAYLINE.
NEXT SLIDE.
NEXT SLIDE JUST SHOWS PICTORIAL
VIEW WHERE OUR MONEY GOES, YOU
CAN SEE IN THE DARK BLUE THE
MAJORITY OF OUR MONEY GOES OUT
TO UNIVERSITIES, AND EXTRAMURAL
GRANTS.
LARGE MAJORITY OF THAT IS
INVESTIGATOR INITIATED GRANTS.
THEN YOU CAN SEE HERE IN LIGHTER
BLUE, THE HEAL INITIATIVE MONEY,
IN PURPLE INTRAMURAL PROGRAM,
WHICH YOU'LL HEAR ABOUT FROM
JEFF DIAMOND LATER TODAY.
AND JUST TO MENTION THE IRP
PROGRAM FUNDING IS NOT SIMPLY
FOR THE SCIENCE BUT ALSO
INCLUDES ABOUT 37% OF THAT MONEY
REALLY TO SUPPORT THE
INFRASTRUCTURE OF NIH IN
GENERAL.
AND THEN WE HAVE THE MONEY WE
USE TO MANAGE IT AND PAY OUR
STAFF.
AND MONEY THAT GOES TO SBIR
GRANTS, SMALL BUSINESS GRANTS,
WHICH IS MANDATED BY CONGRESS.
THEN YOU CAN SEE IN THE BRIGHT
BLUE THE BRAIN INITIATIVE
FUNDING.
AS MENTIONED $75 MILLION IN ALS
FUNDING FOR EXPANDED ACCESS
GRANTS AND RESEARCH IN THE
PUBLIC -- FOR THE PUBLIC/PRIVATE
PARTNERSHIP, WITH THE FDA FOR
ALS.
WE MANAGE, AGAIN, A LITTLE OVER
$300 MILLION FOR THE AGING
INSTITUTE.
OF THE AGENCY FUNDS FOR
ALZHEIMER'S DISEASE AND RELATED
DEMENTIAS.
NEXT SLIDE JUST TO MENTION
YOU'LL BE HEARING THIS AFTERNOON
FROM MIKE, AND LINDA PORTER,
ANNUAL REPORT OF THE HEAL
INITIATIVE, AND WE THANK THEM
FOR BEING WONDERFUL LEADERS, A
VERY AMBITIOUS PROGRAM.
NEXT SLIDE, THE PROGRAM HAS
UNDERGONE SOME CHANGES SINCE
LAST WE MET, MAJOR CHANGES HEAL
GOVERNANCE MOVED OUT OF THE
DIRECTOR'S OFFICE, NIH DIRECTOR
NOW LED BY NATIONAL DRUG ABUSE
AND OUR INSTITUTE.
OUR INSTITUTE IS PRIMARILY
WORKING WITH NIDA ON
CROSS-CUTTING ISSUES BETWEEN
OPIOID OVERUSE AND PAIN
MANAGEMENT, HOW TO PREVENTED
OPIOID OVERUSE DISORDERS IN
FOLKS WHO HAVE CHRONIC PAIN AND
REQUIRE OPIOIDS AND HOW DO YOU
TREAT PAIN IN PEOPLE WHO HAVE
OPIOID USE DISORDER.
THE PAIN SIDE OF THINGS, WHICH
IS TO TRY AND DEVELOP NEW
NON-ADDICTIVE TREATMENTS FOR
PAIN, TO DEVELOP NEW MANAGEMENT
STRATEGIES FOR PAIN, REDUCING
THE RISK OF ADDICTION, LED BY A
BUNCH OF INSTITUTE.
WE'VE BEEN ABLE TO BROADEN THE
PROCESS AND INCLUDE 14
INSTITUTES AND DIRECTORS MEETING
WITH REGARD TO THE PAIN SIDE OF
"HEAL."
OUR MISSION STATEMENT IS HERE,
REDUCE PAIN AND RISK OF OPIOID
USE DISORDER BY DEVELOPING SAFE
AND EFFECTIVE PAIN TREATMENT AND
PREVENTION STRATEGIES TO IMPROVE
QUALITY OF LIFE FOR ALL PEOPLE.
BESIDES THE CROSS-CUTTING
PROGRAMS, WE ALSO WILL BE
WORKING WITH NIDA AND THESE
INSTITUTES TO DEVELOP A "HEAL"
STRATEGIC PLAN, FOCUSING ON THE
PAIN SIDE OF THAT BUT ALSO ON
THE CROSS-CUTTING ISSUES.
AND THIS STRATEGIC PLAN HAS ALL
THOSE THAT WE DO HERE WILL BE A
WORKING GROUP FOR COUNCIL, SO
WONDERING IF ANYONE ON COUNCIL
IS INTERESTED IN WORKING ON THIS
SPACE TO DEVELOP STRATEGIC PLAN
LET US KNOW.
WE WILL ALSO BE REACHING OUT.
NEXT SLIDE.
I JUST WANT TO MENTION WE TALKED
ABOUT THE BUDGET PROBLEMS WITH
THE BRAIN INITIATIVE.
BUT THE REAL POSITIVE THINGS ARE
THAT THE BRAIN INITIATIVE HAS
EXCEEDED EXPECTATIONS AND
REVOLUTIONIZED OUR ABILITY TO
UNDERSTAND BRAIN CIRCUIT
INFORMATION PROCESSING.
THE GOAL WAS APPLY NEW TOOLS TO
UNDERSTAND HOW NEURAL CIRCUITS
UNDER LIE COMPLEX BEHAVIORS.
WE THOUGHT IT WAS GOING TO BE
GREAT BUT IT HAS EXCEEDED
EVERYONE'S EXPECTATIONS.
AND IT'S REALLY GETTING US TO
THE POINT WHERE WE CAN THINK
ABOUT DISEASES, ACTUALLY EVEN A
MUCH MORE SOPHISTICATED WAY
WHICH WE'LL COME TO IN A SECOND.
NEXT SLIDE AGAIN JUST EMPHASIZES
THE BUDGET ISSUE, AND THAT SHOWS
THAT THE IN LIGHT BLUE ON THE
NEXT SLIDE YOU'LL SEE THE CURES
MONEY, THE MAJORITY OF THE MONEY
IN FY 23, AND HOW THE BASE
BUDGET WHICH WAS THE DARK BLUE
GOT REDUCED IN 23, SO WE NEED
BECAUSE IN 24 THAT CURES MONEY
SUBSTANTIAL AMOUNT GOES AWAY, WE
REALLY NEED TO GET THAT BASE
BACK UP TO WHERE IT WAS BEFORE.
NEXT SLIDE.
BUT THE BRAIN ADVANCES ARE
SPECTACULAR, RECENTLY MULTIPLE
ARTICLES PUBLISHED TODAY IN
NATURE, SCIENCE, SCIENCE
ADVANCES ON A CELL CENSUS AND
BRAIN MAPS, AND SO JUST THE
BASICALLY SIMPLIFY WHAT THE
BRAIN INITIATIVE HAS DONE SO FAR
IS DEVELOP WHAT WE CALL A CELL
ATLAS OR CELL CENSUS OF ALL THE
CELLS IN THE BRAIN.
AND THIS IS BASED ON A NUMBER OF
DIFFERENT CHARACTERIZATIONS BUT
PRIMARILY HIGH-THROUGHPUT METHOD
OF LOOKING AT THE RNA AND OPEN
CHROMATIN IN THE DIFFERENT CELL
TYPES, AND THAT ACTUALLY
GENERATES A LIBRARY OF DIFFERENT
CELL TYPES, BUT ALSO MORE THAN
THAT IT ALLOWS YOU GENETIC TOOLS
TO GO IN AND THEN STUDY THE
CONNECTIONS BETWEEN THOSE
DIFFERENT CELLS, TO IDENTIFY
DIFFERENT CELL TYPES AND THEN
LOOK AT ELECTROPHYSIOLOGICAL
PROPERTIES, MOST IMPORTANTLY
GIVES YOU GENETIC KEYS TO GET
PRECISE ACCESS TO PARTICULAR
CELL TYPES.
AND THAT ALLOWS YOU TO MONITOR
CELLS, THEIR ACTIVITY, ALL SORTS
OF BEHAVIORS, AND MOST
IMPORTANTLY FOR DISEASES
MODULATE BEHAVIOR OF DIFFERENT
CIRCUITS.
ALMOST ALL OF OUR DISEASES CAUSE
PROBLEMS BECAUSE THEY AFFECT
ACTUAL FUNCTION OF CIRCUITS.
THE NEXT SLIDE IS AN EXAMPLE
WHAT IS HAPPENING, AND YOU CAN
START THE MOVIE.
IS USING REALLY THE TECHNOLOGIES
OF ELECTRICAL STIMULATION, THE
BRAIN INITIATIVE TECHNOLOGIES
ARE GOING TO BE MORE
SOPHISTICATE AND PRECISE.
IN THIS STUDY THEY ARE
STIMULATING SENSORY ROOTS TO
CERVICAL MUSCLES THAT MOVE THE
ARM.
A PERSON WHO HAD A STROKE.
HERE YOU CAN SEE BEFORE TURNED
ON HOW MUCH DIFFICULTY THIS
YOUNG WOMAN IS HAVING WITH THE
LEFT HAND AS SHE TRIES TO STAB
FOOD TO BRING TO HER MOUTH TO
EAT.
AND SO JUST TO KNOW THAT OFTEN
TIMES WEAKNESS IS NOT
NECESSARILY THE BIGGEST PROBLEM,
BUT THE PROBLEM IS MOTOR CONTROL
THAT IS SO DISABLED WHEN PEOPLE
HAVE STROKE OR OTHER NEURAL
INJURY.
BUT YOU'LL SEE SHE'S TRYING TO
GET IT IN.
SHE HAS TO TIP HER BODY OVER.
YOU TURN THE STIMULATOR ON AND
YOU IS SEE HOW MUCH MORE FACILE
SHE IS WITH HER HANDS.
THERE ARE STUDIES THAT LOOK AT
HOW THIS IS ACTUALLY HAPPENING
USING THE BRAIN INITIATIVE
TOOLS.
THE OTHER POINT, STUDY FUNDED BY
THE BRAIN INITIATIVE, YOU CAN
SEE ALMOST AS AMAZING IF NOT
MORE AMAZING RESULTS IN THE SAME
TYPE OF STIMULATION OF THESE
SENSORY ROOTS, PEOPLE WITH
SPINAL CORD INJURY, ALLOWING
THEM TO WALK WHEN THEY COULDN'T
WALK BEFORE, AND REMARKABLY
PEOPLE WITH PARKINSON'S DISEASE
WITH SEVERE GAIT DISORDER BUT
WITH THE SAME KIND OF
STIMULATION HAVE ALMOST A
NORMAL-LOOKING GAIT.
THEY FOUND A WAY TO ENGAGE
NEURAL CIRCUITS AT SPINAL CORD
LEVEL, ALLOW THEM TO BE MORE
CLOSELY TIED IN TO INPUTS COMING
FROM ABOVE.
THIS IS NOT -- THIS IS VOLUNTARY
MOVEMENT, NOT AUTOMATIC
MOVEMENT.
THIS IS IMPROVED ABILITY TO MAKE
VOLUNTARY MOVEMENTS, NOT
SOMETHING ANYBODY COULD HAVE
GUESSED.
THAT'S THE MESSAGE FROM THE
BRAIN INITIATIVE, YOU KNOW THERE
ARE GOING TO BE JUST AMAZING
THERAPEUTIC AND DIAGNOSTIC
RESULTS THAT ARE GOING TO CHANGE
HOW WE PRACTICE NEUROLOGY AND
PROBABLY EVEN MORE SO
PSYCHIATRY.
THE BRAIN INITIATIVE, AT THE
"HEAL" MEETING WE JUST HAD
PRESENTATIONS BY FOLKS
STIMULATING INSIDE THE BRAIN TO
REDUCE CRAVING IN PEOPLE WITH
OVERUSE DISORDER, AND IS A
GENTLEMAN WHO HAD SEVERE CHRONIC
PAIN AND IN STUDIES FUNDED BY
"HEAL" AND "BRAIN" HAD A CLOSED
LOOP STIMULATOR PUT IN, AND HIS
PAIN MIRACULOUSLY JUST
DISAPPEARED.
SO REALLY AMAZING STUFF COMING
OUT FROM THESE INITIATIVES.
NEXT SLIDE, I'M GOING TO MOVE TO
POLICY PAPERS THAT HAVE COME OUT
FROM THE ADVISORY COMMITTEE TO
THE DIRECTOR OF NIH.
AND THIS IS ABOUT THE POSTDOC
SITUATION IN THE COUNTRY, THE
WORKING GROUP REPORT, AND THEY
HAD A NUMBER OF RECOMMENDATIONS.
SO PEOPLE WHO ARE NOT AWARE IN
THE UNITED STATES AND THIS IS A
LITTLE BIT OF A SIMPLIFICATION,
WE FUND INVESTIGATORS TO DO
GRANT RESEARCH ON GRANTS, THE
WORK IS OFTEN DONE BY WHAT'S
CALLED POSTBACS, PEOPLE IN
TRAINING PRIOR TO BECOMING A
PRINCIPAL INVESTIGATOR OR PhD
student.
THEY ARE IN A PECULIAR POSITION,
NOT STAFF MEMBERS, SO ADVANCED
IT'S PRETTY HARD TO CALL THEM
TRAINEES ANYMORE.
SO, THAT'S WHAT WE'RE DEALING
WITH HERE.
AND THE RECOMMENDATIONS ARE
INCREASE THE PAY AND BENEFITS
AND TREAT THEM AS STAFF MEMBERS.
AND TO EXPAND THE MECHANISM TO
SUPPORT FULL TALENT POOL OF
POSTBAC SCHOLARS.
ONE BIG PROBLEM IN THE U.S.
GRANTS WE HAVE TO SUPPORT
POSTBACS UNDER TRAINING GRANTS
ARE NOT AVAILABLE FOR THOSE
UNLESS YOU HAVE A GREEN CARD OR
U.S. CITIZEN AND YET WE BENEFIT
SO TREMENDOUSLY BY BRINGING IN
TRAINEES FROM FOREIGN COUNTRIES.
NEXT SLIDE SHOWS A COUPLE OTHER
RECOMMENDATIONS, AND THESE
INVOLVE PUTTING MORE EMPHASIS ON
THE ACTUAL CLIMATE AND ECOSYSTEM
WHICH THE POSTDOCS ARE WORKING.
SO TO FACILITATE TRANSITION OF
SCHOLARS TO THE NEXT CAREER
STAGE INCLUDING ROLES BEYOND
ACADEMIC FACULTY, PROMOTE THE
TRAINING AND PROFESSIONAL
DEVELOPMENT.
POSTDOC SCHOLARS, A TO SUPPORT A
SAFE AND HEALTHY ENVIRONMENT TO
DEVELOP PROJECTS SO IMPORTANT TO
NIH AND THEN TO DEVELOP THE
EXPERTISE AND EXPERIENCE TO
BECOME INDEPENDENT
INVESTIGATORS.
NEXT SLIDE.
THE NEXT REPORT TO THE DIRECTOR
THAT I WANTED TO MENTION IS
AROUND THE USE OF NOVEL
ALTERNATIVE METHODS AND NEW
COMMON FUND PROGRAM RELATED TO
THIS.
SO, JUST RECENTLY I DON'T KNOW
IF PEOPLE SAW IT BUT IN SCIENCE
TRANSLATIONAL MEDICINE THERE WAS
AN NINDS-FUNDED STUDY THAT CAME
OUT USING 3D PRINTING TO DEVELOP
CORTICAL STRIATAL iPS CELLS IN
A GEL MATRIX.
AND THIS IS AN EXAMPLE OF THESE
KINDS OF ALTERNATIVE METHODS IN
WHICH YOU CAN STUDY INTERACTION
BETWEEN DIFFERENT CELL TYPES.
THEY HAVE NEURONS.
THEY HAVE GLIA.
AND THE IDEA HERE IS THAT WE
COULD ACTUALLY LEARN MORE FROM
MANY OF THESE COMPLEMENTARY
METHODS, NOT ALTERNATIVE
METHODS, TO THE ANIMAL
EXPERIMENTS BUT POTENTIALLY
COMPLEMENTARY.
I WOULD SAY THERE'S A LOT OF
HYPE AROUND THIS, AND JUST WITH
REGARD TO THIS SCIENCE HAS A
COMMENTARY ABOUT THE ARTICLE,
WHICH THEY ENTITLED 3D PRINTER
CREATES BRAIN TISSUE THAT ACTS
LIKE THE REAL THING, WHICH IS
NOT TRUE.
DEPENDING HOW YOU DEFINE "ACTS"
BUT NOT IN THE BIG PICTURE OF
HOW CIRCUITS ARE WORKING.
WE HAVE TO BE CAREFUL TO STRESS
THESE ARE COMPLEMENTARY AND NOT
ALTERNATIVES.
BUT THERE IS A COMMON FUND
PROJECT DECIDED BY DR.
BERTAGNOLLI TO GO AHEAD.
AND THIS IS DEVELOP MORE OF
THESE MODELS AND THIS IS FUNDED
TO ABOUT $35 MILLION TO $40
MILLION A YEAR, NOT LAUNCHED YET
IN TERMS OF ACTUAL PROGRAMS BUT
OUR NINDS FOLKS, SARAH, JULIA,
JOE AND GRACE ARE WORKING ON
THIS GOING FORWARD.
NEXT SLIDE, GREAT WORK THAT THE
FUNDAMENTAL NEUROSCIENCE WORKING
GROUP DID.
AND REPORT TO COUNCIL WAS
APPROVED AT OUR LAST COUNCIL.
THE SIX MOST SALIENT
RECOMMENDATIONS ARE ON THIS
SLIDE.
WE'RE PURSUING HOW TO MOVE THIS
FORWARD.
RIGHT NOW WE'RE PUTTING TOES IN
THE WATER CONVENING A WORKSHOP,
IDENTIFYING COLLABORATIVE
INTERACTIONS, ENCOURAGING
COLLABORATIVE RESEARCH, THINKING
OF MOVING THE TEAM SCIENCE
RECOMMENDATION INTO OUR R01
PROGRAM.
SO I WANT TO AGAIN THANKS, AND
YOU HAVEN'T SEEN THE LAST OF
THIS.
WE'RE WORKING HARD, WE THINK
THIS IS VERY IMPORTANT.
NEXT SLIDE.
I WANTED TO MENTION THERE'S A
WORKING GROUP OF COUNCIL ENGAGED
IN DEVELOPING A ROADMAP FOR A
MYALGIC SYNDROME, MECF RESEARCH,
CALL FOR PUBLIC INPUT WHICH IS
DUE BY MARCH 28 SO I ASK PEOPLE
TO USE THAT LINK IF THEY HAVE
INPUT ON WHAT THEY FEEL ARE THE
TOP PRIORITIES IN THIS S PACE.
NEXT SLIDE.
NEXT, A HAPPY SLIDE, FORENINDS A
HAPPY SLIDE.
FOR ME TURNING 75 WOULD NOT BE
SO HAPPY BUT NINDS TURNED 75 IN
2025.
WE HAVE A LOT TO BE PROUD OF.
WE'RE LOOKING, ALISSA WILL TALK
TO YOU THIS AFTERNOON WHAT WE
CAN DO TO CELEBRATE AND USE THIS
OPPORTUNITY TO THINK HOW WE CAN
BE MORE EFFECTIVE IN THE FUTURE
IN ACHIEVING OUR MISSION.
WE LOOK FORWARD TO HER
PRESENTATION AND YOUR DISCUSSION
THIS AFTERNOON.
AND NEXT SLIDE.
NEXT SLIDE ILLUSTRATES THE
ACTIVITIES THAT WE INVOLVE IN
USING OUR CONVENING POWERS,
MULTIPLE DIFFERENT MEETINGS IN
DIFFERENT AREAS OF SCIENCE,
BRINGING TOGETHER INVESTIGATORS
AND THIS IS HOW WE LEARN AS AN
INSTITUTE BUT ALSO I THINK WE
CAN PROVIDE A GREAT SERVICE TO
THE COMMUNITY GETTING THEIR
TOPICS DISCUSSED.
TAKE A LOOK AT THOSE.
WE'LL HAVE REPORTS COMING OUT
FOR THE RECENT ONES THAT ARE
OVER AND UPCOMING ONES PLEASE
JOIN IF YOU CAN.
NEXT, A HAPPY SLIDE.
EACH YEAR WE LOOK BACK AT THE
PRESS RELEASES AND NEWS RELEASES
WE'VE DONE OVER THE YEAR.
AND THESE ARE JUST A SMATTERING
OF THE GREAT THINGS THAT ARE
HAPPENING DUE TO NINDS FUNDING.
BUT I ENCOURAGE PEOPLE TO TAKE A
LOOK AT THAT.
IT STRETCHES FROM THE PAPER ON
HEALTH EQUITY THAT WAS PUT
TOGETHER BY THE WORKING GROUP
FOR COUNCIL HERE, AN ENTIRE
ISSUE OF NEURAL WAS DEDICATED TO
THAT.
NEXT TO THAT IS A GWAS STUDY
WHICH IS AN AMAZING STORY, THIS
WAS A TRAINING EXERCISE TO TRAIN
PEOPLE IN AFRICA TO DO GENETIC
RESEARCH AND TRAINING EXERCISES
GWAS FOR PARKINSON'S, THEY
HAPPENED TO HIT A BIG EFFECT
SIZE LINKAGE TO PARKINSON'S IN
AFRICA.
AND IT IS IN AN INTRON ADJACENT
TO THE GLUCOSE GENE, NOT CLEAR
WHAT IT DOES, BUT JUST INDICATES
HOW WE HAVE MISSED A GIANT
SIGNAL FOR YEARS BECAUSE OUR
GWASs ALL WERE LOOKING AT
EUROPEAN POPULATIONS.
SO A TRAINING EXERCISE, 1800
PEOPLE, FOUND THIS AMAZING
FINDING.
THEN THE NEXT ONE, THE LADY WITH
THE SPINAL CORD STIMULATOR WE
TALKED ABOUT.
AND NEXT TO THAT IS THE STUDY
THAT WAS DONE WITH INTRACRANIAL
RECORDINGS AND CLOSED LOOP
SYSTEM IN SOMEONE WITH SEVERE
CHRONIC PAIN THAT I MENTIONED.
THEY DEVELOPED A SIGNATURE IN
THE ELECTRICAL ACTIVITY OVER THE
CORTEX THAT CORRELATED WITH
SEVERE PAIN, AND THAT IN THE
CLOSED LOOP SYSTEM TRIGGERED THE
STIMULATOR AND TOOK THE PAIN
AWAY.
SO THIS PATIENT WOULD SAY HE
WOULD FEEL THE PAIN COMING ON,
AND THEN LIKE BANG, IT WOULD GO
AWAY.
THAT BANG, IT WENT AWAY,
CONCURRED WITH WHEN THE
STIMULATOR WENT ON, QUITE AN
AMAZING STORY.
BOTTOM IS THE PAPER BY AVI NATH,
LONG COVID CASES WHICH HE
NOTICED A NUMBER OF
ABNORMALITIES IN SPINAL FLUID.
NEXT ONE AFTER THAT IS A PAPER
ON CAR-T CELLS USE FOR
MYASTHENIA GRAVIS, CAUSED BY
IMMUNE REACTION AGAINST
ACETYLCHOLINE RECEPTOR, IT'S ONE
OF THE FIRST REALLY AMAZING
FINDINGS IN NEUROTRANSMITTER
RESEARCH, FROM PROBABLY THE
'60s, STILL TREATED WITH VERY
KIND OF BROAD-BASED
IMMUNOSUPPRESSION.
THIS IS REALLY A THERAPY THAT
JUST TARGETS THE CELLS THAT ARE
MAKING THIS ANTIBODY, ABOUT TIME
TO GET A PRECISION THERAPY FOR
MYASTHENIA GRAVIS.
NEXT IS A PAPER BY McGAVEEN,
IN THE MICROGLIA OF THE BRAIN
HOW TO REPAIR AFTER INJURY.
THE NEXT ONE IN THAT ROW FROM
MICHAEL WARD'S LAB AT NIH
LOOKING AT TDP-43, A PROTEIN
THAT AGGREGATES IN
FRONTOTEMPORAL ALS AND
ALZHEIMER'S, AGGREGATION CAUSES
AN ABNORMAL EXPRESSION OF
CRYPTIC EXONS, SO THERE'S A
SPLICING ABNORMALITY, AND THEY
WERE ABLE TO SEE THERE WERE
PROTEINS THAT WERE THEN
EXPRESSED IN CELLS IN WHICH HAVE
YOU TDP-43 AGGREGATES, A
POTENTIAL BIOMARKER.
IN ADDITION THIS MAY HAVE
CAUSATIVE EFFECTS, THE PAPER
RIGHT ABOVE IT, IN DON CLEAVEN'S
LAB SHOWED EXPRESSION LEADING TO
LOSS OF FUNCTION OF STAFFMIN,
LEADING TO AXONAL OUTGROWTH IN
CULTURED NEURONS, COULD THE
ABNORMAL SPLICING BE A CAUSE OF
THE DEGENERATION IN ALS, COULD
BE MANY OTHER THINGS BUT THAT'S
ALSO ONE POSSIBILITY.
AND THEN THE PAPER NEXT TO IT
WITH THE BRAIN IS FROM THE MAYO
CLINIC JACKSONVILLE LABS,
SHOWING IN THE BRAIN OF PEOPLE
WITH ALZHEIMER'S WHERE YOU SEE
TPP 43 YOU SEE CRYPTIC EXON IN
THE PATTERN, THE WHOLE FIELD OF
TDP-43 IS EXPLODING, NOT THE
ONLY AREA THAT'S EXPLODING.
IN SUMMARY I'D LIKE TO EMPHASIZE
THAT WE FEEL THAT ALTHOUGH WE
HAVEN'T ACHIEVED WHAT WE WANT TO
ACHIEVE IN GETTING TREATMENT FOR
PEOPLE WITH REALLY SEVERE
NEUROLOGICAL DISEASES, WE FEEL
THE FIELD IS MAKING A LOT OF
PROBLEM.
WE KNOW THESE ARE HARD PROBLEMS.
AND WE PARTICULARLY AT THIS TIME
WHEN THE BUDGET BECOMES MORE
STRAINED IT'S MORE AND MORE
IMPORTANT TO BE ABLE TO MESSAGE
OUT AND TO REALLY ADDRESS THESE
ISSUES WITH URGENCY TO GAIN THE
TRUST OF THE TAXPAYER.
WE TRY AND DO THAT HERE AT NIH
AND I HOPE OTHERS CAN JOIN.
WITH THAT I'D LIKE TO CLOSE AND
HAPPY TO ANSWER ANY QUESTIONS.
>> THANK YOU.
IT'S GREAT TO HEAR OF THESE
EXCITING DISCOVERIES.
LET'S GO TO SOMETHING UNHAPPY,
WHICH IS BUDGET.
YOU MENTIONED THE FACT THAT THE
$500,000 THRESHOLD CAN'T BE
REDUCED BECAUSE IT REQUIRES
BROAD DECISION.
THE NEW NIH DIRECTOR, NOW WOULD
BE THE TIME IF YOU'RE EVER GOING
TO DO THAT TO DECIDE WHETHER TO
APPROACH THAT AS INSTITUTE-WIDE
MEASURE.
I'M NOT SAYING I ADVOCATE BUT IT
COULD BE A SIMPLE WAY TO DEAL
WITH BUDGETARY CONSTRAINTS.
>> THANKS FOR THAT.
WE ARE HAVING DISCUSSIONS WITH
THE I.C. DIRECTOR'S TABLE ABOUT
DIFFERENT WAYS TO TRY TO DEAL
WITH BUDGETS.
WE DON'T KNOW WHAT THE CUT IS
GOING TO BE BUT I THINK THAT'S
DEFINITELY SOMETHING WE WOULD BE
PUTTING ON THE TABLE.
I WOULD SAY AT NIH THE PEOPLE
REMEMBER YEARS AGO THERE WAS A
PROPOSAL TO LIMIT THE NUMBER OF
GRANTS SOMEONE COULD HAVE, THEY
GAVE A SCORING METHOD, THINGS
DIDN'T FALL INTO PLACE SO THAT
WASN'T GOING FORWARD BUT I THINK
THERE'S -- I WOULD JUST SAY
THAT'S A TENOR I'VE BEEN HEARING
IN TERMS OF LIMITING NUMBER OF,
SAY, R01s.
BUT EVERYTHING DEPENDS ON WHAT
THE BUDGET LOOKS LIKE SO STILL
IN A WAITING MODE.
>> SAMEER?
>> THAT WAS NICE.
WHEN WE TALK ABOUT CONTINUING TO
FY 25 FEELS LIKE WE'RE HUNKERING
DOWN FOR A STORM THAT MIGHT LAST
A LOT LONGER THAN WE WERE
INITIALLY HOPING.
IF THAT'S THE CASE AND THINGS
REMAIN FLAT DO YOU IMAGINE
FURTHER CUTS?
RIGHT NOW HIGH ADMINISTRATIVE
CUT, PAYLINE DROP, SCR CUT.
DO YOU IMAGINE FOR, AS OUT
YEARS, NEED TO BE FUNDED, MORE
CUTS IN THE FUTURE?
AND MY SECOND PART, SUPPOSE
THINGS GET BETTER, IS THE IDEA
TO REVERT ALL TO HOW IT WAS A
COUPLE YEARS AGO?
I FEEL LIKE AFTER 9/11 THAT FUEL
CHARGE AT THAT POINT IS STILL
THERE ON TICKETS.
I WONDER HOW MANY THINGS CUT CAN
BE REVERSED BACK TO LEVELS FROM
A COUPLE YEARS AGO.
>> THAT'S THE MILLION DOLLAR
QUESTION, SAMEER.
I WOULD SAY THAT WE ARE READING
TEA LEAVES, I'M NOT SURE WE'RE
ANY BETTER THAN WHAT YOU GET
FROM READING THE PAPER.
BUT WE'RE HEARING THAT, YOU
KNOW, THE PRIORITIES AT THE
GOVERNMENT LEVEL, THERE'S SO
MUCH PRESSURE IN MULTIPLE
PRIORITIES THAT WE SHOULDN'T
EXPECT TO RECEIVE THE SAME KIND
OF INCREASES WE SAW IN THE LAST
SIX YEARS.
THAT'S WHAT WE'RE HEARING.
NOW, HOW -- WHAT THAT MEANS, THE
DID HE EVER SILL -- DEVIL IS IN
THE DETAILS.
HAVING COME HERE IN 2007 WE DID
GO FROM 2004 TO 2016 WITH A
PRETTY MUCH FLAT BUDGET.
SO WE DO HAVE SOME SENSE OF WHAT
WE WOULD HAVE TO DO.
CERTAINLY, YOU KNOW, WE WOULD
HAVE TO SCALE BACK ON THE THINGS
WE'RE DOING, THERE MIGHT BE SOME
INITIATIVES THAT WE CAN'T LAUNCH
BECAUSE WE DON'T HAVE THE FUNDS.
WE DO WANT TO MAKE A EQUIPMENT
TO THE NEW GENERATION THAT WE
DON'T HIT THEM HARD, THAT WE
WANT -- BECAUSE THAT WOULD PUT
US DOWN FOR TEN, TWENTY YEARS.
SO FOR INSTANCE WITH THE
EARLY-STAGE INVESTIGATORS, WE
WANT TO PAY THEM DOUBLE THE
REGULAR PAYLINE.
WE'LL PAY UP TO 22 PERCENTILE.
TRAINING GRANTS WE DON'T WANT TO
REDUCE AT ALL BECAUSE THAT'S THE
INVESTMENTS OF THE FUTURE THAT
SHOULD WE RENEG NOW WE'LL PAY A
PRICE DOWN THE LINE.
BUT THEN THERE MIGHT BE A LOT OF
OTHER THINGS WE JUST CAN'T DO
BECAUSE WE DON'T HAVE THE FUNDS.
AS WE HAVE TALKED ABOUT AT
COUNCIL, THE GENERAL SUGGESTION
TO US HAS BEEN THAT IN TOUGH
TIMES IT'S BETTER TO FUND MORE
GRANTS AT LESS MONEY AS A
POSSIBILITY GOING FORWARD.
SO THOSE ARE THE KIND OF JUST
GENERAL IDEAS FLOWING HERE.
WE'RE INTERESTED IN SUGGESTIONS.
DO YOU HAVE ANY SUGGESTIONS?
>> WE TALKED ABOUT THE BOTTOM OF
THE SLIDE, WHEN YOU CRUNCH THE
NUMBERS, A GRADUATED GRADIENT,
RIGHT, OF ADMINISTRATIVE CUT.
YOU KNOW, IN THE FALL, YOU RAN
THE NUMBERS, MAYBE IT WAS JUST
NOT WORTH IT.
LIKE YOU SAID, BETTER TO HAVE
SOME FUNDING THAN NOT AT ALL,
WHETHER YOU'RE NEW INVESTIGATOR
OR ONE THAT'S BEEN AROUND.
SEEMED LIKE THAT WAS A GOOD IDEA
BUT APPARENTLY NOT.
>> WELL, GOOD IDEA, JUST IF YOU
DO THE MATH YOU HAVE -- IF YOU
WANT TO FUND PEOPLE AT 50% FROM
11 TO 14 AND ARE ALREADY CUTTING
AT 20, YOU HAVE TO CUT PEOPLE BY
50% DOWN TO ABOUT 6th
PERCENTILE SCORES.
SO THEN THE MAJORITY OF OUR
GRANTS WOULD BE ONLY HALF --
THEY WOULD ONLY GET HALF THE
MONEY THEY ASKED FOR.
THAT'S A BIG HIT TOO.
>> TIM?
>> WALTER, THAT WAS GREAT.
THANK YOU.
RELATED TO THE LAST TOPIC BUT I
THINK THE -- HOW DEEP DOWN THE
LIST TO MAKE ADMINISTRATIVE CUTS
WITH RESPECT TO PRESERVING MORE
BUDGET, AND ONE COMMENT I'D MAKE
WITHIN PERCENTILES, I THINK
THERE'S ASSUMPTION THERE'S AN
ACCURACY OF RESOLUTION THAT
SEPARATES DIFFERENT PERCENTILES.
MY EVEN EXPERIENCE AS A RECEIVER
AND REVIEWER, ONCE YOU'RE IN THE
TOP 10% IT'S CAPRICIOUS WHERE
YOU LAND.
A LITTLE DEPENDS ON WHO WAS IN
THE ROOM.
I TELL PEOPLE WHO ASK FOR
ADVICE, YOU HAVE TO LAND IN THE
TOP 10%, THEN IT'S NOISY.
I THINK IT'S BEEN DANGEROUS TO
SAY, OH, YOU WANT TO PROTECT THE
PEOPLE IN THE TOP 6% BECAUSE
THEY ARE REALLY GOOD.
THERE'S NO DIFFERENCE.
THERE MAY BE AT THE VERY END,
TIPPY TOP BEST GRANT OF THE
YEAR, THAT MAY BE ONE THING BUT
ACTUALLY RESOLUTION TO MAKE THAT
KIND OF CALL, I WOULD SAY YOU
JUST NEED TO MAKE A BLANKET,
MAYBE PROTECT EARLY
INVESTIGATORS SO THEY DON'T
SUFFER THESE CUTS BUT THAT'S A
DIFFERENT PHILOSOPHY.
>> WE DO KNOW A LITTLE ABOUT THE
ACCURACY OF THE PERCENTILES.
JIM NOTH DID THAT STUDY.
YOU'RE RIGHT.
PLUS OR MINUS DEPENDS WHERE YOU
ARE.
IF JIM IS HERE, FOUR OR FIVE
PERCENTILES PLUS OR MINE US
>> IF YOU'RE A FIVE YOU COULD BE
AT ONE OR NINE.
>> RIGHT.
>> OKAY.
>> BOB?
>> BOB, YOU'RE MUTED.
>> APOLOGIES.
AGAIN, TERRIFIC REPORT.
I HAVE A QUESTION WHICH IS A
LITTLE BIT AT RIGHT ANGLES BUT
IS IMPORTANT.
WHAT CONSIDERATIONS IF ANY THERE
ARE IN NINDS WITH REGARD TO THE
ISSUE OF INTEGRITY OF SCIENTIFIC
REPORTING.
I SAW YOU HAVE ONE INITIATIVE
RELATED TO PUBLICATION BIAS.
THE RECENT OUTREEK -- OUTBREAK,
CLAIMS OF PLAGIARISM, IS THERE
ROLE AS A MAJOR FUNDER TO
PARTICIPATE IN THAT DISCUSSION
AND IN WHAT WAY?
WALTER, YOU'RE MUTED.
>> SO I HAVE TO THINK MORE IN
TERMS OF GETTING AT YOUR WHOLE
QUESTION.
SO WE HAVE -- NIH HAS A SYSTEM
OF RESEARCH INTEGRITY WHERE
ALLEGATIONS COME IN.
THERE'S A VERY CONFIDENTIAL
PROCESS BY WHICH THEY ARE ALL
INVESTIGATED AND ACTED UPON.
SO THAT IS ONGOING AND VERY
ACTIVE, UNFORTUNATELY.
AND THEN THERE'S THE OTHER
PROCESS WHICH WE HAVE REALLY
PIONEERED THANKS TO SILVERBERG,
THE IMPORTANCE OF DOING SCIENCE
RIGHT.
IT'S NOT THE SAME.
CHEATING IS NOT THE SAME AS
SLOPPINESS.
BUT THEY ARE BOTH BAD.
AND PARTICULARLY CHEATING.
TERRIBLE.
BUT WE HAVE MADE THIS BIG
INVESTMENT.
WE HAVE NOW CENTERS THAT ARE
DEVELOPING EDUCATIONAL
MATERIALS, WORKSHOPS, WE HAVE A
RIGOR WORKING GROUP THAT MEETS
ALL THE TIME TRYING TO GET --
IMPROVE QUALITY OF THE SCIENCE
THAT WE FUND.
AND THAT'S WHERE WE THINK THAT
WE CAN MAKE THE BEST EFFORT
PROBABLY MORE AS TEACHERS
ENGAGING WITH TEACHERS IN TERMS
OF THAT AND NOT AS POLICEMEN.
BUT OPEN, IF PEOPLE HAVE
SUGGESTIONS, OPEN TO SUGGESTIONS
THERE.
>> I WON'T BELABOR.
AT LEAST IN THE RECENT HARVARD
CASES THERE WERE INVOLVED
PROMINENT P.I.s WHO HAD NOT
REALLY SERIOUSLY BEEN
ADJUDICATED BEFORE WITH RESPECT
TO PLAGIARISM.
BUT NO ONE LOOKED.
SO THE QUESTION, IS THERE SOME
PRO-ACTIVE WAY TO THINK ABOUT
THIS PARTICULARLY PERHAPS AMONG
FOLKS WHO AT LEAST WON'T SUSPECT
OF BEING INVOLVED WITH THAT,
JUST A SIDE CONSIDERATION.
>> I'M GOING TO THINK ABOUT
THAT, BOB.
THAT MIGHT BE SOMETHING TO
DISCUSSION WITH THE OFFICE OF
EXTRAMURAL RESEARCH ONE BY MIKE
LAUER WHERE MOST OF THOSE
PROCESSES WOULD OCCUR, SO A
PRO-ACTIVE LOOK.
OKAY, THANKS.
AMY?
>> YEAH, THANKS.
I WANTED TO GET BACK TO THE
BUDGET QUESTION.
SO I'M CURIOUS HOW YOU'RE
THINKING ABOUT ADMINISTRATIVE
CUTS VERSUS BUDGET CAPS.
I GUESS WHAT I'M THINKING IS I
FEEL LIKE WHEN YOU HAVE SORT OF
ADMINISTRATIVE CUTS ACROSS THE
BOARD IT INCENTIVIZES PEOPLE TO
PAD THEIR BUDGET IN ANTICIPATION
OF CUTS OR TO NOT PAD BUDGET, IN
WHICH CASE THE SCOPE OF WORK NO
LONGER ALIGNS WITH THE BUDGET
THEY ARE RECEIVING AND I THINK
THAT CAN NEGATIVELY IMPACT THE
SCIENCE.
SO, I'M CURIOUS IF YOU THOUGHT
ABOUT THE POSSIBILITY OF DOING
MORE BUDGET CAPS WHERE PEOPLE
CAN KNOW THIS IS WHAT WE CAN
BUDGET FOR AND LOWERING THE
BUDGET CAPS AND APPROPRIATELY
ADJUSTING THEIR SCOPE OF WORK
AND SCIENTIFIC AIMS, IN
ANTICIPATION OF THAT AS AN
ALTERNATIVE.
>> YEAH, I THINK THAT'S REALLY
IMPORTANT.
AND WE DO THAT TO SOME EXTENT IN
THE SENSE THAT TO ASK FOR MORE
THAN $500,000 YOU HAVE TO SUBMIT
TO US AND WE HAVE TO APPROVE IT
GOING FORWARD.
AT THE LAST COUNCIL WE SHOWED
THAT GRANTS ARE COMING IN
GIGANTIC SPIKE IN FRONT OF
$500,000.
IN FACT WE ARE EXPERTING
SOMEWHAT OF A BUDGET CAP ON THAT
SPACE, AND WE MIGHT HAVE TO BE
MORE STRINGENT IN DOING THAT.
AND THEN THE TRICK THEN IS BEING
FLEXIBLE ENOUGH SO THAT YOU
DON'T PREVENT CERTAIN RESEARCH
FROM HAPPENING BECAUSE IT'S
INHERENTLY MORE EXPENSIVE.
SO LIKE A CLINICAL TRIAL FOR
INSTANCE YOU CAN'T PROPOSE A
BUDGET CAP FOR AN R01 AND
CLINICAL TRIAL AND BE WORKING
WITH, SAY, NON-HUMAN PRIMATES,
THAT'S GOING TO BE MORE
EXPENSIVE, SOME SEQUENCING STUFF
IS MORE EXPENSIVE.
THAT'S WHY WE DO IT MORE CASE BY
CASE.
>> IF WE DID CUT BEYOND A
CERTAIN POINT, 25%, WE HAVE TO
RENEGOTIATE AIMS SO IT DOES
ADJUST THAT.
>> MY LAST QUESTION WAS RELATED
TO THIS, DAVID.
THAT THRESHOLD OF BEING ABLE TO
ALTER THE AIMS WHEN THE BUDGET
HAS BEEN REDUCED BY SAY 20%
DOESN'T FALL UNDER NIH GUIDELINE
YOU COULD RENEGOTIATE THE AIM
BUT IT'S A BIG CUT OF WHAT YOU
CAN DO SO THERE MAY BE A LONG
SIDE MAKING MORE DRACONIAN CUTS,
EASTERN FIT -- EVEN IF IT
DOESN'T REACH THE THRESHOLD,
THAT'S AN NIH-WIDE ROLE,
THRESHOLD FOR NEGOTIATION, BUT I
DON'T THINK IT ALIGNS WELL, 20%
CUT TO A GRANT YOU SHOULD BE
ABLE TO SAY, LISTEN, I WANT TO
SAVE THIS CHUNK OF AIM FOR --
I'LL APPLY TO SOME FOUNDATION TO
DO THAT.
>> JUST TO FOLLOW THAT LINE OF
THOUGHT, TIM, YOU'RE SAYING THAT
IF YOU GET SAY A 20% CUT, THAT
YOU ARE THEN ABLE TO RESTRUCTURE
YOUR AIMS, IS THAT WHAT YOU'RE
SAYING?
>> THAT'S WHAT I'M ADVOCATING.
FEELS LIKE 25% IS A PRETTY FAR
OFF LINE TO HAVE TO CROSS FOR
RENEGOTIATION.
>> YEAH.
OKAY.
>> IT WOULD IDEALLY BE MORE,
YEAH, A CENTRALIZED APPROACH AS
OPPOSED TO (INDISCERNIBLE).
>> OKAY.
SO I GUESS WE'RE HOPING THAT
MEMBER THIS IS JUST PREPARATION,
NEEDLESS PREPARATION, BUT
HOPEFULLY WE'LL LEARN MORE IN
MAY.
I GUESS WE'LL PROBABLY HAVE A
CONTINUING RESOLUTION GOING
FORWARD.
NEXT TIME WE MEET.
IN MARCH, YEAH, THEY COULD JUST
KICK THE CAN AGAIN.
>> GREAT TO HEAR ALL THE
PROGRESS, PARTICULARLY ALSO
ABOUT THE POST STRATEGIES
RECOMMENDATIONS, THAT COMES WITH
REALLY INCREASE OF POSTDOC
BENEFITS AND THE GRANT THAT'S
PROBABLY BEEN SET.
SO THE QUESTION RELATED TO THIS
RECOMMENDATION IS IT ONLY FOR
(INDISCERNIBLE) AWARDS OR WHAT
ABOUT THE POSTDOCS BEING FUNDED
ON FUNDED RPG GRANTS?
HOW DO YOU BALANCE THE
DIFFERENCES OVER PRESUMABLY
COMING UP TO 2024 AND MANY OF
THE P.I.s ARE NOT ABLE TO
OBTAIN GRANTS.
>> SO THAT'S THE ROCK AND THE
HARD PLACE PROBLEM THAT THE
COSTS ARE GOING UP AND AMOUNT OF
MONEY IS NOT.
BUT I WOULD SAY ABOUT WHAT YOU
MENTIONED ABOUT THE POSTDOCS,
THE PEOPLE MAY OR MAY NOT KNOW
THAT MAJORITY OF POSTDOCS FUNDED
BY NIH MONEY ARE OFF OF GRANTS
AND NOT FUNDED BY FELLOWSHIP
AWARDS.
AND THE RECOMMENDATIONS FROM THE
COMMITTEE IS THAT NIH MANDATE
THAT THOSE POSTDOCS RECEIVE THE
SAME BENEFITS AND SALARY AS WHAT
GETS ON THE FELLOWSHIP GRANTS.
THAT'S THE RECOMMENDATION.
BUT AS YOU SAID, NIH HASN'T
REALLY OPERATIONALIZED THOSE
RECOMMENDATIONS YET, MAINLY FOR
THE REASONS, AS YOU MENTIONED,
HOW TO DO THAT, PARTICULARLY IF
DO YOU THAT SUDDENLY, THERE'S
THERE MAY BE VERY LITTLE MONEY
LEFT TO DO THE SCIENCE.
SO WE'RE KIND OF STUCK THERE.
SO I THINK PEOPLE STILL ARE
TRYING TO WORK OUT HOW THAT
COULD HAPPEN.
BUT IT DOES, YOU KNOW, THE
RECOMMENDATION IS THAT WE HAVE
SO FAR BEEN IGNORING THE PLIGHT
OF POSTDOCS ON R01 GRANTS AND
THAT SHOULD STOP.
AND WE REALLY SHOULD LOOK AT
THOSE FOLKS JUST LIKE WE LOOK AT
PEOPLE ON THE FELLOWSHIP GRANTS.
NOT WITHOUT AN INCREASE IN
BUDGET, RIGHT.
IT WOULD BE GREAT, INCREASE OF
BUDGET.
>> OKAY.
>> THANKS, EVERYONE.
IF ANYBODY HAS SUGGESTIONS,
ESPECIALLY ON THE FINANCIAL
SIDE, PLEASE LET ME KNOW.
>> YEAH, IT'S TRICKY.
SOME OF THESE ARE ZERO SUM
GAINS.
SO WE'RE A LITTLE AHEAD OF
SCHEDULE.
YAY, I DID IT!
YES, VERY GOOD.
OPTIMIZATION OF THE ECB.
WHY DON'T WE TAKE A BREAK AND
RECONVENE AT 2:45 AND WE'RE STILL AHEAD OF SCHEDULE.
>> IS THAT GOOD, 2:45, FOLKS? >> OKAY.
>> OKAY, WELCOME BACK.
IT'S MY GREAT PLEASURE TO
INTRODUCE DR. HELENE LANGEVIN,
DIRECTOR OF THE NATIONAL CENTER
FOR COMPLEMENTARY AND
INTEGRATIVE HEALTH.
SHE'S BEEN JUST A GREAT
COLLEAGUE AND SHE SERVES AS THE
CO-DIRECTOR OF THE INSTITUTE
DIRECTOR COMMITTEE FOR PAIN HEAL
INITIATIVE INITIATIVE, DIRECTOR
OF THE INTERAGENCY PAIN RESEARCH
COORDINATING COMMITTEE, CHAIRS
THAT, AND HAS A LOT OF
EXPERIENCE ON THE PAIN SIDE.
SHE CAME TO NCCIH FROM BRIGHAM
AND WOMEN'S HOSPITAL, WAS
PROFESSOR OF MEDICINE, CENTER
FOR INTEGRATIVE MEDICINE.
SHE WILL DISCUSS THE MULTI-I.C.
PROGRAM MUSCULOSKELETAL PAIN AND
HER THOUGHTS ABOUT HOW WE CAN
WORK WITH HER TO ACCELERATE THE
WHOLE-PERSON HEALTH.
SHE RECEIVED HER M.D. FROM
McGILL, MONTREAL, AND DID
POSTDOC WORK AT THE MRC AT
CAMBRIDGE, WAS A RESIDENT IN
INTERNAL MEDICINE AND FELLOWSHIP
IN ENDOCRINE AT HOPKINS PRIOR TO
MOVING TO ACADEMIA.
HELENE, THANKS FOR COMING.
>> WELL, THANK YOU SO MUCH,
WALTER FOR THE WONDERFUL
INVITATION TO COME AND PRESENT
SOME OF THE IDEAS THAT WE'VE
BEEN SORT OF DISCUSSING, WITHIN
THE HEAL INITIATIVE, IT'S BEEN A
FANTASTIC FORUM TO TALK ABOUT
INTERDISCIPLINARY RESEARCH.
AS WALTER SAYS, "HEAL" CAN DO A
LOT OF WHAT INDIVIDUAL
INSTITUTES CANNOT DO ON OUR OWN,
ESPECIALLY IN THE PAIN FIELD.
THIS IS REALLY A VERY -- A
GODSEND FOR US AT NCCIH TO
COLLABORATE WITH OUR COLLEAGUES
ACROSS AND ESPECIALLY AT NINDS,
BUT ALSO NIAMS, CHILD HEALTH,
NIBIB, NIAAA, AND NIDA.
I'M GOING TO TALK ABOUT SOME NEW
DIRECTIONS IN PAIN RESEARCH.
AND ALSO SHOW YOU SOME OF THE
PROGRAMS THAT WITHIN "HEAL" THAT
HAVE BEEN SORT OF MOVING US IN
THOSE DIRECTIONS.
CLICK, THERE WE GO.
SO, I'M GOING TO TALK ABOUT TWO
SORT OF WE COULD CALL THEM GAPS
OR CHALLENGES, SOMETHING THAT
NCCIH WOULD LIKE TO SEE MORE OF.
ONE IS CONNECTING THE NERVOUS
SYSTEM WITH OTHER PARTS OF THE
BODY.
SPECIFICALLY I'M GOING TO TALK
ABOUT MUSCULOSKELETAL TISSUES
AND MUSCULOSKELETAL SYSTEM BUT
IT COULD APPLY TO OTHER SYSTEMS,
GASTROINTESTINAL, GENITOURINARY,
ET CETERA, CONNECTING THE
NERVOUS SYSTEM WITH WHAT'S GOING
ON.
WE THINK THIS IS REALLY
IMPORTANT FOR PAIN.
AND THE SECOND PIECE IS
UNDERSTANDING AND SUPPORTING
ENDOGENOUS PAIN RESOLUTION.
HOW DOES PAIN GO AWAY?
IF WE DIDN'T HAVE MECHANISMS
INSIDE US TO MAKE PAIN GO AWAY
WE WOULD BE IN PAIN ALL DAY LONG
FOR EVERY SINGLE PAPER CUT.
AND UNDERSTANDING HOW DOES ACUTE
PAIN NOT PROGRESS TO CHRONIC
PAIN.
SO, THE FIRST OF THESE GAPS,
CONNECTING NERVOUS SYSTEM AND
MUSCULOSKELETAL TISSUES AND
ENVIRONMENT.
WHAT DO I MEAN?
A LOT OF RESEARCH WE DO ON PAIN,
UNDERSTANDING PAIN MECHANISM,
HAS TO DO WITH THE NERVOUS
SYSTEM, UNDERSTANDABLY, RIGHT?
SO, WE HAVE REALLY NOW BECOMING
VERY SOPHISTICATED IN
UNDERSTANDING CIRCUITS, FOR
EXAMPLE, IN THE BRAIN THAT
MEDIATE THE DEVELOPMENT OF
CHRONIC PAIN.
CENTRAL SENSITIZATION, FOR
EXAMPLE, PERIPHERAL
SENSITIZATION, ALSO A LOT OF
EMOTIONAL MECHANISMS TIED TO
PARTS OF THE BRAIN THAT REGULATE
OUR EMOTIONS, AMYGDALA,
PREFRONTAL CORTEX, THAT TIE PAIN
WITH SUFFERING, THE SUFFERING
COMPONENT OF PAIN THAT PEOPLE --
THAT AFFECTS PEOPLE SO MUCH.
THAT'S WHY I CALL THIS THE
NEUROPSYCHOSOCIAL ENVIRONMENT OF
PAIN.
WE'RE VERY GOOD AT THAT.
AND A LOT OF MEASURES WE USE
WHEN WE DO LARGE CLINICAL
STUDIES OF PAIN ARE IN THIS
SPACE, RIGHT?
THIS IS AN EXAMPLE OF THE
MEASURES THAT ARE ON A VERY
IMPORTANT STUDY OF PAIN, THE
ACUTE TO CHRONIC PAIN
TRANSITIONING IS A COMMON FUND
STUDY ONGOING RIGHT NOW.
YOU CAN SEE THE KINDS OF
MEASUREMENTS.
PATIENT-REPORTED OUTCOMES, FOR
EXAMPLE, MOOD, AFFECT, SLEEP,
COGNITIVE FUNCTION, ET CETERA.
NEURO IMAGING LOOKING AT THE
BRAIN, QUANTITATIVE SENSORY
TESTING, THESE ARE ALL IN IN A
SORT OF NEUROPSYCHOSOLE --
SOCIAL SPACE.
AND ON THE LEFT-HAND CORNER IS
OMICS.
THESE ARE CUTTING EDGE
MEASUREMENTS TYPICALLY IN A
BLOOD SAMPLE, IN THIS CASE, AND
A LOT OF LARGE SCALE STUDIES OF
PAIN USE VERY MUCH THESE TYPES
OF MEASURES, OPERA STUDY WAS AN
IMPORTANT STUDY OF
TEMPOROMANDIBULAR PAIN THAT
STARTED IN 2007, VERY MUCH
FOLLOWS A SIMILAR BLUEPRINT.
AND SO WHAT I'M GOING TO BE
TALKING ABOUT IS THE IDEA THAT
WHEN WE DO IT THIS WAY, RIGHT,
WE HAVE OUR NEUROPSYCHOSOCIAL
ENVIRONMENT AND WE HAVE THE --
WHAT WE LOOKING AT THIS IN THE
PERIPHERY IS VERY MUCH SYSTEMIC,
WHEN WE LOOK AT SOMETHING THAT'S
IN A BLOOD SAMPLE IT'S REALLY IN
KIND OF A DIFFUSE I CALL IT
SWIMMING AROUND TYPE OF QUALITY
WHERE WE DON'T REALLY KNOW WHERE
THESE MOLECULES ACTUALLY ARE.
WE CAN MEASURE THEM IN THE BLOOD
BUT THEY GO EVERYWHERE, RIGHT IN
THE WHAT I'M GOING TO ARGUE IS
WHAT NEEDS TO COMPLETE THIS
PICTURE IS TO UNDERSTAND WHERE
IN THE TISSUES ALL OF THESE
OMICS THAT WE'RE MEASURING ARE
ACTUALLY ACTING ON THE TISSUES
AND INTERACTING WITH BOTH THE
TISSUES AND NERVOUS SYSTEM.
SO I'M GOING TO USE THIS AS AN
EXAMPLE, A KNEE JOINT.
SOMEBODY WHO HAS PAIN IN THEIR
KNEE.
WE SAY 20, 30 YEARS AGO SOMEBODY
WOULD HAVE PAIN IN THEIR KNEE,
THE IDEA WAS FIX THE KNEE,
RIGHT?
THIS WAS THE ORTHOPEDIC
APPROACH, THAT WAS KIND OF
DISAPPOINTING IN A LOT OF WAYS.
PEOPLE AT TIMES WOULD FIND
PEOPLE WITH VERY BAD-LOOKING
X-RAYS WITH NO PAIN OR SOMEBODY
WHO HAD PAIN BUT DID NOT HAVE
DEMONSTRABLE ABNORMALITIES
RADIOLOGICALLY.
SO THERE WAS A SHIFT TOWARDS
REALLY PAYING MORE ATTENTION TO
WHAT'S GOING ON IN THE NERVOUS
SYSTEM.
THAT HAS RESULTED IN A GREAT
DEAL OF UNDERSTANDING IN THE
NEUROEFFECTIVE COMPONENTS OF
PAIN.
BUT I WOULD ARGUE THAT THERE'S A
LOT STILL THAT WE DON'T
UNDERSTAND ABOUT THE ROLE OF
THESE PERIPHERAL MUSCULOSKELETAL
TISSUES IN, FOR EXAMPLE, KNEE
PAIN, PERHAPS BECAUSE WE WEREN'T
MAYBE LOOKING IN THE RIGHT
PLACES AND/OR MAYBE WE DIDN'T
HAVE THE RIGHT TOOLS TO LOOK.
I THINK WHAT I'M GOING TO
SUGGEST IS WE NEED TO KEEP
LOOKING.
AND UNDERSTANDING BETTER WHAT
GOES ON IN THE PERIPHERAL
TISSUES CAN HELP US UNDERSTAND A
WHOLE PICTURE OF PAIN, INCLUDING
I WOULD ARGUE WHAT'S GOING ON IN
THE NERVOUS SYSTEM.
THAT WHY I THINK IT'S IMPORTANT
WE REALLY LOOK IN A MORE
HOLISTIC FASHION.
SO, WHAT ARE THE REASONS WHY
THESE TISSUES ARE IMPORTANT, WE
THINK ARE IMPORTANT, IS BECAUSE
WHEN WE THINK ABOUT SOMEBODY WHO
HAS PAIN IN THEIR KNEE WE
USUALLY THINK ABOUT PAIN COMING
FROM THE ARTICULATION,
CARTILAGE, WHAT'S INSIDE THE
JOINT, EITHER THE CARTILAGE IF
SOMEBODY HAS OSTEOARTHRITIS OR
SYNOVIUM WITH INFLAMMATORY
ARTHRITIS BUT OTHER TISSUES ARE
PARTS OF THIS JOINT ON THE
OUTSIDE OF THE JOINT.
WHAT WE CALL THE PERIARTICULAR
TISSUE, CAPSULES, JOINT CAPSULES
, LIGAMENTS, TENDONS, THE
MUSCLES, FASCIA, CONNECTIVE
TISSUE AROUND THOSE MUSCLES THAT
INSERT INTO THE CONNECTIVE
TISSUE OF THE CAPSULE.
WE HAVE KNOWN FOR SOME YEARS NOW
THAT THESE TISSUES ARE
ENERVATED, EXTENSIVELY, WITH
SMALL DIAMETER FIBERS THAT WE
KNOW ARE NOCICEPTORS.
SO, WE ALSO KNOW THAT PAIN IS A
CONVERSATION, BACK AND FORTH,
BETWEEN NERVOUS SYSTEM AND
PARAGRAPH -- PERIPHERAL
TISSUES.
WHEN A C FIBER IS ACTIVATED IT
DUMPS SUBSTANCE P INTO THE
TISSUE WHICH CONTINUES, WHICH
INCREASES THE INFLAMMATORY
RESPONSE, NEUROGENIC
INFLAMMATION.
WHEN YOU HAVE SOMETHING LIKE
THAT GOING ON BY DEFINITION YOU
HAVE THAT GOING ON IN THE
TISSUE, THE OTHER THING THAT
HAPPENS IN TISSUES IS
INFLAMMATORY RESPONSES SUCH AS
NEUROGENIC ARE AUGMENTED BY FAT.
ADIPOSE TISSUE IS INFLAMMATORY
ESPECIALLY IN EXCESS, THAT
CONTRIBUTE TO THE INFLAMMATORY
RESPONSE.
WE KNOW ALL THESE TISSUES HAVE A
VERY IMPORTANT MECHANICAL AND
STRUCTURAL RELATIONSHIP TO EACH
OTHER, ESPECIALLY IN THE
MUSCULOSKELETAL SYSTEM, WHERE A
LOT OF THESE STRUCTURES HAVE
MECHANICAL RELATIONSHIP, THEIR
MOVEMENTS OCCUR IN A SHEER
PLANE, LIKE THIS, THEY MOVE ONE
RELATIVE TO THE OTHER, AND AS
REPRESENTED HERE IN THIS CARTOON
YOU HAVE LAYERS IN GENE THE
JOINT CAPSULE AND THE PURPLE
WOULD BE THE LIGAMENT, NEXT TO
IT.
WHERE THERE'S A LAYER OF LOOSE
CONNECTIVE TISSUE WHERE NERVE
FIBBERS ARE POSITIONED.
WHEN YOU MOVE THE KNEE THE
MOVEMENT IS BETWEEN THOSE TWO
LAYERS, NOT ONE LAYER
STRETCHING, BECAUSE EACH LAYER
ONLY STRETCHES ABOUT 10% BUT
MOVEMENT BETWEEN LAYERS CAN BE
AS MUCH AS 100%.
THIS IS A BIG SOURCE OF
MOVEMENT.
I'LL PLAY A MOVIE THAT SHOWS
THAT.
YOU CAN HAVE -- THE WAY -- I
HOPE YOU CAN SEE THIS.
AT THE TOP WHITE LAYERS, TWO OR
THREE LAYERS ADJACENT OF FASCIA,
CONNECTIVE TISSUE, YOU CAN SEE A
LOT OF SHEER PLANE MOBILITY,
DARK LAYERS IN BETWEEN THE
LAYERS.
WHERE THE LAYERS ARE MOVING IN
SHEER.
DO YOU SEE THIS?
I'M GOING TO PLAY ANOTHER
EXAMPLE OF WHERE THERE'S NOT AS
MUCH MOVEMENT.
AND WE KNOW THIS HAPPENS, I HOPE
YOU CAN APPRECIATE HERE, THESE
LAYERS ARE NOT AS MOBILE.
THEY ARE REALLY LOOKING LIKE
THEY ARE STUCK TOGETHER.
IN FACT THIS IS WHAT HAPPENS.
WHEN PEOPLE HAVE AN INJURY, WHAT
HAPPENS IS THAT YOU GET
ADHESIONS BETWEEN THE LAYERS,
THIS IS A VERY WELL KNOWN
PHENOMENON WITH INFLAMMATION,
CAUSES FIBROTIC PROCESS WITH
LAYERS NO LONGER INDEPENDENT
MOTION.
YOU CAN IMAGINE WHAT THAT DOES
TO A LITTLE NOCICEPTOR THAT'S IN
THE MIDDLE OF THESE LAYERS.
IT AFFECTS ITS FUNCTION.
SO, THE OTHER THING THAT'S
IMPORTANT TO REALIZE IS THAT
INFLAMMATORY RESPONSES ARE NOT
JUST ALL OVER THE PLACE.
THEY ARE SPATIALLY ORGANIZED.
THIS IS AN EXAMPLE SHOWING THE
GREEN STAINING FOR ARGINASE, A
MARKER OF MACROPHAGES,
PRO-RESOLUTION MACROPHAGES THAT
HELP RESOLVE INFLAMMATION.
AND IN THIS EXAMPLE HERE I HOPE
YOU CAN SEE THIS IS ARGINASE,
GREEN STAINING, VERY
SPECIFICALLY LOCALIZED TO ONE
LAYER OF TISSUE WHICH HAPPENS TO
BE THE SHEER PLANE INTERFACE
BETWEEN THE TWO LAYERS.
NOW, WE SOMETIMES TALK ABOUT
INFLAMMATORY SOUP.
I WILL SUGGEST THAT WE SHOULD
START TALKING ABOUT INFLAMMATORY
SANDWICHES, OKAY, INSTEAD.
WHERE YOU HAVE THESE LAYERS THAT
HAVE A SAY HOW THE INFLAMMATION
IS GOING TO BE ORGANIZED.
AND WHEN YOU HAVE DIFFERENT
KINDS OF SANDWICHES, IT AFFECT
MIGHT AFFECT THE MOVEMENT.
ON THE LEFT A BUNCH OF
MAYONNAISE, A LOT OF MOVEMENT
BETWEEN THE TISSUES.
ON THE RIGHT YOU HAVE THICK
PEANUT BUTTER THAT MIGHT NOT BE
SO GOOD AT FAVORING MOTION.
MORE LIKE ACTING LIKE A GLUE.
NOW, IF YOU HAD A NOCICEPTOR
THAT IS IN THIS LAYER, EITHER
MAYONNAISE OR GLUE, AND YOU HAVE
A LITTLE ION CHANNEL THAT IS ON
THE LEFT HERE PICTURED, THAT
OPENS OR CLOSES, RIGHT, IN
RESPONSE TO MECHANICAL FORCE AS
WE KNOW MANY ION CHANNELS DO.
AND BY WAIT WE HAVE SOME ION
CHANNELS WHICH WE KNOW ARE
SPECIFICALLY OPEN IN RESPONSE TO
A FORCE BUT THERE ARE OTHER
CHANNELS LIKE, FOR EXAMPLE,
VOLTAGE GATED CHANNELS, THEY
ALSO EVEN THOUGH FORCE IS NOT
THEIR PRIMARY STIMULUS FOR
OPENING, FORCE CAN MODERATE THE
OPENING OF THESE CHANNELS.
THE REASON THIS MATTERS HERE IS
BECAUSE IMAGINE NOW YOU HAVE AN
ION CHANNEL THAT IS SITUATED IN
A LAYER THAT IS MORE VERSUS LESS
STIFF.
IF YOU HAVE THE SAME WEIGHT ON
TWO RUBBER BANDS, ONE MORE
STIFF, THE STIFFER ONE WILL NOT
DEFORM AS MUCH.
WHEN WE THINK ABOUT CHANNEL
OPENING OR CLOSING TO A FORCE WE
DON'T KNOW IF IT'S THE FORCE OR
DEFORMATION OF MEMBRANE, THE
STRAIN, RIGHT?
THE RELATIONSHIP BETWEEN THE
THRUST AND STRAIN VIA THE
STIFFNESS AS SHOWN ON THE RIGHT.
SO IF YOU HAVE A CELL WHOSE
MEMBRANE IS STIFFER, EITHER
BECAUSE MEMBRANE ITSELF IS
STIFFER OR THE OUTER
EXTRACELLULAR MATRIX IS STIFFER
IN THE CASE OF FIBROTIC OR THE
INSIDE, COULD AFFECT WHETHER THE
CHANNEL IS OPEN OR NOT.
THE MECHANICAL ENVIRONMENT
SURROUNDING THE NOCICEPTOR IS
IMPORTANT.
THAT'S WHY I'M THINKING, I'M
SAYING WE NEED TO UNDERSTAND
THIS WHOLE RELATIONSHIP OF WHAT
I CALL THE PERIPHERAL TISSUE
ENVIRONMENT THAT HAS THIS
METABOLIC STRUCTURAL AND
MECHANICAL COMPONENT, ALL
RELATED.
AND THEY ALL WORK TOGETHER.
AND UNDERSTANDING ALL OF THAT
WILL HELP US UNDERSTAND PAIN
BETTER.
NOW, THE RELATIONSHIP BETWEEN
THIS PERIPHERAL TISSUE
ENVIRONMENT AND THE
NEUROPSYCHOSOCIAL ENVIRONMENT IS
OF COURSE EXTREMELY IMPORTANT,
RIGHT?
WHAT HAPPENS WHEN PEOPLE HAVE
PAIN IS THAT IT AFFECTS THEIR
BEHAVIOR, HOW THEY MOVE.
PEOPLE DO NOT LIKE MOVING OF
COURSE WHEN IT'S GOING TO HURT
TO MOVE SO THEY BECOME -- THEY
RESTRICT MOVEMENT,
K INESIAPHOBIA, AGGRAVATED BY
STRESS, POOR SLEEP.
YOU CAN SEE THAT KIND OF LINK
BETWEEN THE PERIPHERAL TISSUES
WHICH THAT WHOLE MECHANICAL
ENVIRONMENT SURROUNDING THE
JOINTS, MUSCLES, FASCIA, ALL
THESE, CAMERA RECEPTORS AND THE
BEHAVIOR OF THE PERSON.
OF COURSE, ALL OF THIS IS BATHED
IN THE SYSTEMIC ENVIRONMENT.
SO IT'S A BIG COMPLICATED THING.
THE GOOD NEWS, AND WE ARE
MISSING A LOT OF PIECES OF THE
PUZZLE.
WE DON'T STUDY IT VERY MUCH.
THE GOOD NEWS THOUGH IS THE HEAL
INITIATIVE STARTED TO DO THAT.
AND TWO YEARS AGO WE FUNDED A
WONDERFUL PROGRAM WHICH WAS
UNIQUE AND NEW, IN DEVELOPING
QUANTITATIVE IMAGING AND OTHER
MARKERS OF MYOFASCIAL TISSUES
WHICH WE BADLY NEEDED BECAUSE UP
UNTIL NOW WE DIDN'T REALLY HAVE
ANY IMAGING OR OTHER TYPES OF
MEASURES OF LOOKING AT THESE
TISSUES AT ALL.
THEY WERE KIND OF IN THE DARK.
STANDARD MRI, FOR EXAMPLE, DON'T
VISUALIZE SOFT TISSUES.
THEY ARE TUNED TO LOOK AT HARD
TISSUES, CARTILAGE, BONE, ET
CETERA.
YOU DON'T HAVE VERY GOOD
CONTRAST, FOR EXAMPLE, BETWEEN
MUSCLE AND SURROUNDING
PERIMUSCULAR FASCIA USING
STANDARD MRI.
A LOT OF THESE ARE MECHANICAL,
LOOKING IT'S A TISSUE STIFFNESS,
MEASURES USING MR SPECTROSCOPY
OR MULTI-MODAL ELECTROMYOGRAPHY
COMBINED WITH IMAGING, ET
CETERA, SO VERY EXCITING
PROGRAM, NOW TWO YEARS INTO IT.
ANOTHER IMPORTANT PROGRAM IS THE
RE-JOIN INITIATIVE, PART OF
HEAL, TO LOOK AT SENSORY
INNERVATION OF DIFFERENT
EXPONENTS OF THE JOINT I --
COMPONENTS OF THE JOINT, NOT
JUST CARTILAGE, THAT ONLY GETS
ENERVATED, DOES NOT HAVE A
VASCULAR SUPPLY BUT WHEN IT'S
INFLAMED IT DOES.
BUT ALL THESE STRUCTURES AROUND
THE JOINTS HAVE SENSORY
INNERVATION.
WE NEED TO UNDERSTAND HOW THIS
WORKS.
MAPPING ALL OF THESE
INNERVATIONS TO LOOK AT JOINT IN
A MORE HOLISTIC WAY.
THE OTHER IMPORTANT PROGRAM IS
THE BACPAC PROGRAM DEVELOPING
EXTENSIVE AND COMPREHENSIVE
MODELS OF BACK PAIN.
THE NICE THING ABOUT BACPAC,
ALSO TESTING INTERVENTIONS, THE
MODELS DEPICTED HERE ARE MEANT
TO BE ITERATIVE SO THEY CAN
INCORPORATE NEW KNOWLEDGE AS IT
COMES ALONG.
SO WHAT WE'RE PLANNING ON DOING
IS AS NEW KNOWLEDGE COMES AROUND
FROM BOTH THE MYOFASCIAL TISSUE
INITIATIVE AND RE-JOIN ON THE
JOINT, THEY WILL INFORM THESE
MODELS, YOU CAN SEE THE FACET
JOINTS, FOR EXAMPLE, IN THE BACK
ARE JOINTS THAT HAVE ALL THE
COMPONENTS OF THE KNEE, FOR
EXAMPLE, OR OTHER JOINTS, AND SO
THEY ALL NEED TO BE LOOKED AT IN
THAT INTEGRATIVE WAY AS WELL.
AS WELL AS AUTHOR AUTHOR -
THORACO LUMBAR.
BY PUTTING THESE PROJECTS
TOGETHER AND INFORMING EACH
OTHER WE CAN ARRIVE AT A MORE
COMPLETE PICTURE OF BACK PAIN.
THE SECOND GAP OR CHALLENGE THAT
I WANTED TO DISCUSS IS
UNDERSTANDING AND SUPPORTING
ENDOGENOUS PAIN RESOLUTION AND
THE IDEA IS THAT PERHAPS WHAT
WE'RE SUGGESTING IS THAT
UNDERSTANDING BETTER THE
PERIPHERAL AS WELL AS NERVOUS
SYSTEM ENVIRONMENT WILL HELP US
ADDRESS THIS QUESTION.
SO, WHY IS THAT?
WHEN WE THINK ABOUT RECOVERING
FROM ANYTHING, IF ILLNESS, THINK
COVID, THERE IS A PERIOD THAT
IT'S KIND OF A DELICATE PERIOD
WHICH WE USED TO CALL
CONVALESCENS, WE DON'T USE THAT
WORD ANYMORE, THE PERIOD OF TIME
BETWEEN THE END OF THE ILLNESS
AND FULL RETURN TO HEALTH.
AND THIS IS A VERY IMPORTANT
PERIOD WHERE WHEN SOMEBODY DOES
NOT FULLY RECOVER FROM AN
ILLNESS, THEN YOU CAN NOW HAVE
CONTINUED SYMPTOMS THAT COULD
CONTINUE.
WE CALL THIS POST-ACUTE
SYNDROME.
AND IN THE OLD DAYS IF YOU READ
NOVELS FROM THE 19th CENTURY,
PEOPLE PAID A LOT OF ATTENTION
TO THIS RECOVERY, CONVALESCENT
PERIOD, BECAUSE WE DIDN'T HAVE
TREATMENTS WE HAVE NOWADAYS.
BUT NOW PEOPLE ARE KIND OF LEFT
TO NAVIGATE THIS DIFFICULT TIME
ON THEIR OWN.
BUT YOU CAN SEE PEOPLE PAID A
LOT OF ATTENTION TO REST, TO
EXERCISE, TO DIET, ET CETERA.
SO, IF YOU THINK ABOUT PAIN,
WHAT IS THE IDEA HERE, HOW DOES
THIS RELATE TO PAIN?
WELL, OF COURSE WHEN YOU HAVE
THIS TRANSITION, SAY SOMEBODY
HAS SURGERY, OR ACUTE INJURY,
WHAT DETERMINES WHETHER A PERSON
WILL EITHER RESOLVE THEIR PAIN
AND NO LONGER EXPERIENCE PAIN
AFTER A CERTAIN PERIOD OF TIME
OR GO ON TO CHRONIC PAIN IS A
BIG QUESTION, RIGHT?
SO WHAT ABOUT -- WHAT ARE
POSSIBLY SOME OF THE FACTORS
THAT WE WERE JUST LOOKING AT IN
TERMS OF THE PERIPHERAL TISSUE
ENVIRONMENT AS WELL AS THE
NERVOUS SYSTEM ENVIRONMENT
TOGETHER, COULD CONTRIBUTE TO
THIS RESOLUTION OF PAIN?
WE HAVE VERY LITTLE RESEARCH IN
THIS AREA, AN AREA REALLY TO
MOVE INTO AND UNDERSTAND BETTER.
ONE OF THE MECHANISMS MIGHT BE
THIS KIND OF PERIPHERAL
REGULATION OF INFLAMMATION
THROUGH MECHANICAL STIMULATION.
WE KNOW GENTLE LOW AMP PLI
'TUDE STIMULATION CAN PROMOTE
RESOLUTION, WE NEED TO
UNDERSTAND HOW CAN PEOPLE DO
THAT THEMSELVES THROUGH MOVEMENT
AND CORRECTLY ENGAGE MOVEMENT IN
THE RIGHT KIND OF SHEER PLANE
MOTION THAT IS GOING TO NORTH
CAUSE FURTHER DAMAGE AND FURTHER
PAIN BUT EITHER RATHER PROMOTE
HEALING.
AND WHAT ARE OTHER FACTORS USED
IN CONJUNCTION TO PROMOTE THE
RESOLUTION OF THE PAIN AND
HEALING FOR LONG TERM?
SO JUST KIND OF SOME OF THE KIND
OF LOW-HANGING FRUIT HERE TO
INVESTIGATE MIGHT BE EFFECT OF
STRESS MANAGEMENT DURING
RECOVERY PERIOD, POSSIBLY VERY
IMPORTANT.
SLEEP, AS WELL AS MECHANICAL
STIMULATION, EITHER FROM POINT
OF VIEW OF EXERCISES OR MANUALLY
APPLIED MECHANICAL STIMULATION.
AND OF COURSE THE IDEA THAT IF
YOU SUCCESSFULLY RESOLVE PAIN IN
THE ACUTE AND SUBACUTE STAGE,
THIS MAY PRESERVE THE HEALTH OF
THE JOINT IN THE LONG TERM
BECAUSE WHEN JOINTS DON'T HEAL
PROPERLY, AND TISSUES STAY
STUCK, AND DO NOT RESTORE THEIR
MOBILITY, THIS WILL COMPROMISE
THE FUNCTION OF THE JOINT GOING
FORWARD AND PREDISPOSE TO INJURY
OF THOSE DELICATE SORT OF
ARTICULAR STRUCTURES.
SO THE LINK BETWEEN THE
PERIARTICULAR AND ARTICULAR
STRUCTURES,
PATHOPHYSIOLOGYICALLY, IS VERY
IMPORTANT.
WE HAD A WORK SOTH -- WORKSHOP
LAST YEAR TO ADDRESS THIS, ALSO
FROM THE POINT OF VIEW OF HEALTH
RESTORATION.
VIDEO AVAILABLE ON THE WEBSITE.
WE'RE GRATEFUL TO THE HEAL
INITIATIVE TO ALLOW US TO START
ASKING VERY BIG QUESTIONS, THAT
EXPAND ACROSS MORE THAN ONE
ORGAN OR SYSTEM AT A TIME.
THIS IS WHY IT'S SO IMPORTANT
THAT WE WORK TOGETHER TO GAIN
INTEGRATIVE UNDERSTANDING OF
PERIPHERAL TISSUES AND THEIR
SENSORY INNERVATION AND
MUSCULOSKELETAL PLANE, INCLUDING
BEHAVIOR, SOCIAL, ENVIRONMENTAL
CONTEXT.
SOCIETY NEEDS TO SUPPORT ALL OF
THIS IN TERMS OF BOTH RESEARCH
BUT ALSO HELPING PATIENTS TO
RECOVER AND WHICH BRINGS THE
SECOND POINT, UNDERSTANDING AND
SUPPORTING ENDOGENOUS PAIN REST
RESOLUTION BY UNDERSTANDING
TISSUE REPAIR, SLEEP AND STRESS,
WHOLE PERSON SUPPORT, SOCIETAL
PRIORITIZATION OF HEALTH
RESTORATION.
SO, I'M GOING TO STOP HERE
UNLESS WE HAVE TIME FOR
QUESTIONS.
>> THANKS, HELENE.
WE'LL OPEN THE FLOOR FOR
QUESTIONS.
>> FOR THE LAST PART, ACUTE TO
CHRONIC PAIN PREVENTION RESEARCH
EFFORTS, MY QUESTION WAS RELATED
TO WHETHER I SAW STUFF ON THE
PERIPHERAL NERVOUS SYSTEM
INFLUENCE BUT NOT THE CENTRAL
NERVOUS SYSTEM INFLUENCE.
SO MY QUESTION WAS ARE YOU ALSO
INTEGRATING RESEARCH ON THE ROLE
OF GENETICS AND CNS DYSFUNCTION
OR DYSREGULATION TO BETTER
UNDERSTAND WHO AND WHY CAN
PREVENT CHRONIC PAIN FROM
DEVELOPING AND WHO CANNOT.
>> YES, YOU RECALL I LINKED
THROUGH THE TOP IN BOTH WAYS,
MAYBE I WENT FAST.
THERE'S A LINK THROUGH THE
BOTTOM, PERIPHERAL NERVOUS
SYSTEM, ALSO THROUGH THE TOP IS
BECAUSE THE FULL CENTRALLY
MEDIATED PAIN AND SUFFERING AND
THAT IMPACTS THE BEHAVIOR,
RIGHT?
THAT IMPACTS THE MOVEMENT,
IMPACTS WHAT THE PERSON DOES.
AND SO THAT IS HOW IT FEEDS BACK
TO THE TISSUE THAT WAY.
IT FEEDS BACK BOTH WAYS.
IT'S A TWO-WAY CONVERSATION
BETWEEN THE BRAIN AND CENTRAL
NERVOUS SYSTEM AND THE
PERIPHERAL TISSUES.
KIND OF IT'S A CIRCLE.
IT'S KIND OF A FEED FORWARD OR
FEEDBACK CIRCLE.
DOES THAT ANSWER YOUR QUESTION?
>> YEAH, THE REASON I MENTION
THE LAST FEW SLIDES YOU
PRESENTED ON ACUTE TO CHRONIC
AND IF YOU CAN PREVENT THAT,
LOOKING AT THE PERIPHERAL
THERAPEUTICS BUT ONE OF THE
MAJOR QUESTIONS THAT WE HAVE
ESPECIALLY IN THE WORK THAT WE
DO ON CHRONIC OVERLAPPING PAIN
CONDITIONS IS THERE ARE VERY FEW
LONGITUDINAL STUDIES THAT FOLLOW
PEOPLE AS THEY DEVELOP MULTIPLE
CHRONIC PAIN CONDITIONS.
ONE OF THE REMAINING QUESTIONS
THAT WE HAVE IS WHETHER THESE
FOLKS ARE GENETICALLY
PRE-DISPOSED TO JUST DEVELOPING
CHRONIC PAIN REGARDLESS OF
WHETHER THEY HAVE, YOU KNOW, THE
BEST PHYSICAL THERAPY,
ACUPUNCTURE, AND CONVALESCENS
POSSIBLE OR WHETHER IT CAN BE
PREVENTED OR REVERSED.
>> I DIDN'T ANSWER THE GENETIC.
GENETICS IS SO IMPORTANT FOR SO
MANY REASONS.
FACTORS MIGHT AFFECT SOMEBODY'S
PAIN PATHWAYS, FOR EXAMPLE, ALSO
MAY HAVE GENETIC CONDITIONS THAT
AFFECT THE MUSCULOSKELETAL
TISSUES THEMSELVES.
WE'RE ALL FAMILIAR WITH
EHLERS-DANLOS SYNDROME, PEOPLE
HAVE CONNECTIVE TISSUES,
HYPERMOBILE, PREDISPOSING THEM
TO ALL KINDS OF ISSUES WITH
RESPECT TO JOINT INSTABILITY AND
INJURIES, WHICH CAN THEN LEAD TO
HYPOMOBILITY.
THERE'S GENETIC, YOU KNOW,
CONSIDERATION ALL OVER THIS MAP.
FOR SURE, ABSOLUTELY.
>> SAMEER?
>> THANKS, WALTER.
THAT WAS REALLY INTERESTING.
I WONDER, I LOVE THE SANDWICH
METAPHOR.
I WONDER IF THERE ARE IN
EXISTENCE TECHNOLOGIES, WEARABLE
MOBILE TECHNOLOGIES THAT COULD
CHRONICALLY AND CONTINUOUSLY
MONITOR DEGREE OF MOBILITY,
SHEER STRESS, ET CETERA, AS
WE'RE ALL IN THIS WORLD OF
WEARABLE MONITORS, WHETHER IT'S
RECREATIONAL, HOW MANY STEPS YOU
TAKE OR HEALTH RELATED MORE AND
MORE AVAILABLE, THAT COULD BE
OBVIOUSLY USEFUL INFORMATION FOR
THE INDIVIDUAL, FOR THE CARE
TEAM.
YOU KNOW, SOME OF US WORK A LOT
WITH PACEMAKER-LIKE BRAIN
STIMULATION DEVICES, DEEP BRAIN
STIMULATION, ET CETERA, WHICH
NOW HAVE ABILITY TO REPORT
NEURAL DATA.
SO THERE'S A LOT OF INTEREST IN
PAIRING THE NEURAL RECORDINGS,
WITH BEHAVIOR IN GENERAL.
SO INFORMATION FROM A WEARABLE
THAT TELLS YOU ABOUT
INFLAMMATION IN THE JOINT OR IN
A LIMB COULD BE REALLY
INTERESTING AND USEFUL
INFORMATION TO INFORM ININFORM
THERAPY, WHETHER TO CLINICIAN
TEAM OR DEVICE.
>> YES, IT'S COMING.
SO, ONE OF THE -- A LOT OF
TECHNIQUES I MENTIONED BEING
DEVELOPED IN THE CONTEXT OF
THESE MYOFASCIAL PAIN
INITIATIVES, TECHNIQUES THAT
REQUIRE BIG MACHINES AND RIGHT
NOW THEY ARE STILL AT A BETA
STAGE.
ONCE WE KNOW WHAT THE ACTUAL
MEASUREMENT IS, THEN
MINIATURIZING AND PUTTING IT IN
A FORM THAT BECOMES COMPATIBLE
WITH WEARABLE THAT TECHNOLOGY,
THAT KIND OF TECHNOLOGY IS
EXPLODING, RIGHT?
I HAVE FULL CONFIDENCE ONCE WE
CAN FIGURE OUT THE RIGHT
MEASURE, THEN WE CAN MAKE IT
WEARABLE, IN NOT TOO LONG A
TIME.
RIGHT NOW WE'RE NOT -- WE
UNDERSTAND FOR EXAMPLE HOW TO
MEASURE SHEER STRAIN, THAT MOVIE
THAT I TALKED ABOUT, THIS WAS
DONE IN MY LAB USING NOT FANCY
ULTRASOUND MACHINE BUT BETTER
MACHINES CAN DIRECTLY MEASURE
THAT.
IT'S COMING.
NOW, WHAT YOU ALSO MENTIONED WAS
I THINK VERY INTERESTING, IS
MEASURING SIMULTANEOUS BRAIN AND
PERIPHERAL TISSUE MEASUREMENT.
NOW THAT WILL BE REALLY -- WHEN
THAT CAN HAPPEN, AND IT'S NOT
THAT FAR AWAY, IT'S A MATTER OF
CO-REGISTERING TIME SIGNATURES,
IT'S NOT DIFFICULT.
YEAH, I THINK THE AREA OF
QUANTIFIED SELF IN TERMS OF
WEARABLE NEEDS TO MOVE IN THE
DIRECTION OF MORE AND MORE
LOOKING AT TISSUES.
ONE AREA THAT I'M PARTICULARLY
REALLY INTERESTED IN IS TISSUE
pH.
IT'S AMAZING HOW MUCH
INFORMATION THAT CAN GIVE.
AND BELIEVE IT OR NOT, WE DON'T
REALLY HAVE A GOOD WAY, WE CAN
MEASURE YOUR PULSE OXMETRY IN
FINGERS, WHY NOT THE PH OF THE
TISSUES, THAT WOULD BE EXTREMELY
INFORMATIVE.
I THINK YOU'RE RIGHT, THIS IS
WHERE IT'S GOING.
>> THANK YOU.
>> THIS IS A BEAUTIFUL AND
INTERESTING PRESENTATION.
I'M AT HOME CONVALESCING MYSELF,
IT HOME QUITE WELL.
I JUST WANTED TO PIGGYBACK ON
WHAT SAMEER WAS SAYING.
WE'RE IN AN AGE WHERE WE CAN
MEASURE ALL KINDS OF THINGS.
WE CAN MEASURE SIMULTANEOUSLY
AND WHAT YOU SAID ABOUT TIME
STAMPS IS A RELATIVELY SMALL AND
VERY SOLVABLE PROBLEM.
YOU MENTIONED SOMETHING LIKE WE
DON'T KNOW EXACTLY WHAT YET TO
MEASURE, AND MY SUGGESTION IS WE
SHOULD MEASURE IT ALL.
WE SHOULD MEASURE ALL OF IT, AS
MUCH AS WE CAN, SIMULTANEOUSLY,
USE THE BIG DEVICES THAT RECORD
THINGS THAT WE MIGHT NOT EVEN
THINK HAVE ANYTHING TO DO WITH
IT BUT WE MIGHT FIND WHEN WE DO
THE ANALYSIS THAT IT IS QUITE
IMPORTANT, IMPORTANT ASPECT,
CO-FACTOR IN RECOVERY.
I WOULD JUST SUGGEST THAT WE
RECORD -- START RIGHT AWAY GIVEN
THIS DAY AND AGE WE'RE IN, ADD
SUPPLEMENTS TO PEOPLE'S GRANTS
AND HAVE THEM RECORD AS MUCH
DATA AS THEY CAN INCLUDING
HISTORY DATA, EMOTIONAL DATA,
HEART RATE, SLEEP FOR SURE, AND
EVERYTHING.
JUST SEE HOW THAT RELATES TO
RECOVERY.
>> I COULDN'T AGREE MORE.
WE HAD CONVERSATIONS ABOUT
BUDGETS.
BUT I THINK YOU'RE TOUCHING ON
AN IMPORTANT POINT.
ONE SIDE I'D LIKE TO SHOW,
RECOVERY DOESN'T GO IN A
STRAIGHT LINE.
TYPICALLY, PEOPLE HAVE GOOD DAYS
AND BAD DAYS, RIGHT?
IF YOU HAVE MORE GOOD DAYS THAN
BAD DAYS OVERALL TRAJECTORY GOES
TOWARDS RECOVERY.
IF YOU HAVE MORE BAD THAN GOOD
DAYS YOU STAY SICK OR WHATEVER.
HOW TO HELP PATIENTS BECOME
AWARE OF WHAT'S GOING ON IN
THEIR BODIES WHEN THEY ARE
HAVING A GOOD DAY VERSUS NOT
HAVING A GOOD DAY, HOW TO TURN A
GOOD DAY INTO -- A BAD DAY INTO
A GOOD DAY OR, YOU KNOW -- A LOT
OF THAT IS JUST -- COULD BE
GAINED THROUGH JOURNALING AND AS
WELL AS MEASURING WHAT'S GOING
ON IN YOUR -- THE AUTONOMIC
NERVOUS SYSTEM WILL BE EXTREMELY
IMPORTANT HERE, UNDERSTANDING
HOW YOUR BODY IS RECOVERING
BECAUSE WE ALL KNOW RECOVERING
FROM ANYTHING WHERE THERE'S AN
INJURY OR ILLNESS INVOLVES ALL
YOUR SYSTEMS OF OUR BODY WHEN
YOU'RE INACTIVE BECAUSE YOU'VE
BEEN SICK, YOU KNOW, MUSCLE
STRENGTH, STAMINA, APPETITE IS
OFF.
YOUR SLEEP IS OFF.
TEMPERATURE REGULATION.
THERE'S ALL KINDS OF SYSTEMS
THAT NEED TO NOW REGAIN THEIR
FUNCTION.
SO OF COURSE THAT'S NOT GOING TO
GO IN A STRAIGHT LINE.
GETTING DATA ON THAT AND HELPING
PEOPLE TO UNDERSTAND WHAT'S
GOING ON AND PROBABLY GOING TO
BE HIGHLY INDIVIDUAL.
IT'S NOT TWO PEOPLE RECOVER THE
SAME WAY.
IT DEPENDS ON THEIR PHYSIOLOGY,
RIGHT?
SO, THIS IS AN AREA WHERE I
THINK WE CAN MAKE SO MUCH
PROGRESS THAT WOULD HELP PEOPLE
TO NOT ONLY RECOVER BUT ALSO
PREVENT LONG-TERM PROBLEMS.
SO I AGREE.
>> AMEN, SISTER.
THANK YOU.
>> CAN YOU SEE THE CHAT.
DR. POE IS INTERESTED IN SLEEP
AND INTERACTION WITH PAIN.
>> ALL RIGHT.
>> I DON'T KNOW IF YOU HAVE
COMMENTS THERE.
LET ME ASK YOU, I KNOW YOU HAVE
INTEREST IN PAIN RESOLUTION
THROUGH DIFFERENT
MUSCULOSKELETAL MANIPULATIONS,
ANYTHING YOU COULD TALK TO US
ABOUT, HOW YOU THINK THAT'S
WORKING?
>> YEAH.
YOU KNOW, I HAD A BUNCH OF OVER
SLIDES I DIDN'T HAVE TIME TO
SHOW YOU.
BUT THERE'S SOME REALLY
INTERESTING RESEARCH GOING ON
RIGHT NOW.
WE'VE KNOWN FOR A WHILE THAT NOT
ALL MECHANICAL FORCES ACT THE
SAME WAY.
BACK IN THE '90s THERE WERE
SOME STUDIES ON CULTURED CELLS
THAT LOOKED AT THE EFFECTS OF
SMALL AMPLITUDE FORCE VERSUS
LARGER AMPLITUDE FORCE.
YOU CAN SEE THE DIFFERENCE IN
INFLAMMATORY CYTOKINES WHEN THE
FORCE IS LARGE.
ACTUALLY, THE ANTI-INFLAMMATORY
CYTOKINES WHEN THE FORCE IS
SMALL.
IT'S NOT THAT THE SMALL FORCE IS
INJURIOUS, IT'S BENEFICIAL.
THERE'S BEEN A VARIETY OF
RESEARCH, MORE RECENT AT HARVARD
MEDICAL SCHOOL IN A LAB THAT
DOES COMPRESSION USING PNEUMATIC
DEVICE, VERY WELL CONTROLLED,
VERY SMALL AMOUNT OF FORCE
EXERTED ON A MUSCLE AFTER IT'S
BEEN INJURED AND COMPRESS FOR
FIVE MINUTES TWICE A DAY, THAT'S
NOT A LOT.
THE AMOUNT OF COMPRESSION THEY
DO IS OF THE ORDER OF 20% STRAIN
WHICH IS VERY SMALL, RIGHT?
YOU KNOW, IT'S NOT A BIG
SQUEEZE.
BUT THEY SHOW THAT INFLAMMATION
IS DOWN, MUSCLE STRENGTH IS
RECOVERED FASTER, AND THE OTHER
INTERESTING THING THEY SHOW IS
THAT THEY DO -- INJECT SOME HIGH
MOLECULAR WEIGHT DEXTRAN IN THE
ISSUES, YOU SEE THAT THE DEXTRAN
IS CLEARED FASTER IN RESPONSE TO
THE MECHANICAL FORCE, WHICH
SUGGESTS THAT FORCE IS HELPING
TISSUE GET RID OF DEBRIS AND
KIND OF THE -- YOU KNOW, EFFECTS
OF THE INJURY.
AGAIN, THAT INTERACTION BETWEEN
METABOLIC, STRUCTURE, AND THE
MECHANICS.
I THINK ALL OF THAT NOW IS
REALLY COMING INTO ITS OWN.
THE WHOLE FIELD OF
MECHANOTHERAPEUTICS IS
DEVELOPING.
IT'S FAR BEHIND PHARMACO
THERAPEUTICS.
IT HAS A LONG WAY TO GO BUT I
THINK IT HAS A LOT OF PROMISE.
>> THANKS SO MUCH.
WE REALLY APPRECIATE IT.
>> THANK YOU.
THANK YOU FOR THE INVITATION.
>> OH, A PLEASURE.
NOW WE'RE GOING INTO AN UPDATE
ON THE HEAL INITIATIVE.
I WANT TO MENTION BEFORE DAVE
DOES THAT INTRO THAT CHRIS
VEASLEY IS HERE, AND SHE IS --
SHE WAS AT THE LAST "HEAL"
MULTI-DISCIPLINARY WORKING GROUP
MEETING AND CAN BE A LINK
BETWEEN THAT GROUP WHICH LOOKS
AT "HEAL" FUNDING PROGRAMS AND
INITIATIVES BEFORE THEY COME TO
COUNCIL.
SO DAVE?
>> OKAY.
THANKS, WALTER.
>> THANKS, CHRIS.
>> SO ONCE A YEAR WE GET AN
UPDATE FROM THE HEAL INITIATIVE
PROGRAM.
THIS YEAR WE'RE HAVING IT FROM
MICHAEL OSHINSKY IN OUR DIVISION
OF NEUROSCIENCE AND LINDA
PORTER, CHIEF OF PAIN POLICY.
MY UNDERSTANDING IS MICHAEL, YOU
WILL BE GOING FIRST.
IT'S ALL YOURS.
>> THANK YOU SO MUCH, DAVE.
I'LL WAIT FOR THE SLIDES.
I'M EXCITED TO SPEAK ABOUT SOME
ACCOMPLISHMENTS, SOME GOAL POSTS
THAT WE'VE PASSED IN THE HEAL
INITIATIVE SINCE WE STARTED
ABOUT FIVE YEARS AGO.
WE HAVE THESE PROGRAMS THAT ARE
IN THE CASE, PRESENTATION I'LL
BE GIVING, RELATED TO
PRE-CLINICAL AND TRANSLATIONAL
RESEARCH IN PAIN, INSIDE THE
HEAL INITIATIVE.
THE LAST TIME WE GAVE YOU THE
UPDATE WAS DURING THE SUMMER.
SO THESE ARE ACCOMPLISHMENTS
SINCE THAT TIME.
AND -- NEXT SLIDE PLEASE.
FIRST THING I WANT TO SPEAK TO
YOU ABOUT IS WHAT'S THE FOCUS OF
THESE PROGRAMS.
WHAT'S THE FOCUS OF THE PAIN
PORTION OF THE HEAL INITIATIVE,
AND THE GUIDING LIGHT, IF YOU
WILL, FOR THE INITIATIVES THAT
WE HAVE INSIDE OF "HEAL" FOR
ENHANCING PAIN MANAGEMENT.
NOW, THE TOP TWO ARE THE ONES
I'LL BE FOCUSING ON IN MY
PRESENTATION.
THAT'S UNDERSTANDING THE
BIOLOGICAL UNDERPINNINGS OF
CHRONIC PAIN AND REALLY
IDENTIFYING MOLECULES THAT
TARGET AND CELL TYPES AND NERVES
THAT COULD BE USED POTENTIALLY
TO FIRST OF ALL INCREASE OUR
UNDERSTANDING OF PAIN AND THEN
ACT AS TARGETS FOR TREATMENT.
AND THEN OF COURSE TO ACCELERATE
DISCOVERY IN PRE-CLINICAL
DEVELOPMENT OF THOSE
NON-ADDICTIVE PAIN TREATMENTS.
TREATMENTS THAT HAVE LOW
LIABILITY FOR BEING REINFORCING
AND THEN LEAD TO OVERDOSE.
THAT'S A CENTRAL THEME IN THE
HEAL INITIATIVE.
AT THIS POINT "HEAL" INVESTED
$1.25 BILLION ON PAIN RESEARCH
AND CROSS-CUTTING RESEARCH.
THAT'S CROSS-CUTTING RESEARCH
INCLUDES RESEARCH ON OPIOID USE
DISORDER, SUBSTANCE USE
DISORDER, AS WELL AS PAIN.
LET'S SAY LOOKING AT PAIN IN
INDIVIDUALS THAT HAVE CHRONIC
OPIOID EXPOSURE, ET CETERA.
NEXT SLIDE.
SO, THIS GOAL THAT "HEAL" HAS TO
DEVELOP EFFECTIVE NON-ADDICTIVE
PAIN TREATMENTS WE HAVE TO HAVE
A METHOD OR PATHWAY TO
SUPPORTING THE FIELD FOR
DEVELOPING THAT.
NOW, WE KNOW AT THE END OF THE
LINE IT'S GOING TO BE A COMPANY
OR SOME COMMERCIAL ENTITY.
BUT IN ORDER TO GET THOSE
COMMERCIAL ENTITIES, IN ORDER TO
GET PHARMA INVOLVED HERE, WE
HAVE TO DE-RISK PRE-CLINICAL,
DE-RISK PARTS THAT WOULD LEAD TO
THE ASSETS THAT ARE READY FOR
CLINICAL TRIALS THAT CAN BE
TESTED AND THEN ADOPT A PARTNER
THAT CAN PERFORM THE PIVOTAL
STUDIES AND BRING THOSE THINGS
TO MARKET.
SO, THAT'S WHY THE FOCUS OF OUR
PROGRAMS ARE ON THIS VALIDATION
OF THESE BIOLOGICAL TARGETS,
IDENTIFYING BIOMARKERS IN THE
HUMAN CONDITION THAT CAN BE USED
FOR THOSE CLINICAL TRIALS AND
SEEDING THE INITIAL DEVELOPMENT
OF THOSE NOVEL TREATMENTS EVEN
AT EARLY STAGES OR EVEN AT THOSE
OPTIMIZATION STAGES.
NEXT SLIDE.
AND THAT'S WHAT YOU CAN SEE IN
THIS SLIDE.
WE'RE GOING TO SEE THERE'S 14 --
SO ON THE LEFT SIDE, AT THE TOP
YOU SEE THE CHEVRON DIAGRAM WE
SHOWED SEVERAL TIMES.
YOU SEE STAGES OF DEVELOPMENT OF
THERAPEUTICS FROM DISCOVERY,
PRE-CLINICAL DEVELOPMENT,
CLINICAL TRIALS, IMPLEMENTATION
AND DISSEMINATION.
SO ON THE LEFT SIDE ARE THE
PROGRAMS THAT ARE IN THE
PRE-CLINICAL AND TRANSLATIONAL
PORTION OF THE HEAL INITIATIVE
PAIN RESEARCH PORTFOLIO, AND
THERE'S 14 DIFFERENT PROGRAMS
CURRENTLY ONGOING OTHER THAT HAD
RECENT RECEIPT DATES OR FUTURE
RECEIPT DATES, AND THE ONES IN
GRAY ARE THE MORE CLINICALLY
RELATED ONES, OR THE ONES THAT
WILL BE IN LINDA PORTER'S
PRESENTATION AFTER MINE.
I'M GOING TO PICK A FEW THAT HAD
SIGNIFICANT ACCOMPLISHMENTS THIS
YEAR AND THAT'S WHAT I'M GOING
TO PRESENT.
NEXT SLIDE.
SO, DE-RISKING OF PRE-CLINICAL
AND EARLY CLINICAL DEVELOPMENT
IS REALLY WHAT OUR GOAL IS.
THE REASON WE'RE FOCUSING ON
THAT IS BECAUSE THERE WAS
SEVERAL PAPERS THAT CAME OUT
SHOWING THAT NOT JUST A
FINANCIAL INVOLVEMENT WAS BEING
REMOVED FROM THIS AREA FROM
PHARMA BUT ALSO THIS INCENTIVE
FOR DOING THE WORK.
I MEAN, IS IT GOING TO BE
SUCCESSFUL?
WAS LEADING TO MANY, MANY
COMPANIES AND MANY RESEARCHERS
COMING OUT OF THIS PARTICULAR
AREA.
SO THERE WAS A PAPER PUBLISHED
IN 2022, BY MAURER ET AL.
LOOKING AT CLINICAL DEVELOPMENT
PROGRAM, THEY HAD FINISHED,
GREAT LEADS, TOXICITY TESTING,
IT WAS FINE, NOW THEY WERE GOING
TO DO CLINICAL TRIALS.
JUST LOOKING AT CLINICAL TRIALS,
IN clinicaltrials.gov,
ANALGESIC DEVELOPMENT, A HUGE
DIFFERENCE BETWEEN SUCCESS OF
THOSE WITH LOW ABUSE POTENTIAL
AND THOSE WITH A HIGH ABUSE
POTENTIAL.
THOSE WITH HIGH ABUSE POTENTIAL,
IN MANY CASES OPIOIDS HERE,
THERE'S BASICALLY ONE IN THREE
OF THOSE PROGRAMS WERE
SUCCESSFUL.
THAT'S LIKE 30%.
ABSOLUTELY A GOOD BET, SAY IT
THAT WAY.
BUT FOR THOSE WITH LOW ABUSE
POTENTIAL LESS THAN 5%.
SO YOU HAD THIS FIVE TO SIX-FOLD
DIFFERENCE IN RISK, IF THEY WERE
LOW ABUSE POTENTIAL ANALGESICS
THAT WERE GOING INTO CLINICAL
DEVELOPMENT.
AND THAT'S WHY THE HEAL
INITIATIVE IS TRYING TO
FACILITATE AND DE-RISK THAT
EARLY DEVELOPMENT SO BECAUSE OF
THAT THEY PULLED OUT OF ALL THE
INVESTMENTS, VAST MAJORITY OF
INVESTMENTS THEY WERE DOING IN
DEVELOPING ANALGESICS WITH LOW
ABUSE POTENTIAL, WAY TOO RISKY.
AND THAT'S WHY "HEAL" IS FOCUSED
THERE, DE-RISK THESE PROJECTS SO
WE CAN GET PARTNERS LATER, IN
ORDER TO DEVELOP -- FINISH
DEVELOPING THERAPEUTICS.
WE HAVE MORE THAN 50 TARGETS IN
THE PROGRAM, VALIDATION STAGE,
SEVERAL GRADUATED INTO THE LATER
STAGE PROGRAMS.
AND MANY OF THE PROGRAMS, IF NOT
ALL OF THESE, ENCOURAGE OR
REQUIRE THAT ABUSE LIABILITY
TESTING EARLY ON SO WE CAN
ELIMINATE TARGETS THAT MAY HAVE
THAT POTENTIAL.
NEXT SLIDE.
ALL RIGHT.
SO LET'S TALK ABOUT THE
PRECISION HUMAN PAIN NETWORK.
SO, THE VALIDATION OF THESE
TARGETS, ONE THING WE HEARD LOUD
AND CLEAR WAS THAT THE
DE-RISKING IS GOING TO NEED
HUMAN VALIDATION TO SHOW THAT
THE TARGET EXISTS IN HUMAN
CONDITION AND WORKS IN SIMILAR
WAY TO WHAT'S BEING DONE ON
MECHANISTIC EXPERIMENTS INSIDE
THE MODEL SYSTEMS IN ORDER FOR
IT TO BE WORTHWHILE FOR THERE TO
BE INVESTMENT LATER IN IT.
SO WE -- YOU CAN SEE A PROGRAM
LEADS ON LOWER LEFT-HAND CORNER
OF THE SLIDE HERE.
THE PRECISION HUMAN PAIN
NETWORK, I'M NOT GOING TO READ
THROUGH WHAT PRECISION STANDS
FOR.
VERY INTERESTING ACRONYM OVER
THERE.
THE GOAL HERE IS TO GENERATE
DATASETS.
YES, I SAID THAT RIGHT.
DATASETS OF CELL TYPES,
MOLECULAR SIGNATURES AND
FUNCTIONAL TYPES, AND SHARE THAT
DATA IN ORDER FOR IT TO BE USED
FOR OTHER RESERVERS DOING THIS
DEVELOPMENT TO ENSURE THAT THEIR
TARGET IS IN THE HUMAN DRG.
THESE GROUPS ARE TAKING DRGs
FROM PATHOLOGIC SAMPLES FROM
INDIVIDUALS HAVING SURGERIES AND
HAVE DORSAL ROOT GANG --
GANGLIA REMOVED, PROFILING WITH
OMICS TECHNIQUES, AND SHARING
THAT DATA, THE GOAL IS TO SHARE
THAT DATA.
WE'RE TAKING ADVANTAGE OF THE
SPARC PORTAL FOR THE DATA IN
THIS PARTICULAR GROUP.
THERE'S A LOT OF DATA
COORDINATION HAPPENING ACROSS
ACROSS "HEAL."
NINDS WAS INVOLVED WITH SPARC,
THEY DEVELOPED A NICE PLATFORM,
NICE FRONT END.
SPARC PROGRAM BEING USED IN
SEVERAL PROGRAMS.
AND THAT DATA COORDINATING
CENTER , THAT'S THE GOAL,
DEVELOPING THE PLATFORM FOR
SHARING THAT FOR PEOPLE TO
BENEFIT FROM IT.
THERE'S EVEN A GROUP HERE THAT
BENEFITED ANOTHER PROGRAM THAT
I'M GOING TO TO SHOW WHERE HUMAN
VALIDATION IS MAKING A
DIFFERENCE IN DEVELOPMENT
PROGRAMS.
NEXT SLIDE.
BEFORE I JUMP TO THAT I WANT TO
GIVE A SHOUT OUT TO THE RE-JOIN
CONSORTIUM WHICH DR. LANGEVIN
HAD SPOKEN ABOUT.
I WANT TO POINT OUT IMPORTANCE
OF WHAT WE'RE GENERATING.
WE'RE GENERATING AN
UNDERSTANDING OF THE MULTIPLE
TISSUES THAT ARE INVOLVED IN
PAIN OR THAT ARE POTENTIALLY
INVOLVED IN THE PAIN.
LOOKING FOR THE SOURCE OF THEM,
NOT JUST THE NERVE, BUT THE
BONE, CARTILAGE, SYNOVIAL, JOINT
CAPSULE AND LIGAMENTS.
IN THE KNEE, EVEN ONE OF THE
PROJECTS THAT DOES BOTH, SO WE
CAN COMPARE DATA ACROSS THEM AND
VALIDATE WHAT'S BEING DISCOVERED
THERE AND ASK THE QUESTION, HOW
COULD THAT LEAD TO
INTERVENTIONS, NOT JUST OF
MOLECULAR NATURE OF SMALL
MOLECULES OR BIOLOGICS, THIS
DATA WILL BE SHARED THROUGH THE
SPARC PORTAL WE MENTIONED
EARLIER.
THIS RE-JOIN HAS A DATA
COORDINATING GROUP THAT WILL BE
RESPONSIBLE FOR THAT.
SHARING THE DATA, HAVING MORE
RESEARCH, MORE ACCOMPLISHMENTS
HAPPEN, AFTER WE FUND THESE
PROJECTS BECAUSE IT WILL SEED
FUTURE PROJECTS.
NEXT SLIDE.
SO NOW WE COME TO OUR "HEAL"
PAIN THERAPEUTICS DEVELOPMENT
PROGRAM.
REALLY ONE OF OUR FLAGSHIP
PROGRAMS.
WE HAVE AN EARLY TRANSLATIONAL
EFFORT PORTION OF THAT THAT'S
LED BY DR. JULIA BACHMAN AND THE
PORTION LED BY DR. MARY ANN
PELLYMOUNTER.
STAY TUNED TO HEAR HOW THAT
WENT.
AND THEN WE HAVE THESE ONES THAT
ARE IN A PROGRAM WHERE WE BUILD
A CONSULTING TEAM AROUND THE
GROUP THAT HAS AN ASSET, HELPS
THEM WITH OUR NINDS CONTRACTS,
TO ALL THE IND-ENABLING STUDIES
AFTER LEAD SELECTION HAS BEEN
MADE IN ORDER TO PREPARE FOR FDA
FILING AND DO THE PHASE 1
CLINICAL TRIAL.
IF YOU GO TO THE NEXT SLIDE
YOU'LL SEE THAT WE HAVE A VERY
DIVERSE PORTFOLIO OF PROJECTS
AND TARGETS INSIDE THIS PTDP
PROGRAM.
WE HAVE SEVERAL ASSETS YOU CAN
SEE AT THE BOTTOM THAT ARE
REPURPOSED, IF YOU WILL.
WE EVEN HAVE A CONTACT LENS AND
VALIDATING FOR EYE SURGERIES.
THERE'S EYE SURGERIES
TREMENDOUSLY PAINFUL, LET'S SAY
-- THERE'S EYE SURGERIES WITH
PAIN AFTER SURGERY, THE ONLY WAY
TO TREAT THOSE THREE TO FIVE
DAYS IS OPIOIDS, HIGH DOSE
OPIOIDS.
AND THAT'S HOW THEY BENEFIT.
THANK YOU, RETINAL DETACHMENT
ALSO.
THEY HAVE ALMOST ALWAYS -- THEY
SCRATCH THE EYE AND THEY DO UV
TREATMENT TO CROSS-LINK
PROTEINS, AND PUT A CONTACT LENS
ON TOP OF THE EYE TO HOLD THE
SHAPE OF THE LENS THERE BUT THEY
JUST PUT A PATCH OVER IT.
THE PATIENT HAS TO TRY NOT TO
SCRATCH, ET CETERA.
THIS PARTICULAR CONTACT LENS
WILL BE ALLUDING TETRIKANE,
REVOLUTIONARY.
YOU MIGHT SEE TARGETS LOOKED AT
BEFORE THROUGH THESE, VETTING
THESE PROJECTS, LET'S SAY CB1,
SPECIFIC ONES THAT AREN'T
DUPLICATING WORK DONE BEFORE BUT
ADD SOMETHING NEW OR
REVOLUTIONARY TO THE PROJECT.
IN THIS CASE POSITIVE
ALLOSTEERIC MODULATOR AND OTHERS
THAT ARE PERIPHERALLY
RESTRICTED.
LET'S TALK ABOUT WINS IN THE
PROGRAM.
ON THE RIGHT SIDE, MYC 1
INHIBITORS, THIS IS FROM A
COMPANY, THERE WAS A RECENT
PAPER FROM ONE OF THE GROUPS
THAT ARE LEADING A TEAM IN THE
PRECISION PROGRAM, THIS
PARTICULAR TARGET IS IN HUMAN
TISSUES, THIS MNK INHIBITOR IS
DOWNSTREAM IF YOU LOOK AT THE
TOP FIGURE ON THE RIGHT, IL-6,
LOTS OF THINGS ARE INVOLVED IN
THE PAIN PATHWAY.
AND THIS MNK-1 IS DOWNSTREAM,
THEY HAVE A LOT OF POTENTIAL TO
BE USED FOR MANY DIFFERENT PAIN
DISORDERS.
NEUROPATHIC PAIN.
LEFT INTRATHECAL DELIVERY, NOSI
SEPTIN-1, NOT A MU OPIOID, IT'S
NOT REINFORCING, DOESN'T HAVE
THAT ADDICTION LIABILITY.
FOR INTRATHECAL APPLICATION TO
TURN OFF THE PAIN, BEFORE IT
GETS TO THE HIGH BRAIN CENTERS,
THE PATIENT CAN PERCEIVE IT, TWO
PROGRAMS READY FOR IND
SUBMISSIONS THIS MONTH.
THAT'S COMING THROUGH OUR
PROGRAM.
NEXT SLIDE.
THAT'S BACKWARDS.
PLEASE GO FORWARD.
PSPP PROGRAM, THAT'S RIGHT.
NEXT THING I WANT TO HIGHLIGHT
IS THE PSPP PROGRAM,
PRE-CLINICAL SCREENING PLATFORM
FOR PAIN, YOU MIGHT BE FAMILIAR
WITH EPILEPSY SCREENING PROGRAM
FOR 40 YEARS, WE DEVELOPED WITH
THE HEAL INITIATIVE FUNDS,
PLATFORM SCREENING PROGRAM FOR
PAIN, 11 OPTIMIZED MODELS WITH 4
OPTIMIZED ENDPOINTS.
I WANT TO POINT OUT NOW THAT THE
LINK YOU SEE ON THE SCREEN HERE
HAS THE DATA FOR THE CONTROLS,
POSITIVE AND NEGATIVE CONTROLS,
THAT ARE USED IN THE PROGRAM
FROM CARBON MAZEAPEN, DIAZEPAM,
MORPHINE, NAPROXIN], ET CETERA,
FOR SHOWING VALIDATIONS USING
DRUGS SO OTHER GROUPS CAN
BENEFIT IF THEY ARE USING THEM
INTERNALLY, THE TECHNIQUES CAN
BE REPRODUCED, WHAT IT SHOULD
LOOK LIKE IN RESPONSE TO
POSITIVE AND NEGATIVE CONTROL,
POSITIVE AND NEGATIVE CONTROLS
INCLUDING BLINDING AND RIGOROUS
METHODS YOU CAN EXPECT.
THIS PROGRAM HAS INTERACTED WITH
MORE THAN 180 ACADEMIC AND
COMPANIES AT THIS POINT.
THERE ARE CURRENTLY IN THE
PROCESS OF EVALUATING 31 ASSETS,
AND THERE'S SOME THAT HAVE
DISCONTINUED BECAUSE SOME ARE
NOT GOING TO WORK.
WE'RE PROVIDING THAT DATA FOR
THE GROUPS IN PROTECTED PRIVATE
WAY, THE BENEFIT SO THEY CAN USE
THEIR PRIVATE FUNDS FOR
ACCELERATING DEVELOPMENT IF THEY
SEE POSITIVE DATA FROM HERE.
THAT'S THE GOAL OF THE PROGRAM.
ALSO, THE PROFILING, NOT JUST
AROUND PAIN BUT ALSO FOR
OFF-TARGET AND SIDE EFFECTS
USING THE IRWIN TEST ET CETERA.
NEXT SLIDE.
SO THE LAST THING I WANT TO SHOW
IS SOME NEW PROGRAMS AND DO
CONCEPT CLEARANCE.
ONE IS AN R15 PROGRAM TO SUPPORT
UNDERREPRESENTED PAIN
RESEARCHERS AND DIVERSE TRAINEES
IN UNDERGRADUATE FOCUSED
PROFESSIONAL SCHOOLS AND HAVE
THEM COLLABORATE WITH OTHER
INSTITUTIONS THAT ARE MAYBE
DOING CLINICAL PAIN RESEARCH TO
REALLY SEED THE PIPELINE FOR
PAIN RESEARCHERS AT AN EARLY
STAGE.
THAT'S ONE PROGRAM LED BY NCCIH.
SECOND IS STUDIES TO ENABLE
ANALGESIC DEVELOPMENT, THIS IS A
REISSUE AND NOT A NEW PROGRAM
BUT TO ENCOURAGE THESE INITIAL
TRANSLATIONAL EFFORTS THAT WILL
SUPPORT DRUG DISCOVERY PROGRAMS
AND ADVANCE PROJECTS AND PREPARE
THEM FOR THAT PTDP WHICH I
SHOWED A SHRINE ON.
THANK YOU FOR YOUR ATTENTION.
>> THANK YOU, MICHAEL.
LET'S TAKE QUESTIONS.
TIM?
>> THANK YOU, MICHAEL.
I LEARN A TON LISTENING TO YOU.
IT'S NOT MY FIELD BUT I WAS
CURIOUS, WHEN YOU DESCRIBE THE
DE-RISKING EFFORTS WHICH
ESPECIALLY FOR THE LOW ABUSE
POTENTIAL DRUGS ABANDONED, DO
YOU HAVE CONCRETE EXAMPLES HOW
MANY TIMES IT'S TURNED OUT
TARGET THAT HAD BEEN VALIDATED
EXQUISITELY IN ANIMAL MODEL
TURNED OUT TO SIMPLY NOT BE IN
THE HUMAN TISSUE THAT MATTERED?
THAT'S WHAT WAS EXPECTED OUTCOME
FROM HAVING THIS KIND OF OMICS
STUFF.
>> YEAH, SO THERE ARE CLEAR
EXAMPLES OF THINGS THAT WORKED
TREMENDOUSLY WELL.
AND ALTHOUGH THEY MIGHT BE IN
THE HUMAN CONDITION, THEY
REACTED DIFFERENTLY.
PHYSIOLOGY WAS DIFFERENT.
ONE IS SUBSTANCE P EXAMPLE,
ANTAGONIST WORKED TREMENDOUSLY
WELL IN THE ANIMAL MODELS.
AND THEN WHEN IT CAME TO TESTING
THEM IN THE HUMAN, CLINICAL
TRIALS, THEY JUST FELL FLAT ON
THEIR FACE.
ONE EXAMPLE OF THAT.
THERE ARE DIFFERENT
REPRESENTATIONS OF THE SODIUM
CHANNELS IN DIFFERENT PARTS OF
THE GANGLIA OR CELL TYPES.
THE MAIN GOAL OF THE PRECISION
PROGRAM IS TO ELUCIDATE
DIFFERENCES SO WE CAN PREVENT
GOING TO THE CLINICAL TRIALS AND
WASTING LATER DEVELOPMENT.
>> I HEARD WALTER SAY WE HAVE TO
CURE OUR IGNORANCE FIRST BEFORE
WE CAN SUCCESSFULLY CURE A LOT
OF DISEASES BECAUSE THERE'S SO
MANY UNKNOWNS IN THE END, EVEN
WHEN YOU HAVE A TARGET ABOUT THE
CONTEXT HOW IT WORKS WE WANT TO
JUMP AHEAD HOPEFULLY TO THERAPY
BUT USELY -- USUALLY THAT'S
WHERE THE RISK IS.
>> ANGIOTENSIN RECEPTORS HAVE
DIFFERENT EFFECT, THEY WERE
WORKED UP BECAUSE OF
PRE-CLINICAL DATA AND DIDN'T
EXIST IN CELL TYPES IMPORTANT IN
HUMANS, ANOTHER EXAMPLE.
>> THANK YOU.
>> THANK YOU, MICHAEL.
I WANT TO NOTE, WE'RE ACTUALLY
GOING TO TAKE A VOTE ON THE
CONCEPT BUS WE'RE GOING TO DO
THAT TO DO THAT AFTER LINDA'S
PRESENTATION.
>> AM I OKAY TO START?
YEAH, OKAY, GREAT.
SO, THANK YOU TO HELENE AND
MICHAEL FOR SETTING UP THE NEXT
PART OF THE "HEAL" UPDATE.
NEXT SLIDE PLEASE.
I WANT TO TAKE A STEP BACK AND
GIVE YOU BETTER UNDERSTAND OF
WHY WE'RE TALKING SO MUCH ABOUT
PAIN TODAY AND HOW IMPORTANT IT
IS THAT WE REALLY EXPAND OUR
RESEARCH PORTFOLIO HERE.
AND SO A LITTLE BIT OF
POPULATION LEVEL DATA MIGHT HELP
TO PUT THAT INTO PERSPECTIVE.
PAIN IS NOW THE MOST COMMON
REASON THAT PEOPLE SEEK MEDICAL
CARE, VARIOUS DIFFERENT
SETTINGS.
IT'S COSTING US ABOUT $600
BILLION A YEAR INCLUDING LOST
PRODUCTIVITY AND HEALTH CARE
EXPENSES.
THE CHART ON THE RIGHT-HAND SIDE
GIVES AN IDEA PRESCRIPTION
OPIOIDS ARE STILL INVOLVED IN
MANY OF THE OVERDOSE DEATHS THAT
EITHER ARE PRESCRIPTION OPIOID
ONLY RELATED OVERDOSE DEATHS OR
PRESCRIPTION OPIOIDS WITH
OTHER -- SOME OTHER TYPE OF
DRUGS INVOLVED IN IT.
SO THE YELLOW LINE ON THE BOTTOM
ARE THOSE THAT ARE PRESCRIPTION
PLUS OTHERS, AND IT'S GREEN LINE
THROUGH THE BLUE BARS SHOWS A
PEAK AND DROP IN PRESCRIPTION
OPIOID INVOLVEMENT IN OVERDOSE
DEATH.
AND I THINK THIS WAS A LOT TO DO
WITH THE CHANGE IN PRESCRIBING
OF OPIOIDS AND MUCH TIGHTER
RESTRICTION WITH CONFLICTING
NEED TO CONTINUE PRESCRIBE FOR
THOSE THAT NEED IT AS PART OF
PAIN CARE MANAGEMENT.
NEXT SLIDE GIVES YOU A LITTLE
BIT OF SENSE OF NUMBERS OF
PEOPLE WHO ARE AFFECTED IN THE
POPULATION.
SO THE NATIONAL HEALTH INTERVIEW
SURVEY SHOW 50 MILLION ADULT WHO
IS REPORT CHRONIC PAIN, THAT'S
MEASURED PAIN OVER THE LAST
THREE MONTHS SINCE THE
INTERVIEW.
25 MILLION, SO HALF WITH CHRONIC
PAIN ARE AFFECTED BY PAIN,
SEVERE PAIN, ON A DAILY BASIS.
AND THEN WE LOOK AT HIGH IMPACT
CHRONIC PAIN WHICH IS DEFINED AS
PAIN OVER THE LAST THREE MONTHS
WHICH INTERFERES WITH YOUR LIFE.
SO YOU CAN'T GO TO SCHOOL OR
YOU'RE UNABLE TO GO TO WORK,
SOCIAL ACTIVITIES DECLINE
BECAUSE OF OF THE STRONG EFFECT
OF CHRONIC PAIN ON YOUR LIFE.
CERTAIN POPULATIONS ARE MORE
AFFECTED THAN OTHER POPULATIONS.
THERE'S ONE PIECE OF DATA HERE
THAT THOSE WHO ARE IN RURAL
ENVIRONMENTS TEND TO REPORT MORE
PAIN, CHRONIC PAIN, AND HIGH
IMPACT PAIN, AND THAT'S PARTLY
AN ISSUE WITH ACCESS TO BETTER
HEALTH CARE IN SOME OF THESE
ENVIRONMENTS.
NOT ONLY IS THE PAIN CARE AN
ISSUE BUT THE ACCESS TO PAIN
CARE ALSO IS.
THESE ARE ALL THINGS THAT AS I
GO THROUGH THE TALK BRIEFLY I
WILL TRY TO GIVE AN IDEA HOW
"HEAL" IS BEGINNING TO AND
TRYING TO ADDRESS THESE ISSUES.
NEXT SLIDE PLEASE.
SO THIS SLIDE IS SOMEWHAT RECENT
STUDY SHOWING THAT ONCE YOU HAVE
PAIN, ONCE YOU HAVE CHRONIC
PAIN, HIGH IMPACT CHRONIC PAIN
IT DOESN'T GO AWAY AT POPULATION
LEVEL.
IT INCREASES.
THERE WAS A STUDY FROM NATIONAL
HEALTH INTERVIEW SURVEY WHICH
TOOK 2019 DATA, LOOKED APROS
PEOPLE WHO DON'T REPORT PAIN IN
BLACK, NEXT DARKER GRAY COLOR
PAIN BUT NOT CHRONIC, AND THEN
CHRONIC PAIN AND THE LIGHTEST
COLOR HIGH IMPACT CHRONIC PAIN.
THE INCIDENCE OF ALL THOSE GOES
UP, WHEN YOU GO BACK TO THE 2019
DATA, SUBPOPULATION, LOOK AT THE
2020 DATA, THE NEW INCIDENCE OF
CHRONIC PAIN IS VERY HIGH.
AND HIGH IMPACT CHRONIC PAIN AS
WELL, ACTUALLY GOES BEYOND THAT
COMPARED TO NEW INCIDENCE OF
DIABETES, DEPRESSION, HIGH BLOOD
PRESSURE, SOME OTHER REALLY
IMPORTANT CHRONIC CONDITIONS
ACROSS THE U.S.
WHAT YOU SEE IF YOU LOOK AT THE
GRAPH CAREFULLY IS THOSE THAT
DON'T REPORT PAIN, THE SAME
PEOPLE WHO DIDN'T HAVE ANYTIME
2020 NOW REPORT NON-CHRONIC
PAIN, WITH NON-CHRONIC PAIN NOW
REPORTING CHRONIC PAIN.
THOSE WITH CHRONIC PAIN MORE NOW
REPORTING HIGH IMPACT CHRONIC
PAIN.
SO WE'RE NOT MAKING IT BETTER
AND WE'RE NOT MAKING IT GO AWAY.
THAT'S KIND OF THE OVERALL
MESSAGE FROM THIS PARTICULAR
SLIDE.
AND IF WE COULD GO TO THE NEXT
SLIDE.
WHAT I'D LIKE TO DO NOW IS GIVE
YOU SORT OF IN THE RED BLOCK
HERE REALLY HIGH LEVEL
HIGHLIGHTS OF WHAT "HEAL" IS
DOING TO ADDRESS THE PAIN CRISIS
IN THE U.S., AND ALL BASED ON
CLINICAL RESEARCH COMPONENT OF
"HEAL."
AND IF YOU LOOK WITHIN THAT RED
BOX YOU SEE THERE ARE BIOMARKER
PROGRAMS THAT ARE TO ASSESS PAIN
CONDITIONS, PROGRESS OF PAIN
CONDITIONS, ALSO TO BE USED IN
CLINICAL TRIALS.
HELENE TALKED ABOUT THE BACPAC
PROGRAM.
I'LL COME BACK TO THAT BRIEFLY.
AND THEN WE SET UP AND
ESTABLISHED TRIAL NETWORKS IN
"HEAL" WHERE WE CAN LOOK AT
DIFFERENT PHASES OF THE CLINICAL
TRIAL PROCESS, PHASE 2 STUDIES
TO LOOK AT SAFETY, EPPIC-NET
SYSTEM AND THEN WE DID A LARGE
TRIAL THROUGH A CONSORTIUM ON
KIDNEY DISEASE, AND THE PAIN
ASSOCIATED WITH DIALYSIS.
WE HAVE A COMPARATIVE
EFFECTIVENESS NETWORK.
PRAGMATIC TRIALS TO EMBED
INTERVENTIONS INTO HEALTH CARE
SYSTEMS.
BIG PROGRAM ON HEALTH EQUITIES
BECAUSE DIFFERENT POPULATIONS,
DISPARITIES, SEPARATE
DISPARITIES MORE LIKELY TO
REPORT PAIN AND CHRONIC PAIN.
WE'RE LOOKING AT COMORBIDITY, AT
INCLUDING -- MOVING ACCESS TO
PAIN CARE INTO RURAL
POPULATIONS, AND PEDIATRIC
PROGRAMS.
FUTURE REPORTS FOR RURAL PAIN
AND KIDS PAIN.
NEXT SLIDE, IF WE LOOK OVERALL
AT WHAT WE HAVE ADDRESSED AS FAR
AS PAIN CONDITIONS, IN THE
"HEAL" CLINICAL PAIN RESEARCH
NETWORK, YOU CAN SEE LIKE WHAT
PAIN CONDITIONS HAVE BEEN
ADDRESSED BY WHAT NUMBER OF
AWARDS THROUGH THE HEAL
INITIATIVE, AND THIS GRAPH IS
GROWING AS WE ADD MORE STUDIES
TO IT.
IT'S JUST TO GIVE AN OVERALL
SENSE OF IF WE INCLUDE ANYTHING
FROM LONGITUDINAL STUDIES DONE
THROUGH "HEAL," BIOMARKER
PROGRAMS, SOME OF THE PROGRAMS
THAT HELEN MENTIONED, MYOFASCIAL
PAIN ONE, THESE ARE PAIN
CONDITIONS BEING ADDRESSED
ACROSS THE WHOLE SPECTRUM OF
"HEAL" RESEARCH STUDIES.
WE'VE ALSO GOT MORE DATA ON WHAT
INTERVENTIONS ARE BEING TESTED.
THIS IS JUST TO GIVE AN IDEA OF
THE BREAD TH OF THE PROGRAM.
NEXT SLIDE.
"HEAL" RECOGNIZES THAT THERE ARE
CERTAIN POPULATIONS THAT ARE
MORE AFFECTED BY PAIN THAN
OTHERS.
AND ONE THAT IS VERY NOTICEABLE
IS THAT MORE WOMEN ARE AFFECTED
BY PAIN CONDITIONS THAT ARE
EITHER REALLY EXCLUSIVE TO WOMEN
OR MORE PREVALENT IN WOMEN.
AND "HEAL" RECOGNIZES THAT.
IF YOU LOOK AT THE GRAPH ON THE
RIGHT, YOU SEE TOTAL POPULATION
WITH CHRONIC PAIN, AND THAT WAS
HIGH IMPACT CHRONIC PAIN, DARK
BLUE IS TOTAL POPULATION, LIGHT
BLUE MEN, GREEN IS WOMEN.
YOU LOOK ON THE RIGHT-HAND SIDE
THE TYPES OF CONDITIONS AND THE
RELATIVE PREVALENCE OF THESE
CONDITIONS IN WOMEN AND IN MEN.
AND SO HEADACHE AND MIGRAINE,
PROGRAMS PARTICULARLY IN NINDS
THAT ADDRESS THIS.
THIS PARTICULAR CONDITION.
AND THEN THE OTHERS ON HERE ALL
"HEAL" HAS PROGRAMS OR PROJECTS
THAT ADDRESS EACH ONE OF THESE
OTHER PAIN CONDITIONS THAT ARE
PREDOMINANT IN WOMEN,
TEMPOROMANDIBULAR, IRRITABLE
BOWEL, THESE ARE ADDRESSED BY A
SET OF DIFFERENT TYPES OF
PROGRAMS, SOME BIOMARKER
PROGRAMS, SOME TRIALS OF
EFFECTIVENESS, SOME PRAGMATIC
TRIALS.
AND THE NEXT SLIDE TELLS US THAT
THIS WORK IS TIMELY IN THAT THE
WHITE HOUSE RECENTLY RELEASED AN
INITIATIVE ON WOMEN'S HEALTH,
AND TARGETED RESEARCH BEING
IMPROVED AND ENHANCED IN THE
AREA OF WOMEN'S HEALTH.
AND IF WE LOOK ACROSS THE
SPOTLIGHT THAT "HEAL" IS
CURRENTLY DOING TO ADDRESS THIS,
WE CAN SEE THE LIST THAT I GAVE
EARLIER AND HOW IT IS BEING
ADDRESSED, WHETHER BIOMARKER
PROGRAM, FOR EXAMPLE,
MECHANISTIC STUDIES FOR TRIJUST
TRIGEMINAL NEURALGIA, SO ON
THROUGH THE LIST.
AN IMPORTANT AREA OF RESEARCH
NEEDS AND SOMETHING THAT "HEAL"
IS AND CONTINUES TO ADDRESS.
AND THE NEXT SLIDE LOOKS AT
ANOTHER ISSUE THAT "HEAL" IS
LOOKING AT, AND THIS IS THAT
CHRONIC PAIN RARELY COMES BY
ITSELF IN AN INDIVIDUAL, OFTEN
ASSOCIATED WITH OTHER CHRONIC
ILLNESS, THIS GIVES A BURDEN OF
DISEASE, EXAMPLES WHERE CHRONIC
PAIN IS MORE LIKELY TO BE
ASSOCIATED OR HOW LIKELY IT IS
TO BE ASSOCIATE IT'S WITH A
NUMBER OF DIFFERENT POPULATION
LEVEL HIGH IMPACT CHRONIC
CONDITIONS.
AND THE NEXT SLIDE WILL SHOW YOU
THAT "HEAL" IS ADDRESSING SOME
OF THESE ISSUES OR HOW DO WE
TREAT PEOPLE WITH CHRONIC PAIN
WHO HAVE OTHER CHRONIC
CONDITIONS ASSOCIATED WITH THAT
PAIN.
SO THIS HIGHLIGHTS COMPLEXITY OF
NOT JUST DIFFERENCE IN PAIN
CONDITIONS BUT ALSO IN COMORBID
CONDITIONS.
SO WE HAVE A PROGRAM, TWO
PROGRAMS, IMPOWR AND MIRQYLL TO
GIVE DELIVER PAIN CARE FOR
PEOPLE WITH SUBSTANCE USE
DISORDER AND/OR PEOPLE WHO HAVE
BEEN ON OPIOIDS FOR LONG TERM
AND ARE AT RISK FOR SUBSTANCE
USE DISORDER.
EXAMPLE, THESE ARE FAIRLY NEW
PROGRAMS, WHAT THEY HAVE ALREADY
DEVELOPED IS A RISK ASSESSMENT
TOOL FOR HOW DO WE START TO
DETECT THE PEOPLE MOST LIKELY,
IN LONG TERM OPIOIDS, GO ON TO
OPIOID USE DISORDER DISORDER BUT
NEED GOOD PAIN MANAGEMENT.
THOSE TWO PROGRAMS ARE
ADDRESSING THAT.
WE HAVE AN EXTENSIVE PROGRAM ON
HEALTH EQUITIES.
THIS PROGRAM, THERE ARE 11
STUDIES IN HERE, ALL CENTERED ON
THE CONCEPT THAT DIFFERENT
POPULATIONS NEED VERY TARGETED
PAIN MANAGEMENT STRATEGIES THAT
ARE CULTURALLY ACCEPTABLE AND
REALLY ADDRESS THE NEEDS OF
THOSE POPULATIONS IN CONCERT
WITH THE COMMUNITIES WHERE THEY
LIVE AND SO IT'S A REALLY HIGH
COMMUNITY ENGAGEMENT PROGRAM TO
REALLY GET THROUGH SOME OF THE
BARRIERS AND CHALLENGES THAT ARE
ASSOCIATED WITH POPULATIONS OF
HEALTH DISPARITIES.
THOSE PROGRAMS, MOST OF THESE
ARE ADDRESSING CHRONIC PAIN AND
EITHER MENTAL HEALTH CONDITIONS
OR OPIOID USE DISORDERS.
SO HERE YOU GET THAT SORT OF
COMBINED ADDRESS COMORBIDITIES.
AND THIS IS FOR TRIBAL NATION,
SUBSTANCE USE DISORDERS,
OVERDOSE, NORA VOLKOW TOLD US
DEATH IN NATIVE POPULATION IS
HIGHER BY TWO TIMES THAN IN THE
POPULATION, GENERAL POPULATION.
THIS WILL BE WORKING TO PROVIDE
RESOURCES TOKER RESEARCH IN THE
AREA OF PAIN, AND OVERDOSE
SUBSTANCE USE DISORDERS IN
DIFFERENT TRIBAL NATIONS AND
SORT OF BUILD A RESEARCH
INFRASTRUCTURE AND GIVE
RESOURCES TO RUN RESEARCH
PROGRAMS THAT THEY HELP TO
DEVELOP AND ARE REALLY TARGETED
TO THEIR PARTICULAR POPULATIONS
AND COMMUNITIES.
NEXT SLIDE.
TO GIVE YOU AN IDEA OF OUR
"HEAL" EFFECTIVENESS,
COMPARATIVE EFFECTIVENESS
STUDIES, WHERE WE'VE MADE
PROGRESS IN SOME LARGE CLINICAL
TRIALS, ACROSS THE SET OF PAIN
CONDITIONS, AND WHERE THEY ARE.
SO I'M NOT GOING THROUGH THEM
SPECIFICALLY BUT IT'S A RANGE OF
PAIN CONDITIONS BEING ADDRESSED
BY SPECIFIC INTERVENTIONS FOR
ACUTE PAIN, FOR PAIN THAT
MEDICATION AND SELF-MANAGEMENT
ASSISTED IN RURAL POPULATIONS,
FOR THOSE WITH CHRONIC PAIN AND
OUD IN A DIFFERENT POPULATION,
AND STAR COLOR TELLS YOU THAT
THE TRIAL IS COMPLETED AND BEING
PUBLISHED, AND THE SILVER STAR
ARE THOSE TRIALS THAT ARE
ACTUALLY COMPLETED RECRUITMENT
AND NEAR READY TO CLOSE OUT
THEIR TRIALS.
AND WE HAVE BRONZE AND BLUE STAR
AWARDEES WHO ARE 80% OR 50%
RECRUITED AND SO TO GIVE YOU AN
IDEA OF PROGRESS EFFECTIVENESS
NETWORK HAS MADE.
THE NEXT SLIDE.
THERE ARE TWO -- THIS IS THE
EARLY PHASE SO THIS IS THE PHASE
2 TRIAL NETWORK HAS RECRUITED
ENTIRELY FOR THEIR FIRST TRIAL
WHICH IS TESTING A NOVEL CCR 2
AGONIST, THEY WILL GET
INTERESTING RESULTS FROM THERE.
AND THE LARGE PROGRAM TO -- FOR
PAIN MANAGEMENT, SELF-MANAGEMENT
STRATEGIES AND WEANING OFF OF
OPIOIDS FOR THOSE UNDERGOING
HEMODIALYSIS IS COMPLETE.
DATA ANALYSIS ONGOING, HOPEFULLY
PUBLICATIONS WILL BE OUT SOON.
NEXT SLIDE.
THIS ONE GIVES YOU A COUPLE
THINGS HERE THAT HELENE WENT
INTO IN GREAT DETAIL.
I'LL GO QUICKLY.
WE WERE ASKED ABOUT WEARABLE
DEVICES TO MEASURE OUTPUTS OR AS
BIOMARKERS FOR PAIN.
THERE'S A NEW PROGRAM, WE EXPECT
TO FUND SOME OF THESE PROGRAMS
IN 2024, AND THESE CAN BE
DEVICES THAT CAN HELP DEVELOP A
BIOMARKER SIGNATURE OF PAIN,
PAIN PROGRESSION, MONITORING TO
RESPOND, MONITORING RESPONSES TO
TREATMENTS, AND ALSO FOR
OUTCOMES ASSESSMENT FOR PAIN.
AND THEN WE HAVE A LARGE PROGRAM
ON BIOMARKERS THAT ARE
PROGNOSTIC FOR DISEASE
PROGRESSION ACROSS A NUMBER OF
PAIN CONDITIONS.
AND ALSO SOME THAT ARE BEING
DEVELOPED FOR CLINICAL TRIAL
WORK WHERE WE CAN MONITOR HOW
WELL A PARTICULAR DRUG OR
THERAPY IS -- RESPONSE OF THAT
PARTICULAR DRUG OR THERAPY TO
HELP OUR CLINICAL TRIALS.
HELENE TALKED ABOUT BIOMARKER --
MYOFASCIAL PAIN PROGRAM, AND
THEN MENTIONED BACPAC.
BACPAC IS DOING A TRIAL, ALL
ABOUT BIOMARKERS.
AND ALL ABOUT HOW WE CAN USE
VERY DEEP PHENOTYPIC
CHARACTERISTICS OF PATIENTS IN A
CLINICAL TRIAL TO FIGURE OUT
WHICH -- IS A SMART TRIAL DESIGN
WHERE THEY SWITCH AROUND THE
INTERVENTIONS, WHICH
INTERVENTIONS COUPLED WITH DEEP
DATASET ON THE PATIENTS, WHICH
ARE MOST LIKELY TO WORK FOR
SOMEONE WITH PARTICULAR
PHENOTYPIC CHARACTERISTICS IN A
TRIAL SETTING AND THEN IN A
CLINICAL SETTING.
SO THIS IS COMPLETED.
DATA ANALYSIS HAS STARTED.
AND WE EXPECT THIS ONE TO BE
REALLY HELPFUL FOR BACK PAIN,
THE MOST PREVALENT CONDITION OF
PAIN IN THE U.S.
NEXT SLIDE.
WE RECOGNIZE ALL THIS RESEARCH
AND RESEARCH SUPPORT IS
AVAILABLE AND EXPANDING AS OUR
RESEARCH WORKFORCE IN PAIN
ESPECIALLY IN CLINICAL PAIN
RESEARCH IS BEGINNING TO
DWINDLE.
AND SO HEAL HAS PROMOTED A
NUMBER OF DIFFERENT PROGRAMS TO
INCREASE TRAINING FOR PEOPLE IN
DISPARATE POPULATIONS, THROUGH
DIVERSITY SUPPLEMENTS, WE HAVE A
K12 NATIONAL NETWORK MATCHING UP
MENTORS ACROSS THE COUNTRY LIKE
REALLY GOOD MENTORS WITH REALLY
GOOD TRACK RECORDS, WITH
PROMISING YOUNG SCHOLARS WHO
NEED BETTER TRAINING.
THE PURPOSE NETWORK IS A DIGITAL
PLATFORM WHERE INVESTIGATORS AND
TRAINEES AND PEOPLE WITH LIVED
EXPERIENCE CAN COME TOGETHER AND
SHARE INFORMATION, SHARE
CONVERSATIONS, WRITE GRANTS
TOGETHER, THROUGH THIS
NETWORKING PLATFORM.
IT HAS OVER 2,000 MEMBERS
ALREADY FROM THE PAIN COMMUNITY.
THE K99/R00 IS A PROGRAM TO SORT
OF ACCELERATE TRANSITION FROM
POSTDOC TO INDEPENDENT RESEARCH.
AND THEN WE HAVE A SMALL SET OF
ADMINISTRATIVE SUPPLEMENTS FOR
PEOPLE WHO ARE AT EARLY CAREER
STAGES IN PAIN RESEARCH TO
SUPPORT THEM OR THEIR RESEARCH.
THE NEW PROGRAM COMING OUT IS A
T90/R90, INSTITUTIONAL TRAINING
GRANTS.
THE WHOLE TRAINING PROGRAM WILL
BE A COHORT SO SEVERAL PEOPLE
COMING IN ONE YEAR TRAIN
TOGETHER, AND THEY WILL ACCEPT
FOREIGN APPLICANTS WITHIN THE
PROGRAM, NOT THE INSTITUTION BUT
TRAINEES AS WELL AS U.S.
CITIZENS OR GREEN CARDHOLDERS.
SO THAT'S UNIQUE.
THE NEXT SLIDE TELLS US ABOUT
THE HEAL DATA ECOSYSTEM AND THIS
IS BEING SET UP FOR REALLY TO
MAXIMIZE DATA HARMONIZATION AND
SHARING ACROSS THE HEAL
INITIATIVE, AND HAS REALLY
LONG-TERM BENEFITS FOR PEOPLE
BEING ACCESS -- GETTING ACCESS
TO THE DATA.
A HUGE AMOUNT OF DATA COLLECTED
BY "HEAL."
FINALLY IN THE LAST SLIDE, THIS
IS MORE OF AN FYI, ALL THIS
INFORMATION IS IN YOUR PACKET,
TO GIVE YOU A SENSE OR REMINDER
IF YOU WILL OF THE "HEAL"
PROGRAMS THAT ARE BEING
REISSUED, IN 2025 OR 2026, AND
THEY INCLUDE A PROGRAM TO
PROMOTE CARE CENTERED IN PRIMARY
CARE FOR PAIN MANAGEMENT THAT
INCLUDES CONNECTIONS OR
INTEGRATION WITH SPECIALTY CARE,
THIS ONE WAS APPROVED YEAR
BEFORE LAST BY THE COUNCIL.
THE PRISM, PRAGMATIC STUDIES
THAT WE DO TO IMPLEMENT CARE IS
WORKING, THEY WON'T BE DOING
THEIR OWN TRIALS BUT SETTING UP
A REALLY -- USING A COORDINATING
CENTER TO SUPPORT ALL SORT OF
TRIALS THAT ARE TRYING TO
IMPLEMENT AND HELP GOOD BETTER
HEALTH CARE INTO HEALTH CARE
SYSTEMS.
THE BACPAC CONSORTIUM YOU'VE
HEARD ABOUT THAT.
IS COMING UP FOR REISSUE NEXT
YEAR TO REALLY LEVERAGE ALL THE
INFORMATION AND THE
INFRASTRUCTURE, DATA ALGORITHMS
THAT BACPAC HAS ALREADY
DEVELOPED.
WE WILL CONTINUE TO OFFER SMALL
ADMINISTRATIVE SUPPLEMENTS FOR
CAREER ENHANCEMENT AND CLINICAL
RESEARCH ON PAIN.
MENTIONED DATA ECOSYSTEM.
AND THERE ARE TWO NEW CONCEPTS,
ONE WHICH WILL BE SUPPORTED BY
NCCIH, AND THIS IS TO RUN
CLINICAL TRIALS FOR
EFFECTIVENESS IN THE NIH DoD
V.A. PAIN MANAGEMENT LABORATORY
WHICH I DIDN'T MENTION HERE, THE
COLLABORATORY IS SOMETHING
THAT'S BEEN AROUND FOR A NUMBER
OF YEARS AND TRYING TO EMBED
BETTER PAIN CARE INTO THE V.A.
AND DoD SYSTEM IN PARTNERSHIP
WITH THE NIH.
AND THEN WE HAVE A CAREER
DEVELOPMENT CONCEPT FOR K23 AND
K08 AWARDS FOR CLINICAL
RESEARCHERS, IN THE PAIN REALM,
AND THAT'S BEEN BASED ON A
REALLY STRONG PORTFOLIO ANALYSIS
OF HOW SUCCESSFUL THESE TYPES OF
MENTORING PROGRAMS HAVE BEEN IN
THE CLINICAL PAIN RESEARCH ARENA
IN THE PAST.
AND MOVING THAT FORWARD.
SO, I WILL SAY THANK YOU VERY
MUCH AND I CAN TAKE SOME
QUESTIONS I THINK.
MICHAEL, DID YOU HAVE ONE MORE
CONCEPT -- OR REISSUE THAT YOU
WANTED TO MENTION?
>> I PUT THEM ON THE SLIDE
ALREADY.
>> THEY WERE UP.
OKAY.
>> YES.
>> THANK YOU BOTH.
INCREDIBLY INFORMATIVE AND VERY
EXCITING.
I HEARD WALTER SAY YOU CAN'T
JUST GO TO CAPITOL HILL BUT
CAPITOL HILL SHOULD INVITE YOU
EVERY SIX MONTHS TO HEAR ABOUT
THIS, IMPORTANT TO HEAR WHAT NIH
DOES.
THE ADRD WORLD, THE BOOST LED TO
A MASSIVE NUMBER OF PEOPLE WHO
SHIFTED INTO ALZHEIMER'S, NEW
INVESTIGATORS GOING INTO
ALZHEIMER'S, I'M SENSING YOU
FEEL IN THE FIVE YEARS OF "HEAL"
WE STILL HAVEN'T BEEN ABLE TO
INJECT INTO YOUNGER
INVESTIGATORS, WHY DO YOU THINK
THAT IS THE CASE IF IT IS.
>> WE SURVEYED PROFESSIONAL
ORGANIZATIONS TO ASK THAT EXACT
QUESTION.
AND IT'S A COMBINATION OF
THINGS.
IT'S A LACK OF SUPPORT FOR THEIR
RESEARCH.
SO WHAT WE'RE DOING IS REALLY
TRYING TO ADDRESS THAT CONCERN.
ALSO, THE ISSUE OF THESE ARE THE
CLINICAL RESEARCHERS WE TRYING
TO ATTRACT, PRACTITIONERS,
USUALLY IN THEIR ACADEMIC
SITUATIONS THERE IS PRESSURE TO
STAY IN THE CLINIC AND SO IT'S
DIFFICULT TO FIND TIME TO
ACTUALLY DO RESEARCH.
THE OTHER CHALLENGE IS THAT PAIN
RESEARCH NOW NEEDS TO BE REALLY
MULTI-DISCIPLINARY, SO IT'S HARD
TO FIND A PROGRAM WHERE THEY ARE
EXPAND A LITTLE BIT WHERE
PRIMARY INTERESTS MAY BE.
THAT'S ONE OF THE THING T90/R90
PROGRAM WILL DO IS REQUIRED
WITHIN THAT PROGRAM THAT THE
TRAINEES, THE INSTITUTION CAN
OFFER TRAINEES SORTS OF WHAT YOU
THINK OF AS STANDARD PAIN
RESEARCH TRAINING, WHICH MIGHT
BE EFFECTIVENESS RESEARCH OR
WHATEVER.
BUT ALSO TO TIE THEM INTO A
DISCIPLINE THAT'S IMPORTANT FOR
PAIN.
IT COULD BE DATA MANAGEMENT.
IT COULD BE OUD MANAGEMENT.
WE'RE TRYING TO SORT OF TARGET
PLACES WHERE THE SURVEY TOLD US
THAT THE CHALLENGES WERE TO
BRING NEW PEOPLE INTO THE
RESEARCH WORKFORCE.
>> I WOULD ADD WE'RE ALSO
DEVELOPING PROGRAMS THAT WILL
TRAIN THE RESEARCHERS IN THE
TYPE OF RESEARCH THAT WE NEED IN
PAIN.
IN THE PAST THERE'S REALLY BEEN
A DISCONNECT BETWEEN THOSE DOING
THE BASIC BIOLOGY AND STUDY OF
PAIN AND DIFFERENT PROTEINS AND
CELL TYPES, ET CETERA, AND THEN
WHEN THE COMPANIES WENT TO LOOK
AT THESE TARGETS TO SEE WHETHER
OR NOT THEY COULD USE THEM, IF
THEY WERE DRUGGABLE OR IF THEY
COULD BE USED AS STIMULATOR,
THERE WAS A DISCONNECT FROM THE
TYPE OF DATA BEING COMMUNICATED,
TYPE OF EXPERIMENTS BEING DONE
TO VALIDATE THESE TARGETS AND
WHAT WAS NEEDED BY THE COMPANY.
THE WORK HAD TO BE DONE ALL OVER
AGAIN.
SO WE'RE TRYING TO DESIGN THE
PROGRAMS TO FOCUS THE TYPE OF
RESEARCH AND THEN THOSE FUNDING
ANNOUNCEMENTS ARE ENCOURAGING
PEOPLE TO COME IN THE FIELD AND
DO THAT KIND OF WORK, OR
GRADUATE STUDENT WHO WILL BE
FOCUSED NOW WHEN THEY GET THEIR
POSTDOC AND FACULTY POSITION
FOCUSED ON THERAPEUTICS
DEVELOPMENT AND NOT JUST
UNDERSTANDING THE BASIC BIOLOGY
BUT THE BASIC BIOLOGY FOR
THERAPEUTICS DEVELOPMENT.
I'VE HEARD ROB SAY THAT BEFORE
IN THE PAST, YOU'VE SEEN
STUDENTS DOING THAT.
GO AHEAD.
I SEE YOUR HAND IS UP.
>> YEAH, ABSOLUTELY.
THE PAIN FIELD SPECIFICALLY
SUFFERED FROM HISTORICAL
UNDERFUNDING REALLY.
AND IT WAS NOT SEEN AS A VIABLE
AREA.
EVEN FOR JUST BIOMEDICAL Ph.D.
STUDENTS DIDN'T SEEM LIKE AN
AREA THAT WAS ROBUSTLY
CONSIDERED.
WE'VE SEEN THIS GROW A LITTLE
BIT.
IT'S GOING TO LET PEOPLE KNOW
IT'S NOT JUST A FLASH IN THE
PAN.
NIH IS INVESTING IN THE FUTURE
OF THIS.
I HEAR PEOPLE TALKING ABOUT
"HEAL" TRAINING PROGRAMMING
IMPACTING ENTHUSIASM, A VIABLE
AREA FOR SCIENTISTS, SO BRAVO.
>> RIGHT.
I ALSO SAY, AND I THINK MAYBE
THE PRACTITIONERS, FRANCES AND
PEOPLE RUNNING NEUROLOGY
DEPARTMENTS, KNOW WE'RE SWIMMING
UPSTREAM IN TERMS OF CLINICAL
CARE FOR PEOPLE WHO HAVE PAIN,
MOST OF THE REIMBURSEMENT HAS
MOVED INTO PROCEDURAL PAIN
CENTERS.
AND SO NEUROLOGY IS FOR INSTANCE
PRETTY WEAK ON THIS SIDE, ON THE
CLINICAL SIDE OF PAIN, AND THE
REIMBURSEMENT FOR TAKING CARE OF
A PERSON WITH CHRONIC PAIN IS
VERY DIFFICULT, MANY PATIENTS
JUST CAN'T FIND PHYSICIANS TO
TAKE CARE OF THEM.
>> CHRIS?
>> YEAH, I WANT TO ADD, I'M PART
OF THE K12 NETWORK AS WELL, JUST
WANTED TO ADD THERE THAT THERE'S
A LARGE EFFORT TO DO AN ATYPICAL
MENTORSHIP WITH PEOPLE THAT ARE
IN THAT PROGRAM.
I'M A PATIENT MENTOR, FOR
EXAMPLE, IT'S NOT JUST ACADEMIC
RESEARCH MENTORSHIP BUT CLINICAL
MENTORSHIP.
THERE'S COMMUNITY AND PATIENT
MENTORSHIP AND THERE'S GOALS
ALONG ALL OF THOSE AREAS, RIGHT?
SO, IT'S VERY IN DEPTH IN TERMS
OF WHAT THESE MENTEES HAVE TO DO
AND WHERE THEIR GOALS ARE AND
ACTIVITIES THEY ARE GOING TO
MEET IN EACH ONE OF THESE AREAS,
RIGHT, FROM SPEAKING TO TALKING
WITH PEOPLE WITH LIVED
EXPERIENCE AND HOW THAT IMPACTS
THEIR RESEARCH.
SO I'VE BEEN REALLY, REALLY
PLEASED WITH THAT PROGRAM AND I
GUESS THE ONLY THING I CAN SAY
MORE IN SUPPORT IS THAT WE JUST
NEED MORE FUNDING FOR IT.
RIGHT NOW WE HAVE I THINK THREE
MENTEES THAT ARE NOT IN THAT
PROGRAM.
WHICH IS A GREAT START.
YOU KNOW, BUT IN TERMS OF THE
RESEARCH WORKFORCE NEEDED IN
CLINICAL PAIN RESEARCH WE NEED
MORE, RIGHT?
SO JUST WANTED TO ADD THAT.
>> YEAH, THANKS, CHRIS.
WE'RE EXCITED ABOUT THAT
PROGRAM.
THE IDEA IS TO BRING IN EACH
YEAR OVER THE NEXT FIVE YEARS AN
ADDITIONAL COHORT OF TRAINEES.
WE FOUND THE FIRST THREE HAVE
REALLY FOUND SOME ADVANTAGES,
NOT JUST FROM THE WAY TRAINING
PROGRAM IS SET UP BUT JUST
CAREER OPPORTUNITIES ALREADY.
AND SO IT FEELS GOOD TO SEE THAT
THEY ARE DOING WELL AND THEY ARE
FLOURISHING.
>> FRANCES, PERHAPS THE LAST
QUESTION.
>> YES.
FIRST, I WILL ECHO WHAT WALTER
SAID ABOUT NEUROLOGISTS NOT
BEING AS INVOLVED IN PAIN
COMPARED TO, SAY, PEOPLE IN
REHAB MEDICINE OR, YOU KNOW,
OTHER ANESTHESIA.
AND ONE AREA THAT NEUROLOGISTS
TEND TO STILL OWN IS MIGRAINE
PAIN.
AND OF COURSE IT WOULD BE
INTERESTING GIVEN THERE ARE LOTS
OF PARALLELS, THERE'S THE
CENTRAL PART, THERE'S ALL OF THE
ENVIRONMENTAL INFLUENCES,
THERE'S THE GANGLIA, CRANIAL
NERVE GANGLIA, NOT MAYBE DORSAL
ROOT GANGLIA, BUT I'M WONDERING
IF THERE'S, YOU KNOW, THAT
COHORT COULD -- THERE COULD BE
SOME CROSS-FERTILIZATION OF THAT
COHORT WHICH GENERALLY THERE ARE
MORE NEUROLOGISTS WHO UNDERSTAND
THE NEUROAXIS IN A DIFFERENT
WAY, AND MIGHT BE ABLE TO THINK
ABOUT SOME COMORBIDITIES,
WHETHER THAT GROUP COULD BE
CONNECTED, THEY ARE NIH FUNDED,
NINDS FUNDED WITH FOLKS DOING
PERIPHERAL PAIN IN SOME WAY BE
IT SYMPOSIA OR BRINGING THE TWO
WORLDS TOGETHER BECAUSE THEY MAY
NOT BE -- YOU KNOW,
REPRESENTATIVE DIFFERENT
CLINICAL DISEASE SETS BUT
PATHOPHYSIOLOGY MAY BE
SIGNIFICANTLY SHARED.
>> THANK YOU, FRANCES.
AND, YOU KNOW, I TOTALLY AGREE
WITH YOU THAT THE WORLD OF PAIN
ON A CRANIAL NERVE AND WORLD OF
PAIN COMING THROUGH DRGs,
SOMATIC PAIN, HAVE BEEN
SEPARATED FOR MANY YEARS.
THERE'S BEEN SOME
CROSS-FERTILIZATION, WHEREAS
UNDERSTANDING OF HOW THE
TRIPTANES WORK CAPE FROM
UNDERSTANDING SENSITIZATION AT
THE LEVEL OF DORSAL HORN, LOWER
LUMBAR REGION, THE MIGRAINE
RESEARCHERS TRANSFER THAT TO
UNDERSTANDING HOW TRIPTANES WORK
AND TRIGEMINAL GANGLION.
I WANT TO EMPHASIZE ALL OF THE
RESEARCH OR FUNDING
ANNOUNCEMENTS FOR RESEARCH IN
"HEAL" INCLUDE ABILITY FOR
TRIGEMINAL PAIN PROJECTS AND
PROJECTS FOR HEADACHE AND
MIGRAINE.
WE'RE CONSTANTLY WORKING TO HAVE
THEM INCREASE THAT BUT THAT'S
ONGOING.
THE THIRD THING I WANT TO SAY IS
AT THE BEGINNING OF MY TALK I
TALKED ABOUT THAT 4.7% OF
SUCCESSFUL PROGRAMS THAT
HAPPENED WITH NON-ADDICTIVE OSH
LOW ABUSE LIABILITY ANALGESICS.
BASICALLY THEY ARE ALL PROGRAMS
IN MIGRAINE, ALMOST ALL.
ONLY ONE THAT'S NOT.
SO THAT 4.7% IS REALLY, YOU
KNOW, INFLATED BY THE WORK
THAT'S HAPPENED IN THE MIGRAINE
FIELD.
THE REASON FOR THAT IS BECAUSE
WAY BACK IN THE '70s THEY
DETERMINED THAT MEDICATION
OVERUSE HEADACHE WAS COMING FROM
OPIOIDS AND BUTALBITOL, DRUGS
WITH A HIGH ABUSE LIABILITY, USE
MAKE HEADACHE WORSE AND ACUTE
MEDICATIONS NOT WORK AS WELL AS
WELL AS PREVENTIVE MEDICATIONS.
THEY FIGURED THIS OUT EARLY AND
WERE GOING AFTER TARGETS THAT
HAD LOW ADDICTION LIABILITY.
WHEREAS THE SOMATIC PAIN FIELD
IS JUST CATCHING UP.
>> SINCE THAT COMES TO MIND FROM
YOUR QUESTION, THE PURPOSE
NETWORK MIGHT BE A PLACE TO
BRING CONVERSATIONS TOGETHER,
MEANT TO PULL MULTI-DISCIPLINARY
GROUPS TOGETHER.
PERHAPS MICHAEL AND I CAN
PERHAPS GET THEM -- MAKE A
CONNECTION THROUGH THAT NETWORK.
>> ABSOLUTELY.
>> GREAT.
OKAY.
SO, WE DO NEED TO MOVE ON.
THERE WERE FIVE CONCEPTS THAT
WERE -- SIX, SORRY.
SIX CONCEPTS PRESENTED.
WE DO TAKE A VOTE ON THE
CONCEPTS MOVING FORWARD.
THEY WERE BOTH A MIXTURE OF NEW
AND REISSUES.
SO WHAT I'M GOING TO CALL FOR IS
A MOTION TO MOVE FORWARD WITH
THOSE CONCEPTS.
>> SO MOVED.
>> SECOND.
>> SECONDED.
>> OKAY, GREAT.
NOW WE'LL DO THE VOTING IN THE
ECB.
SO IF EVERYONE COULD GO TO THE
ECB LIKE I MENTIONED, YOU'RE
GOING TO WANT TO REFRESH YOUR
SCREEN TO HAVE THE MOST
UP-TO-DATE VERSION AND YOU'RE
LOGGED IN.
GO TO THE VOTING TAB ON THE
FIRST TAB ON THE LEFT.
CLICK ON "HEAL" CONCEPT
CLEARANCE INITIATIVES.
AND THEN YOU CAN VOTE.
>> MAYBE WE SHOULD HAVE THE
JEOPARDY CLOCK.
>> WE GOT IT.
>> THANKS.
OKAY.
THANK YOU ALL FOR THE "HEAL"
SESSION.
NOW WE'LL MOVE TO THE GENERAL
CONCEPT CLEARANCE.
AND SO WHAT WE DO IS PRESENTS
CONCEPTS TO COUNCIL.
WE GAVE YOU DETAILED INFORMATION
IN THE WRITEUPS, IN THE ECB.
WE HAVE A WEALTH OF CONCEPTS.
FIRST WE'LL FOCUS ON REISSUES.
WE HAVE A SLIDES OF THOSE.
OKAY.
SO, THE INTENTION IS NOT TO
MENTION IN DETAIL OR MENTION ANY
OF THEM EXCEPT FOR ONE WHICH
I'LL GET TO IN A MINUTE.
BUT WE'RE HAPPY TO ANSWER
QUESTIONS IF PEOPLE HAVE THEM.
I WANT TO FOCUS ON THE NEXT
SLIDE.
YES.
THE VERY LAST REISSUE, THE
PROGRAM PROJECT GRANT, SO, WE
HAD ALWAYS ENVISIONED THIS WOULD
BE SUNSETTED WHEN WE CREATED THE
RM 1 TEAM SCIENCE PROGRAM,
THERE'S MULTIPLE.
THE NUMBER OF APPLICATIONS AND
AWARDS DECLINED SIGNIFICANTLY
THAT ONE COULD START TO QUESTION
ADMINISTRATIVE BURDEN FOR
APPLICATIONS REVIEW MONITORING
THE AWARDS, ET CETERA.
WE BELIEVE THE TIME HAS COME TO
SUNSET.
WE CAN DO IT IN TWO WAYS, IF YOU
HAVE A STRONG ONE.
ONE, WE DON'T NEED TO REISSUE,
JUST EXTEND IT FOR REASONS WE
DON'T NEED TO GET INTO FOR TWO
ADDITIONAL RECEIPT DATES, MAY
AND SEPTEMBER DATE.
WE WOULD BASICALLY SUNSET THE
PROGRAM.
OR WHAT WE CAN DO IS EXTEND FOR
TWO DATES AND DO A FINAL YEAR
REISSUE FOR THE COMMUNITY SO
THEY WOULD KNOW.
IN BOTH CASES WE'LL PUT OUT A
NOTICE I WOULD SAY IMMEDIATELY
AFTER THIS MEETING EXPRESSING
WHICH WAY WE'RE DOING.
THE QUESTION IS SHOULD WE DO TWO
MORE RECEIPT DATES OR FIVE MORE
RECEIPT DATES.
AND AS I'M SAYING THIS I'M
REALLY LOOKING IF THERE'S A
STRONG PREFERENCE.
I'M GOING TO TAKE SILENCE AS NOT
A STRONG PREFERENCE.
>> NOT STRONG BUT BASED ON
EVERYTHING I HEARD IT WOULD MAKE
SENSE TO DO TWO AS OPPOSED TO
FIVE.
>> I'M SORRY, I COULDN'T HEAR
THAT.
>> BASED ON WHAT I'VE HEARD
TODAY, BUDGETARY CONSTRAINTS,
WHAT YOU TOLD ABOUT FREQUENCY OF
THE PROGRAM PROJECTS, IT WOULD
SEEM TO MAKE SENSE TO GO WITH
ONLY TWO AS OPPOSED TO THE FIVE.
>> AGREED.
SAME REASONS, I HAVE A WEAK
PREFERENCE FOR TWO.
>> SAME HERE.
>> I THINK WHAT WE'LL DO IS A
BLOCK CONCEPT CLEARANCE, WE'LL
KEEP THAT THERE.
BUT I'VE GOTTEN A SENSE WHICH
WAY WE'LL GO HERE.
I MOST IMPORTANT THING IS TO
ALERT THE COMMUNITY, AS SOON AS
WE CAN.
SO IF THERE'S NOT ANY OTHER
QUESTIONS ON THE P01 OR
PREFERENCE EXPRESSED,
EXPRESSING, OR ANY QUESTIONS ON
THE OTHER REISSUES I WOULD ASK
FOR A MOTION TO MOVE FORWARD
WITH ALL OF THOSE.
>> SO MOVED.
>> OKAY.
SECOND?
>> SECOND.
>> PERFECT.
>> WHAT YOU WANT TO DO IS GOING
TO THE VOTING TAB, REISSUE.
I BELIEVE YOU'LL ONLY SEE TEN AT
A TIME.
IF YOU SCROLL TO THE BOTTOM OF
THE PAGE, YOU CAN INCREASE HOW
MANY CONCEPTS YOU CAN SEE, SO
LIKE CLICK 25 OR 100.
AND THEN YOU CAN DO -- YOU CAN
VOTE.
>> ONE CAN SELECT OUT, I TAKE
IT.
>> CAN YOU?
>> YES.
YOU CAN SELECT ALL BUT I BELIEVE
YOU HAVE TO SHOW ALL THE
CONCEPTS BEFORE YOU HIT SELECT
ALL.
>> VOTING YES MEANS WHAT WE JUST
TALKED ABOUT?
>> YEAH.
>> VOTE NO ON THAT ONE
PARTICULAR ONE.
>> YOU DON'T NEED TO VOTE NO.
YOU CAN VOTE YES AND I THINK WE
HAVE A CLEAR IDEA OF WHAT WE'RE
GOING TO DO.
AGAIN, THIS IS JUST -- WHEN WE
GET CONCEPT CLEARANCE IT DOESN'T
MEAN WE HAVE TO DO SOMETHING.
NOW WE HAVE THE ABILITY TO DO
SOMETHING.
IT'S EASIER JUST TO VOTE ON THEM
ALL.
>> OKAY.
THANK YOU FOR THAT.
NOW WE'LL MOVE TO THE NEW
CONCEPTS, WE HAVE A COUPLE.
ONLY ONE WE'RE GOING TO DISCUSS.
I'M GOING TO PASS TO TISH, WAIT,
SHE POINTED AT ME.
>> CHARISSE IS GOING TO GO
FIRST.
>> FROM OUR DIVISION OF CLINICAL
RESEARCH.
>> PRESENTATION NUMBER 9.
>> GREAT.
TISH IN THE ROOM?
>> TAKE IT AWAY.
>> THANK YOU.
HELLO, EVERYONE.
I'M THE PROGRAM DIRECTOR, GLOBAL
HEALTH AND HEALTH DISPARITIES,
JOINED BY MY COLLEAGUE TISH TO
PROVIDE CONCEPT FOR NINDS HEALTH
EQUITY TRAINING PROGRAM.
I'M WAITING FOR THE SLIDES ON MY
END.
I SEE THEM.
THANK YOU.
NEXT SLIDE PLEASE.
THIS CONCEPT IS A CRITICAL
COMPONENT OF IMPLEMENTATION OF
STRATEGIC PLAN, A TWO-YEAR
PROCESS INVOLVING 30 RESEARCHERS
AND CLINICAL EXPERTS THAT
CULMINATED IN TEN MANUSCRIPTS
OUTLINING RECOMMENDATIONS FOR
NINDS TO ADDRESS NEUROLOGICAL
HEALTH DISPARITIES.
TWO SPECIFICALLY FOCUSED ON
TRAINING NEEDS.
I WANT TO POINT OUT HERE OUR
COLLEAGUES IN THE OFFICE FOR
PROGRAMS TO ENHANCE DIVERSITY
WERE ACTIVE CONTRIBUTORS.
TO ASSURE SUCCESS, THE PIPELINE
OF NEUROLOGY IS -- FIRST
MANUSCRIPT ON THE LEFT IS
AUTHORED, CALLING FOR
RECRUITMENT AND TRAINING IN
HEALTH CURRICULA AND DEVELOPMENT
IN HEALTH DISPARITIES RESEARCH
AT EARLY, MID-CAREER, SENIOR
LEVELS, IMPORTANTLY DESCRIBES
NEED TO TRAIN KEY STAKEHOLDERS
IN THE COMMUNITY INTEGRAL TO THE
SUCCESSFUL CONDUCT AND
DISSEMINATION OF NEUROLOGICAL
DISPARITIES RESEARCH.
SECOND MANUSCRIPT ON RIGHT
OUTLINES OUTLINES TRAIN
ACTIVITIES, ONE FOR SCIENTISTS
OF ALL BACKGROUNDS.
MULTIPLE RECOMMENDATIONS CAME,
SOME INCORPORATED INTO PROPOSED
HEALTH EQUALITY TRAINING PROGRAM
CONCEPT, I'LL TURN IT OVER TO
TISH TO PROVIDE MORE DETAILS ON
THE NEXT SLIDE.
>> NEXT SLIDE.
SO, CONCEPT WE'RE PROPOSING IS
INSTITUTIONAL RESEARCH TRAINING
PROGRAM NEUROLOGICAL HEALTH
DISPARITIES AND HEALTH EQUITY
RESEARCH.
YOU CAN SEE ACROSS THE TOP IN
LIGHT BLUE THESE ARE COMPONENTS
THAT WE ENVISION SO FAR WITH
RESPECT TO (INDISCERNIBLE) FIRST
ANCHORED IN RESEARCH PROJECTS
THAT PARTICIPANTS COULD BE
UNDERTAKING IN NEUROLOGICAL
HEALTH DISPARITIES AND PROVIDE
ADDITIONAL TRAINING AND
STRATEGIES AND APPROACHES FOR
BIDIRECTIONAL COMMUNICATION WITH
THE COMMUNITY AND PEOPLE WITH
LIVED EXPERIENCE, GIVEN
EDUCATION INTO THE ROOT CAUSES
OF HEALTH DILLS PARTIES,
TRAINING INTO METHODS FOR THIS
KIND OF WORK.
WE WOULD EXPECT PROGRAMS WOULD
BE LED BY A TEAM INCLUDING
RESEARCHERS AND CLINICIANS,
PEOPLE FROM THE COMMUNITY, WITH
LIVED EXPERIENCE, PUBLIC HEALTH
EXPERTS, FOR GRADUATE, MEDICAL
STUDENTS, POSTDOCTORAL FELLOWS,
CLINICIAN ENGAGED IN THIS
RESEARCH.
WE WOULD ENDEAVOR TO BE ABLE TO
ENSURE THAT INSTITUTIONS THAT
ARE BEST POSITIONED TO PROVIDE
THIS TYPE OF OUTSTANDING
TRAINING WOULD BE COMPETITIVE.
WITH THE BRIEF INTRODUCTION WE
HAVE A COUPLE QUESTIONS FOR
COUNCIL.
FIRST, ARE THERE OTHER TRAINING
COMPONENTS THAT SHOULD BE
INCLUDED?
SECOND, ARE THERE OTHER
POPULATIONS THAT SHOULD BE
TARGETED FOR THIS TYPE OF
TRAINING? SO WITH THAT I THANK
YOU FOR YOUR CONSIDERATION AND
WE'RE HAPPY TO HEAR YOUR
FEEDBACK.
>> THE TITLE OF THIS MENTIONS
NEUROLOGICAL CARE.
NONE OF THE COMPONENTS AND
DOCUMENTS MENTION NEUROLOGICAL
ISSUES.
SO I TAKE IT WILL FOCUS ON
NEUROLOGICAL DISPARITIES AND
NEUROLOGICAL DISEASE AND CARE?
HOW ABOUT YOU FOCUS ON NEUROLOGY
OR NEUROSCIENCE ISSUES?
>> CHARISSE?
>> YES, THIS IS AN
INTERESTING -- IMPORTANT
COMPONENT TO THINK ABOUT HOW
WE'RE ADDRESSING HEALTH
DISPARITIES FROM THE
NEUROLOGICAL PERSPECTIVE, SO THE
EXPECTATION WOULD BE THAT THERE
ARE GROUPS OF RESEARCHERS WHO
HAVE EXPERTISE THINKING HOW TO
ADDRESS DISPARITIES FROM THE
EXAMPLE OF EPILEPSY, DISPARITIES
IN EPILEPSY, BRINGING GROUPS
TOGETHER THAT BOTH HEALTH EQUITY
EXPERTISE AND NEUROLOGICAL TO
BRIDGE THAT GAP SO WE CAN
ADDRESS DISPARITIES THAT ARE
OCCURRING WITHIN THIS.
ABSOLUTELY THE FOCUS WILL BE
COMPONENT OF NEUROLOGICAL HEALTH
EQUITY.
>> CAN YOU DISPLAY THE LAST
SLIDE AGAIN.
IT'S USEFUL TO SCAN IN TERMS OF
TRYING TO ANSWER YOUR QUESTION.
>> COULD WE PUT THE SLIDE BACK
UP WITH THE TRAINING COMPONENTS?
>> HE'S TRYING TO GET IT UP, I
THINK.
>> OKAY.
>> DO YOU SEE THIS IN THE
LABORATORY, IN CLINICS?
YOU MENTIONED RELATIONSHIP TO
THE COMMUNITY AS WELL.
WHERE DO YOU SEE THESE
COMPONENTS BEING GENERATED AND
FUNCTIONING?
>> I THINK THIS WOULD BE
WHEREVER THESE PROGRAMS WOULD BE
HOUSED, IF IN CLINICAL
DEPARTMENT OTHER CLINICAL GROUP
ARE OR COHORT OF TRAINEES OR
EVEN JUST AT AN ACADEMIC
ENVIRONMENT WHERE YOU HAVE
Ph.D. TRAINEES FOR EXAMPLE
THEY WOULD BE CARRYING ON NORMAL
RESEARCH PROJECTS THEY TYPICALLY
WOULD DO IN THAT ENVIRONMENT BUT
THEN WOULD BE -- PROGRAM WOULD
BE EXPECTED TO BUILD OUT
SPECIFIC TRAINING, A SUITE OF
TRAINING ACTIVITIES WHETHER
COURSE WORK, WHETHER
OPPORTUNITIES FOR HANDS-ON OR
PRACTICAL WORKSHOPS, ET CETERA,
TO BE ABLE TO WORK THROUGH, FOR
EXAMPLE, LEARNING HOW TO
INTERACT IN BIDIRECTIONA MANNER
WITH COMMUNITIES YOU WOULD BE
ENGAGING WITH.
AND WITH RESPECT TO, FOR
EXAMPLE, TRAINING AND RESEARCH
METHODS THAT COULD BE SOMETHING
THAT'S DIDACTIC, BOOT CAMP
BASED, LEFT TO THE PROGRAMS TO
COME UP WITH SOMETHING THAT
WORKS WITH RESOURCES AND
INFRASTRUCTURE IN THE
ENVIRONMENT THEY PROPOSE TO DO
THE TRAINING IN.
>> THANK YOU.
>> DID THAT HELP?
>> YES.
IN THE CONTEXT OF GWAS IN THE
AFRICAN POPULATION, SOME
CATEGORIES WE'RE FRIGHTENINGLY
HOMOGENOUS.
I DO A LOT OF ALS WORK.
IT'S PHENOMENALLY HOMOGENOUS
WITH RESPECT TO WHITE PATIENTS.
AND SO IT WOULD BE NICE TO THINK
ABOUT HOW TO GET INTO THE ARENAS
WHERE ONE MIGHT SEE OTHER
ASPECTS OF NEUROLOGICAL DISEASES
BASED ON DIVERSITY.
>> GINA?
>> YES.
HELLO.
I LOVE THIS CONCEPT.
AND HISTORY TELLS US THAT IT'S
GOING TO TAKE MORE THAN JUST A
LITTLE BIT OF WINDOW DRESSING TO
GET THIS DONE.
SO I'M APPLAUDING THE WHOLE
EFFORT AND THE FACT THAT YOU ARE
GOING TO TAILOR THE TRAINING
COMPONENTS TO THE SPECIFIC NEEDS
OF THE PLACE.
IT MIGHT BE THAT SOMEPLACE MIGHT
NEED TO BE SUPPORTED FOR YEARS
BECAUSE CONCEPT NEEDS TIME TO
CHANGE AND PEOPLE'S MINDS NEED
TIME TO CHANGE.
SO I JUST WANTED TO SUPPORT THIS
WHOLE EFFORT AND SAY THAT THIS
IS NOT SOMETHING THAT CAN BE
DONE OVERNIGHT UNLESS THERE ARE
PLACES THAT ARE PRIMED AND READY
FOR IT.
BUT OTHER PLACES ARE GOING TO
NEED A LOT OF WORK.
SO THANK YOU FOR UNDERTAKING
THIS.
>> THIS IS A DIFFERENT KIND OF
TRAINING PROGRAM, MIGHT BE FOCUS
JUST ON POSTDOCS, MAYBE FELLOWS
AND POSTDOCS, CURIOUS HOW DO YOU
PLAN TO NAVIGATE IN TERMS OF
HAVING THE FLEXIBILITY AND
THE -- PROBABLY THE EXTENT OF
INVOLVEMENT AT A GIVEN PLACE FOR
THE TRAINING PROGRAM TO WORK
EFFECTIVELY, BUT THEN AGAIN I DO
SUPPORT THIS.
>> AGAIN, I THINK IT'S GOING TO
DEPENDS -- WE'LL HAVE TO WRITE
THIS IN A WAY TO MAKE SURE THAT
IT'S GOING TO BE FEASIBLE FOR
DIFFERENT FOLKS WITH DIFFERENT
POPULATIONS.
AND DIFFERENT MIXES OF PEOPLE TO
BE ABLE TO PUT TOGETHER
SOMETHING THAT THEN IS GOING TO
MEET -- TICK ALL THE BOXES BUT
ALSO SPECIFIC FOR THEIR
ENVIRONMENT.
I THINK WE'LL HAVE TO THINK
CAREFULLY HOW WE WRITE UP THE
INITIATIVE, CERTAINLY TALKING TO
PEOPLE IN THE COMMUNITY TO GET
FEEDBACK TO SEE WHAT'S BEST
SUITED TO BE ABLE TO HAVE THE
BROADEST REACH, EVEN THOUGH THIS
IS ONE INITIATIVE.
>> LOUISE?
>> I ECHO THE COMMENTS.
ONE CONCERN IS REALLY JUST
OPERATIONALIZING IT.
LIKE MAKING SURE THE COMMUNITY
RESOURCES ARE SET UP BECAUSE
IT'S GREAT AND PEOPLE WANT
TRAINING AND WE WANT TO INCREASE
DIVERSITY AND INCLUSION BUT SOME
PLACES MAY NOT HAVE THIS
INFRASTRUCTURE AND IT REQUIRES A
LOT OF COMMUNITY NETWORKING TO
GET THE COMMUNITIES ON BOARD
BECAUSE THAT'S WHO WE'RE TRYING
TO REACH.
SO KIND OF THINKING ABOUT MAYBE
EVEN INCLUDING COMMUNITY HEALTH
WORKERS, WHICH ARE GOOD BRIDGE
BETWEEN A PARTICULAR COMMUNITY,
BILINGUAL, LANGUAGE BARRIERS.
JUST OPERATIONALIZING SO IT
ACHIEVES WHAT YOU WANT IT TO
ACHIEVE, YOU KNOW, SO WE CAN
DISSEMINATE AND IMPLEMENT TO
OTHER PLACES IS GOING TO BE THE
TRICK HERE.
I'M SURE WITH YOUR GUIDANCE IT
WILL GO VERY WELL.
IT'S JUST TRYING TO GET TO THAT
ACTUAL, YOU KNOW, OBJECTIONABLE
OR OBJECTIVE THAT YOU WANT THIS
PROGRAM TO HAVE.
>> ABSOLUTELY.
YES, THANK YOU FOR THAT COMMENT.
YEAH, THAT'S A GOOD SEGUE TO
MENTION THIS IS ONE COMPONENT OF
OUR IMPLEMENTATION OF HEALTH
EQUITY STRATEGIC PLAN AND SO WE
DON'T EXPECT THAT ONE PROGRAM
ALONE WILL SERVE TO DEAL WITH
ALL OF THE ISSUES THAT WE WANT
TO TACKLE AND SO THIS DOES
DOVETAIL.
THIS IS WHY WE DEVELOPED THIS
COLLABORATION TO ENSURE THAT IT
WORKED WELL WITH THE, FOR
EXAMPLE, COMMUNITY ENGAGED
HEALTH EQUALITY RESEARCH
INITIATIVE WE PRESENTED LAST
YEAR, THAT IS IN THE WORKS AND
WE FULLY ANTICIPATE LESSONS
LEARNED AND RESEARCHERS AWARDED
THROUGH THE HERN WILL WORK WITH
THESE GROUPS AS WELL.
WE'RE ESSENTIALLY BUILDING THE
NEXT GENERATION THROUGH
DISPARITIES, NEUROLOGICAL HEALTH
DISPARITIES RESEARCHERS,
INVESTIGATORS, REALLY TRYING TO
DO THAT IN COLLABORATIVE WAY.
>> I DON'T WANT TO SLOW US DOWN
BUT DO YOU ENVISION A POSSIBLE
TO HAVE A MAJOR UNIVERSITY
PARTNERING WITH ININSTITUTION
PRIMED TO BE MAJOR BUT DOESN'T
HAVE THE STRUCTURE, A JOINT
TRAINING GRANT PROGRAM OR THREE
UNIVERSITIES, IS THAT WHAT YOU
ENVISION?
>> I THINK THIS IS SOMETHING WE
STARTED TALKING ABOUT FROM THE
FIRST TIME WE DISCUSSED THIS.
AND FIGURING OUT A WAY TO
POTENTIALLY BE ABLE TO DO THIS.
IT CAN BE TRICKY BUT THERE MAY
BE SOME CASES WHERE THIS MIGHT
WORK REALLY, REALLY WELL AND
WOULD BE A GREAT WAY TO BRING
GROUPS THAT DON'T MAYBE HAVE
RESOURCES IN HOUSE INTO THE
CONVERSATION AND TRAINING.
SO IT'S SOMETHING ON THE RADAR.
>> SAMEER?
>> THANKS.
LET ME INTERJECT.
LOTS OF DISCUSSIONS ABOUT THIS,
QUESTIONS NOT REALLY EXPLAINED.
THE ISSUE IS THE MECHANISM.
T32, THE T32 DOES NOT ALLOW
NON-CITIZENS, THAT'S ONE THING
TO CONSIDER.
T32s ARE GOING TO BE VERY MUCH
ACADEMIC ORIENTED PLACES, AND
QUESTIONS FOR DOING HEALTH
RESEARCH, IS THAT THE POOL OF
PEOPLE WE WANT TO CONCENTRATE
ON, PEOPLE THAT DON'T HAVE
AGREES, DON'T HAVE PhDs,
M.D.s, SO THE QUESTIONS THAT
WE WERE ASKING WERE TO DO HEALTH
DISPARITIES RESEARCH WHAT ARE
THE KIND OF PEOPLE WE NEED TO
GET AND IS THE USUAL T32
MECHANISM THE RIGHT WAY TO DO
IT?
UNFORTUNATELY THAT WASN'T MADE
EXPLICIT TO THE COUNCIL.
>> WHAT'S REALLY NICE, A LOT OF
WORK WENTZ INTO THE STRATEGIC
PLAN, THERE'S A LOT TO DO.
IT'S GREAT THAT WE'RE STARTING,
YOU'RE STARTING AT A GRASSROOTS
LEVEL.
THIS IS AN INVESTMENT INTO THE
FUTURE.
YOU KNOW, THE FOLLOWING YEAR OR
YEAR AFTER THAT, THREE, FIVE,
TEN YEARS DOWN THE LINE WILL BE
LEADING THIS.
THAT MAGNIFICATION, MAGNIFYING
EFFECT, YOU KNOW, IS AN
INVESTMENT, LIKE ALL OF OUR
TRAINING GRANTS IT REALLY PAYS
OFF WELL.
IT'S A GREAT PLACE TO START.
WITH THE COMMENTS THAT WALTER
MADE, IT'S ATYPICAL, AND IS
GOING TO REQUIRE MAYBE
NON-TRADITIONAL MECHANISMS TO
GET IT TO THE PEOPLE THAT ARE
REALLY GOING TO BE THE SOLDIERS
FOR THIS, TO MAKE THIS HAPPEN.
SO IT WILL BE INTERESTING TO SEE
HOW YOU CAN FIGURE THAT OUT.
MECHANISM WISE.
>> GINA?
>> I THINK THERE'S A WAY TO NOT
NECESSARILY REINVENT THE WHEEL
HERE.
I THINK IT'S QUITE --
MECHANISM-WISE ONE CAN HAVE
WEEKLY IDEA SALON WHERE HAVE YOU
TRAINEES THAT -- ALSO INVITE
COMMUNITY MEMBERS LIKE COMMUNITY
COALITIONS OF SOME SORT TO COME
AND SHARE KNOWLEDGE AND IDEAS.
THERE MIGHT BE A WAY TO -- I
THINK YOU MAKE A REALLY GOOD
POINT, SAMEER, THERE MIGHT BE
THE NEED TO FIND A WAY TO GET
MONEY TO COMMUNITY MEMBERS THAT
HASN'T BEEN TRADITIONAL DONE BUT
I DON'T THINK THAT'S -- IT'S
PROBABLY NOT THE FIRST TIME
THAT'S BEEN DONE SO I'M SURE
THERE'S A WAY AND I WONDER WHAT
TISH AND OTHERS HAVE THOUGHT
ABOUT THAT.
>> I THINK THAT OUR THINKING, WE
STEPPED BACK FROM A SPECIFIC
MECHANISM AND WANTED TO THINK
ABOUT WHAT IS NEEDED, WHO NEEDS
TO BE TRAINED, AND WE CAN PLUG
IT INTO ONE OR MORE MECHANISMS,
AND THERE COULD BE COMPANION
MECHANISMS TO MAKE SURE THAT WE
ARE -- WHATEVER LIMITATIONS WE
HAVE WITH DIFFERENT MECHANISMS
WE CAN MAXIMIZE THOSE AND REALLY
TARGET THE GROUPS THAT NEED TO
BE TARGETED WITH TRAINING THEY
NEED TO GET.
IT DOESN'T HAVE TO BE T32, R25,
IT COULD BE BOTH, OTHER THINGS,
BUT I THINK THAT'S WHAT BEEF GOT
-- WE'VE GOT TO THINK OUT.
WHAT INFORMATION AND WHAT
MECHANISMS WILL ALLOW THAT.
>> THANK YOU.
>> SO, YEAH, AGAIN WHEN WE VOTE
ON THESE CONCEPTS WE DON'T
NECESSARILY HAVE TO HAVE THE
GORY DETAILS BUT IT'S THE BIG
CONCEPT.
SOUNDS LIKE THERE'S A GREAT DEAL
OF SUPPORT FORETHAT.
WHAT WE'LL DO NOW IS MOVE
FORWARD.
THERE WERE THREE NEW CONCEPTS.
AND SO WE'RE GOING TO VOTE ON
THOSE UNLESS THERE WERE
QUESTIONS ON THE OTHER TWO.
WELL, FIRST, WE'LL MAKE A
MOTION.
MOTION TO MOVE --
>> SO MOVED.
>> THANK YOU.
VOTE AWAY ON THOSE THREE.
IN THE MEANTIME ROD CORRIVEAU
WILL PRESENT AD/ADRD TO THE
COUNCIL AND WE'RE GOING TO MOVE
FORWARD ON THOSE.
ROD?
>> I'M HERE.
>> TAKE IT AWAY, ROD.
>> OKAY.
>> I PROMISE NOT TO TAKE LONG
TODAY.
I WANT TO JUST MENTION THE
AD/ADRD PROGRAM IS A LARGE
PROGRAM AT THE NINDS.
WALTER ALREADY MENTIONED THAT
IT'S AROUND $300 MILLION PER
YEAR, THERE ARE MANY PEOPLE
INVOLVED.
AND MANY PROGRAMS INVOLVED, A
LOT OF PEOPLE TO THANK, A LOT OF
HARD WORK FROM REVIEW PROGRAM
OFFICE OF THE DIRECTOR AND
COLLABORATION WITH ESPECIALLY
THE NIA AND OTHER INSTITUTES.
THE FIRST GOAL OF THE NATIONAL
PLAN TO ADDRESS ALZHEIMER'S
DISEASE IS TO PREVENT AND
EFFECTIVELY TREAT ALZHEIMER'S
DISEASE AND RELATED DEMENTIAS.
IN PURSUIT OF THAT GOAL THERE
ARE TRIENNIAL SUMMITS ON
ALZHEIMER'S DISEASE, ALZHEIMER'S
DISEASE RELATED DEMENTIA,
DEMENTIA CARE, RESULTS IN
PRIORITIZED RECOMMENDATIONS AND
ULTIMATELY MILESTONES IN THE
CASE OF THE ADRD SUMMIT, FACA
MILESTONES IN THE NATIONAL PLAN.
AND THOSE MILESTONES ARE
SCIENTIFICALLY, WE HOPE, DRIVE
TOWARD THE GOAL OF THE NATIONAL
PLAN.
NIA LEADS THE OVERALL NIH
RESPONSE TO THE NATIONAL PLAN TO
ADDRESS ALZHEIMER'S DISEASE
WHICH IS REALLY THE NATIONAL
PLAN TO ADDRESS ALZHEIMER'S
DISEASE AND RELATED DEMENTIAS.
THE NINDS AND NIA COLLABORATE
CLOSELY TOGETHER ON FUNDING
OPPORTUNITIES, PAYLINES,
SUMMITS.
THE NINDS LEADS LEWY BODY
DEMENTIA, FRONTOTEMPORAL,
SIGNIFICANT INCREASES IN
RESOURCES AVAILABLE FOR THESE
OVER THE YEARS.
AND THE LAST SUMMIT THAT THE
NINDS LED ON ADRD WAS 2022,
ANOTHER ONE IN 2025.
AMBER McCARTNEY IS PROJECT
MANAGER, THE LEAD OF THE THAT
SUMMIT, THE PROGRAM LEAD.
THERE WILL BE A SCIENTIFIC CHAIR
DETERMINED AT LATER TIME.
YOU'LL HEAR MORE AT ANOTHER
COUNCIL MEETING.
SO, THE INITIATIVE CONCEPTS THAT
I'M GOING TO SHOW HERE ON TWO
SLIDES ARE BASED ON THE
MILESTONES THAT COME FROM THE
ADRD SUMMIT.
AND THEY ARE THE RESULT OF A
PROCESS THAT STARTED LAST JULY
INVOLVING MANY, MANY PROGRAM
DIRECTORS AND INPUT, FROM THE
NIA, INCLUDING DIRECTORS OF BOTH
INSTITUTES.
I WON'T GO OVER THESE INDIVIDUA.
DOCTORS BRODY AND IT WAS HANK
ALSO REVIEWED THESE ALREADY LAST
WEEK YOU'LL NOTICE A NUMBER ARE
REISSUES.
THERE ARE SOME THAT ARE NEW.
WE'VE BROKEN INTO CATEGORIES FOR
TRAINING AND CAREER DISEASE
MECHANISMS.
YOU SEE THE NAME OF THE PROGRAM
DIRECTOR, PROJECT OFFICER, LAST
NIGHT ON THE RIGHT-HAND SIDE.
THIS IS THE FIRST OF TWO SLIDES
WITH CONCEPTS SO I'M GOING TO
PAUSE FOR A MOMENT.
THE PROGRAM DIRECTORS, CONTACTS,
ARE AVAILABLE TO TAKE QUESTIONS
SO I WILL PAUSE AND SEE IF THERE
ARE ANY QUESTIONS.
I HAVE DAVE NODDING AT ME.
HEARING NONE, I'M GOING TO GO TO
THE NEXT SLIDE.
WE HAVE OUR CONCEPTS
TRANSLATION.
RESOURCES.
CLINICAL TRIALS.
AND CLINICAL RESEARCH.
AGAIN, THE PROGRAM DIRECTORS ARE
AVAILABLE TO ANSWER QUESTIONS
ABOUT THESE CONCEPTS.
SOME ARE NEW, SOME REISSUES.
AND SO I WILL ONCE AGAIN PAUSE
JUST FOR A FEW MOMENTS, SEE IF
ANYBODY WOULD LIKE TO ASK
QUESTIONS.
IS.
AND WAIT FOR DAVE TO NOD AT ME
AGAIN.
OKAY.
WELL, THANK YOU VERY MUCH FOR
THE OPPORTUNITY TO JUST SAY A
FEW WORDS.
AND I THINK I MIGHT BE THE LAST
THING HOLDING YOU UP TODAY.
I'LL STOP THERE.
>> NO, WE HAVE SO MUCH MORE.
SO WHAT WE'LL DO NOW IF THERE
ARE NO QUESTIONS ON ANY OF THE
CONCEPTS, WE'LL ASK FOR A MOMENT
TO MOVE FORWARD WITH THOSE.
>> I MOVE WE MOVE FORWARD WITH
THOSE.
>> IS THERE A SECOND?
>> SECOND.
>> PERFECT.
SINCE THERE ARE QUITE A FEW I'LL
MAKE SURE YOU DO SCROLL TO THE
BOTTOM AND SELECT, YOU KNOW,
THERE'S 21 CONCEPTS FOR ADRD,
SELECT 100 SHOW IT SHOWS ALL OF
THEM AND VOTE.
>> I'M PLEASED TO SEE MORE LEWY
BODY-FOCUSED PLANS, THAT'S
EXCELLENT.
MORE ON THE RD PART OF THE ADRD,
THAT'S REALLY HELPFUL.
>> SO, AS WE'RE VOTING I BELIEVE
WHAT WE'LL USE THAT TIME TO TEE
UP THE NEXT SESSION WHICH IS A
PRESENTATION OR INITIAL
DISCUSSION OF OUR 75th
ANNIVERSARY CELEBRATION.
ALYSSA GALLAGHER IS GOING TO LET
YOU KNOW ABOUT THAT.
>> CAN EVERYBODY HEAR ME OKAY?
ALL RIGHT.
CONCEPTS APPROVED.
NOW WE'RE GOING TO PARTY.
SO IT'S WONDERFUL TO SEE ALL OF
YOU.
I WANT TO EXTEND A WARM WELCOME
TO THE NEW MEMBERS ON COUNCIL.
I'M DIRECTOR OF OFFICE OF
NEUROSCIENCE COMMUNICATIONS AND
ENGAGEMENT HERE AT NINDS, THE
COMMUNICATION SHOP.
I'M HAPPY TO KICK OFF THE YEAR
ON A CELEBRATORY NOTE.
I'M GOING TO PROVIDE BACKGROUND
ON CELEBRATIONS AND BRING YOU UP
TO SPEED ON PLANNING EFFORTS
UNDERWAY.
WE'LL SHARE IDEAS OF ACTIVITIES
AND DIFFERENT EVENTS WE WANT TO
HOST THROUGHOUT THE YEAR AND
MOST IMPORTANTLY WANT TO GET
YOUR FEEDBACK AND REQUEST YOUR
SUPPORT AND PARTICIPATION FOR
OUR CONTINUED PLANNING EFFORTS.
AS YOU CAN SEE ON THIS SLIDE, A
LITTLE BIT OF BACKGROUND, IN
1950 THE NATIONAL INSTITUTE OF
NEUROLOGICAL DISEASES AND
BLINDNESS WAS ESTABLISHED.
IN 1968 THE NAME CHANGED TO THE
NAME WE KNOW AND LOVE TODAY.
AND AS WALTER NOTED WE'LL BE
CELEBRATED OUR 75th NEXT YEAR.
NEXT SLIDE PLEASE.
SO WHY DO WE CELEBRATE?
AGAIN, WE WANT TO HOST EVENTS TO
SHARE OUR RESEARCH PRIORITIES,
CELEBRATE ACCOMPLISHMENTS, SOME
OF THE MANY THAT YOU'VE ALREADY
HEARD TODAY THROUGH THE HEAL
INITIATIVE, AND THROUGH THE PAIN
RESEARCH PORTFOLIO.
TO IMAGINE THE FUTURE OF
NEUROSCIENCE WITH STRATEGIC
PARTNERS, AN IMPORTANT POINT AS
WE WANT TO LOOK BACK AND REFLECT
ON THE PAST, THE THE PREVIOUS
YEARS SINCE THE 50th AND 75
YEARS IN THE ENTIRETY BUT LOOK
TO THE FUTURE TOWARDS THAT WITH
ALL OF YOU BECAUSE AS WALTER
MENTIONED EARLIER A LOT OF WORK
STILL NEEDS TO BE DONE.
WE WANT TO PUT THE FOCUS AND
EMPHASIS ON IMAGINING THE FUTURE
OF NEUROSCIENCE.
THIS WILL BROADEN NETWORKS,
INCREASE COLLABORATION
OPPORTUNITIES AND HOPEFULLY ABLE
TO BEGIN RESTORING SOME OF THAT
PUBLIC TRUST AND TRUST IN
INSTITUTIONS THAT HAS BEEN
DETERIORATING FOR A WHILE NOW.
FINALLY WE WANT TO CREATE
DURABLE RESOURCES THAT WILL LAST
BEYOND OBSERVANCE, MINDFUL OF
THE BUDGET SITUATION SO ANYTHING
WE'RE GOING TO BE PUTTING STAFF
TIME, RESOURCES, MONEY TOWARDS
WE WANT IT TO GO INTO THE FUTURE
AND WE ALSO WANT TO BE ABLE TO
LEVERAGE EXISTING RESOURCES,
INCREDIBLY AMAZING AND CREATIVE
STAFF THAT CAN WORK ON SOME OF
THESE ACTIVITIES, EVENTS, AND
MATERIALS.
AND ALSO OUR CONTRACT SUPPORT,
WE WANT TO BE ABLE TO LEVERAGE
MECHANISMS TO PAY FOR SOME OF
THESE THINGS AS WELL.
IT WAS BROUGHT TO OUR ATTENTION
BY SOMEONE ON THE PLANNING
COMMITTEE THAT IN TRADITIONAL
ANNIVERSARY CELEBRATIONS, THE
GIFT IS A DIAMOND.
I WAS JOKING WITH FOLKS WE'RE
NOT GOING TO BE GIVING EVERYBODY
DIAMOND EARRINGS FOR THE
ANNIVERSARY BUT YOU COULD
IMAGINE SOME SORT OF CREATIVE
CRYSTAL-FACETED BRAIN GRAPHIC OR
LOGO ASSOCIATED WITH ALL OF OUR
ACTIVITIES, MATERIALS, AND
EVENTS.
HERE ARE SOME OTHER LOGOS FOR
OTHER INSTITUTES THAT HAVE
CELEBRATED RECENTLY.
KIND OF BLAND, I'M EXCITED TO
INCORPORATE SOME SPARKLE INTO
OURS.
EVERY INSTITUTE CELEBRATING WILL
COME UP WITH A GRAPHIC DESIGN
FOR THEIR CELEBRATION.
SO, AS FAR AS BRANDING AND
DIGITAL CONTENT WE'LL BE REALLY
INVOLVED IN WORKING ACROSS OUR
OFFICE, AND ACROSS INSTITUTE, TO
REALLY CREATE A LARGE
ANNIVERSARY PRESENCE ON OUR
WEBSITE, THAT WILL INCLUDE
HIGHLIGHTS AND TIMELINES AND
OTHER INTERACTIVE FEATURES.
WE'RE ALREADY DISCUSSING
DEVELOPING A COMMEMORATIVE
VIDEO.
WE WERE REALLY JAZZED ABOUT
NIMH'S VIDEO FOR THEIR
ANNIVERSARY WHICH THEY ARE STILL
CELEBRATING NOW.
THEY DID A QUICK 75 YEARS IN 75
SECONDS, ALL OF YOU CAN
APPRECIATE THAT THAT'S ABOUT THE
ATTENTION SPAN WE'RE WORKING
WITH THESE DAYS.
SO EPIC HISTORICAL DOCUMENTARY
IS NOT IN THE FUTURE BUT
SOMETHING LIKE THIS WOULD BE
PRETTY FUN TO DO.
THE OFFICE OF NIH, PROFILES OF
RESEARCHERS OVER THE YEARS,
WE'VE BEEN TAPPING INTO THEM TO
GET OLD PHOTOS AND TELL STORIES
OF THE AMAZING RESEARCHERS THAT
HAVE COME BEFORE US.
AND CERTAINLY MY OFFICE AND
FOLKS ACROSS THE INSTITUTE WILL
BE INVOLVED IN DEVELOPING AND
DISTRIBUTING ADDITIONAL OUTREACH
MATERIALS INCLUDING DIGITAL
TOOLKITS, WE'RE HOPING TO BUILD
A DIGITAL STORYTELLING PLATFORM
WHERE WE COULD INCORPORATE, YOU
KNOW, ALL DIFFERENT KINDS OF
MULTIMEDIA, INCLUDING AUDIO
CLIPS, VIDEO, IMAGERY TO REALLY
TELL LONGER FORM STORIES ABOUT
THE IMPACT OF OUR RESEARCH AND
HOW WE GOT TO WHERE WE ARE.
NEXT SLIDE PLEASE.
AGAIN MORE MATERIALS THAT ARE
COMMON WHEN ANNIVERSARIES COME
UP, COMMEMORATIVE BOOKLET, YOU
SAW THE 50th, THINKING ABOUT
SUBMITTING A SCIENTIFIC JOURNAL
ARTICLE.
FOR THOSE COMING ON CAMPUS NEXT
YEAR FOR SOME CELEBRATIONS
YOU'LL SEE BANNERS AROUND CAMPUS
ON THE LAMP POSTS.
WE'LL PLAN TO ADD THE 75th
ANNIVERSARY LOGO TO ALL OF OUR
OUTREACH MATERIALS,
PUBLICATIONS, AND EXHIBITS.
AND THEN WE'RE THINKING ABOUT
WAYS TO REALLY LEVERAGE THE
ACTIVITIES THAT WE DO ANNUALLY
BY HIGHLIGHTING, YOU KNOW, THESE
MILESTONES, THE BRAIN INITIATIVE
TURN 10 THIS YEAR, 75 NEXT YEAR,
MAYBE A SHOW US YOUR BRAIN
CONTEST, CAN HIGHLIGHT AND
CELEBRATE MILESTONES TOGETHER.
THERE'S A LOT OF WAYS WE'RE
THINKING ABOUT DOING THIS.
THIS GIVES A BREAKDOWN OF THE
BUCKETS OF EVENTS AND
ACTIVITIES, AND OPPORTUNITIES
THAT WE FORESEE COMING UP OVER
THE NEXT YEAR, YEAR AND A HALF.
ONE OF THE THINGS THAT WE'RE
PRETTY EXCITED ABOUT IS HOSTING
A NINDS DAY AT NIH.
EITHER IN AUGUST, SORT OF
THINKING IN AUGUST, THE DATE OF
OUR OFFICIAL ANNIVERSARY, DO WE
WANT TO PUSH IT OFF TO
SEPTEMBER, CLOSE TO THE COUNCIL
MEETING WHERE YOU WILL ALREADY
BE HERE SO WE'RE JUST TRYING TO
FIGURE OUT THE RIGHT TIMING FOR
THAT.
IT WILL DEPEND ON SPACE
AVAILABLE ON CAMPUS BECAUSE HOW
WE ENVISION THIS, HEAD OVER TO,
YOU KNOW, THE INTRAMURAL
PROGRAM, DIFFERENT LABS, PORTER
BUILDING, TO HAVE A SERIES OF
CHATS OR LAB TOURS, WE MIGHT DO
A PRESENTATION AT THE CLINICAL
CENTER THAT HIGHLIGHTS
BREAKTHROUGHS AND ROUND IT OUT
WITH A CAPSTONE EVENT OR
SYMPOSIUM AT NATCHER.
REALLY UTILIZING ALL THE SPACES
ON CAMPUS, AND JUST HAVING A BIG
DAY.
WE'RE ALSO THINKING ABOUT A
SERIES OF NINDS SCIENTIFIC
SYMPOSIA OR WORKSHOPS ON
IMAGINING THE FUTURE OF
NEUROSCIENCE, ALREADY GEARING UP
FOR THE NEXT VERSION OF OUR
STRATEGIC PLANNING PROCESS FOR
THE INSTITUTE.
SO POSSIBLY USING SOME OF THESE
SESSIONS TO HELP INFORM THOSE
INITIAL DISCUSSIONS AND PLANNING
EFFORTS, ONE OF THE VISIONS THAT
WE HAVE.
WE ATTEND A LOT OF ANNUAL
CONFERENCES MEETINGS, FORUMS,
STAFF ARE PRESENTING ALL THE
TIME, EXHIBITING AT LARGE
CONFERENCES, HOW DO WE USE THOSE
EVENTS ALREADY EMBEDDED INTO OUR
SCHEDULES TO HAVE SOME, YOU
KNOW, CONVERSATIONS AND AGAIN
HIGHLIGHT SOME OF THE SUCCESSES
OVER THE PAST 25 YEARS.
WE'RE INTERESTED ON GOING ON A
ROAD TRIP TO HIGHLIGHT, IF
ANYBODY IS INTERESTED IN
HOSTING, WE'D BE APPRECIATIVE, A
PANEL, FIRESIDE CHAT, ENVISION
WHAT THAT MIGHT LOOK LIKE.
I WANTED TO DROP IN THE GENERAL
COMMUNICATIONS IN-BOX, OUR
ADDRESS FOR YOUR IDEAS ANDFULLY
INPUT, CERTAINLY IF WE HAVE A
COUPLE MINUTES, I KNOW WE'RE
RUNNING BEHIND NOW, WE WELCOME
THOSE TODAY AS WELL.
AGAIN, WE HOPE YOU'LL JOIN THE
CELEBRATION.
WE KNOW YOU WILL.
BUT YOU CAN JOIN US FOR
BRAINSTORMING AND PLANNING
DISCUSSIONS.
YOU CAN JOIN US AT A SCIENTIFIC
SYMPOSIUM OR ROAD SHOW OR HOST A
ROAD SHOW.
AND WE WOULD REALLY HOPE YOU
WOULD JOIN US FOR THE NINDS NIH
DAY CELEBRATION, IF IT WORKS FOR
YOU.
THIS IS HOW WE ARE STRUCTURING
THE WORK IN CASE ANY
SUBCOMMITTEES ARE INTERESTING TO
YOU.
WE'RE LOOKING FOR ALUMNI COUNCIL
MEMBERS, MAYBE EVEN PEOPLE WITH
LIVED EXPERIENCE TO JOIN, HELP
US PLAN SOME OF THESE EVENTS.
WE'VE ORGANIZED IT AROUND THE
BUCKETS I TALKED ABOUT,
COMMUNICATION AND OUTREACH
SUBCOMMITTEE, WE'LL HAVE
SUBCOMMITTEE FOCUSED ON PLANNING
NINDS DAY EVENTS.
WE'LL HAVE A STAFF ENGAGEMENT
CELEBRATION COMMITTEE WHICH IS
MORE TOWARD INTERNAL SIDE,
LOOKING AT HOW STAFF ARE
CONTRIBUTING TO THE MISSION AND
WHAT MAKES PEOPLE EXCITED TO GET
OUT OF BED AND COME TO WORK IN
THE MORNING.
AND THEN OF COURSE THE
SCIENTIFIC SYMPOSIA, TRYING TO
IDENTIFY STRATEGY AND FORMAT,
WHAT CRITICAL TOPICS WE WANT TO
PRESENT ON.
SO WITH THAT, I WILL THANK YOU
ALL FOR YOUR TIME AND IF THERE'S
ANY IDEAS OR DISCUSSION OR
QUESTIONS YOU HAVE NOW, I'M HERE
AND I KNOW WALTER IS HERE, VERY
INVESTED IN THIS.
HAPPY TO DISCUSS.
>> THANK YOU.
TO ME, WHAT RESONATED MOST IS
RESTORING PUBLIC TRUST, ON ALL
OUR MINDS I THINK ALL THE TIME.
ONE THING I DON'T KNOW IF YOU
HAVE THOUGHT OF IT BUT ONE OF
THE PLACES, UNLESS THEY HAPPEN
TO BE SICK AND INVOLVED WITH
NIH, THEY ARE NOT GOING TO KNOW
ABOUT IT.
BUT ONE PLACE THEY DO SHOW UP
ARE MUSEUMS.
AND SO SCIENCE MUSEUMS, THIS
WOULD SEEM LIKE A FANTASTIC
OPPORTUNITY TO SOMEHOW CREATE A
TRAVELING EXHIBIT THAT WOULD GET
BUY-IN FROM OTHER SCIENTISTS
MUSEUMS IN OTHER CITIES.
JUST TO HIGHLIGHT WHAT
NEUROSCIENCE IS AND WHAT
ACCOMPLISHMENTS HAVE BEEN MADE,
THAT WOULD ARE RESONATE AND
ENGAGE PEOPLE JUST LOOKING AT
DINOSAURS, FOR EXAMPLE,
LITERALLY.
>> GREAT IDEA.
OTHER I.C.s HAVE DONE JUST
THAT.
EXHIBITS AT AIRPORTS ALSO WHICH
IS REALLY INTERESTING.
SOMEWHERE, WHERE YOU CAN GET OUT
AND CAPTURE THE PUBLIC'S
IMAGINATION.
AND REALLY SHARE WHAT WE'RE
DOING IN THE MISSION BECAUSE
LIKE YOU SAID UNLESS YOU'RE SICK
OR YOU HAVE A LOVED ONE
STRUGGLING WITH A DISORDER OR
YOU'RE IN SCIENTIFIC COMMUNITY,
YOU PROBABLY DON'T KNOW ALL THE
GREAT THINGS THAT WE DO.
THANK YOU, TIM.
THAT'S A GREAT SUGGESTION.
>> I WAS GOING TO SAY THE SAME
THING, WHICH IS THE LAST TWO
POINTS OF WHY WE'RE DOING THIS,
THAT YOU MENTIONED, ABSOLUTELY
RESTORING PUBLIC TRUST, I CAN'T
REMEMBER THE LAST ONE, BUT THAT
WAS SUPER IMPORTANT.
AND I THINK THAT TIM IS SPOT ON,
PUBLIC OUTREACH.
BESIDES MUSEUMS AND AIRPORTS, A
GREAT WAY TO GET PEOPLE IS
THROUGH THE INTERNET.
YOU KNOW, MAYBE SOME SORT OF, I
DON'T KNOW, TIKTOK CAMPAIGN.
INTERACTIVE, PEOPLE COULD
CONTRIBUTE TO THE SCIENCE THE
NINDS DOES AND FEEL LIKE IT'S
NOT JUST THEM LEARNING SOMETHING
BUT ALSO US GETTING A CHANCE TO
LEARN SOMETHING FROM THE PUBLIC
THAT ENGAGES, THAT WOULD BE A
GREAT OPPORTUNITY.
>> GREAT IDEA.
AMY?
>> FIRST, THANK YOU FOR THIS.
THIS IS EXCITING AND FUN AND
ABSOLUTELY A MILESTONE TO
CELEBRATE.
APPRECIATE THE REPORT.
I WANTED TO ECHO WHAT EVERYONE
IS SAYING, ESPECIALLY FLORIAN'S
COMMENTS IN THE CHAT ENGAGING
WITH PATIENTS.
ESPECIALLY JUST TO BRING OUT THE
PERSPECTIVE OF PATIENT ADVOCACY
ORGANIZATIONS.
A LOT OF PATIENT ORGANIZATIONS
WANT TO ENGAGE WITH NINDS BUT
DON'T KNOW HOW.
AND THIS WOULD BE A GREAT
INTRODUCTORY WAY TO ENGAGE WITH
THEM IN A BENIGN CELEBRATORY
WAY.
IT COULD HELP FURTHER
RELATIONSHIPS, THERE COULD BE
SOME NICE WINS DOWN THE ROAD,
ESPECIALLY IF PATIENT ADVOCACY
ORGANIZATIONS PLAY A HUGE ROLE
IN THE FUTURE OF NEUROSCIENCE,
SO I WOULD REALLY ENCOURAGE YOU
TO REACH OUT STRATEGICALLY AND
I'D BE HAPPY TO HELP THINK
THROUGH THAT IF I CAN BE OF
HELP.
>> YEAH, THAT WOULD BE GREAT,
AMY.
I THINK TOO THERE ARE THE
TYPICAL ADVOCACY ORGANIZATIONS
AND PATIENT GROUPS WE WORK WITH
REGULARLY BUT THERE ARE SO MANY
THAT WE HAVEN'T CONNECTED WITH
AND THIS IS JUST A GREAT
OPPORTUNITY TO BUILD THOSE
RELATIONSHIPS SO, YEAH, WOULD
LOVE TO THINK THROUGH THAT WITH
YOU.
THANK YOU.
>> JUST A QUICK QUESTION.
I THINK THESE ARE GREAT POINTS
THAT VALIDATE WHY IT'S SO
IMPORTANT TO HAVE A DOCUMENT,
LEGACY OF INSTITUTION OR ANY
ORGANIZATION.
YOU PHRASED IT BEAUTIFUL.
ONE THING EFFECTIVE LAST TIME
AROUND WAS BUD ROWAN'S BOOK,
WHICH LOOKED BACK.
YOU'VE SHOWN IT.
IT WAS SHOWN IN THE ANNOUNCEMENT
OF YOUR TALK TODAY, EXCELLENT
SUMMARY OF FIRST 50 YEARS OF
NINDS.
SOME OF US DO NOT HAVE TWITTER
OTHER X MACHINES.
WE'RE DIGITALLY UNFRIENDLY.
BUT A BOOK IS SOMETHING THAT'S
DURABLE, A LOT OF PHOTOGRAPHS,
TEXT, AND IN SOME CASE HAS A
KIND OF PERMANENCE AS A RECORD
THAT'S COMMENDABLE.
>> THANK YOU, BOB.
THINKING THROUGH ALL DIFFERENT
TYPES OF MATERIALS, RIGHT,
DIGITAL PIECE, CERTAINLY THAT'S
THE DIRECTION WE'RE HEADING IN
BUT ALSO WHAT OTHER DURABLE
RESOURCES AND PRINT MATERIALS
CAN WE ALSO DEVELOP.
>> ALISSA, YOU NEED TO GET YOUR
PLANE TICKETS READY.
FOLKS CAN REACH OUT TO YOU
DIRECTLY.
>> YES.
>> WITH THEIR IDEAS.
>> I JUST WANTED TO ECHO WE'LL
BE REACHING OUT TO COUNCIL
GENERALLY TO GIVE EVERYBODY THE
OPPORTUNITY TO CIRCLE BACK WITH
US AND GIVE US YOUR IDEAS AND
ENGAGE WITH YOU IN DIFFERENT
WAYS AS WE MOVE FORWARD IN THIS
PLANNING PROCESS.
THANK YOU FOR YOUR ENTHUSIASM.
>> EXCELLENT.
THANKS, ALL.
>> THANKS, AMY.
THANKS, EVERYONE.
>> WE'RE MOVING TO OUR FINAL
ITEM.
WE HAVE THE SCIENTIFIC DIRECTOR
OF INTRAMURAL PROGRAM, JEFF
DIAMOND.
HE'S GOING TO TELL US, GIVE US
AN UPDATE ON THE INTRAMURAL
PROGRAM.
JEFF, ARE YOU WITH US?
THERE HE IS.
>> MORE OR LESS.
>> HELLO, EVERYBODY.
I'D LIKE TO THANK DAVID AND
LEADERSHIP FOR THIS AWESOME TIME
SLOT.
[LAUGHTER]
WHEN DAVID WAS TELLING ME I'D BE
CUTTING INTO YOUR VALENTINE'S
DAY DINNER PLANS, HE ALSO SAID
THAT YOU'RE MORE INCLINED,
COUNCIL IS MORE INCLUDE TO A
DISCUSSION RATHER THAN
PRESENTATION.
SO IN THAT SPIRIT I'M GOING TO
TRY TO KEEP MY COMMENTS
RELATIVELY BRIEF BUT I DO WANT
TO TAKE SOME TIME TO TALK ABOUT
SOME NEW ADDITIONS TO THE
INTRAMURAL PROGRAM AND SOME
EXCITING ROLES FOR SOME PEOPLE
AND TRANSITIONS, A SHORT COMMENT
ON THE EFFORTS OF THE FELLOWS TO
UNIONIZE AT NIH BUT THEN I CAN'T
HELP BUT JUST TAKE A LITTLE BIT
OF TIME AT THE END TO TALK VERY
BRIEFLY ABOUT SOME COOL SCIENCE
THAT'S GOING ON IN THE
INTRAMURAL PROGRAM.
I UNDERSTAND I'M LIMITED TO 75
SECONDS OF ATTENTION SPAN AND SO
EACH OF THOSE I PROMISE WILL NOT
EXCEED THAT.
WE HAVE -- IT'S BEEN A COUPLE
YEARS I THINK SINCE YOU'VE HEARD
FROM THE INTRAMURAL PROGRAM WITH
THE CHANGES THAT OCCURRED IN
INTRAMURAL LEADERSHIP.
A LOT HAS HAPPENED IN THAT TIME.
WE'VE HAD A LOT OF NEW FACES
COME.
WE HAVE THREE ASSISTANT CLINICAL
INVESTIGATORS THAT ARE -- THAT
INTEGRATED INTO THE COMMUNITY
AND ARE WORKING HARD.
YOU CAN SEE THIS ON THE LEFT.
WE HAVE A NUMBER OF NEW TENURE
TRACK INVESTIGATORS THAT YOU CAN
SEE IN THE MIDDLE WORKING IN A
RANGE OF DIFFERENT AREAS.
I ANTICIPATE THIS LIST TO GET
SMALLER IN THE NEXT MONTH OR TWO
AS SONIA AND ARIEL ARE GOING TO
BE PRESENTED BY ME TO THE
CENTRAL TENURE COMMITTEE AND I
IMAGINE THEY WILL BE MOVING OVER
TO THE RIGHT SIDE HERE WHICH
SHOWS THE FOLKS WHO HAVE
SUCCESSFULLY NEGOTIATED THE
CENTRAL TENURE COMMITTEE AND ARE
NOW SENIOR INVESTIGATORS WITH
TENURE AND THEY ARE OVER HERE ON
THE RIGHT.
SO, WE HAVE A REALLY HEALTHY
COHORT OF YOUNG AND SORT OF
EARLY MID-CAREER PEOPLE IN THE
INSTITUTE.
THAT'S BEEN REALLY EXCITING TO
SEE.
SOME OF OUR SENIOR INVESTIGATORS
HAVE ALSO TAKEN ON NEW ROLES,
RESPONSIBILITIES, AND HONORS.
KAREEM IS NEW BRANCH CHIEF OF
SURGICAL NEUROLOGY BRANCH.
I'LL TALK ABOUT KAREEM'S
RESEARCH, HE'S ALSO DOING A
GREAT JOB SO FAR AS THE BRANCH
CHIEF.
THERE ARE TWO THINGS TO NOTE
ABOUT NEW ROLES IN THE LARGER
NEUROSCIENCE COMMUNITY, JUDIE
WALTERS IS THE CHAIR OF THE
NEUROSCIENCE STEERING COMMITTEE
OF AAAS, KATHERINE ROCHE WAS
RECENTLY ELECTED TO BE THE
SECRETARY-ELECT FOR SOCIETY FOR
NEUROSCIENCE.
RICHARD YOULE WHO MADE OUR NEWS
A COUPLE YEARS AGO BY WINNING A
BREAKTHROUGH PRIZE, BY THE WAY
SORT OF GOT THE LID OFF THE
BREAKTHROUGH PRIZE TAP, WE NOW
HAVE TWO OTHER BREAKTHROUGH
PRIZE WINNERS IN THE SAME
BUILDING THAT RICHARD WORKS IN,
RECENTLY BEEN APPOINTED AS NIH
DISTINGUISHED INVESTIGATOR,
WHICH IS AN HONOR THAT IS
BESTOWED ONLY ON 2 TO 3% OF
SENIOR INVESTIGATORS IN THE
INTRAMURAL PROGRAM ACROSS NIH.
SO IT'S A TREMENDOUS AND WELL
DESERVED HONOR FOR RICHARD.
HIRES ARE ACCOMPANIED BY
RETIREMENTS, IT'S NICE TO SEE
THAT RETIREES HAVE CONSISTENTLY
REQUESTED EMERITUS STATUS,
THAT'S ONE OF THE PLEASURES THE
SD HAS, TO PRESENT THEIR
NOMINATION FOR EMERITUS TO THE
SCIENTIFIC DIRECTORS AND
CLINICAL DIRECTORS WHO HAVE
UNANIMOUSLY APPROVED ALL OF THE
APPOINTEES NINDS PUT FORWARD,
AND YOU CAN SEE ALL OF THEM
HERE, KURT FISCHBECK HAS NOT
BEEN PUT FORWARD YET BUT NOT A
DIFFICULT SALES JOB WITH THE
SDs.
IT'S NICE TO SEE SEVERAL EMERITI
ARE EXPRESSING INTEREST IN
BANDING TOGETHER AND HAVING A
BIT OF AN EMERITI COMMUNITY ON
CAMPUS, AND THAT'S NICE TO SEE.
THERE'S BEEN A MAJOR DEVELOPMENT
IN OF AMONG FELLOWS AT NIH.
IN DECEMBER A MAJORITY OF THE
FELLOWS WHO VOTED ON THE UNION
VOTED TO BE REPRESENTED BY
U.A.W.
AND THE FEDERAL LABOR RELATIONS
AUTHORITY CERTIFIED U.A.W. AS
BARGAINING UNIT ON DECEMBER 15,
AND WILL REPRESENT 5,000 FELLOWS
AT NIH.
AND SO NIH WILL PARTNER WITH
U.A.W. TO NEGOTIATE WHAT WILL BE
AN HISTORIC AGREEMENT BECAUSE I
DON'T BELIEVE THERE'S BEEN THIS
KIND OF AGREEMENT WITH A GROUP
IN THE FEDERAL GOVERNMENT.
SO, THAT'S HAPPENING AND IT WILL
BE INTERESTING TO SEE HOW THAT
PLAYS OUT.
SO, IF ANYBODY HAS ANY QUESTIONS
ABOUT THIS, I WOULD BE HAPPY TO
FIELD QUESTIONS ABOUT THE UNION
WITH ADROITLY DELIVERED
NON-ANSWERS BECAUSE WE REALLY
AREN'T ALLOWED TO SAY MUCH OF
ANYTHING ABOUT ANY DETAILS ABOUT
THE UNION.
I DON'T REALLY KNOW ANYTHING, TO
BE HONEST.
THERE'S BEEN VERY LITTLE
SUBSTANTIVE INFORMATION COMING
DOWN THE PIKE.
OKAY.
WHAT I'D LIKE TO DO IS JUST GIVE
A FEW VIGNETTES ABOUT SOME WORK
THAT IS BEING DONE AT DIFFERENT
PARTS OF THE INTRAMURAL PROGRAM
JUST BECAUSE QUITE FRANKLY
THAT'S BEEN ONE OF THE REAL
PLEASURES, TALKING ABOUT THEIR
SCIENCE AND IT'S DAUNTING TRYING
TO PRESENT THIS WORK IN SUCH AN
ABBREVIATED FASHION.
I'M RELIEVED NONE OF THE PEOPLE
WHO IS WORK I'M GOING TO TALK
ABOUT ARE ON THIS CALL.
IT'S A LITTLE BIT OF COMFORT.
BUT I WOULD LIKE TO JUST SHOW
THAT THERE'S WORK AT ALL LEVELS
OF STUDY OF THE NERVOUS SYSTEM,
AND I REALIZE AFTER I DID THIS
THAT EACH ONE OF THESE HAS, YOU
KNOW, AN AUTHENTIC CONNECTION TO
NEUROLOGICAL DISEASE.
SO, I THINK THE FIRST ONE THAT
I'D LIKE TO TALK ABOUT COMES
FROM KENTON SCHWARTZ'S LAB,
WORKING HERE FOR OVER 25 YEARS
LOOKING AT THE BIOPHYSICAL
MECHANISMS OF ION CHANNEL
FUNCTION, STRUCTURE/FUNCTION
RELATIONSHIPS.
RECENTLY HE'S BECOME INTERESTED
IN THE MECHANISMS OF ION CHANNEL
INACTIVATION, AND THIS IS THE
CLASSIC IMAGE OF AT LEAST N TYPE
INACTIVATION, THOUGHT TO BE
MEDIATED BY BALL AND CHAIN
MECHANISM, A BALL PLUGS THE
CHANNEL, THE CHANNEL IS OPEN BUT
BLOCKED AND NO LONGER
CONDUCTING.
NOW, INTERESTINGLY ATTENTION WAS
PIQUED RECENTLY BY THE REPORT OF
MUTATIONS IN THE INNER PORE OF
VOLTAGE GATED POTASSIUM CHANNEL,
IT'S A PATIENT MUTATION THAT
CAUSES EPILEPTIC ENCEPHALOPATHY.
SO, THIS LAB LOOKED INTO THIS,
AND USED CRYO-ELECTRON
MICROSCOPY TO DETERMINE THE
THREE DIMENSIONAL STRUCTURE OF
THIS POTASSIUM CHANNEL, KV2.1,
THIS IS THE WILD TYPE AND
MUTATED FORM.
THEY WERE ABLE TO SOLVE THE
STRUCTURE OF WHAT THEY CALL A
HYDROPHOBIC NEXUS NEAR THE
INTERNAL PART OF THE PORE THAT
CONTROLS KV2.1 INACTIVATION.
YOU CAN SEE THIS KEY MUTATION IN
L403 IS RIGHT HERE.
WHAT THEY FOUND WHEN THEY SOLVED
THE STRUCTURE OF THE MUTATED
CHANNEL IS ACTUALLY A
SIGNIFICANT DISTORTION OF THE
INTERNAL PART OF THE POTASSIUM
CHANNEL PORE, SHOWING THIS IS
ACTUALLY THE MECHANISM OF THE
INACTIVATION AND THEY THINK THAT
IT'S COMMON TO A NUMBER OF
DIFFERENT VOLTAGE GATED
CHANNELS, THIS REGION IS
CONSERVED, SODIUM POTASSIUM
CALCIUM CHANNELS, IS VERY CLOSE
TO THE SITE WHERE THE BALL COMES
IN, IN BALL AND CHAIN
INACTIVATION.
RATHER THAN PLUGGING THE
CHANNEL, THAT BALL AND CHAIN
INACTIVATION MIGHT BE WORKING TO
DISTORT THE PORE.
SO I THOUGHT THIS WAS A COOL
THING AND SPENT MORE THAN 75
SECONDS SO I'LL SPEED UP.
NEXT FROM SONIA SCHULTZ'S LAB,
COMING UP FOR TENURE NEXT MONTH.
SHE IS A GENETICIST WHO TAKES
ADVANTAGES OF THE AMOUNT OF
INFORMATION GENERATED BY
DIFFERENT GENOMICS CONSORTIA,
PROVIDING A LOT OF INFORMATION
ABOUT -- NOT ONLY HEALTHY
CONTROLS BUT LEWY BODY DEMENTIA,
FRONTOTEMPORAL IN ALS, THIS
PAPERS LOOKS AT DIFFERENT CASES.
I WANT TO POINT OUT AS AN
EXAMPLE THE ANALYSIS OF OVER
2,000 LEWY BODY DEMENTIA CASES
ALONG WITH ALMOST 4,000
CONTROLS, THERE WOULD BE NOVEL
RISK LOCUS WHICH IS MUTATION IN
GENE ENCODING ION CHANNEL,
TWO-PORE CALCIUM CHANNEL, THAT
ACTUALLY OPERATES ON
EXTRACELLULAR ORGANELLES TO
REGULATE RELEASE OF CALCIUM AND
PLAYS A ROLE IN LONG-TERM
POTENTIATION AND ALSO SPATIAL
LEARNING AND MEMORY.
IT'S NEAT THIS ANALYSIS SO
SPECIFICALLY POINTED TO A
PROTEIN THAT LOGICALLY PLAYS A
ROLE IN CELLULAR MODEL OF
LEARNING AND MEMORY.
DORIAN McGAFFERN UNDERWENT A
BOARD OF SCIENTIFIC COUNSELOR
REVIEW, BRAIN INSULTS,
CEREBROVASCULAR INJURY, ALSO
RESPONSE TO STROKE.
AND IN THIS STUDY HE LOOKED AT
TWO KINDS OF INSULTS.
HERE HE'S IMAGING MICROGLIA WITH
A MARKER IBA1 THAT LIGHTS UP
MICROGLIA IN CONTROL, AND IN
RESPONSE TO INJURY USING
DIRECTED DELIVERY OF
MICROBUBBLES, THIS IS THROUGH A
THIN -- IMAGING THROUGH A THIN
PART OF THE MOUSE SKULL, AND YOU
CAN SEE THAT IN RESPONSE TO THE
INJURY, THERE IS A LARGE NUMBER
OF NEW MICROGLIA DELIVERED AND
THESE ARE VEGF POSITIVE AND ARE
ALSO EXPRESSING INTERLEUKIN 6
RECEPTOR.
YOU CAN SEE DOWN HERE IF YOU
LOOK AT THE TRANSCRIPTOMIC
PROFILE OF CELLS, IN CONTROL,
AND FOLLOWING THE INJURY, YOU
SEE EXPANSION OF THIS POPULATION
OF MICROGLIA.
THESE ARE WHAT HE CALLS REPAIR
ASSOCIATED MICROGLIA.
YOU SEE THESE FOLLOWING STROKE.
SO THIS IS TISSUE FROM HUMAN
STROKE PATIENT, SHOWING THE
BORDER OF THE INFARCT AND
PERIINFARCT, JUST OUTSIDE THE
BORDER OF INFARCT YOU SEE NEW
VEGF A-POSITIVE MICROGLIA,
CLEARLY ANALOGOUS PROCESS GOING
ON.
THEY WENT ON TO SHOW THAT THESE
RESPONSES AND REPAIR RESPONSE
IT'S FROM MICROGLIA REQUIRE
MONOCYTES AND INTERLEUKIN 6, AND
SO IN A MODEL, MOUSE MODEL, BACK
IN MOUSE AGAIN, HERE YOU CAN SEE
THE CONTROL AND ALL THE WHITE
DOTS ARE NEURONS, FOLLOWING THE
INJURY HERE IN THE ABSENCE OF
MONOCYTES WHEN YOU'VE KNOCKED
DOWN MONOCYTES YOU DON'T GET
INTO RECOVERY HERE, YOU DON'T
SEE A LOT OF NEURONS FILLING
BACK IN HERE, BUT IN THIS CASE
WHEN YOU SUPPLY INTERLEUKIN 6,
SEPARATELY, YOU'RE ABLE TO SORT
OF I GUESS MIMIC THE PRESENCE OF
THE MONOCYTES AND CAUSE VASCULAR
REPAIR AND RECOVERY OF THE
NEURONS IN THIS REGION.
SO, DORIAN IS DOING A NUMBER
OF -- HE'S GOT A NUMBER OF
REALLY COOL PROJECTS THAT HE DID
A BEAUTIFUL JOB OF PRESENTING IN
HIS PREVIOUS REVIEW.
ARIEL LEVINE IS ANOTHER YOUNG
INVESTIGATOR STUDYING CELLULAR
DIVERSITY IN THE SPINAL CORD,
HAD DONE THIS IN THE MOUSE
SPINAL CORD, RECENTLY TAKEN ON
HUMAN SPINAL CORD AND DONE
TRANSCRIPTOMICS OF TISSUE TAKEN
FROM 14 HUMAN DONORS, AND WAS
ABLE TO DISTINGUISH A NUMBER OF
SPINAL CORD TYPES AND ANALYZE
THE RANGE OF NEURON TIMES --
TYPES T YPES IN THE FINAL CORD,
WAS ABLE TO START TO MAKE A
SPATIOTEMPORAL MAP OF THE
DIFFERENT CELL TYPES.
DORSAL TYPES, PARTS OF THE
DORSAL CORD ARE DISTINCT FROM
TRANSCRIPTOMIC STANDPOINT,
WHEREAS THINGS ARE MORE BLURRED
DOWN IN THE VENTRAL PART.
THIS IS SOMETHING SHE SAW IN THE
MOUSE.
AND SO IT PAVES THE WAY, SEEMS
LIKE THE MOUSE WORK THAT SHE'S
DOING IS GOING TO RELIABLY
INFORM, YOU KNOW, THINKING ABOUT
DIVERSITY IN HUMAN SPINAL CORD
AS WELL.
IT'S INTERESTING SHE LOOKS AT
TRANSCRIPTOMIC PROFILE OF MOTOR
NEURONS, SEES THEY ARE ENRICHED
QUITE WELL WITH A NUMBER OF
GENES RELATED TO ALS.
AND SO I THINK THERE'S CLEARLY A
COOL DISEASE ANGLE ON THIS BUT
THIS PART IN THE MIDDLE IS
ENABLING ARIEL I THINK TO START
TO DISTINGUISH THE CIRCUITRY IN
THE SPINAL CORD GIVING RISE TO
DIFFERENT KINDS OF MOVEMENT AND
SHE'S REALLY -- I REALLY ADMIRE
THIS.
SHE'S ATTACKING THAT, TAKING ON
NEW KINDS OF TECHNOLOGY IN HER
LAB, SHE WILL START DOING
PHYSIOLOGY, THIS WILL HELP HER
IDENTIFY SPECIFIC CELL TYPES, TO
MANIPULATE AND SEE THEIR ROLE IN
DIFFERENT KINDS OF MOTOR
PROGRAMS THAT THE MOUSE
EXECUTES.
FINALLY, I'VE BEEN REALLY AMAZED
BY THE WORK KAREEM DOES IN HIS
LAB, A NEUROSURGEON WHO TAKES
ADVANTAGE OF THE ACCESS HE HAS
AS A NEUROSURGEON TO STUDY THE
ORGANIZATION AND FUNCTION OF THE
HUMAN CORTEX, BUT ANOTHER PART
OF THAT IS TAKING ADVANTAGE OF
THE RECORDINGS THEY CAN MAKE
WITH EEG ELECTRODES TO WORK TO
ISOLATE MORE ACCURATELY THE
LOCATION OF EPILEPTIC SEIZURE
FOCI.
HE'S DOING THIS IN COLLABORATION
WITH SARAH INATI, AND THE KEY
HERE IS THAT YOU -- IF YOU HAVE
A SEIZURE FOCUS, THE EEG
SIGNATURE OF THESE ARRIVES AT
DIFFERENT ELECTRODES WITH
DIFFERENT DELAYS.
AND SO YOU OUGHT TO BE ABLE,
IT'S NOT TRIVIAL, BUT YOU CAN
LOCALIZE THE LOCATION OF THE
FOCUS BY RELATIVE ARRIVAL OF POP
GATING WAVES AT DIFFERENT
ELECTRODES.
AND ONE OF THE INTERESTING
THINGS IS THAT THEY HAVE SHOWN
BY DOING THIS KIND OF ANALYSIS
THAT THEY CAN MORE ACCURATELY
LOCATE THE ORIGIN OF THE
ACTIVITY THAT THEY RECORD ON THE
ELECTRODES AND THEY HAVE ALSO
SHOWN THE ENTERICTAL ACTIVITY IS
ARISING FROM THE SAME SOURCES AS
SEIZURE ACTIVITY.
THIS WILL HELP IDENTIFY FOCUS
AND GUIDE SURGERY BECAUSE IT'S
CLEAR THAT -- I GUESS RIGHT NOW
THEY ARE DOING THIS ANALYSIS OF
THE LOCATION POST HOC, AFTER THE
SURGERY, BUT WHAT THEY ARE
FINDING IS THAT WHEN THEY MAKE A
RESECTION, THIS IS DRUG
RESISTANT EPILEPSY PATIENTS,
RESECTION TURNS OUT TO BE WITHIN
THE AREA OF WHERE THEY
IDENTIFIED THE SOURCE, THEY HAVE
A BETTER OUTCOME WITH THE
PATIENT THAN IF THERE'S NOT AN
OVERLAP BETWEEN WHERE THEY DID
THE RESECTION.
THIS IS SOMETHING KAREEM AND
SARA HAVE BEEN COLLABORATORS FOR
A LONG TIME, SARA WAS A STAFF
CLINICIAN IN THE INSTITUTE
BEFORE HIM AND I'M EXCITED TO
SEE HER BRANCH OUT, STILL
WORKING WITH KAREEM BUT ALSO
ESTABLISHING HER OWN RESEARCH
PROGRAM, JUST A CLINICAL
INVESTIGATOR.
I'LL STOP THERE.
AND I'M HAPPY TO -- I WANTED TO
LEAVE TIME FOR ANY DISCUSSIONS.
I KNOW IT'S LATE IN THE DAY.
AND YOU GUYS PROBABLY ARE WIPED
OUT.
BUT, YES?
>> QUICKLY, LOVED HEARING ABOUT
THE SCIENCE BUT A QUESTION ABOUT
CLINICAL INVESTIGATORS.
WE HEARD FROM WALTER EARLY ON
ABOUT THE CLINICAL TRANSLATION
PROGRAM FOR ALZHEIMER'S AND
RELATED DEMENTIAS, I ASSUME
THERE WOULD BE CLINICAL
INVESTIGATORS PART OF THAT.
WOULD THEY BE WITHIN NINDS UNDER
YOUR PURVIEW OR NIA?
>> MOST OF THE FUNDING IS COMING
FROM NIA.
THEY HAVE BEEN REALLY WELCOMING
AND WANTING US TO PARTNER, YOU
KNOW, AS EQUALS MAKING THE
DECISION.
WE HAVE A LOT OF MEETINGS WITH
THEM TO PLAN THIS.
SO, I THINK THE CLINICAL PART OF
THAT WILL SHALL WE WILL HAVE A
LOT OF INVOLVEMENT IN THAT.
>> GREAT.
THAT WHOLE EFFORT IS VERY
EXCITING, THE CLINICAL PART IS
COMING ALONG.
AND THE MODEL THAT CARD USES TO
TAKE ON NEW PROJECTS AND TO
PARTNER WITH INVESTIGATORS WHO
HAVE NEW IDEAS IS -- IT'S VERY
COOL.
ANDY SINGLETON IS THE DIRECTOR
OF CARD.
I REALLY LIKE THE ENERGY AND
IDEAS HE'S BRINGING.
>> I ADD THE AGING INSTITUTE'S
CLINICAL PROGRAM IS IN
BALTIMORE.
SO THIS ONE, I THINK IT WILL BE
LIKELY SUPPORTED BY THE NINDS
CLINICAL PROGRAM IN BETHESDA.
>> THANKS.
SINCE WE DID GET YOU THIS CHOICE
SPOT I ASSUME YOU'LL BE DROPPING
MY VALENTINE OFF LATER TONIGHT?
>> YEAH, IF YOU WANT TO CALL IT
THAT.
[LAUGHTER]
>> I BELIEVE THAT BRINGS US TO
THE FINAL WORD.
WALTER?
FINAL WORD?
>> I GUESS THE FINAL WORD IS
PRAY AND VOTE.
I GUESS.
TWO WORDS.
AND I THINK JEFF, JEFF DIDN'T
MENTION, BUT WE TALKED ABOUT THE
BUDGET.
AND THEY HAVE A LOT LESS LEEWAY
TO DEAL WITH THE BUDGET CUTS
THAN ANYBODY ELSE.
HOPING THE BUDGET COMES THROUGH
FOR ALLOWING NINDS TO MARCH
FORWARD.
I THINK AS YOU CAN TELL, JUST SO
MUCH GOING ON, IT'S REALLY
EXCITING TO SEE INTRAMURAL AND
EXTRAMURAL AND NO MATTER WHAT
HAPPENS WE'RE NOT GOING TO GIVE
UP.
WE'LL KEEP PUSHING FORWARD.
WE APPRECIATE YOUR INPUT AS WE
MOVE FORWARD FOR SURE.
AS YOU CAN SEE, LOTS OF THINGS
WE'RE THINKING ABOUT.
AND INPUT IS REALLY VALUED.
FEEL FREE TO E-MAIL, CALL UP,
WHATEVER.
HAPPY TO HEAR FROM THE COUNCIL.
THANKS.
>> GREAT.
THANKS.
WE'LL RECONVENE TOMORROW FOR
ACTION-PACKED AND EXCITING
CLOSED SESSION.
I THANK EVERYONE FOR THEIR TIME
TONIGHT.
I'M GOING TO GAVEL US OUT.
[END OF PROGRAM]
... THORACOLUMBAR, WITH THE
RESTORATION OF COMPLETES,
COMORBIDITY, COMORBIDITIES, WITH