OKAY, EVERYONE.
GOOD MORNING.
IT'S TIME TO CALL TO ORDER OUR
JOINT COLLABORATIVE RESEARCH ON
ADDICTIONS AT NIH COUNCIL
MEETING.
I'M REALLY HAPPY NORAH VOLKOW
AND WILLIAM KLEIN ARE WITH US
TODAY.
THIS IS THE 13th JOINT MEETING
OF NIAAA, NCI AND NIDA AND THE
12th MEETING ON COLLABORATIVE
RESEARCH ON ADDICTIONS AT NIH.
SO I'M GOING TO ASK ALL THE
COUNCIL MEMBERS TO TELL US WHERE
THEY ARE FROM AND MAYBE ONE
SENTENCE ABOUT THEIR DOMAIN OF
RESEARCH.
I'M GOING TO JUST GO THROUGH THE
LIST AND READ THEM.
AND I APOLOGIZE IF I DON'T
COMPLETELY PRONOUNCE YOUR NAME
PROPERLY.
ARPANA.
>> HI, DR. KOOB.
I'M AT WASHINGTON UNIVERSITY AND
MY AREA OF RESEARCH IS
ENVIRONMENTAL ON SUBSTANCE USE
DISORDERS.
>> KATE BEBE.
>> I'M FROM MILL VALLEY,
CALIFORNIA, AND MY AREA IS
OPIOID USE DISORDER AND
LONG-TERM TREATMENT DEVELOPMENT
FOR DRUGS OF ADDICTION.
>> DEBORAH CHASSLER.
>> CHARLIE --
>> GOOD MORNING, GEORGE AND
TEAM.
I'M A PROFESSOR AT THE
UNIVERSITY OF WASHINGTON AND I
STUDY STRESS MECHANISMS AND HOW
THAT LEADS TO INCREASE IN DRUG
ADDICTION RISK.
>> THANKS, CHARLES.
AND CHRISTIAN DUARTE.
>> I STUDY DEVELOPMENTAL
PSYCHOPATHOLOGY AND SUBSTANCE
USE WITH A GREAT INTEREST IN
INTERGENERATIONAL PROCESSES.
>> THANKS.
IZE -- BUSINESS BELL DURAN.
>> WE ARE IN LATINO CANCER
INSTITUTE BASED IN CALIFORNIA.
I AM WITH THE NCAB AND PATIENT
ADVOCATE.
NICE TO BE HERE WITH YOU THIS
MORNING.
SORRY I COULDN'T BE WITH YOU IN
PERSON.
I'M NOT MONTREAL AT ANOTHER
CONVERSATION.
TRYING TO DEAL WITH THE
TECHNOLOGY HERE.
>> THANKS, ISABELLE.
>> KAREN EM DMONDS.
>> I'M AT HARVARD, CANCER --
>> THANKS, KAREN.
AHMET EDKIN.
>> HE'S NOT THERE.
>> NO.
OKAY.
TAMICHA FELDER.
>> HELLO, EVERYONE.
TAMICHA FELDER, CERVICAL CANCER
SURVIVOR PATIENT ENGAGEMENT AND
SUPPORT WITH SURVIVOR, INC,
BASED IN MARYLAND BUT WE SERVE
NATIONALLY.
>> NANCY GONZALEZ.
I DON'T THINK SHE MADE IT.
ELENA HANSON.
>> GOOD MORNING.
ELENA HANSON.
I'M AT UCLA IN LOS ANGELES AND
IN THE PSYCHIATRY AND ARNT RO
APOLOGY STUDYING SUB STAUSS USE
DRIVERS AND OUTCOMES.
>> AMY BETH HINBERGER.
>> GOOD MORNING, SCIENTIFIC
DIRECTOR OF THE -- BRAIN
INSTITUTE IN CHICAGO AND I'M ON
THE NATIONAL CANCER ADVISORY
BOARD.
>> HAYDEN HUSCAMP.
>> I'M A HEALTH ECONOMIST FROM
HARVARD AND I DO ADDICTION
POLICY AND SERVICES RESEARCH.
>> THANKS, HAYDEN.
DAVID KARIKEN.
>> GOOD MORNING, EVERYBODY.
PROFESSOR AND VICE CHAIR FOR
RESEARCH IN NEUROLOGY AND AT THE
YIND UNIVERSITY SCHOOL OF
MEDICINE AND DIRECTOR OF THE
ALCOHOL RESEARCH CENTER HERE.
MY OWN RESEARCH IS IN THE AREA
OF NEUROIMAGING OF RISK FACTORS
OF -- DISORDER.
>> REGINA LA BELL.
THANKS, DAVID.
REGINA LA BELL.
>> GOOD MORNING.
MY NAME IS REGINA LA BELL.
I'M AT GEORGETOWN UNIVERSITY
WHERE I'M A PROFESSOR AND
DREBLGT THE MASTER OF SCIENCE
ADDICTION POLICY AND PRACTICE.
I WORK ON ADDICTION POLICY
ISSUES.
>> THANKS, REGINA.
ANGELA LAIRD.
>> GOOD MORNING, EVERYONE.
ANGIE LAIRD, DEPARTMENT OF
PHYSICS AT FLORIDA INTERNATIONAL
UNIVERSITY IN MIAMI.
MY FIELD OF RESEARCH IS
NEUROINFOMTIC AND AN ABCD SITE
TI.
>> AND FRANCES LEVEN.
>> I DON'T THINK HE IS THERE.
>> MICHAEL LEWIS.
>> I'M MICHAEL LEWIS.
I'M GETTING AN ECHO HERE.
I HOPE YOU ARE NOT HEARING THAT.
>> NO.
IT'S OKAY, MICHAEL.
>> OKAY.
I'M PROFESSOR AT HUNTER COLLEGE
AND AT THE GRADUATE CENTER CITY
UNIVERSITY OF NEW YORK.
I'M INTERESTED IN MOTIVATION AND
NUTRITIONAL ISSUES INVOLVED WITH
ALCOHOL USE DISORDER.
>> THANKS, MICHAEL.
AND DANE MAYFIELD.
>> GOOD MORNING, EVERYBODY.
I'M DANE MAYFIELD.
I'M WITH THE WAGNER CENTER FOR
ALCOHOL AND ADDICTION RESEARCH
AT THE UNIVERSITY OF TEXAS AT
AUSTIN AND I STUDY MOLECULAR
MECHANISMS OF AUD.
>> THANKS, DANE.
ANNA NAVASASIAN.
EDYANYGUYEN
>> NEUROSURGEON SCIENTIST.
DIRECTOR OF THE WINSHIP TUMOR
CENTER.
MY RESEARCH IS TUMOR IMMUNOLOGY
AND IMMUNE THERAPY FOR TUMORS.
>> MELANIE OTT.
OKAY.
AND FRED --
YOU ARE MUTED, FRED.
TRY AGAIN.
>> SORRY ABOUT THAT.
>> GOOD NOW.
MY NAME IS FRED -- AND I AM AN
ASSISTANT PROFESSOR AT THE OHIO
STATE UNIVERSITY COLLEGE OF
MEDICINE AND COMPREHENSIVE
CANCER CENTER.
MY LAB STUDIES THE ROLE OF DIET
AND LIFESTYLE IN CANCER
PREVENTION AND TREATMENT
RESPONSE.
I'M WITH THE NATIONAL CANCER
ADVISORY BOARD.
THANK YOU.
>> THANKS, FRED.
MARK VONN ZASTER.
I DON'T THINK MARK IS WITH US.
OKAY.
SO I WOULD LIKE TO NOW GO AROUND
THE ROOM AT THE TABLE HERE AND
HAVE EVERYONE INTRODUCE
THEMSELVES.
SO WE'LL START WITH YOU,
ELIZABETH.
IF THAT'S OKAY.
>> GOOD MORNING.
I'M ELIZABETH HOFFMANN,
ASSOCIATE DIRECTOR FOR THE ABCD
STUDIED A NIDA.
>> CHRIS
>> I'M CHRISTOPHER SARAMPOTE AND
PROJECT DIRECTOR FOR THE ABCD
STUDY AND X RESEARCH AT NIDA.
>> I'M PHILLIP, I'M THE DIRECTOR
OF EXTERNAL ACTIVITIES AT NIAAA.
>> I'M TRISH -- I'M THE DEPUTY
DIRECTOR AT THE NATIONAL
INSTITUTE ON ALCOHOL ABUSE AND
ALCOHOLISM.
>> BILL.
>> GOOD MORNING, BIM KLEIN,
ASSOCIATE DIRECTOR OF BAIFRLT
RESEARCH AT THE NARNS CANCER
INSTITUTE.
>> WILSON COMPTON, NATIONAL
INSTITUTE ON DRUG ABUSE.
>> SUSAN WEISS, DIRECTOR OF THE
DIVISION OF EXTRA MURAL RESEARCH
AT NIDA.
>> AND GAYA.
>> GAYA DOWLING, DIRECTOR OF
ABCD PROJECT AND I'M AT NIDA.
>> NORAH, MAKE SURE WE GET YOU.
>> OKAY.
THANKS FOR NOT FORGETTING ME
GEORGE.
I'M NORAH VOLKO KS W, DIRECTOR
OOF THE NATIONAL INSTITUTE ON
DRUG ABUSE.
I WAS HOPING ALL OF THESE WOULD
BE DONE IN PLACE.
I OPTED FOR TECHNOLOGY.
SO I LOOK A FORWARD FOR HEARING
YOUR RECOMMENDATIONS.
SO I PASS IT BACK TO YOU,
GEORGE.
>> AND I'M GEORGE KOOB, THE
DIRECTOR OF THE NATIONAL
INSTITUTE ON ALCOHOL ABUSE AND
ALCOHOLISM.
SO I GUESS I'M SUPPOSED TO --
SORRY.
I WOULD LIKE TO INTRODUCE -- ASK
PAUL LET GRAY TO INTRODUCE
HERSELF.
>> I'M PAULLETTE GRAY, DIRECTOR
OF THE DIVISION OF E TRA MURAL
ACTIVITIES AT THE NATIONAL
CANCER INSTITUTE.
>> THANK YOU, PAULA.
>> OKAY.
GOOD MORNING, EVERYONE.
I'M GOING TO GIVE A BRIEF
INTRODUCTION TO CRAN AND TALK A
LITTLE BIT ABOUT NIAAA UPDATE.
IT SHOULD BE RELATIVELY SHORT.
MAYBE A REVIEW FOR MANY OF YOU,
BUT A COUPLE OF THINGS WE WOULD
LIKE TO HIGHLIGHT FROM NIAAA.
THE COLLABORATIVE RESEARCH ON
ADDICTION AT NIH ENHANCES
COLLABORATION AT NIH.
OUR PURPOSE IS TO DO THIS WITH
BOTH NIAAA, NIDA, NCI AND
SUBSTANCE USE MISUSE AND PUBLIC
HEALTH OUTCOMES.
THERE IS A STEERING COMMITTEE
COMPRISING THE DIRECTORS OF
NIAAA, NIDA AND THE DIVISION OF
CANCER CONTROL AND POPULATION
SCIENCES AT NCI, WHICH IS BILL
KLEIN.
COORDINATING COMMITTEE STAFF BY
REPRESENTATIVES FROM EACH OF THE
THREE ICs IS PART OF THE GONS.
WHAT DO WE DO?
WELL, WE HAVE ONGOING PROGRAMS
THAT WE FUND AND COOPERATE AND
COLLABORATE ON.
THE ADOLESCENT BRAIN COGNITIVE
DEVELOPMENT STUDY, THE LARGEST
LONG-TERM STUDY ON BRAIN
DEVELOPMENT AND CHILD HEALTH IN
THE UNITED STATES THIS YOU WILL
HEAR ABOUT LATER TODAY.
HEALTHY BRAIN AND CHILD
DEVELOPMENT STUDY, HBCD, FOLLOWS
CHILDREN FROM BIRTH TO LONG-TERM
EFFECTS OF PERI NATAL DRUG
EXPOSURE ON DEVELOPMENT.
WE HAVE HIGHLIGHTED
COLLABORATIONS.
SCREENING, BRIEF INTERVENTION
AND REFERRAL TO TREATMENT FOR
PREVENTION FOR ALCOHOL, TOBACCO
AND OTHER DRUGS USE AND MISUSE
IN ADULT POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES.
AN POPULATION APPROACHES TO --
>> WE HOLD ANNUAL JOINT EVENTS.
JOINT CRAN FACILITATES, RESEARCH
PRIORITIES, ACCOMPLISHMENTS AND
OPPORTUNITIES FOR COLLABORATION.
WE DO THE NIDA, NIAAA
MINICONVENTION FRONTIERS IN
ADDICTION RESEARCH.
THIS PROVIDES A FORUM FOR
PRESENTATIONS AND DISCUSSIONS OF
CURRENT NEUROSCIENCE AND
RESEARCH TOPICS.
THIS HAS REALLY BEEN AN EXCITING
MINICONVENTION THAT WE HAVE BEEN
DOING NOW FOR QUITE SOME TIME.
AND SOME OF THE BEST YOUNG
PEOPLE PRESENT IN THIS VENUE.
MEDIA EVENTS AT THE SOCIETY FOR
NEUROSCIENCE AND COLLEGE ON
PROBLEMS OF DRUG DEPENDENCE.
WE USED TO UPDATE THE PRESS
ABOUT NEW SCIENCE AND CHALLENGES
AND OPPORTUNITIES IN THE
ADDICTION RESEARCH FIELD.
SO HERE'S OUR UPDATE FROM NIAAA.
I'M GOING TO BRIEFLY TALK ABOUT
ALCOHOL MISUSE AS A CHRONIC
DISORDER.
CHRONIC DISEASE IS A MAJOR
COMPONENT OF DR. BHATTACHARYA'S
AIM.
IF I MAY SAY SO, ALCOHOL USE
DISORDER AND SUBSTANCE USE
DISORDER ARE POSTER CHILDREN FOR
CHRONIC DISEASES.
THE CHRONIC HEALTH USE DISORDER.
WE HAVE A PREDIJ NOUS NUMBER OF
EMERGENCY ROOM VISITS.
I HAVE SAID THIS IF YOU GO INTO
ANY MAJOR MEDICAL CENTER ON A
FRIDAY OR SATURDAY NIGHT, THE
EMERGENCY ROOM, HALF OF THE
PEOPLE ARE THERE BECAUSE OF
ALCOHOL.
WE LOSE 180,000 PEOPLE A YEAR TO
ALCOHOL.
THERE HAS BEEN INTERESTINGLY
ENOUGH, A DRAMATIC INCREASE IN
ALCOHOL RELATED DEATHS IN THE
LAST 20 YEARS, SINCE 2001.
AND THEY HAVEN'T STOPPED GOING
UP.
SOME OF THIS WAS OBVIOUSLY
EXACERBATED BY THE PANDEMIC, AS
I WILL TOUCH ON BRIEFLY, BUT IT
IS A STEADY INCREASE AND THE
PATHOLOGY ASSOCIATED WITH
ALCOHOL, WHICH IS MANIFEST HAS
BEEN INCREASING IN PARALLEL.
MORE THAN 200 DISEASES AND
INJURY-RELATED CONDITIONS
ASSOCIATED WITH ALCOHOL.
YOU ARE PROBABLY MOST FAMILIAR
WITH THE LIVER, WE HAD A TALK
YESTERDAY ON LUNG, WHICH WAS
REALLY EXCITING FROM DR. SINAR
IN OUR INTRAMURAL PROGRAM.
IT RANGES FROM MENTAL HEALTH
PROBLEMS TO CANCER AND I WILL
TOUCH ON THEM.
ALCOHOL ASSOCIATED LIVER DISEASE
IS THE MOST COMMON
ALCOHOL-RELATED CAUSE OF DEATH.
AND ACCOUNTS FOR ABOUT 50% OF
LIVER ASSOCIATED DEATHS.
THE DEATH RATES ARE INCREASING
FASTER FOR WOMEN AND AMONG YOUNG
ADULTS.
THERE ARE INDIVIDUALS WHO ARE
YOUNGER THAN 30 YEARS OLD
GETTING LIVER TRANSPLANTS
BECAUSE OF ALCOHOL ASSOCIATED
LIVER DISEASE.
SERIOUS ALCOHOL ASSOCIATED LIVER
DISEASE.
YOU KNOW IT IS A SPECTRUM
DISORDER ITSELF.
RANGING FROM FIBROSIS TO
CIRRHOSIS AND EVEN LIVER CANCER
WHICH IS CARCINOMA.
IT PEAKED IN THE PANDEMIC AND
HAS GONE DOWN SLIGHTLY, BUT WE
ARE WAY ABOVE LEVELS FROM 20
YEARS AGO.
THERE IS A SHIFT FOR MORE
PROBLEMS WITH WOMEN AND YOUNGER
PEOPLE WITH LIVER DISEASE WHICH
I SUSPECT IS A REFLECTION OF
THOSE WHO DRINK, DRINKING MUCH
MORE HEAVILY.
ALCOHOL INCREASING THE RISK OF
AT LEAST SEVEN TYPES OF CANCER.
ALCOHOL CONSUMPTION IS THE THIRD
LEADING PREVENTABLE CAUSE OF
CANCER IN UNITED STATES AFTER
TOBACCO AND OBESITY.
INCREASING CANCERS OF THE HEAD,
NECK, LIVER, COLON, LIVER AND
BREAST.
WE HAVE TO THANK THE NATIONAL
CANCER INSTITUTE, BILL KLEIN'S
DIVISION AMONG OTHERS FOR A LOT
OF THE WORK THAT FOCUSED ON
ALCOHOL AND CANCER AND WE HAVE
ALWAYS BEEN HAPPY TO COLLABORATE
WITH THEM.
IN THE U.S. ALCOHOL CONSUMPTION
CONTRIBUTES TO 6% OF CANCER
CASES AND 4% OF DEATHS.
BREAST, MOUTH AND THROAT CANCERS
EVIDENCE SHOWS THIS RISK IS DOSE
DEPENDENT.
THE MORE YOU DRINK THE HIGHER
THE RISK.
YET THERE IS A LARGE GAP IN THE
PUBLIC'S UNDERSTANDING OF 2019
SURVEY SHOWED THAT ONLY 45% OF
AMERICANS RECOGNIZE ALCOHOL USE
AS A RISK FOR CANCER COMPARED TO
89% FOR TOBACCO USE.
SO YOU HAVE BEEN VERY
SUCCESSFUL, BILL, WITH TOBACCO,
BUT WE NEED TO MOVE THE NEEDLE A
LITTLE BIT WITH ALCOHOL.
ALCOHOL MISUSE INCREASES THE
RISK FOR CARDIOVASCULAR DISEASE,
IT CAN CONTRIBUTE TO HEART
ARRHYTHMIAS, HIGH BLOOD
PRESSURE, APEOPLE INA --
APEOPLE INA.
CHRONIC ALCOHOL USE IS
EXACERBATED CARDIAC AND RESERVE
CAPACITY ASSOCIATED WITH AGING.
MY COUNCIL HAS HEARD THIS, MY
STAFF HAVE HEARD THIS STORY
MULTIPLE TIMES, BUT LAST YEAR I
WENT TO THE MAYO CLINIC AND GAVE
A TALK AND A CARDIOLOGIST TOLD
ME THE FIRST TREATMENT HE NOW
USES IN HIS PATIENTS FOR
HYPERTENSION IS TO ASK THEM HOW
MUCH THEY DRINK.
AND APPARENTLY HYPERTENSION IS
DRIVING, I MEAN ALCOHOL IS
DRIVING QUITE A BIT OF
HYPERTENSION.
SO TO SUMMARIZE THIS WHOLE
SECTION, WELL, WE ARE GOING TO
TALK ABOUT MENTAL HEALTH IN A
SECOND.
BUT, YOU KNOW, ALCOHOL MISUSE IS
A WINDOW ON SO MANY OTHER
PHYSICAL CONDITIONS AND MEDICAL
CONDITIONS AND WE'LL TALK ABOUT
WHY WE BELIEVE THAT IS IMPORTANT
FOR ONE OF OUR PROGRAMS THAT WE
ARE ENGAGED IN.
MENTAL HEALTH AND ALCOHOL USE
DISORDERS OFTEN CO-OCCUR
COMPLICATED DIAGNOSES AND
TREATMENT.
THEY INCLUDE DEPRESSION AND PG
ANXIETY DISORDERS, ATTENTION
DEFICIT HYPERER ACTIVITY
DISORDER.
ALCOHOL IS USED TO COPE WITH
STRESS.
IF AN INDIVIDUAL EXPERIENCES
ANXIETY AND DEPRESSION THEY
COULD BE SENSITIVE TO WORSENING
ANXIETY OVER TIME DRIVEN IN PART
BY ALCOHOL WHICH THEY ARE USING
TO TREAT THE ANXIETY.
SO YOU GET INTO THIS KIND OF
SPIRITUALING LOOP.
OTHER SUBSTANCE USE DISORDERS,
SLEEP DISORDERS AND CHRONIC PAIN
ALSO COMMONLY OCCUR WITH ALCOHOL
USE DISORDER AND CAN IMPACT
ALCOHOL USE DISORDER AND OTHER
MENTAL HEALTH CONDITIONS.
SO MOST SUBSTANCE USE DISORDERS
GET INTO THAT SAME SPIRALLING
LOOP.
OF SELF-MEDICATION.
LEFT UNTREATED ALCOHOL AND
MENTAL HEALTH CONDITIONS MAY
INCREASE THE RISK FOR SUICIDE.
AND THEN PRENATAL ALCOHOL
EXPOSURE CAN CAUSE LIFE-LONG
NEURODEVELOPMENTAL DEFICITS.
THIS HAS ALWAYS BEEN A STRIKING
FACT.
11% OF PREGNANT WOMEN REPORT
CURRENT ALCOHOL USE AND 5%
REPORT BING DRINKING.
THERE IS NO KNOWN SAFE AMOUNT OF
ALCOHOL CONSUMPTION DURING
PREGNANCY.
IT CAN CAUSE BIRTH
COMPLICATIONS, BIRTH DEFECTS AND
INCREASE THE RISK OF FETAL
ALCOHOL SPECTRUM DISORDERS,
WHICH IS A BROAD WIDE RANGE OF
IMPAIRMENTS THAT OCCUR DUE TO
ALCOHOL EXPOSURE BEFORE BIRTH.
FETAL ALCOHOL SYNDROME ALL THE
WAY TO DEVELOPMENT DISORDERS
ASSOCIATED WITH ALCOHOL
EXPOSURE.
INDIVIDUALS WITH FETAL ALCOHOL
SPECTRUM DISORDER MAY HAVE
PROBLEMS WITH ATTENTION,
LEARNING AND MEMORY.
BEHAVIORAL REGULATION AND SOCIAL
AND DAILY LIFE SKILLS.
THEY ARE MORE LIKELY TO
EXPERIENCE MEDICAL ISSUES,
ALCOHOL AND OTHER SUBSTANCE USE
DISORDERS AND MENTAL HEALTH
DISORDERS.
THEY OFTEN NEED SUPPORT
THROUGHOUT LIFE TO MITIGATE
THESE ISSUES.
SO THIS IS REALLY, YOU KNOW, A
BIG PART OF OUR PORTFOLIO.
IT IS AN IMPORTANT PART OF THE
PATHOLOGY ASSOCIATED WITH
ALCOHOL AND IT IS ESTIMATED 1%
TO 5% OF U.S. CHILDREN IN THE
FIRST GRADE ACTUALLY MEET THE
CRITERIA FOR FETAL ALCOHOL
SPECTRUM DISORDER.
WHAT ABOUT RESEARCH ON ALCOHOL
AND WHOLE PERSON HEALTH?
WELL, I HAVE ALREADY MENTIONED
THIS, A WHOLE PERSON APPROACH
LOOKS AT THE CONNECTIONS ACROSS
DOMAINS OF HEALTH TO ADDRESS
DISEASE AND IMPROVE PREVENTION,
DIAGNOSE AND TREATMENT
STRATEGIES.
THESE CAN BE BIOLOGICAL,
GENETICS CO-OCCURRING
CONDITIONS, BEHAVIORAL, DIET,
LIFESTYLE, STRESS, SLEEP.
ENVIRONMENTAL, CONDITIONS PEOPLE
ARE BORN, GROW, LIVE WORK AND
AGE, COMMUNITY CONNECTIONS,
SPIRITUALITY AND ACCESS TO CARE
AND RESOURCES.
WE SUPPORT RESEARCH TO IMPROVE
THE IMPLEMENTATION OF ALCOHOL
SCREENING, BRIEF INTERVENTION
AND REFERRAL TO TREATMENT INTO
ROUTINE HEALTH CARE.
WE ARE GETTING SCREENING.
IT IS PROBABLY ON AVERAGE NOW
ABOUT 70% OF PRIMARY CARE
DOCTORS OR HEALTH PROVIDERS ARE
ASKING PEOPLE HOW MUCH THEY
DRINK.
UNFORTUNATELY, THAT IS WHERE IT
ENDS.
A BRIEF INTERVENTION SO THAT IS
AN AREA WE ARE FOCUSING ON.
WE ARE TRYING TO INTEGRATE
TREATMENT STRATEGIES FOR
MULTIPLE ALCOHOL DISORDERS,
UNCOVER THE MECHANISMS ALCOHOL
CONTRIBUTES TO DISEASES ACROSS
THE BODY.
OUR COLLABORATIVE RESEARCH HOLD
PROMISE FOR ENHANCING THE
UNDERSTANDING OF WHOLE PERSON
HEALTH AND IMPROVING SUBSTANCE
MISUSE-RELATED HEALTH OUTCOMES.
SO WE HAVE BEEN PUSHING A
CONCEPT WE CALL TREATING ALCOHOL
USE AS A VITAL SIGN.
WE BELIEVE THAT CAN IMPROVE
OVERALL HEALTH AND I HAVE BEEN
HINTING AT IT THROUGHOUT THIS
PRESENTATION SO FAR.
IT IS AN UNDERAPPRECIATED
CONTRIBUTOR TO MANY HEALTH
CONDITIONS AND OFTEN OVERLOOKED
BY HEALTH PROFESSIONALS IN
PRIMARY CARE AND OTHER HEALTH
CARE SETTINGS.
APPROACHING ALCOHOL USE IS A
VITAL SIGN IN IMPROVING
IMPLEMENTATION OF ALCOHOL
SCREENINGS, BRIEF INTERVENTION
AND REFERRAL TO TREATMENT AND
ROUTINE CARE CAN INCREASE THE
CHANCES AN ALCOHOL-RELATED
PROBLEM IS IDENTIFIED AND
ADDRESSED EARLY.
I SAID BEFORE, IT CAN BE A
WINDOW ON OTHER CONDITIONS THAT
YOU MAY HAVE COME TO SEE YOUR
HEALTH CARE PROVIDER FOR.
SCREENING FOR ALCOHOL USE CAN --
I JUST SAID THAT.
APPROACHING ALCOHOL USE AS A
VITAL SIGN CAN ALSO REDUCE
STIGMA.
SO SUPPORTED BY NIAAA, KAISER
PERMANENTE CALIFORNIA INTRODUCED
UNHEALTHY DRINKING SCREENING
PROCESS.
THEIR TAGLINE WAS WE SCREEN
EVERYONE.
IT NORMALIZED WHAT CAN BE A
SENSITIVE SUBJECT.
ALCOHOL SCREENING AND BRIEF
INTERVENTION SIGNIFICANTLY
IMPROVED DRINKING OUTCOMES.
REDUCED NOT ONLY ALCOHOL USE,
BUT ALSO BLOOD PRESSURE AMONG
PATIENTS WITH HYPERTENSION.
DAVID GOLMAN HAS CREATED A
SCREENING FOR EVERYONE WHO COMES
IN THE NIH CLINICAL CENTER.
WE ARE MAKING SOME PROGRESS IN
THIS DOMAIN.
WE HOPE IT WILL BE EXTENDED.
WE ARE VERY PROUD OF OUR
INTERACTION WITH HEPATOLO GISS.
INTEGRATED TREATMENT OF ALCOHOL
ASSOCIATED LIVER DISEASE CAN
IMPROVE PATIENT OUTCOMES.
MOST OF YOU ARE PROBABLY SAYING
DUH, BUT IT HAS REALLY NOT BEEN
DONE UNTIL VERY RECENTLY.
TREATING ALCOHOL USE DISORDER
WITH MEDICATIONS REDUCES THE
LIKELIHOOD OF DEVELOPING AN
ALCOHOL ASSOCIATED LIVER DISEASE
AND REDUCES IF PROGRESSION OF
EXISTING ALCOHOL LIVER DISEASE.
AFTER DISCHARGE FROM
HOSPITALIZATION FOR ALCOHOL
ASSOCIATED LIVER DISEASE REDUCES
READMISSION AND DEATH.
IN 2022 WE SPONSORED A WORKSHOP
TO BRING TOGETHER ALCOHOL
ASSOCIATED LIVER DISEASE
RESEARCHERS AND SPECIALISTS TO
INFORM IMPROVED INTEGRATIVE CARE
WITH PATIENTS WITH ALD.
THIS LED THE GROUNDWORK FOR
FUTURE CLINICAL TRIALS FOCUSED
ON EVALUATING THE IMPACT OF
INTEGRATED CARE.
THE RESULTING RECOMMENDATIONS
WERE PUBLISHED LAST YEAR AND ARE
BEING IMPLEMENTED ACROSS OUR
PORTFOLIO.
AND THIS IS A REFERENCE TO THAT
PAPER THAT -- I WANT TO REMIND
YOU OF RETHINKING DRINKING.
COLLEGE AIM.
A RESOURCE FOR COLLEGE
ENVIRONMENTS.
IT SHOULD BE AVAILABLE TO EVERY
COLLEGE AND UNIVERSITY IN THE
COUNTRY.
IF YOU ARE SENDING JOHNNY AND
SALARY TO A UNIVERSITY OR
COLLEGE, YOU MIGHT ASK THE
POWERS THAT BE WHAT PREVENTION
PROGRAMS THEY ARE USING.
IT HELPS THEM UNDERSTAND WHAT
RESOURCES MIGHT BE AND TREATMENT
OPTIONS IN THEIR LOCAL ZIP CODE.
HEALTH CARE PROFESSIONALS CORE
RESOURCES AND EDUCATIONAL
RESOURCES THAT COVERS THE BASICS
OF WHAT EVERY PROFESSIONAL NEEDS
TO KNOW ABOUT ALCOHOL.
IT INCLUDES INFORMATION ON
ALCOHOL AND HEALTH, STRATEGIES
AND SCREENING AND INTERVENTIONS.
IT INCLUDES SCREENINGS.
FOR PROVIDERS WHO ARE NOT
ALCOHOL SPECIALISTS THEY CAN
OVERCOME BARRIERS TO CARE FOR
PATIENTS WITH ALCOHOL PROBLEMS,
INCLUDING WAYS TO COUNTERACT
STIGMA IN THEIR PRACTICE.
IT WAS DEVELOPED WITH INPUT FROM
70 CONTRIBUTORS.
.
IT IS EVERYTHING YOU WANTED TO
KNOW ABOUT ALCOHOL AND WERE
AFRAID TO ASK.
THANK YOU VERY MUCH.
WE'D LIKE TO BE YOUR SOURCE FOR
CREDIBLE EVIDENCE-BASED
INFORMATION ABOUT ALCOHOL AND
HEALTH.
I WANT TO GIVE A SPECIAL THANKS
TO DEN POLT LAURA, LAURA AND
TRISH FOR THEIR HELP WITH THESE
SLIDES.
THANKS A LOT, EVERYBODY.
SHOULD WE JUST MOVE ON OR DO YOU
WANT TO OPEN FOR QUESTIONS.
>> YES, 10 MINUTES FOR Q&A.
SO THERE IS TIME.
>> I'M HAPPY TO ANSWER ANY
QUESTIONS IF ANYBODY HAS ANY
QUESTIONS, PLEASE IF YOU HAVE
QUESTIONS, HOW DO THAT DO IT
ONLINE?
THEY RAISE THEIR HAND.
>> WE HAVE A QUESTION FROM KAREN
EMMONDS.
>> I DO A LOT OF WORK WITH
COMMUNITY HEALTH CENTERS AND
THEY PUT ENERGIES INTO
NECESSITIES FOR REQUIRED
REPORTING METRICS LIKE THERE IS
FOR TOBACCO SCREENING AND OTHER
THINGS.
I'M WONDERING IF THERE IS ANY
MOVEMENT TOWARDS WORKING WITH
HHS AND HRSA AROUND TRYING TO
DEVELOP A METRIC HEALTH CENTERS,
WHICH SERVE A TREMENDOUS AMOUNT
OF PEOPLE ACROSS THE COUNTRY,
MIGHT HAVE SOME REQUIREMENTS FOR
SCREENING FOR ALCOHOL?
>> THAT IS A REALLY GOOD
QUESTION.
WE WERE WORKS WITH SAMHSA ON
THIS ISSUE PRIOR TO THE
TRANSITION PERIOD AND WHEN I MET
WITH DR. BHATTACHARYA WE DID
DISCUSS WORKING WITH OTHER
AGENCIES IN THIS REGARD AND HE
SAID HE WOULD PROVIDE AS MUCH
HELP AS I NEEDED.
I'M WAITING FOR OTHER THINGS TO
SETTLE DOWN AND SEE WHERE OUR
OTHER AGENCIES LAND.
I WOULD INVITE ALL OF US AT CRAN
WORKING WITH HRSA AND SAMHSA, I
BELIEVE SAMHSA MOVED IN MAHA
UMBRELLA.
IT IS A REALLY GOOD QUESTION AND
GOOD POINT.
SOME OF YOU KNOW, I'M IR
REPRESSABLE WHEN IT COMES TO THE
AUDIT C.
SO ALL MY FELLOW IC DIRECTORS
HATE ME BECAUSE I TRY TO PUT IT
IN EVERY COHORT AT NIH.
I THINK I HAVE BEEN SUCCESSFUL,
ACTUALLY.
ANY OTHER THOUGHTS OR QUESTIONS.
THAT WAS A REALLY GOOD QUESTION.
>> WE HAVE A QUESTION FROM
CHRISTIAN DUARTE.
>> HI.
THANK YOU FOR THIS PRESENTATION.
I WAS CURIOUS ABOUT THE
INFORMATION ABOUT BING DRINKING
AND ALCOHOL CONSUMPTION DURING
PREGNANCY.
IT LOOKS LIKE IT IS GOING UP
ALSO.
ARE YOU AWARE OF ANY
INTERVENTIONS SPECIFICALLY FOR
THIS PERIOD THAT HAVE BEEN
PARTICULARLY SUCCESSFUL AND ANY
THOUGHTS YOU MAY HAVE ABOUT THIS
INCREASE.
>> BILL, I HATE TO PUT YOU ON
THE SPOT, BUT COULD YOU COME UP
TO THE MICROPHONE AND ANSWER.
WHAT ARE WE DOING ABOUT PREGNANT
WOMEN?
>> SURE.
>> THIS IS BILL DUNTE,
COORDINATOR FOR FETAL ALCOHOL
SPECTRUM DISORDER PORTFOLIO.
>> SCREENING AND BRIEF
INTERVENTIONS HAVE BEEN MOST
SUCCESSFUL.
THAT WAS STUDIES THAT THE CDC
AND NIAAA FUNDED OVER MANY
YEARS.
I'M NOT SURE.
I MISSED A LITTLE BIT OF YOUR
QUESTION YOU WERE TALKING ABOUT
BING DRINKING IN PARTICULAR?
>> YEAH.
SHE SAYS IT LOOKS LIKE IT IS
GOING UP.
THE QUESTION IS WHAT ARE WE
DOING IN THE PREVENTION DOMAIN
FOR THAT?
I KNOW ABOUT THE SCREENING AND
BRIEF INTERVENTION, BUT DO WE
HAVE ANYTHING REGARDING BING
DRINKING?
>> MY RECOLLECTION OF THE DATA
AND TRENDS FOR BINGE DRINKING 4%
TO 5% OVER SEVERAL YEARS.
ONE OF THE THINGS THAT NIAAA HAS
BEEN DOING OVER THE LAST THREE
YEARS.
WE DO HAVE A FUNDING OPPORTUNITY
ANNOUNCEMENT LOOKING AT NOVEL
APPROACHES FOR FASD
INTERVENTIONS AND PREVENTION
APPROACHES.
I DON'T HAVE THE NOTICE OFFHAND,
BUT WE CAN PROVIDE THAT
INFORMATION TO COUNCIL.
AND THE NOTICE HAS BEEN OUT ON
THE STREETS FOR ABOUT THREE
YEARS.
WE'VE HAD A FEW NOVEL APPROACHES
APPLICATIONS COME IN THAT WE
FUNDED.
AND WE'VE REISSUED THAT FUNDING
OPPORTUNITY FOR ANOTHER THREE
YEARS.
SO HOPEFULLY BASED ON THAT
ANNOUNCEMENT, WE'LL BE ABLE TO
ANSWER THAT QUESTION WITH SOME
NOVEL APPROACHES IN THE FUTURE.
>> JUST TO ADD SOMETHING, WE
ALSO HAVE A RESEARCHER WHO IS
STUDYING POLICY ISSUES AROUND
PREVENTION OF DRINKING DURING
PREGNANCY.
AND WHAT WE HAVE TO BE CAREFUL
IS A POLICY DOESN'T DRIVE A
WOMAN AWAY FROM HEALTH CARE.
SO IT IS A LITTLE BIT OF A
BALANCE BETWEEN THE
INTERVENTIONS WE DO TO PREVENT
THIS BEHAVIOR, BUT ALSO NOT TO
DRIVE SOMEBODY AWAY FROM SEEKING
CARE OVERALL.
>> THANKS, TRISH.
>> WE HAVE A QUESTION FROM
ISABELLE DURAN.
>> THANK YOU VERY MUCH.
DR. KOOB WE WORK IN THE LATINO
COMMUNITY AROUND ISSUES OF
CANCER AND CONNECTED THE DOTS TO
ALCOHOL, PROBABLY NOT AS MUCH AS
WE SHOULD.
WE DO THIS THROUGH EDUCATION AND
NATIONAL FORUMS THAT WE DO EVERY
YEAR.
I HAVEN'T, SORRY, VISITED YOUR
SITE AND LOOKED AT THE OTHER
GROUPS HERE, SO I DON'T KNOW
WHAT IS AVAILABLE.
MY QUESTION IS CAN I FIND IN
WHAT IS AVAILABLE ON YOUR
WEBSITE SPECIFIC KINDS OF
PRIMERS OR THINGS IN SPANISH I
CAN PASS ON TO THE VARIOUS
ORGANIZATIONS WE WORK WITH SO
THEY CAN PINPOINT AND LOOK AT
ARE THERE BEST PRACTICES
PROGRAMS THAT ARE WORKING OUT
THERE DIRECTED TOWARDS THE
LATINO COMMUNITY AND CAN BE
PROVIDED IN SPANISH?
>> THAT IS A REALLY GOOD
QUESTION AND I DON'T KNOW THE
ANSWER OFF HAND.
BILL, DOES NCI HAVE SOMETHING --
I KNOW YOU HAVE SOME MATERIAL ON
CANCER, BUT IS ANY OF IT IS
SPANISH?
>> NOT THAT I KNOW OF.
WE CAN TAKE A LOOK.
THERE IS CLEARLY A NEED FOR MORE
OF IT, NOT JUST IN SPANISH, IN
ENGLISH.
WE ARE DOING SOME WORK ON
MESSAGING.
I WILL MENTION THAT IN MY
PRESENTATION.
WEAPON -- WE ARE NOT AS FAR
ALONG WITH ALCOHOL AS WE ARE
WITH TOBACCO.
>> THIS IS WHAT IS GREAT ABOUT
CRAN.
I DON'T HAVE TO SAY I DON'T KNOW
THE ANSWER BECAUSE SOMEBODY IN
THE ROOM HAS THE ANSWER.
ANY OTHER QUESTIONS.
>> OUR FACT SHEETS ARE IN
SPANISH AND ENGLISH, BUT DON'T
GO INTO DEPTH IN TERMS OF THE
PROGRAM.
BUT WE DO PUT OUT OUR FACT
SHEETS IN SPANISH AND ENGLISH.
SOME OF THAT IS ACCESSIBLE AND
WE ARE LOOKING FOR HOW NIH
DECIDES TO COMMUNICATE OVERALL
AND WHAT THEY DO IN TERMS OF
WEBSITES.
>> ANY OTHER THOUGHTS OR
QUESTIONS FROM ANYBODY REAL
QUICK?
ALL CLEAR?
OKAY.
THANKS, EVERYONE.
THAT WAS REALLY INTERESTING AND
WE'VE GOT THINGS THAT WILL BE
USEFUL FOR FUTURE PLANNING.
ALL RIGHT, SO NOW WE'RE READY TO
HAVE DR. VOLKOW TO PRESENT HER
NIDA'S DIRECTOR PRESENTATION.
SHE IS THE DIRECTOR OF THE
NATIONAL INSTITUTE ON DRUG
ABUSE.
>> YES.
GEORGE, THANKS VERY MUCH.
IT WOULD BE FANTASTIC IF SOMEONE
ALLOWS ME TO SHARE MY
PRESENTATION.
BECAUSE IN THE MODE I'M IN NOW
IS NOT LETTING ME SHARE.
IS SOMEONE IN IT CAN LOOK INTO
WHY I CANNOT SHARE?
>> YES.
GIVE ME A FEW SECONDS AND I WILL
ALLOW YOU TO DO THAT.
>> AS DR. KOOB WAS SPEAKING, I
CHANGED MY PRESENTATION TO
CONFORM TO NARRATIVE ISSUES.
>> I JUST CHANGED IT.
IT SHOULD BE OKAY.
>> FANTASTIC.
LET ME SHARE.
AND WHAT I'M GOING TO BE DOING
RIGHT NOW, OBVIOUSLY, LET ME
SEE.
>> IT'S UP, NORAH.
>> OKAY.
IT'S THERE?
>> PERFECT.
>> OKAY.
SO WHAT I'M GOING TO TRY TO DO
TODAY BECAUSE I GAVE A
PRESENTATION YESTERDAY TO OUR
COUNCIL IS TO ACTUALLY IDENTIFY
RELEVANT TOPICS FOR THE THREE OF
OUR INSTITUTES AND I GUESS IF
THERE IS A MESSAGE IN MY BRAIN
IS THAT WE NEED TO START TO
SHIFT THE WAY THAT WE DO SCIENCE
AND ANALYZE PROBLEMS AS SORT OF
SEPARATE CATEGORY.
CERTAINLY IN THE WHOLE FIELD OF
SUBSTANCE USE THERE ARE NO
PEOPLE THAT JUST ABUSE ONE DRUG,
ALCOHOL, OR JUST ABUSE TOBACCO.
THAT FREQUENCY WHICH THESE DRUGS
ARE USED TOGETHER IS EXTREMELY
HIGH, AND YET WE CONTINUE TO
PERSEVERATE INTO JUST
IDENTIFYING AND DOING THE
STUDIES IN SIMPLE MODELS THAT
DON'T CONVEY THE COMPLEXITY OF
THE REALITY THAT IS PATIENTS ARE
EXPERIENCING.
AND I THINK THAT PERFECT EXAMPLE
THAT GEORGE BROUGHT UP REGARDING
CANCER ILLUSTRATES THAT VERY
WELL.
AND CRAN IN A WAY GIVES US THE
OPPORTUNITY TO DO THIS.
SO MY FIRST -- AND I GAVE THESE
REPORT CARDS YESTERDAY BECAUSE
IT WAS VERY RELEVANT FOR BOTH ON
OUR COUNCIL ON CRAN.
THE NOTION OF WHAT IS THE
STATUS?
THIS IS MONITORING THE FUTURE,
THE RESULTS FROM LAST YEAR, THAT
ACTUALLY IDENTIFIES AND
SUMMARIZES IT HAS BEEN
DECREASES, WHICH ARE MARKED HERE
IN GREEN.
ON PATTERNS OF DRUG USE OR
ALCOHOL BETWEEN 23 AND 24.
AND SO THESE ARE SIGNIFICANT
CHANGES IN A ONE-YEAR PERIOD FOR
KIDS THAT ARE 8th, 10th, 12th
GRADE.
AND IT RELATES TO DIFFERENT
TYPES OF INDICATORS.
I'M HIGHLIGHTING TO YOUR LEFT
ALCOHOL BECAUSE YOU CAN SEE
WHETHER IT IS LIFE TIME, PAST
YEAR, PAST MONTH, BINGE DRUNK,
ALL OF THEM ARE GOING IN THE
RIGHT DIRECTION.
I POINTED THIS OUT BECAUSE THIS
IS SOMETHING NOW WE HAVE BEEN
SEEING FOR SEVERAL YEARS.
AND THE SAME THING WITH ELICIT
DRUGS.
THERE ARE SIGNIFICANT PATTERN
CHANGES IN THE DRUGS THAT ARE
FAVORED BY TEENAGERS AND IN
PARTICULAR, WE ARE SEEING A RISE
OF ALTERNATIVE NICOTINE DELIVERY
SYSTEMS, PARTICULARLY PROMINENT
IS ELECTRONIC CIGARETTES.
FORTUNATELY, THEY HAVE BEEN
GOING DOWN EVEN THOUGH THE
PREVALENCE IS EXTREMELY,
EXTREMELY HIGH.
IT IS ONE OF THE MOST PREVALENT
DRUGS TEENAGER FAVOR AFTER
ALCOHOL AND BY THE SIDE OF
MARIJUANA.
FOR EXAMPLE, WE SEE IN
PARTICULAR THERE HAS BEEN A RISE
IN TANDEM OF NICOTINE POUCHES
AND A RISE IN 8th GRADERS OF --
WHICH ARE NICOTINE AND NICOTINE
POUCHES ARE PROVIDED WITH
FLAVORS WHICH MAKE IT VERY, VERY
APPEALING FOR TEENAGERS.
THESE ARE NEW WAYS OF DELIVERY
THAT UNFORTUNATELY ARE CHANGING
THE ACTIONS OF TEENAGERS WITH
NICOTINE.
IT PUTS THEM INTO LATER ON
TRANSITIONING INTO TOBACCO
PRODUCTS, BUT EVEN BY ITSELF
THAT USE OF NICOTINE HAS BEEN
CLEARLY ASSOCIATED WITH RISKS.
HERE IS ILLUSTRATED IN A
DIFFERENT WAY.
THIS IS A TRENDS IN LIFE TIME
PREVALENCE FOR THE PERCENT OF
INDIVIDUALS WHO USE BY GRADE.
SO LIFE TIME.
SO YOU CAN SEE INTERESTINGLY,
THIS IS JUST FOR 12th GRADERS,
FOR ALCOHOL AND FOR CIGARETTES,
THE NUMBER OF INDIVIDUALS HAS
BEEN GOING DOWN.
WHEREAS IN 1979, WE COULD HAVE
90% OF THE 12th GRADERS THAT HAD
USED ALCOHOL ONCE IN THEIR
LIFETIME, WE HAVE NOW BASICALLY
60%.
THIS IS PRETTY STRIKING
REDUCTIONS CONSIDERING THIS IS
LIFETIME PREVALENCE.
THE NUMBER OF THEM ARE 8th
GRADERS, ACTUALLY MUCH SMALLER,
BUT EVERYTHING IS GOING IN THE
RIGHT DIRECTION.
THE SAME THING IN CIGARETTES.
AT ONE POINT IT WAS ESTIMATED
THAT 70% OF 12th GRADERS WOULD
HAVE SMOKED CIGARETTES IN THEIR
LIVES THERE -- LIFETIME.
IT IS LESS THAN 20%.
IT IS GOING DOWN.
NICOTINE VAPING IS GOING DOWN,
BUT STILL SEE APPROXIMATELY 60%
OF TEENAGERS, 12 OR IS 11th
GRADE HAVE EXPERIENCE WITH
VAPING.
THIS REFLECTS THE PATTERN
BEHAVIORAL CHANGES THAT MAKE
CERTAIN PRODUCTS MUCH MORE
APPEALING TO TEENAGERS AND
OTHERS.
I SUSPECT ALL THE COMMERCIAL
INTERESTS THAT ARE MAKING THIS
HAPPEN.
BECAUSE THIS IS A REALITY WE ARE
NOW FACED WITH THE NOTION OF HOW
DO WE TREAT TEENAGERS THAT HAVE
NICOTINE ADDICTION?
AND THAT WE DON'T EVEN HAVE FOR
TREATMENTS THAT WORK FOR TOBACCO
ADDICTION IN ADOLESCENTS.
BECAUSE THE MEDICATIONS THAT WE
USUALLY USE, HAVE NOT BEEN SHOWN
TO BE EFFECTIVE IN THE TREATMENT
OF TEENAGERS.
SO AN AREA OF TREMENDOUS
IMPORTANCE IS, AGAIN, RESEARCH.
OTHER THINGS THAT CAN HELP
TEENAGERS, ADOLESCENTS BASICALLY
OVERCOME ADDICTION TO VAPING
NICOTINE, WHICH IS THE MOST
PREVALENT ONE OF THEM.
THIS IS THE FIRST STUDY I'M
AWARE OF, RANDOMIZED CLINICAL
TRIAL THAT EVALUATES AND SHOWS
EFFECTIVENESS FOR VERENICLYN IN
TEENAGERS THAT HAVE A --
VARENICLINE IN TEENAGE
ADDICTION.
VARENICLINE IS NOT EFFECTIVE
WHEN YOU LOOK AT TOBACCO IN
ADOLESCENTS.
THERE IS A DURING RATION THAT IT
WAS GIVEN IN THE STUDY THAT
COULD ACCOUNT FOR THESE POSITIVE
RESULTS.
BUT IT DOES INDICATE THE EXTENT
TO WHICH THIS CAN BE REPRODUCED
AND REPLICATABLE.
IT ALLOWS TREATMENT FOR NICOTINE
ADDICTION.
IN AS MUCH AS NICOTINE ADDICTION
HAS BEEN SHOWN BY RESEARCHERS TO
SERVE AS A GATEWAY DRUG FOR
PATTERNS OF USE, INCREASING THE
USE OF OTHER SUBSTANCES,
INCLUDING ILLICIT SUBSTANCES
THEN CAN BE OBSERVED FROM THE
PERSPECTIVE THESE COULD BE
PREVENTION INTERVENTION FOR
OTHER SUBSTANCE USE DISORDERS IN
GENERAL.
NOW THIS BRINGS ME TO THE
QUESTION ABOUT THIS IS
TREATMENT.
BUT THE KEY ELEMENT ON ALL OF
THIS IS WHEN SOMEONE NEEDS
TREATMENT ALREADY MANY THINGS
HAVE HAPPENED AND AGAIN WE
ALWAYS TALK ABOUT HOW IMPORTANT
IS PREVENTION.
EVERYBODY SAYS PREVENTION IS THE
MOST EFFECTIVE INTERVENTION WE
HAVE IN HEALTH CARE AND YET IT
DOESN'T GET THE ATTENTION IT
DESERVES.
A LOT OF RESEARCH HAS BEEN GOING
ON IN TERMS OF BASIC FUNDAMENTAL
SCIENCE TO TRY TO UNDERSTAND
WHAT MAKES SOMEONE VULNERABLE TO
A SUBSTANCE USE DISORDER.
WHETHER IT IS ALCOHOL, OPIOID
USE, TOBACCO.
AND GENETICS HAS BEEN
RECOGNIZED.
THAT WAS RECOGNIZED FIRST IN THE
ALCOHOL FIELD.
AND PERHAPS MOST OF THE
HERITABILITY STUDIES WERE
INVESTIGATING THE RISK OF
ALCOHOLISM AND NOBODY WOULD
QUESTION THAT.
MORE RECENT INVESTIGATORS START
TO IDENTITY SIGNIFICANT
HERITABILITY OF OTHER SUBSTANCE
USE DISORDERS.
WITH THE MASSIVE DID THAT CAN BE
BROUGHT TOGETHER TO -- AND THIS
IS PERHAPS THE LARGEST STUDY TO
MY KNOWLEDGE THAT HAS BEEN
PUBLISHED VIS-A-VIS THE SAMPLE
SIZES.
MORE THAN 1 MILLION SUBJECTS.
IT IS IDENTIFYING UNDERLYING
SUBSTANCE USE DISORDERS.
THE MAIN FINDING OF THESE
STUDIES, LIKE OTHERS, THEY ARE
POLYGENIC RESOURCE, NOT JUST ONE
GENE, MULTIPLE GENES.
THAT IS FINDING NUMBER ONE.
WE ALREADY KNEW FROM OTHER
STUDIES THAT PRECEDED IT.
THE OTHER EXTREMELY IMPORTANT
FINDING FROM THIS STUDY IS THE
MAIN VULNERABILITY OF THE GENE'S
CONFER IS NOT TO SPECIFIC
ADDICTIONS.
IT IS NOT LIKE THERE IS A
VULNERABILITY FOR TOBACCO
ADDICTION, THAT IS THE MAIN SIZE
OR CANNABIS OR OPIOID ADDICTION
OR ALCOHOL.
IT IS INSTEAD A GENERAL
VULNERABILITY FACTOR FOR
ADDICTION.
AND THAT IS ULTIMATELY THE DATA
BY ITSELF, BY FAR THAT HAS THE
LARGER EFFECT SIZES FROM ANY OF
THE OTHER SAMPLES OF SUBSTANCE
USE DISORDERS.
IT IS INTERESTING BECAUSE WHEN
YOU LOOK AT IT, THERE ARE 42
GENES ON THAT POLYGENIC SCORE.
BUT FOUR WEIGHT THE MOST.
IT IS INTERESTING BECAUSE IT
IDENTIFIED HAVING THE HIGHEST
WEIGHT IN CONTRIBUTING TO OUR
RACE FOR THIS GENETIC FACTOR.
THE F T O GENE THAT HAS ALSO
BEEN LINKED FOR VULNERABILITY
WITH OBESITY, THE DOPAMINE D2
RECEPTOR, ASSOCIATED WITH
VULNERABILITY FOR A WIDE VARIETY
OF ADDICTIONS AND THE 4B GENE
HAS BEEN IDENTIFIED BY SOME AS A
POTENTIAL TARGET FOR THE
TREATMENTS OF ADDICTION.
AND IT IS AN ENZYME INVOLVED IN
THE DEGRADATION OF AN
INTRACELLULAR MESSENGER.
IT STARTED BY THE EFFECTS OF
DRUGS.
WE KNOW THAT.
WHAT IS INTERESTING BECAUSE
AGAIN THAT IS WHY I STARTED MY
TALK LIKE THAT, THESE GENES,
THESE POLYGENIC SCORES NOT ONLY
INCREASES THE RISK OF MULTIPLE
SUBSTANCE USE DISORDERS BUT
OTHER MENTAL PSYCHIATRIC
DISORDERS, INCLUDING SUICIDAL
BEHAVIOR, ANXIOUSLY, DEPRESSION
AND EXTERNALIZING BEHAVIORS.
PROVIDING AN UNDERSTANDING ABOUT
WHY IS IT SO PREVALENT WE HAVE
THESE CONDITIONS, WHY DO PEOPLE
HAVE THEM AND THEY RUN IN
FAMILIES?
IT IS A CONCEPT AND ULTIMATELY
IT SHOULD BE HOW WE TRANSLATE
THESE INTO INTERVENTIONS AND
EVENTUALLY OBVIOUSLY DEVELOPMENT
OF PREVENTION AND TREATMENT.
THE OTHER EXTREMELY IMPORTANT
COMPONENT FOR ALL OF THE
SUBSTANCE USE DISORDERS AND
BEHAVIORAL DISORDERS IS THAT
ACTUALLY THE SOCIAL DETERMINANTS
OF HEALTH.
IN PARTICULARLY THE CHILDHOOD
EXPERIENCES.
I'M SHOWING YOU A SLIDE THAT IS
VERY OLD, BUT IT IS VERY
ELOQUENT.
IT SPEAKS BY YOURSELF.
IT TELLS YOU WE ARE LOOKING AT
GENETICS AND THEY ARE IMPORTANT
AND THEY PROVIDE AND MAY
INCREASE MY RISK OF THAT
VULNERABILITY FACTOR.
ED A VERAS CHILDHOOD EXPERIENCES
INCREASE RISK FOR A SUBSTANCE
USE DISORDER EIGHT FOLD.
WE HAVE KNOWLEDGE THAT CERTAIN
EXPERIENCES, PARTICULARLY DURING
CHILDHOOD, CAN HAVE LONG LASTING
IMPACT IN THE WELL BEING, IN THE
MENTAL HEALTH WELL BEING,
INCLUDING THE RISK OF SUBSTANCE
USE DISORDER OF THAT CHILD AS
THEY GROW INTO ADULTHOOD.
BY THE WAY, THESE ADVERSE
CHILDHOOD EXPERIENCES CAN IMPACT
OTHER MEDICAL CONDITIONS.
BECAUSE OF THAT, BECAUSE OF ITS
IMPORTANCE, WE KNOW GENETICS AND
WE KNOW THAT ENVIRONMENT IS
IMPORTANT, BUT WHAT WE DON'T
REALLY KNOW IS WHAT IS IT THESE
POLYGENIC SCORE IS DOING TO OUR
ABILITY TO REACT TO THE
EXPERIENCES THAT APPEAR THROUGH
YOUR CHILDHOOD?
THAT IS THE GAP OF KNOWLEDGE
WHERE WE DON'T HAVE.
HOW DO WE LINK THAT BASIC
UNDERSTANDING OF THE GENES, THE
MULTIPLICITY OF GENES AND THAT
DIFFERENT WEIGHTS THEY HAVE IN
AN INDIVIDUAL.
ULTIMATELY IN THE WAY THEY ARE
GOING TO DRIVE TO A CERTAIN
EXTENT, INCREASE THE LIKELIHOOD
THEY RESPOND IN CERTAIN WAYS TO
THE ENVIRONMENT THEY ARE BROUGHT
UP WITH.
THAT IS HOW THE TWO GIGANTIC
STUDIES THAT SOME OF THE MOST
IMPORTANT ONES THAT WE ARE DOING
GOT BORN.
THE ADOLESCENT BRAIN COGNITIVE
DEVELOPMENT, ABCD STUDY TO YOUR
RIGHT, WHICH WAS BORN IN
INTERACTIONS AND DISCUSSIONS
BETWEEN GEORGE KOOB AND MYSELF
WHEN WE WERE TASKED WITH CRAN
WHAT COULD BE REALLY
TRANSFORMATIVE THAT GIVES US THE
OPPORTUNITY BY BRINGING TOGETHER
THE INSTITUTES TOGETHER TO DO
SOMETHING NO ONE ELSE HAS DONE.
THAT IS HOW THE ABCD WAS DONE,
TO ACTUALLY IDENTIFY IN A LARGE
COHORT RESPECTIVELY HOW THE
BRAIN DEVELOPMENTS, HOW IT IS
INFLUENCED BY GENETICS, HOW
ENVIRONMENT AFFECTS IT.
IT WAS INITIATED IN 2016.
IT IS CLOSE TO 10 YEARS, WHICH
WAS ITS ORIGINAL TIMELINE.
YOU WILL WITH BE HEARING SOME OF
THE DETAILS THIS AFTERNOON BY
DR. GAYA DOWLING WHO HAS BEEN
DIRECTING THIS EXTREMELY
EXCITING STUDY.
THIS STUDY WAS BORN OUT OF CRAN
IN CLOSE COLLABORATION WITH THE
ALCOHOL INSTITUTE.
NCI, NIMH AND OTHER INSTITUTES.
WAS SO SUCCESSFUL THAT IT
INSPIRED US TO SAY, OKAY, WE
KNOW THAT THE ABCD WE STARTED
SCREENING AND RECRUITING
CHILDREN 9 TO 10 YEARS OF AGE IS
ALL MISSING A HUGE STAGE OF
DEVELOPMENT.
WE DO KNOW THAT EARLY CHILDHOOD
IS CRUCIAL IN IMPRINTING OUR
BRAINS.
SO REALIZES THAT WE HAD LEARNED
HOW TO DO SUCH A COMPLEX STUDY,
WE LAUNCHED IN 2023, BASICALLY
BEFORE THAT, 2021 WE LAUNCHED
THE PILOT STUDIES AN EQUIVALENT
STUDY THAT IS THE HEALTHY BRAIN
AND CHILD DEVELOPMENT STUDY.
IT IS INITIATED IN INFANCY.
AND HAS BASICALLY -- IS RELYING
ON RECRUITING PREGNANT WOMEN
WITH THE PLAN OF ACTUALLY
MONITORING THEIR CHILDREN FOR 10
YEARS.
IT AIMS TO ACTUALLY RECRUIT
APPROXIMATELY 7,000 INFANTS.
AND WE -- YOU WILL BE HEARING
DETAILS OF THESE STUDIES LATER
TODAY BY CHRISTOPHER SARAMPOTE
WHO IS THE DIRECTOR OF THIS
PROGRAM.
SO IN THE MEANTIME, I DO WANT TO
HIGHLIGHT TWO EXAMPLES BECAUSE
THEY ILLUSTRATE ACTUALLY SOME OF
THE ISSUES OF WHY THIS IS SO
EXTREMELY IMPORTANT.
AND WHAT DOES IT GUIDE US IN
TERMS OF INTERVENTIONS TO
ADDRESS THE PROBLEM OF SUBSTANCE
USE DISORDERS OVERALL, WHICH AS
I SAY AND YOU ARE GOING TO BE
HEARING ME ALL ALONG,
INTERVENTIONS I WOULD PUT
FORWARD AS THE MOST CRUCIAL ONE
OF HOW DO WE PREVENT THEM.
WE HAD SEEN, YES,
EPIDEMIOLOGICAL STUDIES THAT
ADVERSE ENVIRONMENTS ARE
ASSOCIATED WITH WORSE OUTCOMES
AND ESPECIALLY WITH SUBSTANCE
USE DISORDERS.
THROUGH THE ABCD THEY HAVE DONE
MANY, MANY STUDIES THAT HAVE
SHOWN SEVERAL FACTORS THE SOCIAL
DETERMINANTS OF HEALTH THAT
NEGATIVELY IMPACT THE
DEVELOPMENT OF THE BRAIN OF
THESE TEENAGERS.
IN PARTICULARLY, CHILDREN THAT
COME FROM LOW-INCOME FAMILIES,
FOR EXAMPLE, HAVE SIGNIFICANT
CHANGES IN THEIR BRAIN
DEVELOPMENT IN TERMS OF
MORPHOLOGY AND CONNECTIVITY.
THESE CHANGES IN TURN ARE
ASSOCIATED WITH WORSE COGNITIVE
PERFORMANCE.
THIS HAS BEEN DOCUMENTED USING
MULTIPLE MEASURES THAT ARE
ACTUALLY INDICATORS OF IMPORTANT
FOR BRAIN DEVELOPMENT INCLUDING
PREDOMINANTLY BRAIN MORPHOLOGY
AND COGNITIVE CONNECTIVITY.
THEY LOOK AT WHITE MATTER
TRACKS.
WE KNOW THAT THE BRAIN BASICALLY
HAS MORE NEURONS THAN IT IS
ULTIMATELY GOING TO END UP WITH
WHEN WE ARE BORN AND PART OF THE
PROCESS OF DEVELOPMENT IS TO
MAXIMIZE THE NEURONS THAT ARE
GOING TO BE ABLE TO RESPOND TO
THE ENVIRONMENT WHICH THAT CHILD
IS EXPOSED TO.
AND TO CONNECT WITH THE NETWORKS
AND CLUSTER OF NEURONS NECESSARY
TO FORM THE ACTIVITIES THAT
ULTIMATELY THE BRAIN PROCESSES.
AND THAT IS RELYING HEAVILY ON
THE FORMATION OF WHITE MATTER
CONNECTIONS.
SO THIS STUDY ACTUALLY DOES AN
ELEGANT ANALYSIS OF THE STRENGTH
OF THOSE WHITE MATTER TRACKS.
YOU SEE WHITE MATTER FUNCT
FUNCTIONAL -- AND IT SHOWS THE
HOUSEHOLD NICK BRACKET FROM
WEALTHIER PARENTS TO THE RIGHT
AND TO THE LEFT MORE
ECONOMICALLY DEPRIVED FAMILIES.
YOU CAN CLEAR SEE THE
CONNECTIONS ARE MUCH STRONGER IN
CHILDREN OF FAMILIES THAT ARE
WELL TO DO.
WHICH IN A WAY IS LIKELY TO
REFLECT THE FACT THAT A LOT OF
PEOPLE HAVE WRITTEN ABOUT IT,
WHEN PARENTS DON'T HAVE TO HAVE
TO OR THREE JOBS IN ORDER TO
MAINTAIN, TO PROVIDE FOOD AND
HOUSING AND ARE NOT CONSTANTLY
STRESSED, THEY CAN PAY MUCH MORE
ATTENTION AND CHALLENGE THOSE
CHILDREN.
AND THAT IS NECESSARY FOR THE
BRAIN TO DEVELOPMENT.
TO THE RIGHT WHAT YOU SEE IS THE
IT AFFECTS THE STRENGTH OF THE
CONNECTION AND IN TURN THAT IS
ONE OF THE FACTORS THAT DRIVES
THE DIFFERENCES IN COGNITIONS
YOU SEE IN CHILDREN OF DIFFERENT
HOUSEHOLDS.
SUCH THAT CHILDREN THAT COME
DOCTOR BETTER TO DO ECONOMICALLY
FAMILIES DO BETTER IN COGNITIVE
TASKS THAN THOSE THAT COME FROM
LOWER-NUMBER FAMILIES.
AGAIN, NOT SURPRISING THE PLAIN
IS A NEUROPLASTIC SYSTEM AND
RESPONDS TO STIMULATION.
YOU NEED THE STIMULATION IN
ORDER FOR THE CONNECTIONS TO
FORM.
IF YOU DON'T GIVE THEM PROPERLY,
YOU ARE PUTTING THAT CHILD AT A
DISADVANTAGE.
THE OTHER ONE I WANT TO
EMPHASIZE HERE IS BECAUSE IT IS
NOT NECESSARILY WHAT PEOPLE WILL
HAVE EXPECTED AS A FINDING, IS A
PAPER THAT GOT PUBLISHED LAST
YEAR.
AND IT WAS LOOKING AT NOW THAT
THE ABCD CHILDREN ARE IN LATER
TEENAGE YEARS, THEY ARE STARTING
TO TAKE DRUGS SO THAT
RESEARCHERS ARE LOOKING AT THOSE
THAT ARE TAKING NOW ON THE ABCD
CHILDREN THAT MAY BE USING
ALCOHOL, NICOTINE OR CANNABIS
AND GOING BACKWARD AND SAYING
ARE THERE CERTAIN DIRECTORIES
THAT COULD HAVE LEAD US TO
PREDICT THEY WERE ALL GOING TO
DEVELOP -- START TO USE
SUBSTANCES?
VERY IMPORTANT QUESTION BECAUSE
IT RELATES TO THE NOTION, TWO
THINGS.
ONE OF THEM, ARE THERE CERTAIN
FACTORS IN YOUR BRAIN THAT MAKE
YOU VULNERABLE TO ACTUALLY MORE
LIKELY TO DO SUBSTANCES?
AND THE OTHER ONE IS WE ARE VERY
INTERESTED IN UNDERSTANDING HOW
DRUGS USED DURING ADOLESCENCE
COULD NEGATIVELY IMPACT YOUR
BRAIN.
SO IT IS RELATIVE TO THAT.
WHAT IS FASCINATING FOR MY BRAIN
IS WHAT YOU SEE ON THE LEFT.
IFT SORT OF SAYS REGIONAL
CORTICAL VOLUMES AND THICKNESS
ASSOCIATIONS WITH EARLY
SUBSTANCE USE OR ALCOHOL IN A OR
B, THEY ARE VERY, VERY SIMILAR.
THE COLORS REPRESENT AREAS WHERE
YOU HAVE LESS VOLUME IN PURPLE
AND MORE VOLUME IN RED.
LESS COURT KOL THICKNESS IN
PURPLE AND MORE COURT KOL
THICKNESS IN RED.
IF YOU CORTICAL -- LESS CORTICAL
THICKNESS IN PURPOSED AND MORE
CORTICAL THICKNESS IN RED.
THERE ARE OTHER AREAS OF THE
BRAIN THAT SHOW MORE VOLUMES AND
THINNER CORTICAL THICKNESS.
INTERESTINGLY, LET'S LOOK AT
CORTICAL THICKNESS.
LESS CORTICAL THICKNESS ON THOSE
GOING ON TO TAKE DRUGS IN MEDIAL
AREAS OF THE BRAIN, THE FRONTAL
CORTEX AND THE WHOLE MEDIA
BROGMAN.
THESE ARE ASSOCIATED WITH
CORTICES.
THERE IS THE CORTEX HERE.
THAT AREA OF THE BRAIN IS A
PRIMARY MOTOR REGION.
THIS WAS INTRIGUING BECAUSE
STUDIES ON LOW-INCOME SHOWED A
SIMILAR PATTERN.
MORE CORTICAL THICKNESS IN SUB
MATTER AND SIMILARLY WITH THE
VOLUMES INDICATING THAT IN FACT
PERHAPS AND AGAIN WHEN WE ARE
DISCUSSING THE NOTION OF HOW DO
ADVERSE ENVIRONMENTS ULTIMATELY
MAKE YOU MORE VULNERABLE.
THIS MAY CONTRIBUTE.
WHY?
BECAUSE YOU REQUIRE YOUR
PREFRONTAL CORTEX CERTAINLY TO
ACTUALLY MAKE DECISIONS AND
SELF-REGULATE YOURSELF.
ON THE OTHER HAND, THESE PRIMARY
AREAS OF THE CORTEX ALLOW US TO
BE VERY, VERY RESPONSIVE, BUT IN
A MUCH MORE AUTOMATIC FASHION.
I THINK AS WE GATHER THIS
INFORMATION, THEN THE QUESTION
IS ARE THERE THINGS WE CAN DO IF
YOU HAVE SOMEONE ALREADY TAKING
DRUGS THAT CAN HELP BUFFER THESE
CHANGES?
AND MY ANSWER IS I BET YOU THEY
ARE.
WHY?
BECAUSE THE BRAIN IS VERY
PLASTIC.
IF WE CAN PROVIDE THE TYPE OF
STIMULATION THAT WILL ENGAGE
THESE CORTICAL AREAS, I SUSPECT
WE ARE GOING TO START TO SEE
THEM BASICALLY RECOVERING TO
PATTERNS IN OTHER CHILDREN THAT
ARE PERFORMING WELL AT SCHOOL.
SO TODAY YOU ARE GOING TO SEE
THE PRESENTATION FOR THE HBCD.
I'M SHOWING YOU NOT TO DWELL ON
ANYTHING EXCEPT FOR THE FACT TO
DOCUMENT AN ASPECT WE NEED TO
ACTUALLY BE MUCH MORE PROACTIVE
ON BREAKING IS THIS JUST TELLS
US THE DRUGS THAT PREGNANT WOMEN
ARE TAKING.
IT WAS MENTIONED MORE WOMEN THAT
ARE PREGNANT ARE TAKING HIGHER
DOSES OF ALCOHOL.
BUT WHAT IS CLEAR IS THAT
BASICALLY THE MAJORITY OF THE
GROUPS THAT WE HAVE HAVE MORE
THAN ONE SUBSTANCE.
YET OUR WORK HAS BEEN STUDYING
ALCOHOL BY ITSELF, TOBACCO BY
ITSELF, MARIJUANA BY ITSELF.
AND THERE IS LIKELY TO BE
IMPORTANT INTERACTIONS BETWEEN
HOW THESE TWO PHARMACOLOGICAL
AGENTS INFLUENCE THE DEVELOPMENT
OF THE CHILDREN.
I'M USING THIS TO ILLUSTRATE
THAT.
THEN FOR THE LAST PART OF MY
TALK I JUST WANT TO GIVE YOU --
I GAVE YOU THIS YID, BUT THOSE
THAT WERE NOT IN COUNCIL, WHERE
WE ARE WITH THE OVERDOSE CRISIS.
VERY EXCITING NEWS.
WE HAVE BEEN SEEING SIGNIFICANT
DECLINES IN MORTALITY IN THE
PAST YEAR AND THE LARGEST
CHANGES WERE OBSERVED IN THE
LAST NUMBERS RECEIVED BY THE CDC
THAT CORRESPOND TO NOVEMBER
2024.
WHERE WE ACTUALLY WHEN COMPARED
TO NOVEMBER 23 WERE SEEING A 2%
REDUCTION IN OVERDOSE MORTALITY,
WHICH IS VERY, VERY, VERY, VERY
EXCITING.
THERE ARE STILL MANY, MANY
CHALLENGES AND ONE OF THE MOST
IMPORTANT ONES IS WHAT YOU ALSO
THIS DATA IS SHOWING THAT THERE
ARE MULTIPLE DRUGS THAT ARE
CONTRIBUTED TO THE OVERDOSE
MORTALITY.
WE FOCUS ON OPIOIDS BECAUSE 70%
OF DEATHS CONTAIN OPIOIDS.
BUT WE DON'T REALIZE THAT MOST
OF THOSE DEATHS ALSO CONTAIN
OTHER DRUGS.
AND ALSO WE ARE NOT REALLY EVEN
PROPERLY MONITORING FOR THE
CO-PRESENCE OF ALCOHOL AND
OPIOIDS WHICH CAN BE VERY, VERY
MALIGNANT AND NOT GOING TO BE
RESPONDING TO NALOXAN.
WE ARE NOT REACTING TO THE FACT
THAT WHEN PEOPLE HAVE NOT JUST
ONE SUBSTANCE USE DISORDER,
ALCOHOL USE DISORDER, OPIOID USE
DISORDER.
THEY ARE TREATING WITH ALCOHOL
DISORDER THAT IS VERY, VERY
PREVALENT THEY ARE LIKELY TO GO
BACK TO DRINKING EVEN ON
MEDICATIONS TO OPIOID USE
DISORDER AND THOSE INDIVIDUALS
ARE HIGHER RISK FROM OVERDOSES.
SO WE'VE BEEN BASICALLY FOCUSING
AND SAYING WE NEED TO ALSO
ENCOURAGE RESEARCHERS TO WORK IN
POLYSUBSTANCE USE DISORDERS.
I'M HIGHLIGHTING ONE TODAY ONLY.
I DID THAT YESTERDAY.
I'M DOING IT DIFFERENTLY TODAY.
WE ARE EXTREMELY EXCITED FOR THE
PEPTIDE MEDICATIONS FLP1R
MEDICATIONINGS FOR ADDICTION
TREATMENT.
IT TRANSFORMS THE WAY WE CAN
HANDLE THESE CONDITIONS AND MORE
AND MORE PATIENTS ARE BEING
TREATED WITH THESE MEDICATIONS
AND AS A RESULT OF THAT, PEOPLE
ARE STARTING TO REALIZE THAT IT
NOT ONLY DECREASES THEIR CRAVING
FOR FOOD, BUT EVIDENTLY IT SEEMS
TO BE THEIR CRAVING AND DESIRE
FOR DRUGS, BECOMIING SATIATED.
THE CLINICAL DATA NOTED THIS IS
2015 SHOWING THAT, I MEAN NOT
SURPRISING, THAT THE GLP1
PEPTIDE RECEPTORS ARE IN THE
DOPAMINE NUCLEI.
THERE IS DATA TO SHOW SOME
DOPAMINE CELLS EXPRESS
RECEPTORS.
SOME SAY THEY ARE IN THE GABBA
CELLS.
BE IT AS IT MAY, THE V T A IS
REGULATED BY -- LIKE PEPTIDE
RELEASED.
AND THAT IN TURNS MODELS THE
SIGNALLING.
THIS HAS BEEN SHOWN TO BE A
MECHANISM BY WHICH THESE
MEDICATIONS LIKE SEMI GLUTIDE
REDUCE OVEREATING, HIGH FAT DIET
IS REDUCED BY THE USE OF THESE
MEDICATIONS WHERE STANDARD DIETS
DO NOT.
AND THEY DO ACTUALLY REDUCE THE
AMOUNT OF DOPAMINE RELEASED BY A
HIGH-FAT DIET.
THEY REDUCE THE AMOUNT OF
DOPAMINE FROM COCAINE, ALCOHOL,
FROM NICOTINE.
THIS IS JUST A VERY RECENT STUDY
PUBLISHING HOW EXENDIN THESE
MEDICATIONS REDUCES COCAINE
ADMINISTRATION AND SIGNIFICANTLY
REDUCES DOPAMINE INCREASING WITH
COCAINE.
MULTIPLE REPORTS FROM JUST
FACES, FROM SMALL CLINICAL
TRIALS, TWO RANDOMIZED CLINICAL
TRIALS HAVE BEEN PUBLISHED FOR
ALCOHOL, ONE WITH POSITIVE
RESULTS AND ONE WITH I USED THE
SECOND GENERATION DOCUMENTING
DECREASES IN HEAVY DRINKING
DAYS, BUT MANY STUDIES DONE
BASED ON ELECTRONIC RESPECTIVE
ANALYSIS SHOWING SIGNIFICANTLY
BETTER OUTCOMES FOR ACTUALLY
INDICATORS OF ALCOHOL
CONSUMPTION, INDICATORS OF
CRAVING IN OPIOID USE DISORDER
AND INDICATORS OF TOBACCO AND
USE OF NICOTINE AND REDUCING
CANNABIS FOR PEOPLE WITH AN
OPIOID USE DISORDER.
THE TEAM OF RESEARCHERS ALL OVER
THE WORLD CAME UP HIGHLIGHTING
THAT THESE EXTREMELY PROMISING,
BUT REQUIRES THAT WE ALL
ACTUALLY DO THE WORK THAT IS
NECESSARY TO DOCUMENT WHETHER --
WHAT IS THE EVIDENCE FOR
EFFECTIVENESS OF THESE
MEDICATIONS SO THEN THEY CAN BE
PROVIDED TO PATIENTS IF THEY ARE
POSITIVE.
AND THE LAST POINT THAT I WANT
TO MAKE IS OVERALL SORT OF
SPEAKING ABOUT HOW WE NEED TO
ADVANCE RESEARCH THAT ACTUALLY
LEADS WITH THE CO-OCCURRENCE OF
THESE SUBSTANCES BECAUSE THAT IS
WHAT BIOLOGY IS TELLING US IS
HAPPENING BUT ALSO THAT LEADS TO
THE BEST CLINICAL OUTCOMES.
IT IS ALSO TELLING US, AND THIS
IS SOMETHING THAT GEORGE HAS
SPOKEN EXTENSIVELY ON.
WE HAVE SPOKEN TOGETHER.
WE HAVE WRITTEN ABOUT IT, IS
THAT THE PROCESS OF ADDICTION IS
A CYCLE THAT ACTUALLY, LEADS
PEOPLE INTO DIFFERENT STAGES
FROM THE USE OF INTOXICATION TO
WITHDRAWAL TO THEN CRAVING.
OR RECOVERY.
BUT WE TEND TO, IN THE PAST,
HAVE FOCUSED SPECIFICALLY ON
TREATMENT.
HOW DO WE TREAT?
INVESTIGATING THAT STATE OF
COMPULSIVE DRUG YUSZ.
INVESTING THE STATE OF WITHDRAW.
WE HAVE DONE MUCH LESS IN THE
STATE OF RECOVERY.
THE BRAIN IS NEUROPLASTIC AND
ACTUALLY TO WHAT EXTENT THE LIVE
CHANGES WHEN SOMEONE IS
ADDICTED, WITH SOCIAL ISOLATION,
A LOSS OF JOB, BASICALLY
DEPRIVATION THAT THE DISEASE
EXERTS ON THEM, HOW DOES THAT IN
TURN AFFECT THEIR BRAIN?
SO UNDERSTANDING AND
INVESTIGATING THAT PROCESS OF
HOW -- WHAT DOES IT TAKE FOR THE
BRAIN TO RECOVER TO A STATE THAT
ACTUALLY IT CAN BECOME ENGAGED?
ALL OF THOSE STAGES ARE ACTUALLY
EXTREMELY IMPORTANT AREAS WITH
RESPECT TO RESEARCH ON THE ONE
HAND.
EXPANDING IT.
AND IMPORTANTLY, TO BUILD UP AND
TO INFORM ON MODELS OF CARE THAT
ACTUALLY DON'T JUST FOCUS ON
ONE.
LET'S DO THE TREATMENT.
WE REALIZE IT IS IMPORTANT TO
HAVE THE CONTINUITY OF QUARTER
THAT WOULD HOPEFULLY LEAD
SOMEONE TO SUSTAINED RECOVERY.
BUT IN THESE TRANSITIONS, THIS
MODEL ALSO HIGHLIGHTS HOW
CRUCIAL IT IS FOR ACTUALLY
INTERVENTIONS TO PREVENT DRUG
EXPOSURES AND DRUG ESCALATION TO
CURE.
GENETIC OR ENVIRONMENT FACTORS.
HAVING SAID THAT, I JUST WANT TO
MAKE EVERYBODY AWARE THAT IN
JOINTLY WITH THE ALCOHOL
INSTITUTE NIDA, NCI, VERY
IMPORTANT PARTICIPANT, WE TASKED
THE NATIONAL ACADEMIES OF
SCIENCE AND MEDICINE AND
ENGINEERING TO WRITE A
PREVENTION, TO DO A REPORT ON A
PREVENTION INFRASTRUCTURE FOR
MENTAL, EMOTIONAL AND BEHAVIORAL
DISORDERS THAT WAS RELEASED LAST
MONTH AND THAT EMPHASIZES AREAS
THAT ARE CRUCIAL IN TERMS OF
RESEARCH AND INCLUDING THE
IMPORTANCE OF COLLECTING DATA,
BUT ALSO IDENTIFIED
OPPORTUNITIES FOR POLICIES TO
GENERATE AN INFRASTRUCTURE THAT
WILL ALLOW EVIDENCE-BASED
PREVENTIONS TO ACTUALLY BE
DEPLOYED AND SUSTAINED IN
DIVERSE COMMUNITIES SO WE CAN
ADDRESS THE DEVASTATING
CONSEQUENCES THAT SUBSTANCE USE
AND BEHAVIORAL HEALTH DISORDERS
HAVE ON THE LIFE OF AN
INDIVIDUAL.
AND WITH THAT, I END MY
PRESENTATION AND I'M GOING TO
STOP SHARING.
I DO NOT KNOW IF THERE IS TIME
FOR QUESTIONS OR NOT.
>> I THINK WE CAN TAKE A FEW
MINUTES FOR QUESTIONS.
ANY QUESTIONS FROM COUNCIL
MEMBERS.
>> YES A QUESTION FROM ISABELLE
DURAN.
>> THANK YOU VERY MUCH, DR.
VOLKOW.
I REALLY ENJOYED THAT
PRESENTATION PARTICULARLY A
CONCEPT TO ME OF WHOLE PERSON
CARE.
CANCER DOESN'T BEGIN AT THE
CLINIC DOOR.
COMMUNITY AND SOCIAL
DETERMINANTS OF HEALTH THAT
IMPACT DISEASE.
A IT IS MULTIPLE THINGS THAT
CREATE THE RISK.
I HAVE A FEW QUESTIONS, SO
PARDON THE TWO OR THREE
QUESTIONS I HAVE THE OPPORTUNITY
TO ASK YOU.
IN TERMS OF THIS, EDUCATION IS
MOST CRITICAL.
IS THE INSTITUTE POINTING
OUTWARDS TO GET EDUCATIONAL
INFORMATION TO GRADE SCHOOLS
STARTING AT GRADE SCHOOLS TO
INTERVENE INTO TAKING UP THE USE
OF OPIOIDS OR WHATEVER.
THEY ARE STRESSED OR IMPACTED OR
MODELLED BY SOMETHING ELSE.
THAT IS THE ONE THING.
EDUCATION.
CAN YOU GO TO THE DEPARTMENT OF
EDUCATION AND SAY LET'S START AN
EDUCATION PROGRAM THAT GOES TO
ALL OF THE SCHOOLS, PARTICULARLY
THE MOST VULNERABLE.
SO THAT IS ONE.
THE SECOND THING IS I WAS
TALKING TO A RESEARCHER WHO WAS
DOING A RESEARCH PROJECT IN
PHILADELPHIA WITH LATINO KIDS
WHO WERE VAPING.
AND ONE OF THE THINGS HE ASKED
THEM WAS THE FACT THAT THIS IS
AN EXPENSIVE KIND OF HABIT.
HOW ARE YOU AFFORDING IT?
AND THEY SAID THEY WERE SHARING.
THAT RAISED ISSUES WITH ME
ABOUT -- BY SHARING THESE
CIGARETTES, WHAT IMPACTS
LONG-TERM COULD THEY POSSIBLE
HAVE?
COULD THEY HAVE ANY?
THERE IS ANOTHER ASPECT OF
EDUCATION.
DON'T SHARE.
YOU MIGHT BE PASSING IT AROUND.
THIRDLY DO YOU HAVE
DISAGGREGATED SUB POPULATION
DATA SO I CAN LOOK AT THIS DATA
AND KNOW WHAT I CAN TELL THE
LATINO COMMUNITY ABOUT THESE
ISSUES, HOW THEY ARE IMPACTING
THEM AND WHAT WE NEED TO DO TO
INTERVENE AS COMMUNITIES, AS
FAMILIES, AS INDIVIDUALS.
>> VERY IMPORTANT QUESTION AND
YOU ARE POINTING YOUR FINGER ON
EXACTLY ONE OF OUR MAIN TARGETS
FOR INTERVENTION AND THAT IS
EDUCATION AND GOING TO THE
SCHOOLS.
I WAS ACTUALLY SMILING AT THAT
AND LOOKING AT GEORGE BECAUSE HE
WAS SMILING ALSO.
WOE DEFINITELY BOTH OF OUR
INSTITUTES HAVE REACHED OUT TO
THE DEPARTMENT OF EDUCATION TO
MAKE THEM AWARE OF THE
IMPORTANCE OF CURRICULA THAT
RELATE TO EDUCATION, BUT ALSO
PROGRAMS THAT HAVE BEEN SHOWN
FOR WHICH THE EVIDENCE
INDICATES, PROGRAMS BASED ON
SCHOOL, THEY SIGNIFICANTLY
IMPROVE THE OUTCOMES.
UNFORTUNATELY, THERE HAS NOT
BEEN MUCH RECEPTIVENESS.
PART OF IT IS THE CURRICULUM IS
ALREADY SO HEAVY THEY DON'T SEE
WAYS IN WHICH IT CAN BE
INCORPORATED.
SO THIS IS A PROBLEM.
AND I DO HOPE -- WE WERE HOPING
THAT WITH THE RELEASE OF THE
REPORT FROM THE NATIONAL
ACADEMY, THIS WILL BRING
ATTENTION TO PREVENTION,
INCLUDING BUY-IN FROM THE
EDUCATIONAL SYSTEM.
BECAUSE IT IS AN EXTREMELY
IMPORTANT ONE.
THAT IS ONE.
THE OTHER ONE AND I DISCUSSED
THIS YESTERDAY, WAS THE WHOLE
ISSUE OF THE FAMILIES.
FAMILIES ALSO, TWO VERY
IMPORTANT LINE OF DEFENSE WE
HAVE.
NUMBER ONE IS FAMILIES.
NUMBER TWO IS SCHOOLS.
AND WE NEED TO EDUCATE BOTH IN
THE SCHOOL AND IN THE FAMILY.
AND THAT IS A MESSAGE WE WILL
CONTINUE CARRYING ON BECAUSE IT
IS ACTUALLY, YOU KNOW, WHEN
PEOPLE SAY, WELL, THERE'S NO
TIME OR THERE'S NO RESOURCES.
THE ISSUE IS HOW YOU PRIORITIZE
YOUR TIME.
HOW YOU PRIORITIZE YOUR
RESOURCES.
AND NOW WITH OTHER TECHNOLOGIES
WE CAN DELIVER SOME OF THE
INTERVENTIONS IN H WAYS THAT
ARE MUCH MORE ACCESSIBLE TO
EVERYONE.
WHICH COMES BACK TO YOUR
QUESTION ABOUT DISAGGREGATED
INFORMATION.
THE ANSWER IS YES.
IN FACT, RESEARCHERS HAVE BEEN
WORKING TO INVESTIGATE WHAT ARE
FACTORS AND INTERVENTIONS THAT
MAY WORK BETTER IN CERTAIN
GROUPS OR OTHER.
ONE OF THE STRENGTHS AND
RESILIENCY FACTORS OF SERVING
CERTAIN COMMUNITIES LIKE THAT OF
HISPANICS, IS VERY MUCH AMONG
BLACK AMERICANS IS THAT OF THE
FAMILY STRUCTURE.
IN THE LATINO FAMILY STRUCTURE
YOU HAVE THESE VERY CLOSE TIES.
THAT PROVIDES A SUPPORT SYSTEM
YOU CAN, IF USED PROPERLY, CAN
HELP NAVIGATE THOSE TEENAGERS
AND PROTECT THEM.
SAME THING WITH BLACK
COMMUNITIES AND WHAT WE SEE IS
IN GENERAL OVERALL IN BLACK
TEENAGERS, THEY ACTUALLY IN
GENERAL, THEY TEND TO HAVE LOWER
RISK UNTIL THEY START TO REACH
THEIR LATE TEENS WHEN THEY
TRANSITION INTO ADULTHOOD AND
THE FAMILY IS NO LONGER THERE.
I THINK THE DATA IS ALREADY
THERE.
THE EVIDENCE IS ALREADY THERE.
WE WOULD HOPE THAT THERE WOULD
BE POLICIES THAT PROVIDE SUPPORT
FOR INTERVENTIONS THAT ACTUALLY
ARE GOING TO BE CULTURALLY
SENSITIVE SO OTHERWISE PEOPLE
DON'T ACCEPT THEM, DON'T EMBRACE
THEM AND I THINK THAT IS A KEY
ELEMENT.
YOU HAD A SECOND QUESTION IN
BETWEEN.
BUT I BLOCK IT.
>> ONE THING YOU DIDN'T ANSWER,
THANK YOU FOR REMEMBERING THE
QUESTION.
THIS ONE IS THE FACT THEY ARE
SHARING THEIR ELECTRONIC
CIGARETTES.
THAT POSES LONG-TERM ISSUES OF
OTHER DISEASE TYPES OR ANY
ISSUES THAT NEED TO BE
ADDRESSED.
>> I KNOW.
WHEN YOU WERE SPEAKING ABOUT IT,
YES, WE KNOW THAT RIGHT NOW.
YOU WORDED IT VERY WELL.
THAT IS THE MESSAGE IS DO NOT
SHARE YOUR DRUGS.
BECAUSE TO START WITH, YOU DO
NOT KNOW WHAT YOU ARE GOING TO
GET.
THIS IS A MESSAGE THAT WE HAVE
BEEN DOING PREDOMINANTLY WITH
PRESCRIPTION DRUGS WHERE KIDS
MAY TAKE A FRIEND GIVES THEM A
PRESCRIPTION DRUG TO GET HIGH
ON.
AND THEN IT IS A SUBSTANCE THAT
CONTAINS FENTANYL AND THEY
OVERDOSE.
WITH VAPING, YOU CAN ACTUALLY
MIX A WIDE VARIETY OF SUBSTANCES
PLUS THE CONCENTRATION OF SOME
OF THOSE VAPING DEVICES IS
EXTREMELY HIGH.
FOR A TEENAGER THAT DOESN'T HAVE
THE EXPERIENCE, THIS COULD
ACTUALLY LEAD TO POISONING.
SO, INDEED, JUST FROM THE
PERSPECTIVE OF THE RISK THAT
EXISTS, BY DRUG MIXTURES, THE
MESSAGE SHOULD BE THAT ONE.
DO NOT SHARE DRUGS.
>> THANK YOU.
>> OKAY.
SO I THINK WE SHOULD MOVE ON.
THOSE ARE GREAT QUESTIONS AND
GREAT DISCUSSION AND GREAT TALK
BY NORA.
WE WILL HAVE TIME LATER FOR MORE
DISCUSSION.
SO SAVE YOUR THOUGHTS FOR
DISCUSSIONS WE WILL HAVE LATER
ON.
OUR NEXT SPEAKER IS DR. KLEIN,
THE ASSOCIATE DIRECTOR OF NCI'S
BEHAVIORAL RESEARCH PROGRAM AND
BILL IS GOING TO TALK ABOUT
CRAN-RELATED NATIONAL CANCER
INSTITUTE ACTIVITIES AND
PRIORITIES.
SO BILL, IT'S ALL YOURS.
>> GOOD MORNING, EVERYBODY.
THANK YOU GEORGE AND NORA.
I'M GOING TO RIFF OFF THOSE
PRESENTATIONS.
I'M A JAZZ MUSICIAN SO RIFFING
IS MY COMFORT ZONE.
I WANT TO GIVE YOU A SENSE OF
WHAT WE HAVE BEEN DOING,
THINKING ABOUT AT NCI WITH
REGARD TO THE PRIORITIES OF
CRAN.
I WANT TO START WITH SOME RECENT
UPDATES.
FIRST OF ALL, I WANT TO
EMPHASIZE AND THERE IS PROBABLY
NO BETTER TIME TO EMPHASIZE
THIS, THAT WE HAVE LOTS OF DATA
SETS TO THE EXTRA MURAL
COMMUNITY AND THEY ARE STILL
THERE.
DON'T TAKE THEM FOR GRANTED.
ONE OF THEM IS THE TOBACCO USE
SUPPLEMENT TO THE CURRENT
POPULATION SURVEY.
THIS IS A VERY LARGE DATA SET,
TENS OF THOUSANDS OF PEOPLE ARE
RESPONDING TO THESE SURVEYS.
WE HAVE THE DATA FROM THE MOST
RECENT ITERATION PUBLICLY
AVAILABLE.
ONE OF OUR BRANCH RETURNED FROM
A EMBASSY SCIENCE FELLOWSHIP
WORKING WITH THE FRENCH
GOVERNMENT.
THE WAY THEY ARE ADDRESSING THEM
IS USEFUL.
CAROLYN REYES GUZMAN SPENT TIME
WITH THEM TO HELP THEM WITH THE
ALCOHOL AND TOBACCO PLAN.
WE HAVE HAD CHANGES IN THE
TOBACCO CONTROL LANDSCAPE IN THE
LAST SEVERAL MONTHS.
THE OFFICE OF SMOKING AND HEALTH
AT THE CENTER FOR DISEASES
CONTROL, CDC, HAS BEEN
DISBANDED.
THAT WAS A BIG PART OF OUR
TOBACCO CONTROL EFFORT IN THE
U.S.
AS A RESULT OF THAT AND SOME
OTHER CHANGES THAT HAVE
OCCURRED, WE THINK IT IS REALLY
IMPORTANT TO CONTINUE THE WORK
OF THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES TOBACCO STEERING
COMMITTEE AND THE FEDERAL
CESSATION WORK GROUP.
WE FOLDED THEM INTO THE TOBACCO
AND NICOTINE INTEREST GROUP AT
NIH.
JUST WANTED TO LET YOU KNOW
THAT.
THESE ARE PRIORITIES AND
CONTINUE TO BE PRIORITIES AND
WE'LL CONTINUE TO HAVE MEMBERS
OF MULTIPLE AGENCIES INCLUDING
NIH, INVOLVED IN THESE
DISCUSSIONS.
ANOTHER DATA SET I WANT TO MAKE
SURE YOU ARE AWARE OF, I WANT TO
HIGHLIGHT THE HEALTH INFORMATION
NATIONAL TREND SURVEY, WHICH WE
CONDUCT ABOUT EVERY OTHER YEAR
NOW.
WITH REGARD TO THIS PARTICULAR
AUDIENCE, WE HAVE MULTIPLE
MEASURES OF CANNABIS USE AND
ATTITUDES ABOUT CANNABIS.
TOBACCO, OF COURSE, AND ALSO
ALCOHOL.
AND MANY OTHER TOPICS AS YOU CAN
SEE IN THE LOWER BOX.
THESE SLIDES WILL BE AVAILABLE,
SO I WON'T GO THROUGH THE ENTIRE
SLIDE.
THIS IS A TERRIFIC RESOURCE AND
WE ENCOURAGE OUR EXTRA MURAL
COMMUNITY TO USE IT.
WHEN I WAS A FACULTY MEMBER I
HAD MY NEW STUDENTS DOWNLOAD
THIS TO WORK ON IT AND GET A
PUBLICATION IN THEIR FIRST YEAR.
WE HAVE NOW COMPLETED THE 2024
FIELDING AND THOSE DATA ARE
PUBLICLY AVAILABLE AS A FEW
WEEKS AGO.
WE HOPE PEOPLE WILL TAKE
ADVANTAGE OF THAT.
WE ARE ENGAGED IN A DATA LINKAGE
PROJECT TO LINK DATA TO OTHER
SOURCES.
WE HAVE GEOCODES AND CAN LINK TO
POLICY IMPLEMENTATION IN THE
LOCATIONS THEY ARE COMING FROM.
WE REACHED OUR 1,000th
PUBLICATION FROM HINTS DATA.
THIS IS A SURVEY THAT HAS BEEN
OUT SINCE 2002 SO THAT IS
REMARKABLE.
LET'S TALK ABOUT THE ACTIONS WE
ARE TAKING.
WE ARE CONSTANTLY TAKING A LOOK,
AS IS NIDA, AT TOBACCO USE.
YOU CAN SEE WE ARE SEEING A
DECREASE IN FEMALES BUT NOT THE
SAME KIND OF DECREASE IN MALES
JUST LOOKING OVERALL.
THIS IS TOBACCO USERS IN THE
BILLS.
THIS IS W.H.O. DATA.
WE WOULD LIKE TO THINK OUR
PROBLEM IS GOING DOWN, BUT IT IS
NOT EXACTLY GOING DOWN.
WE KNOW FROM OTHER DATA TOBACCO
USE IS REALLY HIGH IN
POPULATIONS SUCH AS PEOPLE WITH
MENTAL HEALTH DIAGNOSES, PEOPLE
IN THE MILITARY, LGBTQ+ AND SO
ON.
THE LEADING CAUSES OF CANCER
DEATHS THAT WE SPEND A LOT OF
TIME TALKING ABOUT TOBACCO USE
IN THE CONCEPT OF CANCER.
LUNG AND BRONCHIALS IS AT THE
TOP.
IF YOU WERE TO CUT THE NUMBERS
IN HALF, IN TERMS OF LUNG AND
BRONCHUS, YOU STILL HAVE THE
LEADING CAUSE OF CANCER DEATH,
10%.
IT SHOWS HOW POWERFUL THE
EFFECTS ARE OF TOBACCO ON CANCER
MORBIDITY AND MORTALITY AND THE
IMPORTANCE OF ADDRESSING IT.
TAKING A LOOK MORE SPECIFICALLY
AT DIFFERENT AGE GROUPS AND USE
OF TOBACCO.
IN THE LEFT MOST COLUMN THE
NUMBERS HAVE COME DOWN SOMEWHAT.
THEY ARE STILL TOO HIGH.
THEY ARE STILL HIGHER THAN WE
WOULD LIKE THEM TO BE.
IT BREAKS DOWN BY AGE GROUP IN
TERMS OF THE TYPE OF PRODUCT
THEY ARE USING.
SECOND COLUMN 45-64, IN
18-24-YEAR-OLDS THE BIG NEWS IS
E-CIGARETTES.
IT IS CONTINUING OVER TIME AND
WE NEED TO CONTINUE TO MONITOR
THROUGH THE SURVEY AND
POPULATION ON HEALTH, THE HAT
STUDY.
OBVIOUSLY TOBACCO AND CANNABIS
NEED TO BE THOUGHT OF IN THE
SAME CONTEXT.
SO WHAT WE ARE SEEING NOW, THIS
IS DATA FROM THE POPULATION
ASSESSMENT OF TOBACCO AND
HEALTH, WAVE SEVEN.
WE CAN SEE A VERY SMALL PORTION
OF PEOPLE USING TOBACCO AND
CANNABIS.
BUT IF YOU LOOK, THE LEFT MOST
PIE THERE, THAT LITTLE BLUE
PIECE, PULLING THAT OUT
EXTRACTING IT AND LOOK AT WHO
THOSE FOLKS ARE?
BLUE IN THE BIGGER PIE IS
COMBUSTIBLE TOBACCO AND
CANNABIS.
THAT IS THE BIGGEST PERCENTAGE
USING TOGETHER.
COMBUSTIBLE PRODUCTS PRESENT
MORE RISK.
THIS IS A VERY DENSE SLIDE.
I WON'T GO THROUGH ALL OF IT, IT
IS JUST IMPORTANT TO UNDERSTAND
WHAT THIS OVERLAP LOOKS LIKE.
OUR TOBACCO CONTROL RESEARCH
BRANCH OF NCI FOCUSED ALMOST
EXCLUSIVELY ON TOBACCO.
WE NEED TO BE THINKING ABOUT
CANNABIS AND ALCOHOL BECAUSE
THESE SUBSTANCES ARE OFTEN USED
TOGETHER.
WHAT DO PEOPLE THINK ABOUT
CANNABIS USE?
IS OUR HEALTH INFORMATION
NATIONAL TREND SURVEY DATA AS I
MENTIONED BEFORE, WE DO MEASURE
ATTITUDES ABOUT CANNABIS.
AS YOU CAN SEE IN THE PIE ON THE
LEFT, ALMOST 50% REPORT AT LEAST
SOME BENEFIT OF CANNABIS.
IT IS A VARIETY OF BENEFITS THEY
MIGHT SEE.
WE NEED TO ADDRESS THAT.
THIS IS NOT SOMETHING YOU SEE
FOR TOBACCO.
MOST PEOPLE DO NOT SEE BENEFIT
TO TOBACCO.
TOBACCO USERS SEE A BENEFIT AND
ARE STILL TRYING TO QUIT.
THE FACT WE HAVE SUCH A LARGE
PROPORTION OF THE POPULATION
REPORTING BENEFIT OF CANNABIS,
IT IS A DEBATABLE ISSUE BUT
SOMETHING TO TAKE INTO ACCOUNT
WITH CO-USE OF ALCOHOL AND
CANNABIS.
ALCOHOL ASSUMPTION IS
WIDESPREAD.
88% OF AMERICANS DRANK ALCOHOL
AT SOME POINT IN THEIR
LIFETIMES.
70% IN THE LAST YEAR.
WE ARE AT THE NATIONAL CANCER
INSTITUTE AND THINK ABOUT BT
WHAT THIS MEANS IN CANCER AND
CANCER SURVIVORSHIP.
50% OF SURVIVORS ARE CURRENT
DRINKING AND 35% EXCEED THE
MODERATE DRINKING LIMITS.
THAT IS AN ISSUE KNOWING ALCOHOL
IS A RISK FACTOR FOR CANCER AS
GEORGE MENTIONED.
WE KNOW LESS ABOUT HOW ALCOHOL
INFLUENCES RECURRENCE AND
SECONDARY CANCERS AND VERY
LITTLE OF REDUCTION IN ALCOHOL
REDUCES CANCER RISK IN CANCER
SURVIVORS.
WE HAVE SOME EVIDENCE, BUT WE
STILL NEED MORE DATA.
BOTTOM LINE IS THERE IS
SOMETHING GOING ON HERE.
TO THE EXTEND WE HAVE CANCER
SURVIVORS DRINKING CESSIVELY
AND IT IS A PROBLEM THAT NEEDS
TO BE ADDRESSED CLINICALLY, AND
IT REALLY ISN'T.
THIS LEFT MOST COLUMN YOU CAN
SEE TOBACCO IN THE 60s,
AWARENESS OF THE LINK BETWEEN
TOBACCO AND CANCER WAS 40%.
IN 2022 UP AROUND 90%.
LOOK WHERE WE ARE WITH ALCOHOL
IN THE SAME YEAR, 2022.
32%.
I HAVE SEEN NUMBERS BETWEEN 30%
AND 40%.
SOME HIGHER.
BUT THE NUMBERS ARE USUALLY
BELOW 50%.
HALF OF THE POPULATION WOULD BE
NICE AND WE ARE NOT THERE SEEING
THE LINK BETWEEN ALCOHOL AND
CANCER.
LOOK AT CONSUMPTION.
IN THE 60s 52% OF MEN, 34% OF
WOMEN USING TOBACCO.
IN 2022 IT WAS DOWN TO 14% AND
11%.
ALCOHOL IN 2022, THE NUMBERS ARE
SIMILAR.
I LIKE THE BOTTOM ROW.
PHYSICIAN USE OF TOBACCO IN THE
1960s WAS 50%.
ISN'T THAT INCREDIBLE?
THAT WAS DOWN TO 2% TO 7%.
I'M GUESSING IT IS BACK UP
AGAIN.
SINCE COVID WE HAVE SEEN HIGH
LEVELS OF STRESS IN PHYSICIANS
WHICH CAN LEAD TO USE OF
SUBSTANCES.
IN 2022 OVER 65% OF PHYSICIANS
USE ALCOHOL, MORE THAN 1 OR TWO
DRINKS A WEEK.
INTERESTING TO SEE THAT IS WHERE
WE ARE AND WE MIGHT BE ABLE TO
LEARN LESSONS FROM THE TOBACCO
STORY TO BE APPLIED TO THE
ALCOHOL STORY.
THEY ARE TWO DIFFERENT PRODUCTS.
WE COULD TALK ALL DAY ABOUT THE
DIFFERENCES.
TOBACCO IS AN ADDICTIVE
SUBSTANCE.
WHEREAS A LARGE PROPORTION OF
PEOPLE WHO DRINK ALCOHOL ARE NOT
ADDICTED.
MOST IS CONSUMED BY PEOPLE OF
HIGHER SES, WHICH IS NOT TRUE OF
TOBACCO.
THOSE ARE SOME DIFFERENCES THAT
WE CAN LEARN SOMETHING FROM
TOBACCO, BUT WE HAVE TO BE
CAREFUL.
IT IS INTERESTING TO TAKE A LOOK
AT THIS ANALYSIS USING ALL OF
US, ONE OF NIH'S PEARLS ALCOHOL
CONSUMPTION BETWEEN CANCER
DIAGNOSIS.
THIS GETS AT SOME OF THE
NUMBERS.
YOU CAN SEE THAT OF THOSE IN
THIS SAMPLE, 13% EXCEEDED
MODERATE DRINKING.
23.8% REPORTED BINGE DRINKING
AND 38.3 ENGAGED IN HAZARDOUS
DRINKING.
THAT IS ASTOUNDING AND
CONCERNING.
WE CAN USE THESE DATA SETS TO
ASSESS ASSOCIATIONS.
AT NCI WE HAVE A WONDERFUL
PROGRAM CALLED THE CANCER
PREVENTION FELLOWSHIP PROGRAM.
A POST DOCTORAL PROGRAM.
AND WE CAN RECRUIT GRADUATE
STUDENTS INTO THIS PROGRAM AND
HAVE THEM WORK WITH
INVESTIGATORS AT NCI.
AND SO WE'VE GOT A STABLE OF
WONDERFUL CANCER PREVENTION
FELLOWS RIGHT NOW WORKING ON
WARNING LABEL RESEARCH REGARDING
ALCOHOL AND CANCER.
DOING SOME REALLY TERRIFIC WORK
IN WHICH THEY ARE COLLECTING
DATA ON WHAT KINDS OF MESSAGES
ARE MOST IMPACTFUL.
THIS SLIDE GIVES YOU A SENSE OF
THE KINDS OF THINGS THEY ARE
LOOKING AT.
FOR EXAMPLE, WHAT ABOUT THE
CERTAINTY IN THE MESSAGE.
SHOULD YOU SAY ALCOHOL CAUSES
CANCER OR MAY CAUSE CANCER?
WE HAVE DONE PILOT WORK.
WHEN PEOPLE ARE TOLD ALCOHOL
CAUSES CANCER NUMBER ONE THEY
ASSUME THAT MEANS THEY ARE GOING
TO GET CANCER WHEN THEY DRINK
ALCOHOL.
THAT IS NOT WHAT WE MEAN, BUT
OFTEN THE WAY IT IS INTERPRETED.
THE SECOND THING IS WHEN PEOPLE
ARE TOLD ALCOHOL CAUSES CANCER,
THEY EXPERIENCE THE
PSYCHOLOGICAL TERM REACTANCE,
BELIEVING THEIR CONTROL IS TAKEN
AWAY AND TRYING TO BE
MANIPULATED.
THAT IS PROBLEMATIC.
WE HAVE THE W.H.O. SAYING
ALCOHOL CAUSES CANCER AND SAYING
THERE IS NO SAFE LEVEL OF
ALCOHOL.
THAT TURNS OUT TO BE A BIT OF AN
ISSUE.
WHEN PEOPLE SAY THERE IS NO SAFE
LEVEL YOUR CREDIBILITY GOES
DOWN.
IT SOUNDS LIKE ONE DROP OF
ALCOHOL IS GOING TO CAUSE YOU TO
GET CANCER.
THAT IS NOT GOING TO SELL VERY
WELL.
IT IS NOT CLEAR THIS NO SAFE
LEVEL W.H.O. LANGUAGE IS GOING
TO WORK ON A WARNING LEVEL.
THESE ARE THINGS WE HAVE BEEN
WORKING ON OUR FELLOWS IN
CONCERT WITH OUR STAFF.
THE PREVIOUS SURGEON GENERAL
RECOMMENDED WE HAVE WARNING
LABELS ON ALCOHOLIC BEVERAGES
LINKING ALCOHOL TO CANCER.
WHAT SHOULD BE ON THOSE LABELS?
WE DON'T KNOW.
WE DON'T HAVE ENOUGH DATA.
WE CAN LEARN FROM TOBACCO, BUT
WE CAN ONLY LEARN SO MUCH.
HERE ARE FINDINGS FROM STUDIES
WE HAVE DONE SO FAR.
WHEN YOU SAY DRINKING ALCOHOL
CAUSES CANCER, IT INCREASING
KNOWLEDGE OF RISK.
IT DECREASES.
SHOULD YOU SAY ALCOHOL CAUSES
CANCER OR COLON CANCER OR BREAST
CANCER?
BOTH OF TRUE AND MIGHT BE MORE
IMPACTFUL.
THOSE MESSAGES DO INCREASE
CREDIBILITY.
IF YOU LOOK AT SOME OF THE
LABELS CANADA, IRELAND AND SOUTH
KOREA ARE USING THEY ARE
FOCUSING ON SPECIFIC CANCERS
LIKE COLON AND BREAST CANCER.
ALASKA HAS JUST APPROVED A NEW
WARNING LABEL THAT FOCUSES ON
ALCOHOL AND CANCER AND THAT WILL
GO INTO EFFECT SOON.
IT WILL BE INTERESTING TO SEE
WHAT THEY DO, THE IMPACT OF WHAT
THAT IS AND THEY DO, IN FACT,
FOCUS ON SPECIFIC CANCERS.
WHAT ABOUT THE SOURCE?
SHOULD YOU SAY IT IS THE SURGEON
GENERAL'S WARNING?
A GOVERNMENT WORNING?
NO, BY THE WAY, THAT DOESN'T
WORK.
OR SHOULD IT BE DON'T INDICATE
WHERE THE SOURCE IS?
PEOPLE DO TRUST THE SURGEON
GENERAL.
SO THE SURGEON GENERAL'S WARNING
IS MORE IMPACTFUL.
THE TYPE OF MESSAGING.
I MENTIONED NO SAFE LEVEL OF
ALCOHOL CONSUMPTION DOESN'T GO
OVER VERY WELL IN OUR
POPULATIONS IN WHICH WE ARE
COLLECTING DATA.
IT INCREASING PERCEIVED ALCOHOL
RELATED CANCER RISK BUT
DECREASES CERTAINTY ABOUT
ALCOHOL RELATED CANCER RISK AND
MESSAGE BELIEVABILITY.
SO YOU HAVE THIS SORT OF TENSION
HERE AND HOW DO YOU RESOLVE THAT
TENSION?
WHAT LABELS SHOULD BE USED?
WE HAVE THIS WHOLE LITERATURE IN
TOBACCO OF WHAT LABELS WORK
THERE.
THOSE LABELS GET LITIGATED TO
THE POINT IT IS DIFFICULT TO USE
LABELS WE KNOW WORK IN
POPULATIONS BUT AREN'T GOING TO
SURVIVE LITIGATION BECAUSE THEY
ARE VIEWED AS VIOLATIONS OF
FIRST AMENDMENT.
LOTS TO DO IN THIS SPACE.
I WANT TO HIGHLIGHT THESE
RECENTLY RELEASED DOCUMENTS.
I HAVE A WHOLE GROUP AT NCI HOW
PEOPLE RESPOND TO CONFLICTING
SCIENTIFIC MESSAGING.
THIS IS IT IN THE WILD.
WHAT HAPPENS WHEN YOU HAVE TWO
BIG REPORTS COME OUT AND THEY
CONFLICT?
THIS NATIONAL ACADEMIES OF
SCIENCE, ENGINEERING AND
MEDICINE CAME OUT WITH A REVIEW
OF ED ON ALCOHOL AND HEALTH IN
THE FALL.
THEY TENDED TO -- THAT REPORT
FOCUSED ON A MUCH SMALLER SET OF
STUDIES AND THE CONCLUSIONS WERE
THAT THE LINK BETWEEN ALCOHOL
AND CANCER WERE MORE MUTED THAN
HAD BEEN THOUGHT.
THE LINK WITH BREAST CANCER WAS
STILL THERE, BUT NOT SO MUCH FOR
THOSE.
THE ICCPUD STUDY, A GROUP RAN
OUT OF SAMHSA.
THEY CAME OUT OF A STUDY MUST
MORE WIDE RANGING AND THEIR
CONCLUSIONS ARE MORE CONSISTENT
WITH THE LITERATURE THAT WE HAVE
BEEN LOOKING AT AND WE'VE BEEN
WORKING WITH.
SUGGESTS THAT THE LINK TO
MULTIPLE CANCERS IS SIGNIFICANT
AS WELL AS OTHER HEALTH ISSUES
MANY OF WHICH GEORGE MENTIONED
IN HIS PRESENTATION.
RIGHT IN THE MIDDLE OF THE SLIDE
YOU HAVE THE SURGEON GENERAL'S
REPORT ON ALCOHOL AND CANCER
RISK.
THIS WAS NOT A REVIEW, PER SE,
IT WAS AN ADVISE I HAVE.
IT WAS THE LAST VIVEK MURTHY
CAME OUT AS SURGEON GENERAL.
IT SUGGESTED A NUMBER OF
DIFFERENT THINGS SO THIS WAS
RELEASED IN 2025.
EXPERT INPUT WAS RECEIVED FROM
DEPARTMENT OF HEALTH AND HUMAN
SERVICES STAFF, INCLUDING NCI
STAFF FROM OUR DIVISION.
THAT WAS COORDINATED BY DAVID
BARRIGAN, MY COLLEAGUE AT NCI.
THERE WAS A RECENT PRESENTATION
AT THE NATIONAL ACADEMIES
WORKSHOP.
A DIFFERENT PART OF THE NATIONAL
ACADEMIES FROM THE ONE THAT CAME
OUT WITH THE CON FLIBLGTING
REPORT.
HERE ARE SOME OF THE CONCLUSIONS
OF THAT SURGEON GENERAL'S
ADVISORY.
PRIMARILY WHAT THE SURGEON
GENERAL SAYS WE NEED TO UPDATE
WARNING LABELS.
THAT IS WHY I FOCUSED SO MUCH OF
THE WORK WE ARE DOING ON WARNING
LABELS.
THIS IS NOT PUBLISHED YET.
WE HAVE A FELLOW WORKING ON A
PROJECT, USING HINTS DATA 60% TO
70% OF THE POPULATION IS
SUPPORTIVE OF THESE WARNING
LABELS.
THAT IS USEFUL.
IF WE PUT SOMETHING OUT AND
PEOPLE THROW IT AWAY AND SAY,
NO, I DON'T WANT THAT.
THAT IS A PROBLEM.
SO HAVING THAT BENEFICENT LABELS
IS A GOOD THING.
REASSESS RECOMMENDS LIMITS FOR
ALCOHOL CONSUMPTION AND WE KNOW
FROM OUR REVIEW OF CANCER
CENTERS THERE IS NOT A LOT OF
ATTENTION BETWEEN THE LINK OF
ALCOHOL A CANCER.
THEY ARE NOT EQUIPPED.
WE HAVE SEEN AN INCREASE IN
TOBACCO AND LESS SO IN ALCOHOL.
WE HAVE A GROUP LOOKING AT
MATERIALS PRODUCED BY CANCER
CENTERS TO SEE WHERE WE ARE.
SOME CANCER CENTERS ARE FURTHER
ALONG.
YOU CAN'T FAULT THEM BECAUSE I
SAID IN RESPONSE TO ONE OF THE
QUESTIONS TO GEORGE, WE DON'T
HAVE TRIED AND TRUE MATERIALS,
WELL-TESTED MATERIALS THAT CAN
BE USED AND THERE IS A GREAT
NEED FOR THAT IN THE LITERATURE.
I DO WANT TO HIGHLIGHT THESE
REPORTS I JUST MENTIONED ARE
GOING TO BE USED IN DEVELOPING
THE 2025 DIETARY GUIDELINES.
ALL OF THESE IMPORTANTS ARE
IMPORTANT.
THERE HAVE BEEN CRITIQUES OF THE
NATIONAL ACADEMIES AND ICCPUD
REPORTS.
WE HOPE TO SEE THE GUIDELINES
COME OUT THIS YEAR.
IT WILL BE INTERESTING TO SEE
WHERE ALCOHOL GOES.
IN GENERAL WE HAVE NOT SEEN
CHANGES IN THE DIETARY
GUIDELINES FOR MANY, MANY YEARS.
I DON'T KNOW IF THIS WILL IMPACT
THAT.
I WILL WRAP UP SAYS WE HAVE
RESOURCES WE HOPE YOU WILL USE,
THE NATIONAL TREND SURVEY.
SMOKEFREE.GOV, WHICH IS A
TERRIFIC TOOL FOR SMOKERS TO USE
FOR CESSATION PUMPS AND SEPARATE
SMOKEFREE.GOV MODULES FOR
DIFFERENT POPULATIONS AND FOR
EXAMPLE, FOR TEENS.
WE HAVE THE TOBACCO USE
SUPPLEMENT TO THE CURRENT
POPULATION SUMMARY.
THE CLASSIFICATION OF LAWS
ASSOCIATED WITH SCHOOL STUDENTS
WHICH TRACKS POLICIES RELATED
OBESITY OUTCOMES, PHYSICAL
ACTIVITY GUIDELINES AND VENDING
MACHINES.
AUTOMATED SELF-ADMINISTERED
24-HOUR DIETARY ASSESSMENT TOOL,
ASA24 IS A GREAT WAY TO TRACK
BEHAVIOR.
WE HAVE THE ACTS 24 LOOKING AT
ACTS COMPLETED OVER TIME IN 24
HOURS.
WE ALL KNOW, THOSE OF US IN
BEHAVIORAL SCIENCE, JUST ASKING
PEOPLE WHAT THEY DID LAST YEAR
IS NOT GOING TO GET YOU VERY
MUCH OR EVEN A MONTH AGO, BUT
TRYING TO TRACK PEOPLE ON A
DAILY BASIS, HOURLY BASIS, GIVES
YOU A MUCH BETTER WINDOW AND WE
HAVE SMART PHONES NOW THAT MAKE
THAT EASIER.
JUST AS AN ASIDE, BY THE WAY, WE
HAVE ALL THESE THEORYS DEVELOPED
IN THE 60s TO UNDERSTAND AND
PREDICT AND INTERVENE ON HEALTH
BEHAVIOR BASED ON PAPER AND
PENCIL SURVEYS IN WAYS WE WOULD
LAUGH OUT NOW.
WE STILL USE THOSE SAME THEORYS
AND WE DON'T HAVE NEW THEORYS
THAT USE INTENSE LONGITUDINAL
DATA WE COULD TRACK USING SMART
PHONES.
WE HAVE A LIBRARY OF WEBINARS
ABOUT ALCOHOL AND TOBACCO.
YOU CAN GO TO THAT LINK AND SEE
WHAT WE HAVE THERE.
YOU CAN GO TO OUR WEBSITE AND
NEWSLETTER FOR ADDITIONAL
INFORMATION AND I'M ALWAYS HAPPY
TO TAKE QUESTIONS OR TRIAGE YOUR
QUESTIONS TO OTHERS WHO HAVE
MORE EXPERTISE ON MY TEAM.
THAT IT IS FOR ME.
THANK YOU.
I'M HAPPY TO TAKE QUESTIONS.
>> BILL, LET'S SEE IF THERE ARE
ANY QUESTIONS FROM THE COUNCIL.
WHILE WE ARE WAITING, I HAVE A
QUICK QUESTION.
>> YES.
>> WHAT ABOUT CANNABIS AND
CANCER?
IS THERE ANY EVIDENCE AND ARE
YOU GUYS GOING TO BE -- IS THE
CANCER INSTITUTE GOING TO BE
LOOKING INTO THIS?
>> YEAH.
ABSOLUTELY.
NO, WE DON'T HAVE ENOUGH
EVIDENCE YET.
THERE WILL BE SOME FOR
COMBUSTIBLE CANNABIS.
WITH REGARD TO EDIBLES AND OTHER
MODES, MUCH LESS CLEAR.
WE NEED MUCH MORE DATA.
WE HAVE A DIVISION OF CANCER
EPIDEMIOLOGY AND GENETICS,
INTRAMURAL PART OF NCI AND THEY
COLLECT THAT EPIDEMIOLOGY DATA.
WE HAVE COHORTS WE FUND
COLLECTING THESE DATA MORE AND
MORE.
IT IS A WHOLE NEW WORLD.
IT IS A WILD WEST WITH CANNABIS
AND WITH ALCOHOL TO SOME DEGREE
AS WELL.
>> IT WAS A GREAT TALK.
SO QUESTIONS FROM COUNCIL?
>> YES.
THERE IS A QUESTION FROM KAREN
EMMONDS.
>> HEY, KAREN.
>> HEY, BILL.
THANK YOU SO MUCH FOR A GREAT
PRESENTATION.
ONE OF THE THINGS NCI AND YOUR
DIVISION HAS DONE SO WELL --
>> GO AHEAD.
>> I'M HEARING SOME BACKGROUND.
SO THE SURVEILLANCE ASPECT --
I'M SORRY.
>> COULD SOMEONE MUTE PLEASE.
>> I THINK WE GOT IT.
SO SURVEILLANCE YOU HAVE DONE IS
REALLY ELEGANT AND SO, SO
IMPORTANT ESPECIALLY WITH TOPICS
WHERE THERE IS AN INDUSTRY THAT
IS CONSTANTLY TRYING TO SHIFT
THINGS AND CHANGE THE DYNAMIC.
IT IS SO IMPORTANT.
THERE IS A RUMOR OUT IN THE
WORLD THAT N HAYNES IS GOING
AWAY.
WIPED IN JUNE AND PROBABLY NOT
GOING TO BE REUPPED AND THAT
SCARES LOOT OF US IN THE SIGN
TICHIC WORLD.
THE POINT IS I'M WONDERING WHAT
THAT MEANS FOR YOUR EFFORTS IN
SURVEILLANCE?
IF SOME OF THESE REALLY
IMPORTANT LARGE SCALE RESOURCES
WE HAVE BEEN DEPENDING ON TO
HELP US UNDERSTAND THESE ISSUES
ARE GOING AWAY IN ONE PLACE,
WHAT CAN WE DO TO HELP YOU
PROTECT THE SURVEILLANCE GOING
ON IN YOUR DIVISION AND, YEAH,
HOW DO WE PROTECT IT?
>> THANK YOU, KAREN.
GREAT QUESTION.
OF COURSE, ONE OF THE BIGGEST
TOOLS AND I DIDN'T MENTION THIS
IN MY PRESENTATION, IT IS AN
IMPORTANT TOOL, SURVEILLANCE
EPIDEMIOLOGY PROGRAM THAT TRACKS
CANCER OVER TIME.
WE JUST PRODUCED AN ANNUAL
REPORT TO THE NATION WHICH WE DO
IN CONSULTATION WITH THE
AMERICAN CANCER SOCIETY AND
THOSE ARE IMPORTANT DATA AS
WELL.
ABSOLUTELY.
THERE ARE A NUMBER OF DIFFERENT
TOOLS THAT ARE USED IMPLEMENTED
BY THE FEDERAL GOVERNMENT TO
CAPTURE IMPORTANT DATA.
I CAN'T REALLY COMMENT ON N
HAYNES OR OTHER TOOLS, OTHER
SURVEYS.
I CAN SAY THAT WE ARE AWARE OF
THE FACT THAT IT IS VERY
IMPORTANT TO MAKE SURE THESE
DATA ARE PROTECTED AND AVAILABLE
TO THE PUBLIC.
AND WE TAKE A NUMBER OF
DIFFERENT MEASURES TO MAKE THAT
HAPPEN.
SOMETIMES OUR DATA ARE SENT OVER
TO ICPSR TO THE UNIVERSITY OF
MICHIGAN BECAUSE THEY, OF
COURSE, ARE A GREAT PORTAL FOR
DATA SETS.
AND WE ALSO ARE MAKING SURE
PEOPLE HAVE LINKING THAT ARE
USEFUL, LINKS THAT HAVEN'T BEEN
BROKEN.
WE ARE DOING WHATEVER WE CAN.
WE ARE ALSO, HOW SHALL I SAY
THIS, WE ARE TRYING VERY HARD TO
MAKE SURE OUR SURVEYS, SURVEY
CONTENT AND USE OF SURVEYS IS
CONSISTENT WITH ADMINISTRATOR
PRIORITIES.
AND WE HAVE TO DO THAT IN A WAY
THAT MAKES SURE THAT THE DATA
CONTINUE TO BE USED AND
AVAILABLE AND ARE NOT GOING TO
RUN INTO ANY PROBLEMS.
>> THANK YOU.
>> OKAY.
I THINK WE ARE GOING TO MOVE ON
BECAUSE IT IS TIME.
AND WE ARE GOING TO, FOR THOSE
OF US HERE IN THE EAST COAST,
WE'RE GOING TO GET A BREAK TO
EAT SOMETHING, I HOPE.
SO TWO THINGS REALLY QUICKLY.
FIRST CHRIS BRADLEY IS THE IT
PERSON RUNNING THE SHOW AND
DOING A GREAT JOB.
HE DID IT YESTERDAY, TOO.
JUST WANT TO GIVE A SHOUTOUT TO
CHRIS.
AND THEN WE HAVE ANOTHER CHRIS.
CHRISTOPHER SARAMPOTE IS THE
DIRECTOR OF THE HEALTHY BABY
COGNITIVE DEVELOPMENT STUDY.
DID I GET THAT RIGHT?
I ALWAYS FORGET THAT ACRONYM.
NO.
I DIDN'T GET IT RIGHT.
SUSAN, WHAT IS IT.
HEALTHY BRAIN AND CHILD
DEVELOPMENT STUDY.
HE IS GOING TO PROVIDE UPDATES
ON THE HBCD STUDY.
CHRISTOPHER IT IS ALL YOURS.
>> THANKS TO EVERYONE FOR THE
OPPORTUNITY TO PRESENT ABOUT
HBCD.
I'M KEENLY AWARE I'M STANDING
BETWEEN FOLKS AND A BREAK AND
LUNCH.
SO I WILL ENDEAVOR TO KEEP
THINGS MOVING.
I'M CHRISTOPHER SARAMPOTE,
PROJECT DIRECTOR ON HBCD.
I'M JOINED BY JANANI PRABHAKAR,
THE PROGRAM OFFICER
ADMINISTERING THE SERIES OF
GRANTS.
I'M JOINED BY THE TALENTED NIDA
TEAM THAT MAKE HBCD HAPPEN.
WE ARE A SMALL TEAM FOR HBCD,
BUT A LARGE GROUP OF PEOPLE WHO
CONTRIBUTE.
I WANT TO THANK -- IT TRULY
TAKES A LARGE VILLAGE TO HANDLE
A STUDY OF THIS SIZE AND I'M
APPRECIATIVE FOR THEIR SUPPORT.
AND I WOULD LIKE TO MOVE ON.
THERE WE GO.
SO JUST FOR FOLKS AS AN OVERVIEW
AND A REMINDER BUT ALSO FOR
FOLKS WHO MAY BE NEW TO HBCD.
THIS IS A LARGE SCALE 10-YEAR
LONGITUDINAL STUDY.
WE ARE BUILDING ON THE LESSONS
FROM THE ABCD STUDY AND TAILORED
TO SPECIFIC POP LEIGH.
24 RECRUITMENT SITES ON THE MAP
ON THE SCREEN TO THE LEFT, THE
BLUE PINNING SPAN URBAN,
SUBURBAN AND RURAL COMMUNITIES.
HELPING US REFLECT THE RICH
DIVERSITY OF THE U.S.
POPULATION.
THE CONSORTIUM IS COORDINATED BY
TWO CORES REPRESENTED BY THE
GREEN AND DARK BLUE PINS.
THE ADMINISTRATIVE CORE IN SAN
DIEGO AND BOSTON CHILDREN'S
HOSPITAL AND THE DATA
COORDINATING CENTER, WASH U,
UNIVERSITY OF MINNESOTA AND UC
SAN DIEGO.
PARTICIPANTS ARE ENROLLED IN THE
SECOND TRIMESTER OF PREGNANCY.
THIS STUDY IS FUNDED BY THE NIH
HEEL INITIATIVE AND SUPPORTED BY
12 SFUTS AND CENTERS.
THANK YOU TO MICHELLE RANK KIN
AT HEAL AND IC STAFF AND THEIR
COLLABORATIVES GROUP, SCIENTIFIC
EXPERTISE AND LEADERSHIP ARE
KROIT CAL TO OUR SUCCESS.
THE HBCD ZUDY IS DESIGNED TO
ANSWER QUESTIONS ABOUT EARLY
CHILDHOOD DEVELOPMENT.
WHAT IS THE NORMAL RANGE FROM BE
BIRTH TO CHILDHOOD?
HOW DO BIOLOGICAL AND OTHER
ENVIRONMENT FACTORS IMPACT?
HOW DOES EARLY LIFE EXPOSURE TO
OPIOIDS, OTHER SUBSTANCES SUCH
AS ALCOHOL, STIMULANTS TOBACCO
AND OTHER ADVERSE VIRMTSAL
CIRCUMSTANCE AFFECT
TRAJECTORIES.
ARE THERE KEY WINDOWS TO ADVERSE
EXPOSURES AND THIS COULD BE
STRESS.
EMILE YOR RATING INFLUENCES
LATER INFLUENCE DEVELOPMENTAL
OUTCOMES.
KEY DEVELOPMENTAL WINDOWS IN
WHICH WE CAN CHANGE DIRECTORIES
ON IMPACT OF CHILDREN'S LIVES.
HBCD IS INTENDED TO PROVIDE A
RICH DATA SET FOR RESEARCHERS
FOR FUTURE STUDY LIKE THE
SUCCESSFUL ABCD PROGRAM.
HBCD AIMS TO ACCOMPLISH THROUGH
DENSE DATA COLLECTION THROUGH
THE FIRST THREE CAREERS OF LIFE
UNTIL 10 YEARS OF AGE.
THIS IS UP TO THE FIRST THREE
YEARS.
THE NUMBER OF VISITS.
NOT SHOWN HERE ARE 5 AND 7,
VIRTUAL VISITS.
THEY COMPLETE QUESTIONNAIRES AND
RESEARCH ACTIVITIES RELATED TO
DEVELOPMENTAL ORIGINS OF HEALTH
AND DISEASE.
PREPREGNANCY AND PRENATAL
FACTORS, ONGOING BIOLOGICAL
FACTORS OF THE CHILD AND THE
BIRTH PARTS.
MEASURE OF CAREGIVER
INTERACTIONS, CHILD BEHAVIOR IN
THE HOME ENVIRONMENT AND I WILL
ADD SLIDES LATER TO DETAIL THIS.
UNDERSTANDING THE FACTORS FOR
SOCIAL AND ENVIRONMENTAL
DETERMINANTS OF HEALTH.
HBCD INVESTIGATORS AND THEIR
WORK IS HIGH POTENTIAL FOR
PUBLIC HEALTH.
THIS IS ONE OF THE REASONS WE
BELIEVE THESE WILL HIGHLY
CONSISTENT WITH HHS AND NIH
PRIORITIES.
IT IS MOST COMPLETE ASSESSMENT
OF CONTRIBUTING FACTORS,
COLLECTING HIGH RESOLUTION
BEHAVIORAL, NUTRITION AND
MEDICAL DATA.
COMBINED WITH ABCD, HBCD CAN
DETERMINE.
IN THE TWO STUDIES WE WILL COVER
ALL OF MENTAL ILLNESS IN THE
EARLIER SIGNS AN SYMPTOMS, BUT
ALSO OTHER DISEASES EL AS WELL.
DATA FROM HBCD WILL PROVIDE
CRUCIAL INFORMATION ON HOW TO
INTERVENE TO GUIDE POLICY
DECISIONS TO PROMOTE CHILD
HEALTH.
SO AS I MENTIONED, THIS IS IS AN
AMBITIOUS ZUDY WITH A BROAD
RANGE OF ASSESSMENTS TO
UNDERSTAND TYPICAL NEURODWROMT
ACROSS THE FIRST STAGES OF LIFE.
THESE ARE KIDS INVOLVED WITH
STUDY PIs, KIDS VOLUNTEER.
AND TO DO THIS WE NEED TO
UNDERSTAND THE NORMAL RANGE OF
VARIABILITY OF BRAIN DEVELOPMENT
USE.
SCANS OF BRAIN STRUCTURE AND
BRAIN FUNCTION.
WE COLLECT EEG DATA THAT CAN BE
COORDINATED ACROSS TIME.
THESE ASSESSMENTS COUPLED WITH
THE RICH BEHAVIORAL AND
COGNITIVE BEHAVIOR COLLECTED IN
ABCD WILL ENABLE TO INFORM
HEALTH OUTCOMES AND ADDRESS
UNANSWERED QUESTIONS HOW
DEVELOPMENT IS REPRESENTED IN
AND DRIVEN BY THE BRAIN.
ONE OF THE MAJOR STRENGTHS OF
HBCD AND ABCD IS THE LARGE SCALE
BIOSPECIMENS.
THEY ARE THE CORNERSTONE OF THE
HBCD STUDY BECAUSE THEY GENERATE
RELIABLE DATA ON THE MECHANISMS,
GENETICS, PROTEINS, THAT MAY
INFLUENCE NEURAL COGNITIVE
BEHAVIOR.
SOCIAL DEVELOPMENT.
HELPS US UNDERSTAND IMPACT OF
PRENATAL AND POST NATAL OUTCOME.
ONE OF THE GREAT THINGS TO IS
SAMPLE BANKED FOR FUTURE
RESEARCH.
WILL BE ACCESSIBLE TO THE
BROADER SCIENTIFIC COMMUNITY TO
NIH COHORTS OR ABCD BIOSPECIMEN
ACCESS PORTAL.
WE COLLECT BLOOD, WHOLE BLOD,
SERUM, PLASMA.
NAIL CLIPPINGS DURING PREGNANCY
AND ONE MONTH POST PARTUM.
UN DURING PREGNANCY.
SALIVA AND IN-PERSON POST NATAL
VISITS.
FROM CHILDREN WE COLLECT IN
PERSON VISITS SALIVA, STOOL AND
URINE.
THE OTHER THING I MENTIONED IS
THESE BIOSPECIMENS STRENGTHEN
THE REPORT FOR -- THE STUDY IS
INNING COLLUSION OF DATA FROM
STUDIES.
THE PROMISE OF GEOCODES AND LINK
TO OTHER DATA SETS.
GEOCODED ADDRESSES WILL LINK
NEIGHBORHOOD LEVEL TO CAPTURE
ENVIRONMENT DETERMINANTS AND
EXTRACT MEDICAL RECORDS WITH
EARLY CHILDHOOD PHYSICAL HEALTH
TO ALLOW FOR THE STUDIES OF
PREDICTORS FOR CHILD HEALTH.
MEASURES OF GROWTH, NUTRITION,
SLEEP, SCREEN MEDIA USE,
PHYSICAL ACTIVITIES, GREEN
SPACE, MEDICAL AND VACCINATION
HIFTS, VISION AND QUALITY OF
LIFE.
I'M JUST GOING TO FLY THROUGH A
COUPLE OF DIFFERENT JUST TO GIVE
YOU A SENSE OF THE COMPREHENSIVE
ASSESSMENT HBCD IS UNDERTAKING.
SO ADDITIONAL MEASURES CAPTURE
PHYSIOLOGICAL DATA AND VISITS
TWO AND THREE IN OUR STUDY FOR
72 HOURS, THEY WEAR TWO MOVEMENT
SENSORS ON LEGS AND ARMBAND THAT
SHOWS HEART RATE.
THEY ARE CUTE.
THE PARENTS GET TO PICK OUT THE
DESIGNS.
THEY DETECT HEART RATE, OXYGEN
SATURATION AND RESPIRATION RATE.
THIS ALLOWS US TO SET SLEEP
WEIGHT CYCLES, PATTERNS OF
MOVEMENT, PATTERNS OF AUTONOMIC
NERVOUS SYSTEM FUNCTIONING.
OVER MULTIPLE TIME POINTS THE
HBCD STUDY USES COGNITIVE
DEVELOPMENT AND THE TOOL BOX OF
INFANT AND TODDLERS AND OTHERS.
HERE IS JUST A SAMPLING.
THIS IS NOT THE FULL RANGE, A
SAMPLING OF THE DOMAINS
CAPTURED.
ANOTHER THING I WOULD LIKE TO
POINT OUT, TOO, THESE INCLUDE
CAREGIVER REPORTS IN RED AND
OBJECTIVE MEASURES IN BLUE.
MULTIPLE POINTS OF DEVELOPMENT
WE ARE GETTING MULTIPLE REPORTS
WHETHER THERE ARE OBJECTIVE
MEASURES OF A CHILD BEHAVIOR AND
COGNITIVE FUNCTIONING AND
LANGUAGE DEVELOPMENT.
FINALLY, WITH THE ASSESSMENTS,
HBCD STUDY CHARTS BEHAVIORAL
DEVELOPMENT AND CHILD CAREGIVER
INTERACTIONS IN FAMILY
ENVIRONMENTS OBSERVATIONS AND
SEVENTY REPORT.
WE HAVE PLAY SCENARIOS IN WHICH
MOTHERS AND THEIR CHILDREN PLAY
AND INTERACTIONS ARE
STANDARDIZED, RECORDS AND STORED
FOR FUTURE USE.
CODED BY A CENTRALIZED TEAM TO
MAXIMIZE ASSESSMENT RELIABILITY.
THAT WAS A FLY BY OF THE
OVERVIEW.
WHAT HAVE WE DONE SINCE CRAN
LAST MET IN 2024?
I'D LIKE TO -- THE FEELING THAT
COMES TO MIND WHEN I THINK ABOUT
THIS, IF YOU HAVE EVER BEEN ON A
FISHING BOAT PILOTING OUT OF THE
HARBOR, THERE IS A LOT OF FOCUS.
YOU DON'T MESS WITH THE CAPTAIN.
THEY ARE FOCUSED ON NOT BUMPING
INTO THINGS AND GETTING ON
TRACK.
THAT IS WHERE I FEEL WE ARE.
WORKING HARD TO MAKE SURE THE
SUCCESS WE HAD LAUNCHING THE
STUDY CONTINUES WITH RECRUI
RECRUITMENT.
I'M EXCITED TO REPORT AND THESE
ARE NUMBERS WE UPDATED TWO DAYS
AGO, 104% OF OUR TARGET AND
ALMOST HALFWAY POINT.
THERE WILL BE A BIG CELEBRATION
WHEN WE GET TO THE HANDFULWAY.
WE ARE 34, 35.
SO CLOSE TO THE 3,500.
WE ARE VERY EXCITED ABOUT THAT.
IT SHOWS OVER THESE 24 SITES,
THAT OUR STAFF, OUR RAs, OUR
SITE MONITORS, THE EXPIRE TEAMS
ARE VERY MUCH FOCUSED AND DRIVEN
ON INVITING AND ENGAGING
FAMILIES TO PARTICIPATE IN THE
HBCD STUDY.
THIS BY THE WAY REPRESENTS MORE
THAN 20,000, OR 20,600
INDIVIDUAL SUBJECT VISITS.
SO STAFF ARE WORKING OVERTIME
LITERALLY TO BE ACCOMMODATING
AND ENGAGE FAMILIES IN THE
STUDY.
THE REASON FOR THE SUCCESS
INCLUDE THE EXTRAORDINARY EFFORT
AND EXPERTISE OF OUR SITE
RESEARCH ASSISTANTS, MONITORS
AND THE INCORPORATION OF STUDY
NAVIGATORS WITH LIVED EXPERIENCE
ARE A RESOURCE FOR OUR
PARTICIPANTS AND FEEDBACK TO OUR
INVESTIGATORS.
THE INCLUSION OF COMMUNITY
ADVISORY BOARDS FROM
PARTNERSHIPS WITH COMMUNITY
RESOURCES AND REFERRALS.
ADDITION OF SUPPLEMENT FUNDS
LAST SUMMER FOR SITE LEVEL
RECRUITMENT.
RECRUITMENT AND RETENTION LEVELS
LED BY THE UNIVERSITY OF
MARYLAND WHO IS MONITORING AND
KEEPING A CLOSE LOOK.
I WANT TO HIGHLIGHT THE EFFORTS
OF -- SHE IS A PROGRAM OFFICER
AND COLLECTS METRICS DATA AS
PART OF A RESULTS-BASED
ACCOUNTABILITY APPROACH AND SHE
CAN ANSWER QUESTIONS ON THAT,
TOO.
ALL IN ALL, YOU CAN SEE THIS IS
JUST A NUMBER OF OUR
RESEARCHERS, BUT STUDY
NAVIGATORS AS A TRAINING LAES
YEAR WORKING TO KEEP OUR
FAMILIES ENGAGED AND KEEP US
SUCCESSFUL.
SO LET ME TALK ABOUT SUBSTANCE
USE IN OUR SAMPLE.
FOCUS ON SUBSTANCE EXPOSURES,
APPROXIMATELY 3% OF SAMPLE
CRITERIA HAD SOME FORM OF
SUBSTANCE USE DURING PREGNANCY.
THIS IS CONFIRMED BY REPORTS
THROUGH THE ASSIST OR TIMELINE
FOLLOWBACK, BUT ALSO VERIFIED OR
ADDED TO BY TOXICOLOGY OF NAILS,
ESPNU -- URINE AND BLOOD.
LAST YEAR WE REPRESENTED 4%.
THAT IS A SIGNIFICANT INCREASE.
WE ARE AIMING TO OVERSAMPLE AND
AIMING TO HIT 12%, THAT IS OUR
GOAL FOR THE TOTAL SAMPLE.
THIS IS ONE OF THE -- OH, NOT
REPRESENTATIVE HERE, BUT I WOULD
ALSO MENTION BECAUSE WE ARE
TRACKING THIS AND IN FUTURE
SLIDES WE WILL HAVE THIS
INFORMATION, ROUGHLY 8% FOR
STIMULANT USE IN PREGNANCY AS
WELL.
JUST A COUPLE OF THINGS DR.
VOLKOW ALREADY POINTED OUT, WE
SEE MULTISUBSTANCE USE WITHIN
OUR SAMPLE AND WE ARE TRACKING
THIS AS WELL.
BUT LET ME JUST MENTION ABOUT
OPIOIDS.
THIS SOMEONE OF THE MOST
CHALLENGING ASPECTS OF HBCD IN
PART TO THE LOWER OPIOID USE OF
PREGNANT WOMEN NATIONALLY, THE
MARGINALIZATION OF WOMENS,
STIGMA AND CONCERNS ABOUT LEGAL
INVOLVEMENT MAY BE A DETERRENT
FOR PEOPLE TO PARTICIPATE IN OUR
STUDY.
THAT SAID, WE HAVE BEEN REALLY
PLEASED WITH THE EFFORT OUR
SITES HAVE MADE TO ENGAGE
MOTHERS WHO USE SUBSTANCES,
PARTICULARLY OPIOID.
THESE ARE NOT ONE TO ONE
COMPAR
COMPARISONS, BUT SIMILARITIES
BETWEEN HBCD AND PRAM AND NSDUH,
BOTH COLLECT DATA ON SUBSTANCE
USE IN PREGNANCY.
7% OR 6.8% WE ARE DOING AT LEAST
AS WELL AS WE ARE EXCEEDING BOTH
THOSE TWO STUDIES WHICH WE ARE
EXCITED ABOUT, BUT WE KNOW WE
HAVE A LOT FURTHER TO GO.
I MENTIONED EARLIER AND I WANT
TO FLY BY THESE QUICKLY.
ANCILLARY STUDIES ARE COLLECTING
ADDITIONAL BIOSPECIMENS FROM
PARTICIPANTS IN ORDER TO HAVE,
ONE, IN THIS CASE THE
BIOSPECIMEN PREGNANCY TO BANK.
THIS IS A CORRECTION AND BANKING
OF DELIVERY SAMPLES, UMBILICAL
CORD BLOOD AND TISSUE.
AS RECENTLY AS TWO DAYS AGO
WHICH WE ARE EXCITED ABOUT OVER
MULTIPLE SITES.
THE SECOND ANCILLARY STUDY BY A
RO1, COLLECTING BLOOD AND PLA
SENTAL SAMPLES FOR TARGETED
DOWNSTREAM ASSAYS TO SEE HOW
BIRTH PARENT FETAL PLACENTA
DEVELOPMENT OUTCOMES MAY EMENCH.
ALMOST HALF OF THE TARGET, 400
HAVE BEEN INVOLVED.
BOTH ANCILLARY STUDIES HAVE
FEENO TYPING BEING DONE AS PART
OF THE HBCD AND THEY ARE
CO-ENROLLED IN HBCD.
SO MOST EXCITINGLY, WE ARE
ANTICIPATING THE FIRST HBCD DATA
RELEASE NEXT MONTH PART OF THE
NBDC DATA HUB.
PRENATAL, THIS IS ONE, IN THE
SECOND OR THIRD TRIMESTER OF
PREGNANCY ON 1400 MOTHERS.
M.R.I. AND BIOSENSITIVE DATA 600
PARTICIPANTS.
EX-EG WITH 3 TO 9 MONTHS AND 120
PARTICIPANTS.
THESE NUMBERS WILL UNDOUBTEDLY
INCREASE.
THE IMPORTANT DATE THERE IS
JUNE, NEXT MONTH.
WE ARE EXCITED THAT THIS IS
HAPPENING AND YOU'LL HEAR MORE
ABOUT THAT LATER ON AS WELL.
I WANT TO MAKE A QUICK NOTE.
I THINK FOLKS ARE FAMILIAR WITH
THIS.
MANY FOLKS IN THIS ROOM HAVE
CONTRIBUTED TO THIS SPESHTS
ISSUE.
IF YOU WOULD LIKE TO LEARN MORE
ABOUT HBCD, OUR PROTOCOLS AND
THE GOALS THERE IS A WONDERFUL
SPECIAL ISSUE THAT HAD BEEN
EDITED BY MEMBERS OF THE PIs
FROM HBCD AND YOU CAN LEARN MORE
THERE.
SO I WANT TO, ON BEHALF OF
JANINE, I WANT TO PROVIDE NFLGS
ON OUR TYPELINE.
WE ARE AT A HIGH STAKES POINT IN
TIME.
JULY 1 WE ARE STARTING OUR LAST
YEAR OF OUR FIRST FIVE-YEAR
FUNDING PERIOD FOR HBCD.
WE ARE CURRENTLY WORKING ON
RENEWING HBCD.
IDEALLY AIMING FOR THE MAY
COUNCIL NEXT YEAR WITH THE IDEA
OF BEING BY JULY 1st TO START
YEAR SIX OF HBCD.
SO WE ARE QUITE EXCITED.
THAT MIGHT BE THE FIGHT OR
FLIGHT.
WE ARE EXCITED AND WORKING HARD.
I KNOW A NUMBER OF OUR PARTNERS
HAVE WEIGHED IN ON THE NOFOs.
AND WE INVITE THEM TO.
WE ARE LOOKING FORWARD TO THE
FINAL PUBLICATION HOPEFULLY THIS
SUMMER.
OKAY.
WITH THAT, I THANK YOU VERY MUCH
FOR YOUR TIME.
I THANK YOU FOR ENDURING ANY
HUNGER PANGS AND HAPPY TO ANSWER
ANY QUESTIONS YOU HAVE.
>> THANK YOU, CHRIS.
THAT WAS GREAT.
SO QUESTIONS FROM COUNCIL?
ANY QUESTIONS OUT THERE?
>> YES, FROM DAVID.
>> YEAH.
THANKS.
SO I NOTICED THAT THE PRENATAL
SUBSTANCE USE CRITERIA FOR
ALCOHOL IS LISTED AS EQUAL TO OR
MORE THAN SEVEN STANDARD
DRINKING A WEEK FOR MORE THAN
TWO WEEKS.
OR EQUAL TO THREE STANDARD
DRINKS ON OCCASION FOR MORE THAN
A COUPLE OF OCCASIONS.
I'M WONDERING WHAT THE
RESOLUTION OF USE IS?
CAN YOU CHANGE THAT?
IS THAT A CHANGEABLE CRITERION?
CAN YOU GO LOWER THAN THAT OR IS
THAT ACQUIRED AS A CUTOFF LIKE
THAT?
>> WE ARE COLLECTING THE DATA.
I THINK IT DEPENDS ON THE ONE
HAND I THINK WE CAN MINE DATA AT
THAT LEVEL, TYPICALLY WE ARE
DESCRIBING IT AS POSITIVE USE.
IT COULD BE YES OR NO.
BUT WE DO HAVE HIGH RESOLUTION
DATA THAT ARE AVAILABLE.
IT IS ALSO HIGH RESOLUTION
BIOLOGICAL DATA FROM OUR
BIOSAMPLES AND TOXICOLOGY
ANNOUNCEMENTS AS WELL IN TERMS
OF PATH AND OTHER MEASURES.
IT WOULD HELP US UNDERSTAND THE
VARYING IMPACTS OF ALCOHOL ON
DEVELOPMENT.
>> GREAT.
THANK YOU.
LOOKS LIKE A REALLY PROMISING
PROJECT.
>> THANK YOU.
>> NORA, DID YOU HAVE A
QUESTION?
COMMENT?
>> YES, YES, YES.
THANKS A LOT.
I DID HAVE A QUESTION AND I
SHOULD KNOW IT, BUT I DON'T.
THIS WAS VERY NICE TO SEE, IN
FACT, HOW SUCCESSFUL THE
RECRUITMENT OF PARTICIPANTS HAS
BEEN OVERALL AND HOW YOU ARE
STARTING TO ACCELERATE THE
NUMBER OF PARTICIPANTS EXPOSED
TO OPIATES AND HOPEFULLY WE CAN
REACH THE GOAL, BUT YOU DID NOT
DWELL MUCH IN TERMS OF THE
SOCIOECONOMIC BACKGROUNDS.
BECAUSE THAT WAS SOMETHING WE
REALIZED FOR THE ABCD WE HAD
BEEN VERY GOOD AT BRINGING
UNDERREPRESENTED GROUPS.
BUT WE DID NOT BALANCE IT WELL
VIS-A-VIS ECONOMIC BACKGROUNDS.
SO HOW ARE WE DOING WITH THE
HBCD?
>> ACTUALLY, I HAVE A SLIDE.
I WAS GOING TO SAY I CAN PULL UP
A SLIDE, BUT I CAN DESCRIBE IT
TO YOU.
THIS IS SOMETHING THAT WE REALLY
BENEFIT FROM THE ABCD AND ALSO
BEING IN A LOCATION WITH NEXT
DOOR TO ABCD STAFF SO WE CAN
TALK ABOUT THE LESSONS LEARNED
ALONG THE WAY.
I JUST WANT TO SHARE THIS ONE
SLIDE WITH FOLKS.
SO WE HAVE BECOME VERY CONCERNED
WITH THE DEMOGRAPHICS AND
EXTERNAL VALIDITY OF OUR OUR
SAMPLE.
THESE ARE OUR STUDY DEMOGRAPHICS
KURNTSLY.
-- KURNTSLY.
-- CURRENTLY.
AWESOME.
APPRECIATE IT.
CHRISS LOOKING OUT FOR EACH
OTHER.
THESE SPEAK FOR THEMSELVES.
SOME AREAS WE ARE REALLY DOING
WELL IN TERMS OF YOU CAN
DESCRIBE A LOT OF OUR SAMPLE AS
BEING MORE HIGH LY EDUCATED OR
HIGHER SES GROUPS.
WHEN WE TALK ABOUT RACE AND
ETHNICITY, WE ARE DOING WELL
WHEN IT COMES TO TRADITIONALLY
UNDERREPRESENTED GROUPS.
WITH OUR WHITE SAMPLE WE ARE
UNDER OUR TARGETS.
THIS IS SOMETHING WE ARE PAYING
CLOSE ATTENTION TO.
ONE OF THE ENCOURAGING THINGS,
ALTHOUGH, FOR EXAMPLE, WITH
WHITE PARTICIPANTS WE ARE BELOW
OUR TARGETS, IT IS STILL HIGH
FREQUENCY COMPARED TO OTHER
GROUPS.
WE ARE LOOKING CLOSELY WITH NOT
ONLY OUR RECRUITMENT RETENTION,
METRICS TEAM BUT BIOSTATISTICS
TEAM HOW THIS ALLOWS US TO
EVALUATE VARIOUS SUBGROUPS IN
HBCD.
WE WORKED HARD TO MAKE SURE WE
ARE ENGAGING SPECIFIC GROUPS
SUCH AS HISPANIC OR LATINO
GROUPS.
WE HAVE FUNDING TO ALLOW FOR
INCREASED SPANISH LANGUAGE
AVAILABILITY.
WE HAVE A SPANISH LANGUAGE
WORKING GROUP IN HBCD, THAT
FOCUSES ON NOT ONLY TRANSLATION
MATERIALS, BUT WORKING WITH THE
FAMILIES.
WE ARE IN YEAR TWO OF
RECRUITMENT.
GETTING READY TO START YEAR
THREE.
WE KNOW THE BOAT HAS LEFT THE
HARBOR AND WE ARE MOVING OUT
INTO THE CHANNEL.
NOW WE HAVE TO PAY ATTENTION TO
GET THE REST OF THINGS ON TARGET
AND CHARTED TO BE ON COURSE.
AND SO WE ARE FOCUSING IN THOSE
AREAS TO SEE WHAT KIND OF
NUDGING ALONG THE WAY, WHAT
RESOURCES CAN BE BROUGHT TO
SUPPORT INDIVIDUAL SITES TO MAKE
SURE WE ARE HITTING THOSE
TARGETS.
>> THANKS.
>> HOW DO I KILL THIS?
>> I THINK THERE IS ONE
QUESTION.
>> YEAH.
ONE MORE QUESTION AND THEN WE
ARE GOING TO TAKE A BREAK.
REMEMBER, EVERYBODY, YOU CAN GET
A HOLD OF ALL OF US ANY TIME YOU
WANT BY SENDING AN E-MAIL.
WE STILL RESPOND TO E-MAILS.
>> THIS IS A REALLY TERRIFIC
STUDY.
CONGRATULATIONS, CHRIS.
I DO HAVE A QUESTION ABOUT THE
CONSIDERATION OF OTHER
EXPERIENCES THAT MOTHERS MAY
HAVE.
SO THINKING ABOUT NORA'S
PRESENTATION.
IF WE THINK ABOUT THE EIGHT FOLD
INCREASE IN RISK FOR MOTHERS
THAT THEY MAY HAVE AS A RESULT
OF THEIR OWN CHILD
EXPERIENCES,ED A VERAS CHILDHOOD
EXPERIENCES OR ACES.
IS THAT SOMETHING YOU ARE
ADDRESSING AS WELL?
>> YES.
SO AT THE BEGINNING OF THAT
FIRST VISIT WE TAKE -- AND THESE
ARE EIGHT-HOUR-DAYS.
SO IT IS QUITE INVOLVED.
AND THOSE INCLUDE VERY DEEP
DETAILED ASSESSMENTS OF PAST
HISTORY, ACES, TRAUMA HISTORIES
WITHIN MOTHERS AND SO I THINK
THAT IS ONE OF THE WONDERFUL
THINGS ABOUT HBCD.
YES, WE HAVE BIOSPECIMENS,
IMAGING AND VERY RICH
SOCIODEMOGRAPHIC AND PERSONAL
HISTORIES OF OUR FAMILIES TO
EXPLORE ASSOCIATIONS.
THE PROOF IN THAT IS SEEING WHAT
YOU ARE GOING TO HEAR ABOUT
LATER TODAY IN TERMS OF ABCD,
WHAT THEY HAVE ACCOMPLISHED TO
PIECE TOGETHER A REALLY BROAD
RICH DATA SET TO HAVE REALLY
IMPORTANT HIGHLY IMPACTFUL
FINDINGS THAT RELATE AMONG
DOMAINS.
WE HOPE TO REPLICATE THAT AND
FOLLOW IN THEIR PATH.
>> SO BELIEVE IT OR NOT, WE ARE
ON TIME.
SO WE WILL RECONVENE AT 12:40
P.M. EAST COAST TIME AND NORA
WILL BE TAKING OVER AT THAT
POINT.
JUST TO REMIND YOU, NORA.
YOU ARE THE FEARLESS LEADER
STARTING AT 12:40.
>> SOUNDS GOOD.
>> THANKS, EVERYBODY.
>> THANKS, BYE.
GOOD AFTERNOON, EVERYONE.
THANKS FOR YOUR PARTICIPATION.
AND NOW WE ARE GOING TO GO TO
THE TOPIC IN THE AGENDA OF THE
ABCD AND IT'S A PLEASURE FOR ME
TO ACTUALLY INTRODUCE DR. GAYA
DOWLING, DR. TRACI MURRAY AND
DR. DIANA ALKIRE.
WE ARE GOING TO GIVE AN UPDATE
OVER THE PAST YEAR SINCE THEY
LAST GAVE A PRESENTATION AT
CRAN.
FOR THOSE OF YOU THAT DO NOT
KNOW DR. DOWLING, SHE IS THE
DIRECTOR OF THE ABCD STUDY.
FOR THOSE WHO DO NOT KNOW, DR.
MURRAY, IS A SCIENTIFIC ADVISER
FOR THE ABCD AND HBCD.
AND DR. ALKIRE IS A PROGRAM
ANALYST.
SO GAYA, PLEASE JUMP IN.
>> THANK YOU, NORA.
AND THANK YOU EVERYBODY FOR AN
OPPORTUNITY AGAIN TO GIVE YOU AN
UPDATE ON THE ABCD STUDY.
AS NORA MENTIONED -- IT DOESN'T
SEEM TO WANT TO ADVANCE.
I'M GOING TO GIVE YOU A BRIEF
UPDATE ON HOW THINGS HAVE BEEN
GOING IN ABCD.
BUT I REALLY WANT TO SPEND MOST
OF THE TIME WITH DIANA
ELABORATING ON WHAT NORA TALKED
ABOUT YESTERDAY IN TERMS OF THE
STUDY IMPACT AND TRACI TO GIVE
AN UPDATE ON A FINDING OF WHY WE
STARTED ABCD TO BEGIN WITH.
MOST OF YOU HAVE HEARD ME TALK
ABOUT ABCD FOR A VERY LONG TIME,
SO I'M NOT GOING TO SPEND A LOT
OF TIME DESCRIBING THE STUDY.
SINCE THERE WERE A FEW NEW
FACES, I THOUGHT I WOULD START
GIVING A HIGH-LEVEL OVERVIEW.
A LONGITUDAL STUDY OF 12,000
KIDS, TWINS AND TRIPLETS.
WE STARTED WHEN THEY WERE 9 OR
10 YEARS OLD IN 2016 AND HAVE
BEEN FOLLOWING THEM EVER SINCE
AND LOOKING AT MANY DIFFERENT
FACTORS THAT INFLUENCE
DEVELOPMENT.
AT THE UPPER RIGHT WE HAVE
MEASURES COVERING PHYSICAL
HEALTH, MENTAL HEALTH, SUBS
STANCE USE, -- SUBSTANCE USE,
ENVIRONMENT, FAMILY.
WE CHECK BIOSPECIMENS.
WE HAVE SOME DATA FROM FIT BITS
AND A CELL PHONE APP THAT
MONITORS TO GET US SOME
OBJECTIVE MEASURES OF ACTIVITY
IN CELL PHONE USE.
GEOCODED DATA SIMILAR TO WHAT
CHRIS DESCRIBED FOR HBCD SO WE
CAN LINK RESIDENTIAL HISTORIES
TO MANY DATA BASES TO GIVE A
BETTER PICTURE OF THE
ENVIRONMENT IN WHICH THE YOUTH
LIVED.
COVID HIT RIGHT IN THE MIDDLE OF
ABCD, WE HAVE SOME DATA ON THE
EXPERIENCES YOUTH HAD DURING THE
ACUTE PHASE OF THE PANDEMIC.
WE WERE PART OF THE NI FOR COVER
INITIATIVE, SO WE WILL HAVE DATA
ON LONG COVID SYMPTOMS AND
ANTIBODY DATA ON INFECTION
COMING DOWN THE PIKE.
THE FIGURE AT THE BOTTOM RIGHT
REALLY JUST SHOWS THE SEQUENCE
OF EVENTS.
WE DO THE NEUROIMAGING EVERY
OTHER YEAR.
THAT VISIT IS FAIRLY LONG, SEVEN
TO EIGHT HOURS WHERE WE COLLECT
ALL OF THE INFORMATION I JUST
MENTIONED.
AND IN THE INTERVENING YEAR
THERE IS NO IMAGING OR FEWER
BIOSPECIMENS AND COGNITIVE
TESTS.
BUT WE CONTINUE TO DO THE
QUESTIONNAIRES.
IT HAS BEEN REPEATING.
SO HERE YOU CAN SEE WE STARTED
THE END OF 2016.
AND IN THE YELLOW IS WHERE WE
WILL BE THIS FALL.
SO WE'RE NOW COLLECTING OUR
NINTH WAVE OF DATA.
AND WHEN WE START IN THE FALL,
MOST OF OUR PARTICIPANTS WILL BE
TURNING 18.
SO REALLY WE HAVE COVERED THIS
SCOPE FROM 9 TO 18.
AS NORA MENTIONED YESTERDAY, WE
ARE PROUD WE HAVE RETAINED 95%
OF THE PARTICIPANTS.
WHEN WE TALK ABOUT RETENTION IN
ABCD, ONLY 5% HAVE OFFICIALLY
WITHDRAWN FROM THE STUDY.
WE DON'T CONSIDER SOMEBODY
WITHDRAWN UNTIL THEY TELL US
THEY DON'T WANT TO BE CONTACTED
ANYMORE BECAUSE WE WANT TO GIVE
THEM THE OPPORTUNITY TO COME
BACK EVEN IF THEY HAVE MISSED
SOME VISITS.
SO THIS FIGURE SHOWS YOU A
LITTLE BIT ABOUT WHERE WE ARE.
IT HAS KCURVES FOR THE VISIT
COMPLETION AT THE VARIOUS
VISITS.
ANNUAL VISIT FROM BASELINE TO
EIGHT-YEAR FOLLOW-UP WHICH BEGAN
LAST FALL.
THE TWO-YEAR FOLLOW UP, THE
THIRD LINE FROM THE LEFT, THE
FLATTENING, THAT IS WHEN COVID
HIT.
ABCD HAS BEEN TRYING TO RECOVER
FROM COVID FOR THE LAST FEW
YEARS.
WE HAD TO CLOSE DOWN.
WE REOPENED.
BUT IT CAUSED US TO KIND OF
SHIFT THINGS OVER A LITTLE BIT,
SO DELAYS IN STARTING THE FOUR
YEAR.
AND IN THE FIVE YEAR, WE REALLY
ASKED SITES TO COME UP WITH A
PLAN TO GET BACK ON TRACK SO WE
COULD GET EVERYBODY BACK IN, AT
LEAST BY THE EIGHT-YEAR
FOLLOW-UP.
IN THE SIX YEAR WE ARE STARTING
TO GET THOSE NUMBERS BACK UP AND
WE'RE ON TRACK FOR THE SEVEN AND
EIGHT YEAR TO GET US BACK TO THE
LEVELS WHERE WE BEGAN.
THE OTHER CHALLENGE WITH COVID
WAS THAT WE TRANSITIONED TO
DOING MOST OF THE PROTOCOL
REMOTELY.
WHICH WAS JUST A NECESSITY FOR
THE THREE-YEAR FOLLOW-UP, WHICH
WAS NOT AN IMAGING YEAR.
IT HAS TAKEN US SOME TIME TO GET
BACK TO DOING MOSTLY IN-PERSON
OR HYBRID VISITS.
THE HYBRID VISITS, WE DO
QUESTIONNAIRES REMOTELY AND COME
IN FOR IMAGING, BIOSPECIMENS AND
COGNITIVE TASKS.
THOSE WHO DID IT REMOTELY
WEREN'T EXCITED TO COME BACK AND
SPEND WHOLE DAYS IN THE SITE.
IT WAS A CONCERTED EFFORT BY THE
RAs AT THE SITE TO BRING THEM IN
PERSON SO WE WOULDN'T LOSE THAT
MUCH DATA.
AS I MENTIONED, WHEN WE TALK
ABOUT RETENTION, WE ARE TALKING
ABOUT NOT HAVING WITHDRAWN, BUT
WE HAVE PARTICIPANTS THAT HAVE
MISSED VISITS.
I LIKE THIS FIGURE BECAUSE IT
SHOWS US KIND OF THE PATTERNS OF
THAT MISSING VISITS.
IN THE BLUE ARE COMPLETED
VISITS.
ACROSS THE X AXIS YOU HAVE THE
VISITS.
FOR MOST PART PEOPLE ARE
COMPLETELY VISITS.
PEOPLE MISSING VISITS WHICH YOU
SEE IN THE RED, SOME COME BACK
FOR A SUBSEQUENT VISIT.
SO THE IDEA WE AREN'T
CONSIDERING THEM WITHDRAWN IS TO
MAKE SURE THAT HAPPENS.
THAT PEOPLE COME BACK EVEN IF
THEY HAVE MISSED ONE, TWO,
SOMETIMES FOUR VISITS.
I THOUGHT IT WAS INTERESTING TO
TAKE A LOOK AT HOW MANY
PARTICIPANTS NEVER MISSED A
VISIT.
MORE THAN 7,000 HAVE NOT MISSED.
A NUMBER THAT MISSED TWO OR
FEWER, WE ARE AT MORE THAN
10,000.
SO WE ARE KEEPING THE COHORT
TOGETHER, WHICH IS REALLY
EXCITING.
I ALSO WANT TO TALK A LITTLE BIT
ABOUT THE IMAGING BECAUSE THIS
TOOK A BIT OF A HIT DURING COVID
AS WELL.
YOU CAN SEE HERE AT THE
TWO-YEAR -- SO COVID HIT IN THE
MIDDLE OF THE TWO-YEAR
FOLLOW-UP.
SO OUR NUMBERS DROPPED FROM
BASELINE TO THE TWO-YEAR
FOLLOW-UP AND MORE SO IN THE
FOUR-YEAR FOLLOW-UP AS WE WERE
COMING OUT OF THE PANDEMIC.
THE SIX-YEAR FOLLOW-UP IS
STARTING TO REBOUND AND WE'VE
JUST BEGIN THE EIGHT-YEAR
FOLLOW-UP IN THE FALL SO WE ARE
ONLY 18%.
HOPEFULLY THAT NUMBER -- AND THE
SITES ARE REALLY FOCUSING ON
THIS EIGHT-YEAR FOLLOW-UP.
THEY ARE DOING BOTH THE SEVEN
AND EIGHT YEAR RIGHT NOW.
BECAUSE THE EIGHT YEAR FOLLOW-UP
IS A NEUROIMAGING VISIT, A LOT
OF THE EFFORT IS BEING
CONCENTRATED TO MAKE SURE WE CAN
GET THAT LAST IMAGING VISIT.
SO I ALSO WANTED TO TAKE A LOOK
AT HOW MANY PARTICIPANTS DO WE
HAVE THAT WE ARE HAVING
COMPLETED AT LEAST T1 IN IMAGING
PROTOCOL.
NEARLY 3,800 HAVE COMPLETED THE
1s IN FOUR IMAGING VISITS.
THE FIFTH IS JUST STARTING SO WE
DON'T HAVE THAT MANY IN THAT
CATEGORY.
IF YOU LOOK AT THE NUMBER WITH
THREE IMAGING VISITS IS NEARLY
8,000.
DESPITE THE STRUGGLES WE HAVE
HAD IN TERMS OF OVERCOMING
COVID, WE HAVE LONGITUDINAL
IMAGING DATA ON A LARGE SUBSET
OF THE POPULATION.
I WANTED TO COME BACK HERE AND
JUST TO POINT OUT THAT THE KIDS
ARE NOW ALMOST 18 YEARS OLD.
SOME OF THEM ARE ALREADY 18
YEARS OLD AND WE ARE COMING ON
THE LAST, THE 10th VISIT FROM
OUR SO-YEAR STUDY, BUT WE KNOW
THAT THE OUTCOMES WE ARE
INTERESTED IN, BRAIN
DEVELOPMENT, SUBSTANCE USE,
MENTAL HEALTH, WE HAVEN'T SEEN
THEM YET.
WE ARE JUST STARTING TO SEE
SIGNIFICANT SUBSTANCE USE.
WE KNOW THE BRAIN IS CONTINUING
TO DEVELOP.
SO WE KNOW WE NEED TO CONTINUE
TO FOLLOW THESE YOUTH AT LEAST
THROUGH THEIR EARLY 20s TO LOOK
AT WHAT NORA AND GEORGE HAVE
BEEN TALKING ABOUT IN TERMS OF
THE FACTORS THAT MIGHT PREDICT
SUBSTANCE USE, A TRANSITION TO
SUBSTANCE USE DISORDERS.
WE CAN'T STOP NOW.
TRACI MURRAY AT THE END OF HER
TALK WILL GIVE YOU INSIGHT OF
HOW WE ARE THINKING ABOUT
PLANNING FOR THE FUTURE.
I WANT TO PUT A PLUG IN FOR ABCD
INSIGHTS AND INNOVATION MEETING.
LAST YEAR WE HELD THE INAUGURAL
AIM AND IT WAS VERY EXCITING.
IT WAS THE FIRST MEETING WE WERE
ABLE TO BRING TOGETHER PEOPLE
USING ABCD DATA IN DIFFERENT
WAYS.
WE'VE GOT SO MUCH DATA THERE IS
A BROAD ARRAY OF SCIENCE COMING
OUT OF ABCD AND WANTED TO BRING
IT ALL IN ONE PLACE.
WE DID THAT LAST YEAR.
BECAUSE OF THE CURRENT EVENTS,
WE HAD TO POSTPONE THIS YEAR AND
SCALE BACK A LITTLE BIT ON THE
MEETING.
BUT WE WANTED TO MAKE SURE WE AT
LEAST DID SOMETHING.
ONE OF THE MOST EXCITING PARTS
OF THE MEETING LAST YEAR IS WE
PROVIDED AN OPPORTUNITY,
PARTICULARLY TO TRAINEES TO MEET
WITH ABCD EXPERTS AND ASK
QUESTIONS.
PEOPLE USING THE DATA, NEW TO
USING THE DATA, BEING ABLE TO
GET THEIR QUESTIONS ANSWERED TO
UNDERSTAND HOW BETTER TO USE THE
DATA.
WE WANTED TO REPLICATE THAT.
SO WE ARE DOING THAT PORTION.
SO WE HAVE IN-PERSON MEETING
THAT IS A LITTLE BIT SMALLER,
BUT FOCUSING IN ON THESE
WORKSHOPS.
ELIZABETH WILL TALK ABOUT THE
NEW DATA SHARING PLATFORM, GIVEN
THAT IS JUST COMING OUT, WE WANT
TO INTRODUCE THAT TO FOLKS,
ANSWER QUESTIONS ON HOW TO USE
IT.
A NEW DATA EXPLORATION AND
ANALYSIS PORTAL.
SOME NEW IMAGING TOOLS.
WORKSHOP ON HOW TO USE THE
LINKED EXTERNAL DATA AND NOW WE
HAVE LONGITUDINAL DATA HOW TO
INCORPORATE LONGITUDE NAT DATA
IN YOUR ANALYSES.
IF YOU HAVE TRAINEES INTERESTED,
REGISTER AT
ABCDSTUDY.ORG/MEETING.
IT IS ONLY IN PERSON.
WHICH IS WHAT WE WANT TO GET OUT
OF IT, HANDS ON EXPERIENCE.
WE WILL FOCUS ON MENTORSHIPS.
WE PAIRED INVESTIGATOR TRAINEES
WITH NIH POs SO THEY COULD GET
SOME MORE HANDS-ON EXPERIENCE.
AND THEN THE LAST THING BEFORE I
TURN THIS OVER IS I WANT TO
ANNOUNCE THAT ABCD IS NOW
SOCIAL.
SO WE HAVE INSTAGRAM ACCOUNTS,
FACEBOOK, YOUTUBE, TWITTER,
BLUESKY, YOU NAME IT.
FOLLOW US ON WHICHEVER OF THESE
PLATFORMS YOU ARE USING AND
YOU'LL BE ABLE TO SEE UPDATES,
YOU'LL BE ABLE TO SEE THINGS
GOING ON AT THE VARIOUS SITES.
WHEN WE HAVE INFOGRAPHICS WE
WILL SHOWCASE THEM.
IT IS A GREAT WAY TO STAY UP
WITH WHAT IS HAPPENING IN ABCD.
WITH THAT, I WILL TURN IT OVER
TO DIANA TO TALK ABOUT WHAT WE
HAVE SEEN IN TERMS OF IMPACT OF
THE STUDY OVER THESE LAST 10
YEARS.
DIANA, ARE YOU THERE?
>> YEAH.
CAN YOU HEAR ME?
>> YES.
>> HELLO, EVERYONE.
NIH FUNDERS INCLUDE 15
INSTITUTES SHOWING THE STUDY'S
VALUE EXTENDED BEYOND WHAT WAS
ORIGINALLY CONCEIVED.
NEXT SLIDE.
THE ABCD DATA --
>> DIANA, YOU ARE BREAKING UP A
LITTLE BIT.
>> HOW ABOUT NOW?
>> I THINK THAT IS BETTER.
>> OKAY.
LET ME KNOW.
OKAY.
SO THE ABCD DATA SET HAS BEEN
USED IN WELL OVER 1,000
PEER-REVIEWED PUBLICATIONS.
ON THE LEFT THESE ARE PLOTTED BY
YEAR AND THE BLUE AND ORANGE
INDICATE WHETHER THE PAPERS
AUTHORS HAVE AFFILIATIONS WITH
ABCD OR NOT.
I ESPECIALLY WANT TO HIGHLIGHT
THE FACT THAT 60% OF THE
PUBLICATIONS ARE BY RESEARCHERS
OUTSIDE OF OUR CONSORTIUM, WHICH
SPEAKS TO THE SUCCESS OF OUR
OPEN SCIENCE APPROACH.
THE STUDY'S FINDING ARE BEING
DISSEMINATED TO BROADER
AUDIENCES.
ALT METRIC KWAUBT FIS AMONG A
LARGE RANGE OF OUTLETS.
THIS IS BROKEN DOWN BY SOURCE
AND THE MAJORITY OF MENTIONS
COME FROM TWITTER OR X, ABCD
RESEARCH HAS RECEIVED MENTIONS
ACROSS SEVERAL OTHER SOCIAL
MEDIA PLATFORMS.
FOCUSING ON ONE OF THESE
PLATFORMS.
HERE ARE A FEW EXAMPLES OF THE
WIKIPEDIA ARTICLES THAT HAVE
CITED ABCD PAPERS WHICH CAN HELP
US APPRECIATE THE BREADTH OF
PUBLIC KNOWLEDGE THE STUDY IS
CONTRIBUTING TO.
WE'RE ALSO STARTING TO SEE THE
IMPACT OF ABCD SCIENCE ON
CLINICAL AND OTHER GUIDANCE
PUBLICATIONS.
FOR THIS I'M DRAWING ON DATA
PROVIDED BY THE BRITISH MEDICAL
JOURNAL IMPACT ANALYTIC SERVICE.
LAST MONTH 87 PAPERS USING ABCD
DATA HAVE BEEN CITED IN 108
CLINICAL AND OTHER DOCUMENTS.
THIS TABLE SHOULD APPEAR PT
THERE WE GO.
THIS TABLE SHOWS THE BREAKDOWN
OF DOCUMENTS INTO DIFFERENT
CATEGORIES.
THE COLUMN HEADERS ON THE TOP
SHOW FOUR MAIN SOURCES.
GOVERNMENT, IGO,
INTERGOVERNMENTAL ORGANIZATION,
THINK TANK AND PMC, GUIDELINES
IN PUBMED CENTRAL.
EACH ROW IS A DIFFERENT TYPE OF
DOCUMENT.
ON THE MAP ON THE RIGHT THESE
DOCUMENTS COME FROM OVER 20
COUNTRIES AS WELL AS SIX IGOs,
W.H.O., UNITED NATIONS AND
UNICEF.
I WILL SHOW EXAMPLES OF THE
VARIOUS CATEGORIES OF DOCUMENTS.
THE DOCUMENTS CITING THE HIGHEST
NUMBER OF ABCD PAPERS IS THIS
SYSTEMATIC REVIEW AND META
ANALYSIS ON ADHD WITH 14 STUDIES
USING ABCD DATA.
IT IS TO SHOW EVIDENCE OF
DIAGNOSIS, TREATMENT, AND
MONITORING OF ADHD TO FORM AN
UPDATE IN THE AMERICAN ACADEMY
OF PEDIATRICS GUIDELINES.
THIS IS A GREAT EXAMPLE OF ABCD
INFORMING CLINICAL PRACTICE.
LOOKING BEYOND THE U.S., A STUDY
USING ABCD DATA ON COGNITION,
PHYSICAL ACTIVITY, SCREEN TIME
WAS REPORTED TO THE USC K HOUSE
OF KMONS.
ANOTHER PAPER EWING ABCD DATA
STUDIED THE PREVALENCE AND
FAMILY-RELATED FACTORS
ASSOCIATED WITH SUICIDALITY AND
SELF-INJURY WHICH HELPED INFORM
A REPORT COMMISSIONED BY THE
GOVERNMENT OF MALAYSIA.
ABCD RESEARCH HAS BEEN CITED BY
PROMINENT THINK TANKSES, THE
URBAN INSTITUTE IN THEIR REPORT
RETURN ON INVESTING IN CHILDREN
THAT USED STATE LEVEL
MACROECONOMIC FACTORS MODERATE
THE ASSOCIATION OF LOW INCOME
BRAIN STRUCTURE AND MENTAL
HEALTH IN U.S. CHILDREN TO
SUPPORT THE ARGUMENT THAT
GOVERNMENT ASSISTANCE IN THE
FORM OF DIRECT CASH PAYMENTS TO
FAMILIES HAS LONG-TERM BENEFITS
FOR DEVELOPMENT.
AND A LEGAL MEMORANDUM FROM THE
HERITAGE FOUNDATION CITED A
STUDY ON PRENATAL CANNABIS
EXPOSURE AND MENTAL HEALTH IN
ABCD.
HIGHLIGHTING SUCH EXPOSURE SHOWS
RISK FOR VULNERABILITY TO BROAD
SPECTRUM PSYCHOPATHOLOGY AS
CHILDREN PROGRESS THROUGH EARLY
ADOLESCENCE.
LOOKING AT INTERGOVERNMENTAL
ORGANIZATIONS, THIS PAPER ON
NEIGHBORHOOD DISADVANTAGE,
NEUROKOIG IN ADDITION AND BRAIN
STRUCTURE WAS IN A PAPER
OPTIMIZING BRAIN HEALTH ALONG
THE LIFE COURSE IN W.H.O.
AND A PAPER FOR CHILDHOOD
SUICIDALITY WAS CITED IN THE
HELPING ADOLESCENTS THRIVE
TOOLKIT PUBLISHED BY THE W.H.O.
AND UNICEF.
TO SUMMARIZE, EVEN BEFORE THE
END OF THE CURRENT DATA
COLLECTION ABCD HAS ALREADY HAD
A GLOBAL IMPACT.
IT GENERATED MULTIDISCIPLINARY
SCIENTIFIC FINDINGS LEADING TO
NEARLY 1,300 PEER REVIEW PAPERS
AN COUNTING.
THESE FOUNDINGS HAVE REACH NOT
ONLY SCIENTISTS, CLINICIANS,
POLICY MAKERS AND THE GENERAL
PUBLIC.
THANK YOU AND I HOPE YOU HEARD
MOST OF THAT.
>> YES, WE DID.
NOW I WOULD LIKE TO INTRODUCE
COMMANDER TRACI MURRAY.
AND I SHOULD SAY IN THE LAST
YEAR SINCE WE WERE HERE TRACI
WAS PROMOTED TO COMMANDER, SO WE
ARE VERY PROUD OF THAT.
WHO IS GOING TO GIVE US A
SUMMARY OF A REALLY EXCITING
PAPER THAT CAME OUT EARLIER THIS
YEAR.
TRACI, ARE YOU THERE?
>> HI.
I'M HERE.
THANKS.
CAN YOU GO TO MY FIRST SLIDE,
PLEASE.
>> DO YOU NOT SEE IT?
IS
>> I'M STILL ON THE TITLE SLIDE.
THERE WE GO.
TO START OFF I WOULD LIKE TO
REMIND YOU OF SOME OF ABDD GOALS
FROM THIS 2018 ARTICLE.
THAT RESEARCHERS WOULD BE ABLE
TO CLARIFY CAUSAL RELATIONSHIPS
BETWEEN SUBSTANCE USE AND
MULTIPLE ASSOCIATED OUTCOME AND
IDENTIFY SOCIAL AND GENETIC
VULNERABILITIES THEY MAY PRECEDE
SUBSTANCE USE AS WELL AS
PROTECTIVE FACTORS THAT MIGHT
MITIGATE RISK.
NEXT SLIDE.
>> THERE MUST BE A DELAY.
>> IS IT NOT COMING UP?
>> NO.
>> HERE WE GO.
JUST A DELAY.
WITH THAT IN MIND, I WOULD LIKE
TO SHARE AN OVERVIEW OF OSBORNE
ETAL PAPERS PSYCHOSIS SPECTRUM
SYMPTOMS BEFORE AND AFTER
CANNABIS USE INITIATION.
THIS TESTS THREE COMMON HIGHPOT
CEASE RELATED TO CANNABIS KNICKS
IN EARLY ADOLESCENCE FOCUSING ON
BEFORE AND AFTER INITIATION.
PREVIOUS STUDIES FOCUSED ON MID
TO LATE ADOLESCENTS, COMBINED
ADOLESCENT AND ADULT SAMPLES OR
USED RETROSPECTIVE REPORTS IN
ADULT SAMPLES.
NEXT SLIDE.
GREAT TIMING.
THESE ARE ILLUSTRATIONS OF THE
THREE HIGHP POPOT -- HYPOTHESI
TESTS.
THE X AXIS IS BEFORE THE
INITIATION AND THE Y AX
SITUATION IS THE NUMBER OF
PSYCHOSIS INTERVENTIONS.
THE SOLID LINE IS ANYBODY WHO
USED CANNABIS AND THE DOTTED
ORANGE LINE IS THOSE WHO NEVER
USED CANNABIS.
WITH SHARED VULNERABILITY THERE
WOULD BE A DIFFERENCE IN
PSYCHOSIS SYMPTOMS BETWEEN
ADOLESCENTS WHO USED CANNABIS
AND THOSE WHO DID NOT.
ADOLESCENTS WHO USED CANNABIS
HAD FACTORS FOR DEVELOPING
PSYCHOSIS SYMPTOMS.
'WED MAJOR LEAGUES INCREASING
PSYCHOSIS SYMPTOMS WOULD PRECEDE
CANNABIS INITIATION.
PSYCHOSIS SYMPTOMS WOULD
INCREASE AFTER CANNABIS
INITIATION.
PREVIOUS EVIDENCE GENERALLY
SUPPORTED CONTRIBUTING RISKS
WITH MIXED EVIDENCE FOR
SELF-MEDICATION.
RESEARCH IN TWIN SAMPLES
SUGGESTED THAT PSYCHOSIS SAMPLES
IN ADOLESCENT CANNABIS USE
CO-VARY, PARTIALLY DUE TO
ENVIRONMENTAL FACTORS WITH MIXED
EVIDENCE FOR GENETIC
CONTRIBUTIONS WHICH SUPPORTS
SHARED VULNERABILITY.
SUBSTANCE USE AND DATES OF
INITIATION WERE COLLECTED WITH
ABCD INTERVIEW AND THE
QUESTIONNAIRE WAS USED TO
COLLECT PSYCHOSIS SYMPTOMS AND
DISTRESS FROM THOSE SYMPTOMS.
THE STUDY ALSO STUDIED IF IT IS
JUST CANNABIS OR OTHER SUB
STAPSS AND THE OERKS COULD BE
INTERNALIZING AND EXTERNALIZING
SYMPTOMS.
THE FINDINGS SUPPORT SHARED
VULNERABILITY IN
SELF-MEDICATION.
SO ADOLESCENTS WHO USE CANNABIS
AT ANY POINT REPORTED MORE
DISTRESS FROM SYMPTOMS RELATIVE
TO THOSE WHO NEVER USE DS
CANNABIS.
THIS IS CONSISTENT WITH SHARED
VULNERABILITY.
THE SYMPTOMS INCREASED IN THE
TIME LEADING UP TO CANNABIS
INITIATION THERE WAS
INSUFFICIENT EVIDENCE FOR RISK.
PSYCHOSIS SYMPTOMS GENERALLY DID
NOT INCREASE AFTER CANNABIS
INITIATION.
NOW WHILE THE CURRENT FINDINGS
SUMMIT A SHARED VULNERABILITY
AND SELF-MEDICATION THERE ARE
IMPLICATIONS FOR FUTURE RESEARCH
TO SELF-MEDICATION AND
CONTRIBUTING RISK.
FOR EXAMPLE, THE FINDINGS
SUPPORTING SELF-MEDICATION DO
NOT MEAN THAT CANNABIS USE IS
EFFECTIVE FOR EA LEAVEUATING
PSYCHOSIS SYMPTOMS.
RESEARCHERS NEED TO EXPLORE
SHORT AND LONG-TERM EFFECTS OF
CANNABIS USE ON SYMPTOMS.
THE LACK OF EVIDENCE MAY BE DUE
TO THE STUDY'S FOCUS ON EARLY
ADOLESCENCE WHEN FREQUENT HIGH
VOLUME CANNABIS USE IS LESS
COMMON.
PREVIOUS RESEARCH SHOWS A DOSE
DEPENDENT ASSOCIATION BETWEEN
CANNABIS USE AND PSYCHOSIS RISK
WITH PSYCHOSIS RISK INCREASING
WITH GREATER FREQUENCY AND
QUANTITY OF CANNABIS USE.
IT IS NECESSARY TO STUDY LATER
STAGES OF DEVELOPMENT WHEN
CANNABIS USE GENERALLY
INCREASES.
AN INCREASE IN PSYCHOSIS
SYMPTOMS DOES NOT NECESSARILY
MEAN AN INDIVIDUAL WILL HAVE A
PSYCHOTIC DISORDER IN ADULTHOOD.
THIS STUDY ACHIEVES ABCD'S
INITIAL GOALS BY PROVIDING A
BETTER UNDERSTANDING OF
ASSOCIATIONS BETWEEN CANNABIS
USE AND PSYCHOSIS RISK DURING
ADOLESCENTS AND POTENTIAL IMPACT
ON OTHER KOUT -- KOUT COMES IN
LATER LIFE.
IT IS IMPORTANT TO STUDY COHORT
STUDIES AND HOW THOSE
EXPERIENCES IMPACT DEVELOPMENT
AND LONG-TERM OUTCOME.
NEXT SLIDE.
AS ABCD ENTERS THE YEAR NINE
FOLLOW UP, WE ARE EXCITED TO
SHARE PLANS FOR ABCD CONTINUING
THE ARC OF DEVELOPMENT EXPERT
PANEL MEETING.
WE ARE CONVENING SCIENTIFIC
EXPERTS FROM VARIOUS FIELDS,
YOUNG ADULTS WITH EXPERIENCE IN
LONGITUDINAL RESEARCH AND ABCD
EXPERTS WITH IN DEPTH KNOWLEDGE
OF THE CURRENT PROTOCOL.
THE GOAL OFL THIS MEETING IS
GATHER INPUT ON THE NEXT PHASE
OF ABCD RELATE TO STUDY DESIGN,
SOCIAL HEALTH AND ENVIRONMENT,
SUBSTANCE USE AND MENTAL HEALTH.
THROUGHOUT MAY AND JUNE THESE
GROUPS WILL PARTICIPATE IN TOPIC
SPECIFIC PREMEETINGS TO IDENTIFY
KEY CONSIDERATIONS IN THEIR
RESPECTIVE AREAS THEN IN JULY WE
WILL HAVE AN IN-PERSON MEETING
WITH ALL EXPERTS TO BUILD ON
INPUT GATHERS FROM THOSE
PREMEETINGS.
THIS MEETING WILL BE PUBLICLY
AVAILABLE THROUGH VIDEOCAST AND
THE PUBLIC VIEWERS WILL HAVE THE
OPPORTUNITY TO SUBMIT THEIR OWN
COMMENTS TO US THROUGH VARIOUS
MECHANISMS.
SO THANK YOU.
>> THANK YOU, TRACI.
I WOULD LIKE TO DO A GENERAL
THANK YOU.
THIS STUDY INVOLVED SO MANY
PEOPLE.
LIKE HBCD, THERE ARE 10 FEDERAL
PARTNERS THAT ARE PART OF IT.
OF COURSE, THE 21 RESEARCH
SITES, COORDINATING CENTER, THE
DATA CENTER, THE INVESTIGATORS
AND TRAINEES AND PARTICULARLY I
HAVE TO DO A SHOUTOUT FOR THE
RESEARCH ASSISTANTS AND STAFF,
PARTICULARLY HOW THEY GOT
THROUGH COVID WITHOUT -- WITH
MINIMAL DATA LOSS AND KEEPING
PEOPLE ENGAGED IS A TESTAMENT TO
THEIR EFFORTS.
AND THE NEARLY, OF COURSE,
12,000 PARTICIPANTS AND THEIR
FAMILIES WHO HAVE DEDICATED A
LOT OF TIME FOR ABCD.
WITH THAT, I'M HAPPY TO TAKE
QUESTIONS.
I WANTED TO START WITH AN ANSWER
TO KATE'S QUESTION FROM
YESTERDAY ABOUT SEX DIFFERENCES.
WHETHER WE ARE SEEING SEX
DIFFERENCES WITH RESPECT TO
SUBSTANCE USE IN THE COHORT.
THERE WAS A PAPER THAT CAME OUT
I THINK LAST YEAR FROM A
PREVIOUS DATA RELEASE THAT
SHOWED IN BASELINE THROUGH I
THINK THE TWO-YEAR FOLLOW UP,
THERE WAS MORE BOYS THAN GIRLS
WERE ENDORSING SUBSTANCE USE.
BUT SINCE THEN AND AROUND THE
THREE-YEAR FOLLOW UP IT EVENED
OUT.
SINCE THEN IT APPEARS
PRELIMINARY ANALYSIS MORE GIRLS
ARE ENDORSING SUBSTANCE USE THAN
BOYS IN THE COHORT.
LET ME KNOW IF YOU HAVE
FOLLOW-UP QUESTIONS TO THAT AND
I'M OPEN TO ANYBODY ELSE'S
QUESTION.
>> I ACTUALLY THANK YOU VERY
MUCH.
IT IS A GREAT PRESENTATION.
IT REFLECTS THE LEADERSHIP AND
PASSION AND COMMITMENT OF THE
WHOLE TEAM.
THE ONLY THING BEFORE WE GO INTO
QUESTIONS, I THINK THE AGENDA WE
ARE AT 1:10 FOR DATA SHARING
PLATFORM FOR ABCD AND HBCD.
WE CAN DO THE FOLLOWING, WE CAN
JUMP INTO THAT WITH DR. LISA
HOFFMANN AND TAKE QUESTIONS
LATER DURING THE DISCUSSION
TIME, IF THAT'S OKAY.
>> THAT'S FINE WITH ME.
>> I'M JUST FOLLOWING THE AGENDA
BECAUSE IT SAYS 1:10 AND IT IS
1:12.
THAT WAS TERRIFIC.
WE SHOULD HAVE A PLAN FOR MORE
TIME.
THAT WAS AN INCREDIBLE
PRESENTATION.
THANKS A LOT, GAYA.
THEN THE NEXT PRESENTATION IS
GOING TO BE GIVEN BY DR.
ELIZABETH HOFFMANN, THE
ASSOCIATE DIRECTOR OF THE ABCD
STUDY AND SHE IS GOING TO GIVE
US AN UPDATE ON THE DATA SHARING
PLATFORM FOR ABCD AND HBCD.
VERY, VERY IMPORTANT BECAUSE
THIS HAS BEEN A MAJOR CHANGE IN
THE WAY WE WERE COLLECTING AND
MAKING THE DATA AVAILABLE AND IT
IS CRUCIAL FOR EVERYONE TO TAKE
ADVANTAGE OF.
SO ELIZABETH, PLEASE JUMP IN.
>> THANK YOU, NORA AND GOOD
AFTERNOON, EVERYONE.
I AM REALLY EXCITED TO BE HERE
BECAUSE I GET TO TELL YOU ABOUT
THIS NEW DATA SHARING PLATFORM
THAT IS VERY SOON TO LAUNCH.
NEXT MONTH.
IT HAS BEEN QUITE A LABOR OF
LOVE FOR A LARGE NUMBER OF
PEOPLE, NOT JUST FOLKS AT NIH,
BUT ALSO LASSO INFORMATICS WHO
HAS DEALT WITH A LOT OF CHANGES
ALONG THE WAY AND THEY HAVE BEEN
VERY NIMBLE.
I'M HUGELY APPRECIATIVE OF THEM.
TO GIVE YOU A QUICK TEASER HERE,
THIS IS THE SPLASH PAGE.
IT IS NOT LIVE YET.
OF THE NIH BRAND DEVELOPMENT
COHORT DATA HUB.
WILL BE IN JUNE.
THIS IS WHAT YOU WILL SEE COMING
IN.
IT IS ALREADY OUT OF DATE.
WE WILL HAVE OTHER FEATURES HERE
INCLUDING AN ANNOUNCEMENTS BLOCK
AT THE BOTTOM.
THIS IS WHERE USERS WILL COME
WHEN THEY COME INTO THE NIH
BRAND DEVELOPMENT'S COHORT'S
DATA HUB.
YOU WILL SEE A WELCOME VIDEO
FROM NORA ON THE LOWER RIGHT.
THIS RESOURCE IS REALLY DESIGNED
TO ACCELERATE SCIENTIFIC
DISCOVERY BY PROVIDING
CENTRALIZED ACCESS TO RICH
LONGITUDINAL DATA, BRAIN,
BEHAVIORAL AND GENOMIC DATA FROM
ABCD AND HBCD STUDIES.
BY BRINGING TOGETHER DATA FROM
BOTH OF THESE STUDIES THAT THE
NBDC IS GOOD RESEARCH THROUGH
EARLY LIFE AND EARLY ADULTHOOD
WHICH HELPS TRAJECTORIES ACROSS
A BROAD AGE RANGE AND
POPULATIONS.
IT PROMISES TO BE AN INCREDIBLY
RICH RESOURCE WHICH WE ARE
EXCITED ABOUT.
SO WHY NOW?
THERE ARE A LOT OF REASONS WHY
NOW, BUT I PROBABLY DON'T NEED
TO TELL THIS GROUP, BUT I HAVE
HIGHLIGHTED A FEW HERE.
FIRSTLY, I WOULD SAY POPULATION
NEUROSCIENCE, WE ARE AT A
PIVOTAL MOMENT NOW WHERE THERE
IS AN INCREASING NEED FOR
RESPONDING TO HOW RESEARCHERS
ARE USING DATA.
THERE NEEDS TO BE INCREASED
SCALEABILITY, I THINK, AND BROAD
ACCESSIBILITY TO A WIDE VARIETY
OF USERS ARE VARYING TECHNICAL
EXPERTISE.
WE ARE DEALING WITH INCREASINGLY
COMPLEX AND DIVERSE
HETEROGENEOUS DATA TYPES, GE
GENOMICS DATA AND THROUGH FITBIT
DATA COLLECTION AND A
TREMENDOUSLY LARGE VOLUME OF
DATA ON THE ORDER OF PETABYTES
FOR ABCD AND HBCD.
THE NBCD SYSTEM IS GOING TO
HANDLE ALL OF THIS SEAMLESSLY,
WE ARE HOPING, WE ARE EXPECTING.
A FEW THINGS I WOULD LIKE TO
HIGHLIGHT COMPONENTS OF THIS
SYSTEM TO FACILITATE ACCESS TO A
WIDE VARIETY OF USERS AND DATA
USE AND ANALYSIS IN PLACE IN
CONTRAST TO OLDER DATA
REPOSITORIES HIS TOR --
HISTORICALLY.
THERE WILL BE TRAINING THAT
ACCOMPANIES THE DATA USE
CERTIFICATION.
USERS NEED TO COMPLETE
RESPONSIBLE USE TRAINING,
COMPLETE A QUIZ AND GET A 90%
PASS RATE TO GET ACCESS TO THE
DATA.
THAT GETS RENEWED EVERY YEAR.
THEY HAVE TO TAKE A QUIZ EVERY
YEAR.
THIS IS REALLY TO HELP SORT OF
LEVEL THE PLAYING FIELD SO WE
DON'T EXPECT EVERYBODY COMING IN
TO HAVE EQUAL LEVELS OF
KNOWLEDGE TO USE DATA, MAINTAIN
SECURITY OF DATA AND SO ON.
THIS PROVIDES OPPORTUNITIES FOR
THAT LEARNING.
THEN THERE WILL BE MULTIPLE WAYS
TO QUERY THE DATA AND INTEGRATED
DATA ANALYTIC TOOLS.
THIS IS IMPORTANT AND THE THING
WE ARE MOST EXCITED ABOUT AND
MOST INNOVATIVE.
USERS CAN DO DATA ANALYSIS IN
PLACE REDUCING THE NEED TO
DOWNLOAD DATA.
THIS WON'T BE AVAILABLE
IMMEDIATELY, BUT IN THE NEXT
SEVERAL MONTHS ON TABULATED DATA
AND FILE BASED DATA.
THERE WILL BE A SECURE
COLLABORATION SPACE.
SO USERS WILL BE ABLE TO COME
INTO THIS DESIGNATED SPACE IN
THE SYSTEM AND COLLABORATE WITH
OTHER USERS.
DOING SIMILAR ANALYSES AND
COMPLETE, CONDUCT PROJECTS
TOGETHER COLLABORATIVELY IN THIS
SPACE AGAIN WITHOUT THE NEED TO
DOWNLOAD DATA BUT STILL
MAINTAINING THAT COLLABORATION
ACROSS INSTITUTIONS.
AND THEN FINALLY, THERE'S GOING
TO BE A VERY DYNAMIC AND GROWING
KNOWLEDGE BASE THAT WILL
ACCOMPANY THIS SYSTEM SO USERS
WILL BE ABLE TO COME IN AND ASK
WHATEVER GRANULAR LEVEL
QUESTIONS THEY HAVE ABOUT
PARTICULAR DATA TYPES OVER TIME
AND THINGS INVOLVE WITH
DIFFERENT DATA RELEASES.
THIS GETS COMPLEX WITH THE
AMOUNT OF INFORMATION NEEDED IS
GROWING CONSTANTLY.
THERE IS ALSO, IF THAT IS NOT
HELPFUL ENOUGH, THERE IS A
HEALTH TICKETING SYSTEM TO COME
IN AND PUT A TICKET IN THE THEY
ARE NOT GETTING ANYWHERE WITH
THE KNOWLEDGE BASE AND TRIAGED
TO SUBJECT MATTER EXPERTS.
WE HOPE THIS WILL BE A RESOURCE
THAT IS POWERFUL AND PROVIDES
OPPORTUNITIES FOR FOLKS TO GET
MORE INFORMATION THEY OTHERWISE
WOULDN'T BE ABLE TO HAVE.
AND I REALLY LIKE THIS SLIDE
BECAUSE IT HIGHLIGHTS WHAT I
THINK IS THE SECOND MOST
WONDERFUL THING ABOUT THIS
SYSTEM.
THE IN PLACE DATA ANALYTICS IS
THE FIRST AND THE SECOND IS THE
INTENTIONAL REDUNDANCIES BUILT
IN THIS SYSTEM.
WE HAVE VARYING LEVELS OF
TECHNICAL EXPERTISE AND
EXPECTATIONS THAT USERS HAVE HOW
THEY WANT TO CONDUCT ANALYSES.
THERE ARE MULTIPLE WAYS OF
QUERYING DATA.
THE LEFT IS DATA EXPLORATION AND
ANALYSIS PORTAL.%
SOME OF YOU MAY BE FAMILIAR WITH
THAT.
IT IS NOW COMING BACK ONLINE,
NEW AND IMPROVED WITH GREATER
FUNCTIONALITIES.
THE FIRST HERE IN DATA
DICTIONARY VIEWER, THIS
COMPONENT IS AVAILABLE TO THE
PUBLIC.
IT DOESN'T REQUIRE A USER
AUTHENTICATING IN.
IT IS OPPORTUNITIES TO VIEW THE
DICTIONARIES AND HIGH LEVEL
SUMMARY STATISTICS OF THE COH
COHORT, VERY HIGH LEVEL.
AND TABULATED DATA STORAGE,
OPPORTUNITIES FOR CREATED AND
DOWNLOADING DATA SETS.
STATISTICS, VARYING LEVELS OF
STATISTICS.
DEWEY BASED AND CODING
ENVIRONMENTS THAT IS COMING
LATER IN 2025.
THE LASSO SYSTEM, THIS IS HERE
AT THE TOP, I MENTIONED LASSO IS
A COMPANY FACILITATES THIS.
THAT IS WHERE USERS WILL LOG IN.
THAT IS THE CENTRALIZED
AUTHENTICATION SPACE WHERE
PEOPLE COME IN AND COMPLETE
THEIR CERTIFICATION AND
TRAINING.
THERE IS QUERYING AND DATA BASE
AND STORAGE BUILT IN THERE.
ON THE LOWER RIGHT, PRIMARILY
FOCUSED ON FILE-BASED DATA
STORAGE SO INCREASING
COMPUTATION AND STORAGE NEEDS
FOR THOSE DATA.
THERE IS ANOTHER COMPONENT HERE
AT THE UNIVERSITY OF MINNESOTA
THAT IS HELPING WITH THAT.
THERE IS FILE-BASED STORAGE
AVAILABLE IN THE SPRING AND THEN
COMING LATER IN 2025, THERE WILL
BE OPPORTUNITIES TO DO THESE
COLLABORATIONS, DATA SHARES.
YOU CAN SEE IN THE ON-DEMAND BOX
IN THE LOWER RIGHT.
THE DATAS ATTACHED HERE ARE A
LITTLE BIT HOPEFUL, BUT I THINK
AS WE GET CLOSER I'M MORE
CONFIDENT WE WILL MEET THEM.
LOOK OUT FOR THESE AS THE
PLATFORM LAUNCHES AND WE WILL
MESSAGE ABOUT THE ADDITIONAL
FUNCTIONALITIES IN TIME.
SO THE DATA ACCESS PROCESS.
I WANTED TO SPEND A COUPLE OF
MINUTES ON THIS BECAUSE THOSE
WHO ACCESSED DATA FROM NDA IN
THE PAST WILL BE USED TO A
SOMEWHAT DIFFERENT WAY OF
APPLYING FOR A DATA USE
CERTIFICATION.
FIRSTLY THERE ARE A COUPLE OF
DIFFERENT WORK FLOWS FOR
APPLYING FOR DATA USE CERT
CERTIFICA
CERTIFICATION.
THERE IS INDIVIDUAL AND BOOTH
LEVEL.
INDIVIDUAL IS SOMEBODY COMES IN,
SINGLE PERSON INVESTIGATOR
CONDUCTING ANALYSES.
MAYBE THEY HAVE A BIG LAB AND
THEY COME IN TOGETHER FROM THE
SAME INSTITUTION ON A GROUP LEFT
DUC.
THAT IS A MORE COMMON WORK FLOW
THAT FOLKS WILL UTILIZE.
AS I MENTIONED BEFORE, EVERYONE
INCLUDING THE TRAINEES WILL NEED
TO COMPLETE TRAINING ON
RESPONSIBILITY USE OF THE DATA
AND KNOWLEDGE QUIZ TO GAIN
ACCESS TO THE DATA.
AND THE DATA USE AGREEMENT IS
VALID FOR A YEAR AND USERS CAN
RENEW AT THAT TIME.
WE ALSO ARE IMPLEMENTING
DEVELOPMENT INTO THE SYSTEM THAT
REFLECTS NEW NIH SECURITY
COMPLIANCE REQUIREMENTS.
THIS IS NOT A PLATFORM
REQUIREMENT OR A NIDA
REQUIREMENT, IT IS NIH-WIDE,
SECURITY COMPLIANCE.
APPROVED USERS OF THE DATA HAVE
TO COMPLY WITH THE SECURITY BEST
PRACTICES.
IF THEY ARE OPTING TO DOWNLOAD
DATA.
THEY HAVE TO ATTEST TO HAVING
COME CLINES SYSTEM OR A PLAN IN
PLACE TO BE CONSIDERED
COMPLIANT.
THE REASON ALL RECIPIENTS NEED
TO HAVE A PLAN IN PLACE IS THAT
IT IS NEEDED FOR DATA DOWNLOAD.
THAT IS ONLY FUNCTIONALITY WE
HAVE WHEN THE SYSTEM LAUNCHES.
BUT INSTITUTE FUNCTIONALITIES
WILL BE AVAILABLE VERY SOON.
RIGHT NOW WHEN A USER COMES IN
TO ACCESS THE DATA,
UNFORTUNATELY, IF THEY DON'T
HAVE A PLAN IN PLACE FOR NIST
COMPLIANCE, THEY CAN'T GET
APPROVAL TO ACCESS THE DATA.
IF THEY HAVE A PLAN IN PLACE
EVEN IF THEY DON'T HAVE THE
COMPLIANCE IN PLACE ITSELF, THAT
IS ENOUGH TO HAVE ACCESS TO THE
DATA.
WHEN WE HAVE THE INSTITUTE
FUNCTIONALITIES BUILT INTO THE
SYSTEM THERE IS AN ADDITIONAL
DUC WORK FLOW.
THEY DON'T HAVE NIST COMPLIANCE.
THAT'S OKAY THEY CAN USE THE
DATA IN PLACE.
THEY JUST CAN'T DOWNLOAD THE
DATA.
HERE IS THE SPLASH PAGE YOU SEE
COMING IN.
IT IS HARD TO TELL, BUT AT THE
TOP RIGHT THERE ARE TABS FOR
DIFFERENT THINGS.
TABS FOR ABCD STUDY, HBCD STUDY.
THAT IS WHERE YOU FIND READ ME
DOCS AND THE DATA RELEASES AND
MORE INFORMATION ABOUT THE DATA
CONTAINED IN THE RELEASES.
THE DATA ACCESS PROCESS.
LE DATA TOOLS.
THAT IS WHERE YOU WILL GO TO
ACCESS A WHOLE BUNCH OF FAQs
AVAILABLE ON THE FAR RIGHT.
HERE IS JUST A VISUALIZATION OF
THE DATA ACCESS PROCESS.
THIS IS A SNAPSHOT OF THE FIRST
PAGE OF THE TRAINING MODULE.
A SIGNING OFFICIAL WILL CO-SIGN
AFTER A USER SIGNED THEIR DUC.
DATA ACCESS COMMITTEE DO THEIR
REVIEW AND THE USER COMPLETES
TRAINING AND THEN THEY HAVE
ACCESS TO THE DOITS.
-- DATA.
AND THEN YOU ARE IN.
THIS IS A SNAPSHOT OF THE VERY
HIGH LEVEL QUERY YOU WILL BE
ABLE TO DO IMMEDIATELY WHEN YOU
COME INTO THE SYSTEM.
ON THE LEFT IT IS SET TO HBCD
RIGHT NOW, BUT, OF COURSE, YOU
CAN SEARCH FOR ABCD DATA AS
WELL.
SO YOU CAN DO THINGS LIKE GET A
BREAKDOWN BY INSTRUMENT.
THIS IS NOT REAL DATA.
THIS IS DUMMY DATA FOR NOW.
YOU CAN ALSO, FOR EXAMPLE, DO A
BREAKDOWN OF PARTICIPANTS PER
SESSION OR MODALITY, DIFFERENT
IMAGING COMPONENTS.
OOPS, SORRY.
AND SO THIS IS JUST VERY QUICK,
WITHIN A MATTER OF SECONDS YOU
CAN QUICKLY FILTER DOWN YOUR
INTERESTED DATA SET TO WHAT YOU
MIGHT WANT TO QUERY FURTHER.
THIS IS THE DATA QUERY COMPONENT
WHICH IS LASSO SYSTEM.
YOU CAN DO IT ON THE DEEP WHICH
I WILL SHOW YOU AN EXAMPLE IN A
MOMENT.
HERE YOU MIGHT BUILD A DATA
QUERY ON RESEARCH DOMAINS AND
YOU HAVE A VISUALIZATION OF THE
DATA SELECTION ACCORDING TO
CRITE
CRITERIA.
THIS IS IN A MATTER OF SECONDS.
IT HAS NICE VISUALIZATIONS.
YOU CAN SEE WHAT YOU ARE GETTING
AND TOGGLE BACK AND FORTH.
THE FINAL COMPONENT IS THE
ABILITY TO DOWNLOAD FILE-BASED
DATA.
IF YOU HAVE A PLAN FOR NIST
COMPLIANCE, YOU CAN DO THAT.
I WANTED TO SHOW YOU A SNAPSHOT
FROM THE DEEP.
THIS IS NOT LIVE YET, BUT WILL
BE WITH THE LAUNCH OF THE
PLATFORM.
THERE ARE A COUPLE OF WAYS TO
QUERY DATA.
THE FIRST IS A NESTED TREE
STRUCTURE.
ABCD ON THE FAR LEFT AND CORE
VERSUS SUB STUDIES.
SO YOU CAN TOGGLE BACK AND FORTH
DEPENDING WHERE YOU WANT TO BE
AND WHAT MEASURES YOU ARE
LOOKING TO QUERY.
YOU CAN GO DOWN TO THE DATA
ELEMENT.
ON THE RIGHT IS A DETAILED LIST
STRUCTURE.
ANYTHING YOU CLICK ON THE NESTED
TREE WILL POPULATE AUTOMATICALLY
TO THE TREE.
YOU CAN SEARCH THE DETAILED LIST
AND GET A LOT MORE INFORMATION
ABOUT DATA STRUCTURES.
THERE IS A DETAILS TAB ON THE
FAR RIGHT WHICH WILL PROVIDE A
LOT OF INFORMATION ABOUT
INDIVIDUAL DATA ELEMENTS AND
HIGH-LEVEL STATISTICS, SUMMARY
STATISTICS.
AND FINALLY, I THOUGHT I WOULD
JUST CONCLUDE THIS WITH COMING
SOON.
A LOT OF THIS IS COMING SOON.
THIS IS THE PART, SOME ASPECTS
WILL BE AVAILABLE IN THE NEXT
COUPLE OF MONTHS, OTHERS LATER
IN 2025.
WE'VE DIVIDED THESE DIFFERENT
INSTITUTE FUNCTIONALITIES BY
USER TIERS.
ANYONE CAN DO ANY ANALYSES THEY
WISH TO DO.
BUT WE THINK THESE DIFFERENT
COMPONENTS REFLECT DIFFERENT
NEEDS OF DIFFERENT TYPES OF
USERS.
SO THE DEEP SYSTEM HAS A LOT OF
COMPONENTS IN PLACE THAT
INCORPORATE THAT MAYBE NOVEL
USERS DON'T KNOW AND IT IS BUILT
IN THERE FOR THEM.
THAT HAS COMPONENTS,
FUNCTIONALITIES FOR CREATION,
AND ANALYSIS BUILT IN.
MORE EXPERIENCE USERS MIGHT WANT
TO BE COMPUTING IN PLACE IN
USING CUSTOMIZED TOOLS FOR DATA
EXPLORATION AND ANALYSIS.
IT IS GOING TO BE A SAND BOX FOR
DATA ANALYSIS AND COLLABORATION
USING TABULATED DATA AS WELL AS
FILE-BASED DATA.
I THINK THE SYSTEM WILL BE BUILT
TO ACOME DATA UP TO 300 VIRTUAL
USERS.
THE MACHINES WILL SPIN UP AND
DOWN DEPENDING ON THE USER
NEEDS.
DEPENDING HOW MUCH COMPUTATIONAL
POWER ONE NEEDS, MACHINES WILL
BE SPUN UP TO ACCOMMODATE.
THAT IS WHERE I THINK I WILL
END.
HAPPY TO TAKE QUESTIONS IF THERE
IS TIME.
MY PERSPECTIVE AND I'M GOING TO
RELY ON GEORGE OR NOT.
IT SAYS HERE 1:25.
I CUT THE DISCUSSION TO ALMOST
NOTHING.
GEORGE, DO WE HAVE TIME OR
SHOULD WE LEAVE THE DISCUSSIONS
FOR THE ♪
♪
>> I THINK WE SHOULD LEAVE THEM
END.
WE HAVE A LOT OF TIME THERE.
SO HOLD ALL YOUR QUESTIONS FOR
ABCD.
AND HBCD.
BECAUSE I WANT TO INTRODUCE DR.
HOOD AND GIVE HIM AMPLE TIME TO
GIVE WHAT IS GOING TO BE A
STELLAR PRESENTATION.
SO ARE WE GOOD TO GO, NORA?
IS THAT OKAY?
ELIZABETH, TERRIFIC
PRESENTATION.
THANKS.
>> YEAH.
GREAT PRESENTATIONS FROM ALL OF
YOU AND LOOK FORWARD TO A
DISCUSSION LATER.
SO ZRCHLT HOOD IS THE PROMINENT
FIGURE IN THE FIELD OF
BIOTECHNOLOGY WITH A ROBUST
EDUCATIONAL AND PROFESSIONAL
BACKGROUND.
HE EARNED HIS M.D. FROM JOHNS
HOPKINS UNIVERSITY AND A PH.D.
IN BIOCHEMISTRY FROM THE
CALIFORNIA INSTITUTE OF
TECHNOLOGY, WE CALL IN
CALIFORNIA CAL TECH.
HIS SIGNIFICANT CAREER BEGAN IN
1967 AS A SENIOR INVESTIGATOR AT
THE NATIONAL CANCER INSTITUTE AT
NIH.
DR. HOOD HAS HELD NUMEROUS
PRESTIGIOUS POSITIONS FACULTY
CHAIRMAN OF BIOLOGY AT CAL TECH,
FOUNDER AND CHAIRMAN OF
BIOMEDICAL TECHNOLOGY AT THE
UNIVERSITY OF WASHINGTON MEDICAL
SCHOOL AND THE INSTITUTE FOR
SYSTEMS BIOLOGY KNOWN AS ISB.
DR. HOOD'S SIGN IFFIC
CONTRIBUTIONS ARE
GROUNDBREAKING.
RENOWNED FOR DEVELOPMENT OF
AUTOMATED DNA SEQUENCES, WHICH
WAS PIVOTAL IN THE HUMAN GENOME
PROJECT.
ADDITIONALLY HE PLAYED A KEY
ROLE IN THE INVENTION OF THE
SYNTHESIZER AND SEQUENCER AND
THE INK JET DNA SYNTHESIZER THAT
ADVANCED MEDICAL RESEARCH AND
MEDICAL DIAGNOSTICS.
HE HELPED DECIPHER THE IMMUNE
DIVERSITY.
PIONEERED SYSTEMS APPROACHES TO
BLOLG AND DISEASE.
HE INITIATED THE FIRST EFFORTS
TO STUDY INDIVIDUAL GENOME AND
FEE HOME ANALYSIS OF POPULATIONS
WHICH LED TO THE CONCEPT OF
DATA-DRIVEN HEALTH.
DR. HOOD IS ON PIONEER SYSTEMS
TO UNDERSTAND THE COMPLEXITY OF
BIOLOGICAL SYSTEMS IN HUMANS.
HIS WORK AT ISB AND THE PHENOME
HEALTH, A NONPROFIT HE FOUNDED,
AND ACTS AS A CEO, INVOLVES
INTEGRATING BIOLOGY, TECHNOLOGY,
COMPUTATION AND ARTIFICIAL
INTELLIGENCE TO DECODE THE
GENOMIC BASIS OF HEALTH AND
DISEASE.
HIS TEAM IS WORKING ON
PERSONALIZED MEDICINE AIMING TO
HEALTH CARE BASED ON INDIVIDUAL
GENOME AND LONGITUDINAL PHENOME
ANALYSIS ENABLING HEALTH CARE
FOCUSED ON OPTIMIZING WELLNESS
AND EARLY DETECTION AND THE
PREVENTION OF DISEASE.
HE IS A MEMBER OF ALL THREE
NATIONAL ACADEMIES.
HE RECEIVED THE LASKER AWARD IN
1987 FOR DECIPHERING IMMUNE
DIVERSITY AND THE NATIONAL
MEDICINE OF SCIENCE FROM
PRESIDENT OBAMA IN 2011.
LOOKING AHEAD, DR. HOOD'S
RESEARCH IS DIRECTED TOWARD THE
FUTURE OF HEALTH CARE THROUGH
THE CONCEPT OF P-4 MEDICINE,
PREDICTIVE, PREVENTIVE,
PERSONALIZED AND PARTICIPATORY.
LEVERAGING BIG DATA SYSTEMS
ANALYSIS, AI AND A NEW STRATEGY
FOR RAPIDLY AND INEXPENSIVELY
GENERATING DRUGS TO TRANSFORM
HEALTH CARE MAKING IT MORE
EFFICIENT AND EFFECTIVE BY
PREDICTING DISEASE, PREVENTING
IT, PERSONALIZING TREATMENT AND
INVOLVING PATIENTS IN THEIR OWN
CARE.
HE'S ADVOCATED AND EXTENSION OF
THE HUMAN GENOME PROJECT, KNOWN
AS THE HUMAN PHENOME INITIATIVE,
SUGGESTING THE ANALYSIS OF 1
MILLION INDIVIDUALS OVER A
PERIOD OF FIVE TO 10 YEARS.
DR. HOOD, WE ARE REALLY LOOKING
FORWARD TO YOUR TALK.
THE TITLE IS THE SYNERGY OF
DATA-DRIVEN HEALTH
DATA-DRIVEN INFORMATIONAL
PEPTIDE DRUG DISCOVERY IN
DEALING WITH DATA-DRIVEN HEALTH
CARHEALTH AND A UNIVERSAL N = 1
HEALTH CARE.
IT IS ALL YOURS, SIR.
>> OKAY.
THANK YOU VERY MUCH.
WELL, LET'S SEE IF WE CAN GET
ON.
I HAVE TROUBLE WHERE MICROSOFT
TEAMS.
I MUST SAY.
I NEED PERMISSION TO SHARE MY
SCREEN.
CAN SOMEONE GIVE ME PERMISSION?
>> YES, GIVE US A FEW SECONDS.
>> PHILIPPE IS DOING THAT RIGHT
NOW.
YOU ARE GOOD TO GO.
I STILL SEE I NEED PERMISSION.
I HOPE TO GOD YOU DON'T HAVE TO
ADVANCE THE SLIDES.
IT'S NOT LETTING ME IN.
>> YEAH.
WE KNOW.
WE ARE WORKING ON IT HERE.
PHILIPPE.
CHRIS, IS THERE A WAY YOU CAN
PUT THESE UP?
>> THERE IS, BUT IT IS A LOT OF
ADVANCES.
I WOULD LIKE TO DO IT MYSELF IF
WE CAN.
>> WE'RE TRYING TO DO IT.
HE'S OUTSIDE OF THE
ORGANIZATION, PHILIPPE.
IS THERE SOME WAY --
>> DO YOU WANT TO TRY AGAIN.
>> OKAY.
>> TRY AGAIN.
>> NOPE.
SAME THING.
>> WELL I'M HAPPY TO ADVANCE --
>> WE CAN GO TO YOU SHOWING MY
SLIDES.
LET'S SEE IF THIS DOES IT.
>> THERE WE GO.
>> YOU THINK SO?
>> IT WAS THERE.
>> NOW I SEE NOTHING -- OH.
>> DO YOU SEE IT?
>> I DON'T SEE IT.
NO.
>> WE SEE IT.
>> OH, I SEE IT NOW.
>> OKAY.
THERE'S PROBABLY A DELAY.
OKAY.
WE'RE READY TO GO IF YOU ARE.
>> LEE, CAN YOU ADVANCE?
>> WE LOST HIM.
NOW WHAT?
>> CHRIS, CAN YOU SEE IF HE IS
STILL ON.
>> CAN YOU SEE THE SLIDES?
I CAN SEE SOMETHING NOW.
>> WE CAN SEE THE SLIDES.
CAN YOU HEAR US?
>> I CAN HEAR YOU FINE.
CAN YOU HEAR ME?
>> YES.
SO IF YOU CAN ADVANCE, WE'RE
READY TO GO.
>> OKAY.
>> TRY ADVANCING.
YEAH.
THAT WORKED.
>> LET'S SEE.
LET'S GO BACK TO --
>> THAT'S THE TITLE PAGE.
>> WELL, LET ME MAKE THREE
COMMENTS BEFORE I GET STARTED
THEN.
ONE, I SEE HEALTH IS THREE
DIFFERENT STAGES.
ONE IS OPT MISZING WELLNESS, THE
SECOND IS DEALING WITH FRANK
DISEASE, DIAGNOSED DISEASE AND
THE THIRD IS BEING ABLE TO
DEFECT VERY EARLY AND REVERSE
WELLNESS TO DISEASE TRANSITIONS.
AND THOSE THREE THINGS I THINK
MAP INTO THE THREE DIFFERENT
MAJOR AREAS THAT WE'RE TALKING
ABOUT IN THIS DIFFERENT MEETING.
I THINK A SECOND THING THAT IS
REALLY IMPORTANT IS THERE WAS A
RECENT PAPER OUT OF STANFORD
THAT SHOWED WITH REGARD TO
HEALTH ABOUT 89% OF IT IS
PHENOMIC IN NATURE, 11% IS
GENOMIC.
THE VAST BULK OF DEALING WITH
WELLNESS AND DISEASE IS YOUR
BEHAVIOR AND THE ENVIRONMENT IN
WHICH YOU LIVE.
THE TWO MAJOR ELEMENTS TO
PHENOMICS.
A THIRD CATEGORY OF THE WHOLE
IDEA OF TELLING YOU ABOUT
DATA-DRIVEN HEALTH AND WHAT IT
IS AND HOW IT IS GOING TO
ABSOLUTELY MAN DAVID A
DATA-DRIVEN INFORMATIONAL
PEPTIDE DISCOVERY.
BECAUSE WE WILL NEED A WHOLE NEW
APPROACH FOR DRUG DISCOVERY.
SO NOW IT IS NOT ADVANCING.
>> I WILL HAVE TO ADVANCE THE
SLIDES FOR YOU, UNFORTUNATELY.
SO IF YOU CAN SAY NEXT SLIDE.
>> OKAY.
I'LL JUST SAY NEXT.
OKAY.
SO WHAT I WANT TO SAY AS AN
ASSISTANT PROFESSOR IN 1960, I
WAS INTERESTED IN HUMAN
COMPLEXITY.
THAT LED ME TO REALIZE AT THAT
TIME THERE WERE TWO MAJOR
ASPECTS OF DEALING WITH HUMAN
COMPLEXITY.
ONE WE NEEDED TO GENERATE THE
TECHNOLOGIES NECESSARY FOR
GENERATING BIG DATA BECAUSE IN
THE END COMPLEXITY MUST BE
SOLVED BY ENORMOUS AMOUNTS OF
DATA FROM INDIVIDUALS.
AND NUMBER TWO, IT WAS QUITE
CLEAR YOU HAD TO BE ABLE TO DO
SOMETHING WITH THAT DATA AND
THAT WAS WHERE THE BEGINNING OF
SYSTEMS BIOLOGY EMERGED.
PLEASE DON'T ADVANCE UNTIL I
TELL YOU TO CLICK.
OKAY.
SO THE FIRST SERIES OF PARADIGM
CHANGES I WAS INVOLVED IN WAS
THIS IDEA OF DEVELOPING OVER A
PERIOD OF 25 YEARS SIX DIFFERENT
INSTRUMENTS FOR ESSENTIALLY
ANALYZING DNA AND ANALYZING,
WELL, DNA RNA AND PROTEINS.
ONE OF THE INCIDENTS ON THE NEXT
CLICK.
COULD YOU ADVANCE IT.
IN THE SPRING OF 1985, CAN YOU
ADVANCE THE SLIDE, PLEASE?
THANK YOU.
OF WHEN 12 OF US GOT TOGETHER
AND DECIDED THAT ONE, IT WAS
FEASIBLE TO DO THE GENOME
PROJECT AND, TWO, WE WERE SPLIT
6-6.
THOSE OPPOSING IT WERE AGAINST
IT BECAUSE IT WAS BIG SCIENCE
AND THEY WERE AFRAID IT WOULD
DESTROY SCIENCE.
OF COURSE, THE HUMAN GENOME
PROJECT IN 2003 GAVE US THE
ABILITY FOR EACH INDIVIDUAL TO
FRAME YOUR POTENTIAL HEALTH
TRAJECTORY.
I WILL SAY MORE ABOUT THAT
LATER.
THE THIRD PARADIGM CHANGE ON THE
NEXT SLIDE THAT CAME UP WAS THAT
I PROPOSED THAT CAL TECH THE
IDEA OF CREATING -- COULD WE
HAVE THE NEXT SLIDE, PLEASE.
CREATING A CROSS DISCIPLINARY
DEPARTMENT RATHER THAN HAVING A
BIG LAB AS I DID WITH ALL THE
DIFFERENT TECHNOLOGIES.
AND CAL TECH BIOLOGY TURNED THAT
DOWN, BUT BILL GATES MADE IT
POSSIBLE TO GO TO THE UNIVERSITY
OF WASHINGTON TO START MOLECULAR
BIOTECHNOLOGY.
AND IN EIGHT YEARS, REALLY, IT
CREATED THE SOFTWARE FOR JOIN
HUMAN GENOME PROJECT, PHIL GREEN
FOR ASSEMBLY AND QUALITY
CONTROL.
RUDY ABERSOL AND JOHN GATES LED
THE PEOPLE IN PROTEOMICS.
AND WE DEVELOPED THE INK JET
TECHNOLOGY IN THE SYNTHESIS OF
PEPTIDE DRUGS AND SO FORTH.
IN 2000, I RESIGNED FROM
UNIVERSITY OF WASHINGTON AND
STARTED ON THE NEXT SLIDE THE
INSTITUTE FOR SYSTEMS BIOLOGY
WAS THE FIRST ORGANIZATION FOR
SYSTEMS APPROACHES.
NEXT SLIDE, PLEASE.
>> LEE, THERE IS A BIT OF A
DELAY.
>> OKAY.
I'LL JUST TALK.
FINE.
AND SYSTEMS BIOLOGY, WHAT WE DID
WAS TO REALLY PIONEER FIRST AN
APPROACH TO NORMAL BIOLOGY WHERE
TREY IDIGER AS A GRADUATE
STUDENT DID -- SHOWING
BEAUTIFULLY WE COULD MAP IT INTO
NETWORKS AND DYNAMICS AND
EXPLAIN THE PHYSIOLOGY OF s
utilizaUtah
Utahly we suggested the idea of
P4 health care.
The essence of that describes
the ideal features of health
care in contrast to precision
medicine which is a focused
effort on one very small
component, usually a single
protein or regulatory element or
so.
And what happened next was
really interesting.
On the next slide, I was able to
persuade the grand dutchy of LUX
EM borge to provide $100 million
over a five-year period to
explore all of the technologies
and strategies we needed to
carry out systems approached to
medicine.
I was offered I found the modern
bureaucracies essentially make
them imbracket KL for new ideas.
In 21 I re-signed and started
phenome health and used that to
drive this idea of data-driven
health which has led to the idea
of a million person project I
will talk about that at the end
of my discussion.
This really has led me on the
next slide to the conviction
that 7 out of 8 of these
paradigm changes, genome project
in part were cat LIZed by small
and agile institutions.
On the next click, they could be
nonprofits and I did a number of
nonprofits that contributed to
these or they could be for
profits and likewise on the next
click I did a number of for
profits.
They rarely come from large
organizations because of
bureaucratic constraints.
OUTCOME OF DATA DRIVEN HEALTH
CREATES US A SPAN TO MOVE INTO
THE 90s AND 100s.
THE DATA DRIVEN HEALTH HAS TWO
COMPONENTS, THE GENOME IT GIVES
YOU A FRAMING OF POTENTIAL
HEALTH TRAJECTORY AND ON THE
NEXT SLIDE, THE ABILITY TO
ASSESS FROM BIRTH TO DEATH THE
ACTUAL TRAJECTORY THAT YOU
ACTUALLY TAKE.
AND ON THE NEXT SLIDE, YOU CAN
SEE FOLLOWING THESE DIVERSE
PHENO TYPES AS YOU CHANGE FROM
BIRTH TO DEATH.
NEXT SLIDE, PLEASE.
ALLOWS YOU TO -- AND THEY ARE
ACTIVATED BY TWO DIFFERENT
ASPECTS.
ONE IS BEHAVIOR AND ONE IS
ENVIRONMENT.
AND FROM THE PHENOMICS ON THE
NEXT CLICK, WE CAN DO MULTIOMIC
DATA ANALYSIS OF BLOOD ANALYZE.
THE GUT BIOME AND SO FORTH FT
ANYTHING THAT CHANGES IN
INFORMATIONAL MOLECULES IS
REGISTERED AS PHENOMICS.
ON THE LAST CLICK ON THIS SLIDE
IT SHOWS YOU THE MILLION PERSON
PROJECT AND THE REASON IT IS SO
IMPORTANT TO EXECUTE THAT IS IT
WILL GIVE YOU THE ABILITY TO
VALIDATE HEALTH IMPROVEMENT FOR
INDIVIDUALS, COST SAVINGS, AND
THE EMERGENCE OF NEW KINDS OF
TECHNOLOGIES FOR PHENOMICS.
SO ON THE NEXT SLIDE YOU CAN SEE
THAT WE'VE USED THE APPROACHES
OF SYSTEMS BIOLOGY TO CARRY OUT
THESE DIFFERENT ANALYSES THAT IS
LOOKING IN A KWAN --
QUANTITATIVE WAY AT SEQUENCE
MOLECULES, DNA, RNA AND
PROTEINS.
THE FIRST IDEA THAT EMERGED ON
THE NEXT CLICK IS THE IDEA THAT
BLOOD IS A SYSTEMS APPROACH AT
LOOKING AT WELLNESS AND DISEASE.
THEY SECRETE MOLECULES INTO THE
BLOOD.
IN SOME CASES WE CAN IDENTIFY
THE ORIGIN OF THE MOLECULES AND
BY FOLLOWING THEIR QUANTITATION,
WE CAN LOOK AT CHANGES
INWELLNESS OPT MIZATION OF
HEALTH AND DISEASE.
ON THE NEXT CLICK THIS WAS KIND
OF A SYSTEMS APPROACH TO
THINKING ABOUT BIOLOGY AND
EVERYTHING.
AND SO NEXT CLICK, PLEASE.
AND OBVIOUSLY THE USE OF ALL OF
THIS DIGITAL DATA THEN REQUIRED
THAT ALLOWS US TO LOOK AT
DYNAMIC COMMUNITIES.
ON THE LAST CLICK WE USE THE
TOOLS OF AI WHICH INCLUDE
KNOWLEDGE GRAPHS, DIGITAL TWINS
AND ULTDLY LARGE LANGUAGE MODELS
OR TRANSFORMERS.
SO ON THE NEXT SLIDE, LET ME
JUST REMIND YOU AGAIN THAT THE
DATA FROM WHICH WE'LL DRAW SOME
NOW GENERAL CONCLUSIONS, NEXT
SLIDE, PLEASE, WAS A FOUR-YEAR
PROGRAM AND WE DREW GENOME AND
PHENOME DATE FROM 5,000 PEOPLE.
WE MEASURED SIX DIFFERENT DATA
FEATURES.
ON THE NEXT CLIK YOU CAN CAN SEE
GENOME, NEXT CLICK, CHEMICAL
PROTEINS AND METABOLITS AND GUT
BIOME.
SO SIX DIFFERENT DATA FEATURES.
FROM ALL OF THESE STUDIES CAME
CONCLUSIONS OF WHAT DATA-DRIVEN
HEALTH WILL LEEZ US -- LEAD US
TO ON THE NEXT SLIDE.
THE FIRST OF THESE -- NEXT
SLIDE, PLEASE.
THE GENOME HAS AT LEAST EIGHT
DIFFERENT CATEGORIES OF
ACTIONABLE FEATURES THAT WE CAN
LOOK AT ON THE NEXT CLICK,
PLEASE.
MY GOODNESS, DOES EVERYBODY HAVE
THIS MUCH TROUBLE.
IT IS A DISASTER.
ANYWAY, THERE ARE FIVE
OPPORTUNITIES, ONE IS EIGHT
GENOME CATEGORY AND WE'LL TALK
ABOUT THOSE IN A MOMENT.
THE SECOND HAS TO DO WITH
STATISTICAL ANALYSES OF THE SIX
DIFFERENT TYPES OF DATA.
AND ON THE NEXT CLICK WE'LL TALK
ABOUT THAT IN JUST A MOMENT,
TOO.
CAN YOU CLICK THROUGH EACH OF
THESE AND I WILL TALK ABOUT THEM
AND KEEP UP WITH YOU.
SO STATISTICAL ANALYSIS LEAD TO
COMMUNITIES.
METRICS FOR WELLNESS, HEALTHY
AGING AND PHYSIOLOGIC TRAITS
LIKE BIOLOGICAL AGE AND BMI AND
FRAILTY ARE IMPORTANT.
FINALLY, TRARNS -- TRANSITION
STATES FROM WELLNESS TO DISEASE
AND WE CAN DETECT THOSE IN THREE
WAYS.
ONE IS USING BLOOD ORGAN
SPECIFIC PROTEINS THAT ASSESS
THE STATE OF WELLNESS AND
DISEASE FOR 25 DIFFERENT ORGANS
SIMULTANEOUSLY.
AND FINALLY, WE ARE GOING TO
SHOW YOU WELLNESS IS THE TOTAL
DIMENSIONAL TILL OF HEALTHY
AGING AND CONTRAST WITH GENERAL
SCIENCE AND WHAT THAT BRINGS TO
US.
THE FINAL POINT IS THERE ARE
THREE ASPECTS OF HEALTH WE NEED
TO BE ABLE TO INTEGRATE AND
OPTIMIZE.
HEALTH OF THE BRAIN, HEALTH OF
THE BODY, HEALTH OF THE GUT
MICROBIOME.
THEY ALL INTERPLAY IN ENORMOUSLY
POWERFUL DIFFERENT WAYS.
ON THE NEXT SLIDE YOU CAN SEE A
LIST OF THE EIGHT DIFFERENT
GENOME POSSIBILITIES AND I THINK
THE TWO THAT ARE REALLY MOST
RELEVANT TO YOU ARE THE
POLYGENIC VARIANTS AND I
POLYGENI PHENOTYPES.
THE POINT ON THE NEXT CLICK IS
IT GIVES US FOUR DIFFERENT
POSSIBILITIES FOR OPTIMIZING
HEALTH.
NEXT CLICK, PLEASE.
SO ONE IS THE ABILITY TO
OPTIMIZE WELLNESS AND AGING.
ANOTHER IS THE ABILITY TO
AMELIORATE OR REVERSE GENOME OR
PHENOME, YOUR BEHAVIOR, LEAD
TO -- THE THIRD IS THE IDEA WE
CAN DO EARLY DISEASE DETECTION
AND PREVENTION AND THE FOURTH IS
WE CAN DEAL WITH DIAGNOSED
DISEASE VERY EFFECTIVE WITH THE
SYSTEMS APPROACH AS IN WHAT
PEOPLE ARE CALLING PRECISION
MEDICINE NOW.
SO ON THE NEXT SLIDE, WE CAN
LOOK AT THE STATISTICS.
THIS IS A COMPLICATED SLIDE WITH
MANY CLICKS.
IF WE COULD GET STARTED.
WE ARE LOOKING AT STATISTICAL
POSSIBILITIES WHERE WE FIRST
STUDIED THE 108 PEOPLE AND WERE
ABLE TO DEMONSTRATE THE SIX
DIFFERENT DATA TYPES.
THERE WERE ABOUT 3500
STATISTICAL CORRELATIONS.
AN EXAMPLE FOR ME WAS WHERE I
HAD VERY LOW VITAMIN D AND IT
TURNED OUT I HAD TWO VARIANT
GENES THAT BLOCKED THE UPDATE IN
VITAMIN D AND TO BRING MYSELF UP
TO A NORMAL LEVEL I HAD TO USE
EXTREME DOSES, 15,000
INTERNATIONAL UNITS AND MAINTAIN
AT 5,000 UNITS.
THAT WAS AN EXAMPLE OF FIXING A
DEFICIENCY IN THE GENOME THAT
OPTIMIZED HEALTH.
IT LED TO VARIOUS BIOLOGICAL
NETWORKS AND DETAIL
UNDERSTANDING OF WHY THE FAILURE
OCCURRED.
SO THAT IS CLASSIC BIOLOGICAL
NETWORKS AND THEY ARE ALL ONE
DIMENSIONAL.
PROTEINS, TRANSCRIPTION FACTORS.
A SECOND STATISTICAL APPROACH IN
THE NEXT CLICK IS CALLED
COMMUNITY ANALYSIS.
AND WHAT IT DOES ON THE NEXT
CLICK, GO AHEAD, IS IT TAKES
THIS HAIR BALL AND IT BASICALLY
ASKS GIVE US THE FEATURES OF
DATA THAT ARE MOST CLOSELY
RELATED STATISTICALLY TO ONE
ANOTHER AND IT TURNED OUT WITH
108 PEOPLE WE HAD 70 COMMUNITIES
OF FEATURES YOU CAN SEE HERE AND
WHAT WAS REMARKABLE ON THE NEXT
CLICK IS ALMOST ALL OF THOSE
COMMUNITIES MAPPED INTO NORMAL
PHYSIOLOGY OR DISEASE
PHYSIOLOGY.
AND THE IMPORTANT POINT WAS THEY
RELATED ALL SIX OF THE DIFFERENT
DIMENSIONS OF DATA TOGETHER IN A
VERY DIFFERENT WAY FROM THE
FIRST BIOLOGICAL NETWORKS WE
TALKED ABOUT.
AND, IN FACT, ON THE NEXT CLICK,
TWO CLICKS, ACTUALLY, YOU CAN
SEE ONE OF THESE NETWORKS
EXPLODING OUT, I HOPE, CLICK
AGAIN.
>> IT EXPLODED.
>> OH, WELL, ANYWAY, ONE
EXPLODES OUT TO SHOW THAT YOU
HAVE 12ANALITES THAT COORDINATE
WITH LDL CHOLESTEROL, ONE WAS
THYROXIN, IT TURNED OUT LILY HAD
IT IN THE FINAL STAGES OF CLASS
3 FOR AEBT CHOLESTEROL.
ALL I'M SAYING IS THESE
COMMUNITIES GIVE US ENORMOUS
POSSIBILITIES TO CREATE
BIOMARKER AND DRUG TARGETS FOR
THE FUTURE.
IN FACT, ON THE NEXT CLICK, IN
THE ORIGINAL 100 PEOPLE WE
LOOKED AT 500 PROTEINS.
ON THE NEXT CLICK WE LOOKED AT
5,000 PROTEINS AND WE HAD 10
TIMES AS MANY STATISTICAL
ASSOCIATIONS.
AND HUNDREDS OF COMMUNITIES THAT
WERE INTERACTING AND WHEN WE
MOVED FROM 100 TO 5,000, WE EVEN
HAD MORE.
SO WE HAVE ENORMOUS NUMBERS OF
DRUG TARGETS.
AND THIS IS AN EXAMPLE OF ONE OF
THE METRICS WE HAVE FOR
PHYSIOLOGIC CHANGE CALLED
BIOLOGICAL AGE WHERE IT MEASURES
THE AGE YOUR BODY SAYS YOU ARE
AS OPPOSED TO YOUR CHRONOLOGICAL
AGE.
THE LOWER YOUR BIOLOGICAL AGE
RELATIVE TO YOUR CHRONOLOGICAL
AGE, THE BETTER YOU ARE AGING.
LET'S GO THROUGH FIVE CLICKS.
WE WERE ABLE TO SHOW FOR EVERY
YEAR A WOMAN STAYED IN THE
WELLNESS PROGRAM, SHE LOST 1.5
YEARS OF BIOLOGICAL AGE, MEN
LOST .8.
A SECOND THING WAS THE METRICS
COULD BE SPECIFIC FOR ORGANS,
MAJOR ORGANS AND YOU GET THE
BIOLOGICAL AGE OF THE ORGANS.
A THIRD IDEA WAS THE METRIC
COMPONENTS THEMSELVES GAVE US
ADVICE ON HOW TO OPTIMIZE ONE'S
BIOLOGICAL AGE, THAT IS REDUCE
IT.
AND THEN FINALLY IN EVERY CASE
WE LOOKED AT, MORE THAN 40
DIFFERENT MINOR AND MAJOR
DISEASES THAT BIOLOGICAL AGE
INCREASED SIGNIFICANTLY.
AND WE WERE ABLE THEN TO TAKE
THE COMPONENTS OF THE BIOLOGICAL
AGE, MAP THEM INTO GRAPHS AND
GAIN ENORMOUS INSIGHTS INTO THE
FEATURE THAT THE METRIC ACTUALLY
REPRESENTED.
IT GAVE US INSIGHTS INTO
BIOLOGICAL NETWORKS AND
BIOLOGICAL COMMUNITIES.
AND THEN ON THE LAST, IS THERE
ONE MORE CLICK?
LET'S GO ONE MORE CLICK.
WE COULD DO THE SAME FOR THE
BIOLOGICAL BMI AND FRAILTY
INDEX, TOO.
THIS SHOWS THE POWER OF A FOUR
YEAR GLIMPSE ACROSS A SET OF
PEOPLE FROM 21 YEARS TO 93 YEARS
IN AGE AND HOW THEY GAVE US AN
ENORMOUSLY BROAD REPRESENTATION
OF INDIVIDUALS AT ALL DIFFERENT
STAGES OF THEIR LIFE.
ON THE NEXT SLIDE IS THE REALLY
IMPORTANT POINT THAT WE CAN
ACTUALLY INTERROGATE AT A VERY
EARLY STAGE, TRANSITIONS FROM
WELLNESS TO DISEASE, WHERE IN
CONVENTION MEDICINE, DO A SERIES
OF CLICKS, ABOUT THREE CLICKS
ACROSS.
WHAT YOU SEE ARE INCREASINGLY
DISARRAY DISEASE PERTURBED
BIOLOGICAL NETWORKS AS THE
DISEASE PROGRESSES UP TO THE
NEXT CLICK, A CLINICAL
DIAGNOSIS.
WHEN ALMOST ALL CHRONIC DISEASES
ARE QUITE COMPLICATED AND MOST
DRUGS ARE HITTING A SYMPTOM,
THEY ARE NOT HITTING THE
FUNDAMENTAL CAUSE OF THE
DISEASE.
AND ON THE NEXT CLICK, WHAT WE
WERE ABLE TO SEE OOVER FOUR
YEARS IS 167 WELLNESS TO DISEASE
TRANSITIONS.
30 OF WHICH WENT TO DIFFERENT
CANCERS.
AND WE ANALYZED BLOODS PRIOR TO
THE DIAGNOSIS TIME FOR 10 OF
THOSE CANCERS AND WERE ABLE TO
DEMONSTRATE IN EVERY CASE
MULTIPLE ELEVATED PROTEINS,
WHICH FOR THE DIFFERENT TYPES OF
CANCER, MAPPED INTO RELEVANT
DISEASE PERTURBED NETWORKS FOR
THOSE CANCERS.
AND WE MEASURED THEM ONE TO FOUR
YEARS PRIOR TO CLINICAL
DIAGNOSIS.
SO THEY GIVE US THE CLUE AS TO
WHERE TO GO TO START ON THE NEXT
CLICK WHAT WE CALL PHENOMIC
MEDICINE WHERE WE CAN DO -- WE
CAN FIND THE EARLIEST DISEASE
PERTUBATION, CLICK, PLEASE, NEXT
SLIDE AND NEXT SLIDE.
WE CAN GET THE DISEASE PERTURBED
NETWORKS, NEXT SLIDE PLEASE AND
TAKE A PREVENTIVE DRUG AND BRING
THEM BACK TO NORMAL BEFORE THEY
EVER REVERT TO DISEASE.
THIS IS THE WELLNESS TO DISEASE
AND THE IDEA HERE IS IN OVER A
10-YEAR PERIOD WE COULD HAVE A
MAJOR IMPACT ON AVOIDING CHRONIC
DISEASES.
AND ON THE NEXT SLIDE IS JUST A
SIMPLE REPRESENTATION OF ANOTHER
APPROACH TO EARLY DISEASE
TRANSITIONS IS THE ORGAN
SPECIFIC PROTEINS.
ON THE NEXT SLIDE YOU CAN SHOW
FOR THE BRAIN, WE HAD MORE THAN
600 OR 700 ORGAN SPECIFIC
TRANSCRIPTS WHICH IN A NORMAL
INDIVIDUAL RELATED TO ONLY 10 OR
SO PROTEINS WE COULD DETECT IN
THE BLOOD.
BUT IN A DISEASED INDIVIDUAL,
THE BLOOD/BRAIN BARRIER OPENED
UP AND THE BLOOD MAPPED
BEAUTIFULLY AND FOR THE BRAIN IT
MAPPED INTO REGIONS OF THE BRAIN
SO YOU CAN SEE WHERE THE
BLOOD/BRAIN BARRIER HAD BEEN
DISEASE.
ON THE NEXT SLIDE, WE DID
EXACTLY THE SAME FOR THE
PLACENTA IN STUDIES I WILL TALK
ABOUT LATER ON PREGNANCY.
WE HAD 31 ORGAN SPECIFIC
PROTEINS AND GAVE US INSIGHTS
INTO MATERNAL HEALTH AND FETAL
HELTS.
ON THE NEXT SLIDE IN THIS
SERIES, WE LOOKED IN A BROAD
SENSE AT SCIENTIFIC WELLNESS AND
ALL OF THE METRICS THAT IT
ENTAILS.
IF WE COULD HAVE THE NEXT SLIDE,
PLEASE.
AND THESE ARE ALL THE OMICS AND
CLINICAL DATA AND ALL OF THE
THINGS WE ARE SO FAMILIAR WITH.
AND WHAT A SYSTEMS APPROACH TO
DISEASE IS ABOUT IS DISCOVERY
DRIVEN, IT IS NOT HYPOTHESIS
DRIVEN.
YOU LOOK AT EVERYTHING THAT IS
THERE AND YOU DEDUCE HOW THE
CHANGE HAS COME ABOUT.
ON THE NEXT CLICK IS IN STRIKING
CONTRAST TO GERO SCIENCE WHERE
THE FOCUS IS ON THE 12 HALL
MAREKS FOR NOW 14 HALLMARKS OF
AGING.
AND IT'S FOCUSED AND HYPOTHESIS
DRIVEN.
I SET UP AN INTEGRATION WITH THE
BUCK TO INTEGRATE THESE TWO
THINGS WITH THE NETWORKS AND
DYNAMIC BIOLOGICAL COMMUNITIES
WE TALKED ABOUT.
THEY LEAD TO A FASCINATING
BEGINNING INTEGRATION ON THE
NEXT CLICK THAT I'M CONVINCED IS
GOING TO COME TO THE ABILITY
TO -- FOR MANY PEOPLE, ANYWAY,
TO HAVE -- COULD WE CLICK NEXT.
A HEALTH SPAN THAT MOVES INTO 90
YEARS AND BEYOND.
SO LET'S GO FROM WHERE WE STAND
NOW AND WHERE WE ARE GOING TO IN
THE FUTURE.
OKAY.
IT IS FEATURES BY ANTHROPORMIC
DATA.
IF YOU DO THIS DATA DRIVEN AND
LET'S GO THROUGH A SERIES OF
CLICKS EACH WITH THE DIFFERENT
DIMENSIONS OF SYSTEMS DRIVEN
SCIENCE EXTENDS ENORMOUSLY THE
ACTIONABLE POSSIBILITIES TO
OPTIMIZE WELLNESS.
OR AVOID DISEASE.
THE GENOME DOES IT.
THE MICROBIOME DOES IT.
CLICK THROUGH THESE NEXT CLICKS.
AND THE WEARABLES DO IT AS WELL
ON THE NEXT CLICK.
THIS GIVES US THE ABILITY TO
ANALYZE UNIQUENESS OF THESE
INDIVIDUALS AND TO DO THE THINGS
I TALKED ABOUT, OPTIMIZE
WELLNESS, LOOK AT DISEASE
DETECTION, AND ON THE NEXT CLICK
ABLE TO DEAL WITH DISEASE AND
ACTUALLY TO LEAD TO BIOMARKER
DRUG TARGET DISCOVERY AND NEXT
CLICK, PLEASE.
AND EVEN CAUSAL RELATIONSHIPS
AND SO FORTH.
SO NOW LET'S GO ON AND TALK
ABOUT WHERE WE'RE GOING TO IN
THE FUTURE.
NEXT CLICK.
SO I JUST POSED THE QUESTION
WHERE WE'RE GOING IN THE FUTURE?
IT COMES FROM PUBLICATIONS AND
SCIENTIFIC JOURNALS THAT HAVE
GWYNN US A GLIMPSE OF WHAT IT
MEANS IN THE POPULATION OF 5,000
INDIVIDUALS OVER A FOUR-YEAR
PERIOD.
ON THE NEXT CLICK, IT PLACES US
NOW IN A POSITION TO SAY, WHERE
ARE WE GOING TO GO?
AND ON THE NEXT CLICK I'LL START
TO TELL YOU WHERE WE'RE GOING TO
GO.
AND THE FIRST THING, OF COURSE,
IS THE MISSION OF PHENOME
HEALTH, FOUR FOLD.
ONE TO GENERATE AND AGGREGATE
VERY LARGE SCALE GENOMIC,
PHENOMIC INFORMATION AND CREATE
FEDERATED DATA BASES IN WHICH WE
BRING OUR ANALYTIC TOOLS TO ON A
NATIONAL AND INTERNATIONAL
BASIS, AS YOU WILL SEE.
NUMBER TWO, WE CAN ANALYZE THE
GENOME AND PHENOME AND WE
CREATED A DATA BASE AND WILL BE
LOOKING NOT ONLY AT INDIVIDUAL
PHENOMES, BUT CHRONIC MAJOR
DISEASES, THE TOP FOUR AND I'LL
SHOW YOU EXACTLY HOW WE'RE GOING
TO DO THAT WITH A BIG DATA
APPROACH.
WE ARE EXPLORING NEW DIMENSIONS
OF HUMAN DATA SPACE OF
MEASUREMENTS AND TECHNOLOGIES,
FUELED BY AI.
AND FINALLY, WE'RE GOING TO
IDENTIFY PARTNERS THAT HAVE BOTH
PATIENTS AND RESOURCES THAT WILL
WORK TOGETHER WITH US AND I'LL
INDICATE FOUR OR FIVE PARTNERS
WE'VE IDENTIFIED SO FAR.
SO ON THE NEXT SLIDE IS GIVEN
THE KIND OF DATA WE ARE GOING TO
USE IN THE PHENOMIC STUDIES WE
ARE JUST BEGINNING AT THIS POINT
IN TIME.
NEXT SLIDE, PLEASE.
ON THE ONE HAND, IT IS THE
THINGS WE DIDN'T IN ARIVALE, BUT
WE ARE DOING BRAIN HEALTH
COGNITION STUDY THAT IS NEW AND
WE ARE LOOKING AT SOCIAL
DETERMINANTS ON HEALTH AND WE'RE
GOING TO BE USING ELECTRONIC
HEALTH RECORDS AS MANY OTHERS
HAVE.
AND ADDITIONAL WEARABLES THAT
GIVE US VALUABLE PHYSIOLOGIC
ANALY
ANALYSES.
WE HAVE A WHOLE SERIES OF NEW
ANALYSES.
I'M ONLY GOING TO MENTION THEM
HOPEFULLY BRIEFLY.
SO ON THE NEXT CLICK ONE OF THE
ANALYSES IS THE ABILITY TO
ASSESS INNATE -- CAN I GET THE
NEXT CLICK, PLEASE.
INNATE AND ADAPTIVE IMMUNITY.
BY USING MORE THAN 10 TIMES THE
DATA WE HAVE ON INDIVIDUALS.
WE'LL USE POLYGENIC SCORES,
SINGLE CELL ANALYSES TO ASSESS
INNATE AND ADAPTIVE IMMUNITY.
NEXT CLICK.
WE WILL USE A NEW MULTISPECTRAL
DEVICE TO ANALYZE SALIVA AND
DISTINGUISH NORMAL AND COVID
INFECTED INDIVIDUALS IN THREE
SECONDS WITH THIS.
WE ARE GOING TO USE A NEW
STRUCTURE OF PROTEINS, ALPHA
STRUCTURES THAT ARE ALLOWING US
EXTREMELY EARLY DETECTION OF
NEURODEGENERATIVE DISEASES THAT
CREATE SPECIAL KINDS OF
STRUCTURES AND ON THE NEXT SLIDE
WE'RE LOOKING AT BRAIN HEALTH
AND COGNITION AND WE'LL TALK
ABOUT THAT A LITTLE BIT LATER.
ON THE NEXT SLIDE WE HAVE AN EP
NOR -- ENORMOUSLY EFFECTIVE NEW
APPROACH WITH THE STANFORD
COLLABORATOR USING -- TO GIVE
VERY SUBTLE TAB LIKE DETECTIONS
AND HE'S DEVELOPED A WONDERFUL
DEVICE THAT CAN TAKE A DROP OF
BLOOD AT HOME AND DETECT 30 OR
40 DIFFERENT METABOLITES.
WHICH MAKES IT VERY RELEVANT TO
STUDY METABOLIC DISEASES AND
THINGS LIKE THAT.
AND THEN FROM LUX EMBORG WE HAVE
SPECTACULAR VOICE AND HAIR
ANALYSIS.
EVERY CENTIMETER OF HAIR IS A
MEASUREMENT OF MULTIPLE MONTHS
OF MORE THAN 150 METABOLIC
CONTAMINANTS THAT EXIST IN THE
ENVIRONMENT.
AND THEY HAVE USED THAT TO THE
EXTENT THEY CAN ACTUALLY LOCATE
THE INDIVIDUAL LIVING LOCATION
IN 14 DIFFERENT CLINICAL
LOCATIONS IN LKS UXEMBORG AND
SWITZERLAND, FRANCE AND BELGIUM.
BASED ON THE CONTAMINANTS THE
INDIVIDUAL SHOWS.
IT IS A REALLY POWERFUL NEW
APPROACH.
ON THE NEXT SLIDE, WE'LL TALK
ABOUT POLYGENIC SCORES AND THE
REASON THEY ARE SO IMPORTANT IS
BECAUSE I THINK IT IS VERY
VALUABLE IF WE ARE LOOKING AT
ALCOHOL AND DRUG ADDICTIONS AND
SO FORTH.
SO YOU CAN TAKE A POLYGENIC
SCORE IF YOU HAVE THE FULL
GENOME ANALYSIS AND CONVERT THAT
ON THE NEXT CLICK INTO GENETIC
RISK.
ON THE NEXT CLICK THAT YOU SEE
HERE, GENETIC RISK IS PLOTTED ON
INCREASING RISK ON THE X AXIS
AND CLINICAL SCIENCE ON THE Y
AXIS.
AND WHAT YOU CAN SEE IS THERE'S
AN EXPONENTIAL INCREASE FOR FOUR
DIFFERENT DISEASE CONDITIONS.
THIS WAS FROM A 2018 PAPER THAT
STUDIED BRITISH BIOBANK
INFORMATION.
AND WHAT I'LL ARGUE IS WE CAN DO
EXACTLY THE SAME THING FOR THE
POLYGENIC SCORES THAT NOW EXIST
FOR ALCOHOLISM AND FOR DRUG
ADDICTION AND SO FORTH.
AND THE NEXT THING WE DID IS TO
REPLACE CLINICAL FEATURES ON THE
Y AXIS WITH LOOKING AT ROUGHLY
800 DIFFERENT METABOLITES IN THE
BLOOD AND SEEING HOW THEY
CHANGED FOR EACH -- ON THE NEXT
SLIDE -- OF 54 DIFFERENT
POLYGENIIC SCORES WE EXAMINED IN
THE ARIVALE POPULATION.
THE REALLY STRIKING THING ON THE
NEXT SLIDE WAS THAT IN EACH CASE
FOR EACH OF THE 54 DISEASES AND
NOR
NORMAL PHENOTYPES WE SAW
INCREASES OR DECREASES IN
METABOLITES WHERE WE KNEW WERE
RELATED TO THE FEATURES OF THE
DISEASE THAT WAS BEING STUDIED.
I'LL ARGUE THAT SMOKING AND
ADDICTION HAVE THESE SAME KIND
OF POLYGENIC SCORES.
SO WHAT WE DID WITH THIS
INFORMATION THEN ON THE NEXT
SLIDE IS LOOK AT LDL CHOLESTEROL
THAT POLYGENIC TRAIT OF
INCREASING RISK FOR THAT.
IN THE ARIVALE POPULATION, AND
WE SHOWS FOR INDIVIDUALS NOT ON
STATENS WITH INCREASED GENETIC
RISK.
THE REALLY IMPORTANT POINT WAS
THOSE THAT HAD HIGH GENETIC RISK
AND HIGH CHOLESTEROL IT ONLY
COULD BE BROUGHT DOWN BY
STATINS, BY CHEMISTRY.
WHEREAS THOSE THAT HAD LOW
GENETIC RISK AND HIGH
CHOLESTEROL, DIET AND EXERCISE
BROUGHT IT DOWN VERY WELL.
WE THINK FOR MOST OF THE
DISEASES, YOU'RE GOING TO TREAT
HIGH AND LOW RISK PEOPLE VERY
DIFFERENTLY.
AND THAT MEANS DOCTORS SHOULD
KNOW THE GENETIC RISKS OF THE
PATIENTS THEY ARE DEALING WITH
FOR AS MANY DISEASES AS
POSSIBLE.
AND FRANKLY, I WOULD ARGUE GIVEN
THE GENETIC RISK TO THE
PHYSICIANS ALONE IS PROBABLY
ADVISABLE, UNLESS THE PATIENT
REALLY WANTED -- MANY OF THEM
WORRY IF THEY KNOW THESE KINDS
OF THINGS.
ON THE NEXT CLICK A REALLY
IMPORTANT QUESTION IS, YOU KNOW,
THE POPULATION WE LOOKED AT IN
ARIVALE WAS MOSTLY 40s, 50s,
60s.
SO A KEY QUESTION IS WHEN DOES
THE HIGH GENETIC RISK MANIFEST
ITSELF?
WITH HIGH LDL CHOLESTEROL IT
DOESN'T HAPPEN IN THE YOUNG
UNTIL LATER ON.
WE HAD AN AIRVALE ONE INDIVIDUAL
ON THE NEXT SLIDE, PLEASE.
THAT HAD A SLIDE THAT HAD A
FAMILY HISTORY OF THREE
GENERATIONS OF PATERNAL
INDIVIDUALS DYING BEFORE THEY
WERE 50 OF HEART ATTACKS.
AND WHAT HE DID WAS IN HIS TEENS
STARTED FOLLOWING HIS LDL
CHOLESTEROL.
WHAT HE WAS ABLE TO SHOW ON THE
NEXT CLICK IS THAT IT STAYED
VERY LOW UNTIL THE MID 30s AND
THEN IT SHOT UP.
HE WAS YOUNG.
HE WAS ATHLETIC.
HE DIDN'T CHANGE HIS DIET.
IT WAS SOMETHING INTRINSIC AND
THE ONLY WAY HE COULD BRING IT
DOWN ON THE NEXT CLICK WAS WITH
STATINS.
WE WILL KNOW FOR ALL OF THESE
DISEASES THE ANALYTES ON THE
NEXT CLICK, PLEASE.
WE'LL KNOW THE ANALYZE THAT WILL
MARK THE MANIFESTATION OF THE
YZ -- DISEASE AND THE FI KI --
PHYSICIAN CAN TREAT.
SO ON THE NEXT SLIDE I'M JUST
MAKING THE STATEMENT THAT
EXACTLY THE SAME IS GOING TO BE
TRUE FOR GENETICS OR GENETIC
RISK AND NICOTINE ADDICTION.
AND ONE OF THE REALLY
INTERESTING THINGS IS THE
POLYGENIC LOW CONTRIBUTIONS IN
THE GENETIC VARIANTS THAT
CONTRIBUTE TO A DISEASE.
IN THE CASE OF SEVERAL EXAMPLES
WHERE WE KNOW A LOT ABOUT IT,
NAMELY ALZHEIMER'S AND LDL
CHOLESTEROL MAP INTO GENES THAT
ARE RELEVANT TO THE GENETIC RISK
AT HAND.
I'M SURE EXACTLY IS GOING TO BE
THE SAME IS GOING TO BE TRUE FOR
NICOTINE ADDICTION AND ON THE
NEXT SLIDE THERE IS THE SAME 50%
OR SO ADDICTION FOR ALCOHOL AND
THEY MAP INTO CERTAIN SETS OF
GENES THAT CAN BE DONE.
AND ON THE NEXT SLIDE WE SHOW
THAT THIS PUTS YOU IN A POSITION
TO LOOK AT THESE THINGS FROM THE
POINT OF VIEW OF POLYGENIC
SCORES ON THE NEXT SLIDE.
IN A NUMBER OF DIFFERENT WAYS.
THAT IS THE SLIDE I DIDN'T GET
IN THERE.
ANYWAY, WE CAN LOOK AT EARLY
DETECTION.
WE CAN KNOW THAT HIGH AND LOW
PEOPLE FOR THESE THINGS ARE
GOING TO HAVE TO BE TREATED
DIFFERENTLY AND, OF COURSE, YOU
CAN THINK ABOUT WHAT TO DO WHEN
YOU HAVE MANIFEST DISEASE.
THE AI I WILL MENTION, WE ARE
INTERESTED IN AI LOOKING AT THE
UNIQUENESS OF EACH INDIVIDUAL
AND FROM THAT ASSESS AND
PRIORITIZE THE ACTIONABLE
POSSIBILITIES RELEVANT TO THAT
INDIVIDUAL.
WE FEED THE KNOWLEDGE GRAPH
WITH INDIVIDUAL DIFFERENCES AND
THEY MAP INTO THE COMMUNITIES
AND THE NETWORKS, BIOLOGICAL
NETWORKS AND THAT IS INFORMATION
THEN THAT CAN BE FED IN THE NEXT
SLIDE INTO TRANSFORMERS, INTO
LARGE LANGUAGE MODELS.
HENCE, WE ARE GOING TO BE ABLE
TO USE THE TRANSFORMER TO
ACTUALLY LOOK AT INDIVIDUALS.
ON THE NEXT CLICK, PLEASE, IN
THE CONTEXT OF EACH INDIVIDUAL
AND PRIORITIZE THE ACTIONABLE
POSSIBILITIES, SEND THOSE TO THE
PHYSICIAN.
AND THAT PHYSICIAN/AI
PARTNERSHIP OPERATIONALLY MAKING
THE PHYSICIAN A DOMAIN EXPERT IN
MANY FIELDS OF MEDICINE AND
HENCE BETTER TO DELIVER ACTION
TO THE -- ACTIONABLE
POSSIBILITIES TO THE PATIENTS.
AND WE'VE ALSO USED A CHATBOT
THAT CAN BE USED FOR PATIENTS
AND FOR PHYSICIANS THAT
BASICALLY CAN ANSWER ANY
QUESTION IN SIMPLE TERMS ABOUT
DATA-DRIVEN HEALTH AND WE CAN
TALK ABOUT THAT.
AND ON THE FINAL CLICK, I WILL
JUST SAY FOR TWO DISEASES,
ALZHEIMER'S AND DIABETES, WE
HAVE DIGITAL TWINS THAT HAVE
GIVEN US ENORMOUS BIG DATA
INFORMATION THAT GIVE US NEW AND
POWERFUL INSIGHTS INTO THESE
DISEASES.
AND WE'RE JUST SUBMITTING FOR
PUBLICATION, A BIG NEW PAPER ON
A DIGITAL TWIN ANALYSIS OF
ALZHEIMER'S IN THE ALZHEIMER'S
DATA THAT EXISTS.
THAT I THINK SAYS REALLY CLEARLY
ALZHEIMER'S IS FUNDAMENTALLY A
METABOLIC DISEASE THAT HAS TO DO
WITH THE HANDLING OF CHOLESTEROL
AND WHAT IT DOES TO ENERGY
DISTRIBUTION IN THE BRAIN.
SO ON THE NEXT SLIDE, WE HAVE
TWO MAJOR AREAS THAT WE'RE
REALLY INTERESTED IN.
IN THE FIRST CLICK, WE'RE AS IN
ARIVALE LOOKING AT INDIVIDUALS
AND THEIR GENOME, PHENOMES OVER
LARGE PERIODS OF TIME AS IN THE
MILLION PERSON PROJECT.
THE INTERNATIONAL PROJECT AND
THE U.S. PROJECT I'M PUSHING ARE
TWO DIFFERENT POSSIBILITIES.
IN THE SECOND CATEGORY WE HAVE
TAKEN -- NEXT CLICK, PLEASE, WE
HAVE TAKEN A BIG DATA APPROACH
TO THE FOUR MAJOR CHRONIC
DISEASES AND WE'VE STARTED WITH
A BIG TRIAL ON DIABETES.
AND WE'RE JUST GETTING STARTED
WITH THE SECOND TRIAL ON
ALZHEIMER'S.
AND WE WANT TO DO THREE THINGS.
ONE, VERY EARLY DETECTION.
TWO, DEFINE WITH OMICS THE
SUBTYPES AND THE MAJOR
TRANSITION FROM EACH SUBTYPE TO
RELEVANT PATHOLOGIES AND THEN
THREE, THE MATCHES BETWEEN
SUBTYPES AND DRUGS OR BEHAVIORAL
LIFESTYLE CHANGES THAT WILL
REVERSE THEM AT AN EARLY STAGE.
ON THE NEXT SLIDE ARE SHOWING
THE THINGS THAT WE ARE ACTUALLY
DOING RIGHT NOW.
AND THE FIRST, OF COURSE, WAS AN
ARPA H GRANT WE GOT FOR $52
MILLION ON THE NEXT SLIDE,
PLEASE.
OVER FIVE YEARS.
TO BE ABLE -- FOUR YEARS, TO BE
ABLE TO LOOK AT THE RISEN ON
ANALYNES IN THE BLOOD TO LARGE
PHENOMIC SETS.
WE HAVE THREE LARGE SETS ONE
FROM TURKEY THAT HAS 10,000
INDIVIDUALS AND ONE FROM ISRAEL
THAT HAS ABOUT 15,000
INDIVIDUALS.
WE ARE HARMONIZING THEM AND
STANDARDIZING THEM AND
EXTRAPOLATING MISSING DATA IN
THOSE SETS.
THREE, WE ARE TAKING A BIG DATA
APPROACH TO A 15-YEAR TYPE 2
DIABETES STUDY WHERE EVERY THREE
YEARS THEY HAVE MASSIVE CLINICAL
DATA WITH BLOOD DRAWS AND
CONVERTING THAT INTO AN OMIC
STUDY THAT SHOULD BE INFORMATIVE
ACROSS THE ENTIRE LIFE HISTORY.
THEY TOOK 400 INDIVIDUALS,
NORMAL, 70 CONVERTED.
WE WILL LOOK AT 70 THAT
CONVERTED AND 70 THAT FAILED TO
CONVERT TO SEE THE DIFFERENCES.
WE ARE DOING AN IMPEDENCE MATCH
BETWEEN OMICS AND TWO CLASSES OF
WEARABLES.
ALL OF THE WEARABLES HAVE
ENORMOUS DIMENSIONS OF DATA THAT
ARE UNRECOGNIZED AND DOING THESE
IN PASHS EDS MATCHES CAN TAKE
WEARABLES TO AT-HOME TO ANALYZE
THE THINGS.
WE WANT TO DEMOCRATIZE
PHENOMICS.
WE ARE DOING A IN KWAULS 1
ANALYA -- N
EQUALS 1.
WE ARE LOOKING AT TYPE TWO
DIABETES.
I CAN'T SEE THAT.
THERE.
WE JUST GOT FUNDING TO CARRY
THAT OUT AND WE'RE DOING THAT
WITH GUARDIAN RESEARCH NETWORK
IN SOUTH CAROLINA.
AND AGAIN, THE IDEA IS EARLY
DETECTION, SUBTYPES AND
APPROPRIATE IMPEDENCE MATCH OF
THERAPIES ESPECIALLY FOR EARLY
REVERSAL.
ON THE NEXT SIDE WE HAVE BEEN
DOING A PREGNANCY STUDY FOR MORE
THAN FIVE YEARS NOW WITH
SEDOOWSKY AT THE UNIVERSITY OF
PITTSBURGH, WHERE WE HAVE TAKEN
150 SUGGESTS THROUGH AND
GATHERED FIVE BLOOD SAMPLES
ACROSS PREGNANCY AT THE
UNIVERSITY OF PITTSBURGH AND WE
ARE JUST NOW BEGUNNING TO
ANALYZE THOSE
SO ON THE NEXT SLIDE THEN LET'S
TALK ABOUT -- CAN WE GET THE
NEXT SLIDE, PLEASE.
THE FACT, DATA DRIVEN HEALTH
ACTUALLY OFFERS SOLUTIONS FOR
EACH OF THE FIVE CHALLENGES OF
CONTEMPORARY HEALTH CARE, NAMELY
QUALITY OF CARE, EXPANDING AGING
POPULATION, EXPLOSION OF CHRONIC
DISEASES, THE LACK OF DIVERSITY
AND THIS IS STILL KEY WHATEVER
TRUMP MAY THINK AND THEN EX
EXPONENTIALLY INCREASING COSTS.
ON THE NEXT SLIDE ARE THE FOUR
REASONS WHY I THINK DATA-DRIVEN
SCIENCE ARE GOING TO GIVE US
TRILLIONS OF DOLLARS OF SAVINGS
IN THE NEXT 10 YEARS OF CON
TEMPORARY HEALTH CARE.
SO IN THE FIRST CLICK, IT IS THE
IDEA BY KEEPI IING PEEL -- PEO
WELL.
CAN WE CLICK AGAIN SO YOU CAN
SEE IT.
JUST AVOIDING DISEASE.
ON THE NEXT CLICK THE IDEA OF
BEING ABLE TO DETECT EARLY.
CAN WE CLICK AGAIN SO WE CAN
SEE.
LOOKING AT THE EARLY TRANSITIONS
AND REVERSAL OF CHRONIC DISEASES
AND WE HAVE THREE DIFFERENT
APPROACHES, I TALKED ABOUT IT.
OPTIMIZING DRUG USES FOR
INDIVIDUAL.
THERE WAS A 2015 NATURE PAPER
THAT SHOWED FOR THE 10 MOST
COMMON DRUGS, LESS THAN 10% OF
THE INDIVIDUALS HAD REALLY
EFFECTIVE RESPONSES AT A COST OF
$600 BILLION PER YEAR.
I SUPPOSE YOU COULD MAKE IT A
PERFECT MATCH OF SUCCESS.
AND THEN BRINGING THE INSIGHTS
FROM THESE BIG DATA APPROACHED
TO CHRONIC DISEASE I THINK WILL
LEAD TO ENORMOUS CHANGES AS WELL
AS KNOWING THE NORMAL PHYSIOLOGY
OF PREGNANCY AND SOMETHING WE
ARE JUST GETTING STARTED ON,
EARLY CHILDHOOD DEVELOPMENT.
SO ON THE NEXT SLIDE THEN LET ME
JUST SAY THAT THE MILLION PERSON
PROJECT ACTUALLY AND CLICK AGAIN
GIVES US THE FOUR BENEFITS I
MENTIONED EARLIER.
IT WILL UNEQUIVOCALLY IMPROVE,
VALIDATE INCREASED HEALTH FOR
THE INDIVIDUAL.
IT WILL LEAD TO ENORMOUS -- CAN
WE HAVE THE CLICK PLEASE.
ENORMOUS COST SAVINGS.
C
CATALYZE NEW APPROACHES OF HOME
TYPES AND SALIVA AND GENERATING
TENS OF THOUSANDS OF ACTIONABLE
POSSIBILITIES AND DRUG TARGETS
FOR WELLNESS AND PREVENTION.
SO ON THE NEXT SLIDE I WANT TO
SAY THIS PART OF THING IS GOING
TO LEAD TO THREE MAJOR PARADIGM
CHANGES IN DATA-DRIVEN HEALTH.
ONE ON THE NEXT CLICK THE IDEA
WE WILL REPLACE DISEASE ORIENTED
WITH WELLNESS AND PREVENTION AND
ULTIMATELY AN N OF 1 MEDICINE
WITH TENS OF THOUSANDS OF
ACTIONABLE POSSIBILITIES.
NUMBER TWO, NEXT CLICK, WILL
LEAD TO DEMOCRATIZATION OF
HEALTH CARE BRINGING IT INTO THE
HOME MEDIATED BY THE CELL PHONE
AND AVAILABLE FOR UNDERDEVELOPED
COUNTRIES AND NUMBER THREE, AI
IS GOING TO BE TRANSFORMATIONAL.
THE PARTNERSHIP BETWEEN AI AND
PHYSICIANS WILL CREATE
SUPERPHYSICIANS THAT WILL HAVE
THE ABLE TO TREAT PATIENTS IN
WAY PHYSICIANS COULD NEVER DO SO
BEFORE.
SO ON THE NEXT SLIDE, SO LET ME
ASK, THIS FINISHES THE DATA-
DATA-DRIN -- DATA-DRIVEN THING.
IS THERE ENOUGH TIME TO GO
THROUGH FIVE OR SIX SLIDES ON
THIS NEW DRUG TARGET.
>> I THINK PEOPLE WOULD LOVE TO
HAVE TIME TO ASK YOU A FEW
QUESTIONS.
THAT IS MY OPINION.
>> OKAY.
SO WHY DON'T WE SKIP THE DRUG
PART.
JUST SAY -- I'LL JUST TELL YOU I
THINK IN 10 YEARS THIS NEW
APPROACH IS GOING TO
REVOLUTIONIZE HOW WE CREATE
DRUGS WITH REGARD TO SPEED,
COST, EFFICIENCY AND O
OPTIMIIZATION.
MY TEAM HAS BEEN FANTASTIC.
PHENOME HEALTH IS SMALL AND WE
HAVE DONE AN ENORMOUS AMOUNT.
ON THE LAST SLIDE IS THE TEAM
THAT HAS SUPPORTED US THE BOARD
IS THREE OF THE MOST OUTSTANDING
PEOPLE I HAVE DEALT WITH IN
RECENT TIMES.
CAN WE HAVE THE NEXT SLIDE,
PLEASE.
JEFF WILKE WAS NUMBER TWO AT
AMAZON FOR THE EARLY YEARS.
ROGER -- WAS NUMBER TWO AT AMGEN
AND MERCK.
AND IS REALLY PIONEERING SOME
STRIKING NEW APPROACHED IN DRUG
DISCOVERY NOW.
AND MARIA KLAWE WAS 17 YEARS AT
HARVEY MUD PRESIDENT DATA
SCIENCE.
AND GEORGE CHURCH AND GILL OMENN
AND RALPH SNYDERMAN HAVE BEEN
TREMENDOUS CONTRIBUTORS AS
MICHELLE WILLIAMS AND LARRY
SMARR.
SO WITH THAT, I AM GLAD TO TAKE
QUESTIONS.
I SUGGEST YOU SWITCH TO ZOOM FOR
OUTSIDE PEOPLE.
THIS IS IMPOSSIBLE TO GIVE A
LECTURE WITH DELAYS LIKE THIS
AND FEEL COMFORTABLE ABOUT IT.
ANYWAY.
>> YOU DID A FANTASTIC JOB
GIVING A LECTURE.
AND I APOLOGIZE FOR ALL THE
TECHNICAL.
>> IT IS NOT YOUR FAULT.
IT IS MICROSOFT'S.
>> AND WE KNOW THAT.
I'M GOING TO LEAD OFF WITH SOME
QUICK QUESTIONS.
COUNCIL MEMBERS, LET'S TAKE TIME
TO ASK LEE A FEW QUESTIONS AND
MOVE ON TO GENERAL DISCUSSION IN
THE AFTERNOON.
LEE, WHAT YOU OUTLINED FROM MY
PERSPECTIVE IS FABULOUS.
WHAT ABOUT THE CHALLENGES
ASSOCIATED WITH MENTAL HEALTH.
THIS IS A NORA QUESTION,
REPOSITORIES OF IMAGING DATA.
WILL THEY BE HELPFUL OR A
HINDRANCE?
>> I DIDN'T TALK ABOUT BRAIN
HEALTH AND IT IS REALLY
IMPORTANT.
I THINK EVERYTHING WE CAN DO AND
SO WE THINK IMAGING IS GOING TO
BE IMPORTANT.
FOR EXAMPLE, I THINK RETINAL
ANALYSES ARE IMPORTANT IN BRAIN
HEALTH.
THEY GIVE YOU A CHANCE TO LOOK
AT THE VASCULAR SYSTEM THERE AND
SO FORTH.
I THINK COGNITIVE ABILITIES ARE
ABSOLUTELY CRITICAL AND MY GOOD
FRIEND MICHAEL MURZINSKY HAS
INVENTED THIS BRAIN ANALYSIS
SYSTEM CALLED BRAIN HQ WHICH HAS
THE ABILITY IN A COMPUTERIZED
GAME KIND OF FASHION TO ASSESS
25 DIFFERENT FEATURES OF
COGNITIVE HEALTH AND WHERE THEY
FIND DEFICIENCIES BECAUSE OF THE
PLASTICITY OF THE BRAIN, IF YOU
HAVE NOT LOST A LOT OF NEURONS,
YOU CAN FILL IN DEFICIENT
REACTION FEATURES SUCH AS
REACTION TIME OR MEMORY OR DEPTH
OF FIELD OR ALL OF THESE KINDS
OF THINGS.
WHAT MICHAEL SHOWED IS A NORMAL
INDIVIDUAL GOES TO A COGNITIVE
MAXIMUM IN EARLY 30s AND FADES
AWAY THEREAFTER.
EVEN INTELLECTUALLY ACTIVE
PEOPLE DON'T GET THE RIGHT KIND
OF EXERCISES FOR MANY COGNITIVE
FEATURES.
WHAT HE DEMONSTRATED IS FOR A
LARGE NUMBER OF 80-YEAR-OLDS, HE
COULD BRING THEM BACK TO WHERE
THEY WERE BEFORE.
SO I THINK BRAIN HQ IS
ABSOLUTELY AN ESSENTIAL PART OF
THE THING AND THE ONE LEADING
FEATURE IS REACTION TIME.
EVERYTHING FOLLOWS THE COGNITIVE
ABILITY OF REACTION TIME IN A
LEMUR LIKE HERD FASHION AND
EVERYTHING.
I THINK ANOTHER THING THAT WE
ARE LOOKING AT IS EEG KIND OF
ANALYSES AND AGAIN, MICHAEL M
THINKS THERE ARE SOME REALLY
FASCINATING POSSIBILITIES WITH
THE BRAIN HG AND EEG BEING ABLE
TO MAKE VERY EARLY PREDICTIONS
ON TRANSITIONS TOWARD DEPRESSION
OR TRANSITIONS TOWARD
SCHIZOPHRENIA OR BIPOLAR DISEASE
AND HE'S GOT A LOT OF CLINICAL
TRIALS DEMONSTRATING ALL THESE
POSSIBILITIES.
THE BRAIN IMAGING CERTAINLY
GIVES US A DIRECT MEASURE OF THE
CHANGE IN CONTENT AND STRUCTURE
OF THE BRAIN.
AND THAT IS GOING TO BE AN
ABSOLUTELY CRITICAL CORRELATIVE
KIND OF THING.
BUT IT IS REALLY IMPORTANT TO
PUT THE PHYSICAL FEATURES
TOGETHER WITH THE OMIC FEATURES.
TOGETHER WITH ALL THE DATA
INTEGRATION MOVE YOU WAY BEYOND
WHAT ANY TYPE OF DATA ALONE CAN
TELL US.
>> IF REACTION TIME IS SO
IMPORTANT, YOU BEST NOT DRINK
ALCOHOL OVER 80.
NORA, YOU HAVE A QUESTION.
>> YES, YES.
LEE, THAT WAS FANTASTIC.
THERE IS NO DOUBT, YOU ARE
ABSOLUTELY RIGHT AND I THINK YOU
ARE VISIONARY ON THIS NOTION OF
HOW CRUCIAL IT IS.
AND IMPORTANTLY WE CAN GET
THERE.
THERE ARE MANY, MANY PROJECTS
GOING ON AT THE NIH TO TRY TO
ACHIEVE IT.
OBVIOUSLY, THE KEY ONE IS -- ONE
OF THE KEY ONES IS THE -- FOR US
AT THE NIH, HOW DO WE TAKE
ADVANTAGE OF ALL OF THE
DIFFERENT INITIATIVES THAT ARE
ONGOING TRYING TO DO WHAT YOU
PRESENTED TO DO IN SUCH A
COMPREHENSIVE FASHION?
SO THAT WE DON'T DO -- THAT WE
MAXIMIZE THESE DATA THAT IS
MERGING, THAT WE GENERATE
COMPARISONS BETWEEN ONE AND THE
OTHER.
QUESTION NUMBER ONE.
AND I CAN STOP THERE.
BUT MY QUESTION NUMBER TWO WHICH
IMMEDIATELY MADE ME VERY EXCITED
BECAUSE YOU HAD SOME BEAUTIFUL
EXAMPLES, YOU ARE LOOKING AT ALL
OF THESE PARAMETERS AND
PROTEOMICS AND WE CAN LOOK AND
TRACK WHO MAY RESPOND OR NOT.
NOW WE ARE EXCITED WITH
ANTI-INFLAMMATORY DRUGS
TARGETING METABOLISM, LIB
PEPTIDE DRUGS.
HOW DO WE MONITOR THE CHANGES
THAT THESE DRUGS ARE DOING IN
ALL OF THESE PARAMETERS?
HAVE YOU, IN YOUR PROPOSAL YOU
HAVE FOR DIABETES, IS THIS ONE
OF THE THINGS YOU ARE GOING TO
BE LOOKING AT?
>> ABSOLUTELY.
SO I MEAN YOU ASKED ME ABOUT
FOUR DIFFERENT QUESTIONS THERE.
>> TWO.
TWO.
>> OKAY.
I WOULD SAY ONE, I HAVE TAKEN
THE INITIATIVE, THE HUMAN
PHENOME INITIATIVE AND RELABELED
IT MAKE AMERICA HEALTHY, BUT I
DID NOT PUT AGAIN ON IT.
WE HAVE PRESENTED IT WITH A KEY
LOBBYIST I HAVE HERE TO THE
TRUMP TRANSITION TEAM AND IT'S
ACTUALLY RECEIVED A LOT OF
ENTHUSIASM ENDORSEMENT.
AND, OF COURSE, WHAT I'VE TALKED
ABOUT HERE, THE MAJOR FOCUS HAS
BEEN ON THE PHENOMICS WHICH ONLY
RECENTLY ALL OF US GOT AROUND TO
DOING.
I ARGUED WITH THEM AT THE
BEGINNING, YOU SHOULD TAKE A
SMALLER NUMBER AND DO PHENOMICS
AND END UP FAR AHEAD, BUT I GOT
NOWHERE.
BUT ANYWAY, WHAT I WOULD SAY IS
LET'S ALL GO TOGETHER AND TRY
AND CONVINCE TRUMP TO DO A
PHENOMIC INITIATIVE NOW THAT
EXTENDS OUT FROM THE ORIGINAL
GENOME THING AND, YOU KNOW, THE
REALLY IMPORTANT THING THAT THIS
THING DOES IS BY BRINGING VOLUME
WILL BOTH DEVELOP NEW
TECHNOLOGIES AND BRING THE COST
DOWN STRIKINGLY.
THE FIRST HUMAN GENOME PROJECT
WE DID THAT SEVEN ORDERS OF
MAGNITUDE OF WHAT THE FIRST
GENOME COST.
WE ARE GOING TO DO THE SAME WITH
THE PHENOME IF WE CAN GET THIS
GOING.
I WOULD LOVE TO COME TO NIH AND
CENTRAL -- STRATEGIZE.
I CAN TELL YOU WHAT WE HAVE DONE
AND HOW WE HAVE DONE IT.
WE ARE FOCUSED ON ARPAH BECAUSE
IT IS MORE FLEXIBLE FOR LARGE
PROJECTS THAN NIH WAS.
I MEAN, NIH'S ATTITUDE WHEN I
WENT AND TRIED TO GET SUPPORT IS
WE ARE DOING ALL OF THIS
ALREADY.
AND I THINK WHAT ALL OF US DID
IS GREAT, BUT IT IS NOT
PHENOMICS.
OKAY.
SO ANYWAY.
I WOULD LOVE TO GET TOGETHER.
I THINK WE COULD BUILD A
FEDERATED SERIES OF PLATFORMS,
WHICH IS WHAT WE ARE GOING TO DO
IN THE EU.
WE HAVE LUXEMBORG INTERESTED,
ASTONIA AND TURKEY.
MAYBE THE UK.
THEY HAVE FINANCIAL PROBLEMS
WITH THE NATIONAL HEALTH SYSTEM
THAT MAY NOT PREVENT THIS.
I MEAN, PHENOMICS IS GOING AHEAD
ON A BIG SCALE IN OTHER PLACES
AND THAT IS ONE OF THE
COMPELLING ARGUMENTS WE HAVE FOR
CONGRESS NOW.
UH AND IT IS GOING AHEAD IN
CHINA IN SPADES.
I'LL TELL YOU.
SO WE HAVE TO GET WITH IT.
AND IF WE DID IT TOGETHER, THAT
COULD BE AN INCREDIBLE
PARTNERSHIP.
WHY DON'T YOU FIGURE THAT OUT
AND I WILL COME ANY TIME YOU
WANT TO TALK ABOUT WHAT WE'VE
DONE AND HOW WE PROPOSE TO DO
IT.
WE ARE DOING A LOT OF THE SAME
KIND OF THINGS YOU HAVE.
WE HAVE A COMPUTATIONAL PLATFORM
THAT IS ABSOLUTELY SUPERB FOR
MULTIOMIC ANALYSIS, COMPATIBLE
WITH ALL THESE CLOUDS.
PERFECT FOR FEDERATED KINDS OF
DATA SYSTEMS WHERE X WANTS TO
KEEP THE DATA TO THEMSELVES, BUT
THEY WILL LET YOU BRING THE
ANALYTIC TOOLS TO THEM AND TAKE
THE META DATA AWAY WITH
APPROPRIATE IP AGREEMENTS AND
ALL THE OTHER KIND OF THING.
THAT IS WHAT WE ARE DOING IN THE
EU AND WITH TURKEY AND IT IS
WORKING BEAUTIFULLY.
>> THANKS.
I WILL REACH OUT TO YOU.
I DON'T WANT TO TAKE ANY MORE
TIME.
>> I WOULD LOVE TO PARTNER WITH
NIH ON THIS THING IN ANY WAY WE
COULD THAT WOULD BE USEFUL.
>> THANKS VERY MUCH.
I TURN IT BACK TO YOU, GEORGE.
>> COUNT US IN AT THE ALCOHOL
INSTITUTE AS WELL.
I REALLY AGREE WITH NORA.
THERE'S SO MUCH WE COULD ALL DO
TOGETHER AND WHETHER WE COULD
EFFECT IT UNDER THE CURRENT
CLIMATE IS THE CHALLENGE.
>> WHEN WE CAN.
I THINK WE HAVE TO HAVE
DETERMINED OPTIMISM AND MOVE
AHEAD AND, LOOK, IF WE CAN'T GET
IT INITIALLY WITH THE -- FROM
THE FEDERAL GOVERNMENT, WE'LL --
I THINK WE CAN GET IT FROM
PHILANTHROPY.
WE HAVE TO WORK TOGETHER IN A
COORDINATED WAY TO MAKE A PITCH
TO THE BILL GATES TO GIVE THE
MONEY AWAY.
THAT IS ONE PLACE WE COULD GO
THAT WOULD BE VERY INTERESTING.
>> SO COUNCILMEMBERS, WE HAVE
HOGGED THE MICROPHONE, NORA AND
I WITH OUR QUESTIONS.
DO YOU ALL HAVE ANY QUESTIONS
FOR LEE?
PLEASE.
THIS IS AN OPPORTUNITY TO ASK IF
YOU HAVE ANY QUESTIONS.
KATE.
>> THANK YOU.
LEE, THANK YOU FOR SUCH A
PHENOMENAL PRESENTATION.
MY BRAIN IS JUST SPINNING TRYING
TO SYNTHESIZE EVERYTHING, BUT I
HAD A SPECIFIC QUESTION
FOLLOWING ON WHAT NORA WAS
ASKING ABOUT.
AND IT HAS TO DO WITH THE AI
CHATBOT FOR PATIENTS AND WHETHER
OR NOT YOU ARE EXPLORING THAT AS
A POTENTIAL INTERVENTIONAL TOOL
FOR FILL IN THE BLANK DISEASE
STATES?
I'M INTERESTED IN HOW IT MIGHT
BE APPLICABLE TO TREATMENTS FOR
SUBSTANCE USE DISORDERS.
THANK YOU.
>> ABSOLUTELY.
WE CAN FOCUS ANY WAY YOU WANT TO
FOCUS.
IT IS ALL A MATTER OF HOW YOU
TRAIN THE AI.
ACTUALLY, WHAT WE DID IS WE HAVE
A LOT OF GENERAL EDUCATIONAL
MATERIAL.
I WROTE A BOOK WITH NATHAN PRICE
ON THIS WHOLE IDEA.
WE PUT THAT IN.
WE WROTE A REVIEW IN NATURE
REVIEWS OF OMICS AND THE
REVOLUTION.
WE PUT THAT IN.
WE HAVE TWO SUB ISSUES OF
SCIENTIFIC AMERICAN, ONE ON THE
FUTURE OF SICIENTIFIC WELLNESS
AND THE OTHER ON HEALTH SPAN.
WE PUT THOSE ON.
CRAIG MUNDY'S NEW BOOK ON
GENESIS, IT IS A SPECTACULAR
BOOK YOU SHOULD READ ON AI
BECAUSE IT GIVES YOU THE
HISTORY, IT GIVES YOU WHERE IT
IS GOING TO GO AND ASKS THE
CRITICAL QUESTION OF HOW CAN WE
CONTROL THIS IN AN APPROPRIATE
WAY?
AND CRAIG HAS BEEN A GOOD FRIEND
AND WE DEBATED ALL OF THESE
THINGS.
SO THOSE ARE -- WE COULD FOCUS
IT WITH THESE THINGS ANY WAY YOU
WANT TO FOCUS IT.
AND WHAT YOU DO IS YOU COULD
HAVE A CHATBOT THAT COULD DO
EVERYTHING PLUS WHAT YOU WANTED.
SO IT ISN'T THAT WE HAVE TO DO
ONE FOR EACH NEW THING.
IT'S WE ADD IN YOUR PARTICULAR
AREA AND MAKE SURE IT KNOWS
EVERYTHING THAT IS KNOWN ABOUT
IT AND IT WILL BE ABLE TO ANSWER
YOUR QUESTIONS.
>> THANK YOU SO MUCH.
>> ANY OTHER COUNCIL QUESTIONS
FOR LEE?
WELL, THANK YOU LEE.
WE ARE SHORT ON TIME BECAUSE WE
WERE SUPPOSED TO CLOSE AT 3:00.
AND I WANTED TO LEAVE IT OPEN
FOR QUESTIONS FOR THE PRESENTERS
OF THE ABCD, AND DATA ANALYSIS
GROUP.
SO ARE THERE ANY COUNCIL
QUESTIONS ON THESE LARGE
COHORTS?
I'D BE INTERESTED, LEE, IF YOU
HEARD THOSE PRESENTATIONS WHAT
YOU THINK OF THE HOW WE COULD
INTEGRATE THAT INFORMATION,
DEVELOPMENTAL INFORMATION WITH
YOUR PROGRAM.
>> OH, I THINK THERE ARE SO MANY
WAYS THESE THINGS COULD BE
INTEGRATED AND BE EFFICIENT.
AND I MEAN, WHAT IS HAPPENING
NOW IS WE ARE ALL REINVENTING
WHEELS INDEPENDENTLY.
WE COULD BE SO EFFICIENT IF WE
ADOPTED THE NOT INVENTED HEAR
SYNDROME AND TAKE WHAT IS OUT
THERE AND USE THE BEST.
I THINK GETTING TOGETHER AND
TALKING ABOUT THESE THINGS COULD
BE VERY, VERY POWERFUL.
I WOULD BE WILLING TO COME OUT
AND DO IT ANY TIME.
AND IT WOULD BE FUN.
I COULD GIVE YOU A TALK ABOUT
THE DRUGS, TOO.
BECAUSE, LOOK, THE DRUGS ARE
REALLY GOING TO -- THEY'RE GOING
TO CHANGE PHARMA EVERY BIT AS
MUCH AS DATA-DRIVEN HEALTH IS
GOING TO CHANGE HEALTH CARE.
I CAN GUARANTEE YOU THAT.
>> WE WOULDN'T HAVE TO USE TEAMS
IF YOU COME OUT HERE.
>> THAT'S RIGHT.
IF I'M IN PLACE, THAT WOULD BE
TERRIFIC.
YEAH.
>> LET'S MAKE IT AN IN-PERSON
MEETING.
ANY OTHER QUESTIONS FROM
COUNCIL, PLEASE?
FOR ANYTHING THAT WE'VE COVERED
TODAY?
>> I HAVE A QUESTION FOR GAYA.
IN THINKING ABOUT ABCD, WE HEARD
THIS GREAT TALK FROM DR. KOOB
AND DR. HOOD AS WELL.
NORA YOU MENTIONED THIS
YESTERDAY ABOUT ALCOHOL AND
SUBSTANCE USE IMPACTING THE
WHOLE BODY AND THIS BEING A
WHOLE BODY ISSUE.
I WONDER IF THERE WILL BE
OPPORTUNITIES IN ABCD
PARTICULARLY AS OUR YOUTH BECOME
ADULTS TO TAKE THE FULL BODY, TO
LOOK AT ADDITIONAL BIOMARKERS
BEYOND THE BRAIN.
LOOKING AT PREDISPOSING FACTORS
IS GREAT, BUT WE HAVEN'T GOTTEN
ALL OF THE BIOSPECIMENS BECAUSE
OF FUNDING.
I'M WONDERING GOING FORWARD IF
WE COULD HAVE A MORE WHOLISTIC
AGGREGATED ASSESSMENT OF HUMAN
HEALTH.
INTEGRATING ALCOHOL AND
SUBSTANCE USE IN HOW IT IMPACTS
NOT JUST THE BRAIN, BUT THE
ENTIRE BODY, INFLAMMATORY
MARKERS.
THAT WOULD BE PHENOMENAL FOR OUR
UNDERSTANDING ESPECIALLY IN A
LONGITUDINAL COHORT.
>> YEAH.
I AGREE.
WE ALWAYS WRESTLED IN ABCD WITH
THE BALANCE TO NOT PUT UNDUE
BURDEN ON PARTICIPANTS AND
COLLECT THE DATA WE NEED.
WE DO HAVE BIOSPES --
BIOSPECIMENS THAT ARE BANKED.
WE HAVE THINGS THAT INCLUDE
HEALTH AND WELL BEING SO WE CAN
GET INPUT ON HOW THAT MIGHT BE
INCORPORATED.
>> THANK YOU.
>> ANY OTHER COMMENTS OR
QUESTIONS?
PLEASE.
OTHERWISE, I'M TURNING IT BACK
TO YOU, NORA.
BECAUSE YOU HAVE ON THE
SCHEDULE, THE WRAPUP, CLOSING
REMARKS.
A YOU HAVE ABOUT 10 MINUTES IF
THERE ARE THINGS YOU WANT TO
TELL EVERYBODY IN ADDITION TO
THAT.
OKAY.
IT IS ALL YOURS, NORA.
>> GEORGE, THANKS VERY MUCH.
THERE IS A LATE MOTIVE IN THE
SUBJECTS PRESENTED TODAY.
THAT COMES TO SAY WHAT IS IT
THAT IS IMPRINTED ON MY BRAIN
TODAY FROM ALL THE DISCUSSIONS
THE NOTION THAT WE ARE NOW IN
THE AREA OF SCIENTIFIC
FINALIZING COMPLEXITY.
THE COMPLEXITY HAS MULTIPLE
SHAPES.
BUT FOR US TO BE ABLE TO
MAXIMIZE OUR SUCCESS IN DOING
THAT WE REQUIRE TO CHANGE
BASICALLY THE WAY THAT WE HAVE
BEEN DOING SCIENCE.
AND ONE OF THE BIG CHALLENGES IS
HOW DO WE INTEGRATE OUR EFFORTS
WITHIN THE NIH, WITHIN THE
VARIOUS PROGRAMS THAT ARE
PRESENTED LIKE BOTH FROM HBCD
AND ABCD AND ALL OF US AND OTHER
PROJECTS SO WE CAN MAXIMIZE IT.
HOW DO WE PREPARE THE FIELD?
HOW DO WE ADVANCE IT?
THAT IS EASIER SAID THAN DONE.
I THINK THAT PULLING OUR HEADS
TOGETHER IN A WAY THAT HOW DO WE
DO IT SCIENTIFICALLY, BUT
ULTIMATELY, TOO, WITH THE GOAL
BECAUSE AS I WAS LISTENING, IT
IS EXTRAORDINARY IF WE CAN START
TO DETERMINE WHO IS AT RISK AND
WHAT WOULD BE THEIR PERSONALIZED
INTERVENTION?
THE ISSUE THAT WE CANNOT KEEP
OUR EYES OFF THE BALL IS WE WANT
THAT TO BECOME ACCESSIBLE TO
EVERYONE.
WHAT WE DON'T WANT IS ALL OF
THESE ADVANCES TO THEN BE
AVAILABLE TO VERY RESTRICTED
GROUP OF PEOPLE AND YOU JUST
EXACERBATE THE GAP BETWEEN THOSE
THAT ARE GOING TO HAVE OPTIMAL
HEALTH WHILE BASICALLY PAYING A
PRICE FOR THE REST OF THE
POPULATION THAT LAGS BEHIND.
IF I WERE TO PUT A POINT, THAT
IS ONE OF THE BIG CHALLENGES
THAT WE HAVE WITH AMERICA.
WE SPEND HUGE AMOUNTS OF AMERICA
BUT AT THE POPULATION LEVEL WE
ARE DOING VERY POORLY.
I THINK THIS IS TRANSFORMATIVE,
THE SCIENCE, AND IT WILL REQUIRE
THAT WE MODIFY ALSO THE WAY THAT
WE CONCEIVE OF MEDICINE AND
HEALTH, INCLUDING WELLNESS.
HOW WE TRACK IT.
BUT ALSO THE POLICIES AND THE
STRUCTURES OF THE SYSTEMS THAT
ARE RESPONSIBILITY FOR PROVIDES
IT.
AGAIN, HIGHLIGHT HOW IMPORTANT
IT IS FOR ALL OF US TO WORK
TOGETHER HERE IN THE ACADEMIC
CENTERS.
I ALSO THINK IT IS CRUCIAL AND
COMES ACROSS THAT WE NEED TO
INTERACT WITH THE OTHER
AGENCIES.
EVEN THOUGH THEY MAY BE OUTSIDE
THE POLICY, THEY ARE THE ONES
PROVIDING THAT SUPPORT FOR THE
POPULATION THAT REQUIRES
ACTUALLY HELP WITH THEIR HEALTH.
I ALSO THINK THE OTHER MOTIVE
THAT IS IMPRINTED TO ME AS A
FUNCTIONAL OF ALL OF THE
DISCUSSIONS IS THE WHOLE CONCEPT
OF HOW CRUCIAL PREVENTION IS AND
HOW WITH ALL THE SCIENCE THAT IS
BEING DEVELOPED AND THESE
BIOMARKERS, HOW WE CAN CONCEIVE
OF PREVENTION IN A DIFFERENT
WAY.
AND HAVING THAT PREVENTION AND I
THINK THAT DR. LEE HOOD'S
PRESENTATION CLEARLY SHOWED IT,
IS WE CANNOT THINK OF A SYSTEM
IN ISOLATION.
I SORT OF SAID, OF COURSE, I
ALWAYS THINK ABOUT THE BRAIN.
TO ME, EVERYTHING IS THE BRAIN.
BUT THE REALITY IS THAT ONE OF
THE FACTORS THAT PREDICT THE
BRAIN IS CARDIOVASCULAR
FUNCTION, METABOLIC PROCESSES.
SO HOW DO WE BRING TOGETHER THAT
COMPREHENSIVE PATTERN IN THE
NOTION OF PREVENTION?
UNFORTUNATELY, DRUGS DISRUPT
MULTIPLE OF THESE PROCESSES.
DEPENDING ON YOUR LEVEL OF RISK
IN THAT PARADIGM, YOU MAY
BASICALLY THROW YOU OFF THE
CLIFF OR YOU MAY HAVE THE
RESILIENCE TO ACTUALLY
ACCOMMODATE FOR THE TOXICITY OF
DRUGS, DEPENDING ON A WIDE
VARIETY OF FACTORS.
UNDERSTANDING THEM BECOMES VERY,
VERY RELEVANT.
AS WE LAUNCH INTO FOR US IN THE
FIELD OF SUBSTANCE USE DISORDERS
IS HOW DO WE PARTICIPATE IN THIS
PROCESS SO THAT WE CAN MAKE IT
CLEAR THAT WE CANNOT CONTINUE TO
IGNORE THE PRESENCE OF
SUBSTANCES AND THE BURDEN THAT
THEY PUT INTO INDIVIDUALS.
AND I DO WANT TO SAY SOMETHING
THAT MAY BE A LITTLE BIT
SENSITIVE, BUT YOU KNOW ME, I
DON'T STOP THERE.
IS THE NOTION OF CONSIDERING
WHAT ARE THE COMMERCIAL
INTERESTS THAT ARE CONTRIBUTING
TO THIS PATHOLOGY?
IN THE FIELD WE ARE IN, DRUGS,
THEY ARE DRIVEN BY INCENTIVES
FOR FUNDING, FOR ACTUALLY MAKING
MONEY, THE DRUG DEALERS.
SORT OF SELLING PRODUCTS.
TOBACCO, MARIJUANA, ALCOHOL, HOW
DO WE GENERATE THE DIALOGUE TO
BRING THAT ALSO INTO TA PLACE
WHY IT IS SO IMPORTANT, YES, WE
CAN DO THE SCIENCE, BUT WORKING
WITH THE OTHER AGENCIES IN A
COMPREHENSIVE FASHION.
I THINK IT IS ANOTHER ASPECT
THAT IS LEFT TO ME AFTER HAVING
WATCHED ALL THE WONDERFUL
PRESENTATIONS.
I DO WANT TO END BY SAYING IT
HAS BEEN A REMARKABLE PLEASURE
TO WORK COLLABORATIVELY WITH THE
ALCOHOL INSTITUTE, THE CANCER
INSTITUTE AND TO MAKE THE STUDY
OF THE ABCD POSSIBLE.
THAT ACTUALLY INSPIRED THE HBCD.
AND WHICH ALREADY HAS
TRANSFORMED OUR UNDERSTANDING OF
BRAIN DEVELOPMENT.
AND GIVEN US A PLATFORM TO
ACTUALLY JUSTIFY INTERVENTIONS
THAT IN THE PAST WE WOULD NOT
HAVE THE EVIDENCE TO DO SO.
SO I'M VERY, VERY GRATEFUL FOR
THAT.
I'M VERY GRATEFUL FOR MY TEAM,
WHICH HAS ACTUALLY DONE AN
OUTSTANDING JOB AND FOR THE
PARTNERSHIP WITH NIAAA AND NCI
AND I'M GRATEFUL FOR COUNCIL TO
GIVE US INPUT BECAUSE LIKE
ANYTHING ELSE IN LIFE, WE ALL
NEED TO -- HOW DO WE PROTECT
PROJECTS WHEN PROJECTS MAY BE
CHANGING?
HOW DO WE DO IT IN A WAY THAT
MAXIMIZES THE IMPACT OF THE DATA
AND KNOWLEDGE WE ARE GATHERING.
WE RELY ON ALL OF YOU FOR THAT.
THERE IS NOT ONE SINGLE PERSON
WHO HAS THE ANSWER.
THANKS FOR YOUR WILLINGNESS TO
BE HERE.
GEORGE, I WILL TURN IT BACK TO
YOU FOR THE FINAL, FINAL
COMMENT.
>> I JUST WANT TO THANK
EVERYONE, ESPECIALLY MY
COLLEAGUES AT NIDA AND NCI AS
WELL BECAUSE WE REALLY ENJOY OUR
COLLABORATION.
IT'S JUST BEEN SO FRUITFUL.
THE ABCD STUDY IS A GEM IN THE
PANOPLY OF GEMS AT NIH AND I
THINK THE HBCD STUDY IS GOING TO
BE EQUALLY IMPORTANT AND, YOU
KNOW, WHEN I SAW LEE HOOD COULD
PREDICT WHAT WAS GOING TO HAPPEN
TO A CHILD BASED ON THE
PLACENTA, I THOUGHT, MY
GOODNESS, WHAT MORE CAN WE DO
THAT IS GOING TO BE FABULOUS.
THIS HAS BEEN A GREAT COUNCIL.
I'M SORRY YOU ALL WEREN'T HERE.
MAYBE IN SEPTEMBER NEXT YEAR WE
CAN ALL GET TOGETHER IN
SEPTEMBER.
MAYBE WE HAVE LIVE COUNCILS FOR
OUR OWN INSTITUTE IN ANY EVENT.
I AM THE ETERNAL OPTIMIST AS
WELL JUST LIKE NORA AND JUST
LIKE LEE HOOD.
SO I HOPE THAT IS INFERKS WITH
YOU -- INFECTION.
THANKS PHILIPPE FOR ALL THE
SLIDES.
I THINK HE FELT LIKE HE GAVE A
TALK.
SO GOOD-BYE EVERYBODY.
>> GOOD-BYE.