GOOD AFTERNOON, EVERYONE.
ACTUALLY I WANT TO WELCOME
EVERYONE TO THE 148TH MEETING OF
THE NATIONAL ADVISORY COUNCIL ON
DRUG ABUSE.
THIS IS THE OPEN SESSION, AND
THE GOVERNMENT IN THE SUNSHINE
ACT AND THE FEDERAL ADVISORY
COMMITTEE HAS REQUIRED THAT AS
MANY ADVISORY COMMITTEE MEETINGS
AS POSSIBLE BE OPEN TO THE
PUBLIC.
THIS INCLUDES MEETINGS OF THE
NATIONAL ADVISORY COUNCIL ON
DRUG ABUSE.
TODAY'S MEETING IS OPEN TO THE
PUBLIC AND IS BEING VIDEOCAST
AND RECORDED.
BEFORE I GO INTO THE ITEMS OF
TODAY'S SESSION, I DO WANT TO
ACKNOWLEDGE AND THANK YOU ALL
FOR BEING HERE AND YOUR
PARTICIPATION OND COUNCIL BUT I
ALSO WANT ALL OF US TO
ACKNOWLEDGE THAT TODAY IS
SEPTEMBER 11TH, A VERY IMPACTFUL
DAY IN TERMS OF WHAT IT MEANS,
AND I DON'T BELIEVE IT IS
IMPORTANT TO NOT FORGET THE
HISTORICAL EVENTS AND THE CON
QENSES IN A WAY THAT IT CAN
MOTIVATE US, INCENTIVIZE US TO
WORK TOGETHER TO AVOID THESE
SITUATIONS FROM HAPPENING IN THE
PAST.
MANY PEOPLE LOST THEIR LIVES AND
MANY IN THE EVENT OF
SEPTEMBER 11 AND THEN ON
SUBSEQUENT DOWNSTREAM EFFECTS
FROM SEPTEMBER 11TH.
AND AGAIN, MY THOUGHTS GO TO ALL
OF THOSE THAT WHO HAVE LOST A
FAMILY OR FRIEND AND ALL OF
THOSE LIVES THAT WE'VE ALL LOST
BECAUSE OF THIS EVENT.
NOW I'M GOING TO GO INTO THE
FORMAL PART AND IS THIS WHERE I
ASK YOU IF YOU HAVE ANY COMMENTS
OR YOU WANT TO MAKE CORRECTIONS
OR EDITS TO MINUTES FROM THE MA.
A COPY OF THE MEETING WAS MADE
AVAILABLE ON YOUR ELECTRONIC
COUNCIL BOOKS UNDER THE NIDA
CURRENT COUNCIL PACK.
ANY COMMENTS, ANYONE?
NO?
MOTION TO VOTE?
SECOND?
EVERYONE?
ANYONE OPPOSED?
ANYONE ABSTAIN?
THEN THE MOTION IS CARRIED TO
APPROVAL OF THE -- NO, THAT'S
JUST THE MEETINGS.
THEN I PASS IT ON TO YOU.
>> SO I'M ALSO GOING TO ASK FOR
A VOTE ON THE OPERATING
PROCEDURES.
THESE WERE ALSO IN YOUR
ELECTRONIC COUNCIL BOOK, AND WE
NEED TO GET THEM APPROVED BY YOU
ON A YEARLY BASIS.
THERE ARE NO CHANGES THAT WERE
MADE SINCE OUR LAST OPERATING
COUNCIL OPERATING PROCEDURES
WERE REVIEWED.
CAN I GET A VOTE TO APPROVE?
COMMENTS, DECLINES, ANYTHING?
OKAY.
THESE ARE APPROVED.
THANK YOU VERY MUCH.
>> NOW I WANT TO ANNOUNCE THE
FUTURE COUNCIL DATES, WHICH ARE
GOING TO BE ON FEBRUARY 4TH,
2025.
THEN ON MAY 13 AND ON MAY 14,
2025.
THIS IS WHEN WE DO THE COUNCIL
ALSO WITH THE NATIONAL
INSTITUTES OF ALCOHOL ABUSE AND
ALCOHOLISM COUNCIL GROUP.
[RECORDING IN PROGRESS]
THE THIRD MEETING NEXT YEAR IS
GOING TO BE ON SEPTEMBER 9,
2025.
THEN I CAN JUMP INTO MY
DIRECTOR'S REPORT.
IT'S ALWAYS ACTUALLY TRYING TO
FIGURE OUT WHAT ARE THE MOST
SALIENT THINGS THAT I WANT TO
BRING TO THE ATEP THE ATTENTIONF
COUNCIL, AND IT FORCES ME TO
THINKING WHAT ARE ASPECTS THAT
ARE VERY RELEVANT IN TERMS OF
PRIORITIES, WHAT ARE ASPECTS
THAT ARE CONCERNING AND THAT WE
NEED ATTENTION IN AREAS THAT WE
REALLY DIRECTLY NEED YOUR INPUT
TO HELP THEM ADVANCE.
SO THAT IS WHAT'S GUIDING THE
DECISION OF MY PRESENTATIONS.
NORMALLY I GIVE YOU AN UPDATE OF
THE ADVANCES ON THE BRAIN
INITIATIVE, BECAUSE IT IS SO
VERY CONSEQUENTIAL TO WHAT WE DO
AS A NEUROSCIENCE INSTITUTE, BUT
WE'RE GOING TO HAVE THE DIRECTOR
OF THE BRAIN, DR. JOHN NGAI,
GIVE A PRESENTATION THIS
AFTERNOON, SO HE WILL GIVE YOU
MORE DETAILS.
I'M NOT GOING TO TAKE TIME TO DO
THAT, EXCEPT TO SAY THAT IT HAS
TOTALLY TRANSFORMED THE WHOLE
FIELD OF NEUROSCIENCE AND IN THE
PROCESS, ADVANCE OUR KNOWLEDGE
ABOUT HOW THE BRAIN WORKS.
WITH RESPECT TO BUDGETS, OUR
BUDGET FOR 2024 AND 2025 ARE
BASICALLY ALMOST IDENTICAL, AND
YOU CAN SEE THAT OUR OPERATING
BUDGET VERSUS THE ONE THAT IS
2025 FOR THE PRESIDENT'S BUDGET.
AND THERE ARE -- I DIVI DIVIDEDE
BASE DOLLARS THAT COME TO NIDA
AND THEN THE DOLLARS THAT COME
TO NIDA THAT ARE UNDER THE HEAL
HEADING.
AND THE HEAL HEADING IS MONEY
THAT CONGRESS ALLOCATED IN ORDER
TO ADDRESS THE OVERDOSE CRISIS.
SO IT'S ASSOCIATED WITH A
GREATER EXPECTATION OF
ACCELERATING SCIENCE THAT CAN
LEAD TO ACTUALLY SOLUTIONS THAT
CAN PREVENT THE OVERDOSE CRISIS
THAT ARE LEADING.
IT CONTAINS TWO COMPONENTS OF
HEAL DOLLARS ALLOCATED BY
CONGRESS.
ALMOST HALF OF IT GOES TO NIDA
WITH RESPECT TO TRY TO I FOCUS N
ISSUES THAT ARE MORE DIRECT TO
THE OPIATE USE DISORDERS AND
OVERDOSES, AND CLOSE TO HALF IT
GOES TO THE NATIONAL INSTITUTE
OF NEUROLOGICAL DISEASES AND
STROKES TO ADDRESS THE ENORMOUS
NEED FOR UNDERSTANDING PAIN AND
DEVELOPING ALTERNATIVE
TREATMENTS.
WHICH OBVIOUSLY CERTAINLY WAS
ONE OF THE FACTORS THAT
INITIATED THE OVERDOSE CRISIS
THAT WE CURRENTLY HAVE.
THERE ARE MULTIPLE INSTITUTES
THAT PARTNER BOTH WITH NIDA AND
NINDS TO ACTUALLY BRING THEIR
EXPERTISE AND PARTICIPATE IN THE
OVERSIGHT OF THE PROGRAMS AND IN
SELECTION OF THE PROGRAMS THAT
ARE ACTUALLY MOVED FORWARD UNDER
THIS BUDGET.
TOTAL BUDGETS FOR 2025 IS
EXPECTED TO BE AT
$1,668,000,343.
THAT'S BASICALLY A FLAT BUDGET,
AND IT HAS ALSO NOT BEEN
INCREASED VERY MUCH SINCE 2023.
THIS IS IMPORTANT BECAUSE THE
COST OF DOING SCIENCE ARE GOING
UP, SO EVEN THOUGH WE ARE NOT
SEEING A DECREASE, IT IS
ACTUALLY THAT DOLLAR AMOUNT IS
GIVING US LESS OPPORTUNITY, IT'S
MORE RESTRICTIVE IN TERMS OF THE
MAGNITUDE OF THE SCIENCE WE CAN
DO, THE PROJECTS THAT WE CAN
FUND.
BUT ALSO IT SORT OF HIGHLIGHTS
WHY WE HAVE TO BE STRATEGIC, WHY
WE HAVE TO TAKE EVERY UTMOST
OPPORTUNITY THAT WE HAVE TO
AVOID REPLICATING PROGRAMS WHEN
THEY ARE NOT NECESSARY, AND TO
MAXIMIZE THE LIKELIHOOD THAT WE
TAKE ADVANTAGE OF OTHER
INFRASTRUCTURE AND PROJECTS THAT
MAY BE ONGOING IN ORDER TO
ADVANCE OUR MISSION.
THIS IS JUST AGAIN A REMINDER OF
THE ORGANIZATION OF NIDA, WHICH
IS ACTUALLY DIVIDED TO IN BLUE
THE INITIATIVES AND IN RED, THE
MORE SCIENTIFIC BASED
OPERATIONS, AND WE HAVE FOUR AND
FOUR BRACKETS IN EACH ONE OF
THEM.
WE ARE LOOKING FOR DIRECTORS OF
DIVISIONS OR CENTERS, AND THAT
IS NOT THE CASE.
WE HAVE FILLED THEM, EXCEPT THAT
WE ARE -- IT IS WITH A VERY
SADDENED HEART THAT I HAVE TO
TELL EVERYONE THAT BOTH
DR. BETTY TAI AND DR. RITA
VALENTINO HAVE ANNOUNCED THAT
THEY WANT TO RETIRE AT THE END
OF THE YEAR.
FOR ME, THIS IS DEVASTATING NEWS
BECAUSE IT'S ACTUALLY -- THEIR
PERFORMANCE HAS BEEN STELLAR AND
OUTSTANDING.
I UNDERSTAND OBVIOUSLY A LOT OF
PEOPLE SORT OF PUT THAT
STATEMENT BUT THE REALITY IS
THAT THEIR ABSENCE WILL BE FELT
AT NIDA.
THERE ARE MANY THINGS THAT
DR. BETTY TAI BROUGHT TO NIDA,
DIRECTOR OF THE CLINICAL CENTER
FOR TRIAL NETWORK AND AS I WORK
TO PICK UP PERHAPS THE MOST
SALIENT, SHE WAS ABLE TO
ORGANIZE AND CONVENE HEALTHCARE
SYSTEMS TO ACTIVELY PARTICIPATE
IN RESEARCH THAT CAN HELP
TRANSLATE THE TREATMENT OF
SUBSTANCE USE DISORDER,
SCREENING OF SUBSTANCE USE
DISORDER INTO THE HEALTHCARE
SYSTEM.
THIS IS MUCH MORE EASIER DONE
THAN ACTUALLY DO IT, BUT THESE
ARE THE WORK THAT HAS COME OUT
OF HER ABILITY TO BRING PIs
FROM MULTIPLE ACADEMIC CENTERS
IN PARTNERSHIP WITH SPECIALISTS
ON ADDICTION HAS MADE THIS
POSSIBLE.
AND NOW WE KNOW I'M GOING TO BE
HIGHLIGHTING A COUPLE OF THE
VERY IMPORTANT ADVANCES THAT
HAVE BEEN DONE IN THIS SPACE,
BUT WE NOW RECOGNIZE IN MANY
HEALTHCARE SYSTEMS, THEY
ACTUALLY ARE PROACTIVELY ENGAGED
IN THE TREATMENT OF SUBSTANCE
USE DISORDERS AND PREVENTION.
OF COURSE MUCH MORE CAN BE DONE
BUT SHE HAS MADE THIS POSSIBLE.
SO I DO WANT TO THANK BETTY FOR
EVERYTHING THAT SHE HAS BROUGHT
TO THE JOB, AND I KNOW KNOWING
ABOUT HER COMMITMENT AND PASSION
FOR SUBSTANCE USE DISORDER THAT
WE CAN ALWAYS COUNT ON HER
WISDOM, EXPERIENCE, AND
SUGGESTIONS.
THE OTHER IS DR. RITA VALENTINO.
RITA HAS ALSO TRANSFORMED OUR
DIVISION OF NEUROSCIENCE AND
BEHAVIOR.
SHE'S ACTUALLY ACCELERATED THE
SCIENCE AND THE COMPLEXITY OF
THE SCIENCE, THAT FUNDING, AND
MANY THINGS SHE HAS HELPED
MATERIALIZE.
I WOULD SAY PERHAPS ONE OF THE
THINGS THAT I VALUE THE MOST IS
HER ABILITY TO CREATE MEANINGFUL
PARTNERSHIP WITH OTHER
ORGANIZATIONS AND INSTITUTES AND
CERTAINLY HER KEY ROLE AS PART
OF BRAIN TO ENSURE AND
PROACTIVELY ENSURE THAT RESEARCH
THAT IS FUNDED THROUGH NIDA TAKE
ADVANTAGES OF ALL OF THE
ADVANCES THAT HAVE COME ACROSS
BECAUSE OF BRAIN.
SO THIS IS JUST A SHORT SUMMARY
ABOUT WHY THESE TWO INCREDIBLE
LEADERS HAVE MADE SUCH AN
ENORMOUS CONTRIBUTION TO NIDA,
AND OF COURSE MORE IMPORTANTLY
TO THE FIELD.
AND SO YES, I WILL MISS THEM.
BUT WE'RE STARTING A SEARCH,
WE'VE STARTED ACTUALLY THE
SEARCH FOR BOTH OF THESE
POSITIONS.
I USUALLY START MY PRESENTATION
IN TERMS OF HIGHLIGHTING TWO OF
THE LARGEST PROJECTS THAT WE
HAVE, WHICH ARE THE ABCD AND THE
HBCD.
BUT BEFORE I JUMP INTO IT, AND
PARTICULARLY BECAUSE I DO HAVE
HERE THE SLIDES IN RECOGNITION
OF DR. RITA VALENTINO AND
EVERYTHING THAT SHE HAS DONE, I
DO WANT TO HIGHLIGHT VERY, VERY
CLEARLY, YES, WE ARE
HIGHLIGHTING THE IMPORTANCE OF
TRANSLATION AND TREATMENT BUT
WE'RE ALSO HIGHLIGHTING THE
IMPORTANCE OF BASIC FUNDAMENTAL
SCIENCE, AND IN OUR CASE, THIS
IS VERY MUCH INTO THE
NEUROSCIENCE WITH ALL OF ITS
BRANCHES INCLUDING GENETICS OR
PHARMACOLOGY.
WITHOUT THAT BASIC KNOWLEDGE, WE
WOULDN'T BE ABLE TO ADVANCE OR
ACTUALLY IF WE ADVANCE, IT WOULD
BE MUCH LOWER, AND SO I DO WANT
TO SORT OF -- I DON'T WANT TO
SPEND TIME OR BELABOR THAT
BECAUSE I'M FOCUSING VERY MUCH
INTO THE OVERDOSE CRISIS AND
OTHER PATTERNS OF DRUG USE, BUT
AT THE ESSENCE OF OUR
UNDERSTANDING WHAT THIS MEANS
AND HOW WE NEED TO MOVE FORWARD
IS THAT BASIC NEUROSCIENCE
THAT'S BEHIND IT.
SO WHERE ARE WE WITH THE
ADOLESCENT BRAIN COGNITIVE
DEVELOPMENT?
IF STUDY WTHIS STUDY STARTED INS
EIGHT YEARS OLD SO WHAT DOES
THAT MEAN, WAS THAT THE FIRST
CHILDREN WHICH WERE 9 TO 10 AT
THAT TIME WHEN THEY WERE
INITIALLY ENROLLED.
SOME OF THEM ARE REACHING THE
AGE OF 18.
IT'S CLOSE TO 12,000 CHILDREN
THAT WERE RECRUITED INTO THE
ABCD, AND WE HAVE 96% RETENTION
EIGHT YEARS LATER.
AND I WANT YOU TO THINK ABOUT
IT.
THIS IS NOT AUTOMATIC.
I DON'T KNOW OF ANY OTHER STUDY
THAT I KNOW OF THAT HAS GOT THAT
LEVEL OF RETENTION, PARTICULARLY
WHEN IT'S SUCH AN EXTRAORDINARY
COMPLEX STUDY.
NOT ONLY ARE WE EVALUATING THE
BRAIN WITH A BATTERY OF TESTS OF
THESE CHILDREN AS THEY ARE
DEVELOPING FROM CHILDREN INTO
YOUNG ADULTS, BUT WE ARE
PERIODICALLY ASSESSING THEIR
BEHAVIORS, THEIR COGNITION,
THEIR SOCIAL NETWORKS, AND WITH
INFORMATION THAT ALSO PERTAINED
TO -- A GREAT THREAT TO
SOCIOECONOMICAL CHARACTERISTICS
THAT WE KNOW AND BEEN
INCREASINGLY RECOGNIZING SINCE
THE COVID PANDEMIC THAT ARE
VERY, VERY IMPORTANT IN
OUTCOMES.
FOR US IN SUBSTANCE USE
DISORDER, THIS IS CLEAR, AND
WE'VE KNOWN IT FROM
EPIDEMIOLOGICAL STUDIES THAT
SOCIAL ADVERSE EVENTS,
PARTICULARLY CHILDHOOD
EXPERIENCES ARE ONE OF THE MAIN
FACTORS CONTRIBUTING TO THE RISK
OF SUBSTANCE USE AND ADDICTION.
AND YES, WE DO CHARACTERIZE
ADDICTION AS A DISEASE OF THE
BRAIN, BUT WE ALSO
CHARACTERIZE -- AND THIS IS NOT
EXCLUSIVE -- AS A DISEASE THAT
IS SIGNIFICANTLY INFLUENCED BY
OUR ENVIRONMENTS.
JUST AS WE CAN LOOK AT OTHER
DISEASES THAT HAVE VERY NEGATIVE
CONSEQUENCES AS DIABETES OR
OBESE IT, ITY, ALL OF THOSE MAYE
STRONG GENETIC COMPONENTS BUT
THERE ARE EXTREMELY IMPORTANT
FACTORS IN THE ENVIRONMENT THAT
ARE MAKING THEM POSSIBLE.
SO THE ABCD, 96% RETENTION.
HOW SUCCESSFUL IT HAS BEEN, I
WOULD SAY I IT'S PROBABLY ONE OF
THE MOST IMPACTFUL STUDIES EVER
DONE IN ILLUMINATING HOW THE
HUMAN BRAIN DEVELOPS, AND NOT
JUST IN GENERAL TERMS ON
AVERAGE, BUT WE ARE GETTING
INDIVIDUAL DEVELOPMENTAL
TRAJECTORIES.
SO THIS GIVES US THE OPPORTUNITY
TO UNDERSTAND, WHY DO THESE
TRAJECTORIES DIFFER?
WHY DO WE OBSERVE DIFFERENCE AND
ADVANTAGES IN PERFORMANCE FOR
CERTAIN CHILDREN AND NOT FOR
OTHERS.
HOW DO SOCIOECONOMIC FACTORS
CONTRIBUTE TO THAT?
AND ONE OF THE THINGS THAT HAS
BEEN MADE THE STORY SUCCESSFUL,
WHICH I ACTUALLY AM INCREDIBLY
GRATEFUL FOR THE LEADERSHIP
BEHIND IT, WHICH ACTUALLY YOU'VE
HEARD ME SPEAK ABOUT HER,
DR. GAYA DALIN, AND SHE HAS
PRESENTED TO YOU AND HER TEAM
AND INCLUDING SUSAN WEISS, SO
THE MANAGEMENT HAS BEEN CRUCIAL
FOR THAT, THE DEPTH AND VOLUME
OF THE INVESTIGATORS TO ENSURE
THAT THE IMPORTANT INFORMATION
IS COLLECTED AND THEIR LOYALTY
TOWARDS THE SUBJECTS AND OF
COURSE THE PARTICIPANTS.
BUT I ALSO THINK THAT A KEY
COMPONENT THAT LED TO BE SO
SUCCESSFUL IS FROM THE
INCEPTION, AND WE HAVE MEETINGS
TO DISCUSS IT WITH
INVESTIGATORS, AND THIS WAS NOT
OBVIOUS AT THE TIME, THERE WERE
PEOPLE THAT WERE AGAINST IT.
WE WANTED TO OPEN ACCESS.
NOT ONLY DID WE WANT OPEN ACCESS
IN MAKING THE DATA AVAILABLE FOR
ANYONE WHO WANTS TO STUDY A
RESEARCH QUESTION IN IT, BUT WE
WANTED TO MAKE IT IN A WAY THAT
IT IS ACCESSIBLE.
SO WHEN WE SPEAK ABOUT DATA
SCIENCE AND OPEN DATA SCIENCE,
YOU CAN MAKE THAT DATA OUT THERE
AND SAY IT'S OPEN ACCESS, BUT IT
IS VERY, VERY DIFFICULT TO
NAVIGATE.
SO IT IS NOT NEITHER AUTOMATIC
THAT YOU CAN HAVE A DATASET AND
PEOPLE ARE GOING TO BE USING IT.
AND THAT HAS NOT BEEN THE CASE
FOR THE ABCD.
BASICALLY THE THEME HAS BEEN
VERY PROACTIVE TO ENSURE THAT
THE DATA THAT IS BEING COLLECTED
IS DEPOSITED AS FREQUENTLY AS
POSSIBLE.
WE HAVE GLITCHES IN THE PROCESS
BECAUSE OF THE COMPLEXITY OF THE
DATASET AND THE FACT THAT
REPOSITORIES MAY NOT HAVE HAD
THE FLEXIBILITY TO TAKE
ADVANTAGE OF IT WHICH HAVE
DELAYED SOME OF THE RELEASES.
BUT THE SUCCESSES COME IN TERMS
OF HOW MANY PEOPLE ARE WORKING
WITH THESE DATA AND IN 2024, WE
REACHED MORE THAN A THOUSAND
PUBLICATIONS, AND YOU SEE IN
YELLOW, THE PUBLICATIONS THAT
COME FROM INVESTIGATORS THAT ARE
NOT PART OF THE ABCD, AND THE
PURPLE ONES ARE FROM
INVESTIGATORS THAT ARE IN THE
ABCD.
AND THIS TELLS YOU THAT WE'VE
SUCCEEDED ON MAKING THIS DATA
ACCESSIBLE TO INVESTIGATORS THAT
MAY DON'T HAVE THE KNOWLEDGE OR
FULL DETAILS OF THE STORY.
SO -- AND THAT INCENTIVIZED
INNOVATION AT MULTIPLE LEVELS,
NOT JUST IN TERMS OF
UNDERSTANDING HUMAN BRAIN
DEVELOPMENT AND WE'RE GETTING
INTO THE AGE OF RISK OR DRUG
TAKING, THE DRUGS, I MEAN HOW
THAT DRUG CONSUMPTION AFFECT THE
BRAIN AND HOW THAT IS INFLUENCED
BY FACTORS IN YOUR ENVIRONMENT,
HOW IT'S INFLUENCED BY YOUR
GENETICS AND HOW WE CAN USE THIS
DATA AS POTENTIAL FOR BIOMARKERS
TO IDENTIFY THOSE THAT MAY BE AT
HIGHER RISK.
TREMENDOUS VALUE FOR MENTAL
HEALTH, AND THERE ARE MULTIPLE,
MULTIPLE GRANTS THAT HAVE
EMERGED TO DO SECONDARY
ANALYSIS.
FUNDED BY ALCOHOL INSTITUTE OR
BASICALLY MULTIPLE, MULTIPLE
INSTITUTES, SO IT IS JUST BEEN
INCREDIBLY IMPACTFUL.
WE OPENED THIS YEAR THE NIH
BRAIN DEVELOPMENT COHORTS, A
BIOSPECIMEN ACCESS PROGRAM SO
THIS WILL ALLOW RESEARCHERS TO
REQUEST WHETHER IT IS SL SALIVA,
BLOOD, TEETH OR HAIR, TO BE ABLE
TO ANALYZE AND INCLUDE IT WITH
THE DATA THAT WE ARE COLLECTING
AND PHENOTYPING.
FINALLY AS I MENTIONED, WE HAD
SOME GLITCHES IN TERMS OF HAVING
TO REMOVE THE REPOSITORY FROM
THE DATA FROM THE ABCD TO OUT OF
THE NIH, AND SO NOW IT IS --
THAT HAS DELAYED RELEASE IN
2024, AND IS GOING TO -- AND
CERTAINLY TO DELAY IT ALSO FROM
2023.
I HAVE VERY STRONG CONFIDENCE
THAT THE DATA WILL BECOME
AVAILABLE AT THE BEGINNING OF
2025, AND THE SAME PLATFORM
WOULD BE UTILIZED FOR THE HBCD,
WHICH IS THE SECOND BIG STORY
THAT I WANT YOU TO ACTUALLY GIVE
YOU AN UPDATE, THE HEALTHY BRAIN
AND CHILD DEVELOPMENT STUDY,
WHICH WAS LAUNCHED A LITTLE BIT
MORE THAN ONE YEAR, ONE YEAR AND
TWO MONTHS AGO.
IT PERTAINS TO 7,000
PARTICIPANTS THAT BASICALLY ARE
PREGNANT WOMEN OR INFANTS, AND
TO MONITOR FOR NINE IT 10 YEARS,
U10 --NINE TO 10 YEARS, UNTIL TT
INTO ADOLESCENCE.
THIS PROGRAM HAD BA BASICALLY BN
LED VERY ABLY BY MICHELLE -- I'M
BLOCKING ON HER NAME -- MICHELLE
FREUND, AND SHE LEFT AND SHE
WENT TO NEW YORK, SO WE OPENED
UP A SEARCH FOR A NEW DIRECTOR,
AND WE'RE VERY HAPPY TO ANNOUNCE
DR. CHRISTOPHER SARAMPOTE WHO
ACTUALLY COMES FROM NIMH WHO
ACCEPTED THAT JOB AS DIRECTOR
AND NOW WE HAVE 2,000
PARTICIPANTS THAT HAVE BEEN
ENROLLED.
THE STUDY IS FUNDED BY DOLLARS
THAT COME FROM HEAL, MORE OF
LESS HALF OF IT, AND OTHER HALF
COMES FROM OTHER INSTITUTES.
A VERY SIGNIFICANT PORTION DOES
COME FROM NIDA, AND ONE OF THE
AIMS OF WHY IT IS ALSO UNDER THE
HEAL FUNDING IS WE'RE TRYING TO
UNDERSTAND WHAT ARE THE EFFECTS
OF EXPOSURE TO OPIOID OR OTHER
DRUGS DURING FETAL DEVELOPMENT,
AND HOW THAT AFFECTS
TRAJECTORIES.
THIS IS SOMETHING THAT IS
NECESSARY TO UNDERSTAND.
AND HOW THE OTHER SOCIAL
DETERMINANTS OF HEALTH THAT ARE
ASSOCIATED WITH SUBSTANCE USE
ALSO DOWNSTREAM INFLUENCE THOSE
TRAJECTORIES.
SO 25% OF THE SAMPLE, WE'RE
AIMING TO HAVE PRENATAL
SUBSTANCE USE EXPOSURE, AND AS
OF NOW, WE ARE CLOSE TO THAT
GOAL, AND YOU SEE THE NUMBERS OF
PREGNANT WOMEN THAT HAVE HAD
EXPOSURE TO DIFFERENT DRUGS.
OPIOIDS, TOBACCO, -- AND
ALCOHOL.
THE MOST FREQUENTLY USED
SUBSTANCES ARE TOBACCO,
MARIJUANA AND ALCOHOL.
AND ONE OF THE AREAS THAT WE'RE
LAGGING BEHIND IS IN OPIOIDS,
BECAUSE WE'RE AIMING TO ACTUALLY
RECRUIT AT LEAST 15% OF THE
SAMPLE WITH EXPOSURES TO OPIOIDS
DURING PREGNANCY.
WE NEED TO FIGURE OUT HOW TO
ACTUALLY REACH OUT TO
COMMUNITIES THAT MAY NOT
NORMALLY SEEK OUT HELP BECAUSE
OF THE FEAR OF PUNITIVE MEASURES
IF THEY ARE CONTAINED -- THEY
ARE PREGNANT AND THEY ARE TAKING
DRUGS.
SO THIS IS A COMPLEX STUDY WITH
A LOT OF ETHICAL IMPLICATIONS,
SO WE ARE DOING THESE WITH
TREMENDOUS AMOUNT OF OVERSIGHT.
THE THIRD STUDY I HAVEN'T
BROUGHT TO YOUR ATTENTION BUT I
ACTUALLY THINK IT IS TIME YOU'RE
AWARE OF IT, IS THE PATH
POPULATION ASSESSMENT OF TOBACCO
AND HEALTH.
THIS IS A NATIONALLY
REPRESENTATIVE LONGITUDINAL
STUDY OF TOBACCO USE, ITS
DETERMINANTS AND IMPACTS IN
NON-INSTITUTIONALIZED
POPULATIONS AGE 12 AND OLDER.
IT STARTED IN 2013 WITH OVER
40,000 PARTICIPANTS.
THIS PROJECT WAS DEVELOPED BOTH
BY THE FDA AND NIH WITH
ASSISTANCE FROM WESTAT AND WEST
TAD SCIENTIFIC PARTNERS.
IT HAS BEEN PREDOMINANTLY FUNDED
BY THE FDA CENTER FOR TOBACCO
PRODUCTS, CTP.
I NIH CONTRIBUTED $6.5 MILLION
AND WE AIM TO CONTRIBUTE A
SIMILAR AMOUNT ON FORWARD.
MULTIPLE INSTITUTES ARE INVOLVED
IN -- WE ARE THE MANAGEMENT BUT
HELPING TO FUND THIS STUDY AND
PARTICIPATE INITY ANALYSIS.
NIDA, NCI IS A BIG PLAYER, NIMHD
AND NIEHS, ODB, OBSSR, NIDDK.
AND AGAIN I'M VERY, VERY
GRATEFUL FOR NIDA'S LEADERSHIP
IN THIS PROGRAM BECAUSE WITHOUT
IT WE WILL NOT BE WHERE WE ARE.
SO WHAT ARE THE IMPACT, HERE
THEY ALSO HAVE 1,000
PUBLICATIONS, BUT IT GOES BEYOND
PUBLICATIONS.
IF THE PUBLICATION DOESN'T
CHANGE PRACTICES THEN IT IS NOT
VERY USEFUL.
AND THE PATH STUDY HAS A BIG
IMPACT ON POLICY AND THESE ARE
SOME OF THE EXAMPLES, HOW THE
DATA COLLECTED FROM PATH HAS
INFLUENCED RULES AND REGULATIONS
AND GUIDELINES.
IN 2022, THE DATA WAS CITED IN
SEVERAL FDA POLICY DOCUMENTING,
INCLUDING TWO PROPOSED RULES.
ONE ON TOBACCO PRODUCTS FOR
MENTHOL IN CIGARETTES, ANOTHER
FOR CHARACTERIZING FLAVORS IN
CIGARS.
THE DATA WAS ALSO CITED IN THE
2023 REPORT OF THE U.S. SURGEON
GENERAL ADVISORY, AND I --
BETWEEN SOCIAL MEDIA, DEPRESSION
AND ANXIETY.
IT HAS BEEN CITED IN
CONGRESSIONAL TESTIMONY
REGARDING FDA REGULATION FOR
ELECTRONIC NICOTINE DEVICE
SYSTEMS, AND IT ALSO HAS BEEN
CITED IN FDA CTP DECISION ON
PREMARKET TOBACCO PRODUCT
APPLICATIONS FOR -- IT'S VERY
IMPORTANT BECAUSE ELECTRONIC
NICOTINE DEVICES, ACTUALLY OF
DIFFERENT TYPES, ARE BECOMING
INCREASINGLY POPULAR AND IN SOME
DEMOGRAPHICS THEY ARE MUCH MORE
FREQUENT IN PREVALENCE THAN
CIGARETTE SMOKING.
BUT IT IS IN MANY WAYS A NEW
TERRITORY AND UNDERSTANDING WHAT
ARE THE APPEALS AND WHO ARE THE
DEMOGRAPHICS OF INDIVIDUALS THAT
ARE MORE RELEVANT IS NECESSARY
IN ORDER TO PROVIDE REGULATIONS
THAT CAN PROTECT AGAINST THEM.
SO THIS IS -- AGAIN, THERE HAS
BEEN A SHIFT IN THE WAY AND THE
RECOGNITION AND THE COMMITMENT
OF THE NIH TO HELP SUPPORT THE
PATH STUDY.
WHICH BRINGS ME TO THESE NUMBERS
HERE.
HOW IMPORTANT ARE NICOTINE
VAPING.
AND I PRESENTED THIS DATA IN OUR
LAST COUNCIL, BUT I DON'T KNOW
IF IT MADE A BIG IMPACT OVERALL,
BUT IT HAS BEEN MAKING A BIG
IMPACT IN MY BRAIN, AND SO I
DECIDED OKAY, I'M GOING TO -- I
HOPE I'M NOT THE ONLY ONE, BUT
I'M GOING TO SHOW IT AGAIN.
THIS IS DATA FROM NSDUH, THE
SAMHSA STUDY.
NEW INITIATES OF SUBSTANCES.
PEOPLE AGE 12 OR OLDER.
AND IN GENERAL, TRADITIONALLY BY
FAR, THE GREATEST NUMBER OF
NEW -- LOOK AT THOSE NUMBERS.
6 MILLION PEOPLE IN 2022
INITIATED NICOTINE VAPING, AND
THAT TELLS YOU WHY THIS IS AN
ISSUE THAT WE HAVE TO KEEP OUR
EYES ON AND WE HAVE TO
UNDERSTAND WHAT ARE THE
CONSEQUENCES AND WHAT ARE THE
PRODUCTS BEING USED AND WHAT I
TELL ACTUALLY WHO ARE THE
DEMOGRAPHICS THAT ARE MOST
VULNERABLE.
SO NUMBER ONE, NICOTINE VAPING
IN NEW INITIATES, NUMBER TWO,
ALCOHOL AND AS YOU WOULD EXPECT,
NUMBER THREE, MARIJUANA.
SO THE DELIVERY SYSTEMS ARE VERY
EFFECTIVE IN DELIVERING NICOTINE
AT VERY -- DOSES VERY FAST AND
DECENT ANSWERS REGARDINGIING --E
GROUP MOST AFFECTED OVERALL BY
NICOTINE DEVICES ARE THE YOUNG
PEOPLE.
I HAVE HERE DATA THAT GOES FROM
18 TO 45 AND OVER.
BUT IF I HAVE PRESENTED DATA ON
TEENAGERS, WE WILL SEE THAT 12TH
GRADERS HAVE THE HIGHEST RATE OF
NICOTINE VAPING.
18 TO 24 OVERALL THE PERCENTAGE
OF -- IS 11%.
VERY SIMILAR NUMBERS FOR MALES
AND FEMALES IN THE GROUP IN A
DEMOGRAPHIC WITH THE HIGHEST
RATES.
THEN THE NUMBERS GO DOWN FROM 20
TO 44 IS -- SO IF I HAD PLOTTED
YOU ZERO, THEY WOULD SAY IT IN
OPPOSITE PATTERN WITH AGE, THAT
IS TO SAY THE 45 AND OVER HAVE
THE HIGHEST RATES OF PREVALENCE
FOR CIGARETTE SMOKING, AND THE
18 TO 24 THE LOWEST.
SO WE'RE SEEING A SHIFTING IN
THE PATTERN OF HOW NICOTINE IS
BEING CONSUMED.
IN TERMS OF THE NEEDS FOR
TREATMENT FOR THIS POPULATION,
THERE ARE 11 MILLION TOTAL ADULT
E CIGARETTE USERS IN THE UNITED
STATES, AND 73% OF THEM INTEND
TO QUIT VAPING IN THE NEXT 3 TO
12 MONTHS.
AND THEY'RE WILLING TO TRY NEW
TREATMENTS, SO THE QUESTION IS,
WHAT DO WE HAVE TO OFFER THEM.
IF THEY WANT TO GO OUT AND GET
TREATMENT, WHAT TIME WE DO?
AND THERE ARE SEVERAL BEHAVIORAL
INTERVENTIONS, AND PARTICULARLY
APPS THAT ACTUALLY HAVE BEEN
TARGETED TO HELP PEOPLE QUIT
VAPING THAT HAVE SHOWN
SIGNIFICANT BENEFICIAL EFFECTS.
AND THESE HAVE ACTUALLY BEEN
SHOWN TO BE EFFECTIVE EVEN IN
ADOLESCENCE.
BUT THE BENEFITS FROM THEM
ARE -- THE EFFECT SIZES OF THOSE
BENEFITS IS RELATIVELY MILD.
SO THERE IS THIS NEED OF
ALTERNATIVE TREATMENTS SO THIS
PAST -- I THINK IT WAS TWO
MONTHS AGO OR THREE MONTHS AGO,
THERE WAS THE FIRST EVER -- TO
ADDRESS ADDICTION TO NICOTINE
VAPING.
THIS WAS A STUDY BASICALLY
FUNDED THROUGH OUR OFFICE OF
TRANSLATION AND INNOVATION, THAT
EVALUATED THE EFFECTIVENESS OF
CYTISINICLINE, A MEDICATION THAT
HAS BEEN USED FOR MANY YEARS IN
EUROPE.
IT WAS BROUGHT TO OUR ATTENTION
MANY, MANY YEARS AGO TO BRING IT
IN TO THE UNITED STATES TO
FACILITATE AN ALTERNATIVE
INTERVENTION FOR TOBACCO
SMOKING.
AND THEN THE NIDA AND NICCHD
HAVE BEEN INVOLVED IN HELPING TO
DEVELOP IT AND GETTING THE KAY
THE DATAULTIMATELY NECESSARY TOA
APPROVAL BUT THIS IS THE FIRST
TIME THE STUDY -- THE OUTCOME
BASTHEY'VEREACHED THEIR OUTCOME.
SO THIS IS, AGAIN, NOW A TOOL
THAT SHOULD BE DEPLOYED SO THAT
WE CAN HELP PEOPLE THAT ARE
ADDICTED TO NICOTINE VAPING TO
STOP IT.
THAT TAKES ME INTO THE TOPIC,
THE OVERDOSE EPIDEMIC.
I PRESENT THIS TABLE ON EVERY
SINGLE COUNCIL AND I CANNOT
NOT -- BECAUSE WE ALL HAVE TO
KEEP ATTENTION TO IT BECAUSE IT
BASICALLY IS MEETING THAT ONE
PERSON IS DYING EVERY FIVE
MINUTES IN THE UNITED STATES
FROM AN OVERDOSE AND THAT IS
UNACCEPTABLE.
IT HAS BEEN UNACCEPTABLE FOR
MANY, MANY YEARS AND IT HAS BEEN
GETTING WORSE AND WORSE AND
WORSE, AND THE COVID PANDEMIC
ACTUALLY ACCELERATED THE RATE AT
WHICH PEOPLE WERE DYING.
BUT FOR THE FIRST TIME EVER,
WE'RE SEEING SIGNIFICANT DECLINE
IN OVERDOSE DEATH THAT IS NOT
WITHIN WHAT I THINK THE ERRORS
OF THE MEASUREMENTS I PRESENT IN
THE PAST, SO AT ONE POINT IT WAS
7%, ANOTHER IT WAS 3 OR 2.5% AND
WE WERE GETTING VERY, VERY
EXCITED ABOUT IT BUT OF COURSE
THE NEXT YEAR IT DISAPPEARED,
BUT IT WAS PREDOMINANTLY DRIVEN
BY DECREASES IN HEROIN AND
NATURAL AND SEMI SYNTHETICS.
WHAT VERY INTERESTING HERE ON
THIS REDUCTION IS 7.5%.
LOOK AT IT.
FENTANYL FOR THE FIRST TIME THAT
I'VE EVER SEEN HAS GONE DOWN AND
IT'S 8.6% LOWER.
AND WHEN YOU SEE DATA LIKE THAT,
MY VIEW IS WHAT IS IT ALSO
TELLING US?
SO IF I SEE THAT 7.5 DECLINE,
IT'S INTRIGUING THAT THERE ARE
VERY LITTLE DECLINES IN COCAINE
AND THEY'RE RELATIVELY LESS
DECLINES IN METHAMPHETAMINE.
SO IN MY BRAIN, ONE OF THE
POSSIBLE EXPLANATION CONSIDERING
THAT THE MAIN STRATEGYS THAT
HAVE BEEN DEPLOYED BY THE
ADMINISTRATION TO ADDRESS THE
OVERDOSE CRISIS ARE TWO.
NUMBER ONE, DEPLOY NALOXONE IN
ORDER TO BE ABLE TO REVERSE
OVERDOSES.
AS EXTENSIVELY AS WE CAN.
AND YOU CAN DEPLOY IT, YOU CAN
SAVE A LIFE.
AND THE OTHER ONE, INITIATE
MEDICATIONS FOR OPIOID USE
DISORDER.
AND THE INITIATIONS OF
MEDICATION FOR OPIOID USE
DISORDER IS METHADONE --
SIGNIFICANTLY REDUCE THE RISK OF
OVERDOSES.
SO THE FACT THAT WE ARE SEEING
IT PREDOMINANTLY CONCENTRATED IN
REDUCTIONS IN OPIOID OVERDOSES
MAKES ME THINK THAT THESE
INITIATIVES HAVE MADE A MARK,
THAT THEY ARE STARTING TO TURN
THE TIDE.
BUT IT'S ALSO MAKING ME AWARE
THAT WE NEED TO EMPHASIZE THE
IMPORTANCE OF PROVIDING
ALTERNATIVE THERAPEUTIC
INTERVENTIONS TO ACTUALLY
PROTECT PEOPLE THAT MAY HAVE A
COCAINE OR A METHAMPHETAMINE USE
DISORDER WERE ACTUALLY ARE AT A
HIGH RISK OF OVERDOSING BECAUSE
OF HOW FREQUENTLY THE
PSYCHOSTIMULANT DRUGS ARE BEING
LACED WITH FENTANYL, PUTTING
THEM AT HIGH, MUCH HIGHER RISK
OF OVERDOSES.
SO YES IT'S GOOD NEWS IN TERMS
OF ACTUALLY WE'RE SEEING
SIGNIFICANT DECREASES, THE
LARGEST WE'VE EVER SEEN AND IT'S
CLOSE TO 111 OR 112 TO 103, SO
IT'S 9,000 PEOPLE THAT DIED
LAST -- THIS IDEA, THROUGH MARC.
BUT AGAIN, I WANT US TO LOOK AT
THE DATA AND THINK ABOUT HOW DO
WE MOVE THESE FINDINGS.
I MENTIONED THAT CERTAINLY ONE
OF THE LIKELY SUCCESSES HAS BEEN
THAT DEPLOYMENT OF MEDICATIONS
FOR OPIOID USE DISORDER AND THIS
HAS RELIED ENORMOUSLY ON
RECRUITMENT OF HEALTHCARE
SYSTEMS IN ORDER TO BE ABLE TO
PROVIDE THESE MEDICATIONS.
SO NOT JUST LIMITING TO
METHADONE, OPIOID TREATMENT
PROGRAMS OR SPECIALIZED CENTERS,
WE'RE GOING OUT INTO THE
HEALTHCARE IN ORDER TO GET
CLINICIANS TO PRE-SCREEN AND TO
PRESCRIBE THESE MEDICATIONS.
AS I MENTIONED BEFORE, THIS IS
ONE OF THOSE THAT THE CITY
AND -- WILL THEY BE BRINGING
MODELS OF TREATMENT AND
DOCUMENTING THEIR EFFECTIVENESS
AND EFFICACY.
BARRIERS IN HEALTHCARE SETTINGS,
ONE OF THE ONES THEY HAVE
FOCUSED ON IS ON EMERGENCY
DEPARTMENT, BECAUSE THIS IS A
PLACE THAT HAS A HIGH LIKELIHOOD
OF ACTUALLY GETTING EXPOSED TO
INDIVIDUALS THAT HAVE ADVERSE
CONSEQUENCES FROM THE USE OF
OPIOID, INCLUDING OVERDOSES.
SO IT GIVES THEM BASICALLY A
DEVELOPER MODEL FOR INITIATING
BUPRENORPHINE TREATMENT IN THE
EMERGENCY DEPARTMENT, SHOWING
THAT THAT SIGNIFICANTLY
INCREASES THE LIKELIHOOD THAT
THE PERSON WILL STAY IN
TREATMENT, SHOWING THAT IT CAN
BE DEPLOYED, AND IN THIS LATEST
STUDY THAT THEY ACTUALLY JUST
PUBLISHED RECENTLY, THEY
ACTUALLY DOCUMENTED ONE OF THE
THINGS THAT WE WERE VERY EXCITED
WITH THE INTRODUCTION, A ONE
WEEK EXTENDED RELEASE
BUPRENORPHINE, THESE WILL GIVE
THE EMERGENCY DEPARTMENT A
LONGER TIME TO COVER BECAUSE
THEY WERE RELUCTANT TO INITIATE
SOMEONE THAT HAD NOT RECEIVED
BUPRENORPHINE IN ONE MONTH, SO
THAT ONE PROVIDED A FLEXIBLE
INTERMEDIATE NUMBER AND THEY
RECENTLY REPORTED THAT IT WAS
ACTUALLY QUITE WELL ACCEPTED.
THEY INCLUDED THE ONE WEEK
INJECTABLE IN INDIVIDUALS THAT
HAVE MILD OPIOID WITHDRAWAL
SYMPTOMS WHICH THEY MEASURE
USING THE COWS AND THEIR CUTOFF
POINT WAS A CUTOFF POINT OF 7.
THESE PATIENTS OUT OF THE 100
PATIENTS THAT THEY TESTED, ONLY
10 OF THEM DEVELOPED MORE SEVERE
WITHDRAWAL SYMPTOMS, WHICH WAS
AGAIN SOMETHING THAT IS CREATING
HESITATION ON MANY CLINICIANS OF
PROVIDING BUPRENORPHINE BECAUSE
OF THE FEAR THAT BUPRENORPHINE
WILL TRIGGER AN ACUTE OPIOID
WITHDRAWAL.
THIS STUDY SHOWS THAT IF YOU
INITIATED IN INDIVIDUALS WITH
RELATIVELY MILD EVIDENCE OF
PRESENCE OF WITHDRAWAL SYMPTOMS,
IT IS SA SAFE AND IT'S GOING TOE
WELL TOLERATED AND IN THIS CASE
IT'S 10% THAT GOT WORSENING IN
WITHDRAWAL SYMPTOMS BUT IT'S
ALSO INTRIGUING THAT THEY
CLEARLY SHOWED THEY WERE
MEASURING FENTANYL AND 63 OF THE
PATIENTS WHO WERE POSITIVE FOR
FENTANYL HAD UNEVENTFUL
INDUCTIONS, DOCUMENTING THAT IT
IS POSSIBLE.
MY QUESTION AS I THINK ABOUT IT
AND I SEE THE SITUATION IN THE
EMERGENCY DEPARTMENT AND THE
RESEARCH QUESTIONS IS WHAT IS IT
THAT WE CAN DO IN THE EMERGENCY
DEPARTMENT OR HOW CAN WE
DECREASE THE SEVERITY OF THE
WITHDRAWAL SYMPTOMS ON A PATIENT
THAT MAY END UP THERE WITH
INTENSE WITHDRAWAL SYMPTOMS SO
YOU CAN INITIATE THE
BUPRENORPHINE SO THAT ASPECT OF
COURSE REQUIRES INVESTIGATION.
THE UTILIZATION AND INITIATION
OF BUPRENORPHINE IN EMERGENCY
DEPARTMENTS IS BEING TAKEN IN
DIFFERENT LEVELS AND DEGREES BY
VARIOUS STATES, BUT FOR EXAMPLE,
CALIFORNIA IS ONE OF THE STATES
THAT HAS EMBRACED AND WE'RE
SEEING MORE AND MORE EMERGENCY
DEPARTMENTS STARTING TO DIRECTLY
PROVIDE BUPRENORPHINE ON
PATIENTS.
AND AGAIN, THAT ALLOWS THEM TO
BE LINKED WITH TREATMENT.
THE OTHER AREA I WANT TO
HIGHLIGHT AND ACTUALLY BECAUSE
IT'S ONE OF THE STUDIES THAT THE
CTN IS ONGOING, THE CTN0131, AND
IT'S A STUDY TO TRY TO ACTUALLY
ADDRESS THE QUESTION OF CAN WE
PROVIDE METHADONE IN AN
ENVIRONMENT THAT'S NOT
NECESSARILY JUST THE OPIATE
TREATMENT PROGRAMS.
METHADONE CLINICS ARE LIMITED
AND MANY INDIVIDUALS DON'T HAVE
ACCESS TO THEM.
MANY INDIVIDUALS DON'T WANT
METHADONE BECAUSE THEY DON'T
WANT TO GET IT FROM A METHADONE
CLINIC.
IN THE PROCESS WHAT WE'RE
OBSERVING IS METHADONE, WHICH IS
A VERY EFFECTIVE MEDICATION FOR
OPIATE USE DISORDER IS BEING
UNDERUTILIZED.
METHADONE HAS MORE THAN A
55-YEAR HISTORY VERSUS
BUPRENORPHINE THAT HAS A LITTLE
BIT MORE THAN A TWO DECADE.
AND JUST LOOK AT THE NUMBERS IN
DIFFERENCES OF PEOPLE THAT ARE
RECEIVING -- PATIENTS THAT ARE
RECEIVING EITHER BUPRENORPHINE
OR METHADONE, AND YOU CAN SEE
THAT DESPITE THE FACT THAT
BUPRENORPHINE IS A MUCH NEWER
TREATMENT, WE HAVE CLOSE TO
900,000 PEOPLE RECEIVING
BUPRENORPHINE, THIS IS AN
UNDERESTIMATE BECAUSE IT'S ONLY
RELYING ON RETAIL PHARMACIES.
WHEREAS THE LOWER ONE IS
METHADONE, AND YOU CANNOT
TOTALLY COMPARE THE BLUES AND
THE BROWNS, BUT BOTTOM LINE IS
THERE ARE 400,000 PEOPLE BEING
TREATED WITH METHADONE IN OPIATE
TREATMENT PROGRAMS.
IT'S A PITY BECAUSE WE KNOW IF
YOU LOOK ALSO AT THE
EPIDEMIOLOGICAL STORIES, WE KNOW
RETENTION IN TREATMENT WITH
METHADONE IS HIGHER THAN -- WITH
BUPRENORPHINE.
BUPRENORPHINE TREATMENT
RETENTION AT SIX MONTHS IS
APPROXIMATELY 50%.
THAT OF METHADONE CAN GO TO 60,
65%.
AND IN PARTICULAR WITH A STRONG
PHYSICAL DEPENDENCE THAT WE ARE
OBSERVING IN PATIENTS WHO ARE
ACTUALLY ADDICTED TO FENTANYL,
INITIATING BUPRENORPHINE CAN BE
SOMETIMES CHALLENGING, IF THERE
ARE HIGH LEVELS OF ABOUTDRAWL
SYMPTOMS, SO INITIATED WITH
METHADONE OFFERS AN ALTERNATIVE
THAT COULD BENEFIT MANY
PATIENTS.
BUT AGAIN WE HAVE A ROADBLOCK
EVEN BY THE LIMITED NUMBER OF
OPIATE TREATMENT PROGRAMS AND
THE FACT THAT SOME PATIENTS
DON'T WANT TO GO TO OTPs.
SO WE'RE INITIATING A TRIAL,
THIS IS AN OFFICE-BASED
METHADONE, WITH PHARMACY
ADMINISTRATION.
OFFICE-BASED METHADONE HAS BEEN
SHOWN TO WORK IN MANY OTHER
COUNTRIES IN THE WORLD, BUT IT'S
NOT ACCEPTED IN THE UNITED
STATES SO THIS STUDY WILL
COMPARE OFFICE-BASED METHADONE
WITH PHARMACY ADMINISTRATION OR
DISPENSING VERSUS OFFICE SPACE
BUPRENORPHINE ON RETENTION IN
MOUD TREATMENT TO GET A SENSE
ABOUT WHAT ARE THE OUTCOMES IF
WE RELY ON OFFICE SPACE AND WHAT
MAY BE SOME OF THE CHALLENGES IN
ORDER TO IMPLEMENT IT.
NOW LET ME GET BACK TO THOSE
NUMBERS ON THE TABLE AND SAY
7.5% DECREASE IN OVERDOSE
MORTALITY MOST OF IT FROM OPEN
YOITS OF ONE TYPE OR ANOTHER
INCLUDING FENTANYL.
BUT THIS DATA IS AN AVERAGE AND
IT BEHOOVES US TO TRY TO
UNDERSTAND THAT THE
DISADVANTAGES AND REDUCTION IN
OVERDOSES ARE NOT WIDESPREAD
ACROSS ALL GROUPS OF RACE AND
DEMOGRAPHICS AND OTHER
DEMOGRAPHICS.
AND WHAT IT SHOWS IN WHITE, THE
GREENISH BLUE, WHITE, THERE ARE
32.9 AGE-ADJUSTED RATE DEATHS
PER 100,000 POPULATION, AND I'VE
SHOWN THIS BECAUSE IT IS
SHOCKING AND WE HAVE TO KEEP OUR
EYES ON THIS NUMBER, THE
DOUBLE -- THE RATE OF MORTALITY
IS DOUBLE IN AMERICAN INDIA AND
ALASKA NATIVES.
IT 65.6 VERSUS 32.9.
THAT'S BASICALLY 50% LOWER IN
WHITES THAN NATIVE AMERICANS.
BUT ALSO LOOK AT THE TRENDS.
IN THE WHITE PEOPLE IT'S GOING
DOWN.
IN THE AMERICAN UNTIL NATIVE
AMERICANS, UNTIL LAST YEAR,
WHERE IT SEEMS TO BE SORT OF
PLATEAUING, BUT CERTAINLY NOT
GOING DOWN BUT IT HAD GONE -- IT
WAS RAPIDLY HIGH, VERY, VERY
STEEPLY.
ALSO PAY ATTENTION TO THE
BLACKS, AND THAT HAS BEEN NOTED
TOO, BLACK PEOPLE ARE DYING AT
50% HIGHER RATE THAN WHITE
PEOPLE.
BUT LOOK AT THE TRENDS.
THOSE TRENDS ARE NOT GOING DOWN.
THOSE CONTINUE TO GO UP.
SO IF WE SAY YES, DEPLOYMENT OF
THESE MEDICATIONS PROBABLY HAS
HELPED, WE HAVE TO RECOGNIZE AND
SAY COULD IT BE POSSIBLE THAT
THESE GROUPS, THIS DEPLOYMENT
HAS NOT BEEN SUCCESSFUL, AND OR
AN ALTERNATIVE THAT THERE ARE
OTHER CHALLENGES.
SO RECOGNIZING THE NUMBER OF
PEOPLE, NATIVE AMERICANS THAT
ARE DYING FROM OVERDOSES IS SO
EXTRAORDINARILY HIGH, WE
LAUNCHED THE MOST LARGEST, MOST
AMBITIOUS STUDIES THAT WE'VE
EVER LAUNCHED, AT NIDA IN
PARTNERSHIP WITH NINDS FUNDED BY
HEAL DOLLARS TO ACTUALLY EMPOWER
NATIVE AMERICAN ORGANIZATIONS TO
LEAD COMMUNITY PROJECTS THAT
THEY PRIORITIZE.
NOW, WHY IS THIS IMPORTANT?
BECAUSE TO START WITH, THERE IS
A LACK OF TRUST OF WESTERN
CULTURE, THERE'S A LACK OF TRUST
OF GOVERNMENT ORGANIZATIONS, SO
IT HAS BEEN VERY, VERY DIFFICULT
TO ENGAGE NATIVE AMERICANS INTO
THE RESEARCH ENTERPRISE AT NIDA,
AT THE ALL OF NIH.
IN FACT NIDA HAS ONE OF THE
HIGHEST SUCCESS RATES BRINGING
INVESTIGATORS THAT ARE NATIVE
AMERICAN BUT IT STILL EXTREMELY
LOW.
SOME SAY WHY IS IT, THIS PROGRAM
WHICH HAS BASICALLY CONCEIVED BY
DR. KATHY ETZ AND VERY ABLY LED,
CAME ABOUT BECAUSE OF ALL OF US
MEETING WITH NATIVE AMERICANS
AND THEIR TRIBES AND THEIR
ORGANIZATIONS TO GET INPUT ABOUT
WHAT IS IT THAT WOULD BE
VALUABLE FOR THEM?
IN ONE OF MY FIRST MEETINGS IT
BECAME CLEAR, THEY WERE
RECOGNIZING THAT THE PROBLEM OF
DRUGS WAS DEVASTATING AND AT
THAT TIME IT WAS PREDOMINANTLY
METHAMPHETAMINE, BUT THEY DIDN'T
HAVE AN IDEA ABOUT WHAT THE
NUMBERS WERE, THEY JUST KNEW
THEY WERE LOSING PEOPLE BUT WHAT
WAS THAT MAGNITUDE, AND THEY
WERE RECORDING IT AS EVEN MORE
IMPORTANT THAN EVEN WE WOULD SAY
SERVING WITH ALCOHOL AND
SUICIDE.
SO IT WAS CLEAR THAT THEY NEEDED
DATA.
IN VISITING MANY OF THESE PLACES
IT IS ALSO CLEAR THAT THEY DON'T
HAVE THE INFRASTRUCTURE THAT YOU
SEE MANY OF THE HEALTHCARE
CENTER, YOU MAY EVEN BE A NEW
INVESTIGATOR BUT SOMEONE IS
GUIDING YOU ON HOW TO APPLY FOR
THE IRB, WHAT ARE THE SUPPORTS,
THAT DOESN'T EXIST.
SO WHAT DR. KATHY ETZ SAID IS
WHY DON'T WE CREATE THIS
INITIATIVE TO BUILD UP AND
EMPOWER NATIVE AMERICANS, TRIBES
AND ORGANIZATIONS THAT ARE AT
DIFFERENT STAGES OF THEIR
READINESS TO DO RESEARCH SO THAT
THEY CAN THEN BECOME ACTIVE
MEMBERS.
THE PROJECT WAS JUST RECENTLY
AWARDED.
IT'S DIVIDED IN TWO PHASES,
PHASE 1, 24-25, AND PHASE 2,
26-30.
THE FIRST PROJECT IS
BASICALLY -- PHASE 1 IS TO
DEVELOP A PLAN, AND IT'S
DEPLOYING $25 MILLION.
WE HAVE SELECTED ALREADY 15
SITES, SO NATIVE AMERICAN
INVESTIGATORS AND ASSOCIATED
ORGANIZATIONS TO START TO FUND
THEM, AND IT INCLUDES NATIVE
RESOURCE NETWORK TO PROVIDE
TRAINING RESOURCES AND PROGRAM
COORDINATION.
SO YES, THE AIM IS TO ENHANCE
CAPACITY TO CONDUCT LOCALLY
PRIORITIZED RESEARCH, TO IMPROVE
ACCESS AND QUALITY OF THE DATA,
AND TO LEAD COMMUNITY
PRIORITIZED RESEARCH PROJECTS
WHICH WILL BASICALLY BE DEPLOYED
AT THE HIGHER LEVEL DURING THE
PHASE 2.
YOU CAN SEE THE DIFFERENCES IN
TERMS OF INVESTMENT.
SO AGAIN, I'M VERY, VERY
GRATEFUL FOR ALL OF THE
LEADERSHIP AND THE EFFORT THAT
CAME ABOUT FOR THIS PROGRAM.
SO IT WAS THREE WEEKS AGO THAT
WE WENT AND VISITED ONE OF THE
SITES THAT WAS SELECTED AS A
GRANTEE.
YOU SEE ME THERE BY THE SIDE TO
MY RIGHT IS DR. MONICA
BERTAGNOLLI.
SO IT WAS EXTRAORDINARY TO SEE
THE COMMITMENT THAT OUR DIRECTOR
OF THE NIH HAS IN HELPING TO
ADVANCE THE SCIENCE IN NATIVE
AMERICANS, AND HER VISION TO
ACTUALLY ENSURING THAT WE CAN
PROVIDE RESEARCH THAT CAN HELP
THOSE COMMUNITIES.
SO SHE ALSO BROUGHT ALONG WITH
HER, YOU SEE THERE, SUSAN
GREGORY TO THE RIGHT, AND THIS
IS THE DIRECTOR OF DATA SCIENCE
AT THE NIH.
AGAIN, EXTREMELY IMPORTANT
BECAUSE TO THE EXTENT THAT WE
CAN EMPOWER THESE COMMUNITIES TO
GENERATE THEIR DATA, TO OWN IT,
AND TO TAKE ADVANTAGE OF IT,
THAT CAN BE VERY, VERY CONKS
QENGS.
CONSEQUENTIAL.
THESE ARE THE OTHER SITES THAT
WERE SELECTED, 15 SITES.
THE KICKOFF MEETING IS GOING TO
BE TOWARDS THE END OF THIS
MONTH.
SO WE'LL BE GIVING YOU UPDATES
ON THIS.
AND THESE ARE SOME OF THE --
JUST EXAMPLE OF OUR RESEARCH
ACTIVITIES FOR THE SUBSTANCE USE
DISORDER.
THEY ARE SIMILAR EXAMPLES FOR
PAIN, SO WE'RE HIGHLIGHTING
BOTH, ADVANCING PAIN WHICH HAS A
MUCH HIGHER PREVALENCE OF NATIVE
AMERICANS THAN THE NON-NATIVE
AMERICANS.
AND ALSO TO CREATE OUR RESEARCH
CAPACITY BUILDING, WHICH IS
CRUCIAL AND FUNDAMENTAL, AND
CENTRAL FOR THIS INITIATIVE.
BUT THAT BRINGS ME TO THE OTHER
GROUP, THAT GROUP OF AFRICAN
AMERICANS, BLACK AMERICANS,
WHICH IS THE OTHER ONE THAT
ACTUALLY IS DISPROPORTIONATELY
AFFECTED.
AND I'M SHOWING YOU THESE
NUMBERS BECAUSE, AGAIN, WE NEED
TO UNDERSTAND WHAT ARE THE
DYNAMICS THAT ARE MAKING THEM
VULNERABLE AND HOW TO TARGET
THEM.
COULD IT BE THAT THEY ARE DYING
BECAUSE WE ARE NOT DEPLOYS
NALOXONE OR MEDICATIONS FOR
OPIOID USE DISORDER JUST SORT OF
IN A WAY THAT IS ACCEPTABLE
TODAY OR THEY CAN ACTUALLY --
CAN'T STAY WITH OTHER TREATMENT?
OR ARE THERE OTHER FACTORS THAT
PLAY AROUND.
WHEN I WAS LOOKING AT DATA THAT
I GET PERIODICALLY FROM
DR. EMILY EINSTEIN AND HER
GROUP, ACTUALLY SHE SENT ME THE
DATA ON OVERDOSES BY AGE, AND
I'M SHOWING YOU JUST THE
OVERDOSES BY AGE OF INDIVIDUALS
THAT ARE 55 TO 64 YEARS BY RACE,
AND IT CAUGHT MY EYE BECAUSE
NORMALLY WE SEE OVERDOSES IN
YOUNGER PEOPLE, RIGHT, 25 TO 44,
AND WE DON'T THINK OF PEOPLE
OVER 55 YEARS OF AGE AND
CERTAINLY NOT MORE THAN 65 YEARS
OF AGE AS PEOPLE TAKING DRUGS,
BUT WHAT WE ARE SEEING ARE
SIGNIFICANT INCREASES OF THE
MORTALITY IN THESE AGE GROUPS,
BUT IF YOU THEN GO AND DWELL ON
THE RACE AND ETHNICITY, YOU CAN
SEE THAT, AGAIN, FOR INDIVIDUALS
AGE 55 AND 64, THE AMERICAN
INDIAN OR ALASKA NATIVES ARE
VERY, VERY HIGH, BUT EVEN HIGHER
FOR THIS AGE GROUP ARE THE BLACK
AFRICAN AMERICANS, THAT'S THE
JELL-O, THE SYELLOW, THE STRONGS
HAVE THREE TIMES GREATER
MORTALITY IN FEMALES IN
OVERDOSES.
THEN 50 TO THE RIGHT, THESE ARE
PEOPLE AGE 65 OR OLDER, NORMALLY
TYPICALLY VERY, VERY LOW RATES
OF OVERDOSES.
LOOK AT THE AFRICAN AMERICAN,
THE OVERDOSES OF 87 PER 100,000.
AND YOU LOOK AT IT AND YOU SAY,
WELL, WHAT IS KILLING THEM?
INTERESTINGLY, THERE ARE TWO
DRUGS THAT ARE DRIVING THE
OVERDOSE DEATHS IN 65 YEARS OR
OLDER.
AND IT IS COCAINE AND FENTANYL.
AND INTERESTINGLY, AND AGAIN,
METHAMPHETAMINE DOES NOT SEEM TO
PLAY VERY MUCH OF A ROLE, AND
HEROIN IS VERY, VERY MINIMAL.
SO THIS IS THE EXPOSURE TO
FENTANYL ON THE ONE HAND, BUT
ALSO COCAINE AND LIKELY
COMBINATION THAT ARE PUTTING
THEM AT RISK.
THIS IS SO NOTABLE THAT "THE NEW
YORK TIMES" HAD A WHOLE
EDITORIAL ARTICLE PUBLISHED ON
JUNE 3, 2024 COMMENTING ABOUT
HOW RAPIDLY THE OVERDOSE DEATHS
HAVE GROWN AMONG BLACK AMERICANS
IN THE UNITED STATES,
PARTICULARLY MEN.
ACTUALLY YOU CAN SEE IN THAT
GRAPH THAT BLACK WOMEN AND WHITE
WOMEN HAVE VERY SIMILAR RATES.
IT'S THE BLACK MEN THAT YOU HAVE
THE OVERREPRESENTATION.
AND THEN THEY WENT ON AND DID AN
ARTICLE ON BOTH -- THAT
BASICALLY WAS IDENTIFYING
INDIVIDUALS MORE THAN 65 YEARS
OF AGE ACTUALLY AS HAVING DIED
AT GREATER RATE DURING THE COVID
PAN DEVPANDEMIC OF OVERDOSES FRM
COVID.
AND THIS IS THE AGE GROUP OF
HIGH RISK, AGAIN, AFRICAN
AMERICANS EXTREMELY HIGH RISK
FOR COVID DEATHS, EMTREEMLY,
HIGH, HIGH RISK AND YET THERE
WERE MORE PEOPLE FROM OVERDOSES
IN THIS AGE RANGE.
HIGH LIEGHT THE QUESTION AND THE
QUESTION, WHAT IS DRIVING THESE
VERY, VERY HIGH RATES OF
MORTALITY?
SO JUST LIKE WE CONCEIVE AN
INITIATIVE TO TARGET RESEARCH
THAT CAN HELP ADVANCE
INTERVENTIONS FOR NATIVE
AMERICAN, IT BEHOOVES US TO
IDENTIFY -- THAT CAN HELP
TREATMENT OUTCOMES IN
INDIVIDUALS WITH SUBSTANCE USE
DISORDER THAT ARE BLACK AND WITH
SPECIAL ALSO EMPHASIS IN ALL THE
GROUPS WHICH IS NOT AGAIN A
DEMOGRAPHIC THAT WE HAVE DONE
MUCH RESEARCH ON.
AND THEN THIS CHANGES THE TONE
OF MY PRESENTATION FROM GOING
INTO IDENTIFYING SOME OF THE
IMPLEMENTATION SERVICES RESEARCH
TOWARDS ADVANCING MEDICATIONS.
I DID MENTION BEFORE THAT ONE OF
THE CHALLENGES THAT WE HAVE WITH
BUPRENORPHINE EVEN, WITH
METHADONE, IS RETENTION.
RETENTION IS POOR, AND SO ONE OF
THE PRIORITIES OF THE
INSTITUTES, AND WE HAVE BEEN
ASKING RESEARCHERS TO
INVESTIGATE, WHAT IS IT THAT CAN
BE BEING DONE TO IMPROVE
RETENTION OF PEOPLE ON
MEDICATIONS FOR OPIOID USE
DISORDER?
AND WE'VE ALSO RECOGNIZED THE
NEED FOR MEDICATION FOR THE
TREATMENT OF STIMULANTS,
ACTUALLY SIGNIFICANTLY
CONTRIBUTING TO OVERDOSE
MORTALITY AND WE DON'T HAVE
ANYTHING.
SO IN THIS BACKGROUND, IT COMES
TO EVERYONE'S ATTENTION, THIS
HAS BEEN IN THE LAY PUBLIC
PRESS, IT HAS BEEN IN THE
TELEVISION NEWS, IT HAS BEEN IN
THE SCIENTIFIC LITERATURE.
INITIALLY BROUGHT ABOUT BY
PATIENTS THAT ARE BEING TREATED
WITH ANTAGONIST DRUGS LIKE
OZEMPIC FOR OBESITY OR MANJARO,
THEY DON'T HAVE DESIRE TO DRINK
OR THEY DON'T HAVE DESIRE TO
SMOKE TOBACCO LED RESEARCHERS TO
DO SMALL CLINICAL TRIALS.
IT SEEMS TO ACTUALLY REDUCE --
THERE WAS A PRESENTATION OF A
RANDOMIZED CLINICAL TRIAL ON
ALCOHOL USE DISORDER THAT SHOWED
SIGNIFICANTLY REDUCE THE HEAVY
DRINKING BASE.
ITDRINKING DAYS, IT WAS A POSITE
OUT COME.
THERE ARE MULTIPLE STUDIES DONE
BASED ON ELECTRONIC HEALTHCARE
RECORDS, AGAIN REPRODUCING ONE
ANOTHER, THE USE OF THESE
MEDICATIONS IN PEOPLE WITH
DIABETES OR OBESITY THAT ALSO
HAVE A SUBSTANCE USE DISORDER
ASSOCIATED WITH REDUCTION OF
THEIR SUBSTANCE USE DISTORD.
THIS HAS BEEN DOCUMENTED FOR
TOBACCO, ALCOHOL, CANNA BUSIN
BUSINESS, FOR OPIOID USE
DISORDER.
BUT SO THE ISSUE HAS COME ABOUT,
PEOPLE START TO BE PRESCRIBING
THESE MEDICATIONS FOR SUBSTANCE
USE DISORDER AND I SELECTED A
PAPER AT THE END TO THE RIGHT
BECAUSE IT SAYS GLP RECEPTOR
AGONISTS ARE PROMISING BUT THEY
ARE UNPROVEN TREATMENTS FOR
ALCOHOL AND SUBSTANCE USE
DISORDER.
AND I SELECTED IT BECAUSE IT
DOES REQUIRE -- AND TODAY, IT IS
OUR RESPONSIBILITY TO ENSURE
THAT THE RESEARCH IS DONE THAT
CAN ACTUALLY DETERMINE WHAT IS
THE EFFICACY OF THESE
MEDICATIONS FOR WHAT AND HOW TO
USE THEM.
SO WE HAVE BEEN FUNDING NOW FOR
MANY YEARS, FOR MORE THAN A
DECADE, FOR CLINICAL STORIES
THAT DOCUMENT ANTAGONIST
MEDICATION SIGNIFICANTLY REDUCE
REWARDING EFFECTS OF DRUGS IN
RATS AND YESTERDAY THERE WAS A
WHOLE DAY, SUPERB SYMPOSIUM
ORGANIZED BY THE NATIONAL
ACADEMY OF SCIENCE, ENGINEERING
AND MEDICINE ON THE POTENTIAL
FOR NEUROPSYCHIATRIC DISEASES.
IT IS QUITE FASCINATING TO SEE
HOW THESE MEDICATIONS THAT HAVE
PROFOUND EFFECTS IN REDUCING
OBESITY AND IMPROVING OUTCOMES
IN DIABETES ARE HAVING PROFOUND
EFFECT IN REVERSING SOME OF THE
NEUROINFLAMMATION THAT IS
ASSOCIATED WITH MANY NARROW
PSYCHIATRIC DISEASES.
SO -- AND IN SUBSTANCE USE
DISORDER, THESE MEDICATIONS
PRODUCE SATIETY, SO WHAT ABOUT
SATIETY WITH DRUGS.
THERE'S ALSO THE DATA FROM
PRE-CLINICAL MODELS INDICATES
THIS IS EXPRESSED IN THE
DOPAMINE NEURONS, IN THE BTA,
THERE IS SOME CONTROVERSY
WHETHER IT IS IN THE DOPAMINE
NEURONS OR NOT, BUT IF THESE ARE
EXPRESSED THAT -- DOPAMINE CELLS
AND THE AGONIST WILL ENHANCE
THAT IN ADDITION.
SO THERE IS A LOT OF
PRE-CLINICAL WORK PROVIDING
EVIDENCE WHY THIS COULD WORK,
AND THESE ARE SOME OF THE
EXAMPLES OF TRIALS THAT WERE
CURRENTLY FUNDED THROUGH OUR
GRANT PORTFOLIO AT DTMC OR A
PROJECT THAT IS BEING ACTUALLY
PREPARED BY THE CLINICAL TRIAL
NETWORK TO EVALUATE -- TO --
BUPRENORPHINE FOR TREATMENT OF
OPIOID USE DISORDER WITH A MAIN
OUT COME ACTUALLY BEING
RETENTION AND TREATMENT TO SEE
IF IT CAN ACTUALLY IMPROVE
RETENTION AND TREATMENT.
AND THEN FROM THE BASIC SCIENCE,
I ACTUALLY SELECTED ONE PAPER
WHICH ACTUALLY -- THAT IS VERY
NOTORIOUS IN MULTIPLE THINGS.
IN ONE OF THEM, BECAUSE IT'S
PART OF OUR AVANT-GARDE PROGRAM
FOR HIV THAT ENCOURAGES
RESEARCHERS TO TAKE RISKS, TO GO
AFTER COMPLETELY INNOVATIVE
IDEAS ON HOW TO ADDRESS THE
PROBLEM OF HIV AND THE
ASSOCIATION WITH SUBSTANCE USE
DISORDER.
THIS WAS A PAPER BY ONE OF THE
GRANTEES, AND ACTUALLY TAKING
ADVANTAGE OF SOMETHING THAT IS
KNOWN, THAT WHEN THE HIV VIRUS
REPLICATE, SOMETIMES THERE ARE
DEFECTS THAT OCCUR IN THAT HIV
VIRUS THAT ACTUALLY LEAD TO A
VIRAL PARTICLE THAT COMPETES
WITH THE ORIGINAL HIV PARTICLE.
SO THEY TOOK THAT CONCEPT AND
FURTHER MODIFIED THESE PARTICLES
IN SUCH A WAY THAT THEY CAN
GENERATE A VIRAL PARTICLE THAT
INTERFERES WITH THE REPLICATION
OF THE HIV VIRUS, AND IN
MONKEYS, AND IN RATS WHERE
THEY'VE TESTED IT, ACTUALLY
PREVENTED THE ANIMALS FROM DYING
SO IT CONTAINED THE VIREMIA FROM
THE HRV.
AND THIS WAS A LONG LASTING
EFFECT, IT'S ACTUALLY IN ONE --
VIRUSES FOR THERAPEUTICS.
THEY WERE ABLE TO PREVENT THE
INFECTION FOR SEVERAL MONTHS.
AND THIS BRINGS ME TO THE END OF
THE PRESENTATION.
THIS FOR US HAS BEEN THE 50-YEAR
ANNIVERSARY FOR NIDA.
IT HAS GIVEN US THE OPPORTUNITY
TO ACTUALLY SEE AND ANALYZE WHAT
HAS BEEN DONE IN THE SCIENCE OF
SUBSTANCE USE AND SUBSTANCE USE
DISORDER, WHERE ARE WE AS AN
INSTITUTE, WHERE H ARE WE AS A
SCIENCE, WHERE ARE WE AS A
COUNTRY, AND THE DIVERSITY OF
THE RESEARCHERS AND
INVESTIGATORS THAT ARE PART OF
OUR GRANTEES.
SO WE HAVE HAD MULTIPLE EVENT TO
CELEBRATE
>> Dr. Anderson: TO HIGHLIGHT
IT, AND TO FORCE US INTO
THINKING, WELL, WHAT ABOUT THE
FUTURE, THIS IS 50 YEARS BEHIND,
WHERE ARE WE GOING.
I THINK FROM THE PERSPECTIVE OF
WHERE WE ARE GOING, THESE ARE
EXTRAORDINARY TIMES.
DATA SCIENCE TELLS YOU IT'S
MACHINE LEARNING, ALL OF THE
TOOLS AND TECHNOLOGY THAT ALLOW
US TO -- TH THE HUMAN BRAIN THAT
ENABLES US TO IDENTIFY CELLS
HAVE COMPLETELY REVOLUTIONIZED
THE WAY THAT WE CAN ADDRESS THE
CONSEQUENCES OF DRUGS TO HUMANS
OVERALL, AND THE DATA SCIENCE
HAS ALSO ENABLED US TO
UNDERSTAND HOW THE SOCIAL
DETERMINANTS OF HEALTH ARE
INFLUENCING TRAJECTORIES.
NOW WE CAN UNDERSTAND THEM.
WE'VE KNOWN ALL ALONG THAT THEY
WERE CRUCIAL, BUT WE DIDN'T KNOW
WHY, WHAT DO THEY DO.
SO THIS IS THE OPPORTUNITY TO
THINK FORWARD, HOW DO WE BUILD
THE RESEARCH INFRASTRUCTURE, THE
DRATRAINING, THE IDENTIFICATIONF
PROGRAMS THAT WILL ALLOW US TO
ACCELERATE AND ADVANCE THESE
DISCOVERIES INTO INTERVENTIONS
THAT CAN PREVENT -- THAT MAY BE
VULNERABLE FOR SUBSTANCE USE OR
SUBSTANCE USE DISORDERS.
THERE ARE OTHER EVENTS THAT
WE'VE BEEN VERY, VERY PROACTIVE
ON PARTICIPATING.
THESE ARE SOME OF THEM.
THE JUST TI COMMUNITY OPIOID
INNOVATION NETWORK BRIEFING THAT
WAS DONE ON JUNE 13TH, 2 2024, D
THE MARIJUANA RESEARCH LUNCH AND
LEARN, AUGUST 16, 2024.
I ALSO -- THE VALUE OF DATA THAT
RELATES TO SUBSTANCE USE AND
SUBSTANCE USE DISORDERS.
SO I WANT TO END BY ADVERTISING
OUR FRONTIERS IN ADDICTION
RESEARCH SATELLITE MEETING WHICH
IS IN PARTNERSHIP WITH THE
ALCOHOL INSTITUTE, AND IT IS A
VERY IMPORTANT EVENT FOR US
BECAUSE IT ENABLES US TO HIGH
LEET SOME OF THE MOST EXCITING
ADVANCES ON NEUROSCIENCE OF
SUBSTANCE USE AND ONE OF THE TOP
INNINGS THIS YEAR IS GOING TO
BE -- RECEPTORS.
AND THE FINAL ADVERTISE M IS FOR
THE ABC, INSIGHTS AND INNOVATION
MEETINGS.
IT BEEN AN EXTRAORDINARY EVENT,
BUT ONE OF THE FACTORS THAT LED
TO BE SUCCESSFUL WAS THE OPEN
ACCESS.
THE OPEN ACCESS IS OPTIMIZED BY
FORMING NETWORK, BY
UNDERSTANDING WHAT THE RESEARCH
ARE, BY GETTING THE INPUT FROM
THE COMMUNITY ABOUT WHAT ARE THE
THINGS WE NEED TO BUILD UPON IT.
AS I WAS WONDERING JUST LAST
NIGHT AFTER I HAD BEEN A WHOLE
DAY LISTENING TO THESE
EXTRAORDINARY TALKS ON
OLIGOPEPTIDES AND SOMEONE ASKED
THE QUESTION, WE ARE SEEING NOW
THAT SOME OF THESE MEDICATIONS
ARE BEING GIVEN FOR THE TREAT M
OF DIABETES AND BEEDZ IN
CHILDREN.
WHAT ARE THE CONSEQUENCES TO THE
DEVELOPING BRAIN?
SO I GO BACK, I SHOOT AN EMAIL
AND I SAID ARE YOU SURE THAT WE
ARE SCREENING FOR THE
MEDICATIONS THAT -- AND
EFFECTIVELY WE ARE.
I THINK THIS IS AN EXAMPLE ABOUT
HOW A DATABASE LIKE THIS ONE CAN
INFORM UN, JUST LIKE -- IT WAS A
EXEE COMPONENT ON THE LONG-TERM
EFFECTS OF COVID IN ADOLESCENTS,
THAT WAS VERY MUCH POSSIBLE
BECAUSE OF THE INCLUSION OF THE
ABCD DATA.
AND AGAIN, JUST TO HIGHLIGHT
THAT THE ABILITY TO GENERATE
DATA THAT CAN BE UTILIZED AND
ACCESSIBLE BY RESEARCHERS IN
THAT COMMUNITY CAN HAVE AN
IMPACT BEYOND ONE THAT WE WOULD
HAVE INITIALLY THOUGHT IT WOULD
HAVE.
SO THANK YOU VERY MUCH FOR YOUR
ATTENTION.
>> WE HAVE TIME FOR QUESTIONS.
WE HAVE LOTS OF TIME.
MARK?
>> HI THERE.
GREAT TALK, NORA, AND I AGREE
THAT IT SUPER EXCITING TO SEE
THE NUMBERS COMING DOWN WITH
OPIOID OVERDOSE.
AND IT'S AMAZING TO SEE THE
IMPROVEMENT IN TERMS OF GETTING
MORE TREATMENT AVAILABLE IN THE
COMMUNITY.
SO THAT'S ALL FANTASTIC.
AND THANKS FOR THAT BEAUTIFUL
SUMMARY.
I WANTED TO JUST REALLY SHOUT
OUT TO DR. VALENTINO AND JUST
MENTION THAT I THINK SHE'S BEEN
AMAZING AND WILL REALLY -- I
THINK SHE'S MADE AN ENORMOUS
CONTRIBUTION AT NIDA, AND I'VE
ALWAYS BEEN AMAZED BY HOW SHE
KEEPS ON TOP OF ALL THESE
DIFFERENT RESEARCH PROGRAMS THAT
ARE SO DIFFERENT IN THEIR FOCUS
AND INVOLVES SO MUCH EXPERTISE
THAT SHE HAS ACCUMULATED OVER
THE YEARS.
SO ANYWAY, I WANT TO
CONGRATULATE HER AND THANK HER.
>> THANK YOU.
I WANTED TO JUST ECHO MARK'S
SENTIMENTS AND CONGRATULATE
DR. SAI AND VALENTINO ON THEIR
VERY LONG LEGACIES OF SERVICE
AND MAJOR CONTRIBUTIONS TO
SCIENCE LEADING TO BIG ADVANCES
IN HEALTHCARE.
CONGRATULATIONS, AND ENJOY YOUR
WELL-DESERVED RETIREMENTS.
WE'RE SORRY TO SEE YOU GO BUT
I'M SURE THAT SOME GREAT PEOPLE
WILL BE COMING IN.
AND THE SECOND IDEA THAT I
WANTED TO JUST BRING UP IS
THINKING ABOUT THE GLP-1 AGONIST
EXCITEMENT AND OPPORTUNITY.
IT SEEMS LIKE THERE MAY BE A LOT
OF DATA -- NAWD THAT YOU HAD --E
ACCESSED SOMEHOW TO DO SOME OF
THE -- THAT WOULD INFORMED
ONGOING -- I WONDER WHAT THE --
>> TOTALLY, AND AGAIN, THIS IS
AN OPPORTUNITY THAT THE EXTENT
TO WHICH THERE ARE OPPORTUNITIES
AND IT WILL DEPEND ON HOW
CONSISTENTLY SUBSTANCE USE
DISORDERS ARE BEING SCREENED.
AND OVERALL, IT IS NOT
NECESSARILY THAT MANY OF THESE
PROGRAMS DO.
SO WHAT THEY TEND TO ACTUALLY
SCREEN FOR IS TOBACCO AND
ALCOHOL.
BUT IN SOME INSTANCES THEY MAY
HAVE EXCLUDED PARTICIPANTS ON
THOSE MEASURES.
BUT WHAT WE NEED TO WORK AND
SORT OF ACTUALLY -- I DISCUSSED
THIS WITH LILI PHARMACEUTICAL
AND I BASICALLY WILL BRING IT UP
WITH NOVA NORDIC AND I'M GOING
TO BE IN A MEETING WITH THEM
SOMETIME IN SEPTEMBER, SO
GETTING A ACCEPTS ABOUT WHAT
DATA IS OUT THERE AND MEANWHILE
WE'RE BEING VERY PROACTIVE AT
LOOKING AT DATABASES THAT EXCEED
THEM, AND CERTAINLY THERE'S BEEN
SEVERAL PAPERS ON THE ELECTRONIC
HEALTH RECORDS AND DR. SU IS ONE
OF THEM, IT GOES BACK TO THE
CTN, HER GROUP ACTUALLY HAS BEEN
DOING A LOT OF STUDIES.
THE WORK FOR HOR ENZO ALSO HE
HAS BEEN WORKING WITH THE V.A.
TO INVESTIGATE AGAIN AND WE ARE
AIMING TO FIGURE OUT HOW WE CAN
IN SAFETY -- TO LOOK AT THE
ALL-OF-US DATA TO ACTUALLY --
BECAUSE THAT'S 800,000 PEOPLE,
AND THEY HAVE DETAIL, ELECTRONIC
HEALTHCARE RECORDS, SO SOME OF
THEM HAVE OTHER -- INCLUDING
GENETICS, MANY OF THEM, SO TO
SEE HOW WE CAN USE THAT AS AN
EXAMPLE FOR THEM TO TAKE
ADVANTAGE, THE ALL-OF-US, TO
UNDERSTAND INTERACTIONS THAT CAN
LEAD TO IDENTIFICATION OF
TREATMENT INTERVENTIONS THAT
COULD BE USEFUL.
SO YES, WE'RE BEING VERY
PROACTIVE TO TRY TO TAKE AS MUCH
INFORMATION AS POSSIBLE.
BUT I AGREE WITH LORENZO THAT AT
THE END OF THE DAY, WE DON'T
NEED TO DO THAT RANDOMIZED
CLINICAL TRIALS TO ACTUALLY
DOCUMENT WHAT THE EFFECTS ARE IN
THIS, BECAUSE YOU KNOW HOW IT
GOES, THERE'S A LOT OF HYPE, AND
I'M VERY EXCITED, MY ACCUMBENS
IS ALL ACTIVATED WITH THESE, BUT
ACTUALLY I DO THINK THAT WE NEED
TO UNDERSTAND THAT MANY OF THE
DATA THAT WE HAVE FROM REAL
WORLD DATA HAS CONFOUNDS THAT
COULD BE DRIVING THIS, AND THE
PRE-CLINICAL DATA AS YOU KNOW
DOES NOT NECESSARILY TRANSLATING
TO HUMANS.
THE USE OF SUBSTANCES IS SO
EXTRAORDINARY COMPLEX, THIS IS
WHY WE ARE ENCOURAGING
RESEARCHERS TO GO AFTER THE
TRIALS THAT ARE NECESSARY TO
MOVE THE FIELD FORWARD.
>> AND THE COMPOUNDING
PHARMACIES AS WELL, YOU COULD DO
A SIMPLE GOOGLE SEARCH AND 100
OF THEM WILL SHOW UP.
THOSE PROBABLY REPRESENT
THOUSANDS AND THOUSANDS OF
PEOPLE THAT ARE GETTING THESE
DRUGS FROM COMPOUNDING
PHARMACIES AS WELL.
>> THE ISSUE WITH COMPOUNDING
PHARMACIES IS WHAT IS THE
QUALITY OF THE PRODUCT.
AND THAT IS MUCH HARRER TO
EVALUATE.
AND SO -- AND AGAIN, IT IS THE
ISSUE, TOO, THEY HAVE BEEN USED
FOR MANY YEARS NOW FOR DIABETES,
IT'S STILL -- THE TSH LOWER
DOSES, SO WE DON'T REALLY
UNDERSTAND WHAT MAY BE, IF ANY,
POTENTIAL LONG-TERM EFFECTS.
THEY APPEAR TO BE QUITE SAFE.
ONE OF THE THINGS THAT WAS
COMMENTED YESTERDAY AT THE
NATIONAL ACADEMY THAT MAY IMPACT
IS THERE MAY BE OTHER TARGETS
APART FROM THAT -- THE HIGHEST
CONCENTRATION OF THE RECEPTOR IS
IN THE CHOROID PLEXUS, SO IT
REGULATES CEREBROSPINAL FLUID.
THEY'VE BEEN RECOGNIZED FOR
THEIR ANTI-INFLAMMATORY
RESPECTS.
EFFECTS.
SO THERE IS A LOT OF BASIC
FUNDAMENTAL RESEARCH ALSO TO
MAXIMIZE POTENTIAL APPLICATIONS.
I SEE QUESTIONS.
HELENA.
>> OKAY.
THANK YOU.
I WANT TO SAY I REALLY
APPRECIATED YOUR ATTENTION TO
SOCIAL DETERMINANTS OF HEALTH.
ALSO SOCIOECONOMIC RACIAL/ETHNIC
DIFFERENCES IN THE PATTERNS
WE'RE SEEING, PARTICULARLY WITH
REGARD TO OVERDOSE AND SUBSTANCE
USE PATTERNS.
AND I WAS STRUCK BY N CREW, THE
NATIVE AMERICAN INITIATIVE.
YOU SPENT SIGNIFICANT TIME
HIGHLIGHTING HOW YOU'VE HAD TO
DO VERY SPECIFIC OUTREACH TO
TRIBAL AND COMMUNITY
ORGANIZATIONS, AND REALLY SHIFT
THE WAY THAT YOU'RE SPONSORING
AND DOING SCIENCE IN ORDER TO
REALLY FOREGROUND THEIR ROLE AND
THEIR GUIDANCE.
AND WHAT I WANTED TO ASK ABOUT
WAS LESSONS LEARNED AND
PRINCIPLES AND BEST PRACTICES
FROM THAT EXPERIENCE, BECAUSE IT
STRIKES ME THAT TO REALLY DO A
RIGOROUS JOB OF SOCIAL
DETERMINANTS AND ALSO ATTENDING
TO THE PARALLEL BUT OFTEN
CONTEXTUALLY DISTINCTIVE
CONDITIONS OF MARGINALIZED
GROUPS THAT ARE
DISPROPORTIONATELY AFFECTED,
IT'S GOING TO REQUIRE A
DIFFERENT APPROACH TO KNOWLEDGE
CREATION, AND THERE'S A LOT TO
BE LEARNED.
MUCH OF IT IS CONTEXT-SPECIFIC,
BUT THERE'S THOUGHT TO BE ALSO
PRACTICES AND ADOPTED ACROSS
CONTEXTS.
SO I WOU WONDERED IF YOU COULD A
LITTLE BIT MORE ABOUT WHAT
YOU'RE LEARNING FROM NCREW AND
SIMILAR ATTEMPTS TO REALLY
RE-THINK THE ROLE OF COMMUNITY
MEMBERS, LEADERS, ORGANIZATIONS
IN CREATING KNOWLEDGE FROM THE
GROUND UP.
>> NO, FIRST THE REASON FOR
SUCCESS, DR. KATHY ETZ, SO I'M
GOING TO BRING HER AND PUT HER
IN THE SPOT BECAUSE SHE HAS BEEN
MY TEACHER, SHE HAS BEEN
EDUCATING ME.
SO WHEN I'VE GONE THROUGH ALL OF
THESE MEETINGS, I GET ALL OF
THIS MATERIAL AND TRAINING
BEFOREHAND, AND SHE HAS BEEN
ABLE FOR ME TO BE ABLE TO GO
INTO THESE TRIBAL COMMUNITIES
AND TO BE EMBRACED BECAUSE SHE'S
EMBRACED.
THEY TRUST HER.
SO BY HER BABYSITTING ME LIKE
THAT, THEY ACTUALLY GET
AUTOMATIC -- AUTOMATICALLY THAT
TRUST.
BUT IT IS KATHY WHO HAS MADE IT
POSSIBLE.
>> CAN I JUST ADD ONE LITTLE PIN
ON TO THAT COMMENT AND QUESTION,
WHICH IS ABOUT THE NATURE OF THE
SOCIAL ENVIRONMENT AND ITS
INTERFACE WITH HUMAN BIOLOGY.
I THINK THAT'S SOMETHING THAT
THE ABCD IS REALLY DRAWING OUT
AND KIND OF BIOSOCIAL NATURE OF
A PHENOMENON LIKE SUBSTANCE USE
DISORDER.
VERY SPECIFIC ENGAGEMENT WITH
NATIVE AMERICAN COMMUNITIES WHAT
THEY TAUGHT YOU ABOUT CREATING
BIOSOCIAL KNOWLEDGE.
>> THAT'S A GOOD QUESTION.
THANK YOU SO MUCH FOR THE
QUESTION.
I THINK THERE ARE SEVERAL
ANSWERS TO IT BECAUSE IT'S A
FAIRLY COMPLEX QUESTION.
SO THE FIRST THING IN TERMS OF
HOW DO WE WORK IN THESE SPACES,
WE ACTUALLY BUILT OUT A VALUE
PRODUCT FOR THE PROGRAM VERY
EARLY ON AND WE'VE WORKED WITH
MULTIPLE STAFF ACROSS THE NIH ON
THAT.
TO SORT OF UNDERSTAND HOW WILL
WE ENGAGE DIFFERENTLY AND ENTER
THE SPACE DIFFERENTLY AND WHAT
DOES IT MEAN TO LOOK LIKE THIS.
THE LANGUAGE WE USE IN THIS
PROGRAM IS AROUND
CO-CONSTRUCTION.
AND THAT OUR VERY FIRST
PRINCIPLE IS TO BUILD
RELATIONSHIP, TO EARN TRUST, TO
NOT TAKE IT FOR GRANTED IN ANY
WAY WHATSOEVER.
AND THAT WE RECOGNIZE THAT'S
GOING TO BE A LONG PROCESS AND
WE'RE HERE FOR THE LONG HAUL AND
INVESTING IN THAT.
I THINK THAT VALUES DOCUMENT HAS
HELPED US TO EDUCATE OUR ENTIRE
TEAM, INCLUDING PEOPLE WHO ARE
NOT FAMILIAR WITH WORKING WITH
TRIBAL COMMUNITIES, TO JUST
THINK DIFFERENTLY ABOUT HOW TO
DO THIS.
AGAIN, WE REALLY PUT THE
PRIORITY ON THE TROIBS AND
NATIVE AMERICAN SERVING
ORGANIZATIONS LEADING.
AT FIRST WE WERE SAYING WE WERE
BUILDING AN AIRPLANE AS WE FLEW
IT.
WE CHANGED THAT TO WE WERE
BUILDING AN AIRCRAFT CARRIER,
REALLY RECOGNIZING THAT WE ARE
NOT THE PLANE, THEY ARE THE
PLANE, AND WE ARE A SUPPORT FOR
THE WORK THAT THEY ARE DOING.
SO LOTS OF DIFFERENT WAYS THAT
WE'RE ENTERING THE SPACE.
I DO WANT TO MENTION THAT THERE
ARE A FEW INITIATIVES AT THE NIH
THAT ARE SEEKING TO SUPPORT
COMMUNITY ENGAGED WORK AND
THAT'S SOMETHING THAT
DR. BERTAGNOLLI AND NORA,
DR. VOLKOW, ARE BOTH VERY
COMMITTED TO, SO WE'RE ALSO
REACHING OUT TO THE OTHER
PROGRAMS AT THE NIH TO LEARN HOW
TO DO THIS.
SOMETHING VERY DIFFERENT ABOUT
THIS PROGRAM IS THAT WE'RE USING
OTHER TRANSACTION AUTHORITY,
WHICH IS NOT A GRANT, NOT A
COOPERATIVE AGREEMENT, AND NOT A
CONTRACT.
AND ALLOWS FOR VERY AGILE AND
FLEXIBLE PROCESSES SO THAT WE
CAN ADAPT AS WE'RE LEARNING FROM
THE COMMUNITIES AND SHIFT AS WE
GO.
SO I COULD GIVE YOU A VERY LONG
ANSWER TO THIS.
IN TERMS OF YOUR OTHER QUESTION
ABOUT SOCIAL MECHANISMS, I THINK
THAT INDIGENOUS COMMUNITIES HAVE
INDIGENOUS KNOWLEDGE, INDIGENOUS
METHODOLOGIES, A VERY DIFFERENT
WAY OF DOING BUSINESS, VERY DILL
VALUE SYSTEMS IN TERMS OF BEING
RELATIONAL WITH EACH OTHER, AND
THAT MAKES ALL THE DIFFERENCE
FOR HOW WE TREAT ADDICTION AND
HOW WE PREVENT ADDICTION.
SO I GUESS I WOULD SAY IT BAKED
IN, BUT I WOULD ALSO SAY STAY
TUNED BECAUSE WE HAVE JUST MADE
THE AWARD THIS MONTH AND WE ARE
WORKING HARD TO COLLECT OUR
LESSONS AS WE GO AND WE LOOK
FORWARD TO SHARING THOSE WITH
ALL OF YOU AND I JUST REALLY
WANT TO AMEND THANKS SO MUCH TO
NORA AND SO MANY COLLEAGUES FOR
SUPPORT FOR THIS.
>> ARPANA.
>> THANK YOU.
THANK YOU, NORA, FOR THAT LOVELY
PRESENTATION.
JUST TO FOLLOW UP ON WHAT WAS
ASKED, I THINK THIS KNOWLEDGE
CAN BE QUITE VALUABLE, SO I
NOTICED IN YOUR SLIDE AT THE
BLUE BAR, PACIFIC ISLANDERS ARE
BEGINNING TO PICK UP, ENGAGING
COMMUNITIES THERE, PERHAPS SOME
OF THESE LESSONS WE'RE GETTING
FROM WORKING IN NCREW MIGHT BE
HELPFUL IN SETTING THOSE
POPULATIONS -- THAT AGAIN,
ISLAND COMMUNITIES WHERE ACCESS
TO TREAT PMENTS MAY BE MORE
DIFFICULT.
>> THEY WERE ALLOWED TO COMPETE
AND I DO NOT KNOW, DID WE HAVE
SOMEONE FROM HAWAII?
>> WE DON'T HAVE ANYTHING WE CAN
PUBLICLY SHARE RIGHT NOW BUT WE
ARE STILL WORKING ACTIVELY TO
MAKE SURE THAT WE HAVE WORK
GOING ON IN HAWAII AS WELL.
>> AND THEN I DO WANT TO
CONTINUE THE RITA IF I COULD AND
CONGRATULATE YOU ON JUST THE
EXTRAORDINARY PORTFOLIO YOU HAVE
BUILT.
THE TWO STUDIES THAT -- YOU
MENTIONED THAT HAVE HAD
TREMENDOUS IMPACT, PARTICULARLY
ON EARLY CAREER INVESTIG INVEST,
ABCD CA KID OWES S ARE NOT KIDS.
WE'LL HAVE THIS UNIQUE
OPPORTUNITY TO STUDY LARGE --
ONE OF THE THINGS I'M CURIOUS
ABOUT A ABC CONTINUES AND KINE
OF MERGES PERHAPS INTO -- IS THE
EFFECT OF STUDY PARTICIPATION.
I THINK ONE OF THE THINGS THAT
MIGHT BE VERY ENCOURAGING FOR
COMMUNITIES WHERE THERE IS
DISTRUST TOWARDS RESEARCH AND
CONCERNS ABOUT THE -- IS TO SHOW
THE POSITIVE IMPACT OF
PARTICIPATING IN THE LONGITUDAL
STUDY.
I THINK ABCD MIGHT BE ONE OF
THOSE EXAMPLES WHERE WE COULD
REALLY DOCUMENT WHAT HAPPENS TO
YOUNG PEOPLE WHEN THEY JOIN A
STUDY AND LEARN MORE ABOUT
THEMSELVES, AND THE OUTCOME THAT
HAS ON THEM POTENTIALLY AS
PARENTS, CAREGIVERS AND AS CON
DULTS IN THE COMMUNITY.
>> ALL M I CAN SAY IS WE'RE
BASICALLY PLANNING ON ABCD TO
.0.
-- STARTING TO CREATE VIDEOS TO
RECRUIT THE TEENAGERS
THEMSELVES.
BECAUSE IT GENERATES A SENSE OF
BELONGING THAT ACTUALLY -- BUT
AS A TRANSITION INTO ADULTHOOD,
THAT ROLE IS GOING TO MANIFEST
IN DIFFERENT WAYS.
BUT WE REALIZE ENORMOUS VALUE OF
TRYING TO KEEP THE ABCD ALIVE
LONGITUDINALLY, BUT IT -- YOU
DON'T HAVE THE FAMILY STRUCTURE,
YOU HAVE EVERYONE GOING
DIFFERENT WAYS.
BUT THAT'S -- WE HAVE TO FIGURE
OUT IN ORDER TO MAKE IT
POSSIBLE.
WE'RE VERY COMMITTED TO IT.
>> I SEE CHARLES.
>> HI, NORA.
I WANT TO COME BACK TO THE
BUDGET SLIDE THAT YOU SHOWED,
AND THE IMPACT OF THE FLAT
BUDGETS THAT WE'VE EXPERIENCED
FOR THE LAST COUPLE OF YEARS.
THIS REALLY HAS A STRIKING
IMPACT ON THE WAY IN WHICH
SCIENCE IS CARRIED FORWARD
BECAUSE CLEARLY AS COSTS,
SALARIES GO UP, AS THINGS BECOME
MORE EXPENSIVE, THAT FLAT BUDGET
IS REALLY GOING TO BE NEGATIVELY
IMPACTED.
YOU COMMENTED ABOUT THAT AND YOU
BROUGHT IT UP, THAT THE ISSUE OF
BEING STRATEGIC, I THINK IS
REALLY IMPORTANT, AND I'M HOPING
THAT YOU COULD EXPAND A LITTLE
BIT ABOUT WHAT THAT ACTUALLY
MEANS.
SPECIFICALLY, WHAT I'M CONCERNED
ABOUT IS THAT NIDA AND OTHER NIH
INSTITUTES RELY VERY HEAVILY ON
THE QUALITY OF THE PEER REVIEW.
PEER REVIEW IS WONDERFUL.
RILEY CAN'T MA IMAGINE ANOTHER
SYSTEM OTHER THAN PEER REVIEW
THAT CAN GIVE US THE KIND OF
QUALITY SCIENCE WE'VE BEEN ABLE
TO ACHIEVE, BUT ON THE OTHER
HAND, IT'S WELL DOCUMENTED THAT
PEER REVIEWERS TEND TO BE VERY
CONSERVATIVE, AND SO WE MISS THE
OPPORTUNITY BY RELYING SOLELY ON
PEER REVIEW TO REALLY GET AHOLD
OF EARLY IDEAS THAT ARE VERY
HIGH IMPACT, AND THAT AS DOLLARS
BECOME EVEN MORE CONSTRAINED,
THE WHOLE PROCESS BECOMES EVEN
MORE CO CONSERVATIVE.
AND THAT'S FINE, WE'LL SURVIVE,
WE'VE BEEN THROUGH BUDGET
DOWNTURNS BEFORE, WE ALWAYS COME
OUT AT THE END BETTER THAN
BEFORE.
BUT ON THE OTHER HAND, I WONDER
IF THERE'S A WAY TO ACTUALLY BE
STRATEGIC IN A FORMALIZED WAY.
MOST OF THE ACTIVITY GETS DONE
BY OUR PROGRAM OFFICERS, WHEN
THEY LOOK AT THE RANKINGS OF THE
PROGRAM, OF THE CSR REVIEWED,
AND THEN RELY ON FUNDING IN
ORDER, BUT MY SENSE WAS THAT WE
MISS THE OPPORTUNITY TO IDENTIFY
HIGH IMPACT STUDIES THAT THE
CONSERVATIVE REVIEWERS JUST
DON'T FEEL LIKE THEY WANT TO
SUPPORT.
SO I WONDER IF THERE'S A WAY TO
BE ABLE TO KIND OF CUT ASIDE A
SMALL AMOUNT OF MONEY FOR REALLY
HIGH IMPACT STUDIES THAT REALLY
COULD BE IDENTIFIED BY SOME
SECONDARY REVIEW PROCESS,
PERHAPS BY THE PROGRAM OFFICERS,
PERHAPS BY COUNCIL, TO REALLY
IDENTIFY EARLY STAGE HIGH IMPACT
STUDIES AND MAKE SURE THAT THEY
GED FUNDED.
YOU KNOW, IT'S REALLY A SERIOUS
CHALLENGE.
I DON'T KNOW HOW TO ACTUALLY DO
THAT, BUT I WAS HOPING YOU COULD
EXPAND ON WHAT YOU MEAN BY
STRATEGIC, AND HOPE THAT WE CAN
COME UP WITH A WAY TO NOT LOSE
THEIR HIGH-RISK PROJECTS.
COMING BACK TO HIGH RISK
PROJECTS, THE R21 MECHANISM IS
DESIGNED TO TRY TO IDENTIFY
THOSE PROPOSALS BASED ON THE
APPLICANT'S PERSPECTIVE OF WHAT
A HIGH IMPACT R21 PROJECT IS.
MY EXPERIENCE WITH THAT, AND
YOU'VE GOT A BROADER VIEW OF
THIS, IS THAT THESE REALLY
AREN'T VERY SUCCESSFUL IN
IDENTIFYING HIGH IMPACT HIGH
RISK PROJECTS.
AGAIN, THE SAME REVIEWERS APPLY
THE SAME LENS AND ARE SUPER
CONSERVATIVE, AND I BELIEVE THAT
R21 GRANTS MAY HAVE A LOWER
FUNDING RATE THAN R01s, BUT I
DON'T KNOW THAT IN HAND.
I'M JUST CURIOUS, WITH THAT IDEA
OF A HIGH RISK R2 # PROGRAM THAT
ISN'T REALLY WORKING IN THE WAY
THAT R21s WERE ORIGINALLY
INTENDED, IS THERE A WAY TO COME
BACK AND PICK A FEW HIGH-IMPACT
STUDIES IN A SYSTEMATIC WAY AND
TAKE A GAMBLE.
MAYBE A TWO-YEAR LIKE THE R21s
DO, WHERE THERE'S A MECHANISM TO
IDENTIFY REALLY CREATIVE
PROJECTS THAT ARE WORTH A SHOT,
THEY COULD FAIL BUT THEY COULD
BE REALLY AMAZING.
WHEREAS WHAT WE HAVE RIGHT NOW
IS A VERY CONSERVATIVE APPROACH
THAT HAS BEEN GREAT, NOT
CRITICIZING IT, BUT IT JUST
MISSES, AND AS WE INTENSIFY OUR
BUDGET CONSTRAINTS, IT JUST
EXACERBATES THAT PROBLEM.
>> AND CERTAINLY I RESONATE WITH
THIS CONCERN AND WE ALL RESONATE
WITH THAT.
WE'RE VERY, VERY AWARE.
SO SOME OF THE THINGS WE'VE
DONE, THAT'S WHY WE ACTUALLY
INITIATED THE AVANT-GARDE
PROGRAM, WHICH IS A HIGH RISK
AREA -- ALSO NIDA IS ONE OF THE
INSTITUTES THAT DOES NOT
AUTOMATICALLY FUND APPLICATIONS
JUST BASED ON THE SCORES AND THE
PERCENTILES.
THE SCIENTIFIC PROGRAM OFFICERS
CAN BRING UP APPLICATIONS THAT
THEY THINK ARE WORTHWHILE AND
MERITORIOUS, AND WE GIVE THE
INVESTIGATOR A CHANCE -- IF THEY
DO, THEN WE FUND THEM.
WHERE WE DON'T HAVE FLEXIBILITY
COMES WHEN THEY DON'T GET A
SCORE, WHEN AN APPLICATION IS
NOT SCORED, THEN THAT TIES OUR
HANDS.
BUT SAID SOMETHING INTRIGUING
AND THAT I LIKE, WE NEVER
DISCUSSED THE ISSUE, NOR HAVE WE
DISCUSSED WAYS IN WHICH WE CAN
ENGAGE COUNCIL TO HELP US
IDENTIFY R21s THAT YOU ALL
THINK COULD BE -- THEY ARE RISKY
BUT THEY ARE WORTHWHILE
INVESTMENTS.
SO WE WILL LOOK INTO THIS,
BECAUSE NA IS A MECH THAT IS A M
ITSELF THAT WE HAVE NOT
EXPLORED.
ANGIE?
>> I HAVE TWO QUESTIONS ABOUT
HPC DSM.
PCD.
YOU'RE AT 2,000 NOW, YOU'RE
GOING TO GET THE FULL SAMPLE BY
'27, 7,000 PARTICIPANTS, SO
THAT'S GOING TO BE A FOUR-YEAR
ENROLLMENT PERIOD SO THAT'S
TWICE THE TIMELINE FOR ADCD.
I WAS WONDERING WHAT THE
IMPLICATIONS WERE FOR THE TOTAL
PROJECT IN TERMS OF NUMBER OF
YEARS BUT ALSO AGES COVERED.
ARE WE STILL AIMING FOR THOSE 10
YEARS, SO WILL IT BE LONGER
BUDGET?
MY SECOND QUESTION, I ALSO
NOTICED YOU ARE LOOKING AT AN
UNDERREPRESENTATION OF THE
OPIOID EXPOSURE, SO I WAS
CURIOUS TO KNOW THE STRATEGIES
TO TRY TO MAKE UP FOR THAT AND
HIT THOSE TARGETS.
>> AND YOU'RE ABSOLUTELY RIGHT,
I WANTED TO BE AS AMBITION WE
WERE TO THE ABCD BUT IN TERMS OF
THE LOGISTICS AND PRACTICALITY
IT WAS CLEAR THAT WAS GOING TO
BE IMPOSSIBLE.
FOYOU ARE GOING AFTER PREGNANT
WOMEN OR INFANTS, AND YOU'RE
ALSO OVERSAMPLING ON PEOPLE
EXPOSED TO SUBSTANCE USE
DISORDER SO THEY ARE COMING FROM
MUCH MORE ADVERSE BACKGROUNDS.
SO WE WERE TRYING TO FIT IT ON
THREE YEARS AND IT BECAME CLEAR
THAT THAT WAS NOT GOING TO BE
LOGICALLY FEASIBLE.
REALISTICALLY FEASIBLE, AND
THAT'S WHY WE WENT FOR FOUR
YEARS.
IT WILL MEAN YES THAT ULTIMATELY
WE WILL HAVE TO FUND FOR 14
YEARS BECAUSE YOU WANT TO GET
THE COMPLETE DATASET.
AND SO THAT IS AN ASPECT -- AS
IT RELAYS TO THE
UNDERRECRUITMENT OF PEOPLE
TAKING OPIOIDS, THE WAY WE GO
ABOUT IT IS WE BASICALLY -- ALL
THE SITES THAT HAVE BEEN
SELECTED, WHAT ARE THE RESOURCES
THAT THEY NEED IN ORDER TO GO
OUT INTO THE COMMUNITY AND BRING
MORE PARTICIPANTS.
THAT MAY REQUIRE THAT WE
SUPPLEMENT CERTAIN GROUPS SO
THAT WE CAN BRING TOGETHER
INVESTIGATORS THAT WERE NOT
INVOLVED IN THE PAST THAT CAN
SHOW THAT THEY CAN PROVIDE IT.
I WAS SOMEWHAT DISAPPOINTED
BECAUSE THEY ARE DOING VERY,
VERY WELL IN THE REST OF THE
DEMOGRAPHICS.
BUT NOT ON EXPOSURES WITH OPIOID
USE DISORDER.
I KNEW IT WAS GOING TO BE
CHALLENGING BECAUSE -- ILLICIT
SUBSTANCES.
GOOD LUCK.
AND SO I DO UNDERSTAND, BUT
THERE ARE INVESTIGATORS THAT
HAVE BEEN SUCCESSFUL, SO MY VIEW
IS, LET'S LEARN FROM THEM, LET'S
TRY TO FIGURE OUT, WHICH IS ONE
OF THE COMPLEXITIES AND
CHALLENGES.
I THINK THOSE ARE ALL OF THE
QUESTIONS?
MELANIE?
>> THANK YOU, NORA.
AND CONGRATS TO YOU AND THE
PROGRAM FOR GREAT PROGRESS.
I HAVE TWO QUESTIONS.
ONE IS RELATED TO THE NCRU
PROGRAM INITIATIVE, WHICH I
THINK IS A WONDERFUL INITIATIVE.
WANTED TO SEE WHETHER IT IS
CURRENTLY OR WILL IN THE FUTURE
CONTAIN A SPECIFIC HIV
COMPONENT, GIVEN THE INCREASE IN
NEW INFECTIONS IN THE TRIBAL
COMMUNITIES.
AND MY SECOND QUESTION IS
REGARDED TO THE EZ MERIT AWARD
WHICH I THINK YOU HAVE VERY
EXCITING APPLICATIONS FOR.
WANTED TO SEE WHEN AND HOW WE'RE
GOING TO EVALUATE THAT IS A
SUCCESSFUL STRATEGY.
>> IN THE SORT OF -- HOW ARE WE
GOING TO EVALUATE THE MERIT OF
ESI AWARDS.
I GUESS WE WANT TO HAVE AT LEAST
FIVE YEARS IDEALLY, BUT WE WILL
EVALUATE THE THREE YEARS.
WE NEED TO EVALUATE THE THREE
YEARS TO GET A SENSE OF WHERE
THIS INVESTIGATES ARE, WHAT ARE
THE CHARACTERISTICS.
BECAUSE WE DON'T WANT TO END UP
WHAT HAPPENED LAST -- I THINK IT
WAS LIKE 35% ARE MALES, I DON'T
WANT TO DO THAT AFTER THE
EVALUATION.
WE KEEP OUR EYES ON A YEARLY
TIME PERIOD BUT THEN THREE YEARS
AND FIVE YEARS AND SEE ARE WE
WHERE WE WANTED, WHERE WE WERE
AIMING TO BE, YES.
WITH RESPECT TO THE -- YOU THINK
I WOULD BE SURPRISED IF WE
DON'T -- WE'VE ALREADY STARTED
TO REDUCE THE UNIT TO HELP
RESEARCH ON HIV BUT ALSO
HEPATITIS C SO YES INDEED.
>> THANK YOU.
>> WELL, NOW WE GO INTO THE NEXT
TOPIC OF THE PRESENTATION AND
IT'S A PLEASURE FOR ME TO
INTRODUCE DR. JOHN NGAI,
DIRECTOR OF THE NIH BRAIN
INITIATIVE.
AND SO HE'S OUT THERE IN THE
CLOUD.
HE IS THE DIRECTOR OF THE NIH
BRAIN RESEARCH THROUGH ADVANCING
INNOVATION NEUROTECHNOLOGIES.
AND HE HAS BASICALLY DIRECTED
THIS BRAIN VERY, VERY ABLY.
HE OVERSEES THE LONG-TERM
STRATEGY AND -- AS HE STRIVES TO
REVOLUTIONIZE AND HAS SUCCEEDED
IN REVOLUTIONIZING ALREADY OUR
UNDERSTANDING OF THE BRAIN IN
BOTH HEALTH AND DISEASE.
SO JOHN, THANKS SO VERY MUCH FOR
AGREEING TO COME AND SPEAK WITH
US.
WELCOME.
>> THANKS, NORA.
THANKS SO MUCH FOR HAVING ME.
SORE ESORRY I CAN'T BE THERE WIU
IN PERSON BUT THE TRIBAL
SCHEDULE HAS BEEN NUTS THESE
DAYS.
I WANT TO GIVE YOU A BRIEF
INTERVIEW OF WHAT WE'VE BEEN
DOING AT BRAIN, GIVE YOU AN IDEA
OF WHAT WE'RE DOING RIGHT NOW
THAT'S HELPING PEOPLE BUT ALSO
HOW WE'RE LAYING DOWN THE
FOUNDATION FOR THE FUTURE.
SO 1 IN 3 AMERICANS SH 1 IN
3 PEOPLE IN THE WORLD ARE LIVING
WITH SOME DISORDER OF THEIR
CENTRAL NERVOUS SYSTEM.
THIS GROUP AMONG ALL, I DON'T
HAVE TO EMPHASIZE THE TOLL THAT
SUBSTANCE USE DISORDER IS TAKING
ON OUR SOCIETY, ON INDIVIDUALS,
AND THEIR FAMILIES.
TOGETHER, MANY OF THESE
DISORDERS OF THE BRAIN ARE
CIRCUIT DISORDERS.
HOW THE CELLS AND CIRCUITS ARE
FUNCTIONING NORMALLY AND HOW
THINGS GO AWRY IN DISEASE.
AND THEY'RE QUITE COMPLEX.
THERE'S ABOUT 100 BILLION
NEURONS IN THE BRAIN, MAYBE
DOUBLE THAT NUMBER OF NEURONAL
CELLS AND THEY FUNCTION BECAUSE
OF THE CONNECTIONS THEY MAKE IN
A VERY ORCHESTRATED WAY, AND WE
SIMPLY DON'T REALLY HAVE THE
TOOLS TO UNDERSTAND HOW THIS
MARVELOUS COMPUTATIONAL MACHINE
WORKS AND UNTIL WE DO UNDERSTAND
HOW IT WORKS AND HAVE THE TOOLS
FOR THAT, THE INTERVENTIONS FOR
THESE DEVASTATING HUMAN BRAIN
DISORDERS WON'T BE FAR AWAY.
SO TO UNDERSTAND HOW THIS WORKS
AT THE CIRCUIT LEVEL AND TO
APPLY THIS KNOWLEDGE TO BEING A
SELL RATE THESE NEW DISCOVERIES
TOWARD DESPERATELY NEEDED CURES.
I OVERSEE THE BRAIN INITIATIVE
AT THE NIH.
WE SPAN 10 OF THE 27 NIH ICs,
SO WE'RE A TRANS-NIH INITIATIVE.
WE'RE UNIQUELY SITUATED FOR
CROSS-CUTTING AND ACCELERATED
DISCOVERY IN NEUROSCIENCE THAT
GOES BEYOND THE CAPABILITY BY
TAPPING SYNERGIES ACROSS
MULTIPLE ICs, DEVELOPING ON
TOOLS -- THAT CAN BE APPLIED WE
HOPE VERY RAPIDLY TO SOLVING
MISSION-SPECIFIC GOALS.
SO OUR GOAL HERE IS TO DEVELOP
AND APPLY NEW TOOLS FOR
UNDERSTANDING HOW NEUROCIRCUITS
UNDERLIE THESE COMPLEX BEHAVIORS
IN HEALTH AND DISEASE AS I
MENTIONED.
TO ACHIEVE THIS GOAL WE ARE
LEMPLING EMERGING TECHNOLOGIES
TO DISCOVER NEW DISCOVERIES
ABOUT NEURAL FUNCTION.
WE'RE USING THESE DISCOVERIES AS
A FOUNDATION FOR DEVELOPING
THESE NEW THERAPIES AND I'LL
TOUCH ON THAT IN A MOMENTMENT
AND VERY IMPORTANTLY, I THINK
THIS RESONATES WITH THE
DISCUSSION WE JUST HEARD IT'S
VERY IMPORTANT TO DISSEMINATE
AND DEMOCRATIZE THESE
TECHNOLOGIES, THESE RICHES FOR
THE BENEFIT OF ALL.
THE INITIATIVE WAS LAUNCHED IN
2014.
IT'S BEEN REMARKABLY PRODUCTIVE.
WE'VE NOW FUNDED OVER 1500
AWARDS SUPPORTING 1700PIs
ACROSS THE NATION.
THE DIVERSITY OF EXPERTISE THAT
WE'VE BROUGHT IN.
WE HAVE ACTUALLY MANAGED TO
BRING IN EXPERTISE OUTSIDE THE
BIOLOGICAL SCIENCES, FOR
EXAMPLE, THE PHYSICAL,
ENGINEERING, SOCIAL SCIENCES,
DATA SCIENCE AND COMPUTER
SCIENCES, TO REALLY COME TO BEAR
ON THESE VERY COMPLEX PROBLEMS.
WE CAN SEE REMARKABLE INCREASE
IN PRODUCTIVITY ACROSS THE BOARD
OVER THE LAST 10 YEARS AND ALSO
REFLECTING IN THE TOP UPPER
RIGHT GRAPH THE DIVERSITY OF
KINDS OF TOPICS THAT WE ARE
COVERING.
NOW THE RESEARCH PORTFOLIO IS --
WE CAN KIND OF LAY IT OUT ACROSS
THESE NINE AREAS.
ON THE LEFT ARE THE SCIENTIFIC
AREAS, FIRST WOULD BE THE BRAIN
CELL AND CIRCUITS TECHNOLOGIES,
WHERE WE'RE SUPPORTING EFFORTS
TO DEFINE AND CATAL CATALOG, MAD
ACCESS THE VARIOUS CELL TYPES
AND CIRCUITS IN THE BRAIN.
SORRY, I JUST THOUGHT MY -- THE
SECOND WOULD BE NEURO --
OPTIMIZATION OF NEW TOOLS FOR
RECORDING AND MODULATING NEURAL
ACTIVITY AT THE CELLULAR LEVEL,
BOTH IN ANIMAL MODELS AS WELL AS
IN HUMAN.
SO THIS ALL SPANS FROM BASIC
RESEARCH ALL THE WAY THROUGH
ACTUAL CLINICAL APPLICATIONS.
NEUROIMAGING TECHNOLOGIES' CROSS
SALES.
AGAIN IN MANY, MANY DIFFERENT
MODEL SYSTEMS AS WELL AS IN
HUMANS, AND ALSO MOVING TO HUMAN
NEUROSCIENCE.
WE HAVE A VERY ROBUST PROGRAM
THAT WE REFER TO AS RESEARCH
OPPORTUNITIES IN HUMANS THAT IS
I THINK UNIQUE IN ITS BREADTH
AND SCOPE THAT ACTUALLY ALLOWS
US TO BRING THE STUDY OF NEURAL
CIRCUITS INTO THE HUMAN DOMAIN,
AND ACTUALLY GETS US SOME SMALL
SUCH CLOSER TO WHAT MAKES US
UNIQUELY HUMAN.
WE HAVE FOUR CROSS-CUTTING
THEMES.
YOU CAN IMAGINE NOT JUST IN
BRAIN BUT ACROSS THE
NEUROSCIENCE AS WELL AS THE
ENTIRE BIOMEDICAL SPECTRUM THAT
WOULD GENERATE DATA AT AN
AMAZING CLIP.
HERE'S A GREAT OPPORTUNITY FOR
THESE DATA TREASURE CONTROVERSY
AND TO FIND NEW WAYS OF
ORGANIZING AND INTERPRETING AND
MAKING IT ACCESSIBLE, AND OF
COURSE UTING AS WE'RE NOW
SEEING, BIG FOCUS ON TRAINING,
INCLUSION AND EQUITY TO MAKE
SURE THAT WE ARE MINDFUL ABOUT
MAINTAINING A GREAT COHORT OR
ACTUALLY PROMOTING THE NEXT
COHORT OF LEADERS IN OUR FIELD.
NORA THINKS THIS IS VERY
IMPORTANT, AS BRAIN STARTS
TOUCHING MORE CLOSELY THE SEAT
OF THE HUMAN BEINGS IN THE
BRAIN, WE REALLY NEED TO BE
MINDFUL OF WHAT WE'RE D DOING TO
MAKE SURE WE'RE FULLY COGNIZANT
OF THE ETHICAL, LEGAL AND
SOCIETAL IMPACTS OF OUR WORK.
SO I WANT TO START OFF BY
SUMMARIZING FOR YOU SOME OF THE
BIG PROJECTS THAT WE'RE DOING
THAT ARE LAYING DOWN THE
FOUNDATION FOR FUTURE
DISCOVERIES AND CURES.
SO AGAIN AS YOU MENTIONED, THE
BRAIN IS REMARKABLY COMPLEX IN D
HUMAN BRAIN IS 86 TO 100 BILLION
NEURONS.
WE REALLY NEED TO GET A HANDLE
ON THE GROUND TRUTH OF HOW THESE
REMARKABLE NEURAL CIRCUITS ARE
PUT TOGETHER TO COMPRISE THE
BRAIN.
SO IN AGAIN 22, WE LAUNCHED
THREE OF WHAT WE CALL THE BRAIN
INITIATIVE -- BRAIN
2.0 TRANSFORMATIVE PROJECTS.
THE FIRST IS THE BRAIN
INITIATIVE CELL ATLAS NETWORK,
WHICH WILL MAP ALL OF THE BRAIN
CELL TYPES AND CIRCUITS ACROSS
MULTIPLE SPECIES BUT WITH A BIG
EMPHASIS ON HUMANS AS WELL AS ON
NON-HUMAN PRIMATES.
THE SECOND IS THE BRAIN
INITIATIVE CONNECTIVITY ACROSS
SCALES.
THE CELL ATLASSING PROJECT WILL
GIVE US THE PARTS LIST SO WE
UNDERSTAND WHAT THEY WILL TYPES
ARE THERE, THEIR PROPERTIES AND
SO FORTH.
THE CONNECTIVITY PROJECT WILL
TELL US HOW THEY'RE WIRED
TOGETHER AND THAT'S CRITICAL FOR
UNDERSTANDING HOW INFORMATION IS
PASSED ALONG AND RECEIVED TO
GIVE RISE TO SENSATION,
BEHAVIOR, COGNITION AND SO
FORTH.
THEN FINALLY WITH THIS GROUND
TRUTH INFORMATION FROM THE PARTS
LIST AND THE WIRING DIAGRAM, WE
WANT A WAY OF BEING ABLE TO
INTERROGATE THIS SYSTEM WITH
BETTER TOOLS SO THIS
ARMAMENTARIUM FOR BRAIN CELL
ACCESS WILL LEVERAGE A LOT OF
THESE DATA TO GET US PRECISION
ACCESS TO THE NEWLY DISCOVERED
CELL TYPES, TO THE CIRCUITS, TO
ASK SPECIFIC QUESTIONS ABOUT HOW
THEY FUNCTION IN BOTH MODELS OF
HEALTH AND DISEASE BUT ALSO
ULTIMATELY TO BE USED AS A BASIS
FOR FUTURE GENE THERAPIES.
SO LET ME JUST TOUCH ON THE
BRAIN CELL CENSUS PROJECT.
THIS WAS A PROJECT ACTUALLY
LAUNCHED IN 2014, IT WAS ONE OF
THE FIRST BRAIN INITIATIVE
PROJECTS AT THE BEGINNING OF THE
INITIATIVE.
IT STARTED WITH A BRAIN
INITIATIVE CELL CENSUS
CONSORTIUM AND THIS RAN AS A
PILOT PHASE FOR THE FIRST THREE
YEARS AND THE IDEA WAS TO
IDENTIFY, DEVELOP AND VALIDATE
SCALABLE TECHNOLOGIES THAT COULD
BE USED TO GIVE US A
COMPREHENSIVE CELL ATLAS OF
MAMMALIAN BRAINS.
THIS WAS BACK IN 2014.
IT WAS QUICKLY SCALED UP INTO
THE BRAIN INITIATIVE CELL CENSUS
NETWORK WHICH RAN FROM 2017 TO
2022.
IT'S STILL KIND OF MOPPING UP
RIGHT NOW.
THE IDEA BEHIND THE BICCN WAS TO
TRULY REVOLUTIONIZE OUR ABILITY
TO CLASSIFY BRAIN TYPES BASED ON
AN INTEGRATED ANALYSIS OF THE
INTEGRATED ANALYSIS OF THEIR
MOLECULAR, ANATOMICAL OR
PHYSIOLOGICAL PROPERTIES.
THIS HAS NOW GIVEN WAY TO THE
BRAIN INITIATIVE CELL ATLAS
NETWORK WHICH IS RUNNING
CURRENTLY FOR THE NEXT FEW YEARS
WHICH AGAIN HAS A BIG FOCUS ON
PUTTING THIS KNOWLEDGE TOWARDS
GIVING US A COMPREHENSIVE ATLAS
OF THE HUMAN BRAIN.
SO THE BICCN IS JUST KIND OF
WRAPPING UP.
WE'VE SEEN SOME REMARKABLE
PUBLICATIONS COMING OUT.
IN OCTOBER OF 2021, THERE WERE
27 PAPERS PUBLISHED IN NATURE
AND NATURE SISTER JOURNALS
FOCUSING ON THE PRIMARY MOTOR
CORTEX.
THIS WAS OUR TEST CASE IN
MULTIPLE MAMMALIAN SPECIES.
IN DECEMBER OF 2023, THE GROUP
PUBLISHED A SERIES OF ARTICLES,
10 ARTICLES, NONE OF WHICH WERE
SUPPORTED BY BRAIN, OF A
COMPREHENSIVE CELL CENSUS AND
ATLAS OF THE MOUSE BRAIN.
IT WAS TRULY A MONUMENTAL
ACHIEVEMENT.
AND THEN A BIT EARLIER LAST
FALL, THERE WERE 21 ARTICLES
PUBLISHED IN SCIENCE AND SIGH
EBBS SISTER JOURNALS, GIVING US
DRAFT HUMAN AND NON-HUMAN
PRIMATE CELL ATLASES OF THE
BRAIN.
SO REALLY TRULY REMARKABLE WORK.
LET ME JUST KIND OF GO THROUGH
THIS WITH YOU VERY, VERY QUICKLY
IN THE INTEREST OF TIME.
SO AGAIN, IN THIS ORIGINAL
PRIMARY MOTOR CORTEX PROJECT, WE
LOOKED AT -- WE PROVIDED A
MULTIMODAL CENSUS AND ATLAS OF
THE PRIMARY MOTOR CORTEX IN
HUMANS, NON-HUMAN PRIMATES AND
MICE.
THIS WAS A TRIUMPH OF TEAM
SCIENCE.
THIS EFFORT ENCOMPASS THED THE K
OF OVER 250 RESEARCHERS ACROSS
THREE CONTINENTS, AND IT SET THE
STAGE FOR A LARGER AND MORE
COMPREHENSIVE ATLAS OF THE MOUSE
AS WELL AS THE DRAFT ATLAS OF
THE BIG BRAINS.
SO AS I MENTIONED IN
DECEMBER 2023, THE GROUP
PUBLISHED THE FIRST
COMPREHENSIVE CELL AT LAPSE OF F
MOUSE BRAIN.
THIS WORK INVOSMED OVERANALYSIS
OF OVER 32 MILLION CELLS WITH
BLEEDING -- THEY IDENTIFIED 5300
STATISTICALLY DISTINGUISHABLE
CELL TYPES BASED ON THE TRANS
SCRIP TOE MIBG PROFILES AND IT
REALLY RER IS GOING TO KEEP US
BUSY FOR MANY YEARS TO COME, IT
GIVES US A MOLECULAR HANDLE FOR
ASKING ACTUALLY HOW SPECIFIC
CELL TYPES CAN CONTRIBUTE TO
BEHAVIOR.
AND THEN WE HAD THE DRAFT CELL
ATLASES OF THE NON-HUMAN PRIMATE
AND HUMAN BRAINS, AGAIN
REPRESENTED AS 21 PAPERS, AND IT
MAPPED THESE BIG BRAINS AT
UNPRECEDENTED DETAIL ACROSS
SPACE, SPECIES AND TIME.
BY THIS, I MEAN THE GEOGRAPHY
ACROSS THE BRAIN, ACROSS
MULTIPLE SPECIES THAT GAVE US A
REALLY GOOD IDEA ABOUT THE
DIVERSIFICATION AND SPECIATION
OF THE PRIMATE LINEAGE WHICH
INCLUDES HUMANS AND ALSO
POTASSIUM OVER DEVELOPMENTAL
TIME AND PAVES THE WAY TO
UNDERSTAND DISEASE PROCESSES AT
THE CELLULAR LEVEL WILL BE KEY
TO UNDERSTANDING THE MECHANISMS
THAT NEED TO BE INTERVENED IN,
IN ORDER TO NOT JUST TREAT
DISEASES WITH BUT ACTUALLY HOPY
TO PREVENT AND CURE.
SO THIS LEADS US TO THE BRAIN
INITIATIVE CELL ATLAS NETWORK.
WHERE NOW WE ARE MOVING BEYOND
JUST GENERATING A LOT OF DATA TO
DEVELOP THESE INTO KNOWLEDGE
BASES THAT CAN BE USED ACTION
BLI FABLI FOR RESEARCHERS ACROSE
BOARD.
OF INTEREST FOR YOU HERE IS IT
ALREADY BEING LEVERAGED IN THE
SCORCH PROGRAM, AS WELL AS IN
THE NIDA NEXUS COLLABORATORY.
SO WE'RE REALLY LOOKING FORWARD
TO SEEING THIS KIND OF CROSS
FERTILIZATION BETWEEN THE TOOLS
AND RESOURCES THAT BRAIN HAS
PROVIDED AS IT ROLLS OUT INTO
YOUR IC, MUTUALLY REINFORCING
TRANSLATION OR REVERSE
TRANSLATION TO UNDERSTAND HOW
THESE NEURAL CIRCUITS ARE
FUNCTIONING AND HOW THEY ARE
CONTRIBUTING TO THESE CONDITIONS
AND HOW WE, THEREFORE, MIGHT
INTERVENE TO GIVE PEOPLE BETTER
LIVES.
IF INFORMATION HAS ALSO BEEN
USED TO STAND UP THE SEATTLE
ALZHEIMER'S DISEASE BIG PROJECT
FUNDED BY THE NATIONAL INSTITUTE
ON AGING, WHERE NOW
INVESTIGATORS HAVE USED MANY OF
THE TECHNIQUES WE DEVELOPED IN
THE BICCN TO IDENTIFY AT A
CELLULAR LEVEL THE PROGRESSION
THROUGH ALZHEIMER'S DISEASE AND
THEY'VE ACTUALLY FOUND SPECIFIC
CELL TYPES THAT ARE OVER AND
UNDERREPRESENTED AT DIFFERENT
STAGE OF THE DISEASE THAT GIVES
US ACTUAL TARGETS FOR LOOKING
AT, AGAIN, HOW TO PREVENT SLOW
OR HOPEFULLY ONE DAY CURE OF
THESE DISEASES.
SO THIS IS THE CELL ATLAS
PROGRAM.
WE'RE VERY, VERY EXCITED ABOUT
IT, AND IT'S RELU GOING TO GIVE
US THE GROUND TRUTH INFORMATION
WE NEED TO UNDERSTAND HOW NEURAL
CIRCUITS FUNCTION.
BUT OF COURSE THE CONNECTIVITY
BETWEEN THESE CELLS IS VERY
IMPORTANT.
WE RECENTLY LAUNCHED THE
CONNECTS PROGRAM WITH 11 GRANTS
TO 40 UNIVERSITIES AND RESEARCH
INSTITUTIONS THAT INVOLVES
INTERNATIONAL COLLABORATIONS.
OVER THE NEXT FIVE YEARS, THE
RESEARCHERS WILL BE TASKED WITH
IDENTIFYING SCALABLE
TECHNOLOGIES THAT CAN BE APPLIED
TO DEVELOPING SYNAPSE RESOLUTION
MAPS IN THE MOUSE BUT ALSO
MICRON RESOLUTION MAPS IN BIG
BRAINS AS WE DID IN THE
BEGINNING OF THE CELL CENSUS
NETWORK, AND THE PROJECTS WILL
DEVELOP COMPLEMENTARY
TECHNOLOGIES ACROSS THREE CORE
AREAS.
THE WORKHORSE FOR THE HIGH
RESOLUTION MAPPING OF COURSE
WILL BE HIGH-THROUGHPUT ELECTRON
MICROSCOPY.
THIS IS A PICTURE FROM THE --
WE'LL BE USING VARIOUS MOLECULAR
SEQUENCING TOOLS TO GIVE US
GREATER THROUGHPUT AND ALSO
MOLECULAR SPECIFICITY TO THESE
ANALYSES, AND VERY IMPORTANTLY,
SOME REALLY COOL OPTICAL IMAGING
TECHNIQUES THAT WILL GET US
BETTER VIEWS, HIGH RESOLUTION
VIEWS OF THE -- HOPEFULLY DOWN
TO THE MICRON LEVEL RESOLUTION.
SO THIS WILL BE -- THE CONNECTS
PROGRAM.
AND FINALLY THE ARMAMENTARIUM
FOR PRECISION PRAIN CELL ACCESS,
HOW TO ACTUALLY GET IN TO TAKE
ACTION WITH THAT INFORMATION TO
CONDUCT MORE PRECISE
INTERROGATIONS OF NEURAL CIRCUIT
FUNCTION AND WE'VE KIND OF
DIVIDED THIS IN THREE HIGHLY
RELATED AREAS: ACCESS TOOLS,
MOLECULAR PAY LOADS AND
DISSEMINATION.
SO WE FUNDED A SERIES OF PILOT
U01 GRANTS TO DEVELOP BETTER
DELIVERY VECTORS WITH GENE
REGULATORY ELEMENTS TO GIVE US
THIS PRECISE TARGETING OF THE
PAY LOALDZ LOADZ LOADS, THESE N
BE OPTOGENETIC, CHEMOGENETIC,
ACT WAY TORES, SENSORS, THEY
COULD BE GENE EDITING TOOLS, YOU
NAME IT, AND THEN OF COURSE
DISSEMINATION IS IMPORTANT AS
WELL, WE HAVE SPHOOD UP A SERIES
OF U24 PROJECTS TO KIND OF GET
ALL THESE THINGS OUT THERE.
THE GROUP HAS ALREADY BEEN
REMARKABLY SUCCESSFUL.
THESE ARE JUST A SMALL SAMPLING
OF PAPERS THAT WERE PUBLISHED
OVER THE LAST FEW YEARS, AND
THEN WE ALSO HAVE, AGAIN, A
VERY -- WE'RE BUILDING A MORE
ROBUST WAY OF GETTING THESE
TOOLS OUT THERE.
I'LL DRAW YOUR ATTENTION TO THE
ADDGENE SQUARE IN THE UPPER
LEFT.
I JUST CHECKED IT YESTERDAY,
THERE ARE OVER 2900 THINGS THE
THERE.
ITEMS THERE PEOPLE CAN ACCESS
FOR USE FOR THEIR OWN RESEARCH.
SO I THINK WE'RE GETTING THERE
IN TERMS OF NOT JUST DEVELOPING
THESE TOOLS, BUT GETTING THOSE
TOOLS OUT FOR PEOPLE TO USE.
NOW OF RELEVANCE TO YOU FOLKS
HERE, WHAT ARE WE DOING TO HELP
UNDERSTAND THE CIRCUITS OF
REWARD AND ADDICTION.
THIS IS JUST ONE EXAMPLE OF
MANY, MANY EXAMPLES FROM A
MULTI-INVESTIGATOR AND
MULTI-INSTITUTION COLLABORATION
WHICH IS TO DEVELOP THESE NEW
WAVE DOPAMINE AND OTHER SENSORS
THAT ARE TUNED TO DIFFERENT
WAVELENGTHS OF LIGHT.
NOW WHY IS THAT SO IMPORTANT?
WE CAN NOW COMBINE THAT WITH
OTHER SENSORS, FOR EXAMPLE,
DOPAMINE RELEASED TOGETHER WITH
ACETYLCHOLINE RELEASE TO GET A
BETTER UNDERSTANDING OF HOW
THESE PROCESSES WORK IN REALTIME
AS THESE ANIMAL MODELS
UNDERGO -- THIS IS JUST ONE OF
MANY, MANY TOOLS THAT I THINK
WILL BE ACCELERATING BUT ALSO IN
PARTICULAR FOR UNDERSTANDING
NEURAL CIRCUITS OF REWARD AND
ADDICTION.
SO A VERY QUICK OVERVIEW.
SORRY IN THE INTEREST OF TIME WE
HAVE TO KIND OF BLAST THROUGH
THIS.
SO TOGETHER OUR GOAL IS TO HAVE
THESE THREE TRANSFORM HIF
PROJECTS TO WORK TOGETHER TO
GIVE US THE GROUND TRUTH
INFORMATION ABOUT HOW NEWER
NEURAL CIRCUITS FUNCTION, TO
GIVE US THE TOOLS FOR
INTERROGATING THEM TO BETTER
TEST -- BOTH NORMAL BEHAVIOR BUT
ALSO IN MODELS OF DISEASE WITH
THE ULTIMATE BLUE SKY GOAL OF
APPLYING THIS PRECISION FOR -- I
THINK ONE DAY GENE THERAPIES FOR
CIRCUIT DISORDERS.
SO THESE ARE THE THREE THAT WE
LAUNCHED BACK IN 2022.
MORE RECENTLY WE LAUNCHED THE
BRAIN BEHAVIOR QUANTIFICATION
AND THE GOAL HERE IS TO DEVELOP
NEXT GENERATION TOOLS AND
ANALYTICAL APPROACHES TO MORE
PRECISELY QUANTIFY COMPLEX
BEHAVIORS AND COMBINE THEM WITH
THE GROWING LIST OF HIGH
PRECISION RECORDINGS OF BRAIN
ACTIVITY.
AND TO USE THIS TO INFORM CLOSED
LOOP THERAPIES DOWN THE LINE FOR
NEUROAND MENTAL BEHAVIORAL
DISORDERS.
FLEURN AND OUR APPROACH WILL
INVOLVE ANIMAL MODELS, HUMAN
MODELS, VERY IMPORTANTLY SENSOR
DEVELOPMENT, DATA COORDINATION
AND A VERY BIG COMPONENT OF THIS
WILL HAVE TO BE AN INTENTIONAL
FOCUS ON THEORY, COMPUTATION,
AND ARTIFICIAL INTELLIGENCE.
SO CAN YOU IMAGINE, WE'RE GOING
TO BE LOOKING AT DATA FROM
MULTIPLE MODALITIES AND THERE'S
GOING TO BE A LOT OF DATA, AND
WE'RE GOING TO NEED TO DEVISE
NEW A.I. APPROACHES TO MAKE
SENSE OF THE DATA IN ORDER TO
TAKE ACTION WITH IT.
SO WE'VE JUST LAUNCHED THIS
PROGRAM.
WE HAD A SERIES OF -- OUR --
CLINICAL SIDE, DATA ARCHIVES,
WE'RE ABOUT TO FUND THE FIRST
DATA CENTERED AI COORDINATING
CENTER AS WELL AS UPCOMING WE
HOPE TO GET TO LAUNCH A PROGRAM
IN SENSOR DEVELOPMENT.
SO THIS IS KEE KIND OF WHERE WEE
WITH THAT.
I THINK THERE COULD BE A LOT OF
GREAT RELEVANCE FOR THE KIND OF
RESEARCH THAT NIDA IS INTERESTED
IN FUNDING.
SO THIS -- THESE ARE FOUR BIG
PROJECTS THAT WE HAVE STARTED
AND THAT RUNDWAY ARE UNDERWAY E
BELIEVE WILL LAY THE FOUNDATION
FOR FUTURE CURES AND HOPEFULLY
ACCELERATE DEVELOPMENT BUT IN
THE MEANTIME, WHAT ARE WE DOING
FOR PEOPLE TODAY?
OVER THE LAST COUPLE OF YEARS,
WE'VE SEEN AN EXPLOSION OF NEW
RECORDING AND STIMULATION
TECHNOLOGIES IN HUMANS, SO
MAINLY BASED AROUND DEEP BRAIN
STIMULATION, THAT ARE GOING FAR
BEYOND THE INITIAL APPLICATION,
WHICH WAS STARTED ABOUT 20 YEARS
AGO FOR TREATING THE MOTOR
SYMPTOMS ASSOCIATED WITH
PARKINSON'S DISEASE AND NOW ARE
BEING APPLIED TO MORE COMPLEX
DISORDERS LIKE TREATMENT
RESISTANT DEPRESSION,
POST-TRAUMATIC STRESS DISORDER,
TRAUMATIC BRAIN INJURY, RECOVERY
OF MOTOR FUNCTION FOLLOWING
STROKE, BINGE EATING DISORDER,
AND I KNOW THERE'S SOME REALLY
COOL STUFF OUT THERE, FOR
INDIVIDUALS LIVING WITH
SUBSTANCE USE DISORDER.
SO IT WAS REALLY AN AMAZING TIME
HERE.
I THINK THESE ADVANCES HAVE BEEN
FUELED BY A YOU HAVE TO REALLY
KNOW WHERE IN THE BRAIN ARE THE
INDIVIDUAL THAT WILL RESPOND TO
NEUROMOD LAYING, WHETHER IT BE
INVASIVE WITH A DBS ELECTRODE OR
NONINVASIVE FOR EXAMPLE WITH
TMS.
ADVANCES AND RECORDING
STIMULATION TECHNOLOGIES, AND
VERY, VERY IMPORTANTLY,
ARTIFICIAL INTELLIGENCE
ALGORITHMS TO BE ABLE TO DEACON
VDE-CONVOLVE INTO ACTUAL ACTIVIY
BIOMARKERS THAT CAN LITERALLY
TELL US IS THIS INDIVIDUAL IN A
BAD OR GOOD STATE, AND IF WE
FROM THAT STATE TO A BETTER
STATE ACCORDINGLY.
I THINK WE'RE SEEING A GREAT
AMOUNT OF SUCCESS BUT THEY'RE
REALLY POINTING THE WAY FOR A
REVOLUTION AND USING THIS
TECHNOLOGY TO ADDRESS THESE
VERY, VERY COMPLEX AND
INTRACTABLE DISORDERS.
NOW ANOTHER SIDE OF WHAT WE'VE
BEEN SUPPORTING HAS BEEN IN THE
AREA OF BRAIN COMPUTER
INTERFACE.
I'LL JUST GIVE YOU ONE EXAMPLE,
ONE OF MANY.
THIS IS A STUDY FROM THE BRAIN
GATE 2 CONSORTIUM.
THIS STUDY ACTUALLY JUST CAME
OUT THIS YEAR, JUST VERY
RECENTLY.
IT WAS FUNDED BY NISM DCD BUT
IT'S BASED ON A LOT OF
TECHNOLOGY THAT BRAIN SUPPORTED
IN EARLY DAYS.
SO HERE'S AN EXAMPLE WHERE WE
HAVE INDIVIDUALS, THEY CAN
EITHER I END STAGES OF ALS, THEY
MIGHT HAVE HAD A STROKE OR HAVE
OTHER REASONS FOR PARALYSIS AND
THEY'RE UNABLE TO COMMUNICATE.
THEY'RE LOCKED IN.
THEY'RE COGNITIVELY FINE BUT
THEY'RE LOCKED IN.
AND WE'VE SEEN MANY, MANY REALLY
COOL STUDIES RECENTLY THAT HAVE
DEVELOPED BRAIN-COMPUTER
INTERFACES WHERE ELECTRODES ARE
PLACED ON VARIOUS AREAS OF THE
BRAIN AND THE INDIVIDUAL IS
ASKED TO EITHER IMAGINE WRITING
LETTERS OR IMAGINE SAYING WORDS
OR SENTENCES OR ACTUALLY TRYING
TO ARTICULATE THE -- AS BEST I
CAN, AND THIS HAS LED TO SOME
PRETTY INTERESTING BCR,
BRAIN-COMPUTER INTERFACE
NEUROPROS THEEPROSTHESIS THAT CE
THE INDIVIDUALS THE ABILITY TO
COMMUNICATE EITHER THROUGH TEXT
OR A SPEECH SYNTHESIZER.
BUT THE RUB IS THAT THEY REQUIRE
A LOT OF TRAINING AND THEY STILL
HAVE QUITE THE BIT OF ERROR RATE
AND THEY'RE A BIT SLOW.
SO -- TO DEVELOP A BCI
BRAIN-TO-SPEECH SYNTHESIZER THAT
REQUIRED ALMOST NO TRAINING.
IT WAS LITERALLY PLUG AND PLAY.
AND IN ORDER FOR THIS TO WORK
FOR PEOPLE IN A MORE GENERAL WAY
TO REACH MORE PEOPLE, IT REALLY
DOES NEED TO BE MORE PLUG AND
PLAY.
SO HERE ON THE LEFT WE JUST SHOW
THE ELECTRODES THEY PLACED OVER
VARIOUS AREAS OVER PREMOTOR,
PRIMARY MOTOR CORTEX.
THEY HAD THE INDIVIDUAL JUST
IMAGINE TRYING TO A ARTICULATE
WORDS, AND THEY WENT THROUGH THE
ARTIFICIAL NEURAL NETWORK.
THEY WERE ABLE TO DESIGN THE
DECODER IN A WAY THAT REQUIRED
ALMOST NO TRAINING.
AND THEN THE REALLY COOL THING
HERE IS THAT WHEN THEY RAN IT
THROUGH A SPEECH SYNTHESIZER,
THEY USED RECORDINGS OF THIS
INDIVIDUAL PRIOR TO HIS DEED, TO
MAKE A SPEECH SYNTHESIZER THAT
ALLOWS HIM TO SPEAK IN HIS OWN
VOICE.
SO HERE ARE JUST SOME DATA.
WHAT'S REALLY QUITE REMARKABLE,
25 DAYS AFTER SURGERY, AFTER
JUST 30 MINUTES OF TRAINING,
THIS INDIVIDUAL WAS ABLE TO
BASICALLY READ BACK THROUGH THIS
BRAIN COMPUTER INTERFACE 50
WORDS WITH -- WITH VERY, VERY
LITTLE TRAINING.
ANOTHER HOUR AND A HALF OF
TRAINING, THEY WERE ABLE TO
DEVELOP A 125,000 WORD
VOCABULARY WITH ABOUT 90%
ACCURACY AND SOON THEREAFTER TO
GET IT DOWN TO 9 7% ACCURACY.
SO THIS IS TRULY REMARKABLE.
-- TO MORE AND MORE PEOPLE WHO
NEED IT.
I'M GOING TO PLAY YOU SOME VID
VIDEOS, THE FIRST TRY NUMBER ONE
AFTER ABOUT 30 MINUTES.
IT WAS REALLY QUITE EMOTIONAL,
THEY HAD TO STOP THE TRIAL
BECAUSE EVERYBODY INCLUDING THE
EXPERIMENTERS WERE CRYING.
IN THE NEXT VIDEO I'LL SHOW YOU,
YOU'VE GOT TO HANG ON TO YOUR
SEATS, IT GOES THROUGH THE
PROCESS THAT THEY WENT THROUGH,
AND TOWARD THE END, YOU'LL HEAR
WHAT SOUNDS LIKE SOMEBODY
NARRATING OVER IT, BUT IT'S
ACTUALLY THE HUMAN PARTICIPANTS'
SYNTHESIZED VOICE.
HE'S ACTUALLY TALKING TO US.
IF YOU HAVE A BOX OF TISSUE
NEARBY, YOU MIGHT WANT TO GRAB
IT.
OH, WAIT A SECOND.
DID I NOT ENABLE THE SOUND?
DO YOU HEAR THAT SOUND OR NOT?
>> RIGHT NOW, YES.
>> CO COULD YOU HEAR THE SOUND
WHETHER IT STARTED?
YOU COULD HEAR IT?
OKAY.
SO IF NOT, JUST SOMEBODY SCREAM
OUT AND I'LL QUIT AND GET BACK
IN.
>> A LOT OF THE DEMONSTRATIONS
OF BCI TECHNOLOGY OVER THE PAST
FEW DECADES TOOK WEEKS OR MONTHS
TO GET WORKING.
THE FIRST TIME HE TRIED TO USE
THE SYSTEM, IT JUST WORKED.
>> OKAY, READY?
THAT FIRST TIME THAT HE TRIED TO
SPEAK AND THAT WORD APPEARED ON
THE SCREEN, HE STARTED CRYING, I
STARTED CRYING, HIS FAMILY
STARTED CRYING, BASICALLY
EVERYONE, WE HAD TO PAUSE, WE
STOPPED THE REST OF THAT
EXPERIMENT TRIALS, COMPOSE
THEMSELVES, ALL RIGHT, LET'S DO
IT AGAIN, AND IT KEPT WORKING.
SO YEAH, IT WAS -- IT WAS REALLY
SPECIAL.
IT WAS A SPECIAL MOMENT.
>> PEOPLE WHO DO NOT HAVE THE
ABILITY TO COMMUNICATE WELL OR
QUICKLY ARE OFTEN ISOLATED AND
LONELY.
HAVING SOMETHING LIKE THIS WILL
GIVE THEM HOPE AND OPPORTUNITY
TO BE MORE OF THEMSELVES.
>> I THINK WE'RE AT A POINT
WHERE IT DOES WORK WELL ENOUGH
THAT IT REALLY LETS THEM JUST BE
A PART OF SOCIETY AND TO TALK.
>> I AM ABLE TO STILL WORK FULL
TIME FOR CLIMATE ACTION, AND I
AM ABLE TO DO THAT WELL AND MORE
EFFICIENTLY WITH THIS DEVICE.
>> HONESTLY, THE REASON THIS IS
SO TRANSFORMATIVE IS BECAUSE IT
PROVIDES HOPE FOR PEOPLE LIVING
WITH THESE KINDS OF DISEASES,
THAT AS THEY FACE THEIR DISEASE,
THAT THEY KNOW THAT THEY WILL
HOPEFULLY HAVE THE ABILITY TO
RETAIN COMMUNICATION.
>> SO I THINK YOU'LL AGREE, THIS
IS AMAZING.
THIS IS REALLY THE STUFF OF
SCIENCE FICTION 10 YEARS AGO,
AND THE PROGRESS THAT WE'RE
MAKING IN BOTH THE BCI SPACE AS
WELL AS THE DBS SPACE, I THINK
REALLY DOES GIVE US HOPE AND
OPPORTUNITY FOR FOLKS THAT ARE
LIVING WITH THESE DEVASTATING
DISORDERS.
SO THE FLIP SIDE OF THIS IS
THAT -- A VERY IMPORTANT
RESEARCH OPPORTUNITY IN HUMANS
THAT BRINGS IN HUMAN SUBJECTS
THAT ARE IMPLANTED FOR OTHER
REASONS, WHETHER THEY'RE
PREPARING FOR SURGERY AND USING
THIS AS AN OPPORTUNITY TO
UNDERSTAND HOW NEURAL CIRCUITS
FUNCTION AND FOR EXAMPLE,
UNDERLIE MEMORY FORMATION,
MEMORY RETRIEVAL, SPATIAL
NAVIGATION AND SO FORTH.
AND THIS WAS A GREAT OPPORTUNITY
TO WORK AS I REFER TO AWAKE
BEHAVING HUMANS TO REALLY GIVE
US GREAT INSIGHTS INTO HOW THESE
COMPLEX CIRCUITS UNDERLIE ALL
THAT MAKE US HUMAN.
OF COURSE THIS RAISES MANY
ETHICAL ISSUES AND IT GOES FAR
BEYOND -- WE HAVE A WORKING
GROUP THAT HELPS GUIDE US IN
THESE AREAS.
WE HAVE A SERIES OF GUIDING
PRINCIPLES THAT AGAIN GO FAR
BEYOND SAFETY AND GET INTO
ISSUES OF AGENCY, MALIGNED USE,
DUAL USE, PUBLIC CONCERNS AND
ACTUALLY BEING VERY COGNIZANT OF
THE REALITY THAT WE REALLY NEED
PUBLIC EDUCATION AND ENGAGEMENT
IN ORDER TO MAKETHICALLY SOUND
DECISIONS IN ORDER TO DEVELOP
THESE TECHNOLOGIES FOR THE
BENEFIT OF ALL TO DEMOCRATIZE
THEM.
WE'VE HOSTED ALONG THE WAY
OCCASIONAL TOPICAL WORKSHOPS.
WE ACTUALLY HAVE A TEAM, ONE OF
OUR PROGRAM TEAMS IS ACTUALLY
FOCUSED ON NEUROETHICS AND WE --
IN THIS AREA AS WELL.
I JUST FINALLY WANT TO TOUCH ON,
AGAIN, I MENTIONED THIS BEFORE,
THE SUCCESS OF ALL WE DO IS
GOING TO BE DEPENDENT ON HAVING
A STRONG CREATIVE INNOVATIVE
WORKFORCE AND AGAIN BUILDING THE
NEXT GENERATION OF LEADERS WHO
WILL CARRY THIS ON IN THE
FUTURE.
WE'RE VERY, VERY COMMITTED TO
THIS.
ONE OF THE EXPERIMENTS THAT WE
INSTIGATED A FEW YEARS AGO WAS
THE INCLUSION OF THE PLAN FOR
ENHANCING DIVERSE PERSPECTIVES
OR PDP IN OUR APPLICATION
PROCESS AND HERE THIS REALLY
DESCRIBES THE SUMMARY OF ACTUAL
STRATEGIES THAT WILL BE USED TO
EMPLOY DIVERSE PERSPECTIVES IN
THE FURTHER -- OF THE -- I THINK
NIDA HAS ACTUALLY BEEN AT THE
FOREFRONT OF TAKING OFF THE PDP,
WE'RE VERY, VERY EXCITED THIS.
WE'RE JUST GETTING DATA ON HOW
THIS IS WORKING AND WE'LL
FINE-TUNE THIS AS WE GO ALONG.
OKAY.
SO JUST A VERY QUICK MENTION
ABOUT BUDGET.
I HEARD YOUR DISCUSSION ABOUT
BUDGET.
SOME OF YOU MAY HAVE HEARD ABOUT
BRAIN'S BUDGET WOES.
BRAIN IS A BIT TRICKY.
WE GET OUR FUNDING FROM TWO
SOURCES.
ONE IS TO THE BASE ALLOCATIONS
TO THE 10 PARTICIPATING ICs.
SO NIDA IS A PARTICIPANT IN
BRAIN, PART OF, OR THAT NIDA
BUDGET GOES TOWARDS THE BASE
BUDGET.
WE ALSO RECEIVED FUNDS FROM THE
21ST CENTURY CURES ACT, WHICH
GIVES AUTHORIZED FUNDS TO THE
BRAIN INITIATIVE AND A FEW OTHER
PROGRAMS FOR YEARS BETWEEN 2017
THROUGH 2026.
AND THESE NUMBERS FLUCTUATE UP
AND DOWN JUST BECAUSE OF KIND OF
BUDGET REALITIES.
SO THE FUNDING FOR BRAIN
HISTORICALLY HAS BEEN GREAT,
IT'S BEEN GOING UP VERY, VERY
RAPIDLY OVER TIEMENT YOU CAN SEE
TIME.YOU CAN SEE THE PROGRESS WE
MADE.
AND THEN THE CHALLENGE CAME
ABOUT WHEN THE CURES ACT
AUTHORIZATION BALLOONED FROM
$152 MILLION TO $450 MILLION, SO
A DECISION WAS MADE TO TRIM THE
BASE ALLOCATION DOWN TO
$230 MILLION BUT WE STILL NETTED
60 -- INCREASE AND WHEN WE GOT
INTO A BIT OF TROUBLE IS WHEN
THAT BASE ALLOCATION WASN'T
RESTORED SO THIS CURRENT FISCAL
YEAR FY 24, WE SUSTAIN WOULD A
278 MILLION OR 40% CUT THAT
WE'RE GOING TO BE LOOKING AT AN
EVEN GREATER CUT NEXT YEAR IF
THE BASE ISN'T RESTORED.
SO WE'RE DOING OUR BEST TO
MANAGE THIS BUDGET SCENARIO.
THE REALITY IS WE'RE STILL
FUNDING A LOT OF GREAT SCIENCE,
OUR PRIORITIES ARE STILL THE
SAME, THEY JUST BROUGHT TO
SHARPER FOCUS.
IF FOLKS NEED MORE INFORMATION
ABOUT THIS, WE'VE SET UP A
COUPLE BEIGES ON OUR WEBSITE TO
HELP PEOPLE NAVIGATE THROUGH IT.
WE'RE DOING OUR BEST TO GET THE
WORD OUT TA BRAIN IS REALLY
FUNDING IMPACTFUL SCIENCE.
MORE INFORMATION ABOUT THE BRAIN
INITIATIVE WE FOUND HERE.
IF YOU'RE INTERESTS, WE CAN
SUBVIBE TO TOO MANY EMAILS.
I KNOW I'M RUNNING A LITTLE BIT
LATE, I JUST WANT TO BRING YOUR
ATTENTION TO TWO UPCOMING
EVENTS.
AT THE MEETING IN CHICAGO COMING
UP IN EARLY OCTOBER, THEIR BRAIN
INITIATIVE ALLIANCE, ONE OF OUR
PARTNER UMBRELLA ORGANIZATIONS
IS HOSTING WHAT WE CALL THE
TOOLMAKERS EVENT, WHERE PEOPLE
COME IN AND THEY SHOW THEIR
WARES.
IT'S A REALLY GREAT TIME, YOU
CAN SEE THIS FROM LAST YEAR'S
EVENT.
PEOPLE COME IN TO SHOW THEIR
WARES, WHETHER IT'S WIDGETS OR
SOFTWARE OR WHAT YOU HAVE, AND
JUST A GREAT OPPORTUNITY FOR
PEOPLE TO FIND OUT WHAT TOOLS
AND RESOURCES ARE OUT THERE THAT
THEY CAN APPLY TO THEIR
RESEARCH, SO THIS IS COMING UP
IN OCTOBER.
THEN BRAIN ISLESS HOSTING THIS
NEURAL A.I. WORKSHOP, IT'S A
HYBRID WORKSHOP ON NOVEMBER 12TH
AND 13TH.
THERE'S LIMITED SEATING
AVAILABLE, WE'RE REALLY GOING TO
LOOK AT THE OPPORTUNITIES FOR
HOW WE CAN DRIVE BETTER AI
ALGORITHMS BUT ALSO IN A
DIFFERENT WAY HOW
UNDERSTANDING -- A BETTER
UNDERSTANDING OF NEURAL CIRCUITS
MIGHT ONE DAY LEAD TO BETTER
A.I. ALGORITHMS AND ALSO NEW AND
MORE COMPUTER ARCHITECTURE.
SO WE'RE EXCITED ABOUT THAT.
IF THERE'S TIME FOR QUESTIONS,
I'LL BE HAPPY TO TAKE THEM.
>> WE'RE A LITTLE OVER TIME BUT
I THINK IF THERE'S A COUPLE OF
QUESTIONS, WE SHOULD HAVE THEM.
>> ASK ME ANYTHING.
BUT I DON'T WANT TO KEEP YOU
FROM YOUR BREAK EITHER.
>> NO, NO, NO, NO, I THINK
THAT -- NO, TERRIFIC
PRESENTATION AND IT'S JUST
EXTRAORDINARY AND RILEY IT'S
UNFORTUNATE THAT YOU'RE
STRUGGLING WITH THE -- SO TWO
QUESTIONS.
I APOLOGIZE FOR MY IGNORANCE BUT
I WAS SURPRISED THAT THEY ARE
BASICALLY PLACING THE ELECTRODES
IN THE PREMOTOR CORTEX AND NOT
IN THE -- AREA WHICH IS WHERE IF
YOU WOULD HAVE ASKED ME I WOULD
HAVE THOUGHT THAT'S WHERE IT
COMES.
SO HOW WAS THE DECISION MADE OF
WHAT WOULD BE THE AREA THAT YOU
NEED TO IMPLANT IT?
>> IN THIS PARTICULAR CASE, AND
ALSO -- THERE WERE TWO SUCH
PAPERS PUBLISHED JUST A BIT
EARLIER FROM THE BRAIN GATE
GROUP, ALSO FROM EDDIE CHANG'S
GROUP.
SO THE DIFFERENCE HERE IS THESE
SUBJECTS THAT THEY ENDPAIJED IN
THESE PROJECTS, THEY WEREN'T
COMPLETELY PARALYZED.
HE WAS TRYING TO ARTICULATE, HE
WAS TRYING TO SPEAK.
SO WHAT THEY WERE DOING WAS THEY
WERE READING OUT THE SIGNALS
FROM THE SPEECH MOTOR CORTEX,
AND BEING ABLE TO DECODE THAT
INTO ACTUAL WORDS AND WHAT YOU
HAVE.
THERE'S BEEN OTHER WORK DONE,
REALLY COOL WORK, WHERE AGAIN BY
THE BRAIN GATE GROUP, WHERE THEY
DID A BRAIN TO TEXT NEURAL
PROSTHESIS, WHERE THEY DIDN'T
HAVE THE PERSON IMAGINE THE
LETTERS OF THE ALPHABET.
THEY HAD HIM IMAGINE DRAWING IT,
SO YOU CAN IMAGINE, THE KINETIC
MOVEMENT OF TRAWI DRAWING DIFFET
LETTER, THEY COULD ACTUALLY
BEAUTIFULLY PARSE THESE INTO
DIFFERENT DOMAIN, AND ACTUALLY
DEVELOP A BRAIN TO TEXT
PROSTHESIS THAT'S PROBABLY
ALMOST AS GOOD AS ME WITH MY
CLUMSY THUMBS ON MY IPHONE.
SO THERE'S DIFFERENT WAYS OF
GETTING THIS DONE.
HERE THEY ACTUALLY USED FOUR
ELECTRODES, BUT I THINK THERE'S
SOME SECRET SAUCE IN THEIR
DECODER THAT ALLOWS THEM TO DO
IT WITH ALMOST NO TRAINING, VERY
LITTLE.
SO IT STILL AN INVASIVE
INTERFACE, BUT THAT MEANS THAT
YOU DON'T HAVE TO BRING A PERSON
IN AND HAVE THEM SIT IN A LAB
FOR A MONTH TO GET THIS THING TO
WORK.
IT'S LITERALLY GETTING VERY
CLOSE TO PLUG AND PLAY.
SO THAT'S, I THINK, THE SOMEWHAT
LONG-WINDED SIMPLIFIED ANSWER TO
YOUR QUESTION.
>> AND THEN MY OTHER QUESTION IS
ALSO SCIENTIFIC AND I APOLOGIZE
FOR THAT IGNORANCE.
IT'S PRETTY REMARKABLE AND
YOU'RE SEEING SOMETHING THAT IS
REQUIRING AN OUTPUT, BUT HOW
MUCH MORE COMPLEX IS TO GENERATE
A SIGNAL THAT IS INTERNAL,
WITHOUT NECESSARILY HAVING TO
EMERGE INTO MOVEMENT?
SO IF YOU'RE BLIND AND YOU WANT
TO SEE, HOW IS THAT PROBLEM --
>> GREAT QUESTION.
SO PART OF IT IS BEING CLEVER AS
MINGED TO YOU, THE BRAIN TO TEXT
PROSTHESIS WAS HAVING THE PERSON
LITERALLY IMAGINE WRITING WITH
HIS HAND, JUST THE PEN STROKES.
THAT'S GETTING CLOSER, I THINK,
TO WHAT YOU'RE THINKING ABOUT.
AND THE OTHER IS STILL SCIENCE
FICTION BUT SCIENCE FICTION CAN
BECOME A REALITY REALLY QUICKLY.
THIS IS ONE OF THE THINGS WE'RE
REALLY KEEPING OUR EYES ON.
SO TO BE DETERMINED BUT STAY
TUNED.
>> FANTASTIC.
I'M VERY SELF CONSCIOUS BECAUSE
I HAVE SO MANY QUESTIONS.
YOU CAN REFUSE TO ANSWER IT,
JOHN, BUT MY QUESTION IS, IN
LOOKING AT THIS HORRIBLE BUDGET
LOSS THAT YOU HAVE, WHAT IS YOUR
SENSE OF TRYING TO ENGAGE
INDUSTRY TO HELP SUPPORT SOME OF
THESE ACTIVITIES BECAUSE THEY
RELY ON THEM, MANY OF THESE NEW
OPERATIONS, SO --
>> RIGHT.
SO LITERALLY ALL OF THE DBS
TRIALS THAT THEY WERE
SUPPORTING, THESE WERE FIRST IN
HUMAN EARLY STATE TRIALS, THESE
ARE DONE IN PARTNERSHIP WITH
DEVICE MANUFACTURER, WE COULDN'T
DO IT WITHOUT THEM.
THERE'S THAT.
BUT I DIDN'T HAVE TIME TO SHOW
YOU IN THE -- THIS IS A HUGE,
HUGE ENDEAVOR, SO WHAT I DIDN'T
GET INTO IS WHAT THE
COMPUTATIONAL DEMANDS ARE GOING
TO BE, WHAT THE THEORETICAL
DEMANDS ARE.
SO JEFF LICTMAN JUST PUBLISHED A
PAPER CHARACTERIZING ALL THE
CONNECTIONS IN ONE CUBIC
MISDEMEANOMILLIMETER OF HUMAN C.
THIS WAS DONE IN COLLABORATION
WITH GOOGLE RESEARCH, SO AGAIN A
GREAT EXAMPLE OF A
PUBLIC-PRIVATE PARTNERSHIP.
BASICALLY GOOGLE PUT IN THEIR
OWN RESOURCES TO DO THIS.
THAT 1 CUBIC MILLIMETER OF
57,000 CELLS AND I CAN'T
REMEMBER HOW MANY SOME ODD
MILLION CONNECTIONS OCCUPIED ONE
PETABYTE OF DATA, OKAY?
NOW, A MOUSE BRAIN IS ROUGHLY
THREE -- LARGER, SO IN ORDER TO
DO A COMPLETE MOUSE BRAIN AT
SYNAPSE RESOLUTION WHICH THEY
HAD, AND IT NOT EVEN FULLY
PROOFREAD, WOULD BE AN EXOBYTE,
SO A THOUSAND PETABYTES, SO
BASICALLY A MILLION LAPTOP
COMPUTERS WORTH OF STORAGE, IF A
LAPTOP COMPUTER HAS A TERABYTE.
THIS IS AN ENORMOUS CHALLENGE IN
TERMS OF NOT JUST DATA STORAGE,
BUT IN TERMS OF ANALYSIS, HOW DO
YOU MOVE IT AROUND, HOW ARE YOU
GOING TO GET IT OUT IN A USABLE
FORM TO OTHER -- TO BROADER
USERS.
IF YOU WERE TO IMAGINE THIS
CRAZY IDEA OF DOING A HUMAN
BRAIN, THAT'S ANOTHER THOUSAND
TIMES.
THAT'S A ZETABYTE, WHICH IS A
THOUSAND EXOBYTES.
IT'S ABOUT THE WORLD'S INTERNET
TRAFFIC OVER A YEAR.
IT'S CRAZY.
RIGHT NOW WE DON'T HAVE THE
TECHNOLOGY TO DO A WHOLE MOUSE
BRAIN BUT WE'RE GETTING THERE.
FROM THE TIME WE CONCEIVED OF
THE PROJECT TO THE TIME WE
FUNDED THE FIRST ONES, THE
ABILITY TO SEGMENT THE CELLS AND
PROCESSES IN THESE IMAGES HAS
GONE UP TREMENDOUSLY.
AND I THINK WE CAN DO IT.
IT'S A CHALLENGE BUT I THINK --
LOOK, THE CHALLENGE IS WE HAVE
TO SCALE BY A FEW ORDERS OF
MAGNITUDE BUT THE GOOD NEWS IS
IT'S ONLY THREE HOURS OF
MAGNITUDE.
WE'VE ALREADY FA TASKED THE GROP
TO NOT JUST DEVELOP THE
TECHNOLOGIES AND HAVE THE TOOLS
TO SHOW FOR IT, BUT WE'VE
DEMANDED THAT THEY ACTUALLY
DEVELOP THE TOOLS ON A BIG
ENOUGH HUNK ON THE BRAIN THAT WE
CAN ACTUALLY USE THE INFORMATION
MOVING FORWARD.
SO THE CONNECT PROJECT TOGETHER
WITH THE BI CAM PROJECT, WE'RE
FOCUSED ON BASAL GANGLIA TO
DEVELOP A COMPREHENSIVE CELL
ATLAS, WE ALREADY HAVE THAT IN
THE MOUSE, BUT ALSO TO DEVELOP A
CONNECTIVITY MAP.
CAN YOU IMAGINE ALL THE
DIFFERENT PROCESSES BASAL
GANGLIA IS IMPORTANT IN,
ESPECIALLY IN AREAS OF MOTOR
FUNCTION, REWARD, ADDICTION,
WHAT HAVE YOU.
WE'RE NOT JUST GOING TO HAVE THE
TOOLS TO -- BUT GREAT ACTUAL
INFORMATION TO DO A LOT OF GREAT
RESEARCH, HENCEFORTH.
>> THANKS VERY MUCH.
>> ARE WE GOING TO BREAK NOW?
>> WE'RE A LITTLE BIT BEHIND.
IT'S 3:10 NOW.
WHY DON'T WE START BACK UP AT 3:25.
IT'S A PLEASURE FOR ME TO
INTRODUCE DR. VANI PARIYADATH,
DR. ALEXA ROMBERG, AND THE OTHER
FROM THE DEPUTY BRANCH CHIEF,
PREVENTION RESEARCH BRANCH OF
DESPR, AND THEY'RE GOING TO BE
SPEAKING ABOUT ADVANCING SOCIAL
DETERMINANTS OF HEALTH IN THE
DNB AND DESPR PORTFOLIO.
VANI, ALEXA.
>> THANK YOU.
IT'S A PLEASURE TO BE HERE.
I'M ALEX IS A ROMBERG, THE P IN
DESPR.
I'M HERE WITH VANI PARIYADATH,
BRANCH CHIEF FOR THE BEHAVIORAL
AND COGNITIVE NEUROSCIENCE
BRANCH IN DNB.
AND IN OUR LAST COUNCIL MEETING,
AND EVEN EARLIER TODAY IN THIS
COUNCIL MEETING, SOME QUESTIONS
ABOUT HOW NIDA IS ADDRESSING
SOCIAL DETERMINANTS OF HEALTH
CAME UP, AND THIS IS SOMETHING
THAT WE THINK ABOUT BASICALLY
ALL THE TIME AND WE ALSO
COLLABORATE WITH VANI AND DNB ON
SO WE THOUGHT THIS WOULD BE A
GREAT CHANCE TO TAKE A FEW
MINUTES TO DISCUSS FURTHER.
IN OUR 30 MINUTES TODAY, VANI
AND I WOULD LIKE TO SHARE WITH
YOU WAYS THAT DESPR AND DNB ARE
ADDRESSING SOCIAL DETERMINANTS
OF HEALTH IN OUR EXTRAMURAL
RESEARCH PORTFOLIOS.
WE'D ALSO LIKE TO HIGHLIGHT
AREAS OF SCIENTIFIC OVERLAP,
RELEVANT BETWEEN THE DIVISIONS
AND SOME OF OUR COLLABORATIONS
AND THEN WE'D ALSO LIKE TO LEARN
THROUGH DISCUSSION WITH YOU I
HOPE SOME NEW IDEAS TO REALLY
FOSTER IMPACTFUL SCIENCE ON
SDOH.
THE DIAGRAM ON THE RIGHT IS
PROBABLY FAMILIAR TO YOU AT THIS
POINT.
THE NIH SOCIAL DETERMINANT OF
HEALTH RESEARCH COORDINATING
COMMITTEE OFFERS THE
CONCEPTUALIZATION THAT SOCIAL
DETERMINANTS OF HEALTH ARE THE
CONDITIONS IN WHICH PEOPLE LIVE
IN THE WIDER SET OF STRUCTURAL
FACTORS SHAPING THE CONDITIONS
OF DAY LEA LIFE.
DAILY LIFE.
AS NORA REFERRED TO EARLIER,
NIDA, LIKE MANY PARTS OF NIH,
ARE REALLY INTERESTED IN THE
SOCIAL AND ENVIRONMENTAL AND
STRUCTURAL FACTORS AND MOVING
BEYOND CONE ACCEPT ACTUALIZATION
OF HEALTH, THAT FOREGROUND OF
ONLY INDIVIDUAL LEVEL
CHARACTERISTICS.
SO THE REVERY M RESEARCH FRAMEWK
CREATED BY THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DISPARITIES IS A USEFUL
TOOL FOR MAKING THIS MOVE BEYOND
THE INDIVIDUAL KIND MORE
CONCRETE.
THE RESEARCH FRAMEWORK REFLECTS
FACTORS RELEVANT TO PROMOTING
HEALTH OVERALL AND FOR REDUCING
HEALTH DISPARITIES.
I'M NOT GOING TO GO THROUGH THIS
MATRIX IN DETAIL, AS MANY OF YOU
ARE ALREADY LIKELY FAMILIAR WITH
IT, BUT THE DESPR AND DNB
PORTFOLIOS COVER A LOT OF THE
BOXES WITHIN THIS MATRIX IN
DIFFERENT WAYS ACROSS THE
VARIOUS BRANCHES AND DIVISIONS.
THERE ARE SEVERAL WAYS WE CAN
THINK ABOUT HOW OUR INTERESTS
AND PRIORITIES WITHIN THE
DIFFERENT PARTS OF THIS MATRIX
ARE GOING TO FEED INTO OUR STUDY
CONCEPTUALIZATIONS AND RESEARCH
CONCEPTUALIZATIONS AND WHETHER
THAT IS EXPLICITLY OR
IMPLICITLY, AND WHETHER THAT IS
A NIDA PROGRAM STAFF WRITING A
NOTICE OF FUNDING OPPORTUNITY OR
AN INVESTIGATOR DESIGNING A NEW
RESEARCH STUDY.
SO OUR INTERESTS AND PRIORITIES
ARE GOING TO BE REFLECTED IN
WHAT WE MEASURE, THE DATA THAT
WE COLLECT AND THE WAY THAT WE
COLLECT IT.
IT IS ALSO GOING TO BE REFLECTED
IN WHAT WE DO WITH OUR ANALYSES,
WHAT WE FOREGROUND, VERSUS,
QUOTE-UNQUOTE, CONTROL FOR IN
OUR ANALYSES.
WHETHER WE TEST FOR INTERACTIONS
OR NON-LINEAR EFFECTS.
AND ALL OF THESE DECISIONS IN
TURN ARE GOING TO DETERMINE THE
TYPES OF CONCLUSIONS AND
SOLUTIONS THAT CAN FOLLOW FROM
THE RESEARCH.
SO IN ONE EXAMPLE OF THIS, I
KNOW WE ALREADY HEARD IN COUNCIL
MEETINGS AS WELL ABOUT HOW SDOH
VARIABLES ARE BEING INCORPORATED
INTO ABCD AND HBC STUDIES, A
GREAT DATA SOURCE FOR RESEARCH
ONGOING.
WE'RE NOT GOING TO REVISIT THOSE
STUDIES AS PART OF THIS TALK,
BUT THESE QUESTIONS ABOUT
MEASUREMENT AND ANALYSES REALLY
CUT ACROSS RESEARCH WITHIN DNB
AND DESPR, AND ALL THE DIFFERENT
METHODOLOGIES THAT WE USE.
SO IN ADDITION TO THIS KIND OF
MEASUREMENT QUESTION AND
ANALYTICAL QUESTION, OUR PRAY OR
THE AND INTERESTS IN THIS MATRIX
ARE ALSO GOING TO BE REFLECTED
IN WHAT WE CHOOSE TO INTERVENE
ON.
SO TO MAXIMIZE IMPACT ON HEALTH,
WE NEED TO INTERVENE AT THESE
LIKE COMMUNITY AND SOCIETAL AND
STRUCTURAL LEVELS IN ADDITION TO
THE INDIVIDUAL LEVEL.
BUT MOVING UP IN THESE LEVELS IS
QUITE CHALLENGING, AS WE THINK
ABOUT HOW TO REALLY DESIGN
INTERVENTIONS WHILE IMPLEMENTING
THEM AND TESTING THEM.
SO IN DESPR TO HELP US BUILD A
RESEARCH PORTFOLIO THAT INFORMS
AND TESTS INTERVENTIONS THAT CAN
HAVE AN IMPACT, WE'VE BEEN ADD
VO CAUGHTING FOR RESEARCH
INFORMED BY WHAT WE TERMED THE
SPECS PRINCIPLES, ORIGINALLY
KIND OF DEVELOPED AND
ARTICULATED BY OUR SRB BRANCH,
AND THESE INCLUDE
SUSTAINABILITY, PATIENT AND
STAKEHOLDER ENGAGEMENT, EQUITY,
CONNECTING RESEARCH TO PRACTICE,
AND SCALABILITY.
SO THESE PRINCIPLES REALLY
ENCOURAGE SCIENCE THAT IS FIRMLY
ROOTED IN THE COMMUNITIES THAT
ARE MEANT TO BENEFIT FROM THE
RESEARCH, AS WELL AS BRINGING IN
VOICES OF THOSE THAT WORK IN THE
SYSTEMS, IN THE SETTINGS, THAT
MAY PAY FOR THE INTERVENTIONS OR
IMPLEMENT THE INTERVENTIONS.
AND HERE I WANT TO HIGHLIGHT, AS
I WAS TALKING ABOUT WHAT DO WE
CHOOSE TO MEASURE, WHAT DO WE
CHOOSE TO ANALYZE, THAT WE IS
VERY OPEN AND WE SHOULDN'T ONLY
BE THOSE WITH PH.D.s WHO DO
RESEARCH FULL TIME FOR A LIVING,
MAKING THOSE DECISIONS, BUT
BRINGING THOSE OTHER VOICES IN
TO MAKE REALLY WELL INFORMED
DECISIONS.
BRINGING TOGETHER THE PARTNERS
NEEDED TO INTERVENE ON
STRUCTURAL FACTORS IS QUITE
DIFFICULT.
IT NECESSARILY INVOLVES
COMMUNITY PARTNER, BUT ALSO
PARTNERS IN GOVERNMENT AND
SERVICE SYSTEMS.
AND YOU KNOW, WE TALK A LOT
ABOUT, I THINK, THE DIFFICULTY
OF MULTIDISCIPLINARY RESEARCH
WITHIN ACADEMIA, BUT IT'S NOT
JUST THE SCIENCE THAT'S SILOED.
IT'S ALSO THE FACT THAT THESE
SERVICE SYSTEMS ARE NOT DESIGNED
TO WORK WELL TOGETHER, MUCH LESS
TO DO RESEARCH, OR PARTICIPATE
IN A RESEARCH CONTEXT.
SO IN ADDITION, THERE CAN BE A
STEEP LEARNING CURVE FOR
INVESTIGATORS WHO WERE TRAINED
POTENTIALLY ON HOW TO WORK WITH
INTERVENTIONS THAT ARE REALLY
FOCUSED AT THE INDIVIDUAL LEVEL
IN MOVING UPSTREAM TO THOSE KIND
OF COMMUNITY OR STRUCTURAL
LEVELS AS WELL.
ONE TOOL THAT WE TURN TO IN
DESPR TO HELP ADDRESS THESE
CHALLENGES IS THE USE OF PHASED
MECHANISMS.
SO WE NOW HAVE NOFOs, KIND OF
STANDING NOFOs WITH LOTS OF
RECEIPT DATES THAT COVER BOTH
HEAL AND NON-HEAL RESEARCH
TOPICS THAT USE THE
R61/R33 MECHANISM.
SO THE R61 PHASE IS
MILESTONE-DRIVEN, IS MEANT TO BE
EXPLORATORY, IT'S KIND OF LIKE A
BIG R21, AND THE CONTINUATION TO
THE R33 PHASE IS DEPENDENT ON
MEETING THOSE MILESTONES.
SO THE ADVANTAGE THIS AFFORDS US
IS THAT IT ENABLES WORK IN THE
R61 PHASE TO BE COMPENSATED
COLLABORATIVE WORK BY THE STUDY
TEAM TO REALLY PREPARE THE STUDY
FOR THE BIG PHASE, THE
R33 PHASE.
SO THE STUDY TEAM MEMBERS
INCLUDING THOSE COMMUNITY
PARTNERS OR SYSTEM-LEVEL
PARTNERS OR GOVERNMENT PARTNERS
CAN WORK ON, FOR EXAMPLE,
GETTING ADMINISTRATIVE LEGWORK
OUT OF THE WAY AND OVERCOMING A
LOT OF THOSE HURDLES IN PLACE
FOR STRUCTURAL INTERVENTIONS.
ESTABLISHING FEASIBILITY OF THE
STUDY.
REFINING HYPOTHESES THAT ARE
FULLY INFORMED BY WHAT THE
VARIOUS PERSPECTIVES AND
CONSTRAINTS MAY BE ON THE
INTERVENTION.
AND THAT ALLOWS NIDA TO END THE
THE -- AND THE STUDY TEAM TO
EACH WORK OUT SOME OF THOSE
CHALLENGES BEFORE WE COMMIT TO A
FULL TRIAL IN THE R33 PHASE.
SO ONE OF THE THINGS THAT I
WOULD LIKE TO KIND OF TALK ABOUT
IN OUR DISCUSSION TIME AFTER
THIS IS TO HEAR IDEAS FROM YOU
AS COUNCIL ABOUT WAYS THAT WE
COULD BUILD ON THIS FOUNDATION.
WHETHER THERE ARE SPECIFIC WAYS
THAT YOUR INSTITUTIONS ARE
SUPPORTING YOU OR FAILING TO
SUPPORT YOU, TO BUILD THE KINDS
OF PARTNERSHIPS AND STUDY TEAMS
THAT ARE NEEDED FOR THESE HIGHER
LEVEL INTERVENTIONS, AND REALLY
HOW NIDA CAN LEARN FROM THOSE
SUCCESSES AND CHALLENGES.
SO DESPR HAS FUNDED A LOT OF
PROJECTS THAT TARGET SOCIAL
DETERMINANTS OF HEALTH THROUGH
BOTH TARGETED APPLICATIONS AND
INVESTIGATOR INITIATED
SUBMISSIONS.
SO AS AN EXAMPLE, THE BOXES ON
THIS SLIDE ARE SOCIAL
DETERMINANT OF HEALTH DOMAINS
THAT ARE TARGETED WITHIN THE
HEAL PREVENTING OUD INITIATIVE.
YOU CAN SEE IT'S A WIDE VARIETY
OF DOMAINS WITH SOME POTENTIALLY
MORE INDIVIDUALLY FOCUSED AND
SOME POTENTIALLY MORE
STRUCTURALLY FOCUSED.
LOOKING AT THIS LIST IT'S CLEAR
THE INTERVENTIONS IN THESE AREAS
ARE GOING TO IMPACT A LOT MORE
THAN JUST SUBSTANCE USE OR OUD.
RATHER, WE'D EXPECT
INTERVENTIONS IN THESE DOMAINS
TO IMPACT MANY AREAS OF MENTAL,
BEHAVIORAL, PHYSICAL HEALTH ANDD
WELL-BEING.
SO THIS BRINGS ME TO ANOTHER
AREA WHERE WE WOULD REALLY LIKE
YOUR FEEDBACK.
WE THINK ABOUT THE POTENTIAL
GENERALITY OF EFFECTS OF
INTERVENTIONS ON SOCIAL
DETERMINANTS OF HEALTH, ARE
THERE SPECIFIC DOMAINS THAT YOU
AS COUNCIL THINK THAT WE SHOULD
ESPECIALLY PRIORITIZE OR FOCUS
ON?
ARE THERE AREAS THAT YOU THINK
THAT NIDA COULD MAKE THE LARGEST
ILIMPACT.
I WANTED TO END MY SESSION BY
GIVE YOU GO AN UPDATE ON THE
NIDA RACIAL EQUITY
COLLABORATIVE.
THIS IS FUNDED THROUGH NOFOs
THAT WERE RELEASED ABOUT TWO
YEARS AGO.
THIS COLLABORATIVE IS A REAL
COLLABORATION BETWEEN DESPR AND
DNB.
THE SCIENCE SPANS FROM BASIC TO
APPLIED.
AND IT'S REALLY THAT DIVERSITY
OF PERSPECTIVES, AND SCIENTIFIC
METHODS, THAT MAKES THIS
COLLABORATIVE SO EXCITING.
THERE ARE NOW 19 RESEARCH
PROJECTS THAT ARE FUNDED THROUGH
THE COLLABORATIVE, AS WELL AS
THE COORDINATING CENTER, AND THE
COORDINATING CENTER IS REALLY
FOCUSED ON PROVIDING SUPPORT FOR
PROJECTS IN THE AREAS OF
COMMUNITY ENGAGEMENT OF WORKING
EFFECTIVELY WITH THEIR COMMUNITY
PARTNERS, AND DISSEMINATING TO
LAY AND ACADEMIC CHANNELS AS
WELL.
SO BECAUSE THIS COLLABORATIVE IS
REALLY FOCUSED ON RACIAL EQUITY
AND REDUCING HEALTH DISPARITIES
RELATED TO SUBSTANCE USE FOR
RACIAL AND ETHNIC MINORITIZED
POPULATIONS, IT WON'T COME AS A
SURPRISE TO YOU THAT A LOT OF
THE PROJECTS INTERSECT WITH
SOCIAL DETERMINANTS OF HEALTH.
I'VE GOT A FEW OF THEM UP THERE.
INCLUDING THINGS LIKE
TRADITIONAL CULTURAL ENGAGEMENT
FOR NATIVE AMERICAN COMMUNITIES,
NEIGHBORHOOD LEVEL STRUCTURAL
RACISM, EMERGENCY MEDICAL
SERVICES, AND TREATMENT SYSTEMS
FOR OUD.
SO THE QR CODE IN THE TOP RIGHT
OF THE SLIDE WILL TAKE YOU TO
THE COORDINATING CENTER WEBSITE
WHERE CAN YOU GET A LOT MORE
INFORMATION ABOUT THE
COLLABORATIVE.
THE ONE ON THE BOTTOM RIGHT OF
THE SCREEN IS GOING TO TAKE YOU
TO THE LIST OF FUNDING
OPPORTUNITIES.
WE'VE GOT ONE MORE ROUND OF DUE
DATES AVAILABLE FOR THIS
COLLABORATIVE BEFORE THOSE
RFAs CLOSE IN NOVEMBER.
SO I'D LIKE TO HAND IT OVER TO
VANI TO TELL YOU MORE ABOUT DNB.
>> THANKS, ALEX IS A.
SO I'M A.I'M GOING TO SWITCH TOK
ABOUT DNB'S PORTFOLIO IN THIS
SPACE.
IT'S GOING TO FEEL LIKE A
SLIGHTLY DIFFERENT PRESENTATION.
THAT'S BECAUSE FOR US, WE'RE AT
A MUCH MORE NASCENT STAGE IN
TRYING TO UNDERSTAND AND
INCORPORATE SOCIAL DETERMINANTS
OF HEALTH SO WE'RE STILL
LEARNING FROM OUR COLLEAGUES IN
DESPR AND BEYOND AND OF COURSE
ARE HOPING FOR FEEDBACK FROM ALL
OF YOU TO TRY TO DO THIS BETTER.
SO LET ME START BY TALKING ABOUT
WHY WE EVEN NEED TO THINK ABOUT
SOARNL DETERMINANTS IN
NEUROSCIENCE.
SO TRADITIONALLY NEUROSCIENCE
MODELS HAVE DEALT WITH
INDIVIDUAL LEVEL VARIABLES BUT
WITH MORE RECENT STUDIES WE'VE
LEARNED THAT BY INCLUDING
VARIOUS SOCIAL AND PHYSICAL
ENVIRONMENTAL VARIABLES, WE CAN
ARRIVE AT A MUCH MORE KN NUANCE,
MUCH MORE COMPLETE PICTURE OF
THE IMPACT ON REAL WORLD
OUTCOMES.
SO HERE FOR EXAMPLE IS A PAPER
THAT YOU'VE SEEN AT I THINK NORA
PRESENT AT A PREVIOUS COUNCIL
MEETING, IT USE THE ABCD DATA
SET AND THEY WERE BEING LOOKING
AT THE IMPACT OF LOW INCOME ON
HIPPOCAMPAL VOLUME.
IMPORTANTLY WHAT THEY FOUND WAS
THAT WHEN THEY INCLUDED
INFORMATION ABOUT STATE LEVEL
ANTIPOVERTY PROGRAMS, THEY GOT A
MUCH MORE -- A MUCH DIFFERENT
UNDERSTANDING THAN WHAT WE HAD
PREVIOUSLY.
THEY SAW A MUCH BIGGER IMPACT OF
THE STATE LEVEL INTERVENTIONS
THAN THE BASIC ASSOCIATION
BETWEEN INCOME AND BRAIN
STRUCTURE.
SO IN GENERAL, WHAT WE'RE HOPING
FOR BY INCLUDING SOCIAL
DETERMINANTS IS TO CONSTRAIN,
INFORM AND IMPROVE OUR
BIOLOGICAL EXPLANATIONS.
SO ULTIMATELY THE GOAL IS TO BE
ABLE TO IDENTIFY MALLEABLE
CIRCUITS AND/OR BEHAVIORAL
CONSTRUCTS FOR CONTEXTUALLY
RELEVANT INTERVENTIONS.
SO WITH THAT IN MIND, WE'VE BEEN
TRYING TO ADVANCE FROM MODELS
THAT LOOK AT BRAIN IN A VACUUM
TO ONES THAT INCORPORATE
INTERACTIONS BETWEEN THE BRAIN
AND THE BROADER SOCIAL AND
PHYSICAL ENVIRONMENT.
SO IN TAKING THIS ON, WE'VE
IDENTIFIED A FEW CHALLENGES THAT
NEED TO BE ADDRESSED.
SO FIRST OFF, WHAT ARE THE
ASPECTS OF THE ENVIRONMENT THAT
MATTER MOST, WHETHER WE'RE
TALKING ABOUT INDIVIDUAL,
INTERPERSONAL OR STRUCTURAL
LEVEL VARIABLES.
AND TO GET AT THIS, WE'RE TRYING
A COUPLE OF DIFFERENT
STRATEGIES.
SO ONE IS WE'RE TURNING TO A
BROADER RANGE OF EXPERTISE THAN
WE TYPICALLY INCLUDE IN
NEUROSCIENCE STUDIES, SO SHOWN
HERE, FOR EXAMPLE, IS TEXT FROM
ONE OF OUR ACTIVE FUNDING
ANNOUNCEMENTS, WHERE WE'RE
EXPLICITLY ASKING INVESTIGATORS
TO BRING IN EXPERTISE NOT JUST
IN NEUROSCIENCE AND PSYCHOLOGY,
BUT ALSO BRING IN ANTHROPOLOGY,
SOCIOLOGY OR OTHER FIELDS AS
NEEDED FOR THE QUESTIONS THAT
THEY'RE ASKING.
THE OTHER THING THAT WE'RE
TRYING TO DO MORE IS ENCOURAGE
MORE COMMUNITY PARTNERED
RESEARCH, WHICH WE HEARD ABOUT A
LOT TODAY.
AS WITH OTHER DOMAINS, EVEN IN
OUR LABORATORY-BASED STUDIES,
WE'VE SEEN THAT COMMUNITY
PARTNERED RESEARCH CAN HELP
DEVELOP MORE RELEVANT RESEARCH
QUESTIONS, CAN HELP ADDRESS
UNDERREPRESENTATION OF
MARGINALIZED GROUPS, AND
FINALLY, JUST GENERALLY IMPROVE
STUDY VALIDITY.
AND I WANT TO POINT OUT THAT
THESE ARE NOT EXPECTATIONS THAT
WE'RE ONLY HOLDING FOR OUR
INVESTIGATORS.
THIS IS ALSO A STANDARD WE'RE
HOLDING OURSELVES TO.
SO FOR EXAMPLE, LIKE I SAID,
WE'RE TRYING TO LEARN FROM OUR
COLLEAGUES IN DESPR AND OTHER
ICs AT THE NIH TO GET AT THAT
BROADER EXPERTISE THAT WE DON'T
NECESSARILY HAVE OURSELVES.
SO WITH THAT IN MIND, YOU HEARD
A LITTLE BIT ABOUT THIS WORKSHOP
EARLIER TODAY.
SO THIS WAS A HEAL WORKSHOP THAT
WAS HELD EARLIER THIS YEAR LED
BY DR. JOHN FIDOTA, ALONG WITH A
TEAM FROM DNB, DESPR AND DTMC.
SO AGAIN, SPEAKING TO BRINGING
THAT BROADER EXPERTISE TO
UNDERSTAND RECOVERY WITHIN THE
BROADER SOCIAL AND ENVIRONMENTAL
CON TECH.
SO ONE OF THE REALLY IMPORTANT
FEATURES OF THIS WORKSHOP WAS
THAT THERE WAS AN ENTIRE PANEL
FOCUSED ON PEOPLE WITH LIVED
EXPERIENCES.
I CANNOT EMPHASIZE ENOUGH HOW
TRANSFORMATIVE THIS WAS FOR A
LOT OF US AT LEAST IN THE
NEUROSCIENCE SIDE, IN WERE A LOT
OF INSIGHTS THAT WE GOT, A LOT
THAT WE LEARNED AND THAT IS
MAKING US RE-EVALUATE HOW WE'RE
THINKING ABOUT LONG TERM
RECOVERY.
THAT QR CODE UP TOP SHOULD TAKE
YOU TO THE WEBSITE, INCLUDING
RECORDINGS FROM THAT MEETING AND
I STRONGLY ENCOURAGE TAKING A
LOOK.
THE SECOND CHALLENGE WE'RE
TRYING TO ADDRESS IS HOW DO WE
GO ABOUT ASSAYING THE
ENVIRONMENT COMPREHENSIVELY AND
EFFICIENTLY.
BECAUSE IN TRYING TO GET A
PICTURE OF THE HOST ENVIRONMENT,
WE DON'T WANT TO INCREASE THE
BURDEN ON THE PARTICIPANT, AND
AT THE END OF THE DAY, WE WANT
TO BROADEN ACCESSIBILITY.
SO WE HAVE MULTIPLE EFFORTS
UNDERWAY THAT SEEK TO TRY TO
UNDERSTAND BARRIERS TO
PARTICIPANT ENGAGEMENT AND ALSO
TRY TO ADDRESS THEM BY
DEVELOPING NOVEL STRATEGIES, SO
FOR EXAMPLE, DEVELOPMENT OF
REMOTE ASSESSMENT TOOLS.
THE OTHER THING THAT WE'RE
TRYING TO DO IS ALSO CAPTURE
VARIABILITY OVER TIME.
AND TO BE ABLE TO GET AT THESE
SPAISH YO SPATIAL TEMPORAL PROJ,
APPROACHES LIKE THIS BRAIN
INITIATIVE PROGRAM THAT YOU
HEARD ABOUT EARLIER TODAY, TO
GET AT THESE CONTEXTS IN BOTH
ANIMAL MODELS AS WELL AS IN
HUMAN STUDIES.
SO FINALLY LET'S ASSUME WE HAVE
ALL THIS COMPREHENSIVE DATA, HOW
DO WE UNCOVER COMPLEX DYNAMIC
PATTERNS IN THIS DATA BECAUSE
REALLY WE'RE TALKING ABOUT BOTH
MULTIDIMENSIONAL AS WELL AS
MULTILEVEL VARIABLES.
SO TO GET AT THIS ASPECT, WE'RE
REALLY ENCOURAGING A COMBINATION
OF NOVEL COMPUTATIONAL AND
STATISTICAL APPROACHES COMBINED
WITH EXTANT CONCEPTUAL MODELS
THAT CAN GET US A BETTER -- A
MORE NUANCED PICTURE OF THE
COMPLEX POTENTIALLY NON-LINEAR
RELATIONSHIPS BETWEEN THESE
VARIABLES.
SO FINALLY, WE'LL BE COMING FULL
CIRCLE BY ALSO PARTNERING WITH
COMMUNITIES, IMPACTED
COMMUNITIES IN HOW WE THINK
ABOUT INTERPRETATION.
BOTH BECAUSE WE NEED THAT ADDED
CONTEXT AND ALSO WE DON'T WANT
TO EXACERBATE STIGMA IN THESE
AREAS.
SO WITH THESE CHALLENGES IN
MIND, WE'VE ISSUED A SERIES OF
FUNDING ANNOUNCEMENTS SINCE
2018.
AND BRINGING BACK THIS NIMHD
FRAMEWORK THAT ALEXA SHOWED
EARLIER.
WHEN YOU LOOK AT THE PLACES
WHERE OUR FUNDING ANNOUNCEMENTS
HAVE BEEN TRYING TO MAKE SOME
MOVEMENT, THE DOMAINS THEY'VE
BEEN FOCUSED ON, NOT
SURPRISINGLY YOU SEE MOST OF THE
EMPHASIS IS IN THAT TOP LEFT
QUADRANT THAT FOCUSES ON THE
INDIVIDUAL AND INTERPERSONAL
LEVELS OF INS FLEUNS OR
BIOLOGICAL OR BEHAVIORAL DOMAINS
OF INFLUENCE.
WITH A LITTLE BIT SMASHING IN
OTHER PARTS OF THE THAT MATRIX.
AS WE SEE IT NOW, IT SEEMS
ALMOST IMPOSSIBLE TO GET AT THAT
LOWER RIGHT QUADRANT FOCUSING ON
SERVICES AND IMPLEMENTATION IN
OUR INDIVIDUAL PROJECTS.
SO ONE OF THE THINGS WE'D LOVE
TO HEAR FROM YOU IS IF THERE ARE
CREATIVE WAYS TO INCORPORATE
THIS IMPORTANT INFORMATION INTO
OUR PROGRAM AS A WHOLE, PERHAPS
AT A HIGH LEVEL.
SO I ALSO WANT TO TALK ABOUT
TRYING TO UNDERSTAND HOW WE KNOW
IF ANY OF THIS IS WORKING,
BECAUSE IN PREVIOUS COUNCIL
MEETINGS, WE'VE BEEN ENCOURAGED
TO THINK ABOUT METRICS AS WE
UNDERTAKE NEW INITIATIVES.
SO THIS IS VERY EARLY DAYS FOR
US OF COURSE, SO WE START OFF BY
JUST LOOKING AT WHETHER OUR
TARGETED NOFOs ARE BRINGING IN
MORE APPLICATIONS IN THE SPACE.
SO 2018 IS WHEN THAT FIRST NOFO
WENT OUT, THEN YOU HAD A SERIES
OF OTHERS BACKING THEM UP, AND
YOU SEE THAT AT MINIMUM, THE
NUMBER OF APPLICATIONS HAVE BEEN
GOING UP.
MORE IMPORTANTLY, WE'RE SEEING
THAT THEY'RE BEING RECEIVED
BITTBITBETTER IN REVIEW, SO THEN
SCORES ARE IMPROVING, YOU'RE
GENERALLY SEEING A SHIFT IN THE
DISTRIBUTION OF SCORES TO THE
LEFT OVER TIME, AND ULTIMATELY
GIVING US MORE APPLICATIONS THAT
ARE DEEMED MERITORIOUS TO
CONSIDER.
SO THE REAL QUESTION IS, ARE WE
STIMULATING IMPACTFUL RESEARCH.
AGAIN THIS IS OBVIOUSLY REALLY
EARLY DAYS, SO WE CAN LOOK THE A
PUBLICATIONS, AND SURE, THE
EARLY PUBLICATIONS SEEM TO HAVE
MORE IMPACT AS COMPARED TO THEIR
FIELD BASED ON THE RELATIVE
CITATION RATIO.
BUT REALLY WHAT WE WANT TO KNOW
IS WHETHER WE'RE HAVING AN
IMPACT ON REAL WORLD OUTCOMES.
THE GOAL FOR US IS TO BE ABLE TO
MAKE THIS RELATIONSHIP
RECIPROCAL WHERE WE CAN GIVE
INFORMATION ABOUT -- TOWARDS
DEVELOPING NOVEL INTERVENTIONS
TO OUR COLLEAGUES AT DTMC AND
DESPR.
HOPEFULLY WE'LL BE THERE IN THE
NEXT FEW YEARS.
SO I WANT TO END BY TALKING
ABOUT ONE SPECIFIC PROGRAM.
A LOT OF WHAT I DISCUSSED TODAY
DEALT WITH HUMAN NEUROSCIENCE.
SO THIS IS AN EXAMPLE -- THIS
PROGRAM IS CALLED TRANSINDA,
TRYING TO UNDERSTAND THE IMPACT
OF EARLY LIFE SOCIOENVIRONMENTAL
FACTORS IN NON-HUMAN MODELS, AND
USING A CONSORTIUM APPROACH, AND
THE HOPE IS TO UNDERSTAND THE
INFLUENCE OF THESE FACTORS ON
BRAIN AND BEHAVIOR OVER
DEVELOPMENT AND ULTIMATELY LOOK
AT THE IMPACT THAT HAS ON
SUBSTANCE USE-RELATED BEHAVIORS
IN ADOLESCENTS AND EARLY
ADULTHOOD.
SO THIS IS JUST TO GIVE YOU AN
EXAMPLE OF THE WAY THAT OUR
RESEARCH SUNDAYGOING A CHANGE
ALL THE WAY EVEN INTO OUR
PRE-CLINICAL RESEARCH IN ANIMAL
MODELS.
AND HOPEFULLY WE'LL HAVE UPDATE
ON THIS AS WELL IN A FEW YEARS.
SO I WANT TO END BY THANKING THE
ARMY OF PEOPLE WHO'VE BEEN
LEADING THE VARIOUS EFFORTS WE
DISCUSSED TODAY.
OR BEEN INVOLVED WITH THEM IN
OTHER WAYS.
AND I WILL LEAVE THIS LIST OF
DISCUSSION QUESTIONS THAT WE
BROUGHT UP OVER THE COURSE OF
THIS TALK.
AGAIN WE'D LOVE TO HEAR YOUR
FEEDBACK AND WE'RE HAPPY TO
ANSWER ANY QUESTIONS TOO.
THANK YOU.
>> HI, VANI.
GREAT PRESENTATION.
I'M REALLY INTERESTED IN THE
POINT YOU MADE ABOUT HOW THAT
LOWER QAW DRAP QUADRANT OF THE H
FRAMEWORK IS SORT OF
UNADDRESSED, AND I'M THINKING
SPECIFICALLY ABOUT THE MASSIVE
IMPACT THAT GETTING RESIDENTIAL
HISTORY IN THE ABCD STUDY HAS
HELPED GET SOME OF THOSE
SOCIETAL LEVEL, STATE LEVELS,
MEGAN H ERDING'S LAB HAS PUT SO
MUCH EFFORT INTO HELPING WITH
THE DATA COLLECTION, PULLING THE
DATA, GETTING EVERYTHING SO THAT
IT'S AVAILABLE FOR FOLKS TO USE.
SO WHY NOT IMPLEMENT SOMETHING
LIKE THAT?
AS A NEUROIMAGER, I CAN GET YOU
THE BRAIN IMAGING DATA, I CAN
GET YOU THE INDIVIDUAL AND THE
INTERPERSONAL DATA, BUT I DON'T
HAVE THE EXPERTISE TO THEN GO UP
AND GRAB THOSE ADDITIONAL
MULTILEVEL MEASUREMENTS THAT ARE
SO NEEDED.
I'D BE MORE THAN HAPPY TO SHARE
MY DATA, SO MAYBE THINKING SORT
OF LARGELY ABOUT SHARING WITH
PEOPLE LIKE ME HOW TO COLLECT
RESIDENTIAL HISTORY, BECAUSE I
SPENT AN HOUR WITH MEGAN JUST TO
GET A TINY LITTLE GLIMPSE OF HOW
COMPLICATED THAT ACTUALLY IS.
AND THEN HOW TO LINK TO THOSE
EXTERNAL DATASETS.
SO HAVING SOME MECHANISM OF
SUPPORT THAT ALLOWS PEOPLE LIKE
ME WHO GET THE INDIVIDUAL LEVEL
DATA TO THEN MAYBE EXPAND OUR
DATASETS IS SOMETHING THAT
POPPED INTO MY HEAD.
>> THAT'S A REALLY GREAT POINT.
I JUST WANTED TO CHECK WHEN YOU
SAY SUPPORT, DO YOU MEAN -- IS
IT JUST FINANCIAL SUPPORT OR
ALSO RESOURCES IN TERMS OF --
>> BOTH.
YOU'RE GOING TO GIVE ME MONEY TO
DO IT BUT YOU'RE GOING TO BE
ABLE TO DO FASTER AND BETTER
BECAUSE YOU ALREADY HAVE THE
KNOW-HOW HOW TO DO THAT.
>> I'M JUST SMILING BECAUSE
WE'VE HAD -- THESE ARE THE EXACT
CONVERSATIONS THAT WE'VE HAD.
AND IT'S AN AMAZING POINT.
THANK YOU.
>> THANKS FOR THIS.
I HAD A QUESTION ABOUT ON YOUR
DISCUSSION QUESTIONS, YOU TALK
ABOUT HOW THESE SOCIAL
DETERMINANTS OF HEALTH TARGET --
HEALTHMANY AREAS OF HEALTH, NOTY
SUBSTANCE USE, AND ONE AREA
THAT'S OBVIOUSLY -- THERE'S A
LOT OF THAT THAT'S A LITTLE --
FROM BRAIN DISORDERS IS
CERTAINLY CRIMINAL JUSTICE
INVOLVEMENT.
I KNOW YOU HAVE TRAUMA HERE.
I'M AT GEORGETOWN.
I THINK A LOT ABOUT
WASHINGTON, D.C. AND THE IMPACT
OF INTERGENERATIONAL TRAUMA AS A
RESULT OF CRIMINAL JUSTICE
INVOLVEMENT.
SO I GUESS THAT'S ONE OF THE
QUESTIONS THAT I HAD OR ISSUES
TO RAISE, IS HOW YOU'RE LOOKING
AT THAT, THE INTERGENERATIONAL
IMPACT OF CRIMINAL JUSTICE
INVOLVEMENT.
>> YEAH, THAT'S GREAT TO --
THANK YOU FOR RAISING THAT.
YOU'RE LIKELY FAMILIAR WITH
JCOIN, SO WORKING A LOT IN
INTEGRATING OPIOID TREATMENT IN
CARCERAL SETTINGS.
WE ALSO HAVE RESEARCH IN OUR
PREVENTION PORTFOLIO, FOR
EXAMPLE, LOOKING AT IMPLEMENTING
PREVENTION PROGRAMS WITH YOUTH
THAT ARE INVOLVED IN THE
JUVENILE JUSTICE SYSTEM, WHETHER
THAT'S THROUGH DEFERRAL OR
THROUGH DETENTION AS WELL, AND
MANY OF THOSE YOUTH HAVE
CAREGIVERS OR PARENTS THAT HAVE
BEEN INVOLVED AS WELL, SO REALLY
LOOKING AT THOSE CASCADING
EFFECTS IS ONE WAY THAT WE ARE
ADDRESSING THIS.
IT CHALLENGING BECAUSE THOSE
SYSTEMS ARE ALWAYS CHANGING.
THEY CHANGE A LOT AFTER THE
PANDEMIC, AND GAINING ACCESS IS
ALWAYS A CHALLENGE.
IN ADDITION TO THAT SORT OF KIND
OF JUSTICE SYSTEM INVOLVEMENT,
THERE'S ALSO INTEREST IN DESPR
IN SORT OF -- THE JUSTICE SYSTEM
INVOLVEMENT, ARE THERE KIND OF
COMMON PATH TO PREVENTION, OR
HOW IS TREATMENT ACROSS THOSE
MULTIPLE KINDS OF CHALLENGES,
HOW MIGHT THAT BE EFFECTIVE OR
CROSS-EFFECTIVE?
>> I ACTUALLY HAD A QUESTION OR
COMMENT OF SORTS ABOUT THE FIRST
BULLET POINT YOU HAD THERE.
WE'VE BEEN LOOKING AT UNIVERSITY
OF ST. LOUIS AT COMMUNITY
ADVISORY BOARD, SO HAVING A
CONSTELLATION OF INDIVIDUALS WHO
CAN HELP WITH -- SDOH IN
SUBSTANCE USE DISORDER ACROSS
SCIENTIFIC FIELDS, SO HAVING
SOMEONE THAT COULD BE --
NEUROSCIENCE AS WELL AS -- SO
ONE QUESTION WE'RE TRYING TO
GRAPPLE WITH, AND THIS IS
SOMETHING EARLY INVESTIGATORS
HAVE BROUGHT UP, IS HOW -- OUR
COMMUNITY LIAISONS.
IT'S NOT -- -- ACCOUNTS AND IN
ORDER TO DO THIS -- ON A
DAY-TO-DAY BASIS BUT --
COLLEAGUES IS, IN AN EFFORT TO
BE INTENTIONAL ABOUT NOT MISUSE
THEIR TIME, WE'VE GOT TO BE ABLE
TO GET RESOURCES TO THEM
QUICKLY -- MY QUESTION WOULD BE
DO YOU HAVE ANY ADVICE ON HOW
DOES
>> THANKS FOR RAISING THAT.
IT'S A REALLY IMPORTANT POINT.
IT'S SOMETHING THAT HAS COME UP
QUITE A BIT IN DISCUSSIONS WITH
THE RACIAL EQUITY COLLABORATIVE,
AND SOMETHING THAT INVESTIGATORS
AND COORDINATING CENTER HAVE IN
SOME WAYS BEEN ABLE TO SUPPORT
EACH OTHER, BUT IT REALLY
REQUIRES INSTITUTIONAL PROCESSES
TO CHANGE, AND FOR THAT, YOU
OFTEN NEED A LITTLE BIT OF
CLOUT, RIGHT?
YOU NEED FOLKS AT MULTIPLE
CAREER STAGES WHO HAVE BROUGHT
IN FUNDING THAT UNIVERSITIES OR
OTHER RESEARCH INSTITUTIONS
REALLY WANT TO LISTEN TO BECAUSE
IT IS IMPERATIVE THAT WE ARE
COMPENSATING FOLKS FOR THEIR
TIME, AND THAT'S ONE -- AND
THOSE SHARED COMMUNITY ADVISORY
BOARDS CAN BE A REAL STRENGTH.
I KNOW THAT THEY'RE A PART OF
THE CANCER CENTERS, NCI FUNDS,
AND FOR SOME OF OUR APPLICANTS
THEY'VE BEEN ABLE TO GAIN ACCESS
THROUGH THOSE CENTERS THAT THEY
MAY HAVE AFILL YAIGS WITH.
AFFILIATIONS WITH.SO THAT'S AN K
WOULD BE GREAT TO THINK HARD
ABOUT AND SEE IF THERE'S
ADDITIONAL INNOVATION WE CAN DO
TO SMOOTH THAT PATH WHILE FOLKS
ARE ADVOCATING AT THEIR
INSTITUTIONS FOR CHANGE.
>> ANY MORE QUESTIONS?
YES, PLEASE.
>> I SEE SOME ONLINE, THOUGH.
I THINK I'M BEHIND OTHERS.
>> I HAVE A QUESTION IF WE CAN
HEAR.
CHRISTIANE.
SO FIRST I JUST WANT TO THANK
YOU FOR DOING THIS.
I THINK WHAT YOU ARE -- BOTH OF
YOU ARE DOING BY PUTTING
TOGETHER THESE TWO DIVISIONS AND
THE CHALLENGES THAT YOU ARE
HAVING TO INTEGRATE AND FIND THE
SYNERGIES ACROSS THE PROTOCOLS
IS SO IMPORTANT, AND I THINK
IT'S WHAT EVENTUALLY WILL MOVE
US FORWARD.
AND I ALSO WANT TO RESONATE THE
QUESTION THAT THE COLLEAGUE, DRE
BEGINNING, HER QUESTION ABOUT
THE MEASUREMENT OF ADDRESSES,
FOR EXAMPLE.
SO I THINK ONE BIG PROBLEM THAT
WE HAVE IS THAT WE ARE NOT
RECOGNIZING THE COMPLEXITIES
THAT ARE INVOLVED IN MEASURING
THE EXPOSURES THAT WE ARE
INTERESTED IN IN THIS CASE, WHAT
WE'RE CALLING SOCIAL
DETERMINANTS OF HEALTH.
SO THE BRAIN IS COMPLEX, BUT THE
PROCESS IS THAT WE'RE TRYING TO
CAPTURE THAT ARE RELEVANT TO HOW
THE BRAIN IS FUNCTIONS ARE ALSO
EXTREMELY COMPLEX, AND I THINK
IT'S VERY EASY FOR US TO -- HAS
BEEN VERY EASY TO NOT PUT ENOUGH
THINKING AND RESOURCES IN THAT
BASKET.
BY HAVING THIS CONVERSATION AND
GETTING TWO BRANCHES TO TALK, I
THINK WE CAN MAYBE MIRROR THIS
EXERCISE IN OUR UNIVERSITIES AND
OUTSIDE SO THAT THIS CAN BE
TAKEN MORE TO THE LEVEL THAT IT
SHOULD.
SO I THINK IT'S STIMULATING
CALLS FOR PROPOSALS THAT HAVE A
FOCUS ON THE EXPOSURE SIDE OF
THINGS RATHER THAN THE OUTCOMES
THAT CAN MAKE A BIG DIFFERENCE
ALSO IN TERMS OF SHOWING THAT WE
RECOGNIZE THE COMPLEXITY AND
THAT WE HAVE WAYS THAT THIS CAN
BE IMPROVED AND GET BETTER.
SO JUST WANTED TO THANK YOU.
>> DEBORAH?
>> THANK YOU.
INTERESTING PRESENTATIONS ALL
DAY.
I WANT TO RESPOND TO THE
QUESTION THAT WAS RAISED ABOUT
THE UNIQUE CHALLENGES OF
SUBSTANCE USE DISORDER, AND FOR
ME, THE FIRST THING THAT COMES
TO MIND, OF COURSE, IS THE
CRIMINALIZATION OF DRUG USE.
AND OFTEN, ESPECIALLY WITH
SPECIFIC POPULATION GROUPS,
SUBSEQUENT INCARCERATION.
AND INCARCERATION'S RELATIONSHIP
TO TRAUMA, SHAME, INTERNALIZED
STIGMA, EXTERNALIZED STIGMA,
WHICH, OF COURSE, DRIVES PEOPLE
UNDERGROUND, WHICH RESULTS IN
MORE OVERDOSES.
SO I FEEL LIKE IT'S SOMETHING
THAT NEEDS ADDRESSING, THAT AS
PERHAPS PART OF THE -- WHAT
CHRISTIANE WAS JUST TALKING
ABOUT, HOW WE'RE RECOGNIZING THE
COMPLEXITIES OF THINGS.
IF WE'RE NOT TALKING ABOUT
WHAT'S THE RESULT OF
CRIMINALIZED DRUG USE, WE'RE
KIND OF MISSING A WHOLE TRUNK OF
INFORMATION THAT SO IMPACTS
PEOPLE.
ESPECIALLY AS YOU WERE
EXPLAINING MUCH EARLIER IN THE
DAY, THE IMPACT OF THE HARMS OF
FATALITIES ON NATIVE AMERICAN
COMMUNITIES AND BLACK
COMMUNITIES.
AND BLACK MEN IN PARTICULAR.
>> THANK YOU, DEBORAH, AND ALSO
CHRISTIANE.
I THINK BUILDING ON THAT, I WANT
TO CONGRATULATE BOTH OF YOU
BECAUSE IT'S SO IMPORTANT IN
PARADIGM SHIFTING, WHAT YOU'RE
DOING, AND BRINGING NEUROSCIENCE
TOGETHER WITH SOCIAL SCHOLARSHIP
AND RESEARCH.
IT'S VERY EXCITING.
IT'S QUITE AMBITIOUS.
AND WHAT YOU'RE REALLY TALKING
ABOUT DOING IS LINKING DATA
ACROSS VERY DIFFERENT LEVELS OF
SCALE AND FORGING COLLABORATIONS
ACROSS RADICALLY DIFFERENT
FIELDS.
YOU KNOW, FROM NEUROSCIENCE TO
SOCIAL SCIENCE, AND ALSO
BRINGING IN COMMUNITY
PARTNERSHIP AND ENGAGEMENT,
THAT'S TREMENDOUSLY COMPLICATED
AND IT'S NOT USUAL, AND IT'S
SOMETHING THAT WE'RE ATTEMPTING
TO DO AND -- OUR JOINT DATA
NEUROSCIENCE AND SOCIETY CENTER.
I THINK I SPOKE LAST TIME ABOUT
OUR PILOT PROJECT INVOLVING LAW
ENFORCEMENT HELICOPTER NOISE,
ITS IMPACT ON SLEEP DISRUPTION,
ITS IMPACT ON BRAIN DEVELOPMENT
AS A RESULT IN SOUTH L.A., WHERE
THE HELICOPTERS ARE REALLY
DEPLOYED AND TARGETED AS A
SOURCE OF MULTIGENERATIONAL
TRAUMA.
AND I THINK WHAT WE'RE
DISCOVERING IS THIS IS A LONG
HAUL.
IT REALLY REQUIRES LONG-TERM
INVESTMENT.
WE HAVE TO RENDER AND BRIDGE
CONCEPTUAL -- WE HAVE TO COME UP
WITH BRIDGING CONCEPTUAL FRAME
WORKS AND SHARED LANGUAGES, NEW
RELATIONSHIPS, NEW FORMS OF
RELATIONSHIPS NOT ONLY ACROSS
DISCIPLINES BUT ALSO WITH
MARGINALIZED COMMUNITY MEMBERS.
AND MY QUESTION FOR NIDA AND
FOUR FUNDERS IN GENERAL IS, HOW
DO YOU TAKE INTO ACCOUNT THE
PROFOUND NATURE OF THIS
UNDERTAKING?
THE LONG TERM INVESTMENT THAT
WILL PROBABLY BE NEEDED AND ALSO
THE INVESTMENT AND TRAINING
SCHOLARS THAT HAVE MULTIPLE
SKILLS AND CAN CROSS
DISCIPLINES, MULTI-LANGUAGES,
MULTI-CONCEPTUAL FRAME WORKS?
THAT'S A VERY BIG LIFT, BUT I
THINK ABSOLUTELY NECESSARY AT
THIS MOMENT AS WE RECOGNIZE THAT
THIS IS EXACTLY THE KIND OF
SCIENCE THAT WILL BRING US
FORWARD.
>> THANKS FOR RAISING THAT, AND
I THINK MAYBE WE CAN HELP SOME
MORE OFFLINE ABOUT YOUR PILOT
PROJECT AND HOW THOSE IDEAS
MIGHT INFLUENCE THE WAYS THAT WE
THINK ABOUT STRUCTURING SCIENCE
AS WE'RE PUSHING THIS FORWARD AS
WELL.
WE'RE VERY FORTUNATE, VANI AND I
GET TO TALK A LOT, AND THIS IS
VERY MUCH -- IT IS A LONG-TERM,
IT IS A LONG-TERM PROJECT, AND
WE'VE BEEN REALLY FORTUNATE, FOR
EXAMPLE, WORKING REALLY CLOSELY
TOGETHER ON THE NATIVE RACIAL
EQUITY INITIATIVE WHERE WE HAD A
FRAMEWORK AND LOTS OF SUPPORT
FROM OTHER PROGRAM STAFF AT NIDA
TO REALLY THINK ABOUT HOW OUR
DIFFERENT SCIENCES COULD WORK
TOGETHER IN THAT SPACE, AND I
EXPECT THAT WE'LL LEARN A LOT AS
THAT COLLABORATIVE CONTINUES AS
WELL, IT'S STILL VERY EARLY DAYS
FOR IT.
WE HAVE A WHOLE OTHER COHORT TO
FUND SO I'M HOPING IN A COUPLE
YEARS EVEN WE MIGHT HAVE LIKE A
PUBLIC MEETING IN WHICH WE COULD
TALK WITH INVESTIGATORS IN THE
COORDINATING CENTER TO KIND OF
START TO GET AT THIS LIKE HOW DO
YOU REALLY WORK WITH
NEUROSCIENCE PROJECT AND AN
APPLIED PROJECT AND ALL OF THE
DIFFERENT COMMUNITY MEMBERS THAT
ARE GOING TO BE INTERESTED IN
THE DIFFERENT SYSTEMS THAT ARE
INVOLVED, TO PUSH IN THE SAME
DIRECTION.
>> THANK YOU.
>> CAN I JUST ADD TO THE
QUESTION ABOUT THIS BEING SUCH A
HUGE UNDERTAKING, ABSOLUTELY,
BUT WE DID THIS ONCE WITH
GENOMICS, RIGHT?
I DON'T KNOW THAT WE EVER
APPRECIATED HOW MUCH WORK WOULD
GO INTO IT, HOW MUCH TIME WOULD
GO INTO IT, AND IT PAID OFF SO
WELL.
AND I THINK WE'RE BASICALLY
DOING THE SAME THING AGAIN NOW
IN TRYING TO UNDERSTAND THE
ENVIRONMENT.
>> THANKS VERY MUCH.
[APPLAUSE]
>> THE NEXT PRESENTATION IS
GOING TO BE GIVEN BARRE CHEL TI
LAJ FOR PEOPLE WITH LIVED OR
LIVING EXPERIENCES WORK GROUP.
AND SHE -- RAH CHEL IS RACHEL E
JOINING US VIRTUALLY.
RACHEL, WELCOME.
>> HELLO.
CAN YOU HEAR ME OKAY?
>> WE CAN HEAR YOU VERY WELL.
>> EXCELLENT.
OKAY.
LET ME GO AHEAD AND SHARE MY
SCREEN.
>> I'LL GO AHEAD AND GET
STARTED.
I THINK THIS PRESENTATION NICELY
FOLLOWS UP ON WHAT WE WERE JUST
TALKING ABOUT, ABOUT THE
IMPORTANCE OF COMMUNITY
ENGAGEMENT AND ENGAGING PEOPLE
WITH LIVED EXPERIENCE.
SO I'M EXCITED TO PRESENT THIS
PROPOSAL TO YOU TO STAND UP A
WORK GROUP TO COUNCIL MADE UP OF
PEOPLE WITH LIVED AND LIVING
EXPERIENCE.
BY WAY OF BACKGROUND, AS WE WERE
JUST TALKING ABOUT, WE KNOW
ENGAGEMENT OF COMMUNITY PARTNERS
AND PEOPLE WITH LIVED AND LIVING
EXPERIENCE NOT JUST AS RESEARCH
PARTICIPANTS BUT ACTUALLY AS
ADVISORS AND PARTNERS IN THE
RESEARCH FROM THE CONCEPTION OF
A RESEARCH IDEA ALL THE WAY TO
RESULTS DISSEMINATION.
INCREASE RESEARCH QUALITY,
RESEARCH RELEVANCY AS WELL AS
THE UPTAKE OF RESEARCH FINDINGS.
AND RELEVANT NIDA FUNDING
OPPORTUNITIES HAVE OFTEN IN
RECENT YEARS INCLUDED A
REQUIREMENT FOR A PLAN TO ENGAGE
COMMUNITY PARTNERS OR
STAKEHOLDERS, SOMETIMES AS A
SCORABLE CRITERIA, BUT WE KNOW
THAT EVEN WHEN RESEARCHERS ARE
VERY WELL-INTENTIONED, AND
OFTENTIMES DEPENDING ON WHAT
FIELD THEY'RE COMING FROM,
DEPENDING HOW THINGS ARE DONE
AND HOW FAMILIAR RESEARCHERS ARE
IN WORKING WITH THE COMMUNITY
ENGAGEMENT EFFORTS, CAN MAYBE
NOT GO AS WELL AS THEY WERE HOPE
TO AND CAN EVEN CAUSE HARM AND
LEAD TO FEELINGS OF TOKENISM OR
CORRUPTION FROM COMMUNITY
PARTNER.
CURRENTLY THERE'S A LACK OF
ACCOUNTABILITY FROM RESEARCHERS
IN TERMS OF HOW THEY ENGAGE
PEOPLE WITH LIVED AND LIVING
EXPERIENCE IN RESEARCH.
WE ALSO KNOW THERE CAN BE A LOT
OF SYSTEMIC AND INSTITUTIONAL
BARRIERS TO RIGOROUS ENGAGEMENT
WORK, AND BECAUSE THERE'S A LOT
OF GROWING INTEREST IN INCLUDING
VOICES OF PEOPLE WITH LIVED
EXPERIENCE, NOT JUST IN
SUBSTANCE USE DISORDER RESEARCH
BUT ACROSS MANY HEALTH
CONDITIONS.
THERE'S SOME INITIATIVES
CURRENTLY UNDERWAY AT THE
BROADER NIH-WIDE LEVEL THAT ARE
WORKING TO IDENTIFY AN NIH-WIDE
FRAMEWORK THAT CAN HOPEFULLY
HELP TO ENCOURAGE MORE
MEANINGFUL ENGAGEMENT AND
ADDRESS SOME OF THESE BARRIERS.
BUT WE ALSO KNOW THAT THE
POPULATION THAT WE'RE WORKING TO
HELP OF PEOPLE WHO USE DRUGS IS
UNIQUE IN MANY WAYS COMPARED TO
OTHER HEALTH CONDITIONS.
AGAIN, LIKE WE WERE JUST TALKING
ABOUT IN THE LAST CONVERSATION,
AND THIS COMMUNITY CAN REQUIRE
SPECIFIC ENGAGEMENT APPROACHES
THAT ARE SENSITIVE TO THE HIGH
LEVELS OF WIDESPREAD STIGMA
AGAINST PEOPLE WHO USE DRUGS AND
THE CRIMINALIZATION OF DRUG USE
AND ALL OF THE THINGS THAT CAN
FOLLOW FROM THAT.
SO WITH ALL OF THAT IN MIND, WE
PROPOSE THAT THIS WORK GROUP
PROVIDE INPUT AND FEEDBACK TO
HELP US DEVELOP A SET OF NIDA
WIDEN GAUGEMENT GUIDELINES OR
STANDARDS THAT CAN ADDRESS THE
UNIQUE SENSITIVITIES THAT PEOPLE
WITH LIVED AND LIVING EXPERIENCE
WITH DRUG USE FACE AND THEN WE
CAN TURN THIS INTO A PUBLIC
FACING WEBPAGE WHERE WE CAN
SHARE THE GUIDELINES AS WELL AS
UP TO DATE AND HELPFUL RESOURCES
ABOUT HOW TO IMPLEM THESE
GUIDELINES, AND OBVIOUSLY THIS
WON'T FIX ANYTHING BUT REVIEWING
THIS IS ONE STEP TO HELP
INCREASE THE ACCOUNTABILITY AND
FOSTER MORE MEANINGFUL
ENGAGEMENT IN NIDA-FUNDED
RESEARCH.
THE IDEA FOR THIS WORK GROUP HAS
REALLY COME ABOUT OVER THE LAST
YEAR.
WE'VE BEEN HAVING CONVERSATIONS
WITH COMMUNITY GROUPS AND PEOPLE
WITH LIVED EXPERIENCE WHO HAVE
BEEN INVOLVED IN RESEARCH IN THE
PAST.
AS WELL AS INTERNAL
CONVERSATIONS WITH PROGRAM
STAFF.
SO WE'RE BEING VERY MINDFUL THAT
THIS EFFORT IS NOT DUPLICATIVE
TO ONGOING EFFORTS AT NIDA AND
AS WELL AS THE ONES ACROSS NIH
MORE BROADLY, AND THAT THIS WILL
REALLY WORK TO STRENGTHEN
ONGOING EFFORTS YOU KNOW WITHIN
DIFFERENT PARTS OF NIDA AND KIND
OF CREATE A NIDA-WIDE FRAMEWORK
THAT CAN BE RELIED UPON.
SO THE WORK GROUP MEMBERS WILL
BE A DIVERSE GROUP OF PEOPLE
WITH DIVERSE REPRESENTATION
ACROSS RACIAL AND ETHNIC
IDENTITIES, GEOGRAPHIC
LOCATIONS, AGES, GENDERS,
EXPERIENCES WITH SUBSTANCE USE
DISORDER TREATMENT SYSTEM, THE
CRIMINAL LEGAL SYSTEM AND AS
WELL AS DIFFERENT EXPERIENCES
WITH RESEARCH.
WE'RE PLANNING ON RECRUITING
MEMBERS TO A PUBLIC CALL THAT WE
CAN DISSEMINATE THROUGH A
VARIETY OF CHANNELS INCLUDING
COMMUNITY PARTNER ORGANIZATIONS
SUCH AS HARM REDUCTION
ORGANIZATIONS, DRUG USER UNIONS,
BECAUSE WE'RE REALLY HOPING THAT
WE CAN REACH PEOPLE THAT WE MAY
NOT HAVE HEARD FROM BEFORE IN
OTHER INITIATIVES.
THE WEBPAGE PRODUCT THAT WE SEE
AS KIND OF THE MAIN OUTPUT FROM
THIS WORK GROUP WILL SERVE AS A
RESOURCE FOR BOTH THE RESEARCH
COMMUNITY AS THEY WORK ON
APPLYING FOR AND CARRYING OUT
NIDA-FUNDED GRANTS AS WELL AS A
RESOURCE FOR THE COMMUNITY OF
PEOPLE WITH LIVED AND LIVING
EXPERIENCE WHO ARE INTERESTED IN
RESEARCH, SO FUNDING
OPPORTUNITIES THAT COME OUT
AFTER THIS WEBPAGE IS UP WILL BE
ABLE TO LINK TO THIS WEBPAGE TO
HELP THOSE APPLICANTS AND
COMMUNITY PARTNERS REALLY
UNDERSTAND NIDA'S PRIORITIES
AND -- UP TO DATE RESOURCES.
SO THAT'S OUR PLAN IN A
NUTSHELL.
THIS SLIDE IS SHOWING THE
OFFICIAL WORK GROUP COLLAR TER,
CHARTER SO IWILL READ THIS QUICN
OPEN IT UP FOR DISCUSSION.
SO THE COUNCIL WILL CONVENE A
WORKING GROUP TO ADVISE ON WAYS
TO ENHANCE AND INCREASE
MEANINGFUL ENGAGEMENT OF PEOPLE
WHO HAVE LIVED AND LIVING
EXPERIENCE WITH DRUG USE IN
NIDA-FUNDED RESEARCH.
SUGGESTIONS AND PRIORITIES
IDENTIFIED BY THE WORKING GROUP
WILL INFORM A WEBPAGE THAT
SUMMARIZES NIDA'S EXPECTATIONS
FOR RESEARCHER ENGAGEMENT OF
PEOPLE WITH LIVED AND LIVING
EXPERIENCE WITH DRUG USE AND
WILL BE PRESENTED TO COUNCIL.
WORKING GROUP MEMBERSHIP WILL
INCLUDE COUNCILMEMBERS AND
COMMUNITY MEMBERS WITH
APPROPRIATE EXPERTISE, WHICH
INCLUDES PEOPLE WITH CURRENT OR
FORMER EXPERIENCE WITH DRUG USE
THEMSELVES OR AS A FAMILY MEMBER
OR CAREGIVER OF SOMEONE WHO HAS
USED DRUGS.
THAT IS WHAT I HAVE.
FOR
PRESENTATION.
I WILL STOP SHARING MY SCREEN.
>> RACHEL, THANKS VERY MUCH.
NOW WE HAVE AN OPPORTUNITY FOR
COMMENTS AND QUESTIONS.
YES, REGINA, PLEASE.
>> THANKS FOR THIS, RACHEL.
I HAD A COUPLE QUESTIONS.
AND IT MAY BE TOO EARLY IN THE
PROCESS FOR THIS, BUT AT
GEORGETOWN, WE ALWAYS INVOLVE
PEOPLE WITH LIVED EXPERIENCE IN
ALL OF OUR WORK AND WE ALWAYS
PAY THEM FOR THEIR TIME.
SO THE QUESTION IS WHETHER OR
NOT THERE WOULD BE A
CONSIDERATION FOR RESEARCHERS TO
BUILD THIS IN TO GRANTS
PROVIDING PEOPLE WITH AN
HONORARIA.
THAT WAS MY FIRST.
>> SORRY -- YES, I THINK
THAT'S -- WELL, FIRST FROM OUR
END, WE WILL DEFINITELY BE
COMPENSATING THE PEOPLE WITH
LIVED EXPERIENCE WHO WILL BE ON
OUR WORKING GROUP.
AND I THINK THAT THAT IS LIKELY
THE KIND OF RECOMMENDATION THAT
MIGHT END UP IN THE GUIDELINES,
SOMETHING AROUND, YOU KNOW,
FINANCIAL COMPENSATION FOR
COMMUNITY PARTNERS SINCE THAT IS
SUCH AN IMPORTANT ISSUE THAT'S
OFTEN FRAUGHT WITH CHALLENGES.
>> THEN MY SECOND QUESTION,
UNDERSTANDING THIS IS FOR NIDA,
PEOPLE OFTEN USE ALCOHOL AND
OTHER DRUGS, IF THERE'S ANY
CONSIDERATION GIVEN TO OPENING
IT UP TO ALCOHOL AND OTHER
DRUGS.
>> I THINK THAT'S A GREAT IDEA.
WE HAVEN'T PUT ANY LIMITATIONS
AROUND SPECIFIC TYPES OF DRUGS.
I THINK WE'RE REALLY LOOKING FOR
A BROAD PERSPECTIVE AND SINCE
MOST PEOTHOSE PEOPLE USE A LOT F
SUBSTANCES AS YOU INDICATED I
THINK THAT COULD DEFINITELY BE A
POSSIBILITY.
>> IT WOULD MAKE A LOT OF SENSE
BECAUSE ALCOHOL IS SO PREVALENT
IN ALL OF THE SUBSTANCES, AND
THAT IS THE REALITY AND THAT'S
WHAT WE WANT TO GET, REAL LIFE.
ANY OTHER QUESTIONS?
>> WE HAVE TO TAKE A VOTE.
SO THIS IS BASICALLY BROUGHT TO
YOUR ATTENTION SO THAT WE COULD
VOTE -- OH, I SEE THERE WAS
ANOTHER QUESTION.
DEBORAH, DID YOU HAVE --
>> YEAH.
JUST DETAILS.
I'M VERY EXCITED YOU'RE DOING
THIS.
I ACTUALLY WONDERED HOW MUCH
INPUT THE MEMBERS WILL HAVE IN
LEADING ITSELF OR, YOU KNOW,
DETERMINING MEETINGS AND THE
CHARTER, YOU KNOW, EXPANDING THE
CHARTER, HOW DECISIONS WILL BE
MADE, IF THEY'RE REQUIRED TO
MAKE DECISIONS, WHAT KIND OF
INPUT WILL THE MEMBERSHIP HAVE
ON THE THINGS THAT WE'LL DO AND
SO ON.
SO JUST SORT OF THINKING ABOUT
THE PICTURE OF WHAT IT'S GOING
TO LOOK LIKE WHEN IT'S
IMPLEMENTED.
>> WE'RE DEFINITELY IN THE EARLY
STAGES BUT I WILL SAY WE HAVE
WRITTEN THE CHARTER IN A WAY WE
ARE TRYING TO KEEP IT BROAD SO
WE CAN BE VERY FLEXIBLE TO WHAT
WE HEAR FROM THE WORK GROUP
MEMBERS, SO I THINK WE WANT TO
BE OPEN TO WHATEVER IDEAS THEY
COME TO THE TABLE WITH AND, YOU
KNOW, BE AS FLEXIBLE AS
POSSIBLE.
>> NO MORE QUESTIONS.
>> OKAY.
SO ONCE AGAIN, WE'RE BRINGING
THIS TO YOU AS AN IDEA FOR THIS
WORK GROUP, AND WE WOULD LIKE --
WE NEED TO GET A VOTE FROM YOU
ON WHETHER YOU THINK THIS IS
SOMETHING THAT WE SHOULD DO AND
IF YOU ARE OKAY WITH IT, THEN WE
WILL START TO MOVE FORWARD WITH
SETTING UP -- THIS IS A WORK
GROUP THAT'S ADVISORY TO
COUNCIL.
SO CAN I GET A MOTION TO
APPROVE?
SECOND?
ALL IN FAVOR?
OKAY.
GREAT.
THANK YOU VERY MUCH.
APPRECIATE IT.
AND YOU'LL BE HEARING MORE ABOUT
THIS.
THANKS, RACHEL.
>> THANKS MUCH.
NOW WE GO INTO THE SECTION OF
OUR PROGRAM WHICH IS THE CONCEPT
CLEARANCE FROM NIDA STAFF.
AND TODAY WE ONLY HAVE ONE
DIVISION PRESENTING.
AND IT IS THE DIVISION OF
NEUROSCIENCE AND BEHAVIOR, AND
IT'S GOING TO BE PRESENTED BY --
WHO'S GOING TO BE PRESENTING TWO
CONCEPTS.
>> THANK YOU VERY MUCH.
IT IS MY PLEASURE TO PRESENT TWO
CONCEPT TODAY ON BEHALF OF MY
DIVISION AT DNB.
SO THIS FIRST ONE IS CEBRA,
CUTTING EDGE BASIC RESEARCH
AWARDS.
THIS IS ACTUALLY RELEVANT TO A
QUESTION THAT WAS ASKED EARLIER
TODAY ABOUT NIDA PROGRAMS THAT
SUPPORT HIGH RISK INNOVATIVE
RESEARCH.
CEBRA IS A UNIQUE OPPORTUNITY
THAT NIDA PRESENTS TO
INVESTIGATORS LOOKING TO ADD NEW
PERSPECTIVES TO THE FIELD OF
ADDICTION NEUROSCIENCE.
CEBRA ENCOURAGES PROPOSERS TO
PRESENT BOLD, TECHNICALLY
AUDACIOUS PROPOSALS WITH A
STRONG RATIONALE BUT PRACTICAL
DEMONSTRATION TO DEVELOP INTO
THE NEXT GENERATION OF TRANSPORT
TRANSFORMATIVE CAPABILITIES.
THE PROGRAM IS INTENDED AS A
RISK TOLERANT ENVIRONMENT THAT
PRESENTS OPPORTUNITIES TO APPLY
NOVEL TOOLS OR APPLY NOVEL
APPROACHES THAT IF SUCCESSFUL
WOULD POINT IN NEW DIRECTS AND
INCREASE THE DEPTH AND BREADTH
OF WHAT IS POSSIBLE WITH
FUNDAMENTAL RESEARCH.
THE SECOND CONCEPT IS THE
HEALTHY BRAIN --
>> YOU MIGHT WANT TO JUST STOP
AND ASK FOR COMMENTS BECAUSE
THEY'RE SO DIFFERENT.
ARE THERE ANY COMMENTS?
ON CEBRA?
>> OKAY, I WILL MOVE ON TO THE
NEXT ONE.
THIS IS THE HEALTHY BRAIN AND
CHILD DEVELOPMENT OR HBCD STUDY.
THIS CONCEPT PROPOSES A
COMPETITIVE RENEWAL OF THE HBCD
STUDY AND EXTEND THE PROGRAM
PAST THE END OF ITS CURRENT
PROJECT PERIOD ON JUNE 30TH,
2026.
USING A PROSPECTIVE LONGITUDAL
DESIGN, THE HBCD STUDY AIMS TO
FOLLOW APPROXIMATELY 7,200
PREGNANT PERSONS AND THEIR
CHILDREN FROM THE PRENATAL
PERIOD INTO CHILDHOOD TO
UNDERSTAND THE GENETIC,
NEUROCOGNITIVE SOCIOEMOTIONAL
AND ENVIRONMENTAL INFLUENCES ON
EARLY DEVELOPMENTAL TRAJECTORIES
AND HOW EARLY LIFE EXPOSURES TO
OPIOIDS AND OTHER ENVIRONMENTAL
CIRCUMSTANCES AFFECT THOSE
TRAJECTORIES.
NIDA IS SEEKING COUNCIL APPROVAL
FOR THIS CONCEPT TO RENEW ALL
THREE INTEGRATED COMPONENTS AT
THE CONSORTIUM, THE RESEARCH
SITES, THE COORDINATING
ADMINISTRATIVE CORE, THE DATA
COORDINATING CENTER FOR ANOTHER
PROJECT PERIOD TO ALLOW THE
CONSORTIUM THE TIME AND
RESOURCES TO COMPLETE ENROLLMENT
OF 7200 PREGNANT PERSONS AND
CHILDREN TO EXTEND STUDY VISITS,
THROUGH THE FIRST DECADE OF
LIFE.
AND ACHIEVE PRIMARY OBJECTIVES
TO UNDERSTAND HOW THE
PREPRENATAL ENVIRONMENT
INFLUENCES DEVELOPMENTAL
TRAJECTORIES THROUGH CHILDHOOD.
AND I'LL PAUSE FOR ANY
QUESTIONS.
>> QUESTIONS?
THANKS SO MUCH.
>> THANK YOU VERY MUCH.
>> AND NOW WE GO TO THE SECTION
ON PUBLIC COMMENTS.
DID WE GET ANY COMMENTS?
>> I DON'T BELIEVE WE DID.
WE CAN STILL RECEIVE COMMENTS
FOR 10 DAYS AFTER COUNCIL, SO IF
THERE'S ANYBODY WHO IS -- SORRY,
WE HAVE NOT RECEIVED ANY PUBLIC
COMMENTS.
WE STILL ACCEPT PUBLIC COMMENTS
FOR 10 DAYS AFTER COUNCIL
HAPPENS, SO IF THERE'S ANYBODY
THAT'S OUT THERE WATCHING AND
WOULD LIKE TO SEND US SOME
FEEDBACK OR SOME SUGGESTIONS,
PLEASE DO SO.
YOU CAN SEND THEM TO ME AND WE
WILL TAKE THEM INTO
CONSIDERATION.
>> SO IF NO MORE COMMENTS, I
GUESS WE CAN ADJOURN
>> WE CAN ADJOURN.
>> THANK YOU ALL AGAIN.
WE REALLY APPRECIATE YOUR TIME.
WE LOVE TO SEE YOU.
IT'S REALLY NICE TO SEE YOU IN
PERSON FOR THOSE OF YOU WHO ARE
HERE.
FOR THOSE OF YOU WHO ARE ON
SCREEN, WE ALSO APPRECIATE YOUR
COMMENTS AND YOUR THOUGHTS AND
LOOK FORWARD TO THE NEXT TIME.
>> WE HAVE THESE VERY FORMAL
PRESENTATIONS AND DISCUSSIONS,
BUT WE COUNT ON YOU TO REACH OUT
TO US OUTSIDE OF THE TIME WHERE
WE HAVE COUNCIL, IF YOU HAVE
SUGGESTIONS, PLEASE SPEAK UP.
SO WHAT I'M SAYING IS YOUR JOB
DOES NOT TERMINATE WHEN YOU
LEAVE THIS ROOM, BUT IT'S
ACTUALLY WE ARE COUNTING ON YOU
ON PROVIDING US THAT FEEDBACK,
BECAUSE THIS IS AN OPPORTUNITY
THAT WE VR TO GET YOUR EXPERTISE
INTO WHAT WE ARE DOING.
SO THAT JUST TO SAY THAT WE
VALUE VERY MUCH EACH ONE OF YOUR
INPUT AND ANYTHING THAT YOU FEEL
YOU WANT FURTHER ANSWERS OR
INFORMATION ON WHAT WAS
PRESENTED OR SUGGESTIONS, PLEASE
REACH OUT TO US.
YOU CAN DIRECTLY REACH OUT TO ME
OR YOU CAN DIRECTLY REACH OUT TO
SUSAN OR TO WILSON, AND WE WILL
RESPOND.
AND WITH THAT, I WISH YOU A VERY
GOOD TRIP BACK HOME, WHEREVER
THAT MAY BE.