I WANT TO SAY THANK YOU TO OUR STAFF FOR GETTING US PREPARED FOR THE COUNCIL AND ALSO FOR THE GUESTS WHO COME, GRANTEES AS WELL AS SOME OF THE ORGANIZATIONS WHO ARE REPRESENTATIVE OF OUR FRIENDS OF NIMHD COALITION WHICH YOU'LL GET A CHANCE TO HEAR AND MEET LATER ON. PEOPLE WILL BE COMING IN AND OUT HOPEFULLY, ALSO HAVE SOME REPRESENTATION FROM THE OTHER INSTITUTES, I ALREADY SEE A COUPLE OF OUR COLLEAGUES FROM THE NATIONAL CANCER INSTITUTE HERE. SO WITH THOSE INTRODUCTORY REMARKS I SAY WELCOME AND I WOULD LIKE TO TURN THIS 38 MEETING OF THE NATIONAL ADVISORY COUNCIL OVER TO DR. JOYCE HUNTER WHO IS THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE MINORITY HEALTH AND HEALTH DISPARITIES WHO WILL GIVE YOU OVERVIEW OF THE COUNCIL AS WELL AS SPEAK TO YOU ABOUT ISSUES OF CONFIDENTIALITY AND CONFLICT OF INTEREST. JOYCE. >> THANK YOU, DR. MADDOX. GOOD MORNING, EVERYONE. I AM GOING TO START WITH SOME RULES AND REGULATIONS. FIRST THING IN THE MORNING. SO I'LL START WITH GOING OVER THE FOLDERS, YOU HAVE A RED FOLDER N. THAT FOLDER YOU WILL FIND CONFLICT OF INTEREST FORM, YOU ALSO FIND AN CONSENT FORM, A ROSTER, MINUTES FROM THE LAST MEETING, ON THE RIGHT HAND SIDE OF THE FOLDER YOU WILL FIND AGENDA, POLICY ISSUES THAT RELATE TO THE LAWS AND OPERATING PROCEDURE OF THE COUNCIL, STANDARDS OF CONDUCT, SCORING SHEETS. SPECIAL RULES THAT RELATE TO SPECIAL GOVERNMENT EMPLOYEES. I WANT TO DRAW YOUR ATTENTION THOUGH TO CONFLICT OF INTEREST CERTIFICATION FORM AND CONFLICT OF INTEREST RECUSAL FORM. THOSE TWO FORMS IDENTIFY UNIVERSITIES AND ORGANIZATIONS WHICH MAY HAVE A FINANCIAL INTEREST. THE SPECIAL ACTION DOCUMENTS THAT WE ARE GOING TO BE REFERRING TO LATER IN THE DAY DURING CLOSED SESSION OF COUNCIL WILL ALSO CONTAIN ADDITIONAL INFORMATION ABOUT CONFLICT OF INTEREST. IF AT ANY TIME THERE IS A DISCUSSION IN WHICH ANY OF THOSE ORGANIZATIONS ARE UNIVERSITIES ARE CALLED INTO PLAY, WHETHER WE'RE DOING THE SPECIAL ACTION -- SPECIFIC SPECIAL ACTION INITIATIVE, WE DO ASK THAT YOU RECUSE YOURSELF FROM ANY DISCUSSIONS AND FURTHER YOU LEAVE THE ROOM. I WOULD LIKE TO CALL YOUR ATTENTION YOUR TO THE COUNCIL MINUTES FROM SEPTEMBER 9TH, 2014. THE COUNCIL MEMBER -- THE MINUTES SHOULD BE ON THE LEFT HAND POCKET OF YOUR FOLDER. KNOWING YOU HAVE ALREADY REVIEWED THESE TWO OR THREE TIMES, I ASK ARE THERE ANY CONCERNS OR ISSUE WITH THE MINUTES? IF NOT MAY I HAVE A MOTION TO APPROVE MINUTES? >> MOTION. >> SECOND. >> SECOND. >> ALL IN FAVOR. >> AYE. >> ANY OPPOSED. THEN THE MOTION IS CARRIED AND MINUTES ARE APPROVED. LET ME QUICKLY TELL YOU ABOUT OUR FUTURE MEETING DATES AS YOU CAN SEE ARE ON YOUR AGENDA, THEY ARE EXTENDED OUT THROUGH SEPTEMBER 2016. WE DO ASK THAT YOU LET US KNOW IF THERE IS A MEETING DATE THAT YOU ABSOLUTELY CANNOT MEET. IT IS VERY IMPORTANT WE ALWAYS HAVE A QUORUM DURING THE COUNCIL SESSION. OUR POLICY DOES ALLOW FOR COUNCIL MEMBER TO MISS ONE MEETING DURING THE CALENDAR YEAR BUT WE TRY TO ACCOMMODATE SOMETIMES WITH TELECONFERENCES WHEN POSSIBLE. BUT THERE ARE SOME ISSUES WHERE WE REALLY DO NEED TO HAVE YOU PRESENT WITH US. PLEASE ALSO NOTE THAT WHILE YOU ARE SERVING ON COUNCIL YOU CANNOT SERVE ON ANY NIH PEER REVIEW PANEL. I THINK THOSE ARE THE THINGS I'M GOING TO COVER HOUSEKEEPING WISE FOR NOW AND I WILL TUNE BACK IN WITH YOU LATER. I'M GOING TO TURN THE MEETING BACK OVER TO DR. MADDOX AT THIS TIME. >> THANK YOU, JOYCE. I'M ALREADY GETTING READY TO DO WHAT I ASKED YOU TO DO TO SPEAK TO MICROPHONE WITHOUT IT BEING TURNED ON SO WE MUST HAVE OUR MICROPHONES IN USE TODAY BECAUSE WE ARE RECORDING THE COUNCIL AND I THINK MOST IMPORTANT ASPECT OF THIS IS AS DR. HUNTER MENTIONED YOU APPROVE THE MINCE OF LAST MEETING. WE WANT GOOD MINUTES AND THE MINUTES YOU JUST APPROVED WILL BE UP ON OUR WEBSITE IN A FEW DAYS AND THEN OF COURSE THE MINUTES FROM THIS MEETING HOPEFULLY YOU WILL APPROVE THEM AT THE JUNE MEETING AND THEY WILL BE PUT ON THE WEBSITE AS WELL. SO USE YOUR MICROPHONE SO WE CAN HEAR YOU BUT NUMBER TWO, SO THAT WE CAN HEAR WHAT YOU REALLY HAVE TO SAY AND GET IT IN OUR MINUTES. I WANT TO TAKE A MOMENT NOW JUST TO HAVE COUNCIL MEMBERS INTRODUCE THEMSELVES. I HAVE THE PLEASURE OF MEETING MANY OF YOU LAST NIGHT AND ONES I DIDN'T MEET LAST NIGHT I MET THIS MORNING SO WONDERFUL GROUP OF COUNCIL MEMBERS WE HAVE. AS I MENTIONED EARLIER I'M SO HOPEFUL THAT SECRETARY BURWELL WILL APPROVE THIS SLATE AND WE'LL HAVE A COMPLIMENT OF RIGHT PEOPLE WE NEEDTOR COUNCIL ACTIVITIES. THE OTHER THING I WANT TO MENTION, WE HAVE SEVERAL COUNCIL MEMBERS WHO HAD LET US KNOW EARLY ON THEY WOULD NOT BE AT THIS MEETING. Y'ALL MAY RECALL THAT AT THE SEPTEMBER MEETING DR. FINE WHO IS AD HOC MEMBER FROM VA DID LET US KNOW HE WAS GOING TO BE OUT OF THE COUNTRY I BELIEVE TODAY. SO HE WILL NOT BE HERE. DR. TALAMONAS CONTACTED ME YESTERDAY TO LET US KNOW THAT HE'S BEEN HAVING SOME MEDICAL ISSUES AND HE TOLD US THIS BACK IN JUNE WHEN I FIRST GOT A CHANCE TO WORK WITH HIM, AND HIS DOCTORS ASKED HE NOT TRAVEL FOR A WHILE SO WE HAVE AGREED PERHAPS HE WILL RESIGN FROM THE COUNCIL WE'LL HAVE TO FILL THAT SLOT SHORTLY. DR. VALERIE MONTGOMERY RICE, A REGULAR, I DON'T KNOW THAT VALERIE HAS MISSED THE COUNCIL MEETING BUT SHE IS NOT HERE TODAY BECAUSE SHE HAD SOME PRIOR ENGAGEMENT THAT WAS ALREADY ON HER CALENDAR BEFORE OUR COUNCIL DATE GOT IN PLACE. DR. HILL TON HUDSON WHO WILL BE NEW IN TERMS OF MY HAVING AN OPPORTUNITY TO MEET HIM, HAD LET US KNOW THOUGH HE WAS NEW AD HOC TO OUR COUNCIL THIS FIRST COUNCIL HE WOULD NOT BE ABLE TO ATTEND. HAVING SAID THAT, WE HAVE GOT SEVERAL COUNCIL MEMBER WHOSE ARE HERE. BRING A LOT OF NOT ONLY HIGH QUALITY IN TERMS OF THE RESEARCH AND PUBLIC POLICY BUT HAVE A WONDERFUL BIOs SO LET'S START BY INTRODUCING OUR STAFF THEN GOING THIS WAY BACK TO DR. HUNTER. >> NATHAN STINSON, DIRECTOR OF THE DIVISION OF EXTRAMURAL SCIENTIFIC PROGRAMS IN THE INSTITUTE. >> DR. LINDA THOMPSON ADAMS DEAN OF COLLEGE OF HEALTH SCIENCES WESTCHESTER UNIVERSITY. >> DR. EDDIE GREEN, MAYOR CLINIC, ROCHESTER, MINNESOTA WITH INTEREST IN CHRONIC KIDNEY DISEASE AND HEALTH DISPARITIES, CURRENTS BOARD OF TRUSTEE AT MAYO AS WELL. >> I'M MIKE RASHEED, MOST RECENTLY CHIEF AMERICAN OFFICER OF THE (INDISCERNIBLE) FAMILY OF COMPANIES. JUST RETIRED A FEW MONTHS AGO SO ENJOYING MY LIFE. >> GOOD MORNING, MY NAME IS HAPPY (INAUDIBLE) I'M PROFESSOR EPIDEMIOLOGY AT THE UNIVERSITY OF CALIFORNIA SAN DIEGO. I'M A PARANATAL EPIDEMIOLOGIST BY TRAINING, I WORK WITH USCD WOMEN AND CHILDREN HIV PROGRAM. I WORK IS ON ETHNIC HEALTH DISPARITIES, ASIAN PACIFIC AISLANDER, AFRICAN -- CARDIOVASCULAR DISEASE AND OSTEOPOROSIS. I'M THRILLED TO BE HERE. >> GOOD MORNING, MY -- I'M (INDISCERNIBLE) SINCE THE LAST COUNCIL MEETING CHAIR OF (INAUDIBLE) SCHOOL DEAN PUBLIC HEALTH BOSTON UNIVERSITY SO NOT SURE WHO COUNCIL NEEDS TO CHANGE THAT, FORMAL WRITE UP. [APPLAUSE] >> JUDY BRADFORDER CO-CHAIR FENWAY INSTITUTE BOSTON DIRECTOR SENTENCER FOR POPULATION RESEARCH AND LTB HEALTH. >> I'M BILL RILEY ACTING DIRECTOR OFFICE OF BEHAVIORAL SOCIAL SCIENCE RESEARCH AND EXOFFICIO MEMBER OF THE COUNCIL. >> GOOD MORNING. (INAUDIBLE) RIVERS ON RESEARCH MOVE FIT COUNCIL CENTER, SEVERAL STATE COUNCIL ADVISORY COUNCILS FOR STATE OF FLORIDA AS WELL AS LEGISLATURE, MOST RECENTLY APPOINTED BY THE GOVERNOR OF THE CANCER CENTERS OF EXCELLENCE PROGRAM WHERE WE DEVELOPED STANDARDS AND MEASURES FOR COMMUNITY BASED FRACK AT THISES IN TERMS OF REPORTING CANCER CONTROL AND PREVENTION ISSUES WITHIN THE STATE OF FLORIDA, GLAD TO BE HERE AS WELL. >> GOOD MORNING, I'M LINDA STENOFFIER KEY NATION OAK EVENT NAY ACTIVE AMERICAN CANCER RESEARCH CORPORATION AND PRESIDENT OF NATIVE AMERICAN CANCER INITIATIVES INCORPORATED. >> I'M ROSS HAMMOND, SENIOR FELLOW ECONOMICS AT THE BROOKS INSTITUTION HERE IN WASHINGTON KC, I ALSO DIRECT A RESEARCH CENTER, SENTENCER ON SOCIAL DYNAMICS AND POLICY WHICH DOES LOTS OF RESEARCH ON PUBLIC HEALTH TOPICS INCLUDING OBESITY AND TOBACCO CONTROL. >> I'M LINDA GREEN, LAW PROFESSOR UNIVERSITY OF WISCONSIN MADISON, AND MY AREAS OF RESEARCH ARE IN EQUALITY IN SPORTS LAW AND ALSO IN JUDICIAL POWER. >> GOOD MORNING. I'M DONNA BROOKS, EXECUTIVE OFFICER OF THE INSTITUTE. >> I'M JOYCE HUNTER DEPUTY DIRECTOR. >> THANKS, EVERYONE. WE HAVE SOME GUESTS WHO ARE ALREADY HERE. DR. SIMPSON WOULD YOU LIKE TO INTRODUCE YOURSELF, WE'LL HAVE A CHANCE TO SAY SOMETHING SHORTLY. MIC P MIC (OFF MIC) >> THANKS. NEXT. (OFF MIC) >> NICE TO SEE YOU, WE HAVE TO PUT A MICROPHONE BACK THERE. I SEE THAT NOW. ANY OTHER VISITORS BACK THERE I'M MISSING? NATASHA, WHEN SOME OF THE VISITORS COMES IN, PLEASE ALERT ME SO WE CAN INTRODUCE THEM. WE ARE GOING TO GET STARTED NOW WITH THE PRESENTATION. I DO RECALL SOMEONE MENTIONED EARLIER THAT WE HAVE OTHER GUESTS BUT THEY WILL BE INTRODUCED DURING THE PRESENTATION. IS THE POWERPOINT PRESENTATION UP? GUYS AND GALS? OKAY. THIS IS A WONDERFUL OPPORTUNITY TO ADDRESS THE COUNCIL. I WOULD LIKE TOCOIT FROM THE CONTEXT OF WHAT'S GOING ON AT THE INSTITUTE SINCE WE LAST MET WITH YOU. OF COURSE, MANY OF YOU ARE NEW TO THE COUNCIL SO YOU DON'T KNOW WHAT WE DID AS RELATES TO THE LAST COUNCIL SO I HOPE WE CAN FILL IN SOME OF THAT VOID FOR YOU AS WELL. ALSO I WANT TO MAKE THIS CLEAR THAT THIS IS A VERY DYNAMIC COUNCIL, SO IF THERE'S -- THERE ARE QUESTIONS THAT YOU HAVE OR ANY COMMENTS YOU WANT TO MAKE FEEL FREE TO MAKE THEM. WE WILL AGAIN ASK THAT YOU USE MICROPHONE SO I WILL ASK SOMEBODY TO BE SURE THAT THERE THEY USE THE STANDS UP MIC IN THE BACK OR THOSE OF YOU IN THE AUDIENCE WHO WOULD LIKE TO MAKE A COMMENT THAT YOU COME TO THE TABLE UNTIL WE GET THE MICROPHONE. THE WAY I WANT TO MANY OF YOU COME FROM LONG DISTANCES MAYBE DON'T KEEP IN CONTACT WITH WHAT'S GOING ON IN THE INNER CIRCLE OF THE BELTWAY AND MAY NOT HAVE A GOOD SENSE WHAT'S GOING ON AT THE NATIONAL INSTITUTES OF HEALTH. I WANT TO GIVE YOU AN UPDATE ON NEWS AN NOTES ASSOCIATED WITH NIMHD. TALK BUDGET LEGISLATIVE AFFAIRS. YOU DON'T COME TO WASHINGTON WITHOUT A SENSE OF HOW MUCH MONEY WE HAVE AT OUR DISPOSAL. I WILL SAY A WORD OR TWO APTER ABOUT OUR GRANTS AND PROGRAMS. I'LL RECOGNIZE OUR GUEST SPEAKERS AND HAVE AN OPPORTUNITY HOPEFULLY LEFT FOR A FULL DIALOGUE AND DISCUSSIONS WITH THE COUNCIL. IN TERMS OF NEWS FROM THE NIH, MANY OF YOU KNOW, KNEW OF THE WORK OF DR. DON LINDEBERG WHO HAS BEEN THE DIRECTOR OF THE NATIONAL LIBRARY OF MEDICINE NOW FOR MANY, MANY YEARS. HE'LL RETIRE AT THE END OF MARCH. DR. COLLINS OUR AGENCY HEAD, HAS TAKEN THE TIME NOW THAT DR. DR. LINDEBERG WILL BE RETIRING TO REASSESS THE NATIONAL LIBRARY OF MEDICINE AND ITS GOAL AND FUTURE FOR THE NEXT TEN YEARS. MUCH LIKE WE'RE DOING AS WE THINK ABOUT THE VISION FOR NIMHD OVER THE NEXT TEN YEARS SO HE HAS FORM AD WORKING GROUP OF THE ADVISORY COMMITTEE TO THE DIRECTOR TO LOOK AT AND ITS AGENDA CURRENTLY AND WHERE IT MIGHT SEE ITSELF IN THE NEXT DECADE. AND HE HAS ASKED DR.S HARLAND QINTOFF FROM YALE AND DR. ERIC GREEN WHO ARE YOU WILL MEET BECAUSE HE'S SPEAKER TO CO-CHAIR THIS IN NATIONAL LIBRARY OF MEDICINE. IN TERMS OF OTHER CHANGES AROUND THE AGENCY, WE HAVE 27 INSTITUTES AND CENTERS. AND ONE OUR NEWEST CENTERS ESTABLISHED TEN YEARS AGO WAS THE ASHNAL CENTER FOR COMPLIMENTARY AND ALTERNATIVE MEDICINE OR NCAMM AS WE CALLED NOW RENAMED CONGRESSIONALLY MANDATED TO HAVE A NEW NAME. AND IS NATIONAL CENTER FOR COMPLIMENTARY AND INTEGRATIVE MEDICINE OR NCCIH. WE'LL BE TALKING ABOUT NCCIH FOR YEARS TO COME BECAUSE WE LOVE THOSE ACRONYMS. WE HAD A WONDERFUL DISTINGUISHED VISITOR HERE A FEW MONTHS AGO. PRESIDENT OBAMA VISITED NIH AND THOSE WHO HEARD THE PRESENTATION AT THE SEPTEMBER MEETING YOU WILL RECALL THAT I SPOKE ABOUT THE EFFECTS OF EBOLA, NOT ONLY IN WEST AFRICA BUT WHAT IT WAS DOING TO US HERE AT THE AGENCY BECAUSE WE DID HAVE EBOLA PATIENT HERE AND WE WERE ALL GEARED UP TO WORK WITH THE NATIONAL INSTITUTE ON ALLERGY INFECTIOUS DISEASE IN THE CLINICAL CENTER TO SEE WHAT WE CAN DO NOT ONLY TO HELP DEVELOP A VACCINE BUT WHETHER WE COULD PARTICIPATE IN SOME OF THE CARE AND SOME OF THE ASSISTANCE IN WEST AFRICA. SO PRESIDENT OBAMA CAME HERE TO THANK NIH AND CONGRATULATE THE SCIENTISTS WORKING IN OUR INTRAMURAL LABORATORIES ON DEVELOPING A POTENTIAL EBOLA VACCINE, HEAVY SITED THE SCIENTISTS AND IT WAS A TERRIFIC SHOW OF SUPPORT THAT MADE THE FRONT PAGE OF NIH RECORD NEWSPAPERS. IT WAS WONDERFUL HAVING HIM HERE. HE EMPHASIZED THE IMPORTANCE OF BIOMEDICAL RESEARCH AND HOW THE RESEARCH WE DO HERE IS CRITICAL AS WE ATTACK GLOBAL THREATS. ONE OTHER INITIATIVE I THINK OUR COUNCIL MEMBERS WILL BE INTERESTED IN IS THE FACT THAT WE HAVE BEEN WORKING AND TALKING ABOUT THIS KNEW FOR YEARS, AT LEAST FIVE YEARS ABOUT PUTTING TOGETHER A SINGLE INSTITUTIONAL REVIEW BOARD APPROACH FOR MULTI-SITE RESEARCH REVIEWS. WE HAVE SOLICITED THROUGH THE REQUEST FOR INFORMATION, I DON'T KNOW IF ANY OF YOU SITTING AROUND THE COUNCIL TABLE RESPONDED BUT IT WAS IN THE NIH GUIDANCE GRANTS AND CONTRACTS, THIS GRAFT DRAFT POLICY WE COMMENT ON REGARDING USE OF SINGLE INSTITUTIONAL REVIEW BOARD OR IRB FOR DOMESTIC SITES THAT ARE SUPPORTED BY NIH AND THE GOAL OF THIS SINGLE I AREB IS TO ENHANCE AND STREAMLINE THE PROCESS AND REVIEW THE INEFFICIENCIES WE SEE PARTICULARLY WHEN WE HAVE NETWORKS OF MULTI-SITE NETWORKS AND YOU FIND THAT A NETWORK IN ONE PART OF THE COUNTRY SITE IS HAS AN IRB THAT QUICKLY MOVING FORWARD ON A COMMON PROTOCOL AND THEY HAVE NOT GOT ENTHEIR WORK DONE EFFICIENT MANNER. IT SLOWS DOWN THE WORK AND SLOWS DOWN THE RESEARCH EFFORTS. SO WE'RE HOPING THAT THESE TO OR CONSTITUENCIES TO GIVE THEM OUR DRAFT POLICY. AND HOPEFULLY WILL BE THE FINAL DRAFT. YOU ALL HAVE BEEN KEEPING UP WITH THE NEWS AND YOU RECALL THAT BEFORE -- AFTER PRESIDENT OBAMA CAME FOR HIS VISIT HE GAVE THE STATE OF THE UNION ADDRESS AND WE WERE VERY, VERY PLEASED THAT WE WERE MENTIONED IN THE STATE OF THE UNION ADDRESS BECAUSE OUR PRESIDENT UNVEILED PRECISION MEDICINE INITIATIVE IN THE STATE OF THE UNION ADDRESS AND THIS IS A BOLD REVOLUTIONIZING INITIATIVE. IT'S GOING TO BE TWO STAGES, I'LL HAVE TWO COMPONENTS, ONE COMPONENT WILL BE A NEAR TERM COMPONENT, THAT'S WHERE WE HAVE BEEN ASKED TO FOCUS ON CANCER. THEN THIS LONGER TERM EFFORTS WE'LL FOCUS ON OTHER DISEASES AND DR. ERIC GREEN WHO IS CO-CHAIR OF THE NIH PRECISION MEDICINE INITIATIVE WILL BE HERE TO SPEAK WITH US TODAY. I'M DELIGHTED THAT HE TOOK TIME FROM HIS BUSY SCHEDULE TO DO THIS SO YOU WILL BE ABLE TO GET IN DEPTH INFORMATION AROUND THIS FISHTIVE, SOME OF THE FUND ASSOCIATED WITH IT, I'LL TELL YOU OUR SECRET WHEN WE GET TO THE BUDGET DOLLARS BECAUSE NIMHD WENT OUT ON SOME OF THIS. WE ARE HOPEFUL THAT MANY OF OUR GRANTEES WILL INDEED BE ABLE TO PARTICIPATE IN SOME OF THE RFAs THAT ARE LIKELY TO COME UP WITHIN THE NEXT FEW MONTHS ACTUALLY BECAUSE THE FUNDING FOR THE PRECISION MEDICINE INITIATIVE ACTUALLY BEGINS IN 2016. THE OTHER THING THAT HAS BEEN VERY EXCITING FOR NIH ACTUALLY BEGINNING ALMOST FIVE YEARS AGO WHEN WE BEGAN THINKING ABOUT THIS BRAIN INITIATIVE. IT'S BEEN A VISION OVER A 12 YEAR PERIOD THAT WE WANTED TO BE ABLE TO LOOK AT MANY NEW TECHNOLOGIES TO HELP US ADVANCE BASIC NEUROSCIENCES. THAT GOT UNDERWAY WHEN WE UNVEILED THE PORTER BUILDING. ACTUALLY UNVEILED TWO DAYS BEFORE I CAME AN BOARD AS ACTING DIRECTOR OF NIMHD, I GOT THE PLEASURE OF SITTING THERE WITH THE OTHER INSTITUTE DIRECTORS AND UPHOLDING THE IMPORTANCE OF THIS BUILDING. BUT ALSO WE HAVE A A BRAIN INITIATIVE THAT IS GOING TO NOT ONLY INVOLVE INTRAMURAL LABORATORIES IN IN THE PORTER BUILDING BUT ALSO THE EXTRAMURAL COMMUNITY. WE HAVE A INITIATIVE THAT'S BEEN LAUNCHED, FUNDED 58 AWARDS BUT THE 2016 MARK WILL BE I THINK THE REAL STORY HERE BECAUSE WE WILL HAVE A TOTAL OF ABOUT 135 MILLION FOR THE BRAIN INITIATIVE AND 70 MILLION OF THOSE WILL BE NEW DOLLARS THAT WE WILL SEE FROM 2016. IN 2016. WE'RE VERY PLEASED THAT DR. NORA VOLKOW WHO LEADS THAT INITIATIVE WILL SPEAK TO OUR COUNCIL THIS MORNING AS WELL. NOW, I SPOKE WITH YOU AT THE SEPTEMBER COUNCIL, WE TALKED TO YOU AT THE JUNE COUNCIL AND JOYCE AND DR. RUFFIN AND STAFF PRIOR TO MY COMING SPOKE TO YOU ABOUT THIS IN THE FEBRUARY COUNCIL 2014. THAT WAS WONDERFUL OPPORTUNITY THAT NIH PUT BEFORE US TO ENHANCE DIVERSITY IN THE NIH BIOMEDICAL RESEARCH WORK FORCE. NIMHD WAS ACTIVELY INVOLVED IN PLANNING THESE INITIATIVES, IN FACT WE WERE THE LEAD, NOT ONLY SEEING THAT THE INITIATIVES WERE DEVELOPED AND DESIGNED WITH SUPPORT FROM THE NIH COMMON FUND OFFICE AND FROM NHLBI, BUT WE ACTUALLY DEVELOPED RFAs, HIRED STAFF TO RUN THESE INITIATIVES AND GET INITIATIVES STARTED, PLEASED TO REPORT TO YOU NOW THESE INITIATIVES HAVE BEEN AWARDED. AND THERE ARE THREE INITIATIVES, ONE IS THE BUILDING INFRASTRUCTURE MEETING TOTY VERSE FINISHTIVE, THE BUILD PROGRAM, THIS PROGRAM WAS REALLY TARGETED TO AS A TRAINING AWARDS PROGRAM, TO SEE THAT YOUNG INVESTIGATORS AS WELL AS STUDENTS WHO COME FROM DIVERSE BACKGROUNDS HAVE OPPORTUNITIES TO CONDUCT BIOMEDICAL RESEARCH AND THEY'RE MEASURED THROUGHOUT THEIR BIOMEDICAL RESEARCH EXPERIENCES. THEN AS PARTS OF THE MENTORING ASPECT OF THIS, WE ACTUALLY CREATED A MENTORING NETWORK, THE NIMRN THAT IS A NATIONWIDE NETWORK THAT WILL ACTUALLY LINK THE TEN SITES WHO ARE ON THE GROUND IN THE VARIOUS LOCATIONS AROUND THE COUNTRY TO ACTUALLY LOOK AT WHAT MECHANISMS ARE BEING USED AT EACH SITE AND WHICH PERHAPS HAVE THE BEST PRACTICES. THIS WILL BE A NETWORK THAT WILL NOT ONLY MEASURE STUDENTS BUT WILL ALSO SERVE TO MENTOR FACULTY. OF COURSE, WE BELIEVE THAT TO DO SOMETHING LEAK THIS, IT MUST BE EVALUATED, BECAUSE THIS INITIATIVE, THESE INITIATIVES ARE FUNDED THROUGH THE COMMON FUND, IT'S LIKELY THEY WILL BE JUST TEN YEAR INITIATIVES BECAUSE THE COMMON FUND PRINCIPLES ARE BASED ON FIVE TO TEN YEAR PERIODS OF AWARDS SO WE ARE HOPING THAT THESE CERTAINTY FOR EVALUATION OR COORDINATION EVALUATION CENTER WILL GIVE APPROXIMATE OPPORTUNITY WHAT WORKS, WHAT DOES NOT WORK AND WHO SEEMS TO BE DRIVING THESE TYPES OF PROGRAMS, THEN WE WANT TO BE ABLE TO DISSEMINATE THE INFORMATION TO THE RESEARCH IMMUNITY. THIS IS JUST THE START. THESE ARE JUST THE START. HOPEFULLY THIS WILL TAKE ON AND PEOPLE WILL RECOGNIZE THAT THIS IS A WAY TO TRAIN AND MENTOR A DIVERSE BIOMEDICAL RESEARCH WORK FORCE. THIS GIVES YOU A SENSE OF WHERE THESE SITES ARE LOCATED. THEY ARE INDEED AROUND THE COUNTRY AND WE'RE HOPEFUL THAT ADDITIONAL PARTNERS WILL BE JOINING THE NETWORK AND WE THINK THAT THIS WILL OCCUR THROUGH SUPPLEMENTS IN SOME OF THE EXISTING GRANTS, JUST SEE HOW THE OTHER INSTITUTES TAKE ON TO THIS. THIS IS A TRANS-NIH INITIATIVE, FUNDED OUT OF THE COMMON FUND WHICH MEANS THAT IN AND OF ITSELF IS TRANS-NIH SO WE HAVE BEEN VERY MUCH EXCITED ABOUT THIS PROGRAM BECAUSE WE ALSO HAVE SOME FUNDED PARTNERS WHO ARE LOCATED IN THE AMERICAN IS A MOIIA, GUAM AND NORTHERN MARIANNA ISLANDS. AS YOU LOOK AT THE SITES WE CAN SEE DISTRIBUTION THAT PERHAPS WE CAN SEE US FILLING IN SOME OF THE GAPS. LET'S TALK A FEW MINUTES WHAT'S GOING ON AT NIMHD. ONE OF THE THINGS I WANT TO START WITH FIRST IS THAT IT'S ABOUT COMMUNICATING, COMMUNICATING COMMUNICATING. WE THINK THAT IT'S CRITICAL NOT ONLY TO BE ABLE TO COMMUNICATE AMONG OURSELVES AND I THINK STAFF WILL ALL AGREE THAT WE'VE DONE EVERYTHING WE POSSIBLY COULD OVER THE LAST TEN MONTHS TO SEE THAT WE ENHANCE COLLABORATION AND OUR COMMUNICATION AMONG OURSELVES. EVERYTHING FROM KEEPING OUR DOORS OPEN TO HAVING REGULAR PLAN AND SCHEDULE MEETINGS. BUT I THINK ANOTHER WAY TO GET COMMUNICATION ONGOING AND KEEP ONGOING IS TO WORK TOGETHER TO HARMONIZE INITIATIVES AND PROJECTS THAT WE THINK ARE IMPORTANT. SO WE HAVE TEAM EFFORTS HERE ALL THE TIME AND ONE TEAM EFFORT I WANT TO BRING TO YOUR ATTENTION IN THIS SLIDE, THAT IS NIMHD HAS A WONDERFUL NEWS LETTER THAT WE HAVE ENTITLED HEALTH DISPARITIES , WE'LL USE THIS NEWS LETTER TO HIGHLIGHT OUR STAFF ACTIVITIES, STAFF AWARDS AND RECOGNITION ISSUES THAT GO ON ACROSS THE NIH AS WELL AS ACROSS OUR STAKEHOLDER COMMUNITIES AND I WANT TO SAY CONGRATULATIONS TO KELLY CONSIDERINGTON AND COMMUNICATIONS OFFICE BECAUSE WE ASKED THEM TO DO THIS AND KELLY CAME ON A DETAIL WITH US FROM THE CLINICAL CENTER AND HAS PUT THINGS IN PLACE OVER THE SHORT PERIOD OF TIME SHE'S BEEN HEREMENT THE MOST RESENTENCE THING SHE PUT IN PLACE WAS MONDAY. THANKS TO DR. THOMAS AND OTHERS WHO GOT BACK TO ME AND SAYS HEY, NIMHD IS ON FACEBOOK AND WE'RE ON TWITTER SO AS OF MONDAY IF YOU HAVE TO TWEET US FEEL FREE TO DO THAT. I MENTION TO THE STAFF YESTERDAY I SAID DO YOU HAVE AN IDEA HOW MANY HITS WE HAVE GOT ALREADY? WE HAVE BEEN ONLY BEEN UP A FEW DAYS. BUT AGAIN THANKS TO THE COMMUNICATION STAFF, YOU HAVE DONE A WONDERFUL JOB. NOW, I ALSO WANT TO SAY THE NEWS LETTERS AND THE NOTES WE GET WE ALSO WANT TO GET NEWS LETTERS AND NOTES FROM THE COUNCIL MEMBERS. AND OUR DEAN OVER HERE THAT BECAME DEAN, IT WOULD BE GREAT TO PUT THAT IN OUR NEWS LETTER AND BE ABLE TO RECOGNIZE THE ACCOMPLISHMENTS OF OUR COUNCIL. AND ANGELA BATES HAS ASSURED ME THAT HE'S READY AND WILLING TO ACCEPT ALL NOTES AND EMAILS, PHONE CALLS FROM COUNCIL MEMBERS BECAUSE WE WILL HIGHLIGHT COUNCIL MEMBERS AND THEIR ACTIVITIES IN OUR NEWS LETTER AS WELL. WE HAVE SEVERAL NEW APPOINTMENTS AND SEVERAL STAFF ON DETAIL SINCE I LAST MET WITH YOU IN SEPTEMBER. WE'RE PLEASEED THAT DR. WI CHEN FOUND A WONDERFUL OPPORTUNITY AT THE CENTER FOR SCIENTIFIC REVIEW, SHE WAS A TREMENDOUSLY COMPETENT SCIENTIFIC REVIEW ADMINISTRATOR IN CENTER FOR RESEARCH REVIEW AT NIMHD. SHE HAD BEEN WITH THEM TWO AND A HALF YEARS BUT FOUND AN OPPORTUNITY TO RUB A STUDY SECTION AT CSR THAT WAS MORE IN LINE TO HER DISCIPLINE AND BACKGROUND AND TRAINING SO WE WISH HER WELL AND WE HAD A GOING AWAY CELEBRATION FOR HER A COUPLE OF WEEKS AGO. I'M PLEASED TO ANNOUNCE AND LIKE OUR STAFF HERE, AND OUR DETAILEES WHO HAVE COME FROM THE OTHER INSTITUTES TO STAND WHEN I INTRODUCE YOU I'M VERY PLEASED THAT DR. COURTNEY ATMAN CAME TO NICCHD, SHE CAME IN JANUARY ACTING CHIEF OF STAFF, SHE KEEPS EVERYBODY ON POINT, I'M LOOKING TO SEE STAFF NODDING HER HEAD SHE'S A WONDERFUL E ADDITION TO NICHD. SHE CAME FROM NINDS WHERE SHE RAN A PROGRAM IN OFFICE OF SPECIAL PROGRAMS AND DIVERSITY. I DON'T KNOW IF DR. NANCY GREEN IS HERE TODAY BUT NANCY WILL BE JOINING US IN A FEW DAYS TO SERVE ON DETAIL FROM THE NATIONAL CANCER INSTITUTE, SHE IS A HEALTH ECONOMIST. AND WE ARE VERY EXCITED BECAUSE AS YOU WILL HEAR MORE ABOUT OUR STRATEGIC PLANNING GOALS, AND THE FOCUS OF OUR VISIONING PROCESS, I THINK WE'LL RECOGNIZE WE HAVE SOMEONE TO HEALTH ECONOMICS ON OUR STAFF IS VALUE-ADDED SO SHE WILL BE JOINING US. AS SHE COMES ON THE HEALTHCARE DELIVERY RESEARCH PROGRAM AT NCI. DR. FARHAT. ARE YOU HERE? NOT YET. SHE'S THERE. SORRY ABOUT THAT. SHE'S BEEN A WONDERFUL ADDITION TO OUR STAFF AND I HAVE KNOWN HER SHE WORKED AT NICHD SEVERAL YEARS BEFORE GOING TO THE CANCER INSTITUTE. PRIOR TO JOINING US, SHE WAS A HEALTH SCIENTIST ADMINISTRATOR AT NCI AND SHE WILL WORK IN THE STREAM PLANNING LEGISLATION AND SCIENTIFIC POLICY OFFICE. DR. KEVIN GARDENER MAYBE AT ANOTHER MEETING THIS MORNING BUT YOU ALL MAY RECALL THAT I INTRODUCED KEVIN TO THE COUNCIL IN SEPTEMBER. AS THE ACTING DEPUTY SCIENTIFIC DIRECTOR. THOSE OF YOU WHO KNOW NIMHD WELL KNOW THAT WE LOST OUR SCIENTIFIC DIRECTOR AS WELL AS OUR CLINICAL DIRECTOR ALL WITHIN THE SPAN OF THREE TO FOUR MONTHS. I CAME HERE IN APRIL, COUPLE OF MONTHS THEREAFTER, FUEROS DR. REEDE, OUR CLINICAL DIRECTOR AND DR. BILL COLEMAN DIED IN AUGUST SO KEN HAS BEEN HELPING ME AND US RUN THE INTRAMURAL PROGRAM AND HE'S DONE A WONDERFUL JOB SO HE'S OFFICIALLY APPOINTED ACTING SCIENTIFIC DIRECTOR AND HE'S A TENURED INVESTIGATOR IN THE NATIONAL CANCER INSTITUTE AND ALSO AS SENIOR INVESTIGATOR IN THE NIMHD INTRAMURAL PROGRAM. MS. MILDRED QUARRELS, I DON'T KNOW IF SHE IS HERE YET, I UNDERSTAND SHE HAS PROBLEMS GETTING IN THIS MORNING BUT WE'RE WONDERFULLY PLEASED TO HAVE HER HERE. SHE'S A GRANTS MANAGEMENT SPECIALIST WHO COMES FROM NIAID. SHE'S VERY COMPETENT AND QUALIFIED IN THIS JOB. KENNETH (INAUDIBLE) FROM THE NATIONAL INSTITUTE OF NEUROLOGY, AND -- HI. GOOD TO SEE YOU, KEN. I THINK I HAD HERE INITIALLY KEN WAS ON A DETAIL, KEN IS OFFICIALLY NOW OUR BUDGET ONE OF OUR BUDGET STAFF IN OUR BUDGET OFFICE AND WE'RE PLEASED TO HAVE HIM HERE. WE HAVE ALREADY SEEN VALUE HAVING HIM HERE AS WE WORK THROUGH CONGRESSIONAL JUSTIFICATION A FEW WEEKS AGO. TERRY WILLIAMS WHO WORKED WITH US AS A CONTRACTOR IN THE GRANTS MANAGEMENT OFFICE IS NOW OVER INTO THE BUDGET OFFICE BECAUSE WE'RE TRYING TO TRANSITION OUR BUDGET STAFF TO GET A CONSORTIUM OF REALLY GOOD PEOPLE BECAUSE BUDGET AS YOU KNOW AND BUDGET MANAGEMENT IS CRITICAL TO US IN TIMES OF CONSTRAINED FUNDING SO WE WANT TO BE SURE WE GOT THE RIGHT TEAM OF BUDGETEERS THEN. I THANK (INAUDIBLE) FOR REACHING OUT TO SEE THAT WE HAVE A WELL ESTABLISHED BUDGET OFFICE. THE OTHER THING I WANT TO SAY, LAST BUT CERTAINLY NOT LEAST, AS RELATES TO WHAT WE HAVE BEEN DOING HERE AT THE NIMHD, WE HAVE BEEN TRYING TO SEE WHERE WE BEST FIT AND HOW WE CAN ADHERE TO THE MISSION INSTITUTE IN A WAY THAT'S EFFICIENT AND GETS OUR MISSION ACCOMPLISHED. ONE THING WE RECOGNIZE THAT'S IMPORTANT TO RECOGNIZE PEOPLE FOR WHAT THEY DO, WE HAD A GREAT STAFF PRESENCE THIS PAST YEAR SO NIMHD HAT NAG RECALL STAFF RECOGNITION CEREMONY IN DECEMBER 8TH, THIS IS A PICTURE OF OUR STAFF WILSON HALL AT NIH AND WE RECOGNIZE OUR STAFF WITH THEIR COMMITMENT AND ACHIEVEMENT OVER THE LAST CALENDAR YEAR AS WELL AS TO RECOGNIZE LONG STANDING EMPLOYEES WHO HAD LONG TERMS OF SERVICE. WE HAD SOME OF OUR STAFF AT LEAST ONE, MAYBE TWO AND AT NIH OVER 40 YEARS. SO WE HAVE A VERY, VERY ACCOMPLISHED STAFF. WE HAVE GONE FROM LOOKING AT OURSELVES TO TO WITHIN. PEOPLE WORKING TOGETHER TO ACCOMPLISH THE GOALS OF NIMHD MISSION. TO IMPROVE THE HEALTH OF THOSE WHO ARE UNDERSERVED AND SEE THAT RESEARCH AT THE NIH IN HEALTH DISPARITIES COORDINATED AND FACILITATED IN SUCH A WAY THAT WE CAN BE ABLE TO TELL THE AMERICAN PUBLIC HOW THEIR TAX PAYER DOLLARS ARE SPENT TO REDUCE AND ELIMINATE HEALTH DISPARITIES. SO I THINK WE'RE GETTING OURSELVES PRETTY WELL FIT TO CONTINUE TO MOVE FORWARD BUT WE FOUND COLLABORATION OUTSIDE OF OURSELVES IS CRITICAL. COLLABORATIONS ARE WITH OTHER INSTITUTES, BUT WITH OTHER AGENCIES AND WITH THE COMMUNITIES IS PARAMOUNT TO A MISSION SUCH AS THIS INSTITUTE HAS SO ONE OF THE THINGS THAT WE WASH TOGETHER AS A TEAM OVER THE LAST SEVERAL MONTHS IS TO IDENTIFY SOME COLLABORATIONS TRANS-NIH. AND THE GOOD THING ABOUT IT IS ONCE PEOPLE KNOW THAT YOU WANT TO PARTNER AND THAT YOU'RE OPEN TO PARTNERSHIPS, THEY COME TO YOU AND SAY WILL YOU PARTNER WITH US SO IT'S NOT ALWAYS ALL GOING OUT OH, HELP US CO-FUND THIS, PEOPLE ARE COMING UP TO US. THESE ARE JUST SOME SELECT PARTNERSHIPS THAT I WANTED TO BRING TO YOUR ATTENTION, BECAUSE SOME YOU WILL HEAR ABOUT TODAY. EVEN IN CONTEXT OF SOME OF THE REMARKS I HAVE YET TO MAKE. OR FROM SOME OF THE STAFF PRESENTATIONS LATER DURING THE CLOSED SESSION AND OF COURSE WHEN DR. DON MULLEN AND STAFF PRESENTS THE VISIONING YOU WILL SEE THE FOLKS WE HAVE BEEN COLLABORATING WITH. YOU WILL HEAR ABOUT THE ADOLESCENT MEDICINE TRIALS NETWORK, A COLLABORATION WITH NICHD, AND SEVERAL INSTITUTES WITH FUNDING FROM THE OFFICE OF AIDS RESEARCH. I KNOW COUNCIL MEMBERS ALWAYS LIKE TO KNOW, YOU'RE COLLABORATING REACHING OUT, WHICH WAY DID THE MONEY GO IN YOU'RE GIVING THEM MONEY OR ARE THEY GIVING US MONEY? IN THIS PARTICULAR CASE IT'S A WONDERFUL COLLABORATION BECAUSE THE OFFICE OF AIDS RESEARCH PROVIDES THE FUNDING FOR US TO PARTICIPATE IN THIS ADOLESCENCE MEDICINE TRIALS AND YOU ARE HEAR ABOUT THIS LATER TODAY. WE'RE COLLABORATING NATIONAL INSTITUTE OF ALLERGY INFECTIOUS DISEASE WITH FUNDING TO BE PARTICIPANTS IN THE CENTER FOR AIDS RESEARCH. FOR THOSE OF YOU WHO HAVE KNOWN NIH FOR YEARS YOU KNOW THE C FAR PROGRAM IS A LONG STANDING PROGRAM THAT IS INVESTIGATING AIDS ACROSS POPULATIONS BUT MOST IMPORTANTLY ALSO LOOKING AT AIDS TREATMENT AND MANY THERAPIES WE HAVE IN PLACE TODAY THAT HAVE HELPED US REDUCE THIS EPIDEMIC ON THE DOMESTIC SIDE IS NOT POSSIBLE WITHOUT THE WORK FOR CENTERS FOR AIDS RESEARCH. WE'RE ALSO WORKING WITH NIDA, THIS IS ONE OF THE INITIATIVES WITH THE DIRECTOR OF NIDA, DR. NORA VOLKOW REACHED OUT TO US AND ASKED NIMHT TO PARTICIPATE WITH HER AND NIDA AND TWO OTHER INSTITUTES ON THE ADOLESCENT BRAIN COGNITIVE DEVELOPMENT INITIATIVE AND THAN IS AN EXCITING INITIATIVE SHE WILL TELL YOU ABOUT. THE NATIONAL INSTITUTE ENVIRONMENTAL HEALTH SCIENCES HAS ASKED US TO PARTNER WITH THEM ON CENTERS OF EXCELLENCE ON ENVIRONMENTAL HEALTH DISPARITIES IN COLLABORATION WITH THEM AND THERE'S AN RFA THAT WILL BE -- IF IT'S NOT ON THE STREET I BELIEVE ALREADY ON THE STREET, NASHADA IS OUT THERE AND WE ARE CONTRIBUTING TO THIS. THIS IS ONE OF THE INITIATIVES WHICH NIMHD IS CONTRIBUTING FUNDS. THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE HAS COME TO US AND ASKED US TO PARTNER WITH THEM ON TWO STUDIES AND ONE IN PARTICULAR RELATESES TO INCLUSION OF DIVERSE POPULATIONS IN GENOMIC DATABASES AND DR. ERIC GREEN WILL BE HERE TODAY SO HE WILL TELL YOU ABOUT THE PROPOSAL THAT HE'S PRESENTED TO US. AS YOU KNOW FOR NIMHD, IT'S CRITICAL THAT WE PLAY A BIG ROLE IN REACHING OUT TO OUR CONSTITUENCIES BUT MOST IMPORTANTLY TO THE POPULATIONS THAT WE SERVE TO SEE THAT THEY INDEED ARE INCLUDED IN SOME OF THE BIG DATA INITIATIVES THAT WE DO. IN PARTICULAR WHEN IT COMES TO REGISTRIES AND BIOBANKS AND DATA BANKS WE NEED TO BE WORKING WITH THEM TO BUILD TRUST IN OUR MECHANISMS AND OUR APPROACHES IN TO OUR ISSUES OF CONFIDENTIALITY, ALL THE THINGS THAT WE TALK ABOUT BUT I THINK NIMHD CAN DO IT PERHAPS BETTER THAN ANY INSTITUTE BECAUSE WE HAVE COUNCIL OF BELIEVERS AND STAFF OF BELIEVERS AND WE ALL AT LEAST THINK WE KNOW HOW TO DO IT IN A WAY THAT WILL PLEASE OUR GROUPS. OFFICE OF BEHAVIORAL SOCIAL SCIENCES RESEARCH, WE'RE PLEASED DR. HAIRILY HAS BEEN AN AD HOC MEMBER OF OUR COUNCIL BUT WE WERE APPROACHED BY SOME FORMER NIH STAFF WHO ARE COLLABORATING NOW WITH THE ACADEMY OF SCIENCES WHO CAME TO NIMHD AND ASKED US TO WORK WITH THEM TO PUT TOGETHER A WORKSHOP IN JUNE ON TRAINING AND POPULATION HEALTH SCIENCE. YOU CAN TALK ABOUT WANTING TO DO MORE RESEARCH IN POPULATION HEALTH BUT WE NEED A CADRE OF TRAINED POPULATION HEALTH SCIENTISTS. THE OFFICE OF BEHAVIORAL SOCIAL SCIENCE RESEARCH IS PUTTING THE LION'S SHARE OF DOLLARS INTO THE WORKSHOP AND CO-FUNDING WITH C RILEY AND OBSSR, THE WORKSHOP HELD AT THE INSTITUTE OF MEDICINE IN EARLY JUNE. LAST BUT NOT AT LEAST, WE ARE VERY THRILLED TO BE TALKING TO YOU ABOUT A COLLABORATION THAT WE HAVE WITH OUR INTRAMURAL PROGRAM, DIVISION OF INTRAMURAL RESEARCH OBVIOUSLY PART OF THE OFFICE OF DIRECTOR OF NIH. WE ARE PARTICIPATING IN THE MEDICAL RESEARCH DOLLARS PROGRAM, I WILL SAY MORE P ABOUT THAT IN A FEW MINUTES. THIS IS JUST A QUICK READ FOR YOU, AS YOU THINK ABOUT THESE INITIATIVES THAT I JUST MENTIONED. CENTERS OF EXCELLENCE ON ENVIRONMENTAL HEALTH DISPARITY, THAT PROGRAM I SHOW YOU ABOUT IN WHICH WE ARE PARTICIPATING IN THE CENTERS GROUP IS A P-50 SENTENCERS INITIATIVE. AND DR. RASH MASHADI, WE CALL HER THAT BECAUSE WE STUMBLE OVER HER NAME ONCE IN A WHILE BUT STAND UP SO THE STAFF CAN SEE YOU, BECAUSE THERE MAYBE SOME COUNCIL MEMBER WHOSE MAY HAVE SOME QUESTIONS HAS BEEN THIS INITIATIVE AND YOU WOULD BE THE RIGHT ONE TO ANSWER THE QUESTIONS. FROM FRANCISCO SI IS OUR COORDINATING PROGRAM OFFICER, ALONG WITH DR. RICK BURSON, AND DR. ADELAIDE PRESARIO WHO IS LOOKING AT ADOLESCENCE MEDICINE TRIAL NETWORK AND WILL BE PRESENTING BACK TO YOU DURING THE CLOSED SESSION OF COUNCIL. YOU CAN SEE THIS IS A LONG STANDNDING NATIONAL NETWORK DEVOTED TO HEALTH AND WELL BEING OF HIV INFECTED YOUTH AND YOUNG ADULTS AT HISK FOR HIV. YOU MAY RECALL WHEN WE HAD OUR JUNE COUNCIL, WE MADE IT PRETTY CLEAR THAT WE'RE INTERESTED IN HIV AIDS, ONE HIGH PRIORITY AREAS. FOLKS WILL SAY WHY PERHAPS. THE WHY IS THAT OF ALL THE HEALTH DISPARITY ACTIVITIES THAT CAME OUT OF THE FORMER PRESIDENT CLINTON AND SECRETARY SHELA INITIATIVE IN 2000, THERE WERE SIX AREAS IN WHICH WE WERE ENCOURAGED TO REDUCE THE HEALTH DISPARITIES. HIV AIDS WAS ONE OF THEM. AND IF YOU LOOK AT THE OTHERS INFANT MORTALITY, CANCER, HEART DISEASE, DIABETES, IMMUNIZATION YOU WILL SIDENOTES AND GAP IS CLOSING BUT WITH HIV IT'S NOT CLOSING. MAKE'S WIDENING. WHEN YOU THINK ABOUT WOMEN HETEROSEXUAL WOMEN SO WE'RE PLEASED TO REACH OUT TO DO MORE WITH HIV AIDS AND PLEASED OFFICE OF AIDS RESEARCH SUPPORTS US IN THAT REGARD. I MENTION IT'S CRITICAL FOR US TO LOOK AT INCLUSION OF DIVERSE POPULATIONS AND CLINICAL TRIALS. WE ALL KNOW THIS IS A DIFFICULT OUTREACH EFFORT TO EXPLORE. WE HAVE STAT AND INSTITUTE WHO ARE DETERMINED TO WORK TOGETHER TO SEE WE DO MORE TO GET THESE MISSING PATIENTS AS THEY SAY IN TO OUR CLINICAL TRIALS. REASON I SHOW THIS PARTICULAR SIDE, ESTABAN RASHAD HAS DONE A SERIES OF PUBLICATIONS IN NATURE AND ONE IN SCIENCE WHICH HE TALKED ABOUT THE FACT THAT EFFECTIVE CLINICAL TRIALS AND MANY OF THEM FUNDED BY THE NIH REALLY ARE VERY MUCH LACKING WHEN IT COMES TO EXCLUSION OF MANY MINORITY ETHNIC AND RACIAL MINORITY GROUPS. WE HAVE TO GIVE OUT THE MESSAGE THAT IT'S NOT THAT WE JUST WANT OUR MINORITY POPULATIONS TO BE INCLUDED IN THE STUDY TO MAKE IT MORE EXACT OR MAKE THE STUDY MORE EFFICIENT IN HOW WE REPORT THE DATA BUT WE NEED TO TELL OUR COMMUNITIES TO NOT BE INCLUDED MIGHT ALSO HURT THEM BECAUSE THERE ARE MANY DRUGS AND THERAPIES THAT OFTENTIMES ARE USED IN MINORITY COMMUNITY, IN PARTICULAR WHEN IT COMES TO ASTHMA INHALANTS USED IN HISPANIC COMMUNITY AND HISPANIC AMERICANS THAT CAN HARM THEM AND RASHAAD TELL AS STORY AS A YOUNG PRACTICING PHYSICIAN AND SAW THIS YOUNG BOY ON THE STREETS IN NEW YORK AND HE'S ACTUALLY GASPING FOR BREATH AND TURNS OUT NEBRASKALYZEER HAD BEEN USED IN ASTHMA ATTACK AND IT WAS SHOWN IN INGREDIENTS AND COMPONENTS OF IT WERE ACTUALLY HARMFUL. SO WE WANT TO SEE THAT OUR POPULATION ALL OF OUR POPULATIONS ARE INCLUDED IN CLINICAL TRIALS NOT BECAUSE WE WANTS TO GET ALL THE NUMBERS RIGHT BUT BECAUSE WE WANT TO ACTUALLY IMPROVE THEIR HEALTH. SO WORKING WITH THE HUMAN GENOME RESEARCH INSTITUTE WE BELIEVE WILL HAVE AN OPPORTUNITY TO DO A MUCH MORE AGGRESSIVE -- HAVE A MORE AGGRESSIVE PLAN TO DO THIS. THE MEDICAL RESEARCH SCHOLARS PROGRAM, JUST A FEW MINUTES TO TELL YOU ABOUT THIS PROGRAM, THIS IS A PROGRAM NIH HAS HAD IN PLACE FOR THREE YEARS. IT WAS INITIALLY SUPPORTED WITH THE HOWARD HUGHES MEDICAL INSTITUTE BEING A MAJOR PARTNER. THE PROGRAM IS A COMPREHENSIVE YEAR-LONG OPPORTUNITY FOR MEDICAL IN THEIR SECOND THIRD OR FOURTH YEAR. WE LIKED THEM THE THIRD OR FOURTH YEAR BUT WILL TAKE SECOND YEAR STUDENTS AS WELL TO COME TO NIH ALL VETERINARIAN STUDENTS, THEY COME TO THE NIH, ALL EXPENSES PAID FOR ONE YEAR. TO GET AN INTENSIVE OPPORTUNITY TO WORK IN LABORATORY, THEY HAVE DIDACTIC COURSES. THEY MEET WITH HEALTH POLICY LEADERS ACROSS NIH. AND IT'S JUST A WONDERFUL OPPORTUNITY. NIMHD HAD A CHANCE TO LOOK AT THE PRIOR CLASSES. THAT HAVE COME THROUGH NOMINATION AND ACCEPTANCE PROCESS. AND RECOGNIZE THAT DIVERSITY WAS NOT THERE. IT'S JUST NOT THERE AND IT WAS NO REASON THAT WE COULD SEE NOT BEING THERE EXCEPT WE NEEDED MORE APPLICATIONS IN ORDER TO BE SELECTED, LIKE IF YOU DON'T WANT WRITHE A GRANT AND COMMIT YOU WON'T GET FUND SOD IF YOU DON'T PUT IN AN APPLICATION TO THE PROGRAM THE CHANCES OF YOU GETTING SELECTED ARE NOT -- DO NOT EXIST. SO WE LOOK AT THE PROGRAM, AND WORKING WITH OUR STAFF, WE DECIDED WE BELIEVE THAT WE DID A FULL COURT PRESS, PICKED UP OUR PHONE, CONTACTED DEANS OF MEDICAL SCHOOLS, PRESIDENTS OF COLLEGES, THAT WE COULD MAKE A DIFFERENCE. AND DR. NATE STINSON AND DELORES HUNTER TOOK THIS ON AT MY REQUEST AND HAVE DONE A A FANTASTIC JOB. AND VERY, VERY SHORT PERIOD OF TIME. I THINK WE HAD MORE TIME GIVEN TO US WE DIDN'T FIND OUT ABOUT THE PROGRAM UNTIL MID FALL. THAT THIS WAS -- THAT SOME OF THE ISSUES EXISTED. WE FOUND OUT IN MID FALL IT WAS SCHEDULED TO CLOSE, THE APPLICATION PROCESS WAS SCHEDULED TO CLOSE ON JANUARY 15. WE EXTENDED TO JANUARY 31st AND NATE DELORES AND I SAT IN ON THE APPLICATION PROCESS TWO WEEKS AGO, STUDENTS ARE BEING INTERVIEWED. WE HAVE OUR SELECTION COMMITTEE MEETING NEXT WEEK. WE'RE PLEASED TO SAY THAT IT IS A VERY, VERY GOOD IN TERMS OF HAVING SOME HIGHLY QUALIFIED AND WELL REPRESENTED DIVERSE MINORITIES AVAILABLE TO US FOR THE NEXT YEAR. NOW ONE OF THE THINGS THAT I SHOULD TELL YOU THIS CAME ACROSS , WAS THE NIMHD STAFF TIME AND EFFORTS IN OUR ENERGY BEHIND IT, IT COSTS US ABOUT ONE 1/2 MILLION DOLLARS, ABOUT HALF WHAT THE PROGRAM COSTS. BUT IF YOU SPEND MONEY TO DO SOMETHING, AND MAYBE YOU HAVE A LITTLE BIT MORE POWER. SO WE ARE VERY PLEASED ABOUT THIS. WE ALSO ARE TAKING COLLABORATIONS BEYOND THE NIH AND WORKING WITH VARIOUS COMMUNITY GROUPS AND ORGANIZATIONS. THE -- THESE ARE SOME OF THEM. WE HAVE A COLLABORATION WITH THE GEN YOUTH FOUNDATION WHICH HAS A BOARD OF DIRECTORS THAT'S ACTUALLY CHAIRED BY FORMER AND THEY ARE IN COLLABORATION WITH THE NATIONAL DAIRY COUNCIL AND THE NATIONAL FOOTBALL LEAGUE TO LOOK AT THE FOOTBALL GAME SUPERBOWL, SO YOU WOULD SEE THE LITTLE GIRL WHO ACTUALLY SAYS OR SOMETHING, THIS IS THE GROUP THE GEN YOUTH FOUNDATION IS A GROUP THAT'S PROMOTING EXERCISE FOR 60 MINUTES AS WELL AS RIGHT NUTRITION BUT STARTING IN SCHOOL SO IT PROMOTE SCHOOL LUNCH SO WE'RE COLLABORATING WITH THEM. WHAT WE'RE PROVIDING TO THEM THROUGH COMMUNICATIONS OFFICE, IS TO TAKE ALL THE MATERIALS GOOD PORTION OF WHAT THEY PRODUCE IN TERMS OF INFORMATION AND TRANSLATING INTO SPANISH. THEY HAVE WONDERFUL HEALTH MESSAGE BUS ALL IN ENGLISH SO WE'RE HELPING THEM BY GETTING THEM TRANSRATED IN SPANISH. WE'RE ALSO INTERESTED IN, YOU WILL HEAR FROM IRENE AND STAFF THIS AFTERNOON AS WE TALK ABOUT VISIONING WE BELIEVE SOCIAL DETERMINANTS BY THE CAME IN TO OUR OFFICE AND TO PARTNER WITH US. ASKED US TO GIVE THEM INTELLECTUAL CAPITAL AROUND MEN'S MENTAL HEALTH. WE'LL LOOK AT MEN'S MEMBER TALL HEALTH ACROSS THE LIFE SPAN BUT BEING SPECIFICALLY COGNIZANT OF THE AFRICAN AMERICAN MALE IN PARTICULAR THE YOUNG MALE FOCUSING ON DEPRESSION AND STRESS AND WHAT ARE SOME OF THE MARKERS OF STRESS AND DEPRESSION, MOST PEOPLE THINK THAT YOU CAN'T PHYSIOLOGICALLY MEASURE THEM BUT WE CAN. THESE ARE SELECTED STAFF PRESENTATIONS WHERE YOU JUST SORT OF QUICKLY GO THROUGH, WE ARE IN DEMAND. OUR STAFF IS ALWAYS ASKED TO GO OUT TO GIVE NOTE ADDRESSES. THESE ARE THREE OF TEN I HAVE DONE AT COUNCIL. BUT WE ENJOY GIVING OUR COMMUNITIES THE INFORMATION THEY NEED NOT ONLY TO WRITE GRANTS AND KNOW WHAT PROGRAMS ARE ONGOING AT THE NIMHD BUT ALSO GIVE THEM A SENSE OF WHERE THE FEW FUTURE LIES WITH US IN TERMS OF WHAT OUR VISION IS. WHERE SCIENTIFIC AREAS AREA OF PRIORITIES. I WANT TO THANK IN PARTICULAR TWO HERE WE PICKED UP ON, DR. IRENE MULLEN WHO WENT TO BELLAGIO TO REPRESENT US SPEAKING ON SOCIAL DETERMINANTS OF GLOBAL IMMIGRANTS AND MIGRANT HEALTH AND DR. PAMELA THORNTON WHO WAS A PROGRAM OFFICER ASSOCIATED WITH THE BUILD PROGRAM WHO GAVE LESSONS LEARNED FROM MATERNAL CHILD HEALTH UPCOMING PUBLIC HEALTH ASSOCIATION ANNUAL MEETING BACK IN NOVEMBER. ONE OF THE THINGS THAT GAVE US -- HAS GIVEN A LOT OF JOY OVER THE LAST FEW MONTHS, THE FACT WE HAVE BECOME MORE COGNIZANT OF IMPORTANCE OF US SHOWING THAT WE REPRESENT MANY POPULATIONS. THIS IS THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES AND YOU KNOW WE'RE TALKING POPULATION HEALTH NOW AND THE HEALTH OF POPULATION WHO ARE UNDERSERVED AND DISPROPORTIONATELY SEEM TO BE UNWELL OR IN POOR HEALTH. AS WE HAVE MADE AN EFFORT TO REACH OUT TO AMERICAN INDIAN ALASKA NATIVE COMMUNITY, AND WE HAD A FIRST TIME RESEARCH FORUM HERE AT THE NIH AND I TOLD YOU ABOUT IT, IN SEPTEMBER. THAT WE WERE GOING TO HAVE IT. IT HAPPENED. WE HAD THIS IN NOVEMBER. WE USED THIS FORUM TO BRING IN SOME OF THE BRIGHTEST AND BEST AMERICAN INDIAN ALASKA NATIVE RESEARCHERS AND FOR THEM NOT ONLY TO TELL US BUT ALSO KNOW WHAT ARE THE HURDLES AND CHALLENGES THEY FACE AS THEY CONDUCT THEIR RESEARCH. WE NEED TO KNOW CHALLENGES MANY TERMS OF ADDRESSING THIS IN PERSPECTIVE OF NEW INVESTIGATORS. WE WON'T GET NEW INVESTIGATORS WITH AMERICAN INDIAN ALASKA NATIVE COMMUNITY THEY KNOW THEIR CHALLENGES IN GETTING INTO THIS FIELD OF RESEARCH. SO DR. DOROTHY CASTILL SHEPHERDED THIS PROGRAM WITH US DR. HUNTER AND TEAM AT THE NIH. CERTAINLY IN THE SEPTEMBER MEETING RECOMMENDATIONS THAT CAME OF THIS AND ONE I CAN TELL YOU WILL WERE ALREADY WORKING DILIGENTLY TOWARDS TO GET MORE AMERICAN INDIAN ALASKA NATIVES TO SERVE ON STUDY SECTIONS. WE HAVE HAD CONVERSATIONS WITH DR. RICHARD NAKAMORA, DIRECTOR OF CSR AND ONE OTHER INSTITUTES WHO HAS ITS OWN INSTITUTE REVIEW UNIT AS ALL OF OUR INSTITUTES DO. NATIONAL INSTITUTE OF CHILD AND HUMAN HEALTH DEVELOPMENT PICKING UP SOME OF THE AMERICAN INDIAN ALASKA NATIVE RESEARCHERS THAT WE ARE NOW MUCH MORE AWARE OF THAN PREVIOUSLY AND ASKED THEM TO SERVE ON OUR STUDY SECTION. WE HAVE HAD SEVERAL WORKSHOPS, YOU WILL SEE FROM THEIR TITLES THAT THESE WERE TARGETED, FOCUS WORKSHOPS NOT WORKSHOP LET'S HAVE ANOTHER WORKSHOPS BUT WORKSHOPS THAT HELP GET OUR VISION CONSUMMATED. WE MET WITH THE NATIONAL HISPANIC MEDICAL ASSOCIATION SEVERAL MONTHS AGO, BACK IN EARLY AUGUST SEPTEMBER WHO CAME TO US WANTING US TO WORK WITH THEM TO DEVELOP TO LOOK AT THE BEST PRACTICES AND STRATEGIES FOR RECRUITING MORE HISPANIC AMERICANS TO BIOMEDICAL RESEARCH BUT MAINLY FACULTY POSITIONS. DR. LENA RAOS PRESIDENT OF NATIONAL HISPANIC MEDICAL ASSOCIATION LED THIS EFFORT WITH OUR STAFF AT NIMHD, WE HAD THIS WORKSHOP OR SUMMIT ON JANUARY 29th. WE'RE LOOKING AT WAYS WHICH WE CAN EXPAND OUR I DIVERSITY WHEN IT COMES TO ALL UNDER-REPRESENTED MINORITIES BUT CERTAINLY WHEN IT COMES TO HISPANIC AMERICANS IN FACULTY TENURE TRACK POSITIONS. WE HAD A RESEARCH FORUM LAST WEEK FOCUSING ON HIV AIDS BUT LOOKING AT IT FROM PERSPECTIVE OF YOUNG MEN WHO HAVE SEX WITH MEN, AGAIN, THAT ADOLESCENCE OR HIGH RISK GROUP FOR HIV AIDS AND IT WAS A FABULOUS MEETING. THE SPEAKERS WERE SOME OF THE BEST I HEARD. I DON'T KNOW IF THIS TALK WAS WEBCAST OR RECORDED BUT IF IT WEREN'T WE SHOULD HAVE IT -- FIND SOME WAY TO DO SYNOPSIS OF IT AND PUT IT ONLINE, IT WAS ONE OF THE BEST WORKSHOPS I HAVE ATTENDED AT NIH IN QUITE A WHILE. WE'LL USE THESE PRESENTATIONS TO HELP GUIDE US AS WE CONTINUE TO THINK ABOUT PACKAGING OUR VISION. FOR THE NEXT TEN YEARS. WE HAVE A COUPLE OF UPCOMING WORKSHOPS. I WOULD LIKE TO MENTION THEM TO YOU NOW IN THE SENSE OF INVITING COUNCIL MEMBERS TO PARTICIPATE IN ANY OF THESE WORKSHOPS. THE OLD DAYS WE INVITE COUNCIL MEMBERS TO COME TO ANY WORKSHOP AND MOST PART PAY FOR YOUR WAY. THINGS ARE VERY DIFFICULT IN TERMS OF TRAVEL IN GENERAL AND HOW WE PLAN AND STRATEGIZE AND ORGANIZE TRAVEL. BUT THESE ARE TWO WORKSHOPS THAT ARE BY INVITATION ONLY. WE COULD ACCOMMODATE ONE OR TWO COUNCIL MEMBERS. QUESTION ARE LOOKING AT MARCH 30, 31st FOR A BOND WELL PLANNED WORKSHOP COMMUNITY BASED MULTI-LATERAL INTERVENTIONS FOR CHRONIC DISEASE, THIS CAME FROM OPERATION PLANNING PROCESS. YOU MAY RECALL I TOLD YOU IN SEPTEMBER NIMHD HAD OPERATIONAL PLANNING PROCESS, FIRST TO PLAN HOW WE SPEND OUR DOLLARS OVER A PARTICULAR FISCAL YEAR, WE WANT TO PAY ABSOLUTE MORE MONEY IN CHRONIC DISEASES BUT WE NEED TO KNOW HOW WHEN -- WHAT APPROACH TO TAKE. SO THIS WORKSHOP IS MARCH 1st AND 31st IS BEING ORGANIZED BY DR. -- IF YOU'RE INTERESTED IN ATTENDING WE CAN ACCOMMODATE ONE OR TWO COUNCIL MEMBERS WHO MIGHT BE PARTICULARLY INTERESTED IN THIS AND WORKING IN OUR STAFF WE CAN DECIDE IF YOU IF WE PAY FOR IT OUT OF COUNCIL FUNDS OR WHETHER WE PAY FOR IT OUT OF A GRANT IF YOU ALREADY HAVE A GRANT. WE'LL FIND A WAY TO ACCOMMODATE ONE OR TWO COUNCIL MEMBERS IF YOU WOULD LIKE TO ATTEND. THE WORKSHOP WE'RE HAVING AT THE INSTITUTE OF MEDICINE WHICH IS A VISION FOR THE FUTURE, INTERDISCIPLINARY POPULATION HEALTH SCIENCE, WORKING WITH DR. RILEY AND DR. CHRIS BACKWACK, COORDINATOR FOR THIS, WE CAN COORDINATE ONE COUNCIL MEMBER TO ATTEND THE IOM ROUND TABLE. BUT WE NEED TO KNOW THAT TODAY BECAUSE WE HAVE TO STRATEGIZE WHAT THE OTHER ORGANIZERS TO BE SURE WE GET YOUR NAME INTO THE GUEST LIST. THIS AGAIN WILL BE A TYPICAL IOM STUDY WHICH WE'LL COME OUT WITH STRONG RECOMMENDATIONS AROUND WHAT WE SHOULD BE COOING TO ENHANCE THE POPULATION SCIENCE CADRE OF INVESTIGATORS SO WE'LL COME ONE A WHITE PAPER AT THE END FOR VERY SPECIFIC RECOMMENDATIONS. THE LAST THING I WANT TO TAKE A FEW MINUTES TO TALK TO YOU ABOUT WILL BE BUDGET. AS YOU KNOW, WE DO HAVE A 2015 BUDGET BUT IT WAS DONE VERY, VERY DIFFERENT THIS TIME RATHER THAN BEING SORT OF CR THAT CAME IN THREE MONTHS INTERVALS IT WAS A CR THAT WENT ON ITS OWN FOR THE ENTIRE YEAR. WE GOT A BUDGET THAT ON DECEMBER 16th THAT WILL TAKE US THROUGH SEPTEMBER 30th 2015. NIH RECEIVED $30.1 BILLION WHICH WAS INCREASE OF HALF A PERCENT FROM FY 2014 AND IF YOU DO IT IN REAL DOLLARS OR BIOMEDICAL RESEARCH INDEX WE CALL THE (INAUDIBLE) DOLLARS IT TOOK A BIG HIT. WE TOOK A LOSS. BUT THAT IS OUR BUDGET FOR 2015. NIMHD BUDGET FOR 2015 IS 270.9 MILLION SO WE GOT THE INCREASE TRANS-NIH RECEIVED. THE NIH 2016 PRESIDENT'S BUDGET REQUEST, KEEP IN MIND THE BUDGET HAS GONE TO THE PRESIDENT. AND THE PRESIDENT'S REQUEST IS FOR NIH TO HAVE A BUDGET OF 31.3 BILLION. AN INCREASE OF 1 BILLION, OVER 2015. NIMHD REQUEST IS 281.55 MILLION. SO WE'RE KEEPING IN LINE WITH THE AGENCY. WE DIDN'T STAY STAGNANT AND WE DIDN'T GET A CUT. SO WE'LL REVERT TO THAT. AS WE THINK ABOUT THE 2016 REQUEST, THERE ARE SOME TARGET AREAS WE SHOULD BRING TO YOUR ATTENTION, PRECISION MEDICINE, AS I TOLD YOU ABOUT AND DR. GREEN WILL GO IN DETAIL ABOUT, IS A MULTIPLE IC INITIATIVE AND IT WILL RECEIVE $200 MILLION IN 2016. AND I TOLD YOU THAT IT WAS TARGETED TO BE A NEAR TERM AS WELL AS LONG TERM INITIATIVE WITH $70 MILLION DEVOTED TO CANCER AND $130 MILLION DEVOTED TO OTHER DISEASES SO WE WILL TALK DIABETES, OBESITY, ET CETERA. I'M VERY PLEASED TO ANNOUNCE THAT NIMHD GOT 5.94, IS THAT? 5.94 MILLION OF THOSE DOLLARS SO WE'LL BE LOOKING TO BE WORKING WITH A TRANS-NIH INITIATIVE, PERHAPS TO SEE HOW WE MIGHT BEST USE THESE FUNDS AND MAYBE TALK ABOUT SOME OF THE INCLUSION CLINICAL SUBJECTS AND DATABASES BUT WE'RE STRATEGIZING AND INTERESTED IN WHAT COUNCIL MIGHT WANT TO ADVISE ON THIS. $100 MILLION ALSO IN 2016 STARTED TOWARD ANTI-MICROBIAL ASSISTANCE, NIAID WILL RECEIVE THOSE FUNDS, NIAID WILL RECEIVE FUNDS ON FLU VACCINE AND THE BRAIN INITIATIVE THAT YOU WILL HEAR ABOUT AGAIN, NEW DOLLARS, $70 MILLION, I THINK I TOLD YOU THAT 135 MILLION WAS IN FOR 2015, THAT WAS MADE UP MAINLY OF DOLLARS SUBMITTED THROUGH THE TRANS-NIH APPROPRIATIONS PROCESS. THEN NIA, NATIONAL INSTITUTE ON AGING, GOT $50 MILLION OR GET 50 MILLION-DOLLAR IF THE PRESIDENT'S BUDGET PREVAILS IN 2016 FOR ALZHEIMERS. THIS IS A QUICK PIE CHART TO SHOW YOU HOW WE SPENT THE DOLLARS IN 2014. WE HAD 268.5 MILLION IN 2014 AND YOU JUST HEARD WE HAD 270 MILLION IN 2015 AND IF BUT LU CAN YOU WE WILL GET TO 80 MILLION IN 2016. WE PUT THE MAJORITY OF OUR FUNDS COLLECTIVELY TO OUR CENTERS PROGRAMS. IF YOU LOOK AT OUR CMI YOU LOOK AT CENTERS OF EXCELLENCE, YOU LOOK AT THE TRANSLATIONAL CENTERS, THEY MAKE UP THE BULK, ABOUT 126 PLUS MILLION DOLLARS WENT INTO CENTERS PROGRAM. INTRAMURAL PROGRAM WHICH IS THE -- I DON'T HAVE A MARKER HERE, MAYBE I DO HAVE A POINTER. INTRAMURAL PROGRAM IS 6.8 MILLION. OF THAT 6.8 MILLION WHICH IS ABOUT CONSTANT IN 2015. ABOUT ONE AND A HALF MILLION WILL DEDICATE TOWARDS THE MEDICAL RESEARCH SCHOLARS PROGRAM. WE DO HAVE AN ENDOWMENT PROGRAM I WILL MENTION IN A FEW MINUTES THAT IS A HALLMARK OF THIS INSTITUTE, WE'RE THE ONLY INSTITUTE AT NIH THAT HAS THE ENDOWMENT MANDATE AND THE OPPORTUNITY TO MAKE ENDOWMENT GRANTS SO THAT ACCOUNTS FOR $21 MILLION EACH YEAR. THEN WE HAVE COMMUNITY BASED PARTICIPATORY RESEARCH PROGRAM AND WE HAVE LOAN REPAYMENT PROGRAM, JUST TO GIVE A SENSE HOW $268 MILLION HAS BEEN SPENT. AND PEOPLE WILL ASK WHAT ARE OTHER PROGRAM? THAT'S A FAIRLY SIGNIFICANT NUMBER, $32 MILLION. THAT'S ANY PROGRAM THAT WE SUPPORT 10 MILLION OR LESS IN THAT COMES SBIR, STTR, SOME OF OUR EDUCATION GRANTS, SOME OF OUR SCIENCE EDUCATION OUTBREAK PROGRAM THAT'S -- NOT BE IN EXISTENCE AFTER THIS YEAR. OR AFTER 2016 I GUESS AND WE HAVE SOME MONEY THAT WENT TO OUR INTRAMURAL DREAM PROGRAM THAT'S NOW GOING TO BE REPLACED IN EARNEST WITH THE MEDICAL RESEARCH MEDICAL SCHOLARS RESEARCH PROGRAM. THIS GIVES YOU A SENSE OF WHAT WE TRY TO DO IN 2015, THIS IS PROFILED TO YOU JUST A LITTLE BIT DIFFERENTLY, YOU WILL SEE OUR 270.9 MILLION WHICH IS OUR BUDGET. WE'RE VERY PLEASED TO HAVE THIS LINE HERE THIS YEAR. RPGs, RESEARCH PROJECT GRANTS. THESE ARE THE RO-1s AND SOME OF THE R21s, YOU HEARD AT THE SEPTEMBER COUNCIL NIMHD WAS PARTICIPATING IN THE NIH WIDE RO-1 PROGRAM WHICH MEANS THAT INVESTIGATORS SUBMIT GRANT APPLICATIONS AND DO NOT HAVE TO WAIT UNTIL WE PUT OUR SOLICITATION SO WE'RE PLEASED THAT WE'LL SPENDS A RESULT MORE MONEY IN THE RPG LINE THOUGH WE HAVE SPENT SOME IN RPGs IN 2014 BUT THESE WERE RESEARCH PROJECT GRANTS IN TO SOLICITATION RFAs BUT WE WILL ADD TO THIS THE INVESTIGATOR INITIATED RO-1s. WE WILL PUT ABOUT $8 MILLION IN SBIR STTR, AROUND 126 MILLION, 127 MILLION ACTUALLY. OTHER RESEARCH THAT WILL BE MAKING UP MANY OF OUR EDUCATION PROGRAMS WILL TAKE ON ANOTHER 54 MILLION. THEN TRAINING WAS A SMALL AMOUNT THAT'S DEDICATED TO TRAINING NOW, 150,000, THAT MAYBE THROUGH A FELLOWSHIP OR SOMETHING THAT WE FUNDED THROUGH ONE OF THE OTHER INSTITUTES. BUT COMING UP TO 2016, NIMHD WILL BE TRAINING IN THE T-32 PROGRAM. SO WE COMMITTED $20 MILLION IN 2016 TO PUT INTO A TRAINING LINE. BUT PUT A LITTLE BIT IN CONTRACTS AND WE PUT ABOUT 15 1/2 MILLION DOLLARS IN RESEARCH MANAGEMENT AND SUPPORT. THAT'S WITH SALARIES AND INFRASTRUCTURE. WE HAD A BUDGET HEARING SECRETARY'S BUDGET HEARING WAS ON FEBRUARY 4TH. AND TO BRING THIS TO ATTENTION SHOWN A STRONG INTEREST IN NIMHD, HE NEVER FAILS TO FIND OPPORTUNITY TO SEND THROUGH HIS STAFF AND EMAIL TO ME OR SOMEONE IN OUR STAFF AND ASK WHAT WHAT WE'RE DOING IN KIDNEY DISEASE MINORITY POPULATION OR WHAT HAVE WE DONE SINCE WE HAVE BEEN AN INSTITUTE. WHAT ARE OUR PLANS FOR THE FUTURE AND WE COULD HAVE PERHAPS, GUESSED TEN MONTHS AGO HE WAS GOING TO ASK THESE QUESTIONS BECAUSE NOW WE CAN TELL HIM WHAT WE'RE DOING, WHAT WE HAVE DONE AND WHAT OUR FUTURE PLANS ARE. AND WE HAD A VERY, VERY FAVORABLE REPRESENTATION OF MISDISCUSSION WITH SECRETARY BURWELL AT YOU ARE OUR HEARING ON FEBRUARY 4TH. THESE ARE QUICKLY, I'M GOING TO PUT THIS ONLINE, SO YOU GUYS AND GALS CAN GO TO THE WEBSITE, ALL THE PRESENTATIONS WILL BE ON OUR WEBSITE FOR THE OUTSIDE COMMUNITY. SO IF YOU WANT TO USE THIS DATA OR ANY OF THIS INFORMATION LATER DR. NATASHA WILLIAMS IS OUR CONGRESSIONAL LIAISON, THESE ARE THE BILLS OF INTEREST SHE HAS SEEN BEING IMPORTANT US AT NIMHD. WE WANT TO MENTION THAT ON JANUARY 21st, INTRODUCED THE NATIONAL PROSTATE CANCER COUNCIL ACT, THIS BLUSHED THE NATIONAL PROSTATE COUNCIL ON SCREENING AND EARLY DETECTION. THIS WILL BE WORKING SOMEWHAT WITH THE PRECISION MEDICINE INITIATIVE AS WELL AS TO MENTION THAT SUCH A HIGH OUTCOME FROM DEMOCRAT FROM NORTH DAKOTA SUBMIT AD RESOLUTION DESIGNATING THE WEEK OF FEBRUARY 8TH AS NATIONAL TRIBAL COLLEGE AND UNIVERSITIES WEEK. THIS RESOLUTION PASSED UNANIMOUSLY WITHOUT AMENDMENT. I CALL YOUR ATTENTION TO THIS TO GIVE YOU A LITTLE BIT OF DETAIL BUT NOT MUCH BECAUSE WE DON'T HAVE A LOT OF FINAL WORDS TO SAY ON THIS. BUT NIMHD WILL LEAD THE TRIBAL CONSULTATION INITIATIVE. AS YOU MAY KNOW, MANY FEDERAL AGENCIES HAVE TRIBAL CONSULTATION ADVISORY GROUPS. NIH HAS NOT HAD ONE. DR. COLLINS AND TABAK DECIDED NIH WILL HAVE ONE AND THEY'RE WORKING NOW WITH THE TRIBAL LEADERSHIP TO GET THIS TRIBAL CONSULTATION IN PLACE. I THINK RIGHTLY SO. ASKED NIMHD TO LEAD THIS CONSULTATION ADVISORY GROUP, ONCE ESTABLISHED WE GET THE MEMBERSHIP IN PLACE, THE FIRST MEETING SCHEDULED FOR FEBRUARY BUT I DON'T THINK WE'LL BE CLOSE TO MARCH BUT WE'RE STILL WORKING HARD BUT WE HAVE TO GET THE SUPPORT FROM OUR TRIBAL LEADERS. WE HAVE HAD OUTREACH ACTIVITIES OURSELVES THAT GO BEYOND COLLABORATION EARLIER. I HAVE MORE OPPORTUNITY TO BRIEF REPRESENTATIVE ROBIN KELLY DEMOCRAT FROM ILLINOIS WHO REQUESTED NIMHD SPEAK TO HER. NEW CHAIR OF THE CONGRESSIONAL BLACK CAUCUS BRAIN TRUST, THE RE SEARCH AM SHE SHOW AD LOT OF INTEREST WHAT WE'RE DOING AND SPOKE TO THE EFFORTS WE MENTIONED TO HER REGARDING DEPRESSION AND STRESS AND SHE'S VERY INTERESTED IN VIOLENCE IN PARTICULAR. YOUTH VIOLENCE IS ONE OF HER AREAS OF INTEREST. WE ALSO HAVE HAD SEVERAL CONVERSATIONS WITH FORMER SURGEON GENERAL RICHARD CORMONA WHO WILL BE HERE MARCH 2ND TO TALKN'T ABOUT COLLABORATIONS WITH HIM ANDDD INSTITUTE WORK HE'S DOING TO ENGINEER PROGRAMS WITH HISPANIC COMMUNITY THAT HE SERVES IN THAT AREA OF THE COUNTRY IN TEXAS AND BEYOND. I ALSO WANTED TO TAKE THIS MOMENT TO ASK DR. LISA SIMPSON, AND HER STAFF AT THE ACADEMY HEALTH, YOU HAVE HEARD ME TALK SINCE JUNE. THE FACT NIMHD WANTED TO HAVE FRIENDS OF THE NIH COALITION. MANY INSTITUTES HAVE FRIENDS GROUPS. THESE ARE COALITION ADVOCATES FOR US. WHO SPEAK NOT ONLY ABOUT THE SCIENCE THAT WE DO AND HOW IMPORTANT IT IS, BUT REACH OUT TO COMMUNITIES AS WELL AS THE CONGRESS. DR. WILLIAMS WHO IS OUR LIAISON HERE AT THE BROOKINGS INSTITUTE HAS BEEN HERE TO PUT THIS IN PLACE, WE HAVE THE COALITION JUST ABOUT START AND WE HAVE OUR NEW CHAIR WITH US TODAY SO I WAS GOING TO ASK DR. SIMPSON TO SAY A FEW WORDS. >> THANK YOU, DR. MADDOX. WE ARE JUST DELIGHTED TO HAVE THIS OPPORTUNITY TO WORK WITH THE COMMUNITY AND ALL THE STAKEHOLDERS TO LAUNCH THIS COALITION WITH NIMHD. OVER 5,000 INDIVIDUAL AND ORGANIZATIONAL MEMBERS. I SEE ONE FORMER BOARD MEMBER, DR. ALLEN GRIA AND WE'RE DELIGHTED TO HAVE TN OPPORTUNITY TO STEP UP AND SERVE AS A BIT OF A RESOURCE FOR THIS STARTING COALITION. AS PART OF OUR MISSION AND OUR MEMBERSHIP, WE HAVE A VERY STRONG FOCUS ON DISPARITIES. WE HAVE OVER 800 MEMBERS WHO ARE VERY ACTIVE IN OUR DISPARITIES INTEREST GROUP, DISPARITIES RESEARCH IS A THEME EVERY YEAR AT OUR ANNUAL SCIENTIFIC MEETING. -- SCIENTIFIC MEETING. THE TOP ABSTRACTS EVERY YEAR 2300 SCIENTIFIC ABSTRACTS SO THAT IS WHY WE'RE INTERESTED AND WHY WE'RE DELIGHTED TO HAVE THIS OPPORTUNITY TO WORK WITH COLLEAGUES, WE'RE JUST GETTING STARTED SO PLEASE THIS IS JUST A HELLO. AND INVITATION TO STAY TUNED TO HEAR MORE. WE WANT TO RAISE VISIBILITY OF THE INSTITUTE AMONG STAKEHOLDERS AND AS DR. MADDOX SAID, ESPECIALLY WITH THOSE WHO CONTROL PURSE STRINGS IE CONGRESS. ACADEMY HEALTH MANAGES TWO OTHER FRIENDS GROUPS. WE HAVE FRIENDS OF AGENCY HEALTHCARE RESEARCH AND QUALITY AND FRIENDS OF NATIONAL CENTER FOR HEALTH STATISTICS AND AS ADVOCATES, FRIENDS AND PARTNERS WE CAN HELP RAISE AWARENESS OF THE IMPORTANT WORK OF THE INSTITUTE AND WHY IT MUST CONTINUE TO BE SUPPORTED. I WANTED TO INTRODUCE ANOTHER COLLEAGUE HERE DR. MARGO EDMONDS WHO IS VICE PRESIDENT FOR EVIDENCE GENERATION AND TRANSLATION. ALSO OUR EXECUTIVE AT ACADEMY HEALTH CERTAINTY FOR DIVERSITY INCLUSION AND MINORITY ENGAGEMENT AS WELL AS STRATEGIES FOR DISPARITIES. WITH THAT I'M PLEASED, JUST FELL HEALTH LOW AND STAY TUNED. WE'D LOVE TO GET YOU ALL VERY INVOLVED WITH THE COALITION. THANKS. >> THANK YOU, LISA. NATASHA, DID YOU WANT TO SAY A WORD OR TWO? TERMS HOW YOU ASSISTING PERHAPS DR. SIMPSON. >> THANK YOU. WE'RE VERY EXCITED, WE HAVE BEEN WORKING ON THIS DR. MADDOX FRIENDS OF NIMHD WHO ARE INVESTED IN OUR MISSION. SOME OF THE ACTIVITIES AND POSSIBLE ACTIVITIES WE WILL ENGAGE IN WILL BE OPPORTUNITIES FOR NIMHD TO WORK WITH THE MEMBER ORGANIZATIONS DISSEMINATE RESEARCH AND TALK SCIENCE DISPARITIES. NIMHD PARTICIPATE IN FRIENDS SPONSORED EVENTS WHICH WILL ALSO GIVE US THE OPPORTUNITY TO PROMOTE MOTOR OUR MISSION, RESEARCH AND TO REACH OUT AND EDUCATE THE COMMUNITY ABOUT THE WORK THAT WE DO. WE ENCOURAGE OUR FRIENDS TO ATTEND ADVISORY COUNCIL MEETINGS TODAY AS WELL AS OTHER ACTIVITIES THE INSTITUTE MAY UNDERTAKE. WE ALSO TO PROVIDE UPDATES TO FRIENDS GROUPS ABOUT THE WORK WE ARE DOING. IF ANYONE HAS ANY QUESTIONS PLEASE CONTACT ME. THANK YOU. >> THANK YOU, NATASHA. LOOK FORWARD TO HEARING MORE ABOUT THE FRIENDS OF NIMHD. I MENTION TO YOU DR. CAMONA WILL BE COMING UP, HIS WORK IS MAINLY IN THE SOUTH BUT HIS FOUNDATION IS ACTUALLY LOCATED IN ARIZONA. LET'S TAKE A QUICK MOMENT TO TALK ABOUT THE -- SOME PROGRAMS, I MENTIONED TO YOU THAT THE ENDOWMENT PROGRAM IS UNIQUE TO NIMHD. THIS PROGRAM WAS MANDATED ON THE MINORITY HEALTH AND HEALTH DISPARITIES VERGE EDUCATION ACT OF 2000 OR PUBLIC LAW 106525 IF YOU WANT TO GO INTO THE PUBLIC LAW TO ACTUALLY READ THE DETAILS OF THIS ACT THAT SPECIFICALLY SAID NIMHD HAD THE MANDATE AND HAD THE RESPONSIBILITY OF MAKING AWARDS TO ACADEMIC INSTITUTIONS. TO BUILD RESEARCH INFRASTRUCTURE RECRUIT TRAIN AND MAINTAIN DIVERSE STUDENT BODY AND FACULTY. THESE LOOK DIFFERENT FROM YOUR USUAL TRAINING GRANTS. OR INFRASTRUCTURE GRANTS. YOU ARE FAMILIAR WITH RESEARCH CENTERS MINORITY INSTITUTIONS OR CMI OR CENTERS OF EXCELLENCE OR THE TCCs. THEY CAN PROVIDE TRAINING DOLLARS BUT FOR THESE ENDOWMENT PROGRAMS WE CAN ACTUALLY ALLOW THE INSTITUTIONS WHO ARE ELIGIBLE TO BRING ON TOP NOTCH FACULTY TO RECRUIT, THEY CAN USE THESE DOLLARS TO RECRUIT ENDOW CHAIRS ENDOWED FACULTY. I DON'T KNOW THAT ANY OTHER PROGRAM IN THE FEDERAL GOVERNMENT DOES THIS, I HAVE DR. SIMPSON AND DR. HUNTER WHO JUST DID ASSESSMENT EVALUATION OF THE PROGRAM FOR US. THE REASON WE WANT TO LOOK AT THIS PROGRAM, NUMBER ONE IT IS UNIQUE WHICH MEANS WE HAVE INSTITUTIONS OUTS THERE WHO ARE NOT ELIGIBLE FOR THEM, ASK DR. SIMPSON OR HUNTER TO ADDRESS ELIGIBILITY IF COUNCIL MEMBERS REALLY WANT TO KNOW. BUT THERE ARE SPECIFIC ELIGIBILITY CRITERIA, EVERYBODY IS NOT ELIGIBLE. AND EVERYONE WHO I THINK SHOULD HAVE AN OPPORTUNITY TO APPLY FOR ENDOWMENT PROGRAM ARE NOT ELIGIBLE SO WE NEED TO TAKE A HARDER LOOK WHAT THE THE PROGRAM HAS DONE OVER 15 YEARS, HOW IT'S DOING IT, WHAT DO WE SEE VALUE-ADDED KEEPING THE ENDOWMENT PROGRAM GOING OVER NEXT 10, 15 YEARS. SO WE HAVE JUST DONE A REVIEW OF THE PROGRAM, BECAUSE IT IS SCHEDULEED TO RECOMPETE IN 2016. SO WE WANT THOUGHT HOW THE PROGRAM SHAPED OUT OVER THE LAST SEVERAL YEARS, 15 YEARS TO BE EXACT. DURING THE LAST 15 YEARS WE MADE 156 AWARDS TOTALING $410 MILLION, ALMOST A HALF A BILLION DOLLARS, NOT TOUCHUP SHABBY, SO WE NEED TO FIND OUT WHAT'S DONE AND HOW IT'S DONE, AND WE WOULD BE VERY PLEASED SOME OF WHAT DR. STINSON AND HUNTER'S COMMITTEES FOUND OUT. SO WE WILL BE PRESENTING ASPECTS OF THIS ENDOWMENT REVIEWED TO YOU AT JUNE COUNCIL AS WITH WE GET READY TO CONSTRUCT OUR ANNOUNCEMENT TO RECOMPETE THE PROGRAM FOR 2016. JUST WANT TO GIVE YOU A HEADS UP SO IF THERE ARE ANY QUESTIONS YOU HAVE, ANY COMMENTS YOU WANT TO MAKE AROUND THE PROGRAM YOU CAN MAKE IN OPEN SESSION BUT ALSO CONTACT DR.S HUNTER AND STINSON. THIS IS JUST TO GIVE YOU AN IDEA OF SOME OF THE RFAs THAT WE PUT OUT SINCE WE SPOKEN TO YOU, THEY'VE ALL CLOSED BUT TO GIVE YAW SENSE OF DIVERSITY OF THINGS THAT WE HAVE BEEN SOLICITING. SYSTEM LEVEL HEALTH SERVICES POLICY RESEARCH ON HEALTH DISPARITIES, YOU HEARD US TALK ABOUT THE FACT THAT WE WANT TO BE INVOLVED IN THE AREA GRANT MECHANISM, THE R-15 PROGRAM, A PROGRAM THAT NIMHD DID NOT PARTICIPATE IN AND THE GENERAL PROGRAM ANNOUNCEMENT BUT ONLY FOR -- IN THE RFA ARETHAT. HERE IS ONE THAT WE PUT OUT -- ARENA. HERE IS ONE EARLIER THIS YEAR, IT'S CLOSED BUT TO US CANNED ON ENHANCING HEALTH DISPARITIES RESEARCH AT UNDERGRADUATE INSTITUTIONS. THESE INSTITUTIONS ARE LESS RESEARCH INTENSIVE BUT SEE WHAT THEY CAN GIVE US IN TERMS OF FOCUS ON HEALTH DISPARITIES RESEARCH. WE HAVE USED THE STTR OR THE TECHNOLOGY GRANTS AS WELL AS SMALL BUSINESS GRANTS TO HELP DEVELOP SOME INITIATIVES FOR TECHNOLOGIES FOR IMPROVING HEALTH DISPARITIES AS WELL AS INNOVATION FOR HEALTHY LIVING USING THE SET ASIDE TO GET BY THE SBIR STTR PROGRAM. WE PUT OUT TWO NOTICES TO CALL YOUR ATTENTION TO, KEEP IN MIND NOTICES ON GOING FOR A COUPLE OF YEARS, THESE ARE NOT EXPIRED. IF YOU WOULD LIKE TO PARTICIPATE IN THE RESEARCH PROJECT GRANT, INVESTIGATOR INITIATED GRANT, WE'RE OPEN FOR THE THREE DEADLINES, SO YOU HAVE IF GOOD IDEA AND YOU HAVE A HYPOTHESIS SUBMIT A GRANT TO NIMHD RO-1. YES PARTICIPATING IN A PROGRAM ANNOUNCEMENT WITH REVIEW INTERVENTIONS WITH HEALTH PROMOTION DISEASE PREVENTION IN NATIVE AMERICAN POPULATIONS WE'RE VERY EXCITED ABOUT AS WELL. HEALTH DISPARITIES VISITING SESSION YOU WILL HEAR A LOT ABOUT THIS, COUPLE OF HOURS AFTER LUNCH. AND THIS IS AN EXCITING OPPORTUNITY FOR THE INSTITUTE TO BEGIN THINKING ABOUT OUR FUTURE. THIS VISIONING PROCESS IS NOT JUST FOR US, WHAT IS IT ABOUT HEALTH DISPARITIES RESEARCH AND ABOUT THIS SCIENCE THAT WE WANT TO SHARE ACROSS THE GLOBE IF YOU WILL BUT MOST IMPORTANTLY HOW WE CAN LEAD AN EFFORT TO MAKE HEALTH DISPARITIES A SCIENCE AND MAKE THE RESEARCH THIS SCIENCE IS ABOUT, STABLE AND ENDORSED. AND ADDRESSED ACROSS THE BIOMEDICAL RESEARCH SPHERE. WHAT WE DID FIRST WAS TO RECOGNIZE THAT WE HAD A LOT OF STAFF WITHIN OUR INSTITUTE WHETHER KNEW THE SUBJECT MATTER VERY WELL BUT WE CAN BENEFIT FROM BRINGING IN EXPERTS SO NIMHD HAS SOUGHT AND RECEIVE THE SUPPORT OF DR. PAULA BRAKEMAN, SERVING ON P EPISODIC SABBATICAL. I MENTIONED TO YOU AT ONE OTHER CONFERENCES. DR. PETER MCLISH WHO COMES TO US FROM ONE HOUSE AND DR. GRABBER COMES TO US FROM THE UNIVERSITY OF SAN FRANCISCO. BOTH OF THEM ARE HERE TODAY AND THEY WILL BE HELPING US THROUGH THE VISIONING. WOULD YOU STAND PLEASE. NO STRANGER TO NIH BECAUSE WE USED PAULA IN SO MANY ACTIVITIES INCLUDING KEYNOTE SPEAKER IN HEALTH DISPARITIES SEMINAR SERIES AND TRANSLATIONAL COURSE. PETER, WOULD YOU STAND UP SO WE CAN THANK YOU APPROPRIATELY. PETER HAS THE NEWER SCIENTIST COMES FROM DISTINGUISHED CAREER AND MOORE HOUSE, WE ARE PLEASED BECAUSE PETER SERVED ON THE ADVISORY COMMITTEE TO DIRECTOR OF NIH FROM A BROAD PERSPECTIVE HOW WE SHOULD BE THINKING ANT IT BECAUSE HE KNOWS HOW OUR LEADERSHIP THINKS ABOUT HOW INSTITUTES SHOULD OPERATE AND HOW WE SHOULD WORK. SO THANKS FOR AGREEING TO BE OUR CONSULTANTS HERE. ONCE WE GOT CONSUL AT THAT PARTICULAR TIMES IN PLACE AND TALKING AMONG -- CONSULTANTS IN PLACE AND HOW IMPORTANT THIS PROCESS MIGHT BE WE PRESENTED TO THE NIH INSTITUTE DIRECTORS AND IF YOU WANT SOMETHING TO TAKE TRACTION TO MOVE FORWARD YOU HAVE TO BRING YOUR COLLEAGUES ALONG WITH YOU. I PRESENTED FROM THE NIH INSTITUTE DIRECTORS MEETING DECEMBER 18th. SO STAFF INCLUDING DR. BRAVEMAN, WE HAVE A MARVELOUS SHOW OF SUPPORT FROM THE INSTITUTES. BECAUSE THEY UNDERSTAND WHEN THEY TALK ABOUT HEALTH DISPARITIES RESEARCH, IT IS NOT NIMHD, WE HAVE 268 MILLION, 270 MILLION IN 2015. ACCORDING TO THE NIH DATA IT SAYS WE PUT IN $2.6 BILLION IN HEALTH DISPARITIES RESEARCH SO MUCH IS PERHAPS NOT DISPARITIES VERGE AS I SHOWED SEPTEMBER COUNCIL BUT MORE HEALTH DISPARITIES RELEVANT OR MINORITY HEALTH RESEARCH IN SENSE DIFFERENCES BETWEEN VARIOUS MINORITY POPULATIONS BUT NOT REALLY LOOKING WHY THERE ARE DIFFERENCES SO WE NEED SOMETHING IN PLACE ALL OF NIH CAN SEE AS ITS OWN. AND OWNING IT SO IT WAS IMPORTANT THE INSTITUTE DIRECTORS BECAME INVOLVED AND STAFF HAS HAD A PLANNING SESSION YOU WILL HEAR MORE ABOUT THIS AFTERNOON INVOLVING ALL THE INSTITUTES AND REPRESENTATIVE PROGRAM STAFF FROM THE INSTITUTES WHO WILL BE SHARING IN HELPING US DEVELOP THE VISION STATEMENT. I HOPE THIS VISION STATEMENT WILL BE READYSYME IN NOVEMBER AFTER MANY MEETINGS AND WORKSHOPS AND YOU CAN SEE THEM LISTED THERE, DIFFERENT APPROACHES TO DEVELOPING A VISION STATEMENT, WE'LL PUBLISH THE VISION STATEMENT WHERE SHOULD WE BE GOING IN HEALTH DISPARITY OVER THE NEXT TEN YEARS? THIS VISION STATEMENT WILL HELP TO INFORM A STRATEGIC PLAN AND STAFF WILL BE WORKING WITH THE OTHER INSTITUTES MAYBE SOMETIME IN FEBRUARY OF NEXT YEAR TO LOOK HOW WE CAN DEVELOP A STRATEGIC PLAN TO ADDRESS THIS VISION AND KEEP IN MIND, THIS IS DYNAMIC IF NOT STATIC. SOME THINGS WE OVERCOME BEFORE WE GET TO THE VISION STATEMENT. I NOW WANT TO TAKE SOME TIME SAY A FEW WORDS ABOUT OUR SPEAKERS TODAY. I JUST REALIZED DR. ERIC GREEN ARRIVED. THANK YOU, ERIC. Y'ALL HAVE SEEN FROM MY PRESENTATION HOW MUCH I APPRECIATE AND HOW MUCH THE INSTITUTE APPRECIATE THE FACT THAT WE HAVE THREE IMPORTANT SPEAKERS WITH US TODAY. PROBABLY THE MOST CRITICAL SPEAKERS EVER IN THE CREATION OF THIS INSTITUTE. AS YOU KNOW THE INSTITUTE WAS CREATED IN 2010. SO WE ARE FIVE YEARS OLD. PEOPLE ARE LOOKING TO SEE NOT WHAT HAVE WE DONE BUT WE'RE GOING. I FEEL THAT THERE ARE THREE AREAS THAT ARE CRITICAL FOR THIS INSTITUTE OUTSIDE OF HIV AIDS, POPULATION HEALTH TRAINING, SOME OF THE SPECIFIC THINGS THAT I HAVE SPOKEN TO YOU ABOUT. BUT I THINK WE NEED TO BE PART OF THE NIH FAMILY OF IDEAS AND WE NEED TO BE ABLE TO SHOW COLLECTIVELY WE HAVE A ROLE TO PLAY IN THE NIH AGENCY. DR. GREEN IS O CO-CHAIR OF THE NIH INITIATIVE, HE'S DIRECTOR OF NATIONAL HUMAN GENOME RESEARCH INSTITUTE. I HAVE KNOWN ERIC FOR MANY YEARS SINCE HE CAME HERE AS THE SCIENTIFIC DIRECTOR. OF THE HUMAN GENOME RESEARCH INSTITUTE. AND RUNS ONE OF OUR INTRAMURAL DATABASES FOR ALL OF THE NIH BUT MOST IMPORTANTLY CAME TO US WITH A STRONG SCIENTIFIC BACKGROUND AS INVESTIGATOR OF GENOME CENTER. AT WASU. HE'S BEEN A CONSUMMATE SCIENTIST HERE BUT WHEN I ASKED HIM TO PRESENT MANY TIMES WHEN YOU HAVE A NEW INITIATIVE THAT THE AGENCY IS JUST LAUNCHING AND GET QUESTIONS FROM CONGRESS, WE ARE OFTENTIMES HESITANT TO GO OUT AND TALK ABOUT IT. I WANT TO SAY ERIC IMMEDIATELY AGREED TO DO THIS AND WE'RE PLEASED HE DID. SO TAKE THIS TIME AFTER HE PRESENTS TO ASK QUESTIONS ABOUT HOW WE CAN GET ENGAGED FURTHER AS AN INSTITUTE, I MENTIONED TO YOU, I HAVEN'T TOLD ERIC PERSONALLY YET BUT HE AND I HAVE BEEN WORKING ON A PROPOSAL THE LOOK AT INCLUSION OF CLINICAL DIVERSE POPULATIONS IN CLINICAL DATABASES AND THAT'S ONE OF OUR INITIATIVES WE WILL TAKE ON WITH THE HUMAN GENOME RESEARCH INSTITUTE. HE MAY SAY A WORD OR TWO ABOUT THAT IN HIS PRESENTATION. SECOND SPEAKER WILL BE DR. NORA VOL WOW, ASKED US TO PARTICIPATE WITH THE NIDA OR THE NATIONAL INSTITUTE OF DRUG ABUSE ON THEIR ADOLESCENT BEHAVIOR AND COGNITIVE DEVELOPMENT INITIATIVE AND SHE AGAIN CO-CHAIR OF NIH BRAIN INITIATIVE AND TO BECOMING IN TO AN INSTITUTE WITH ALL THE MANY THINGS THAT SHE HAS ON HER PLATE TO SPEAK TO US ABOUT, THIS INITIATIVE AND HOW WE MIGHT PLAY A ROLE EARLY ON BEFORE INITIATIVES DESIGN, THAT'S CRITICAL. ERIC AS WELL AS NORA, NO, WHAT WE THINK ARE THE IMPORTANT AREAS FOR HEALTH DISPARITIES COMMUNITY AND IN PARTICULAR HEALTH DISPARITIES RESEARCH, HE AND HIS COMMITTEES AND SHE AND HER COMMITTEE WORKS TO DEVELOP NEW INITIATIVES AND NEW PROGRAMS THAT WE MAYBE ABLE TO GET IN ON THEM EARLY ON. OUR LAST SPEAKER IS DR. JAMES JACKSON, COMES AS NO STRANGER TO MANY OF YOU. JIM SERVED ON ADVISORY COMMITTEE TO DIRECTOR OF NIH, HE IS IMPORTANT TO OUR COUNCIL TODAY BECAUSE HE'S GOING TO BE TALKING TO US A GREAT DEAL ABOUT SOME OF THE SOCIAL DETERMINANTS. I TOLD YOU SEPTEMBER COUNCIL NIMHD IS ROOKING FOR WAYS TO BE UNIQUE AND SPEND OUR MONEY IN WAYS WHICH IT'S NEEDED. NOT DUPLICATING WHAT CATEGORICAL INSTITUTES ARE DOING. THAT DOESN'T MEAN THERE MIGHT NOT BE A PLACE TO SUPPORT CARDIOVASCULAR RESEARCH OR RESEARCH PROSTATE CANCER AND DIABETES, WE WILL BUT WE NEED TO COME AT IT FROM MAYBE A DIFFERENT PERSPECTIVE THAN NIDDK O NHLBI WOULD. WE WANT TO GET DR. JACKSON SORT OF GET US JAZZED UP IF YOU WILL BEFORE OUR VISIONING SESSION THIS AFTERNOON. SO THAT WHEN IRENE AND STAFF GOES OVER OUR PLAN AND I THINK SHE'S ALREADY DROPPED SOMEWHERE IF NOT ON YOUR DESK I HAVE A P COPY HOW TO APPROACH THE VISION SESSION THIS AFTERNOON BUT JIM WILL GET US TO THINKING AROUND SOME OF THE ISSUES IN A PROACTIVE WAY. THIS GIVES YOU GUYS TEN MINUTES NOW TO ASK ME SOME QUESTIONS. OR MAKE A FEW COMMENTS. THANK YOU. [APPLAUSE] AND WE'LL HAVE TIME THROUGHOUT THE DAY. YES. >> CAN YOU CLARIFY MORE ABOUT THE SINGLE IRB FOR MULTI-SITE RESEARCH? FOR INTERNAL AND EXTRAMURAL RESEARCH IN -- IS THERE ANY POTENTIAL EXTERNAL IRB? >> I THINK THEY WILL. I THINK THAT'S THE PLAN. FIRST NOTICE THIS POLICY IS LIMITED TO MULTI-SITE PROJECTS THAT COME UNDER ONE COMMON PROTOCOL APPROACH. I THINK WHAT WILL HAPPEN FIRST IS LOOK AT IT FROM THE PERSPECTIVE OF SEVERAL COOPERATIVE AGREEMENTS THAT WE ALREADY HAVE. AS YOU SAY FROM SOME OF THE INTRAMURAL PROGRAMS THAT ARE COLLABORATIVE ACROSS THE INSTITUTES, BECAUSE KEEP IN MIND, IT'S NOT A SINGLE IRB FOR THE OUTSIDE COMMUNITY, WE HAVE PROBABLY 18 IRBs HERE ON THIS CAMPUS OR CLOSE TO IT, BECAUSE EACH INSTITUTE THAT CONDUCTS RESEARCH AND CLINICAL TRIALS INTRAMURAL LABORATORIES HAS -- EACH INSTITUTE HAS ITS OWN IRB EXCEPT A COUPLE OF SMALLER INSTITUTES WHO HAVE SHARED IRBs. I DON'T KNOW WHEN THIS POLICY IS GOING TO GET STOOD UP BECAUSE WE WAIT TO GET COMMENTS FROM THE OUTSIDE COMMUNITY. I THINK WHAT WILL HAPPEN NEXT AFTER WE SEE COMMENTS COME IN WILL PUT OUT STATEMENTS WE ROUTINELY DO THAT REPRESENTS A Q&A, QUESTIONS WE GOT FROM THE PUBLIC AND THEN OUR ANSWERS, QUESTIONS WE GOT FROM THE PUBLIC AND THEN OUR ANSWERS, BEFORE A FORMAL POLICY IS RELEASED. >> I ENCOURAGE YOU TO MAKE CERTAIN NAVAJO NATIONS IN PARTICULAR BEVLY PIGMENT IS ONE YOU GET INPUT FROM AND THE ALASKA NATIVE MEDICAL CENTER, IRB LOCATED THERE IN MONTANA. THERE'S ATTEMPTS IN INDIAN COUNTRY TO HAVE ONE MAJOR IRB. LET'S JUST SAY IT DID NOT WORK. >> WE DEFINITELY PAY ATTENTION BUT WE HAVE ALREADY PAID ATTENTION, I DON'T THINK I MENTIONED LAST NIGHT ONE QUESTION THAT CAME UP FROM OUR AMERICAN INDIAN RESEARCHERS WHO ATTENDED THE WORKSHOP ON NOVEMBER 30th WAS THE WHOLE IDEA OF IRBs AND HOW WE PAY PARTICIPANTS ON IRB PARTICULARLY FROM THE NATIVE COMMUNITIES. THE PERSON THAT WAS THERE, DR. SALLY ROCKEY FROM OFFICE OF EXTRAMURAL RESEARCH AND SHE WILL BE THE ONE THAT ULTIMATELY WILL SHAPE THIS POLICY SO YES, WE DID HEAR ABOUT SOME OF THE CHALLENGES THAT WE WILL BE FACING. IF WE PUT OUT POLICY SUCH AS THIS WITHIN NATIVE COUNTRY. >> I HAD QUESTION FOR VALUATION OF YOU ARE YOU PROGRAMS, THE ONE RUNNING FOR FIVE YEARS. >> ENDOWMENT. >> ENDOWMENT, THIS IS A QUESTION FOR YOU, WOULD IT BE BETTER TO HAVE OUTSIDE EVALUATION RATHER THAN INSIDE EVALUATION? IN THE SENSE THAT IT WOULD BE A WAY TO HAVE MORE TRANSPARENCY? >> ACTUALLY WE HAVE A COMMITTEE THAT HAS DONE THE LION'S SHARE ASSESSING FROM THE STANDPOINT WHERE THE SITES ARE. ELIGIBILITY CRITERIA WAS. WHAT TYPES OF THINGS WE BOUGHT WITH THIS MONEY, HOW MUCH MONEY THEY GOT. WHICH ONES WERE ABLE TO RECOMPETE BECAUSE SOME UNIVERSITIES WERE ELIGIBLE. BUT DID NOT RECOMPETE WELL WHEN THEY CAME BACK IN, KEEP IN MIND WHEN THEY GET ENDOWMENT THEY'RE ALLOWED TO KEEP THE ENDOWMENT FOR 20 YEARS I GUESS THEN TO GAIN INTEREST ON THE ENDOWMENT. I THINK THE REASON I WANTED TO HAVE COUNCIL TO SEE THIS, AT JUNE, THAT WILL BE MY OUTSIDE, WE'LL HAVE THE OUTSIDE TAKE A LOOK AT THIS BEFORE WE PRESENT TO THE JUNE COUNCIL, WE HOPE TO BE ABLE TO DO THIS AT THIS COUNCIL BUT WE DIDN'T HAVE ENOUGH TIME, WE DIDN'T GET THE REPORT FROM THE ININSIDE COMMITTEE UNTIL LAST WEEK. DR. HUNTER, DR. STINSON WOULD YOU LIKE TO ADD ANYTHING? FEEL FREE TO. >> WHEN DR. STINSON AND I CO-CHAIRED THIS COMMITTEE BUT ONE OTHER POINT TO ADD TO WHAT DR. MADDOX WAS SAYING ABOUT THINGS THAT WE LOOKED AT FIRST AND FOREMOST WAS A OBJECTIVE OF THE ORIGINAL RFA THAT WENT OUT. WHAT WAS IT THEY WERE -- WHAT WERE THE PROGRAMMATIC ISSUES THAT WERE IN THE ENDOWMENT? AND HOW DID THEY GO ABOUT ACHIEVING GOALS AND OBJECTIVES FROM THE INITIAL LAUNCH OF THE PROGRAM IN 2001 THROUGH 2014. IT IS A UNIQUE INTERESTING PROGRAM, BECAUSE UNLIKE RO-1 WHERE YOU GET $800,000, YOU SPEND THIS INTO YOUR RESEARCH, WAS THIS ENDOWMENT AWARD YOU DON'T SPEND THAT. THAT IS PUT INTO THE CORPUS OF YOUR INSTITUTE ENDOWMENT BUT HOW YOU INVEST THAT MONEY T PROGRAMMATIC INCOME THAT ALLOWS YOU TO ACCOMPLISH SOME OF THE OBJECTIVES OF THE PROGRAM LIKE ENDOW CHAIRS AND REDESIGNING YOUR CURRICULUM RECRUITING STAFF SO IT'S NOT A PROGRAM WHERE YOU GET INSTANT BANG FOR THE BUCK BUT YOU LOOK AT IT OVER THE LONG TERM. ONE THING TO KEEP IN MIND IN A PROGRAM LIKE THIS, CURRENTLY WE'RE THE ONLY AGENCY IN THE FEDERAL GOVERNMENT THAT HAS A PROGRAM LIKE THIS. SO AFTER 15 YEARS IT WAS TIME TO LOOK AT WHERE WE ARE, WHERE WE'RE GOING, HOW MUCH MONEY HAS BEEN INVESTED AND WHAT TANGIBLE THING CAN WE ACTUALLY SEE HAVE COME OUT OF THESE PROGRAMS. REMEMBER ALL THE SCHOOLS ARE NOT CREATED EQUAL THAT ARE IN THE PROGRAM. THE OTHER PIECE OF THIS THAT GIVES ME A BIT OF HEART BURN, WE WANT TO WAIT TO ANALYZE THE REPORT AS WELL AS SHARE WITH THE COUNCIL MEMBERS BUT JUST A LIMITED AMOUNT OF INVESTIGATORS QUALIFY FOR THIS. IN MY VIEW THEY'RE NOT NECESSARILY THE ONES THAT NEED THE ENDOWMENT THE MOST. SO WE NEED TO LOOK AT IT AGAIN AND JOYCE MENTIONED WHAT WAS THE CRITERIA THAT WAS PUT IN THE FIRST ANNOUNCEMENT. DO WE NEED TO MODIFY THAT A BIT O SPREAD THE WEALTH. THE UNIVERSITIES AND COLLEGES THAT HAD THE FUNDS ALREADY DOING QUITE WELL WITH IT, LET THEM CONTINUE TO GAIN INTEREST WITH WHAT THEY HAVE GOTTEN. WE ARE SUCCESS STORY THERE. LET'S CREATE A A POLICY ON INITIATIVE WHICH THOSE WHO HAVE NOT HAD AN ENDOWMENT, CAN BE ELIGIBLE FOR ENDOWMENT WE WILL SHARE THIS AT THE JUNE MEETING TO GET YOUR INPUT. WITH THAT I WOULD LIKE TO WELCOME DR. ERIC GREEN TO THE PODIUM AND GIVE HIM A CHANCE TO GIVE US SOME INSIGHTS ON PRECISION MEDICINE INITIATIVE. [APPLAUSE] >> GO AHEAD AND START WHILE WE HOOK UP THE COMPUTER. FIRST DELIGHTED TO BE HERE AND THANK YOU FOR THE INVITATION AND ALSO FOR THE KINDS WORDS THAT YVONNE EXPRESSED ABOUT MYSELF BUT ALSO OUR INSTITUTE AND INDEED AS I KNOW SHE WENT OVER IN HER DIRECTORS REPORT THERE IS EXCITING DISCUSSION P UNDERWAY BETWEEN OUR TWO INSTITUTES ABOUT NEW OPPORTUNITIES IN GENOMICS YOU WILL HEAR ABOUT AT FUTURE COUNCIL MEETINGS THAT CAN BE PRODUCTIVE NEW PARTNERSHIPS. SO MY DAY JOB IS TO RUN THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE. BUT LIKE A LOT OF PEOPLE IN LEADERSHIP POSITIONS NIH WE END UP WITH OTHER RESPONSIBILITIES AND SO WHAT I'M GOING TO TELL YOU IS NOT JUST WHAT'S GOB ON SO MUCH IN MY INSTITUTE IN THIS PRESENTATION BUT RATHER TELL YOU ABOUT RECENT FAST PACED IF YOU WILL DEVELOPED THAT HAPPENED AROUND THIS THING CALLED PRECISION MEDICINE INITIATIVE. SO WHAT I WILL DO IN THE NEXT 20 MINUTES OR SO IS TO FIRST TELL YOU THE STORY BECAUSE IT'S A GREAT STORY ON TOLD. IT DIDN'T COME OUT OF NOWHERE. IT'S INTERESTING TO HEAR HOW IT'S DEVELOPED. I WILL TELL YOU THE CURRENT VISION AND IT'S NOT A PLAN YET, MORE LIKE A PLANNING PROCESS, THAT I WANT TO UPDATE YOU ABOUT. LET'S START WITH THE STORY, THAT STARTS IN THE WHITE HOUSE TO BE HONEST WITH YOU. TURNS OUT THE PRESIDENT HAD A LONG STANDING INTEREST IN GENOMICS, BIOMEDICAL RESEARCH IN PARTICULAR THOUGH IN GENOMICS. WHEN HE WAS SENATOR OBAMA IN 2006 HE INTRODUCED A BILL IT WAS ALL ABOUT PERSONALIZED MEDICINE, THE GENOMICS AND PERSONALIZED MEDICINE ACT OF 2006. IT ENDED UP GETTING PASSED BUT IT REALLY REFLECTED HIS CONSIDERABLE INTEREST IN THE NOTION OF GENOMICS AND POSSIBLE APPLICATIONS TO IMPROVING HUMAN HEALTH. SINCE HE BECAME PRESIDENT HE OBVIOUSLY HAS HAD INPUT FROM PEOPLE LIKE FRANCIS COLLINS AS THE NIH DIRECTOR AND OBVIOUSLY SOMEBODY VERY WELL VERSED STRONG ADVOCATE FOR GENOMICS. BUT ALSO ERIC LANDER, MAJOR GRANTEE OF MY INSTITUTE, MAJOR SUPER STAR IN THE GENOMICS COMMUNITY WHO SERVES AS CO-CHAIR OF THE PRESIDENT'S COUNCIL ADVISERS SCIENCE AND TECHNOLOGY, SO HE'S BEEN HAD MANY DISCUSSIONS AROUND GENOMICS. BUT INCREASINGLY I THINK HE GOT INTERESTED BECAUSE OF PERSONAL STORIES ABOUT RECENT GENOMIC ADVANCES AND OPPORTUNITIES IN GENOMICS THAT MIGHT BE HIGHLY RELEVANT TO HUMAN HEALTH, HUMAN DISEASE. AND THAT ACTUALLY RESULTED IN A MEETING IN THE OVAL OFFICE INVOLVING A NUMBER OF INDIVIDUALS INCLUDING FRANCIS COLLINS AND ERIC LANDER WHERE THIS WAS DISCUSSED AT WHICH TIME IT WAS VERY CLEAR HIS INTERESTS WERE TO DO SOMETHING BOLD IN THIS AREA. HE REQUEST AD PLAN TO BE BROUGHT TO HIM WITH NUMBER OF MONTHS. THE DISCUSSION BROADENED BEYOND GENOMICS AND WAS FRAMED AROUND PHRASE OF PRECISION MEDICINE. BUT AS IT WAS FRAMED IT WAS TO RECOGNIZE GENOMICS PLAY AN IMPORTANT ROLE AND OTHER PERSONALIZED ASPECTS OF HEALTH AND DISEASE SUCH AS LIFESTYLE, ENVIRONMENTAL EXPOSURE, SO FORTH SO VERY MUCH IS BROADENING THE CONFECTION FOR THIS DISCUSSION THAT INVOLVES INDIVIDUALIZING MEDICAL CARE TO ADVANCE HUMAN HEALTH. SOME OF THIS ADMITTEDLY WAS ALSO BUILT ON A REPORT THAT CAME OUT OF NATIONAL RESEARCH COUNCIL SEVERAL YEARS AGO PRECISELY ENTITLED PRECISION MEDICINE AND TALKING ABOUT BUILDING AND KNOWLEDGE NETWORK FOR BIOMEDICAL RESEARCH AND TAXONOMY OF DISEASE THAT GOT A LOT OF ATTENTION. THE CONCEPT HERE WHICH APPARENTLY THE PRESIDENT NOT ONLY UNDERSTOOD BUT GOT QUITE EXCITED ABOUT WAS RELATIVELY SIMPLE AND DISCUSSED FOR A WHILE. THE IDEA TODAY THE WAY WE PRACTICE MEDICINE, IS BASED ON EXTENTED RESPONSE TO THE AVERAGE PATIENT. WE KNOW THAT'S NOT OPTIMAL. WE CAN ENVISION TOMORROW, MEDICAL CARE IS BASED ON INDIVIDUAL DIFFERENCES THAT ARE GENOMIC DIFFERENCES, ENVIRONMENTAL DIFFERENCES AND LIFESTYLE DIFFERENCES THAT WILL ENABLE A MORE PRECISE WAY TO PREVENT AND TREAT DISEASE. AND WHAT WE WERE ENVISIONING AND PRESIDENT WAS ENVISIONING WAS COULD WE THINK OF RESEARCH INITIATIVES THAT WOULD HELP US GET FROM TODAY TO TOMORROW AND HAVE IT HAPPEN QUICKER. ADMITTEDLY PRECISION MEDICINE ISN'T ALL NEW, IT'S NOT LIKE WE HAVEN'T HAD EXAMPLES OF INDIVIDUALIZED CARE. FOR OVER MANY HUNDREDS OF YEARS WE HAVE HAD PRESCRIPTION EYE GLASSES AND OVER A HUNDRED YEARS BLOOD TRANSFUSIONS, INDIVIDUALIZED APPROACHES TO CARE OF ISSUES, MEDICAL ISSUES PEOPLE ENCOUNTER BUT WHAT WAS CLEAR IS THIS IS THE TIP OF THE ICEBERG, THERE'S NEW OPPORTUNITIES FOR A NUMBER OF REASONS AND WHAT WAS REALLY NEEDED NOW OF COURSE WAS SOMETHING BOLDER. WE NEEDED RIGOROUS RESEARCH PROGRAM TO PROVIDE A STRONGER SCIENTIFIC EVIDENCE TO TURN THIS BASIC CONCEPT INTO REALITY. THIS WOULD INVOLVE RECRUITING THE BEST AND BRIGHTEST FROM ALL DIFFERENT DISCIPLINES, IN FACT I HI THE COMMUNITY OF INDIVIDUALS INVOLVED IN THIS WAS MUCH LARGER THAN WE HAD COON ACCEPT ACTUALIZED, THINGS LIKE THIS EVEN A DECADE AGO. THE IDEA IT WAS TIME TO BE BOLD AND GO UNPRECEDENTED SCOPE AND SCALE. BECAUSE OPPORTUNITIES SEEMED RIGHT TO DO IT NOW. AND WHAT THE PRESIDENT WAS ASKING FOR IS HOW TO JUMP START PRECISION MEDICINE ACCELERATE THIS IN A FASHION THAT WOULD YIELD THE KIND OF BENEFIT THAT ONE COULD READILY ENVISION. SO THIS HAPPENED BASICALLY IN JUNE, FRANCIS COLLINS RETURNED FROM THAT MEETING AND ENLIST AD SMALL GROUP OF US, COUPLE IN THIS ROOM EVEN TO STRATEGIZE AND SPEND LOTS OF TIME OVER THE SUMMER MONTHS JULY AUGUST SENT TO BRING SCIENCE BACK TO THE PRESIDENT THAT WOULD BE EXCITING ENGAGING, BOLD AND SO FORTH. THE IDEA WAS TO HAVE THIS BE SOMETHING HE WOULD LAUNCH WITH THE REMAINING TWO YEARS OF HIS PRESIDENCY. BY OCTOBER OR SO IT WAS BROUGHT BACK TO THE PRESIDENT AND HE GOT VERY EXCITED AND SAID WE'RE GOING TO DO THIS. HE SAID BASICALLY WHAT HE WANTED TO DO IS MAKE SURE IT GOT BUILT TO HIS BUDGET PROPOSAL FOR FISCAL 16. AND SO WE WORKED TO HELP REFINE ALL THE DETAILS THAT WE NEEDED FOR THAT. AND COME NOVEMBER, IT WAS CLEAR STARTED TO LOOK LIKE WHAT THE ROLE-OUT MIGHT LOOK LIKE AND WE GOT WORD FROM THE WHITE HOUSE, ONE DAY IN NOVEMBER, I FORGOT THE DAY BUT THIS WAS GOING TO GET MENTIONED IN STATE OF THE UNION ADDRESS, THAT CAUSED GREAT CELEBRATION OF THOSE OF US MEETING EVERY FRIDAY I CAN TELL YOU FOR MANY, MANY, MANY WEEKS TRYING TO FLUSH THIS OUT. WE WAITED AS DECEMBER ROLLED AROUND AND STATE OF THE UNION, 21st CENTURY BUSINESSES RELINE ON AMERICAN SCIENCE AND TECHNOLOGY, RESEARCH AND DEVELOPMENT. I WANT THE COUNTRY THAT ELIMINATED POLIO AND MAP THE HUMAN GENOME TO LEAD A NEW ERA OF MEDICINE, ONE THAT DELIVERS THE RIGHT TREATMENT AT THE RIGHT TIME. [APPLAUSE] O PATIENTS WITH CYSTIC FIBROSIS THIS SITUATION HAS REVERSED DISEASE ONCE THOUGHT UNSTOPPABLE SO TONIGHT I EACH LAUNCHING A NEW PRECISION MEDICINE INITIATIVE TO GET US CLOSER TO CURING DISEASES LIKE CANCER, DIABETES AND GIVE ACCESS TO PERSONALIZED INFORMATION WE NEED TO KEEP OURSELVES AND FAMILIES HEALTHIER. WE CAN DO THIS. [APPLAUSE] >> IT WAS ONE OF THE OLD TIMES IN THE ENTIRE SPEECH BOEHNER AND THE PRESIDENT CLAPPED TOGETHER AND BOTH SIDES OF THE AISLE STOOD UP. WHAT WE WERE DELIGHTED TO HEAR WE KNEW IT WOULD GET MENTIONED BUT WE DIDN'T KNOW WHAT THE WORDING WOULD BE. HE NAMED THE INITIATIVE CAME AS A SURPRISE TO MANY OF US INCLUDING THOSE OF US GATHERED AT FRANCIS COLLINS'S HOUSE WATCHING THE PROCEEDINGS LIVE NOT BEING CERTAIN WHAT WOULD GET SAID BY THE PRESIDENT. SO WE WERE QUITE EXCITED ABOUT THIS. THAT WAS JANUARY 20th. JUST SO HAPPENS BY COINCIDENCE, SECRETARY BURRWELL, SECRETARY DEPARTMENT OF HEALTH AND HUMAN SERVICES WHO WORKS CLOSELY WITH THE PRESIDENT AND ALSO INVOLVED IN THESE MEETINGS AND STRATEGY SESSIONS RELATED TO PRECISION MEDICINE VISITED NIH. JANUARY 28th. IT WAS REALLY GRATIFYING BECAUSE FOR MANY MONTHS FRANCIS HAD BEEN TELLING ALL OF US WORKING AWAY HARD AT THIS THAT THE PRESIDENT WAS INTERESTED, HE WAS REALLY INTO THIS, REALLY INTO IT AND THAT WAS SUPPOSED TO BE THE RALLY CRY TO ET GUS TO WORK EXTRA HARD AND COME UP WITH SOMETHING REALLY BOLD AND STRATEGIC. BUT IT WAS INTERESTING BECAUSE WHEN THE SECRETARY WAS HERE SHE DID A TOWN HALL MEETING FOR NIH STAFF AND QUESTIONS WERE SUBMITTED. ONE OF THE QUESTIONS UNSCRIPTED, ONE QUESTION THAT WAS ASKED OF HER WAS YOU WORK CLOSELY WITH PRESIDENT OBAMA FOR A NUMBER OF MONTHS ESPECIALLY NOW IN NEW ROLE BUT EVEN IF YOUR PREVIOUS ROLE IN THE ADMINISTRATION. TELL US THINGS NIH STAFF WOULD BE INTERESTED TO KNOW FROM YOUR CLOSE WORKINGS. THIS IS WHAT SECRETARY BURRWELL SAID. >> WITH REGARD TO CUPFUL THINGS ABOUT THE PRESIDENT. TWO THINGS KNOW TO HELP YOU IN YOUR DAY TO DAY WORK. THE FIRST ONE IS, AND I'M SURE YOU TOLD THE TEAM THIS, PRECISION MEDICINE THING, THAT'S HIM. THIS IS LIKE A PRESIDENTIAL PRIORITY. THIS IS THE AMOUNT OF TIME THAT IS BEING SPENT ON THIS ISSUE BY THE PRESIDENT OF THE UNITED STATES RELATIVE TO I CAN GO THROUGH A WHOLE LIST OF ISSUES. IS INCREDIBLE. SO WHAT YOU SHOULD KNOW AND WHAT YOU SHOULD TAKE FROM THAT IS THIS IS HIS OWN PERSONAL INTEREST, IT IS WHAT Y'ALL DO. HE BELIEVES SO MUCH THIS IS ABOUT OUR NATION'S INNOVATION IN SCIENCE, OUR ECONOMY, HE BELIEVES THIS IS ABOUT THE HEALTH AND WELFARE OF OUR PEOPLE SO THIS WHILE PRECISION MEDICINE, IT IS I THINK GIVES YOU A FEW -- A VIEW TO HIS THINKING ABOUT THE WORK Y'ALL DO EVERY DAY. >> PRETTY COOL, THAT WAS TO SAY JANUARY 28th AND ON JANUARY 30th A NUMBER OF US GATHERED IN THE EAST ROOM OF THE WHITE HOUSE FOR THE FORMAL ANNOUNCEMENT WHERE THE PRESIDENT POINTED OUT, IT WAS ALL TIMED THE WEEK PRIOR TO HIS BUDGET, THAT'S WHY THE BUDGET, INCLUDING A NEW PRECISION MEDICINE INITIATIVE THAT IS CLOSER TO CURING DISEASE LIKE CANCER AN DIABETES AND GIVES ACCESS TO PERSONALIZED INFORMATION THAT WE NEED TO COVER OURSELVES AND FAMILIES HEALTHIER. THAT WAS THE GRAND ANNOUNCEMENT AND THERE WAS CONSIDERABLE PRESS COVERAGE, THE POPULAR PRESS COVERED THIS IN ALMOST INSTANTANEOUSLY. SIMILARLY THE SCIENTIFIC PRESS APPROPRIATELY PICKED THIS UP IN LOTS OF STORIES WERE IMMEDIATELY WRITTEN AS HAVE A NUMBER OF STORIES WRITTEN SINCE THEN. ONE THING I ALLUDED TO EARLIER, ONE THING THAT IS CERTAINLY CRITICAL FOR THE SUCCESS OF THIS INITIATIVE, IS GOING TO BE HAVING BIPARTISAN SUPPORT. E YES, THIS IS HIS IDEA BUT ULTIMATELY THIS HAS TO GET FUNDED BY CONGRESS, THAT WILL REQUIRE BIPARTISAN SUPPORT. IT WAS GRATIFYING TO SEE EARLY ON AFTER THE ANNOUNCEMENT IN THE NEW YORK TIMES ARTICLE THAT SENATOR (INAUDIBLE) FROM INDIANA QUOTED SAYING THIS WAS AN INCREDIBLE AREA OF PROMISE. BILL CASSIDY WHO IS A PHYSICIAN, THERE WILL BE BIPARTISAN SUPPORT AND HOPEFULLY THAT'S THE CASE. THAT'S BASICALLY THE STORY BEHIND PRECISION NED MEDICINE INITIATIVE. NOW LET ME TELL YOU WHAT IT IS, THE CURRENT VISION LOOKS LIKE. ACTUALLY IF YOU WANT TO GET PROBABLY THE MOST ARTICULATE EXPLANATION OF WHAT IT LOOK LIKE AS OF THE TIME OF ANNOUNCEMENT, I WILL TELL YOU THIS ARTICLE, WRITTEN BY FRANCIS COLLINS AND VIRAL VARMUS WAS RELEASED ONLINE BY NEW ENGLAND JOURNAL THE HOUR THE PRESIDENT MADE THE ANNOUNCEMENT AND PROVIDES RATIONALE AND EARLY PLANS FOR THE PRECISION MEDICINE INITIATIVE. LET ME TELL YOU IN BROAD STROKES. IT HAS THREE MAJOR ELEMENTS. A NEAR TERM ELEMENT, A LONGER TERM ELEMENT AND THEN SOME CHANGES THAT ARE GOING TO BE NEEDED WITH RESPECT TO POLICY. RECOGNIZING CANCER IS AT LEADING EDGE OF PRECISION MISDEMEANOR SIN YET SO MUCH MORE TO LEARN. THE IDEA IS SIMPLY TO ACCELERATE , RAMP UP HE WAS TO INCLUDES MORE CANCER TYPES AND PURSUE THE THINGS MOVING FORWARD BUT ACCELERATE AT FASTER CLIP. THE LOCKER TERM EFFORT -- LONGER TERM EFFORT INVOLVES EXPANDING THIS MODEL TO OTHER DISEASES, THE CENTER PIECE OF THIS EFFORT WILL BE BUILDING OF A NATIONAL RESEARCH COHORT OF OVER A MILLION VOLUNTEERS, USING THAT TO GENERATE THE KNOWLEDGE BASE NECESSARY FOR PLEA AGREEMENT IMPLEMENTING PRECISION MEDICINE. THE POLICY CHANGES REALLY REVOLVE -- INVOLVE REMOVING BARRIERS TO CLINICAL IMPLEMENTATION, INVOLVES CHANGING FEDERAL RULES, ENHANCING RESEARCH PROTECTIONS AND ADVANCING OVERSIGHT OF FDA PRODUCTS SO THOSE ARE THE KEY ELEMENTS BUNDLED TO THE CURRENT VISION OF INITIATIVE BUT IN ORDER FOR THIS TO BECOME REALITY FROM VISION TO REALITY REQUIRES FUNDING IS BUILT TO THE PRESIDENT'S BUDGET FOR FISCAL 16 IS $215 MILLION, MONEY BROKEN DOWN TO DIFFERENT AGENCIES. THE NIH THE CANCER COMPONENT WILL GET 70 MILLION, THE COHORT COMPONENT WHICH I WILL TELL YOU MORE IN A MINUTE ABOUT 130 MILLION. FOOD AND DRUG ADMINISTRATION GETS MONEY, OFFICE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY. THAT'S THE PRESIDENT'S BUDGET. WE WILL SEE WHAT HAPPENS AS IT PERCOLATES THROUGH THE LEGISLATIVE APPROPRIATIONS PROCESS TO SEE WHAT IT ULTIMATELY BECOMES. THAT IS STORY AND THE VISION. SO WHERE ARE WE NOW? WHERE YES NOW TOO SARZOTTI-KELSOE TRYING TO GO FROM PLANNING TO HAVING THE PLAN TO GET THIS OFF THE GROUND. WE VERY MUCH ARE IN A VERY EARLY STAGE OF PLANNING. I DON'T WANT TO GIVE -- E WE ARE JUST ENTERING A VERY INTENSE PLANNING PHASE. WHAT I CAN TELL YOU IS THE NEAR TERM CON POINT WILL BE HANDLED BY THE NATIONAL CANCER INSTITUTE AND THEY HAVE AN ADVISORY PROCESS NOW DEEPLY ENGAGED EXACTLY WHAT THEY'RE GOING TO DO ACCELERATE CANCER AS MODEL FOR PRECISION IS MEDICINE. I WILL SEND YOU TO NCI INDIVIDUAL WHOSE KNOW MORE ABOUT THIS THAN I DO, BUT THIS WILL BE HANDLE BADE SINGLE INSTITUTE. ON THE POLICY CHANGE FRONT I DON'T HAVE THE EXPERTISE TO TELL YOU ALL THE DETAILS, I WILL TELL YOU TO WATCH FOR HOPEFULLY MAJOR ADVANCES IN AREAS OUTLINED AND POINT OUT AS RECENTLY AS LAST WEEK I THOUGHT IT WAS INTERESTING THAT NEW ENGLAND JOURNAL PUBLISHED ANOTHER PERSPECTIVE THAT VERY MUCH TALKED ABOUT TRYING TO ACCELERATE OVERSIGHT OF GENOMIC TESTING TO TEAL WITH ERA OF PRECISION MEDICINE SO EXPECTING CONSIDERABLE ADVANCES TO HAPPEN COMING WEEKS AND MONTHS IN POLICY ARENA AS WELL. WHAT I WILL FOCUS ON IS THIS LONGER TERM INVOLVEMENT OF BUILDING A NATIONAL COHORT, MY INSTITUTE WILL BE MOST INVOLVED IN IN PARTICULAR. THE IDEA OF LONGER TERM NEED IS GENERALIZE OPPORTUNITIES IN PRECISION MEDICINE BEYOND CANCER. AND TO GENERATE A KNOWLEDGE BASE TO MOVE THESE IDEAS TO FULL RANGE AND SPECTRUM OF DISEASE. WHAT'S CLEARLY NEEDED IS RESEARCH, CONSIDERABLE RESEARCH. SOME OF THIS THAT CREATES NEW -- ANALYZING A WIDE ARRAY OF ANALYTICAL VARIABLES, BEHAVIORAL PHYSIO LOGICAL, ENVIRONMENTAL RECOGNIZING ALL THESE DIFFERENT ELEMENTS, WE NEED PILOT STUDIES TO BEGIN TO INVESTIGATE SOME OF THE EARLY IDEAS IN PRECISION MEDICINE BY NO MEANS DO WE KNOW PRECISELY WHAT IT WILL LOOK LIKE AND PILOT STUDIES WILL BE NECESSARY EARLY PHASES. WE NEED TO UTILIZE THE MOST PROMISING APPROACHES AND SCALE THIS UP AND TAKE ADVANTAGE OF GREATER NUMBER OF INDIVIDUALS STUDYING OVER LONGER PERIOD OF TIME TO HAVE IT BENEFICIAL TO RESEARCHERS AND PARTICIPANTS. SO THE IDEA, THE ACCOMPLISH THAT IS TO BUILD A NATIONAL RESEARCH COHORT. OTHER COUNTRIES HAVE DONE AND SOMETHING THE UNITED STATES HAS NOT DONE YET AT THIS SCALE OR SCOPE. IT'S ENVISIONED MAYBE SOMETHING GREATER THAN A MILLION, PERHAPS SUBSTANTIALLY LARGER THAN THAT BUT THIS IS THE NUMBER WE WORK ON FOR NOW. IT WILL NOT START FROM SCRATCH. THE IDEA IS TO TAKE ADVANTAGE OF IMMEDIATE COHORTS MANY WHICH ARE FUNDED BY NIH, HUNDREDS ARE AVAILABLE, WE HAVE TO FIGURE OUT WHICH CAN BE REPURPOSED FOR THIS UNIFORM WE KNOW THOSE WON'T BE AD VAT -- ADEQUATE AND THERE WILL BE CONSIDERABLE GAPS WITH NEW VOLUNTEERS AS PART OF THIS EFFORT. WE EXPECT PARTICIPANTS TO SHARE GENOMIC DATA LIFESTYLE INFORMATION BIOLOGICAL SAMPLES IMPORTANTLY LINKED TO ELECTRONIC HEALTH RECORDS. WE HOPE TO PROVIDE SCIENCETISES WITH A READY PLATFORM UNPRECEDENTED PLATFORM FROM ALL SORTS OF STUDIES TO PROPEL UNDERSTANDING OF HEALTH AND DISEASE. AND IN DOING SO YES EXPECT TO FORGE NEW MODELS TO EMPHASIZE ENGAGE PARTICIPANTS AND IMPORTANTLY OPEN RESPONSIBLE DATA SHARING WITH STRONG PRIVACY PROTECTIONS PROTECTIONS SO TAKING SOME EARLY LESSONS OF WHAT'S SUCCESSFUL ON SMALLER SCALE IS NOT EASY BUT DOING THIS ON A LARGE SCALE WITH THE NATIONAL COHORT. LET ME EMPHASIZE, THESE IDEAS AREN'T BRAND NEW. IN FACT SOME OF THESE IDEAS HAVE BEEN PROPOSED PREVIOUSLY. FRANCIS COLLINS PANT A DECADE AGO PROPOSED SOMETHING SIMILAR AND IT WAS VIEWED AT THAT TIME TO BE TOO EXPENSIVE AND COHORTS WEREN'T AVAILABLE AND BUILDING FROM SCRATCH IS PROHIBITIVE. THOUGH IDEAS CAME UP ABOUT EXISTING COHORTS, DISCUSSED SEVERAL YEARS LATER, IT WAS CLEAR THAT YES WE COULD USE SOME INTERESTING COHORT BUT THAT WASN'T GOING TO BE SUFFICIENT, WE NEED TO FILL IN SO THESE IDEAS HAD BEEN BUBBLING ALONG A NUMBER OF YEARS. WHY NOW THIS IS THE RIGHT TIME AND SIGNTISES THINK IT IS THIS IS THE RIGHT TIME? LET ME SUMMARIZE FIVE MAJOR AREAS I THINK THAT MAKE TODAY DIFFERENT THAN DECADE AGO WHEN FRANCIS COLLINS PROPOSED THE IDEA. FIRST IS ONE MOST FAMILIAR WITH. GENOMICS SUBSTANTIALLY CHANGED. IN THE PAST TEN YEARS. BACK TEN YEARS AGO, COST TO SEQUENCE A HUMAN VOLUME GENOME WAS IN THE MULTI-MILLIONS IN THAT TIME. TODAY WE CAN SEQUENCE A HUMAN GENOME SOMETHING APPROACHING A THOUSAND DOLLARS, BUT CERTAINLY LESS THAN $5,000. THE AMOUNT OF KNOWLEDGE ABOUT THE GENOME STRUCTURE AND FUNCTION IS SUBSTANTIALLY INCREASED IN LAST TEN YEARS AND HOW FAST YOU CAN SEQUENCE, I MEAN TEN YEARS AGO IT WOULD TAKE WEEKS TO MONTHS. NOW WE CAN DO IT IN LESS THAN A DAY. SO GENOMICS HAS A VERY DIFFERENT ROLE THAN IT WOULD HAVE BEEN TEN YEARS AGO IN TERMS OF WHAT IT HAS TO OFFER T. OTHER THING THAT'S CHANGED SUBSTANTIALLY ARE ELECTRONIC HEALTH RECORDS. THE UNITED STATES IN PARTICULAR. TEN YEARS AGO ONLY ABOUT 20 TO 30% HEALTHCARE PROVIDERS HAD ELECTRONIC HEALTH RECORD. TODAY THAT FIGURE IS WELL OVER 90%. THAT PROVIDES INCREDIBLE OPPORTUNITIES TO HAVE DATA AVAILABLE THAT ARE SITTING THERE IN PATIENTS ELECTRONIC HEALTH RECORDS THAT CAN BE USED FOR RESEARCH PURPOSES. FROM THINK HOW WORLD CHANGED TECHNOLOGICALLY THE LAST TEN YEARS. WE DON'T HEAR THE PHRASE N HEALTH DEVICES TEN YEARS AGO AND ALL SORTS ARE COMING TO THE THE FOREPERSON: DOING LIFESTYLE ENVIRONMENTAL EXPOSURES SO FORTH. IN ADDITION THINK HOW THE WORLD CHANGED WITH SMART PHONES. IN THE UNITED STATES, TEN YEARS AGO A MILLION PEOPLE HAVE SMART PHONES, THAT NUMBER IS NOW 160 MILLION, IN FACT, 58% OF ADULTS NOW HAVE SMART PHONES THAT PROVIDES OPPORTUNITIES PERHAPS OF CAPTURING ALL SORTS OF INFORMATION ABOUT INDIVIDUALS AND TRANSMITTING THAT TO BE ABLE FEED INTO RESEARCH INFRASTRUCTURE AND FEED TO RESEARCH DATA RESOURCES. THE OTHER THING THAT CHANGED SUBSTANTIALLY IS DATA SCIENCE, BIOINFORMATICS, COMPUTATIONAL BIOLOGY, BIG DATA. THIS IS ENVISION TO BE A VERY BIG DATA PROJECT AND PROGRAM BUT I THINK OUR DATA SCIENCE CAPABILITIES ARE UP TO THE TASK AND JUST SORT OF THINK COMPARED TO TEN YEARS AGO OUR COMPUTE POWERS IS AT LEAST 16 FOLD GREATER THAN IT WAS THEN. THE OTHER KEY THING, THIS IS GOING TO BE A PIVOTAL ASPECT OF THIS PROGRAM, FROM IS A WHOLE NEW WORLD WITH RESPECT TO WHAT OUR RELATIONSHIP IS WITH PARTICIPANTS IN RESEARCH PROGRAMS. I THINK THE WORD PARTNERSHIP WILL BE KEY TO THE SUCCESS OF THIS PROGRAM. PATIENTS ARE NOT JUST SUBJECTS BUT PART OF THE SCIENTIFIC ENTERPRISE, THEY ARE PARTNERS IN THIS EFFORT. THAT WILL ALLOW THE USE OF EXISTING COHORTS AND BEING ABLE TO CAPITALIZE ON WHAT EXISTS BUT ALSO WILL INVOLVE ENTHUSIASM AND RECRUITMENT OF INDIVIDUALS TO PARTICIPATE IN THIS, TAKING ADVANTAGE OF THE NEW SOCIAL MEDIA AND SOCIAL TRENDS CROWD SOURCING AND CITIZEN SCIENCE. THE VERY CLEAR INDICATION THAT AMERICANS REALLY DO WANT TO PARTICIPATE IN RESEARCH AS LONG AS THEY'RE PARTNERS AND THEY KNOW ABOUT IT AND INFORMED ABOUT IT AND REGARD PART OF THE SCIENTIFIC ENTERPRISE AND NOT JUST TREATED AS SUBJECTS. WE WILL HAIR THESE THAT CHANGE IN SOCIALOLOGY IF YOU WILL TO MAKE THIS SUCCESSFUL. SO WHAT IS ENVISIONED IS BRIG NEW IDEAS HOW WE ENGAGE PARTICIPANTS, HOW WE ENLIST THEIR PARTICIPATION, HOW WE CONSENT THEM, NEW IDEAS FOR INTEGRATING DATA AND TAKING ADVANTAGE OF NEW DATA SCIENCE POWERFUL CAPABILITIES. ALSO NEW WAYS OF DOING RESEARCHs SPECIALLY MULTI-DISCIPLINARY WAYS. WE BELIEVE THIS COHORT CAN PROVIDE THAT EXACT OPPORTUNITY. BUT OF COURSE, THESE ARE ALL GENERAL IDEAS HOW YOU OPERATIONALLIZE THEM TO THINK ABOUT WHAT DO YOU NEED TO DO STARTING NEXT YEAR IN ESSENCE. THAT WILL INVOLVE A LOT OF STRATEGIC PLANNING TO KICK OFF THAT STRATEGIC PLANNING PROCESS A COUPLE OF WEEKS AGO WE HELD THE FIRST OF WHAT WILL WILL BE MANY WORKSHOPS TRYING TO BUILD THE U.S. NATIONAL RESEARCH COHORT. WE BROUGHT TOGETHER 80 TO 90 REPRESENTATIVES FROM A WIDE VARIETY OF FIELDS, FROM ALL SORTS OF DIFFERENT DISCIPLINES AND WE SPENT TWO DAYS DISCUSSING MAJOR AREAS OF IMMEDIATE RELEVANCE TO THE START OF THIS COHORT, IDENTIFY COHORT, RECRUITING PARTICIPANTS, ENGAGING PARTICIPANTS, THINKING DATA PRIVACY, NOVEL WAYS OF RETURNING INFORMATION PARTICIPANTS. DATA COLLECTION THROUGH MOBILE DEVICES. AND THINKING THE INFORMATICS AND ELECTRONIC TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TEST TO CLINICAL RESEARCHERS THINKING ABOUT OBSERVE RATIONAL STUDIES INTERVENTION STUDIES, TACKLING NUMEROUS LONG STANDING CHALLENGES WITH ELECTRONIC HEALTH RECORDS BECAUSE THEY'RE IN HEAVY USE DOESN'T MEAN THEY'RE PERFECT, THEY'RE FAR FROM PERFECT SO THIS MIGHT BE THE VEHICLE TO HELP IMPROVE THE PROBLEMS. DEALING WITH THE EXPROSIVE ADVANCES -- EXPLOSIVE ADVANCES HEALTH TECHNOLOGIES AND KEEPING PACE EVERY DAY WHAT WE READ AND HEAR ABOUT. GETTING ACCESS AND DATA SHARING MODELS JUST RIGHT. MUCH HAPPENED IN LAST FIVE YEARS IN THIS ARENA BUT WE NEED TO GET IT RIGHT GOING FORWARD. FINALLY ALSO DECIDING WHETHER TO INCLUDE PEDIATRIC POPULATIONS OR NOT. THAT IS A WHOLE DIFFERENT SET OF ISSUES WE NEED TO GRAPPLE WITH THE COMING WEEKS SO THIS GIVES YOU A FLAVOR OF THINGS DISCUSSED MANY THE WORKSHOP. WHAT ARE THE NEXT STEP? THEY ARE FIRST FRANCIS IS PUTTING A WORKING GROUP ADVISORY COMMITTEE TO THE DIRECTOR TO BASICALLY CRAFT OUT A MORE DEFINITIVE DETAILED VISION WHAT THE COHORT WILL LOOK LIKE CATHY HUDSON ONE DEPUTY DIRECTOR AND RICK (INAUDIBLE) PROMINENT GENETICIST GENOME CYST FROM YALE UNIVERSITY IS CO-CHAIR AND THEY'RE GROUP MEMBERS IN THE COMING WEEK OR TWO. THAT GROUP IS CHARGED WITH PLANNING THIS VISION IN THIS FISCAL YEAR. THE REASON TO PLAN IT THIS FISCAL YEAR, IF WE'RE SUCCESSFUL, FUNDS WILL COME NEXT FISCAL YEAR WHICH MEANS THEY HAVE TO BE PENT SPENT BY FISCAL 16 WHICH MEANS WE NEED TO GET GOING IF WE GET FUNDING ANNOUNCEMENTS OUT THERE. RESULT WORKING GROUP IS PLANNING TO DELIVER INTERIM REPORT IN SEPTEMBER. WORKING VERY HARD BETWEEN NOW AND THEN. IN ADDITION THIS HAS TO REQUIRE ADDITIONAL MEETINGS AND WORKSHOPS. WE HAVE A LIST OF ONES FROM THE FIRST WORKSHOP AND MANY OF YOU THINK OF VARIANTS WE NEED TO HAVE MEETINGS ABOUT. THE WAY THIS WILL BE IMPLEMENTED AND YVONNE MENTIONED THIS IS NOT ONE INSTITUTE BUT TRANS-NIH WAY THE WAY INITIATIVES LIKE GRAIN BRAIN HAVE BEEN DONE, BIG DATA TO KNOWLEDGE PROGRAM, ANOTHER TRANS-NIH IMPLEMENTATION MODEL AND I WILL CO-LEAD THIS EFFORT WITH GARY GIB BONNES AN HEART LUNG AND POLLUTE INSTITUTE AND TAKING OUR GROUP AND PHI TABORING HOW TO IMPLEMENT THIS. PART OF OUR CHALLENGE IS WE NEED TO GET FUNDING OPPORTUNITIES ANNOUNCED BYNAL IF WE GET SUCCESSFULLY EVERYTHING REVIEW AND SPENT IN FISCAL 16. THIS ISN'T JUST NIH, I SHOULD STRESS THIS WILL INVOLVE COORDINATION WITH MULTIPLE OTHER GOVERNMENT AGENCIES, INCLUDING SISTER AGENCIES BICLIKE THE FDA BUT THE DEPARTMENT OF DEFENSE, VETERANS ADMINISTRATION, WHITE HOUSE VERY ENGAGED AS YOU MIGHT IMAGINE AS OFFICE NATIONAL COORDINATOR. SO LOTS OF PLACES THAT YOU CAN CONTINUE TO MONITOR WHAT HAPPENING AND READ OUT HERE IS A SIMPLE URL, PRECISION MEDICINE, WE WILL PUT ALL INFORMATION INITIATIVE AS IT GROW OVER TIME AT THIS WEBSITE. SO THAT'S NIH. THEN THERE'S -- FOR EXAMPLE HERE IS HOW YOU CLICK FROM THERE TO THE WORKSHOP PAGE I SHOWED YOU EARLIER. HERE IS THE WHITE HOUSE HAS A WEB PAGE DEDICATED TO INFORMATION ABOUT INITIATIVE THERE AS WELL. SO MY LAST SLIDE, I CAN'T HELP BUT BE SENT MENTAL. I HAVE BEEN INVOLVED IN GENOMICS FOR OVER A QUARTER CENTURY. I GOT TO TELL YOU, THERE IS AN EERIE SIMILARITY, SOME MIGHT BE DETAILED ABOUT -- AND THE ANSWER WILL BE WE DON'T KNOW YET. THE REASON I'M SENT MENTAL AND THERE'S THE DEJA VU, PRECISELY 25 YEARS AGO FEBRUARY OF 1990, WE WERE ABOUT SEVEN MONTHS FROM LAUNCHING THE HUMAN GENOME PROJECT. I WAS THERE, AT A POST DOC AND MUCH LESS THAN I AM NOW AND I WAS GOING TO PARTICIPATE IN THE GENOME PROJECT FROM DAY ONE AS I DID. I WILL TELL YOU SEVEN MONTHS BEFORE IT STARTED WE DIDN'T KNOW WHAT WE WERE GOING TO DO, WE HAD A GOAL, WE HAD GENERAL IDEAS AND WE HAD A LOT OF PLANNING AND A PLOT OF MEETINGS AND CRITICAL DISCUSSIONS. IN MANY WAYS THAT'S HOW WE FEEL NOW, SEVEN MONTHS AWAY FROM LAUNCHING THIS THING. WE HAVE A LOT OF GOOD IDEAS, IT'S INCREDIBLY EXCITING, AUDACIOUS BUT THE DALES NEED TO BE WORKED OUT, WE WILL WORK THOSE OUT FORE SEVERAL YEARS SO I DON'T WANT TO GIVE THE IMPRESSION IT'S WORKED OUT, I FULLY EXPECT MANY OF YOU TO HELP US ALONG THE WAY. WE WILL REACH TO ALL COMMUNITY, ALL INSTITUTES TO HELP DESIGN THIS, TO BE MAXIMALLY EFFECTIVE WE NEED THE ENTIRE COMMUNITY TO HELP GET THAT INPUT THAT WE NEED. WITH THAT I WILL STOP AND HAPPY TO ANSWER ANY QUESTIONS. THANK YOU. [APPLAUSE] >> GREAT PRESENTATION. CONGRATULATE FOR HELPING TO LEAD THIS, ARE THERE STATE AND LOCAL INITIATIVES ALONG WITH THE FEDERAL INITIATIVES AS WELL? PROGRAMS THAT MAY ALREADY BE IN BUSINESS TENSE FROM PRIVATE GOVERNMENT PARTNERSHIPS FOR EXAMPLE? >> I'M TRYING TO THINK OF EXAMPLES THAT HAVE COME UP, WHAT I WOULD SAY IS THAT ANY PLACE PUBLIC PRIVATE GOVERNMENTAL, THAT HAS EXISTING INDIVIDUALS ESPECIALLY IN CONTAINED IN HEALTHCARE SYSTEMS WITH GOOD ELECTRONIC MEDICAL RECORDS, WE WILL BE IN CONVERSATIONS WITH THEM THAT INCLUDES FEDERAL PARTNERS AS WELL. EARLY CONCLUSIONS FROM THE WORKSHOP WAS ESPECIALLY WHEN YOU HAVE INDIVIDUALS WHO ARE SEEM TO BE VERY STABLE IN THEIR HEALTHCARE SYSTEM, MAYBE A GREAT OPPORTUNITY TO TAP INTO ESPECIALLY OVER A LONG PERIOD OF TIME, MEASURED PERHAPS IN DECADES. >> I THINK IT WAS A CLEAR PRESENTATION SO THAT WAS HELPFUL THANK YOU. MATHEMATICALLY WE KNOW THAT INDIVIDUAL DETERMINANTS DOESN'T MATTER HOW LOW YOU GO, GENOMICS ULTIMATELY INTERACT WITH ENVIRONMENTAL DETERMINANTS. IF ONE -- IF THE GAME WERE IN IS PREDICTING HEALTH OR PREDICTING RESPONSIVENESS TO PHARMACO THERAPEUTICS, WE KNOW THAT ABSENT ENVIRONMENTAL DETERMINANTS YOUR PREDICTIVE CAPACITY REMAINS LOW. >> ENVIRONMENTAL TERMS. WE BELIEVE THIS GIVES US AN OPPORTUNITY, SO YOU WANT TO FEEL FREE TO WEIGH IN, THESE NEW TECHNOLOGIES FOR MONITORING THE M. HEALTH TECHNOLOGIES AND OTHER TECHNOLOGIES MIGHT GIVE US THE CAPABILITIES OF MEASURING THINGS WE PREVIOUSLY NEVER MEASURE. DO YOU WANT TO EXPAND ON THAT, SOMEBODY WHO IS HEAVILY INVOLVED ALL SUMMER LONG IN THE PLANNING PROCESS. MCMIC >> EXPANSION INTO BEHAVIORAL ENVIRONMENTAL INFLUENCES, ESPECIAL SPECIALLY GEOLOCATION, ACTIVITY LEVELS, DIETARY, SMOKING ALL THE VARIOUS THINGS THAT WE MIGHT KNOW ABOUT AS WELL AS SOCIAL DETERMINANTS WE CAN EXTRACT FROM LOCATION AND THAT SORT OF THING. SO I THINK GROUP IS THINKING BROADLY BUT IT WILL BE USEFUL AS ERIC SAID AS WE MOVE FORWARD, MORE INPUT ON WHAT THOSE THINGS OUGHT TO BE. WE PROBABLY WILL MAKE SURE WE NEED TO PRIORITIZE BECAUSE WE HAVE TO WORRY ABOUT ORNAMENTS ON CHRISTMAS TREE, IT MAY FALL OVER ON ITSELF. >> NICE THING ABOUT THE TECHNOLOGY, IT ALLOWS US TO DO THAT MORE PASSIVELY WITH LESS RESPONDED VERSION THAN TYPICALLY FROM MORE TRADITIONAL WAYS OF MEASURING SO WE TRY TO DO AS MUCH PASSIVE MONITORING AND PRECISION MEDICINE TYPE MEASURE MENT AS WE CAN. >> THAT'S A I THOUGHT WHAT YOU WOULD SAY. I SUPPOSE IT'S GOOD TO HEAR. I SUPPOSE MY PLUG IS, I THINK FREQUENTLY THINK OF ENVIRONMENTAL DETERMINANTS IN THESE CONTEXT, IT WOULD BE NICE TO HAVE. THE ARGUMENT I'M MAKING IS IF THE GOAL TRULY IS AS THE PRESIDENT SAID TO UNDERSTAND OUR HEALTH AND PREDICT OUR HEALTH AND PREDICT THE RESPONSE TO THERAPEUTICS, ACTUALLY ABSENT INCLUSION OF ENVIRONMENTAL DETERMINANTS ENTERPRISE IS MATT MATHEMATICALLY LIMITED. >> THAT'S THE DIFFERENCE BETWEEN NOW AND TEN YEARS AGO WHEN THIS WAS PROPOSED. TEN YEARS AGO THIS WAS NOT WITHIN THE REALM OF POSSIBILITY TO CAPTURE THAT DATA. I THINK BILL ONE THE FIRST TO ADMIT NOT THAT M HEALTH DEVICES ARE READY NOW BUT I WOULD INVOTE THE QUOTE I SOMETIME USE IN SITUATIONS, SEEMS LIKE WE CAN TRY TO IMAGINE SKATING TO WHERE THE PUCK IS GOING TO BE, IF WE CAN GET THIS UP, THE TECHNOLOGY AS IN GENOMIC TECHNOLOGY OVER THE LAST TEN YEARS, IF TECHNOLOGY DOES HALF THE THINGS IT HAS POTENTIAL TO DO, WHILE FIVE YEARS FROM NOW IF WE HAVE THIS GOING WE MIGHT HAVE GREAT DATA TO BE ABLE TO ANSWER QUESTIONS YOU'RE RAISING. >> THE OTHER BALANCE I WONDER ABOUT IS BALANCE BETWEEN PREVENTION AND TREATMENT. TALKED ABOUT VERY DIFFERENTLY IN THAT FRAME DIFFERENT PRESENTATION AND FOR ISSUES LIKE MINING THE COHORT FOR DIFFERENT STUDIES AND PEDIATRIC PARTICIPANTS FOR SOME PREVENTION ANGLES OR DISEASES, THAT MAYBE CRITICAL TO GETTING PREVENTION PRIORITY. >> I AGREE WITH YOU. ANY TIME YOU BUILD UP RESEARCH PORTFOLIO PEOPLE WILL BRING DIFFERENCE LENSES AND EMPHASIS. THE SCALE OF THIS ARE ALLOW OPPORTUNITIES FOR ALL THOSE THINGS. >> THANKS, HI. IN ADDRESSING AS ELOQUENTRY YOU DID THE PROFICIENCY OF INFORMATION REGARDING GENETICS AND DIVERSE POPULATIONS WILL THERE BE OPPORTUNITY TO BRING INTERNATIONAL POPULATIONS IN SOME COHORTS AFRICAN POPULATIONS? >> GREAT QUESTION. THERE'S A WHOLE OTHER STORY ESPECIALLY IN GENOMICS ISSUES IN AFRICA. BUT I DON'T KNOW IMMEDIATE ANSWER, I THINK WE ABSOLUTELY WANT TO LINK UP WITH OTHER INTERNATIONAL PROGRAMS TO THIS AND ANY OPPORTUNITIES TO INTEGRATE DATA, WHAT KEY THINGS THEY'RE GOING TO BE ON ANY INDIVIDUALS AND TRADE OFF, BEST WAY TO ACCOMPLISH ALL OF THIS. BUT I THINK THAT IS STILL TO BE DETERMINED. [APPLAUSE] YOU ALL HEARD ME MENTION THIS MORNING WHEN I GAVE MY INTRODUCTORY VECTOR'S REPORT, I WAS PLEASED AS AN ACTING INSTITUTE DIRECTOR TO REACH OUT TO TWO OF OUR MOSTLY FIGHTING SPEAKERS HERE AT THE NIH THESE DAYS BUT MOST IMPORTANTLY TO TWO PEOPLE WHO ARE IN CHARGE OF TWO OF THE MOST EXCITING INITIATIVES THAT ARE ONGOING HERE AT AGENCY. YOU HEARD ERIC SPEAK ABOUT PRECISION MEDICINE INITIATIVE AND NOW WE HAVE DR. NORA VOLKOW WHO WILL SPEAK ABOUT THE ABCD PROJECT OR ADOLESCENT BEHAVIOR COGNITIVE AND DEVELOPMENT PROGRAM AS WELL AS THE BRAIN INITIATIVE. I DON'T DO THIS, BECAUSE I HAVE KNOWN HER SINCE SHE CAME TO THE NIH BECAUSE SHE WAS A INSTITUTE DIRECTOR AT THE TIME I WAS SERVING AT ACTING DEPUTY DIRECTOR OF NIH AND I WAS PLEASED TO BE ON THE SEARCH COMMITTEE THAT BROUGHT HER INTO THE NIH SO I KNOW HER WELL, I KNOW HER FROM BACKGROUND, PRY COMING TO THE NIH BUT SHE IS A STRONG CANDIDATE OF INSTITUTE DIRECTOR HERE AT THE AGENCY, STRONG CANDIDATE FOR PARTNERSHIP AND LEADERSHIP AND DEVELOPMENT SO I'M GOING TO DO SOMETHING I DON'T USUALLY DO, I WILL READ HER BIO BECAUSE I WANT YOU TO KNOW HOW FANTASTIC SHE IS. NOT ONLY FROM STANDPOINT OF SCIENCE BUT SHE GIVES LOT OF HERSELF PARTICULARLY TO CAUSE OF SUBSTANCE ABUSE. SHE BECAME THE DIRECTOR OF GNASH INSTITUTE ON DRUG ABUSE IN 2003 HER WORK IS INSTRUMENTAL DEVELOPING PROGRAMS AROUND DRUG ADDICTION AND ANY DISEASE SPECIFICALLY RELATED TO HUMAN BRAIN SHE'S A PSYCHIATRIST AS WELL AS A VERY NOTED SCIENTIST AND HAS DONE GREAT DEAL OF WORK ON ABUSABLE DRUGS. SHE WAS BORN IN MEXICO AND ATTENDED MODERN AMERICAN SCHOOL AND GOT A MEDICAL DEGREE FROM THE NATIONAL UNIVERSITY OF NEW MEXICO IN MEXICO CITY AND SHE IS SOMEONE THAT IF YOU WANT TO GO ON TO GOOGLE AND GOOGLE THE SPEAKERS YOU WILL SEE DR. VOLKOW HAS BEEN A TED PRESENTER MORE THAN ONCE, I DON'T REMEMBER HOW MANY TIMES BUT CERTAINLY FOR A THAN ONCE. I HAD THE PLEASURE OF HEARING HER AGAIN YESTERDAY. I HEAR HER EVERY DAY HEN WE ARE AT INSTITUTE DIRECTORS MEETING BUT IT'S GREAT TO HAVE HER GIVE YOU A PRESENTATION BECAUSE SHE COVERS IT, NUTS AND BOLTS FROM BEGINNING TO END SO SHE WILL TALK TO US TODAY ABOUT TWO ASPECTS OF WHAT SHE DOES NOW AND ONE IN PARTICULAR THAT RELATES VERY WELL TO NIMHD. WE ARE VERY INTERESTED IN ADOLESCENT BRAIN DEVELOPMENT, SPECIFICALLY ISSUES WITH COGNITION. BUT YOU ALSO HEARD ME SAY WE'RE INTERESTED IN TRYING TO LOOK WHAT'S GOING ON AS RELATES TO DEPRESSION AND STRESS IN COMMUNITIES OF COLOR. AND WHETHER THERE'S SOMETHING WE CAN ACTUALLY BE FOCUS ON AS RELATES TO NOT ONLY THE BEHAVIORAL ASPECT BUT MAYBE THERE ARE BUY LOGICAL ISSUES WE SHOULD EXPLORE. WE'RE NOT AFRAID TO SAY THAT HUMAN HEALTH IS VERY COMPLEX. WE HAVE TO BE SURE THAT WE'RE LOOKING EVERY ASPECT OF HUMAN HEALTH. BUT CERTAINLY THE BRAIN DRIVES US SO WITH THOSE REMARKS I WOULD LIKE TO ASK DR. VOLKOW TO COME FORWARD AND GIVE PRESENTATION ON THESE TWO INITIATIVES BUT ALSO TO SAY HOW MUCH WE APPRECIATE YOUR COMING, BECAUSE I DON'T KNOW HOW MANY -- I SEE COUNCIL SPOKE THE LAST SEVERAL MONTHS BUT WE'RE GLAD YOU ACCEPT OUR INVITATION. >> THANKS VERY MUCH, I WANT TO THANK YOU FOR GETTING ME THE OPPORTUNITY TO SPEAK TO YOU AND WANT TO THANK THE COUNCIL MEMBERS, AS INSTITUTE DIRECTOR ONE CHALLENGE THAT WE HAVE AND WE HAVE NOT SUCCEEDED EXPANDING THE REPRESENTATION OF SCIENTIFIC MINORITIES IN RESEARCH ENTERPRISE SO YOUR INPUT ON HOW TO HELP US ADDRESS THESE ISSUES IS VERY RELEVANT. AND INPUT SCIENTIFICALLY HOW TO UNDERSTAND THE COMPLEXITIES OF THE ISSUES, THAT RELATE TO DISEASE IN DISPARATE POPULATIONS, THAT EXACERBATE WHATEVER CONSEQUENCE THAT YOU LOOK UP ON ANY PARTICULAR DISEASE SEEMS TO BE WORSE IN NIGH NORTIES, THAT'S A SCIENTIFIC CHALLENGE THAT WE HAVE IN FRONT OF US TO ADDRESS. I WAS ASKED TO SPEAK ABOUT TWO INITIATIVES. THE BRAIN INITIATIVE WHICH IS EXCITING AND THE OTHER ONE ON THE ABCD AND WHAT LED TO IT. SO I WILL (INAUDIBLE) IN THE LIMITED TIME I HAVE TO BE SUCCINCT ON EACH. BUT LET ME START BY SPEAKING ABOUT THE BRAIN INITIATIVE BECAUSE YOU HEARD THE INITIATIVE OF PRECISION MEDICINE WHICH WAS THE 2014 INITIATIVE, BUT 2013 OBAMA LAUNCH ANOTHER INITIATIVE, QUESTION LAKED THE NEXT GREAT AMERICAN TO PROJECT. YOU LOOK AT IT WHAT IS THE GREATEST CHALLENGE THAT WE HAVE IN FRONT OF US IN SCIENCE TO UNDERSTAND HOW THE HUMAN BRAIN WORKS. BY FAR IS MOST COMPLEX ORGAN OR SYSTEM WE KNOW ABOUT AND WE ACTUALLY NOW ARE DEVELOPING THE TOOLS THAT ARE BRINGING US A GLIMPSE ABOUT THE COMPLEXITY OF THIS EXTRAORDINARY BRAIN OF OURS THAT ULTIMATELY MAKES US HUMAN. THE BRAIN INITIATIVE IS INITIATIVE THAT INVOLVES MULTIPLE AGENCIES, PUBLIC AND PRIVATE EFFORT, NIH IS ONE OF THE PLAYERS. SO ARE PRIVATE FOUNDATIONS, SOME MADE REMARKABLE CONTRIBUTIONS TO OUR ADVANCES IN TIME. IN PARTICULAR I WOULD LIKE TO HIGHLIGHT THE INSTITUTE FOR BRAIN SCIENCE AS ONE TRANSFORMATIVE, ON THE WAY THEY HAVE BEEN ABLE TO CHALLENGE SOURCES IN ORDER TO ADVANCE NEUROSCIENCE SO WITHIN CONTEXT THE LANDSCAPE OF ORGANIZATION BEING INVOLVED WITH THE BRAIN INITIATIVE, THE BIG QUESTION WAS WHAT SHOULD NIH ROLE BE. WHAT NIH CAN BRING TO THE TABLE THAT WILL HELP ADVANCE THE WHOLE FIELD ON UNDERSTANDING HOW THE BRAIN WORKS. I'M VERY PLAID EVIDENCE BASED THAT BRAIN DISORDERS ARE A LEADING SOURCE OF DISEASE BURDEN AND COST TO THE UNITED STATES. AND YET AT THE SAME TIME THERE WERE CERTAIN RECENT BREAK THROUGHS IN TECHNOLOGY THAT HAD REALLY OPENED THE POSSIBILITY FOR ALL TO INVESTIGATE WHAT HAPPENS IN THE BRAIN OF PEOPLE WITH BRAIN DISORDER. TECHNOLOGY SHOWS POTENTIAL WHAT HAVING TECHNOLOGY CAN DO TO SCIENCE WE'RE VERY AWARE THAT THERE ARE MANY LIMITATIONS VIS-A-VIS THE SUCCESS OF TOOLS AN TECHNOLOGY THAT ENABLE US TO EXPLORE IN MUCH GREATER DETAIL AND SPECIFICITY HOW THE BRAIN WORKS SO BASED ON THE BACKGROUND IT WAS DETERMINED THE NIH COULD PLAY A REALLY IMPORTANT ROLE IF WOE W FOCUS THE BRIAN OUR INVOLVEMENT ON THE BRAIN INITIATIVE IN DEVELOPMENT OF TOOLS AND IT CANNOLOGY. THAT'S EXACTLY WHAT THE REEL OF THE NIH IS IN THE BRAIN INITIATIVE. NOW, ACCESS TOOLS AND TECH NOLS GET DEVELOPED, THE OPPORTUNITY TO INVESTIGATE PROCESSES IS GOING TO BE SOMETHING THAT WE'LL START TO -- WILL START TO EMERGE. THE WAY IT WAS CONSTRUCTED IS WE WILL START AND THE PROJECT WAS IDENTIFY LET'S LOOK TEN YEARS FOR NIH INVOLVEMENT ON THE BRAIN. THE FIRST YEAR FIRST FIVE YEARS IS FOCUSING SIGNIFICANTLY ON THAT DEVELOPMENT OF TECHNOLOGY AND TOOLS. YOU WANT TO SEE IT'S VERY IMPORTANT THE NIH IS A MONEY ASSIGNED TO IT. BECAUSE IF THERE'S NO MONEY, IT IS MUCH MORE CHALLENGING. SO WE SOME OF THE INSTITUTES GOT TOGETHER AND PUT MUST BE ON THE OFFICE OF DIRECTOR, SO THE FIRST YEAR WE WERE ABLE TO COLLECT $40 MILLION TO LAUNCH THIS INITIATIVE TO PROVIDE FOR PROJECTS THAT WILL BE FUNDED ON FIVE YEARS. ALL THOSE PROJECTS ARE TECHNOLOGY AND TOOL DRIVEN. WE WERE HOPING IN THIS YEAR 2015 THERE'S -- JUMPS FROM 40 MILLION TO 100 MILLION AND PLAN ACCORDINGLY. UNFORTUNATELY WE DID NOT GET THAT BUT WE GOT TO 75 MILLION. BUT I AM SHOWING YOU THAT OUR PREDICTION WHERE THE PROJECTS WOULD BE THAT ACTUALLY ENABLE US TO EXPAND FROM TECHNOLOGY INTO INVESTIGATIONS WITH NEUROSCIENCE THAT START TO EMERGE, THESE TECHNOLOGIES ARE DEPLOYED. FOR $500 MILLION A YEAR FOR THE PAST -- THE LAST FIVE YEARS OF THE TEN YEARS BRAIN INITIATIVE. THIS IS WHAT WE EXPECT AND LIKE TO GET IN ORDER TO ADVANCE FASTER. WHETHER WE WILL GET THERE OR NOT IS UNCLEAR BUT IT IS VERY IMPORTANT THAT WE STRIVE FOR IT. AS I SAID MEANTIME WE WERE CALLED BY $25 MILLION BASED ON OUR EXPECTATIONS. SO WHAT WE DO WITH THE FIRST -- IT WAS ACTUALLY $46 MILLION, MY MISTAKE. FOR THE FISCAL YEAR 14. THIS ENABLED US TO FUND CTA PROJECT THAT REFLECT THE FOLLOWING AREA. THERE WAS DISCUSSION IF YOU WERE TO BUY THE UMBRELLA SALES, HOW SALES COMMUNICATE WITH ONE ANOTHER TO FORM CIRCUITS AND WHAT THE FUNCTION OF THOSE CIRCUITS AND ULTIMATELY HOW CAN WE TAKE THAT INFORMATION INTO THE HUMAN BRAIN. SO THESE SIX DIFFERENT RFAs WERE ON ACTUALLY LET'S DEVELOP PROJECT THAT ENABLE US TO CLASSIFY NEURONS IN THE BRAIN. WE DON'T REALLY KNOW EVEN HOW MANY CLASSES OF NEURONS WEAPON. NOT TO SAY EVEN GLIAL CELLS. WE DON'T KNOW HOW THEY COMMUNICATE WITH EACH OTHER NOR HAVE THE TOOLS TO LOOK AT THOSE COMMUNICATIONS. SO THE RFAs WERE FOCUSING ON HELPING CLASSIFY ON TOOLS THAT WE HAVE, SOME OF THE RFAs WERE DOING THAT BUT ALSO RFA SPECIFICALLY ENHANCE OUR ABILITY TO HAVE BETTER MARKERS HOW TO CLASSIFY CELLS AND HOW TO HAVE BETTER MARKERS TO ACTUALLY LOOK AT THOSE CIRCUITS AND TO START TO DISCUSS THE RFA FOR THE NEXT GENERATION WAS A SMALL AMOUNT OF MONEY FOR PILOT PROJECTS WE TRY TO LOOK INTO AREAS THAT ARE TRANSFORMATIVE VIS-A-VIS THE WAY WE ENTERGATE THE HUMAN BRAIN. THAT WAS IN YEAR 14, FOR FUNDING YEAR 15 WE WERE SHORT IN FUNDS BY 25 MILLION SO WE ONLY HAVE 25 MILLION IN NEW FUNDS. THE CONSENSUS WAS WE'RE SO SUCCESSFUL IN THE TYPE OF GRANTS WE GOT, IN FISCAL YEAR 14, THAT WHOLE RECOMMENDATION WAS LET'S JUST REISSUE THE SAME REQUEST FOR PROPOSAL. BECAUSE THE SUBJECTS WERE VERY THE PROPOSAL WERE HIGH QUALITY AND WE DIDN'T HAVE SUFFICIENT FUNDS TO BE ABLE TO ACTUALLY SUPPORT INVESTIGATORS THAT HAVE VERY PROMISING TECHNOLOGIES AND TOOLS. BASICALLY FUNDING THE NEW GRANTS THEY WILL FOLLOW THE SAME SUBJECT TOPIC AREAS THAT WE HAD IN 14. SO THAT IS, I'LL BE HAPPY TO ANSWER QUESTIONS AT THE END FOR THE BRAIN BUT I WANT TO JUMP INTO NIDA AND THE ABCD PROJECT. WHY DID WE GO INTO THE ABCD PROJECT? THERE IS A -- I WANT TO GIVE YOU SOME BACKGROUND. WE HAVE KNOWN NOI NOW FOR MANY, MANY YEARS, EPIDEMIOLOGICAL STUDY IT IS PERIOD OF GREATEST VULNERABLE FOR SUBSTANCE USE DISORDERRER, THE PERIOD FOR GREATEST VULNERABILITY FOR BEHAVIORAL DISORDERS FROM CHILDHOOD INTO ADULTHOOD. THAT IDENTIFIES A TEMPORAL PERIOD DURING KIDS ACTUALLY AT GREAT RISK TO ENDING UP WITH VARIOUS ADVERSE CONSEQUENCES, IF YOU PROVIDE SUPPORT SOCIAL SUPPORT, YOU CAN ALSO STRENGTHEN THE LIKELIHOOD THEY WILL BE SUCCESSFUL. THERE YOU HAVE IN THE GRAPH OVER THE PERIOD OF RISK FOR DEVELOPING TIGHT KNOWSIS OF SUBSTANCE USE DISORDER WHICH PEAKS AROUND LATE TEEN YEARS AND IF YOU HAVE NOT BECOME ADDICTED AS ADULT THE LIKELIHOOD YOU WILL BECOME ONE IS MUCH LOWER. NEUROSCIENTIFICLY WHY IS THAT SO? ALL THESE PROCESS REFLECT BIOLOGICAL CHARACTERISTICS OF OUR BRAIN. NOT JUST (INAUDIBLE). ONE OF THEM IN THE BRAIN IS MORE NEUROPLASTIC WHEN YOU'RE A CHILD OR ADOLESCENT, ONE THING THAT DRUGS DO IS THEY TRIGGER THE MOLECULAR TARGETS OF NEUROPLASTICITY. A DRUG STRENGTHEN SIGNALING IN CERTAIN PATHWAYS WHILE THEY WEAKEN SIGNALING IN OTHERS SO THEY STRENGTHEN PATHWAYS WITH DRUG TAKING BEHAVIOR AND PATTERNINGS ASSOCIATED WITH STRESS REACTIVITY. AT THE SAME TIME THEY THESE CHANGES OF COURSE ARE VERY NEGATIVE AND DEVASTATING. IF KIDS TAKE DRUGS EARLY ON THOSE NEUROPALACIC CHANGES OF YOUR FACTOR AND ANALYSIS ARE LONGER LASTING. SUCH GREAT VULNERABILITY. THE OTHER ASPECT OF WHY THIS IS RISK IS OUR BRAIN WHEN WE'RE BORN IS NOT FULLY DEVELOPED. THE BRAIN SLOWEST DEVELOPMENT ORGAN WE KNOW OF AND THE HUMAN BRAIN IS THE SLOWEST ORGAN IN TERMS OF DEVELOPMENT, AND WILL NOT FULLY DEVELOP IN OUR EARLY 20s. THAT CHANGES THAT OCCUR DURING THIS PERIOD ARE ACTUALLY VERY FLEX COMPLEXION REFLECT A PROCESS WHICH THE BRAIN IS EXTRAORDINARY ORGAN, NEUROPLASTICITY. OUR BRAIN IN THESE 20 YEARS IS DEVELOPING ITSELF IN ORDER TO OPTIMIZE THE LIKELIHOOD TO PERFORM IN THE ENVIRONMENT IT'S BEING RAISED AND SO THE QUESTION ABOUT WHY SOCIAL STRUCTURES ABOUT SUPPORT YOU GIVE TO CHILDREN AND ADOLESCENTS IS EXTRAORDINARY IMPORTANT IN OUTCOMES. BOTH IN HEALTH AND DISEASE. AMONG THE CHANGES THAT ARE OCCURRING VERY RELEVANTTOR SUBSTANCE USE DISORDERS AND WHAT WE'RE DISCUSSING HERE IS CONNECTIVITY OF THE BRAIN. SO THE BRAIN IS A NETS WORK. AND NETWORK ALLOWS THE BRAIN FOR MULTIPLE AREAS TO COMMUNICATE WITH ONE ANOTHER. ONE OF THE SLOWEST AREAS TO CONNECT IN OUR BRAIN IS THAT LINKS FRONTAL CORTEX WITH OUR BRAIN. FRONTAL CORTEX FLOWER BRAIN IS WHERE WE PROCESS INFORMATION THAT ENABLE US TO ACCEPT CONTROL OVER OUR ACTIONS AND SELF-CONTROL OVER OUR EMOTIONS. AND THAT REQUIRES THE PROPER CONNECTIVITY OF THE FRONTAL CORTEX WITH THE LIMBIC BRAIN. THIS EXPLAINS EXACTLY WHY KIDS ARE MORE LIKELY TO ENGAGE IN RISKY BEHAVIORS, WHY? BECAUSE THE COGNITIVE PROCESS OF THE FRONTAL CORE THAT HE CAN EVALUATE DECISION DECIDE THIS IS RISKY, UBERTY NOT DO IT, ARE ACTUALLY NOT FULLY FORMED. SO THE INFRASTRUCTURE THAT ALLOWS YOU TO INSERT INHIBITION IS NOT FULLY FORM, THEREFORE YOU'RE MORE LIKELY TO REACT IMPULSIVELY. BUT ALSO HAS IMPORTANT ASPECT. BIOLOGISTS ARE STRIDE GNARLLY INTELLIGENT. WHENEVER YOU HAVE A YOU ASK WHY WOULD BIOLOGY DO THIS AND YOU ARE DOING THIS TO AN ADVANTAGE BECAUSE BY NOT HAVING CONSTANT FRONTAL CONTROL THIS RESULTS IN MUCH MORE INTENSE EMOTIONAL REACTIONS THAT MAY FACILITATE WILLINGNESS TO EXPLORE ENVIRONMENTS AND SOMETIMES THEY RISK PARTICULARLY THINGS RELATE TO YOUR CAPACITY TO LATER ON PERFORM BETTER CAN HAVE POSITIVE EFFECTS SO WE HAVE A ENTHRALL BALANCING SYSTEM WHERE THESE LACK OF CONNECTIVITY PUTS THE SAME TIME BUT CERTAIN SIGNALS HAVE ADVANTAGE VIS-A-VIS EXPROPRIATION OF ENVIRONMENT. SO THIS LACK OF CONNECTIVITY BETWEEN THE PRE-FRONTAL CORTEX AND AMYGDALA IS CONSIDERED TO BE ONE OF THE REASONS WHY RISK OF ENGAGING IN RISKY BEHAVIOR INCLUDING DRUG TAKING, HEIGHTENED NEURAL PLASTICITY EXPLAINED WHY THE PROCESS OF ADDICTION IS A FACTOR AND LONGER LASTING IN ADOLESCENCE. AS WE HAVE KNOWN ALL ALONG, DRUGS ARE IMPORTANT FOR -- BUT NOT EVERYBODY BECOMES ADDICTED AND DEPENDING ON THE DRUG HERE AND THERE YOU CAN ESTIMATE APPROXIMATELY 10% OF INDIVIDUALS EXPOSED TO DRUGS WILL BECOME ADDICTED BUT TO,POSE IN ADOLESCENTS YOUR PROBABILITY OF BECOMING ADDICTED IS HIGHER THAN 10% AND CAN MORE THAN DOUBLE DEPENDING ON THE DRUG. WE ALSO RECOGNIZE AT LEAST 50% OF THE VARIANTS THAT RELATES TO VULNERABILITY IS DETERMINED BY YOUR GENES. WHICH ARE INVOLVED LIKE ANY OTHER COMPLEX DISEASE, WE DON'T KNOW THE WHOLE STORY BUT WHAT IS CHEERILY EMERGING, THIS IS A SUBJECT THAT IS EMERGING ACROSS ALL STUDIES WE DO IN ILLNESSES WHEN WE TRY TO EXPLAIN GENES AN INVOLVEMENT ON DISEASE, WHAT HAPPENS IS THOSE GENES ARE MODULATING OUR VULNERABILITY TO THE ENVIRONMENTAL FACTORS AND THAT IS ULTIMATELY THAT INTERACTION BETWEEN THE ENVIRONMENTS AND THE GENES THAT THE DETERMINES THE PROPENSITY OF DISEASE. SO THE AREA OF PRESENTATION WHEN YOU ASK THE QUESTION WHAT ABOUT THE INFLUENCE OF ENVIRONMENT BECAUSE IF YOU DON'T TAKE IT INTO ACCOUNT, YOUR LIKELIHOOD OF IDENTIFYING GENES IS GOING TO BE VERY MUCH MATHEMATICALLY LIMITED, VERY LIMITED, I THINK THERE ARE MULTIPLICITY OF EXAMPLES THAT ATTEST TO THAT. THIS IS EXTRAORDINARY. IMPORTANT. LIKE OTHER FIELD. WE KNOW THE ENVIRONMENTS ARE VERY, VERY IMPORTANT. SOCIAL SUPPORT IS ONE OF THE MOST POWERFUL PROTECTIVE EFFECTS. YOU CAN ALSO TURN IT AND SAY SOCIAL STRESSES PARTICULARLY CHILDHOOD AND ADOLESCENTS ENHANCE VULNERABILITY OF BECOMING ADDICTED. SO THE BIG QUESTION FOR US IS THAT AS A SCIENTIFIC QUESTION, HOW DO WE EXPLORE THE ROLE GENES IN THE ENVIRONMENT. HOW THE ENVIRONMENT INFLUENCES GENES. WITH THE WHOLE EXPLOSION OF EPIGENETIC MECHANISMS THAT ENABLE US TO INVESTIGATE AS THE GENE LEVEL HOW ENVIRONMENT CAN SILENCE OR ACTIVATE THAT GENE, IT HAS GIVEN NEW TOOLS TO INTERROGATE HOW ENVIRONMENTAL FACTORS INFLUENCE BIOLOGY. THE CHALLENGE FOR US, DISEASES LIKE ADDICTION OR MENTAL ILLNESS, FOR OTHER MEDICAL DISEASES IS NOT JUST CLASSICAL BRAIN DISORDERS, HOW DO WE QUANTIFY SOCIAL ENVIRONMENTAL STRUCTURES BECAUSE FOR ALL HUMAN CREATURE IT IS SOCIAL ENVIRONMENT ONE OF THE MOST IMPORTANT FACTORS THAT WE HAVE IN INFLUENCING MULTIPLE BIOLOGICAL PARAMETERS AND CERTAINLY PARAMETERS THAT RELATE ED TO BRAIN. SO THESE INTERACTIONS OF ENVIRONMENT WITH OUR GENES WITH OUR DEVELOPMENTAL STAGE WITH AND WITHOUT EXPOSURE TO DRUG WILL EFFECT THE BRAIN DIFFERENT WAYS SO IF YOU HAVE THE VULNERABILITY GENETIC, IF YOU HAVE STRONG SOCIAL STRESSORS THAT WILL PRIME THE BRAIN TO BE PRONE TO PRODUCE CHANGES THAT RESULT IN ADDICTION. WHEREAS IF YOU DON'T HAVE VULNERABILITY FACTORS AN YOU HAVE A STRONG SOCIAL SUPPORT SYSTEM YOU MAY EXPERIMENT WITH DRUGS BUT THOSE CHANGES IN THE BRAIN WILL NEVER RESULT IN THE PHENOTYPE OF ADDICTION WHICH IS CHARACTERIZED BY COMPULSIVE ADMINISTRATION OF DRUGS BY LOSS OF CONTROL, EVEN THOUGH IT HAS CATASTROPHIC CONSEQUENCES. SO THIS IS WHERE WE ARE WITH THE SCIENCE, WHERE WE ARE WITH UNITED STATES AN WHY WE SAY NOW WHY DO WE NEED THIS? THIS IS JUST TO ILLUSTRATE ONE THING WITH WE ARE, WE HAVE THE TOOLS TO START TO INTERROGATE THE BRAIN. THE TO ENTERGRATE HOW ENVIRONMENTAL FACTORS INFLUENCE THE BIOLOGY THAT MAKES YOU VULNERABLE TO DRUG ADDICTION. THIS IS AN OLD STORY, NOW IT'S 12 YEARS OLD. BUT A CLASSICAL, IT SHOWS IN HUMAN PRIMATES HOW A CHANGE IN SOCIAL STRUCTURE CAN PROFOUNDLY MODIFY THE BIOLOGY OF THE BRAIN IN WAYS THAT MAKE YOU VULNERABLE TO ADDICTIVE BEHAVIOR AND IMPULSIVEITY. THROUGHOUT SCIENCE, THE PAST 10, 15 YEARS ONE THING THAT HAVE EMERGED CONSISTENTLY IS THERE IS RECEPTOR IN BRAIN, DOPAMINE D-2 RECEPTOR THAT MODULATE OUR PROPENSITY TO IMPULSIVEITY -- LOW LEVELS MAKE YOUR MORE AS A RESULTERRABLE, HIGH LEVELS PROTECT YOU. THESE STORIES SHOW THAT ANIMALS IN A GROUP FIRST IN ISOLATION HAVE LOW LEVELS OF DOPAMINE RECEPTORS. ISOLATION IS EXTRAORDINARY STRESSFUL FOR PRIMATES AND IT DOWN REGULATES DOPAMINE T-2 RECEPTORS. IF YOU PUT THESE CREATURES INTO AN ENVIRONMENT THAT IS GROUP HOUSED, IF THE ENVIRONMENT IS NOT STRESSFUL LIKE IF YOU'RE A DOMINANT RECEPTOR UP REGULATE SO YOU DO AN INTERVENTION THAT ACTUALLY REVERSES A FACTOR THAT WAS MAKING ANIMALS VULNERABLE FOR ADDICTIVE BEHAVIORS. PUT THE SAME ANIMALS IN A ENVIRONMENT THAT'S STRESSFUL SUCH AS BEING A SUBORDINATE, STRESSFUL TO BE A PRY MITT SUBORDINATE THAT FURTHER -- PRIMATE SUBORDINATE, EXACERBATING THE VULNERABILITY FOR DRUG TAKING SO BIOLOGICALLY WE HAVE NOW BEEN ABLE TO IDENTIFY SOCIAL ENVIRONMENTAL INTERVENTION WHETHER YOU ARE DOMINANT STRESS VERSUS ENHANCES IN THE EXPRESSION OF A PROTEIN BRAIN THAT MODULATE YOUR VULNERABILITY FOR DRUG TAKING. ACTUALLY DISCUSS ALSO SHOWN TO BE THE CASE, DEPENDING OF SOCIAL SUPPORT STRAWING THAT CAN MODULATE THE LEVELS OF DOPAMINE D-2 RECEPTORS YOU HAVE IN YOUR BRAIN. WE NOW HAVE THE TOOLS TO START DO TO INTERROGATE THE IMPORTANT DIALOGUE BETWEEN ENVIRONMENT AND BIOLOGY ON THE ONE HAND AND THE MI TO SHOW YOU THOSE CONNECTIVITY PATTERNS, ANSWER IMAGING THAT ALLOWS YOU TO LOOK AT THE STRUCTURE BETWEEN ONE AREA OF THE BRAIN AND THE OTHER AND WHAT THEY SHOWED HERE WAS THEY WERE COMPARING ACTIVITY OF A PATHWAY THAT LEADS THE FRONTAL CORTEX WITH THE LIMBIC BRAIN IN INDIVIDUALS THAT HAD BEEN GREAT (INAUDIBLE) SOCIAL DEPRIVATION ENVIRONMENT VERSUS THOSE THAT DO NOT. TO ASSESS THE TIME THEY SPENT IN TERMS INFLUENCE THE CONNECTIVITY OF THIS PATH. AND WHAT THEY HAVE SHOWN IS CONNECTIVITY OF THE FRONTAL CORTEX WITH LIMBIC BRAIN WAS UNDERDEVELOPED, IN THESE KIDS RAISING IN (INAUDIBLE) AND DISRUPTION IN THE PATHWAY WAS BASICALLY DIRECTLY RELATED TO THE MONTHS THEY HAVE SPENT IN THE OR FANNAGE SO WE HAVE TOOLS. WE HAVE THE TOOLS TO EXPLORE THIS SPACE. IN THE MEANTIME, WHY NOW? WE HAVE TOOLS BUT WHY NOW EXACTLY? WHY THE URGENCY? IT RELATES TO CHANGES THAT ARE HAPPENING IN OUR COUNTRY AND ONE OF THEM THAT I DO WANT TO HIGHLIGHT BECAUSE IT'S RELEVANT FOR ADOLESCENTS AND VERY RELEVANT FOR MINORITIES POPULATIONS THAT HAVE ANY ASSOCIATED WITH RATE OF RISK NOT JUST TAKING DRUGS BUT MORE POSHLY GREATER RISK OF ADVERSE CONSEQUENCES. WE ARE LEGALIZING MARIJUANA THROUGHOUT THE UNITED STATES WHETHER IT IS FOR RECREATIONAL OR MEDICAL PURPOSES. IT IS BECOMING INCREASINGLY EASIER TO GET ACCESS BUT MORE IMPORTANTLY EASIER TO GET ACCESS TO IS THAT THE NORMS OF VIEWING MARIJUANA AS A DRUG THAT IS NOT HARMFUL ARE DRAMATICALLY CHANGENING OUR COUNTRY AND THEY HAVE CHANGED OVER THE PAST FIVE YEARS. EVEN THOUGH THERE'S NO DATA TO SHOW THAT MARIJUANA IS NOT HARMFUL OVER THE PAST FIVE YEARS, WE HAVE SEEN MYONORTY BELIEVING IT WAS HARMFUL TO MAJORITY IN THE UNITED STATES. THIS RELATES TO STRONG ADVERTISEMENT AND ATTENTION IN THE MEDIA AND LOBBYING FOR ACTUALLY THE LEGALIZATION OF MARIJUANA IN ORDER TO BE ABLE TO GET MORE TAXES, BUT ALSO CRITICIZING THE FACT THAT MARIJUANA LAWS ARE PUTTING MINORITIES IN TO PRIA AND JAIL -- PRISON AND YALE WHICH IS VERY CORRECT BUT THE ISSUE IS NOT -- THE SOLUTION IS NOT LEGALIZATION, THAT WILL ALLOW SELLING OF DRUGS THE ISSUE IS ONE OF DECRIMINALIZING. ALL THESE DIALOGUES ARE VERY MUCH CONFUSING IN THE WHOLE PERSPECTIVE OF AMERICAN CITIZEN, THERE IS CHANGING ATTITUDES AND NORM AND THAT INFLUENCES BEHAVIOR. ONE FACTOR THAT IT INFLUENCES BEHAVIOR ARE LAWS SO SOMETHING IS EVEN ELSE THINKS THIS IS A GOOD THING, IT DOESN'T CAUSE YOUR HARM, IT DECREASES THE LIKELY HAD YOU ENGAGE IN BEHAVIORS. SO WE SEE POLICY CHANGES HAPPENING. I SHOW YOU THE DATA THAT RELATES TO MARIJUANA CONSUMPTION, THAT IS PROBLEMATIC TESTIMONY MARIJUANA H THAT RELATES TO REGULAR USE, BASICALLY ALMOST EVERY DAY. AND IF YOU LOOK AT ANIMAL EXPERIMENTS OR IN HUMAN EXPERIMENTS THESE MARIJUANA CONSUMPTION LINKED WITH WORSE OUTCOMES. SO IN TERMS OF IN YOUR LAB THERE IS A GRAPH THAT SAYS DAILY MARIJUANA VERSUS 20 DAYS, YOU CAN SEE IT HAS BEEN INCREASING SINCE 2008. SEVEN YEARS VERY SIGNIFICANT DECREASES, AT LEAST 50% DECREASES IN THE REGULAR USE OF MARIJUANA. FROM INDIVIDUALS OR OLDER TO HAVE THE DIFFERENT DATA FROM DIFFERENCE COHORT, 48,000 KIDS A YEAR SURVEY FOR USE PATTERN SO MARIJUANA AND OTHER DRUG, THERE YOU HAVE VIS-A-VIS THEIR BELIEF THE NUMBER OF KIDS THAT BELIEVE MARIJUANA IS HARMFUL. YOU SEE ALMOST IN OUR -- IN THE UNITED STATES IN OUR HIGH SCHOOLS 6% OF KIDS ARE USING MARIJUANA REGULARLY. THAT PATTERN THAT LEADS TO DAILY MARIJUANA USE IS BASICALLY NARROWED BY THE NEGATIVE PATTERN OF PERCEPTION OF RISK. SO MORE KIDS BELIEVE MARIJUANA IS HARMFUL YOU HAVE LOWER USES OF MARIJUANA LIKE IN 1991. AND AS YOU HAVE LESS KIDS BELIEVING MARIJUANA IS HARMFUL YOU SEE HIGHER PATTERNS. INDEED IT LOOKS LIKE REGULAR MARIJUANA USE IS GOING UP IN THE UNITED STATES. PERCEPTIONS OF RISK ARE GOING DOWN. THAT'S CORRECT BUT YOU CAN TAKE A LOOK AT WHAT HAPPENED, IT'S STILL NOT AS BAD AS IT WAS IN 1979. SO VERY INTERESTING HIGH RATES OF REGULAR USE OF MARIJUANA. BUT THE MARIJUANA IN 1977 WAS 2%, MARIJUANA LOOKS -- THAT DIFFERENCE IN CONTENT MAKES ALL THE DIFFERENT, ADDICTIVENESS VIS-A-VIS ALSO ADVERSE CONSEQUENCES SO I'M NOT GOING TO GO THERE ARE O THAT, I'M GOING TO CONCENTRATE IS MARIJUANA HARMFUL TO THE ADOLESCENT BRAIN BECAUSE TEASE THAT'S WHERE WE'RE LIKELY TO HAVE ADVERSE EFFECTS. MULTIPLE STUDY VERSUS SHOWN IF YOU ARE A MARIJUANA USER YOUR LIKELIHOOD OF COMPLETING SCHOOL OBTAINING A DEGREE IS MUCH LOWER. SO THIS REPLICATED MULTIPLE TIMES BUT SELECTING A PAPER THE MOST RECENT PAPER OF 2014 LARGE COHORT OF INDIVIDUALS THAT DOES REFULLY KATE AND THERE IS A DOSE EFFECT. IF YOU ARE A REGULAR DAILY USER YOUR LIKELIHOOD OF FINISHING SCHOOL IS BASICALLY HALF. DEGREE ATTAINMENT IS DRAMATICALLY -- I WANT TO EMPHASIZE, THIS SOMETHING THAT WE NEED TO BE PAYING ATTENTION TO. WHETHER IT NOT GOING TO HARM OR NOT, THE DATA ARE SHOWING THAT IT'S GOING TO INTERFERE WITH PERFORMANCE AT SCHOOL. THE OTHER ONE REPLICATED IS USE OF MARIJUANA REGULARLY ALSO INCREASES THE LIKELIHOOD OF BECOMING ADDICTED AGAIN. MORE YOU USE DRUGS THE MORE YOU LIKELIHOOD BECOMING ADDICTED BUT ALSO INCREASES THE RISK FOR BECOMING ADDICTED TO OTHER DRUGS THAT ALSO HAVE BEEN DOCUMENTED BY MANY OTHER INVESTIGATORS. WHAT HAPPEN HAS NOT BEEN DOCUMENTED ON TO MY -- THIS IS THE FIRST TIME RECOLLECTED IS INCREASE SIGNIFICANTLY THE RISK OF SUICIDE ATTEMPT. THIS ALERTED ME, I PRESENT IT BECAUSE THEY PUBLISH IT IN THE LANSETT WHICH IS VERY PRESTIGIOUS BUT IT'S THE FIRST TIME AND OBVIOUSLY JUST SHOULD ALERT US AND IT NEEDS REPLICATION BUT WE CANNOT IGNORE A FINDING LIKE THIS ONE. ANOTHER STORY WE CANNOT IGNORE WAS PAIN HE WERE PUBLISHED AT THE NIH 2012 ON AGAIN LARGE COHORT, 1,000 INDIVIDUALS FOLLOWED PROSPECTIVELY WITH MEASUREMENTS OF -- BEFORE DRUG INTAKE AND THEN ALSO SHOWING THAT THOSE THAT REGULARRY USE MARIJUANA DURING ADDRESS SENTS BUT NOT DURING ADULTHOOD HAVE A SIGNIFICANTLY IN DECREASE THE IQ. WHEN YOU LINK THIS WITH STUDIES SHOWING WHEN YOU USE MARIJUANA DURING ADOLESCENTS, SHOWING CHANGES IN CONNECT ACTIVITY THIS THESE TWO AREA, ONE IS THE HIPPOCAMPUS WHICH IS VERY IMPORTANT NOT JUST FOR MEMORY BUT ALSO FOR MODULATING STRESS RESPONSES THERE IS 80 TO 90% REDUCTION IN FIBER DENSITY SO NOT -- IT'S A HUGE EFFECT. SAME THING ON THE (INAUDIBLE) WHICH IS WHAT THE HELL IS -- SOME PEOPLE DON'T KNOW WHAT (INDISCERNIBLE) STUDIES IN ALZHEIMER'S DISEASE, EVERYBODY HAS BECOME VERY INTERESTED IN (INAUDIBLE). IT HAPPENS THE (INDISCERNIBLE) IN THE POSTERIOR PARIETAL CORTEX, IT'S ONE OF THE MANY HUMPS OF THE BRAIN, IT'S NETWORK, THE BRAIN IS A NETWORK SO YOU THINK ABOUT NETWORKS LIKE AIRPORTS, SOME OF THE MAIN HUNDREDS SAY CHICAGO, PERHAPS DALLAS. WHAT HAPPENS WHEN THOSE HUNDREDS BREAK? OR CLOSE, YOU CREATE PANNED UPON YUM. SO WHEN YOU CREATE PANDEMONIUM, THAT'S ONE OF THE FIRST REGION IF NOT THE FIRST REGIONS THAT SHOW ABNORMALITIES IN PATIENTS WITH ALZHEIMER'S DISEASE. THESE SHOWN ON ACTIVITY OF THE BRAIN REGION CAN DIRECTLY PREDICT IN PATIENTS WITH (INDISCERNIBLE) LEVEL OF CONSCIOUSNESS. SO WHAT ARE THE CONSEQUENCES REALLY OF IMPAIRING THE CONNECTIVITY OF THESE BRAIN REGIONS THAT IS COMMUNICATING WITH THE REST OF THE BRAIN? YOU CAN FORESEE THEY ARE LIKELY HAS BEEN SIGNIFICANT. FOR IMAGING STUDIES ARE LARGE BUT IN TERMS OF CREATING AND CONSOLIDATING THE DATA THEY ARE ALERTING US BUT THEY OF COURSE NEED REPLICATION. THEY DID SHOW THAT YOUNGER YOU ARE WHEN YOU INITIATE MISH WHATNA THE WORSE THE CONNECTIVE ITY PATTERN IN THESE TWO REGIONS SO THIS HIGHLIGHTS WHY ABCK. WE HAVE TOOLS, WE HAVE EVIDENCE SMOKING MARIJUANA IS NOT GOOD FOR YOUR TREATMENT, IT'S ALSO NOT GOOD FOR INTELLECTUAL ABILITY AND THE BRAIN THE WORK IS CONNECTED. IN THE MEANTIME WE ALSO KNOW THAT THE ADOLESCENCE IS NOT JUST MARIJUANA, ADOLESCENTS TAKE ALCOHOL, DRINK EXCESSIVELY, SMOKE CIGARETTES. CAN YOU BELIEVE THAT NICOTINE HAS BEEN AROUND FOR HOW MANY YEARS WE DONE REALLY ACTUALLY KNOW HOW NICOTINE AFFECTS THE ORGANIZATION AND THE FUNCTION OF THE ADOLESCENT BRAIN. WE DON'T KNOW. THERE ARE SOME STORIES HERE AND THERE FOR COCAINE, HERE AND THERE FOR MARIJUANA AND ALCOHOL. MOST CAME FROM ALCOHOL BUT IT FEELS LIMITED. THIS IS WHAT LED US TO SAY WE NOW HAVE THE TECHNOLOGY. DON'T DON'T WE OWE IT TO THE PUBLIC TO PROVIDE THE EVIDENCE IN AN OBJECTIVE WAY TO ENABLE SOMEONE MAKING POLICY OR PARENT OR ADOLESCENT OR TEACHER TO KNOW EXACTLY WHAT DRUGS ARE COOING OR NOT DOING ON THE DEVELOPING BRAIN. NOW WE HAVE TOOL, LET'S PROPOSE A STORY THAT IS SUFFICIENTLY SAMPLED SUCH THAT DATA HAS THE POWER THE ADDRESS QUESTIONS. HOW DO DRUG EXPOSURES INFLUENCE THE INDIVIDUAL BRAIN TRAJECTORIES FROM A CHILD AS IT TRAN SIGNATURES TO ADULTHOOD AND HOW THAT'S RELATED TO FACTORS SUCH AS SOCIAL ENVIRONMENTS, POW HAO IT RELATES TO MENTAL ILLNESS, HOW THOSE CHANGES INDIVIDUAL TRAJECTORIES IN BRAIN DEVELOPMENT, ULTIMATELY PREDICT BEHAVIORS. IN MY BRAIN IS A NO BRAINER. FOR YEARS AND YEARS AND YEARS AND YEARS, I ACTUALLY WHILE I WAS A CHILD, I WOULD GO TO THE PEDIATRICIAN AND THEY WILL WEIGH ME AND HEIGHT AND ALL THESE AND THE PEDIATRICIAN WILL SPEAK WITH MY NOTHER, YOU KNOW, YOUR CHILD IS THIS OR THAT STANDARD DEVIATION BELOW OR ABOVE THE CURVE. WOULDN'T IT BE EXTRAORDINARY THAT WE WOULD HAVE A STANDARD ABOUT DEVELOPMENTAL TRAJECTORIES ARE? WHAT DETERMINES THE DIFFERENCE? HOW THIS INFLUENCE, HOW CAN WE ACTUALLY ACCELERATE THOSE PROCESSES WE SEE THAT THEY ARE DECREASED WITHOUT A MAP AND A STANDARD OF WHAT THAT IS, WE CANNOT DO IT. AGAIN, WE HAVE THE TOOLS. WHAT MORE IMPORTANT PROJECT TO DO THAN TO ACTUALLY FOCUS AND PROVIDE INFORMATION BETTER TRANSITIONS ASSOCIATED WITH A LOT OF MORBIDITY IN A PERIOD OF LIFE WHERE YOU ARE AT YOUR TOP OF HEALTH. THAT IS WHY WE JOIN FORCES AMONG MULTIPLE INSTITUTES AND SAID LET'S DO IT. THAT IS HOW THE ABCD STUDY WAS BORN. ADOLESCENT BRAIN COGNITIVE DEVELOPMENT, NATIONAL LONGITUDINAL STUDY. MULTIPLE INSTITUTES INCLUDING THE NIMHD THAT WE HAVE HIGHLIGHTED THERE BECAUSE THESE FUNDAMENTAL FOR MINORITIES AN DISPARITIES. WE WANT TO GIVE THAT GREATER LIKELIHOOD. TO DO SOCIAL INTERVENTIONS. THAT MAKE A DIFFERENCE. QUESTION NEED TO UNDERSTAND WHAT WE'RE LOOKING AT AND THE BRAIN IS CRUCIAL AND FUNDAMENTAL IN HELPING IMPROVE OUTCOME, NOT JUST FOR MENTAL DISORDERS. BUT HEALTH OUTCOMES IN GENERAL. THE STORY PROPOSES THE TEN YEARS LONGITUDINAL STUDY, 10,000 CHILDREN TO ASSESS EFFECT OF DRUGS ON INDIVIDUAL BRAIN TRAJECTORIES AND OTHER RELEVANT ENVIRONMENTAL STIMULI. THE WAY THIS PROJECT WAS CONCEIVED, FOLLOW DIFFERENT STAGE,FIRST BRING EXPERIMENT PANEL WORKSHOP OF SCIENCETISES THAT ARE EXPERTS ON IMAGING IN PROSPECTIVE STUDY DELAWARE SIGN, FEN TYPE I CHARACTERIZATION ON INDIVIDUAL CHARACTERIZATION OF ENVIRONMENT, THAT DESIGN THE MAIN STRUCTURE OF THE PROPOSE STUDY. THAT PROPOSE STUDY PUT FORWARD REQUEST FOR INFORMATION FROM JULY, AUGUST. WE GOT MORE THAN 200 RESPONSES MANY FROM GROUPS AND ORGANIZATIONS. BUT SUMMARIZE AND MODIFY PROPOSE ACCORDINGLY AND PRESENTED THAT INTO A SATELLITE SYMPOSIUM AT NEUROSCIENCE AND GETTING IN INVESTIGATORS. THEN WE HAVE FUNDING OPPORTUNITY ANNOUNCEMENT RELEASED FEBRUARY 2015 THAT YOU SEE HERE. ISSUE FEBRUARY 4, QUEUE MARCH ST. AND APPLICATION DUE DATE IS APRIL 14, 2015. THE CHALLENGES AHEAD ARE -- IS GOING TO BE THE LARGEST PROSPECTIVE STUDY EVER DONE ON ADOLESCENTS, IS NOT GOING TO BE ONLY INCLUDING PERIODIC BRAIN AIM IMAGINING, AS IMPORTANT AND MORE COMPLEX AND DIFFICULT IS HOW YOU DO A PROPER PHENOTYPIC CHARACTERIZATION OF CHILDREN TRANSITIONING TO ADULTHOOD. AS DIFFICULT, HOW DO YOU A A PROPER REQUIREMENTAL CHARACTERIZATION WITH STRONG OF EMPHASIS OF SOCIAL SUPPORT OR STRESSORS THAT IS MEANINGFUL WITHOUT OVERWHELMING THE SYSTEM. AND THE LOT OF CHALLENGES ARE GOING TO BE BASICALLY NOT -- I THINK THAT'S LIKELY ONE OF THE SIMPLEST ONE, ON CHARACTERIZATION OF VICTIMS AND THEIR ENVIRONMENTS AND OTHER CHALLENGES TONE SURE THE -- TO ENSURE THE -- THAT YOU DON'T LOOSE PARTICIPANTS AND HOW DO YOU IN YOUR PARTICIPANT RECRUITMENT HOW DO YOU ENSURE THAT THE SAMPLES IS A SAMPLE THAT WILL BE REPRESENTATIVE. THESE ARE CHALLENGES AHEAD OF US BUT IT'S NOT SOMETHING THAT WE HAVE NOT SEEN BEFORE. WE CAN GO ON AND ON AND OBSESS ABOUT THE PERFECT STUDY OR BEST EFFORTS, LET'S INVOLVE THE SCIENTIFIC COMMUNITY AND CREATE AN OPEN ACCESS PROJECT. THAT WILL HAVE FLEXIBILITY TO INCORPORATE ADVANCES AS THEY DEVELOP AND EMERGE INCLUDING JUST NOT JUST GENETICS BUT EPIGENETICS BUT EVEN NEW DISCIPLINES EVOLVING THAT ARE FUNDAMENTALLY IN OUR QUERY OF THAT INTERACTION BETWEEN BIOLOGY AND ENVIRONMENT AS WELL AS (INAUDIBLE) THE EPITRANSCRIPTOMICS SO NOW I HAVE BECOME A DEFENDER OF THE EPITRANSCRIPTOMICS. THAT'S WHY I BRING IT UP HERE. WHY ALL OF THESE? BECAUSE WE WANT TO BE ABLE TO BE IN A POSITION TO HAVE THE BEST PREVENTION INTERVENTION THAT WE CAN HAVE. PREVENTION INTERVENTION NOT RELATE TO DECREASING SUBSTANCE USE DISORDERS BUT INTERVENTION THAT IMPROVE THE LIKELIHOOD FOR EACH ONE OF THOSE CHILDREN TO SUCCEED AS THEY TRANSITION TO ADULTHOOD. WE DON'T PAY ATTENTION TO BRAIN BUT SOCIAL ENVIRONMENT INCLUDING DRUG WE WILL NOT BE ABLE TO DO IT PROPERLY. AT THE SAME TIME FROM THE BASIC PERSPECTIVE OF SCIENCE THIS IS AN EXTRAORDINARY OPPORTUNITY TO GOAL INTO A PROCESS THAT IS FASCINATING, THOUSAND HUMAN BRAIN ULTIMATELY CONNECTS AND THOUSAND HA IS RELATED TO GENES. AND WHAT IS THE VARIABILITY BETWEEN ALL OF US. AND I THINK THAT THIS STUDY HAS POTENTIAL OF HELP L ADVANCE ALL OF THOSE AREAS OF SCIENCE. THANKS VERY M. [APPLAUSE] >> ANY QUESTIONS FOR DR. VOLKOW? >> THAT WAS TRULY POWERFUL PRESENTATION BUT I HAVE TO SAY IT WAS ACUTE LITER FEWING TO US WITH TEENAGERS AT HOME. BUT I HAVE A QUESTION OUT OF PURE CURIOSITY. I KNOW DRUGS ARE EVERYWHERE WHERE W THESE KIDS, WE HAVE TO WORRY EVERYWHERE BUT LOOKING AT THE DRUG PROBLEM OF THE INNER CITY, DOES POPULATION DENSITY HAVE ANY INDEPENDENT IMPACT ON VULNERABILITY OF THESE ADOLESCENT BRAINS? OR IS IT JUST THROUGH NEIGHBORHOOD ISSUES AND POVERTY THAT WE SEE THE BIGGER PROBLEM? >> BOTH OF THOSE FACTORS ARE INFLUENCING THE PATTERNS OF BEHAVIORS AND URBAN DENSITY DEPENDING ON CONDITIONS IT APPEARS CAN HAVE ADVERSE EFFECTS OR POTENTIALLY BENEFICIAL ONE. VERY MUCH DEPEN DEBIT OF THE SOCIAL STRUCTURES THAT CAN HELP SUPPORT INDIVIDUALS MOVE FORWARD OR NOT. POPULATION DENSITY IS NEGATIVE WHEN YOU HAVE EASY ACCESS TO DRUGS AND YOU DON'T HAVE ALTERNATIVE BEHAVIORS FOR ADOLESCENTS TO ENGAGE WITH WHERE THEY DON'T HAVE THE SOCIAL SUPPORT OF PARENTS OR EDUCATION OF SYSTEM TO CARRY THEM THROUGH. YOU HAVE VERY ADVERSE EFFECTS. BUT THE FACTOR IS NOT JUST SORT OF FOCUSED IN URBAN AREA, WE HAVE VERY SERIOUS PROBLEM OF DRUG USE IN OUR COMMUNITIES. FOR EXAMPLE, ALCOHOL USE CAN BE VERY DEVASTATING IN OUR COMMUNITIES. AND ALSO IMPORTANTLY FOR EXAMPLE THERE'S NEW EPIDEMIC OF INJECTION OF HER NGUYEN IN OUR COUNTRY THAT IS -- HEROIN IN OUR COUNTRY WHICH DIFFERENT THAN WE HAVE SEEN IN THE PAST INJECTION HEROIN WAS A DOMINANT OF OUABAIN CENTERS. NOW WE SEE IT IN RURAL COMMUNITIES. ALSO UNFORTUNATELY WE'RE ALSO SEEING OVER REPRESENTED IN AFRICAN AMERICANS SO AGAIN, YOU SEE THE VERY MUCH DEVASTATING EFFECT EFFECTS, IN COMMUNITIES THAT BECAUSE THEY ARE SOCIALLY MORE VULNERABLE YOU CAN INTERJECT DRUGS IN EASIER WAY SOCIAL SYSTEMS THAT HAVE PROTECTIVE FACTORS THAT DON'T ALLOW THEM. >> SO ARE THE TREATMENT PARAMETERS THAT ARE BEING DEVELOPED USING MANY OF THESE THINGS THAT WE HAVE LEARNED ABOUT THE ADDICTIVE BEHAVIOR IN ADOLESCENTS USED EFFECTIVELY NOW TO COUNT IRACT THINGS THAT YOU MENTION HERE TODAY AND MAKE ADOLESCENTS MORE SUSCEPTIBLE? >> IN THE AREA OF PREVENTION, THERE'S PREVENTION AN AREA OF TREATMENT. IN AREA OF PREVENTION UNFORTUNATELY THERE ARE MANY EVIDENCE BASED PREVENTION STRATEGIES THAT HAVE BEEN SHOWN NOT NOT TO DECREASE DRUG TAKING BUT ALSO HAVE WIDESPREAD EFFECT ON BEHAVIOR, RISKY BEHAVIOR LIKE SEXUALLY TRANSMITTED DISEASES AND IMPROVED PERFORMANCE AT SCHOOL. THE RATE OF LIMITATION IN THE SCHOOL SYSTEMS IS MINIMAL OR IN THE COMMUNITIES. SO THIS IS ONE OF THE ISSUES THAT I THINK WE NEED TO HIGHLIGHT THAT MANY TIMES WE DO HAVE THE TOOLS AND THAT CHALLENGE USING IMPLEMENTATION AND AS WE DISCUSS IN A LOT OF THESE ISSUES I THINK AREA OF SCIENCE, WE DO IDENTIFY AREA OF SCIENCE, SCIENCE OF IMPLEMENTATION, IS MORE THAN JUST SCIENCE SOMETIMES TO IMPLEMENT, BECAUSE IT DOES REQUIRE FOR A SOCIETY TO WANT TO INVEST THOSE RESOURCES. THAT'S FOR PREVENTION, SAME THING WITH TREATMENT INTERVENTIONS. WE KNOW FOR EXAMPLE THAT YOU ARE A CHILD THAT HAS UNABLE TO RESIST YOUR BEHAVIOR, AND HAS A LOT OF TIME IMPROPER SOCIAL SKILLS, YOU CAN DO INTERVENTIONS THAT IMPROVE THEM AND IMPROVE MANY OUTCOMES BUT AGAIN ACCESS TO THAT TYPE OF INTERVENTION IS VERY LIMITED. THAT'S THE ANSWER, YES WE HAVE THEM, THERE'S ROOM FOR IMPROVEMENT ABSOLUTELY. THE MAIN CHALLENGE WE HAVE IS WHEN NOT IMPLEMENTED. >> I LOVED YOUR PRESENTATION. FABULOUS PRESENTATION. THIS LOOKS LIKE A VERY STATIC MODEL. SO I DON'T SEE INTERACTIONS REALLY I HOPE YOU PUT INTO YOUR MODELING NOT ONLY LIKE STATIC CONCEPT AS POSITIVE RELATIONS OR ACADEMIC, MORE INTERACTIONS YOU TALK ABOUT HOUSING IT'S NOT THE HOUSING IT'S THE INTERACTIONS THAT HAPPEN WHEN YOU HAVE MORE PEOPLE LESS PEOPLE FOR EXAMPLE. SECOND, I DON'T SEE ANYTHING INSTITUTIONAL SUPPORTS WE TALK COMMUNITY SUPPORTS BUT I THINK INSTITUTIONAL SUPPORTS IS SOMETHING WE SHOULD LOOK SOMETHING MIGHT BE AND THE LAST THING, THE DIFFERENCE BETWEEN ON SET OF SUBSTANCE ABUSE AND PERSISTENCE, AND WHETHER THE MECHANISMS ARE THE SAME. >> THOSE POINTS ARE RELEVANT AND I KNOW ABSOLUTELY AS WITH RESPECT TO DYNAMIC MEASURES, THAT'S WHY I SAY PROBABLY THE HARDEST CHALLENGE IS GOING TO BE THE PHENOTYPIC CHARACTERIZATION OF ENVIRONMENT, AND THAT'S WHAT I WAS MEANING. WE WENT TO NOT WITH DEPARTMENT OF EDUCATION TO FIGURE OUT IF THEY WERE INTERESTED ON GETTING INVOLVED. BECAUSE THAT SCHOOL SUPPORT SYSTEM AS WELL AS INDIVIDUALS IN THAT SCHOOL, IS VERY VALUABLE SHOWN TO BE BENEFICIAL, THE OTHER WAY. THEY EXPRESS THERE, THEY CAN SUPPORT AT LEAST THEY WILL HAVE THAT SUPPORT FROM THE PERSPECTIVE FROM BEING ABLE TO ASSESS INFORMATION. LIKEWISE WE ARE DISCUSSING OPPORTUNITIES WITH OTHER AGENCIES, BUT WOULD YOU SPEAK ABOUT INSTITUTIONS WHAT SPECIFICALLY WERE YOU SPEAKING OF? >> FOR EXAMPLE, ONE OF THE THINGS WE HAVE SEEN CONSTANTLY, I WORK ARE HAVE A TREMENDOUS EFFECT ON LIKELIHOOD OF DEVELOPING A -- RELATED TO SUBSTANCE AND SUICIDE RELATED TO MANY, MANY THINGS. SO BEING A LUNCH PROGRAM OR NOT MIGHT BE VERY IMPORTANT IN TERMS OF THE DEVELOPING BRAIN. SO THAT'S AN INSTITUTIONAL SUPPORT. IT'S NOT A FAMILY SUPPORT, IT'S NOT A COMMUNITY SUPPORT, IT'S A POLICY THAT ALLOWS PEOPLE TO GET THAT. SO I THINK THAT'S THE SORT OF THING WE COULD BE LOOKING AT. THAT ONE THING THAT YOU MENTION TALKING ABOUT THIS IS -- WE HAVE A LOT OF STUDIES ON THE GROUND. MANY PEOPLE THAT YOU COULD ADD THAT DOSE OBSERVATIONS OF INTERACTIONS. Q. THIS WAS AN ISSUE, NOTION NOT WITHIN THE PERSPECTIVE OF THE INSTITUTION ITSELF BUT THAT PERSPECTIVE OF THE FAMILY AND THE INDIVIDUAL, THE NUTRITION COMPONENTS BEING ONE OF THE RELEVANT FACTORS THAT'S GOING TO HAVE TO BE EVALUATED. AND THERE'S ALL SORTS OF TECHNOLOGIES LIKE CELL PHONE TO ALLOW YOU TO QUANTIFY PRECISELY WHAT TYPE OF FOOD SOMEONE IS GOING TO BE TAKING. ONE ISSUE WE'RE GOING TO END UP BASED ON REALITY, WE ARE VERY SENSITIVE TO THE UNITED STATES, 30% OF THE KIDS WILL BECOME OBESE. THE NOTION OF OBESITY IN TERMS OF HOW DOES IT INFLUENCE TRAJECTORIES IS GOING TO EMERGE WHETHER WE LIKE IT OR NOT OR UNLESS WE CHANGE THE TRAJECTORIES BUT WE HAVE NOT SAID GOT IN TERMS OUR INSTITUTIONAL SUPPORT CAN HELP MODIFY PARAMETERS BUT ONE WE HOPE WILL EMERGE IS ONE OF THE THINGS THAT ERIC SAID, SAME THING FOR US, WE CANNOT PUT SO MANY THINGS INTO THE INCREASE RISK THAT IT FALLS OVER AND THE CHILDREN'S STUDY DID NOT HAVE TO BE STOPPED. SO THE WAY WE CONSTRUCT NOT TO FALL INTO THAT, I SAY AGAIN CHOOSING THOSE ENVIRONMENTAL PHENOTYPIC CHARACTERIZATION, THAT WE CAN DO TO EVERYONE OF THEM, IS FUNDAMENTAL. THE SAME TIME WE WANT TO GENERATE FLEXIBILITY. THIS IS A TEN YEAR PROBLEM TO BE ABLE TO SUPPORT TO SUPPLEMENT PROJECTS THAT MAYBE SPECIFICALLY DIET SPECIFIC QUESTIONS THAT MAY NOT BE INCLUDED ABOUT EVERYTHING. NUTRITIONALLY SO VERY RELEVANT ABOUT HOW THE BRAIN WORKS AND DEVELOPS THAT THESE WILL EMERGE IN A WAY THAT -- SO EACH KID WILL HAVE A DISEASE NOT AT THE LEVEL OF DETAIL THAT WE CAN SUPPLEMENT. SO THAT WE CAN HAVE THAT LEVEL OF DETHE TAIL SO WE CAN USE THAT INFORMATION AS FEEDBACK FOR THOSE MAKING POLICY. BECAUSE THIS IS ONE OF THE THINGS THAT WE WANT TO BE ABLE TO SHOW. THIS IS THE DATA, THIS IS NOT ME THINKING (INAUDIBLE) OR -- THIS IS WHAT IT DOES. THIS IS WHAT NICOTINE DOES. HOW IT RELATES TO MENTAL ILLNESS. WE WANT TO HAVE THE OBJECTIVE DATA SO THE POLICY MAKERS AND THE INSTITUTIONS THAT CAN MAKE DECISIONS OF WHAT MAKES SENSE BASED ON OBJECTIVE INFORMATION. Q. LOOK AT POPULATION OF HIV INFECTED ADOLESCENTS WHERE THERE'S ABOUT 70% DRUG USE INCLUDING ALCOHOL AND TOBACCO AND EASY ACCESS, WE LIVE IN SAN DIEGO. SO ACCESS TO METHAMPHETAMINE THROUGH THE BORDER. MY QUESTION WAS, WILL THE ENROLLMENT CRITERIA EXCLUDE CHILDREN WHO HAVE HIV OR OTHER CHRONIC CONDITIONS WHERE ILLNESS ITSELF MIGHT BE A RISK FACTOR FOR ELICIT DRUG USE? >> YES. AGAIN, FROM 10 TO 21 BUT A LOT OF COMMENTS WE GOT FROM THE SCIENTIFIC COMMUNITY WAS TO TRY TO GET YOUNGER AGE OF KIDS SO THEY ARE PRE-PUBESCENT. ONE REVENGES ALSO WAS TO EXCLUDE KIDS THAT HAVE A MEDICAL CONDITION THAT COULD AFFECT THE BRAIN FUNCTION. BUT WHAT WILL HAPPEN IS THERE WILL BE KIDS THAT DURING THAT TRANSITION WILL BECOME INFECTED. HIV INCIDENCE IS LOW FORTUNATELY BUT IS NOT SERAL SO SOME MAY BECOME INFECTED IN A 10,000 SAMPLE, I DON'T KNOW BUT WE WILL HAVE OTHER INFECTIOUS DISEASES, SEXUALLY TRANSMITED THAT WILL BE EMERGING. SO THAT, IT'S AGAIN THESE ARE GOING TO GET PERSPECTIVE SAMPLE AND WE WILL END UP ALSO HAVING SIGNIFICANT NUMBER OF KIDS THAT RECEIVE PSYCHOTHERAPEUTIC. 7 TO 9% RECEIVE SIMULANT MEDICATIONS IF BORN IN THE UNITED STATES SO WE WILL RECRUIT THEM WHERE THEY ARE NOT TAKING MEDICATIONS BUT THEY GROW, THEY MAY. (OFF MIC) >> HOW DO YOU DETERMINE WHETHER THE CHILDREN ARE USING DRUGS? >> VERY IMPORTANT QUESTION. ANOTHER ONE THAT RELATES TO WHAT IS THE RELIABILITY VIS-A-VIS ACTUALLY SOMEONE REPORTING DRUG USE? WE HAVE USED THE -- WE HAVE MULTIPLE RESEARCH FUTURE SAMPLES 48,000 KIDS WHERE YOU ASK THEM WHETHER THEY TAKE DRUGS OR NOT. HOW DO YOU KNOW THAT THEY ARE TELLING THE TRUTH? YOU NEVER KNOW 100%, IT'S LIKELY TO HAVE A CERTAIN LEVEL OF ERROR, THAT'S NUMBER ONE, BUT WHAT WE DO KNOW IS THAT THE CLOSE VERY INDEPENDENT SURVEY, THE PREVALENCE RATE ON THE CHANGES THROUGH EXTRAORDINARY SIMILAR INDICATING THAT EVEN THOUGH IT MAY NOT BE PERFECTLY ACCURATE, IT IS INDUSTRIAL, VALIDITY. RESEARCHERS HAVE SHOWN THERE IS A RELATIONSHIP CELL REPORTS AND POSITIVE DRUG URINE. THERE IS -- WE CANNOT INSERT -- IT IS NOT 100% ACCURATE. THAT IS DOING A STUDY LIKE THIS ONE THERE ARE UNCERTAINTIES THAT YOU'RE GOING TO BE FACING IN YOUR SAMPLE. >> YOU MENTIONED URBAN, RURAL. AND I WONDER THEREFORE ABOUT THE RESUBMISSION OF YOUR SAMPLES. >> I WAS ACTUALLY HOPING TO GET RESOURCES, WE ARE DOING THE STUDY RIGHT NOW WE HAVE BUDGET THAT IS VERY LOW, SUCH A PRIORITY THAT SAYS WE'LL DO IT NO MATTER WHAT BUT THAT LIMITS WHAT WE CAN DO. WE -- SO WE WANT, VERY LIKELILY BILIMIT OF OUR FUNDS THAT MOST OF THE STUDIES, MOST ARE GIVEN TO ACADEMIC CENTERS THAT HAVE ALREADY THE IMAGING CAPABILITIES AND ACCESS TO THE POPULATIONS. SO UNFORTUNATELY, WE HAVEN'T GOT -- WE WILL GET PROPOSAL IN -- UNFORTUNATELY I AM VERY CONCERNED THAT WE WILL END UP WITH URBAN POPULATION AND WE WILL BASICALLY, AND HAVE BEEN FROM DAY ONE DEMANDING THERE IS A WAY TO GET -- THERE'S GOING TO BE MINORITIES THAT WE'RE NOT ABLE TO REPRESENT PROPERLY. SO WE WERE HOPING THAT -- I'M SOMEONE THAT DOESN'T GIVE UP SO WE'RE TRYING TO GET SPECIFIC RESOURCES TO EXPAND OUR CAPABILITY. FOR EXAMPLE, THE QUESTIONS THAT WAS BROUGHT BEFORE IN TERMS OF AMERICAN INDIAN, IT WILL BE EXTREMELY IMPORTANT POPULATION, LOOKING TO TRY TO UNDERSTAND HOW THOSE SOCIAL ENVIRONMENTS THAT ARE GREAT DEPRIVATION INFLUENCE UNDER THEIR INDIVIDUAL TRAJECTORIES SO WE CAN LEARN HOW TO INTERVENE SO WE CAN LEARN HOW TO LEARN HOW TO INFLUENCE OUR BRAIN. [APPLAUSE] >> OKAY. WE'RE GOING TO TAKE A A BREATHER THEN WE'RE GOING TO HEAR OUR LAST SPEAKER FOR THE MORNING. WE'RE VERY EXCITED THAT DR. JAMES JACKSON IS HERE WITH US. AGAIN, HE IS NO STRANGER TO THE SCIENCE OF HEALTH DISPARITIES. DR. JACKSON IS THE DISTINGUISHED UNIVERSITY PROFESSOR OF PSYCHOLOGY AND DIRECTOR OF THE INSTITUTE FOR SOCIAL RESEARCH AT THE UNIVERSITY OF MICHIGAN. AND WE KNOW ABOUT THE MANY AWARDS AND MANY ACHIEVEMENTS THAT HE'S HAD, THROUGHOUT HIS CAREER BUT THOSE HERE AT NIH LOVE HIM FOR OTHER REASONS INCLUDING THE FACT HE SERVED ON MANY ADVISORY BOARDS INCLUDING NATIONAL INSTITUTE ON AGING COUNSELOR, BOARD OF SCIENTIFIC COUNSELORS AND NATIONAL INSTITUTE OF MENTAL HEALTH COUNCIL, HE SERVED ON THE ADVISORY ECONOMY ECONOMY TO THE DIRECTOR OF NIH AND HAS A NUMBER OF NATIONALLY RECOGNIZED AWARDS. WE WANTED TO HAVE AN OPPORTUNITY FOR ALL OF US TO HEAR HIM IN THE SAME ROOM TOGETHER AS WE PREPARE OURSELVES FOR THE VISIONING SESSION AFTER LUNCH. WITHOUT ANY FURTHER INTRODUCTIONS I'M GOING TO ASK JIM TO COME DOWN AND GIVE US HIS TAKE ON SOME OF THIS AND GIVE US A FEW MINUTES MAYBE TO ASK HIM A COUPLE OF QUESTIONS. THANK YOU, JAMES. >> THANK YOU VERY MUCH, DR. MEADOWS. MY THANKS TO THE COUNCIL FOR GIVING ME AN OPPORTUNITY TO SPEAK WITH YOU. YOU ASKED LAURA VERY DIFFICULT QUESTIONS I HAVE A BIG STORY TO TELL. AND IT'S VERY PERVERSE STORY. SO PROBABLY IF I GIVE YOU AN OPPORTUNITY YOU WILL HAVE EVEN MORE QUESTIONS, TO ASK. THIS IS A VERY LARGE STORY. WE WON'T BE ABLE TO DIG IN TO EACH AND EVERY ONE OF THE SLIDES I WANT TO LAY THIS OUT. IN TERMS OF WHAT IT LOOKS LIKE. YOU HAVE TO TRUST ME A LITTLE BIT WITH REGARD TO WHAT THE SLIDES LOOK LIKE. SO SO WE TALK ABOUT THIS AS THE ENVIRONMENTAL AFOR DANCES MODEL, AS A WAY TO TRY TO UNDERSTAND, DISPARITIES WE OBSERVE AMONG RACIAL ETHNIC GROUPS IN THE UNITED STATES. SO WHAT BECOMES CLEAR AS I TALK IS THAT I THINK ONE OF THE BIG PROBLEMS WITH RESEARCH ON DISPARITIES IS THAT WE HAVE NO CONCEPTUAL MODEL OF HOW THOSE PARTICULAR DISPARITIES EMERGE. AS WILL BECOME CLEAR WHETHER THE MODEL I'M GOING TO TALK ABOUT RIGHT OR WRONG IS A FRAMEWORK WHICH WE CAN GENERATE HYPOTHESES THAT INDEED ALLOW US TO TEST PREKICK FROM THOSE AND IF CONFIRMED OVER LONG ENOUGH PERIOD OF TIME, MAY TELL US SOMETHING ABOUT WHERE THESE DISPARITIES COME FROM. SO NORA IS NOT HERE LONGER BUT I WANT TO THANK THE NATIONAL INSTITUTE OF DRUG ABUSE FOR SOMETHING TOTALLY DIFFERENT. WE HAVE A TOTALLY DIFFERENT LINE OF RESEARCH RELEVANT TO THIS, THEY FUNDED WHICH LOOKS AT MODELS FOR SEPARATING THE EFFECT OF RACE OR RACIAL GROUP MEMBERSHIP FROM THE EFFECTS OF ETHNIC GROUP MEMBERSHIP AND THAT RESEARCH IS GOING EXTREMELY WELL , LAST FEW YEARS, BUT THEY FUNDED QUITE A BIT OF THIS RESEARCH, I'M GRATEFUL THE NATIONAL INSTITUTE OF MINORITY HEALTH DISPARITIES BECAUSE IT'S THEIR FUNDING WHICH HAS LED TO THIS PARTICULAR MODEL COMING TOGETHER. PARTICULARLY FOR INTEGRATIVE DISPARITIES AT THE UNIVERSITY OF MICHIGAN. THERE'S A CAST OF THOUSANDS, THIS IS NOT AND I STORY OR ME STORY. THIS IS A STORY ABOUT A LOT OF VERY GOOD POST DOCS, GRAD STUDENTS AND OTHER COLLEAGUES WHO WORK ON THIS STUDY. WE HAVE QUITE A FEW PUBLICATIONS THAT HAVE COME OUT OF THE PEOPLE THAT YOU SEE LISTED HERE. I WAS GOING TO RUN H DOWN, VICE PRESIDENT QUAIL SAID IN MIND TERRIBLE THING GOT MIXED UP TERRIBLE THING TO LOSE, THE MIND IS A TERRIBLE THING TO WASTE, UNITED NEGRO COLLEGE FUND, WHAT THIS TALK IS ABOUT TODAY IS VINDICATING VICE PRESIDENT DAN QUAIL, BECAUSE ACCIDENTLY HE GOT IT RIGHT. IN MY CORE SET OF ISSUES IS THE FACT THAT WE HAVE NOT INSERTED INDIVIDUAL AND GROUP MOTIVATION INTO WAYS WE CAN THINK ABOUT HEALTH DISPARITIES AND THE NOTION WITH REGARD TO THE REGARD THE MIND A TERRIBLE THING TO LOSE GETS TISSUE GOING. THIS WAS IN THE NEW YORK TIMES, WHY IS IT THAT PEOPLE CONTINUE TO CONSUME SALTY FATTY OTHER KINDS OF FOODS WHEN WE ACTUALLY KNOW THAT THEY'RE NOT GOOD FOR US. THESE HAVE INCREASED OVER TIME. WHY ARE EPIDEMICS OF DIABETES AND OBESITY OUT OF CONTROL? IN FACT, IN HEALTH AFFAIRS REPORT AD COUPLE OF YEARS AGO THAT FOR ALL THE WORK THAT WE HAVE DONE TO TRY TO REDUCE DISPARITIES, OVER THE LAST 20 YEAR PERIOD DISPARITIES HAVE ACTUALLY INCREASED. THEY INCREASE EVEN THOUGH MILLIONS AND MILLIONS AND MILLIONS OF DOLLARS HAVE BEEN SPENT. MY ARGUMENT IS WE GOT THE MODELS WRONG AND WE HAVE TO CORRECT THAT. THE MODEL I'M GOING TO SHOW YOU IS THE RIGHT ONE OR NOT I DON'T KNOW BUT WE HAVE TO GIN TO THINK ABOUT THE FRAMEWORKS BECAUSE WE WE'RE NOT GETTING ANYWHERE WITH THE CURRENT MES NOW. WE'RE SPENDING A LOT OF MONEY AND SPINNING OUR WHEELS SO THE BROAD DIMENSION TO TALK ABOUT, THE CULPRIT THAT IS REALLY IMPORTANT IN IN THIS WHOLE THING IS CHRONIC STRESS. CHRONIC STRESS HAS BEEN OVERLOOKED AS A MAJOR ELEMENT WITH REGARD TO OBSERVED DISPARITIES THAT WE SEE AMONG RACIAL ETHNIC GROUPS. THERE ARE RACIAL DIFFERENCES IN MATERIAL WELL BEING, DISPARITIES IN PSYCHIATRIC HEALTH THOUGH NOT NECESSARILY WHAT YOU MIGHT THINK. THE ROLE OF MEATVATION SELF-REGULATION AND OTHER PSYCHOLOGICAL PROCESSING HEALTH IS IMPORTANT. I WANT TO END UP WITH SOMETHING WHICH IS REALLY STRANGE AT THE END, IT'S WHAT I CALL THE MASQUERADE OF RACIAL GROUP DIFFERENCES THE POINT I WANT TO MAKE SHEER IS THAT NOT -- HERE IS NOT ALL RACIAL GROUP DIFFERENCES ARE REALLY ABOUT RACIAL DIFFERENCES AMONG GROUPS. I'M GOING TO HOPEFULLY WE CAN GET TO THAT BEFORE THE END OF MY TALK. THIS JUST MAKES THE POINT THAT WHEN WE DECIDED THAT RATES UNDER TREATMENT WITH THE WAY WE UNDERSTAND RACIAL AND ETHNIC DIFFERENCE, ALL WAS RIGHT WITH THE WORLD. BECAUSE AS THIS FIGURE SHOWS, AFRICAN AMERICANS HAD HIGHER RATES OF ADMISSION TO MENTAL HEALTH FACILITIES THAN DID WHITES. THIS ALL WENT TO HELL. WHEN WE STARTED DOING REVENUE LENS RATES IN TERMS OF HOUSEHOLD SURVEYS, I LOVE THIS GRAPH FROM THE ECA STUDY, THIS SET IN A BOOK FOR 15 YEARS. WHAT THIS SHOWS IS THE RATE OF DEPRESSIVE DISORDER IS HIGHER AMONG NON-HISPANIC WHITES THAN IT IS AMONG AFRICAN AMERICANS. IN FACT AS I WILL SHOW YOU IN A FEW MINUTES F THIS SHOWS THAT RATES OF LIFETIME ALCOHOL DISORDERS ARE ALSO HIGHER FOR AFRICAN AMERICANS. IT'S LOW IN EARLY YEARS, NORA WAS MAKING THE POINT ABOUT ADOLESCENTS,LY SHOW YOU COUNTER DATA TO THAT IN A FEW MINUTES WHICH IS REALLY QUITE INTERESTING. LOOK AT THE LEFT AND WHAT YOU SEE IS THAT OVER THE LIFETIME AFRICAN AMERICAN RATES OF ALCOHOL DISORDERS INCREASE WHILE FOR WHITES IT DECREASES. THIS IS NOT I THINK A COHORT EFFECT, WE LOOKED AT THIS A LOT, THESE ARE REAL DIFFERENCES AND WE THINK IT'S BECAUSE OF WHAT HAPPENS OVER THE LIFE COURSE AND WE THINK IT HAS TO DO WITH STRESS. SO SOCIAL INEQUALITY, I CAN SHOW YOU 5,000 SLIDES ABOUT THIS ONE. PLENTY OF WORK. OTHERS HAVE SHOWN ME THAT. WE KNOW A LOT OF DATA, THIS IS FIVE YEAR MELANOMA SURVIVAL, THOUGH THESE RATES ARE LOW FOR AFRICAN AMERICANS NOTICE THAT SURVIVAL RATES ARE MUCH BETTER FOR WHITES THAN THEY ARE FOR AFRICAN AMERICANS. I CAN SHOW YOU LOTS AND LOTS OF THESE PARTICULAR GRAPHS, THEY ALL MAKE THE SAME POINT, DESCRIPTIVELY, FOR ETHNIC AND RACIAL MINORITIES DISPARITIES IN PHYSICAL HEALTH ARE WORSE THAN THOSE OF NON-HISPANIC WHITES. HOW DOES THIS OPERATE? THE MODEL WAS A GOOD ONE TO PICK ON BECAUSE HE'S IN ENGLAND. I CAN PICK ON OTHER PEOPLE IN THE UNITED STATES, I WON'T DO THAT BECAUSE THEY CAN SPOT OUT WHERE I LIVE. BUT HE MAKES A POINT THAT POWER SOCIAL PARTICIPATION, SOCIAL ENVIRONMENT BEHAVIOR IN EARLY LIFE REALLY ARE LINKED TO WHAT WE OBSERVE IN TERMS OF DISPARITIES. AND THIS PARTICULAR MODEL WHICH I KIND OF LIKE TO PICK ON STARTS THE LEFT-HAND SIDE, EVENT WAITENING THE PATHOPHYSIOLOGICAL CHANGES AND EFFECTS WELL BEING, MORTALITY AND MORBIDITY. THE INTERESTING THING ABOUT THIS MODEL SIT HAS TO BE RIGHT. IT'S JUST NO DOUBT ABOUT IT. ALL THESE THINGS ARE GOING TO INFLUENCE WHAT THE OUTCOMES ARE. THAT'S NO DOUBT ABOUT IT. THE PROBLEM WITH THIS PARTICULAR MODEL IS THAT YOU CANNOT DERIVE HYPOTHESES AND PREDICTIONS FROM THIS PARTICULAR MODEL. WE NEED MODELS WHICH YOU CAN HAVE APRIORI PREDICTIONS TESTED EMPIRICALLY TO UNDERSTAND WHAT THOSE DIFFERENCES ARE. SO MORTALITY BY GRADE THIS WORK CAME OUT, MARVIN REPORTED ON THIS, IF YOU HAVE A BETTER JOB YOU'RE GOING TO LIVE LONGER. THAT'S GREAT. IF YOU HAVE A WORSE JOB THOUGH, THAT'S NOT SO GREAT. BUT THE FACT IS, WE UNDERSTAND THAT. THE LAW OF SMALL EFFECTS I LIKE WITH REGARD TO THE RELATESSED OUTCOMETS THAT WE SEE. I THINK THE POINT WAS MADE THIS MORNING FROM THE DIRECTOR OF THE GENOME INSTITUTE, NORA MADE THIS POINT. I CALL THIS THE LAW OF SMALL EFFECTS. IN TERMS OF RACE RELATED OUTCOMES INTO DISPARITIES. THERE'S NO ONE SINGLE FACTOR THAT PRODUCES OBSERVED PHYSICAL AND MENTAL HEALTH DISPARITIES IN PROCESS OUTCOMES AMONG RACIAL AND ETHNIC GROUPS. I CAN'T STRESS THAT ENOUGH. IF YOU SAY I WOULD TO FIND OUT WHAT CAUSES THIS YOU'RE LOST BEFORE YOU EVEN START. IT'S THE WRONG WAY TO THINK ABOUT IT. THE FACT IS IF A GROUP OF SMALL DIFFERENCES THAT ACCUMULATE OVER THE LIFE COURSE THAT PRODUCE OBSERVED DIFFERENCES IN ADULTHOOD, AND OLDER AGE AMONG DIFFERENCE RACE AND ETHNIC GROUPS, I'M GOING TO SEW YOU A LOT OF DATA. WHAT ARE -- SHOW YOU A LOT OF DATA. SO WHAT THE FACTORS. GENE GENE ENVIRONMENT INTERACTIONS, WE DO RESEARCH ON GENE ENVIRONMENT INTERACTION INTERACTIONS. PERCEIVED RACISM IS IMPORTANT, DISCRIMINATION IS NOT A GOOD THING, IT'S PREVALENT IN OUR SOCIETY SOT AND HAS NEGATIVE EFFECTS ON THOSE INDIVIDUALS DISCRIMINATED AGAINST. CULTURAL FACTORS ARE IMPORTANT. HOW WE PREPARE FOOD HOW WE LIVE TOGETHER. NORA MENTIONED SOCIAL SUPPORT. THESE ARE ALL IMPORTANT FACTORS WHICH ARE INFLUENCED TO CULTURE. MAY HAVE I DON'T RECALL DIFFERENCES THAT EXIST IN VARIOUS GROUPS THROUGH PROCESSES -- SOCIAL ECONOMIC STATUS IS REALLY IMPORTANT BUT SOCIAL ECONOMIC STATUS DOES NOT EXPLAIN ALL THE THINGS THAT WE OBSERVE WITH REGARD TO THE DIFFERENCES. SOCIAL AND PSYCHOLOGICAL FACTORS ARE IMPORTANT. I SHOW SOME DIFFERENCES THERE. SO THINGS THAT P I WANT TO EMPHASIZE IN THE TALK TODAY ARE LIFE COURSE SELECTION. WHICH IS CRITICAL. I WANT TO TALK ACCUMULATED TREATMENT DIFFERENCE, ALLO STAT IC LOAD, I THINK IS CRITICAL IN TERMS OF HOW WE UNDERSTAND HOW THESE DIFFERENCES ACCUMULATE, CULTURALLY ENVIRONMENTALLY MEDIATED BEHAVIORAL COPING STRATEGIES. AND THOSE PEOPLE WHO KNOW MY WORK KNOW THAT I REALLY EMPHASIZE THESE AS BEING IMPORTANT. THE POINT THAT I WANT TO MAKE IS THAT INDIVIDUALS ARE AN GENIC. INDIVIDUALS JUST DON'T LAY BACK AND SAY DO BAD THINGS TO ME. THEY ACTUALLY WANT TO TAKE CONTROL OF THEIR LIVES AND THEY TRY DO SOMETHING ABOUT IT. THE PROBLEM IS THAT THEY DO THE WRONG THINGS. WE'LL TALK ABOUT THAT. WE CANNOT PARSE THESE OUT INTO THEIR CONSTITUENT PARTS. SO WE BELIEVE THAT THE CHRONIC STRESS IS A POSSIBLE PATHWAY FOR PHYSICAL AND MENTAL HEALTH DISPARITIES THAT WE HAVE SEEN IN RACIAL AND ETHNIC GROWSES. CAUSES OF STRESS, THIS MAKES A POINT STRESS IS WORSE OVER TIME, AMERICAN PSYCHOLOGICAL ASSOCIATION IS TAKING THAN BAROMETER OF STRESSORS, AND IT IS INCREASING. THIS SLIDES MAKES A POINT TOO, THE WORK SHOWS OVER TIME LIFE IS GETTING MORE STRESSFUL FOR EVERYONE. THAT IS, WE LIVE IN VERY, VERY STRESSFUL TIMES AND IT'S INCREASING. THERE'S LIVING ARRANGEMENTS THAT FAVOR NON-HISPANIC WHITES. WE KNOW THAT. WE KNOW NEIGHBORHOOD CHARACTER TS AN SEGREGATION EFFECTS HEALTH OUTCOMES. WORK BY WALLACE AND RUE AND OTHER PEOPLE, CLEARLY MAKE THIS PARTICULAR POINT. WE KNOW THAT NEIGHBORHOODS ARE DIFFERENTIALLY STRESSFUL. SOME LIVE IN REALLY GREAT NEIGHBORHOODS. AND THEY'RE QUIET AND IT LOOKS LIKE ONE OF THE STREETS OUT MOVIES AND WE HAVE OTHER PEOPLE WHO LIVE IN NEIGHBORHOOD WHENCE THERE ARE DRIVE BY SHOOTINGS. OTHERS OCCUR IN THOSE PARTICULAR NEIGHBORHOODS. TRUST ME, IF YOU LIVE IN THOSE KINDS OF NEIGHBORHOODS IT IS VERY, VERY STRESSFUL FOR YOU. NEIGHBORHOOD AFOR DANCES. THIS IS A POINT MODEL NAME COMES FROM. NEIGHBORHOODS ALSO AFFORD THINGS. NEIGHBORHOODS ARE NOT JUST BAD OR GOOD OR WHATEVER BUT THERE ARE THINGS THAT THEY ARE TO THE INDIVIDUALS THAT LIVE IN THOSE NEIGHBORHOODS. SOME NEIGHBORHOODS IT'S EASIER TO GET FOOD AND SERVICES AND JOBS IN COMPARISON TO OTHER NEIGHBORHOODS. SOME NEIGHBORHOODS ALSO AFFORD DIFFERENTIAL COPE REGULAR SOURCES. AND SOME NEIGHBORHOODS YOU CAN GET A FAST FOOD OUTLET ON EVERY SINGLE CORNER OR IF YOU WANT LIQUOR IT'S ON EVERY CORNER OR YOU WANT CIGARETTESSER OTHER BAD FOOD THERE, ALL THESE ARE AVAILABLE. NEIGHBORHOODS AFFORD DIFFERENTIAL KINDS OF THINGS, THIS IS AN ENVIRONMENTAL IMPACT. SO THE EPIDEMIOLOGICAL PARADOX WHICH THE STORY IS ABOUT IS THE FACT THAT DISPARITIES IN PHYSICAL HEALTH FAVOR WHITES OVER BLACKS BUT DISPARITIES IN MENTAL HEALTH FOR THE MOST PART FAVOR BLACKS OVER WHITES. THERE'S NO MODEL LIKE -- THAT ACCOUNTS FOR THIS PARTICULAR DIFFERENCES. WHY SHOULD THAT BE THE CASE? AND WE TOO OFTEN IN OUR FIELD, I GET TO PREACH A BIT BECAUSE I HAVE THIS THING. WE TEND TO SEPARATE OUT MENTAL HEALTH AND PHYSICAL HEALTH LIKE THEY'RE DIFFERENT EVEN THOUGH YOU'RE TRAINED IN MEDICAL SCHOOL, YOU'RE TRAINED EVERYWHERE. THESE SYSTEMS ARE INNER RELATED THE BRAIN PLAYS A VERY IMPORTANT ROLE IN THE WAYS IN WHICH IT MEDIATES THAT. WHAT NORA TALKED ABOUT IS COMMUNICATION, I THINK THAT'S A FACT. BUT WHAT WE DO IS THAT WE STUDY PHYSICAL HEALTH. THEN WE COME HERE AND STUDY MENTAL HEALTH. THEY DON'T GO TOGETHER. SO THIS PARTICULAR FRAMEWORK SAYS IF WE LOOK AT THESE THINGS TOGETHER, IN SYNERGISTIC WAYS WHAT DO WE LEARN? LET ME SHOW YOU A SLIDE WHICH SOME WAYS ARGUES AGAINST THIS ISSUE. I I WILL EXPLAIN WHY THIS IS TRUE. THIS IS DIABETES FOR FEMALES 2004, 2005, BLACKS IN PINK, WHITES IN GREEN. I DON'T KNOW WHY THEY'RE IN PINK, I HAVE IN NO IDEA. SOMEBODY DID THAT. WHAT'S VERY INTERESTING ABOUT THIS, IF YOU LOOK AT THE DIFFERENCES BETWEEN THE GROUPS, THIS IS UP TO 44 YEARS OF AGE, IF YOU LOOK AT THESE TWO PARTICULAR GROUPS UP TO 44, THERE ARE NO DISPARITIES. THERE ARE VERY SMALL DIFFERENCES WHICH EXIST. LOOK AT WHAT HAPPENS WHEN YOU BEGIN TO LOOK AT MIDDLE AGE. THIS IS WHEN DISPARITIES EMERGE. WILL SHOW YOU A LOT OF SLIDES THAT MAKE THIS PARTICULAR POINT THAT IF WE LOOK DOWN HERE AND WE SAY WHAT'S GOING ON OVER THERE, THERE ARE NO DISPARITIES. IN FACT I'M GOING TO SHOW YOU FAVORABLE DISPARITY FOR AFRICAN AMERICANS, AND UNFAVORABLE DISPARITIES AS WE LOOK INTO MIDDLE AGE AND SO ON. HYPERTENSION EVEN, SAME THING. VERY SMALL DIFFERENCES, UP TO 484 YEARS OF AGE BETWEEN BALANCE AND WHITES IN TERMS OF HYPERTENSION BUT LOOK AT WHAT HAPPENS AFTER 45 YEARS OF AGE, IT EXPLODES SO THAT BLACK RATES REALLY GO THROUGH THE ROOF. SO THERE ARE CLEARLY LINKS FROM CHILDHOOD. I DON'T DOUBT THAT. OVER THE LIFE COURSE BLACKS MORE THAN ANY OTHER GROUP LIVE FEWER YEARS, HEALTH RACE ETHNICITY AND MOBILITY ARE OBVIOUSLY LINKED IN COMPLEX WAYS AS THE PEOPLE TRAVERSE THEIR LIFE COURSE. SO THIS IS THE FIRST CONTROVERSIAL THING I WILL SAY AND PROBABLY THE MOST CONTROVERSIAL THING I WILL SAY. I BELIEVE BLACKS MAYBE MORE SELECTED FOR POSITIVE HEALTH THAN WHITES EARLY IN LIFE AND ALSO LATE IN LIFE. WE ACCEPT THE LATE P LIFE CROSS OVER WITH REGARD TO MORE FAULTY, WELL KNOWN BUT I WILL MAKE THE ARGUMENT THEY'RE SELECTED POSITIVE HEALTH EARLY IN LIFE. IF WE LOOK AT INFANT FETAL AND PERINATAL MORTALITY RATES, WHAT WE SEE IS EVERY PARTICULAR POINT THROUGH THE INFANT MORTALITY ONE YEAR ONE DAY BLACKS ARE TWO, TWO AND A HALF SOMETIMES THREE TIMES MORE LIKELY TO DIE IF WE ADD IN SPONTANEOUS ABORTIONS THAN THIS NUMBER ABSOLUTELY SKYROCKETS. THE POINT TO MAKE HERE, IF THAT IS TRUE, ONE SIMPLE ASSUMPTION HAS TO BE TRUE. ORGANISMS DIE BEFORE STRONGER ORGANISMS. WEAKER ORGANISMS DIE BEFORE STRONGER SO BY ONE YEAR ONE DAY OF LIFE, BLACKS ARE MORE HIGHLY SELECTED FOR POSITIVE HEALTH THAN ARE WHITES. WHAT ARE THE IMPLICATIONS OF THAT? IF YOU LOOK AT STRESS RELATED CAUSES OF DEATH ONLY, IS WHAT I'M LOOKING AT, YOU GET THIS VERY INTERESTING SIGMOIDAL CURVE. BLACKS AT THIS POINT DIE MORE THAN WHITES, YOU SEE DEATH RATES ARE VERY HIGH. BUT LOOK AT WHAT HAPPENS HERE, ONE TO FOUR YEARS OF AGE OR SO ON, BLACKS ARE DYING AT LOWER RATES THAN WHITES. BLACKS DIE LOWER RATES THAN WHITES, FEMALES AT THIS PARTICULAR POINT. BUT LOOK WHAT HAPPENS AS IT ACCELERATES INTO MIDDLE AGE AND OLDER AGE, BLACKS BEGIN TO DIE AT HIGHER RATES. ALSO TRUE WITH REGARD TO MALE, YOU SEE EXACTLY THE SAME RELATES SHIP WHICH IS THERE, BLACKS ACTUALLY -- IF YOU WERE LOOKING AT THIS AREA, THEN THESE DISPARITIES WOULD BE POSITIVE. BECAUSE IT SEPARATES ARE LOWER THAN THE DEATH RATES FOR NON-HISPANIC WHITES. IF YOU LOOK AT ALL CAUSE MORTALITY YOU GET THE SAME SIGMOIDAL RELATIONSHIP, ACCIDENTS AND OTHER KIND OF THINGS, THIS IS VERY IMPORTANT IN TERMS OF OUR UNDERSTANDING ABOUT THE WAY THESE THINGS PLAY OUT OVER THE LIFE COURSE. IN FACT IF YOU DISAGGREGATE THIS IS A DISAGGREGATION OF DEATH FOR BLACKS, YOU CAN SEE ALMOST THE HIGHEST RATES OF DEATH ARE HERE BEFORE THE INFANT MORTALITY AND LOOK WHAT HAPPENS EARLIER YEARS, LOOK WHAT HAPPENS OVER HERE AS YOU BEGIN TO GET GIGANTIC MORTALITY SWEEPS. OUR ARGUMENT IS THERE'S A REASON FOR THAT, THERE'S A REASON WHY YOU SEE THESE PARTICULAR RELATIONSHIPS. FOR HEALTH BEHAVIOR, RACIAL AND ETHNIC GROUP DISPARITIES THAT I TALKED ABOUT. THEY PARALLEL BECAUSE OF THINGS THAT I'M TALKING ABOUT. LET'S LOOK AT THE SMOKING RATES AMONG MALES. SMOKING RATES AMONG BLACK MALES ARE VERY LOW IN THE EARLIER YEARS IN AD LESS SENTS. THIS IS ALWAYS SOMETHING VERY PECULIAR THAT PEOPLE DON'T UNDERSTAND WELL WHY THOSE RATES ARE LOWER THAN WHITES BUT WHAT'S REALLY INTERESTING ABOUT THIS IS THE ACCELERATION OF SMOKING RATES AMONG BLACKS SUCH THAT WHEN YOU REACH MIDDLE AGE BLACKS ARE ACTUALLY SMOKING AT RATES THAT ARE GREATER THAN -- THOUGH IN EARLIER YEARS THEIR RATES WERE LOWER. IF YOU LOOK AT SMOKING AMONG FEMALES, EVEN THOUGH IT'S LOWER YOU GET EXACTLY THE SAME ACCELERATION OVER TIME FOR BLACK FEMALES THAT YOU DON'T SEE AMONG WHITES. OBESITY IS ONE OF THE FEW DISORDERS THAT WE SEE THAT ACTUALLY SHOW DISPARITIES EARLIER IN LIFE. BUT WHAT'S INTERESTING ABOUT THIS, THIS INCREDIBLE ACCELERATION SO THAT BY AGES 40 TO 59 YEARS OF AGE, ALMOST 60% OF AFRICAN AMERICANS MEET CRITERIA, MEET CRITERIA FOR OBESITY. AND WE DON'T THINK ABOUT THAT. THERE'S A REASON FOR THAT. THAT 60% CAN'T ALL BE PEOPLE WHO ARE LAZY BE DON'T WANT TO TAKE CARE OF THEMSELVES IN SOME WAYS. THERE HAS TO BE AN UNDERDIE LYING CAUSE AS TO WHY WE OBSERVE THESE KINDS OF NUMBERS. IT HAS TO BE AN UNDERLYING CAUSE. IF WE LOOK AT NATIONAL HEALTH NUTRITION EXAMINATION SURVEY, WE GET SOME REASON WHAT MIGHT BE GOING ON. WHAT'S INTERESTING ABOUT THESSALY SLIDES I'M GOING TO SHOW YOU IS THAT AFRICAN AMERICAN FEMALE OBESITY, IS TOTALLY NON-RESPONSIVE TO EDUCATION. IT'S TOTALLY NON-RESPONSIVE TO EDUCATION. COLLEGE COLLEGE EDUCATED FEMALES ARE AS LIKELY TO BE OBESE AS WOMEN WITH LESS THAN HIGH SCHOOL DEGREE. LOOK WHAT HAPPENS TO WHITE WOMEN, RESPONSIVE TO EDUCATION. HIGHER LEVELS EDUCATION LEAD LOWER LEVELS OF OBESITY. THAT'S TRUE 45 TO 64, AFRICAN AMERICAN WOMEN AGAIN, THESE ARE WHITE WOMEN, NOTICE THE DECREASE WITH REGARD TO INCREASE EDUCATION. BUT NOT FOR BLACK FEMALES, AND ALSO PREDICTIVE PROBABILITY OF EDUCATION AGAIN FOR WOMEN 65 YEARS OF AGE AND OLDER. THIS IS AN IMPORTANT FACT. THAT INDEED EDUCATION AND OTHER KINDS OF PLACEMENT WITHIN THE MOBILITY STRUCTURE ARE NOT AFFECTING OBESITY RATES FOR AFRICAN AMERICAN WOMEN IN THE SAME WAY THAT IT'S AFFECTING OBESITY RATES FOR WHITES. THERE'S SOMETHING ELSE THAT'S GOING ON FOR AFRICAN AMERICAN WOMEN. DOES NOT EXPLAINED BY EDUCATION INCOME AND OTHER KINDS OF THINGS. VIGOROUS PHYSICAL ACTIVITY FOR AFRICAN AMERICAN WOMEN. THIS SLIDE SHOWS YOU AT EVERY SINGLE AGE GROUP AFRICAN AMERICAN WOMEN HAVE LESS VIGOROUS PHYSICAL ACTIVITY THAN NON-HISPANIC WHITES. THERE'S A REASON FOR THAT TOO AS A WELL. IF WE LOOK AT ALCOHOL YOU, NORIA RA MADE THIS POINT BUT WHAT'S INTERESTING ABOUT ALCOHOL USE FOR MALES IS THAT IT ACCELERATES INTO MIDDLE AGE. THE RATES ARE RELATIVELY LOW IN COMPARISON TO OTHER GROUPS IN YOUNGER YEARS, BUT ACCELERATES TO MIDDLE AGE. SAME TRUE FOR DRUG USE, SAME FOR MARIJUANA USE, THAT WE SEE. WHAT DOES THAT MEAN? BEFORE EXPLAINING THAT, I WANT TO SAY SOMETHING ABOUT MENTAL HEALTH STATUS. I TALKED ABOUT THAT BEFORE. IN COMPARISON TO HEALTH DIFFERENCES I TALKED ABOUT PARTICULARLY MIDDLE AGE THERE'S FEW DIFFERENCES IN TERMS OF MENTAL DISORDERS BETWEEN BALANCE AND WHITES AND THE DIFFERENCES ARE THERE ACTUALLY FAVOR AFRICAN AMERICAN WHITES OVER WHITES. THIS IS THE RESEARCH THAT'S BEEN DONE EVER SINCE WE STARTED DOING THESE STUDIES IN PEOPLE'S HOUSEHOLDS. AND ONCE YOU SEE HERE IS THERE'S BEEN NO MAJOR STUDY SINCE THE ECA STUDY IN THE LATE '70s AND '80 THAT HAS EVER FOUND HIGHER RATES OF DEPRESSIVE DISORDERS FOR AFRICAN AMERICANS COMPARISON TO WHITES. THEY SIGNIFICANTLY LOWER IN TERMS OF RATES OF MAJOR DEPRESSION. I MIGHT ADD THERE'S ALSO SIGNIFICANTLY LOWER IN RATES OF -- THERE'S A REASON FOR THAT. SO THIS SUGGESTS THE FACTORS RELATED TO GENDER, GENES AND SO ON CANNOT ALONE EXPLAIN DISPARITIES SO DESCRIPTION OF DISPARITIES IS NOT ENOUGH AND I WANT TO MAKE AN ARGUMENT THAT SELF-REGULATION OF INDIVIDUAL HEALTH BEHAVIORS ACTUALLY PLAYS A ROLE IN THE EPIDEMIOLOGY THAT WE OBSERVE. AND THE FACT IS, IT'S VERY IMPORTANT SECOND POINT IN THIS BULLET YOU GOT TO STOP THINKING ABOUT PEOPLE AS THESE LACK OF AGENCY AND JUST VESSELS TO TAKE IN THOSE THINGS WHICH HAPPEN TO THEM. WHEN PEOPLE ARE IN SITUATIONS WHERE THEY'RE CONFRONTING THESE KINDS OF STRESSFUL EVENTS AND SO ON, THEY ARE -- THEY TRY TO DO SOMETHING ABOUT IT. PROBLEM IS WHAT DO THEY DO? SO STRUCTURAL LIFE INEQUALITIES HYPOTHESIZE MENTAL HEALTH AND MENTAL HEALTH DISPARITIES. THAT'S THE MOST COMMON THEORETICAL MODEL TO EXPLAIN MENTAL HEALTH DISPARITIES. AFRICAN AMERICAN VERSUS AWFUL OUTCOMES BECAUSE THEY LIVE IN BAD CONDITIONS. THAT'S WHAT EXPLAINS. BUT HOW DOES IT EXPLAIN THE DIFFERENCES BETWEEN THE MENTAL HEALTH OUTCOMES AND THE PHYSICAL HEALTH OUTCOME? STRUCTURAL LIFE INEQUALITY IS INCOME AND SO ON ARE BIG AND UNFAVORABLE FOR AFRICAN AMERICANS. WE KNOW THAT PHYSICAL HEALTH DISPARITIES AS I HAVE SAID ARE LARGE AND UNFAVORABLE FOR AFRICAN AMERICANS PARTICULARLY MIDDLE AGE. BUT MENTAL HEALTH DISPARITIES RUN IN THE COUNTER DIRECTION. AFRICAN AMERICANS HAVE LOWER RATES THAN DO WHITES BUT WHY. SO THIS IS THE FRAMEWORK, THIS IS FIVE POINTS TO MAKE THIS PARTICULAR POINT, ONE COPING STRATEGIES IN THE FACE OF NON- RACE AN RACE STRESSORS ARE THEMSELVES HARMFUL TO PEOPLE'S HEALTH. THE THINGS THAT PEOPLE DO TO PROTECT THEMSELVES ARE HARMFUL TO PEOPLE'S HEALTH. STRESS RELATED PRECURSORS ARE SERIOUS MENTAL HEALTH PROBLEMS ARE MORE AVAILABLE TO PEOPLE'S CONSCIOUSNESS THAN ARE THOSE OF PHYSICAL HEALTH PROBLEMS. IF YOU HAD A BAD DAY, AT H NIH, AT THE END OF THE DAY YOU KNOW IT. YOU DON'T FEEL GOOD, YOU GOT HEADACHE, YOUR STOMACH IS UPSET, YOU'RE MAD AT YOUR BOSS, MAYBE NOT THIS BOSS BUT YOU'RE MAD AT YOUR -- WHAT THE SITUATION MAYBE. THAT'S AVAILABLE TO YOUR CONSCIOUSNESS. YOU KNOW THAT, THE PRECURSORS OF MENTAL DISORDERS ARE AVAILABLE TO PEOPLE'S CONSCIOUSNESS. THIS PSYCHOLOGICAL AWARENESS MOTIVATES PEOPLE TO ACTION. YOU ARE MOTIVATED TO DO SOMETHING ABOUT REDUCING YOUR LADIES AND GENTLEMEN REDUCING YOUR STOMACH ACHE. GETTING RID OF THESE PARTICULAR BAD FEELINGS THAT YOU HAVE. IT MOTIVATES YOU TO DO THAT THEREFORE YOU DO IT. YOU ARE GROWING A TUMOR FOR PANCREATIC CANCER, YOU DON'T HAVE A CREW. A CLUE YOU'RE GROWING A TUMOR UNTIL IT REACHES STAGE 4 OR 5, SO OFTEN BECAUSE IT'S NOT AVAILABLE TO THEIR CONSCIOUSNESS AND THUS YOU DON'T DO ANYTHING ABOUT IT. YOU DON'T DO ANYTHING ABOUT IT. BUT THESE OTHER THINGS YOU TRY TO DO SOMETHING ABOUT IT. SO DOM AND OTHERS SUGGESTED PEOPLE EAT COMFORT FOOD TO REDUCE ACTIVITY IN THE CHRONIC STRESS RESPONSE NETWORK. BECAUSE YOU ARE AWARE OF THAT, YOU TRY TO DO SOMETHING ABOUT IT. OTHER BEHAVIORS. SMOKING, ALCOHOL, DRUG USE HAVE SIMILAR IMMEDIATE EFFECTS TO REDUCE THE ACTIVATION OF STRESS RESPONSE NETWORK. THAT IS REWARDING. THAT IS REWARDING. TURN IT OFF AND YOU ABSOLUTELY FEEL BETTER. SO THIS IS THE MODEL, IT'S VERY SIMPLE, THE ENVIRONMENT IS A SOURCE OF POOR HEALTH BEHAVIORS, THE ENVIRONMENT IS THE SOURCE OF STRESSORS, POOR HEALTH BEHAVIORS THEMSELVES ARE RELATED TO THE CHRONIC ACTIVATION OF THE HPA AXIS AND SO ARE STRESSORS. POOR HEALTH BEHAVIORS ARE RELATED TO PHYSICAL HEALTH DIS ORDERS, THERE'S SOMETHING BAD ABOUT DRINKING AND SMOKING AND OTHER THINGS THAT YOU DO. THEY'LL KILL YOU. YOU WILL FEEL BETTER BUT YOU'RE DYING THAT IS WHY IT'S PERVERSE. IN OUR ARGUMENT, POOR HEALTH BEHAVIORS INTERACT WITH THE CHRONIC ACTIVATION OF THE HPA AXIS TO REDUCE THE PSYCHIATRIC HEALTH DISORDERS THAT WE SEE. IT'S A VERY SIMPLE MODEL. THIS IS THE MODEL THAT INDEED WE'RE TRYING TO TEST. SO THE COMPLEX INTERACTIONS THAT ARE THERE. OTHER CHRONIC STRESS WE KNOW WE GET CONTINUED RELEASE OF C RF SORT SOLVE. LONG TERM ACTIVATION OF HPA AXIS IS NOT GOOD FOR YOU, NOT GOOD TO HAVE LONG TERM ACTIVATION. THIS GRAPH MAKES THE SAME POINT. THE PROBLEM IS CHRONIC STRESS. THE HUMAN HAS NOT EVOLVED TO HANDLE CHRONIC STRESS VERY WELL. WE HANDLE PERIODIC STRESSOR, WE HAVE EVOLVED TO BE ABLE TO DO THAT BUT THE CHRONIC DAY IN DAY OUT KINDS OF STRESSORS THAT WE GET IF WE DIDN'T EVOLVE TO DO THAT. SO COMFORT FOODS HIGH IN FAT MAY AID IN SHUTDOWN OF THE STRESS RESPONSE, ALCOHOL, NICOTINE AND DRUG USE STIMULATES RELEASE OF DOPAMINE AND YOU GET THIS EFFECT BUT THE PROBLEM IS THAT THESE DRUGS ALSO FURTHER ACTIVATION OF HPA AXIS THUS INDIVIDUALS ARE PSYCHOLOGICALLY RELEASED FROM STRESS, THAT IS THEY FEEL BETTER. BUT THEY ARE NOT PHYSICALLY RELEASED FOR THE EFFECT OF STRESS SO THEY FEEL BETTER, THAT'S GREAT. BUT THEY STILL ARE HAVING PHYSIOLOGICAL EFFECTS SO THE GENERAL HYPOTHESIS IS TWO, WEAKER HYPOTHESIS, POOR HEALTH BEHAVIORS MASS THE STRESS RESPONSE AND THE EVIDENCE SAYS THAT ACTUALLY CHANGE THE NATURE OF THE STRESS RESPONSE IN TERMS OF THE HPA AXIS OF THE AND OTHER BRAIN HORMONES. SO I WILL SHOW YOU SOME DATA THE PREDICTION IS CLEAR. WE'RE CLEARLY PREDICTING AN INTERACTION BETWEEN STRESS AND POOR HEALTH BEHAVIORS ARE GOING TO HAVE DETRIMENTAL eEFFECTS ON AT THIS PHYSICAL HEALTH AND MENTAL DISORDER. THIS IS THE FRAMEWORK WE HAVE BEEN USING, THE ARGUMENT IS THAT THERE IS INDEED AN INTERACTION SUCH THAT BAD BEHAVIORS REALLY INDEED INTERACT WITH THE CHRONIC STRESS THAT PEOPLE ARE UNDER TO EFFECT PSYCHIATRIC HEALTH OUTCOMES. THIS IS WHAT WE'RE TESTING. SO WE HAVE DONE A LOT OF THESE. WHEN WE TEST THIS AND WE LOOK AT WHITES WE FIND THERE IS A HIGHER LEVEL OF STRESS, WE DON'T NEED TO GO INTO DETAIL, UNDER LOW LEVELS OF STRESS THERE'S NO DIFFERENCES DEPENDING UPON THE KIND OF BEHAVIORS PEOPLE ARE ENGAGED IN. THESE ARE THINGS LIKE SMOKING, DRINKING, OTHER THINGS PEEP DOLL, BUT LOOK WHAT HAPPENS UNDER HIGH STRESS. AND FOR WHITES YOU GET THIS NICE INTERACTION. THE MORE STRESS YOU'RE UNDER THE MORE YOU ENGAGE IN BEHAVIORS THE HIGHER THE PROBABILITY ARE THAT YOU HAVE MAJOR DEPRESSION. THIS IS BLACKS. THIS IS WHY THIS IS PERVERSE. SO FOR BLACKS YOU GET THE SAME EFFECT UNDER LOW STRESS. NOT MUCH IS GOING ON AT ALL WITH REGARD TO THESE BEHAVIORS. BUT UNDER HIGH STRESS IF YOU ENGAGE IN SMOKING DRINKING AND OBESE, THE PROBABILITY OF YOUR BEING A CASE OF MAJOR DEPRESSION IS LOWER THAN ZERO. ON THE OTHER HAND IF YOU DON'T SMOKE YOU DON'T DRINK YOU DON'T OVER EAT AND DON'T DO THESE THINGS PROBABILITY IS ALMOST 80% THAT YOU'LL BE A CASE OF MAJOR DEPRESSION. THAT'S WHY IT'S PERVERSE. THESE THINGS TURN OUT PROTECTIVE. OUR ARGUMENT IS THEY'RE PROTECTED THROUGH THE IMPACT OF TURNING OFF THE HPA AXIS AND PSYCHOLOGICALLY RELEASING THE PERSON FROM THE PARTICULAR STRESSORS. EVEN THOUGH THIS PHYSIOLOGICAL CASCADE CONTINUES. SO IF YOU DON'T LIKE THAT STUDY YOU MIGHT SAY JACKSON YOU'RE CRAZY. WE WENT TO BALTIMORE AND WE TOOK A LOOK AT THE CATCHMAN STUDY, THE SAME THING AND WHAT WE FIND FOR WHITES IS EXACTLY WHAT WE FOUND MANY THE LAST STUDY AND WHAT WE FIND FOR BLACKS IS EXACTLY THE LAST STUDY. THIS PARTICULAR SAMPLE. IF YOU DON'T THINK THAT'S ENOUGH, HERE IS THIRD STUDY USING THE NESAR DATA THAT WAS DEVELOPED BY NIDA, A BIG 40,000 PERSON TWO TON POINT IN TIME COHORT. WHAT YOU GET IN THIS CASE IS THE SAME THING. FOR BLACKS VERSUS WHITES. THESE EFFECTS WERE LOW, THIS IS SIGNIFICANT WE ARE REPEATING THIS, USING BETTER MEASURE OF STRESS THAN WHAT WE HAD BEFORE. WE HAVE EARLY LEARN ENVIRONMENTALLY MEDIATED COPING STRATEGIES TO DEAL WITH THE STRESSFUL CONDITIONS OF LIFE. FOR EXAMPLE, I DON'T HAVE TIME TO GO INTO ALL OF IT, AFRICAN AMERICAN WOMEN WHO ARE INVOLVED WITH FOOD PREPARATION AND OTHER KINDS OF THINGS EARLY IN LIFE, LEARN, THEY LEARN THIS IS JURISOUR PRESENTATION. THEY WERE UNDER STRESS AND THEY LEARN EARLY ON THAT YOU EAT CORN BRED YOU FEEL BETTER. PARTICULARLY IF YOU SLOP BUTTER ON IT. PARTICULARLY IF YOU SLOP BUTTER ON IT YOU ABSOLUTELY FEEL BETTER. THIS IS A LEARNED BEHAVIOR. YOU HAVE COME TO LEARN THAT YOU ARE FEELING THE EFFECTS OF STRESS THERE ARE THINGS THAT YOU CAN DO TO REDUCE IT. AND CULTURALLY -- WHAT'S REALLY INTERESTING IS AFRICAN AMERICAN WOMEN HAVE LOWEST RATES, THE LOWEST RATES OF ALCOHOL USE, DRUG USE AND EVERYTHING ELSE. BUT THEY HAVE THE HIGHEST RATES OF OBESITY. AND THE REASON IS BECAUSE IT'S CULTURALLY CONDITIONED, IT'S ACCEPTED WITHIN THE BLACK COMMUNITY, IS NO ACCIDENT SOME OF THE MOST OBESE WOMEN WILL BE FOUND IN THE AFRICAN AMERICAN CHURCH. NO ACCIDENT, WHAT DO WOMEN DO IN THE AFRICAN AMERICAN CHURCH? THEY COOK AND THEY PREPARE MEALS AND THEY DO OTHER THINGS. AND ENGAGE IN BEHAVIORS WHICH ARE CULTURALLY ACCEPTABLE. TO DEAL WITH STRESS. WHAT DO AFRICAN AMERICAN MEN DO? AFRICAN AMERICAN MEN ARE SO ACTIVE AS YOUNGSTERS THAT WE GIVE THEM RITALIN AT RATES THAT ARE WAY BEYOND ANYTHING WE DONOR NON-HISPANIC WHITES. WHAT'S THE EFFECT OF THIS ACTIVITY, IT HAS THE SAME EFFECT AS EATING THE CORN BREAD. WHAT HAPPENS TO AFRICAN AMERICAN MALES AS THEIR AGE? WHEN THE KNEES GO OUT, WHEN THEY LOSE THE ABILITY TO BE ABLE TO ENGAGE IN THIS KIND OF HEAVY EXERCISE? THEY TURN AROUND AND DO OTHER THINGS, THAT'S WHY I SHOWED YOU IN MIDDLE AGE YOU GET THE RISE OF DRINKING, DRUG USE, MARIJUANA USE BECAUSE THEY'RE TRYING TO DEAL WITH THE STRESSORS IN THEIR LIVES THAT CAN'T DEAL WITH IT ANY OTHER WAY. AFRICAN AMERICAN WOMEN IS NOT A PROBLEM. THEY JUST CONTINUE ON EATING. AND THEY DO. THAT'S WHY YOU GET HIGH RATES OF OBESITY IN OLDER AGE BECAUSE THEY'RE DEALING WITH STRESSES IN THEIR LIVE WITH A WELL LEARNED RESPONSE THAT COMES FROM THEIR ADOLESCENCE AND CHILDHOOD. THESE BEHAVIORS ARE EFFECTIVE IN TERMS OF DOING THAT BUT THESE BEHAVIORS CONTRIBUTE WITH LACK OF RESOURCES AND OTHER THINGS TO PRODUCE CHRONIC STRESS OF THE LIFE COURSE AND GET THE NEGATIVE RACE DISPARITIES AND PHYSICAL HEALTH AND MORBIDITY AND MORTALITY. THESE COPING STRATEGIES WHICH ARE EFFECTIVE IN REDUCING IN PRESERVING AFRICAN AMERICAN MENTAL HEALTH, CONTRIBUTE TO PHYSICAL HEALTH DIFFERENCES. SO IN OTHER GROUPS, BLACKS AND SAUDI BUY REDUCED RATES OF PSYCHIATRIC DISORDERS, WITH HIGHER RATES OF PHYSICAL HEALTH MORBIDITY AND ACCESS WITH EARLY MORTALITY. I DON'T KNOW HOW MUCH TIME YOU GOT, BUT I WANT TO HURRY THROUGH SOMETHING. SO WHAT'S INTERESTING ABOUT THIS, THE FACT WE GET THE RACE DIFFERENCES, AND THE QUESTION IS, JAMES, IF YOU ARE PROPOSING A BIOLOGICAL MECHANISM THAT INDEED IS OPERATING TO PRODUCE THESE PARTICULAR KIND OF OUTCOMES, IS THAT BIOLOGICAL DIFFERENCE, THAT PIE LOGICAL PROCESS DIFFERENT FOR BLACKS THAN WHITES. THAT'S A RIDICULOUS QUESTION, WHY DO WE OBSERVE THOSE PARTICULAR DIFFERENCES THAT WE OBSERVE, THAT'S WHAT WE HAVE BEEN WORK ON, THIS IS OUR MOST RECENT WORK. THIS DRAFT I SHOW YOU THERE ARE REALLY RACIAL GROUP DIFFERENCES THAT WE OBSERVE. THE POINT HERE THAT SKIN TONE IS THE MOST OFTEN USED MARKER OF RACE, THIS GIVES EXAMPLES TO WHAT'S GOING ON WITH REGARD TO SKIN TONE THAT MIGHT HAVE AN EFFECT ON DIFFERENCES IN TERMS OF RACIAL GROUPS. BUT WHY SHOULD WE OBSERVE LARGE CONSISTENT INCONSISTENT DIFFERENCES AMONG RACIAL AND ETHNIC GROUPS WHO NEVER ASKED OURSELVES THAT QUESTION. WHEN SELF-REPORTED RACE ETHNICITY IS A MOST OFTEN USED CATEGORIZATION, IN BOTH BIOLOGICAL AND SOCIAL RESEARCH, NORA TOLD YOU TODAY HOW THEY'RE ABLE TO MEASURE THESE KINDS OF THINGS. WHAT DOES ONE SOCIAL GROUP IDENTITY HAVE TO DO WITH GROUP DISPARITIES AND MORBIDITY AND MORTALITY. BECAUSE IF THE SOCIAL IDENTITIES REALLY MATTER, WE HAVE A PERFECT WAY WHICH WE CAN INTERVENE IN DISPARITIES AND WE KNOW LONGER NEED TO ARE THESE DISPARITIES BEGINNING TOMORROW. EVERY AFRICAN AMERICAN IN THE UNITED STATES SAY THEY'RE WHITE. I'M NOT BLACK. YOU GOT THAT WRONG. I'M REALLY WHITE. IN -- AND THAT WILL GET RID OF DISPARITIES. THAT WILL GET RID OF THEM, THAT'S SILLY AS HELL. SO THOSE SOCIAL THINGS AND THE WAY WHICH WE MARK RACE REALLY CAN'T BE RELATED TO WHAT IT IS WE OBSERVE WITH REGARD TO RATE DIFFERENCES SO THE ARGUMENT THAT WE MAKE IS THE MOST IMPORTANT THING ABOUT BEING BLACK IN THIS PARTICULAR SOCIETY IT'S A SIGNAL AND A MARKER TO BE DISCRIMINATE AGAINST, A SIGNAL AND MARKER TO BE DISCRIMINATED AGAINST. THOSE PEOPLE WHO HAVE DARK SKIN IN THIS PARTICULAR SOCIETY FACE MORE DISCRIMINATION RACISM, OTHER KINDS OF ISSUES IN THE SOCIETY AND THIS IS WHAT LEADS TO DISPARITIES THAT WE OBSERVE. SO THERE ARE SOME THINGS WHICH ARE RACE EFFECTS LIKE STEREOTYPE THREAT. ABOUT PEOPLE WHO KNOW THIS WORK IT SAYS IF YOU ENGAGE PEOPLE'S RACE IDENTITIES THAT INDIED THEY DON'T PERFORM VERY WELL ON A DIFFICULT TASK. MAYOR DISCRIMINATION PERCEPTIONS MAKE SENSE. BLACKS AND LATINOS AND OTHERS IN THE SOCIETY RECEIVE MORE DISCRIMINATION IN THEIR ENVIRONMENT. SAME WITH REGARD TO EVERY DAY DISCRIMINATION. WHY RACE GROUP DIFFERENCES IN PHYSICAL COMPLEX ISSUE? SO COMPLEX AS A COMPLEXIN ANYWHERE PLAY AMONG SCENES AND ENVIRONMENTAL FACTORS -- GENES AND -- DISEASE RISKS IS A COMPLEX ISSUE. I WANT TO MAKE THIS POINT, THIS IS CONTROVERSIAL, RACE ETHNICITY IS NOT A VARIABLE. NOT A VARIABLE WE CAN DECIDE YOU TO ONE OR TWO. THEN WE CAN TURN AND AID SIGN YOU TO THE OPPOSITE. IT'S NOT A MIRACLE. RACE IS A COMPLEX CONSTRUCT THAT ADULTHOOD CAPTURES A WIDE SET OF LIFE EXPERIENCES THAT PEOPLE HAVE HAD AS A PART OF GROWING UP IN A PARTICULAR GIVEN SOCIETY. THAT'S WHAT RACE IS. RACE IS A DESTINATION MORE THAN IT IS A CATEGORIZATION. WE NEED TO UNDERSTAND INDIVIDUAL BECOMES RACIALIZED TO EXPERIENCE OVER THE LIFE COURSE WITH A PARTICULAR CULTURE DURING UNIQUE PERIODS OF HISTORICAL TALK. THAT'S REALLY IMPORTANT. THE MEANING OF WHAT IT IS TO BE BLACK TODAY IS VERY DIFFERENT FROM THE MEANING OF BLACK IN 1850. YOU CAN UNDERSTAND THAT. IT'S A PARTICULAR TIME IN CULTURAL HISTORY AND THESE THINGS HAVE THEIR IMPACT. THIS MAKES THE POINT AS PEOPLE TRAVERSE LIFE COURSES OVER THIS TIME, THIS IS A DISADVANTAGED GROUP, THIS IS AN ADVANTAGED GROUP, ON AVERAGE THERE WILL BE DIFFERENCES BETWEEN THOSE PARTICULAR GROUPS. SO INDIVIDUAL RACE IS BEST CONCEPTUALIZED AS A SET OF PROPENSITIES RATHER THAN A MUTUALLY EXCLUSIVE CATEGORIES AND THESE PROPENSITIES CHANGE OVER TIME AND ACROSS CONTENTS. IT'S VERY IMPORTANT THAT WE UNDERSTAND THAT RACE IS NOT MERELY A CATEGORIZATION BUT IT PROPENSITY WE CAN COME TO UNDERSTAND. SO WHAT WE FOUND OUT BY USING A RELATIVELY SIMPLE SET OF THINGS THAT WE CAN ASSIGN WHITE AND BLACK PEOPLE TO THE PROBABILITY OF BEING BLACK. SO IF BEING RACIALIZED OVER TIME IS IMPORTANT, WHITES CAN BE RACIALIZED JUST AS BLACKS CAN BE RACIALIZED. PLAQUES ARE MORE LIKELY RACIALIZED BECAUSE THE ISSUE OF SKIN TONE, WHERE THEY LIVE, HISTORY AND OTHER ISSUES. BUT WHITES CAN BE RACIALIZED TOO. WHAT HAPPENS IN A SOCIETY FOR WHICH WHITES BECOME RACIALIZED. SO WE DID PROPENSITY SCORE ANALYSIS, WE ASSIGN PEOPLE TO RACIAL GROUPS IRREGARDLESS WHAT THE RACIAL CATEGORIZATION IS AND WE REESTIMATED THESE PARTICULAR DESIGNS. REMEMBER THIS IS A WHITE EFFECT WE GOT BEFORE, WHITES WHO ENGAGE IN THESE BEHAVIORS, ARE WORSE OFF UNDER HIGH STRESS, IF YOU LOOK AT THE LOWEST QUARTILE PROPENSITY OF BEING BLACK, THAT IS THESE ARE WHITES, THIS IS KIND OF A JOKE, SO I HAVE TO TAKE IT THAT WAY. SO THESE PEOPLE ARE REALLY WHITE. SO IF YOU'RE REALLY WHITE THE EFFECT IS EXACTLY -- THE EFFECT EXAGGERATES. ON THE OTHER HAND THIS IS THE HIGHEST QUARTILE PROPENSITY OF BLACK SCORE FOR WHITES, NOTICE HOW THOSE THINGS CHANGE AROUND. THEY LOOK MORE LIKE BLACKS, I SHOWED YOU IN THE FIRST PLACE THAN THEY DO IN TERMS OF WHITES. SO THIS IS BALANCE, I SHOWED YOU BEFORE, IF BALANCE ARE HIGH STRESS AND ENGAGE IN BAD THINGS, THEY ARE PROTECTED. THIS IS THE HIGHEST QUARTILE OF BEING BLACK. THESE PEOPLE WHO ARE BLACKER THAN BLACK. AND IF YOU'RE BLACKER THAN BLACK YOU ARE REALLY PROTECTED BY ENGAGING THESE PARTICULAR BEHAVIORS. THE EFFECT IS EXAGGERATED. BUT WHAT HAPPENS TO WHITES BLACK S WERE THE LOWEST QUARTILE, YOU GET SOMETHING VERY DIFFERENT, WE RUN ANALYSIS IN DIFFERENCE KINDS OF WAYS. WE LOOK AT BLACKS AN WHITES REGARDLESS ABOVE AND BELOW THE MEDIAN. THOSE PEOPLE WERE EITHER BLACK OR WHITE WHO ARE BELOW MEDIAN OF BEING BLACK LOOK LIKE WHITES WE OBSERVED BEFORE, THOSE ABOVE THE MEETING BEING BLACK, RATHER THEY'RE WHITE OR BLACK THEY LOOK LIKE WHITES. THIS IS A VERY IMPORTANT POINT. THIS IS NOT A RACE EFFECT. IT'S NOT A RACE EFFECT. THE EFFECT HAS TO DO WITH REGARD TO THE WAYS IN WHICH YOU LIVE YOUR LIFE. AND THE REASON WE SEE THIS WITH REGARD TO AFRICAN AMERICANS BECAUSE THERE ARE MORE LIKELY TO BE RACIALIZED THAN WHITES ARE BUT IF WHITES ARE RACIALIZED THEY LOOK LIKE BLACKS. SO THIS POINT IS WELL TAKEN SO THE EFFECT IS THAT THE MECHANISMS WE'RE PROPOSING ARE WORKING IN THE SAME WAY FOR BLACKS AND WHITES IF THE IDENTIFICATION OF WHETHER YOU'RE BLACK OR WHITE WHICH BECOMES VERY IMPORTANT. IF YOU CAN REFOUND IT YOU GET SOMETHING DIFFERENT. SO YOU CANNOT UNDERSTAND NECESSARY ON A BIOECOLOGICAL MODEL. THAT IS BIOSOCIAL MODEL WE USE THAT ARE IMPORTANT WE ARE DOING OTHER STUDIES, I WILL MENTION ONE, OUR DVD CLINICAL STUDIES, THAT'S VERY IMPORTANT, PREDICTION WAS VERY CLEAR. AND I WILL STOP HERE. PREDICTION THAT WE MADE BASED ON THE MODEL AS TO WHY YOU OBSERVE SUCH LOW RATES OF COMPLIANCE WITH REGARD TO WHAT HAPPENS POST HEART ATTACK IS BECAUSE YOU'RE TAKING AWAY FROM PEOPLE. THOSE COPING MECHANISMS THEY NEED SO WHAT DO THEY TELL YOU WHEN YOU GO INTO REHAB? NO SMOKING, NO DRINKING, NO EATING RICH FOODS AND -- SO WHAT YOU ARE DOING IS PEOPLE ARE NOT DEPRESSED IN THIS RELATIONSHIP BECAUSE OF THE HEART ATTACK. THEY ARE DEPRESSED BECAUSE YOU TOOK AWAY FROM THEM THEIR COPING MECHANISMS THAT THEY USE. OUR ARGUMENT IF WE DO THIS STUDY, PEOPLE WHO ARE DROPPED OUT PEOPLE WHO ARE MOST STRESSED AND YOU GET THESE (INAUDIBLE) WHAT WE SHOW WHEN WE TRY TO SHOW IF PEOPLE WHO ARE UNDER STRESS DO WHAT THE DOCTOR SAYS THERE WILL BE A CASE OF MAJOR DEPRESSION IN A YEAR IF YOU DO WHAT THE DOCTOR SAYS. SO WHAT DO YOU DO? YOU DONE DO WHAT THE DOCTOR SAYS, SO THAT'S THE STUDY WE'RE TESTING AND THEY ALL HAVE THAT FLAVOR TO IT. I'M GOING TO STOP THERE. THANK YOU. [APPLAUSE] >> ARE YOU ABLE TO STAY AROUND FOR A WHILE? >> SURE. (OFF MIC) >> WE'LL GET YOU THERE BUT WE NEED YOU AFTER LUNCH BECAUSE WE WANT THE FOLKS TO ASK A FEW QUESTIONS AN DELVE INTO THIS VERY STIMULATING. WHAT WE'RE GOING TO DO NOW IS TAKE A QUICK PICTURE, VERY QUICK, SO COUNCIL MEMBERS, PLEASE STAY HERE FOR FIVE MINUTES, THEY NEED A COUNCIL PHOTO FOR OUR NIH RECORDS, AND I ASK DR. HUNDREDER IF SHE WILL STAY BACK WITH US, I WILL GET A PICTURE OF COUNCIL AND LEADERSHIP AND THEN WE'LL QUICKLY GO OFF THE LUNCH AND STILL HAVE AN HOUR FOR LUNCH, THEN AS FOLKS GATHER BACK LET'S SEE, WHERE ARE WE NOW? COULD WE ENSURE THAT PEOPLE MAYBE NOT TAKE A FULL HOUR, MAYBE TAKE 50 MINUTES FOR LUNCH AND GET BACK HERE AROUND 12:35. 1:35. DID I GIVE ENOUGH TIME? 1:30678 COME BACK AT 1:30. THEN WHAT WE DO IS WE'LL GET A CHANCE TO ASK DR. JACKSON SOME QUESTIONS WHICH WILL BE IS PREIALABLE TO THE VISIONING SESSION, WE'LL HAVE A COUPLE OF HOURS FOR THAT THEN GO INTO CLOSED SESSION. SO THANK YOU ALL. NIMHD, STAFF, YOU GUYS CAN GET SOME LUNCH BUT BE BACK HERE BY WITHIN THE NEXT 50 MINUTES. WE'RE REQUIRED EVERY TWO YEARS TO BRING TO ATTENTION OF COUNCIL HOW THE INSTITUTE GRANT APPLICATION PROCESS AS WELL AS GRANTS THAT COME IN AND SUPPORTED, HOW IT HAS RESPONDED TO INCLUSION OF WOMEN AND MINORITIES IN CLINICAL STUDIES AS YOU MAY RECALL, THE POLICY WAS PUT IN PLACE AT NIH, WHEN WAS IT, GEORGE? 1993 WAS WHEN THE LEGISLATION CAME UP, THE LANGUAGE CAME UP AND I THINK IT WAS PROBABLY '94 BEFORE WE IMPLEMENTED THE THE POLICY THAT SPECIFICALLY SAID INVESTIGATOR WHOSE SUBMIT APPLICATION TO THE NIH CLINICAL STUDIES ASSOCIATED WITH THEM HAVE TO INCLUDE MINORITIES AND WOMEN, IF NOT DESCRIBE AND EXPLAIN WHY NOT. SO EVERY TWO YEARS, WE PRESENT TO COUNCIL AND THIS HAPPENS ACROSS THE INSTITUTES, THE INSTITUTES REQUIRED TO WE PRESENT OUR BIANNUAL REPORT HOW OUR GRANT FAIRED IN THE AREA OF INCLUSION OF WOMEN AND MINORITIES. DR. DERRICK TABER IS INSTITUTE STAFF WHO HAS BEEN RESPONSIBLE FOR THAT REPORT, THE LAST SEVERAL YEARS AND WE'LL GIVE YOU A BRIEF PRESENTATION TODAY. WHAT WE LIKE FOR YOU TO OBSERVE IS INDEED WHAT DOES THE NUMBERS LOOK LIKE, DO THE NUMBERS LOOK REASONABLE. GIVEN THE APPLICATIONS THAT WE HAVE IN. AND I GUESS WE SHOULD IN THIS CASE TAKE A VOTE WHETHER YOU THINK OUR GRANTEES ARE MOVING THE RIGHT DIRECTION OR NOT. SO WE'LL LISTEN TO DERRICK FIRST TO GIVE AN OVERVIEW HOW WE FAIRED AND I'LL HAVE A DISCUSSION WITH YOU IF YOU CARE TO AND THEN WE'LL TAKE A VOTE WHETHER WE'RE HEADING THE RIGHT DIRECTION OR WE NEED TO DO MORE OR PROGRAM STAFF NEEDS TO BE MORE VIGILANT IN TRYING TO GET PIs TO UNDERSTAND AND APPRECIATE THE INCLUSION PRINCIPLES. SO DR. TABOR. >> THANK YOU. SINCE DR. MADDOX HAS ALREADY GIVEN AN INTRODUCTION WE WILL GO TO THE FIRST SLIDE WHICH LAYS THE KEY ASPECTS OF THE PUBLIC LAW. IN THIS PUBLIC LAW NIH WAS DIRECTED TO DEVELOP GUIDELINES TO ENSURE THE INCLUSION OF WOMEN AND MINORITIES IN CLINICAL TRIALS. THESE ARE THE KEY ASPECTS OF THE LAW. THINK I WANT TO POINT OUT THAT MINORITY GROUPS AN SUBPOPULATIONS MUST BE INCLUDED IN ALL CLINICAL RESEARCH STUDIES. WOMEN AND MINORITIES MUST BE INCLUDED IN PHASE 3 CLINICAL TRIALS. COST IS NOT AN ACCEPTABLE REASON AND NIH SUPPORT MUST SUPPORT OUTREACH ACTIVITIES. TO RECRUIT AND RETAIN WOMEN AND MINORITIES. ACTUALLY WE SUPPORT THIS BY PROVIDING SUPPORT TO THE GRANTEE S, WE ALSO PROVIDE REGIONAL SEMINAR ACE CROSS THE COUNTRY SEMINARS ACROSS THE COUNTRY SPONSORED OUT OF EXTRAMURAL RESEARCH AND IN THERE THEY TEACH A COURSE ON INCLUSION AS WELL AS HUMAN SUBJECTS RESEARCH. PRIOR TO 2015, THIS WAS THE DEFINITION OF CLINICAL RESEARCH, IT'S BEEN SO YOU MAY RECOGNIZE IT, IT HAS BEEN REPLACED BY A NEW DEFINITION THIS IS WHAT WAS IN PLACE FY 2013 AND 2014, THE YEAR WHICH THIS PRESENTATION AND REPORT ON YOUR TABLE, IN YOUR FOLDER REPRESENTS. THIS IS CURRENT DEFINITION OF CLINICAL RESEARCH, ITS WILL BE THE DEFINITION APPLIED GOING FORWARD. SO IN IN 2017 WHEN COUNSEL HAS TO APPROVE THE REPORT THIS WILL BE THE TESTIFY IN ADDITION OFFERED AT THAT TIME. NOTICE STUDIES FALLING UNDER EXEMPTION FOUR ARE NOT CONSIDERED CLINICAL RESEARCH BY THIS DEFINITION, THAT WAS TRUE FOR THE OTHER ONE AS WELL. THIS IS EXEMPTION FOUR, IF YOU HAVEN'T SEEN IT IN A WHILE, IF YOU DO CLINICAL RESEARCH YOU PROBABLY HAVE SEEN IT. BASICALLY IT CONCLUDES IF INFORMATION IS REPORTED BY INVESTIGATOR IN SUCH A MANNER SUCH THAT CANNOT BE IDENTIFIED DIRECTLY OR EDIFIERS LINKED TO THE SUBJECT, IT SATISFIES THIS EXEMPTION. NIH DEVELOPED A POLICY IMPLEMENTATION PAGE FOUND AT THE URL AND THE CLINICAL RESEARCH COVERS THESE AREAS. BASICALLY ALL OF NIMHD'S RESEARCH CONDUCTED BY THESE DIFFERENT PROGRAMS AND OTHERS, AS LONG AS THEY INVOLVE HUMAN SUBJECTS THEY COME UNDER THIS POLICY. SO HOW IS IT WE COMPLY WITH THE POLICY? IN PUB LOOK LAY LAW THERE'S FIVE SECTIONINGS TWO OF THE MOST IMPORTANT DEAL WITH POLICY AND OTHER WITH ROLES AND RESPONSIBILITIES. THIS REALLY SPEAKS TO THE ROLES AND RESPONSIBILITIES OF FUNDED INVESTIGATORS. I'M GOING TO SHOW YOU WHAT WE TO. IN ORDER TO BE COMPLIANT WITH THIS LAW BUT INVESTIGATORS ARE REQUIRED TO DO THESE THINGS. AGENTS ACTUALLY DEVELOPED THE SYSTEM FOR WHICH INDIVIDUALS SUBMIT THIS ELECTRONICALLY, IT'S CALLED THE INCLUSION MAGMENT SYSTEM. WHILE THIS WAS IN FORCE THE YOUTH AND OLDER SYSTEM AND THEY COMMITTED BY PAPER AND IT WAS THEN UPLOADED BY STAFF. WHAT ARE SOME OF THE CHALLENGES WITH INVESTIGATORS COMPLYING WITH THE LAW? THESE ARE SOME OF THE THINGS THAT WE SEE. DATA ENTRY MAYBE INCOMPLETE. IT MA U NOT COME ON TIME IF IT'S IN AN APPLICATION IT'S JUST NOT COMPLETED AND THIS IS NOTED BY THE REVIEWERS AND I'LL SPEAK TO THAT A LITTLE BIT LATER. ONCE THE STUDY HAS STARTED, IT'S OFTEN DIFFICULT SOMETIMES TO TELL WHETHER OR NOT THE STATUS OF THE PROGRAM, WHETHER OR NOT THERE ACTUALLY ENROLLING INDIVIDUALS OR NOT. THERE'S ALSO THE ISSUE OF UNKNOWN CATEGORIES. WE SEEK TO IDENTIFY THE ETHNICITY OF THE PARTICIPANTS AS WELL AS RACE AND THEY CANS ARE INDICATE UNKNOWN FOR GENDER, SEX , UNKNOWN FOR ETHNICITY AND UNKNOWN FOR RACE. SOME CASES THIS GETS TO BE A HIGH NUMBER. ND IT IS A CHALLENGE TO GET INVESTIGATORS TO NOT HAVE SO MANY UNKNOWNS. THE OTHER IS JUSTIFICATIONS. IF THEY PROPOSE TO NOT INCLUDE MINORITIES OR WOMEN IN A STUDY, THEY MAY FAIL TO PROVIDE ADEQUATE JUSTIFICATION. ANY TIME THAT HAPPENS THEY GET WHAT'S CALLED A BAR THAT'S MANAGE TO CLEAR IF WE WANT TO FUND THAT APPLICATION. I'M GOING TO SHOW YOU SOME DATA THAT SHOWS NOT ONLY ARE WE IDENTIFYING WHERE THIS DATA MAYBE LACKING OR WASN'T PROVIDED OR INSUFFICIENT BY THE GRANTEE BY THE APPLICANT AS SUBMITTED BUT ALSO HOW IT'S RESOLVED. IF WE'RE GOING TO FUND THEM AND HOW THAT BAR IS REMOVED. THIS IS A EXAMPLE OF TWO SLIDES I'M GOING TO SHOW YOU THAT SHOW LEVEL OF COMPLIANCE WITH POLICY. I WANT YOU TO NOTICE THE FIRST LINE IDENTIFIES TOTAL NUMBER OF APPLICANTS REVIEWED BY APPLICATIONS REVIEWED BY REVIEW ROUNDS OR BY COUNCIL ROUNDS. WHAT'S IMPORTANT IS HOW MANY HAVE HUMAN SUBJECTS, IT'S ONLY THAT THAT WE HAVE BE CONCERNED ABOUT. THE RAW DEALS WITH INCRUDING MINORITIES AND WOMEN IN CLINICAL RESEARCH IF A STUDY DOESN'T INVOLVE HUMAN SUBJECTS WE DON'T HAVE TO WORRY ABOUT IT BUT IF IT DOES THIS IS WHERE IT'S TALLIED. THE NEXT IMPORTANT MIND HOW MUCH IS APPROVED BY IRG AS SUBMITTED SO 329 OF THE 361 APPLICATIONS DEALT WITH HUMAN SUBJECTS AND OF THOSE, 327 WERE APPROVED. FULLY COMPLIED WITH THE LAW. THAT MEANS THAT ONLY TWO ACTUALLY DIDN'T. THESE CATEGORIES OVER HERE IDENTIFY CATEGORIES WHERE THEY DID NOT SATISFY THE CRITERIA. NAMELY MINORITY ONLY INCLUSION, SEX GENDER ONLY INCLUSION. MINORITY AND SEX GENDER INCLUSION, TOTAL MINORITY INCLUSION, OR TOTAL SEX GENDER INCLUSION. SO BECAUSE REVIEW GROUP DOES WE'RE ABLE TO IDENTIFY WHAT THEY FAILED TO MEET SO IN THIS CASE THOSE TWO APPLICATIONS, FAILED TO MEET THE INCLUSION HERE AND GENDER INCLUSION. WHAT'S IMPORTANT IS THAT WE TOTAL THIS UP AND THAT'S NUMBER OF TOTAL OF TOTAL UNACCEPTABLE APPLICATIONS. WE LOOK AT THIS ROUND, 100%. THIS ROUND 100% SO THE ONLY TWO ROUNDS JANUARY 13th AND AUGUST 13th WHERE THERE WERE UNACCEPTABLE APPLICATIONS. THIS IS 2013, I WILL SHOW YOU THE SAME THING FOR 2014. IN 2014, WHAT I HAVE IS THE MAY, YOU CAN SEE THAT IN THIS ONE THERE'S NOT A PROBLEM AT ALL, THIS ONE, THERE'S NOT A A PROBLEM AT ALL EITHER. IN THIS HOWEVER YOU NOTICE TWO APPLICATIONS HERE FOUR APPLICATIONS HERE THAT WERE NOT ACCEPTABLE. BUT THE QUESTION NOW BECOMES OUT OF THOSE UNACCEPTABLE APPLICATIONS WHICH ARE WE GOING TO FUND. MANY THE JANUARY ROUND 2013 WE CHOSE TO FUND ONE APPLICATION AND THAT'S WHY YOU ONLY SEEP ONE APPLICATION SEE ONE APPROXIMATELY ICATION OUT OF THE JANUARY 13 -- APPLICATION THAT HAD A BAR. IF WE PLAN TO FUND THEM, IF WE PLAN TO FUND THEM, AND THE REASON FOR DOING IT IS TO SHOW WHAT HAPPENS. SO HERE WE WERE GOOD, THIS SHOULD BE HERE, THIS A ARROW SHOWS IN THIS THIS ARROW, IT'S GOOD. IT'S WHAT HAPPENS AS WE GO DOWN. SO EACH LINE HERE, WHERE YOU HAVE AN ARROW, YOU ALSO HAVE THIS H HIGHLIGHTED AREA, THIS IS THANK YOU ACTUALLY A SUMMARY. THESE TWO SHOW THERE IS A PROBLEM BUT THE THING I WANT TO SHOW YOU IS NO MATTER WHAT THE PROBLEM IS, WHAT CATEGORY, BEFORE THIS WAS FUNDED, THE BARS WERE REMOVED THAT'S THE CRUCIAL PART. NOTHING GETS OUT THAT HAS A HUMAN SUBJECTS FLAG OR BAR WITHOUT THAT BAR BEING REMOVED. THAT IS HOW WE DETERMINE WHETHER OR NOT WE'RE IN COMPLIANCE. ALMOST ALL PARTS OF OUR INSTITUTE WHOOSHING ON THIS. -- INSTITUTES WHOOSHING ON THIS. THE CHART IS GENERATE -- INSTITUTES WORK ON THIS. PROGRAMS HAVE TO TAKE ACTION WHERE THERE ARE HUMAN SUBJECTS ISSUES. GRANTS MANAGEMENT AS TO OVERSEE TO MAKE SURE WE HAVE DONE OUR WORK SO BEFORE THEY APPROVE RELEASE, THEY HAVE TO KNOW BARS HAVE BEEN REMOVED. PROGRAM IS NOT 100% RESPONSIBLE FOR IT. IT'S THEIR JOB BUT GRANTS MANAGEMENT MAKES SURE THAT IT'S DONE BEFORE THE AWARD GETS OUT THE DOOR. JUST TO GIVE A SENSE OF HOW MANY TOTAL HUMAN SUBJECTS APPLICATIONS WERE SUBMITED THAT WE FUNDED THEN BUT HAD A BAR. THAT WAS ONE AND ONE, LESS THAN 2% IN BOTH CASES. WE ALSO HAD BEEN LOOKING AT SUMMARIZING HOW MANY MINORITIES ARE INVOLVED IN OUR STUDIES AND WHAT IS THE BREAKDOWN BY MALES AND FEMALE. FEMALES. THIS CHART ALSO TABULATES HOW MANY ARE UNKNOWN. SO YOU CAN START TO SEE THAT THERE'S 65 UNKNOWNS IN THIS PARTICULAR CASE, 315 ALL TOGETHER SO WHAT I HAVE IS MINORITY ENROLLMENT,SO FEMALES. AND NOTICE MORAINAL -- MORE FEMALES THAN MALES. FOR A TOTAL OF 37,043. COMPARED WITH THE OVERALL ENROLL ENROLLMENT FOR FY 13 OF 50,498. SO 73% OF PARTICIPANTS IN NIMHD FUNDED STUDIES IN 2013 WERE FROM MINORITY GROUP BUS THIS IS DOUBLE WHAT YOU TYPICALLY FIND FROM THE NIH WIDE LEVEL OF PARTICIPATION OF MINORITIES. THIS SHOWS THE DATA FOR 2014, FAILED TO POINT OUT THE NUMBER OF PROTOCOLS IS IMPORTANT. 191 IN 2014, 187 IN 2013. AGAIN YOU SEE THAT WE HAVE A VERY HIGH LEVEL MINORITY PARTICIPATION IN LAST AND H HIGH LEVELS OF OF MALES AND FEMALES INVOLVED. IF YOU LOOK AT UP KNOWN IT'S A -- UNKNOWN IT'S LARGE NUMBER COMPARED TO 2013. MAYBE A PARTICULAR STUDY AT PARTICULAR POPULATION WHERE THEY JUST A DO NOT WANT TO IDENTIFY WHAT THEIR RACE IS. AND IT OCCURS ACROSS ALL RACES. I PUT THIS TOGETHER TO GIVE YOU A HISTORICAL PERSPECTIVE WHERE WHERE WE HAVE BEEN IN 2007 VERSUS 2014. IT'S NOT REALLY APPROPRIATE TO SUM IT AND ADD IT BECAUSE EACH YEAR IS DIFFERENT PLUS THE THING IS SOME OF THE COUNTS IN 2013 ARE IN -- COUNTED AGAIN IN 2014. SOME DROP OUT IN 2013 AND THEREFORE I DON'T COUNT IT SO THERE'S DUPLICATES AND SUMMING THEM WOULDN'T MAKE SENSE. SO THIS SHOWED WHAT I TRIED TO SHOW IN MY PRESENTATION IS EXPOSURE FIRST TO WHAT THE LAW IS, SOME OF THE REQUIREMENTS OF THE LAW HOW NIMHD ADDRESSES THOSE REQUIREMENTS AND HOW WE HAVE FULFILLED THE INTENT OF THE LAW. MAKING SURE APPLICANTS ADDRESS INCLUSION POLICY AND THAT ALL CONCERNS ARE RESOLVED BEFORE ANY AWARD IS FUNDED. AT THIS TIME I WOULD LIKE TO TURN IT BACK TO DR. MADDOX. [APPLAUSE] >> THANK YOU. WITHIN THING THE COUNCIL MIGHT WANT TO HEAR AND THEN I'LL ASK FOR QUESTIONS OR COMMENTS, WOULD BE WHAT DOES IT TAKE TO HAVE THE BAR REMOVED. AND HOW MUCH BEAR ACTION WILL STAFF -- INTERACTION WILL STAFF HAVE TO HAVE WITH PI IN ORDER TO GET BARS. AFTER THAT WE'LL OPEN IT. >> REMOVING A BAR CAN BE A LABORIOUS PROCESS OR IT CAN BE A RELATIVELY QUICK ONE. SOMETIMES THEY JUST FAIL TO ADDRESS IT AND SO THEREFORE THEY WILL NEED TO. OTHER TIMES THEY LEFT OUT THE HUMAN SUBJECTS SECTION ENTIRELY THAT'S PROBABLY THE GROSSEST PROBLEM WHERE THEY LEAVE OUT THE ENTIRE HUMAN SUBJECTS SECTION. THE IRG BELIEVES THEY LEFT IT OUT BUT WE BELIEVE IT INVOLVES HUMAN SUBJECTS SO IT'S ON PROGRAM TO CONTACT THAT INVESTIGATOR ONE, ASK THEM TO SUBMIT THE HUMAN SUBJECTS SECTION. IF THEY GIVE EXEMPTION, DOESN'T MATTER, SUBMIT A HUMAN SUBJECTS SECTION SO THEY HAVE TO SUBMIT THE HUMAN SUBJECTS SECTION AND WE HAVE TO APPROVE THAT. THE OTHER THING ONCE WE APPROVE IT AND WE HAVE A TWO PHASE P PROCESS IN OUR INSTITUTE THAT THE PROGRAM OFFICIAL APPROVES IT, THE TUITION DIRECTOR OR THE SUPERVISOR HAS TO APPROVE IT, THEN WEAPON TO SEND IT TO OER TO APPROVE, ONCE OER APRO-S IT, CONNECT CHANGE THE BAR AND THE AWARD CAN BE RELEASED SO THAT'S THE PROCESS. IN SOME CASES, THEY HAVE TO GIVE IT AN INTERMEDIATE CODE WHICH ALLOWS GRANT TO BE MADE BUT RESTRICTS HUMAN SUBJECTS. >> COMMENTS FROM COUNCIL? >> YES. >> I WAS WONDERING IF THE DEFINITION OF MINORITY INCLUDED ASIANS AND PEOPLE OF MIXED RACE? >> IT DOES. IN YOUR REPORT, IN YOUR REPORT, YOU'LL NOTICE THAT ON I THINK IT'S TABLE ONEA AND #B, NOT IN THE SLIDE BACK BUT ACTUAL REPORT. IN THE ACTUAL REPORT IT LISTS THE DIFFERENT RACIAL GROUPS AND ALSO THERE'S A PLACE WHERE THEY CAN INDICATE MORE THAN ONE RACE. >> CAN YOU QUICKLY REVIEW THE REASONS FOR THE CHANGE IN DEFINITION OF CLINICAL RESEARCH BUT WHAT'S ADDED, WHAT WAS TAKEN AWAY AND WHY. >> EXCELLENT QUESTION, I'M NOT SURE I'M IN THE BEST POSITION TO ANSWER THAT. I THINK PART IS DRIVEN BY THE CHANGE IN THE ACTUAL SYSTEM AS WELL AS A CHANGE IN WANTING TO NO LONGER LOOK AT CLINICAL STUDIES LIKE SECONDARY STUDIES FOR EXAMPLE. TREATED A LITTLE BIT DIFFERENT. THIS REMOVES THAT. ANY STUDY THAT IS PROSPECTIVE, THAT'S ONE BIG DIFFERENCE, THE OLD DEFINITION DID NOT HAVE THAT PROSPECTIVE PART IN IT. THIS IS A KEY PART SAYING HOW WE DO CLINICAL STUDIES IS COMPLEX. SOMETIMES WE TAKE EXISTING DATA WHERE WE HAVE IDENTIFIABLE INFORMATION, WHICH MAKE IT IS HUMAN SUBJECTS, SOMETIMES WE JUST USE TODAY, OTHER TIME WE'RE ADDING TO THAT THROUGH A PROSPECTIVE STUDY. SO THE NEW GUIDANCE ADDRESSES ALL THOSE DIFFERENT KINDS OF STUDIES IN DIFFERENT TYPES AND I THINK BETTER REFLECTS REALITY. IS THERE ANY OTHER ADDITION TO THAT? >> SOME OF THE CHANGES ALSO RELATED TO PROBABLY 2012, THERE WAS A DAO INQUIRY HAVING TO DO WITH CLINICAL TRIALS AT NIH AND DURING THAT DISCUSSION IT BECAME CLEAR TO THE WORK GROUP THAT WAS PUTTING TOGETHER RESPONSE JO, THAT THERE WAS FAIR AM OF CONCLUSION WITH APPLICANTS AND NIH ABOUT WHAT'S CLINICAL RESEARCH, WHAT IS REALLY CLINICAL TRIAL. A LOT HAD TO DO IF YOU CAN REMEMBER, YONDER RECK, YOU WANT TO GO BACK TO THAT SLIDE WHERE THEY TALK ABOUT THE SPECIFIC -- BACK ONE SAYING THOSE FROM A TO Z THEY REALLY WANT TO GIVE A LITTLE MORE GUIDANCE BECAUSE THERE WAS CONFUSION OF CONNING THINGS THAT WEREN'T RELATED TO ANY TYPE OF HEALTH RELATED OUTCOME AND WHAT THAT MEANT. A LOT OF APPLICANTS, FINDING IN DIFFERENT WAYS. SO THIS -- THAT PROCESS OF DEALING WITH INQUIRY AROUND CLINICAL TRIAL MORPHED INTO A SENSE A NIH NEEDED TO REDEFINE, BECOME CLEARER ABOUT WHAT IT MEANT BY CLINICAL RESEARCH AND CLINICAL TRIAL. >> IT LOOKS LIKE TWO AND THREE WERE NOT IN THE PREVIOUS DEFINITION. >> NO. LET'S GO BACK TO IT. >> EPIDEMIOLOGICAL BEHAVIORAL HEALTH OUTCOME. >> IN HERE THEY DO TALK ABOUT THIS IS NOT FULLY COMPLETE BECAUSE IN THE PAST THEY MENTIONED EPIDEMIOLOGICAL BEHAVIORAL STUDIES BECAUSE THERE WAS A QUESTION IF I WAS DOING A BEHAVIORAL INTERVENTION OR SURVEY DOES THAT ALSO -- I LOOK AT BEHAVIOR DOES THAT CONSTITUTE DO YOU THINK RESEARCH AND THAT ISSUE WAS YES. I THINK THIS SLIDE IS JUST NOT COMPLETE. >> THAT SLIDE ISN'T COMPLETE. THE OTHER SLIDE, THERE ARE TWO SESSIONS MISSING ON THE OLD SLIDE THE FIRST SLIDE. THIS CAN DEPICT IT A LITTLE BIT MORE CLEARLY BUT AS DR. STINSON WAS ALLUDING TO NIH WAS CLEAR ABOUT WHAT IT MEANT WITH CLINICAL CLINICAL RESEARCH AND CLINICAL TRIALS, WHEN IT COMES TO PHASE 3 CLINICAL TRIALS THERE'S NIH DEFINED PHASE 3 CLINICAL TRIALS SO YOU HAD TO BE VERY CLEAR ABOUT WHAT THOSE THINGS MEANT. A LOT HAS TO DO WITH THOSE STUDY THAT WERE NOT CLINICAL RESEARCH. AND YOU BEGAN TO MIX APPLES AND ORANGES SO THE ATTEMPT WAS TO TRY TO CLEAR THAT UP BETTER. THE OTHER THING TOO IS THAT THOSE STUDIES THAT TEAR RECK WAS SHOWING, THOSE ARE NOT CLINICAL TRIALS REFER TO, THOSE ARE NOT PHASE 3 CLINICAL TRIALS. >> IN YOUR REPORT WE DON'T HAVE PHASE 3 CLINICAL TRIALS. LET ME GO ONE OTHER WAY. BECAUSE IN THIS DEFINITION, THIS SLIDE, THIS IS FROM PREVIOUS DEFINITION. SO IT INCLUDES PATIENT ORIENTED RESEARCH. THAT'S WHAT THAT WAS. BUT CLINICAL RESEARCH INCLUDES OUTCOMES RESEARCH BEHAVIORAL RESEARCH. SO THANK YOU. >> I'M CURIOUS ABOUT THE PERCEPTIONS OF OTHERS BUT I'M PERSONALLY CONCERN HAD THE ROLLING OUT OF THE ELECTRONIC MEDICAL RECORD WILL RESULT IN MORE UNKNOWNS WHEN IT COMES TO RACIAL ETHNIC IDENTITY BECAUSE THERE'S DATA POINTS FORCED TO ELECTRONIC HEALTH RECORD BUT RACIAL ETHNIC IS NOT ONE OF THEM. AND MANY OF OUR STUDIES INVOLVE SEPARATE SURVEYS PATIENT ALSO FILL OUT RECORDING RATE ETHNIC IDENTITIES, MANY OTHER STUDIES INVOLVE DATA MANAGEMENT TO TRY TO AS CERTAIN THAT INFORMATION. THE ELECTRONIC MEDICAL RECORDS DOES NOT PUT EVIDENCE CAPTURING THAT. IS THERE ANY INTEFAITH BETWEEN NINHD AND GOVERNING BODIES? >> OUR EXTRAMURAL STAFF WERE HERE AND OUR EXTRAMURAL STAFF LEADERSHIP MIGHT COMMENT BUT THAT'S AN EXCELLENT POINT YOU'RE MAKING. THIS IS SOMETHING THAT WE NEED TO TALK TO NIH CENTRAL ABOUT. CERTAINLY OFFICE OF EXTRAMURAL RESEARCH WE HAVE STAFF COMMITTEE TO EXPLORE THAT A BIT MORE. MY INTERRING THING FOR ME LOOKING AT THE DATA SEEING HOW THE RACIAL ETHNIC INCLUSIONS THE POPULATIONS ARE DROPPING. SINCE THE TIME WE FIRST INITIATED THE POLICY, THERE COULD BE MANY REASON WISE BECAUSE THE RESEARCH PORTFOLIO LOOKS DIFFERENT THE POPULATIONS WE'RE BRINGING IN BASED ON THE TOPIC AREAS MAYBE DIFFERENT BUT IT COULD BE THE PIs ARE USING THE ELECTRONIC MEDICAL SYSTEMS TO TRY TO CAPTURE SOME OF THESE AND THEY CAN'T CAPTURE. SO WE DO NEED TO FOLLOW-UP ON THAT. >> A LOT OF INVESTIGATOR INVESTIGATORS ARE IMPUGNING RACE ETHNICITY TO DATA AND I THINK IT SHOULD BE USED AS A STANDARD OF EXCELLENCE WITH THE LEVEL TO WHICH THE DATA HAVE COMPLETE SIGNIFICANT -- WE'RE GOING TO SEE (INAUDIBLE). (INAUDIBLE) >> SO AS THE NINHD STAFF, SITS ON THE NIH INCLUSION GOVERNANCE COMMITTEE I WILL PUT IN MY TWO CENTS. WE HAVE ROLLED OUT A NEW SYSTEM OF HOW INVESTIGATORS ARE TO REPORT DATA. BUT ONE OF THE THINGS THAT WE TRIED TO GET AWAY FROM A LOT IS BEING COUNTED AND MORE SO FOCUSING ON WHAT RESEARCH QUESTION IS AND WHATEVER THE DISEASE OR CONDITION IS THAT'S UNDER CONSIDERATION AND WHAT PERCENTAGE OF THE POPULATION IS BEING REPORTED. HAS BEEN SHOWN TO BE IMPACTED BY THAT DISEASE AND CONDITION SO THEN IT BECOMES IMPORTANT IF YOU ARE GOING TO DO A PARTICULAR STUDY ON THIS DISEASE AND CONDITION YOUR TARGET POPULATION SHOULD AT LEAST REFLECT HOW THIS DISEASE IMPACTS THE ACTUAL U.S. POPULATION SO THERE'S A NEW SYSTEM ROLLED OUT, IT WAS ROLLED OUT IN STAGES, THERE'S TRAINING FOR STAFF, THERE'S TRAINING FOR PI, THERE'S TRAINING FOR REVIEW STAFF AND AGAIN, NIH IS TRYING TO GET AWAY FROM BEING -- BUT GETTING TO WHAT IS THE IMPACT ON THE ACTUAL DISEASE AND CONDITION THAT IS BEING CONSIDERED. THE PROCESS AND WHAT'S REFLECTED IN THE DATA THAT DEREK SHOWED US. IS THERE ANY QUESTION THAT COUNCIL WANT US TO ADDRESS SPECIFICALLY BEFORE WE CALL FOR A VOTE TO SEE IF YOU ACCEPT AT LEAST THE DATA? IT IS WHAT IT IS BUT DO YOU THINK OUR STAFF IS GOING AT THIS PRETTY MUCH THE RIGHT WAY. IF YOU DO AGREE I WOULD LIKE A MOTION. TO THAT EFFECT. (OFF MIC) >> BRING IT A LITTLE CLOSER. (OFF MIC) >> I STILL, I WOULD LIKE TO SEE MAYBE EVEN THE CALL FOR THE VOTE TO BE PHRASED A LITTLE BIT DIFFERENTLY. IN PART THAT I KNOW FROM LOOKING AT OTHER PEOPLE WHO ARE DOING WORK. AND WHEN THEY CLAIM THEY HAVE CERTAIN PEOPLE SOMETIMES THE INVESTIGATORS ARE I THINK KNOWINGLY MISREPRESENTING DATA SO THAT IT WILL LOOK BETTER. HOW IN THE WORLD ARE THE STAFF SUPPOSED TO BE ABLE TO KNOW THAT? WE ASSUME THAT EVERYONE IS GOING TO BE ETHICAL BUT IF YOU TALK ABOUT CUTTING OFF GRANT FIGURES, GOING TO AN ACADEMIC CENTER OR SOMETHING ELSE, THEY'RE GOING TO LIE. I KNOW THEY DO. SO I THINK THE QUESTION, I DON'T THINK -- >> WHY DON'T WE STAFF IT THIS WAY. I WOULD LIKE TO NOT SPEND A LOT OF TIME DISCUSSING WHAT YOU JUST SAID BECAUSE THAT GIVE MESS A LOT OF APPOINTMENT SO I WOULD LIKE THE PHRASE IT DO YOU ACCEPT THE STAFF BIANNUAL REPORT. WHEN WE DO THE REPORT BY BIYENIAL DATA. SO WE PRESENT IT TO YOU BY ANNUAL DATA CAN I HAVE A SECOND? ALL IN FAVOR PLEASE SAY AYE. ANY OPPOSED? SEEING NONE, DERRICK THANK YOU. >> THANK YOU. >> THE NEXT ACTION ITEM WHICH LE NEED YOUR CONCURRENCE ON IS REFLECTED IN OUR CONCEPT REVIEW SESSION. FOR THOSE WHO KNOW HOW NIH WORKS YOU KNOW THAT WE COME UP WITH RFAs, FUNDING OPPORTUNITIES ANNOUNCEMENTS ALL THE TIME BUT BEFORE FUNDING OPPORTUNITY ANNOUNCEMENT IS OUT ON THE STREET AND WE HAVE A CONCEPT, WHAT IS THIS FUNDING OPPORTUNITY ANNOUNCEMENT GOING TO BE ABOUT? WHAT ARE THE GOAL? WHAT ARE THE OBJECTIVES, WHAT ARE WE EXPECT TO GLEAN FROM THE RESEARCH. SO BEFORE WE DROP OR WRITE AN RFA AND PUBLIC IT AND GET READY TO SOLICIT APPLICATIONS, WE BRING OUR CONCEPTS TO THE COUNCIL. OUR IDEAS. WHAT DO WE THINK WOULD BE A GOOD APPROACH TO A PARTICULAR AREA OF FOCI OR PARTICULAR RESEARCH QUESTION SO WE HAVE TWO CONCEPTS THAT WE'RE GOING TO BE PRESENTING TO YOU TODAY, THIS SHOULD BE QUICK BECAUSE WE WANT TO KNOW IF YOU LIKE THE IDEA, IF THE IDEAS MAKE SENSE, NOT HOW MUCH MONEY WE PUT IN IT OR TYPE OF MECHANISM EVEN THAT WE'RE GOING TO USE. BUT IS IT A GOOD IDEA, IS THE SCIENCE RIGHT. IS THE OPPORTUNITY RIGHT TO DO THIS NOW. DR. JENNIFER ALVIRAZ AND (INDISCERNIBLE) WILL PRESENT CONCEPT CLEARANCE OF BUILDING PUBLIC HEALTH RESEARCH CAPACITY IN U.S. AFAILIATED PACIFIC ISLANDS. >> THANK YOU, GOOD AFTERNOON, A--DIE WILL PROVIDE MORAL SUPPORT FROM THE SIDE THERE. SO TO START OFF THIS CONCEPT FIRST JUST WANT TO REMIND US OF THE REGION OF THE WORLD WE'RE TALKING ABOUT HERE SO WE ARE TALKING ABOUT A SERIES OF ISLANDS THAT ARE IN BETWEEN THE U.S. WEST COAST AND AUSTRALIA AND CLOSER TO AUSTRALIA SO I THINK THIS REGION IS ACTUALLY SO FAR AWAY SOMETIMES THAT IT LITERALLY FALLS OFF THE MAP WHEN WE'RE THINKING OF THE GEOGRAPHY THAT FALLS UNDER OUR DOMAIN. SO MORE SPECIFICALLY FOR THE U.S. AFFILIATED PACIFIC ISLANDS, THIS INCLUDES THREE SOVEREIGN STATES THAT HAVE A COMPACT OF FREE ASSOCIATION WITH THE UNITED STATES SO THAT MEANS THAT THEY ARE INDEPENDENT NATIONS BUT THAT THE UNITED STATES RESPONSIBLE FOR THEIR HEALTH EDUCATION SECURITY OTHER THINGS. THEY ARE DOMESTIC ENTITIES SO THEY'RE ELIGIBLE FOR FEDERAL DOMESTIC GRANTS. THE REMAINDER OF THE U.S. AFFILIATED PACIFIC ISLANDS ARE TERRITORIES OF THE UNITED STATES GUAM, THE COMMONWEALTH OF THE NORTHERN MARIANNA ISLANDS AND AMERICAN SAMOA. I SHOULD HAVE NAMED THE INDEPENDENT STATES BEING FEDERATED STATES OF MICRONESIA AND MARSHALL ISLANDS. SO SOME BACKGROUND ON THIS CONCEPT, THERE'S A CLEAR NEED FOR RESEARCH CAPACITY BUILDING IN THE USA PI. SO THOUGH THIS REGION IS ELIGIBLE FOR FEDERAL FUNDING THEY MOSTLY RECEIVE FUNDING TO PROVIDE SERVICES THROUGH THE CDC OR SAMSA. VERY LITTLE RESEARCH INVESTMENT IS MADE IN THIS REGION. IF YOU LOOK AT THE NIMHD PORTFOLIO IN PARTICULAR, WE HAVE A SECTOR OF RESEARCH ON U.S. POPULATIONS BUT TEND TO BE THOSE RESIDING IN THE 50 U.S. STATES NOT THE USA PI. OTHER STUDIES LOOKING AT USA PI WHERE USA PI POPULATIONS ARE INCLUDED OFTEN THIS DATA IS AGGRAVATED WITH OTHER PACIFIC ISLANDER POPULATIONS OR NATIVE HAWAII AND OTHER PACIFIC ISLANDERS AND EVEN ASIAN AMERICANS SO THERE'S LESS GRANULAR DATA ON USAPI POPULATIONS. THOUGH THERE ARE SOME DATA SOURCES AVAILABLE MEDICAID, MEDICARE, BRSS FOR EXAMPLE, THESE DATA SOURCES ARE REALLY UNDERUTILIZED AS FAR AS RESEARCH EFFORTS. SO OUR PROPOSAL IS TO USE AS A MODEL SOME GLOBAL HEALTH PROJECTS DO WE HAVE A U-24 PROGRAM RESOURCE RELATED RESEARCH IN MINORITY HEALTH AND HEALTH DISPARITIES. WE HAVE TWO PROJECTS IN THE CARIBBEAN AND WE WANT TO USE THAT MODEL TO SUPPORT WORK IN OTHER UNDERSTUDIED REGIONS LIKE USAPI. SO WHAT WE PROPOSE IS A MECHANISM THAT ALLOWS BOTH CAPACITY BUILDING AS WELL AS DIRECTLY SUPPORTING RESEARCH. SO THE FIRST GOAL OF THIS INITIATIVE WOULD BE TO BUILD CAPACITY OF ORGANIZATIONS IN THE USA PI TO CONDUCT POPULATION HEALTH RESEARCH OR PUBLIC HEALTH RESEARCH. THROUGH THE ENHANCEMENT OF CORE FACILITIES EQUIPMENT OR PERSONNEL, ESTABLISHMENT OF RESEARCH NETWORKS WITHIN THE USA PI AND 50 STATES AND ELSEWHERE. DATA LINKAGES TRAINING ACTIVITIES, DISTANCE LEARNING, MENTOR SHIP OPPORTUNITIES, THESE -- THIS IS A VERY SPREAD OUT AND VERY DISTANT FROM THE MAINLAND US. THE INITIATIVE TO SUPPORT AND EVALUATION IMPLEMENTATION DISSEMINATION STRATEGIES. WE ALSO WANT THE INITIATIVE TO SUPPORT FOUNDATIONAL POPULATION HEALTH RESEARCH IN THE USA PI. NOT JUST PILOT DATA FOR A SINGLE STUDY BUT THE KIND OF RESEARCH THAT COULD REALLY IDENTIFY BASELINE DATA OR PRELIMINARY DATA FOR A NUMBER OF DIFFERENT STUDIES THAT MAYBE DONE IN THE FUTURE. SO SOME TOPIC AREAS MAY INCLUDE THE INCIDENCE OR PREVALENCE OF INFECTIOUS AND NON-COMMUNICABLE CHRONIC DISEASE OR RISK FOR THESE CONDITIONS, THE TYPE AND INTENSITY AND QUALITY OF THE HEALTHCARE RECEIVED HEALTH SEEKING PATTERNS AND BARRIERS TO FORMAL HEALTHCARE AS WELL AS OTHER KINDS OF HEALTH SEEKING PRACTICES AND BEHAVIORS. AND COMMUNITY LEVEL HEALTH NEEDS NOT ADEQUATELY ADDRESSED BY EXISTING SERVICES. SO WE PROPOSE A A COOPERATIVE AGREEMENT THESE ARE NOT RESEARCH INTENSIVE INSTITUTIONS WE'RE TALKING ABOUT HERE, THE NIMHD STAFF WOULD BE INVOLVED IN PROVIDING TECHNICAL ASSISTANCE AND PROGRAMMATIC GUIDANCE FOR THESE INSTITUTIONS. THE ELIGIBILITY WOULD BE LIMITED TO INSTITUTIONS LOCATED IN THE U.S. API. AND ALTHOUGH WE WOULD BE WANT TO ENCOURAGE PARTNERSHIP WE WANT TO MAKE SURE THAT THE HIGHER INTENSITY INSTITUTIONS DON'T TAKE OVER THE EFFORTS OF THESE LESS RESEARCH INTENSIVE INSTITUTIONS SO TO LIMIT THE AMOUNT OF MONEY THAT COULD GO TO THESE PARTNERS. SO THAT IS OUR INITIATIVE, HAPPY TO ANSWER ANY QUESTIONS THAT YOU MAY HAVE. QUESTIONS FROM COUNCIL, COMMENTS? >> THIS IS A VERY IMPORTANT EFFORT IN CALIFORNIA, WE HAVE THE SECOND LARGEST PACIFIC ISLANDER COMMUNITY OUTSIDE OF HAWAII. ROUGH HAVE YOU CONSIDERED COLLABORATING WITH UNIVERSITY OF HIGH HAY SINCE THEY ESTABLISHED INFRASTRUCTURE TO WORK WITH NATIVE POPULATIONS? ALSO AS WAY OF PARTNERING U.S. TRAINED PACIFIC ISLAND RESEARCHERS WITHIN OCEANA? >> WE DIDN'T WANT TO SPECIFY WHAT PARTNERSHIP AHEAD OF TIME WE ASSUME INSTITUTIONS IN HAWAII CALIFORNIA AND OTHER POCKETS OF RESEARCHERS OR OPI POPULATIONS WOULD BE DEFINITELY PRIME CANDIDATES FOR COLLABORATION, AT THE SAME TIME WE WANT TO MAKE SURE THAT THE GRANTEE WAS ONE OF THE INSTITUTIONS IN THE USA PI RATHER THAN THOSE OTHER INSTITUTIONS. >> GREAT IDEA AS WELL. AND THE TELLING STATEMENT IS MOST RESEARCH IS DONE ON POPULATIONS ALREADY ON THE MAINLAND SO TO SPEAK. A LITTLE CONCERNED THIS LAST BULLET. DON'T WANT TO GET INTO THE WEEDS ABOUT MONEY BUT AS YOU BUILD CAPACITY COULD IT NOT TAKE MORE IN TERMS OF RESOURCES TO HELP FORM PARTNERSHIPS BEING CONCERNED ABOUT THAT JUST AS A ASIDE. >> IT'S A TRICKY TO FIGURE THE BUDGET ISSUES IN THIS CASE BECAUSE ON THE ONE SIDE YOU DONE WANT TO FLOOD NON-RESEARCH INTENSIVE INSTITUTIONS WITH MONEY WHO AROUND -- WHO DON'T HAVE THE INFRASTRUCTURE TO HANDLE THAT AMOUNT OF MONEY AT THE SAME TIME YOU DON'T WANT TO PUT THE MONEY IN THE HANDS OF THE MORE RESEARCH INTENSIVE INSTITUTIONS WHO MAY NOT BE ABLE TO FULLY UNDERSTAND THE NEEDS OF THE INSTITUTIONS IN THE USA PI. WE ARE AWARE OF DIFFICULTIES, THIS 15% NUMBER FLUCTUATED OVER TIME WE THOUGHT ABOUT THIS. LINDA. (OFF MIC) (OFF MIC) >> GREAT POINT. THANK YOU. (OFF MIC) (OFF MIC) >> I'M SUPPORTIVE, ME QUESTION IS ON THE PROGRAMMATIC GUIDANCE WHAT ARE YOU THINKING? IT'S PROGRAMMATIC GUIDANCE CONTENT SPECIFIC OR IS IT GENERAL? CAN YOU EDUCATE US A LITTLE BIT ON THAT? >> I'M NOT SURE I UNDERSTAND THE QUESTION. >> YOU PROVIDE PROGRAMMATIC GUIDANCE. MY QUESTION IS PROGRAMMATIC IS A BIG WORD. WONDERING WHETHER OR NOT PROGRAMMATIC CHANNEL OR A SPECIFIC AGENT TA YOU HAVE IN MIND? >> SO WE'RE NOT SPECIFYING AHEAD OF TIME WHAT RESEARCH PROJECT. SO THE PROGRAMMATIC GUIDANCE WOULD BE RELATED TO IF YOU HAVE IDENTIFIED SPECIFIC AIMS FOR A PROJECT HOW TO ACTUALLY ENACT THOSE AIMS AND KEEP WITHIN THE SCOPE OF WHAT YOU TO POSED AND THINGS LIKE THAT. >> SUCCESS FROM NIMHD PART IF THE SEEDS, CANCER WORK, THAT'S WHAT WE'RE THINKING, JUST TRYING TO UNDERSTAND WHAT IS SUCCESS AT THE END OF THE DAY. >> SUCCESS I THINK WOULD BE MORE IF THIS INITIATIVE COULD FOSTER MORE RESEARCH. IT COLLIEIATES RESEARCH NETWORKS. SO RESEARCH IN THE FUTURE AFTER THE PROJECT IS OVER. >> LINDA. >> HIS ASSISTANT KAREN CLOSSEN HAVE DONE A BUNCH OF WORK ON THOSE ISLANDS PRIMARY CANCER BUT SOME CHANGE FROM C CHANGE AND HE WILL GIVE YOU PRACTICAL ADVICE AS WELL AS TRAVELING TIPS FOR GOING TO THE RURAL REGIONS OF SOME ISLANDS TO KEEP IN MIND THESE ISLANDS HAVE TOTALLY INDEPENDENT CULTURES FROM ONE ANOTHER. THEY CANNOT BE GROUPED TOGETHER IN ANY WAY IN PARTS OF ONE ISLAND. CAN'T BE GROUPED WITH OTHER PARTS OF THE ISLAND EITHER. >> BUILDING AND THAT YOU MENTIONED EARLIER THERE ARE A NUMBER OF FEDERAL AGENCIES THAT ARE TASKED WITH HELP, THINKING ABOUT HEALTH WITHIN THESE LOCATIONS LIKE THE CDC AND I'M AWARE OF WHAT'S INVOLVED IN WHAT I'M ABOUT TO SAY SO I WON'T SAY IT LIGHTLY BUT CONSIDER REACHING OUT TO THOSE INSTITUTIONS AS YOU FORM THIS PLAN TO THINK ABOUT WHAT KIND OF ISSUES THEY HAVE EXPERIENCE IN. THAT MAYBE HARD TO ASSESS. >> ABSOLUTELY. I THINK UNLIKE US AT NIH SOME FUNDING AGENCIES HAVE STAFF PLACED IN THOSE REGIONS SO DON'T HAVE THE SAME TRAVEL ISSUES I THINK THAT'S DEFINITELY THE PLAN TO ENGAGE THOSE PARTNERS. >> THESE ARE TYPES OF COMMENTS WE NEED. THIS IS EXACTLY THE LEVEL OF DISCUSSION WE WANT. ONE NOTE OVER THERE. >> CAN ALMOST PREDICT REACTION OF MY COLLEAGUES IN HAWAII AND CALIFORNIA, THAT IS WHY ISN'T THERE AN EFFORT TO TRY TO EXAMINE RISK FACTORS AND PREVALENCE OF CHRONIC DISEASE IN THE EXISTING PACIFIC ISLANDER POPULATION HERE IN THE MAINLAND. SO THIS MIGHT BE AN OPPORTUNITY TO COMPARE PREVALENCE RISK FACTORS AMONG MYGRAND PACIFIC ISLANDERS AND THOSE STILL IN THE NATIVE ISLANDS. >> THE THINKING WAS WE DO HAVE GRANTS THAT GO TO -- WE HAVE GRANTEES IN THE POPULATION IN THE MAINLAND, WE DON'T HAVE ANY GRANT THAT ARE LOCATED WHERE THE GRANTEE IS IN THE -- SO IT'S REALLY UNDERDEVELOPED REGION THAT WE HAVE NOT MADE A SUFFICIENT INVESTMENT. WE FEEL LIKE THERE ARE OPPORTUNITIES TO LOOK AT THESE POPULATIONS WITH EXISTING MECHANISMS. WE ARE -- WE WOULD LIKE TO ENCOURAGE THROUGH THIS INITIATIVE THE USE OF EXISTING DATA WITH US MAINLAND POPULATION S FOR COMPARISON OR HYPOTHESIS TESTING, THAT SORT OF THING. >> WE REALLY HAVE MODELED THIS AFTER THE INITIATIVE WE HAD IN THE CARIBBEAN AND WHAT WE DID THERE WAS THE FOCUS ON BUILDING CAPACITY IN INSTITUTIONS THAT HAVE NOT BEEN RECIPIENTS OF RESEARCH DOLLARS LIKE UNIVERSE OF THE WEST INDIES. AND REALLY THE RESULT OF THAT IS, AND THE WEALTH OF DATA AND THE SYSTEMS THAT THEY WERE ABLE TO DO BY BUILDING SOME PERSIST ING INFRASTRUCTURE IS NOW WE'RE HAVING DISCUSSIONS WITH THEM ABOUT BUILDING ON THAT TO DEVELOP YOUR OTHER RO-1 APPLICATIONS BECAUSE THEY HAVE ACTUALLY COLLECTED A FAIR AMOUNT OF DATA ABOUT POPULATION THERE, THEY ARE THINKING ABOUT THINGS OF DOING THOSE TYPE OF COMPARISONS FROM THAT PERSPECTIVE, WE -- FUND PROJECTS WITH PEOPLE ON MAINLAND U.S. LOOKING AT COMPARING POPULATIONS ON THE CARIBBEAN BUT NOW BECAUSE WE BUILT THAT CAPACITY THERE, WE CAN FUEL ORGANIC GROWTH IN THE RESEARCH ENTERPRISE THERE. WE WANTED TO EXTEND THAT MODEL WE THOUGHT WORKED VERY WELL FOR AREAS THAT WERE REALLY UNDERSUPPORTED. BUT WE'RE IMPORTANT POPULATIONS. >> GREAT DISCUSSION. IN FACT, WE CAN USE SOME OF THIS DISCUSSION ACTUALLY IN THE INTRODUCTION TO THE RFA WHY WE'RE HEADING IN THIS DIRECTION. THIS IS EXACTLY THE LEVEL OF DISCUSSION WE NEED WHEN WE HAVE WE THINK A GOOD IDEA. WE WANT TO BE ABLE TO FLUSH IT NOT A SUCH A WAY THAT APPLICANTS RESPOND AND BEING ELIGIBLE FOR THESE PROGRAMS, ONE THING I HAVE TO TELL YOU CONCEPTS ARE INTENTIONALLY SLIGHTLY VAGUE. IF YOU -- THIS WAS SOMETHING THAT YOU WANTED TO APPLY TO AND YOU HELPED US WRITE IT, YOU WOULD BE CONFLICT AND WE WOULDN'T P ABLE TO ACCEPT YOUR APPLICATION. THIS IS ONE THAT'S UNUSUAL AND YOU PROBABLY WOULDN'T MAKE APPLICATION. THIS IS WHY WE HAVE WE HAVE TO BE CAREFUL HOW WE LAY THEM OUT. DO I GET A SENSE FROM YOU THAT YOU LIKE THE IDEA? COULD I HAVE A MOTION TO APPROVE THE IDEA UNDERSTANDING THE STAFF WILL FLESH IT OUT WITH THE COMMENTS THAT YOU HAVE MADE AND YOU SEE IT BACK HERE AGAIN WHEN IT BECOMES AN RFA. YOU CAN SEE -- SO MOVED. SECOND. ALL IN FAVOR PLEASE SAY AYE. ANY OPPOSED. THANK YOU VERY MUCH. NOW WE HAVE ONE MORE. WE HAVE JENNIFER AGAIN. >> BEFORE I START LYNN TA B CAN YOU EMAIL US ALL THE NAMES THAT YOU, I DON'T KNOW IF I CAUGHT THEM ALL, (OFF MIC) SO THIS IS A MOUSEFUL, THIS CONCEPT IS INSTITUTIONAL FACTORS THAT PROMOTE RESEARCH CAREERS FROM DIVERSE BACKGROUNDS IN THE BIOMEDICAL BEHAVIORAL SCIENCES. MY PARTNER ON THIS INITIATIVE, FURTHER BACK THAN ANYONE. SO AS SOME BACKGROUND, NIH HAS SUPPORTED TRAINING MENTORING AND RESEARCH EDUCATION PROGRAM THAT HAVE BEEN SUCCESSFUL IN FOSTERING THE RESEARCH CAREERS THE INDIVIDUALS AND PROGRAMS. HOWEVER THESE PROGRAMS HAVE NOT SUBSTANTIALLY INCREASED DIVERSITY OF THE BIOMEDICAL RESEARCH WORK FORCE AS A WHOLE. SO SOMETHING MORE THAN THIS NEEDS TO BE OPPORTUNITY, MORE EFFORTS NEED TO BE AT THE INSTITUTIONAL LEVEL TO IMPROVE DIVERSITY IN THE BIOMEDICAL WORK FORCE ON DIFFERENT SCALE. AN IMPORTANT STEP IS WHAT INSTITUTIONS ARE CURRENTLY DOING TO BUILD DIVERSITY. IN THE BIOMEDICAL WORK FORCE. SO THE NATIONAL INSTITUTE ON GENERAL MEDICAL SCIENCES ISSUED AN RFA THAT YOU MAYBE AWARE OF. NOT CURRENT RFA, RESEARCH TO UNDERSTAND INFORM INTERVENTION THAT PROMOTE RESEARCH CAREERS AND STUDENTS BIOMEDICAL BEHAVIORAL SIGNS T. THIS IS AN RO-1 THAT'S ISSUED IN THE PAST. THIS RFA GENERATED IMPORTANT KNOWLEDGE ABOUT RECRUITMENT AND RETENTION OF INDIVIDUALS OF UNDER-REPRESENTED BACKGROUNDS IN BIOMEDICAL RESEARCH CAREERS, PRIMARILY CUSSED ON INDIVIDUAL LEVEL FACTORS SO WHO STAYS IN RESEARCH CAREER, WHAT ARE THE CHARACTERISTICS OF EFFECTIVE MENTORS. FOCUSED LESS INSTITUTIONAL LEVEL EXAMINATION OF POLICIES AND PRACTICES THAT PROMOTE DIVERSITY. ALSO NOT CLEAR WHAT THE FUTURE OF THE RFA IS, SO THERE IS NO REAL MECHANISM NOW AT NIH TO SOLICIT PROJECTS EXAMINING INSTITUTIONAL LEVEL FACTORS THAT PROMOTE DIVERSITY OF BIOMEDICAL RESEARCH WORK FORCE. IT IS POSSIBLE FOR APPLICANTS TO SUBMIT TO PARENT ANNOUNCEMENT BUT THESE APPLICATIONS ARE VERY DIFFERENT FROM THE DISEASE FOCUS APPLICATIONS BEING REVIEWED. THEY KIND OF DON'T HAVE HAVE A NEAT HOME TO BE RECEIVED. AND I DON'T KNOW IF YOU CAN READ THIS BUT THIS IS A LIST OF THE AWARDS MADE THROUGH THE NIGMS RFA. YOU CAN SEE THESE AWARDS TEND TO BE EVALUATION OF A SINGLE PROGRAM. SOMETIMES NIH FUNDED PROGRAM, PRETICKETING WHO STAYS, PREDICT ING WHAT PSYCH LOGICAL EMOTIONAL CHARACTERISTICS OF PEOPLE WHO STAY. FAR FEWER THAT ARE LOOKING AT THE SYSTEMIC LEVEL, THIS THIRD ONE ENHANCING DIVERSITY IN ACADEMIC MEDICINE THROUGH FACULTY NETWORKS, REALLY STANDS OUT AS THE KIND OF PROJECT WE'RE TALKING ABOUT BUT NOT THE PROJECT THAT YOU SEE A LOT OR THAT HAS BEEN SUBMITTED OR FUNDED THROUGH THIS PREVIOUS RFA. SO WHAT WE'RE PROPOSING IS SUPPORT RESEARCH FROM APOLOGETICS THAT EXAMINE ROLE OF INSTITUTIONAL CHARACTERISTICS, POLICIES AND PRACTICES, PROMOTING DIVERSITY IN THE BIOMEDICAL RESEARCH WORK FORCE PIPELINE FROM UNDERGRADUATE TO INDEPENDENT RESEARCH CAREER STAGES. THIS COULD BE ADMISSIONS POLICIES, RECRUITMENT AND RETENTION OF TRAINEE, FACULTY, CURRICULUM, TRAINING OPPORTUNITIES BUT REALLY NOT JUST ONE PROGRAM BUT INSTITUTIONAL LEVEL ACTIVITIES UNDERTAKING TO PROMOTE DIVERSITY. IT'S EDUCATION THE PRODUCTS USING A GREAT RATHER THAN INDIVIDUAL LEVEL DATA. SO RATHER THAN DOES THIS PERSON PERSIST IN BIOMEDICAL RESEARCH CAREER, WHAT ARE THE GRADUATION RATES, PLACEMENT RATES, TENURE RATES, THIS KIND OF THING. THE ULTIMATE GOAL FOR FINDING FORM INTERVENTIONS THAT TARGET KEY INSTITUTIONAL FACTORS INFLUENCING WORK FORCE DIVERSITY AND EXTERNALLY FUNDED TO RECEIVE PROGRAMS LIKE THOSE THE NIH SUPPORTS ARE NOT TARGETED UNDER THIS INITIATIVE SO THE FOCUS IS REALLY WHAT INSTITUTIONS ARE DOING WITH THEIR EXISTING RESOURCES TO PROMOTE DIVERSITY. AND THAT IS THE CONCEPT. >> I THINK THE COUNCIL MEMBERS WANT TO KNOW ONE THING, HOW WILL THIS DIFFER FROM ANY OF THE OTHER PROGRAMS THAT ARE OUT THERE? THIS MOST OF THE OTHER WORK FORCE DIVERSITY PROGRAMS ARE NOT RESEARCH PROGRAM, THEY ARE TRAINING PROGRAMS SO NIH SUPPORTS THE TRAINING BUT DOESN'T DO RESEARCH ON WHATKINE OF THINGS PROMOTE WORK FORCE DIVERSITY. SO THE -- THE NIGMS RFA ALTHOUGH SUCH APPLICATIONS COULD HAVE BEEN SUBMITTED TEND TO FOCUS ON INDIVIDUAL LEVEL FACTORS RATHER THAN SYSTEM LEVEL FACTORS THAT PROMOTE THESE THINGS SO THAT WOULD BE THE BIGGEST DIFFERENCE. COUNCIL. QUESTIONS? >> I HAVE A COMMENT, IT HAS TO DO WITH WOULD THIS BE SERVED BY CON JOINED RO1s? EACH INSTITUTION LOOKING IN AGGREGATE DATA. SO MEANS THAT YOU NEED A LOT OF INSTITUTIONS TO PARTICIPATE TO LOOK AT INSTITUTIONAL FACTORS BECAUSE THE NUMBER OF INSTITUTION IS YOUR NUMBER OF SUBJECTS. SO I'M A LITTLE WORRIED HOW TO STRUCTURE IT SO YOU GET INSTITUTIONS, WILLING TO SHARE THEIR DATA, THE TRY TO USE THIS INFORMATION IN IN A WAY THAT LOOKS AT INSTITUTIONAL FACTORS SO MULTIPLE RO-1s TYPE OF >> THAT IS A POSSIBILITY WE COULD CONSIDER. THERE IS EXISTING DATA OUT THERE ONE COULD DO WITHOUT NECESSARILY GIVING EACH INSTITUTION AN RO-1. WHERE THE ACADEMIC INSTITUTIONS REPORT DATA IN TO iPADS OR THINGS LIKE THIS. WHAT WE PROBABLY NEED TO SORT OUT IS THE LEVEL, ARE WE TALKING MULTIPLE INSTITUTIONS OR ARE THERE WAYS THAT INSTITUTIONS SINGLE INSTITUTION STUDIES WHERE THEY IMPLEMENT AD POLICY AND THEY HAVE DATA BEFORE OR AFTER. SO I THINK WE WILL NEED TO SORT THAT OUT ABOUT WHAT KIND OF SCOPE WE'RE TALKING ABOUT. >> WHAT CHANGED MY MIND MIGHT BE CONSORTIUM SUCH AS THE COMMITTEE ON INTERINSTITUTIONAL COOPERATION OF THE BIG TEN PLUS CHICAGO WHICH ACTUALLY DOES UNDERTAKE A NUMBER OF PROJECTS ACROSS THE CIC FOR VARIOUS PURPOSES INCLUDING DIVERSITY AND SCIENCES, MAYBE THERE ARE SOME NATURAL INSTITUTIONS OR INSTITUTIONAL GROUPS NOT CALLED OUT SPECIFICALLY BY NAME BUT THE CHARACTERISTICS OF THE GROUP MIGHT MEND ITSELF TO COMBINED PROPOSAL OR MAYBE NOT DOING ANYTHING AS A GROUP BUT THERE MIGHT BE NATURAL PARTNERSHIPS OR WORKING RELATIONSHIPS THAT MIGHT FACILITATE A CONSORTIUM EFFORT SO SOMEHOW TO -- IT GOES TO A LITTLE BIT OF WHAT YOU'RE SAYING. IT MAYBE IMPLAUSIBLE ACROSS CERTAIN INSTITUTIONS, BUT ON THE OTHER HAND WE CAN PROBABLY ALL THINK OF NATURAL GROUP LIKE THE UNIVERSITY OF CALIFORNIA WHERE THEY HAVE CAPACITY AT THE SYSTEM LEVEL TO SUPPORT THIS KIND OF WORK ON A SYSTEM LEVEL. >> THERE ARE A NUMBER OF ORGANIZATIONS THAT SERVE A VARIETY OF DIFFERENT WHETHER COMMUNITY COLLEGES OR MINORITY SERVING INSTITUTIONS OR LAND GRANT UNIVERSITIES, THERE'S A LOT OF THOSE INSTITUTIONS THAT I THINK THEY WOULD BE WELL POISED TO DO THIS KIND OF WORK. >> ONE QUICK POINT YOU MIGHT WANT TO LOOK AT. THERE'S ANOTHER NEGMS RFA CALLED MODELING THE SCIENTIFIC WORK FORCE. THERE'S A UO-1 MECHANISM DESIGNED TO ADDRESS THE SAME QUESTIONS ABOUT THE PIPELINE BUT I THINK IT'S DISTINCT FROM WHAT YOU PROPOSE IN THE SENSE YOU'RE INTERESTED IN INSTITUTIONAL CHARACTERISTICS BUT I WAS INVOLVED IN THE ADVISORY ROLE OF WHAT WENT INTO THAT RFA. THERE WAS A COB SHUTS CHOICE TO MAKE ATE U MECHANISM TO ENCOURAGE THIS CROSS COLLABORATION THAT IS BEING TALKED ABOUT HERE. YOU MIGHT ASK HOW THAT WENT. >> I (INAUDIBLE) I DON'T KNOW ENOUGH ABOUT MECHANISMS WHETHER OR NOT THIS WOULD NOT BETTER LEND ITSELF TO A UO-1, I THINK ABOUT IT, NO MATTER WHAT IT REQUIRES SOME INVESTIGATOR, SOME INSTITUTION, MEANINGFUL NOT REALLY USEFUL. IT WILL BE GIVE US THESE DATA AND THE ANSWER IS WELL YOU AND WHOSE ARMY BUT IF YOU COME WITH THE FEDERAL GOVERNMENT BEHIND CHANGE IS DYNAMIC. AND THAT IS MY IMPRESSION WHERE UO-1 IS USEFUL, AND TO CONSIDER ONE FURTHER ECHOS IT. HOW WOULD I DO THIS? IT'S HARD TO FIGURE HOW I WOULD DO IT WITHOUT OFFICIAL BACKING TO GIVE DATA FROM OTHER PLACES. >> THERE IS A SMALL POOL FOR THIS KIND OF WORK. EVERYONE WOULD SAY LET'S DO THIS. THE ORGANIZATIONS THAT REALLY POISED TO DO THIS, WHO HAVE COALITIONS IN PLACE FOR EXAMPLE MOST LIKELY CANDIDATES FOR THIS KIND OF PROGRAM. ALL OF THESE COMMENTS HAVE BEEN EXTREMELY HELPFUL. I THINK WHAT WE'RE GOING TO DO WITH THIS ONE IS TAKE IT BACK TO THE DRAWING BOARD AND HAVE MORE DISCUSSION AROUND IT. WE DID NOT BRING THIS UP IN OPERATION PLANNING SESSION IN LAST SUMMER WHEN WE WENT THROUGH THE MOTIONS OF TRYING TO LOOK AT PLANNING FOR 2016 BUT THIS IS ONE WE LIKE THE IDEA OF WORKING WITH INSTITUTIONS TO LOOK AT SOME OF THEIR INSTITUTION POLICIES THAT MIGHT ADVANCE. BEST PRACTICES BUT I AGREE WITH WHAT WE'RE HEARING. MANY WILL NOT WILLINGLY SHARE SOME OF THIS INFORMATION AND SOME MAY NOT KNOW THEY'RE WORKING WITH THE CONTEXT OF BEST PRACTICE. WE'LL TAKE COMMENTS WE HEARD TODAY AND PROGRAM STAFF WILL WORK TOGETHER TO LOOK AT THIS AGAIN, IF WE DECIDE WE ARE ADAMANT ABOUT MOVING FORWARD ON SOMETHING LIKE THIS, WE'LL BRING IT BACK TO THE JUNE COUNCIL. AT THIS POINT IN TIME WE PLAN TO FUND IT OUT OF 2016 FUNDINGS ANYWAY SO WE HAVE ENOUGH TIME TO DO THAT. >> JUST GOING TO ADD DR. HAMMOND MADE ON THE LAST SET OF COMMENTS ABOUT THE PREVIOUS PROPOSAL, THERE ARE OTHER GROUPS WITH THE SAME DATA EDUCATION DEPARTMENT, AND OTHERS THAT YOU MIGHT WANT TO CONSIDER GETTING SOME DATA INPUT HOW THEY GO ABOUT COLLECTING IT. SOME MANDATORY, SOME NOT, THIS KIND OF THING. THINK ABOUT THOSE TO DESIGN THE GRANT. >> WE DON'T WANT TO DUPLICATE THAT'S ONGOING RE-ENGINEER AGAIN IF THERE'S SOMETHING WE E WORK WITH OR A GROUP WE CAN COLLABORATE WITH WHO HAS SOMETHING UNDERWAY. JENNIFER, THANK YOU FOR THIS. WE HAVE GOT SOME GOOD DISCUSSION OUT THERE FROM YOU AND WE'LL USE THAT IN ONE OF OUR STAFF SESSIONS TO TEASE THIS OUT SOME MORE AND IF WE DECIDE WE WANT TO MOVE FORWARD WE'LL BRING IT BACK TO YOU AT THE JUNE MEETING. [APPLAUSE] >> OKAY. WE HAVE A LOT OF EXCITEMENT STILL LEFT I HOPE. ONE OF THE THINGS THAT WE WANTED TO DO BEFORE WE MOVE ANY FURTHER WITH OUR VISIONING PROCESS IS SHARE SOME OF OUR EXCITEMENT AND IDEAS WITH COUNCIL. AS Y'ALL KNOW AND HAVE HEARD FROM PREVIOUS COUNCIL MEETINGS NIMHD HAS BEEN TAKING A LEAD ROLE TRYING TO DEFINE WHAT HEALTH DISPARITIES RESEARCH IS. WHAT IT IS, WHAT DOES IT SUBSUME, IN TERMS OF POLICIES AND PRACTICES AND APPROACHES AND ALSO WE RECOGNIZE THAT WE HAVE TO WORK WITH THE COMMUNITY AT LARGE TO GET DEFINITIONS STRAIGHT AS WE THINK ABOUT OUR INSTITUTE AND WHAT OUR MISSION IS. WE SAY WE'RE THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. THE SAME MINORITIES THAT WE'RE LOOKING AT THEIR HEALTH STATUS ONCES THAT WE'RE INTERESTED IN LOOK AT WHETHER THERE ARE DISPARITIES, WE HAVE TALKED ABOUT THIS BEFORE THAT MINORITY HEALTH RESEARCH AND HEALTH DISPARITIES RESEARCH IS PROBABLY NOT THE SAME. THEY'RE SWINED, RELATED BUT NOT THE SAME. SO WE HAVE BEEN SPENDING A LOT OF TIME HERE AT THE INSTITUTE TALKING ABOUT THIS, WE TALKED TO AT COLLEAGUES AT OTHER INSTITUTES, THE INSTITUTE DIRECTORS. AND OF COURSE THE MAJOR DRIVE FOR THIS HAS COME FROM WITHIN THE INSTITUTE ITSELF. OUR STAFF HAS SPENT LOTS OF MAN AND WOMAN HOURS IN SESSIONS TALK ING ABOUT OUR VISION FOR HEALTH DISPARITIES AND VISION FOR HEALTH DISPARITIES RESEARCH. DOCTORS MULLEN AND DR. DEBORAH DURANT WHO RUNS OUR OFFICE OF STRATEGIC PLANNING EVALUATION AND ANALYSIS HAVE BEEN THE DRIVERS KEEPING US ON POINT AND MOVING FORWARD. IN THIS INITIATIVE. WE HAD A RETREAT IN JANUARY AND IRENE IS GOING TO PRESENT SOME OF THE DETAILS OF THAT RETREAT WITH YOU. TO HELP US THINK AN APPROACH THAT FOCUS AND STRATEGICALLY DEVELOP APPROACH TO IDENTIFY HEALTH DISPARITIES AS A RESEARCH AREA. AS A DISCIPLINE. WHICH MEANS IF IT'S A DISCIPLINE RESEARCH AREA NEEDS TO COME WITH THE TOOLS AND TECHNOLOGIES AT ANY DISCIPLINE HAS HAS TO HAVE RIGOR ASSOCIATED WITH IT. IT HAS TO BE SOMETHING THAT ONE CAN ACTUALLY MEASURE IN 2015 IF WE'RE LUCKY FOR A VISION STATEMENT AT THE END OF THE YEAR PEOPLE CAN SAY THIS IS WHERE NIMHD WAS IN 2015 BUT IN 2010 GIVEN ITS VISION THIS IS THE DIRECTION THAT NIMHD HOPES TO LEAD THE FIELD WITH HEALTH DISPARITIES RESEARCH. SO I'M GOING TO ASK IRENE TO GIVE AN OVERVIEW HOW WE HAVE GOTTEN TO WHERE WE ARE TODAY. I WILL ASK DR. PETER MCLEISH AND DR. PAULA BRAIDMAN TO COME TO THE TABLE AND BE HERE WITH US AS WE HAVE SOME DISCUSSION AROUND THIS IMPORTANT TOPICKIC. >> GOOD AFTERNOON AGAIN. GLAD TO BE HERE THIS AFTERNOON TO PRESENT THE SCIENCE VISION NIMH IS LEADING FOR FUTURE OF HEALTH DISPARITIES RESEARCH. DR. KEVIN GARDENER AND I WILL BE CO-PRESENTING AND IN OUR TALK WILL PROVIDE THE GOALS AND ROADMAP FOR THE PROCESS. WE WILL APPRECIATE YOUR FEEDBACK. THIS IS WHERE YOU -- EVERYONE HAS TO PUT THEIR THINKING CAPS ON. PROVIDE COUNCIL AND INPUT INTO THIS SCIENCE VISION PROCESS THAT WE ARE EMBARKING ON. SO OUR SCIENCE VISION PROCESS IS ABOUT APPRECIATING THE VALUE OF SCIENCE. SCIENCE AND APPLICATIONS PRINCIPLES CAN BE FOUND EVERYWHERE. BASICALLY HEALTH, SAFETY, OUR HOMES, COMMUNITIES EVEN OUR SOCIAL NETWORKS AND RELATIONSHIP S ARE ALL PROFOUNDLY SHAPED BY TECHNOLOGICAL ADVANCE ADVANCES. THEY'RE SHAPED BY INNOVATION AS WELL AS DISCOVERIES OF SCIENCE. SO WHEN DR. MADDOX FIST ANNOUNCED THE CHARGE FOR NIMHD TO LEAD ON BEHALF OF THE NIH, SCIENCE VISION FOR HEALTH DISPARITIES, WE KNEW THIS WAS THE RIGHT TIME. GIVEN THIS YEAR 2015, MARK IT IS 30th ANNIVERSARY OF THE RELEASE OF THE LAND MARK REPORT THE HECKLER REPORT, THIS WAS A REPORT OF THE SECRETARY'S TASK FORCE ON MINORITY HEALTH ON PLAQUE AND MINORITY HEALTH, IT WAS RELEASED IN 1985. UNDER THE REEDER SHIP OF FORMER SECRETARY HUMAN HEALTH SECRETARY MARGARET HECKLER, IT WAS ALSO THE FIRST CONVENING OF THE GROUP OF EXPERTS BY THE US GOVERNMENT TO CONDUCT A COMPREHENSIVE STUDY OF RACIAL AND ETHNIC MINORITY HEALTH. AND IT REALLY MARKED A SYMBOL FOR SCIENTIFIC CHANGE. SO HERE WE ARE. 30 YEARS LATER TO EMBARK ON THIS SCIENCE VISIONING. SO THE GOAL IS TO BUILD ON CURRENT OBSERVATIONS TO HELP MATURE THE FIELD OF HEALTH DISPARITIES RESEARCH. AND YOU CAN TELL WE HAVE HAD RICH PRESENTATIONS WHICH ARE STIMULATING AND IS REALLY INFORMING OUR MISSION PROCESS, THIS MORNING FROM DR. NORA VOLKOW, FROM PRECISION MEDICINE, AND FROM OUR -- DR. JAMES JACKSON. SO WE'RE REALLY EXCITED WE FEEL THIS IS APPROXIMATE HISTORIC PROCESS WE'RE EMBARKING ON BUT THE QUESTION IS HOW IS THIS GOING TO BE DONE? THE CHARGE IS A BOLD AMBITIOUS ONE. NOT ONLY JUST FOR NIMHD OR NIH BUT THE ENTIRE RESEARCH COMMUNITY, BECAUSE A NEW VISION FOR PREFERRED FUTURE IN WHICH HEALTH IS IMPROVED FOR ALL GROUPS AND EQUITY IS ACHIEVED, WILL ONLY EMERGE IF WE HAVE REVISED SCIENCE VALUES. WE APPRECIATE THE VALUES. IF WE HAVE IMPROVED COMMUNICATION, AND COLLABORATION. WE'RE ABLE TO IDENTIFY MULTI-DISCIPLINARY SYSTEMS AND APPROACHES, AND IN PARTICULAR EMBRACE NEW TECHNOLOGIES. SO THESE ARE FOUR OF SOME FAILURES IN WHICH WE THINK WE NEED TO BUILD UPON IN ORDER TO SHOW THE SIGNS. -- SHOW THE SCIENCE. SO WE THOUGHT ABOUT THE BEST WAY TO SET THIS IN MOTION AND TRY TO AS CERTAIN RESEARCH QUESTIONS AND CROSS-CUTTING SCIENTIFIC AREAS FOR THE DIALOGUE. THE CORE RESEARCH QUESTION INCLUDED THE -- SOME OPPORTUNITIES FOR A TRULY TRANSFORMMATION HEALTH DISPARITIES SCIENCE AGENDA. THE QUESTION WAS SOME OF THE KEY RESEARCH QUESTIONS THAT SHOULD BE GIVEN HIGH PRIORITY BECAUSE KNOWLEDGE IN THOSE AREAS MIGHT INFORM TRANSLATIONAL EFFORTS THAT HAVE HIGH IMPACT ON REDUCING HEALTH DISPARITIES. WE NEED TO LOOK BEYOND TRADITIONAL COLLABORATORS, OSSIFIC DISPRINTS AND APPROACHES THAT MAYBE HELPFUL IN ADDRESSING RATE KALECAL FAILURES -- CRITICAL FAILURES. WE'RE EXCITED ABOUT THE FUTURE BUT WE HAVE TO ASK CHALLENGING QUESTIONS, WHY ARE DISPARITIES SO PERTINENT, ARE WE REALLY DO WE HAVE THE RIGHT MODELS, DO WE HAVE THE RIGHT QUESTIONS. HAVE WE BEEN PROVIDING THE RIGHT QUESTIONS BUT TO THE WRONG -- THE RIGHT ANSWERS TO THE WRONG QUESTIONS. SO BASED ON THAT, THE NIMHD AS DR. MADDOX MENTIONED HAD THE SCIENTIFIC VISIONING RETREAT FOR TWO DAYS TO DELIBERATE ON THE SCIENCE TO LOOK AT WHAT ADVANCES HAD BEEN MADE IN THE PAST DECADE AND DISCUSSED A BROAD, WE HAD FIVE SCIENTIFIC AREAS OF INQUIRY TO DISCUSS WHICH WOULD HELP US TO IDENTIFY SOME SCIENTIFIC AREAS TO MOVE THE PROCESS FORWARD. PARTICIPANTS INCLUDED COLLEAGUES FOR NIMH INSTITUTES AND CENTERS AND THESE WERE THE FIVE AREAS THAT WERE DISCUSSED. WE REALLY WANTED TO -- THE MODEL SYSTEMS IS ONE OF THE AREAS WE KNOW MANY SCIENTIFIC DISCIPLINES ARE GUIDED BY MODELS, COULD BE CONCEPTUAL MODELS THEORETICAL MODELS, OPERATIONAL, AND THESE MODELS ARE BASED ON CONVENTIONAL KNOWLEDGE TO HELP US, PREDICT. AND OPERATIONALLIZE SCIENTIFIC DISCIPLINE SO MODELS, MODEL SYSTEMS ARE AN ESSENTIAL PART OF ANY SCIENTIFIC ACTIVITY. AND DURING THIS SESSION PARTICIPANTS ENGAGED IN RICH DIALOGUE ABOUT THE PREVAILING MODELS, CURRENTLY GUIDED HEALTH POPULATION HEALTH AND HEALTH DISPARITIES, WHETHER THEY LOOKED ALSO AT THE ADEQUACY OF OR APPROPRIATENESS OF THESE MODELS. DEBATING ON EMERGING THEORIES OR KNOWLEDGE, MAYBE NEEDED TO BUILD A FUTURE HYPOTHESIS ON THE SCIENCE ADVANCE THAT WE'RE. EMBARKING ON. AND IT CAME UP WITH SOME CONSENTS THAT WE NEEDED TO CONSIDER INCORPORATE MOVING FORWARD AT NEWER MODELS FOR HEALTH DISPARITY SCIENCE. THERE WAS ALSO A SESSION ON LIFE COURSE SCIENCE IMPROVES SCIENCE DISCIPLINES THAT HAVE PROVIDED INSIGHT INTO THIS EMERGING SO IN THIS SESSION TOPIC SUCH AS EPIGENETICS, PHYSIOLOGY OF CHRONIC STRESS AND ORTHO STATIC LOAD, TELOMERE BIOLOGY DISCUSSED THE SCIENCE OF BEHAVIOR CHANGE WAS ANOTHER TOPIC AREA. WE KNOW BEHAVIORS REALLY STRONG PROXIMAL DETERMINANT OF HEALTH. AND WE PAIRED FROM EARLIER PRESENTATIONS BY DR. JAMES JACKSON AND DR. VOLKOW THAT MOST INDIVIDUALS WHO ROUTINELY ENGAGE IN HEALTH RISK BEHAVIORS KNOW THE RISKY BEHAVIORS ARE DETRIMENTAL TO THEIR HEALTH. IF THE GROUPS FROM DISADVANTAGED BACKGROUNDS AND ENGAGE IN HEALTH RISK BEHAVIORS PUTS THEM AT FURTHER DISADVANTAGE WHICH IS PROBLEMATIC GIVEN THOSE MULTIPLE BURDENS WE ALREADY FACE. SO THE SCIENCE OF BEHAVIOR CHANGE DISCUSSIONS WERE LOOKING AT SOME OF THE TARGET INTERVENTION TARGETS, SOME MECHANISMS OR METRICS THAT ARE RELEVANT TO UNDERSTANDING THOSE MECHANISMS, THOSE CELL CHANGE, CELL REGULATION, REACT -- STRESS REACTIVITY AND RESILIENCE, AND COPING SKILLS ARE THOSE INTERPERSONAL AND SOCIAL PROCESSES THAT INFLUENCE BEHAVIOR. WE KNOW THAT WE ARE ALL COMPLEX MECHANISMS, WE ALL COMPLEX ORGANISMS AND OUR CONCEPT OF BEHAVIOR AND HOW WE EMBARK BEHAVIOR CHANGE THROUGHOUT THE LIFE COURSE IS REALLY HAS TO INCLUDE ALL THOSE SOPHISTICATED INTERNAL COGNITIVE PROCESSES IN ADDITION TO EXTHEREIN OBSERVED ACTIONS. -- EXTERNALLY OBSERVED ACTIONS. WE HAD -- I WAS FASCINATING WITH -- AND I'M SURE MOST OF YOU WERE, WITH DR. VOLKOW'S PRESENTATION WE KNOW TRADITIONAL MODELS OF BEHAVIOR HAS HEAVILY RELIED ON THE BASIC PREMISE OF SOCIAL COGNITION THAT BEHAVIORS RESULT FROM A SINGLE SYSTEM THEY FOUND EXECUTIVE FUNCTION PART AND YOU EITHER HAVE TO CONTROL YOUR BEHAVIOR, WE HAVE ALL LEARNED RECENT AD VASES IN BUREAU OF NEUROSCIENCES. ADDICTION RESEARCH AS WELL AS THE BUREAU OF ECONOMICS. THAT THE BRAIN IS MORE COMPLEX AND THAT THERE IS A MODEL THAT BASICALLY THAT THE BRAIN TWO PARTS OF THE BRAIN WHERE THERE'S NEAR TERM REWARDS OR IMPULSIVE CHOICES OR THERE'S ABSTRACT REASONING PART OF YOUR BRAIN. IMPULSIVE CHOICES OR PREFERENCES FOR SHORT TERM REWARDS RESULTS FROM THAT EMOTION RELATED PART OF THE BRAIN. THAT'S WHAT DR. VOLKOW WAS MENTIONING. SOMETIMES WE LEARNED THAT MOST BEHAVIORS LIKELY RESULT FROM THE INTERPLAY OF IMPULSE FOR IMMEDIATE REWARDS OR THE ABSTRACT REASONING. BUT IN SITUATIONS OF REALLY HIGH STRESS WHERE MOST OF OUR HEALTH DISPARITY POPULATIONS MAYBE SOCIAL DISADVANTAGE AND UNDER HIGH STRESS, THIS IMPULSIVE MODEL USUALLY WILL PREVAIL. SO THERE'S REALLY A LOT OF RESEARCH THAT'S NEEDED IN THIS AREA. TO LOOK AT THE BUREAU OF CHANGE INTERVENTIONS WE'RE EMBARK ON AND WHETHER WE USE THE RIGHT APPROACH. POPULATION HEALTH WAS ANOTHER TOPIC AREA, IT WAS FOCUSED ON THE SCIENTIFIC METHODS AND MEASURES. THE GROUP LOOKED AT CONSTRUCTS, WE'LL TALK ABOUT THAT IN THE NEXT SLIDES. AND SHOW YOU SOME OF THE RESEARCH QUESTIONS THAT CAME UP. SUDDENLY TRANSLATION DISSEMINATION AND IMPLEMENTATION SIGNS WAS AN AREA THAT WE THOUGHT WAS NEEDED TO BE DISCUSSED. TO GAIN NEW INSIGHT INTO HOW WE CAN USE SIGN TO INFORM POLICY AND PRACTICE. SO I THINK AFTER DISCUSSION A LOT OF PRE-PLANNING WORKSHOPS WE KNOW THAT HEALTH DISPARITIES RESEARCH REALLY REQUIRES A VERY RIGOROUS AND TRANSPARENT STRATEGY FOR DETERMINING AND ASSESSING DISPARITIES. THE STRATEGY OF THIS RIGOROUS NEED TO HOLD ACROSS MULTIPLE DIMENSIONS OF THE POPULATION IT NEEDS TO HOLD ACROSS MULTIPLE HEALTH INDICATORS, MORBIDITY, CHRONICITY, PREVALENCE, LIFE EXPECTANCY. IT ALSO NEEDS TO HOLD ACROSS TIME AND LIFE SPAN IN -- TALKING MONTHS OR TALKING GENERATIONAL OR TRANSGENERATIONAL AND ALSO LOOK AT VARIOUS POPULATION SIZES. WE HAVE SMALL POPULATIONS THAT WE ALSO NEED TO LOOK AT HOW MEASUREMENTS OF DISPARITIES ARE CONDUCTED OR INTERACT. DISTRIBUTION OF HEALTH ACROSS THESE DIFFERENT SIZES OF POPULATIONS WITHIN LARGE GROUPS. WE ALSO KNOW THAT WE NEED TO REVIEW ALL THE RELEVANCE OF HEALTH PERTINENT TO INDIVIDUAL FAMILY OR COMMUNITY. SO TALKING SOCIAL CULTURAL ENVIRONMENT AS WELL AS INTERVENING VARIABLES LIFE COURSE TRAJECTORY IN THESE PATHWAYS OF EMBODIMENT. SO THESE ARE FOLLOWING THE SERIES OF PLANNING SESSIONS AND DISCUSSION, ON -- WITH NIH COLLEAGUES, THESE SCIENTIFIC TOPICS CAME TO THE TOP OF THE LIST AS NEEDED FOR DISCUSSION AND WE WILL REVIEW THESE TOPIC AREAS AND WE WILL APPRECIATE YOUR INPUT SO IT'S THE NINE AREAS INCLUDE POPULATION HEALTH, HOW WE NEED TO ADVANCE SCIENTIFIC METHODS AND MEASURES, COMPLEX MODELS AND SYSTEM SIGNS PRACTICE OF CLINICAL TRIALS AND BIOETHICS, BIOLOGY OF CHRONIC STRESS, WHICH INCLUDES BIOLOGY OF DIVERSITY. DEVELOPMENTAL NEUROSCIENCE AND BEHAVIOR, ALONG THE LIFE COURSE. WE HEARD ABOUT ADOLESCENT COGNITIVE BEHAVIOR. PRECISION MEDICINE AND HOW WE CAN INFORM THIS INITIATIVE TO REALLY ANSWER QUESTIONS ABOUT HEALTH DISPARITIES AND IT WAS INCLUDESSED, SCIENCE OF COMMUNITY ENGAGEMENT, DISSEMINATION AND IMPLEMENTATION SCIENCE. AND TEAM SCIENCE. INTO INTERDISCIPLINARY TRAINING. WE SUDDENLY FELT THAT WE'RE NOT LOOKING AT THESE TOPICS IN ISOLATION LOOKING AT ADVANCES MADE TO HELP US REALLY MOVE FORWARD AND DIVIDE MODELS AND STRATEGIES TO ADVANCE THE SCIENCE SO WE NEED TO REALLY -- I SHOULD SAY THAT CATALYZEING ON THE NECESSARY COLLABORATIONS AND DELIVERING RELIABLE TOOLS AND RE SOURCES TO THE HEALTH DISPARITIES COMMUNITY SHOULD BE A MAJOR THEME OF THIS SCIENCE VISION. JUST FOR THE PURPOSE OF THE -- I WAS GOING TO TALK ABOUT THE POPULATION HEALTH BUT FOR PURPOSES OF THE SCIENCE VISIONING PROCESS, WHAT WE TALK ABOUT POPULATION HEALTH, WE REFER TO THIS DEFINITION WHERE HEALTH -- REFERRING TO THE HEALTH OF POPULATION MEASURED BY HEALTH STATUS INDICATORS, AND INFLUENCED BY THE SOCIAL ECONOMIC POLICY AND FISCAL ENVIRONMENT. INFLUENCED BY CULTURE AND HEALTH PRACTICES, RESILIENCY AND COPING SKILLS, HUMAN BIOLOGY AND INVOLVEMENT, EARLY LIFE ADVERSE EVENTS HEALTH AND HEALTH RELATED SERVICES. AS AN APPROACH POPULATION HEALTH FOCUSES ON ANY RELATED CONDITIONS AND FACTORS THAT INFLUENCE BEHAVIOR OF POPULATION OVER THE LIFE COURSE. IDENTIFY SYSTEMIC VARIATIONS AND APPLY THE RESULT IN KNOWLEDGE TO DEVELOP AND IMPLEMENT POLICIES. THIS IS TAKEN BY DAVE AND OTHER COLLEAGUES WORKING ON POPULATION HEALTH. THIS IS ALSO (INAUDIBLE) AND OTHERS DEFYED WHAT POPULATION HEALTH IS, THIS IS THE THINKING AND FOR THE SCIENTIFIC PROCESS THIS IS WHAT WITH WE FOCUS ON WHEN WE TALK POPULATION HEALTH AND WHEN WE TALK ABOUT THE METHODS WE LOOKING AT METHODS THROUGH THIS FIELD. SOP AS A SCIENTIFIC AREA THAT WE WOULD LIKE TO ADVANCE AND HELP ADVANCE HEALTH DISPARITIES SCIENCE WE WERE LOOKING AT IDENTIFYING FEASIBLE HEALTH DISPARITIES REDUCTION METHODS, IDENTIFYING THE METHODOLOGYIES. CONDUCTING MORE RESEARCH TO ACHIEVE A GREATER UNDERSTANDING OF THOSE CAUSAL MECHANISMS, EXCEPT GOOD DIFFERENCES IN RESILIENCE AND DISEASE RISK. WHAT ARE SOME OF THE MODELS AND TOOLS AND THE NEED FOR ADVANCED CONCEPTUAL -- AND OTHER MODELS THAT INTEGRATE THOSE DETERMINANTS IN HEALTH DISPARITIES RESEARCH UTILIZING THE LIFE COURSE PERSPECTIVE. AND DEFINITELY THE REFERENCE POP LATION ANOTHER THING THAT'S IMPORTANT TO REALLY NEED TO HAVE APPROPRIATE STUDY DESIGNS, MULTI-LEVEL INTERVENTIONS, TO PINPOINT THE RELATIVE ENTRY POINTS TO INTERVENTIONS TO LOOK AT APPROPRIATE SCALES, FOR ACHIEVING POPULATION WIDE IMPACTS. SO INFORMING OUR IMPLEMENTATION AND DISSEMINATION SCIENCEER AS WELL AS NEW TOOLS OR APPROPRIATE DATA AND STATISTICAL METHODS FOR EXAMPLE, GEOGRAPHICAL MAPPING, AND THOSE GEOSPATIAL TECHNIQUES. I WANT TO TALK ABOUT ALSO COMPLEX MODELS AND SYSTEM SCIENCE. WE KNOW HEALTH DISPARITIES SCIENCE AND POPULATION HEALTH DEALS WITH SYSTEMS. AND SYSTEMS ARE CONFLICTS AND INDEED ORGANISMS, SOCIETIES AND PUBLIC HEALTH SYSTEMS IN GENERAL ARE COMPLEX ADAPTIVE SYSTEMS. IS THE TERM USED SO VALUABLE INSIGHTS HOW TO UNDERSTAND AND MANAGE THEM CAN BE GAINED FROM THIS NEW AS WE KNOW NEW RELATIVELY INTERDISCIPLINARY FIELD OF COMPLEXITY SCIENCE. WHEN A FIELD IS COMPLEX, IT MEANS SIMPLE SCIENTIFIC TOOLS MAY HAVE LIMITED ABILITY TO SOLVE THOSE PROBLEMS. HOWEVER, WE NEED TO CHOOSE COMPLEX MODELS AND SYSTEM SCIENCE TOOLS WITH CAUTION, THIS IS AN AREA RELATIVELY NEW TO PUBLIC HEALTH RESEARCH AND HEALTH DISPARITIES RESEARCH AND WE ALL REALIZE A NEED FOR MORE TRAINING AND UNDERSTANDING HOW THE FIELD WORKS. BUT INCREDIBLY USEFUL PROVIDING PROCESS GUIDANCE AND MECHANISM TO HEALTH DISPARITIES RESEARCH, OUTCOMES AND PROCESSES AND HOW DIFFERENT COMPLY NATIONS OF ACTIONS -- COMBINATIONS OF ACTS MAY PRODUCE DIFFERENCE RESULTS SO IN A SENSE WE FEEL THEY COULD PROSIDE INSIGHT AND MAKE A HUGE CONTRIBUTION TO ADVANCE HEALTH DISPARITY SCIENCE. SO SOME OF THE SCIENTIFIC OPPORTUNITIES IN FLEX COMPLEXION MODELS, INCLUDE MODEL AGO POACHES TO EPIDESIGN INTERVENTIONS. WE ARE TALKING APPROACHES THAT CAN HELP TIP THE DUAL SYSTEMS AND INFLUENCE DETERMINANTS OF POPULATION HEALTH BY EFFECTIVE POLICY. WE ALSO LOOK AT TECHNIQUES AND DATA AND INFORMATION THAT CAN HELP UNCOVER THE CAUSAL MECHANISMS AS WELL TOOLS OF SYSTEM SCIENCE THAT CAN HELP US UNDERSTAND AND ADDRESS THE SYSTEM. A LOT IS GOING ON IN THIS FIELD OF COMPLEX SCIENCE BUT THE QUESTION REALLY REMAINS WHICH TOOLS HELP US BECAUSE WE KNOW CURRENT LIMITATIONS OF THE SYSTEM AND HAS BEEN E AND I THINK WE -- AS I MENTIONED WE WERE TREADING WITH CAUTION BECAUSE OF THE POTENTIAL THAT WE DO NOT WANT TO CAUSE ANY HARM WITH PUTTING -- MAKING WRONG ASSUMPTIONS IN COMPLEX SYSTEM MODELS, BECAUSE WE KNOW PREDICTION MODELS IN COMPLEX SYSTEMS SCIENCE DOES NOT NECESSARILY REMOVE ANY UNCERTAINTIES. BUT THAT DOESN'T MEAN WE CANNOT TRY TO UNDERSTAND THE SYSTEM AND EXPLORE THE SCIENCE. AND USE THE KNOWLEDGE GAINED FROM DISCIPLINES TO HELP US. IT'S ALSO A FIELD THAT CAN MOVE BEYOND TRADITIONAL PARTNERSHIPS BECAUSE WHEN YOU LOOK AT MODELING THE -- IT ACTUALLY GOES BEYOND THE HEALTH SYSTEM THE LOOK AT NETWORKS TO LOOK AT OTHER FIELDS, EDUCATION AND AGRICULTURE AND ALL THAT. SO THAT'S THE PLAN FOR THIS USING COMPLEX SYSTEM SCIENCE. THE BIOETHICS AND CLINICAL TRIALS I DON'T NEED TO PERSUADE ANYONE, IT'S REALLY WHAT WE WERE LOOKING AT WAS MORE RIGOR IN CLINICAL TRIAL DESIGNS, CONSIDERATION. IN TERMS OF WE TALK ABOUT PRECISION MEDICINE BUT IT'S REALLY ALSO PRECISION SCIENCE WHAT IS CLINICALLY MEANINGFUL INCLUSION OF GROUPS AND RESEARCH STUDIES. IS IT 10%, 20, SHOULD WE CONSIDER THE DISEASE PREVALENCE OF THAT DISEASE CONDITION WHEN DESIGNING THE TRIAL? WHAT ABOUT THE SCALE AND THE SIZE OF EXPOSED GROUP OR AT RISK GROUPS. ALSO GIVEN CONSIDERATION TO REALLY DESIGNING CLINICAL TRIALS THAT ARE CULTURALLY CONGRUENT AS WELL. SO AT THIS POINT I WILL ASK DR. TREVIN GARDENER WHO WILL PRESENT THE NEXT FEW SLIDES AND THEN WE WILL GO ON FROM THERE. >> OKAY. SO FIRST I WANT TO SAY I THOROUGHLY ENJOYED THE VISIONING PROCESS. THE SCIENTIFIC VISIONING PROCESS, IT'S NOT JUST BECAUSE ESSENTIALLY LAB RAT FROM THE INTRAMURAL RESEARCH PROGRAM AND DON'T GET OUT THAT MUCH. IT'S MUCH MORE THAN THAT. I FOUND EACH OF YOU GUYS THE FOLK MS. THE EXTRAMURAL RESEARCH PROGRAM TO BE A RICH KNOWLEDGEABLE RESOURCE OF HEALTH DISPARITIES, SCIENCE EXPERTISE. AND IT HELPED TO SHAPE MY THINKING. YOU CAME TO THE TABLE WITH VERY STRONG OPINIONS. AND YOU WEREN'T AFRAID TO -- YOU WERE NOT SHY. AND YOU WERE READY TO WORK. AND WORK IS WHAT WE DID. WE GOT GRANULAR. WE GOT VISCERAL. WE GOT TRIBAL. WE MOVE FORWARD, IN A WAY THAT WAS PROGRESSIVE, PRODUCTIONTIVE AND IT WAS IN A WAY THAT WAS NOT SIMPLY BY COMING TO AGREEMENT, WE DIDN'T ALL COME TO AGREEMENT. WHAT WE MOVE FORWARD WAS A MUTUAL UNDERSTANDING AND RESPECT FOR OUR DIFFERENT PERSPECTIVES. IF WE WERE MORE THAN A TEAM, WE WERE MORE THAN A TEAM, WE WERE A TRIBE. IT WAS A LOT OF FUN. I REALLY ENJOYED IT. NOW MY -- THE SESSION I PARTICIPATED IN WAS LIFE COURSE SCIENCES SESSION. AND I THINK ONE OF THE FUNDAMENTAL BIOLOGICAL TRUES THAT UNDERPIN OR CHARACTERIZE IT IS LIFE COURSE PERSPECTIVE IS A BIOLOGICAL FACT THAT IS UNAVOIDABLE. INEVITABLE, INAIL I CAN'T BELIEVE, THAT'S THAT THINGS CHANGE. THINGS CHANGE OVER TIME. SO ONE OF THE MAJOR OBJECTIVES OF HEALTH DISPARITIES RESEARCH WITHIN THE LIFE COURSE PERSPECTIVE IS TO DEFINE AND CHARACTERIZE HOW OUR CHANGING BIOLOGY WHETHER IT'S CHANGES THAT OCCUR ACROSS DEVELOPMENT, CHANGES THAT OCCUR THROUGH MAINTENANCE OR CHANGES THAT OCCUR THROUGH DECLINE, HOW THOSE DETERMINANTS, HOW THE FEATURES ARE INFLUENCED BY WHERE AND HOW WE LIVE. WHERE AND HOW WE LIVE. SO BASICALLY THIS PERSPECTIVE OFFERS US A WAY OF LOOKING AT HEALTH, NOT DISCONNECTED STAGES UNRELATED TO EACH OTHER, BUT AS AN INTEGRATED CONTINUUM. IN OTHER WORDS WE WERE FAVORING LONGITUDINAL APPROACHES RATHER THAN CROSS SECTIONAL APPROACHES, IT SUGGESTED A COMPLEXIN ANYWHERE PLAY BETWEEN THE BIOLOGICAL PSYCHOLOGICAL SOCIAL AND ENVIRONMENTAL FACTORS THAT CONTRIBUTE TO HEALTH OUTCOMES. Z AND PROVIDES A WAY TO SNUFF OUT AND IDENTIFY THOSE CRITICAL LIFE SENSITIVE LIFE STAGES OR WINDOWS OF VULNERABILITY THAT ARE AFFECTED BY BIOLOGICAL SOCIAL BEHAVIORAL DETERMINANTS AND HOW THEY CAN HAVE INFLUENCE ON HEALTH DISPARITIES. ARE YOU DOING THIS? YOU CAN. SO SOME OF THE CRITICAL QUESTIONS, CAN WE MEASURE EFFECT OF CHRONIC STRESS DUE TO SOCIAL -- AND UNDERSTAND HOW STRESS EFFECTS HEALTH AND DISEASE ON SET. ALSO HOW TO INTEREST GENERATIONAL HEALTH DISPARITIES DIFFERENCES IN HOW OUR PARENTS LIVED AND WHERE THEY LIVED. HOW THEY IMPACT THEIR OWN INDIVIDUAL LEVEL HEALTH AND CHRONIC DISEASE TRAY CORRECTORRIES. HOW DO EARLY EVENTS AFFECT RISK OF DISEASE AND HEALTH TRAJECTORY IES IN THEIR LIVES AND CAN WE INTERVENE. NEXT SLIDE. THE NEXT FEW SLIDES SOME OF THE PRESSURE POINTS, SOME OF THE AREAS WE THINK WILL HAVE THE MOST IMPACT. AND WE'LL BEGIN WITH EPIGENETICS. EPIGENETIC REGULATION IS SIMPLY A INFLUENCE OR A STABLE CHANGE IN GENE EXPRESSION PATTERNS THAT CAN BE INHERITED. BUT INHERITED IN THE ABSENCE OF CHANGE TO DNA SEQUENCE. MOREOVER, IT'S OFTEN INFLUENCED, IT'S REVERSIBLE AND OFTEN INFLUENCED BY CHANGES IN THE ENVIRONMENT THEREFORE AVOIDABLE. MANY OF THE CHANGES THAT WE -- THAT DRIVE EPIGENETIC REGULATION ARE CHANGES IN CHROMATIN ACCESSIBILITY. THERE ARE DIFFERENT WAYS THIS CAN OCCUR, ONE IS TRUE SLOW CALLANT MODIFICATIONS OF CHROMATIN, SPECIFICALLY DNA HEALTH METHYLATION TO OPEN AND CHANGE ACCESSIBILITY OF THE MACHINERY OF THE NUCLEUS TO CHANGE THE GENE EXPRESSION -- CHANGE EXPRESSION GENE EXPRESSION PATTERNS THAT CAN BE STABLY PASSED ON. THESE EPIGENETIC CHANGES CAN OCCUR ACROSS THE WHOLE LIFE COURSE. IT DEFINES ACCUMULATED EFFECTS, WINDOWS OF VULNERABILITY. EMBRYONIC DEVELOPMENT AND FETAL DEVELOPMENT, GOOD EXAMPLE OF THAT IS IT IS KNOWN THAT FETAL EXPOSURE TO FAMINE DURING THE DUTCH HUNGER WINTER OF 1944 WAS LINKED TO OBESITY IN ADULTHOOD. MOREOVER, THAT OBESITY IN ADULTHOOD WAS LINKED TO CHANGES IN METHYLATION STATUS IN IGF-2 GENE, INSULIN LIKE GROWTH FACTOR 2 GENE. WHAT DRIVES A MAJOR DRIVER OF EPIGENETIC REGULATION THROUGHOUT THE LIFE COURSE IS GOING TO BE THE ACCUMULATION, THE ACCRUAL, AND ANALYSIS OR BIOSPECIMENS TO LOOK AT MARKERS. THE LIFE COURSE PERSPECTIVES DEMAND THAT THAT ACCRUAL, THAT ACCUMULATION OCCUR IN A LONGITUDINAL FASHION. OKAY. NOW, TWO AREAS IN THE AREA OF THE FIELD OF CHRONIC STRESS BIOLOGY ARE TELOMERE BIOLOGY AND ALLO STATIC LOAD. TELOMERES ARE ESSENTIALLY THE HOUR GLASSES OF THE CELL, MAMMALIAN CELLS HAVE LINEAR DNA SO THERE'S A PROBLEM WITH REPLICATION AT THE ENDS SO GRADUALLY THERE IS A SHORTENING OF THE TELOMERES, THE ENDS OF. CHROMATIN. FOR INSTANCE, WE ARE BORN WITH TEN KB, KILO BASES OF TELOMERES. THAT LEVEL, THAT LENGTH OF TELOMERE SHORTENS ABOUT .025 KBs EVER YEAR. DRAMATIC SHORTENING AND OR LOSS OF TELOMERE LENGTH ASSOCIATED WITH EARLY CELLULAR SIB ESSENCE, CAN LEAD TO -- SENESCENCE. CAN LEAD TO IMPAIRED TISSUE REPAIR AND RENEWAL. AND MAJOR TARGET OF STRESS. STRESS CAN CAUSE DIFFERENT EFFECTS ON THE LENGTH OF OUR TELOMERE. SO TELOMERE LENGTH CAN BE SEEN AS BIOMARKER FOR PHYSIOLOGIC STRESS. ANOTHER IMPORTANT AREA IS ALLO STATIC LOAD. SIMPLY PUT, ALLO STATIC LOAD IS BEST WAY IS ESSENTIALLY THE COST OF THE USE OF ADAPTIVE PROPERTIES AND STRATEGIES. OVERUSE OF THE FLIGHT OR FIGHT RESPONSE TO THE HYPOTHALAMIC PITUITARY ADRENAL ACCESS CAN HAVE A COST. THE COST FROM CHRONIC STRESS, CHRONIC WEAR AND TEAR ON THE ORGAN SYSTEMS OF OUR BODY. THE KEY ASPECT OF ALLO STATIC LOAD PROVIDES A WAY TO MEASURE BIOMARKERS, TO GET A BUY LOGICAL READ OUT OF ACTUAL STRESS. PROVIDES A COMMON GROUND FOR BEHAVIORAL SCIENCES AND PHYSIOLOGISTS TO WORK TOGETHER. WE CAN ACTUALLY GET, PROVIDING A MEANS OF A BIOLOGICAL READ OUT, WHAT CAN BE INFLUENCE OF SOCIAL ECONOMIC BEHAVIORAL FACTORS ON THE PHYSIOLOGY OF THE BODY. OKAY. I'M ALWAYS AMAZED BY THE FACT THAT OUR BODIES CONTAIN ABOUT 150 TO 300 TRILLION CELLS. THAT'S AN IMPRESSIVE NUMBER. WHAT'S AS IMPRESSIVE BUT SOME CASES DISTRESSING ONLY ONE-THIRD OF THAT IS HUMAN. THE REST IS MICROBIOME. IT IS A LIVING DYNAMIC PART OF OUR EXISTENCE H. IT INFORMS AND IS INFLUENCED BY THE GENOME METABALOME AND EPIGENOME. IT IS INFLUENCES AND IT IS INFLUENCED BY ENVIRONMENTAL BIOLOGY, SOCIAL CULTURAL FACTORS. THE MICROBIOME IS UNTAPPED AREA THAT IS WIDE OPEN FOR DISCOVERY, IT'S GOING TO LEAD TO MAJOR UNDERSTANDING OF PER TEAR TEAR BIGS -- PERTURBATIONS MAY INFLUENCE DISEASE OR INFLUENCE. IT HAS MASSIVE IMPORTANT IMPLICATIONS FOR HEALTH DISPARITIES RESEARCH. NOW, THE BRAIN UNDERGOES DRAMATIC CHANGES DURING CHILDHOOD THAT CONTINUES ON INTO EARLY ADULTHOOD. AND THAT IS ANOTHER BROAD WINDOW OF VULNERABILITY THAT CAN BE INFLUENCED BY VARIETY OF SOCIAL BEHAVIOR, ECONOMIC AND ENVIRONMENTAL FACTORS. KEY ASPECTS ARE UNDERSTANDING AND IN ESSENCE HOW BRAIN ARCHITECTURE OUR THE BRAIN IS INFLUENCED BY EARLY CHILD, IT WILL INVOLVE CONCEPTS OF DEVELOPMENTAL WINDOWS. ASK QUESTIONS HOW PRE-NATAL CARE HOW PARENT INTERACTIONS AND COGNITIVE STIMULATIONS HAVE AN EFFECT ON THE DEVELOPING BRAIN. CONCEPTS OF LATENCY HAS TO BE ENTERTAINED. WE WILL ASK QUESTIONS HOW CHANGES IN ENVIRONMENT INFLUENCE PLASTICITY COGNITION AND BEHAVIOR. THE FLIP SIDE HOW DO WE LOOK AT HOW THESE PROPERTIES INFLUENCE ARE COGNITIVE DECLINE. SO THESE ARE MAJOR AREAS THAT WE HAPPEN TO BE LOOKING AT. YOU HEARD EARLIER TODAY ABOUT HOW THE BIOLOGY OF I ADDICTION, THE NEUROBIOLOGY OF ADDICTION INFLUENCES THIS PROCESS. I WON'T SPEND A LOT OF TIME TALKING PRECISION MEDICINE BECAUSE YOU GOT A LECTURE FROM ERIC GREEN BUT I WANT TO EMPHASIZE THIS IS AN AREA NIMHD MUST JUMP ON WITH BOTH FEET. WE MUST LOOK AT PRECISION MEDICINE THROUGH THE HEALTH DISPARITY LENS. WE MUST PUT PRECISION MEDICINE IN THE COMPLETE CONTEXT, COMPLETE CONTEXT OF PATIENT. WHERE AND HOW WE LIVE. SOCIAL BIOLOGICAL DETERMINANTS. I SHOULD TELL YOU A STORY. MUST HAVE BEEN FOUR OR FIVE YEARS AGO. MY PRIMARY APPOINTMENT WAS NCI, ABOUT 2010 OR 2011, FOUR YEARS AGO WE HAD A TOWN MEETING AT NCI HAROLD VARMUS WAS SPEAKING. THE WORD PRECISION MEDICINE HADN'T GAINED ANY THEM TEMPO. AND THE PERSONALIZED MEDICINE WAS IN VOGUE. AT THAT MEETING DR. VARMUS MADE TWO COMMENTS, WE SHOULD NEVER USE THE TERM PERSONALIZED MEDICINE AND WE SHOULDN'T USE IMPACT AS A VERB. FOR SOME WE WERE ESSENTIALLY FUNCTIONALLY MUTE FOR A FEW DAYS AS WE RECONSTITUTE OR VOCABULARY BUT IT MADE SENSE. HOWEVER I HAVE TO SAY WE HAVE TO UNDERSTAND HOW ALL CONTEXT WITH THE PATIENT IMPACT THESE DIFFERENT OMES THESE ARE ALTERED BY WHERE AND HOW WE LIVE. SO I WILL CLOSE BY SAYING IN ORDER TO GET MORE PRECISE IN PRECISION MEDICINE WE HAVE TO GET PERSONAL. THAT'S IT. [APPLAUSE] >> WE JUST HAVE THE LAST TWO COMMUNITY ENGAGEMENT, ADVANCE SCIENCE OF COMMUNITY ENGAGEMENT AND I WOULD NOT GO IN TO IT IN THE INTEREST OF TIME BECAUSE I WANT TO ALLOW TIME FOR DISCUSSION. AND LOOKING AT THE SCIENTIFIC AREA OF DISSEMINATION AND IMPLEMENTATION SCIENCE. WE ALSO TALK TEAM SCIENCE, INTERDISCIPLINARY TRAINING WHICH I DISCUSSED IN EARLIER SLIDE. I WANT TO JUMP TO THE PROPOSED TIME LINE, DR. MADDOX PRESENTED THAT IN THE DIRECTORS REPORT. BUT NEXT STEPS HOLDS WORKSHOPS FILL IN YOUR INPUT AND FEEDBACK ON SCIENTIFIC TOPICS. WE PLAN ON HAVING WORKSHOPS BETWEEN MARCH AN JUNE WITH EXTERNAL SCIENTIFIC COMMUNITY. WE WILL ALSO HAVE REQUEST FOR INFORMATION ON SCIENTIFIC AREA AND WOULD LIKE TO ENGAGE STAKEHOLDER COMMUNITY, EVERYONE THAT HAS A STAKE IN THIS PROCESS TO MAKE SURE WE'RE DOING THE RIGHT THING AND WE ARE REACHING OUT IN TERMS OF COLLABORATION. WE LOOK AT SOME PAPERS JULY THROUGH AUGUST AND A LARGE MEETING TO BE CONVENED IN SEPTEMBER 2015. BUT AS DR. MADDOX MENTIONED BY NOVEMBER WE HOPE TO HAVE A SCIENCE VISION STATEMENT AND PUBLICATIONS FOR DISSEMINATION IN JANUARY. SO THAT IS OUR PRESENTATION. AND WE LIKE TO OPEN FOR DISCUSSION. I DID WANT TO MENTION IN YOUR PACKET, IT INCLUDED SUMMARY POWERPOINT PRESENTATIONS ON THE FIVE CROSS CUTTING SCIENTIFIC AREAS OF INQUIRY THAT STAFF WAS CO-LATED AND I WOULD LIKE TO ACKNOWLEDGE THEM, THEY DID A TREMENDOUS JOB IN PULLING THESE MEETINGS TOGETHER AND PLANNING RETREAT AND PLANNING AS WELL AS DR. BRAVEMAN AND DR. MCLEISH. BUT THIS IS OPEN FOR DISCUSSION. WE WELCOME YOUR INPUT AND WOULD LOVE TO HEAR WHAT YOU WANT TO SAY ABOUT THIS PROCESS. THANK YOU. THANK YOU VERY MUCH. [APPLAUSE] >> WE WANTED TO PRESENT YOU WITH SOME OF OUR CONCEPTS. SOME OF THE THINGS THAT WE HAVE BEEN THINKING ABOUT NOW OVER THE LAST TEN MONTHS THAT WE HAVE BEEN ENTERTAINING MOVING FORWARD ON VISIONING AROUND TOPIC OF HEALTH DISPARITIES. SO WHAT WE'D LIKE TO HAVE FROM YOU NOW IS YOUR REACTION TO WHERE WE ARE, SOME OF WHAT YOU HEARD, THE TIME LINE AND I GUESS I SHOULD ADD THAT ONE OF THE THINGS THAT WE WERE HOPING TO GET FROM YOU TODAY BUT RECOGNIZING YOU ARE PARTNERS SO YOU'LL BE CONTINUING TO DIALOGUE WITH US THROUGHOUT THE PROCESS, WE WOULD GET SOME IDEAS FROM YOU IF YOU THINK WE'RE HEADING IN THE RIGHT DIRECTION, THIS F THIS IS A GOOD IDEA, DOES THE FIELD NEED US TO DO THIS. AND LEAD SCIENCE HEALTH DISPARITIES AGENCY. THE OTHER THING WE HOPE TO COME OUT OF THIS, MAYBE NOT TODAY BUT THROUGHOUT THE PROCESS, FIND OURSELVES IN A PLACE TO APPRECIATE WHAT HEALTH DISPARITIES ARE AND WHAT HEALTH DISPARITIES RESEARCH IS. WE DO NEED A DEFINITION. I THINK THAT WE ALL EMBRACE. THE OTHER ASPECT ARE WHAT ARE SOME OF THE COMPONENTS OF HEALTH DISPARITIES, WHAT ARE FACTORS THAT CONTRIBUTE TO RESEARCH AGENDA, WHETHER TOOLS TECHNOLOGY RESOURCES, WORK FORCE, AND WHAT ARE THE HIGH PRIORITY AREAS THAT WOULDN'T SHOULD BE ADDRESSING WITHIN THE CONTENT OF HEALTH DISPARITIES NOT JUST NIMHD, AND ACROSS THE FIELD OF RESEARCH. I WOULD STATE AGAIN SOMETHING I STATED EARLIER TODAY, NIMHD DOESN'T HAVE THE FUNDS TO ARTICULATE AN AGENDA FOR ALL AREAS OF SCIENCE THAT MIGHT BE IMPORTANT SO WE HAVE TO STRATEGIZE AND DETERMINE OUR HIGHEST PRIORITY AREAS SO THIS IS FOOD FOR THOUGHT. I DON'T WANT TO PUT THEM ON THE SPOT BUT DR.'S BRAVE LAND AND MCLEISH HAVE BEEN WITH US THROUGHOUT. THEY COME IN, FLY IN AND OUT AND GIVE INSIGHTS EF ONCE IN A WHILE. I DON'T KNOW IF Y'ALL WANT TO RESPOND FIRST OR WOULD LIKE TOO SEE WHAT COUNCIL HAS TO SAY FIRST. SEE WHAT REACTION FROM THE COUNCIL. >> SO THANK YOU FOR BRINGING THIS UP, IT'S BEEN FASCINATING AFTER HEARING DR.S JACKSON AND GREEN. SEEMS THERE ARE TWO PARTS TO THIS PROCESS AND I CAN'T DECIDE IF FIRST IS HARDER THAN SECOND PART BUT THE FIRST PART FEELS LIKE WHAT'S BEEN DONE WHICH IS TO ASK WHAT ARE PROMISING AREAS TO EXPLAIN HEALTH DISPARITY, AS A RESULT WHAT SHOULD BE AN EXPANSIVE PORTFOLIO THAT TRIES TO GRAPPLE WITH THE SCHOLARSHIP AROUND DISPARITIES AND IDENTIFY DIRECTIONS FORWARD. WHAT I HAVE SEEN THAT'S DONE COMPREHENSIVELY INCLUDING QUOTH HEN SAN FRANCISCO MEDICINE AND MICROBIOME, ALL THAT. I HAVE NO DOUBT THE AX SECRETARIES MATTER TO HEALTH DISPARITIES. THE SECOND PART WHAT NEEDS TO BE DONE OF WHAT MATTERS MOST. IF WELCOME AGREE ALL THIS MATTERS THE QUESTION IS WHAT MATTERS MOST TO REDUCE HEALTH DISPARITIES, AT THE END OF THE INSTITUTE AND BY CRAFTING WHAT MATTERS MOST ONE CAN HELP FIGURE OUT PRIORITY SETTING. DRAMATICS. WHAT MATTERS MOST EXERCISE, IS NOT SO STRAIGHT FORWARD I.'S CERTAINLY YOU WILL DIFFICULT FROM THE METHODS POINT OF THE VIEW AND CONCEPTS POINT OF VIEW. I SUPPOSE MY WORRY ABOUT PART ONE, THE LIFE COURSE APPROACH, INVOLVING ALL ELEMENTS OF INDIVIDUAL DETERMINISTIC WITH ENVIRONMENTAL DEMONISM ALL WHICH IS CORRECT, DISAGREE WITH NOTHING THAT WAS PRESENTED. INTRODUCES THE OPPORTUNITY TO DO A MULTI-TRILLION DOLLARS BODY OF RESEARCH WHICH I'M SURE YOU WOULD BE GLAD TO FUND IF YOU HAD THAT MONEY. THE HARDER QUESTION IS WHERE ONE PUTS FINITE RESOURCES. ONE SHOULD ARGUE FINITE RESOURCES IN GREATEST RETURN ON INVESTMENT. IT'S I HAVEN'T SEEN THAT THINKING HAPPENING SO I'M FRAMING SEEMS TO ME LOU LIKE THAT'S THE NEXT STAGE OF THINKING THAT NEEDS TO HAPPEN. IN THIS CASE MIC (OFF MIC) SEE IF I CAN REACH THIS FAR. I HAVE WHAT MAY SEENs SO TEARIC RESPONSE BUT THOSE WHO KNOW ME KNOW HOW HOW MUCH I THINK ABOUT IT AND WORK IN ADOPTING OR ADAPTING POPULATION HEALTH. AS RELATES TO SMALL POPULATION. AND SPECIFICALLY LGBT PEOPLE. SO I WANTED TO I HEARD THAT EARLIER TALKING SPECIFIC POPULATIONS AND PLACES THAT ARE NOT ALREADY WELL BUILT OUT ON THEIR OWN. JUST AS AN EXAMPLE OF THIS, WE HAVE NOW IN THE WORLD OF LGBT HEALTH A POPULATION OF PEOPLE THAT WE PROBABLY ARE NOT GOING TO SEE AGAIN. PEOPLE IN THEIR '60s AND '80s. PEOPLE WHO CAME OUT AT THE TIME WHEN THERE WAS REALLY NO SAFE PLACE TO BE FOR MOST GAY PEOPLE. SO THE REAL ISSUE NOW THAT'S HAPPENING NATIONALLY IN MANY, MANY PLACES AROUND WHAT TO DO, WITH LGBT ELDERS. WHERE PEOPLE ARE TRYING TO UNLIKE OTHER PEOPLE DON'T HAVE FAMILIES THAT ACCEPT, MANY DON'T ARE CHILDREN OR ARE DISTANCED FROM THEIR CHILDREN SO THEY FIND THEMSELVES WITHOUT KNOWING WHERE THEY'RE GOING TO GO AS THEY AGE. SO WE HEAR STORY ARES ABOUT ELDER GAY PEOPLE WHO MOVE INTO FACILITIES AND ARE THEN NOT ACCEPTED BY THE PLACES WHERE THEY LIVE. THERE MAYBE ONLY ONE OR TWO OTHER GAY PEOPLE THERE, MAYBE PEOPLE DON'T TELL THEM. MANY REPORTS OF HOW PEOPLE ARE SO AFRAID IF THEY LET SOMEONE KNOW WHO IS A CARE TAKER FOR THEM OF THEIR CHARACTERISTICS THEN THEY WILL BE DAMAGED IN SOME WAY. WE HEAR THESE STORIES ALL THE TIME AND WE HAVE INCREASINGLY SOME RESEARCH ABOUT THEM SO I THINK I JUST WANT TO MAKE A POINT THE LIFE COURSE IS NOT THE SAME FOR EVERYBODY. THIS IS ONE PARTICULAR GROUP OF PEOPLE WE NEED TO REPAIR TO WORK FOR AND HAVE ORGANIZATIONS THAT CARE FOR THEM DO THAT IN A WAY PEOPLE DON'T TO GO BACK INTO THE CLOSET. ARE WE SAFE TO DO THAT. BUT WE HAVE TO DO THAT WITHIN OOH SOCIETY THAT DOESN'T MAKE IT EASY FOR THERE TO BE SPECIAL PLACES THAT CAN BE FUNDED, PEOPLE -- THIS PARTICULAR GROUP OF PEOPLE. SO I JUST I MOSTLY WANTED TO SAY THIS BECAUSE I THINK WHEN WE TALK LIFE COURSE WE'RE TALKING ABOUT A LIFE COURSE, A PARTICULAR PERIOD OF LIFE COURSE OF A GROUP OF PEOPLE NOW RECOGNIZED AND ACCEPTABLE IN OUR COUNTRY. WHAT WILL HAPPEN WITH THEM. THIS MAY NOT BE THE ONLY GROUP OF PEOPLE THAT YOU FIND LIKE THAT. SO I'M HOPING IN THE DISCUSSION AROUND POPULATION HEALTH LIFE COURSE SCIENCES, THOSE TWO AREAS WORK TOGETHER, THAT THERE WILL BE A FOCUS ON THE SPECIFICS OF THE GROUPS OF POPULATION, NOT JUST A BROAD STUDY BUT ALL SORTS OF PEOPLE. >> THANK YOU. SPEAKING AS A NON-SCIENTIST, I'M TRYING TO FRAME THIS. MAYBE WEARING A BIT OF MY PAST PUBLIC POLICY HAT AND THINKING ABOUT HOW IT WOULD BE IMPORTANT TO COMMUNICATE THE NEED FOR WHAT THIS ENTERPRISE MINORITY HEALTH DISPARITIES. I WOULD ASK THREE QUESTIONS, WHAT DO WE KNOW CAUSES ABOUT MINORITY HEALTH DISPARITIES AND WHAT LEVEL DO WE KNOW IT. AT THE GENOMIC LEVEL, THE CELLULAR LEVEL AND YOU CAN GO ON LIKE THAT. IT'S NOT ENOUGH TO ASK WHAT DO WE KNOW BUT IT'S ALSO IMPORTANT5rIT ET CETERA. THE SECOND QUESTION I HAD WOULD BE MAYBE ADDRESSING IT A DIFFERENT WAY, THAT WOULD BE WHAT ARE THE MOST CRITICAL HEALTH NEEDS FOR MINORITY POPULATIONS, THAT MIGHT BE A WINDOW AT THE STRATEGIC IDENTIFICATION OF PRIORITIES. SO THAT COULD BE ANOTHER ONE. A THIRD MIGHT BE LOOKING AT THIS AS AN INSTITUTIONAL LEVEL, WHAT IS CRITICAL TO LONG TERM VIABILITY AND SUSTAINABILITY OF A HEALTH DISPARITIES RESEARCH ENTERPRISE IN ADDRESSING THAT WAY YOU'RE LOOKING AT THIS WHAT NIH IS DOING BUT ALSO WHAT MIGHT BE NECESSARY IN OTHER PLACES AND SPHERES AND WITH OTHER INSTITUTIONS AND TO THINK MORE ABOUT THE LONG TERM SUSTAINABILITY OF THE ENTERPRISE AND THAT COULD ALSO MAYBE DRIVE AN AGENDA THAT MIGHT NOT BE CONSISTENT WITH WHAT MIGHT BE DRIVEN BY QUESTIONS I ASK BEFORE BUT MIGHT BE DIFFERENT IN QUALITY, DIFFERENT IN THE WAY ONE MIGHT APPROACH IDENTIFYING DECIDING THE ANSWER TO THE QUESTION. >> WE'RE SUPPOSED TO BE LISTENING NOT RESPONDING. BUT ONE THING I WANT TO MENTION IS YOU TEASED OUT OF ME. WE TALK ABOUT HEALTH DISPARITIES AND ABOUT COMPARING ONE RACIAL ETHNIC GROUP TO ANOTHER AND HOW LONG WILL IT PERSIST AND HOW LONG WILL THE DISPARITY EXIST, IT ALL DEPENDS WHAT MINORITY GROUP YOU'RE TALKING ABOUT OR POPULATION YOU'RE DEALING WITH. SO WE'RE INCLINED TO THINK MORE AND MORE OF POPULATION HEALTH, MEANING THAT WE LEAVE OUT NO POPULATION THAT IS UNDER-REPRESENTED OR UNDER-REPRESENTED IN THE COURSE OF THE HEALTH SYSTEM. I DO THINK WE HEAR MORE NOW ACROSS THE NIH, THAT REALLY IS ABOUT POPULATION HEALTH WHETHER IT'S LGBT COMMUNITY, WHETHER IT'S THE AFRICAN AMERICAN COMMUNITY OR WHETHER IT'S THE ASIAN AMERICAN COMMUNITY, TALK ING MAYBE COLORECTAL CANCER OR SOME TYPE OF GASTROENTERIC DISEASE. SO WE ARE WE ARE VERY INTERESTED IN CONTINUING DIALOGUE WITH EVERYBODY IN THE FIELD. ALSO ASK THE QUESTION ARE WE HEADING IN THE RIGHT DIRECTION. SHOULD BE MORE ABOUT POPULATION HEALTH AND THAT WAY YOU GET THE HEALTH DISPARITIES OF MANY POPULATIONS THAT HAPPEN TO BE IN NEED AT THE PARTICULAR PLACE IN TIME. IRENE WAS CAREFUL TO TALK HEALTH DISPARITIES RELATING TO TIME AS WELL AS LIFE SPAN. AT ONE POINT IN TIME THE POPULATION YOU SEE IS UNDERSERVED OR POPULATION MAY NOT BE ONE. THERE'S DYNAMICS THERE WE NEED TO FLUSH OUT. I MISSED YOU. >> THAT'S FINE. MAYBE IT'S LACK OF COFFEE SO FORGIVE ME, I WAS SUPPOSED TO GET SOME COFFEE P TODAY AND I DIDN'T EVEN IN THE FLIGHT HERE, THE COFFEE MACHINE WAS OUT. SO MIGHT SOUND COMPLETELY OUT OF IT BUT I'M REALLY WORRIED. I THINK YOU HAVE DONE AN AMAZING JOB, DON'T GET ME WRONG BUT I WONDER HOW TRANSFORMATIVE YOU WANT TO BE. I WORRY THE WAY WE GO WE'RE NOT GOING TO BE TRANSFORM ACTIVE AGAIN. SO I WOULD THINK DIFFERENTLY THE APPROACH, ONE THING I THINK PARTNERSHIPS HERE ARE CRITICAL. BECAUSE YOU DON'T HAVE MONEY BUT YOU CAN DO PARTNERSHIPS WITH OTHER INSTITUTES BUILT ON STUDIES WITHIN STUDIES THAT APPROACH DIFFERENT COMPONENTS OF THE DISPARITIES. SECOND THING, I'M VERY WORRIED ABOUT REALLY THINKING MORE NOT ONLY CONCEPTUALLY BUT METHOD LOGICALLY, I THINK ONE OF THE -- I THINK DOING DISPARITIES RESEARCH FOR 20 YEARS, I CAN TELL YOU METHOD LOGICALLY WE DON'T HAVE CERTAIN TOOLS WE NEED. AND I THINK WE KEEP FINDING THE SAME THINGS BECAUSE WE DON'T REALLY -- I THINK INNOVATION IS CRITICAL. THIRD, I THINK THE WAY WE DO RFAs MIGHT BE A LIMITATION AND MIGHT REQUIRE DOING SOP INNOVATION AWARDS, THAT ALLOW PEOPLE TO CREATE THINGS COMPLETELY OUTSIDE THE BOX. THAT ALLOW MORE TRANSFORMATIVE THAN THE TYPICAL POPULATION HEALTH, YOU CAN GET AWARDS TO PEOPLE FOR METHODS, DIFFERENT CONCEPTUAL MODELS TO IMPRO VISE AND IMPLEMENT IN SHORT TERM TO SIGN. I'M WORRIED ABOUT LINGUISTIC INCLUSION, I HEAR A LOT ABOUT BIOLOGY, BIOLOGY, BIOLOGY AND NOT THEY I'M AGAINST IT, DONE GET ME WRONG BUT LIKE IF I CITED A DOCTOR TO COME HOME AND TELL ME WHERE YOU INVEST THE MONEY, GUESS WHAT, HE'S GOING TO TELL MU MUSIC. I WORRY THE PEOPLE THAT WE HAVENAL THE TABLE ARE PEOPLE THAT HAVE VERY SPECIFIC VIEWS ABOUT BIOLOGY BUT THERE'S A LOT OF LANDSCAPE OUT THERE THAT I HAVE HEARD VERY LITTLE, CULTURAL FACTOR, LITTLE ABOUT ENVIRONMENT AND SOCIAL INTERACTION SO I'M VERY WORRIED IF WE DO WITH DO SAME PATH. >> DON'T BE WORRIED. AL YOU MENTIONED IS DISCOVERED YOU JUST DIDN'T HEAR PIECES TODAY. DON'T BE WORRIED. ALL THINGS TO EVERYBODY SO WE'RE NOT GOING TO TRY TO REINVENT THE WHEEL AND LOOK AT SOME OF THE AREAS OF SCIENCE WHEN IT COMES TO HEALTH DISPARITIES THAT THE INSTITUTES COULD BE DOING. WE'RE MAINLY FOCUS ON WHAT I'M CALLING THE HEALTH DETERMINANT WHICH IS COULD BE SOCIAL AS WELL BUT WE HAVE THE DEFINE WHAT HEALTH DISPARITIES RESEARCH IS FIRST. WE MUST DO THAT OR SAY WE'RE NOT IN THE BUSINESS OF BEING AN INSTITUTE. THAT IS GOING TO LOOK AT ELIMINATING AND REDUCING HEALTH DISPARITIES. WE NEED TO SEE WHETHER THIS IS AN AREA NIH SHOULD BE INVOLVED IN. >> JUST TO BUILD ON WHAT EVERYONE HAS SAID ALREADY WHICH I AGREE WITH, TO THINK WHAT IT MEANS IN TERMS OF A WAY TO BE STRATEGIC WITH RESOURCES OF THIS INSTITUTE. ONE IDEA THAT OCCURRED TO ME IS TO TRY TO SEPARATE YOUR VERY NICE LIST OF IMPORTANT AREAS AND NEW AREAS WHERE REAL PROGRESS CAN BE MADE TO A SET OF THINGS GOING ON ALREADY. IN OTHER PARTS OF NIH, ALREADY UNDERWAY, THINGS LIKE PRECISION MEDICINE INITIATIVE AND THERE'S WORK ON THEBIOME AND OTHER OMICS AND THERE IT SEEM IT IS WHOLE INSTITUTE CAN NUDGE EFFORTS TO INCLUDE DISPARITIES FOCUS AS PARTS OF WHAT'S GOING ON FOR PRECISION MEDICINE HAVE DIVERSITY IN COVERAGE AND CO-RESPONDSOR SPECIFIC ELEMENTS OF THOSE THINGS BUT THERE'S ANOTHER SET THAT I HAVE HEARD MENTIONED WHICH MAYBE THINGS THAT JUST GET OVERLOOKED BY WHAT'S GOING ON ELSEWHERE AT NIH VERY IMPORTANT, SO THESE COULD BE THINGS ABOUT SMALL POPULATION GROUPS OUTSIDE THE CONVENTIONAL BOUNDRY OF PUBLIC HEALTH, EDUCATION OR HOUSING OR OTHER THINGS WE HEARD MENTIONED, THINGS THAT CROSS LIGHTS LOST OF SILOS OF SCIENCE THAT INVOLVE FORCED INTERACTION ACROSS FIELDS THAT DON'T TALK TEACH OTHER LOU LIKE SOCIAL SCIENCE AND BIOLOGY OR INVOLVE MULTIPLE LEVELS OF SCALE, MIGHT BE HARD TO JAM TO A RO-1 LINEUP AND THEY MIGHT BE METHODS THAT DON'T EXIST OR NASCENT LIKE SYSTEM SCIENCE OR OTHER METHODS THAT YOU NEED TO BE DEVELOPED WITH AN EYE TOWARD SPECIFIC FUNCTIONAL GOALS RESEARCH. SEEMS SEPARATING LIMITED THINGS TO SORT OF MAKE A TWEAK ON WHAT'S GOING ON ALREADY SORT OF COLLABORATE ACROSS INSTITUTIONS TO LEVERAGE THINGS AND THINGS MORE A PUSH IS NEEDED. >> THE TRANS-NIH COMMITTEE THAT'S MADE UP, ACTUALLY OF OTHER INSTITUTES LEADERSHIP ARE GOING TO BE PROVIDING REGULAR COMMENTS ON THIS PROCESS ACTUALLY, WE HAVE SOME STAFF FROM SOME OF THE OTHER INSTITUTES HERE TODAY SO THEY'RE LISTENNENING ON THIS AS WELL. >> DR. ADAMS. >> I WANTED TO I REALLY THINK THIS IS A REALLY GOOD DIRECTION. I THINK THE THING THAT I WAS THINKING ABOUT IS BUILDING ON SOME OF THE WORK WITH LOW BIRTH WEIGHT WHERE WE HAVE THERE'S A LOT OF RESEARCH DONE ALREADY WITH LOW BIRTH WEIGHT AND CLOSING THE GAP. I THINK ABOUT THE WORK THAT WE DID IN MARYLAND AND WE DIDN'T SEE THE SES VARIATIONS BETWEEN WOMEN OF COLOR, IT WAS THAT THEY WERE COLOR, THEY HAD MORE LOW BIRTH WEIGHT RATE PROBLEMS SO HOW DO WE BEGIN TO UNDERSTAND THAT LOOKING AT THE OTHER LANGUAGE WITH TEAM SCIENCE, HOW DO WE GET INTERDISCIPLINARY TEAM TO TACKLE THIS PROBLEM THAT WE ALREADY KNOW HAVE INFORMATION ABOUT THEN HOW DO WE IMPLEMENT PROGRAMS OF PRACTICE SO WE INFLUENCE LONG TERM POLICY SHIFTS AND CHANGE IT IS WAY WE TAKE CARE OF WOMEN WHO ARE PREGNANT. IT'S A SHORTER TIME FRAME TO SEE IF WE'RE MAKING A DIFFERENCE BECAUSE IT'S NOT LIKE WE -- WE'RE LOOKING AT SOMETHING THAT IS TANGIBLE AND A SHORTER TIME PERIOD TO SEE IF WE CAN REALLY IMPLEMENT -- IF I WERE THINKING ABOUT WHERE TO START THAT'S A GOOD PLACE TO START AND WE HAVE BEEN STRUGGLING TO TRY TO IMPROVE TO TEAL WITH THIS PROBLEM. I HAVE BEEN WORKING ON THIS ISSUE FOR A LONG TIME AND I WOULD LOVE TO SEE HOW WE COULD TACKLE THIS IN A MULTI- DISCIPLINARY WAY LOOKING AT BEST PRACTICES AND HOW TO IMPLEMENT CHANGE WE FUND AND WAY WE PRACTICE. SO THAT'S SOMETHING I WOULD BE INTERESTED IN SEEING TO REDUCE THE GAP BETWEEN PEEP OF COLOR AND WHITE WOMEN AND HOW DO WE BEGIN TO SAY WHAT WORKED AND WHAT DID NOT WORK. AND THERE ARE A LOT OF BIOLOGICAL ISSUES WE WOULD FIND OR NOT FIND IF WE DID THIS WORK. >> TWO COMMENTS. DR. GREEN, SURE, THANK YOU. THAT'S RIGHT SO I CAN'T ADD A LOT TO WHAT'S BEEN SAID BUT TWO THINGS THAT CAME UP, I WAS STRUCK THIS MORNING BY THE FACT THAT THE BIOINFORMATICS WORLD THE MEDICAL RECORD WORLD AND PATIENT WORLD WILL CHANGE IN VERY SHORT ORDER. THOSE ARE THINGS WE HAVE TO TAKE INTO ACCOUNT. AND LITTLE BIT WAS SAID THIS MORNING BUILDING PARTNERSHIPS WITH PATIENTS OR SUBJECTS OR COHORTS WHATEVER YOU WANT TO CALL THEM, THIS IS GOING TO GROW, THIS WILL GIVE US A CHANCE TO AS DR. GREEN TALKED ABOUT HAVE INN RAYTIVE AND TRANSFORMATIVE STUDIES IN KNOWING WHERE WE CAN HAVE THE BIGGEST IMPACT. SO WE'RE TALKING ABOUT LOOKING FOR SIGNAL TO NOISE. WE HAVE ALMOST 40 YEARS OF DATA COLLECTING. AND ONE THING ON THERE ARE SLIDES WITH IMPLEMENTATION SCIENCE HOW WE 'RELATE TO THAT IN THE CONTEXT OF CROSS FERTILIZATION WITH MULTIPLE STUDIES SO I THINK THERE'S REAL OPPORTUNITIES THERE. AND THEN THE FINAL THING, THE NIMHD AND THE NIH CAN PUSH INVESTIGATORS TO BUILD CAPACITY FOR HEALTH DISPARITIES RESEARCH, FIRST TIME WAS INCLUDING MINORITIES IN STUDIES, I WOULD LIKE TO SEE WHAT OTHER INSTITUTES DO, ARE THEY AS CLOSE AS YOU ARE TO HAVING 90%, 99% EFFECTIVENESS IN THIS AREA FOR EXAMPLE SO THOSE ARE REAL OTHER OPPORTUNITIES THAT WE HAVE MISSED ON AS WELL. WE CAN PUSH A LITTLE BIT AND I THINK GET SOME TRACTION THAT MAY HELP INFORM THE VISIONING PROCESS IF YOU WILL. (OFF MIC) >> HOW ABOUT NOW? OKAY. SO THERE ARE A LOT OF THINGS SAID TODAY THAT RESONATED. ING WITHING WITH HOW -- BEING WITH HOW WE SET PRIORITIES. HOW DO WE LEVERAGE, DEVELOP PARTNERSHIPS? AND HOW DO WE USE PERSPECTIVE TO DO THAT? I THINK SPEAKING FROM THE INTRAMURAL RESEARCH PROGRAM WE REALLY HAVE TO LEVERAGE WHAT WE HAVE, WE CAN'T DO EVERYTHING AND THE CHARGE IS TO DO TRANSFORMATIVE RESEARCH THAT CAN'T BE DONE ANYWHERE ELSE SO THE IDEA PRIORITIZING LOOKING AT WHAT WE CAN DO IS REALLY, THAT RESONATES. THAT'S INVOLVES PARTNERSHIPS THAT AREN'T DONE BY OTHER INSTITUTES. HAVING A STRONGER PARTNERSHIP WITH BEHAVIORAL SCIENCE THAT'S ALL PART. SO THAT'S HOW THEY CAN BE TRANSFORMED MAKING USE OF THE TALENTS WE HAVE. OUR ABILITY TO KNOW WHAT ELSE IS GOING ON AROUND US AND TO LEVERAGE THAT. >> I THINK DR. ARNETTE WAS NEXT. YOU WERE NEXT? I THINK SHE WAS BEFORE YOU. BUT GO AHEAD. LET'S LET A GO BEFORE L. DR. ARNETTE THEN DR. LINDA B. >> I AGREE WITH ALL THE RELATIONS PROPOSED. I'M A PERINATAL EPIDEMIOLOGIST AND I'M FASCINATED WITH LIFE COURSE BUT I WANT TO EMPHASIZE THE IMPORTANCE OF DISSEMINATION FROM SMALL POPULATIONS. I WORK WITH NON-OBESE ASIANS WITH DIABETES. IN THE STATE OF CALIFORNIA ASIAN S PACIFIC ISLANDERS COMPLIESER COMPRISE THE SECOND POPULATION. 13% TWICE THAT OF AFRICAN AMERICAN BUS FEW STUDIES ON ASIANS WITH DIABETES. KEISER PUBLISHED A PAPER A YEAR AND A HALF AGO BASED ON TWO MILLION MEMBERS OF AN HMO IN NORTHERN CALIFORNIA AND PACIFIC ISLANDER HAVE THE HIGHEST DIABETES PREVALENCE FOLLOWED BY NUMBER TWO, PHILIPPINO, THREE, ASIAN INDIANS, EXCEEDING PREVALENCE OF DIABETES AKNOCK NATIVE AMERICANS, LATINOS AND AFRICAN AMERICANS SO THIS SHOCKED THE MEDICAL COMMUNITY. AND WHAT WE FOUND -- PUBLISHED TEN YEARS EARLIER WAS THAT WHEN WE MEASURED VISCERAL FAT BY CT SCANS, FILL BY KNOWS WITH 26 END CHOICE LINES HAD THREE TIMES THE VOLUME OF VISUAL ADIPOSE TISSUE COMPARED TO OVERWEIGHT AFRICAN MORN AMERICANS A. OCREA PLACE WITH INDIANS KOREANS AN JAPANESE. RECENTLY THE AMERICAN DIABETES ASSOCIATION ASKED TO ESTABLISH NEW BMI SCREENING CUT POINTS FOR ASIANS. I WAS ONE OF THE FIVE CO-AUTHORS, IMPLEMENTED IN JANUARY OF THIS YEAR. SO MY CAUCASIAN PHYSICIAN KNEW THE GUIDELINES. I DON'T KNOW HOW EFFECTIVELY THAT'S BEEN DISSEMINATED ACROSS THE NATION. SO AS LONG AS WE ARE PUBLISHING IN JOURNALS THAT THE LAY AUDIENCE DOESN'T READ, DISSEMINATION BECOMES VERY ESSENTIAL AND URGENT. >> DR. (INDISCERNIBLE) AND DR. RIVERS. >> I HAVE A LIST OF THINGS. I HAVE SOME STUDIES LOOK AT PROPENSITY SCORE, >> MICROPHONE. >> LINDA BLARE EXORCIST REACTION IN ME FOR A LOT OF IT AND NOT CERTAIN WHAT TO DO BUT IT'S FASCINATING. BUT I WOULD LIKE TO SEE FUTURE STUDIES LIKE THAT BECOME THE MODEL. AS YOU TALK UNDERSERVED ASIAN COMMUNITIES IN CALIFORNIA OR AMERICAN INDIANS, ANYWHERE WE HAVE UNIQUE PATTERNS. 50% ARE (INAUDIBLE). WE HAVE THE HIGHEST INFANT NORMALITY RATE OF ANY COMMUNITY. SHOW WATER BAY HAS 15% MORTALITY RATE. YOU ARE LOOK AT 70% TOBACCO PRE-LENS IN NORTHERN PLAINS AN AMERICAN INDIAN. HIS STUDY COULD BE USED TO BRANCH OUT TO LOOK AT TIP PINOPOPULATION OR VIETNAMESE POPULATION OR AMERICAN INDIAN POPULATION. I THINK SOCIAL DETERMINANTS ONLY ASK FOR PRIORITY, SOCIAL DETERMINANT PROJECTS THAT REALLY GOING TO CHANGE THE ENTIRE ENVIRONMENTS WHERE PEOPLE LIVE IS PHENOMENAL FOR PEOPLE WHO LIVE IN URBAN AREAS AND UNDERSERVED URBAN AREAS YOU CAN FIND A SAFE PLACE TO EXERCISE. YOU CAN FIND PLACE TO GET QUALITY FOOD IS WONDERFUL AND IS VERY IMPORTANT TO SUPPORT THOSE YET AT THE SAME TIME I DON'T WANT YOU TO FORGET THAT MANY OF UNSERVED NOT UNDER UNSERVED PEOPLE LIVE IN RURAL AND FRONTIER AREAS. SO WE NEED BALANCE IN THE FUTURE. LET'S SUPPORT SISTER-IN-LAW DETERMINANT BUS NOT WHO ARE DYING AT COMMON EXORBITANT RATES. AS THE CONCEPT MOVES FORWARD AND YOU GET READY TO PUT IN THE LANGUAGE THAT NONE OF US HAVE ACCESS TO, I WOULD REALLY LIKE TO SEE LANGUAGE YOU MUST PARTNER WITH AN ACADEMIC ORGANIZATION OR IT MUST -- YOU MUST BE A BEGINNING PROJECT, EXAMPLE WHEN YOU SAY YOU MUST PARTNER FOR ME, I'M SORRY, I AM RESEARCHER, I'M A COMMUNITY BASED NON-PROFIT CORPORATION, WHEN YOU MAKE ME PARTNER WITH UNIVERSITY I'M GIVING AWAY HUNDREDS OF THOUSANDS OF DOLLARS BECAUSE THEY'RE INDIRECT RATE AND OTHER CRAP. I CAN HERE PEOPLE FOR CONSULTANT TO DO WHAT I NEED DO AND NOT BE FORCED TO HAVE A FORMAL RELATIONSHIP SIMPLY LIKE WHEN THE NAVIGATION RFA CAME OUT ABOUT TEN YEARS AGO THE LANGUAGE SAID YOU HAD TO BE BEGINNING PROJECT. WE HAVE BEEN DOING NAVIGATION FOR EIGHT YEARS BEFORE THAT HAD COME OUT. WE WERE TOLD WE WERE INELIGIBLE. JUST BECAUSE YOUR STAFF MAY NOT KNOW WHAT'S GOING ON AT THE TIME TO PUT IN A WORD SUCH AS YOU MUST BE NEW TO THIS, ACCIDENTLY ELIMINATES THOSE WHO MAY HAVE A GOOD FOOT UP WHAT THE WORK IS. SO BE CAREFUL AND THINK ABOUT JUMP A LITTLE BIT ABOUT WHAT THE LANGUAGE SHOULD BE. ALSO ON THE PERSONALIZED MEDICINE DIFFERENT BULLETS CAME UP ON THESE SLIDES THAT IRENE WAS SHARING, THE OTHER GROUP. PERSONALIZED MEDICINE MOST KNOW INDIAN COUNTRY HAS SOME COMMUNITIES OPPOSED TO GENETIC SPECIMEN NAVAJO NATION IS THE MOST OUTSPOKEN BUT THE CONCERNS ARE NOT OPPOSED TO SCIENCE THEY'RE OPPOSED TO INSUFFICIENT PROTECTIONS OF INDIVIDUAL PRIVACY AND TRIBAL NATIONS PRIVACY AND PROTECTIONS. MAKE CERTAIN YOU REALIZE OTHER COMMUNITIES WANT TO BE INVOLVED IN THOSE ACTIVITIES AND THE FIRST TIPPING PLACE TO START THAT ARE THE FIVE FEDERALLY RECOGNIZED TRIBES IN MONTANA. THEY HAVE TAKEN PART IN THE FARM SEW GENETIC STUDY AS COMMUNITY BASED PARTICIPATORY RESEARCH, A WIN WIN PARTNERSHIP WITH THE TRIBAL NATIONS AND THE OTHER UNIVERSITY AND SO JUST BECAUSE IT LOOKS LIKE THERE'S A BARRIER, AVOID THE MACE TAKES OTHER INSTITUTES DO AND GENERALIZE THINKING ALL OF US, ANY CULTURES ARE UNIQUE. AND KEEP IN MIND THE CULTURE UNIQUENESS THAT SOME OF THE LANGUAGE INTO THE RFA MAY ACCIDENTLY ELIMINATING A SOMETHING IS A UNIQUE. WE LOOK AT THE GAY LESBIAN TRANSSEXUAL COMMUNITY THEY'RE A UNIQUE CULTURAL INSHOES AND THEY'RE NOT THE -- ISSUE AND THEY'RE NOT THE SAME AROUND THE COUNTRY, THEY'RE DIFFERENT IN FLORIDA AS COME POWERED TO COLORADO. USE THE DETECTTORS AND SAY HAVE WE INADVERTENTLY EXCLUDED. WHAT YOUR INSTITUTION IS KNOWN FOR IS INCLUSION. IN THE EXCLUSION HAVE BEEN MISTAKES. SO WE WOULD LIKE TO SEE THAT TO CONTINUE. YOU HAVE A BULLET TALKING CLINICAL TRIALS. THE MOST SUCCESSFUL CLINICAL TRIAL RECRUITMENT ANY STUDY ANY TIME IN THE UNITED STATES IS DANIEL PETER WRIGHT'S WALKING FORWARD PROGRAM. THE PROTOCOLS WE HE DOES ARE IF MILLIMETERNAL. I ENCOURAGE YOUR STAFF THE TALK -- PHENOMENAL. HE HAS A 2% REFUSAL TO PARTICIPATE RATE. IT IS PHENOMENAL. PEOPLE RAVE ABOUT THAT. IN NIH STUDIES WE CONTINUE TO BE STUCK IN THAT OTHER GROUP, THERE'S SO FEW OF US BUT IF YOU HAVE RESEARCHERS AND YOU KNOW THERE'S PROTOCOLS THAT REALLY ARE SUCCESSFUL TO BE ABLE TO SHARE THEM WITH OTHER RESEARCHERS AROUND THE COUNTRY SO MAYBE THEY CAN CONSIDER INCLUDING COMPARABLE PROTOCOLS FOR WHATEVER UNDERSERVED COMMUNITY, I DON'T CARE WHO, IF IT'S THE PHILIPPINO, GAY LESBIAN, AMERICAN INDIAN, ALASKA NATIVE, WHOEVER IT HAPPENS TO BE. THERE ARE SOME EXAMPLES AND THEY'RE NOT ALWAYS ACKNOWLEDGED IN ALL NIH DOCUMENTATION OF THESE VERY, VERY SUCCESSFUL PROTOCOLS. >> THANK YOU. I HAVE TO LEAVE TO CATCH A PRESENT BUT AS I THINK ABOUT THE GOOD WORK THAT'S DONE AND THE COMMENTS, SEEMS TO ME THERE ARE THREE ACT SEIZE, NUMBER ONE IS WHAT NEEDS TO HAPPEN TO UNDERSTAND IN ORDER TO HELP HEALTH DISPARITIES. NUMBER TWO, WHAT ARE YOU PARTICULARLY GOOD AT? NUMBER THREE, WHAT IS THERE ENOUGH MUCH TO DO. AT THE END OF THE DAY YOU WANT THE INTERSECTION OF THOSE THREE BULLETS. IT'S A MATTER OF WHAT YOU CAN DO BUT IT'S (INAUDIBLE) A LITTLE OF PROBLEM SO WONDERING, THE REASON I SAY THAT, I'M TRYING TO FIGURE THE WAY THROUGH THIS DISCUSSION TO PROVIDE YOU WITH THE TOOLS, TO HELP WHITTLE DOWN, GIVEN ALL THIS WHAT SHOULD BE DONE, WHETHER WHAT NEEDS TO HAPPEN, WHAT ARE YOU IN A POSITION TO DO AND HOW DOES -- MUCH MONEY YOU HAVE, THAT'S A LENS TO NARROW DOWN, >> GOOD COMMENTS. KEEP IN MIND NIMHD HAS A MISSION AND THE MISSION HERE AS A NATIONAL INSTITUTES OF HEALTH, IS TO REDUCE AND ULTIMATELY ELIMINATE HEALTH DISPARITIES. SO WE HAVE TO UNDERSTAND AN APPRECIATE WHAT THEY ARE HOW DOES ONE REDUCE THEM. AND TEN YEARS FROM NOW ARE YOU GOING TO HAVE TO TELL SOMEONE DID WE ARE DEUCE THEM. IN ORDER TO SEE AN INSTITUTE THAT DRIVES AND IS SUCCESSFUL AND ACTUALLY IS CONTINUED. SO WE ARE REALLY LOOKING AT THIS FOR FUTURE OF NOT ONLY THE SIGNS OF HEALTH DISPARITIES BUT OF THE INSTITUTE. SO ALL THE PARTS YOU MAKE ARE GREAT BUT I TELL YOU WE ARE ASKED WHAT HAVE YOU DONE. TO ELIMINATE OR REDUCE HEALTH DISPARITIES, WHAT YOUR PLAN FOR DOING SO IN THE FUTURE, SO THE IDEA IS WHERE DO WE START FROM, WHAT HAVE WE DONE? WHAT DOES THE GROUND WORK LOOK LIKE NOW? SO THESE ARE SOME OF THE THINGS THAT WE'RE WRESTLING WITH AS AN AGENCY. >> IT MAKES A REALLY EXCITING AND AT THE END OF THE DAY ONE HAS TO START SOMEWHERE. I THINK MOST OF THE DISCUSSION IS AROUND THAT, IS AROUND WHAT MATTERS MOST, WHAT CAN WE DO TOWARDS WHAT MATTERS MOST. AND I WONDER WHETHER OR NOT THERE IS DISTINCT EXERCISE. THAT TAKE AS DAY OR TWO TO HELP WHITTLE DOWN TO HAVING SAID THAT. WHAT MATTERS MOST, THAT'S BUCKET A, NUMBER TWO HOW DOES HA INTERSECT WITH WHAT REQUEST SUITED TO DO, AND 3, WHAT DO WE NEED TO ACHIEVE THEM. >> DR. REUBEN YOU HAVE THE LAST WORD ON THIS DISCUSSION. ON ON THIS DR. UNLESS DR. BRAVEMAN HAS SOMETHING TO OFFER. Q. GREAT PRESENTATION, IT'S REALLY GOING THE RIGHT DIRECTION. PERFECT TIMING FOR US TO REALLY MATURE. OUR APPROACH TOWARD HEALTH DISPARITIES RESEARCH. I WOULD JUST LIKE TO STRONGLY ENCOURAGE US TO CONSIDER THE INVESTMENT NIMHD HAS ALREADY MADE OVER THE PAST TEN YEARS AS RELATES TO REALLY ADDRESSING HEALTH DISPARITIES. NOT ONLY NIMHD, CENTERS OF EXCELLENCE OVER 3,000 PLUS RECIPIENTS TO THE INVESTMENT OF OTHER ICs SUCH AS NCI, COMMUNITY NETWORKS PROGRAM AND TAKING ADVANTAGE OF THAT INFRASTRUCTURE THAT HAS BEEN ESTABLISHED. THE P 20 P-60 CENTERS. THIS AGENDA LEVERAGE OR MATURE THE INVESTMENT OF NIMHD, OVER THE PAST TEN YEARS SO REALLY WOULD LIKE TO SEE THE AGENDA THAT WAS PRESENTED FRAMED IN THAT CONTEXT BECAUSE I THINK THERE'S SOME GREAT INFRASTRUCTURE, I CAN SPEAK FOR FLORIDA IN PARTICULAR, WITH OUR P-20 CENTER, WE HAVE GREAT COMMUNITY RELATIONSHIPS, INSTITUTIONAL PARTNERSHIP, A CADRE OF RESEARCHERS ABLE TO EMPLOY, TRANSDISCIPLINARY APPROACHES. SO HOW DO WE LEVERAGE THE INCH INFRASTRUCTURE TO FURTHER MATURE OUR APPROACH IN THE SATE OF FLORIDA AS RELATES -- STATE OF FLORIDA AS IT RELATES TO ADDRESSING DISPARITIES. WE TALK ABOUT TRYING TO ESTABLISH PRY YOUR AT THIS BUT I THINK PRIORITIES MUST BE CONSIDERED AT THE STATE LEVEL. TIMES PASS WHERE WE CONSIDER GLOBAL APPROACH TOWARD ESTABLISHING NATIONAL PRIORITY HEALTH DISPARITIES BUT WE MUST CONSIDER WHAT'S GOOD FOR FLORIDA MAY NOT BE GOOD FOR CALIFORNIA. OR MAY NOT BE NECESSARILY GOOD FOR GEORGIA, GIVEN THE CHANGE DEMOGRAPHIC, GOVERNMENT STRUCTURE AND POLICIES IN PLACE SO AFTER WE WHITTLE DOWN TO FIGURE OUT WHAT ARE THE BEST APPROACHES AT THE STATE LEVEL CONSIDERING ENVIRONMENT BECAUSE THAT'S AS DR. VARMUS STATED WHERE AND HOW WE LIVE MATTERS BUT HISTORICALLY OUR APPROACHING DISPARITIES HAS BEEN AT NATIONAL FRAMEWORK, AT THE NARC NATIONAL DIALOGUE OF CONVERSATION -- NATIONAL DIALOGUE THAT ALMOST DEGREE NEGATE IT IS PREMISE WHERE AND HOW WE LIVE. SO JUST WANT TO LEAVE THAT. >> THIS HAS BEEN GREAT DISCUSSION. I'M HOPING THAT DR.S GARDENER AND MULLEN ARE TAKING NOTES, I'M TAKING NOTES AND I'M SURE WE HAVE NOTE TAKERS HERE WHO WILL ARE GET THIS. OUR NEXT STEPS REALLY ARE TO BE WORKING TOWARDS SETTING UP THESE UPCOMING WORKSHOPS AROUND THE VARIOUS TOPIC AREAS. AND OF COURSE AS ALWAYS, WE WANT TO HEAR FROM OUR COUNCIL SO IF LESS'S COMMENTS, IDEASES THAT YOU WOULD LIKE TO GET TO US BEFORE WORKSHOP WORKSHOPS TAKE PLACE WE WILL ALERT YOU WHEN THEY WILL TAKE PLACE. WE WILL INVITE YOU TO SOME OF THE WORKSHOPS. WE WON'T WHERE B ABLE TO BRING ALL COUNCIL MEMBERS TO EVERY WORKSHOP BUT HOPING TO HAVE AT LEAST ONE COUNCIL MEMBER AT EACH WORKSHOPS. THE NEXT STAGE WILL BE AFTER THE WORKSHOPS TO HAVE A HUGE SUMMIT WE BRING ALL THE WORKSHOPS TOGETHER BUT PRIOR TO THAT, EACH OF THE WORKSHOPS WILL BE RESPONSIBLE FOR DEVELOPING A WHITE PAPER THAT WILL BE REFLECTED OF WHAT WENT ON AT THAT WORKSHOP AND THESE PAPERS WILL COME TOGETHER TO FORMULATE THE SUMMIT. HAVING SAID THAT, WE HAVE A LOT OF INFORMATION THAT WE HAVE TO DIGEST, BOTH FROM THE STAND POINT OF WHAT COUNCIL SAID BUT ALSO LISTENING TO THE OTHER INSTITUTES WHO NOT ONLY REPRESENT HERE TODAY BUT AS IRENE AND KEVIN AND STAFF WORK THROUGH A PLANNING COMMITTEE, EFFORT, WE'LL HEAR FROM SOME OF THE OTHER INSTITUTES. SO WITH THAT, I'M GOING TO NOW CLOSE THIS SESSION OF COUNCIL. WHICH MEANS THAT ANY GUESTS OR ANY FOLKS WHO DO NOT HAVE A A NEED TO KNOW AND TO BE AT THIS COUNCIL, CLOSED SESSION, I WANT TO DESCRIBE SOME ACTIVITIES TO THE CLOSED SESSION OF COUNCIL.