>> GOOD MORNING EVERYBODY AND THANK YOU FOR SUCH A TERRIFIC TURN OUT. WE HAVE THE MOST LOYAL MEMBERS AND WE ALWAYS HAVE SUCH HIGH ATTENDANCE AND I THINK IT POINTS TO EVERYONE'S COMMITMENT TO THE MISSION OF NIH AND WHATEVER CONTRIBUTION ANY OF US--EACH OF US COULD MAKE AND I'M NORMAN AUGUSTINE AND I WOULD LIKE TO WELCOME OUR INVITED GUESTS SPEAKING WITH US OVER THE NEXT TWO DAYS AND PARTICULARLY THE MEMBERS OF THE PUBLIC WHO HAVE THE INTEREST TO BE HERE AND SAY A FEW WORDS AND A FEW MINUTES AS THE OPPORTUNITIES THAT YOU'LL HAVE IF YOU WISH AS A MEMBER OF THE PUBLIC TO MAKE COMMENTS. TODAY AND TOMORROW, OUR MEETING IS VERY HEAVILY FOCUSED ON STATUS REPORT FROM THE SMRB WORKING GROUP ON APPROACHES TO ASSESS THE VALUE OF BIOMEDICAL RESEARCH AND I PUT EMPHASIS ON THE WORD APPROACH AS WE'VE NOT BEEN ASKED TO DO AN ASSESSMENT BUT OUTLINE HOW ONE MIGHT GO ABOUT DOING THE ASSESSMENT. IMPORTANT DISTINCTION AND REALIZING HOW DIFFICULT IT'S BEEN TO DO THAT. I CAN'T IMAGINE HOW DIFFICULT IT WOULD BE IN THE SECOND PART OF THIS. BUT WE'LL ALSO BE GETTING AN UPDATE ON NIH ACTIVITIES THAT ARE ONGOING WITH A PARTICULAR LOOK TO THE FUTURE. BUT I'LL GO OVER THE AGENDA IN A LITTLE BIT. IT'S A FULL AGENDA AS IS ALWAYS THE CASE. I DO WANT TO CALL YOUR ATTENTION TO THE OFFICIAL MEMBERSHIP OF OUR NEWEST BOARD MEMBER GILL OMENN, INTERNSHIP AT THE OFIRST OF OREGON, HE HAS BEEN HARD PAID UP UNTIL NOW. WE HAVEN'T TOLD HIM THE REST BUT GIL IS ACTIVELY CONTRIBUTING ALL ALONG AND HE TELLS ME THAT HE JUST WAS OFFICIALLY MADE A MEMBER AND NOW THEY SENT HIM A BIG PACKAGE TO RENEW HIS SECURITY FORM OR WHATEVER IT IS SO GIL THANK YOU FOR YOUR CONTRIBUTION. I HAPPENED TO HEAR A LECTURE BY GILL LAST SUMMER WHICH WAS TERRIFIC AND THERE'S ALSO A NEW FACE AT THE TABLE TODAY, DR. LINDA ERMBAUM, WITH THE NATIONAL INSTITUTE OF DEVELOPMENTAL HEALTH SCIENCES AND I WOULD ALSO NOTE THAT DR. COLLIDE YANYY, AT THE SCHOOL OF MEDICINE, WE ARE SO PLEASED TO HAVE YOU AS PART OF OUR TEAM. JUST THE BACKGROUND, COLLIDE HAS PARTICIPATED IN THE LAST SEVERAL MEDINGS AS AN INFORM FORMAL MEMBER AND LINDA HAS ATTENDED BOARD MEETING IN PERSON BEFORE SO YOU HAD AN OPPORTUNITY TO MEET BUT THEY WILL BE SERVING IN AN ADHOC CAPACITY UNTIL WE GET ALL THE PAPERWORK STRAIGHTENED OUT SO THEY CAN BE OFFICIAL AND I'M SURE THAT IF THE GOVERNMENT WILL NOT SHUT DOWN AGAIN, THAT WILL HAPPEN SOON. ALSO, ONE OF OUR OTHER INCOMING MEMBERS WASN'T ABLE TO JOIN US TODAY BUT WILL BE AT THE NEXT MEETING AND THAT'S DR. GARY GIBBONS DIRECTOR OF THE NHLBI. PROBABLY BE A GOOD THING SINCE THIS MEETING IS BROADCAST, I WOULD CALL YOUR ATTENTION TO THAT. AND WHEN YOU SPEAK IF YOU'LL PUSH THE LITTLE BUTTON AND WHEN YOU'RE DONE SPEAKING, YOU TURN IT OFF, THAT WOULD BE TERRIFIC, TRY TO SPEAK INTO THE MICROPHONE AND--BUT SINCE IT IS A PUBLIC MEETING, IT WOULD BEES WITH TO GO AROUND THE TABLE SO THE PUBLIC GET SOME IDEA OF WHO ALL IS HERE. MARTHA WOULD YOU WANT TO START UP. >> GOOD MORNING,U MAN NATIONAL INSTITUTE OF DENTAL AND CRANIAL RESEARCH DIRECTOR. >> DANIEL GOLDEN, CHAIRMAN OF THE INTEL SIS CORPORATION AND FORMER NASA DIRECTOR. >> RICHARD HODIS, NATIONAL INSTITUTE ON AGING. >> [INDISCERNIBLE] >> GIL OMENN, DIRECTOR OF CENTER FOR BIOINFORMATICS AND PROFESSOR FOR THE UNIVERSITY OF MICHIGAN. >> STEVE CATS NATIONAL INTUITY OF ARTHRITIS AND MUSCULOSKELETAL SKIN DISEASES. >> FRANCIS COLLINS DIRECTOR OF THE NATIONAL INSTITUTES OF HEALTH. >> LINDA BERBALM, DEPARTMENT OF MEDICAL SCIENCES. >> ARTHUR RUBEN STEIN, PROFESSOR OF MEDICINE UNIVERSITY OF PENNSYLVANIA. >> ALAN GIEWT MATCHER DIRECTOR OF NATIONAL INSTITUTE OF CHILD AND HUMAN DEVELOPMENT. >> TONY FAUCI, DIRECTOR OF THE NIAID. >> CLIFF ROGERS DIRECTOR OF NATIONAL INSTITUTE OF DIABETES, ASK KID FLEE AND LUNG DISEASES. >> HARVARD MEDICAL. >> AMY PATTERSON, NIH. >> THANK YOU ALL VERY MUCH. WE HAVE TWO FOLKS GOING TO JOIN US LATER THIS MORNING THAT'S DR. BRIGS AND DR. ROGERS. OH MY GOODNESS, YOU'RE HERE. >> GRIFF IS HERE TOO. >> WHERE? >> [LAUGHTER] >> THIS CLOAKING WORK HAS GOT TO STOP. [LAUGHTER] I SAW YOU COME IN AND SAY HELLO BUT I THOUGHT YOU WERE GOING TO BE LEAVING. NOW I'M A LITTLE SHAKEN BUT I'M GOOD. [LAUGHTER] I'M GOING TO SAY THAT SAUL SNYDER WON'T BE ABLE TO JOIN US BECAUSE I UNDERSTAND HE IS ILL THIS MORNING BUT HE HAD PLANNED TO BE HERE AND HOPEFULLY WILL BE HERE TOMORROW. >> ANYWAY WE'RE GLAD TO HAVE ANYBODY HERE THIS, IS PRETTY DARN CLOSE TO HUNDRED PERCENT ATTENDANCE, I THINK. BUT ANYWAY, WE DO HAVE A LOT TO ACCOMPLISH. WE WILL DEVOTE MOST OF THE TIME TO THE VOBR BIY MEDICAL RESEARCH GROUPS THEY'VE BEEN WORKING TERRIVE LIKE UNDER GAIL'S LEADERSHIP AND WE WILL GET A CHANCE TO HEAR FROM VISITORS AND SHARE THOUGHTS WITH US. FOLLOWING THAT, TODAY WE WILL HEAR FROM DR. TABAK, SOME OF THE THINGS THAT ARE HAPPENING AT NIH AND SOME OF THE FUTURE PLANS. LARRY WILL TALK ABOUT THE NEWEST CHARGE THAT FRANCIS AND HAS GIVEN US THAT HAS TO DO WITH THE REVIEW OF THE NIH AWARD AND REVIEW PROCESSES. THEN TOMORROW WE'LL HEAR SOME MORE ABOUT THE DOBR ACTIVITIES AND THEN WE'LL CONCLUDE DISCUSSION OF--WITH THE FULL BOARD OVER ANY ITEMS OF PEOPLE WANT TO DISCUSS OR FOCUS ON THE DOBR FOR IT. AND I--I THINK THE MOMENT, I WILL ASK GAIL TO TALK MORE ABOUT THE SESSIONS. SHE WILL BASICALLY BE CHAIRING MOST--MOST OF THIS MEETING SINCE IT IS WITHIN HER PURVIEW, THE TOPICS ARE. BUT BEFORE SHE DOES, FRANS, SHE--FRANCES, YOU USUALLY GET THE FIRST WORD. >> THANK YOU ALL FOR BEING HERE, I THINK TELL BE AN INTERESTING DAY AND HALF WHEN WE HEAR WHERE THE GROUP GOT TO WITH THIS IMPORTANT ISSUE, DELIBERATING OF HOW WE CAN DO A BETTER JOB OF UNDERSTANDING WHAT THE BIOLOGICAL AND BIOMEDICAL RESEARCH IS. WE CAN HARDLY HAVE A MORE IMPORTANT TOPIC AT THIS MOMENT. AS YOU KNOW WE'VE BEEN THROUGH A VERY DIFFICULT TIME AND IT AIN'T OVER AS FAR AS ANYBODY CAN TELL. OF COURSE LOOKING BACK OVER THE LAST 10 YEARS, NIH HAS BEEN STEADILY LOSING ITS PURCHASING POWER FOR BIOMEDICAL RESEARCH DOWN EVEN BEFORE THE SEQUESTER TO ABOUT 20% LESS THAN WHAT WE HAD IN TERMS OF OUR INFLATION ADJUSTED DOLLARS IN 2003. THEN IN THAT DREADFUL MOMENT IN MARCH WHEN THE SEQUESTER DID KICK IN, THE POISON PILL THAT WAS SUPPOSED TO BE SO POISONOUS THAT IT DIDN'T GET SWALLOWED, DID GET SWALLOWED AND WE GOT POISONED AND WE LOST A BILLION AND A HALF DOLLARS THAT WOULD HAVE GONE TO MEDICAL RESEARCH IN FY14, DOLLARS THAT WERE GOING TO GO TOWARDS HIGHLY PEER REVIEWED, HIGHLY RANGED RESEARCH CAUSING US TO BE UNABLE TO FUND ABOUT 640 GRANTS THAT HAD SCORED VERY HIGHLY IN PEER REVIEW AND THOSE ARE GONE. AND DESPITE OUR BEST EFFORTS TO COME UP WITH WAYS TO TRY TO MITIGATE SOME OF THE DAMAGE, THERE'S NO WAY THAT CAN YOU GET BY, WITH THAT KIND OF SERIOUS BLOW TO THE ENTERPRISE WITHOUT REAL CONSEQUENCES. WE DON'T KNOW WHICH OF THOSE GRANTEES MIGHT HAVE BEEN THE PRODUCERS OF THE NEXT BREAK THRAW OR PERHAPS A YOUNG SCIENTIST WHO MIGHT HAVE GONE ON TO WIN THE NOBEL PRIZE WHO DECIDED AFTER THIS BLOW TO DO SOMETHING ELSE. THE SEQUESTER IS VERY SERIOUS HARM TO NIH. ON TOP OF THAT OF COURSE, WE HAVE SUFFERED IN THE PAST THREE WEEKS THROUGH AN UNPRECEDENTED SHUT DOWN OF THE FEDERAL GOVERNMENT COMING ON OCTOBER 1st AT A VERY DIFFICULT TIME DURING THE YEAR. A FEW OF US REMEMBER THE LAST GOVERNMENT SHUT DOWN, BUT THAT AT LEAST HAPPENED IN THE SORT OF TIME OF YEAR WHERE THINGS ARE A BIT SLOWER AROUND THE HOLIDAYS IN DECEMBER AND EARLY JANUARY. THIS HIT US SMACK IN THE MIDDLE OF PERHAPS ONE OF OUR BUSIEST TIMES, RESULT NOTHING REALLY SERIOUS DAMAGE BEING DONE TO OUR ENTERPRISE. FOR THE INTRANSLATIONAL RESEARCH MURAL PROGRAM, SCIENCE CAME TO A HALT XEAPT FOR A FEW INDIVIDUALS INVOLVED IN ANIMAL CARE OR OUR CLINICAL CENTER THAT HAD TO CONTINUE OF COURSE ITS RESPONSIBILITIES TO TAKE CARE OF PATIENTS BUT WERE NOT ALLOWED TO ADMIT ANY NEW PATIENTS TO PROTOCOLS UNLESS THOSE PATIENTS WERE IN EMINENT DANGER OF DEATH. WE THEREFORE VACATED MANY OF THE LABORATORIES, 75% OF NIH EMPLOYEES WERE FURLOUGHED FOR THOSE 16 DAYS. IT WAS HEART BREAKING TO WALK THROUGH LABORATORIES WITH LIGHTS OFF AND NOTHING HAPPENING THAT ONLY DAYS BEFORE HAD BEEN BURSTLING WITH--BUSTLING WITH CUTTING EDGE RESEARCH. WE DID EVERYTHING WE COULD TRY TO ADOPT TO THE REQUIREMENTS THAT WERE PLACED UPON US IN A GOVERNMENT SHUT DOWN WHICH ARE VERY RIGID AND WE DIDN'T HAVE MUCH OPPORTUNITY TO DO MUCH FREELANCEY AND SO WE DID HAVE TO STOP RESEARCH EVEN THOUGH MUCH OF IT WAS IN CRITICAL PHASE. YOU CAN IMAGINE BEING A POST DOC WHO IS ANXIOUS TO GET EXPERIMENTS DONE AND PUBLICATIONS SUBMITTED AND YOU'RE NOT ALLOWEDDED TO USE YOUR E-MAIL. A VERY DIFFICULT AND POINTLESS EXPERIENCE FOR ALL THE PEOPLE WHO YOU HERE. WE DID MANAGE TO COME BACK ON OCTOBER 17th AND I THINK MANY OF US AT NIH WERE CONCERNED THAT OUR WORKFORCE WILL BE SO DEMORRALLIZED THAT IT WOULD BE HARD TO GET STARTED UP AGAIN. IN THAT REGARD, WE NEEDN'T HAVE WORRIED. PEOPLE CAME BACK FIRED WITH ENERGY AND DETERMINATION TO MAKE UP UP FOR LOST TIME, ROLL UP THEIR SLEEVES, GET EVERYTHING STARTED AGAIN. THEY BELIEVE IN WHAT THEY DO, THEY ARE EXCITED TO BE HERE AND THEY MISS MISSING THE CHANCE TO WORK WITH THEIR COLLEAGUES AND MORAL IS PRETTY GOOD BECAUSE PEOPLE ARE DETERMINED TO MAKE THE MOST OF BEING BACK. LOTS OF BAD THINGS HAPPENED WITH OUR PEER REVIEW PROCESS. AS THE EXTRAMURAL COMMUNITY WAS INITIALY SOMEWHAT PROTECTED FROM THE SHUT DOWNS BECAUSE GRANTS THARPE AWARDED WERE AWARDED SO PEOPLE COULD KEEP WORKING, BUT PEER REVIEW, AGAIN, OCTOBER TO COULD HARDLY BE A WORSE TIME TO ENCOUNTER THIS KIND OF BLOW. SO FOR INSTANCE, OCTOBER 7th IS ONE OF THE BIGGEST DAYS OF THE YEAR FOR SUBMISSION OF NEW GRANTS. PEOPLE WHO TRIED TO DO SO, DISCOVERED WE WERE NOT HOME AND THEY WERE IN FACT EXPLICITLY TOLD DON'T SUBMIT THEM. NOW THAT WE'VE STARTED BACK UP AGAIN, SALLY AND RICHARD HAVE WORKED INTENSIVELY TO COME UP WITH A STRATEGY TO PROTECT THIS CYCLE OF APPLICATIONS SO NEW DUE DATES WERE ANNOUNCED LAST FRIDAY SLIPPING ALL OF THOSE IN NOVEMBER THAT WILL OF COURSE ADDRESS THE REVIEW STAFF BECAUSE THEY LOST A MONTH THEY WOULD NORMALLY HAVE TO GET THOSE APPLICATIONS MRIIDATIONS ON TO REVIEW AND COUNCIL AND EVEN MORE DISSTRESSING THE COMPLICATIONS OF AMPLICATIONS THAT COME IN DURING THE SUMMER WHICH WERE SCHEDULED FOR PEER REVIEW IN OCTOBER, I WATCH THIS TABLE THAT WAS PROVIDED TO ME OF HOW MANY STUDY SECTION MEETINGS WERE BEING LOST EACH DAY OF THE SHUT DOWN. IF YOU HAVEN'T LOOKAD THE VOLUME OF WHAT WE DO IT IS BREATH TAKING. BY THE SHUT DOWN ENDED WE HAD TO CANCEL OVER 200 PEER REVIEW MEETINGS RESPONSIBLE FOR REVIEW OF OVER 11,000 GRANTS. THEY JUST COULDN'T HAPPEN. AND THOSE OF COURSE WERE BEING LINED UP TO GO THRAW PEER REVIEW IN OCTOBER, SUMMARY STATEMENTS CREATED AND THEN GO TO JANUARY COUNCIL. INITIALLY IT SEEMED HOPELESS THAT WE WOULD BE ABLE TO CATCH UP ON THIS GIVEN THE LOGISTICS OF TRYING TO RESCHEDULE THOSE MEETINGS BUT WITH A PHENOMENALLY INTENSE AND DEDICATED EFFORT OF THE STAFF OF CSR BUT TELEVISION THE INSTITUTE AND AGAIN MUCH CREDIT TO RICHARD NAKAMURA AND SALLY ROCKY FOR MAKE THANKSGIVING POSSIBLE. WE ARE NOW DETERMINED TO GET ALL THOSE RUVIEWED BY CREATIVE MEANS. MANY OF THOSE WILL BE DONE BY TELEPHONE OR BY INTERNET BECAUSE THERE'S NO WAY WE CAN PUT TOGETHER MORE THAN 200 FACE-TO-FACE MEETINGS IN THE SHORT TIME AVAILABLE IN ORDER TO GET THOSE LINED UP FOR JANUARY COUNSEL BUT WE DETERMINED TO DO SO. I THINK THE COMMUNITY WAS QUITE ALARMED THAT YOU MIGHT SEE THOUSANDS OF GRANTS LOSING MONTHS IN THE REVIEW PROCESS AND NOW WE'VE MADE EVERY EFFORT TO TURN IT AROUND. BUT IT HAS BEEN A WRENCHING EXPERIENCE AND WE SHOULD NEVER HAVE HAD TO GO THROUGH THIS AND HERE WE ARE. SO JUST TO PUT THAT IN THE CONTEXT OF WHAT WE ARE GOING TO TALK ABOUT HERE FOR THE NEXT DAY AND HALF, CERTAINLY I'VE BEEN ASKED IN MANY INTERVIEWS WITH THE PRESS AND I ACTUALLY HAVE THE OPPORTUNITY NEXT MONDAY TO SPEND AN HOUR WITH THE WALL STREET JOURNAL EDITORIAL BOARD AND ANOTHER HOUR WITH THE WALL STREET JOURNAL REPORTERS. THEY ARE GOING TO SAY WHAT IS THE VALUE OF WHAT YOU DO AND WHAT WERE THE CONSEQUENCES OF THE SEQUESTER ON WHAT YOU THOUGHT YOU COULD DO AND NOW CANDCAN'T AND WHAT HAPPENED DURING THE SHUT DOWN IN TERMS OF LOSSES TO THE COUNTRY ON THE BASIS OF THIS MINDLESS PROCESS AND I WANT TO BE ABLE TO GIVE THEM THE BEST IS ANSWERS I CAN BUT FRANKLY AS YOU ALL KNOW, I THINK ALL THE ECONOMIC ANALYSIS THAT HAVE BEEN DONE, I HAVE PROS AND CONS AND NONE OF THEM ARE PERFECT AND FOR YOU TO BE ABLE TO LAY OUT BETTER MARCHING ORDERS ABOUT HOW THOSE ANALYSIS SHOULD BE DONE IN A NATION THAT WILL BE MOST RIGOROUS AND MOST COMPEL SUGGEST TIMELY INDEED. THE OTHER THING THAT'S TIMELY ABOUT THIS DISCUSSION IS LARRY WILL TALK TO YOU ABOUT THE NEXT TASK FOR THE SMRB RELATED TO WAYS THAT WE COULD SPEED UP AND MAKE MORE EFFICIENT PEER REVIEW IN A WAY WE'RE DOING A PILOT PROJECT, NOT OF OUR OWN PLANNING THAT WILL PLAY INTO THAT. BY WHAT WE DO IN THE NEXT MONTHS WITH THE 11 GRANTS THAT GO THROUGH THE PROCESS TO BE SURE TO COLLECT DATA THAT GOES AND THIS WILL BE WOB OF THE LARGEST EXPERIMENTS, WE HAD TO FIGURE OUT HOW TO SPEND IN A VERY SHORT ORDER, ASK WE HAD TO BE CREATIVE AS WELL. SO WE WANT YOUR THOUGHTS IN THE MODERN ERAELECTRONIC CAPABILITIES ABOUT HOW OUR PEER REVIEW PROCESS COULD BE BEEFED UP IN A FASHION PARTICULARLY TO SHORTEN THE TIME TABLES BETWEEN SUBMISSION AND GRANT AWARDS AND MANY PEOPLE ARE ANXIOUS TO SEE SOMETHING DONE ABOUT THAT SO THAT GREAT IDEAS DON'T LINGER ANY LONGER THAN NECESSARY BEFORE HAVING A CHANCE TO GET STARTED. THAT WILL BE VERY IMPORTANT AND A TIMELY TASK FOR SMRB GOING FORWARD. ANYWAY, I WILL TELL YOU WE HAD A TOWN HALL MEETING YESTERDAY OF THE NIH FAMILY. I CONVENED THE GROUP THAT COULD FORM IN PERSON IN THE MASSEUR AUDITORIUM AND WE HAD 2665 PEOPLE ON THE WEB BECAUSE IT WAS A WEBCAST BUT JUST TO NIH THAT TELLS YOU HOW INTERESTED PEOPLE WERE GATHERING TOGETHER AGAIN TO TALK ABOUT WHERE WE ARE. AND THE GENERAL SENSE WAS A SENSE OF DETERMINATION, POSITIVE ATTITUDES ABOUT HOW TO MAKE THE BEST OF A DIFFICULT SITUATION. BUT PEOPLE ARE SUFFERING THROUGH THIS. PEOPLE WHO HAVE GREAT DREAMS, GREAT VISIONS ABOUT WHERE MEDICAL RESEARCH COULD GO AT AN EXCEPTIONALLY EXCITING TIME WHEN IT COMES TO THE SCIENTIFIC POSSIBILITIES AND YET FOR MOST PEOPLE'S MEMORY, PROBABLY IN THE HISTORIC SENSE, THE MOST CHALLENGING TIME WITH REGARD TO RESOURCES THAT WE WOULD LIKE TO BE ABLE TO PUT INTO THAT RESEARCH. SO IN THAT CONTEXT, WE APPRECIATE ALL OF THE WISE INPUTS FROM THIS GROUP SINCE YOUR ORIGINAL GATHERING AND NORM I WANT TO PARTICULARLY THANK YOU FOR YOUR CONTINUE LEADERSHIP OF THIS GROUP YOUR CREDIBILITY AND THOUGHTFULNESS CARRIES A LOT OF WEIGHT WITH US AND WITH THE WORLD AND AGAIN THANKS TO EVERYBODY ELSE WHO PUTS TIME INTO THIS AND VERY BUSY SCHEDULES TO DELIBERATE AND COME FORWARD WITH THE KINDS OF OUTPUTS WE VALUE AND PUT INTO ACTION, I PROMISE YOU. SO THANKS FOR THE CHANCE TO SAY PROBABLY MORE MINUTES THAN I SHOULD HAVE IN THE MIDDLE OF YOUR SCHEDULE BUT I JUST HAD TO. >> YOUR PASSION IS WELCOME. >> THANK YOU FRANCIS AND I THINK I SPEAK FOR ALL PEOPLE OF OUR GROUP WHO ARE SIMPLY ADMIRERS OF NIH AND THE RESPECT WE HAVE FOR THE WAY, YOU, YOUR COLLEAGUES HAVE DEALT WITH THIS. AFTER A 22% REAL BUDGET CUT FROM THE FEW YEARS AGO, TO THINK THAT TO HAVE THIS INSULT ADDED TO IT SPEAKS TO YOUR COMMITMENT AND I THINK WE ALL THANK YOU FOR THAT AND GLAD WE CAN TRY TO BE A BIT OF HELP BUT I--MY FOOT NOTE, YOUR COMMENTS, I SPEND A GOOD DEAL OF TIME ON THE HILL AND OVER IN THE ADMINISTRATIVE PART OF THE GOVERNMENT, SPEAKING ON BEHALF OF RESEARCH, AND EDUCATION THOSE ARE MY TWO HOT BUTTONS OF MY RETIREMENT AND THE--AND WITH RESEARCH, I OF COURSE TALK SOME ABOUT THE IMPORTANCE OF BIOMEDICAL RESEARCH AS I UNDERSTAND IT AND I MUST SAY I'M NOT ENCOUNTERED SITUATIONS LIKE YOU SEE IT--I KNOW YOU GET THIS ALL THE TIME BUT I'VE BEEN IN WASHINGTON SINCE 1965, OFF AND ON AND THIS GOES PASSED ANYTHING I'VE SEEN. AND JUST PERIPHERAL PROBLEMS, WHEN GUTMACHER TO TALK TO PEOPLE ON THE SCIENCE COMMITTEES, YOU CAN'T GET THEM TO TALK ABOUT THE SCIENCE BUDGET BECAUSE THEY'RE SO WRAPPED UP IN--THEY FOUND A HUMANITIES STUDY THAT THEY THINK IS NOT APPROPRIATE FOR GOVERNMENT SPENDING. AND ONE OF THE LESSONS I LEARNED IS WITH ALL THE BRILLIANCE OF OUR SCIENTISTS, NEVER USE THE WORDS FOREIGN, ANIMALS OR SEX IN THE TITLE OF THEIR PROJECTS BECAUSE THAT'S BECAUSE A CAUSAL DECISION TO TAKE OVER THE SURFACE, SO AS FAR AS I CAN SEE. SO WE HAVE A LOT OF WORK TO DO AND THOSE OF US WHO ARE INDIRECT BENEFICIARIES ARE THE ONES THAT HAVE GOT TO GET OUT THERE AND START MAKING A MESSAGE, SO WITH WHAT YOU AND YOUR TEAM ARE DOG, I THINK I ECHO WHAT FRANCIS SAID, THE TIME IS RIGHT. WITH THIS LET ME GO TO A COUPLE ADMINISTRATIVE MATTERS. THE FIRST ONE IS THAT MEMBERS OF THE PUBLIC WHO WOULD LIKE TO SPEAK BEFORE THE BOARD ARE CERTAINLY INVITED TO DO SO. CAN YOU SIGN UP OUT THE DESK IN THE HALL AND WE WOULD ASK THAT YOU RESTRICT YOUR REMARKS TO NO MORE THAN FIVE MINUTES SO THAT YOUR FELLOW SPEAKERS WILL HAVE AN OPPORTUNITY TO TALK. AS ALWAYS IF YOU WOULD LIKE TO SUBMIT A LONGER STATEMENT, WE WELCOME THAT IT WILL BE POSTED ON OUR WEB SITE AND WE DO APPRECIATE ALL THE INPUT WE RECEIVE, IT HELPS US DO OUR JOB. THE SECOND THING HAS TO DO WITH THE CONFLICT OF INTEREST RULES THAT THE REGULATIONS CALL FOR US TO BE REMINDED OF THOSE BEFORE EVERY MEETING SO DR. PATTERSON IF YOU WOULD DO THAT. >> HAPPY TO DO THE HONORS NORM. ALL OF YOU KNOW YOU ARE SPECIAL GOVERNMENT EMPLOYEES AND AS SO ARE BOUND BY THE RULES OF CONDUCT THAT APPLY TO GOVERNMENT EMPLOYEES AND PART OF WHAT THAT MEANS IS THAT IN ADVANCE OF EVERY MEETING YOU'RE SCREENED FOR ANY POTENTIAL REAL, PROFESSIONAL OR FINANCIAL CONFLICT OF INTEREST AND I WOULD LIKE TO REMIND EVERYONE AS WE ALWAYS DO TO PLEASE BE MINDFUL DURING THE COURSE OF THE DISCUSSION OF A SPECIFIC MATTER THAT COMES UP THAT MAY PRESENT A REAL OR PERCEIVED CONFLICT, PLEASE RECUSE YOURSELF FROM THE DISCUSSION AND SPEAK TO ME. THANK YOU VERY MUCH AS ALWAYS FOR YOUR SERVICE. WE'RE DEEPLY GRATEFUL. >> THANK YOU AMY. AND AMY, A SPECIAL THINGS TO YOU AND YOUR TEAM. THE FACT TAKEN--THEY WE'RE ABLE TO MEETOT HEELS OF THE EPISEED WE JUST BEEN THROUGH SPEAKS TO A GREAT DEAL OF LACRITY ON THE PART OF YOUR FOLKS. LET'S THEN TURN TO THE SUBSTANCE OF THE MEETING AND GAIL--I'M HAVING TROUBLE KEEPING TRACK OF PEOPLE. GAIL IS GOING TO LEAD THIS NEXT SECTION OF THE MEETING AND SHE OF COURSE AS I SAID IS CHAIRING THE VOBR GROUP WHICH HAS BEEN MEETING VERY FREQUENTLY LARGELY BY TELECONAND GAIL THE FLOOR IS YOURS. >> WELL, THANK YOU NORM AND I THINK THE INTRODUCTORY COMMENTS FROM YOU AND FRANCES BOTH HAVE SET THE STAGE WELL FOR TODAY AND TOMORROW'S DISCUSSION. I'D LIKE TO JUST START OUT BY SAYING THAT WHEN I--WELL, FIRST OF ALL YOU ALL HAVE RECEIVED SLIDES AHEAD OF TIME. THEY'RE PRINTED OUT THEY'RE NOT EXACTLY IDENTICAL TO THE ONES I HAVE HERE BUT ALSO REALIZING THAT MOST IN THE ROOM WERE ON A CONFERENCE CALL JUST THREE WEEKS AGO I. E. FULL SMRB BOARD TO HEAR THE PRELIMINARY FINDINGS THAT IN THE INTEREST OF TIME AND GIVEN THAT THERE ARE NO BREAKS SCHEDULED AND WE HAVE OUTSTANDING PANELISTS TO HEAR FREQUENCY WE WANT TO HAVE FULL DISCUSSION THE NEXT DAY AND HALF, I WOULD LIKE TO US TO JUST MAKE A FEW REALLY HIGH LEVEL COMMENTS ABOUT WORK TODAY SO THAT WE CAN FOCUS ON THE DISCUSSION. I HOPE THAT IS ACCEPTABLE TO EVERYBODY. AND THE ONE THING THEY WOULD LIKE TO DO IS TO JUST THANK THE WORKING GROUP AND THAT IS, ON THE--FROM OUR EXTERNAL MEMBERS OF THE SMRB THAT'S BEEN NORM, THEN GOLDEN AND GIL, AND ART, AND THEN FROM THE NIH WE HAVE ALAN AND RICHARD AND STEVE AND GRIFFIN AND MARTHA AND I WOULD SAY ALMOST EVERY ACTIVITY THAT WE'VE HAD MEANING FACE-TO-FACE MEETINGS OR CONFERENCE CALLS WE'VE HAD ALMOST A HUNDRED% PARTICIPATION EVERY TIME. A LOT OF PEOPLE SPENDING A LOT OF CAREFUL THOUGHT. NOW WHEN FRANCES GAVE US THIS CHARGE, WELL, IT'S BEEN OVER A YEAR AGO, WE ALL JUMPED AT CHANCE BECAUSE WE THOUGHT WHAT COULD BE MORE IMPORTANT THAN TO TALK ABOUT THE VALUE OF BIOMEDICAL RESEARCH AND COMMUNICATE THAT EFFECTIVELY. AS IT TURNS OUT, I THINK TOO A COMMITTEE MEMBER, WE WERE SHOCKED AT HOW DIFFICULT THE TASK IS NOT TO NECESSARILY JUST TALK ABOUT THE VALUE OF BIOMEDICAL RESEARCH, BUT TO ACTUALLY PROVE IT AND TO COME UP WITH METHODOLOGY THAT COULD BE IN FACT CREDIBLE BUT ALSO RIGOROUS ENOUGH THAT IT WOULD BE ACCEPTED BY POLICY MAKERS AND THE PUBLIC. SO, MOST OF US ON THIS COMMITTEE HAVE SERVED ON MANY COMMITTEES, BUT I THINK WE ALL AGREE THIS HAS BEEN ONE OF THE MOST DIFFICULT CHARGES. WE WERE CHARGED TO NOT NECESSARILY DETERMINE THE VALUE OF BIOMEDICAL RESEARCH, BUT DETERMINE THE PROCESSES AND METHODOLOGY TO ADDRESS THE VALUE AND THEREIN LIES THE CHALLENGE. THE OTHER THING THAT WE WERE CHARGED WITH WAS TO COME UP WITH THE APPROACH FOR APPROPRIATELY COMMUNICATING THE VALUE WHICH IS OBVIOUSLY VERY TIGHTLY CONNECTED. I MUST SAY THAT TO DATE MOST OF OUR EFFORT HAS BEEN FOCUSED ON THE PROCESSES, AND THE RIGOR OF THE PROCESSES AS OPPOSED TO THE METHODS FOR COMMUNICATING THE RESULTS ONCE THEY ARE OBTAINED. SO I THINK THE OTHER THING THAT I JUST WANTED TO EMPHASIZE WITH RESPECT TO THE CHALLENGES IS THAT THEY HAVE BEEN REAL AND I'M GOING TO MENTION A FEW OF THOSE IN THE DETAIL. OBVIOUSLY, IN FACT, THIS IS AN IDEAL TIME AS BOTH FRANCIS AND NORM HAVE ALLUDED TO. I THINK NOT ONLY FOR THE POLICY MAKERS THAT ARE BECOMING MORE AND MORE DEMANDING IN TERMS OF ACTUAL EVIDENCE FOR VALUE, BUT ALSO THE PUBLIC, THE PATIENTS THAT ARE ARE WAITING FOR THE RESULTS BUT ALSO THE WALL STREET JOURNAL AND THE BUSINESS COMMUNITY. THE ECONOMIC DEVELOPERS IF YOU WILL OF THIS COUNTRY AND THOSE COMPETITIVENESS WANT TO KNOW MORE AND WANT MORE RIGOR APPLIED TO THE PROCESS. IN FACTS YESTERDAY I SPENT THE DAY AT THE NATURAL ACADEMIES WITH A DELEGATION OF DIVISION OF FINANCE AND ECONOMIC DEVELOPMENT FROM CHINA AND THEY SHARED WITH US THEIR 10 TOP PRIORITIES, NOT A SINGLE HEALTH PERSON IN THE AUDIENCE. NUMBER TWO PRIORITY WAS TO IMPROVE ADVANCES IN BIOMEDICAL HEALTH AND TECHNOLOGY. SO THEY'RE BANKING ON IT FOR THEIR ECONOMIC COMPETITIVENESS IS ECONOMIC DEVELOPMENT. THEY ARE INDEED SERIOUS AS WE SHOULD BE. BUT I THINK THAT THE PUBLIC AT LARGE IS BECOMING A LOT MORE INTERESTED IN THE INVESTMENT BUT ALSO A LOT MORE CRITICAL IN TERMS OF WANTING PROOF OF THE ACTUAL VALUES COMPARED TO THE LARGE INVESTMENT OF OVER 30 BILLION DOLLARS A YEAR IN THE RESEARCH BUDGET. SO, I WOULD JUST SAY THAT SEVERAL KEY POINTS IN TERMS OF PROCESSES THAT WE FOCUSED ON, HAVE BEEN TOO IDENTIFY DIFFERENT VERY SPECIFIC TOPICS THAT COULD BE STUDIED IN DEPTH AND THEN TO CARRY OUT VS SYSTEMATIC ANALYSIS OF THOSE STUDY TOPICS AND WE HAVE DEVELOPED A LIST OF EXAMPLES AND OPTIONS THAT WILL BE IN TED REPORT AND THEN ALSO THE SECOND THING THAT WE HAVE FOCUSED ON IS TO MAKE THE STRONG RECOMMENDATION WHICH I'M SURE WOULD HAVE OCCURRED ANYWAY, BUT THAT WITH NIH'S FOCUS ON BIG DATA AND BETTER COLLECTION OF SCIENTIFIC DATA GIVEN ALL THE NEW TECHNOLOGY TO DO THE SAME AS FAR AS TRACKING RESEARCH CONTRIBUTIONS AND IMPACT OF THOSE RESEARCH CONTRIBUTIONS AND THE RESEARCH. AND WE MADE THE SPECIFIC RECOMMENDATION IN FACT THAT THERE BE SYSTEMATIC EFFORT TO ASSOCIATE THIS EFFORT WITH A TRANS-NIH COMMITTEE THAT HAS BEEN PREVIOUSLY APPOINTED ON BIG DAT AND THAT THAT THEN WILL PROVIDE STANDARD METHODOLOGY HOPEFULLY ACROSS INSTITUTES IN TERMS OF CAPTURING AND ANALYZING THE VALUE AND RETURN ON INVESTMENT. SO JUST A FEW OTHER POINTS; AND THAT IS THAT I THINK WE WOULD ALL AGREE THAT THE MOST FUNDAMENTAL CONTRIBUTION OF NIH IS THE GENERATION OF NEW KNOWLEDGE AND SECONDLY, THEN THE APPLICATION OF THAT NEW KNOWLEDGE TO BETTER PUBLIC HEALTH OF OUR CITIZEN AND THOSE IN THE WORLD AND THEN LASTLY TOO, FOR THE BROADER CYCLE IMPACT, WE WILL HEAR ABOUT THAT TODAY AND SOME OF THE PRESENTATIONS FROM SOME OF THE PANELISTS THAT WE WILL HEAR ABOUT. I JUST LIKE TO SAY THAT, HOWEVER, I THINK THAT ALL OF US WOULD AGREE THAT THE ACHILLES' HEEL IS REALLY THE ABILITY OF NIH TO SHOW IN FACT, THE CONTRIBUTION OF THE RESEARCH--BASIC RESEARCH FINDINGS FOR THE BETTERMENT OF PUBLIC HEALTH AND THE REASON IT'S THE ACHILLES' HEEL IS BECAUSE THE ROLE OF NIH IS TO GENERATE THE NEW KNOWLEDGE AND THEY ARE DEPENDENT ON OTHERS TO IMPLEMENT THAT KNOWLEDGE AND APPLY IT TO PRACTICE. SO ONE OF THE KEY THING SYSTEM TO BETTER COORDINATE, COMMUNICATE BINDINGS WITH OTHER AGENCIES--FINDINGS WITH OTHER AGENCIES THAT ARE INVOLVED IN THE IMPLEMENTATION AND ALSO THE PRACTICING MEDICAL COMMUNITY THROUGH BETTER CAPTURE OF DATA BUT ALSO COMMUNICATION AND THEN TO ALSO NOT LOSE SITE WITH THE IMPACT OR TRAINING BEING AT THE VERY TOP OF THE LIST IN TERMS OF BROADER SOCIETAL IMPACTS AND I KNOW THIS AUDIENCE KNOWS THIS ALL TOO WELL SO I WON'T GO INTO THAT. BUT YOU'LL HEAR FROM ROGER GLASS WHO WILL TALK ABOUT LEADERSHIP DEVELOPMENT IN OTHER COUNTRIES AND THE ROLE THAT NIH AND THE GROAB GLOBAL HEALTH PRIORITIES THAT HAVE BEEN ESTABLISHED BY THE FOGARTY AS WELL AS NIAID AND OTHERS THAT HAVE HAD INSTITUTES AND EMPHASIS ON GLOBAL, THE DEVELOPMENT OF LEADERS THROUGH THESE RESEARCH PROGRAMS AND TRAINING PROGRAMS AND HOW IMPORTANT THAT CAN BE AND LASTLY NOT TO FORGET THE ROLE OF NIH AND RESEARCH AND INVESTIGATORS IN DIPLOMASY, SCIENTIFIC DIPLOMASY IF YOU WILL. I KNOW THAT RINGS A BELL WITH YOU AND ALAN AND HOPEFULLY YOU WILL TALK A LITTLE BIT ABOUT THAT ALSO TODAY. ONE OF THE MOST DIFFICULT CHALLENGES IN TERMS OF BEING ABLE TO ACTUALLY PROVE THE VALUE OF BIOMEDICAL RESEARCH FOR NIH, FUNDED BY NIH IS ACTUALLY THE TIME LAG BETWEEN THE DISCOVERY AND THEN THE--BEFORE THE IMPACT IS REALIZED. HOWARD GARISON FROM FASA IS HERE THIS MORNING AND WE'RE CHATTING A BIT AHEAD OF TIME. I DON'T WANT TO STEAL HIS THUNDER BUT I WANT HIM TO SHARE WITH YOUF=q‡ PROVIDES A VERY GOOD LESSON ALONG THESE LINES AND WE'VE GIVEN SOME SPECIFIC EXAMPLES IN THE REPORT. THE OTHER THING I WOULD MENTION IS THAT GILL OMENN HAS SERVED AS OUR CONSCIOUS IN MANY WAYS AND OUR SMALL WORKING GROUP AND HE KEEPS TELLING US DO NOT FORGET TO EMPHASIZE FAILURES AND THE LEARN TAG COMES FROM FAILURES BECAUSE THIS IS POORLY UNDERSTOOD BY THE PUBLIC BUT ALSO POLICY MAKERS BUT INFORMATION FROM A KNOWLEDGE GAIN FROM FAILURES IS JUST AS IMPORTANT AS THAT FROM SUCCESS. SO I THINK THE ONLY OTHER THING THAT I REALLY WANTED TO EMPHASIZE IS AGAIN, THE VERY IMPORTANT ROLE IN BETTER WAYS TO INSURE THAT THE BASIC KNOWLEDGE THAT'S GENERATED IS APPLIED TO PUBLIC HEALTH AND IMPLEMENTED BY THOSE OTHER BODIES INCLUDING THE FEDERAL AGENCIES AS WELL AS PRACTICING MEDICAL COMMUNITY AND OTHERS IS ACTUALLY IMPLEMENTED IN HOW WE ACTUALLY TRACK THAT. AND WITH THAT I WOULD LIKE TO GO TO OUR FIRST PRESENTER TODAY WHICH IS ALAN, HE'S THE HEART AND SOUL OF AAAS, HE WILL TALK TO US NOT ONLY FROM HIS FORMER NIH ROLE BUT ALSO HIS CAPACITY--HIS PERSPECTIVE BOTH FROM THE U.S. BUT ALSO THE INTERNATIONAL COMMUNITY AND HOW OTHER COUNTRIES ARE LOOKING AT THE VALUE OF BIOMEDICAL RESEARCH AND EXPRESSING IT TO THEIR CONSTITUENTS. OUR CHAIRS OF THIS PANEL FOR GIL OMENSOUTH AMERICA AND STEVE KATZ, SO GIL AND STEVE, I KNOW LOOKING FORWARD TO YOU ASKING ALAN ALL THOSE QUESTIONS. THANK YOU. >> SO IT'S REALLY A TREMENDOUS PLEASURE TO BE HERE AND THANK YOU FOR THE INVITATION. I WANT TO TAKE BACK PARTIAL THANKS BECAUSE FRANCIS AND NORM AND GAIL EACH GAVE A LITTLE BIT OF WHAT I WAS GOING TO SAY. SO THANK YOU EXCEPT FOR THAT PART. I HAD A LOT OF TROUBLE TRYING FIGURE OUT WHAT I WOULD SAY TO YOU ALL. I DECIDED TO TITLE THIS THE ACCOUNTABILITY CONUNDRUM FOR BIOMEDICAL RESEARCH. I'M NOT TOTALLY SURE WHAT THAT MEANS, THE WORD CONUNSUPPORTED DRUM BUT I'VE COME UP WITH A DEFINITION FOR THIS PURPOSE. I SHOULD ALSO CONFESS THAT I SPEND A LOT OF TIME DIGGERRING ABOUT WHAT WOULD I TALK ABOUT TODAY BECAUSE SOME OF YOU KNOW I HAVE AN ANCIENT PRINCIPLE THAT I NEVER VIOLATE AND GIVEN THE LEVEL OF--YOU LIKE THAT? I LIKE THAT. GIVEN THE LEVEL OF EXPERTISE IN THE GROUP AND THE WORK THAT'S BEEN DONE SO FAR, I REALLY HAVE BEEN TRYING TO FIGURE OUT IF I HAD ANYTHING TO SAY THAT MIGHT BE USEFUL TO THIS GROUP AND WHAT I AM GOING TO REALLY TALK ABOUT IS WHAT I HAVE BEEN THINKING ABOUT AS AN OVERLAY OF MORE GRANULAR ACCOUNTABILITY THAT'S BEING DEMANDED OF RESEARCH IN GENERAL ON TOP OF DEMONSTRATING THE OVERALL SCIENTIFIC VALUE AND LET ME START WITH THAT. THE CONUNDRUM IS THAT WE SPEND MOST OF OUR TIME TALKING ABOUT THE OVERALL VALUE OF THE ENTERPRISE, BUT MY OBSERVATION IS THAT POLICY MAKERS AND MEMBERS OF THE PUBLIC ARE ASKING FOR MORE AND MORE GRANULARITY. THEY'RE ASKING FOR ACCOUNTABILITY AT THE LEVEL OF INDIVIDUAL PROGRAMS OR INDIVIDUAL GRANTS. AND I THINK WE AT LEAST HAVE TO CONSIDER THAT AS YOU GO ON WITH YOUR WORK AND THAT'S WHAT I'M GOING TO TALK ABOUT. BUT I THOUGHT THAT IT MIGHT BE AT LEAST USEFUL TO START A BIT OF TALKING ABOUT THE OVERALL SOCIETAL CONTEXT FOR SCIENCE AND TECHNOLOGY AS I SEE IT IN THIS POINT IN TIME AND HOPE THAT THIS LEADS INTERESTING. IT WAS CHARLES DICKENS USED TO SAY, I HAVE TO TELL YOU I'VE BEEN USING THE LINE, THE BEST OF TIMES AND THE WORST OF TIMES FOR MUCH OF MY ADULT LIFE. WHEN I WAS AT NIH AND GAVE OUT ALMOST A BILLION DOLLARS A YEAR, I ACTUALLY BECAUSE I HAD A BAD CLASSICAL EDUCATION ALWAYS SAID AS SHAKESPEARE SAID, NOBODY EVER CORRECTED ME. OKAY? YOU HAVE A BILLION DOLLARS AND YOU'RE THE SMARTEST PERSON IN THE ROOM. AS SOON AS I HIT AAAS, SOMEBODY SAID IDIOT! IN ANY EVENT. I THINK WE IN SCIENCE ARE IN FACT EXPERIENCING CERTAINLY THE BEST OF TIMES IN MANY WAYS BUT ALSO SOME OF THE MOST DIFFICULT TIMES. OT ONE HAND WE ARE IN FACT, LIVING IN THE BEST OF SCIENTIFIC TIMES AND THERE'S NO QUESTION ABOUT THAT. ADVANCES IN SCIENCE ARE COMING AT A FABULOUS RATE BOTH INCREMENTALLY AND BOTH IN TERMS OF THE QUANTUM JUMPS IN UNDERSTANDING THAT WE'VE GOTTEN, WE'RE ABLE TO ASK QUESTIONS AND THAT HAVE NEVER BEEN CONCEPTUALIZED BEFORE IN MY OWN FIELD, NEUROIMAGING TECHNOLOGY, TECHNOLOGY LIKE THAT ARE GIVING US GREAT OPPORTUNITY, TRANSFORMATIVE BREAK THROUGHS OF HIGH RISK PAY OFF RESEARCH IS GETTING EASIER TO GET FUNDED OR WE'RE SEEING MORE ENERGY DEVOTED TOWARDS THE MOST NOVEL KIND OF SCIENCE. THESE ARE ALL GOOD THINGS. SCIENCE AND TECHNOLOGY HAVE NEVER BEEN MORE IMPORTANT OR PROMINENT IN MODERN LIFE. THIS IS A LIST THAT I'VE BEEN PUTTING TOGETHER OF THE GLOBAL SCIENTIFIC ISSUES WHEN I GO THROUGH THEM BUT I WOULD AT THIS POINT IN THE HISTORY OF THE WORLD CHALLENGE YOU TO FIND A MAJOR ISSUE OF MODERN LIFE THAT DOESN'T HAVE A SCIENCE AND TECHNOLOGY COMOPPOSITE BEHAVIORIAL COMPONENT TO IT AS THE CAUSE OR AS THE CURE. THE COROLLARYS OF THAT IS THAT FOR PEOPLE, NORMAL PEOPLE WHO PROSPER IN THE MODERN WORLD THEY HAVE TO HAVE A FUNDMENTAL UNDERSTANDING AND COMFORT WITH SCIENCE, MORE AND MORE COUNTRY VS REALIZED THAT IN ORDER FOR THEM TO PRO--PROSPER THEY HAVE TO HAVE SCIENTIFIC CAPACITY AND OF COURSE IN ORDER FOR SCIENCE TO PROSPER OUR RELATIONSHIP WITH THE REST OF SOCIETY HAS TO BE VERY STRONG. THERE'S NO QUESTION THAT NOR COUNTRIES ARE INVESTING IN THEIR OWN SCIENTIFIC ENTERPRISE, NORTHERN NECK, SOUTH, EAST, WEST, AT ONE POINT I HAD BEEN IN COUNTRIES WHERE I HAD BEEN IN THE PHYSICAL PRESENCE OF THE CHIEF OF STATE OR SCIENCE OF EDUCATION MINISTER WHO SAID BASICALLY, WE'RE INVESTING IN SCIENCE, SCIENCE IS GOOD FOR INNOVATION, INNOVATION IS GOOD FOR THE ECONOMY, WE'RE GOING TO TAKE OVER THE WORLD. WE'RE BUILDING ON THE COUNTRY ON ITS BRAINS THEREFORE WE'RE INVEST BE IN SCIENCE AT A GREAT RATE. AND IF YOU LOOK AROUND THE WORLD, THIS IS JUST R&D EXPENDITURES IN DIFFERENT PLACES BUT I WOULD PARTICULARLY DRAW YOUR ATTENTION TO WHAT'S GOING ON IN ASIA, MOST OF THAT IS CHINA, AND INDIA BUT THEY'RE CERTAINLY OUT INTERNAL AUDIT VESTING THE UNITED STATES. I LOVE THISz3 SLIDE BECAUSE SORT OF THE AMERICAN CENTRIC POINT OF VIEW IS ALTS THOUGHT THAT WE ARE THE MOST PRODUCTIVE SCIENTIFIC ENTERPRISE IN THE WORLD. WELL EUROPE AS BEEN OUT PUBLISHING THE UNITED STATES AND THE ARTICLES FOR MANY, MANY YEARS SINCE THE MID19 NIEPTS AND IT'S TRUE--MID1990S BUT IT'S TRUE THAT IT'S STILL THE CASE THAT AMERICAN PAPERS ARE CITED MOST FREQUENTLY BUT THE REST OF THE WORLD IS REALLY COMING UP VERY RAPIDLY AND WE'RE IN THESE DIFFERENT THINGS, SO SCIENCE IS GOING ON IN MORE AND MORE PARTS OF THE WORLD. SO IS THAT GOOD OR IS THAT BAD FROM?Y AN AMERICAN POINT OF VIEW? AND AGAIN I'M STILL ON THE CONTEXT PART. IF YOU'RE PARTICULARLY NATIONALISTIC, IT'S NOT SO GOOD. RIGHT? BECAUSE WE'RE NO LONGER NUMBER ONE IN EVERY AREA OF SCIENCE AND I'LL COME BACK TO THAT POINT IN A MINUTE BUT SUPER SURRESH HAD THIS GREAT LYNN, SCIENCE ANYWHERE IS GOOD FOR SCIENCE EVERYWHERE, AND I HAD TO SLIP THAT IN BECAUSE I DO BELIEVE THAT TRUE. OKAY, SO, THINGS ARE GOING WELL, SO WHAT'S THE PROBLEM? I MADE THAT. WHEN I WAS AT NIH, I HAD SIX PEOPLE WHOSE SOLE FUNCTION WAS MY PERSONAL LIFE. NOW THAT THE I'M AT AAAS, I DO ALL MY OWN SLIDES, MY OWN SPEECHES BECAUSE I HAVE TO PAY THE PERSON. SO IF YOU DON'T MIND I'D LIKE A LITTLE MORE ADMIRATION. [LAUGHTER] I DID MAKE THAT MYSELF. I THERE ARE AN ARRAY OF FORCES THAT ARE CONVERGING TO MAKE THE OVERALL SOCIETAL CLIMATE MUCH MORE ROCKY THAN IT HAD EVER BEEN BEFORE AND I THINK NORM'S COMMENTS WERE RIGHT ON THE MARK. I'VE BEEN IN WASHINGTON FOR OVER 30 YEARS AND I HAVE NEVER SEEN A CLIMATE SIMILAR TO THE CLIMATE WE'RE NOW LIVING IN. WHAT'S HAPPENING IS THAT THESE FORCES ARE CONTRIBUTING TO MORE AND MORE CALLS FOR ACCOUNTABILITY THAN JUST ARGUING THAT VALUE AIN'T CUTTING IT AND THAT'S A POINT I WILL TRY TO MAKE. SIMILAR FORCES ARE INTERNAL TO SCIENCE THAT ARE UNDERMINING SORT OF OUR RELATIONSHIP WITH THE REST OF SOCIETY, YOU KNOW THEM AS WELL AS I DO. I WON'T GO TO THEM IN ANY DETAIL BUT AS YOU KNOW WE AT SCIENCE MANAGE VENE FOR EXAMPLE, PUBLISHED THE COREE AN STEM--CORRIAN STEM CELL PUBLICATION, I DID NOTHING BUT CLEANING THAT UP, THE SPREAD EFFECT, GENERALIZED EFFECT ON PUBLIC VIEWS OF THE SCIENTIFIC ENTERPRISE AND THEIR TRUST AND CONFIDENCE IN SCIENCE IS UNDERMINED BY ANY FACTOR, ANY INCIDENT THAT OCCURS NO MATTER HOW RARE THEY ARE. TO SAY THESE ARE RARE EVENTS DOESN'T DO ANYTHING FOR THE ARGUMENT. THE CONSEQUENCE OF THAT OF COURSE IS THAT WE HAVE TO MAKE SURE OUR OWN HOUSE IS IN ORDER AND EVERY TIME SOMEBODY VIOLATES ONE OF THOSE FACTORS, ONE OF THOSE STABBED--STANDARDS WE HAVE TO MAKE CLEAR THAT WE'RE PAYING ATTENTION. THESE ARE ALL INTERNAL FACTORS BUT THEY'RE EXTERNAL ONES AS L. THE BIG ONE THAT EVERYBODY TALKS ABOUT IS FUNDING, YOU DON'T NEED A LECTURE FROM ME ON THE FUNDING SITUATION. YOU WILL GET A TINY ONE. I HATE THIS SLIDE. YOU MAY KNOW THAT AAAS DOES AN ANALYSIS OF THE FEDERAL BUDGET EVERY YEAR. IT'S BEEN DOING IT FOR I DON'T KNOW 40 YEARS OR SOMETHING LIKE THAT AND THIS IS A SLIDE IN CONSTANT DOLLARS AND WHAT IT SHOW SYSTEM THAT THE LAST POINT, THIS LAST POINT IS THE PRESIDENT'S FANTASY BUDGET FOR SCIENCE BUT IN CONSTANT DOLLARS WHAT HAPPENED OVER TIME AND I THINK IT'S IMPORTANT THAT WE ALL PAY ATTENTION TO IT IS THAT WE'RE UNDERMINING ALL OF THE PROGRESS THAT WE HAD, PARTICULARLY ACCOMPANYING THE DOUBLING OF THE NIH BUDGET. IN FACT, THE DOUBLING IS BEING TAKEN APART. AND I THINK THAT JUST IN LIFE WE SHOULD MAKE THAT POINT AS FREQUENTLY AS WE CAN. THERE ARE OTHER FACTORS THAT ARE MAKING THEM--THINGS TOUGH. ONE OF THEM IS THE ISSUE ABOUT OUR EMINENCE. I DON'T THINK THE U.S. HAS TO BE PRE-EMINENT IN EVERYTHING IN THE WORLD BUT MORE AND MORE INDICATORS ARE SUGGESTING THAT ARE VERY EMINENCE IN SOME FIELDS OF SCIENCE IS AT RISK. THE EFFECTS OF THAT ARE PRETTY SEVERE. THAT IS, IF WE'RE NOT AMONG THE VERY BEST IN THE WORLD, FEWER FOREIGN STUDENTS WILL COME, THERE COULD BE A BRAIN DRAIN OF AMERICAN SCIENTISTS, I DON'T THINK WE'RE SEEING THAT YET, AND AGAIN, CAN YOU READ AS WELL AS I CAN BUT A CRITICAL POINT IS IF WE'RE NOT AMONG THE VERY BEST, OUR RELATIONSHIP WITH THE REST OF THE PUBLIC GETS UNDERMINED. ONCE WE CAN'T SAY WE HAVE AMONG THE BEST SCIENCE IN THE WORLD, THE PUBLIC STARTS TO LOSE CONFIDENCE AND STARTS TO LOSE TRUST. I MADE THAT. [LAUGHTER] AND THEN THERE'S THE ISSUE OF THIS SORT OF BROADER RELATIONSHIP, IS THIS BORING? >> IT'S OKAY? >> KEEP GOING? OKAY, THANK YOU. SHE KNOWS I USED TO TBHORK MENTAL HEALTH, I NEED A LOT OF HEALTH. OKAY. SO I'M STILLOT CONTEXT ISSUE, I USED TO HAVE LITTLE THINGS LIKE ROCKETS--BUT AFTER TONY AND I TESTIFIED ON THE HILL, I HAD MY ROCKETS OUT HE WHISPERED TO ME QUIETLY, YOU WANT TO MAKE SOME PROGRESS, KILL THE ROCKETS. [LAUGHTER] >> REMEMBER, IT WAS IMPORTANT, BUT THIS IS TOO, RIGHT? SO EVERY TIME I MAKE REFERENCE TO THE FACT THAT OUR RELATIONSHIP WITH THE REST OF SOCIETY IS A BIT TENUOUS PEOPLE ALWAYS SAY TO ME, NO, NO, NO, PEOPLE LOVE SCIENCE. AND IT'S TRUE. THIS IS A STUDY FROM SCIENCE INDICATORS DONE BY THE NATIONAL SCIENCE BOARD AND YOU CAN BE THE READ IT SO I CAN TELL YOU ANYTHING I WANT BUT IF YOU LOOK AT THE PRESTIGE OF VARIOUS ENTERPRISES, SO THAT'S FIREFIGHTERS OVER ON THE LEFT AND SCIENTISTS, THEN NURSES, THEN CLINICIAN AND LAWYERS ARE ALWAYS DOWN HERE I'M HAPPY TO REPORT. WE HAVE HIGH PRESTIGE AND PEOPLE HAVE BELIEVED FOREVER BELIEVED THAT THE BENEFITS OF SCIENCE OUTWEIGH THE HARMFUL RESULTS OR THE RISKS. THE PROBLEM IS THEY HAVE NO IDEA WHAT IT IS AND WHAT IT ISN'T? SO JUST FOR THE RECORD ASTROLOGY IS NOT SCIENTIFIC. ONE'S THAT THE SCARIEST OF THIS, IS THAT NUMBER THAT HAS HELD UP OVER TIME THAT IS 47% OF THE POPULATION DOESN'T BELIEVE IN EVOLUTION. I THINK THAT THE ATTENTION THAT WE'RE EXPERIENCING ACTUALLY COMES FROM A WIDE VARIETY OF FACTORS. SOME OF IT IS WIDE SPREAD MISUNDERSTANDING AND KNOW ABOUT THE AUTISM ISSUE, YOU KNOW ABOUT GMOs AS AN ISSUE. SOME OF IT'S ABOUT POLITICAL ERECONOMMIC INCONVENIENCE THAT'S THE ISSUE WITH CLIMATE CHANGE, VERY BIG ISSUES AND ISSUES FOR BIOMEDICAL RESEARCH AND ISSUES FOR THE REST OF RESEARCH IS THE CONFLICT THAT I BELIEVE IS ONGOING BETWEEN WHAT SCIENCE IS SHOWING AND WHAT NORMAL PEOPLE BELIEVE ABOUT THE WORLD AND I'LL JUST GIVE YOU AN EXAMPLE--DANG--I HAD A LIST, I TOOK IT OUT, HITOO MANY SLIDES OF THE LIST OF THE VALUE ISSUES BUT THERE ARE THINGS LIKE EMBRYONIC STEM CELLS, THE OBJECTION TO EMBRYONIC STEM CELLS HAS NOTHING TO DO WITH WHETHER PEOPLE BELIEVE THAT THEY CAN LEAD TO GREATER TROAMENTS OR THAT THE GUIDELINES IN RESEARCH WILL LEAD TO BETTER DIAGNOSTICS IT HAS TO DO WITH PEOPLE BELIEVING ON WHEN LIFE BEGINS. THAT'S NOT A SCIENTIFIC QUESTION. WE DON'T I HAVE SCIENTIFIC WAY TO ASK THAT AND MY OWN FIELD, THEY'RE SEEING MORE AND MORE ISSUES WHERE WHAT NEUROSCIENCE IS SHOWING CONFLICTS WITH PEOPLE'S THOUGHTS LIKE THEY HAVE NO PROBLEM CONCEPTUALIZE TAG HAVE YOU SEPARATE MIND AND BODY, RIGHT? THAT YOUR BRAINS AND HARD THING, THEY HAVE A LOT OF TROUBLE THINK BEING THEMSELVES AS BEING MUCH MORE BASED IN BIOCHEMICAL. ANYWAY, WHAT HAPPENS, IS, THAT ONLY SCIENTISTS ARE STUCK WITH WHAT SCIENCE SAYS. THE REST OF THE WORLD CAN DISREGARD IT, DENY IT OR DISTORT IT WITH RELATIVELY LITTLE CONSEQUENCE AND ONCE THEY DO THAT, THEY'RE RELATIONSHIP WITH SCIENCE IS AGAIN UNDERMINED. WE CARE ABOUT ALL OF THIS BECAUSE WE'RE LESS ABLE TO DO OUR JOB IF WE DON'T HAVE RATIO RECEPTORS FOR THE PRODUCTS OF WHAT SCIENCE DOES. SECONDLY I GOT THAT POINT FROM THE SCIENCE MINISTER IN JAPAN THAT SAID IN HIS ADULT LIFE, HE HAD NEVER SEEN SO MANY SAMPLES OF MEMBERS OF SOCIETY SUGGESTING THAT LINES RESEARCH RESEARCH SHOULD NOT BE DONE. THEY DIDN'T WANT TO THE QUESTION TO BE ASKED. THAT'S A SCARY THOUGHT. PUBLIC SUPPORTS UNDERMINED BUT TRUST AND CONFIDENCE ALSO ARE WEAKENED BECAUSE IN FACT FOR EXAMPLE, VALUE AND WHAT VALUES SHOW AND HA SCIENCE SHOWS, VALUES TRUMP SCIENCE EVERY TIME AND WE CAN ARGUE THAT LATER IF YOU WOULD LIKE. WHAT IT'S DOING, WHAT THIS ATTENTION IS DOING, I THINK IS CONTRIBUTING TO THE INCREASE IN CALLS FOR VALUE AND AND ACCOUNTABILITY. PEOPLE LIKE ME AND I'VE BEEN IN MEETINGS WITH NORMAL ON THE HILL WHERE WE GOT HIT WITH SOME OF THIS STUFF HEAD ON, THAT IS WHAT ARE WE GETTING FOR ALL OF THAT MONEY. WHAT ARE WE GETTING FOR THAT BIG GRANT? NOT WHAT ARE WE GETTING FOR THE WHOLE ENTERPRISE, RIGHT? IT'S NOT ABOUT THE WHOLE ENTERPRISE. IT IS, PEOPLE SAY TO ME ALL THE TIME, WHERE YOU WHINING, NIH AS 30 BILLION DOLLARS THAT'S A LOT OF MONEY. BUT THE QUESTION HAS MOVED TOWARDS WHAT ARE WE GETTING FOR THAT PROMULGATE A GOOD DAY, WHAT ARE WE GETTING FOR THAT INDIVIDUAL GRANT? AND FOR SURE AND I WANT TO MAKE THIS POINT BECAUSE WE HAVE A TENDENCY IS PARTICULARLY IN THE BIOMEDICAL ADVOCACY COMMUNITY, THERE IS A TENDENCY TO TALK A LOT ABOUT HOW MANY RO-1s WERE MADE AND WHAT THE SUCCESS RATE IS AND THINGS LIKE THAT. I CAN JUST TELL YOU NOBODY CARES. THE ONLY PEOPLE WHO ARE ARE US, THE REST OF THE WORLD POINTED. IMPACT FACTORS IS ANOTHER ONE, IF YOU CAN IMAGINE THAT IN MY BUSINESS. THE OTHER THING THAT SEEMS TO BE HAPPENING IS THAT THE USE OF WHAT PEOPLE CALL TRACE BACKS YOU KNOW WHAT THAT IS, HERE'S THIS WONDERFUL THING THAT HAPPENED AND THESE ARE THE THINGS THAT LED TO IT AND SO, THIS BASIC RESEARCH ULTIMATELY LED TO INCREASES IN ECONOMIC GROWTH, COMPETITIVE, SECURITY, HEALTH OF THE PUBLIC, THEY'RE NOT WORKING AS WELL AS THEY HAVE DONE IN THE PAST. THEY ONLY HELP MINIMALLY, BUT THEY CAN'T HELP WITH THE ACCOUNTABILITY PROBLEM AT THE INDIVIDUAL GRANT LEVEL OR AT THE PROGRAM LEVEL. I HAD TO PUT THIS IN. THIS IS LIKE THE BEST ACCOUNT OF TRACE BACKS IN THE ENTIRE WORLD. IF YOU NEED FACTOIDS, I DO THIS FOR A LIVING, RIGHT? THIS ITERATION AND THE NEXT ONE HAS THE VERY BEST LIST OF FACTWHAT SCIENCE HAS DONE FOR YOU AND THE BAD PART IS, IT'S NOT HOLDING AS AN ARGUE ANYMORE. MANY STAKEHOLDERS WANT TO BE ASSURED AT A MUCH HIGHER LEVEL OF GRANULARITY. AND IF YOU THINK THAT'S NOT TRUE, THINK ABOUT YOUR SIBLING AGENCY NSF. WHAT HAPPENED THERE IS THAT THIS PHILOSOPHY OF INCREASE ACCOUNTABILITY AT A MORE GRANULAR LEVEL LED TO THE AMERICAN COMPETES ACT, THE DEVELOPED THE BROADER IMPACTS CRITERIA AND I BELIEVE IT COULD EASILY HAPPEN TO NIH AS WELL. SO I CO CHAIRED A TASK FORCE OF THE NATIONAL SCIENCE BOARD THAT LOOKED AT THEIR REVIEW CRITERIA, AND I WAS VERY STRUCK WHEN I LOOKED AT THE AMERICAN COMPETES ACT THAT IT REQUIRES, THAT'S THE AUTHORIZATION OF NSF, IT REQUIRES THAT EVERY GRANT, THE ORIGINAL VERSIONS RIGHT, THAT EVERY GRANT ADDRESSED DIRECTLY ONE OR MORE SOCIETAL GOALS AND YOU CAN READ THEM AS WELL AS I AT A VERY SPECIFIC LEVEL. SO THIS TASK FORCE ACTUALLY TRIED TO MAKE SOME REVISIONS TO THE WAY IN WHICH THE BROADER IMPACTS CRITERION WAS USED LOOKING AT THE CRITERION, THE MOST IMPORTANT PART WAS THAT NOBODY KNEW WHAT IT MEANT OR WHAT TO DO WITH IT, BUT THEY KNEW IT HAD TO HAPPEN, RIGHT? SO IT BECAME VERY PROBLEMATIC AND WHAT WE CAME UP WITH IS SOMETHING THAT I THINK THE BIOMEDICAL COMMUNITY MIGHT ALSO THINK ABOUT. THAT'S WHY IT WENT THROUGH IT. AND THAT IS THAT IF AN INDIVIDUAL PROJECT ITSELF DOESN'T HAVE DEMONITABLE IMPACTS, WE DARN WELL BETTER BE ABLE TO DEMONSTRATE THE BROADER IMPACT OF THE NEXT LEVEL UP. SO THE AGGREGATION OF PROJECT INTO A PROGRAM OR THE AGGREGATION OF WHATEVER INTO A MUCH CLEARER SENSE OF WHAT YOU'RE GETTING FOR THE MONEY. AND THIS IS AN ARGUMENT AT AN INSTITUTIONAL LEVEL THAT YOU COULD DO IT FROM A AGENCY LEVEL AS WELL IF THE SIZE OF THE PROJECT IS LIMIT THED RIGHT. A HUNDRED DOLLARS, $200 GRANT ISN'T NECESSARILY GOING TO HAVE CLEAR IMPACTS LIKE THAT. SO HOW DID THAT WORK OUT? WE DON'T ACTUALLY KNOW YET BUT WE DID WIND UP WITH SOMETHING CALLED A DRAFT AND THIS HAS GONE OFF THE TABLE BUT I PUT IT IN BECAUSE IT'S IMPORTANT. NSF, ALMOST CAME FRIGHTENINGLY CLOSE TO HAVING SOMETHING CALLED THE HIGH QUALITY RESEARCH ACT THAT WOULD REQUIRE THE NSF DIRECTOR TO CERTIFY INDIVIDUALLY ONE AT A TIME THAT EVERY GRANT IS RELEVANT TO NATIONAL SECURITY EXPECTATIONS ECONOMIC COMPETITIVENESS OR THE HEALTH OF THE PUBLIC. MANY PEOPLE FOOLISHLY THOUGHT IT WAS ONLY ABOUT SOCIAL AND BEHAVIORIAL SCIENCE. IT WAS NOT ONLY ABOUT SOCIAL AND BEHAVIORIAL SCIENCES BECAUSE AS WE STARTED TO DELVE DEEPER INTO IT, THERE IS THIS UNDERLYING CURRENT THEY THINK WE NEED TO ATTEND TO THAT I'VE BEEN REFERRING TO ABOUT THIS GRANULAR ACCOUNTABILITY. SO AMERICA COMPETES ACT, THE AUTHORIZATION FOR NSF IS NOW ON THE TABLE, WE DON'T KNOW WHAT'S GOING TO HAPPEN BUT THE THREAT IS ALWAYS THERE BECAUSE THE SAME PEOPLE ARE INVOLVED ON THE HILL THAT THEY WILL MAKE SOME KIND OF CERTIFICATION REQUIREMENT, AND GOD FORBID WE HAD TO DO THAT FOR NIH, WE WOULD BE IN VERY DEEP STUFF. LEFT YOU THINK THIS IS--LIST YOU THINK THIS IS A AMERICAN PHENOMENON UNIQUE TO THE NSF. THE RESEARCH COUNCILS OF THE UNITED KINGDOM ARE NOW ASKING INDIVIDUAL SCIENTISTS TO DELINEATE THEIR IMPACT PLANS FOR INDIVIDUAL GRANTS AND HOW THEY'RE GOING TO GET THERE IN DOING IT AND THE RC BUK GROUP, THAT'S THE AGGREGATION OF THE RESEARCH COUNCILS IN THE U. K. IS WILLING TO HELP PAY TO MAKE THE IMPACT TO HAPPEN AND NSF HAS NOT VOLUNTEERED TO PAY FOR BROADER IMPACT, THEY JUST DO IT AND I THINK IT'S A MESSAGE AND GAIL AND I WERE SPEAKING EARLIER, I--IT WAS PART OF A MEETING THAT ALL OF THE EUROPEAN SCIENCE MINISTERS A COUPLE YEARS AGO AND I CAN TELL YOU THAT THE EUROPEAN COMMISSION IS MORE AND MORE GETTING FACE WIDE EXACTLY THIS ISSUE. NOW THEY HAVE WON OTHER ISSUE WHICH IS THE TENSION MEAN MAKING GRANTING DECISIONS ON THE BASES OF EXCELLENCE OR ON THE BASIS OF EQUITY AND THEY HAVE DEALT WITH THAT BY SETTING ASIDE A LARGER AMOUNT OF MONEY TO BE OR SORT OF THE NEWER COUNTRIES TO GET A FIXED BLOCK GRANT TO HELP BUILD THE SCIENCE CAPACITY. BUT THE BALANCE BETWEEN EXCELLENCE AND DIRECT IMPACT HAS SHIFTED AND THIS NEW HORIZON 2020 GIVING--YOUIGABILITY GAUNTIC BUDGET THAT WENT UP 28% OR SOMETHING LIKE THAT, THEY WERE ALL LAMENTING THAT THEY DIDN'T GET THE 32%, ONLY WENT UP 28% TOWARD BABIES BUT A PART OF THAT IS 40% OF IT HAS HAS HAD TO BE DESIGNATED VERY CLEARLY FOR HAVING AN IMPACT. SO MY QUESTION IS OBVIOUS I HOPE: SO WILL THAT LEVEL OF ACCOUNTABILITY AND VALUE BE DEMANDED OF BIOMEDICAL RESEARCH WHILE WE'RE WORRYING ABOUT THE VALUE? JUST TO MAKE YOUR PATH A LITTLE HARDER, WHILE WE'RE WORRIED ABOUT THERE ARE NEW AND DIFFERENT WAYS TO TALK ABOUT THE VALUE OF BIOMEDICAL RESEARCH, SHOULD WE ALSO BE WORRYING MORE IN AN ANTICIPATORY MODE ABOUT THE VALUE--I DON'T THINK SPECIFIC RESEARCH PROGECS--BUT DEFINITELY RESEARCH PROGRAMS. I THINK THAT WE CAN'T GET AWAY FROM WHAT'S WRONG WITH CONTINUING TO CITE WHAT HAVE WE DONE FOR YOU LATELY, WHAT DO I HOPE YOU'RE GOING TO DO FOR YOU? , I DON'T THINK THE GENERAL LEVEL IS GOING TO HOLD OVER TIME. AND I THINK WE HAVE TO COME UP FOR BETTER OUTCOME MEASURES OF BOTH CONTRIBUTIONS TO THE PRODUCT PROGRESSIVE SCIENCE WHICH WE DON'T ACTUALLY DO IN A VERY SYSTEMATIC WAY OR IMPROVEMENTS IN HEALTHCARE AND HEALTH PRACTICE. YEAH, THEN WE GOT TO EVALUATE AGAINST THEM. THERE IS A GROWING COMMUNITY OF SCHOLARS ACTUALLY WHO WORRY ABOUT ABOUT THIS IN A PROFESSIONAL WAY HAVE YET TO SEE THE PRODUCTS IN A WAY THAT I THINK WILL BE RELY TREMENDOUSLY USEFUL BUT THERE'S NO QUESTION THAT THERE ARE PEOPLE OUT THERE DOING IT. YOU MAY REMEMBER THAT JACK MARBURGER, WHO WAS SCIENCE ADVISOR TO PRESIDENT BUSH RAISED THE SET OF ISSUES AND THAT IS STOP TELLING ME, STOP ASSERTING HOW GREAT IT IS AND GIVING ME THE SAME 35 EXAMPLES WE NEED TO HAVE MUCH MORE SCIENTIFIC WAYS OF DEMONSTRATING WHAT YOUR CLAIM IS AND NSF HAS THE SCIENCE OF SCIENCE POLICY PROGRAMMED AND A REASONABLE QUESTION IS SHOULD WE BE DOING THAT MORE FOR BIOMEDICAL RESEARCH. SHOULD THAT BE ON THE AGENDA OF WHERE WE'RE GOING. THANK YOU. [ APPLAUSE ] >> ALAN THANK YOU VERY MUCH YOUR PERSPECTIVE FROM THE NIAAA STANDPOINT, CAME OUT AND WE SHOULD APPLAUD YOU A BIT MORE FOR DOING THOSE GRAPHICS ON YOUR OWN NOW. >> THANK YOU VERY MUCH. >> I HOPE YOU LEARNED. >> THERE IS LIFE AFTER NIH, I GUESS TO LEARN HOW TO DO GRAPHICS. >> IT'S MY ONLY MARKETETTABLE SKILL. >> YOU TOUCH OFFICE OF DIVERSITY SOW MANY ISSUES THAT OUR COMMITTEE HAS TALKED ABOUT AND LABORED OVER AND I'D LIKE TO REALLY STRESS THE LAST ONE BECAUSE OUR COMMITTEE, IF YOU LOOK AT GAIL'S REPORT, THE REPORT OF THE COMMITTEE, WE HEARD FROM MANY, MANY, MANY PEOPLE WHO HAVE BEEN CONCERNED WITH THAT SCIENCE OF SCIENCE. AND HOW TO DO THAT SORT OF EVALUATION AND MY QUESTION TO YOU IS, WE'VE HEARD ABOUT THE CHALLENGE OF COMMUNICATION, OF EDUCATION, OF OPPORTUNITY, OF NOT GIVING US SPECIFIC EXAMPLES BECAUSE OF THE DIFFICULTY WITH TRACE BACK WHICH IS ANOTHER THING WE TALKED ABOUT EXTENSIVELY BECAUSE THAT REALLY CONFOUNDS THE ISSUE, WHO GETS CREDIT? WELL EVERYBODY SHOULD GET CREDIT BUT YOU KNOW HOW DOES THE NIH GET CREDIT FOR WHAT THEY DO BUT I WOULD ASK YOU, HOW WOULD YOU GO ABOUT TRYING TO GET THAT SCIENCE OF SCIENCE, TAKING INTO ACCOUNT NOT ONLY EXAMPLES OF WHAT HAVE WE DONE FOR YOU TODAY, BUT ALSO WHAT HAVE WE LEARNED AS GILL TALKED ABOUT DURING OUR SESSIONS AND AS GAIL ALLUDED TO, SCIENCE IS INHERENT IN SCIENCE IS FAILURE, BASICALLY. SO HOW DO WE EDUCATE IN TERMS OF EDUCATING THE PUBLIC AND THE ADMINISTRATION, ET CETERA ABOUT HOW SCIENCE IS DONE. AND AS A CONSEQUENCE WHAT IS THE VALUE OF BIOMEDICAL RESEARCH? >> I DON'T HAVE A GOOD ANSWER TO YOUR QUESTION, BUT I'LL GIVE YOU AN ANSWER ANYWAY. NEVER HELD ME BACK IN THE PAST. THE ISSUE ABOUT FAILURE, I'M REALLY GLAD THAT'S COME UP BECAUSE THAT'S A CONCEPT THAT SEEMS TO BE A-CULTURALLY BOUND AND B-EXTREMELY DIFFICULT TO CONNOTE. I ONCE HAD THE PRIVILEGE OF BEING INVITED BY THE PF THE [INDISCERNIBLE] IN CHINA WHO IS NOW THE HEAD OF THE CHINESE NSF, NSFC. HE ASKED ME TO COME. TOOK ME OUT IN THE BEAUTIFUL LAKE OUT THERE WITH THE HEADS OF HIS DEPARTMENTS AND ALL HE WANTED ME TO TALK ABOUT WAS FAILURE AND THAT FAILURE WAS THE NORM IN SCIENCE AND WE EXPECT FAILURE BUT HIS DEPARTMENT HEADS HAD A DIFFERENT CULTURAL BACKGROUND WHERE FAILURE IS BAD. YOU DON'T DO FAILURE, ALL RIGHT? SO WE HAD THE--IT WAS A VERY INTERESTING EXPERIENCE FOR ME. BUT GENERALIZING FROM THAT, I THINK THAT IT'S THE NATURE OF THE SCIENTIFIC ENTERPRISE THAT THE PUBLIC NEEDS TO UNDERSTAND BETTER AND WE HAVE TO FIND A WAY TO CONNOTE IT. WE USE TERMS LIKE SCIENCE IS SELF-CORRECTING WHENEVER A BOO BOO OCCURS, RIGHT? SOMEBODY MAKES A MISTAKE OR SOMEBODY MAKES AN INTENTIONAL MISTAKE AND WE SAY LSCIENCE WILL CATCH IT, YOU KNOW DON'T WORRY ABOUT IT. >> IF IT'S IMPORTANT. >> YES, IF IT'S IMPORTANT. IF IT WAS PUBLISHED IN SCIENCE. BUT--SORRY--I WOULD P---A LITTLE PR. BUT WHAT WE'RE MISSING IS THE NATURE OF THE ENTERPRISE BUT AS WE'RE THINK BEING HOW WE CAN NOTE THE VALUE OF SCIENCE, IT'S IMPORTANT TO EMBED IN IT, RIGHT, THE PROCESSES AND THAT, YOU KNOW HYPOTHESIS, USUALLY IS WRONG, CERTAINLY THEORIES ARE USUALLY WRONG AND THE PUBLIC HAS NO UNDERSTANDING ABOUT THAT. WE SPEND SO MUCH TIME. WE ARE ENTERPRISED IN PUBLIC EDUCATION ABOUT SCIENCE ON SCIENCE CONTENT WITHOUT FOCUSING ON SCIENCE PROCESS AND WE HAVE TO FIND WAYS TO EMBED IN THE SCIENCE DISCUSSION WHAT THE PROCESS IS OR WHAT WE'RE DOING OTHERWISE YOU CAN'T GO OUT AND JUST SAY, HEY, WE LIKE TO FAIL BUT THERE HAS TO BE A WAY AS WE TALK ABOUT SCIENTIFIC ADVANCES TO MAKE SURE THAT WE'RE CONNOTING THE PROCESS AS WELL AS THE CONTENT. I DON'T KNOW IF THAT ANSWERS YOUR QUESTION. IT'S A LONG ANSWER. >> NO IT DOES HAVE TO BE BUILT-IN AS PART OF THE COMMUNICATION EDUCATION PROCESS. YEP. >> --OF THE FEDERAL ENTERPRISE AND RESEARCH COMMUNITY, THE VIEW OF SOCIETY IS THE BROADER PUBLIC, IN A SENSE THAT PEOPLE WANT RESULTS AND JUST AS THOSE SOCIETAL IMPACTS THAT YOU LISTED THERE, THAT COME UP FOR THE NSF HAVE POWERFUL INTERESTS BEHIND THEM, I THINK IT'S EVEN GREATER WHEN IT COMES TO PERSONAL HEALTH OR MAYBE EVEN POPULATION HEALTH, PEOPLE ARE DESPERATE TO HAVE PREVENTION, TREATMENT, THEY'RE DESPERATE TO SEE THAT THE SCIENTIFIC COMMUNITY IS JUST AS PASSIONATE ABOUT MAKING PROGRESS AND YIELDING BENEFITS AS THEY ARE AND IT'S HARD TO MATCH THAT BECAUSE THE PATIENT TO PATIENT ADVOCATE SYSTEM FANTASTIC AND VERY, VERY IMPORTANT TO OUR ENTERPRISE. LET ME ASK TO YOU APPLY SOME OF WHAT YOU DESCRIBED THIS MORNING TO THE AREA THAT YOU KNOW BETTER THAN MOST, WHICH IS BIOBEHAVIORIAL AND SOCIAL BEHAVIORIAL RESEARCH AND SOCIAL HEALTH GOALS. IF WE ASK ABOUT RISK FACTORS, MECHANISMS, DIAGNOSTICS, PREVENTION, TREATMENT, POPULATION IMPROVED METRICS. WHAT CAN WE SAY ABOUT OBESITY. --LET'S JUST IN THE BEHAVIORIAL--ESPECIALLY BEHAVIORIAL OBESITY, HOMICIDES, SUICIDES, DEMENTIAS, GIVE US A QUICK ASSESSMENT OF HOW OUR ENTERPRISE HAS REGRESSED ON THESE SOCIALLY EXTREMELY WELL RECOGNIZED PROBLEMS? >> SO THOSE ARE AREAS WHERE WE MADE GREAT PROGRESS AND LOUSY PROGRESS. BUT I THINK WE HAVE BEEN OUR OWN ENEMIES TO SOME DEGREE IN BEING VERY DEFENSIVE ABOUT IT, THAT IS WITH APOLOGIES TO MY FRIENDS IN THE BEHAVIORIAL AND SOCIAL SCIENCES, THEY ARE THE MOST DEFENSIVE. THE FIRST THING THEY DO IS GIVE YOU A LECTURE ON QUALITATIVE RESEARCH, THE FIRST THING WE SHOULD DO IS TAKE THAT WORD OUT OF THE VOCABULARY. THE SECOND ONE THERE WERE TWO PEOPLE OBJECTED IN THE OLD DAYS SAYING BIOMEDICAL AND BEHAVIORIAL RESEARCH, HAROLD VARMIS AND ME, AND I OBJECTED BECAUSE I DON'T KNOW IF IT AIN'T RIGOROUS BAG IT. AND SO THOSE KINDS OF THINGS, I THINK ARE VERY IMPORTANT. >> I THINK WE NEED SOMEHOW TO EDUCATE THE SCIENTIFIC COMMUNITY TO BE MUCH MORE PRAGMATIC IN ITS DEALING. I CAN TELL YOU FROM A PHYSICIST, EVERY TIME A PHYSICIST SAYS TO YOU I CAN'T EXPLAIN GRAFFIT ISSUES TO YOU IT'S MUCH MORE COMPLICATED. THAT MEANS YOU'RE A MORON AND I'M MUCH TOO SMART. AND MY RESPONSE IS IF I'MOT MORON END, IS, I HATE YOU. [LAUGHTER] NOW WE DO THAT ALL THE TIME. I DON'T KNOW EXACTLY HOW TO DO OBESITY, BUT WE KNOW, I MEAN THERE ISN'T A PERSON I CAN'T IMAGINE WHO DOESN'T UNDERSTAND IT TO BE A BEHAVIORIAL ISSUE AS WELL AS A BIOLODGESICAL ISSUE--BIOLOGICAL ISSUE. BUT I DON'T REALLY KNOW HOW WE CAN CONMOTE THAT OTHER THAN BE VERY DIRECT IS NEVER SAY SOME OF THE BAD WORDS THAT THAT DIVERT PEOPLE OR DISTRACT PEOPLE. >> --SPECIFICALLY GAIL STRESSED THE--[INDISCERNIBLE] [LOW AUDIO ] [LOW AUDIO ] >> OUR RECORD IS MEDIUM FRANKLY PARTLY BECAUSE LIKE MANY FIELDS OF SCIENCE BEHAVIORIAL AND SOCIAL SCIENCE RESEARCH DOESN'T WANT TO HAVE THE ACCOUNT FOR ITS UTILITY MORE THAN ANY OTHER AREA OF SCIENCE WANTS TO HAVE THAT ACCOUNT FOR ITSELF UTILITY BUT I THINK FIRST OF ALL THAT NOBODY SHOULD EVER--NO SCIENTIST SHOULD EVER BE ALLOWED TO SAY OUTLOUD, I DO WHAT I DO BECAUSE IT'S INTERESTING AND PROVOCATIVE NOT BECAUSE IT'S OF USE TO SOCIETY. WE SHOULD HAVE A PROHIBITION IN SCIENCE ABOUT PEOPLE ACKNOWLEDGING THAT EVEN IF THAT'S TRUE. SOUNDS LIKE A PR THING? IT'S NOT. YOU SAY THAT TO YOUR NEIGHBOR, YOU NEIGHBOR SAYS WHY SHOULD WE GIVE MORE MONEY TO YOU THAN I GIVE TO CLASSICAL ARCHEOLOGY, IT'S VERY INTERESTING. SO THAT'S PART A. PART B, I THINK WE HAVE TO HELP OUR COLLEAGUES SEE HOW THEY'RE CONTRIBUTING TO THIS BROADER ENTERPRISE THAT WILL LEAD TO THAT BIGGER EFFECT. IT'S MUCH HARDER IN THE SOCIAL AND BEHAVIORIAL SCIENCES TO DEMONSTRATE THE IMPACTS IN A LINEAR FASHION, PARTLY BECAUSE FUNDING AS BEEN TOUGH. PEOPLE HAVE NOT FOCUSED ON SOME OF THOSE ISSUES. VIOLENCE IS A GREAT EXAMPLE. THE ACTING DIRECTOR OF NIMH DURING THE GREAT VIOLENT HORROR IN THE GOVERNMENT AND WE WERE SORT OF PROHIBITED FROM DOING ANYTHING ON VIOLENCE, CDC WAS PROHIBITED FOR 17 YEARS DOING RESEARCH ON TRI-ARM RELATED VIOLENCE AND SO IT'S BEEN TOUGH BUT I THINK THERE ARE WAYS THAT THE USEFULNESS CAN BE ARTICULATED AND THE PROBLEMS WITHOUT A DOUBT ARE NOT REDUCIBLE TO BIOLOGICAL PHENOMENA, THEY CANNOT BE ADDRESSED WITHOUT IT AND WE NEED TO THE WHOLE SCIENTIFIC COMMUNITY ARTICULATED IN IT. I WILL SAY IT'S BEEN VERY DIFFICULT TO GET THE REST OF THE SCIENTIFIC COMMUNITY TO HELP MOBILIZE ON BEHALF OF SOCIAL AND BEHAVIORIAL RESEARCH DURE THIS LAST SPADE WITH THE U.S. CONGRESS. THE FIRST TIME IT HAPPENED WE GOT 160 SCIENTIFIC FIELDS TO COME TOGETHER AND SIGN ON TO LETTERS, THIS TIME THEY'RE ALL SOCIAL AND BEHAVIORIAL SCIENCE SOCIETIES, VERY POLITICAL. WE ALL NEED TO SORT OF HINGE TOGETHER. I DON'T KNOW IF THAT HELPS. >> IT'S GREAT EXAMPLE HOW IMPORTANT IT MIGHT BE--TONY JUST LEFT. I WAS GOING TO SAY FABULOUS PROGRESS ON HIV/AIDS DRUGS AND IT'S BEEN AMAZING AND PRODUCTIVE AND YET EVERY TWO YEARS TONY GOES TO THE BIG INTERNATIONAL AIDS MEETING AND THAT ANNOUNCES THAT DESPITE ALL THIS PROGRESS, THERE ARE MORE PEOPLE INFECT WIDE AIDS THAN BEFORE. AND MOST OF THAT IS NOT GOING TO BE ADDRESS BY DRUGS EXCEPT PREVENTING TRANSMISSION IMMEDIATELY TO NEW BORNS. MOST OF IT WILL RELY ON BEHAVIOR CHANGE AT LEVELS OF PERSONAL INTERACTION LEVELS, SOCIETAL LEVELS, ABOUT THE SIZE OF THE GENERAL DOMAIN. YOU KNOW, THAT'S THE THING. >> MIMH IS--[SPEAKING AT ONCE ] >> SO IF WE'RE ASKED TO FOLLOW THE EFFECT, THE IMPACT, THE BENEFIT FROM BASIC FOUNDATIONAL WORK TO ECOLOGICAL EFFECTS THEN REAL METRICS OF PUBLIC HEALTH HOW CAN THIS BE DONE? HOW CAN IT BE DONE BETTER AND WHAT ROLE IF ANYTHING SHOULD WE PERCEIVE WITH THE RESEARCH ENTERPRISE. >> FIRST ON THE AIDS EXAMPLE, NIMH AND NIDA, AND NIAAA HAVE HAD BIG PROGRAMS ON FUNDAMENTAL RESEARCH UNDERLYING AND UNDERSTANDING BEHAVIOR CHANGE AND THEN TRANSLATING IT INTO EFFECTS NOT ONLY ON HIV/AIDS BUT ON AN ARRAY OF OTHER ILLNESSES AND IT'S BEEN INCREDIBLY EFFECTIVE. JUST THINK ABOUT WHAT HAPPENS IN THE ABSENCE OF A VACCINE. I THINK WE, THE BIOMEDICAL COMMUNITY, NEED TO FIND A WAY TO BE MORE INCLUSIVE. WE'RE PERHAPS A LITTLE BIT TOO TERRITORIAL IN OUR DESCRIPTIONS OF WHAT IT IS WE THE ENTERPRISE ARE DOING IF SOMEBODY ASKS A QUESTION FROM THE END OF WHAT ARE YOU DOING ABOUT AIDS? THE ANSWER IS, WE'RE STUDYING YOU KNOW NEW ANTIRETROVIRAL, WE'RE STUDYING NEW VACCINES, APPROACHING WHATEVER, I THINK WE NEED TO CLAIM THESE OTHER DOMAINS BECAUSE THEY'RE ESSENTIAL TO WHAT'S HAPPENING AND THE SUCCESSES AND AT THE RISK OF GETTING TOO SPECIFIC IF THERE FOR A CHALLENGE. SO SAN FRANCISCO BASICALLY THE AGENTS ACTIVITY RATE WAS BROUGHT DOWN IN LARGE PART, DECADES AGO THROUGH THE RESULT OF BASIC BEHAVIORIAL RESEARCH ON HOW DO YOU CHANGE DEHAIR AND THEN GOT TRANSLATED INTO PRACTICE AND I THINK WE HAVE LOTS OF EXAMPLES OF THAT. WE IT IN BLOOP,--BLOOD PRESSURE, WE HAVE IT IN--I KNOW IT DIDN'T WORK SO WELL. BUT FRANCIS? >> SO I WANT TO COME BACK TO YOUR POINTING OUT WHICH IS I THINK A REAL TREND BECAUSE ALSO ONE THAT SHOULD CAUSE US CONCERN THAT INCREASING PRESSURE NOT ONLY TO DEFEND THE OVERALL ENTERPRISE, BUT VERY SPECIFIC GRANULAR COMOPPOSITE BEHAVIORIALOPPOSITE B EHAVIORIAL PHENOTYPENTS OF THIS BUT I WA TO HIGHLIGHT THE NEGATIVE CONSEQUENCES OF THAT MAY HAVE IF NOT RESISTANCE TO WHAT IT COMES TO BASIC SCIENCE BECAUSE YOU COULD PICK ANY PARTICULAR GRANT WHERE SOMEBODY'S STUDYING C.ELEGANS WORK AND YOU COULD IDENTIFY POTENTIAL DOWN STREAM MEDICAL BENEFIT BUT IT'S GOING TO BE A BIT OF A SHAKY PATHWAY THAT YOU ARE TRYING TO MAP OUT THAT YOU MAY YOURSELF NOT BE QUITE SURE IS GOING TO BE THE CASE, IF THERE IS EVER AN AREA OF RESEARCH THAT WE BELIEVE COLLECTIVELY IS THE FOUNDATION OF EVERYTHING BUT INDIVIDUALLY, IS UNPREDICTABLE IN TERMS OF IMPACT, THE MOST BASIC OF OUR BASIC SCIENCE PORTFOLIO WOULD BE THERE. I HAVE FOUND IT USEFUL IN THAT REGARD TO ACTUALLY HAVE A LIST OF TRAITS BACK ALTHOUGH YOU'RE SAYING THEY DON'T WORK SO WELL, ALTHOUGH IN THIS CASE, THEY'RE STILL REALLY VALUABLE SO THAT OKAY, YOU'RE READY TO SITE THOSE PEOPLE WHO STUDY MISMATCHED REPAIR AND BACTERIA JUST BECAUSE IT SEEMED LIKE AN IMPORTANT BIOLOGICAL PHENOM NANOG AND FELL INTO A MAJOR CAUSE OF COLON CANCER IF IT'S INHERITED IN FAMILIES OR YOU TALK ABOUT PEOPLE WHO STUDY REVERSE TRANSCRIPT ACE BECAUSE IT'S A BIOLOGICALLY REVERSE AT INFORMATION FROM RNA TO DNA AND IN THE PROCESS REPAIRED US FOR THE INCREDIBLE TRIUMPHS OF ANTIRETROVIRAL THERAPY. HAVING THOSE IN YOUR BACK POCKET WHEN YOU SAY WHERE WHY ARE YOU DOING THIS STUFF, WHY DON'T YOU FOCUS ON TROONSALATION, HAS BEEN A VERY VALUABLE PART I THINK OF OUR DEFENSE WITH THE ENTERPRISE BUT I'M WORRIED THAT YOU'RE SUGGESTING THAT EFFECTIVENESS IS WANING AND IF SO WE'RE IN TROUBLE IN TERMS OF BASIC SCIENCE DEFENSE SO CLARIFY THAT FOR ME. >> OKAY, FIRST OF ALL I MAY HAVE OVERSTATED, I AM NOT SAYING THAT WE SHOULDN'T HAVE A LONG LIST OF TRACE BACKS. I--YOU KNOW I FEEL FROM RISING ABOVE THE GATHERING STORM MOSTLY, NUMBER TWO, I BETTER WORK. YOU KNOW THAT'S AN ASTOUNDING ARRAY FOR MAKING THE ARGUMENT AND IT'S GREAT. WHAT I'M ARGUING AGAINST IS TOTALLY DEPENDING ON IT. THAT IS IF WE DON'T COME UP WITH BETTER EXPLANATIONS FOR WHY WE'RE SUPPORTING ALL OF THAT BASIC RESEARCH OTHER THAN WE'RE QUIETLY HOPEFUL THAT IT'S GOING TO PAY OFF, WHICH MANY OF OUR COLLEAGUES ARGUE, YOU KNOW I'M NOT REALLY SURE, BUT ... YOU KNOW IF I REALLY HIT IT LUCKY, LOUSY ARGUMENT AND I DON'T HAVE THE ANSWER BUT I GOT THE QUESTION. AND I CAN TELL YOU THAT UNLESS WE HAVE CONSTANTLY FILLING BUCKET OF TRACE BACKS THAT ARE NEW AND DIFFERENT, A-WE'RE IN TROUBLE, BUT B-WHEN WE ARTICULATE WE DON'T KNOW WHERE THIS IS GOING. NO. BAD ANSWER. BAD ANSWER. THERE HAS TO BE A BETTER ANSWER AND THAT ANSWER MAY BE, THIS IS PART OF A CUMULATIVE ENTERPRISE. THIS IS PART OF AN AGGREGATED ENTERPRISE THAT'S TRYING TO GET AN ANSWER TO IT FUNDAMENTAL QUESTION THAT WE HAVE TO KNOW BECAUSE OF BLAH, BLAH. >> WE HAD THIS WITH WHY ARE YOU FUNDING. I GOT A LOT OF GRIEVE FOR FUNDING ERIC CANDEL'S LEARNING OF [INDISCERNIBLE], IT WAS LIKE MORON WHAT ARE YOU DOING? LOUSY MODEL. LEARN SUGGEST WAY TO SIMPLISTIC. WE GAVE HIM THE GRANT PAY. IF WE HAD SAID WE DON'T KNOW WHERE IT'S GOING, THAT'S A TERRIBLE ANSWER, BUT A BETTER ANSWER MAY BE, I DON'T KNOW. I'M TRYING THAT IN THE AGGREGATE, THIS LINE OF RESEARCH IS INTENDED TO BE FUNDAMENTAL FOUNDATIONAL TO UNDERSTANDING THIS PROCESS AND DON'T STOP THE SENTENCE, RIGHT? AND THAT PROCESS IS CRITICAL TO DISEASE OF X OR Y AND I DON'T THINK WE HAVE TO FALL PREY TO THE SOUND BITE ANSWER OF YOU KNOW WHY ARE YOU DOING THAT. AND IF IT'S SO, THANK YOU FOR COMING. SO ALAN THANK YOU. NO, NO, YOU DID EXACTLY WHAT I WAS HOPING YOU WOULD DO AND AS I TOLD OUR COMMITTEE THAT YOU WOULD DO, THANK YOU VERY MUCH, IT'S OBVIOUSLY PUT A LOT OF THOUGHT INTO IT, AS ONE OF THE AUTHORS OF THE--GET OUR COMMUNITIES TOGETHER IN THE GATHERING STORM, I THINK--I'VE THOUGHT A LOT ABOUT THIS ISSUE OF YOU KNOW EDUCATING REPUBLIC, POLICY MAKERS, YOU KNOW IF WE DON'T REALLY DO THAT, IN K-12. IT'S ALMOST AN IMPOSSIBLE TASK AND WHILE THERE HAVE BEEN A LOT OF ADVANCES IN EDUCATIONAL REFORM IN MATH AND SCIENCE SINCE THE GATHERING STORM REPORT, I FEAR WE HAVEN'T DONE WHAT YOU'RE CAUTIONING AND THAT IS TO EMPHASIZE THE PROCESS AS MUCH AS CONTENT F. WE EMPHASIZE THE PROCESS, THEN IT MAKES OUR JOB A LOT EASIER IN TERMS OF CONVINCING PEOPLE OF THE VALUE OF BY O MEDICAL RESEARCH--BIOMEDICAL RESEARCH, IF THEY UNDERSTAND THINGS, IF THEY UNDERSTAND THE PREMISE OF HYPOTHESIS, RESEARCH AND ET CETERA, AND ET CETERA, AND I THINK WE NEED TO BE COMMUNICATING MORE TO OUR FRIENDS IN K-12 EDUCATION THAT WE HAVE TO INCORPORATE THIS EVEN BETTER AND WE HAVE TO FUND THE PROGRAM FOR THE EXTENT THAT THEY DO LAB RATOREY BASED RESEARCH--LABORATORY BASED RESEARCH ALONG WITH THEIR SCIENCE COURSES WHICH WE KNOW THEY CAN'T. IN ALABAMA THE CHEMISTRY TEACHERS ARE STILL HAVING TO PAY FOR THEIR OWN BROWN PAPER TOWELS THEY USE IN THE CHEMISTRY LAB, SO I THINK WE HAVE A LONG WAY TO GO BUT I'M CONNECTICUT VINCEED THEY'RE GOING BACK TO THAT IS MAYBE THE ANSWER IN THE LONG RUN BECAUSE YOU CAN'T WAIT UNTIL, YOU KNOW YOU'RE A POLICY MAKER AND THEN TRY TO EDUCATE. >> ANOTHER QUESTIONS? DAN? >> I JUST WANT TO TAKE THE DISCUSSION TO A MUCH HIGHER LEVEL TO TAKE A LOOK AT WHY WE'RE SEEING WHAT WE SEE. AND THAT IS IF YOU THINK ABOUT IT, THERE'S TERM OIL IN THE DEVELOPED WORLD AND THERE'S FEAR AND CONCERN ABOUT THE LOSS OF AN ABILITY TO EARN A LIVING AT THE VERY CORE. WHAT IS HAPPENING IS THE INTERNET HAS OPENED UP GLOBAL COMPETITION ON THE VERY BROADER SCALE AND ARTHUR AND I WERE TALKING ABOUT IT THIS MORNING AND AS THAT HAPPENS, A SECOND PHENOMENA IS OCCUR TAG WHILE THE INTERNET IS CREATING OPPORTUNITY GLOBALLY TO COMPETE WITH WHAT WE HAVE HERE IN AMERICA AND EUROPE, AT THE SAME TIME THE INTERNET IS WIPING OUT THE LOWER AND MIDLEVEL JOBS. SO WHAT YOU ARE SEEING ON THE PART OF AMERICAN PEOPLE IS THIS FEAR IS EXPRESSED IN THE PEOPLE THAT ARE REPRESENTING THEM AND THE PEOPLE THAT ARE REPRESENTING THEM IN MANY CIRCUMSTANCES ARE THERE TO GET GOVERNMENT OUT OF THEIR LIVES. SCIENTIFIC RESEARCH IS AT THE VERY CORE OF GOVERNMENT FUNDING SO THERE ARE SOME MAJOR FORCES AT PLAY AND WHEN YOU WANT TO GO IN INDIVIDUALLY TO DEAL WITH THIS ISSUE, AND NOT BE COGNIZANT OF IT, IT MAKES THE COMMUNICATIONS ALMOST INEFFECTIVE AND I THINK AS WE GO AT THE RECOMMENDATIONS FOR THIS PANEL, WE NEED TO THINK THROUGH THE TIERED LEVEL OF COMMUNICATIONS, YOU MADE A NUMBER OF VERY WONDERFUL POINTS BUT IT JUST CAN'T BE BOTTOMS UP AND IT NEEDS TO BE THOUGHT THROUGH AT THE DIFFERENT LEVELS BECAUSE RIGHT NOW IT USED TO BE ADMINISTRATIONS WERE VERY SUPPORTIVE OF SCIENCE AND ADMINISTRATIONS LATELY HAVE CLEAVED FROM THIS PERSON'S VIEW TO TALK ABOUT THE IMPORTANCE OF SCIENCE BUT THE INDEPTH OF COMMITMENT TO SCIENCE ISN'T THERE AND YOU CAN'T TAKE THAT FOR GRANTED SO I WOULD SAY THAT ONE OF THE THINGS WE OUGHT TO TALK ABOUT IS--I DON'T WANT TO SPEND A LOT OF TIME, I'LL COME BACK TO IT IN THE SESSION I'M GOING TO BE CHAIRING, WE NEED TO TIER IT. THE SECOND POINT I WOULD LIKE TO MAKE IS SOMETHING THAT STEVE KATZ BROUGHT UP AND THAT IS FAILURE. FAIL SURA FEAR THAT EVERY HUMAN BEING EXPERIENCES AND WHEN THEY'RE PAYING TAX MONEY AND WANT TO HAVE THEIR TAX MONEY USED EFFECTIVELY TO IMPROVE QUALITY OF THEIR LIVES THEY THEN HAVE EXPECTATIONS THAT ARE SOMETIMES UNACHIEVABLE BY THE PEOPLE WHO ARE SPENDING THE TAX MONEY. I HAD THAT EXPERIENCE AT NASA BECAUSE IF YOU HAVE FAILURE IN SCIENCE, YOU KNOW, A TREE FALLS IN THE FOREST YOU MIGHT NOT HEAR IT, BUT IN NASA YOU GET AN A+ OR AN F-MINUS WHEN A BILLION PEOPLE WATCH. SO THE WHOLE ISSUE OF FAIL SURVERY KEEN AND I WILL TELL YOU EVEN BEFORE SOME OF THESE--FAILURE IS KEEN AND I WILL TELL YOU BEFORE I SPEND A LONG TIME OF THIS THAT I SPENT A LONG TIME TRYING TO EXPLAIN TO PEOPLE THAT HUMAN BEINGS LEARN FROM FAILURE. A CHILD TOUCHES A HOT PLATE, THEY NEED TO TOUCH THAT HOT PLATE, THEY NEED TO TOUCH IT SO THAT NEXT TIME THEY WON'T TOUCH THAT HOT PLAY AND THAT'S LOGICAL BUT ON THE OTHER HAND WE SPENT A HUNDRED MILLION DOLLARS TO LAUNCH THAT SPACE DRIFT, WHY DID IT FAIL? YOU ARE DUMMIES? IT'S NOT THAT PEOPLE ARE BAD PEOPLE, BUT THEY WANT TO FEEL THAT THEY'RE THE CENTER OF EXCELLENCE IN THEIR LIVES AND THE PUBLIC OFFICIALS REPRESENT THOSE CENTERS OF EXCELLENCE AND UNLESS YOU COULD LIVE UP TO THE FANTASY OF WHAT'S BEING REQUIRED, IT'S VERY HARD COMING BACK AND TALKING ABOUT FAILURE. SO AGAIN AS I THINK WE FORMULATE THESE ISSUES, WE NEED TO THINK ABOUT HOW WE'RE GOING TO DEFINE TERMS THAT ARE STRAIGHT FORWARD AND EXPLAINABLE. THE FINAL POINT I WANT TO MAKE IS, I TALK ABOUT TIERING AND THE LEADERSHIP NEEDS TO DO IT AND CLEARLY THE GATHERING STORM WAS AN WONDERFUL EXHIBITION OF LEADERSHIP BUT WHEN IT ALL GOT SAID AND DONE, THE MONEY NEVER GOT THERE. THE PRESIDENT CAME TO TALK ABOUT LOVE FOR SCIENCE HIS BUDGETS NEVER REFLECTED IT SO THERE ARE PROBLEMS AT THE LEADERSHIP LEVEL. BUT NOW AT THE CORE IS SOMETHING THAT I TRIED AND I FOUND VERY HELPFUL, THE GOVERNMENT LEADERSHIP HAS TO SPEND TIME DEVELOPING THE SCIENCE OF COMMUNITY THAT AT A FUND TO SPEND THE TIME TO NOT TALK TO EACH OTHER, BUT TO TALK THE LOCAL SCHOOLS, THE CHILDREN BECAUSE SCIENTISTS ARE STILL VERY MUCH HEROES IN THE SCHOOL AND SCIENTISTS DO NOT REALLY SPEND THE TIME AND HAVE THE PERSONAL COMMITMENT BECAUSE THEY ARE TOO BUSY. THE LAST STORY IS A STORY OF HOPE AND THEN OF DEPRESSION. ONE OF THE THINGS WE DID AT NAYS S&P WE SAID ONE% OF YOUR GRANT IS TO DO PUBLIC OUTREACH AND THAT STARTED TO REALLY MAKE A DIFFERENCE UNTIL RECENTLY I HEARD THE ADMINISTRATION DECIDED TO TAKE THE FUNDS AWAY FROM NASA AND OTHER AGENCIES DEDICATED TO EDUCATION AND THEY PUT IT INTO A BIG POOL AT THE DEPARTMENT OF EDUCATION. I WOULD SAY THAT IS A BATTLE WORTH FIGHTING WITH THE ADMINISTRATION AND THE PRESIDENTIAL LEADERSHIP NEEDS TO BE HELD ACCOUNTABLE BECAUSE THEY DESTROYED ONE OF THE THINGS THAT WAS BEGINNING TO MAKE A DIFFERENCE. END OF SPEECH NO QUESTIONS. >> THERE IS A VERY IMPORTANT POINT THAT I WOULDN'T WANT TO NOT COMMENT ON AND THAT IS THIS PUBLIC COMMUNICATION. IT'S CRITICALLY IMPORTANT. MY GENERATION OF SCIENTISTS WHO ARE TOLD, GUTMACHER OUT TO TALK TO THE PRESS, YOU TALK TO THE PUBLIC, YOU KNOW YOU'RE SELLING YOUR SOUL TO THE EVIL EMPIRES AND THAT HAS CHANGED. YOUNG PEOPLE, YOUNG SCIENTISTS ARE MORE AND MORE INTERESTED IN ENGAGING US OLD GUYS, STILL IT'S MORE OF A BATTLE. BUT THE PROBLEM IS THAT THE METROPOLITANNOR BY WILL ITING THEM STILL, DON'T WASTE YOUR TIME. THE OTHER IS THAT IT'S A LEARNED SKILL. TALKING TO THE PUBLIC, ALL RESPECT MY COLLEAGUES, MANY OF THEM SHOULD NOT BE ALLOWED OUT IN PUBLIC AND WHEN THEY DO, HAY SAY LITTLE THINGS LIKE YOU DON'T UNDERSTAND, RIGHT? OR YOU'RE NOT QUITE UP TO IS, YOU DON'T HAVE MY BACKGROUND. SO THERE ARE TRAINING PROGRAMS, JUST TO BRAG, WE AT AAAS HAVE A PROGRAM THAT GOES ALL OVER THE COUNTRY ON A COST REIMBURSEMENT BASIS. WE'VE TRAINED THOUSANDS OF SCIENTISTS, 78% OF THEM ARE YOUNG SCIENTISTS, THEY'RE THE ONES THAT WANT TO DO AND WE NEED TO ENCOURAGE THEM AND WE NEED TO BUILD IN WAYS TO HELP TRAIN THEM HOW TO DO IT BECAUSE IT'S NOT AN INNATE SKILL. IT'S AN ACQUIRED SKILL. AND THEY WILL HAVE TO LEARN HOW DO IT SO YOU'RE ABSOLUTELY RIGHT ABOUT THE NEED. YOU KNOW, IT SHOULDN'T BE THAT FRANCIS AND HIS COLLEAGUE VS TO DO THIS BY THEMSELVES. IF WE HAD MASSES OF GOOD ADD SCIENTISTS AUGHT THERE TALKING ABOUT THIS--OUT THERE TALKING ABOUT THIS, BIOMEDICAL RESEARCH, WE WOULD GET SOME PRESS AGAIN. >> LAST QUESTION. >> BUT LET ME COME BACK AND JUST SAY, TO DO THAT TRAINING, TAKES RESOURCES. IT'S WONDERFUL WHAT THE AAAS IS DOING BUT THAT'S WHY I MADE THE STATEMENT THAT THERE NEEDS TO BE SOME PUSH BACK BECAUSE IF THE ADMINISTRATION DOESN'T DO IT, THE CONGRESS CERTAINLY IS NOT GOING TO DO IT. AND AT A TIME WHEN THE AMERICANS ARE SEEING THE SCORES IN THE TIME OF AMERICA IN SCIENCE AND MATH AND STEM AREAS DECREASING, HAVING THE ABILITY TO HELP IMPROVE THAT EVEN AS ONE OBJECTIVE IS CRUCIAL BECAUSE THE UNDERSTANDING OF THE RELATIONSHIP OF SCIENCE, MATH, AND TECHNOLOGY IS STILL PRETTY STRONG, TO THE ECONOMY. SO I WOULD ARGUE THAT IT'S TERRIFIC THAT THE AAAS IS DOING WHAT THEY'RE DOING BUT TO EDUCATE HUNDREDS OF THOUSANDS OF SCIENTISTS TAKE SMALL RESOURCES BUT STILL RESOURCES AT ITS CORE. >> I WOULD LIKE TO PERHAPS TAKE A LITTLE BIT OF A DIFFERENT APPROACH AND THINK ABOUT IT MORE PRAGMATICALLY. I APPRECIATE THE PRESENTATION FROM DR. LESNER, BUT I THINK WHAT'S MISSING FROM THE DIALOGUE IS A DIFFERENT KIND OF SCIENTIFIC SELF-AWARENESS, THAT IS TO SAY RESPONSIBILITY TO WHAT'S HAPPENING HERE. I THINK FUNDAMENTALLY SCIENCE IS GOOD AND THAT NO ONE QUESTIONS THAT BUT THE ONE LEVEL THIS SITUATION IS MOST IT'S COMMUNICATION AND I THINK WE HAVE SUBITANTIABILITY TO MAKE CLEAR WHAT IT IS WE'RE DO ANDING WHAT WHY AND I THINK THE LESSONS I'VE LEARNED AND FRANCIS HAS BEEN OVER MY SHOULDER WHEN WE'VE BEEN IN THESE ENVIRONMENTS WITH PATIENTS AND WERE THE INSTITUTES IS THAT VERY SOPHISTICATED, . TELEIGENCE VOCABULARY KASP A RY GROUP WILL LOOK US IN THE EYE AND SAY YOU'RE SPEAKING DIFFERENT LANGUAGES AND AT THAT POINT IN TIME IT'S IMPOSSIBLE TO COVER THAT GULF AND IT SHOULDN'T BE RELATIVE TO CHOSEN WIDE WHAT TO TAKE THE CHARGE TO COMMUNICATE. I THINK IT BE INCUMBENT UPON ALL OF US THAT DO SCIENCE TO BE RELATERS AND HELP PEOPLE UNDERSTAND WHAT WE'RE DOING AND WHY WE'RE DOING IT AND ACCEPT SOME RESPONSIBILITY TO DEMONSTRATE VALUABLE SO THAT THE ISSUES OF VAILURE ARE NOT--FAILURE ARE NOT [INDISCERNIBLE] AND A FIRM NO IS AS GOOD AS A STRONG YES BECAUSE IT TELLSEROUS WE SHOULDN'T GO BUT--TELLS US WHERE WE SHOULDN'T GO. BUT THIS NOTION OF ACCEPTING RESPONSIBILITY, OF CULPABILITY OR WHERE WE ARE RIGHT NOW AND A REQUIREMENT TO BE TRANSPARENT WHETHER IT'S CLINICAL RESEARCH, TRANSLATIONAL OR BASIC, ALL OF US SHOULD ACCEPT THAT REQUIREMENT TO BE TRANSPARENT IF WE CAN'T COMMUNICATE IN A SPOKEN WORD, WE SHOULD DO SO IN A WRITTEN WORD, ONE OTHER ANECDOTE, ONE OF FRANCE SISS TASKS WITH HIS PEOPLE IS TO DO A PROJECT ON HIS BEHALF LOOKING A SICKLE CELL LINE AND WHAT IS REQUIRED IN THE APPLICATIONS FOR THE CELL LINE ARE TO CREATE A STATEMENT OF RELEVANCE AND WE WERE STRUCK THAT MANY OF THE INVESTIGATORS SIMPLY AREN'T ABLE TO DO THAT. AND THAT NEEDS TO BE REVISITED BECAUSE THE ARGUMENT IS COACHING THEY SAY WE'RE NOT ABLE TO DO WHAT I DON'T UNDERSTAND. WE CAN OHM BE RESPONSIBLE FOR THAT. >> THANKS CLYDE. >> ONE LAST QUESTION ARTHUR? >> AT THE RISK OF BEING PROVOCATIVE OR NEGATIVE, WHAT WORRIES ME SOME IS WE'VE HAD THESE KINDS OF CONVERSATIONS OVER AND OVER AGAIN AND THE REAL QUESTION I HAVE IS ARE WE SAYING ANYTHING DIFFERENT THAN WE'VE SAID FOR A VERY LONG TIME? THAT WE HAVE TO DO ALL THESE THINGS WHICH ARE LEGITIMATE AND ONE OF THE THINGS STRIKES ME, YOU KNOW WOR THE BIG PROBLEMS IN THE--COUNTRY IS THE HEALTHCARE DELIVERY TWO AND HALF TRILLION DOLLARS AND EVERYBODY'S--LOOK WHAT'S HAPPENING WITH TECHNOLOGY AND LACK OF IT AND SO ON. SO I DO THINK THAT WE SHOULDN'T DO THINGS THAT WE DON'T BELIEVE IT BUT I--IN, BUT I ALSO THINK WE REALLY NEED TO FOCUS SOME ABOUT DISCUSSION ON HOW WE WILL IMPROVE AND MAKE CHEAPER, IMPROVE THE VALUE OF OUR HEALTHCARE SYSTEM BECAUSE THE NIH IS A TINY PIECE OF IT, BUT [INDISCERNIBLE] COULD BE [INDISCERNIBLE] IN GENERAL WE DON'T TALK ABOUT WHEN WE'RE TALKING ABOUT OBESITY AND DIABETES, IT IS ONE THING TO SAY WE HAVE ON SOLVE THE PROBLEM WITH BEHAVIOR AND SCIENCE AND SO ON, BUT THE BIG ISSUES AT THE MOMENT THAT SEEM TO RESONATE WITH AT LEAST PARTS OF CONGRESS AND THE ADMINISTRATION, YOU SUDDEN HOW DO WE GET THESE COSTS UNDERCONTROL AND WE COULD IMPACT BY A WHOLE VARIETY OF RESEARCH AND SO ON. I KNOW WE DO IT TO SOME EXTENT BUT IT'S REALLY A BIG FOCUS AND I'M TRYING TO THINK OF WAWE CAN DO DIFFERENTLY THAT WILL MAKE AN IMPACT RATHER THAN COMMUNICATE WHERE THIS IS IMPORTANT WITH THE DISEASE AND I HOPE I SAID IT RIGHT. IT'S REALLY TO BE RESPONSIVE TO WHAT THE COUNTRY IS WORRYING ABOUT, AT LEAST AT SOME LEVEL RATHER THAN JUST SAY, WE NEED TO DO WHAT WE'RE SAYING BETTER INCLUDES FAILING IT. SOME OF IS REALLY IMPORTANT. >> I WOULD ARGUE THAT BEING MORE PLAIN SPOKEN COULD BE STRONG [INDISCERNIBLE]. >> [INDISCERNIBLE] >> THANKS ALAN I THINK YOU BROUGHT US PERSPECTIVE FROM THE NATIONAL SCIENCE BOARD EXPERIENCE AND THE COMMENTS ABOUT WHAT'S HAPPEN NOTHING THE E. U. AND ESSENTIALLY THE U. K. ARE HIGHLY RELEVANT. WE [INDISCERNIBLE]. --SOME VERY USEFUL COMMENTS, I'M LOOKING FORWARD TO THE REST OF THE DAY, THANK YOU. [ APPLAUSE ] >> WE HAVE TIME FOR YOU TO MAKE A FEW COMMENTS ABOUT THE STUDY THAT YOU SHARED WITH ME EARLIER THIS MORNING IF YOU WOULD LIKE TO DO THAT. I THINK IT MIGHT BE BE HELPFUL. EITHER PLACE IS FINE. >> HOWARD MAYBE JUST A FEW WORDYOUR BACKGROUND. >> HOWARD GARRISON I DIRECTOR OF OFFICE OF PUBLIC AFFAIRS, AMERICAN SOCIETIES OF EXPERIMENTAL BIOLOGY AND AS IS LEAVING ALAN I WOULD LIKE TO THANK YOU FOR YOUR PRESENTATION. IT WAS EXCELLENT AND I HAVE A FEW WORDS TO SAY ABOUT IF I-- >> [INDISCERNIBLE] >> ALAN RAISED A NUMBER OF EXCELLENT POINTS, I WANT TOED EARLIER THIS MORNING I MENTIONED TO DR. CASSELL THAT MY FAVORITE TRACE BACK STUDIES, IT WAS A STUDY DONE BY JULIUS COMROE AND ROBERT DRIFTS IN THE 1970S WAS FUNDED BY NIH, IT WASOT ORIGINS OF INNOVATIONS AND PULMONARY MEDICINE AND THEY DID A BRILLIANT STUDY, BREECHING OUT TO COLLEAGUES IN THE MEDICAL FIELD ASKING ABOUT THE MOST IMPORTANT DEVELOPMENTS THAT TOOK PLACE IN THE PAST 30 YEARS AND THEN THEY WENT BACK AND LOOKED AT BASIC RESEARCH THAT ENABLED THOSE STUDIES. IT'S A VERY, VERY WELL DONE STUDY, CAREFULLY CRAFTED AND MAKES AN EXCELLENT POINT ABOUT THE TIME FRAMES AND THE NATURE OF THE RESEARCH THAT LEADS TO IMPORTANT INNOVATION AND HEALTHCARE. I RECOGNIZE AS ALAN POINTED OUT THAT IT'S DIFFICULT TO MAKE THOSE POINTS AND THEY'RE NOTTICISM AND HE WILL THEY TAKE A LOT OF TIME AND EFFORT BUT AS DR. COLLINS POINTS OUT, IT'S ABSOLUTELY ESSENTIAL THAT WE BE ABLE TO DO THAT. AND SO, I'LL SEND A COPY TO THE WEB SITE AND APPEND A FEW COMMENTS, DIRECTING PEOPLE TO THIS WORK. IT REALLY IS VERY SCHOLARLY AND WHEN I READ IT THE FIRST TIME, IT WAS EYE OPENING TO ME AS A SOCIAL SCIENTIST ABOUT THE NATURE OF THE RESEARCH THAT LEADS TO CHANGES IN HEALTHCARE. I JUST WANT TO SAY THAT ALAN'S POINT ABOUT THE GRANULARITY OF THE CALLS FOR JUSTIFICATION OF RESEARCH IS EXTREMELY IMPORTANT AND EVEN THOUGH THE PARTICULAR BILL HE MENTIONED IS NOT MOVING FORWARD IN CONGRESS THERE IS AN EVER PRESENT THREAT THAT IT WILL BE AND THE NATIONAL SCIENCE BOARDS WORK TO RAISE THE DISCUSSION TO THE PORTFOLIO LEVEL IS QUITE IMPORTANT. IT WAS A VERY IMPORTANT BREAK THROUGH. I WILL SEND ALAN A MESSAGE THANKING HIM FOR THAT BUT THANK YOU AND I--I THINK IS AN EXCELLENT DISCUSSION. >> THANK YOU HOWARD. AND I DID SEND JUANITA A COPY OF THE PAPER YOU REFERENCED AND WE HAVE IT AND WE WILL SHARE IT. AND HOWARD AND I WERE CHATTING THAT EARLIER THIS MORNING IT MIGHT BE THAT IF EACH INSTITUTE DID THIS WITH A SET NUMBER OF PUBLICATIONS ON A YEARLYY BASIS THEN YOU'D HAVE THAT ALWAYS TO REFER BACK TO, TO TRY TO SELECT THE TOP 10, YOU KNOW MOST IMPACTFUL BUT THEN IN A VERY SYSTEMATIC WAY, IT'S JUST THESE AUTHORS SEEM TO DO WITH RESPECT TO MULL MONITORARY MEDICINE, MAYBE CAN YOU DO THAT WITH RESPECT TO SAY BOTH CARDIAC AND INFECTIOUS DISEASES BUT THEN TO DO IT IN A VERY SYSTEMATIC WAY CAPTURE ALL THE DATA BEHIND IT AND THEN YOU HAVE THAT ONGOING IN TERMS OF TRACE BACK. BUT PETER ORSZAG IS NOT QUITE HERE. HE WENT TO THE WRONG ENTRANCE. SINCE WE DIDN'T HAVE A BREAK SCHEDULE. WE WILL ALLOW YOU ONLY 10 MINUTES BECAUSE WE WANT TO BE READY WHEN HE COMES IN BECAUSE HE HAS A SHORT AMOUNT OF TIME TO SPEND WITH US AND CRITICAL INFORMATION FOR US AND--NO, NO, OKAY. SO ANYWAYS STRETCH YOUR LEGS BUT BE BACK IN 10 MINUTES. >> WE ARE ABSOLUTELY DELIGHTED TO PETER ORSZAG HAS ARRIVED. MITCH DANIEL SYSTEM A VERY GOOD FRIEND, BOTH OF US TOGETHER FOR A WHILE, BEING AT LILLY SO I KNOW WHAT YOU'VE BEEN THROUGH AT OMBR--VOMBR, TO A CERTAIN EXTENT I'M ALSO MARRIED TO A BANKER AND I KNOW, I NOTE THAT YOU'RE ACTUALLY CHAIRING THE FINANCIAL STRATEGY AND SOLUTIONS GROUP FOR CITICORP SO I KNOW YOU WILL BE ABLE TO SOLVE ALL OUR FINANCIAL PROBLEMS AND BE CREATIVE IN YOUR ROLE IN INVESTMENT BANKING BUT WE'RE REALLY, REALLY INTERESTED FROM WHAT YOU HAVE TO TELL US FROM THIS PERSPECT AND I HAVE FROM YOUR OMB PERSPECTIVE AS WELL SO WE REALLY APPRECIATE YOUR MAKING SUCH A GREAT EFFORT TO ESPECIALLY! WE MIOSES THE OPPORTUNITY TO--MISSED THE OPPORTUNITY EARLIER ON BUT WE REALLY DIDN'T TELL YOU HOW MUCH WE APPRECIATE YOU BEING HERE AND NORM AND MARTHA WILL CHAIR AND MODERATE RATHER THE DISCUSSION FOLLOWING YOUR PRESENTATION WHICH I'M SURE WILL BE EXCELLENT. >> THANK YOU. I LEARNED A LESSON THIS MORNING BECAUSE MY NORMAL PRACTICE IS WHEN I GET IN THE BACK OF A CAR TO GO INTO MY READING MATERIALS AND NOT PAY ATTENTION TO MY SURROUNDINGS, AND THIS MORNING WAS AN ATTEMPT WHERE IT BACK FIRED AND THE DRIVER SAID WE HAD PULLED UP TO A NONEXISTENT VACANT LOT, AND 900 DIFFERENT THAN 9000 ROCKVILLE PIKE AND I APOLOGIZE FOR THE DELAY AND A LIFE LESSON THAT OCCASIONALLY IT'S GOOD TO LOOK OUT THE WINDOW. SO GIVER THAT--GIVE ME SOME SENSE OF HOW YOU WANT THIS TO RUN IN TIMING. >> WE WANT TO YOU TAKE ALL THE TIME YOU NEED. >> HOW MUCH TIME DO YOU HAVE? >> [LAUGHTER] >> WELL, NOT ALL DAY, THAT'S FOR SURE. BUT SERIOUSLY, WE CAN SAVE SOME TIME OFF LUNCH. SO JUST PROCEED AND YOU'LL CUT YOU OFF WHEN WE HAVE TO. >> I WILL GIVE YOU A LITTLE BIT ON WHAT'S HAPPENING IN HEALTHCARE AT LARGE BECAUSE THAT'S AN IMPORTANT CONTEXT AND THEN I WANT TO TALK ABOUT THE STATE OF THE LITERATURE ON THE ECONOMIC RETURN TO BIOMEDICAL INFORMATION BECAUSE I DON'T THINK IT'S AS GOOD AS IT CAN BE SO I WILL TRY TO MAP OUT OR PRESENT THE STUDIES THAT ARE KIND OF OUT THERE. AND WHAT I'M HOPING TO DO IS GET AT THAT MODERATELY QUICKLY AND WE CAN TAKE THIS, INCLUDING HOW I HOPE WE CAN BUILD OUT THAT EVIDENCE BASE BECAUSE THAT WILL BE IMPORTANT FOR COMING BUDGET BATTLES TO MAKE THE CASE FOR NIH, OPPOSE TO SORT OF AN ABSTRACT THIS, IS GOOD FOR THE WORLD. ALL RIGHT, SO GENERAL CONTEXT HERE. >> EVERYONE KNOWS HEALTHCARE SPEND SUGGEST THE KEY LONG-TERM FISCAL DRIVER, BLAH, BLAH, BLAH, BLAH. SO YOU HEARD THIS MILLIONS OF TIMES. SOMETHING VERY INTERESTING IS HAPPENING THOUGH, THAT YOU PROBABLY HAVE NOT HEARD AS MUCH ABOUT, WHICH IS HEALTHCARE SPEPPEDDING AS THROWED DOWN DRAMATICALLY OVER THE PAST FEW YEARS AND A LOT OF PEOPLE SAY THAT'S BECAUSE OF THE ECONOMY. SO I WILL FOCUS ON MEDICARE BECAUSE THE A TECHNICAL PAPER FROM THE CONGRESSIONAL OFFICE SUGGESTED WHAT IS OBVIOUS WHICH IS THERE'S NO REASON THAT YOU SHOULD EXPECT THE ECONOMY TO AFFECT MEDICARE, BECAUSE MOST MEDICARE BENEFICIARIES HAVE SOME KIND OF SUPPLEMENTAL INSURANCE SO THEY'RE NET OUT OF POCKET EXPENDITURES ARE PRETTY LOW AND SECTIONAL SECONDLY, THE MAJORITY OF INCOME COMES FROM SOCIAL SECURITY AND THAT'S NOT SUBJECT TO THE SAME ECONOMIC FLUCTUATIONS, SO THERE'S NO REAL REASON TO EXPECT IT IN THE ECONOMY SO THE CBO TECHNICAL FOLKS FOUND. YEAH, FOR THOSE WHO ARE ALSO INTERESTED IN LOOKING AT THIS IN A DIFFERENT WAY, IF THERE WERE A STRONG RELATIONSHIP BETWEEN MEDICARE SPENDING AND THE ECONOMY, YOU EXPECT TOXIC EFFECTS SEE IT IN THE CROSS SECTIONAL DATA TOO, YOU EXPECT THE SATES THAT EXPERIENCE THE STRONGEST, BIG OF THE INCREASES IN THE EMPLOYMENT AND BIGGEST HOUSING CRISIS AND MEDICARE SPENDING SLOWED DOWN THE MOST. THIS IS A TECHNICAL GROUP SO CAN YOU PROBABLY IMMEDIATELY INTUITIVELY SEE THAT IF YOU RAN A REGRESSION OR TRIED TO DO THE CORRELATION THERE, IT'S BASICALLY ZERO. SO THAT'S CONSISTENT WITH ANOTHER STUDY SUGGESTING NO REAL RELATIONSHIP, EITHER TIME SERIES OR CROSS SECTIONALLY BETWEEN ECONOMIC ACTIVITY AND THE ECONOMY. SO IT'S NOT THE ECONOMY, WHAT IS IT? AND WILL IT CONTINUE? AND IT IS INTERESTING WHERE YOU CAN SEE THAT MEDICARE SPENDING SLOWED DOWN ALSO, THE BIG DIFFERENCE BETWEEN THIS AND THAT, WELL FIRST OF ALL THIS ONE GOT REVERSED SO HOPEFULLY THAT'S NOT WHAT'S ABOUT THAT HAPPEN BUT MORE IMPORTANTLY THAT PREVIOUSK CELLERATION WAS DRIVEN BY PLACE CUT, BY REIMBURSED RATE REDRUBBINGSES THAT WERE--REDUCTIONS THAT WERE REGULATED THAT IS A FLOW QUICKLY BUT NOT A SUSTAINABLE PATHWAY FORWARD ON A LONG-TERM BASIS. THIS SLOW DOWN WAS HAPPENING, THERE WERE A BUNCH OF REIMBURSEMENT TYPES AS PART OF THE AFFORDABLE HEALTHCARE ACT, THIS IS ALMOST ALL QUANTITY PRICED, IS THAT'S A MUCH DIFFERENT PHENOMENON. JUST TO GIVE YOU SOME SENSE OF HOW IMPORTANT THIS IS, THE TOP BLUE LINE IS CLICHEED. WE'RE FALLINGAVE CLIFF THIS, IS TERRIBLE, THE WORLD'S GOING--GOING TO BLOW UP VERY QUICKLY, SO THAT THE OFFICIAL PROJECTION. JUST TO GIVE YOU SOME SENSE OF HOW BIG ANIMPACT THERE WOULD BE IF WE COULD SOMEHOW CONTINUE A SLOWER GROWTH IN HEALTHCARE SPENDING THIS, SIDELINE SHOWS YOU MEDICARE SPENDING IS A SHARE OF GDP FCOST PERBENEFICIARY GROW IN THE FUTURE AT THE SAME RATE AS THEY DID BASICALLY OVER THE PAST FIVE YEARS. TRAUMATICALLY, YOU SEE A TINY LITTLE BUMP FROM DEMOGRAPHICS; SCRAMATICALLY DIFFERENT PICTURE AND THE PICTURE OF THE UNITED STATES WOULD BE MUCH MORE AH SPISHES IF THIS SLOWER GROWTH WERE TO CONTINUE. NOW WHY DOES THIS MATTER FOR BIOMEDICAL STUFF? IT MATTERS IN TWO WAYS, ONE IS I BELIEVE IT'S THE THING THAT'S DRIVING THIS SLOW DOWN. HERE IS THE ANTICIPATED CHANGE IN PAYMENT POLICY FOR A WHOLE VARIETY OF PROVIDERS. IF YOU--IF FACT I JUST DID THIS AT THE INNOVATION SUMMIT IF YOU ASK EXECUTIVES AND OTHER PROVIDERS WHAT SHARE--DO YOU BELIEVE MORE THAN 50% OF YOUR REVENUE WILL NOT BE SEEN FOR SERVICE BY SOME DATES 2018 TO 2020 AFTER A SHOW OF HANDS, CONSISTENTLY, I GUESS SAY TWO-THIRDS, THEY EXPECT THE MAJORITY OF THEIR REVENUE TO BE RISK BASED IN SOME WAY EITHER, EITHER A BUNDLED PAYMENT OR AN ACCOUNTABLE CARE ORGANIZATION. THAT IS IMPORTANT BECAUSE THE DECISION MAKER THEN FOR WHAT VALUE ENHANCING INNOVATION INCLUDING BIOMEDICAL STUFF, IS GOING TO SHIFT FROM EITHER MEDICARE OR AN INSURANCE COMPANY TO WHOEVER THE ACO IS FOR THE BUNDLED PAYMENT. SOW JUST PAUSE ON THAT. IF I'M A HOSPITAL EXECUTIVE AND I'M GETTING $7000 PER YEAR TO TAKE CARE OF ALL THE HEALTHCARE THAT SOMEONE NEEDS IN AN ACCOUNTABILITY CARE ORGANIZATION, THEN THE DISTINCTION BETWEEN.ME AND AN INSURANCE COMPANY IS KIND OF HARD TO SEE BECAUSE I'M THE ONE AT RISK FOR INTENSITY. SO AS NEW DEVICES, NEW DRUGS, NEW WHATEVER COME ON THE MARKET IT'S REALLY GOING TO BE MY CALL AS TO WHETHER THAT IS A BIG ENOUGH BENEFIT TO QUALITY TO JUSTIFY THE EXTRA COST. IF THE--SO WHAT I'M SAYING IS IF THAT WERE TO CONTINUE, I THINK THERE ARE TWO CONSEQUENCES, ONE IS THE PROBABILITY THIS CONTINUES HIGHER AND SECONDLY, THE NATURE OF INNOVATION OR AT LEAST THE DECISION MAKERS AFFECTING INNOVATIONS SIGNIFICANTLY DIFFERENT THAN OUR HISTORICAL MODEL SUGGESTS. SO THAT HAS FAR REACHING CONSEQUENCE. SO THAT'S KIND OF BACK DROP FOR THIS DISCUSSION. NOW LET'S TURN TO--OH BY THE WAY JUST AS AN ASIDE, THE CONGRESSIONAL BUDGET OFFICE STARTED--JUST STARTED TO TAKE THE DECEL BRAGS INTO ACCOUNT BECAUSE--THESE ARE THE TECHNICAL CHANGES WHICH ARE NOT DUE TO ECONOMY AND NOT DUE TO POLICY CHANGES SO THEY'RE BASICALLY REFLECTING ONGOING DECELERATION, $1.2 TRILLION, 785 MEDICARE, 445 BILLION DOLLARS IN MEDICAID OVER A DECADE IN DEFICIT REDUCTION FROM THIS ONGOING DECELERATION, NO ONE KNOWS THAT NUMBER. THAT'S MORE THAN BEING DISCUSSED AS PART OF BUDGET KNOCKSS, BLAH, BLAH, BLAH, BLAH, AND IT JUST GOES TO SHOW YOU SPENDING OUT INTO 2020. THESE ARE HUGE. AND THEY FULLY HAVEN'T MARKED TO MARKET YET. THEY'RE TAKING ONLY PART OF THE DECELERATION AND ASSUMING THAT GETS PROPAGATED OUT. SO THAT'S THE BACK DROP. SO NOW LET'S TURN TO THE VALUE OF BIOMEDICAL ACTIVITY IS THE WAY I LIKE TO THINK ABOUT THIS IS TO BREAK THAT DOWN IN TWO PIECES AND THE LITERATURE ON BOTH PIECE SYSTEM NOT VERY GOOD. SO THE TWO PIECES AT LEAST IN MY MIND ARE WHAT IS THE IMPACT OF IMPROVED HEALTH ON PRODUCTIVITY, AND ECONOMIC ACTIVITY, AND THEN SECONDLY, WHAT IS THE IMPACT OF BIOMEDICAL INNOVATION ON HEALTH AND THERE ARE STUDY THAT TRY AND DO BOTH BUT LET'S GO THROUGH THIS. MY FRIENDS FROM THE CORPORATE SECTOR WILL KNOW THAT THERE ARE A WHOLE BUNCH OF CORPORATE TYPE STUDIES THAT LOOK AT THE RELATIONSHIP BETWEEN HEALTH AND PRODUCTIVITY THAT'S TYPICALLY SOLVE REPORTED BUT NOT ALWAYS BUT TYPICALLY. AND TYPICALLY GET PEOPLE WHO SAY THEY'RE HEALTHIER OR HAVE A HIGHER LEVEL WELL BEING ALSO REPORT THEY'RE MORE PRODUCTIVE AND THAT'S A CORRELATION AND THERE ARE CAUSAL RELATIONSHIPS IN BOTH DIRECTIONS SO ONE DOESN'T KNOW QUITE WHAT TO MAKE OF THAT OTHER THAN THERE IS A POSITIVE ASSOCIATION BETWEEN FEELING HEALTHY AND FEELING PRODUCTIVE REGARDLESS OF THE CAUSAL DEMENTIA. NOW WHAT CAN THEN DO IS SAY, WELL, WHAT ABOUT LOOKING AT CHANGES RATHER THAN LEVELS? SO IF THERE'S A CHANGE IN YOUR HEALTH STATUS, WHAT DOES THAT THEN DO TO YOUR--HOW YOUR PRODUCTIVITY CHANGES? AGAIN DOESN'T SOLVE THE CAUSALITY PROBLEM BUT THE SAME RELATIONSHIP IS PRESENT IN CHANGES AS OPPOSE TO--OPPOSE TO JUST LEVELS, SOMEONE WHO REPORTS THAT THEY HAVE--THEY'RE BASICALLY AT HIGHER HEALTH RISK OR LESS HEALTHY THAN SHOWS UP AS BEING LESS PRODUCTIVE IN TERMS OF THE CHANGE IN THERE. SO TAKES OUT THE SIXTH EFFECT FOR THE INDIVIDUAL AND YOU SY HOW THINGS CHANGE OVER TIME. THIS IS FROM THE CORPORATE WORLD. CAN YOU ALSO GO OUT AND ASK PEOPLE DIRECTLY AND THEN TRY TO COMPUTE THE VALUE OF OF LOST PRODUCTIVITY FROM POOR HEALTH WHICH IS WHAT GALLOP AND OTHER VS DONE. CAN YOU GET PRETTY BIG NUMBERS AND GOAL OPEN MEETING AS DONE THIS ACROSS DIFFERENT PROFESSIONS, AGAIN THIS IS--I DON'T KNOW HOW MUCH TO MAKE OF THIS BECAUSE THIS IS LITERALLY JUST GOING OUT AND ASKING PEOPLE RATHER THAN ANY MORE DIRECT MEASURE, BUT IN THE ABSENCE OF ANY OTHER INFORMATION, IT PROVIDES SOME SENSE IT COULD BE QUITE IMPORTANT. AND THEN THERE ARE IS--THERE IS ATTEMPT TO TRY TO COMBINE THESE AND YOU TRY TO LINK THAT TO CORPORATE DATA ON ACTUAL ABSENTEEISM AND ACTUAL BENEFIT COSTS AND SO ON AND SO FORTH, SO WHAT THESE GUYS DID IS THEY TOOK SURVEYS OF EMPLOYEES AND LINKED TO THE MEDICAL RECORDS OF THE EMPLOYER AND ALSO THE EMPLOYMENT RECORDS OF THE EMPLOYER AND WHAT'S INTERESTING IS, A LOT OF THE COSTS IN TERMS OF PRODUCTIVITY IN HUGE VARIANTS BUT A LOT OF THE COSTS IN TERMS OF LOST PRODUCTIVITY FOR OVER ALL COSTS COMES FROM--VARIES FROM CONDITION TO CONDITION AND ALSO COMES FROM THIS--IT MEANS THAT YOU'RE THERE BUT YOU'RE NOT REALLY THERE, SO, YOU'RE NOT REALLY PAYING ATTENTION. I THINK WE ALL HAVE EXPERIENCED COWORKER WHO IS WOULD FIT INTO THAT CATEGORY FROM TIME TO TIME AND I FIND SOMETHING ABOUT THIS IS EVEN THOUGH--THE YOU KNOW THE CLASSIC KIND OF CORE HEALTHCARE PROBLEMS SO CANCER IS AN EXAMPLE, I MEAN THEY'RE YOU KNOW A QUARTER, ALMOST A THIRD OF THE TOTAL COST IS OUTSIDE OF WHAT WE WOULD TRADITIONALLY MEASURE AS QUOTE HEALTHCARE COSTS BECAUSE IT INVOLVES BEING ABSENT FROM WORK AND THEN NOT BEING FULLY PRESENT AT WORK WHEN YOU ARE THERE. SO I GUESS THE POINT OF THIS IS JUST THERE HAVE BEEN SOME ATTEMPTS TO MAP HEALTH PRONGED ACTIVITIES AND THEY'RE NOT GREAT, BUT THEY'RE TYPICALLY SURVEY BASED. ANOTHER RELATED THEME IS, THERE WAS A RECENT HEALTH AFFAIRS ARTICLE BY DAN GOLDMAN ABOUT WHAT IF INSTEAD OF TRYING TO AEACH INDIVIDUAL DISEASE, WE WERE MORE FOCUSED ON DELAYING AGING SO THE VARIOUS BIOMARKERS OF AGING ITSELF AS BEING THE FOCUS AND LESS DISEASE BY DISEASE, BY DISEASE. THEY SUGGEST, THEY SUGGESTED HUGE BENEFITS IN TERMS OF THE NUMBER OF PEOPLE THAT WOULD BE BENEFITED FROM THAT KIND OF AGING FOCUS AS OPPOSE TO DISEASE FOCUS. NOW THE PROBLEM WITH THAT OF COURSE IS THEY MADE UP THE NUMBERS, BECAUSE WHAT DOES IT MEAN TO SAY YOU FOCUS ON AGING YOU HAVE TO THEN ASSUME SOME IMPACT, BASICALLY AND THAT'S ASSUMING THE WHOLE ANSWER AS IT WERE, BUT NONETHELESS THERE'S THESE STUDIES. SO YOU PUT ALL THAT TOGETHER AND THAT FIRST PIECE IS NOT OVERWHELMING THREE CONVINCE NOTHING MY OPINION AND I HOPE WHEN WE COME BACK, WE CAN--AFTER I RUN THROUGH THIS, SECOND PIECE WE CAN TALK ABOUT WAYS THAT WE CAN POSSIBLY MAKE THAT BETTER IN THE FUTURE. NOW THERE,'S ANOTHER--THERE'S ANOTHER PAPER THAT DOES THIS MORE SCIENTIFICALLY. IT LOOKS FANCIER BUT I'M GOING TO TELL YOU THEY ALSO KIND OF MADE UP THE NUMBERS AT THE END OF THE DAY. SO MURPHY AND TOLE VILLAGE IS ONE OF THE CLASSIC AREAS IN THE AREA OF--PAPERS IN THE AREA. TO GET LARGE BENEFIT FROM HEALTH IMPROVEMENT AND HISTORICALLY $3.2 TRILLION PER YEAR ADDED IT ECONOMIC ACTIVITY IF YOU WILL BECAUSE OF IMPROVEMENTS IN HEALTH THAT'S A VALUE TO A TYPICAL VALUE AND VALUE IN TERMS OF DOLLARS AND LIFE EXPECTANCY IMPROVEMENT SINCE 1900. THE KEY THING TO REALIZE ABOUT THIS IS IT'S ALL PREDICATED ON--IF YOU HAVE AN IMPROVEMENT IN MORTALITY FROM SOMETHING, IT'S NOT BEEN HARD TO MAP THAT INTO AN ECONOMIC VALUE AS LONG AS YOU'VE GOT THE VALUE OF A STATISTICAL LIFE, THAT'S THE KEY PARAMETER. SO THEY JUST TAKE FROM THE LITERATURE, 6.3 MILLION DOLLARS WHICH IS NOT CRAZY IN TERMS OF VALUE OF STATISTICAL LIFE BUT EVERYTHING'S DRIVEN OFF OF THAT VARIABLE AND YOU COULD SCALE THESE UP OR DOWN DEPENDING ON WHAT NUMBER YOU PICK THERE. SO AGAIN, IT'S NOT FULLY ASSUMING THE ANSWER BUT PREDICATED ON OR VERY SENSITIVE TO THAT PARTICULAR PARAMETER. GIVEN THAT PARAMETER AND WHAT THEY DO, WA'S INTERESTING TO KNOW, I DON'T MEAN TO BE OVERLY CRITICAL, WHAT THEY SEE THAT'S INTERESTING IS POINT OUT SEVERAL THINGS THAT ARE PERHAPS INTUITIVE BUT THAT ARE WORTH KIND OF HIGHLIGHTING, THE FIRST IS THE VALUE OF DELAYING OR MITIGATING A DISEASE IS INCREASED IF THERE ARE A LOT OF PEOPLE IN THE POPULATION DEMOGRAPHICALLY AT AN AGE IMMEDIATELY PRIOR TO THE MOST--YOU KNOW WHERE THE MODAL INCIDENCE OF THE DISEASE IS. THE BENEFIT OF INVESTING IN HEALTH OR THE DESIRE TO IMPROVEMENT INCREASES AS WEALTH INCREASES. THAT THERE ARE C UT ADDRESSING DISEASE A AND DISEASE B. IN FACT, THEY SHOW THIS HERE, THAT IS JUST BASICALLY THE VALUE OF FINDING SOMETHING THAT MITIGATES CANCER IS HEIGHTENED, IF YOU'VE ALSO INVEST INDEED SOMETHING THAT MITIGATES CARDIOVASCULAR DISEASE SO THAT MORE PEOPLE REACH THE AGE AT WHICH THE CANCER HIT AND SO THERE'S POSITIVE COMPLEMENTARITY, YOU CAN SEE THESE ARE REALLY BIG NUMBERS. SO THE POINT IS THERE'S BEEN A MASSIVE IMPROVEMENT IN LIFE EXPECTANCY, PEOPLE DO VALUE LIFE, QUITE HIGHLY. I MEAN SIX MILLION DOLLARS IS AN EXAMPLE, SO YOU PUT THOSE TWO FACTS TOGETHER AND YOU GET VERY BIG NUMBERS FROM HIFULTRY AND THEN WHAT THEY DO IN THIS TABLE IS SAY, WELL WHAT IF WE GOT ANOTHER 10% REDUCTION IN MORTALITY RATES WHAT WOULD THAT KIND OF DO. SO THAT'S THE VALUE OF ONE. IF YOU PICK ONE APPROACH TO THE FIRST QUESTION OF VALUE OF HEALTH ON WELFARE OR PRODUCTIVITY IF YOU WILL AND THOSE ARE DIFFERENT CONTENTS BUT I THINK THIS IS PROBABLY THE BEST SINGLE STUDY, BUT AGAIN, IT'S JUST--ENTIRELY PREDICATED ON THAT VALUE OF A STATISTICAL LIFE. SO WHAT ABOUT THE VALUE OF BIOMEDICAL INNOVATION ON HEALTH, THE SECOND PIECE? THERE HAVE BEEN A BUNCH OF STUDIES ON THIS, TOO, ONE THAT HAS USED JUST AGGREGATE DATA FROM [INDISCERNIBLE], THEY TAKE 10 YEAR INVESTMENT PATTERNS FROM IT, AND THEN CORRELATE THAT WITH CHANGES IN MORTALITY RATES FOR THIS SPECIFIC DISEASES, YOU CAN SEE THEY GET PRETTY IMPRESSIVE RESULTS FOR CARDIOVASCULAR STUFF AND FOR STROKES, THE RESULT FOR DIABETES AND FOR CANCER A LITTLE BIT MORE MIXED, SO JUST TO--IT MIGHT BE KIND OF HARD TO READ BUT WHAT HA UPPER LEFT THING IS SAYING IS THAT BASICALLY AS THE 10 YEAR AVERAGE AND THEY ARGUE 10 YEAR AVERAGE ARE RELEVANT GIVEN THE TIME LAG BETWEEN A BIOMEDICAL INNOVATION AND THE ACTUAL IMPACT ON HEALTH, THE AVERAGE--THE AVERAGE INVESTMENT GOES UP, YOU SEE OVER TIME A CORRELATION WITH THE DECLINE AND THE MORTALITY RATE AND THAT CONDITION. NOT PROOF POSITIVE BUT YOU KNOW IT LEEDS FOR THESE TWO THINGS, A PRETTY TIGHT HISTORICAL CORRELATION. THIS IS FOR THE NIH AS A WHOLE AND AGE ADJUSTED MORTALITY RATES AS A WHOLE. THAT ACTUALLY LOOKS PRETTY GOOD SO AGAIN ONE HAS TO BE CAREFUL ABOUT THE SIMPLE TIME SERIES AND CORRELATIONS AND CAUSATIONS BUT NONETHELESS IF YOU MATCH THESE TWO THINKS UP, THEY MATCH FAIRLY CLOSELY. THAT AND WASHINGTON D. C. IS GOOD ENOUGH FOR GOVERNMENT WORK THAT WOULD KIND OF STRIKE MOST PEOPLE AS DEFINITIVE PROVE EVEN THOUGH IT'S NOT QUITE. THERE'S ALSO A BUNCH OF STUDIES, KIND OF FRANK LICHTENBERG HAS DONE TO LOOK AT VINTAGE DRUGS TO SEE HOW THAT CORRELATES WITH--WITH ACTIVITIES OF DAILY LIVING AND OTHER HEALTH METRICS TO GIVE YOU SOME SENSE OF THAT, THIS IS FOR NURSING HOMES, PEOPLE IN NURSING HOMES AND YOU CAN SEE THAT IF--THE WAY THEY DID THIS, NOW HERE'S THE CAVEAT ON THIS, TO ILLUSTRATE THE DIFFICULTIES, IN DIFFERENT STATE THERE IS ARE DIFFERENT MIXES OF DRUGS USED BY NURSING HOME OCCUPANTS AND SO THEY BASICALLY SAID IF YOUR STATE USES AN OLDER DRUG NET AND YOU'RE LESS HEALTHY AFTER WE TRY TO CONTROL FOR EVERYTHING ELSE, WE WILL CONTRIBUTE THE PART THAT SURVIVES AFTER CONTROLLING EVERYTHING ELSE, WE WILL ATTRIBUTE THE OLDER DRUGS TO THE WOWORSE HEALTH IN YOUR SPACE, BASICALLY. AND ON THAT BASIS YOU CAN THEN TRY TO TEASE OUT THE EFFECTS OF DIFFERENT VINTAGES, THAT'S A PRETTY BIG LEAP OF FAITH BUT FOR WHATEVER IT'S WORTH IT SUGGEST THERE IS' BEEN A SIGNIFICANT BENEFIT FROM NEWER DRUGS AS OPPOSE FROM THIS CASE 1990 OR EARLIER VINTAGE DRUGS. HE DOES THE SAME THING BASICALLY FOR THE DISABILITY RATE. THIS ONE IS BASED IF I REMEMBER RIGHT ON DRUG MIXES IN MEDICAID. SO IN MEDICAID, THE DRUG MIX BY STATES BECAUSE OF FISCAL CONSTRAINTS OR LOTS OF OTHER REASONS MIGHT VARY AND IF YOU CONTROL FOR EVERYTHING ELSE, AND THEN LOOK AT THE DRUG MIX IN MEDICAID AND DISABILITY RATES CAN YOU PROJECT THAT OUT THE POPULATION AS A WHOLE NOW THE DIFFICULT NEUROECTODERMAL ALL OF THIS IS, THERE ARE--DIFFICULTY IN ALL OF THIS IS THERE ARE LOTS OF THINGS THAT VARY BETWEEN A NURSING HOME IN TEXAS OR A NURSING HOME IN TEXAS AND MEDICAID IN TEXAS AND MEDICAID IN COLORADO AND UNLESS YOU ARE CONFIDENT THAT YOU HAVE THE BIG CONFOUNDING FOUNDERS DOWN IT'S A BIG LEAP OF FAITH TO SAY THAT THIS DRUG MIX DIFFERENCE IS WHAT LEADS TO THIS HEALTH IMPROVEMENT. SO THAT'S PRETTY MUCH THE LITERATURE AND YOU CAN SEE WHY I START WIDE MY INITIAL STATEMENT THAT IT'S--KIND OF C+ AT BEST. WE CAN TALK ABOUT WAYS THAT THAT MIGHT IMPROVE, I WANTED TO JUST END THOUGH ON ANOTHER THING THAT'S HAPPENING THAT IS WORTH NOTING BECAUSE IT'S SO BIG. AND IT'S RELEVANT TO THE VALUE OF BIOMEDICAL INNOVATION. I'M CO CHAIRING A NATIONAL ACADEMY OF SCIENCES PANEL WITH RON LEE ON THE GROWING GAP IN LIFE EXPECTANCY BY EICATION AND INCOME. AND FOR THOSE OF WHO YOU HAVEN'T BEEN EXPOSED TO THESE DATA BEFORE, IT'S JUST STUNNING WHAT'S BEEN HAPPENING. SO IF YOU LOOK AT LIFE EXPECTANCY AT--SORRY--AT BIRTH. THOSE WHO HAVE A COLLEGE DEGREE OR MORE THOSE HAVE BEEN GOING UP DRAMATICALLY AT THE BOTTOM OF THE EDUCATION DISTRIBUTION IT'S FLAT, SO LIFE EXPECTANCY, THE ONES YOU READ ABOUT IN THE NEWSPAPER ANYTHING UP IN AVERAGE BUT THE GAPS, MORETALLITY GRADIENT IS ALSO STEEPENING SIGNIFICANTLY OVER TIME THAT'S FOR FEMALES. NOW YOU MIGHT SAY, THAT IS ONLY BECAUSE OF THIS WEIRD MIX OF PEOPLE WHO ARE HIGH SCHOOL DROP OUTS TODAY, AND HIGH SCHOOL DROP OUTS THAT THE SELECTION EFFECTS AND THAT'S CAUSING SOME KIND OF ABNORMALITY. WHAT I FIND INTERESTING IS I HAD--MAYBE I DIDN'T CONCLUDE IT. WELL, THE--TAKE MY WORD FOR THIS, I DEPARTMENT CONCLUDE IT, BUT TAKE ME WORD FOR THIS, IF YOU LOOK AT LIFETIME EARNINGS UNDER SOCIAL SECURITY, MONTHLY EARNINGS AND DO THE SAME CALCULATIONS YOU GET BASICALLY THE SAME RESULTS. SO THE GAP IN LIFE EXPECTANCE SEINCREASING DRAMATICALLY SO MUCH SO THAT ACTUALLY SOCIAL SECURITY RESEARCHER SUGGEST THAD AT AGE 65, TYPICAL MALE, HAD A COLLEGE GRADUATE RELATIVE TO A HIGH SCHOOL DROLL OUT IN 1990, THE DIFFERENTIAL WAS ABOUT A YEAR TODAY IS OVER FIVE IN THE SCALE OF DEMOGRAPHIC SYSTEM SYSTEM--DEMOGRAPHIC SYSTEM MONUMENTAL CHANGE. IT IS RELEVANT IN SOME WAYS BECAUSE IT WILL INFORM THE CONTEXT IN WHICH INNOVATION IS HAPPEN NOTHING THE FUTURE. WHY IS THIS HAPPENING? PART OF IT IS BEHAVIORIAL, SMOKING RATES IN PARTICULAR CAME DOWN VERY SHARPLY AMONG COLLEGE EDUCATED PEOPLE, NOT SO SHARPLY, NOT AS SHARPLY AMONG LESS EDUCATED PEOPLE. PART OF IT IS ACCESS TO HEALTHCARE BUT ONLY PART OF IT IS, ANOTHER PART OF IT MAY HAVE TO WITH THE STUDIES ON STRESS, THAT PEOPLE AT THE TOP OF THE SOCIOECONOMIC DISTRIBUTIONS FEEL IN CONTROL OF THEIR LIVES AND THEREFORE HAVE LOWER LEVELS OF STRESS, EACH CONDITIONAL ON SMOKING AND WHATEVER, OTHER BEHAVIOR. NOW WHY WOULD THAT HAVE CHANGED. NOW WE'RE GETTING QUITE INTO--WE'RE SPECULATING BUT IT'S NOT IMPLAUSIBLE TO ME THAT AS INCOME AND EQUALITY INCREASES THAT SOMEONE WHOSE AT THE FIFTH PERCENTILE OR FEELS MORE STRESSED THAN SOMEONE AT THE 90th PERCENTILE. SO AS THE GAP AND INCOME INCREASES THAT THE ADVERSE EFFECT ON HEALTH ALSO INCREASES. THIS IS A QUESTION THAT THE PAN CELL STRUGGLING WITH IS HOW MUCH OF THIS IS LIKELY TO CONTINUE. WELL, THE GRADIENT CONTINUE TO STEEPEN AND ACTUALLY I--I HESITATE TO SAY THIS IN THIS ROOM BECAUSE NOW I AM--AS I MY KIDS LIKE TO SAY, YOU'RE THE WRONG KIND OF DOCTOR, YOU KNOW? BECAUSE YOU'RE NOT A REAL DOCTOR. BUT THE TRIVIAL EXAMPLE IS NOW SOMEONE IN THIS ROOM CAN TELL ME IT'S A STUPID EXAMPLE IT WHICH I WOULD APPRECIATE FOR HOW THIS MIGHT CONTINUE IS THE SEROGENICLY FROZEN CORN BLOOD OR PLACENTA CELLS? I AM CURIOUS WHETHER THIS IS A GOOD OR NOT GOOD EXAMPLE. HERARY WHAT I KNOW HALF THE POPULATION IS PAYING THE DOLLARS TO SEROGENICLY FREEZE THE CORE BLOOD OR CELL GENES OFFER A PLACENTA SERVICE. THE BIG QUESTION IS WHETHER, AS YOU KNOW PUBLIC BANKS ARE DEVELOPING WHETHER HAVING YOUR OWN CORD OR PLACENTA BLOOD WILL MATTER. BUT LET'S FOR THE SAKE OF ARGUMENT, ASSUME THAT IT MIGHT. IF IT DOES, THEN IT'S NOT HARD TO FIGURE OUT WHO THE HALF OF THE 1 PERCENT OF THE POPULATION IS, ROLL FORWARD 20 OR 30 YEAR FIST THAT INDIVIDUAL MATCH MATTERS THAT'S ONE EXAMPLE OF THE KINDS OF THINGS THAT WOULD FURTHER STEEPEN THE GRADE YEBT BECAUSE I CAN--GRADIENT BECAUSE I CAN TELL YOU, I KNOW THESE COMPANIES THEY'RE ONLY MARKETING TO A PARTICULAR TEGGIC--STRATEGIC MENTORSHIP--SEGMENT OF THE POPULATION. MORTALITY STEEPENING NOT SO GREAT. ALL SUGGESTIONS SUGGEST THAT NIH INVESTMENTS ARE VERY VALUABLE BUT NEITHER PART OF THE TWO STAGE PROCESS OF NAILING DOWN THAT ANSWER QUITE PRECISELY AREN'T DONE VERY WELL. THANK YOU VERY MUCH. [LAUGHTER] [ APPLAUSE ] QUESTIONS? >> THANK YOU VERY MUCH THERE'S A LOT OF NUMBERS AND DATA HERE AND YOU'VE EXPLAINED IT THE SAME WAY THAT WE ARE DEALING WITH THE APPROACH TO BIOMEDICAL, THE VALUABLE BIOMEDICAL RESEARCH AND THAT ALL THE LITERATURE OUT THERE S&P MIXED--IS MIXED WITH HOW YOU APPROACH THIS, HOW DO YOU GET TO THIS PLACE SO MAYBE I'LL ASK YOU A DIFFERENT QUESTION. >> OKAY. >> HOW IN YOUR WORLD WHEN YOU'RE CONTRAFORTING WHAT YOU'RE DOING WITH CITI OR OTHER GROUPS I IMAGINE YOU HAVE OTHER GROUPS YOU CONTRAST WITH LOOKING AT THE VALUE OF WHAT YOU DO, DO HAVE YOU ANY SPECIFIC FORMULAS THAT THAT WE CAN INCORPORATE FOR US? >> THE DIFFICULTY IS THAT'S A MUCH EASIER PROPOSITION BECAUSE--I FEEL LIKE--YEAH, OKAY. THANK YOU FOR LETTING ME SIT AT THE GROWN UP TABLE. [LAUGHTER] DID THE THE DIFFICULTY IS THAT THAT--OH ETHANK--OH, THANK YOU. YEAH, THAT'S BETTER. THE DIFFICULT IS THAT THAT IS A MUCH EASIER QUESTION TO ANSWER BECAUSE MOST OF THE PEOPLE WHO WOULD BE PURCHASING SERVICES FROM A PLACE LIKE CITI GROUP ARE INTERESTED IN PRETTY STRAIGHT FORWARD METRICS THAT ARE QUANTIFIABLE. I THINK YOUR CHALLENGE IS INSTEAD NOR SIMILAR TO HOW--MORE SIMILAR TO HOW ONE VALUES BASIC RESEARCH IN GENERAL BECAUSE THE BENEFITS ARE DIFFUSE. THE MAPPING FROM WHAT YOU DO TO ANY OF THOSE BENEFITS IS ALSO KIND OF NEBUE LOWS AND IT'S A LOT EASIER TO SAY, WE CAN DELIVER GLOBAL TRANSACTION SERVICES, BENY AND A HALF FOR BLAH, BLAH, BLAH, THAT'S EASY. BUT YOU KNOW WHAT'S SIMILAR. I'LL TELL YOU WHAT'S SIMILAR IS THE ATTEMPTS THAT HAVE BEEN MADE TO VALUE AND IF YOU READ THE NEWSPAPERS, YOU KNOW, THE SUGGESTION WOULD BE NEGATIVE VALUE TO VALUE THE ROLE OF MEDIATION IN GENERAL, HOW DO YOU VALUE THE FACT THAT WE ALL DON'T HAVE TO WALK AROUND WITH--YOU KNOW WE'RE NOT ALL BARTERING, I'LL TRADE YOU MY DIET COKE FOR YOUR PEN WHICH IS NOT AN EFFICIENT WAY TO RUN AN ECONOMY, HOW DO YOU WILL HAVEUE THE LIQUIDITY OF THAT OF HAVING LOTS OF DIFFERENT INSTRUMENTS THAT PEOPLE CAN TRADE IN AND FINANCE ACTIVITIES WITH AND GREASE THE WHEELS OF THE ECONOMY. THAT IS A VERY HARD QUESTION THAT DOESN'T REALLY GET--WHERE THE STATE OF THE LITERATURE I'D SAY IS NO BETTER THAN WHAT I JUST PRESENTED FOR YOUR WORLD AND I THINK THAT ILLUSTRATES A CHALLENGE WHICH IS, THAT IS SIMILAR IN NATURE IN THAT IT'S KIND OF HARD TO DO BECAUSE YOU'RE EITHER GOING TO DO A TIME SERIES ANALYSIS WHERE YOU HAVE TWO SIMPLE STATISTICS AND YOU TRY TO CORRELATE THEM [INDISCERNIBLE] BASICALLY OR YOU DO A CROSS COUNTRY KIND OF THING OR CROSS STATE KIND OF THING WHICH IS SIMILAR TO THE LICHTEN BERG STUFF AND PEOPLE ARE ALWAYS GOING TO SAY, YEAH BAH THERE ARE 14,000 OTHER THINGS THAT VARY BETWEEN THOSE TWO COUNTRIES OR 22 STATES OR DA-DA-DA-DA. NOW THAT'S ONE ANSWER, NOW THE SECOND ANSWER WHICH IS MORE PROMISING AND IS SPECIFIC TO YOU IS THAT THE HOPE THAT CAN YOU CONTROL THINGS BETTER AND HAVE A MORE ROBUST RESEARCH AGENDA AND MORE COMPELLING ANSWERS IMPROVES AS THE DATA IMPROVES IN OTHER WORDS--AND EXPANDS. WE WOULD FIND IT MORE COMPELLING IF WE HAD INDIVIDUAL HEALTH RECORDS, TO CONTROL FOR ALL OTHER OBSERVABLE ASPECTS OF A PATIENT EXCEPT FOR THE DRUG MIX. I WOULD FIND IT THAT WOULD BE A MORE RELIABLE BASIS THAN JUST LOOK AT STATE MEDICAID SHARES WHERE YOU HAVE AGGREGATE DATA AND LOTS OF THINGS GOING ON. SO IT OPENS UP THE POSSIBILITY THAT OVERTIME AS THE DIGITAL BACKBONES ARE DOLED OUT, TELL BE EASIER TO DO POPULATION BASED ANALYSIS WHERE THE RESULTS WOULD BE AT LEAST A LITTLE MORE ROBUST THAN WHAT WE HAVE TODAY. SO THE SLIDE YOU SHOW OF MEDICARE COSTS OVERTIME AND THOSE ALTERATIONS I THINK FOR MANY OF US IF WE WERE TRYING TO ASPIRE TOWARDS CAUSAL RELATIONSHIP WE WOULD LIKE TO ASK ABOUT IT WOULD HAVE TO DO WITH BIOMEDICAL RESEARCH AND CARE AND IMPROVED HEALTH AND SAME PROCESS CONTROL COSTS YOU POINTED OUT THE OTHER FORCES OF THOSE WHICH ARE INFLUENCING AND SHORT-TERM PROFOUNDLY THE COSTS AND YOU COMMENTED THE COSTS WERE NOT DUE TO COSTS FOR PRODUCT BUT FOR USE OF PRODUCTS SO I GUESS THE QUESTION IS WITH THOSE SORTS OF FEATURES BEING PREDOMINANT NOW SEEMS TO MAKE IT ALL THE MORE DIFFICULT TO SOMEHOW MAKE THE PREDICTIONS OF MEDICAL DISCOVERIES OVER THE LAST 10, 20 YEARS WHEN WE HAD THESE OTHER FACTORS OCCURRING AND MAYBE YOUR COMMENT IF YOU HAD THE HEALTH RECORDS WILL LET YOU PARSE IT OUT BUT IT SEEMS TO BE A CHALLENGE UNDERSTANDING WHAT ONE CAN REASONABLY ATTRIBUTE TO THE SORT OF THE BIOMEDICAL SORT HERE. THAT'S RIGHT, THE UPSIDE FOR YOU IS--IT'S KIND OF LIKE THERE'S OFTEN THE DISCUSSION, IS THAT I THINK MOST PEOPLE BELIEVE IN THE INVESTMENT OF BIOMEDICAL INNONAPOPTOTIC IS AND HAS BEEN VERY VABLUE AND THE DIFFICULT SETO REENFORCE THAT WITH THE INDIVIDUAL STORIES OF HERE'S GRANDMA AND AND THAT IS DIFFICULT TO PIN DOWN EXACTLY WHAT THE SAMUE IS, $12 TRILLION WITH ANY KIND OF SCIENTIFIC PRECISION AND THE CHALLENGE THAT YOU'RE HIGHLIGHT SUGGEST ONE OF MANY IN DOING THAT. NOW THERE'S ALSO A QUESTION OF OF--I KNOW I DON'T WANT TO RAISE BASIC QUESTIONS THERE, BUT THERE'S ALSO THE QUESTION OUT OF--ACTUALLY HOW CRUCIAL THAT IS. AND YOU KNOW GETTING THAT NUMBER DOWN MORE PRECISELY HOW MUCH THAT WILL AFFECT THE PUBLIC DISCUSSION PUBLIC FUNDING WHAT HAVE YOU BECAUSE I THINK YOU'RE ACTUALLY, MY OWN PERSONAL OPINION IS YOU'RE ACTUALLY IN A PLACE WHERE THERE'S GENERIC KIND OF YES THAT'S VALUABLE AND IT'S UNLIKELY YOU'RE GOING TO COME UP WITH HAD A--THIS IS SIMILAR TO THE WAY I FEEL ABOUT PEOPLE TO MOTIVATE FISCAL DISCLINE NOW BY SAYING NO THE LAUNCH ON FISCAL GAP IS 74 TRILLION INSTEAD OF 64 TRILLION I DON'T THINK THAT'S THE KEY DRIVER OF BEHAVIOR AT THIS POINT SO SIMILARLY I'M NOT SURE ABOUT THIS AND I DON'T WANT TO DISCOURAGE QUANTIFICATION BECAUSE I THINK IT'S VERY VALUABLE BUT I AT LEAST RAISE A QUESTION THAT GIVEN THAT THE DIGITAL BACKBONE IS THERE YET AND THERE HASN'T BEEN SOME SENTENCE FOR ACADEMICS AND OTHERS TO DO THIS SORT OF THING AND THERE HAVE BEEN STUDIES IN THE CULTURE CONFIRMED THAT I DID THIS TOO WHICH YOU'RE FAMILIAR WITH BUT I GUESS I WOULD JUST JUST QUESTION WITHOUT HAVING THE ANSWER HOW MUCH TRACTION YOU GET FROM NAILING A NUMBER. >> IF I COULD FOLLOW UP ON THE TRACTION QUESTION, YOU KNOW YOU HAVE BEEN SPEAKING MOST IMPRESSIVELY AS A RIGOROUS ACADEMEITION IN THOUGHT. YOUR BACKGROUND INCLUDES A GREAT DEAL OF RELEVANT POLICY EXPERIENCE SO WHEN YOU SAY THERE IS A BACKGROUND, HIGH LEVEL OF CONFIDENCE, VALUE RESEARCH AND RELATE THAT TRACTION, CAN YOU RELATE THAT TO YOUR POLICY EXPERIENCE AND AGREE TO WHICH THIS CONVICTION WHICH YOU SAY IS WIDE SPREAD DOES OR DOESN'T MANAGE TO HAVE IMPACT ON SUPPORT FOR EXAMPLE OF BIOMEDICAL RESEARCH BY POLICY MAKING ESTABLISHMENTS? >> YEAH, BUT BEFORE I DO THAT, THE PROBLEM IS THE CONTEXT IS ALMOST IMPOSSIBLE. WHAT HAS HAPPENED--LET'S JUST BE CLEAR, I DON'T KNOW WHAT WILL HAPPEN TO THOSE NOTES, BUT I DON'T KNOW AND I DON'T CARE BECAUSE I'M OUT OF OFFICE AND I DON'T CARE. [LAUGHTER] BUT THE PROBLEM IS BOTH PARTY VS BOUGHT INTO A FACADE OF A PATHWAY FOR DISCRETIONARY SPENDING AND I THINK NO ONE WILL EVER LIVE BY AND SO THE DEFINITE NUMBERS LOOK BETTER, THEY ACTUALLY LOOK WORSE BECAUSE THE HEALTH PROJECTIONS I THINK ARE TOO HIGH. THEY LOOK BETTER BECAUSE THE DISCRETIONARY NUMBERS WHICH ARE WRITTEN DOWN IN LAW ARE LOW AND YOU WILL SEE THAT PLAY OUT IN REALTIME OVER THE FY14 OR THE FUNDING LEVEL WILL BE AND THAT'S NOTHING RELATIVE TO FISCAL YEAR 2020. TPHAOEUGZINIZEATION--ORGANIZATIO N YOU LOOK--I SHOULD HAVE BROUGHT THESE CHART BUT IF YOU LOOK AT A SHARE OF NONDISCRETIONARY FUNDING AS A SHARE OF GDP, EVEN UNDER THE NONSEQUESTER LEVELS WE WERE ON TRACK FOR BEING ABOUT A PERCENTAGE POINT OF GDP BELOW THE LOWEST LEVEL SINCE 19 SEIVET AND BELOW THE AVERAGE SINCE 1970 AS A SHARE OF GDP AND THEICAL SENCH IN THAT KIND OF CONTEXT, LOTS OF THINGS, LOTS OF JOUSTLING AND LOTS OF NONEVIDENCE BASED DECISION MAKING ABOUT PRIORITIES IN THAT ENVIRONMENT SO HAVE YOU THIS TENSION BETWEEN I DO BELIEVE AND I SAW IT ON A DAILY BASIS THAT YOU KNOW NIH INVESTMENTS ARE SORT OF LIKE APPLE PIE. WHO CAN BE AGAINST THEM? THE PROBLEM IS THERE'S NOT ENOUGH MONEY FOR THE APPLE PIE AND BEER SO THERE'S A LITTLE BIT OF TENSION THERE AND I GUESS THE QUESTION I WAS RAISING IS IN THAT CONTEXT HOW MUCH DIFFERENCE WILL IT MAKE TO HAVE A NUMBER AND MAYBE, YOU KNOW I DON'T WANT TO COMPLETELY CHANGE IT, BUT TO BE ABLE TO HAVE THIS ORGANIZATION CAN GET BEHIND AND SAYS, IF WE COULD ACHIEVE X, THAT'S IT, YOU KNOW ONE AND HALF MILLION DOLLARS VALUE PER PERSON TO THE TYPICAL MATTER, THAT MIGHT MATTER. SO REALLY ELEGANT PRESENTATION, I THINK IT CLARIFIES A LOT OF THINGS THIS GROUP WILL RESCUE WITH AND A LOT OF IT COMES TO ATTRIBUTION, HOW DO YOU IDENTIFY THE COMPONENT THAT YOU CAN SAY NIH DID THAT OPPOSE TO ALL THE OTHER ELEMENTS IN THE ECOSYSTEM, IF YOU DO THAT ON A GLOBAL SCALE ACROSS ALL OF MEDICINE, MANETIN MAY BE RIGHT, I HOPE SO THERE MAY BE SOMETHING THAT THE NIH PLAYED A SIGNIFICANT ROLE, BUT NOT THE ONLY ROLE, JUST TELLS YOU THERE WAS A CORRELATION SO SOME OF THE DISCUSSION HAS EVOLVED AROUND THE DISCUSSION OF OKAY, IF WE CAN'T DO THIS RIGOROUSLY FOR ALL OF MEDICAL RESEARCH AND OUTCOMES BECAUSE THE ATTRIBUTION PROBLEM IS TOO HARD, CAN WE PICK CASE EXAMPLE WHERE WE HAVE A BETTER SHOT AT IT WOG OF THOSE HUMAN GENOME PROJECT ON A RETURN INVESTMENT OF 11 AND 2011 AND THE SIZE OF ONE, AND IT GROWS AND ACTIVITY IN THE UNITED STATES, OTHER THAN WE COULD THINK ABOUT WOULD BE FIGURING OUT WHAT THE BENEFIT HAS BEEN ECONOMICALLY OF THE DEVELOPMENT OF ANTIRETINAL LOCATION RERIVAL WORD FOOTWORK HIV/AIDS WORK AND IT WOULD BE CRITICAL OR GOING BACK FURTHER, LEARNING ABOUT HYPERTENSION AND IT'S A MAJOR RISK FACTOR FOR STROKES AND HEART DISEASE, THOSE ARE APPLIED WE HAVE A HUGE COMPONENT OF THAT REALAISIZATION AND WE HAVE A SUCCESS STORY FOR HEART DISEASE AND STROKE. HOW COMPELLING ARE THOSE KINDS OF CASE EXAMPLES LACKING A MORE RIGOROUS ANALYSIS OF THE BIG PIBLGHTURE SHOULD WE TRY TO PUSH THAT HARDER WHERE WE DEFEND OUR ANSWERS A BIT MORE AGAINST ACCUSATIONS THAT WE'RE TAKING MORE CREDIT THAN WE SHOULD. >> THE QUESTION PROMPTED YOUR EARLIER QUESTION ABOUT HOW--HOW ONE MEASURES, ACTUALLY I WOULD SAY THE CHALLENGE FOR YOU AND THIS WEEK, TWO IDEAS ONE OF WHICH IS THE ONE YOU JUST MENTIONED IS THE CHALLENGE IS ACTUALLY--I CAME BEFORE MY DETOUR WITH THE CAR FROM THE ROBERT WOOD JOHNSON FOUNDATION BOARD MEETING AND THAT IS A MORE SIMILAR CHALLENGE WHICH IS CHILDHOOD OBESITY RATES MAY HAVE TOPPED OFF OR MAYBE PERHAPS POSSIBLY MAYBE ROBERT WOOD JOHNSON HAS A HUGE GROUP ON GROUPA AND HOW MUCH CAN WE COLLECT ON THAT IS IT'S A SIMILAR ON WHAT DOES THE FOUNDATION DOES KIND OF PROBLEM BECAUSE THERE ARE A HUGE NUMBER OF THINGS THAT ARE AT WORK SO JUST TO GET SOME SENSE OF THAT, ONE IS THE KIND OF APPROACH, THAT IF YOU HAVE A PARTICULAR PROGRAM THAT YOU'RE FUNDING AND THAT WORKED--CAN YOU SHOW THE RELATIVE CONTROL GROUP OR WHATEVER DOES THAT WORK REALLY LTHE FOUNDATION HAS BEEN HIGHLIGHT TAG KIND OF THING. THE OTHER THING YOU MIGHT WANT TO DO THAT OCCURRED TO ME JUST FROM THE FOUNDATION ANALOGY IS, THEY HAVE FOUND IT BENEFICIAL TO DO KIND OF THOUGHT LEADER INTERVIEWS, YOU COULD DO A SURVEY OF, YOU KNOW THE TOP 50 OR HUNDRED, AND JUST ASK THEM, MORTALITY FROM CARDIOVASCULAR DISEASE DECLINED BY ACTS HOW IMPORTANT DO YOU THINK NIH WAS AND MUCH LESS THAN THE DISEASE, THAT'S ALSO THAT MIGHT BE HELPFUL. THIS IS THE KIND OF--I DON'T WANT TO CALL IT ADVERTIDING BUT--ADVERTISING BUT IT COULD POTENTIALLY BE HELPFUL IN TERMS OF YOU HAVE A DIFFICULT QUANTIFICATION PROBLEM AND IN THAT SETTING SOMETIMES THE KIND OF INFORMED OPINION IS THE SUPPLEMENT TO OTHER THINGS THAT YOU COULD POSSIBLY DO. >> YOU KNOW IN 1969 I SAT AROUND THIS TABLE WITH THE NHLBI AND WE WERE CELEBRATING THE DECLINE IN DEATHS ALREADY BY THAT TIME SO THIS EXPLANATION IT IS VIRTUALLY FLAWLESS BLOOD PRESSURE CONTROL UNUSUAL BEHAVIOR, ET CETERA, COUNTED WERE THE GAINS FOUR TIMES OVER. >> YEAH [LAUGHTER] >> AND THAT MEANS THE ASSUMPTIONINGS CO VARIANTS BECOME THERE,. >> YEAH, I, GHEE, ALL THE CREDIT IS ASSOCIATED AND VAST BENEFIT BECAUSE ALL OF THE PROGRESS IS GETTING BACK TO THE BASE, SO HOW DO YOU SUGGEST THIS MIGHT BE DONE BETTER OR LEARN WHAT WE CAN FROM THIS, AND WE SHOULD MOVE ON TO HOW WE CAN DO THE MOST WE CAN WHEN IT'S AVAILABLE. >> YEAH, SEE, THAT'S THE QUESTION I WAS RAISING WHICH WAS--LOOK, I THINK THAT ONE CAN IMPROVE BECAUSE AS I MENTION AS YOU GOT MORE AVAILABLE YOU CAN BE A LITTLE BIT MORE CONFIDENT ABOUT THE RESULTS BUT THE QUESTION I WAS RAISING ABOUT WHETHER IT'S--THAT'S WHERE THE MAJORITY OF YOUR EFFORT SHOULD BE WAS INFORMED BY A CONCERN THAT FOR THE FORESEEABLE FUTURE IT SHOULD BE CLEAR THAT'S THE NEXT TWO OR THREE WEEKS, THAT'S THE NEXT KIND OF THREE-FIVE YEARS KIND OF THING THAT I'M SKEPTICAL YOU WILL MAKE VAST LEAP FROGS IMPROVING IN THE QUALITY OF THIS AND WERE THEREFORE IF YOU WANT TO MAKE PROGRESS OVER THE NEXT FIVE YEARS, YOU KNOW THERE'S NO HARM IN A LITTLE BIT OF THIS SORT OF THING BUT I DON'T THINK THAT'S WHERE YOU'RE GONNA--I THINK IT WILL BE MOSTLY KIND OF HIGHLIGHTING THE SUCCESS STORIES AND THEN MAYBE SUPPLEMENTARY THINGS, I DON'T KNOW WHETHER IT'S THE THOUGHT LEADERS OR WHAT HAVE YOU BUT SORT OF THE PURE QUANTIFICATION, THE NUMBER BEING 1.4 TRILLION AS TO 1.2 TRILLION. I'M A LITTLE SKEPTICAL. >> ONE OF THE CHALLENGES OF DEFINING THE VALUE OF BIOMEDICAL RESEARCH WITH THE NIH IS REALLY BECAUSE SO MANY OTHER NOT JUST FACTORS BUT AGENCIES AND THE PRIVATE PRACTITIONERS CAN IMPACT PUBLIC HEALTH AND AS A PREVIOUS DIRECTOR OF OMB, I WONDER IF YOU COULD SHARE WITH US, SOMETIMES I WONDER HOW INDIVIDUALS IN THOSE POSITIONS CAN LOOK AT THE NIH BUDGET AND RIGHTLY SO, IT'S TERRIFIC THAT IT'S AS HIGH AS IT IS BUT AT THE SAME TIME CONTRAST THAT WITH THE BUDGET OF CDC WHICH ONE MIGHT ARGUE SHOULD BE ONE OF THE MAJOR IMPLEMENTORS OF NEW KNOWLEDGE AND APPLY TO PUBLIC HEALTH AND THEN FDA IN TERMS OF REGULATING THE NEW PRODUCTS MANY OF WHICH COME FROM NIH RESEARCH AND BUDGET RISK TODAY IS LESS THAN MONTE MONTGOMERY COUNTY SCHOOL DISTRICT HOW CAN WE EXPECT THE MAJOR REGULATOR TO MAYBE DO AS MUCH AS THEY SHOULD DO IN TERMS OF PROMOTING REGULATION AND SCIENCE AND CDC AS FAR AS IMPLEMENTING AND YOU KNOW IMPACTING PUBLIC HEALTH AT LARGE? >> SO IT'S ALSO A LOT BECAUSE IT THEN REFLECTS POORLY PERHAPS ON THE PERFORMANCE OF NIH AND INVESTMENT OF BASIC RESEARCH BECAUSE IT NEVER ACTUALLY GETS TRANSLATED FOR THE PAGE OR IMPROVEMENT OF PUBLIC HEALTH OR TAKE A VERY LONG TIME TO DO IT. >> SO I GUESS I HAVE THREE THINGS TO SAY ON THAT. THE FIRST IS IT'S ACTUALLY BASICALLY ALMOST A HUGE PROBLEM TO ALLOCATE BASIC RESEARCH DOLLARS PERIOD BECAUSE HOW DO YOU KNOW HOW MUCH, YOU KNOW, YOU MUCH ONE SHOULD SPEND ON ACTIVITY BEHAVIORS OF A AND B AND THE ANSWER IS YOU DON'T. THERE'S NO SCIENCE THERE. THIS IS WHY I THINK THAT KIND OF ZERO BASED BUDGETING THAT YOU START AT ZERO EVERY YEAR AND YOU BUILD A BUDGET FROM THAT, ALMOST OBVIOUSLY HAVE SUBTRACTION TO IT BUT THE IMPLEMENTATION IS OVERWHELMING BECAUSE YOU DON'T REALLY KNOW WHAT THE RIGHT LEVELS ARE SO YOU WOULD BE REOPENING A SITE EVERY YEAR WHEREAS INERTIA BASED BUDGETING DIALING UP OR DOWN EACH YEAR IMPLEASITLY TAKES LAST YEAR'S LEVEL AS KIND OF THE RIGHT STARTING POINT WHICH CLEARLY CAN'T BE OPTIMAL BECAUSE HISTORIC [INDISCERNIBLE] DOES CAUSE IT TO ARISE BUT IT DOES AVOID THE ENDLESS NAYS ASTERISKS GAZING AND ENDLESS TROUBLE. THE POINT IS IF THE NUMBER'S GOING TO BE ARBITRARY AND LAST YEAR'S LEVEL MIGHT BE AS GOOD AS ARBITRARY NUMBER AS ANY AND IT AVOIDS MOST OF THE NUMBER ABOUT WHAT THE NUMBER IS, THEN THE SECOND THING IS, WELL, OKAY, BUT WELL IS DIALING UP AND DIALING DOWN AND HOW DOES THAT GET DECIDED? AND THAT'S ALSO CHALLENGING BUT TYPICALLY WHAT WILL HAPPEN IS THERE HAS TO BE SOME KIND OF STORY FOR WHY A PARTICULAR INVESTMENT, WHY SOMEONE--SOME AGENCY SHOULD BE BUMPED UP OR DOWN THAN SOMEONE ELSE AND IN THE ABSENCE OF THAT, MOST VARIATIONS YOU SEE, THE AGENCIES AT LARGE ARE ACTUALLY PRETTY SMALL. THE SEQUESTER WHICH EVERYONE COMPLAINS ABOUT IS THE ACROSS THE BOARD CUT, THAT'S THE KIND OF AGENCY LEVEL OPPOSE TO INDIVIDUAL PROGRAMMATIC LEVEL IS OBVIOUSLY NOT WHAT RESULT IN THE PROCESS BUT NOT AS FAR OFF AS PEOPLE BELIEVE AND THEN THE FINAL THING I WOULD SAY IS SO I'M NOT GIVING YOU ANYTHING REALLY TO HANG ON TO BECAUSE PARTLY THIS IS ART AND NOT SCIENCE. THERE'S THE PATH THAT OMB SAYS, THAT ACTS OR WANTS A BIT OR WHY AND WE NEED TO DO--A BIT MORE WHY AND WE NEED TO DO THAT OPPOSE TO THERE BEING SOME KIND OF FULLY FLEDGED OUT MANAGEMENT BUDGETING INTEGRATION THAT DOESN'T REALLY--DOESN'T REALLY DO IT. THE FINAL THING I WOULD SAY ABOUT THIS, THOUGH IS I DO THINK IT'S INTERESTING AND FORGIVE ME FOR NOT KNOWING THE ANSWER TO THIS PIECE BUT I DO THINK IT'S INTERESTING TO BE EXPLORING ALTERNATIVE WAYS OF USING THIS FUNDING AND I AM PARTICULARLY AND AGAIN I HAVEN'T THOUGHT ENOUGH ABOUT IT IN AN NIH CONTEXT BUT I HAVE IN OTHER CONTEXT NTHERE'S NO WAY IN MY MIND THAT OPTIMAL ALICATION OF RESEARCH FUNDING IS ZERO% PRICES IN MOST SETTINGS. I DON'T KNOW WHETHER SOME PRIZE ORIENTATION HAS BEEN CONSIDERED OR HAS BEEN DONE I KNOW WE WERE TRYING TO CREATE AUTHORITY IN OTHER AGENCIES-- >> [INDISCERNIBLE] >> --HAVE YOU USED IT? FOR WHAT. >> IT'S BOBBLED UP OUT OF-- >> HERE'S THE REASON I RAISE IT IS IF I WERE PLAYING THE GAME FROM THE OTHER SIDE AND WANTING A LITTLE TOP LINE INCREASE A COOL NEW PRIZE FOR SOMETHING WOULD BE ADDED, NOW THE RESULTS MIGHT BE YOU HAVE TO STAY WITHIN THE SAME TOP LINE, OF COURSE. >> THE UNFUNDED MANDATE IS VERY FAMILIAR. >> YES. >> BUT MY POINT IS THAT THERE'S AT LEAST SOME PROBABILITY SAYING THAT WE WOULD LOVE TO DO A FAIRLY SIGNIFICANT PRIZE FOR X AND ACTUALLY THINKING THROUGH CAREFULLY WHAT THE X IS, MIGHT BE A WAY OF A TYPICAL UP OR DOWN ADJUSTMENT AND I ALSO THINK FRANKLY FOR DOLLAR FOR DOLLAR IN CERTAIN SETTINGS, NOT ALWAYS, BUT AS PART OF A PORTFOLIO, THAT THE PRIZE EFFECT IS A THE UNEXPECTED PATHWAYS FOR THE EFFECTIVE AND C THE GAL VANNIZED EFFECT OF THE GOAL IS WORTH SOMETHING. >> THANK YOU THAT WAS A SPECTACULAR PRESENTATION. THANK YOU, BUT I WANT TO QUESTION YOU SPECIFICALLY ABOUT THE MAD SON ANALYSIS BECAUSE I THINK THEY'RE VERY MUCH PROBLEMATIC EVEN THOUGH AT FIRST GLANCE IT SEEMS AS IF THAT ANSWER TO THE QUESTION, EVERYBODY GO HOME AND BE HAPPY BUT THERE ARE A NUMBER OF INFLECTION POINTS THERE AND ONE WONDER FIST THERE MIGHT NOT HAVE BEEN AS A CARDIOLOGIST, THERE WAS CERTAIN PUBLIC HEALTH MESSAGES AND DISCOVERIES THAT MAY HAVE DRIVEN SOME OF THOSE INFLECTIONS. I WAS WONDER FIGURE WE COULD PULL THIS BACK UP. SO, I'LL JUST LOOK AT IT. YEAH SO A COUPLE POINTS FIRST, THE LAST WORD MOVEMENT IN SOME OF THE CHARTS ARISES BECAUSE THIS IS INFLATION SO EVEN THOUGH NOMINAL WAS DECLARED IN REAL TERMS THERE HAVE BEEN MORE OF THEM, THANKS. BUT YES, WHAT I MEAN HE ARGUES AND AGAIN I DON'T THINK THIS WILL GET YOU OUT OF THE BOX BECAUSE IT SORT OF IT, THERE'S SORT OF THESE BREAK THROUGH POINTS THAT WE HAVEN'T REACHED YET WITH REGARD TO SAY DIABETES THAT WE READ IN THE 50S AND 60S UP THERE AND THE ACCELERATION IS DEPENDENT ON THAT POINT NOW THAT OBVIOUSLY IS NOT QUITE NEOLITHIC BUT IT ALSO DOESN'T THAT INTERESTING BECAUSE YOU'RE DEFINING THE POINT EXPOST AS THE POINT AT WHICH THINGS START TO ACCELERATE AND YES, THAT'S A TRUE STATEMENT. SO I DON'T--I'M SORT OF WITH YOU IN TERMS OF--IF YOU WANT ONE SIMPLE CHART, FOR INSTANCE TESTIFYING AND HE WANTS TO SHOW OFF, THERE YOU GO, RIGHT DISM THAT'S A PRETTY SIMPLE CHART, LOOKS PRETTY GOOD. YOU COULD SAY THAT'S THE ONLY THING GOING ON, YOU COULD EASILY VALUE THAT IMPROVEMENT ON LIFE EXPECTANCY BASED ON THE HELPFUL STUFF AND YOU ARE GOING TO GET SOME MASSIVE RETURN ON BASED ON THESE TWO. NIH TO MORTALITY RATES FROM HERE AND RINE.TALLITY RATES TO VALUE FROM STATISTICAL LIFE, YOU WILL MASSIVE RETURN ON NIH INVESTMENT. >> AS I RECALL THEY ADVOCATE AN NIH BUDGET MULTIPLIED BY 10 IN ORDER TO MAKE THIS WORK, WE LIKE THAT BUT IT WAS HARD TO DEFEND. >> YEAH, SO I'M WITH YOU IN TERMS OF NOT FINDING THAT. AND AGAIN FOR THE QUESTION ARISES, LIKE, WHY EXACTLY IS IT 10 YEARS? WHAT ARE THE PATHWAYS? WHAT DOES IT LIKE LIKE OVER FIVE? OR 11? YOU KNOW ALL THOSE SORTS OF-- >> BUT I THINK IT WAS THE BACK END OF YOUR PRESENTATION THAT PEAKED MY INTEREST MOST BECAUSE ONCE YOU THINK ABOUT PROLONGING LONGEVITY IN THE CONTEXT OF DOING SO AND INCREASING ECONOMIC PRODUCTIVITY THEN HAVE YOU A DIFFERENT CIRCUMSTANCE AND IF YOU'RE THINK BEING THE ACCESS TO HIRE EDUCATION HA IS IT ABOUT HIGHER EDUCATION THAT WELLS TO LONGEVITY FOR ACCESS TO THAT HEALTH AND IT HAS TO BE INFORMED BY SCIENCE SO I WONDFER THEREY A WAY TO CONNECT THESE STOPS AND MAKE THE ARGUMENT THAT THE IMPROVEMENTS WE'VE SEEN IN MORTALITY RATE VS TRULY TRANSLATED MORE LINEARLY TO IMPROVEMENTS IN HEALTH AND THAT IN TURN LEADS TO CONTRIBUTION IN THE ECONOMY AND THAT'S THE METRIC THAT MATTERS MOST. >> YEAH, SO LET ME COMMENT FOR A SECOND ON EDUCATION HEALTH RELATIONSHIP. SO WHAT'S CLEAR IS THE GRADIENT HAS GONE UP THERE'S ALSO DUAL CAUSALITY ON THE EDUCATION FRONT. THERE HAVE BEEN STUDIES SHOWING THAT PEOPLE WHO HAVE BEEN TOLD THAT THEY HAVE A VERY SHORT LIFE EXPECTANCY, NOT SHOCKINGLY ENROLLING IN COLLEGES AT MUCH LOWER RATE THAN OTHERWISE SIMILAR PEOPLE WHO ARE NOT SO INFORMED. AND THAT KIND OF MAKES SENSE, RIGHT? BECAUSE GOING TO COLLEGE IS VIEWED AS AN INVESTMENT THAT PAYS OFF OVER TIME. SO THERE IS FOR THE THRIP SIDE OF--FLIP SIDE OF THINGS, IS IF YOU KNOW YOU'RE GOING TO LIVE A LONG TIME IT MAKES SENSE TO BE INVESTING UP FRONT IF YOU THINK THAT'S GOING TO HELP YOU OVER A LONGER PERIOD OF TIME. SO THERE'S THAT CHANNEL, MOST OF THE EVIDENCE SUGGESTS THAT THAT CHAN CELL A MUCH SMALLER EFFECT THAN EDUCATION LEADING TO BETTER HEALTH. IN PART BECAUSE YOU'RE MORE LIKELY TO FOLLOW MEDICAL RECOMMENDATIONS, A WHOLE VARIETY OF DIFFERENT REASONS AND BOTH THINGS ARE HAPPENING AND ONE OF THE THINGS, ONE OF THE REASONS WHY THESE ARE TROUBLING TO ME IS WE HAVE ALSO SEEN A MUCH STEEPER GRADIENT IN EDUCATIONAL ATTAINMENT BY FAMILY INCOME THAN HISTORICALLY. SO, I THINK ONE OF THE MOST DAMNING INDICTMENTS OF THE STATE OF THE OPPORTUNITY IN THE UNITED STATES IS IF YOU'RE IN THE BOTTOM PERCENTILE AND HAVE YOU INCOME AND YOU ARE IN THE TOP QUINTILE OF TEST SCORES, SAT TEST SCORES YOUR RATE OF COLLEGE COLPLETION IS ABOUT THE SAME AS IF YOU ARE IN THE TOP QUINTILE OF INCOME AND YOU'RE IN THE BOTTOM QUINTILE OF TEST SCORES. THAT JUST SHOULD NOT HAPPEN. THE POINT IS THE RETURN TO COLLEGE WHICH IS INCREASINGLY KIND OF ENJOYED BY DISPROPORTIONATELY BY PEOPLE WHO COME FROM PRIVILEGED BACKGROUND SYSTEM WHAT THAT'S SAYING IS THAT IT'S A RELATIVE BASIS IS THE RETURN TO COLLEGE NUMBERS THAT ARE TYPICALLY LIKE YOU GET A SEVEN-10% RETURN FOR YOUR REAL RETURN ON COLLEGE, DOES NOT INCLUDE HEALTH BENEFITS THAT OCCURS FROM ADDITIONAL EDUCATION ALSO AND THAT CAN BE PRETTY BIG. IF YOU BELIEVE THAT YOU KNOW PART OF THE FIVE YEAR DELTA IS EDUCATION BASED. IT'S A PRETTY BIG DEAL. >> SO YOUR DATA ACCORDING TO DISCRIMINATED RACE, WHITE MALES AND WHITE FEMALE SYSTEM THAT BECAUSE THE EDUCATION VARIABLE TRUMPED THE INFLUENCE OF RACE OR DOES IT MEAN THAT IF WE SAW THE RACE SPECIFIC DATA THE DELTAS WOULD BE EVEN LARGER. >> IT'S ONLY SEPARATED BECAUSE THAT'S THE QUALIFIER AND IMPROVING THE STUDIES WERE--WAY THE STUDIES WERE DONE. BUT TO GET TO THE KEY POINT IS THERE ARE SOME DIFFERENCES BETWEEN BY RACE IN BY RACE AND GENDER IN THIS GRADIENT, LIKE IF YOU DO THE BREAK DOWN BY THE MATRIXES THAT CAN YOU DO, IN THE VAST MAJORITY OF THE BOXES YOU HAVE THE GRADIENT STEEPENING SIGNIFICANTLY. >> [INDISCERNIBLE]. >> CAN YOU MAKE AN EXAMPLE WHERE CDC, FDA MADE A CASE ACCESSIBLE THAT SOMETHINGKS SIGHTING CAME OUT OF NIH FUNDED RESEARCH THAT THEY NEED TO FOLLOW THROUGH OR THAT THE HEAD OF HHS OR SOMEBODY INSIDE THE OMB THOUGHT THERE WAS SOMETHING IMPORTANT FOR SOCIETY THAT YOU REALLY NEEDED TO SORT OUT OF BENEFIT OF THE SOCIETY, BASED ON INFORMATION OF POWERFUL AND NEW RESEARCH FINDINGS, FROM A DIFFERENT AGENCY. >> RIGHT. >> NO. >> THEY WERE TOO BUSY? NO. NO. >> WITH THAT CLEAR ANSWER, I HATE TO BREAK IN, BUT PETER WE REALLY ARE INDEBTED TO YOU. THIS IS TERRIFIC, I HAD A WHOLE LIST OF QUESTIONS THAT I RESTRAINED MYSELF BUT I'LL MAKE ONE OBSERVATION, LOOKING AT YOUR DISTRIBUTION IF YOU GIVE NIH 100% CREDIT FOR THE CHANGE IN LIFE EXPECTANCY YOU SHOW, IT'S A COUPLE OF YEARS AND THAT'S WHY I DEVOTE A LOT OF MY EFFORT TO PROMOTING RESEARCH BUT I GUFF REALIZED, I READ THE OTHER DAY, THIS IS TRUE THAT YOU COULD INCREASE YOUR LIFE EXPECTANCY BY 3.2 YEARS IF YOU WIN AN ACADEMY AWARD. [LAUGHTER] SO I'M GOING ON A WHOLE NEW PATH. >> YEAH THAT STEMS RELATIVE TO THE PEOPLE WHO ARE NOMINATED BUT DIDN'T GET IT. >> IA IS THAT IT RIGHT? YEAH THAT,'S BEEN CRITICIZED TOO BY THE WAY BUT WHATEVER. >> IT'S A STATISTIC. >> I SUSPECT IT DESERVEDLY HAS BEEN. THANK YOU PETER SO MUCH THAT YOU CAME IN AND EXPRESSED HOW WE DEVELOP METHODS TO ADDRESS THE BIOMEDICAL RESEARCH SO WE REALLY APPRECIATE YOUR BEING HERE AND I KNOW WE WON'T BE DIS APPOINTED IN WHAT YOU HAVE TO TELL US. >> THANK YOU VERY MUCH GAIL AND NORM. IT'S A PLEASURE TO BE HERE. THIS IS A GROUP THAT'S APPARENTLY A SUCKER FOR THE BIG ASSIGNMENT [LAUGHTER] --AND KNOWS HOW TO PROBE THE WEAKNESSES OF ALL OF THOSE AROUND THIS TABLE TO PICK UP WHAT SEEMS TO BE A DAUNTING AND OVERWHELMING TASK, EVEN I WAS PRIVILEGED TO SEE A PRELIMINARY SET OF SLIDES THAT YOU SENT AROUND TO BE SHARED AND IT'S EVIDENT THAT HAVE YOU DONE A CONSIDERABLE AMOUNT OF WORK AND I'M HERE FIRST NOT TO CREW IT UP, NOT TO THROW A MONKEY WRENCH INTO THE WORKS AS YOU'RE PROGRESSING AND I HOPE OFFERING A FEW COMMENTS OR PERSPECTIVES THAT MAY BE USEFUL TO YOU. NO ONE I THINK CAN BE ENGAGED IN THE HEALTH ENTERPRISE AT ANY LEVEL TODAY AND NOT BE ALARMED AT THE CURRENT STATE OF SUPPORT AND UNDERSTANDING OF THE SCIENTIFIC ENTERPRISE AND ITS MISSION. I CAN TELL YOU THAT IF THERE'S A SPECIAL ISSUE OF JAMA THAT'S COMING OUT ON HEALTHCARE IN NOVEMBER AND WHEN THEY INVITED ME TO INCLUDE OR PROVIDE A COMMENTARY IN THIS ISSUE, I TOLD THEM THAT I THOUGHT IT WOULD BE ESSENTIAL TO HAVE A COMMENTAR THAT'S FOCUSED SPECIFICALLY ON HEALTH RESEARCH BECAUSE HEALTHCARE IS SO DEPENDENT ON HEALTH RESEARCH AND THIS WILL BE COMING OUT LATER IN THE MONTH. NOW, WITHOUT TRYING TO ANTICIPATE, IT HAS IN IT FOR ME ONE OF THE CATEGORY OF WHAT I CALL FOR WASHINGTON, NO BRAINER, NONSTARTER IDEAS WHICH MEANS IT'S OBVIOUSLY THE CORRECT THING TO DO AND IT'S THE RIGHT THING TO DO BUT POLITICALLY IT'S VERY TOUGH TO GET IT STARTED. BUT I THINK THE CHALLENGE FOR THIS COMMITTEE IN PART IS HOW DO WE IN AN ERA THAT IS FILL WIDE SKEPTICISM, FILLED WITH CONTROVERSY, FILLED WITH ETIOLOGY, FILLED WITH DISBELIEF AND WANTING OF THE CHAMPIONS THAT HISTORICALLY HAVE STOOD UP FOR SCIENCE AND PARTICULARLY FOR BIOMEDICAL SCIENCE IN THE CONGRESS, HOW DO YOU MANAGE TO PRESENT A CASE THAT CAN NOT MERELY REENFORCE THE BELIEVERS, BUT, PURSUEDE THE SKEPTICS. SO THIS IS THE--THIS IS THE TASK. SO LET ME OFFER THREE GENERAL OBSERVATIONS AND LET ME ELABORATE A BIT ON SOME OF THEM FOR YOUR CONSIDERATION. I COULDN'T HELP BUT BE STRUCK WHEN I SAW THE SLIDE SET THAT THE GROUP ASSERTED AS ONE OF ITS FIRST FINDINGS THAT THE VALUE OF RESEARCH PERFORMED AT THE NIH IS INCONTROVERTIBLE, I BELIEVE THAT WAS THE CHOICE OF WORDS. NOW EVERYONE AROUND THIS TABLE, MYSELF INCLUDED, IS UTTERLY CONVINCED OF THE VERACITY OF THAT ASSERTION. I WOULD URGE THE COMMITTEE HOWEVER, AND THE LARGER GROUP TO ADOPT THROUGHOUT, A POSTURE OF DISINTERESTED NEUTRALITY IN ITS LANGUAGE AND APPROACH TO THE QUESTION OF PERFORMANCE BECAUSE I BELIEVE THAT IF YOUR ULTIMATE GOAL IS TO INCLUDE THOSE WHO ARE NOD ALREADY PERSUADED THAT YOU WILL DO BETTER IF THE LANGUAGE, FRANKING AND APPROACH COMES FROM A POSITION ITSELF OF SCIENTIFIC SKEPTICISM THAN IF IT BEGINS FROM A POSITION OF CONVICTION WITH THE IMPLICATION THAT OUR JOB IS TO NOW BRING FRO THE LIGHT OF TRUTH INTO THE DARKNESS OF DOUBT. SO THAT'S JUST AN ATTITUDEINAL SUGGESTION OF PROMOTION. SECOND REALLY MOST FUNDAMENTAL POINT THEY WANT TO MAKE IS THAT THERE ARE MANY DIFFERENT PURPOSES THAT EVALUATION OF THE RESEARCH ENTERPRISE CAN SERVE AND I BELIEVE CLARITY AND SPECIFICITY FOR YOURSELF AND YOUR THINKING ABOUT WHY ARE WE UNDERTAKING AN EVALUATION WILL GUIDE THE NATURE, EXTENT, METHOD, SPEED, USEFULNESS OF THE EGALLUATION THAT YOU--EVALUATION THAT YOU WOULD PROPOSE. AND LET ME LAY OUT VERY, VERY, BRIEFLY THREE DISTINCT PURPOSES THAT EVALUATION MIGHT SERVE. THE FIRST PURPOSE IS TO PROVIDE WHAT SEEMS TO BE THE IMPLICATION OF THE MANDATE IN CHARGE, A COMPREHENSIVE UNDERSTANDING OF VALUE OF RESEARCH OVERTIME IN THE MANIFEST EXPRESSIONS, EXPRESSIONS OBVIOUSLY IN HEALTH, BUT IN TERTIARY, QUADRINARY, AND HIGHER ORDER SPINOFF BENEFITS FROM SOCIETY. SO ONE PURPOSE IS TO SAY, WE NOW CANNOT QUANTITATIVELY ESTIMATE WHAT THE OVERALL ACHIEVEMENT OF OUR SCIENTIFIC INVESTMENT HAS PRODUCED AND OUR JOB NOW IS TO MAKE THAT ASSESSMENT. THAT'S PURPOSE ONE. PURPOSE TWO IS SPECIFICALLY AIMED AT PERSUADING SKEPTICS ABOUT THE VALUE OF RESEARCH INVESTMENT NOW YOU MAY THINK THAT NUMBER ONE IS TANTAMOUNT TO NUMBER TWO BUT I WANT TO MAKE THE CASE THAT THESE ARE TWO QUITE DIFFERENT PURPOSES AND THEY THEY HAVE DIFFERENT IMPLICATIONS FOR HOW YOU WOULD PERCEIVE IN WANTING TO MOUNT AND CARRY OUT AN EVALUATION. AND A THIRD PURPOSE THAT IS ALSO IMPLICITY AND EMERGES AT SOME POINTS IN THE DISCUSSION AS I'VE SEEN IT FROM YOUR WORK IS A MANAGERIAL PURPOSE. IT'S THE PURPOSE OF GUIDING INVESTMENT PROGRAM PRIORITY AND CHOICE FOR THE RESEARCH ESTABLISHMENT AS IT GOES FORWARD 689 SO I WANT TO LAY OUT THE PROPOSITION THAT WHAT WOULD BE REQUIRED TO DO THE COMPREHENSIVE FULL EVALUATION AND WHAT WOULD BE MOST EFFECTIVE AS THE PERSUASIVE ARGUMENT IN FAVOR OF THE VALUE AND WHAT WOULD BE THE TOOLS OF MANAGEMENT TO GUIDE SECISION MAKING INTERNALLY AND ABOUT INVESTMENT IN RESEARCH THAT THEY CALL FOR THREE QUITE DIFFERENT STRATEGIES AND APPROACHES AND IN FACTS THAT CAN BE ENFORCING AND OVERLAPPING BUT I WOULD ARGUE THEY'RE QUITE DIFFERENT IN SCALE, COMPLEXITY, NNEED FOR DIFFERENT TYPES OF EVIDENCE AND ULTIMATELY USEFULNESS OF THE EVALUATION ITSELF. NOW MY THIRD BASIC OBSERVATION IS THAT IMPLICITY IN A LOT OF WHAT I WAS READING WAS THE NOTION OF HOW CAN THE NIH DO BETTER AT EVALUATING ITSELF AND IT'S OWN WORK. AND I THINK THAT IF YOU WANT TO HAVE AN EVALUATION THAT IS ALSO PERSUASIVE AND MAKES THE LARGER CASE, YOU NEED TO THINK CAREFULLY ABOUT WHAT PARTS OF IT CAN THE NIH MOST OPTIMALLY AND EFFECTIVELY CARRY OUT AND WHAT PARTS TO ACHIEVE THE PURPOSE MIGHT IT BE SUPERIOR TO/ INDEPENDENT AGENCIES BATEL A RAND, UNIVERSITIES, THE WHOLE ARRAY OUTSIDE EVALUATORS. NOW ANOTHER PART OF THAT IS THAT THE INFORMATION THUS FAR IS TO MY EYE AND IT'S BEEN PART OF THE DISCUSSION BUT IT'S BEEN IN THE SCALE AND SCOPE OF RESOURCES THAT WOULD BE REQUIRED TO ACCOMPLISH THE GOALS THAT YOU'RE TALKING ABOUT. NOW I CAN TELL YOU FROM THE VANTAGE POINT OF HOW SHALL WE SAY FRANCIS, A CLIENT ATTEMPTING TO DO WORK ON BEHALF OF THE NIH AS ARE AS OTHERS FROM THE VANTAGE POINT OF THE IOM, WE'RE CONSTANTLY CHASING OUR COMMITTEES TO SAY DON'T IGNORE WHAT THIS IS GOING TO COST. TAKE IT INTO NCCOUNT. THINK ABOUT WHAT YOU WANT TO INVEST AND ANOTHER WAY TO APPROACH THIS PROBLEM, IN FACT WOULD BE TO THINK ABOUT WHAT IS IT WORTH FOR THE NIH TO ALLOCATE TO ITS EVALLIAATIVE ENTERPRISE FOR ANY OF THESE THREE PURPOSES BUT EVEN NARROWLY FOR THE MANAGERIAL PURPOSE, THE THIRD PURPOSE AND THEN HOW WOULD YOU DEPLOY THOSE RESOURCES. SO START FROM THE RESOURCES OUT AS WELL AS FROM THE PROBLEM BACK IN. NOW I CAN TELL YOU FROM WORK AT A NUMBER OF NONPROFIT FOUNDATIONS THAT IT'S VERY TYPICAL FOR A FORWARD LOOKING FOUNDATION TO THINK ABOUT BETWEEN ONE AND TWO AND HALF PERCENT AND SOME SPEND MORE OF THEIR PROGRAM RESOURCES ON EVALUATION IN ORDER TO GUIDE THEIR OWN GRANT MAKING AND PHILANTHROPY, GOING FORWARD. NOW AT NIH, YOU HAVE OF COURSE ATTENTION BECAUSE EVERY DOLLAR YOU MIGHT SET ASIDE AND ASSIGN TO EVALUATION IS A DOLLAR THAT IS NOT GOING INTO PROGRAMS. SO THIS WILL BE A BALANCING QUESTION WHERE A GROUP OF THOUGHTFUL ADVISORS SUCH AS ASSEMBLED AROUND THIS TABLE AND LEADERSHIP GROUP WITH FRANCIS WILL NEED TO THINK HARD ABOUT BUT IS THE NIH PREPARED TO THINK OF EVALUATION IN TERMS OF A HALF OF ONE% OF ITS PROGRAM? 1 PERCENT? WHAT IS IT WILLING TO THINK ABOUT? AND THEN REALISTICALLY TO MAP THAT NUMBER AGAINST THE SCALE AND SCOPE OF WHAT WOULD BE REQUIRED TO DO ANY OF THESE THREE LEVELS OF EVALUATION? NOW FINALLY BEFORE I COME BACK TO THE THREE LEVELS, I JUST WOULD SAY ONE OTHER POINT THAT STRUCK ME, AND THIS IS ABOUT WHAT ONE DOES INSIDE VERSES 11 DOES OUTSIDE AND THIS COMMITTEE IS STRUGGLING AND TAKING ADVANTAGE OF AND IT'S TAKING A LOT OF THOUGHTFUL PEOPLE TO GIVE INPUT ABOUT WHAT ARE THE IDEAS FOR EVALUATION BUT I HOPE THAT YOU MIGHT ALSO CONSIDER ESSENTIALLY TAKING A LEAP OUT OF NIH'S OWN PROGRAMMATIC APPROACH TO RESEARCH ITSELF, TO BASICALLY ASK YOURSELF IF WE REALLY WANTED TO GET THE BEST IDEAS FROM THE UNIVERSE OF POTENTIAL PARTICIPANT ABOUT HOW TO DO THIS EVALUATION. IF WE CAN SPECIFY THE TASK, THAT'S OUR JOB, THEN WHY NOT HAVE APPLICATIONS THAT CAN THEN BE REVIEWED IN THE SAME WAY THIS WE WOULD PEER REVIEW ANY SCIENTIFIC QUESTION BECAUSE WE WANT TO TREAT EVALUATION ITSELF AS A SCIENTIFIC ENTERPRISE, AS A PARTS OF THE SCIENTIFIC ENTERPRISE AND INDEED, I WOULD SUBMIT NOW AS WE COME BACK TO PARSE THE PROBLEM THAT THE SCIENCE OF EVALUATION WHICH RUNS EVERYTHING FROM CLINICAL TRIALS TO PROGRAMMATIC ASSESSMENTS AS WE'RE TALKING ABOUT IS A PART OF THE PORTFOLIO OF WHAT YOU WANT TO EVALUATE. SO THAT'S JUST ANOTHER OPERATIONAL SUGGESTION TO CONSIDER BY THE COMMITTEE. NOW AS I THINK THEN BACK NOW ABOUT THE THREE BIG PURPOSES AT LEAST AS I DIFFERENTIATE THEM AND YOU LOOK AT THE PORTFOLIO OF WHAT DOES THE NIH DO, OF COURSE THERE'S A CONTINUUM AND THERE'S A HUGE COMPLEXITY BUT TO ME I ALSO THINK IT CAN BE PARSED INTO SOME LARGE CATEGORIES. ONE IS THAT IT INVOLVES DISCOVERY RESEARCH. THAT'S A HUGE PART OF THE ENTERPRISE. SECONDLY AND IT CAN BE CALLED DEVELOPMENTAL OR TRANSLATIONAL OR TARGETED RESEARCH WHICH WOULD COVER EVERYTHING FROM THE GERONTOLOGYSTS NOEL PROJECT TO TRANSLATIONS TODAY BECAUSE THEY'RE ALL ABOUT INCLUDING DISCOVERY BUT MAINLY TOWARD A GOAL THAT'S PREDEFINED, UNDERSTOOD AND KNOWN. AND THE THIRD I WOULD SUGMITT IS EVALUATION RESEARCH WHICH COVERS THE CLINE CAM TRIALS AND THE PROGRAM ASSESSMENTS ANDÖE THE RANGE THAT NIH SUPPORTS. NOW WHEN YOU THINK ABOUT ASSESSING THIS TYPE OF RESEARCH, ACROSS ALL THESE TYPES OF RESEARCH, ALL THESE POTENTIAL EFFECTS STARTING WITH HEALTH AND YOU THINK ABOUT NUMBER ONE THE TIME HORIZON REQUIRED WHICH IS MEASURED IN YEARS IF NOT DECADES NUMBER THE DIVERSITY OF EFFECTS AND NUMBER THREE, THE PROBLEM WHICH IS FOLLOW ONE AND TWO THE MANY OTHER ACTORS THAT FOLD THAT ARE ON THE STAGE HERE AFTER, I WOULD SAY THAT SPEAKING PERSONALLY IF I HAD JUST THE FIRST PURPOSE IN MIND, THE GRAND EVALUATION AND TRIED TO DO IT ACROSS THE BOARD AND TRIED TO DO IT WITHIN THE BUDGET, I DON'T THINK THE SOLUTION EXISTS. AT LEAST I'M DOUBTFUL THAT IT EXISTS AND THEREFORE I WOULD SAY BEFORE I ANNOUNCED DOING THAT, I WOULD WANT TO TRIANGULATE WHAT WE'RE WILLING TO DEVOTE TO THIS, WHAT WE'RE WILLING TO BELIEVE WE CAN ACCOMPLISH AND WHAT OUR PURPOSE IS. NOW LET ME TURN TO THE SECOND PURPOSE WHICH IS PROOF OF CONCEPT AND LET ME MAKE A SUGGESTION FOR CONSIDERATION BECAUSE I THINK THERE ARE OBVIOUSLY A NUMBER OF WAYS TO COME AT THE VALUING OF RESEARCH, FREQUENTLY AND AGAIN IT WAS BEAUTIFULLY ILLUSTRATED IN SOME OF THE EXAMPLES THAT THE SLIDE DECK HAD WITH CERTAIN CLUSTERS OF RESEARCH ACTIVITY OR IRPT FERON OR OTHER RESEARCH ENTITY, USUALLY A WAY TO THINK ABOUT EVALUATING RESEARCH ISSUE START WITH THE RESEARCH ACTIVITY AND YOU TRACK IT THROUGH EVERY STAGE OF FOLLOW ON IMPLICATION AND ATTEMPT TO DO ALL OF THAT VALUING. I WOULD SUBMIT THERE'S ANOTHER WAY THAT I THINK IS MORE MANAGEABLE AND POTENTIALLY MORE PERSUASIVE THOUGH NOT AS COMPREHENSIVE IN MAKING THE CASE THAT WOULD BE TO BEGIN INSTEAD WITH THE END OF EXPERIENCE OF PATIENTS IN 1963, IN 1988, AND IN 2013 WITH THE FOLLOWING 25 CONDITIONS THAT I HAVE TO BE A PRETTY SUBSTANTIAL NUMBER ACROSS THE BOARD. WHAT WAS IT LIKE TO BE SOMEONE YET UNDIAGNOSED WITH X? HOW WAS IT MANAGED? WHAT WERE THE LIFE PROSSPECTS? WHAT HAPPENED--WHAT WAS YOUR EXPERIENCE IN THE INSTITUTIONS THAT YOU WERE CARED FOR IN THAT ERA? THEN WHAT HAPPENED BY 1988 AND THEN WHAT HAPPENS TODAY? I BELIEVE THAT IF WE CAN DEMONSTRATE FROM THE VANTAGE POINT OF THE END USER IN THIS INSTANCE, THE PATIENT, OF WHAT THE LIFE EXPERIENCE HAS BEEN LIKE AND WHY IT IS SO TRANSFORMED IN THESE, AMAZING RANGE OF CONDITIONS, YOU MOBILIZE THROUGH A SET OF CASES EFFECTIVELY, A MORE POWERFUL ARGUMENT ABOUT THE MINIMUM BENEFIT OF RESEARCH BECAUSE YOU'RE TALKING ABOUT THE DIRECT HEALTH CONSEQUENCE AND IF ALONG THE WAY, YOU CAN POINT TO NEW LINES OF DISCOVERY THAT SPUN OFF FROM EARLY BASIC WORK AND YOU CAN POINT TO ADDITIONAL BENEFITS FROM THE SAME ADVANCE THAT NOW TREATS THESE PATIENTS THAT'S TREATED MORE WIDELY AND YOU CAN SHOW WHY PRODUCTIVITY AND INDEED WHOLE BRANCHES OF ECONOMY HAVE CHANGED BECAUSE OF THIS, BUILDING OUT OF THE CASES, TO ME IF I WERE JUST THINKING ABOUT HOW I WANTED TO MAKE THE PERSUASIVE CASE, I WOULD SAY, I WOULD HAVE A BETTER CHANCE OF DOING IT, WITH GETTING MY ARMS AROUND IT MORE READ ILLEGALS SCHEPUSHING IT TO THE--PUSHING IT TO THE CONCLUSION THAT WILL MAKE IT PERSUASIVE IF I STARTED WITH THE END USER RATHER THAN THE BEGENERATEDDING DISCOVERY. NOW THESE ARE NOT EXCLUSIVE OBVIOUSLY, YOU CAN DO PINCHERS ON BOTH, CAN YOU DO SOME OF BOTH BUT AGAIN IT'S RESOURCES AND PURPOSE AND KEEPING BOTH IN MIND AS YOU BEGIN TO THINK ABOUT THE CHASES. NOW WHEN IT COMES TO MANAGEMENT CHOICES ABOUT PROGRAM, PROGRESS, I ACTUALLY BELIEVE THIS IS AN AREA WHERE AS AN INSTITUTION, THE NIH CAN MAKE THE MOST PERSUASIVE CASE ON ANNUAL AND--AN ANNUAL AND SEMIANNUAL BASIS TO THE APPROPRIATORS AND AUTHORIZATION COMMITTEES OF ITS MANAGEMENT TOOLS TO TRACK PROGRESS AND DETERMINE THE PACE OF SUCCESS IN ITS MAIN RESEARCH PROGRAMS. THIS IS A VERY DIFFERENT FORM OF EVALUATION. THIS DOES HAVE TO BE INSIDE, BUT THIS CALLS FOR A DEGREE OF CONSIDERATION ESPECIALLY COMPLICATED FOR THE CHALLENGE OF BASIC DISCOVERY RESEARCH BUT DOABLE, I BELIEVE AND INDEED CALLED FOR INCREASINGLY FOR THE PURPOSE OF EVIDENCE. THIS IS EVIDENCE THAT IS NOT WHAT THE SCIENTIFIC ENTERPRISE ACCOMPLISHES. THIS IS EVIDENCE OF WHY AN INVESTMENT AT NIH NOW IS A DOLLAR WELL SPENT BECAUSE WE'RE MANAGING THAT DOLLAR TO ITS GREATEST ACHIEVEMENT. YOU COULD IMAGINE A CASE WHERE I ACCOUNTED SAY, WELL THE--COULD SAY THE SCIENTIFIC ENTERPRISE HAS BEEN FAN OF THEICALLY SUCCESSFUL BUT IT'S REALLY 10% OF IT THAT'S ACCOUNTED FOR A HUNDRED% OF THE SUCCESS. 90% DIDN'T ACCOMPLISH A THING FOR US AND IF I'M SITTING BACK AND I SAY WELL DO I HAVE TO SPEND THOSE 9-CENTS FOR EVERY 10th THAT'S GOING TO ACCOMPLISH SOMETHING. THE ANSWER THAT IS YOUR THIRD MOE MODE. WE ARE IN A POSITION NOW MORE CLEARLY, MORE HONESTLY WHAT WE ARE DOING WELL, WHERE WE HAVE TO REAPPORTION, REPRIORITIZE, REINTENSIFY BECAUSE WE SEE WE HAVE THE TRACKING MONITORING FEEDBACK AND ABILITY TO MAKE THESE ALLOCATION DECISIONS AND WE KNOW WE HAVE TO DO ON A CERTAIN TIME FRAME THAT IS MORE THAN A YEAR BECAUSE THAT'S THE WAY SCIENCE WORKS AND THAT'S PART OF THE CASE FOR WHAT I HOPE WILL TURN MY NO BRAINER-NONSTARTER IDEA INTO A MAYBE STARTER BECAUSE MY PROPOSAL IN THIS IS FOR A FIVE YEAR ROLLING BUDGET FOR BIOMEDICAL SCIENCE. THAT'S THE NO BRAINER NONSTARTER BUT THAT'S WHAT SCIENCE REQUIRES. I PROPOSE THAT THE CONGRESS EVERY YEAR MAKE AN APPROPRIATION BUT IT'S FOR THE FIFTH YEAR HENS AND IT'S BASED ON THE KIND OF EVALUATION YOU WOULD BRING TO THEM SOPHISTICATED A HERE'S WHY IT'S WORTH WHILE AND THIS IS THE WHY THE INVESTMENT NOW IS STARTING TO PAY AND HERE'S HOW WE ARE GOING TO IMPROVE IT SO THAT THE END OF THIS NEXT APPROPRIATION YOU WILL SEE THE RESULTS AND BY THE WAY WE STARTED BEFORE AND WE CAN SHOW YOU HOW WE DID IT FROM FOUR YEARS AGO UNTIL TODAY. NOW IF YOU CAN GET INTO WHAT I DESCRIBED THERE AS THE NEW SOCIAL COMPACT FOR HEALTH RESEARCH, I THINK WE'RE IN A VERY DIFFERENT PLACE AS A COUNTRY AND THAT DOES DEPEND ON EVALUATION. IT DEPENDS ON BEING ABLE TO MAKE THE CASE FOR NOT JUST SCIENCE AT LARGE BUT FOR THE PERFORMANCE OF THE AGENCY AS A STEWARD OF RESEARCH DOLLARS. SO IN CONCLUSION, I ADMIRE DRAMATICALLY THE UNDERTAKING THAT YOU'VE ALL GRABBED HOLD OF. I THINK IT IS CRUCIAL TO BE ABLE TO MAKE THE CASE BOTH FOR SCIENCE AND FOR THE AGENCY'S SUCCESS IN MANAGING. I WOULD BE CAUTIOUS ABOUT UNDERTAKING THE TOTALITY OF EVERYTHING THAT SCIENCE HAS DONE EVEN THOUGH CONCEPTUALLY IT IS CORRECT. BUT PRACTICALLY I WOULD JUST LEAVE IT AS A GLOBAL STANDARD AGAINST WHICH WE'LL BE MEASURING CONSTANTLY BUT WE'RE NOT GOING TO TRY TO REALLY ACCOMPLISH THAT, WE KNOW IT'S THERE AND WE ARE GOING TO BE DOING BITS AND PIECES ALONG IT IS WAY. AND IF YOU CAN THINK OF THIS AS WITH THE SAME RIGOR AS SCIENTIFIC STRATEGY INCLUDING THE IDEA OF ENLISTING THE BEST IDEA IN THE NATION AND APPLYING THE SAME KIND OF RIGOR AND SCIENTIFIC STANDARD AS YOU WOULD TO ANY SCIENTIFIC CONTENT QUESTION, I THINK THAT WE WILL REALLY HAVE MADE THE PROGRESS HERE. SO WITH THAT I WILL PAUSE AND WELCOME EITHER QUESTION OR ANY COMMENT AND SUGGESTION FROM YOU. SO THANK YOU. >> THANK YOU HARVEY SO MUCH. JUST AS WE EXPECTED. [ APPLAUSE ] ELOQUENT. DAN AND RICHARD ARE GOING TO MODERATE THE DISCUSSION. WITH A COUPLE OF QUESTIONS, SUPERB JOB IN MANY RESPECTS BUT PARTICULARLY FOCUSING US ON THE ALTERNATIVE KINDS OF EVALUATION WE MIGHT BE TACKING ABOUT WAS EXTRAORDINARILY USEFUL SO A FIRST QUESTION FOR THE--FOR PERHAPS FOR POTENTIAL APPROACHES BUT AT LEAST FOR THE FIRST TWO SEEMINGLY MORE THAN THE THIRD IN YOUR CHARACTERIZATION, THE ISSUE OF WHETHER THIS IS A SELF-ASSESSMENT OR FOR MANY REASONS OF OBJECTIVITY AND CREDIBILITY AND IT OUGHT TO BE INVOLVED IN AN OUTSIDE EVALUATION IS SOMETHING YOU HAD A LOT OF EXPERIENCE WITH AND LOTS OF EVALUATIONS, DO YOU WANT TO COMMENT FURTHER ON THE DEGREE TO WHICH IT GROUP AND THAL HECK MENDATIONS, REMEMBERING THIS GROUP IS RECOMMENDING APPROACHES NOT THE OUTCOME OF THE EVALUATION OUGHT TO BE FOCUSING ON WHO DOES THE EVALUATION. >> FIRST NO ONE INSIDE OR OUTSIDE COULD ACCOMPLISH THE EVALUATION WITHOUT SYSTEMATIC DATA COLLECTION ON THE PART OF THE NIH. SO ANYTIME WE'RE TALKING ABOUT EVALUATION AND BACKING IT UP TO WHAT IS THE EVIDENTIARY BASE FOR THE EVALUATION THAT WILL DEPEND ON A CAPACITY WITHIN THE NIH TO ASSEMBLE AND CLASSIFY AND MAKE AVAILABLE THE ARRAY OF RELEVANT MEASURES AND GID POSTS AND STANDARDS AND PERFORMANCE OF ALL THE MEASURES THAT ARE DEEMED RELEVANT FOR THE CONTINUING EVALUATION. SO THERE'S NO EXCLUSION OF ANY CIRCUMSTANCE OF A CRUCIAL ROLL FOR NIH, I BELIEVE THAT FOR REASONS THAT YOU ALLUDED, COMBINATION OF OBJECTIVITY AND CREDIBILITY THAT YOU'LL BE ADVANTAGED BY GETTING OUTSIDE ASSESSMENT, OUTSIDE PER TASIPATION TO CONDUCT THE WORK. AGAIN IT'S PART OF THE PURPOSE OF PERSUASION. YOU WON'T HAVE AS READY A CASE IF IT'S AN INTERNALLY GENERATED CASE COMPLETELY, THAN TPHAOEUGZINIZEATION--ORGANIZATIO N IS GARNERED FROM AN INDEPENDENT--ORGANIZATION GARNERED FROM AN INDEPENDENT BODY FROM THE NIH AND HAVE IT BE AVAILABLE FOR POLICY MAKERS SO I THINK THAT IF I WERE DESIGNING IT, IT WOULD BE AN INSIDE AND OUTSIDE COMBINATION. IT WOULD INVOLVE NIH WITH A COMMITMENT TO A VALUE OF STRATEGY, THAT BY THE WAY, ALTHOUGH YOU WEREN'T FOCUSING ON THE THIRD, IT'S ACTUALLY VERY, VERY THEN CONNECTED TO THE THIRD PURPOSE BECAUSE A PART OF THE INTERNAL MANAGERIAL PURPOSE IS FED ALSO BY THAT DATA COLLECTION. BUT THAT'S TO ME, THE MOST EFFECTIVE COMBINATION, I THINK. >> AND THEN SECOND RELATED POINT, THE TWO FIRST PURPOSES, THE OVER ALL EVALUATION OF IMPACT AND VALUE OR THE GOAL OF CONVINCING SKEPTICS ARE IN LARGE MEASURE RETROSPECTIVE. THEY LOOK TO SEE WHAT'S CONTRIBUTION, AND THE THIRD WHICH MANY OF US WOULD REGARD AS THE HIGHEST USE OF POTENTIAL EVALUATION AND DIFFERENT. SO WHEN YOU EXPRESSION YOUR VISION, MOST OF US WOULD EMBRACE THE NOTION OF A FIVE YEAR LEAD ON BUDGET THE PROCESS BY WHICH YOU PROSPECTIVELY COMING UP FOR A COMPELLING ARGUMENT AS TO WHERE THERE'S MORE FUNDS IN THE FIFTH YEAR IS LESS CLEAR. IT HAS TO BE DEPENDENT ON CREDIBLE, OR RETINAL LOCATION ARE SPECTIVE ANALYSIS SO WE HAVE AN IDEA HOW TO PREDICT BECAUSE WE CAN GO THROUGH WHAT WE THOUGHT IS A VERY, VERY, THOUGHTFUL PROCESS, HOW THAT WOULD BECOME CONVINCING OR COMPELLING TO THE OUTSIDE WORLD IS NOT SO CLEAR TO MOW IF YOU COULD ELABORATE ON THAT. >> I THINK THE BEST CONVINCING EVIDENCE OF THE FUTURE IS WHAT YOUR SUCCESS HAS BEEN IN THE PAST. SO IN THE SAME WAY YOU WOULD LOOK AT A FEIGNABLE ADVISOR AND SAY WHY DID I LOOK AT THIS ONE VERSES THAT ONE. I WANT TO LOOK AT WHAT THE TRACK RECORD AS BEEN EMPLOY I BELIEVE IF THE NIH HAS BEEN ACCURATE, CANDID, ABLE TO TAKE ACTION WHEN THINGS ARE NOT GOING AS ORIGINALLY EXPECTED AND ABLE TO MAKE MIDCOURSE CORRECTION, ABLE TO DOUBLE DOWN WHEN THERE'S THE ABILITY TO SEE THE BREAK THROUGH TANTALIZINGLY CLOSE, ET CETERA. ABLE TO ADAPT AND DEMONSTRATE THAT, IT'S FOUNDATION ABOUT OUR ABILITY TO MAKE THIS PROJECTION. IT'S BECAUSE WE DID IT THREE OR FOUR YEARS AGO AND IN THE FIRST INSTANCE OF COURSE, IT WILL TAKE A--THE VERY BEGINNING IT DOES TAKE A STEP OF FAITH WHICH IS BUILT UP OUT OF THE LARGER DEMONSTRATION OF PROOF AND IT MAY TAB A SKEPTIC IN CONGRESS COULD SAY, WELL I CAN'T DENY NASCIENTIFIC ENTERPRISE HAS TRANSFORMED THE LIVES OF MILLIONS OF PEOPLE IN THE UNITED STATES FOR THE BETTER. AND SO I'M WILLING TO MAKE THIS BET BUT I WANT TO SEE WHAT YOU'RE GOING TO DO IN THE NEXT, TABOO, THREE, FOUR, YEARS. AND THAT WOULD BE A FAIR ASSESSMENT AND THEN IT'S UP TO US TO PROVE IT. >> I WOULD LIKE TO DEAL WITH THE PROSPECTIVE VIEW BECAUSE I THINK THAT'S EXCELLENT AND I'LL COME BACK TO IT IN A MINUTE. BUT THE FIRST PART I WANT TO EXPLORE GIVES ME GREAT ANGST IN HOW YOU DESCRIBE ITEM NUMBER THREE. SOME ALWAYS VIEW LATELY MANAGEMENT TOOLS AS DIGITS AND A YES AND A NO. IN FACT, NORM AND --I WERE TALKING EARLIER TODAY ABOUT FILLING OUT FORMS LIKE GIL HAD TO DO FOR THE NIH OR FILLING OUT AN SF-86 FOR A SECURITY CLEARANCE. THEY GIVE YOU SO MANY WORDS, THEY GIVE YOU SO MUCH SPACE AND YOU HAVE TO FIT THAT INTO A BOX. AND AS MORE AND MORE YOUNG PEOPLE GET COUPLED TO THE DIGITAL WORLD, YOU LOSE A JUDGMENT FACTOR BECAUSE EVERYTHING'S REDUCED TO NUMBERS AND DIGITS. AND AS WILD AS I AM ABOUT WHAT YOU WERE SAYING. PART OF THE STRENGTH OF SCIENCE ISN'T A DIGIT, EVERYTHING ISN'T A YES OR A NO AND IF AS A COMMUNITY, BIOMEDICAL RESEARCH COMMUNITY LOSES THE ABILITY OR OBJECTIVITY IN THINGS AND THEY GET THE DIGITS AND NUMBERS AND OTHER ISSUES, I REALLY WORRY AND I WATCHED THIS HAPPEN. SO YES I LIKE THE CONCEPT, BUT, IF--ONE YOU NEED IN INTERACTION AMONG HUMANS AND YOU CAN'T MAKE A TABLE, YOU CAN'T MAKE A CHART, YOU CAN'T MAKE A YES OR A NO IN THE CONVERSATION THAT TAKES PLACE AMONG HUMANS AND BY THE WAY, I'M GLAD THAT THE NIH IS GOING TO MEET ITS DEADLINES WITHOUT PEOPLE TALKING TO EACH OTHER BUT I REMIND EVERYONE, COMMUNICATION IS ABOUT 80% HANDS AND FACIAL MUSCLES AND EYES AND DIGITS THAT COME OUT OF THE MOUTH ARE DIFFERENT. SO I REALLY WORRY ABOUT THAT. THE SECOND PART OF IT IS, IN MY EXPERIENCE WHEN YOU GET TO DIGITS AND NUMBERS, YOU LOSE CONTROL OF THE EVALUATION PROCESS BECAUSE PEOPLE START THINKING AND IT'S ALWAYS ATTRACTIVE TO DO IT BUT I REALLY WANT TO EXERCISE WORDS OF CAUTION ON THIS. I'M GOING TO STOP AT THIS POINT AND ASK YOU TO RESPOND. >> WELL I ACCEPT THE COMMENT WHOLE HEARTEDLY. I THINK THAT THEICAL SENCH WHAT'S THE RIGHT--CHALLENGE IS WHAT'S THE RIGHT MODEL FOR INFORMED JUDGMENT? ED MODEL IN MY EXPECTATION WILL INCLUDE SOME MEASURES WHICH ARE RELATIVELY OBJECTIVE AND SOME MEASURES WHICH ARE RELATIVELY JUDGMENTAL AND BASED ON EXPERT, IF YOU WILL SENTIMENT. THE DEGREE TO WHICH THE AGENCY WILL DOES HE PEND ON EACH OR BOTH IS REALLY PART OF THE CRAFT OF MANAGEMENT AND UTILIZING TOOLS IN THE SAME WAY THAT YOU WOULD IF YOU WERE IN BUSINESS IN DECIDING WHAT WILL WORK AND WHAT WON'T WORK IF TERMS OF RESEARCH STRATEGY, NOW WHAT I THINK WE'RE FOUND OF THINKING BECAUSE IT'S TRUE, THAT YOU NEVER CAN KNOW WHAT SCIJ@h DISCOVERY WILL LEAD TO SOME UNEXPECTED BREAK THROUGH BECAUSE IT REVEALED A FUNDAMENTAL ASPECT OF NATURE THAT WAS PREVIOUSLY NOT ONLY UNSUSPECTED, NOT EVEN DIRECTLY SEARCHED FOR AND I THINK THAT PART OF A--THIS IS WHERE A STRATEGY OF PORTFOLIO COMES INTO THE PICTURE THAT YOU WOULDN'T WANT THE ENTERPRISE THAT IS DRIVING PROGRESS TO BE EXCLUSIVELY LOOKING AT EITHER DISCOVERY OR TRANSLATION OR EVALUATION. YOU HAVE TO THINK ABOUT THE MIX AND YOU HAVE TO THINK ABOUT WHAT GOES INTO THE JUDGMENT ULTIMATELY THAT'S OBJECTIVE AND SUBJECTIVE ABOUT THE--THE VALUE. WHAT I THINK IS IMPORTANT IS TO BE ABLE TO DO IT IN A TRANSPARENT WAY, THAT'S EXPLICABLE AND THAT'S ITSELF CONVINCING THAT THIS WAS DONE OPENLY AND WITH FULL OPPORTUNITY FOR LEGITIMATE DIFFERENCES OF VIEW TO BE AIRED AND TAKEN INTO ACCOUNT. THAT'S PROCESS. AND I UNCLE THINK THAT PART OF WHAT--I THINK THAT PART OF WHAT WILL MAKE IT A SUCCESS OR NOT IS PART OF HOW THAT PROCESS PLAYS OUT. BUT I TAKE YOUR CAUTION THAT IF ONE ASSUMES THROUGH THAT EVALUATION MEANS RELYING NOW ON A SET OF NUMBERS AND STOP THINKING, IT'S LIKE THE REVIEW COMMITTEES FOR FACULTY WHO CAN COUNT THE PAPERS BUT NOT READ THEM THEN WE'RE MAKING A DREADFUL MISTAKE AND THAT MAY LEAD TO A--SHALL WE SAY A FALSE PRECISION WHICH IS NOT THE GOAL. THE GOAL HERE WOULD BE TO MAKE BETTER JUDGMENTS. >> THANK YOU. >> JUST ONE OTHER FOLLOW UP TO SAY, I LIKE YOUR CONCEPT OF THE FIVE YEARS. IN FACT, I SPEND MY LIFE LIVING IN THE FUTURE. I HAVE DONE THAT ALL MY CAREER AND WHEN I WAS IN THE GOVERNMENT, WE HAD A FIVE YEAR PLAN. SO I BELIEVE DEEPLY YOUR SUGGESTION ABOUT THIS FIVE YEAR PLAN IS CORRECT, UNFORTUNATELY BECAUSE OF THE CONTROL THAT THE CONGRESS FEELS IT HAS TO HAVE, IT'S GOING TO LIMIT IT TO A YEAR. HOWEVER THAT WOULDN'T STOP THE NIH FROM HAVING--THEY DECLARE HERE IS OUR FIVE YEAR PLAN, WE WILL MONITOR IT, AND WE WILL MEASURE IT AND AT THE END OF THIS FIVE YEAR PERIOD, WE WILL COME BACK AND TELL YOU, YOU MAY NOT BUDGET FOR US, BUT PART OF THIS FIVE YEAR PLAN IS LIKE PLANTING A SEED, WATERING IT AND NURTURING IT, YOU CAN MAKE A FIVE YEAR CASE AT THAT POINT IN TIME IN TERMS OF PROJECTIONS FOR FUTURE BUDGETS AND THAT I BELIEVE IS DOABLE AND I STRONGLY ENDORSED THAT CONCEPT TO THE NIH. THANK YOU. >> THANK YOU. >> FRANCIS? >> SO I APPRECIATE HARVEY YOUR FORMATION OF THE THREE COMPONENTS PRESENTATION AND I THINK PARTICULARLY THE FIRST TWO FIT RIGHT BACK IN THE MIDDLE OF WHAT THIS PARTICULAR VALUE OF BIOMEDICAL RESEARCH GROUP IS WRESTLING WITH, THE THIRD ONE IS RESEARCH OBVIOUSLY MORE COMPREHENSIVE OF FUTURISTIC ORIENTED WHICH IS ANOTHER ISSUE THAT WE STRUGGLE WITH AROUND THE TABLE EVERY THURSDAY WHEN INSTITUTE DIRECTORS TOGETHER AND DAN WE DO HAVE FIVE YEAR PLANS BUT THEY'RE GENERALLY DONE BY INSTITUTES FOR THEIR PARTICULAR AREA. WE DON'T HAVE A COMPREHENSIVE ACROSS ALL OF NIH. THAT WAS TRIED ONE TIME THOSE OF YOU MIGHT REMEMBER WHEN DR. HEELY WAS THE NIH DIRECTOR. IT DIDN'T TURN OUT SO WELL IN THAT SITUATION, MAYBE IT'S APPROPRIATE TO THINK ABOUT IT AGAIN. OBVIOUSLY, MAYBE NOT. AND OBVIOUSLY CREATE A GREAT DEAL OF POTENTIAL FOR GOOD AND POTENTIAL KD--SALLY WHA. I WANTED TO MAYBE ASK OR THINK ABOUT MORE WHERE WE GO FROM HERE BECAUSE I THINK YOU HAVE NICELY PORTRAYED THE CHALLENGE IN BOTH OF THESE AREAS. I THINK WHAT YOU SAID IN TERMS OF HAVING A TRULY COMPREHENSIVE ANALYSIS OF BIOMEDICAL RESEARCH AND BEING ABLE ACROSS DECADES AND DISCIPLINES AND DISEASES IN PARTICULARLY THIS THORNY PROBLEM ABOUT ABUTION THAT WILL BE EXTREMELY DIFFICULT TO SAY HOW YOU WOULD DO THAT EVEN IF YOU HAD ALMOST INFINITE RESOURCES. I THINK THAT DOESN'T MEAN THAT THERE COULD NOT BE EFFORTS MADE IN THAT DIRECTION BUT THEY HAVE TO BE DEFINED UP FRONT WITH ALL OF THE CAVEATS THAT YOU WANT TO ATTACH ABOUT THE IMPERFECTIONS AND THE FACT THAT YOU MAY BE OFF BY AN ORDER OF MAGNITUDE AND ALL THAT, SO MERE IT IS PERHAPS THE PERSUADING SKEPTICS WHICH WE POINT TO WHICH WE HAVE TALKED ABOUT IN TERMS OF TAKING SPECIFIC EXAMPLES. I LIKE YOUR IDEA OF PICKING AT THE FAR END, OKAY WHAT ABOUT SOMEBODY WHO HAS IT, HOW IS THAT CHANGED. WE OFTEN TALKED ABOUT TAKING EXAMPLES OF INVESTMENTS THAT WERE MADE IN BASIC SCIENCES AND HOW THEY PAID OFF, HOW IT WAS A GENOME OR INTERFERON, BUT THOSE I THINK COULD HAVE [INDISCERNIBLE]. OBVIOUSLY THIS GROUP IS GOING TO DO IS TO COME FORWARD WITH RECOMMENDATIONS ABOUT THE CHARACTERISTICS OF THE KIND OF ANALYSIS THAT WE WOULD MOST LIKE TO SEE DONE. THIS GROUP WILL NOT DO THEM. AND THEN THE QUESTION WILL BE OKAY, NOW WE KNOW WHAT WE WANT, HOW ARE WE GOING TO GET IT? AND HERE'S WHERE I THINK INNSITUTE DIRECTORS AND MYSELF WILL WRESTLE WITH THIS QUESTION. IS THIS THE SORT OF THINK THAT WILL BE ACCOMPLISHED WITH RFA OF SOME SORT, A CONTRACT, A PRIZE BECAUSE EARLIER IN THIS MEETING, WE HAD ONE RAISING HIS ENTHUSIASM FOR PRIZE FOR SPEAKERS AND WE WONDER FEDERAL YOU COULD GIVE US THOUGHTWHAT YOU HAVE ABOUT HOW WE TAKE THE WISDOM OF THIS ENTERPRISE AND CONVERT IT INTO PRODUCT E WILL INFORM THIS VERY IMPORTANT CONVERSATION IN A WAY THAT HASN'T QUITE HAPPENED SO FAR. >> LTHANKS, FRANCIS, I WOULD BEGIN WITH THE PRINCIPLE THAT I WOULD TREAT IT AS A SCIENTIFIC QUESTION. NOT ANYTHING LESS. AND THAT MEANS IF THE INSTITUTE DIRECTORS AND YOU COME TOGETHER AND AGREE THAT THIS IS SOMETHING THAT COLLECTIVELY, WE--WE WOULD BENEFIT FROM HAVING, THEN IT'S THE QUESTION OF HOW DO WE REDUCE THIS NEED INTO A STATEMENT OF PURPOSE THAT CAN BE CONVERTED INTO AN RNA AND GAIN THE BENEFIT OF THE BEST THINKING THEN OF EVERYBODY IN THE COUNTRY, WHO WANTS TO MEET THIS CHALLENGE AND ALTHOUGH HOPEFULLY WITH A DOZENT PEOPLE THAT YOU'LL BE HEARING FROM OR TWO DOZEN OR AS MANY DOZENS AS YOU TALK TO IN THE COURSE OF YOUR DELIBERATIONS THAT WILL BE AMPLIFIED IN ORDER OF MAG NIFEUD. BY HAVING EVERY LEADING EVALUATIVE GROUP IN THE COUNTRY THINKING HARD ABOUT HOW DO WE RESPOND TO THAT RFA. SO ONE THING THEY WOULD SAY--THEY WOULD SAY IF I WERE ASKING OR THINK BEING A REALLY GOOD OUTCOME WOULD BE WHAT ARE THE ELEMENTS THAT THE INSTITUTE DIRECTORS AND LEADERSHIP OF NIH NEED TO TAKE INTO ACCOUNT, OR SHOULD TAKE INTO ACCOUNT, IN FORMULATING THEIR REQUEST FOR EVALUATION AND I SAY REQUEST BECAUSEIME GOING BACK RICHARD TO THE POINT ABOUT THINKING THAT IT'S BETTER DONE WITH THE OUTSIDE GROUPS. BUT YOU KNOW THAT'S ALSO A JUDGMENT AND THAT'S SOMETHING THAT THE LEADERSHIP NEEDS TO THINK THROUGH SO I START WITH THE INDEED OF SCIENCE, I GO ALONG WITH THE MODEL WITH THE IDEA THAT'S UNDERSTOOD AND LARGER IN THE COMMUNITY, I WOULD THINK ABOUT HOW I AM GOING TO USE THE RESULTS BAUDS YOU KNOW--BECAUSE YOU KNOW BEGINNING WITH THE END IN MIND IS A GOOD STRATEGY FOR THIS AND THEN I WOULD TRY TO DO IT IN A WAY THAT WAS PILOTED AND NOT THINKING THAT ONCE WE START, WE HAVE TO DO THE WHOLE THING. WE HAVE TO SWALLOW THE WHOLE COW OR IT'S NOT WORTH THE FIGHTER BITE. I WOULD RECOMMEND A STAGING BECAUSE YOU WILL LEARN A LOT FROM THE FIRST ROUND AND EVEN THOUGH WE FEEL A TREMENDOUS SENSE OF URGENCY, THIS WILL NOT BE ACCOMPLISHINGED IN WEEKS OR MONTHS YOU THINK OF ITAISE LEARNING EXPERIENCE ALSO FOR THE ORGANIZATION. AND HAVE A STAGED WAY OF GAINING THE EVALUATIVE INPUT AND HOW USEFUL IT IS AND THEN FROM LEARN PROGRESS THAT, THAT'S A PRINCIPLE THEY THINK WOULD HELP MAKE IT SUCCESSFUL. >> SO FRANCIS AS ONE WHO WAS AT THE FIRST REGIONAL MEETING DURING DR. HEELY'S STRATEGIC PLAN AND AT THE FINAL MEETING WHERE PHIL SHARP TOLD EVERYBODY THATEE DIDN'T HAVE TOXIC EFFECTS EXPLAIN TO THE PUBLIC THE BENEFIT OF THE RESEARCH OR TRAINING,--I'M SORRY BUT IT'S TRUE, THAT'S WHAT I WAS THINKING ABOUT EARLIER TODAY--BUT I WAS JUST COMMENTING TO GRIFFIN THAT I THEN WENT TO THE ADVISORY COMMITTEE ALMOST EVERYTHING IN THAT WAS RECOMMENDING IN THE FEW BOUND COPIES OF THE PLAN THAT WAS RELEASED WAS IMPLEMENTED, INCLUDING A VACCINE CENTER HERE ON CAMPUS, IMPROVED COMMUNICATION--I MEAN YOU KNOW A NUMBER OF THINGS. ALL I'M SAY SUGGEST I THINK THE PROBLEM WAS AND WHY THIS WAS SO CONTROVERSIAL IS THAT THE SCIENTIFIC COMMUNITY REALLY DIDN'T UNDERSTAND THE NEED FOR STRATEGIC FUNDING AND OR WHAT IT WAS AND HOW COULD YOU POSSIBLY DO STRATEGIC PLANNING FOR SCIENTIFIC RESEARCH. NOW MOST UNIVERSITIES URPD GO THIS PROCESS, PROFESSIONAL SOCIETIES UNDERGO THE PROCESS, SO, MAYBE IT WAS MORE A LACK OF BEING INFORMED ON WHAT THE PROCESS IS ALL ABOUT OR LACK OF FORM. THAT SAID I WOULDN'T BE A BIG FAN OF GOING THROUGH ANOTHER STRATEGIC PLANNING PROCESS HOWEVER I LOVE HARDY'S IDEA OF THE FIVE YEAR BUDGET AND PLAN ESSENTIALLY. I THINK IT MAKES A HECK OF A LOT OF SENSE. IN FACT, A LONG TIME AGO ASM TOOK THE POSITION THAT THE DIRECTORSHIP OF NIH AND THE DIRECTORSHIP OF CDC SHOULD BE FOR FOR EVERY FIVE YEARS INSTEAD OF FOUR, CHANGING WITH EVERY ADMINISTRATION IN ORDER TO PROVIDE CONTINUITY. YOU MAY NOT THINK THAT'S A GOOD IDEA, WE THINK IT'S A GOOD TIME AT THE TIME BUT WE LOST THAT ONE. BUT ANYWAY, JUST A FEW THOUGHTS BUT THANKS AGAIN HARVEY YOU DID A GREAT JOB. >> HARVEY THAT WAS VERY INSIGHTFUL AS I EXPECTED AND I FIND A LOT OF APPEAL IN STARTING WITH THE BENEFITS THAT VOLVE FROM RESEARCH AND THEN TRACEY BACK TO WHAT RESEARCH CAN YOU RELATE THOSE BENEFITS TOO. IF YOU ARE TRYING TO DO COST BENEFIT ANALYSIS, A COUPLE THINGS YOU HAVE TO ALIGN, ONE AS YOU TRACE BACK, THERE ARE A LOT OF FAILURES ALONG THE WAY THAT SOMEHOW HAVE TO BE TIED IN AND SECONDLY SOMETHING THAT'S TROUBLED ALL OF OUR DISCUSSIONS WOULD YOU LAY THE OUTCOME OF THAT RESEARCH, FOR THE BASES OF THE OUTCOME, FOR THE HUGE INTERMEDIARY COST THAT WENT WITH IT AND HOSPITALS AND POSITIONS PROVIDING FOR MEDICAL DEVICES AND SO ON AND TO DO A COST BENEFIT ANALYSIS, YOU HAVE TO DO THOSE IMPLEMENTING COSTS AS WELL. AND IT'S A COMPLEX PROBLEM. IF YOU LOOK AT IT AS A CONVENTIONAL COST EFFECTIVENESSICAL THEANCH IT WOULD PROVE TO BE--IT WOULD PROVE TO BE ENORMOUSLY COMPLEX ON THE CONTRIBUTION ON THE BENEFIT SIDE AND THE COST SIDE ACTUALLY AND ONE MODEL OF THIS IS THINKING IN TERMS OF THE RESEARCH FUNDING THAT WHAT RESEARCH DOES IS IS MAKE POSSIBLE DECISIONS RESEARCH OF BENEFITS FOR OTHER SOURCES. AND IF YOU ASSUME WE DO THAT BECAUSE WE BELIEVE THAT THE QUALITY OF LIFE IS WORTH THAT COST IN SERVICE, THEN REALLY THE VALUE OF RESEARCH IS THAT IT ENABLES SOCIETY AND INDIVIDUALS TO COME TO THOSE CHOICES THAT PREVIOUSLY WERE UNAVAILABLE. AND I THINK THAT'S HOW I WOULD PORTRAY THE BEEN FIT OF THAT INVESTMENT BUT I AGREE WITH YOU THAT IT'S--IT GETS VERY, VERY, VERY DICEY OTHERWISE ONCE YOU GET INTO ALL THE DOWN STREAM KICKOFFS OF DELIVERY AS WELL AS--COSTS OF DELIVERY AS WELL AS DEVELOPMENTAL COSTS. >> THANK YOU. THANK YOU. IT'S PRECISELY BECAUSE THE QUANTITATIVE ANALYSIS IS SO COMPLEX AND SO DIFFICULT TO ACLIGHTLY REPRESENT THEY--ACCURATELY REPRESENT THAT I WAS INTRIGUED THAT WE MIGHT TAKE AN APPROACH OR COMPARE STATEMENTS OR SCENARIOS AND LOOK AT DIFFERENT AREAS OF HEALTH THAT INTRIGUED ME BECAUSE IT CAN BE BACK FILLED WITH PATIENT STORIES, IT CAN BE PALPABLE IN THE CONSTITUENCY THAT WOULD BE LISTENING BUT THE QUESTION I HAVE FOR YOU IS WHETHER OR NOT YOU'VE SEEN ON A BIG PLATFORM SUCCESS USING THAT APPROACH. USING A THEY--THE RETINAL LOCATIONICAL MODEL THAT IS INTUITIVELY INTRIGUING TO US OR HAVE YOU SEEN IT ACTUALLY BECOME OPERATIONALLIZED AND RESULT IN THE EFFECT THAT IS SIMILAR TO WHAT WE WOULD LIKE TO GAIN. THAT IS HAS IT BEEN USED TO MAKE THE EVALUATION WORK IN OTHER CIRCUMSTANCES. >> IT'S A VERY--IT'S A VERY GOOD QUESTION. OFFHAND I DON'T HAVE AN EXACT PARALLEL IN MIND BUT IT LEADS TO ME TO MAKE ONE OTHER SUGGIEST THAN I THINK--SUGGESTION THAT I THINK WOULD REENFORCE. I WOULDN'T TAKE JUST ANY ONE IDEA AND JUST ADOPT IT. IF ONE WERE WANTING TO TON WHAT'S GOING TO BE PERSUASIVE. I WOULD GET THE MARKETING RESEARCH, THE END AND THE GROUP TEWS LOOK AT DIFFERENT STORIES AND CASES AND IDEAS AND RARINGMENTS AND THEN I WOULD LEARN FROM THEM WHAT DO THEY NOW THINK, WHAT DID THEY THINK BEFORE, WHAT DO THEY NOW FEEL, HOW FAVORABLY, HOW WHA DID THEY BELIEVE BEFORE IS IMPORTANT NOW WHAT DO I THEY THINK IS IMPORTANT BECAUSE ESECIALTIALLY IF YOU LOOK AT THE SUCCESS OF UNDERSTANDING THE ROLE OF NOW SOCIAL MARKETING AS WELL AS CONVENTIONAL MARKETING AND USING THAT AS A BASES FOR DETERMINE WHAT IS ARE IS IT, WHAT ARE THE KINDS OF QUESTIONS WE MOST WANT TO ANSWER, THAT'S HOW I WOULD APPROACH IT SO YES IT WOULD BE INTERESTING TO SEE OTHER PREVIOUS ILLUSTRATIONS BUT IT WOULD BE MORE VALUABLE TO GET SOME CONTEMPORARY MARKET RESEARCH ON WHAT'S ACTUALLY GOING TO RESONATE WITH PEOPLE. HOW WOULD THEY RESPOND TO IT AND USE THAT AS A WAY OF DECIDING THINGS WE WANT TO MOST LOOK AT. >> HARVEY THIS IS VERY HELPFUL LET ME FOCUS ON THE 25 CASE STUDIES IT'S RELEVANT FOR US BECAUSE WE DID PUT SOME IN BOXES AND THERE IS THIS HARD PROBLEM ABOUT CASE STUDIES, HOW DO YOU DETERMINE WHAT THE PURPOSE IS, IS IT TO SHOW THE BEST POSSIBLE EXAMPLES. IS IT TO SHOW THE RANGE OF CAMPS, SHOW THE SAMPLING PROCESS AND IS IT IF YOU'RE GOING TO HIGHLIGHT PATIENTS WHICH ARE THE MOST MOVING FOR TARGET OFFEDIENCES HOW DO YOU DEAL WITH THE FULL SET OF TARGET POPULATION FOR TREATMENT FOR EXAMPLE AFTER ALL THESE DECADES WE REACH 50% OF PATIENTS WITH DIAGNOSE, TREATMENT AND BLOOD PRESSURE CONTROL, 50% WOULDN'T BE REPRESENT INDEED YOUR MODEL OF THE 2013 TREATED PATIENT. YOU KNOW MANY OTHER EXAMPLES AND WE'VE STRUGGLED WITH THIS BECAUSE WE PICK SO MANY, WE WERE PARTICULARLY INSTRUCTIVE ABOUT THE PROCESS, VERY POSITIVE STORIES BUT THERE ARE OTHERS WHERE WE WORKED HARD AND HAD A TREMENDOUS AMOUNT OF RESEARCH WHERE IT'S JUST HARD AND DON'T HAVE ANYTHING TO OFFER FOR ALZHEIMERS. I WOULD SAY THE PICTURE FROM ALZHEIMERS FROM 50 YEARS AGO TO TODAY IS MORE DIAGNOSIS. IN THE CASE OF MENTALLY CLINICALLY ILL. IT WAS ROUGH THEN AND PRETTY AWFUL NOW. AND YOU GO DOWN THE LIST SO HOW WOULD YOUAZ VISE THIS NOT JUST PICKING ONE THAT'S INSTRUCTIVE BUT I DIDN'T COVER THIS, OR ARE YOU TRYING TO SUGAR COAT IT AND ALL THIS. YOU KNOW? >> WELL, AGAIN LET'S GO BACK TO PURPOSE, AGAIN. THE FIRST THING I WOULD SAY IS THAT MY PURPOSE HERE WOULD NOT BE COMPREHENSIVE FULL ACCOUNTING OF EVEN THIS ONE CASE. WHAT I WOULD WANT TO SHOW WITH THE CASE I WOULD DESCRIBE AS THE MINIMUM SUCCESS ATTRIBUTABLE TO THE RESEARCH SO THAT WE'LL BE ABLE TO MAKE ASSERTIONS OF THE TYPE BASED ON THIS EXPERIENCE. THE VALUE OF THE RESEARCH WAS AT LEAST X, NOT THAT WE KNOW IT'S X+ SEVEN Y, HERE'S REASONS WHY, BUT X WE KNOW WE CAN MAKE THE CASE. SECONDLY I WOULD PICK PICK A SERIES OF CASES NOT ALL OF WHICH DEMONSTRATED DRAMATIC PROGRESS BECAUSE I THINK THAT PARTS OF THE CANDOR AND THE PERSUASIVENESS IS ENHANCED WHEN ONE CAN SAY THE FRUITS OF RESEARCH HAVE NOT YET BEEN PICKED. AND ONE WAY TO FURTHER ILLUSTRATE THAT IS WHY I WAS SAYING AT THE 1963, 19882013 BECAUSE THERE WILL BE CASES THAT IF YOU HAD MADE YOUR ASSESSMENT IN 19, YOU KNOW 88 AND THOUGHT WELL WE HAVEN'T PROGRESSED IN 63, WELL WE MIGHT AS WELL STOP, YOU THEN HAVE MISSED WHAT CAME TO 2013. SO THE ABSENCE YET OF BENEFIT DOESN'T MEAN IT'S NOT GOING TO OCCUR AND AN ABILITY TO SHOW SOME THINGS WHICH DESPITE RESEARCH THUS FAR, HAVE NOT YIELDED TO NEW DISCOVERY. I THINK THAT'S PART OF THE HONEST DEPICTION OF THE RANGE OF EFFECT. IT ALSO BY THE WAY, IS A SPUR TO FURTHER INVESTMENT WHEN YOU CAN SEE THE CASES THAT LOOK THE SAME 25 YEARS AGO BUT GOSH, BECAUSE WE STAY WIDE IT, LOOK WHAT WE WERE ABLE TO ACCOMPLISH. LOOK WHAT WE NOW CAN DO FOR PEOPLE CAN JOINT DISEASE WHO WOULD OTHERWISE BE IMMOBILIZED. LOOK WAWE CAN DO WITH PATIENTS WHO ARE FOLLOWING CANCERS LOOK WAWE CAN DO, ET CETERA. THAT'S THE WAY I WOULD TRY TO MAKE THE CASE THAT SCIENCE DOESN'T--AND CROSS SECTION NEGLIGENCE TIME DOESN'T SHOW EVERY ANSWER BUT THE PROCESS IS SUCH THAT WE KNOW FROM EXPERIENCE THAT--THAT CONSCIOUS THOUGHTFUL PRIORITY BASED INVESTMENT CAN REALLY PLAY OFF AND THAT'S THE CASE THAT I WOULD MAKE IT. >> YOU ALSO HAD A COMMENT ABOUT THE COMPLEXITY OF THE PORTFOLIO OF NIH. >> YEAH. >> YOU ADDRESSED ONLY THE SEARCH ANOTHER BIG FUNCTION, PRETTY MUCH EMBEDDED RESEARCH IS TRAINING. >> ONE OTHER WE DON'T TALK ABOUT MUCH IS THE NIEWN COMMUNICATIONS PUBLIC EDUCATION ASPECT THAT WE'RE TRYING TO INFLUENCE PEOPLE TO MAKE MORE RATIONAL HEALTHY DECISIONS. >> AND WHERE WE COULD MULTIPLY THE BENEFIT OF THE RESEARCH ADVANCES IF WE COULD IN FACT, INFLUENCE THE DOWN STREAM ACT OF ALL KINDS. HOW IMPORTANT DO YOU CONSIDER THAT TO BE OR IS THAT NOT NIH'S ROLE? >> HERE'S WHERE I DO THINK, I THINK ALL OF US HAVE A KIND OF OBLIGATION ON THE SCIENCE SIDE, ONE OF THE FIRST THINGS I FIND MOST APPALL OUGHT CURRENT DIALOGUE ON THE SCIENCE IS AN ARBITRARY DISFAVOR OF SOCIAL SCIENCES RESEARCH, IF CAN YOU ARBITRARY LYLE DISOIEVER ONE STREAM OF SCIENCE, AND THE KIND OF PROBLEMS YOU'RE TALKING ABOUT, INDIVIDUAL BEHAVIOR AND CHOICE, EFFECT ON HEALTH, THESE PROBLEMS CANNOT BE DEALT WITH WITHOUT A COMBINATION OF BIOLOGICAL, CLINICAL AND SOCIAL SCIENCE. SO I THINK IT'S AN INCIDENCAL VALUE BUT AN EXTREMELY IMPORTANT VALUE OF THIS EXERCISE TO DEMONSTRATE HOW THE SEVERAL STREAMS OF RESEARCH ALL CONTRIBUTE NATURALLY AND SIGNIFICANTLY TO THE ACHIEVEMENT OF PROGRESS. NOW WHEN IT COMES TO THE QUESTION ABOUT THE ACTUAL DELIVERY OF PROGRAMS IN THE FIELD THAT I THINK, IT'S A QUESTION FOR THE LEADERSHIP AND HHS, BUT I THINK THAT IT'S NOT MAINLY NIH'S ROLE AND I THINK THAT WHEN YOU LOOK AT THE INVESTMENT AND NEED FOR FDA FOR EXAMPLE NREGULATORY SCIENCE, AND THE CDC, ON FIELD PROGRAMS DELIVERY ET CETERA. I THINK THEY'RE COMPLIMENTARY TO WHAT NIH IS DOING AND IF YOU LOOKED AT IT FOR AN INTEGRATED WAY FOR THE DEPARTMENT YOU WOULD WANT TO INCLUDE ALL, BUT HERE I THINK THE FOCUS FOR THE COMMITTEE IS ON MISSION AND SERVICE. BUT NIH MISSION DOES EMBRACE THE FULL SPECTRUM OF SCIENCE. WITHOUT ANY RESERVATION FOR MY VANTAGE POINT. >> ANY OTHER QUESTIONS. >> HARVEY IT WAS TERRIFIC. >> IT WAS REALLY THOUGHT PROVOKING. >> [ APPLAUSE ] >> OKAY, GOOD AFTERNOON. I THINK I INHERITED INTRODUCING YOU. GAIL STEPPED OUT FOR A MOMENT BUT DR. GLASS IS OF COURSE THE DIRECTOR OF THE FOGARTY INTERNATIONAL CENTER AT NIH. GOING TO TALK A LITTLE BIT ABOUT THE VERY TOPIC, TALK ABOUT VALUE OF NIH SUPPORTED RESEARCH AND DOES AND WE WILL TURN THE FLOOR TO YOU TO TALK FOR A WHILE AND THEN ASK QUESTIONS AND GAIL WILL TAKE OVER. >> THANK YOU. I'M DELIGHTED TO BE HERE TO SPEAK WITH YOU. I'M A BIT HUMBLED IN THIS AUDIENCE OF GURUS AND RESEARCH BUT I WANT TO BEGIN THAT IN THE 21st CENTURY, GLOBAL HEALTH HAS GONE BEYOND THE INFECTIOUS DISEASES IN HIV TO THINK ABOUT THE CHRONIC DISEASE OF MENTAL WELLNESS, AND NORM YOU SAID THIS IN YOUR BOSTON UNIVERSITY COMMENCEMENT WAS 40 YEARS OF AGE OF AMERICANS AT THE TURN OF THE 1900, ABOUT 78 BY THE TURN OF THE CENTURY, TWO AND HALF YEARS OF DECADE THROUGHOUT THE 20th CENTURY. IN CHINA THE SAME CHANGE OCCURRED IN A PERIOD OF ABOUT 50 YEARS AND DONE THAT WITHOUT THE INFRASTRUCTURE AND DONE THAT WITHOUT THE RESEARCH THERE, AND YOU HAVE TO BE HUMBLED BY THE VALUE WE TRIBUTE IN THE RESEARCH ENDEAVORS, CLEARLY THE CHINESE HAVE DONE SOMETHING DIFFERENT TO ACHIEVE A VERY DIFFERENT IMPORTANT SUCCESS. --CARDIOVASCULAR DISEASE WAS THE NUMBER ONE CAUSE OF DEATH WORLD WIDE, CANCER DIRECTOR SAID THAT 85% OF THE CANCERS WERE IN LOW AND MIDDLE INCOME COUNTRIES AND FOR MENTAL HEALTH THE NUMBER TWO CAUSE OF [INDISCERNIBLE] WORLD WIDE WERE MENTAL ILLNESS SO CLEARLY FOR GLOBAL HEALTH RESEARCH IT'S A GLOBAL SPECTRUM. JULIO FRANKS WOULD SAY THAT LOCAL AND GLOBAL ARE PAT OF THE SAME SPECTRUM. SO I ASK WHAT DO SAY HAVE TO DISTRIBUTE IN JAMA AN OPINION PIECE TO THINK ABOUT WHAT'S THE VALUE OF OUR INVESTMENT. I WANT TO TALK ABOUT FOURf1y DIFFERENT VALUES OF THIS, THE VALUE OF GLOBAL HEALTH FOR THE PUBLIC, THE VALUE IN TERMS OF KNOWLEDGE GENERATED, THE VALUE IN E-PRESCRIBING ITS OF LEADERSHIP AND CAN PASTY BUILDING AND TRAINING AND THE VALUE IN TERMS OF DIPLOMASY, I'M NOT GOING TO DWELL ON THE VALUE FOR ECONOMIC DEVELOPMENT ALTHOUGH THAT MAY IN FACT BE ONE OF THE LARGEST VALUES. NOW WHEN I FIRST TOOK THIS JOB, I WAS SENT DOWN TO CONGRESS TO MEET WITH A CONGRESSMAN, FRANCIS YOU DO THIS ALL THE TIME BUT FOR ME IT WAS AN EXPERIENCE. HE LOOKED AT HIS WATCH, HE SAYS I'M GOING TO BACK TO MY STATE IN THE NORTHWEST IN 10 MINUTES TO CATCH A PLANE AND I WANT YOU TO TELL ME WHY I SHOULD HAVE THE TAXPAYERS IN MY DISTRICT WHO ARE UNEMPLOYED LOGGERS SPEND MONOGLOBAL HEALTH AND HE LOOKED AT HIS WATCH IMMEDIATELY AND I SCRATCHED MY HEAD ON THE SPOT AND I SAID, WELL, WHAT ARE THE HEALTH PROBLEMS IN YOUR COMMUNITY? I MEAN DO HAVE YOU CHILDREN IN YOUR COMMUNITY? HE SAID YES, I SAID DO ANY OF YOUR CHILDREN HAVE DIARRHEA NUMBER TWO CAUSE OF HELPIZATION? DID YOU KNOW THAT ORAL THERAPY CAME FROM TREATMENT IN THIS BANGLADESH IN AMERICAN AND RESEARCH RESEARCHERS? HE SAID NO I DON'T KNOW THAT. I SAID DO ANY YOUR CONSTITUENTS HAVE CANCER. HE SAID YES, A LOT OF THEM. I DID DO YOU KNOW THE FIRST ONE CAME FROM UGANDA WITH BURKEETS LYMPHOMA EBV I VIRUS AND THAT'S THE‡O@ TREATMENT OF UNDERSTANDING VAC SEEK SEEN CANS PREVENT CANCER. DID YOU KNOW THAT--HOW ABOUT ALLS HYMERS I'M LOOKING AT RICHARD HERE--WELL, THE GURU OF ALZHEIMERS I SAID DO PEOPLE IN YOUR PEOPLE COMMUNITY HAVE ALZHEIMERS. HE SAID YES. I SAID IT'S ROUGHLY WON IN THREE WHO WILL GET THIS AND ONE IN SIX, TELL BE VERY HIGH. YOU KNOW WHERE SOME OF THE MOST INTERESTING RESEARCH IN ALZHEIMERS IS GOING, FRONT PAGE OF THE NEW YORK SOMETIMES. >> HE SAID NO IN CO COLUMBIA BECAUSE THIS OF COLLECTION OF PEOPLE BECAUSE OF THE MUTATION WHO ARE BEING FOLLOWED FOR EARLY BIOMARKERS AND TREATMENT. SO I SAID DO HAVE YOU ANY SMOKERS IN YOUR CONSTITUENCY, MY WORK WITH RICHARD DOLL ON SMOKING? DOES ANYBODY TRAVEL TO AFRICA HOW ABOUT USE THE ARDIMESIN TO PROTECT YOU WHEN YOU'RE THERE. EYE SURGERY, YOU THINK OF THE DECLINE IN THE COST OF EYE SURGERY BECAUSE OF INNONAPOPTOTICCATIONIVATIONS IN INDIA THROUGH THE--INNOVATIONS IN THE INDIA, CARED BY QUARTERS OF MILLIONS IS THAT OF COURSE YOU TO US TO IMPROVE THE QUALITY OF CARE. SO MY 10 MINUTES ABOUT WAS ABOUT UP, I WENT THROUGH THAT AND HE LEFT WITH A COMPLETELY DIFFERENT IMPRECIOUSES SO MY FIRST VALUE FOR THE PUBLIC AND WHY THE GLOBAL HEALTH INVESTMENTS ARE SO CRITICALLY IMPORTANT. BUT THEN THERE'S THE ISSUE OF KNOWLEDGE. WHEN I WAS A RESIDENT BARRY AND OTHERS CAME TO SPEAK DURING MY RESIDENCY. EACH OF THESE CHARACTERRERS HAD GONE OUT ROOTING FOR VIRUSES AND RARE DISEASES AND FAR CORNERS OF THE WORLD AND WITH THE TRIBE AND NEW GUINEA, WHY SHOULD WE BE SUPPORTING THESE COOKIE STAFFS TO FAR OFF PLACES? NOW MANY SCIENTISTS WENT TO THE SEE THE FOUR TRIBES AND NEVER CAME BACK WITH MUCH. OR TO AUSTRALIA, THESE TWO CHARACTERS CAME BACK AND WON NOBEL PRIZES. NOW IT TOOK MANY YEARS TO GO FROM THE DISCOVER I THEY MADE TO HEPATITIS HEPATITIS VACCINES TO DEMONSTRATION OF THE PREVENTION OF HEPATITIS IN ALL CHILDREN AND THE PREVENTION OF HEPATIC LIVER CANCERS. TOW THESE ARE ALL LONG-TERM CONSEQUENCES AND WE'RE THINKING ABOUT SHORT-TERM EVALUATIONS AND MONEY IT WOULD TAKE TOO LONG FOR THIS MONEY TO ACCUMULATE TO THOSE DISCOVERIES, THE SAME WITH BURKEETS. SO BY DEMONSTRATING BASIC MEDICAL PRINCIPLES AND KNOWLEDGE, WE REALLY CONTRIBUTED GREATLY FROM THIS FORAY INTO GLOBAL HEALTH RESEARCH. THE ONE AREA AND I WOULD SAY IN THE HIV AREA, THERE ARE LOOEDS OF DELIVERY MADE THROUGH THIS RESEARCH EFFORT THAT COME RIGHT HOME TO HELP US WITH OUR HIV PROBLEM AT HOME SUCH AS THE RECENT TREATMENT OF PREVENTION TRIAL COULD HAVE ONLY BEEN CONDUCT INDEED AN AREA OF HIPRIVATE SECTORULENCE AND NIAID WAS KEY AND A NUMBER OF PHOBE ARTY TRAINEES. THE ONE AREA WHERE GOOD DATA HAS BEEN DEVELOPED HAS BEEN ONE AREA IN THE SMALLPOX ERADICATION PROGRAM WHICH WAS PERHAPS THE BIGGEST EFFORT IN GLOBAL HEALTH INTERVENTION, PRIOR TO PROGRAM, A MILLION AND HALF TO TWO MILLION DEATHS A YEAR. THE COST OF THIS PROGRAM, THE VALUE IS OVER A BILLION DOLLARS A YEAR IN ECONOMIC DECLINE OR PROBLEMS THE VALUE OF THE PROGRAM WAS A'RE OVER A HUNDRED MILLION DOLLARS AND THE RETURN ON INVESTMENT ARE 450 TO $1 SPENT AND IT'S CONTINUING EVERY YEAR. SO THAT'S AN AREA WHERE WE CAN USE BUT THERE'S VERY FEW SUCH--SO THAT'S WELL DEFINED EXAMPLES. THE OTHER WAY TO LOOK AT THIS IS WHAT'S THE VALUE OF NOT INVEST NOTHING GLOBAL HEALTH RESEARCH IF WE HAVE OUTBREAKS OF SARS OR COONA VIRUS OR DRUG RESISTANT TB WHICH SPREAD. THE VALUE OF THE ECONOMIC POTENTIAL OF DELAY IS ENORMOUS AND THAT'S SOMETHING WE NEVER FULLY ESTIMATE EO I THINK THE HUGE CONTRIBUTIONS TO GLOBAL HEALTH RESEARCH. I THINK THE FRONTIERS OF SCIENCE TODAY, MANY OF THESE WILL BE ABROAD AND WE NEED--WE ABSOLUTELY ESSENTIAL TO USE THESE UNIQUE POPULATIONS, TALENTED INVESTIGATORS, UNUSUAL SYSTEMS OF CARE DELIVERY AND THE USE OF MOBILE TECHNOLOGY AND OTHER LEAP FROG TECHNOLOGIES TO ACCESS THESE. BUT IN THIS ERAI THINK THIS WILL BE CRITICAL. NOW--I WANT TO GO TOXIC EFFECTS REALLY THE VALUE OF TRAINING BECAUSE FOGARTY IS A HEAVILY INVEST INDEED TRAINING AND SINCE I'VE BEEN THERE, I'VE ALWAYS BEEN CHALLENGED TO SAY WHAT'S THE VALUE OF THIS TRAINING AND HOW CAN YOU SHOW US IMPACT WHEN WE'RE TRAINING MEDICAL STUDENTS OR POST DOCS. THEIR VALUE IS A LITTLE BIT LIKE COMPOUND INTEREST. TELL GO UP EVERY YEAR BEYOND WHAT EVERY EVALUATED AT FIVE YEARS IT'S NOT WORTH VERY MUCH, BUT IN 20 YEARS IT'S HUGE. IN AUGUST, I WAS VISITING WITH INVESTIGATORS AT OUR PROGRAM, MEDICAL EDUCATION PARTNERSHIP IN UGABBEDDA AND AT THE CLOSE OF THE PROGRAM, THE MINISTER OF HEALTH GOT UP, GAVE A LITTLE BABBLE ABOUT UGANDA AND THE HISTORY, AND THEN HE LOOKED AT THE AUDIENCE AND HE SAID, YOU KNOW BACK IN 1998, I WAS A FOGARTY FELLOW AT WESTERN RESERVE. IT WAS THE FIRST TIME I USE A COMPUTER AND SCENE SNOW ASK IT GOT ME INTO HIV RESEARCH AND I'VE BEEN THERE EVER SINCE AND I SAID I JUST RECENTLY I TOOK THIS JOB AS MINISTER OF HEALTH AND I SAT BACK AND I WAS DELIGHTED, YOU CAN SEE THE SMILE ON MY FACE, IT WAS DELIGHTED AND I SAID HOW DO WE EVALUATE THE IMPACT OF THIS MAN'S CONTRIBUTION IN TERMS OF DOLLARS. HE'S CLEARLY GOT LEADERSHIP, HOW DO I EVALUATE THIS? I WENT TO [INDISCERNIBLE] TO MEET WITH STUDENTS AND DEAN AND FOGARTY FOLLOW OS, THE DEAN LOOKED AT ME AND SAID I DID MY IMMUNOLOGY TRAINING IN WESTERN RESERVE IN THE SAME AIDS PROGRAM AND I NOW HAVE AN AIDS LABORATORY, AIDS RESEARCH FROM NIH AND DOCTORAL AND POST DOCTORAL TRAINING PROGRAM AND I SAID THAT'S WONDERFUL, HOW DO I EVALUATE THIS? IN TERMS OF THE TERM OF THIS COMMITTEE. SO FOR ME, THIS IS CLEARLY A CHALLENGING SUBJECT AND I DON'T HAVE A CLEAR ANSWER EXCEPT THROUGH THE ANECDOTES AND I WAS SO TICKLED THAT PETER ENDED UP WITH MATHEMATICAL FORMA LA ENDED UP BEING GRATEFUL AND THAT TO ME WAS REASSURING. OUR PROGRAMS AT FOGARTY, OUR FIRST PROGRAM WAS IN AIDS TRAINING AND RESEARCH WHERE WE TOOK YOUNG INVESTIGATORS, BROUGHT THEM INTO THE STATES OR GAVE THEM AND EMPOWERED THEM TO LINK TO U.S. INSTITUTIONS TO BUILD UP TRAINEES AND BUILD UP A RESEARCH ESTABLISHMENT AND IT'S BEEN INCREDIBLY SUCCESSFUL AND AFTER 20 YEARS ACCIDENT THE BUILD AND SLIM CRIPS AND OTHERS IN THE WORLD WERE TRAINEES FROM THE PROGRAM. NOW WE ATTRIBUTE ALL OF THEIR SUCCESS TO OUR FOGARTY FELLOWSHIP 20 YEARS AGO BUT IN FACT THEY HAVE MUCH GREATER FUNDING FROM OTHER PARTS OF THE WORLD. BUT I SAY THAT ALSO BECAUSE SINCE HARVEY JUST LEFT AT THE IOMMEETING THIS YEAR, TWO OF THE 10 FOREIGN ASSOCIATES WHO WERE INDUCT INTOED THIS MEETING WERE NELSON COMBO AND AND NIH GRANTEES AND I'M SMILE BEING AT FRANCIS BECAUSE HERE'S AN AIDS RESEARCHER NOW IN CHARGE OF THE MEDICAL RESEARCH COUNCIL IN HIS REORGANIZATION HAS COME TO FRANCIS AT NIH AND SAID, WE, SOUTH AFRICA WANTS TO GIVE YOU, NIH MONEY SO THAT YOU CAN DO PEER REVIEW SO THAT YOU CAN DECIDE WHO ARE OUR BEST RESEARCHERS AND SEND THAT MONEY BACK TO US. WE'LL PAY FOR OUR RESEARCHER, YOU PAY FOR YEARS BUT ISN'T THIS AN INCREDIBLE VALUE, HOW DO I VALUE THAT. AND WE'VE DONE THIS NOW AND HAVE SEVERAL HUNDRED GRANTEES, POST DOCS ON CAMPUS AND ARE PAID FOR BY THE BRAZILLIANSLIANS AND RUSSIANS AND THE LIKE AND THEY'RE ALL VALUE ADDED AND TRYING TO LEARN AND BE PART OF AN EXTENDED NIH COMMUNITY SO I THINK THAT EARLY TRAINING AND LEADERS TO ME IS HUGE. NOW HOW DO WE, HOW ABOUT AMERICANS, WHERE DO WE GO WITH THIS, WE HAVE A PROGRAM THAT WHEN I GOT HERE TRAINED 20 MEDICAL STUDENTS A YEAR TO GO OVERSEAS. LAST YEAR, SIX YEARS LATER WE SENT 93 POST DOCS, U.S. INAND FOREIGN POST DOCS AND COHORT OF MEDICAL STUDENTS TOGETHER WITH A FULL BRIGHT PROGRAM ON THEIR EARLY TRAINING EXPERIENCES. SUCCESS FOR US FOR SOME OF THEM HAS BEEN TO COME BACK AND DETAILS K-AWARDS. MOVE OF THESE THE MAJORITIOR NOT JUST IN HIV AND INFECTIOUS DISEASES BUT IN ALL AREAS OF BIOMEDICAL RESEARCH IT'S BEEN QUITE ASTOUNDING TO SEE THE IMPACT. THE QUESTION TO YOU AS TO MY OWN BOARD AND HOW DO I EVALUATE THESE PEOPLE NOW, IN FIVE YEARS AND IN 10 YEAR WHEN IS THEY'RE LEADERS? I CAN LOOK AROUND THE TABLE HERE TO PEOPLE HERE WHO FRANCIS COLLINS WENT TO NIGERIA, GOT INTERESTED IN HAPPEN MAP, HTHREE AFRICK AMEPY, YOU THINK THIS HAS A LINK TO HIS EARLY CAREER EXPERIENCE AND STEVE KA TZ, I HAVE PICTURES OF STEVE WALKING INTO A HOUSE IN UGAND AND NOW--65, AND HIS TWO SONS ARE DOING GLOBAL HEALTH AND HE AN INTEREST OF, SO THIS LITTLE EARLY, CALL IT EARLY CHILDHOOD EXPERIENCE BUT MY COMMUNICATORS SAID I SHOULD CALL IT EARLY CAREER EXPERIENCE AND GOT RID OF ROTOVIRUS AND THROUGH VACCINE PROGRAMS IN PART BECAUSE WHO ELSE WOULD THINK OF WORKING ON CAREER AND DISCIPLINARY REAL DISEASE FIST THEY HADN'T SPENT TIME IN BANGLADESH TO GET THIS BAPTISM. WE ALSO WORK TO GET PLATFORMS FOR RESEARCH AND LOW AND MIDDLE ENEMY RESEARCH, THESE PROGRAMS INCLUDE PROGRAMS IN ETHICS CAN WE DO INVESTIGATIONS WITHOUT AN ETHICAL FRAMEWORK. HOW ABOUT RESEARCH MANAGEMENT, JUST CONTROLLING OUR FUNDS AS WE GO ALONG AND HOW ABOUT THE RESEARCH MACHINETALLITY. WE WOULD SAY BUILD AND THEY WOULD COME AND PART OF THE BUILDING AND THEY WILL COME HAS BEEN THE PROGRAM THAT FRANCIS BOUGHT INTO ALONG WITH ERIC GUSBY. WE FUNDED 13 MEDICAL SCHOOLS IN SUBSAHARAN AFRICA AS THE NEXT STEP TO NOT ONLY FUND AIDS TROIMENT BUT TO TRAIN AIDS DOCTORS AND DOCTORS IN GENERAL AND HEALTH PROFESSIONALS AT ALL LEVELS. AND WHO ARE THE PEOPLE WHO GOT THESE GRANTS. THEY ARE THE GRANTEES WHO LEARNED HOW TO DO RESEARCH THROUGH THE PROGRAM, MANY OF THESE PIs AND DEANS IN THE SCHOOLS ARE PEOPLE WHO HAVE BEEN TRAINED THROUGH THE NIH PROGRAM. HOW DO I EVALUATE THAT AND I NEED YOUR HELP. >> SO I WANT TO CLOSE WITH A TIDBIT ON THIS AREA AND IT WAS IMPORTANT FOR THE STATE DEPARTMENT OF DELOAMACY, COUPLE YEARS AGO, WE PUT OUT OUR FIRST GRANT FROM NIH TO SEERIA TO WORK ON SMOKING TO WORK ON SMOKING HOOKAS, AND NOW WHY DO WE FEEL LIKE, NOW MY 21 YEAR-OLD SUN THINGS THAT BECAUSE IT'S SMOKING THERE IT'S COOL AND BECAUSE IT'S THROUGH WATER HE DOESN'T GET NICOTINE AND TAR, WRONG. AND TOGETHER WITH THE U.S. AND TENNESSEE NOT THE OTHER DEMONSTRATE THAD PRINCIPLE AND THAT STUDY GOT THE NUMBER ONE AWARD FOR RESEARCH BY THE MEDICAL COUNCIL IN SYRIA BEFORE ALL THE UPRISING. HOW ABOUT IRAN. IT HAS BEEN A GENTLEMAN OF RESEARCH FOR DECADE FOR YEARS AND WE HAD ONE VISITED YALE AND YALE LOOKING AT METHADONE TREATMENT AS A PREVENTIVE TREATMENT FOR HIV BECAUSE IT'S SO RAMPANT THAT THEY REFUSE TO USE METHADONE BEFORE DEMONSTRATION OF IMPACT FOR HIV. SO THE TRIAL IS WHAT I ASK THE INVESTIGATOR WILL THE GOVERNMENT USE THIS THEY SAID THEY'RE MONITORING THIS AND THEY WILL USE IT AND HOW ABOUT THIS, IRAN STANDS IN A CORNER OF THE WORLD WHERE DRUG RESISTANT TB IS RAM ANT. WE JUST HAD A GRANT OVER THE SHUT DOWN, I DON'T KNOW FIELD FUNCTIONS TOLD YOU THIS BUT OVER THE SHUT DOWN TO OPEN OUR E-MAILS WE WERE ABLE TO GET SEQUENCE OF STRAINS RESISTANT STRAINS OF TB SEQUENCE TO LOOK THE PATTERN DISTRIBUTION. THE IRANIANS HAVE BEEN THE ONLY GROUP IN THE WORLD FOLLOWING UP ON A COHORT OF PEOPLE AND ADULTS FROM NIEHS, WHERE ELSE CAN WE STUDY THIS EXPOSURE IN COLLABORATION WITH A NEW DAY WITH GLOBAL HEALTH. THE FRONTIER OF SCIENCE, I SEE MANY WILL BE ABROAD IN THE GLOBAL HEALTH ARENA AND THERE'S A TREMENDOUS NEED BECAUSE IF WE WANT TO DO CLINE CLINICAL TRIALS WITH GOOD ETHICS AND CLEARANCE, MANY OF THESE WILL BE PUSHED OVERSEAS. IF WE WANT TO THINK ABOUT LEAP FROG TECHNOLOGIES AS DONE IN NORTHWESTERN KENYA TO PUSH ALL THE TREATMENT OF HYPERTENSION AND DIABETES OUT OF THE HOSPITAL TO THE CLINIC TO THE COMMUNITY USING CELL PHONES AND DIFFERENT APPLICATIONS WE WILL LEARN THEM ABROAD. WHAT'S THE METRIC. WHAT'S THE METRIC WE SHOULD USE. IS IT LIFE EXPECTANCYS, PATENTS AND PUBLICATIONS AND COMPETITIVENESS AND JOBS AND INCOME, IT'S BEEN OUR BUSINESS, IT'S DIPLOMATIC ACHIEVEMENTS, PUBLIC CONFIDENCE? SO AT THE END STRESS TARGET OF PUBLIC AND LEADERSHIP AND COMPASSITY THAT WE'RE BUILDING WHICH IS CLEARLY EXTENDS THE REACH OF NIH AND OVERSEAS AND TO THE PROBLEMS OF ECONOMIC DEVELOPMENT I WAS DELIGHTED WHEN SAID AFTER A FEW GOOD ANECDOTES MAY BE HELPFUL. DAN GOLDEN YOU SAID WE DON'T HAVE TO TALK IN DIGITS WE HAVE TO THINK BEYOND. KIONLY END WITH MY FAVORITE QUOTE FROM ALBERT EINSTEIN: AS I THINK ABOUT MY OWN EVALUATION: THAT EVERYTHING THAT CAN BE COUNTED IS NOT--DOES NOT NECESSARILY COUNT AND EVERYTHING THAT COUNTS CAN NONET NECESSARILY BE COUNT--CONNOT NECESSARILY BE COUNTED. THANK YOU VERY MUCH D. >> SO ROGER I DID EXACTLY AS I HOPED AND GIVE COMPELLING EXAMPLES IN EMERGING ITS OF I DIDN'T GLOBAL EXAMPLES, ANYTHING IT IS. I WONDER IN TERMS OF OF TRYING TO DETERMINE THE IMPACT OF GLOBAL HEALTH WITHIN FOGARTY HAVE YOU UNDERTAKEN ANY SYSTEM ACCOUNTIC EXERCISES, DO YOU PLAN TO AND IF SO WOULD THE WORK OF THIS GROUP MAYBE INFLUENCE HOW YOU WOULD GO ABOUT TRYING TO TRYING TO DO IT. >> I WOULD LOVE TO HAVE INSIGHTS TO THIS GROUP FIRST OF ALL BECAUSE THIS EVALUATING LONG-TERM TRAINING IS HARD. WE'RE PREPARING A REVIEW FROM OUR FIRST GRANTEES 10 YEARS AGO. NOW THESE ARE FOUR YEARS OF MEDICAL SCHOOL THEY'RE HARDLY INTO RESEARCH ORBIT BAH MANY OF THEM HAVE DONA BIG THINGS, AND THREE OR FOUR YEARS AGO AND HALF A DOSEN OF THEM HAVE THIS ALREADY, THEY HAVE PROFESSORSHIPS THEY'VE BEEN SOUGHT AFTER SO WE'RE LOOKING FOR DIFFERENT METRICS AND THE METRICS MAY WELL BE THESE SORTS OF METRICS BUT I WOULD LOVE TO THINK THROUGH HOW I EVALUATE THE LONG-TERM TRAININGS FROM THE PROGRAM, WE HAD A REUNION OF THOSE PEOPLE AT THE AIDS MEETING HERE LAST YEAR WITH 25 YEARS OF THE PROGRAM. THE PEOPLE WHO HAVE THE LONG-TERM STANDARDS. ANOTHER SPEAKER--I WENT TO SPEAK AT UCLA AND BEFORE I SPOKE, I ASKED TO THE GRADUATES WHAT HAPPENED WITH THEIR AGE-[INDISCERNIBLE] PROGRAM, ROGER SENT ME A LIST OF MINISTRIES OF HEALTH, AIDS PROGRAMS THROUGHOUT SOUTHEAST ASIA, MAJOR LEADERS IN LABORATORY SCIENCE, THAT ARE GRADUATES OF THIS PROGRAM 25 YEARS LATER, 2010-15 AND I THINK THAT TYPE OF INFORMATION WOULD BE INCREDIBLY VALUABLE AND WE WOULD LOVE TO GO BACK AND DO THAT MORE. >> I LOVED YOUR TALK, IT DIDN'T HAVE A LOT OF NUMBERS, IT PROVED THE POWER THE POWER OF ANECDOTES, MAYBE WE NEED TO THINK THERE THROUGH AND HAVE A BETTER BALANCE. THERE'S ALWAYS TEMPATION TO HAVE THEY THING CLEARLY AND TRACEABILITY, BUT WHAT YOU SAID HITLY AND I FOUND IT TO BE VERY, VERY, POWERFUL SO I DON'T THINK WE SHOULD IGNORE WHAT WE'RE HEARING BUT WE ALSO SHOULD NOT IGNORE WHICH IS FRANCIS WHERE YOU STARTED YOU HAD A SESSION HERE I DON'T KNOW HALF A YEAR AGO WHERE YOU SHOWED US VIDEOS OF A CONFERENCE YOU HOSTED. IT WAS VERY-- >> [INDISCERNIBLE] >> IT WAS VERY, VERY POWERFUL. SO I THINK YOU JUST REENFORCED LET'S NOT RUN AWAY FROM ANECDOTES BUT ADDRESS ANOTHER MESSAGE, BUT IT WAS CLEAR. >> [INDISCERNIBLE]. >> I SHOULD PROBABLY ADD THAT I'M DELIGHTED DR. COLLINS INCLUDED MOBILE HEALTH AS ONE OF THE FIVE MILLARS OF HIS ADMINISTRATION AND IT'S BEEN AN ABSOLUTE DELIGHT TO HAVE THESE INTERACTIONS WITH HIM ON A REGULAR BASIS BECAUSE WE SEE TREMENDOUS VALUE IN NIH AND FUNDING WITH INDIA, CHINA, SOUTH AFRICA AND THE FUTURE OF BRAZIL SO WE SEE THAT AS A NICE DEMONSTRATION OF ACCEPTANCE OF THE VALUE OF THE RESEARCH AND THE FACT THAT WE SHARE VALUES AND ACHIEVING THAT GOAL. THOSE GOALS OF RESEARCH. , WE ARE MINDFUL THAT YOU-- >> WE ARE MINDFUL YOU HAVE A BIG OBLIGATION TOMORROW AND SAFE TRAVEL TOMORROW TO ATLANTA. >> SO WE HAVE A GREAT FINAL PANEL TODAY WITH MANY ACCOMPLISHED INDIVIDUALS AND ARTHUR AND ALAN ARE GOING TO MODERATE THE PANEL AND I WILL LET YOU CHOOSE HOW YOU INTRODUCE THE PANEL AND HANDLE THE QUESTIONS WITH RESPECT TO THE INDIVIDUAL SPEAKERS. >> ARTHUR AND I TALKED ABOUT IT, BECAUSE OF THE QUANTITY AND QUALITY OF THE PANEL. WE ARE NOT GOING TO INTRODUCE THEM, YOU HAVE THE BIOGRAPHIES RATHER THAN SPENDING AN HOUR AND A HALF GOING THROUGH BIOS WE THOUGHT WE MED GIVE THEM TIME TO SPEAK INSTEAD, I THE BASIC IDEA IS THAT WE'LL ASK THE PANELISTS TO EACH SPEAK FOR FIVE MIN 10 MINUTES AND WE THOUGHT WE WOULD HAVE TIME FOR QUESTIONS OF CLARIFICATION AFTER EACH SPEAKER BUT TRY TO LIMIT TO ONLY THAT. SO THAT AT THE END OF THE PRESENTATIONS WE WILL HAVE AT LEAST ROBUST IF NOT RAMBUNCTIOUS GROUP. AND THE PANELISTS YOU CAN TELL FROM LOOKING AT THE BIOS DO COME FROM A BROAD RANGE OF DIFFERENT PERSPECTIVES. WHAT THEY HAVE IN COMMON IS SOMETHING THAT THEY WERE MESHING BEFORE WHICH IS THAT WE NEED TO BE CONSCIOUS OF THE END USERS OF WHAT WE'RE DOING. IN MANY WAYS, THIS IS I PANEL. THANK YOU VERY MUCH--SO WE CAN SEE THE PANEL NOW. THAT THE PANEL REALLY DOES REPRESENT AGAIN A DIVERSE GROUP OF VIEWS THAT'S IF NOT TOTALLY RANDOM, REPRESENTATIONAL, CERTAINLY DOES REPRESENT A NUMBER OF END USERS OF THE KIND OF SCIENCE AND OTHER KINDS OF THINGS WE TRUE TO SUPPORT NIH AND SO WITHOUT ANY FURTHER ASHES DUE WE'LL HAVE PANELISTS, JUST IN THE ORDER WE HAVE YOU LISTED HERE IN THE PROGRAM SO WE WOULD START WITH ELAINE GALLIN WHO IS QE PHILANTHROPIC ADVISORS. THANK YOU FOR BEING HERE. >> THANK YOU,OOSE A PLEASURE TO BE HERE. I'VE LEARNED LOTS THIS MORNING. MY COMMENT ITS TODAY REFLECT MY EXPERIENCE AS A PAST DIRECTOR FOR A CHARITIABLE FOUND MEDICAL RESEARCH PROGRAM. EFFORTS ON A VARIETY OF COMMITTEES AND BOARDS AND MOST RECENTLY, THE CONSULTING WORK THAT A KEYING COLLEAGUE AND I DO FOR NOT FOR PROFIT ORGANIZATIONS. IN PREPARATION, THE PANELISTS SAID--AGREED THAT WE WOULD SET THE STAGE FOR MANY PANEL MEMBERS REPRESENT HERE. THOSE GROUPS REFERRED TO AS VOLUNTARY ORGANIZATION, ENDOWED FORGEINIZATIONS AND HEALTH ORGANIZATIONS LIKE RESEARCH A LIAISONNANCE AND AMERICA. MY FIRST SLIDE, DO--OH I HAVE IT, OKAY; SORRY. MY FIRST SLIDE IS A SLIDE YOU'RE FAMILIAR WITH, IT'S TAKEN FROM THE FMRB SLIDE SET I RECEIVED AND BASED ON RESEARCH AMERICA DATA, JUST TOPS THE U.S. HEALTH INVESTMENTS BY SECTOR BETWEEN 2001 AND 2011 AND I SHOW IT TO SHOW IN THE BLUE LINE THATITIOUS' ADENTIFIED IN THE YELLOW ARROW SAID THAT THIS SECTOR BASICALLY CUBES MUCH LESS TO THE U.S. HEALTH RESEARCH ENTERPRISE IN TERMS OF DOLLARS, THEN THE FEDERAL GOVERNMENT DURING INDUSTRY. HOWEVER BESPIED THIS MODEST DOLLAR DIRECTION, THIS AREA WHICH IS COMCOMOPPOSITE BEHAVIORIAL PHENOTYPE WITH SHNDS OF ORGANIZATIONS IS POLITICAL CONSTRAINTS ASK PRIME FROM FOR PROFIT MOTIVES, AS WELL AS ORGANIZATION TO TRY TO PROVIDE THE RISK CAPITAL IN HEALTH HAS GREATLY AMPLIFIED IMPACT IN U.S. HEALTH RESEARCH. ON THE NEXT SLIDE. I HAVE IT AGAIN, SORRY ABOUT THAT. THE TOP PORTION OF THE NEXT SLIDE DEPICTS ANOTHER DEC THAT YOU'RE ALL FAMILIAR WITH IN PINK. THAT IS THE HEALTH RESEARCH CONTINUUM. FROM BASIC RESEARCH THROUGH TRANSLATIONAL AND CLINICAL RESEARCH TO OPERATION AT RESEARCH AND I SHOWED THIS TO GET PICKED ON THE BOTTOM PORTION OF THE SLIDE ON THE YELLOW BOXES, ARE A SAMPLING OF SOME OF THESE ORGANIZATIONS THAT ARE WITHIN THIS SECTOR AND TO SHOW THORS THESE ORGANIZATIONS AND WHERE THE BOXES ARE PLACED INDICATES WHERE WITHIN THE HEALTH RESEARCH CONTINUUM THEY WORK AND TO JUST--JUST EMPHASIZE THEM LIKE THE HOWARD HUGH'S MEDICAL INSTITUTE OR THE WELCOME FUND BUT MAINLY BY O MEDICAL RESEARCH THAT'S IN THE BASIC REALM OR LEFT PORTION OF THAT ARROW WHERE OTHER ORGANIZATIONS LIKE THE ROBERT WIDE JOHNSON ORGANIZATION THAT YOU HEARD PETER TALK ABOUT REALLY AT THE OPERATIONS RESEARCH OR THE RIGHT END OF THE SPECTRUM AND A REALLY CONCERNED WITH THE OPTIMIZING PUBLIC HEALTH AND HEALTHCARE DELIVERY. VOLUNTARY HEALTH ORGANIZATIONS OFTEN FUND THROUGHOUT THIS SECTOR. ORGT POINT I WOULD LIKE TO MAKE IS THAT OF SOME THESE ORGANIZATIONS ARE ENDOWED ORGANIZATION WHICH MEANS THAT MAKING THESE ARE RELATIVELY SIMPLE. THEY HAVE TO GET THEIR BOARD TO BUY INTO AN IDEA OR THE BOARD COMES TO THE STAFF WITH A PARTICULAR IDEA, THEY HAVE A SMALL GROUP OF STAKEHOLDERS WHICH MAKE THOSE DECISIONS. OT OTHER HAND, VOLUNTARY HEALTH ASSOCIATIONS AND MANY, MANY MORE VOLUNTARY HEALTH ASSOCIATIONS IN THE UNITED STATES THAN FOUNDATIONS REALLY HAVE--ARE CONCERNED ABOUT THE PATIENTS AND PATIENTS NEEDS. AND THEY RAISE THEIR MONEY FROM THOSE PATIENTS COMMUNITIES AND WE CERTAINLY SAW WHAT HAPPENED WHEN PATIENTS OR THEIR COMMUNITIES GET UPSET WHEN THE SUSAN G KOMEN FOUNDATION HAD A PROBLEM WITH PLANNED PARENT HOOD AND THEIR FUNDING LEVELS DECREASED. SO THERE ARE DIFFERENT MOTIVATIONS. DRIVES DECISION MAKING AMONG THESE ORGANIZATIONS. AS MIGHT BE EXPECTED EMPHASIS, ASSESSMENT AND IMPACT EVALUATION WITHIN THIS SECTOR REALLY VARY CONSIDERABLY. WE HAD HEARD FROM HARVEY FINEBERG MIGHT BE STANDARD AND SOME SPEND MORE AND SOME SPEND MUCH LESS. SOME OF IT DEPENDS ON THE PROGRAMS THAT THEY ARE--THAT THEY'RE SUPPORTING. FOR EXAMPLE, ORGANIZATIONS LIKE THE MULTIPLE MYELOMA ORGANIZATION WHICH IS NOW VERY FOCUSED ON PRODUCT DEVELOPMENT BASICALLY STRUCTURES ITS GRANTS USING MILESTONES, THOSE EFFECTIVELY TRACK PROGRESS AND EVALUATE INVESTMENTS. IT'S A FAIRLY SIMPLE STRAIGHT FORWARD MODEL, IT MAY BE HARD TO GET TO THAT PRODUCT BUT IT'S REALLY A VERY NICE PARADIGM, IT'S CONTRAST IN CAREER DEVELOPMENT PROGRAMS WHICH HOW MANY FOUNDATIONS SUPPORT IS MORE DIFFICULT. CAREER PATHS DON'T FOLLOW RIGID MILESTONES RESEARCHERS RECEIVE SUPPORT FROM A VARIETY OF FUNDERS AND CAREER TIME CANS BE LONG AND UNPREDICTABLE. WHEN I WAS AT THE CHARITABLE FOUNDATION, WE MADE SIGNIFICANT INVESTMENTS IN JUNIOR AND LEVEL CLINICAL INVESTIGATOR AWARDS WITH THE GOAL OF HELPING THOSE INDIVIDUALS ESTABLISH THEIR RESEARCH CAREERS. WELL IT WAS NOT POSSIBLE TO ESTABLISH A CAUSAL RELATIONSHIP BETWEEN RECEIVING A GRANT AND CAREER SUCCESS. ASK WE DIDN'T MIND THAT. WE DID MEASURE MULTIPLE METRICS TO ASSESS OUR GRANTEES WERE ESTABLISHING SUCCESSFUL CAREERS AND WERE SPENDING TIME DEVOTED TO CLINICAL RESEARCH. THIS WAS A RECURRING PROGRAM AND WE WANTED TO BE SURE THAT OUTSTANDING INVESTIGATORS WERE BEING SUPPORTED AND WE WERE SUCCESSFUL IN KEEPING NEM IN CLINICAL RESEARCH. HOWEVER, SOMETIMES IT WAS NOT NECESSARY TO TRACK MULTIPLE FACTORS WHEN ASSESSING A PROGRAM. FOR EXAMPLE, A SMALL GRABT GRANTS PROGRAM THAT WE FUNDED THAT WAS TARGETED TOWARDS DEVELOPING LOW COST POINT OF CARE DIAGNOSTIC FOR AIDS CARE AND TREATMENT IN AFRICA AND OTHER LOW SOURCE REGIONS HAD TWO VERY STRAIGHT FORWARD METRICS. THE SHORT-TERM METRIC WE CARED ABOUT IS WHETHER WE INVESTIGATORS OBTAINED ADDITIONAL SUPPORT TO CONTINUE THEIR WORK AFTER OUR GRANT ENDED BECAUSE WE WERE INTERESTED IN SEATING FIELD AND WORKING ON THE DEVELOPMENT OF LOW COST DIAGNOSTIC AND OUR LONG-TERM METRIC IS VERY SIMPLE. WE FOCUSED ON WHETHER THE RESEARCH SUPPORTED BY THE PILOT GRANTS LEADING TO A VIABLE POINT OF CARE DIAGNOSTIC WE GAVE 10 GRANTS, KNEW IT WAS A HIGH RISK PROGRAM AND SO WE NEEDED TO GIVE, WE CHOSE TO GIVE MULTIPLE SMALL GRANTS. WE DIDN'T HAVE A LOT OF MONEY HOPING WE MIGHT HAVE A 10% SUCCESS RATE. AND IN FACT WE DID. ONE OF THOSE DIAGNOSTICS BECAME AVAILABLE NINE YEARS LATER. IN CONTRAST TO THE DIAGNOSTICS PROGRAM IN 2007 WHEN THE CHARITABLE FOUNDATION LAUNCHED THE LARGE INITIATIVE, WHICH FUNDED FIVE LARGE SCALE IMPLEMENTATION RESEARCH PROGEBS THAT WERE DESIGNED TO IMPROVE DELIVERY OF INTEGRATED PRIMARY HEALTHCARE BY REGIONAL HEALTH SYSTEMS IN ARCS FRICCA AND ALSO TO MEASURE OUTCOMES WE SPENT CONSIDERABLE RESOURCES TO FOR A DATA CENTER AND TO SUPPORT AN EXTERNAL EVALUATION TEAM. THIS IS STILL ONGOING SO NOT ALL PROGRAMS THEY REQUIRE THE SAME SORT OF ASSESSMENT. SOME PROGRAMS TAKE MUCH LONGER TO ASSESS THAN OTHERS. THERE'S NO ONE SIZE THAT FITS ALL. I'M SURE WE'LL HEAR MORE ABOUT THAT THAN THE OTHER ORGANIZATIONS. I DO WANT TO MENTION THAT I WAS EXCITED TO HEAR FROM ROGER GLASS AND NELSON COMBO AND THEY WERE JUST INDUCTED INTO THE NATIONAL ACADEMY OF SCIENCES WHEN I WAS AT THE DORIS INSTITUTE CHARITABLE FOUNDATION, WE THOUGHT OF THE PORTFOLIO AS HAVING TWO POTS, ONE OF THE SMALLER POTS WAS 20% AND VARIED OF TOTAL GRANT MAKING WE CALLED OUR HIGH RISK POT AND WE INVESTED A LOT OF THAT IN AFRICA AND BOTH OF THOSE WONDERFUL INVESTIGATORS RECEIVED OUR GRANTS AS WELL AS FOGARTY GRANTS SO IT'S FUN TO HEAR ABOUT THE SUCCESS OF OUR GRANTEES. NOW ADOPTED LIKE TO TAKE A PHO MINUTES TO TRY TO ADDRESS THE VERY PROVOCATIVE AND HARD QUESTIONS THAT THE SMRB SENT TO ME. I WAS VERY HAPPY TO LISTEN TO THE TALK THIS MORNING SO I'M NOT SO INTIMIDATED ABOUT THE DIFFICULTY OF ANSWERING THESE QUESTIONS FIRST OF ALL THE FIRST QUESTION WAS WHAT NIH GOES MATTER MOST TO YOU AND I THINK THE FIRST TWO ADVANCING KNOWLEDGE AND APPLYING UNCLE TO IMPROVE HEALTH OR THE TOP NIH GOALS, BUT THE OTHER GOALS THAT ARE ALSO CRITICALLY IMPORTANT AND CLOSELY RELATED BECAUSE YOU REALLY CAN'T HAVE ALMOST ONE WITHOUT THE OTHER ARE DEVELOPING AND SUPPORTING AND OUTSTANDING BLY BIOMEDICAL WORKFORCE CONTRIBUTING TO U.S. COMPETITIVENESS AND ECONOMIC GROWTH AND ALSO FOSTERING SCIENTIFIC AND HEALTH LITTERACY. THE NEXT QUESTION, THE NEXT TWO QUESTIONS DEALT WITH HOW TO COMMUNICATE NIH'S VALUE AND I PONDERED THIS FOR A LONG TIME AND --I CAME UP WITH BASICALLY COMPELLING EXAMPLES AS THE MOST POWERFUL APPROACH AND I FELT LIKE I SHOULD BE THINKING OF SOMETHING NEW BUT THERE ARE LOTS OF COMPELLING EXAMPLES I LISTED SOME OF THEM, SOME OF THEM ARE THINGS YOU ALREADY TALKED ABOUT, THERE IS NOTHING LIKE A FABULOUS STORY. THE QUESTION IS HOW YOU TELL IS AND WHO YOU TELL IT DO AND HOW YOU PACKAGE IT AND I THINK THERE ARE MANY HERE THAT ARE MUCH BETTER AT COMMUNICATING THINGS LIKE THAT THAN I AM. AND THEN THE LAST QUESTION, QUESTION FOUR HAD TO DO WITH MEASURES OF HEALTH AND THE VALUE OF THE WORK THAT NIH IS DOING AND I KEPT THINKING THIS IS REALLY, REALLY COMPLICATED SO MY BULLETS ON THOSE SLIDES SAY THAT MULTILE MEASURES NEED TO BE COLLECTED INCLUDING MEASURES THAT CAN BE RELATED TO ECONOMIC IMPACT AND OF COURSE PETER ORZAG'S TALK WAS INTIMIDATING ABOUT HOW WELL YOU CAN DO HA AND THEN WHATEVER MEASURES ARE CHOSEN AND LOOKED AT, THOSE MEASURES THIS BE SABLE TO LINK THE NEW KNOWLEDGE GAIN TO SPECIFIC HEALTH INTERVENTIONS AND THEIR IMPACTS AND I JUST LISTED A FEW OBVIOUS THINGS LIKE VACCINES AND OTHER THINGS. THE LAST BULLET, I THINK IS WORTH MENTIONING. I THINK IT'S ALSO IMPORTANT TO TRY TO CAPTURE HOW NIH CAN ADVANCE, THE PRACTICE OF EVIDENCE BASED MEDICINE AND EXAMPLES FOR THAT. AND HOW NIH ADVANCES CAN IMPROVE HEALTHCARE DELIVERY SO THAT ULTIMATELY, TO PARAPHRASE JEWELIO FRANK ONE CAN GET MORE HEALTH FOR THE MONEY IN THE UNITED STATES. I ALSO HAVE A NOTE TO CHALLENGE ON THE BOTTOM THAT OF COURSE THE FULL IMPACT OF NIH'S HEALTH CONTRIBUTIONS GETS LIMITED IF WE HAVE A POORLY FUNCTIONING HEALTH SYSTEM OR OTHER EXTERNAL FACTORS. WE CERTAINLY SEE THAT WITH THE HPV VACCINE THAT A GREAT VACCINE BUT OUR UPTAKE OF ACINATION IN THIS COUNTRY IS SUBPAR. SO WITH THAT I WILL STOP AND TURN IT OVER TO THE NEXT PERSON. [ APPLAUSE ] >> THANKS SO MUCH FOR THE INVITATION TO PRESENT TODAY EMPLOY IT HAS BEEN A FASCINATING DISCUSSION, I WANT TO PREFASMY COMMENTS BY POINTING OUT THAT ALL HRA MEMBER ORGANIZATIONS RECOGNIZE THAT CONE CYSTENT FUNDING FOR BIOMEDICAL RESEARCH--CONSISTENT FUNDING FOR BIOMEDICAL RESEARCH FOR NHIERARCHIES H IS IMPORTANT. THE NEED FOR CONSISTENT AND STUDILY INCREASING INVESTMENT IN BIOMEDICAL RESEARCH BY NIH IS ONE ISSUE ON WHICH OUR DIVERSE MEMBERSHIP CAN ABSOLUTELY AGREE WITH NO HESITATION. AS A MATTER OF FACT, THE MEMBER SHOULD WILL BE IN SUPPORT OF DR. FINEBERG'S FIVE YEAR ROLLING APPROPRIATION IDEA. WHEN HRA RECEIVED THE INVITATION TO ADDRESS THIS MEETING WE WERE ASKED DIFFERENT QUESTIONS THAN ELAINE WAS ASKED TO ADDRESS AND IT WAS ABOUT HOW FUNDERS OF BIOMEDICAL RESEARCH AND TRAINING EVALUATE THE IMPACT OF THEIR AWARD PROGRAMS AND THE VALUE OF BIOMEDICAL RESEARCH. I'LL BE PROVIDING AN OVERVIEW OF SOME OF THE PUBLISHED STUDIES THAT EVALUATE THE OUTCOME OF THE AWARD PROGRAMS THAT OUR MEMBER ORGANIZATIONS AND COLLABORATIVE WORK THAT OUR MEMBER ORGANIZATION VS ENGAGED IN TO TWEP A COMMON APPROACH TO UNDERSTANDING AND DOCUMENTS THE VALUE OF THOSE PROGRAMS AND THEN CARL RHODES, AND MARIE NIERRAS WILL DISCUSS THE IMPACT OF ENVIRONMENTAL RESEARCH. >> OOH THAT'S SMALL, SORRY ABOUT THAT, THE HEALTH RERESEARCH GREW OUT OF COLLABORATION OF 15 OR SO FUNDERS THAT STARTED AROUND 1998. THE ORGANIZATION WAS FORMALLY CREATE INDEED 2005. DEVELOPED GOVERNANCE AND MEMBERSHIP STRUCTURES IN 2006 AND NOW HAS 55 MEMBER ORGANIZATIONS. ELAINE GAL AN WHOM YOU JUST HEARD FROM WAS A FOUNDING HRA BOARD NUMBER AND ALSO HAPPENS TO BE THE PRINCIPLE ARCHITECT OF THIS MISSION STATEMENT THAT YOU SEE BEFORE YOU. ALL HRA ORGANIZATIONS SHARE AN INTEREST THE ENTIRE CONTINUUM OF BIOMEDICAL RESEARCH AND WANT TO SEE THE INVESTMENT OF THE RESEARCH HAD THE GREATEST IMPACT POSSIBLE. HRA HAS A NUMBER OF STRATEGY LIST OFFICE OF DIVERSITY THIS SLIDE AND ONGOING ACCYSTS TO ACHIEVE HIS MISSION BUT I WANT TO MENTION ONE IN PARTICULAR HERE BECAUSE OF ITS RELEVANCE TO THE ISSUE AT HAND, ONE OF THE DRIVING FORCES THAT ENCOURAGE THE FORMATION OF THE ALLIANCE WAS THE ABSENCE OF AN ONGOING RESOURCE TO DOCUMENT THE CONTRIBUTIONS OF NONGOVERNMENTAL FUNDERS TO RESEARCH AND TRAINING. NIH HAD CRISP AND THEN REPORT, IF SOMEONE WANTED TO KNOW ABOUT WHAT NONGOVERNMENTAL SUPPORTERS IN A FIELD OR DISEASE AREA, THEIR ONLY RESOURCE WAS TO DIG THROUGH A LOT OF WEB SITES AND ANNUAL REPORTS. PUBLISHED STUDIES THAT ATTEMPTED TO DESCRIBE THE ENTIRE LANDSCAPE OF BIOMEDICAL FUNDING HAD TO RELY ON DATA FROM SMALL AND LESS THAN REPRESENTATIVE SAMPLES, TO DESCRIBE THE CONTRIBUTION CONTRIBUTIONS OF PRIVATE FUNDERS. HRA BUILD THE GRANTS IN THE HEALTH RESEARCH SHARED PORTFOLIO DATABASE, CONTAINING DATA ABOUT PEER REVIEW GRANTS AWARD BY H RA MEMBER ORGANIZATIONS INCLUDING A LOT OF INTERESTING DATA ABOUT INVESTIGATORS. KEY RESULTS FROM THE FIRST FORMAL ANALYSIS OF GRANTS DATA WERE PUBLISHED IN THE ARLOF THE JOURNAL OF ACADEMIC MEDICINE A YEAR AGO AND PREPARING FOR SECOND ANALYSIS NOW. WE HOPE THATEB EVENTUALLY THE DATABASE WOULD HELP US CONTRIBUTE A FEW PIECES OF THE PUZZLE TO BETTER DOCUMENT THE DOCUMENT OF FUNDED RESEARCH. AS I MENTIONED HRA ORGANIZATION SHARE AN INTERESTED IN THAT ENTEAR CONTINUUM AND BECAUSE OF THAT AS YOU MIGHT EXPECT THE MEMBERSHIP HAS THE DIVERSITY OF OF FUNDING RESEARCH AS YOU HEARD FROM ELAINE IN TERMS OF THE TOTAL LANDSCAPE OF MEMBERS, WE HAVE PRIVATE FOUNDATIONS DISEASE SPECIFIC PUBLIC CHARITIES THAT USEED APPROACHED--USE THOSE APPROACHES. I WANT TO SHARE WORK OUR ORGANIZATION VS DONE TO ASSESS WHETHER RESEARCH, TRAINING/CAREER DEVELOPMENT AWARD PROGRAMS ARE MEETING THEIR GOALS HRA ORGANIZATION VS STRUGGLE WIDE THIS CHALLENGE FOR YEARS AND IN ADDITION TO THE EFFORTS OF INDIVIDUAL ORGANIZATIONS I'LL SHARE WITH YOU, THEY ATTEMPTED TO CREATE A COMMON ROADMAP OF HOW TO ADDRESS CONTRARY DEVELOPMENT AWARD FOR APPROXIMATION SCIENTISTS. IN THE ANALYSIS OF GRAPHS DATA I MENTIONED,Y LEARNED THAT RESEARCH PROJECT AND 30% DEVOTED TO CAREER DEVELOP AND WANT TRAINING AWARDS. THIS IS AN IMPORTANT AREA FOR OUR ORGANIZATION. HRA MEMBERS HAVE LONG DISCUSSED COMMON CHALLENGES AND EVALUATING AWARD PROGRAMS AND THESE ARE ALL THINGS WE'VE HEARD TODAY, LENGTH OF THE TRANSLATION LAGS, THE SECOND CHALLENGE FOLLOWING LOGICALLY FROM THE FIRST AND THE INCREMENTAL NATURE OF THE RESEARCH PROCESS IS THE DIFFICULTY OF ATTRIBUTING SUCCESS. TO ONE SPECIFIC AWARD OR FUNDING STREAM. IF TRULY DOES TAKE A VILLAGE TO NURSE A CLINICAL IDEA FROM CONCEPT TO CLINICAL APPLICATION OVER A NUMBER OF YEARS. MORE SPECIFICALLY RELATED TO ASSESSING IMPACT OF RESEARCH TRAINING PROGRAMS. THE EVALUATION ISSUES THAT HAD HRA ORGANIZATIONS NIGHITION MORE THAN ANY OTHER IS IDENTIFYING AN APPROPRIATE COMPARISON GROUP. MOST STUDYING USED THE TIER GROUPS AND FEW HAVE TEAMED TO MATCH THEIR AWARDEES FROM OTHER AWARDEES FROM ORGANIZATION WHICH IS CREATES THE NEW SET OF CHALLENGES. I WILL TALK ABOUT FEW OF THOSE IN THE NEXT SLIDE. BUT THE COMPARISON ISSUE HIGHLIGHTS THE DIFFICULTY IN DISENTANGLING THE SELECTION OF THE BIAS. IF THE COMPARISON GROUP IS THE HIGHEST TIER OF UNSUCCESSFUL APPLICANTS APPLICANTS AND DEFICIENCY IN OUTCOMES, WHAT IS ACCOUNTED FOR THAT DIFFERENCE. THOSE WHO WERE SELECTED AND DIFFERENT FROM THE NEXT TIER IN SOME WAY ARE THE DIFFERENCE IN OUTCOMES MEANING SUCCESSFUL REGARDLESS OF RECEIVING THE AWARD. MEANING YOU JUST CONFIRMED SLEEKING THE BEST AND BRIGHTEST? SORE DID THE AWARD ITSELF MAKE A DIFFERENCE. FUNDS THAT PERMITTED RESEARCH OR OTHER CHARACTERISTICS OF THE AWARD SUCH AS M-TEBURKEULOSEIS MENTORING, PROTECTED TIME FOR RESEARCH OR SPECIFIC OPPORTUNITIES. SEVERAL HRA ORGANIZATIONS HAVE CRUELTIED DO THE PUBLICKED EVALUATION LITERATURE, SPECIALLY WITH RESPECT TO CAREER DEVELOPMENT AWARD. THE APPROACH USED BY THE SCHOLAR AWARDS PROGRAM AT THE MARCH OF DIMES USED THE GROUP AT UNSUCCESSFUL APPLICANTS AT THE SAME PROGRAM AND THEY USE THOSE PROXY OUTCOME MEASURES, SCIENTIFIC PRODUCTIVITY AS IDENTIFIED BY PUBLICATIONS AND CITATIONS AND RESEARCH SUPPORT INSTITUTIONAL PRESTIGE AND STATUS AND REMAINING RESEARCH. HERE'S ADDITIONAL SAMPLES FROM OTHER HRA ORGANIZATIONS AND PRODUCTIVITY TO THE NUMBER OF PUBLICATION AND CITATIONS IN A COHORT OF AWARDEES AND THEY WELCOME FUND TOOK A SLIGHTLY DIFFERENT APPROACH IN THE FIRST STUDY PUBLISH INDEED 2,000,003, THEY EXAMINED THE SUCCESS OF THE BRIDGING AWARD, THE CAREER AWARDS AND THE BIOMEDICAL SCIENCES PROGRAM USING FOLLOWING INDICATORS OF ESTABLISHING AN INDEPENDENT RESEARCH CAREER. CURRENT FACULTY POSITION, POSITION, TIME ON RESEARCH, EXTRACTION OF EXTERNAL GRANT SUPPORT, PUBLICATIONS AND CITATIONS, RATHER THAN USING A AND AND REINTONESES TO ANNUAL SURVEY OF CAPS AWARD SEES CONDUCTED EVERY YEAR IN 1997, THEN IN 2008 THEY ATTEMPTED TO EXAMINE THE CAUSAL EFFECTS OF THE PROGRAM, THIS TIMANNIZING AGAINSTARS WARDEES USING THE GROUP OF SCORE THE THREE SUCCESSFULLY MORE COMPETITIVE CLUSTERS OF UNSUCCESSFUL APPLICANTS EVEN THOUGH PROPENSITY SCORE ANALYSIS IS A SOPHISTICATED TECHNIQUE USEDDED TO CONTROL THE INFLUENCE OF CONFOUNDINGLY VARIABLES ON THE ESTIMATES OF CAUSAL EFFECT, THE AUTHORS CONCLUDE THAT IT'S NEARLY IMPOSSIBLE OF SELECTION BIAS FROM EFFECTS. IS THE INDEED PUBLISH INDEED THE FALL OF THE JOURNAL OF ACADEMIC MEDICINE. THEY EXAMINED CHARACTERISTICS AND CLINICAL SCIENCE AND SCIENCE DEVELOPMENT APART WHICH SUPPORTS EARLY TV SCIENTISTS TO INDEPENDENT SEARCH CAREERS AND THE COMPARISON GROUP THEY AUGMENT THAD AS A COMPARISON GROUP HIGHER THAN THE PERCENTAGE FOR ALUMNI, THE DID RECOGNIZE THE BIAS NOTING THE SUCCESS BY THE CHARACTERISTICS OF THE AWARD PROTECTED TIME NETWORKING TIEWPT OR THE SELECTION OF BESTS AND BRIGHTEST WHO SUCCEEDED REGARLESS OF THE AWARD AND FUND CAREER DEVELOPMENT AWARDS SCIENTISTS JOIN FORCES TO DEVELOP A LODGESSIC COMMON TO PROGRAMS ITS AND PROGRAM RESOURCES AND ACTIVITIES AND THE CHANGES AND RESULTS YOU HELP TO ACHIEVE WITH THE PROGRAM. WE'VE HEARD FROM DIFFERENT AREAS TODAY IT'S BEST TO START BACKWARDS AND AGREED UPON FOR SHORT-TERM, MIDTERM AND LONG-TERM OUTCOMES MAY BE INTEREST IN OW CURRENT DISAND TARGET POPULATION AND IMPROVED CLINICAL PRACTICE AND UMPIRES PROVE ABILITY TO DIAGNOSE AND TREAT BUT THEY'REOT FAR RIGHT HAND SIDE IN THE YELLOW THE NEXT OUTCOME, THE NEW THERAPEUTICS AND DIAGNOSTICS INCREASED LEVEL FOR PRODUCTIVITY AND IN THE MIDTERM OUTCOMES AND FOR THE RESEARCH AND INTERNAL ADVANCEMENT INICATORS AND--INICATORS AND FINALLY I WANT TO LEAVE YOU WITH THIS, RESPECTABLE RESEARCH TRAINING PROGRAM AND CONSENSUS EVOLVED AND THIS WILL SOUND LIKE THE SERENITY PRAYER. TO ACCEPT THAT WE WILL NEVER BE ABLE TO FULLY DISENTANGLE THE SUCCESS OF THE BEST STUDENTS OR CHARACTERISTICS OF THE RESEARCHER AWARD ITS, ACCEPT THAT WE WILL NEVER BE ABLE TO ATTRIBUTE SUCCESS WITH FULL CERTAINTY BUT THAT WE DO NEED TO MONITOR AND TRACK AWARDEES TO INSURE THAT THEY'RE DOING WHAT THEY PROMISE TO DO AND WE DO NEED TO IDENTIFY ACCEPTABLE PROXY MEASURES FOR OUTCOME AND IMPACT AND WITH THEY WILL TURN THIS OVER TO CARL. [ APPLAUSE ] >> THANKS FOR HAVING US TODAY, AFTER HEARING CADES TALK I FEEL AS IF WE'RE GOING FROM THE COSHONDURAS MIC TO THE OTOMIC BECAUSE--COSMIC TO THE ATOMIC BECAUSE HHSMI IS IN DIDN'T CONTEXT BUT I WOULD LIKE TO TELL YOU ABOUT HOW MANAGE OUR FLAGSHIP PROGRAM AND HOW WE CARRY OUT EVALUATION. AND I'M GOING TO GO INTO SOME--HOPEFULLY NOT TOO MUCH DETAIL BUT SOME DETAIL ON THAT. AS SOME OF YOU KNOW, HOWARD HUGH SYSTEM NOT EXACTLY A FOUNDATION IT'S A MEDICAL RESEARCH ORGANIZATION AND THE MISSION WHICH WAS ACTUALLY WRITTEN BY HOWARD HUGHES MANY YEARS AGO, I BELIEVE 1953, A SCIENCE PHILOSOPHY WHOSE MISSION IS TO ADVANCE BIOMEDICAL WERE AND SCIENCE EDUCATION FOR THE BENEFIT OF HUMANITY. SINCE 2003. WE CAN START AT THE BOTTOM, OUR CURRENT ENDOWMENTMENT IS AROUND 16 BILLION DOLLARS, IT'S REMAINED RELATIVELY CONSTANT IN TERMS OF DOLLARS OVER THE PAST TWO OR THREE YEARS AND IN REAL DOLLARS IT'S DOWN SOME EXTENT. I SHOULD ALSO MENTION WE'RE CURRENTLY ON A THREE YEAR BUDGET PLAN, WE'RE ALL HOPING IT MIGHT BE INCREASED SLIGHTLY, DEPENDING ON WHAT HAPPENS IN THE NEXT YEAR OR SO BUT WE'RE UNDER A BIT OF RESTRICTION ON WHAT WE CAN DO RIGHT NOW. SINCE 2003. IN RESEARCH AND SCIENCE EDUCATION WE SPENT ABOUT 7.1 BILLION DOLLARS. IN 2012 OUR AND WERE RESEARCH SUPPORT THAT'S PRIMARILY OUR INVESTIGATOR PROGRAMS, WE SPENT ALMOST 700 MILLION DOLLARS AND THEN IT WAS ANOTHER 114 OR 15 MILLION FOR SCIENCE EDUCATION AND INTERNATIONAL RESEARCH. NOW THERE WAS A REMARK ABOUT HAVING A BOARD AND HOW IT MIGHT BE POSSIBLE TO PURSUEDE THEM TO MOVE IN CERTAIN DIRECTIONS? IF YOU LOOK SOME OF YOU KNOW THE MEMBERS OF THIS BOARD AND WE ALMOST OPERATE ON THE PRINCIPLE THAT ANY MAJOR DIRECTION WE WANT TO MOVE IF AND THE THOUGHT ABOUT, WE LIKE TO WORK SO THE BOARD OF TRUSTEES THINKS IT'S THEIR IDEA. MANY OF YOU HAVE TRIED TO PRACTICE THAT AND WE'VE BEEN REASONABLY ACCESSIBLE IN THAT, AND THE BOARD OF TRUSTEE SYSTEM CONCERNED AND A COUPLE OF IMMINENT SCIENTISTS, JOE AND PAUL, DAVE AND RICHARD. BUT OTHER WHO IS WILL BE PRIMARILY PAYING ATTENTION TO THE WAY THAT OUR BUDGET AND ENDOWMENT IS SOMETHINGED. OUR LEADERSHIP BOB TEAGEAN HAS BEEN US WITH FOR THREE YEARS, AND GERRI RUBEIN WHO DIRECT OURS PHARMA CAMPUS AND HAS BEEN WITH US SINCE 2000. WE HAVE A NEW VICE PRESIDENT REPLACING JACK SIXON WHO--DIXON WHO RETIRED RECENTLY AND WE HAVE ERIN AND SEAN WHO ARE HHMI INVESTIGATORS AND THEY OBLIGATIONSERATE LABORATORIES, AS DOES BOB BUT THEY SPEND MOST OF THEIR TIME IN THE ADMINISTRATION AND LEADERSHIP FOR OUR VARIOUS DEPARTMENTS. AND THE OTHER IMPORTANT GROUP AS FAR AS HELPING US REVIEW OUR POLICIES AND COMING UP WITH NEW TYPES OF INITIATIVES. THIS IS OUR MEDICAL ADVISORY BOARD, A NUMBER OF SENIOR PEOPLE, MOST OF THEM VERY WELL KNOWN AND I SHOULD ALSO SAY, ASILE MENTION LATE OR, THEY PARTICIPATE IN REVIEWS AS I'LL SAY WE HAVE FOUR REVIEW SESSIONS PER YEAR FOR INVESTIGATORS AND WE ASK THE MEMBERS OF THE BOARD TO BE WITH US ON THESE SESSIONS AND THEY'RE DIRECTLY REINTEGRATED SERVICES VOLVE INDEED THE REVIEWS AND THE FACT THAT THEY ATTEND THESE ANYWHERE FROM 50 TO SEIVET REVIEW SESSIONS A YEAR AND HELPS US INSURE CONSISTENTY IN THE REVIEW PROCESS. SO AMONG OUR REVIEW PROCEDURES ARE PEER REVIEWER SPEC SCIENTISTS AND WE OPENED UP A RESEARCH SCIENTIST THAT DEALS WITH NEUROSCIENCE OR AND IMAGING. THAT'S HOW THE IN LOUDEN AND LEES BURG AND THEY INCLUDE THE CONSTRUCTION OF A BUILDING IN DURBIN SOUTH AFRICA FOR INVESTIGATOR WHO IS ARE STUDYING THE INTERACTION BETWEEN HIV AND DRUG RESISTANTS TUBERC CLOSEIS AND THEN AS I SAID--TUBERCULOSIS AND THEN AS I SAID WE HAVE CONSIDERABLE EFFORT IN SCIENCE RANGING FROM FUNDING RESEARCH PROGRAMS AT SMALL COLLEGES AND RESEARCH INSTITUTIONS AND BEGINNING A VENTURE INTO CREATING FILMS FOR PUBLIC EDUCATION. SO OUR PROGRAM, I THINK SOME OF THE LEGEND IS LOST THERE SO I'LL SAY THAT--LET'S SEE, NO IT'S NOT, BETTER THAN I THOUGHT. PEOPLE NOT PROJECTS. I WANT TO EMPHASIZE THAT ONCE WE MAKE THE DECISION TO HIRE AN INVESTIGATOR AND I SHOULD SAY INVESTIGATORS BECOME OUR EMPLOYEES, THEY BECOME A HOST OF THE FACILITY BUT WE PAY SALARY AND THEY ARE BE IN OUR LABORATORIES AND ARE FUNDED BY AN HHMI AWARD. SO FOR THE MOST PART WE'RE INTERESTED IN FINDING THE BEST PEOPLE AND ALLOWING THEM A LOT OF FREEDOM TO PURSUE WHAT PROJECTS THEY WOULD LIKE TO DO. AND IT'S ALMOST AS IF LET'S SAY IF YOU HAVE AN IDEA FOR DOING SOMETHING NEW RELATED TO WHAT YOU ARE DOING ALREADY OR SOMETHING ELSE, MY OWN--THE SCIENTISTS THAT I'M RESPONSIBLE FOR AND THE NUMBER OF PLACES DON'T HAVE TO CALL ME AND ASK ME IF THERE'S--IF THEY CAN SWITCH TO ANOTHER PROJECT OR IN ANOTHER DIRECTION. IT'S USUALLY AN EXTENSION OF WHAT THEY'RE DOING ALREADY. BUT AS LONG AS THEY CAN DO THAT WITHIN THE BUDGET THAT WE GIVE THEM WE ARE WILLING TO DO THAT, ALL I WE WILL DO REMIND THEM THEM NAIN FIVE YEARS THEY WILL BE REVIEW. WE ARE INTERESTED IN THEIR ATTEMPTS TO MAKE TRANSFORMING DISCOVERIES. HIGH RISK PROJECTS ARE OFTEN EMBARKED UPON BY OUR INVESTIGATORS, HOPEFULLY SOME WILL YIELD A HIGH REWARD, NOT ALL OF THEM AND WE ARE VERY FLEXIBLE IN HOW THEY CAN USE THEIR FUNDING WHICH MOST OF OUR INVESTIGATORS, NOT ALL OF THEM WOULD AGREE IT'S GENEROUS FUNDING. SO OUR GENERAL FUND IS 650 MILLION DOLLARS A YEAR. SALARIES, OCCUPANCY COST TO THE INSTITUTION AND A RESEARCH BUDGET AMOUNT ABOUT 1.4 MILLION PER INVESTIGATOR PER YEAR. INDIVIDUAL AMOUNTS MAY VARY. WE HAVE A FEW OTHERS TO BE APPOINT THD YEAR DEPENDING ON HOW WELL WE CAN CORKS SIGN COLLABORATIVE AGREEMENTS WITH NEW INSTITUTION. WE HAVE 40 EARLY YEAR SCIENTISTS THAT, OR SIX-YEAR NONRENEWABLE TERMS BUT ALL ARE ELIGIBLE AT ONE TIME OR ANOTHER TO APPLY IN A GENERAL COMPETITION WHICH ENABLES APPOINTMENTS THAT ARE FIVE YEARS AND AND RENEWABLE AND THERE ARE 41 LABORATORY GROUPS THAT ARE ON FIVE YEAR APPOINTMENTS AND REVIEWED IN MUCH THE SAME WAY. OUR HOST INSTITUTIONS ARE ALL AROUND THE COUNTRY, MANY ARE AS YOU IMAGINE CONCENTRATED IN THE NORTHEAST AND WEST COAST. BUT WE HAVE A NUMBER OF SITES ALL OVER. A TOTAL RIGHT NOW IS 70 HOST INSTITUTIONS AND BY THAT WE MEAN THAT THERE'S AT LEAST ONE INVESTIGATOR WHO IS ON THE FACULTY AT THAT INSTITUTION AND IT'S THEIR INSTITUTIONS WITH WHICH WE SIGN COLLABORATIVE AGREEMENTS. SO I MENTIONED PEOPLE AND NOT PROJECTS EARLIER. WE WANT THEM TO FEEL THAT THEY CAN BE CREATIVE AND HAVE A RESPONSIBILITY TO GO AFTER RISKY BUT HIGH IMPACT QUESTIONS. WE ASK THEM TO SPEND 75% OF THEIR TIME ON RESEARCH, THEY ALSO CAN TAKE ON OTHER DUTIES FROM OTHER DUTIES IN THEIR DEPARTMENT OR SCHOOL OR UNIVERSITY AS WELL AS THEY CAN DO CONSULTING UNDER RELATIVELY STRINGENT RULES FOR THAT SORT OF THING. >> WE PROVIDE ADMINISTRATIVE LEGAL, OPERATIONAL AND SCIENTIFIC ASSISTANCE. WE HAVE ABOUT A HUNDRED PEOPLE IN THE FIELD INCLUDING OUR MANAGERS OF ADMEN ADMINISTRATIVEBœ SERVICES, PURCHASING, HR ISSUES AND OTHERS TO LOOK AT AND HELP WITH THE INTERACTIONS WITH THE HOST INSTITUTIONS. AND AS I MENTIONED BEFORE, WE PROVIDE A COMPLETE SALARY AND BENEFITS FOR INVESTIGATORS AND OTHER EMPLOYEES. WE GIVE THEM RELATIVELY GENEROUS BUDGETS AND SOMETHING THAT IS BECOMES MORE IMPORTANT FOR THEM WE HAVE ABOUT 40 MILLION DOLLARS THAT WE CAN USE EACH YEAR FOR EQUIPMENT. SO FOR MAJOR SCIENCE AND PURCHASES OF SCIENTIFIC EQUIPMENT, ANYTHING IN ACCESS OF $15,000, THEY WOULD WRITE A JUSTIFICATION AND WE WILL CONSIDER FUNDING FOR THOSE DEVICES AND MANY INVESTIGATORS IT PLACES LIKE YALE FOR EXAMPLE, WILL DECIDE TO SHARE--WILL BE ENCOURAGED AND WILL OFTEN DECIDE TO SHARE THESE EQUIPMENT PIECES OF EQUIPMENT AND IN MANY CASES WE WILL ALSO SHARE THE COSTS WITH A HOST INSTITUTION AS WELL. THE OTHER THING I SHOULD MENTION EACH INVESTIGATOR IS ASKED TO ATTEND A SCIENTIFIC MEETING. WE HAVE SEVEN OF THOSE EVERY YEAR AND ABOUT HALF OF THEM WHO ARE ATTENDING GIVE SHORT TALKS ABOUT THEIR WORK. MANY OF THEM WOULD LIKE TO TALK ON THE FIRST DAY AND THEY GOT A LOT OF RESPONSE AND OTHER INVESTIGATOR WHO IS HEAR THEM, THEY ALSO BREAKA GRADUATE STUDENT AND A POST DOC OR A POSTDOCTORAL FELLOW TO THE MEETING SO THESE LESS EXPERIENCED OR YOUNGER I SHOULD SAY INDIVIDUALS GOT A CHANCE TO INTERACT WITH INVESTIGATORS AND OCCASIONALLY I WILL SEE SOMEONE WHO IS I PREDOCTORAL STUDENT AND A HUGHES LAB WHO COMES BACK TWO OR THREE YEARS IN A POST DOC IN ANOTHER HUGH'S LAB O THERE'S REALLY A GREAT STUDENT FOR INTERACTION AT THOSE MEETINGS. SO WHAT'S HAPPENED DURING THE LIFE OF THE INVESTIGATOR PROGRAM? WE. >> WE HAVE A LARGE NUMBER OF NOBEL LAUREATES AND I HAVE TO SAY IN FAIRNESS THAT ALL OF THESE INVESTIGATOR WHO IS WON THE NOBEL PRIZE WERE SUPPORTED BY HHMI, BUT THEY WERE ALSO CERTAINTIED BY NHIERARCHIES H, WHETHER THEY'RE IN INSTITUTIONS OR ORGANIZATIONS AND OTHERS SO WE DON'T FEEL WEEK CAN TAKE FULL CREDIT FOR THAT. IN FACT, I THINK NIH GIVES A LOT OF CREDIT FOR MAKING THESE INDIVIDUALS ELIGIBLE FOR OUR COMPETITION BECAUSE WE GENERALLY TART WITH PEOPLE WHO HAD ABOUT FIVE, 10, 15 YEARS OF EXPERIENCE. SO WE'RE PROUD TO ADVERTISE THESE WINNERS, WE HAD TWO OR THREE FOR THE MEDICINE AWARD, RANDY AND TOM ALONG WITH JIM. JIM HAPPENS TO BE ONE OF OUR SCIENTIFIC REVIEWERS SO WE'RE PROUD TO CLAIM HIM AS WELL AND THERE ARE SIX OTHER INVESTIGATOR WHO IS WON THE NOBEL PRIZE BUT ARE NO LONGER HUGHES INVESTIGATORS. WE HAVE A LARGE NUMBER OF THE MEMBERS OF THE NATIONAL AKD--SALLY ME. I CREATE THD SLIDE LATE LAST WEEK AND SINCE THEN, I BELIEVE SIX OF OUR VOTERS ARE NOW MEMBERS OF THE INSTITUTE OF MEDICINE BECAUSE THEY MAKE APPOINTMENT THIS IS YEAR. SO THERE ARE--WE ALSO LOOK AT OTHER ACHIEVEMENTS, A NUMBER OF INVENTIONS THAT HAVE BEEN CREATED OR DEVELOPED BY INVESTIGATORS, A NUMBER OF INVOLVED IN START UP COMPANIES AND THIS IS ACTUALLY DATA THAT'S A BIT OLDER, A LARGE NUMBER OF PATENTS, WE SHARE IN PATENT APPLICATION BAH WE TURNOVER THE INTELLECTUAL PROPERTY AND TRRL TRANSFER AGREEMENTS AND A HOST OF OTHER INSTITUTIONS. SO LET ME TALK BRIEFLY ABOUT THE REVIEWS, CAN YOU DO IT A LITTLE FASTER SO WE ARE TIME FOR EVERYBODY. SO--SO THESE ARE THE CRITERIA, I WILL NOT READ THROUGH THIS BUT THESE ARE THE RITERRIA THAT WE USE--KRIST FERIA WE USE WHEN AN INVESTIGATOR COMES UP FOR REVIEW EVERY FIVE YEARS. WE WANT THEM TO IN THE JUDGMENT OF REVIEWERS TO MEET A NUMBER OF THESE KRIST TERYARKS SIGNIFICANT QUESTIONS, GOING INTO NEW AREAS, FORGING LINKS BETWEEN BIOLOGY AND MEDICINE AND THEN WE WOULD LIKE TO KNOW ABOUT FUTURE CONTRIBUTION IN A GENERAL WAY BUT WE DON'T ASK FOR SPECIFIC AIMS OR GOALS. THEY REVIEWED EVERY FIVE YEARS, MEMBERS OF OUR SCIENTIFIC REVIEW BOARD, MEDICAL ADVISOR BOARD AND ADHOC SCIENTISTS ARE ON THE REVIEW PANEL, WE DON'T ASK OUR OWN INVESTIGATORS TO PARTICIPATE IN THE VERMEN INFECTED VIEW. WE HAVE A NUMBER OF GENERALISTS AND A NUMBER OF SPECIALISTS AS WELL. SO THESE ARE THE MATERIALS THEY SUBMIT IN ADVANCE OF THE REVIEW MEETING. SOME OF THE THINGS YOU WOULD EXPECT, ONE THAT'S A BIT UNUSUAL AND SOME OF YOU KNOW HAROLD VARMIS KNOW ABOUT THIS, I THINK, THIS HAS TO DO WITH HAVING THEM SIB MITT THE PUBLICATION THAT THEY'VE GENERATED DURING THE CURRENT APPOINTMENT AND TERM AND THAT'S VERY IMPORTANT WE THINK FOR REVIEWERS THAT'S GENERALLY ONE OF THE FIRST THINGS THEY LOOK AT. THEY COME TO CHEVY CHASE FOR RESEARCH PRESENTATION, QUESTIONS AND DISCUSSION. THE PANEL IS AN ADVISORY PANEL. THE DECISION IS MADE BY THE DEPARTMENT OF THE PRESIDENT BECAUSE IT'S AN EMPLOYMENT. SUCCESS EMPLOY REVIEW, A FIVE YEAR TERM, THAT'S RENEWABLE AND A NONRENEWABLE APPOINTMENT WHEN THE COMMITTEE UNABLE TO MAKE POSITIVE RECOMMENDATION THEY GET A TWO YEAR TERM AND THEN THIS SHOWS THE GENERALLY RUNNING AT ABOUT 80% SUCCESS PER YEAR THE MOST RECENT YEAR WAS UP A LITTLE BIT OR DOWN IN TERMS OF SUCCESS. WE'RE NOT SURE WHETHER THAT'S SIGNIFICANT OR NOT. THAT WAS AN AWN USUAL YEAR BUT CAN YOU SEE OVER THE PAST 12 YEARS, THE NUMBER OF INVESTIGATORS WHOSE TERMS WERE TERMINATED IS ABOUT 20%. >> A LITTLE BIT OF DATA ON THE HHM PRRD THE TWOOT LEFT ARE PALMER AND RIDER ON THE RIGHT END. THE AVERAGE IS SOMEWHERE BETWEEN 10 AND 15 YEARS AND YOU NOTICE THAT RECENTLY WE ARE HAVING INCREASEDDED THE PERCENTAGE OF WOMEN IN THE--IN THE COHORT. ASK I'LL SAY ONE THING ABOUT COMMUNICATIONS. WE HAVE A GREAT STAFF ABLE TO WRITE UP THESE ACHIEVEMENTS THAT OUR INVESTIGATORS HAVE AND THIS IS A RECENT ONE WHICH WE THINK EVENTUALLY WILL BE APPLICABLE IS FROM A BASIC STUDY BY CHRISTINE SIDE MAN AND HER HUSBAND AND WE THINK IN THE LONG RUN IT'LL HAVE PRACTICAL APPLICATIONS. THANK YOU. >> MARIE YOU'RE NEXT. >> THANK YOU VERY MUCH FOR THE INVITATION TO SPEAK TODAY, WE APPRECIATE ALL THE PEOPLE CLOSELY SOABTED WITH THE NIH. I'M HAPPY TO MAKE THIS PRESENTATION TODAY. THIS IS BY WAY OF INTRODUCTION TO THE JDRS, THE JDR INFORMATION IS TO FIND A CURE FOR TYPE ONE DIABETES AND IT'S COMPLICATIONS THROUGH THE SUPPORT OF RESEARCH. WE ARE NOW 40 + YEARS OLD AND SINCE OUR INCEPTION, WE HAVE RAISED MONEY EVERY YEAR, WE HAVE SUPPORTED RESEARCH, THE BEST RESEARCH TO FIND A CURE FOR TYPE ONE DIABETES AND IT'S COMPLICATIONS WHEREVER THAT RESEARCH IS, IN THE LAST FUNDING YEAR 2012, WE PROVIDED A 110 MILLION U.S. DOLLARS IN DIRECT SUPPORT FOR RESEARCH IN 18 COUNTRIES. JDRF HAS A HISTORY OF PARTNERING WITH DIABETES, STAKED HOLIERS, PATIENTS, GOVERNMENT, INDUSTRY, REGULATORY AGENCIES ISSUES, ET CETERA WE HAVE PARTNERED WITH--WE ARE STRONG PARTNERS WITH THE NIH. WE PARTNER WITH NIH LIKE ORGANIZATIONS OUTSIDE OF THE U.S. WE ALSO PARTNER WITH OTHER DIABETES SPECIFIC FOUNDATIONS LIKE THE EUROPEAN FOUNDATION FOR THE STUDY OF DIABETES. WE HAVE PARTNERS WITH LARGER FOUNDATIONS WITH BROADER MISSIONS LIKE THE WELCOME TRUST, WE ARE. WE HAVE ALWAYS BEEN AT JDRF ACTIVE ADVOCATES FOR RESEARCH FUNDING INCLUDING FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH, WE'RE ALSO ADVOCATES TO AND REGULATORY AGENCIES IN THE U.S. AND OUTSIDE OF THE U.S. FOR AND ON BEHALF OF OUR CONSTITUENTS WHO ARE ALL THE PEOPLE WHO HAVE TYPE ONE DIABETES AND THE PEOPLE WHO CARE FOR THEM JDRF STRATEGY AFFECTS EVERYONE IN ALL PHASES OF THE DISEASE. THIS IS A NATURAL HISTORY CHART OF THE DISEASE AND IT GIVES YOU THE MAIN STRATEGIC GOALS OF THE FOUNDATION WHICH ARE TO FIND A CURE OF COURSE BUT ALSO TO PREVENT THE DISEASE AS WELL AS TO TREAT AND PREVENT THE COMPLICATIONS OF DIABETES. SO ONE OF THE QUESTIONS THAT WAS ASKED WAS HOW DOES OUR ORGANIZATION SET ITS GOALS? WE INTERPRETED THAT AS THREE PARTICULAR THINGS, AND MECHANISMS AND PROVIDING FUNDING AND I WILL SAY THAT FROM--SINCE JDRF WAS FOUNDED BY VOLUNTEERS BY PEOPLE WHO HAD TYPE ONE DIABETES AND THEIR FAMILY MEMBERS, VOLUNTEER VS ALWAYS PLAYED AN IMPORTANT ROLE IN THE FOUNDATION, THEY PROVIDE INPUT INTO WHAT RESEARCH PRIORITIES SHOULD BE SHOULD BE DEVELOPED EACH YEAR AND THEY ARE ALSO THE FINAL ARBITER OF WHAT THE FOUNDATION FUNDS. SO WHILE AT THE FOUNDATION ALL APPLICATIONS MIRROR IMAGEICATION GUESS THROUGH EXTERNAL SCIENTIFIC PEER REVIEW, THE FINAL FUNDING DECISION IS MADE BY VOLUNTEERSOT JDRF RESEARCH COMMITTEE. WE AT JDRF HAVE ALWAYS TRIED TO IDENTIFY GAPS AND WE HAVE BEEN PARTICULARLY OPORTUNISTIC AND WE CONSULT WITH OUR PARTNERS IN GOVERNMENT WITH OTHER FOUNDATIONS AND WITH OUR INDUSTRY PARTNERS AND AND WE RECEIVE INPUT FROM SCIENTIFIC EXPERTS. WE DO THIS ON ANNUAL BASESIS TO DETERMINE WHAT THE SHORT-TERM RESEARCH PRIORITIES ARE WHICH ARE TRANSLATED INTO OUR RFAs. WE ALSO CONSULT WITH ALL THESE GROUPS INCLUDING A GROUP OF VOLUNTEERS THAT WE CALL THE TWORKS BEFORE R B VOICES COUNSELS WHICH ARE A GROUP OF PATIENTS WHICH HELP TO DEVELOP MEDIUM TERM AND LONG E-PRESCRIBING TERM STRATEGY AT THE FOUNDATION. ALL THAT IDENTIFICATION OF GRAPES AND OPPORTUNITIES DEVELOPS MECHANISMS WE CAN USE TO PROVIDE SUPPORT FOR FOR RESEARCH ACTIVITIES THAT WE FEEL WILL LEAD US TO A CURE AND AGAIN WE CALL ON VOLUNTEERS AND PARTNERS AND OUTSIDE SCIENTIFIC EXPERTS TO HELP PROVIDE RESEARCH FUNDING OVERSIGHT FOR WHATEVER WE FUND. SO HOW DO WE ASSESS WHETHER OR NOT WE'RE MEETING OUR GOALS? WE HAVE TWO LEVELS OF ASSESSMENT. WE EVALUATE SCIENTIFIC PROGRESS, THIS IS LIKELY TO BE GRANULAR AT THE LEVEL OF PARTICULAR GRANTS OR AWARDS OR AWARD PROGRAMS. AND THAT INCLUDES FAMILIAR MEASURES SUCH AS ANNUAL REPORTING WHICH INCLUDES SITE VISITS. WE DO PROVIDE SOME MILESTONE BASED PAYMENTS FOR SOME AWARDS. SOMETIMES IN ORDER TO CONTAIN COSTS, SO FOR EXAMPLE, WE GENERALLY HAVE MILESTONES FOR CLINICAL TRIALS THAT WHERE ACHIEVEMENT OF PARTICULAR RECRUITING MILESTONES TRIGGER PAYMENTS BUT WE ALSO HAVE AWARDS THAT ARE ARE MUCH MORE CONTRACT LIKE FOR DEVELOPMENT FOR EXAMPLE FOR PARTICULAR DEVICE ALEGORITHMSES THAT ARE DEFINED BY MILESTONES THAT NEED TO BE REACHED IN ORDER TO TRIGGER PAYMENTS. IN GENERAL THE OVERRIDING QUESTIONS WE USE TO EVALUATE PROGRESS IS HOW DOES THE RESULT OF RESEARCH CONTRIBUTE TO UNDERSTANDING OF DISEASE. WE ALSO EVALUATE FOR PROGRAM EFFECTIVENESS AND HERE I ICE EXAMPLE OF EVALUATIONS THAT WE DO WITH OUR PARTNER AT NIDDK FOR THE SPECIAL STATUTORY FUNDING FOR TYPE ONE DIABETES. WHERE TOGETHER WE EVALUATE THE ACHIEVEMENT OF STATED GOALS. WE ALSO TAKE A LOOK AT WHETHER OR NOT THE SCIENCE FUNDED WAS SUCCESSFUL, WHAT WAS LEARNED PARTICULARLY AND WHAT ARE THE NEW OPPORTUNITIES THAT WERE GENERATED BY THAT RESEARCH. EENOUGH HAS BEEN SAID TODAY ABOUT TRAINING AND BECAUSE WE'RE A VOLUNTEER ORGANIZATION THE NUMBER ONE QUESTION WE LOOK AT BY VOLUNTEERS AND MECH NICHES DID THE AWARDEE MAKE A CAREER IN DIABETES RESEARCH? OR IN PATIENT CARE? WE DON'T DO THE MORE FAMILIAR FORMS OF EVALUATION OF TRAINEES BECAUSE OUR VOLUNTEERS FORCE US TO FOCUS ON THE BOTTOM LINE. WE HAVE A COMMUNICATIONS DEPARTMENT AT JDRF WHERE WE COMMUNICATE RESEARCH NEWS TO OUR COMMUNITY. WE ALSO ARE ON SOCIAL MEDIA, WE HAVE AFFILIATES THROUGHOUT THE WORLD WHERE RESEARCH NEWS AND PUBLICATIONS ARE AVAILABLE IN THE LOCAL LANGUAGE AND WE TRY ALWAYS TO PROVIDE MULTIPLE MESSAGES TO OUR COMMUNITY BOTH TO HELP PROVIDE SUPPORT FOR THE WORK OF THE FOUNDATION BUT ALSO TO VOLUNTEER AND TO PARTICIPATE IN CLINICAL RESEARCH. WE HAVE PARTNERED WITH THE NIH PARTICULAR LE IN RECRUITMENT FOR--PARTICULARLY IN RECRUITMENT FOR DIABETES TRIALS. WE HAVE A TRACK RECORD OF PROVIDING SUCCESSFUL RECRUITS FOR CLINICAL TRIALS. AND THIS IS THE GRAFF THAT WE SHOW THAT IS SORT OF THE BOTTOM LINE FOR THE RESULTS OF OUR ACTIVITIES AND THAT IS THAT IN COLLABORATION WITH ALL OF OUR PARTNERS, WE HAVE MANAGED TO SUCCEED IN REDUCING MORTALITY IN PEOPLE WITH TYPE ONE DIABETES AND THIS JUST SHOWS THAT PEOPLE WITH DIABETES ARE LIVING LONGER AND HEALTHIER LIVES AND THANK YOU AGAIN FOR YOUR ATTENTION. [ APPLAUSE ] >> MARY YOU'RE UP. >> THANK YOU ALAN AND THANK YOU FOR THE INVITATION TO BE WITH YOU. IT'S BEEN AN OPPORTUNITY, PROVIDED ME WITH AN OPPORTUNITY TO TRY TO THINK ABOUT LESSONS LEARNED OVER THE YEARS AS AN ADVOCATE AND TO TRY TO COME UP WITH SOME RECOMMENDATIONS. FOR THOSE WHO DON'T KNOW WHAT RESEARCH MARK IS, WE ARE AN ALLIANCE, A NONPROFIT ALLIANCE OF PEOPLE AND INSTITUTIONS FROM ACROSS THE RESEARCH ECOSYSTEM AND THAT INCLUDES PATIENT GROUPS, ACADEMIC INSTITUTIONS, BUSINESS AND INDUSTRY AND SCIENTIFIC AND CLINICAL SOCIETIES. 97 THAT ALLIANCE IS COMMIT TO MAKING RESEARCH FOR HEALTH A HIGHER PRIORITY IN THIS NATION BUT I'M GOING TO TALK PRIMARILY TODAY ABOUT ADVOCACY FOR NIH WHICH HAS BEEN AT THE HEART OF OUR MISSION BUT NOT ITS ONLY COMPONENT. SO IN TERMS OF ADVOCACY FOR NIH, THERE WE GO. THERE'S PLENTY OF GOOD NEWS INCLUDING THE FACT THAT THE MISSION IS CLEAR AND THE AMERICAN PUBLIC IS POSITIVE ABOUT RESEARCH. IT WOULD BE HARDER TO BE AN ADVOCATE FOR THE NIH IF THE PUBLIC WERE IN A NEGATIVE SPACE, IF YOU WILL. THERE IS SOME NUANCE IN THIS, HOWEVER AND I'LL TALK ABOUT THAT AND THEN OF COURSE SCIENTIFIC OPPORTUNITY HAS NEVER BEEN GREATER AND I WILL SAY THAT IN THIS REALLY CHALLENGING TIME OF AUSTERITY AND ECONOMIC CHALLENGING TIMES THAT IT IS WORK WE DO IS SO IMPORTANT. NIH HAS FAIRED BETTER THAN OTHERS. IT'S NOT ENOUGH AND IT'S BY NO MEANS SOMETHING AN ADVOCATE SHOULD BE SATISFIED WITH. BUT WE'RE CONSTANTLY IN THE BUSINESS OF WINNING, HEARTS, MINDS AND VOTES FOR NIH. >> SOME OF THE CHALLENGES THAT I AS AN ADVOCATE AND MANY OF US EXPERIENCE IS THAT OUTTHERE, IN--OUT THERE THE IN THE WORLD WE'RE TRYING TO INFLUENCE THERE IS A PERCEIVED LACK OF ACCOUNTABILITY AND THIS IS NOT JUST ABOUT NIH WHEN I SAY LACK OF ACCOUNTABILITY, IT'S VERY MUCH IN THAT GOVERNMENT ACCOUNTABILITY MANTRA THAT WE HEAR SO MUCH ABOUT BUT MORE SPECIFICALLY FOR NIH WE TALK ABOUT NIH FOCUS GROUPS AND OTHERWISE MEASURE, PEOPLE SENSE OF WHAT OR HOW RESEARCH IS DOING, THEY HAVE A LOT OF TROUBLE COMING UP WITH SPECIFIC EXAMPLES OF RESULTS. THEY'RE LOOKING FOR SOLUTIONS AND RESULTS BE ABSOLUTELY AND WE'RE ALIGNED THAT WAY, EVERYONE WHO'S INVOLVED FOR RESEARCH FOR HEALTH BUT WE VICTORY DONE COLLECTIVELY A GOOD ENOUGH JOB, I WOULD SAY IN EXPRESSING WHAT WE MEAN BY PROGRESS IN WAYS THAT PEOPLE CAN QUICKLY RELATE TO. I THINK IT IS A FACT, I KNOW IT IS A FACT THAT OTHER STAKEHOLDERS IN THE RESEARCH ECOSYSTEM DON'T ALWAYS FEEL VALUED OR HEARD, THE VERY EXISTENCE OF THIS PANEL TODAY EMPHASIZES THAT NIH DOES FEEL THE VALUE OF PATIENT GROUPS AND I KNOW ALSO OF INDUSTRY BUT THAT SAID, WE'RE NOT ALWAYS SPEAKING WITH ONE VOICE ACROSS THE RESEARCH ECOSYSTEM AND I THINK THERE ARE WAYS THAT ARE RELATIVELY EASY FIXES. I'LL GET TO THAT. IT'S A FACT THAT SCIENCE AND SCIENTISTS ARE LARGELY INVISIBLE IN THIS COUNTRY AND THAT MAKE ITS HARD SOMETIMES TO BE AN ADVOCATE FOR SCIENCE. YOU'VE SPENT A LOT OF TIME, I GATHER, I WISH I COULD HAVE BEEN HERE ALL DAY TALKING ABOUT ECONOMIC IMPACT ANALYSIS AND WE HEAR VERY OFTEN THAT THEY AREN'T CONVINCING, THE ONES THAT HAVE BEEN PRODUCED TO DATE. ANOTHER POINT IS THAT WITH ALL THE CONVERSATION ABOUT OBAMA CARE, THEY SORT OF MIND SHARE INCLUDING THE MEDIA MIND SHARE AROUND HEALTH AND SUCKED INTO INTO THAT A CA CONVERSATION AND IT CROWDS OUT CONVERSATION ABOUT RESEARCH. IT'S A FACTOT GROUND BUT SOMETHING WE HAVE TO KEEP WELL IN MIND. AND THEN FINALLY MOST HEALTHCARE PROVIDERS WHICH WHO ARE THE MOST TRUSTED SOURCES FOR RESEARCH INFORMATION ACCORDING TO POLING WE AND ARE VS DONE SIMPLY DON'T TALK ABOUT RESEARCH. AND THAT HURTS US AS WELL. OR IT'S A CHALLENGE. NOW, ROOTING ALL OF OUR WORK IS A WONDERFUL STATEMENT FROM PRESIDENT LINCOLN IN I BELIEVE IT WAS 1853 POINTING OUT THAT PUBLIC SENTIMENT IS EVERYTHING AND WE HAVE TO ALWAYS BE MINDFUL OF THIS. AND FOR THAT REASON, RESEARCH AMERICA HAS PROVED SOMETIME NOW BEEN KEEPING A PULSE ON PUBLIC SENTIMENT VIA COMMISSIONED PUN LICK OPINION POLES AND WE HAVE JUST A HOST OF INFORMATION FROM THOSE. I'LL SHOW YOU A LITTLE BIT OF IT. THE GOOD NEWS AND THERE IS A LOT OF GOOD NEWS FROM PUBLIC POLLS. MOST PEOPLE AGREE EITHER STRONGLY OR SOMEWHAT THAT BASIC RESEARCH IS NECESSARY. THIS KIND OF BLOWS APART THE MYTHS THAT'S COMMONLY--I COMMONLY HEAR AMONG BASIC SCIENTISTS IN PARTICULAR THAT THE PUBLIC DOESN'T SUPPORT BASIC RESEARCH, REALLY ONLY CARE ABOUT TRANSLATIONAL OR CLINICAL OR HOWEVER ELSE THEY MAY DESCRIBE THE RESEARCH. WELL THERE ACTUALLY IS NO DATA TO SUPPORT THAT ASSUMPTION THAT THAT'S WHAT THE PUBLIC. A'S THE ONLY THING THE SUBLICK SUPPORTS THERE. 'S A DIFFERENCE IN UNDERSTANDING AND SUPPORTING THEY JUST GO WITH THE TERM BASIC AND THIS IS NOT JUST OUR DATA, IT GOES BACK TO 1982 WHEN THE NATIONAL SCIENCE BOARD STARTED ASKING THIS IDENTICAL QUESTION AND THE NUMBER VS NEVER CHANGED WITHIN A COUPLE OF PERCENTAGE POINTS. NOW JUST ABOUT HALF OF THE UNITED STATES AMERICANS SAY WE SHOULD NOT SCALE BACK MEDICAL RESEARCH IN WHAT WE HAVE COME TO CALL THE SEQUESTER OR SEQUESTRATION. ALTHOUGH THIS SURVEY IS A LITTLE BIT OLD BY NOW WE'LL BE ASKING THIS QUESTION AGAIN SOON, SLIGHTLY DIFFERENT FORMAT AND I WOULD NOT IMAGINE THAT THE RESPONSE WOULD CHANGE. HOPEFULLY IT WILL BE A HIGHER PERCENTAGE SAYING IT WILL NOT SCALE BACK RESEARCH. I THINK IT'S INTERESTING TO LOOK AT WHAT LIKELY VOTERS THIS IS NOT JUST GENERAL PUBLIC BUT LIKELY VOTER HIS TO SAY NOT TOO LONG AGO ABOUT WHAT GOVERNMENT WAS SPENDING TOO MUCH MONEY ON, ABOUT THE RIGHT AMOUNT OR NOT ENOUGH ON. POW WE CLEARLY WOULD LIKE TO SEE, MORE AND MORE PEOPLE SAYING THAT WE NEED TO SPEND MORE MONEY ON SCIENTIFIC RESEARCH BUT WE HAVE TO START FROM WHERE THE PUBLIC IS. I THINK THIS IS A VERY INTERESTING SNAPSHOT WHICH AGAIN WILL BE UPDATING BEFORE LONG. NOW THIS IS ANOTHER POLE, RESULT WE'VE SEEN FOR A LONG TIME AND REPLAINED ROBUST OVER 20 YEARS NOW THAT OVER HALF OF THE PUBLIC SAY THEY WILL BE WILLING TO SPEND MORE, A DOCTOR MORE PERWEEK IN TAXES, IF THEY WERE CERTAIN THAT ALL THAT MONEY WOULD BE SPENT ON ADDITIONAL MEDICAL RESEARCH AND WE DO TALK ABOUT TAXING AS ONE OF THE REVENUE SOURCES THAT WE MIGHT BEING LOOKING AT AND IN THIS CURRENT CLIMB AT WITH A BUDGET CONFERENCE COMMITTEE TALKING ABOUT SOME BIG PATIENTS IN THE CLINIC PICTURE AS WELL AS NITTY-GRITTY SMALLER, RELATIVELY SMALLER ISSUES, TEXAS WILL COME UP AND WE WILL BE TALKING ABOUT IT WITH THIS RESULT IN MIND. NOW I THINK IT'S ALSO VERY IMPORTANT TO KEEP IN MIND THAT PEOPLE ARE MORE LIKELY TO SAY, THAT MEDICAL RESEARCH IS PART OF THE SOLUTION TO A BIG CONCERN IN THE NATION, RISING HEALTHCARE COST, RATHER THAN TO SEE IT AS PART OF THE PROBLEM. THE PEOPLE WHO SEE IT AS PART OF THE PROBLEM CERTAINLY ARE QUITE OUTSPOKEN AND HAVE POINTS TO RAISE THAT WE NEED TO LIFIC TO BUT WE REMAIN--LISTEN TO AND WE REMAIN IN COMFORTABLE TERRITOR NEUROECTODERMAL TERMS OF PERCENTAGE OF RESEARCH AS A SOLUTION. AND ONE OF THE REASONS IT'S ESPECIALLY IMPORTANT IS SHOWN IN THIS TREND, GRAFF HERE YOU CAN SEE FOR A QUESTION THAT WE HAVE BEEN ASKING SINCE 1992, ALTHOUGH IN THE FIRST COUPLE OF YEARS ONLY IN ONE STATE EACH TIME, YOU CAN SEE THE CHANGE OVER TIME IN THE RESPONSES TO THIS QUESTION. WHAT WOULD YOU SAY IS THE SINGLE MOST IMPORTANT HEALTH ISSUE FACING PEOPLE IN THE UNITED STATES. IT'S NOT ABOUT YOU, BUT PEOPLE IN GENERAL AND YOU CAN SEE HOW ELGT CARE COSTS, COVERAGE, INSURANCE THAT WHOLE ISSUE IS SKY ROCKETED TO THE TOP AND YOU CAN ALSO SEE HOW OBESITY IN THAT BROWN LINE IS GONE FROM NOT BEING MENTIONED AT ALL TO A SIGNIFICANT PERCENTAGE OVER TAKING EVEN CANCER. NONE OF THIS MEANS THAT THIS IS REFLECTIVE OF REFULENCE, THIS S&P STRICTLY A TOP OF MIND IMPRESSION THAT PEOPLE GIVE BUT IT TELLS US THAT WE NEED TO BE TALKING ABOUT RESEARCH AS PART OF THE SOLUTION TO CONTROL HEALTH COSTS AS WELL AS PART OF THE SOLUTION TO ADDRESS AND CONTROL OBESITY, EATS. NOW, JUST BRIEFLY ON ECONOMIC IMPACT, I GATHER YOU'VE HAD QUITE A CONVERSATION ABOUT THIS, YOU PROBABLY HAVE SEEN THIS ILLUSTRATION IN TERMS OF MONEY SPENT AND LIFE EXPECTANCY IN OTHER PLACES BEFORE BUT IT KIND OF HELPS UNDERSCORE THE UNITED STATES IS NOT GETTING A RETURN ON INVESTMENT FOR DOLLARS SPENT WHEN IT COMES ON HEALTH. AT LEAST IT'S MEASURED IN LIFE EXPECTANCY AND WE HEAR THIS OR VERSIONS OF IT QUITE OFTEN WHEN WE'RE ADVOCATING FOR NIH. THROW IN SOME ADDITIONAL COMMISSION POLE RESULTS HERE TO KIND OF--I THINK THESE ARE CONNECTED THAT 55% PEEL THAT WE'RE NOT MAKING ENOUGH PROGRESS IN MEDICAL RESEARCH WHEN WE ASK A FOLLOW ON QUESTION, WHY IS THAT? PRETTY HEALTHY PERCENTAGE SAY IT'S NOT BECAUSE WE'RE SPENDING ENOUGH MONEY ON IT. NOT A GIANT PERCENTAGE BUT ENOUGH TO WORK WITH IF YOU WILL BUT I THINK THIS WHOLE ISSUE KEEPS WRAPPING BACK TO PEOPLE'S INABILITY TO SEE AND TO FEEL THAT WE'RE NOT MAKING ENOUGH PROGRESS AND FIND WAYS TO COMMUNICATE WHAT WE'RE DOING THAT IS ON THE PROGRESS TRACK AND GETTING US WHERE WE WANT TO BE IS IMPORTANT. NOW THERE IS I GREAT DEAL OF EXCEPT SKIMP ABOUT--SKEPTICISM ON THE FINE PRINT DOWN HERE, THE CLAIMS BEING MADE IN THIS NATURE ARTICLE, THE AUTHORS REPORTS THAT THE EVIDENCE BEHIND CLAIMS THAT RESEARCH IS DRIVING ECONOMIC GROWTH IS PATCHY AT BEST. HERE'S ANOTHER ONE, CONCEST TESTING THE--CONTESTING THE IMPACT OF GROWTH IN THE ECONOMY IS DUE TO R&D. I CAN ASSURE YOU WE HEAR A LOT OF PUSH BACK ABOUT THAT STATEMENT ALLOWED TO WE CONTINUE TO USE IT AS DO MANY OTHERS. VERY RECENTLY A COUPLE DAYS AGO IN NATURE WE SEE A CALL FOR BETTER ECONOMIC MODELS AND THIS IS A BRAND FLUE PIECE THEY THINK IS WORTH--NEW PIECE THAT IS I THINK IS WORTH CALIFORNIAING TO YOUR ATTENTION. --CALLING TO YOUR ATTENTION. THAT'S NOT SAYING THAT ANECDOTES DON'T MATTER. I'M A STRONG PROPONENT OF ANECDOTES. NOW STANDING SHOULDER TO SHOULDER, I WILL SHOW YOU A FEW QUICK THINGS BUT THE POINT IS THAT ALL OF THE MEMBERS OF THE RESEARCH ECOSYSTEM SHOULD BE SPEAKING WITH ONE VOICE ABOUT THE VALUE OF THE ECOSYSTEM, MEANING, YOU KNOW RIGHT DIRECTOR OF NATIONAL INSTITUTE TO THE SPECIFICS THAT NIH ADVOCATES AND PEOPLE FUNDED BY NIH SHOULD ALSO BE TALKING ABOUT THE IMPORTANCE OF INDUSTRY SUPPORTED RESPONSE OF SCIENCE SUPPORTED BY WILL PHILANTHROPIC AND PATIENT SECTORS. THESE THINGS DON'T ALWAYS HAPPEN, HOWEVER. WE'RE NOT SPEAKING IN CHORUS AND IN ALINEMENT WITH EACH OTHER BUT WE REALLY HAVE TO. AND WE HAVE TO BECAUSE THAT'S THE WAY EVERYBODY WANTS US TO, INCLUDING OURSELVES. RESEARCH AND RESEARCHERS, RESEARCH INSTITUTIONS WANT TO WORK TOGETHER TURN IT IS OUT THE PUBLIC THINKS THEY'RE MORE LIKELY TO BE IN COMPETITION THAN WORKING TOGETHER. BUT OVERWHELMINGLY, WANT EVERYBODY TO WORK TOGETHER. I MEAN IS KIND OF A NO BRAINER. WE WERE ASKED ACTUALLY BY INDUSTRY PARTNERS TO EXPLORE THIS QUESTION TO FIND OUT HOW THE PUBLIC FELT ABOUT IT AND SURPRISED TO SEE HOW STRONGLY THE WORK TOGETHER MESSAGE RESONATES. SO NOT ONLY DO WE NEED TO DO IT BUT WE NEED TO TALK AS THOUGH WE'RE DOING IT RATHER THAN UNDERCUTTING ONE ANOTHER WHICH SOMETIMES HAPPENS. ANOTHER PROBLEM I CITED EARLIER IS THAT SCIENCE IS INDIVIDUAL, 2/3RDS OF THE AMERICAN PUB LIBRARY FOUNDATION CAN'T GUESS OR OFFER A NAME OF AN AMERICAN SCIENTISTS MANY WHO WHOM THEY GUESS ARE DECEASED BUT IT TURNS OUT TO BE A DIFFICULT TO QUESTION TO ASK AN AMERICAN AND THAT'S KIND OF SHOCKING AND I THINK IT DOES INDICATE THAT WE DON'T DO A VERY GOOD JOB DELVE IDENTIFYING WITH THE GENERAL WAY THE GENERAL PUBLIC CAN PICK UP ON IT. ALSO HORRIBLE ANY COMMENTS OR ORGANIZATION WHERE MEDICAL AND HEALTH RESEARCH IS CONDUCTED. YOU CAN SEE THE POWER OF BRANDING HERE AND NIH SHOULD BE GOOD TOWARD THE TOP OF THE LIST, ANYWAY. BUT BUT THE MAIN POINT IS DON'T SAY MY UNIVERSITY AND MY STATE BUT THEY DON'T, BUT THEY DON'T. WE BUT PRETTY RECENTLY ASKED THIS QUESTION, THAT INICATES THAT SURPRISINGLY, SMALL PERCENTAGE OF PEOPLE KNOW UNDER KNOW, THAT MEDICAL RESEARCH TAKES PLACE IN THE UNITED STATES. NOW THIS IS PRR PROBLEMATIC GIVEN THAT VOTES FOR RESEARCH COME FROM EVERY STATE IN THE COUNTRY. SO WE'RE WORKING ON THIS ALL THE TIME AND WE'RE HOPING TO CHANGE THE DON'T KNOW IN THE POSITIVE DIRECTION AND INFORM PEOPLE THAT ARE SO CLEAR THAT RESEARCH DOESN'T TAKE PLACE EVERYWHERE. THIS NEEDS TO BE AN ALL-AMERICAN NOT ONLY PRIORITY, BUT AN ALL-AMERICAN ACTIVITY. KNOWING RESEARCH IS CLOSE AT HAND AND KNOW TAG PEOPLE THEY KNOW ARE CONDUCTING RESEARCH OR MAYBE ENGAGED IN IT AS A VOLUNTEERS KNOW TEAR IN A RESEARCH PROGRAM. --VOLUNTEERING UNSUPPORTED TEAR TEAR--VOLUNTEER IN A RESEARCH PROGRAM. NOW WE'VE BEEN ASKING THIS QUESTION FOR A VERY LONG TIME, 20 YEARS, THE GOOD NEWS MERE IS THAT THE NIH HAS DOUBLED DOUBLED--PARTICULAR NIICALLY THE HHS RESPONSE IS ACCURATE AND WE GIVE PEOPLE THE BENEFIT OF THE DOUBT WHEN THEY SAY HEALTH DIDN'T THAT THEY REALLY NEED, THE CABINET AGENCY OR THE CABINET DEPARTMENT. NOW TO POINT I MADE EARLIER ABOUT BROADER ABOUT THE IMPORTANCE OF PEOPLE OF HEARING ABOUT MEDICAL RESEARCH FROM THEIR HEALTHCARE PROVIDER AND WE DO KNOW IT'S IMPORTANT TO THEM AS A TRUSTED SOURCE, VERY FEW PEOPLE SAY THAT THEY--IF THEY EVER TALKED WITH AND THE--WE DON'T KNOW IF THE CONVERSATION WAS INITIATE BIDE THE PATIENT OR THE HEALTHCARE PROFESSIONAL I MIGHT ADD BUT THAT'S A VERY TINY PERCENT AND IT'S AN ENORMOUS MISSED OPPORTUNITY. SO SOME SUGGESTIONS I THINK IT'S TIME FOR ALL OF US, ADVOCATES AND MEMBERS OF THE RESEARCH COMMUNITY COMEMS WHO P. S. SHOULD BE ADVOCATES TO GET OUT OF THE COMFORTABLE ECHO CHAMBER AND TALK TO NEW AUDIENCES AND THERE ARE MANY OF THEM ALL OVER THE COUNTRY. I BELIEVE WE DO NEED ECONOMIC MODELS THAT SHOW ECONOMIC IMPACT. I THINK WE NEED INCENTIVES FOR INDIVIDUAL SCIENTISTS TO ENGAGE THE NONSCIENCE PUBLIC, I THINK IT'S FORTUNATE EDUCATE GRANTEES ABOUT OTHER STAKEHOLDERS INCLUDING INDUSTRY AND PATIENT GROUPS SO THAT THEY DON'T--THE EXPECTATION CAN END THAT EITHER OF THOSE GROUPS WILL MAKE THE CASE IF WARE NOT MAKING THEIRS AS WELL. WE HAVE TO UNDERSTAND EACH OTHER FIRST AND BE ABLE TO SPEAK WITH ONE VOICE AND THEN OPENING A DIALOGUE WITH HEALTH CARE PROVIDERS TO SEE IF WE CAN'T GET TO A POINT WHERE MORE ARE TALKING ABOUT RESEARCH, EVEN IN PASSING. I DO BELIEVE THAT ACCOUNTABILITY IS A KEY BI-WORD I KNOW YOU TALKED ABOUT THAT EARLIER TODAY BUT IT REALLY IS PART OF OUR CONTRACT WITH THE PUBLIC AND IT'S IMPORTANT TO TAKE IT SERIOUSLY. SPEAKING OF ANECDOTES YOU MAY OR MAY NOT BE FAMILIAR WITH THIS ONE, AFTER PAUL GREEN GUARD WON THE NOBEL, HIS SISTER WHO HAPPENS TO A JOURNALIST WROTE A PIECE IN THE NEW YORK TIMES BASICALLY MAKING THE POINT THAT FOR ALL THROUGH HER LIFE SHE AND HER SIBLINGS TRIED REALLY HARD TO UNDERSTAND, JUST EVEN IN GENERAL TERMS WHAT THEIR BRILLIANT BROTHER WAS DOING. BUT AS SHE SAID IT TOOK ANOTHER JOURNALISTS TO HELP HER UNDERSTAND THAT SOMEDAY, SOMEDAY, YOU'LL NOTICE, ONE DAY HIS WORK MIGHT HELP CURE DISEASES LIKE PARKINSONS AND ALZHEIMERS, SO WHEN I SAY THIS SCIENTIFIC AUDIENCE, REALLY HOW HARD IS IT TO SAY SOMEDAY MY WORK MIGHT HELP CURE A DISEASE LIKE X, Y, AND Z. NO PROMISES MADE. LONG-TERM COMMITMENT IS EVIDENT BUT THAT'S WHAT IT'S GOING TO TAKE TO WIN MORE HEARTS AND MINDS. AND ULTIMATELY VOTES. AND HERE'S ANOTHER ANECDOTE IF YOU WILL, WONDERFULLY SAID BY MIKE BISHOP, IF I HAD TO DO IT TALL OVER AGAIN, I WOULD SPEND MORE TIME TALKING TO GENERAL AUDIENCES AND PUBLIC AFICIALS. IF WE COULD FIND A WAY TO MAKE THAT A VALUED WAY TO SPEND A LITTLE TIME BY HER SCIENTIST EARLIER IN THEIR CAREER AND THROUGHOUT THEIR CAREER MAKE A BIG DIFFERENCE, WIN A LOT OF HEARTS AND MINDS. I ALWAYS SAY TO SCIENTISTS, THERE ARE FOUR WORDS THAT GO TOWARD WINNING HEARTS AND MINDS THAN ANY OTHERS AND THEY ARE THE FOLLOWING, I WORK FOR YOU. IT'S ALSO A NICE WAY TO SAY IS THAT I TREASURE IS THAT I HAVE THE OPPORTUNITY TO ADVOCATE FOR RESEARCH. THANK YOU. [ APPLAUSE ] >> ANTWONET? >> YES, I WAS ASKED TO BE A PATIENT PARTICIPANT BECAUSE I AM ONE OF THE MEMBERS OF THE NIH PATIENT ADVISORY GROUP AND I WAS ASKED BY DR. GOWAM AS WELL AS MISS LAURA COLONELS TO PARTICIPATE TODAY. WELL, THANK YOU FOR INVITING ME. LIKE MANY PATIENTS THAT ARE SEEN HERE AT NIH, MY HEALTHCARE JOURNEY BEGAN ELSEWHERE, I AM NOT GOING TO DIVULGE ANY OF THE NAMES OF THOSE FACILITIES BUT I WILL REFER TO TWO OF THEM AS HOSPITAL A AND B. WELL, SINCE CHILDHOOD, MY MAIN PROBLEMS HEALTH WISE HAVE BEEN SEVERE ANEMIA COUPLED WITH AN INABILITY TO GAIN WEIGHT. IT WAS LATER TERMED FOR MY CASE AS MALABNORMALITIES SORPTION SYNDROME. THESE PROBLEMS LEAD TO A LINE OF MANY BLOOD TRANSFUSIONS AND THEN TO OTHER CHRONIC HEALTH CONDITIONS. ONE IN PARTICULAR IS BEING DIAGNOSED HIV POSITIVE. IT WAS FOR THAT MAJOR HEALTH COMPLICATION THAT HOSPITAL A WAS DESPERATELY TRYING TO GET ME TREATMENT THROUGH DRUG COMPANY TRIALS. BUT THEY WERE UNSUCCESSFUL TIME AND TIME AGAIN DUE TO MY SEVERE ANEMIA. IN THE MEAN TIME I WAS GETTING WEAKER AND WEAKER. MY PHYSICAL WEAKNESSES WERE FOLLOWED BY MANY HOSPITALIZATIONS DURING ONE OF MY IN-PATIENT STAYS THE GOOD LORD SENT ME AN ANGEL IN HUMAN FORM NAMED DR. LAURA O'BRIEN. AT THAT TIME SHE WAS A CLINIC PHYSICIAN FELLOW FROM NIH OF THE NIAID DIVISION DURE--DOG HER CLINICAL ROTATION THEIR AT HOSPITAL A. DR. O'BRIEN TOOK 30 MINUTES OUT OF HER VERY BUSY SCHEDULE TO TELL ME ABOUT NIH AND THEIR INVOLVEMENT IN CLINICAL TRIALS. BUT I SAID TO HER, TO BE PERFECTLY HONEST, I'LL REALLY GETTING TIRED EMOTIONALLY AND YOU CAN SEE HOW WEAK I'M GETTING PHYSICALLY OF GIVING SO MANY TUBES OF MY WELL NEEDED BLOOD AWAY AND THEN LATER BEING DENIED TO PARTICIPATE IN TRIALS BY DRUG COMPANIES. SHE ASSURED ME THAT THAT WOULD NOT BE THE CASE AT NIH. AFTER I WAS RELEASED, AN APPOINTMENT WAS MADE BY MY PRIMARY CARE PHYSICIAN AT HOSPITAL A TO BE SEEN HERE. THUS BEGAN A NEW JOURNEY FOR ME. IT WAS ON FEBRUARY THE 10th 1999 AT SEVEN AMIN THE MORNING THAT I ARRIVED TO START MY PARTNERSHIP AND RESEARCH HERE AT THIS INSTITUTION. BY THE WAY, BY THE TIME I GOT HERE MY CD4 COUNT WAS THREE AND I HAD A VIRAL LOAD OF 130,645. I DON'T HAVE ANY SLIDES TO PROVE THIS TO YOU BUT IT'S RIGHT HERE, YOU CAN PASS IT AROUND. I WAS STILL A BIT SKEPTICAL FOCUSING ON MY PREVIOUS EXPERIENCES AND EXPECTATIONS ARE BEING TURNED DOWN TO PARTICIPATE IN AN NIH CLINICAL TRIAL BUT AT THE END OF MY APPOINTMENT THAT MORNING WITH MY NEW HEALTH CARE TEAM HERE, NURSE SAID TO ME, CAN YOU GO TO OUTPATIENT PHARMAC SCHEPICK UP YOUR MEDICATION--PHARMACY AND PICK UP YOUR MEDICATION. I WAS AMAZED AND EXTREMELY SHOCKED TO HEAR THAT. OH AND BY THE WAY, MY FIRST PHYSICIAN FELLOW SEEN HERE AT NIH WAS MY ANGEL DR. LAURA O'BRIEN. OF COURSE MY JOURNEY DIDN'T JUST STOP AT THAT POINT BECAUSE I'VE HAD MANY OTHER HOSPITALIZATIONS HERE AT NIH AND OTHER LOCAL HOSPITALS SINCE FEBRUARY OF 1999. HERE IS AN INCIDENT THAT I WOULD LIKE TO SHARE WITH YOU. IT WAS LATER THAT YEAR IN DECEMBER OF 1999, I BEGAN HAVING MAJOR BACK PAIN. SO I WENT TO THE E. R. AT A FACILITY CLOSE TO MY HOME, REFERRED TO AS HOSPITAL B. AFTER THE DOCTOR THOUGHT MY PROBLEM WAS UNDERCONTROL, I WAS DISCHARGED FROM THEIR EMERGENCY ROOM THEN THE VERY NEXT DAY, I ENDED UP BACK IN THE E. R. BUT THIS TIME RETURNED TO HOSPITAL A SCREAMING AT THE TOP OF MY LUNGS IN EXCRUCIATING PAIN. THAT EMERGENCY ROOM VISIT RESULTED IN A TWO AND HALF WEEK COMA, COUPLED WITH A TWO AND HALF MONTH IN-PATIENT STAY PER ME. WHILE THERE THE HEALTHCARE TEAM AT HOSPITAL A WOULD VERBALIZE IN MY COMATOSE PRESENCE THAT I WAS BRAIN DAMAGED AND A QUADRAPLEDGEIC TO MY LOVED ONES IN MY HOSPITAL ROOM WHEN THEY WOULD ASK THEM HOW I WAS DOING. IT WAS UNKNOWN TO THAT HEALTHCARE TEAM THAT ALTHOUGH MY EYES WERE CLOSED, I WAS ABLE TO SOAK UP MY SURROUNDINGS LIKE A SPONGE. AND AS YOU CAN SEE, I DID WAKE UP OUT OF THAT COMA, BUT MY LEFT ELBOW WAS SEVERELY CONTRACTED. I HAD AN INABILITY TO MOVE, WALK, TALK, OR EAT PLUS I HAD MANY TUBES ATTACHED TO ME AND I HAD A TRACH IN PLACE. IT WAS DURING MY LAST GRAND ROUNDS FROM DOCTORS AT HOSPITAL A, I WAS ABLE TO ASK QUESTIONS WITH MY FINGER ON THAT TRACH, ONE QUESTION BEING WHAT CAUSED MY COMA. THE DOCTORS WERE STILL A BIT CLUELESS BUT DID ADMIT THAT SOON AFTER GIVING ME ONE OF MANY MEDICATIONS IN THEIR EMERGENCY ROOM I HAD A REACTION BUT MY DISCHARGE SUMMARY FROM HOSPITAL A SAID SPINAL MENINGITIS/ENCEPHALITIS OF UNKNOWN ORIGIN OF OF COURSE WHEN I ASKED AND REQUESTED FOR MORE DOCUMENTATION REGARDING THAT MEDICATION THE STORY HAD CHANGED MAJORLY OVER TIME AND OF COURSE I TRULY EXPECTED THAT TO BE THE CASE. I THOUGHT I WAS GOING TO BE SENT TO A REHAB FACAs . SIT OR A--REHAB FACILITY OR A HOME FROM RELEASE FROM THAT LONG HOSPITAL STAY AT HOSPITAL A. HOWEVER, I SERS PLACED PERMY TEAM'S REQUEST IN A HOSPICE FACILITY. WHILE IN HOSPICE I WAS STILL RECEIVING MY MEDICAL CARE FROM HOSPITAL A. ALTHOUGH MY MOTHER AND MY FRIEND MR. LARRY HOLMAN, WERE VISITING ME THERE, THEY WERE NOT--THEY WERE VERY .'LL AT EASE AT MY LACK OF IMPROVEMENT OF COURSE IT WAS HOSPICE'S PLUS--IT OCCURRED TO ME THAT MY MOTHER WAS GETTING OLDER AND I WAS GETTING WEAKER SO AFTER TWO WEEKS IN HOSPICE, I CALLED MY MOTHER AND FRIENDLIRY AND REQUESTED THEY HAD TAKE ME HOME. WITHIN TWO HOURS THEY WERE THERE, GATHERED MY ITEMS WE LEFT, OF COURSE AGAINST MEDICAL ADVICE. FOR A SHORT PERIOD OF TIME I WAS STILL UNDER THE CARE OF HOSPITAL A AND IN MY OPINION TAKING TOO MANY UNNECESSARY MEDICATIONS. SO I CONTACTED MY NURSE CASE MANAGER PAMELA STALLS AND SAID, I WOULD LIKE TO HAVE MY CARE CONTINUE AT NIH. WITHOUT A BEAT SHE CONTACTED THE P. I. IN THAT DEPARTMENT AND AN APPOINTMENT WAS SET FOR ME. I WAS AGAIN UNDER THE EXCELLENT CARE OF MY HEALTHCARE TEAM IF PHYSICIAN FELLOW DR. O'BRIEN. SHE REVIEW ALL THE MEDICATION FROM MY IN-PATIENT STAY AT HOSPITAL A AND SAID SHE DIDN'T UNDERSTAND WHY I WAS STILL BEING DESCRIBED MANY OF THEM. SO DR. O'BRIEN SCALED BACK MY MEDICATIONS FROM 15 DIFFERENT MEDICATIONS BELIEVE IT OR NOT, I LEFT THE HOSPITAL WITH 15 DIFFERENT MEDICATIONS TO AROUND FIVE THAT WERE ABSOLUTELY NEEDED FOR MY CONDITION PLUS SHE HAD THE FEEDING TUBE REMOVED. ALSO SOMETHING ELSE HAD CHANGED OVER THE YEARS SINCE MY BEING BACK UNDER THE CARE OF AN EXCELLENT TEAM HERE AT NIH. HIGH PROGNOSIS WENT FROM QUADRAPLEDGEIC TO PARAPLEGIC AND NOW JUST SPASTIC PARAPORESIS. TO KEEP MY LOWER EXTREMITIES CLOSE RESPONSE SPASM SYMPTOMS UNDER CONTROL I AM CURRENTLY RECEIVING ACCUPUNCTURE AND PHYSICAL THERAPY HERE AS WELL. BOTH OF THESE HAVE ASSISTED ME IN BEING PRODUCTIVE, IN MOVING MY LEG, STANDING AND THE ABILITY TOXIC EFFECTS TAKE A FEW STEPS IN THE PARALLEL BAR OR A WALKER. FURTHER MORE MY CURRENT CD4 COUNT IS NOW 562 WITH A VIRAL LOAD OF LESS THAN 40%. AS MY BIOINDICATES, I SERVED AS MY MOTHER MISS PATTY MAYS CAREGIVER UNTIL HER HEART FAILURE ON APRIL 15th OF THIS YEAR. OVER THE YEARS, I WITH THED HER BEING OF SERVICE TO OTHERS AS WELL. SHE WAS TRULY A BLESSING AND AN INSPIRATION IN MY LIFE IT WAS JUST A FEW YEARS EARLIER THAT SHE HAD ENCOURAGED ME TOXIC EFFECTS SERVE AS A CO-CAREGIVER BESIDE HER TO PROVIDE QUALITY OF LIFE FOR HER LAST LIVING BROTHER MR. ALBERT MOODY GLOVER UNTIL HIS DEATH IN DECEMBER OF 1995. AS RAY RESULT OF THOSE EXPERIENCES, I AM CURRENTLY SERVING AS A CAREGIVER TO MY FRIEND MR. LARRY HOLMAN JUST LIKE MY MOTHER DID. SHE STEPPED UP TO THE PLATE WITHOUT HESITATION. ALTHOUGH MR. HOLMAN IS NOT IN ATTENDANCE TODAY, HE HAS AUTHORIZED ME TO BRIEFLY DISCUSS HIS RECENT EXPERIENCES AT THIS FACILITY. HE WAS THE FIRST NHIERARCHIES H AND BE--NIH AND BEGAN HIS PARTNER AND RESEARCH ON SEPTEMBER 9th OF THIS YEAR. HIS CLINIC COORDINATOR SAID TO HIM, IF YOU DID NOT COME IN FOR TREATMENT TODAY, YOU WOULD HAVE DIED WITHIN THE NEXT SIX MONTHS. DUE TO THE CONDITION HE WAS IN, PLUS FORGETS TO EAT FOOD, DRINK WATER, I SAID TO MYSELF, I THINK HE WOULD NOT LAST PAST OCTOBER 1st, WOW CURIAATIVE INTERVENTION. MR. HOLMAN CLINICAL RESEARCH TEAM HAS TAKEN A DIFFERENT APPROACH BY NOT JUST PLACING A BANDAGE ONE OF HIS ILLNESSES, LIKE OTHER MEDICAL FACILITIES HAD DONE FOR HIM OVER TIME. BY PLACING HIM IN THE HOSPITAL HERE AT NIH FOR TWO AND HALF WEEKS, HE WAS GIVEN A SERIES OF TESTS, SCANS, PLUS CONSULTED WITH OTHER DEPARTMENTS FOR HIS CARE. THEY HAD GOTTEN TO THE ROOT OF WHAT WAS CAUSING HIS AILMENT CONSEQUENTLY A DIAGNOSIS WAS GIVEN, WAS DECLINE IN CONDITION, HE WAS TREATED FOR THE RIGHT COMBINATION OF MEDICATION AND VITAMINS AND AS A RESULT HE IS MAKING A TREMENDOUS RECOVERY IN SUCH A VERY SHORT PERIOD OF TIME. WITHOUT THE EXCELLENT TREATMENT PROVIDED HERE AT NIH, HIS LIFE EXPECTANCY WAS EXTREMELY GRIM. AND BY THE WAY, HE DID MAKE IT PAST THAT OCTOBER 1st DAY I WAS TALKING ABOUT, TODAY THE 21st, THE 24th? , IT'S HIS 51st BIRTHDAY TODAY SO HE'S MADE IT. THESE EXPERIENCES HAVE PROVEN TO ME THAT IF YOU WANT TO REAP A GOOD MEDICAL HARVEST, NIH IS THE SOIL WHERE YOU NEED TO LABORATORY--PLANT YOUR SEED. ON BEHALF OF MR. LARRY HOLMAN AND MYSELF, THIS FACILITY HAS NOT ONLY ADDED YEARS TO OUR LIVES, BUT LIFE TO OUR YEARS AND WE ARE VERY GRATEFUL. THANK YOU. [ APPLAUSE ] >> THANK YOU FOR SHARING YOUR STORY AND YOUR RESEARCH PARTNER WITH US. >> YOU'RE A TOUGH ACT TO FOLLOW. I GUESS I HEARD HOW IMPORTANT ANECDOTES ARE IN TERMS OF THE MESSAGE THAT WE NEED TO GENERATE FROM THE NIH AND AND I'M GOING TO ADD TO THAT AS A ANOTHER PERSONAL END USER, GIVEN THE FACT THAT MOST OF MY CAREER WAS IN THE AREA OF PROFESSIONAL SPORTS, I CONSIDER MY EXPERIENCE HERE AS A THREE-PETE OR IN MY MYSELF AS A TRIPLE THREAT PATIENT. 35 YEARS AGO THIS MONTH I WAS DIAGNOSED WITH MELANOMA. I THOUGHT THAT IT WAS A DEATH SENTENCE BECAUSE OF A VERY DEAR FRIEND OF MINE A COLLEAGUE AT WORK HA ALSO CONTRACTED MELANOMA AND DIED WITHIN MONTHS THE FORTUNATELY A YOUNG RESEARCHER BY THE NAME OF STEVE ROSENBERG AGREED TO TAKE ME ON AS PART OF HIS RESEARCH PROTOCOL. AND AFTER SUCCESSFUL SURGERY AND 10 YEARS OF BEING CLOSELY FOLLOWED, I WAS DECLARED CURED. DURING THAT PERIOD, THE BLOOD WORK THAT WAS TAKEN HERE DISCOVERED THAT I HAD A RATHER HIGH PSA. MY PSA RAN 20 + IN THE COURSE OF TRYING TO FIGURE OUT WHAT WAS GOING ON, I HAD BIOPSIES EVERY 26 MONTHS 20 TOTAL, 20 + QUARTERS EACH AND EVERY TIME. MATTER OF FACT, THEY WERE SO CONFUSED AS TO WHAT WAS GOING ON, THEY THOUGHT WELL MAYBE ANOTHER INSTITUTION MIGHT HAVE A BETTER PERSPECTIVE OF THIS, SO THEY SENT ME UP TO JOHNS HOPKINS. AND THEY GAVE ME ANOTHER BIOPSY. AGAIN THERE WAS ANOTHER SIGN OF CANCER BUT THE PSA WAS EXTRAORDINARY. AND IN 2004 I HAD AN EXPERIMENTAL ENDORECTAL COLONIAL MRI THAT WAS INVENTED BY DR. PETER CHOYKE, WHO WAS THE MODEL MOLECULAR IMAGING PROGRAM, IT WAS NOT A TERRIBLY PLEASANT PROCEDURE BUT I WAS PROBABLY THE FIRST PATIENT TO UNDERGO THIS EXPERIMENTAL TREATMENT I WAS TRULY HONORED TO HAVE BEEN CHOSE TONE DO THIS. IT'S A NUKES FEC TECHNOLOGY THAT PROVIDES A MUCH MORE CLEAR AND PRECISE IMAGE OF WHAT'S GOING ON INSIDE ONE'S INEREDS. BY THE WAY THE RESULTS WERE NEGATIVE AND WE JUST DECIDE THAD I'M GOING TO LIVE WITH 20 BLUES PSA. >> IF THAT WERE NOT ENOUGH GOING TO THE THREE-PETE I WAS IN AN EXAMINATION. THEY FELT A LUMP ON MY NECK AND WE WENT THROUGH SEVERAL ULTRASOUNDS AND WE FOUND A MASS THAT WAS ON MY THOI ROADWAY, AND AND BIOPSIES AND SURGERIES AND 150 MILLI CURIES OF RADIOACTIVEIE O DINE. THINGS LOOK PRETTY GOOD, EXAMINATION THIS WEEK AT THE CLINIC INDICATED THERE'S A TINY INDICATION THAT EVERYTHING IS NOT COMPLETELY GONE BUT IT LOOKS PRETTY GOOD. SO HOW DO I FEEL ABOUT THE NIH? IF NOT FOR MY GOOD FORTUNE AS A PATIENT, I MOST LIKELY WOULD NOT BE HERE PRESENTING TO YOU TODAY. THE EXTRAORDINARY CARE BY DEDICATED PHYSICIANS WHO MOST CERTAINLY DON'T COME HERE BECAUSE OF THE PAY AND ALSO THE USE OF EXPERIMENTAL TREATMENTS AND DIAGNOSIS NO DOUBT SAVED MY LIFE AND I AM SO PLEASED THAT THE DETAILED RECORDS FROM THE LONGITUDINAL CARE THAT I HAVE RECEIVE INDIVIDUAL BEEN ENTERED INTO THE NATIONAL DATABASE THAT THEY MAY BE HELPFUL IN THE DIAGNOSE AND I GUESS TREATMENT OF PATIENTS AROUND THE WORLD. NOT BEING AN EXPERT IN THE ENTIRE MEDICAL FIELD, I DO SENSE THAT RESEARCH IS NIH IS NOT GOVERNED TOTALLY AND PRIMEAR ILLEGALS BY THE BOTTOM LINE THAT EXPERIMENTAL PROCESSES LIKE THE ENDOCORRECT OLDER PEOPLE COIL--ENDORECTAL COIL MAY NOT BE OUTSIDE THE PROFESSIONAL MEDICAL KNOWLEDGE AND TO MY KNOWLEDGE, ALL THESE BREAK THROUGHS ARE SHARE WIDE THE OUTSIDE MEDICAL PROFESSION AROUND THE WORLD. NOW HAVING BEEN A PART OF THE NIH AS LONG AS I'VE HAD YOU MIGHT AGREE AND SUSPECT THAT I'VE SEEN A FEW FELLOW WHO IS HAVE TABBEDDED TO MY CARE OVER THESE 35 YEARS. THE FACT THAT THE CLINICAL CENTER ROTATES FELLOWS ON A REGULAR BASIS PROVIDES IN MY JUDGMENT AN EXCEPTIONAL TRAINING PROCESS FOR YOUNG PHYSICIANS BRINGING THEM CURRENTOT LATEST STANDARDS OF MEDICAL CARE AND WHEN THEY LEAVE THE NIH TO GO ELSEWHERE IN THE PRIVATE PRACTICE OR BO RESEARCH THEY CARE WITH THEM THE BEN THEIR EXTRAORDINARY NIH EXPERIENCE AND THUS THE NIH IMPACT IS FELT WELL BEYOND THIS CAMPUS. OBVIOUSLY A VERY LIMITED VIEW OF THE RESEARCH CARRIED ON INTRA AND EXTRAMURALLY AND THUS CAN ONLY IMAGINE THE NUMBER OF PATIENTS THROUGHOUT THE COUNTRY AND THE WORLD WHO HAVE ALREADY AND WILL IN THE FURRURE BENEFIT FROM NEW TREATMENTS AND DIAGNOSTIC DEVICES THAT CONTINUALLY ARE DEVELOPED HERE AT THE NIH. GIVEN MY SINGULAR EXPERIENCE THERE'S NO DOUBT THAT MANY HAVE ALREADY BENEFIT BY EARLY DETECTION OF TUMORS AND BECAUSE OF NIH'S ROLE IN THE DEVELOPMENT OF THE ENDORECTAL COIL. HOW DO I FEEL ABOUT THE NIH. IT'S DIFFICULT TO ADEQUATELY EXPRESS HOW I FEEL. MY EXPRESSIONS ARE INADEQUATE FOR THE EXCEPTIONAL CARE AND TREATMENT BY THE DEDICATED PHYSICIANS I HAVE ENCOUNTERED. I'M TRULY INDEBTED AND THERE IS LITTLE I WON'T DO TO SHOW MY GRATITUDE FOR BEING TREATEDDA AT THAT EXTRAORDINARY INSTITUTION. THANK YOU. [ APPLAUSE ] >> ON BEHALF OF ALL OF YOU, WE THANK YOU FOR YOUR DISCUSSIONS. HOW ARE WE ON TIME? LET ME KNOW IF WE NEED TO GO ON FROM THE NEXT? DO WE HAVE ANYONE FROM THE PUBLIC SIGNED UP. >> THE ANSWER'S NO? >> THE INQUIRY IS NO. >> THE ANSWER IS NO. >> EYE THINK WE SHOULD BE GOOD TO ANSWER QUESTIONS. >> THIS CAME UP IF OTHER TALKS BUT FOR THOSE WHO DIDN'T BRING THIS UP, I WOULD ASK EITHER FROM YOUR OWN ORGANIZATIONS FROM YOUR OWN ORGANIZATIONS OR PERPERSONNAL PERSPECTIVE, EATS IT IS, HEARING THE THINGS YOU TALK ABOUT DURING THE DAY ARE THERE BEST PRACTICES YOU WOULD HOLD UP THAT WE SHOULD BE KEEP NOTHING MIND AS WE THINK ABOUT HOW TO ASSESS THE BIOMEDICAL RESEARCH, EITHER BEST PRACTICES OR WHAT WOULD BE THE ONE THING, YOU KNOW PHILOSOPHIC POINT OR WHATEVER YOU THINK WE NEED TO MAKE SURE WE KEEP IN MIND AS WE MOVE FORWARD WITH THIS, ANY WISDOM LOOKING AT PRESENTATIONS OR HEARING THE PART OF THE CONVERSATION WE WANT TO ADD. >> I WOULD JUST LIKE TO ADD THAT, I WOULD ENCOURAGE YOU TO ALWAYS TRY TO BE AS TRANSPARENT AS CAN YOU WITH THE WHOLE COMMUNITY AND THE PUBLIC AND TO WHENEVER POSSIBLE TO SHARE THE INFORMATION SO THAT IT IS STUDIED AND ACCESSIBLE NOT JUST BY PEOPLE WITHIN NIH BUT MORE BROADLY IN THE ACADEMIC COMMUNITY BECAUSE THERE'S A LOT TO LEARN FROM IT AS YOU DEVELOP MODELS AND TOOLS. >> IF IT'S ALL RIGHT I LIKE TO COMPLEMENT YOU ALL IT WAS A WONDERFUL SERIES OF PRESENTATION. ON BEHALF OF ANYONE I WOULD LIKE TO ASK YOU, ANYONE OF YOU OR ANYONE CAN ANSWER IS THE CLIMATE AT MOMENTENT IS OBVIOUSLY CHANGE FRIDAY WHAT YOU HAVE BEEN USED TO OR WHAT WE'VE BEEN USED TO OVER THE PAST FEW YEARS, SO THIS COMMITTEE LOOKS ASTERISKS HOW WOULD WE COMMUNICATE OR ASSESS THE VALUE OF BIOMEDICAL RESEARCH. IT SEEMED THAT IN THE PAST IT WAS EASIER TO DO THIS TO THE PUBLIC TO CONGRESS, TO OTHERS OTHERS AND THAT THEY WERE MORE RECEPTIVE TO MANY OF THE WAYS WE WERE ABLE TO DO IT AND MARY POINTED OUT MANY WAYS THAT THE MOMENT THERE SEEMS TO BE A MUCH GREATER FEELING OF KEPTICISM OR DOUBT OR LESS PERSUASION, THAT WE LESS PERSUADE ALL OF US IN THE PAST. I WONDER IF YOU HAVE ANY THOUGHTS ABOUT HOW WE CAN DO BETTER HOW WE CAN COMMUNICATE THIS VALUE, IF WE BELIEVE IN THAT AND THE NEW IDEAS AND APPROACHES WE MAY THINK ABOUT THAT WOULD MAKE A DIFFERENCE IN THE FUTURE. >> I GUESS I WOULD SAY THAT THERE'S A WAY TO CONSIDER THE INCREASE SKEPTICISM IN THE GENERAL PUBLIC AND THEIR ELECTED OFFICIALS AS A POSITIVE IN THE WAY AND I MEAN AS A SCIENTIST YOU EMBRACE SKEPTICISM. YOU KNOW YOU WANT TO ASK QUESTIONS, YOU PUSH BACK ON CLAIMS. AND I THINK IF WE THINK ABOUT IT THAT WAY FOR A MOMENT, IT MAY BE POSSIBLE TO RETHINK HOW WE'RE--RETHINK WHAT WE'RE SAYING AS CLAIMS WE ARE MAKING AND MOUNT THE EVIDENCE FOR THOSE CLAIMS AND DO IT IN NEW WAYS. PEOPLE ARE HEARING MORE OFTEN THAN IN THE PAST AND I DON'T KNOW IF YOU NOTICE THAT TIMED PERFECTLY FOR THE WORLD SERIES SOME NOW GROUP HAS RELEASED ITS INTENTION TO PURSUE MONEY BALL FOR GOVERNMENT. PERFECT RIGHT. THE GEANIOUS OF RELEASING IT LAST WEEK, THE SPOINT LET'S MAKE SURE WE'RE GETTING OUR MONEY'S WORTH AND BE GUIDED BY METRICS AND MUCH MORE SO THAN GUT INSTINCTS SHALL WE SY, NOW I ACTUALLY THINK THAT THE RESEARCH ENTERPRISE WILL DO VERY WELL, IN KIND OF ASSESSMENT LIKE THAT FWE RUN TOWARD IT RATHER THAN AWAY FROM IT, BUT WE HAVE TO GET AWAY FROM THE TRUST US WE'RE SMART WE KNOW WHAT'S BEST FOR YOU KIND OF PERCEPTION. I THINK THIS GROUP IF YOU LOOK AT THE END POINT OR OUTCOME FOR SELECTED DISEASES OVER A PERIOD OF TIME, I JUST--THAT'S KIND OF WHAT WE'RE TALKING ABOUT, I THINK THAT'S A VERY STRIKING WAY TO ILLUSTRATE ADVANCES THAT WILL REALLY SPEAK TO JOHN Q PUBLIC. >> TO OFFER A SUGGESTION, I THINK THE SEFDZ CLEAR THAT YOU HAVE, WE HAVE A FANTASTIC STORY TO TELL. BUT I THINK WE NEED TO THINK ABOUT HOW BEST TO TELL IT AND WE ENGAGE THE BEST MINDS AVAILABLE, MONEY MAY NOT BE AVAILABLE FOCUSED ON FUND THIS BUT I DARE SAY, I WOULD THINK THAT THERE ARE SOME EXPERTS IN THE FIELD OF DISSEMINATION OF INFORMATION THIS, IS A NEW DAY, A NEW DAY IN TERMS OF HOW INFORMATION IS DISSEMINATED AND I THINK WE OUGHT TO TAP INTO THE BEST MINDS AS TO HOW TO SELL OUR PRODUCT. NTHAT'S A VERY GOOD POINT. THANK YOU. ARE THERE OTHER QUESTIONS. >> YES. >> SORRY. >> I NEED TO ADD SOMETHING HERE NOT ONLY WHEN IT COMES TO LIKE MEDICAL STUDENTS AND SCHOOLS AND PATIENTS, SOME PEOPLE THINK THEY HAVE A STRANGE IDEA OF WHAT NIH IS, IT'S JUST RESEARCH AND WE DEAL WITH MONKEYS AND WHITE RATS AND THEY DON'T WANT ANYTHING TO DO WITH POSSIBLY DO PSAs, PUBLIC SERVICE ANNOUNCEMENTS OR LIKE JERRY WAS SAYING, IT'S A NEW AGE. QUITE POSSIBLY SOME FACEBOOK OR SOME TYPE OF NEW AGE TYPE OF COMPUTER TO LET FOLKS KNOW THAT NIH IS MORE THAN JUST LITTLE WHITE RATS AND MONKEYS AND RABBITS, THAT WE SAVE LIVES HERE. >> I THOUGHT ALL OF YOU WERE TERRIFIC. THANK YOU. [LOW AUDIO ] TRY GAIN. THANK YOU. SLIDE 10, COMPETITION OR COOPERATION IN MEDICAL RESEARCH, YOU KNOW THE SAME PEOPLE WHO DON'T KNOW THE NIH EXISTS, AND CAN'T NAME A PLACE WHERE RESEARCHERS CONDUCTED SEEM TO HAVE PERCEIVE THAD WORE MORE COMPETITIVE THAN COOPRATIVE THAN MEDICAL AND WERE QUITE POSSIBLY THEY ARE CORRECT. IN FACT WE REWARD AND THE SAME THING IN PRACTICE MANY PEOPLE ARE QUITE ANXIOUS ABOUT GOING FOR A SECOND OPINION BECAUSE THEY'RE AFRAID THE FIRST DOCTOR OR HOSPITAL WILL NOT TAKE THEM BACK. THERE'S SOMETHING FUNDAMENTALLY WRONG ABOUT THE ATTITUDES THAT PEOPLE PERCEIVE IN OUR HEALTHCARE ENVIRONMENT AND MAYBE IN THIS OUR RESEARCH ENVIRONMENT. WOULD YOU ELABORATE IN YOUR INTERPRETATIONS OF THESE FINDINGS. >> I THINK ACTUALLY THAT YOU JUST SAID IT. THAT YOU KNOW THAT THEY'RE--THE PUBLIC PERCEPTION IS REFLECTIVE OF WHAT PEOPLE SEE, FEEL, OBSERVATION. YOUR STATEMENT ABOUT NOT WANTING TO GET A SECOND OPINION BECAUSE THEY'RE AFRAID THAT THEY MAY BE EXCLUDED FROM WHERE THEY STARTED OUT, OR THERE WOULD BE A BAD ATTITUDE THERE OR SOMETHING, AND OF COURSE THIS ISN'T ABOUT SECOND OPINIONS HERE. IT'S NOT EVEN MENTIONED. LET ME JUST SAY THAT PUBLIC OPINION POLING IS AN ART. IT'S--IT'S BEEN VERY WELL STUDIED AND I THINK WE PRACTICE IT AT THE HIGHEST LEVEL BUT IT IS STILL--IT'S ABOUT PERCEPTION AND ATTITUDES. IT'S NOT ABOUT QUIZZING FOR KNOWLEDGE AND TEST THAT AGAINST, IN FACT OBJECTIVE REALITY. SO I THINK WE'VE HELPED PERPETRATE THE--THE UNFORTUNATE PERCEPTION THAT WE'RE WE AREN'T ALL WORKING TOGETHER BUT WE CAN OVERCOME IT BY SAYING THAT WE ARE AND SHOWING THAT WE ARE. IT HAS TO BE MORE THAN WORDS. IT HAS TO BE DEMONSTRATIONS AND THAT GOES TO STANDING SHOULD TORE--SHOULDER TO SHOULDER. AND IT IS UNFORTUNATE NOW, THAT AT THIS MOMENT IN TIME WHEN WE NEED RESEARCH MORE THAN EVER, WE NEED ITS TRANSLATION TO PRACTICES AND WE NEED EVERY ELEMENT OF THE RESEARCH ECOSYSTEM WORKING WELL AND FASTER IT'S UNFORTUNATELY A FACT THAT PEOPLE FROM INDUSTRY AREN'T WILLING CAN AND THEY'LL EVEN TELL US THAT TO TALK ABOUT NIH AS A PRIORITY FOR THEM AND SOMETIMES PEOPLE IN ACADEMIA ARE AREN'T WILLING TO TALK ABOUT RESEARCH AS A PRIORITY FOR THEM GIVEN THEY HAVE OTHER PRIORITIES, SAME IN INDUSTRY AND WHEN WE AREN'T ALL STANDING SHOULD TORE SHOULDER AND SPEAKING WITH ONE VOICE ON BEHALF OF THE WHOLE, WE FALL RIGHT INTO THE TRAP OF PUBLIC OPINION GOING AGAIN, TURNING AGAINST US WHEN WE MOST NEED IT MOST STRONGLY. >> JUST AS WE TALK ABOUT THAT, I THINK IT'S IMPORTANT THAT WE TALK ABOUT HOW MAIN ARE DELAYED AND HAVING TROUBLE WITH PATIENTS AND MULTIPLE IRBASKS I THINK IT WOULD BE WONDERFUL IF NIH COULD FIGURE OUT HOW TO MAKE CLINICAL TRIALS SO THAT THEY DON'T FALL BEHIND SCHEDULE, IT SAVES MONEY, AN EFFICIENT MANAGEMENT, SIMPLIFYING, INFORM CONSENT, DOING THINGS THAT PEOPLE HAVE TALKED ABOUT FOR A DECADE, MAKING THAT HAPPEN. >> AND I'D LIKE TO ADD TO THAT QUICKLY AND I TOTALLY AGREE WITH YOU AND ALL INSTITUTE VS RALLIED AROUND THIS CAUSE OVER THE COURSE OF THE LAST YEAR WITH A GROUP OF HIGH LEVEL CLINICAL RESEARCH LEADERS BANDING TOGETHER TO FIGURE OUT WHAT WE COULD DO TO ADDRESS MANY OF THOSE PROBLEMS AND I AM ACTUALLY QUITE ENCOURAGED BY THE PATH WE'RE NOW ON FOR SUCH THINGS AS CENTRAL IRBs, SUCH AS THE NEED TO BE SURE THAT THOSE WHO ARE OVERSEEING CLINICAL TRIALS HAVE BOTH THE TIME AND THE CLOUD TO MAKE SURE THAT THE TRIAL IS STAYING ON TRACK AND NOT FALLING BEHIND IN ENROLLMENT IN PLANE OTHER THINGS. SO I THINK WE'RE AT A REAL TURNING POINT HERE FOR WHAT HAS BEEN A PRETTY SERIOUS ISSUE. >> FIELD FUNCTIONS COULD JUMP IN ON THAT TOO, I DIDN'T PUT ANYTHING ABOUT CLINICAL TRIALS IN MY SLIDES BUT WE HAVE LOTS OF, YOU KNOW VERY ROBUST SET OF DATA ON PUBLIC ATTITUDES TOWARD CLINICAL TRIALS SO IT'S QUITE NEW, JUST CAME OUT OF THE FIELD THIS SUMMER AND WE'VE BEEN SHARING THAT WITH VARIOUS GROUPS, HAPPY TO SHARE IT WITH ANYBODY HERE. >> AS A MATTER OF FACT, MARY, I THINK SOME OF YOUR PREVIOUS SLIDES, I MEAN, QUESTIONS HAVE ACTUALLY ASKED THE QUESTION ABOUT REFERRALS FROM PHYSICIANS TO PATIENTS IN CLINICAL TRIALS AND THE MAJORITY SAY THEY NEVER MENTION POLITICAL TRIALS AND WHEN YOU DIG DOWN AND TRY TO FIGURE OUT WHY, IT'S BECAUSE THEY'RE AFRAID THEY WON'T GET THEM BACK AS PATIENTS SO CASE IN PAINT, IN THE DRUNK FORUM, FDA MADE THIS POINT CASE ABOUT HAVING, WELL, PERMANENT CLINICAL TRIAL SITES IF YOU WILL JUST LIKE POST OFFICES, AS JANET WOULD SUGGEST. SO MAKE THEM LIKE POST OFFICES BUT IMPROVE EFFICIENCY. YOU CAN ONLY IMAGINE IF YOU HAVE TO START UP A CLINICAL TRIAL, 10 DIFFERENT SITES AND YOU ONLY ENROLL FIVE PATIENTS PER SITE, THE COST OF THAT TIME DELAY. SO YOU'RE VERY MUCH ON TARGET AND IT'S GREAT TO HEAR THAT YOU'RE GOING TO HELP WITH THAT. AGAIN, ONE OF THE GLOBAL HEALTH NETWORKS AND SITE, IT'S PROVEN THE POINT OF HOW VALUABLE THAT IS TO HAVE NETWORKS AND CENTRALIZED SITES. CENTRALIZED IRBs. >> I HAD A QUESTION IF I MAY? D. FOR ANYONE WITHHOLD CARE TO COMMENT. WHEN I SEEK TO ADVOCATE FOR BIOMEDICAL RESEARCH ON THE HILL, I OFTEN REFORETO COMMENT OR YOUR CHART THAT SHOWS A AMERICA HAS MORE THAN ANY OTHER COUNTRY IN THE WORLD PER CAPITA ON BIOMEDICAL RESEARCH AND YET OUR LIFE EXPECTANCY IS QUITE INFERIOR. AND WHEN I RUN INTO THAT, I POINT OUT IF YOU CORRECT THOSE DATA NOT CORRECT BUT ACCOUNT FOR THOSE DATA SUCH THINGS AS HOMICIDES, USE OF ILLEGAL DRUGS AUTOACCIDENTS AND SO ON, YOU GET A QUITE DIFFERENT STORY. THE SAME PEOPLE WHO CRITICIZE THAT ARE TRYING TO CUT BACK ON THE BEEVER HAIR SCIENCE MAKE THEM IL-- BEHAVIORIAL SCIENCE AND MAKE THEM'LL AND NOT SUPPORT THEM AT ALL AND YOU HELP ME WITH--I'VE HAD NO PROGRESS ON THE SUBJECT AND I WOULD WELCOME ANY IDEAS. >> NORM FIRST OF ALL YOU'RE A SUPERB ADVOCATE AND WE'RE FORTUNATE TO HAVE YOU STABBED SHOULD TORE SHOULDER WITH--SHOULDER TO SHOULDER WITH. I KNOW WHAT YOU'RE TOG BEING AND WE HEAR ABOUT IT QUITE OFTEN, THE RESIEVANCE TO BEHAVIORIAL RESEARCH TO ECONOMIC RESEARCH, ALSO UNDER ATTACK RIGHT NOW. AND I DO THINK THAT IT'S A MISTAKE TO RUN AWAY FROM IT, WE HAVE TO ENGAGE AROUND IT. LISTEN TO THE SKEPTIC, YOU KNOW WE'RE NOT ALWAYS GOING TO CHANGE MINDS, CHANGE THOSE HEARTS AND MINDS BUT IF WE REFUSE TO LISTEN, JUST SAY, WELL, LOOK THIS IS NECESSARY, TAKE MY WORD FOR IT, THIS IS WHAT PEER REVIEW SAYS OR WHATEVER, WE'RE NOT GOING TO MAKE PROGRESS AND I THINK IT COMES DOWN TO THE ROLE OF GOVERNMENT CONVERSATION IN COMBINATION WITH ANY STATE BELIEFS AND THOSE ARE THINGS THEY DON'T THINK WE ARE GOING TO WORK OUT OVERNIGHT IN THIS COUNTRY JUST IN OVER ARCHING SENSE BUT WHEN WE CAN SHOW EVIDENCE, WE CAN SHOW WHAT HAPPENS WHEN YOU PUT BEHAVIORIAL RESEARCH TO WORK. THAT IN FACT, CAN YOU CHANGE SOCIAL NORMS AND YOU CAN MAKE SMOKING SOMETHING THAT IS OUTLAWS PRETTY MUCH EVERYWHERE AND YOU DO IT IN THE--WITH A COMBINATION OF APPROACHES, POLICIES AND OTHERWISE, BUT THOSE ARE ROOTED IN RESEARCH AND AS ONE OF OUR BOARD MEMBERS SAID TO ME ONCE, YOU KNOW KEEP IN MIND, WE'RE MAKING, DOING OUR ADVOCACY AND RUNNING INTO ROAD BLOCKS THAT ONCE THE SCIENCE IS IN, AND BEHAVIOR CHANGES 11 REASON OR ANOTHER THROUGH DRUGS, THROUGH POLICIES, WHATEVER THEN EVERYBODY FORGET ITS WAS BROUGHT TO YOU BY SCIENCE. YOU KNOW AND EVEN MAKING THAT LINK IN PEOPLE'S MINDS AND WE USE A FRAMEWORK OF THEM, NOW AND I IMAGINE, REMEMBER BACK IN THE OLD DAYS WHEN YOU KNOW PICK YOUR TOPIC, AIDS WAS A DEATH SENTENCE, YOU KNOW, NOW, WE HAVE A TREATABLE, CONTROLLABLE, EVEN PREVENTIBLE DISEASE. WELL IMAGINE IF WE CAN ERADICATE IT FROM THE EARTH. GNAW THERE'S A BEHAVIORIAL COMPONENT TO BE SURE BUT PRETTY MUCH EVERYTHING CAN COME DOWN WITH A LITTLE WORK TO THEN NOW AND IMAGINE AND CAN LINK WITH PUB LIBRARY FOUNDATION ASSPIRRATIONS AND IF--MAYBE IT'S A WAY OR SAME SOMETIME ITS WORKS AS A WATO CONVINCE THE NAY SAYERS THAT WE'RE ON THE SAME SIDE IN TERMS OF THEIR ASPIRATIONS, AND THEY DON'T WANT US TO BE A NATION WITH LOW LEVEL OF LIFE EXPECTANCY FOR ANY NUMBER OF REASONS. AND THEY DON'T WANT US TO BE A NATION OF MORBIDLY OBESE PEOPLE. HOW ARE WE GOING TO GET THERE IS NOT ALWAYS SOMETHING WE CAN AGREE ON BUT IF WE CAN, LIEN ON ASSPIRRATIONS, I THINK THERE'S HOPE. >> WELL, THANK YOU VERY MUCH FOR MODERATING THE DISCUSHION, SPECIAL THANKS TO THE PANEL. THE VARIOUS PERSPECTIVES YOU'VE BROUGHT TO US HAS REALLY BEEN REMARKABLE AND I CERTAINLY HAVE LEARNED A LOT AND WE THANK YOU SO MUCH. >> [ APPLAUSE ] YOU'RE MOST WELCOME TO A IF YOU LIKE. WE HAVE ANOTHER LITTLE BIT OF TIME TO GO ACCIDENT ONE OTHER PIECE OF BUSINESS AND THAT IS LARRY YOU WERE GOING TO TALK TO US A BIT ABOUT CURRENT STATUS OF ACTIVITIES AND THEN TALK A LITTLE BIT ABOUT FUTURE PLANNING. AND YES--NO INTRODUCTION BUT LARRY IS PRINCIPLE DEPUTY DIRECTOR OF NIH. >> THANK YOU NORM, AND GOOD AFTERNOON, SO I NOTICED THAT NORA LEER SO I WON'T TALK ABOUT FLOODS THIS MORNING SO I WOULD LIKE TO GIVE YOU A BRIEF SET OF UPDATES. AND THIS IS GOING TO BE A FAIRLY BROAD VIEW OF A NUMBER OF THINGS SO WITH ME, WHAT I WOULD LIKE TO COVER ARE INITIATIVES THAT ARE ONGOING ENHANCING TRANSLATION OF DATA INTO KNOWLEDGE AND THERE ARE TWO DIFFERENT PROGRAMS I'LL DRAW YOUR ATTENTION TO, SECOND TO DEVELOPMENT OF THE UNDERSTANDING OF THE HUMAN BRAIN AND THE BRAIN INITIATIVE, EFFORT ITS INSURE A ROBUST AND BIOMEDICAL RESEARCH COURSE AND THEN FINALLY, THE VARIOUS THINGS WE'RE DOING TO SUPPORT THE BEST SCIENCE AND DYNAMIC AND PEER REVIEW SYSTEM AND THAT WILL LEAD INTO A REAT THE SAME TIME OF THE CHARGE RELATED TO WHAT WE HOPE THE SMRB WILL NEXT TACKLE IN THIS VERY IMPORTANT SPACE OF OURS. SO WITH REGARD TO THE BIG DATA TO KNOWLEDGE BDTWO K INITIATIVE. AS I'M SURE YOU ALL APPRECIATE WE DEAL WITH A MYRIAD OF DIFFERENT DATA TYPES. YOU CAN OF COURSE BLAME MOST OF THIS ON GENOMICS AND WELL I SAID THAT DELIBERATELY, BUT OF COURSE YOU CAN PICK ANY OTHER TIME OF OMIC OUTPUT THAT YOU WISH. AND OF COURSE, NOW, THERE ARE JUSTICE EXTRAORDINARY ADVANCES IN IMAGING, BOTH AT THE CELLULAR LEVEL AS WELL AS IN THE CLINIC AND THEN PHENOTYPING IS NO LONGER JUST TAKING A BLOOD PRESSURE MEASUREMENT OR HEIGHT, BUT OF COURSE NOW, INVOLVES VERY DETAILED AND SOPHISTICATED MEASUREMENTS AND THEN THERE'S THE VARIOUS ENVIRONMENTAL EXPOSURES THAT NEED TO BE TAKEN INTO ACCOUNT AND THEN OF COURSE THE ELECTRONIC HEALTH RECORD AND SO WHEN YOU TAKE ALL OF THIS TOGETHER, ANYONE OF THESE INDIVIDUALLY IS DAUNTING BUT OF COURSE THE REALICAL SENCH TO INTEGRATE ALL OF THESE ON THE FLY TO MAKE SHOULD SORT OF CO HERENT PATTERN TO HELP US DO BETTER AT PREVENTING AND DIGITEXTING DISEASES DISEASES AND CONDITIONS. NOW JUST TO GIVE YOU ONE LITTLE SNAPSHOT OF WHAT ALL THESE DATA ARE DOING TO US IN TERMS OF USAGE, THIS IS DAILY USES FROM THE NCBI WEB SITE, SO AS CAN YOU SEE, AND THIS IS IN USERS PER MILLIONS, SO BACK IN 1998, I DON'T THINK YOU CAN CALL THAT BIG DATA, BUT TODAY WE GET 28 MILLION DAILY PAGE VIEWS, FOUR MILLION USERS, THE DOWNLOAD IS 35 TERRA BITES A DAY. SO INDEED WE HAVE COME INTO THE ERA OF BIG, BIG DATA. SO WHAT ARE WE DOING ABOUT THIS. WELL, FRANCIS CONVENED A WORKING GROUP OF HIS ADVICERY COMMIT EYE TO THE DIRECTOR. THIS WORKING GROUP THE DATA AND INFORMATICS WORKING GROUP DELIBERATED FOR OVER A YEAR. THE MAJOR THEMES IN IN REPORT INCLUDE FIRST THE ARTICULATION THAT BIOMEDICAL RESEARCH IS AT A PIVOTAL POINT AND UNLESS WE WORK HARD AT TAKING INTO ACCOUNT THE DELUGE OF DATA AND THE BEST WAYS TO INTERPRET IT AND ANALYZE THE DATA, WE REALLY RISK FAILING TO CAPITALIZE ON ALL THESE REMARKABLE TECHNOLOGICAL ADVANCES TO DO THIS WE HAVE TO HAVE CULTURAL CHANGES AND NOT ONLY HERE WITHIN NIH BUT ALSO THE MANY FOR EXTENSION, THE MANY INDIVIDUALS THAT NIH SUPPORTS IN THE EXTRAMURAL COMMUNITY. AND SOY TO DO THIS OF COURSE, YOU HAVE TO HAVE NEW OPPORTUNITIES AND APPROACHES FOR DATA SHARING AND DATA ANALYSIS AND DAT INTEGRATION AND THIS ISN'T A ONE TIME FIX. YOU DON'T JUST HAVE A SINGLE PROGRAM AND SAY, OKAY NOW WE'RE ALL DONE. WE ARE IN THIS FOR THE LONG HALL MEANING FOREVER AND WE RARELY SAY FOREVER AROUND HERE AT NIH BUT THIS IS ONE THING WHERE I THINK WE CAN BE SAFE IN SAYING THAT. SO FIRST IN TERMS OF APPROACHING THE NEW GROUP, FIRST A LEADERSHIP POSITION HAS BEEN CREATED. THE ASSOCIATE DIRECTOR FOR DATA SCIENCE, THE ACRONYM IS ADS, WHICH RESONATES WITH SOME. ERIC GREEN WHO YOU KNOW FROM THE NATIONAL HUMAN GENOME INSTITUTE IS THE ACTING A DS AND HAS BEEN REALLY CATALYZING ALL SORTS OF EXCITING FIRST STEPS IN OUR APPROACH TO THE BIG DATA PROBLEM. AMONG THESE IS THE CREATION OF ACTUALLY TWO GOVERNING OVERSIGHT BODIES, ONE IS A SCIENTIFIC DATA COUNCIL WITH REPRESENTATION ACROSS NIH WHERE ISSUES OF HOW BEST TO APPROACH THINGS LIKE INTEGRATION AND SHARING, POLICIES AND SO FORTH CAN BE ADJUDICATED AND THEN THERE IS A PARTNER DATA COUNSELS AND I WILL ADMINISTRATIVE DATA COUNCIL WHICH LOOKS MORE AT SOME OF THE INTERNAL ADMINISTRATIVE WORK THAT IS BEING DONE AND CERTAINLY THERE WAS DISCUSSION ABOUT HOW CAN WE MAKE BETTER USE OF DAT THAT THAT WE ARE ACCUMULATING AND EACH OF THESE COUNSELS CAN PLAY AN IMPORTANT ROLE GOING FORWARD AND INSURING THAT WE DO THIS IN THE BEST POSSIBLE WAY AND THEN THERE'S A TRANSNIH INITIATIVE THAT IS LARGELY EXTRAMURAL AND IN ITS CHARACTER AND BIG DATA TO KNOWLEDGE INITIATIVE AND THIS WILL INVOLVE A SERIES OF FUNDING OPPORTUNITIES FOR EXTRAMURAL INVESTIGATORS TO COME UP WITH BETTER WAYS OF APPROACHING THE GENERAL ISSUE OF WHERE IS THE DATA SO IF I DO AN EXPERIMENT AND SOMEBODY IN CALIFORNIA DOES AN EXPERIMENT WE HAVE A CAT ON LOG OF WHERE--CATALOG IS, AND WHERE THOSE ARE. HOW DO WE ACCESS THEM? HOW DO WE EXTRACT THEM IN REALTIME? PART THREE IS CAN WE DEVELOP THE ANALYTICS THAT ALLOW US TO MERGE THEM EVEN THOUGH I USE DWELVE 150 AND MY COLLEAGUE SAID DECEMBER 1st, 1950, THAT USUALLY IS A STOP BUT OF COURSE WE NEED TO OVERCOME THAT SILLINESS. AND THEN THE NOTION THAT THERE WILL BE TEAMS OF SCIENTISTS THAT WILL HAVE TO BE ENGAGES TO SOLVE SOME OF OUR REALLY BIG PROBLEMS SO IF YOU THINK BACK TO THAT SLIDE WHERE I DISPLAYED DIFFERENT TYPES OF DATA AND SAID WELL THE REALICAL SENCH TO MERGE THOSE ALL AND INTEGRATE THEM IN REALTIME THAT'S THE SCALE OF CHALLENGE WE'RE REFERRING TO SO ALL OF THESE THINGS WILL BE AT LEAST BEGUN UNDER THIS PARTICULAR EXTRAMURAL SET OF PROGRAMS. NOW ADDITIONALLY, WE ARE LOOKING AT ACTIVITIES IN THE AREA OF REPRODUCIBILITY OF SCIENCE AND I KNOW THAT THE GROUP HAS-- >> BEFORE YOU LEAVE THAT COULD YOU GO BACK. SURE. >> I LIVED THROUGH THIS IN THREE DIFFERENT CAREERS AND RIGHT NOW THAT IS WHAT MY COMPANY DOES, BOTH FROM THE ANALYTICS AND THE COMPUTATIONAL ENGINE AND I'VE ADVISED A NUMBER OF DIFFERENT GOVERNMENT ORGANIZATIONS, THERE ARE TWO THINGS I DON'T WANT TO DO TELL WHAT YOU TO DO BUT A SUGGESTION, YOU NEED AN ARCHITECT THERE'S AN DIFFERENCE BETWEEN AN ASSOCIATE DIRECTOR FOR DATA SCIENCE AND AN INFORMATION ARCHITECT. MANY ORGANIZATIONS HAVE HAD STARTS AND STOPS ON THIS VERY SUBJECT AND THERE'S A DIFFERENCE BETWEEN'S DESIRE AND A NEED FOR SOMETHING AND A VERY CAREFUL PLAN WITH A TOP LEVEL ARCH ECTOMYOSINNURE THAT GO MAKE IT HAPPEN. WITH MILESTONES IN BETWEEN AND THIS REQUIRES SKILLS THAT ARE NOT NECESSARILY HERE WITHIN THE REALM OF THE NIH AND IT'S NOT GOING TO COME FROM GIVING OUT SCIENTIFIC GRANTS. THIS IS SOMETHING THAT NEED ITS BE AT THE CORE AND YOU NEED SOME BATTLE HARDENS ADVISORS AND YOU'VE YOU'VE DONE IT, FINE BUT-- >> SO WE ARE DOING IT, ALL RIGHT? >> OKAY. >> SO IN FACT YOUR POINTS ARE SPOT ON, OF COURSE. YOU LIVED THROUGH THIS FYOU COULD TELL US HOW IT ALL ENDS UP IN THE END THAT WOULD SAVE US A LOT. [LAUGHTER] >> WELL LET ME JUST JUMP IN AND SAY IN MANY, MANY CASES IT ENDS UP BY SPENDING A LARGE AMOUNT OF MONEY, GETTING RID OF THE TEAM, BRINGING IN ANOTHER TEAM, SPENDING ANOTHER AMOUNT OF MONEY, HAVING YOUR DIRECTOR GO UP AND GET BEAT UP BY CONGRESS AND FINALLY ON THE THIRD TRY IT HAPPENS. I'M NOT MAKING THIS UP. >> NO OF COURSE WE APPRECIATE WHAT YOU'RE SAYING. ALTHOUGH AROUND HERE I'M THE ONE THAT GOES BEFORE CONGRESS AND GETS BEAT UP. BUT THAT'S WHY ERIC WAS ASKED TO SERVE AS THE PROG ELECTED DRECKOR. IF YOU THINK--THERE'S A LOT OF PARALLEL BETWEEN THE THOUGHT PROCESS THAT ONE NEEDS TO USE FOR THAT AND THIS. THAT SAID ERIC WOULD BE THE FIGHTER ONE TO SAY THAT THIS IS NOT TRULY HIS AREA OF EXPERTISE BUT UNDER FRANCIS' LEADERSHIP WE ARE VERY CLOSE TO SIGNING ON SOMEBODY WHO WOULD MEET THE EXACT TYPE OF CRITERIA YOU ARTICULATED. >> AGAIN JUST FOR THE SAKE OF REDUNDANCY HAVING BATTLE SCARS AT A CORPORATION IN THE GOVERNMENT AND IN MY OWN COMPANY, IT'S NICE TO HAVE A LEADER BUT HAVING AN EXPERT ADVISORY BOARD THAT CAN CONSTANTLY CHECK AND MEASURE IS REALLY IMPORTANT. >> AND AMONG THE VERY FIRST THINGS THAT THE PERMANENTADS WILL DO IS TO CONVENE SUCH AN EXPERT GROUP. >> PERHAPS YOU WOULD LIKE TO JOIN. >> [LAUGHTER] >> OH BY THE WAY ... >> OKAY, SO, BUT, NO, THANK YOU SO NOW NEXT TO TALK ABOUT ANOTHER WAY THAT WE WANT TO ENHANCE TRANSLATION OF DATA INTO KNOWLEDGE IS THAT RELATES TO ACTIVITIES TO ENSURE REPRODUCIBILITY OF RESEARCH FINDINGS. YOU ARE ALL FAMILIAR WITH THE MANY PUBLICATIONS THAT HAVE OCCURRED IN RECENT DAYS ON THIS SUBJECT. PART OF THIS STARTED WITH COLLEAGUES FROM INDUSTRY RAISING CONCERN, BELIEVE IT OR NOT HOW MUCH COULD WE RELY ON POETIC TECTIAL DRUG TARGETS, DRUG TARGETS, SLIP SLIDING AWAY AND SO FORTH. BUT THEN ALSO SOME DISCUSSION OF SOME OF THE SPECIFIC PROBLEMS, STATISTICAL DESIGN CONSIDERATIONS AND ANIMAL STUDIES PUBLISHED RECENTLY IN CANCER RESEARCH AND FOE FORTH. SO AGAIN NIH IS TRYING TO TAKE THIS ON, HEAD ON. WE UNDERSTAND THE ISSUES AND ARE NOW BEGINNING TO WORK ACROSS THE NIH TO FIND WAYS OF ADDRESSING THIS. FRANCIS PUT TOGETHER AN ODORS HOC GROUP INTERNAL TO NIH TO START THIS AND THE FIGHTER THING THIS GROUP HAS RECOGNIZED IS THAT THIS IS A PROBLEM OF ALL AREAS OF RESEARCH, NOT JUST SPECIFIC TYPES OF STUDIES, WHILE THIS EMERGED EARLIEST IN THE AREA OF NEUROLOGY AND BIOMARKERS RESEARCH RELATED TO CANCER IT REALLY ISN'T A SPECIFIC TO ANY OF THOSE AREAS BUT INDEED, YOU KNOW COURSES THROUGHOUT BIOMEDICAL RESEARCH THIS HAS BEEN OBSERVED IN CLINICAL AND PRECLINICAL RESEARCH ALTHOUGH WE FIND THAT THERE IS A NEED FOR GREATER EMPHASIS AT THE MOMENT THAN THE PRECLINICAL SPACE TO CLINICAL RESEARCHERS ARE MORE TUNED IN TO THESE GENERAL ISSUES JUST BY VIRTUE OF THE TYPES OF WORK THAT THEY HAVE TO DO AND TYPES OF THINGS THAT THEY HAVE TO DO TO GET THEIR STUDIES THROUGH IRBs AND SO FORTH. SO THIS HAS BEEN THE SUBJECT OF A NUMBER OF DISCUSSIONS WITHIN INSTITUTES AND AREA DIRECTORS AND ONE WAS THIS MORNING PRIOR TO YOUR MEETING STARTING. CLEARLY UNDERLYING ISSUES REINTEGRATED SERVICES CLUED CORE TRAINING OF INVESTIGATORS, LESS THAN OPTIMAL EVALUATION OF SCIENCE AND THEN FINALLY A SERIOUS OF PERVERSE REWARD INCENTIVES THAT HAVE CREPT INTO OUR SYSTEM WHICH UNFORTUNATELY MAY LEAD SOME TO YOU KNOW NOT DO AS THOROUGH OR RIGOROUS A JOB AS THEY MIGHT OAREDINAR ILLEGALSY DO. SO HOW DO WE ADDRESS THIS, WE TALK ABOUT IT. WE ARE SPEAKING TO VARIOUS ADVISORY GROUPS ABOUT THIS. WE ARE SPEAKING TO NATIONAL ADVISORY COUNCILS AND THE REASON WE'RE DOING THIS IS THAT EACH OF YOU REPRESENT YOUR HOME ORGANIZATION, AND PRESUMABLY WILL BRING THIS BACK TO THE HOME ORGANIZATION FOR FURTHER DISCUSSION, ADDITIONALLY MANY OF YOU ARE INVOLVED IN EDITORIAL BOARDS FOR JOURNALS. INDEED SOME OF YOU ARE EDITORS OF JOURNALS AND THAT TOO IS A PLACE WHERE THIS DISCUSSION NEEDS TO BE HAD SO WE'RE DOING THIS ACROSS NIH AT EACH INSTITUTE AND CENTER. WE WANT TO ENHANCE FORMAL TRAINING. WE THINK THAT THERE IS A SLIGHT GAP THAT HAS EMERGED AND BASIC EXPERIMENTAL DESIGN CONSIDERATIONS AND THE TYPE OF STATISTICS THAT ONE NEEDS TO USE TO AVOID THIS SORT OF ISSUE. WE THINK THERE ARE WAYS TO IMPROVE THE EVALUATION OF APPLICATIONS IN PART BY ADOPTING A MORE SYSTEMATIC REVIEW PROCESS SO THAT WE DON'T MISS ANYTHING IN ADVERTENTLY. EVERYBODY'S ON THERE ARE CELL PHONE, WATCHING THEIR iPHONE AND SOMEONE IS CREAMING AT YOU TO SEE MORE PATIENTS BUT YET WE HAVE TO MAKE SURE THAT WE ARE MORE RIGOROUS IN REVIEW AND THEN FINALLY TO TRY AND ADDRESS THESE PERVERSE INCENTIVES TO WORK THROUGH APPROACHES THAT MIGHT AFFORD INVESTIGATORS AN INCREASED STABILITY SO THAT THERE IS MORE OPPORTUNITY FOR THEM TO CONDUCT STUDIES AT THE HIGHEST AND MOST RIGOROUS LEVEL POSSIBLE. SO WE ARE WORKING THROUGH A SERIES OF ACTIONS, WE ARE DISCUSSING STAKEHOLDER COMMUNITIES AND SOLISIT G FEEDBACK FROM THEM AND THE OFFICE OF INTRAMURAL RESEARCH IS CREATING A NEW MODULE OF RELATED FOR RESEARCH INTEGRITY AS IT RELATES TO EXPERIMENTAL BIASES AND STUDY DESIGNS TO BE INCLUDED IN THE STANDARD ETHICS TRAINING COURSE THAT ALL OF OUR RESEARCH FELLOWS ARE REQUIRED TO PARTICIPATE IN, THIS WILL ALLOW US TO TEST THIS MODULE AND ONCE IT IS ROAD TESTED, THE OFFICE OF EXTRAMURAL RESEARCH WILL MAKE IT AVAILABLE PROMINENTLY ON THEIR WEB SITE FOR INSTITUTIONS AROUND THE COUNTRY TO ADOPT AND THEY MAY WANT TO USE IT DIRECTLY, THEY MAY WANT TO CREATE THEIR OFTEN VERSION OF IT BUT WE WILL ENCOURAGE ADOPTION EXTRAMURAL TRAINING PROGRAMS FOR ALL FELLOWS AND TRAINEES. THE INSTITUTES AND CENTERS ARE CONDUCTING A SERIES OF PILOTS, STARTING NOW, NOW THAT WE'RE BACK UP UP FOR BUSINESS, FIRST--CONSPIRE GOING TO BE LOOKING AT A WAY OF FORMALIZING THE EVALUATION OF THE SPECIFIC PREMISE OF A GRANT APPLICATIONS APPLICATIO N SO LET ME ELABORATE BRIEFLY ON WHAT THIS MEANS SO IF YOU THINK TYPICAL TWO WAY GRANT APPLICATION, THERE'S USUALLY A TWO WAY BACKGROUND AND THEN A DESCRIPTION OF WHAT THE INDIVIDUAL HOPES TO ACCOMPLISH AND THEN THERE'S THE LINK BETWEEN WHAT WAS IN THE BACKGROUND AND WHAT THEY HOPE TO ACCOMPLISH AND THE UNDERPINNINGS OF WHAT THEY HOPE TO ACCOMPLISH ARE DERIVED FROM PRIOR WORKS, LIKE THE INVESTIGATOR THEMSELVES, SOMETIMES FROM OTHER INVESTIGATORS AND WHAT WE RARELY FORMALLY EVALUATE WHAT THAT UNDERPINNING IS. SO IF YOU TAKE THE EXTREME WORST SCENARIO, ONE WOULD PROPOSE A CLINICAL TRIAL BASED UPON SIX PUBLISHED ANIMAL STUDIES, ALL OF WHICH WERE UNDER POWERED INAPPROPRIATELY DESIGNED BUT YET IN FACT, THE RESULTS WERE POSITIVE, WOULD WE WANT TO BELIEVE THAT THE CLINICAL TRIAL IN HUMANS IS THE THING TO DO NEXT? AND SO SEVERAL ICs ARE GOING TO FORMALIZE THIS BY HAVING SOMEONE SCIENTIFICALLY LOOK AT THE UNDERLYING PREMISE OF THE APPLICATION. OTHER INSTITUTES WILL BE USING CHECK LISTS TO AID IN A MORE SYSTEMATIC EVALUATION OF THE GRANT APPLICATION, HERE THE CONCERN HAS BEEN EXPRESSED BY BASIC RESEARCHERS, IF YOU GO OVER THE CHECK LIST WILL YOU NOT BUMP UP AGAINST INNOVATION AND CREATIVITY, BECAUSE OBVIOUSLY IF YOU IN FACT HAVE A PARADIGM SHIFTING PROPOSAL, IT'S NOT GOING TO FIT ANY OF YOUR CHECK LISTS AND WE NEED TO UNDERSTAND THAT, WE NEED TO APPRECIATE THAT, BUT NEVERTHELESS, THERE ARE MANY TYPES OF RESEARCH WHERE DOING A SYSTEMATIC EVALUATION TO MAKE SURE THAT EACH OF THE BASES HAVE BEEN COVERED WOULD BENEFIT FROM, SO THEY'RE GOING TO BE PILOTING THAT APPROACH, CHANGE TO BIOSKETCH SO I'M OLD ENOUGH TO REMEMBER WHEN YOU WERE PROMOTED BASED OFFICE OF DIVERSITY THE WEIGHT OF YOUR CURRICULUM VITA THAT IF YOU HAD MORE THAN 18-POUNDS YOU'RE A PROPROFESSOR, SO WE GOT KNOW AWAY FROM THAT. BUT WE'VE EXPLAINING WHAT AN INDIVIDUAL'S WORK IS ABOUT, ECHICIZING THE TOP NUMBER, FIVE, 10, PAPERS THAT THE INDIVIDUAL HAS PUBLISHES THAT THE PUBLISHED SO CHANGES TO THE BIOSCHEDDULE WILL ENABLE TO THE INVESTIGATOR TO PUT INTO CONTICKET HIS OR HER WORK PRESUMABLY LESSENING THE NEED TO PUBLISH PAPERS THAT ONE HOPES AND PUT MORE EMPCISE ON IMPORTANT AND SIGNIFICANT PAPERS THAT ARE DONE WITH GREAT RIGOR MPLET APPROACHES TO PRODUCING AND HAVE LONGER MORE STABLE SUPPORT FOR OUR INVESTIGATORS SO SOME INSTITUTE VS GONE TO THE STEP OF SAYING THERE WILL BE CERTAIN TYPES OF RESEARCH THAT THEY WILL PROVIDE FUNDS FOR TO REP--REPLICATE STUDIES TO MAKE SURE THEY'VE BEEN REPLICATED, IT'S AICALICAL THEANCH SEVERAL COUNSELS AND BUDGETARY STRESS WE'RE IN SO IF YOU DO THE CALCULUS SO I'M MAKING UP NUMBER FIST YOU HAVE TO SPEND TWO MILLION DOLLARS REPEATING THREE PRECLINICAL ANIMAL STUDIES TO INSURE REPRODUCIBILITY, WEIGHT AGAINST THE 30 MILLION DOLLARS THAT THE HUMAN CLINICAL TRIAL WOULD COST, CLEARLY, I THINK YOU CAN SEE THAT THOSE REPRODUCIBILITY STUDIES MIGHT BE APPROPRIATE AND INDEED COST CONSCIOUS. SO SEVERAL INSITUDEITUTES AND--INSTITUTES AND CENTERS WILL PILOT THIS. ADDITIONALLY WE WILL CONVENE MEETINGS WITH EDITORS STUDY SECTION CHAIRS AND BSC CHAIRS TO RAISE AWARENESS WITH THEM AND TO WORK FOR CLOSELY WITH JOURNAL EDITORS. SOME JOURNALS NOTABLY NATURE, THE NATURE FAMILY OF JOURNALS AND SCIENCE HAVE REALLY EMBRACED THIS CONCERN AND PROBLEM AND THE NATURE JOURNALS IN PARTICULAR HAVE ADOPTED A VERY SPECIFIC SERIES OF STEPS THEY'RE NOW USING FOR THE JOURNAL IN NATURE. BUT WE NEED TO EXPABD THOSE JOURNALS. NOW JUST SWITCHING GEARS ACCEL WAITING DEVELOPMENT OF THE HUMAN BRAIN, THE SO CALLED BRAIN INITIATIVE, I THINK WE DON'T HAVE TO BELABOR THIS BUT BRAIN DISORDERS OBVIOUSLY AFFECT ALL OF US. NEURODEGENERATIVE DISORDERS OF MANY TYPES, THE ANNUAL COST OF DEMENTIA IN THIS COUNTRY IS ABOUT 200 BILLION DOLLARS. EARLIER YOU HEARD ALL SORTS OF DIRE ECONOMIC PROJECTIONS AND IN LARGE PART DRIVEN BY NEURODEGENERATIVE DISORDERS, COGNITIVE AND DEFECTIVE ORDERS SIMILARLY ARE DEVASTATING IN THE MANIFESTATION. NEURODEVELOPMENTAL DISORDERS, AUTISM OF COURSE FRONT AND CENTER FOR SO MANY OF PEOPLE IN THIS NATION AND THEN OF COURSE, INJURY AND INSULT IN THESE DISORDERS, WE'RE ALL AWARE OF THE TERRIBLE [INDISCERNIBLE] OF PTSD PARTICULARLY AMONG SERVICE MEN AND WOMEN. SO, THESE ARE SERIOUS, SERIOUS CONDITIONS AFFECTING US ALL DIRECTLY OR INDIRECTLY. THE GOALS OF THIS BRAIN INITIATIVE ARE LISTED HERE. REALLY IT'S TO TAKE ADVANTAGE OF THE EXPLOSION OF NEW AND INNOVATIVE TECHNOLOGIES THAT HAVE COME AVAILABLE TO CONSTRUCT THE DYNAMIC PICTURE OF GREEN FUNCTION THAT INTEGRATES NEURONAL CIRCUIT ACTIVITY OVER TIME AND SPACE. SO THE STATE-OF-THE-ART NOW, OF MEASURING SIGNAL FROM ONE NEURON AT A TIME NOW THE GOAL WILL INTEGRATE ACROSS MULTIPLE NEURONS, MULTIPLE, HUNDREDS, OF THOUSANDS, AND THIS IS ALL BUILT UPON THIS GROWING SCIENTIFIC FOUNDATION OF INTERDISCIPLINARY WORK ENCOMPASSING THE NEURAL SCIENCES, GENETICS SCIENCES, PHYSICS ENGINEERING, NANO SCIENCE AND SO FORTH REMARKABLY IF YOU THINK ABOUT 30 YEARS THESE TERMS WERE JUST EMERGING AS TERMS AND NOW OF COURSE THEY'RE PART OF THE LEXY CONAND THEY'RE ALL NEEDED TO REALLY UNRAVEL THE REMARKABLE MYSTERIES THAT LAY BEFORE US IN TERMS OF BRAIN FUNCTION. FRANCIS AS CREATE AID VERY HIGH LEVEL WORKING GROUP OF HIS ADVISORY COMMITTEE, THE BRAIN WORKING GROUP THEY IN RECORD TIME PROVIDED A SERIES OF HIGH PRIORITY RESEARCH AREAS FOR FISCAL YEAR 14, YOU CAN JUST SCAN THROUGH THOSE MORE RAPIDLY THAN I CAN READ THEM OUT TO YOU. SADLY WE WILL NOT HAVE RESOURCES TO TOUCH EACH ONE OF THESE NINE--IT DOES GIVE YOU A BREDTH AND SCOPE OF THE CHALLENGES BEFORE US SO THIS IS A VERY, VERY, EXCITING TIME, NOT ONLY FOR NEUROSCIENCE COMMUNITY BUT FOR ALL OF BIOMEDICAL RESEARCH. THIS OF COURSE DOFF TAILS SIGNIFICANT AND IMPORTANT WAY WITH THE BIG DATA INITIATIVE BECAUSE AFTER ALL THE BIGGEST BADDEST COMPUTER OF ALL IS THE HUMAN BRAIN. AND VOLLEYBALLSLY IN ORDER TO BE ABLE TO DO THESE THINGS YOU WILL REQUIRE A COMPUTATIONAL APPROACHES, THE LIKES OF WHICH WE HAVEN'T SEEN BEFORE AT LEAST IN BIOMEDICAL RESEARCH. SO REALLY THE TIME IS RIGHT FOR THESE TWO CO OCCUR SIMULTANEOUSLY. WHAT I'M WE'RE GOING TO NEED ALL SORTS OF GREAT SCIENTISTS TO DO THIS AND MANY TYPES OF OTHER WORK, THAT WE HAVE IN FRONT OF US, WE HAVE INITIATIVES TO INSURE ROBUST AND DIVERSE BIOMEDICAL WORKFORCE, THERE'S A GROUP RELATED TO THE BIOMEDICAL RESEARCH FORCE AND THEY ARTICCULED A SERIES OF CHALLENGES THEY THINK ARE ALL-TOO FAMILIAR TO THIS GROUP. THEY NOTED THAT IT'S INCREASINGLY DIFFICULT TO LAUNCH INDEPENDENT AND THEY'RE STAYING TOO LONG AND THIS WEEK'S INCREASINGLY DIFFICULT FOR YOUNG PEOPLE TO LAUNCH THEIR INDEPENDENT CAREER. THE ECONOMIST TWO TOOK A SWING AT THIS HAD AN INTERESTING PERSPECTIVE AND THAT IS THEY SAY YOUNG PEOPLE LOOK AT ENTRY LEVEL SALARIES THAT WE PAY FOLKS IN BIOMEDICAL RESEARCH AND THEY SAY LOOK THESE ARE RELATIVELY LOW SALARIES IF YOU COMPARE THEM TO OTHER FIELDS OR OTHER PROFESSIONS AND INDEED THERE'S THIS VERY, VERY, LONG TRAINING TIME AND SO ON BALANCE THIS MAKES BIOMEDICAL RESEARCH LESS ATTRACTIVE THAN SOME OF THESE ALTERNATE CAREERS AND WE NEED TO ADDRESS THAT AND THEN THIS THEREY AT NOTION THAT THE TRAINING PROGRAMS ARE LARGELY DESIGNED TO CREATE COPIES OF US. THE TRADITIONAL ACADEMIC WHOLE BE THE PROFESSOR AT THE UNIVERSITY AND THERE'S LITTLE ACKNOWLEDGMENT THAT MANY OF OUR Ph.D.s WILL NEED TO FIND EMPLOYMENT IN SCIENCE BUT OUTSIDE OF THE TRADITIONAL ACADEMIC RUBRIC. AND> SO, LAUNCHED INITIALLY IS THE EP-SEVEN BEST PROGRAM. THEAC KRONE IMPEDIMENTS STANDING FOR BROADENING EXPERIENCES IN SCIENTIFIC TRAINING. THIS IS AN NIH COMMON FUND PROGRAM THAT YAI WE HAVE--YEAH THAT WE HAVE GREAT ACRONYMS, I'LL TELL YOU. AWE THE CLEVER ONES FRANCIS DREAMS UP SO I HAVE TO GIVE HIM CREDIT SO THIS PROGRAM, LOOK FOR NEW AND INNOVATIVE APPROACHES TO COMPLEMENT WHAT WE ALREADY DO IN TERMS OF OUR TRAINING EFFORTS AND REALLY THE IDEA IS TO PREPARE OUR Ph.D. TRAINEES AND POST DOCTORAL TRAINEES TO DO THINGS OTHER THAN THE SORT OF TRADITIONAL MODEL THAT ALL OF US GREW UP WITH AND THE FIRST ROUND OF THESE WERE ANNOUNCED IN SEPTEMBER, SEPTEMBER 23rd AND AS YOU CAN SEE, ALL OF THESE WILL REQUIRE EVALUATION TO DEPRIVATIONON STRAIGHT WHAT IMPACT THEY DO SUCCEED IN HAVING. THERE'S A WHOLE OTHER SERIES OF WORKFORCE INITIATIVES TO IMPROVE GRADUATE STUDENT AND POST DOCTORAL TRAINING AND INCREASING POST DOCTORAL DOCTORAL STIPENDS FULL DISCLOSURE, MY KID A A POST DOC I'M REALLY GLAD ABOUT THAT ONE. CONSIDER POLICIES ON BENEFITS, WHICH ARE NOT UP TO WHERE THEY NEED TO BE FOR YOUNG PEOPLE LIVING ON STIPENDS. SO THE COMPREHENSIVE TRACKING OF TRAINEE SYSTEM ACTUALLY ONE OF OUR GREATEST SHORT COMINGS. YOU WOULD THINK THAT WE WOULD BE ABLE TO TRACK PEOPLE FROM THE TIME THEY INTEREST A LAB, YOU KNOW AS A HIGH SCHOOL STUDENT TO THE TIME THAT THEY THEY RETIRE FROM WHATEVER IT IS THAT THEY'RE DOING AND EVERYTHING IN BETWEEN AND WE DON'T HAVE A WAY TO TRACK THAT SO A GREAT DEAL OF EFFORT IS DEVELOPING FOR TRAINEES IN PARTICULAR AND IN PARTICULAR THIS IS A TRANSGOVERNMENTAL SCIENCE CV WHY A UNIQUE IDENTIFIER WILL BE PROVIDED AND THAT WILL ENABLE US TO TRACK THINGS AND THAT'S IMPORTANT BECAUSE IN THE PAST PEOPLE ENTERED THE SYSTEM AND STAYED IN THE SYSTEM--BLOOD PRESSURE WAY UP BUT NEVERTHELESS, WE HAVE TO OPEN UP THAT CONVERSATION AGAIN. CONTRACT WE MADE WITH ACADEMIC HEALTH CENTERS WE MADE YEARS AGO NEEDS SOME UPDATES SHALL WE SAY. AND SO THESE ARE THE MANY INITIATIVES THAT ARE ONGOING ALL OF WHICH ARE DESIGNED TO APPROVE WORKFORCE ISSUES. BUT AS PART OF THIS ALSO, WE HAVE TO KEEP IN MIND THAT THE BIOMEDICAL RESEARCH WORKFORCE DOESN'T LOOK LIKE OUR NATION. IT SORT OF LOOKS LIKE ME. AND WE NEED TO DO BETTER THAN THAT AND WE NEED TO BE ABLE TO ENCOURAGE PEOPLE FROM ALL PORTS OF OUR NATION WITHOUT REGARD TO GENDER, ETHNICITY, AGE, SOCIOECONOMIC STATUS, WE NEED TO ENGAGE THE BEST MINDS REGARDLESS OF WHERE THEY ARE IN OUR NATION AND WE'RE HARD AT WORK TO TRY TO ENHANCE OUR ABILITY TO DO THIS. A WORKING GROUP OF THE ACD WORKED FOR 18 MONTHS ON THIS CLYDE YANCY WHO SEEMS TO BE ON MANY OF THESE BOARDS I DON'T KNOW WHAT YOU DID IN A FORMER LIFE BUT THANK YOU FOR BEING ON ALL OF THESE THINGS. WAS DEEPLY INVOLVED IN THIS. WE HAVE A SERIES OF DIFFICULT CHALLENGES AHEAD OF US. THE FIRST IS NO ONE SET OF INITIATIVES, NO MATTER WHAT WE DO, NO ONE SET OF INITIATIVES IS GOING TO TRANSFORM OUR WORKFORCE INTO ONE THAT IS MORE REFLECTIVE OF OUR NATION. AND AT THE VERY TIME WE HAVE TO REACH OUT TO COMMUNITIES THAT ARE HISTORICALLY UNDERREPRESENT INDEED SCIENCE AND POINT OF FACT, WE HAVE LOST THE TRUST OF MANY WITHIN THOSE COMMUNITIES AND SO WE HAVE TO REBUILD THAT TRUST. AND THIS IS SOMETHING THAT TAKES TIME AND EFFORT AND NO MATTER WHAT NIH DOES AND SO MARRY HOW SUCCESSFUL NIH IS AT THEIR END, OBVIOUSLY FOR THIS WORK, WE HAVE TO HAVE COLLABORATION AND COOPERATION WITH ALL THE EXTRAMURAL PARTNERS. THE SEAT CHANGE IS THE ARTICCULE BY ALL INSTITUTE AND CENTER DIRECTORS THAT DIVERSIFYING THE NIH FUNDED WORKFORCE AND INSURING FAIR PEER SEE--PEER REVIEW, IT'S THE JOB OF EVERYBODY SO WE ALL BENEFIT. SO WHAT ARE WE DOING TO TRY AND MEET THESE VERY IMPORTANT GOALS. WE HAVE FOREINTERRELATED APPROACHES, THE NIH BUILDING INFRASTRUCTURE, LEADING TO DIVERSITY PROGRAM, BUILD WHICH IS A PROGRAM THAT SEEMS TO ENHANCE THE PIPELINE AT THE POINT OF INTERSECTION WHERE WE THINK NIH CAN HAVE THE MOST IMPACT, NAMELY THE TIME WHEN YOUNG PEOPLE IN COLLEGE ARE DECIDING WHETHER OR NOT TO PROCEED TO GRAD EDUCATION. THE DROP OFF POINT BETWEEN INDIVIDUAL WHO IS ARE MAJORING IN THE SCIENCES WHICH LOOKS LIKE A SOMEWHAT DIVERSE COHORT AND THEN IT IS CORHOOTER THAT WINDS UP GETTING PH Ds AND BIOMEDICAL RESEARCH RELEVANCE PROGRAMS IS DRAMATICALLY DIFFERENT. SO THE DATA THAT I--THAT STICKS IN MY MIND IS WE PRODUCE ABOUT 500 PH Ds RELATED TO BIOMEDICAL SCIENCE FROM MEMBERS OF UNDERREPRESENTED GROUPS EACH YEAR. 500. YOU KNOW WE JUST GOTTA DO MUCH, MUCH, MUCH, BETTER. THE NATIONAL RESEARCH MENTORING NETWORK, AN APPROACH TO AUGMENT WHAT IS BEING DONE LOCALLY, WE UNDERSTAND THAT MENTORING IS BEST DONE AT HOME BUT ALL AVAILABLE DATA SUGGESTS THAT IT'S NOT SUFFICIENT PARTICULARLY FOR NUMBERS ON THE UNDERREPRESENTED GROUP. INCREASING FAIRNESS AND PEER REVIEW. SEPARATE SUBGROUP OF THE ACB WORK GROUP ON DIVERSITY IS MEETING TO INSURE THAT WE ARE THAT WE ARE LOOKING AT THIS IN THE MOST RIGOROUS WAY POSSIBLE. AND FINALLY ENGAGEMENT BY ALL NIH LEADERSHIP AND ENGAGEMENT AND RECRUITMENT FOR CHIEF SCIENTIFIC OFFICER FOR DIVERSITY AND WE THOUGHT LONG AND HARD ABOUT THIS BECAUSE SOME ORGANIZATIONS WHEN YOU HAVE SOMEBODY FILLING A ROLE LIKE THIS, ALL DIVERSITY ISSUES BECOME THAT PERSON'S PROBLEM AND THEN EVERYBODY WIPES THERE HANDS AND SAY, OKAY, WE'RE DONE NOW. RAUGHTIER WE WANT THIS INDIVIDUAL TO BE ABLE TO COME TO NIH TO CAD LIARS WORKING COLLABORATIVELY OF COURSE ALL INSTITUTES AND CENTERS AND FULLBACKING AND PREMATURE OF THE NIH DIRECTOR TO REALLY ENHANCE THINGS THAT WE'RE DOING IN THIS--THAT WE'RE DOING HERE AND SO THAT LEADS ME TO THE FINAL FINAL THING I WOULD LIKE TO TALK TO YOU ABOUT AND THAT'S HOW WE SUPPORT THE BEST SCIENCE THROUGH A DYNAMIC ANDENTIOUS FICIENT PEER REVIEW SYSTEM--EFFICIENT PEER REVIEW SYSTEM. I WILL DO A QUICK BACKGROUND ON PEER REVIEW, TELL BUT ONGOING EFFORTS BECAUSE IT'S VERY IMPORTANT FOR THIS GROUP AS WIEWR BEGINNING TO EMBARK ON YOUR NEW CHARGE TO UNDERSTAND WHAT'S ALREADY GOING ON BECAUSE WE WANT TO MINIMIZE DUPLICATION AND MINIMIZE THE CROSS PURPOSE TYPE OF THING THAT CAN EMERGE AND WE WANT TO LEARN FROM ONE ANOTHER SO MANY REASONS IT'S GO TO KNOW BLOOD SAMPLE THE EFFORTS SO I THINK YOU'RE ALL QUITE FAMILIAR WITH THE TWO TIER SYSTEM WE USE AND IT IS INDEED THE GOAL OF ALL EXTRAMURAL RESEARCH, AND WE CAN'T REST ON THE LAURELS AND WE HAVE TO INNOVATE AND OPTIMIZE THIS PROCESS. YOU HEARD ABOUT THE SHUT DOWN IMPLICATION IF WE LOOK AT THISIE YEARLYY BASES WE REVIEW 70-80,000 APPLICATIONINGS WE HAVE ABOUT 23,000 REVIEWERS AND WE 2500 MEETINGS AND THAT'S WHY WHEN YOU SHUT DOWN DURING A CRUCIAL TIME--THE ORIGES OF THIS ARE WITHIN THE PUBLIC SERVICE ACT AND IT REQUIRES WRITTEN RESEARCH UNDER REVIEW--THAT SPEAKS TO WHERE WE ARE GOING TO ASK YOU TO TAKE A PARTICULAR LOOK SO WE ARE INVOLVED IN A CONTINUOUS REVIEW OF PEER REVIEW THE PEER REVIEW ENHANCE REPORT, THE LAST ONE IS DISPLAYED HERE, WE ARE DOING SURVEYS, A FEW BUMPS IN THE ROAD BUT I THINK PEOPLE ARE NOW EITHER USED TO OR HAPPY WITH THE NEW SYSTEM OF SCORING AND GRANT APPLICATION SHORTENED AND SO FORTH, I MENTIONED A FEW MOMENTS AGO THEY HAD A SUBGROUP OF ACD GROUP ON WORKING DIVERSITY THAT IS SPECIFICALLY LOOKING AT PEER REVIEW TO INSURE BEING DOWN WITH FAIRNESS AND--LOOK AT THIS IN A SCIENTIFIC WAY, WE ARE PLANNING TO PILOT DIFFERENT FORMS VAL DAD THE IMPLICITY BIAS PILOT THOSE PROGRAMS WITH THE STUDY SECTION, BOTH OF THIS IS IN DIRECT RESPONSE FOR RECOMMENDATIONS MADE BY THE ORIGINAL ACT WORKING ON THEM. AND WE HAVE ONGOING EFFORTS TO DEVELOP NEW APPROACHES FOR INSURING NIH PEER REVIEW IS A DYNAMIC PROCESS THAT'S RESPONSIVE TO IMPORTANT AND IMPORTANT TRENDS IN OPPORTUNITY THIS IS TOUCHES UPON WHAT YOU ALL HAVE BEEN AND HARD WORK THAT YOU'RE COMMITTEE HAS BEEN DOING. THE CHALLENGE OF COURSE IS THAT AND CONCONSTRUCT RESEARCH AND EVERYBODY WANTS TO KNOW IF THAT'S IMPORTANT RESEARCH OR NOT, NOBODY WANTS TO WAIT UNTIL 10-15, TWEBT OR 30 YEARS FOR LONGER THAT NO ONE NEEDS TO WAIT TO MAKE THAT DETERMINATION, IF YOU WANT AN ALEGORITHMS THAT TELLS YOU WHEN YOU GET AN APPLICATION, THIS WILL GIVE YOU IMPORTANT RESULTS. AND I KNOW THAT YOU ALL HAVE BEEN WRESTLING WITH THIS, AND YOU HAVE BEEN WRESTLING WITH THE PROBLEM, AND THE RESEARCH, HOW DO WE DESCRIBE HOW IMPORTANT OR NOT IT'S BEEN SO WE HAVE BEEN EXPLORING WITHIN NIH, A VARIETY OF PROGRAMS, BOTH QUANTITATIVE AS WELL AS QUALITATIVE TO HELP US WITH SORT OF UPFRONT ASSESSMENT AND SO WHAT WE'RE TRYING TO DO IS WE'RE TRYING TO TAKE SOME OF THESE QUANTITATIVE APPROACHES--SO STAY TUNED WE'LL HAVE MORE TO SAY ABOUT THAT. SO HERE WE ARE WE'VE GOT THESE APPROACHES AND TRY AND DEVELOP METHODS TO IDENTIFY EMERGING FIELDS OF SCIENCE. SO WHAT WOULD HAVE BEEN GREAT IF ONE YEAR BEFORE RNAi BECAME IMPORTANT WE HAD FIGURED THAT OUT. NOW EVERYBODY AROUND THE TABLE WOULD HAVE LIKED TO DO THAT BUT THERE IT IS. AND THEN OF COURSE FIGURING OUT WAYS OF COUPLING WHERE SCIENCE IS. EITHER REALLY HOT OR MORE. THERE'S THE OTHER SIDE OF THE COIN THAT WE RARELY TALK ABOUT, BUT HAPPEN WHEN IS A FIELD OF SCIENCE IS PASSED ITS PRIME. WHAT HAPPENS WHEN WE--YOU KNOW HAVE GOTTEN THE POINT WHERE FIELD OF SCIENCE NEEDS TO CONTRACT SO WE'RE LOOKING AT BOTH OF THESE SUCH THAT WE CAN KEEP OUR STUDY SECTIONS ORGANIZED IN A WAY BECAUSE THIS IS A DYNAMIC SYSTEM WE HAVE BEEN FINDING IT DIFFICULT TO FIND APPROPRIATE REALTIME MEASURES OF THIS, SO THAT'S REALLY THEWILL CALFERG THAT THIS GROUP IS WORKING ON. SO ALL THE BACKGROUND THAT'S ALL THE STUFF THAT'S GOING ON, HERE'S WAWE WANT THE SMRB TO DO AND THIS IS COMPLIMENTARY TO WHAT'S AT STAKE FOR THE ONGOING EFFORTS SO WE WILL COMMUNICATE SO YOU KNOW WHAT THE OTHER GROUPS ARE DOING AND YOU WILL KNOW WHAT THEY WERE DOING. ALL OF THIS EVENTUALLY GETS FED UP TO THE ACD WORKING GROUP BUT WE WON'T BE BRIEFING YOUOT OTHER GROUPS AND CONVERSELY, WE WILL BE BRIEFING THEM ON WHAT YOU ARE DOING. THE CHARGE TO THIS GROUP IS TO FOCUS ON STREAM LINING AND SHORTENING THE PROCESS WHILE MAINTAINING HIGH QUALITY REVIEW. NOW RICHARD NAKAMURA AS HE SAW ME THIS MORNING SAID NOW PLEASE TELL SMRB WHEN THEY'RE THINKING ABOUT HOW TO STREAM LINE AND SHORTEN THE PROCESS THAT THEY SHOULDN'T USE THE EXPERIMENT THAT WE'RE NOW ENGAGED IN AS EVIDENCE THAT WE CAN DO THIS ALL THE TIME, BECAUSE INDEED HE ARGUED SO I'M JUST A MESSENGER NOW, INDEED HE ARGUE THAD BECAUSE WE HAVE A LITTLE FLEX IN OUR SYSTEM, IT ALLOWS US TO STAND UP AND BE ABLE TO AND BE ABLE TO ACCOMMODATE WHAT IS TRULY AND UNUSUAL AND EXTRAORDINARY SITUATION. ABSENT THAT FLEX AND IT WOULD HAVE BEEN NO WAY TO BE ABLE TO ACCOMPLISH THIS. SO ANYWAY, WITH THAT IN MIND. SO, WE'VE GOT A RESEARCH ENTERPRISE THAT IS FACING ALL SORTS OF CONSTRAINTS AND YOU SPENT THE ENTIRE DAY HEARING ABOUT THIS. BUT YET, IT'S THE BEST TIME TO DO SCIENCE AND I MEAN EVERYBODY UNDERSTANDS THAT HOW DO WE RECONCILE THAT. SO PLEASE, WE WANT YOU TO RECOMMEND WAYS TO OPTIMIZE OUR PROCESS FOR REVIEWING, AND AWARDING GRANTS. THE SCOPE OF DELIBERATIONS ARE FOCUSED ON WAYS IN WHICH WE CAN STREAM LINE THE PROCESS AND MAKING IT FROM ALLOICATION TO ALLOCATION OF FUNDS BECAUSE WE DON'T WANT GREAT IDEAS JUST SITTING THERE WAITING, LYING IN FALLOW AND TWO TO ADDRESS THE ADMINISTRATIVE BURDEN ON APPLICATIONS AND SCIENTIFIC REVIEW COUNSEL MEMBERS AND NIH STAFF, ALL OF WHICH ARE BEING PUT INTO A PRESSURE CHAMBER THESE NEXT FEW WEEKS WHILE MAINTAINING AND THIS IS THE KEY, WHILE MAINTAIN AG I HIGH QUALITY REVIEW PROCESS. BUT WE DON'T COME TO YOU WITH THE E. C. CHALLENGES SO THAT'S WHY WE THINK YOU ARE THE BEST GROUP TO HELP WITH US THAT AND THEN FINALLY TO RECOMMEND STRATEGIES AND OPTIONS FOR IMPROVING THE PROCESS, AND THEN GIVE US THE RATIONAL FOR RECOMMENDATION BECAUSE WE WILL HAVE TO DEFEND THEM NO DOUBT. OKAY, WITH THAT, THANK YOU AND WE'LL OPEN IT UP FOR DISCUSSION. OKAY. GAIL? >> THANK YOU. THAT REALLY IS A GREAT UPDATE ON ALL THE THINGS CURE WORKING ON, YOU WILL BE BUSY. ANY QUESTIONS--AND SO I WONDER AS FAR AS ROLE OF THE SMRB AND THE CHARGE YOU'VE GIVEN IT ARE YOU ASKING THAT THEY ALSO LOOK AT THIS ISSUE OF THE QUALITY OF THE REVIEW, OR YOU'RE ASSUMING THE QUALITY IS AS GOOD AS IT CAN BE, THAT DOESN'T NEED TO BE CHANGED THEN YOU'RE SAYING, YOU KNOW HELP US IMPROVE EFFICIENCY AND REPPATIVITY WITHOUT GIVING UG JESTIONS ABOUT MAIN [INDISCERNIBLE]. AND SOME OF THE THINGS THEY'RE LOOKING AT, AND SO, AND THAT WOULD BE AN AREA OF OVERLAP AND SO YOU MIGHT WANT TO STEER CLEAR OF THAT, BUT IF THERE IS SOMETHING OBVIOUS THAT COMES OUT WE WILL LISTEN TO THAT BUT THAT IS SOMETHING THAT IS CENTRAL TO WHAT THE ENHANCEMENT AND PEER REVIEW INITIATIVE IS. >> YEAH I WOULD HATE TO SEE US RILE THAT OUT GIVEN THE IMPORTANCE ANY OTHER COMMENTS? >> HEARING NONE, I THINK LARRY THANK YOU VERY MUCH. >> WE'VE REACHED THE WITCHING HOUR, 25 MENUTES AHEAD OF CENTRAL STANDARD TIME AND WE'RE IN TROUBLE. IN ANY EVENT I THINK IT'S BEEN A REMARKABLE DAY WE'VE COVERED A GREAT DEAL, TOMORROW I THINK WE START AT 8:30 AM I RIGHT ABOUT THAT, OKAY? SO IF THERE ARE NO FURTHER COMMENTS, WE WILL ADJOURN UNTIL