 Well, good afternoon, everyone. I'm Eric Green, Director of the National Human Genome Research Institute, and I want to give my own welcome to all of you to this closing symposium, as we are calling it. Before I get into what I want to do in framing this symposium, I wanted to give my own thanks first to Jonathan and other members of the National Museum of Natural History for this wonderful three-year partnership we now have had with them and will continue to have. Not only the exhibition, which was fantastic and is fantastic, but also the various collaborative projects we're doing with them, scientific in some cases, and then programmatic, such as these series of symposia that we've put on and other things that we've done jointly with them. Obviously, I want to also thank Johnson and Johnson, SEMA, and her colleagues for sponsoring this event, for being a major donor to the exhibition. And while I'm at it, I should thank all the other donors without having the kind of corporate and private support to raise money to put the exhibition on. It would have never happened. And also a special thanks to the Foundation for NIH, which are our partners and helped raise the money necessary for making the exhibition come to pass. So what I was asked to do and planned to do was really to frame the day. And in order to frame the day for this symposium, there's really two things I want to accomplish. I want to, first of all, tell you really about why we're here. What are we celebrating in this symposium? And in essence, we're celebrating the end of a run of the exhibition in this building. So I want to tell you the story about this exhibition. And then the second thing I want to do is to tell you a little bit about the science to frame the discussion that we're going to have. We chose to focus on human health and medicine and how genomics has great potential to change many of the aspects of how we practice medicine. So I want to frame that a little bit so that you understand the context for the subsequent conversations. So first, I want to drill a little deeper. Jonathan introduced the exhibition. But there is a story behind it. It didn't just happen by accident. And there really is a story to be told about this exhibition that I think is worth knowing, especially with the motivation that we and the museum and the Smithsonian has around public engagement, public education, and science literacy in general. I became director of the National Human Genome Research Institute almost five years ago. I've been involved in genomics for a little over a quarter century. But when I became director, one of the things I turned to my staff and in particular members of an education group we have at the Institute, and I said, we should really think about ways we could do more to engage the public and to educate people about genomics. And we said, you know, we're really close by to the Smithsonian and they know what they're doing. Why don't we go have a conversation with them? And so we were fortunate enough to actually have a first meeting with the Smithsonian. We went right to the top, and fortunately, the top actually was willing to meet with us. And a small group of us met with Dr. Wayne-Clough, who's currently the secretary of the Smithsonian Institution and his staff. And we just started talking about genomics and we started talking about our mutual interests. We came up with three basic elements of why there would be a great potential for a wonderful partnership. And indeed, the partnership was born. We recognized that these two great federal institutions were remarkably close to one another, really only about 10 miles apart as a crow would fly. We also had mutual interest in genomics, both from a research point of view, which of course were a research institution. But there's, as Jonathan said, a lot of research going on in the Smithsonian and a lot of genomics. And that was growing. But of course, we also had mutual interest in genomic literacy and in genomic knowledge and public education. And as we talked and we thought about it, the secretary turned to me and said, well, isn't there something we might want to commemorate or do something special? This was 2011. I said, well, in two years, we're going to have a lot to celebrate. Because in 2013 will have been the 10th anniversary of the completion of the Human Genome Project. It would also be the 60th anniversary of that famous discovery of Watson and Crick, the double helical structure of DNA. And all of a sudden, light bulbs went off in our heads. And he said, you know, it is time to put together an exhibition jointly between these two institutions. Your Institute, the National Human Genome Research Institute, and in particular this museum, the National Museum of Natural History. And really, you know, sort of the rest is history. Because all of a sudden, we said, we're going to do it. And we agreed to it. I didn't know what that meant, actually, to be honest with you. And we actually didn't have the money for it. But miraculously, we quickly found major donors to be willing to help us make it happen. We put teams together from my institute and then this Smithsonian, this museum in particular. And then we just had this intense and actually insane phase of actually designing and fabricating an exhibition so that it would open in the middle of 2013 to commemorate that special year. I'm told that usually an exhibition of this type would be designed and fabricated over a four to six year period or so. And we decided we were going to do it in two years. And it worked. And then miraculously, actually, it opened. And people came, including people who wanted to review the exhibition in particular. And the reviews were quite positive, actually. We had a nice review in The Washington Post. Wall Street Journal ran a nice review. Similarly, The New York Times was quite complimentary about our exhibition. And as you heard, the people came. And they came and they came and they came. And at the end of the day, over 2.6 million visitors went through hall 23 on the second floor of this museum. And what they saw and what they experienced was a lot of high tech, hands-on, highly interactive video and various things that really engaged them and really sparked imagination. And also included an area for hands-on activities to learn by actually purifying your own DNA and doing various activities that make ones think about how our genome is the blueprint for physical characteristics that all of us have. And it was just remarkably fun to watch the public engage in this. It also was a great venue to take VIPs through, especially here in the DC area. And we had our share of VIPs visit the exhibition among those 3.8 million. And included Jim Watson, the Nobel Laureate, discover the double helical structure of DNA. And included Sandra Day O'Connor, a member of the board for this museum, but also the first woman on the US Supreme Court. It included two members of the cabinet, Secretary Sebelius and Secretary Napolitano. Then they were secretaries. Now they're no longer in the cabinet, but they came and they purified some of their own DNA as part of their hands-on learning experience. And it included Congresswoman Louise Slaughter, a great supporter of genomics research in the US Congress. And it also included scientific delegations such as a major group of international leaders in genomics that we brought through who spent a few hours here while they were in the DC area, the major workshop we had put on. And it was great. The 14 months the exhibition was here, I think was nothing short of spectacular success. But then, you know, it was time, as we always agreed to, that it would close here and it would have to be packed up and it would have to be shipped around because it had another life associated with it. And so it was bittersweet when it had to hit the road and we had to box it up. And this wonderful Hall 23, which 3.8 million people had gone through and seeing the exhibition now, all of a sudden had to be empty as all of it had been boxed up and it hit the road and off it went to San Diego. And in fact, just this past Saturday, I personally and some of my staff were out in San Diego for the tour to begin, as you heard, at the Ruben H. Fleed Center in San Diego where it is now open. And the rationale for touring the exhibition, of course, and here are two of the first venues it's gonna see is so that more and more people, more and more families can engage and see hands-on what this exhibition is all about, what Genomics is all about. It's first up, as I said, as San Diego. From there, we'll go up the coast to San Jose and from the dates that are shown there. And then beyond there, it has a series of venues that we'll go to over the next four or five years, St. Louis, Portland, Milwaukee, and so on and so forth. Now, not everyone will be able to see this exhibition and we realize that no matter how many cities it went to. And so from the very beginning, we designed and implemented a website, a dedicated website for the exhibition called UnlockingLivesCode.org. If you didn't see it in hall 23, you could even take a virtual tour like you're in a Google car or something walking your way through the exhibition if you go to this website. You could see many of the videos. You could see many of the interviews. You can see many of the compelling stories all told in the exhibition, all on this website. I'd strongly encourage you to go view this website if you haven't, even if you have seen the exhibition, go see it and if you haven't, you certainly wanna go see it. And then in addition to the exhibition and in addition to the website, we recognize there was so much more to be told about the stories and genomics. And so we put on a whole bunch of associated programming with the Smithsonian Associates, with the Smithsonian and with various other partners, including generous donors who helped us make all these things happen. We've been very aggressive about videotaping these things as we are doing today and getting it up on our YouTube channel called Genome TV and also on the UnlockingLivesCode.org website. And this will, today's program will add to our collection of wonderful associated programming. So that brings us to today. And today we're here to really celebrate this first 14 months of the exhibition and we decided to focus things on the medical aspects. And as Jonathan said, there's many components of this exhibition and many that the Smithsonian's interested in, many that we're interested in. But today we decided what we would focus on are some of the more medical and health related applications of genomics. So I wanna just now transition to the second things that I wanna say in framing the day, because what I wanna just briefly tell you about in case you weren't aware of what the some spectacular opportunities now exist in genomics as we think about their possible applications to medicine. So if I was asked to summarize a quarter century of genomic progress, especially in human genomics in six major areas, I would tell you very quickly that what has gone on in genomics is as follows. First of all, the human genome was sequenced for the first time by the Human Genome Project one of the key things we celebrate in the exhibition. A tremendous amount of work has gone on in the last 11 and a half years since the end of the genome project, whereby we've advanced our understanding about how the human genome actually functions. Now we have a whole lot more to learn and there's many mysteries buried in all those letters of sequence that make up the human genome, but we've learned an awful lot in 11 and a half years. Meanwhile, we've developed incredible new technologies that have changed the face of genomics. In fact, that first human genome sequence produced by the Human Genome Project cost something on the order of a billion dollars or so, depending upon how you do the calculations. Today you can sequence a human genome, approaching a thousand dollars, not quite there, but will probably be there within a year. That's a million fold reduction in the cost of sequencing a human genome in the past 11 and a half years. We've used the opportunity to inexpensively sequence genomes to now sequence not just thousands of human genomes, but tens of thousands of human genomes. And with that, we've learned a tremendous amount about how all of our different genomes vary slightly from one another. And that information has proven to be incredibly important for understanding how variations in our genome play a role in our health and disease. And in fact, it's been so critical that it's really set up a series of studies, very large studies in fact, that have accelerated the pace at which we can now unravel the genomic basis and genomic causes of human disease. Rare diseases, common diseases and diseases like cancer and so on and so forth. And what that has set up, of course, are some vivid examples whereby there are nice examples that we can point to, whereby genomics is being used for medical care. And it's sort of that excitement that I think that really has set the stage for this symposium today. But what are some of the examples I would give when I say that there's some vivid examples emerging where genomics is being applied? I'll just quickly cite five of them, although we could probably brainstorm and even come up with more. But some of the ones I'm sure we'll be hearing about today might be as follows. I think most people would probably lead with cancer. Cancer actually is a disease of the genome. There are aberrations picked up in cells in their genome that make those cells grow out of control and be tumors and basically be the cause of cancer. And it is now clear that we've learned by sequencing the genomes of tumors, we've learned a lot about what goes wrong in a cell to make it a cancerous cell and what information we might get about an individual patient's genome, a tumor genome that might indicate the best way to treat that individual. And if you look to ads on the web or you look to ads that you hear on the radio or on television such as this one for this particular cancer treatment facility, you will see very much sprinkled in their advertisement, genomic this, genomic that, genomic this and so forth because genomic testing is now becoming mainstream for many types of cancer treatment. And increasingly I think that will grow in the future. Another low-hanging fruit exciting area of clinical applications of genomics relates to the fact that we respond differently to medications and this big word of pharmacogenomics is an example where we're learning which genomic differences might play a role in how we metabolize drugs and might make us either a good responder or a bad responder. And increasingly there are more and more medications where getting genomic information about a patient is very helpful and in fact some cases called for prior to deciding what medication to put them on. In the past few years in particular we have seen it become mainstream virtually that for a patient with an ultra rare disease, particular disease for which nobody seems to know what is wrong with that patient that sequencing their genome just makes sense because it's reasonably inexpensive compared to the massive workup that has been done clinically where it has not yielded an answer. And by using the tools of genome sequencing nowadays it is in many cases possible to identify the genomic causes of very rare diseases in patients oftentimes ending their diagnostic odyssey. And in fact I just saw this last week in nature was this article talking about this exact circumstance where in particular they say children bore with disorders not readily explained by standard tests and sometimes be diagnosed through genome sequencing and analysis. This is indeed mainstream. Another thing capturing a lot of attention these days is in the prenatal circumstance where lots of genomic testing has been done historically in the prenatal stage but nowadays instead of having to use invasive methods such as amniocentesis and chorionic villus sampling to access that fetal DNA, instead it can just simply be accessed by a simple blood draw of a pregnant woman because there's teeny bits of fetal DNA floating around in the bloodstream of pregnant women and these ultra sensitive methods we now have for sequencing DNA can detect that cell-free DNA in maternal blood making this non-invasive method of doing prenatal genome sequencing a diagnostic reality and increasingly we'll be hearing about that in the coming days. And also it hasn't escaped people's attention that well at the other side of pregnancy at the newborn stage maybe perhaps we should be sequencing everybody's genome at the newborn stage and take that sequence data put in their electronic health record and have it follow them throughout life. Lots of questions about this and in fact we regard this as a research area and in fact we've just recently launched a major program to study this wondering about some of the logistical hurdles also thinking about some of the ethical issues that one would want to investigate before this would be done at a large scale but Time Magazine and places like that in the popular press indeed cover this because it is something to contemplate as not so unrealistic in the future. So Genomics is finding its way into clinical practice already and much of the discussion today will be what's the pace at which we'll see that continue but whether we believe it's gonna go really fast or whether we believe it won't go so fast Genomics is absolutely finding our way into the public's life on a daily basis and in fact if you go to the newsstand you will see this discussed there's no question that Angelina Jolie and her circumstance with a mutation in the gene that predisposed her to breast and ovarian cancer caught the public imagination was a cover story on Time Magazine. Similarly just about a week or two ago Time Magazine put on the newsstand a special issue, a compendium issue if you will of multiple stories about how DNA shapes your life. This is very much on the newsstands as you go through the grocery store or the drug store. This is becoming part of the public dialogue related to Genomics. It's not just the newsstands though I find it's also coming into our living room through our television for example. I'll show you a quick news advertisement that at least is showing here in the Washington D.C. area I've been told from others around the country that similar ads are being run by healthcare networks in other cities but it does again give you an impression of how Genomics is coming into our living room. This ad I first saw during an advertisement spot on Sunday morning during the major news shows. Some say your health is the luck of the drawl but Innova's groundbreaking genomic research is working to change that. We're studying the genetic makeup of infants to detect if, when and how disease may occur so we can learn to tailor the best care for each patient. Providing individualized healthcare, anticipating and preventing illness that's predictive medicine. Innova, join the future of health. I find that advertisement very interesting for a lot of reasons, some good, some not, maybe so good and I would imagine we're gonna talk about some of this in our panels today because I think it raises many issues worth considering. So another way to summarize what I just was trying to convey to you is that I've been involved in genomics now for about 27 years, a little over a quarter century but when I got in, I think the relevance of genomics has changed radically over that timeframe. When I first got involved it was about a year before the Human Genome Project began and I got involved in the Genome Project at a time when really genomics was just about biomedical researchers, it was people on laboratories at benches, it was computer scientists sitting at computer terminals but that's what it was for a good amount of time. I think 11 and a half years ago when the Genome Project ended and we started to realize that there might be relevant ways to think about how genomics could play a role in health and disease, we did engage healthcare professionals more and more mostly in a research way to think about working with us to design studies that might help us understand the role that genomics plays in health and disease and I think that's been a productive 11 and a half years. As I think I tried to convey to you to see how genomics is now coming into our living room and onto our newsstands, the world is changing in that I think genomics is increasingly getting relevant to patients and friends and relatives of patients which really means all of us and whether it's a cancer patient or whether it's a pregnant woman, whether it's somebody who's about to be given a medication, there are examples where the word genomics is gonna be part of the lexicon between the interaction of a patient and a healthcare professional. And that is the reason why our institute, National Human Genome Research Institute, as well as many others who do genomics research around the world recognize that it's not just the science that we need to be thinking about, it's this broader context of how the science and the general public really meet and have to realize that there's important engagement that must go on. That's the reason why we did the exhibition here at the Smithsonian, it's the reason why we're touring it around the country but it's also the reason why we have events like today's event is to try to engage and have a dialogue thinking about how now genomics is finding its way into the public discussion and today we'll be particularly focusing on how it is relevant for their health. So that leads us to what we're gonna do today with a health theme but also a celebratory theme but also it's a reflective theme. We're here to reflect on this and have a discussion. Now we could have had a scientific symposium, I could have brought just brilliant researchers up here, in fact we are bringing brilliant researchers up here or we're not sitting at this podium and telling them just to give a scientific talk, rather we decided it would be very interesting to bring them here and really have a conversation and have conversations really framed around very specific questions that are of particular interest and that cover several major areas. So I'm just now wrapping up my framing talk but then in particular we're gonna transition to the first discussion that's focusing on genomic medicine and then when that's done after our break we're gonna actually have a discussion around genomics and global health and some very interesting developments that we thought would be of great interest to you. And then in the evening we have a session where we have the advice columnist from the Washington Post, Carolyn Hacks, here to talk about this, a very practical voice, if you will, for many things associated with challenges in society and she's particularly gonna talk about genomics but also have a personal side of this as you'll hear about her personal story with the mother with a genetic disorder called ALS. And I'll let her tell you that story.