 Well, good morning everyone. Let me also give you my immediate thanks for coming here and joining us for this important two-day meeting. I asked Terry Minolia what I should do in these opening remarks, and she said, after thinking about it for a few days, came up with the idea of just saying, just say sign directly. So I'm not exactly sure I know what that means, but I thought about it a little. So looking around the room and actually knowing the people that were invited to this, I recognize that there's a core group of people who know probably everything I'm about to say, and then an even larger set of people that may not know everything I'm going to say, but have heard me speak recently, and a lot of this can be very redundant. And when my remarks are not so much for them, there actually are some folks that came to this meeting that were, maybe they were all invited by Mark Williams from what I just heard, is that we really want to reach out to constituencies and stakeholders to others that we thought would be very informative to the discussion, who I don't actually think have been to at least an NHGRI-sponsored meeting in the last year or two, or maybe ever. And so I really thought it was important as a new guess to our community to set the context, especially for them, and I'll hopefully you'll, even the rest of you will hear something you want to hear that'll be of value. But I do think setting the context in a meeting like this, which was started by hearing the introduction about the first couple of genomic medicine meetings is important, but in particularly for the new faces. There's a lot of places I could then start for setting the context, but I just want to put you in the brains, if you will, of NHGRI and our thinking about what we are trying to accomplish in helping to fund and lead the field of genomics to sort of calibrate progress in many ways. We often sort of have as the starting point of this the completion of the human genome project and recognizing that in many ways catapulted the field forward in setting up a remarkable set of opportunities. NHGRI, by the way, is increasingly getting obsessed with this date. We just passed the nine-year point, nine years after completion. In fact, I pulled out this was the press release that we put out on April 14th, 2003, where we declared the genome project over. I will tell you we're planning all sorts of interesting things for the 10th anniversary of this, as you might imagine. It's a big deal, 10 years. Next April will be the 10th year, and so we really think a lot about how far we have come and how much time has elapsed. For example, you may not know, it's been 3,307 days since the genome project ended. It's actually 79,000 hours and a little over 4 million minutes. I've even given it down to the seconds. Really what we think about more than anything is has the time been well spent. And much of our time since the end of the genome project for NHGRI's perspective was very much focused on a vision we put out and published in 2003, the day the genome project ended, that really described a path forward for taking advantage of the opportunities that were put forth by having a reference human genome sequence and lots of ideas about how to capitalize on the technologies and data that came out of the human genome project. And I think it's fair to say that the successes since the end of the genome project have been impressive year after year after year. Accomplishments, just a highlight reel, is shown here on this timeline. And I think in many ways the pace at discoveries that have happened and advances, especially technological advances, in genomics have actually in many ways happened faster than any of us could have predicted even the most optimistic of individuals back in 2003. And so what we find ourselves now, of course, is that imagery such as this, which you always envisioned eventually would be relevant, applying genomics to clinical medicine. But we didn't know when this would happen. We find that it's relevant now. And it actually became relevant just not that long ago. And so the data that's been generated since 2003, the technologies that have come about, have created remarkable opportunities for making these kind of images a very real one, real ones. If I was going to single out, it's probably obvious to most of you, but just again to the guests who are here, what drives this in our brain more than anything else, if I was going to give you one example of what has happened since 2003 that pushes us faster and faster into imagery like this. Of course, it relates to the development and advancement in the technologies for sequencing genomes. And many of you sort of recognize this as sort of our iconic view, which we now have and show frequently the precipitous drop in the cost of sequencing DNA, sequencing human genomes going faster than Moore's law and really making possible the kinds of studies we're going to hear about today that without this advance, we would not be at this meeting today without any question. If you just want to put specific numbers on, again, for especially those of you who don't think about genomics day in and day out like some of us do, if you go back to the sequencing of the human genome as part of the genome project, that was an endeavor that took six to eight years, cost something on the order of a billion dollars depends exactly what we count and what you don't count. But if you round up, it's about a billion dollars for that first sequence. The moment the genome project ended, the estimates were if we went then to sequence a second genome using the technologies that were available that time, it still would have taken something on the order of three to four months and still would have cost something on the order of 10 to 50 million dollars. Again, we could never be talking about what we're going to be talking about today and tomorrow if that was the price tag for sequencing an individual's genome. But what's happened with new technologies, fancy all sorts of different technologies today, we can sequence a genome in two to three days for something like four to eight thousand dollars, maybe even cheaper in some people's hands. And of course, what is even more remarkable is we can sequence the coding regions, the whole exome sequencing now is routine for under a thousand dollars. And as a result of that, it allows the kinds of studies that we're going to be talking about to become very real here and now. So I give this as an example, there are other things that have advanced the field remarkably. But I think more than anything, it's slides like this that summarize what really changed many things for us. And we recognize that several years ago, that the field was going faster than we had even anticipated. And so it was time to put out a new strategic vision, which looking around the room, many of you were involved in many workshops and many deliberations. And we just heard, as Dan pointed out, the early meeting that was the final major meeting that led to input that we collected before we finally put the final form, this strategic vision that was published just a little over a year ago. And if for any of you who have not seen this or want to get access to it or any of the other things about a strategic planning process, of course, you can go to this convenient URL and get that information. What the strategic plan, I'm just going to just again for the new folks here, describe is a new vision for moving from the base pairs of the Human Genome Project to the bedside of patients, or if you prefer the metaphor from the double helix to human health, and doing so now in a way that's far more descriptive of the steps that are going to be needed to actually implement genomic medicine in a very real and practical way, but still require an enormous amount of research that was going to be required, but now would be organized into five major domains of activity, one describing activity that advances our understanding about the structure of genomes, which we're very familiar with increasingly using knowledge of genomics to understand how genomes work, the biology of genomes, applying that to the understanding of the biology of disease, then taking it out and actually trying to change the practice of medicine by advancing the science of medicine using genomic approaches, and finally demonstrating that indeed what you are doing is actually improving the effectiveness of healthcare. These five domains represent the organizing framework for our strategic plan, which we encapsulate in graphic form in Figure 2 in the strategic plan, which now is the icon that I can tell you the Institute sort of looks at critically and almost constantly describing the five domains, but then describing in these hypothetical density plots of progress in accomplishments that are taking place across those domains in different time intervals dating back to the genome project and looking out into the future, where our eyes are critically focused, of course, is the next decade. And why we are here is to think about what should we be doing as a field, what should NHGRI be doing as a funding agency to make this reality of this density plot with an emphasis in particular of massive accomplishments in the second and third domain, but thinking as much as we can to move that center of gravity out to the more clinically oriented domains. So in thinking about this, what we want to do in workshops like this and meetings like this is to help us very much think about our future because the investments that we will make in genomics now will very much change the future of this field, and we want to make those investments widely and productively. Dan set me up very nicely in pointing out that at this early meeting, which was the last meeting where the community had substantial input into what eventually became our new strategic vision, he described debate and the debate was around was it ready? Was the field ready to apply genomics to medicine? And that's actually was interesting because what I would say has changed between then and now is that I don't think there's a debate about if it's time to do that or whether it's going to happen, but the debate that I want to describe to you is a very real one and thinking across these five progressive domains is not so much if it's going to happen but the rate at which it's going to happen. And by that I mean, and I'm being totally candid with you, is that both internally within the Institute, and we have representatives of this institute, they will all agree with this, also around our advisory process, such as our council, and I know we have several council members here, they will absolutely tell me what I'm about to tell you is absolutely true. And I hear constantly from members of the community, constructive arguments about the pace at which we are going to move from the leftward part of this graphic graphic to the rightward part. There is a constituency that everybody's bought into it, as far as I can tell, but some believe we will casually stroll our way through and you know eventually we will sort of get rightward. There's another group of individuals both inside the institute and outside the institute who think we'll speed walk there because everything's just moving and the opportunities are here and we should go at relatively brisk pace. And then there's others, again, both internally and externally, who think that it's absolutely happening a mad dash and we should just, we're actually going to get there. No question about it and it's going to happen sooner than we could have anticipated. I don't know the right answer here. I arbitrate a lot of these debates. I actually enjoy the debates. We're going to figure this out. And that's part of it is I think what we don't know is which of these scenarios are really the right one, the correct one and we're going to learn. And the fact of the matter is what we're talking about in a gathering like this meeting as it was for the genomic medicine one and two meeting is to really explore the more rightward side of this as you start to apply genomics in a fashion that might actually both help to understand the biology disease but even beyond that of thinking about how you might actually change medical science and perhaps even thinking about whether that's practical and whether that's actually going to be effective at improving healthcare overall. So this is the context by which we've had these three meetings. The other key context that I really want to stress especially from NHGRI's point of view is the reason we're having these forums is our acute interest in learning. Learning about what that front ebb looks like and learning to figure out what the rate of accomplishment is going to be moving from left to right. So I just really want to stress that we aim to learn. We are here as students of this and we are critically listening. We did in the first two meetings but the reason we decided to have the series of meetings was to give us an opportunity to bring people in who are already starting to do these kinds of activities which at the early meeting we were told will happen way out there. We discovered they're already starting to happen. We said we need to learn from them and hopefully you'll learn from each other and we can help facilitate and see that happen. By the way Mark Williams you do notice the clip the thing on Wisconsin right. There you go excellent. So the Wisconsin connection if I'm going to show a student I have to show a student at the University of Wisconsin just sorry my bias. And so that's that's really what I hope I really want you to recognize how appreciative we are of having you come here into the other meetings basically to teach us and to help educate us about what this looks like and we hope you get something out of this as well. And the other thing that I really want to stress that NHGRI is we are still students of some of this is is do recognize that across these five domains we're really good at this I mean this is this is our bread and butter for a long time. These domains basic science it's human genome project and even understanding genomes that is absolutely our comfort food we're I think we're pretty good at it and we are getting to be better and better at translational science as you move rightward and but we still have a lot to learn but again that is something that we appreciate is important and we are trying to get more and more competency in that area and as I've come to learn including from some folks in this room is as we even move more rightward than that we need to be thinking about how we actually implement this at a practical level in medicine and there's a whole science associated with that and there we very much are not even sure we're in college yet about that we're early days but we are we are good learners and we are working very hard to get to really understand that component of this as well. So that's mostly what I wanted to tell you I think very much in the spirit of of making you appreciate that we very much regard this as a work in progress this is something we need to learn about as we try to understand the kind of programs we're going to put across in the coming years and that's exactly the kinds of things we want to learn about in genomic medicine specifically by many of the people in this room. So I was thinking about a best way to close and I'd like to close with quotes at least for some of my talks and I was pondering what would be the best one and I was sitting in my office yesterday and then all of a sudden I looked up literally I saw a quote that I have above my door in my office at work and I just took a photograph of it because I thought it was really appropriate. It's an Einstein quote I'm sure many of you heard if we knew what we were doing it wouldn't be called research and absolutely that's what we feel like I mean this is absolutely research and we are trying to figure out exactly the best way to move forward we're trying to learn from you and others and we'll be listening acutely. So with that I will close and I actually still think we're ahead of schedule so which is always good if there are any media questions for me from an NHGRI perspective or big picture I'm happy to answer them I'm going to be at this entire meeting you can also catch me to break. But are there any immediate burning questions about anything I said? I don't have a question but I this is like a bureaucratic comment I was actually listening to some of the videotapes from previous meetings and it's incredibly frustrating when people ask questions and then engage in a dialogue and don't use the microphones. That's a very good point just an action maybe we didn't make that comment at the beginning everybody knows this but we are and Terry correct me if I'm wrong we're videotaping this entire meeting it will be put up on the web and so we were we are assuming that anything that people are talking about this we regard this as an open meeting we're doing this is in part on behalf of the community we are assuming that anything you're going to talk about you are comfortable at being broadcast if you are not comfortable with that delete those slides before you get up here because we we want all these talks to be able to be put up on our genome TV channel of YouTube so but but as a result I agree with what Dan said let's be really cognizant of using microphones yes starting with you using a microphone yeah just curious can you hear this yeah so I'm Sean Tunis a member of EGAP's working group in the from the center for medical technology policy it's my first time hearing you speak or so I'm kind of from the I guess the fifth domain that you described and that's so a friend of Mark Williams um yeah and so I haven't really looked at the participant list but you know many of the things that you described in the sort of implementation research there's obviously lots of folks around NIH who think you know daily and deeply about those things and I and I just wonder to what extent NHGRI you know works closely with folks from you know all around NIH on you know to kind of dive into those other areas as well or whether it's mostly an outward facing to you know folks like uh you know some of the other people that Mark invited uh I think it's both I mean so we're learning who some of those folks are I mean and and but it's early days and part of it is we're trying to understand again we're getting back to the pace of this and we need to understand not just so much generically about about what we need to know we want to understand it within a context of what we might actually need to implement so that we have real specific examples to talk to them about but increasingly the answer is we we are learning about that we need to learn more and it's occasionally it's people like Mark or somebody from the outside that puts two people at NIH together that happens all the time and that's okay okay Rex turn it over to you