 Actually, I'm going to pick up pretty close to where Jim left off in talking about policy and many of the things I'm going to raise, which I promise to do quickly because I know we're all anxious, to stand up and stretch our legs and to get to some more discussion maybe back and forth with all the panelists, is I'll be talking about things that many of the different speakers have mentioned in the course of their individual stories and what I'm going to try to do is to come back and look at it and put it into some context from a purely policy perspective and pull the different pieces of the landscape that we've heard about together. And so I do think about policy most of the time. I think about the science as part of the policy and of course the science is the origin for all of the policy questions that we think about. And I like to imagine that we would have in an ideal world a nice iterative dialogue that could take place between the research that was being done, the knowledge that we were learning through that research and the policies that we were putting back into the field to guide the research and to oversee the research. And of course the policy and the research would all be within a framework of agreed upon consensus ethical norms that everyone in society could fall behind and everything would be lovely. Of course that's not the world that we live in and particularly in our area of science where technology is moving very quickly and our different ideas about how to use this technology and all of the different applications that are possible within medicine, within research, but also outside of those two domains means that we're really needing to be iterative, yes, but that we will have to deal with some uncertainty as we go forward and be as thoughtful as we can be and always be adaptive to what we're doing. So again, as I said, I'm going to pick up where we dropped off with Jim talking about genomic medicine. We've heard from others too about how really genomics as it moves into medicine, but in general is becoming increasingly relevant to the public. From a research perspective what we're doing now is we get very excited about learning more about the common diseases, trying to tease apart the weaker genomic effects that contribute to disease. We're needing to study lots and lots of people and others have mentioned this. We were excited a few years ago when we were talking about thousands. Now we're talking about tens of thousands and even more. And really what we want to do is bring this into the clinic and put it in the doctor's hands. And again, Rick mentioned earlier it's not just a laptop anymore, but he wants it on an iPhone, so it can be as maximally flexible as possible. And this is all looking at it just from the perspective of the research community and our structured environment where research is a domain that we control and we move forward in through methods and processes that we understand. But of course, as genomic technology has moved out and become accessible, the public has gotten excited about it. It's really cool stuff. And there are companies out there in response to public demand that are putting the technology into the consumer's hands. And so the birth of the direct-to-consumer companies have made it possible in a very exciting way, I think, for individuals to ask questions about their own genome if they want to. There's a lot of debate over how that should happen, over when it should happen, over what value it actually means and how do we control the information or influence the information that they're given. But really, they're also not just doing it for health reasons. They're also doing it for ancestry reasons to learn more about their families and where they come from. And just because they might have a value or put a value on something that's useful to them, and that's not something that we can mandate or that we can control or that really we can even decide in advance what it will be and make decisions about what's appropriate or not. In addition to just their interest in the technology and in knowledge about their own genomes, they're also increasingly eager to see research and to move research forward. And this is healthy people as well as sick people. And so they're really starting to push for this. There are groups like PatientsLikeMe, Private Access, where they're building platforms to shape the research agenda, to make it possible to control the choices about how their data are used, to invite researchers in to use their data, and to really think about the policy questions in terms of privacy and confidentiality that are important to them and to be able to have the ability to make their own choices about that happen. SAGE BioNetworks is another group and 23andMe, one of the director-consumer companies, also has a very strong research aim and is building a strong research database with their clients, those that are willing and interested to go forward. And this is something that as a research community will be very powerful for us, but we will need to adjust to the different dynamics through which this process moves. And so then we come back to the big question about genomic medicine. And are we there yet? We've heard a lot about the potential today. A lot about the remaining policy questions. Are we ready for this? There's been a lot of debate over the last few years with DTC companies as well as others. And I would think that in general, no, we're not. But we're also not here anymore, where there's a big gap. We have had successes that have taken place, where we've crossed the bridge from research and been able to make a difference in an individual's life or in a family's life based on genomic information. And what we really are about trying to do right now is move from these individual success stories and the anecdotes to common practice where we have the infrastructure and the policies and the framework from which to make this common practice and make it available to a broad swath of our society and use it every day. And again, that's part of why we are so excited to be here at the Smithsonian to engage the public on these questions and to have them begin to think about this from an informed perspective so that when it comes their time to interact with the clinical side of genomics that they are able to do so in a productive and constructive way. So I'm just going to try to talk about a few of the policy issues, again, pulling together things that I've heard others say today, that I think span both research and clinical issues. I won't be able to touch on all of them, obviously. One of the things that I think is very important and that we are dealing with in various ways is the autonomy of choice for our research participants and for our patients as we continue to move into the clinical sphere. And that can be through how their research data are used, when they're used, as well as, again, the risk that they're willing to take, for instance, around privacy. Perhaps they want to share their data, again, like patients like me and others that go to those services. They don't want to be told that there's too much risk and they shouldn't do this. This then involves looking at our oversight and regulatory structures. Again, others have mentioned this from the perspective of things such as coverage and reimbursement. But it also has to do with how we oversee the research that we're doing. But, and again, of course, the testing that would go out into play for different things, genetic tests, direct-to-consumer tests, et cetera. And then access issues is something that I think is very important. If we want genomic medicine to truly be successful, we want to make sure that it is rolled out in a way that is equitable across society and that is not held up for other legal reasons or other issues that may come to play. Some of that has to do with gene patents, which we've heard about a lot today, which is great. Others has to do with genetic testing and coverage and reimbursement, which other speakers have mentioned as they're thinking about the technologies and moving it forward. And then, again, something we've also heard a lot is healthcare readiness. And this is from the perspective of physicians and healthcare teams, also in terms of the infrastructure, the hospitals, the electronic medical records, and of course, from the patient perspective, getting ready to be able to integrate the information and to apply it in a way that is broad-based and affordable and successful. So if we look first at the autonomy briefly and we think about how the public has been hearing about this over the past few years, we've had stories in the news, the stories that tend to make the news are not always the positive ones, at least the ones that stick with us, about things such as Indian tribes who are unhappy about how their DNA has been used for research. The Henrietta Lack story that Rebecca Skloot told so effectively a few years ago in terms of how the HeLa cells were generated. And then, of course, a series of lawsuits brought in different states for how newborn spots from screening, newborn screening spots had been used and the choices that were made by states for what was appropriate in terms of research access, et cetera, without asking for individual patients' consent for what was happening. Just this past January, we did move with regard to privacy from the land of the theoretical to the real in terms of being able to identify de-identified or anonymous participants by name, strictly from their genomic information, by combining not just the genomic information from a research space but also putting it together with all of the other digital information out there about all of us on the internet. And then, again, most recently, HeLa has made the news, again, with the publishing of the whole genome analysis of one particular HeLa cell line and the questions that raised for the descendants of Henrietta Lacks in terms of, again, their choices about what was done as well as the privacy that might be attendant to that. And then I want to raise one other issue that's not a research question, and I apologize for missing this layering aspect. But last week's Supreme Court decision that made a lot of news around the Maryland case where it was agreed from a court in a split decision that it was acceptable to collect DNA at the time of arrest. I remember that evening I happened to be home watching the news and I was horrified just from a perspective of the things and questions that would be raised for me in the job about what this meant from the public because the news stories were putting this in a context which linked collecting DNA and using DNA information with an inability to have any privacy and what a frightening world this now meant because this was going to be happening. And if the government could not keep safe their confidential secrets, how could they possibly protect your DNA information? And again, coming from a research base where we do have many important government community resources, this is a very frightening prospect in terms of the PR and the damage control to explain the processes that we have in place. And so it's very important I think to think about the public perspective and how they're hearing it to make sure that we give them back the information that's important to explain what really happens. One discussion that has gone on in response to the Identifiability story that came out in January was again to try to begin to put this into context. And so Eric Green and our colleagues published a brief commentary to try to note that the advance that had been made with regard to identifying specific individuals through their research data combined with other information on the internet was not just about genomic data. The questions that it raised was not just about genomic research data but about all of the data that we're collecting. And the tension that it could expose really was about the competing or not competing but the dual values that we have in our society to respect participants, to respect privacy, to promote confidentiality but also the value to advance health research and to move science forward. And what we said in that commentary was to push for new conversations to look at all of the available options that we have today in today's society with all of the opportunities that technology provides as well as the limitations that it may expose to us to begin to look for new solutions. And I was very excited last week to see this did not have anything to do with our paper but that the Global Alliance was announced where just that happened where the community came together, stakeholders from all different sectors of the research community and the public to begin to make a promise to one another to think about how to move forward and share data in a way that respected participant interests allowed them control over choices with regard to privacy and how their data were used. And I think this will be very exciting as we go forward to watch how this develops and what models come out of this alliance. Other things that are coming up in the future which I think will be of interest to you all in terms of this ongoing conversation. NIH has had a genomic data sharing in place for five years for genome-wide association study data. We are hoping to release in the next month or so a new updated policy that will expand the data sharing expectations and the policy model to all different genomic types and this will also again be an opportunity to look at how we are regarding participant autonomy in terms of consent choices for use of data as well as privacy models. Also the common rule, the federal oversight rule that is in place to guide all human subjects research is being revamped. There was a notice nearly two years ago but the recent headlines about the Henrietta Lacks story in terms of the publication of the genome has given new energy to those debates within the government and so we are again looking at how we might be able to move this common rule forward where again there were proposals made about updating our mechanisms for acknowledging participant choice and for protecting with regard to today's world and today's risks, the genetic information and genomic information in the data that we will be sharing. The myriad story we have already heard about this speaks to access and again people mentioned this morning whether or not gene patents would hold up both research or access to clinical testing and the decision came out this morning and I don't wanna say anything other than that a few 20 minutes ago or so. Larry Brody was showing me a new slide that a competitor of myriad already has on their homepage. A great graphic that with the glowing Supreme Court saying your genes have been freed and they're offering BRCA1 testing now coming forward so just within the last few hours since this decision has happened it's already moving very quickly. The Angelina Jolie story has also come up another very powerful aspect and variable within the public conversation through one well-known person sharing a personal story about the family history and the choices that she made with regard to her genetic background was really illuminating not just as an education moment for many in the public but also as an opportunity to talk about the choices and the ability to make a choice but another point that I think is really important and one which we haven't had a chance to really deal well with yet because of where we are in the process of moving towards genomic medicine is the aspect of coverage and reimbursement for genomic testing and she raises in her story which I think was very important and will make a great contribution the fact that she was able to make a choice and she was able to have the testing despite the cost she was able to choose to have surgery and not everyone has those choices and that's going to be important for genomic medicine to really go forward for us to find ways to make sure that we all have choices about whatever the genetic disease may be to choose or not to choose how to go forward and how to affect our healthcare choices. In terms lastly of readiness for the healthcare system again we've heard already about the need for physicians to be educated we've published on this before not just the physicians but the entire healthcare team but it's starting as genomics moves into the clinic for the rubber to hit the road and we're seeing rather frightening quotes from physicians who are struggling to deal with this new information with the push from their patients for this new information to really understand what to do with it and to make sure that they're providing the best care and so it's really becoming increasingly urgent that we find ways to deal with this. This is not the most exciting policy issue it's not when you think about from an ethical standpoint but it is fundamental to going forward. We've been building resources for this again not very exciting but we're very happy to say that within the next few months we'll have new resources coming out for pharmacists a critical component of the healthcare team. We are now beginning to talk to physicians we're in the very early stages and hoping that they also will begin to come together as a community and put together resources from an education standpoint competencies for training to begin to ready themselves for this technology moving into the clinic. And then finally a final piece is as the specialists begin to try and introduce standards for clinical care. This also has been something in the news of late six weeks ago or so the American College for Medical Genetics and Genomics put forward the first clinical guidelines for whole genome sequencing and the return of incidental findings which Jim mentioned the concept of incidental findings and how complicated it can be for individuals to decide what to do. Since that first release of the paper in just the six weeks there've been at least four papers that I know of I know there are many others in the works coming out with different opinions, different expertise and experts speaking about how this position is wrong how it's right, how it should be different to go forward and obviously it's just highlighting the massive amount of work to be done in this space for us to get where we're trying to go which brings us back to the question of are we there yet and how do we get there really. And so in summary what we'd like to avoid is massive fear. We don't want the public not to engage we don't want physicians not to engage. We want everyone to see genomics for the potential that it offers. We also don't want them to be so confused they don't know which direction to go. And in the end what we're striving to do is to find balance between moving the research forward and respecting the individuals that will have to help us to move it forward as research participants and as patients in the end. And I will stop there. Thank you very much Laura. So we're at the end of our talks for today. I don't know if anybody has any burning questions for any of our speakers Laura or anyone preceding her. Eric or do you have any thoughts too that you'd like to close us with? Nope. All right well then I'd like to thank everyone for participating for the web audience. Everybody have a good day. Thank you very much. Good job.