 Okay, we've reached the ever-popular council-initiated discussion phase. This is, I guess, Terry's coined a new phrase, back-to-you portion of the council meeting, where we turn over the agenda to the council members and we ask you to bring issues to our attention. This is a good opportunity if you want to hear in a future meeting a report on a certain topic or want to engage us in a conversation and give us a chance to collect some information. So the floor is yours. Any topics you want to hear? We try to anticipate them thinking about speakers and thinking about things to cover, looking ahead to February. Anything brewing? Yes, we're still in the PG-rated part of the program, so we're not quite at the R. Hold on to some of your thoughts. Yes. Well, something in the, at some point we probably ought to hear something in the personalized medicine initiative space. You mean precision medicine? Yeah, that too. You know, I'm sorry, I used the wrong term, but I still think mine is right. We will, yeah, I think that will naturally happen as soon as we see, as it develops, what we can say. But absolutely, I think that'll be a regular update. Make it the same point, but I think maybe this is what you're meaning is, but moving beyond the obvious and the cliche is, you know, what, what can NHGRI be doing? What should the genomics community be doing to either promote precision medicine or to be more fully engaged in the precision medicine initiative? I mean, you know, I sort of waffle back and forth, you know, someday, you know, this is what we do in terms of genomics and medicine, so it's not exactly new. But on the other hand, it's a, it's a wonderful opportunity for us to move it forward. And so whenever it comes up, it just seems like we should focus more on the role of NHGRI and the role of genomics in general precision medicine because my guess is going forward, we're going to hear a lot. There's more to precision medicine than genomics, so I hope there is. Absolutely, a lot more. But on the other hand, we have a responsibility around this table to this institute and see what we can do to help promote this initiative. Amy? I guess we haven't heard from the large-scale genome sequencing centers since they've kind of been re-tooled, have we? Well, they're about, the largest centers are going to be a topic of, or discussion at the closed session of this meeting. Okay. So. But I mean, but I mean. Beyond down the road, probably February might be too soon. But yeah, we'll obviously want to keep updates about them. Yep, Val? Let me just, but Amy, are you thinking more about like the, for us to bring you an annual report from the Common Disease Center? Would there be value in doing that? No, but maybe we can hold this till after the closed session maybe. But I was thinking more just future directions, a one-time thing of how they fit in future directions. Yeah, I know we had this, we got some report on this a few sessions ago. But I think we need to maintain close contact with the FDA, particularly in the events of the precision medicine thing. One of the big obstacles is actually at our institution is getting approval of things which I think should be easily approved. Because gene directed therapy such using vectors that are already being utilized. And if you're just using a different gene but the same viral vectors and certain things. I think the process still needs to be worked on to be much streamlined. So I forgot which council meeting we had the FDA, I'm looking back last February. So we had last February, so it has about a year. That's okay, wow, that was a lot. Meanwhile, I would say we have ongoing interactions with them better than ever and we could report on that almost any time. And then meanwhile with, maybe we should just go for the top. We could try to get Rob here. We could use our Duke colleague to help persuade Rob to find time on his foot. It'll be an incredibly busy schedule. Maybe we could even get, so already can put in a plug. Maybe we could get Rob K. But he would probably, I'm sure bring his staff that are working on the genomics area that staff we have relationship with. So again, that's a great suggestion to shoot for, maybe for February. There's always stuff, I mean there's a lot of, again we know because we're interacting with them frequently now. So that must, that's a political question. Wow, who could be, well, yeah. Your CTO is also awesome, or CIO, Taha, the FDA. Yeah, yeah, he's been working on their open FDA. Every project and all the data that they're releasing is actually an incredible model for how this should all be happening. What data are they releasing? All right, is that better? So they're trying to release as much information as they can. That isn't privileged information from the filings. But they've got kind of adverse drug reaction responses that they're releasing, it's a pretty interesting data set. Open FDA. Yeah, there was an article coming up describing the whole process to be out this month. I don't know, I seem to remember, maybe February we talked about the CIR RFA and I would like to hear an update about the status and the outcome of the review. So that will be reviewed in the fall and it will be coming to February. So it won't probably be for next council meeting, but once we have a new director for NLM, it would be great if we could get them to come to council to give their vision. Right, so certainly I completely agree with you. I think unlikely may, it's hard to say, may would be unlikely, may be possible. Certainly not February. I would say the same thing about the directorship of the Precision Medicine Initiative cohort program, acting director now, but I mean that search is going to start at very, I'm sure it'll be also placed in a very fast timeline, but both of those would be extremely appropriate. Are there any other, I mean, thinking about, are there any other institute directors? Are there any other leadership positions at NIH? I'm just trying to think out loud, I mean, we can be monitoring for this all, but people you want to hear from that we could be inviting. Those are easy to local, yeah. I would actually like to hear from the director of NIMHD. That's a great suggestion, brand new. I've only been across the room from how you actually have been, I've not yet, but he's coming to see me, I think we're going to arrange meetings. He's going to come around, but he's only been on the job, but I think two weeks, three weeks, but that's a great suggestion, yeah, yeah. Bob? I was going to suggest we hear the director of NIMHD. That's exactly what I was just about to suggest. Great minds, take a like. And I know, I know Elyseo per established pretty well, Elyseo said. And it actually leads to something else, which is, this is not very well formed in my mind. I'm not sure how we're going to go about this. But thinking about precision medicine and the genomic medicine work group, there is a certain amount of pushback against genomic medicine and precision medicine out in the academic community from people who are really, really focused on the social and behavioral determinants of health. And also people that are really public health focused. And I really think that some sort of a meeting of the minds between precision medicine, genomics, and social behavioral health and public health people, because I actually don't think they're antithetical at all. But it's being posed as being possibly. I'm interested in hearing you more say more about that. I mean, I'm curious how that view comes in, how you have that view. How I have the view, what? That there's a disconnect or a tension between public health researchers and precision medicine, I guess I wouldn't see it that way at all. Yeah, I guess I get the view particularly from public health researchers and social behavioral determinants, researchers at UCSF who said to me, things like, this is really a lot of resources being spent on stuff that affects a very small number of people. And yet, we could use these resources much more effectively if we study things that involve many more people at the same time. And also that it's an overemphasis on genetics and genomics as a determinant of health. And that there are many other factors that are as or more important that we're not spending money on. So that kind of thing. Yeah, you're right, and it's not from everybody, it's just there are some. I've given many talks on precision medicine initiative over the last ten months or something like that, nine months in particular. And I remember one of them I gave was at a public health meeting. And they were very unhappy that it was being called precision medicine as opposed to precision health as an example. So again, people are gonna disagree over many aspects of this, including cosmetic aspects like the name. Yeah, Gail? Yeah, and I agree that there's a lot of tension. And I think one of the other things that people who critique this argue a lot is that it will exacerbate health disparities. It will reify categories of race that are mainly social in origin anyway. Et cetera, so, and I know there was a call for proposals. And what was the institute, might have been the one with the new director. But U54 proposals about, that we're looking at precision medicine and disparities. Yeah, so, and, yeah, sorry. But I just wanted to say that I imagine that those will be reviewed and maybe even some awards made before the next meeting, but maybe not. But I guess there's a lot of energy in the community about sort of addressing this in a really thoughtful way, addressing the ethics of it, addressing some of the critiques. And it would be nice to hear about genomics and health disparities in the context of precision medicine. Go ahead, you had a response. Thank you very much. I would just echo that I think it's really important to have people who have diverse views about it. I don't, I think just as there are people who might criticize it and be critical of the focus on genomics and sort of the way in which it might be conceptualized and operationalized at different institutes. I think the U54 in particular really encouraged a wide range of disciplines to be engaged in the precision medicine effort. So I think it'd be really timely to have that director and someone who works in the space of genomics and health disparities come and present. So one suggestion along those lines, and I for one, love precision medicine, what I'm very interested in. Also very concerned that precision medicine could widen health disparities, right? Like all kinds of technologies can. And so I think it's a really important problem. It's one of the things that we spent a lot of time at the meeting that Vince organized last week. So one potential strategy is to kind of understand where our colleagues in population health are coming from, right? They're getting attacked in lots of different directions in terms of their funding. The National Science Foundation, those that receive funding from National Science Foundation, is constantly under attack for behavioral research. And so they look at those of us who do genetics and precision medicine and say, how come those guys are getting all the resources? And so maybe one model could be the NHGRI model of having a set aside for LC research in those aspects. And I think that should be a big component of precision medicine. And to also broaden the definition, as my understanding is, that it includes those behavioral determinants. And so in fact, it should be seen as a rising tide lifts all boats and that this is going to be broad and inclusive both in terms of research and population. But maybe Eric, you as someone who's been on the throttle of the PMI can speak more to that. It is absolutely intended to include that, Jay. Do you want to make a comment as a member of the working group? I mean, there was plenty of discussion about the social determinants also being factored in the precision medicine initiative, in addition to genomic data of various other. Being socioeconomic, kind of, yeah. So I think there was, throughout the entire process, there was I think a constant sort of awareness of the possibilities of this increasing disparities and issues like that and the notion that it was something that we not only had to be cognizant of it, but also built in kind of a response in the way this was structured. How that comes to be executed, I think, remains to be seen. Maybe the Pony Express hasn't brought it out to the West Coast, but on our side, I definitely have gotten a lot of concerns from colleagues also at Stanford on the population health side about could this precision medicine initiative end up sidelining a lot of the things that they think is important. And I think it's a mistake. I think they're intimately aligned. I think basically, to make it as oversimplified as possible, talk about N of one studies for population health researcher may look at you like you're a lunatic. I mean, how can you do an N of one study on anything? Okay, great suggestions. Other suggestions? Topics or future presentations? This ad is a further response to that. I think the way people think about precision medicine is everyone's got kind of a different conception of it in their head. But the way this might actually come to pass, I think it could end up broadly enabling exactly those same folks that you're talking about. Right, if it all works. I'll just add one more comment about a possible type. I would just thinking backwards and also forwards. I would love to see some more basic science and kind of some of the presentations in the future. I don't know if that would be in code or GGR or something like that. And so give us a little more detail what you're looking at. Are you interested in program highlights? Are you interested in from program staff? Are you interested in members of the community who are grantees who could describe their work? Yeah, I would be more interested in members of the community. But we just need to get you started and then hard to stop you. Thank you very much.