 Good morning. It's a real pleasure for me to welcome all of you to the Global Leaders in Genomic Medicine meeting 2014. It's great to see everybody here, despite the polar vortex, which I think caused both chill and fear among many. But all of you have really made great journeys to be here from various parts of the globe and we're very grateful. As I've talked to many of you, the word that comes to mind about this meeting, for me at least, is passion. We're united globally by a passion to see how genomic information might inform us about the biology of disease as well as a passion to think about how the potential of the genome to optimize the quality of healthcare delivery around the globe. Secondly, I think the word that comes to mind is vision. Again, as I've talked to many of you, each of us I think has a vision for having genome-wide information as an integral part of both science and healthcare delivery and we have a vision and a roadmap and a pathway to take us there. And that's what I think we will be seeing over the next two days is a number of different visions and roadmaps and pathways to bring genome information into healthcare delivery. Some of you have suggested that this would be a landmark meeting. I would say it might be. I think the default is that we have some great conversations. We learn through rich discussions what's going on around us globally and that would not necessarily be a bad thing. But I think if we can end the two days that we spend together with a notion of how we might change and optimize the trajectory of genomic medicine in even some small and meaningful way, then in one, two, three, or five years we might look back and say this was a landmark meeting for the field. So I think it's up to us. So 10 years ago, as everybody knows, Francis Collins and colleagues announced the completion of the first sequencing of the human genome and I think it was him that actually got us here in part by encouraging the global community to actually participate in finding the way that genomics and genomic studies could make its way into medicine and arguably that journey began well before 2003 and we are still on that journey. But the past 10 years, as everybody I think in this room knows, has seen some remarkable accomplishments that bring genomics into medical practice. You're going to hear undoubtedly about a number of opportunities to sequence genomes for diagnosis and even for therapeutic selection, the emergence of novel risk assessment tools and the integration of these tools into electronic medical records, making risk assessments for common chronic diseases, combined with genomic information, a much more powerful way to understand which populations need preventative care and further treatment. The cancer genomes have given us insights not only into the biology of disease but ways to better prognosticate and select therapies, pharmacogenomics, both in cancer as well as the use of germline sequence information and genotypes to select drugs, and the emergence of a series of targeted therapies, the likes of which were never possible prior to the use of genomic information. The United States FDA, both approximately 120 drug labels with genomic information to guide the use of those drugs, 10 years ago that number was probably around four or five. But the challenges I think and we recognize that these are, this information is really, if anything, seldom used and the question is how do we actually encourage and the adoption of this type of information to day-to-day clinical practice. Some of us were involved in a meeting here in the U.S. a couple of years ago, which was a similar meeting of centers and institutes involved in genomic medicine across the United States to begin to understand some of the challenges and barriers, and this publication earlier this year highlighted those, and I think it reflects the kinds of discussions we hope to have over the next two days about developing evidence that shows the value and benefit of genetic and genomic information in the care of patients, the engagement of the institutional leaders of which you are a major part, but also other institutional leaders and physician leaders across the globe in understanding and beginning to be disciples of this information, educational initiatives, and with the proliferation of electronic medical records, the challenges of how to fully integrate genetic information and provide information to provide, give information to providers in a just-in-time format that allows them to make robust clinical decisions, and perhaps most importantly is to create a viable financial model that doesn't simply add costs and new technologies to the things that we're already doing, but can take away costs and remove waste from the system. So we're here today with 25 nations represented, about 50 of you have traveled extremely long distances to be here, and again as I said we're grateful and honored that you could be here. It's also clear from this map that we have some unrepresented regions of the globe that wasn't necessarily by design, and we knew coming into this that we would not be able to reach out to all of the pockets of expertise of genomic medicine around the globe, but we hope if there is to be any future meetings coming out of this that we would have, that this would become a magnet for others to bring together those nations and areas of the globe that are not appropriately represented. Many of you filled out a questionnaire that we put to you some questions about what's the state of the art in your particular organization or nation or region of the globe, and this is a somewhat semi-quantitative view of some of your responses. What you see on the left-hand side are a number of initiatives or platforms that we asked whether they were currently being used in the clinic as far as genomic medicine is concerned, and today as you can see there are a number of sequencing technologies that appear to be present in 50 percent to two-thirds of your organizations and specialized centers. There are also a number of technologies, particularly these platform technologies that are hardly used at all in half to two-thirds of your organizations, but we also asked you where do you want to be three to five years from now, and as you can see there's sort of a right shift in this in this data suggesting that not only will there be a proliferation of sequencing and other technologies in specialized centers in your nations for the most part, but clearly widely available and interpretation might be in less specialized centers and community-based practices perhaps, pharmacogenomics as well as family history, genetic counseling, electronic medical records and clinical decision support. So I think that's a terrific aspiration. The question is how do we get there and that I think is one of the things that we want to spend some of our time thinking about in the next two days. We also asked you what you perceive as the greatest challenges in your particular organization or region of the world and not surprisingly as we found even in our United States meetings on this topic that evidence, evidence is critically important for mobilizing genomics into medicine, reimbursement frameworks that allow for these technologies to be used and paid for, bioinformatics and the creation of an electronic medical record structure, access to point of care information and education that enables clinical decision making and clinical decision support. And many of you also asked where should we be investing. So as we thought about this meeting, our organizing committee thought about this meeting, we felt that there were several outcomes that could take place. One might be to some sort of international body or steering committee that could begin to think about a more collective agenda that is enabling for genomic medicine implementation. There also was the possibility that if we had specific ideas to implement that we might chart some working groups, again globally populated working groups to think about what the implementation agenda should be. Certainly we hope that there will be opportunities for international collaboration and maybe some pilot projects to expand on what we're going to hear over the next two days and we certainly would welcome your input about other ideas and activities and actions that could come from this meeting. Our agenda is packed and we're going to do our best to stay on time. You all have copies of this. I'm not going to go through it in great detail but we attempted to hear from many of our international colleagues what was happening in their institutions and organizations in terms of genomic medicine implementation. We also want to share with you some of those activities that are taking place within the United States. This afternoon we'll have a panel discussion. We hope to have six or so global leaders in genomic medicine will you have a discussion with us about ideas for implementation on a broader scale and tomorrow we'll have some breakout groups that reflect really your requests for prioritization of some of the challenges. We're hoping that action-oriented outputs will come out of those breakout groups that will lead to things that we can do collectively after this meeting is done. These were the meeting objectives that we put in the invitation letters to you. I think they're quite obvious. I'm not going to go through them but I do think we should be benchmarking our activities coming out of this meeting with the objectives that we set forth. I thought this would be a good time for us to introduce ourselves. I know this is going to take a couple of minutes, Terri, or you've been warning me about my time but I would just like each of us to just maybe stand up, say your name and your organization and just let's just go around the room. It'll take a couple of minutes but I think it's important. I'm André Sirotat, chairman of the French National Institute for Medical Research and Health. I'm the director of the Institute of Genomics and Biophobetics and the chairman of the National Islands for Health and Health. I'm the chairman of the Institute of Genomics and Biophobetics and the chairman of the National Research and Health. I'm Frank Loeb from the National Research Fund in Mexico. I'm the general director of the Max Verstenter of the Surgeon's Medical Medicine. Good morning. I'm Kepp Loeb from the Central Medical Genetics in Belgium and I'm the coordinate from Europe. Hi, I'm Michael Brunquitz. I'm the director of Medical Genetics in Brazil and I'm the president of the Surgeon's Medical Medicine. I'm John Long from the National University of St. Claude National University Health System. I co-chair the stratified medicine program office of the National Medical Research Council in St. Claude. I'm the general director of the National University of St. Claude National University of St. Claude. I'm the president of the National University of St. Claude National University of St. Claude. Good morning. I'm Ardoine D'Tecco Verdi from the Johns Hopkins University of St. Claude. I'm Bruce Korf, University of Alabama at Birmingham. Good morning. I'm Greg Puritz, University of Pennsylvania. I'm from Philadelphia. I'm from Harvard Medical School and I'm the partner of Small Care. Good morning. I'm Paul Osgoe from the Canadian Institute of Health Reserve. I'm David Ledbetter, Guising Air Health System. I'm Stephen Kimmel from the University of Pennsylvania. I'm Esina, advisor, department of biotechnology in India and responsible for infectious diseases and biomedical genomics institute in Kalyanya. Kevin Moses, science-funding rock and truss company. What's it from? Rock and truss. Hello. Kevin Leon from Geneva, Canada. Dr. Mock, I guess you said. I'm Daniel Renner from Israel. I'm in the different tests. Some of them in the first month of May. Good morning. I'm Alan Scholl here from the University of Maryland in Baltimore. Irwin Bodger from the Icon School of Medicine in Mount Sinai, New York. I'm Daniel Renner from Geneva, Georgia. Welcome. Thank you. That was great. So speaking of thank yous, this is a complex meeting as I'm sure you can imagine. And I just wanted to highlight the people both from Duke University, NHGRI and the Institute of Medicine that have made this meeting possible. In particular, reader Chambers has worked with me and Terry Minoglio to to bring together I think a series of complex logistical issues to make this meeting happen. Before we move on to what the agenda, I just wanted to also do some I guess housekeeping items. I wanted to remind everybody that this meeting is being video cast live thanks to the team in the back, which means that the people that are watching this need to hear your remarks. So there are microphones that I would encourage you to use if you have a comment to make or a question to ask. And if the microphone is not accessible, whoever is receiving the question should repeat the question. So those on the web could know what's being asked. We're going to try to be on time. Terry has volunteered to monitor our speakers and give them. And this device will also encourage us to remain on time with our remarks. There's a coat room out across the Great Hall and to the right. So if those of you that need to park your coats or bags, there's that facility there and there are restrooms also out this door and to the right down the hall just before you get to the stairs. I also want to know that there were some mistakes in the booklet. Some of you have pointed out to me. I apologize that we weren't able to get the most accurate information at the time of printing, but if you give us and Rita or Teji the corrected information, we'll make sure that the electronic version that we distribute after the meeting has all the corrected information. With that, it's my pleasure to introduce our next speaker, Dr. Francis Collins, who as you know was the leader for the completion of the human genome project. At that time, he was the director of the National Human Genome Research Institute. He's now the director of the National Institutes of Health. And as this slide indicates, he's a risk taker. He's an awardee and an advisor to President Obama. And of course, everybody knows that he's a rock star.