 Well yeah, I have the microphone, thank you very much for inviting me, I appreciate the small one, I appreciate the small one as well. This is the eye as seen by the devils, they were amazing, they collected the degree of science and all that, since I don't have time I'll get on with it. My name is Fahad Amoula and I'm really a molecular pathologist at Kuwait University, and he switched me a little bit, that's what I was going to talk to you about. We moved into genomic medicine as well as a private entity, so I might want to introduce Kuwait a little bit in the health service system, Kuwait has a public sector challenge really, and I will give you a brief history of our work and capability, just for you to know. And as a private sector model as well, which you know about, and a little touch on the genome area. So Kuwait is about 17,000 kilometers, where it's a little bit bigger than Singapore. The population is about 3 million, and one half million, or one million around the Kuwaiti that works here, that work there from all over the place. And we have six governments, and the public, the hospital, the ministry, the health system is public and private, and it should help insurers to visit the private and the public as free for everybody with minimal fee for the expatriate, something like $2 to see, especially. And we have centralized health service, and centralized hospitals as well. And we have the Kuwait cancer control center, so they have complicated health cancer from the country. And we have medical genetics, and we have one university, which is Kuwait University, but many public universities. And the research is orchestrated and organized by the research administration of the university. They do funding, set priorities, and so on. This is Kuwait University, but if you want to get some private external funding, you go for K-FAST, the Kuwait Foundation for Advancement of Science, which takes 1% of every profit from business, and gives it to research programs and education and funding. This is what my research, actually, is under my desk. I'm not a university resident here. And we have also the Kuwait Institute for Scientific Research, which you can also apply on the board. But this is interesting because in 2006, this was published in Nature, basically Oil Rich for Science School. And this is not surprising because 0.1% of our GDP only is given to research and development, 0.1%. And that's really very low. There is a trend now that increased in Qatar and Saudi Arabia to 5%, there may be more. But Kuwait Bahrain UAE remains in the low standard of research. And what you will see is an effort by few people that want to live this beyond the 1% of 0.1%. I made a cry in the scientists about how difficult the system is. I mean, there is not one American in our university who tried to come and realize they can't do anywhere. And we let it. It's just very extremely challenging environment. You get delayed because of tenders, everything is tender. You have to buy your agents, things are tender. And if things are tender, you don't know why you bought them. They arrived after a year. So I said, well, another revolution is needed. And this is really a way out of the current revolution and not this next. Because science is the only way to move forward for everybody, really. And so we started to convince the policy makers around 2008, even more. And they gave up around 2012. And to demonstrate the effectiveness of genomic medicine and procteranostics, really. And to focus on cost-effectiveness, because they want to know how much they say. And that's good, because our cousins are the juniors. So we do that. And so really we do not know how much money we want to save. The model, the financial model, is because it's unknown. But there's a nice review by James Comfort. And I encourage you to read it. But also the benefit is not whether you found the mutation now. It's a lifelong benefit. It's maybe you find something now, but maybe you find something later. And this is a very important concept. So it's unknown. But when I'm talking to the policy maker, I'm telling him, look at generation four. It would cost you millions to treat breast cancer here. It would cost you millions to treat that. But it would actually save you millions if you can predict them before they happen. That was a quick response. Not only this. But here's Ashland Brocker, an American patient, who did not feel the pain. And the discoveries are priceless. I mean, imagine the discoveries. You get out, the IP, you get out from these discoveries are really priceless. So we don't put a figure on that. And we thought the policy maker, how important it is to be changing medicine from descriptive to mechanistic, from empirical to evidence-based and so on. And we also showed them that we don't need prior knowledge anymore. We can do exome sequencing and find something. And it's as effective as Sanger sequencing. And if you do a 70x, you don't even need to confirm that. As Sihama and Raditz have shown. But we also showed them that out of 250 patients that Yang looked at, with unknown neurological, unknown syndrome, 25% were diagnosed in this study. So we're trying to tell the policy maker we have something. We're trying to tell them also we were looking at a disease on, we can divide it into lung cancer, squamous, adenu and blood cell in the past. Now we're looking at specific pathway. And this is not only useful for drug sensitivity, but also for survival. This is dramatic. If you want to convince any policy maker, you really show them the effect of the morphinid in melanoma when they have most of them, anyway, here at the patient. And here's the anesthesies in this individual. And in 15 weeks, they all disappear. And you do not show them the picture after 23 weeks because the metastasies come back again. But this is dramatic. We show them that we're doing the same thing in a way we can subdivide the breast cancer with the luminal, basal, and we've done our own archipelago classification as well. And for the policy maker, again, we showed them before we started, 80% of the people of the woman with turtle amplification died within two years. Since we instituted her septum treatment, 80% are living in Kuwait. And so we passed through this discovery loop, which everybody know about. And we make sure we have European, at least, molecular quality network assurance in Kuwait because we only are a country among Europeans and Americans that have this quality assurance. It didn't work. We talked about the model. This simply did not work. I was not able, I failed to convince the policy maker to put anyone into this. I wanted to sequence everybody in Kuwait. And we went down to sequence in 10,000 and this did not work. I was not able to convince them. And we realized it's not really reaching the people themselves, it's reaching only a few people. And few doctors actually know about what's the benefit of this. And so there was also no mechanism how the hospitals or the Ministry of Health case at Kuwait University and the school that broke the panel back is when they told me, okay, we're doing this only for Kuwait. I'm not expecting it. And I put 100 views to this. So we decided to go private and try a bottom up approach. So we, I went to a center, a medical center for things, most of the specialty, pediatrics, audiology, everything. And I accepted myself into that model as genomic medicine. And this is under the license of Dr. Jermaine Aldamey, the surgeon. And now we offer that as this. So to make things cheaply, instead of buying 11 sequences, you buy one, but you make a network of laboratory from around the world. And so we make a network together, we offer 2,000 genetic tests. And we have together 11, about 11 generation sequencing. And most of us have CPA of the certification. And we offer what is important, is the counseling. Most people ignore this in our part of the work. What we do is genetic disorders and counseling, personalized genomic health, predicted genomics, and entirely family. Not too much individual, but dangerous to do that yet. But genetic and molecular counseling services as well. But we work on the bioinformatics. The report has to be very effective and interesting. So we work with Darrell Baker, who really are looking for thunder here. We need help in that. But this is a system we make, that Darrell Baker made, and this looks at the body view. So the doctor is in the breast surgeon in floor number 10, has a patient with breast cancer. He would click on this patient and click on the breast. And this picture comes out as this, and the genome, only the genes associated known with breast cancer comes out here. If he wants to know all she has a melanoma, only she has a dark patch there, he would click on the skin and that brings out the genes involved in substance disorders. So this is kind of dynamic report, really. So we wanted to make sure that it serves the clinician and the patient and that the report is dynamic. So it's updated. The report looks effective. I hate a report that is 100 or 50 pages and it tells you this and that and this and this set. I mean, the patients don't have the time to do this, so that's what we want. Also, we give the patients their own genome or own enzyme on their mobile phone as well. Because you can conspire it now and you can take it in the very happy way. And if they want help, they will call up. If they want to do this, if they want, they will do it. If they don't want, that's okay. So it's up to them. We are open-minded. Sometimes the codones, well, not sometimes the codones, code for protein, but in synonymous changes, we now realize that this synonymous change is also called for transcriptional factor binding. So it's important to know that the change, although it doesn't change the amino acid, it will also change the transcriptional factor. What do we do with the data generation? Well, we did not want to reinvent the box. So we knocked them down into already known databases. It's great for the insulin syndrome and, you know, for breast cancer, but others are lacking behind what we're doing this. And for whole exomes, whole genomes, we're working with the genomic medicine alliance. Genomic medicine alliance and we are trying to drop whole exomes for free for everybody from every international and we're going to talk about this tomorrow. And databases are very dangerous. This is a recent paper in the Republic, in the genetics showing that 66 percent, this is a curated database. 66 percent of the mutations we have to reclassify from class 1 non-pathogenic to sometimes pathogenic and the points are perfect. So databases are dangerous. We need to look at them in a very, very, a good way. So this is the way for Saudi Arabia and the Gulf states and 50 percent to 70 percent are for synchronous. And by the way, we are ignored completely from the human 1,000 genome project. So we started a project and now we're all funded by Qatar National Foundation and it's important that this unique, understand that this unique variants can change your the phenotype dramatically compared to common ones. And so also we need to sample the population very well because the X's, the green X's are from Qatar and you can see they cluster probably near the Turkish the Egyptians, near the Africans, everywhere. This means our population in Qatar at least is heterogeneous. So we cannot go to one group and we have to publish and we started to do this with Dr. Lutfi Shusha and the collect samples in 2012 and also involvement on the transition population in the moment. Ladies and gentlemen the economics should be done internationally not this. We have very high rate areas of homozygosity compared to Orkney and here is just the taste of some of the of the exons from Bedouin and you start to get about 139,000 variants and 13 per set 13,000 of the 464. And this rate drops down when you start to look at a Syrian lady running away and her child which is interesting. So I think there is a time to do this. You've heard this I visited Saudi today, you should have been here but they are planning to sequence the Saudis you know about 100,000 of them and this is important and why just look at this. The the Saudis have problems whenever the Saudis start something, also the the Saudis start something else and so they announce also the the Gino project again really this is my message we need to educate educate is really key and behind this veil is a human who is really 90% of the Saudis are asking why 90% Yeah, because if you add the copy number variation in the first location you realize actually much more than 99 identical to any other. So thank you very much for listening. This question probably could have been asked for some of the other speakers but Genetac is offering tests that are based on the Gino variation. So if I read out what you're telling us you will also be offering tests that will be unique to this region of the world as well. Right, so we do the other than the 1000 plus some of the Gino we have done already we run out of at least 1000 and go up to at least 50 or 40. Based on the genetic variation we know about from 1000 genomes. And who's paying for that? The patients themselves in the private sector but also funding the government as well because now they realize we are doing better than I was at the university and the government is now sending this out to Genetac. And Genetac cannot be between your gene. Great. I wanted to ask you about the comment you made about giving the exomes to patients on a mobile phone. Who wants those and what do they do with them? Right. And some people actually you'll be surprised. I was paying for them and they are so educated I want to look at it and we show them the way to look at it. I the sequence belongs to her but the message I want to add is we should collect these sequences somewhere and this way it's criminal criminal to the genome initiative to take one information from the exomes and genome and so on. So I'm collecting information about the questions. Thank you very much. Thanks for coming all this way. The next presentation is from Korea from Dr. Park Ki-han.