 We have a practice at NHGRI, yeah, Vence, why don't you come on up? We have a practice at NHGRI of inviting recently appointed senior leaders to come to the council, give a presentation about their scientific goals and the vision of their institute, and to have a conversation with the council about possible areas of common interest in terms of research. Today's guest speaker is Dr. Elisayo Perez-Stable. He is the director of the National Institute on Minority Health and Health Disparities, and I've asked Vence Bonham to do his introduction to you. So good morning. I am so honored and pleased to introduce Alea So Perez-Stable, who is the director of the National Institute of Minority Health and Health Disparities. The National Institute of Minority Health and Health Disparities conducts and supports research training, research capacity building, infrastructure development, public education, and information dissemination programs to improve minority health and reduce health disparities. NIMHD is the lead organization at NIH for the planning, reviewing, and coordinating and evaluating minority health and health disparities research across NIH, so working with all of the 27 institutes and centers with regards to disparities research. Dr. Perez-Estable is expertise spans a broad range of health disparities disciplines. His research interests have centered on improving the health of racial and ethnic minorities and underserved populations, advancing patient-centered care, and improving cross-cultural communication skills among healthcare professionals, and prompting diversity in the biomedical research workforce. He's recognized as a leader in Latino healthcare and disparities research, and he has spent 32 years leading research on smoking cessation and tobacco control policy in Latino populations in the United States, addressing clinical and prevention issues in cancer screening and mentoring over 70 minority investigators. Prior to becoming the NIMHD director, he was a professor of medicine and chief of the division of general internal medicine at the University of California, San Francisco. He was the director of the UCSF Center for Aging in Diverse Communities, which is funded by the National Institute of Aging, and he was the director of the UCSF Medical Effectiveness Research Center for Diverse Populations. He was elected to the National Academy of Medicine in 2001. He earned his BA in chemistry from the University of Miami and his medical degree from the University of Miami. And since his arrival at NIMHD, there's been really a new era of collaboration between NIMHD and NHGRI and also with a number of other institutes across NIH. And I just want to thank him for building the bridges around research initiatives between NHGRI and pleased to have him here today. Thank you for the kind introduction, Vince, and Eric for inviting me. And I'm pleased to present to you this morning on sort of what the vision and agenda for our institute is. And I'll start by reviewing history. This was, our IC was actually initially an office under the NIH director that was established in 1990 by then Secretary Lewis Sullivan. Subsequently, it was transitioned to be a center by the year 2000, championed by the Congressional Black Caucus and particularly representative Lewis Stokes. That probably was the critical step in that it afforded us ability to have a grant portfolio. And then as part of the ACA legislation in 2010, it was transitioned to an institute. And there were a number of legislators involved in that. Dr. John Ruffin was the director through all these entities until his retirement a little over two years ago. And then Yvonne Maddox became acting until I started on September 1. So this is my ninth month, not yet full gestation. And our budget, as you can see, is 280 million. This is with the extra 3% we got in December. And we are the second smallest institute, although the two other centers, Fogartian, Complementary Medicine, are also smaller than we are. So our mission as events outline is really to lead scientific research on advances in minority health and health disparities. And I'll spend a little time differentiating and defining those two. Support research in minority health is defined by the census and then also understand the causes and to reduce the lead to and reduce health disparities in specific populations. Although we have a limited training portfolio, we are very interested in promoting diversity in the scientific workforce. I think this is a crisis that the profession faces on both the clinical and scientific fronts. And we are very supportive of the efforts that Hannah Valentine and all the institutes are doing on this area. And then of course, communicating to the public and to our colleagues as well as fostering collaborations and partnerships both within NIH and outside. So our definition of minority health is to look at distinctive characteristics within these minority racial ethnic groups in the US. And I'll go over those for a minute. There is a common social disadvantage that these groups have been subject to some level of discrimination. It's a common theme. It's not all equal. There's clearly a legacy of slavery in the US that is distinct and disproportionately affects African-Americans. But all of the minority groups share some level of discrimination. It coincides that they're also almost universally we're underrepresented in any biomedical research regarding humans. And most of them are also underrepresented in the scientific workforce. The exception to this are the certain Asian national origin groups, particularly from the northeast part of Asia and South Asia. These are the minority health populations in the US by the Office of Management and Budget. This is what they define whether we like it or not. This is what we live with. And this mandates our minority health component of our institute. African-American or Black, Asian, which are very heterogeneous and represent over 30 different countries and really dozens of languages, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander. And here I will emphasize that this group is different than Asian, even though we frequently see it lumped together with Asian. And then Latino or Hispanic, which is actually an ethnic group. All of this, of course, is driven by self-identification. And this is an issue that has been accepted both by the census and by the scientific community that deals with minority health and health disparities. That is the gold standard is self-identification of race, ethnicity. We are told that the 2020 census is considering using a single question again and making it race or ethnicity, so that right now it's Latino, Hispanic, ethnicities ascertain first, and then they ask race. And they're also proposing adding another ethnic group to this options, which is North African, Middle, Eastern. And we'll see what happens since I assume these need congressional approval. Health disparity populations includes not only the race ethnic groups, but also low socioeconomic status and underserved rural residents. And by low SES, we mean essentially people with less formal education or low income or otherwise disadvantaged. And others who may also be subject to discrimination or have poor health outcomes attributed to this social disadvantage. The groups that are the main group that is under discussion actively now is sexual gender minorities, although it has not yet been processed fully by the department. And we believe that these individuals also have on being underserved in healthcare. Now, as director of NIMHD, I am empowered on paper to make that decision, although I don't think Dr. Collins would let that happen exclusively. And it also says that director of ARC, of the Agency for Healthcare Research and Quality, is consults with me on this. You look at ARC's list of disparity populations, you can see it's quite inclusive and you'd wonder who is left after seeing that list. But it is actually, they call it a priority population and not disparity. So they do make that distinction. And so I would emphasize that all of these groups could potentially be considered, although we emphasize the top three as listed in this slide. So health disparities is then the difference that adversely affects a disadvantaged population based on one or more health outcome. And then our research, our science is devoted to knowing why these different health determinants or factors lead to these differences. The mechanism, pathways that this happens and then developing and testing interventions to decrease these disadvantages. Eventually, hopefully in some cases eliminate them. We've come to this consensus on these four outcomes that we wanna emphasize. They're common ones, higher incidence or prevalence or premature or excess mortality in diseases where populations differ. Some global burden of disease measure, disability adjusted life here is being a common one used in global health. And so therefore I think one that we would adopt. And anything that is related to patient or population reports or individual reports on health related quality of life, daily functioning and emphasize using standardized measures that have already been made, found to be both reliable and valid in testing the outcome of interest. These are some of the risk outcomes or the mechanisms that we are interested in whether it be lifestyle, issues around stress, whether it be biology or epigenetic risks that lead to greater susceptibility, faster progression or greater severity. Things around clinical events that adversely impact health. This relates to both differential treatments that happen in the healthcare setting, adverse events of medications, falls or progression of disease. In other words, progressing from chronic kidney disease to dialysis as a major event doesn't change diagnosis, yet it becomes an important mechanism for disparities. And then utilization of care, whether it be lack of access, abuse or use of appropriate services, screening, hospitalizations, et cetera. An area I think that on a disparity perspective has a lot to be learned. I like to use a simple diagram of saying what minority health and health disparities are about. They do have overlapping variants, but they do explain separate or independent variants. And similarly with race, ethnicity and social class or SES, these are intermingled, overlapped, but do have independent variants. It's not all about social determinants, yet it isn't all about race, ethnicity issues either. Our scientific staff developed this overall framework to try to capture what our science is. And it was derived in part from work that I did while I was on NIA's council with Marie Bernard, Carl Hill and Norman Anderson where we published a framework of research in disparities in aging and research. And it tries to present the idea that this is not a simple one dimension of research, but we really are focused on biological, behavioral, environmental influences, both physical and social cultural ones, as these relate to the healthcare system. And then across the spectrum of individual, interpersonal, community-based and societal ones. So the individual behavior, mechanisms and biology are obviously important and interpersonal interactions. Social networks is a powerful factor that we don't fully understand as how it relates to both the family as well as one's community and then the broader community and society as it relates to policy. And in thinking about health disparities, all of these factors are really interacting and we are focused on all of these with regards to health outcomes in looking at race, ethnicity, socioeconomic status and rural. To move on to a different and related topic, inclusion of minorities in clinical studies is not minority health. So if you have a research project where 40% of your sample is minority and you're asking a question that's fundamental in your science, that's great, but it's not minority health just because you have minorities in it. And it has been some confusion around that topic at NIH for many years and we want to clarify that. We're in the process of doing that. So I'll keep repeating it until we finalize it. But we do want to call it inclusion and I think it's something that's very important. We're all familiar with the tables that our investigators, that we filled out as investigators on our grants for women and minority groups and children and the very old also need to be in this consideration and we ought to differentiate U.S. and international participants in our studies. This is an issue of social justice, good science. Hopefully we'll find out. And then common sense since almost 40% of the U.S. population now is one of those minority groups I outlined before. And then the fourth issue is the workforce diversity. As I said, it's an urgent societal issue. It has been very slow incremental change over the 30 plus years I've been in a physician and we're not there. We're far from there. And I think in the clinical world, there's been some, a little bit more progress. 10, 12% of the clinicians are now under-represented minorities. Pardon the interruption. Your conference contains less than three participants at this time. If you would like to continue, press star one now. Happens everywhere, right? Happens at the IC director's meetings too. And less than 5% of our NIH submitted grants or funded grants are actually by with African-American or Latino principal investigators. Dr. Collins and Dr. Tabak have really taken this on. Hannah Valentine was hired. We've been very rigorously looking at what has happened with this and try to define interventions independent of what's already happened for the pipeline to try and improve this. But I think these data are compelling in and of themselves and if we don't do something about it. Your conference contains less than three participants at this time. If you would like to continue, press star one now, or the conference will be terminated. All right, I can only hope, right. So let me final, let me finish by saying a few things about some research issues without going through an extensive review of portfolios or looking at the broad view of things. These are some topics that I think are familiar to all of you that are relevant in disparities and genetics. And cancer is the obvious one where I'll show you some data from breast, but even just today Eric talked about a prostate cancer report. Colon cancer has identified some predisposing loci that increased in African-Americans where we do see an excess rate. Lung cancer, multiple myeloma. So this is where probably most of the work you're familiar with. Just last week, there was a paper published out of UCSF on asthma in African-Americans on some susceptibility genes that were only found in African-American children. Diabetes with Mexican-Americans having a two to four fold increase rate of diabetes is not just about behavior or obesity or lack of physical activity. There's a genetic predisposition. And most of you are familiar with the April one story in chronic kidney disease, which is a significant increased risk for chronic kidney disease predominantly among African-Americans that is found in a significant number of the US African-American population. These are seer rates for cancer in women. And just taking one look at this with this very global category of race ethnicity and notice here that Asian Pacific Islanders are lumped together, one has to see that race does matter in thinking about disease because you see these dramatic differences in rates that are not always explainable. Cervical cancer, we think is caused by infectious agents so we can see that, but it's the least common of these. But let me focus for a minute on breast cancer and just tell you quickly about a story that probably many of you are familiar with. For many years we've known Latinas or Hispanic women have lower risk of breast cancer. A number of years ago, a group at UCSF led by a lot Ziv and I actually allowed a fair man as the first author, looked at ancestral markers and in a case control design in the Bay Area and found that, and this is a study that already existed, immigrants unless acculturated women were protected from breast cancer and then found that a European ancestry was associated with a higher risk of breast cancer and after adjustment with all the other risks for breast cancer that were collected in that study, the odds ratio was attenuated to 1.39 but was remained significant. They replicated this with a similarly designed case control study in Mexico, although again the odds ratio was somewhat attenuated in those results. And then a couple of years ago in lumping together a number of samples in Northern California and Southern California including the multi-ethnic cohort study, they were looking for a genetic association with lower risk of breast cancer among women of Latin American origin and then replicated it with a number of other studies that were available from Mexico, Columbus Consortium and Women's Health Initiative. They found a site in the eastern receptor gene area that was significantly associated with lower risk of breast cancer. The odds ratios were consistently in the 0.6 range for this study including with a trend towards this being actually more significant in eastern receptor negative breast cancers, although this is not yet to really found on strong evidence. And the gene is present in 15% of Latino women if Mexican and Central American, all of indigenous American ancestry, that's where the location is. The gene has not been found in other populations. I think there as of the time that this was published in Nature Communications, there was one person in China and one person somewhere else that had this allele but it's predominantly a Latin American allele and it's 15%. So it's not uncommon. So again, this is not something that would have been sought for or thought of even though it's not in a new area without knowing either epidemiology was different and then pursuing it with this population in mind and it is protective gene which is sort of a nice twist supposed to in the susceptibility or increased risk gene. These are some grants that we fund that are in the genetics space. We're also, I think, wanna mention where we support the H3 Africa initiative and have been and will continue to support it. The triple negative breast cancer access among African Americans, also among Latinos, although that has been less well publicized, biological environmental modifiers vitamin D3 and prostate cancer issues around clinical sequencing with a CSER, two sites. With Eric's support, we actually partnered on the new round of CSER by also having genome partner with us on our precision medicine centers that we either are about to fund or just funded. There will be at least three that are funded and we will be partnering scientifically on that. There's no net exchange of funding but mostly just a sort of a collaboration and then of course the APOL-1 understanding basis of disparities in rates of kidney disease, particularly around, there's been a lot done around transplant issues but there are other issues related to APOL-1 that need attention. Our priorities are really focused on science and health disparities of minority health in the framework I presented. I don't want NIMHD to be about anything else about what we do. We are definitely involved in social determinants and behavior as well as biology and all of these factors are important. I want to do more in the health services world and the healthcare setting across the spectrum, so from primary care to the hospital. This is not an area, I think that NIH has been heavily emphasizing in the past but I think we have something special there in terms of health disparities in minority health and by the fact that that means collaboration with other agencies like AHRQ or PCORI. I want to rebalance our portfolio so we've been predominantly funding centers and I want to have a more balanced portfolio where we have more R01 science as well as continue to promote diversity in the workforce and emphasize population and community health. We've created three branches within our scientific programs. Up until now there were no branches, it was all just one big program and these are our programs, it's just emerging so we're still in the development phase and need a new branch chief and need more scientists so if you know anyone, send them our way. These are concepts that we've cleared and that we have coming out of program announcements. The health services research one is already out. There's one on HIV treatment, there's one on immigrant populations which will be very broad, focused on etiologies and interventions. There's one on disparities in surgical care, social epigenomics for minority health and health disparities as well. These are all approved and in process. We are gonna host, we're planning to host three additional scientific workshops. We're concluding this visioning process that was started by Dr. Maddox before I arrived. We had a measurement and methods conference in April and this week we're having etiologies and interventions. This is trans-NIH as well as external scientists who are coming and hopefully we'll come to some closure on that. Reflecting a little bit the vision I presented as well as more detail of the content of the science. We wanna have IT information technology in minority health and health disparities and the National Science Foundation has once a partner with us on that. We're working with NHGRI on the issue of phenotype versus genotype, sort of revisiting that. Mostly just to bring clarity to the field for community sake of where we stand on this both from both perspectives. I think it's a good, it's been about 10, 12 years since the last time this was done at NIH. And then one on structural racism and cultural competence. These are constructs that I have always wondered whether they're research constructs, they're really more systems constructs and I'm not clear that there is a research agenda to pursue here but they're important constructs and have some sort of an agreement on where we should go. If there is research to be done to help define those areas and the Office of Minority Health is very interested in this topic on the cultural competence side but I think there's also worthwhile to go through that. We're having a Disparities Research Institute so this summer it's intended to be bringing in promising scientists who are interested in minority health and health disparities and this can be my ideal candidate for this is senior postdocs to mid-assistant professors, not R01 funded yet. So the people who might benefit from one week exposure to some in-depth presentations, networking with extramural scientists who will bring as well as us, us meaning NIH and it'll be in the summer so whoever we can get. And we are, it's a change of what NIMHC has done in the last five years but I think this is the direction I wanna see us invest this effort in. And finally, I'll mention our intramural program which has been essentially non-existent. We have allocated 2% of our budget to intramural. Tragically both the scientific director and the clinical director passed away shortly after Dr. Ruffin retired and so I got a blank slate and option one was why you have one and when I figured out what we could do with it I said of course I want one and option two is what are we gonna do with it and I think that's gonna be focused on population science with probably some sort of a clinical component. It's still very much in flux. My first step was to recruit a scientific director. Kevin Gardner has been acting and done a wonderful job of it and we have an add out for a senior scientist. We will have a scientific director and then immediately following a second recruit of an established scientist to help set this up. One of the ideas is a new cohort study maybe of immigrants, something to be defined. The other component has been to network with other institutes programs with similar interests and we have I think through Kevin's work been able to network with well genome as well as aging NHLBI, NCI, NIDDK and child health where there are scientists either new recruits or established scientists in these institutes that have an interest in minority health and health disparities and try to create a monthly seminar and create some synergy and mutual support around this topic without necessarily being funded all by NIMHD. We are of course supporting some of these efforts. So I think I've probably gone longer than I should have. So thank you for your attention. I'll be happy to answer questions. Vince, if I have time, yeah, so thank you. I had a question for you having to do with outreach to potential research subjects and what role you think your institute plays in helping spread the word that disparity research as well as minority health research requires involvement of people of minority backgrounds. Right, so just to clarify, so our research participants involvement in studies on human beings should be across the board include minorities. So whether it is a minority health question or whether it's a disparities question or just a question that involves recruitment. And I think this is what we're calling inclusion. If the research is focused on a minority health question, intra-group or comparison of groups, even if the outcome is actually favorable, let's say Latinos have lower rates of heart disease than whites, so it's not technically a disparity, but yet we wanna know questions about that and so we would do a study like that or African Americans have lower rates of suicide and we wanna ask questions about why that might be and the mechanisms for that. And then disparities includes more than minorities. It includes people of socioeconomic disadvantage. My own personal view on this is that those are the fundamental pillars of health disparities in the United States today. There are probably half a dozen other groups that would make a case for their inclusion. We do have rural underserved residents in our mandate. Clearly there are some rural populations that are not underserved or have disparities. Either Jackson Hole or let's say the ranchers in Central California are not, but certainly West Virginia, the rural South, much of that is driven I think by social class and race ethnicity, but that is one of our options. So that's the clarity we want to bring to this. We've presented this to everywhere and once we got some sense of it, since January I've been presenting to different councils. I've presented IC Director's Meeting and I don't think that there is any fundamental disagreement with this view based on so far, whatever. So we have Eric and then Shanita and then Gal. First, thank you very much coming and speaking with us. Many of the people in the NHGRI community, many of the people around this table are very interested in genomic medicine, pushing the findings from genomics into the translational space. That's going to expand as we build the Precision Medicine Initiative and start to realize translational results there. However, often the valve that controls the uptake of this new technology is the payers themselves, the insurance companies for example. And I have a concern that in fact the discussion in our hearts frankly, are wanting to use these new findings to reduce health disparities. But my concern is if we're not proactive they're actually gonna increase health disparities because only the wealthy can afford it. So how do we make sure that genomic medicine, precision medicine is not really medicine for the wealthy, it's medicine for everyone? Well, you highlight a really critical point that I think we all need to keep front and center as we move forward. The experience with IT uptake is one that we can look on as a possible way. So minorities and people of less or more disadvantaged socioeconomic status have been, we're initially left behind when we went to let's say electronic medical records in the ability to see your medical records and communicate with your doctor. But what we've seen with time is that this lag has been closed and there has been catch up. And in the more recent uptakes of EMR, minorities have been as almost as engaged as whites or the higher socioeconomic status groups. But I share your concern, I do think that the digital divide could worsen disparities. And so unless we put that as front and center in our discussions, this could happen. If you have to pay $50,000 a dose for a biological agent that leads a 70% remission of a particular cancer, then there are some people who are not gonna be able to access it. And so some of it has to come from government regulation. Some of it has to come from the providers of the agents and some of it has to come from the research, the knowledge that we generate to make this something accessible. When we do find treatments, they really make a difference. So I thank you for your comment. Thank you, thank you for a great presentation and overview of NIMHD. I'm actually really excited about the vision you put forward and was just curious about two things. One was what your vision was for the R01 program and portfolio and do you see that unfolding in the way that sort of the framework that you outlined for minority health and health disparities or do you have a different vision for that? And then my second question is related to an initiative that predates you and it's the community-based participatory research centers and whether or not you see that having a role in the future of NIMHD. Right. So thank you for your questions and comments. As a recent extramural scientist, I know that there's a community of investigators out there who focus on these topics, minority health and health disparities. And they haven't seen NIMHD as a source unless they got central funding because there were no R01s. So NIMHD only signed up to the parent R01 two years ago under when Yvonne first became acting. And so we get a trickle of R01s compared to other institutes with adjusting for budget size. So I wanna see that grow. That's why we're putting out program announcements and saying we are interested in grants in this area, in that area and it's not meant to be this is all we're gonna fund at all. I think I really want just to get people's creative juices going and have them look at us as a place to send grants. And the concepts we've approved and a couple more that we're gonna propose to council next month are ones that came out of program scientists, maybe had a little influence on some of them out of our meetings and discussions about scientific areas. And we're not done. I mean, our idea is to keep generating these and put them out. But I very much wanna see anything that, good idea that a scientific community sends in and then have the same problem all the other institutes have of we can't fund all the good science that's out there, which is I think is a good place to be. That's balanced with our centers, which we need to maintain, although it's gonna be a balancing of the portfolio. The CBPR is, I'm very much in support of community engagement and community based research. I'm not religious about CBPR. And NIMHD has been sort of the main place where CBPR has thrived at NIH with some other programs, let's say at NCI I was familiar with or I'm sure other ICs have had them as well, but not as much. So they will be part of our, one of the many things that we will be supporting. I don't think we're gonna have a specific CBPR sort of say set aside to put it that way. But the centers are ones, they will definitely be considered and we will give them fair evaluation, good evaluation as a scientific method, not sort of say, oh, this is no good because it's community based. So does that answer your question? And I didn't fully answer your point about recruitment science region. I think that was what you were going at. And I think people have done this several times over the last two decades. And I also sense the need that to bring people back together at some point to say, okay, what are our best practices? Because NINDS has a whole program that we are participating in. It's been a big issue with PMI. I think the CSER came up when I was there back in September. So I think that it's time to revisit and there's not gonna ever be like, this is the best science on it. I mean, it's almost like an expert opinion and common practice that people will say, this works and then create some sort of a common ground that we can refer people to. There's been a fair amount done, though, in this space. Yeah, although, thank you, Lucille. That was really what I was driving at. But I think two things. One is, of course, it's a moving target because things are not the same as they were 10 or 20 years ago. And secondly, I think the clarity you're bringing to the distinction between inclusion and minority health research is an important distinction and it's worth thinking about in this area of recruitment science. Gail. Yeah, and I joined the chorus of thanking you because it's awfully nice to meet you and it's wonderful to hear your vision for this new institute, or relatively new. My question is about five slides before you finish. You mentioned target areas that you want to bring people together to revisit, and one at the third out of four. You don't have to pull it up necessarily, but was really looking at the relationship between self-identified race and ethnicity and biological genetic science. And of course, this is the bugaboo that has really plagued everybody, and whenever anybody talks about this, they have to go over, like, okay, race, it's a social, and so I like how you started with your program and that self-identified race ethnicity is how you envision a lot of the work because of course a lot of it is, that's what determines health and access to healthcare. But then I'm very curious about what your vision is for that one bullet and how you hope to move that conversation forward. It's a really tough one, and we've got all these CSER grants that are gonna come in and they're gonna try and argue that they're gonna focus on inclusion of underrepresented groups because of the value for genome science. So they're gonna have to address how do they recruit them, measure them, define them. So I'm so curious what you're gonna do with that bullet. If I had a sort of a future lens, we could find out. We have even a tentative date, and I'm not sure if that's gonna hold up sometime in October. So we're partnering with Vince, is really leading this for genome and we're working actively on setting, defining the identity. The whole notion is this. Many years ago, much of my sort of scientific community said, okay, race and ethnicity are social constructs and this is how we define it. And there was this whole thing, all the genome is, there's more intra-individual variation than there is between groups and this is 90s kind of discourse. With the genome definition and the ancestral marker became a tool, it became a tool to discovery. And I showed you one product of that. I think there's a number of other active research areas in that, particularly interesting in the admixt populations of which Latin Americans are. Hispanic Latin Americans are very admixt, 500 years of admixtures. So it's an interesting blend of three major racial groups. Similarly, you could look at Hawaii that way or India maybe, those are the three groups that come to mind. So I always thought it's a tool. It's a tool for exploration and discovery. It doesn't replace the social construct. When all the ancestral marker stuff started coming out in the early part of the 21st century, the social scientists I knew got very nervous about this and they kind of like, I would talk about it, bring it up and they'd get very upset about, you're defining race as a genetic thing, is it deterministic? And then on the other hand, meetings I didn't go to, geneticist, we're also thinking, well, maybe this is what we're really gonna focus on. So I think we need to come to some sort of mutual consensus at NIH and I don't think we're, I think we have sort of have it, but really maybe put it down as saying what are, because I think if you go one way or the other with exclusion, you're missing part of the picture. And as far as I'm concerned, at least while I'm alive, race will continue to be a social construct. And someday maybe everybody will, it makes, and then we'll just be all humans and maybe that'll happen, although it hasn't happened yet and it won't happen in the near future. Given social, cultural, political and all these other reasons why people don't mix, even if you put them all together in one place, in one country. So I think it's a tremendous opportunity for scientific knowledge advancement using these tools for both discovery and associations. Now whether or not is Charles here, routine? No, he would say, well, at some point, patients will come in and say, well, here's my ancestral mix and this is what you should know for precision medicine because drug A works in this group and not works in that group or drug B or if this disease is, if you have this, and maybe that's where we'll go in the future. I'm not saying that's not likely, but we're not there yet. I mean, except for cancer and of course some unusual diseases, we're not at that point yet in the clinical arena, although it will be maybe in the future. That'll be sooner, I think. Does that help? I ask questions. So I let Vince introduce you so maybe I get to thank you. Thank you. I would say, and I think you can quickly see, he's been a terrific addition to the group of Institute and Center Directors. He's also been a quick study. You've only been here nine months. He's very quickly learning. Considering you came from outside the government, I always have great admiration for people outside of the government coming into a job like this. It's so much you have to learn just about all the government speak and he's just done this fantastically, but also you can see brings an incredibly collegial spirit that is just wonderful to have and we really already regard him as a great friend of the Institute and I am sure you'll be hearing more about interactions between our two institutes in the coming months and years. So thank you for coming and meeting our council and vice versa. Thank you. Vince wants the last word. I just want to follow up. I always give it to him. On the question about the meeting, Larry Brody and I are leading the planning from NHGRI. So if you have any feedback, because we're still developing this meeting throughout the day, please come up to one of us and just share your thoughts and comments. All right, good news is it's on to lunch. Believe it or don't, we have instructions for lunch. The reason there are instructions is that we need to take the annual council photo and for the first time in two and a half weeks we have decent weather. So comfort's gonna lead you out to the steps over by the parking garage. The experienced council members know where that is. So if you're new, just latch on to somebody. Won't take long to do the picture. Once it's done, please go into the cafeteria. It's on the ground floor of this building. Procure your lunch if you want to lunch. And then your executive session with Eric gets moved today since it's a one day council meeting. That's gonna take place on the fourth floor in the conference room there. So take the elevator up to the fourth floor. When you get off the elevator, there's double glass door. There'll be someone at the desk to admit you and conference room is right there. We will resume the, and complete. When do we, so they should get their line. So we're gonna meet up on the fourth floor, just me and council alone in the room. Probably by 12, 20, 12 or whenever they get food. And then we should. Back here at 1.30. So we'll resume the open session at 1.30 in this room. Okay. We're gonna follow that. So I'll see you guys on the fourth floor. After the first, everybody to the photo. And then up to the fourth, get your lunch up to the fourth floor. Great, great. Yes, yep, somebody. You can leave stuff. You can leave stuff here if you, whatever you need for the executive session, take with you.