I think I'm just going to read from the beginning of the book so it doesn't require much contextualization. It's a real pleasure to get to read with you guys and in this room. My first public reading was in the Topeka Public Library. And this, so I feel like I've really, I've come a long way. So I'll just read from the beginning of the book. The city had converted an elevated length of abandoned railway spur into an aerial greenway and the agent and I were walking south along it in the unseasonable warmth after an outrageously expensive celebratory meal in Chelsea that included baby octopuses the chef had literally massaged to death. We had ingested the impossibly tender things entire, the first intact head I had ever consumed, let alone of an animal that decorates its layer, has been observed at complicated play. We walked south among the dimly gleaming disused rails and carefully placed stands of sumac and smokebush until we reached that part of the high line where a cut has been made into the deck and wooden steps to send several layers below the structure. The lowest level is fitted with upright windows overlooking 10th Avenue to form a kind of amphitheater where you can sit and watch the traffic. We sat and watched the traffic and I am kidding and I am not kidding when I say that I intuited an alien intelligence felt subject to a succession of images, sensations, memories, and affects that did not properly speaking belong to me. The ability to perceive polarized light, a conflation of taste and touch as salt was rubbed into the suction cups, a terror localized in my extremities bypassing the brain completely. I was saying these things out loud to the agent who was inhaling and exhaling smoke and we were laughing. A few months before, the agent had emailed me that she believed I could get a strong six-figure advance based on a story of mine that had appeared in the New Yorker. All I had to do was promise to turn it into a novel. I managed to draft an earnest if indefinite proposal and soon there was a competitive auction among the major New York houses and we were eating cephalopods in what would become the opening scene. How exactly will you expand the story?  I'll project myself into several futures simultaneously, I should have said, a minor tremor in my hand. I'll work my way from irony to sincerity in the sinking city, a would-be Whitman of the vulnerable grid. A giant octopus was painted on the wall of the room where I'd been sent the previous September for evaluation, an octopus and starfish and various gill-bearing aquatic craniate animals for this was the pediatric wing and the sea scene was intended to calm and distract the children from needles or the small hammers testing reflex amplitude. I was there at the age of 33 because a doctor had discovered incidentally an entirely asymptomatic and potentially aneurysmal dilation of my aortic root that required close monitoring and probable surgical intervention and the most common explanation of such a condition at such an age as Marfan, a genetic disorder of the connective tissue that typically produces the long-limbed and flexible. When I met with the cardiologist and he suggested the evaluation, I'd noted my excess proportion of body fat and conventional arm span and only slightly above average height but he counternoted my long, thin toes and mild double jointedness and contended that I might well fall on the diagnostic spectrum. Most Marfanoids are diagnosed in early childhood, thus the pediatric wing. If I had Marfan, the cardiologist had explained the threshold of surgical intervention was lower, was basically nigh because the likelihood of what they called dissection, a most often fatal tearing of the aorta is higher among Marfanoids. If I did not have an underlying genetic condition, if my aorta was deemed idiopathic, I would still probably require eventual surgery but with the more distant threshold and the possibility of much slower progression. In either case, I was now burdened with the awareness that there was a statistically significant chance the largest artery in my body would rupture at any moment. An event I visualized however incorrectly as a whipping hose spraying blood into my blood before collapse of far look comes into my eyes as though, et cetera. There I was at Mount Sinai Hospital Underwater in a red plastic chair designed for a kindergartner, a chair that had the immediate effect of making me feel ungainly, gangly in my paper gown and thus confirming the disorder before the team of evaluators arrived. Alex, who had accompanied me for what she called moral support but was in fact practical support as I had proved unable to leave a doctor's office with even the most basic recollection of whatever information had been imparted to me there, sat across from me in the lone adult chair, no doubt placed there for a parent, notebook open in her lap. I'd been told in advance that the evaluation would be conducted by a trio of doctors that would then consult and offer its opinion which I thought of as a verdict but there were two things about the doctors now entering with bright smiles that I was not prepared for. They were beautiful and they were younger than I. It was fortunate Alex was present because she would not have otherwise believed me but the doctors, all of whom appeared to be originally from subcontinental Asia were themselves ideally proportioned in their white coats with flawlessly symmetrical high boned faces that no doubt through some deft application of shadow and gloss glowed with almost parodic health even in hospital like a dusky gold. I looked at Alex who raised her eyebrows back at me. They asked me to stand and proceeded to calculate the length of my arms and the curvature of my chest and spine and the arch of my feet to perform so many measurements according to a nosological program mysterious to me that I felt as if my limbs had multiplied. That they were younger than I constituted an unfortunate milestone beyond which medical science could no longer stand in benevolent paternal relation to my body because such doctors would now see in my pathologized corpus their own future decline and not their past immaturity. And yet in this room outfitted for children, I was simultaneously infantilized by three improbably attractive women in their mid to late 20s. Well from the more than literal distance of her chair Alex looked on sympathetically. It can taste what it touches but has poor proprioception. The brain unable to determine the position of its body in the current particularly my arms and the privileging of flexibility over proprioceptive inputs means it lacks stereognosis the capacity to form a mental image of the overall shape of what I touch. It can detect local texture variations but cannot integrate that information into a larger picture cannot read the realistic fiction the world appears to be. What I mean is that my parts were coming to possess a terrible neurological autonomy not only spatial but temporal. My future collapsing and upon me as each contraction expanded however infinitesimally the overly flexible tubing of my heart including myself I was older and younger than everyone in the room. Her support was moral and practical but also self-interested and that Alex had recently proposed in pregnating herself with my sperm.  The subject was broached at the Metropolitan Museum which we often visited weekday afternoon since Alex was unemployed and I a writer. We had met each other in my freshman in her senior year of college in a dull class about great novels and felt an instant and mutual sympathy but had not become best friends until we found ourselves almost neighbors in Brooklyn when I moved there a few years after graduation and we began our walks. Walks through Prospect Park as light died in the Linden's walks from our neighborhood of Boreham Hill to Sunset Park where we would watch the soft wing kites at magic hour. Nocturnal walks along the promenade with the looming intensities of Manhattan glittering across dark water. Six years of these walks on a warming planet although walking wasn't all we did had rendered Alex's presence inseparable from my sense of moving through the city so that I intuited her beside me when she wasn't. When I crossed a bridge in silence I often felt it was silence shared between us even if she was visiting her parents upstate or spending time with a boyfriend who might could be counted on to hate. Maybe she broached the subject at the museum and not over coffee or the like because in the galleries as on our walks our gazes were parallel directed in front of us at canvas and not at each other a condition of our most intimate exchanges. We would work out our views as we co-constructed the literal view before us. We did not avoid each other's eyes and I admired the overcast sky quality of hers dark epithelium and clear stroma but we tended to fall quiet when they met which meant we'd eat a lunch in silence or idle talk only for me to learn on the subsequent walk home that her mother had been diagnosed in a late stage. You might have seen us walking on Atlantic tears streaming down her face my arms around her shoulders but our gazes straight ahead or perhaps you've seen me during one of my own increasingly frequent lacrimal events being comforted and kind while we moved across the Brooklyn Bridge less a couple than conjoined. That day we were standing before Jules Bastien-LePage's Joan of Arc. Alex looks a little like this version of her and she said apropos of nothing I'm 36 and single. Thank God she had broken up with her latest a divorced labor lawyer in his late 40s who had done some work for the health clinic she'd co-directed before it folded. After two glasses of wine he invariably began regaling everyone with an earshot with stories about his time undertaking suspiciously vague humanitarian labor in Guatemala. After three glasses of wine the lawyer started in on his ex-wife's sexual repression and general fragility. After four or five he began to interweave these incommensurate discourses so that genocide and his feelings of sexual rejection achieved implied equivalence within his slurred speech. Whenever I was around I made certain his glass was full. Not a day has gone by in the last six years when I haven't wanted a kid. I'm that cliche I want my mom to meet my child. I have 75 weeks of unemployment benefits and insurance plus modest savings and while I know that means I should be more afraid to reproduce than ever what it actually makes me feel is that there will never be a good time that I can't wait for professional and biological rhythms to coincide. We're best friends you can't live without me. What if you donate the sperm? We could work out your level of involvement.  Three translucent angels hover in the top left of the painting. They have just summoned Joan who has been working at a loom in her parents' garden to rescue France.  Joan appears to stagger toward the viewer reaching her left arm out maybe for support in the swoon of being called. Instead of grasping branches or leaves, her hand which is carefully positioned on the sight line of one of the other angels seems to dissolve. The museum placard says that Basjian LaPage was attacked for his failure to reconcile the ethereality of the angels with the realism of the future saint's body but that failure is what makes it one of my favorite paintings. It's as if the tension between the metaphysical and physical worlds between two orders of temporality produces a glitch in the pictorial matrix. The background swallows her fingers. Standing there that afternoon with Alex, I was reminded of the photograph Marty carries and back to the future crucial movie of my youth. As Marty's time traveling disrupts the prehistory of his family, he and his siblings begin to fade from the snapshot. Only here it's a presence not an absence that eats away at her hand. She's being pulled into the future. Thank you very much. Thank you. Thank you.


Well, first of all, I want to compliment Eric and Rick for tour de force in terms of a review of the landscape of what's going on in genomics. And as I stand here, I want to make sure I'm complimenting what they say and not being repetitive, so I have to be a little quick in terms of what to do. It reminds me of saying that when I first went skydiving, the instructor said, listen, if both parachutes don't open, don't worry, you have the rest of your life to figure something out. So in a matter of a couple seconds here, I'll try to make sure that I can say something that I think adds to the body of discussion. Let me just touch on a few points that I think both of them made quite well, but I can give you at least an insider's baseball view of what it all means. As both Eric and Rick referenced, there has been this very fast rush to miniaturization, to faster speeds of sequencing, and to ever lower costs of getting the sequence itself. And I think both of them did a nice job of giving this metaphor of the computer industry moving from mainframes to midframes, where we were probably three, four years ago, to now where it's down in that genome exhibit, you're seeing it basically on a desktop. And this industry is tracking perfectly to what we saw in the computing industry. I think what also, though, should be maybe I could give you some sense of is what's going on from an industrial perspective to do that. And the pace of innovation, as been said, is four times faster than the venerable Moore's law. What that then means is really interesting changes inside an organization, a corporation, to deliver that rate of innovation. And so our Ion Torrent team is now comprised of about 500 scientists. They work 24 by 7. They have set up their schedules to do that. They have huddles that are happening every eight hours in terms of reviewing technical progress. And so the point I would simply say is that in our organization, and I'm sure in our competitors' organizations, the pace of innovation, the method of organizational approach is a real advantage. It's here in the United States. And I think it's one of the great byproducts that's come out of this human genome project and ultimately this race towards creating that ISEEC product that Rick challenges us to to get to here in the next couple of years. You know, having said that, just to jump down, we believe that there has been an important decision made at least by our organization in this technology race. And there are three broad approaches to how you can do this bridge between the chemical world, which is your genome, and the digital world, which is the information of what it means. And the three basic approaches are to use light or essentially a camera or a laser to take a picture of it. The second approach would be to thread it through a hole, if you will, and then read it as it comes through, a nanopore approach, or the third approach is to use transistors or a semiconductor to basically be able to read a change in pH, or that's what we do here, onto a transistor and instantaneously then determine what it was, ATC or G. And we chose that approach, others have chosen different approaches. They all have their merits, they all have some consequences, but they all are driving towards us at a point of miniaturization, faster speeds, lower costs. We're trying to take advantage of a trillion dollars that goes into the semiconductor industry and is moving at a similar breakneck pace. The other point I'd say in terms of industry ramifications is now the advent of an enormous event of venture capital going into the IT part of the genomics race. There are probably no fewer than 40 companies that have been funded by various venture capital entities to develop companies that will take this amount of information and then turn it into something relevant. And it's a very vibrant part of the industry that we see today, it's very exciting, and it's very uncertain how it all in terms of will be structured. Who will do these information systems? Who will buy these information systems? And so it's a truly entrepreneurial phase that we find ourselves in in this genomic race going on. What I'd like to do is just jump down to a few points that maybe I can talk to in terms of other aspects of the environment we're in right now of this genomics era. And I'll just talk to a few of them around policy, funding, and the practice of medicine. As I was saying the other day, once something is possible then you have to do it. And that's really the discussion going on now of how do you take this incredible amount of science, of research, of technology and move it into the clinic to do good benefit for patients. And in order for that to happen you have to create the right commercial environment to be in place. We need the right regulatory framework. We need the right reimbursement framework because we're talking healthcare. And many of those things aren't quite in place yet today in the United States. They're actually in place in other countries in a far better way. But here in the United States we've got some work to do to further clarify, further refine the regulatory environment to allow this commercial diagnostics, this commercial practice of medicine to take place. Specifically in the area of reimbursement, the basic regulatory scheme for reimbursement in genomics is actually being leveraged off what was done in an earlier era of clinical chemistry. It's completely inappropriate to support the level of work that would get done in genomics. And so right now, quite frankly, the economics aren't so great for running a human genome at mass scale at a hospital near you. And so that has to get rectified. The other thing that's also in contention right now is just the regulatory framework of what can be allowed. And without overcomplicating it there are two ways that diagnostic tests get done in the United States. One is directly overseen by the FDA and the other is done by Medicare or CMS. And the question is where will these genomic tests ultimately get practiced? Will it be in this FDA regulated environment or in this Medicare CMS regulatory environment? They are very different. And quite frankly there's contention between the two bodies that creates complication and uncertainty. And as you know, whenever you have uncertainty it's very hard then to launch a business with more success. The one point I would say about how these diagnostic tests will happen in the future is something that Eric pointed out. Up till now virtually all the gene tests that were done have been monogenic. Single genes that you're looking for, simple tests, and it's a fairly simple approach in terms of getting some reimbursement for that. All the things that both Eric and then Rick talked about are being multigenic are complex, require lots of analysis, very sophisticated IT tools, and are going to be more like how a radiologist interprets an image. And this is going to be much more in the mainstream of medicine. And our current regulatory approach, reimbursement approach doesn't support that. And so these tests and then how they have to be treated are fundamentally different, as I say, than what was in the past. Last point I would simply say on policy is just something Rick and Eric both also pointed out. It is unfortunate that we find ourselves in this golden era of understanding of what it means and what it can do in terms of outcomes for patients. And yet it comes at the very same time that we're cutting back funding for the research in this space. Again, I would point out other countries are doing just the opposite. And the one thing I'd like to share with you is actually an image. This is the breast cancer genome. It's fitting that we're looking at that given the ruling from the Supreme Court today on the myriad gene patents that centered around the BRCA gene, relative and important to breast cancer. But the question I would give to you is, what will the doctor of the future look at to determine what problem you have genetically and what can be done then therapeutically to solve your problem? And we spent a lot of time about that in industry thinking about somebody has to look at this information. Somebody has to then be able to quickly ascertain what's going on and then render a diagnosis. And again, this is a fundamentally different workflow in medicine than has been done before. And I have often said to people, this is an image. This is just like an MRI or a CAT scan. And there is a medical specialty called radiology in that field that's been trained up to look at those images. That same specialty does not exist in the practice of medicine. And so we've got some fundamental things to figure out in terms of what is the focal point of this new genomic error in medicine because who's going to do the work? And who's going to ultimately sit down with the patient and tell them what's going on? You know, I don't know if this is quite true. You go do the work to do the final analysis. But I've heard that in medical school here, circa 2013, you're only getting two to three weeks of training in genomics at the average medical school program today. That's got to fundamentally change. It probably has to be flipped on its ear. So big changes have to come and, you know, in order to really support what we think is an incredible error ahead of us. What I'd just like to finish up with then to be brief is talking about what's next. Our organization is on a fast pace to continue to innovate around this whole idea of reading DNA. Everything we've spoken to you about is about reading DNA. And yet with its approaching now economics that make mass sequencing possible on many fronts, it opens up a whole new chapter then in terms of writing DNA or creating synthetic genes or genomes. And this combination of reading DNA and writing DNA, I think, is going to be a massive economic stimulus in the 21st century. If the 20th century was about the physical sciences, creating of semiconductors and moving electrons around, 21st century is all about the understanding of life and harnessing the ability to read and write DNA. And you don't have to go very far to think about the possibilities. The chemical industry is based off of breaking down organic matter ultimately into chemicals, into plastics and the like. There is massive move underway in terms of research to create biological pathways and microbes to have the same effect. And when we have this ability to harness the power to read and write DNA, you can transform big portions of the chemical industry as an example. That will change both the materials industry, change the energy industry and the possibilities are endless. And so we're extremely excited not only about the innovation going on and reading DNA, but in case of our organization, we have a very large R&D effort geared up to figure out how to write DNA in a very cost effective way to make these transformations in different industries possible and to bring about this life sciences century here in the 21st century. Thanks very much. Let's see for a second. So what I was gonna do is have our three people talking about the use of technology to answer questions together. But why don't we see if there's anybody have a burning question for Mr. Lucier and if not, we'll skip the second panel because we are sitting around a bit behind. But a burning question from the reporters, anybody? I think you're off the hook, sir. What I'd like to do is ask Susan Dillon to come up. She's from Johnson & Johnson and Ken is an immunologist working in this area and using these technologies to figure out how to get to the era of actual clinical care.


Coming to you from our GIS Studios, I am Anicia Antoine and this is your Midday News Brief. In an effort to aid in the fight against the COVID-19 pandemic, the Republic of China Taiwan has donated a total of 10,000 surgical masks to St. Lu Shan judicial workers, including frontline policemen and firefighters. The ambassador of the Republic of China Taiwan to St Lu Shan, His Excellency Peter Shen, recognized the important role the frontline workers play in keeping the country safe. The ambassador explained that the donation forms part of Taiwan's commitment to assisting the people of St Lu Shan. The Minister for Home Affairs and National Security, Senator Hon. Hr. Francis, expressed gratitude to the government of the Republic of China Taiwan for their continuous support. The hand-in-over ceremony of the surgical face masks took place on Friday, August 14, 2020. Last week, city police officers concluded training and lectures on searching, case file compilation, care custody, prisoner rights and ticketing offences. The training was facilitated by Mr. Forster Chico of the Royal St Lu Shan Police Force. This was preceded by a three-day training program on effective communication conducted in partnership with the Ministry of Justice and the Office of the Director of Public Prosecutions. Mayor Peter Shen D. Francis said the objective is continuous training and development of city police officers to meet the high demands of the job. In keeping with its policy of inclusion, the government of St Lu Shan has been strengthening its relationship with St Lu Shan in the diaspora to greater support and facilitate their contributions towards national development via investment, skill transfer, trade, tourism and other goodwill initiatives. The St Lu Shan diaspora has always played an important and integral role in the development of fair helen, its contribution to St Lu Shan is priceless. As St Lu Shan adapts to life with COVID-19, the government is further increasing outreach to St Lu Shan in the diaspora who are desirous of contributing to the development of the country. This is an opportunity for the diaspora to be a part of the recovery of St Lu Shan post COVID-19. The St Lu Shan diaspora fair's unit, headed by Ambassador Her Excellency Joyce Lynn Fletcher, is ready and willing to provide the required assistance to help you contribute to St Lu Shan's recovery and development. To find out how you can participate in the development of St Lu Shan, contact Dr Joyce Lynn Clark Fletcher, Ambassador for diaspora fairs at JoyceLyn.fletcher.govt.lc. This has been your midday news brief. Thank you for watching.