There are very few genomics projects with the level of ambition of the NIH All of Us Research Program. The latest release includes data from more than 747,000 participants, 535,000 whole genomes, 480,000 electronic health records, and—for the first time—long-read sequencing, proteomics, transcriptomics, and a large collection of information extracted from clinical notes. More than 24,000 researchers are now using the resource. But the program is also arriving at an important transition: roughly 80 percent of its original ten-year funding runs out this year. So what happens when a massive national research experiment begins to come of age? Josh Denny, CEO of All of Us, joins us to talk about what the program has accomplished, what researchers are beginning to learn from the data, and what comes next. We discuss the extraordinary scale and diversity of the resource and the growing use of genetics alongside electronic health records and other forms of health data. All of Us is beginning to move from building infrastructure toward producing discoveries that could affect patient care. Denny explains why the program’s diversity is not simply a matter of representation but a scientific necessity. The project has already identified roughly 1.3 billion genetic variants, including more than 275 million that had not previously been observed. That diversity becomes even more important, Denny argues, as medicine moves toward increasingly personalized predictions and treatments. “We are capturing such a richer population and so much more kinds of data that we can’t actually reason through it as humans,” he says. “If the data underneath it are highly biased and not representative, then we’re going to make the wrong conclusions.” We also discuss All of Us as a platform for a much broader picture of human health—from electronic health records and wearables to nutrition, the microbiome, multiomics, environmental exposures, and eventually pediatric data. Denny shares examples of participants whose lives have already been changed by medically actionable genetic results and describes how researchers can build new studies on top of the All of Us population. What is the next phase of the program and that of precision medicine? “We’re going to have to redefine our definition of disease,” Denny says. Rather than treating something like type 2 diabetes as a single condition, he imagines increasingly precise descriptions of an individual’s biology, exposures, risk, and response. After years spent building one of the largest health datasets in the world, All of Us is beginning to show what we might actually do with it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.mendelspod.com/subscribe
