Despite political and popular rhetoric, changes in our health care system will occur because of pressures to control costs, promote prevention, and increase efficacy. As part of these pressures, there is increasing desire to leverage the power of genomic technologies to discover novel disease susceptibility genes and drug targets, and to tailor therapies that account for a person's genetic predisposition and disease etiology. Fortunately, the United States has the research infrastructure to realize this translational ge-nomics goal in both a timely and cost-effective manner. The question is whether the scientific and political leadership has the will to follow through. To maintain preeminence in this area and to keep the fruits of the human genome project in the public domain, what is needed in the United States is a national effort to coordinate existing large population-based studies and large-scale sequencing and analysis centers so as to form a "synthetic cohort" that spans cradle to grave (Box 1), whose participants are fully sequenced and whose wealth of longitudinal data, including high-quality data on clinical outcomes and response to treatment, are made rapidly available to the scientific community. It represents an avenue of enormous potential and is the only such avenue whereby progress beyond the incremental can be made in short order. President Obama should adopt and promote this initiative with the same vigor and imagination that President Kennedy promoted manned spaceflight to the moon.
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