In his first address to a joint session of Congress on Tuesday night, President Donald Trump spoke for an hour about healing, unity, and, most uncharacteristically, America’s current greatness. The speech was a departure from past addresses in tone and demeanor–there was no “American carnage” to be found–but its content hardly tread new ground. Trump attacked Obamacare, promised to reform the tax code, and floated other ideas–some that skewed closer to Republican orthodoxy, and others that were closer to the left’s policy doctrine.

He began by denouncing bigotry and hatred, two things his opponents often accuse him of espousing: “Recent threats targeting Jewish community centers and vandalism of Jewish cemeteries, as well as last week’s shooting in Kansas City,” he said, “remind us that while we may be a nation divided on policies, we are a country that stands united in condemning hate and evil in all of its very ugly forms.”

In contrast to his dire Inaugural Address, or his smattering of grim remarks throughout the presidential campaign, Trump pointedly spoke to all Americans, not just the slice of the electorate that supported him. “We are one people, with one destiny,” he said. “The time for small thinking is over. The time for trivial fights is behind us. We just need the courage to share the dreams that fill our hearts.” It was unclear if Trump’s mention of “trivial fights” was referring to the skirmishes he incites–he called House Minority Leader Nancy Pelosi “incompetent” a few hours earlier–or is he was simply condemning his detractors.

Before addressing his ideas and governing vision, Trump indulged in his election victory, and the movement he ignited, which he called a “rebellion,” and an “earthquake.” His supporters, he said, “were all united by one very simple, but crucial demand, that America must put its own citizens first, because only then can we truly make America great again.”

To do that, Trump said, evoking the vision that shaped his campaign promises, the military would be built-up, manufacturing would make a comeback, and infrastructure would be a top priority. Trump also discussed, at length, his plans for immigration. “My job is not to represent the world,” he said. “My job is to represent the United States of America.”

He said he is open to immigration reform, as long as it would “improve jobs and wages for Americans, to strengthen our nation’s security, and to restore respect for our laws.” He added: “If we are guided by the well-being of American citizens, then I believe Republicans and Democrats can work together to achieve an outcome that has eluded our country for decades.”

Earlier in the day, Trump gave a speech to TV anchors at the White House, where he floated immigration ideas that contrasted his usual sentiments. In mostly improvised remarks, he said he is open to a path to legalization for immigrants who are in the U.S. illegally. He also posited the idea that children brought to the country illegally by their parents–so-called Dreamers–could attain citizenship.

But his speech to Congress made no mention of the potential changes in his thinking on immigration. Instead, he applauded the work immigration agents are doing to remove “gang members, drug dealers and criminals that threaten our communities and prey on our very innocent citizens.” He also asked a pointed question to those in Congress who take a softer stance on immigration: “What would you say to the American family that loses their jobs, their income or their loved one, because America refused to uphold its laws and defend its borders?”

Toward the end of the address, Trump commemorated William “Ryan” Owens, the Navy SEAL who was killed during a raid in Yemen in January. Trump was criticized–by lawmakers and Owens’s father–for approving the raid, and has since placed blame on “the generals” and on the Obama Administration. On Tuesday night, Carryn Owens, the fallen soldier’s widow, sat in First Lady Melania Trump’s box. To a raucous standing ovation, Trump looked at Owens and said: “Ryan’s legacy is etched into eternity.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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Do you guys remember Kim Davis? You know, the t-shirt layering Kentucky clerk who kicked off the Supreme Court’s landmark marriage equality ruling by illegally denying gay couples marriage licenses under “God’s authority?”

Well if you thought her 15 minutes of fame were up, you’re wrong. Davis has reportedly been invited by a secret lawmaking admirer to attend President Obama’s final State of the Union tonight–and people are not happy about it.

Davis’s attendance openly contrasts that of Jim Obergefell, the lead plaintiff in the landmark marriage equality case, who has also been invited along with Army Ranger Lisa Jaster and engineer (and immigrant) Oscar Vazquez to attend Obama’s speech. They, along with other guests, will help to commemorate Obama’s accomplishments over the past year, while he lays out his plans for his final year in office.

The identity of Davis’ mystery date is still unknown, but whoever they are is clearly making one big passive-aggressive gesture for GOP optics.  After the controversial clerk’s presence was confirmed, social media users began voicing their distaste for Davis online:

Kim Davis is attending Obama’s final State of the Union address. No word yet on if Mel Gibson’s invite got lost in the mail #SOTU @absrdNEWS

— Michael Blackman (@ParaComedian09) January 12, 2016

I hope they sit #KimDavis next to, in back of and in front of gay married couples at #SOTU. — Ripley in CT (@RipleyInCT) January 12, 2016

Kim Davis will be at the SOTU, because Republicans needed someone more unconstitutional than they are to balance out the crowd.

— Sarah Wood (@SarahWoodwriter) January 11, 2016

While we’re not quite sure how all of this will play out, it is likely to be some kind of spectacle. But hey, if Davis is looking for a post-speech night cap to calm the nerves she’s already got an invite to DC’s famed gay sports bar Nellie’s. I wonder if she’ll take him up on the offer: 

I’m taking Kim Davis to Nellie’s after the SOTU – anyone want to join???? — Andy Cohen (@Andy) January 12, 2016

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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Are you both a Wes Anderson fan, and a political junkie? Well in that case, I have something for you: a short version of the State of the Union if it were directed by Wes Anderson, courtesy of CNN.

Wes Anderson is a very decorated director, who directed movies such as “The Royal Tenenbaums,” “Moonrise Kingdom,” and “The Grand Budapest Hotel.” His style is distinctive–his movies feature saturated colors, symmetrical scenes, silly dialogue delivered in a straight manner, a narrator, handwritten notes–among many other markers. In fact, it’s distinctive enough that it lends itself to parody quite well–for example, here’s SNL’s take on his directing style, but applied to a horror film.

So in terms of paying homage to/parodying Anderson’s style, CNN hit the nail on the head. I do have to say, sometimes it does seem as though CNN has a little too much fun with the technology that it has at its disposal. Remember the time that it brought a hologram of will.i.am to the 2008 election day results coverage? Or the time that it took an utterly unnecessary approach to explaining how the Iowa caucus works, and even Anderson Cooper realized how ridiculous the entire thing was?

But this take on the State of the Union–tonight will be Obama’s last–was a fun way to generate some buzz before the big event. CNN explained its motivations on Youtube, saying that “With all the tradition, pomp and quirks, the State of the Union Address is straight out of a Wes Anderson movie.” Additionally, an article that accompanied the video explained:

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Picture your Netflix homescreen. Besides some errant selections courtesy of your (ahem, tasteless) roommate, it’s pretty much a haven of your unique preferences. Like a doting butler, it recommends you watch “Breaking Bad” since you enthusiastically plowed through every episode of “Orange is the New Black.” Netflix knows you. Or think about Amazon. It’s your data-powered best friend. It recalls your purchase history and movie preferences better than you do. So what if this data-powered framework for knowing you is applied to healthcare? What if your doctor knows you as well as Netflix?

That’s what the Precision Medicine Initiative aims to do–unleash the full power of science and data to make our healthcare system better, more effective, and more specific to individuals and conditions. The new model proposes a system of health care that treats you like the complex human being you are. Just as Amazon cares deeply about your past purchase behavior, the new healthcare system would care about the science-based reasons you’re you: your genes, your lifestyle, and your environment. Instead of pushing purchases, it would use what it knows about you to determine what treatments and preventions work best for your health.

President Barack Obama announced the Precision Medicine Initiative during his 2015 State of the Union Address and since then people have been discussing the pros, cons, and implications. Here’s an overview of precision medicine and what it means for you.

What is precision medicine?

Take a look at the video below for a summary of precision medicine from Jo Handelsman, Associate Director for Science at the White House.

Precision medicine revolves around you. It uses your genes, environment, and lifestyle to determine what treatments keep you healthy.

The Precision Medicine Initiative may be new, but precision medicine has some history. Doctors already use it to treat conditions like cancer and Cystic Fibrosis. Examples of precision medicine in action include processes like blood typing and medications like Imatinib (Gleevec), a drug for Leukemia that inhibits an enzyme produced by certain genes. The new initiative plans to expand the reach of precision medicine to to tackle other diseases.

The plan stems from a  2011 report from the National Academy of Sciences. The report called out a major healthcare weakness: data suggests possible causes of deadly diseases, yet we don’t treat people until telltale signs and symptoms surface. You don’t wait until your friend’s liver is wrecked to stage an alcoholism intervention. Why wait for symptoms of a deadly disease when early risk factors might be available?

Great idea in theory, right? Of course, the execution promises far more complexity. Experts hope that precision medicine is within our grasp now because of recent scientific advances that make it easier to collect and analyze patient data.

Advances That Make Precision Medicine Possible

Advancement 1: New Methods of Uncovering Biological Data

It’s easier to understand patients and tumors on a cellular and genetic level more than ever before because of things like:

• The Human Genome Project, an initiative that aims to map the DNA sequence of the human genome to determine a sort of biological instruction manual for how humans function. The study of the genome is called genomics.
• Proteomics, a discipline that involves studying proteomes, the entire system of proteins in an organism. The goal is understanding changes, variations, and modifications in proteins over time to determine biomarkers for human diseases, especially cancer.
• Metabolomics, a field that leverages analytical tools to discover and quantify metabolites, which are substances produced by metabolism. Studying them provides experts with a glimpse of an organism’s physiological functioning as metabolism is a huge factor in overall health.

Advancement 2: New Tools For Biomedical Analysis

New analytic tools make it possible to decipher the intricate medical data collected by the disciplines above. Computers and programs help to collect, store, and study biological and medical information. Overall, the discipline is called bioinformatics.

Advancement 3: New Digital Health Tools That Make Large Datasets Manageable

I said large data sets. Sound familiar? Yes, we’re talking Big Data. You’ve probably heard enough about it, but it’s actually an amazing thing, especially when applied to healthcare. Take a look at the video below for more information.

From collecting to analyzing, sophisticated data management tools make the Precision Medicine Initiative possible.

Collectively, these advances create the right environment for the unified national effort that the Precision Medicine Initiative proposes.

How will it work?

The President’s 2016 Budget provides $215 million for the program. Four key agencies slated to do a bulk of the work each get a chunk of the budget.

National Institutes of Health (NIH)

Project Budget: $130 million.

Task: Recruit a volunteer research cohort and leverage existing data.

The National Institutes of Health must find 1 million American volunteers willing to provide medical records, gene profiles, lifestyle data, and more. While data drives the initiative, you need people to get the data. In addition to this, the NIH will find existing studies and research to build a foundation for the initiative. It’ll collaborate with stakeholders to determine approaches for collecting patient information.

National Cancer Institute (NCI)

Budget: $70 million.

Task: Find better cancer treatments.

The National Cancer Institute will explore precision treatments for cancer by increasing genetically based cancer trials, researching cancer biology, and establishing a “cancer knowledge network” to inform treatment decisions.

Food and Drug Administration (FDA)

Budget: $10 million.

Task: Develop safe, new DNA tests.

The Food and Drug Administration will seek technologies that rapidly sequence DNA and the human genome. Tests should make genetic data collection easier and more standardized.

Office of the National Coordinator for Health Information Technology (ONC)

Budget: $5 million.

Task: Manage the data.

The ONC has a tough job. It needs to figure out how to store, use, access, and exchange all of this medical data without any privacy concerns.

What Precision Medicine Could Mean For You

Here’s Notre Dame’s video on precision medicine in action:

Precision medicine could mean treatments more specific to you. For example, about 55-65 percent of women with mutations in the BRCA1 gene get Breast Cancer; only 12 percent of those without the gene get it. If the gene mutation is discovered, doctors can recommend enhanced prevention measures like increased cancer screenings or prophylactic surgery to remove at-risk tissue.

We hope more precise treatments lead to better outcomes. Using precision medicine, we hope to answer many questions, including:

• How can we treat this better?
• Is there a cure?
• Why does this disease happen in the first place?

The Downsides to Precision Medicine

Of course, the Precision Medicine Initiative has some drawbacks. The sheer amount of time it will take to collect and analyze all of this patient data leads the charge of negative comments. Below are some other downsides.

Interpretability

This article from the New Yorker calls out the problem of interpretability. To quote the author,l Cynthia Graber,

Many doctors are simply not qualified to make sense of genetic tests, or to communicate the results accurately to their patients.

Since doctors will be the sole executors of the initiative, more need to become fluent in the human genetic code. Programs like MedSeq have recognized this need and are already working to make genetic information translatable for practitioners.

The Budget Just Isn’t Enough

Experts say that even the $215 million proposed isn’t enough to meet the initiative’s lofty goals, like recruiting one million patient volunteers. One upside? Money can be saved by incorporating existing data, which the initiative plans to do.

Collecting the Data is Going to be Hard (This is an Understatement) 

If they do save money by integrating data from different studies, keeping the data clean will be hard considering the different time frames, constructs, and controls of various studies.

And as a practicing doctor writing for a New York Times blog points out, the lifestyle factors will be especially hard to study because of some uncooperative and intensely complex patients.

Insurance Companies May Not Pay For It

Precise matching of individuals to disease treatments sounds great, and extremely expensive, especially in the early days. Patients will need even more help determining what treatments suit them.

Hope For the Future

Sorry to bring up Netflix up again, but let’s face it, it’s very good at leveraging data to give you what you want. Consider any of its popular original series. Do you think Netflix just guessed what 50 million subscribers would like? Probably not. It used its massive stores of data to make informed decisions.

Early doctors and researchers puzzled over the symptoms of just a few patients, trying to find patterns, causes, and cures. While they did a fair job with the resources they had, trial and error medicine should be relegated to the less fortunate past. Today we have the power and knowledge to access data that helps doctors make more informed decisions on healthcare treatments.

Precision medicine will be complicated, difficult, time consuming, and who knows what else. But imagine what we can learn. We should be cautious, but we can also dare to hope.

Resources

Primary

White House: Infographic: The Precision Medicine Initiative

White House: FACT SHEET: President Obama’s Precision Medicine Initiative

White House: Precision Medicine is Already Working to Cure Americans: These Are Their Stories

National Cancer Institute: BRCA1 and BRCA2: Cancer Risk and Genetic Testing

National Institutes of Health: Precision Medicine Initiative

National Cancer Institute: What is Cancer Proteomics?

Additional

Nature: Obama to Seek $215 Million for Precision-Medicine Plan

New England Journal of Medicine: A New Initiative on Precision Medicine

National Academies: Toward Precision Medicine

National Institutes of Health: Precision Medicine Initiative

Nature: U.S. Precision-Medicine Proposal Sparks Questions

Brookings Institution: The Significance of President Obama’s Precision Medicine Initiative

New Yorker: The Problem With Precision Medicine

The New York Times: A Path For Precision Medicine

National Human Genome Research Institute: What is the Human Genome Project?

BioTechniques: What is Metabolomics All About?

Bioplanet: What is Bioinformatics?

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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Justice Ruth Bader Ginsburg is pretty much the best. At 81, she’s cooler than I could ever hope to be. I would very much like to be her friend. Or she can be my mentor/life coach. Either way, you should all aspire to be friends with RGB too, and here are just a few of the reasons why.

She’d Be a Great Drinking Buddy

This article was inspired by the comments Ginsburg made yesterday about why she looked so sleepy at last month’s State of the Union.

RBG is my spirit animal MT @voxdotcom I wasn’t “100% sober” at the State of the Union http://t.co/dpXnb4gwPupic.twitter.com/jTbVqyBolE

— Erin K. Stabile (@erinkstabile) February 13, 2015

She explained that she wasn’t “100 percent” sober, after she had enjoyed a “very fine California wine” brought to dinner by fellow Justice Anthony Kennedy.

That’s right, kids, our Supreme Court Justices–at least two of the cool ones–pre-gamed the State of the Union.

She’d Motivate You to Work Out

I would like to point out again, RBG is 81 years old. That being said, she has been working out with a personal trainer since 1999. She explained her workout routine, saying :

I do a variety of weight-lifting, elliptical glider, stretching exercises, push-ups. And I do the Canadian Air Force exercises almost every day.

Although she had some health concerns in November, I bet she’s still prioritizing her health and hitting the gym. Meanwhile, I am 100 percent sure I could not do anything called “Canadian Air Force exercises,” so I could really use a work out buddy like RBG to kick my ass into gear.

She’d Definitely Be Down for a Galentine’s Day Party

When asked at what point Ginsburg believes there are enough women on the Supreme Court, she had an awesome answer: when there are nine. She went on to explain that there were nine men for many years, so why not try out nine women?

She’s long been a strong feminist who isn’t afraid to put her views out there. She also is aware of the fact that she’s an outlier from a generation where women weren’t necessarily given the same opportunities as men. She at one point remembered:

My mother told me two things constantly. One was to be a lady, and the other was to be independent. The study of law was unusual for women of my generation. For most girls growing up in the ’40s, the most important degree was not your B.A., but your M.R.S

I can’t think of a better role model for young women who want to pursue their dreams.

She Knows When to Put Differences Aside for the Sake of Friendship

RBG can teach us that just because you disagree with someone doesn’t mean that they don’t have something they can teach you. She and fellow justice Antonin Scalia are basically polar opposites when it comes to beliefs and views. That being said, they can put that all aside and still have a great time together. For many years they had a tradition of spending New Years Eve together along with their spouses. They’ve traveled together–once even riding an elephant together on a trip to India. Another time in France, she went parasailing, although Scalia sat that one out. Being friends with people who force you to defend your opinions and see things a different way is a good thing–Scalia and Ginsburg are absolutely proof of that.

If you can’t get enough of Scalia and Ginsburg’s friendship, there’s actually a one-act comedic opera dedicated to the two. This is the plot:

What happens when Supreme Court justices go before a Higher Power? In this comic opera, Justices Ginsburg and Scalia must pass through three cosmic trials to secure their freedom. The catch: they may have to agree on the Constitution.

Both Ginsburg and Scalia saw it, and liked it.

She’s Very Sassy and Quotable

RBG is well known for her expertly crafted decisions. In the recent Hobby Lobby case, her dissent was nothing short of withering. She called the decision one of “a startling breadth,” and ended with this pretty awesome last paragraph:

In the Court’s view, RFRA demands accommodation of a for-profit corporation’s religious beliefs no matter the impact that accommodation may have on third parties who do not share the corporation owners’ religious faith—in these cases, thousands of women employed by Hobby Lobby and Conestoga or dependents of persons those corporations employ. Persuaded that Congress enacted RFRA to serve a far less radical purpose, and mindful of the havoc the Court’s judgment can introduce, I dissent.

Or how about this quote in her dissent against the decision that gutted the Voting Rights Act:

Throwing out preclearance when it has worked and is continuing to work to stop discriminatory changes is like throwing away your umbrella in a rainstorm because you are not getting wet.

What a BAMF.

So there are a lot of reasons to love RBG, and I didn’t even mention her groundbreaking and brilliant legal career. Either way, she’s definitely a woman who should get a hell of a lot of respect, and if there’s anyone who should be allowed to drink wine and then fall asleep at the State of the Union, it’s her.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Five Reasons Why We Should All Want to Be BFFs With RBG appeared first on Law Street.

Senator Joni Ernst may be a newcomer to Washington D.C., but she’s already making a big splash. She was just selected by the Republican Party to give its response to President Barack Obama’s State of the Union address. That’s a pretty good thing for which to be chosen–the last few years the spot of responder has included Senator Marco Rubio and Representative Paul Ryan. Ryan, of course, ran for Vice President last year, and Rubio’s name keeps popping up on the list for possible 2016 contenders.

But what does this choice actually mean? When I said that Ernst is a newcomer, I really meant newcomer–before running for Iowa’s Senate seat, she was in the Iowa State Senate. So, she’ll only have been in Washington for about a month before speaking for the entire GOP in response to the President. She in some ways ran her campaign on the fact that she was a Beltway outsider–her most talked-about ad of the 2016 elections involved her discussing castrating pigs as a child.

Honestly, it’s probably that outsider status that inspired the GOP to pick her as the responder. President Barack Obama and, by extension, the Democrats have run the Executive Branch since 2008. The GOP is probably going to paint them as tired, crony-filled, and too nationally focused to look out for the average American. On the other hand, Ernst is pretty much the definition of a fresh face. She’s also a woman, which given the gender gap that has made or broke some recent national elections, probably appeals to the Republican Party. For those reasons, this is a pretty good strategic choice on the GOP’s part.

On the other hand, she’s also a risky choice. She’s untested on the national stage, and she’s said some weird things in the past. For example, she subscribes to the conspiracy theory that Agenda 21, a sustainable environmental plan created by the United Nations, is a secret drive to force Americans off their land. Last November, she stated:

All of us agreed that Agenda 21 is a horrible idea. One of those implications to Americans, again, going back to what did it does do to the individual family here in the state of Iowa, and what I’ve seen, the implications that it has here is moving people off of their agricultural land and consolidating them into city centers, and then telling them that you don’t have property rights anymore. These are all things that the UN is behind, and it’s bad for the United States and bad for families here in the state of Iowa.

It’s a relatively popular Tea Party idea–but coming out against the U.N. is…extreme, to say the least.

It’s definitely a good position to be in for your first few months in Washington, but whether or not Ernst will be able to rise to the occasion will have to be determined. No matter what, one thing is certain: it will be an interesting speech to watch.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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