Research & Diagnostics: Illumina • Eric Green
Invariant Learning: Public-Private Synergy
What happens when the architect of genomic innovation inside government moves into one of the industry's most important companies?
Dr. Eric Green, Chief Medical Officer of Illumina and former NHGRI Director, reflects on the transition from government to industry – and what it reveals about how innovation actually scales.
The conversation explores public-private risk sharing, commercialization, multi-omics, AI, end-to-end genomic workflows, and the often-overlooked societal barriers that determine whether breakthrough technologies reach routine healthcare.
The central lesson: scientific innovation is only half the challenge. The other half is building systems capable of absorbing it.
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Nic (01:34)
Eric, welcome back to UnNatural Selection. We last time we met on this forum was a little bit over a year ago when you had just left the NHGRI after about 20 some odd years in service. 31.
Dr. Eric Green (01:48)
thirty thirty-one years, fifteen as the institute director.
Nic (01:52)
Wow, 31 years, yeah. so a long and and obviously very decorated career and in stimulating innovation across genomics. And and now.
I'm talking to chief medical officer Doctor Eric Green from Illumina.
Dr. Eric Green (02:06)
Illumina.
That's right. Six months into the the the position. Yeah.
Nic (02:11)
Yeah.
And so I really enjoyed our original conversation, but in this circumstance, I actually what I thought would have been really interesting would be to unpack your transition because the worlds that you've lived in largely overlap significantly. You're leading innovation within genomics, but the perspective is very different. Whereas originally you were the architect of innovation across genomics, now you are within one of the key players in that architecture.
Dr. Eric Green (02:41)
Yeah, you know, the other thing I also like
Like
to point out, of course, I grew up in academia. I mean, I was completely trained in academia and even, you know, went through residency postdoc. I was even an assistant professor in academia before going into the government, and then a long stint in the government, and now the private sector. So it it's it's with a deep appreciation of each of those three parts of the ecosystem that I now think a lot about the relative roles of each and and the important core.
Choreography and involvement of each of those parts of the ecosystem to really make progress in an area like genomics and genomic medicine.
Nic (03:21)
Yeah, it's almost like the the for profit angle was like the missing piece to the whole puzzle that you were putting together, right? From all these different per perspectives.
Dr. Eric Green (03:30)
at a personal level, you know, some people you you know, they say, is it just completely different? Or, you know, obviously some people tongue in cheek say, you went to the dark side, especially after being in the government. You know, the truth of the matter is it it it wasn't totally a foreign concept. I will tell you that all the years that I was at NHGRI, and particularly when I was the director, we interacted a lot.
With the, especially the technology companies. I mean, the goal of reducing the cost of sequencing a human genome by more than a million-fold to deliver on the $1,000 genome, you know, that happened through the efforts of and coordination among academia, government funding, and the private sector and companies like Illumina and so on. I was an HGRI director, I can certainly tell you that I regularly interacted with especially the CEOs of these companies in particular.
I would regularly meet with the CEO of Illumina because we wanted to choreographed what NHGRI was funding in technology development so that it would be maximally synergistic with the efforts going on at a company like Illumina because we knew at the end of the day the successful commercialization of any advances was going to take place in the private sector.
Nic (04:44)
Yeah. Yeah, we we spoke about that, how
a a lot of the innovation that you were doing was exactly that, like architecting how these pieces come together. And a big part was f stimulating innovation by the financing that you would drive, thinking about what pieces needed to come together to drive down costs, to make it more accessible and so on, right?
Dr. Eric Green (05:03)
right? Yes, and the government has to take responsibility for the highest risk work. I mean, the the especially, and now I've learned a lot more in my in my months at Illumina, that they have a lot of work to do to go from an advance to an instrument to deployment around the world in laboratories and hospitals, but they only want to invest.
things that have been de-risked to an and so the really incredible innovation, a lot of that should be government funded and and has been government funded, you know, when we started the the sequencing technology development program at NHGRI, which really basically started a year after the Human Genome Project ended.
W there was an absolute willingness then by then director Francis Collins to fund some projects that were extremely high risk and were likely gonna mostly fail. But a couple of them paid off and they really moved things forward. I mean, we also funded some medium risk and some lower risk. You needed that
Nic (06:01)
Mm-hmm.
Dr. Eric Green (06:01)
portfolio. But but but industry is not situated, especially a publicly traded company, they can't do extensive amounts of high risk, they do a little.
But they can't they can't sort of lay out as many different high risk options as as the government can. And that's why I've really I've come to respect that synergy between the the the the public funding of of government work, especially in technology development, and the commercialization of it by the private sector.
Nic (06:30)
Yeah, so actually, you know, i the the question I always start with is one about impact and what drives your work. And I actually I'm curious,
from your six months now at Illumina, has your definition of impact or what need or impact drives your work, has that evolved by your current experience, or do you think it's still largely what it was a year ago?
Dr. Eric Green (06:53)
ago? There's a couple couple of thoughts I have in thinking about that, because, you know, I will tell you that on an hour by hour basis, you know, the majority of the time I feel like I'm doing a job incredibly similar.
you know, being an NHGRI director or being the Illuminati Cief Medical Officer. It is really about constantly trying to figure out what are the barriers, what are the obstacles that are preventing us from taking full advantage of the opportunities to bring genomics into medicine. That is my laser focus. You know, there's differences on how I operationalize that, but most of the time thinking about those things are fundamentally the same. I think the things that have shifted a little bit.
Since I've gotten to Illumina is I've gotten I would say twofold. i and they're almost in different scales or different dimensions. I mean, one of them is really gaining a deep appreciation for how things truly got get operationalized, you know, in terms of commercializing, selling, you know, getting things into laboratories, getting things into clinics, getting things into hospitals, getting things into healthcare systems, you know, sort of from a perspective of a business.
You know, and that is far less Ivory Tower and far less sort of high-level strategic thinking about it. I mean, it is really on the ground. How do you convince people to buy this or deploy that, so on and so forth. So there's a and and recognizing that in order for that to happen, this has to happen in the context of a company. In the case of a publicly traded company, a company that has to, you know, be accountable to s its
The people that own the company, the stockholders and the board of directors and so forth. So and of course, for that, I'm I'm a student because I do not have a business mind. I have no business credentials. but I'm I'm a I'm a good student and I I learn a lot and I ask a lot of questions. And they don't need me for my business skills. So I sit and I I listen and I learn. I think the other thing that really has changed in this new role, which is fascinating and daunting at the same time.
Is that, you know, three decades at NHGRI, you know, it's it is the US National Institutes of Health. Yes, we have a world view. Yes, we collaborate with lots of people around the world, and yes, we think a lot about you know how to get genomics into healthcare worldwide in all settings. But the fact of the matter is, I will tell you that just the challenge of getting genomics deployed in US healthcare.
you know, was overwhelmingly consuming my attention. I mean, maybe not a hundred percent of my attention, but a lot of it, because we had to practically get this done in the US. And and Illumina really thinks globally. I mean, they are a global company and they think about the whole world because that is their their customer bases worldwide. And and there what's fascinating and daunting at the same time is when you've seen one healthcare culture in a country.
You know, just how any one country approaches healthcare from a cultural political perspective, you've seen one, right? And you've got hundreds of countries. So you have hundreds of different contexts by which genomics is trying to change healthcare. And it it almost makes my brains explode because it's it's it's just so complicated. I mean just the US is complicated in and of itself. And then you start looking country by country by country. And and and what's what's fascinating is it's not always predictable.
I mean, I've done quite a bit of international traveling in the first six months. And I can tell you that you go to one country and you see their incredible enthusiasm for genomics in clinical domain A, B, and C, and yet they don't care so much about D and E. And then you go to the next country and they're all over D and E and they couldn't care about A and B, and
maybe they're
Nic (10:43)
Mm-hmm.
Dr. Eric Green (10:43)
lukewarm about C. And it's sort of like, wow. And and and and many of these things are very different than the US. And some of this is cultural. You know, how much you you know, even the balance between
Medicine and prevention differs from country to country. So when they have precious health care resources, where they want to invest to use genomics sometimes is more on the prevention side, sometimes it's more on the medicine side. And sometimes it's more about, you know, young people in pediatric period, and sometimes it's more about taking care of the elderly. So it's so cultural, it's so complicated, and
Nic (11:19)
Mm-hmm.
Dr. Eric Green (11:20)
so it's
you know, I I I I mean I'm I am a chief medical officer for a a company that thinks about hundreds of countries and it's it's it's daunting in that respect. But it's fascinating at the same time. imagine. this. right?
Nic (11:30)
I can imagine. I mean, that's why I was looking forward to this. And I would imagine also competition takes in a whole different role, right? I mean, thinking naively, I've never been director of NHGRI, but my guess is that you didn't deal much with competition then because your purview was the US and nobody's competing with the NIH.
now competition takes a whole different role from your perspective, right? Because now you are competing with other companies that may not offer the same high-value sequencing service that Illumina does.
Dr. Eric Green (11:52)
right? does,
Nic (11:59)
But you still there are competitors out there.
Dr. Eric Green (12:01)
there. There are competitors. No, absolutely. That's absolutely the case. Although I will tell you, and I I sort of chuckle when I say it, but it is true. You know, being an NIH institute director, you get a little competitive about your area of science. So
You know, there would always be issues about where does new money, or you know, when they're gonna do a new
Nic (12:18)
sure.
Dr. Eric Green (12:18)
project, how much genomics could I get infused in an NIH wide project? and you know, so you you are your role as an institute director is to evangelize for your area. And it gets a little competitive sometimes, but it's all about it it's all about, you know, getting more money for your area of science that you're gonna give to your scientists who who you give grants to.
To move the field forward. It's all about moving the field forward.
Nic (12:45)
That's interesting. Yeah, so y so your competition at N H GR was more internal to the overall NIH. Now you're competing more externally against direct competitors.
Dr. Eric Green (12:56)
Yep. Although internally, you know, one of the things though, I mean there's a another there is another point to be made is Illumina's constantly looking for where are is where are going to be the great opportunities for Illumina in in different clinical domains.
And you know, there's not a blueprint here that we or there's not a playbook that just accurately tells us exactly how any of this gonna unfold. And by the way, it may be different in different countries. And so, you know, internally there is competition internally to try to convince the decision makers here, you know, where to sort of lean in a little harder in terms of this clinical area or that clinical area, another clinical area. Of course, that's part of my role as the chief medical officer is to strategically advise the company where to be leaning in across
many competing clinical areas that that that are ripe for development of new genomic approaches.
Nic (13:48)
Yeah, you know, it's interesting also I I and I can totally see how your previous role plays into this because before you were looking at such a macro scale about where genomics was going. And clearly that's also given how macro and global Illumina is, getting your perspective about where genomics has come from, where it is and where it's going is tremendously valuable to shaping that strategic path.
Dr. Eric Green (14:12)
I I I I hope so and I think so. I I mean
Nic (14:15)
Mm.
Dr. Eric Green (14:15)
they appreciate
a lot of the perspective I bring. I th I I think the other thing though that I I feel like I'm helping Illumina and I I feel like I'm contributing internally is you know you you don't you think of Illumina as a company, right? They're not a funder. But the you know in the Genome Institute they're not a company for sure and they are a funder. So I have a lot of experience of funding work. I mean the fact of the matter is Illumina has I'm not hundreds, hundreds of
collaborations and external relationships at all levels because th you know they're they're a sort of the leading company, they're constantly wanting to help you know get their technologies into the hands of early adopters so there's lots of things that and then they want feedback. But they're also very involved in trying to move the field forward because again if a certain clinical area is moved forward and it gets widely accepted as standard care, then you know, in the long run there's gonna be a lot more
basically interest in in using our technologies and using it for those applications. All that is along with the way saying Illumina does a lot of supporting through collaborative means of various partnerships and so forth, a lot of research. And so I have brought a perspective of a funder that to sort of how do you prioritize, how do you organize things? And so that's been a lot of fun because and it may be a little surprising for me at first. I didn't realize quite how much they were doing, but they're you you look around the world and they're
highly interactive, highly collegial. they really do very much view part of their role is to stimulate the use of genomics in different clinical domains, and they'll stimulate that by leaning in and and helping support through through various types of resources they can they can provide to make things go faster.
Nic (16:04)
Yeah, it's interesting. And you mentioned a little earlier about
I guess the difference between for profit and and government, where government you have to take these big risks, these big bets that maybe public companies wouldn't be able to because you've got quarterly returns and shareholders and so on. So then
Dr. Eric Green (16:20)
on. Especi
especially in the technology realm. Especially in the technology realm. that's right. exactly, right? All the time, right. Trying to discover drugs. So yeah, I g I completely agree.
Nic (16:23)
True. Yeah, that's right. Well, yeah, exactly. Right. Because in pharma, you're taking those big bets all the time with trying to discover drugs. And in those, you know, 10 to 20 years in development and super expensive. So yeah, I completely agree.
So in the technology realm then, has your perspective on innovation evolved now when you're trying to you're trying to make big bets, but you also do have quarterly returns and annual returns and so on, and you're beholden to a market.
Dr. Eric Green (16:52)
market.
Nic (16:53)
so you're still thinking in big scales, but maybe not government big scales anymore, right?
Dr. Eric Green (16:58)
right? I right, and and what has been
really
exhilarating and and it really started literally on day two when I arrived here is is I you know they've sort of pulled back what I would call the RD curtain and I get to go and talk to the R D scientists. And there's hundreds of them. I mean Illumina by the way is one of these companies that has been incredibly successful because they firmly believe in that RD is a high priority. So they take a lot of their revenue they generate and they they plow it right back into R D. And
What what our the the R D team of course does here is is combine intellectual advances that have happened in academia, and then they they license and you know pay royalties and all that to universities that took place, and combine it with tons and tons of their own. But opening the curtain, I came to appreciate the incredible depth of talent that a place like Illumina has.
that that that pulls together all of these pieces that at the end of the day allows these these these instruments to be manufactured and to be ruggedized so and and simplify the workflow by just constant simplification so that you could get these you know in into the hands of routine laboratory technicians who could load them and generate prodigious amounts of genomic data.
And and so, you know, you you they they show me a machine that is and and and the way they have it lined up, you know, they show me a machine that's going to be released in three years or four years or five years. I they just have this incredible vision of how it's gonna be developed. But meanwhile, if you sort of say, well, you know, this precursor of this machine, how did that come to be? And it was like, it's these 16 patents. It's these upstream patents and then these these platform patents and then these data processing patents, it it's just it's just a whole different world.
Nic (18:55)
Mm-hmm.
Dr. Eric Green (18:56)
And
and it's what w being able to talk to these people who have spent, you know, many of them, you know, decades pulling these pieces of technology and expertise together to be able to build and and and then manufacture and then disseminate these high-tech, sophisticated instruments. It's just, you know, I'm I'm so in awe of of of the depth and breadth of the talent in a place like Illumina. absolutely.
Nic (19:23)
absolutely.
I guess, you know, what when we talk about the depth and and breadth of talent and and what it takes to be a good leader across both, because now you've been top leader in government, also top leader at Illumina, what do you think are the biggest differences in that impact your success as a leader? First of all, in AHGRI, what would like after 31 years, what were the things you realized, like, okay, I need to be really good at ABC?
in order to be the best director of the NHGRI, how does that compare to becoming the best CMO in a company that like Illumina? Is there overlap? Are they totally different? What's been that transition like?
Dr. Eric Green (20:01)
like? I really want to stress, Nick, my roles are very different. So,
Nic (20:05)
Yeah.
Dr. Eric Green (20:05)
so and and and and and and maybe uniquely so because the way Illumina is utilizing me. I I I don't have a very big team. I've all I have very few internal responsibilities. They're trying to keep me very free.
To be a strategist, an evangelist, and and be able to do projects rather than manage people. Going back to your question, the the very first thing I would tell you is I truly believed my success at NHGRI was that I I had a responsibility of running an organization of over 600 people, but I surrounded myself with an incredible leadership team. And, you know, it was I just felt like a conductor of an orchestra of very talented musicians.
And yes, I'd be interacting with them, and yes, I mentored them, and yes, we were all a team. But they were incredible. And you know, and I was very fortunate that we, you know, when one would leave or one would retire, I would I would find the next one to be, you know, also outstanding. So I would credit the you know, I but then there was also the culture of genomics that was maintained. I I I took that baton from Francis Collins. NHGRI up, you know, was a wonderful place to work, a a wonderful
culture, attitude, a lot of enthusiasm, and a lot of accomplishments by a lot of very talented people. Coming to Illumina, I don't, I mean, I don't surround my I I'm a in again, I'm I'm almost a student here. I play a very
Nic (21:29)
Mm-hmm.
Dr. Eric Green (21:29)
different role. I have very few people surrounded, but I, you know, even my few people are terrific, but it's it's much more about advising the other leaders here. I mean advise the other members and and and really represent the company outward.
but also funnel what I hear from the outside about challenges, barriers, things that they need help, and bring that back to the executive team and other parts of the company, say what can we do at Illumina to sort of help the ecosystem be able to keep moving genomics forward in in in medicine.
Nic (22:06)
Yeah. No, I can definitely see that. And and now that you've played, even though your roles are different, now you're playing a role, you've played a role in both sides.
Were were there misconceptions that you had when you were at the in government looking at industry that now you have a whole different perspective on and maybe even perspectives that industry might have in the government that you think are misconceptions from how they think the government operates?
Dr. Eric Green (22:33)
Well, yes, and I probably have lots of those observations about how I think people don't quite understand the the federal government's scientific agencies very well.
But
we'll leave that as as a story for another day. Here's what I'd say. I think I was a little bit different in that because genomics, especially the last 23 years, was really in awe of the successes of these DNA sequencing technology companies and recognizing the importance of reducing the cost of genome sequencing.
to all the other successes in genomics that that the NHGRI leadership, myself included, always had good relationships with companies like Illumina because it it was really important for us. And so it wasn't like a we versus them. It was like we needed each other. and so I I I never and I also had lots of good friends. I even had, you know, people that trained in my lab who then went on and worked at Illumina. So I I never there was never a
you know, my view that there were they were y that they it was a bad thing to be in a company. I none of none of that. I I think my big surprise, you know, i i is was i was this idea that I hadn't quite appreciated h the the incredible amount of science that they do in the R and D. I I just I I I knew there was a lot of R and D, but until I got here and got to really meet the people in at at multiple sites and multiple countries.
You know, and and learn about some of the things that they not only have done that is publicly known, but how they have this roadmap for the next decade and how they conceptualize that roadmap and how they can deliver on it, that I I really came to appreciate that is an incredibly sophisticated organization. You know, and it's you know, it's also not it's it's not a startup. So that's the other thing, of course. It's i it it'd probably be a different experience if I went from NHGRI to a startup or a very small company.
You know, in in in twenty twenty eight Illumina's gonna be celebrating their thirtieth anniversary as a company. So they're you
Nic (24:39)
well.
Dr. Eric Green (24:39)
know, they're they're they're a mature company. And so but it really shows because they have a level of sophistication in some of these areas that's pretty impressive.
Nic (24:48)
Yeah. Yeah, it's well thirty years is really impressive and it's it's you know, I've I've
I spent a little time in government, but my expertise has always been like academia with the Human Genome Project and in Harvard, icons and and the for profit space. And I think one of the biggest misconceptions that I've seen is that people feel like your incentives are very different if you're like in pharma versus
for profit versus academia. And from my experience, when you're working with the RD folks, they're
all largely trying to cure disease, right?
Dr. Eric Green (25:25)
Completely
agree with you. A hundred percent. And that's absolutely right. And and and I can tell you that they are they are so eager to learn about especially at a place like Illumino, because their instruments are increasingly being tailored towards finding their way into hospitals and clinics and health systems, they are so eager to learn about how medicine is practiced. and so again, I find I spend quite a bit of time just
Teach them some fundamentals about clinical medicine because they really, they, they know where their machines are headed over the next decade. So they're very excited about that. The other thing I'd say, you know, related to what we were just talking about is, you know, going back the other way, you know, the view of the company leaders and staff about what the government's all about. I actually I again it might be unique. I I really do believe that people who are involved in genomics in any way, shape, or form.
really recognize that the genome institute at NIH, the National Human Genome Research Institute, is not conventional government. You know, it's it's not even, you know, it's it's an un it's an unusual cultural and stylistic NIH institute. Even with an NIH, they're unique. And so and and they're so I mean they're still relatively young as an institute and they they have on as their, you know, their initial success the Human Genome Project. So I don't think, you know, anybody
that
I've run into here have has thought about, you know, NHGRI as sort of, you know, government bureaucracy in any way, shape, or form, in part because they realize we're so different than the rest of the federal government, maybe even different than a lot of different parts of NIH. So so again, I I think that that's you know, it's obviously is different, government service, giving out grants, et cetera, et cetera. but but the analogies between, you know, board of director meetings at
Illumina versus council meetings at NHGRI, you know, it's still the same thing. You're getting these this these you take these external advisors very seriously. You appreciate how they're trying to be helpful to you and your cause, and you work very hard preparing to meet with them to get the most out of those interactions.
Nic (27:38)
Yeah, I mean I just just thinking from my years at the Human Genome Project, I always looked at
s some of these organizations like NHGRI as almost like startups within government. you know, so much during those years, at least when I was in the Human Genome Project, felt like the Wild West. We were like inventing the cars we were driving. And
Dr. Eric Green (27:59)
could tell you, you know, and I was there, I I you know, I I got to NHGRI four years into the Human Genome Project, but especially it was right when they started to scale up some of the genome centers. And it did have a start-up thing because basically what you were you know, th this was about giving out in fact
biggest grant, but I don't know if it's still the case, but at that time, NHGRI broke the record for the largest NIH grants given out because they did it for like several of the biggest genome centers. The number of zeros after the budget was so high that it was it was it was like not heard of to give that big of a grant. Because there was really no other example in NIH's history where they were funding production work. And when you think about, I mean it was more traditionally to give out little R you know R01 grants to individual investigators.
Genome Project was about you know basically funding industrial scale genome mapping and sequencing. And so talk about the Wild, Wild West. I mean, Francis Collins had to do all sorts of battles to try to have funding, you know, structures of grants that were being funded that were completely unprecedented in scope and
Nic (29:04)
Mm-hmm.
Dr. Eric Green (29:04)
scale, but because they were funding a different kind of activity than had traditionally been funded by NIH.
Nic (29:10)
Yeah. And and if we think about you you just mentioned about like obviously bringing genomics to the point of scale where you're driving down costs. That was a big part of what you were doing by stimulating innovation. It's like, you know, we go from like the billion dollar genome now to what are we at like a couple hundred dollars or something like that. And and Illumina's largely made its scale and size of the organization based on sequencing.
Dr. Eric Green (29:35)
Yes.
Nic (29:35)
So if we think about now where the costs have plummeted on the sequencing aspect,
you as chief medical officer, w where is your sight set on where, say, for example, a luminous strategy should go in the future to keep up the the metabolism that it's built up over the years?
Dr. Eric Green (29:54)
years.
No, it's a great question. And I will tell you that I already had a pretty good idea w what that would look like before I got here, but what I'm about to tell you
I deserve no credit for because Illumina was way ahead of me. It already was moving in that direction on multiple fronts. And there there really are two major things to dri you know there's probably more than two, but I'll just give you two that I think really tell us where we are right now in the field and therefore exactly where Illumina's positioned itself. the first thing of course is and we already knew it, in fact is going beyond genomics into other omics.
And the reason I'll take credit for it, I definitely knew it because I'm very proud of the fact that the very last named program that got out the door before I left NHGRI was the multi-omics of human disease or mode program,
Nic (30:44)
Yeah, well.
Dr. Eric Green (30:45)
where, you know, it goes back, we started planning it maybe I guess at this point about three, four years ago, and it was this whole idea of if we're really going to understand human health and disease, we have to move beyond DNA sequence data. We need to go into other omics, transcriptomics, you know, epigenomics, proteomics.
Nic (31:00)
Mm-hmm.
Dr. Eric Green (31:00)
You know,
all you know, just sort of start laying it all out. And and we knew it. And so we stimulated that through a a a granting program. And I think that consortium's in about, you know, second or third year and it's going well. And lo and behold, I arrived at Illumina. And the I think it was the week actually that I arrived. they announced that they had acquired SOMA Logic. they were now going to have a whole proteomics platform by acquiring a proteomics company. and by the way, in short order, they also announced
Something called Five Base, which is basically a technology for high throughput methylation analysis on the same platforms that you could do you do DNA sequencing. So what I will tell you is Illumina is really a multi-omics company now, as they should be. So that's one thing, you know, I and I completely endorse what they're doing, and we're looking for all sorts of opportunities to fully capitalize on that. I think the other thing, which again I could have anticipated, and sure enough, they were way ahead of me, is
The
other thing Illumina needs to do, and they are actively doing, is to think about end-to-end solutions. And by that I mean the vision, which I've always had, and but it's it's going to be hard to realize, but it's absolutely where the world is going, is that you know, DNA or genome sequencing or even omics is not going to just be done in a handful of specialized laboratories. Increasingly, it needs to be widely disseminated in a you know highly decentralized way to clinics and hospitals.
And all sorts of environments around the world. And in order to do that, you can't just plop down an instrument and say you figure out how to feed it and you figure out how to analyze the data coming out the other end. Optimally, you want to deliver a complete solution that gives you end-to-end capabilities, where you know, at one end you squirt in some blood or some saliva or some DNA. Off the other end comes a DNA report. And and you have as as few touch points along the way, maybe no touch points along the way.
Because at the you know, I I and by the way, I I I trained clinically. My clinical subspecialty or my clinical specialty is laboratory medicine or clinical pathology, all about clinical laboratories. And and I I I learned that as a resident, right? I mean, you know, you y if you're gonna get a C B C done in a rural community setting at some hospital or some clinic, you know, it's not can't be some complicated
a multi-step technology. It's gonna have to just be a machine. You squirt something in, it gives you an answer in a few minutes. We need to get genome sequencing at that point. And so those are the two things, multi-omics, end-to-end solutions, including data analysis. It's got to be fully interpreted. Just give me the answers. Obviously a lot of hurdles to get us there, but that's the aspirational goal. right?
Nic (33:47)
Well, no, I was actually gonna ask you about that, right? Because obviously I've spent a lot of time in the genomic space.
Precision medicine is all about the multiomics and how these different fields come together. And what's really, I think, opened up a lot of that, obviously with dropping costs is one thing, but the ability to interpret data and connect points that were seemingly disconnected before because we just didn't have the analytics.
Now, with the LLM-based technology that we're all living in, it really opens an entirely new set of opportunities and possibilities when it comes to
how do you now look at data from seemingly disparate fields, like you mentioned, proteomics, lipidomics, genomics, and all these different fields, maybe even some environmental information there as well. Because as you know as well as I do, genomics is largely probabilistic science, right? I mean, there are some diseases that are like you have this genetic mutation, you're going to get this disease.
But by and large, it's probabilistic. And now you have polygenic risk scores and all kinds of different variations that are gonna be
not deterministic, more like give you a risk stratification as to whether you may or may not get a disease. And then the rest of it boils down to your lifestyle, your environment, your socioeconomics, and so on. So building better and better models for that has all of a sudden become a possibility with AI.
Dr. Eric Green (35:07)
AI. Well I'll tell you, Nick, I recently had an epiphany and I'll I this is the first time I'm I'm telling this to anybody. but and we'll see if I'm right or not. And maybe it's my advancing age that I keep having these these these thoughts, but
I I have for many years have pointed out that when the Human Genome Project began, it was nineteen ninety, we really didn't have a very functional internet. I mean we started the genome project with an incredibly cursory internet. I mean I didn't even get my first email address until two years into the genome project or something like that.
You know, I mean it was a very different place. And you know, I've sometimes done the thought experiment. You know, what would have happened with the Human Genome Project if there never would have been advances in the Internet or there was no Internet? And it's like, I don't even want to think about it. I mean, it would we would have been dead in our tracks in some ways. So it was fortuitous that as the Genome Project progressed, you know, the Internet just came to life and was just became commonplace and just standard of life. I mean, that's just part of
Nic (36:03)
Mm-hmm.
Dr. Eric Green (36:04)
life, right? Okay. I wonder if we're gonna look at sort of around the twenty
26, 2025, or maybe this next five years. You know, we are now beginning to hit the accelerator on multi-omics. I mean, I think we talked about it a little before, but I mean, really, when you think about
Nic (36:20)
Mm-hmm.
Dr. Eric Green (36:21)
it, multi-omics is now coming to the fore. Everybody agrees about it. Technologies are available, capabilities are there, costs are coming down. We're going to now start to talk about multi-omics. And I believe we are also now really having AI just become so commonplace in our lives that over the next
next
five years I think we'll look back and say, how do we ever exist without all these tools? And I also predict that we won't be able to capitalize on multi-omics without these advances in AI. And I wonder if the analogy between the Genome Project and the Internet, and then fast forward between multi-omics and AI, we'll look back and say, wow, we were really lucky on both cases. It was fortuitous,
Nic (37:03)
Yes.
Dr. Eric Green (37:03)
but you know, it was it was both of these
were matches made in heaven. And I just wonder if historically we'll look back and say those were both critical partnerships and without progress would have been slowed. So
Nic (37:17)
absolutely.
Dr. Eric Green (37:17)
Absolutely.
Nic (37:18)
And and so many things have to come together, right? Because it's not just technology, it's also institutions' ability to absorb innovation and people's ability, right? Especially you're a clinician. In inventing or discovering a new technology is one thing. Getting it all the way down to the point of care, all the implementation science that goes in there, all the cultural and technical training that goes into
Coordinating multidisciplinary teams or preparing a whole health system to
absorb a new technology in a way that's sustainable and responsible and safe, those are all hurdles that go into adoption of new technologies. And so a lot of things have to come together for any new technology to be absorbed into the healthcare system. And I'm sure you're dealing with that much more now. You mentioned earlier on that now you're looking at like commercial models and the technology and all these things that they come together to create a new technology with an alumna.
But then Illumina also has to think about how do you get that new technology in the hands of in this case, now you're talking about clinicians.
Dr. Eric Green (38:17)
You're talking about clinicians.
Yes. So, and you know, when I when I give talks, which I do frequently, I often point out that, you know, we must constantly remind ourselves that going forward, we have scientific slash medical challenges, and then we have societal slash healthcare challenges. And and we can't just focus on one. Just, you know, you know, yes, we gotta figure out how to interpret all this data and how to understand human genomic variation and non-coding DNA and multiomics.
And all that, and then we have to understand it's how it influences health and disease. But that's all sort of knowledge. But then we have to operationalize it in society as part of health care, with healthcare being one of the most societally complicated components of every country's existence. And with that comes a lot of attitudes and a lot of a lot of barriers and a lot of views that are not uniform.
And so 100%. And I mean, I think it's another thing that I think Illumin very appreciative to have me help them think through is that they may do everything perfect, but if they're not at the table helping to think about these non-scientific, non-medical issues, then they then they may not be as successful. And so I think they're willing to to be at the table to think about some of these these challenges as well.
Nic (39:43)
It's exciting though, because you you mentioned earlier too that Illumina, at least from what I heard, is transitioning from a a research based organization to trying to get now into the clinical workflow. And and what's made that possible is that the genome doesn't cost a billion dollars anymore, right? So it's like it's commonplace in research now as population health or public health programs start adopting this, and obviously I'm speaking with my icon sat here.
if we think about it being incorporated into like newborn
screening, for example, now a whole different set of challenges comes up, which is now how do you prepare clinicians that may or may not have been trained in genomics to start using it in a commonplace way where you can do it at at scale across populations.
Dr. Eric Green (40:31)
And and remember, and and it's it's physicians, it's nurses, it's pharmacists,
Nic (40:35)
Mm-hmm.
Dr. Eric Green (40:36)
it's physician assistants, it's all those and it's all in in of going in for different countries, many of
of
are they all of which have different systems for educating their health professionals and and different constraints on how decisions are made and how clinical guidelines are established. That's absolutely right. And so they but but I mean Illumina leaning into healthcare in a very serious way because they realize the opportunities there both from a company's point of view but also from an impact on the human condition is critically high and critically important.
Nic (41:14)
And you you obviously had a hand in making genomics such not commonplace because they're still in that path, but making it so accessible to researchers. And we talked about the impact that the internet had in making that available, but now what AI is doing in the interpretation of data. How
how do you think people will view today when they look back fifty years from now and they think about the first, say, thirty years of genomics?
Which
I would
say there was some overselling in the beginning. You know, we thought we were gonna cure all diseases by in 20 years or so. And then we realized that it was much more complicated than we thought. But I almost feel like we're at this cusp where we're actually starting or we've started already, like with technologies like Cl CRISPR and other things. We've started to see bear the fruit of the work that started back in 1990. And I feel like it's only accelerating.
Dr. Eric Green (42:10)
I think it is accelerating, and you sort of hinted at, you know, twenty, thirty years from now, you know, how will we look back
And wonder, you know, I I I I've come up with a a thought, and maybe because since joining Illumina, I've been on airplanes a lot. I do travel a lot for this job, but that's okay. so and and I a thought I had recently, and I've even made a slide for it that I use in my talks, is
You know, the fact of the matter is none of us would get on an airplane these days if we were told that the mechanic who did all the preventive maintenance and care of that air airplane basically took care of that airplane but had no blueprint, no knowledge of the details of how that that airplane was put together. Somehow it just cared for the airplane without having blueprint information, part by part, functional by functional diagram of that airplane. You wouldn't do it. You wouldn't get on that airplane.
I wonder if 25 years from now, maybe far less, we will look back and we will say, you once had physicians and other healthcare professionals like pharmacists practicing, you know, medicine without having the blueprint of the patient in front of them, be
Nic (43:24)
Mm-hmm.
Dr. Eric Green (43:24)
able to look up their sequence and get answers as they're doing it. How barbaric. You know, you half wonder
Nic (43:30)
Yeah.
Dr. Eric Green (43:30)
if we will look at it and say, How did you possibly practice medicine? An era just like we just would never.
Ever imagine a an airplane mechanic operating without a blueprint available to them. So, you know, we're certainly not there now, and I'm sure it's an oversimplification, but I I you know I just there's a lot of things where you look back on I can't believe that you could, you know, existed without antibiotics. How did you ever exist without MRIs? How did you, et cetera, et cetera? and I I just I really believe, I don't know if it'll be five, ten, twenty years, but I do believe we'll look back and just say, how could you not have had
That genome sequence in front of you in real time as you're practicing healthcare. yeah.
Nic (44:11)
yeah. Yeah, and into what we're talking about before with the om multi omics as well. You know, how do you interpret somebody's health looking at it through one vector, which is genomics? At that point it's gonna be proteomics and lipidomics and metabolomics and all the omics.
Dr. Eric Green (44:26)
Absolutely. Eve even better yet, fair point.
Nic (44:29)
So I you know, I know we're running on time and you've been so generous. I I'd like to finish off with a zoom out question, which and and by all means, you've been one of the most accomplished people that I've met, and you're by no means close to an end. I mean, you're just opening up a new chapter in your career, which is really extraordinary and exciting. But if you could somehow put yourself at some point in the future, whether if it's five years, 10 years, whatever it is.
Where you feel yourself reflecting back in the body of work that you've
worked on, that you've accomplished over your career, what do you think would be the the best possible outcome or scenario that would give you the most fulfillment about what you've accomplished? What do envision as being that thing that gives you the best sense of accomplishment?
Dr. Eric Green (45:19)
Yeah, in a in a simple phrase, I think what I would say is if I could reach a point in my life or my afterlife where the consensus view
of all of society is that when it came to medicine, we successfully fulfilled the promise of the Human Genome Project. And I that would that would that would make me feel very satisfied and very happy.
Because I must say, as somebody who, you know, got pulled into the Human Genome Project as a freshly minted physician scientist, with some people advising me it might not be a good career move for me, 'cause
Real physician scientists should work on the Human Genome Project. I don't agree with that. I still don't agree with that. And also, I think a lot of skeptics that the genome project, you know, was or has been overhyped as to how it's going to impact medicine, that there were promises made and they haven't been fulfilled. Boy, you know, and I'm not saying it's gonna happen overnight, and I readily acknowledge it's been hard and it will always be hard. But if we could ever get to a point where the consensus view is that we fulfilled the promise of the human genome project.
project with respect to the use of genomics in medicine. That that that's what I would love to hear or my descendants to hear.
Nic (46:44)
Well, I mean, speaking for myself, I think that I've started seeing signs of that already. I mean, if you think about the baby KJ story last year or any level of CRISPR-based therapeutics and treatments, we're we're finally at a phase where we're no longer diagnosing disease or we're no longer just purely brisk stratifying somebody. We're actually curing.
Dr. Eric Green (47:14)
I agree.
Nic (47:14)
In in in a way that is impossible
without the human genome project having taken place.
Dr. Eric Green (47:20)
Right. So I agree with you and I would say that that is getting us closer to fulfilling. I'm I'm ambitious. I still think we could do a lot more before we totally say it's fully fulfilled. agree. treated.
Nic (47:30)
I completely agree. I think really the next transition is beyond N of one, can we get it to the point that it's accessible to anybody who has a potentially genetic disease that could be treated?
Dr. Eric Green (47:41)
And I mean and you're giving great examples on the therapeutic side you know I but I also want to point
Out, I really would love to see this again, this idea that every encounter you have with a healthcare professional starting with you know week three of your life, all the way through, at every encounter, you know, looking at that genome sequence, or maybe getting more ohmic data, but every encounter involves an integration of genomic and/or other ohmic information into the decision-making process, just like just like routine.
CBCs are done and other standard clinical laboratory tests are done.
Nic (48:22)
I completely agree. Well, with that, Eric, it it's always an honor talking to you. I I consider you a friend. It's always so much fun learning and hearing about the work that you're doing. And and it's not gonna be too long before I see you again because I think you're coming to the icons conference at Harvard, right?
Dr. Eric Green (48:37)
I will absolutely be there. Nick, it's always great talking to you. I loved joining you for this podcast. It's always great having a conversation. I share your passions on many of of these of these topics, and so it's great to have this conversation.
