The US National Institutes of Health (NIH) will start enrolling 1 million or more US citizens as the first key step to implementing President Obama's nationwide Precision Medicine Initiative (PMI) (Nat. Biotechnol. 33, 325, 2015). Plans for the clinical research cohort were outlined in September by the NIH Advisory Committee to the Director. Volunteers recruited to the study will agree to let researchers collect biological specimens as well as detailed information about their health status, including genomic sequence data. In turn, that information will be systematically curated and analyzed to underpin the PMI. Among its recommendations, the working group emphasized the importance of actively engaging those individuals who join this cohort, allowing some of them to participate not only in clinical studies outside the initiative but also in oversight of the initiative itself. Giving volunteers a say in how the PMI is governed and allowing them to decide how fully they will participate once it is under way are but two of the steps recommended to build adequate safeguards, including guarantees of maintaining individual privacy, into the experience for all participants, according to NIH director Francis Collins. NIH anticipates spending $215 million in fiscal 2016 in this first phase of the initiative.