■d anniversary of d-day, thursday, june 6. >> c-span is your unfiltered view of government. we are funded by theuse television companies and more including mediacom. >> we believe that whether you out in the middle of anywhere, you should have acce■ t, reliable internet. ♪ >>ediacom supports c-span ce ale other television providers giving you a front row seat to democracy. >> up next, a senate appropriations subcommittee hears testimony on the national institutes of health 2025 budget request. during the hearing the director

and other leaders from the agency field questions on psychedelic drug research, fent overdoses and maternal care among other topics. this is just over one hour and 45 minutes. ■7■/ >> the senate appropriations subcommittee on labor, healt related agencies will please come to order. that morning. today is our fourth hearing on

the biden administration's fiscal25 budget requests w -- to testify f in front of this committee as the director of the national institutes of health. as the granddaughter of an nih fundedwhat an appropriate role biomedical research plays in treating and curing disease, bolstering our economic growth leader in innovation. i know my colleagues here today agree. i am looking forward to working é a bipartisan manner again this year to develop a labor hhs bill i canthe senate, the house and be signed intothat sht invests in nih and the promise of finding lifesaving cures and ts for deadly disease is

pure but i want toy to do that n a green to adequate topline discretionary funding level. because of house republicans insistence on cutting fundi prot year's labor hhs allocation was more than $2 billion less then in fiscal year 2023. the first such decrease in more than a decade. even under those constraints, i was proud that we were able to fight back cuts to secure a $300 million increase for nih in fiscal year 2024. just like last year, more than a republicans insisted on cutting discretionary funding as their price of raising the debt limits. as a result, backfiscal year 2011 through fiscalt= year 2015,

funding for in nominal result, nih funding also decreased over the same period. starting in fiscal year 2016, coress finally decided overly restrictive discretionary caps were stifling critical investments including nih. ■d began modestly increasing domestic spending as a result. from 2016 until fiscal year 2020 three, funding for labor hhs increased on average a modest 3.3% per year.

that allowed the subcommittee to increase fun friod of time. unfortunately, republicans are now again insisting on cutting funding for domestic programs including in labor hhs. and that is putting consistent meaningful increases for nih in peril. i'm deeply concerned that that stagnating funding for n.i.h. just like what happened last time as i describeed. almost every senator here today will say they strongly support n.i.h. funding. that's easy. but if that's the case, as we have seen over the last decade, we need a workable top line that allows for a workable labo allocation. and i hope we can return to the few years ago and agree to adequate funding for labor h.h.s. that allows meaningful,

consistent increasesor n.i.h. alternatively agreeing to the draconian cuts proposed by our house republican colleagues on the other side of the capitol, it would be devastating for biomedical research. it would set back years of progress made towards curing disease and weaken america's competitiveness, particularl and we just can't let that happen. director bertagnoli and others to discuss the budget. this budget highlights the need for tipped investments along a wide range of republican priorities and speaks to research you all research as director of the 2.i.h. i'm pleased to see the reportttr diagnostics, improve treatment and precision care for patients, including targeted investments for research on women's health and in support of the going to

cut the cancer dea least 50% over the next 25 years.ime when we are seeing the spread of h-5n1 bilu infection yesterday, it highlights the i am interested to hear from dr. marrazzo about about the important work that nyack is funding to detect and monitor this virus so that we can limit its spread. the fiscal year 2025 budget including mandatory cures act funding. funding.g mandatory cures t an increase of $1.25 billion over fiscal year 2024. an increase of $1.25 billion over fiscal year 2024.

backfill decreased cures act funding that falls under this jurisdiction of the he committee. declining cares act funding combined with difficult diaps created a uniquely challenging situation for fiscal year 2024 and will again in fiscal year 2025. outside of those increases in discretionary spending for cares act programs, which i'm happy to see maintained, i am pleased to research, mental health research, and neuroscience research. and ■gring are under attack in this country, i was pleased to see the budget proposes a $76 million increase for the offic but i was surprised to see that the budget does not call for any new resources for alzheimer'

i want to hear more about that and i alzheimer's disease research from dr. hodes. and i want to hear about how nih is working to address our nation's al substance abuse disorder crisess remain stubbornly high. nearly,e died of an overdone. in my state, there were 1828 drug overdose deaths in 2022, surpassing the record set in 2021. of those deaths, 1464 involved opioids. i would like to hear from dr.u"? volkow about how they aregetherd to this crisis.

i also want to hear about how nih is investing in the next generation of researchers, partic data that reveal a decline in the number of u.s. postdoctoral scholars ani two years. i want to know how you are supporting early stage investigators, particurly women and those from diverse backgrounds. and finally, i want to hear■g■h about nih's ongoing research on long covid. it has been more than three years since congress appropriated -- [applause] it has been more than three years since congress appropriated $1.2 billion for long covid research and nih has and has yet to deliver treatments for thidetating disease. dr. gibbons, i want to know how you plan to leverage the recover initiative to be more efficient

and effective to finally move the needle for millions of americans who continue to suffer. and appreciate all of you being here today.turn it over to ranking member capito for her opening remarks. following senator capito's opening statement, wwi■hll from director bertagnolli, and then senators will have five mink you for being here. dr. bertagnolli, it is good to thank you for being here but also congratulations on your fairly nearly new role as nih direct. i also want to thank you for coming to west virginia in march to see firsthand the amazing things that we are doing at west virginia university, including seeing the work that the team 's disease and addiction. as you witnessed, my home state

of west virginia is a ruralh chn the country. a partnership with nih is critical for us to make improvements. dr. volkow, who has also visited west virginia, dr. hodes who says he is coming, wjust have and dr. marrazzo, and dr.mell gibbons, thank y fportant healtg our nation.■' and i said, many of you have visited or will visit, and i'mtg funding year, as chair baldwin lined that out. edical research at nih is a priority for me and has been for this long bicameral bipartisan priorities as well. the budget proposes $49.8 billion in funding for nih including arpa h. the budget also proposes an additional $1.bi mandatory funding for the cancer moonshot.

last year, i was proud that we were at least able to get an increase of $300 million in very tough headwinds in discretionary spending for nih. nih isn't just a great research and biomedical research institution, it's also a driver on in national economic activity across the nation in 2023. in my small state of west virginia, nih supports 759 jobs and $140.8 million economic impact in 2023 alone. this is in a state we reallyn''e us as one of theas for medical innovation, but we are proving the nation wrong every day. the nih impacts every american in some way, and i hope again to work in a bipartisan way to funr cancer, parkinson's, als, alzheimer's disease, and other conditions that ag■ i mentionedi

-- i will get it someday, joins me -- with a name like capito that gets mispronounced have to time, you would think i would be better at this. i'm trying. i'm trying. she joinede esearch advancements we are doing in west virginia. muf this has been made possible by the partnerships fostered by nih over the years. reseer state are making significant contributions to biomedical research in areas ranging from cancer to alzheimer's disease, to substance use disorders. average in new cancer diagnoses and deaths. devotes increases to findinggetû cures and treatments for cancer. childhood cancer star act, i look forward to hearing about5 to combat cancer and grow our clinic

escially among our i will continue to prioritize fostering nih collaboration with smaller more rural states. last year we were ableo the nih idea program. this program provides funding for 23 states, including mine, that historically received very little federal research fundin and i'm proud of the friendship and partnership with nih for his the idea program and the other nih program has been instrumental for marshall uner institutions in the stateh in neuroscience, cancer, stroke. dr. bertagnolli was able to hear about west virginia clinical ann translation science institute's new mobile unit, named maverick, purchased thanks to an nih grant. dr. s a this mobile unit to give individuals all over the state -- we know access is the issue

in rural states -- the ability arreatments and is a prime issue of how nih investments can directly affect people. i do want to take a moment, and the chair and i are like-mindedt that the proposed nih budget doesn't devote new resources specifically for alzheimer's disease research at nih. i have seen through closed hands through both of my parents the devastine family, the patient, and■; the caregivers. nearly seven million americans are currently living with alzheimer's in our country. and the national cost of caring r's and other dementias is estimated to reach $360 billion this year. that is staggering. alzheir' research must remain a national priority. i would also like to see more abuse. the national iti

abuse receives only a nominal increase in this budget. dr. volkow has vised my state and has seen firsthand how west virginia is in the crosshairs, and every state is in thecrosshd addiction crisis. i would like to add my voice in agreement with the chair on the reveng covid. and i know we have many in the audience today. i know we are dealing with a tough funding situation this year but investments in biomedical research are so important for the future of our country. before i close, i would like to address dr. bertagnolli on something we learned last week. that is concerning. for years, the nih's leadership has taken the stance that nih gain of function reseah ' happening with the echo healthne of virology in china. this appears to be false based on the doctor's response to a

house committee last week.■% when asked if nih grant funded gain of function research at wuhan. he quote, "if you are speaking about the generic term, yes, we did.” last year hhs debarred the wuhan institute from receiving federal grants for 10 years and just la wnd plans to debar them too. i think both of those suld have probably been done much sooner. nih has a credibility problem here when it comes to gain of function research, and i strongly encourage you and dr. marrazzo in your new roles torch integrity and trust to the nih in this area. thank you very much. i look forward to your testimony. ai senator capito. i will now introduce our witnesses. we have ■

we have dr. gary gibbo, ctor ofl heart, lung, and blood institute. dr. richard hodes is the director of the national institute on aging. dr. jeanne marrazzo is the director of the national institute of allergy and infectious diseases. dr. w. kimryn rathmell is the director of the national cancer and dr. nora volkow is the director of thtional institute on drug abuse. thank you all for joining us today, and i look forward to we will start with director bertagnolli. you may deliver your opening remarks. dr. bertagnolli: chair baldwin, it is an honor to testify before you today concerning our fiscal let me start by sincerely

thanking y provided to nih in fiscal year 24. every state received a share of nih investment. each year, nih awards over 60,000 grants, supporting more we are proud to contribute toore nationwide innovation in bi■tedxt generation of researchers who will meet the challenges of the future. nih is guided by the principle that our work is not finished when we dever scient our work is finished when all people are living long and healthy lives. decades of sustained investment in fundamental science arecitin. how can the brain be reprogrammed to relieve anxiety or

how can we replace a defective gene, thereby achieving durable remission of a debilitating disease? how do we enlist the specific function of the immune responsef to eliminate an advanced cancer? our laboratories are delivering answers to these questions and many more. but we still have work to do. families across the country are facing high rates of maternal mortality, strug■linto care for those suffering from alzheimer's disease, and losing loved ones to substance use disorders. the 2025 president's budget needs, including the cancercal moonshot, brain initiative, women's health research funding to promote mental health, to overcome suffering from long covid, and to achieve longer and healthier lives for people with down syndrome. our track record demonstrates

that with continued funding and support, nih researchers will deliver progress towards undetag i call your attention to two overarching concerns. first, many are underrepresented in medical research, especially belong to minority groups, or live in rural locations. and second, for the wealth of data we now collect, we still lack comprehensive diverse data from the clinical care environment that can power new artificial intelligence approaches to improve health. on behalf of the 27 institutes and centers of nih, i present two new programs to address these important needs. first, to ensure that research discoveries benefit all who need them, we must partner with reaching them even, for rural location far from a major academic medical center.!= to do this, we will enlist primary care clinicians on the

front lines to develop ways to overcome health challenges that matter to the communities theyr. care providers practicing inll e the main focus, supporting them so that their patients will --a an knowledge generation and also benefit from research that allows people to receive better care. next, consider how information technogy world and how much more efficient and inclusive our research would be if we could better collect data to learn from everyone. artificial intelligence and machine learning are revolutionizing what is possible for biomedical research an clinical care. new technologies, we need to of invest more in a secure and sustainable data sharing vernment, industry, anding academic partners, we will enable health innovation on a national scale, supporting secure researcher access to data

along with advanced analyt and computational power. and we will incorporate what we have learned from projects such as all of us, to obtain people's permission to use their health data for research and deliver results back to them, inviting them to be our true partners in research. thesfoch people from all locations and walks of life will accelerate progress and ensure that no one is left out. when we ask people what they need and deliver results t benefit them when we are■ anes, we will earn trust.■ so, nih-supported discoveries have benefited all of us and we are poised to do so much more. your continued support of our mission to help all people lives crucial. thank you for the opportunity to appear before you today. i look forward to your questions. chair baldwin: thank you, dr.

■0bertagnollii am going to kicku of qstio. more than a decade ago, researchers at the university wisconsin madison studying avian flu, or h5n1, warned that only a few mutations in the virus would allow it to transfer to mammals. today, h5n1 has infected 51 dairy cattle herds across nine states. just yesterday, a second human case of h5n1 infection was detected in michigan. fortunately, as far as we know, the virus hasn't spread to my home state of wisconsin, but it has caused concern for dairy farmers in my state and across the country. i recently convened a roundtable

with feder and statege wisconsin on the current state of the disease and strategies for mitigating its impact on human and animal health. scientists still don't know how the virus is spreading or how nd our roughly 100,000 farmworkers are at the highest risk of infection. so dr. marrazzo, tell me about thespread of mutations in the virus and the work you are doing to develop a vaccine against it. dr. marrazzo: thank you for that question, chair baldwin. this is an incredibly important topic and i do want to acknowledge the great work that our university of wisin colleagues have done. in fact, they have been part of one of the networks that i want that has been on our radar for a long time. because when it does get into human hosts, we have seen a mortality of about 50%. so this is something we really do not want to happen.

what we've been doing for more than 10 years is funding a group of investigators called the■x centers for excellence in influenza research and response, of which your univertys one. and what they dos his virus in wildlife, including migratory source of these viruses.■z■ that is important, because, as you mentioned, you need to track the mutation wild so that you can be prepared to prepare the vaccines and antivirals that you need if the viruses get into human hosts. so, really important network that has been doing incredible work. outbreak.has been informing us with regard to the current outbreak the good news is that many of the viruses that they similar, if not identical, to the case in both humans that we although, the sequencing hasn't been done in the human case we heard about yesterday but we assumewill be the same one.

so the good news is that we are really prepared to not only tese have in the stockpile, but also to really develop if good place. we are also working with some of the other agencies involved in this and are continuing to demonoclonal antibodies, vaccines, and antiviral drugs, all very much a part of our remit and very much engaged in doing this. chair baldwin:■ you. dr. volkow, while recent cdc data shows a slight decrease from the prior year, overdose deaths still claimed more than 100,000 lives for the third year in a row.e deaths are largelyta. a study published last week shows the availability of il skyrocket. 115 million ilcit fentanyl

pills were seized by law enforcement last year. we can and must do more to sp■c this epidemic and save lives. i know that this is a bipartisan priority for members of this committee, including senator capito and myself. t's why we provided a $5 million increase for opioid r 2024 labor hhs bill. so dr. volkow, two years ago hhs launched a coordinated national strategy to prevent overdoses. whatñ7 can healing community study and what interventions it has found to be most effective at the local level?■! dr. volkow: thanks very much f■r your interest on this very challenging issue posed by the overdose crisis.■e the healing community study aimed to actually empower the communities in order to give them the resources and the support necessary for them toal

circumstances in which they find. because we see that the overdose crisis is across the natn an we wanted to learn from this community. so the healing community studies empowers them, allowing them to get the data and to develop■ interventions that are more likely to be beneficial. as a result of that, we have learned strategies that then can be deployed to other states. one just in ccess to data that allows communitiesa difference or not.

and in the process, we have seen a significant expanded distribution of naloxone and significant expanded recruitment of people and improvement in tht

with pain properly with opioids when they need it and other treatments. chair baldwin: thank you. senator l. ■;-- senator capel -- senator capito. sen. capito: thank you. i will stick with yo dr.u've s'h nih at west virginia university on his use of ultrasound to slow addiction and alzheimer's. i want to talk to dr. hodes about that as well. what kind of promise does that work have with ultrasound to decreasei know there is no one e solution fits all here. that is the difficult part of what you deal with every single day. what do you see in terms o dr. volkow: you are seeing me

smilcathis is a perfect example where science can transform the way that we can tackle problems, like in this case, addiction. it is possible because of our understanding of how theinted in addiction. and through brain technologies, to be able to manipulate them in a non-intensive way very selectively. using low intensity focused ultrasound to basically restructure the way that the area of the brain gets disrupted by drugs. what he has shown is dramatic. reduction, in craving and anxiety in people with severe substance abuse disorder. this is an intervention that is not invasive, that requires one or two interventions, and has an effect that lasts a week if not

four weeks. we are funding research to try■é to exploit how to maximize it so that others can take advantage of it. sen. capito: it is quite remarkable to watch. i've watched it myself. dr. hodes is also doing the same. well, it's brain, it is interesting how all of these are i know that you have had a long history of studying alzheimer's. what do you think about this as a potential breakthrough, in combination with what we are seeing with some of the pharmaceuticals and other available -- i don't know if they are full treatments, but ao handle alzheimer's? as noted, it is gratifying to see convergence of technologies and approaches. in this case, the progress in the past years in alzheimer's haen the first fda approval of a drug for treatment of early-stage.

what we have learned from the series of successful and unsuccessful trials is that the effect is very strongly related heplished. what we havehown in studies in west virginia was■ that the use of targeted ultrasound in combination with an antibody to amyloid increased the effect in decreasing amyloid in the brain. data, which now wl be followedp, weffective in combination the treatments we have available. sen. capito: it can be done without nih and without the innovators we have nci designations and clinical trials. and i don't know who wants to answer this. but, there are 14 states, including my state, that don't have an nci designated cancer center. you know, you have seen the our cancer statistics in our

ate are very disappointing and devastating to us."? it goes back to my rural area question. my understanding anecdotally through the professionals i've talked with is that in order to 10 million of repeating research into a center beforey in some rural states that don't have the resources and other i am some jesting here that -- i am suggesting here that, have you ou a carve out or a way for access for the more rural states to take into consideration the certain dynamics in a state like that as opposed to bigger medical centers that are aroundz i don't know who wants to --dr.o

first, the cancer centers are one part of the portfolio. and we would love to have more cancer centers. i know w?pe are emerging and working towards becoming in terms of reaching out to rural america particular with delivering on the discoveries to get to patients, which is what we want here, i will first say thhe nci has long had a dedication to this, but i grew up in iowa and i understand very much what it means to have great distance froer■i medical center. it was at vanderbilt where, although we have nashville, the surrounding area had very similar issues.

i will tell you a couple of things we are doing to try to take that on. cer centers, we have 2200 sites that do clinical trials around the nation. the world in terms of a broadn network for clinical research. i think we have over 100 clinical trials in west virginia. and we also have the national community oncology researchq>: program which is another way of engaging community oncologists, because that is really ware. but we know that is not enough. so we have engaged a group to work across agencies and with community centers to look at our capacity building opportunities. absolutely, it is a huge priority for us. sen. durbin: thank you and welcome to the nih team.■p it was about 10 years ago when i met with francis collins at nih went tough one of the

mmend to my colleagues. i can remember as a member of the houswh congressman john porter, decided to double the budget of niit sen that agency. still we feel the benefits today. i ask dr. collins, what is itan? doubling it is not realistic. what iseath each year. i am goio which shows what hapd after that. 9t engaged roy blunt, who deserves credit for his leadership on this, an seatmate who will be here closely, senator murray, as well as lamar alexander, to make sure that year after year we continue national institutes of health. this chart will show you that we did a pretty good job of it. the slope that heads on up

there, the blue slope i would attribute to the team that came together. the orange part is the deficit where we failed to reach 5% real growth. i would just say two things. i commend my colleagues the theory that this is national security, this is national ask the american people if it's wort o;wf th■eir tadoll i am not going to take a penny away from the pentagon, but for god's sake, nih are doing things that savmore lives thaanyone working at the pentagon. [applause] ■(so i encourage the creation oa new team. senator capito, you sound like from your questions are deepbj'a good thing. i hope in the memory of roy blunthat you will join in the effort as we move forward and i invite others to be part of it. andi count on senator murray as the chair of the full committee to move in that directio

let my colleagues, i have some have taken an interest in. this success story for the national institutes of health has had its ups and downs in given areas. placed on the national mall, each bearing the nam a grandparent, spouse, parent, child, neighbor, or friend battling als. one will bear the name of my friend and constituent who w in the white house with president obama. his wife, a true courageous individual, used to work on my . and of course they have two little daughters. they have been battling als for years, with some limited success. advisedly, because i know you hardly ever want to use that word around als.

dr. collins called me at one point years ago and said, we have come to the conclusion that we are hng direction in our research with als which is not coming up with anything aftert. what is the status of efforts today in research on als? >> tlet me say that this ia tragic, tragic disease and we are approaching it with the sense of urgency it deserves. what has happened following, among other things, the act for als, which has been great for us, is the collaboration between nih researchers and the people affected by this terrible disease.■c strategic priorities for tackling the disease. diagnosis, treatment, management, prevention, and cure. we have to use that word, cause that is what our goal is. and we are in implementation let me give you specifics of

implementation. there is an active partnership with the fda critical path initiative for drugs that are experimental, which is certainly critical for hope for these■. a new, accelerating medicines partnership for als that is done under th will be announced imminently. also, some practical but critical things like data sharing, prognosis in the genetics of als, biomarker development, and more new trials. seconds left. the blood brain barrier seems to be a topic which i hear about more and more in breakthroughs in medical research. can sentences what we are finding? dr. bertagnolli: well, we are finding that there are

techniques.e this barrier prevents drugs from getting into the brain, where they need to work. we are finding certain techniques are able to open the barrier so that the drugs that we need to get in can pass through. the details don't matter, but i can tell you this incredibly tive area of research to bring more therapies, effective therapies to those affected by . sen. durbin: my last comment,o . we lost john mccain, ted kennedy, and beau biden and i hope that even at northwestern university where there are research breakthroughs that we can find a way to treat this malady more effectively. thank you. chair baldwin: senator hyde-smith. sen. hyde-smith: thank you, chairman and ranking member, and i appreciate our panel being here today. i am going to direct my question to dr. rathmell. the university of mississippi,

my state, is the only academic medical center, much like senator capito. we are working to achieve our nci designation, but we are not ere yet. first lung transplant and heart transplant in the country in the early 1960's. i am proud of that.e working hat there but we aren't there yet. get there, we are talking about the trials and treatments and although we don't have that designation yet, bringing these trials and treatments to mississippi and what that looks , th dr. rathmell: yeah, absolutely. thank you for the ques so, as i said before, we do have

multiple resources that we used to bring clinical trials in. the national community oncologye in your state. i will expand on the group that convening. one of the cochairs of the group comes from baptist health care center in memphis. so, his group really sees a lot of patients in the mississippi area. that group is working across federal agencies, v.a., indian health service, cms, american cancer society, where there arex can make clinical trials more accessible and more desired and mo available. and then we are doing other things as well. smaller centers cannot nessarily have all of the staff that they need to run

clinical trials, and so we have piloted a virtual clinical trials office which has been heralded as a different oppoun i think that that will s democratize the ability to bring clinical trials a lot further. that is part of with this group will be looking at.■z sen. hyde-smith: thank you for that. and i am certainly going to ask for your commitment as well at ummc to help us get there. your recent editorial stressed the imance of clinical trials, the infrastructure to addressing and eliminating the inequities in the health care system, you highlighted that increasing community conduct cancer research is the key goal. and we sure hope that we are part of all of that. will this plan involve getting granting mechanisms? and at impact would our declining budgets have on the initia there?

dr. rathmell: am so gladweearlye here. and we want to work with you to be able to do moref the flat budget makes it tougher initiatives. and we have to come up with newe initiatives out there within the today. so that is where part of the reinvigorateres act would bolster our infrastructure for clinical trials.t a future where we think that ic could be much more available to patients everywhere, where they are. and that takes real infrastructure.և sen. hyde-smith: thank you so much. and i have a little time left, so, dr. bertagnolli, thank you for being here as well. the nih provides support to mississippi through the institutional develop award, the idea program.

and ur idea awards totaling over $17 million. and as you know, the ia networks of biomedical research is excellent for funding biomedical research/g developments, including the network in mississippi colleges and universities. and they are collaborating to increase this research infrastructure in my state. ble through the nih commitment to that pgr but i certainly encourage the nih commitment to the program and funding that it provides to mississippi and other states. how committed are you to ensuring that nih allocates at idea program under your leadership? dr. bertagnolli: so, senator, i,

but i can tell you that this is truly among my highest priorities. to make sure that our research, which means our funding, is delivered d through communities such as those served by the idea so, not just the idea program alone. ability to do research. what we are the actual trials, the actual studies. i think that states like yours have done a great job to devel the capacity and now we will put that capacity to work. and that is going to be really exciting and i think of eathank. chair baldwin: next, i recognize the chair of our full committee, sen. murray: tha youerch chair baldwin, and thank you for the work you do. nih is fighting some of our most

devastating adversaries. cancer, alzhe■he'd addiction, lg covid -- [applause] -- to say nothing of rare seas the lifesaving work at nih really sws this. i have been reminding my colleagues, if we are serious about protecting our families here, we need robust defense and nondefense spending. unfortunately, the tough caps that are squeezing dod are squeezing nih. derail breakthrough patients and families desperately counting on today.een very clear that we have to invest in nondefense and defense. we need parity andich saves countless lives, get their due as well. i am proud to say that we have a long history of bipartisan support for nih. i have worked across the aisle many times to advance this work fo funding increase.

i hope that we can come together to support this work again along with many of our other crucial mestic priit wi because i have a really important questionee it is something i have been pressing on nih for years about how the agency will make sure supporting researchers whoot create a hostile work environment for colleagues and students. we have seen nih fall short when it comes to holding grantees accountable and complicit as initutions pass the harasser. we simply can't afford to ha a'd and its workers harm by ■qseal harassment, discrimination, or bullying in the workplace. nih is in a position to set standard for a safe work environment in the biomedical research field. under your leadership now, talk to us about what steps you are institutions and your grantees

accepted and will result in the loss of federal funding? dr. bertagnolli: thank you so much, chair murray. of any type, sexual abuse, harassing, bullying, any type is absolutely not to be tolerated. anywhere.your advocacy in championing this really important issue. first of all, thank you for your support in giving us the authorities to require that institutions that we fund must report to us anyone who has been found to exhibit this behavior. has a real finding of this behavior. and when that happens, their funding is withdrawn. solid andt stepovided us with. however, we still have more work to do we

and so, i really ld to working with you on that. i will say that it is stil possible to pass the harasser if someone has been accused but no. it is possible for them to then move and get a new job and for us not to know what the results been. let me tell you, we have been trying to combat this as well by having an anonymous tip line. and we do get and follow up on everything we get with anonymous tip lines. but we can work better to close- legislative solution? dr. bertagnolli: i think that we need to work with you. i think we don't -- i would like to work with you on that, because i am not sure i exactly know the answer. discussion and figure out the best way. so thank youray: let's follow un

that. i also wanted to talk about the fact that women are half of thet comes to federal investment in [applause] i strongly support thestration'o tackle this problem head-on, including the executive order that president biden signed in march to better prioritize investments in women's health across the federal research portfolio. this is really a needed step to make sure women's health i better understood so women can ry st there are significant gaps in what we know about diseases and conditions that impact women, and la universal as menopause. talk to us about what nih is doing to advance women's health research, includin conditions like menopause that are so common and yet so misunderstood and overokdr. berk

you. so, nih has a long-term commitment to women's health in many ways.call your attention to the framingham study. 75 years of understanding women's cardiovascular health. 50% women for those 75 years. we have gained a lot of knowledge over that. researchcr institutes and centers address women's health. however, we absolutely can do more. the new initiative now gives us an opportunity to address current challenges that are really important to women. you have already illustrated a few, maternal health, a vulnerable time, mental health, postpartum depression, so many areas there that deserve more attention. alzheimer's disease, which has an increased risk in wlth overa. a normal time of life, but the change in hormones can be

incredibly disruptive, and there are also long-term health still haven't developed the treatments and approaches that we need, although we have made some progress. we can do more. and then, finally, what is our approa we are taking, instead of a bit by bit approach, we want to take a lifespan approach to women's health. a much more comprehensive and lifespan approach that coordinates across all our sen. murray: i appreciate your attention to that and i think iy of us that we really want to see what we can do to make sure that nih is focin it. i mentioned menopause working with a number of women senators making sure that we have the resear and coordinate what we are doing here a h a better focus. i think it was senator murkowski who said to us, if men went through menopause we would have an institute at nih. we we are just asking to make sure we really focus on so, thank you.

chair baldwin: vice chair collins. sen. collins: thank you very i am going to forgo an opening statement because i have so many questions that i want to ask. and reallylzheimer's disease, along covid, tick-borne illnesses, and also diabetes. dr. hodes, we have talked to so much over the years. and this committee has been generous in funding alzheimer's research in the last five years. and i would like to hear from you, have we made any progress e support from congress which has been enormously helpful and which has yielded important

results. in the past year, fda approval of the first drug which target the underlying process of alzheimer's. in terms of prevention, another important area, we have seen studies reporting the effect of repairing hearing deficits with hearing aids in those with hig'g something like a 50% increase in cognitive decline in the population. early studies have pointed to the possible role of multivitamins in reducing cognitive decline, as well as targeted coaching to address the dik factors. giving us an opportunity to test by imaging and blood biomark the various components, biochemically, molecularly, of so with alof successes, some of which i have summarized these past years, where we are now is an understanding that alzheimer's is a complex disease, meaning that multiplet: pathways that can occur in an individual. more importantly, we now have the ability to monitor this with

biomarkers and studies that will identify the best treatment for individuals. a growing number of unique targets now in early stage clinical trials could see the lifestyle interventions too.e ht advance in the work is only partially there. the increase in the understanding that we have of the disease targeting diverse oars i think is enormously promising. collins: thank you very much. i am encouraged as well.i thinkt that alzheimer's is a multifactorial dis a important, as well as the amyloid plaque that we focused on for so many years. dr. marrazzo, hhs recently released the national public health strategy to prevent and control vectorrne ■t.of the

cade-hagen tick act, which i authored with senator murray and others building on theratege illnesses. this is increasingly a problem in the statema 20 years ago, we did not have ticks in maine that transported transmitted these kind of diseases like lyme disease. of maine, they are all over the united states. it creates real problems. maine had a record high number of lyme disease cases in 2023. and as ticks continued to■+■t expand, those cases are likely to increase. i was pleased specific goal of reducing the number of lyme disease cases by

25% by the year 2035. could you briefly update us on d tick-borne disease diagnostics, treatments, and potential vaccines? because one problem is there's been a real dispute in the medil community onow t treat lyme disease. dr. marrazzo: collins, as someone who did my residency in connecticut and worked in old lyme for a summer, where i think i saw every manifestation of■d lyme disease, and recently coming from alabama, where we saw tons of tick-borne illness, i could not -- your comments could not resonate with me more. it's a really challenging infection, and you highlight the fact that we still, 25 years even really have a good ■diagvánostic test that we can e for it. lisa rolla g -- serology is very frustrating. it leads to a lot of■ misinterpretation. let me just say that we released our strategic plan, as you know,

and the support from this 2019, committee in this area has been critical in advances for both in so in the basic area, one of the finished with both intramural and extramural scientists sequencing the genome, which is very exciting, because you can now go in and be more specific about genetic targets to try to develop some of these vaccines e the antigenic components? response that probably, frankly, informs post-treatment syndrome, chronic lyme disease, but is clearly a post-treatment inflammatory syndrome. i'll jump ahead to that and just note that in 2021, i think, we actually had a proposaour work specifically on posttreatment conditions and

awarded seven big that, to try s th p areas and how can we best address it. with the diagnosis, we're really looking ■6carefully at a numberf new serology approaches, some point of care diagnostics, which will help people a lot in the field, especially as people come time.ergency rooms in the summ and the last thing is the we have a pretty successful vaccine for dogs. there is a canine vaccine. vaccine is actually working, and we're trying to learn from that analogy to develop and refine es, which has been really challenging. i'll stop there. there's more, but i'll stop there. sen. collins: madam chair, i'll ask that i submit my question on diabetes. i'm concerned about the cut that is in the budget and surprised to see that, and on long covid as well, the recover initiative has been very controversial, th%

maine medical center, i'm proud to say, is involved in the research, but i'll submit that. madam chair: offensive line, and any opening i want tsue end i we timeline we need for questions for the record. thank you. senator schatz: ? >> thank you. i think i speak for most of us when i say this is■1 one of our favorite hearings, it gives us the most hope about the future. dr. bertagnolli, i wanted to start win to launch nih's first ever hawaiian pacific islander health research our worry is this is going to take 17 months to stand up, so quickly?reassure me that this i'm in no position to hector you for not already being up, but can you please reassure us that this is going to happen quickly? dr. bertagnolli: thifollactive o much more to care for our indigenous peoples. hundreds of millions of dollars in pain management, research,;#6

what have we learned in the last several years about chronic pain treatment? dr. volkow: the whole infrastructure was energized tte effective for patients that are suffering from pain. pain is devastating. it's very, very prevalent. but it has been neglected. as a result of that, many people we think ended up getting drugs that were very dangerous, which, of course, contributed tremendously to the overdose

so thanks to the resources thatw have come from the initiative, we've been able to uncover new treatments for pain that are not targets.e, complety we want to me chronic pain conditions and other areas that we've never sen. schotz: : what do you think by multipronged?

dr. volkow: itons to help the pn live with pain. like many patient, for example. sen. schatz: how much of this is sort of, i'm not sure i'm using the right terminology, how much is getting into cms and the that's the question i have. it does seem like over the last three to five years, a lot of important discoveries that are not so, you ■(ñkn■ow, they're nt merely suggestive, like we think we know some things about pain management, but it doesn't seem to me that in its application in the healthcare context that dality. dr. volkow: that's why it's so important in all of these projects we work closely with cms, so we can ask them the questi■on would lead to its reimbursement? so we work very closely. for example, acupuncture is a perfect example of a partnership that's being developed, for it shows effectiveness, you want to be able to provide it to patients and be reimbursed. sen. schatz: you're not concerned these are two separate agencies that only talk when necessary? dr. volkow: no, there is an active, very proactive interestt

ourselves to make collaborations across agencies. otherwise the science doesn't go into the patient. it stays in the journal, in the laboratory. sen. schatz: it's time for my annual question about psychedelic research. i think part behalf we have totd drug policy and a kind of move toward liberalization of drug policy, for maybe libertarian reasons, for criminal justice reasons, and the question of whether or not some of these things that are used recreationally and sometimes abused are medicine. that is a separate conversation. i am personally for drug liberalization. i am also a son of a principal investigator, and i'm not prhis medicine until all of you do the adequate research. so where are we with psychedeli[

there's a bunch of accumulated data that seems to indicate that this needs supervision, and the with talk therapy and supervision. can you ta this? dr. volkow: you are absolutely correct. this is an area of tremendous excitement from the very ly understanding how to optimally use it on patients. because the data is starting to translate into evidence that it could be beneficial, what has happened is that clinicians are ahead of actllwhere thdata is. so it's being offered to a wide variety of patients without sufficient evidence, including the question that you ask. how do you optimally give it without prod ensuring that you're having long-term effe

are giving the drug is going to influence your therapeutic response. it's crucial. but like any■ing else, what people get excited about, they want to start believing a little bit in fairy tales. it's not a magic. it's very promising. but we need more research.hank . sen. moran: thank you very much. dr. hodes, i was very interested in your answer to senator collins' question about the state of research regarding alzheimer's. let me ask an additional question. what's the latest in the research, what is the researc's syndrome? is that connection still viable and are we learning something about both at the same time? drhodes: yes, it's a very important connection between two very important conditions we need to address. as many may know, individuals with down's syndrome, likely related t have, as they age, and the good news is living with down's syndrome, now age into older adulthood at a very high proposition, develop alzheimer's disease.

there's been an extremely active og a network of longitudal studies, looking at markers to discuss how they establish a networkor and clinical trials are already in progress. for example, looking at the effect of of a growth factor as therapy in those with do?"'s syndrome or preventive therapy, as well as behavioral. we're working all the way from the basic ience, conneins syndre and the relationship to alzheimer's, through clinical trials, infrastructure, ■and active clinical trials. sen. moran: what would change in the way that we would then address the issue of down's syndrome? dr. hodes: certainly as down's ndes to the risk of alzheimer's, this becomes similar to the rare but tragic early onset, dominant zh where we know with high

priority, high probability, that individuals will develop alzheimer's. we know that years in advance, and importantly, now that weaset allows us to intervene early in these populations to prevent. sen. moran: thank you. my following questions are really about process, mostly data. this can be to dr. hodthat's now available in many instances, but related to alzheimer's, electric health records, dino, clinical treatment results, insurance claims, medical images, is there a way now that nia can harness that data, uncover new insights and patterns that wean't see through individual research projects? maybe that's my question. is that being done? doctor

can amplify upon it, because you're actually right. real-world data, the kinds you mentioned are critically important to fully understanding the waof what goes on with the health of the population, the way to maximize it.■÷ there have been very important real-world data studies already carried out around alzheimer's disease, and importantly, i would say that now the promise more than ever ifor o leverage these real-world data initiatives in the context of the large data initiatives nih-wide, federal agency-wide that i think dr. bertagnolli can commen.nolli: i'll be quick. the data we used has got ton good enough that we can make life-altering decisions based on right now, our real-world data is not at that level of accuracy, frankly. we are working really hard with fda and with parer gather real-d data into one where we really

can harness it appropriately, artificial intelligence to make life-altering decisions. right now, it tends to be more■ hypothesis-generating than testing, and we're going to fix that. sen. moran: it's not sufficient data, it's determining how to harness the data to get it in a rmlli: it's the accuracy and the interoperability, you know, you got to compare apples to apples, data is in the clinical environment can really lead to mistakes. sen. moran: thank you for using a rstand. finally, this may be a statement because of the shortage of time. i raise this in last year or prus. taback. at one point in time, the funding of aarp was at the expense of more clinical research at nc i hope that's not a pattern.

i assume that you will say that it depends on how much money you have, but i want to make certain that you are prioritizing nci competitive cancer grants with fy25 funding, dr. bertagnolli. dr. bertagll arpah is that we have our team members meet routinely to review what's happening in our senior agency and make sure thatmplify. sen. moran: that was also directed to you, dr. rathmell. dr. rathmell: that's what i'd say as well. madam chair: senator kennedy? sen. kennedy: thank you, madam chair. dr. bert these comments to you, because you, of course, are the director of the nih, but i could also direct them to each member of this distiui ed people would agree are facts. natitutes of health are more to the point the men and women there.

are one of the most extraordinary collections of minds in the world. maybe in all of human history. your work, their work, has saved billions of lives. their work, your work, has improved the quality of life for billions of people, not just in america, but worldwide.

the national institutes of health is part of, at least in ell, is part of the institution of public health. anotr fact in my judgment.h[ as a rest of the pandemic, the institution of public health, at least in america, and i think in some respects throughout the world, has been tarnished.■w and that's dangerous.

that's very dangerous for iclth crisis. i don't care to partake in whose at fault for that -- in who's at fault for that, or depending upon your perspective, who receives the credit for that. i'd like to suggest that we do some■+■thing about it and that e learn from it.■ and i think the nih is the he requisite credibility to do that.

now, here are my suggestions. nur the air on gain of function research. i would gently suggest that you -- i don't know you could do it in aymnce with some of the your best minds making presentationses. be technical, but also speak directly to the americunction research is. tell them how it is funded.cz tell tyers are funding. tell them what, if any, america's involvement was with the gain of funcon research at the wuhan lab.

tell them the benefi oga be transparent. that needs to be done. and i think the nih could lead. number two, at a different symposium or extdepress conference, i would like to see the nih take the lead in speaking to the world and to the american people about what we learned from the pandemic. wh did we get right? what did we get wrong? here's why we got it wrong. here's why we got it right. here's how we saved lives. here's how we could have saved more lives if we had known what we know now. the american people, they don't ristotle every day, they're too busy earning a living, but they get it. you know, hindsight is

wonderful. doing those two things, we could remove some of the tarnish on the institution of public health in america.int. i know there are risks here. and i know some of you are thinking, you know, what planet -é get mixed up in this political hot mess? because it's important. and it's not going away, folks. neither one of those topics is going away.

so i would gently, again, gently suggest you put those work and consider doing those two things. dr. bertagnolli: on behalf on madam chair: senator brit? sen. britt: i want to thank you for appearing before this su deep gratitude to you,4■ dr. bertagnolli. is that right,

no, try again? how do you say it properly? not that i'm going to be able to do it. oh, yeah, the alabama in me, you know? i love it. ok, ok, good. madam director, how we do that? thank you so much for visiting alabama this year. i am deeply grateful for your time and letting you come and visit with the incredible men and women that work there, see the work that's being done, figuring out how we can partner to continue to change lives for the better. really, really appreciate it. and then also, and here we're going to have another challenge with how to say your name, is it -- marrazzo, we are very proud, obviously, you having been at uab, and to■u know what a special place is uab is, the tremendous work that is done there, and look forward to working with you in your new as you both know, in alabama over a third of our 67 counties birthing facilities or maternity care providers. last fall, three more alabama hospitals announced closures of their roe county without

access to labor and delivery services. additionally, alabama hams the highest maternal morty rate in the nation. i'm of the mindset, as i believe probably the men and women sitting at that table as well,

it is also to a degree associated with substance abuse disorder.>> that is why itand mw before, during and after pregnancy is vital and i'm thankfor leadership in this space. i want to continue to partner. this research

funding is so important but yet, it last month i proud to partner with senator butler from california on a bill that would provideing on this initiative. i would like to thank all of you on the nih staff for your technical assistance to make sure we can get this important billi'm committed to continuingo work with senator a way to get this passed into law. and not just in alabamawe are gn that to help with america's ty crisis. i know i'm almost out of. two quick questions. when it comes to■■0 c whichs what we see happening here,

unfortunately, i want to commend chairwoman murray and vice chair collins. this committee did its work last year. we finished july 27, all 12 bills out of committee. they did not■3et to the president's desk until 230 six days later. can quickly about what acr does --a a cr does to your agency? . if you don'■9know h much you have does spend, it is hard to plan and make all of the strategic decisions we need to make that don't, at the very end we do the best we can. and we are grateful for our >> would you allow me to ask one more quen?thank you so much. in■q your vit to alabama, you

were able to see some of the research we are doing there. how our community and diverse on in alabama is a great place for clinical tria. could you speak to that very quickly as to why you think those things match uso well? >> it is absolutely critical serve our populations having so many of these intersect and have to do with community in an effective way with our clinical trial infrastructure. th is wh are launching a new clinical trial network caret into the communities. the doctors and clinicians on the front lines like the onea and west virginia and other parts of the nation. we are excited about this. it an all nih effort to work with these communities to get them the reseah th n >> we each have a couple of

remaining questions. ■knew data from the national science foundation reveals the in the number of postdoctoral scholars at academic institutions in over 40 years. employment indicators suggest that life science phd's are choo to pursue careers in the industry instead. in order for america to out innovate the rest of the world we must invest in the next education -- the nexthers. i was proud to announce the next researcher act. since the bill was signed the 2y cares act nih has increased funding for early stage investigators by 63%.

the recent plan to increase the minimum postdoctoral raising ita year. and d care. a major step in the rit direction but it falls short of the $70,000 minimum salary that ur advisory committee recommended. how is nih tracking the impact of the stipeand why are not cos. i will say this discussion -- how do we better support our ■4young, next-generation, the os that will transform -- that discussion happensvery in our meetings across our nih directors. we need support them on so many levels. you hit briefly on the increa sa working group of the advisory -e

director. we are responding to other parts of that working group. you also alluded to why have we no gone farther faster. w challenge of -- do we fund mo research at a lower level or do we fund násmaller numbers at the full level that the committee asked us to do? it was an economic calculation. we have made a declaration that as funding allows we will increase it to the full $70,000 a year. that was requested and advised by the committeeve next hopefully three years. and finally, you■$o also talked about the early stage investigators support. we do have special revie early e investigators.

we hope they get a less stringent funding rate. we putut a challenge every year to achieve at least -- it■+ be 1100 early stage investigators last year we had 1600. and i am optimistic we will get >> an estimated 20 million americans continue to suffer more than -■a■■@- more than thre years appropriated funds to nih for long covid research. and ih worked slowly to enroll still zero fda treatment for critics feared it might not