a historic day with regard to tobacco. there was significant action passed by the senate and the house. this is something you lived in. you live with this for some time. how big a deal is today? >> it is a huge deal, it is not to be underestimated. i was just telling dr. sanjay gupta that in the 80s when i was in congress, it took 3 or 4 attempts to pass a bill in the house and the senate that prohibited smoking on international flights, we didn't dare take on domestic flights, and we lost it 4 times in a row. they have a right to lobby, that

is legitimate, but it shows you how attitudes in public education have changed over the years to the point where we can regulate nicotine and tobacco frontally by the government. is a huge achievement because it is health problems. >> we talk about preventable health problems all the time. $100 billion a year going to treat tobacco related illness. when you think about something like this happening, so many smokers begin early in life, before the age of 19 and continue smoking into adulthood. when you decrease the amount of advertising geared towards kids, doesn't make a difference. is this going to have an impact? >> absolutely. the reduction in cigarette smoking over the last decade has been a victory for public health prevention strategies. i only wish we had as a fact of a strategy for the rest of

substance abuse. this whole issue of regulating tobacco is a major victory for science. i sound a little parochial. the truth is nicotine is highly addicting, you start very early. we have been unable to get a hand on the regulatory side of it. in that process we have been able to reduce the number of smokers phenomenally. some of it is behavior change. what we have learned from research on behavior change, some of it is regulatory. you have to stand outside, that had a big effect. you had to stand outside, this

reflects public attitudes, don't smoke on me. adding this regulatory framework will have a phenomenal public health affect, as well as doing the right thing. >> back to this room for second, the relationship between tobacco smoking and mental illness, as someone who has mental less, more likely to smoke, what is the impact likely to be on this community? >> people who have mental illness are dramatically less likely to smoke than other people. as more and more legislation is passed that restricts use of tobacco, the concentration is higher and higher. a lot of people who start smoking as kids have social phobia. have awkward -- you see a lot of anxious kids smoke. there is some biological evidence to suggest nicotine has some effect on anxiety as well.

there is going to be this core of people who continue to smoke. it will be more concentrated on young people who have mental disorders. we have to look at the full spectrum. we have to get through the prevention stuff. we have another group to deal with. >> you are a founding member of the medical foundation. how does it get put on the agenda. and some of the issues we're talking about today. the president is very interested in science. he gave a speech talking about wanting to put 3% of the gdp into scientific research, probably not enough, but a good start. and he has put scientists in to important positions. secretary chu is a nobel

laureate. secondly, what we are trying to do is bring together all of the stakeholders. the biotech companies, the university's, disease groups, and organizations like this to get behind an agenda. that would really move scientific research, in part to gillette medical innovation to the top of the agenda. we have more money in transitional research to take more of the scientific discoveries to bedside. we have not scratch the surface. we are living in the dark ages with regard to these maladies. finally, we need to get kids.

more interested in science and medicine and research. it needs to be cool to be a doctor. >> i thought it was cool. [laughter] >> maybe not as cool as being a football player. we really need to raise falafel of understanding. i told sanjay gupta something, he had a chance to meet the surgeon general, made the decision to stay at cnn, he made the right decision. he made the right decision for the country. raising public knowledge of science and research is critical to making advancement and you have a chance to do that every

day, you do it well, keep it up. [applause] >> let's say on science, specifically with regards to some of the advancements in understanding mental illness. how hard is it for you to communicate, is that understood, what is happening in the brain and how you convey that to people who need to know? >> it is only about 20 years since we started talking about mental and addictive disorders, brain disorders, an amazing phenomenon. i am old enough to remember teaching people about schizophrenic mothers and refrigerator parents as a cause of schizophrenia, now you say it in a public audience and everybody laughs. they sort of assume it. probably the most useful tool

that we have been given was modern brain imaging that allows you to look into the brain of a living, breathing, wake individual, healthy, and healthy, while they are awake, and watch their brain in action. and you can actually see concrete differences between brain structure and function in a schizophrenic individual and a non schizophrenic individual. the ability to visualize, and actually show people the brain differences has reduced people's the ability to deny it. in the issue of addiction, which is a brain disease, has been much higher. the reason is it is harder is it is true that addicts did do it to themselves. after you use drugs for a long

time. people conceptualize that. they conceptualize and understand the mental disorders which are fundamentally brain diseases. >> is there an addictive personality? someone who is set up to be an addict to something. there is a major genetic contribution to become addicted. and it is a big genetic contribution and people do very in their susceptibility. genes don't do you to any thing. it is not inevitable that you will become an addict but you are more or less susceptible once you have been exposed to it. that little nuance is very important. i have never seen any science to support the notion of an addictive personality but it is

common in the lay public. if you are not addictive to chocolate chip cookies you are addicted to heroin. that is probably not defensible from a scientist's point of view. >> if you have a tumor on your brain, you can diagnose that, a broken bone in your back. or blockage in one of your arteries, that is very concrete. you can show the image. the object of angeles -- mental illness, psychiatrists say this is why you are depressed, let me show you. or is it still more clinical? >> still more clinical. for some disorders you can see things, brain damages. you can see changes in those images as well, understanding mechanisms of action. lot of the more common mental

disorders, we don't have objective tests. we have some basic conditions. for migraine, somebody has to describe, there are a lot of symptom based conditions. some of those are very challenging for complex reasons. there is a lot of concern that people use the diagnosis for their own purposes. there is a concern that a lot of vietnam vets who are getting to retirement age who seemed to have been able to work for the last there years, decide they have ddsd. they describe the symptoms, you can go on google and learn about the symptoms. can we prove they have the symptoms or not? there is a big push, can we get an objective test for that reason? we are just not there yet. >> what happens? if you play that out, this is an issue we will be confronted with, we are having a lot of

troops returning home. if they say they have it, if they say they have these symptoms, what happens? >> we have problems on both sides. the one i just described is a minor one in comparison. people who don't have the condition complain of having it. for secondary gain. many people who have it don't talk about having it. we see this particularly in the military where there's a macho mentality. among kids, there is embarrassment. among working-class people, we see in surveys more and more that people are coming to same mental disorder is like diabetes, there is an imbalance of thing that you need to take a medicine to get the balance right but a lot of people still have this sense of stigma and don't want to talk about it. that is the problem. getting people to recognize and admit the problem, tell somebody about it. >> this may be an impossible

question to answer, this could be a huge budgetary issue, you are paying to take care of people, symptomatic to the point where they are disabled from it but the science isn't perfect. from a political standpoint, how do you deal with that? doctors, scientists, do you say the evidence isn't there yet so we're going to hold off on making decisions? what happens? >> it goes back to what we were talking about a minute ago, innovation and scientific research. the truth is we haven't gone very far. there is so much we don't know about the way the body operates, the way the cells operate. i look at this from the government's view.the need for a capital expenditures budget. i am on 3 or 4 boards for u.s. steel. we spend half of every meeting

talking about tax. we couldn't run those companies without borrowing huge amounts of money and putting it into capital investment to come up with a new product, the new things we can sell. we don't do that as a country. we have these budget debates, we have to pay for everything every year. there is no bar wing for the future to make tax. if we could delay the onset of alzheimer's by just 3 years, we would save billions of dollars. half of the nursing-home the country, talk about depression, schizophrenia, any of these things. we need a cap tax budget in the united states. we need to put the money in translation research to find better remedies. we are on the threshold of personalized madison, we know

that if we can no your gene map we can probably taylor something that would treat your depression. and on and on. there was a study recently on prostate, they said there are probably 50 kinds of prostate cancer but we don't know how to diagnose that so we treat everybody the same. the same with lipitor. lipitor may not work for me. we can see the future but we can't quite get there. the only way is a capital budget at the federal level, where we borrow the money, make the investments and move the needle. it will save us billions of dollars. [applause] >> congressman gephardt has

outlined the objectives of individualized medicine including mental health. let me pose a question this way. what is the rate limiting said? >> everyone says we are not where we should be. >> why not? if we were able to wave a magic wand would be a cap expenditure? what else would you need to say this is where we need to be? >> no question that we have got to make serious investments and assure the scientific community that those investments will be sustained over time. that is what the congressman is suggesting. what happened over the course of the last few years was the budget ramped up, and it actually began to be taken apart. the affect on the ability to recruit young scientists, that is who we are affecting the most, is very dramatic.

they don't see reliable funding down the road, why would they go into that kind of career? it is hard to recruit clinical scientists anyway and we are involved in an effort to recruit translation landis so i was delighted to hear you make reference to that. the new cadre of people who are trying to move from basic science to clinical science, clinical application. we have got to give them a career. we have to assure them that if they divert their lives and brainpower to solving these problems, they will have a future. that is very hard to do with a mindset that appropriates year by year, doesn't have any build inconsistency. n nihhas done very well, but it doesn't have the assurance that it will be there later. we did have a very big infusion of money with stimulus funds.

$21.5 billion have suddenly been in fused into science of which $10 billion in biomedical research. i don't mean to sound like i am winding about it but what will happen 2 years out? will we have another cliff? one of the things going on in the scientific community is trying to figure out how will we prepare for this? how will we make sure the investments will be sustained over time? on awful lot of people are running into the feeding frenzy for the new money and they will be very hungry later. translation research, taking things from the laboratory to clinical practice. that aside from the money for a second, getting the new researchers excited about doing this kind of work, what excites you? can you give us examples of things that have gone from the laboratory to clinical practice that you think are noteworthy?

>> one of the things i like is what has happened with cancer and cancer treatment. the increased understanding of the genetic basis of different cancers, there's no such thing as cancer, the genetic basis of different cancers, individual differential responses to different kinds of drugs have allowed us to develop cancer treatments that are almost personalized, there suddenly individualized, specific kinds of cancer. that is one of the most fantastic advances in cancer treatment. it is not a cure, it is treatment. but it is based on basic science findings and they have been tremendous. we have not made the same transitional leaps in treatment for mental health, we have very

good treatments, we really do. for any other chronic disorders, they are not what they ought to be. we have not been able to generate enough basic understanding of the mechanisms of mental disorders to target medications in a much better way. it is coming very fast. i believe the basic and translation 05 ants -- trans age science will move us into a more personalized medicine, more individual treatments and an approach where we will focus on symptoms. i wanted to slipped that in. >> may i add an analogy? if there's anybody in the audience as the ignorant as i am about science, this will help. i have a friend at the university of california who has

an apartment in neurology, he says neurology is the black hole of medicine. we have known the reason for a lot of these things, but we have a come up with ways to deal with it. he gave me a football analogy. science research, bench research is like being in the end zone and getting to the first ten yard line. we are expecting the pharmaceuticals coming up with an attempt to treat the program and take it -- that is $1 billion. nine out of ten things they try fails. the key is, how do we get from 10 to 40 or 50 so that it is just 50 more yards to bedside? that is where this translation 0 effort needs to take place.

it takes committed capital over a long period of time, and young researchers, whether they are here or somewhere else who are willing to stay with it, a young researcher, 42 or 43-year-old before they can start to do their work. they aren't seen as cool. they aren't seen as going to wall street or being an entertainer. we need to raise the level of public understanding, and admiration for that kind of activity. we have to get scientists to get in front of the public and tell what you do because it is exciting. >> staying on this football analogy, public health overall, prevention in the first place,

we are talking about remarkable technology coming in the future including individualized madison. >> we don't know. we haven't invested nearly as much energy in prevention as we have in treatment. >> why is that? >> i think, as we follow the money again, there is money available to pay for treatment. there is not enough money to pay for prevention. most of the focus in prevention in the mental health arena is on secondary prevention which is to say trying to nip in the blood, before they get severe, makes a great deal of sense.

who is depressed, there is a qualitative -- everybody gets sad periodically. where to draw the line is unclear. even with the relative least restricted definitions we have right now, 60% of the population of the u.s. has had a mental illness. that seems like a crazy number and we have reported those numbers, there was lot of criticism saying that is ridiculous. if i were to tell you that 99% of the population had a physical illness at some point in their life, there are hang nails, there are equivalents of the common cold for mental disorders, if you have a snake phobia and live in the forty-first story of a high-rise in manhattan it doesn't get in a way of your life unless your next-door neighbor's kid has a snake. it turns out that most of the

people who have serious mental illnesses as adults started out as kids with some signs of something, a deathly fear of dogs at the age of 4, or school phobia, they couldn't get into the classroom, various things. most of those people grow out of it when they grow up but some don't. it just gets worse and worse and piles up and up. the trick is to figure out how we can go early in life to these kids who have these problems and figure out how to get them through that critical transition to adulthood. that seems to me to be the practical way in which we can do prevention. those kids are in pain and they are willing to be helped. everybody wants to quit smoking after they get cancer. the trick is to quit smoking before they have cancer. they are having a good time.

those kids are not having a good time. we may not call them having a serious disorder, but that is the future of serious disorders. how do we get in there? take the 100 kids who have a problem, 20 of whom will have something serious, find out which 20 that is and do something. we have a look at early onset simple treatment of minor disorders. going downstream and looking at things, we are practicing 1915s cardiology, waiting for the heart attack. we are doing a good job on a heart attack. what about stanton's? we don't know anything about that. >> so many questions, i couldn't help but think as you were talking, i have 3 daughters and each time my wife got pregnant after she delivered the child, there was always -- i am a neurosurgeon. i have questions about whether she would develop postpartum depression. i was stunned at how little i

could figure out about something i thought would be so prevalent and as a result have so much information. when it comes to the idea of subjective purses objective criteria i didn't know what to tell her. you just haven't seen yourself the last few days verses you're not eating well, you're not taking care of yourself. how does the average person that important information like that? >> they don't get very good information. with the advent of the internet there is a lot more bad information out there too. >> information and knowledge. >> there is misinformation. we really need some way of adding what is good and bad information because there's so much information. people have vested interest in various kinds of information. it is possible, we know a lot about this stuff because we have done follow-up studies. if you feel a certain way, what is the probability -- you can

get early profiles. after the disaster, it is not until 30 or 60 days later we know who has pgst. is there some way in the first week that we can sort out through all that distressed or sleepless nights, who is going to have postpartum depression? yes, we can. we haven't done a great deal of research in figuring out what to do about early intervention, getting in early, most of the work is waiting until after it happened and try to do something about it. we haven't done a good job communicating to people who treat these people how to detect those differences. >> just to put a button on this, a lot of the reasons we haven't done a good job is because there hasn't been a strong enough interest in the prevention side of things compared to the treatments? >> that is right. the place where there is the

strongest interest in prevention is in pgst. after the auto accident, one out of 10, should you tell who that is? should you be putting them into treatment to begin with? because that is such a common thing, particularly with net of veterans coming back, a great deal of interest in this in israel because of the many terrorist incidents, there's a great deal of research going on and some fascinating and productive stuff about doing early interventions to prevent the onset of ptst. >> as a doctor, as a citizen of this country, you hear what dr. kessler is talking about and you think medically, morally, financially, it makes sense to prevent diseases in the first place, whether it be